PMID- 10120158 TI - Accepting the challenge of physician practice. PMID- 10120159 TI - RBRVS is still evolving: seven issues of interest to physicians and health information professionals. AB - Coding and billing of physician services have taken a new turn with RBRVS. Important information is highlighted in seven vignettes contained in this article. PMID- 10120160 TI - Diagnosis related group coding accuracy of the peer review organizations. AB - Congress created the peer review organizations (PROs), in part, to check the accuracy of diagnosis related groups (DRGs) billed to Medicare. This study determined the accuracy of the peer review organizations' abstraction of DRGs during federal fiscal year 1985. A two-stage cluster design sampled 7050 medical records from 239 hospitals stratified by size. Credentialed medical record professionals used blinded techniques with reliability checks to abstract the ICD 9-CM codes and select the correct DRGs. Physicians reviewed medical records whose abstracted DRG differed from the DRG paid by the fiscal intermediary. The peer review organizations reported abstracting 1715 of these discharges. The peer review organization selected the correct DRG in 75.6 percent of the 1715 abstractions, a significantly lower proportion than the 80.3 percent paid accurately by the fiscal intermediaries. Upcoding compounded the peer review organizations' errors. PMID- 10120161 TI - Principles of medical record documentation. AB - The following is an excerpt from a brochure titled "Principles of Medical Record Documentation" developed jointly by representatives of the American Health Information Management Association, the American Hospital Association, the American Managed Care and Review Association, the American Medical Association, the American Medical Peer Review Association, the Blue Cross and Blue Shield Association, and the Health Insurance Association of America. Although their joint development of this brochure is not intended to imply either endorsement of, or opposition to, specific documentation requirements, all seven groups share the belief that the fundamental reason to maintain an adequate medical record is its contribution to the high quality of medical care. PMID- 10120162 TI - Input/output units. AB - I/O units span a broad range of sophistication. An elementary von Neumann implementation requires that the CPU directly controls the I/O unit. The CPU must repeatedly test the status of the device to see if the requested operation has been finished. A major advance in the design of the I/O unit was made possible by the addition of interrupts to the computer. This feature facilitated multiprogramming, with its associated increases in efficiency and productivity. In many applications today, large amounts of data must be transferred and many interrupts must be processed. The performance of the I/O unit in systems running these applications is critical. In transaction processing, for instance, the speed and efficiency of the I/O unit is more critical than the speed of the ALU. PMID- 10120163 TI - One-on-one with Arthur Ashe: tennis star discusses personal, professional issues related to AIDS disclosure. Interview by Gary Baldwin. PMID- 10120164 TI - Future dream. PMID- 10120165 TI - Critical issues in system implementation. PMID- 10120166 TI - A new paradigm for clinical decision support based on the patient record. PMID- 10120167 TI - A group decision support system for health care TQM. PMID- 10120168 TI - A new information resource for the health care organization. PMID- 10120169 TI - Clinical applications for decision support systems. PMID- 10120171 TI - The Oregon initiative: ethics and priority setting. PMID- 10120170 TI - Setting health care priorities in Oregon. PMID- 10120172 TI - The Oregon Medicaid program: is it just? PMID- 10120173 TI - Medicaid rationing in Oregon: political wolf in a philosopher's sheepskin. AB - Although the details of the proposal have shifted since it was first described, the Oregon Medicaid waiver has had one consistent feature: it will reduce benefits to AFDC mothers and children who are currently covered by Medicaid in that state, in the hopes of increasing coverage for other individuals who are now uninsured. Because of the adverse consequences for the AFDC population, there should be strong evidence supporting the purported benefits of the proposal before proceeding with the waiver. One of the most intriguing aspects of the waiver proposal is the claim that the money currently being spent on AFDC beneficiaries could be redistributed to expand coverage to a substantial number of the uninsured. The concept is that far more people could receive the most valuable services if those now being served gave up their coverage of the least valuable services. Other purported benefits of the waiver include enhanced citizen participation in decisionmaking, cost-savings, and improved payment levels and delivery arrangements. Remarkably, this analysis of the proposal reveals that the waiver is likely to achieve none of its stated objectives, and instead will have adverse consequences not identified by its proponents. What the proposal would do is to insulate politicians from visible responsibility for limiting benefits for AFDC children and adults. Finally, the proposal undermines 25 years of Medicaid as an entitlement program. As such, it would establish as a social ethic the principle that the poor can be relegated to inadequate care. Such an extreme measure is not justified by the fiscal situation in Oregon, which is not extraordinarily poor or overtaxed, and does not have a particularly generous or unusually expensive Medicaid program. PMID- 10120174 TI - The Oregon Medicaid priority-setting project: the impact on poor children. PMID- 10120175 TI - Paradigm shift in American health care: are we ready for a comprehensive system? PMID- 10120176 TI - Trends in total hospital financial performance under the prospective payment system. AB - In this article, the author examines trends in determinants of total hospital facility revenues, expenses, and net profits during the period 1977-89. Measures of change in transaction prices are developed, which enable an analysis of trends in real hospital outputs and total factor productivity. The main source of hospital spending growth in excess of the gross national product is identified as growth in hospital employee compensation. PMID- 10120177 TI - Health care indicators. PMID- 10120178 TI - Medicaid Voluntary Contribution and Provider-Specific Tax Amendments of 1991 (Public Law 102-234). AB - On December 12, 1991, the President signed into law House Resolution 3595, the Medicaid Voluntary Contribution and Provider-Specific Tax Amendments of 1991 (Public Law 102-234). A description of the provisions follows. PMID- 10120179 TI - Good quality care increases hospital profits under prospective payment. AB - This study shows that, contrary to popular belief, the prospective payment system discourages skimping on medically indicated care. The quality of care on a nationally representative sample of Medicare discharges underwent judgmental review using implicit criteria. The reviewing physicians identified hospitalizations that omitted medically indicated services and diagnoses overlooked because of this skimping. After deduction for the cost of the omitted services and probability of negative diagnostic tests, good quality care would have increased hospital profits a significant 7.9 percent. As the specificity of diagnosis and intensity of treatment increase, the DRG payment rises faster than the cost of providing medically indicated services. PMID- 10120181 TI - What does the Consumer Price Index for prescription drugs really measure? AB - This article examines the conceptually desirable attributes of a fully quality adjusted prescription drug price index. It provides an understanding of how the Consumer Price Index for prescription drugs and medical supplies treats quality changes in prescription drugs and, in particular, quality changes associated with the introduction of new drugs. PMID- 10120180 TI - New Jersey's Medicaid waiver for acquired immunodeficiency syndrome. AB - This article contains data from a study of New Jersey's home and community-based Medicaid waiver program for persons with symptomatic human immunodeficiency virus illness. Major findings include lower hospital costs and utilization for waiver participants compared with general Medicaid acquired immunodeficiency syndrome admissions in New Jersey. Average program expenditures were $2,400 per person per month. Based on study findings, it is evident that the waiver program is an important means of providing financial benefits and access to services and that comprehensive case management is a critical factor in assuring program quality. PMID- 10120182 TI - A longitudinal comparison of charge-based weights with cost-based weights. AB - The diagnosis-related group weights that determine prices for Medicare hospital stays are recalibrated annually using charge data. Using data from fiscal years 1985 through 1987, the authors show that differences between these charge-based weights and cost-based weights are increasing only slightly. Charge-based weights are available in a more timely manner and, based on temporal changes in the weights, we show that this is an important consideration. Charge-based weights provide higher payments than cost-based weights to hospitals with higher case-mix indexes, but have little effect on hospitals with low cost-to-charge ratios, high capital costs, or high teaching costs. PMID- 10120183 TI - Health of retired workers: survival status and Medicare service use. AB - Data from the Social Security Administration's 1982 New Beneficiary Survey and Master Beneficiary Record were matched with 1984 data from the Medicare Automated Data Retrieval System to study the effects of self-reported health on subsequent health service usage and survival. Proportionately, more new retired workers who reported poorer health in 1982 were decreased by December 1984. Functionally dependent beneficiaries as determined by the Functional Capacity Limitation Index had death rates four to five times greater than those who reported no limitations. The health status of retired workers who received Social Security benefits before age 65 was no better than beneficiaries 65 or over. Decedents were more likely than survivors to incur Medicare charges, and to have substantially higher median charges--$8,834 compared with $285. PMID- 10120184 TI - Transitional funding: changing Ontario's global budgeting system. AB - In 1988, Ontario introduced transitional funding, a collaborative process between the Ministry of Health and the hospitals to modify Ontario's global budgeting system. The goals are to achieve greater equity; encourage hospital efficiency, and promote a shift from inpatient to outpatient services. To implement these goals, inpatient care is being measured in terms of case-mix groups, i.e., a classification system comparable to the diagnosis-related groups. However, since there is no patient level cost data, cost weights are being derived from patient level data from New York State. Transitional funding draws attention to both positive and negative aspects of global budgeting. PMID- 10120185 TI - Physician cost experience under private health insurance programs. AB - Little information is available on private payer claims cost experience for specific categories of health care. A study was conducted in which physician claims cost experience and trends among 15 Blue Cross and Blue Shield Plans were compared. Between 1986 and 1988, physician claims cost per covered person increased at an average annual rate of 17 percent, approximately 6 percentage points higher than for Medicare. Annual charges were highest for laboratory (24 percent), radiology (19 percent), and medical care (18 percent) services. Utilization trends were also examined in the study. The number of radiology imaging procedures performed increased 48 percent between 1986 and 1988, and the number of hospital visits declined by 6 percent. PMID- 10120187 TI - Managing risk. A priority in the health service. PMID- 10120186 TI - Alternative geographic adjustments in Medicare payment to health maintenance organizations. AB - The payment received by a health maintenance organization (HMO) for its Medicare enrollees is proportionate to the average cost of Medicare beneficiaries in that county. However, HMO market share in an area appears to decrease costs in the fee for-service sector, so that HMOs are paid less. For this and other reasons, alternative payment formulas may be desirable and several are developed in this article. The conceptually simplest location factor would be an input price index. An alternative strategy would also recognize systematic variation in utilization. Utilization rate is regressed on variables such as county population density and physicians per 1,000 persons. The predicted utilization rate times an input price index could serve as a location factor. The value of alternative location factors are presented for specific counties. PMID- 10120188 TI - Perfect purchasing. PMID- 10120189 TI - A case for treatment. PMID- 10120190 TI - Talking positive. PMID- 10120191 TI - Old age benefit. PMID- 10120192 TI - Guidelines for pragmatic assessment for health planning in developing countries. AB - Although the primary health care strategy implemented since the Alma Ata declaration of 'health for all' appears to have contributed to improvements in selected health outcomes, the current ad hoc approach to health assessment and planning has impeded more substantial gains. A comprehensive yet pragmatic framework for country-level health programmers is needed that would permit consideration of the multiple steps involved in policy formulation and implementation. In the present paper, drawing upon an epidemiologic model (Iterative Measurement Loop) and an economic model (Cost-Effectiveness Analysis), we present guidelines for a pragmatic assessment for health planning. A format is provided for the conduct of these tasks which is operational in nature, is specific to the target country (or relevant region), can simultaneously consider multiple interventions, and is comprehensible to persons without sophisticated medical and/or economic backgrounds. Such a format enables articulation and consideration of local concerns as well as national and global considerations. PMID- 10120193 TI - Is the worst of the epidemic over? Back calculation of HIV seroprevalence in The Netherlands. AB - This article calculates back the HIV seroprevalence in the Netherlands from AIDS cases notified 1982-1990 and rates of progression from HIV to AIDS adopted from American studies. It discusses a number of problems, such as changing AIDS definitions and the possible impact of AZT treatment. We estimate that the Netherlands had approximately 6762 HIV seropositives by the end of 1988, which is considerably lower than earlier expectations. When a hypothetical decrease of 10% in the manifestation of AIDS cases due to AZT treatment was incorporated, the estimate for the end of 1988 becomes 7549. After deduction of the AIDS patients who had died by the beginning of 1989 from this estimate, the HIV seroprevalence by the end of 1988 is approximately 7000. The distribution of seroincidence over time suggests that the HIV epidemic in our country has passed its summit and that the HIV incidence is falling quickly. The question arises as to how far this fortunate development may be considered a success of the Dutch AIDS policy, a policy characterised by more openness than in many other countries. The material studied here, however, allows no definite answer to this intriguing question. PMID- 10120194 TI - Targets--are they sensible? AB - Targets are becoming increasingly important in the new NHS for both purchasers and providers. Targets must be meaningful and carefully considered before it becomes sensible or realistic to attempt to achieve them. Choosing an unworkable target no matter how well-intentioned, will not achieve the desired result. This paper discusses the role of targets, comments on targets that are in use and proposes a set of 'Golden Rules' for the selection of targets. PMID- 10120196 TI - Cost-utility in practice: a policy maker's guide to the state of the art. AB - In recent years QALYs (quality adjusted life years) have achieved considerable fame or perhaps even notoriety in health services policy making. Yet little has been done to date to assess the potential benefit in policy terms of studies that have used cost-utility analysis (CUA). It was in recognition of this fact that this particular investigation was undertaken. An evaluation of 51 cost-utility studies is reported in the paper. Several criteria were applied to each study including aspects of technical and policy relevance. The main findings were: few studies had been undertaken; they were limited to few areas of health care; their technical execution was often of poor quality; the majority of studies used the empirical findings of health state valuations obtained from original developers of different quality of life techniques; and many claimed their results to be 'favourable' (i.e. efficient interventions). This claim, however, is misguided because individual results get fed into generalised QALY league tables which ignore the context of specific studies and use results not performed on a common basis. Consequently, the state of the applied art of CUA is currently open to considerable question. PMID- 10120195 TI - Impact on the general public of media campaigns against AIDS: a French evaluation. AB - The article presents the results of the first national survey in a representative sample of the French population of 18 years of age and over (n = 1000; March 1990) about knowledge, attitudes, beliefs and practices toward HIV infection. It focuses on the impact of the media campaigns about AIDS and condom promotion that were initiated since April 1987 by French public health authorities. A total of 53.2% of respondents were able to correctly quote at least one of the slogans of the campaigns and 48.4% felt they have been personally influenced by the campaigns. Respectively 25.4%, 12.1%, and 11.2% declared that the campaigns have made them more concerned of individual risk of HIV infection and prompted them to condom use and HIV testing. Among heterosexually active respondents, 16.9% declared condom use in the past 12 months, age, marital status, level of education, HIV testing and self-acknowledgement of influence of campaigns being the main factors related to condom use in multidimensional analysis. Respondents who recognise having been influenced by campaigns are less likely to believe in HIV transmission through casual contact and to express discriminatory attitudes toward HIV carriers but more likely to support HIV mandatory screening for the general population. The difficulties to properly evaluate media campaigns for AIDS prevention are discussed as well as the complex trade-offs that general public information has to face between promotion of both individual behavioural change and societal support and empathy for HIV carriers and persons with AIDS. PMID- 10120197 TI - Revising the chart of accounts. PMID- 10120198 TI - Lives at stake. How to respond to a woman's refusal of cesarean surgery when she risks losing her child or her life. AB - What can healthcare providers do if a pregnant woman refuses cesarean delivery when the life of the fetus and perhaps her own life are in jeopardy? Only in exceptional circumstances would it be morally permissible, or morally required, to compel her to submit to invasive medical procedures against her will. Ethical analysis of all maternal-fetal issues depends on how the maternal-fetal dyad is conceptualized. The pregnant woman and her fetus may be viewed as an organic whole (the one-patient model) or as two distinct individuals (the two-patient model). The one-patient model balances prospective benefits to the fetus with possible harm to the mother. In exceptional situations, such as near certainty of serious harm to the fetus and the mother if a cesarean is not performed, a physician or institution wishing to override the woman's refusal within the one patient model invokes paternalism. Recourse to the courts to force the woman to undergo the cesarean would probably not be feasible when applying the one-patient model. The two-patient model focuses more on fetal well-being because it views the fetus as a distinct individual and patient. Catholic institutions usually subscribe to the two-patient model. When near-certain harm to the fetus is coupled with probable benefit to the woman, the institution may ethically override her right of refusal of a cesarean. However, the institution must be prepared to face legal scrutiny should they override the woman's wishes. Other means of achieving the goals of medicine (such as persuasion based on a good doctor-patient relationship) are preferable from both an ethical and a human standpoint. PMID- 10120199 TI - Protecting children's health. CHA's immunization program helps organizations increase vaccination rates in their communities. AB - In response to the increasing outbreaks of vaccine-preventable diseases in the United States, the Catholic Health Association (CHA) has developed a new resource to help its members launch programs that will increase immunization rates among children in their service area. Vaccines are the building blocks of basic primary care. But society and the healthcare system have erected barriers that prevent children from being fully immunized. Impediments include missed opportunities, cost barriers, and facility and resource barriers. Catholic healthcare providers can help eliminate these barriers and ensure that all children in their service areas are vaccinated by assessing their immunization resources, seeking out unvaccinated children, and collaborating with community organizations and agencies. CHA's immunization campaign will guide Catholic healthcare providers as they protect children from preventable diseases. Immunization may help reduce the costs of emergency and acute care for conditions that could have been prevented. PMID- 10120200 TI - Skills for selecting valued leaders. Eastern Mercy Health System takes a nine step approach to choosing managers. AB - Catholic healthcare facilities seek skilled leaders who can adapt to the organization's culture. Eastern Mercy Health System, Radnor, PA, has developed an educational course, Selecting Valued Leaders, that teaches interviewers selection skills on the basis of the organization's values and mission. The course covers four major topics. The first is building culture. Each participant examines his or her organization's history, communication styles, organizational behavior, and mission. Next, course participants discuss the competencies necessary for a leader's success. Eastern Mercy Health System has identified the following six competency clusters essential for its values-oriented leaders: empower people, steward resources, integrate values, act as advocate, support sponsor's priorities, and maintain Catholic identity. The third part of the course covers a nine-step approach for selecting values-oriented leaders. Participants discuss topics such as the search committee, job description, search strategy, and job offer. In the final section of the course, participants sharpen their selection skills. They review appropriate interview procedures and discuss open-ended questions to ask the candidate. PMID- 10120201 TI - Regionalization of human resources. SCHCS healthcare facilities collaborate to head off labor shortages. AB - Shortages of healthcare personnel become more pronounced each year. Effective human resource strategies are therefore important to facilities' success. The Sisters of Charity Health Care Systems (SCHCS), Cincinnati, is meeting the labor shortage head-on through collaborative regionalization among its facilities. Regionalization develops an integrated continuum of care on local and regional bases, helps SCHCS members avoid duplication of services, and ensures communities' future access to care by spreading financial risk among partners. SCHCS human resource personnel encourage employees to stay within the organization if they must relocate or are looking for career advancement. Members use a systemswide brochure to recruit nurses and allied health professionals. To attract employees from outside SCHCS, human resource personnel join forces at trade association conferences, job fairs, and school career days. SCHCS human resource personnel recruit and select values-oriented employees. Values-based human resource guidelines provide a framework for SCHCS members to assess how effectively the core values and mission are demonstrated in policies, programs, procedures, behaviors, and culture. PMID- 10120202 TI - Learning to value differences. A Catholic healthcare system implements a cultural diversity education program. AB - Each year the U.S. labor force is becoming increasingly diverse. Many healthcare organizations are adopting plans to meet the needs of leaders who manage culturally diverse groups of employees and to ensure that the organization can continue to attract and retain employees of all cultures. In December 1988 Mercy Health Services, Farmington Hills, MI, began a cultural diversity program to increase the number of minority and women employees, especially in management and leadership positions. Its education program was designed to enhance manager and employee awareness of their own biases and those of others and to build skills in dealing with persons from a variety of cultures. Mercy Health Services first held 90-minute educational sessions for managers. The sessions covered expected demographic changes and the importance of working together. Employees then attended sessions where they practiced interactive exercises to help each person recognize his or her own biases. In the subsequent weeks the corporate human resources staff experienced an increase in the number of employee relations problems managers and nonmanagers attributed to diversity conflict. In response, Mercy developed a pilot series of awareness- and skill-building workshops for those who managed Mercy's most culturally diverse staffs. They heard lectures on racial and gender issues and watched and discussed conflict resolution videos. Most workshop participants increased their awareness of cultural bias and their commitment to learning and practicing skills to deal with conflict. PMID- 10120203 TI - Criteria to counter tax-exemption threats. The CHA Board of Trustees recommends not-for-profit facilities adopt voluntary community benefit standards. Catholic Health Association. PMID- 10120204 TI - An innovative way to continue the ministry. A Catholic multi-institutional healthcare system achieves public juridic person status. AB - Members in a Catholic multi-institutional healthcare system that has been established as a public juridic person know their missions will be carried on even if they must leave the healthcare field. The establishment of a public juridic person was a goal of the Catholic Health Corporation (CHC), Omaha, since it began in 1980. The juridic person was to be named Catholic Health Care Federation (CHCF) in order to distinguish the canonical juridic person from the civil law corporation. It took many years to determine which competent authority was the most appropriate to grant CHCF public juridic status. The Congregation for Institutes of Consecrated Life and Societies of Apostolic Life (CICLSAL) was deemed the appropriate authority. CICLSAL established CHCF as a public juridic person on June 8, 1991. CHCF's member religious institutes are the same as CHC's. But CHCF is the canonical sponsor for two owned facilities and manages a third community-owned facility. The religious institutes remain the sole canonical sponsor for their own facilities; however, they jointly sponsor three facilities through CHCF. Public juridic person status is a way for CHCF to continue Christ's healing mission. PMID- 10120205 TI - New guidelines may facilitate hospital mergers. PMID- 10120206 TI - A network educates African-American women. PMID- 10120207 TI - Ancilla Systems. Housing for low-income elderly. PMID- 10120208 TI - The last gift. PMID- 10120209 TI - The hospital of the year 2000: three scenarios. AB - The topic for the 1991 Duke Forum, The 27th Annual Duke Forum on Health and Hospital Affairs, is "The Hospital of the Year 2000: Three Scenarios." The organizers, B. Jon Jaeger and myself, selected it because we believed in the fall of 1990 that no one could predict the direction that national health policy might take over the next decade. There are many forces with a stake in national health policy, and the major providers of health care--hospitals and doctors--are only two of them. Moreover, most of those forces, as will appear from the discussion below, have conflicting motives, and no national health policy is likely to emerge until there is a broad compromise, which brings most of those conflicting motives to some sort of consensus. We began with two assumptions. First, sufficient attention is being given elsewhere to what a national health policy ought to be. The AMA has a "Health Policy Agenda for the American People." The AHA is working on one. The Business Roundtable is looking at the matter. The AFL CIO has given it attention for a number of years, and they took another look at it in Florida in February 1991. The National Leadership Commission on Health Care, now the National Leadership Coalition on Healthcare Reform, is working on a plan; so is the Health Care Leadership Council in Washington. The Pepper Commission has published its report. Other congressional groups and the Department of Health and Human Services are examining national health policy. (ABSTRACT TRUNCATED AT 250 WORDS) PMID- 10120210 TI - Hospitals in the year 2000: three scenarios. Report of the 1991 National Forum on Hospital and Health Affairs, held in Durham, North Carolina, May 15-17, 1991. PMID- 10120211 TI - National health insurance: government activity. PMID- 10120212 TI - National health insurance: academic medical center reaction. PMID- 10120213 TI - Incremental change: federal activity. PMID- 10120214 TI - National health insurance: a system reaction. PMID- 10120215 TI - National health insurance: community hospital reaction. PMID- 10120216 TI - Incremental change: state activity. PMID- 10120217 TI - Incremental change: academic medical center reaction. PMID- 10120218 TI - Incremental change: a system reaction. PMID- 10120219 TI - Incremental change: community hospital reaction. PMID- 10120220 TI - Mandated coverage: federal activity. PMID- 10120221 TI - Mandated coverage: business activity. PMID- 10120222 TI - Mandated coverage: labor activity. PMID- 10120223 TI - Mandated coverage: academic medical center reaction. PMID- 10120224 TI - Mandated coverage: a system reaction. PMID- 10120225 TI - Mandated coverage: community hospital reaction. PMID- 10120226 TI - Performance surveys: quality tools emerging for the 1990s. PMID- 10120227 TI - Illness episodes, physician visits, and depressive symptoms. AB - Although there is a large literature examining the effects of distress on the demand for medical care, the data on which this literature is based are equivocal. Nonetheless, this literature is cited frequently by those who advocate a national mental health policy designed to produce a cost-effective "medical offset effect." In this study, longitudinal data on illness episodes, physician visits, and depressive symptoms were collected from 940 Medicare recipients enrolled in a health maintenance organization (HMO) under a Tax Equity and Fiscal Responsibility Act (TEFRA) contract. Seven waves of interviews were conducted over a period of 1 year. This article presents two sets of analyses. In the first, controlling for chronic conditions and demographics reported at baseline, the relationships between depressive symptoms reported at baseline, and all illness episodes and physician visits that occurred over the subsequent year are examined. In the second, controlling for depressive symptoms and demographics reported at baseline, the relationships between illness episodes and physician visits over the study year, and depressive symptoms recorded at the final interview are examined. The data indicate that, whereas depressive symptoms at baseline are virtually unrelated to subsequent illness episodes and physician visits, illness episodes and physician visits are related to subsequent depressive symptoms. These data indicate, therefore, that policies aimed at diverting the distressed from seeking medical care may result in further inequities in the receipt of needed care. PMID- 10120229 TI - Perspectives. The beleaguered Blues. PMID- 10120228 TI - The psychosocial quality of nursing home work. AB - Trained observers used components of the functional job analysis technique to categorize 3,371 tasks performed by 214 nursing assistants in four nursing homes on five occasions over 12 months. The extent to which each task was oriented toward residents versus data or things was coded along with the "level of complexity" of each of these orientations. A psychosocial index was created by multiplying orientation by complexity. Three questions structured the analyses: (a) To what extent do nursing assistants' tasks involve interacting with residents, as opposed to focusing on data or manipulating things? (b) How complex are these tasks? (c) What are the implications of the task analysis data for assessing the quality of psychosocial care? Findings reveal that even among the direct care tasks (69% of total), the orientation was not predominantly toward the resident. Functional complexity of the tasks observed was consistently low. Those task types with the greatest psychosocial quality were those performed least frequently and vice versa. Implications of these results for restructuring nursing assistants' work are discussed. PMID- 10120230 TI - Perspectives. Jewish hospitals: staying when the getting gets tough. PMID- 10120231 TI - A new look at hospital ward lighting. PMID- 10120232 TI - Planning a regional burns centre--the trials and tribulations. PMID- 10120233 TI - Economical solution for Hampshire hospice. PMID- 10120234 TI - Health service management must face the asset management challenge. PMID- 10120235 TI - Designing the next generation of American hospitals. AB - Change has always been a part of the hospital's operating environment, but the changes predicted for American hospitals during the next two decades pose considerable challenge to those who manage health care services and those who design medical facilities. The next generation of American Hospitals are responding to changes in technology, availability of human resources and demand of the public, private and government interest groups. Hospitals and architects that understand the predictable changes and anticipate the unknown, will be able to plan a facility that responds to the needs of future health care delivery. PMID- 10120236 TI - Environmental control of glutaraldehyde. PMID- 10120237 TI - Why hospitals should say no to the euthanasia initiative. PMID- 10120238 TI - Can a hospital be a winner under Medicare? PMID- 10120239 TI - MICRA (Medical Injury Compensation Reform Act): balancing compensation and cost containment. PMID- 10120241 TI - Medi-Cal managed care. AB - Managed care programs may give California communities a cost effective way to provide health care to a growing Medi-Cal population. In this issue California Hospitals explores the benefits and risks of these programs. PMID- 10120240 TI - Erosion of California health care system continues. PMID- 10120242 TI - What's happening with medical waste? PMID- 10120243 TI - Tough medical waste rules for New York state. PMID- 10120244 TI - Stericycle, Inc.: recycling potentially infectious waste. AB - With this article, HHMM begins a series on alternative methods of destroying tracked medical waste. This article was prepared for HHMM by Stericycle, Inc. It describes the Stericycle method of disinfecting medical plastics and of recycling materials into useful products. PMID- 10120245 TI - Q & A: disinfecting Resusci Annes. PMID- 10120246 TI - Processing flexible endoscopes: glutaraldehyde and the STERIS SYSTEM 1. PMID- 10120247 TI - Revolutionary questionnaire provides insights into patients' outcomes. PMID- 10120248 TI - Florida hospital finds relief in lost & found rep. PMID- 10120249 TI - Community links showcased: preview of AHA reform package. PMID- 10120250 TI - Group health benefits fraud: who's winning a lose-lose game? PMID- 10120251 TI - Retirees and HMOs: a cost saving tactic. PMID- 10120252 TI - Tools for competitive success. AB - In recent months there has been much discussion of the ability of American firms to compete in a global environment. While few hospitals worry about international competition, the growing focus on competitive strategies has generated some useful approaches. This article will look in particular at the use of quality, time, and cost as competitive strategic tools. PMID- 10120253 TI - New examination for alien foreign medical graduates visa requirement--HHS. PMID- 10120254 TI - Revision of fee schedules; 100% fee recovery, FY 1992--NRC. Final rule. AB - The Nuclear Regulatory Commission (NRC) is amending the licensing, inspection, and annual fees charged to its applicants and licensees. The amendments are necessary to implement Public Law 101-508, signed into law on November 5, 1990, which mandates that the NRC recover approximately 100 percent of its budget authority in Fiscal Year (FY) 1992 less amounts appropriated from the Nuclear Waste Fund (NWF). The amount to be recovered for FY 1992 is approximately $492.5 million. PMID- 10120256 TI - Membership survey report--Part 2. PMID- 10120255 TI - The MIS guidelines. PMID- 10120257 TI - LPTP's (Laboratory Proficiency Testing Program) educational assistance program (EAP)--a review. AB - The Educational Assistance Program (EAP) of the Laboratory Proficiency Testing Program (LPTP) in Ontario, Canada, provides at-the-bench in-service education to the technological staff in smaller, remote or rural hospital laboratories. This service is provided to laboratories which have either been identified by LPTP as experiencing problems or on direct request. The tutorials are conducted by experienced volunteer technologists. LPTP carries out mandatory testing and proficiency evaluation in Ontario. Funded by the Ministry of Health of Ontario, EAP is offered voluntarily and without charge as part of LPTP's educational component of external quality assessment. Preliminary post-tutorial proficiency testing results show improved performance and recipient evaluation forms express an enthusiastic response. Both support continuation of this unique program. PMID- 10120258 TI - Siblings of children with special needs. AB - Siblings of children with special needs have received little attention in the occupational therapy literature. However, siblings play an important role in the development of children with special needs. Siblings are also at risk for problems of emotional adjustment that have an impact on their own well-being as well as the well-being of the family. The research on siblings of special needs children is reviewed and followed by a description of the Ottawa Children's Treatment Centre sibling programme. PMID- 10120259 TI - National healthcare reform: politics, passion and power. PMID- 10120260 TI - UNIX and healthcare systems: a good marriage. AB - Powerful and versatile, UNIX makes open systems affordable in today's complex healthcare marketplace. As more emphasis is placed on combining the best systems for the least money, UNIX plays an important role. How many hospitals are using it already? PMID- 10120261 TI - Software life cycle demands reform, calls for open networks. AB - Healthcare organizations can no longer accommodate the four-to-eight-year cycle for information software development. The senior VP of a large teaching hospital in Houston offers solid ways to shorten the cycle and be prepared to incorporate more rapid changes in technology. PMID- 10120262 TI - Understanding cultural diversity. PMID- 10120263 TI - Looking for control in the middle of crisis. PMID- 10120264 TI - Home care agency: a hospital function? PMID- 10120265 TI - Culturally competent practices in hospitals. PMID- 10120266 TI - When cultures meet in health care. PMID- 10120267 TI - Bridging the culture gap. PMID- 10120268 TI - L.A. inferno. PMID- 10120269 TI - L.A. hospitals: "I've never seen anything like this before". PMID- 10120270 TI - Long nights in Long Beach. PMID- 10120271 TI - Jacarandas and smoke. Interview by Lianne E. Clenard. PMID- 10120272 TI - Atlanta reels after riots. PMID- 10120273 TI - When a plane goes down.... PMID- 10120274 TI - Delta 191: the Dallas experience. PMID- 10120275 TI - Lessons from La Guardia. PMID- 10120276 TI - Building-collapse rescue. PMID- 10120277 TI - Can your system survive? PMID- 10120278 TI - Avianca Flight 52. PMID- 10120279 TI - Calculating consultant costs. PMID- 10120280 TI - Consultants listings. PMID- 10120281 TI - Successful employment of non-traditional staff. PMID- 10120282 TI - Splendid spaces. City Springs Cafe. Mercy Medical Center, Baltimore, Maryland. PMID- 10120283 TI - Struggling to save our kids. AB - Many more than ever face the crises of childhood: violence, drugs, bad schools, poverty, divorce, or two parents at work. And no one seems to care. PMID- 10120284 TI - Boys. Most dangerous and endangered. AB - As both victims and perpetrators of crime and other pathologies, America's boys need help. An important lesson: Work on solutions with groups, not just individuals. PMID- 10120285 TI - Cath labs more integral to hospital planning, services. PMID- 10120286 TI - Making the most of the shift to outpatient services. AB - As hospitals watch an increasing percentage of their business shift to the outpatient setting, they will have to adapt their facilities and services to the new requirements of ambulatory care. Convenience and accessibility head the list of patient expectations. The following case studies show how two hospitals captured more ambulatory business in their markets--one by expanding its home health care program, the other by introducing management control systems and streamlining operations. PMID- 10120287 TI - Alliances becoming more critical. Interview by Donald E.L. Johnson. AB - Too many hospitals underutilize the services of their alliances, primarily because of lack of commitment from the CEO and a failure to involve physicians in management, administration and planning, according to David P. Hunter, chief executive officer of The Hunter Group, in an interview with Donald E.L. Johnson, editor and publisher of Health Care Strategic Management. Increasingly, alliances will offer new kinds of information and data services. They may even take on medical training and educational functions to improve their members' competitive edge. In any event, Hunter says, alliances must do more to involve physicians in hospitalwide cost, quality and performance issues. PMID- 10120288 TI - Large hospitals must develop strong managed care depts. PMID- 10120289 TI - Average weekly hospital discharges edges up. PMID- 10120290 TI - Averting CQI failure: five early warning signs. AB - Many hospitals, disappointed with their quality programs, are starting to ask, "What went wrong?" This article identifies five early warning signs of failing programs--and what to do about them. PMID- 10120291 TI - Principles for treating aggressive patients in a day hospital: balancing safety with patient autonomy. AB - Responding to an increase in the number of acutely and severely ill patients being treated in partial hospital programs, this paper addresses the treatment of aggressive patients in acute partial hospital settings. The authors review the limited conceptual literature published in this area and then suggest concrete strategies of intervention that fit the day-to-day life of a day hospital. They take as a guiding principle for these interventions an extension of the tenet of deinstitutionalization that patients be treated in the least restrictive manner possible and offer a variety of possible interventions for managing aggressive acts, ranging from least to most restrictive. Six issues which arise in applying less restrictive controls in the partial hospital treatment of aggressive patients are then identified, and illustrations of the principles employed in each of these areas are provided through reflection on two representative clinical vignettes. Taken together, these principles and interventions suggest ways for staff to intervene with aggressive patients, with each other, and with the significant others in patients' lives, in a manner which respects and fosters patients' autonomy and individual responsibility for their own behavior while maintaining a safe environment. PMID- 10120292 TI - A three-year follow-up study of patients in a day treatment program. AB - A 3-year follow-up study was conducted with 73 psychiatric patients in a Finnish day treatment program. The treatment outcome for these patients, who carried a wide range of diagnoses, was measured using psychiatric rehospitalization as a criterion. There were a large number of patients who were disabled and had been receiving social security benefits during the 3 years following discharge from the day treatment program. The rehospitalized cases involved mainly patients with a diagnosis of schizophrenia or personality disorder; use of neuroleptic medication was significantly associated with poor results. The numbers of psychiatric hospitalizations before treatment in the day treatment program in 1985 was found to be independent of hospitalizations during follow-up years. The results of the study support the claim that day treatment does not increase the likelihood of rehospitalization. Day treatment may reduce the length of stay during rehospitalization, but it is also clear that it cannot stop the rehospitalization of patients with severe diagnoses. PMID- 10120293 TI - Measures in the day hospital. I. The global assessment of functioning scale. AB - This clinical study explored the use of the Global Assessment of Functioning Scale (GAF Scale) in a day hospital setting. In general, the GAF Scale was found to be of use in categorizing patients and in detecting change from admission to discharge. However, changes in GAF Scale scores may lack clinical significance, and moreover, there was little evidence of concurrent validity. Implications for the use of the GAF Scale in day hospitals were discussed. PMID- 10120294 TI - Measures in the day hospital. II. The interpersonal behavior survey. AB - This study explored the use of the Interpersonal Behavior Survey (IBS) with a day hospital population. The patients completed the IBS in such a way as to suggest potential deficits in a variety of assertiveness skills and potential excesses in two areas of aggressiveness. Moreover, the IBS was correlated with measures of psychological distress, suggesting the relevance for training in social skills for this population. PMID- 10120295 TI - Treatment effectiveness outcome research in adult partial hospitalization. AB - The pilot study at Charter Kingwood was designed as an integral part of continuous quality improvement. Research focused on patient appropriateness and outcome treatment results. The Day Therapy Appropriateness Scale was administered along with pre and post tests of the Index of Self Esteem (ISE) and General Contentment Scale (GCS). Other instruments included a Patient Satisfaction Survey and alumni quarterly follow-up checklist letter. The outcome study demonstrates that patients were appropriately placed in treatment and improved with treatment. Results showed that patients improved 20% after 2 weeks of intensive group therapies. The Patient Satisfaction Survey had 17 items and 4 categories to select degrees of satisfaction or dissatisfaction with the overall program, staff, therapy groups, and individualized treatment goals. Results supported a 90% overall satisfaction with services provided. An alumni quarterly follow-up emphasizing postdischarge planning and aftercare verified that 96.3% of participants benefited from the program, 82% participated in aftercare, and 98.3% would recommend significant others for treatment. PMID- 10120296 TI - Integration of partial hospitalization and inpatient child/adolescent psychiatric units: "A question of continuity of care". AB - In an ever-changing health care field, an organization must be willing to change to meet the needs and demands of its patients. With continuity of care as the impetus for change, the Harold E. Fox Center at St. Joseph Mercy Hospital experienced a significant change in the delivery of child/adolescent psychiatric services. To improve patient outcomes and patient, family, staff, physician, and community satisfaction, the partial hospitalization program and the inpatient unit were integrated. A treatment team model was adopted for the integrated program. This program consisted of a teacher, social worker, nurse, and activity therapist. Physicians supervised the team in the delivery of treatment for their patients. These patients were placed on a treatment team upon admission and were maintained in the team until discharge. A survey was completed analyzing patient, parent, and staff satisfaction with the new model of service delivery. The results indicated favorable support for the concept of the integrated program; however, the operation of such a program still requires refinement. PMID- 10120297 TI - Who goes where? PMID- 10120298 TI - Decisive action. PMID- 10120299 TI - Running out of steam. PMID- 10120300 TI - Warmer welcomes. PMID- 10120301 TI - West Midlands storm clouds gathering. PMID- 10120302 TI - Second 100 interior design giants. PMID- 10120303 TI - Fire drill: a primer on Cal 133. PMID- 10120304 TI - Two recent developments regarding tax-exempt status of hospitals. PMID- 10120305 TI - Failure to notify physicians of patient's deteriorating condition a basis for hospital liability. PMID- 10120306 TI - Pitfalls and opportunities for environmental marketers. AB - Issues such as global warming, ozone depletion, insufficient landfill capacity, and excess packaging are foremost on the minds of consumers. Companies face a myriad of environmental challenges, but they also recognize the opportunities to be gained by implementing responsible marketing action plans. PMID- 10120307 TI - Industry's response to green consumerism. AB - By now, most people recognize that green is a fundamental business issue and not a marketing fad. As a result, companies must integrate environmental planning into their overall business strategy. The author recommends four approaches to help gain a competitive edge. PMID- 10120308 TI - Marketing's agenda for the 1990s. AB - Companies must master six specific issues to achieve market leadership in this decade. Successfully applying these six make-or-break issues can shape an organization's marketing strategy and boost its bottom line. PMID- 10120309 TI - The value of long-term commitment. PMID- 10120310 TI - Structuring a successful turnaround. PMID- 10120311 TI - New models for hospital-affiliated medical group practice: the use of medical foundations and management service organizations. PMID- 10120312 TI - Physician-hospital partnering: medical clinic foundations, practice acquisitions, mergers, and MSOs. PMID- 10120313 TI - The challenge ahead: the state agenda for the coming years. AB - The mid-1990s promise to be extremely challenging years as state leaders and institutions struggle to bring accountability and predictability back into their political systems. Faced with continuing budgets troubles, increasing demands for services and a shift of responsibility from the federal to the state level, the American states will be hard pressed to satisfy constituent needs or improve state services. However, the tough times may result in long-term improvement in state government, as administrators streamline agencies, legislators trim inefficient or redundant programs and state leaders generally seek new and cost effective solutions to social and economic problems. PMID- 10120314 TI - Culture translates global thinking into local action. PMID- 10120315 TI - Volunteers chairing events. PMID- 10120316 TI - Components of a training program for understanding and valuing diversity. PMID- 10120317 TI - Environmental issues: the challenge for the chief executive. AB - Businesses are under pressure to adopt environmental policies and incorporate them into their strategic business planning as a matter of routine. These pressures are coming from at least five sources--stricter legislation, consumer demand, competitive advantage, staff concerns and community pressure. The challenge is enormous but there is growing evidence that sound environmental management provides pay-off in bottom line results. Business organizations have a vital role to play and its good for them. There are opportunities for new business as well as threats to those organizations which continue to ignore the trends. PMID- 10120318 TI - Strategic planning: balancing short-run performance and longer term prospects. AB - Strategic planning activities can, to varying degrees be anticipatory or hindsight in orientation. Anticipatory activities prepare the firm for future strategic surprises and enhance the firm's effectiveness in dealing with turbulence and unpredictability in the external environment. Hindsight activities on the other hand, rely greatly on ex-post analysis (of information on past events), emphasize efficiency in key processes and operations, and are predicated on reasonable continuity and stability in the external environment. While both sets of activities are necessary to maintain the balance between effectiveness and efficiency, a relatively greater emphasis on one set or the other is crucial under different degrees of environmental turbulence and unpredictability. Informed implementation of the appropriate degrees of anticipatory and hindsight orientations through differentially emphasizing separate sets of strategic planning activities should enable managers to exercise better strategic control and optimize the firm's short-run performance as well as long-term prospects. PMID- 10120319 TI - The corporate board: confronting the paradoxes. AB - Corporate governance and the role of boards is a topic hotly debated in boardrooms, associations and media across the industrialized world. However intense, discussions are largely national phenomena due to the widespread belief that boards cannot be compared on an international plane. The authors argue the contrary: that there is a great deal to be learned from such comparisons because boards in different countries are more similar than they are different. Insights are drawn from a four-year study the authors have conducted involving boards from eight countries. The full results have been published earlier this year by Oxford University Press, as The Corporate Board; Confronting the Paradoxes. PMID- 10120320 TI - Strategic group decision support systems--a guide for the unwary. AB - Considerable interest is currently being shown in the use of information technology to assist in improving group process, particularly those associated with strategic planning. Three major approaches are developing to provide this support, and these are described in this article. In general, articles about Group DSS are overwhelmingly favourable to the approaches, although research findings suggest that some forms of Group DSS can have deleterious effects on the quality of meetings. These research findings are discussed. PMID- 10120321 TI - HealthVest prepares to run 6 Healthcare Intl. facilities. PMID- 10120322 TI - Shake-up trims 2 VPs' jobs at New York's Presbyterian. PMID- 10120323 TI - 2 Pa. hospitals convince Justice Dept. that their merger has merit. PMID- 10120324 TI - St. Louis system to invest money in 2 rural hospitals. PMID- 10120325 TI - 2 Illinois hospitals seek fed OK to merge; study tallies savings. PMID- 10120326 TI - 5 more Dallas facilities put in for trauma duty. PMID- 10120327 TI - IRS revokes approval of joint venture. PMID- 10120329 TI - Andrew pounds states, hospitals. PMID- 10120328 TI - Profitable Fla. hospital to donate $1 million for clinic ... with a catch. PMID- 10120330 TI - Candidates have little to say about long-term-care reform. PMID- 10120331 TI - Making primary care the primary concern. AB - The nation's growing needs for primary-care physicians aren't being met by the current medical education system, experts are warning. And they say not enough is being done to correct the situation. Only about 14% of 1992 medical school graduates are planning careers in primary care, compared with 37% in 1981. But trade associations, research groups and primary-care providers are promoting new programs and new roles for medical education to reverse the trend. PMID- 10120332 TI - Humana's board approves division of healthcare chain. PMID- 10120333 TI - Temporary physicians can be key to hospital strategies. AB - When a physician staffing crisis occurs, hospitals often turn to services specializing in placing interim doctors, or locum tenens. But these docs can do more than fill an emergency need; they can be used for some strategic purposes such as test marketing a new physician service, assisting during peak periods and broadening recruitment guidelines. Wanda Dearth, who heads an interim physician staffing firm in Irving, Texas, offers some advice. PMID- 10120334 TI - Requests pouring in for AHCPR's new practice guidelines. AB - Since the early March release of the first practice guideline by the Agency for Health Care Policy and Research, on postoperative pain management, the agency's clearinghouse has received more than 110,000 telephone calls and letters requesting copies. The agency also has issued guidelines on urinary incontinence and pressure ulcers. It has mailed 615,000 pieces of literature on the guidelines, and more requests are being filled daily. PMID- 10120335 TI - Hospitals in New York state may have easier time raising cash with tax-exempt bonds. AB - New York state hospitals considering the sale of tax-exempt bonds as early as next year might find it easier to get to market, said the new executive director of the New York State Housing Finance Agency, which oversees the organization that acts as a conduit for not-for-profit hospitals wanting to issue bonds. Among the new exec's priorities is the streamlining of the state's cumbersome bond pricing process. PMID- 10120336 TI - Providers express fears over entitlement caps. PMID- 10120337 TI - Agency's tax exemption disputed. PMID- 10120338 TI - Patient-centered care gains interest--surveys. PMID- 10120339 TI - La. to buy Hotel Dieu to replace Charity. PMID- 10120340 TI - New Jersey told to trim Medicaid payments. PMID- 10120341 TI - Calif. to resume payments; hospitals not enthusiastic. PMID- 10120342 TI - Pennsylvania seeks new limits on Medicaid. PMID- 10120343 TI - Southern California merger to form 'medical supergroup'. PMID- 10120345 TI - Task force hammers out guidelines for Kansas City area. PMID- 10120346 TI - Dallas facility acts to prevent Medicare cutoff. PMID- 10120344 TI - Project to test whether electronic data linkup can cut claims costs. PMID- 10120347 TI - Former hospital staffer faces prison, fine for role in X-ray scam. PMID- 10120348 TI - JCAHO places N.Y.'s Woodhull on probation. PMID- 10120349 TI - AHA to lose $2.4 million, makes layoffs. PMID- 10120350 TI - Nursing home group rips new inspection rules. PMID- 10120351 TI - Putting guidelines into practice. AB - More hospitals are beginning to use principles and techniques borrowed from other industries to improve the quality of care. They're developing treatment guidelines, usually based on comparative data and the collected expertise of their caregivers, and they're "benchmarking," comparing their care patterns with those of hospitals that get better results and modifying practices accordingly. PMID- 10120352 TI - Caremark set to buy group, stalks another. PMID- 10120353 TI - Final rules ensure tough reclassification hurdles. PMID- 10120354 TI - Consumers keep information lines ringing. AB - Some of hospital's most cost-effective marketing is a result of the telephone calls they receive, not so much the calls they make. Hospitals that want to attract more business are offering consumers timely healthcare information that's only a telephone call away. Such programs have been so effective that some hospitals are rethinking their telephone marketing strategies. PMID- 10120355 TI - Keane buying its way into top vendor ranks. AB - Formerly tiny Keane Healthcare Services Division is elbowing its way into the top ranks of hospital information systems vendors through the acquisitions of two struggling companies. The moves will expand Keane's client base from 30 hospitals to more than 200 in less than a year, making it one of the 10 largest vendors of patient accounting software. PMID- 10120356 TI - Mass. authority's bond sales set record. AB - Fueled by low interest rates and competitive construction costs, the Massachusetts Health and Educational Facilities Authority recorded its heftiest fiscal year ever in new tax-exempt bond issues for hospitals and universities. The authority issued $1.25 billion in debt during its fiscal year ended June 30. Healthcare-related bonds accounted for two-thirds of the total. PMID- 10120357 TI - Hospitals mounting efforts to aid Andrew-hit hospitals. PMID- 10120358 TI - AHA seeks support for its plan from physician group. PMID- 10120359 TI - Sandoz, Caremark agree to $20 million settlement. PMID- 10120360 TI - Dems, GOP kick off grass-roots campaigns. PMID- 10120361 TI - Rochester, N.Y., effort reaps satisfaction. PMID- 10120362 TI - HealthTrust hires exec to push 'aggressive growth strategy'. PMID- 10120363 TI - Calif. Blues to form for-profit unit. PMID- 10120364 TI - Top Blues exec says its plans are healthy overall. PMID- 10120365 TI - Calif. Healthcare, Sutter consider merger. PMID- 10120366 TI - Southern Florida hospitals' cash flow among casualties in wake of Hurricane Andrew. PMID- 10120368 TI - In the wake of layoffs, questions arise about AHA's financial affairs. PMID- 10120367 TI - Fight for control of National Heritage on hold. PMID- 10120369 TI - Battle lines drawn on bill to give states reform help. PMID- 10120370 TI - Nation's first hospital: a history of healing. PMID- 10120371 TI - MCI Critical Care merger approved. PMID- 10120372 TI - Humana documents sought for investigation of legislators. PMID- 10120373 TI - Democrats playing politics with healthcare--Sullivan. PMID- 10120374 TI - Groups demand presidential debate on healthcare. PMID- 10120375 TI - Baylor system seeks buyer for facility in eastern Texas. PMID- 10120376 TI - Texas panel urges coverage for kids, moms. PMID- 10120377 TI - FDA approvals 'paralyzed'--Dingell. PMID- 10120378 TI - Cumberland-Pricor merger advances. PMID- 10120379 TI - Ill. demonstration to investigate separate subacute classification. PMID- 10120380 TI - Bush gains ground on healthcare, but still trailing Clinton--poll. PMID- 10120381 TI - Healthcare reform plan's aim is simple--stick with what works. PMID- 10120382 TI - Maine group practices settle antitrust charges. PMID- 10120383 TI - Mass. Blues plans to proceed with Bay State Merger. PMID- 10120385 TI - Robots give providers a helping hand. PMID- 10120384 TI - Tough times can be best of times for management companies. AB - The tough operating environment facing hospitals in the next decade should mean more business for hospital management companies. When hospitals run into financial turbulence, many boards look to management firms for the right pilots to guide their facilities back to profitability. But even healthy hospitals are looking to the management sector to help them steer clear of problems. PMID- 10120387 TI - PPS year 10 rules released by HCFA. PMID- 10120386 TI - Securities backed by healthcare receivables. AB - Prudential Securities has placed $40 million in medium-term, taxable notes believed to be the first AAA-rated securities backed by healthcare receivables. Standard & Poor's Corp. rated the three-year notes, which were issued by NPF III, an Ohio company created to buy receivables from cash-strapped providers, and are backed by the Medicare, Medicaid and insurance receivables of 21 hospitals and healthcare providers nationwide. PMID- 10120388 TI - Fine tuning self-pay collections. PMID- 10120389 TI - Prescription for change: an interview with FDA Commissioner Dr. David Kessler. AB - Dr David A. Kessler took over as Commissioner of the Food and Drug Administration in December 1990. Since then, he has initiated many changes to improve the structure and efficiency of the agency. In this interview, he describes some of the problems and challenges associated with the process of reviewing and approving new drugs. PMID- 10120390 TI - Nursing the system. Key users are sometimes "out of the loop". AB - Among those with a particular interest in hospital information systems are those who teach nursing students at the college level. To get their views, Southern Hospitals interviewed four Nurse Scholars involved with nursing and research projects for universities across the South. In 1989, Atlanta-based vendors HealthQuest and HBO & Company of Georgia established the Nurse Scholars Program in an effort to help academia stay abreast of technology. It provides nurse educators with comprehensive instruction in emerging technologies and uses of automated patient care systems. The scholars are encouraged to share their new knowledge with students, faculty, practitioners and administrators so that future nurse executives will better understand and communicate what they need and want from information systems. PMID- 10120391 TI - Working smarter with patient-focused care. AB - Aspects of the patient-focused care approach make it clear that ideas that revolutionized other industries are just as useful to healthcare organizations. Lee Memorial Hospital in Fort Myers, Fla. and Atlanta's Northside Hospital have adopted this approach. PMID- 10120392 TI - Helping hospitals prepare for change. PMID- 10120393 TI - Capture your market share. Healthcare's largest growth area requires strategic facilities planning. AB - The outpatient consumer has more choices than ever before. Hospital's delivery systems must be optimized to remain competitive and survive financially. PMID- 10120394 TI - The insider's approach. Reduce costs and assure quality through case management. PMID- 10120395 TI - Managing cultural diversity in the work place. AB - Much of the cultural diversity and racial prejudice that exist in the healthcare industry today is rooted in ignorance more than outright bigotry. The time is ripe for facing the problems and seeking solutions. PMID- 10120397 TI - The three R's: reducing, reusing & recycling. Cut costs while improving community image. PMID- 10120396 TI - Keeping the patient happy. AB - Customer service is the catch word for the 90s and hospitals are constantly looking for ways to make their customer--the patient--happier. In a section of the country where fried chicken, grits and gravy are home-cooking staples, an unlikely marriage between Southern hospitals and a European food preparation process may be the key to many hospitals' ability to cater to the patient by offering gourmet meals on a regular basis. PMID- 10120398 TI - Healthcare effectiveness begins within. PMID- 10120399 TI - Nurses vulnerable to lawsuits. AB - With the modern expansion of malpractice insurance among nurses, economic recession and the potential to garnish wages has encouraged attorneys to bring suit against nurses. The cases illustrated stagger the imagination. PMID- 10120400 TI - Culture shock--the road to TQM. AB - Total quality management thrusts the company that adopts this philosophy on a road which determines customers' needs and fine tunes each and every operation in the facility to meet those needs. Crawford Long Hospital at Emory University, Atlanta is traveling that road. PMID- 10120401 TI - Help for safety-net hospitals. PMID- 10120402 TI - Trustee orientation: the basic building block of board effectiveness. PMID- 10120403 TI - Managed care in the 1990s: providers' new role. PMID- 10120405 TI - Ensuring prudent investments. PMID- 10120404 TI - Succession plan succeeds. PMID- 10120406 TI - Hospital treats urban decay. PMID- 10120407 TI - Trustees lead state's reform effort. PMID- 10120409 TI - Boards and medical staff: how well do they understand each other? PMID- 10120408 TI - Streamlining governance to complement strategic plan. System's unifying strategic plan shows need for board collaboration. PMID- 10120410 TI - Hospitals without walls: trustees reach out to the community. Interview by Karen Gardner. AB - "A futurist is someone who either predicts or invents the future, and I really try to do both," says Leland R. Kaiser, Ph.D., president of Kaiser & Associates, Brighton, CO, and associate professor, University of Colorado at Denver School of Business. Kaiser--a former hospital trustee--says, "When you're inventing the future, you're using a vision of how you would like to see the organization be in the future, and then you help the organization achieve that." Kaiser concentrates on helping institutions achieve a vision that has been formed by his many years of health care and management experience as well as an extraordinary sensitivity to the needs of communities and the potential that the United States health care system has to address those needs. Futurist Kaiser recently spoke with Trustee editor Karen Gardner about his vision of health care delivery, the central role that trustees must play in order to realize that vision, and the promise of a truly community-based health care system. PMID- 10120411 TI - The hidden cost of AIDS. PMID- 10120412 TI - Cost-shopping for care. A burgeoning movement calls on doctors and hospitals to post prices. PMID- 10120413 TI - Power in top management teams: dimensions, measurement, and validation. AB - Top managers' power plays a key role in strategic decision making. However, although numerous scholars have recognized its importance, very few have attempted to measure the phenomenon. In this article, I present a set of dimensions measuring top managers' power and suggest a measurement methodology to facilitate empirical inquiry. Data from a group of 1,763 top managers in three industries were used to assess the validity and reliability of the power dimensions in three studies. Results demonstrate strong support for the proposed power dimensions. PMID- 10120415 TI - Are your accounts costing you money? AB - How can you set prices if you don't know or admit to all of your costs? A consultant points out often overlooked expenses. PMID- 10120414 TI - A derivation of the underlying constructs of just-in-time management systems. AB - Researchers have recommended that the theoretical constructs underlying just-in time (JIT) management systems be identified and developed if JIT is to be fully understood and its full capabilities realized. In this study, we advanced this conceptual development through an instrument based on the relevant literature and empirically deriving three underlying constructs: (1) operating structure and control, (2) product scheduling, and (3) quality implementation. We report a content analysis of these constructs and develop propositions regarding their relationships, predecessors, and outcomes. PMID- 10120416 TI - Data decisions. PMID- 10120417 TI - Can JCAHO satisfy its customers? PMID- 10120418 TI - The future of rural hospitals. AB - In summary, the pressures facing our nation's rural hospitals are likely to continue without significant relief from either federal or state governments. The strategies we see evolving in this environment include increased research on efficient operation with limited resources as well as increased competition for scarce resources within America's urban sectors. Not a pretty picture, but survival oriented. PMID- 10120419 TI - Healthcare access management in rural hospitals. PMID- 10120420 TI - Recent actions taken on advance directives. PMID- 10120421 TI - A history of international collaboration. PMID- 10120422 TI - Serving the international patient. PMID- 10120423 TI - Rural health care and its impact on hospitals. PMID- 10120424 TI - Designing fire safe interiors. AB - Any product that causes a fire to grow large is deficient in fire safety performance. A large fire in any building represents a serious hazard. Multiple death fires almost always are linked to fires that grow quickly to a large size. Interior finishes have large, continuous surfaces over which fire can spread. They are regulated to slow initial fire growth, and must be qualified for use on the basis of fire tests. To obtain meaningful results, specimens must be representative of actual installation. Variables--such as the substrate, the adhesive, and product thickness and density--can affect product performance. The tunnel test may not adequately evaluate some products, such as foam plastics or textile wall coverings, thermoplastic materials, or materials of minimal mass. Where questions exist, products should be evaluated on a full-scale basis. Curtains and draperies are examples of products that ignite easily and spread flames readily. The present method for testing curtains and draperies evaluates one fabric at a time. Although a fabric tested alone may perform well, fabrics that meet test standards individually sometimes perform poorly when tested in combination. Contents and furnishings constitute the major fuels in many fires. Contents may involve paper products and other lightweight materials that are easily ignited and capable of fast fire growth. Similarly, a small source may ignite many items of furniture that are capable of sustained fire growth. Upholstered furniture can reach peak burning rates in less than 5 minutes. Furnishings have been associated with many multiple-death fires.(ABSTRACT TRUNCATED AT 250 WORDS) PMID- 10120425 TI - Minimizing the cost of employee turnover. PMID- 10120426 TI - Continuous quality improvement: an analysis of the new paradigm in healthcare. AB - Evaluating the quality of medical care is a documented activity extending as far back as 1910, when William Flexner, MD, examined the nation's medical schools. Standards promulgated by the federal government and by voluntary accreditation agencies have been primarily responsible for driving the development and widespread use of monitoring activities over the past 20 years. A new wind is blowing, however. Momentum is increasing to incorporate the principles of industrial quality improvement into the healthcare arena. In this study, Michelle Harvey poses the following questions: Have hospitals made the transition from traditional quality assurance to continuous quality improvement? Is an individual hospital's transition affected by such variables as bed size, region, profit or nonprofit status, and system affiliation? This analysis suggests that opportunities to facilitate transition to the new paradigm abound. PMID- 10120427 TI - QI team shares ownership and gets results. AB - The FOCUS-PDCA framework for process improvement developed by the Hospital Corporation of America helps the healthcare team look at work as a series of processes that can be improved rather than focus on the people involved in the processes. It is data driven, and it encourages teamwork and shared ownership in the process improvement opportunity. This article describes how, by using FOCUS PDCA, the length of stay (LOS) quality improvement (QI) team at Hubbard Regional Hospital in Webster, MA, has decreased dramatically the time patients spend awaiting nursing home placement. PMID- 10120428 TI - Building a quality culture through small and large successes. AB - Total quality management (TQM) is a unifying business strategy for achieving and sustaining growth. TQM proceeds, step by step, project by project, to transform the organization into one smoothly working, quality-focused team. For successful implementation of TQM, the small projects are every bit as important as the large ones. The simple, accessible successes validate the skills that employees are acquiring and encourage them to try more complex, long-term endeavors. This article discusses several TQM projects conducted at Baptist Medical Center in Columbia, SC: streamlining medical records processing (a large project that freed up millions of dollars in cash flow); improving the reliability of all hospital equipment; and ongoing small successes in the recovery room. Although the dollar value of the projects varied considerably, all were critical to creating a culture of total quality management at Baptist Medical Center. PMID- 10120429 TI - Using a quality improvement team to reduce patient falls. AB - Preventing falls among hospitalized patients continues to be a major concern of nurses, as evidenced by the volume of literature on this subject during the past 10 years. Yet, preventing falls, like preventing medication errors, has been a difficult and chronic issue for most nursing departments. Carolyn Corbett and Barbara Pennypacker describe how the nursing staff at Robert Packer Hospital in Sayre, PA, finally has experienced success by applying the systematic methods and principles of continuous quality improvement and establishing a fall prevention process. PMID- 10120430 TI - Improving quality at Parkview. AB - Parkview Episcopal Medical Center in Pueblo, CO, has been implementing a continuous quality improvement (CQI)-driven organization since April 1988. Under the leadership of Michael Pugh, the medical center's president and CEO, Parkview has made great progress in this effort. However, there is much more to be accomplished in the years to come. PMID- 10120431 TI - Legislative forum: a comparison of healthcare reform bills. PMID- 10120432 TI - HQEF update: master's degree program guidelines for a concentration in healthcare quality management. AB - The Healthcare Quality Educational Foundation (HQEF), in its quest to identify formal educational opportunities for healthcare quality leaders, determined that academia lacked a standardized curriculum for healthcare quality management. Because a majority of the members of the National Association for Healthcare Quality (NAHQ) expressed a need for master's degree programs, the foundation appointed a committee composed of academicians and quality management professionals to define a curriculum appropriate for a master's degree program with a concentration in healthcare quality management. This article identifies the HQEF's goals and outlines the activities undertaken by the committee to define guidelines for colleges and universities interested in developing master's degree programs. PMID- 10120433 TI - The role of hospital leadership in the continuous improvement of patient care quality. American Hospital Association. AB - This article was prepared by the American Hospital Association (AHA) Division of Quality Resources for hospital CEOs, senior managers, medical staff leaders, and trustees specifically to help clarify the relationship of ongoing hospital quality management activities to new continuous quality improvement (CQI) or total quality management (TQM) efforts. The focus of CQI/TQM as an overall management philosophy extends far beyond the scope of this article. However, due to the volume of member inquiries received by the AHA Division of Quality Resources, and in response to the division's charge, the AHA staff has identified the need to discuss the application of CQI concepts and methods to existing quality monitoring and evaluation activities. PMID- 10120434 TI - Career professionals who volunteer: should their motives be accepted or managed? AB - Career professionals, such as business executives who devote their time and talents to committee work in voluntary organizations, are highly valued as volunteers. These professionals have a variety of motives for adding volunteer work to their demanding schedules. Should volunteer agency administrators accept and reward these motives indiscriminately, or should they try to mold them to conform to agency values? The answer, according to this study, is yes to both alternatives, depending on whether the aim is to improve these volunteers' attitudes or their performance. PMID- 10120435 TI - How nonprofit human service organizations manage their funding sources: key findings and policy implications. AB - Major findings and policy implications on how nonprofit social service organizations manage their funding relations are summarized. Data from in-depth case studies of six medium-sized social service organizations with distinctive funding profiles yielded findings on the major contingencies associated with controlling fees, the volatility of donations, and the driving force of public funding relationships for funders (public and private), nonprofit managers, and the role of nonprofit organizations. PMID- 10120436 TI - Redefining the board's role in fiscal planning. AB - Board approval of an operating budget, a traditional exercise of board authority, can trivialize board leadership and stultify managerial prerogatives. Considered within a new governance paradigm, conventional budget approval is not only unnecessary, but dysfunctional. This article argues that boards should proactively establish policy for financial planning and then require administrative budgeting throughout the year to meet the policy criteria. The result is that boards stay focused on the bigger issues, particularly program priorities and goals, leaving managers the authority to create and adjust budgets within policy boundaries. PMID- 10120437 TI - Anticipating shortage of caregivers, "Arizona model" for patient care redesign creates two new positions at University Medical Center, Tucson. PMID- 10120438 TI - Study points to promising approaches for managing costs and reducing excess utilization. PMID- 10120439 TI - Scanlon Plan underlies participative management initiative that bundles education, gainsharing and employee suggestions at Boston's Beth Israel. PMID- 10120440 TI - Ten reasons why hospital turnaround programs fail. PMID- 10120441 TI - Focused care centers, decentralization, cross-training, and care paths define "world class healthcare" at Florida's Lee Memorial. PMID- 10120442 TI - Innovations to support patient care units are focus of nursing-led redesign initiative at St. Francis Hospital. PMID- 10120443 TI - In search of safer blood. PMID- 10120444 TI - Medicare program; fee schedules for the services of certified registered nurse anesthetists--HCFA. Final rule. AB - We are revising the Medicare regulations to allow certified registered nurse anesthetists (CRNAs) to receive Medicare payment for the anesthesia services and related care they furnish. In addition, this final rule sets forth the fee schedules under which payment is made for the services of CRNAs, except for the services of CRNAs in certain rural hospitals who are paid on a reasonable cost basis. This rule, which is effective for services furnished on or after January 1, 1989, implements section 9320 of the Omnibus Budget Reconciliation Act of 1986, as amended by section 4084 of the Omnibus Budget Reconciliation Act of 1987, section 411(i)(3) of the Medicare Catastrophic Coverage Act of 1988, section 608(c) of the Family Support Act of 1988, and sections 6106, 6107 and 6132 of the Omnibus Budget Reconciliation Act of 1989. This final rule does not reflect the changes concerning the calculation of payment rates contained in section 1833(1)(4) of the Social Security Act, as enacted by section 4160 of the Omnibus Budget Reconciliation Act of 1990. Those changes apply to services furnished on or after January 1, 1991. Thus, the changes to the payment calculation provisions described and published below are applicable only to services furnished in calendar years 1989 and 1990. PMID- 10120445 TI - Clinical Laboratories Improvement Act program; granting and withdrawal of deeming authority to private nonprofit accreditation organizations and of CLIA exemption under state laboratory programs--HCFA. Final rule. AB - This rule permits HCFA to approve or disapprove accreditation organizations and State laboratory programs and thereby determine that laboratories accredited by a HCFA-approved private, nonprofit accreditation organization are deemed to meet the requirements set forth in 42 CFR part 493 of the regulations, which implement section 353 of the Public Health Service Act (PHSA) or, in the case of State laboratory programs, are exempt from the requirements. Section 353 of the PHSA was enacted by the Clinical Laboratories Improvement Act of 1967 (CLIA '67) and was amended by the Clinical Laboratory Improvement Amendments of 1988 (CLIA). PMID- 10120446 TI - Operator service access and pay telephone compensation--Federal Communications Commission. Final rule; order on reconsideration. AB - Five petitions for reconsideration or clarification were filed regarding Policies and Rules Concerning Operator Service Access and Pay Telephone Compensation, CC Docket No. 91-35: Report and Order and Further Notice of Proposed Rule Making, 6 FCC Rcd 4736, 56 FR 40,793 (1991) (hereinafter Report and Order), in which the Commission adopted policies and rules concerning consumer access to operator service providers (OSPs) and compensation for competitive public payphone owners for calls not utilizing their presubscribed OSPs. In response to the petitions, the Commission adopted an Order on Reconsideration (hereinafter Order) in which it reaffirmed that: (1) Call aggregators must allow consumers to use equal access ("10XXX") codes according to the schedule described in the original Report and Order, with certain clarifications; (2) all OSPs, except those exempted in the Order, must establish an 800 or 950 access number within six months of the effective date of the previously adopted rules; and (3) calls initiated with an 800 number that does not serve as an OSP's access code are not within the scope of the statutory provision that required the Commission to consider payphone compensation. In addition, the Commission granted the request to order local exchange carriers (LECs) to offer blocking and screening services designed to control potentially fraudulent 10XXX calling. The Commission deferred certain unblocking deadlines pending the deployment of the required LEC services. PMID- 10120447 TI - Focus shifts to individual cost centers. States revamp defense against Boren suits. PMID- 10120448 TI - Combatting infection in group homes for AIDS residents. PMID- 10120449 TI - Turning inward for growth. 1992 retirement housing survey. PMID- 10120450 TI - A look ahead. What lies down the road for retirement housing. AB - Contemporary Long Term Care in conjunction with Senior Housing Investment Advisors, Inc. presents the State of the Senior Housing Industry Report. This analysis highlights many of the significant issues which industry practitioners and new investors and development sponsors will likely face throughout the next 12 months. PMID- 10120451 TI - 1992 architectural design awards. PMID- 10120452 TI - Making the pieces fit. Consistency is key in care planning and charting. PMID- 10120453 TI - A fresh start. Federal guidelines bring new perspective on incontinence. PMID- 10120454 TI - Resident funds and OBRA. PMID- 10120455 TI - Collaboration a panacea? PMID- 10120456 TI - Challenges to health care. PMID- 10120457 TI - Perceptions of procedural pain: parents, nurses, and children. AB - The study's purpose was to determine if children, their parents, and their nurses differ in their perception of pain associated with health care procedures. A convenience sample of 40 subjects was obtained in a pediatric clinic. The subjects were triads of a child, the child's parent, and the nurse. The study utilized an exploratory design. Self-reports of pain were measured using the Oucher scale. Data were collected during a routine physical examination that included an immunization. Subjects rated the child's perceived pain after the immunization. No significant differences were found between the child's and the parent's scores. A significant difference was found between the child's and nurse's score (p = .0084). Initial findings suggest that there are differences in pain perception between nurses and children. PMID- 10120458 TI - The Budreau infant irritability scale. PMID- 10120459 TI - Participating in the NSI (Nutrition Screening Initiative). PMID- 10120460 TI - Waste management: winning support. PMID- 10120461 TI - The effective enlistment of volunteers. PMID- 10120462 TI - What part of no don't you understand? PMID- 10120463 TI - Managing volunteers. AB - In summary, non-profit organizations are often blessed with an abundance of enthusiastic and talented volunteers. However, to use volunteers effectively, development directors must be diplomatic, highly skilled and very well-organized. They must also understand the unique aspects of managing volunteers. The effective management of volunteers can ensure success for a non-profit organization and bring great satisfaction to volunteers who will work their hearts out for causes and organizations they believe in. PMID- 10120464 TI - Reform delivery, not just financing. PMID- 10120465 TI - The insurance industry's role in reforming delivery. PMID- 10120466 TI - From reality to vision. PMID- 10120467 TI - Insurers and others--share responsibility for health care reform. PMID- 10120468 TI - Whither private health insurance? Self-destruction or rebirth? AB - The American public increasingly finds itself disenchanted with the system for health care financing in this country. Three forms of reform proposal are examined: those that place the locus of primary responsibility for health insurance coverage on the individual, those that would rely on employer mandates with patients and government bearing the residual responsibility, and those that lodge chief financial responsibility with the government, and act as primary agent for cost control. The second approach, government-mandated employer provided health insurance, appears to be the most politically viable at this time. However, that option is likely to be acceptable to the business community only if the mandate is coupled with additional regulation of private health insurance. Specifically, private health insurance in such a system likely would be based on mandatory open enrollment, community-rated premiums, and all-payer reimbursement, under which every payer pays a given provider the same fee for the same service. PMID- 10120469 TI - The ethics and legality of HIV seroprevalence studies. PMID- 10120470 TI - Waste not. Hospitals reduce, recycle and manage waste. AB - In the '80s, medical waste became a dirty word. On the heels of popular, and often distorted, fears about the dangers of medical waste, hospitals faced a monumental task: to evaluate their current handling of waste and, in many cases, develop new programs and disposal methods. PMID- 10120471 TI - Health policy task force considers recommendations. PMID- 10120472 TI - Sound incident reports reduce risk. PMID- 10120473 TI - Spot the flaw. PMID- 10120474 TI - Speak after the tone. PMID- 10120475 TI - MISG-uided money. PMID- 10120476 TI - Joint ventures. A marriage made in heaven or hell? PMID- 10120477 TI - Joint ventures. A new lease of life. PMID- 10120478 TI - Data briefing. Dentistry in the NHS. National Association of Health Authorities and Trusts. PMID- 10120479 TI - Sol y sombra. PMID- 10120480 TI - Name, set and match. PMID- 10120481 TI - Home alone? PMID- 10120482 TI - Patient rules, OK? PMID- 10120484 TI - Pooled learning. PMID- 10120483 TI - South East Thames. Difficult times, radical measures. PMID- 10120485 TI - When playtime's over. PMID- 10120486 TI - Fire at will. PMID- 10120487 TI - All systems go. PMID- 10120488 TI - Ambulance services. Cowboys and engines. PMID- 10120489 TI - Ambulance services. The sky's the limit. PMID- 10120490 TI - Organizational and environmental determinants of hospital strategy. AB - This study focuses on the relationship between the business strategy of acute care hospitals and several organizational and environmental characteristics. Business strategy is assessed using the Miles and Snow (1978) typology. The organizational characteristics examined are size, system membership, type of ownership, and case-mix severity. The environmental characteristics examined are those of the local environment, which includes general economic factors and measures of market structure. General economic factors include family income, unemployment rate, percent of population over 65, and ratio of physicians to general population. The measures of market structure include the Herfindahl index and each hospital's individual market share. The results of our analysis using multiple regression indicate that organizational characteristics are more likely than environmental factors to influence the business strategy of hospitals. Specifically, hospitals that are relatively small or operate independently are less likely than other hospitals to follow a proactive strategic orientation. PMID- 10120491 TI - A human resources decision support model: nurse deployment patterns in one Canadian system. AB - Optimal deployment of current staff--as opposed to recruitment of new staff--has been recognized as an effective strategy for dealing with nurse human resource shortages in hospitals, especially during periods of overall nursing shortages. In this article we present a model for maximizing current nursing staff resources by incorporating three dimensions of staff deployment: workforce stability, employment mix, and average paid hours. Using centralized provincial payroll data from British Columbia, we analyzed a set of three indices that measure these factors to examine patterns of nurse deployment and their impact on total nurse human resource requirements. Furthermore, by constructing hypothetical scenarios and changing the parameters according to possible situations depicted by the model, it is possible to demonstrate the impact of alternate management strategies on nurse requirements. The results emphasize the need for dealing with staff deployment in a multidimensional manner that may vary by facility type; it is not the size of the full-time nursing component alone that should be the dominant consideration for all facilities. Innovative approaches to management are called for to maximize the deployment of a limited human resource pool. PMID- 10120492 TI - Pay allocations by hospital administrators: an empirical analysis. AB - This study uses a policy-capturing approach to examine 816 pay-increase decisions made by 17 hospital administrators. Subjects were asked to respond to packages consisting of hypothetical employees who varied in performance levels, specialized skills or expertise, difficulty in replacing, potential turnover, and current salary. Results indicated that all five factors were significant and in the direction expected for most of the raters. None of the hypothesized interaction effects were significant for any of the raters. Results also showed that subjects' explicit rankings of the importance of the factors did not correspond highly with the rankings of their regression weights. The implications of this study for both research and practice are discussed. PMID- 10120493 TI - Determinants of capital structure. AB - This study analyzes the determinants of hospital capital structure in a new market setting that are created by the financial pressures of prospective payment and the intense price competition among hospitals. Using California data, the study found hospital system affiliation, bed size, growth rate in revenues, operating risk, and asset structure affected both short- and long-term debt borrowings. In addition, percentage of uncompensated care, profitability, and payer mix influenced short-term borrowings while market conditions and ownership affected long-term borrowings. Most significant of all is the finding that smaller hospitals tend to borrow more, possibly because they cannot generate funds internally. PMID- 10120494 TI - Contract management behavioral health programs: are hospitals satisfied with their performance? AB - Many hospitals have opted to develop and operate inpatient behavioral health programs utilizing contract management providers. This article identifies key performance characteristics for such programs and summarizes the degree of performance satisfaction reported by 48 hospitals. Performance characteristics include bed occupancy, net income, contract management fees, marketing support, staffing ratios, and staff turnover. The survey data also compares bottom-line performance characteristics for groups of contract management programs rated most and least satisfactory in overall performance. The survey findings are used to develop contract negotiation strategy designed to shift greater accountability for program performance to contract management providers in order for hospitals to achieve maximum return from these programs. PMID- 10120495 TI - Hospital-reviewer relations and effective utilization review. AB - A survey of utilization review nurses revealed substantial variation in the relationships between these nurses and the hospitals at which they review cases. Hospitals providing reviewers with complete responses to questions were associated with high levels of utilization review compliance, which was a significant factor in explaining the savings associated with utilization review. Improving relations between hospitals and utilization reviewers may yield higher levels of utilization review compliance and significant cost savings. PMID- 10120496 TI - Administrative complement and managerial efficiency in South Carolina hospitals. AB - This article examines the infrastructure and efficiency of administrative personnel employed by hospitals in South Carolina. The analysis suggests that variation in the administrative complement and the efficiency of hospital administrators is related to the scale of operations and related organizational complexity, the occupancy rate, ownership, and affiliation with multihospital systems. The results of the study also indicate that the administrative complement should be regarded as a resource that results in a discretionary rather than a committed cost and might be altered to increase productivity and improve profitability. PMID- 10120497 TI - The racial integration of medical and nursing associations in the United States. AB - Nursing associations and hospital nursing staffs integrated well before most racial integration took place in American society. In contrast, hospital medical staff integration lagged behind, and separate medical associations representing the distinctive concerns of two groups of practitioners have continued to exist. This article describes the divergent histories of these two fields and explores some reasons for these differences from a population ecology perspective. Nursing associations, unlike their medical counterparts, faced environmental constraints that made them ineffective as advocates for the economic interests of nurses. Yet, the American Nurses' Association served a more constructive role in the efforts to achieve racial integration than did the American Medical Association. More recent increases in market competition are now moving the more broadly based hospital and medical associations into a niche similar to the American Nurses' Association and giving rise to new organizations that are addressing more narrowly defined interests. PMID- 10120498 TI - Operating characteristics and comparative performance of investor-owned multihospital systems. AB - Investor-owned multihospital systems (IOMS's) have grown in number and influence in the United States in recent years, but very little is known about their comparative characteristics and performance. Since 1982 all hospitals in Florida have been required to submit standardized financial and operating data to the Health Care Cost Containment Board. This study analyzes data for the three largest IOMS's in Florida (American Medical International, Hospital Corporation of America, and Humana) for the years 1982-1989. Efficiency ratios, operating characteristics, and operating margins were compared. A multiple regression analysis was performed to determine the amount of variance in operating margins, which was explained by the efficiency measures and operating characteristics. PMID- 10120499 TI - The legality of state limitations on medical malpractice tort damage awards. AB - This study reviews the legal status of state medical malpractice damage limitations or "caps" now being challenged regularly on federal and state constitutional grounds. The case law resulting from the many state tort damage control laws passed during the mid-1980s in response to the "tort-insurance" crisis is examined, and the legal and economic implications of that litigation are analyzed. This study concludes that (1) the outcome of litigation depends largely on whether the challenge is heard in a federal or state court, (2) challenges based on the right to a jury trial are more likely to be successful, and (3) the influence of cap laws on insurance rates and availability to date has been minimal. PMID- 10120500 TI - An interview with the College's 1992-93 Chairman. Interview by Walter Wachel. PMID- 10120501 TI - Age discrimination and the healthcare executive. American College of Healthcare Executives Public Policy Statement. PMID- 10120502 TI - Managing the board and governing the organization. PMID- 10120503 TI - Boards in transition. AB - In recent months, the shareholders of some of America's top companies have scrutinized the role of their boards, echoing the national trend toward greater accountability in business. A similar scenario is being played out in healthcare organizations. PMID- 10120504 TI - Growing a culture of leadership by building better boards. AB - Delaying and avoiding tough decisions, demonstrating an aversion to any kind of risk-taking, and the absence of accountability are some of the frequent criticisms heard about voluntary boards. But even highly paid, professionally packed boards can fail without the right leadership culture. PMID- 10120505 TI - Institutional advance directives. PMID- 10120506 TI - Bush/Clinton reform proposals. PMID- 10120507 TI - Receivables and the bottom line. PMID- 10120508 TI - 'Landlocked' hospital finds room for its MRI unit under the ground. Stuart Circle Hospital. PMID- 10120509 TI - Total quality management in environmental services: phenomenon or just a fad? PMID- 10120510 TI - ASHES (American Society of Healthcare Environmental Services) to bestow three new awards in 1992. PMID- 10120511 TI - NFPA (National Fire Protection Association) to change medical gas standards in '93. PMID- 10120512 TI - Buying natural gas on spot market saves money. PMID- 10120513 TI - Setting up a workable safety-recognition program. PMID- 10120514 TI - Security pay up 13 cents during first-quarter '92. PMID- 10120515 TI - Developing personal effectiveness in NHS managers. PMID- 10120516 TI - Making the NHS personnel function effective. PMID- 10120517 TI - The "expert plus" role of personnel advisers in an NHS trust. PMID- 10120518 TI - Accelerating the pace of change in the NHS. PMID- 10120519 TI - Collective bargaining in the Canadian health care system. PMID- 10120520 TI - Innovation and change in the NHS: a case study. PMID- 10120521 TI - Methods of assessment. PMID- 10120522 TI - Evaluating the personnel department. PMID- 10120523 TI - Supply costs per procedure identified in new HMM survey. PMID- 10120525 TI - Radiology non-salary expenses per procedure. PMID- 10120524 TI - Personal protective equipment prices: calm before the storm? PMID- 10120526 TI - Hospitals use alternative off-site methods. AB - More stringent state regulations on incinerating and autoclaving infectious medical waste on site, coupled with the high costs involved with having the waste hauled off site to be incinerated, is causing hospitals to look at alternative off-site disposal. PMID- 10120527 TI - I.v. free-flow risk creates alarm, possible price changes. PMID- 10120528 TI - Self-renewing or "evergreen" clauses in hospital purchasing have legal consequences. PMID- 10120529 TI - Patient-centered care: reinventing the hospital for the 21st century. PMID- 10120530 TI - The selling of health care services: are all sales jobs the same? AB - The selling activities of 272 salespeople were identified by polling 122 health care services organizations nationwide. A taxonomy of sales jobs was developed to classify the range of selling tasks within health care. The taxonomy is presented, discussed, and compared with a similar industrial one. Managerial implications and suggestions for future research are discussed. PMID- 10120531 TI - Who leaves the service area? Profiling the hospital outshopper. AB - Rural hospitals are facing a crisis of major proportions. Declining patient loads, revenues, and profits are the norm. The authors find that in rural communities, the likelihood of going to the local hospital increases with age and may decrease with income. PMID- 10120532 TI - Does advertising affect your nurses? AB - As hospitals move from image advertising to ads that highlight specific services, they need to consider a potential "second audience"--their employees. In an exploratory study of nurses and their opinions of hospital advertising, the potential impact of ads on nurses' role congruence and clarity and on their feelings of being valued by the hospital was examined. Specific recommendations for hospital advertising are offered. PMID- 10120533 TI - The expanded health belief model as a basis for enlightened preventive health care practice and research. AB - The health belief model has served as the primary theoretical vehicle for preventive health care research and practitioner guidelines for the past two decades. However, it has been criticized for its rational belief tenets. An expanded health belief model is proposed that explicitly incorporates a process orientation and adds several constructs with good potential to explain difficulties practitioners encounter in fostering realization of health risks and/or gaining long-term compliance with preventive health care recommendations. Illustrative practitioner implications are described and an agenda for research on the expanded model is outlined. PMID- 10120534 TI - Adaptation and customer expectations of health care options. AB - Customer expectations change as competition intensifies. The authors use adaptation and exchange theories to explain customer expectations, disconfirmation, and satisfaction as applied to three types of health care providers: physicians, walk-in clinics, and hospital emergency rooms. The results show how new referents for expectations challenge competitors to increase performance in order to match changing industry standards. PMID- 10120535 TI - Patient satisfaction: the impact of past experience. AB - The effects of previous hospital experiences on satisfaction with subsequent hospital experiences are significant and cannot be ignored. The study findings suggest that prior satisfaction with the health care system in general and with the same hospital when applicable has a significant influence on patient evaluations of current hospital experience. Suggestions are offered to manage the effects of prior satisfaction on patient evaluations of current hospital experience. PMID- 10120536 TI - Allocating human resources among the services of a health care organization. AB - The problem of optimizing the allocation of human resources among the services of a health organization is explored. The suggested approach borrows from normative budgeting models (ADVISOR) and product portfolio matrices to derive an allocation rule that seems to offer a reasonable rationale for eliminating certain services and reallocating the available resources to other services. The authors describe the approach and its implementation. PMID- 10120537 TI - Addressing national and regional health needs: a framework for health planning. AB - Completion of the first decade since the Alma-Ata Declaration of 'health for all' (1978) has led to numerous appraisals, in international forums, of progress achieved by the current primary health care strategy. Although this strategy appears to have contributed to improvements in selected health outcomes, changing circumstances in many developing countries may now require a more flexible and country-specific approach to health care programming. This article argues for the development of a pragmatic framework: to articulate problems which should be addressed in the development of national health programs; and, to organize concepts and methodologies to address these problems. Such a framework should enable an assessment of currently implicit value judgments, and enable strategies to be considered that assess several input and output variables simultaneously. Moreover, this framework would, we believe, further the goal of improved health delivery at a national level, and serve as a guide for further methodologic and conceptual development. PMID- 10120538 TI - The public and private sectors in health: economic issues. AB - Major changes in the public/private mix of health services are occurring in many countries. These changes may be analysed by examining the financing and provision of services and subsidization of the purchase of the factors of production. The public sector and not-for-profit and for-profit elements of the private sector must be viewed as separate entities in such analyses due to their differing objectives, motives and form of operation. The issues to be dealt with by countries in finding the public/private mix which is appropriate for their health system and achieves their objectives include efficiency, quality, regulation, equity and consumer choice and satisfaction. The recommendations for action for countries include: promoting collaboration between private and public sectors; testing different public/private mix models; identifying appropriate expansion paths for private sector services; improving information for policy and planning decisions; enhancing management capacity; and, reviewing programme and project support. International agencies also have a role in this process by supporting countries through the provision of technical assistance, financial aid, promoting policy reviews, and facilitating the sharing of information and experiences among countries concerning these public/private mix issues. PMID- 10120539 TI - Researching real answers for real-life problems: getting beyond research stereotypes. PMID- 10120540 TI - Comprehensive orientation: the road to retention. AB - This study evaluated the relationship between the type of orientation received by registered nurse employees in the hospital and the turnover behavior of these employees within the first 12 months of employment. The comprehensiveness of the orientation programs of six major metropolitan hospitals was evaluated using a structure evaluation tool. The records of registered nurses who attended the September 1988 orientation programs at these hospitals were examined to identify their employment status and pertinent demographic data one year from the date of participation in orientation. Data were analyzed to determine if an association existed between the comprehensiveness of orientation and employment status. The data revealed no significant difference between "stayers" and "leavers" after participation in orientation programs meeting greater than 80 percent of the criteria for program comprehensiveness. Significantly more "leavers" than "stayers" resulted from participation in programs meeting greater than 90 percent of the criteria for program comprehensiveness. PMID- 10120541 TI - Evaluation principles for health care training institutions: the basics. PMID- 10120542 TI - Questions concerning medical care provided in hospitals. PMID- 10120543 TI - The financial state of Japanese health care institutions. PMID- 10120544 TI - The present medical situation and problems of remote areas in Japan. PMID- 10120545 TI - Informed consent in the regional hospital of Japan--with a particular reference to consent forms. AB - A consent form is a part of medical record, from which one would know how much attention is paid to informed consent. A survey of the consent forms from the various hospitals in the regional area of Japan, Shizuoka prefecture, indicated that the satisfactory consent forms are prepared in the large leading hospitals. PMID- 10120546 TI - A study of evaluation methods for hospital medical care systems. AB - When we seek to evaluate hospital medical care services, we first collect data regarding the existing system in order to gather information and to develop a method of analysis that we can use for evaluation. We took the OPD system as an example, taking into account systematic OPD services based on queuing theory and computer simulation. As a result of the computer simulation model based on experimental conditions, we were able to offer recommendations for modifications of the present system that could improve patient service. The hospital manager can use this information to aid him in the decision making processes concerning the hospital. A study of the methods for the evaluation of hospital medical care services is important. It is necessary to develop a regional medical care information system as well as a hospital medical care information system. PMID- 10120547 TI - Background of hospital evaluation in Japan. PMID- 10120548 TI - The management of medical records. AB - An optical disk filing system is an efficient approach to storing medical records; however, this system has not yet been put to practical use because it is usually a "stand-alone" type indirectly connected to a hospital information system. We have developed a medical record management system with an optical disk filing system connected to the host computer in the hospital information system. We can retrieve and display the medical records through the CRT (Cathode Ray Tube) terminals of the hospital information system at every ward and outpatient clinic. The patient's clinical information can be sent to several areas in the hospital using the hospital information system. PMID- 10120549 TI - Development of a hospital management system to analyze nursing information using a microcomputer. AB - We have developed a hospital management system to analyze the large amount of the nursing information using a microcomputer system. In this system, we have combined the information from the patient database and the nursing database in order to evaluate the quality of medical care in the hospital. The utilization of a microcomputer is useful for filing and analyzing it and presenting the results in a variety of formats, including graphic representations. PMID- 10120550 TI - Desirable reviewal and problems to be solved for health care, toward the matured society. PMID- 10120551 TI - Anticancer movement in Ibaraki Prefecture (Ibaraki Formula). PMID- 10120552 TI - Management of breech presentation--present and the future. PMID- 10120553 TI - Breastfeeding in Japan: historical perspectives and current attitudes and practices. AB - 1. We took an extensive overview of the history of breastfeeding in Japan. Japanese people, especially farming villagers have lived with a mixed religious atmosphere including primitive religion, Shintoism and Buddhism during more than 1,000 years. In such circumstances, they had three kinds of traditional practices for inadequate breast milk production, that is, praying to God or Buddha, foods or medicines based on their experiences and wet nursing. 2. Farm villagers used to primarily feed their babies by their own breasts and some who couldn't supply adequate milk, compensated with their neighbor's milk until a century ago, because most villagers' wives had plenty of milk at that time. 3. The characteristics of farm villagers' customs were: A. irregular breastfeeding. B. a mother's keeping skinship with her baby all day. C. sleeping in the posture of KAWA's character. D. late weaning. E. EJIKO was popular nursing tool. 4. Instead of wet nursing, bottle feeding was initiated in Japan after 1867. As a result, many infants suffered from malnutrition. On the other hand, some breast-fed infants suffered from beriberi and lead encephalopathy. 5. Until 1974-75, when the recommendations of WHO and Japanese Government were announced, there had been a steady decline in breastfeeding throughout Japan. Thereafter, physicians supported breastfeeding and made efforts to diminish the disadvantages of breastfeeding in the medical field. 6. According to the report of the Japanese Government, difficulty to supply sufficient milk and obstacles against working were the most important complaints of breastfeeding mothers. I suggested strategies for solution of these complaints: A principles at puerperium in our maternity ward include effect of my low-calorie diet, and Japanese methods of massage for the breasts. B my proposals for working mothers who want to breastfeed. &. I have discussed some results of Japanese breastfeeding research. 8. Some results of our Breastfeeding Promotion Movement have been mentioned. PMID- 10120554 TI - Can doctors compete with their own hospital? PMID- 10120555 TI - How marketing has paid off for these practices. PMID- 10120556 TI - What's the recession done to your buying power? PMID- 10120557 TI - Edward L vs. the Medicare bureaucrats. PMID- 10120558 TI - What's needed to keep a lid on malpractice premiums. PMID- 10120559 TI - Medicine's generation gap grows wider. PMID- 10120560 TI - I switched fields at age 59. PMID- 10120561 TI - Are nasty surprises hiding in your malpractice policy? PMID- 10120562 TI - 10 morale boosters for off-shift staff. PMID- 10120563 TI - Implementing near-patient coagulation monitoring. PMID- 10120564 TI - The role of the laboratory in a patient-driven system. PMID- 10120565 TI - FHP to buy 2 firms to boost West Coast service. PMID- 10120566 TI - Indianapolis HMO dropping Maxicare pact. PMID- 10120567 TI - American Transitional to relocate. PMID- 10120568 TI - Humana to sell Tampa facility. PMID- 10120569 TI - Humana-New Orleans part of sale. PMID- 10120570 TI - Lawsuits threaten New York's hospital reimbursement system. PMID- 10120571 TI - Union challenges Minnesota reform plan. PMID- 10120573 TI - 20 DRGs account for 50% of outliers--study. PMID- 10120572 TI - Conservative Democrats' plan for reform gets some support. PMID- 10120574 TI - Docs' group backs global budgeting. PMID- 10120575 TI - IRS' attention to exec pay is misdirected. PMID- 10120577 TI - Healthcare a key issue--White House official. PMID- 10120576 TI - Psych hospitals make a day of it. AB - While partial hospitalization programs have existed for decades, they only recently have surged among the many psychiatric services offered. Patients typically spend the day in treatment sessions and other activities and then go home at night. With the inpatient psychiatric industry in a slump, both payers and providers are turning to this less-expensive alternative, with good results. PMID- 10120578 TI - HHS releases transplant-survival study. PMID- 10120579 TI - Bargaining unit rules having little effect on hospital union activity. AB - The number of hospital union elections rose only slightly between 1990 and 1991, suggesting that the National Labor Relations Board's new hospital bargaining unit rules haven't had much impact on hospital organizing efforts. NLRB data appear to contradict the dire predictions of many hospitals and labor attorneys who said expanded bargaining unit categories would lead to unbridled union organizing efforts. PMID- 10120580 TI - Patients buying Blues plan's 'one-stop shopping' concept. AB - Blue Cross of Western Pennsylvania said its efforts to give patients in suburban and rural settings primary medical care and health insurance assistance in "one stop shopping" clinics have exceeded expectations and may be expanded next year. The president of a Blue Cross subsidiary that's pioneering the project said, "We're ecstatic about how the concept is working." PMID- 10120581 TI - No hospital immune from business office thievery. AB - Hospital finance executives who think it's impossible for employees to steal cash from a well-run business office should think again. Internal auditors say that even with the most secure checks and balances, some hospitals still could fall victim to crafty employees who find ways to beat the system and draw cash or checks from the facility for their personal use. PMID- 10120583 TI - Fla. hospitals get donations to aid homeless employees. PMID- 10120582 TI - Iniki's casualties include 3 hospitals. PMID- 10120584 TI - Judge puts hold on new reclassification criteria. PMID- 10120585 TI - AMA's PAC no. 2 in getting donations. PMID- 10120586 TI - Both sides 'win' appeal of price-fixing convictions. PMID- 10120587 TI - NME faces suit; facility subject of probe. PMID- 10120588 TI - National Heritage board OKs sale. PMID- 10120589 TI - HCA to sell 22 psych hospitals, take $300 million 3rd qtr. charge. PMID- 10120590 TI - HFMA sells data bases to Ohio State prof. PMID- 10120591 TI - WelCare drops bid for National Heritage. PMID- 10120592 TI - Emergency intubation mistake 'rampant'. PMID- 10120593 TI - New packing, shipping rules may be shelved. PMID- 10120594 TI - Texas Back Institute moving its services to crosstown rival. PMID- 10120595 TI - NME's 20% skid in profit tied to psych losses. PMID- 10120596 TI - 2 healthcare systems in Northern California call off merger talks. PMID- 10120597 TI - Calif. practice to decide on Caremark bid. PMID- 10120598 TI - SunHealth mulls plan to form its own partner-owned excess liability insurance company. PMID- 10120599 TI - Columbia 'bet' yields tenfold return. PMID- 10120600 TI - Iowa hospitals settle ad restriction charges. PMID- 10120601 TI - Senate panel's report hits Md. Blues plan's finances, expenses. PMID- 10120602 TI - Groups: VA failing to address sexual harassment, assaults. PMID- 10120603 TI - Report links poor care to level of insurance. PMID- 10120604 TI - Group purchasing survey. Purchase groups buy goods worth over $15 billion. AB - Members of purchasing groups bought $15.4 billion in goods and services last year, according to the 62 respondents to Modern Healthcare's 1992 purchasing survey. Members of 37 groups that reported volume for both 1990 and 1991 bought $14.3 billion in goods and services, a 25% jump. Some of the biggest gains were reported by groups that focused on increased contract use rather than new members. PMID- 10120605 TI - HCFA rules border hospitals must take Mexican transfers. PMID- 10120606 TI - Unions praise TB guidelines. PMID- 10120607 TI - Healthcare systems' newest balancing act: 'Doing more with less.'. AB - Many hospital systems are caught in a bind. They know it's important to spend money to achieve the integration of their organizations, and those bills can be especially high in a system's start-up years. But they're also feeling the heat to reduce expenditures for overhead and system wide staff to help individual hospitals in the current difficult economic environment. PMID- 10120608 TI - Senate backs insurance reforms, but House unlikely to follow. PMID- 10120609 TI - Despite challenges, looking overseas offers opportunities to fill needed hospital slots. AB - A number of factors will cause more hospitals to consider hiring foreign nationals for difficult-to-fill positions. While there are many benefits to looking overseas, many executives are reluctant to take the step--the challenges of the hiring process are one of the main reasons they're giving. Debra Saber Salisbury gives some suggestions on the hiring approach. PMID- 10120610 TI - Fla. hospital running ads as settlement. PMID- 10120611 TI - Ore. hospital appeals dismissal of lawsuit. PMID- 10120612 TI - Monitor maker sues traders, alleging short-selling mischief. PMID- 10120613 TI - Execs plan to stay the course after election. AB - Executives at publicly traded hospital companies don't intend to scrap their long term growth strategies and switch to emergency plans if Bill Clinton wins the presidential election in November. That's the overwhelming response to a report by Salomon Brothers warning that the performance of hospital companies' stocks and bonds could suffer if the Democrat takes over at the White House next year. PMID- 10120614 TI - Health leaders among CEOs for Clinton. PMID- 10120615 TI - 1992 LTC (long term care) buyer's guide. PMID- 10120616 TI - Abusive "lifesaving"? Another look at CPR. PMID- 10120617 TI - Readers' responses ... medical noncompliance. AB - The Second Opinion staff invited a number of its readers who are physicians to respond to our recent Case Stories section on medical noncompliance, which included a case story by Kevin Coleman and commentary and overview by Arthur W. Frank (Second Opinion 17, no. 3 [January 1992]). Our thanks to those who shared their reflections, a number of which have been excerpted here. PMID- 10120618 TI - Transplants, justice, and health care reform. What can health insurers contribute? PMID- 10120619 TI - The case. Hoses and hope. PMID- 10120620 TI - Commentary. Listening for the healing story. PMID- 10120621 TI - Commentary. Stories that heal, wheel within a wheel. PMID- 10120622 TI - New tricks for video surveillance. PMID- 10120623 TI - Managing your company's claims. PMID- 10120624 TI - Systems delivery: evolving new strategies. AB - Leading-edge organizations are considering major investments in new systems development tools, methods, and techniques in order to improve their capability to deliver information systems more quickly, inexpensively, and effectively. From discussions with senior managers in twelve such companies, the authors have developed a framework for addressing many of the issues involved in these decisions. They argue that redesigning systems development is a major process change that is strategic in nature and that requires significant senior management involvement. Companies must understand their current capabilities and envision their needs in the future. PMID- 10120625 TI - Whose responsibility is IT (information technology) management? AB - Line managers are increasingly assuming responsibility for planning, building, and running information systems that affect their operations. This is forcing organizations to evaluate how they allocate IT decision-making responsibilities. This paper describes a conceptual framework and an intervention process that can help firms devise and implement an effective IT management architecture. The authors illustrate their methods with real world examples. PMID- 10120626 TI - Revitalizing executive information systems. AB - As the saying goes, "garbage in, garbage out"--and this is as true for executive information systems as for any other computer system. Crockett presents a methodology he has used with clients to help them develop more useful systems that produce higher quality information. The key is to develop performance measures based on critical success factors and stakeholder expectations and then to link them cross functionally to show how progress is being made on strategic goals. Feedback from the executive information system then informs strategy formulation, business plan development, and operational activities. PMID- 10120627 TI - Critical IT (information technology) issues: the next ten years. AB - In 1982, Robert Benjamin published a forecast of the state of information technology in the year 1990. He wrote that the information systems environment was in "a considerable state of flux" and information systems managers could benefit from a prediction of the "end-point scenario [in order to] focus major planning strategies." Ten years later, it's time to provide a new set of landmarks for another decade of flux. Benjamin and his coauthor, Jon Blunt, envision the information technology world of 2000. What can we expect? What should we not expect? And what can we not even begin to guess? PMID- 10120628 TI - The ethics and legality of HIV prevalence studies: a contrary view . PMID- 10120629 TI - CHIM'90 (Center for Healthcare Information Management): organizations working together toward common ends. Interview by Bill W. Childs. PMID- 10120630 TI - Voice memo gets thumbs up throughout Holy Cross Hospital. PMID- 10120631 TI - Systems implementation: planning to avoid the pitfalls. PMID- 10120633 TI - A hospital information systems fable. PMID- 10120632 TI - Community support and innovation keep Lancaster Memorial Hospital healthy. PMID- 10120634 TI - Hanging up the knife. A novel surgical technique promises to save patients time, money and blood. PMID- 10120635 TI - Survey results: consultant ratings. AB - Information systems consulting in healthcare is big business today. We have not attempted to determine from our results just how much is being spent on an annual basis, but the figure would probably be in the hundreds of millions. One observation made by a CIO that I thought summarized the findings very well was, "This business becomes more complicated every day and the risks become greater due in part to the shrinking dollars available for all healthcare needs. When I lock our hospital in for perhaps 10 to 12 years with a new information system, I'm going to get all the professional help I can get to make sure I don't make a mistake." Unfortunately this doesn't always save the day but if both the hospital management and the consultant do their homework it can be money well spent. PMID- 10120636 TI - Intraoperative computers: an idea whose time has come! AB - Enterprise Systems' James Alland and Patricia Gallagher discuss the reasons few operating rooms are automated and explain the benefits of intraoperative automation. PMID- 10120637 TI - The birthing of a vision. PMID- 10120638 TI - 1990 laboratory systems review. PMID- 10120639 TI - Trends in laboratory information systems: 1980-1990. AB - Laboratory information systems are charged with the responsibilities of controlling costs, improving productivity, improving reporting and expanding management control over operations. The LIS that can meet these challenges must allow significant flexibility, interfacing and integration with other systems, efficient operations and enhanced information management. In the current environment of "do more with less," a well-designed, cost-effective laboratory information system is essential to the economic survival of today's laboratory. PMID- 10120640 TI - The new lab--using integrated information systems to deliver much more than test results. PMID- 10120641 TI - Artificial intelligence in healthcare management. AB - Computers have manipulated data to increase the efficiency of their users. AI represents the next evolutionary step. PMID- 10120642 TI - Materials management at a community hospital: a success story. AB - Author Loran Walker tells a success story about Southside Hospital in Suffolk County, NY. Under the direction of Matthew Zagami, the hospital implemented a computerized materials management program that cuts costs. PMID- 10120643 TI - The basic need for hospital cost accounting expands. AB - Due to the nature of the health delivery process, hospitals can neither control nor accurately predict the daily volume of the patients it will serve. Jim Ryan, marketing manager for CPSI discusses megatrends affecting cost reporting needs and the difficulties involved in hospital cost accounting. PMID- 10120644 TI - Tisch Hospital/NYU Medical Center: world class medical services embrace the forefront of technology in radiology. AB - Tisch Hospital/NYU Medical Center implemented a radiology information system to cope with a 92 percent bed occupancy rate. PMID- 10120645 TI - Applying manufacturing techniques to hospital A/R management. PMID- 10120646 TI - Iliad: diagnostic tools for general medicine. Interview by Bill W. Childs. PMID- 10120647 TI - Installation of a materials management system. AB - Installation in five months using existing staff--that's what it took Waukesha Memorial Hospital (WMH) to go from the first installation planning meeting to a fully operational system. This article explains the process WMH followed to install the HBO Materials Management system in five months using in-house staff. PMID- 10120648 TI - The advantages and disadvantages of leasing as an alternative financing method. AB - The pros and cons of leasing as an alternative financing method are the topic of this article by Alan N. Frankel. A lease must meet certain criteria to qualify as a "true" lease and provide tax advantages. PMID- 10120649 TI - History of California health system. The first great battle over health finance reform. PMID- 10120650 TI - Disability insurance: merging group and individual policies. AB - This case study explains how the Mecklenburg Medical group, after discovering a gap in the disability insurance for its physicians, followed through by negotiating a new plan which also covered non-physician employees. PMID- 10120651 TI - Practicing medicine with a computer. PMID- 10120652 TI - HL7 (Health Level 7)--the future becomes a reality. PMID- 10120653 TI - The contract process: a methodology for negotiation. Part I. AB - This is the first of a three-part series on the contract process for acquiring a hospital information system product. Part One addresses negotiation methodology; points which will facilitate effective negotiation. Part Two will cover contract contents focusing on those topics which must be included in a good contract. Part Three will discuss contract philosophy and contract management; subjects which are critical to the good rapport buyers and vendors want. The adversarial approach to the contract process is not the best approach. Rather, the process should be treated as a step in the building of a partnership and relationship in which both parties win. PMID- 10120654 TI - Bedside terminals: a look into the future. PMID- 10120655 TI - Healthcare informatics. PMID- 10120656 TI - Pharmacy systems review. PMID- 10120657 TI - The key to supporting comprehensive healthcare, research and planning. PMID- 10120659 TI - Increased productivity: the compelling reason to install electronic claims. PMID- 10120658 TI - MSA puts executive information systems in perspective. PMID- 10120661 TI - The RFP: help or hindrance? PMID- 10120660 TI - Connectivity: a new alternative. PMID- 10120662 TI - HAP (Hospital Accreditation Program) scoring guidelines: decentralized laboratory testing standards. PMID- 10120663 TI - HAP (Hospital Accreditation Program) scoring guidelines: surgical and anesthesia services standards. PMID- 10120664 TI - HAP (Hospital Accreditation Program) scoring guidelines: monitoring and evaluation standards. PMID- 10120665 TI - HAP (Hospital Accreditation Program) scoring guidelines: infection control standards. PMID- 10120666 TI - Board recommends obstetrics and anesthesia indicators for hospital consideration. PMID- 10120667 TI - Rehabilitating workers' comp using cost containment. PMID- 10120668 TI - When does managing medical costs pay off? PMID- 10120669 TI - Audit software eliminates unnecessary charges. PMID- 10120670 TI - Injured system. AB - Workers' compensation laws, designed to protect workers who incur job-related injuries and illnesses, are provoking outcries because of the rising costs of medical care. PMID- 10120671 TI - The 'Plant, technology, and safety management' chapter from the 1991 Consolidated Standards Manual. PMID- 10120672 TI - Joint Commission enhances efforts to gain field input via CEO survey. PMID- 10120673 TI - Bringing an infection control program into compliance in six months. PMID- 10120674 TI - Twelve-month performance--ten elements with highest contingency rates. PMID- 10120675 TI - CQI (continuous quality improvement)--a step beyond QA. PMID- 10120676 TI - Orientation begins for test site hospitals. PMID- 10120677 TI - Medication Use Task Force refines components, processes. PMID- 10120678 TI - Hospitalwide task force disbands. PMID- 10120679 TI - Managed-care operations adding indemnity plans. PMID- 10120680 TI - When disaster strikes. PMID- 10120681 TI - An analysis of invalidity benefit claim durations for new male claimants in 1977/1978 and 1982/1983. AB - This study analyses the duration of Invalidity Benefit (IVB) claims commencing in 1977/1978 and 1982/1983 using a hazard rate model. The analysis was carried out against a background of a substantial increase in the numbers claiming IVB. The main data base comprises a 1% random sample of all National Insurance records for the period 1975-1984, provided by the DHSS. Estimates are made of factors that influence claim durations. The results suggest that while age and health conditions are important, claim durations are also influenced by more narrowly defined economic considerations. PMID- 10120682 TI - New worlds of access--but at what price? PMID- 10120683 TI - Strategic information architecture. PMID- 10120684 TI - The clinical information systems contract process--mandatory contract contents: Part II. AB - This is the second of a three-part series on the contract process for acquiring clinical information systems. Part One addressed points which facilitate effective negotiation. Part Two identifies topics which must be included in a good contract. Part Three will discuss contract philosophy and contract management. PMID- 10120685 TI - EMERGISOFT takes the heat off in the ER. PMID- 10120686 TI - Computers to cut costs in cardiovascular surgery. PMID- 10120687 TI - Honey, I shrunk the HIS. PMID- 10120688 TI - The paperless hospital: taking the next, safe step. PMID- 10120689 TI - 1990 radiology systems. PMID- 10120690 TI - HL7--a cure or a bandage? PMID- 10120692 TI - Point-of-care systems--ICU basic system building blocks. PMID- 10120691 TI - A new paradigm for healthcare. PMID- 10120694 TI - Kaiser Permanente's success story. Interview by Bill W. Childs. PMID- 10120693 TI - Consultants who make a tremendous impact on the healthcare industry. Interview by Bill W. Childs. PMID- 10120695 TI - Getting physicians online. PMID- 10120696 TI - Guidelines for implementing HL7. AB - There is no magic HL7 software that connects and transfers data between hospital systems. Successful implementation of an HL7 interface depends not only on the software, but, more importantly, it demands close communication between the System Integrator and the vendors, and careful management of the interface process. PMID- 10120697 TI - Overview of the CIO position. PMID- 10120698 TI - Implementation planning: should the process be expanded? PMID- 10120699 TI - TDDs (telecommunication devices for the deaf) and emergency access. PMID- 10120700 TI - Citation Computer Systems. AB - Many people think of Citation Computer Systems, (a network-based laboratory information system company located in St. Louis, MO), as a small mid-western company, with a small number of small customers. Nothing could be further from the truth. Citation has more than 500 users in 48 states and Canada. Its user base includes hospitals in bed ranges from 16 to more than 1,000 as well as a high number of reference laboratories and clinics. Citation has been growing at double digit percentages--and they are profitable. To find out the reasons for such success, Art Randall visited four of Citation's customers to interview those responsible for laboratory management. PMID- 10120701 TI - Automated random access lab testing system speeds discrete tests and ensures accuracy. PMID- 10120702 TI - Professional use of information systems. PMID- 10120703 TI - PACE/CPC (Patient Care Expert Systems/Clinical Protocol Consultant): nursing care planning and decision support for the 1990s. PMID- 10120704 TI - The world of IBM and healthcare. PMID- 10120705 TI - OSCAR (our system cares about recovery): an intuitive system for Tallahassee Memorial Regional Medical Center. PMID- 10120707 TI - Short interval scheduling to catch the eyes of nursing innovators in the '90s. PMID- 10120706 TI - New intensified education in healthcare information technology. Interview by Bill W. Childs. PMID- 10120708 TI - HL7: a practical perspective. Part I. PMID- 10120709 TI - Meta Health Technology is meeting the challenges of the future. Interview by Karol Marlowe. PMID- 10120710 TI - The hand-held computer: no longer a toy. PMID- 10120711 TI - Managing chronic pain cases. PMID- 10120713 TI - 'Nursing care' scoring guidelines (intents and score 1s) for the 1991 Accreditation Manual for Hospitals (AMH). PMID- 10120712 TI - The 'Plant, Technology, and Safety Management' chapter from the 1991 Consolidated Standards Manual (CSM). PMID- 10120714 TI - Preparation for a Joint Commission visit: the time to start is now. PMID- 10120715 TI - Recidivism in the management of medical back pain. AB - One Ohio hospital underwent three years of 100% focused review of admissions for medical back problems (DRG 243) due to excessive numbers of admissions previously noted. On cessation of the focused review, the volume of admissions rose at this hospital, and the admission denial rate increased. Reinstitution of focused review appeared to decrease the number of admissions, but did not affect the rate of admission denials. PMID- 10120716 TI - Data watch. Workers' compensation costs. PMID- 10120718 TI - Decision grid helps hospitals identify areas needing improvement. PMID- 10120717 TI - Risk management survey helps set department priorities. PMID- 10120719 TI - Cost shifting: the final straw in federalization of health care. AB - While cost controls applied by Medicare and indemnity insurance programs initially helped curtail abusive medical billing practices, creative billing techniques have since resulted in runaway medical costs and rising insurance premiums. Employers have been forced to increase employee's contributions to health care by increasing deductibles, copayments, and coinsurance or by simply dropping health care benefits. If National Health Insurance comes to pass, and that is a cry now coming from major employers, it will be followed in time by federalization of all health care delivery systems, including Workers' Compensation. It is the providers who shift their fees into Workers' Compensation, which pays from the first dollar, who will cause the business community to petition Washington for relief. It will claim the need for cost controls in Workers' Compensation to keep American business competitive in world markets. PMID- 10120720 TI - Making a winner of workers' comp. PMID- 10120721 TI - Pathlab III makes a comeback. AB - In the last couple of weeks, two distinctly different documents crossed my desk. The first was a 1989 industry trends report from Ron Johnson. The second was a Laboratory Systems Market report from Sheldon I. Dorenfest & Associates. As I reviewed both documents, the first thing I noticed was the major difference in the systems sales and client lists between the two reports. As an example, Dorenfest had recorded 95 total 3M clients and Johnson's report showed 144. All other companies were also very different. I suppose one discrepancy comes about by Dorenfest asking hospital users whom they have as vendors, while Johnson asks the vendors who their clients are. All this aside, while reading the Dorenfest report, I finally wandered down to the reports on the laboratory vendors and read with awe the one-liner on 3M's Pathlab III system, "No longer a force." A sensational statement, I thought. After reading these reports I decided to call a few experts in the lab field that I thought might give me a better picture of where 3M was in the lab business. To these calls I also added some conversations I have had with some 3M management. PMID- 10120722 TI - Hospitals, IS vendors can learn a valuable lesson from Korean businessmen. PMID- 10120723 TI - IMIA (International Medical Informatics Association): demystifying powerful technologies. Interview by Bill W. Childs. PMID- 10120724 TI - Installing order entry using a loaned staff concept. PMID- 10120725 TI - The Compucare Company enters the 1990s. Interview by Bill W. Childs. PMID- 10120726 TI - How to get your money's worth from information technology. PMID- 10120727 TI - Executive information systems in healthcare organizations. PMID- 10120728 TI - The dynamic German healthcare marketplace. PMID- 10120729 TI - HL7: here and now. Part II. PMID- 10120730 TI - The clinical information system contract process--contract philosophy and management: Part III. AB - The first two installments in this series dealt with contract negotiation methodology and contract contents. This final segment deals with subjects that all too often overlooked, but which are just as important as the first two. They are important because the attitude with which parties enter contractual arrangements largely determines the parties' future relationship and the management of contracts large determines whether the contract is successful. PMID- 10120731 TI - Temporary nursing service agencies: double jeopardy--who is at risk? AB - The nature of temporary nursing service agencies and the employer-employee relationship with its implications for job performance, Workers' Compensation liability, and unemployment benefits risks have been discussed here. Also explored were the issues surrounding the controversies involved in temporary nurses' provision of care. There are moral, ethical, and legal issues surrounding temporary nurses and the agencies providing them that have an impact on patients, practitioners, and administrators of institutions using them. While no clear-cut answers have been put forth, increased awareness of the ramifications of the use of temporary agency nurses brings caution to all concerned. PMID- 10120732 TI - When people have a vision. AB - Candler General Hospital President John T. Carpenter has a vision for the future. This vision, developed more than 20 years ago at Grady Memorial Hospital, is to place valuable information in the hands of practicing physicians and care giving nurses. He believes that with the hospital's new Ulticare system from HDS, he may be just a year away from achieving his dream. PMID- 10120733 TI - Planning computer technology to streamline patient care work. PMID- 10120734 TI - Software validation and FDA inspections. PMID- 10120735 TI - HIS choices for small rural hospitals: a fresh approach to an old concept. PMID- 10120736 TI - Workstation technology: a new generation. PMID- 10120737 TI - Strategic planning for information services at multi-facility health systems. AB - Without benefit of an up-to-date, in-depth appraisal of any specific multi facility's organization, the healthcare facility's mission statement and philosophy, and a detailed understanding of the current situation within each of the IS divisions and/or Data Processing departments, it is merely possible to generically assess the needs in light of today's readily available technology, and to subjectively and logically apply ones past experience to determine a preferred approach. Therefore, this overview of strategic planning considerations ought to be used with caution. A workable plan requires extensive on-going effort, and comes alive only when it is adopted by management. In the event that no previous information services planning activity has occurred within the organization, or where a prior strategic plan is more than three years old, prudent advice would include a strong recommendation to begin such a process without delay. PMID- 10120738 TI - Preparing your organization for technological change. AB - It is not always easy to know exactly why a particular group resists change. However, experience shows that an intelligent application of this basic five-step change process--coupled with a sound technological implementation plan--leads to more rapid and more productive introductions of technology into organizations. The process can be expensive in terms of time and energy but nowhere near the cost of an expensive technical system that never gains user acceptance. PMID- 10120739 TI - Healthcare provides many opportunities for card technologies. AB - Smart cards and optical memory cards are among the fastest growing technologies today. Though their use in healthcare is not yet widespread, they promise great potential benefits in several areas of healthcare delivery. Both cards are credit card-sized plastic devices that can store information. Embedded in smart cards are one or more computer chips which store and process information, and some cards provide as much computer power as a PC. Optical memory cards use laser technology to store and read information. PMID- 10120740 TI - Revolution by evolution. AB - The vision of an electronic healthcare record is achievable and pieces of the requisite technology are in place. More importantly, with their investments in networks and departmental and enterprise-wide systems, many hospitals have implemented data gathering, storage and analysis capabilities that position pieces of their electronic record of the future. PMID- 10120741 TI - Building a model for the development of better healthcare systems. PMID- 10120742 TI - Appendix B-2: survey eligibility criteria and selected AMH standards for tailored surveys of CMHCs. Joint Commission on Accreditation of Healthcare Organizations. PMID- 10120743 TI - Corrections to the 1991 Accreditation Manual for Hospitals (AMH). Joint Commission on Accreditation of Healthcare Organizations. PMID- 10120744 TI - Hospital-based home care department targets four areas for improvement. PMID- 10120745 TI - Surveys-at-a-glance. National performance data--medical staff elements. PMID- 10120746 TI - Organ procurement requirements clarified. PMID- 10120747 TI - CLIA-88--regulatory overkill. PMID- 10120748 TI - Survey fees to track inflation in 1991. PMID- 10120749 TI - Six steps for calculating the grid score. PMID- 10120750 TI - Patient demands pushing surgeons to learn technique. PMID- 10120751 TI - Reimbursement for lap cholies is catching up. PMID- 10120752 TI - Occupational acquired HIV infection and workers' compensation. PMID- 10120753 TI - The "new breed" of HMIS vendors, products, services and capabilities. PMID- 10120754 TI - Baxter and MICRO Healthsystems form a strategic alliance to promote time-saving technology. Interview by Bill W. Childs. PMID- 10120755 TI - A practical approach to hospital cost accounting. PMID- 10120756 TI - Cerner's primary mission in healthcare: to treat patients. Interview by Bill W. Childs. PMID- 10120757 TI - Patient lifting can be eliminated. PMID- 10120758 TI - Observation beds scoring guidelines (intents and score 1s) for the 1991 AMH ("Hospital-Sponsored Ambulatory Care Services" chapter) PMID- 10120759 TI - Observation beds scoring guidelines (intents and score 1s) for the 1991 AMH ("Emergency Services" chapter) PMID- 10120760 TI - Restraint & seclusion scoring guidelines (intents and score 1s) for the 1991 AMH ("Management and Administrative Services" chapter). PMID- 10120761 TI - Restraint & seclusion scoring guidelines (intents and score 1s) for the 1991 AMH ("Medical Staff" chapter). PMID- 10120762 TI - Cytology scoring guidelines (score 1s) for the 1991 AMH ("Pathology and Medical Laboratory Services" chapter). PMID- 10120763 TI - Provision for assistance in communication scoring guidelines (intents and score 1s) for the 1991 AMH ("Management and Administrative Services" chapter). PMID- 10120764 TI - "Forensic Services" chapter scoring guidelines (intents and score 1s) for the 1991 CSM. PMID- 10120765 TI - Continuity of care scoring guidelines (intents and score 1s) for the 1991 CSM ("Professional Services" chapter). PMID- 10120766 TI - Continuity of care scoring guidelines (intents and score 1s) for the 1991 CSM ("Patient Management" chapter). PMID- 10120767 TI - "Infection Control" chapter scoring guidelines (score 1s) for the 1991 CSM. PMID- 10120769 TI - Hospital/physician interface capabilities in the medical community. PMID- 10120768 TI - Ambulatory care survey--surprising and revealing. PMID- 10120770 TI - The focus of the 1990s. PMID- 10120771 TI - A decade of service ... a vision fulfilled. Interview by Bill W. Childs. PMID- 10120772 TI - Best kept secrets ... Infostat, Inc. AB - The Infostat HICS appears to be a viable option for small- to medium-size hospitals (up to 400 beds). An open systems approach takes advantage of RISC computer architecture, UNIX operating system environment, fourth generation languages and industry-standard protocols. A comprehensive application set is provided in an integrated database environment. Price/performance appears to be very competitive. The commitment to TQM fits right in with current healthcare industry emphasis and should be a critical success factor in Infostat's future in the HMIS marketplace. The acquisition of Infostat by CHC will place much stronger emphasis on patient care and clinical systems to reinforce the already strong presence in the financial systems. The combined expertise and broad product offerings should make this team a strong contender in selected marketing environments. PMID- 10120773 TI - The future of optical storage technology in healthcare--Geneva or Venice? PMID- 10120774 TI - A special wing for a special population. New Jersey facility accommodates Huntington's victims. PMID- 10120775 TI - Plans target workers comp. PMID- 10120776 TI - Laparoscopic laser cholecystectomy. PMID- 10120777 TI - What times are these. PMID- 10120778 TI - A report from the experts. Interview by Bill W. Childs. PMID- 10120780 TI - EDI (electronic data interchange) revolutionizes the healthcare marketplace. PMID- 10120781 TI - Computers in transplant surgery. PMID- 10120779 TI - Best kept secrets ... First Coast Systems, Inc. (FCS). AB - The FCS/APaCS system is a viable option for small-to medium-size hospitals (up to 400 beds). The table-driven system takes full advantage of IBM AS/400 computer architecture. A comprehensive application set, provided in an integrated database environment, is adaptable to multi-facility environments. Price/performance appears to be competitive. Commitment to IBM AS/400 environment assures cost effective hardware platforms backed by IBM support and resources. As an IBM Health Industry Business Partner, FCS (and its clients) benefits from IBM's well known commitment to quality and service. Corporate emphasis on user involvement and satisfaction, along with a commitment to quality and service for the APaCS systems, assures clients of "leading edge" capabilities in this evolutionary healthcare delivery environment. FCS/APaCS will be a strong contender in selected marketing environments. PMID- 10120782 TI - Micro systems: the ultimate in downsizing. Interview by Bill W. Childs. PMID- 10120783 TI - The mission of Medicus: the informed executive. Interview by Karol Marlowe. PMID- 10120784 TI - Rose Medical Center and INVISION. AB - The management at Rose Medical Center envisions a future where both physicians and nurses are actively involved together in the use of their information system; a system which eventually should provide a "paperless" chart. PMID- 10120785 TI - The introduction of bar coding technology at Kaiser Permanente. PMID- 10120786 TI - 1991 laboratory systems review. AB - Healthcare Informatics Clinical Systems Editor Dennis Winsten and Managing Editor Karol Marlowe conducted an annual survey of laboratory systems to find out what solutions are being offered. Also, a wrap-up of trends in the laboratory information systems marketplace. PMID- 10120787 TI - Best kept secrets ... Source Data Systems, Inc. (SDS). AB - The SDS/MEDNET system is a cost-effective option for small- to medium-size hospitals (up to 400 beds). The parameter-driven system lets users control operations with only occasional SDS assistance. A full application set, available for modular selection to reduce upfront costs while facilitating steady growth and protecting client investment, is adaptable to multi-facility environments. The industry-standard, Intel-based multi-user processors, network communications and protocols assure high efficiency, low-cost solutions independent of any one hardware vendor. Sustained growth in both client base and product offerings point to a high level of responsiveness and healthcare industry commitment. Corporate emphasis on user involvement and open systems integration assures clients of leading-edge capabilities. SDS/MEDNET will be a strong contender in selected marketing environments. PMID- 10120789 TI - System Analysis Corp. is the up-front company without the up-front costs. PMID- 10120788 TI - Enterprise Systems; ten years and a zest for HL7. Interview by Bill W. Childs. PMID- 10120790 TI - Hospital laboratory automation grows substantially in the decade of the 1980s. What will happen in the '90s? PMID- 10120791 TI - 1990 cost of risk survey: a yardstick for managers. PMID- 10120792 TI - Bedside systems. Making their contributions in hospitals across the country. PMID- 10120793 TI - Montgomery Ryland welcomes IHS to the National Healthtech family. Interview by Bill W. Childs. PMID- 10120794 TI - Best kept secrets ... Healthcare Affiliated Services, Inc. PMID- 10120795 TI - 1991 pharmacy systems review. PMID- 10120796 TI - Healthcare information systems: issues & answers. AB - In our April 1991 issue of Healthcare Informatics, I visited with several well known consultants in our business about information systems trends and changes. Part way through this process, I was reminded of the several lesser-known healthcare systems consultants that are independent, and yet fulfill very important roles in their services to the healthcare community. Most of these consultants place ads in the classified section of our magazine and support Healthcare Informatics month after month. I have met many of them at HIMSS, ECHO, HFMA and other meetings around the country. They often have valuable insights to our marketplace. With these things in mind, I set about to ask them some important questions. The following answers are from this bright group of industry experts. Read what they have to say on the issues, and if you ever need their expertise, give them a call. PMID- 10120797 TI - The industrial orthopedic rehabilitation market: a niche opportunity. AB - The industrial orthopedic rehabilitation market is an opportunity for hospitals of all sizes to provide a needed service with significant revenue potential. For a 250-bed community hospital, an industrial orthopedic rehabilitation program can generate $3.5 to $4 million in revenue. Based on the authors' experience, contribution margins from the programs, if designed properly, can range from 30% to 40%. A well-designed industrial orthopedic rehabilitation program adds to a strong orthopedics product line by providing continuity of care and the "extras" that make a program successful. For a hospital that is developing an orthopedics product line and trying to build a presence in the marketplace, an industrial orthopedic rehabilitation program can introduce your services to local employers, opening the door for their use of other "high tech" orthopedic services that you provide. Industrial rehabilitation is synonymous with what is often referred to in health care as the outpatient "workers' compensation" or "injured workers"' market. Essentially, this market consists of employees whose on-the-job injuries or job-related chronic conditions require medical care. These injuries may or may not involve lost workdays during which injured employees are unable to perform job functions. Since the orthopedic segment of the industrial rehabilitation market represents the bulk of the injuries and costs, developing the services and programs that can produce return to work (or case settled) outcomes for these workers represents a sound opportunity for health care providers. However, since workers' compensation insurance is liability (not health care) insurance, understanding the rules and regulations specific to this insurance segment in your state, along with the needs of all the key players in the system, is the key to developing programmatic elements critical to long-term success. PMID- 10120798 TI - Data watch. Watching workers' comp costs. PMID- 10120799 TI - Avoiding injury in the workplace. National Safety Council. AB - This article considers the dangers posed to workers by their work environment- from hazardous substances to poor workplace design--and gives commonsense management solutions for worker safety. PMID- 10120800 TI - Revisions for the 1991 AMHC: Scoring guidelines (intents and score 1s) and confidentiality and disclosure policy. Joint Commission on Accreditation of Healthcare Organizations. PMID- 10120801 TI - Hospitals use M&E (monitoring and evaluation) to improve quality. PMID- 10120802 TI - Research project on community health care delivery systems develops principles. PMID- 10120803 TI - Agenda for Change initiatives: setting the record straight. PMID- 10120804 TI - Surveyors challenge staff to continuously improve. PMID- 10120805 TI - Home Infusion Therapy Task Force holds first meeting. 21 key processes targeted for indicator development. PMID- 10120806 TI - Medication use and infection control indicators enter alpha testing phase. PMID- 10120807 TI - Workers' comp derailment: expectations not met. AB - Two years ago RIMS formed the Risk Management Roundtable to identify trends and issues affecting the field and to develop mechanisms to broadly disseminate views and concerns. In March 1990 Risk Management published the Roundtable's first article, "The 1990s: The Decade of Risk Management," developed by its "new risk team." Focusing on how the risk management function is performed and how it is perceived, particularly by senior management, the article generated ample discussion. In this issue the Roundtable's workers' compensation team explains how the system's original intent has been eroded. The team also offers advice on how various players, including workers, employers, doctors, lawyers, insurers, regulators and legislators, can help cure the system.(ABSTRACT TRUNCATED AT 250 WORDS) PMID- 10120808 TI - Avoiding workers' comp claims meltdown. PMID- 10120809 TI - Techniques to solve the workers' comp puzzle. PMID- 10120810 TI - Wellmark attacks the healthcare information problem at its source. Interview by Bill W. Childs. PMID- 10120811 TI - The changing concept of computerized patient records. PMID- 10120812 TI - Innovation and ingenuity challenge the status quo. PMID- 10120813 TI - Bell Atlantic is moving from maverick to major player. Interview by Bill W. Childs. PMID- 10120814 TI - A busy year for PHAMIS. Interview by Bill W. Childs. PMID- 10120815 TI - Mainframe system expands HCA Wesley information resources. PMID- 10120816 TI - Best kept secrets ... Dairyland Computer & Consulting Company. PMID- 10120817 TI - Hospital-wide network increases information access. PMID- 10120818 TI - The CIO in higher education and healthcare. PMID- 10120819 TI - Special report. Integrating managed care. Continuity of care: integrating the components. AB - Although illnesses may attack specific parts of the body, treating anything less than the whole man can lead to serious problems. Catastrophic illnesses, for example, are often accompanied by depression. Employees being treated for alcohol or substance abuse may also be suffering from psychiatric disorders. Irrespective of which came first, the alcoholism or the depression, the conditions are intertwined. And their treatments need to complement one another. As companies contract with increasing numbers of specialty providers in an attempt to manage health care costs and utilization, communication among vendors can break down. Treatments may be repeated. Therapies can contradict one another. Employees sometimes fall through the cracks. What's needed is care that is comprehensive and continuous. The following series of stories examines the positive changes that may accrue when managed care techniques are applied in a synoptic fashion. PMID- 10120820 TI - Infected on the job? Don't get stuck twice. PMID- 10120821 TI - Success factors in the design & development of a decision support system. PMID- 10120822 TI - Executive information systems--serving a new generation of healthcare executives. PMID- 10120823 TI - Diagnostic quality teleradiology--elusive myth or reality? PMID- 10120824 TI - News travels fast at the Medical Center of Delaware. PMID- 10120825 TI - Using knowledge base systems in healthcare. PMID- 10120826 TI - A prescription for healthcare cost containment. PMID- 10120827 TI - An academic department of health informatics: a vision for the 21st century. AB - The purpose of this article is to share the vision of an academic health science center in creating a centralized academic and service Department of Health Informatics. To do this, we will present background on the institution, a brief discussion of informatics (including medical and health informatics), and then look in-depth at the Department of Health Informatics, including its mission, goals, organizational structure and operations. PMID- 10120828 TI - Balloons, lasers and scrapers. Help for hearts and blood vessels. AB - To help unclog heart and leg arteries, doctors can choose from a growing array of tools. The now common heart bypass surgery and balloon angioplasty are being joined by high-tech motorized devices and lasers. PMID- 10120829 TI - Lloyd Aubry to focus on workers' compensation. Interview by Thomas R. Luevano. PMID- 10120830 TI - Developing a workers' compensation cost-control program. PMID- 10120831 TI - Armour Foods thin slices workers' comp costs. AB - Armour found its workers' compensation costs to be disproportionately high. In response, it set up a "Focal Physician" program, which dealt successfully with the problem. PMID- 10120832 TI - It's our job to help stop insurance fraud. PMID- 10120833 TI - A risk manager's guide to workers' comp providers. PMID- 10120834 TI - Improving workers' comp. PMID- 10120835 TI - Using communication boards in the field. PMID- 10120836 TI - How can information technology address the problems facing healthcare in the 1990s? Healthcare Informatics' new editorial review board speaks out. PMID- 10120837 TI - Systems integration and knowledge coupling. An aggressive, post-acquisition direction--Knowledge Data Systems (KDS). Interview by Bill W. Childs. PMID- 10120838 TI - New listing service advances HL7 standards. PMID- 10120839 TI - The electronic medical record: catalyst for change. PMID- 10120840 TI - Healthcare computing trends. AB - The following are excerpted results of the 1991 survey commissioned by Hewlett Packard's Medical Products Group, in concert with the Healthcare Information Management and Systems Society at the annual HIMSS conference. The survey was prepared by J.C. Pollock Associates, an opinion research firm, in conjunction with HIMSS. More than 400 HIMSS members responded to the following key issues facing healthcare information management professionals. PMID- 10120841 TI - Can 4GL revolutionize your lab? PMID- 10120842 TI - Ten technologies that promise efficiency in the clinical lab. AB - As the decade of the '90s begins, laboratory information system (LIS) suppliers are aggressively pursuing the use of new technologies to enhance the performance, accessibility, convenience and portability of their laboratory information systems. The past year has shown some exciting progress in new developments in laboratory information systems. This article will provide a brief summary of each of these innovations in laboratory information systems. PMID- 10120843 TI - The forgotten children in hospital automation: anatomic pathology labs & blood banks. AB - New Hanover Memorial Hospital is a large hospital in southeastern North Carolina at the forefront of addressing a dilemma that all busy hospitals face: when and how to automate their anatomic pathology (AP) labs and blood banks. PMID- 10120844 TI - Anatomy of a laboratory systems selection. AB - At HealthTrust we believe that if it is a good idea today, it probably was a good idea yesterday, and therefore should be professionally and appropriately implemented as soon as possible. And that's how we approached the survey of our hospital's needs, the investigation of 50 vendors in the laboratory system industry and a vendor selection in 90 days. PMID- 10120845 TI - Systems review. The competitive edge for labs under pressure--General Laboratory Systems, Antrim Corporation. PMID- 10120846 TI - "Always remain conscious in a hospital; it's the safest bet for survival...". PMID- 10120847 TI - New surgical procedure spurs laparoscope purchases. PMID- 10120848 TI - Know your volunteers. Healthcare facilities should review laws regarding employee status. AB - For the most part, healthcare providers and volunteers have no legally enforceable obligations to one another. However, problems can arise for providers when they incorrectly categorize certain individuals, treating them as volunteers when for legal purposes they should be considered employees. The status of individuals who have never been employees and who perform volunteer services is usually not an issue, but questions can arise when an organization provides someone with an economic benefit other than cash in return for services. The U.S. Supreme Court has ruled that when individuals expect economic benefits (e.g., food, shelter, clothing, transportation, medical care), they may be legally in an employment relationship with the organization that provides them. Moreover, the question of whether work donated can be considered volunteer service arises most often when employees give time during off hours. The U.S. Department of Labor has ruled that individuals cannot be considered volunteers when performing their regular work in the same work week in which they were considered employees. Healthcare providers can also be held responsible for sexually or racially discriminatory behavior on volunteers' part. Finally, employers should take care that their use of volunteers does not give rise to a charge of an unfair labor practice. PMID- 10120849 TI - Selecting an HIS direction for the future. AB - Hoag Memorial Hospital Presbyterian, Newport Beach, CA, and The United Hospital, Grand Forks, ND, expand their data integration, access and functionality with a new hospital information system. PMID- 10120850 TI - Designing a hospital data network for the 21st century. AB - There are many factors to consider when designing a data communications network for the medical center of the 21st century. User requirements are changing and expanding. New technologies for data handling are emerging. The most important factor is that you acquire the available expertise and develop a real-world plan for future data networks. This plan must serve as a guide to implementation of the network strategy. In this way, the hospital can be assured that its capital is being invested wisely. PMID- 10120851 TI - Bedside systems offer positive incentives. AB - Art Randall visited John F. Kennedy Medical Center in Edison, NJ, to see how well the staff is adapting to its new bedside systems. The consensus was that these systems provide patients with a high level of quality personal care, enhance the nurse's capability to provide such care, and increase community image. PMID- 10120852 TI - Remote computing gives hospitals new information systems options. AB - Grace Hospital in Morgantown, NC, replaced its information system with a remote computing system. As a result, the hospital is free of the burden of operating, maintaining and programming a large system. PMID- 10120853 TI - Healthcare information systems: just what the doctor ordered. PMID- 10120854 TI - Dermatitis from medical gloves causes rash of worker complaints. PMID- 10120855 TI - Predictors of hospital readmission. A meta-analysis. AB - Summarizing the results of research related to identifying potential predictors of hospital readmissions has been difficult because of conflicting results across studies. Using the techniques of meta-analysis, the results from 44 studies were examined in the present study. Overall, the mean readmission rate was 27%, with significant differences based on patient diagnosis. Although diagnosis, age, initial length of hospital stay, and prior use of hospital resources were related to readmission, the strength of the relationship is trivial. Combining data from 12 intervention studies designed to reduce readmission indicated that the overall treatment effect was not significant. Further research is needed to determine demographic, clinical, and social predictors of readmission if strategies are to be developed to reduce readmission and the resulting health care costs. PMID- 10120856 TI - Survey postponement and delay policy. AB - All surveys shall ordinarily be conducted no sooner than 30 days in advance of the due date, unless otherwise authorized by the organization, nor later than 60 days after the due date. All requests for adjustment to a survey date (either a scheduled date or a due date) are to be acted upon by the scheduling department. The scheduling department is to consult with the appropriate accreditation service department or the vice-president for accreditation surveys (or his/her designee) whenever unusual circumstances arise. PMID- 10120857 TI - Care of the dying patient standards for the 1991 CSM. PMID- 10120858 TI - Care of the terminally ill patient standards for the 1992 AHCSM. PMID- 10120859 TI - Monitoring and evaluation standards and scoring guidelines for the "Quality Assurance" chapter of the 1991 CSM. PMID- 10120860 TI - Summary list standards and scoring guidelines for the 1992 AHCSM. PMID- 10120861 TI - 1992 Accreditation Manual for Hospitals shorter, more concise. PMID- 10120862 TI - Position statement on "authority and responsibility" approved by board. PMID- 10120863 TI - Medical records services focuses on survey. PMID- 10120864 TI - Peer review complements QI efforts. PMID- 10120865 TI - Transcriptionists and cervical strain. PMID- 10120867 TI - Insurance crisis: home offices go naked. PMID- 10120866 TI - Laparoscopic laser cholecystectomy. AB - The popularity of laparoscopic laser cholecystectomy is growing largely because the procedure has been found to be safe and effective. The entire gallbladder and the gallstones can be removed using this minimally invasive technique. The patient benefits are considerable as are the benefits to the health care system. New and experienced OR nurses and surgical technologists may find the training rewarding and the technology interesting. PMID- 10120868 TI - Who beats stress best--and how. AB - In a faster spinning world, managers are finding new ways to ease stress in workers and themselves. Wisdom comes from surprising sources--like the Army--and pays off. PMID- 10120869 TI - Leadership standards incorporated into survey. PMID- 10120870 TI - Documentation of nursing process standardized after survey. PMID- 10120871 TI - Who complains about what to the Joint Commission. PMID- 10120872 TI - Agenda for Change initiatives now turn to survey process. PMID- 10120873 TI - Home infusion therapy indicators readed for alpha testing. PMID- 10120874 TI - Medication use and infection control indicators complete alpha testing phase. Indicators prepared for beta testing. PMID- 10120875 TI - Hartford project sheds light on cardiovascular care. PMID- 10120876 TI - Will the insurance crisis threaten your disability coverage? PMID- 10120877 TI - Back talk takes story cross-country. PMID- 10120878 TI - Risk management, safety management, and quality assurance. AB - The changes that have taken place in health care during the past few years have also created changes in our hospital safety programs. We can no longer address the safety issue as a dual function of a department manager. The safety management program plays an important role in the overall success of the quality of the facility. Safety is no longer a program that stands alone and oversees the fire safety program. To have a successful risk management and quality assurance program, safety management has to be included as an integral part. PMID- 10120879 TI - Workers' comp gains Mass appeal. PMID- 10120880 TI - Shooting down workers' comp costs. PMID- 10120881 TI - In pursuit of the patient-centered, online medical record. PMID- 10120882 TI - Orwell's prediction pays dividends in patient care. PMID- 10120883 TI - Increasing admissions via the enterprise extended network. PMID- 10120884 TI - Promoting the exchange of clinical protocols, International Institute opens doors. PMID- 10120885 TI - Redefining the "family" doctor. PMID- 10120886 TI - Expert systems: a new dimension for the lab. PMID- 10120887 TI - What do optical disks have in store for medical records: fad or solution? PMID- 10120888 TI - Making the right connections with fiber optics. PMID- 10120889 TI - Lotus 1-2-3 brings scientific procedure to estimating healthcare costs. PMID- 10120890 TI - From laying cable to data entry, HIS goes live in 4 weeks. PMID- 10120891 TI - Expert system teaches, tests, consults with physicians of internal medicine. PMID- 10120892 TI - Control worker's comp costs. PMID- 10120893 TI - Can hospitals re-focus on quality care by partnering with IS experts? PMID- 10120894 TI - TQM: evolution or revolution? PMID- 10120895 TI - Lakeview LAN reduces receivables 30 percent. PMID- 10120896 TI - Payor/provider perspectives on EDI: achieving cost controls?. Interview by Loran Walker. PMID- 10120897 TI - Flexible 4GL HIS responds to market demands. PMID- 10120898 TI - Automating the manual pharmacy: an easy pill to swallow. PMID- 10120899 TI - Change comes to Texas workers' comp environment. PMID- 10120900 TI - Cardiovascular, oncology, and trauma indicators for beta testing. PMID- 10120901 TI - Hospital CEOs give Joint Commission improved performance ratings. PMID- 10120902 TI - Quality utilization management department key to solving QA problems. PMID- 10120903 TI - Tailored survey policy: tailored to fit whose needs? PMID- 10120904 TI - Task force appointed to review information management standards. PMID- 10120905 TI - Home care program completes first accreditation cycle. PMID- 10120906 TI - Successfully managing IS development and implementation. PMID- 10120907 TI - Balancing cost containment, quality care and IS investments. PMID- 10120908 TI - Hardware strategies: what to expect in the next year. PMID- 10120909 TI - Surmounting IS obstacles--blueprint for success. Interview by O. George Kennedy. PMID- 10120910 TI - Computer-based patient records: the push gains momentum. PMID- 10120911 TI - Users comment on new PHS (Professional Healthcare Systems) Level 7 system. PMID- 10120912 TI - Treating Grady's growing pains yielded a healthier bottom line. PMID- 10120913 TI - Clinical system improves physician productivity. PMID- 10120914 TI - Building on a legacy of product strength & flexibility--Gerber Alley. Interview by Bill Childs. PMID- 10120915 TI - Bayfront's hospital-wide LAN provides growth path for future. PMID- 10120916 TI - Windows on Henry Ford. PMID- 10120917 TI - EIS (executive information systems): decisions vs. reactions. PMID- 10120918 TI - The future of open applications: what it means to IS & you. PMID- 10120919 TI - Automated PCARs (patient care activity record): new dimensions in patient care. PMID- 10120920 TI - IS success: how does your department rate? PMID- 10120921 TI - Revisions to scoring guidelines for the Accreditation Manual for Home Care, 1991 edition. PMID- 10120922 TI - Final tailored survey policy revisions approved. PMID- 10120923 TI - Smoking standard clarified. PMID- 10120924 TI - Hospital adapts Deming's principles to prepare for focused survey. PMID- 10120925 TI - "The Great White Lie" distorts truth. PMID- 10120926 TI - Survey fees to rise an overall 6%. PMID- 10120927 TI - Advisory committees revamped. New structure seeks to improve function. PMID- 10120928 TI - The organization and the injured worker. PMID- 10120929 TI - Occupational health: offering a spectrum of services. AB - Hospitals must continue to explore ways in which to meet the needs of the employer market. As health care costs (workers' compensation and otherwise) account for a larger portion of a company's total expense dollars, the employer will continue to have a greater voice in how those dollars are expended. Hospitals and occupational health programs that recognize this fact will not only survive, they will prosper. PMID- 10120931 TI - Ark. providers oppose payment plan. PMID- 10120930 TI - Changes in physicians' sources of pharmaceutical information: a review and analysis. AB - Since 1952, 20 datasets have been generated through 17 studies in an attempt to describe the sources and importance and/or use of information about pharmaceuticals by physicians. The authors review the findings of the studies and subject them to three sequentially relevant, but different, meta-analytic procedures. The results of these analyses indicate significant changes in the sources and importance of various commercial/noncommercial and personal/nonpersonal information as they relate to physicians' prescribing behavior. Those changes over time have specific implications for marketers of pharmaceuticals. PMID- 10120932 TI - Employee v. independent contractor: tax and other considerations for group practices. AB - The classification of physicians and associated health care professionals as employees or independent contractors in a group practice context is an important and frequently misunderstood issue, with many traps for the unwary. This article discusses the effect of classification on a group's responsibilities, the factors to consider in determining whether a health care professional should be classified as an employee of the group or an independent contractor, and the practical considerations involved in reclassification of an improperly classified worker. PMID- 10120933 TI - Facing revenue shortfalls. Interview by Donald E. Johnson. AB - In the face of increasing revenue shortfalls, 367-bed Frankford Hospital in Philadelphia is betting on improved relations with its physicians, continuous quality improvement and multidisciplinary teams of employees to identify ways to curtail costs and become more efficient. "There's no magic bullet," says John B. Neff, president of Frankford Health Care System, in the following interview with Donald E.L. Johnson, editor and publisher of Health Care Strategic Management. Neff would like to see health care move away from a-la-carte services to providing care through integrated delivery systems. PMID- 10120934 TI - Using practice parameters in quality assessment, quality assurance and quality improvement programs. PMID- 10120935 TI - The weapon of education. AB - Aggressive prevention campaigns could spare as many as 10 million people from contracting the HIV virus by the year 200, reports the World Health Organization. Shared first-person experience, such as registered nurse Barbara Fassbinder's testimony before the National AIDS Commission, is powerful ammunition. PMID- 10120936 TI - Elevating CIOs--from technocrats to sr. exec.s. PMID- 10120937 TI - Outsourcing is in in Oceanside. PMID- 10120938 TI - Reimbursement & reporting requirements: can your HIS handle the endless, ongoing changes? PMID- 10120939 TI - Cost justified: is your HIS earning its keep? PMID- 10120940 TI - Patient-centered data: achieving corporate goals. PMID- 10120941 TI - Relieving document/attachment headaches. PMID- 10120942 TI - The CHIME (College of Healthcare Information Management Executives) initiative unfolds. Interview by Bill Childs. PMID- 10120943 TI - Hospitals in crisis. AB - Information poor: your system's aging, your budget slashed, your quality challenged--where do you go from here? PMID- 10120944 TI - UNIX: 7 questions you were afraid to ask. PMID- 10120945 TI - Growing and enhancing OR efficiencies at Erlanger Medical Center. PMID- 10120946 TI - How to prompt physician use of the HIS. PMID- 10120947 TI - Angioplasty advances call into question the mandate for open-heart back-up. PMID- 10120948 TI - A historical perspective on health reform. AB - To truly understand the changes occurring in today's health care arena, one must be aware of the history of health reform. Author Ivan Fawley, FACMGA, presents the history of health care policy and regulation from the turn of the century to present day. PMID- 10120949 TI - Nurses' pact includes disability clause for HIV infection on the job. PMID- 10120950 TI - Pay only the proper premium. Annual audit a good time to avoid excessive worker's comp costs. PMID- 10120951 TI - More accidents feared as electrical tools are used in rising number of laparoscopies. AB - Laparoscopic and endoscopic procedures are rising in popularity and frequency, and surgeons prefer using electrosurgical tools to do those procedures. But the limited visibility in this type of operation and the potential for mishaps with the surgical tools has raised concerns that more accidents might occur during surgery and that physicians and hospitals might face increased liability. PMID- 10120952 TI - HANYS criticizes laparoscopic gall bladder guidelines. PMID- 10120953 TI - Protests from providers succeed in blocking Arkansas' plan for Medicare-based reimbursement. PMID- 10120954 TI - Advanced technology in the operating room. AB - Today's operating room is a high-tech environment. Minimally invasive procedures are fast becoming a standard for certain conditions. Lasers have taken their place as routine surgical tools in many specialties. On the horizon are new imaging technologies. If you are planning for new ORs, you'll want to consider the role of advanced technology in your new suite. PMID- 10120955 TI - The future for cardiac catheterization labs. PMID- 10120956 TI - Ways to tame workers' comp premiums. PMID- 10120957 TI - Development of a work rehabilitation center. AB - Because many employees re-injure themselves upon returning to the workplace after rehabilitation, it became apparent (especially in the era of rising workmans compensation costs) that some employees' jobs needed to be modified. In this case study, a work rehabilitation center with work-hardening and physical conditioning was considered a viable solution. PMID- 10120958 TI - Definition and yield of inclusion criteria for a meta-analysis of patient education studies in clinical preventive services. AB - Because selection of studies for a literature review influences conclusions, inclusion criteria are of utmost importance. For a meta-analysis of studies testing effects of patient education on preventive behaviors, we present the framework and concepts used for setting inclusion criteria for primary studies. We also present the yield in terms of number and distribution of studies that resulted from the inclusion criteria. Because we were interested in a diverse range of behaviors and a broad definition of patient education, we present a method for grouping behaviors by type of behavior change and describe parameters for subgrouping interventions by orientation and communication channel. Of 5,451 citations located and abstracts screened, 561 citations reporting potentially relevant studies were reviewed. Based on our inclusion criteria, 171 citations contained relevant studies, of which 64 studies (found in 62 citations) also met our acceptability criteria. We examine the effects of alternate inclusion criteria on the yield of primary studies and their distributions across the subgroupings. PMID- 10120959 TI - Texas non-subscribers still have protections. PMID- 10120960 TI - Standing guard over workers' compensation. PMID- 10120961 TI - A broad brush approach to managed care. PMID- 10120962 TI - Stanford University Hospital. A unique stockless program. PMID- 10120963 TI - Lap cholie complications raise credentialing issues. PMID- 10120964 TI - NY State issues guidelines for lap cholecystectomy. New York State Health Department. PMID- 10120965 TI - Stress in California. PMID- 10120966 TI - Hospital marketing efforts target employers. PMID- 10120967 TI - Managing workers' compensation controls costs, improves care. PMID- 10120968 TI - Beyond workers' compensation: a new vision. PMID- 10120969 TI - Guidelines for managing low back pain: a policy checklist. AB - Back injuries devour one-third of health care benefits and workers' compensation, yet corporate strategies vary widely in their approach to back pain prevention, treatment and rehabilitation. These recommendations provide a benchmark for evaluation policies on low back pain. They emphasize a sports medicine approach, focused on returning workers to activity as soon as possible. PMID- 10120970 TI - Premium-priced controversies. PMID- 10120971 TI - Social unrest and the L.A. riots--lessons for hospitals and health-care reform. PMID- 10120972 TI - Gun fight in the ER coral. PMID- 10120973 TI - Emergency room cycles. PMID- 10120974 TI - Granny dumping. PMID- 10120975 TI - Escape from the abyss. Why do people go to the emergency room? PMID- 10120976 TI - Policing the ER police. PMID- 10120977 TI - The Saturday night special. PMID- 10120978 TI - Policies and practices related to information system adoption in hospitals owned by Ministries of Health in the Arab Gulf. AB - This is a discussion paper based on the findings from a study of the factors affecting the adoption of computer-based hospital information systems (CBHIS) in the Arabian Gulf. The study involved on-site visits to hospitals in Bahrain, Kingdom of Saudi Arabia, Kuwait, Qatar and the United Arab Emirates as well as visits to ministries of health in these countries. The focus of this paper is on the adoption of CBHIS by ministry of health (MOH) hospitals, in specific, because of the main role that ministries of health play as providers of health care in the Region. Prior to describing CBHIS adoption practices, an overview of the Region in terms of its economic development and its health care delivery systems is presented. Next, the research setting along with the major findings are briefly described followed by a discussion of the advantages and disadvantages of centralized CBHIS adoptions. Finally, management guidelines related to the adoption of CBHIS by multi-hospital institutions are proposed. PMID- 10120979 TI - Adopting an information management approach to the design and implementation of information systems. AB - As the NHS adopts an information management approach to coordinated handling of total information resources, methods of systems analysis and design require assessment to ensure that they are appropriate. Mandatory use of Structured Systems Analysis and Design Methodology (SSADM) may be encouraging a damagingly narrow view of information systems. Research is described in which an holistic view of information systems is applied, allowing the needs of information users to play a stronger role in determining how information will be supplied to them. The techniques may also assist the training activities associated with implementing new systems. PMID- 10120980 TI - Clinicians into management: on the change agenda or not? AB - This article examines the issue of drawing medical consultants into managerial decision making. It commences by examining both historically and comparatively the influences on doctors and their reluctance to adopt managerial roles and responsibilities. It progresses to an analysis of the impact of the NHS and Community Care Act particularly in relation to the separation of purchaser and providers and the development of contracting mechanisms. The argument presented suggests that the rapid adoption of the clinical directorate model, as the favoured mode of organisation in acute units, has led to clinicians assuming 'imitation' general manager roles. The authors question whether this is the best use of the unique skills and time of clinicians. They compare with experience in the USA and propose that collaborative working between doctors and general managers is essential in health care. The article suggests a set of tasks for clinician managers and then discusses the issues of training support and development which will be required if clinicians are to perform these tasks effectively. PMID- 10120981 TI - Institutions for Mental Diseases (IMDs): facilities and clients. AB - This paper describes a cross-sectional study of institutions for mental diseases (IMDs) and the clients they serve in one state. Primary and secondary data were collected to provide an in-depth look at the demographic, social, behavioral, medical, psychiatric and treatment attributes of a random sample of clients in IMDs. Detailed financial, service and operational data were collected on a 100% sample of facilities in the state. The findings indicated a client population dissimilar in age and behavioral attributes from a typical nursing home patient, but in keeping in many respects with the descriptions of nursing home clients with psychiatric disorders. Facilities appeared similar to nursing homes in their size and many operations. This unique database can be used to explore a predictive resource model of these institutions as well as to begin to examine the quality and effectiveness of this form of institutional care for the severely mentally ill. PMID- 10120982 TI - Hospital-physician integration: case studies of community hospitals. AB - Hospitals are attempting more meaningfully to involve physicians in management as one approach to increasing the efficiency and effectiveness of their operations. The purpose of this research was to explore the relationship between the structure of the medical staff organization, the extent to which physicians are integrated into hospital decision making and the hospital's financial performance. A measure of hospital-physician integration was developed based on Alexander et al's (1986) dimensions of hospital-physician integration which were based on Scott's (1982) organizational models, ie, autonomous, heteronomous and conjoint. A multiple case study design, which comprised eight community non teaching hospitals over 200 beds located in the Province of Ontario, Canada, was used to examine the relationship between variables. Study results suggest that there is variation among community hospitals on both contextual and organization factors. Hospitals with high levels of hospital-physician integration were located in highly populated areas, had formulated and implemented a strategic plan, had highly structured medical staff organizations, and had no budgetary deficit. In contrast, hospitals with moderate or low levels of integration were more likely to be located in lowly populated areas, had little planning activity, had a moderately structured medical staff organization, and had deficit budgeting. Suggested areas for future research include examining the role of the Board of Trustees in determining physicians' organizational roles and identifying differences in commitments, characteristics, and motivations of physicians working in rural versus urban hospitals and their impact on integrative strategies. PMID- 10120983 TI - A statistical study of factors influencing outpatient service in health districts. AB - This paper describes a statistical study within NHS health districts, using routinely available data, of the supply of outpatient services, the demands made on these services and the resulting balance of supply and demand. Indicators of supply have been investigated which aim to reflect the resources available within a district for outpatient services and indicators of demand have been studied which link to the number of general practitioners who are considered likely to make use of the services provided. Some preliminary analysis is attempted of relationships between the observed balance of supply and demand and the predictions based on the statistical models developed. PMID- 10120984 TI - Managing the multicultural laboratory, Part I: Tools for understanding cultural differences. AB - This article will help laboratory managers better manage their culturally diverse employees by explaining what is meant by "culture" and by presenting a research based model for assessing the different values, attitudes, and behaviors exhibited by those of different cultural backgrounds. The useful cross-cultural data presented come from an exciting research analysis compiled by Dutch social psychologist and management consultant, Dr. Geert Hofstede. This multi-national corporate study compared the cultures of more than 40 nationalities using four different cultural characteristics. As members of an empirically based profession, laboratory professionals should welcome some hard data about a soft subject. This model will enable laboratory managers to understand their own cultural biases and will interpret some of the attitudes and behaviors of those with different national or ethnic backgrounds. By understanding the elementary principles of culture and by replacing outdated stereotypes with educated generalizations, clinical laboratory managers can take a vital step toward becoming effective multi-cultural managers. PMID- 10120985 TI - The managerial role in the speaker-listener exchange. A two-dimensional action plan. AB - According to various studies, listening ranks as one of the most important communication skills. Yet studies also indicate that this is an area where most people--managers and staff members alike--are lacking. One way to improve listening effectiveness is through a formal listening training program. However, most medical institutions do not offer such programs. Because of the importance of listening, clinical laboratory managers cannot afford to wait for these formal programs. Fortunately, there is a two-dimensional action plan that managers can use to improve both their own listening skills and those of their staff members. This article describes the elements of this two-part action plan. The first part focuses on how managers can improve the speaker-listener exchange as speakers. This involves considering how and where the message is communicated. The second part of the plan examines how managers can assist effective listening as listeners. This involves creating an environment conducive to listening and learning how to give active feedback. Finally, the article examines how individual differences can affect a person's listening skills. PMID- 10120986 TI - Ethics in health care, Part II: The product of shared deliberation. Working within a pluralistic culture. AB - In a pluralistic society, ethics must be understood as "what we ought to do and become, as civilized persons, in light of who we say we are." This understanding of ethics can help hospital ethics committees produce policies and consultations that are the result of shared deliberation and respect. The ethical principles of respect for autonomy, non-maleficence, beneficence, and justice are considered, and it is shown how these principles reveal values that are central to the practice of contemporary health care. Finally, the issue of refusing medical interventions--and some of the religious, ethical, and legal values that affect this issue--are explored. Part I of this article (1) described the process and activities of typical ethical committees functioning in health-care facilities today. This article will consider some of the more substantive issues these committees must deal with and some of the ethical conclusions and insights that have arisen as a result of the shared deliberations of these groups. PMID- 10120987 TI - Laboratory manager's financial handbook. Expense management--supplies. PMID- 10120988 TI - Instrumentation Laboratory ACL (automated coagulation) systems. PMID- 10120989 TI - Cross-training personnel. PMID- 10120990 TI - Appreciating the full scope of diversity. PMID- 10120991 TI - Cashing in on the trend toward variable-term computer leases. AB - Lessors make a large part of their profit from customer-requested changes such as upgrades or early termination of fixed-term computer leases. As lessees recognize the financial penalty associated with these changes, they are increasingly negotiating for variable-term computer leases. PMID- 10120992 TI - A leasing strategy that weathers the dynamics of the midrange market. AB - IBM's recent strategies in the midrange market, such as shorter product cycles, more aggressive price/performance, and introducing many more advanced midrange products, have forced midrange users to take a new look at the financial benefits of leasing. PMID- 10120993 TI - Shopping in the used computer market. PMID- 10120994 TI - Building an EIS (executive information system) your CFO will really use. PMID- 10120995 TI - EDI (electronic data interchange) strategy: businesses shift from technical to business goals. PMID- 10120996 TI - Role of the Public Health Commission. PMID- 10120997 TI - 'Masterpiece' lives up to Board's expectations. PMID- 10120998 TI - The State and health care reform. PMID- 10120999 TI - The heart of the matter. AB - Coronary heart disease deaths have declined in New Zealand, as in other Western countries, during the past two decades. This is probably due to a combination of population lifestyle changes and improved treatment of the disease. However, the social class gradient for coronary disease has reversed and it is now more common in lower socio-economic groups who are increasingly disadvantaged in our community. Socioeconomic factors are powerful, primary determinants not only of coronary disease but also of many of the other health problems outlined in the New Zealand Health Charter. Policy making and health services delivery shape societal conditions essential for true health. These factors are considered in relation to the spectrum of human communication and the current transitional changes in our health system. PMID- 10121000 TI - Incentive compensation for health sector professionals. PMID- 10121001 TI - Mobile retinal screening--a Waikato Area Health Board initiative. AB - In conclusion the Waikato Area Health Board has shown that regular eye review can be offered to all patients with diabetes by means of a register of people with diabetes, and the provision of a mobile retinal screening service. The use of a mydriatic camera is a practical and cost-effective way of providing this service, and with suitably designed carrying systems it can be provided at almost any venue, ensuring access even for people in remote rural areas. Demands for our service have meant that we are now offering retinal screening to other Waikato communities which do not have access to a visiting ophthalmologist. PMID- 10121002 TI - Queen Elizabeth Hospital assignment. PMID- 10121003 TI - Mortality data won't die. PMID- 10121004 TI - The "V" word. PMID- 10121005 TI - Special report. Kathleen Buto: getting ready for RBRVS in 1993. Interview by Carol Manco. PMID- 10121006 TI - State unit on aging involvement with continuing care retirement community (CCRC) legislation. AB - State units on aging (SUAs) from 29 states with continuing care retirement community (CCRC) legislation were surveyed to (a) assess staff familiarity with CCRC legislation, (b) examine interdepartmental working relationships surrounding such legislation and ask what role(s) ombudspersons are playing in CCRC oversight, (c) determine what role(s) aging units have had in developing legislation, and (d) gain insights regarding legislative impact. Results indicate that SUAs have been active in legislative development but vary greatly in the intensity of their involvement with the implementation and enforcement of CCRC regulation and in their perception of legislative impact. PMID- 10121007 TI - Should the government pay? Caregiver views of government responsibility and feelings of stigma about financial support. AB - Financial support strategies to assist informal caregivers of the elderly have been implemented and/or experimented with in several states. Little is known about how receptive caregiving families are to receiving financial support from the government to assist with in-home care, particularly whether they feel stigmatized. Few existing programs have assessed caregivers' views. In examining caregivers' reactions to receiving means-tested financial assistance, it is important to assess whether they consider support of the disabled a government responsibility as well as a possible stigma. Caregivers (N = 155) of disabled veterans aged 65 and older who receive Veterans' Administration disability allowances (Aid and Attendance) were surveyed. Results indicate that caregivers feel the government is primarily responsible for supporting the long-term disabled who are cared for at home. For the most part, these caregivers did not feel stigmatized or uncomfortable receiving means-tested government assistance to support in-home care. An important implication of this study is that financial support can be a workable component of an integrated service delivery system to support informal caregiving. PMID- 10121008 TI - The role of social supports in older women's recovery from hip fractures. AB - Interviews were conducted with 101 women, ranging in age from 65 to 94, to determine the types of assistance that family members, friends, and formal services provide older women recovering from hip fractures, and the influence of social support variables on their recovery. More women were receiving help from members of their informal network in such areas as meal preparation, shopping, and running errands. More women were also using physical therapy and housekeeping services as a result of their fractures. The strongest predictors of recovery were the women's physical abilities prior to their fracture and the progression they had made at the time of the first interview. Results suggest that social support variables may have a more indirect than direct association with older women's recovery from hip fractures. PMID- 10121009 TI - Demystifying the cardiopulmonary code team response. AB - OBJECTIVE: To familiarize the reader with the sequence of events in a hospital based cardiopulmonary resuscitation. DATA SOURCES: The American Heart Association's Textbook of Advanced Cardiac Life Support and the Standards and Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiac Care. DATA EXTRACTION: The roles and responsibilities of members of the cardiopulmonary code team are discussed. DATA SYNTHESIS: A typical code sequence is described, with emphasis on drug therapy. CONCLUSIONS: This information will provide a better understanding of the cardiopulmonary resuscitation team response and, in particular, the role of the pharmacist as an integral team member. PMID- 10121010 TI - Compliance issues and extemporaneous preparation of medications for pediatric patients. AB - OBJECTIVE: Medications often are produced in a form that makes administration to pediatric patients difficult. Even when available in liquid forms, some medications can pose compliance problems in children. Various strategies and techniques are discussed which provide information on how to increase compliance in this special group of patients by providing preparations that can be rapidly formulated and easily administered. CONCLUSIONS: The pharmacist and pharmacy technician can benefit from an increased awareness of the special needs of the pediatric patient regarding drug therapy. With the increasing probability of an expanded scope of practice for technicians, this information can be of interest to both pharmacists and technicians. PMID- 10121011 TI - A primer of drug safety surveillance: an industry perspective. Part I: Information flow, new drug development, and federal regulations. AB - OBJECTIVE: To place the fundamentals of clinical drug safety surveillance in a conceptual framework that will facilitate understanding and application of adverse drug event data to protect the health of the public and support a market for pharmaceutical manufacturers' products. Part I of this series provides a background for the discussion of drug safety by defining the basic terms and showing the flow of safety information through a pharmaceutical company. The customers for adverse drug event data are identified to provide a basis for providing quality service. The development of a drug product is briefly reviewed to show the evolution of safety data. Drug development and safety are defined by federal regulations. These regulations are developed by the FDA with information from pharmaceutical manufacturers. The intent of the regulations and the accompanying guidelines is described. An illustration from the news media is cited to show an alternative, positive approach to handling an adverse event report. DATA SOURCES: This review uses primary sources from the federal laws (regulations), commentaries, and summaries. Very complex topics are briefly summarized in the text and additional readings are presented in an appendix. Secondary sources, ranging from newspaper articles to judicial summaries, illustrate the interpretation of adverse drug events and opportunities for drug safety surveillance intervention. STUDY SELECTION: The reference materials used were articles theoretically or practically applicable in the day-to-day practice of drug safety surveillance. DATA SYNTHESIS: The role of clinical drug safety surveillance in product monitoring and drug development is described. The process of drug safety surveillance is defined by the Food and Drug Administration regulations, product labeling, product knowledge, and database management. Database management is subdivided into the functions of receipt, retention, retrieval, and review of adverse event reports. Emphasis is placed on the dynamic interaction ;of the components of the process. Suggestions are offered to facilitate communication of a review of adverse event data for various audiences. CONCLUSIONS: Careful drug safety surveillance is beneficial to the health of the public and the commercial well-being of the manufacturer. Attention to basic principles is essential and, as illustrated, may be sufficient to resolve some problems. PMID- 10121012 TI - Technician education and training programs. An addendum. PMID- 10121013 TI - Potential for microbial contamination of ADD-Vantage admixtures. AB - OBJECTIVE: To test for potential bacterial contamination of the ADD-Vantage system when the components are assembled in various hospital environments. STUDY DESIGN: One hundred fifty ADD-Vantage units were assembled by three different people in three separate locations within a hospital. Each person assembled ten units per day; the study spanned five days. After 72 hours of incubation, units were inspected for evidence of contamination. SETTING: ADD-Vantage units were assembled by a pharmacist in a laminar-flow hood, a pharmacy student using the pharmacy counter, and a nurse at a patient's bedside table. Personnel at each site wore their regular work attire. Each person observed handwashing techniques normally used during routine working hours. DATA EXTRACTION: Positive results were sent to the hospital microbiology laboratory for determination of growth type. RESULTS: After 72 hours, none of the systems exhibited microbial growth on visual inspection. No differences in microbial contamination of the ADD-Vantage systems relative to assembly site, day of assembly, or person performing the assembly were observed. The incidence of contamination was calculated at less than seven percent. CONCLUSIONS: There is minimal risk of bacterial contamination when ADD-Vantage systems are compounded either on a pharmacy counter or at a patient's bedside. Larger samples must be studied in order to detect differences in the incidence of contamination among assembly sites. PMID- 10121014 TI - Issues in contemporary drug delivery. Part VI: Advanced cardiac drug formulations. AB - OBJECTIVE: To identify and discuss the clinical utility of new delivery systems and formulations of cardiac drugs. DATA SOURCES: Studies describing or evaluating new drug delivery systems for cardiac drugs were identified through a MEDLINE literature search. STUDY SELECTION: All studies describing or evaluating new delivery systems for cardiac drugs were reviewed. DATA EXTRACTION: Data were abstracted and evaluated by each author independently. DATA SYNTHESIS: The most common oral sustained-release formulations include the wax-matrix system, the gastrointestinal therapeutic system (GITS), and the spheroidal oral drug absorption system (SODAS). The wax-matrix delivery system is limited by the occurrence of "dose-dumping." In a low-pH setting, the wax-matrix formulation may dissolve too rapidly, liberating the entire dose in a short period of time. The clinical relevance of this phenomenon is unknown. The GITS and SODAS formulations are less likely to be affected by pH and food. Nitroglycerin is available by many routes of administration. The topical patch forms are convenient to use, but are associated with the development of tolerance. A buccal formulation incorporates a relatively short onset of effect with a three- or four-times-daily dosing regimen. Although tolerance is less of a problem with buccal nitroglycerin than with topical nitrates, this formulation is less convenient to use because of buccal irritation and interference with eating and talking. A new spray formulation of nitroglycerin offers longer shelf-life storage stability and an easier mode of administration. The spray canister is stable for three years compared with 12 weeks for an opened bottle of sublingual nitroglycerin tablets. Sublingual administration of oral cardiac drugs offers the potential for a more rapid onset of effects. Although nifedipine is often given sublingually, objective data indicate that it is not absorbed buccally but rather in the stomach. It appears that the chew-and-swallow route is most appropriate for nifedipine. Captopril is absorbed sublingually but its efficacy has not been demonstrated. Transdermal clonidine improves compliance and is associated with fewer adverse effects than oral clonidine. Transdermal formulations of beta blockers are currently being evaluated. CONCLUSIONS: Further advancements in the development of novel delivery systems for cardiac drugs are expected in the future. PMID- 10121015 TI - California State Board of Pharmacy proposed technician regulations. AB - The following proposed technician regulations represent the final draft after having received public comment. This draft is the latest in a series of events that have transpired in California in the Board of Pharmacy's efforts to adopt technician regulations. In June, the California Board of Pharmacy was notified by the Office of Administrative Law (OAL) that the Board's technician regulations had been disapproved on grounds of "clarity and consistency." However, Board officials did not consider any of the objections to be insurmountable. When the Board established its timetable for incorporation of the technician regulations, it was expected that OAL would reject the proposed guidelines at least once. For previous reports see jPT 1992;8:87 and 1991;7:201. PMID- 10121016 TI - Perspectives. Is there a doctor in-house? PMID- 10121017 TI - Perspectives. Global budgets: medicine with side effects. PMID- 10121018 TI - Perspectives. Covering the bases: Clinton & health reform. PMID- 10121019 TI - Perspectives. Noninvasive surgery: George Bush & health reform. PMID- 10121020 TI - Perspectives. Hospital wars: is peace in sight? PMID- 10121021 TI - Perspectives. California health reform: as easy as A, B, C? PMID- 10121022 TI - Perspectives. CHAMPUS: marching toward reform. PMID- 10121023 TI - The development of a hospital-based helicopter program. PMID- 10121024 TI - Flight program economics for the 1990s. PMID- 10121025 TI - Air medical insurance and risk management. PMID- 10121026 TI - Mid-year report and fleet survey. PMID- 10121027 TI - Transport considerations for the head-injured patient: are we contributing to secondary injury? AB - The association between an improved prognosis and early treatment, including surgical intervention, makes air transport for the head-injured patient an important component of care. Patient positioning and the use of hyperventilation have been modes of treatment used for decreasing cerebral edema and ICP for many years. This standard of care should be emphasized during air medical transport as well. PMID- 10121028 TI - 20 years of service. PMID- 10121029 TI - The effective management of pilots. AB - Managers must understand the roots of pilot behavior in order to learn how to foster respect based on trust and professional expertise, rather than on position or status. The work environment must support individual creativity in order to allow for professional growth. If managers start with the conviction that their jobs will be complete when they have adequately trained each of their subordinates to replace them, then the managers become truly effective. The process of playing one subordinate against the other is ineffective. Successful managers of pilots learn to identify and build on individual interests and strengths. There must be no hidden agendas. When pilots feel important, valued, trusted, and supported, they can become indispensable members of the team. PMID- 10121030 TI - Establishing the electronic medical record. PMID- 10121031 TI - Medical records on computer. PMID- 10121032 TI - Radiology information systems review. PMID- 10121033 TI - Prelude to CQI: creating the IS vision. PMID- 10121035 TI - Gauging the document imaging revolution. PMID- 10121034 TI - Hypertext, hypermedia, & healthcare. PMID- 10121036 TI - Achieving on-time, in-budget IS conversions. PMID- 10121037 TI - Standardizing the CPR's infrastructure. PMID- 10121038 TI - Moving patients at the stroke of a key. PMID- 10121039 TI - Pieces of the CPR pie: textual search tools. PMID- 10121040 TI - Strategic planning: implementing decentralized systems. PMID- 10121041 TI - The case for enterprise-wide optical disk archiving & work process re-design. PMID- 10121042 TI - Beyond nursing care plans. PMID- 10121043 TI - The past, present, & future of medical encoding systems. PMID- 10121044 TI - Increasing radiology department productivity--CHC Infostat RIS. PMID- 10121045 TI - Moving toward the computer-based patient record. PMID- 10121046 TI - Nobody wins when CIOs walk the plank. PMID- 10121047 TI - Power to the portables. AB - Portable computing devices generally are classified into four categories: laptop, palmtop, notebook, and pen-based computers. If a portable unit weighs over eight pounds, call it a laptop. If a stylus is used to input data, call it pen-based or a pen computer. Palmtops frequently are electronic organizers or resources: Sharp's Wizard line stores appointments and addresses; Franklin's Med-Spell contains Stedman's medical dictionary. Notebooks often incorporate a QWERT keyboard, and sometimes include a pointing device. NEC's notebooks in 1988 were the first sub-laptop computers. According to a 1992 report from Market Intelligence Research Corp., Mountain View, Calif., 4.6 million sub-laptops were sold in 1991 for $2.6 billion. By 1998 the market may reach $25 billion. The report predicts that one sub-category of pen computers, which are designed to be held in one hand while information is input with a pen-like stylus, will prove most useful to the health-care industry. Pen tablets, as opposed to pen clipboards, use faster, more expensive processors, store more data, and "are expected to allow [caregivers] to carry full patient charting with them ... and allow information to be recorded directly to patient files." Sub-laptops are on line in many healthcare facilities: Greenwich hospital, Stanford University Medical Clinic, Humana Hospital Audubon, Rancho Los Amigos Medical Center, and others. PMID- 10121048 TI - The systems, the strategy behind the $39 mil turnaround at Mercy. AB - Everyone has felt the economic pressures of the last several years, especially people responsible for the bottom lines of most healthcare delivery systems. Executives at Mercy Healthcare Sacramento, a division of Catholic Healthcare West, were no exception. After a $19 million loss in 1987 the healthcare system made numerous changes that eventually moved its earnings to $15 million in fiscal year 1990-91. PMID- 10121049 TI - The IS impact on group practice management. PMID- 10121050 TI - Ensuring doc involvement for IS success. PMID- 10121051 TI - Light pens & touch screens & voice, oh my! PMID- 10121052 TI - Ties that bond: going beyond simple links between hospitals & physicians. PMID- 10121053 TI - Negotiating the purchase of an HIS. AB - To summarize, do your homework. Don't accept the contract as it is presented. Negotiate the best deal you can. Be fair. And if you have done everything exactly right, keep your fingers crossed and hope the system doesn't crash. PMID- 10121054 TI - The evolution of integrated delivery systems. PMID- 10121055 TI - The team approach to managing an LIS. PMID- 10121056 TI - Hospital labs & commercial labs: the lines continue to blur. PMID- 10121057 TI - Marketing outpatient laboratory services. PMID- 10121058 TI - Here a fax, there a fax ... facsimile transmission vs. the remote printer. PMID- 10121059 TI - LIS printer applications: one size fails to fit all. PMID- 10121060 TI - Calculating the odds: patients, outcome probabilities & ICUs. PMID- 10121061 TI - Automating clinical labs. PMID- 10121062 TI - Automation helps safeguard blood from AIDS. PMID- 10121063 TI - Strengthening the weak link in the patient care chain. PMID- 10121064 TI - Speak to me: managing risk with voice recognition technology. PMID- 10121065 TI - ACB (Alberta Cancer Board) leverages info with relational database. PMID- 10121066 TI - OSHA, dollars & fun: counting CAI's benefits. PMID- 10121067 TI - 5 big mistakes to avoid when selecting an LIS. PMID- 10121068 TI - Bottom line forces lab in from the cold. PMID- 10121069 TI - New compliance instruction for the bloodborne pathogens standard. PMID- 10121070 TI - Sporicidin responds to the recall of its products. AB - In the January 1992 edition of HHMM, we reported on the seizure and recall of Sporicidin International's sterilant and disinfectant products by a joint action of FDA, EPA, and, indirectly, the Federal Trade Commission (FTC). This month, we provide Sporicidin's perspectives on the government action and its aftermath. PMID- 10121071 TI - Administrator sees changes in health care transforming hospitals. PMID- 10121072 TI - Hospital wins award for capturing the changing face of volunteers. PMID- 10121074 TI - Hospitals not immune as violence increasingly invades ERs. PMID- 10121073 TI - Hospitals target pregnant patients with baby shower, exercise classes. PMID- 10121075 TI - Model document emerges from patients' rights lawsuit. Sharp Cabrillo Hospital, San Diego. PMID- 10121076 TI - Patient satisfaction surveys shape hospital's TQM moves. PMID- 10121077 TI - Drunk drivers do time, witness horrors of the road. PMID- 10121078 TI - Medicare physician-payment reform and the resource-based relative value scale: a re-creation of efficient market prices? PMID- 10121079 TI - State legislative focus: California, Florida, Minnesota. PMID- 10121080 TI - States lead health system reform movement. '92 state legislative survey. PMID- 10121081 TI - HMO financial solvency: should hospitals be concerned? PMID- 10121082 TI - The National Practitioner Data Bank. PMID- 10121083 TI - Can (should) states enact antitrust immunity for health care providers? PMID- 10121084 TI - Election '92. PMID- 10121085 TI - Investor-owned hospitals respond to Andrew's devastation. PMID- 10121086 TI - Election 1992: a road map for providers. PMID- 10121087 TI - For better or worse? The moral and policy lessons of Minnesota's HealthRight legislation. AB - Minnesota's recently enacted HealthRight legislation places the state at the forefront of American health reform. How did the state manage to overcome the policy gridlock in evidence in other states and at the national level? And how well does the legislation fare under close ethical scrutiny? Among the most important factors that permitted Minnesota to enact reforms were the explicit linkage in the legislative debate of the goal of cost containment to the desire to expand access, the public perception that HealthRight is incremental and consistent with earlier reform efforts in Minnesota, and the lengthy public debate that preceded the enactment of HealthRight. Although it endeavors to create a fair and efficient health care system, it is not at all certain that HealthRight, in its present form, will achieve these normative goals. PMID- 10121088 TI - Ethical considerations surrounding first time procedures: a study and analysis of patient attitudes toward spinal taps by students. AB - A patient is not always told when a student is performing a procedure for the first time. Withholding this information is a form of deception. It is justified on paternalistic grounds (it is in the patient's interest not to know), or on public policy grounds (given the choice, patients would refuse, thus compromising the training of future physicians). Using the spinal tap procedure (lumbar puncture) as a paradigm, 173 patients were surveyed to determine how they felt about first time procedures by medical students, interns, and residents. The patients indicated that they would be willing to be the subject for a student's (52%), intern's (62%), or resident's (66%) first spinal tap. This paper reassesses the ethics of consent for first time procedures based on responses to this survey. PMID- 10121089 TI - Electronic roundtables for medical ethics. AB - Electronic mail creates special opportunities and burdens for academicians and others. This article first describes e-mail and how it works in a university setting. It then presents the transcript of an electronic exchange of the issue of multiple or repeat abortion. The debate was inspired by a case presented during "ethics rounds" for students at a university medical center. The value of e-mail in this case is considered, and the electronic medium is found to be useful for sharing ideas and stimulating debate about issues in medical ethics, as well as for educational purposes. PMID- 10121091 TI - The Office for Protection from Research Risks. PMID- 10121090 TI - Religious ethics and active euthanasia in a pluralistic society. AB - This article sets out a descriptive typology of religious perspectives on legalized euthanasia--political advocacy, individual conscience, silence, embedded opposition, and formal public opposition--and then examines the normative basis for these perspectives through the themes of sovereignty, stewardship, and the self. It also explores the public relevance of these religious perspectives for debates over legalized euthanasia, particularly in the realm of public policy. Ironically, the moral discourse of religious traditions on euthanasia may gain public relevance at the expense of its religious content. Nonetheless, religious traditions can provide a context of ultimacy and meaning to this debate, which is a condition for genuine pluralism. A table setting out the views of various denominations with regard to euthanasia is included. PMID- 10121092 TI - Ethics committees in hospitals. PMID- 10121094 TI - Managed Care Task Force develops recommendations. American Osteopathic Hospital Association. PMID- 10121093 TI - NFPA 101 balances security, life safety. PMID- 10121095 TI - From a patient's point of view. PMID- 10121096 TI - Total quality management and medical transcription. PMID- 10121097 TI - How hospitals can use activity based costing. PMID- 10121098 TI - Developing and using a budget manual. PMID- 10121099 TI - Controlling telephone costs. PMID- 10121100 TI - Solution to "An activity based costing problem". PMID- 10121101 TI - Peripheral controllers and devices--Part 1. AB - In this article, we looked at several peripherals, described their characteristics, and described how they are connected to computers. We included some discussions of problems caused by electrical and mechanical differences between computers and peripheral devices. During the past few years, many companies have addressed such problems. Numerous standards have been defined as a result of this work. These standards specify everything from what type of connectors will be used to the timing of electrical signals. They make it easier for peripheral manufacturers to design their devices for a wide range of computers. Peripherals and their controllers are important components of any computer system. Sometimes, however, other parts of the system, such as the control unit and main memory, receive more attention. Many engineers want to design new processors, but shy away from the design of peripherals and controllers; they consider such designs less glamorous. In reality, designs for some peripherals and their controllers can be more challenging than the design of the CPU itself. A computer without peripherals is of little use, other than as a paper weight. Until we attach peripherals to the computer, none of its power is accessible to the user. Peripherals turn computers into useful tools. PMID- 10121102 TI - Establishing an integrated PC network for transcription and chart management. PMID- 10121103 TI - Proposed revision to the Uniform Hospital Discharge Data Set June 1992. National Committee on Vital and Health Statistics, Subcommittee on Ambulatory and Hospital Care Statistics. PMID- 10121104 TI - How well do Medicare claims data summarize the hospital record? PMID- 10121105 TI - Coding notes: development of coding policy. PMID- 10121106 TI - Walk a mile in my shoes. AB - This RN, RRA-eligible, presented an inservice educational program on an average day in the life of a nurse to a Medical Record Department. The following article is her presentation. PMID- 10121107 TI - Improved record completeness and documentation quality through teamwork. PMID- 10121108 TI - Prospective payment in-service presentation for nurses. AB - This was a brief overview of the prospective payment system. Again, this overview was designed as a tool for an in-service educational program. Certainly not all of the complexities of the prospective payment system were discussed in this article. Many more items could be expanded upon, such as attestation, length of stay, and coding functions. At the end of the presentation, it is suggested that you invite the nursing staff to your department to view the coders and/or the utilization review process. An orientation to the HIM or Medical Record Department for the nursing staff could be an excellent way to open the door for more communication and teamwork. PMID- 10121109 TI - Getting back to healthcare: the new automation strategy. AB - The health information professional's role as partner, consultant, and problem solver for clinicians is critical as the healthcare industry, the last major industry to automate itself, progresses toward true information management. PMID- 10121110 TI - Nursing clinical education: a partnership with health information management professionals. AB - Today's HIM professional can be a positive and an integral component in providing nursing clinical education. Creativity is the key. HIM professionals can share expertise in the documentation and quality assessment process as well as in the transition to the computerized patient record. By providing HIM information through nursing clinical education, a collaborative partnership can emerge. PMID- 10121111 TI - Is having clinical experience the key to becoming director of quality assurance? PMID- 10121112 TI - A salute to nursing and health information management. PMID- 10121113 TI - Imaging technology: a new efficiency tool for nursing. PMID- 10121114 TI - Consents and patient advocacy: how well do you measure? PMID- 10121115 TI - Physician acceptance of computerized clinical records. PMID- 10121116 TI - Preparing physicians for a computer-based patient record system. AB - The Providence experience provides a model which encompasses both preparation for a computer-based patient record and a physician-oriented approach to achieving quality documentation for the physician component of the patient record. The study comparing Providence to a similar medical center demonstrated the value of the new system in achieving quality patient records. Many hospitals in the Seattle area, including Overlake, now use this system or variations of it. PMID- 10121117 TI - Preferred provider organizations. A review and update. Part II. PMID- 10121118 TI - The attitudes of surgeons toward clinical trials. PMID- 10121119 TI - The impaired surgeon. Diagnosis, treatment, and reentry. Committee on the Impaired Physician, American College of Surgeons Board of Governors. PMID- 10121120 TI - An insider's view of the National Practitioner Data Bank. Interview by Robin E. Stombler. PMID- 10121121 TI - Preferred provider organizations--a review and update. Part I. AB - This is the first of two articles on preferred provider organizations (PPOs). Part I focuses on how PPOs operate, their rapid growth in the private sector, and the Health Care Financing Administration's (HCFA's) involvement with PPOs for Medicare beneficiaries. Part II, which will appear in next month's issue of the Bulletin, will report on recent research concerning PPOs' cost-effectiveness, states' legislative activities affecting PPOs, and potential liability issues created by PPOs, as well as the College's views on these types of health care delivery systems. PMID- 10121122 TI - Designing a physician computer network for a managed care environment. PMID- 10121123 TI - Applying concurrent engineering concepts to clinical information systems. PMID- 10121124 TI - Looking north: the Canadian health care system and its information systems implications. PMID- 10121125 TI - AHA's reform vision. Implications for health care information and management systems. PMID- 10121126 TI - The challenge of using information systems to support managed care. PMID- 10121127 TI - Experimentation with nurse staffing models pays at Tri-City Medical Center--even when it sometimes doesn't. PMID- 10121128 TI - Boston's Beth Israel fights "the hourly mentality.". PMID- 10121129 TI - PIP cuts costs, empowers nurses at Baptist, Miami. PMID- 10121130 TI - Clinical pathways stretch patient care but shrink costly lengths of stay at Anne Arundel Medical Center in Annapolis, Maryland. PMID- 10121131 TI - Anne Arundel Medical Center. A home health service for every maternity patient. PMID- 10121132 TI - Teams manage teams at Pittsburgh's St. Clair Hospital through an elaborately structured QUEST for quality gains hospitalwide. PMID- 10121133 TI - A CQI approach to utilization management at California's Fresno Community Hospital. PMID- 10121134 TI - Revitalized culture of openness and trust is foundation for broad TQM initiatives at 500-bed Crawford Long Hospital in Atlanta. PMID- 10121135 TI - Sustained turnaround follows restructuring at Cardinal Glennon Children's Hospital. PMID- 10121136 TI - Ambitious "Care 2000" initiative decentralizes work processes at San Diego's Mercy Hospital & Medical Center. PMID- 10121137 TI - Cross-functional process improvement--five success factors and five pitfalls. PMID- 10121138 TI - RN "business managers" of mini product lines characterize case management at St. Peter's Medical Center, New Brunswick, New Jersey. PMID- 10121139 TI - Operational restructuring revisited. PMID- 10121140 TI - Kids Rx US. James Whitcomb Riley Hospital for Children, Indianapolis. PMID- 10121141 TI - Crazy shapes with big hearts. Bellevue Hospital, New York. PMID- 10121142 TI - A children's beach far from the sea. St. Margaret's Center for Children, Albany, NY. PMID- 10121143 TI - A cure for institutional design syndrome. Beth Israel Hospital, Boston. PMID- 10121144 TI - The diagnosis for health care. PMID- 10121145 TI - The doctor is in style. Providence Hospital, Oakland, CA. PMID- 10121146 TI - Annual directory & buyer's guide 1992. AB - Contract Design is pleased to present the 1992 edition of its comprehensive listing of the nation's top contract furnishings sources to our readers. Information is organized in the following sections. An Alphabetical Listing by company names provides the updated addresses and telephones of contract furnishings manufacturers, importers and other suppliers. An Associations roster includes the updated addresses and telephones of the design community's professional and trade associations. A Trade Marts directory lists the addresses and telephones of the trade marts whose showrooms display contract furnishings around the nation. And finally, a Classified Product Listing identifies major contract furnishings sources who supply given categories of products, such as executive task seating. We hope the design community finds this Directory and Buyer's Guide to be useful throughout the year. Your suggestions for improving future editions are always welcome. Our thanks to all the members of the design community who helped us prepare the 1992 edition. PMID- 10121147 TI - Hit by a slow, moving target. PMID- 10121148 TI - Hot topic... California Technical Bulletin 133. PMID- 10121149 TI - What do the aging want? PMID- 10121151 TI - Calling health care central. PMID- 10121150 TI - Come home to Nagoya... Morning Park Chikaramachi Retirement Community. PMID- 10121152 TI - The sharper image... Kaiser Permanente/San Diego's new MRI unit. PMID- 10121153 TI - Is health care too specialized? PMID- 10121154 TI - Your money or their lives. Patient advocates are learning from AIDS activists how to work the system. PMID- 10121155 TI - Oregon's bitter medicine. PMID- 10121156 TI - Data watch. Health promotion initiatives. PMID- 10121157 TI - Bringing cost containment to rural networks. PMID- 10121158 TI - Managed care comes to workers' compensation. PMID- 10121159 TI - Filling the gaps in stop-loss insurance. AB - Stop-loss insurance can provide protection from catastrophic medical claims for self-insured companies: But buyer beware. PMID- 10121160 TI - Case management evolves into a quality care program. PMID- 10121161 TI - Employers negotiate with hospital group. AB - Buyers Health Care Cooperative uses Medicare cost data and other hospital data to negotiate hospital contracts. PMID- 10121162 TI - Filling the communication gap. AB - Forming a new partnership, B&H and Mercer plan a survey on communication among all parties involved in health care delivery. PMID- 10121163 TI - N.J. revamps hospital billing system. PMID- 10121164 TI - Lacking funds, Minnesota coalition folds. PMID- 10121165 TI - Measuring quality of life. PMID- 10121166 TI - Avoiding lifelong pledges in retiree plans. PMID- 10121167 TI - Should private payers rush to adopt RBRVS? PMID- 10121168 TI - Data watch. Opinions on health care reform. PMID- 10121169 TI - While Congress debates, the states legislate. PMID- 10121170 TI - Presidential candidates' propose health care platforms. PMID- 10121171 TI - Health reform plans adapted from Jackson Hole vie for support. PMID- 10121172 TI - Lobbyists want to limit federal intervention in health care. PMID- 10121173 TI - Massachusetts' "miracle" reform plan stalls. PMID- 10121174 TI - Politics aside, three employers join forces. PMID- 10121175 TI - Hawaii--a blueprint for health care reform. PMID- 10121176 TI - Data watch. A sample of outcomes and cost data. PMID- 10121177 TI - Practice guidelines are adding value to managed care. PMID- 10121178 TI - The quest for quality data. PMID- 10121179 TI - Labor makes strides in health care cost containment. PMID- 10121180 TI - Courts favor shareholder activity in health care reform. PMID- 10121181 TI - Expanding employee assistance programs is paying dividends. PMID- 10121182 TI - Cincinnati splinter group seeks results. PMID- 10121184 TI - Employee assistance programs. PMID- 10121183 TI - Employers are cool to Minnesota's reform. PMID- 10121185 TI - Health care reform must be a group effort. PMID- 10121186 TI - Abnormal occurrences for first quarter CY 1992 dissemination of information--NRC. PMID- 10121187 TI - Acquisition regulation; incremental funding and protests--HHS. Final rule. AB - The Department of Health and Human Services is amending its acquisition regulation (HHSAR), title 48, Code of Federal Regulations, chapter 3, to make two administrative changes. PMID- 10121188 TI - Medicare program; Medicare and Laboratory Certification Program; enforcement procedures for laboratories--HCFA. Correction notice. AB - In the February 28, 1992 issue of the Federal Register (FR Doc. 92-4050) (57 FR 7218), we established rules for sanctions that HCFA may impose on laboratories that are found not to meet Federal requirements. This notice corrects both typographical and technical errors made in that document. PMID- 10121189 TI - Medicare program; self-implementing coverage and payments provisions: 1990 legislation--HCFA. Final rule with comment period. AB - This rule updates Medicare regulations to add or conform them to certain self implementing provisions on coverage of services and payment requirements under the Omnibus Budget Reconciliation Act of 1990 (OBRA '90). OBRA '90 was enacted November 5, 1990 and the cited changes to the statute are already in effect. Certain related self-implementing provisions of the Omnibus Budget Reconciliation Act of 1989 (OBRA '89), and the Medicare Catastrophic Coverage Act (MCCA) of 1988, are included as necessary for consistency and clarity of the OBRA '90 provisions. PMID- 10121190 TI - Medicare program; HHS' recognition of NAIC Model Standards (National Association of Insurance Commissioners) for regulation of Medigap policies--HCFA. Notice. AB - This notice contains a list of the ten standardized Medicare supplemental insurance benefit packages that may be offered to Medicare beneficiaries consistent with the requirements of section 1882 of the Social Security Act (the Act), as amended by sections 4351 through 4358 of the Omnibus Budget Reconciliation Act of 1990. This list is included in section 9 of the Model Regulation adopted by the National Association of Insurance Commissioners (NAIC) on July 30, 1991, which is reprinted at the end of the notice. Until the publication of this list, certain provisions of section 1882 of the Act relating to this type of insurance were inapplicable to sellers who are not also the issuers of health insurance policies being sold to Medicare beneficiaries. PMID- 10121191 TI - Standards for protection against radiation; extension of implementation date- NRC. Final rule. AB - The Nuclear Regulatory Commission (NRC) is extending the implementation date for its revised standards for protection against radiation and making a conforming change to its regulation. See SUPPLEMENTARY INFORMATION for specific regulatory parts affected. This rule extends the date by which NRC licensees are required to implement the revised standards for protection against radiation to January 1, 1994. The 1-year extension provides licensees additional time to examine and implement the regulatory guidance developed to support the rule. It also establishes a concurrent implementation date for NRC licensees and Agreement State licensees. PMID- 10121192 TI - Medicare program; beneficiary counseling and assistance grants program--HCFA. Interim final rule with comment period. AB - This interim final rule establishes a minimum level of funding for grants made to States for the purpose of providing information, counseling, and assistance relating to the procurement of adequate and appropriate health insurance coverage to individuals who are eligible to receive benefits under the Medicare program. This rule implements, in part, section 4360(a) of the Omnibus Budget Reconciliation Act of 1990. PMID- 10121193 TI - Medicaid program; Medicaid Management Information System (MMIS) performance review; notification procedures for changes in requirements, performance standards, and reapproval conditions--HCFA. Final rule. AB - This rule eliminates the requirement in the Medicaid regulations that HCFA meet certain Federal Register notification requirements for any changes in performance standards and other conditions for reapproval of State Medicaid Management Information Systems (MMISs), even if such Federal Register notice would not otherwise be required. An independent Federal Register publication requirement will remain in place with respect to changes in system requirements and other conditions for approval of MMISs. We believe that a revised process for notifying States and other concerned parties of changes in performance standards and other conditions of reapproval is appropriate and will facilitate the efficient issuance of revised MMIS review requirements and methodologies each year. PMID- 10121194 TI - Medicare program; changes to the hospital inpatient prospective payment systems and fiscal year 1993 rates--HCFA. Final rule. AB - We are revising the Medicare hospital inpatient prospective payment systems for operating costs and capital-related costs to implement necessary changes arising from our continuing experience with the systems. In addition, in the addendum to this final rule, we are describing changes in the amounts and factors necessary to determine prospective payment rates for Medicare hospital inpatient services for operating costs and capital-related costs. These changes will be applicable to discharges occurring on or after October 1, 1992. We are also setting forth rate-of-increase limits for hospitals and hospital units excluded from the prospective payment systems. Finally, we are changing and clarifying the criteria and procedures concerning the reclassification of hospitals by the Medicare Geographic Classification Review Board (MGCRB). These changes result from public comment and our analysis of hospital reclassifications for Federal fiscal year (FY) 1992. PMID- 10121195 TI - Collection from third party payers of reasonable costs of healthcare services- DoD. Final rule. AB - This final rule would amend the DoD regulation that implements 10 U.S.C. 1095. This statute generally provides for collection by the United States from third party payers of reasonable costs of healthcare services provided in facilities of the Uniformed Services to DoD beneficiaries who are also beneficiaries under the third party payer's plan. This final rule also implements recent legislative amendments that expanded their third party collection authority to cover outpatient services, automobile liability and no-fault insurance policies, and Medicare supplemental insurance plans. Active duty members are included in collections from automobile liability and no-fault insurance carriers. In addition the final rule revises methods for determining reasonable costs for inpatient care services. PMID- 10121196 TI - Quality management program and misadministrations; NRC override of OMB disapproval of NRC information collection request--Nuclear Regulatory Commission. Final rule. AB - The Commission has voted to override the Office of Management and Budget (OMB) disapproval of the information collection requirements imposed in the final rule entitled "Quality Management Program and Misadministrations" (July 25, 1991; 56 FR 34104). As part of this final rule, the Commission is amending its regulations to reflect OMB's assignment of a new control number to these information collection requirements. The Commission reevaluated the need for this final rule and the information collection requirements it contains. The Commission continues to believe that its requirements for written quality management programs and misadministration reports, if complied with, have a reasonable likelihood of decreasing misadministrations (e.g., wrong dose or wrong patient) with a small incremental cost to licensees. Without the reporting and recordkeeping requirements, it would not be possible to implement and enforce these regulations effectively. PMID- 10121197 TI - Licensing of low-power medical devices in the 450-470 MHz band--FCC. Final rule. AB - The Commission has decided that hospitals and healthcare institutions will no longer be required to separately license low-power medical devices operating on the offset frequencies in the 450-470 MHz band. Instead, they will be permitted to operate such devices under the authority of other licensed radio facilities. This action will reduce the cost and burden associated with the licensing of these devices. PMID- 10121198 TI - Medicare program; schedule of limits on home health agency costs per visit for cost reporting periods beginning on or after July 1, 1992; correction--HCFA. Notice with comment period; correction. AB - In the July 1, 1992 issue of the Federal Register (FR Doc. 92-15496) (57 FR 29410), we published a notice with comment period that set forth a revised schedule of limits on home health agency costs that may be paid under the Medicare program. The July 1, 1992 notice applies to cost reporting periods beginning on or after July 1, 1992. This notice corrects errors made in the July 1, 1992 document. PMID- 10121199 TI - Medicare program; criteria and standards for evaluating intermediary and carrier performance during FY 1993--HCFA. General notice with comment period. AB - This notice describes the criteria and standards to be used for evaluating the performance of fiscal intermediaries and carriers in the administration of the Medicare program beginning October 1, 1992. The results of these evaluations are considered whenever HCFA enters into, renews, or terminates an intermediary agreement or carrier contract or takes other contract actions (e.g., assigning or reassigning providers of services to an intermediary, designating regional or national intermediaries, etc.). This notice is published in accordance with sections 1816(f) and 1842(b)(2) of the Social Security Act. We are publishing for public comment in the Federal Register those criteria and standards against which we evaluate intermediaries and carriers. PMID- 10121200 TI - Mailability of sharps and other medical devices--Postal Service. Amendment to final rule. AB - In response to further comments, and to ensure that parcels covered by this rule will be in complete compliance with Department of Transportation regulations on shipping papers and marking of hazardous materials, and to preclude parcels of this type from being rejected by the airlines, we are amending the final rule titled Mailability of Sharps and Other Medical Devices, dated June 30, 1992. PMID- 10121201 TI - Medicare and Medicaid programs; revaluation of assets--HCFA. Final rule. AB - This final rule revises the Medicare and Medicaid regulations that are affected by section 2314 of the Deficit Reduction Act of 1984 and sections 9110 and 9509 of the Consolidation Omnibus Budget Reconciliation Act of 1985. Those provisions amended sections 1861(v)(1) and 1902(a)(13) of the Social Security Act. This rule describes new limitations on the valuation of assets acquired as the result of changes in ownership occurring on or after July 18, 1984. These changes affect hospitals and skilled nursing facilities under the Medicare program and hospitals, nursing facilities, and intermediate care facilities for the mentally retarded under the Medicaid program. PMID- 10121202 TI - Medicare and Medicaid; requirements for long term care facilities--HCFA. Final rule. AB - In Federal Register document 91-22274, published on Thursday, September 26, 1991, beginning on page 48826, we amended Medicare and Medicaid rules applicable to requirements for long term care facilities. In addition to correcting typographical errors, we are making a limited number of technical corrections to our September 26, 1991 document to take into account changes made by other regulations, but not included in the document, or inconsistencies between preamble statements and the regulations text. All such technical corrections are explained in the preamble to this rule. PMID- 10121203 TI - Departures from manufacturer's instructions; elimination of recordkeeping requirements--NRC. Final rule. AB - The Nuclear Regulatory Commission (NRC) is amending its regulations to eliminate certain recordkeeping requirements related to the preparation and use of radiopharmaceuticals. Specifically, this rule eliminates recordkeeping requirements related to the justification for and a precise description of the departure, and the number of departures from the Food and Drug Administration (FDA) approved manufacturer's instructions. Both the NRC and the FDA staffs agree that the major trends in departures that may be identified by this recordkeeping are already discernible and collecting additional data is unnecessary. PMID- 10121206 TI - The role of the medical laboratory technologist in drinking and driving cases. Part 1: The Criminal Code and blood collection for alcohol analysis. AB - Police officers can now demand blood samples from suspected impaired drivers in Canada to determine their Blood Alcohol Concentration. The medical laboratory technologist has been given the authority to take blood samples for legal purposes, as well as the authorization to complete certificates used as evidence in court. The proper procedures for the taking of blood samples and the completion of certificates are described in detail. The Criminal Code offences dealing with drinking and driving, the means by which police officers can legally obtain blood samples, the Blood Alcohol Kit, and the provision of providing blood collection evidence in court are discussed to aid the technologists in understanding their role in this process. The Criminal Code definitions of a "qualified medical practitioner", a "qualified technician", and "approved containers" are also described. PMID- 10121205 TI - Less-radical surgery. PMID- 10121204 TI - Wanted: GPs. AB - Too many physicians are being trained as specialists and not enough as generalists. As a result, the nation's health care system emphasizes high-cost, high-technology medicine at the expense of basic and preventive care. PMID- 10121207 TI - National credentialing. Implications of the development of provincial regulatory bodies. AB - The CSLT Board feels that it has developed a structure that will allow it to deal with provincial regulatory bodies as they develop while continuing to cooperate with provincial societies. It has accepted that there will be significant changes in the role of the CSLT, particularly in the area of credentialing. The primary concern of the CSLT is national standards and portability of certification. The Board is committed to responding to the changes brought about through provincial regulatory legislation and to working with the bodies designated under this legislation to preserve national certification. PMID- 10121208 TI - The 1991 CCHFA standards and risk management. PMID- 10121209 TI - Qualification of medical laboratory technologists. Canadian Society of Laboratory Technicians. PMID- 10121210 TI - Membership survey report. Canadian Society of Laboratory Technologists. PMID- 10121211 TI - Evaluation of films for use in portal imaging in radiation therapy--a study at the Saskatoon Cancer Centre. AB - A new type of film--Ektamat G--was tested at the Saskatoon Cancer Centre Radiation Therapy Department and compared to Ortho G film. The study evaluated each film's contrast, density and radiation dose to the patient. Findings indicate that Ektamat G is a practical alternative to Ortho G for use as a port film in radiation therapy. PMID- 10121212 TI - Should you ever blow the whistle? PMID- 10121213 TI - Making new employees an integral part of the team. PMID- 10121214 TI - Pharmacy services: next summit for chains. Consultant pharmacists brace for stiffer competition. PMID- 10121215 TI - Working smart. Avoid computerization pitfalls. PMID- 10121216 TI - Bloodborne pathogen safeguards. How to prepare for OSHA inspections. PMID- 10121217 TI - Staff abuse in nursing homes. Negative stereotypes perpetuate injustice. PMID- 10121218 TI - Sponsors must face harsh realities. Sagging economy presents new challenges. PMID- 10121219 TI - Hopes pinned to new provider tax. PMID- 10121220 TI - We are looking at designing an exercise/wellness program at our facility. Can you provide information on this topic? PMID- 10121221 TI - Taking a peek at annual incomes. Salaries reflect facilities' revenues. PMID- 10121222 TI - How to slow the revolving door. Aging in place and resident turnover. PMID- 10121223 TI - Multi-dimensional care. Geriatric networks overcome fragmentation. PMID- 10121224 TI - New regs promote aging in place. PMID- 10121225 TI - Total quality management. PMID- 10121226 TI - Get a jump on preparing for surveys. PMID- 10121227 TI - No excuse for malnutrition. PMID- 10121228 TI - Extended and partial extended surveys. PMID- 10121229 TI - Scandinavian home care for the elderly. AB - Scandinavian countries provide an example of proactive social policies that aid in the health care of the elderly. Systems in both Norway and Sweden emphasize decentralization of services; with their strong social systems, these countries' home care services for the elderly could be applied with good results elsewhere. PMID- 10121230 TI - The global home care labor market. AB - The home care industry has survived one round of labor shortage and currently meets its needs. But when the economy improves and many of the workers stop working, no longer needing to earn this income, will the industry have access to enough home care aides and paraprofessionals? PMID- 10121231 TI - Solving problems with traveling health care professionals. PMID- 10121232 TI - The importance of cross-cultural effectiveness. AB - The need to be cross-culturally competent is increasing in today's society, where many nationalities live within the same geographical area. Each nationality may have different cultural or religious beliefs that affect how they accept care; providers must be aware of these beliefs in treating diverse children. PMID- 10121233 TI - Addressing cultural diversity through transcultural nursing. PMID- 10121234 TI - A new home health classification method. AB - The Home Health Care Classification Method used with the assessment instrument and scoring methodology can predict resource requirements in terms of three cohorts of time and volume of nursing and all provider visits. This HHCC Method can be used to predict care requirements for planning purposes, including the staffing and provider mix, to determine the scope and type of services, to identify the fiscal needs and constraints, and to fulfill other administrative needs. It also can track the home care process, measure patient outcomes for home care quality assurance, facilitate efficient documentation, and form the basis for predicting costs of home health care. The coding schemes developed for the Classification of Home Health Care Nursing Diagnoses and Interventions can be used not only to code but also statistically to analyze home care nursing data. This classification provides the mechanism to link nursing diagnoses to nursing interventions. It can be used in other research studies and has the potential for the design of computer systems for home health care. PMID- 10121235 TI - Lessons to be learned. Home care in other countries. AB - In a study of home care in six European countries, researchers from Columbia University found that home care is generally an entitlement provided on a public basis. Programs differ from country to country, but this right is a common thread in care of the elderly. PMID- 10121236 TI - Toward an International Association for Home Care. AB - There is a great need and a growing interest in the creation of an International Association for Home Care. The NAHC Board of Directors has already approved this proposal, and is moving ahead toward implementation. Undoubtedly, the creation of an international group will bring wide-scale benefits to home care interest, caregivers, and beneficiaries in America and all across the world. PMID- 10121237 TI - HealthRIGHT. On the move for US health reform. PMID- 10121238 TI - The health care crisis in Russia. AB - Home care in the former Soviet Union is tied into a system of health care that revolves around the polyclinic, which provides both home and institutional care. As a US delegation of home care professionals saw on a visit a year ago, the whole system is in a state of crisis. PMID- 10121239 TI - The evolution of home care in The Netherlands. AB - As the Netherlands strives to reform its entire health care delivery system, home care is perhaps the one sector where the opportunity for innovation is the greatest. Home care is evolving from a low-technology, noncompetitive, and simply regulated field to an arena in which technology, market forces, and increasing regulatory complexity characterize its growth. PMID- 10121240 TI - Battling AIDS through home care in Uganda and Zambia. AB - Innovative home care programs, providing a variety of services to persons with HIV infection and their families and reflecting different health, political, cultural, social, and philosophical concepts, have been developed in Africa, starting in 1987. In 1989 the World Health Organization (WHO) Global Programme on AIDS conducted a descriptive study of some of these programs. It is hoped that these experiences will assist planners and health care providers in their decision making and thereby benefit persons with HIV infection and their families. The lessons learned about the context, backgrounds, structure, process, and outcome of the six selected home care programs can be used and adapted by policymakers and program planners in their own settings when deciding on "their" model of home care. PMID- 10121241 TI - The birth of home care in China. AB - China, one of the world's largest and oldest civilizations, is just beginning to develop formal home care programs. While these new programs seek to borrow from more established Western programs, they also borrow a great deal from the rich tradition of elder esteem and family care in China's history. PMID- 10121243 TI - A national strategy to encourage productive aging. PMID- 10121242 TI - The Dominican Republic's focus on aging. AB - The Dominican Republic needed to assess its aging population to develop an understanding of its needs and expand opportunities for integrating the elderly into society. The two articles included here offer a perspective on how this small nation undertook such a task. First, a Kansas State University study found the country's elderly poor, hungry, and uninvolved. Under a new national strategy, which redefines the aged as an asset rather than a liability, the country is working to coordinate efforts of diverse organizations to include the aged in their projects--no small feat in a developing country. PMID- 10121244 TI - Toward productive & participatory aging in India. AB - The programs that address the issues of the elderly in India have changed their format. From a program of doles to the destitute elderly, the country now looks to programs of empowerment to enable the elderly to be active participants in the process of development. PMID- 10121245 TI - Japan's Golden Plan for the elderly. AB - One of the most industrialized nations in the world, Japan has an increasing number of workers reaching retirement age. Faced with tremendous health care costs for its elderly, Japan has proposed a 10-year plan to lessen costs and put health care back into the community. PMID- 10121246 TI - The reform and redirection of long-term care in Ontario. AB - In Ontario, the current fragmented health services system cannot respond to projected demands. Several government reports recommend a shift of focus from institutionalization to community-based services--one-stop shopping--to integrate services. PMID- 10121247 TI - A prescription for cutting health care costs. AB - The pharmaceutical's link to home care is basic: prescription drugs keep patients at home instead of in institutions. For example, drugs keep Alzheimer's disease patients more alert and thus better able to function and perhaps to stay home longer. Although prescription drugs may be expensive, their long-range cost is lower than institutionalization. PMID- 10121248 TI - From laboratory to medicine cabinet. AB - The process of developing a new drug moves back and forth between industry and regulatory scientists. Although their relationship may sometimes seem adversarial, the common goal is to produce safe, effective medicines that keep patients at home. PMID- 10121249 TI - Expanding European markets for immunotherapy drugs. AB - Exploding markets for immunotherapeutics have hastened research and development of new drugs to treat patients in institutions and at home. Recent figures reveal just how quickly this market is expanding. PMID- 10121250 TI - Solving medication noncompliance in home care. AB - The problem of medication noncompliance is frequently encountered by home care nurses and poses a continuous challenge in daily practice. Because of their advantageous position, home care nurses can be instrumental in addressing this problem. This article discusses various types and causes of noncompliance and presents some solutions that can be implemented in the home. PMID- 10121251 TI - The emergence of the home care pharmacist. AB - As the fastest growing ambulatory care market in the United States, home care provides a challenging opportunity for pharmacists, but this opportunity has yet to be fully realized. This article will explore the potential for pharmacists in home care and barriers that have kept pharmacists from becoming full-fledged members of the home care team. PMID- 10121252 TI - Medication knowledge and compliance. Home care vs. senior housing clients. AB - Are home care patients as knowledgeable about their medications and do they take them with as much adherence to prescription as their counterparts in senior citizen housing do? A study concentrates on knowledge and compliance in two geriatric populations. PMID- 10121253 TI - Color coding patient medications. AB - "When I first met Mr. K, he had just been discharged from the hospital, where he was treated for congestive heart failure. This was his third admission this year- his physician thought he might not be taking his medications correctly. The doctor had referred him to our home care agency for instructions in taking his medications and for cardiopulmonary assessment." A home care nurse explains how she developed a simple medication coding method to ensure an elderly patient's independence--and health. PMID- 10121254 TI - Strategic planning for tomorrow's success. AB - The changes that have occurred in the home care industry in the last few years have been immense. To be competitive agencies now must consider activities as broad ranging as forming mission statements and expanding services. Pharmacy services might be a first step to individual agency change. PMID- 10121255 TI - The criminal prosecution of Medicare cost reports. AB - In this opinion piece, the authors review a Medicare fraud case that they consider to have far-reaching impact on the industry. Their article seeks to inform the industry of the possible ramifications that these verdicts could have on Medicare cost reports--verdicts that the authors deem "devastating." PMID- 10121256 TI - Taking your Medicare claims to court. AB - Appealing denied claims involves time, energy, and a determination to preserve the Medicare rights of both the provider and patient. But the reasons for taking Medicare claims to court far outweigh any excuses for not doing so. And given the capricious and arbitrary decisions of some intermediaries, corporate survival may depend upon it. PMID- 10121257 TI - Access to health care: rhetoric vs. reality. AB - This article has attempted to provide a broad stroke overview of some of the populations who are effectively denied adequate or any access to health care in our country. As there are multiple barriers to access, as illustrated earlier, so too social workers and discharge planners must be cognizant of the various ways that they can provide entree to health care for those who are disenfranchised. In a succeeding article, we will explore avenues for individual advocacy as well as for systematic change in the delivery system that can be effectuated by social workers and discharge planners. PMID- 10121258 TI - Discharge complications. Documentation: prelude to problem solving. PMID- 10121259 TI - The American Hospital Association's vision for health care reform. PMID- 10121260 TI - Mentally ill patients. Enfranchised, but disenfranchised. PMID- 10121261 TI - Medicaid application unit combines advocacy with pragmatism. PMID- 10121262 TI - Medicaid program brings in revenue, improves institutional relationships. PMID- 10121263 TI - The maintenance, funding and modification of retiree medical benefits. AB - Retiree medical benefits are an ever-growing concern as costs escalate and the date for implementation of Statement of Financial Accounting Standards No. 106 approaches. These authors summarize case law relevant to employers' right to modify or terminate benefits and discuss methods of funding theses liabilities. PMID- 10121264 TI - Managed health care: great cost savings with minimal legal risks. AB - Managed care offers great promise for health care cost savings, but it is not without risk. This author suggests how that risk can be minimized. PMID- 10121265 TI - In harm's way. PMID- 10121266 TI - Surviving the streets. PMID- 10121267 TI - Attacking violence as a public-health emergency. PMID- 10121268 TI - Mass murder & EMS. PMID- 10121269 TI - Sticks and stones. Violence against homosexuals may be the fastest-growing hate crime. PMID- 10121270 TI - Unfriendly fire. PMID- 10121271 TI - Knock-knock ... carelessness in approaching a scene opens the door for trouble. PMID- 10121272 TI - Tactical EMS. If a SWAT team operates in your jurisdiction, you must have an EMS preplan. PMID- 10121273 TI - Beat the clock. PMID- 10121274 TI - Collision. PMID- 10121275 TI - School daze. PMID- 10121276 TI - MDR (multidrug-resistant) tuberculosis. PMID- 10121277 TI - Querying Mrs. Quayle. Interview by Jim Halsey. PMID- 10121278 TI - Are we doing the whole job? PMID- 10121279 TI - Computerizing housekeeping: how it can enhance your accountability. PMID- 10121280 TI - Environmental control. Are you really managing? PMID- 10121281 TI - Hospitals and their disposal of infectious waste. AB - A thorny problem facing many hospital managers (often the environmental services manager) today is how to safely handle and dispose of infectious and hazardous waste in a cost-effective fashion. This is a very complex issue, involving myriad regulations, ethical issues, and cost analysis. PMID- 10121282 TI - The role of the Medical Care Advisory Committee in the administration of state Medicaid programs. A twenty-year perspective. AB - Every state Medicaid program has a Medical Care Advisory Committee (MCAC). MCACs are required by federal regulations to have representation from state human service agencies, health care providers, and Medicaid consumers. Survey data presented in this study show the make-up of MCACs by representative group. Other data presented show meeting frequencies, subcommittee structure, and information about MCAC activities. Comparisons are made from historical MCAC data showing long-term trends of their composition and structure. It is argued that MCACs can be useful to state Medicaid agencies in policy development but have not been structured to do so. Recommendations are given to make MCACs more useful. PMID- 10121283 TI - Reliability and accuracy of resident evaluations of surgical faculty. AB - This study examines the reliability and accuracy of ratings by general surgery residents of surgical faculty. Twenty-three of 33 residents anonymously and voluntarily evaluated 62 surgeons in June, 1988; 24 of 28 residents evaluated 64 surgeons in June, 1989. Each resident rated each surgeon on a 5-point scale for each of 10 areas of performance: technical ability, basic science knowledge, clinical knowledge, judgment, peer relations, patient relations, reliability, industry, personal appearance, and reaction to pressure. Reliability analyses evaluated internal consistency and interrater correlation. Accuracy analyses evaluated halo error, leniency/severity, central tendency, and range restriction. Ratings had high internal consistency (coefficient alpha = 0.97). Interrater correlations were moderately high (average Pearson correlation = 0.63 among raters). Ratings were generally accurate, with halo error most prevalent and some evidence of leniency. Ratings by chief residents had the least halo. Results were generally replicable across the two academic years. We conclude that anonymous ratings of surgical faculty by groups of residents can provide a reliable and accurate evaluation method, ratings by chief residents are most accurate, and halo error may pose the greatest threat to accuracy, pointing to the need for greater definition of evaluation items and scale points. PMID- 10121284 TI - Why nonprofits don't measure cost-effectiveness. PMID- 10121285 TI - Managing cultural diversity. PMID- 10121286 TI - Sharpening your interviewing skills. PMID- 10121287 TI - 14 fallacies of capital campaigns. AB - Shortcuts are always easier and almost always fatal. Stick to the time-tested verities of fund raising and you can't go wrong. PMID- 10121288 TI - Making major gifts happen. PMID- 10121289 TI - Fund-raising research: prospecting for gold. AB - As the fund-raising field grows and becomes more sophisticated, the need for research intensifies. Knowing the sources of information can simplify the task. PMID- 10121290 TI - Non-profit software package directory. PMID- 10121291 TI - Latex allergies: when rubber rubs the wrong way. AB - Health-care workers are at highest risk of allergies to latex because of their frequent contact with gloves and other medical devices made from rubber. But others also can develop problems due to their sensitivities and the ubiquity of latex. PMID- 10121292 TI - A taxonomy of case management tasks in community mental health facilities. PMID- 10121293 TI - How public opinion really works. AB - The public's thinking on issues progresses through seven predictable stages, the dean of American pollsters finds. Politicians make a big mistake just looking at raw numbers. PMID- 10121294 TI - The right cure for health care. AB - An aging population with nearly unlimited access to high-priced doctors and technology is pushing medical costs skyward. Managed care is the best way to bring them down. PMID- 10121295 TI - Health insurance in developing countries: lessons from experience. AB - Many developing countries are currently considering the possibility of introducing compulsory health insurance schemes. One reason is to attract more resources to the health sector. If those who, together with their employers, can pay for their health services and are made to do so by insurance, the limited tax funds can be concentrated on providing services for fewer people and thus improve coverage and raise standards. A second reason is dissatisfaction with existing services in which staff motivation is poor, resources are not used to best advantage and patients are not treated with sufficient courtesy and respect. This article describes the historical experience of the developed countries in introducing and steadily expanding the coverage of health insurance, sets out the consensus which has developed about health insurance (at least in Western European countries) and describes the different forms which health insurance can take. The aim is to bring out the advantages and disadvantages of different approaches from this experience, to set out the options for developing countries and to give warnings about the dangers of some approaches. PMID- 10121296 TI - ED's new role requires new standards and support. PMID- 10121297 TI - Work with area employers to improve cost-efficiency. AB - Employers are becoming more active in affecting health care delivery systems and developing new health care coalitions and systems. Hospitals will benefit from building a dialog with the employers and industry groups in their service areas. By sharing information and working together, hospitals and employers have the opportunity to check rising costs, avoid duplication of services and maximize utilization of health care resources. PMID- 10121298 TI - Package pricing project improves hospital-physician relations. Interview by Donald E.L. Johnson. AB - St. Joseph Mercy Hospital in Ann Arbor, Mich., is one of the four hospitals participating in a unique federal project testing package pricing for coronary by pass procedures. In the following interview with Donald E.L. Johnson, editor and publisher of Health Care Strategic Management, Garry C. Faja, CEO of St. Joseph Mercy, explains how the project has impacted relations between the medical staff and hospital administrators. It has led to more sharing of data and ideas as well as unifying the many people involved in the hospital's cardiology program. Surprisingly, it was the cardiac surgeons who spearheaded the project. "They saw it as a direction for the future," Faja said. PMID- 10121299 TI - Collaboration will demand CEO time commitment. PMID- 10121300 TI - Planning indicators. Premier survey provides a view of the hospital of the future. PMID- 10121301 TI - Planning for health care reform; more work for fewer dollars. AB - A major concern from hospitals about adopting the Canadian national health insurance plan as a model for reform is the potential for limits on hospital capital and operating expenditures set at national and state levels. Also, some hospitals fear that they would receive limited income from patient revenues despite a significant increase in expenses. Germany, with a quasi-private, quasi public approach, offers a more pluralistic model that might be a more suitable approach, although with either option U.S. hospitals may need to provide more care with relatively fewer dollars. PMID- 10121302 TI - Supporting and operating a clinical research program. PMID- 10121303 TI - Hospital consolidation gives opportunity to redefine focus. Interview by Donald E.L. Johnson. AB - P/SL Healthcare System, Denver, just completed a five-year ordeal of consolidating two hospitals, expanding tertiary services and building and moving into a new $120 million facility, Presbyterian-St. Luke's Medical Center. The process was interrupted by the sale of the hospitals, which forced a construction halt. In this interview with Donald E.L. Johnson, editor and publisher of Health Care Strategic Management, Donald W. Lenz, president of P/SL Medical Center, discusses planning the merger, constructing the facility, managing the move and positioning the hospital for the future. The hospital's design is innovative, with parts of the facility resembling a fine hotel. The curved building is attractive and improves productivity by concentrating central services in easily accessible areas. PMID- 10121305 TI - Forecasts may be flawed because of people factor. PMID- 10121304 TI - New patient tower mixes aesthetics with practicality. AB - The new patient tower at Presbyterian-St. Luke's Medical Center in Denver gave administrators and architects the chance to create a new hospital. At the same time, they had to adapt their designs to the existing services and layouts of the adjacent hospital, Presbyterian Denver. The result was a mixture of aesthetics and practicality that offers an uncommon level of patient comfort in a non institutional setting and provides staff with an efficient, functional hospital environment. PMID- 10121306 TI - Planning indicators. How hospitals respond to cost-saving measures. PMID- 10121307 TI - How providers can preserve mutually beneficial joint ventures. AB - Joint ventures between hospitals and physicians were formed at a dizzying pace during the 1980s. Many of these joint ventures are now a source of concern for both hospital and physician partners. In the following article, the authors discuss their experience with joint ventures in the wake of recent and proposed regulatory and legislative activity and present several practical strategies for hospital executives to consider regarding their joint ventures. PMID- 10121309 TI - Special report on antitrust. New antitrust merger guidelines. PMID- 10121308 TI - IRS announces an "amnesty" program for unwinding joint ventures. PMID- 10121310 TI - Brief of the Law Reform Commission of Canada to the Royal Commission on new reproductive technologies. PMID- 10121311 TI - Substitute decision-making and the substitute decision-maker. PMID- 10121312 TI - Foetal tissue transplantation research: a Canadian policy analysis. PMID- 10121313 TI - The CEO as organizational architect: an interview with Xerox's Paul Allaire. Interview by Robert Howard. AB - As chairman and CEO of the Xerox Corporation, Paul Allaire leads a company that is a microcosm of the changes transforming American business. With the introduction of the first plain-paper copier in 1959, Xerox invented a new industry and launched itself on a decade of spectacular growth. But easy growth led Xerox to neglect the fundamentals of its core business, leaving the company vulnerable to low-cost Japanese competition. Starting in the mid-1980s, Xerox embarked on a long-term effort to regain its dominant position in world copier markets and to create a new platform for future growth. Thanks to the company's Leadership through Quality program, Xerox became the first major U.S. company to win back market share from the Japanese. Allaire describes his efforts to take Xerox's corporate transformation to a new level. Since becoming CEO in 1990, he has repositioned Xerox as "the document company" at the intersection of the worlds of paper-based and electronic information. And he has guided the company through a fundamental redesign of what he calls the "organizational architecture" of Xerox's document processing business. Few CEOs have approached the process of organizational redesign as systematically and methodically as Allaire has. He has created a new corporate structure that balances independent business divisions with integrated R&D and customer operations organizations. He has redefined managerial roles and responsibilities, changed the way managers are selected and compensated, and renewed the company's senior management ranks. And he has articulated the new values and behaviors Xerox managers will need to thrive in a more competitive and fast-changing business environment. PMID- 10121314 TI - What is a global manager? AB - To compete around the world, a company needs three strategic capabilities: global scale efficiency, local responsiveness, and the ability to leverage learning worldwide. No single "global" manager can build these capabilities. Rather, groups of specialized managers must integrate assets, resources, and people in diverse operating units. Such managers are made, not born. And how to make them is--and must be--the foremost question for corporate managers. Drawing on their research with leading transnational corporations, Christopher Bartlett and Sumantra Ghoshal identify three types of global managers. They also illustrate the responsibilities each position involves through a close look at the careers of successful executives: Leif Johansson of Electrolux, Howard Gottlieb of NEC, and Wahib Zaki of Procter & Gamble. The first type is the global business or product-division manager who must build worldwide efficiency and competitiveness. These managers recognize cross-border opportunities and risks as well as link activities and capabilities around the world. The second is the country manager whose unit is the building block for worldwide operations. These managers are responsible for understanding and interpreting local markets, building local resources and capabilities, and contributing to--and participating in--the development of global strategy. Finally, there are worldwide functional specialists--the managers whose potential is least appreciated in many traditional multinational companies. To transfer expertise from one unit to another and leverage learning, these managers must scan the company for good ideas and best practice, cross-pollinate among units, and champion innovations with worldwide applications. PMID- 10121315 TI - Is Germany a model for managers? AB - Most American managers have a hard time making sense of Germany. The country has a fraction of the resources and less than one-third the population of the United States. Labor costs are substantially higher, paid vacations are at least three times as long, and strong unions are deeply involved at all levels of business, from the local plant to the corporate boardroom. Yet German companies manage to produce internationally competitive products in key manufacturing sectors, making Germany the greatest competitive threat to the United States after Japan. The seemingly paradoxical nature of the German economy typically evokes one of two diametrically opposed responses. The first is to celebrate the German economy as a "model" worth emulating--indeed, as the answer to declining U.S. competitiveness. The alternative, more skeptical response is to question Germany's staying power in a new, more competitive global economy. According to Kirsten Wever and Christopher Allen, the problem with both points of view is that they miss the forest for the trees. Observers are so preoccupied with praising- or blaming--individual components of the German economy that they fail to see the dynamic logic that ties these components together into a coherent system. In their review of recent research on the German business system, Wever and Allen argue that managers can learn an important lesson from Germany. In the global economy, competition isn't just between companies but between entire socioeconomic systems. Germany's ability to design a cohesive economic and social system that adapts continuously to changing requirements goes a long way toward explaining that country's competitive success. PMID- 10121316 TI - From the classroom to the corner office. AB - Going from Catholic nun and teacher to president and CEO of a $5.7 billion bank is a monumental leap. But Rosemarie Greco found that teaching school is not so different from managing a business. For many years, two insights have guided her transformation and climb up the corporate ladder: that both women and men have the ability to shape their professional destinies, and that there is unlimited power in the fusion of organizational vision and individual fulfillment. Hired in 1968 by Fidelity Bank in Philadelphia as a secretary, Greco was determined that every day on the job she would learn something new about banking. She took careful notes and stored them in a three-ring binder that soon became the bank's official training manual. This led to a promotion to the training department of human resources, putting Greco on a career path she had never envisioned. Along the way, Greco met obstacles, such as a boss who put his own name on her new ideas--a boss whom Greco later fired after she was promoted above him. She helped revise Fidelity's salary-grading system when the bank faced a sex discrimination class-action suit. At the same time, slotting employees into the newly created job grades opened Greco's eyes to the fact that the work of men was valued much more highly than that of women at the bank. When Greco was promoted to director of human resources--and later as CEO--she worked to change that discriminatory corporate culture until Fidelity Bank became one of the top organizations in the country for women to work in.(ABSTRACT TRUNCATED AT 250 WORDS) PMID- 10121317 TI - Capital disadvantage: America's failing capital investment system. AB - The U.S. system of allocating investment capital is failing, putting American companies at a serious disadvantage and threatening the long-term growth of the nation's economy. The problem, says Michael Porter, goes beyond the usual formulation of the issue: accusations of "short-termism" by U.S. managers, ineffective corporate governance by directors, or a high cost of capital. The problem involves the external capital allocation system by which capital is provided to companies, as well as the system by which companies allocate capital internally. America's system is marked by fluid capital and a financial focus. Other countries--notably Japan and Germany--have systems with dedicated capital and a focus on corporate position. In global competition, where investment increasingly determines a company's capacity to upgrade and innovate, the U.S. system does not measure up. These conclusions come out of a two-year research project sponsored by the Harvard Business School and the Council on Competitiveness. Porter recommends five far-reaching reforms to make the U.S. system superior to Japan's and Germany's: 1. Improve the present macroeconomic environment. 2. Expand true ownership throughout the system so that directors, managers, employees, and even customers and suppliers hold positions as owners. 3. Align the goals of capital providers, corporations, directors, managers, employees, customers, suppliers, and society. 4. Improve the information used in decision making. 5. Foster more productive modes of interaction and influence among capital providers, corporations, and business units. PMID- 10121318 TI - Managing price, gaining profit. AB - The fastest and most effective way for a company to realize maximum profit is to get its pricing right. The right price can boost profit faster than increasing volume will; the wrong price can shrink it just as quickly. Yet many otherwise tough-minded managers miss out on significant profits because they shy away from pricing decisions for fear that they will alienate their customers. Worse, if management isn't controlling its pricing policies, there's a good chance that the company's clients are manipulating them to their own advantage. McKinsey & Company's Michael Marn and Robert Rosiello show managers how to gain control of the pricing puzzle and capture untapped profit potential by using two basic concepts: the pocket price waterfall and the pocket price band. The pocket price waterfall reveals how price erodes between a company's invoice figure and the actual amount paid by the customer--the transaction price. It tracks the volume purchase discounts, early payment bonuses, and frequent customer incentives that squeeze a company's profits. The pocket price band plots the range of pocket prices over which any given unit volume of a single product sells. Wide price bands are commonplace: some manufacturers' transaction prices for a given product range 60%; one fastener supplier's price band ranged up to 500%. Managers who study their pocket price waterfalls and bands can identify unnecessary discounting at the transaction level, low-performance accounts, and misplaced marketing efforts. The problems, once identified, are typically easy and inexpensive to remedy. PMID- 10121319 TI - The new society of organizations. AB - Managers in every organization from the largest publicly owned company to the smallest not-for-profit face the same unsettling imperative: to build change into their organization's very structure. On the one hand, this means being prepared to abandon everything that the organization does. On the other, it means constantly creating the new. Unless this process of abandonment and creation goes on without ceasing, the organization will very soon find itself obsolescent- losing performance and with it the ability to attract and hold the people on whom its performance depends. What drives this imperative is the nature of the organization itself. Every organization exists to put knowledge to work, but knowledge changes fast, with today's certainties becoming tomorrow's absurdities. That is why any knowledgeable individual must likewise acquire new knowledge every several years or also become obsolete. Familiar as the term "organization" is, we have only begun to reckon with the implications of living in a world in which the fundamental unit of society is--and must be--destabilizing. That is why questions of social responsibility now arise so often and from so many quarters. We need new ways to understand the relationship between organizations and their employees, who may in fact be unpaid volunteers, independent professionals whose organization is a network, or knowledgeable specialists who can--and often do- move on at any moment. For more than 600 years, no society has had as many competing centers of power as the one in which we now live. Drucker explains why change is--and must be--the only constant in an organization's life and explores the consequences for managers, individuals, and society overall. PMID- 10121320 TI - A clinical approach to hospital security. AB - The establishment of a crime/loss prevention program gives the security department the capability of diagnosing crime risks before they adversely affect your hospital's operation and budget. This article discusses how the use of consultive services together with your in-house diagnostic team can ensure the security and safety of your healthcare institution. PMID- 10121321 TI - Security investigations in a healthcare environment. PMID- 10121322 TI - Life safety issues in healthcare facilities. PMID- 10121323 TI - Proper ventilation improves indoor air quality. AB - Buildings constructed in the 1970s often achieved energy efficiency at the cost of adequate fresh air, leading to unhealthy working conditions. Through a program of preventive maintenance, inspections and attention to employee concerns, most indoor air-quality problems can be avoided. PMID- 10121324 TI - Managing the conversion process. PMID- 10121325 TI - Promotion-in-place: a logical approach. AB - The promotion-in-place system, says the author, can be a valuable tool for your healthcare institution. It can create a climate for individual achievement without the traditional roadblocks to success. PMID- 10121326 TI - On-the-job training. AB - The quality of training given by the security department has a direct impact on the job performances of each security officer. The author discusses how on-the job training can be a vital part of the training effort when done properly and effectively. PMID- 10121327 TI - Guidelines on preventing abduction of infants from the hospital. National Center for Missing and Exploited Children. AB - With the goal of preventing crimes against children, the NCMEC--in cooperation with the FBI, the IAHSS, and the University of Pennsylvania School of Nursing- has studied infant abductions from hospitals and other sites, and considers them preventable in large part by "hardening the target." PMID- 10121328 TI - High technology helps hospital protect newborns, reduce theft, and increase safety of staff and patients. PMID- 10121329 TI - A time to look at healthcare security management. AB - Gone are the days when we can ignore the necessity for professional healthcare security management and hope the need will go away. It won't. As responsible managers, says the author, we must take a realistic approach in determining how to properly manage the risks being realized daily in healthcare institutions. PMID- 10121330 TI - Female security officers: a discussion of the possible advantages for the female in the hospital security setting. AB - Female security officers may be an unrecognized resource for specific performance attributes which are valuable to the security task in hospitals. This article discusses some of the advantages the female security officer may contribute to desirable performance outcomes on the job in hospital security. PMID- 10121331 TI - Bicycle patrols in a healthcare setting. PMID- 10121332 TI - Private security's challenge to police chiefs. AB - The author discusses why police chiefs who have not yet given thought to developing a security partnership agenda should begin now. Partnerships, he says, should be cultivated between public police and private security. PMID- 10121333 TI - Special case management--breaking traditional stereotype views of hospital security. PMID- 10121334 TI - Prison uprising--one medical center's special response. PMID- 10121335 TI - Health care fraud: security management's role. PMID- 10121336 TI - Computerizing your security operation--it can be done! PMID- 10121337 TI - How in-house security forces take on new duties to stay competitive. PMID- 10121338 TI - Two recent cases: is employer required to provide secure workplace? PMID- 10121340 TI - An update on increasing ER violence and what's being done about it. AB - Violent incidents in the hospital emergency room are increasing in intensity throughout the country, endangering the lives of the medical staff, security officers, patients, and visitors. Much of the violence is attributed to the spread of gang and drug activity, along with overcrowded, understaffed ERs due to a depressed economy. This report covers recent incidents of ER violence and the public demands of ER physicians and nurses for increased security. We will also detail security measures--from training in the psychology of violence to installing state-of-the-art metal detectors--that hospitals are now utilizing as deterrents. PMID- 10121339 TI - Psychiatric hospital cuts worker's comp costs; wins OSHA Award. PMID- 10121341 TI - Screening for weapons, explosives: what to be aware of. PMID- 10121342 TI - The California car crash disaster: how hospitals responded. PMID- 10121343 TI - Million dollar fraud: detecting, investigating, and preventing large-scale hospital theft. AB - Because hospitals often have large amounts of capital expenditures, they are particularly vulnerable to massive fraudulent schemes. Sometimes, the perpetrators are top-level executives, chief financial officers, or board members working in conjunction with outside contractors and suppliers. The losses can be devastating as witnessed by the recent uncovering of "Operation Catscam"--a large scale x-ray scam, involving phony invoices, kickbacks, and outright theft of supplies, that operated for 14 years and bilked hospitals in New York and New Jersey out of at least $10 million. This report will detail recent incidences of massive hospital fraud: how the crimes were committed, how they were detected, the amount of loss involved, and procedures the institutions later put in place to prevent such thefts from recurring. In addition, we'll offer tips from investigative experts on how the security department can involve itself in helping to spot fraud early in the game and how to proceed with an in-house investigation. PMID- 10121344 TI - Finding alternatives to employee lay-offs. PMID- 10121345 TI - A closer look at managed care. PMID- 10121347 TI - Total quality management--fad or future? PMID- 10121346 TI - Conduction cooking: exciting new technology. PMID- 10121348 TI - A new organizational structure for the 1990s. PMID- 10121349 TI - How to work with the impossible employee. PMID- 10121350 TI - Avoiding common computer management mistakes. PMID- 10121351 TI - Menu planning for the basic customer "groupies". PMID- 10121352 TI - Personal computers and risk management. AB - The personal computer is fast becoming an important tool for healthcare administrators. In this article, the authors describe a patient-incident report program at their hospital that enables management to provide patients with higher quality care and, concomitantly, reduce the possibility of litigation. PMID- 10121353 TI - Co-dependency in the workplace. AB - Co-dependency has become a familiar term in recent years. No only do mental health professionals encounter the phenomenon, but with the bestseller status of Co-Dependent No More (Beattie 1987), more and more laypersons have begun to identify co-dependent individuals among family members and friends. Community health nurse managers may encounter this problem in clients as well as in other nurses. Of particular concern to the community health nurse manager is co dependency among nurses on the staff. Co-dependency exhibited by nurses can have a negative effect on group morale and team spirit in a community health setting. This article defines co-dependency and presents guidelines for responding to it in community health nurses. PMID- 10121354 TI - Hospital smoking policies: who enforces them? AB - As opprobrium is increasingly given to the act of smoking, many institutions- hospitals especially--are seeking to curtail the amount of smoking that occurs within their buildings through various policies. This, however, raises two necessary questions: What does policy enforcement mean? And who shall enforce the rules? The article below discusses the results of a survey of North Carolina hospitals that asked these questions and more. PMID- 10121355 TI - Decision-making styles of a medical center's management group: a case study. AB - It has been said that those in a position to hire select people like themselves. Is this true? The following article--a study of the decision-making styles of a medical center's management group--makes a compelling argument in favor of this idea. PMID- 10121356 TI - Hospital community partnership. A daycare venture provides benefits, opens doors for new opportunities. AB - Building successful joint ventures with local community organizations is a priority for many hospitals. Not only does this type of venture strengthen important relationships, it can also open the door for other mutually beneficial joint activities as well. When a partnership provides a needed service and can be started with minimal expenditures, it becomes even more valuable for all parties concerned. PMID- 10121357 TI - How we improved turn around time through voice-communication technology. AB - This hospital phlebotomy team tackled their age-old turn around time (TAT) problem by implementing a technology that is becoming commonplace in a variety of businesses. Through the use of two-way communication headsets, this hospital laboratory significantly reduced TAT, improved service perceptions by the medical and nursing staffs, and diminished stress levels of the venipuncture team. PMID- 10121358 TI - Goals. PMID- 10121359 TI - Hospital and public health agency relationships. PMID- 10121360 TI - Chugging along to 2000. Taking charge of the shape of change. PMID- 10121361 TI - Building fabric. Knoll creates new textiles for a deconstructivist hospital... Augusta Medical Center. PMID- 10121362 TI - Building on our strengths through market-based reform. PMID- 10121363 TI - Competitive pricing: ASIM's (American Society of Internal Medicine) alternative. PMID- 10121364 TI - Helping Oregon set its priorities. Interview by C. Burns Roehrig. PMID- 10121365 TI - Can professional unity survive the budget crunch? PMID- 10121366 TI - Modern technology and unaffordable costs. PMID- 10121367 TI - The feminization of medicine. PMID- 10121368 TI - How to educate your patients. PMID- 10121369 TI - Controlling health care costs. American Society of Internal Medicine. PMID- 10121370 TI - Comprehensive health reform and negotiated fees. PMID- 10121371 TI - Medical technology and the reimbursement dilemma. PMID- 10121372 TI - Are machines driving public demand? News media coverage of medical technology. PMID- 10121373 TI - Taking the PROs down a new road to quality. Interview by C. Burns Roehrig. PMID- 10121374 TI - Candidates advocate their own brands of health care reform. PMID- 10121375 TI - Presidential politics and health care reform. PMID- 10121376 TI - ASIM (American Society of Internal Medicine) and ACP (American College of Physicians) offer different paths to reform. PMID- 10121377 TI - Where have all the internists gone? PMID- 10121378 TI - Rising prescription drug prices. American Society of Internal Medicine. PMID- 10121379 TI - Health care technology assessment: a renewed focus for the '90s. PMID- 10121381 TI - Red flags on the quality road. PMID- 10121380 TI - The quality journey. PMID- 10121382 TI - Managing hospital risks. PMID- 10121383 TI - Caring for children. PMID- 10121384 TI - Texas Lt. Gov. Bob Bullock. Interview by Ann Ward. PMID- 10121385 TI - The rural AIDS front. PMID- 10121386 TI - Women and the health care system. PMID- 10121387 TI - In pursuit of perfect choice. Feminism and reproductive technology. PMID- 10121388 TI - From pillow to post. PMID- 10121389 TI - Tu-be or not tu-be. PMID- 10121390 TI - Good timing. PMID- 10121391 TI - South Western Regional Health Authority. Equal opportunity knocks. PMID- 10121393 TI - Bear necessities. PMID- 10121392 TI - Snow sweat. PMID- 10121394 TI - Smear campaign. PMID- 10121395 TI - Data briefing. Organ transplants. National Association of Health Authorities and Trusts. PMID- 10121396 TI - Hotel services. Tender is the site. PMID- 10121397 TI - Hotel services. A change of menu. PMID- 10121398 TI - Hotel services. Five-star treatment. PMID- 10121399 TI - Who foots the bill? PMID- 10121400 TI - Best of the best. PMID- 10121401 TI - The final whistle? PMID- 10121402 TI - Accessories after the act. PMID- 10121403 TI - Coming up roses? PMID- 10121404 TI - The new age. PMID- 10121405 TI - Bones of contention. PMID- 10121406 TI - Emotional rescue. PMID- 10121407 TI - Flexible friends ... physiotherapy staffing. PMID- 10121408 TI - Daydream believers ... strategic development replaces traditional planning processes in the NHS. PMID- 10121409 TI - The guinea pig's tale ... better management of resources. PMID- 10121410 TI - Talkin' about a revolution. PMID- 10121411 TI - Trent: first in the race against time. PMID- 10121412 TI - Energy management. A lot of hot air? PMID- 10121413 TI - Energy management. Money for nothing. PMID- 10121414 TI - Energy management. Lights out. PMID- 10121415 TI - Brief encounters. PMID- 10121416 TI - Standard bearers. PMID- 10121417 TI - A flat earth syndrome. PMID- 10121418 TI - Pandora's profits. PMID- 10121419 TI - Legal and medical issues in therapeutic interchange: implications for pharmacists, physicians, and P & T committees. AB - In today's health care environment, pharmacists, physicians, P & T Committees, hospital administrators and other clinicians involved in therapeutic interchange issues should be knowledgeable about the legal and medical issues associated with this practice. In this paper, a general discussion of liability under tort law is provided, followed by a specific discussion of the legal aspects of therapeutic interchange. In addition, steps that hospitals, P & T Committees, physicians, and pharmacists can take to establish sound therapeutic interchange policies--and thus reduce liability risks--are presented. Armed with this knowledge, clinicians and administrators can continue to provide cost-effective, patient-oriented care that uphold their professional responsibilities. PMID- 10121420 TI - Evaluation of the use of i.v. ciprofloxacin. AB - A drug usage evaluation was conducted at our institution, a 344-bed teaching hospital, in order to determine whether intravenous ciprofloxacin was being used appropriately based on preestablished hospital criteria. PMID- 10121421 TI - Drug usage evaluation of epoetin in chronic renal failure. AB - All patients (48) followed by the chronic dialysis program on either peritoneal dialysis or incenter hemodialysis who received epoetin were included in this 1 year retrospective study. Variables evaluated included appropriateness of patient selection, drug dosage, monitoring of epoetin therapy as well as treatment outcome, incidence of side effects, cost versus reimbursement of epoetin, and need for iron supplementation. The target hematocrit of 30 to 36% was reached by 84.6% of patients. The difference between the baseline and treatment hematocrits was statistically significant (p less than 0.01). The average number of transfusions dropped significantly from 0.66 to 0.11 per patient per month (p less than 0.01) and the mean percentage of cytotoxic panel reactivity antibody was also significantly reduced (p less than 0.01) during treatment with epoetin. Serious side effects of epoetin therapy were rare, but four hemodialysis patients experienced five episodes of clotted accesses. The incidence of hypertension requiring addition or change of antihypertensive medication was 17.1%. No seizures were observed during the study period. The results of this study also revealed that more careful attention to iron status was needed during the period of data collection. A nomogram for prediction of iron need based on initial hemoglobin and ferritin levels was also studied and found to be accurate in 87.5% of patients. PMID- 10121422 TI - Drug use evaluation of acetaminophen-containing products at a community hospital. AB - The Humana Hospital, a 356-bed facility, set up a drug use evaluation (DUE) program to monitor the administration of products containing acetaminophen (APAP), to observe the extent of overdosing of APAP products, and to educate and resolve the problems. The DUE originated in the OB/GYN unit and then was expanded to all hospital units. The study methods and the process used to resolve noncompliance with recommended dosing guidelines are presented below. PMID- 10121423 TI - A multidisciplinary process to determine, communicate, and manage an antibiotic formulary. AB - This article describes a collaborate process developed by the Pharmacy & Therapeutics Committee to define, determine, communicate, and manage an effective antibiotic formulary. Multiple professional disciplines represented by the antibiotic subcommittee evaluated each classification of antibiotics and recommended a preferred drug(s) for each classification. Decisions were based on relative safety, efficacy, and cost with minimal duplication of therapeutic equivalent antibiotics. A therapeutic interchange policy was unnecessary because extensive communication measures developed by the committee proved effective. The strategy used strengthened pharmacist/physician working relationships. This process permitted rationality and understanding by the medical staff, which resulted in unanimous formulary acceptance. PMID- 10121424 TI - Overcoming unit dose drug distribution system logistical problems on a 32-acre campus. AB - The literature contains numerous articles regarding the implementation of unit dose drug distribution systems, but little has been written concerning the logistical problems sometimes encountered with such systems. This article describes the implementation of a drug distribution system at a psychiatric institution at which the inpatient units are scattered throughout a 32-acre campus. PMID- 10121425 TI - Pharmacy agenda for change: the time is now. AB - In the midst of society's debate and focus on patient care and outcome, healthcare providers must articulate their strategic positioning to be part of the collective societal drive. Pharmacy as an integral component of healthcare provided, must also take the opportunity to create its own agenda for change. This agenda revolves around pharmacists agreeing on aspects of pharmaceutical care for which they are legally and ethically responsible. Pharmacists must also strive to gain social and cultural authority for those aspects for which the profession has accepted responsibility. Pharmacist action is needed to ensure appropriate drug therapy to the public. PMID- 10121426 TI - Description of a computerized adverse drug event monitor using a hospital information system. AB - To improve the detection and characterization of adverse drug events (ADEs) in hospitalized patients, a computerized adverse drug event monitor was developed. Computer programs were written to allow for voluntary as well as automated detection of adverse drug events using the HELP hospital information system, a large integrated hospital database containing computerized patient medical records and a knowledge base allowing for automated medical decisions. Programs were created to allow simple computer entry of potential adverse drug events by physicians, pharmacists, and nurses. Automated detection of potential adverse drug events relied on signals such as sudden medication stop orders, "antidote" orders, and selected abnormal laboratory values. Each day a list of all potential adverse drug events from these sources was generated and a pharmacist reviewed the medical records and interviewed healthcare personnel associated with patients identified as having potential adverse drug events. This process allowed for characterization of the event, causality assessment, and follow-up of the resulting clinical course by the pharmacist. The permanent storage of these results in the computerized patient medical record permits their future retrieval to prevent adverse drug events during subsequent hospital care. The authors conclude that fully integrated hospital systems will permit the further development and evaluation of computer-assisted methods for the detection of adverse drug events in hospitalized patients. PMID- 10121427 TI - A matter of principle. PMID- 10121428 TI - Breakthrough thinking in healthcare design. PMID- 10121429 TI - How design impacts wellness. PMID- 10121430 TI - Vidarkliniken. PMID- 10121431 TI - Planetree transplanted. PMID- 10121432 TI - The hospital as a healing place. PMID- 10121433 TI - The healing environment compendium. AB - The Healthcare Forum Journal--with the help of our readers and Leland Kaiser--has compiled the following compendium of resources to serve as an aid to hospitals and other healthcare organizations in creating healing environment. This is a necessarily incomplete listing of facilities and programs. If you know of additional resources to help hospitals create healing environments, please let us know. We'll report further resources in upcoming issues. PMID- 10121434 TI - Workspace design and productivity. PMID- 10121435 TI - The people side of TQM. PMID- 10121436 TI - Differences make a difference. Interview by Joe Flower. PMID- 10121437 TI - The approach of the number crunchers. PMID- 10121438 TI - Florida Hospital. PMID- 10121439 TI - Life and death after Cruzan: recent developments in right to die cases. PMID- 10121440 TI - Is FDA's medical device evaluation process overly complaisant to industry? PMID- 10121441 TI - New IRS audit guidelines for tax-exempt hospitals put thumbscrews on joint ventures. PMID- 10121442 TI - The National Practitioner Data Bank: big brother or paper tiger? PMID- 10121443 TI - Biomedical and health services research in Canada: a review. AB - Using published evidence of research grants, the historical development of funding sources for biomedical and health services research in Canada is discussed. The imbalance between health services research, which includes health services administration and biomedical research, is examined. It is argued that the current funding arrangement should be restructured to accommodate field based, application research through an independent agency. Needs-focused and integrated research activities that are policy relevant and which involve practitioners are required if current limitations in the system are to be addressed. Thus, health administration as a discipline will receive the necessary technological assistance needed to improve management practices. PMID- 10121444 TI - Planning for strategic change? A participative planning approach for community hospitals. AB - Strategic planning is becoming to hospitals what business case analysis is to private corporations. In fact, this type of planning is becoming essential for the professional management of Ontario hospitals. The participative strategic planning process at Toronto East General Hospital (TEGH) is an example of how a professionally structured and implemented strategic planning process can be successfully developed and implemented in a community hospital. In this article, the environmental factors driving planning are reviewed and the critical success factors for the development and implementation of a strategic plan are examined in the context of TEGH's experience. PMID- 10121445 TI - A specialized home care team does make a difference. AB - Results of a study done in a large teaching and research facility in Alberta reveal that a specialized home care team can substantially lower the cost of caring for people who are ventilator dependent. With the assistance of a pulmonary physician, the Respiratory Home Care program has shown excellent results. Patients report that they "feel as safe at home as in the hospital", and the savings to the health care system are estimated to be about $2,000,000 per year. PMID- 10121446 TI - Alberta's Acute Care Funding Project. AB - Alberta initiated the Acute Care Funding Project (ACFP) in 1988, a new hospital funding system that institutes case mix budgeting adjustments to the global budget so that hospitals can be treated more equitably. The initiative is a significant departure in principle from the former method of funding. The ACFP is summarized and critiqued, and focuses on the inpatient side of the picture. The various elements of the project are discussed, such as the hospital performance index, the hospital performance measure, the Refined Diagnostic Related Group, case weights, typical and outlier cases, and the costing mechanisms. Since its implementation, the ACFP has undergone substantial changes; these are discussed, as well as some of the problems that still need to be addressed. Overall, the system offers incentives to reduce length of stay and to increase the efficiency with which inpatient care is provided. PMID- 10121447 TI - New chapel ministers to the spiritual needs of medical center users. PMID- 10121448 TI - Health care salary hikes edge out inflation in '91; '92 raises tally about 5%. PMID- 10121449 TI - How to test out your emergency generators. PMID- 10121450 TI - How to control rodents in health care facilities. PMID- 10121451 TI - Device tracking: what's covered? How'll it work? PMID- 10121452 TI - Calculating pneumatic systems' productivity. PMID- 10121453 TI - How to prepare more effective in-service training. PMID- 10121454 TI - Fewer facilities contract for more 'hotel' services. PMID- 10121455 TI - Most hospitals in West to spend big on construction, ADA. PMID- 10121456 TI - Joint Commission gets tough. PMID- 10121457 TI - The evolution to market-driven quality. AB - Quality experts and Baldrige Award recipients agree that whether or not a company wins the coveted award, it gains countless benefits from going through the application process. In 1989, one unit at GTE applied for the Baldrige. This article details the results of that process, as well as the company's ongoing pursuit of market-driven quality. PMID- 10121458 TI - TQM and the financial function. AB - The author maintains that financial officers should take a leadership role to improve the processes that provide value to a company's internal and external customers. He suggests several ways that the financial function can participate in and contribute to total quality management. PMID- 10121459 TI - Why technical-market research? AB - Customers frequently need assistance in knowing what they want or might need. One process, technical-market research, helps understand the mind of the consumer so that the voice of the customer can be better translated into new products by designers, engineers, and marketers. PMID- 10121460 TI - Quality as a strategic weapon. AB - Motorola, Northern Telecom, Federal Express, and Cintas have reaped the benefits of implementing quality-oriented strategies. While other forms of competitive advantage are either short-lived or can be quickly duplicated, these firms have shown that only companywide quality is virtually unassailable. PMID- 10121461 TI - Planning priorities for empowered teams. AB - Many companies are considering using self-managed teams to move from a traditional management structure to a system that gives employees much greater responsibility and involvement. But companies can stumble badly in setting up these teams. Here are six ways to sidestep the planning pitfalls. PMID- 10121462 TI - Market fragmentation versus market segmentation. PMID- 10121463 TI - The role of intelligence in formulating strategy. PMID- 10121464 TI - Quick response technology: the key to outstanding growth. PMID- 10121465 TI - Quality of life in long-term geriatric care: the dietitian's role. AB - The dietitian plays a leadership role in improving the quality of life of nursing home residents. A better understanding of this role can strengthen practice in this area. This paper attempts to define the role of the dietitian in the nutritional care of the elderly in long-term care facilities. The impact of poor appetites, extended stays and nutrient requirements on menu planning and recipe development are discussed. Resident empowerment, improvement of the dining environment, evaluation of eating skills, and eating rehabilitation are proposed as new roles for the dietitian in the promotion of food consumption. The characteristics of nutritional assessment and therapeutic diets as they relate to long-term geriatric care are discussed. PMID- 10121467 TI - Suture prices to rise 6%. PMID- 10121466 TI - Satisfaction of recent University of British Columbia dietetics graduates with undergraduate education and current job. AB - This study was designed to investigate the career status of recent University of British Columbia (UBC) dietetics graduates and their satisfaction with undergraduate education and current job. All graduates from the UBC Dietetics Program between 1978-1987, inclusive (n = 238), were mailed questionnaires. Information was sought regarding success in obtaining a dietetic internship, current employment status, job satisfaction, and satisfaction with undergraduate education. Questionnaires were returned by 67% (n = 130) of those who received them. Approximately 83% were eventually successful in obtaining an internship. Most respondents (68.5%) were employed as dietitian/nutritionists, and 69% of those who were employed worked full-time. Those who interned had significantly higher salaries than those who did not. A measure of overall job satisfaction revealed that 89.6% were satisfied to very satisfied with their present job, and scores on the Brayfield-Rothe Index of Job Satisfaction revealed no differences between those who did and did not intern. With regard to undergraduate education, respondents were most satisfied with library resources, class size and quality of teaching, and least satisfied with internship opportunities. Those who had interned were significantly more satisfied with their undergraduate education than were those who had not. We conclude that success in obtaining a dietetic internship affects salary and satisfaction with undergraduate education, but does not affect job satisfaction. PMID- 10121468 TI - Pharmacy non-salary expenses per admission. PMID- 10121469 TI - Hospitals look to industry for solutions on how to improve materials handling. PMID- 10121470 TI - Smoke evacs extract airborne bacteria from O.R. laser sites. PMID- 10121471 TI - Hospitals must negotiate warranty needs such as service, spare parts, early in process. AB - At a recent seminar, a question was asked about what the Federal law requires a supplier of hospital equipment to provide in the way of a warranty covering repair service and the availability of spare parts. In this dialogue, Dr. Decker develops the problem and presents some clarifications and suggestions. PMID- 10121472 TI - Who will pay future hospital bills? PMID- 10121473 TI - RBRVS fee update. PMID- 10121474 TI - Organized systems of care. A vision of a future healthcare delivery system. AB - Policymakers no longer question that healthcare system reform will occur; rather they differ on the timing and direction of change. The Washington Business Group on Health envisions a future healthcare delivery system called an organized system of care (OSC). An OSC is an integrated financing and delivery system that uses a panel of providers selected on the basis of quality and cost management criteria to furnish members with comprehensive healthcare services. The most important system attribute of the OSC will be the commitment of all involved to the mission of promoting the health of system members. To accomplish this mission, OSCs will incorporate the principles of continuous quality improvement. Care will be delivered through care management teams, which integrate the physical, psychological, and administrative needs of the member. Such teams might be made up of primary care physicians, nurses, and mental health professionals. Although the entire team would be responsible for the OSC member, one team member would be assigned primary responsibility for overseeing and planning care with the member. PMID- 10121475 TI - A training project helps the poor. A rural healthcare facility offers job training, gains employees. AB - As poor Americans look for work, healthcare facilities face a shortage of workers. One facility, Saint Francis Medical Center in Grand Island, NE, found a way to help some of the area's financially disadvantaged persons receive technical training and employment as it eased its own personnel shortage. Saint Francis leaders assembled a team of representatives from the hospital's staff, the Greater Nebraska Job Training Program, Lincoln, and Central Community College, Grand Island, to establish the Rural Allied Medical Business Occupations program. The team reviewed several job descriptions to help it decide which jobs to include in the program and surveyed area hospitals to ensure the positions selected were experiencing shortages. The program received a grant as a demonstration project from the U.S. Department of Education. After identifying participants who had the aptitudes and interests for the jobs, the Rural Medical Allied Medical Business Occupations program arranged for participants' training and assistance with items such as tuition, child care, and transportation. Participants received training at Central Community College and at Saint Francis Hospital. Saint Francis Medical Center deemed the program a success. The hospital has hired seven healthcare workers who would not have been available if they had not been trained through this program. Moreover, the program provides yet another way for the hospital to help fulfill a major portion of its mission: to help the poor. PMID- 10121476 TI - The necessity of mission integration. A system develops processes to weave values into the life of the organization. AB - Essential to the future vitality and viability of a mission-driven organization is the integration of the mission into the organization's programs, policies, practices, and accountability. Holy Cross Health System (HCHS), South Bend, IN, launched an intensive educational effort with managers, staff members, and trustees to reinforce the basic belief that mission permeates all departments. Using the mission statements principles of fidelity, excellence, empowerment, and stewardship, HCHS leaders initiated a systemwide mission assessment and development effort. During assessment, each facilities' ad hoc team addressed and responded to the organization's mission standards on the basis of availability of personnel, size, facility, and particular circumstances. The assessment process called for interdisciplinary, institutional review teams to explore all aspects of mission activity. This process enabled HCHS to launch a systemwide educational effort about the importance and necessity of mission integration. HCHS then used the mission statement elements fidelity, excellence, empowerment, and stewardship to define new relationships of accountability. PMID- 10121477 TI - Advancing mission in the marketplace. Integrated strategic planning and budgeting helps a system remain accountable. AB - In the late 1980s Holy Cross Health System (HCHS), South Bend, IN, began to implement a revised strategic planning and budgeting process to effectively link the system's mission with its day-to-day operations. Leaders wanted a process that would help system employees internalize and act on the four major elements articulated in the HCHS mission statement: fidelity, excellence, empowerment, and stewardship. Representatives from mission, strategic planning, and finance from the corporate office and subsidiaries examined planning and budgeting methods. From the beginning, HCHS leaders decided that the process should be implemented gradually, with each step focusing on refining methodology and improving mission integration. As the process evolved. HCHS developed a sequence in which planning preceded budgeting. The system also developed a variety of educational and collaborative initiatives to help system employees adapt to the organization's change of direction. One critical aspect of HCHS's ongoing education is an ethical reflection process that helps participants balance ethical considerations by viewing an issue from three perspectives: social vision, multiple responsibility, and self-interest. PMID- 10121478 TI - Informed strategy. Information managers should play a key role in determining an organization's direction. AB - Hospital chief executive officers need to set directions for their facilities' information systems, and information professionals need to play a more direct role in strategic planning, according to speakers at the Computers in Healthcare Conference last May. To implement effective information systems, chief information officers must be closely connected with the organization's capital budgeting and strategic budgeting process. A key strategic role for information systems managers is to educate organization personnel in the use of information technology. As demands placed on information systems increase, improving end users' skill level is the best way to take the pressure off. Information managers must create systems that respond to changes in healthcare, including the trend toward outpatient care. The information requirements for strategic planning include an external assessment and an internal assessment. Managers should strive to create information systems capable of answering strategic questions concerning patients, payers, practice patterns, and other key issues. Information systems also must provide data that allow managers to assess strategic decisions. They should also give top managers access to information that will help them identify and pursue broad new goals and directions. PMID- 10121479 TI - A community of caring. Patients in a rehabilitation unit experience holistic healing through a spiritual support group. AB - Empowered by empathic knowledge of the pain and suffering endured by patients, a pastoral care giver can foster holistic healing, integrating a spiritual dimension into the lives of responsive individuals by helping them form a circle of love, a Community of Caring. A Community of Caring can be effective in many specialized hospital units or long-term care centers. In a hospital physical rehabilitation unit, for example, a chaplain successfully provided a time, place, and ambience where patients could share their deepest feelings, thoughts, and concerns and learn together techniques of coping. This Community of Caring helped patients overcome feelings of inadequacy and low self-esteem, encouraged self acceptance despite physical losses, and stimulated new concepts of spirituality, notably the importance and the sacredness of the present time spent in recuperation. Participants in the Community of Caring discussed ideas such as the concept that all activity, even mundane rejuvenative therapy exercises, can be- at least potentially--sacramental activity; the importance of fully using all facets of physical therapy; and the idea that days spent in recuperation can be a time for deepened relationship with self, others, and a compassionate God. The sessions helped many patients mobilize their inner resources and assume greater personal responsibility for their healing and recovery. PMID- 10121480 TI - Improving the quality of governance. A multiunit organization takes steps to strengthen local boards. AB - "A Plan for the Healthcare Apostolate," adopted in 1981, established goals and strategies to strengthen the Daughters of Charity National Health System-East Central (DCNHS-East Central). The plan provided the basis for a series of steps taken during the past decade to improve local-level governance. DCNHS-East Central has taken actions in the areas of board composition, trustee orientation and development, board leadership, definitions of governance roles and responsibilities, and performance evaluation. These steps have resulted in substantial improvement in the performance of local-level governance functions within DCNHS-East Central. PMID- 10121482 TI - Crisis communications. PMID- 10121481 TI - The complexities of medical record computerization. PMID- 10121483 TI - Community and medical staff collaborate in needs assessment. PMID- 10121484 TI - Elizabeth Seton Prenatal Clinic. Care with dignity for limited-income women. PMID- 10121485 TI - Saving graces. PMID- 10121486 TI - Bridging the leadership gap: transforming health care organizations for the 21st Century. PMID- 10121487 TI - Healing environments: the 21st century health facility. PMID- 10121488 TI - Managing hospital infections. AB - Major infections in hospitals may cause, or contribute to, patient deaths and, at best, disrupt hospital routines. Elaine Leaver describes the management response to a major infection in the hospital environment. PMID- 10121489 TI - Benefits of mentorship. AB - The potential benefits to individuals and organisations of mentorship, why these benefits are not always exploited to the full within the health service, and new approaches to mentorship to overcome these problems are outlined by Kevin Moore. PMID- 10121490 TI - Management ... practice Manager. AB - Carole Green became a Practice Manager because she wanted to influence directly what was happening and to see the results of her work; she was the first GMTS I management trainee to work in general practice. Her job combines the roles of business manager, company secretary, contracts negotiator, marketing manager and - at times -- general factotum. PMID- 10121491 TI - The sky's the limit. How to plan your career in EMS. AB - Contrary to popular opinion, it is possible to make EMS a career. The key is deciding that the field of prehospital care is where you ultimately want to be and planning where you want to go and what you want to do within the field. Follow these tips on becoming an EMT, moving up to paramedic and, finally, deciding whether to become a manager, and find out for yourself that the sky really is the limit. PMID- 10121492 TI - Your annual career checkup. PMID- 10121493 TI - An EMS organization for everyone. AB - It seems that no matter what EMS niche you choose or what information or support you need, there's an organization ready to help. The following organizations and associations can provide information about their area of expertise for people considering a career in that branch of medical services and serve as a way to network with other members of that field. PMID- 10121494 TI - All the president's medics. The White House Medical Unit. AB - All EMS providers must work for an ambulance company, right? Wrong. There are many avenues open to EMTs and paramedics that even those involved in EMS don't know about. Take a look at three providers with unique jobs: They help provide medical care for the president and vice president of the United States. PMID- 10121495 TI - CAHEA-accredited EMS programs. Committee on Allied Health Education and Accreditation, American Medical Association. PMID- 10121496 TI - EMS degree programs. Opening doors you didn't know existed. AB - Bachelor's and master's degrees in EMS are not yet commonplace, but with each year, they are becoming more important. A degree in EMS can provide not only the essentials of good paramedic skills, but also a knowledge of biology, anatomy and physiology, advanced chemistry and EMS management. Dwight Polk and Stuart Langford discuss the current status of bachelor's and master's degree programs in EMS and talk to people who have gone far in their chosen careers because they have such a degree. PMID- 10121497 TI - Tough choices. The ethics of CPR. PMID- 10121498 TI - Moving into management. When opportunity knocks, should you answer? PMID- 10121499 TI - JEMS 7th annual buyers' guide. 1993 edition. PMID- 10121500 TI - Are you gaining by restraining? PMID- 10121501 TI - In a TV age. ACLS (advanced cardiac life support) training through teleconferencing. PMID- 10121502 TI - Mastering EMS management. Are graduate degrees necessary? PMID- 10121504 TI - Give me proof. Is EMS really worth it? PMID- 10121503 TI - You better shop around. How to make competitive purchasing meet your needs. PMID- 10121505 TI - HIV testing. Whose right to know? AB - This is the second article in a two-part series. Part one of this installment of The Legal File (July 1992) focused on the law as it pertains to infectious disease testing of individuals. This month's column focuses on who needs to know the results of such testing. PMID- 10121506 TI - Evaluation of state efforts to improve systems of care for children and adolescents with severe emotional disturbances: the CASSP (Child and Adolescent Service System Program) initial cohort study. AB - In 1984, the National Institute of Mental Health (NIMH) began funding its Child and Adolescent Service System Program (CASSP). In this paper, we present findings from a descriptive study of the experiences of the initial cohort of states to receive CASSP grants, conceived and conducted when the projects were approaching the end of their fifth and final year of NIMH funding. Detailed case studies were conducted of each of the 10 initial cohort projects, and the findings analyzed across projects. Data were collected from three major sources: (1) existing documentation about the projects, (2) site visits to each of the projects, and (3) information from relevant secondary sources. Findings suggest that the initial cohort projects utilized a variety of strategies and encountered a variety of barriers and facilitating factors. The projects generally implemented the intended CASSP program and did so by using a variety of strategies. The projects were judged by stakeholders in their states to have influenced the service systems in their states in the intended directions: toward a more comprehensive system of care that emphasizes community-based treatment; toward better integrated, more collaborative efforts among the state agencies involved; toward a more detailed understanding on the part of system stakeholders of the mental health problems of children and adolescents who have severe emotional disturbances, and of the influence of those problems on the lives of the children and their families; and toward increased involvement by parents and other family members in the care of these children and adolescents. PMID- 10121507 TI - The impact of private utilization management on psychiatric care: a review of the literature. AB - Psychiatric care in the United States is increasingly practiced subject to some form of utilization management (UM) by third parties. This paper reviews recent studies of UM in the privately insured mental health sector, and finds some limited evidence that UM reduces utilization and costs to the payer. Less is known about UM's effect on mental health outcomes, or its financial impacts on patients, providers, and society. Implications concerning the regulation of UM are discussed, and suggestions are made for future research on the impact of UM. PMID- 10121508 TI - Job ending among youth and adults with severe mental illness. AB - This study examined job leaving over a 36-month period among 326 persons (74 youth and 252 adults) with severe mental illness who were participating in an urban vocational rehabilitation program. Data from 627 job endings indicated that younger clients displayed job-ending patterns that were different in some aspects from such patterns for nondisabled youth (such as displaying a lower average job tenure) yet similar to job-ending patterns for nonhandicapped youth in other ways (such as displaying a high frequency of job changing). Youth and their adult counterparts with mental illness displayed similar tenure on agency-sponsored placements but significantly different tenure on independent jobs. While adults held their independent jobs for an average of seven months, youth averaged only three months at competitive employment. Youth also were significantly more likely than adults to be fired from both placements and independent jobs. These findings and others are discussed in terms of their implications for development of public policy and service delivery models for providing on-going job support to youth and adults with severe psychiatric disabilities. PMID- 10121509 TI - Comprehensive care of pregnant mentally ill women. AB - Since the onset of deinstitutionalization, there has been an unanticipated and dramatic increase in pregnancies among women with chronic mental illness, with no specific planning for how to address the unique clinical needs of this high-risk population. Shortcomings in delivering care to mentally ill women within general health care systems are reviewed, including failure to assist with family planning, failure to observe worsening mental health during pregnancy, inadequate planning for child custody, lack of access to services, and omitted pelvic examinations. Necessary components of a system to provide comprehensive and coordinated care for pregnant mentally ill women are described. These include assessment of adaptation to pregnancy and competency to care for an infant, somatic and psychotherapeutic treatment, parenting skills training, family planning services, outreach, and close liaison with obstetric services. A Chicago based collaborative program is described as an example of providing comprehensive, specialized care with limited financial resources. PMID- 10121510 TI - Multifacility utilization by the chronically mentally ill in the Department of Veterans Affairs. AB - The objectives of this research are (1) to quantify the multifacility utilization patterns ("shared care") for a selected subset of patients with a chronic mental disorder, (2) to examine the patient characteristics correlated with several observed utilization patterns, and (3) to determine facility groups through cluster analysis, based on multifacility readmissions. Patients were identified from the VA's hospital discharge abstract system based on a diagnosis of schizophrenia in any discharge during the two-year study period. All discharges for this cohort during the period were analyzed. Essentially, three different groups of patients from this cohort were found. The vast majority have one or two hospitalizations and in the process are seen at one or maybe two facilities. However, two small minorities are hospitalized many times. One small group confines these hospitalizations to relatively few facilities while the other travels from facility to facility around the country. These two groups present very different clinical management problems from each other as well as from the majority. Since the distribution of travel distance between facilities remained similar for all types of patients (median distance was about 120 miles), facilities were clustered based on the number of linkages they shared. By use of six different measures of the disjointedness of shared care, clustering produced a reasonable number of meaningful groups which account for a majority of possibly uncoordinated shared care. We feel that these results and this approach can be useful for administrators, policymakers, and researchers. By looking simultaneously at the utilization patterns of its clients and their characteristics (e.g., age) as well as the utilization patterns within groups of facilities, any multifacility health system can characterize its shared care and identify those clients and facilities most in need of intervention, resources, and future study. PMID- 10121511 TI - Early implementation of legislative children's mental health reform: the Minnesota/Hennepin County Experience. AB - The objectives of this study were to identify the strengths and weaknesses of Minnesota's Comprehensive Children's Mental Health Act of 1989 and its early implementation in Hennepin County, Minn. Data were collected from official documents and key informants relative to three implementation criteria: (1) community-based and family-centered values; (2) the range, coordination, and affordability of services; and (3) process, outcome, and consumer accountability. Findings suggest that the state law is a laudable, yet seriously limited, attempt to reform the system of care for children with emotional disorders. While the law is strong in its intent regarding community-based value, range, and coordination of services as well as process accountability, implementation has been hampered by weaker intent with respect to other criteria and by a lack of a comprehensive financing plan. Despite these limitations in the state law, Hennepin County has moved to use the law as leverage to improve the local system of care. Implications for reformers in other states center on the issues of state/county relationships, scope of initial efforts, choice of organizational structure, and the interplay of financing and accountability issues. PMID- 10121512 TI - Evaluation of music therapy and other treatment modalities by adult psychiatric inpatients. AB - The purpose of this study was to investigate adult psychiatric patients' evaluation of music therapy and other aspects of their overall treatment. Twenty seven patients hospitalized on an open psychiatric ward of Tulane Medical Center in New Orleans served as subjects. They rated music therapy, art therapy, recreation therapy, traditional therapies, and general aspects of care provided during their hospitalization with a semantic differential consisting of four adjective pairs. Results from a one-way analysis of variance showed that music therapy was rated significantly higher than art and recreation therapy on the pleasurable/painful scale, but no significant differences were found among the activity therapies on the three remaining scales. Further one-way analyses of variance showed that the activity therapies taken as one aspect were rated significantly higher than several therapies on specific scales; also, they were not significantly less important or less successful than medication, which was rated highest on these two scales. The author suggests that an instrument with multiple evaluation scales may be specifically adapted to any program, and can provide information to guide music therapists in delivering valuable therapeutic services. PMID- 10121513 TI - Technology: life's salvation or costly sin? AB - Technology assessment will be the methodology of choice; it will provide the information necessary to make tough investment decisions. It will be a vital tool when analyzing healthcare investments. Technology assessment is probably one of the planks in the process of ensuring better outcomes research, which can be applied after having selected and used the technology. Even if you find technology assessment tougher to learn and more complicated than product evaluation, hopefully you'll recognize its inevitability and be on the cutting edge to adopt it. Make your research go beyond a comparison of acquisition cost and usage. Look at technology assessment as a deterrent to the accelerating cost of operating a hospital--as an investment in more cost-effective health care. PMID- 10121514 TI - Overview of ethylene oxide alternative methodologies in the clinical setting. PMID- 10121515 TI - Looking back to stay ahead in sterilizer technology. PMID- 10121516 TI - High speed sterilization cycle process and recovery system. PMID- 10121517 TI - AbTox Plazlyte plasma sterilization. PMID- 10121518 TI - HCFC-124, replacement sterilant for 12/88 EtO. AB - Hospitals can continue to operate their 12/88 sterilizers, knowing that an environmentally improved mix that meets the requirements of the Clean Air Act is available now in small quantities and will be widely available in 1994. Moreover, a long-term environmentally acceptable mix, also called for by the Clean Air Act for the next century, is now being tested. Both new mixes are formulated for use without change to existing equipment. PMID- 10121520 TI - Status report on ozone sterilization. PMID- 10121519 TI - Development of VHP sterilization technology. PMID- 10121521 TI - 100 percent EtO. PMID- 10121522 TI - Pain management: engineering successful outcomes. PMID- 10121523 TI - Glucose analyzers. ECRI. PMID- 10121524 TI - Product recall. PMID- 10121525 TI - Developing an effective procedure for cleaning and disinfecting G.I. flexible endoscopes. AB - The field of flexible endoscopy continues to grow at an accelerated pace. The procedures are more aggressive, the patients are sicker, the accessory instruments are more numerous, the infection control issues are more complex and the medicated patient requires more intense observation. Developing in-hospital processing procedures that are logical and supported by a rationale that includes testing is necessary in the absence of coherent, complete recommendations from flexible endoscope manufacturers. These procedures will have the highest probability of compliance and will also have the highest probability of achieving a safe product for patient use. PMID- 10121526 TI - The Medical Waste Tracking Act--results and repercussions. PMID- 10121527 TI - Hospital liability--the materiel management connection. PMID- 10121528 TI - Using vendor/commodity files in hospital acquisitions. PMID- 10121529 TI - Intravenous medication connectors. ECRI. PMID- 10121530 TI - It might be legal, but is it ethical? PMID- 10121531 TI - Trail-blazing on the healthcare quality improvement journey. PMID- 10121532 TI - Critical care nurses surveyed about safety on the job. PMID- 10121533 TI - Sharps safety. AB - All employees need to be very careful handling sharps to minimize risks to themselves and coworkers. The attention, awareness and attitude that lend themselves to safe practice can only be developed through thorough training and following correct procedures. If you have an accident/injury, report it immediately and follow your hospital's Exposure Control Plan. Many resources are available to further your learning in this area. If you are uncomfortable with your knowledge of infection control, Universal Precautions, sharps handling, etc., check with your supervisor, hospital library, and infection control staff for reference materials to increase your level of understanding. PMID- 10121534 TI - Policy concerning fraudulent preparation of documents. Joint Commission on Accreditation of Healthcare Organizations. PMID- 10121535 TI - Standards for individual competence assessment clarified. PMID- 10121536 TI - Hospital improves quality assessment process following survey. PMID- 10121537 TI - Access to provider performance information: a growing health care reform issue. PMID- 10121538 TI - New policy addresses survey cancellation. Policy pertains to organizations with planned closures. PMID- 10121539 TI - Hospital CEOs say Joint Commission improving its performance. PMID- 10121540 TI - Communicating clinical pastoral assessments with the healthcare team. PMID- 10121541 TI - Pastoral research in a hospital setting: a case study. AB - Provides a summary of research procedures and outcome data of a utilization review of the pastoral services of a large university medical center. Notes particularly the value of such a project both in terms of concrete knowledge gained and in terms of serendipitous discoveries leading to further research. PMID- 10121542 TI - Medicaid costs and birth outcomes: the effects of prenatal WIC participation and the use of prenatal care. AB - This study examines the effects of prenatal WIC participation and the use of prenatal care on Medicaid costs and birth outcomes in five states--Florida, Minnesota, North Carolina, South Carolina, and Texas. The study period is 1987 for Florida, Minnesota, North Carolina, and South Carolina and January-June 1988 for Texas. Prenatal WIC participation was associated with substantial savings in Medicaid costs during the first 60 days after birth, with estimates ranging from $277 in Minnesota to $598 in North Carolina. For every dollar spent on the prenatal WIC program, the associated savings in Medicaid costs during the first 60 days ranged from $1.77 to $3.13 across the five states. Receiving inadequate levels of prenatal care was associated with increases in Medicaid costs ranging from $210 in Florida to $1,184 in Minnesota. Prenatal WIC participation was associated with higher newborn birthweight, while receiving inadequate prenatal care was associated with lower birthweight. PMID- 10121543 TI - Closing institutions in New York State: implementation and management lessons. AB - This article examines the lessons learned about implementation and management from the closing of six large institutions for people with mental retardation in New York State. Unanticipated problems occurred, despite special attention to implementation issues in policy design and demonstrated management capacity in similar circumstances. A study of the closure experience showed that subtle but important changes in policy as well as changes in the context of implementation confounded the reasonable expectations of success that policymakers, managers, and analysts would normally have under these circumstances. A closer look, however, suggests that this experience should not be surprising. A more appropriate understanding of the role of policy, policymakers, and managers in implementation suggests that the burden falls heavily on middle managers, and that policy management capacity and an intergovernmental management perspective are crucial to implementation success. Moreover, this experience suggests that a broader definition of success that encompasses this normal turbulence of implementation provides a better appreciation of the requirements of implementation. PMID- 10121544 TI - Rural residence and poor birth outcome in Washington state. AB - It is often assumed that poor birth outcomes are more common among rural women than urban women, but there is little substantive evidence to that effect. While the effectiveness of rural providers and hospitals has been evaluated in previous studies, this study focuses on poor birth outcomes in a population of rural residents, including those who leave rural areas for obstetrical care. Rural and urban differences in rates of inadequate prenatal care, neonatal death, and low birth weight were examined in the general population and in subpopulations stratified by risk and race using data from five years (1984-88) of birth and infant death certificates from Washington state. Also examined were care and outcome differences between rural women delivering in rural hospitals and those delivering in urban facilities. Bivariate analyses were confirmed with logistic regression. Results indicate that rural residents in the general population and in various subpopulations had similar or lower rates of poor outcome than did urban residents but experienced higher rates of inadequate prenatal care than did urban residents. Rural residents delivering in urban hospitals had higher rates of poor outcomes than those delivering in rural hospitals. We conclude that rural residence is not associated with greater risk of poor birth outcome. White and nonwhite differences appear to exceed any rural and urban resident differences in rates of poor birth outcome. PMID- 10121545 TI - Physician staffing of small rural hospital emergency departments: rapid change and escalating cost. AB - We surveyed all 37 rural Washington state hospitals with fewer than 100 beds to determine how rural emergency departments are staffed by physicians and to estimate rural hospital payments for emergency department physician services. Only five hospital emergency departments (14%) were still covered by the traditional rotation of local practitioners and billed on a fee-for-service basis. Ten hospitals (27%) paid local private practitioners to provide emergency department coverage. Twelve other hospitals (32%) hired visiting emergency department physicians to cover only weekends or evenings. The remaining 10 rural emergency departments (27%) were staffed entirely by external contract physicians. Thus, 86 percent of rural hospitals contracted for emergency department coverage, and 59 percent obtained some or all of this service from nonlocal physicians. Most of the 32 hospitals with some form of contracted services have changed to this emergency department coverage in the last few years. The cost of these services is high, particularly for the smallest hospitals that have fewer than eight emergency department visits per day and pay physician wages of nearly $100 per patient visit. Emergency staffing responsibility has shifted from local practitioners to the hospital administrators because of rural physician scarcity and a desire to improve quality and convenience. The cost of these changes may further undermine the economic viability of the smaller rural hospitals. PMID- 10121546 TI - A descriptive analysis of health insurance coverage among farm families in Minnesota. AB - This paper reports the findings of a study of health insurance coverage and access to health services among farm families in Minnesota. The study included 1,482 families actively engaged in farming during 1989. While less than 10 percent of the population were uninsured during this period, the majority had limited coverage with high deductible and coinsurance provisions. Moreover, they were paying an estimated 15 to 20 percent more for their plans than a similar plan would have cost in the Minneapolis-St. Paul, MN, area. With the exception of cost, satisfaction with health services was found to be very high, and there were few indications of access problems. PMID- 10121547 TI - Rural community and physician perspectives on resource factors affecting physician retention. AB - This study was undertaken to investigate issues affecting recruitment and retention of physicians in a rural north Florida community. As part of this investigation, the authors examined the relevant context of medical care and physician practice for this community. The results identify a number of problems not uncommon in rural communities and supported by previous literature. Physicians felt isolated, dissatisfied with job security and professional autonomy, and frustrated by a lack of cooperation among the major providers of health care. More importantly, upon closer scrutiny, some of the most appealing characteristics of this community for incoming physicians become its weaknesses. Access to a regional medical center nearby and nearness to a metropolitan area were both cited as positive attributes to their choice of practice location. In this community, however, these appear to have resulted in a highly divided medical system. Many of the employed and insured patients in the county prefer to get their medical care in the nearby city. At the same time three separate entities within the community--a federally funded community health center, a county public health unit, and a community hospital--are expected to provide services for the poor and uninsured. The resulting lack of a comprehensive approach to provision of services contributes significantly to the dissatisfaction among providers and to their ultimate retention. PMID- 10121548 TI - Our Community Hospital: the evolution of a rural primary care hospital. AB - In the next few years, Our Community Hospital, located in the small town of Scotland Neck, NC, will undergo a conversion through which it may serve as an appropriate model for similar small hospitals in distressed rural communities. With technical and grant assistance from the Office of Rural Health and Resource Development of the North Carolina Department of Human Resources, the hospital has begun to phase out almost all acute care services and will expand and strengthen its focus on primary care, emergency medical services, and services for elderly persons. This paper addresses four issues of greatest concern to hospital administrators, rural health professionals, academics, and rural residents interested in hospital conversions: (1) community involvement during the planning process; (2) the evolution of the program's structure; (3) financing for the project; and (4) the development of cooperation between state and federal governments, foundations, and private groups. This case study describes one possible course in addressing an acute health care problem facing rural America- the viability of rural hospitals. PMID- 10121549 TI - State health policy and rural hospitals. AB - Many rural hospitals are experiencing difficulties. This article explores the views of various government and hospital officials on state health policy for rural hospitals. The authors discuss how these officials define the rural hospital issues and suggest appropriate state interventions to assure hospital viability and local access to care. The authors recommend that states, hospitals, and communities decide through a formal process what level of health and medical care should be available in rural areas, and states assist in low-cost ways those rural hospitals that are ready to change or that, with help, will be ready to make such operational changes as service reconfiguration, affiliations, and working agreements with other health care organizations to continue and improve local access to health care. PMID- 10121550 TI - Cancer in rural versus urban populations: a review. AB - Rural-urban comparisons have identified higher age-, race-, and sex-adjusted cancer incidence and mortality rates in urban populations for most anatomic sites, suggesting that rural populations are at lower risk from cancer. Conversely, findings that rural cancer patients are diagnosed at later stages of disease, that higher proportions of rural cancer cases are unstaged at diagnosis, and that rural cancer patients are at a more advanced stage of illness when referred to home health care agencies, suggest that rural cancer patients are disadvantaged when compared to their urban counterparts. This paper summarizes rural-urban patterns of cancer mortality, incidence, and survivorship since 1950; outlines rural-urban differences in utilization of health care services; questions the appropriateness of using rural-urban comparisons of cancer mortality and incidence to evaluate access to cancer care; and suggests potential approaches to the question of whether rural residents have access to cancer care comparable to that available to urban residents. PMID- 10121551 TI - HIV issues for rural hospitals in U.S. frontier areas. AB - A Survey of 108 hospital administrators in the eight states of the Mountain Census Region was conducted to identify frontier rural hospitals' experiences (fewer than 50 beds) in the provision of care and services to patients with HIV infection; to assess the availability of HIV care and services in these small, remote rural hospitals; and to assess the status of education and policy development related to HIV infection. Of the 62 hospitals that responded, 16 (26%) had provided care and services to HIV-infected patients. Acute inpatient and emergency room care were the services most commonly utilized. An additional 11 hospitals reported the presence of HIV-positive individuals in their medical service areas. Thus, nearly 44 percent of the hospitals were aware of the importance of addressing HIV infection as a local concern. Employees in the hospitals that had experienced caring for HIV-positive persons expressed more concern about acquiring HIV infection than those in hospitals that had not. Four nursing assistants, two registered nurses, and one dietary worker had refused to provide care. HIV education consisted primarily of video programs, presentations by in-house staff, and sending employees away to workshops. Despite this HIV education, most staff remain fearful of caring for HIV infected patients. Major concerns expressed by the hospital administrators were related to enforcing universal precautions, confidentiality, staff response, community acceptance, and cost of care. Only 30 hospitals (48%) had AIDS policies in effect, and these focused primarily on infection control and universal precautions.(ABSTRACT TRUNCATED AT 250 WORDS) PMID- 10121552 TI - Health status and needs of migrant farm workers in the United States: a literature review. AB - Migrant farmworkers lead a hard life filled with strenuous work, stress, and anxiety about employment; live under substandard conditions; and rarely get the health care they require. Preventive care is a luxury they cannot afford. Year round nutritious meals are rarely possible, due to long working hours, traveling, and living in housing without adequate cooking and refrigeration facilities. Children may attend up to six or more schools during the course of a school year. Crowded housing conditions support the invasion of parasites, infectious diseases, and viral infections. Dermatological conditions from working around a wide variety of plants, dirt, and in the sun are frequent. Exposure to pesticides, herbicides, and other chemical additives creates the likelihood of acute reactions, such as headaches and rashes, and also puts workers at risk of developing chronic diseases as the level of exposure rises because of accumulation and mix of various chemicals. Yet, we know little about the health status of this population. We are unable to estimate crude death rates, age specific death rates, or prevalence rates of most common causes of death, such as heart disease,cancer and stroke. There is no information about occupational accident rates, infectious disease rates, or even postneonatal mortality. We do know that when migrants go to a clinic, they are often likely to have the chronic conditions of hypertension or diabetes. They present symptoms of acute conditions such as dental problems, dermatitis, otitis media among children, and acute upper respiratory infections. Women frequently need obstetrical care, reflected (ABSTRACT TRUNCATED AT 250 WORDS) PMID- 10121553 TI - Computer applications, software, and training utilized by hospital administrators. PMID- 10121554 TI - Improving health manpower: a global perspective. PMID- 10121555 TI - Estimating the cost of capital for nonprofit hospitals. PMID- 10121556 TI - Social marketing: get the credit you deserve inside your organization. PMID- 10121557 TI - Practical volunteer administrator professional development strategies. PMID- 10121558 TI - Guess who made me a Medicare cheat. PMID- 10121559 TI - How well is the AMA doing its job?. Interview by Anita J. Slomski. PMID- 10121560 TI - I tell patients: an HMO is like a bus. PMID- 10121561 TI - America's health crisis. How sick is the system? PMID- 10121562 TI - America's health crisis. The Dx--and the Rx. PMID- 10121563 TI - America's health crisis. National health insurance: still a bitter pill. PMID- 10121564 TI - America's health crisis. Doctors' message to the politicians. PMID- 10121565 TI - Hospital admissions plunge, but revenues don't. PMID- 10121567 TI - Lawyers take aim at a landmark malpractice reform act. PMID- 10121566 TI - Bush vs. Clinton: what's ahead for doctors? Debate between the top health-policy advisers. PMID- 10121568 TI - Where business has turned against doctors. PMID- 10121569 TI - Educate your patients without taking more time. PMID- 10121570 TI - Coping with payment reform. Avoiding the most common mistakes. PMID- 10121571 TI - Long-term care: money's not your only worry. PMID- 10121572 TI - Why doctors don't like treating family. PMID- 10121573 TI - Experts critique doctors' ideas for reforming health care. PMID- 10121574 TI - The FTC cocks its fist, and doctors back off. PMID- 10121575 TI - A look at controlling billing office expenditures. AB - Teresa Babyak, M.H.A., M.B.A., and Pamela Ludin, CMA, describe an in-depth survey and subsequent study performed which looked specifically at the billing expenses of university-affiliated obstetrics and gynecology groups from around the country. PMID- 10121576 TI - The health care environment in 1995. PMID- 10121577 TI - How CQI and medical ethics will transform health care administration. PMID- 10121578 TI - Surviving on the edge of change. AB - The face of rural America is changing dramatically, according to author Bruce Behringer, M.P.H. Rural health care, in its broadest sense, continues to struggle for its very survival. Things, however, are beginning to look up and Behringer describes the positive changes taking place. PMID- 10121579 TI - The increasing challenge of physician recruiting. AB - Physician recruiting for any group is both difficult and time consuming. For rural groups the task can appear nearly impossible, yet the organization's very survival depends on successful recruiting. Susan Cejka writes about the problems faced by rural groups in recruiting and what some are doing to solve it. PMID- 10121580 TI - Using technology to help rural practice. AB - Health care providers in rural settings are faced with the same issues as those in urban areas, write Susan Dymond, M.B.A., and Christopher Rankin, but those issues are compounded by the isolation of distance. One answer to this problem is to use telecommunications and satellite technology to bridge these distances and that's just what Texas Tech University is doing. PMID- 10121581 TI - Networking for success. PMID- 10121582 TI - A catalyst for cooperation. PMID- 10121583 TI - The ambulatory care medical record: an administrative nightmare. AB - The patient medical record, according to Becky Glass and Sherri Mitchell, is a little recognized and highly underrated commodity that drives the practice and can often cripple it if not handled correctly. The authors describe how they successfully created "calm from chaos" in their academic group practice. PMID- 10121584 TI - Research results on physician recruitment and retention in rural areas. PMID- 10121585 TI - The loyalty crisis and the American work force. PMID- 10121586 TI - Who should call the plays? AB - The seamless health care organization is a term increasingly used to describe efforts to deliberately bring into alignment heretofore diverse interests in financing, organization, delivery and utilization of health services, writes Mary Alice Krill, Ph.D., FACMGA. Her article describes one such system. PMID- 10121587 TI - Knowing what to charge and documenting your worth. AB - Author Ellen Kirkemo Sautter, M.B.A., explains that many physicians and administrators face the dilemma of establishing appropriate pricing levels for existing and new services. Sautter offers several successfully tested tactics to help groups in this area. PMID- 10121588 TI - Combining operations and theory to compete in the '90s. AB - What happens when the wheel of academic theory meets the road of business practice reality? Author David Lindo, Ph.D., describes how one group successfully combined the two in its mission to be the premier radiology group in an expanding service area. PMID- 10121589 TI - Lab staffing today, Part 1. The shortage gets worse, but laboratorians get better. PMID- 10121590 TI - Lab staffing today, Part 2. Recoiling from CLIA, living with less. PMID- 10121591 TI - Creative strategies to survive the shortage. AB - A newly promoted lab manager scrambled to find workers for the 3-11 shift and to fill her own former position as evening supervisor. Her solutions were driven by flexibility and imagination. PMID- 10121592 TI - Coping with CLIA, Part 2. How to meet the new personnel requirements while continuing to operate your laboratory. PMID- 10121593 TI - Parasitic infection from blood transfusions. PMID- 10121594 TI - HFMA reports 52% drop in earnings. PMID- 10121596 TI - First nurse representative named to Joint Commission. PMID- 10121597 TI - New Ill., N.Y. laws address self-referrals. PMID- 10121595 TI - Use taxes for charity care--N.J. coalition. PMID- 10121598 TI - Conn. physicians settle federal charges that they boycotted HMO. PMID- 10121599 TI - Physicians aren't refusing to take Medicare cases because of lower fee schedule rates, poll concludes. PMID- 10121600 TI - Enrollees block GHA conversion. PMID- 10121601 TI - Medical waste rules delayed. PMID- 10121602 TI - Quality 'tools' not always effective. PMID- 10121603 TI - AHA's revised budget for 1992 includes $6 million adjustment to cover 'errors and omissions'. PMID- 10121604 TI - California group picks Sutter Health over Caremark. PMID- 10121605 TI - Johnson's move puts ball in Bush critics' court. PMID- 10121606 TI - CEOs must take direct route in contracting with employers. PMID- 10121608 TI - Derwinski exit not expected to affect VA medical system. PMID- 10121607 TI - R.M. meets T.Q.M. AB - Top honors for an overall program in the Modern Healthcare/MMI Cos. risk management awards go to Redlands (Calif.) Community Hospital for a team-approach program that has reduced malpractice claims and employee injuries. For an individual project, the prize goes to McLaren Regional Medical Center, Flint, Mich., whose early-return-to-work program for injured employees has cut workers' comp costs and improved staff morale. PMID- 10121609 TI - Rising violence in ERs cause hospitals to redesign security. AB - A growing number of problems caused by drugs, alcohol, gang violence and domestic quarrels are spilling over into emergency departments, creating security challenges for the nation's hospitals. In response, facilities are stepping up security measures, including redesigning emergency departments, installing airport-type metal detectors and broadening staff training. PMID- 10121610 TI - States organize to woo physicians to rural areas. PMID- 10121611 TI - More vendors aim pitch at small hospitals. AB - Computer vendors, operating in a sluggish market, are looking for business wherever they can find it, and small hospitals are virgin territory for many applications, including clinical and departmental systems. Sharply falling prices for minicomputers, microcomputers, printers and storage devices have cut the total cost of systems by at least 30% to 40%, putting them within the reach of smaller facilities. PMID- 10121612 TI - Finance execs would elect Bush by landslide. AB - If healthcare finance executives were the only ones who could vote for president, George Bush would be sleeping peacefully, knowing that he would remain in the White House for another four years. In a mock election conducted by Zimmerman & Associates, 83% of hospital finance executives voted for the incumbent, 15% voted for Arkansas Gov. Bill Clinton and 2% were undecided. PMID- 10121613 TI - Small business lobby opposes Clinton's health reform plan. PMID- 10121614 TI - Disappointing earnings forecast rocks Medical Care America Stock; other companies feel aftershocks. PMID- 10121615 TI - Conn. children to get low-cost insurance. PMID- 10121616 TI - Health economist trashes reform plans of both Bush and Clinton. PMID- 10121617 TI - Consolidation of two systems forms Trinity Regional Health. PMID- 10121618 TI - Grand jury investigating Hermann Hospital in Houston. PMID- 10121619 TI - Hospital violated 'dumping' law--court. PMID- 10121620 TI - Harvard to pay infected workers lump-sum benefit. PMID- 10121621 TI - Top La. business groups plan merger to add lobbying muscle. PMID- 10121622 TI - Continental to buy 3 hospitals from REIT. PMID- 10121623 TI - Standardized designs used in Kaiser project. PMID- 10121624 TI - Tough rules urged for tissue banks. PMID- 10121625 TI - Psych facilities flood the market as chains rush to unload them. PMID- 10121626 TI - St. Luke's Health acquires Crittenton. PMID- 10121627 TI - Top managers net 7% salary hikes. PMID- 10121628 TI - HCFA's physician panel miffed at getting tepid topics to tackle. AB - The panel formed by HCFA to give physicians a voice in the regulatory process has been so frustrated by the fluffy topics the agency has given it to review that one member has threatened to resign. But after a recent meeting between HCFA officials and the chairman of the Medicare Participating Physicians Advisory Council, both sides are hopeful that future agendas will include more significant topics. PMID- 10121629 TI - Studies show woe in primary-care supply. PMID- 10121630 TI - Federal merger rules give hospitals a hand. PMID- 10121631 TI - Mergers thrive despite wailing about adversity. AB - A push is under way to reform federal and state antitrust laws to permit more collaborative hospital activities. The intent of such reform is to ensure that cost-cutting, quality-enhancing joint projects aren't hampered by federal or state restrictions. But much evidence indicates that hospitals have done just about anything they've wanted in terms of collaboration, and they've done it a lot in the past few years. PMID- 10121632 TI - CareNetwork looks to new leadership. AB - Just 18 months after a successful public offering, CareNetwork, a Milwaukee-based managed-care company, is looking for new leadership to restore investors' confidence shaken by a string of quarterly losses. Some critics fault the hospital owners for much of the company's trouble, which includes shareholder lawsuits and the loss of some contracts, and which led to the resignation of two executives. PMID- 10121633 TI - Hospitals delay deals; bond volume falls 15%. AB - Many municipal healthcare bond deals were put on hold during the third quarter of this year because of a wide spread in interest rates, resulting in a 15.5% dip in total volume compared with last year. Some 143 new tax-exempt healthcare bond issues worth a total of $5.07 billion were sold in July, August and September, compared with 191 issues worth $6 billion sold in the year-ago period. PMID- 10121634 TI - Health reform hopes wither in Congress. PMID- 10121635 TI - HCFA planning new Medicare processing system. PMID- 10121636 TI - Providers, states angered by budget office plan to nix disproportionate-share hikes. PMID- 10121637 TI - Humana initiates own probe of documents. PMID- 10121638 TI - Con artist duping East Coast hospitals into wiring him cash. PMID- 10121639 TI - TQM means big investment, multiple-year wait for results. PMID- 10121640 TI - 'Healthcare campaign gifts total $13.6 million'. PMID- 10121641 TI - Chicago HMO offers $9 million for MedCare. PMID- 10121642 TI - Conn. fights feds over surcharge. PMID- 10121643 TI - Offer for RehabCare puts company into play. PMID- 10121644 TI - American Shared sees 'significant loss'; NMR announces layoffs. PMID- 10121645 TI - Baxter reports 13% gain in 3rd-quarter earnings, excluding Caremark unit. PMID- 10121646 TI - AmHS shareholder signs separate supply contract with Baxter. PMID- 10121647 TI - Minn. waste task force calls old disposal methods reliable. PMID- 10121648 TI - Critics assail White House stance on benefits cutoff. PMID- 10121649 TI - Humana loses $166 million in 4th quarter; write-downs, restructuring charges cited. PMID- 10121650 TI - Miss America decries inaction on AIDS, sides with Clinton. PMID- 10121651 TI - A rarity--S&P's upgrades exceed downgrades. PMID- 10121652 TI - Bush administration says it will push to automate health claims processing. PMID- 10121653 TI - 1992 up & comers. PMID- 10121654 TI - New data base to be public. PMID- 10121655 TI - Two Medicaid suits resolved. PMID- 10121656 TI - Subacute care offers flexibility, revenue. PMID- 10121657 TI - Use of nurse temps affects staff morale--survey. PMID- 10121658 TI - More women boss the business office. PMID- 10121659 TI - AMI earnings soar 735% in 4th quarter. PMID- 10121660 TI - HCA write-off leads to $268 million loss. PMID- 10121661 TI - New OrNda management tidies balance sheet with 4th-quarter charges totaling $59.3 million. PMID- 10121662 TI - Recapitalization effort aids HealthTrust's income. PMID- 10121663 TI - RNFAs (RN first assistants) seeking reimbursement, recognition. PMID- 10121664 TI - Studies examine OR injuries from sharps. AB - Needlesticks and cuts are common during surgery, exposing the surgical team to patients' blood. In some of these cases, patients might also be exposed to the worker's blood. New studies are shedding light on the frequency and type of exposures. PMID- 10121665 TI - 1992 salary/career survey: gains are moderate. PMID- 10121666 TI - ASC managers earn less, but raises higher. PMID- 10121667 TI - Self-paced modules save preceptor's time. PMID- 10121668 TI - Small changes add up to big improvements. PMID- 10121669 TI - Computer simulation assists with patient flow. PMID- 10121670 TI - Claims payment issues: an HMO perspective. AB - One of the primary objectives of a complete healthcare delivery system is to provide appropriate and timely payment to providers. One major health maintenance organization (HMO) meets that objective by refining database management, fee uniformity, and electronic claims submission. PMID- 10121671 TI - The importance of medical records to patient accounting. AB - Medical record processing delays can be significant and costly for hospitals. As hospitals seek to enhance financial performance through improved billing processes, medical record department functions should not be ignored. These functions can affect the financial performance of the institution in many ways. Successful hospitals will be those that actively manage these functions and integrate them with the billing process. PMID- 10121672 TI - Total quality management: care dealers vs. car dealers. AB - Let's turn our "flawed system into the Toyota City of world health care," proposes Fortune magazine. I shudder at the thought. Deming-Juran-type TQM procedures can help to ensure that cars and their drivers do not die on the road. Skillfully adapted for health care, these same procedures can help keep patients from dying on the operating table. These procedures can also respond to Fortune's indictment that the "U.S. medical system is as wasteful and managerially backward as Detroit before Henry Ford." However, people are not cars, and care dealers are not car dealers. PMID- 10121673 TI - Health care costs tied to many issues. AB - Although, in 1990, the United States spent about $750 billion (12.2 percent of the Gross National Product) on health care, 31-37 million people in this country are uninsured. Another 4 million people are thought to be underinsured. We have one of the highest infant mortality rates among developed industrialized nations and rank 19th in health care and well-being among those nations. Our life expectancy is lower than those of some third-world countries. The United States and South Africa are the only two industrialized nations without a national health care policy. In spite of these statistics, U.S. health care costs continue to rise and, by the year 2000, are expected to reach $1.5 trillion (15 to 17.5 percent of the GNP. Per capita spending on health care will reach $5,515 by the year 2000, compared with $2,425 in 1990 and $1,016 in 1980. PMID- 10121674 TI - Physician and nonphysician managers as decision makers: are the differences justified or just an illusion? AB - If the cost of health care is to be curtailed, it is necessary to understand physician behavior and decision making. Not only is physician decision making critical from a clinical perspective, but, as the number of physician executives increases, they must be able to integrate their clinical expertise and management skills into the business context. This article explores differences in decision making methods between physician and nonphysician managers. PMID- 10121675 TI - Biotechnology: will it break the health care bank? AB - Pharmaceuticals traditionally have been viewed as a cost-effective component in medicine's technological armamentarium. The use of pharmaceuticals has been estimated to account for 6-8 percent of the nation's total expenditures on health care. The first wave of pharmaceuticals/biologicals that has been produced by the biotechnology industry has offered therapies that can provide much benefit to patients, but it has also raised concern about the cost of these new recombinant drugs. In addition to pricing, methods of promotion and modifications in the FDA approval process have raised concerns. PMID- 10121676 TI - Sometimes we're our own worst enemies. AB - There is a sense of frustration among physicians involved in the decision and policy making processes within health care institutions. Because the endpoint is reached at glacial speed, too much time, money, and opportunity is lost. The decision making process can be repetitious and tedious because of unnecessary steps. By eliminating certain tactics and strategies employed by upper-level management in many health care institutions, the decision making process becomes more effective. This article focuses on the medical staff's role in the decision making process; explains why tactics to involve the medical staff are ineffective and why eliminating the medical staff from certain aspects of the process does not jeopardize the institution; and concludes that the hospital board and its delegates should be autonomous in the decision making process. PMID- 10121677 TI - IRS determinations present challenges to physician compensation mechanisms. AB - In recent months, the Internal Revenue Service (IRS) has issued several pronouncements that may affect compensation arrangements based on hospital physician joint ventures, as well as traditional employee/independent contractor compensation arrangements. The result of the pronouncements is that not-for profit hospitals are without certainty in developing physician compensation schemes that are competitive in the marketplace and comply with newly evolving IRS guidelines. PMID- 10121678 TI - The paradoxes of national health reform during the Wilson era. AB - The current debate over health care reform may represent yet another opportunity to establish a national health policy. A similar level of activity occurred during the presidency of Woodrow Wilson. In many ways, the failure to enact national health reform (NHR) in the early 20th Century represents a paradigm for subsequent failed attempts to enact NHR. PMID- 10121679 TI - Expanding horizons: physiotherapy leaders must chart the frontiers of the future. PMID- 10121680 TI - The effectiveness of videotapes in communicating information to rural physiotherapists. AB - This study investigated the effectiveness of videotaped versus written discharge summaries in communicating patient information to rural physiotherapists. Twenty seven rural Manitoba physiotherapists were randomly divided into two groups and tested after viewing videotapes and reading written summaries on four patients with neurological conditions. Group I saw the videotapes on the four patients first, then answered multiple choice questions regarding the patients' problems, goals and treatment for physiotherapy. Group II read the written reports first, then answered the same questions. The process was then repeated in reverse order. A statistically significant difference existed between Group I's videotape scores and Group II's written summary scores (t = 4.69, 25 d.f., p = 0.002, 1-tailed unpaired t test). There was no significant difference between Group I and Group II's videotapes score. A rating scale of the videotapes by the physiotherapists strongly supported videotaped communication. This study has relevance to those who need to communicate patient information to health care workers in distant locales. PMID- 10121681 TI - Aging in place: the new continuum of care. PMID- 10121682 TI - Total quality management: the bridge to customer satisfaction. PMID- 10121683 TI - Quality management program boosts financial performance. PMID- 10121684 TI - Merger guidelines: 'road map' to assess antitrust violations. PMID- 10121685 TI - Assessments, care plans must document resident progress. PMID- 10121686 TI - Culinary strategies help residents with dysphagia regain dignity. PMID- 10121687 TI - Program provides assisted living to low-income elderly. PMID- 10121688 TI - The quality of life award. PMID- 10121689 TI - Continuous quality improvement crucial to survey success. PMID- 10121690 TI - Setting targets improves facility restraint reduction efforts. PMID- 10121691 TI - Clinical, emotional support vital to success of AIDS unit. PMID- 10121692 TI - Crisis communications plan minimizes negative publicity. PMID- 10121693 TI - Filing a Medicare exception may increase reimbursement. PMID- 10121694 TI - Unauthorized disclosure of medical records opens facility to liability. PMID- 10121695 TI - Achieving the potential of a computerized assessment tool. PMID- 10121696 TI - The impact of the federal budget strategies on the needs of the frail elderly. PMID- 10121697 TI - Long term care of the elderly: improving use of the system. PMID- 10121698 TI - Is there game playing at Medicare? PMID- 10121699 TI - Harsh issues in home care for the frail elderly. PMID- 10121700 TI - Harsh issues in Medicare. PMID- 10121701 TI - The impact of state budget strategies on the needs of the frail elderly. PMID- 10121702 TI - Harsh issues in Medicaid. PMID- 10121703 TI - Training for exemplary service. PMID- 10121704 TI - Exemplary service guaranteed. PMID- 10121705 TI - The secure restaurant. Part I: Employee & customer safety. PMID- 10121706 TI - Keeping score on service. PMID- 10121707 TI - A new frontier for health care risk management. AB - Today's sophisticated medical environment, combined with society's penchant for litigation, has created a broad array of perils for risk managers in the health care industry. Risk managers must deal with dilemmas posed by regulatory and technological changes that have vastly altered the medical field. PMID- 10121708 TI - A new era for hospital liability. AB - Hospitals are no longer merely facilities with equipment where autonomous physicians practice; they owe a direct duty of reasonable care to patients. This dramatic transition for hospitals will ensure a sea of change in the character of hospital medical practice and management. PMID- 10121709 TI - Nursing liability. Critical issues in the emergency department. PMID- 10121710 TI - Expert systems for risk management. PMID- 10121711 TI - The savings potential of 24-hour coverage. AB - In summary, there are costs to maintaining separate systems to cover both work- and non-work-related injuries and illnesses; there are also significant costs associated with achieving coordination--if not integration--of the two plans. Overall, the financial data do not indicate that the overlap between workers' compensation and health benefits is of such magnitude as to justify integration regardless of cost; however, the data do suggest that judicious exploitation of opportunities to coordinate the two programs, especially in regard to managing health care providers, may generate significant savings. PMID- 10121712 TI - High-risk clients and mental health care management. AB - A framework characterizing high-risk psychiatric patients by their probability of hospitalization and lengthy stay is introduced. Risk curves are then developed for each patient showing the potential impact of mental health case management on patient risk. Preliminary empirical analysis reveals that although most patients benefit from the case management intervention, some 30% of the client population may face an increase in risk of hospitalization and lengthy stay. PMID- 10121713 TI - A macro model of change in specialty and spatial distribution of physicians in Canada, 1971-1981. AB - Most studies on physician distribution have examined static relationships involving the influence of such factors as socio-economic status. This study employs a causal model to study change in physician ratios (general practitioners and family physicians, and specialists) between 1971 and 1981 as a function of change in hospital bed ratios, population size, age distribution, educational attainment of the population, population "native", owner-occupied dwellings, and geographic proximity to the nearest metropolitan area, using physician data for 189 Canadian census divisions. The results, derived from LISREL VI analyses, indicate that specialists experienced increases in their supply in higher socio economic status areas and in those areas losing general practitioners and family physicians (from 1971 to 1981). General practitioners and family physicians appear to have moved into areas with a relatively low percentage of owner occupied dwellings and areas where a large percentage of the population is "native". Both groups of physicians appear to have increased in areas where there were increases in hospital facilities over the decade. The study confirms the known association between the two physician groups; that is, general practitioners and family physicians increased in areas gaining specialists and specialists increased in areas where considerable decreases in general practitioners and family physicians were occurring. Findings are discussed in terms of implications for physician manpower planning. PMID- 10121714 TI - Strategic decision support in preventive health care. AB - This nontechnical interdisciplinary paper highlights major principles of strategic decision support in preventive health care and points to selected key literature. It begins by looking at preventive health care from strategic perspectives such as determinants of health, health care costs, objectives of prevention, political order constellations and available data. Next, the paper identifies strategic decisions and decision-making to be supported. Having gained strategic perspective, it discusses tools for decision support. These tools are here related to two planning steps (i) assessment, problem and goal analysis; and (ii) design and choice of alternative interventions. Qualitative as well as quantitative aspects of computer-assisted policy analysis in preventive health care are outlined and examples presented. PMID- 10121715 TI - Defense of patient's contribution to fault in medical malpractice actions. PMID- 10121716 TI - Exclusion from Medicare: building a case for physicians. PMID- 10121717 TI - Roundup: extractors. Eight manufacturers of extractors provide details about their systems. AB - Choosing an extractor for a specific set of plant conditions can be complicated and costly, if you make the wrong purchasing decision. Extractors come in two types: centrifugal and compression, but there are numerous models of each. Here, eight manufacturers of extractors provide details about their systems. PMID- 10121718 TI - Knowing healthcare customer needs key to profitable niche marketing. AB - A potential $177 million-a-year market has been opened to textile rental operators, thanks to OSHA's recent ruling on bloodborne pathogens. Healthcare providers nationwide are now searching for solutions to their protective apparel needs. Such customer needs are what drive niche markets. Whether you've been serving the healthcare market for years or are just now targeting it, here are the marketing strategies you need. PMID- 10121719 TI - Strategic analysis of the industry for '93. AB - Continued industry consolidation and head-to-head competition, especially among large industrial companies is expected once again for 1993. Industry growth exceeding gross domestic product (GDP) also should continue. Although much of the industry experienced recession-imposed margin pressures during the past year, the low-inflation economy is providing a positive environment for improved profitability. The industry's core customer base continues to be stable. In fact, six of those industries--health and medical services, telecommunication services, communications, motor vehicles and parts, travel/transportation services, and food and related products--are among the top 12 U.S. industries picked for growth. TRSA's Long Range Planning Committee and association staff have developed this strategic analysis of the industry to help member companies develop their own action plans. PMID- 10121720 TI - Bloodborne pathogens compliance update. Local OSHA regulations cover textile rental companies in 23 states and two U.S. territories. AB - The last phase of the federal OSHA standard on occupational exposure to bloodborne pathogens became effective July 6. However, compliance deadlines may vary in the 23 states and two U.S. territories that have their own OSHA offices. The states and territories have the option of adopting the federal standard or drafting their own plans. Here's a status report on the OSHA-approved state programs for bloodborne pathogens. PMID- 10121721 TI - Survey shows employee and physician issues lead D&O insurance claims. PMID- 10121722 TI - Next Congress brings challenges. PMID- 10121723 TI - Adapting to the changing hospital-physician relationship. AB - The future health care environment will make it difficult--if not impossible--for hospitals and physicians to function independently. Trends in health care are going to force hospitals and physicians to reexamine and restructure their traditional relationships. This restructuring will have to be accomplished in the midst of competitive pressures from a variety of sources and with interference from various governmental and regulatory agencies. The success--if not the survival--of hospitals and their medical staffs depends upon a mutually beneficial relationship between hospitals and physicians. PMID- 10121724 TI - Turnarounds: the morning after. PMID- 10121725 TI - Rural hospitals involve community. PMID- 10121726 TI - The gift of life--organ donation programs need board support. PMID- 10121727 TI - Physicians plan on being major factor in reform debate. PMID- 10121728 TI - The ingredients of good governance. PMID- 10121729 TI - Physicians and governing boards: forging better relationships. Interview by Karen Gardner. PMID- 10121730 TI - Chilling prostate cancer. AB - Patients rave about a new treatment. Some doctors are less sure. PMID- 10121731 TI - Philanthropy and the '91 recession. PMID- 10121732 TI - Exposing children to volunteerism. PMID- 10121733 TI - HAVE (Hospital Awards for Volunteer Excellence) winners sketch programs. PMID- 10121734 TI - Recruitment and recognition issues for quality assurance programs. PMID- 10121735 TI - 20 personal traits of leaders. PMID- 10121736 TI - AHA's Davidson on health reform. Interview by Mary Grayson. PMID- 10121737 TI - Points of light awards: any impact? PMID- 10121738 TI - Cost accounting in hospitals. AB - Cost accounting in hospitals has presented until recently serious difficulties because every patient was considered a unique case. However, it is possible to establish statistically homogeneous groups of patients and to identify inputs needed. As hospitals are multiproduct companies it is advisable to have recourse to direct cost techniques and information technology. PMID- 10121739 TI - Financing health services in a depressed economy. PMID- 10121740 TI - Changing role of hospitals in the Philippine health system. AB - The PHC approach is a cost effective solution to the problem of health care delivery in the developing countries, with very limited resources. Instituting such an approach on a nationwide basis requires a drastic departure from traditionally accepted and time hallowed methods. In the Philippines, this required a complete rethinking and overhauling of the entire public health structure. PHC is a system and a system approach is accordingly called for to implement PHC effectively. PMID- 10121741 TI - Concerted action programme on quality assurance in hospitals in Norway. AB - Below are the results of the assessment phase of a research project conducted in Norway. This project dealt with various quality assurance strategies and their effect on improvement of care with respect to: prophylactic antibiotic use in surgery; preoperative assessment; keeping records and prevention and therapy of bedsores. PMID- 10121742 TI - Protection of the environment a modern challenge for hospital management. AB - Hospital management is more and more confronted with the necessity of protecting the environment. All hospitals can significantly contribute without additional costs to the protection of the environment by specifically avoiding and reducing packaging materials. If additional costs ares inevitable, the hospital should look for acceptable solutions in the conflict between ecology and economy and make patients contribute towards financing by means of increased tariffs. The public must be made to understand that it is possible to take measures in favour of a better protection of the environment in hospitals, but that it has its price. We may work on the assumption that society is always more disposed to sacrifice economically if it is a case of doing something for the environment. PMID- 10121743 TI - Collaborative care: a hospital strategy for an open Europe. PMID- 10121744 TI - Issues in the development of social work information systems: the case of hospital social work departments. AB - Information systems have been proposed as a valuable resource for promoting the efficient and effective operation of hospital social service departments. However, the development and implementation process must overcome the tensions inherent to collection and utilization of structured information by social work practitioners. These include the need for quantified data about qualitative phenomena, compatibility with existing work routines, compatibility with norms and perceptions of information needs at different levels, and potential versus actual utilization of the data. The authors examine these issues and present strategies for dealing with them, in the context of a project to develop a country-wide information system for social work departments in general hospitals in Israel. PMID- 10121745 TI - Data collection: are social workers reliable? AB - Social workers are required to collect a considerable amount of personal information about clients and their families which may be unrelated to direct clinical work. Administrators often use this for the purpose of payment, service documentation, agency planning, and accountability. The worker's concern about the appropriateness of collecting this data may result in poor compliance or even falsification of information. In a survey of Minnesota social workers, noncompliance with data collection requirements was substantial. The authors also found a significant degree of conflict about privacy and confidentiality issues. These findings suggest a basis of concern for those who must rely on accurate data for administrative planning. PMID- 10121746 TI - Dispose or reprocess: which should it be? PMID- 10121747 TI - Is bigger better? PMID- 10121748 TI - Tunnel washer trends. PMID- 10121749 TI - Providing soul in a reformed system. PMID- 10121750 TI - CQI in diagnostic imaging. PMID- 10121751 TI - Hospital-physician imaging ventures. PMID- 10121752 TI - PACS facts & fallacies. PMID- 10121753 TI - The evolving role of radiologic science professionals. AB - In summary, radiologic science professionals face a peculiar balancing act for the future. They must remain technologically able while practicing patient care that meets the expectations of a customer-oriented environment. That it will be difficult is without question--yet rising to meet challenges is one of the hallmarks of professionalism. Our own "new professionals" must stand ready to provide this leadership. PMID- 10121754 TI - Applied situational leadership. PMID- 10121755 TI - Computer-phobic administrators, put your fears aside. PMID- 10121756 TI - Managing the reimbursement crisis. PMID- 10121757 TI - Creating a sense of community. PMID- 10121758 TI - Self-directed work teams. PMID- 10121759 TI - Referral expectations of radiology. AB - In summary, the data suggest that the traditional role of the radiologist as an expert consultant who provides an accurate written report is still the dominant perception. This study emphasizes the importance of development of communication skills and communication standards, with particular emphasis on written data as the single most important factor in keeping a strong clinician referral base. PMID- 10121760 TI - Surveying for excellence in radiology. PMID- 10121761 TI - Networking for efficiency. PMID- 10121762 TI - Patient-centered care. PMID- 10121763 TI - Downsizing: the aftermath. AB - Downsizing is perhaps the synonym for management in the 1990's. Many managers believe it is a sure means of lowering overhead, reducing bureaucracy and improving organizational decision making. Downsizing is the systematic reduction in numbers of managers and employees working for an organization. It is designed to make the organization more cost efficient and/or competitive. It is more than simply a matter of cutting some number of employees from an organization's payroll. It involves the rearrangement and reassignment of virtually all employees in an organization. PMID- 10121764 TI - The new skill environment. PMID- 10121765 TI - The ethics of Medicare. PMID- 10121766 TI - Buyers guide supplement--mammography imagers. AB - We invited vendors who sell mammography units to submit photographs of their imaging units, close-ups of the control panels, and to provide you with information about the characteristics of their models. We didn't ask for prices since most companies will negotiate to suit the buyer. Their responses are produced here for your convenience. PMID- 10121767 TI - Credentialing: the role of the American Board of Medical Physics. PMID- 10121768 TI - Automating a radiology practice. PMID- 10121769 TI - Competencies required of health service managers in the 1990s. AB - A mailed survey of three hundred and twenty Australian health service managers provided a ranked list of competencies perceived as essential for effective management. A high level of concordance was evident as to the relative importance of forty-nine competencies generated in four focus groups. Of seven clusters of competencies: leadership, decision-making and public relations/communication were ranked most highly. Only eight differences between the various groups of managers reached significance and these related to level of manager, years of management experience, discipline and size and type of organisation. This study extends understanding of the 'real world' management development needs of one group of the health industry. In conclusion, it is suggested that educators and managers need to cooperate more closely to develop learning programs which facilitate the acquisition, practice and assessment of identified competencies. PMID- 10121770 TI - The Victorian Management Residency Programme. AB - This paper describes an innovative approach to the development of health managers in the Victorian health system. Under what is known as the Management Residency Programme, young graduates are recruited to undertake a rigorous two year programme which blends the academic specialisation necessary for health managers, with the techniques of action learning available through exposure to a range of management situations in various field placements. The proponents of action research are seriously challenging the traditional approach to management education and the Management Residency Programme provides a unique opportunity to maximise the benefits of each philosophy. PMID- 10121771 TI - The hospital of the future--planning for change. AB - This paper describes the hospital planning model developed by the North Eastern Metropolitan Region of the Health Department Victoria to forecast acute public hospital bed-day requirements in the Region. Three age-specific variables: population; separation rate; and length of stay have been used to estimate the level of demand for hospital services. The model also delineates services delivered on a same day or long stay basis. The application of the model to three local government areas demonstrates the importance of population growth and ageing on the type and level of hospital services required and the implications thereof for service delivery and the physical configuration of hospitals. PMID- 10121772 TI - Reciprocal health care agreements and Australian health policy. AB - Shortly after the introduction of Medicare, following the return of the Australian Labor Party to government in 1983, the Federal Cabinet decided to extend basic health care coverage to the international level by seeking reciprocal health care agreements with other countries. This policy has resulted in the gradual establishment of a series of treaties providing Australian travellers with coverage in a number of countries and the process is continuing. This article examines the origins and nature of Australian government policy in this area, chronicles the development of treaty links and discusses some of the international and domestic policy issues associated with reciprocal health care agreements. PMID- 10121773 TI - Human resource development in rural health care facilities. AB - In this paper, human resource development problems facing rural health care facilities are identified and it is recognised that, particularly in the face of escalating demands for training arising from environmental pressures such as implementation of the structural efficiency principle, a coordinated approach to meet these problems is desirable. Such coordination is often sought via a regional staff development service. Accordingly, using the organisational life cycle as a conceptual framework, staff development services in five NSW health regions are examined. Ranging from a cafeteria style to a results-orientation, a diversity of strategic approaches to staff development is reflected. PMID- 10121774 TI - Six values for ethical decisions: a guide for new members of ethics committees. PMID- 10121775 TI - The influence of health insurance status on the organisation of patient care in Sydney public hospitals. AB - Utilising intensive semi-structured interviews with health professionals working in public hospitals in Sydney, a comparison was made of the perceived similarities and differences in the medical and administrative management of patients who were covered by Medicare and those who were privately insured. Interviewees argued that there was evidence of preferential access to public hospital care for privately insured patients due to medical misrepresentation of the urgency of their cases. They reported that some medical and administrative practices existed which compromised the choice of admission as a Medicare patient for those with private insurance, and for those without private insurance who were referred to hospital by a specialist. It was suggested also by the interviewees that medical considerations encouraged continuity of specialist care for Medicare patients admitted to hospital when they were known to an attending specialist. Such an allegation places in some doubt the claim made by private insurers that choice of doctor is permitted only under their cover. Interviewees did not report knowledge of any form of compromise in the quality of hospital care on the basis of medical preference for private patients. However, it was reported that private patients may, in some instances, be denied a full range of hospital services due to doctors' attempts to monopolise their treatment. PMID- 10121776 TI - The successful development of decentralised health service management: an evaluation of area health services in New South Wales. AB - Decentralised provision and management of health services has been regarded by many governments as a means of improving the management of hospitals and health services that have become increasingly expensive, complex and fragmented. There has been no known formal evaluation in Australia of the success or otherwise of health services where such decentralised structures have been put in place. Known as 'area health services', decentralised administration of public hospital and health services were first introduced in Sydney, Australia in 1974. The experience has been evaluated. The outcome appears to be successful in terms of rationalisation, co-ordination and equity, but also because the decentralised health authority embraces responsibility for the health of all members of their community and is not confined to patients who attend hospitals and clinics. PMID- 10121777 TI - 'How can I know what I think till I see what I say?' Evaluating health care structure. PMID- 10121778 TI - The continuing impact of home oxygen therapy for respiratory patients on a hospital budget. AB - Home oxygen therapy for chronic lung disease is a prominent example of an increasing tendency for the provision of adaptive medical technologies by tertiary-level hospital outreach. Flinders Medical Centre has carefully monitored its home oxygen service using cost-centre management. Despite strict prescription criteria and cost-saving technological advance, this budget remains under continued pressure. Demand from eligible patients is increasing, and their enhanced survival means that numbers accumulate over the years. Unfortunately, long-term community support does not fit easily into conventional hospital budgetting. Hospitals at present do not explicitly record the benefits nor bring to account the cost savings from maintaining patients in the community. Several intermediate improvements are suggested. PMID- 10121779 TI - Privatisation in health care: theoretical considerations, current trends and future options. AB - Privatisation is once again back on the Australian political agenda. More significantly, privatisation has become an issue in the health care industry, following a proposal by the New South Wales government to privatise a public hospital in Port Macquarie. The main aims of this article are to discuss: the international move towards privatisation, the benefits of privatisation, the problems associated with privatisation in health care, and the potential health care services which could be privatised. PMID- 10121780 TI - A case for regionalisation of radiation oncology services. AB - The provision of radiation oncology services in Australia has been a source of concern and difficulty for governments for many years. This paper examines the requirements for a regional radiation oncology service. For this to operate effectively and efficiently, it is necessary to have appropriate equipment which is adequately staffed; an adequate population in the catchment area of the service, and adequate specialist support services that can be involved in the diagnosis and management of people with cancer. PMID- 10121781 TI - Casemix and costing hospital information program, Brisbane South Regional Health Authority: a preliminary study to determine the emergency department component of DRG costs. AB - The issue of costs incurred for patients in the Emergency Department who are subsequently admitted was investigated by the authors to determine the significance of costs and to identify which DRGs and clinical specialties are likely to be affected. A theoretical costing study was performed in collaboration with the staff in the Emergency Department for patients admitted through this Department. The Study was a preliminary one with a number of methodological limitations. This paper describes how the costing exercise was performed. The DRGs most likely to be admitted via this route are identified and recommendations for further study are made. The study results identify a number of issues that require resolution prior to the introduction of casemix based funding. PMID- 10121782 TI - Medicine and the health professions: issues of dominance, autonomy and authority. AB - Medical dominance of health care has traditionally been the organising principle in health care delivery. Medical power is manifested through the professional autonomy of doctors, through their pivotal role in the economics of health services, through dominance over allied health occupational groups, through administrative influence, and through the collective influence of medical associations. Using Friedson's four factor definition of medical dominance, a structured interview schedule was developed to examine one aspect of medical dominance, that is, doctors' control over the allied health professions. Ninety interviews were carried out with a sample of nurses, physiotherapists, occupational therapists, speech pathologists and psychologists working in various health care settings in metropolitan Sydney, seeking their perceptions on the way in which the medical profession interacts with their occupational group. The findings indicate that a significant proportion (73%) of health professionals did not feel regarded as professional equals by doctors. Nor did they feel that doctors had an adequate knowledge and understanding of their professions (73%). However, the majority (74%) felt that they had sufficient autonomy and were able to discuss doctors' instructions and offer advice or suggestions to doctors. Length of service significantly contributed to perceptions of professional autonomy amongst allied health professionals. These results support the view that the increased autonomy of the allied health professions has not impinged on medical dominance in the health care delivery system. Recommendations for further research and the training of medical and allied health professionals are made. PMID- 10121783 TI - The NHS Patient's Charter: consumer, policy and partisan political functions. AB - The contents of The Patient's Charter, a recent initiative of Britain's Conservative government, with its origins in the broader Citizen's Charter policy, are summarised and discussed. The Charter details ten Rights which patients are to enjoy and introduces nine national standards relating to patient care practices and maximum waiting times for emergency services and outpatient clinics. The Charter also foreshadows future plans for national and local standards. New rights granted to patients include being given detailed information on local health services, including quality standards and waiting times, guaranteed admission for treatment within two years of going on a waiting list, and the right to a prompt written reply from the chief executive or general manager to any complaint about the NHS. The functions of the Patient's Charter are analysed in terms of their consumer, policy implementation and partisan political significance. PMID- 10121784 TI - The Victorian Management Residency Programme: a student's perspective. AB - In February 1990, a new management training programme was established in Victoria which aimed to attract promising young graduates into the health system and develop their skills and competencies for a successful career in health services management. This innovative approach to the development of health executives combines the principles of action learning with the academic specialisation that is considered essential for health managers. The Management Residency Programme involves a series of placements to a variety of health care institutions over a two year period. These placements allow wide exposure to different management situations and provide the opportunity for the Resident to interact with a multitude of diverse health personnel. This paper seeks to explore the strengths of the Management Residency Programme for both the trainee and the health system as seen from the perspective of an ex-Resident. PMID- 10121786 TI - Protecting the patient on IV therapy. PMID- 10121785 TI - Japanese workplace productivity: what can health care managers learn from this phenomenon? AB - In this paper, factors which have contributed to the high levels of workplace productivity in Japan are examined. On any number of productivity indicators, Japan outperforms Australia. A summary of the debate about whether Australia can learn from Japanese workplace productivity practices is presented. An analysis of what health care managers can learn from Japanese workplace productivity is conducted. Six Japanese-influenced measures are identified as having utility, or potential utility, for Australian health care. It is concluded that the adoption of some or all of these measures should be given careful consideration by health care managers. PMID- 10121787 TI - Does the emperor really need new clothes? PMID- 10121789 TI - A systematic approach to instructional planning ... a primer for health care managers. PMID- 10121790 TI - Translating guidelines into operational tools. PMID- 10121788 TI - TQM's dimming light. PMID- 10121791 TI - Using continuous quality improvement to purchase value in health care. PMID- 10121792 TI - Individual freedoms and employer policies and benefit practices. PMID- 10121793 TI - The philosopher in the health care setting: objections and replies. AB - This article presents a series of objections against having philosophers in the health care setting and rebuttals to these objections. These objections occur often enough to deal with them as characteristic criticisms. The rebuttals outline and advocate the positive--yet limited--function of the philosopher's presence in health care. PMID- 10121794 TI - Speaking about ethics with authority (thoughts from the Cadillac Public Library). PMID- 10121795 TI - An ethics committee for a HMO an oxymoron? Certainly not! AB - In developing a plan-wide ethics committee for a health maintenance organization (HMO), one will inevitably be faced with the numerous differences between a HMO and any other health care facility. These differences offer advantages and disadvantages with regard to the formation of an ethics committee and strongly influence the logistics and functions of such a committee. Managed health care is a new arena for an ethics committee, one in which the role of an ethics committee is beginning to unfold. PMID- 10121796 TI - Point and counterpoint. Should HECs consider financial costs of care during case review? A reply. PMID- 10121797 TI - Point and counterpoint. Should HECs initiate policies to prevent recurring bioethical dilemmas? PMID- 10121799 TI - Perspectives. President Clinton: what will it mean? PMID- 10121798 TI - Ethics committees in Japanese medical schools. AB - The present features and functions of ethics committees in 80 Japanese medical schools were surveyed by employing questionnaires. Seventy-nine schools had already established committees on each campus (however, the ethics committee at Kitasato Medical University was formally established after the completion of this survey). The major role of Japanese ethics committees may be said roughly to correspond to that of Institutional Review Boards (IRB) in the U.S., although ethics committees have other functions as well. Among the ethics committees' many problems, two significant weaknesses should be underscored. The first is the inappropriate composition of the membership of the committees: more non-campus members, younger professionals, and women should be invited to participate. The second concern is the committees' essentially closed review process: this process has not been adequately open to the public even in cases in which the issue of the patient's confidentiality does not arise. However, several schools are now preparing to open their meetings to non-members and this policy should improve the present situation. It is fortunate, however, that the ethics committees in Japan's medical schools were established by members from each campus and not as a response to national directives or legislation. PMID- 10121800 TI - Perspectives. Researchers protest congressional "meddling". PMID- 10121801 TI - Perspectives. Doctors and managed care: a rocky road to accommodation. PMID- 10121802 TI - Flight nurse physical requirements. PMID- 10121803 TI - Critical incident stress debriefing: keeping your flight crew healthy. AB - Most flight team members have experienced some type of a stress reaction in their flight career, but few have been debriefed appropriately. Debriefings are necessary to keep flight personnel mentally healthy. Fatal crashes have always drawn attention, and some teams have been debriefed afterward. Proper debriefing and formal mental health evaluation may be the answer. PMID- 10121804 TI - Air medical safety: paying the price. PMID- 10121805 TI - 1992 Program listings with aircraft operators and types. PMID- 10121806 TI - How to develop a hospital fire safety program. PMID- 10121807 TI - Fire safety evaluation system for Canadian hospitals Phase I report. AB - This paper presents the Canadian Hospital Fire Safety Evaluation System (CHFSES) as a framework based on the project team's analysis. The CHFSES will be vigorously tested to ensure that the final product is unquestionably an effective fire safety evaluation system for hospitals in Canada. The CHFSES will be a dynamic system that can easily be modified to reflect changes in the National Building Code of Canada. PMID- 10121808 TI - Professional indemnity insurance and district health authorities. PMID- 10121809 TI - Manchester Central Hospitals (CC) NHS Trust telecommunications management--case study. PMID- 10121810 TI - The elusive cure: health care reform. AB - Everyone seems to believe Americans are entitled to the best health care, regardless of cost. But how to curb soaring health expenses and provide care to the 37 million uninsured in our country is a perplexing problem, one that policy makers and providers are trying to solve with a wide variety of health reform proposals. PMID- 10121811 TI - Innovative nutrition service maximizes profits. PMID- 10121812 TI - Children in hospital: II. Reading therapy and children in hospital. AB - Following the survey of book and library services described in the first of these two articles (Health Libraries Review, 8, 210-219), a research project funded by BNB Research Fund in 1991 investigated the theory and practice of reading therapy with children in hospital. Hospital play staff had been identified as the therapists most commonly involved and a number of them were interviewed using advance notice questionnaires and structured discussion. The following aspects were investigated: definitions of reading therapy, children in hospital, the reading therapy process, materials used, evaluation, services to facilitate and promote reading therapy, training and the role of libraries and librarians. Recommendations relate to practice, to provision and listing of materials, to evaluation procedures and to training. The final conclusions relate to the role of librarians in the processes and development of reading therapy with children in hospital. PMID- 10121813 TI - The revised final formaldehyde standard. OSHA. PMID- 10121814 TI - Medical waste disposal alternatives: ABB (Asea, Brown, Boveri) Sanitec. PMID- 10121815 TI - Should you monitor for glutaraldehyde exposure? PMID- 10121816 TI - Update: OSHA and occupational exposure to tuberculosis. PMID- 10121817 TI - Complaint management software choices grow but remain slim; users tout speed, efficiency and impact of computerization. PMID- 10121818 TI - Malpractice rates tied to patient communications, better relations, lower risks of lawsuits and aids workers in providing quality care. PMID- 10121819 TI - Skeptical patients wonder why hospital asks about advanced directives, survey finds; educational efforts begin. PMID- 10121820 TI - Experts advise adjustments for new patient reps facing resistance from nurses and doctors; administrative support, relationship building reduce obstacles. PMID- 10121821 TI - Quality changes at Illinois hospital add color, cut costs; employee recognition, participation power engine of effort. PMID- 10121822 TI - Cost-conscious businesses contract directly with hospitals for patients, profits. PMID- 10121823 TI - Mediation skills can diffuse conflict among staff, patients; techniques stop short of court. PMID- 10121824 TI - Patients served food fit for a governor; hospital chefs seen as essential, expendable. PMID- 10121825 TI - Shift to CQI begins with new educational standards, hospitals greet change, grumble about it. PMID- 10121826 TI - Complaints bring bad news, doctors learn good news habits through hospital patient relations sessions. PMID- 10121828 TI - Advanced directives plans for patients take shape; questions remain about new Federal law. PMID- 10121827 TI - National commission assesses risks of AIDS transmission in health care; fears persist despite reassurances. PMID- 10121829 TI - Yelling at angry callers can be good customer service, speaker says. PMID- 10121830 TI - Hunting pregnant patients takes seven days a week at hospitals with services to offer. PMID- 10121831 TI - Older values contribute to better stays, even as patients become customers. PMID- 10121832 TI - Last chance to complain can lead to speedy resolution of patients' problems. PMID- 10121833 TI - Minnesota case pits patient's rights versus futile care, judge weighs life and death decision. PMID- 10121834 TI - Joint Commission's proposed patient rights standard. Joint Commission on Accreditation of Healthcare Organizations. PMID- 10121835 TI - California pilot project makes patients happy, some hospitals see threat to their business. PMID- 10121836 TI - Philadelphia hospital to feed revolution in patient care. PMID- 10121837 TI - Complaint system finds patients getting angrier about bills. PMID- 10121838 TI - Looking for leadership in health care reform. AB - By the time this issue of Hospital Ethics is received, the national elections will be history. Regardless of outcome, efforts to develop a health reform package will continue well into the future. The health reform models championed by the presidential candidates will continue to have their supporters, regardless of which candidate becomes president. PMID- 10121839 TI - New court decision and study raise questions of PSDA impact. AB - The PSDA was passed with the idea that patients would be given a greater role in decision making near the end of life. The following articles summarize the Elbaum case in New York and a study in California, which show some limitations in what might be expected from advance directives. PMID- 10121840 TI - Primary-care patients pirated by hospital-based specialists. PMID- 10121841 TI - Transplant programs draw criticism. PMID- 10121842 TI - References define unique rural ethical issues. PMID- 10121843 TI - UVA (University of Virginia) program takes ethics education to hospitals. PMID- 10121844 TI - Missouri and Kevorkian continue to provoke controversy. AB - At the opposite ends of the right-to-die spectrum, Jack Kevorkian tries to hoodwink Michigan's doctors into joining his "obitiatry" movement and a Missouri health department official tries to "relieve" the state's residents of rights under Cruzan. PMID- 10121845 TI - A new defense: the maternity waiver program. AB - The Maternity Waiver Program is a freedom of choice waiver granted by the Health Care Financing Administration. A freedom-of-choice waiver allows certain sections of the Social Security Act to be waived, specifically statewide effectiveness; duration, amount and scope of benefits; and freedom of choice. The waiver allows the state to direct women to whom they can receive prenatal care. By restricting statewideness, the state can set up the program on a county by county basis. By waiving amount, duration and scope, the state can provide additional services to women in waiver counties that are not offered in nonwaiver counties (e.g., home visits). And by waiving freedom-of-choice, the state can set up a primary provider network which ensures that women have access to quality and comprehensive maternity services which are coordinated from the initial encounter through the postpartum period. The end result is a healthier birth outcome. PMID- 10121846 TI - High risk channeling to improve Medicaid maternal and infant care. AB - To improve the medical care access of the poorest women and newborns, South Carolina began a High Risk Channeling Project since April 1986. The Project directs physicians to screen all Medicaid-eligible pregnant women and newborns for specified clinical high risk factors. High risk patients are channeled to designated clinics for prenatal and newborn care. Channeled pregnant women are directed to deliver their babies at regional referral hospitals. For the first two years of the Project, about two-thirds of pregnancies and 60% of newborns were actually screened. Channeled women were much more likely than the non channeled to deliver at higher level hospitals. In counties where relatively few women were channeled, the rate of prematurity among Medicaid newborns was significantly higher than in other counties. PMID- 10121847 TI - Avoiding the cost burden of newborn screening for the poor and uninsured: Mississippi's model. AB - The Mississippi State Department of Health Genetic Screening Program began in 1982 with hospitals joining the program on a volunteer basis. In 1985 legislation which mandated Newborn Screening provided the Mississippi Department of Health with the responsibility to promulgate rules and regulations establishing laboratory standards, to assure that each newborn was screened and to bill the hospital for each test. The Mississippi State Department of Health charges $12.75 per each newborn tested. This cost includes PKU, T4 (TSH if T4 is abnormal), and Hemoglobinopathy screening, as well as an administrative and follow-up charge. In order to compare the costs of existing systems which coordinate services related to newborn screening, a survey has been done. The confirmatory test for hemoglobinopathy screening will be performed in the Mississippi State Department of Health Laboratory beginning July 1, 1990. This will enable the Mississippi Genetic Screening Program to charge for patients who qualify for Medicaid. PMID- 10121848 TI - The reduction of black infant mortality: an eighteen month evaluation of three Tennessee Black Health Care Task Forces' demonstration projects. AB - The problem of low birth weight has emerged as the single most important cause of infant death or subsequent handicaps in infancy and childhood. Although low birth weight babies (below 5.5 pounds) represent a small percentage of all babies born, well over half of all infant deaths occur among this group. The problem is even more serious for tiny infants. The relationship between infant mortality/morbidity and low birth weight has been known for many years and despite dramatic overall changes and medical advances, the incidence of low birth weight among high-risk populations continues to be a perennial problem. Efforts have been made nationally to develop programs that identify the conditions which increase the risk of having a low birth weight infant; programs that seek to reduce the risk of low birth weight; and research on new approaches to prevent premature labor as well as promoting the normal growth and development of a fetus. Since 1987, the Black Health Care Task Force, established by the Tennessee Department of Health and Environment has funded three infant mortality reduction pilot projects (Alton Park/Dodson Avenue Health Care in Hamilton County, Memphis Health Center and, Memphis-Shelby County Health Department) that operated in the two Tennessee counties where the Black infant mortality rates were extremely high. The projects goals were (1) to improve birth weight and survival rates of black infants born to indigent and Medicaid women; (2) to reduce maternal morbidity among indigent and Medicaid women; (3) to enhance the participation of indigent and Medicaid maternity clients in the appropriate and timely prenatal intrapartum and postpartum services; (4) to reduce the incidence of unplanned pregnancies among adolescents; and (5) to increase the utilization of family planning services by indigent and Medicaid women. Data will be reported and analyzed to assess whether or not the projects had a positive effect on birth outcome and a subsequent reduction in infant mortality. The data for this analysis is based on enrollment data provided by the projects, and linked birth and infant death certificates for project and nonproject comparisons, as retrieved from the Department of Health and Environment's Vital Records. PMID- 10121849 TI - Gift of life: enhancing the availability of obstetrical care in Alabama. AB - In mid-May, 1988, Montgomery and surrounding counties were dealing with a health care crisis approaching the break-down point. Indigent women were giving birth to about a third of the babies born in the area. Most without the benefit of any prenatal care. PMID- 10121850 TI - The role of perceived barriers in the use of a comprehensive prenatal care program. AB - This study focused on the use of community-based networks for prenatal care by black women in three high-risk communities in Chicago. We examined factors associated with use of network affiliated medical providers among 177 women. Sociodemographic factors and health status measures had no effect on network affiliated provider use. However, perceived barriers to care differentiated those who used affiliated providers from those who used alternative sources for care. Out of ten possible barriers, the odds ratios for job demands, travel time to providers and child care were significantly different from one. Implications for program modifications and expansion are discussed. PMID- 10121851 TI - The caregiver is the key to the long-term care issue. PMID- 10121852 TI - Managing international medical costs. AB - Many countries are experiencing medical cost increases exceeding those in the United States, both in real terms and as a percentage of GDP. Although in most foreign countries the majority of medical costs are directly borne by governmental programs, there is a growing trend to cost shift more of this responsibility onto the corporate sector, perhaps leading multinational corporations to consider devising international cost-containment strategies. PMID- 10121853 TI - President Bush's vision for a healthy America: a record and a plan. AB - During his first term in office, President Bush has been committed to improving the health of all Americans through a series of new programs and an increased level of funding for services to vulnerable populations. Recognizing the need for reform of the health care financing system, the President has put forward a comprehensive proposal that preserves the strengths of the U.S. systems while addressing its weaknesses. It is a system built on choice and incentives, not on government mandates and fiat. PMID- 10121854 TI - Putting people first: health care our families can afford. AB - With U.S. health care costs expected to reach 16.4 percent of the gross national product by the year 2000, the nation can no longer afford not to have a national health care plan. The reciprocal problems of cost control and access to health insurance can be addressed by implementing health expenditures targets and market reform guaranteeing coverage, reforming health care insurance, improving our primary care delivery system, and improving health education. Such a program will enable America to have the confidence and productivity necessary to achieve global economic leadership. PMID- 10121855 TI - George Bush: tell me where it hurts. AB - During his first three-and-one-half years in office President Bush has compiled some impressive achievements in the areas of disease prevention and protection for the disabled. But for much of his first term, Bush ignored the twin perils of health care inflation and a rising number of uninsured Americans. Late in his term, the President put forward a plan combining tax credits for the uninsured and a greater emphasis on managed care to control costs. PMID- 10121856 TI - Bill Clinton: scalpel at the ready. AB - Democratic presidential candidate Bill Clinton has put comprehensive reform of the U.S. health system near the top of his agenda, vowing to put a plan before Congress within the first 100 days of his administration. And, working with a Democrat-controlled Congress weary of health policy gridlock, Clinton might have the leeway he needs to push major reform ahead. But the candidate's track record in Arkansas suggests the five-term governor is more comfortable forging consensus instead of leaping into the unknown. PMID- 10121857 TI - Singing the Blues on Capitol Hill. PMID- 10121858 TI - Nursing home reform: five years later. AB - In 1987 Congress enacted landmark legislation designed to overhaul federal oversight of the U.S. nursing home industry. Changes included creation of a "bill of rights" for residents, a new outcome-oriented inspection system, and new staffing requirements. Five years later, despite delays in the issuance of necessary regulations, portions of the law have succeeded in improving the quality of life of the estimated 1.5 million elderly and disabled American confined to a nursing home. PMID- 10121859 TI - Court awards for medical testing: why the trend is controversial. PMID- 10121860 TI - The gang that shoots straight. Jackson Hole Gang. PMID- 10121861 TI - American Health Information Management Association. Position statement. Issue: Healthcare reform. AB - The use of electronic data interchange for claims processing and the development of the computer-based patient record will allow for the reduction of administrative costs of our healthcare system. AHIMA will continue to collaborate with the public and private sector in the implementation of the recommendations of the IOM report and the WEDI report. PMID- 10121862 TI - The D*A*T approach to total quality management. PMID- 10121863 TI - Interdisciplinary teaching provides allied health students a new look at health information management professionals. PMID- 10121864 TI - Application of the multiskilled staffing innovation to the health information management professional. PMID- 10121865 TI - Building a strategic information systems plan: a cooperative effort among health professionals. PMID- 10121866 TI - Peripheral controllers and devices--Part 2. PMID- 10121867 TI - Understanding healthcare reform. PMID- 10121869 TI - Optical disk technology. PMID- 10121868 TI - QA Section Board commentary on specialty credentialing. PMID- 10121870 TI - Ethical issues in long-term care. PMID- 10121871 TI - Thoughts on reform in long-term care. AB - The authors, drawing on their experience as administrators at Winnipeg's Deer Lodge Centre, ponder the challenges facing long-term care facilities in light of improving community-supported care, changing resident's needs, and the fragile state of today's health care economy. This article identifies the need for fresh, resident-oriented thinking among administrators and staff in the distribution of power in long-term care facilities, and proposes new social interactions that can enliven and humanize residents' and staff's mutual roles and behaviours. PMID- 10121872 TI - Community versus hospital: the costs of caring for level III patients. AB - New health strategies advocate community-based care as a cost-efficient alternative to hospital services. In response to this, a chronic care hospital in Ontario examined the financial requirements needed to supply home care to 10 of its level III patients. The specialized services essential to these patients were tabulated and compared with costs for hospital care. This article describes the study, provides a daily cost breakdown for one patient, and presents its conclusions. PMID- 10121873 TI - A home away from home: extended care in pediatrics. AB - In 1982, the Winnipeg Children's Hospital initiated its Pediatric Extended Care Unit for children who require prolonged respiratory support. Since its creation, 34 children have stayed at the unit for periods ranging from a few months to nearly three years. Most have been successfully discharged to their natural or foster families to assume their place in the community. PMID- 10121874 TI - Quick response teams: a new approach in utilization management. AB - In a 12-month pilot project, a "quick response team" was able to prevent 206 admissions out of the 237 referrals it received. In December 1990, an Ontario hospital implemented the project to avoid unnecessary hospital admissions of frail, elderly and disabled adults. Based on actual home care and hospital staffing costs, the pilot project illustrated that a quick response team is a cost-effective alternative to hospitalization for this patient population. PMID- 10121875 TI - Transition to program management. AB - In their continuing pursuit of quality, effectiveness and efficiency, Canadian hospitals are adopting program management as an organizational model. West Park Hospital, a 406-bed continuing care and rehabilitation facility in Toronto, has recently introduced a comprehensive and decentralized program-management structure. This article describes West Park's five-year transition from a traditional administrative structure to program management. PMID- 10121876 TI - No (pregnant) woman is an island: the case for a carefully delimited use of criminal sanctions to enforce gestational responsibility. PMID- 10121877 TI - Are we morally obligated to make gifts of our bodies? PMID- 10121878 TI - Presumed consent to organ donation: a reevaluation. PMID- 10121879 TI - Do we own our bodies? PMID- 10121880 TI - Medical peer review: the need to organize a protective approach. PMID- 10121881 TI - RU 486: the politics of choice. PMID- 10121882 TI - Lee Memorial Hospital records positive early results for first of several "focused care centers," foundation of hospitalwide conversion. AB - This article is the second of two parts. In the March 1992 issue, authors Francine Gomberg and Kurt Miller discussed the reasons for fundamental change at Lee Memorial Hospital in Fort Myers, Florida, and set out the parameters of their "World Class Healthcare" initiatives. PMID- 10121883 TI - How healthcare-specific quality initiatives impact the bottom line. PMID- 10121884 TI - What's healthy about health care design? Woodside Place at Presbyterian Medical Center, Oakmont, Pa. and Dept. of Cardiothoracic Surgery, Columbia Presbyterian Hospital, New York City. AB - Designers must get involved with America's ailing health care system in new ways, as the National Symposium on Healthcare Design observes in awarding 1992's Health Environment Awards. PMID- 10121885 TI - No bones about it. Resurgens Orthopaedics, Atlanta, Ga. PMID- 10121886 TI - Danny's boy. St. Judes Children's Research Hospital, Memphis, Tenn. PMID- 10121887 TI - Child-friendly. Lucile Salter Packard Children's Hospital, Stanford University, Ca. PMID- 10121888 TI - Considerations in choosing directors, officers, and trustees insurance. AB - Today, health care organizations need to carry D&O insurance regardless of immunity laws and indemnification provisions. This is a vehicle for the corporation to insure its own liability for indemnification obligations as well as the D&O's when indemnification is not available. D&O policies are not black and white, so be prepared by asking questions about the carrier's defense obligations before a claim. There are knowledgeable and professional D&O carriers who genuinely want to enter into a long-term commitment with you and your board. Take advantage of opportunities to meet the claims representatives as well as marketing people to evaluate this. PMID- 10121889 TI - Could your hospital benefit from an owner-controlled insurance program? AB - In summary, underwriters are reaching out to consider some construction projects that are traditionally too small to qualify for an OCIP (under $80,000,000). A hospital system with an ongoing capital expenditures budget in excess of $100,000,000 over any three-year period can group its construction projects together to meet the minimum qualifying amounts generally required by underwriters for the OCIP. The approach of wrapping up the coverage for all the contractors on-site into one policy makes good economic sense and is administratively manageable with the computer support systems available from some brokers today. The concentrated effort of loss prevention, coupled with the control factor of knowing how much insurance is available and the security of the insurer providing it, makes for a winning combination in addressing the unknown risk brought on by large construction projects at the hospital. PMID- 10121890 TI - Fleet loss control for health care. PMID- 10121891 TI - The risk manager educates the board: meeting the challenge. PMID- 10121892 TI - 'Workers' compensation costs are uncontrollable': exploding the myth. PMID- 10121893 TI - Controlling risk factors in construction projects. PMID- 10121894 TI - Computer software and copyright protection: health care implications. PMID- 10121895 TI - Winners and losers. Primary and high-tech care under health care rationing. PMID- 10121896 TI - Special Report. Putting outcomes research to work. PMID- 10121897 TI - Physicians' attitudes on health care reform. PMID- 10121898 TI - The difficulties of quantifying quality. PMID- 10121899 TI - Moving health care data electronically. PMID- 10121900 TI - Physicians differ on health care reform measures. AB - Providers agree that the health care system needs to be reformed. They differ slightly in their approaches and vary in their views of the causes for current problems. PMID- 10121901 TI - A case study: Spiegel saves $1 million with plan redesign. PMID- 10121902 TI - Miami Chamber joins HMO for small firms. PMID- 10121903 TI - Vermont considers a single-payer plan. PMID- 10121904 TI - Avoiding risks in managed care contracting. PMID- 10121905 TI - What buyers should ask about quality. PMID- 10121906 TI - Rx for health care. PMID- 10121907 TI - Painful remedies. PMID- 10121908 TI - Medicine's great journey. One hundred years of healing. AB - At the close of the 19th century, bloodletting was state-of-the-art medical practice and life expectancy in the United States was about 40 years. Excerpts from a newly published photo collection chronicle the dizzying changes that have occurred since then. PMID- 10121909 TI - A matter of death and life. Where should German doctors draw the line? PMID- 10121910 TI - Medicare program; fee schedule for physicians' services--HCFA. Correction of final rule. AB - In the November 25, 1991 final rule (56 FR 59624) on the Medicare fee schedule for physician services, we inadvertently set forth regulations on the fee schedule at 42 CFR, part 415. However, our plan for the recodification of HCFA regulations calls for general regulations on payment for Part B medical and other health services to be codified in part 414, with part 415 reserved for regulations on payment to teaching physicians, teaching hospitals, and provider based physicians. Therefore, in this correction notice, we are redesignating in their entirety the physician fee schedule regulations contained in part 415, subpart A to part 414, subpart A, and reserving part 415 for future use. Also, this document corrects technical errors that appeared in the final rule published in the Federal Register on November 25, 1991 (56 FR 59502) entitled "Medicare Program; Fee Schedule for Physicians' Services". PMID- 10121911 TI - Core Data Set Requirements--IHS. Changes to Indian Health Service Core Data Set requirements (CDSR)--correction. AB - This notice modifies the data set associated with the Community Health Representative Information System (CHRIS) of the Indian Health Service (IHS) CDSR. PMID- 10121912 TI - Advisory Council on Trauma Care Systems; establishment--HRSA. PMID- 10121913 TI - Eligibility rules for special emergency paging--FCC. Final rule. AB - This action modifies 90.38 of the Commission's Rules by expanding the eligibility of end users to which special emergency paging licensees can provide service. Hospital paging systems could not be used to inform participants in an organ donor program of the availability of a suitable organ. The Commission has decided that patients actively awaiting an organ transplant should be eligible under the Special Emergency Radio Service to receive paging service. PMID- 10121914 TI - Abnormal occurrences for second quarter CY 1992; dissemination of information- NRC. PMID- 10121915 TI - Medicare program; schedule of limits for skilled nursing facility inpatient routine service costs--HCFA. Final notice with comment period. AB - This final notice with comment period sets forth an updated schedule of limits on skilled nursing facility routine service costs for which payment may be made under the Medicare program. Section 1888(a) of the Social Security Act requires that for cost reporting periods beginning on or after October 1, 1992, and every two years thereafter, the Secretary update the per diem cost limits for skilled nursing facility routine service costs. PMID- 10121916 TI - Medicare program; changes to the hospital inpatient prospective payment systems and fiscal year 1993 rates; correction--HCFA. Final rule; correction. AB - In the September 1, 1992, issue of the Federal Register (FR Doc 92-20647) (57 FR 39746), we revised the Medicare inpatient hospital prospective payment systems for operating costs and capital-related costs. Additionally, in the addendum to that final rule, we described changes in the amounts and factors necessary to determine prospective payment rates for Medicare hospital inpatient services for operating costs and capital-related costs. These changes are applicable to discharges occurring on or after October 1, 1992. This notice corrects errors made in that document. PMID- 10121917 TI - Medicare and Medicaid programs; quarterly listing of program issuances and coverage decisions--HCFA. General notice. AB - This notice lists HCFA manual instructions, substantive and interpretive regulations and other Federal Register notices, and statements of policy that were published during April, May, and June 1992 that relate to the Medicare and Medicaid programs. Section 1871(c) of the Social Security Act requires that we publish a list of Medicare issuances in the Federal Register at least every 3 months. Although we are not mandated to do so by statute, for the sake of completeness of the listing, we are including all Medicaid issuances and Medicare and Medicaid substantive and interpretive regulations (proposed and final) published during this timeframe. We also are providing the content of the revision to the Medicare Coverage Issues Manual published between April 1 and June 30, 1992. On August 21, 1989 (54 FR 34555), we published the content of the Manual and indicated that we will publish quarterly any updates. Adding the Medicare Coverage Issues Manual changes to this listing allows us to fulfill this requirement in a manner that facilitates identification of coverage and other changes in our manuals. PMID- 10121918 TI - Medicare program; payment to hospitals for furnishing photocopies to peer review organizations--HCFA. Final rule. AB - This final rule amends the regulations governing Utilization and Quality Control Peer Review Organizations (PROs) to provide for a uniform methodology for determining payment to hospitals for the costs of furnishing photocopies of medical records of Medicare beneficiaries to PROs. We also are establishing the rate of payment for these costs at $.07 per page. This amount includes payment for labor and supply costs, but not the costs of equipment and overhead, which are already otherwise paid under the Medicare program. PMID- 10121919 TI - Receipt of byproduct and special nuclear material--NRC. Final rule. AB - The Nuclear Regulatory Commission is amending its regulations governing the condition of licenses for production and utilization facilities to allow a reactor licensee to receive back byproduct and special nuclear material that is produced by operating the reactor after that material has been sent off-site for processing, such as compaction or incineration. PMID- 10121920 TI - Medicare program; revised procedures for paying claims from providers of services -HCFA. Final notice. AB - This final notice announces the implementation of a uniform payment policy and procedures for paying providers of services under Medicare Parts A and B. The revised payment policy allows providers to elect to receive claims payments through either (1) electronic funds transfer; or (2) hard copy checks sent directly by first class mail. The procedures allow intermediaries and carriers to pay providers through direct deposits into providers' bank accounts if the providers (1) are already electronic media claims billers; (2) accept an electronic remittance notice in lieu of a paper remittance notice; and (3) request electronic funds transfer in writing. The procedures are issued in response to requests from both contractors and HCFA regional offices to implement a policy for payment methods that treats all payees uniformly. PMID- 10121921 TI - Use of alternative dispute resolution--HHS. Notice of interim policy. AB - The Department has developed an interim policy to address the use of alternative dispute resolution (ADR) as required by the Administrative Dispute Resolution Act (ADR Act), Public Law No. 101-552. This interim policy also responds to the Negotiated Rulemaking Act, Public Law No. 101-648, and relevant elements of the Executive Order on Civil Justice Reform (E.O. 12778). The Department is adopting an interim policy because we need a baseline of experience and knowledge from our own pilot activities and those of other agencies before finalizing a policy. PMID- 10121922 TI - Cost of hospital and medical care and treatment furnished by the United States; certain rates regarding recovery from tortiously liable third persons--Office of Management and Budget. PMID- 10121923 TI - Survival tactics. AB - Once seen as stubborn naysayers, the American Medical Association and the American Hospital Association are trying a kinder, gentler approach to the health care reform debate. For both groups, it's a matter of survival. PMID- 10121924 TI - We have met the future: managed care. PMID- 10121925 TI - Measuring and assessing productivity. PMID- 10121926 TI - Stress, job satisfaction, and the medical technologist. PMID- 10121927 TI - Thorough reference-checking can avoid trouble for hirers. PMID- 10121928 TI - Images of the past--visions for the future. 41st Welch Memorial lecture. PMID- 10121929 TI - The knowledge tree. PMID- 10121930 TI - C.A.M.R.T. (Canadian Association of Medical Radiation Technologists) code of ethics. PMID- 10121931 TI - Private practice for x-ray technologists. PMID- 10121932 TI - Radioexposure levels observed with sub-optimal fluoroscopic systems. AB - Contemporary radiology increasingly performs invasive procedures for therapeutic purposes. These new requirements stress the patient's and the workers' (physicians, nurses and technologists) radiological exposure, specifically during long periods of fluoroscopy. The worker-exposure level and the patient's dose are related to the equipment geometry (i.e., an above- or under-table-top x-ray tube), the medical practice, the operating mode and the overall performance of the equipment. Using the effective dose concept for the patient and the exposure rate at the operator body surface for some spatial locations around the equipment, the authors show the variation on the dose to the patient and the operator while a collimator is opened larger than the detector size. They stress that a non-optimum opening size of the collimator may be penalizing for the patient and for the operator, specifically when the latter works near equipment mounted with an over-table-top x-ray tube. This particular piece of an equipment is the easiest one to control and maintain. Better use and better quality control should contribute to significantly reducing patient and operator exposure. The authors present statistics obtained on equipment surveyed in 1990 to comply with the Quebec Public Protection Law. PMID- 10121933 TI - Large field studies of hospital based services: lessons from occupational therapy. AB - A study with a quasi-experimental design was developed to evaluate the effectiveness of hospital-based occupational therapy services in Nova Scotia. Seven hospitals with occupational therapy services were matched with seven hospitals without occupational therapy services. Within the two hospital groups, subjects were matched on the basis of diagnosis and disability. Outcome measures included measures of functional performance in activities of daily living, and community living skills. This paper discusses some of the strengths and weaknesses of conducting large field studies of hospital based services. It is based on our experience with an occupational therapy outcome evaluation. Some of the strengths include well developed and implemented hospital admission and discharge practices, personal contact with key hospital staff, support of the hospital occupational therapy directors and the Nova Scotia Department of Health, and professional support through national guidelines on the client-centered practice of occupational therapy. Study weaknesses can be categorized into three major areas including evaluation issues, hospital issues, and professional issues. Our experience can contribute to the scientific literature on outcome studies on occupational therapy and to the conduct of large field studies of hospital based services in general. PMID- 10121934 TI - Medicaid asset transfers draw governors' attention but extent of abuses remains unclear. PMID- 10121935 TI - Strategic planning overcomes lack of vision. PMID- 10121936 TI - What are the keys to retaining administrators in long-term care? PMID- 10121937 TI - OBRA serves up paperwork. Food service departments find pros and cons in new regs. PMID- 10121938 TI - Reeling in HMOs. PMID- 10121939 TI - Hitting the mark. Hospital seniors' groups targeted by LTC insurer. PMID- 10121940 TI - Ways to cut paperwork. PMID- 10121941 TI - Wound care: a different animal. PMID- 10121942 TI - Care planning: pulling together. Interdisciplinary bedside rounds improve efficiency. PMID- 10121943 TI - Nurse aide registry rules. PMID- 10121944 TI - Reducing unnecessary psychoactive drugs. PMID- 10121945 TI - Low osmolar contrast media: a quality and cost dilemma. AB - As a medical group manager, cost/benefit decisions will not often be yours to make alone. But your participation--especially on cost, reimbursement and legal matters--can be valuable. It should be presented in a thorough and factual manner. Your role in getting others to accept the decision can also be vital and accomplished by providing pre-decision information and feedback once the decision has been implemented. PMID- 10121946 TI - Selection of a professional liability insurance policy. AB - A review of the professional liability insurance policy of one corporation's physicians stimulated a review of the policies used to protect the physicians and corporation from the financial risk of professional liability. It was clear that little was known about the insurance carrier. This case study chronicles the group's actions to address this problem. PMID- 10121947 TI - Certified nurse midwives: a cost-effective alternative to physician staffing. AB - This case study analyzes the cost-effective benefits that far outweigh the management risks of employing certified nurse midwives. In addition to providing a financial benefit, the midwife receives high ratings as a patient care asset to any practice. The author of this professional paper asserts that medical groups that fail to respond to a competitive environment, in which patients have multiple choices, will not survive. PMID- 10121948 TI - Healing mind & body. AB - A comprehensive care plan must go beyond the physical. The Visiting Nurse Association (VNA) of Louisville, a private nonprofit agency serving Louisville and 13 surrounding counties in Kentucky and southern Indiana, began its in-home mental health program in 1978 with one mental health nurse. Today VNA has 20 mental health nurses who make more than 10,000 home visits to 800 patients a year. The program includes treatment of the mentally ill, geriatric patients with mental or emotional problems, people suffering from Alzheimer's disease and related dementia, and emotionally disturbed children. PMID- 10121949 TI - The necessity for maternal-infant perinatal home care. AB - By rendering the described care, home nursing should be able to better meet the needs of the childbearing and childrearing families throughout the United States, as well as be instrumental in lowering the country's perinatal death rate. Future generations can profit from individuals' being raised in homes that are better prepared for their birth and rearing. An area of home nursing will be reestablished, and families will once again benefit from nursing being in the home during the perinatal period. PMID- 10121950 TI - Functional facts: a public health approach to functional assessment. AB - Too often patient evaluation focuses on diseases and symptoms. The author developed this tool to help caregivers conduct a simple, informal evaluation of a patient's ability to perform daily activities and thus help promote awareness of wellness and prevention among patients and caregivers. PMID- 10121951 TI - Prevention and home care: not strange bedfellows. PMID- 10121952 TI - The nutrition screening initiative. AB - Elderly individuals are the largest demographic group at risk for nutrition disorders. Home care professionals can incorporate routine screening, counseling, and interventions by noting risks and indicators for poor nutrition in the homes they visit using the Nutrition Screening Initiative checklist system. PMID- 10121953 TI - A community health program for the elderly. AB - The few existing health education programs for the elderly of a southeastern Pennsylvania community focused on illness rather than prevention. After several nurses conducted a survey of healthy seniors, they developed a stress-reduction program--a first step toward assisting the elderly to maintain health and independence. PMID- 10121954 TI - Home safety & older adults. AB - Home care workers are in a prime position to identify personal and environmental risk factors for seniors living at home. This article identifies many of these risks and offers a logical approach to alleviating some of them. PMID- 10121955 TI - Public & private partnerships in health promotion. Atlanta Regional Commission, Area Agency on Aging. AB - Home care agencies promote wellness just by their definition. They can go beyond the home, however, and work with area businesses to promote wellness and disease prevention in the broader elderly community. PMID- 10121956 TI - The drumbeat for reform continues. PMID- 10121957 TI - College graduates: do we have too many or too few? PMID- 10121958 TI - Characterization of errors detected during central order review. AB - Characterization of prescribing errors detected by dispensary pharmacists in a tertiary-care teaching hospital is described. During the 25 week study period, 1330 prescribing errors were identified from a total of 237,798 medication orders processed by the pharmacy, representing a rate of 5.6 errors per 1000 orders. Resident physicians wrote more errant medication orders than any other physician class. Errors most often occurred on the general medicine teaching wards. The most common drug classes implicated were non-formulary medications and antibiotics. Approximately 11% of errors were defined as potentially fatal or severe (Type A) errors, 7% were potentially serious (Type B), 21% were potentially significant (Type C) and 61% were problem orders (Type D) based on a classification system of severity. The most common error types were inappropriate dosing of antibiotics and the prescribing of medications for patients who had a potential conflicting allergy history. The acceptance of pharmacists' suggestions was 67%. The study identified three major areas where future educational and corrective measures could be aimed: adherence to the formulary, antibiotic prescribing and allergy validation. PMID- 10121959 TI - AIDS and healthcare management. PMID- 10121960 TI - Is your facility affected by the OSHA bloodborne standard? PMID- 10121961 TI - Assessment of need for services for mentally disordered offenders and patients with similar needs. PMID- 10121962 TI - The provision of secure psychiatric services in Leeds; Paper i. A point prevalence study. AB - The results of a point prevalence study were used to assess the relative contributions of a local Special Care Unit, Regional Secure Unit and Special Hospitals to the provision of secure psychiatric services in Leeds. Over a six month period, a comparison was undertaken of all patients admitted to the three tiers of security; particular emphasis was given to mentally abnormal offenders. Most admissions to the Special Care Unit were transferred from the general psychiatric wards; admissions to the Regional Secure Unit were mainly from the Court and prisons. On the census day, 7.1 patients per 100,000 population from the catchment area were in one of the three tiers of security, with the Special Hospitals providing the main long-stay service component. The findings show that the three tiers perform distinct, but complementary, functions, and emphasise a need for medium to long-stay secure facilities. PMID- 10121963 TI - The provision of secure psychiatric services in Leeds; Paper ii. A survey of unmet need. AB - This paper reports the results of a survey of statutory and voluntary staff who are likely to have contact with people requiring treatment in the secure psychiatric facilities provided in Leeds. The survey seeks to assess whether there is under-provision of Secure Unit beds, and if the three-tier local secure service is adequately addressing the needs of patients in the Special hospitals, prisons and the community. Researchers monitored all demands for psychiatric reports to prison over a six-month period, to identify any unmet need for secure psychiatric facilities. The findings show that patients with a learning disability were unable to transfer from a Special Hospital to a lower level of security. There is also a significant unmet need for medium to long-stay Secure Unit beds, and that many patients in the community have significant unmet needs for access to psychiatric services, including structured, intensively staffed community accommodation. PMID- 10121964 TI - Referral rates to a regional adolescent psychiatric service: a comparison of visited and unvisited general practitioners. AB - A survey was undertaken through personal visits to general practitioners to determine the effectiveness of distributing information about a Regional Adolescent Psychiatric Service for emotionally and conduct disordered adolescents. The referral rates to the Unit over the four years before, and over the four years after the period of the visits were recorded both for those GPs who were visited and those who were not. The findings show an immediate significant increase in referral rates among the visited general practitioners, which was still evident after four years. This finding supports the hypothesis that a personal approach is more likely to be an effective means of disseminating information than posted printed materials. This paper also contains a description of other valuable, but unquantifiable results. PMID- 10121965 TI - Do we measure up? The development of a multidisciplinary quality assurance and audit system in a psychiatric rehabilitation setting. AB - The purpose of this paper is to describe a simple system of multidisciplinary team quality assurance and audit, and to consider its use in a rehabilitation unit. The Merton rehabilitation team at Springfield University Hospital, Tooting, developed this system, and this paper also outlines some of the problems encountered during the system's development. The system not only offers criteria by which to assess performance in a long-term and rehabilitation setting, but also provides a method for evaluating the multidisciplinary team's performance. PMID- 10121966 TI - Blood pressure measurement by junior hospital doctors--a gap in medical education? AB - A questionnaire survey, combined with an observational study, evaluated the knowledge of doctors in training grades on the practical aspects of blood pressure measurement. Eighty (non-consultant) junior hospital doctors, graduates from 30 separate medical schools, participated in the study. The results show that 27 (33%) doctors acknowledged no formal education on how to measure blood pressure. This lack of precise theoretical knowledge was matched by an observed poor clinical technique in over one third of the study group. The precision and accuracy of blood pressure recording is fundamental to the clinical examination of patients, and crucial in their management in both hospital and community settings. The findings of this study support the urgent need for further training and assessment of blood pressure measurement at undergraduate, and postgraduate level. PMID- 10121967 TI - Working conditions of British resident hospital oral and maxillofacial surgeons. AB - The aim of this study was to determine the opinions of on-call senior house officers in British oral and maxillo-facial surgery, or related units, about aspects of their working conditions. Despite concern about the conditions of service of junior hospital staff in other clinical specialties, the results suggest that most senior house officers in this discipline are satisfied with their present posts. However, regular review of their conditions of service is still indicated. PMID- 10121968 TI - Expanding your career ladder. PMID- 10121969 TI - Establishing an off-site catering program. PMID- 10121970 TI - Dietitians view the horizon. AB - In honor of the American Dietetic Association's landmark 75th anniversary, FM asked ADA members representing six market sectors to share their perspectives on the opportunities & challenges for dietitians in the '90s. An exciting era lies ahead. PMID- 10121971 TI - Putting quality management to work. AB - Quality Management [QM] processes are helping independent operators & contractors find more creative ways of doing business & enhance the quality of their products. In this roundtable, a panel of 10 QM veterans & rookies discusses specific applications of their processes, ranging from building better communications with customers to getting more for their purchasing dollars. Read ahead to learn how to make QM work for you. PMID- 10121972 TI - Managing volunteers in foodservice. PMID- 10121973 TI - Rx for an ailing bakery. PMID- 10121974 TI - 1993 Industry growth. AB - According to industry tracker Technomic Inc., 1993 food purchases in noncommercial foodservice will increase only slightly, moving up a little less than 1%. While this is greater than the 1992 growth rate of 0.3%, it's still less than half as strong as that of the commercial market. PMID- 10121975 TI - FDA to the rescue. PMID- 10121976 TI - Patient restraints. Improving safety, reducing use. PMID- 10121977 TI - Closer ties with physicians skirt safe harbors fears. PMID- 10121978 TI - CIO takes on larger role, even at smaller hospitals. AB - Today's hospital CIOs must have more than computer, data analysis and technical skills. They must be knowledgeable about hospital management techniques, how hospitals interact with patients and their medical staff, and broad health care issues, such as community health standards and the role of managed care. Finding qualified CIOs will be increasingly difficult. PMID- 10121979 TI - Collaboration can work--given the right commitment. Interview by Donald E.L. Johnson. AB - Community health care networks require an unprecedented level of collaboration between hospitals and other providers. But how can hospitals that are steeped in a competitive mindset convert to a collaborative approach, especially if they have competed directly? In the following interview with Donald E.L. Johnson, editor and publisher of Health Care Strategic Management, Len B. Preslar Jr., president of The North Carolina Baptist Hospitals Inc., in Winston-Salem explains how to overcome impediments to collaboration. There is an increasing recognition by hospital leaders of the need to collaborate but a continuing underestimation of the time and energy needed to make it work. PMID- 10121980 TI - New hospitals may resemble malls. AB - Hospital designers and planners are adopting several features of the ubiquitous retail shopping mall to create a new model for a user-friendly, market-driven health care facility. Also, they are building and renovating hospitals in stages, which allows maximum flexibility in adapting to increasingly rapid changes in reimbursement patterns, clinical priorities and patient demand. PMID- 10121981 TI - Contract managers may be route to CQI and savings. PMID- 10121982 TI - Planning indicators. More hospitals outsource facility planning and management functions. PMID- 10121983 TI - Twenty myths about national health insurance. PMID- 10121984 TI - Satellite centers help academic facilities tap outpatient market. AB - Academic medical centers have had difficulty adjusting to the shift from inpatient to outpatient services. They have been slow to provide care in a readily accessible, easy-to-use setting. Satellite ambulatory care centers can help make large teaching hospitals more customer oriented as well as help them attract inpatients. PMID- 10121985 TI - Children's hospice care. AB - This article seeks to define the principles that are at the heart of the concept of children's hospice care and to indicate the wide range of activities to which that concept is relevant. The discussion is organized around five main points: 1) an analysis of that which is distinctive of the hospice philosophy or hospice like approaches to care; 2) a sketch of situations involving children to which approaches guided by such a philosophy are or might be relevant; 3) a description of the principal contexts within which these approaches might be implemented; 4) some suggestions concerning the application of ideal models to practical realities; and 5) some concluding remarks concerning issues for practice and research. References to relevant literature indicate the present status of work in this field. PMID- 10121986 TI - Reactions of the institutionalized elderly upon learning of the death of a peer. AB - An exploratory study of 25 institutionalized elderly people who witnessed the death of a co-resident is reported. Two topics are examined: thoughts and feelings of the survivors about their own death and the climate surrounding the death of a peer. Data obtained through a semistructured interview reveal that learning of a peer's death leads more than one third of the elderly residents to consider their own death. Witnessing a peer's death seems to have little positive or negative influence. On one hand, 84% of them state that they want to be informed of the impending death of a well-known peer; on the other hand, 80% reported that the staff does not say when a peer is dying. Half of the respondents perceive the staff as indifferent to the death of an elderly person. PMID- 10121987 TI - Home health benefits of federally qualified HMOs likely to increase. AB - There are differing opinions as to whether the Program Memorandum simply expresses HCFA's interpretation of existing law or whether the Program Memorandum adds new requirements for federally qualified HMOs. If the Program Memorandum is "additive," then the procedures by which it was issued may be subject to legal challenge for failure to comply with the federal Administrative Procedure Act applicable to formal rulemaking. PMID- 10121988 TI - Special report on licensure, accreditation & CON. Proper documentation of quality assessment and improvement activities is essential under new JCAHO policy. PMID- 10121989 TI - Hospitals should evaluate EKG arrangements for compliance with anti-kickback statute. AB - The discontinuation of separate payments for EKG interpretations, and the manner in which HCFA has bundled reimbursement for this service with all visits and consultations, has generated significant controversy because of its often illogical impact. For example, the new method results in additional reimbursement to certain specialists who rarely, if ever, order EKGs (e.g., dermatologists), while cardiologists and other internists who routinely interpret EKGs ordered by others receive no direct Medicare reimbursement. Consequently, several bills have been introduced in Congress that would repeal this provision. While there is a reasonable possibility that one of these bills will eventually be enacted, as of this writing the ban on separate interpretation payments remains in effect, and hospitals must therefore remain cognizant of the fraud and abuse implications of their payment arrangements with physicians who interpret EKGs. PMID- 10121990 TI - The Medicare secondary payor provisions: possible rewards and pitfalls. AB - A 1990 report prepared by the Office of Inspector General estimated that as much as $1 billion is lost to the Medicare program annually because (i) secondary payor situations are not detected and (ii) insurance companies often do not pay when they are required to be the primary payors. Office of Inspector General, No. A-09-98-00151, April 1990, Medicare and Medicaid Guide (CCH) [symbol: see text] 39,112, at 25,649. In order to better enforce the MSP provisions, suggestions have been made at the Congressional level to impose sanctions against providers who demonstrate a pattern of inappropriate billing practices such as double billing, repeated failures to screen beneficiaries for other insurance coverage, and the repeated submission to Medicare of bills that should be submitted to another payor. (See the Subcommittee Report on erroneous payments under the MSP program, supra.) Although authority for such sanctions has yet to be adopted, given the fiscal problems currently plaguing the federal government, providers can expect increased enforcement of the MSP provisions as a means of reducing Medicare costs, and should review their screening and billing practices accordingly. PMID- 10121991 TI - Joint Commission Accreditation Manual for Hospitals. PMID- 10121992 TI - Quality programs: satisfying the customer. PMID- 10121993 TI - The environmental challenge. AB - We now come to the ultimate question of whether we should be optimistic or pessimistic about our environmental future, and indeed our survival. If we believe human beings to be rational and thus ultimately acting in their own self interest, there is no reason to believe that the environmental challenges confronting us as individuals and as a society are not resolvable in a manner that allows both economic development and a reasonable quality of life for human beings. Indeed, we see, at least in the developed world, recognition of the magnitude of the problems that we face and movements toward solutions. Yet our nemesis is time. Irretrievable seconds are ticking away as we struggle against ignorance and economic self-interest. Our concern must be not whether we will act, but whether we will act in time to forestall environmental catastrophe for our civilization. The ultimate solution to our environmental problems must come from a fundamental change in the self-serving psychology that produced the tragedy of the commons. Self-interest must be sublimated not only to the greater needs of society, but to the needs of our posterity. The tragedy of the commons can only be avoided if our time horizon shifts from the short- to long-term. In addition, there must be a shift in values from obsession with economic development to concern for the quality of human life. These shifts dictate that in the future our economic, political, and social system must be built upon a foundation of "sustainable" growth. This means that "industries (and nations, for that matter) cannot thrive if they sacrifice future quality of life for present economic gain. In the long run, the principles of economic growth and environmental quality reinforce each other." How do we make this esoteric speculation relevant to our job each day as materiel managers in health care delivery organizations? We can do this by first understanding the problems that we confront and how we are a part of these problems. Next, we must assume a leadership role in confronting and resolving these problems. This means being an advocate for the environment and championing initiatives within the institution to resolve problems and advance environmental responsibility. Finally, we must remember that every day, with each purchase order we issue, we vote for or against the environment. PMID- 10121994 TI - The ethical responsibility of the hospital to the environment. AB - The ethical responsibility of the hospital to the environment is a relatively new concept. It is complex and ever changing as the whole field of medicine continues to evolve. The recent dilemmas of medical waste washing up on beaches and waste laden barges not finding an accepting port should convince us that this issue is becoming more serious. Responsible change in this area calls for creative and imaginative leadership. It is a terrible contradiction when an institution committed to the health and wholeness of those whom it serves is not also committed to the health and wholeness of the environment. PMID- 10121995 TI - Environmental laws in health care. AB - Federal and state regulations regarding the management and disposal of medical waste are currently quite extensive and will only become more comprehensive in the future. The public's heightened awareness and concerns over infectious diseases and discoveries of medical waste on beaches in New Jersey, Alabama, and other states, as well as medical waste being found in open trash bins and at public landfills, has brought to the public's attention the need for governmental intervention into this growing area of concern. Because regulations originating from the local, state, and federal levels have the potential to significantly affect hospitals, it is important that a specific person or department within the organization have a clearly designated responsibility to stay informed and follow up on these regulations. The designated person or department must work closely with the hospital's attorney to make sure that he or she stays current on environmental laws and keeps the institution adequately advised of its legal responsibilities. PMID- 10121996 TI - Total quality management and statistical quality control: practical applications to waste stream management. AB - TQM offers a completely new approach to problem solving in health care. The approach requires dedication and persistence in monitoring, understanding, and changing systems at a level that has never been reached before in the United States' health care system. Materiel management, purchasing, nursing, housekeeping, and administration now have the necessary tools to centrally study the medical waste stream flow at their facilities. The intent of this article is to display how TQM techniques can be applied to minimize a hospital's medical waste stream. The approach of studying medical waste as a defect generated during the process of delivering high-quality care enables a hospital to pinpoint causes of these defects, modify the parent system of the defect, and lessen the generation of medical waste defects. Successful implementation of these techniques as a continuous process will enable hospitals to be leaders in the preservation of their host communities' environments. PMID- 10121997 TI - Protecting employees from medical waste: the human resources perspective. PMID- 10121998 TI - Establishing a hazardous chemical and waste management program in a health care setting. PMID- 10121999 TI - U.S. health expenditure performance: an international comparison and data update. AB - In this article, the authors present the most recently available data on the health care financing and delivery systems of the 24 industrialized member countries of the Organization for Economic Cooperation and Development (OECD). U.S. health expenditure performance is compared with the performance of other OECD countries. Thirty-six tables of data from 1960-90 are presented on health expenditures, health care prices, availability and utilization of health care services, health outcomes, and basic economic and demographic factors. PMID- 10122000 TI - International infant mortality rankings: a look behind the numbers. AB - The very unfavorable infant mortality ranking of the United States in international comparisons is often used to question the quality of health care there. Infant mortality rates, however, implicitly capture a complicated story, measuring much more than differences in health care across countries. This article examines reasons behind international infant mortality rate rankings, including variations in the measurement of vital events, and differences in risk factors across countries. Its goal is to offer a broader context for more informed debate on the meaning of international infant mortality statistics. These statistics offer opportunities to identify strategies for improving the U.S. health care system and learn from other countries that have been more successful. PMID- 10122001 TI - Hospital financing reform and case-mix measurement: an international review. AB - A review of reforms in the financing of hospital services in eight European countries and Australia reveals a commitment to a common objective of relating resource use to hospital workload by means of a standardized case-mix framework in the pursuit of greater efficiency. While this objective is also shared with the U.S. prospective payment system (PPS), it is noteworthy that the majority of countries reviewed favor a global budgeting approach to financing hospital services. Ongoing evaluation of these reforms should facilitate an assessment of the merits of case-mix adjusted global budgeting relative to the patient-based alternative. PMID- 10122002 TI - Nursing home resident assessment and case-mix classification: cross-national perspectives. AB - Two broadly applied systems in the United States, the National Resident Assessment Instrument/Minimum Data Set and the Resource Utilization Groups, have provided new insight into the quality, delivery, and financing of nursing home care. In this article, the authors describe research efforts in eight other nations to translate, validate, and use one or both systems to understand their own long-term care systems. This consortium of studies, using common instruments, provides potential cross-national analyses that capitalize on differences in practice patterns and system designs to address critical policy issues. PMID- 10122003 TI - Recent health policy initiatives in Nordic countries. AB - Health care systems in Sweden, Finland, and Denmark are in the midst of substantial organizational reconfiguration. Although retaining their tax-based single source financing arrangements, they have begun experiments that introduce a limited measure of competitive behavior in the delivery of health services. The emphasis has been on restructuring public operated hospitals and health centers into various forms of public firms, rather than on the privatization of ownership of institutions. If successful, the reforms will enable these Nordic countries to combine their existing macroeconomic controls with enhanced microeconomic efficiency, effectiveness, and responsiveness to patients. PMID- 10122004 TI - Administrative costs in selected industrialized countries. AB - The costs of health administration are compared across several countries, accompanied by discussion of some of the variations in the definition of health administration. The influence of American health accounting on other countries is examined, and findings are presented regarding the relative costs of insurance based and direct-delivery systems. Data are presented on health administrative spending providing gross as well as per capita measures. PMID- 10122005 TI - Health care indicators for the United States. PMID- 10122006 TI - National health accounts: lessons from the U.S. experience. AB - The national health accounts (NHA) are the framework within which type of services and sources of funding for health care expenditures are measured. NHA, devised to portray the structure of health care delivery and financing in the United States, provide essential information necessary for the formulation of public health policy and for international comparison. In this article, the authors describe the importance of the NHA nationally and internationally, and provide a blueprint of the definitions, sources, and methods used to create this system of NHA in the United States. PMID- 10122007 TI - Integrated health care systems: taking us through & beyond crisis. PMID- 10122008 TI - Quality is key to managing for operating efficiency. PMID- 10122009 TI - Research as a management tool. PMID- 10122010 TI - Campaign hits the issues. PMID- 10122011 TI - Winning strategies: successfully changing directions in rural health care. AB - Despite record hospital closings in the 1980s and continuing dire statistics--56 Texas counties don't have hospitals--the rural health care crisis is not intractable. For some Texas hospitals, a combination of innovative strategies and grassroots determination has either reopened the doors or provided new services and a viable basis for future growth. Here are the stories of five such turnarounds. PMID- 10122012 TI - Patient Self-Determination Act pitfalls. PMID- 10122013 TI - Malpractice study: a cooperative first step. PMID- 10122014 TI - Special report. NHS Trusts. PMID- 10122016 TI - Deus ex machina. PMID- 10122015 TI - Going Dutch. PMID- 10122017 TI - Air freshener. PMID- 10122018 TI - Healthcare technology for managers. The future starts here. PMID- 10122019 TI - Heart of the matter. PMID- 10122020 TI - Pill poppers. PMID- 10122021 TI - South West Thames. The battle of St George's. PMID- 10122023 TI - Split decisions. PMID- 10122022 TI - Bed and breakfast blues. PMID- 10122024 TI - How to meet a challenge. PMID- 10122025 TI - Special report. New healthcare buildings. PMID- 10122026 TI - Data briefing. Prison medical service. National Association of Health Authorities and Trusts. PMID- 10122027 TI - Managing risk--a priority in the Health Service. PMID- 10122028 TI - Happy now? PMID- 10122029 TI - Outpatients outclassed. PMID- 10122030 TI - One of us? PMID- 10122031 TI - All dressed up--but nowhere to go? Countdown to community care. PMID- 10122032 TI - Healthcare technology for managers. Test drive. PMID- 10122033 TI - Skin deep. PMID- 10122034 TI - Scotland. 2001: a space-saving odyssey. PMID- 10122035 TI - Issues in formulary management: therapeutic interchange. The value, cost, and quality of therapeutic interchange. AB - Therapeutic interchange is a process of substituting a prescribed medication with one that offers therapeutic and cost benefits. The practice not only provides short-term savings but also is associated with decreases in lengths of stay in hospitals and total hospital drug expenses. There may be medicolegal implications when FDA-approved indications differ for interchanged drugs. The potential for liability is decreased when a standard of care is met, but since standards can change, guidelines should be reviewed regularly. High-tech, high-cost drugs are sometimes appropriate for therapeutic interchange. Pharmacy and therapeutics committees should assure best value by considering indirect expenses, quality, and therapeutic outcome, as well as product cost. Therapeutic interchange programs enable pharmacy managers to neutralize or at least slow the rate of drug cost increases, ensuring appropriate utilization of resources and more favorable patient outcomes. PMID- 10122036 TI - Issues in formulary management: therapeutic interchange. Establishing guidelines: roundtable discussion, Part 1. PMID- 10122037 TI - Issues in formulary management: therapeutic interchange. Communicating a policy: roundtable discussion, Part 2. PMID- 10122038 TI - Inhalation devices--which is best for your patient? PMID- 10122039 TI - Cost comparison of oral, nasogastric, and intramuscular cimetidine drug delivery systems. AB - Under diagnosis-related group prospective payment, the role of the hospital pharmacy department is to develop and promote cost effective and rational drug therapy. This study, conducted in a simulated fashion, evaluated the cost effectiveness of various cimetidine drug delivery systems: oral, nasogastric, and intramuscular. The evaluation was also extended to compare time efficacy between different dosage forms for each route of administration with the exception of the intramuscular route. Each of four nurses and four pharmacy technicians conducted 10 trials for each system to detect a statistical significance difference in pharmacy preparation and nursing administration time with at least 80% statistical power. The results showed no statistically significant difference (P > 0.1) between the total oral administration time of a unit-dose tablet or liquid. A significant difference was detected among the pharmacy-prepared liquids, and unit-dose liquid administered nasogastrically (P < 0.01). The most cost-effective system is the orally administered unit-dose tablet and the most expensive system is the unit-dose liquid administered nasogastrically. PMID- 10122040 TI - Criteria for use of total parenteral nutrition administered by a central venous catheter in adults. Presbyterian Hospital, Albuquerque, New Mexico. AB - Criteria for a utilization review of total parenteral nutrition administered by a central venous catheter are presented. Areas covered include: indications and contraindications for use, appropriate monitoring criteria, complications related to parenteral nutrition, dosing, and outcome of therapy. PMID- 10122041 TI - Survey of clinical pharmacokinetic software for microcomputers. AB - Twelve distributors of pharmacokinetic software programs for microcomputers were surveyed to determine scope of drug coverage; the pharmacokinetics models, methods, and equations used; hardware requirements including use of math coprocessor, random access memory (RAM) required, storage space, printer support and mouse use; software features including availability of windows, pull-down menus, context sensitive help, graphical representation of data, ability to export data including to ASCII file and ability to store patient data; availability of support including toll-free telephone numbers, 24-hour support and clinical consultations; costs; and frequency of updates. PMID- 10122042 TI - Children's health. The dream and the reality. PMID- 10122043 TI - Partnerships help children in need. PMID- 10122044 TI - Let's form a circle. Interview by Joe Flower. PMID- 10122045 TI - The Healthcare Forum children's health resources guide. PMID- 10122046 TI - Making the connection of trust. Interview by Joe Flower. PMID- 10122047 TI - Putting learning to work. PMID- 10122049 TI - The odyssey. PMID- 10122048 TI - Quality and the bottom line. PMID- 10122050 TI - House calls by phone.... PMID- 10122051 TI - Profits and pitfalls in direct contracting.... PMID- 10122052 TI - The 1992 biotechnology agenda: a message for candidates Bush and Clinton. PMID- 10122053 TI - Bush's and Clinton's health care views: a clear choice for voters. PMID- 10122054 TI - Singing the Blues: many Blue Cross/Blue Shield plans charged with mismanagement, insolvency. PMID- 10122055 TI - Genetic discrimination by insurers: legal protections needed from abuse of biotechnology. PMID- 10122056 TI - Bailey-Boushay House: a home with a heart for people living with AIDS. PMID- 10122057 TI - Cooperation, compromise key to 'perfect' health care interiors. PMID- 10122058 TI - Ensuring plant flexibility for telecommunications. PMID- 10122059 TI - How to plan and execute a major moving project. PMID- 10122060 TI - How to 'expand' parking capacity via restriping. PMID- 10122061 TI - How to get the most out of your furniture dealer. PMID- 10122062 TI - '92 equipment budgets up; replacement targeted. PMID- 10122063 TI - Meeting employees' needs through on-site child care. PMID- 10122064 TI - Doctors and managers in Yorkshire--a meeting of minds. PMID- 10122065 TI - Evaluation of a service development group. PMID- 10122066 TI - Implementing a health care assistant strategy. PMID- 10122067 TI - Doctors and teachers: a tale of two professions? PMID- 10122068 TI - Team building--the need to balance customer and employee needs. PMID- 10122069 TI - Assessing and training at work. PMID- 10122070 TI - Tax exemption in a reformed healthcare system. PMID- 10122071 TI - Transplantation tragedies. PMID- 10122072 TI - The relative importance of cash discounts. PMID- 10122073 TI - The transition to regional networks. Changes in reimbursement and approaches to care favor cooperative arrangements among providers. AB - As costs escalate and the delivery system becomes more fragmented, organizations throughout the United States have begun to call for basic reform of the healthcare system. Several national organizations, including the American Hospital Association and the Catholic Health Association, have presented working proposals advocating coordinated regional healthcare delivery systems. The proposed networks would provide a full continuum of services from prevention through aftercare and long-term care, and from primary through tertiary care. In the past few years, providers themselves have begun to see the value of cooperative efforts. Collaborative ventures such as group purchasing and sharing mobile equipment have increased as hospitals look for ways to reduce costs and control overhead. Mergers and affiliations are also becoming more common. As they develop, different networks will allow for various kinds of interrelationships among components. In general, these systems will provide high-volume, low-cost services at a number of sites and low-volume, high-cost services at a central location. Secondary and tertiary campuses will focus increasingly on specialty care, and as volume increases at primary campuses, secondary and tertiary organizations will establish more primary affiliations. To make the transition from a competitive to a cooperative healthcare delivery system, providers will have to reexamine their mission and values and, in many cases, refocus their vision of the future. PMID- 10122074 TI - Rekindling the spark. Five strategies to help healthcare administrators remain motivated when facing change. AB - Many healthcare administrators find it difficult to stay renewed in their careers as pressure mounts on an already stressful work environment. Five strategies can rekindle the spark that once made a healthcare career so attractive. Sharply focused goals are the infrastructure of a harmonious work environment. When people progress toward achieving goals, dissatisfaction with their work environment decreases. Healthcare administrators must also find solutions to problems that chip away at happiness, such as chronic understaffing or a personality conflict with a colleague. If supervisors develop positive problem solving attitudes, employees tend to emulate them. Administrators need to personalize their leadership style. If subordinates sense their administrator is involved in their occupational struggles, their loyalty will increase and their stress will decrease. A manager needs to be surrounded by creative, energized people because upbeat people have a way of renewing one's spirits. Meaningful friendships can provide support and a fresh perspective on problems. Finally, healthcare administrators must remain steadfastly hopeful even when budgets cast red ink and the future direction of healthcare is uncharted. PMID- 10122075 TI - What separates outstanding from average leaders? A study identifies leadership competencies and implications for professional development. AB - As the healthcare crisis mounts, healthcare organizations must be managed by especially competent leaders. It is important for executives to assess and develop the competencies necessary to become "outstanding" leaders. In our study of leadership competencies among leaders of religious orders, we found that outstanding and average leaders appear to share characteristics such as the ability to articulate their group's mission, the ability to act efficiently, and the tendency to avoid impulsive behavior or excessive emotional expression. Outstanding leaders, however, differed from average leaders in seemingly small but significant ways. For instance, nearly three times as often as average leaders, outstanding leaders expressed a desire to perform tasks well--or better than they had been performed in the past. The study also assessed how members of religious orders perceived their leaders. In general, they tended to rate leaders of their religious institutes as transformational leaders--leaders who welcomed doing things in a new way and inspiring their own staffs to search out new ways to provide services. PMID- 10122076 TI - The value of systematic reading. Retaining and applying current information is vital in developing leadership ability. AB - Keeping up-to-date, having the right information, and growing in knowledge and awareness are more important than ever. Reading is one of the primary ways to develop professional expertise and leadership ability--and to stay competitive. Many persons are facing the new reality: Job security is an inner factor based on inner competence. Part of that competence has to do with one's ability and skill in continually learning. People who read not only develop more competence in their current abilities but, equally important, develop confidence in their ability to learn and meet the demands of accelerated change. Reading helps people stay up-to-date and broaden their perspectives. Reading also provides enjoyment. But if we do not remember and apply what we read, it has little value. People therefore must read widely and read deliberately for retention and application. To make reading a part of their lives, people must make a commitment to read every day, read material that interests them, visit bookstores and libraries, work at retention and application, discuss with others what they are reading, and test what they read against their own experience. PMID- 10122077 TI - Practical dreamers. Successful leaders envision and create the organizations of the future. Interview by Judy Cassidy. PMID- 10122078 TI - Transformational leaders. Ten practices to help executives meet the challenges of the 1990s. AB - Today, healthcare chief executive officers (CEOs) face many pressing issues. To survive the 1990s, CEOs must master "transformational practices" such as continuous quality improvement. CEOs can adopt the following 10 practices to help them become transformational leaders: Establish and act on key commitments. Form teams. Establish a job shadow program. Brainstorm more. Befriend the opposition. Communicate more. Wipe out gossip. Look for breakdowns. Revise the appraisal system. PMID- 10122079 TI - A systematic method of accountability. Sound policies allow facilities to account for the level of charity care they provide. AB - Charity care policies can help hospitals accurately determine, define, and account for the level of charity care they provide. This information will help hospitals budget appropriately and measure trends that will ultimately affect the organization's viability. State governments, the federal government, and the Internal Revenue Service are more closely scrutinizing not-for-profit hospitals' tax-exempt status. As a result, the American Institute of Certified Public Accountants (AICPA) has revised its requirement to report on charity care. To meet the AICPA's requirement, healthcare providers must develop their own definition of charity and determine criteria for providing care free or at a reduced rate. Setting policies to support the organization's definition of charity is necessary for the development of internal systems that promote the early identification of individuals seeking healthcare who will be unable to pay for services. Several policy implications may result from the facility's charity care determination process. For example, patients exhibiting extreme hardship might still be eligible to receive charity care even though their income and assets exceed the hospital's income guidelines. An organization planning to develop a charity care policy must first thoroughly assess its current charity care practices and cost accounting capabilities. Obtaining input from all the departments involved in the development of the charity care policy is necessary to make the transition as smooth as possible. PMID- 10122080 TI - New survey process expands sanctions. HCFA proposes more enforcement remedies and broader disclosure requirements for nursing facilities. AB - The Health Care Financing Administration (HCFA) has proposed a new process for surveying and certifying nursing facilities for participation in Medicare and Medicaid. The process would be grounded in the principle that all federal requirements must be met and enforced. Surveyors would use a severity and scope scale to evaluate a deficiency's seriousness and determine the appropriate corrective remedy. The more severe or pervasive the facility's shortcomings, the harsher the sanction. HCFA and the states have been reluctant to use the traditional remedy for noncompliant facilities--terminating their participation in Medicare or Medicaid. The available remedies would be expanded to include intermediate sanctions such as temporary management, denial of payment, directed plan of correction, and civil money penalties. The critical factors for determining the remedy would be the severity and scope of the deficiencies and whether they pose an immediate and serious threat to resident well-being. A facility could appeal the specific remedy, but not the conclusion that violations have occurred. Importantly, except for civil money penalties, the states would have to impose enforcement remedies at the time violations are uncovered, regardless of any other provision of state law, such as a policy precluding penalties while a hearing is pending. The proposed regulations also would impose two new notification requirements on nursing facilities--one for any facility that receives a nursing staff waiver, and the other for a facility rendering substandard care. PMID- 10122081 TI - Serving the community: beyond medical care. PMID- 10122082 TI - St. Mary's Hospital. A speakers bureau helps a hospital share its mission. PMID- 10122083 TI - Living and growing into death. PMID- 10122084 TI - A new community-oriented network in Italy for the collection and processing of clinical and epidemiological information. AB - This study illustrates a project to implement a clinical information system based on a general practitioner's network covering the national territory. The project is important because there are no other such systems in operation in Italy. Moreover, as is well known, both the quality and the quantity of health information made available by the National Health Service are far from optimal. This community-oriented network enables end-users to share software for the management of outpatient clinics that is produced by Informedica Janssen and distributed throughout Italy to over 16,000 physicians. The features of potential participants in the network as well as the software they have adopted are described. PMID- 10122085 TI - National health ensurance: the lesson of baseball, diapers, and pecan parlors. PMID- 10122086 TI - Health care's high-tech future: a forecast of super drugs, genetic therapy, and bionics. PMID- 10122087 TI - From general manager to chief executive. AB - For the general manager moving to the position of chief executive, it means more than a superficial change of title: it brings changes to organisational relationships, increased public exposure and personal accountability, and pressure to use time more effectively. Neil Goodwin explores the personal changes for general managers becoming chief executives and highlights the key areas for organisational and personal development. PMID- 10122088 TI - Public spending and NHS finance. AB - Reliability, the Chancellor's Autumn Statement on the country's economic prospects, and the Government's public spending plans seldom go hand in hand. Last year's statement, however, offers an insight into this year's discussions and negotiations and their effect on NHS resources. Tom Jones sets the scene. PMID- 10122089 TI - Child health. AB - Current provision for children's health involves many different professions in many different locations. Managers must find local solutions to improve the organisation of services which will lead to better and more coordinated health care. PMID- 10122090 TI - Cardiovascular disease. AB - A figure between 550 pounds and 960 pounds is the estimated cost of buying one quality adjusted life year by screening for and preventing development of coronary heart disease risk factors. So what is it that is stopping the prevention of 180,000 deaths each year? PMID- 10122091 TI - Training needs analysis. AB - With limited training budgets and an increasing range of training opportunities available, provider units will need to have effective training strategies. The Grantham model, described by Kevin Teasdale and colleagues, offers a clear and practical approach. PMID- 10122092 TI - Management ... working day of a health services manager. AB - Purchasing is in a state of change at the moment--and purchasers are on a fast learning curve. Add to that the proposed merger of two HAs and the agenda's a busy one. Peter Stansbie, DGM, NE Warwickshire HA goes through a typical day. PMID- 10122093 TI - Computerization of obstetrical patient tracking in a family medicine residency program. PMID- 10122094 TI - Emergency department applications of digital dictation and natural language processing. AB - The emergency physician has a number of challenges that must be addressed in providing high quality emergency health care delivery. One of these is the need to develop accurate documentation of the patient's health status and the patient's response to treatment in the ED. Digital dictation when combined with natural language processing is an evolving technology that is very user-friendly, fast, flexible, and cost-effective. Together, they can potentially improve risk management, reimbursement, and ultimately patient care. All the specialties of medicine are facing tremendous challenges of quality in the coming decade. In the past, an ED would wait for an incident or maloccurrence to happen. The director would analyze the cause, educate the staff, and write a new policy. Quality assurance meant searching for deviance and promoting compliance. The approach of "quality as a process of continuous improvement" suggests that the old ways don't work. We must have access to the detailed information about our clinical practice in order to assess outcomes, evaluate procedures, and undergo any meaningful change. It is said, "We cannot change what we cannot measure". Certainly tens of thousands of handwritten illegible ED reports represent an effective barrier to any substantive insight into our clinical process, and that constitutes an absolute barrier to any effective change. Digital dictation represents one gateway into the electronic record. Combined with NLP and appropriate information management, this technology holds tremendous potential for growth and provides for quality in the coming decade. PMID- 10122095 TI - An information system for quality and utilization management in ambulatory surgery. PMID- 10122096 TI - A tool for administrative decision making: predicting health status from management information system data. PMID- 10122097 TI - Managing perinatal data with the Regenstrief medical record system. PMID- 10122098 TI - Automated telephone reminders for improving ambulatory care services. AB - In conclusion, automated telephone reminders offer a single inexpensive approach to many different problems associated with ambulatory care. Depending on the exact application, their effectiveness is equal to or better than other more expensive and time-consuming approaches for reducing costs and improving the quality of patient care. In some cases, such as medication reminders, it may be the only feasible approach to effective care. PMID- 10122099 TI - Health profiles of New York City communities. PMID- 10122100 TI - Health area profiles as tools for primary care development: New York's primary care initiative. AB - It is anticipated that the ACS measures will figure significantly in the formal evaluation of the PCI, which will be carried out by an independent evaluator during the second and third years of the program. ACS measures will also form, along with other relevant data, a module for program reporting that is part of the overall program for project monitoring and review. The program should be evaluated on its ability to adhere to ACS measures; infuse primary care resources into a community; observe and measure changes in the community's patterns of use for health services; examine the community's health status, especially for hospitalization for otherwise preventable conditions; and sustain effective, adequate health care resources within the community. PMID- 10122101 TI - Methods of compensating physicians contracting with managed care organizations. PMID- 10122102 TI - Developing a computerized ambulatory medical record to document health promotion and disease prevention activities during the clinic encounter. AB - The authors believe that the computerized medical record may enhance physician delivered preventive services by providing timely individual feedback. Additionally, we note that interest in health promotion and disease prevention in the medical community as well as the general population has been increasing during the last decade. In response to this increased interest, we believe that health promotion and disease prevention activities should be conducted by every clinician and should include basic measures such as immunizations, appropriate screening tests, and advice and counseling about lifestyle. Additional investigation into the use of computers and computer-generated reminders to enhance the delivery of preventive services is needed. PMID- 10122103 TI - Determinants of a merger in a publicly-funded health system: a political-economy perspective. AB - This article reports the results of a case study, spanning a period of 10 years, of the merger of two hospitals in a publicly-funded health system. A political economy model was used to analyse the determinants of the merger. Results show that external political economy factors, mainly pressure from the state to rationalize health services and the organization's needs to acquire critical resources, significantly contributed to the merger decision. At the internal political economy level, groups and individual strategies also played a determinant role. Our study suggests that merger in the public sector may not necessarily result from efficiency motives. PMID- 10122104 TI - Association of Air Medical Services 1992 standards. PMID- 10122105 TI - Air-medical accreditation update. CAAMS (Commission on Accreditation of Air Medical Services) passes the one-year mark. PMID- 10122106 TI - Where earth meets sky. Safe operations at helicopter scenes. PMID- 10122107 TI - ALS intercept and tiered response. Improving patient care or stealing the run? PMID- 10122108 TI - The drug box chill-out. PMID- 10122109 TI - Can you ventilate? A study of provider ventilation skills. PMID- 10122110 TI - Protecting yourself. PMID- 10122111 TI - 1992 EMS salary survey. PMID- 10122112 TI - DMATs (Disaster Medical Assistance Teams) respond to Andrew and Iniki. PMID- 10122113 TI - Uncompensated hospital care. PMID- 10122114 TI - Cost methodology in long-term care evaluations. PMID- 10122115 TI - Trapped between state and market: regulating hospital reimbursement in the northeastern states. PMID- 10122116 TI - American values: are they blocking health-system reform?. Interview by Mark Holoweiko. PMID- 10122117 TI - What kind of group practice works best? PMID- 10122118 TI - A 6 1/2-pound device saves me tons of time. PMID- 10122119 TI - How the rules of confidentiality are shifting. PMID- 10122120 TI - Conducting QI studies that effect change. PMID- 10122121 TI - To improve communication, cultivate your writing. PMID- 10122122 TI - A laboratory graphic data acquisition system. PMID- 10122123 TI - MEDLINE and MeSH: challenges for end users. AB - Through casual observations, formal consultations, and educational sessions, the authors have identified various indexing features of the National Library of Medicine's Medical Subject Headings (MeSH) that pose challenges to end users while attempting to obtain relevant retrieval when searching MEDLINE. These problematic features include the use of Explodes, Tree structures, subheadings, Text Word vs. subject heading searching, and central concept searching. End-user search software is becoming more sophisticated with an increasing number of choices offered for search strategy formulation. Methods of instruction to orient the end user to these systems will also have to become more detailed. A review of the literature, that discusses end-user problems with using MEDLINE and MeSH, is included. PMID- 10122124 TI - Quality assurance to continuous quality improvement: challenges for the medical staff. AB - Hospital medical staffs will have to make a major transition over the next few years from quality assurance to continuous quality improvement. As this article discusses, many elements of the change are new to health care, as yet untested, and should be approached carefully. PMID- 10122125 TI - Structuring group medical practices: shareholder and partnership agreements. AB - This article is the second in a series addressing the structuring of group medical entities, shareholder relationships, and general representation factors. In this article, a number of the legal and business considerations for entering into shareholder and partnership agreements are discussed, and various types of practice structures and recommended group practice agreement provisions are described. PMID- 10122126 TI - Economic credentialing and the fraud and abuse caveat. AB - Courts often uphold hospital credentialing decisions based in part on economic criteria. Nonetheless, as this article discusses, arrangements where medical staff privileges or other benefits appear to be offered to physicians as an incentive to refer patients may be suspect under the Medicare/Medicaid fraud and abuse law. PMID- 10122127 TI - Medical staff contracting: legal structures and reimbursement opportunities. AB - This article is the first in a series analyzing the physician/hospital contracting process, including hospital-based physician arrangements and management, service, and venture contracts. This article begins the series with a general exploration of the opportunities available to physicians when entering into relationships with hospitals. PMID- 10122128 TI - Development, evaluation, and implementation of medical practice parameters. AB - In response to growing concerns about the quality of medical care, physicians and physician organizations are increasingly turning to practice parameters as a possible solution. This article describes recent efforts by the American Medical Association and others to develop, evaluate, and implement medical practice parameters, and provides an overview of the possible legal implications raised by the use of practice parameters. PMID- 10122129 TI - Florida's experiment in health care regulation: the Patient Self-Referral Act of 1992. PMID- 10122130 TI - Implementing the Patient Self-Determination Act. AB - On December 1, 1991, the federal Patient Self-Determination Act became effective. The Act's purpose is to ensure that a patient's right to direct his or her own health care decision making is maintained. This article discusses the requirements of the Act, summarizes the interim rules promulgated to implement the Act's provisions, and assesses the soundness of the Act. PMID- 10122131 TI - Building a successful hospital-business alliance. PMID- 10122132 TI - Trustee insights on business and health care. AB - Many hospital board members are active business people in their communities and are sensitive to and aware of increasingly difficult problems both hospitals and business face. This article summarizes two focus group discussions held with the members of the MHA Governance Council earlier this year. The Council is comprised of 25 hospital trustees and three hospital executives. PMID- 10122134 TI - The state of public opinion in Michigan: setting the stage for election '92. PMID- 10122133 TI - Swedish health care: a collision course with American medicine. PMID- 10122135 TI - The 'V' flight formation. PMID- 10122136 TI - Putting the patient first. PMID- 10122137 TI - How business is responding to health issues. PMID- 10122138 TI - RehabCare execs rebuff $45 million takeover bid by Continental Medical. PMID- 10122139 TI - Upgrading Hotel Dieu will be costly for La. PMID- 10122141 TI - Poll on healthcare reform plans gives Clinton edge with voters. PMID- 10122140 TI - 'Soft money' contributing clout to the elections. PMID- 10122142 TI - First debate sheds little light on healthcare stances. PMID- 10122143 TI - Managers, trustees must ensure that executive compensation isn't excessive in not for-profit sector. PMID- 10122144 TI - Defense probing NME billing. PMID- 10122145 TI - Shared information could revolutionize healthcare. AB - Hospitals soon may learn the value of shared information technology. The idea of "community health information networks" is picking up steam as payers and policymakers look for ways to control costs and measure the quality of care. Backing from the federal government is likely to make the transition speedier and perhaps less painful than it was for other industries. PMID- 10122146 TI - 'Seamless' delivery. AB - Healthcare experts are touting the so-called integrated system as an "ideal" approach to healthcare delivery. They say these systems won't squander time, money or patient care contracting with each other or attempting to reconcile conflicting financial and utilization incentives that normally exist among hospitals, physicians, insurers and other providers. PMID- 10122147 TI - Healthcare tab to hit $1.7 trillion by 2000. PMID- 10122148 TI - Hospitals' total margins fall, reversing trend. PMID- 10122149 TI - MRIs give their views to help hospitals mount defenses when they face malpractice charges. AB - Hospitals may save themselves millions of dollars in medical malpractice costs by following the lead of a New York hospital that used the technology to prove it hadn't caused the brain damage of a woman born more than 20 years earlier. The hospital's attorney said MRI technology is "now able to prove to some extent in some cases the timing of brain damage." PMID- 10122150 TI - Behavioral health managers take hold. AB - With mental health and substance-abuse treatment costs averaging about 10% of a company's annual health bill, companies are looking for new ways to cap expenses. Some firms have decided to give specialists the job of managing the behavioral health portion of their medical benefits programs, according to a new survey of 350 companies by the Wyatt Co. PMID- 10122151 TI - Mount Sinai uses unusual bonds as part of refinancing package. PMID- 10122152 TI - HCFA suspends collection of overpayments. PMID- 10122153 TI - Supreme Court to rule on retroactive Medicare pay. PMID- 10122154 TI - Century managed, 'courted' by Columbia. PMID- 10122155 TI - Columbia has 3 deals in various stages to expand Fla. operations. PMID- 10122156 TI - AHA, state group execs to discuss antitrust reform. PMID- 10122157 TI - 2 Blues plans agree to merge. PMID- 10122158 TI - Cigarette tax proposal pulled from Ark. ballot. PMID- 10122160 TI - Integrated delivery is slow going, but system leaders say it's effective. PMID- 10122159 TI - Taxes anchor uncompensated-care plan. PMID- 10122161 TI - System revamps incentives to promote integration. Evangelical Health Systems. PMID- 10122162 TI - Health costs don't impede competitiveness--CBO. PMID- 10122163 TI - Knowing where misconceptions lurk can reduce construction mistakes. PMID- 10122164 TI - Healthcare played role in campaign, but never center stage--experts. PMID- 10122165 TI - Winning designs shed lots of light. AB - From an outpatient surgery center in Minnesota to a teaching hospital in South Korea, each of the nine projects recognized in the 1992 Design Awards Competition uses sunlight well, one quality desirable in contemporary architecture. The winning designs also share clear organization, the ability to expand easily and exteriors that complement their surroundings. PMID- 10122166 TI - Hospitals investing carefully despite better access to capital. PMID- 10122167 TI - Report cities outpatient overpayments. PMID- 10122168 TI - As healthcare groups help fill campaign coffers, the question is: what is the money buying? AB - The American Medical Association, with $1.4 million in contributions, led in campaign giving among 125 healthcare-related political action committees that reported a total of $7.6 million in contributions since Jan. 1, 1991. While consumers groups contend such special-interest giving provides clout in healthcare policy decisionmaking, the PACs say the money doesn't buy votes, only access to candidates and lawmakers. PMID- 10122169 TI - Group practice management activity grows. PMID- 10122170 TI - More hospital-physician computer links sought. PMID- 10122171 TI - Foam recycling gives hospitals an environmentally correct way to handle food service refuse. PMID- 10122172 TI - Health needs of men gaining emphasis. PMID- 10122173 TI - Hackers ring up big phone bills for hospitals. AB - A big telephone bill--possibly in six figures--can be a painful way for a hospital to find out its phone system isn't secure. When unusually large long distance bills start to show up, chances are a professional telephone hacker has broken in. According to experts, one in 15 businesses has been victimized by long distance toll fraud, and loss estimates range from $900 million to $4 billion a year. PMID- 10122174 TI - Home care PPS holds promise of profits. AB - Home healthcare agencies might be able to make money under a Medicare prospective payment system, according to preliminary results from the first year of a three year HCFA demonstration project. After a year, most of the 26 agencies in the project made a profit under the per-visit reimbursement system HCFA is testing. A per-episode of care system will be tested later next year. PMID- 10122175 TI - Minn. hospital sues HHS over reclassification. PMID- 10122176 TI - Outlier cases are concentrated at only a few facilities--study. PMID- 10122177 TI - Pa. tries to fill donation plan void. PMID- 10122178 TI - Feds seize New Medico records. PMID- 10122179 TI - Long-term care. Regulatory changes targeted on several fronts. PMID- 10122180 TI - RehabCare goes to court to thwart takeover. PMID- 10122181 TI - Miami merger makes room for public beds. PMID- 10122183 TI - Porter restructuring costs 65 their jobs. PMID- 10122182 TI - New hospital company leases first facility. PMID- 10122184 TI - Study: same-day registration aids performance. PMID- 10122185 TI - Hospitals win concessions. PMID- 10122186 TI - LifeNet alters heart allocation rules. PMID- 10122187 TI - Fallout continues at S.D. hospital. PMID- 10122188 TI - Pharmacy study to focus on outcomes. PMID- 10122189 TI - Observers see Clinton win putting reforms into motion. PMID- 10122190 TI - Defense Dept. starts payment program. AB - The Department of Defense's healthcare system is starting a program to collect reimbursement for care from third-party payers. Walson Air Force Hospital at Fort Dix, N.J., is the first Defense Department facility at which the policy will be implemented. The program could collect as much as $2.5 billion annually when it's under way at all facilities. Walson has hired CIS Technologies to handle its billing and collections. PMID- 10122191 TI - Finances make physicians willing to discuss employment. PMID- 10122192 TI - Indigent-care funding rejected in Calif. and Okla., embraced in Ga. PMID- 10122193 TI - 'Safe harbor' chilly for managed care. PMID- 10122194 TI - Hospitals' total margin at 5-year high. PMID- 10122195 TI - Receivables financing continues to evolve. AB - It's not known how many hospitals are selling their receivables for cash, but the potential market is enormous. Providers will charge more than $800 billion for healthcare services this year. At any one time, the nation's hospitals are awaiting payment on $14 billion in receivables. Many say hospitals would be better off attempting to improve their own billing and collection systems; others are more than sold on the programs. PMID- 10122197 TI - Illinois Blues settle suit for $2.4 million. PMID- 10122196 TI - AHA's 'white paper' keeps chill factor in hospital forecast. PMID- 10122198 TI - 2 patients sue, say copayments were inflated. PMID- 10122199 TI - Hospitals call for charity-care legislation. PMID- 10122200 TI - Pa. hospitals draft exemption bill. PMID- 10122201 TI - Economics widely used in reviewing doctors. PMID- 10122202 TI - Florida hospital's office space is taxable, appeals court rules. PMID- 10122203 TI - Longtime regional mainstays fold. PMID- 10122204 TI - National Rehab to acquire Healthfocus. PMID- 10122206 TI - VHA inks big pact but faces task of changing physician loyalties. PMID- 10122205 TI - Clinton wants VA hospitals open to more vets. PMID- 10122207 TI - Blues mull end to association with Associated Group. PMID- 10122208 TI - 2 insurers drop from HIAA to tout their own reform ideas. PMID- 10122209 TI - Fee fight set to escalate. PMID- 10122210 TI - Ambitious goals, political shoals. AB - President-elect Bill Clinton's vaunted skills as a consensus-builder will be put to the test next year as he advances a healthcare reform agenda. His ambitious proposals, which could produce the most sweeping changes in delivery and financing since the 1965 enactment of Medicare and Medicaid, must be steered through a sea of special interests and diverse congressional reform plans. PMID- 10122211 TI - Ousted Humana lobbyist OK'd payment to ex-lawmaker. PMID- 10122212 TI - Texas, Methodist talks break down. PMID- 10122213 TI - Veterans wonder where VA fits in. PMID- 10122214 TI - Accreditation competition needed. PMID- 10122215 TI - High court decision on AIDS case draws fire. PMID- 10122216 TI - Multitude of healthcare plans may hinder direct contracting. AB - As distinctions among managed-care products become less distinct, hospitals and other groups operating provider networks may face a tougher time winning new business, especially in direct contracting. Aggressive HMOs and commercial insurers frequently have used their broader array of managed-care--including increasingly popular point-of-service plans--to grab new business from hospitals. PMID- 10122217 TI - Coalition in New York studies improving access to capital. AB - A coalition convened by the Greater New York Hospital Association is studying ways to improve access to capital, an area of healthcare reform the group says has been largely overlooked. The group, including representatives from hospitals, investment banking, accounting firms and the state, will issue a report outlining its recommendations. The findings also will be presented to the White House. PMID- 10122218 TI - AHA report lambasted for lack of proof. PMID- 10122219 TI - Push is on to reform state antitrust laws. PMID- 10122221 TI - Beverly Enterprises plans to shed 33 nursing facilities. PMID- 10122220 TI - Mitchell: reform hinges on economic health. PMID- 10122222 TI - FTC reviewing affiliation of hospitals in Sacramento. PMID- 10122223 TI - Champion calls off deal to buy 14 hospitals. PMID- 10122224 TI - HCA sells HealthTrust stock for $160 million. PMID- 10122225 TI - Clinical automation: reality hinders efforts to fill info system wish lists. AB - Responses to Modern Healthcare's fourth annual survey of hospital executives on key information systems issues demonstrated some confusion about many of the new clinical information system products. In many cases, they aren't yet commercially viable. Hospitals can't justify the sometimes steep costs. And opinions are divided about what the systems should do and how they should do it. PMID- 10122226 TI - Humana split keeping recruiters busy. PMID- 10122227 TI - Rules outline charges to residents. PMID- 10122228 TI - Nursing home profits continue to rise. PMID- 10122229 TI - New hospital specializes in elective procedures. PMID- 10122230 TI - Friendly Hill network to manage northern Calif. physician group. PMID- 10122231 TI - Hospital profits rose 23% in '91--AHA. PMID- 10122232 TI - Rush-Presbyterian in Chicago among hospitals on probation. PMID- 10122233 TI - Connecticut hopes changes in payer tax pass federal muster. PMID- 10122234 TI - Developer expands legal battle to block opening of K.C. facility. PMID- 10122235 TI - 'Trim-the-deficit push would aid reform.'. AB - A deficit-reduction bill will offer the most likely legislative vehicle for a healthcare reform proposal next year, one member of the House Ways and Means health subcommittee said. Rep. Benjamin Cardin (D-Md.), speaking to the National Association of Public Hospitals earlier this month, also said, "There is no perfect healthcare reform proposal. We need to take risks and move forward." PMID- 10122236 TI - AMA delegates to reconsider self-referral stand. PMID- 10122237 TI - Has managed competition's time come? PMID- 10122238 TI - Reform, revenue cuts loom as likely. PMID- 10122239 TI - Pa. report ranks, rankles in study of heart surgery. PMID- 10122240 TI - Companies sweeten wellness plans. PMID- 10122241 TI - JCAHO adds surcharge to pay 'Agenda' costs. PMID- 10122242 TI - Public hospitals find long road to autonomy. AB - More public hospitals and systems are looking to be freed from ties to the governments that control them. They're hoping to achieve greater efficiency and more independence from governmental processes and political wrangling. But the very politics they seek to escape can play havoc with public hospitals' attempts to revamp longstanding relationships with their governmental sponsors. PMID- 10122243 TI - Proposed changes in arbitrage rules aim to simplify cumbersome process. AB - The Internal Revenue Service has proposed an overhaul of its rules governing profits earned by not-for-profit institutions when they temporarily invest proceeds from the sale of tax-exempt bonds. The current rules, implemented in 1986 to counteract such abuses, are long and complicated, IRS officials admit. The new rules could be in place by June 30. PMID- 10122244 TI - Charter's earnings better than expected. PMID- 10122245 TI - Federal government approves larger-than-expected update for physician fee schedule. PMID- 10122246 TI - Ultrasound nearly as common as standard x-ray equipment at nation's hospitals- study. PMID- 10122247 TI - New N.J. health system to draw money from unemployment fund. PMID- 10122248 TI - Robot goes through first drill in surgery. PMID- 10122249 TI - Columbia-Presbyterian's new facility combines patient care and research. PMID- 10122250 TI - Supreme Court upholds Missouri's cap on amount of non-economic damages. PMID- 10122251 TI - For-profits miffed over bidding for Miss. facility. PMID- 10122252 TI - Hospital goes bargain hunting, buys mall. PMID- 10122253 TI - Orlando hospital picked to create state-of-the-art facility for Disney. PMID- 10122254 TI - EKG pay group seeks to repulse veto. PMID- 10122255 TI - AMA delegations urge get-tough policy. PMID- 10122256 TI - Provider group seeks to overturn court rulings affecting Medi-Cal. PMID- 10122257 TI - VA mulls regional plan for hospitals. PMID- 10122258 TI - PET projects: providers like what they see. AB - Advocates of positron emission tomography--PET--see a bright future for a technology that until now has been largely confined to research use because of cost and reimbursement issues. PET, which captures images of cellular activity, or metabolism, offers results that are a step beyond other imaging technologies. As the reimbursement picture changes and new applications are developed, the technology could see rapid growth. PMID- 10122259 TI - Disproportionate-share spending frozen. PMID- 10122260 TI - Direct contracting with employers doesn't need to be complicated. AB - The idea of physicians and hospitals banding together to contract with employers isn't new. These providers have formed direct contracting organizations, and a variety of complex models have been devised, many taking the form of business corporations and limited partnerships. Sometimes they're necessary, but a lower cost, simple organization might be just the answer to a changing payer environment. PMID- 10122261 TI - Converting public hospital to private not-for-profit can be political tussle. PMID- 10122262 TI - Hospitals could benefit from clash of the endoscopy titans. PMID- 10122263 TI - Study amends lore about CABG volume, cost. AB - Contrary to a key legend of the healthcare quality movement, the best care doesn't always cost less. And while high volume often does lead to higher quality, low volume doesn't necessarily preclude it. Those are among the findings from a study of Medicare data on coronary artery bypass graft surgeries. Researchers found some common denominators among hospitals that consistently achieved superior outcomes in the procedures. PMID- 10122264 TI - Hospitals not quite as uncompensated for care in 1991. PMID- 10122265 TI - Hospitals pile junk high, but fervor subsiding. AB - While the junk bond market has been good to hospital companies this year--feeding them $2 billion through the sale of high-yield bonds--some say a post-election chill has cooled the junk bond fervor. One healthcare system, citing a "collapse" in the junk market, called off a $200 million hospital acquisition deal. However, many analysts say a recent slump in junk bond prices represents an oversupply of issues, not a market collapse. PMID- 10122266 TI - First Data acquires Gerber. PMID- 10122267 TI - REMEDY: a project to collect unused surgical items to send for use overseas. PMID- 10122268 TI - RACORSE: donating unused OR supplies. PMID- 10122269 TI - Reducing surgical trash starts with packaging. PMID- 10122270 TI - Plastic recycling project converts OR waste to crayon boxes. PMID- 10122271 TI - When a good doctor isn't hard to find. Direct mail piece drives physician referral service. Montgomery General Hospital, Olney, MD. PMID- 10122272 TI - Following the tracks of marketing dollars. Database marketing gives three hospitals a marketing edge. PMID- 10122273 TI - Two hospitals get physical. Open houses and award-winning logo spark rehab center's promotional campaign. Rehabilitation Hospital of Indiana, Indianapolis. PMID- 10122274 TI - Entering the brave new world of desktop. In-house publishing saves dollars and increases flexibility. Harbor Hospital Center, Baltimore, MD. PMID- 10122275 TI - Giving new life to those old phone books. Recycling campaign improves hospital's environmental image. Albany Medical Center, NY. PMID- 10122276 TI - Jazzing up recruitment. Hermann Hospital, Houston, TX. PMID- 10122277 TI - Taking on reform. Ad campaign strives to educate public and increase enrollment in health plan. KPS Health Plans, Bremerton, WA. PMID- 10122278 TI - Greeting cards combat cancer. Pediatric patients design holiday cards and raise money. M.D. Anderson Cancer Center, Houston, TX. PMID- 10122279 TI - Managing risk. Creating a hazard-free workplace. PMID- 10122280 TI - Facility design enhances quality care, staff efficiency. PMID- 10122281 TI - Ethics committees provide decision-making support. PMID- 10122282 TI - Mental health program increases functioning ability of residents. PMID- 10122283 TI - Maintaining the balance between technical and human excellence. PMID- 10122284 TI - Hospital-based HMO: an outpatient study. AB - With the increasing pressure from managed care companies and in cooperation with its medical staff's independent practice association, the Vista Hill Foundation formed its own specialty health maintenance organization. This is a report on an outpatient study of treatment satisfaction among 124 mental healthcare providers (50% of whom were psychiatrists) and their 218 patient experiences. Treatment outcome was rated as "very satisfactory" or "satisfactory" in 82% of the studied cases. Managed care was found to cause "mild" to "moderate" treatment interference in 26% of the cases and "significant" to "major" interference in 6%. There was no interference reported in 60% of the cases studied. Our study demonstrates that a hospital provider and its managed care system can provide satisfactory care, but it also reveals the need to constantly review treatment programs to reduce interference. The study and report are part of Vista Hill Foundation's ongoing quality review efforts. PMID- 10122285 TI - Informed price setting. AB - Informed price setting in private psychiatric hospitals is based on many factors, including accounting cost, economic cost, mission, long-term plans, and competition. Because no single cost accounting method yields the "right" price without the input of judgment and the consideration of other factors, several appropriate and useful methods of cost accounting should be considered. And because various approaches to price setting carry varying degrees of risk, informed price setting must evaluate them all. PMID- 10122286 TI - The integration of inpatient treatment and transitional day hospital: application of a problem-solving approach. AB - Because of the trend in inpatient psychiatry toward a marked decrease in length of hospitalization, clinicians must reconceptualize the manner in which psychosocial treatments are organized in the inpatient milieu. Considerable data suggest that problem-solving therapies may be a productive way to integrate the groups and activities in the therapeutic milieu. This paper describes the application of a problem-solving approach to the therapeutic milieu and indicates that the therapeutic gains from this approach may be enhanced by combining inpatient treatment with a transitional day hospital program. We identify the empirical underpinnings of this model and describe how it has been used to treat a schizophrenic patient. We suggest that problem-solving therapies are effective for promoting behavioral change on the general psychiatric inpatient unit. PMID- 10122287 TI - Factors influencing length of inpatient stay for depressed adolescents in a psychiatric hospital. AB - The author applied a twelve-item checklist of criteria for hospitalization to determine the impact of each on length of stay for a group of depressed adolescents admitted to two units of a private child and adolescent psychiatric hospital. Attempts were made to control for the influence of insurance status on time spent in the hospital. Active suicidal preoccupation without active preparation or attempt was the only item found to have significant impact on length of stay. PMID- 10122288 TI - Laboratory services for psychiatric facilities. AB - The science and marketing of psychiatric treatment are rapidly changing, and the changes are reflected, in part, in the recent evolution of the use of laboratory services. Nevertheless, there are few, if any, articles in the literature addressing how a laboratory service can best assist a psychiatric hospital. This article presents a scaffolding of current issues to be considered when determining how a laboratory can assist the psychiatric facility. It cites the special laboratory needs of the psychiatric hospital and issues to be considered when evaluating laboratory service. PMID- 10122289 TI - The case. Clint Wooder. PMID- 10122290 TI - The future of health care technologies. PMID- 10122291 TI - Workers' compensation. What works in managed care. PMID- 10122292 TI - Quality and Delta Dental Plan of Massachusetts. AB - This article on Delta Dental Plan of Massachusetts's total quality management program is the winner of the Coopers & Lybrand/Sloan Management Review Quality Award. Delta Dental Plan's enviable TQM program emphasizes now-standard elements such as teamwork and employee involvement and more cutting-edge elements such as service guarantees. Here's how it's done. PMID- 10122293 TI - Beyond business process redesign: redefining Baxter's business network. AB - Business process redesign has focused almost exclusively on improving the firm's internal operations. Although internal efficiency and effectiveness are important objectives, the authors argue that business network redesign--reconceptualizing the role of the firm and its key business processes in the larger business network--is of greater strategic importance. To support their argument, they analyze the evolution of Baxter's ASAP system, one of the most publicized but inadequately understood strategic information systems of the 1980s. They conclude by examining whether ASAP's early successes have positioned the firm well for the changing hospital supplies marketplace of the 1990s. PMID- 10122294 TI - Forecasting the extent of the HIV/AIDS epidemic. AB - This paper has a dual objective: (1) to describe the current status of the structure of a newly developed model system to generate a wide span of U.S. HIV/AIDS estimates; and (2) to implement that system through the development of a dataset of HIV/AIDS incidence and prevalence, by stage, in the U.S. for a range of past and future years. There are many uncertainties regarding the anticipated effects of HIV/AIDS; examination of many of these effects indicates multiple societal difficulties. The characteristic of AIDS-growth is that of a long delayed but inexorable disabling morbidity "taking off" in 1991-1992 from an HIV population widely thought to be 1.0-1.5 million spread throughout the Nation. Although widely dispersed, its impact, even at this early stage of growth, is to endanger the health and social support systems of our urban centers. The spread of AIDS cases into the smaller cities and rural counties indicates that those problems will not be limited to our major cities. This paper provides new and purposely pessimistic estimates of the levels of prevalence and incidence of HIV/AIDS for future years, based on U.S. AIDS cases reported. Although these numbers are essentially upper bounds, their values are consistent with the upper sides of some recent broad band projections released in early Summer 1989 by the U.S. Government Accounting Office (GAO). However, our estimation has generated data within a more proscribed range. A first set of forecasts has been provided to the State of Virginia's Department of Health for their use in statewide resource planning. The United States and the world face a severe HIV pandemic in the coming decade. The certainty of the threat is acknowledged by all of the major private and public medical authorities and institutions. Yet, to date, no official projection of the emergence, the level, and the sweep of the epidemic has been accepted by the medical community. And, there is certainly little agreement on the impact on the delivery of health care services in the United States and Canada, as well as throughout the world. On 26 June 1989, the U.S. GAO released a report that concluded, in part, that the Federal government's official data [e.g. from the Centers for Disease Control's (CDC) Morbidity and Mortality Weekly Report (MMWR) of 12 May 1989] were greatly understating the epidemic's extent. Specifically, the CDC's estimate of 185,000-320,000 (cumulative) cases of AIDS expected to be reported by the end of 1991 contrasted with GAO's estimate of 300,000-480,000.(ABSTRACT TRUNCATED AT 400 WORDS) PMID- 10122295 TI - Modelling the use of health services by populations of small areas to inform the allocation of central resources to larger regions. AB - Modelling the use of health services by local populations can inform the allocation of central resources to larger regions. At aggregate, e.g. regional, level, use is largely driven by supply and such analysis can be misleading. At small area level, however, populations effectively compete for services and their different relative use of services, after allowing for varying availability, reflects variations in their relative need. Empirical quantitative estimates can thus be made of the net relation of factors such as mortality or social deprivation to relative need for health services. These estimates can then be used in weighted capitation formulae for allocating resources to larger regions. PMID- 10122296 TI - Financial penalties for failing to honor patient wishes to refuse treatment. PMID- 10122297 TI - Under scrutiny. Physician recruitment. AB - Physician recruiting has become a strategic planning nightmare. The laws are unclear and in transition but both hospitals and physicians must adapt to a new regulatory environment. Waiting is not an option. PMID- 10122298 TI - Increased regulation. Do the benefits outweigh the costs? AB - A Florida attorney suggests that regulations designed to control costs, such as the new safe harbor rules, should determine whether the benefits to the public exceeds the cost. PMID- 10122299 TI - Overcoming rehab recruiting obstacles. AB - Recruiting the right people can set you apart from your competition. This Georgia rehab hospital found that a "caring" management style was the key. PMID- 10122300 TI - Daring decisions. Making an impact on physician recruiting. AB - In 1987 the trustees of 59 bed Habersham County Medical Center decided to build a new hospital complete with new technology in order to survive the lure of larger hospitals in less rural nearby areas. When Dick Dwozan became the CEO of the centre three years ago, he inherited this still unfulfilled dream and knew that it would take organization, determination, and some hard decisions for the aspiration to come true. The farsighted Dwozan realized that HCMC's success in the years ahead lay beyond the construction project. Four key areas required this immediate attention: physician recruitment, internal staff development, marketing and long-range planning, and improvement of its public image. PMID- 10122301 TI - Need a physician? You may qualify for a free doctor search. AB - A pro bono search is available to Southern rural hospitals in areas where the doctor shortage is particularly acute. Find out how to qualify and how to submit your application. PMID- 10122302 TI - Non-traditional recruiting pays off. PMID- 10122303 TI - Boosting the bottom line. AB - Good help is hard to find, especially for hospital business offices. By calling in the "experts", hospitals have found an expedient way to improve cash flow, reduce A/R days and boost the bottom line. PMID- 10122304 TI - Evaluating hospital services. PMID- 10122305 TI - Attract a new workforce with cultural understanding. AB - Many hospital executives make typical errors in managing Hispanic employees. See how making some simple adjustments to management style to respect their cultural heritage can make a difference in performance. PMID- 10122306 TI - Managing change at the highest levels: the executive challenge. AB - Two hospital executives, one in Florida and one in Louisiana, have differing management styles, but they both manage change well. With senior level management taking on a new look, CEOs and COOs are tackling recruiting and decision-making with a renewed entrepreurial spirit. PMID- 10122307 TI - Hospital conducts ethics survey. PMID- 10122308 TI - An action plan for trustee education. PMID- 10122309 TI - Violence: hospitals cope with America's new family value. PMID- 10122310 TI - What is planned giving and how can trustees help? PMID- 10122311 TI - The AHA's commitment to health reform needs trustee leadership. PMID- 10122312 TI - Linking technology with mission. PMID- 10122313 TI - Selecting and orienting trustees. PMID- 10122314 TI - Antitrust: efforts to break down barriers to hospital collaboration. PMID- 10122315 TI - Technology assessment: making decisions based on a sound business plan. PMID- 10122316 TI - On-line medicine. PMID- 10122317 TI - The troubling ghosts of scourges past. PMID- 10122318 TI - 1993 career guide. PMID- 10122319 TI - Salary survey. PMID- 10122320 TI - Institutional and strategic choice perspectives on board involvement in the strategic decision process. AB - The level of a board of directors' involvement in strategic decisions can be viewed as an institutional response or as a strategic adaptation to external pressures for greater board involvement. We examined the antecedents and effects of board involvement from both the institutional and strategic choice perspectives. Data obtained from personal interviews with 114 board members and archival records indicated that board size and levels of diversification and insider representation were negatively related to board involvement, and organizational age was positively related to it. Furthermore, we found board involvement to be positively related to financial performance after controlling for industry and size effects. Overall, the results suggest that both theoretical perspectives are necessary for a comprehensive description of the strategic role of boards. PMID- 10122321 TI - The past is the past--or is it? The use of retrospective accounts as indicators of past strategy. AB - This study challenges the common assumption that retrospective accounts of business strategy are reliable and valid. Chief executives reported their firms' current strategies, and two years later, they reported their firms' strategies of two years earlier. Of these retrospective accounts, 58 percent did not agree with the previous and validated reports of past strategy. Retrospective errors appear to occur systematically and may be attributable to faulty memory or to attempts to cast past behaviors in a positive light. PMID- 10122322 TI - Andrew vs. launderers. PMID- 10122323 TI - U.S. healthcare: after the election. PMID- 10122324 TI - Impact on radiology. PMID- 10122325 TI - Designing effective charge tickets. PMID- 10122326 TI - Alternative cardiac care. PMID- 10122327 TI - Systems evaluation and implementation. PMID- 10122328 TI - Drug information sources used by community pharmacists in Louisiana: a preliminary study. AB - OBJECTIVE: There is a paucity of information in the literature regarding the type of reference sources that are used by community pharmacists to answer drug information questions. This survey was conducted to determine the frequency of use of selected drug information references by independent and chain pharmacists in Louisiana. DESIGN: A study population of 15% of registered pharmacists was obtained by random stratification of all pharmacists on the mailing list of the Louisiana Board of Pharmacy on the basis of zip code and gender. These pharmacists were mailed an uncoded, pretested questionnaire and were asked to complete and return it if they were employed by an independent or chain pharmacy; nonchain and independent pharmacists were asked to return their questionnaires uncompleted. No follow-up was performed. PARTICIPANTS: Ninety-one independent pharmacists (mean age=45 y; mean years of experience=21) and 71 chain pharmacists (mean age=40 y; mean years of experience=16). OUTCOME MEASURES: The frequency of use of selected drug information reference sources by independent and chain pharmacists and the type of drug information questions received by pharmacists were determined. A Statistical Analysis System software program was used to analyze the data. Spearman's rank test was used to determine statistical differences between independent and chain pharmacists. The a priori level of significance was p less than or equal to 0.05. RESULTS: A 54% response rate was obtained.(ABSTRACT TRUNCATED AT 250 WORDS) PMID- 10122329 TI - Ethical decisionmaking in home care. Home Health Assembly of New Jersey. AB - Since 1985 the Ethics Committee of the Home Health Assembly of New Jersey has been advocating the application of ethical principles in the delivery of home health care, developing ethical reference tools including an in-service casebook and a code of ethics. Recently the committee developed guidelines that address the process of ethical decisionmaking for the variety of situations that arise in the home health care setting. PMID- 10122330 TI - The hospital ethics committee and moral authority. PMID- 10122331 TI - The duty to promote personal well-being: a response to "Nutrition and Hydration: Moral Considerations," a statement by the Catholic Bishops of Pennsylvania. PMID- 10122332 TI - Autonomy and futility. AB - One of the underlying ethical values of the Patient Self-Determination Act (PSDA) is the legal right of patients to decide on their own medical care, i.e., to accept or refuse medical treatment. Yet, there is a growing concern that a patient's legal right to determine medical treatment might result in health care professionals violating their own personal and/or professional ethical values. I shall therefore briefly review the requirements of the PSDA and outline the consequences of this act for a particular case. The application of the Act becomes problematic in this case because the health care professionals involved believe that the treatments involved are medically futile. I consider the potential conflict between autonomy and futility. The thesis defended is that patient autonomy is not an absolute moral right and that health care professionals are not only permitted, but are sometimes morally required, to withhold and/or withdraw futile treatments even if the patient or the patient's surrogate request (demand!) that the treatments be continued. PMID- 10122333 TI - Mt. St. Anonymous; the adolescent living-related donor. AB - Seventeen-year-old David is a perfect organ match for his younger brother, Ken, who has kidney failure. David understands that the procedure presents some risk for him and that after surgery he may no longer be able to continue playing football. His idols all have been football players and he now plays on his high school's team. Nevertheless, he wants to donate a kidney to his brother and agrees to being a donor as soon as the option is mentioned. He never displays any ambivalence and says, "I want to donate my kidney because then I'll be a hero to my family." This close family--of two parents and five older siblings--strongly supports the seventeen-year-old's decision, especially after an older brother, who was also a perfect organ match, is found medically (anatomically) unsuitable. The parents and two of the older siblings could still be medically acceptable donors: their organs are likely to be better grafts (one haplotype matches) than a non-related cadaveric kidney would be, but less compatible than the perfect organ match (haploidentical) that could be provided by David, the adolescent brother. Studies have shown that in the short run there is little difference in the survivability of organs from different classes of donors. After several years, however, there is a significant difference with perfectly matched kidneys being much less prone to rejection than the less ideally matched organs. PMID- 10122334 TI - Point and counterpoint. Is it beneficial for ethics committee functions to be mandated in statutes and/or regulations? PMID- 10122335 TI - Food service: a benefit or a liability? PMID- 10122336 TI - Fiscal problems a reflection of national dilemma. Private pay, Medicaid under pressure. PMID- 10122337 TI - Planning care for the AIDS resident in a SNF. PMID- 10122338 TI - Higher intensity specialization. Reach new heights through subacute care. PMID- 10122339 TI - Lessening linen loss. Simple steps can halt 'vanishing act'. PMID- 10122340 TI - The case of the secret shopper. An unbiased look at retirement communities. PMID- 10122341 TI - Drawing the family into care planning. Preparation and interaction are key. PMID- 10122342 TI - Defusing conflict. Abuse prevention strategies. PMID- 10122343 TI - Meeting the letter of the law. PMID- 10122344 TI - Encouraging appropriate use of sleep medications. PMID- 10122345 TI - Products & services directory 1993. PMID- 10122346 TI - Medication mishaps. Avoiding inappropriate use of prehospital meds. AB - Although we believe in the usefulness and effectiveness of certain medications used in prehospital care, there actually have been few studies conducted that prove the efficacy of medications in this environment. Use of prehospital medications should be carefully considered by EMS providers. Medications should be used when the diagnosis or cause of symptoms is clear, the medication is clearly effective in treating them, the side effects or complications are minimal, and the transport time is sufficient to allow the medication to take effect. PMID- 10122347 TI - "No way!" Handling patients who refuse care. PMID- 10122348 TI - Avalanche rescue. PMID- 10122349 TI - America's painful doctor shortage. AB - Conventional wisdom says we have too many physicians. So how come medical headhunters are thriving as they recruit for small towns and hospitals desperately short of staff? PMID- 10122350 TI - The United States does a poor job of evaluating Medicare hospitals: perhaps Australia can help. AB - The United States spends more money per person on healthcare than does any other country in the world, and this rate of spending is increasing. Healthcare expenses currently absorb more than 12 percent of the American gross national product, and recent projections indicate that such expenses will exceed 16 percent by the year 2000. By the year 2005, the U.S. Medicare program is expected to absorb more of the national budget than either Social Security or defense. One justification for the high rate of spending has been that, for those who receive it, U.S. healthcare is the best in the world. There is, however, no way to validate this view because no national or international agreed-upon set of criteria for measuring quality of care exists. Proponents of the American system seem to assume that if it costs more, it must be better. If this is true, it is certainly not reflected in American consumer satisfaction: a recent poll of citizens of ten developed countries indicated that Americans were by far the least satisfied with their healthcare system. This article focuses on the American oversight of Medicare hospitals to determine it, in this narrow area, dissatisfied American consumers are justified. PMID- 10122351 TI - State health insurance initiatives: what the literature is telling us. AB - The absence in the United States of a comprehensive national health insurance system has left a significant number of people either without coverage or with only partial (and inadequate) coverage. Individual states have sought to remedy this through a number of initiatives, but the majority have been incremental in nature, not universal. Sifting through the extensive literature on what states are doing and have been doing, the author reveals the nature of their attempts (and their infrequent successes) and provides issues and questions that must be dealt with before a system acceptable--and accessible--to all can be achieved. PMID- 10122352 TI - Cost inflation and resource distribution in the Korean healthcare sector under national insurance. AB - In 1989, Korea finally implemented a universal national health insurance policy. However, the expansion in coverage has created a number of ongoing problems: a rapid demand-pull inflation in medical costs stimulated by the fee-for-service payment system and an increasing maldistribution of available resources. The author discusses the sources of these problems and provides a taxonomy of possible methods to bring them under control. PMID- 10122353 TI - Implementing the managed market. Considerations on the introduction of reforms in the U.K. AB - Although the concept of the managed market system arose in the United States, it has taken hold elsewhere, notably in England, where changes to the National Health Service have been forthcoming from the conservative government. In this article, the author examines some of these developments. PMID- 10122354 TI - Avoiding the stereotype. It's no longer "Manana" for Mexico. PMID- 10122355 TI - Time control. Planning. PMID- 10122356 TI - The Faculty of Public Health Medicine. AB - In this article, the author describes the organization of the medical industry in the United Kingdom. As he provides some of the history of its development, he reveals the difficulties inherent in attempting to maintain both a centralized health service and an efficient system that is able to provide proper care for all communities throughout the nation. PMID- 10122357 TI - Longitudinal patterns of California Medicaid recipients with acquired immunodeficiency syndrome. AB - In this study, the authors examine the longitudinal experience, annual trends, and subpopulation differences in Medicaid use and expenditures for persons with acquired immunodeficiency syndrome (AIDS) in California from 1983 through 1986. About two-thirds of adult males were enrolled in Medicaid within 1 month of their AIDS diagnosis. These recipients averaged approximately 20-percent higher lifetime expenditures than those enrolled at a later time. Monthly expenditures were higher in the beginning of enrollment and prior to death than in the months in between. From 1983 through 1986, there was a shift of care from inpatient to outpatient settings. In 1986, children and adult females had higher median expenditures than did adult males. PMID- 10122358 TI - Omnibus Budget Reconciliation Act of 1990 (Public Law 101-508). AB - On November 5, 1990, the President signed into law House Resolution 5835, the Omnibus Budget Reconciliation Act (OBRA) of 1990 (Public Law 101-508). Following are summaries of the Medicare and Medicaid provisions. PMID- 10122359 TI - Impact of Medicare payment policy on home health resources utilization. AB - In this study, the association between Medicare regulations and the provision of public home health care is examined. Medicare clients were compared with non Medicare groups of those 65 years of age or over and those under 65. Results suggested that both age- and payer-related factors contribute to utilization of services. Older patients showed greater need for chronic illness care relative to younger patients; however, Medicare patients used fewer resources and had poorer outcomes relative to older non-Medicare patients. PMID- 10122360 TI - Explaining resource consumption among non-normal neonates. AB - The adoption by Medicare in 1983 of prospective payment using diagnosis-related groups (DRGs) has stimulated research to develop case-mix grouping schemes that more accurately predict resource consumption by patients. In this article, the authors explore a new method designed to improve case-mix classification for newborns through the use of birth weight in combination with DRGs to adjust the unexplained case-mix severity. Although the findings are developmental in nature, they reveal that the model significantly improves our ability to explain resource use. PMID- 10122361 TI - Factors affecting the availability and use of hemodialysis facilities. AB - This article describes factors related to the geographic distribution of hemodialysis facilities and the relationship between availability and use. Such facilities tend to be concentrated in the same types of areas as other medical resources, and the number of medical specialists in an area is related to the rate of treatment for renal diseases. The proportion of treatment stations in an area owned by for-profit organizations is not related to the total treatment rate, but the market share of for-profit facilities is positively related to in center treatment and negatively related to home treatment. PMID- 10122362 TI - Physician customary charges and Medicare payment experience: study findings. AB - Customary charges have had significant impacts in determining reasonable prices under the historic Medicare physician payment system. This article contains new, comprehensive information on customary charges as well as data aggregated at the physician level. These baseline data have some important policy implications, such as the study findings, that indicate that the Medicare fee schedule is likely to have significant impacts on individual physician practices. The study is based on data for medical, surgical, and consultation services for nine States. PMID- 10122363 TI - Output and inflation components of medical care and other spending changes. AB - From 1965 to 1990, spending on medical care rose from 5.9 to 12.2 percent of gross national product. This rise was the consequence of greatly expanded government and government subsidized private insurance coverage operating in an environment where payments for insured care by and large covered whatever costs were incurred. As a result, the personal consumption of medical care experienced both output and price average growth rates strikingly above economywide norms. Indeed, the output growth rate in this sector rivaled growth in several goods sectors with greatly expanded supplies. However, whereas goods in the latter sectors have become more accessible through lower relative prices, consumers with insufficient insurance coverage are being crowded out of the market for medical care by higher relative prices. PMID- 10122364 TI - Business, households, and governments: health care costs, 1990. AB - This annual article presents information on health care costs by business, households, and government. Households funded 35 percent of expenditures in 1990, government 33 percent, and business, 29 percent. During the last decade, health care costs continued to grow at annual rates of 8 to 16 percent. Burden measures show that rapidly rising costs faced by each sponsor sector are exceeding increases in each sector's ability to fund them. Increased burden is particularly acute for business. The authors discuss the problems these rising costs pose for business, particularly small business, and some of the strategies businesses employ to constrain this cost growth. PMID- 10122365 TI - Health care indicators. PMID- 10122366 TI - Patterns of psychological type among health care executives. AB - The results described in this article represent a first comprehensive description of the psychological types of health care executives. The Myers-Briggs Type Indicator (MBTI), an instrument that assesses an individual's psychological preferences along extraversion/introversion, sensing/intuition, thinking/feeling, and judging/perceiving dimensions, was administered to a nationwide sample of active American College of Healthcare Executives affiliated Fellows, Members, and Nominees. The psychological preferences among these affiliates are described and compared to general business management norms. Similar to what is observed in the general business sector, the most frequently occurring psychological type seen among health executives was thinking-judging. Unlike their general business counterparts, health care executives were observed to be significantly more thinking and less feeling in their psychological orientation. Health care executives working in for-profit settings revealed a greater preference for intuition than those in not-for-profit settings, who indicated a preference for sensing. Further examinations are made by membership status and gender. PMID- 10122367 TI - Cancer treatment in rural areas. AB - The inability to deliver cancer prevention and treatment to the rural population poses a significant barrier in the national effort to reduce cancer mortality. Since 25 percent of the U.S. population lives in rural areas and few rural areas are readily accessible to cancer centers or Community Clinical Oncology Programs (CCOPs), the prospects for accomplishing the National Cancer Institute (NCI) Goals for the Year 2000 are limited unless substantive changes occur in rural cancer care delivery. This article reviews the problem of cancer risk and care in rural areas and describes one effort to deliver state-of-the-art cancer treatment to rural patients in Virginia. It describes the needs and barriers to access in rural Virginia, the structural elements of the Rural Cancer Outreach Program, and the health policy issues that result when subspecialty care is exported to disadvantaged areas. PMID- 10122368 TI - Incorporating an understanding of independent practice physician culture into hospital structure and operations. AB - The culture values that have dominated the independent practice physician community in the United States include a set of "shared understandings" (individual autonomy, the fact that physicians relate best to other physicians, belief in science, and humanitarian ideals) that affect physician beliefs and values. Given that the current evolution of the health care system inevitably will draw physicians closer to corporate settings, corporate managers will benefit from gaining an explicit understanding of the origins and ramifications of these shared understandings. Managers can then establish organizational environments that effectively reduce the tensions between cultures of the physician and the organization. This article develops a framework of these "shared understandings" and proposes a range of managerial actions to reduce the tensions between the cultures. PMID- 10122369 TI - Strategic alliances: two perspectives for understanding their effects on health services. AB - Strategic alliances are an organizational innovation likely to have profound consequences on the delivery of health services. As an innovation, it is important that attention be given to the fundamental research issues associated with their adoption and outcomes. Using a variance and process perspective, selected research issues are identified for the alliances and participating organizations within the alliances. The variance perspective at both the alliance and participating organization levels considers the explanation of outcomes and specific stages in the adoption process at a particular point in time. The process perspective considers the particular steps or events in the overall adoption process over time. The managerial implications for each perspective are discussed. PMID- 10122370 TI - Total quality management in a health care organization: how are employees affected? AB - Since the late 1980s, health care managers have exhibited a rapidly growing interest in large-scale total quality management (TQM) programs. This quasi experimental study examines the effects of one such TQM program on employee job satisfaction, perceptions of organizational climate, and general opinions concerning the work situation. Two years after the TQM program had been introduced, responses of participants and nonparticipants were compared. Participants in the program exhibited a higher level of job satisfaction and more favorable opinions regarding both the organization and their work. PMID- 10122371 TI - Health care reform: toward a healthier society. PMID- 10122372 TI - The German health care system: a model for hospital reform in the United States? AB - Experience in Germany illustrates that the United States could potentially achieve universal access, comprehensive and high-quality services, and value for the money expended with what is often referred to as a "quasi-private and quasi public" health care system. The German hospital system is analyzed from a number of perspectives, and it is concluded that this approach has some advantages over a single-payer, monolithic-type national health insurance model. This is primarily because of its pluralistic prepayment system and because the commencement of reimbursement negotiations are without direct governmental intervention. The adoption of the German design in the United States, it is concluded, would result in a sharp change in policy direction from a conceptually procompetitive, market-driven hospital environment to a highly federally regulated, state-administered one. The implementation of the German approach in this country would also require a shift from managed care plans and other third party payers having to micromanage the use of health care services for individual patients to tightly centralized national and state fiscal controls (e.g., institutional global capital and operating budgets) targeted at providers. PMID- 10122373 TI - Organ donation and transplantation: the need for a multipronged approach for equitable allocation. PMID- 10122374 TI - The implications of advance directives on the health care institution. PMID- 10122375 TI - Courts view authorization for PVS patients differently. PMID- 10122376 TI - Plastics prices inch up 1%. PMID- 10122377 TI - Hospitals, vendors eye quick dawning of standard EDI (electronic data interchange). PMID- 10122378 TI - Hospitals saving with custom-made implants. PMID- 10122379 TI - Food and nutrition services non-salary expenses. PMID- 10122380 TI - 1992 survey of the healthcare material management and central service professions. PMID- 10122381 TI - Developing the CS workforce of the future: partnering with your local college. PMID- 10122382 TI - Conflict management: essential skills for healthcare managers. PMID- 10122383 TI - Directory of education. PMID- 10122385 TI - Directory of Federal offices. PMID- 10122384 TI - Directory of resources. PMID- 10122386 TI - Directory of national associations. PMID- 10122387 TI - 1992 corporate profiles. PMID- 10122388 TI - AIDS, hospice and volunteers. The Casey House volunteer program. A case study. PMID- 10122389 TI - Volunteers are working: patients come back to give back. PMID- 10122390 TI - Environmental scanning for Social Services. AB - This article describes the development of a process of systematic regional environmental scanning as part of strategic planning in the Ministry of Social Services (MSS) in British Columbia, over the 1987-1990 period. Social Services, a large regionalized social service organization, adopted a formal strategic planning process in early 1988. Ministry services are delivered in ten regions with widely varying characteristics. To ensure that this diversity is reflected in the planning process, it is essential that regional environmental information receive consideration. A simple format was developed and regional directors asked to consult with their staff and to scan their regions for issues that may impact the ministry over the medium term. The information obtained was presented by regional directors at a Senior Management Committee meeting and included in the ministry's annual Business Plan, a document which informs staff, contractors, stakeholders, and the community at large of the ministry's values, objectives, and operational goals. The inclusion of regional analyses adds useful information to the Plan. A second output of the planning process is the ministry budget. The systematic regional scans were found to be extremely useful to regional staff, other directors, and to the ministry executives while setting priorities. PMID- 10122391 TI - The basics: curbing delinquent self-pay debt. AB - Delinquent accounts attributable to Medicare/Medicaid, managed care companies, and third parties, are a major problem. The delinquent accounts of individuals are no less a problem. It is a given that sometimes an individual who owes a hospital money will not pay the bill, which may result in the hospital turning over the delinquent account to a collection agency and thus losing a large percentage of the revenue from that account to the agency. If the bill cannot be collected even by the collection agency, then the account becomes a total write off, costing the hospital the labor and products it used in servicing that account. Thus, developing the skills to achieve in-house payment resolution is critical. PMID- 10122392 TI - Happily married: private branch exchange & voice processing. PMID- 10122393 TI - Stand-alone devices & patient monitoring: the integration imperative. PMID- 10122394 TI - Video teleconferencing: saving lives & costs in Texas. PMID- 10122395 TI - Making the case for electronic claims. PMID- 10122396 TI - Anatomy of IS success: interfacing divergent systems across platforms. AB - As information management requirements of typical hospitals are analyzed, it becomes apparent that no single vendor or integrated suite of software can satisfy every need. This fact should be recognized as a strategic issue rather than a tactical one. PMID- 10122397 TI - Baby Bells reach out to healthcare with market strategies, projects. PMID- 10122398 TI - Hubs chosen over fileservers for campus-wide network. PMID- 10122399 TI - Bonding physicians with networks. PMID- 10122400 TI - HOT: the emergence of health oriented telecommunication applications. AB - America has benefited from decades of outstanding health services. However, the American health system now is in crisis--with runaway medical cost inflation, hospital closures, and unacceptably high and increasing numbers of uninsured people. Key solutions for bringing the health system into balance remain untapped in the potentials of health-oriented telecommunication, or HOT applications. HOT applications could rally the immense unused personal resources of the public for improving their own health, help upgrade the delivery and efficiency of healthcare and its administration, and improve public health's ability to deal with present and emerging system-level problems impacting health. PMID- 10122401 TI - $1.6 billion CHCS (Composite Health Care System) project flayed by experts. PMID- 10122402 TI - HL7 keyed to integration of diverse systems. PMID- 10122403 TI - Breaking with tradition to reengineer the medical record. PMID- 10122404 TI - Paperless by 2000: implementing EDI (electronic data interchange) for healthcare claims processing. PMID- 10122405 TI - The impact of EDI & ANSI standards on administrative cost containment. PMID- 10122406 TI - Problems predicted for PSDA (Patient Self-Determination Act); hospitals report consumers aware of new law. PMID- 10122407 TI - Studies focus on satisfaction factors among ER and outpatients. PMID- 10122408 TI - Cleveland hospital surveys outpatients. PMID- 10122409 TI - Game of chance elicits cost-saving ideas, employees make money by saving it. PMID- 10122410 TI - Pennsylvania hospital late making AIDS discovery; six patients infected. PMID- 10122411 TI - Federal officials criticized for ignoring alleged improper practices by JCAHO. PMID- 10122412 TI - Hospitals catching heat from no smoking policies. PMID- 10122413 TI - Health reform and the VA medical care system. AB - Although the Department of Veterans Affairs medical care system is literally the largest health care system in the free world, it's value has been largely overlooked in the debate on national health care reform. VA performs essential functions and provides special services that must not be lost in the process of reform. Restructuring the U.S. health care delivery and financing systems will certainly affect VA, therefore any serious plan for reform should specify the VA's role and responsibilities in tomorrow's national health care system. PMID- 10122414 TI - Fear & loathing: why Californians are concerned about health care. AB - A larger percentage of Californians than Americans overall lack insurance, and a poll of state residents shows a greater level of concern about health care costs and access. Among the reasons: a recognition that the uninsured face serious barriers to care and a fear among middle-class Californians that insurance and medical care costs could make coverage unaffordable. PMID- 10122415 TI - Pricing pain: relief in sight on drug costs? AB - Rising prescription drug prices have given state and federal health policymakers a headache. With pressure from Capitol Hill, drug makers appear to be moderating their pricing. PMID- 10122416 TI - Lessons from the first to the latest nation to enact national health insurance. AB - In 1989, South Korea became the latest country to enact a national health insurance plan. In 1989-91, South Korea experienced a 22 percent increase in health care spending despite instituting the world's highest level of cost sharing and coinsurance. Now, taking a page from the lesson book of Germany--the first country to adopt a national insurance strategy--South Korea is applying a system of global budgeting that should produce an optimal amount of cost control while preserving consumer choice. PMID- 10122417 TI - The role of America's academic health centers in a reformed health system. AB - The nation's 110 academic health centers could and should play a critical role in the quickly evolving American health system. By spanning both the academic and medical establishments, such centers can help transform medical treatment and education. As such, centers could become an intellectual link connecting the various professions. The variety of academic health centers would allow each one to serve as a laboratory for local or regional change. PMID- 10122418 TI - The growing role of chiropractic in health care delivery. AB - The number of U.S. chiropractors grew by two-thirds between 1978 and 1988, and new data show that more than 5 percent of Americans used chiropractic during a six-quarter period, spending an annual average of $411. As U.S. policymakers debate creation of standard or minimum benefit packages, these new findings may help to determine whether chiropractic meets the criteria of clinical efficacy and cost-effectiveness. PMID- 10122419 TI - Cutting malpractice costs with contracts? PMID- 10122420 TI - Health information management in the computer era. AB - Medical record professionals are confronted with change at practically every front. Technologic advancements are changing the technical aspects of our job responsibilities. These advancements also have implications for the interpersonal aspects of our jobs. The effect of new technology on working relationships is exacerbated by the introduction of TQM, which also encourages a change in organizational relationships through a move away from traditional heirarchical management by fostering teamwork and staff empowerment. The changes that are transforming health care organizations can be viewed in two lights: (1) as unwanted hindrances to accomplishment or (2) as opportunities to enhance accomplishment. Medical record professionals are presented with unprecedented opportunities to enhance our accomplishments and maximize our position in health care facilities. We cannot long for the way things were or be satisfied with the status quo. Such action (or lack thereof) will only ensure that our role on the health care team will be taken over by someone else. To capitalize on the opportunities presented, medical record professionals must hone the knowledge and skills we already possess, gain other knowledge and skills necessary to function in the computerized environment, and, most of all, be proactive rather than reactive. Such action will ensure that we truly become health information managers. PMID- 10122421 TI - Staff empowerment: a medical record department's preliminary experiences with continuous quality improvement. AB - After observing the results of continuous quality improvement, no one would argue against its value in the workplace. However, learning to apply the concepts requires change on everyone's part, and the challenge lies in effecting this change. Not everyone will want to work in this type of environment and, if the organization is truly committed to continuous quality improvement, those individuals may have to make hard decisions as to whether the organization is the right place for them to work. Certain skills are required for staff empowerment to be successful, and training in these skills is essential. The medical record department staff learned early in this process that, although the group possessed job skills, interaction and team skills were lacking. The Development Dimensions International program helped the managers and staff identify the weaknesses of the group and provided educational tools for improvement. The changes often are so subtle, the group does not realize anything has changed. It was not until recently, when the medical record department staff was requested by administration to identify department quality improvement projects, that the group looked back at where the process started and realized how different things are today from three years ago--now staff members lead team meetings, work-groups are redesigning their job processes, and teams update the rest of the department staff on its progress at department meetings. Everyone expressed a sense of pride and accomplishment that the group had indeed responded to the challenge. The experiences of the medical record department thus far clearly support empowerment of employees.(ABSTRACT TRUNCATED AT 250 WORDS) PMID- 10122422 TI - Myth of the empowering manager: communicating a vision. AB - As a manager, you control access to resources as well as social networks. Creating a communication environment open to change requires becoming more involved in the work experience. There are no shortcuts in developing a successful management style. To manage successfully requires a great deal of commitment and high levels of self-confidence, self-esteem, and professionalism on the part of management. PMID- 10122423 TI - Moving up to high performance. AB - The case for changing to a high-performance culture is simple. Figure 7 suggests a fairly simple decision-making approach. Analyze your current business results. If you are completely satisfied, then celebrate and communicate your good fortune. If you are less than satisfied, look at each of the eight systems of work. Is your organization achieving the results its design dictates? If you want another result, you probably need to alter the organizational design that produces that result. PMID- 10122424 TI - Professional advancement of women in health care management: a conceptual model. AB - Ragins and Sundstrom suggest three major conclusions based on power and gender differences within organizations. The first is that power develops or detracts as individuals progress along their career track. HIM professionals who accept the challenges that changing roles bring can also develop a new sensitivity to the value of power as a tool. They can use their negotiating skills to avoid being placed in work roles that result in a decrease in power. The second difference between men and women within organizations is that obstacles often impede women's career paths more than men's. Perceptions by women and men of a woman as homemaker and mother create serious conflicts when jobs are demanding and time intensive. Lastly, Ragins and Sundstrom suggest that career progression is influenced by both intrinsic factors (personal and professional) and extrinsic factors (organizational and interpersonal). The interaction between these factors is often driven by gender differences allowing men to progress and succeed, whereas women remain beneath the glass ceiling. HIM professionals, like other women health professionals, are graduating from advanced programs in health care and business administration at a greater rate than ever before in the history of this country. Not all these graduates will be able to acquire top-level administrative positions in the traditional health care institutions (e.g., hospitals). Therefore, if they wish to advance, they may have to move to nontraditional work settings. This is especially true for HIM professionals. The expanding computerized environment in traditional and nontraditional health care settings presents great potential for the development of new roles and responsibilities that have not been identified as male roles. HIM professionals and women in other health care professions who aspire to advance to upper administrative positions in traditional and nontraditional settings must be willing to take the risks inherent in assuming these changing roles and responsibilities. Successful women leaders in upper administrative positions recognize and take opportunities when they are offered and are not reluctant to assume more responsibilities and power in an organization. Lastly, if women are to move through the glass ceiling, health care institutions must become sensitized to the factors that prevent women's advancement and facilitate entry level opportunities for women in administration. Continuing education and opportunities for mentoring and networking, combined with flexibility in work structures, will promote the integration of women at high administrative levels in health care, not only within their own professions, but in corporate health care as well. PMID- 10122425 TI - An operational decision-making model for the cognitively sensing-thinking manager. AB - Whereas all managers face decision-making situations, not all managers discharge the decision-making process in the same manner. Individuals possess different personalities that influence how they gather and process information and subsequently make decisions. Research has reported a link between personality type and a preferred cognitive decision-making style. ST personalities prefer structured methods to resolve problems. For ST managers, a three-dimensional decision-making models is proposed. The model is based on the decision-making process initiated by Dewey and evolved by theorists and practitioners over time. Unique to the model is the institution of a second dimension of operational categories. Thus, the decision process is not conducted within a vacuum but within a context defined by the problem to be resolved. A further degree of thoroughness is achieved by unfolding the categorical dimension into sub categories and conducting the decision-making process at that level. Several additional managerial tools exist that are compatible with the ST cognitive style and that facilitate an effective and efficiency decision process. What does this mean for the practicing health information manager? The manager's first step is to identify his or her personality type. The popularity of the MBTI as an organizational and career counseling tool has received wide acceptance across industries, including health care. The MBTI can be obtained, administered, scored, and interpreted only by trained personnel. Such individuals may be found in human resource and staff development departments; career centers and seminars; and vocational-technical schools, community colleges, and universities. PMID- 10122426 TI - How motivation defines productivity. AB - People "do" things voluntarily because they have a motive to do so. When forced to change comfortable ways of performing, they resist. It is as simple yet as profound as that. Aiming at targets that fulfill employee needs leads to higher productivity and a higher level of job satisfaction. The payoff is translated into improved quality, lower turnover, and a more positive work environment. This is reality. It is common sense. It is good management. PMID- 10122427 TI - Research review: medical record department resource allocation--a look toward the future. PMID- 10122428 TI - The critical attributes of leadership. AB - The final decade of this century is a period of unprecedented change that by all indicators will continue unabated well into the next millennium. This article explored some elemental and immutable truths about leadership, management, communication, and negotiation essential to organizational success, particularly during periods of accelerated change. The case is made for a level of integrity, ethical conduct, and self-control to match the technical competence essential for managerial success in a technologically intensive work environment. These attributes and skills coupled with a widening scope of institutional vision are critical to sustained leadership and growth in an unstable world. Those without these abilities will be diminished in their capacity to communicate or negotiate. Hence, they will be thwarted or powerless to create task attraction, to effect change, or to promote excellence. These lessons are applicable to the dynamic changes occurring within the health care industrial complex, including health information management. PMID- 10122429 TI - Maternal self-esteem: from theory to clinical practice in a special care nursery. AB - Maternal self-esteem is examined from theoretical and clinical perspectives. The construct of maternal self-esteem is described, and infant and maternal factors affecting it are delineated. These factors include infant health, maternal perception of infant health, and newborn characteristics. Particular emphasis is placed on maternal perception of the infant's health and behavior. The preterm infant within the context of the special care nursery is used as a clinical illustration, thus bridging the gap from theory to clinical practice. General unit guidelines and clinical intervention strategies, for all disciplines, are suggested to enhance the maternal self-esteem of preterm mothers. PMID- 10122430 TI - Health care concerns among parents of children with mental retardation. AB - This preliminary study compared concerns of parents of children with moderate mental retardation and parents of children with severe mental retardation, on four health care variables, using a questionnaire format. Parents of children with severe impairments and those with school-aged children, had significantly more concerns regarding the hospitalization of those children, than did parents of children with moderate mental retardation or those with preschool children. Similarly, parents of children with severe disabilities had significantly more concerns on the parent-professional relationship variable than did individuals with moderately affected offspring. A high level of concern on the professional competence variable was expressed by all respondents. Study results suggested that severity of intellectual impairment is an important determinant of the number and nature of concerns that are experienced by parents when seeking health care services for their children with mental retardation. Suggestions for improving professional knowledge and service delivery are provided. PMID- 10122431 TI - Antecedents of behavior: parents of high-risk newborns. AB - The Theory of Reasoned Action (Ajzen & Fishbein, 1980) was used to develop an instrument to measure antecedents of parental behavior. The subjects, a convenience sample of 10 parents of high-risk newborns were interviewed 24 to 36 hours after their infant's admission to the neonatal intensive care unit (NICU). Likert and semantic differential scales (Osgood, Suci & Tannenbaum, 1956) were developed based on salient themes identified from the qualitative analysis of the interview transcripts to measure parents': (a) attitudes, (b) social norms, (c) previous experiences and (d) expectations. The instrument was evaluated on 30 parents using a repeated measures design. Results reflect the reliability and validity of the instrument, an emerging model of antecedents of parent's behavior and the presence of differences in antecedents of parent's behavior. PMID- 10122432 TI - Peer support group for adolescents with chronic illness. AB - This study assessed the effects of a monthly peer support group for adolescents with cancer and other hematological diseases. These adolescents shared activities and experiences with nondisabled high school students. At the group's conclusion, the adolescents reported that the group helped them cope with their illness and improved the quality of their daily lives. Nondisabled students reported that the group favorably affected their attitudes about, and intended behavior toward, peers with chronic illnesses. These results suggest that such groups can provide important benefits for individuals with chronic illnesses as well as for their nondisabled peers. PMID- 10122433 TI - The stalled response to AIDS. PMID- 10122434 TI - Strategic planning as used by chief executive officers. AB - In summary, the interviews obtained from this study suggest that CEO's in a variety of industries are attempting to "fit" their strategic planning process to their perceived environmental conditions. Indeed, management thinkers believe the biggest challenge in strategic planning will be turning CEO's into true strategic thinkers. The most successful companies, ultimately, will make strategic planning a high priority and involve all levels of management in the process. Planning becomes the unifying force that directs company actions. Hospital CEO's are obviously becoming more aware of this point as they strive to include all relevant parties (boards, physicians, etc.) in the process. Further, they seem to view planning in the classical sense, that is, as a dynamic, ever-evolving cyclical process more so than their general industry and academic contemporaries. Those hospitals that do develop strategic planning and strategic management have a definite advantage over competitors. Priorities are set and objectives are validated. This, in turn, improves productivity and creates the necessary framework for controlled growth. In addition, planning promotes teamwork and heightens motivation, bringing managers and employees together not only to meet but to exceed company goals. PMID- 10122435 TI - Informational influences on physician referrals. AB - Today's health care marketers are devoting significant resources to increase physician referrals, an area vital to their continued survival. The goal of this investigation was to integrate the findings of previous research on physician referrals, and to provide an up-to-date assessment of those influences underlying physician referral behavior. A questionnaire was mailed to 1,800 physicians differing in specialty and years in practice. Three informational influences were found to affect physician referrals: Program Information, Patient Input, and Location. The results suggest a need for specialists and other organizations interested in managing physician referrals to (a) establish and maintain a network of relationships among those physicians referring patients and specialists being referred to through personal communication, (b) maintain a pool of knowledgeable professionals willing to supply relevant and current information to physicians, and (c) provide complete and prompt feedback information to the referring physician. Managerial implications and directions for future research are also discussed. PMID- 10122436 TI - Evaluating health care services from the perspective of the elderly. AB - The increasingly important over-50 age group continues to grow, presenting a unique segment for health care marketers. The present study examines the elderly's expectations and perceptions of service quality, exploring the relationship between service quality and age. In addition, the study investigates the relationship between the image of an out-patient clinic and the perceived level of service quality. The findings suggest that the elderly expect more information and more personalized attention from the multiple health care providers associated with each service encounter. Implications for exceeding the elderly's expectation of service quality and future research directions are also presented. PMID- 10122437 TI - Indicators of hospital closure under PPS and Blue Cross/Blue Shield cost-based reimbursements. AB - Using an adaptation of discriminant analysis on a sample of 120 hospitals in the state of Alabama, this paper illuminates characteristics of hospitals closed due to financial failure under PPS and cost-based Blue Cross/Blue Shield reimbursement systems. The results show high debt levels, poor revenue and cost ratios, poor utilization management, and the inability to collect effectively on outstanding accounts in the year prior to hospital failure. PMID- 10122438 TI - Internationalization of multi hospital systems. AB - Much like the manufacturing multinationals of yore, professional service establishments are now going abroad in large numbers. Two factors drive their expansion overseas--the increasing restrictions on their operations domestically, and the inviting opportunities in some of the global markets. A survey of multi hospital corporations both with and without experience in foreign markets was conducted regarding the expansion of their operations overseas. Examined were factors central to the decision-making process including: the various types of foreign health care systems; the entry strategies in penetrating foreign markets (fully owned, joint ventures, etc.); favorable factors and barriers considered in choosing foreign markets; the ability to transfer standardized systems from operations in the U.S.; and the profits from such operations. Respondents provided information regarding the above factors that are critical in determining an overseas expansion strategy. PMID- 10122439 TI - How to improve occupancy rates by educating the health care consumer. PMID- 10122440 TI - Physical environment as a hospital marketing tool. AB - People use tangible cues to form opinions about intangible products such as health care. This paper examines roles that physical environment tangible cues play in: (1) communicating with patients, doctors and staff members; (2) creating favorable patient attitudes; (3) developing positive service quality perceptions; and (4) market segmentation, targeting, and positioning. PMID- 10122441 TI - Plan for revenue production in nutrition care at Banning Memorial Hospital: a case study. PMID- 10122442 TI - Minor emergency clinic: key to the future of successful hospitals. AB - This project set out to determine whether there is a relationship between the minor emergency facility an individual uses and their choice of a hospital for in patient care. In studying this relationship, the factors that are important to persons choosing a clinic or hospital facility, as well as the influence of a physician, were also identified. A structured, undisguised telephone survey was used for interviewing a randomly selected sample population of 189 San Angelo residents. Analysis of the survey data indicated that dependency does exist between minor emergency clinic use and the hospital chosen for in-patient care. The results of this study also suggested that hospitals' marketing strategy should shift the emphasis of their advertising from the hospital itself to their physician association and clinics. In addition, a number of other interesting observations concerning the relative importance of various medical factors to the participants was also explored. PMID- 10122443 TI - Group empowerment: group purpose and QWL (quality of working life) in a state psychiatric hospital for adolescents. PMID- 10122444 TI - Is directed blood transfusion a good idea? AB - The appearance of transfusion-transmitted HIV infection has heightened awareness of dangers that have always been present. Directed donation, while no panacea, may provide one alternative. PMID- 10122445 TI - Coping with CLIA. Part 4. A master plan for implementing CLIA. PMID- 10122446 TI - A phased approach to transfusion reaction investigation. PMID- 10122447 TI - Spreadsheet templates for calculating linearity according to EP6-P. PMID- 10122448 TI - The marketing activities of hospitals: environmental, organizational, and managerial influences. AB - This article reports the results of a study designed to examine the relationship of environmental, organizational and structural factors, perceptions of key decision makers about competitive conditions, and changes in operational performance with the level of the marketing activities engaged in by 145 California hospitals. Measures assessing the impact of environmental conditions and the perception of the key decision makers were found to be related to the marketing activities of the organization. However, the relationship between measures which examined the structural and performance impacts on the marketing activities did not demonstrate the same predictive ability. The results suggest that marketing activities were affected by the key decision maker's assessment of the competitive nature of the environment, influence of key stakeholders, and tangible changes in the organization's task environment. Performance and other measures were not found to be as influential in determining these activities. PMID- 10122449 TI - How contracting will force us to ask questions we never asked before. AB - This paper examines the impact of the separation of the purchaser from the provider and in particular the effects of placing service contracts. The paper assumes the role of the purchaser authority and examines some of the questions and assumptions that will influence the type of work to be purchased. PMID- 10122450 TI - Management information and self-governing NHS hospital trusts. AB - The proposal for self-governing hospital trusts within the NHS, announced in the White Paper Working for Patients on 31 January 1989 and enacted through passage of the National Health Service and Community Care Act 1990 last July, introduces free market incentives to NHS hospitals. Hospitals applying for self-governing status must first demonstrate that they have an information system appropriate to support decision making in the new context. An overall information systems flow and an approach to information systems development are recommended based upon the Freeman Hospital model. The Freeman Hospital is a national pilot site selected by the NHS Management Executive for development of information systems for NHS hospitals. PMID- 10122451 TI - Hospital management by product lines. AB - Over the last decennium many reforms of the reimbursement systems have taken place to improve the economic performance of health service organizations. These environmental changes have stimulated many hospital managers to introduce types of internal management control. Consequently budgeting is a very well known management tool. Less known in Europe is product-line management. The main purpose of this article is to introduce the concept of product-line management. Attention is paid to ways product lines can be defined in hospitals and which elements the implementation of product-line management envelope. Emphasis is laid on the consequences for the organizational structure and the cost information system. Finally, we deal with the advantages and disadvantages of product-line management. PMID- 10122452 TI - Differences in access and quality of care across HMO types. AB - This paper investigates differences between various HMO types (eg, staff model, group model, IPA model) in their access and quality of care outcomes. Several sources of evidence are analyzed, including research findings reported in the health administration literature, survey data from a random sample of 42 HMOs, and accreditation data gathered from 26 HMOs in four states. Consistent with previous research, both the random sample survey data and the accreditation data indicate that group and staff model HMOs score more favorably than IPA models in terms of the level of services provided, preventive care, and various quality of care outcomes. Data from the random sample survey indicate that IPA models score more favorably on measures of patient satisfaction and access outcomes. These findings are consistent with speculation that IPAs trade off utilization and quality controls for patient access and physician autonomy. Contrary to speculation, the effect of HMO type on access and quality may be independent of the degree to which physicians are financially and organizationally tied to the HMO. PMID- 10122453 TI - Pricing and openness in contracts for health care services. AB - This paper explores the objective of increased competition and considers whether different types of competition are likely to lead to desirable market outcomes. Potential sources of market failure, and hence inefficiency, are examined. The paper then considers what type and degree of regulation may be necessary if the forces of unrestrained competition cannot be expected to achieve desirable outcomes. A number of different options, ranging from minimal regulation to central pricing schedules, are then discussed. Consideration is given to whether openness in costing and/or pricing is necessary and desirable in both short and long term. The paper raises a number of practical problems which may be faced and suggests ways in which incentives can be created to mimic the characteristics of a competitive market. PMID- 10122454 TI - Multi inter-organizational information systems: competitive strategies for teaching hospitals in the 1990s. AB - As the environment surrounding the health care industry has changed, the ability of administrators to manage these relationships remains very limited due to their ever-increasing complexity. These organizational relationships offer both challenges and opportunities for innovative strategies that address the issues of coordination and control. As these environmental changes take place, the application of information systems technology becomes more important for managing these relationships and achieving competitive advantages. A theoretical model is presented to serve as a basis for empirical investigations into the role of information systems technology in health care organizations--more specifically teaching hospitals. PMID- 10122455 TI - In search of service quality measures: some questions regarding psychometric properties. AB - Confirmatory factor analysis was used to evaluate the construct validity of SERVQUAL, an instrument intended to measure consumer-reported service quality. Results indicate the hypothesized conceptualization of service quality was not valid in a health care setting. It is suggested that additional measurement attention to consumer perceptions may provide further insight into subjective health care service quality evaluation. Implications of failing to consider the measurement properties of this and other constructs are discussed. PMID- 10122456 TI - Perspectives. New Jersey's journey from DRGs to deregulation. PMID- 10122457 TI - Perspectives. Look homeward, health care. PMID- 10122458 TI - Epsom General Hospital orthopaedic theatre. AB - The Surrey Section of the London Branch held a very successful meeting on Wednesday 9th September 1992 at which Mr Stephen Kirby BSc, CEng, Director of Estates, gave a talk and tour of the new Private Ward Unit and Ultra Clean Ventilation Theatre at Epsom General Hospital. The new Northey Ward, is a result of the refurbishment of what was a 31 bed section of the Hospital Surgical Block on the 5th floor. The new Ward provides a total of 18 single bed Wards, each complete with bathroom/WC, the Unit also accommodates a 5 bed Day Ward. All the facilities provided are of extremely high standard, which given the very tight building programme, detailed elsewhere, is indicative of the dedication of both the Designers and Contractors who are congratulated on their achievement. With regard to the UCV Theatre the following information was prepared by Aidan Hardy who is a Project Engineer with Epsom General Hospital. We are delighted to be able to print this report for our readers. PMID- 10122459 TI - 'Well, which do you recommend--doctor?'. PMID- 10122460 TI - Safety of portable electrical equipment. PMID- 10122461 TI - New EME (Electro-Medical Equipment) module available now. PMID- 10122462 TI - Looking out for your MT environment. PMID- 10122464 TI - By whose standards? PMID- 10122463 TI - Update on the Medical Transcriptionist Certification Program and core certification examination. AB - The Medical Transcriptionist Certification Program is well under way toward development of the new core exam. The following report was given to the 1992 house of delegates (HOD) by Carrie Boatman, CMT, chair of the Medical Transcriptionist Certification Program. It contains preliminary information regarding the core exam and the steps that have already been taken. The certification board approved the blueprint for the written portion of the core exam, which is also printed here. PMID- 10122465 TI - The future of tax-exemption for nonprofit hospitals and other health care providers. PMID- 10122466 TI - Tax-exemption for hospitals: towards an understanding of community benefit. PMID- 10122467 TI - The Medicare & Medicaid anti-kickback statute and the safe harbor regulations- what's next? PMID- 10122468 TI - Genetic narratives: biology, stories, and the definition of the family. PMID- 10122469 TI - An exception to the employment-at-will doctrine for nurses. PMID- 10122470 TI - Data watch. Paying for retiree health care. PMID- 10122471 TI - Should private payers adopt RBRVS fee schedules? AB - Independent Blue Cross and Blue Shield plans are adopting RBRVS-based fee schedules for reimbursing physicians. Some argue that private payers should follow suit. PMID- 10122472 TI - Do you know what treatments your health plan covers? AB - Employee benefits plan documents need to spell out specifically what experimental treatments are excluded to avoid costly litigation. Lawyers explain the implications of recent lawsuits against employers. PMID- 10122473 TI - Health promotion programs yield long-term savings. AB - Companies implement health promotion programs as an investment that they hope will result in decreased health care costs in the future. B&H reviews the health promotion programs of Coors, Waste Management, and Baker Hughes. PMID- 10122474 TI - Rural group focuses funds on education. PMID- 10122475 TI - A competitive system has hurt consumers. PMID- 10122476 TI - Patients left out in the cold. PMID- 10122477 TI - Introducing "Robodoc". A robot finds his calling--in the operating room. PMID- 10122478 TI - Facing the powers that be. AB - Lobbyists, entrenched forces in congress and self-interested friends will try to stymie Clinton's efforts. A look at four key arenas of combat. PMID- 10122479 TI - Planning to be poor. With a little help, the nursing home won't get your savings- your kids will. PMID- 10122480 TI - List of designated primary medical care health professional shortage areas (HPSAs); list of withdrawals from primary medical care HPSA designation--HRSA. Notice. AB - This notice provides two lists. The first is a list of all areas, population groups, or facilities designated as primary medical care health professional shortage areas (HPSAs) as of June 30, 1992. Second is a list of previously designated primary medical care HPSAs that have been found to no longer meet the HPSA criteria and therefore are being withdrawn from the HPSA list. HPSAs are designated or withdrawn by the Secretary of Health and Human Services (HHS) under the authority of section 332 of the Public Health Service Act. PMID- 10122481 TI - Health Resources and Services Administration; statement of organization, functions and delegations of authority--PHS. PMID- 10122482 TI - Medicaid program; Drug Use Review program and electronic claims management system for outpatient drug claims--HCFA. Interim final rule with comment period. AB - This interim rule implements provisions of section 4401 of the Omnibus Budget Reconciliation Act of 1990 by specifying requirements for a Drug Use Review program, including the establishment of Drug Use Review Boards, and for an Electronic Claims Management system for outpatient drugs. PMID- 10122483 TI - Medicare and state health care programs: fraud and abuse; safe harbors for protecting health plans--HHS. Interim final rule with request for comment. AB - In accordance with section 14 of the Medicare and Medicaid Patient and Program Protection Act of 1987, this interim final rule establishes two new safe harbors and amends one existing safe harbor to provide protection for certain health care plans, such as health maintenance organizations and preferred provider organizations. The first new provision protects certain incentives to enrollees (including waiver of coinsurance and deductible amounts) paid by health care plans. The second new provision protects certain negotiated price reduction agreements between health care plans and contract health care providers. Finally, an existing safe harbor has been amended to protect certain agreements entered into between hospitals and Medicare SELECT insurers. These safe harbors specifically set forth various standards and guidelines that, if met, will result in the particular arrangement being protected from criminal prosecution or civil sanctions under the anti-kickback provisions of the statute. PMID- 10122484 TI - A cross-cultural program for environmental management. AB - For those who have responsibility for safety programs in health facilities the primary objective is to effectively orient, train and retrain environmental service and housekeeping personnel, regardless of their individual background, so that each employee has the knowledge, skills and work habits to safely and effectively meet performance expectations. With an increasingly diverse multicultural workforce, however, we need to reexamine many of our assumptions of what constitutes adequate safety training for all employees. This paper examines some of the basic issues that arise when addressing a multicultural workforce. Two questions are at the heart of the discussion: (1) how do you effectively communicate with a multicultural base group, and (2) how do you know if your communication has been effective to ensure the health and safety of your employees? PMID- 10122485 TI - Screening of pregnant women for evidence of current hepatitis B infection: selective or universal? AB - This paper reports the findings of a retrospective survey which assessed the accuracy of the selective screening programme for hepatitis B infection. The survey was undertaken in the antenatal clinics of West Lambeth Health Authority during 1988 and 1990. Forty per cent of hepatitis B positive patients were not screened, which highlights the problems associated with selective screening programmes. The implications for obstetricians and midwives are discussed, and recommendations are made. PMID- 10122486 TI - Misplaced elderly patients in hospital: clarifying responsibilities. AB - In an attempt to assess the service provided by a geriatric department for the elderly population within its District, a census of the elderly patients occupying general medical beds in the same District was undertaken. These patients were assessed according to five criteria which identified patients as 'geriatric'. Sixty-one per cent of the patients occupying general medical beds were over the age of 65 years, and almost a half of these were geriatric according to the criteria used. The authors conclude that quantifying misplaced geriatric patients by screening for geriatric characteristics in a general medical population was a useful way of auditing the performance of a geriatric service. PMID- 10122487 TI - A survey of long-term care elderly patients in the South West Thames Region. AB - This paper describes a survey which focuses on the patients in National Health Service long-term care beds. It examines the dependency levels and mental impairment of geriatric patients in 15 Departments of Geriatric Medicine, and determines the extent and distribution of patient dependency, including the number of independent patients. The findings support the view that there is a need for National Health Service long-term care beds. PMID- 10122488 TI - Throughput in a department of geriatric medicine: a problem of time, space, and behaviour. AB - Over a period of 16 years, the annual admissions to the Merton part of the St George's Department of Geriatric Medicine increased, then decreased, before rising again. Examination of the mean length of stay and bed turnover indicated that patient management was continually changing. However, this was not confirmed by a percentile analysis of the pattern of length of stay after admission. Present plans for hospital medical services for elderly people are based on the hypothesis that length of stay shortens linearly with time. The results of this study do not support this hypothesis. They do, however, imply the need to regularly review the policies for the medical care of elderly people. PMID- 10122489 TI - The Homefinder service. AB - This paper describes the establishment of a Homefinder service for elderly patients at Charing Cross Hospital in 1985. The contribution made by this service over a five-year period in reducing acute medical bed occupancy by long-stay patients is discussed. PMID- 10122490 TI - Organising a continence advisory service. AB - Modern surgical techniques have greatly improved the treatment of incontinence, but there remains a large number of patients for whom conservative management will be necessary. This paper reports the appointment of a continence adviser 10 years ago, and describes the subsequent development of a District Continence Advisory Service. Experience has shown that this appointment is essential, not only in terms of facilitating the service, but also as a means of ensuring cost efficiency. PMID- 10122491 TI - The New Deal: an account of progress in reducing junior hospital doctors' hours in England. AB - This article reviews the background that led to the publication of The New Deal, and sets out the key elements of that agreement. It describes the work aimed at achieving successful implementation, and discusses the principal issues which will influence further progress. PMID- 10122492 TI - Do we require initiatives to reduce ophthalmic outpatient waiting lists? AB - This paper describes a five week initiative, which aimed to reduce the waiting list for new referrals to an ophthalmic department. A cohort of 317 patients was examined qualitatively to help determine the future direction of ophthalmic resources. Cataract was the most frequent diagnosis, and one in five new patients were referred for surgery. A third of all referral letters contained inaccurate diagnoses, suggesting that grading waiting times on the basis of referral letters is unsatisfactory. Ten per cent of referrals suffered from conditions that could potentially lead to irreversible visual loss. There was no significant difference between the non-attenders (19%) and attenders in relation to their diagnoses or subsequent management. This initiative effectively reduced the outpatient waiting time from 28 weeks to two weeks, thereby maintaining the outpatient waiting time at eight weeks over the following year. PMID- 10122493 TI - How much do junior staff influence patient throughput in a surgical unit? AB - A study was undertaken of inpatient throughput in a surgical department on a 'split site' District General Hospital. The study compared the individual contribution of equally qualified and experienced surgical registrars working at both sites. The results show that one registrar was associated with a statistically significant higher patient throughput, which appeared to be the result of a more expeditious approach to patient management. There was no evidence of an accompanying reduction in the quality of care delivered. The additional throughput amounted to approximately 300 extra patients in two years, and made a substantial contribution to the surgical workload in the District. PMID- 10122494 TI - Has outpatient quality assurance improved performance? AB - A prospective study of the outpatient department was undertaken as part of a quality assurance initiative to improve patient care. Senior managers and clinicians set realistic performance targets for attendances, availability of records, waiting times and delay in correspondence to general practitioners. From February 1989 to January 1990, performance was analysed each month, and data and subsequent management changes publicised. The results show improvements in all areas studied, which supports the generally held belief that clinicians wish to improve the care offered to patients. PMID- 10122495 TI - Quality assurance in Guy's Hospital accident and emergency department. AB - This paper describes the development of a comprehensive, practical audit by the medical staff at the Accident and Emergency Department at Guy's Hospital. The audit has enabled a comprehensive systematic review of clinical care and its documentation. The results shows that audit of Accident Emergency medicine is possible when channelled by proforma. Junior doctors in this specialty exercise great autonomy, and the audit highlights their need for proper training and guidance from senior medical staff in the review of major and minor cases. PMID- 10122496 TI - Smoking prevalence and attitudes of Gwynedd Health Authority staff towards passive smoking and the Authority's non-smoking policy. AB - In 1989, a postal survey was undertaken to investigate the smoking prevalence and attitudes of Gwynedd Health Authority employees towards the Authority's non smoking policy, passive smoking and other related issues. The results show a smoking prevalence rate of 22% for those participating in the survey, with over half of all smokers expressing a wish to stop. Although the rate was similar for males and females, it was marginally higher amongst nursing staff and young employees. Smoking prevalence was highest among the ancillary staff, and lowest among the medical and dental professions. Most employees were in broad agreement with the Authority's non-smoking policy, and a majority thought it about right or favoured extending it. Most non-smokers and ex-smokers believed passive smoking to be a health hazard, with an increased number rating it anti-social. Attitudes towards these issues were similar for males and females, with marked differences between the groups employed in different areas of the service. Younger employees were more aware of the dangers of passive smoking, but less sympathetic towards the policy than the older ones. The findings of this study highlight the differences between smokers and non-smokers on all smoking issues. The implications for health education and the Authority's non-smoking policies are discussed. PMID- 10122497 TI - Who's winning the information revolution. AB - The company of the future is already here, formed by the technological ferment that is transforming all of business. These examples are powerhouses. PMID- 10122498 TI - Firm control. PMID- 10122499 TI - Quality or quantity. PMID- 10122500 TI - What's up doc? PMID- 10122501 TI - Strange route. PMID- 10122502 TI - Countdown to community care. Smart moves. PMID- 10122503 TI - Information for purchasers. Indispensable. PMID- 10122504 TI - Mapping health needs. PMID- 10122505 TI - How to pass the intelligence test. PMID- 10122506 TI - Current treatment of gram-positive infections: focus on efficacy, safety, and cost minimalization analysis of teicoplanin. AB - The current health care environment has had a significant impact on hospital Pharmacy and Therapeutics Committee formulary decisions. In evaluating a new therapy for formulary inclusion, a cost savings along with equivalent or an improvement in patient care and safety is optimal. Teicoplanin is an investigational glycopeptide antimicrobial agent with a spectrum of activity similar to vancomycin. Unlike vancomycin, however, teicoplanin has a long elimination half-life permitting administration once daily, and is well tolerated when given intramuscularly. In addition, teicoplanin is associated with a favorable safety profile. Red man syndrome does not appear to be a significant clinical problem. Results of our cost minimalization analysis using the average acquisition costs of vancomycin revealed that teicoplanin (400 mg), at an average acquisition cost of less than $28.46 when administered intravenously and $30.93 when administered intramuscularly, offers a clinically efficacious, safe, and less expensive alternative to vancomycin therapy. PMID- 10122507 TI - The economic impact of clinical pharmacists' unsolicited recommendations. AB - Clinical pharmacists in a 580-bed teaching hospital reported all targeted recommendations that occurred during a 5-month evaluation period. Five types of clinical recommendations were identified: (1) to start drug therapy, (2) to stop drug therapy, (3) to increase drug dose, (4) to decrease drug dose, and (5) to suggest alternative drug therapy. Two thousand sixty-four unsolicited, accepted recommendations were submitted to the investigator by approximately eight holders of full-time equivalent positions dedicated to clinical pharmacy services during the evaluation period. Three hundred forty-four recommendations were selected (every sixth submitted recommendation) and evaluated for their economic impact. The costs of drugs, monitoring, and treatment for the drug regimens were compared before and after each recommendation. Three classes of drugs (antineoplastics, anti-infectives, and gastrointestinal agents) contributed more than 90% of the economic impact. The net economic impact of the evaluated recommendations was a cost saving of $4636.06; this extrapolated to a net cost saving of $34.10 per pharmacist-day. PMID- 10122508 TI - Delayed psyllium allergy in three nurses. AB - The use of psyllium has been associated with various allergic reactions. Three nurses at the Prescott Veterans Affairs Medical Center had differing degrees of psyllium allergy. The reactions ranged from sneezing to chest congestion and wheezing. Two nurses were available for skin testing, and both had a positive wheal reaction. Psyllium allergic reactions have been reported rarely in the literature; however, they may be more prevalent than previously realized. PMID- 10122509 TI - Renal disease audit and drug usage evaluation for all patients. AB - The object of this study was to develop a concurrent automated screening system to identify patients with a glomerular filtration rate (GFR) less than 50 mL per minute who might need dose or interval adjustment of drugs that are excreted primarily renally. The design of this investigation was a concurrent study of all patients in a level II trauma 317-bed community health center. The data were extracted after daily monitoring of patient laboratory values, specifically, blood urea nitrogen, serum creatinine, creatinine clearance, and chart review. It was concluded that, in 1991, a total of 70 pharmacy-initiated interventions were made on the basis that potentially harmful side effects might have occurred if drugs that primarily are excreted renally were administered to patients identified with a calculated GFR less than 50 mL per minute. PMID- 10122510 TI - A simplistic approach to restocking crash carts. AB - An organized crash cart can bring a sense of structure to a potentially chaotic situation. By standardizing every crash cart, time and confusion can be saved, which in turn may save a life during an emergency situation. This article describes one hospital's solution to the design and restocking of crash carts. This approach streamlined the process of restocking the medication component of the crash carts by the pharmacy department. No matter what time of day or night a code was called, the pharmacy could have the medications replaced within minutes. PMID- 10122511 TI - Pharmaceutical service differences between teaching and community hospitals. AB - The purpose of this study was to inventory the highly specialized units maintained in teaching hospitals and compare and contrast the scope and level of pharmaceutical services provided in teaching and similar-size community hospitals. In 1989, a 30-item questionnaire was mailed to a sample of 120 teaching hospitals. The scope and level of services provided was compared with similar size hospitals in the 1989 American Society of Hospital Pharmacists' survey of hospital-based pharmaceutical services. Teaching hospitals maintain more licensed and occupied beds, are more likely to be a member of a nonprofit multisystem organization, maintain many specialized care units and high speed transportation vehicles, exercise more control over specialized drugs and products, provide a broader array of pharmacy services to ambulatory patient populations, offer a more extensive and broader array of clinical services, maintain more extensive drug information resources, exercise more comprehensive formulary management initiatives, engage in broader diversified service initiatives, and generate 50% more annual pharmacy costs per occupied bed than do similar-sized community hospitals. Teaching hospitals are complex organizations that provide care to patients who require higher levels of pharmaceutical services than those provided in similar-sized community hospitals. PMID- 10122512 TI - Activity analysis of sterile products technicians. AB - Work sampling techniques were used to determine the amount of time sterile products technicians spent performing predefined activities. Twenty-two predefined activities were divided into three major categories: admixture preparation techniques, total parenteral nutrition preparation techniques, and other activities. The total time spent by all sterile products technicians revealed the greatest amount of time consumed preparing sterile products in minibags (362.2 minutes), whereas drug manufacturers piggyback (DMPB) doses required 65.8 minutes. Preparation of these small volume parenterals took approximately 1.3 minutes per dose, whereas syringes consumed 123.5 minutes, or approximately 1.8 minutes per dose. Preparation of miscellaneous products required 57.7 minutes, or 1.9 minutes per dose. TPN consumed 240.7 minutes in total, or 5.5 minutes per bottle. Other activities included paperwork (154.8 minutes), communication (169.1 minutes), and sorting prepared intravenous solutions by nursing unit and time of administration (102.5 minutes). Work sampling was effective in quantifying activities performed by sterile products technicians. PMID- 10122513 TI - Japan: a sobering lesson. PMID- 10122514 TI - A natural experiment. PMID- 10122515 TI - Realities vs. perceptions. PMID- 10122516 TI - Desperately seeking solutions. PMID- 10122517 TI - Meaning in numbers. PMID- 10122519 TI - Competent admitting process creates positive first impression. PMID- 10122518 TI - The Human Genome Project. PMID- 10122520 TI - A dialogue on stewardship. A multiunit organization commits to improving utilization of scarce resources. AB - To initiate a dialogue and begin addressing the issues of appropriateness of patient care and resource utilization, since 1988 leaders within the East Central Region of the Daughters of Charity National Health System (DCNHS-EC) have conducted a series of workshops involving managers, physicians, ethicists, attorneys, and others. The dialogue initiated in these workshops, along with the results of a 1991 survey of the region's local health ministries, has provided DCNHS-EC with baseline information on how each of the region's institutions supports care givers in making ethical decisions at the bedside level. The first workshop focused on the ethical dimensions of providing high-quality care with reduced reimbursement, local initiatives for ensuring quality while containing costs, and steps DCNHS-EC hospitals could take to promote effective use of scarce medical resources. Subsequent workshops provided opportunities for further exploration of these issues. Another workshop is being planned for late 1993 or early 1994. DCNHS-EC health ministries are taking a number of concrete steps to improve appropriateness of care and resource utilization. The support of local management, governance, and physician leaders is critical to these efforts. PMID- 10122521 TI - Clinical practice guidelines. The Agency for Health Care Policy and Research fosters the development of evidence-based guidelines. AB - As medical technology increases rapidly and becomes more complex, clinical practice guidelines can help healthcare providers assess current practices and integrate technological advances. Through the Agency for Health Care Policy and Research (AHCPR), the federal government has begun to facilitate the development of clinical practice guidelines. Expert or contract panels, authorized by the AHCPR, develop guidelines on specific clinical conditions. The AHCPR guideline methodology is designed to produce evidence-based guidelines that are valid, clinically applicable, and clinically flexible. Each panel spends a year or more developing the guideline, beginning with an extensive literature search and review. The panel prepares evidence tables, statistically analyzes aggregate data (where appropriate), conducts harm and benefit analyses, and prepares health policy analyses (or cost-impact studies). During this process, the panel holds an open forum to solicit comments on the guideline topic. After this public discussion, the panel prepares a final draft of the guideline. Several hundred individuals review the guideline. Some policymakers believe clinical practice guidelines can lead to better healthcare outcomes. Guidelines can provide information in a useful format for clinicians to use at the bedside or the point of decision making in patient care. Guidelines also provide information that can be used in continuing education and professional education programs. PMID- 10122522 TI - Improving utilization and patient care. A rural hospital reduces length of stay through policy revisions and education. AB - In 1990 Saint Vincent Memorial Hospital, Taylorville, IL, intensified efforts to improve resource utilization. A program of daily case review and medical staff education has helped the hospital reduce average length of stay from between 7 and 8 days to between 5 and 6.8 days. Steps taken to achieve this include: Hiring an outside medical adviser to oversee collection and analysis of data related to length of stay and conduct case reviews Appointing a medical review officer and a physician-specific case manager Establishing a Utilization Management Task Force, which has reformed the policy concerning patients with methicillin-resistant Staphylococcus aureus to ensure discharge in a timely manner; implemented a nonacute-day reporting system; and completed a transitional care study to identify the benefits of transferring medically stable Medicare patients to the Skilled Nursing Facility. PMID- 10122523 TI - Outcomes data: rational utilization, better doctor-patient relations. PMID- 10122524 TI - Living longer and better than expected. A wellness-based model keeps CCRC residents active, healthy, and out of nursing homes. AB - The McCauley, a continuing care retirement community in West Hartford, CT, promotes a wellness philosophy that helps its residents retain their health and independence and extend their lives. The wellness program centers around the individual, not around the services provided. The residents have significant input and initiative in maintaining their own health. The health program is based on a nursing model, with each resident relating to a primary nurse as needs become evident. The nurses' goal is to know each person's holistic needs--to assist in maintaining physical, emotional, and spiritual balance. The program's approach to physical health requires a strong emphasis on prevention, including individualized fitness programs. The McCauley fosters mental and social well being by allowing patients to maintain independent living for as long as they are able and by maximizing their self-direction. Another contributor to mental well being is the opportunity for personal growth and intellectual stimulation. The McCauley promotes spiritual well-being by supporting continued participation in churches or synagogues from previous neighborhoods, fostering a supportive network within the community, and recognizing the value of residents' volunteer activities. PMID- 10122525 TI - Patient participation. Planetree empowers patients to achieve better outcomes. PMID- 10122526 TI - Indigency, ethnicity, and hospital viability. The growth of racially diverse communities challenges Catholic providers and sponsors. AB - A Catholic Health Association study analyzes correlations between the ethnic and racial composition of communities served by Catholic hospitals and these hospitals' viability and capacity to serve their communities. It also describes the extent to which Catholic hospitals serve racially homogeneous communities, on the one hand, and racially and ethnically diverse communities, on the other. For comparison, the study focuses on hospitals in two groups. Group A consists of hospitals in the top quartile based on their proportion of care for the poor and top-quartile percentages of black and Hispanic residents in their local communities. Group B consists of hospitals with bottom-quartile levels of care for the poor and bottom-quartile percentages of black and Hispanic residents. The study found that, from 1985 to 1990, group A hospitals continued to provide high levels of care for the poor (between 28 percent and 32 percent on average) while average margins fell from about 4 percent to below 1 percent. During the same period, the amount of care group B hospitals provided to the poor remained between 5 percent and 6 percent; although their margins declined, these hospitals were significantly more profitable than group A hospitals. The financial stress currently being experienced by many hospitals that serve communities with relatively high percentages of ethnic and racial minorities is troubling. Without basic reform of the healthcare system, many of these facilities may have to close, leaving many in their communities without access to adequate healthcare. PMID- 10122527 TI - Marketing home healthcare. PMID- 10122528 TI - Parents' needs and rights when a baby dies. PMID- 10122529 TI - Carondelet Health Care Corporation. Community nursing demonstration project will involve patients in their care. PMID- 10122530 TI - Communicating with residents, families and staff. PMID- 10122531 TI - What residents value most. PMID- 10122532 TI - Consultant dietitians: the opportunity is now. AB - Times have never been better for the consultant dietitian who must not only maintain cost effectiveness while providing quality clinical services, but initiate innovative, marketable dietary services to generate revenue. PMID- 10122533 TI - Agency nurses: the right solution to staffing problems? PMID- 10122534 TI - Accountability of certified long-term care administrators. AB - To whom and in what ways are administrators and their facilities accountable? This profile of administrators who have completed ACHCA's Professional Certification Program explores how certification increases one's social accountability and improves facility performance. PMID- 10122535 TI - Psychodrama therapy. PMID- 10122536 TI - Values and nursing home life: how residents and care givers compare. AB - Do you and your staff know exactly what your residents want from your facility? This study compares residents' top ten concerns with what their administrator and staff think their top concerns. PMID- 10122537 TI - The effects of market structure and bargaining position on hospital prices. AB - PPOs and HMOs have gained widespread acceptance due in part to the belief that excess capacity and competitive market conditions can be leveraged to negotiate lower prices with health care providers. We investigated prices obtained in different types of markets by the largest PPO in California. Our findings indicate that greater hospital competition leads to lower prices. Furthermore, as the importance of a hospital to the PPO in an area increases, the price rises substantially. Our testing of alternative methods for defining hospital geographic markets reveals that the common practice of using counties to define the market leads to an underestimate of the price-increasing effects of a merger. PMID- 10122538 TI - A randomized trial to evaluate the effectiveness of a Medicaid HMO. AB - The value of health-care services used by AFDC Medicaid patients receiving care in a voluntary enrollment HMO is contrasted with that of health care services used by Medicaid patients receiving fee-for-service (FFS) care. The randomized assignment of Medicaid recipients to the HMO or to FFS allows the authors to conclude that the apparent lower use of HMO enrollees results from the HMO's selection of patients with lower needs for care rather than from technical efficiency. Patients had lower use while in the HMO, but disenrollees and those who refused enrollment had significantly higher use than FFS participants. In contrast to the effect of HMOs on non-Medicaid populations, the Medicaid HMO studied provided significantly fewer outpatient services, but the same level of inpatient services as the FFS sector. Overall, voluntary enrollment of Medicaid eligibles into the HMO resulted in higher state expenditures for Medicaid because of favorable selection. PMID- 10122539 TI - Implications of basing health-care resource allocations on cost-utility analysis in the presence of externalities. AB - Cost-utility analysis is increasingly being advocated as a tool for helping to establish funding priorities among programs and services in the health-care sector. As currently conducted, however, cost-utility analysis is problematic as a basis for achieving allocative efficiency because it excludes externalities. The exclusion of externalities may bias program ranking in unpredictable ways, leading to a non-optimal allocation of resources. Consideration of externalities also raises a number of distributional issues for the evaluation of health services and highlights the important of developing economic evaluation methods that are consistent with the conceptual basis for allocating resources. PMID- 10122540 TI - Cost effectiveness/utility analyses. Do current decision rules lead us to where we want to be? AB - Despite the growing literature on economic evaluation of health care programmes, little attention has been paid to the theoretical foundations of cost effectiveness and cost utility analyses and the validity of the decision rules adopted as methods of achieving the stated goals. We show that although applications of the techniques can be used to pursue some managerial objectives in the context of highly constrained environments, such applications are inconsistent with both welfare economic objectives and the interpretations of the findings of these applications. Alternative strategies are identified as potential and practical methods for pursuing welfare economic objectives. PMID- 10122541 TI - Persistence in the use of pharmaceuticals by the elderly. Evidence from annual claims. AB - An analysis of four-and-a-half years of claims data from the Pennsylvania Pharmaceutical Assistance Contract for the Elderly (PACE) program shows a pronounced degree of persistence in annual prescription drug expense by individual enrollees from year to year, particularly among the heaviest users. There is evidence of eventual regression to the mean, but it takes a substantial length of time--far longer than observed for other types of health care used by the elderly. The study findings raise questions about the insurability of drug expenses in non-group Medigap policies. PMID- 10122542 TI - Tax harmonization and the reduction of European smoking rates. AB - Amidst growing optimism that smoking in Europe can be greatly reduced by the year 2000, this paper simulates the possible impacts of European tax harmonization in the context of rising incomes. A range of price and income elasticities are chosen from econometric studies which use micro information. This is justified by the aggregation problems associated with studies in the smoking literature which use aggregate data. Using micro elasticities, the simulations reported in this paper show that the aims of fiscal harmonization are at variance with the aims of health promotion. PMID- 10122543 TI - Policy implications of recent hospital competition studies. PMID- 10122544 TI - Adverse selection: does it preclude a competitive health insurance market? AB - In sum, although fixed dollar subsidies have the great virtue of ferreting out cross subsidies, society may not be satisfied with the results. The scenario described by Marquis is only one of many. People seem to want lifetime insurance offering low premiums if things go bad rather than premiums that change annually as health outcomes are realized [see, e.g., Light (1992)]. But nondiversible risk may be too great for a market in life contracts to exist. PMID- 10122545 TI - Scrap contingency fees? Malpractice problems might get worse. PMID- 10122546 TI - How to tell if an HMO will make you money. PMID- 10122547 TI - Who says inefficiency doesn't pay? PMID- 10122548 TI - Why I don't take medicine's good people for granted. PMID- 10122549 TI - Practice expenses: doctors pull hard on the reins. PMID- 10122550 TI - What patients think you're really worth. PMID- 10122551 TI - How many headaches can a computer cause? Count 'em. PMID- 10122553 TI - When doctors say Yes and insurers No. PMID- 10122552 TI - Managed care is a pox on us and our patients. PMID- 10122554 TI - How do you rate with your office manager? PMID- 10122555 TI - Opportunity for improvement a state of mind. PMID- 10122556 TI - Auxilians are a vital bridge. PMID- 10122558 TI - Concluding thoughts on leadership. PMID- 10122557 TI - Strong alliances key for tomorrow's allied health personnel needs. PMID- 10122559 TI - Hospitals top list of industries in illnesses, injuries. PMID- 10122560 TI - HCFA reverses requirement that hospitals treat patients transferred from Mexico. PMID- 10122561 TI - New reporting guidelines from HFMA urge separation of charity, bad debt data. PMID- 10122562 TI - Lawmakers urged to close ERISA loopholes. PMID- 10122563 TI - HRET restructuring includes new post of VP for education. PMID- 10122564 TI - Battle now centers on 'managed competition' definition. PMID- 10122565 TI - Wilensky: Bush needed to use harder sell on healthcare agenda. PMID- 10122567 TI - Insurance group reform plan shifts from past stands. PMID- 10122566 TI - Affiliated Medical president, other executives accused of embezzlement conspiracy. PMID- 10122568 TI - Someone must guide tech acquisition. PMID- 10122569 TI - Hospitals gird to fight 'disease of the future'. AB - With cancer expected to strike one in three Americans now living, the disease is transforming the way hospitals are organized and the directions in which they will grow in the 1990s. Not only is cancer altering the way hospitals treat patients, but it's channeling patients into two arenas that hold the best chances for future growth--outpatient services and preventive medicine. PMID- 10122570 TI - Governors' group reports gains, but no agreements, in efforts to develop health reform plan. PMID- 10122571 TI - As reporters close in, execs learn to exhibit grace under pressure. AB - As healthcare continues at the forefront of the political agenda, hospital executives are finding both themselves and their institutions in the media's cross hairs. Yet not everyone feels comfortable talking to the press. Execs who feel unsettled in the glare of the media are gaining practical experience in media relations, crisis management and "damage control" strategies through various programs and seminars. PMID- 10122572 TI - 'Expert' tags infections, drug use. PMID- 10122573 TI - Software makers give Unix its due. PMID- 10122575 TI - New 'language' unveiled for images. PMID- 10122574 TI - Economic-impact study seen as vehicle to spur growth, deter tax. AB - A new report commissioned by Pennsylvania's Delaware Valley Hospital Council to quantify hospitals' value to the five-county area in services, salaries and other economic benefits could serve as ammunition for economic development leaders to help attract new businesses and by the region's hospitals in defense of their property-tax exemptions. PMID- 10122576 TI - Researchers blast exams done by non-radiologists. PMID- 10122577 TI - Study finds ultrasound procedures falling short. PMID- 10122578 TI - Urban hospitals rip N.J. uncompensated-care law. PMID- 10122579 TI - Panel urges tough approach to TB. PMID- 10122580 TI - Foundation, Sutter trade blows over rate hikes. PMID- 10122581 TI - GAO criticizes VA closing of Calif. hospital. PMID- 10122582 TI - HMOs plan 9.6% premium hikes. PMID- 10122584 TI - Delayed deal aided by $15 million 'note'. PMID- 10122583 TI - Ruling gives state regulators more leverage. PMID- 10122585 TI - IRS seeks to collect on recruitment incentives. PMID- 10122586 TI - Spun-off Caremark exploring neonatal-care facility venture. PMID- 10122587 TI - Self-insured unions sue to challenge New York's approach to cost-shifting. PMID- 10122588 TI - Clinton, congressional Dems begin filling key positions. PMID- 10122589 TI - AHA developing voluntary program to note community networks' public benefits. PMID- 10122590 TI - Healthcare data firms set merger. PMID- 10122591 TI - Pa. expanding child healthcare. PMID- 10122592 TI - Reform scheduled for fast track, but time of arrival still unclear. PMID- 10122593 TI - Managed competition tack endorsed. PMID- 10122594 TI - Pesch bids for 2 affiliated hospitals. PMID- 10122595 TI - FTC, Florida investigate proposed deal between Columbia, Adventist. PMID- 10122597 TI - AMA hardens stand against other reform proposals. PMID- 10122596 TI - The Blues at a crossroads. AB - The nation's Blue Cross and Blue Shield plans may be facing the greatest challenges in the association's 60-year history with the prospects of radical changes in the nation's healthcare system. The Blues, still the nation's largest insurer despite consolidation and growing competition, are dealing with such thorny issues as negative publicity over the operation of some plans and disputes over public ownership of Blues affiliates. PMID- 10122598 TI - HMOs outscore both PPOs, traditional indemnity plans in degree of customer satisfaction. AB - A higher percentage of participants in health maintenance organizations say they are satisfied with their health plans than are those who have traditional indemnity plans or are enrolled in preferred provider organizations. The results, derived from a new study of consumer satisfaction, also show that 85% of Americans who have health insurance coverage say they are satisfied with those plans. PMID- 10122599 TI - Experimental imaging system replaces X-rays with holograms. PMID- 10122600 TI - The lessons of 'virtual reality'. PMID- 10122601 TI - Fewer healthcare strikes in '92. PMID- 10122602 TI - O'Leary-led cost-cutting aids financial turnaround at AMI. AB - Wall Street analysts are giving Robert O'Leary good grades for his first year as chief executive at American Medical International. Mr. O'Leary, who joined the Dallas-based hospital chain in July 1991, has spent the past year and a half recruiting his own team of senior executives and implementing a new agenda for the company. But it's his aggressive cost-cutting and the bottom-line improvements that have earned him the highest marks. PMID- 10122603 TI - HIMA manufactures its own reform ideas. PMID- 10122604 TI - 3 large commercial insurers criticize HIAA's reform plan. PMID- 10122605 TI - Charging interest on accounts receivable. PMID- 10122606 TI - A randomised controlled trial of long stay nursing home and geriatric ward care for the elderly. A summary of main findings. AB - This paper reports outcome data on mental and physical ability levels, mortality and accidents rates, from a randomised controlled trial evaluating health authority funded nursing home and long stay geriatric ward care in one inner London health district. There were no differences between settings in relation to mortality rates, although respondents randomised to the nursing homes deteriorated more rapidly in overall and functional ability levels; they also experienced a higher accident rate than respondents in the wards. This has to be balanced against the previously published observational data from the evaluation which clearly indicated that quality of life in the homes was superior to that in the wards. There was more occupational therapy input into the wards in comparison with the homes, and activities were promoted most in the patient's Club in the hospital setting. Although quality of life was superior in the homes in relation to flexibility and preservation of resident's dignity. PMID- 10122607 TI - The high point of efforts to improve access to health care by "documentation". AB - The set of articles of which this article is a part has documented the tension between the advocates and the opponents of government intervention in the American health care system. This article will focus on a chapter of American health care history that is almost forgotten and has still never been told in its entirety. The story of the Committee on the Costs of Medical Care (CCMC), which existed from 1927 to 1933, represents the apogee of the factual approach effort to changing health care delivery in America. PMID- 10122608 TI - Developing integrated delivery systems: an era of change in hospital-physician relationships. PMID- 10122609 TI - The protocol solution: a mildly acidic commentary. AB - Protocols have captured the imagination of American's health care guru's. These self-proclaimed experts promise decreases in health care expenses of up to 25 percent if protocols for the appropriate use of expensive procedures are adopted throughout the country. With the establishment of several proprietary protocol companies and the push to develop national clinical guidelines, protocols have appeared on the health care scene with a vengeance. However, protocols will have dramatically different effects, depending on how and where they are implemented. This article will concentrate on the challenges of implementing protocols in a single health care institution, typically a hospital or a managed care institution. PMID- 10122610 TI - Important points in managed care contracts. AB - Health care is increasingly managed through some contractual relationship. Such contracts vary and the contracting entities may be clinics, universities, health maintenance organizations, individual practitioner organizations, preferred provider organizations, corporate health plans, or other structures. It is estimated that within 10 years more than 70 percent of all health care will be provided through some type of managed care plan. PMID- 10122611 TI - An insider's view of the Canadian system. AB - There is much to be learned from examination of health care delivery systems of other countries. But the task must be approached with caution. No other system is likely to lend itself to wholescale reproduction in this country, and all are certain to have their own flaws. In this article, based on a presentation at the 1991 ACPE National Conference in Toronto, Ontario, Canada, a Canadian describes his country's system, warts and all, and how it might be made better. PMID- 10122612 TI - Solving physician-hospital administration conflicts: a physician strategy for the '90s. AB - Today's health care climate creates increased potential for conflict between hospital administrators and hospital-based physicians. Voluminous regulations, increasing operating costs, professional liability exposure, changing methods of reimbursement, constraints on capital expenditures, and similar constraints on bed expansion have caused hospitals to explore new and innovative sources of revenue. Hospitals have become more eager to provide "bundled" services and health care "packages" in order to compete for discounted reimbursement contracts demanded by large-volume purchasers. While the impact of these changes is clearly felt in the private sector, similar fiscal constraints also may require university hospitals to modify their traditional role as leaders in education, research, and community service. In short, all hospitals are under intense pressure to increase revenues, reduce operating costs, and maintain the scope and quality of services provided. PMID- 10122613 TI - Operating room management: what goes wrong and how to fix it. AB - Operating rooms are probably the most difficult of all hospital areas to manage. This article describes a number of common management problems in operating rooms and identifies four broad management areas that must be adequately addressed to ensure an effectively run O.R. It also suggests possible approaches for dealing with the four areas. PMID- 10122614 TI - A survey of human resources in managed care organizations. AB - Although managed health care is increasing exponentially in the United States, minimal published information exists regarding the human resources needed to perform various managed care activities. This article reports on the results of a national survey of managed care organizations regarding the quantitative use of nurse and physician reviewers and the type of activities being performed. PMID- 10122615 TI - Meeting nursing's challenge. PMID- 10122616 TI - Conflict, confusion surround therapy bundling issue. PMID- 10122617 TI - Portable learning cart enhances nurse assistant education. PMID- 10122618 TI - 'Holiday room' comforts residents, provides therapeutic environment. PMID- 10122619 TI - Hotel conversions offer senior living development opportunities. PMID- 10122620 TI - Fighting for health care reform in a new congressional climate. PMID- 10122621 TI - The facility master plan: a road map for your future. AB - Current and anticipated changes in the mental healthcare delivery system demand a comprehensive facility planning process. As reimbursement for acute care decreases and the influence of managed care increases, most private psychiatric hospitals will need to develop a facility master plan to best use their current buildings and property. The facility master plan will become a road map and provide a logical route for expanding, modifying, and using current hospital assets during the changes imminent in the years ahead. PMID- 10122622 TI - The role of facility management in psychiatric hospitals. AB - Executive managers can ensure the most efficient management of the physical assets of their psychiatric hospital by involving the facility management staff in all phases of all planning and implementation. This paper stresses how maintaining expert in-house staff and equipping them with comprehensive computer based tools results in the efficient use of available space and in good management of both capital and operating expenses. As the hospital liaison with outside design firms and regulatory agencies, the facility management staff can effectively communicate the facility's requirements and represent its interests. PMID- 10122623 TI - Signs, symbols, and the psychiatric environment. AB - The demands on the design and subsequent built environment for psychiatric treatment are exacting. Inside and out, the facility must offer a safe, comfortable, nonthreatening, readily comprehensible set of surroundings to support the therapy taking place there. All messages sent by the environment must convey sincere respect for the patient and sensitive concern for his or her physiological and psychological well-being. PMID- 10122624 TI - Safety considerations in the psychiatric setting. AB - Safety in the psychiatric setting involves many aspects of facility design, renovation, operations, training, and administrative control. Through the application of a systematic hazard-control program, risks may be identified and action taken to reduce or eliminate the potential for accidental or self inflicted injuries. This paper addresses specific aspects of the hazard-control process and its application at The Sheppard and Enoch Pratt Hospital, Baltimore, Maryland. PMID- 10122625 TI - The NAPPH (National Association of Private Psychiatric Hospitals) critical indicator project. AB - The National Association of Private Psychiatric Hospitals (NAPPH) initiated the Critical Indicator Project in 1986 to develop measures of quality and other important clinical aspects of inpatient psychiatric treatment. The tools used to collect data have undergone extensive refinements, and the data collected have been analyzed by researchers and clinicians. After careful review, in January 1990 the NAPPH Board of Trustees endorsed full implementation of the Critical Indicator Project in all member hospitals. This paper describes the project and its current major implications. PMID- 10122626 TI - Facility issues of the 1990s. AB - In the 1980s there was overbuilding of facilities of all kinds, including facilities with acute psychiatric beds. A subsequent decrease in patient days in most of these hospitals caused significant excess capacity. With all the problems now confronting mental healthcare facilities, it may be difficult to focus attention on hospital buildings; however, intelligent planning for the use of these large investments may be part of an overall solution. An awareness of problems facing our facility managers should enhance the planning process and minimize unwanted surprises. PMID- 10122627 TI - The high-risk patient: a profile of acute care psychiatric patients who leave without discharge. AB - An acute care psychiatric hospital faces the dilemma of maintaining a safe and secure environment for its patients while gradually providing them with enough independence to assume responsibility for the management of their own behaviors. When patients leave the hospital building, grounds, or an off-ground activity without prior authorization from the attending physician or if they do not adhere to restrictions during a medical/therapeutic pass, they are placing themselves, the hospital, and others in a high-risk situation. An analysis and review of the closed medical records of patients who had eloped were conducted to determine if a pattern existed among them. The medical records studied included clinical notes, assessments, physician's orders, precautions and restrictions, lengths of stay, notes on the hospital environment, and patient-specific demographic data. The findings suggest that there are some consistent factors related to patient elopements that, when recognized, may help clinicians decrease this highly disruptive behavior. PMID- 10122628 TI - The changing face of adolescent inpatient psychiatric treatment. AB - Widespread changes in the criteria and resources for psychiatric inpatient treatment of adolescents present enormous challenges and demand serious and far reaching adaptive efforts. Among these efforts may be a redesigning of the inpatient treatment milieu to accommodate different patient populations for whom different models of treatment and therapeutic strategies are necessary. This paper describes the redesigning and successful integration of an adolescent inpatient unit at a private psychiatric hospital to include separate treatment tracks for three different patient populations. An intensive/reconstructive treatment track provides the long-term inpatient treatment of youth with treatment-refractory personality disorders who have the clinical justification and resources for therapy that aspires to effect structural personality change. An acute crisis intervention track provides short-term inpatient treatment with an adaptation-oriented and highly focused approach to patients who have had limited previous treatment, are confined to short lengths of stay by financial constraints, or for whom regression should be discouraged. Finally, a psychosocial skills treatment group conducts longer term inpatient treatment for neurobiologically impaired patients. Psychotic, severely developmentally disturbed, profoundly abused patients, and those with extremely primitive personalities characterized by an abundance of deficits cannot tolerate the emotional and interpersonal intensity of a reconstructive treatment approach, but can benefit from a supportive, developmental, ego-building strategy. PMID- 10122629 TI - The changing face of the healthcare market. Interview by Virginia Sowers. AB - Angelica CEO Jim Stefoff knows a good market opportunity when he sees one. And right now, the time is right for textile rental companies to make inroads into the small medical and dental office market that is emerging in the aftermath of the OSHA bloodborne pathogens ruling. But, Stefoff cautions, the industry must be in full compliance with OSHA regulations and able to provide the right delivery system and products. PMID- 10122630 TI - Reusables get high marks in adult incontinence care market. AB - The adult incontinence care market is coming of age. As environmental concerns gradually erode the popularity of disposables, nursing homes and hospitals are looking at reusables in a new light. In addition, the aging of the U.S. population is expected to increase the demand for incontinence care products. A recent study found that the sales of reusable cloth diapers and pads accounted for $385 million annually. All of these factors add up to a lucrative market for textile rental companies that can supply these products. PMID- 10122631 TI - Mixed plants sort through bloodborne pathogens rule. AB - As with any regulation, the OSHA bloodborne pathogens rule contains gray areas, particularly for mixed plants that must implement plantwide healthcare exposure controls when only a portion of the work is regulated. Hand-washing chambers and material handling systems offer partial solutions for reducing employees' exposure to pathogens that may be present in soiled laundry. PMID- 10122632 TI - JCAHO's Agenda for Change will make patient outcomes a board priority. PMID- 10122633 TI - Systems' boards must focus on broader issues for health reform. PMID- 10122634 TI - AHA's chairman-elect on trustees and health care's future needs. Interview by Mary Grayson. PMID- 10122635 TI - Strategic plan targets rural needs. PMID- 10122636 TI - The Safe Medical Devices Act: gauging impact on hospitals. PMID- 10122637 TI - Justifying reasonable compensation. PMID- 10122638 TI - Anticipating reform under Clinton. PMID- 10122639 TI - Family violence: hospitals' new community problem. PMID- 10122640 TI - Working with paid shop managers. PMID- 10122641 TI - Community foundations: a growing presence in philanthropy. PMID- 10122642 TI - The art of attracting volunteers: a hallmark of excellence. PMID- 10122643 TI - Join the campaign against violence. PMID- 10122644 TI - Meet the AHA's chairman-elect. PMID- 10122645 TI - Training volunteers for maximum hospital advantage. PMID- 10122646 TI - Dodge/Sweet's construction volume outlook for 1993. AB - Recovery of the construction industry from its post-'80s crash was never going to be "business as usual." The excess of the previous decade--commercial overbuilding, the banking crisis, the federal-budget deficit--all meant that the upturn would take place against a backdrop unlike any seen before. Indeed, cyclical recovery within the context of structural change is a good way to look at what has happened so far in 1992, and what is expected to occur over the next several years. PMID- 10122647 TI - Patient treatment adherence. Facility design and counseling skills. AB - OBJECTIVE: To describe the essential facility characteristics for a model patient counseling area: (1) activities that should be accommodated by the facility; (2) special environmental and interior design features, with a discussion of their impact on the healthcare provider-patient interaction; (3) storage and equipment requirements; and (4) determination of space requirements for the counseling area. A second objective is to suggest a strategy to follow when justifying an adherence clinic. DATA SOURCE: Primary and secondary sources of literature were reviewed in the areas of pharmacy, psychology, and architecture to identify design specifications for the patient counseling area. CONCLUSIONS: The design of a counseling area can indirectly affect the quality of the interaction between the patient and healthcare provider, primarily in terms of its effect on communication. The key features that should be included in the design of the area are different levels of privacy (visual and auditory), "soft" interior decoration, and accommodation of people with disabilities. There are several design-related barriers to communication that should be avoided in the facility. The space required for a counseling area is dependent upon the scope of services provided--approximately 100-130 square feet may be necessary. PMID- 10122648 TI - Reassessment of external insulin infusion pumps. AB - OBJECTIVE: To discuss the potential role of continuous subcutaneous insulin infusion (CSII) therapy in patients with insulin-dependent diabetes mellitus (IDDM). DATA SOURCES: Published studies describing intensive insulin therapy are reviewed and evaluated. DATA SYNTHESIS: CSII delivers insulin at a preset basal rate and at bolus doses, when needed, throughout the day. Although this technology allows for greater lifestyle flexibility, the risks of hypoglycemia and ketoacidosis are also increased if the pump malfunctions. Studies have shown that CSII therapy may offer some advantages over conventional insulin therapy; however, the full impact of these benefits has yet to be determined. The National Institutes of Health has recommended seven commercially available insulin pumps for patient use. Cost ranges between $2000 and $3500; the average lifespan is about five years. CONCLUSIONS: CSII may be a viable alternative to multiple daily injections for maintaining glycemic control in patients with IDDM who require intensive insulin therapy. PMID- 10122649 TI - A primer of drug safety surveillance: an industry perspective. Part III: Managing adverse-event data. AB - OBJECTIVE: To place the fundamentals of clinical drug safety surveillance in a conceptual framework that will facilitate understanding and application of adverse drug event data to protect the health of the public and support a market for pharmaceutical manufacturers' products. Part III of this series describes management of adverse-event data. This process involves an interplay of regulations, labeling, and product knowledge. Types of databases are defined and the scope of paper files and computerized files is discussed. Database management is discussed in terms of four processes: receipt, retention, retrieval, and review of adverse-event reports. A summary of the application of the fundamentals to the incident described in the scenario shows that knowledge of the fundamentals may be sufficient to make a substantial contribution to the health of patients and the commercial well-being of manufacturers. DATA SOURCES: This review uses primary sources from the federal laws (regulations), commentaries, and summaries. Very complex topics are briefly summarized in the text and additional readings are listed in the appendix. Secondary sources, ranging from newspaper articles to judicial summaries, illustrate the interpretation of adverse drug events and opportunities for drug safety surveillance intervention. STUDY SELECTION: The reference materials used were articles theoretically or practically applicable in the day-to-day practice of drug safety surveillance. DATA SYNTHESIS: The role of clinical drug safety surveillance in product monitoring and drug development is described. The process of drug safety surveillance is defined by the Food and Drug Administration regulations, product labeling, product knowledge, and database management. Emphasis is placed on the dynamic interaction of the components of the process. Suggestions are offered to facilitate communication of a review of adverse-event data for various audiences. CONCLUSIONS: Careful drug safety surveillance is beneficial to the health of the public and the commercial well-being of manufacturers. Attention to the basic principles is essential and, as illustrated, may be sufficient to resolve some problems. PMID- 10122650 TI - Perspectives. Medicaid: end it or mend it? PMID- 10122651 TI - Ergonomics in hospitals. PMID- 10122652 TI - Second guessing OSHA: what will an ergonomic standard look like? PMID- 10122653 TI - Mixed waste woes for hospitals. PMID- 10122654 TI - Malpractice attorneys usually can get patient rep records, lawyer warns. PMID- 10122655 TI - Pre-admission briefing, video aid hospital's PSDA education. PMID- 10122656 TI - CHS strengthens commitment to osteopathic hospitals with Pinellas Park acquisition. PMID- 10122657 TI - Improving the delivery of clinic care. AB - There has been an increasingly widespread movement toward the delivery of health care in outpatient settings. Hospitals must start to prepare for the shift from inpatient to outpatient services. Reductions in reimbursement and increasing costs will force hospitals to collect and obtain more data on outpatient services. Projecting future demands and assessing current utilization rates are two of the key factors in maintaining stability. This article is a case study of a major urban medical center's outpatient clinic. It includes a summary of observations on the clinic's daily operations and several recommendations for improvement. While the original analysis was highly specific to the actual facility observed, this article has been structured so that it may be applied to other institutions. PMID- 10122658 TI - Using reciprocal allocation of service department costs for decision making. AB - This article has provided a look into the use of the reciprocal method as an alternative to more conventional methods of hospital service department cost allocation methods. The reciprocal method can be used with readily available software and with data that are largely already known. This method will provide not only appropriate allocation values for financial reporting but data that can be used for hospital decision making. In the highly competitive and sometimes hostile environment in which hospitals now fight to survive, any additional relevant data--especially that generated at almost no additional cost--should be provided to managers to help in the decision-making process. PMID- 10122659 TI - Medicare and Medicaid; charges to residents' funds in nursing homes--HCFA. Final rule. AB - This final rule protects the personal funds (including personal needs allowances) of residents in skilled nursing facilities (SNFs) and nursing facilities (NFs) whose care is paid for by Medicare and Medicaid. It sets forth the items and services that are included in program payment and those for which a facility may charge residents. The regulations are required by section 21(b) of the Medicare Medicaid Anti-Fraud and Abuse Amendments of 1977 and sections 4201 and 4211 of the Omnibus Budget Reconciliation Act of 1987. PMID- 10122661 TI - Food and Drug Administration; statement of organization, functions, and delegations of authority: Center for Food Safety and Applied Nutrition (CFSAN)- HHS. PMID- 10122662 TI - Food and Drug Administration; statement of organization, functions, and delegations of authority: Center for Biologics Evaluation and Research (CBER)- HHS. PMID- 10122660 TI - Medicare program; payment change for home dialysis--HCFA. Final rule. AB - This final rule implements section 6203(b) of the Omnibus Budget Reconciliation Act of 1989, which limits Medicare payment for home dialysis equipment, supplies, and support services. Also, in accordance with section 6203(b), we are requiring that, for Medicare payments to be made to a supplier of home dialysis supplies and equipment when the patient's self-care home dialysis is not under the direct supervision of a Medicare approved renal dialysis facility, the patient must certify that the supplier is the sole supplier of his or her dialysis supplies and equipment. In addition, the supplier must agree to receive payment on an assignment basis only and must certify that it has entered into a written agreement with an approved dialysis facility, under which the facility agrees to furnish the patient with all home dialysis services. We are also providing a one time-only opportunity for certain home dialysis patients to immediately change their current method of payment. PMID- 10122663 TI - National Institutes of Health; statement of organization, functions, and delegations of authority: Office of Research on Minority Health (ORMH) and Office of Research on Women's Health (ORWH)--HHS. PMID- 10122664 TI - Allowing employees to pick the one "that's good for you". AB - Point-of-service plans offer advantages to be employers and employees as both groups seek affordable quality health care. PMID- 10122665 TI - The problem solver. A breakthrough in surface coating technology ... The Invisible Shield. PMID- 10122666 TI - Sampling and accessing people with AIDS. Implications for program evaluation. AB - This article describes issues that arose in attempting to conduct a survey of people with acquired immune deficiency syndrome (AIDS) as part of an evaluation of a program to deliver health and social services to this population. Demands to maintain the confidentiality of people with human immunodeficiency virus (HIV) infection posed a large impediment to randomly sampling and accessing program recipients. Efforts to contact people with AIDS through the mediation of health service providers encountered problems of nonimplementation and slow accrual. Comparisons of the obtained sample with a more comprehensive data base of program clients suggest that clients who were more accessible and compliant were overrepresented in the sample. People with AIDS themselves, however, were willing to be interviewed, as demonstrated by refusal rates less than 11%. Future studies of people with AIDS must overcome direct service providers' lack of time to contact and recruit respondents; it may be wise to allocate funds to support recruitment activities conducted by an administrative staff person in the service delivery agency. PMID- 10122667 TI - Health decision makers' perceptions of program evaluation. Relationship to purpose and information needs. AB - This study investigates alternate reasons for conducting program evaluation in community health care settings and their relationships with information needs. One hundred thirty-six community health care decision makers were used in this survey. Results of a factor analysis indicated three major purposes for conducting program evaluation, listed in order of use: accreditation, true evaluation, and pseudo-evaluation. A second analysis on need for information showed little differences in responses. Five factors were identified: descriptive information for validity/credibility, opinions, financial information, action information, and empirical information for validity/credibility. There was no relationship between the five types of information needs and accreditation, suggesting that accreditation was a symbolic use of evaluation; however, information needs were predictors of true evaluation and pseudo/quasi evaluation. Regression analyses indicated that descriptive information providing evidence of validity/credibility was predictive of the purpose of true evaluation whereas empirical and descriptive evidence of validity/credibility were predictors of quasi/pseudo evaluation. Information for decision makers acted as a suppressor variable on the latter. PMID- 10122668 TI - Sources of evaluation instruments. PMID- 10122669 TI - Local hospital systems: forerunners of regional systems? AB - Over the past several decades, the hospital industry has been undergoing a major organizational change that has until now been little examined. Local hospital systems (LHSs) are combinations of two or more hospitals that are in the same company and located in or around the same metropolitan areas in this country. This article presents the first detailed examination of the 402 such systems that have been identified to date. LHSs offer great potential for achieving the cost, quality, and access benefits that are often attributable to regional systems. The degree to which LHSs have attained some basic structural features expected of regional systems are examined. Differences are compared within ownership categories. Issues and challenges facing leaders in the field, should they hope to achieve the potential of regional systems, are discussed. PMID- 10122670 TI - Local hospital systems: fact or fancy? AB - In summation, Luke's article presents a series of concepts and tools that provide insight into local system building. Most of the material holds up well to the "reality test." Additional studies should be undertaken that include ambulatory, aging, and social services. The regional system of the future will likely include a range of services from wellness to hospice. We need to know how to bundle such services and provide them within the capitation payments. Such service offerings must be easily accessible to the consumer. We have our work cut out for us! PMID- 10122671 TI - Regional systems face organizational development challenges to integration. AB - Luke concludes his article by recommending regional system formation be permitted, even encouraged. I certainly agree with that encouragement and also agree that demonstration and evaluation projects should be initiated to determine what works and what does not work in regional system development. At the present time that information is gathered and shared on an ad hoc basis through alliances of systems, such as American Healthcare Systems. Although this ad hoc mechanism is useful, it needs to be supplemented with more research, policy initiatives, and structured evaluations. Luke has made a positive contribution with his national study, and more work of this nature will aid the development of regional systems across the United States. PMID- 10122672 TI - What are the essentials of system integration? AB - In summary, the Luke article is a solid starting point for understanding the relationships between existing hospital systems, developing regional systems, and ultimate benefits to patients, their employers, and their communities. We clearly have a long way to go though, and the attention should turn to some of the key functional features of integrated systems. PMID- 10122673 TI - The exit interview: locking the barn door. AB - The exit interview is not a universal response to the turnover problem. Rather, the exit interview is simply one more vertical channel through which employees can send information upward in the organization. Since it occurs essentially at the very end of the employment relationship, it may indeed seem like locking the barn door after the horse has been stolen. This is one door, however, that tends to come open by itself if it is not monitored regularly and periodically relocked. PMID- 10122674 TI - Empowerment: the latest motivational strategy. PMID- 10122675 TI - Loneliness and the nurse manager. AB - Everyone has occasional bouts of loneliness. Managers may experience loneliness resulting from internal and external tensions of life and management. It is important that the manager understand the concept of loneliness and the special vulnerability managers may have to this painful feeling. Methods have been outlined for coping with loneliness and should be part of every manager's coping repertoire. PMID- 10122676 TI - A psychoeducational model of management consultation: evaluation and follow-up. AB - Evaluation and follow-up are an integral part of business today. For the creative management consultant, it presents the challenge of incorporating as many feedback mechanisms as possible into the consultation process itself. The management consultation then becomes a continuously evolving, self-correcting service designed to better meet the needs of the consumer. PMID- 10122677 TI - Managerial burnout. AB - It is well to understand that the consequences of burnout due to work-related stress are usually quite serious. Yet, this kind of burnout can and should be prevented; if detected early, it is manageable. Organizations should take steps to identify their executives who are most susceptible to burnout and offer them a broad range of assistance. There are, after all, no more important resources than human resources, and this, of course, includes an organization's executive-level employees. PMID- 10122678 TI - Positive politics: playing corporate games with personal integrity. AB - The desire for power is personal. Competence and political intelligence are the prerequisites for handling power in a healthy manner. Politics is not a nasty word or a set of behaviors that inevitably turns you into a shady character of whom your mother would be ashamed. You need never divorce your own morality from the situation. The choice to improve your political functioning is yours. You always retain the right to play, and you retain the right to decide when to play. But you are a better manager, a better professional, and a more educated person if you can identify what others are doing and how their behavior will impact you. It is not just for success, it is for survival--success and survival on your own terms. PMID- 10122679 TI - Maximize learning through wellness. AB - By achieving wellness to some degree in all five components of health, the self concept of the health care employee can be raised. If the worker begins with physical health, this can in turn affect the emotional, mental, social, and spiritual health of the individual. All of these elements of well-being have been shown to have a profound effect on learning abilities and performance levels of the adult. Health care professionals are dealing with life or death decisions on a daily basis. Hopefully, everyone would agree that the health care team should be performing at its peak ability. To do this, each member of the health care team should strive for wellness. The health care facility should promote wellness for its employees first, so they in turn can deliver quality health care services. Keeping current with the constant changes in the health care industry and learning new information is a critical part of that delivery of quality care. PMID- 10122680 TI - Organizational ethics development and the expanding role of the human resource professional. AB - In summary, organizational ethics development trends have expanded the responsibility of human resource professionals. Human resource professionals who have been adequately trained and have competently responded to these role expansion challenges are more likely to contribute to strong ethical cultures in productive organizations. PMID- 10122681 TI - Nurse recruitment: strong health and safety programs make a difference. AB - Today's nurse is looking for more than just a challenging position with appropriate compensation. The security afforded by a safe and healthy working environment in the hospital may actually be the deciding factor in a nurse's choice of employer. PMID- 10122682 TI - Maximizing the results of new graduate orientation. AB - However, a word of caution seems appropriate. The administration at this hospital has long believed that no matter how good the orientation program, or the employee benefits package, or the employer's sensitivity to employees' intrinsic needs, the new nurse will be more likely to experience job satisfaction if she has, or obtains and accepts, a relatively realistic view of the job prior to accepting the position. Concerted efforts have been made to describe the role and the environment at the time the new graduate interviews for the position. Yet these nurses reported they had no real concept of the role until they were well into the orientation period. In effect, then, the importance of the preceptor's role in facilitating the process of transition cannot be over-emphasized. PMID- 10122683 TI - The manager's influence on retention. AB - Each manager holds the key to promoting job satisfaction. Through increased autonomy, staff are empowered to control the destination of their clinical practice. Control over your own clinical practice increases autonomy and therefore leads to greater retention in the work area. PMID- 10122684 TI - A supervisor asks: "The hostile employee". PMID- 10122685 TI - Death concern and attitudes toward the elderly in nursing home personnel. AB - The present project investigated the relationship between death fear and threat, attitudes toward the elderly, and personal anxiety toward one's own aging in a group of 145 nursing home employees and a matched comparison group of 130 individuals who worked in non-death related occupations. Contrary to predictions, nursing home personnel did not have higher levels of death threat when compared to controls; in fact, control group subjects had higher levels of death concern on two dimensions of death fear (fear of the dead and fear of significant others dying). However, the results also indicated that increasing levels of death concern were associated with greater anxiety toward aging, especially in the nursing home sample, and nursing personnel displayed significantly fewer positive attitudes toward the elderly than did controls. PMID- 10122686 TI - Death competency: a study of hospice volunteers. AB - Three groups of hospice volunteers, trainees (N = 52), medium-term (2 to 42 months, N = 94), long-term (48 months or more, N = 96), and nonhospice and nonpatient care controls (N = 78) completed Bugen's Coping with Death Scale, the Templer/McMordie Death Anxiety Scale, and a new self-efficacy scale related to hospice and the ability to deal with death in general. The groups did not differ on the Death Anxiety Scale. However, on the Coping with Death Scale, experienced volunteers scored higher than trainees and controls; and on the self-efficacy scale all hospice volunteer groups believed themselves more able to deal with death than controls. In this study, the death competency scales appear more useful than the death anxiety measure in distinguishing hospice patient care volunteers from controls. The potential usefulness of these scales in future efforts at selection and evaluation are noted. PMID- 10122687 TI - Funding working capital with tax-exempt debt. PMID- 10122688 TI - Bootstrap finance: the art of start-ups. AB - Entrepreneurship is more popular than ever: courses are full, policymakers emphasize new ventures, managers yearn to go off on their own. Would-be founders often misplace their energies, however. Believing in a "big money" model of entrepreneurship, they spend a lot of time trying to attract investors instead of using wits and hustle to get their ideas off the ground. A study of 100 of the 1989 Inc. "500" list of fastest growing U.S. start-ups attests to the value of bootstrapping. In fact, what it takes to start a business often conflicts with what venture capitalists require. Investors prefer solid plans, well-defined markets, and track records. Entrepreneurs are heavy on energy and enthusiasm but may be short on credentials. They thrive in rapidly changing environments where uncertain prospects may scare off established companies. Rolling with the punches is often more important than formal plans. Striving to adhere to investors' criteria can diminish the flexibility--the try-it, fix-it approach--an entrepreneur needs to make a new venture work. Seven principles are basic for successful start-ups: get operational fast; look for quick break-even, cash generating projects; offer high-value products or services that can sustain direct personal selling; don't try to hire the crack team; keep growth in check; focus on cash; and cultivate banks early. Growth and change are the start-up's natural environment. But change is also the reward for success: just as ventures grow, their founders usually have to take a fresh look at everything again: roles, organization, even the very policies that got the business up and running. PMID- 10122689 TI - The work of the leader. AB - Lieutenant General William G. Pagonis led the 40,000 men and women who ran the theater logistics in the Persian Gulf War during its three phases of operation: Desert Shield (buildup), Desert Storm (ground war), and Desert Farewell (redeployment). By military standards, it was a challenging assignment. By the conventions of any nonmilitary complex organization, it was unheard of. In the Persian Gulf, Pagonis's challenges included feeding, clothing, sheltering, and arming over 550,000 people. All of this in an hostile, desert region with a Muslim community distrustful of the "infidels" sent there to protect them. The lessons of leadership gleaned through Pagonis's experiences in the Gulf cross military boundaries--they apply equally to general management and leadership development in the private, civilian sector. To gain a clear sense of the overall organization in an area the size of the Southwest Asian theater, Pagonis deputized proxies, dubbed "Ghostbusters," to be his eyes and ears throughout the desert. His goal was to build a leadership-supporting environment, combining centralized control with decentralized execution. Pagonis believes vision is defined by the leader, but the subordinates define the objectives that move the organization toward the desired outcome. The roots of leadership, Pagonis claims, are expertise and empathy. A leader's work is not only to apply these traits but also to cultivate them--both on a personal and organizational level. True leaders create organizations that themselves cultivate leadership. This can only be achieved through rigorous and systematic organizational development. PMID- 10122690 TI - Is management still a science? AB - New technologies are transforming products, markets, and entire industries. Yet the more science and technology reshape the essence of business, the less useful the concept of management itself as a science seems to be. On reflection, this paradox is not so surprising. The traditional scientific approach to management promised to provide managers with the capacity to analyze, predict, and control the behavior of the complex organizations they led. But the world most managers currently inhabit often appears to be unpredictable, uncertain, and even uncontrollable. In the face of this more volatile business environment, the old style mechanisms of "scientific management" seem positively counterproductive. And science itself appears less and less relevant to the practical concerns of managers. In this article, science journalist David Freedman argues that the problem lies less in the shortcomings of a scientific approach to management than in managers' understanding of science. What most managers think of as scientific management is based on a conception of science that few current scientists would defend. What's more, just as managers have become more preoccupied with the volatility of the business environment, scientists have also become preoccupied with the inherent volatility--the "chaos" and "complexity"--of nature. They are developing new rules for complex behavior in physical systems that have intriguing parallels to the kind of organizational behaviors companies are trying to encourage. In fact, science, long esteemed by business as a source of technological innovation, may ultimately prove of greatest value to managers as a source of something else: useful ways of looking at the world. PMID- 10122691 TI - The reluctant entrepreneur. AB - Unlike a lot of corporate executives, Ken Veit never longed to be his own boss. But after 30 years on the fast track, he lost his high-powered job at one of the world's largest insurance companies and was forced to take an entrepreneurial leap of faith. In 1989, Veit signed a franchise agreement to own and operate a Cartoon Corner store in a mall in Scottsdale, Arizona. Cartoon Corner was based on the Disney store idea, but it carried hundreds of products featuring cartoon characters from every movie studio. Most important, Cartoon Corner offered extensive training and an elaborate management support system for its franchisees. The company planned to franchise 100 stores over the next few years, then go public. If all went well, its young executives claimed, the Cartoon Corner chain would build a market valuation of up to $100 million by the mid 1990s. In addition, the mall, which was in the planning stages when Veit signed on, was supposed to become a new kind of entertainment mall, with seven movie theaters, a space-flight simulator, and a shark-filled aquarium. It had all sounded too good to be true--and it was. Despite Veit's careful forecasting, he suffered a series of unexpected catastrophes. The mall failed to keep its promises. The franchisor lost its venture capital. The Gulf War dried up retail traffic. But it was too late to back out. Veit went forward on his own, truly alone for the first time in his life. When the mall and his store finally opened in May 1991, they did so in the midst of a recession. Despite the inspirational stories of other former executives, Veit has learned that the life of an entrepreneur is not all it's cracked up to be. As he notes, "I began with well above-average experience, a proven concept, and excellent capitalization, yet in my case, personal bankruptcy remains a distinct possibility." PMID- 10122692 TI - Balancing corporate power: a new Federalist paper. AB - In an effort to govern their increasingly complex organizations, chief executives in some of today's largest corporations are turning to one of the world's oldest political philosophies-federalism. Given that organizations are seen more and more as minisocieties, the prospect of applying political principles to management makes a great deal of sense. Federalism is particularly appropriate because it offers a well-recognized system for dealing with paradoxes of power and control: the need to make things big by keeping them small; to encourage autonomy but within bounds; and to combine variety and shared purpose, individuality and partnership, local and global. As London Business School professor Charles Handy explains it, federalism responds to these paradoxes by balancing power among those in the center of the organization, those in the centers of expertise, and those in the center of the action--the operating businesses. The centers of federal organizations meet regularly, but they do not need to live together. Doing so would concentrate too much power in one place, whereas federalism gets its strength and energy from spreading responsibility across many decision points. Guided by five principles, federalism avoids the risks of autocracy and the overcontrol of a central bureaucracy. It ensures a measure of democracy and creates a "dispersed center" that is more a network than a place. That's why Asea Brown Boveri CEO Percy Barnevik calls his sprawling "multi-domestic" enterprise of 1,100 separate companies and 210,000 employees a federation. It succeeds because the independent bits, be they individuals, clusters, or business units, know they are part of the greater whole. PMID- 10122693 TI - Profits with a purpose: an interview with Tom Chapman. Interview by Nancy A. Nichols. AB - Greater Southeast Community Hospital is located in the center of one of Washington, D.C.'s most troubled and isolated neighborhoods. Like so many inner city hospitals, it serves a population struggling with high rates of poverty, crime, and illiteracy. As a result, the area suffers from the highest rates of infant mortality, cancer, and coronary disease in the D.C. area. When Tom Chapman joined the hospital in 1984, it was giving away roughly 11% of its care-or about $11.5 million worth of medical services to indigent residents. If things continued at that rate, the hospital would soon go out of business. His challenge: to keep Greater Southeast solvent while shoring up the community that surrounds it. Chapman, who grew up in a housing project himself, understands the problems of inner cities innately. Working in tandem with community residents, Greater Southeast has developed a broad range of preventive and supportive programs, such as housing, day care for children and the elderly, nursing home services, and literacy training. Last year, Chapman was promoted to CEO of Greater Southeast Health Care, a broad network comprising two hospitals, three nursing homes, a physician care network, and over 50 community programs. He remains true to his original mission: "I want to create a network of participants, stringing together various organizations and players, each of whom have something special to contribute to urban problems.... What we are really doing is creating a community." PMID- 10122694 TI - 1992 infant kidnappings: incidents down but problems remain. AB - Infant kidnapping from hospitals remains a low incidence, high visibility crime, and 1992, so far, seems to bear this out. By the end of August, only two such kidnappings have been reported compared to 11 for all of 1991, and some ascribe this to the considerable expense and effort many hospitals have gone to to beef up security in their maternity areas. PMID- 10122695 TI - Hyperbaric chamber nurse dies of decompression sickness; unit gets OK. AB - Experts in the field of hyperbaric medicine say the chambers used to treat dive accident victims and enhance the healing of problem wounds are safe despite the death last August of a nurse. Joyce Vause, 52, died of decompression sickness July 22, 1991 about an hour after she left work at Bay Medical Center, Panama City, FL. Shortly before her death, Vause has been in a hyperbaric chamber attending a patient who had been in a diving accident. PMID- 10122696 TI - Special report. Legionnaire's disease: still a problem for hospitals but a costly one to solve. PMID- 10122697 TI - How you can obtain safety management certification. PMID- 10122698 TI - Building your own and your employees' self-confidence. PMID- 10122699 TI - Another look at performance appraisals. PMID- 10122700 TI - Have women come a long way? PMID- 10122701 TI - Let's get a better recipe for quality care. PMID- 10122702 TI - A confusion of charters. PMID- 10122703 TI - Quick, quick, slow. PMID- 10122704 TI - Countdown to community care. Twilight zone. PMID- 10122705 TI - Open all hours. PMID- 10122706 TI - Local heroes. PMID- 10122707 TI - Countdown to community care. Private lives. PMID- 10122708 TI - An out and out success? PMID- 10122709 TI - Climb every mountain. PMID- 10122711 TI - Accidental public health? PMID- 10122710 TI - Swiss role. PMID- 10122712 TI - Wait for it. PMID- 10122713 TI - Managing in the community. New money. PMID- 10122714 TI - Byting into community care. PMID- 10122715 TI - Final rules on Medicare payments to DME suppliers create new business landscape. PMID- 10122716 TI - Long-term care insurance: are federal standards needed to protect elderly and chronically ill? PMID- 10122717 TI - FTC regulation of health care advertising: when providers deceive. PMID- 10122718 TI - Transportable skills: the edge for the '90s. AB - Traditionally, when a senior-level executive was recruited for a new position, that person packed personal belongings, loaded the moving van, and concentrated on getting the family settled in a new location. Now, those executives have something else to take with them to their new jobs--transportable skills. PMID- 10122719 TI - Career extensions: bringing academicians and practitioners in healthcare management together. AB - A growing number of health administration faculty are realizing that they can learn a lot by periodically stepping out of academe and into practice settings. And healthcare executives who are opening their organizations to faculty fellows are realizing that they can learn a lot, too. PMID- 10122720 TI - CEO-ship: avoiding the rocks of self-malpractice. PMID- 10122721 TI - The executive as career manager. AB - When it comes to career planning, it's easy to say, "I'll do it tomorrow," or "I'll do it next month." Don't put off this critical aspect of your career development. Just do it now. PMID- 10122722 TI - In search of internal morality. AB - Are there specific moral requirements for healthcare executives that go beyond institutional loyalties or even institutional and corporate ethics? The answer is "yes," and they're a part of healthcare's internal morality. PMID- 10122723 TI - Wage index reimbursement needs repair. PMID- 10122724 TI - Affiliate survey guides ACHE into '93. PMID- 10122726 TI - Executive search firm 1993 directory. PMID- 10122725 TI - Supplier partnerships can affect CQI. PMID- 10122727 TI - The Medicare Fee Schedule unveiled: an account of physician payment reform. AB - On January 1, 1992, the Medicare program unveiled a new method for paying physicians known as the Medicare Fee Schedule (MFS). The new fee schedule is a complex system of administrative pricing based on the resource inputs used in producing physician services. The MFS consists of three parts: (1) a Relative Value Scale (RVS) which assigns to each medical service a value relative to all other services; (2) a Conversion Factor (CF) which converts the relative values into dollars; and (3) a Geographic Adjustment Factor (GAF) which adjusts payments based on geographic differences in the cost of producing physician services. In the paper we explain: how the relative values were determined; how the GAF was constructed; and how the CF was calculated. In addition, we explain balancing billing limits and the Medicare Volume Performance Standards (MVPS). We then present computer simulations of the impact of the MFS on payments to physicians. We find that the MFS will: (1) redistribute payments away from surgeons, radiologists, and other procedure-based specialties toward the primary care specialties, (2) redistribute payment away from urban areas toward rural areas, (3) redistribute payments away from invasive procedures and diagnostic tests toward evaluation and management services. We conclude with a discussion of the future refinements of the MFS, its applicability to other payors, and whether it will accomplish its intended purposes. PMID- 10122728 TI - Evaluation and policy considerations in the introduction of extracorporeal membrane oxygenation. AB - The introduction of extracorporeal membrane oxygenation (ECMO) in Australia was associated with establishment of the technology at two teaching hospitals followed by appraisal through a consensus conference and a subsequent synthesis report and cost analysis. The assessments and associated policy processes have helped to define the place of the technology, but many uncertainties remain due to limited relevance of results from other countries, the preliminary nature of local data and absence of controlled trials. This experience raises questions concerning approaches by professional groups, funding authorities and assessment agencies in dealing with specialised new techniques which are associated with a small national caseload. PMID- 10122729 TI - Why does length of stay vary for orthopaedic surgery? AB - This study examines the variation in length of stay in orthopaedic surgery in Grampian in 1988. It highlights the extent of variability across clinicians for patients with the same condition. The results indicate the importance of patient's age, type of admission and Diagnosis-Related Group. The inclusion of variables to identify the consultant in charge significantly improves the explanatory power of the model for all of the seven conditions investigated. PMID- 10122730 TI - The QLDS: a scale for the measurement of quality of life in depression. AB - It has been apparent for some time that utilisation of health services is more influenced by how people feel than by their 'objective' symptoms. Research has also shown that compliance with treatment regimens is dependent on the impact of that treatment on the patient's well-being. Such findings highlight the need to assess the patient's view of his or her progress through the health care system. This has led to a growing interest in quality of life assessment and, in particular, to the impact of illness and its treatment on the quality of life of the patient. Perhaps surprisingly, interest in quality of life measures for outcome assessment in Psychiatry has been slower to develop than in other specialties. While a number of clinician- and patient-completed measures of the severity of depressive symptoms exist, no measure of the quality of life of depressed patients is available. This paper describes the development and testing of the Quality of Life in Depression Scale (QLDS), a new measure designed to fill this gap. The theoretical basis for the instrument is that life gains its quality from the ability and capacity of the individual to satisfy his or her needs. The items included in the QLDS were derived from 30 qualitative interviews with depressed or recently recovered patients. Further interviews were held with depressed patients to establish the face and content validity of the instrument. Respondents had little trouble completing the questionnaire and found the content to be relevant to their experience of depression. The QLDS represents an important advance in our ability to understand the impact of depression on quality of life. PMID- 10122731 TI - A new measure of quality of life in depression: testing the reliability and construct validity of the QLDS. AB - Our previous paper described the development of a new quality of life scale for use with people suffering from depression; the Quality of Life in Depression Scale (QLDS). This paper reports on the testing of the scale for reliability and construct validity. Reliability was assessed by giving the questionnaire to the same set of patients on two occasions 2 weeks apart. This test-retest technique yielded a correlation of 0.94, with high internal consistency at both time 1 and time 2. A test of split-half reliability also indicated very high reliability. Construct validity was measured by comparing scores on the QLDS with those on an established scale of well-being from the same group of patients. The results gave a correlation between the two measures of 0.79, giving a satisfactory validity. It is concluded that the QLDS is a reliable and valid measure which is easy to use and acceptable to patients. Further tests of discriminative, concurrent and criterion validity are planned. PMID- 10122732 TI - They just don't get it. PMID- 10122733 TI - Two courts deal with physician moral character issues. PMID- 10122734 TI - IV solution prices to rise 5%. PMID- 10122735 TI - ACS (Advanced Cardiovascular Systems) cuts prices to retain hospitals amid production halt. PMID- 10122736 TI - Asset management relieves radiology headaches. PMID- 10122737 TI - Success through organisational audit. AB - In the April issue of Health Services Management, Tessa Brooks discussed the appropriateness of total quality management to the NHS. Here she describes a means of assessing and monitoring an organisation's ability to deliver quality services: organisational audit. PMID- 10122738 TI - Competing for private patient revenue. AB - The opportunity to maximise revenue from private patients is now available to NHS hospitals. A survey of UGMs found that most felt they could compete with private hospitals but identified a number of obstacles. David Jones analyses the survey. PMID- 10122739 TI - Anaesthesia. AB - Anaesthesia is, perhaps, the single greatest advance in medical history. Yet even today there are uncertainties about the patient's depth of sleep and the efficacy of some techniques. Cost and quality are issues that managers and anaesthetists must tackle together. PMID- 10122740 TI - The loneliness of the long-distance manager. AB - Many top managers have been tempted to neglect their own development in the face of massive work agendas. The experiences of 12 senior NHS managers, who were involved in a project designed and implemented by the NHS Training Directorate (NHSTD), bear this out, as Margaret Attwood and colleagues discuss. PMID- 10122741 TI - Management ... working day of a health services manager. AB - The estates function has developed from a mainly operational job to one with considerable strategic importance. John Baker, Estates Manager, Bedford Hospital NHS Trust, outlines the challenges of managing the NHS estate today. PMID- 10122742 TI - Without human intervention. AB - Like electronic imaging, EDI is intended to eliminate paper. Will it also eliminate imaging? PMID- 10122743 TI - Measuring customer perceptions of emergency facility services: a qualitative approach. AB - The purpose of this study was to use a qualitative research technique and define problems faced by one hospital that was attempting to increase demand for its emergency services. A telephone survey of 450 affluent and well-educated suburban residents was conducted to determine their perceptions of six major facilities. Topics included actual and preferred facility use by injury type, general perceptions concerning staff and facility, and other components of service quality. Results indicated that a variety of sociological, psychological, environmental, and situational factors interacted when the respondents formed attitudes concerning hospital emergency use and service. They were often uncertain of their real attitudes and conveyed varying opinions about the desirability or effectiveness of similar services. Health care providers should note these differences and modify the marketing mixes in a manner that best conveys their unit's competitive advantages. They could also benefit from using the qualitative research technique described in this paper and from adopting the marketing concept. PMID- 10122744 TI - Assessing perceived health among older adults: conceptual review and proposed measurement model. AB - This paper discusses two theories of health service utilization and their relationship to the construct of perceived health. A three dimensional model of perceived health is presented. This model is discussed in the context of the unique physiological and lifestyle changes experienced by the older adult that may correlate with their perceptions of health. A proposed measurement model is offered in an attempt to tap into the multidimensional aspects of the perceived health construct. PMID- 10122745 TI - Comparison advertising: an analysis of its effectiveness in the medical profession. PMID- 10122746 TI - Marketing health promotion to corporations: overcoming the cost/benefit problem through a customer orientation. AB - Many corporations are reluctant to offer health promotion programs for their employees because there is no concrete evidence that the financial benefits will be greater than the capital outlays necessary for implementation and operation. This presents a major problem when marketing health promotion programs. The problems with cost/benefit analysis in the health promotion field are first identified. Then, the weaknesses in the health promotion research are outlined. Finally, marketing philosophy and strategies which avert these problems are presented. Health promotion programs offered at the worksite are increasing in number (Forouzesh and Ratzker, 1985). Much of this growth is a response on the part of corporations to the causes of death in the United States and the increases in health care costs. In 1987 diseases of the heart and blood vessels were the leading cause of death in the U.S. with an estimated 976,706 deaths (American Heart Association, 1989). This figure is more than twice the second leading cause of death, cancer. It was also determined that more than one-fourth of the American population suffered from some form of cardiovascular disease. However, death is not the only expense to society. It was estimated that cardiovascular disease cost $94.5 billion in 1990 (American Heart Association, 1989). U.S. corporations directly or indirectly were responsible for paying much of this cost. Therefore, corporations are searching for solutions to these problems. Health promotion programs offered at the worksite are one potential approach to decrease health care costs and deaths due to cardiovascular disease.(ABSTRACT TRUNCATED AT 250 WORDS) PMID- 10122747 TI - Strategic planning and marketing research for older, inner-city health care facilities: a case study. AB - Numerous health care facilities, located in downtown metropolitan areas, now find themselves surrounded by a decaying inner-city environment. Consumers may perceive these facilities as "old," and catering to an "urban poor" consumer. These same consumers may, therefore, prefer to patronize more modern facilities located in suburban areas. This paper presents a case study of such a health care facility and how strategic planning and marketing research were conducted in order to identify market opportunities and new strategic directions. PMID- 10122748 TI - The marketing concept and health care professionals. PMID- 10122749 TI - Customer satisfaction in the retirement living environment. PMID- 10122750 TI - Successful managed care: serving four masters. AB - Successful managed care requires serving four masters: the consumer, the employer, the hospital, and the physician. Managed care organizations that deal with these key issues effectively are more likely to achieve success (see Table 1). Managed care entities must recognize and respond to the needs of the four masters. While it is true that no one plan can provide everything for each party, each managed care entity can and should determine those aspects that are of greatest importance to them (see Table 2). PMID- 10122751 TI - Aftermarket performance of initial public offerings for health care firms. PMID- 10122752 TI - Marketing EAPs: issues and prospects. PMID- 10122753 TI - The management of upstream and downstream risk through selective contracting. AB - Common strategies employed by many organizations include designating certain suppliers as primary sources and targeting certain customers who are appealing competitively. Such selective strategies are appearing more frequently in the health care sector today. This paper examines the use of selective contracting by managed care programs to simultaneously increase control over costs (provider selection) and decrease risk (subscriber selection). PMID- 10122754 TI - Tracking patient satisfaction at an academic medical center. AB - Rising consumer expectations for convenient, quality health care is forcing many hospitals to focus increasing attention to measuring consumer perception and satisfaction with the care provided. At the University of Virginia Health Sciences Center, getting in close touch with the consumer has assumed a strategic position. As one part of the evolving Marketing Information System, a patient satisfaction tracking system is being designed to illicit patient feedback and hospital responses to service issues, assess patient satisfaction with various services, serve as a benchmark for evaluating changes in satisfaction over time, and provide necessary information for medical center planning, marketing and evaluation. PMID- 10122755 TI - Examination of the role of social class as a predictor of choice of health care provider and satisfaction received: a model and empirical test. PMID- 10122756 TI - Health care seeking behavior of the elderly: an empirical investigation. AB - The elderly population represents an increasingly large market for health care services and has typically been seen as a homogeneous market segment. This research indicates that the elderly market is in fact a very heterogeneous market which can be segmented by demographic and behavioral characteristics. PMID- 10122757 TI - Preference regression modeling of multiple option healthcare delivery systems. AB - A collection of statistical analysis procedures is applied to the task of estimating relative market shares among different healthcare plans under the offering of multiple options. The results are developed into an interactive spreadsheet for estimating market shares when consumer perceptions of plan features are modified through product redesign or communications strategies. PMID- 10122758 TI - Segmenting the student healthcare market: implications for long-term and preventive healthcare. AB - This paper presents the findings of a cross-institutional study of health care concerns and activities of 18-25 year old college students. In general, the subjects tended to perceive themselves as quite healthy, and were not highly concerned about health issues. However, the subject group was not homogeneous. Therefore, this paper identifies three different segments of college students- the "Unconcerned" group, the "Worried" group, and the "Physical Image" group--and details their different attitudes, concerns, and behaviors. PMID- 10122759 TI - Medicare coded me right out of practice. PMID- 10122760 TI - Managed care: the payoff keeps getting better. PMID- 10122761 TI - How lawyers have invaded the delivery room. PMID- 10122762 TI - Our hospital keeps claims reviewers off my back. PMID- 10122763 TI - Will Minnesota's sweeping changes spread nationally? PMID- 10122764 TI - When your carrier's assigned lawyer isn't enough. PMID- 10122765 TI - My charge slips make E/M (evaluation/management) coding a breeze. PMID- 10122766 TI - Technology: redesigning the medical system. AB - During the next century, medical technology will become the driving force in American health care, according to Leland Kaiser, Ph.D., FACMGA. Society will no longer view health care as simply a cost to be reduced to the lowest possible level. Health expenditures will be seen as a societal investment in human resource productivity. PMID- 10122767 TI - Group practices expand electronic communications. AB - In today's health care industry, there is a tremendous need for the communication of information from a myriad of parties to be centralized, packaged and delivered between and among all providers and payers, write Kathleen Covert and Kevin Green in describing one health care network doing just that. PMID- 10122768 TI - Developing a business information strategy. AB - The information systems requirements necessary to survive in this coming technological age will be tremendous. Thus, author Craig Fales offers his strategies for successfully developing a business information strategy. PMID- 10122769 TI - Enterprising physicians and hospitals: collaborating in the face of continued change. AB - In today's complex, interdependent world, it is increasingly difficult to act autonomously writes Marvin Cadwell. He believes that physicians, other health care providers and suppliers need to join together in building new organizational structures to deliver cost-effective, accessible health care. PMID- 10122770 TI - Opportunities abound for automating the patient record. PMID- 10122771 TI - Automating its records worked for this practice. PMID- 10122772 TI - The impact of information technology on group practice. PMID- 10122773 TI - A programmed approach: upgrading the computer system. PMID- 10122774 TI - Physician compensation in the era of managed care. PMID- 10122775 TI - How to avoid the high costs of physician turnover. AB - Physician recruitment is a complex, time consuming and competitive activity that is costly in terms of incurred expenses, administrative and physician time and lost revenue. Judith Berger and Robert Boyle, FACMGA, describe how to develop a well-designed retention and recruitment plan to avoid such costs. PMID- 10122776 TI - Feds probe Ga. hospital. PMID- 10122777 TI - Mayors, governors, business leaders in accord on managed competition, split on mandates, global budgets. PMID- 10122778 TI - AHA program won't include accreditation. PMID- 10122779 TI - Columbia holds off on hospital bid. PMID- 10122780 TI - NRC has fined 118 hospitals since 1980. PMID- 10122781 TI - Delay Defense system--GAO. PMID- 10122782 TI - New governor promptly proposes provider tax. PMID- 10122783 TI - 'Clinical pharmacists save hospitals money'. PMID- 10122784 TI - Helix gets an intense look from the IRS. PMID- 10122785 TI - IRS plans audits of 10 more providers. PMID- 10122786 TI - Two partnerships formed to fight TB. PMID- 10122787 TI - Clinton picks round out health team selections. PMID- 10122788 TI - Ill. hospital consolidation stumbles. PMID- 10122789 TI - Inflation outpaces physician pay--AMA. PMID- 10122790 TI - Nurse vacancy rate drops to 8.7% in '91. PMID- 10122791 TI - Market forces or force the market? AB - States think they have some answers to the healthcare cost spiral. But the answers can be as different as the states themselves. Some advocate rigorous regulation to contain costs, while at the other end are those who believe good old competition is the best weapon against healthcare inflation. An increasing number of experts say both camps are partially right. So who's having the most success? PMID- 10122792 TI - Judge dismisses FTC's complaint against Ukiah, Calif., acquisition. PMID- 10122793 TI - The year in review '92. AB - Healthcare in the year 1992 began with a wave of mergers, was buffeted by presidential politics and the fury of two devastating hurricanes and ended with the selection of the healthcare policy team for the incoming Clinton administration. The top 10 stories of the year, as chosen by the editorial staff of Modern Healthcare, recap the hectic year. PMID- 10122794 TI - Attracting good managed-care plans that deliver on promises. AB - Imagine it's the year 2000. Managed care accounts for nearly 50% of your hospital's patient revenues. Are you prepared? Are you pursuing the more desirable managed-care organizations while staying clear of those that fail to deliver on promises? Consultants Sally Berger and Diane Millikan offer advice to help facilities woo top-notch managed-care plans and thereby increase their market shares. PMID- 10122795 TI - Physician management firms the newest threat to hospitals' efforts to tap flow of patients. PMID- 10122796 TI - 9$ billion wave of redemptions in municipal bond market expected to kick off new year. AB - More than $9 billion of municipal bonds could be redeemed on Jan. 1, which could translate into interest-rate savings for hospitals poised to issue new debt. The huge redemption is the result of the decline in interest rates since the early 1980s, which prompted a rush to issue bonds. Because much of that debt can be redeemed after 10 years, the first wave of redemptions is expected to occur in 1993. PMID- 10122797 TI - Medicare. Operating losses worsened in 1991. PMID- 10122798 TI - The promise of health care in a continuing care retirement community. PMID- 10122799 TI - Health plan case mix: definition, measurement, and use. PMID- 10122800 TI - Persistence of health care expense in an insured working population. PMID- 10122801 TI - Demographic risk factors derived from HMO data. PMID- 10122802 TI - Some evidence refuting the HMO "favorable selection" hypothesis: the case of Kaiser Permanente. PMID- 10122803 TI - Assessing health plan case mix in employed populations: ambulatory morbidity and prescribed drug models. PMID- 10122804 TI - Assessing health plan case mix in employed populations: self-reported health status models. PMID- 10122806 TI - Risk-based contributions to private health insurance. PMID- 10122805 TI - Can risk-assessment tools be feasibly used in the health benefit marketplace? PMID- 10122807 TI - Adjusting health benefit contributions to reflect risk. PMID- 10122808 TI - Adjusting contributions to address selection bias: three models for employers. PMID- 10122809 TI - Risk adjustment of employer contributions: How well will it work? PMID- 10122810 TI - Shifting the financial burden: the VA ambulatory care discharge policy. AB - The Department of Veterans Affairs is a primary source of health care services for many of the nation's uninsured and underinsured. Changes in congressionally mandated eligibility criteria and limited increases in appropriations have forced the Department to adopt a policy of discharging chronic but stable outpatients who have been treated for non-service-connected health conditions. Survey data from one VA medical center suggest that many, but not all, of those discharged: 1) have either Medicare or private insurance coverage; 2) have not sought or found alternative physician services in their local communities; 3) have discontinued taking previously prescribed medications; 4) report worsened health status since discharge; and, 5) have been hospitalized. In general, discharged patients from the lowest income group report the greatest financial access barriers. Preliminary analyses of the discharge policy suggest the potential for decreased access to needed medical services due to financial factors and cost shifting from the VA to patients and other federal, state and local payers and providers. PMID- 10122811 TI - Factors and perspectives affecting nursing resource consumption in community hospitals. AB - The consumption of professional and non-professional nursing resources on medical/surgical nursing units varies sharply among community hospitals. In an effort to explain the variation, this study examines several factors: socio economic characteristics of the population; supply of registered nurses; hospital characteristics such as size, complexity and diversity of services; patient characteristics such as case mix index and nursing care acuity index; and production system characteristics such as efficiency of technical support systems and the structure of nursing care delivery. Nursing skill mix varies more than the staffing levels among hospitals. The research suggests that factors associated with a clinical-rational model such as nursing acuity index and the efficiency of clinical/support systems explains little, whereas factors associated with economic-rational model of hospital revenues--like case mix, number of hospital services, poverty (through Medicaid program) and age distribution (through Medicare program)--do significantly affect nursing resource consumption. The results point to the presence of resource allocation to nursing based on hospital revenues rather than patient care needs. PMID- 10122812 TI - Is there a future for planning teams? AB - Health care planning in the NHS is undergoing a revolution. The proposals in Working for Patients, which involve the separation of funding from the provision of services, and the proposals for community care in Caring for People have profound consequences for the planning and provision of services for the so called priority groups. Planning teams, which were first established after the 1974 reorganisation, have been one of the main vehicles for planning coordinated care for such groups. The current study, which updates earlier findings, was carried out shortly before the publication of Working for Patients. It found an increased number of planning teams catering for a wider range of client groups, increasing unit involvement in care group planning and more emphasis on joint planning with local authorities. The implications of the findings for the post review NHS are discussed, in particular the future of joint planning, the future of CHC involvement in planning and the future of planning teams themselves. PMID- 10122813 TI - Longitudinal analysis of patient satisfaction among Medicare beneficiaries in different models of health maintenance organizations and fee-for-service care. AB - Based on a randomly selected nationwide sample of Medicare beneficiaries, this study analyzes changes in patient satisfaction over a one year period for beneficiaries receiving care in a variety of delivery settings: fee for service, group model HMO, staff model HMO, and Independent Practice Association model HMO. The findings reveal the patient satisfaction changes significantly over a one year period, from lower levels of satisfaction to higher levels of satisfaction. The primary explanation for this change in satisfaction is a decline in health status over the same one year period. Additional differences in satisfaction with care were observed for Medicare beneficiaries served by different types of delivery settings with varying degrees of utilization controls. PMID- 10122814 TI - Resource management in community residential facilities for adults with learning disabilities. AB - The trend towards community living for people with learning disabilities puts pressure on traditional hierarchical lines of resource management. A sample of 150 community residential facilities is surveyed in order to describe the systems used to manage resources in the community and to assess the impact they have on the quality of service provided. There are marked differences amongst provider agencies in the degree to which responsibility for resource management is devolved to facility managers and this has a direct effect on the quality of care. Residential homes which operate under centralised management systems are more institutional in their care practices and less responsive to individual clients' needs. In contrast, homes in which responsibility is delegated to the facility manager provide a service more in keeping with current philosophies of care. The results of this survey suggest that more responsibility for resource management can be delegated to facility managers without losing control of expenditure and with improvements in the efficiency and effectiveness of care. PMID- 10122815 TI - Project risk definition and measurement in a not-for-profit setting. AB - The health care finance literature on capital investment decisions generally applies conventional market risk concepts without distinguishing between proprietary and not-for-profit forms of organization. Since proprietary firms have shareholder wealth maximization as their primary goal, a project's relevant risk is its contribution to the riskiness of the equity investors' well diversified stock portfolios, or its market risk. However, not-for-profit organizations do not have shareholder wealth maximization as their primary goal, and thus market risk concepts are not applicable. Rather, the relevant risk in a not-for-profit setting is a project's corporate risk; that is, the project's contribution to the riskiness of the organization. The difference in risk definition and measurement between proprietary and not-for-profit firms has two implications for managerial decisions: (1) in making capital investment decisions, a manager must define and measure a project's riskiness on the basis of the firm's organizational form; and (2) although diversification for the sole purpose of risk reduction is not a valid rationale for proprietary firms because stockholders can achieve the same result at less cost, risk-reducing diversification does make sense for not-for-profit firms. PMID- 10122816 TI - Reducing blood and body fluid exposures among clinical laboratory workers. Meeting the OSHA standards. AB - This article examines risks and exposure patterns in clinical laboratories to help identify the most effective methods for implementing the OSHA standard for protection against bloodborne pathogens, especially hepatitis B virus and the human immunodeficiency virus. Using eye-opening figures, tables, and statistics, the authors identify areas where clinical laboratorians can improve their protection and conclude by offering three strategies for reducing blood and body fluid exposures in clinical laboratories. PMID- 10122817 TI - Quality assurance, an administrative means to a managerial end: Part IV. AB - This is the fourth and final part of a series of articles on laboratory quality surveillance. Part I addressed the historical background of medical quality assurance. Part II covered surveillance guidelines of the Joint Commission on Accreditation of Healthcare Organizations (JCAHO) and the College of American Pathologists with emphasis on quality assurance (QA) and the ten-step process. Part III focused on the JCAHO transition from QA to quality assessment and improvement. Part IV concludes the series by discussing the systematic identification of quality indicators in the total quality management and continuous quality improvement environment. PMID- 10122818 TI - Crisis management: strategies for building morale in uncertain times. AB - In economically stringent times, clinical laboratory managers face additional obstacles to boosting morale. This article describes five time-tested strategies that help strengthen morale in these tough times, including: developing a culture supportive of collaborative problem solving, controlling rumors, building a group identity, making yourself available, and projecting an attitude of hope. By using these strategies, laboratory managers will improve their chances of staying hopeful and positive during this time of crisis and change. In addition to the practical techniques described, managers will also learn that uncertain times require looking beyond the bottom line to their staffs and their needs. Managers must learn how to care and affirm others to truly succeed in building morale in these uncertain times. This article combines practical advice with stories and anecdotes from a variety of settings--from East Indian folklore to the television series "M*A*S*H" Managers will find both ways to stay positive when the joy has gone out of their work and reminders of why we must remain hopeful in the face of crises. PMID- 10122819 TI - Talking about technology. TransLogic CTS. PMID- 10122820 TI - Recruiting and retaining medical technologists. AB - Personnel recruitment and retention is one of the most challenging facets of management. Despite turnover rates, identifying and retaining good employees should be foremost on any managerial agenda. An effective employee recruiting/relations program enhances the overall productivity of an operation by addressing concerns at staff level, often considered the core of activity. In this issue, we asked our respondents: What methods do you use to recruit and retain medical technologists? PMID- 10122821 TI - Health-care reform: should the marketplace reign? PMID- 10122822 TI - The '93 budget imperative: do more with less. AB - Faced with another year of belt tightening, CIOs hope that by doling out the IS dollars more wisely in 1993--to training, maintenance, and client/server solutions--they'll be able to breathe a little easier. PMID- 10122823 TI - Helping the community to decide on health services. PMID- 10122824 TI - Transforming support services through competition. PMID- 10122825 TI - Improving safety in health-care institutions. AB - Floors in hospitals and other healthcare institutions must be hygienically clean but they must also have a high degree of slip-resistance to avoid accidents during walking--especially for patients recovering from illness or surgery, or weakened by the effects of age. Good slip-resistance and clinical cleaning are difficult to combine because conventional slip-resistant floors have a rough surface to provide maximum grip, making them virtually impossible to clean to a high standard. This article discusses the development of materials which satisfy both criteria. PMID- 10122826 TI - Major development proposed for Auckland Adventist Hospital. PMID- 10122827 TI - Health information strategy for New Zealand. AB - The health information strategy signposts the direction for health information services to meet national health information requirements for the 1990s and beyond. The Department of Health is involved in the essential business of funding and monitoring the health sector, providing policy advice and managing resources. The New Zealand Health Information Service will provide the data and analysis from both electronic and manual based systems to support the 'business' of health. Information systems must meet the needs of users. This requires consistency between the information strategy and the direction and goals of the organisation it is designed to service. The approach to health information is consistent with and supports the overall strategy and direction for the development of health services in New Zealand. The development and implementation of the New Zealand Health Information Strategy has been and continues to be an exciting and daunting challenge. All health professionals, managers and the public want high quality, relevant and timely information. The task now is to harness the information technology to support the health sector by providing the vital information. PMID- 10122828 TI - A comparison of the impact of institutionalization on spouse and nonspouse caregivers. AB - We report on a study of 106 spouse and nonspouse primary caregivers of cognitively impaired older people. Half of these caregivers cared for someone in a community setting, half cared for someone in an institution (a nursing home or hospital). The study used the multidimensional Caregiver Burden Inventory (CBI) to measure the burden that these caregivers felt. A 2 x 2 multivariate analysis of variance found an effect of the interaction of relationship and living arrangement on two CBI subscales: Time Dependence Burden and Developmental Burden. Spouses showed a significantly greater difference in Time Dependence Burden scores than did nonspouses in both living arrangement groups, and nonspouses showed a significantly greater difference in Developmental Burden than did spouses in both groups. We conclude with a discussion of how programs can help different types of caregivers cope with feelings of burden. PMID- 10122829 TI - Respite service to family caregivers by the senior companion program: an urban rural comparison. AB - The Senior Companion Program (SCP), a federally sponsored program, aims to enlist older volunteers to provide in-home services to the homebound elderly. A survey of 48 sample SCP projects providing family caregiver services reveals a distinctly different trajectory of urban and rural project development. In both environments, the longer a project has been in existence, the greater the number of volunteers in service. However, the number of clients served increases for urban projects, but not for rural projects. Relatedly, the unmet need for family caregiver services, the number of referrals unserved by the project, is considerably greater in rural areas. These results suggest that because of factors unique to rural areas, the expansion of clientele may be more restricted in rural settings compared to that in urban settings, thereby implying that rural urban differences should be reflected in project planning and implementation. PMID- 10122830 TI - Older rural nonsurvivors: their prediction and terminal care. AB - This research reports on nonsurvivorship by comparing two groups of older rural adults: 138 survivors and 45 nonsurvivors from the third wave of a longitudinal study. They were part of a sample of 418 adults aged 65 and older, first interviewed in 1976. The purposes of these analyses were to examine (a) the predictors of nonsurvivorship to very old age, (b) the final health crises of rural nonsurvivors, and (c) the formal and informal supports addressing their terminal health needs. Average age at death was 83. Results showed that only minimal variance in nonsurvival to very old age could be predicted using standard demographic and psychological variables. The relative importance of predictors varied according to time of measurement (age). Terminal illnesses were similar in type to those of the general aging population. Final illnesses were usually multiple and lengthy, and deaths seldom occurred in the older rural adults' county of residence. Families usually cared for older members without the assistance of formal supports except for a physician, who usually lived out of the county or in the adjoining state. Implications for practitioners are discussed. PMID- 10122831 TI - Cost-sharing and the future of fees for service for frail elders in state programs. AB - Although Congress has rejected the concept of mandatory cost-sharing under the Older Americans Act, many states already use client fee systems under state funded home and community-based services programs. This research included a survey of actual state experiences and a review of earlier studies. States are compared on issues concerning policy and experience with fee systems, including income verification, fee schedules, termination policies, and costs of administration. Although policy and practice differ markedly across states, certain states are close to operationalizing comprehensive policies in this area. The author concludes that there is a need to conduct additional state-level demonstrations that address policy issues identified in the research. Evaluation research is needed to determine program effectiveness and efficiency, particularly concerning whether cost-sharing increases the amount of services available and ensures a high level of services to minorities. PMID- 10122832 TI - Advance directives worldwide: health record professionals as patient advocates. PMID- 10122833 TI - Getting the coding right--commitment from the clinician. PMID- 10122834 TI - Risk management for health records--a practical approach. PMID- 10122835 TI - CARES (Center for AIDS Research, Education and Services): a model collaborative effort. PMID- 10122836 TI - Shelter in the storm: disasters put hospitals to the test. AB - If disaster response is the ultimate test of our health care delivery system, California hospitals over the past three years have been subjected to what seems like final exams. Beginning with the Loma Prieta earthquake in 1989 and continuing with the Oakland firestorm in October 1991, the I-5 dust storm in November 1991, the Cape Mendocino quake in April, the Los Angeles riots in May, the Landers and Bear Lake quakes in June, and forest fires throughout the summer, California hospitals have risen to each and every occasion, showing consistent dedication to quality care while under tremendous stress. During these disasters, hospitals served as shelters in the storm for their communities, as thousands of wounded, sick and frightened poured through their doors. Staff performed more than their usual duties during these crises. Some worked double shifts. Others came to work and pitched in even though they were off duty. Many comforted patients while they worried about the safety of their own families and homes. Following are the experiences of some of these individuals. PMID- 10122837 TI - Turning waste reduction into a winning situation. PMID- 10122838 TI - A short course regarding ER account collection. PMID- 10122839 TI - Walk-in clinics. PMID- 10122840 TI - Outpatient registration's "self-pay follow-up" system. PMID- 10122841 TI - Using a quality improvement plan to improve professional image. PMID- 10122842 TI - The arduous road to health reform. PMID- 10122843 TI - Selecting the "right" emergency department staffing group. PMID- 10122844 TI - Confidentiality issues in the 90's. AB - Technology, new methods for collecting data, expanding needs and uses of data, all have significantly increased the complexity of maintaining confidentiality of patient information. To safeguard against misuse of, and inappropriate access to, sensitive information, hospitals must develop organization-wide approaches. They should involve all key hospital players in developing such systems, including, but not all limited to, access managers, data processing, administration, medical and nursing staff and health information managers. PMID- 10122845 TI - Hospitals continue struggle with hurricane aftermath. AB - Hurricane Andrew hit south Florida at 3:00 a.m. on Monday, August 24, 1992. At its peak, its winds reached 164 miles-per-hour, and the resulting destruction of life and property has been well documented. However, there are stories yet to tell; stories that are not really unfamiliar to readers who know about health professionals' commitment to their patients and their professions. One individual, Frank V. LeBlanc, a spokesman for the Louisiana Hospital Association, said that the press seldom if ever follows up with coverage of what physicians, nurses, medical technicians, practical nurses, etc., accomplish during and after storms and other disasters. "They take our industry's commitment for granted," he said, "as though police and firemen, doctors, nurses and teachers are all expected to work day and night without sleep or additional pay. I think," he added, "that our society has taken advantage of these people and their deep sense of duty." What follows are a few need-to-be-told stories beyond what has already been reported, and additional to our own coverage in the September/October 1992 issue of Health Systems REVIEW, which was done almost while our printer was inking the presses. The first of a three-part article is an interview with Tony Degina of Deering Hospital, Miami, which was all but brought down by the hurricane. Next, the story of the hardest hit hospitals on the Louisiana coast. Finally, part three focuses on the September Pacific hurricane, Iniki, that ravaged the Hawaiian island of Kauai. PMID- 10122846 TI - Computerized patient records. CPR--the key to reform. PMID- 10122847 TI - CPR (computerized patient records)--desirability vs practicality. PMID- 10122848 TI - The NAPPH (National Association of Private Psychiatric Hospitals) today--under new management. Interview by John Herrmann. AB - When Robert L. Trachtenberg took over the executive directorship of the National Association of Private Psychiatric Hospitals some five months ago, he walked into a situation wherein several psychiatric specialty hospitals in Texas were under fire. "There were a lot of questions," Trachtenberg says, "and challenges to the credibility of psychiatric hospitals." He was referring to the Texas state investigation into abuses by personnel within psychiatric hospitals. Last year, the Texas Senate Interim Committee on Health and Human Services conducted an eight-month investigation into the conduct of the state's psychiatric hospitals after a newspaper article recounted the unconventional way in which a 14-year old boy was picked up and admitted to a psychiatric facility. After a number of public hearings, three private agencies overseeing Texas psychiatric hospitals adopted rules to prevent further problems in the areas of patient rights, fraudulent billing, patient recruitment and the admission and discharge process. The Senate Interim Committee, however, felt these rules needed to be codified into law and has drafted over 30 bills to be presented to the Texas legislature as omnibus legislation next January. Trachtenberg went to work to iron out methods to encourage better overseeing and state governance, as well as tackling the related issues of standards of care and managed care/utilization review. His background as Deputy Administrator of the Alcohol, Drug Abuse and Mental Health Administration within HHS provided him with a broad spectrum of knowledge about the field of psychiatry and its problems, and his vast experience in federal government--over 32 years of running domestic programs--enable him to have a keen sense of what can get done, and how. Health Systems REVIEW recently discussed the role of the NAPPH under its new leader, Bob Trachtenberg. What follows is an edited version of that conversation. PMID- 10122849 TI - Standard EDI in health care: where we are now--& where we're going? PMID- 10122850 TI - TQM tools and the hospital finance department. PMID- 10122851 TI - NME steps into volunteer services. PMID- 10122852 TI - EPIC goes one on one with the chairman. PMID- 10122853 TI - 1993 state legislation: same plan, new players. PMID- 10122854 TI - Recovering from partisanship. PMID- 10122855 TI - Price bundling: a second opinion. PMID- 10122856 TI - The 103rd Congress--a preview. PMID- 10122857 TI - Personnel utilization. Don't throw the baby out with the bath water! PMID- 10122858 TI - Affiliated societies of the Alabama Hospital Association. Number 5 in a series. PMID- 10122859 TI - The fallout from medical waste. AB - Problems with medical waste in other states have led to new federal regulations, as well as requirements here in Alabama. The result: more paperwork and additional costs for hospitals. PMID- 10122860 TI - The taxman cometh. Is your not-for-profit hospital prepared? AB - Voluntary hospitals face new scrutiny over the old benefit of tax exemption. With the standards becoming murkier, not-for-profit institutions wonder where they stand. PMID- 10122861 TI - Quality improvement in ambulatory care: a network approach to quality improvement. AB - Quality Improvement in Ambulatory Care (QIAC), a national demonstration project undertaken in northern Minnesota, recently was honored by the American College of Physician Executives at its 1992 national meeting in San Francisco. The Merck, Sharp & Dohme Award for Advances in Quality, an award recognizing significant advances in improving the quality of healthcare delivery, was awarded for the first time ever to the QIAC project. Impartial reviewers, using objective criteria, selected this project as this year's most significant advance in improving healthcare quality because of its magnitude and its innovation. PMID- 10122862 TI - Principles of data collection applied to customer knowledge. AB - Are customers becoming more demanding or is the state of excellence in service in the United States in decline? With the dawning of the Age of the Global Marketplace and its attendant competition, American consumers have come to expect a higher standard in products and services. They naturally choose to purchase products that have proved to be well made and reliable. In brief, they require satisfaction. Yet business and medical journals, newspapers, and books all have been eager to tell the story of the sad state of customer service. The "demands of American consumers for high-quality service are higher than ever and businesses that ignore the new realities of customer satisfaction can jeopardize not only their future sales but also their very survival" (Szabo, 1989, p. 16). PMID- 10122863 TI - Legislative forum: Health Access America. PMID- 10122864 TI - Quality leadership: the key to quality management. AB - Quality leadership is a precondition for implementing quality management. How organizational leaders structure and direct an organization as well as how they behave within an organization are critical elements to the success of an effective quality management process. This article addresses these leadership issues and presents a plan for quality management implementation. Several behavioral tools are described that address potential obstacles to the implementation process. PMID- 10122865 TI - Information technology and today's health care management. AB - With the move to CPR, health information managers will be challenged to reengineer the ways they manage processes within the medical record department. A lot of age-old health information problems (i.e., missing documents, lost test results, and missing records) can be solved and productivity improved with imaging. The digitized records will allow simultaneous access to readily available, legible, and usable information for patient care, research, audits, and correspondence. However, the transition from a manual to computerized record presents many challenges. Health information managers will have to monitor the changeover carefully, anticipating the needs for new information and developing the necessary mechanisms to produce it, as well as implementing new technologies as they emerge. Conditions are right for an advance in health care information systems. Pressures and changes in structure in the health care industry require better management tools. Acceptance of HIS as a management tool is growing rapidly among the health care provider community. The technology to realize the CPR and advanced decision support systems is available. All the pieces are there- they just need to come together. As the health care organization's view of and need for information systems change, medical record professionals must draw on their knowledge and experience and make the transition from managers of record systems to managers of health care information systems. PMID- 10122866 TI - The request for proposal and vendor selection process. AB - The RFP and vendor selection process is critical to the successful acquisition and installation of systems to automate health information management departments. The effort expended in the planning process, through the requirements definition, needs assessment, and conceptual system design are absolutely essential to the development of concise requirements for the RFP document. These requirements are also essential in evaluating vendors during the vendor screening and site visit process. Follow-up documentation evaluating all systems under consideration clarifies each system's utility in terms of the ability to meet or exceed conceptual design requirements. In a competitive vendor environment, these decisions will continue to become more difficult. However, the preparation of clear requirements, and the distribution of a concise RFP will assure the successful acquisition of health information management systems to meet health care needs today and in the future. PMID- 10122867 TI - Case study in health information management: strategic planning. AB - The strategic planning process has proven to be invaluable to Riverside Hospital's success. Involvement of all levels of the organization and integration of plans solidifies organizational commitments and provides a framework that assures accomplishment of overall goals. With major developments in computerization of medical records and other systems that support patient care data analysis on the horizon, Riverside's integrated plans are defining crucial information system projects. As the pool of available resources for projects continues to shrink, the planning format described assures funding of information system needs that will secure a position for Riverside in the health care marketplace of the future. PMID- 10122868 TI - Implementing a mainframe coding/abstracting system. AB - In conclusion, the successful implementation of a medical record abstracting system was realized due to the following factors: extensive planning, thorough organization of tasks, controlled implementation, and ongoing controls. While thorough planning and organization will result in an efficient implementation, ongoing controls will ensure continued success and produce high quality results for any medical record system. PMID- 10122869 TI - Using database software for quantitative review and active caseload lists in a community health setting. PMID- 10122870 TI - The implementation of self-managed teams in health care. AB - Self-managed teams are one of the most effective tools now available for tapping the unrealized potential of health care organizations. Executives and managers involved with self-managed teams are speaking of new levels of productivity, new commitment among workers, and new optimism about meeting the challenges of competition. GSH's ability to create peak-performance teams will certainly give the hospital a critical competitive advantage over competing hospitals in the Dayton area. Success requires commitment and patience. Health care organizations that believe in the power of worker participation will not regret following the path to a self-managed team environment. PMID- 10122871 TI - Equipment leasing: are you overlooking what may be your best financing option? AB - In this era of increasingly scarce resources, it is imperative that decision makers choose alternatives that are the most efficient and effective use of the resources available. In terms of equipment acquisition, this means not only selecting the right equipment but also choosing the best method of financing the acquisition. Leasing is one alternative that may be the most efficient and effective use of capital. Health information managers should have a basic understanding of the factors to be considered when evaluating the lease vs. purchase alternative. In the competition for increasingly scarce resources, knowing how to present alternatives to the decision makers can make the difference between denial or approval of equipment acquisitions for the health information department. PMID- 10122872 TI - The Cleveland Health Quality Choice Program: an evaluation of quality. AB - The Cleveland Health Quality Choice Program, since early in its inception, has taken advantage of the unique relationship between the purchasers of health care and the providers. Regardless of the outcome of this endeavor, a collaboration has been established between the two and among the medical community involved in this program--a collaboration that the Cleveland community hopes to maintain in the future. Picture it...the business and medical communities sitting down at one table and coming to a consensus on various issues...quite an accomplishment in itself. PMID- 10122873 TI - The use of the medical record and financial data to examine the cost of infections in the elderly. AB - This study demonstrates what can be accomplished when the medical record and other data sources are utilized. By using the medical record as well as financial data and input from the infectious disease department, a detailed analysis of infections in an elderly population in relation to cost and length of stay was completed. This pilot study also enabled the hospital to determine the types of studies that should be done in the future. Quality assessment and improvement studies that examine the effectiveness of infection control procedures over time, the importance of examining both community-acquired and nosocomial infections, and the differences that severity of illness may have on cost and length of stay are all areas that have been identified as needing further study. Future studies in this area and other areas will continue to utilize the medical record. However, the data obtained from the medical record should not be examined alone. It should be analyzed along with other data sources such as severity of illness data, financial data, quality assessment data, infection control data, and risk management data in order to examine epidemiological trends over time. Only when several data sources are used together to investigate a particular aspect of care will that aspect of care be thoroughly and completely examined. PMID- 10122874 TI - Health care quality problems in Ohio: analysis by diagnosis related groups. AB - Quality problems occur throughout the health care system, regardless of the disease or diagnosis. Peer review groups and health care organizations can take advantage of this finding to design quality improvement programs that will have a greater impact on health care quality than traditional quality assurance programs. Problems associated with high volume diagnoses or high risk procedures can be analyzed with the understanding that lessons learned in those examinations can be applied to many other aspects of health care. Continuous quality improvement can be implemented, using specific indicators and criteria as models for the overall factors contributing to quality in the health care system. Quality improvement experts estimate that the majority of all quality problems originate in the system, rather than in the performance of individuals. An in depth analysis of our hospital and health care systems, complementing the performance-based quality assurance programs already in place, will facilitate the comprehensive improvement of quality throughout our health care institutions. PMID- 10122875 TI - Legal review: free coding instruction for physicians' office staff--Medicare fraud? PMID- 10122876 TI - Utilization control in HMOs. AB - Health Maintenance Organizations (HMOs) have emerged as a major vehicle to reduce transaction costs associated with defining the limits of health insurance coverage and to provide appropriate provider incentives. This article explains the heterogeneous set of incentives used by HMOs to reimburse providers and performs empirical tests of their effectiveness. The empirical analyses reveal that utilization of health care services is reduced when (1) physician compensation is based on salary or capitation arrangements rather than some measure of output; (2) bonuses and paybacks are based on individual rather than group performance; and (3) when the HMO operates as a proprietary (for-profit) organization. Utilization is not significantly affected by incentives placed on the hospital. Finally, physician ownership of the HMO was found to lead to higher levels of utilization. PMID- 10122877 TI - Medicaid program; prohibitions on FFP for educational and vocational training for institutionalized individuals--HCFA. Final rule. AB - This final rule revises and clarifies the meaning of the prohibition against the use of Federal financial participation (FFP) for vocational training and educational activities in intermediate care facilities for the mentally retarded (ICFs/MR) and in psychiatric facilities or programs providing psychiatric services to individuals under age 21. It resolves issues that have been raised by the States and courts regarding the method and criteria that have been used by HCFA to determine which services are not eligible for FFP because of the educational and vocational training services exclusion. PMID- 10122878 TI - Medicaid program; elimination of certain written documentation pertaining to Medicaid long-term care facilities--HCFA. Final rule. AB - This final rule deletes a requirement in Medicaid regulations pertaining to State survey agencies, which certify facilities as meeting the requirements for participation in the Medicaid program. Specifically, we are deleting the requirement that State survey agencies, when certifying facilities with deficiencies, must provide written documentation that the deficiencies do not jeopardize resident health and safety or seriously limit the facility's capacity to furnish adequate care. Because there are already other written requirements for documentation of these deficiencies, this revision eliminates an unnecessary administrative burden, while ensuring resident health and safety. PMID- 10122879 TI - Medicare program; withdrawal of coverage of thermography--HCFA. Final notice. AB - This notice announces the withdrawal of Medicare coverage of thermography for all indications. Evidence indicates that thermography is not effective in diagnosing or treating illness or injury. PMID- 10122880 TI - Medicaid program; limitations on provider-related donations and health care related taxes; limitations on payments to disproportionate share hospitals--HCFA. Interim final rule with comment period. AB - This interim final rule establishes in Medicaid regulations limitations on Federal financial participation (FFP) in State medical assistance expenditures when States receive funds from provider-related donations and revenues generated by certain health care-related taxes. The rule also adds provisions that establish limits on the aggregate amount of payments a State may make to disproportionate share hospitals for which FFP is available. This interim final rule implements provisions of the Medicaid Voluntary Contribution and Provider Specific Tax Amendments of 1991. PMID- 10122881 TI - Medicaid program; limitations on aggregate payments to disproportionate share hospitals: fiscal year 1993--HCFA. Notice. AB - This notice announces the "preliminary" national aggregate Federal fiscal year 1993 limit on, and individual State allotments for, Medicaid payments made to hospitals that serve a disproportionate number of Medicaid recipients and low income patients with special needs. We are publishing this notice in accordance with the provisions of section 1923(f)(1)(C) of the Social Security Act. That section requires the Secretary, at the beginning of each Federal fiscal year (beginning with Federal fiscal year 1993), to estimate and publish in the Federal Register the national payment limit, and each State's allotment within that national limit, for disproportionate share hospital (DSH) payments for which Federal financial participation (FFP) will be available under Medicaid. PMID- 10122882 TI - Medicare program; revision of the Medicare Economic Index--HCFA. Final rule. AB - Before January 1, 1992, Medicare payments for physicians' services under Part B were limited by the Medicare Economic Index (MEI), which capped prevailing charges. Beginning January 1, 1992, Medicare payments for physicians' services under Part B are made based on a fee schedule. Annual updates to the conversion factor used in establishing the physician fee schedule are based in part on the MEI. This final rule revises the method used to calculate the MEI to more accurately reflect year-to-year price changes affecting the cost of providing physicians' services, thus ensuring appropriate adjustment of Medicare payments. PMID- 10122883 TI - Medicare program; inpatient hospital deductible and hospital and extended care services coinsurance amounts for 1993--HCFA. Notice. AB - This notice announces the inpatient hospital deductible and the hospital and extended care services coinsurance amounts for services furnished in calendar year 1993 under Medicare's hospital insurance program (Medicare Part A). The Medicare statute specifies the formulae to be used to determine these amounts. The inpatient hospital deductible will be $676. The daily coinsurance amounts will be: (a) $169 for the 61st through 90th days of hospitalization in a benefit period; (b) $338 for lifetime reserve days; and (c) $84.50 for the 21st through 100th days of extended care services in a skilled nursing facility in a benefit period. PMID- 10122884 TI - Medicare and Medicaid programs; preadmission screening and annual resident review -HCFA. Final rule with comment period. AB - This rule sets forth State requirements for preadmission and annual review of individuals with mental illness or mental retardation who are applicants to or residents of nursing facilities that are certified for Medicaid. It also sets forth an appeals system for persons who may be transferred or discharged from facilities or who wish to dispute a determination made in the preadmission screening and annual review process. These provisions implement several provisions of the Omnibus Budget Reconciliation Act of 1987 (OBRA '87), Public Law 100-203 and the Omnibus Budget Reconciliation Act of 1990 (OBRA '90), Public Law 101-508. PMID- 10122885 TI - Adjustment of status; certain H-1 nonimmigrant nurses--INS. Final rule. AB - This final rule implements section 162(f) of the Immigration Act of 1990 (IMMACT 90). Section 162(f) of IMMACT 90 retroactively amended the Immigration Nursing Relief Act of 1989 (INRA) to allow additional alien nurses, their spouses, and children to become lawful permanent residents of the United States. This rule establishes procedures for the adjustment of status to that of lawful permanent resident for these alien nurses and certain family members in the United States. This rule alleviates the critical shortage of nurses in the United States by allowing qualified registered nurses who had formerly been granted temporary employment authorization under the H-1 category the opportunity to live and work permanently in this country as lawful permanent residents, with the possibility of becoming United States citizens in the future. This rule also makes organizational, grammatical, and stylistic changes to agency regulations which will make them easier to read and use. PMID- 10122886 TI - Medicare program; Part A premium for 1993 for the uninsured aged and for certain disabled individuals who have exhausted other entitlement--HCFA. Notice. AB - This notice announces the hospital insurance premium for calendar year 1993 under Medicare's hospital insurance program (Part A) for the uninsured aged and for certain disabled individuals who have exhausted other entitlement. The monthly Medicare Part A premium for the 12 months beginning January 1, 1993 for these individuals is $221. Section 1818(d) of the Social Security Act specifies the method to be used to determine this amount. PMID- 10122887 TI - Medicare program; monthly actuarial rates and monthly supplementary medical insurance premium rates beginning January 1, 1993--HCFA. Notice. AB - As required by section 1839 of the Social Security Act, this notice announces the monthly actuarial rates for aged (age 65 or over) and disabled (under age 65) enrollees in the Medicare Supplementary Medical Insurance (SMI) program for calendar year 1993. It also announces the monthly SMI premium rate to be paid by all enrollees during calendar year 1993. The monthly actuarial rates for 1993 are $70.50 for aged enrollees and $82.90 for disabled enrollees. The monthly SMI premium rate for 1993 is $36.60. PMID- 10122888 TI - Attacking AIDS. AB - Nearly 12 years after the epidemic began, AIDS activists and public health officials think they finally have a commander in chief who will wage an all-out war against the disease. Are expectations running too high? PMID- 10122889 TI - Health lobby is already out hustling. PMID- 10122890 TI - Reasons for participating in occupational therapy groups: perceptions of adult psychiatric inpatients and occupational therapists. AB - Little is known about the attitudes of psychiatric patients towards the specific role of occupational therapy within the overall context of hospital-based treatment. The present study examined this issue by asking 102 adult psychiatric inpatients to indicate their reasons for participating in an occupational therapy group programme, and comparing their responses to those of 31 occupational therapists. Both groups gave high ratings to "reasons for participation" that were related to the achievement of positive therapeutic outcomes, although therapists rated these items significantly higher. The patients, on the other hand, gave higher ratings than therapists to items related to escaping the hospital routine (e.g., "to decrease boredom"), and to achieving "secondary gains" (e.g., to get passes to leave the hospital). The results emphasize the importance of preparing patients for participation in therapy groups in order to enhance the therapeutic value of these experiences. PMID- 10122891 TI - Predictors of burnout for psychiatric occupational therapy personnel. AB - Burnout is inherent in many health care professions. This research investigation was conducted to determine if burnout existed at significant levels and if a relationship between burnout, work environment factors and demographic characteristics existed among a group of psychiatric occupational therapy personnel. The study design was a descriptive survey format utilizing mailed questionnaires. Eighty-nine respondents completed the Maslach Burnout Inventory, the Work Environment Scale and a demographic questionnaire. A series of regression analyses were performed. The results indicated that the following were significant predictors of burnout: work involvement, a large percentage of clients on one's caseload diagnosed with schizophrenia, work pressure, age, income level, the length of time working in psychiatric occupational therapy, caseload size and the amount of overtime performed on a weekly basis. Implications for psychiatric occupational therapy practice are discussed and recommendations for future research are made. PMID- 10122892 TI - Better planning needed to strengthen patient-care systems. AB - The word "change" is on everyone's lips this year. The desire for change in patient-care information applications is very strong, too, according to a recent Computers in Healthcare patient-care systems survey. Three nursing executives have studied the CIH survey results and give their view on why strategic planning for patient-care systems is so poor when the desire for these applications is so great. PMID- 10122893 TI - CARE 2000 program refocuses on patients at Mercy in San Diego. AB - Two patient floors are now up and running with Mercy Hospital and Medical Center's CARE 2000 plan for restructuring and decentralizing patient care, and patient satisfaction has already made measurable leaps forward. The new management plan at the San Diego hospital increases nursing time with patients, moves formerly centralized services right onto the patient floor, decreases the number of caregivers a patient must see and makes "care partners" of ancillary staffers. Also, bedside information systems design goes hand-in-glove with new management concepts that are working well. PMID- 10122894 TI - Record it without words: designing a CPR (computer-based patient record). AB - Two way-communication between users and developers is a must when creating a truly functional computer-based patient record. The solution for tackling this daunting task may be to use structured requirements analysis supported by CASE tools. PMID- 10122895 TI - Information technology can improve healthcare quality. AB - A big move meant big change for Emergency Department personnel at John Peter Smith Hospital, part of the Tarrant County Hospital District, Forth Worth, Texas. Implementing a patient tracking system has allowed ED managers and clinicians to assess outcomes, reengineer patient flow and investigate clinical issues, ultimately resulting in better, more timely care. PMID- 10122896 TI - ECS (electronic claims submission) paradigm shift revisited: the next phase. AB - Public demand for healthcare cost reductions has not only risen to the top of the political agenda this fall, it has become strident. Legislators are under pressure to act quickly. Suddenly, electronic claims submission is being understood for its ability to lop billions off of the staggering cost of healthcare administration. Several initiatives are now in the works that are set to bring ECS into widespread use. PMID- 10122897 TI - WEDI (Workgroup for Electronic Data Interchange) co-chair predicts big savings from EDI. AB - Electronic data interchange has the potential to save billions of healthcare dollars--that's the gospel according to Joe Brophy. The Travelers Insurance Company president and co-chair of the Health and Human Services Workgroup on Electronic Data Interchange is taking this sermon to the people. PMID- 10122898 TI - 1992 electronic claims listing. Product roundup. AB - Late in 1991, Health and Human Services Secretary Louis Sullivan challenged health insurers and providers to increase the number of claims moved electronically by 10 percent each year. [See "Electronic claims are smart way to trim costs, share outcomes," January 1992 Computers in Healthcare, p. 52.] "Eventually, to receive care, every American patient will need only to present a health insurance card issued by a private or government plan to a hospital or doctor," according to Sullivan. "Patients will know how much their insurance will pay and what cost they are responsible for....Ultimately, patients should not have to fill out insurance forms." Numerous companies are striving to do away with those ever-present paper forms. Approximately 40 electronics claims firms listed here are specializing in claims management--from the standpoint of the clearinghouse, the physician's office or the hospital. We asked them about their best-selling electronics claims product, its price and any new products they now have for electronic claims or electronic data interchange. We hope this listing helps boost this year's electronic claims beyond Sullivan's 10 percent mark. PMID- 10122899 TI - Information architecture: the repository alternative. AB - The skillful design of an information architecture that suits a healthcare organization is a top priority for information managers. But they have been hampered both in their conceptual approach to managing information flow and their technological capabilities for designing that flow. Information--both clinical and administrative--must be fluid and accessible. These key success factors lie in the increasingly prevalent database repository approach. And the technology is here to make it happen. PMID- 10122900 TI - HL7 looks beyond the hospital walls. AB - HL7 is trying to build a bridge linking more than just providers and payers. Through electronic data interchange, the standards group hopes to better link physicians' practice management systems with their affiliated hospitals' information system, creating a crossfeed of information that could ultimately have profound effects on the quality of patient care. PMID- 10122901 TI - Telecommunications may offer poor a 'road' to healthcare. AB - A report by the Environmental Science and Policy Institute paints a picture of a healthcare telecommunications "super highway" system with on and off ramps leading directly to the most disaffected in our society. It offers an inviting tour into the possibilities of tomorrow, but is it realistic? PMID- 10122902 TI - The coming revolution in information systems. AB - A revolution is coming--is absolutely essential--in healthcare. The chief information officer must be among the generals who plan battle strategies and lead the campaigns to fight inflating costs and overwhelming demands. Without their leadership and expertise, armies of healthcare providers are destined to fail, and legions of citizens will fall victim to a system inadequate to meet their needs. PMID- 10122903 TI - Reengineering: more than meets the eye. AB - Changes too often leave us shaken, unsteady and unable to perform, yet hospital reengineering usually means major, lingering change. Systematic reengineering, properly implemented, can reduce the strain. PMID- 10122904 TI - Expensive iron doesn't equal high technology. Interview by Carolyn Dunbar and Joy Young. AB - In a candid interview with Computers in Healthcare, Nobel Prize winner Arno Penzias, Ph.D., calls healthcare backward and archaic, the last remaining cottage industry of our time. "Physicians are not going to the keyboard," he states with conviction born of his own experience in what he characterizes as today's very un high-tech healthcare organizations. PMID- 10122905 TI - Apple founder targets healthcare as NeXT market. Interview by Carolyn Dunbar and Michael L. Laughlin. AB - Cofounder and former chairman of the board of Apple Computer Steven Jobs looks beyond the 1980s image of a petulant, embittered young man, fighting with all who failed to share his vision, and many who did. Today, as a founder, president and chairman of NeXT, Inc., he looks to more high-minded applications of his computer genius. PMID- 10122906 TI - Enabling technologies build bridge to 21st century. AB - The sophisticated healthcare institutions of the future will be computer-driven integrated clinical creatures. But which technologies are key to overall information access? Futurist Tim Zinn stalks tomorrow's "best of breed" I/S technologies. PMID- 10122907 TI - A new era dawns for the University Hospital Consortium. Interview by Carolyn Dunbar. AB - A group of 60 university hospitals and medical centers has evolved from its original goal of gaining greater purchasing clout to a new goal: The University Hospital Consortium is becoming an information corporation, with the enormous information potential to affect treatment outcomes, practice patterns and clinical research. Sam Schultz, UHC's vice president of Information Services, tells Computers in Healthcare his organization is on the verge of a new age of discovery. PMID- 10122908 TI - ECS (electronic claims submission) wake-up call for providers. AB - Washington's brisk winter winds may signal a brisk change in the way healthcare insurance claims are processed. A series of events this fall appear to be jump starting stalled efforts to effect a paradigm shift. PMID- 10122909 TI - I/S strategic planning in multis must curb redundancies. AB - Multifacility healthcare organizations bring a unique set of problems to information services executives. If they're smart, I/S strategic planners can boost system access but keep redundancies throughout the organization to a minimum. PMID- 10122910 TI - Back to the future. AB - The healthcare landscape is changing too rapidly to support the old ways. A better approach called "ends planning" demands clinicians become true decision makers in the planning process. PMID- 10122911 TI - Election year holds hope for healthcare reforms. Interview by Carolyn Dunbar. AB - Healthcare strategist Paul Ellwood tells Computers in Healthcare that major health reform initiatives he was instrumental in developing will be debated in Congress this fall and stand a good chance of passing into law. The outcomes reporting aspect of the reform package has significant implications for I/S and for the computer-based patient record. PMID- 10122912 TI - A strident public impatience drives true change. Interview by Carolyn Dunbar. AB - Sunquest's president and chief executive officer, Sidney Goldblatt, M.D., says the inefficient way information is shared in healthcare is "stupid" and wouldn't be tolerated in other industries. Until the public becomes impatient and strident about flagrant waste and begins to demand most cost-effective methods in healthcare, true change will take a lot longer. PMID- 10122913 TI - Laboratory trends shift with the winds of technology. AB - Mixing laboratory trends with new technology, the changing market and today's vendors is a little like using a high-speed centrifuge to separate blood, yet nowhere near as accurate. Are interfaces, portability and UNIX going to come out in high percentages? Lab expert Gary Braley sorts out the situation. PMID- 10122914 TI - Client-server design provides model for 'coopetition' alliances. AB - As healthcare organizations move from isolated departments to integrated information sharing, who will pilot this change? Both the director and manager of pathology data systems at the University of Michigan Hospitals in Ann Arbor suggest vendors, system integrators and hospital administrators put aside competition and try a new concept--"coopetition"--to solve the problem. PMID- 10122915 TI - 1992 laboratory listing. Product roundup. PMID- 10122916 TI - Meeting set to build consensus. AB - Europe and America clasp hands across the water on healthcare information standards at meeting of CEN Technical Committee 251. PMID- 10122917 TI - Britannia rules. PMID- 10122918 TI - Australasia heats up for growth. PMID- 10122919 TI - DRGs' effects worldwide. AB - The United States' Prospective Payment System has become a blueprint for healthcare cost-savings efforts worldwide. Not without its critics, PPS is now being modified and adopted in an effort to create a universal healthcare system in Europe. PMID- 10122920 TI - Four countries studied on quality. PMID- 10122921 TI - New approaches to managing diabetes. PMID- 10122922 TI - Training to improve customer relations. PMID- 10122923 TI - Service America goes on-line in healthcare. PMID- 10122924 TI - Eldercare foodservice: responding to the age of maturity. AB - America is rapidly aging. In response, foodservice professionals are breaking all precedents as they expand & market meal programs to accommodate the growing number of seniors in need of nutrition services. Five case studies illustrate how directors & dietitians are improving the quality of life for this nation's elders. PMID- 10122925 TI - Let's really cure the health system. PMID- 10122926 TI - Europe's lessons for the U.S. AB - President-elect Clinton can learn a lot from this continent about health care and how to revitalize cities. But industrial policy is another story. PMID- 10122927 TI - Yes, the market can curb health costs. AB - Memo to Clinton's transition team: forget those tough expenditure ceilings you're considering. Look instead at what managed competition is already accomplishing. PMID- 10122928 TI - Patient-focused hospitals begin reporting good results. PMID- 10122929 TI - Hospital/physician relations. How to manage and improve ties with group practices. AB - As doctors increasingly choose to enter group practices, hospitals must find new ways to build and maintain good relationships with physician groups. Hospitals should go beyond standard communication and relationship-building techniques and surprise their group physicians with innovative services, such as direct-to-bed admissions for the doctors' patients, computer links with the hospital, or placing a medical records branch office at the group practice. PMID- 10122930 TI - Health status of the community becoming focus of MHS (Mercy Health Services) system. Interview by Donald E.L. Johnson. AB - Since hospitals exist to stabilize and improve the health of the people they serve, they should form community health care systems that offer the full spectrum of services in an organized way, says Edward J. Connors, president of Mercy Health Services, in the following interview with Donald E.L. Johnson, editor and publisher of Health Care Strategic Management. Skills in epidemiology are desperately needed to accomplish this, as well as skills in statistics, information systems and outcomes measurement. Connors believes that a consensus has formed on the core content of health status measurement. Hospitals should start building the information base needed to improve the health status of their target population. PMID- 10122931 TI - Health status will be more important than outcomes. PMID- 10122932 TI - Planning indicators. Doctors utilize hospitals less, offices more. PMID- 10122933 TI - New rules on physician incentives. AB - The Office of Inspector General recently issued a Special Fraud Alert listing physician incentives it might consider "suspect." How should hospitals conform their incentive programs to the ruling? PMID- 10122934 TI - The evolution of Medicaid managed care in New York State. An interview with Rachel Block. Interview by Robert A. Padgug. PMID- 10122935 TI - Quality and Medicaid managed care. Who's watching? PMID- 10122936 TI - Another kind of Bronx cheer. Community-oriented primary care at the Montefiore Family Health Center. PMID- 10122937 TI - Single payer--fifty players? Alternative payers for universal health insurance. PMID- 10122938 TI - Universal access in Canada. Questions of equity remain. AB - Health/PAC readers will remember Samuel Wolfe's previous Bulletin article about Canada's national health care system ("Importing Health Care Reform? Issues in Transposing Canada's Health Care System to the United States," Summer 1990), in which he described the uniqueness of our northern neighbor's experience. At that time, Wolfe expressed doubt that a Canadian-like model could find sufficient political and social momentum to be propelled south. In this latest article, Wolfe is joined by his long-time colleague, Robin Badgley, to discuss the inequity and inequality they believe still exists within the Canadian system. Wolfe and Badgley's insightful analysis of what they see as shortcomings of the Canadian model and suggestions for their remedy are especially welcome given the questionable validity of most criticism of the Canadian system that Americans hear. Their work helps us understand the real problems that remain in the still evolving Canadian system. As Americans discuss the various possibilities for progressive single-payer reform, many envision of state-based system. Wolfe and Badgley point out that demographically rooted inequalities and the lingering health burdens of social class may interfere with truly national universal access. They also alert us to the dangers that federal retreat from adequate levels of support would pose to such a state strategy. Samuel Wolfe has a unique background as a country doctor, psychiatrist, and public health official who attended the difficult birth of Saskatchewan's provincial health plan--the prototype for Canada's national health insurance. A respected teacher, researcher, and community health activist, Wolfe has taught in the United States for more than 25 years. He will soon move back to Canada and the welcome security of its universal health care system. PMID- 10122939 TI - Medicaid managed care. A mixed review. PMID- 10122940 TI - Old and in the way. PMID- 10122941 TI - Benchmarking. Springboard or buzzword? PMID- 10122942 TI - Benchmarking. Building on received wisdom. PMID- 10122943 TI - Benchmarking the inpatient admitting process. PMID- 10122944 TI - Benchmarking. Looking for the light--not the heat. PMID- 10122945 TI - Best practices in ambulatory surgery. PMID- 10122946 TI - Benchmarking--a conversation with Robert C. Camp. The source. Interview by Joe Flower. PMID- 10122947 TI - Benchmarking: tales from the front. The search for what works. Compendium of experiences. PMID- 10122948 TI - Benchmarking. Tracking "the best" hospitals. PMID- 10122949 TI - Shodo management. PMID- 10122950 TI - Translating operational change into facility design. PMID- 10122951 TI - Self-induced bloodletting. PMID- 10122952 TI - Getting a jump on the 21st century. PMID- 10122953 TI - Point of service products: not just another managed care fad. PMID- 10122954 TI - State health insurance reforms: models or impediments for national health care reform? PMID- 10122955 TI - Courts slowly answer patient dumping law questions. PMID- 10122956 TI - Antitrust prosecution of health care professionals: the jury is still out. PMID- 10122957 TI - The FDA moves to implement the Safe Medical Devices Act. PMID- 10122958 TI - Hospital doubles size of emergency center--without disrupting care. Brackenridge Hospital, Austin, TX. PMID- 10122959 TI - Which on-site waste-treatment option will work best for you? PMID- 10122960 TI - Construction management controls costs, schedules. PMID- 10122961 TI - New Life Safety Code contains key fire changes. PMID- 10122962 TI - Health facilities prepare to meet the EPA's strict new silver-recovery regulations. PMID- 10122964 TI - Monitrend offers 2nd-quarter '92 operations data. American Hospital Association. PMID- 10122963 TI - Solution dyeing: more 'environmentally friendly'. PMID- 10122965 TI - Marketing to maximize profitability. AB - An effective marketing strategy should focus on serving profitable customers, not just adding new ones. The author offers five steps that marketers can follow to ensure that their efforts provide the greatest boost to the bottom line. PMID- 10122966 TI - The key to marketing to older consumers. AB - Marketers must put aside stereotypes and unexamined assumptions to reach older consumers. In this article, the author details their values and describes a technique that can be used to effectively position a product or service in older consumers' minds. PMID- 10122967 TI - A game plan for regional marketing. AB - Should your company consider taking a niche-marketing approach to fragmented national markets? Regional marketing is not for every firm or for every product or service. Here are the pluses to consider, as well as the pitfalls that must be overcome, before wading into regional waters. PMID- 10122968 TI - Targeting a company's real core competencies. AB - By recognizing its core competencies, a company can clearly define organizational boundaries and focus resources for maximum advantage. The authors outline an approach for identifying those competencies that can provide a company with the best chance to achieve long-term competitive advantage. PMID- 10122969 TI - The art of strategic sales alignment. AB - As companies move through the stages of their corporate life cycle, many fail to adjust their sales model to meet new business requirements. This article illustrates that problem with a case study of a major telecommunications organization and includes a three-step process that can be used during strategic planning and budgeting. PMID- 10122970 TI - Measuring product creation effectiveness. PMID- 10122971 TI - Encouraging employee-led change through constructive learning processes. PMID- 10122972 TI - If it ain't broke, it's because you fixed it. Education and awareness keep fleets running. PMID- 10122973 TI - The Ambulance Manufacturers Division--quietly serving the ambulance industry. PMID- 10122974 TI - Is EMS endangering kids? PMID- 10122975 TI - Adverse selection with a multiple choice among health insurance plans: a simulation analysis. AB - This study uses simulation methods to quantify the effects of adverse selection. The data used to develop the model provide information about whether families can accurately forecast their risk and whether this forecast affects the purchase of insurance coverage--key conditions for adverse selection to matter. The results suggest that adverse selection is sufficient to eliminate high-option benefit plans in multiple choice markets if insurers charge a single, experience-rated premium. Adverse selection is substantially reduced if premiums are varied according to demographic factors. Adverse selection is also restricted in supplementary insurance markets. In this market, supplementary policies are underpriced because a part of the additional benefits that purchasers can expect is a cost to the base plan and is not reflected in the supplementary premium. As a result, full supplementary coverage is attractive to both low and high risks. PMID- 10122976 TI - Estimating the indirect costs of teaching. AB - Medicare's Prospective Payment System pays teaching hospitals using a regression coefficient in a log-log cost function. Previous literature showed that this coefficient is sensitive to the covariates included in the function, but specified teaching intensity as the logarithm of one plus the intern and resident to-bed ratio. Provided the true relationship is log-log, adding one biases the coefficient substantially but not predicted cost. In a re-specified equation that makes this bias negligible, the coefficient is not nearly as sensitive to the inclusion of other covariates. Because further issues remain to be explored, it is premature to use our results for policy purposes. PMID- 10122977 TI - The determinants and effects of health expenditure in developed countries. AB - Previous studies of international differences in health spending have been restricted to the use of relatively small samples of cross-sectional data. Our objective here is to re-examine the results of previous work using a sample of 560 pooled time-series and cross-section observations. Results confirm the importance of GDP as a determinant of health spending, with an estimated income elasticity at or around unity, but also suggest that OECD countries should not be regarded as a single, homogeneous group. The importance of some non-income variables is also confirmed, although the direct effect of these factors appears to be small. PMID- 10122978 TI - Conversion factor instability in international comparisons of health care expenditure: some econometric comments. PMID- 10122979 TI - Reweighing heat: response to Culyer, van Doorslaer and Wagstaff. PMID- 10122980 TI - Job satisfaction among hospital nurses: facility size and location comparisons. AB - Despite recent declines in turnover and vacancy rates, maintaining a stable nursing staff continues to be critical to the effective operation of American hospitals. Job satisfaction is a pivotal element in nurse retention, and organizational theory suggests that some of the factors that influence job satisfaction vary by facility size. This is a study of job satisfaction among a sample of 731 nurses providing direct patient care in 22 hospitals. The sample includes approximately equal numbers of nurses employed in very small rural hospitals (1-49 beds), medium sized facilities located in small towns (50-99 beds), and larger metropolitan institutions (> 100 beds). Differences by hospital size were observed in overall job satisfaction and in five sub-dimensions of that concept (i.e., professional status, task requirements, pay, organizational policies, and autonomy). With the exception of pay, the results indicated that nurses employed in the very small rural hospitals were more satisfied with their jobs. Differences by hospital size were also observed in the personal characteristics of the nurses, several specific aspects of their job, and in their perceptions of job mobility. A set of four hierarchically nested ordinary least squares regression models indicated that job-specific characteristics were the most powerful predictors of job satisfaction. PMID- 10122981 TI - Job satisfaction and retention of rural community health nurses in North Dakota. AB - A correlation between job satisfaction and employment longevity has been demonstrated by a number of researchers. However, the measurable aspects of job satisfaction only partially explain an individual's tenure at a particular job. Information about the relationship between job satisfaction and retention of community health nurses in a rural state was provided by 258 community health nurses in North Dakota who responded to a mailed questionnaire. Job satisfaction assessment included measures of autonomy, task requirements, salary, benefits, rewards, professional status, organizational climate, and interpersonal interactions. Job satisfaction was analyzed by taking into account the individual importance of each component. While the majority (61%) of the responding nurses indicated that they expected to stay in their current jobs for a period of five years or more, they were dissatisfied with various aspects of their jobs. The greatest factor influencing the nurses' choice of current position was job availability, followed by preferences for the particular health care agencies or communities. These findings indicate that retention of rural nurses should focus on strategies that go beyond improving job satisfaction. PMID- 10122982 TI - Nursing supply and characteristics in the nonmetropolitan areas of the United States: findings from the 1988 National Sample Survey of Registered Nurses. AB - This study examines the supply and selected characteristics of nurses working in nonmetropolitan areas of the United States using the most recent data reported in the third national sample survey of registered nurses in 1988. Nursing supply is analyzed in terms of the ratio of registered nurses per 100,000 people for three standard nonmetropolitan census county size classifications and nine regional groupings of states. Seven dimensions relating to the educational background and current professional characteristics of registered nurses are studied. Findings indicate a notable difference in the ratio of nurses per population across county size and regions of the country. In terms of characteristics selected for this study, the educational background, salary gap, and time spent in various activities differentiate nurses in rural areas from those working in urban counties. Results of this study should be particularly relevant because a variety of educational, financial, and other incentives are being considered to address what is perceived to be a crisis in rural nursing availability. PMID- 10122983 TI - A three-tier model for the delivery of rural obstetrical care using a nurse midwife and family physician copractice. AB - To meet the needs of a large indigent rural population, a rural regional referral hospital in northeastern Kentucky developed a maternity program that utilizes nurse midwives and family physicians as the primary medical providers with support from obstetricians. After five years, the number of deliveries at the hospital has increased almost 30 percent, and the maternity center is now responsible for more than 70 percent of all deliveries at the medical center. Accounting for the large increase in the number of deliveries is an increasing number of women from surrounding areas who now utilize the maternity center and the hospital for their obstetric care. During the same time, there has been a corresponding decrease in deliveries to women with no prior prenatal care and a shift toward obtaining earlier prenatal care in the hospital service population. Results of the study suggest that combining the skills of nurse midwives and family physicians with surgical backup provided by a consulting obstetrician is an effective means of meeting the health care needs of an indigent, underserved rural population. PMID- 10122984 TI - The relationship of rural clinical rotations to where registered nurses practice. AB - An objective of exposing health profession students to rural clinical experiences was to overcome problems of geographic maldistribution of health personnel. Nevertheless, little can be said about the impact of rural training rotations on the supply of health personnel in rural areas or on students' decisions about where to practice. To assess the relationship between rural clinical rotations and practice locales, surveys were administered to all applicants taking registered nurse exams in Arizona in July 1990, February 1991, and July 1991. The students most likely to be working in rural locations were rural high school graduates with rural clinical experience during nursing school. Students who were urban high school graduates with rural clinical experience were only slightly less likely to locate in rural areas. Rural and urban high school graduates with no rural clinical experience were far less likely to choose rural practice. Rural rotations were associated with rural job selection only if students attended rural educational programs. PMID- 10122985 TI - Meeting the health care needs of rural elderly: client satisfaction with a university-sponsored nursing center. AB - Responding to health care needs of the elderly has presented great challenges for health care professionals. These problems are compounded in rural communities by physical and social isolation, increased poverty, and lack of transportation. An innovative approach to meeting health needs of rural elderly is through nursing centers. Through an emphasis on health promotion and maintenance of optimal level of functioning, these primary health care facilities can foster independence and self-care for this targeted population. In addition, nursing centers serve as clinical sites for student learning experiences and settings for nursing research. This article focuses on a nursing center established at Edinboro University of Pennsylvania (EUP), which tailors its services to the elderly living in Edinboro. Results of a client satisfaction survey, based on the Risser Patient Satisfaction Instrument, are described in addition to patterns of nursing center usage, general categories of care, teaching interventions, referrals, counseling, and frequency of visits. Findings from the survey indicated a general high client satisfaction level with nursing care received at the center. Discussion also includes plans to expand services to elderly in the community through home visits. PMID- 10122986 TI - Sports injury/illness reporting at major sporting events: development and implementation of a data collection system. AB - When a large number of athletes compete intensely over a short period of time, a variety of sports injuries and illnesses are often encountered. Maintaining health records at these events presents a challenge to medical organizing committees. Accurate data collection is important, not only for planning of medical services, but also for development of prevention programs and policies relating to athletes' health. Recruitment of a dedicated data collection team with sports medicine background and computer expertise will facilitate collection and analysis of medical data at this type of event. This paper reviews the development and implementation of a sports injury and illness recording system used at the 1989 Jeux Canada Summer Games. Over 3500 participants had access to comprehensive medical services during the two weeks of competitions. Information on medical encounters was available daily during the games and a final report on sports injuries and illnesses was easily generated. PMID- 10122987 TI - Canadian physiotherapists' professional identity: an exploratory survey. AB - This survey was funded and conducted by the Ontario and Canadian Physiotherapy Association Task Force on Professional Identity. Professional identity influences the image an occupation projects to its clients, the public, other occupations and governments. As an aid to planning strategy for advancing the professional image of physiotherapy, an open-ended questionnaire explored Canadian physiotherapists' professional identity. Professional identity is promoted by Canadian Physiotherapy Association (CPA) branches and districts. Most therapists identified their skills and potential benefit for patients, but only 15% identified themselves as a member of a health profession involved in a rewarding career. Physiotherapists have achieved many characteristics of an independent profession, but expressed frustration reveals that some members lack power on a personal and professional level. PMID- 10122988 TI - A comparison of physical therapy in Canada and the United States. PMID- 10122989 TI - Foundation turns on footlights. Variety show fuels parenting and children's programs. Yakima Valley Memorial Hospital, WA. PMID- 10122990 TI - The future of healthcare. Seven experts look ahead. AB - If there were ever a time to have a crystal ball, it's now. In today's healthcare environment the only thing that seems certain is change. To help marketers make some educated guesses about the future of healthcare, hospitals, and the market, PROFILES invited seven experts to prognosticate. They considered what might happen in this decade, and what could be reality in 25 to 50 years. They address topics ranging from surgery of the future to how consumers will find healthcare information. Here are a few of their predictions: 1. Managed care will dominate the market. 2. More hospitals will close. Those remaining will consolidate or collaborate and draw closer to their communities. 3. Doctors and hospitals will build partnerships. More doctors will be salaried. 4. Cost controls will increase. 5. Quality will differentiate hospitals and drive marketing. 6. Patients will become more involved in their care and in their selection of hospitals. 7. Drug treatments will play an increased role as surgery declines. PMID- 10122991 TI - Sending physicians back to school. Direct mail education program brings strong response. Continental Medical Systems, Inc., Mechanicsburg, PA. PMID- 10122992 TI - The healing powers of direct mail. Small, rural hospital promotes high technology and new image. Barrow Medical Center, Winder, GA. PMID- 10122993 TI - Opening a passport to the senior market. Club offers food, fun, and friendly advice. Bayshore Community Hospital, Holmdel, NJ. PMID- 10122994 TI - Turning small wonders into big results. Media campaign and LDR renovation increase births for two hospitals. Singing River Hospital, Pascagoula, MS; Ocean Springs Hospital, MS. PMID- 10122995 TI - Catching the subacute wave. Spring Creek Rehabilitation Hospital, Dallas, TX. PMID- 10122996 TI - Spicing up staff morale. Gourmet chefs turn cafeteria into fine restaurant. Harborview Medical Center, Seattle, WA. PMID- 10122997 TI - Breaking into cancer's big leagues. Image campaign with modest budget brings Texas-sized results. Northeast Medical Center Hospital, Humble, TX. PMID- 10122998 TI - Why the prognosis for reform is poor. PMID- 10122999 TI - Global health care policy innovative challenges. Interview by Professor Sakai Iwasaki. PMID- 10123000 TI - The future of hospitals. PMID- 10123001 TI - Strategic intent & direction for the NHS in Wales. Welsh Health Planning Forum. AB - The Welsh Principality has a health service that is separately managed from that of England. Its director, John Wyn Owen, chairs a Welsh Health Planning Forum which was established in 1988 by the Secretary of State for Wales as an advisory subgroup of the Executive Committee of the Health Policy Board of the NHS. Its role is to give expert advice on the planning of health services. In November 1989, the Forum launched what is likely to become a landmark document in Welsh NHS history. Strategic Intent and Direction for the NHS in Wales is reproduced here in its entirety. PMID- 10123002 TI - Dr Louis W Sullivan--Secretary of Health and Human Services, USA. Interview by Dieter JR Pohl. PMID- 10123003 TI - Geriatric planning: planning for our elderly. AB - The objective of this article is to persuade policy-makers that we can improve planning for our elderly. An alternative model is presented--The Geriatric Centre -with location based upon city neighbourhoods, suburban and rural communities, and having neighbourhood responsibility, accountability and a comprehensive service delivery. PMID- 10123004 TI - Successfully integrating information systems into healthcare. AB - Many hospital managers are currently looking at implementing hospital information systems (HIS) for the first time, or planning replacement of their first HIS. This article is intended as a resume of 'best practice' in terms of how to approach the selection and implementation of an integrated HIS--a "Do's and Don'ts Guide" for hospital managers. Emphasis is placed on the importance of management assuming overall responsibility for the HIS as a vital communications tool to support the provision of healthcare. Since the HIS underpins the 'business aims' of the institution, these need to be clearly defined at the outset. How to evaluate the benefits of an HIS supplier and aspects such as encouraging an atmosphere of ownership of the HIS by all staff are reviewed in the article. PMID- 10123006 TI - A multicentre audit of hospital referral for radiological investigation in England and Wales. Royal College of Radiologists Working Party. AB - OBJECTIVE: A baseline audit of radiology referral practice before the introduction of a strategy for change involving guidelines of good practice, monitoring, and peer review. DESIGN: Prospective data collection over a continuous 12 months period at each centre sometime between January 1987 and December 1989. SETTING: Five district general hospitals and one district health authority. SUBJECTS: 159,421 inpatient discharges, deaths, and day cases and 861,370 outpatient attendances under the care of 722 consultants from 25 clinical specialties. MAIN OUTCOME MEASURES: Monitoring of x ray examination referrals per 100 inpatient discharges, deaths, and day cases and per 100 new outpatient attenders after establishment of a computerised data collection system. RESULTS: Referral rates for all x ray examinations varied between firms in the same specialty or sub-specialty by as much as eightfold for inpatients and 13-fold for outpatients, and for chest x ray examination by as much as ninefold for inpatients and 25-fold for outpatients. There was no consistent relation between high referral and teaching status of the centre or specialty or subspecialty. CONCLUSIONS: The variation that persisted at all levels of disaggregation of the data supports a recent suggestion that at least a fifth of x ray examinations carried out in Britain may be clinically unhelpful. An intervention study that examines the effect of guidelines of good practice and attendant peer review procedures on the baseline referral levels described above is needed to test this hypothesis further. PMID- 10123005 TI - The renaissance of excellence: re-establishing good management in a devastated teaching hospital. AB - An institutional development team of four technical advisers has been working at Mulago Hospital, the 1440-bed National Teaching and Referral Hospital, since 1983 to assist the hospital to re-establish working management systems, drug and supplies procurement arrangements and an engineering maintenance service. The hospital was in poor shape at the beginning of the project, but has improved over time. The Team works with counterparts to advise, coach, train, facilitate and support their development. External factors have contributed to the progress made, but the Team's contribution included long term availability in the hospital, the sustainable nature of the counterpart relationship, practical and material assistance, and access to outside charitable funds. PMID- 10123007 TI - Hospital supply response to prospective payment as measured by length of stay. PMID- 10123008 TI - The economics of group practice: a reassessment. PMID- 10123009 TI - Tax exemption and community benefits of not-for-profit hospitals. PMID- 10123010 TI - Market forces and the public good: competition among hospitals and provision of indigent care. PMID- 10123011 TI - Medical malpractice, technological change, and learning-by-doing. PMID- 10123012 TI - The cost-effectiveness of community care for former long-stay psychiatric hospital patients. PMID- 10123013 TI - The future of nursing home policy: should policy be based on an excess demand paradigm? PMID- 10123014 TI - Macro forecasting of national health expenditures. PMID- 10123015 TI - Policy and research on health manpower regulation: never too late to deregulate? AB - Research on health manpower regulation has reached a consistent conclusion for the last two decades that is likely to carry into the 1990s: deregulate. Research has progressed in recent years, however, and research in the 1990s will be quite different from that of the past two decades. While the battle cry "never too late to deregulate" will continue to be heard, the "easy" targets, those markets with the least extensive or least important information asymmetry, have already been attacked. What is (or should be) finally emerging in the 1990s is a more challenging appraisal of health manpower regulation, one that recognizes greater complexity in health care markets and consumer preferences than has been recognized in past research. Lessons for the 1990s include the need to recognize, accept, and study information asymmetry and its consequences, and to more closely analyze the hypothesis that occupational interest groups, while meeting their self-interest, also may be serving the commonwealth. Such a reorientation leads us to ask different questions of regulation in future research, all directing attention to the informational attributes of markets: (1) How much information asymmetry exists in different health care markets, and how important is it? In which information-asymmetric markets is manpower regulation most likely to benefit consumers? (2) How can information asymmetry between consumers and providers be reduced, thereby facilitating deregulation? (3) How many regulations, of what type, are consumers willing to eliminate, for what benefits? Simplistic policy recommendations are less likely with this new orientation, and there is a great deal of interesting research awaiting health services researchers. PMID- 10123016 TI - Hospitals hold the line on charges in effort to hold on to customers. AB - In a response to public criticism of spiraling healthcare costs, a handful of hospitals have cut room rates and other patient charges in an effort to make their services more affordable, allowing the facilities to use their low-cost image as a marketing tool. To help keep a lid on their prices, the hospitals are focusing on slashing administrative costs while investing in outpatient and home healthcare services. PMID- 10123017 TI - Physician fee schedules help employers control cost increases. PMID- 10123018 TI - New technology helps companies, providers find best routes for marketing, expansion. PMID- 10123019 TI - Reduction of work force. PMID- 10123020 TI - Healthcare smart cards: tragedy in plastic? Or a happy ending waiting for a venue? PMID- 10123021 TI - Computer-assisted planning for orthopedic surgery. AB - Faced with challenging deformities and crippling arthritis, orthopedic surgeons frequently are called upon to perform increasingly complex reconstructive surgery. The desired goals of treatment include correction of deformities, relief of pain, and preservation or restoration of function. PMID- 10123022 TI - Legalities, lawsuits & liabilities: a primer for pulling the plug. PMID- 10123023 TI - Pharmacy computing reaches maturity. PMID- 10123024 TI - Justifying a new HIS to the belt-tightening CFO. PMID- 10123025 TI - IS choices for growing facilities. PMID- 10123026 TI - Kicking tires at Humana. PMID- 10123027 TI - Streamlining information access via the smart, hub-based, hospital-wide network. PMID- 10123028 TI - St Bartholomew's Hospital--project review. PMID- 10123029 TI - Disposal of fluorescent lamps. PMID- 10123030 TI - Environment means business. PMID- 10123031 TI - Local colors. Central Washington Hospital, Wenatchee. PMID- 10123032 TI - The truth about SARA (Superfund Amendments and Reauthorization Act). PMID- 10123033 TI - TB update: NIOSH recommends respiratory protection for healthcare workers. PMID- 10123034 TI - QI teams flourish in Michigan hospital four years after starting TQ; healthcare trailblazer boasts of savings, customer satisfaction. PMID- 10123035 TI - System proponents say satisfaction raised only by measuring patients' expectations. PMID- 10123036 TI - Data watch. A snapshot of mid-sized employer benefits. PMID- 10123037 TI - Survey: paternalism limits cost control at mid-sized employers. PMID- 10123038 TI - What's ahead in health care for 1993? PMID- 10123039 TI - Employers plan more aggressive cost-cutting strategies, benefits survey shows. PMID- 10123040 TI - Health care group aims at community-based delivery systems. Institute for Alternative Futures. PMID- 10123041 TI - Reformers choose sides in health debate. PMID- 10123042 TI - Florida group benefits from quality data. Central Florida Health Care Coalition. PMID- 10123043 TI - R.I. reform package may save millions. PMID- 10123044 TI - Many factors influence medical outcomes. PMID- 10123045 TI - Fewer insurers can improve competition. PMID- 10123046 TI - Start the revolution with me. Insurers offer a plan to fix the health-care mess. PMID- 10123047 TI - Medicare and Medicaid programs; approved information collection requirements and HCFA's claims collection authority--HCFA. Final rule with comment period. AB - This final rule updates our display of control numbers assigned by the Office of Management and Budget (OMB) to approved "collection of information" requirements contained in regulations governing the Medicare and Medicaid programs. In addition, it incorporates a technical change to our regulations to reflect increased agency authority under the Federal Claims Collection Act, 31 U.S.C. 3711 et seq. This rule is issued in accordance with OMB regulations concerning approved collections of information and to conform to changes made by Public Law 101-552. PMID- 10123048 TI - Medicare program; continuous use of durable medical equipment--HCFA. Final rule. AB - This final rule responds to public comments on the October 9, 1991 interim final rule with comment period that set forth the Secretary's determination, required under section 1834(a)(7)(A) of the Social Security Act, of the meaning of the term "continuous" as that term is used in defining a period of continuous use for which we make payments for durable medical equipment. PMID- 10123049 TI - Federal financial participation in state assistance expenditures; federal matching shares for Aid to Families with Dependent Children, foster care and adoption assistance, job opportunities and basic skills training, Medicaid, and aid to needy aged, blind, or disabled persons for October 1, 1993, through September 30, 1994--HHS. Notice. AB - The Federal percentages and Federal medical assistance percentages for Fiscal Year 1994 have been calculated pursuant to the Social Security Act. These percentages will be effective from October 1, 1993, through September 30, 1994. This notice announces the calculated "Federal percentages" and "Federal medical assistance percentages" that we will use in determining the amount of Federal matching in State welfare and medical expenditures for programs under titles I, IV-A, IV-E, IV-F, X, XIV, XVI (Aid to the Aged, Blind, or Disabled), and XIX. The table gives figures for each of the 50 States, the District of Columbia, Puerto Rico, the Virgin Islands, Guam, American Samoa, and the Northern Mariana Islands. The percentages in this notice apply to State expenditures for assistance payments, IV-A child care, JOBS services, and medical services (except family planning and certain JOBS expenditures which are subject to a higher matching rate). The statute provides separately for Federal matching of administrative costs. Sections 1101(a)(8) and 1905(b) of the Act requires the Secretary of Health and Human Services to publish these percentages each year. The Secretary is to figure the percentages, by formulas described in sections 1101(a)(8) and 1905(b) of the Act, using the Department of Commerce's statistics of average income per person in each State and in the Nation as a whole. The percentages are within upper and lower limits given in those two sections of the Act. The statute specifies the percentages to be applied to Puerto Rico, the Virgin Islands, Guam, American Samoa, and the Northern Mariana Islands.(ABSTRACT TRUNCATED AT 250 WORDS) PMID- 10123050 TI - Tapping the largest single capital source. Senior's home is sponsor's biggest competitor. PMID- 10123051 TI - Integration of care and caring. Could you provide information on what the role of social services should be in long-term care facilities? PMID- 10123052 TI - A mixed bag. Nursing home chain survey identifies divergent strategies. PMID- 10123053 TI - Nursing shortage takes center stage. PMID- 10123054 TI - Unnecessary drug requirements. PMID- 10123055 TI - Medical use of psychotherapeutic drugs. Don't overlook appropriate treatment. PMID- 10123056 TI - Occupational Outlook Handbook, 1982-83 edition. How accurate were the projections? AB - Users need to know if the outlook information in the Occupational Outlook Handbook proves right. This evaluation shows that most of the 1980-90 projections were on target. PMID- 10123057 TI - A nursing evaluation of unit dose and computerized medication administration records. AB - A nursing evaluation of the unit dose system and a computerized medication administration record (MAR) was conducted to determine satisfaction with and perceptions of the effectiveness of these programs. A Nursing Evaluation Questionnaire was used to document nurses' attitudes towards the new programs. Of 228 questionnaires distributed on eleven nursing units, 152 were returned (response rate 66.7%). Full-time registered nurses represented 73.7% of the respondents, part-time 21% and casual 5.3%. Of the 152 respondents, 86.6% reported at least "some" time savings preparing and administering medications with the unit dose system, with 57% of this group reporting "significant" time savings. Unit dose was considered a safer distribution system by 82% of the respondents. Almost all of the respondents (99.3%) would choose to work with the unit dose system. Of the 152 respondents, 86% reported the computerized MAR decreased time spent charting medications administered, with half of this group reporting "significant" time savings. The computerized MAR was considered a safer charting method by 74% of the respondents. All of the respondents (100%) would choose to work with the computerized MAR. The evaluation indicated the unit dose system and computerized MAR were well accepted by nursing staff and were perceived to be working effectively. PMID- 10123059 TI - Going clinical: the White Paper--two years later. AB - Overall, there is agreement from attendees at the Regional Seminars that the White Paper on the Establishment and Elaboration of Clinical Pharmacy Services is a document of major importance to the profession, that the principles and the skills stressed in the White Paper should be promoted continually through seminars and standards, and that it is appropriate in terms of meeting the needs of practitioners for the advancement of clinical pharmacy practice. There is a general sense that these "How To" efforts are the best mechanism for practitioners to increasingly adapt to the needs of becoming clinical practitioners. In addition, the idea is often expressed that this type of seminar needs to be offered repeatedly for different practice populations. There are implications expressed for political action by CSHP and for changes in our schools of pharmacy. Overall, the first efforts of CPAC have been met with broad satisfaction and a demand for further publications, educational seminars and research projects. PMID- 10123058 TI - A cost effective approach to surgical antibiotic prophylaxis. AB - Cefoxitin has been the prophylactic antibiotic of choice for appendectomy and colorectal surgery at this institution. Recent information suggests that cefazolin and metronidazole given as a single intravenous preparation could be a cost-effective alternative to cefoxitin or cefotetan for surgical antimicrobial prophylaxis of uncomplicated appendectomies. This study was conducted to determine the efficacy, toxicity, and cost of the current antibiotic regimens used for prophylaxis of uncomplicated appendectomies, to evaluate the efficacy, toxicity and cost of the cefazolin plus metronidazole combination in uncomplicated appendectomies, and to facilitate a cooperative working relationship between the Departments of Pharmacy and General Surgery. Although the numbers involved were small, this study suggests that the cefazolin/metronidazole combination is cost-effective. It is suggested that research is warranted in evaluating combinations such as this as cost-effective alternatives to current therapy. PMID- 10123060 TI - Enhancing service delivery and building a data base. PMID- 10123061 TI - Discharge strategy dramatically reduces patient overstays. PMID- 10123062 TI - Discharge planning: a look at successful collaboration. AB - The Department of Patient Services and Discharge Planning is an efficient, well integrated, cost-effective group of clinical programs that has merged behind the common goal of high-quality patent care. So much is read about the bickering between the disciplines and the issues related to turf; however, this department has been able to transcend to another level where the patient becomes the focus and patient-centered, patient-valued care becomes the mission. PMID- 10123063 TI - Discharge planning for foreign nationals: complex, complicated. PMID- 10123064 TI - High-risk screening: a chronology. PMID- 10123065 TI - Discharge planning has high profile in England. PMID- 10123066 TI - Scene communications pitfalls. AB - Sloppy communications endanger patients' lives. Here's a pragmatic approach for improving dispatch protocols and advice on avoiding fundamental scene goofs. PMID- 10123067 TI - EMS in the fast lane. PMID- 10123068 TI - Don't crowd me! PMID- 10123069 TI - Developing a QA program. AB - EMS administrators and staff must focus as much attention as possible on effective delivery of patient care. In the past, much of our time and many of our resources were spent on administrative activities, neglecting the most basic purpose of EMS organizations: patient care. We, as a nation, already have policies, indicators and procedures to evaluate the care provided in the hospital setting. The development of an EMS QA program will help you set--and meet--those same standards in the field. PMID- 10123070 TI - Completely effective Bloodborne Pathogens Standard compliance. PMID- 10123071 TI - The evolution of utilization review liability. PMID- 10123072 TI - Informed consent and battery claims in AIDS transfusion cases. PMID- 10123073 TI - Special report on taxation. Living with the new reimbursement bond regulations. PMID- 10123074 TI - Inspector General issues another "fraud alert"; what's left of physician recruiting? PMID- 10123075 TI - Institutional Review Board policies and procedures provide protection for human research subjects and hospitals. PMID- 10123076 TI - Providing patient-centered care. PMID- 10123077 TI - The long-distance administrator. PMID- 10123078 TI - Shrinking share. PMID- 10123079 TI - Succeeding in uncertainty. PMID- 10123080 TI - In due time. PMID- 10123081 TI - The U.S. medical liability system: conceptual model and proposals for reform. PMID- 10123082 TI - Adherence to medication regimens: updating a complex medical issue. AB - Clinicians face nonadherence as the norm in everyday medical practice. The literature suggests a number of techniques that are likely to increase adherence when incorporated into regular clinical practices and routines. Central to these guidelines appears to be the doctor-patient relationship. For instance, the physician who uses understandable language, encourages open doctor-patient exchange, fosters participation by patients in their own medical care, and creates a friendly and efficient environment should increase the likelihood of adherence. Clinicians can also check adherence to medication regimens by requesting patients to bring in their pill bottles (or other prescription containers) for a discussion on how the medication appears to be working for them. This should elicit information from the patient about problems related to medication adherence. Since patient variables and social support affect adherence behaviors, eliciting information from patients about their understanding and beliefs regarding their particular illness and treatment, as well as enlisting the support of family and friends, may encourage adherence. Identifying what individual patients perceive as obstacles in following treatment regimens decreases their likelihood of nonadherence; these are difficulties that can be negotiated during the medical interview. Individualizing the treatment and minimizing its complexity may provide the solution that encourages adherent behavior. Frequent reeducation, reinforcement, and encouragement, as well as training in self-management and self-monitoring, will at the very least maximize the patient's comprehension of the illness and his or her motivation for adherence--an especially important requisite for living with a chronic condition. Some patients may even wish to openly solicit family and friends for help in the management and monitoring of their illness and treatment, and to structure their environment to support adherence. Education programs for the patient featuring handouts and pamphlets that provide information about the illness in written and illustrated form have been used successfully. Education programs such as patient oriented package inserts to accompany the medications and brief written summaries of complex treatment plans may also be useful. The purpose of such patient education adjuncts to illness and treatment lie in the hope that they will enhance the likelihood of following treatment recommendations. Through their use, the reason for the treatment and its potential effectiveness will, it is hoped, be better understood (Ley 1988). Overall, significant advances have been made in adherence research. Measurement systems have become more finely tuned, and the definitions and criteria for adherent behaviors are more clear and precise.(ABSTRACT TRUNCATED AT 400 WORDS) PMID- 10123083 TI - Physician-patient satisfaction: equity in the health services encounter. PMID- 10123084 TI - Joining the bar code revolution. PMID- 10123085 TI - What are all those lines and spaces? Understanding bar code technology. PMID- 10123086 TI - Innovative ideas for complying with OSHA regs. PMID- 10123087 TI - Boost QI efforts with expert technology. PMID- 10123088 TI - Marketing imaging services. AB - "Communication with physicians and patients is critical to successfully marketing technology," says Mr. Bouchard, author of a new handbook for radiology managers. In this section from his book, he describes the components of a successful marketing plan and tries to dispel several myths about marketing. He also describes benchmarks for success, and provides a sample plan to promote mammography services. PMID- 10123089 TI - Continuous quality improvement at work in radiology. AB - The performance of a system depends on how its parts fit together. A radiology department is such a system. When doctors complain to administrators about the time it takes to get test results, the system isn't performing well. Use of the continuous quality improvement (CQI) process helps analyze the system, identify problems and fix them. At Sentara Norfolk General Hospital one year ago, an average 72.5 hours elapsed between the time a radiological examination was completed and a written report delivered. Today, that time is 11.3 hours, and still improving. This article describes Sentara Health System's CQI process and how it worked for radiology. PMID- 10123090 TI - Redesigning radiology's work: an imperative model for the future. PMID- 10123091 TI - Pension plans of radiology practices. AB - Despite the ubiquity of pension plans in radiology practices and their importance to employees and radiologists, no data on pension plans are available. This lack of information is particularly unfortunate given proposed government actions that would require radiology practices to extend their pension plans to cover employees of hospital radiology departments. To develop information on pension plans and to show the adverse consequences of such actions, the American College of Radiology conducted a stratified telephone survey of 120 radiology practices in the United States. Some 88% of radiology practices have retirement plans. Results indicate that 91% of hospitals already have pension plans for their employees. Under the proposed government regulations, each radiologist would be required to provide pension coverage for an average of 7.4 hospital employees who assist radiologists in their hospital-located work. Concerns about these regulations had led radiology practices to freeze or terminate 23% of their pension plans by late 1990. The negative consequences of the proposed regulations are therefore quite serious. PMID- 10123092 TI - Medical device reporting for user facilities. AB - Reprinted from a report by the Center for Devices and Radiological Health, this article answers questions about the "tentative final rule," which outlines medical device reporting requirements for user facilities, distributors and manufacturers. Besides providing general information about the proposed regulation, the article describes which facilities are affected, which device related incidents must be reported and how to report them. PMID- 10123093 TI - OSHA safety requirements for hazardous chemicals in the workplace. AB - This article outlines the Occupational Safety and Health Administration (OSHA) requirements set forth by the Hazard Communication Standard, which has been in effect for the healthcare industry since 1987. Administrators who have not taken concrete steps to address employee health and safety issues relating to hazardous chemicals are encouraged to do so to avoid the potential of large fines for cited violations. While some states administer their own occupational safety and health programs, they must adopt standards and enforce requirements that are at least as effective as federal requirements. PMID- 10123094 TI - An integrated approach to measuring potential spatial access to health care services. AB - In recent years there have been several attempts to develop quantitative measures of potential spatial access to health care services which, despite their limitations, offer many positive ideas that can perhaps be integrated into a logically consistent and generally acceptable index. It is in this vein that the current paper presents an integrated approach, drawing partially from past contributions, to measuring potential spatial access to health care services. The final access index is derived as the culmination of a series of individual measures, starting with an initial gravity formulation and progressing through successive stages as new elements, consistent with the definition and conceptualization of potential spatial access, are introduced. Application of the proposed index to the ambulatory medical care system of the Akron, Ohio SMSA, demonstrates the validity of the measure, and its suitability as a potential health care planning tool. PMID- 10123095 TI - An application of a spatially distributed queuing model to an ambulance system. AB - An application of a spatially distributed queuing model to an ambulance system is presented. The purpose of this research was to assess the usefulness of a variation of the "hypercube" queuing model developed specifically for modeling an ambulance system. The model was applied to the emergency medical system of Greenville County, South Carolina using historical data. Results indicate that the model provides reasonably accurate estimates of system performance measures when the input parameters can be accurately specified. PMID- 10123096 TI - Ethical considerations for the group therapist. PMID- 10123097 TI - Perspectives. 1992: healthcare policy reaches a crescendo. PMID- 10123099 TI - Perspectives. Florida builds on managed competition. PMID- 10123098 TI - Perspectives. ERISA: health reform's first hurdle? PMID- 10123100 TI - Fetal monitoring during air medical transport. AB - A prior survey of physiologic monitoring practices during maternal air medical transport by helicopter found that cardiotocography is rarely utilized. The authors report their experience with fetal heart-rate monitoring during helicopter transport of high-risk mothers. The technique is as readily applied to the care of the patient in a helicopter as it is in the modern labor and delivery suite. The study found no substantial reasons why such monitoring should not be used in air medical transport. PMID- 10123101 TI - Foundation for aeromedical research. Past, present and future. AB - Research is vital for the future of air medical transport. It is not only needed to prove the medical benefits and safety of air medical transport, but also to find out the efficacy of using rotor- and fixed-wing aircraft to move patients. Moreover, in order to grow, the air medical transport profession must integrate new technologies and methods through development and testing. PMID- 10123103 TI - New studies show impact of DNR on care and costs. PMID- 10123102 TI - The transfer pyramid: an educational and marketing tool. PMID- 10123104 TI - Skeptical but optimistic outlook given to Clinton administration. PMID- 10123105 TI - Whose rights prevail for dead mother carrying living fetus? PMID- 10123106 TI - Aid-in-dying voted down, but issue heats up. PMID- 10123107 TI - Surrogate decisions come under scrutiny. AB - Although the ethical, moral, and legal aspects of surrogate decision making for incompetent patients have been widely discussed and debated, the extent of agreement between patient wishes and surrogate choices have only recently emerged. The following articles describe the findings of a recent study and summarize some views on the impact of state surrogacy statutes on advance directives. PMID- 10123108 TI - Affiliated societies of the Alabama Hospital Association. Number 6 in a series. PMID- 10123109 TI - Employee child care: benefitting hospitals and staff alike. PMID- 10123110 TI - Senior partners. AlaHA's Senior Citizens Advisory Council and the health concerns of older citizens. AB - Both hospitals and seniors groups will be among the prominent players when health reform discussions heat up. In the spirit of cooperation and greater understanding, the two have teamed up to form the Senior Citizens Advisory Council. PMID- 10123111 TI - Total cost management: an introduction. PMID- 10123112 TI - A plan to involve staff nurses in building a cost-effective unit. PMID- 10123113 TI - Results of the 1992 manpower survey. PMID- 10123114 TI - Changing provider behavior--the new PRO scope of work. PMID- 10123115 TI - An optical view ... optical healthcare card. PMID- 10123116 TI - Joint Commission Report. Information Management Task Force. PMID- 10123117 TI - Professional practice forum: photographs and videotapes. PMID- 10123118 TI - A look at Master's Degrees among health information management professionals from 1985 to 1992. PMID- 10123119 TI - Development of a model graduate program and center of excellence in health information resources management: University of Alabama at Birmingham experience. PMID- 10123120 TI - Early experience in training health information managers. PMID- 10123121 TI - Call me professor? Managing an academic career in health information management. PMID- 10123122 TI - The academic internship in the Stephens College Health Information Management Program. PMID- 10123123 TI - Embracing the total quality management philosophy in education: a lesson in leaves. PMID- 10123125 TI - Health information management as a system of production and service. PMID- 10123124 TI - Keyless data capture: a report of the Automatic Identification Teacher's Institute. AB - There is tremendous potential in auto ID technologies for increasing productivity and accuracy in the management of health information. We must make a commitment to integrate keyless data capture technologies into medical record administration and medical record technology curricula. Our profession will seize the opportunity if we can educate students and practitioners in the knowledge and skills to unleash this potential. A recent study of medical record administration, and medical record technology, programs by Elaine Patrikas revealed that, at best, some programs devote a maximum of 10 hours of instructional time to the teaching of keyless data capture technologies. HIM professionals can aggressively pursue applications that demonstrate tremendous cost savings, so that upper management will seriously consider them. Improvements in the flow of, and access to, information do directly impact patient care thus helping our profession fulfill its mission and preparing tomorrow's leaders and decision makers. PMID- 10123126 TI - Retrospective calculation of HIV-specific bed census using admission and discharge dates from existing health information data. PMID- 10123127 TI - Concurrency and process synchronization. PMID- 10123128 TI - Home health agency computer systems: current status and future directions. PMID- 10123129 TI - User as software developer: back to the future in custom-designed applications with hypertext and hypermedia. PMID- 10123130 TI - Coding specialist program. PMID- 10123131 TI - Listening to patients: a clear sign for hospitals. Interview by Matthew D. Pavelich. PMID- 10123132 TI - One hospital's trip up the down staircase. AB - This study illustrates one hospital's response to fiscal restraint. An Edmonton facility was able to reduce its budget while changing its strategic direction. During a planning process the hospital identified clinical needs that were not being met and, subsequently, reduced less utilized programs while allowing funding of new programs. This article identifies notable features of the budget reduction, provides information required to duplicate the process, and concludes with an analysis of the merits and shortcomings of such an approach. PMID- 10123133 TI - Americans and Medicare: setting the record straight. PMID- 10123134 TI - Health agencies and fundraising success. AB - Non-profit health agencies face critical decisions when allocating resources for fundraising efforts. Agency managers and board members need to consider the pros and cons of using in-house or contracted fundraisers. Marketing expenditures, target populations, and fundraising techniques must be determined. A recent study analysed data from 85 Canadian health agencies to learn more about the characteristics of agencies that are successful in fundraising. This article provides a brief description of the study and its findings. PMID- 10123135 TI - Hospital capital funding. AB - It is critical that hospitals have a long-range plan in place to ensure that buildings and equipment are replaced when necessary. A study undertaken in British Columbia contrasted the Greater Vancouver Regional Hospital District's capital plan (past and future) to a proposed capital replacement model. The model, developed using accepted industry standards and criteria, provided an asset value that was used for comparison purposes. Building and equipment expenditures of the Surrey Memorial Hospital were also compared against the model. Findings from both studies are presented in this article. PMID- 10123136 TI - Economy, costs and funding: key issues for Canada's health care system. AB - The complex relationship between health care and the economy has been the subject of many a study. Mutually dependent on one another, the proficiency with which the government funds services, such as health care, is contingent upon the strength of the economy. Sustaining a healthy economy, therefore, becomes essential to the well-being of Canadians. This article explores some of the key issues which are affecting the Canadian economy, health care costs and health care funding. PMID- 10123138 TI - Restrictive state advance directive statutes: risk management implications. PMID- 10123137 TI - What's involved in a program transfer between hospitals? AB - More hospitals are being forced to restructure in a bid to cope with financial constraints. One effective option is the transfer of clinical programs between facilities. The procedure is complicated and commands good leadership, negotiating skills, trust and a comprehensive understanding of the program being transferred. This article deals with the knowledge gained from the recent successful transfer of the Adult Cystic Fibrosis Program and its associated operating funds from one Toronto hospital to another. PMID- 10123139 TI - Patients leaving against medical advice: assessing the liability risk. PMID- 10123140 TI - Controlling risks in the use of lasers. PMID- 10123141 TI - Risk management and medical technology: the case of obstetrical malpractice. PMID- 10123142 TI - Revised standards for protection against radiation; minor amendments--NRC. Final rule: minor corrective and conforming amendments. AB - This final rule makes a number of minor corrective and conforming amendments to the NRC's revised standards for protection against radiation. The final rule is necessary to correct recently discovered errors in the text of the revised standards, to conform portions of regulatory text to the Commission's decision to defer mandatory implementation of the revised standards until 1994, and to reflect the recent OMB approval of the use of NRC Forms 4 and 5. PMID- 10123143 TI - Medical devices; procedures for premarket notification, premarket approval, classification, performance standards establishment, banning devices, and availability of regulatory hearings--FDA. Final rule. AB - The Food and Drug Administration (FDA) is amending the medical device regulations governing procedures for premarket notification, premarket approval, classification, performance standards development, banning devices, and availability of regulatory hearings to conform these procedures to applicable provisions of the Safe Medical Devices Act of 1990 (the SMDA). Its publication promotes clarity and certainty to regulated industry and thus fosters economic growth by correcting the provisions in FDA's existing regulations to conform them to the now-governing statutory provisions. PMID- 10123144 TI - Privacy Act of 1974; report of new system--HCFA. Notice of new system of records. AB - In accordance with the requirements of the Privacy Act of 1974, we are proposing to establish a new system of records, "Evaluation of the Medicare SELECT program, HHS/HCFA/ORD No. 09-70-0058." We have provided background information about the proposed system in the "SUPPLEMENTARY INFORMATION" section below. Although the Privacy Act requires only that the "Routine Uses" portion of the system be published for comment, HCFA invites comments on all portions of this notice. See "DATES" section for comment period. PMID- 10123145 TI - Medical and dental reimbursements rates for fiscal year 1993; correction--DoD. PMID- 10123146 TI - The nurse, the elderly caregiver, & stress. AB - The benefits of home care can carry a hefty price for the overburdened elderly caregiver, typically the patient's spouse, in terms of stress, deteriorating health, even burnout. The home care nurse can watch for warning signs and intervene to prevent situations that could endanger the caregiver and patient from escalating. PMID- 10123147 TI - Values incorporation throughout the organization. AB - Values are an issue that everyone talks about yet they are hard to grasp tangibly. Their importance is illustrated by the good they do within an organization: increased staff retention, enhanced marketing, and--most important- improved patient satisfaction. This article provides a hands-on approach to defining and implementing an organization values-in-action program. PMID- 10123148 TI - Producing peak performers--the key to quality patient care. AB - Quality patient care extends only as far as those who deliver such care. To unlock quality service in each employee, the manager must address three combinations that include recruitment, training, and environment. PMID- 10123149 TI - Team building--the agony and the ecstasy. AB - Teamwork depends on individuals working together--but it also relies on individual responsibility for communicating. Different individuals and types of organizations will affect the framework of teams. This article offers a guide to building the team euphoria. PMID- 10123150 TI - Achieving excellence through values management. PMID- 10123151 TI - Caring for the community. AB - Humboldt Home Health Services, in Eureka, California, has stretched its vision of "good business" to include the development of many new programs that not only respond directly to patient and community needs, but are also economically viable, self-sustaining, and builders of staff self-esteem. PMID- 10123152 TI - The power of caring. Management by values. AB - The home care industry is unique in terms of what is driving us, demographics and new technology and personal choice. We are going to continue to grow at a meteoric rate. But we have a responsibility in the face of all this success to keep our standards high and to be consistent in our values. PMID- 10123153 TI - Neighborhood nursing--the community as partner. AB - Neighborhood nursing seeks to make community health nursing activities more far reaching than those currently reimbursed by third parties, focusing on the issues of health promotion and disease prevention as significantly as the industry has focused on the acute care provision in home care. Yet variables in community nursing have changed what was the traditional focus of community health nursing practice. One agency is developing a program that will allow delivery of a different type of community health nursing. The outcome is a much richer delivery of care. PMID- 10123154 TI - The competitive edge of dynamic marketing. AB - Home care is becoming a more and more competitive field. The key to success in competition is differentiating yourself from the competitors. And the key to that is exceptional customer service--going above and beyond what your customer expects. PMID- 10123155 TI - Do the right thing. AB - Management by values is essentially practicing what you preach. The statement is simple, yet in real life, solutions aren't so clear. What are some insights on making that task a little easier? The renowned management consultant and author offers helpful guidance. PMID- 10123156 TI - Management by values. PMID- 10123157 TI - The ethics of caring. AB - It is critical that those of us in leadership roles strive to match the level of caring exhibited by our clinicians. Over the long term the capacity to which we demonstrate a similar level of ethics in caring may determine the success or failure of our individual agencies and the ultimate success of the home care industry. PMID- 10123158 TI - The hierarchy of needs for good staff performance. The Health Care Group, Inc. PMID- 10123159 TI - An interview with a professional: accountability and productivity in fund raising [by William Olcott]. PMID- 10123160 TI - Emergency care. Texas hospitals to the rescue. AB - An average of 17 Texans die every day as a result of accidental injuries. Our ability to respond to trauma in Texas will be a high priority issue in the upcoming Legislative session. In the meantime, metropolitan areas and remote rural locations across Texas have had to come up with ways to handle what is often a trauma crisis. Efforts are also underway to reduce the number of accidents and injuries in the first place. This month, HealthTexas takes a look at these trauma issues. PMID- 10123161 TI - Out of order. PMID- 10123162 TI - Countdown to community care. Pawn again. PMID- 10123163 TI - Any port in a storm. PMID- 10123164 TI - Nursing management. Developing world. PMID- 10123165 TI - Nursing management. Keeping up appliances. PMID- 10123166 TI - Goodwin House, a place for healing. AB - The following report is excerpted from a senior thesis project prepared by Kirstin Shank. For her thesis, Shank produced an exceptionally thorough and thoughtful proposal for a home for people living with AIDS and HIV. The specifics of her plan may not be easily translated for all such centers, but her holistic approach to designing a therapeutic environment can indeed serve as a models for designers across the country grappling with similar challenges. PMID- 10123167 TI - Ethical dilemmas faced by directors of nursing. PMID- 10123168 TI - Problematic ethical issues of administrators and staffs today. PMID- 10123169 TI - Ethical issues: politics, policies and people. PMID- 10123170 TI - Physical restraints: practice, attitudes and knowledge among nursing staff. PMID- 10123171 TI - "Bad outcome" criminal neglect cases: recent trends that threaten nursing facilities. PMID- 10123172 TI - Eliminating inappropriate use of chemical restraints. AB - Facilities can become free of physical restraints, as many providers have learned. They can also become chemically restraint free, even though psychoactive drugs are used for some residents. PMID- 10123173 TI - ACHCA (American College of Health Care Administrators) code of ethics. PMID- 10123174 TI - Ethical codes and the health professions: looking at the ACHCA code. AB - Codes play an important role in both the development of professions as well as provide ethical guidance for their members. They should be recognized as an aggregate "best" effort to define the moral expectations and boundaries of professional behavior and practice. In addition, they cannot and should not be viewed as a means of policing professional standards given their lack of formal legal backing. Finally, they should be amended as needed. With respect to the ACHCA Code, while not attempting to be overly specific and allowing for reasonable professional interpretation, it is well designed and addresses most of the major attributes found in such formal statements. Coupled with parallel documents addressing "standards of practice" and a more detailed listing of "patients rights," long-term care professionals should be prepared to meet most of the difficult professional challenges facing them. PMID- 10123175 TI - Remembrance of repasts past: culinary reminiscence. AB - If food acquisition, preparation and eating over a lifetime have personal and collective meaning, can the memory of these events contribute to residents' well being? This innovative program shows you how. PMID- 10123176 TI - No kidding--there's a state where doctors like Medicaid. PMID- 10123177 TI - What am I practicing--medicine or insurance? PMID- 10123178 TI - This makes retirement so much nicer. PMID- 10123179 TI - The health plan Clinton will send to Congress. PMID- 10123181 TI - Psych unit keeps hurting, and NME feels the loss. PMID- 10123180 TI - Humana accounting change pares net income. PMID- 10123182 TI - AMI, RehabCare sign preferred vendor pact. PMID- 10123183 TI - Dropping preferred stock dividends aids HealthTrust. PMID- 10123184 TI - Detroit hospitals sue auto insurance firms. PMID- 10123186 TI - Florida hospital settles 'dumping' charges. PMID- 10123185 TI - Mayo Clinic strengthens ties with Deere. PMID- 10123187 TI - L.A. County drops plans for $316 million hospital. PMID- 10123188 TI - FTC appealing judge's Ukiah decision. PMID- 10123189 TI - Report dissects growth in Medicaid costs. PMID- 10123190 TI - Cap on tax-free health benefits seen as major bone of contention in push toward health reform. PMID- 10123191 TI - Nursing facility trade groups prepare for push to include long-term care in reform plans. PMID- 10123192 TI - Hospitals need kinder, gentler TQM. PMID- 10123193 TI - Officials 'lack data to set spending limits'. PMID- 10123194 TI - $26 million tax removed from Ark. tax package. PMID- 10123195 TI - Cost-conscious businesses are asking providers to offer occupational health programs. PMID- 10123196 TI - Computerization helps hospital cafeterias serve up profits. PMID- 10123197 TI - Fla. hospitals plan quality-indicator project. PMID- 10123198 TI - Utah upholds Intermountain's exemptions. PMID- 10123199 TI - Florida task force recommends regional purchasing alliances. PMID- 10123201 TI - Provider magazine surveys top 40 nursing facility chains. PMID- 10123200 TI - A portrait of long term care. Corporate executives talk about industry trends. Interview by Marla Fern Gold. AB - Provider spoke with corporate executives about the trends changing the face of long term care. They talked about a variety of tools--quality initiatives, diversification, financing, and staff recruitment--that are having an impact on the industry. PMID- 10123202 TI - OSHA regulations demand strict documentation, compliance. PMID- 10123203 TI - Determining deductions for the costs of long term care. PMID- 10123205 TI - 'Highstepping' exercise program promotes strength, self-esteem. PMID- 10123204 TI - Carryover of disallowed costs: a new-provider battle. PMID- 10123206 TI - Creating community continuum increases facility market share. PMID- 10123207 TI - Survey inconsistencies point to need for better training. PMID- 10123208 TI - The health care worker's rights in negligence when exposed by a patient to the HIV virus. PMID- 10123209 TI - Patient flow. Primer for a busy breast center. PMID- 10123210 TI - Quality control in mammography. Everyone has a role. American College of Radiology. PMID- 10123211 TI - Creating a TQM culture. AB - Creating a culture and environment for quality improvement is hard work that takes time and commitment. It is often frustrating and painful. For an organization to be successful in this transformation, leadership is not just important, it is vital. The leaders in TQM have new roles to play, roles that go against the grain of many of the forces that led to management success. The tasks of the leaders in a TQM organization emphasize building teamwork and removing barriers that prevent the organization from meeting customer needs. When Jamie Haughton, CEO of Corning, was asked where in his job he found the time to commit to TQM, he replied, "Continuous quality improvement is my job; it is the most important thing I do ... Quality is the primary responsibility of the leader." PMID- 10123212 TI - Continuous quality improvement for radiology. PMID- 10123213 TI - What's your imaging center worth as a business? PMID- 10123214 TI - PACS/teleradiology. Third quarter wrap-up. PMID- 10123215 TI - Radiologic technology: in search of professionalization. PMID- 10123216 TI - Managed care. Future impact on industry. PMID- 10123217 TI - Radiolabeled monoclonal antibodies (for the radiology administrator). AB - Cheaper, faster, safer, these are not the attributes of 1993 automobiles, but criteria for new diagnostic tests in medicine. To achieve these characteristics, medicine is increasingly looking to biotechnology for answers. And the mother of all biotechnology is monoclonal antibody research. In past issues, Administrative Radiology published articles discussing the role of biotechnology in the development of radiopharmaceuticals used in nuclear medicine. In this issue, Richard Wahl, M.D., reviews, in plain talk, the current status and prospects for diagnostic imaging with radiolabeled monoclonal antibodies. Are there any such procedures of value today? Are there any that are FDA approved? Will there ever be such agents that are either useful or approved? If so, will any insurance carrier pay for them? For the answers to these and other "hot" questions, the reader is encouraged to continue on and read this month's Technology Review section. PMID- 10123218 TI - Interventional radiology complication rates. PMID- 10123219 TI - Determinants of hospital ethics committee success. AB - In December 1990, an empirical study assessing hospital ethics committee (HEC) success was completed. Success was measured in terms of the number of interventions undertaken by the committees in four functional areas: education, guidelines development, prospective and retrospective case review. Some commonly quoted success determinants, such as multidisciplinarity, physician chairpersons, and a high institutional status of the chairperson were found not to foster success; the latter two, actually decreased committee success. PMID- 10123220 TI - Exploring the role of the ethics committee psychiatrist. AB - Healthcare ethics committees (HEC) have emerged as institutional forums for addressing bioethical dilemmas. Psychiatrists have important roles to play on these committees. Their skills in group process assessment, mental status examination, and character assessment have diverse applications. Psychiatrists can facilitate communication within the committee and as HEC-based clinical ethics consultants. HECs must be concerned with how they arrive at ethical decisions, guarding against political influence or individual monopolization. Psychiatrists can assist these efforts as organizational consultants to HECs. The perception of psychiatrists as reflective, tolerant of ambiguity, humanizing, and approachable about ethical aspects of health care suggests they would make excellent committee leaders. Psychiatrists also have important committee roles to play as ethics educators and policy makers. More demographic data is needed to investigate psychiatrist participation on HECs. Studies of how they are perceived by their ethics committee colleagues may reveal new roles and potential pitfalls for HEC psychiatrists. PMID- 10123221 TI - The community bioethics committee: a unique pathway out of bioethical dilemmas. AB - We believe that most bioethics committees as well as individual ethics consultants have major shortcomings in that they are unlikely to be open to serving the widest number of citizens who may need their services when facing bioethical dilemmas. The HDCC serves as a community resource, is open to all citizens, is free standing, and provides a wide variety of perspectives which can assist patients, their families, and healthcare providers to explore a range of values and options. The HDCC serves as a model for communities that seek to establish a bioethics resource. Further, the HDCC model permits the further exploration of ways in which important healthcare issues can be faced. AHD believes, in keeping with its mission, that the creation of the HDCC can increase the public's awareness of and involvement in healthcare issues. As B. Jennings reminds us, The mission of community health decisions projects is to stimulate a well-informed conversation where many voices are heard and all reasonable perspectives given due consideration. They not only inform, but also enable responsible civic participation and thoughtful health care decisionmaking. The HDCC model can serve to bring discussions on bioethical dilemmas out of secrecy into safer, yet more open, community fora. PMID- 10123222 TI - Point and counterpoint. Should healthcare ethics committee members be paid? PMID- 10123223 TI - Wastewater monitoring in hospitals. PMID- 10123224 TI - Analyzing the benefits of regulation: the OSHA EtO report. PMID- 10123225 TI - Medical waste treatment technology 3: the Mediclean IWP-1000. PMID- 10123226 TI - Health care reform at the state level. PMID- 10123227 TI - As I see it ... resource-based relative value scale (RBRVS). PMID- 10123228 TI - Harrison Memorial in Bremerton, Washington records satisfaction all around from 2 year-old "private practice" unit nursing experiment. PMID- 10123229 TI - Contract Design. 1991 annual directory and buyer's guide. PMID- 10123230 TI - Wayfinding in San Diego. Vandever Clinic. PMID- 10123231 TI - Issue one: health care. PMID- 10123232 TI - New drug, antibiotic, and biological drug product regulations; accelerated approval--FDA. Final rule. AB - The Food and Drug Administration (FDA) is issuing final regulations under which the agency will accelerate approval of certain new drugs and biological products for serious or life-threatening illnesses, with provisions for any necessary continued study of the drugs' clinical benefits after approval or with restrictions on use, if necessary. These new procedures are intended to provide expedited marketing of drugs for patients suffering from such illnesses when the drugs provide meaningful therapeutic benefit compared to existing treatment. Accelerated approval will be considered in two situations: (1) When approval can be reliably based on evidence from adequate and well-controlled studies of the drug's effect on a surrogate endpoint that reasonably suggests clinical benefit or on evidence of the drug's effect on a clinical endpoint other than survival or irreversible morbidity, pending completion of studies to establish and define the degree of clinical benefits to patients; and (2) when FDA determines that a drug, effective for the treatment of a disease, can be used safely only if distribution or use is modified or restricted. Drugs or biological products approved under these procedures will have met the requisite standards for safety and effectiveness under the Federal Food, Drug and Cosmetic Act (the act) or the Public Health Service Act (the PHS Act) and, thus, will have full approval for marketing. PMID- 10123233 TI - Waste stream reduction--disinfectants. PMID- 10123234 TI - The role of the medical laboratory technologist in drinking and driving cases. Part 2: The use of hospital alcohol results as evidence and providing testimony in court. AB - Medical laboratory technologists routinely conduct alcohol analyses for medical purposes, however, in certain circumstances the results are used legally to determine a driver's Blood Alcohol Concentration. The technologist who performed the analysis may subsequently be required to provide evidence in court. The primary areas of interest to the court in these cases are: the type of swab utilized, the continuity of the blood sample, the method of analysis, the margin of error of the results, and the conversion of a serum alcohol concentration to a blood alcohol concentration in units as per the Criminal Code. Pre-trial preparation, courtroom procedures, and suggestions to enhance the technologist's credibility as a professional witness are outlined. PMID- 10123235 TI - Restraint restrictions. PMID- 10123236 TI - Psychiatric emergencies. PMID- 10123237 TI - Stormy weather. PMID- 10123238 TI - Coping with driving risks. PMID- 10123239 TI - A little bit of Ireland. PMID- 10123240 TI - The domiciliary consultation service: outdated anachronism or essential part of community psychiatric outreach? AB - This paper describes a retrospective audit of a domiciliary visiting service in adult psychiatry in one district over a six-month period. General practitioners requested urgent assessment visits for three-quarters of the sample population, but were not present when the consultant attended. When the referrals were compared to the official definition of a domiciliary visit, less than a third were considered to fit the criteria. The implications of these findings are discussed. PMID- 10123241 TI - The Small Area Health Statistics Unit. PMID- 10123242 TI - Emergency admissions under Section 4 of the Mental Health Act 1983: reasons for a high rate. AB - One of the aims of the Mental Health Act 1983 was to discourage the use of emergency orders; the criteria for using the emergency provisions provided by Section 4 of the Act are stricter than those of the corresponding Section 29 of the previous Mental Health Act 1959. In 1986-87 the Mental Health Act Commissioners found a comparatively high level of admission under Section 4 in Cambridge. This study was undertaken to examine the hospital careers of all Section 4 admissions in Cambridge over a two-year period, and to compare these with admissions for assessment by two doctors under Section 2 of the 1983 Act and informal admissions. Almost 50% of all the Section 4 admissions were not continued on a compulsory admission by the end of the 72 hour duration of the Section. The findings suggest that these patients might have been more appropriately admitted informally or not at all. PMID- 10123243 TI - Closing the asylums: where do all the former long-stay patients go? AB - The ongoing closure of the old asylums has resulted in large numbers of potentially vulnerable people living in the community. Where are these patients now and how are they coping? This study answers these questions in relation to a cohort of former long-stay patients discharged between 1985 and 1989 in Somerset Health District. The findings show that, as a group, they are a settled non mobile population whose residential setting is not under threat. However, day care arrangements are inadequate with 45% of the study population without any structured day care. Most patients had unmet needs in the categories 'living space', 'work' and 'leisure'. Such studies are simple to conduct, and require little research funding. This methodology is recommended as a crude means of measuring unmet needs in this group of vulnerable individuals. PMID- 10123244 TI - Adult domestic violence. AB - Adult domestic violence in Leicestershire was reviewed by examining the clinical notes of all patients aged 14 years and over attending the Accident and Emergency Department of the Leicester Royal Infirmary in 1988 with a history of assault. Of the 341 patients so classified, 297 victims were identified. This paper describes the results of the review, including the age and gender of the victims, and the nature and cost of the violence. Suggestions are made to improve the management of adult domestic violence. PMID- 10123245 TI - Screening for patients at risk of alcohol related problems: the results of the York District Hospital Alcohol Study. AB - This study examined the feasibility of training medical and nursing staff in the use of a brief Alcohol Screening Questionnaire, which assists the early identification of patients who drink to excess. Over a two-year period 7,217 questionnaires were completed on patients admitted to York District General Hospital. Analysis showed the screening questionnaire to be a quick and reliable instrument, although the characteristics of the screener influenced its effectiveness. The results suggest that hospital staff require little training before they can effectively identify patients who drink to excess. PMID- 10123246 TI - Mastering the art of hospital-physician collaboration. PMID- 10123247 TI - Recruiting physicians within IRS and HHS guidelines. PMID- 10123248 TI - Plan scenarios for managed competition and global budgeting. PMID- 10123249 TI - Managing competition in the health care industry. AB - Health-care decisions made by consumers are generally not made by informed choice. Hospitals, expanding their market beyond physician referrals, are discovering that consumers are interested in taking a more active role. Managed competition programs may be one of the first concepts to fine-tune a new broad based health-care system. PMID- 10123250 TI - KPMG: conventional health plans headed for extinction. PMID- 10123251 TI - Patient-focused care pays hospital-wide dividends. Interview by Donald E. L. Johnson.. AB - By decentralizing ancillary services, streamlining processes and cross training professional and paraprofessional employees, hospitals can improve patient satisfaction and staff efficiency, says David L. Bernd, executive vice president and chief operating officer of Sentara Health Systems, Norfolk, Virginia, in the following interview with Donald E. L. Johnson, editor and publisher of Health Care Strategic Management. But hospitals should not convert to patient-focused care primarily to cut costs, he warned. Cost savings could result, but only on a hospital-wide basis, as a result of new efficiencies and reduced lengths-of-stay. At the unit level, costs are likely to go up as ancillary services are moved to patient-focused units and more resources are devoted directly at each patient. PMID- 10123252 TI - An interview with: Bruce D. Harman on negligent employment and security directors. PMID- 10123253 TI - Special report. Protecting your executives and their families from criminals. PMID- 10123254 TI - Visual comfort. Florida's Health Park Medical Center, Fort Meyers. PMID- 10123255 TI - Critical condition. PMID- 10123256 TI - Family value. Highbridge-Woodycrest Center, New York City. PMID- 10123257 TI - Who cares? Taking health care design a step further. PMID- 10123258 TI - Healing spirit. University of California San Diego Medical Center. PMID- 10123259 TI - Green solace. Carl and Dorothy Bennett Cancer Center, Stamford, Connecticut. PMID- 10123260 TI - Quiet compassion. A comforting refuge for terminally ill AIDS patients. Bailey Boushay House, Seattle. PMID- 10123261 TI - Gentle delivery. Community Hospital of Chula Vista, California. PMID- 10123262 TI - Soft neutrals. Creating a warm envelope for radiation patients. California Pacific Medical Center, San Francisco. PMID- 10123263 TI - Prototype home. A new respite home and day care center for children with AIDS. Kirk Scharfenberg House, Boston. PMID- 10123264 TI - Clinical clarity. Setting a new standard for ambulatory health care. Kirklin Clinic, Birmingham, Alabama. PMID- 10123265 TI - Preserving the doctor-patient relationship in a system of limited funds. PMID- 10123266 TI - A national paradox: satisfied with their own care, Americans want to overhaul the system. PMID- 10123267 TI - Are we building reform on an untested foundation?. Interview by C. Burns Roehrig. PMID- 10123269 TI - Workforce mix: a pot about to bubble. PMID- 10123268 TI - Does the mandate for change mean managed competition? PMID- 10123270 TI - Limits are inevitable: our best bet is to set them ourselves. Interview by Diana L. Madden. PMID- 10123271 TI - Clinical appropriateness, therapeutic equivalence, and cost of conversion of H2 antagonist therapy. AB - A 12-month drug monitoring program targeting the use of H2 antagonists was initiated at the Erie County Medical Center, a 650-bed academic teaching hospital in Buffalo, NY. Discussed in this article are the development of indicators used to determine appropriateness of therapy, implementation of a H2 antagonist monitoring and screening program, examination of the effect of the program on budgetary expenditures for H2 antagonist therapy, evaluation of adverse effects and potential drug interactions associated with drug use, and measurement of possible drug cost savings resulting from the implementation of the program. PMID- 10123272 TI - Hospital reimbursement in Alberta: outcomes management is on the way. AB - The Alberta government has initiated a process to alter fundamentally the way it pays hospitals. As with most provinces, Alberta has been paying hospitals for what they spend. The new Alberta model will initially pay hospitals for what they do and ultimately will pay hospitals for what they ought to do; that is, for the outcomes that should be achieved. This article describes the initial step of what is expected to be a lengthy journey. The principles underlying the model are: it should be a prospective case-based system; there should be performance linkages between types of hospitals; severity should be incorporated into the model; and cost or cost proxies should be used where possible in weight development and clinical concerns, both nursing and medical, should be addressed. For the past two years funding adjustments have been made on the basis of the calculation of a Hospital Performance Index (HPI). The HPI is the average predicted cost per case divided by the unweighted average actual cost per case. The HPI is intended as an interim measure only. Ultimately, the system will evolve into a true prospective case-based system with volume controlled via role statements and linked to clinical outcomes. PMID- 10123273 TI - Promoting physician-nurse collaboration throughout the organization. AB - For health care institutions embracing the total quality approach to management, interdisciplinary collaboration focused on the processes associated with patient care is vital. To attain a vision of effective physician-nurse collaboration, specific initiatives at all levels of the University of Alberta Hospitals have helped to transform the vision into current reality. PMID- 10123274 TI - Surgical waiting lists II: Current practices and future directions using the Province of British Columbia as a test study. PMID- 10123275 TI - The implications of urban social and economic realities on strategic management of hospitals. AB - As Ontario embarks on restructuring its health care system and realigning resources to meet population-based needs, health care providers and planning agencies need to link epidemiological data (a community's socioeconomic, demographics and health status) and assess its implications on hospital utilization trends. A fundamental challenge for hospitals and other providers is to "know their communities" along these lines. This article summarizes the results of a multidimensional review of a section of a large urban community and integrates it with utilization of acute inpatient beds. General observations are offered for policy makers and hospital management. PMID- 10123276 TI - Health care crisis--total quality management as a potential solution: a personal viewpoint. PMID- 10123277 TI - Beyond four walls: ideas and applications on regional planning of health care services. PMID- 10123278 TI - Child care center's new playground proves that safety isn't child's play. PMID- 10123279 TI - Sound maintenance extends life spans of parking facilities. PMID- 10123280 TI - Cross-training cuts FTEs--and boosts morale. PMID- 10123281 TI - Matrixes reveal true costs of flooring, finishes. PMID- 10123282 TI - How do energy, utilities affect health costs? PMID- 10123283 TI - New products as well as new space improve gift shop's old image. PMID- 10123284 TI - Health care environmental issues: what does the future hold? PMID- 10123285 TI - Site assessments lessen risk of property liability. PMID- 10123286 TI - Thorough preparation key to successful surveys. PMID- 10123287 TI - ED workers face the growing threat of violence. PMID- 10123288 TI - Department mission statements: time to update? PMID- 10123289 TI - Baylor Plan for stockless I.V. shattering distribution myths. PMID- 10123290 TI - Price survey: X-ray film. Tough competition tempers prices. PMID- 10123291 TI - Central service non-salary expenses. PMID- 10123292 TI - Enhanced delivery system helps bridge traditional-JIT (just-in-time) gap. PMID- 10123293 TI - Hospitals enjoy varied equipment financing alternatives. PMID- 10123294 TI - Primary care medical groups: gatekeepers will dominate a managed care marketplace. PMID- 10123296 TI - Physician surplus or shortage? A "semi-optimistic" forecast for primary care. PMID- 10123295 TI - The new "food chain" of managed care: battleground of the 1990s. PMID- 10123297 TI - Using the emergence of primary health care in hospital strategy and community reform. Part I. PMID- 10123298 TI - IRS application of health care laws: an analysis of IRS enforcement techniques. PMID- 10123299 TI - Using the emergence of primary health care in hospital strategy and community reform. Part II. PMID- 10123300 TI - A primer on the legal pitfalls of physician ownership and self-referral practices. PMID- 10123301 TI - Thromboses in the arteries of commerce: inefficiency in blood bank regulation. PMID- 10123302 TI - Breast cancer in Canada: to screen or not to screen? AB - Lomas (1988) and Sabatier (1987) have suggested models by which to examine the roles that values, scientific knowledge, institutions, and the learning process play in the formulation of both national and clinical health-care policies. Utilizing their frameworks, this article offers an explanation for the development of high-volume screening mammography policies in Canada, despite the suggested inefficacy of screening technologies for 'unavoidable' illnesses such as carcinoma in the breast. The preliminary results of Canada's National Breast Screening Study further complicate this tissue. Inappropriate framing of the 'problem' in the policy-making process, by actors highly influenced by societal values and scientific evidence, is identified as the reason for present and planned policies and practices contradicting the first principles of health policy analysis. PMID- 10123303 TI - Health systems in transition: the British and Italian experiences. PMID- 10123304 TI - The societal and organizational contexts of culturally sensitive mental health services: findings from an evaluation of bilingual/bicultural psychiatric programs. AB - The Hispanic mental health literature focuses mostly on cultural and clinical issues. This paper argues that researchers and practitioners concerned with mental health services for Hispanics and other minority groups need to pay more attention to the societal and organizational contexts that facilitate or impede the development of effective culturally sensitive psychiatric programs. Utilizing data from an evaluation of three New York psychiatric programs for seriously mentally ill (SMI) Hispanic patients, the paper discusses societal and organizational factors that influenced the programs' development. Among societal forces were the significance of Hispanics as a voting bloc, the political organization of Hispanic mental health professionals, the philosophy of ethnic assimilation in American society, prevailing views about the place of cultural knowledge in psychiatric treatment, and fiscal crises, and the shortage of Hispanic mental health professionals. Among organizational factors, hospital administrative support and program leadership mediated the effects of societal forces upon the programs, while ethnic competition and lack of coordination between the program and other organizational units acted as barriers to the programs' development. The findings are relevant to any innovative mental health service in an organizational setting. PMID- 10123305 TI - Mental health services for Asian Americans and Pacific Islanders. AB - Inquiries over the past three decades have shown that ethnic minorities drop out of treatment early and tend to have poorer outcomes in psychotherapy. Despite the widespread acceptance that culturally responsive therapy and programs will produce better treatment outcomes for ethnic minorities, few studies have empirically tested this proposition. This paper reviews two types of interventions, ethnic match and parallel programs, to make the mental health system more responsive to the needs of Asian Americans and Pacific Islanders. PMID- 10123306 TI - Ethnic minority status and adolescent mental health services utilization. AB - Adolescents who are members of ethnic minority groups constitute a large and ever increasing proportion of the population. While the information base regarding mental health problems and mental health services utilization in adolescents in general is slowly increasing, relatively little knowledge has accumulated about the particular needs and practices of youth of color. The purpose of this article is to review the available literature about adolescent mental health needs and service utilization as well as literature regarding adult ethnicity and mental health service utilization. The conclusion of this review is that significant gaps exist in our knowledge base regarding ethnicity in adolescents and its implications for the utilization of mental health services. The limited data available suggest that significant numbers of adolescents of color have multiple needs for mental health care and that a complex set of barriers exists to prevent them from obtaining appropriate services. A variety of suggestions are offered to improve the opportunities for and the quality of mental health services for ethnic minority adolescents. PMID- 10123307 TI - Costs and use of public mental health services by ethnicity. AB - This paper used data obtained from Santa Clara County, California, to study the costs and use of public mental health services among ethnic populations (Asians, Blacks, Hispanics, and Whites). The study had access to 12,436 unduplicated users of services. The study found Whites had the highest per capita costs, while Asians incurred the lowest. However, after controlling for other demographic characteristics, Asians incurred higher costs than Whites. This reversal of Whites and Asians occurred because cost distributions are more skewed for Whites than Asians. Asians had the highest median costs and Hispanics the lowest. The top 5% of users incurred about 50% of the total public mental health costs. PMID- 10123308 TI - Providing culturally appropriate mental health services for minorities. AB - Research on the use of outpatient mental health services has shown lower rates of utilization by minorities. Barriers include economic considerations, access difficulties, and cultural factors. Promoting the use of outpatient mental health services by minorities can have a positive effect on the overall cost of health and mental health care, as well as increasing access to care and quality of care for minority populations. Advantages and disadvantages of various approaches to providing culturally appropriate programming in mental health services are discussed. PMID- 10123309 TI - Determining policy on sales reps in the OR. PMID- 10123310 TI - New technology expanding endoscopic surgery market. PMID- 10123311 TI - Interactive video helps patient decisions. PMID- 10123312 TI - A double standard for video camera reprocessing? PMID- 10123313 TI - A model for making project funding decisions at the National Cancer Institute. AB - This paper describes the development of a model for making project funding decisions at The National Cancer Institute (NCI). The American Stop Smoking Intervention Study (ASSIST) is a multiple-year, multiple-site demonstration project, aimed at reducing smoking prevalence. The initial request for ASSIST proposals was answered by about twice as many states as could be funded. Scientific peer review of the proposals was the primary criterion used for funding decisions. However, a modified Delphi process made explicit several criteria of secondary importance. A structured questionnaire identified the relative importance of these secondary criteria, some of which we incorporated into a composite preference function. We modeled the proposal funding decision as a zero-one program, and adjusted the preference function and available budget parametrically to generate many suitable outcomes. The actual funding decision, identified by our model, offers significant advantages over manually generated solutions found by experts at NCI. PMID- 10123314 TI - A practical guide for adapting to the 1992 CPT4 coding structure. AB - With the implementation of the revised CPT4 coding structure on March 31, 1992, physicians and healthcare financial managers alike were reminded of the fact that more regulation often means less reimbursement. Authors Ciotti and Smith offer a personal look at how they struggled with the revised regulations and a guide to this "coding labyrinth." PMID- 10123315 TI - Son of COBRA: the evolution of a Federal malpractice law. PMID- 10123316 TI - The good news: you've survived. PMID- 10123317 TI - Using a mini to the max. PMID- 10123318 TI - Avoiding the pathway potholes. PMID- 10123319 TI - An ounce of prevention: a safety program that works. PMID- 10123321 TI - The Veterans Affairs National Center for Clinical Ethics. PMID- 10123320 TI - The legal consensus about foregoing life-sustaining treatment: its status and its prospects. AB - The legal consensus that has evolved through adjudication and legislation since the Karen Quinlan case in 1976 is founded on the premise that there is a bright line between passive euthanasia and active euthanasia. Indeed, the term passive euthanasia is often eschewed in favor of less emotionally-laden terminology such as "forgoing life-sustaining treatment" or "terminating life support" so as to further sever any possible connection with active euthanasia. Legal approval has been bestowed upon passive euthanasia under certain circumstances while active euthanasia is routinely condemned. This consensus was put to a test in 1990 when the United States Supreme Court ruled on the Cruzan case. However, the Court's narrow decision did not upset the consensus, and in the most significant appellate decisions handed down by state courts since Cruzan, there has been a reaffirmation--and possibly even an extension--of the consensus. Two other threats to the legal consensus about forgoing life-sustaining treatment have begun to manifest themselves: the increasing pressure for mercy killing and "futility" cases. Both of these challenge the fundamental premises on which the consensus is grounded. PMID- 10123322 TI - A right to health care. PMID- 10123323 TI - Managed competition: a health reform plan that "puts people first". AB - With its emphasis on consumer information; proper incentives for physicians, hospitals, and insurers; and fair tax treatment; managed competition deserves the attention it has received in the debate over how to reform the U.S. health system. It provides a better route to ensuring access and controlling costs than alternative proposals. President-elect Clinton should use the managed competition model as a blueprint for the health plan he has promised in the first 100 days in office. PMID- 10123324 TI - Is managed competition a field of dreams? AB - In recent months, managed competition has gained the upper hand in the debate over how to reform the U.S. health system and likely will be a part of President elect Clinton's proposal. But recent data reveal that managed care plans, an important piece of the managed competition approach, have not significantly altered the rate of increase in costs. These findings cast doubt on the assumption by managed competition advocates that the proper incentives exist to cause the health delivery system to reorganize itself. PMID- 10123325 TI - The revolution that wasn't: health care's role in the 1992 elections. AB - Ever since Harris Wofford won a U.S. Senate seat in Pennsylvania in November 1991 largely by calling for national health insurance, health reform has been considered a "top-tier" issue. But post-1992 election polls reveal that while Americans have remained disenchanted with the current system, they have not refined their views on reform much further. Because the issue is so complex and because specific proposals involve so many trade-offs, the best course of action for candidates in the 1992 races was to echo voter dissatisfaction and signal a desire for reform without stating specifics. PMID- 10123326 TI - Pure community rating: a quick fix to avoid. AB - Insurance coverage denial and excessive premium rates have made the small employer health insurance market a popular target for sweeping reforms. Many proponents of small market insurance reform have advocated pure community rating by requiring carriers to charge the same rate to all of their customers as a solution. But legislating the use of pure community rating could do more harm than good in solving the problems of cost and access. A more sensible approach would limit rate differences through either rating bands or community rating by class. PMID- 10123327 TI - Community rating: an idea whose time has come (again). AB - The 20-year movement away from community rating of health insurance premiums in favor of experience rating has produced extreme inequities in the availability and affordability of health insurance coverage in the U.S. Current rating practices also have contributed to a rapid shift among employers to self-insure, thus allowing them to rewrite their benefit plans. By returning to a community rating system, the nation would eliminate many of these current market distortions. PMID- 10123328 TI - DataLine. Progress scant in changing physician practice. PMID- 10123329 TI - President Clinton: now what? AB - Bill Clinton was elected President on a consistent theme of economic revival and reform of the nation's health care system. As he prepares to take office, the President-elect is under extreme pressure to keep his promises on reform, women's health, and AIDS. But the new Administration faces challenges from Congress, the health care lobby, and a deficit-ridden budget. PMID- 10123330 TI - Rochester, New York: a model for health reform. AB - The 50-year-old health care experiment conducted in Rochester, New York, has yielded encouraging results. The policies implemented there include coverage by a single payer, community rating, a spending cap, encouraged use of HMOs, and general cooperation among providers, employers, insurers, and the area's one million residents. Surveys of those residents and local employers indicate that they are more satisfied with Rochester's health system than the rest of Americans are with the U.S. system. PMID- 10123331 TI - From DRGs to deregulation: New Jersey launches new reforms. PMID- 10123332 TI - The 1993 MT reference library. PMID- 10123333 TI - Update on the core certification examination. PMID- 10123334 TI - Debunking false assumptions about quality management. PMID- 10123335 TI - Bylaws. American Association for Medical Transcription. PMID- 10123336 TI - Update: strategic planning. American Association for Medical Transcription. PMID- 10123337 TI - How much wood should a woodchuck (or a medical transcriptionist) chuck? PMID- 10123338 TI - A system that works: managing managed care in psychiatry. AB - The Carrier Foundation, a not-for-profit psychiatric facility in Belle Mead, NJ, has been working with managed care for the past 5 years. As managed care began to affect patients' access to care, the quality improvement department at The Carrier Foundation became involved in case management. Through case management, the quality improvement department began to provide guidance to private review organizations to preserve and protect patients' rights and to ensure accurate reporting of clinical data. PMID- 10123339 TI - Using a team approach to implement automatic printing of pathology/radiology reports. AB - In a quality environment, improvement starts with a commitment from top management and flows down to all levels in the organization. One of the many ways in which an organization can demonstrate this commitment is by first listening to customers and then taking actions to improve services based on the identified needs of those the organization serves. This article describes a quality process in action and demonstrates how teamwork and commitment can produce the desired outcome: customer satisfaction. PMID- 10123340 TI - Developing efficiency standards to improve service in hospital admitting. AB - The efficiency of admitting services at York Central Hospital in Richmond Hill, ON, Canada, was studied in terms of the timing of admissions. Over a 10-month period, information was collected relating to 1,630 patients' admissions. This information resulted in recommendations allowing the standard of waiting time to be changed and the standard of an admission time to be set. The patient wait time now is to be no longer than 15 minutes with an acceptable level of 80%. The information gathered in a 6-month period during the original 10 months of study showed that the admission process takes no longer than 18 minutes with an acceptable level of 90%. PMID- 10123341 TI - Impact of the Safe Medical Devices Act on healthcare facilities. AB - The Safe Medical Devices Act (SMDA) of 1990 (Public Law 101-629) is a federal law that became effective November 28, 1991. The SMDA mandates all facilities that use medical devices (referred to as device user facilities) to report serious injuries, serious illnesses, and deaths to the U.S. Food and Drug Administration (FDA) and the manufacturer. The purpose of the act is to protect the public by ensuring that medical devices are not unsafe for their intended use. PMID- 10123343 TI - Nursing's agenda for health care reform. PMID- 10123342 TI - The fiduciary responsibilities of the hospital board of directors. AB - With the dynamic movement toward healthcare reform, increased attention is being focused on the duties and legal liabilities of hospital governing board members. Given the dual duties of loyalty and care and the legal and regulatory pressures to contain costs and assure quality, the role of the governing board is increasing in complexity and importance. PMID- 10123344 TI - Driving fear from the healthcare setting. AB - Even the most well-intentioned healthcare managers will encounter roadblocks to successful implementation of continuous quality improvement as long as fear remains pervasive in the workplace. This article discusses the roots of fear, explains how fear impedes improvement efforts, and describes methods to identify and eradicate fear. PMID- 10123345 TI - The use of control charts to improve healthcare quality. AB - Control charts are a basic tool for understanding variation in all healthcare processes. Control chart limits are not standards; rather, they divided variation into special and common cause, each of which requires a different management response. Each type of data--variables, count defect, or defectives data- requires a different type of chart (e.g., X bar and R, X bar and S; C or U; P or NP). Individual observations where events are infrequent can be charted on an individual's chart with moving range limits or by several alternative methods discussed in this article. PMID- 10123346 TI - Hospital boards: not just for show. PMID- 10123347 TI - Rural health care: an American perspective. AB - Over the past five years, the authors have researched various aspects of health care in rural communities in the United States. Interviews were conducted with some 100 rural physicians and hospital administrators, 75 hospital governing board members, and other rural community leaders. The difficulties of maintaining reasonable access to health services in rural communities are discussed, as are the strategies for rural health care used by policy makers and hospital governing boards. PMID- 10123348 TI - By natives for natives: healing for total wellness. Interview by Matthew D. Pavelich. PMID- 10123349 TI - Excellence in diversity. AB - Health agencies in Canada provide services to a population that is culturally diverse. Most health care facilities are being asked to accommodate beliefs, values, customs, and practices from many cultures, and health care professionals are increasingly being asked to be sensitive to this need. This article documents illustrative scenarios from health agencies in Alberta and discusses ways in which health professionals can provide high-quality care with deference to various cultural perspectives. PMID- 10123350 TI - Access by air: Mission Air provides vital link. AB - Every year thousands of Canadians must travel far from home to receive specialized medical treatment or diagnosis. For many individuals, funds for air travel are limited. The Mission Air Network removes some of this stress by arranging free flights for patients and family members or escorts, using seats donated by commercial, corporate and government sponsors. PMID- 10123351 TI - The health network: an alternative form of care delivery. AB - The Health Network, a community and social service organization of volunteers and a small staff aims to serve three suburban and rural communities west of Ottawa. In June 1991, the Health Network approached Ontario's Ministry of Health for funding of community-based health services for these municipalities. In light of decreasing resources in hospitals, this article reviews how the Health Network became organized and summarizes a community needs assessment complete in September 1989. PMID- 10123352 TI - Program outcome and QA: a new approach to evaluation. AB - Health care providers and managers are familiar with the limitations of current quality assurance (QA) practices, which do little to indicate the overall effectiveness of health care programs. This article discusses a comprehensive method of evaluating program effectiveness, efficiency, cost, client satisfaction, and adherence to standards. The authors present the Brockville Psychiatric Hospital's experience in evaluating a new program with data collected from a multi-faceted QA perspective, and suggest that combining program evaluation with QA could become the standard for future program assessments. PMID- 10123353 TI - Salaried physician programs: the Manitoba experience. AB - The method by which physicians are compensated, particularly the fee-for-service model, is the subject of considerable debate among health policy analysts, funding agencies, health care administrators, and the medical community at large. Prevailing arguments identify the shortcomings of the fee-for-service model but generally fail to explore alternate methods of remuneration for physicians. This article examines the deficiencies in the fee-for-service model and examines an alternate remuneration model--a salary-based system now being used in seven rural Manitoba communities. PMID- 10123354 TI - Twenty grantees seek transformation: from discipline-driven, compartmentalized entities to patient-driven, unified care systems. PMID- 10123355 TI - Five original recipes for strengthening hospital patient care. AB - Organizational innovation has a varied parentage--its famous mother being necessity--that can include the economic climate, marketplace characteristics, an organization's unique history and culture, leadership style, and corporate species. The following five Robert Wood Johnson Foundation/Pew Charitable Trusts grantees (see article, page 1) cast their own perspectives on approaches to strengthening nursing. The first three chose different emphases on programs built on existing practice models. The fourth hospital focuses on preparing the groundwork for major change, while the last looks outside at educating the youth who will eventually fill its caregiver roles. PMID- 10123356 TI - Multi-year restructuring changes stick at Stanford University Medical Center, bringing costs and charges down in a managed care market. PMID- 10123357 TI - Data innovations spur physician involvement in the quality process at Memorial Medical Center of Jacksonville, Florida. PMID- 10123358 TI - Healthier communities--by design? PMID- 10123359 TI - Baby boom. Berry Women's Health Pavilion, Dayton, Ohio. PMID- 10123360 TI - Bringing the hospital home. Northeast Medical Plaza, Houston. PMID- 10123361 TI - True or false: design promotes healing. PMID- 10123362 TI - The new look of healing. Massachusetts General Hospital. PMID- 10123363 TI - Rolling on an ooey gooey wheel. Arkansas Children's Hospital. PMID- 10123364 TI - Nothing to sneeze at. Johns Hopkins Asthma & Allergy Center. PMID- 10123365 TI - Paging Dr. Clinton. PMID- 10123366 TI - Is it need? Or is it purely greed? The AMA hits doctors on self-referrals. PMID- 10123367 TI - Big costs, broken promises. Companies get rough on retiree health benefits. PMID- 10123368 TI - Civilian Health and Medical Program of the Uniformed Services (CHAMPUS); fiscal year 1993 updates--DoD. Notice of updated mental health per diem rates. AB - This notice provides for the updating of hospital-specific per diem rates for high volume providers and regional per diem rates for low volume providers; the updated cap per diem for high volume providers; and the beneficiary per diem cost share amount for low volume providers to be used for FY 1993 under the CHAMPUS Mental Health Per Diem Payment System. PMID- 10123369 TI - Office of Administration and Management; statement of organization, functions, and delegations of authority--Administration on Aging. PMID- 10123370 TI - Notice regarding Federally Supported Health Centers Assistance Act of 1992--HRSA. Notice. AB - The Secretary of Health and Human Services (the "Secretary"), in consultation with the Attorney General, provides the following notice regarding Public Law 102 501, the "Federally Supported Health Centers Assistance Act of 1992" (the "Act"). The Act provides for liability protection for certain health care professionals and entities. This notice sets forth information whereby an entity or a person can determine when, and the extent to which, it is deemed to be an entity as described in the Act. PMID- 10123371 TI - Medicare and Medicaid programs; quarterly listing of program issuances and coverage decisions--HCFA. General notice. AB - This notice lists HCFA manual instructions, substantive and interpretive regulations and other Federal Register notices, and statements of policy that were published during July, August, and September of 1992 that relate to the Medicare and Medicaid programs. Section 1871(c) of the Social Security Act requires that we publish a list of Medicare issuances in the Federal Register at least every 3 months. Although we are not mandated to do so by statute, for the sake of completeness of the listing, we are including all Medicaid issuances and Medicare and Medicaid substantive and interpretive regulations (proposed and final) published during this timeframe. We also are providing the content of revisions to the Medicare Coverage Issues Manual published between July 1 and September 30, 1992. On August 21, 1989 (54 FR 34555), we published the contents of the Manual and indicated that we will publish quarterly any updates. Adding the Medicare Coverage Issues Manual changes to this listing allows us to fulfill this requirement in a manner that facilitates identification of coverage and other changes in our manuals. PMID- 10123372 TI - Medical devices; reclassification and codification of hip joint metal polymer/metal semi-constrained porous-coated uncemented prosthesis--FDA. Final rule. AB - The Food and Drug Administration (FDA) is announcing the reclassification and codification of the hip joint metal/polymer/metal semi-constrained porous-coated uncemented prosthesis. FDA issued an order in the form of a letter to two manufacturers reclassifying the device from class III into class II. Accordingly, FDA is amending the regulations as set forth below. PMID- 10123373 TI - Abnormal occurrences for third quarter CY 1992; dissemination of information- NRC. PMID- 10123375 TI - Excess baggage. PMID- 10123374 TI - Acid Rain Program: general provisions and permits, allowance system, continuous emissions monitoring, excess emissions and administrative appeals--EPA. Final rule. AB - Title IV of the Clean Air Act (the Act), as amended November 15, 1990, requires the Environmental Protection Agency (EPA or Agency) to establish an Acid Rain Program to reduce the adverse effects of acidic deposition. To implement this statutory mandate, the Acid Rain Program requirements will be codified in seven regulations. This action delineates all or portions of five final regulations that were initially proposed December 3, 1991: General Provisions and Permits; the Allowance System; Continuous Emissions Monitoring; Excess Emissions Penalties; and Administrative Appeals. (The administrative appeals procedures were originally proposed as a subpart of the permits rule; EPA has decided to remove it from part 72 and place it in a separate part 78.) In addition to the final rules, this action includes a brief overview of the acid rain problem, summaries of major provisions of the proposed rules, the public's comments on these proposals, and summaries of the major changes that have been made in this final rule. DATES: These rules become effective February 10, 1993. The incorporation by reference of certain publications listed in the regulations is approved by the Director of the Federal Register as of February 10, 1993. PMID- 10123376 TI - Dangerous diagnosis. AB - Most policy experts assume that the public will have to make sacrifices if the health care system is overhauled. The public assumes nothing of the kind. The upshot could be a major political backlash against Bill Clinton and Congress. PMID- 10123377 TI - The Democratic Party takes on healthcare reform. AB - The public is expecting delivery on the Democratic Party's election promises of healthcare reform. Now, with a Democrat in the White House and a Democratic majority in Congress, the time seems ripe for real reform. But unity continues to elude the party on this hot issue, says former Colorado Governor Dick Lamm. PMID- 10123378 TI - CQI and technology: partnership drives improvement. AB - CQI plus technology equals increased financial success, according to Parkview Episcopal Medical Center. For this Pueblo, Colo., community hospital, the results of this equation are impressive--time saved, a motivated workforce and last but not least, more revenue. PMID- 10123379 TI - Managed-care systems tackle new territory. AB - The vital application of managed-care information systems is in contract management. Ten products now on the market have the potential to streamline this function. These contract-management systems range from standalone workstations to new modules built into the hospital information systems. CIH Contributing Editor Walter Wieners gives their advantages and disadvantages, and tells the best way to decide which system is right for your organization. PMID- 10123380 TI - HotList. Voice-activated systems. AB - Introducing Computers in Healthcare's newest monthly section, the product "HotList." Each month this easy-to-read grid will focus on a particular kind of application. This month, the HotList outlines voice-activated systems. PMID- 10123381 TI - Easycycling: fighting a winning battle. PMID- 10123382 TI - Focus on improvement. PMID- 10123383 TI - Management theory: a practical application. Q.I. inspections and facility rounds. PMID- 10123384 TI - Guest relations. PMID- 10123385 TI - AIDS: what does economics have to offer? AB - AIDS is rapidly becoming a major health problem in developing countries. Limited empirical information is available about the impact of AIDS on the household, the community, the health sector and the broader economy. Special problems exist in estimating the direct economic costs of AIDS in developing countries, including large out-of-pocket expenditures on health care and shortages of drugs and supplies; the difficulties of valuing resources used in caring for people with AIDS; and the lack of treatment alternatives. The calculation of indirect costs is complicated by difficulties in calculating the value of non-market production and international comparisons of the value of healthy life years lost may be erroneous, due to the higher level of average wages in developed countries. Existing evidence on the impact of AIDS at the household, community, sectoral and macroeconomic level is reviewed. Special attention is given to the impact of AIDS on the health sector and the resource allocation decisions which are made at this level. A policy-relevant research strategy would include addressing the particular information needs of the health sector, as well as studies which can help to inform government policy to mitigate the impact of AIDS at the household, community, sectoral and macroeconomic levels. PMID- 10123386 TI - What role for WHO in the 1990s? PMID- 10123387 TI - The 21st century American health care system. PMID- 10123388 TI - A century-old leadership style revitalizes the heroic hospital. AB - "Those who fail history are destined to repeat it." Emmett C. Murphy, Ph.D., an international business consultant found that the key to individual and organizational leadership is a heroic commitment to service and the reengineering of the work that it requires. Murphy, whose clients include IBM, General Motors, Johns Hopkins, Centers for Disease Control, Johnson & Johnson, and Memorial Sloan Kettering; was a consultant with Booz-Allen Hamilton and served on the faculties of the Massachusetts Institute of Technology and the State University of New York before founding E. C. Murphy, Ltd. His firm focuses on the application of quality improvement and work reengineering strategies for creating a patient-focused "heroic" organization. Recently, Dr. Murphy and Michael Snell co-authored an intriguing management book based on the fundamental business strategies historically found in an unlikely western figure. The The Genius of Sitting Bull (Prentice Hall, 1993), Murphy and Snell examine the leadership styles of the Sioux chief and General Custer at the peaks of their careers and used 13 heroic strategies common to Sitting Bull's management style as a metaphor for for successful leadership on the great plains of American health care and business life. PMID- 10123389 TI - Establishing a group practice "without walls". AB - The group practice "without walls" has become a health care delivery system that is preferred by an increasing number of physicians. This article traces the experience of Premier Medical Group, PC, a "second generation" clinic without walls in the Denver Metropolitan area, to highlight the potential benefits and the key issues related to the development and implementation of a group practice without-walls model of health-care delivery. The model promises to address physician business and professional needs by building on the best aspects of a traditional group practice, in an overall organizational structure that maximizes each physician's autonomy, individual practice style, and practice identity. The successful implementation of a group practice without walls depends upon physician leadership and impetus, clear goals-and-objectives, competent professional staff, and legal-and-financial guidance. PMID- 10123390 TI - Health care partnerships must be accountable, based on data. AB - A successful health-care partnership with employers depends on agreeing to goals and measures of success as well as sharing a wide range of clinical and claims information. The following case study tells how Twin County Community Hospital, the only hospital in Galax, VA met the demands of a group of employers for better service, lower costs and a more stable relationship, even though it had what it describes as good relations with the community and a long-standing tradition of minimal pricing. PMID- 10123391 TI - Developing a collaborative culture in a hospital setting. Interview by Donald E.L. Johnson. AB - Moving an organization from "me"to "we" can be a frightening proposition for any organization. Tim Harrington, chief executive officer of Victory Hospital, Waukegan, IL, offers his perspectives to Health Care Strategic Management publisher, Donald E. L. Johnson. Harrington found that a collaborative environment within Victory hospital and Baxter enabled the introduction of total quality management and continuous quality improvement concepts to be freely introduced into the system. He also provides guidance for establishing and fostering collaboration among hospital departments, especially amid middle management personnel. PMID- 10123392 TI - Special report on licensure, accreditation and CON. JCAHO increases flexibility in standards for 1993. PMID- 10123393 TI - New hotel for recuperating patients also popular with commercial guests. PMID- 10123394 TI - Special report. Federal, state activities to regulate security officers. AB - There are growing indications that Congress, in this session, will try to pass some form of federal standards for private security officers. In doing so, the U.S. Government will join a growing number of states that are seeking to regulate the hiring and training of both proprietary and contract officers. In this report, we'll update you on what can be expected in Washington in the year ahead. We'll also give you details on a new New York bill designed to regulate the security industry in that state. PMID- 10123395 TI - New technologies improve CCTV (closed circuit television) performance in garages. PMID- 10123396 TI - Five easy steps toward greater creativity. PMID- 10123398 TI - Dysphagia, dysphasia, dys-what-ia?! PMID- 10123397 TI - Attracting and keeping the best employees. PMID- 10123399 TI - Disposable versus reusable linen: back to the future. AB - Decisions regarding health care practices and technology are never static. As new information becomes available, and internal and external forces shift, new decisions may have to be made. Such is the decision regarding reusable versus disposable linen. Until very recently, reusable linens were not comparable with disposable linen in the quality characteristics that directly impact patient and staff safety and health. Given the current test results on the latest generation of reusable fabrics, it is time to go back to reconsider this decision for the future. PMID- 10123400 TI - A disposable choice for hospital waste. AB - "On-site incineration is becoming an increasingly important alternative for the treatment and disposal of institutional waste. Incineration reduces the weight and volume of most institutional solid waste by 90 to 95 percent, sterilizes pathogenic waste, detoxifies chemical waste, converts obnoxious waste (such as animal carcasses) into innocuous ash, and provides a substantial reduction in off site disposal costs, making on-site incineration highly cost effective. Many systems have payback periods of less than one year. In addition, on-site incineration reduces the need to depend on off-site disposal contractors, which, in turn, minimizes potential exposures and liabilities associated with illegal or improper waste disposal activities." At this time, the hospital has found its best method for the treatment of infectious and noninfectious medical waste. It is not a perfect method, but all current technologies have limitations. There are several promisingly innovative approaches being pursued; however, they are only in developmental stages. "Winston-Salem, Forsyth Memorial Hospital is reducing infectious wastes ... with an innovative microwave system being used for the first time in the United States. Once the waste is run through the microwave system, the infectious content is destroyed. As a result, ninety percent of the hospital's infectious waste can be sent to the local landfill, which saves more than $200,000 a year in transport and disposal costs. The hospital hopes the $650,000 German system will pay for itself in three years." It is hoped that these new technologies will progress into reliable treatment options for medical waste during the 1990s. In the meantime, our hospital will continue to pursue refinements in its on-site operation, which is already providing cost savings, improved safety, and environmental benefits. PMID- 10123401 TI - Information sources for medical waste management. AB - Although many hospital professionals now have personal access to online databases, popular communications services may not have the full range of electronic services needed for technical problem solving. Librarians are practiced at cross-disciplinary technical research and so health professionals may be best served by consulting an experienced database search analyst so that important information is not accidentally missed. Additionally, many commercially produced databases have repackaged and redistributed data developed by NIOSH and other federal agencies, data that are readily available in the public sector. The cost of accessing or purchasing commercial databases is usually higher than for federal databases, though commercial products use the federal databases to develop their products. Public agencies should always be consulted to obtain the most current information issued by those bodies and also because a variety of free and low-cost support materials may be available. Because of the expense of routinely consulting electronic databases when comparable printed materials may be available at a lower cost, a small reference collection of books, journals, and audiovisuals may be desirable. A selective print reference collection is found in Appendix A. PMID- 10123402 TI - A company's commitment to waste reduction, recycling, and reuse. AB - Charles Heiman would be proud to see his vision being carried on and that Standard Textile is not only doing well, but also doing good. As an industry leader, Standard Textile has incorporated the entire cradle-to-grave concept in product creation. As a result, Standard Textile can compete in tomorrow's markets because the end user will mandate an environmentally sound product or process when alternatives are available. As a society, we are faced with some tough decisions about our environment and the world we live in. A very positive step all health care facilities can take for our future and our children's future is to employ a reusable and recyclable system. Switching from disposable to reusable textiles dramatically reduces the amount of solid waste but does so without using excessive water because of state-of-the-art recycling facilities now available. It also can offer the user better performance of the products they need to use. The answer is simple enough--investment in reusable and recyclable systems is in everybody's interest. PMID- 10123403 TI - The operating room as a source of recycling material. PMID- 10123404 TI - Analysis of an organization's waste stream. AB - The steps involved in conducting a waste stream analysis for a health care organization have been described. The development of a corporate position on the organization's stewardship of its environment can be the major result of such an analysis. This position would communicate to the community the organization's commitment to the environment and would be used as policy guiding corporate decisions that affect the environment. As a result of the corporate policy, a health system waste management program could be developed. This program would consist of standardized policies and procedures, educational requirements for employees, roles and responsibilities' defined in job descriptions, public education programs, recycling programs, and capital equipment acquisition. Additionally, such a program would promote economies of scale. A waste stream analysis is only as good as the information it contains. Making it of sufficient priority within the organization ensures that adequate time and personnel are allocated to complete the analysis in a precise manner. A well completed analysis is a major component of the larger issue of an organization's responsibility to its environment. PMID- 10123405 TI - Recycling in a multihospital system. PMID- 10123406 TI - The future of medical waste regulation: simplicity and consistency as goals. AB - There are some favorable signs. At this time of federal budget constraints, the EPA is tightening its belt. EPA's Science Advisory Council recognizes these fundamental constraints and urges the agency to consider relative risks to public health and the environment in establishing regulatory priorities. If Congress and EPA follow this informed advice, and consider honestly where medical waste fits into the spectrum of environmental risks, there is at least a chance that they could come up with a simple system--just enough to satisfy public opinion, but not enough to keep people from solving the problem. PMID- 10123407 TI - Health program. Columbia Presbyterian Hospital, New York. PMID- 10123408 TI - Healing advances. New York Hospital. PMID- 10123410 TI - Collaboration: a prerequisite to effective reform. PMID- 10123409 TI - Dynamics of a medical staff development plan. AB - All hospitals must work at retaining a strong, stable, and highly qualified medical staff. To successfully do this requires a formal medical staff development plan. Institutions without such plans could be operating at a loss down the road. PMID- 10123411 TI - Healthcare reform: moving forward. AB - One of the toughest and most important issues facing America today is healthcare reform. To examine this issue more closely, four industry observers were invited to share their thoughts with Healthcare Executive. PMID- 10123412 TI - Healthcare reform begins at home. AB - The number and magnitude of problems characterizing the inadequacy of the United States' healthcare services have been well-chronicled. Not surprisingly, the type and variety of solutions are almost as numerous and diverse. Given the nominal influence the average healthcare executive can exercise over reform at the federal or state levels, initial efforts should begin at home. While not disregarding political realities, healthcare executives must become more assertive and creative. PMID- 10123413 TI - Moral integrity and healthcare leadership. PMID- 10123415 TI - Minimizing workers' comp write-offs. PMID- 10123414 TI - Take time for financial planning. PMID- 10123416 TI - Advocating healthcare reform. AB - Although sweeping healthcare reforms may be slow in coming, political and public concerns over the inequities in the current system should keep the process moving. As healthcare leaders, you need to stay atop the issues and keep the conversations going. PMID- 10123417 TI - Minimally invasive therapy in five European countries: diffusion, effectiveness and cost-effectiveness. PMID- 10123418 TI - Evaluation of argon laser treatment of diabetic retinopathy and its diffusion in The Netherlands. AB - Argon laser treatment of diabetic retinopathy (DR) is the best evaluated case in the field of minimally invasive therapy. A well-organized randomized controlled trial was followed by formal cost-analyses and cost-effectiveness analyses. Laser treatment of DR proved to be cost-effective in a situation where there was no satisfactory treatment previously. Subsequently, screening strategies for retinopathy were developed. Systematic screening for DR in diabetic populations would be cost-saving from a societal perspective. The availability of effective and cost-effective therapy and cost-saving screening strategies for DR warrants active policy making to stimulate the implementation of strategies to control retinopathy in diabetic populations. Such strategies would ideally include both guided diffusion of argon lasers and the organization of screening programs. Data from the Netherlands are used to illustrate the diffusion of argon lasers in health care. After a slow start, argon lasers have diffused widely in the Dutch health care system. This development is complemented by recommendations for screening of the European diabetic population, which were issued in 1991. More active cooperation of all parties involved would benefit in preventing blindness from DR. PMID- 10123419 TI - Setting new standards for customer advocacy. AB - Dell Computer Corporation pioneered the direct marketing of personal computers in 1984 and became the first company in the PC industry to offer manufacturer-direct technical support. According to surveys of corporate buyers, the company provides the best after-sale service and support of any computer maker. Here's how Dell has institutionalized the delivery of customer satisfaction. PMID- 10123420 TI - A vigorous approach to customer service. AB - PPG Industries, Inc. is the world's largest supplier of automotive original coatings. Its business-to-business customers require individualized service based on specific requirements. The company has solidified these relationships by establishing satellite supply facilities, applying the quality process to problem solving, and providing a variety of outlets for customer feedback. PMID- 10123421 TI - Designing--and sustaining the gains from--a service strategy. AB - Every company needs to develop a strategic approach to customer service. This article describes how to structure a service strategy, and how business partnerships can be used to enhance the customer service function. PMID- 10123422 TI - Achieving a sustainable service advantage. AB - Many managers believe that superior service should play little or no role in competitive strategy; they maintain that service innovations are inherently copiable. However, the author states that this view is too narrow. For a company to achieve a lasting service advantage, it must base a new service on a capability gap that competitors cannot or will not copy. PMID- 10123423 TI - Geriatric nutrition assessment: comparison of a screening tool to a dietitian assessment. AB - A priority in nutrition care is early identification of patients at risk of developing nutrition disorders. Simple identification measures such as nutrition screening on admission must be demonstrated to be as effective as the more lengthy traditional nutrition assessment. This study compares a nutrition screen to a clinical assessment in a geriatric setting. Seventy-two consecutive admissions to a geriatric assessment unit were both screened and individually assessed by different staff dietitians. Results of the assessment and the screen corresponded in classifying those at nutrition risk 92% of the time and those not at nutrition risk 77% of the time. The screen was found to be highly sensitive (88%) and specific (83%). A geriatric nutrition screen that has a high degree of agreement with a lengthier assessment may be a useful tool for the clinical practitioner in early identification of patients at nutritional risk. PMID- 10123424 TI - Health care 1993: top 10 trends for the "era of health reform". PMID- 10123425 TI - Review of 1992 predictions: an .850 average on forecasts. PMID- 10123426 TI - Bringing health care to children: the importance of ambulatory care. PMID- 10123427 TI - Overcoming barriers to health care access for medically underserved children. AB - The NYCHP was designed to serve the special needs of medically underserved, extremely disadvantaged children in New York City. As a model, and as the flagship program of a national network, the NYCHP demonstrates that it is possible to provide a medical home for children in a variety of challenging situations where access to traditional providers is limited. It is clear, however, that mobile units or other creative ways to overcome barriers to access to care are an insufficient long-term answer. Ultimately, the public sector must take steps to ensure that all American children have regular access to a true medical home regardless of their social or economic situation. In the interim, special initiatives such as the NYCHP must continue to fill the gap. PMID- 10123428 TI - School-based health centers: a model for delivery of adolescent health care in Portland, Oregon. PMID- 10123429 TI - Pediatrics in an inner city environment: a practice responds to the challenges of the 1990s. PMID- 10123430 TI - Caring for children with chronic illness. AB - This article has outlined some factors to consider in designing services for chronically ill children and their families. The most important factors are ensuring coordination and communication among providers, meeting the psychosocial needs of patients and families, and designing a child-friendly outpatient environment. In going beyond the suggestions outlined here, do not be afraid of trying new ideas even if it means making mistakes. When the oncology clinic at The Children's Hospital of Philadelphia moved to its present location in the fall of 1989, one of the new spaces that had been designed was a parent lounge adjacent to the day hospital. The aim was to provide a place for parents to relax while their children were receiving treatment. The parent lounge was a large room with windows, comfortable furniture, and a television set. When the parent lounge was not used, it became clear that parents were unwilling to leave their children while they were undergoing treatment. Sometimes the only way to discover whether an idea will work is to try it and find out from children and their families whether or not it best serves their needs. PMID- 10123431 TI - Managed health care for children. PMID- 10123432 TI - Planning and design of children's health care facilities. AB - Children are not small adults, but children do live in an adult-oriented world. With few exceptions, most of the environment, as designed and built, is intended to meet the needs of adults. Children adapt and have to make do. An increasing body of knowledge is telling us, however, that the sick or injured child heals best in an environment that is unique--one that responds to the child's emotional and physical needs. A health care environment that is responsive to the needs of children and their families, as well as the caregivers, will provide a more tolerable, perhaps even more pleasant experience, for the child and family and thereby enable caregivers to provide services more easily and efficiently. The new result may well be improved outcomes and health status. As planners, designers, or caregivers, we all have a responsibility to create these special environments and help each child achieve his or her highest possible level of health. PMID- 10123433 TI - A reasonable probability of substantial harm? Health care workers, AIDS, and the duty to disclose. PMID- 10123434 TI - The Medicare fee schedule--what has changed, where does it lead? PMID- 10123435 TI - Medicare PROs and the assessment of quality: should physician-specific quality data be released to consumers? PMID- 10123436 TI - Sale of a tax exempt hospital to a for-profit corporation: federal tax issues. PMID- 10123437 TI - Tax planning after General Counsel Memorandum 39,862: the brave new world of tax exempt hospitals. PMID- 10123438 TI - Operation of the National Practitioner Data Bank. PMID- 10123439 TI - Spoliation of evidence: the unnecessary tort. Bondu v. Gurvich. PMID- 10123440 TI - The military's role in rebuilding America. PMID- 10123441 TI - Taming health care costs now. PMID- 10123442 TI - The pastoral counselor as mental health professional: a comparison of the training of AAPC Fellow Pastoral Counselors and Licensed Clinical Social Workers. AB - Compares the academic and clinical training requirements for Fellow level members of the American Association of Pastoral Counselors (AAPC) with those of Licensed Clinical Social Workers (LCSWs). Concludes from the empirical findings that AAPC Fellows receive more education, clinical training, and continued supervision than do Licensed Clinical Social Workers. Notes a need for additional and similar types research comparing education and clinical requirements of pastoral counselors with those of other mental health professionals. PMID- 10123443 TI - Primary care--a primary focus. PMID- 10123444 TI - Budgets: who needs them, who has them? PMID- 10123445 TI - This is what we're all about. American College of Medical Group Administrators. AB - This MGM Journal spotlights the College, its members, their quest for professionalism and some of their ideas for managing medical group practices effectively, writes Andrea Rossiter, College director. This article profiles who they are, what's important to them and what they expect to get out of their pursuit. PMID- 10123446 TI - Enhancing physician involvement in group practice. AB - In this case study, Lynda Venters, FACMGA, describes how her group's competitive environment required greater physician involvement in corporate planning and support of group decisions as well as keeping physicians informed of the changes occurring in health care both locally and nationally. PMID- 10123447 TI - The need for and use of mentoring in group practice. AB - Medical group managers are facing a number of challenges relating to patients, employers, insurance companies and government agencies, writes Ron Menaker, FACMGA. These issues have significant implications for how group practices provide medical care and it is these issues which underlie the need to utilize mentoring. PMID- 10123448 TI - Development of a written investment policy. AB - Like many medical groups, J. Frederick Rice's had no formal method of evaluating the performance of the investment manager employed to manage the benefits plan. Rice, FACMGA, in his case study, describes how his group set formal, written goals as a means of measuring performance. PMID- 10123449 TI - Developing a mission-compatible, time-of-service collections program. AB - Linda Horton's article explores the reasons why a comprehensive, time-of-service collection program was the desired goal of her organization. Horton, FACMGA, also describes the process used to select, develop and implement a collections program that blended prudent policies with the group's mission to service the underserved. PMID- 10123450 TI - Learning how to learn: the key to CQI. AB - Learning is a search for truth, and our individual definitions are inevitably limited, writes Irwin Rubin, Ph.D. Because learning is a dynamic circular process, information about a problem or opportunity will be limited unless four perceptions of the truth--each valid, yet incomplete--are accepted. Rubin describes these four perceptions and how to most effectively get them all to work together. PMID- 10123451 TI - Using quality and efficiency evaluations of physicians. AB - Most physicians have long felt that there must be a better way to address the need for improving the cost effectiveness of medical care other than the process heavy, invasive tactics of traditional UR. The QE strategy of replacing case-by case pretreatment authorizations and certifications with a more thorough retrospective analysis of medical practice patterns appears to have the potential to dramatically improve managed care results while minimizing many of the more irritating aspects of traditional UR. The QE managed care strategy has much to offer the manager of a medical group practice who has come to realize the importance of demonstrating superior quality and efficiency as a way out of the "price discounting" game. PMID- 10123452 TI - Lab salaries. Part 1: A precarious balance on the shaky dollar. PMID- 10123453 TI - Lab salaries. Part 2: With budgets frozen, careful management is key. AB - Money woes have led to delays in hiring and capital investment. While maintaining a low financial profile has not helped morale, lab management is trying to meet the challenge bravely. PMID- 10123454 TI - Helping staff excel: career growth without a ladder. PMID- 10123455 TI - Strategic planning for an integrated bar code system. PMID- 10123457 TI - Hypertext for the hyperlaboratorian. PMID- 10123456 TI - Creating a newsletter for the laboratory. PMID- 10123458 TI - Health care reform and the practice of medicine. AB - Widespread concern about the high cost of health care and the growing number of uninsured is fueling a movement for major reform of the American health care system. The public forum is now inundated with reform proposals. This article analyzes the roots of the current health care crisis and the substance of a number of key reform plans, with special attention to the implications of reform for physicians. PMID- 10123459 TI - The evolution of medical staff credentialing. AB - As medicine has developed more and more into a business, the process of medical staff credentialing has evolved. Today, physicians need to be affiliated with a hospital or other health care entity in order to practice. Health care entities, in turn, must be able to ensure quality of care and efficiency. The mechanisms that have developed to achieve these purposes comprise the process of medical staff credentialing as it now exists and will shape the continued evolution of credentialing in the future. PMID- 10123460 TI - Physicians' tort liability for communications relating to AIDS. AB - This article reviews some of the case law in which individuals have sued based on communications made in connection with AIDS, with particular focus on cases involving the tort liability of physicians and hospitals for various types of failures in communication and breaches of confidentiality. PMID- 10123461 TI - Antitrust pitfalls in outpatient services. AB - Increasingly, services traditionally provided to inpatients are moving to the outpatient setting, resulting in greater antitrust risk. Antitrust issues are most likely to arise when a hospital with a large share of the inpatient market attempts to increase outpatient volume by restricting their patients' choices of outpatient providers, or when providers who control scarce outpatient resources attempt to restrict competition by denying other providers access to a facility. This trend has affected physicians both as competitors of hospitals in the outpatient services market and as participants with hospitals in ventures for the provision of outpatient care. PMID- 10123462 TI - Preparing adequate medical staff committee minutes: tips for handling a difficult task. AB - Preparation of medical staff committee minutes can be a difficult and frustrating challenge for medical staff leaders and those who advise them. Inadequate or inaccurate minutes can lead to loss of a defense against liability and poor performance on accreditation surveys and governmental inspections. This article discusses the purposes of minutes and offers various tips for achieving these purposes through careful preparation and review. PMID- 10123463 TI - The Inspector General's fraud alerts: questionable utility for hospitals and practitioners. PMID- 10123464 TI - Curbing the abuse of summary suspension. California Medical Association. PMID- 10123465 TI - Endosurgery instruments: reusables vs disposables. PMID- 10123466 TI - Study identifies best practices in ambulatory surgery centers. PMID- 10123467 TI - Robot helps surgeons perform hip surgery. PMID- 10123468 TI - Patients' memory under anesthesia: implications for the OR. PMID- 10123469 TI - TQM techniques used to reduce lost OR charges. PMID- 10123470 TI - Job$ '92. PMID- 10123471 TI - The health care Titanic: women and children first? AB - The plight of people who lack access to health care has captured national attention and led to a number of proposals to remedy the problem. The authors look at three types of proposals being advanced--"pro-competition" plans, "pay-or play" plans, and a national health care system--and find that they fail to address adequately the pressing needs of two groups of the poor: women of childbearing age and elderly women. PMID- 10123472 TI - Shifting the burden of proof. AB - The law places an extremely heavy burden of proof on those who wish to remove life support--even for patients in persistent vegetative states. A number of public opinion polls show that up to 85 percent of Americans would not want artificial nutrition and hydration for themselves under such circumstances. In light of these findings, a different evidentiary standard is appropriate. PMID- 10123473 TI - The art of recruiting primary care physicians. PMID- 10123474 TI - Bringing political advocacy home. PMID- 10123475 TI - Defining and enhancing the medical staff's role in strategic planning. PMID- 10123476 TI - Community well-being: lessons from the Third World. PMID- 10123477 TI - Minimizing risk with self-insurance. PMID- 10123478 TI - Trustees: prepared to lead through health reform maze? PMID- 10123479 TI - Tax-exempt challenges continue. PMID- 10123480 TI - Educational resources for trustees. PMID- 10123481 TI - Changes ahead as hospital boards shift focus. PMID- 10123482 TI - Clinton's taxing health reform. PMID- 10123483 TI - How medicine mistreats the elderly. AB - Hamstrung by biases and limited facts, doctors routinely deliver shoddy care to old people. This guide shows how to reject that medical mindset and stay healthy longer. PMID- 10123484 TI - Cutting the cost of staying healthy. Managed care limits options but can save big. PMID- 10123486 TI - The meaning behind the acronyms.... PMID- 10123485 TI - AIDS knowledge and attitudes for January-March 1991. Provisional data from the National Health Interview Survey. PMID- 10123487 TI - 1993 equipment & service guide. PMID- 10123488 TI - Behind closed doors: intimate violence. PMID- 10123489 TI - Myths ... family violence. PMID- 10123490 TI - The abused and the abusers. PMID- 10123491 TI - A safe place for help. PMID- 10123492 TI - Kentucky's landmark domestic violence legislation. PMID- 10123493 TI - Victims among the ill--the adult abuse medical protocol. PMID- 10123494 TI - Reporting spouse and partner abuse. PMID- 10123495 TI - Closed fists. PMID- 10123497 TI - Perspectives. Health care costs soar toward $1 trillion. PMID- 10123496 TI - Mammography-related beliefs of older women. A survey of an HMO population. AB - Although breast cancer risk increases with age, most studies show that mammography use decreases. A 15-minute telephone survey of 548 women health maintenance organization (HMO) members aged 65 to 74 who had not obtained a mammogram within the past year was undertaken to identify sociodemographic factors as well as knowledge, belief, and attitudinal characteristics associated with mammography history. Women who had never had a mammogram were less likely to have received a physician's recommendation and more likely to express negative attitudes about mammography, such as having a mammogram means "looking for trouble" and "makes me nervous." In addition, they expressed doubts about their need to have a mammogram and reported that "other problems" prevented them from having a mammogram. These results suggest that women who have never had a mammogram may require more intensive interventions to encourage them to obtain mammograms. In addition to receiving a mammography recommendation from their physicians, they might benefit from individual or small group educational sessions where negative attitudes about mammography could be explored and modified. PMID- 10123498 TI - Perspectives. Lobbyists gird for the health care revolution. PMID- 10123499 TI - Perspectives. Stock ownership: sullying research purity? PMID- 10123500 TI - A non-traditional request-for-proposals. PMID- 10123501 TI - Capturing & preserving precious patient data. PMID- 10123502 TI - Marketing manipulations: database telemanagement. PMID- 10123503 TI - Building strong networks eight ways. AB - It is becoming common in healthcare institutions that the charter of Information Services goes beyond providing data. IS often needs to empower the user community with the right information and the right tools, which enable them to perform their jobs more efficiently and effectively. Creating such an infrastructure requires an information network, one that allows information to flow at all levels within and outside the facility. This fortifies and enhances the business process and enables institutions to function efficiently and profitably. But developing such an information network requires analysis and planning. The following eight steps detail considerations you should make to ensure the creation of an infrastructure robust enough to address the needs of today, and capable of incorporating technologies that might be required in the future. PMID- 10123504 TI - A new generation in Vincennes. PMID- 10123505 TI - Fanning the SPARC. PMID- 10123506 TI - Bloodborne pathogens training programs and teaching aids. PMID- 10123507 TI - USPS (United States Postal Service) amends sharps regulations. PMID- 10123508 TI - Q & A: precautions when handling x-ray developing chemicals. PMID- 10123509 TI - The political landscape for health care reform in 1993. PMID- 10123510 TI - Relationships for change. PMID- 10123511 TI - Hospitals and community health centers. PMID- 10123512 TI - Hospitals exhibit caution in spending. AB - A recent survey of 290 hospital chief financial officers revealed reduced growth in spending despite increased access to capital. According to the 1992 LINC Hospital Capital Survey, significantly fewer respondents reported their availability of funds was deteriorating (19 percent in '92 versus 27.5 percent in '91). Yet hospitals are exercising caution and appear reluctant to take on large amounts of additional debt. What follows is a portion of the LINC report--an analysis of factors affecting access to capital, as well as the use of funding sources and types of capital projects being funded--prepared by The Linc Group, Inc., Chicago. PMID- 10123513 TI - Developments in the patient dumping law: the confusion continues. PMID- 10123514 TI - Health care reform: consensus or confrontation. PMID- 10123515 TI - Rural health system reform. PMID- 10123516 TI - Cost-benefit and cost-effectiveness analysis. PMID- 10123517 TI - Cost accounting ratios: a practical application. PMID- 10123518 TI - Certificate of Need revisited. PMID- 10123519 TI - Medicaid program; exemption of poverty level pregnant women from the cooperation requirements of establishing paternity and obtaining medical support and payments as a condition of eligibility; technical correction--HCFA. Final rule with comment period. AB - In general, as a condition of eligibility for Medicaid coverage, each legally able applicant and recipient is required by section 1912(a) of the Social Security Act (the Act) to cooperate with the State in establishing the paternity of any eligible child born out of wedlock and in obtaining medical support and payments. The condition is required to be met unless the individual establishes good cause of not cooperating. Section 4606 of the Omnibus Budget Reconciliation Act of 1990, (OBRA '90), Public Law 101-508, provides an exemption to this requirement for certain pregnant women and women in the postpartum period, as described in section 1902(l)(1)(A) of the Act. We have identified this group as "poverty level pregnant women". This final rule with comment period modifies our regulations to incorporate and interpret this exemption. PMID- 10123520 TI - Medicare, Medicaid and CLIA programs; CLIA program fee collection; correction- HCFA. Correcting amendments. AB - This rule corrects a technical error in a rule entitled, "Regulations Implementing the Clinical Laboratory Improvement Amendments of 1988 (CLIA)" which inadvertently deleted some content of another rule entitled, "CLIA Program Fee Collection." Both rules were published in the Federal Register on February 28, 1992. We are restoring, without change, the content of sections 493.602 through 493.634, which was incorrectly removed effective September 1, 1992. PMID- 10123521 TI - Few changes visible on the horizon. Construction outpaces acquisitions. PMID- 10123522 TI - Generating positive attention from the press. PMID- 10123523 TI - Clinton Administration tackles health care reform. Cost containment remains overriding concern. PMID- 10123524 TI - Breaking away. Charge nurses ruled ineligible for unionization. PMID- 10123525 TI - Going their own way. Deemed status edges ahead. PMID- 10123526 TI - Taking the care home. Project provides nursing follow-ups for discharged residents. PMID- 10123527 TI - Resident assessments come up short. PMID- 10123528 TI - Positive attraction. Unit-based, self-managed teams draw top talent. PMID- 10123529 TI - Pregnancy laws guard working women's rights. PMID- 10123530 TI - Cost-effective prescribing. PMID- 10123531 TI - Only one chance to make a good first impression. PMID- 10123532 TI - The care management form. AB - The primary care physician and the continuing care unit administrator at Providence Center in Scarborough, ON collaborate with Bridget Campion, clinical ethicist at St. Joseph's Health Center in Toronto to describe a process and form that staff has developed to elicit and convey patient treatment preferences in long term care. Meant to be completed as soon after the patient's admission as possible, and subject to review and revision, the Care Management Form is one attempt to promote patient autonomy in long term care. PMID- 10123533 TI - Our heritage: does it have a future? PMID- 10123534 TI - Clear writing and health workers: what's the connection? PMID- 10123535 TI - Pastoral care: integrating the whole person. PMID- 10123536 TI - Pastoral care: a cornerstone of healing. PMID- 10123537 TI - CSHP statement on pharmaceutical care. Canadian Society of Hospital Pharmacists. PMID- 10123538 TI - User interfaces: where the rubber meets the road. AB - Today's users face a dizzying array of interface tools from which to choose. Keyboard, mouse, voice or touchscreen, Windows, pull-down menus, point-and-click- so many choices, but which is best? PMID- 10123539 TI - The healthcare CIO's role in business process redesign. AB - At Bishop Clarkson Memorial Hospital in Omaha, CEO D. Max Francis has a passion. He talks it day and night. His managers will practice modern management processes and techniques. Where the majority of healthcare organizations are still remarkably hierarchical in their management structure, Clarkson Hospital has broken those traditional boundaries. Former Clarkson CIO Harry McQueen says that under the CEO's enthusiastic leadership, this regional tertiary-care center has undertaken business process redesign and has realized significant, measurable results. PMID- 10123540 TI - AHIMA (American Health Information Management Association) executives expand their role in electronic record issues. Interview by Carolyn Dunbar. AB - Four of the top leaders in the American Health Information Management Association met with Computers in Healthcare, detailing their coalition-building efforts to make the computer-based patient record a reality. They reinforce their belief in the eventual reality of the CPR and its security, and call for sanctions and penalties for those who misappropriate or misuse patient records. PMID- 10123541 TI - Contract dangers lurk in turnkey implementations. AB - Turnkey systems may seem the simple solution to automating a hospital. But too often, poorly negotiated and vaguely worded agreements turn such purchases into an implementation nightmare. PMID- 10123543 TI - HotList: scheduling systems. PMID- 10123542 TI - Priority worksheet brings order to information systems projects. AB - "Eeeny, meeny, miny, moe, and the first priority is ..." maybe the CEO's pet project or nursing's necessity. Putting aside "gut feel" for an objective method promises to streamline the process of prioritizing I/S projects, according to Saint Alexis Hospital Medical Center leadership. PMID- 10123544 TI - Hot issues. Health care sizzles on the front burner. PMID- 10123545 TI - Make sure physician contracts meet IRS and HHS guidelines. PMID- 10123546 TI - Texas law on pronouncement of death. PMID- 10123547 TI - Journey's end. PMID- 10123548 TI - Part exchange. PMID- 10123549 TI - Countdown to community care. Tomorrow's world. PMID- 10123550 TI - HISStory lessons. PMID- 10123551 TI - Regional round-up. Mersey: a league of their own. PMID- 10123552 TI - The Prescription Drug User Fee Act of 1992: speeding up the drug approval process. PMID- 10123553 TI - Should human tissue transplants be regulated? PMID- 10123554 TI - Federal courts still split on autologous bone marrow transplants. PMID- 10123555 TI - Utilization management law and policy: emerging liability trends. PMID- 10123556 TI - Courts grapple with AIDS-related information. PMID- 10123557 TI - Vertical restraints: the proper analysis of physician agreements with health plans and hospitals. PMID- 10123558 TI - Needle, syringe prices stabilize. PMID- 10123559 TI - Baxter shakes industry with acquisition of Stuart. PMID- 10123560 TI - Acute care nursing non-salary expenses per patient day. PMID- 10123561 TI - Chargeable medical supplies per admission. PMID- 10123562 TI - Catholic Health Association. Standards for community benefit. PMID- 10123563 TI - A postelection look at healthcare reform. PMID- 10123564 TI - The Clinton election: implications for healthcare. PMID- 10123565 TI - Forging a future for Catholic healthcare. PMID- 10123566 TI - The bishops' role in preserving the ministry's vitality. PMID- 10123567 TI - Empowering the frail elderly. PMID- 10123568 TI - Technology decision making. A constructive approach to planning and acquisition will require a paradigm shift. AB - Technology should be viewed as an integrating rather than a divisive element in hospital planning. In the past, technology decision-making responsibility has often been diffused throughout hospitals, but providers are beginning to take a more considered and coherent approach. The process of making decisions about technology has four key elements: assessment, planning, acquisition, and management. The most important aspect of the assessment phase is the formation of a technology advisory committee to review and evaluate requests for new and emerging technology; review capital budget requests for new and replacement technology; and set mission-based and strategic priorities for new, emerging, and replacement technologies. Technology planning allows hospitals to set long-term goals for technology acquisition. The process involves an audit of existing technologies, evaluation of other hospitals' technologies, and review of technology trends. A well-defined technology plan will, in turn, facilitate the acquisition and management process, allowing hospitals greater flexibility in negotiating costs and budgeting for training, spare parts, service, upgrades, and support. By pooling resources with other providers in their region, hospitals can further enhance the effectiveness of their use and acquisition of technology. Collaboration allows providers to share the risks of technologically volatile and intensive services and avoid costly duplication of equipment and facilities. PMID- 10123569 TI - Technology: a moral evaluation. Ethical questions on the use of technology from a macro and micro perspective. PMID- 10123570 TI - Developing a model for technology assessment. A system helps its facilities prepare for technological change. AB - In 1991 the Franciscan Health System (FHS), Philadelphia, created a Technology Assessment Task Force to support specific goals and strategies in the FHS strategic plan and to help prepare its members for technological change. Because FHS is a large and diverse system, with facilities in seven states both on the East Coast and in the Pacific Northwest, the task force needed to develop flexible recommendations with broad applicability. The task force recommended a time-phased approach for changing the way technology is identified, acquired, and used in FHS organizations. Key recommendations included (1) creating a standing FHS technology steering committee, (2) implementing a technology assessment model for selected technology activities, (3) sponsoring systemwide technology conferences, and (4) reviewing FHS technology actions, revising as appropriate. The system and hospital leadership adopted the task force's recommendations and are now implementing them. PMID- 10123571 TI - Assessment in action. Facilities' approaches to technology assessment are related to their size and services. PMID- 10123572 TI - Technology framework. A system's five-phase approach integrates values with vision. AB - Healthcare providers must assess how a technology can benefit patients and how it relates to existing technology. They must also look at a new technology's expense, quality, efficacy, and appropriateness. In March 1990 Mercy Health Services (MHS), Farmington Hills, MI, developed a five-phase technology assessment approach to help each hospital division balance its resources with the needs of its community. A technology assessment approach should: Be apolitical, unbiased, and objective Examine the relationship between existing, new, and emerging technologies Balance the community's needs with the healthcare organization's resources The five phases of MHS's technology assessment approach are as follows: Baseline assessment Regional vision Coordination and implementation Measurement and analysis Report results PMID- 10123573 TI - Does Catholic medical education have a future? PMID- 10123574 TI - Preserving a presence in medical education. Universities need Church leaders' support to promote Catholic values in healthcare. PMID- 10123575 TI - Catholic identity in medical schools. PMID- 10123576 TI - The rock from which living water springs. PMID- 10123577 TI - The fullness of life. Integrating patient care, teaching, and research. PMID- 10123578 TI - Help for a heartsick region. PMID- 10123579 TI - A collaborative publication saves money, enhances communication. St. Vincent Infirmary Medical Center. PMID- 10123580 TI - The ballerina's victory. PMID- 10123581 TI - Appointment breaking: causes and solutions. AB - From a review of research on health care appointment breaking, the authors find that patient demographic characteristics, psychosocial problems, previous appointment keeping, health beliefs, and situational factors predict no-show behavior. Suggestions are offered for designing the marketing mix to increase patient appointment keeping. Methods for mitigating the negative effects of no shows on health care providers are described. PMID- 10123582 TI - Challenges and opportunities for personal selling. AB - Health care organizations are beginning to use sales forces in much the same way as traditional for-profit organizations have used selling programs in the past. However, numerous challenges to the implementation of selling in the health care industry have yet to be overcome. The authors report viewpoints expressed by administrators in a national survey of health care organizations. PMID- 10123583 TI - Hospital image: a correspondence analysis approach. AB - In today's competitive health care industry, understanding hospital image is becoming increasingly important. The authors employ a method of analysis that is new to hospital image research--correspondence analysis. They use it to assess the images of 16 hospitals in a competitive health care market in terms of their associated features. Strategic implications of the study findings are presented. PMID- 10123584 TI - Forecasting the adoption of new medical technology using the Bass model. AB - A mathematical model, the Bass model, was used to forecast the adoption of new medical technology based on durable equipment. When the model was applied to five successful medical technologies, actual unit sales were predicted for three. The technologies investigated are computed tomography (CT scan), magnetic resonance imaging (MRI), ultrasound, hemodialysis, and lithotripsy. Because unit sales data for dialysis and ultrasound could not be obtained or estimated from secondary sources for the years immediately after market entry, application of the Bass model produced questionable results for those technologies. However, results for CT scan, MRI, and lithotripsy suggest that this model can be used to predict the adoption of new medical technology based on durable equipment when annual unit sales data can be estimated for the period immediately after market entry. PMID- 10123585 TI - Physician information acquisition and believability. A field experiment on source and type of information. AB - An experiment was conducted to assess the impact of type of source (colleague, salesperson, advertisement) and type of information (positive vs. negative) on physician believability of information. Results indicate personal sources of information are perceived as providing more believable information than advertisements. In general, positive information about a product seems to be more believable than negative information. Implications for effectively targeting the busy physician are provided for health care researchers, practitioners, and public policy officials. Finally, future research directions are discussed. PMID- 10123586 TI - Do patient perceptions of quality relate to hospital financial performance? AB - Analysis confirms that patient perceptions of quality are associated with hospital financial performance. Multivariate analysis involving more than 15,000 patients discharged from 51 medical/surgical hospitals shows that discrete dimensions of hospital quality (i.e., medical and billing systems and discharge processes) explain approximately 17%-27% of the variation in financial measures such as hospital earnings, net revenue, and return on assets. The findings suggest that measurable improvements in patients' judgments of hospital quality might translate into better financial performance. The implications of these results and the limitations of the study are discussed. PMID- 10123587 TI - Information content of dentists' Yellow Pages advertising. AB - Content analysis was performed on 1,007 Yellow Pages dental display ads to investigate whether such advertisements include the information important to consumers. The authors found a significant information gap between what consumers considered important when selecting a dentist and the information provided in the advertisements. The research was supported in part by a grant to Caroline Fisher from the American Marketing Association. PMID- 10123588 TI - Locating MRIs through marginal analysis. AB - The location decision for a magnetic resonance imaging (MRI) services facility is evaluated through marginal analysis. Both population-based and referral-based data are applied. The results provide input for a series of practical recommendations for MRI service providers. PMID- 10123589 TI - State abortion statutes on the eve of the Supreme Court's decision in Planned Parenthood of Southeastern Pennsylvania v. Casey. PMID- 10123590 TI - Comment: surrogate mother contracts: a view of recent legislative approaches. PMID- 10123591 TI - Health care collaboration, antitrust, and the 1992 merger guidelines: do competition and cost effective co-operation conflict? PMID- 10123592 TI - The peer review privilege: a dying cause? PMID- 10123594 TI - Paramedic educational programs. PMID- 10123593 TI - Information resources. PMID- 10123595 TI - Take aim for a name. PMID- 10123596 TI - EMS psychology 101. PMID- 10123597 TI - Total quality management. A style for the future. PMID- 10123598 TI - TQM in action. PMID- 10123599 TI - Facts vs. feelings. Intuition can be 20/20. PMID- 10123600 TI - EMS in the United States. A survey of providers in the 200 most populous cities. PMID- 10123601 TI - EMS providers in America's 200 most populous cities. PMID- 10123602 TI - State EMS directors. PMID- 10123603 TI - 1992 Accreditation Manual for Ambulatory Health Care survey eligibility criteria and standards changes. JCAHO. PMID- 10123604 TI - Corrections to Appendix A (section III, page 179) of the 1993 AMH and Appendix B.1 (section III, page 132) of the 1993 MHM. JCAHO. PMID- 10123605 TI - Implementing restraint standards in hospitals. AB - In summary, a hospital's restraint policy or procedure should specify the following: The requirement for a physician's order for each restraint episode; The time within which such an order must be obtained if restraints are applied before the order is issued; The maximum time that restraint may be applied without obtaining a new order; A requirement for periodic observation of the patient and the maximum time between such observations; and A requirement for proper attendance to the patient's needs. The documentation of each restraint episode should contain evidence of at least the following: A physician's time limited order. Attendance to the needs of the patient. Periodic observation of the patient. Evidence that reapplication of restraints after a trial release is a result of the same condition that led to the initial application. Without such documentation, the reapplication requires a new order. PMID- 10123606 TI - Medical center improves conscious sedation policy. PMID- 10123607 TI - Articles misconstrue Joint Commission's position on quality improvement. PMID- 10123608 TI - Review of albumin excluded from blood usage evaluation. PMID- 10123609 TI - Survey fees to cover accreditation process costs. PMID- 10123610 TI - Causes of the nursing shortage: a critical review of the theoretical and empirical literature. PMID- 10123611 TI - Hope can be cruel when you're working in hell. PMID- 10123612 TI - We're making a difference in Croatia. PMID- 10123613 TI - Starting out: success is a longer reach these days. PMID- 10123614 TI - Put your practice where shoppers throng? AB - It's no longer just the big chains locating in malls and small shopping centers. More and more traditional practices are thriving there, too. PMID- 10123615 TI - I could keep this patient alive. But why? PMID- 10123616 TI - Keep the focus on our patients--not the "big picture". PMID- 10123617 TI - Courts let UR firms off the nook--and leave doctors on. PMID- 10123618 TI - Can "America's family doctor" reshape medical education?. Interview by Berkeley Rice. PMID- 10123619 TI - Pediatricians take some big steps in earnings. PMID- 10123620 TI - New York lawmakers haggle over infusion to cut Blues' rate hikes. PMID- 10123622 TI - Ukiah hospital suffers setback: case to stay in California court. PMID- 10123621 TI - Cuomo plans to expand global budgeting. PMID- 10123623 TI - Settlement's repercussions feared. PMID- 10123624 TI - Budget cuts to slash Medicare surveys. PMID- 10123625 TI - Panel's decision puts GME disputes on hold. PMID- 10123626 TI - Changes in MSAs spell big payment shifts for some. PMID- 10123627 TI - Health spending hits $838 billion in 1992. PMID- 10123628 TI - New price change measure created. PMID- 10123629 TI - Regulation, competition can work together in a redesigned system. PMID- 10123630 TI - Bush warns of runaway federal health bill. PMID- 10123631 TI - 4th quarter kind to hospital ratings. PMID- 10123632 TI - Self-insured medical equipment service could end up being costly. PMID- 10123633 TI - Financial health gives HMOs hope in reform discussions. PMID- 10123634 TI - Healthcare bond volume jumps 70% in 4th quarter. PMID- 10123635 TI - Congress shuffles the healthcare deck. PMID- 10123636 TI - Rep. Stark wastes no time dusting off reform bill. PMID- 10123637 TI - VA nominee wants to zero in on healthcare. PMID- 10123638 TI - HCA agrees to settle charges in Texas probe. PMID- 10123639 TI - Staffing shortages putting patients at risk--nurses. PMID- 10123640 TI - Nu-Med files Chapter 11. PMID- 10123641 TI - ProPAC urges revision of wage rates. PMID- 10123642 TI - W.R. Grace makes bid of $89 million to buy Home Intensive Care. PMID- 10123643 TI - HHS urged to stay neutral on mergers. PMID- 10123644 TI - Epic prepares for 'managed competition'. PMID- 10123645 TI - Home infusion depresses Medical Care revenues. PMID- 10123646 TI - Scope of surgery cut at 4 more hospitals. PMID- 10123647 TI - Community Psychiatric takes a 'gamble' on transitional niche. PMID- 10123648 TI - Hospital settles landmark HIV case. PMID- 10123649 TI - Calif. Blue Cross plans IPO for new unit. PMID- 10123650 TI - New Boston facility under fire. PMID- 10123651 TI - Brown aims for more VA access. PMID- 10123652 TI - AMI posts big jump in first quarter earnings. PMID- 10123653 TI - HMOs see drug price hikes double in wake of Medicaid 'best price' legislation- GAO. PMID- 10123654 TI - In terms of independence, hospital boards have big edge over most corporate boards. PMID- 10123655 TI - 1993 Trustees of the Year: Pam Rhodes and Carolyn Lewis. PMID- 10123656 TI - Panel widens probe of inappropriate Medicare charges. PMID- 10123657 TI - Even with Clinton in White House, state initiatives face uphill climb. PMID- 10123658 TI - Conditionally accredited hospitals mirror the rest of the industry. PMID- 10123659 TI - NLRB ruling raises concerns on committees. PMID- 10123660 TI - Pulse of cash flow among systems' vital signs. PMID- 10123661 TI - Panetta eyes cost limits. PMID- 10123662 TI - Shalala questioning gets a bit pointed. PMID- 10123663 TI - Mathis defends exemption. PMID- 10123664 TI - Physicians sanctions rise; variations hit. PMID- 10123665 TI - 2 Lansing, Mich., hospitals merge, control 41% of beds. PMID- 10123666 TI - Joint Commission modifies, expands smoking regulations. PMID- 10123667 TI - New management company targets minority markets. PMID- 10123668 TI - Cuomo's proposed budget cuts to intensify battle over rates. PMID- 10123669 TI - Findings halt clinical trials of centoxin. PMID- 10123670 TI - Hospital says secret deal marred marriage of Quincy, Ill., facilities. PMID- 10123671 TI - First lady to have key role in crafting reform. PMID- 10123672 TI - Government report backs feds' stance on antitrust issue. PMID- 10123674 TI - Long-term care to be studies in reform process. PMID- 10123673 TI - Mediplex buys firm run by chairman's sons. PMID- 10123675 TI - Sales of 'no-frills' insurance grow slowly. PMID- 10123676 TI - Hospitals continue move into home care. PMID- 10123677 TI - Judge upholds tough reclassification rules. PMID- 10123678 TI - Have focused strategy for ambulatory care. PMID- 10123679 TI - Orthopedic implant price hikes moderating. PMID- 10123680 TI - Cleveland facility sued in contract battle. PMID- 10123681 TI - Providers seek to rein in retiree health costs. PMID- 10123682 TI - Distressed-hospital level drops a few percentage points. PMID- 10123683 TI - Healthcare shown to have highest default rate on non-rated debt. PMID- 10123684 TI - Small obstetrical unit provokes big battle. PMID- 10123685 TI - Calif. hospitals caught in crossfire of nurse union fight. PMID- 10123686 TI - Ex-exec, hospital settle wrongful discharge suit. PMID- 10123687 TI - Fla. group seeks to form panel. PMID- 10123688 TI - Stanford, primary group negotiating affiliation. PMID- 10123689 TI - Va. hospital ventures struggle. PMID- 10123690 TI - Senate report blasts D.C. Blues plan's waste. PMID- 10123691 TI - 5 embezzling execs sentenced. PMID- 10123692 TI - Affiliated Medical agrees on buyers for two more hospitals. PMID- 10123694 TI - Casey prepares health plan. PMID- 10123693 TI - Sutter joint venture envisions 'integrated' care. PMID- 10123695 TI - Rural healthcare summit to meet in March to devise reform recommendations. PMID- 10123696 TI - Applause, warnings of task's scope greet appointment of Hillary Clinton. PMID- 10123697 TI - IRS requiring more information on executive compensation at tax-exempt organizations. PMID- 10123698 TI - Cincinnati HMO imposing 'gag clause' in effort to mute criticisms by physicians. PMID- 10123699 TI - Hospital closes after management firm quits. PMID- 10123700 TI - 2 former NME execs subjects of FBI probe. PMID- 10123701 TI - Justice Dept. probe targets Conn. hospitals. PMID- 10123702 TI - FTC files complaint against Fla. hospital swap. PMID- 10123703 TI - CBO: reform won't cut deficit. PMID- 10123704 TI - Embargo antiquates Vietnamese healthcare. PMID- 10123705 TI - Life in the slow lane at the FDA. PMID- 10123706 TI - Malpractice reform. Study sees big savings. PMID- 10123707 TI - School-based clinics aid in delivering care. PMID- 10123708 TI - Hospitals giving E-mail a stamp of approval. PMID- 10123709 TI - Healthcare stocks: some bright spots in a cloudy year. PMID- 10123710 TI - Baptist, Miss. county set to sign lease pact. PMID- 10123711 TI - Receivables due continues to decline. PMID- 10123712 TI - Empire Blues offer cost, access plan. PMID- 10123713 TI - New Jersey hospital execs decry Blues' planned rate reductions. PMID- 10123715 TI - Trial unlikely to end Wis. hospital war. PMID- 10123714 TI - Drug prices rise 4 times inflation rate. PMID- 10123716 TI - Court ruling favors home-care agencies. PMID- 10123717 TI - Kaiser to build outpatient complex. PMID- 10123718 TI - N.Y. surcharges invalidated. PMID- 10123719 TI - January surge makes Charter one of top-performing stocks. PMID- 10123720 TI - Wis. sues hospital to retrieve Medicaid money. PMID- 10123721 TI - Florida sues Adventist over hospital swap. PMID- 10123722 TI - Critics attack CBO's reform assessments. PMID- 10123723 TI - Hospitals must advance beyond advertising to true marketing. PMID- 10123724 TI - Social HMOs: a reform idea on the rise. PMID- 10123725 TI - Execs edgy over global budgeting. PMID- 10123726 TI - New army medical center deploys state-of-the-art technology, facility design. PMID- 10123727 TI - Firm offers to sell bad debt to highest bidder. PMID- 10123729 TI - Plans unfold for reform task force's research. PMID- 10123728 TI - Humana to keep one hospital. PMID- 10123730 TI - Outpatient business aids AHM. PMID- 10123731 TI - Alliance offers help with benefits assessment. PMID- 10123732 TI - Urban, teaching hospitals consider pullout from NJHA. PMID- 10123733 TI - Insurance cost 'unaffordable'. PMID- 10123734 TI - Automation, bar coding bring patient account management down to size. AB - By combining bar code scanning technology with computer-assisted record retrieval technology, St. Vincent Hospital and Healthcare Center in Indianapolis, Ind., has automated its patient financial records management operation. In the process, the hospital has not only streamlined its account management process, but has also reduced labor and storage costs and improved access to patient information. PMID- 10123735 TI - Digital radiography. PMID- 10123736 TI - The sibling group: beginning to meet the needs of child siblings of psychiatrically hospitalized children. AB - Child siblings of children admitted to psychiatric hospitals often find themselves in a unique and potentially isolating situation. Because of the crisis affecting all family members and the focus of both parents' and professionals' energies on the identified patient, this sibling group is often overlooked. This paper describes an educational and supportive group designed by the authors to begin to address the needs of this population and offered as part of the family services component of a child and adolescent psychiatric unit. The group serves multiple functions by diminishing the non-hospitalized children's sense of isolation, offering them education and support, and providing the treatment providers an opportunity to assess the needs of the inpatient's sibling. The authors describe a highly structured format that facilitated group members' participation. PMID- 10123737 TI - Dramatic changes in care: the experience of one psychiatric hospital. AB - Recent and dramatic changes in this country's mental healthcare service are widely documented. To assess the extent and timing of those changes at one private psychiatric hospital, the authors examined length of stay, number of admissions, and patient age for general trends between 1980 and 1990 and more closely examined trends between July 1990 and December 1991. We related our findings to data for other private psychiatric hospitals and compared them with data from psychiatric units in general hospitals. The results are discussed in terms of changes in insurance coverage, changing utilization by different age groups, and a national shift from inpatient to outpatient care. PMID- 10123738 TI - Strategic implications of healthcare reform for mental health providers. AB - While most of the recent national attention on healthcare reform has focused on physicians, acute-care hospitals, and the insurance industry, what about mental healthcare providers? Where do psychiatric hospitals, psychiatrists, psychologists, and other mental healthcare professionals fit into the healthcare payment system of the future? For example, if the United States ends up with what is called universal access--a payment source for all Americans--will it include mental health benefits? The stakes are high; one quarter of the American population either has no health insurance or is covered by Medicaid. Many current reform proposals include tort reform; but how would it affect mental healthcare providers? Will managed care--primarily health maintenance organizations (HMOs) and preferred provider organizations (PPOs)--be a part of the reshaping of the United States healthcare system? This article has three objectives: To summarize the various healthcare reform proposals and provide a description of the key elements anticipated in the most likely reform package. To consider the strategic implications of payment reform for the mental healthcare industry. To identify strategies for mental healthcare providers that are likely to be useful regardless of the shape of healthcare reform. PMID- 10123739 TI - Comorbidity in an inpatient eating disordered population: clinical characteristics and treatment implications. AB - Data are presented that describe the clinical characteristics of 96 patients treated at the C.F. Menninger Memorial Hospital, Topeka, Kansas, from November 1983 to June 1989. Their Axis I eating disorder diagnoses were as follows: 53 had diagnoses of bulimia; 21 had anorexia nervosa; 2 had both diagnoses; 17 had atypical disorders or eating disorders not otherwise specified; and 2 had a diagnosis of psychological factors affecting physical conditions. Seventy-three percent of the cohort were found to have either Axis I or Axis II disorders or both, comorbidity. Borderline personality disorder was found in 46% of the sample, although 20% of the patients with borderline disorders were diagnosed retrospectively. Depression was the largest comorbid Axis I diagnosis. Patient variables for sexual abuse, drug and alcohol addiction, purgative behaviors, and interpersonal relationships are also described. The authors conclude that a substantial subpopulation of eating disordered patients are significantly comorbid for other psychiatric illnesses. This high incidence of comorbidity may help explain the frequency of refractoriness of many eating disordered patients who do not respond to outpatient or short-term inpatient hospitalization. The authors recommend that additional research studies address the problems of the comorbid eating disordered patient and suggest that the findings be taken into account by clinicians and payers. PMID- 10123740 TI - Treatment outcome and continuous quality improvement: two aspects of program evaluation. AB - Increasingly, various stakeholders from insurance companies to patients are demanding verification of treatment effectiveness. With this pressure for accountability, program evaluation is essential to the continued existence of psychiatric hospitals because it permits understanding the effects specific interventions or procedures have on the quality and effectiveness of care. Two inpatient aspects of program evaluation are treatment outcome and continuous quality improvement. This article describes the conceptual bases of both treatment outcome and continuous quality improvement, depicts their complementary characteristics, and suggests how these two aspects of program evaluation can be integrated. PMID- 10123741 TI - The liability of physicians who examine for third parties. PMID- 10123742 TI - Adoption and abandonment of matrix management programs: effects of organizational characteristics and interorganizational networks. AB - Organizational design theorists argue that organizations adopt matrix (departmentalized) structures for technical reasons, to solve problems of internal coordination and information processing. Research on interorganizational networks suggests that organizations adopt new structures because of mimetic forces and normative pressures. We examined the effects of both sets of factors on the adoption of matrix management in a group of hospitals. Multivariate analyses revealed that matrix adoption is influenced not only by task diversity, but also by sociometric location, the dissemination of information, and the cumulative force of adoption in interorganizational networks. Such variables exert little influence on decisions to abandon matrix programs, however. PMID- 10123743 TI - Contact with AIDS patients as a source of work-related distress: effects of organizational and social support. AB - In this study, we hypothesized that a nurse's exposure to acquired immunodeficiency syndrome (AIDS) patients as part of the work role is positively associated with distress as indexed by negative mood at work. Given this expected relation, we sought to identify factors that might reduce the negative effects of caring for AIDS patients on nurses. We predicted that both organizational and social support would moderate the relationship between extent of exposure and negative mood, with the relationship being strongest when support is low and weakest when support is high. The results of tests among a sample of 256 nurses supported all the hypotheses. We discuss implications of this study and directions for future research. PMID- 10123744 TI - Performance effects of information asymmetry and economies of scope in diversified service firms. AB - This study examined the performance effects of information asymmetry and economies of scope in diversified service firms. Tests using both accounting- and stock-market-based measures of performance revealed that information asymmetry improved performance more than economies of scope. As hypothesized, the benefits of information asymmetry were greater for firms offering services whose quality cannot be determined until after their purchase (experience services), and the benefits of economies of scope were greater for firms offering services whose quality can be determined prior to purchase (search services). However, without considering the interactive effects of service characteristics, economies of scope were negatively associated with performance for diversified service firms overall. PMID- 10123745 TI - AIDS knowledge and attitudes for 1991. Data from the National Health Interview Survey. PMID- 10123746 TI - Organizational and community transformation: the case of a rape crisis center. PMID- 10123747 TI - Organization development in public social services--the irresistible force meets the immovable object. PMID- 10123748 TI - Assessing prospects for organizational change: the uses of force field analysis. PMID- 10123749 TI - Toward a developmental approach to program evaluation. PMID- 10123750 TI - The interorganizational coordination of services to children in state custody. PMID- 10123751 TI - The early stage in the creation of two self-help organizations: an exploratory study. PMID- 10123752 TI - Integrating care for the geriatric patient. Examples from the Social HMO (SHMO). AB - Managing the care of geriatric patients with chronic disease focuses attention on the functional impairments that place these patients at risk in the home environment. Maintaining patients in their preferred home settings requires physicians to coordinate effective discharge planning and long-term community care resources. A service coordinator or case manager can play a key role in coordinating the broad array of services needed, as well as linking the providers involved. A coordinated acute and long-term care service delivery system is described, with examples from the Social HMO (SHMO). Data are presented on SHMO enrollee demographic characteristics, chronic disease conditions and functional levels, as well as data on care plans, utilization and costs. A case example illustrates how ongoing medical and long-term care are integrated. Implications for geriatric care and HMO practice are discussed, with recommendations for improving geriatric care in the next generation of SHMO sites. PMID- 10123753 TI - Innovations in clinical care in the social HMO. PMID- 10123754 TI - 1987 to 1991 cost and utilization of Class IV HIV patients. AB - The 1987 to 1991 direct medical costs and service utilization of Class IV Human Immunodeficiency Virus (HIV) patients cared for at a Group Health Cooperative of Puget Sound (GHC) are described and compared across four time periods: 1987-'88, 1989, 1990, and 1991. Cost and utilization information for an age- and sex matched control group of GHC enrollees not having Class IV HIV conditions are also compared to those of the Class IV HIV group. Data are presented on pharmacy, inpatient care, outpatient visits by physician specialty, laboratory, radiology, home health/hospice and other costs. The costs of the Class IV HIV population are, on average, 20 times those of the control group. The percent distribution of the control group's costs did not experience much change from 1989 to 1991. Conversely, the Class IV HIV group experienced a shift in costs from the inpatient to outpatient setting from 1987-'88 to 1989. This shift was temporary, as the locus of care shifted back to the inpatient setting over the following 2 years. Anecdotal evidence suggests that antiretroviral treatment may have led to a period in which patients required less intensive settings to manage their illness. Inpatient costs may have increased as the initial benefit of zidovudine treatment began to wane. The Class IV HIV population had greater percent of total expenses in pharmacy, laboratory, radiology, and home health/hospice services, and lower percent of total expenses in outpatient primary and specialty care than the control group. PMID- 10123755 TI - Alcoholism: a guideline for early detection and treatment. Group Health Cooperative of Puget Sound. AB - Early detection and treatment of alcoholism benefits patients. Group Health Cooperative of Puget Sound (GHC) charged a committee with identifying ways to improve this area of care within their organization. The results of the Committee's investigation led to the recommendation for use of the CAGE screening tool. Follow-up activities included the development of a practice guideline on the early detection, referral and treatment of alcoholism. PMID- 10123756 TI - A preconception assessment program. PMID- 10123757 TI - A pre-operative teaching program for children. AB - The Fallon Clinic Pediatric Department initiated a unique pre-operative teaching program in the HMO ambulatory setting for children undergoing elective surgery. The new program is based upon a pre-surgery appointment scheduled 1 week before elective surgery. At this visit, the patient completes required laboratory and other pre-operative testing and a physical examination is performed by the child's pediatrician. PMID- 10123758 TI - An HMO lactation program. PMID- 10123759 TI - Clinical practice and new technology: prostate-specific antigen (PSA). AB - In response to a marked increase in the use of an available test, Group Health Cooperative of Puget Sound (GHC) evaluated the use of prostatic specific antigen (PSA) as a screening test for prostate cancer. A project team reviewed the literature and determined that PSA did not meet GHC's criteria for screening. An implementation team then developed a comprehensive program to educate staff, facilitate practice change, measure outcomes and provide continuing feedback to physicians. These efforts are described and preliminary reports reported. PMID- 10123760 TI - Reducing outpatient costs of nonsteroidal antiinflammatory drugs at a Department of Veterans Affairs teaching hospital. AB - OBJECTIVE: To determine how formulary changes, based on the recommendations of a clinical pharmacy specialist, affected outpatient nonsteroidal antiinflammatory drug (NSAID) prescribing patterns and drug costs in a Department of Veterans Affairs (VA) teaching hospital. DESIGN: Cost-benefit analysis. SETTING: VA teaching hospital. PATIENTS: Outpatient veterans. INTERVENTIONS: Sulindac, piroxicam, and diflunisal were removed from the formulary and made available only on a case-by-case review process. Buffered aspirin and phenylbutazone also were removed from the formulary; these drugs were made unavailable altogether. Ibuprofen, indomethacin, salsalate, enteric-coated aspirin, and plain aspirin retained their formulary status and were available for routine prescribing. MAIN OUTCOME MEASURES: Changes in the number of prescriptions dispensed and in prescription costs for each NSAID were measured 3 months before and 5 and 21 months after implementation of formulary changes. RESULTS: No prescriptions were dispensed for diflunisal, buffered aspirin, and phenylbutazone 21 months after implementation of the formulary changes. During this same period, prescriptions for sulindac and piroxicam declined 95.7 and 97.1 percent, respectively. The average cost per outpatient NSAID prescription declined from $14.78 to $4.75 (67.9 percent) after 21 months. An extrapolated yearly savings of $137,704 was calculated. CONCLUSIONS: Formulary changes based on recommendations of a clinical pharmacy specialist resulted in altered physician prescribing patterns and reduced outpatient drug costs for NSAIDs in a VA teaching hospital. PMID- 10123761 TI - Radiographic contrast media: an introduction to its use, adverse-effect profile, and economic impact. AB - OBJECTIVE: To provide an overview of the development, chemistry, adverse-effect profile, and economic impact of radiographic contrast media (CM). DATA SOURCES: Information was collected by conducting a MEDLINE search for clinical trials, reviews, and other articles pertaining to the use of CM. References cited in published review articles and manufacturer's product information also were used. STUDY SELECTION: Studies, review articles, and editorials were selected for review if they addressed the synthesis, clinical use, or economic impact of CM. Comparative studies conducted in humans were used to address the adverse-effect profile of CM. DATA EXTRACTION: Data were extracted from reviews and editorials when the information from multiple sources was consistent and pertained to the purpose of this review. Comparative reviews addressing adverse reactions were reviewed by the author for appropriate methodology and reporting of results. DATA SYNTHESIS: Radiographic CM are iodine-containing compounds that can be injected intravascularly or intrathecally for multiple diagnostic tests. CM are differentiated according to water solubility, viscosity, radiopacity, and osmolality. In the past decade, low-osmolality CM (LOCM) have been developed that may impart fewer adverse effects, such as flushing, nausea, vomiting, allergic reactions, cardiovascular effects, and nephrotoxicity. The use of LOCM has steadily increased since their introduction in 1985. The cost of LOCM is approximately 10-to 20-fold higher than previously available CM. This represents a growing financial burden to the healthcare system. CONCLUSIONS: CM are an integral tool in diagnostic medicine. LOCM appear to be safer than previous agents; however, they are also more expensive. Balancing safety and financial concerns will be a recurring issue facing both the medical society and third party payers when selecting appropriate CM to administer to patients. PMID- 10123762 TI - National survey of community pharmacists on technicians. PMID- 10123763 TI - Managed mental health care and the psychiatric hospital: is rapprochement possible? PMID- 10123764 TI - Partial programs: less means more for some patients, providers and insurers. PMID- 10123765 TI - Realignment: California's bold new approach to mental health or another deinstitutionalization fiasco? PMID- 10123766 TI - The hospital's role in educating the public. PMID- 10123767 TI - Implications of a Clinton presidency for hospitals. An early assessment. PMID- 10123768 TI - 1993 California hospitals public policy agenda. PMID- 10123769 TI - Need for health care reform and access perceived by Californians. PMID- 10123770 TI - Baton Rouge General employs mix of quality tools, data analysis, and benchmarking with other SunHealth hospitals to improve processes. PMID- 10123771 TI - Just-in-time approach to systemwide efficiency and quality borrows from industrial techniques. PMID- 10123772 TI - Health maintenance organizations; HMO qualification determinations and compliance actions--HCFA. Notice. AB - This notice sets forth the names, addresses, service areas or modified service areas, and dates of qualification or expansion of entities determined to be Federally qualified health maintenance organizations (FQHMOs) during the period April 1, 1992 through September 30, 1992. It also includes the service expansion area for one FQHMO that had been inadvertently omitted from the previous Federal Register notice that covered the period August 6, 1991 through March 31, 1992. Additionally, it sets forth compliance actions taken by the Office of Prepaid Health Care Operations and Oversight for the period April 1, 1992 through September 30, 1992. This notice is being published in accordance with our regulations set forth at 42 CFR 417.144 and 417.163, which require publication in the Federal Register of certain determinations relating to FQHMOs. PMID- 10123773 TI - Health care programs; fraud and abuse; amendments to OIG exclusion and CMP authorities resulting from Public Law 100-93-- Office of Inspector General, HHS. Final rule and clarification. AB - This final rule clarifies the scope and purpose of the exclusion authority provisions originally set forth in final rulemaking published in the Federal Register on January 29, 1992 (57 FR 3298). That final rule implemented the OIG sanction and civil money penalty (CMP) provisions established through section 2 and other conforming amendments in the Medicare and Medicaid Patient and Program Protection Act of 1987, and other statutory authorities. This clarifying document modifies the final rule to give greater clarity to the original scope of the authorities contained in 42 CFR part 1001. In addition, this rule is providing further clarification to the discovery provision set forth in part 1005 of the regulations. PMID- 10123774 TI - National Institutes of Health; statement of organization, functions, and delegations of authority--HHS. PMID- 10123775 TI - Hospital upgrades CCTV; installs integrated system in new maternity unit. PMID- 10123776 TI - An interview with: Russell Colling on trends in hospital security. PMID- 10123777 TI - Outside firm wins management contract for 785-bed Northwestern Hospital. PMID- 10123778 TI - Special report. Violence in hospitals: What are the causes? Why is it increasing? How is it being confronted? AB - In previous articles and reports, we have reported on violence in emergency rooms and other hospital areas, and what steps some security directors have taken to prevent and deal with it. In this report, we'll review two recent developments: Increased demands by nurses and their organizations in this country and Canada that hospitals take action to discourage workplace violence. Increased reports of gang violence spilling over into the hospital environment, and the threat this poses to the safety of hospital workers. PMID- 10123779 TI - How to use case studies: continuity cases vs. one-shot cases. AB - Cases are a widely used instructional technique in health services administration education. This article discusses the merits of using cases in graduate education and identifies two types of cases, one-shot cases and continuity cases. The continuity case has many advantages for professional education. In particular it requires the students to recognize and cope with the interactions among decisions. Continuity cases are good vehicles both for instruction and for evaluation of students' competence. The supply of good continuity cases, however, is very limited. Consequently, despite the advantages of this type of case, instructors must consider using a blend of continuity and one-shot cases. Suggestions for the mix of cases within a curriculum are presented. PMID- 10123780 TI - Integrating a curriculum: the role and function of a capstone course. AB - The rationale for establishing a strategy to integrate learning within a health administration curriculum is presented. Strengths and weaknesses associated with six models are presented which examine the student, market, internship/practicum, case course, and thesis/major paper as integrators as well as the self integrating curriculum. The capstone course is presented as a hybrid of multiple models with a unique educational philosophy. The concept of the capstone course is examined with specific reference to design parameters associated with the capstone course used in the health management and policy curriculum at the University of New Hampshire. Suggestions and issues for faculty to consider as they develop a capstone course are also included. PMID- 10123781 TI - International activities in health administration programs in the United States and other countries. PMID- 10123782 TI - Cross-national training in health administration: the training of Latin Americans in U.S. institutions. PMID- 10123783 TI - Reflections of an international student enrolled in a health administration program in the United States. PMID- 10123784 TI - The AUPHA/HIAA faculty fellowship in the health insurance industry: the first fellows' views. PMID- 10123785 TI - Marketing matters: the implications for health administration educators. PMID- 10123786 TI - Service priorities outlined. PMID- 10123787 TI - Health care facility security. PMID- 10123788 TI - 23 Crown Health Enterprises. PMID- 10123789 TI - New Southern Cross Hospital opens in Wellington. PMID- 10123790 TI - Overseas hospitals are embracing quality performance imperative. AB - The International Quality Study examined 241 acute care hospitals in the United States, Germany, Japan and Canada. The American Quality Foundation is an independent, non-profit, New York-based think tank addressing national public and economic issues related to quality and productivity, and identifying long-term management needs relative to these issues. PMID- 10123791 TI - Two public health providers for Christchurch. PMID- 10123792 TI - Public Health Commission sets pilot goals. PMID- 10123794 TI - Reforming the reformatory. PMID- 10123793 TI - New health reforms need support of appropriate information systems. PMID- 10123795 TI - Staffing intelligence services: a survivor's guide. AB - Work at the Department of Health on the information needs of District Health Authorities as purchasers demonstrates the need for co-ordinated information services that handle both numeric and text data--termed intelligence. The DHA Project has built information implications into its health needs assessment protocol and has shown, through pilots, the steps involved in developing co ordinated provision. These developments contrast sharply with the long established NHS dichotomy between the roles of librarians--often narrowly perceived, and those of information officers--equally narrowly defined but with a greater command of resources. Consideration of how intelligence services are to be staffed raises issues which involve appreciating wider changes in information education. Most current courses no longer perpetuate the skills divide between those who will be at ease handling text information (librarians) and those who are able to create and use database management systems holding numeric data (information officers). Skills needed for the intelligence function cross the boundary. Some librarians are already able to encompass the required range of skills, but without retraining many will face unequal competition with the new generations of graduates from information management and information science courses. Local training opportunities are essential, but there is also a growing number of higher degree courses which can be used for career enhancement and some of them are available on a distance learning basis. The NHS Training Directorate has begun the process of assisting courses it deems relevant to NHS information management training, but the Department of Health should specify the staff competencies required as part of quality assurance standards for intelligence services. PMID- 10123796 TI - Responsibility for funding NHS library services. AB - This paper is intended to contribute to discussion and debate on sources of funding for NHS library services which is a complex issue in the present climate of organizational change. Topics covered include the management and organization of services, the users, their requirements and sources of funding. In conclusion a number of specific issues that need addressing are raised. PMID- 10123797 TI - Who uses NHS libraries? Preliminary results from a survey of postgraduate medical libraries in North East Thames. AB - Recent changes have made Regional Deans fund-holders for postgraduate medical education. Allocations from the Dean's budget often fund NHS library infrastructure and associated costs arising from the information and study needs of junior medical staff. To provide adequate levels of stock and services for all library users requires funding from all appropriate sources. This paper describes a survey carried out in North East Thames to facilitate appropriate funding by and for user groups other than junior doctors. The wide variation in results is discussed. The survey is not seen as definitive, but as part of the beginning of the evolutionary process of allocating funds for libraries serving postgraduate medical education and other users. Further research is suggested, particularly in other Regions, to provide comparative data. PMID- 10123798 TI - The funding of postgraduate medical education in NHS libraries--is a formula workable? A case study from the North East Thames and North West Thames Regions. PMID- 10123799 TI - Formula funding in a multidisciplinary medical library: a case study at St George's Hospital Medical School, University of London. PMID- 10123800 TI - Eldercaring employees: an agenda for employers. AB - The aging of the U.S. society and the growth in female labor force participation have produced a workplace environment in which eldercare is becoming common. In the context of the employed caregiver, this article reviews the nature of long term caregiving arrangements, including the onset of long-term care need, the trajectory that such care takes and the means by which most long-term care needs are met. Six specific recommendations are offered for employers to proactively plan for the impact of eldercare in the workplace. PMID- 10123801 TI - Nursing home reform: its legislative history and economic impact upon nursing homes. AB - This article presents a legislative history of Subtitle C of the Omnibus Budget Reconciliation Act of 1987 (OBRA '87). It articulates the philosophy behind the act and describes the economic and organizational impact on the nursing home industry. Additionally, data from Connecticut nursing homes are analyzed to determine the factors that affect the costs of complying with OBRA. PMID- 10123802 TI - Key points to consider in the design and delivery of group long-term care insurance services. AB - Long-term care insurance is a rapidly growing form of risk protection that many employers are beginning to make available to employees and their family members. Benefits managers need to use care in navigating the not yet fully charted waters of this new field of group insurance. PMID- 10123803 TI - Challenges and opportunities in the provision of long-term care. AB - The demands for long-term care are substantial and, given our nation's demographics, are likely to become a critical issue for the economy. Through employee assistance programs and the provision of long-term care benefits, employers are likely to see a substantial increase in individuals' concern for the provision of care. PMID- 10123804 TI - Medical care decisions with limited resources: can equitable decisions be made? PMID- 10123806 TI - Data watch. 1992 health benefits: the year in review. PMID- 10123805 TI - Benefits: where are we headed? PMID- 10123807 TI - States show new interest in regulated health planning. PMID- 10123808 TI - Networks of care may serve as a model for health reform. PMID- 10123809 TI - Pay-related health care plans bring equity to cost sharing. PMID- 10123810 TI - HMO rate increases slowed last year. PMID- 10123811 TI - Employers push data-collection effort. PMID- 10123812 TI - Cost control and managed competition. PMID- 10123813 TI - Employer health coverage for domestic partners--identifying the issues. AB - Several well-known companies now offer employees the opportunity to provide health coverage to gay, lesbian, or opposite-sex domestic partners, and others are considering doing so. This article examines the practical, tax, and other legal issues that employers need to consider as they make decisions about this benefit. Issues include the criteria that employees and their domestic partners must meet in order for coverage to be available, the cost of coverage, and how coverage is taxed in different situations. PMID- 10123814 TI - Reinstatement of the sexual harasser: the conflict between federal labor law and Title VII. AB - Greater numbers of employers are adopting and vigorously enforcing policies prohibiting sexual harassment in the workplace. Discipline, including possible termination of employment, often is prescribed for the violation of such policies. When employees are represented by a union and covered by a collective bargaining agreement, final decisions relating to discipline often are made by arbitrators pursuant to the agreement's grievance and arbitration procedure. For a variety of reasons, arbitrators may decide that a lesser form of discipline than that imposed by the employer is warranted for acts of sexual harassment. Such arbitration awards present a substantial conflict between two compelling public policies--the public policy favoring the private resolution of workplace disputes and the public policy against sexual harassment. This article will address the several federal courts of appeals' decisions that have attempted to resolve this conflict. PMID- 10123815 TI - OSHA compels disclosure of safety and health audits: smart enforcement or misguided policy? PMID- 10123816 TI - 1993 Buyer's Guide. PMID- 10123817 TI - Department of Transportation guidelines ... for EMT-ambulance, EMT-intermediate, EMT-paramedic, EMT-dispatcher, and EMS instructor training programs. PMID- 10123818 TI - State and province survey. PMID- 10123819 TI - Organizations. PMID- 10123820 TI - Hospital safety management. PMID- 10123821 TI - Hurricane Andrew reverses natural order: the helpers need help. Part I. PMID- 10123822 TI - Hurricane Andrew reverses natural order: response from the top: we will rebuild. Part II. PMID- 10123823 TI - The integrator of care: a coordinated health care system. PMID- 10123824 TI - Market reform and universal coverage: avoid market failure. AB - Determining the marketing mix for hospitals, especially those in transition, will require critical analysis to guard against market failure. Managed competition requires careful planning and awareness of pricing components in a free-market situation. Alain Enthoven, writing for the Jackson Hole Group, proposes establishment of a new national system of sponsor organizations--Health Insurance Purchasing Cooperatives--to function as a collective purchasing agent on behalf of small employers and individuals. PMID- 10123825 TI - The role of executive and physician representative calling programs in TQM/CQI. AB - Many hospital Total Quality Management/Continuous Quality Improvement programs focus on the patient as the ultimate consumer of the hospital's service. Recent research utilizing data provided by Hospital Corporation of America has shown that "quality, as measured by patient satisfaction, is associated with financial strength as measured by earnings, net revenues, and return on assets ... Relatively small increases in the level of patient satisfaction are associated with millions of dollars in year-end earnings for the average hospital. "However, there are other significant customer groups on which hospitals need to focus. Chief among these are physicians, who still play a major role in determining which hospital a patient will utilize. It is reasonable to assume that the positive financial impact that has been demonstrated for the patient market also exists for the physician market. PMID- 10123826 TI - Collaborative efforts enhance program development. Interview by Donald E.L. Johnson. AB - Alan Weinstein, a 26-year health care industry and hospital association veteran and president of Premier Hospitals Alliance Inc. since 1983, talks in his interview with HCSM's editor and publisher, Donald E.L. Johnson, about collaboration, managed competition, managed care and new and old Premier programs. In addition, he explains how the Westchester, Ill., alliance reviews its 70 programs and decides when to drop those that are not in great demand or have completed their life cycles. Premier is a cooperative owned by 50 major nonprofit teaching and research hospitals and systems located in 42 cities nationwide. PMID- 10123827 TI - Integrating capital budgeting techniques. AB - A.J. Hogan, in "Capital Expenditure Planning: The Value of Information to Hospitals," published in 1987 in Hospital and Health Services Administration, illustrated the value of information to the expenditure process. He noted that knowing what your competitors are up to, as well as where your facility stands in the market, can enable all concerned to make better judgments. One of the likely outcomes of good judgments is the efficient use of all resources. Unfortunately, Hogan's model draws on a non-existent computerized regional planning agency with the authority to approve or deny proposals. Integrated strategic financial planning also illustrates the value of information. In this case, information is readily available. The sources are the administrators: finance, accounting, marketing, and planning experts, doctors, nurses, statisticians, and epidemiologists. Each can make a unique contribution to the process, and together they can effectively guide the organization's capital budgeting programs. We have illustrated that there does exist a planning model that can work with the plurality of viewpoints in today's hospitals to produce the "most informed" decisions with known sensitivity to the decision criteria used. PMID- 10123828 TI - Courts continue to liberally invoke ERISA preemption in health care settings. PMID- 10123829 TI - Special report on reimbursement. Inspector General's office publishes new managed care safe harbors. PMID- 10123830 TI - Developments in patient transfer law: the confusion grows. PMID- 10123831 TI - Cost-control issues within the hospital environment in the United Kingdom. AB - Health care in the United Kingdom is dominated by the National Health Service, which operates under a system in which care is delivered free at the point of need and is funded by taxation. Experimentation with a number of different models has occurred since 1980 and has culminated in recent National Health Service reforms characterized by the separation of purchaser and provider functions. An inescapable result of this is the formal definition of the relationship between need and service provision (contracts or performance arrangements), and the equally unavoidable costing of "patient episodes" or equivalent as a tool for estimating both supply and demand. This change has completely altered the way in which individual capital and revenue costs are viewed in the National Health Service. With regard to drugs, costs can now be seen as part of a patient's consumption of resources as opposed to a hospital budget heading. The new system acknowledges that higher drug costs can be incurred if the overall patient episode cost is reduced as a result. Such a reduction in average patient costs might then lead to more contract work and a higher revenue for the hospital. Quality of care specifications by purchasers may also affect drug costs. PMID- 10123832 TI - Health economics in the United States: cost implications. AB - World health care costs are increasing uncontrollably and will continue to grow even if draconian controls are implemented immediately. In the United States, the health care objectives are to control the escalating costs of health care and increase access to quality care. To achieve these goals, new administrative controls will be put in place to respond to the cost pressures. New policies to accommodate these new controls will be made by the state and federal governments and by various private third parties. The policies will contain incentives and disincentives for private and institutional providers and beneficiaries. As a result, providers are responding with various cost-control techniques and payors are attempting to reduce costs. In addition, new decision makers in hospitals, insurance companies, and government will be evaluating new technologies by new standards. In order to gain or maintain significant market penetration for a product, drug and device manufacturers will have to develop a multifaceted strategy to present their products in the most favorable economic light. PMID- 10123833 TI - Cost effectiveness of teicoplanin and ceftriaxone: a once-daily antibiotic regimen. AB - There is a high incidence of staphylococcal infection in febrile neutropenic children with a central venous line. These patients are usually initially treated with empiric antimicrobial therapy that provides broad spectrum coverage. In a study evaluating a conventional regimen of vancomycin 40 mg/kg/d plus ceftazidime 100 mg/kg/d given in three divided doses to 41 febrile children with leukemia or lymphoma, the response rate was 87% after a mean treatment duration of 16 days. A once-daily regimen of an investigational antibiotic, teicoplanin, 10 mg/kg/d and ceftriaxone 50 mg/kg/d evaluated in 47 febrile children with leukemia was found to produce an equivalent rate of success and require the same mean duration of therapy. A cost-effectiveness analysis comparing the economic impact of replacing the conventional regimen with once-daily teicoplanin-ceftriaxone revealed that a 16-day course of the latter treatment would produce cost savings in terms of the cost of the antibiotics and other nonreusable materials, as well as in nursing time. Using French drug pricing data, the savings calculated for drugs and materials were 478 FF ($80 US). The teicoplanin-ceftriaxone regimen saved approximately 14 hours in nursing time per patient. Extrapolations based on estimates of hospital occupancy and the ratio of days a patient receives antibiotic therapy to the total duration of hospital stay suggest that an average hospital ward could achieve monthly costsavings of 7,641 FF ($1,273 US) for antibiotics and materials. PMID- 10123834 TI - Cost control of therapy for i.v. catheter infections. AB - Intravenous catheter sepsis is an important challenge for physicians because it is associated with a high incidence of complications, and treatment can be very costly. Significant complications occur in about 25% of cases and include septic shock, suppurative thrombophlebitis, metastatic infection, and endocarditis. The risk of such complications is increased when catheter removal or appropriate antibiotic therapy is delayed, when Staphylococcus aureus is the pathogen, and probably when a prosthetic heart valve or pulmonary artery catheter is present. The optimum duration of antibiotic therapy for intravenous catheter sepsis has not been established and depends on the pathogen and on the presence of other risk factors for complications. A treatment duration of 1 week may be adequate for pathogens, such as coagulase-negative staphylococci or Candida, that are unlikely to cause complications, while > or = 2 weeks of antibiotic therapy is warranted for S aureus. Recent approaches that may help to reduce costs include shortening the duration of parenteral antibiotic treatment either by giving oral agents for part of the treatment period or by using a synergistic combination of antibiotics. Also, for infections in subcutaneously tunneled catheters, intraluminal administration of small volumes of highly concentrated antibiotics often is an effective alternative to prolonged systemic antibiotic therapy. PMID- 10123835 TI - Teicoplanin vs vancomycin: cost-effectiveness comparisons. AB - The rising incidence of methicillin-resistant staphylococci and resistant enterococci in recent years has led to increased use of vancomycin as an active combatant in the treatment of gram-positive infections. Teicoplanin is an investigational glycopeptide that shares a similar spectrum of activity with vancomycin and appears to have similar efficacy. Teicoplanin offers several theoretical advantages compared with vancomycin including once-daily dosing, fewer side effects, and the option for intramuscular administration. While these may be perceived as substantial advances in the glycopeptide class of antibiotics, teicoplanin will probably not replace the now generically available vancomycin on hospital formularies. If competitively priced as a once-daily dosing regimen, teicoplanin will likely gain initial acceptance as an alternative in patients with an intolerance to vancomycin infusion-related side effects or in patients placed on combination aminoglycoside therapy for extended periods of treatment, as an intramuscular antibiotic in patients with poor venous access, and for routine antibiotic prophylaxis where protection from resistant gram positive pathogens is important. The use of teicoplanin in the hospital may become more widespread as its side effect profile and economic advantages of less frequent dosing compared with vancomycin become better understood. PMID- 10123836 TI - Roundtable discussion. Cost justification of innovative drugs through assessment of total health care costs. PMID- 10123837 TI - Cost-effectiveness issues for home i.v. therapy in the United States. AB - The popularity of home infusion therapy is increasing as it becomes recognized as a cost-effective alternative to hospitalization with the added benefit of improving patient quality of life. Selection of appropriate candidates for home i.v. therapy requires consideration of many variables pertaining to the medical and psychosocial suitability of the patient. Innovations in drug delivery devices have created opportunities for patients to receive parenteral therapy at home who would otherwise be considered inappropriate candidates for this treatment option. The cost of providing home IV therapy is mainly attributable to pharmacy and nursing services. Other contributing cost factors include the expense of ancillary supplies, supply delivery and management, and those costs created by administrative and regulatory requirements. When appropriately managed, home administration of IV medications can be a cost-effective way of delivering safe, effective, and quality care to an increasing population of patients. PMID- 10123838 TI - Treating bone and joint infections with teicoplanin: hospitalization vs outpatient cost issues. AB - The relative cost of outpatient parenteral antibiotic treatment of bone and joint infections with the investigational drug teicoplanin was compared with the cost of inpatient treatment. A private practice infectious disease group used teicoplanin to treat 49 patients (53 treatment courses) with bone and joint infections. The outpatient treatment program "saved" $403,680 compared with inpatient treatment, based on per diem reimbursements of $700 for inpatient treatment and $220 for outpatient treatment. Any cost analysis should be interpreted carefully because accurate calculation of outpatient treatment savings requires distinguishing among actual costs, charges, and reimbursements. In addition, there may be hidden costs related to lack of efficacy, toxicity, or litigation. Consideration should also be given to whoever is the beneficiary of the savings. Is it the indemnity insurance company, the provider, or the patient? Specific characteristics of the treatment, including ease of use, effectiveness, and monitoring requirement, may affect the savings. Our study showed that teicoplanin allows once-daily dosing, is easily administered, is generally efficacious, and has minimum requirements for blood level monitoring. These characteristics improve the cost effectiveness of using the drug in an outpatient treatment program. PMID- 10123839 TI - Cost implications of home care on serious infections. AB - More than 250,000 Americans will receive home IV drug therapy this year. Antibiotics will account for two-thirds of this care. Over 60% of infections treated at home are caused by gram-positive cocci, with staphylococci accounting for approximately 24% of the pathogens. Bone and joint infections represent the most common diagnoses among patients receiving parenteral antibiotics at home, and many of the infections treated at home were initially acquired in the hospital. The most common serious complications of coronary bypass surgery, the most frequently performed operation in many hospitals, are sternal wound infections are methicillin-resistant The major pathogenic causes of these infections are methicillin-resistant Staphylococcus aureus and Staphylococcus epidermidis. These complications are usually treated with prolonged inpatient IV therapy and surgery. In a study in which patients with sternal wound infections or mediastinitis secondary to coronary bypass surgery were treated with teicoplanin, preliminary results showed that the mean postoperative hospital stay was decreased by more than 7 days compared with patients receiving other types of antibiotic therapy. This was accomplished by changing from intravenous to intramuscular therapy as soon as the patient became stabilized and then discharging the patient after an additional 2 days to complete intramuscular therapy at home. In addition to enhancing the quality of life for the patient by allowing early hospital discharge and early ambulation, home therapy offers the additional benefits of decreasing the risk of cross infection to other patients, as well as to the already infected patient. PMID- 10123840 TI - Impact of nosocomial infections on hospital costs. AB - Modifications in antibiotic programs for treatment of nosocomial infections can result in significant cost savings within a hospital. Most hospitals initially treat nosocomial infections empirically, based on their epidemiologic history. Designed to be effective against a broad range of possible pathogens, this type of therapy usually includes two or more drugs administered parenterally. This is expensive because the total cost of treatment includes the cost of not only multiple drug therapy but also the materials and labor needed to prepare and administer them. "Streamlining of therapy" to a single oral or parenteral agent can usually be done once more definitive information is known about the pathogen and the patient's condition. This approach maximizes therapeutic effectiveness and reduces costs. Streamlining therapy for nosocomial infections has helped Hartford Hospital decrease the antibiotic budget from 30 to 15% of the total drug budget, resulting in annual cost savings of $150,000 to $250,000. PMID- 10123841 TI - The true cost of monitoring antibiotic levels. AB - Antibiotic assays are most often ordered for the purpose of toxicity monitoring, which usually involves determination of peak and trough antibiotic concentrations in the blood. The cost of monitoring antibiotic levels is probably higher than is commonly appreciated. Factors that contribute to the cost of this service include staffing the microbiology laboratory with appropriate personnel, who are responsible for determining the adequacy of sample collection and related patient information; analyzing the specimens in a timely manner; and taking action to modify drug dosage and dosage intervals in light of the test results. There are also costs related to the reagents, consumables, and equipment used in the assay, as well as to revenue and capital overheads. Additional clinical and laboratory costs can be incurred in the event of litigation pursuant to antibiotic-induced toxicity. With hospital and government policymakers devoting increasing attention to the escalating costs of health care, pressure to move away from the routine use of drugs having dose-related toxicity may increase, the objective being to save on assay costs. PMID- 10123842 TI - Cost implications of malpractice and adverse events. AB - The ninth most common allegation against hospitals in 1989 was infection/contamination exposure, with the average claim costing nearly $34,000. Most malpractice claims are associated with inpatient surgery, according to 1990 statistics, and the average cost of a claim for infection and contamination related to surgery was over $64,000 in 1990. Physicians currently pay as much as $50,000 annually for malpractice insurance, and hospitals in some major metropolitan areas pay $8,000 per bed for insurance. An estimated 5% of hospitalized patients acquire nosocomial infections at an annual cost of approximately $10 billion. Prolonged hospitalization, usually for parenteral antibiotic treatment, accounts for more than three-fourths of this cost. To reduce the costs of malpractice, nosocomial infections can be prevented through infection-control programs, or damages can be reduced by treating infections with more efficacious and safer drugs that decrease the pain and suffering associated with the infection. PMID- 10123843 TI - Comparisons among national health care systems in the European marketplace. AB - Most European countries have adopted either a Bismarckian system of compulsory health care insurance or a national health care system funded by taxation. For both systems, a basic level of health care is free at the point of use for all citizens. Health care has been undergoing reforms in most European countries. In the western nations, the autonomy of providers of services has increased, elements of competition and cost control have been introduced, and incentives to provide more cost-effective care have been initiated. Most central and eastern European countries have begun to return to the social insurance model for funding services. The ownership of some hospitals in these countries has been transferred to the private sector or to not-for-profit organizations. The European countries vary widely in their standards of facilities and professional staffing, and these generally reflect the prosperity of the country. During the 1980s, western countries implemented measures to limit the growth of health care expenditure, resulting in some reduction in the proportion of the gross domestic product spent on health care. Cost controls may not be as effective in the 1990s, as a result of demographic changes. More modern health care systems will likely develop in some of the central and eastern European countries, although this change will probably be slow. PMID- 10123844 TI - Roundtable discussion. Maximizing potential cost benefits of teicoplanin through appropriate usage. PMID- 10123845 TI - Generic drug prices post small hikes. PMID- 10123846 TI - VHA to crack whip following Baxter-Stuart linkage. PMID- 10123847 TI - Hospitals cutting expenses with remanufactured radiology equipment. PMID- 10123848 TI - Scrub standardization trims losses, yields savings. PMID- 10123849 TI - Cardiac cath non-salary expenses. PMID- 10123850 TI - Emergency department non-salary expenses. PMID- 10123851 TI - Adaptive monitoring in the ICU: a dynamic and contextual study. AB - The wealth of physiological data made available by current medical monitoring systems can be used efficiently only if the monitoring system is capable of relieving human personnel of relatively low-level tasks by performing intelligent data interpretation, contextual analysis and advice tasks. The system described in this paper can choose the variables to which most processing time will be devoted on the basis of the evolution of the patient. PMID- 10123852 TI - A real-time, multichannel scaler-analyzer system for clinical investigations. AB - The design of a fast, versatile multichannel scaler-analyzer system is described here. This system is especially suitable for clinical measurements in real time from multichannel nuclear sources characterized by single or multiple isotopes. The instrumentation characteristics are as follows: 1) The system is programmable and modular, with 16 channels maximum per module. The active channels can be selected. The channel scanning time depends upon the selected system configuration. 2) The true acquisition phase is autonomous. The acquired data are transferred from the instrumentation to the master computer under interrupt control. 3) The system is constructed from commercially available components. Their high integration and speed have led to powerful, compact, flexible instrumentation while containing cost. PMID- 10123853 TI - California health care 2001: the outlook for America's "Bellwether" State. PMID- 10123854 TI - California physician groups prosper in the "food chain" of managed care. PMID- 10123855 TI - Redundancy or retirement? AB - The majority of senior health service managers are long serving career managers, nurtured for years in a relatively safe and secure career structure. It is a shattering experience, therefore, for a manager to find him or herself facing redundancy or premature retirement. Roger Taylor provides a framework of ideas to help managers cope with these events, and to help them obtain the most advantageous settlement. PMID- 10123856 TI - Costing and pricing. AB - With spreadsheets at the ready, accountants in the NHS are waiting to apply the uniform costing methodology emerging from the National Steering Group on Costing. Before the money-number-crunchers hijack its eventual final report Costing for contracts, general managers need to work out the implications for their role in pricing services and contracts. PMID- 10123857 TI - Radiology. AB - Advances in imaging present new opportunities to clinicians--but at what cost and what benefit to patients? Managers must understand new techniques in order to be able to make informed assessments of their worth. PMID- 10123858 TI - Dentally-based specialties. PMID- 10123859 TI - Mentally disordered offenders. AB - Purchasing authorities are urged to consider the needs of mentally disordered offenders in their purchasing plans. But, asks Dr Gad, what is the most appropriate provision? PMID- 10123860 TI - Management ... working day of a health services manager. AB - Bob Nicholls, General Manager of Oxford RHA, shed some light on an RGM's typical day. It's not the orderly, leisurely affair some might imagine but one spent in and out of meetings and briefings and culminating in the regional review PMID- 10123861 TI - Applying the supply module to case carts. AB - When Hinsdale Hospital in Hinsdale, Illinois, decided to shift the pulling of cases from the Surgery Department to the Sterile Processing Department, a number of computer system changes had to be implemented to facilitate a smooth, functional transition. Seventy percent of the inventory carried in Surgery was transferred to SPD. To eliminate a cumbersome and uncoordinated supply requisition and pulling process that had existed in the OR, all written information had to be manually entered into a computer supply requisition module, and corrections made based on clinician "mental notes". This took the guesswork out of pulling and billing cases, from SPD's point of view. Additionally, new item numbers were assigned to indicate whether particular supplies were located in the OR or SPD. Hardware in the OR and SPD were networked together so the departments could share information and print requisitions in both locations. Finally, a detailed procedure on pulling cases was written for SPD to ease the transition and provide practice continuity for all SPD workers. PMID- 10123862 TI - Flawless information system implementation. AB - When it was decided to replace the homegrown materiel management information system at Barnes Hospital, a 1,200-bed hospital in St. Louis, Missouri, with a more comprehensive one, the aim was to have a swift, error-free selection, testing and implementation process. It met these goals by dedicating the following resources to the process: 1) a dedicated, full-time user responsible for requirements definition, testing, training and user support, 2) a dedicated IS support team for selection, testing and implementation of the software package, 3) availability of additional personnel in Materiel Management for general assistance, 4) a team approach, both at the project team level, and hospital wide, 5) a total commitment to quality at every phase, 6) a thorough approach to testing, both at the system level, and at the unit, or program level and 7) the vendor commitment of extra time, money and energy to help us make the system work to the best of its ability. PMID- 10123863 TI - Why product standardization fails. AB - In the attempt to introduce product standardization, many materiel managers fail to take stock of the forces that work against its success. Personal attitudes of clinical staff and others favoring freedom, individualism and decisions based on patient care rather than the bottom line, must be considered if product standardization is to take hold. It is also the responsibility of hospital administration to acknowledge product standards as part of the overall mission of the hospital. Product standardization that takes a more interpersonal perspective can succeed. PMID- 10123864 TI - Pick and Pack: a just-in-time forms order and delivery system. AB - Since the University of Alabama Hospital at Birmingham (UAB) had an in-plant print shop, the idea of purchasing forms from an outside supplier on a JIT order and delivery system didn't occur to them. But after establishing a successful medical/surgical JIT system at University of Alabama Hospital at Birmingham (UAB), the Director of Support Services and the Director of Purchasing looked at and developed a program to have a JIT forms inventory system by using their own print shop in conjunction with an outside supplier. The system, called Pick and Pack, basically works like this: An outside supplier buys flat-bed forms printed by the UAB Print Shop for resale back to UAB, and also produces their own custom, continuous forms to sell to UAB. The supplier warehouses, then picks and packs per individual UAB patient care unit order and delivers the forms to the UAB Material Management loading dock. Requisitioning is on-line for each patient care unit, Materiel Management and the supplier. Success was achieved in a step-by step manner, reducing a time-consuming, labor-intensive receiving process to a one-person process. Inventory of forms is estimated to have been reduced by $90,000 and approximately 2,160 cubic feet of space freed for other uses. PMID- 10123865 TI - Materiel management information systems. PMID- 10123866 TI - OSHA's bloodborne pathogens standard: what you don't know can hurt you. PMID- 10123867 TI - New devices claim to reduce injuries from needlesticks. PMID- 10123868 TI - Work redesign means major changes for hospitals, ORs. PMID- 10123869 TI - JCAHO survey process to focus on hospital function. PMID- 10123870 TI - Suggested procedures for occupational HIV exposure. PMID- 10123871 TI - Questions regarding videotapes in the OR. PMID- 10123872 TI - Staff nurses manage their own OR education. PMID- 10123873 TI - Teamwork used for participatory meetings. PMID- 10123874 TI - Building a successful ambulatory surgery program. PMID- 10123875 TI - Patient-focused care reorganizes services. PMID- 10123876 TI - Innovative hospital redesign includes ORs. PMID- 10123877 TI - You can go home again. TV spot raises awareness of hospital's home care service. Memorial Health System. PMID- 10123878 TI - A quality cure for healthcare. AB - It is the watchword of the '90s in every industry, including healthcare. PROFILES talked to three hospitals midway through their TQM/CQI efforts to find out how they got where they are and where they plan to go. They shared their mission statements, management expectations, quality newsletters, a clever "brag quotient," their problem-solving systems, flow charts, and a continuous improvement roadmap. PMID- 10123879 TI - Good health is not for women only. Hospital carves a niche with men's health education series. Emanuel Hospital and Health Center. PMID- 10123880 TI - Two hospitals just a heartbeat away. Public education promotion draws new patients. Fairview Southdale Hospital and Fairview Ridges Hospital. PMID- 10123881 TI - Making the most of annual report dollars. PMID- 10123882 TI - Employees get a sneak peek. Direct mail and launch event give preview to image campaign. Hahnemann University Hospital. PMID- 10123883 TI - Restraint reduction: customizing approaches to care. AB - The numbers highlight the success: Physical restraint use in nursing facilities has declined nearly 50 percent during the past three years--from 40 percent in 1989 to 22 percent in 1992--according to federal statistics. These figures are the clearest sign that restraint reduction efforts are working. But the challenge is not over yet, as providers struggle to bring restraint numbers down even further and make restraint alternatives the standard of care. PMID- 10123884 TI - Strong drug testing policies uphold workplace standards. PMID- 10123885 TI - Strategies ensure conflict-free succession, facility survival. PMID- 10123886 TI - Providers must prepare for IRS scrutiny of tax-exempt status. PMID- 10123887 TI - Geriatric mental health issues play critical role in care plan. PMID- 10123888 TI - Comfort, motivation are rewards of intergenerational program. PMID- 10123889 TI - Developing a market niche for low- to moderate-income seniors. PMID- 10123890 TI - Bridging the gap: physicians in long term care. PMID- 10123891 TI - Context effects on responses to questions about AIDS. PMID- 10123892 TI - From deinstitutionalization to the social enterprise. PMID- 10123893 TI - The cultures of illness. PMID- 10123894 TI - Managing the multicultural laboratory, Part III: Putting the cross-cultural tools to work. AB - This third article provides two case studies that enable laboratory managers to see how the cross-cultural model postulated by Dr. Geert Hofstede can be practically applied to two important issues--staff training and conflict resolution between employees. In addition, the opinions of several managers from a variety of industries are presented to add realism and perspective. This encourages laboratory managers to step outside the laboratory environment and learn from other managers who have years of experience supervising culturally diverse groups of employees. Part I of this series explained what is meant by "culture" and featured the research-based model set forth by Dutch social psychologist and management consultant, Dr. Geert Hofstede. His four dimensions of culture (Power Distance, Masculinity/Femininity, Individualism/Collectivism, and Uncertainty Avoidance) provide a useful framework for understanding the different values, attitudes, and behaviors exhibited by those of different cultural backgrounds. Part II presented advice in the form of 13 anecdotes from experienced cross-cultural managers. Issues of performance management, interpersonal skills, and language and safety were explored in light of the four dimensions. In this third article, abbreviated reference tables adapted from Hofstede's research are presented that make these cross-cultural data more useful for management decision making. Laboratory managers will receive practical, "real world" advice that will help them to positively resolve conflicts and to take full advantage of staff training opportunities. PMID- 10123895 TI - Multiskilled health practitioners: a viable strategy for health-care delivery. AB - Multiskilled health practitioners offer a viable strategy for addressing the personnel shortages and cost-containment pressures that most departments within hospitals and other health-care organizations are experiencing. With sufficient attention to state licensure and practice act constraints, management issues, and employee job satisfaction through job enrichment and appropriate employee selection, multiskilled health practitioners can benefit both employers and employees. The results of a national documentation project relative to multiskilled workers in health care are provided with applications and guidance for managers who wish to implement the concept. PMID- 10123896 TI - Renewal and change for clinical laboratory managers. AB - This article examines barriers to change in the clinical laboratory and discusses suggestions for maintaining vitality, renewal, and professional growth. The major barriers to change and renewal include institutional pressures that underlie the personnel shortage and financial implications of laboratory service, time pressures associated with the normal operation of a laboratory, work habits that develop early in the career of a laboratory manager, and managerial policies that limit or discourage change. Some solutions to overcome these barriers include goal setting, job or career change, lifelong learning, good staff members, mentors, and outside interests. PMID- 10123897 TI - Customer service in the clinical laboratory. PMID- 10123898 TI - Pharmacia CAP system. PMID- 10123899 TI - Proposed CLMA (Clinical Laboratory Management Association) code of ethics. Task Force on Ethics. PMID- 10123900 TI - The incineration system installed at Hope Hospital Salford. PMID- 10123901 TI - The prevention and control of Legionellosis (including Legionnaires Disease) and other hazardous water borne micro-organisms. PMID- 10123902 TI - Clinical waste--the law on health and safety. AB - In summary, the basic legal requirements are found in the COSHH Regulations, which require the identification of hazards, the quantification of risks and appropriate action to remove or control them. Monitoring of performance is essential to ensure controls are working, and to enable you to learn from any mistakes and from what does not work. As far as new methods of treatment of waste are concerned, HSE will apply the same standards to them in judging their effectiveness at removing the hazards, and must be certain that they do not introduce risks of their own for operators or public. PMID- 10123903 TI - The Environmental Protection Act 1990. PMID- 10123904 TI - Window of opportunity. PMID- 10123905 TI - A joint venture solution to clinical waste disposal. PMID- 10123906 TI - Major opponents revise stances; ups chance of health care reform. PMID- 10123907 TI - Volunteers, not just doctors wear beepers at Ohio hospital. PMID- 10123908 TI - Florida hospital simplifies services using patient-focused unit. PMID- 10123909 TI - The impact of case management on psychiatry. PMID- 10123910 TI - The 1992 Oregon Plan. PMID- 10123911 TI - Financial counseling service (outstationed eligibility). AB - The Financial Counseling Service is a caring service providing financial relief and other resources to an eligible patient or family in a time of crisis. It provides an excellent example of how government and private organizations can work together in a time of diminishing resources to provide better services to patients in need. PMID- 10123912 TI - TQM in admissions ... Harrisburg Hospital. PMID- 10123914 TI - Managed care: our future. PMID- 10123913 TI - Managed care--controlling patient access. PMID- 10123915 TI - Operating system components--Part II. AB - To summarize this discussion, let us look at a prototype, a capsule scenario in an OS. You make a process creation request on your local timeshare system. The long-term scheduler queues up this request, and eventually creates the corresponding process. Your process takes its turns executing, scheduled by the short-term scheduler. You request a tape drive to retrieve some archived data you need, and thus invoke the resource manager. You use the file manager to access the archived data. You use the I/O system to interact with the application program and to print the reports. The memory manager is swapping pages of your data and program between main memory and secondary memory. The dispatcher in the kernel is loading your process context into the CPU when your process is next on the execute list. The interrupt handler in the kernel is servicing interrupt requests, such as those made when you do I/O to the tape. The concurrency control in the kernel is coordinating your updating and spooled printing activities. So, your process is invoking activities throughout the various layers of the OS. Most of the time, you are unaware of these many varied activities. PMID- 10123916 TI - The best and the brightest: the making of a recruitment tape. PMID- 10123917 TI - What is the CPR (computer-based patient record)? PMID- 10123918 TI - Power of the computer-based patient record. PMID- 10123919 TI - Survey of attitudes and understanding about the computer-based patient record. PMID- 10123920 TI - Information privacy: medical record directors' perceptions of policy and practice. AB - In summary, it appears that much work remains to be done in ensuring medical information privacy, especially in larger healthcare facilities. Managers of these organizations are urged to confront these issues now, while there is still time to act in a proactive management mode. Media and legislative scrutiny with respect to privacy are increasing, and it is only a matter of time before managers in the medical community find themselves reacting to queries from external parties. It is far better to resolve the problems while they are under one's own control than to wait for outside scrutiny to force a reactive reconsideration. PMID- 10123921 TI - From paper to paperless: one hospital's journey. PMID- 10123922 TI - Challenges in the approval process for the physician computerized signature. PMID- 10123923 TI - The national networks--present and future. AB - The stunning changes in the handling of information brought about by the microcomputer would have been hard for the average person to foresee at the beginning of the 1980s. It is not as hard to visualize the next decade. Electronic records will become a reality. They will be transmitted across the country via high speed digital networks in response to user and patient need. Using networks to transmit files is not a difficult procedure, and health information managers should familiarize themselves with the new "wired" environment if they have not yet done so. PMID- 10123924 TI - From the basement to the penthouse and towards CPR (computer-based patient records). PMID- 10123925 TI - Library research. PMID- 10123926 TI - The politics of transplantation: paving the way for reform? PMID- 10123927 TI - Physician groups define positions on health care reform. PMID- 10123928 TI - The 1993 Medicare fee schedule. PMID- 10123929 TI - Scanning the crowd. Brigham & Women's Hospital. PMID- 10123930 TI - Wellness centers. PMID- 10123931 TI - Birthing centers. PMID- 10123932 TI - Healing environments. PMID- 10123933 TI - Health care malls. PMID- 10123934 TI - Recovery care centers. PMID- 10123935 TI - Imaging for healing. PMID- 10123936 TI - Diagnostic imaging centers. PMID- 10123937 TI - Intensive care units. PMID- 10123938 TI - Planetree update. PMID- 10123939 TI - Women's health centers. PMID- 10123940 TI - Long-term-care facilities. PMID- 10123941 TI - Health care interior design scholarship competition ... Janet Rothbert White and Carol Ovenburg. PMID- 10123942 TI - Health care environment award competition ... Ellerbe Becket, Inc. PMID- 10123943 TI - Exemplary health care facilities ... Orlando, Florida. PMID- 10123944 TI - Medical offices. PMID- 10123945 TI - Medical/surgical nursing units. PMID- 10123946 TI - Physical rehabilitation centers. PMID- 10123947 TI - Skilled nursing facilities. PMID- 10123949 TI - Dental offices. PMID- 10123948 TI - Child health care facilities. PMID- 10123950 TI - Hospice facilities. PMID- 10123951 TI - Psychiatric care units. PMID- 10123952 TI - Future trends in healing. PMID- 10123953 TI - With children in mind: novel approaches to waiting area and playroom design. PMID- 10123954 TI - Marin General Hospital addition and master plan. PMID- 10123955 TI - Healthcare design research. PMID- 10123956 TI - A healing environment: the Planetree hospital project at San Jose Medical Center. PMID- 10123957 TI - Mental health design: a case study ... Camarillo State Hospital and Developmental Center. PMID- 10123958 TI - Feng Shui for healthcare design. PMID- 10123959 TI - The Aga Khan University Hospital and Medical Center. PMID- 10123960 TI - Lambeth Community Care Centre: a case study. PMID- 10123962 TI - Health care interior design scholarship competition ... Annabelle Perdomo and Urien Cohen & Gerald Weisman. PMID- 10123961 TI - The many possibilities of art for health. PMID- 10123963 TI - Health care environment award competition ... Child Development Center, Children's Hospital, Oakland, Calif. PMID- 10123964 TI - Exemplary healthcare facilities ... San Francisco. PMID- 10123965 TI - Creating excellence in healthcare design. PMID- 10123966 TI - New regional children's hospital at Stanford ... Lucille Salter Packard Hospital for Children. PMID- 10123967 TI - What a healthcare client needs from a designer. PMID- 10123968 TI - The benefits of developing healthcare design standards: a case study of William Beaumont Hospital. PMID- 10123969 TI - Product development: design for change. PMID- 10123970 TI - Creating and maintaining high synergy project teams. PMID- 10123971 TI - VIP suites: a new trend ... University of Alabama Hospital, Birmingham. PMID- 10123972 TI - Current trends in cancer center design. AB - I would like to summarize the most important issues that we discovered from the people we interviewed for our study. Patient environments are increasingly important. Patient control and patient amenity are paramount in treating cancer. High-tech equipment is going to be the driving force of the future. Telecommunication and electronic link-ups between facilities will be essential to share information. The use of imaging, and especially the MRIs, are going to increase, with some facilities running 24-hour shifts. Mobile service, such as a bus that goes on the road to take some of the more sophisticated treatment modalities out to rural areas, will increase. Designers may be planning interiors of mobile units in addition to chemotherapy departments. An exciting area where treating cancer is headed is in new facility types. There has already been an outgrowth from inpatient hospice units to separate hospice facilities. These are designed to help people make the transition into another lifestyle. But, in addition to hospices, wellness communities, like the one in Santa Monica, are being developed to provide all types of additional services required by the cancer patient. These services include items such as nutrition planning, consulting, self-help groups, and many other services that are growing out of the standard of care that regular hospital treatment provides. In designing cancer centers, there are many similarities to other healthcare environments, but there are unique characteristics that only occur with cancer patients. The main reason is that cancer is just a different kind of disease.(ABSTRACT TRUNCATED AT 250 WORDS) PMID- 10123973 TI - Effects of interior design on wellness: theory and recent scientific research. AB - To summarize briefly, key general points in this presentation include the following: To promote wellness, healthcare facilities should be designed to support patients in coping with stress. As general compass points for designers, scientific research suggests that healthcare environments will support coping with stress and promote wellness if they are designed to foster: 1. Sense of control; 2. Access to social support; 3. Access to positive distractions, and lack of exposure to negative distractions; A growing amount of scientific evidence suggests that nature elements or views can be effective as stress reducing, positive distractions that promote wellness in healthcare environments. In considering the needs of different types of users of healthcare facilities- patients, visitors, staff--it should be kept in mind that these groups sometimes have conflicting needs or orientations with respect to control, social support, and positive distractions. It is important for designers to recognize such differing orientations as potential sources of conflict and stress in health facilities (Schumaker and Pequegnat, 1989). For instance, a receptionist in a waiting area may understandably wish to control the programs on a television that he or she is continuously exposed to; however, patients in the waiting area may experience some stress if they cannot select the programs or elect to turn off the television. Some staff may prefer bright, arousing art for corridors and patient rooms where they spend much of their time; however, for many patients, such art may increase rather than reduce stress. A difficult but important challenge for designers is to be sensitive to such group differences in orientations, and try to assess the gains or losses for one group vis-a-vis the other in attempting to achieve the goal of psychologically supportive design. Designers should also consider programs or strategies that combine or mesh different stress-reducing components. For example, it seems possible that a program enabling patients to select at least some of their wall art or pictures would foster both control and access to positive distraction. As another example, the theory outlined in this paper suggests that an "artist-in-residence" program, wherein an artist with a caring, supportive disposition would work with patients, might foster social support in addition to control and access to positive distraction. Running through this presentation is the conviction that scientific research can be useful in informing the intuition, sensitivity, and creativity of designers, and thereby can help to create psychologically supportive healthcare environments.(ABSTRACT TRUNCATED AT 400 WORDS) PMID- 10123974 TI - Extra. Health Care Reform Task Force work plan eyes private-sector savings to help fund universal coverage. AB - The following document describes the process President Clinton's Health Care Reform Task Force will use to develop his reform plan by the May 7 deadline--and sheds light where it may come down on some issues. This information is disclosed in a memo by Ira Magaziner, senior White House adviser for policy development, and obtained by HCR Week. PMID- 10123975 TI - Civilian Health and Medical Program of the Uniformed Services (CHAMPUS)--DoD. Notice of revised rates. AB - This notice provides the updated adjusted standardized amounts, DRG relative weights, outlier thresholds, and beneficiary cost-share per diem rates to be used for FY 1993 under the CHAMPUS DRG-based payment system. It also describes the non regulatory changes made to the CHAMPUS DRG-based payment system in order to conform to changes made to the Medicare Prospective Payment System (PPS). PMID- 10123976 TI - Battling for national health reform. AB - At stake are the futures of all health care providers, including those that provide home care and hospice care. Who in Washington holds the ammunition to wage a winning war? Here is your insider's guide to the health reform leaders and their likely strategies. Be assured only that their battles will be intense. PMID- 10123977 TI - Speaking out for home care and hospice. AB - Here you have it in black and white: unprecedented support for home care from our nation's policymakers--both the long-standing proponents and newly elected officials. With increasing numbers willing to verbalize their commitment and with a new administration holding up health reform as a top priority, we see before us this country's opportunity to prove that actions speak louder than words. Committee selections will be complete by March; the information here was current at press time. PMID- 10123978 TI - Toward meaningful reform. National Association for Home Care. AB - This paper was prepared by the National Association for Home Care, representing the nation's home care providers--including home care agencies, home care aide organizations, and hospices--and the individuals they serve. NAHC is committed to assuring the availability of humane, cost-effective, high-quality home care services to all individuals who require them. Toward this end, NAHC has long advocated the development of a national plan to ensure universal access to basic acute-care and long-term care services. This paper outlines the specific recommendations of NAHC to ensure the appropriate inclusion of home care and hospice services in health care reform proposals. NAHC believes that no health care proposal is complete without ensuring access to high-quality home care and hospice in both the acute and long-term care setting. These vital services provide millions of individuals--the aged, infirm, disabled, and children--the ability to receive care in the settings that allow them the highest level of satisfaction, independence, and dignity--in their homes. PMID- 10123979 TI - A future of optimism. AB - Megatrends in demographics, technology, and the political machine all point to a brighter health care future for our nation's elderly. In his speech before the first meeting of the Utah Gerontological Society, delivered in Salt Lake City on November 4, 1992, Senator Moss gave the documented reasons for his optimism. PMID- 10123980 TI - Employer strategies for modifying or terminating retiree benefits in the 1990s. AB - Over the past decade, access to health care coverage has become a crucial national concern. At the same time, the rising cost of health care, the aging of the population, and new accounting requirements for retiree medical benefits have caused employers to reevaluate their commitment to providing unrestricted health care benefits to the retirees. This article discusses the key federal appellate court decisions concerning an employer's decision to modify or terminate retiree medical benefits. It then explores alternatives for meeting the statutory, legal, and accounting challenges faced by employers who now offer retiree health care coverage. PMID- 10123981 TI - The efficacy of a national Family Health Services Authority based cervical cytology system. AB - District health authorities have been instructed to operate a cervical cytology call and recall screening programme using the age-sex registers held by the Family Health Services Authority. This paper reports the results of a 1989 survey of women from two diverse health districts to determine the uptake of cervical screening between these health districts. The results show a low uptake in all areas, even after accounting for inaccurate information. Many invitations were sent to the wrong address, or to women who were not eligible for a smear test. The former was a particular problem in the inner city district of Parkside. The provision of an effective scheme will depend on all those involved addressing the problems found by this study. This is essential if general practitioners are to meet the new targets for payment set by the government for cervical cytology screening. PMID- 10123982 TI - Improving antenatal care: the role of an antenatal assessment unit. AB - Rising demand for obstetric services combined with developments in clinical practice prompted a reappraisal of the maternity services provided in Northampton. This has resulted in a new outpatient day assessment centre for patients with antenatal complications, providing improved clinical facilities at minimal cost. This paper describes the development of the unit and reviews the first 200 referrals. An alternative to inpatient hospitalisation for antenatal complications is proposed, which offers considerable potential benefits to patients and budgets alike. PMID- 10123983 TI - An analysis of conditions presenting to a dental hospital emergency clinic. AB - A retrospective analysis of 1,000 consecutive patients was undertaken to determine the frequency and types of common dental problems presenting to the Emergency and Oral Medicine Clinic at Bristol Dental Hospital. The results show that most attenders presented with problems readily manageable by dental practitioners, but providers of emergency dental services should be aware that rare, but serious, conditions can occur. Information presented in this paper should be incorporated into the design of undergraduate curricula and emergency dental services. PMID- 10123984 TI - Dentists' attitudes to cross-infection control. AB - The wearing of gloves by dentists undertaking clinical procedures has been recommended by many authorities as an essential element of dental surgery cross infection control. This paper reports an investigation into patterns of glove wearing by practising dentists, and considers the effect of practice location and practising arrangements on this issue and other aspects of cross-infection control. The results show that these factors, including the type of patient treated, may influence the pattern of glove-wearing by dentists in England and Wales. These findings suggest that groups least likely to follow the recommended infection control procedures should be targeted when assessing dental education requirements. PMID- 10123985 TI - Care of elderly patients with a fractured neck of femur. AB - This survey was designed to compare the clinical management of elderly patients admitted to hospitals with a hip fracture, with the recommendations in the recent Royal College of Physicians report "Fractured Neck of Femur". The results highlight large discrepancies between the 'ideal' clinical management as recommended, and that which occurs in practice. Particular concerns include the lack of experienced medical supervision provided for patients perioperatively, the high proportion of junior anaesthetic and surgical staff performing the operation, and the widespread poor rehabilitation facilities. These findings suggest that, unless the quality of clinical care for such patients is vastly improved, the predicted exponential rise in the number of elderly people sustaining a hip fracture will create a heavy burden on scarce National Health Service resources. PMID- 10123986 TI - The influence of changing age and referral for end-stage renal failure in Newcastle upon Tyne. AB - This paper reports a retrospective analysis of renal replacement therapy in patients over 60 years-of-age admitted to regional unit in Newcastle upon Tyne during a 7-year period. The changing age patterns of referral for management of end-stage renal failure have been reviewed, including the morbidity and mortality of this age-group managed for end-stage renal failure by haemodialysis, peritoneal dialysis and transplantation. The results show an alarming increase in the number of referrals aged over 60 years (> 36% in 4 years). Associated medical problems, methods of treatment and management (including special needs), and the effects of the rapidly increasing proportion of elderly patients on renal services are described. PMID- 10123987 TI - Sources and types of referral to a haematology department. AB - An audit was undertaken of the case notes of all new outpatients referred to the haematology department at the Leeds General Infirmary over a one-year period. The source, reason for referral, final diagnosis and outcome were determined in each case, along with essential biographical details. The results show that general practitioners initiated over half of all referrals, often prompted by written comments from a hematologist on a full blood count advising them that further tests were required. Almost a third came from other departments at the study hospital and the remainder originated from hospitals outside the district. Most general practitioner referrals were made with a request for a diagnosis. Hospital initiated referrals were more likely to have a final diagnosis of a malignant haematological disease, whereas those from general practice tended to have benign or self-limiting conditions. Ninety-one per cent of patients referred had an abnormality. There were low numbers of both clinic defaulters and those patients required to be re-referred to other specialties. These results suggest that the high quality of referrals is largely due to the general practitioner's decision to refer patients based on the full blood count result. This often occurs after discussion with haematology medical staff. The possible impact of the government's White Paper proposals on this outpatient service is discussed. PMID- 10123988 TI - Orthoptists reduce false-positive hospital referrals. AB - This paper describes changes in the pattern of new referrals of children from birth to 2 years-of-age to the Hospital Eye Service in Oxford, following the implementation of a community-based orthoptic secondary vision-screening programme. The findings show that the number of false positive referrals was reduced by a half following the introduction of the service; false-positive referrals were also discharged sooner. This paper reports the findings of this survey and the results demonstrate the cost-effectiveness of the programme compared to outpatient attendance. PMID- 10123989 TI - Improving the diet of under fives in a deprived inner city practice. AB - This paper reports the introduction of a programme of dietary education to a selected group of young mothers living in a deprived inner city area. The programme was devised by a general practitioner and practice health visitors in collaboration with two hospital dietitians. A diary was used to provide data on diet, food choice, shopping habits, eating together, and planning and frequency of meals. These were included in a list of twelve 'desirable' food groups and three organisational skills, thus providing an individual syllabus for teaching, and a means of assessing the intervention. At the start of the study milk, fruit, vegetables and protein containing iron were common dietary omissions. However, the results show that these foods were an established part of the children's diets following the intervention. The dietary diaries provided a successful means of analysis, and the teaching programme is continuing in this practice. The limitations of such a small study are acknowledged, and a long-term controlled study is suggested. PMID- 10123990 TI - Anticipating paradigm shifts in foodservice. Part II. PMID- 10123991 TI - Packaging that sells. PMID- 10123992 TI - Complying with OBRA. PMID- 10123993 TI - Recycling & source reduction. PMID- 10123994 TI - Hurricane causes hospitals to rethink disaster plans. PMID- 10123995 TI - Anticipating paradigm shifts in institutions. Part I. PMID- 10123996 TI - A surgeon's perspective on the RBRVS. PMID- 10123997 TI - Keeping the promise of payment reform. PMID- 10123998 TI - Balancing ethics with socioeconomics. Interview by C. Burns Roehrig. PMID- 10123999 TI - Will health reform help--or hurt--primary care? PMID- 10124000 TI - Who's ethical? PMID- 10124001 TI - Health care reform: glacier or avalanche? PMID- 10124002 TI - RBRVS' first year gets mixed reviews. PMID- 10124003 TI - Evaluation of i.v. ceftriaxone usage in a community-based hospital. AB - Ceftriaxone is primarily used for the treatment of gram-negative nosocomial pneumonia and for gram-negative bacteremias. The following study examines whether ceftriaxone, a broad spectrum parenteral cephalosporin antibiotic, was being administered appropriately based on pre-established hospital criteria. PMID- 10124004 TI - Evaluation of an aseptic technique testing and challenge kit (ATTACK). AB - Currently, there is considerable discussion and concern about quality assurance when sterile pharmaceuticals are prepared by pharmacists and other health professionals. This study describes the utility of a kit made by Marsam Pharmaceutics Inc. in detecting microbial contamination during simulated drug transfers by syringe. Common microbial detection techniques were incorporated in a simple series of transfers intended to simulate actual use. Growth promotion studies were carried out using Trypticase Soy Broth initially in tubes and then in vials (as supplied in the kit). Three test organisms were employed (Staphylococcus epidermidis, Bacillus subtilis, and Candida albicans) and inoculated at three levels, < 1000, < 100, and < 10 CFU/mL. All studies demonstrated growth occurring in 100% of the trials in 8 days. Similar studies were initiated in stored media (32 month) to determine the effects of time on the ability of the medium to support growth. Growth promoting ability of 32 month old media showed no significant difference. 100% of the vials inoculated showed growth in 8 days. Once the growth promoting qualities of the medium and vials was established a kit was developed then a study to determine the effectiveness of the kit as used was undertaken. Kits were manipulated according to the directions for use by a trained individual, under aseptic conditions and by an untrained individual in an area described as less than desirable. No growth occurred in the vials of the 10 kits used to illustrate good technique and good environmental conditions with 30% (3 of 10) of the kits showing contamination when transfers by syringe were carried out in the less than desirable setting.(ABSTRACT TRUNCATED AT 250 WORDS) PMID- 10124005 TI - Home parenteral antibiotic therapy for patients with cystic fibrosis. AB - Cystic fibrosis is a genetic disease that affects multiple organ systems. Pulmonary complications associated with it frequently require intense intravenous antibiotic therapy. Home care allows patients to be treated at home, reducing the disruption of family life. New drug administration devices allow the patient increased mobility and independence. With adequate family and nursing support, patients may be able to attend work or school. Reduced hospital stays are good for the patient and cost effective for the hospital. The success of home antibiotic therapy depends on careful selection of the candidate, antibiotic regimen, nursing agency, and home care company. Many patients and families, though motivated, cannot manage the additional stress and time commitment required for home intravenous antibiotic and chest physical therapy. This time commitment may be reduced somewhat by limiting the number of antibiotics and the frequency of their administration. PMID- 10124006 TI - Challenges to Medicare payment rules on constitutional grounds rejected. PMID- 10124007 TI - Texas decision directs attention to "on-call" status. Fought v. Solce. PMID- 10124008 TI - Patient records. What to save, how to save it, how long to save it. PMID- 10124009 TI - How to select the ideal hematology analyzer. PMID- 10124010 TI - Creating a bar code chemistry system. PMID- 10124011 TI - Finding a temporary agency to meet your needs. PMID- 10124012 TI - Use patterned interviewing to reveal 'people skills'. PMID- 10124013 TI - We carved out bar coding goals--and reached them. PMID- 10124014 TI - Introducing computer literacy skills for physicians. AB - Computers are integral to medical practice, education, and research. While medical students learn computer skills during their training, many practicing physicians do not have the same computer experience. To familiarize this group with the exciting developments in medical informatics, the Himmelfarb Health Sciences Library and Department of Computer Medicine at the George Washington University Medical Center organized a workshop "Introducing Your Office Computer!" for attending physicians. The workshop featured a short lecture/video presentation on computer applications in medicine followed by a "computer fair" of five computer applications. Eleven physicians attended the workshop. Feedback was very positive; many called later to request more detailed instructions on using the programs demonstrated. It was a valuable experience for the staff, and new bridges were built between departments and clients. PMID- 10124015 TI - An analysis of transaction logs to evaluate the educational needs of end users. AB - End users at the University of Southern California (USC) have free access to the last ten years of MEDLINE through a local online system known as USCInfo. Librarians at USC Norris Medical Library provide documentation and offer formal and informal training on the use of the system to search MEDLINE. To assess the educational needs of the end users, 643 searches were analyzed. Although a high proportion (84%) of the searches were judged to be successful, the use of medical subject headings (MeSH) to obtain optimal results was low; only 20% of all successful subject searches employed MeSH. Also, the advanced features of the system were underutilized. While it is promising to learn that many end users are obtaining positive results, methods which will encourage end users improve their retrievals need to be developed. PMID- 10124016 TI - Developing a publicity plan for library research: the Rochester Study. AB - The hospital librarians in Rochester, New York and a research team developed and administered a questionnaire to measure the impact of information provided by the librarian on physicians' clinical decision making. While the research was underway, the librarians also developed a publicity plan. The goal of the plan was to create awareness of the study results in the local client population, as well as in the health care community at large. The plan served to describe and put in priority order the types of media that the librarians would use to publicize the study to target groups. This article includes examples of a nationwide and an institution-specific publicity plan. those developing publicity plans for future library research may want to allocate adequate funds to hire a media consultant to increase their prospects for national exposure. PMID- 10124017 TI - A graphical teaching aid for explaining MEDLINE and access to it. PMID- 10124018 TI - Some notes on management in a hospital. PMID- 10124019 TI - Rediscovering quality: implications for hospital leaders. PMID- 10124020 TI - Health care in transition: a closer look at Great Britain. PMID- 10124021 TI - Tuberculosis: a re-emerging public health threat. PMID- 10124022 TI - Sometimes, the best part of the meeting is what's not on the agenda. PMID- 10124023 TI - Moving from director to empowerer. PMID- 10124024 TI - Quality: how do we define it? AB - When U.S. industry, in the 1980s, woke up to the fact they were losing ground to foreign companies, their first attempts to woo consumers back to the fold revolved around cutting costs to lower prices. It didn't work. But someone finally took notice of the work Edwards Deming and Joseph Jurand were doing to add quality to the value formula for products and services in Japan. A few U.S. companies tried this approach, and it worked. Today everybody is on the quality bandwagon. Pick up any publication--from national news weeklies to small trade newsletters--and there it is. PMID- 10124025 TI - N.J. group's board backs its managers. PMID- 10124026 TI - Strong managed-care presence lowers cost, mortality--new study. PMID- 10124027 TI - Surprise surveys to begin July 1. PMID- 10124029 TI - Hamot to pay some taxes. PMID- 10124028 TI - Under fire, hospital takes Medicare leave. PMID- 10124030 TI - Hospital payments in doubt. PMID- 10124031 TI - White House weighs Medicare cut. PMID- 10124032 TI - IRS gives nod to integrated delivery plan. PMID- 10124033 TI - Physician groups criticize proposals. PMID- 10124034 TI - Hospital hooks new line. PMID- 10124035 TI - Needlesticks studied. PMID- 10124036 TI - HHC settlement to aid its nurses. PMID- 10124038 TI - S&P's "A" rating plays hard to get for hospitals. PMID- 10124037 TI - NLRB upholds ruling of Beverly harassment. PMID- 10124039 TI - HealthEast bonds upgraded. PMID- 10124040 TI - OrNda buys hospital in Fla. from Pearce. PMID- 10124041 TI - Troubled Catholic hospital sold to group. PMID- 10124042 TI - Two large dialysis chains' earnings rise. PMID- 10124043 TI - Providers scurry for capital in wake of Towers charges. PMID- 10124044 TI - Ga. insurance programs aim to aid access. PMID- 10124045 TI - New Ohio law imposes physician billing limits. PMID- 10124046 TI - Ind. hospital keeping up with its neighbors ... Columbus Regional Hospital. PMID- 10124047 TI - Legality of task force meetings hit. PMID- 10124048 TI - Scrap tax cap, groups urge Clinton. PMID- 10124049 TI - TQM must be based on data, analysis to satisfy customers. PMID- 10124050 TI - Reconfiguring the finance department. PMID- 10124051 TI - Overhaul was only first step at Phoenix facility ... Maricopa Medical Center. PMID- 10124052 TI - Detroit-area network forms, vows rate cap. PMID- 10124053 TI - Hospitals begin to lose ground in physician pay. PMID- 10124054 TI - Medicare mortality calculations won't include admission-related severity adjustments this year. PMID- 10124055 TI - Hospital system revamps its signal-calling to resolve mismanagement allegations. PMID- 10124057 TI - Physicians still making most of the decisions. PMID- 10124056 TI - Blues association stiffens its guidelines. PMID- 10124058 TI - N.Y. facility's revamp is turning things around. PMID- 10124059 TI - Los Angeles facility mulls tighter security after gunman shoots 3. PMID- 10124060 TI - Hospitals, employees face devastating losses in aftermath of Hurricane Andrew. PMID- 10124061 TI - Coping with change challenges OR managers. PMID- 10124062 TI - Manual clarifies surgical, anesthesia standards. PMID- 10124063 TI - Big changes are coming in 1994 accreditation manual. PMID- 10124064 TI - Planning critical for successful OR move. PMID- 10124065 TI - Emergency surgery and OSHA compliance. PMID- 10124066 TI - Tuberculosis: a resurging health care issue. PMID- 10124067 TI - Back up healthcare marketing with infection-control basics. AB - In the wake of OSHA's bloodborne pathogens regulation requiring employer-provided apparel for healthcare employees, numerous companies are rushing to capture the market, while others are stepping back for fear that the market is too difficult to serve. Both groups need to reassess their positions. These guidelines adapted from TRSA publications should help get you and your employees up to speed on what it takes to serve the healthcare market. PMID- 10124068 TI - Views from Capitol Hill--11 congressional leaders paint varying reform scenarios. Interview by Marybeth Burke. AB - The following exclusive interviews with top congressional health care leaders were conducted by Washington-based reporter Marybeth Burke. In the interviews, Burke found that congressional health care leaders are optimistic yet cautious that comprehensive health care reform legislation will pass in 1993 under President Clinton. Some members of Congress believe that the election of a president committed to action on the issue drastically improves the outlook for reform. Others say that long-term controversy over reform will not resolve itself overnight. Lawmakers expect the issue to heat up quickly as soon as Clinton hands Congress a legislative reform package, but they are reluctant to predict quick enactment. PMID- 10124069 TI - Trustees' role critical in advocating future health care reform. PMID- 10124070 TI - How to best use local contractors for hospital construction. PMID- 10124071 TI - Community leads hospital planning. PMID- 10124072 TI - From competition to collaboration. PMID- 10124073 TI - 'Aid-in-dying' debate will continue. PMID- 10124074 TI - The importance of being a volunteer. PMID- 10124075 TI - Use of cost and quality data closely linked to reform plans. PMID- 10124076 TI - New hospital emphasizes patient accessibility and continuity of care. Interview by Karen Gardner. AB - As a 14-year veteran of the board of Lutheran Hospital of Indiana Inc., Fort Wayne, Thomas Baumgartner participated fully in the evolution of Lutheran's new acute care facility, which opened last May after five years of planning and construction. The Lutheran system includes the new not-for-profit, 350-bed hospital; a subsidiary comprising four urgent care clinics; joint ventures with several medical entities that provide clinical services such as rehabilitation and nursing; and a four-year college (the Lutheran College of Health Professionals). Located in a city of approximately 190,000, Lutheran Hospital- one of three tertiary care facilities in Fort Wayne--serves a 20-county region. To update its facilities and better meet the needs of this large service area, the new hospital design features a hospital tower connected to two medical office buildings by a two-story "medical mall." Baumgartner, who is chairman of the Lutheran system board and executive vice president and chief operations officer of Fort Wayne National Bank, recently spoke with Trustee editor Karen Gardner about the process of building a new hospital. PMID- 10124077 TI - Automation = savings. From soil sorting to ironing or folding, computers and equipment handle Presbyterian's laundry. PMID- 10124078 TI - Boss is liable for sexual harassment problems. PMID- 10124079 TI - Rural health: challenges & opportunities. PMID- 10124080 TI - Radiosurgery. Integration of radiation therapy, surgery & radiology. PMID- 10124081 TI - Medicare Part B policy. What you thought you knew can ruin your practice. PMID- 10124082 TI - From batch reading to on-line reporting. PMID- 10124083 TI - The administrator's role in physician contracts. PMID- 10124084 TI - Managing acute care. AB - In the last few years, much medical-facility construction has been driven by what insurers want. Hospitals have built facilities for well-reimbursed procedures and closed money-losing ones. Health-maintenance organizations increasingly expect to hold down costs by making prepayment arrangements with doctors and their hospitals. President Clinton has pledged early action on health-care reform, which will likely change planners' priorities. Whether the nation goes to Clintonian "managed competition" or a Canadian-style nationwide single-payer system (the two most likely options), the projects on these pages reflect two large-scale trends that are likely to continue: the movement of more procedures from inpatient to outpatient facilities and the separation of treatment functions from ordinary office and administrative tasks so that the latter are not performed in the same high-cost buildings as technology-intensive procedures. Various schemes that make care more "patient-centered" have been tried and been shown to speed healing, even for outpatients, but such hard-to-quantify issues get short shrift in an era of knee-jerk cost containment. The challenge in tomorrow's healthcare universe--whatever it becomes--will be to keep these issues on the table. PMID- 10124085 TI - Reforming the legal framework for health in Australia: a modern patchwork. PMID- 10124086 TI - 'Is there such a thing as defensive nursing practice?'. PMID- 10124087 TI - Defining death, natural death legislation and withdrawal of treatment. AB - This article summarises and comments on a number of legal developments (legislation and judicial precedents) in Australia and England in recent years concerned with definitions of death, and withdrawal of life-preserving treatment. The general thrust of these developments and other proposed legislation is four fold: (i) to respond to technological advances in clinical medicine; (ii) to strengthen patient rights of autonomy and self-determination in the right to refuse treatment; (iii) to reflect a shift in dominant community attitudes and social morality, and to approximate more closely to common clinical practices, which take account of 'quality-of-life' considerations as well as 'sanctity of life' in decision-making for patients unable to express a view because of youth or impaired mental capacity; (iv) to give a greater certainty and legal guidance to clinicians, and to give legal protection to clinicians who follow certain decision-making procedures. PMID- 10124088 TI - Confidentiality, public interest and the health professional's duty of care. PMID- 10124089 TI - One year of the Act: a Tribunal view of the first twelve months of the NSW Mental Health Act 1990. PMID- 10124090 TI - Hospital professional liability. PMID- 10124091 TI - Perspectives. A decade of mixed blessings under Medicare's PPS. PMID- 10124092 TI - Donna Shalala's health care vision. PMID- 10124093 TI - Perspectives. Childhood vaccinations: removing the fig leaf. PMID- 10124094 TI - Perspectives. States rediscover certificate-of-need laws. PMID- 10124095 TI - Perspectives. Clinton unveils Medicare cuts; health groups hold their fire. PMID- 10124096 TI - Reducing laboratory costs with pen computing. PMID- 10124097 TI - Countering advanced HIS marketing tactics. AB - An explosion of technological advances and system developments in the information systems industry pushes the envelope in both hardware and software design. Equipment breakthroughs--reduced instruction set computing chips, or RISC, and DEC's 64-bit Alpha chip--herald an exciting new era in price-performance computing. And object-oriented programming systems, or OOPS, and computer assisted software engineering, or CASE tools, both promise a golden age in programming productivity. At the same time however, marketing mavens at healthcare information system, or HIS, vendors keep pace with their cohorts in Research and Development by blazing new trails in the science of sales and marketing. To help healthcare executives keep pace with new developments in selling, let's review a few infamous breakthroughs in marketing. They put a new twist on the old saw: "caveat emptor." Following each marketing "advance" are counters to new marketing tricks, each recommended to keep savvy CIOs a step ahead. PMID- 10124098 TI - An advantageous use of consulting services. PMID- 10124099 TI - Experience speaks on client-server myths & truths. PMID- 10124100 TI - Beyond benchmarks: assuring hardware performance. PMID- 10124101 TI - Build vs. buy: the rules are changing. PMID- 10124102 TI - In search of the elusive, function-rich fully integrated, platform-independent HIS. PMID- 10124103 TI - Caught with your LAN down: security issues in an age of networks. PMID- 10124104 TI - An incremental approach to automation: considering the modular HIS. PMID- 10124105 TI - Square MUMPS (Massachusetts General Hospital Utility Multi Programming System) in round networks. PMID- 10124106 TI - Building better bridges across a growing information gap. PMID- 10124107 TI - Implications of EDI implementation: the WEDI (Workgroup for Electronic Data Interchange) demonstration projects. PMID- 10124108 TI - America's most computer advanced healthcare facilities. AB - Healthcare Informatics polled industry experts for nominations for this listing of America's Most Computer-Advanced Healthcare Facilities. Nominations were reviewed for extent of departmental automation, leading-edge applications, advanced point-of-care technologies, and networking communications capabilities. Additional consideration was given to smaller facilities automated beyond "normal expectations." Facility representatives who believe their organizations should be included in our next listing, please contact Healthcare Informatics for a nomination form. PMID- 10124109 TI - N.Y.'s year-old demo project models EDI success. PMID- 10124110 TI - System-wide decision support: made with CASE (computer aided software engineering). PMID- 10124111 TI - Postcards from the leading edge. PMID- 10124112 TI - Update: TB regulations from California. AB - As might be expected, the California Occupational Safety and Health Administration (Cal OSHA) has taken the lead in issuing regulations to protect healthcare workers from occupational TB infection. CHEM believes the Cal OSHA regulations will provide a template for the general shape of regulations that will be issued by other states and federal OSHA. Therefore, the regulations are printed here in full, along with the resolution of the California State Assembly that empowered Cal OSHA to issue the regulations. Some references to other sections of the California Code of Regulations have been deleted. CHEM's comments are at the end. PMID- 10124113 TI - Beth Israel waste disposal costs. PMID- 10124114 TI - Is an employer trip reduction program in your future? PMID- 10124115 TI - Insurance: the death spiral. PMID- 10124116 TI - Fiscal year 1993 state home per diem rates for domiciliary, nursing home, and hospital care--DVA. Notice of state home program per diem rates for FY 1993. AB - Public Law 100-322, section 134(a)(2) provides for an increase in per diem rates for domiciliary, nursing home, and hospital care in State Veterans Homes. The VA is giving notice of increases for State home per diem for FY 1993 as follows: Domiciliary care--$11.79, nursing home care--$27.61, and hospital care--$27.61. PMID- 10124117 TI - Medicare raises physician fees for nursing facility visits. PMID- 10124118 TI - Ups and downs of assisted living. PMID- 10124119 TI - Stroke caregivers can find help, but little new technology. PMID- 10124120 TI - Cultivating the rural continuum of care. PMID- 10124121 TI - Orchestrating service delivery. HUD projects take first step to address aging-in place. PMID- 10124122 TI - Medicare revisions open opportunities. New cost reporting forms enhance prospective payment. PMID- 10124123 TI - Pinpointing special care. Dedicated unit makes wound care a specialty. PMID- 10124124 TI - High performance evaluations. How to upgrade nurse aide appraisals. PMID- 10124125 TI - Assisted living gets two boosts. HUD, Massachusetts take steps to encourage growth of projects. PMID- 10124126 TI - 1993 software buyers guide. A listing of software providers serving the long-term care industry. PMID- 10124127 TI - Updating communications. DON's skills set the tone for staff relations. PMID- 10124128 TI - Avoid accident/incident citations. PMID- 10124129 TI - Charges to residents' funds. PMID- 10124130 TI - The status of employee caregiver benefits. AB - The number of employee caregivers in the workforce is growing. This trend will impact on employers in both the public and private sectors. PMID- 10124131 TI - Life cycle benefits. AB - Life cycle benefits are designed to meet the needs of employees throughout the stages of life. Many employers in both the public and private sectors are finding that this approach to benefits makes sense from a number of perspectives. PMID- 10124132 TI - Reassessing retiree benefits: the new challenge. AB - For most employers, uncertainty about the future shape of the U.S. health care system, rising health care costs and FAS 106 accounting rules mean it is important to manage retiree medical costs. Survey data shows many employers are taking steps to manage their future retiree health care costs. These steps include reducing benefit levels, introducing service-related contributions and introducing managed care elements to retiree medical plans. PMID- 10124133 TI - Future trends of welfare benefits in the '90s. AB - A number of economic and demographic factors have had a marked effect on welfare plans in Canada and will continue to affect them for the rest of the decade. This situation presents major challenges for plan trustees. PMID- 10124134 TI - European health issues. PMID- 10124135 TI - Getting the most from software. AB - Menu planning and diet office software can help operators cut labor requirements, establish charges for diet instructions and much more. PMID- 10124136 TI - Promoting National Nutrition Month. PMID- 10124137 TI - Total quality management: a matter of quality polarity analysis and management. AB - Alvin Zander claims that group members are often more concerned with personal needs and rights than those of the organization. People tend to have their attention on only half (the upside of their preferred pole and the downside of the other) of the whole "picture" of a polarity. By making a complete, accurate diagram of the entire polarity and continually updating and using it, people can promote collaboration and effectiveness despite the automatic tendency for people to be both blind to the entire situation and individualistically undermining successful management of the polarity over time. In other words, most efforts to produce noteworthy and lasting results in successful implementation of total quality management most likely will be limited--or result in failure--due to the fact that nursing managers, staff, and administrators view autocratic management and employee empowerment as separate choices to be made and are unclear that their day-to-day action impacts both direction and empowerment continually. Polarity analysis and management tend to integrate what appear to be personal and individual needs with those of others in a collaborative partnership. When addressing any polarity, it is important to acknowledge that people at all levels of the organization potentially are paradoxically the greatest resources and the biggest barriers to unprecedented breakthrough results. Overzealous action to reduce autocratic leadership will subsequently affect empowerment negatively and thus ultimately erode direction. Likewise overzealous action to increase empowerment will promote a lack of focus and finally erode organization and compliance. As any group of people begins to experience the recurrence of the ups and downs of both poles, there is increased frustration, resignation, and sense of ineffectiveness. PMID- 10124138 TI - Finding and keeping nurses: every hospital manager's challenge. AB - To reduce the impact of the nursing shortage, hospital administrators must do whatever is necessary to develop an environment where nurses want to work. Nurses have many choices in job selection, and they must be able to clearly perceive the benefits of working in one hospital over another. Hospital administrators who have a desire to be leaders in quality patient care must be innovative and creative in their attempt to recruit and retain nurses. The shortage of nurses is not only real but is probably permanent. The economics of the health care industry are not likely to change. The winners will be the nurses, as their overall quality of work life will improve. PMID- 10124139 TI - Employee orientation: the key to lasting and productive results. AB - A large body of research emphasizes the importance of planning, commitment, and communication of the corporate culture, and the role of key personnel, supervisors, and colleagues in shaping the attitude of the new employee. Ineffective orientation programs usually fall short in meeting these requirements and therefore are costly to the organization. An endless cycle ensues: recruitment, selection, ineffective orientation, improper training, job dissatisfaction, poor performance, turnover, and loss of productivity; recruitment, selection, and so on. Effective orientation programs are designed as a process, customized to meet the needs of the organization, and they consider all of the requirements needed to be successful. The resulting picture can be painted differently: recruitment, selection, effective orientation, training, job satisfaction, improved performance, retention, and increased productivity. Of course this cycle also must be repeated under certain circumstances, but not for the same reasons and certainly not as often. Instead of increased costs, there is actually a cost savings. PMID- 10124140 TI - Powerful communication skills: the key to prevention and resolution of personnel problems. PMID- 10124141 TI - Administrators who cannot let go: the super manager syndrome. AB - Super managers manage boundaries; leaders transcend boundaries. Super managers want to ensure their success and that of their organization by getting the various units in the organization to do their jobs well. They want to get the right individuals and groups together to get the job done. Leaders, on the other hand, tend to be more concerned with team development and total quality management, which is accomplished by crossing boundaries. The tasks of a leader are viewed as getting the right people together to get a job done, which might involve bringing people from different units together. As Hirschhorn has said, Today you want a different kind of team. As you supervise large numbers of people, and as rapid changes in product lines and technologies require you to rely on the initiatives of team members, you need to authorize individuals in the team to think for themselves, come up with new ideas, try alternative approaches- in other words be nonconformists. Perhaps the most important distinction between a leader and a super manager is that a leader can see the whole forest without becoming concerned with all the varieties of trees and their interaction at different points in time. PMID- 10124142 TI - Is there a difference in nurse burnout on the day or night shift? AB - Since it appears that burnout continues to be a problem for health care workers, this area deserves continued investigation and study. While stresses unique to the night shift are identified in the health care literature, the examination of burnout in relation to shifts worked does not appear to be present. While this preliminary study did not provide statistically significant data from which generalizations can be made, the tendency toward significance between the day and night shiftworkers in the area of personal accomplishment is important and identifies the need for further study in this area. One answer to the nursing shortage has been to extend shift lengths from eight hours to 12 hours. In fact, the popularity of extended shift hours is increasing in spite of indications that most 12-hour nurses report fatigue. Not only do studies need to be done to determine if quality of care is suffering, but the effect of 12-hour shifts on burnout and potential subsequent withdrawal from nursing needs to be examined. Symptoms of burnout rarely get better when ignored and therefore are deserving of recognition and attention. Since both intrinsic and extrinsic factors are involved, this issue should not be addressed only by further research investigation, but by incorporation of relevant concepts in nursing education, attention to handling stress in the workplace, and organizational intervention to minimize extrinsic stressors in the workplace. Extrinsic stressors may be reduced through attention to such issues as workload, flexible scheduling, and conflict management. PMID- 10124143 TI - Journal club: a tool for health care management and development. AB - While the journal club concept has its roots in medical practice, the premise of the concept can easily and effectively be assimilated into health care management practice. Health care executives and managers can greatly facilitate the journal club process by establishing a solid methodology for article presentations that focuses on critical and timely issues related to health care management. With upper management support and member commitment, the journal club can be a powerful vehicle for ongoing management and personal career development. PMID- 10124144 TI - The importance of budgeting with nontraditional staffing patterns. AB - Are nontraditional staffing patterns cost effective? The advantages qualitatively seem to outweigh the disadvantages, but the numbers, when examined quickly, present an opposing view. Each institution is individual and thus the hospital administrators must assess the real reasons for their staffing and budgetary problems. Nontraditional staffing patterns have been shown to decrease the use and cost of agency personnel; therefore, the schedules are cost effective if a hospital frequently utilizes these services. A blanket statement cannot be made for all institutions. Another fact attributed to these innovative staffing patterns, the decrease in the turnover rate, needs to be further assessed. For although hospital employees in general considered inflexible scheduling a common reason for dissatisfaction, each institution must examine itself before changing schedules. For some hospitals, turnover can be decreased by using other benefits. An example taken from a New York City hospital that had a moderately high turnover rate found turnover rate due to inaccessibility to public transportation. A change with the scheduling would not have greatly decreased the turnover rate, but a shuttle service from the major subway and bus stations did. Thus the point is that nontraditional staffing patterns may not appear cost effective upon first looking at the numbers, but after an individual assessment of each institution the real need for change in scheduling patterns can be determined. Also benefit percentages and use of overtime must be calculated carefully. Last, with the present and projected hospital personnel shortages, cost effectiveness may sometimes be overlooked in order to meet staffing requirements. This fact exemplifies the need for hospital administrators to acquire budgeting knowledge in order to assess cost effectiveness and prevent hospital losses. PMID- 10124145 TI - Behavior improvement: a two-track program for the correction of employee problems. AB - In the best of all possible working worlds no one would ever have to be involuntarily terminated from employment. Whether a punitive discharge for a severe violation of a word rule, or a gentle dismissal for failure to meet job standards, termination is one of the most difficult tasks a supervisor ever has to perform. However, it is the effect on the employee that should dominate the supervisor's thoughts and actions, not the personal uneasiness with which the supervisor greets the task. It is because of the impact on the employee that the supervisor has a responsibility to do everything reasonably possible to ensure the employee's success before resorting to dismissal or discharge. Adopting this sort of caring attitude toward employees is not easy; most of our management role models of past years were raised on authoritarianism. As a result there is in many supervisors a tendency to simply weed out the troublesome employee and start again with someone new. However, any supervisor can fire, but it is the exceptional supervisor who can salvage an employee and turn a source of problems into an effective producer. PMID- 10124146 TI - How Continental Bank outsourced its "crown jewels.". AB - No industry relies more on information than banking does, yet Continental, one of America's largest banks, outsources its information technology. Why? Because that's the best way to service the customers that form the core of the bank's business, says vice chairman Dick Huber. In the late 1970s and early 1980s, Continental participated heavily with Penn Square Bank in energy investments. When falling energy prices burst Penn Square's bubble in 1982, Continental was stuck with more than $1 billion in bad loans. Eight years later when Dick Huber came on board, Continental was working hard to restore its once solid reputation. Executives had made many tough decisions already, altering the bank's focus from retail to business banking and laying off thousands of employees. Yet management still needed to cut costs and improve services to stay afloat. Regulators, investors, and analysts were watching every step. Continental executives, eager to focus on the bank's core mission of serving business customers, decided to outsource one after another in-house service--from cafeteria services to information technology. While conventional wisdom holds that banks must retain complete internal control of IT, Continental bucked this argument when it entered into a ten-year, multimillion-dollar contract with Integrated Systems Solutions Corporation. Continental is already reaping benefits from outsourcing IT. Most important, Continental staffers today focus on their true core competencies: intimate knowledge of customers' needs and relationships with customers. PMID- 10124147 TI - How I turned a critical public into useful consultants. AB - When Peter Johnson was an executive in the private sector, he viewed conflict with company outsiders as, at best, an annoyance. But when Johnson became the administrator of Bonneville Power Administration in Portland, Oregon, he realized that outsiders had the power to bring the organization down. To survive, BPA had to listen to the people affected by the agency's decisions-BPA's harshest critics. BPA had long been respected, but by the time Johnson arrived in 1981, the agency was reviled. People were put off by BPA's father-knows-best approach to decision making, whereby the agency first made decisions and then explained them. So Johnson took what many thought was an unimaginable risk. Despite the warnings of attorneys and his own deep apprehensions, he opened up BPA's decision making to the public. The first attempts to involve BPA's critics were full of fireworks, but thanks to BPA's rock-solid commitment to public involvement, success soon followed. Experiences early on proved to Johnson that involving the public in BPA's decision making was a practical alternative to litigation. Moreover, BPA's stakeholders--once the agency's adversaries--became BPA's partners in making better decisions, and the agency gained authority and legitimacy. PMID- 10124148 TI - Crisis prevention: how to gear up your board. AB - Today's critics of corporate boardrooms have plenty of ammunition. The two crucial responsibilities of boards-oversight of long-term company strategy and the selection, evaluation, and compensation of top management--were reduced to damage control during the 1980s. Walter Salmon, a longtime director, notes that while boards have improved since he began serving on them in 1961, they haven't kept pace with the need for real change. Based on over 30 years of boardroom experience, Salmon recommends against government reform of board practices. But he does prescribe a series of incremental changes as a remedy. To begin with, he suggests limiting the size of boards and increasing the number of outside directors on them. In fact, according to Salmon, only three insiders belong on a board: the CEO, the COO, and the CFO. Changing how committees function is also necessary for gearing up today's boards. The audit committee, for example, can periodically review "high-exposure areas" of a business, perhaps helping to prevent embarrassing drops in future profits. Compensation committees can structure incentive compensation for executives to emphasize long-term rather than short-term performance. And nominating committees should be responsible for finding new, independent directors--not the CEO. In general, boards as a whole must spot problems early and blow the whistle, exercising what Salmon calls, "constructive dissatisfaction." On a revitalized board, directors have enough confidence in the process to vigorously challenge one another, including the company's chief executive. PMID- 10124149 TI - Who's on the fiddle. PMID- 10124150 TI - HA law. PMID- 10124151 TI - Nuts and Baltics. PMID- 10124152 TI - Health management training and qualifications. Multiple choice. PMID- 10124153 TI - Health management training and qualifications. Virtual reality. PMID- 10124154 TI - Health management training and qualifications. Raising the roof. PMID- 10124155 TI - Health management training and qualifications. NonPC. PMID- 10124156 TI - The vision thing. PMID- 10124157 TI - Countdown to community care. Planning blight. PMID- 10124158 TI - Pacemaker. PMID- 10124159 TI - Dare to be different. PMID- 10124160 TI - Tip of the iceberg. PMID- 10124161 TI - No half measures. PMID- 10124162 TI - Countdown to community care. Going it alone. PMID- 10124163 TI - Facilities management. Dog bytes dog. PMID- 10124164 TI - Facilities management. Classic FM? PMID- 10124165 TI - Above the law. PMID- 10124166 TI - Building integrated systems--the holographic organization. AB - Organized delivery systems will be the vehicle for addressing cost, technology, quality, chronic illness, and information management issues in the context of caring for defined populations. PMID- 10124167 TI - Building integrated systems--on the brink of a third generation. AB - The ability to capture both financial and clinical data is at the heart of integrating the insurance and delivery functions. PMID- 10124168 TI - Building integrated systems--driving the nitroglycerin truck. AB - Both sides of the bizarre, sadomasochistic relationship between physicians and hospitals bring baggage to the "arranged marriage" of the integrated healthcare system. PMID- 10124169 TI - Building integrated systems--medical informatics. AB - The computer-based patient record will be the integrated regional healthcare system's most valuable asset. PMID- 10124170 TI - Building integrated systems--getting paid to keep people healthy. PMID- 10124171 TI - The twice-born personality. Interview by Joe Flower. AB - Abraham Zaleznik focuses on some things that might seem old-fashioned: talent, the individual mind, and a fascination with the content, the product, the nuts and bolts of the business. He is the great champion of the individual in corporate life. There has been a lot of discussion about the difference between managers and leaders. It was Zaleznik who started the discussion some 15 years ago in a seminal Harvard Business Review article called "Managers and Leaders: Are They Different?" A lot of his colleagues at Harvard, prime developers of the profession of management, thought he was nuts. He argued that management and leadership involve completely different mindsets, and that great business enterprises suffer when they are given over to professional managers. His ideas strike sparks against those of other people we have interviewed in this series. He questions the value of the total quality movement, and the importance of teamwork. Where Russell Ackoff spoke of democracy and free markets within the corporation, Zaleznik praises hierarchy. Where Terry Deal found cohesion and motivation in the meanings and rituals of the workplace, Zaleznik dismisses workplace ritual as a waste of time and energy. PMID- 10124172 TI - Keeping an eye on time. PMID- 10124173 TI - Further thoughts on the reward of health care assistants. AB - Discusses the need to view HDAs in a multiskilled generic context, irrespective of function (for reward purposes). Suggests three groups (direct care, indirect care and support). Mentions assimilation, then some NHS examples. Refers to a previous article in Health Manpower Management, Vol. 18 No. 1 and updates a Table therein. Mentions surveying the local labour market. Suggests a possible logical route, then an alternative scenario. Concludes that there is no one route to local variations, but there is a common need to separate NVQ-competence training, skill-mix and reward issues first--then link all together into one overall strategy comprising all component parts. PMID- 10124174 TI - Performance appraisals: never mind the boss, please the customer. AB - Compares the general conception of the performance appraisal system as evidenced in yesterday's and today's attitudes and goes on to prognosticate the approach of tomorrow. Radically proposes the removal of such a system altogether, switching from performance appraisal to systems analysis, involving feedback from external (customer/supplier) as opposed to internal (management) sources. Also extends the paradigm shift to salaries, communications and promotion, and highlights training as a vital component, if Deming's seminal eleventh and twelfth points are to be realized. PMID- 10124175 TI - Organizational review and analysis: a case study. AB - Pursues an organizational review and analysis of the Human Resource Department (HRD) in a large Canadian health care facility, when a decision was taken to make all management activities the purview of an independent board. Identifies objectives, examines the many different functions of HR management and makes recommendations. Implementation is vital, regardless of risks, whether the review has been conducted internally or externally by consultants. PMID- 10124176 TI - Managers as social surgeons. AB - Deals with the Health Service manager's problems of pruning staff in NHS Trust applications. Compares handling staff with a surgeon handling patients pre-, during and post-operations. Concludes that the Health Service manager must consider the key issues of communication, involvement, unambiguity and encouraging the free expression of dissent. PMID- 10124177 TI - Business planning: learning by doing. AB - Places business planning in health care within a contextual and conceptual framework as a background to describing a development programme for the NHS in Scotland to facilitate the learning of key managers about the business planning process. The programme highlighted a "learning-by-doing" approach, whereby a number of change initiatives were triggered and future prospects for planning and learning identified. PMID- 10124178 TI - Cafeteria benefits in the NHS? AB - Choice of benefits in addition to (or as an alternative to part of) base pay. Lessons from the USA. How much applies to the NHS in the UK? Discusses some examples and describes a process of devising such a scheme. Concludes that there is a need to consider such a scheme in relation to an organizations's labour market and culture. Is it appropriate? Or are there better ways to the same results? PMID- 10124179 TI - Making the manpower information role proactive. AB - With a second wave of Trusts now operating, there is an ever-increasing need for manpower information to be both accurate and clearly-presented for internal use. Explains the approach used by North Herts NHS Trust--a first-wave Trust, to making the function more proactive, and increasing its value to managers. PMID- 10124180 TI - Why doesn't performance pay work? AB - The NHS is about to embark on the widescale introduction of performance-related pay. A number of recent studies have seriously questioned the efficacy of merit pay. Utilizing the expectancy theory of motivation, explains why performance pay is unlike to motivate NHS staff. PMID- 10124181 TI - New roles for old. AB - The creation of clinical directorates in acute hospital services has directed attention towards the clinical director role. The two "support" roles of clinical nurse manager and business manager have received less attention. Reports on an action research study into these roles, examining recruitment and selection, monitoring of performance, training needs and succession planning. Deals with the clinical nurse manager role. PMID- 10124182 TI - Measuring effectiveness: is NHS Personnel getting it right? AB - The material presented in this article is the result of a study undertaken at the request of NHS Personnel on behalf of the Department of Health. The central aim was to develop and validate a qualitative measure of personnel management effectiveness, which would be useful and easy to use for those working at regional and unit level. PMID- 10124183 TI - Filling the gap. EMS social service referrals. PMID- 10124184 TI - The Wyoming experiment. Rural EMS issues, needs, problems and actions. PMID- 10124185 TI - Here to stay? Recruiting EMS volunteers. PMID- 10124186 TI - EMS recruitment. A personal story. PMID- 10124188 TI - Vanishing volunteers. PMID- 10124187 TI - Big hug. Octopus is a better way. PMID- 10124189 TI - Caring at the end of life. PMID- 10124190 TI - Competency: the asceticism of our time--the role of pastoral care in ethical decision-making. PMID- 10124191 TI - Cancer care and community clergy: hospital based training models. PMID- 10124192 TI - Counselor of quality. AB - Coping with cancer from the patient's or counselor's viewpoint means that strengths and resources depend on assessing predominant problems and acting appropriately to alleviate them. It does not always mean resolution of problems, but it does require understanding where the pressure points are that lead to more distress. Thus, counselors anticipate as well as understand actual distress; visualize various outcomes of different interventions, medical or otherwise; and narrow the gap between what is hoped for and what might be possible. Pastoral counseling needs a viewpoint that maintains morale in the utmost phase of terminal illness. Facing mortality is difficult for the counselor as well as significant others. Therefore, they must deal directly with bereavement and potential loss, if possible, indicating their willingness to confront ultimate questions, even without answers. Overall, the purpose of quality counseling is in the counselor: limitation is not futility. The job of counseling is not to figure out the universe or explain the unexplainable. Rather, the purpose of counseling is to help a suffering individual to come back within the range of normalized behavior and to become acceptable and credible. In this way, out of the web of vulnerability can come further strengths and resources. PMID- 10124193 TI - Where do chaplains fit in the world of cancer care? AB - Finally, what are we about in modern chaplaincy? We have successfully shed our old image as a profession that is more tolerated than valued as a part of the team. We have become as skilled in interacting sensitively with patients and family members as any member of the health care team. We have become integrated professionals in the modern hospital. While maintaining these skills and that place, we need to reappropriate some of the unique features of who we are as people of faith and reintegrate them into our practice. The time when embracing science meant devaluing religious faith has come to an end. We can and must use the strengths of both science and religion to help cancer patients and their families strive for health. As we continue to grow in using the tools of science to bring people to faith and hope, we need to appropriate some other tools of psychology to help us. As I discussed, the role of assessment needs a great deal more exploration. Research on spiritual issues in coping with cancer is still in its infancy and desperately needs the participation of chaplains. We need the data from this research to help us maximize our patient's ability to use religious faith in their coping. As chaplains, we will always be on a bridge between science and religion. We will always have to be careful to stay balanced and not to wander too far toward one end of this bridge or the other. To keep our ministry in perspective, we must always remember that science is a method and a set of skills that we use while religious faith is at the center of who we are. PMID- 10124194 TI - Families with cancer: insights from family therapy. PMID- 10124195 TI - Cancer and family members. PMID- 10124196 TI - Health promotion in oncology: a cancer wellness doctrine. PMID- 10124197 TI - Consequences of differential residence designations for rural health policy research: the case of infant mortality. AB - In 1991, members of the rural caucus proposed numerous bills designed to attenuate the rural-urban differences in health care delivery and health status. Implicit in the legislative process is the assumption that "rural America" differs systematically from "urban America." However, research has consistently demonstrated that there is not a single rural America but rather, those areas outside of the major metropolitan areas represent a complex mosaic of varying social and environmental settings. Rural communities differ in meaningful ways along a number of socioenvironmental parameters, and accordingly, health status indicators also differ across rural communities. Thus, health outcome statistics averaged across rural communities will often mask important disparities experienced by certain population groups. Policies based on these aggregate indicators may overlook the needs of the most disadvantaged. While a number of measures of rurality have emerged in the last decade, much of the information presented to policy-makers is either too aggregated (i.e., metropolitan nonmetropolitan) to identify important differences across the range of communities, or it is gathered in agency-specific categories that are not comparable. The central question under examination in the current context is the possibility of distorting the picture of infant health status by aggregating the diverse rural locales of the United States. Empirical results indicate that when considering infant mortality, any rural disadvantage is contingent upon how 'rural' and 'urban' have been defined. Further, the results indicate that conclusions must be conditioned on other important sociodemographic parameters such as region of the country and race. PMID- 10124198 TI - Reaching children of the uninsured and underinsured in two rural Wisconsin counties: findings from a pilot project. AB - Debates about the accessibility, costs, and coverages of health care for the population at large have recently accelerated. This paper addresses some of the demographic, health, and fiscal ramifications of creating a preventive health care bridge to children in uninsured and underinsured families in two rural Wisconsin counties. The study findings revealed that the initial health status of children making a preventive health visit under a minimal copayment plan was noticeably worse than the status of those who had the free Early and Periodic Screening, Diagnosis, and Treatment (EPSDT) program available to them on a more or less continual basis. Upon their first visit, the children who did not have access to a free EPSDT program had a greater number of medical and dental health problems and fewer preventive dental care visits than their EPSDT contemporaries. Beyond a greater number of problems, however, we found no noticeable differences between the two groups in the types of health problems present (i.e. the clinical distribution of the problems was similar across the two groups). This paper also contrasts referral completion rates and rates of diagnostic confirmation of identified problems between the two groups. Finally, we provide estimates of the cost of coverage for each unprotected child. PMID- 10124199 TI - Rural-urban differences in stigma and the use of care for depressive disorders. AB - Stigma may be a particularly important barrier to mental health care in rural communities where lack of anonymity increases the probability that someone who seeks care will be labeled "crazy." This study examined rural-urban differences in the stigma associated with depressive symptoms and the stigma associated with seeking treatment for depressive disorders. In addition, the study compared how the stigma associated with seeking treatment predicted use of care in rural and urban residents with a history of depressive symptoms. Two hundred subjects from metropolitan and adjacent non-metropolitan counties rated one of four randomly selected vignettes using 14-point semantic differential scales. The findings indicated that rural residents with a history of depressive symptoms labeled people who sought professional help for the disorder somewhat more negatively than their urban counterparts. Logistic models controlling for sociodemographic characteristics demonstrated that the more negative the labeling, the less likely depressed rural residents were to have sought professional help. Labeling was not associated with use of care among urban people with depressive symptoms. We concluded that prospective studies are warranted to inform the development of interventions to decrease the stigma associated with seeking treatment for depressive disorders in rural communities. PMID- 10124200 TI - Rurality and prescription drug utilization among the elderly: an archival study. AB - Despite documentation that rural elderly have reduced access to both primary care and specialist physician services, there have been very few studies comparing rural and urban patterns of prescription drug use. This is unfortunate, because prescription drugs are the most commonly used type of health care by the elderly. This research merged claims data for a random sample of 18,641 enrolled elderly in the Pennsylvania Pharmaceutical Assistance Contract for the Elderly (PACE) for the years 1984 through 1988 with Medicare inpatient and outpatient health services records and with county-level demographic and health services resources data bases to test several models of factors associated with prescription drug use. The Human Resources Profile County Code from 1980 census data (HRPCC80) in the Area Resource File provided a very detailed (10 levels) definition of rurality. Consistent with our hypotheses based on preliminary studies, neither rurality designations nor county-level health care resource indices, nor interaction terms of health services resources with rurality were powerful predictors of prescription drug use. Use of health services (from Medicare data) and variables of longevity and continuity in the PACE program were consistently robust predictors of prescription drug use. Personal demographic characteristics were also strong predictors: white widowed women under age 85 with relatively higher incomes used more prescription drugs. PMID- 10124201 TI - The rural hospital as a provider of health promotion programs. AB - Although patient education has always been recognized as an essential function of a hospital, it was not until the health concerns of the nation focused on prevention that hospitals began to develop activities aimed at primarily healthy individuals. Hospital health promotion evolved from patient education about specific diseases to programs focused on modifying of lifestyle practices to prevent future debilitating conditions. Studies conducted in the early 1980s show hospital-based health promotion programs increasing in number and including such target populations as senior citizens, children, business people, and hospital employees. However, the extent of involvement of the rural hospital in offering health promotion programs has not been clearly established. The current study was conducted to determine the status of health promotion programs in rural North Carolina hospitals. Elements considered were types of programs, target audiences, methods of financing, staff use, and availability of specialized facilities for health promotion programs. The results indicate rural hospitals do offer health promotion programs, but their primary focus is on hospital employees. Most programs are offered at low or no cost, making those offered for the community readily accessible. If input from the community is used and programming is aimed at specific health needs of rural populations, the rural hospital could make a significant contribution to an overall primary prevention strategy, lowering community health care costs. PMID- 10124202 TI - A literature review of health issues of the rural elderly. PMID- 10124203 TI - How public opinion really works. PMID- 10124204 TI - How doctors are bailing out of self-referral facilities. PMID- 10124205 TI - Are you driving young doctors away from primary care? PMID- 10124206 TI - Groups dangle big salaries--but for how long? PMID- 10124207 TI - My parents' final request: help us die. PMID- 10124208 TI - Practice sales to hospitals: who gets the best deal? PMID- 10124209 TI - Practice sales to hospitals. Do you really want to work for your hospital? PMID- 10124210 TI - You learn plenty in the ER--and not just about medicine. PMID- 10124211 TI - Has this doctor-governor found the key to health reform?. Interview by Berkeley Rice. AB - Under the leadership of internist Howard Dean, the nation's only physician governor, Vermont is adopting a comprehensive health-care plan that will revolutionize the way the state's doctors practice medicine. As Vermont goes, so may the nation, for Dean is one of the key advisers to the Clinton administration on health-care reform. But if the Vermont plan serves as a model for the rest of the country, many doctors may find it a better pill to swallow. Among other things, it could mean that nearly all the state's physicians will, in effect, participate in a state-run HMO and be subject to global fees and budgets that will also cover hospitals (see opposite page). While the plan's specific provisions are still being debated, Dean's views have spread to other states and to the Clinton administration through his role as co-chairman of the National Governor's Association task force on health care. In a recent interview with Senior Associate Editor Berkeley Rice in the governor's office in Montpelier, Dean discussed Vermont's new health plan, its importance as a model for other states, and his unique perspective as physician-governor. PMID- 10124212 TI - Look what the stork brought for OBGs. PMID- 10124213 TI - Employee payments for health care services. PMID- 10124214 TI - Health services: the real jobs machine. AB - In terms of employment, the best performer over the last decade was health services; the industry added nearly 3 million jobs, accounting for 1 of every 6 new jobs in the economy since 1980. PMID- 10124215 TI - Columbia to merge 2 Miami hospitals. PMID- 10124216 TI - HCA has small profit in '92. PMID- 10124217 TI - Margins are CFOs' top worry. PMID- 10124218 TI - New device maker group starts. PMID- 10124219 TI - Geisinger loses appeal of its HMO's tax status. PMID- 10124220 TI - More IRS integration rulings set. PMID- 10124221 TI - Buyout bid has N.D. town abuzz. PMID- 10124222 TI - Florida hospitals still feeling hurricane's effects. PMID- 10124223 TI - 2 Quincy, Ill., hospitals agree to new deal. PMID- 10124224 TI - St. Louis hospital cuts project size. PMID- 10124225 TI - Lobbyists tolerate panel's clandestine approach. PMID- 10124226 TI - Placing layoffs in pretty packages. Hospitals using creative marketing programs to emphasize the up side of efforts to downsize. PMID- 10124227 TI - New index tracks hospital prices. PMID- 10124228 TI - Rural managed competition would need subsidies--report. PMID- 10124229 TI - Basic pitfalls can undermine hospital-service firm relationship. PMID- 10124230 TI - Self-referral law's fee caps jolt revenues of Fla. groups. PMID- 10124231 TI - Recruiting women physicians requires hospitals to offer benefits, flexibility. PMID- 10124232 TI - HFMA toughens policies on law-breakers. PMID- 10124233 TI - Physicians settle with Maine on antitrust charges. PMID- 10124234 TI - AFL-CIO adopts principles for reform, not a specific plan. PMID- 10124235 TI - Keane-PHS merger all but dead as deadline passes. PMID- 10124237 TI - D.C. Blues plan gets aid extension. PMID- 10124236 TI - USC hospital initiates $2 million security plan. PMID- 10124238 TI - Judge appoints operator for Towers Financial. PMID- 10124239 TI - AHA execs meet with White House task force. PMID- 10124240 TI - Texas to appeal dismissal of Methodist suit. PMID- 10124241 TI - Legacy direct contract emphasizes quality. PMID- 10124242 TI - Maryland hospitals' profits jump in '92. PMID- 10124243 TI - Nevada hospitals dispute report. PMID- 10124244 TI - Mass. report targets hospital inefficiencies. PMID- 10124246 TI - VA budget envisions shift to PPS, new investment in medical care. PMID- 10124245 TI - Pa. Gov. Casey seeks to slash health spending by $600 million. PMID- 10124247 TI - Clinton's all-inclusive package of sacrifice is making it tough for lobbyists to press their case. PMID- 10124248 TI - Baxter acquisition of Stuart division is off. PMID- 10124249 TI - OTA report assails profits on new drugs. PMID- 10124250 TI - Why endure frustration? Medical records need cooperative overhaul. PMID- 10124251 TI - Get the computers right, and physicians will get with the program. PMID- 10124252 TI - Large sale of HCA stock nixed. PMID- 10124253 TI - Purchase groups passed in Fla. PMID- 10124254 TI - Des Moines merger to form state's largest provider. PMID- 10124255 TI - Practice acquisitions pose risk--HHS. PMID- 10124256 TI - Texas hospitals enjoy surge in 'dispro' payments. PMID- 10124257 TI - Effects of paper strike rippled to hospitals. PMID- 10124258 TI - Winner assesses community needs, benefits. PMID- 10124259 TI - Institutional ethics. Beliefs versus behavior: survey shows disagreement. PMID- 10124260 TI - Transplant experts ponder new procedures and donor policies. PMID- 10124261 TI - Care of the dying. Families of landmark cases tell their stories. AB - In recent years, despite differences in opinion, society has forged a general consensus about how health care decisions will be made for incapacitated patients. Key to this general agreement is the participation of family members in discussions with health providers, courts, lawyers, and legislators. The following articles summarize some recent involvement of these families in educational efforts. PMID- 10124262 TI - Gallup poll sheds light on elderly suicide wishes. PMID- 10124263 TI - Searching for ethical values in reform strategies. PMID- 10124264 TI - Professional ethics. Self-referral policies and practices examined. PMID- 10124265 TI - Who's who? AHP's chairmen and Si Seymour award winners. PMID- 10124266 TI - Finding the future--our view. PMID- 10124267 TI - Who speaks for mission? PMID- 10124268 TI - Closing the circle. PMID- 10124269 TI - Notes to newcomers. PMID- 10124270 TI - From vision to revision: the secrets of getting into print. PMID- 10124271 TI - A legacy of 25 shining years for healthcare philanthropy. PMID- 10124272 TI - What a trustee expects of a development officer. PMID- 10124273 TI - Auxiliaries, guilds, and hospitals: a family feud. PMID- 10124274 TI - Non-profit hospitals: succeeding despite an unfriendly bureaucracy. PMID- 10124275 TI - Giving and ... house cleaning? PMID- 10124276 TI - A violation of boundaries: when therapeutic relations become sexual. Interview by Matthew D. Pavelich. PMID- 10124277 TI - Supported employment: a three-way partnership. AB - This article outlines changes over the years in patients' vocational and industrial training at Whitby Psychiatric Hospital in Greater Metropolitan Toronto. The transition from traditional workshops to an integrated community based vocational training program--supported employment--is discussed, as is the importance of partnership among the hospital, the client, and the employer for success in such a program. PMID- 10124278 TI - Art therapy: a unique alternative for healing. AB - This article focuses on three aspects of art therapy. By defining the parameters of the field and outlining its possibilities in treatment, the author discusses the populations who can benefit from art therapy and why. The implications of introducing an art-therapy program to a health care facility are also discussed, as are ways of minimizing problems and promoting support among staff. PMID- 10124279 TI - The key to successful program planning. AB - For program planning to be cost-effective, it must combine clear vision and realistic strategy. Reliable demographic information on target populations is essential, and in-house research can contribute substantially to the accuracy of information that health care administrators use in such planning. This article describes research into the traumatic brain-injured population at Toronto's Queen Elizabeth Hospital and discusses how this information can be used by health care administrators. PMID- 10124280 TI - Wandering patients: potential for tragedy. AB - Patients in acute care who wander from hospital premises present a serious challenge. This article describes the case of a patient who wandered from Vancouver's Lions Gate Hospital and subsequently died of hypothermia. As a consequence, the facility developed a comprehensive but simple procedure called Code White to ensure that such a tragedy does not happen again. PMID- 10124281 TI - Focus on board effectiveness. AB - In its ongoing effort to promote and ensure the highest quality of health care throughout Canada, The Canadian Hospital Association has entered into a partnership with The Centre for Quality in Governance, a Toronto-based non-profit organization formed in 1992. The Centre's mandate is to improve the effectiveness of organizations by researching and evaluating various aspects of governance. PMID- 10124282 TI - Disaster planning by video. PMID- 10124283 TI - Utilization management: reduced costs--improved service. AB - This is the first of a two-part series in which the authors discuss utilization management initiatives at Lions Gate Hospital in North Vancouver, British Columbia. These initiatives included data collected from the Hospital Medical Records Institute that led to a change in care patterns in the Psychiatry Department, adapting an external same-day surgery program that reduced bed-days, and an analysis of Emergency Room admissions that led to 55 per cent reduction in the number of these patients waiting for beds. In addition, a quick response program saved 2,000 bed-days, and a hospital-community discharge planning committee identified opportunities for further evaluation. PMID- 10124285 TI - 1993 Computers in Healthcare market directory. Associations, agencies and groups. PMID- 10124284 TI - Annual update of the HHS poverty guidelines--HHS. Notice. AB - This notice provides an update of the HHS poverty guidelines to account for last (calendar) year's increase in prices as measured by the Consumer Price Index. PMID- 10124286 TI - 1993 Computers in Healthcare market directory. PMID- 10124287 TI - It's time to replace private health insurance with a national health care system. PMID- 10124288 TI - Coordination of medical malpractice insurance benefits: circuits ponder who pays? PMID- 10124289 TI - Off-label uses of drugs and medical devices: should the FDA crack down? PMID- 10124290 TI - Courts hostile to insurers reneging on hospital payments. PMID- 10124291 TI - HMO physicians' shared risk pools are dangerous to patients' health. PMID- 10124292 TI - CEO leadership in succession planning. AB - Hospital executives recognize that medical staff stability and growth must be carefully managed. However, when it comes to succession planning, the CEO must assume a leadership position. PMID- 10124293 TI - Get ready for your interview. AB - A successful job interview requires serious planning. You need to determine what information your interviewer seeks before the interview even takes place. PMID- 10124294 TI - Beyond personnel: human resources comes to grips with its leadership role. AB - The human resources department has emerged as a major thrust in healthcare organizations. Strong CEO and human resources relations are critical to successful strategic planning and implementation. PMID- 10124296 TI - Keys to creating an effective ethics program. AB - Ethics is not a box that can be checked after every employee has been through an ethics training program or has acknowledged reading the code of conduct. Ethics has to do with the basic culture and operating values of an organization. PMID- 10124295 TI - The changing healthcare workforce: a call for managing diversity. AB - It's 2000. Walk into a department of a typical healthcare organization. Of the 14 employees, four are African-American, five are Hispanic, three are Asian, and two are white. Seven are women. For at least half of the group, English is a second language. Are you willing to teach English to improve service to patients and internal customers? How much training is your organization willing to provide? What impact does diversity have on productivity? And thinking more globally, how does your organization move from a number-crunching affirmative action posture to a workforce that reflects its patients and society? PMID- 10124297 TI - The 1940s: the transition. PMID- 10124298 TI - Healthcare and President Clinton's first 100 days. PMID- 10124299 TI - Cutting through the confusion of managed competition. PMID- 10124300 TI - IDN development: issues to resolve. Integrated delivery networks offer care givers the opportunity to provide patient-focused care. PMID- 10124301 TI - Primary care program improves reimbursement. The Federally Qualified Health Center program helps hospitals improve services to the medically indigent. AB - Under a program created by Congress in 1989, certain primary care treatment centers serving the medically and economically indigent can become Federally Qualified Health Centers (FQHCs). Recently enacted rules and regulations allow participants in the FQHC program to receive 100 percent reasonable cost reimbursement for Medicaid services and 80 percent for Medicare services. An all inclusive annual cost report is the basis for determining reimbursement rates. The report factors in such expenses as physician and other healthcare and professional salaries and benefits, medical supplies, certain equipment depreciation, and overhead for facility and administrative costs. Both Medicaid and Medicare reimbursement is based on an encounter rate, and states employ various methodologies to determine the reimbursement level. In Illinois, for example, typical reimbursement for a qualified encounter ranges from $70 to $88. To obtain FQHC status, an organization must demonstrate community need, deliver the appropriate range of healthcare services, satisfy management and finance requirements, and function under a community-based governing board. In addition, an FQHC must provide primary healthcare by physicians and (where appropriate) midlevel practitioners; it must also offer its community diagnostic laboratory and x-ray services, preventive healthcare and dental care, case management, pharmacy services, and arrangements for emergency services. Because FQHCs must be freestanding facilities, establishing them can trigger a number of ancillary legal issues, such as those involved in forming a new corporation, complying with not-for-profit corporation regulations, applying for tax-exempt status, and applying for various property and sales tax exemptions. Hospitals that establish FQHCs must also be prepared to relinquish direct control over the delivery of primary care services. PMID- 10124302 TI - Care of the dying: a Catholic perspective. Part I, Cultural context: a CHA document challenges care givers to define appropriate care for the dying. AB - In a society tempted to adopt legalized assisted suicide and euthanasia as appropriate responses to dying, the healthcare community is challenged to nurture positive attitudes toward death among all ages and to help those with terminal illnesses to live well while dying. Whereas family and friends were once the primary care givers, now members of the healthcare professions are. This shift has introduced tensions between medical professionals and patients, including their families, in defining appropriate behavior toward the dying. To enable the terminally ill to live well while dying, we need to allow them to retain as much control as possible within the limits of belonging to a community. Also, we need to secure their network of significant relationships so they can experience the affective bonds of trust and love that support personal dignity and enhance the meaning of life. Medical technology is to be used in service of the total good of the patient. This includes not only the relief or cure that therapy can bring, but also what the patient prefers, values about life, and regards as giving ultimate meaning to life. Catholic healthcare institutions are challenged to promote a sensitivity and respect for cultural diversity as they respond to the needs of the dying and those who care for them. PMID- 10124303 TI - Why we should not legalize euthanasia. The foundational ethical principle obliging us to protect life must be translated into a concrete norm. AB - The euthanasia debate is really the backdrop for a discussion within our society about the very nature of human life and meaning. Because the origin of life is in God, human beings do not have dominion over life but are stewards of life. The powerful combination of sanctity and stewardship is expressed in the foundational ethical principle. This principle says that no person has the right to directly take innocent human life and in fact there is a positive obligation to nurture and protect life. In our secular society there is a need to develop a "natural" metaphysic of sacredness. Such a metaphysic can serve as bedrock from which a foundational principle can be developed and then applied in concrete moral norms. It can show that life contributes to the full dignity of the human person. For this perspective to be effective in countering the movement to legalize euthanasia, this sense of integral wholeness of human personhood must be demonstrated in a convincing manner. It can be because a dualistic philosophical bias has been found wanting by Western culture. We must arrive at what ethicists would call concrete norms that guide individual choices. At issue is how we translate our foundational principle--Do not directly attack innocent human life- into a concrete norm when confronted with the possibility of death. Some persons question whether the concrete norm opposing euthanasia should be a matter of public morality. To answer this question, we must turn to our foundational principle.(ABSTRACT TRUNCATED AT 250 WORDS) PMID- 10124304 TI - Does compassion include euthanasia? Physicians' roles in caring for the terminally ill preclude the use of euthanasia. AB - As technological advances continue to allow physicians to prolong dying patients' lives, healthcare providers face many issues surrounding physician-assisted suicide and euthanasia. When a physician performs euthanasia or assists in suicide, he or she is killing the patient. The action can in no way be interpreted as allowing an eventually inevitable death to occur earlier rather than later. The physician is culpable. Physicians play three important roles when caring for terminally ill patients: adviser, friend, and priest. The risks inherent in each of these could create an illusion that performing euthanasia and assisting in suicide are humane and logical options. Finally, physicians should not miss opportunities for grace when caring for dying patients. When physicians convey the diagnosis, when patients express the desire to control the timing of the death, and when patients are feeling sadness and anger, physicians must rise to the occasion to act as friend and minister and to introduce grace and healing to the dying. PMID- 10124305 TI - Decision tree. A process for determining when to withdraw or continue life sustaining medical treatment. AB - Whether to provide life-sustaining treatment for never-competent adult patients or formerly competent patients whose wishes are unknown is one of the most difficult decisions healthcare providers face. To help address this problem, in 1992 the National Center for State Courts published Guidelines for State Court Decision Making in Life-sustaining Medical Treatment Cases. The publication contains a decision tree to help judges determine whether decisions to continue or discontinue life-sustaining treatment is within the law. A modified version of the tree has been developed for members of the institutional ethics committee and other staff who consult on patient cases at St. John's Regional Health Center. Springfield, MO. The revised decision tree grew out of center staff's extensive experience in making life-sustaining medical treatment decisions and essentially reflects St. John's practice in this area. Persons who wish to use it should first run some of their own cases against the model to see if it fits their needs. They should also realize that no consensus exists in state laws regarding standards for making decisions in this area. PMID- 10124306 TI - Mental healthcare for rural seniors. An outreach program in Cedar Rapids, IA, uses an integrated approach to break down barriers to care. AB - Several barriers prevent elderly persons, especially those living in rural areas, from receiving mental health services. The Abbe Center for Community Mental Health is breaking down some of these barriers in the Cedar Rapids, IA, area. The center's Elderly Outreach Project identifies and provides mental health services to the area's rural elderly. A multidisciplinary team (psychiatrist, nurse, and social worker) assesses and treats home-bound clients. Four major barriers prevent seniors from using traditional mental healthcare services: A lack of trained professionals. Because many professionals have not received training in geriatrics, those working with elderly clients should be encouraged to attend educational conferences to fill gaps in their knowledge. Organizational barriers. Transportation and cost may prohibit elderly persons from seeking mental healthcare. Facilities must revise policies detrimental to clients' well-being. Ageism. Many elderly persons have internalized negative and incorrect beliefs about what aging is or should be. Education about "normal" aging is essential. Stigma. The stigma of mental illness is particularly troublesome. Services such as in-home counseling allow clients to get the help they need while keeping their mental illness confidential. To eliminate the barriers to mental healthcare, increased financial resources are necessary to develop, implement, and maintain innovative programs that can reach frail, isolated, hard-to-find persons in need of mental health, medical, and social services. PMID- 10124307 TI - SSM Health Care System--fostering workplace diversity. PMID- 10124308 TI - The wrong stuff. PMID- 10124309 TI - Equity in the finance of health care: some international comparisons. AB - This paper presents the results of a ten-country comparative study of health care financing systems and their progressivity characteristics. It distinguishes between the tax-financed systems of Denmark, Portugal and the U.K., the social insurance systems of France, the Netherlands and Spain, and the predominantly private systems of Switzerland and the U.S. It concludes that tax-financed systems tend to be proportional or mildly progressive, that social insurance systems are regressive and that private systems are even more regressive. Out-of pocket payments are in most countries an especially regressive means of raising health care revenues. PMID- 10124310 TI - Equity in the delivery of health care: some international comparisons. AB - This paper presents the results of an eight-country comparative study of equity in the delivery of health care. Equity is taken to mean that persons in equal need of health care should be treated the same, irrespective of their income. Two methods are used to investigate inequity: an index of inequity based on standardized expenditure shares, and a regression-based test. The results suggest that inequity exists in most of the eight countries, but there is no simple one to-one correspondence between a country's delivery system and the degree to which persons in equal need are treated the same. PMID- 10124311 TI - The effect of per-item fees on the behaviour of general practitioners. AB - The recent government White Paper 'Working for Patients' emphasised the use of financial incentives as a means of altering the behaviour of general practitioners (GPs) in the U.K. This paper examines the impact of financial incentives on GPs' behaviour with respect to maternity care and cervical cytology. Changes in per-item fees over the period 1966-89 appear to have had little effect on the numbers of treatments; rather service provision was related to patient demand and the availability of GPs. However, target payments for cervical cytology introduced in 1990 appear to have had a major impact. PMID- 10124312 TI - Technological diffusion in primary health care. AB - The paper contains a theoretical and empirical analysis of the driving forces behind the diffusion of dry chemical laboratory equipment in Norwegian primary health care. The empirical analysis is embedded in a theoretical model of a dynamic investment problem focusing on heterogeneity in the potential adopters' profit functions. The empirical analysis indicates that most adopters are too late in adopting the new technology. A logit analysis of the diffusion process lends some support to the notion that profit function heterogeneity influences the diffusion process. An offspin of the empirical analysis is information on the reimbursement system, indicating that this system does not promote efficient resource allocation in the sector. PMID- 10124313 TI - Hospital expenditures in the United States and Canada: do hospital worker wages explain the differences? PMID- 10124314 TI - Equity in the finance and delivery of health care. PMID- 10124315 TI - Miss. bills react to proposed lease. PMID- 10124316 TI - JCAHO standards could be 'traumatic'. PMID- 10124317 TI - Study gauges indemnity/HMO gap. PMID- 10124318 TI - FTC hit, public wooed over Fla. hospital deal. PMID- 10124319 TI - Calif. provider's tax exemption denied. PMID- 10124320 TI - Foundation, Sutter agree on contract. PMID- 10124321 TI - Bears circle Medical Care America. PMID- 10124322 TI - Colorado, Indiana bills offer hospitals exemptions. PMID- 10124323 TI - Geisinger to amend exemption tack. PMID- 10124324 TI - AHA weighing revamp in dues structure. PMID- 10124325 TI - JCAHO to disclose incidence of 'Type I' citations. PMID- 10124326 TI - CBO head warns price controls could severely limit quality, quantity of medical care in U.S. PMID- 10124327 TI - Med schools must do more to advance rural healthcare. PMID- 10124329 TI - N.Y. blast sends record number to hospitals. PMID- 10124328 TI - Charity care and the law: case is far from closed. PMID- 10124330 TI - AMA backs away from hard line on reform. PMID- 10124331 TI - Tests proffer standards on blood barriers. PMID- 10124332 TI - In anticipation of reform, hospitals show renewed interest in managed-care ownership. PMID- 10124333 TI - Group's arrangement with subacute firm seeks savings. PMID- 10124334 TI - Black execs believe discrimination hinders their careers--survey. PMID- 10124335 TI - 'Execs should promote integration'. PMID- 10124336 TI - Reliability of a functional mobility assessment tool with application to neurologically impaired patients: a preliminary report. AB - The purpose of this preliminary study was to examine the intratester and intertester reliability of a functional mobility assessment tool (FMAT). Seven licensed physical therapists with varying amounts of clinical experience served as raters. Twelve patients with neurological deficits were subjects for this study. Raters were asked to provide eight possible ratings for each of eight critical mobility functions. Average weighted kappa coefficients ranged from .82 to .97. Intraclass correlation coefficients ranged from .73 to .97 for the first assessment and from .52 to .97 for the second (retest) assessment. A high degree of agreement between and within seven raters indicated that this tool may provide an effective assessment of stroke, brain injury, and spinal cord injury. Preliminary findings indicate the functional mobility assessment tool is reliable, thereby increasing the usefulness of this method for clinical assessment. The high resolution of the FMAT makes this tool ideally suited for use in future studies focusing on the prediction of mobility function following neurological insult. PMID- 10124337 TI - Accuracy and reliability of 'specialized' physical therapists in auscultating tape-recorded lung sounds. AB - This study investigated the accuracy and inter-rater reliability of 'specialized' physical therapists in the auscultation of tape-recorded lung sounds. In addition, a correlation was investigated between accuracy of interpretation and the number of years of specialization in the field of cardiorespiratory physical therapy. This research follows an earlier study which investigated the accuracy and inter-rater reliability of auscultating tape-recorded lung sounds in a 'non specialized' cohort of physical therapists. The subjects were 26 'specialized' cardiorespiratory physical therapists working in acute urban teaching hospitals. These individuals were required to have been practising currently and exclusively for at least one year in the area of cardiorespiratory physical therapy. Participants listened with a stethoscope to five different sounds and identified them from a standardized list of terms. One of three tapes with the same lung sounds in different order was randomly selected for each physical therapist. The percentage of correct answers for all subjects was calculated. An accurate response in the detection of lung sounds was arbitrarily defined as a percentage of correct answers of 70% or greater. The difference between the pooled correct response rate of 50% and the arbitrarily set value of 70% was statistically significant (z = 2.23, p < 0.05), indicating that the 'specialized' physical therapists were not accurate in identifying lung sounds. There was no relationship evident between the accuracy and the number of years of cardiorespiratory 'specialization' (r = 0.08). Analysis of inter-rater reliability revealed 'fair agreement' (kappa = 0.26) among subjects. These results were similar to those found in the previous study.(ABSTRACT TRUNCATED AT 250 WORDS) PMID- 10124338 TI - Some computer-based decision support tools for the rehabilitation manager. AB - The recent introduction of the Management Information System (MIS) guidelines has sparked much interest among health care institutions across Canada regarding proper approaches to the recording and interpretation of various financial and workload indicators. While the benefits of the MIS guidelines are widely acknowledged, much less attention has been directed to how departmental managers can analyze and make use of the vast amount of information generated. In this paper we attempt to review some of the computer-based decision-support tools that may be useful to the manager of the rehabilitation services department in analyzing the various MIS data that are collected. The data are assumed to be available through a computerized rehabilitation information system which includes workload measures. The quantitative models reviewed in this paper include basic descriptive statistics, deviation, trend and what-if-analysis and graph-plotting. Although the use of such tools can assist the rehabilitation manager in the routine decision-making process, it is very important that we ask the right questions and employ the proper model to make the most rational and best decision. In this respect, ongoing training in general problem-solving skills, decision-making processes, and use of computer-based decision-support tools may be very beneficial. PMID- 10124339 TI - Communicating the hospital vision on health reform. PMID- 10124340 TI - Volunteer training key to success for family violence programs. PMID- 10124341 TI - In Camden, NJ, teen center is hospital's bridge to community. PMID- 10124342 TI - AHA revises management advisory on patients' rights. PMID- 10124343 TI - Starting a Medicare service. PMID- 10124344 TI - Auxiliaries and foundations: a collaborative model. PMID- 10124345 TI - Teen volunteering on the rise. PMID- 10124346 TI - Gift shop redesign adds retail space, enhances hotel-like image. PMID- 10124347 TI - RMI (Resource Management Initiative) and quality--getting the climate right. AB - The literature on the Resource Management Initiative (RMI) identifies an improvement in the quality of patient care as one of its principal aims. Successful implementation of RMI requires a change in behaviour. The mechanism or process by which this is to be achieved is not clear. This paper explores the possible nature of this relationship. We suggest that an understanding of the mechanisms through which an acute hospital can influence quality is best viewed from the perspective of organisational climate. The paper suggests a normative model for exploring climate and quality linkages through the operation of six key organisational levers. The applicability of the model is discussed throughout with reference to a RM acute hospital. PMID- 10124348 TI - Development of a claim review and payment model utilizing diagnosis related groups under the Korean health insurance. AB - This paper describes the development of a claim review and payment model utilizing the diagnosis related groups (DRGs) for the fee for service-based payment system of the Korean health insurance. The present review process, which examines all claims manually on a case-by-case basis, has been considered to be inefficient, costly, and time-consuming. Differences in case mix among hospitals are controlled in the proposed model using the Korean DRGs. They were developed by modifying the US-DRG system. An empirical test of the model indicated that it can enhance the efficiency as well as the credibility and objectivity of the claim review. Furthermore, it is expected that it can contribute effectively to medical cost containments and to optimal practice pattern of hospitals by establishing a useful mechanism in monitoring the performance of hospitals. However, the performance of this model needs to be upgraded by refining the Korean DRGs which play a key role in the model. PMID- 10124349 TI - The politics of medical quality: auditing doctors in the UK and the USA. AB - Following the 1989 white paper Working for Patients, medical audit has emerged as the principal officially-approved means of assuring the quality of NHS medical care. Beneath the surface consensus, however, significant arguments continue concerning both the purposes and the character of such audit. A 'medical model' of medical audit is in competition with a more managerial approach, while consumer interests, however unsuccessfully, are also trying to claim a role. Comparison with the system of peer review in the USA indicates that medical audit in the NHS is likely to be particularly weak with respect to public accountability. Nevertheless, when taken together with other features of the white paper's proposals, the universalization of medical audit offers managers an opportunity to begin to constrain the behaviour of hospital doctors at the local level. PMID- 10124350 TI - The making of effective managers: the Sudanese and the US perspectives. AB - This article, the first from the International Project on Culture and Management, a worldwide study to determine the role of national culture in managerial behavior and effectiveness, accomplishes two tasks. It describes the essential features of the design of the whole project and compares the questionnaire responses of US and Sudanese college students on four aspects of normative managerial behavior-personality, knowledges skills, and values. Data are analyzed by factor analysis and stepwise regression. The findings validate the hypothesis that Americans and the Sudanese expect significantly different behaviors from their managers in all four areas. PMID- 10124351 TI - The impact of advertising on price and practice volume. A case study of dental markets. AB - Advertising is often considered a catalyst which stimulates competition by communicating the important attributes (information) of goods and services to consumers. Theoretically, advertising makes demand responsive to strategic price differences. This advertisement-induced price elasticity puts competitive pressure on the providers' pricing strategy. It has been assumed that this effect also exists in the health care market. This study investigates the impact that the advertising of services has on the price and demand behaviour in the dental care market. The sampling frame includes 1,326 dentists, 558 (44.3%) of whom have advertised their services. The statistical results seem to dispute the claim that advertising lowers the consumer's price and increases the advertising dentist's market share. PMID- 10124352 TI - Profitable and unprofitable DRGs: the implications for access. AB - Given a choice, hospitals would prefer to admit a patient with the potential to contribute to an accounting profit and prefer not to admit a patient with the potential to contribute to an accounting loss. It is suggested that if all hospitals found the same DRGs to be unprofitable, access to inpatient care would be denied those patient types. A set of 509 hospitals was stratified according to bedsize, Medicare load, type of control, teaching status and geographic location. The 10 most and 10 least profitable DRGs were identified for each hospital category and a Spearman's rank order correlation was used to determine the similarity or dissimilarity across hospital category. The results indicate that the more alike hospitals are in terms of bedsize, Medicare load and teaching status, the more alike are the DRGs that are determined to be unprofitable (or profitable). Conversely, the less alike they were on these characteristics, the less alike were the unprofitable (or profitable) DRGs. There were no differences evident when the hospitals were classified according to type of control or geographic location. These results are generally encouraging in terms of potential access but disturbing in terms of possible further financial threat to rural hospitals. PMID- 10124353 TI - Nebulous guidelines leave room for interpretation. PMID- 10124354 TI - Improving your organization's creativity quotient. PMID- 10124355 TI - Health information management--a coding supervisor's perspective for a comprehensive coding management program. PMID- 10124356 TI - Integrating hospital and community systems. PMID- 10124357 TI - Purchasing intelligence--the role of the library. PMID- 10124358 TI - The mathematical conundrum of voice recognition technology. PMID- 10124359 TI - Privatization in health care institutions. PMID- 10124360 TI - Finders' fees. PMID- 10124361 TI - A survey of children's hospital fund raising programs. PMID- 10124362 TI - The fund raising company--Philanthropy Inc. PMID- 10124363 TI - Marketing to millionaires: myths and mistakes. PMID- 10124364 TI - Planning for success. PMID- 10124365 TI - Overcoming employee campaign obstacles. PMID- 10124366 TI - TARGETing success: the performance report. PMID- 10124367 TI - Using strategic planning in fund raising. PMID- 10124368 TI - Starting and sustaining planned giving. PMID- 10124369 TI - The annual appeal: a communications tool. PMID- 10124370 TI - Parity--an opinion. PMID- 10124371 TI - Growth motivation. PMID- 10124372 TI - Building stronger governing boards for philanthropic organizations. PMID- 10124373 TI - Together we gain. PMID- 10124374 TI - Our role--a partnership with others. PMID- 10124375 TI - The Little Shop of Horrors? Fund raising in a small shop. PMID- 10124376 TI - Professionalism. PMID- 10124377 TI - A cause to party. PMID- 10124378 TI - Physician prospects--an accurate diagnosis creates a healthy result. PMID- 10124379 TI - Questioning traditional practices. PMID- 10124380 TI - Don't let undue influence un-do planned gifts to your hospital. PMID- 10124381 TI - AHP's goal for the future. PMID- 10124382 TI - AHP's testimony on FASB's (Financial Accounting Standards Board) proposed accounting rules for contributions. PMID- 10124383 TI - Creating a legacy. PMID- 10124384 TI - Special challenges for hospital fund development programs. PMID- 10124385 TI - Socioeconomic characteristics of the Fellowship. PMID- 10124386 TI - Medicare volume performance standards. PMID- 10124387 TI - Oregon pro: as the nation waits, Oregon moves forward. PMID- 10124388 TI - Oregon con: Oregon's experiment: just another Medicaid cutback. PMID- 10124390 TI - Extra. Interdepartmental staff of Health Care Reform Task Force. PMID- 10124389 TI - Seeking cost-effectiveness and improved outcomes, Kaiser Permanente cuts variation in clinical care through TQM processes. PMID- 10124391 TI - Dr. Jacobs' alternative mission. A new NIH office will put unconventional medicine to the test. PMID- 10124392 TI - "Hello? I'm home alone ..." Up to 10 million U.S. children are latchkey kids; hot lines are helping them battle fear and loneliness. PMID- 10124393 TI - Dr. Kevorkian's death wish. PMID- 10124394 TI - Medicaid program; eligibility and coverage requirements--HCFA. Notice of delay of effective dates and compliance dates. AB - This notice delays by 6 months the effective dates and compliance dates of the final rule with comment period on Medicaid Eligibility and Coverage Requirements published January 19, 1993 in the Federal Register (58 FR 4908). PMID- 10124395 TI - Medicare program; Peer Review Organizations: new PRO contracts for all states and territories and the District of Columbia--HCFA. Notice. AB - This notice gives a general description of Utilization and Quality Control Peer Review Organization (PRO) contract requirements and significant changes in the PRO program. It outlines new requirements for the review activities of PROs for contracts entered into beginning April, 1993. This notice fulfills the requirements of section 1153(h)(1) of the Social Security Act. That section requires publication of any new policy or procedure adopted by the Secretary that affects substantially the performance of PRO contract obligations at least 30 days before the date the policy or procedure is to be used. PMID- 10124396 TI - OK, Bill, it's time to pick your remedy. PMID- 10124397 TI - Family feuds. AB - Once brothers in arms, large and small companies within the same trade associations are realizing that the main thing they have in common is competition with one another. PMID- 10124398 TI - Perspectives on utilization management: the broader picture. PMID- 10124399 TI - Operational optimization through custom programming and a multi-user environment. AB - This report describes the use of microcomputers which use custom written software to rectify inadequacies of a hospital wide computer system. The current laboratory information system is unable to provide patient reports which adequately track Clinical Immunology Laboratory test results over an extended time frame. The approach taken by this reference laboratory has proven to be extremely useful to physicians; it aids in laboratory quality assurance activities and increases the overall efficiency and effectiveness of the laboratory. PMID- 10124400 TI - The career ladder. AB - With the addition of the proposed Certificate of Continuing Professional Studies (CCPS) which has not yet been implemented, the Society will have developed an open-ended career ladder for medical laboratory technologists. Moving from one step to the next may entail a return to school; it will certainly entail hard work and commitment. There are no barriers to prevent a motivated individual from progressing up the ladder. The ladder is illustrated in diagrammatic form below. The shaded areas represent the elements that are not yet in place. PMID- 10124401 TI - Human pathogens importation regulations. Department of National Health and Welfare. PMID- 10124402 TI - Shared information boosts competition in healthcare networks. AB - The time has come for healthcare providers to stop hoarding information. By building healthcare information networks, providers at all levels can gain a competitive edge not by "owning" information, but by better using richer, more complete, "shared" information. PMID- 10124403 TI - Open systems drive health information networks. AB - Health information networks are coming. Hospitals that plan ahead--using open architecture adhering to accepted standards--will have the competitive edge in an age of shared information. PMID- 10124404 TI - Competition turns to United Healthcare for technology edge. Interview by Carolyn Dunbar and Michael L. Laughlin. AB - Joel Ackerman serves as director of advanced technologies for Minneapolis-based ProviderLink, an electronic claims software subsidiary of United Healthcare Corporation. United Healthcare is a managed-care company that owns and operates 19 fee-for-service and capitated health maintenance organizations in 15 states serving almost two million members. In addition, United Healthcare has subsidiary operations selling services to more than 80 other Blue Cross Blue Shield plans and indemnity and HMOs--including its competitors. These services include managing departments such as pharmacy, providing specialized contract clinics like mental health or chemical dependency, performing utilization-review services, and providing computer outsourcing such as enrollment and electronic claims processing. Ackerman has been involved in both American National Standards Institute (ANSI) efforts and the Health and Human Service's Workgroup on Electronic Data Interchange (WEDI). PMID- 10124405 TI - Contrasting approaches aim at similar network goals. AB - At any node on the network implementation timeline, whether in the first planning stages or after the bottom-line benefits are stacking up, networking is a compelling idea. So compelling, with flexibility, cost-cutting results and strengthened community resources, that it extends its influence into the future of the organizations it serves. Two institutions, University Hospital in Denver and the Medical Center of Delaware in Wilmington, Del., illustrate networking's tempting benefits. University Hospital disabled its mainframe, switching to an Ungermann-Bass Access One smart hub in January of this year. Their systems are added to the network one-at-a-time, with plans for complete integration once everything is working online. In contrast, the Medical Center of Delaware shifted to networking in 1987, following a five-year implementation plan. The completed, integrated network is now a strategic tool for containing costs an MCD. PMID- 10124406 TI - Survey shows continued strong interest in UNIX applications for healthcare. AB - As part of the general computer industry movement toward open systems, many are predicting UNIX will become the dominant host operating system of the late 1990s. To better understand this prediction within the healthcare setting, Computers in Healthcare surveyed our readership about their opinions of UNIX, its current use and its relative importance as an information services strategy. The upshot? CIH readers definitely want more systems on UNIX, more healthcare applications written for UNIX and more trained resource people to help them with faster installation and more useful applications. PMID- 10124407 TI - Product overview. HotList--telecommunications. PMID- 10124408 TI - A high-profile abrasion. Where do you draw the line between precautions and paranoia? PMID- 10124409 TI - Pediatric priorities. Interview by Marie Nordberg. PMID- 10124410 TI - The parent trap. PMID- 10124411 TI - Fighting for children's lives. PMID- 10124412 TI - Presidential party. Here's a behind-the-scenes look at the Democratic National Convention's command center. PMID- 10124413 TI - Planning guide for on-premise laundries. PMID- 10124414 TI - Support services: benefit or burden. PMID- 10124415 TI - The attraction is static! Static Attraction Cleaner (SAC-10). PMID- 10124416 TI - Hats off to a winning team. PMID- 10124417 TI - Decrease your linen expense with these methods. PMID- 10124418 TI - Making an on-premise laundry work for you. PMID- 10124419 TI - Perceptions of practice problems encountered by family physicians, pediatricians, and orthopedic surgeons. AB - Information about physicians' practice problems was solicited through a structured questionnaire mailed to a group of family physicians, pediatricians, and orthopedic surgeons. Overall, a lack of personal time was the major concern across the three groups of physicians. Comparisons among the three types of physicians revealed two patterns: Family physicians reported more concerns in the "interpersonal" dimension, whereas orthopedic surgeons had more concerns in the "legal-economic" dimension. These patterns of differences persisted with two variables controlled: gender and time period in which they completed their residency program. These findings indicate that physicians' concerns in their practice vary among the specialties, and they imply that the changed economy and reimbursement system might have more impact on one than the other. Thus the effectiveness of residency training and continuing education might be improved by emphasizing the specialty-related problems in practice. PMID- 10124420 TI - Surgery resident selection and evaluation. A critical incident study. AB - This article reports a study of the process of selecting and evaluating general surgery residents. In personnel psychology terms, a job analysis of general surgery was conducted using the Critical Incident Technique (CIT). The researchers collected 235 critical incidents through structured interviews with 10 general surgery faculty members and four senior residents. The researchers then directed the surgeons in a two-step process of sorting the incidents into categories and naming the categories. The final essential categories of behavior to define surgical competence were derived through discussion among the surgeons until a consensus was formed. Those categories are knowledge/self-education, clinical performance, diagnostic skills, surgical skills, communication skills, reliability, integrity, compassion, organization skills, motivation, emotional control, and personal appearance. These categories were then used to develop an interview evaluation form for selection purposes and a performance evaluation form to be used throughout residency training. Thus a continuum of evaluation was established. The categories and critical incidents were also used to structure the interview process, which has demonstrated increased interview validity and reliability in many other studies. A handbook for structuring the interviews faculty members conduct with applicants was written, and an interview training session was held with the faculty. The process of implementation of the structured selection interviews is being documented currently through qualitative research. PMID- 10124421 TI - Process evaluation of a system (Partners for Prevention) for prevention-oriented primary care. AB - Process evaluation can identify program components that are related to success, that are generalizable to other settings, and that improve future applications of the program. The Partners for Prevention pilot project tested an office-based system aimed at increasing cancer prevention and screening in primary care offices and involving 17 physicians in private practice. Process evaluation techniques included monitoring systems, satisfaction surveys, and focus groups with the program participants. Each evaluation technique provided different information concerning strategies. The program was difficult to implement on busy days, the materials were useful but needed more flexibility, communication between patient and physician was facilitated, and the office coordinator was a crucial person. Program philosophy was acceptable, but materials needed refinement. The flow sheet and patient health check have been dramatically simplified and customized. New strategies are being tested in a randomized control trial. PMID- 10124422 TI - Managed care: past evidence and potential trends. AB - Enrollment in network-based managed care plans has grown rapidly, raising important questions about the actual impact of different types of managed care plans on health care use, expenditure, and quality of care. In this article, we analyze the literature on the performance of managed care plans relative to fee for-service plans. We find strong evidence that staff- and group-model HMOs have lowered utilization and expenditure relative to fee-for-service while maintaining quality of care. The relatively sparse evidence is more mixed on the performance of newer forms of managed care organizations (MCOs). We also speculate on future trends in network-based managed care. It is likely that employers will increase their economic leverage with managed care firms, accelerating processes that are leading to greater concentration of marketshare among managed care firms. In turn, newer forms of MCOs will increase their economic leverage with providers, which will help MCOs contain costs and monitor quality. Some of the newer MCOs will adapt important features of staff- and group-model HMOs, including increased emphasis on provider selection and reselection. PMID- 10124423 TI - Managed care: the burden of a great potential. PMID- 10124424 TI - What works in managed care--and what doesn't. PMID- 10124425 TI - Managed care: a real solution to community health? PMID- 10124426 TI - Organizational changes for the 21st Century. PMID- 10124427 TI - Dealing with illiteracy in the workplace. PMID- 10124428 TI - Reorganization of JCAHO's standards manual slated for 1995 finalization. PMID- 10124429 TI - Consider the hidden messages in some menu choices. PMID- 10124430 TI - Helping employees reach peak performance. PMID- 10124431 TI - Safety training may reduce costs. PMID- 10124432 TI - National health expenditures projections through 2030. AB - If current laws and practices continue, health expenditures in the United States will reach $1.7 trillion by the year 2000, an amount equal to 18.1 percent of the Nation's gross domestic product (GDP). By the year 2030, as America's baby boomers enter their seventies and eighties, health spending will top $16 trillion, or 32 percent of GDP. The projections presented here incorporate the assumptions and conclusions of the Medicare trustees in their 1992 report to Congress on the status of Medicare, and the 1992 President's budget estimates of Medicaid outlays. PMID- 10124433 TI - Introducing fees for services with professional uncertainty. AB - A change in payment system of general practitioners from capitation to a mix of one-half capitation and one-half fee for service in Copenhagen, Denmark, resulted in a significant overall increase in diagnostic and curative services. The rate of increase differs between services. In this article, it is assumed that the rate of increase varies with doctors' professional uncertainty relative to the services studied. Professional uncertainty is measured as the degree to which performances of a service are determined by diagnoses made. The data validate the measure given the assumption. PMID- 10124434 TI - Measuring the relationship between income and NHEs (national health expenditures). AB - This article uses recently published time series data for the Organization for Economic Cooperation and Development countries to estimate income elasticities for health care expenditures. Several different models and alternative specifications are examined to determine the sensitivity and robustness of the estimated relationships. Income is the dominant-determinant of health care spending and longrun income elasticity for health care is significantly greater than unity. This implies that health care is a luxury good, and expenditures will tend to rise with the level of national income. There is little evidence that the degree of public finance reduces the level of health care expenditures. PMID- 10124435 TI - Comparing physician fee schedules in Canada and the United States. AB - Although Canada and the United States have fundamentally different systems for financing health care, there are many similarities between the two countries in their approaches to physician payment. The similarities have increased recently with the adoption of the Medicare fee schedule. Canadian provinces have been using fee schedules for more than 20 years. This article provides an overview of the fee schedules used by Medicare and the four largest Canadian provinces, highlighting specific similarities and differences. We conclude that, although some differences in service definitions exist, the major areas of contrast relate to what services are paid for and how fees are updated. Updating fees is important because it affects how rapidly expenditures grow. PMID- 10124436 TI - A layman's guide to the U.S. health care system. AB - This article provides an overview of the U.S. health care system and recent proposals for health system reform. Prepared for a 15-nation comparative study for the Organization for Economic Cooperation and Development (OECD), the article summarizes descriptive data on the financing, utilization, access, and supply of U.S. health services; analyzes health system cost growth and trends; reviews health reforms adopted in the 1980s; and discusses proposals in the current health system reform debate. PMID- 10124437 TI - Hospital and Medicare financial performance under PPS, 1985-90. AB - Although an increasing number of hospitals are reporting net losses from the Medicare prospective payment system (PPS) for inpatient care, overall hospital facility profit rates remain stable. Hospitals that reported net profits in the Medicare inpatient PPS sector in PPS 7 (1990) had smaller increases in Medicare expenses than hospitals that reported PPS losses in PPS 7. Medicare PPS inpatient net losses in PPS 7 were more than offset by non-Medicare net profits. Even though Medicare PPS revenues grew more slowly than the gross domestic product from 1985 to 1990, other hospital revenues grew more rapidly. PMID- 10124438 TI - Americans' health insurance coverage, 1980-91. AB - The authors of this article have used Current Population Surveys to summarize public and private health insurance trends in the United States over the last 12 years. Key findings include the declining percentage of the non-elderly population with employer-sponsored coverage and increasing numbers of low- and middle-income uninsured. That is, in a period of fast-rising health care costs, the poor and the near-poor in working families have been losing coverage for health care and facing increasing risks of inadequate care and financial loss. These data highlight health care access and financing problems now facing the Nation. PMID- 10124439 TI - An outlier pool for Medicare HMO payments. AB - Medicare pays "at-risk" health maintenance organizations a prospective capitation amount that is established by the adjusted average per capita cost (AAPCC) formula for estimating the amount enrollees would have cost had they remained in the fee-for-service sector. Because the AAPCC accounts for a very small percentage of the variation in beneficiary costs, considerable research has been devoted to improving the formula. A way to improve the explained variance is to remove the most expensive beneficiaries from the AAPCC payment system and pay for them separately. This article examines one approach to a payment system that combines the AAPCC with an outlier payment mechanism. PMID- 10124440 TI - Outcomes of California's Medicaid cost-containment policies, 1981-84. AB - In 1982, California enacted a package of tough Medicaid cost-containment measures. This article examines its effects on program expenditures through 1984 by enrollment group and service category. Total expenditures fell by 19 percent (or $656.5 million) after inflation. Expenditures per enrollee declined for almost every group, with enrollees on cash assistance taking the greatest reductions. Ambulatory, physician, and pharmacy spending declined the most followed by long-term and hospital care. The effects of these policies are of particular importance in the early 1990s as States face even greater fiscal challenges and seek lessons from past attempts at controlling program costs. PMID- 10124441 TI - Using chronic disease risk factors to adjust Medicare capitation payments. AB - This study evaluates the use of risk factors for chronic disease as health status adjusters for Medicare's capitation formula, the average adjusted per capita costs (AAPCC). Risk factor data for the surviving members of the Framingham Study cohort who were examined in 1982-83 were merged with 100 percent Medicare payment data for 1984 and 1985, matching on Social Security number and sex. Seven different AAPCC models were estimated to assess the independent contributions of risk factors and measures of prior utilization and disability in increasing the explanatory power of AAPCC. The findings suggest that inclusion of risk factors for chronic disease as health status adjusters can improve substantially the predictive accuracy of AAPCC. PMID- 10124442 TI - Price indexes for pharmaceuticals used by the elderly. AB - The analysis presented in this report was undertaken to identify those drug entities that account for a significant proportion of the retail expenditures for prescription drugs used by the elderly. Commercial data bases were used to develop fixed weight Laspeyres price indexes based specifically on drugs used in the elderly population. The indexes provide the capability to analyze price trends for drug groupings that are not possible with the producer price index (PPI) or the Consumer Price Index (CPI). From 1981 through 1988, the average annual rate of increase in manufacturers' prices was 9.1 percent, and retail prices increased at an average annual rate of 6.6 percent. The indexes represent potentially powerful tools in analyzing drug price trends, an important component of drug program expenditure forecasting and management. PMID- 10124443 TI - Quality improvement in the hospital: managing clinical processes. PMID- 10124445 TI - A new infrastructure for health care reform. Interview by C. Burns Roehrig. PMID- 10124444 TI - CQI in the internist's office. AB - Five ASIM members relate their experiences with using continuous quality improvement (CQI) theory in their practices. Although critics grumble about paperwork and data collection, supporters claim that CQI is a lifesaver for private practice. PMID- 10124446 TI - Scoring Clinton: can he expand access and cut the deficit? PMID- 10124447 TI - Managed competition: not perfect, but promising. PMID- 10124448 TI - Internists' attitudes about health care reform. PMID- 10124449 TI - TQM: redefining doctoring. AB - The physician many consider to be the father of "total quality management" in health care explains the philosophy behind the theory. He believes TQM has created a new job description for physicians--one that involves working on a team to improve the system for providing care. PMID- 10124450 TI - Antibiotic prophylaxis in cesarean section: use of cost per case comparison to influence prescribing practices. AB - Results of a previously conducted DUE revealed that 91% of obstetric patients received antibiotic prophylaxis with cefoxitin despite the existence of obstetric department guidelines recommending the use of cefazolin. In the present DUE, antibiotic selection in C-section prophylaxis was reviewed and individual prescribers, both compliant and noncompliant with guidelines, were identified. Over a 2-month period, physicians who prescribed other than cefazolin for C section prophylaxis were issued "Dear Doctor" letters, reminding them of existing guidelines. A significant change in prescribing patterns following this intervention was not demonstrated. A multidisciplinary approach was then undertaken. Prescribers were stratified by number of procedures, antibiotic requested, and antibiotic cost per case (average and median). Results were reviewed with Co-chiefs of Ob/Gyn. Letters to both compliant and noncompliant prescribers were issued. A grand rounds presentation describing the results of the DUE was also given. A follow-up review showed that the conversion to cefazolin prophylaxis reached 80%, with accompanied extrapolated yearly cost avoidance of nearly $5,500. PMID- 10124451 TI - Medical office building attracts attention of community, physicians. PMID- 10124452 TI - Health care reform: what to expect, what AHA proposes and what it will mean to you. Interview by Ellen Weisman. PMID- 10124453 TI - Prepare cooling towers now for summer's heat. PMID- 10124454 TI - Improving access to care drives updated ED designs. PMID- 10124455 TI - More regulators target fluorescent-lamp disposal. PMID- 10124456 TI - PPE (personal protective equipment) selection: don't ignore employees' concerns. PMID- 10124457 TI - Waste segregation relies on precise definitions. PMID- 10124458 TI - Economics, comfort: what price productivity? PMID- 10124459 TI - Tunnel washer efficiency saves laundry a bundle. PMID- 10124460 TI - "American College of Physician Inventors" formed. PMID- 10124461 TI - Review of methods & simulators for evaluation of noninvasive blood pressure monitors. AB - Automated noninvasive blood pressure (NIBP) monitors have found widespread use both inside and outside clinical environments in recent years. Present methods for evaluating the measurement accuracy of this class of devices involve population studies that are meticulous, time-consuming and costly. These methods are also impractical for routine evaluation. NIBP simulators offer an alternative approach to evaluating automated NIBP monitors without directly using human subjects. They enable evaluation to be carried out on demand with little training, providing a safe and convenient way for manufacturers and hospitals to validate the performance of both new and existing monitors. PMID- 10124462 TI - Digitization of medical documents: an X-Windows application for fast scanning. AB - This paper deals with digitization, using a commercial scanner, of medical documents as still images for introduction into a computer-based Information System. Document management involves storing, editing and transmission. This task has usually been approached from the perspective of the difficulties posed by radiologic images because of their indisputable qualitative and quantitative significance. However, healthcare activities require the management of many other types of documents and involve the requirements of numerous users. One key to document management will be the availability of a digitizer to deal with the greatest possible number of different types of documents. This paper describes the relevant aspects of documents and the technical specifications that digitizers must fulfill. The concept of document type is introduced as the ideal set of digitizing parameters for a given document. The use of document type parameters can drastically reduce the time the user spends in scanning sessions. Presentation is made of an application based on Unix, X-Windows and OSF/Motif, with a GPIB interface, implemented around the document type concept. Finally, the results of the evaluation of the application are presented, focusing on the user interface, as well as on the viewing of color images in an X-Windows environment and the use of lossy algorithms in the compression of medical images. PMID- 10124463 TI - Bioelectrical impedance analysis for measurement of body fluid volumes: a review. AB - The need for a portable, inexpensive, accurate and safe method for measuring body composition is well established. Bioelectrical impedance analysis (BIA) has the potential to partially meet this need by estimating the water component of body composition. There are still a number of unresolved questions and limitations to the applications of BIA, however. This paper briefly reviews the theory of BIA, its application and its limitations. Recent progress in the development and validation of swept or multiple frequency BIA used to determine both extracellular water and total body water is discussed in detail. PMID- 10124464 TI - Transforming America's hospitals: becoming tomorrow's vertically integrated health systems. PMID- 10124465 TI - Can IT (information technology) help in Working for Patients. AB - The Government's White Paper, Working for Patients, identified as a key objective the improvement in quality and quantity of care available to NHS patients. This, the Government argued, is to be achieved by the introduction of a market economy within the NHS. But is the introduction of intra competition and contracting for patients sufficient? Can these measures alone improve the quality and quantity of care available for the patients? Bernard Jones and Graham Worsdale argue that the strategic use of information technology (IT) is an essential element in Working for Patients. PMID- 10124466 TI - Tackling teenage pregnancy. PMID- 10124467 TI - General practice. AB - Medicine is developing at an extraordinary rate in all clinical specialties, the pace largely driven by science and technology. General practice is developing professionally at a similar pace, but in addition is experiencing a huge change in the management of primary care, generated by the engine of policy and organisational change in the NHS. PMID- 10124468 TI - Doctors' dilemma? AB - Finite resources--infinite demand. The need to ration--or prioritize--health care has resurfaced as an issue for debate among managers, politicians and clinicians. Joanna Lyall reports on the arguments for and against. PMID- 10124469 TI - Management ... working day of a health services manager. AB - The private sector is not immune from financial pressures; some of the effects of these directly affect staff. As manager of a small independent hospital, John Audsley, Director, Benenden Hospital, finds that his proximity to staff--and patients--is always a factor in decision making. PMID- 10124470 TI - Customer satisfaction planning and industrial engineering move hospital towards in-house stockless program. AB - By integrating customer satisfaction planning and industrial engineering techniques when examining internal costs and efficiencies, materiel managers are able to better realize what concepts will best meet their customers' needs. Defining your customer(s), applying industrial engineering techniques, completing work sampling studies, itemizing recommendations and benefits to each alternative, performing feasibility and cost-analysis matrixes and utilizing resources through productivity monitoring will get you on the right path toward selecting concepts to use. This article reviews the above procedures as they applied to one hospital's decision-making process to determine whether to incorporate a stockless inventory program. Through an analysis of customer demand, the hospital realized that stockless was the way to go, but not by outsourcing the function--the hospital incorporated an in-house stockless inventory program. PMID- 10124471 TI - Outsourcing: the new age of hospital supply management. AB - As the healthcare industry faces increasing pressure to identify and cut costs, outsourcing of Central Service functions may become dominant. The authors represent Baxter Healthcare's vision for CS in the next decade, which includes supplying comprehensive case kits containing all the consumable supplies needed for a patient's entire length of stay. The goal is to replace large, on-hand inventories and expensive CS functions with a procedure-based processing, packing and delivery service. The vision is already underway from several vendors. There should be cost savings in picking and replenishment functions currently handled in the OR, repair and CS costs. Hospital personnel may not be replaced, but their functions will change. The arrangement requires long-term thinking, mutual acceptance of risk and the development of trust. PMID- 10124472 TI - Surgery, sterilization and sterility. AB - The history of sterilization was not linked from the first with surgery. Surgery came first, fully 600 years before the principles of asepsis and anesthesia were even introduced in the middle of the 1800s. Also in the 1800s, the beginnings of thermal sterilization were being developed in the food industry. The basic principles of antisepsis and prevention of wound suppuration, including the destruction of germs on instruments, dressings, the hands of the surgeon and his assistants, and everything else in contact with the wound were clearly elucidated by Lister in the 1870s and remain the inviolate principles of surgical asepsis today. In general, the marriage between the surgeons and the sterilizers was a successful one; the major handicap to eternal bliss and harmony, however, was an incompatibility between the partners. As in many marriages, the partners made unwarranted demands upon each other, and became frustrated when these demands were unfulfilled. The field of surgical sterilization and surgical safety is less confused by technical inconsistencies than it is by semantic nightmares, such that we will never reach a universal definition of sterility. However, we do not really need a universal definition of sterility. Rather we should learn how to translate sterility tests in terms of the real world infections hazards. PMID- 10124473 TI - A systems perspective on OR inventory. AB - As materiel managers focus their efforts on inventory reduction and control in the Operating Room, computerization offers solutions to some complicated OR specific practices. Preference cards contain not only items, but also trays or packs, equipment and patient care plans that are physician/procedure specific. Through automation, inventory needs can better be predicted and automatic issuance and return of supplies used or not used during the case can be accomplished by editing an on-line screen version of the card. In addition, charge matrices can be geared not only to classes of items, but also to the time- and acuity-driven OR and Recovery Room. Automation can also create detailed cost data inclusive of supply and equipment use, time of resource use, personnel use, etc. to allow management to know what procedures, specialties and physicians provide profit or loss to the hospital. Finally, when interaction between systems is required, the OR system should be able to translate item names between systems. PMID- 10124474 TI - Infrared ear thermometers. ECRI. PMID- 10124475 TI - A duty to report patient care mistakes? Changing roles for healthcare managers. PMID- 10124476 TI - What to say to the OSHA reviewer. PMID- 10124477 TI - Unannounced surveys: a positive force. PMID- 10124478 TI - Ongoing preparation leads to successful survey. PMID- 10124479 TI - Internal QI activities highlight needs of accredited organizations. PMID- 10124480 TI - Alternative dispute resolution and the physician--the use of mediation to resolve hospital-medical staff conflicts. AB - The use of adversarial methods to resolve disputes arising out of medical staff matters can be time-consuming, costly, and disruptive to the hospital-medical staff relationship. As this article suggests, mediation is the preferred method of alternative dispute resolution for reaching mutually acceptable solutions with minimal harm to relationships. PMID- 10124481 TI - Issues in medical staff planning: past, present, and future. AB - More and more hospitals are preparing and utilizing medical staff development plans. This article discusses how the nature and purposes of hospital medical staff planning have evolved over time, the increasing impact of this activity upon physicians, and the new issues raised by current trends in medical staff planning. PMID- 10124482 TI - Structuring group medical practices: liability insurance, retirement plan considerations, and ownership transition. AB - This article is the fourth in a series addressing the structuring of group medical practice entities, shareholder relationships, and general representation factors. In this article, important considerations relating to liability insurance and pension plans, and both the phasing in and phasing out of shareholders are discussed. PMID- 10124483 TI - Managed care liability for medical malpractice and utilization review. AB - Managed care subscribers alleging harm due to physician negligence often assert claims against their managed care plans as well. This article reviews five theories of liability under which relief has been sought and describes some of the defenses managed care organizations have raised to avoid liability. PMID- 10124484 TI - Distinguishing negligence from intentional tort when a health care provider deviates from a patient's consent. AB - A number of California appellate courts have held that a health care provider's unintentional deviation from a patient's consent will support a cause of action for "technical battery"--an intentional tort. This policy has allowed plaintiffs to circumvent California's statutory malpractice damage limits and seek punitive damages, thus posing a significant threat to the foundation of California medical malpractice tort law reform. The California Supreme Court recently acknowledged the problem and appears to be taking steps toward a solution. PMID- 10124485 TI - National Practitioner Data Bank Guidebook Supplement. PMID- 10124486 TI - "Is there any reason not to participate in Medicare"? PMID- 10124487 TI - Medical staff contracting: contract terms and the negotiation process. AB - This article--the second in a series analyzing the physician-hospital contracting process from the physician's perspective--addresses negotiation of specific contract terms, including such controversial issues as exclusive contracts, mandatory managed care arrangements, and tie-in of contract terms and medical staff privileges. Also discussed are the goals and expectations of physicians and hospitals during the contracting process. PMID- 10124488 TI - Consultants challenge sterile supply storage. PMID- 10124489 TI - Hepatitis C poses another risk to the surgical team. PMID- 10124490 TI - Low nursing staffing levels causing stress. PMID- 10124491 TI - How to write a business plan for the OR. PMID- 10124492 TI - A link to life: high technology in long term care. PMID- 10124493 TI - Provider software buyer's guide. AB - To help long term care providers find new ways to improve quality of care and efficiency. Provider magazine presents the third annual listing of software firms marketing computer programs for all areas of nursing facility operations. On the following five pages, more than 80 software firms display their wares, with programs such as minimum data set and care planning, dietary, accounting and financials, case mix, and medication administration records. The guide also charts compatible hardware, integration ability, telephone numbers, company contacts, and easy-to-use reader service numbers. PMID- 10124494 TI - Diverse workforce creates opportunities, challenges. PMID- 10124495 TI - New accounting standards change complexion of retiree benefits. PMID- 10124496 TI - Proactive policies minimize litigious labor problems. PMID- 10124497 TI - Collage program stimulates creativity, problem-solving skills. PMID- 10124498 TI - Geriatric wellness programs promote independence for residents. PMID- 10124499 TI - Providers must find balance between care and overtreatment. PMID- 10124500 TI - National Practitioner Data Bank identifying 'gypsy' physicians. PMID- 10124501 TI - New direction for PRO program presents challenges for hospitals. PMID- 10124502 TI - Determining the health of your hospital's receivables. PMID- 10124503 TI - Streamlining governance system takes political acumen and TLC. PMID- 10124504 TI - Managing chronic health conditions is a critical need ignored by many. PMID- 10124505 TI - 'Don't forget the children; they're not just little adults': a plea. PMID- 10124506 TI - Health reform begins locally. PMID- 10124507 TI - Synergy is key to consolidation of are hospital boards. Interview by Frank Sabatino. PMID- 10124508 TI - New concepts of health and healing may affect hospitals' approach to care. PMID- 10124509 TI - Where do new ideas come from? AB - Where do launderers come up with the ideas they use to upgrade their plants? Columnist Carl Shusterman is not opposed to "borrowing" ideas if they improve your facility and make you look good. PMID- 10124510 TI - Screening program for colorectal cancer: effect on stage distribution. AB - BACKGROUND: The prognosis of patients with colorectal cancer is related to stages of disease at the time of diagnosis. Ultimately, the goal of fecal occult blood test (FOBT) screening programs is to reduce colorectal cancer mortality. METHODS: We reviewed the medical records and pathology reports of all 60 Harvard Community Health Plan (HCHP) members who were diagnosed as having colorectal cancer during the 2 years after our FOBT screening program began. The stage distribution of these 60 cases were compared with that of 76 cases diagnosed at HCHP before the FOBT screening program was started. RESULTS: Eight of 60 colorectal cancers diagnosed after the FOBT screening program was begun (13%) were diagnosed as a result of a positive screening test (Group I). The remaining 52 cases (87%) were diagnosed as a result of symptoms, physical findings, and/or the presence of anemia (Group II). Three of 8 Group I colorectal cancers (38%) were stage A, as compared with 8 of 52 of Group II colorectal cancers (15%). None of the 8 Group I colorectal cancers was stage D (metastatic) at the time of diagnosis, as compared with 11 of 52 Group II colorectal cancers (21%). CONCLUSIONS: We observed a favorable shift in the stage distribution of colorectal cancers diagnosed at HCHP after the FOBT screening program began (p less than .05). The shift was not attributable only to FOBT screening. We believe that the educational components of the program were important to its effectiveness. Our results support continued use of FOBT at HCHP. PMID- 10124511 TI - Mental health services within the HMO group. AB - This paper describes the organizational characteristics, benefits, referral, utilization, and costs of mental health services within 17 health maintenance organization (HMOs) comprising The HMO Group in 1990. All 17 health plans responded to the questionnaire, resulting in a 100% response rate. Responses to the survey reflected the complexity of the HMO mental health services field. Overall, The HMO Group members provided mental health service coverage, partly dependent upon state mandates, employer group priorities, and local competitive benefit structures. HMOs reported that service utilization rates and the productivity of their mental health providers were critical information needs. Overall, the responses reflected the need for continued information sharing between The HMO Group members, the modification of management information systems, and continuation of establishing a mental health aggregate data base. PMID- 10124512 TI - Outside the Washington Beltway: the action has moved to the states. PMID- 10124513 TI - The nurse practitioner in the HMO. PMID- 10124514 TI - The crisis in primary care. What it means for HMOs. PMID- 10124515 TI - The Talk Listen Care Kit: talking to kids about sex and AIDS. PMID- 10124516 TI - The Fallon Safety Display. PMID- 10124517 TI - Mobile health education program: "Blood and Guts Van". PMID- 10124518 TI - Determinants of expenditures and use of services among elderly HMO enrollees. AB - This study examined determinants of expenditures and use of services by a group of elderly HMO enrollees. Study subjects were 895 elderly members of the Fallon Community Health Plan who enrolled between January 1, 1980 and December 31, 1983. We explored whether the determinants of expenditures and utilization varied across different types of services, specifically inpatient hospital care and ambulatory care. Having a heart problem, a mobility/disability, and arthritis were consistent predictors of high resource use. Having a mental health problem and a history of past hospitalization were also significant predictors across most models. The health policy implications of these data and their implications for quality assurance within the HMO setting are discussed. PMID- 10124519 TI - Bridgeport Hospital: evolution revolutionizes climate for quality. PMID- 10124520 TI - HECs: are they evaluating their performance? AB - Although the incidence and composition of HECs has been well characterized, little is known about how HECs assess their performance. In order to describe the incidence of HEC self-evaluation, the methods HECs use to evaluate their performance, and the characteristics of HECs that influence self-evaluation, we surveyed the readers of Hospital Ethics. 290 HECs in 45 U.S. states, the District of Columbia, Puerto Rico and three Canadian provinces, completed questionnaires. Of the 241 HECs included in the data analysis, 97.9% had performed some self evaluation. Responding committees largely made formative rather than summative evaluations and appeared to evaluate performance in light of their own objectives rather than basing assessments on specific structural, process, and outcome measures of quality. Responding committees used certain evaluation criteria more extensively than others--among these, the number of participants and staff knowledge of the service provided--with the choice of criteria differing with the function being evaluated. Eight characteristics of HECs influenced the probability of self-evaluation, including age, number of beds and meetings, the existence of a mission statement, and a budget. The presence of certain characteristics made HECs six times more likely to evaluate their performance than HECs without the characteristic. PMID- 10124521 TI - The Parkland approach to demands for "futile" treatment. AB - Recent literature in medical ethics has emphasized disputes concerning the relative usefulness or uselessness (futility) of medical treatments. In our institution, these disputes typically arise in the context of critical care, with patients or families requesting or demanding a treatment (such as cardiopulmonary resuscitation) that in the treating physician's view holds no promise of benefit. In the context of revising our general treatment refusal/withdrawal/withholding guidelines, we provided a structure for resolving such disputes in a manner that balances the often conflicting goods of patient/family autonomy, physician autonomy, and institutional responsibility. PMID- 10124522 TI - The "seven tunnels" of Japanese medical ethics. PMID- 10124523 TI - Point and counterpoint. Should academic ethics committees be available to review lapses in scientific integrity? PMID- 10124524 TI - Educating healthcare ethics committees. A national dissemination project. PMID- 10124525 TI - Perspectives. Managed competition in rural areas: will the seed take? PMID- 10124526 TI - Perspectives. Health industry wields computers in cost, quality battle. PMID- 10124527 TI - Air medical transport: "hot air" and a French lesson. PMID- 10124528 TI - Flight helmets: how they work and why you should wear one. PMID- 10124529 TI - Communications survey. PMID- 10124530 TI - IS management reports to .... PMID- 10124531 TI - Connecting lab to client facilities: link or sink. PMID- 10124532 TI - Value, survival & the LIS contribution. PMID- 10124533 TI - Improved efficiency in hematology. PMID- 10124534 TI - 1993 LIS review. 7th annual state-of-the-lab. PMID- 10124535 TI - Ways to avoid snafus while implementing a laboratory information system. AB - If you are about to embark on a new or replacement LIS, your consideration of the following suggestions will help deflect problems common to LIS implementations. These suggestions have evolved over my 10 years of experience as a consultant working with laboratory information systems, and 20 years of general experience with clinical and reference laboratories. Consider these suggestions, use them, and avoid snafus. PMID- 10124536 TI - Optical disk archiving to enhance LIS TQM. PMID- 10124537 TI - Securing the future with outsourced expertise. PMID- 10124538 TI - Serving computing clients to battle cancer. PMID- 10124539 TI - Achieving LIS changeover in 5 months or less. PMID- 10124540 TI - Claims processors join to influence reform. Association for Electronic Healthcare Transactions. PMID- 10124541 TI - Hospitals of the future. PMID- 10124542 TI - Medical turnaround. U.C. San Diego Medical Center. PMID- 10124543 TI - Metropolitan health. Guggenheim Pavilion, Mount Sinai Medical Center, New York City. PMID- 10124545 TI - Patients first. PMID- 10124544 TI - Healthy trends. PMID- 10124546 TI - Unions propose TB standard in letter to OSHA. PMID- 10124547 TI - ACGIH (American Conference of Governmental Industrial Hygienists) announces change in formaldehyde TLV (threshold limit value). PMID- 10124548 TI - Annual occupational safety and health report card. PMID- 10124550 TI - White House health reform: who the key players are. PMID- 10124549 TI - Sharps containers classified as medical devices. PMID- 10124551 TI - Paul Ellwood and the Jackson Hole Group--a close-up. Interview by John Herrmann. PMID- 10124552 TI - The Medicare Transaction System. PMID- 10124553 TI - De-slicing the data. AB - A new imaging technology inexpensively displays 3-D medical data accurately. Here are several rave reviews, including one source who believes that every facility with a CT or MR scanner will eventually want access to the technology. PMID- 10124554 TI - States scrutinize Medicaid programs. PMID- 10124555 TI - Measuring an inexact science. PMID- 10124556 TI - AHIMA and healthcare reform: building the computerized patient record is like putting a man on the moon. PMID- 10124557 TI - Congressional healthcare reform plan. PMID- 10124558 TI - Update on the Accreditation Manual for Hospitals. PMID- 10124559 TI - Professional practice tool: forms management guidelines. PMID- 10124560 TI - The role of the health information manager in maintaining (or regaining) accreditation, certification, and licensure through quality assurance. PMID- 10124561 TI - Command language interfaces and layering. PMID- 10124562 TI - Teaming up. PMID- 10124563 TI - Critical paths: a tool for clinical process management. PMID- 10124564 TI - Clinical application of quality improvement concepts and tools: C-Section process improvement. PMID- 10124565 TI - Continuous quality improvement: eliminating a transcriptionist shortage. PMID- 10124566 TI - The importance of perceptions in successful implementation of total quality management. PMID- 10124567 TI - A quality IDEA (induction, deduction, evaluation, action) for medical records. PMID- 10124568 TI - The use of lead positions as an alternative to the traditional manager. AB - The use of lead employees with expanded roles and increased responsibilities gives a manager a unique opportunity to improve communications while cutting costs and lifting morale. It allows a manager to better utilize employees to schedule employees, monitor work flow, assess quality, and assign tasks that have been traditionally given to a manager. There are many different ways of viewing a task: there is the view of the employee who performs the task, the employee affected by the task, and the manager responsible for the results of the task. A good manager needs to be knowledgeable and flexible enough to see all points of view, to ensure that the job is completed in the most effective and cost efficient manner possible while still meeting the needs of those involved. In this time of high technology and job complexity, managers must use all resources available to them while keeping costs down and getting the job done efficiently. PMID- 10124569 TI - Effectiveness research and the health information manager. PMID- 10124570 TI - Risk management and finance: the link. AB - The benefits of the risk management (RM) department of a healthcare organization often are intangible. Perhaps that is why it is difficult for the finance department to understand the need for RM. But while it is difficult for finance personnel to understand the advantages of RM, strong communication between the two departments can be beneficial to the entire organization. This communication can be strengthened in large part by educating each department on the language of the other. It also is necessary to review the effectiveness of RM constantly and to provide results in terms that both senior management and finance personnel can understand. PMID- 10124571 TI - Clinical competence evaluations: the integration of quality assessment monitoring and performance appraisals. AB - The quality of patient care services provided by individuals not subject to the medical staff privilege delineation process must be evaluated. With the advent of total quality management, the food and nutrition services department at Walter Reuther Psychiatric Hospital in Westland, MI, has begun using a quality assessment system that simplifies and improves the objectivity of the performance appraisal process while providing valuable data for improving the quality of patient care. PMID- 10124572 TI - Improving the quality of healthcare delivery to homeless tuberculosis patients: a new approach. AB - "Doing things the same old way" can lead to complacency and eventually to a breakdown in the healthcare system. Such is the case with the deadly disease tuberculosis (TB). While TB was thought to be a disease of the past, the United States is experiencing an alarming rise in the incidence of the disease, especially among those least likely to get help or to stick with a treatment program. This article explores a more creative approach for reaching out to treat homeless people who have TB. PMID- 10124573 TI - A survey of parents regarding the admission of a child for growth hormone monitoring. AB - This article describes response to a questionnaire requesting information from parents about their knowledge of hospital facilities/procedures and their satisfaction with the routines associated with the admission of their children for 24-hour growth hormone monitoring. The adjustment of children to stressful medical procedures is more successful if parents can act as "therapeutic allies" to their children. Unless parents have a clear understanding of (and satisfaction with) the procedures their children must undergo, they cannot be expected to fulfill this role adequately. By isolating areas in which parental knowledge is lacking or inaccurate, as well as areas of dissatisfaction, the nursing staff is in a better position to improve patient adjustment to medical procedures and to plan ways of improving patient care. The results of this study indicate that more information about hospital facilities needs to be provided to parents of children who have not had previous hospital admissions. In general, however, most parents were satisfied with the explanation given for why their children had to have growth hormone monitoring and the routines associated with the procedure. PMID- 10124574 TI - Quality communication: managing conflicts and confrontations in the healthcare setting. AB - Unresolved conflicts between healthcare associates can lead to decreased teamwork and result in mistakes. Because the goal of healthcare organizations is to provide quality care, it is in the organization's best interest to avoid these damaging results. Healthcare managers have a responsibility to promote quality communication among healthcare workers. Formal negotiations, mediation, and assertiveness techniques all are very effective in resolving conflict. PMID- 10124575 TI - Developing a standard of practice while undergoing a facility merger. AB - While the three facilities that eventually became Centennial Medical Center in Nashville were in the process of merging, it became necessary to merge all of the nursing policies and procedures to establish one standard of practice. Many areas of nursing are not accountable to the vice president of nursing, yet she is responsible for nursing standards of care and practice. To bring it all together, the author formed a council of all the chairs of the manual revision process; this council condensed 35 manuals to 19 manuals, developed historical files on all active and inactive policies, developed a flow chart for new policy manual assignments, and developed one standard of practice for the medical center. PMID- 10124576 TI - HCFA mortality data: a tool for quality improvement efforts. AB - Health Care Finance Administration mortality data, which are obviously useful information, deserve close scrutiny. Many factors attributable to patient outcome are not considered when analyzing these data (e.g., health prior to hospital admission). These data should not be used alone, but as a tool to guide quality improvement efforts. PMID- 10124577 TI - Legislative forum: Rochester's healthcare plan may be a model for Clinton's. PMID- 10124578 TI - Implementing total quality management in healthcare: how do we get there from here? AB - Total quality management (TQM), with its long and proven record of success in manufacturing and other service industries, is relatively new to the healthcare field. But given the success of TQM in pioneering healthcare organizations, many more organizations will implement it in the coming years. TQM provides the most promising hope for improving the nation's healthcare quality while controlling costs. This change will have its advantages, but will not be without pitfalls and problems. That is why there are specific steps that must be taken to make TQM a success. PMID- 10124579 TI - Operations analysis and the CPR (computer-based patient record) team. PMID- 10124580 TI - Computer-based record systems that meet physician needs. PMID- 10124581 TI - Benefits and obstacles for hospital executives of the electronic medical record. PMID- 10124582 TI - A clinical information system for ambulatory care in geriatrics: management perspectives. PMID- 10124583 TI - Clinical information needs in ambulatory care: building a longitudinal patient record. PMID- 10124584 TI - A personal perspective on an essential technology. PMID- 10124585 TI - Avoiding the mistakes of the past. PMID- 10124586 TI - Tort reform: treating the symptoms, not the disease? PMID- 10124587 TI - Teaching risk management to physicians. AB - In summary, the risk manager should take an active role in educating the medical staff. The seven areas discussed can serve as a checklist for the risk manager and, of course, can be expanded. The risk management strategies described should be encouraged to become a part of physicians' daily practice patterns. Physicians then will be better prepared to help their patients deal with adverse outcomes as well as feel more comfortable about the medical-legal environment in which they practice. PMID- 10124589 TI - Operation Hillary. PMID- 10124588 TI - A mandatory physician loss prevention seminar. AB - In summary, this article has reported on the experience of a mandatory physician loss prevention seminar that is sponsored by a professional liability company. The article includes only highlights of the seminar program; by no means is it a detailed report. Also, the literature cited in the references is hardly an exhaustive search. Implications for the development, implementation, and evaluation of a hospital-based seminar program were both implicitly and explicitly discussed, as were some of the seminar's limitations, both within the seminar and its evaluation. It is hoped this article will stimulate health care risk managers to either develop their own seminars or modify certain aspects of their existing seminars, both for their medical staff and hospital (employee) staff. Involvement in risk management/loss prevention seminars are both educational and challenging for the professional health care risk manager. They may also prevent claims, conserve the institution's financial resources, prevent patient injury, and improve the quality of patient care delivered. PMID- 10124590 TI - A cure for the wrong disease. PMID- 10124591 TI - Data watch. The communication crisis. PMID- 10124592 TI - Facing deadline, businesses shifting more costs to retirees. AB - Rather than eliminate retiree health benefits, most companies are using a variety of strategies that force retirees to pay more. Those strategies range from giving retirees a lump sum to purchase benefits and prefunding. PMID- 10124593 TI - Communication gap exacerbates health care crisis. AB - Mercer-B&H survey shows employers, doctors, insurers, and workers do not understand each other's most basic concerns. For example, respondents disagree on such issues as how to define quality care and whether freedom to choose a doctor is important. PMID- 10124594 TI - Benefits managers' new role: selling cost cutting to employees. PMID- 10124595 TI - Getting employees to say no ... to smoking. AB - Frustrated by higher health costs from smoking, more employers are finding ways to help smokers kick the habit. Employers share their secrets to running a successful smoking cessation program. PMID- 10124596 TI - Ohio group ranks hospitals on costs, usage. PMID- 10124597 TI - Outcomes as a measure of performance. PMID- 10124598 TI - States implement collective purchasing. PMID- 10124599 TI - The unsung heroes of health care reform. PMID- 10124600 TI - Health care: covert operation. PMID- 10124601 TI - 'Medicine' for '724 children'. PMID- 10124602 TI - Hillary's hard sell. PMID- 10124603 TI - Creation of the Emergency Medical Radio Service--FCC. Final rule. AB - The Commission has adopted rules that create the Emergency Medical Radio Service. This action was taken to redress the adverse consequences on public health and safety resulting from current crowding on emergency medical channels. The rule changes will establish a discrete radio service category dedicated strictly to eligibles providing basic or advanced life support services on an ongoing basis and thereby ensure the reliability of emergency medical communications. PMID- 10124604 TI - Recruitment and retention of home care aides. Promoting employee longevity. AB - Home care aides play an essential part in home care services, yet agencies experience a high turnover rate in this position--an average of 50% annually. One Medicare-certified agency determined to address and resolve the situation. PMID- 10124605 TI - Two populations in need. The Metropolitan Elder Care Alliance. AB - The elderly population in the Chicago area benefits from an unusual home care aide program--one in which the aides also benefit: aides are drawn from the population receiving public assistance and given training that offers them a career ladder and opportunity they might otherwise not have had, all while helping others. PMID- 10124606 TI - Networking the rural community. AB - A branch network of affiliate hospitals has been providing home care services to rural North Dakota residents successfully for a decade. Here's how this effective system meets the special challenges that a rural environment poses for hiring, training, scheduling, and supporting home care aides. PMID- 10124607 TI - The shared aide program. The cluster care experience. AB - Traditional home care services use a one-on-one caregiver-to-client approach in time blocks. In urban setting caregivers may cross each other's paths as aides from several agencies each visit several patients in one building. Cluster care services use a team approach by tasks, consolidating visits and providing a more coordinated, cost-effective approach to services. PMID- 10124608 TI - Training paraprofessionals for psychiatric support. New supports in expanding care for the elderly. AB - The need for mental health services for the elderly continues to grow while access to those services is critically limited. Gaps in service delivery become even more pronounced as elderly services increasingly shift from acute care and long-term care to the home. Home care aides could serve pivotal roles in providing support for clients experiencing mental health problems, as evidenced by the following results of implementing a training and demonstration grant for preparing psychiatric home care aides. PMID- 10124609 TI - Home Care Aide Association of America position paper. National uniformity for paraprofessional title, qualifications, & supervision. PMID- 10124610 TI - Enriching lives. Mental health supportive home care aides. AB - The emotional and social support of paraprofessionals can profoundly affect the quality of life of those in need. This model program for supportive home care aides received accolades for its contributions to the welfare of clients during an audit conducted by the Massachusetts Department of Public Health. PMID- 10124611 TI - Using adult education techniques to teach--not to train--home care aides. AB - With much to learn in a short time, home care aide students need teachers to maximize learning by conducting a course that is student centered, the way home care is client centered. Standard adult education techniques emphasize recognizing the characteristics of adult learners; they also promote the self respect of home care aides as they prepare for their increasing responsibilities. PMID- 10124612 TI - Computer-Assisted Retrospective Clinical Activities Statistics (CARCAS) Program. AB - Clinical pharmacy services have been demonstrated to have a positive impact on patient care in the hospital setting. Accurate and complete documentation of interventions aimed at improving drug use is essential to assess workload characteristics, determine the impact of pharmacist activities, justify current programs and predict future clinical staffing requirements. The need for an improved system of collecting and analyzing clinical workload statistics led to the development of a Computer-Assisted Retrospective Clinical Activities Statistics (CARCAS) Program in our department. Using a pre-defined clinical activity coding system, pharmacist activities were efficiently documented on a daily basis using an existing distributional computer system. Training requirements and data entry time were minimal. The CARCAS Program appeared to capture more clinical pharmacist activities than the earlier manual system. The flexibility of the CARCAS Program should permit adaptation to other hospitals with similar computer systems regardless of the nature of their clinical programs. PMID- 10124613 TI - Pharmacy support of a provincial neonatal transport team. PMID- 10124614 TI - Establishment of a bone marrow transplant satellite pharmacy. AB - The planning, establishment and operation of a bone marrow transplant (B.M.T.) satellite pharmacy in a 1100-bed teaching hospital are described. The B.M.T. satellite pharmacy was established because of the specialized pharmaceutical care needs of this patient population with a high risk for drug-related problems. The satellite pharmacy, which is located within a 19-bed Oncology Unit, provides integrated clinical-distributive services (unit-dose, IV-admixture system) to all B.M.T. patients. The satellite is open 10.5 hours per day, seven days per week. Staff consists of three full-time equivalent (F.T.E.) staff pharmacists, a 0.5 F.T.E. technician, and one F.T.E. clinical pharmacist. Staff pharmacists rotate between provision of B.M.T. pharmacy services, and provision of pharmacy services for the provincial Home Parenteral Nutrition program. The pharmacists are responsible for all aspects of drug distribution and clinical services for B.M.T. patients. Additional drug distribution and clinical services are provided to other Oncology Unit patients. The establishment of a satellite pharmacy has provided unique opportunities for pharmaceutical care of the B.M.T. patient. PMID- 10124615 TI - Managed care and case management: an overview. AB - This article presents a brief overview of managed care and discusses the role of case management. Characteristics of each are given along with a brief history, description of current models, and a forecast of the next generation. Major issues and implications for social work and discharge planning are also covered. PMID- 10124616 TI - Views and trends. Managed care. PMID- 10124617 TI - Public health care: facing the challenge of managed care. PMID- 10124618 TI - More rurals turning to swing beds for long-term care. PMID- 10124619 TI - Issues for patient and family. AB - This article explores managed care in the 1990s from the perspective of patient and family. This perspective is a complicated one because there is no one managed care program and there is even more diversity among patients and families. Four major issues are singled out for discussion: choice, access, cost, and quality of care. Also discussed are the skills needed by patients and families, as well as health care professionals, that are taking on growing importance in the managed care environment: communication, negotiation, and advocacy. PMID- 10124621 TI - Vending: new paths to success. PMID- 10124620 TI - Rising to the challenge of home health care. AB - The managed care concept has had a major impact on most health care delivery systems (from the hospital to home) and the professional practice of the people within those systems. It is important that all types of providers who are involved in an individual's care have a basic understanding of the challenges they each face. Sharing information may contribute to a more efficient transfer of the client's care from one provider to another and improve continuity of care and cost containment. This article presents some of the challenges that the Visiting Nurse Association of Chicago (VNAC), a home care provider, has faced as a participant in managed care. PMID- 10124622 TI - Payment for nutrition services. PMID- 10124623 TI - Trauma centers form a health-care system. PMID- 10124624 TI - RBRVS apprehension may be an administrative red herring. AB - "The RBRVS has been accepted as a rational and systematic approach to determining fees for physician services. By adopting this method, the federal government has corrected the distorted incentive structure for physician payment, and has provided itself and others another tool with which to build an improved health care system." The words of RBRVS architect and Harvard School of Public Health economist Dr. William C. Hsiao are receiving mixed reviews from health-care administrators and strategic planning consultants. While RBRVS is gaining some respect among health-care practitioners for lowering the cost of Medicare services, an unexpected ramification is developing. Many physicians are avoiding the administrative paperwork of another federal medical program by joining physician-hospital alliances where hospitals are luring physician fidelity with administrative incentives. PMID- 10124625 TI - The public-private health partnership. AB - The comprehensive plan for a 21st Century American Health System that is embodied in the Jackson Hole Group initiatives will require both government and private sector actions. The new government roles will include implementing a public private design for universal health-insurance coverage, insurance market reforms, tax-code revisions, and a national health-outcomes accountability system. These new government roles are necessary for the private health sector to perform its major role--to compete effectively on the basis of health-care costs, high quality, and value to the patient. PMID- 10124626 TI - Group practices and hospital affiliation of medical practices. AB - Federal reimbursement systems, state constitutional amendments, and fiscal responsibilities are driving physicians and hospitals into alliances that were unheard of a decade ago. How those alliances are established is critical to the success of those new affiliations. James Unland explores several forms of physician groups and physician-hospital alliances. The "Group Practice Without Walls," "The Mutual Service Corporation" and others are explored in this article. In a world of changing health-care programs, Unland states there is a middle ground where group-practice ownership and control are shared. The exact type of structure, ownership, and control will depend upon many factors. Unland makes a point-by-point evaluation of a hospital-group alliance that integrates numerous medical practices into a single operational entity. PMID- 10124627 TI - Strategic thinking about collaboration and integration. PMID- 10124628 TI - Statistical notes. Consumer attitudes toward health-care purchases. PMID- 10124629 TI - Scott & White measures "quality of health" in outcomes studies. Interview by Donald E.L. Johnson. AB - "Although Scott & White has been involved in outcomes studies for several years, we feel it's time that health care be truly accountable. In order to do this, we need to measure the results of what we're doing in our everyday practice," explained Kermit B. Knudsen, MD, director of the Scott & White Center for Outcomes Studies in Temple, Texas. Knudsen shares his perspective with Health Care Strategic Management publisher Donald E.L. Johnson, Knudsen's goal for the center is to have outcomes studies become a routine part of medical practice, measuring the actual "quality of health" outcomes for patients treated at Scott & White. PMID- 10124630 TI - Economic issues and credentialing decisions: the controversy continues. PMID- 10124631 TI - Special report on reimbursement. Office of Inspector General to focus on disclosure compliance by health care providers. PMID- 10124632 TI - The discipline of teams. AB - Groups don't become teams because that is what someone calls them. Nor do teamwork values by themselves ensure team performance. So what is a team? How can managers know when the team option makes sense and what they can do to ensure team success? In this article, drawn from their recent book The Wisdom of Teams, McKinsey partners Jon Katzenbach and Douglas Smith answer these questions and outline the discipline that makes a real team. The essence of a team is shared commitment. Without it, groups perform as individuals; with it, they become a powerful unit of collective performance. The best teams invest a tremendous amount of time shaping a purpose that they can own. The best teams also translate their purpose into specific performance goals. And members of successful teams pitch in and become accountable with and to their teammates. The fundamental distinction between teams and other forms of working groups turns on performance. A working group relies on the individual contributions of its members for group performance. But a team strives for something greater than its members could achieve individually. In short, an effective team is always worth more than the sum of its parts. Katzenbach and Smith identify three basic types of teams: teams that recommend things--task forces or project groups; teams that make or do things--manufacturing, operations, or marketing groups; and teams that run things -groups that oversee some significant functional activity. For managers, the key is knowing where in the organization real teams should be encouraged. Team potential exists anywhere hierarchy or organizational boundaries inhibit good performance.(ABSTRACT TRUNCATED AT 250 WORDS) PMID- 10124633 TI - Health and the welfare of U.S. business. AB - Business leaders continue to blame the skyrocketing cost of health care for jeopardizing the global competitiveness of U.S. industries, and they continue to turn to Washington for the solution. Yet after a study of 16 countries, Wharton researchers David Brailer and R. Lawrence Van Horn have discovered that health care costs do not directly hinder U.S. competitiveness. Their conclusion: there is indeed a health care crisis in the United States as well as a competitiveness crisis. But the two are unrelated, and confusing them makes it difficult to solve either one. The real problem, according to the authors, is the hands-off approach that employers typically adopt when it comes to health care. No matter how Washington responds to the health care crisis, employers must explore their own role in ensuring the health of their work force. And they must realize that their role can be a strategic one. Instead of containing costs by fine-tuning benefits packages, companies can control costs and improve health care delivery by treating health care like any other crucial component of production. Brailer and Van Horn propose three strategies for managing health care delivery: First, companies must intervene in the supply side of the health care market. This may mean creating a clinic alone or with other companies, or joining with other companies to procure health care. Second, companies need to translate corporate health benefits into the most cost-effective set of services at the local level. Finally, companies must encourage and educate employees to participate in decisions regarding health care delivery.(ABSTRACT TRUNCATED AT 250 WORDS) PMID- 10124634 TI - Loyalty-based management. AB - Despite a flurry of activities aimed at serving customers better, few companies have systematically revamped their operations with customer loyalty in mind. Instead, most have adopted improvement programs ad hoc, and paybacks haven't materialized. Building a highly loyal customer base must be integral to a company's basic business strategy. Loyalty leaders like MBNA credit cards are successful because they have designed their entire business systems around customer loyalty--a self-reinforcing system in which the company delivers superior value consistently and reinvents cash flows to find and keep high quality customers and employees. The economic benefits of high customer loyalty are measurable. When a company consistently delivers superior value and wins customer loyalty, market share and revenues go up, and the cost of acquiring new customers goes down. The better economics mean the company can pay workers better, which sets off a whole chain of events. Increased pay boosts employee moral and commitment; as employees stay longer, their productivity goes up and training costs fall; employees' overall job satisfaction, combined with their experience, helps them serve customers better; and customers are then more inclined to stay loyal to the company. Finally, as the best customers and employees become part of the loyalty-based system, competitors are left to survive with less desirable customers and less talented employees. To compete on loyalty, a company must understand the relationships between customer retention and the other parts of the business--and be able to quantify the linkages between loyalty and profits. It involves rethinking and aligning four important aspects of the business: customers, product/service offering, employees, and measurement systems. PMID- 10124635 TI - Strategy as stretch and leverage. AB - Global competition is not just product versus product or company versus company. It is mind-set versus mind-set. Driven to understand the dynamics of competition, we have learned a lot about what makes one company more successful than another. But to find the root of competitiveness--to understand why some companies create new forms of competitive advantage while others watch and follow--we must look at strategic mind-sets. For many managers, "being strategic" means pursuing opportunities that fit the company's resources. This approach is not wrong, Gary Hamel and C.K. Prahalad contend, but it obscures an approach in which "stretch" supplements fit and being strategic means creating a chasm between ambition and resources. Toyota, CNN, British Airways, Sony, and others all displaced competitors with stronger reputations and deeper pockets. Their secret? In each case, the winner had greater ambition than its well-endowed rivals. Winners also find less resource-intensive ways of achieving their ambitious goals. This is where leverage complements the strategic allocation of resources. Managers at competitive companies can get a bigger bang for their buck in five basic ways: by concentrating resources around strategic goals; by accumulating resources more efficiently; by complementing one kind of resource with another; by conserving resources whenever they can; and by recovering resources from the market-place as quickly as possible. As recent competitive battles have demonstrated, abundant resources can't guarantee continued industry leadership.(ABSTRACT TRUNCATED AT 250 WORDS) PMID- 10124636 TI - How architecture wins technology wars. AB - Signs of revolutionary transformation in the global computer industry are everywhere. A roll call of the major industry players reads like a waiting list in the emergency room. The usual explanations for the industry's turmoil are at best inadequate. Scale, friendly government policies, manufacturing capabilities, a strong position in desktop markets, excellent software, top design skills--none of these is sufficient, either by itself or in combination, to ensure competitive success in information technology. A new paradigm is required to explain patterns of success and failure. Simply stated, success flows to the company that manages to establish proprietary architectural control over a broad, fast-moving, competitive space. Architectural strategies have become crucial to information technology because of the astonishing rate of improvement in microprocessors and other semiconductor components. Since no single vendor can keep pace with the outpouring of cheap, powerful, mass-produced components, customers insist on stitching together their own local systems solutions. Architectures impose order on the system and make the interconnections possible. The architectural controller is the company that controls the standard by which the entire information package is assembled. Microsoft's Windows is an excellent example of this. Because of the popularity of Windows, companies like Lotus must conform their software to its parameters in order to compete for market share. In the 1990s, proprietary architectural control is not only possible but indispensable to competitive success. What's more, it has broader implications for organizational structure: architectural competition is giving rise to a new form of business organization. PMID- 10124637 TI - A needs assessment of sick-child care benefits for nurses. AB - Women are entering the healthcare workforce in greater and greater numbers. As many of these women have children, increased attention is being given to the types of employer-sponsored benefits offered to workers, especially assistance for those with sick children. The authors describe the results of a small survey conducted in Maryland on this subject, the results of which point to the need for changes in human resources management in hospitals. PMID- 10124638 TI - Laying the groundwork for a smooth transition to TQM. AB - The increasingly popular corporate philosophy of total quality management (TQM) can (and should) be applied to the healthcare industry--as structured and bureaucratic a system as can be found. Yet one does not begin by running, but by learning how to walk. So, too, with TQM. In this article, the author makes several suggestions that will enable healthcare managers to take those first few steps toward better quality service and patient care. PMID- 10124639 TI - Does planning pay off? A look at the experience of New Mexico's rural hospitals. AB - When Medicare's prospective payment system (PPS) was implemented, hospitals faced the prospect of diminishing reimbursement. Added to other fundamental changes involving medical practice, consumerism, competition, and medical technology, hospitals had significant incentives to focus more attention on strategic planning. This article examines how rural hospitals altered their strategic planning in response to PPS and the extent to which planning is related to better performance. It presents results from a case study of rural New Mexico hospitals. The implications of these results for other hospitals are discussed by the authors. PMID- 10124640 TI - Quality improvement naysayers. PMID- 10124641 TI - We've got to stop meeting like this. AB - Meetings are an integral aspect of healthcare management. Too often, however, they are run inefficiently and with the wrong emphases, thus diminishing their inherent value. The words of wisdom from this veteran of innumerable meetings should provide readers with some pointers on how to get their meetings back on track. PMID- 10124642 TI - Healthcare politics. Upsetting the contented. PMID- 10124643 TI - Providing the power of information. PMID- 10124644 TI - Hospitals face a new scrutiny. Tough questions. AB - Hospital administrators and media relations personnel might do well to take that Clinton campaign mantra "It's the economy, stupid" and tack up it on the wall as a daily reminder of a new reality. Media coverage and the public's perception of health care issues have shifted dramatically, and hospitals must be prepared to deal with new public perceptions. PMID- 10124645 TI - When the media comes to call. AB - In most communities, the hospital administrator no longer has the luxury of choosing between standing in the limelight and melding into the background. If newspaper and broadcast reporters have not turned up at your hospital doorstep, they will. PMID- 10124646 TI - Focus groups: market research on a budget. PMID- 10124647 TI - Save costs on equipment maintenance. PMID- 10124648 TI - Pound foolish. PMID- 10124649 TI - Promises to keep. PMID- 10124650 TI - Countdown to community care. Back to front. PMID- 10124651 TI - More than just hot air. PMID- 10124652 TI - Data briefing. The world's children. PMID- 10124653 TI - The UK health reforms: the fundholding experiment. AB - In April 1991 the UK embarked on the most radical reforms of its health care system in 50 years. Unusually it employed two quite distinct models of quasi market reform. One made District Health Authorities the purchasers of hospital and community health services. The other gave family doctors the money to buy these services on behalf of their patients. This latter model was the most radical part of the NHS reforms. This paper reports on a project that has monitored the family doctor fundholding scheme in detail. PMID- 10124654 TI - Competition in the UK National Health Service: mission impossible? AB - Despite the dominant ideology of the 1980s being libertarian, pragmatism triumphed and, despite several attempts to privatise the UK National Health Service, the Thatcherite reforms maintained public finance and sought to create competition in the supply of health care. Even this partial reform was radical and has led to major changes in structure and process. However, the Government has refused to evaluate both the cost and the outcome of the reforms. Furthermore, with minimal definition of how the 'internal market' was to work, the Government has regulated the competitive processes in an ad hoc manner, often responding to obvious but unforeseen problems (e.g. local monopoly power). Competition is costly to create, requiring large investments in managerial personnel and information technology, and difficult to sustain because of the propensity of capitalists, through self interest, to destroy capitalism. Problems such as quality, equity and the closure of excess capacity were well defined prior to the NHS reforms and have not yet been resolved following the reforms. Whether adversarial rather than collaborative relationships are more efficient in the health care sector is unknown. Indeed there remains little evidence to sustain the claims of political rhetoric that competition 'works' i.e. increases efficiency, enhances equity and contains costs. Despite this reformers seek to create competition and complete mission impossible. PMID- 10124655 TI - Health for All indicators in health interview surveys. AB - The World Health Organization's strategy of health for all 2000 (HFA 2000) has, among other things, attempted to reduce the actual differences in health status between and within countries. In order to evaluate the progress made towards the attainment of the HFA strategy, each country reports their status of achievement to the World Health Organization every 3 years. This study investigates the extensiveness and the methodology of interview surveys which measure health as a source of information for HFA in the European Region. This study focuses on the comparability of data which derive from the interview survey. The study shows that the different questions (related to the same indicator) in interview surveys mostly lead to incomparable information because there is a lack of uniformity both in phrasing and in the standards and methods used. PMID- 10124656 TI - Searching for a common currency: critical appraisal of the scientific basis underlying European harmonization of the measurement of health related quality of life (EuroQol) AB - The EuroQol has recently been proposed as a measure of health-related quality of life based on individuals' valuations of health states. The derived values would be used in assessing cost-effectiveness and establishing priorities across a wide range of health-care activities. In this paper we identify some of the limitations of the EuroQol in its role as a particular method for deriving the more generic QALYs. More specifically we explore the implications of using the EuroQol as a measure of individuals' and communities' valuation of health outcomes. We show that the EuroQol suffers from several major limitations and thus cannot be relied upon to provide a valid measure to be used in economic appraisals or studies concerned with establishing priorities as proposed by its proponents. An alternative approach is identified and discussed. PMID- 10124657 TI - Regional integration of health services in Poland--an ambitious pilot project. AB - A new and very important feature of the health care reform in Poland is a set of initiatives emerging locally and striving for decentralisation of the management structure. The most promising manifestation of this process consists in the ambition to set up regional systems of integrated health services, guaranteeing provision of comprehensive care and run efficiently by competent managers. The direction of reform has been strongly encouraged by the Ministry of Health and Social Welfare, but still faces many barriers, mainly because of the misuse of the concept of integration by former health politicians. In the seventies and eighties integration was implemented in a very formal way, neglecting both medical professional attitudes and managerial abilities of decision makers. A major mistake was the resignation of inclusion of the rich 'parallel systems' within the services available to the general public. In the new political circumstances regionalised services, or health consortia as they are called, are a deliberate response to the need for decentralisation and efficient use of scarce resources. Three regions which volunteered to start an extensive experiment were selected through a formal competitive process. They include more than six million inhabitants and almost one quarter of the territory of the country. New organisational arrangements, networks of contracts and agreements, channels of financing and quality control programmes will be monitored in pilot areas to make them applicable all over the country. PMID- 10124658 TI - The economy and health. AB - The interrelationships between sectors in an economy (especially between the health sector, on one hand, and the rest of the economy, on the other hand) are often ignored when many developing countries strive to achieve some general socioeconomic as well as specific sectoral goals. Macroeconomic policies adopted in developing countries, especially in Sub-Sahara Africa, to deal with the economic crisis failed to take adequate measures to protect the health of the people. Policy makers and the planners have contributed to the problems of the health sector by not devising necessary built-in measures to mitigate the negative impact of macroeconomic and sectoral policies on health. The paper attempts to bring into focus the linkages between the economy and the health sector and to proffer to policy makers and planners, especially in Sub-Sahara Africa, what should be done in future to minimize the negative impact of macro and sectoral policies on health. PMID- 10124659 TI - The attitudes of Ontario hospitals toward transitional funding: response to a survey. AB - A survey of hospital administrators throughout Ontario was conducted to determine their views about the strengths and weaknesses of the new Transitional Funding system, especially as it existed between Phase One and Phase Two when many changes were taking place. The basic findings of the survey are presented. The authors go on to explore some of the answers and determine whether the hospital's responses were influenced by their participation in the process and whether they were "winners" or "losers" as a result of the changes. This type of information should be useful to policy makers in Ontario as they modify the overall hospital financial system, and also be useful to policy makers outside the province who are contemplating making such changes. PMID- 10124660 TI - Work force planning in the 90s, Part I: Efficiency, economy and political will- the need for a new approach. AB - Critical to health services management in today's economic climate is efficient utilization of our costly and sometimes limited supply of health care professionals. This two-part article gives an overview of current issues in health care work force planning in Canada. In Part I, the problems of estimating current supply are discussed. Needs-based and demand-based forecasting are contrasted. Comprehensive needs-based planning is recommended and changes needed in order to move toward this type of planning are discussed. In Part II, the maldistribution of health care professionals and various corrective measures within the context of needs-based comprehensive planning are discussed. PMID- 10124661 TI - Changing perspectives on hospital governance. AB - In the light of fundamental changes in the delivery of health and social services in Canada, hospital governance must be concerned with protection and enhancement of the organization on behalf of the owner (i.e., taxpayer) as well as accountability to the community it was established to serve. Based on a review of current literature, the authors suggest that the roles and responsibilities of a hospital board entail seven major activities: establish the mission, philosophy and future directions of the institution; choose and evaluate the chief executive officer; establish the ethical principles for the organization; ensure high quality care and services; attract resources to the institution and ensure their effective use; integrate the organization with its environment; and undertake its own self-evaluation, education and development. To play these roles effectively, hospital boards will need to develop more direct links with their communities and learn to share decision making with them. PMID- 10124662 TI - A "partnership"--a case study. AB - The Misericordia and The General Hospital (Grey Nuns) of Edmonton (two sites) have formed a partnership and established one board and management structure responsible for the three sites. Described are the processes and techniques used during the assessment stage to determine the viability and desirability of such an action. To study the issue, a task force was formed, drawing equally from the boards of the two hospitals, and involving the participation of the Catholic Archbishop of Edmonton. The responsibilities and actions of the task force are described, along with the observations of the other participants--the owners, management, medical staff, employees and the community. PMID- 10124663 TI - The Comprehensive Health Organization--a practical solution for an integrated health care system. AB - This brief report takes a look at the structure and functions of a new type of health care delivery system, the comprehensive health organization (CHO). The development of such a system, however, requires a new mindset or shift of focus: none of the activities of a CHO has been part of the training or experience of providers in the Canadian health care system. The range of services a CHO would offer, whether they would be provided by the CHO or by an outside contractor, the possible risks involved, and who the potential participants would be are also discussed. PMID- 10124664 TI - Purchasers versus providers--defining roles in a regionalized health system. PMID- 10124665 TI - Cleveland's Quality Choice. Outside pressures force tough purchasing choices. PMID- 10124666 TI - Surgical pack prices stay steady. PMID- 10124667 TI - Critical care non-salary expenses per patient day. PMID- 10124668 TI - Anesthesia department non-salary expenses. PMID- 10124669 TI - Technology assessment taking center stage in capital equipment acquisition process. PMID- 10124670 TI - Global budgets: a key to Clinton's reform strategy? PMID- 10124671 TI - Identifying charity care in financial statements. PMID- 10124672 TI - Care of the dying: a Catholic perspective. Part II: Social and political context- Catholic providers must exemplify a caring community. Catholic Health Association. AB - Fears of abandonment and isolation in an institution have increased the public demand for euthanasia and assisted suicide. To quell this movement, Catholic healthcare providers must provide a caring community where patients and care givers enable each other to confront the fear of death and find support in living with human limitation. To begin to address the social and political dimensions of issues about the end of life, Catholic healthcare providers must use clear and consistent definitions of the terms used to describe these issues, such as death with dignity, right to die, euthanasia, allowing to die, and assisted suicide. By acknowledging the influence of the media in forming attitudes and opinions, healthcare institutions can seize opportunities for public education on fundamental human and religious values. The first effort has to be directed toward educating members of the media. The Catholic Church supports the concept of advance directives, which provide an opportunity for people to express their values and the ways they would expect those values to be honored in decisions about medical treatment. Courts' role in resolving decisions about treatment should be limited. Patient self-determination is best exercised when a patient (or surrogate), in consultation with a physician, decides what is best. Catholic healthcare institutions should advocate for legislation that fosters an appropriate balance between protecting a patient's right to self-determination and the state's interests to protect life. At the same time, institutions' advocacy efforts should demand sufficient resources for holistic care for the dying. PMID- 10124673 TI - Converting a unit to patient-focused care. AB - OBJECTIVE: St. Vincent Hospitals and Health Services, Indianapolis, implemented the patient-focused care concept, Care2001, to maintain or improve the quality of patient care and to reduce the overall complexity of delivering healthcare, which adversely affected St. Vincent's efficiency. With the streamlining possible using the patient-focused approach, St. Vincent hoped to realize cost savings as well. Pilot program: In January 1990 St. Vincent introduced the Seton Unit, a patient focused care pilot program serving a homogeneous group of surgery patients. Program design: The Seton Unit required facility redesign, such as replacing the traditional central nurses' station with nurse substations,and job class reconfiguration, which established five job classifications: unit representative, unit support assistant, team care specialist, pharmacist, and clinical manager. RESULTS: The Seton Unit initially offered better quality care and increased patient, physician, and staff satisfaction; increased direct care; reduced length of stay; improved service; and reduced costs. After the initial impact of Care2001, satisfaction levels dropped somewhat, necessitating refinements. Satisfaction levels have since improved. IMPLICATIONS: The patient-focused care concept is succeeding at St. Vincent. The hospital has already expanded it to other units and is committed to implementing the concept hospital-wide. PMID- 10124674 TI - Sponsorship networks. A new model for preserving congregations' presence in the Catholic healthcare ministry. AB - A renewal of vision is necessary today as healthcare shifts from an acute care to a community health focus. In regions where there are multiple sponsors, they can foster this renewed vision by forming sponsorship networks. A sponsorship network begins when sponsors in a region come together to discuss collaboration and explore ways to motivate the leaders of their institutions to better meet their community's healthcare needs. A sponsorship network would focus on community health through more effective resource use and integration of resources among providers. Such a network encourages providers to assess community needs and collaborate to meet them, provides criteria for maintaining quality and mission, and explores sponsorship responsibilities within institutions and beyond. The collaborative process involves five stages: preplanning, foundation building, problem setting, implementing, and assessing. A group of sponsors in St. Louis provides an example of how sponsors can initiate such a process. PMID- 10124675 TI - Mission integration preserves sponsor's values. AB - Sponsorship of a healthcare organization by a religious community requires sponsors to maintain significant influence and ultimate control over mission, quality of services, and assets. To ensure the mission of its sponsor (the Religious Sisters of Mercy) permeated all its operations, St. Edward Mercy Medical Center, Fort Smith, AR, incorporated the nine Mercy values into the organization's core documents in the mid-1980s. As St. Edward's services and service area grew, the program approach to mission effectiveness appeared inadequate. St. Edward implemented a mission integration plan to ensure the inclusion of Christian values in decision making, direction setting, and strategic planning. The Mission Integration Council provides the forum and authority for planning and implementing the mission integration strategies and provides a formal process for evaluating those actions in light of the mission statement and core Mercy values. PMID- 10124676 TI - In the best interest of the patient. Applying this standard to healthcare decision making must be done in a community context. AB - Acting in the "best interest" of another implies taking certain steps or following certain rules so that the person and his or her concrete human community will survive and potentially flourish. The long-term understanding of best interest refers to the balance of benefits and burdens with respect to the ultimate goals or purposes of a community within which an individual is situated; short-term best interest refers to that balance with respect to a specific healthcare decision, without reference to the overall situation. However, considering only short-term best interest is unsatisfactory in the final analysis. Any decision to sacrifice individual preference for communal best interest should include three crucial aspects: (1) The individual must be a willing (or potentially willing, in the case of a child) member of the community, (2) individuals never lose their moral standing in the community, and (3) society can justify failure to accept the autonomous decisions of some individuals only (a) if it is impossible, (b) that failure is necessitated by attempts to meet the needs of other individuals, and (c) that decision is not based on unfair or unjust practices. Applying the concept of best interest to nontherapeutic research on children, one can conclude that the indirect benefit to the child is in his or her best interest only when the long-term benefit to the community, in terms of both survival and flourishing, is adequately considered. In addition, healthcare surrogate decision makers, acting in the best interest of a person who cannot make decisions and has not previously expressed his or her wishes, must take into account the long-term interests of the community. PMID- 10124677 TI - An effective, efficient elder care program. Providence ElderPlace focuses on maintaining the continuum of care. AB - Providence ElderPlace, Portland, OR, is an innovative long-term care health maintenance organization. The program is a type of integrated delivery network, offering comprehensive benefits and coordinating the delivery of healthcare services in a specific geographic market. Providence ElderPlace is based on the Program for All-Inclusive Care for the Elderly (PACE), which was developed 20 years ago by On Lok Health Services of San Francisco. PACE helps frail elderly persons remain in their homes as long as possible. PACE is financed through an integrated funding pool of Medicare, Medicaid, and private fees. To be eligible for PACE, an individual must be in need of nursing home care but able to live in the community, with support. Providence ElderPlace provides all healthcare, community-based, and long-term care support services from an adult day healthcare setting. Participants usually attend the day center three times a week. When participants are not at the center, a team of workers visit their homes to observe participants and provide personal and chore support services. PMID- 10124678 TI - Educating the community about healthcare reform. PMID- 10124679 TI - A sign of God's presence. PMID- 10124680 TI - St. Elizabeth's Hospital. Grief support group helps children come to terms with death. PMID- 10124681 TI - Humanitarian efforts aid Polish people. PMID- 10124682 TI - Applications of lasers in medicine: the 1990s & beyond. AB - The uses of lasers in medicine extend from surgery to photodynamic therapy. Nearly all medical specialties have come to accept the laser as a key tool of the trade. PMID- 10124683 TI - Managing the replacement cycle of laser inventory. AB - Medical lasers are quickly moving into the replacement phase of technology management. Barnes Hospital (St. Louis, MO) is using its laser team to define a process of planned laser replacement using the experience gained from traditional medical equipment replacement cycles, quality improvement principles and tools, and other formalized interdisciplinary teams. The process described in this paper has six basic steps: (1) A decision is made to request a replacement laser. (2) An appropriation request form is completed and submitted with the clinical and/or technical justifications. (3) Those requests initiated outside of the Clinical Engineering Department are reviewed by the Clinical Engineer/Medical Laser Safety Officer (CE/MLSO). (4) The CE/MLSO presents the requests to the hospital Laser Committee, and (5) then to the Laser Users' Group. (6) Finally, an Expenditure Authorization Committee reviews all capital expense requests, including those for replacement lasers, and allocates funds for the next fiscal year. This paper illustrates and evaluates the process, using an example from the review process for 1993 equipment purchases at Barnes Hospital. PMID- 10124685 TI - Longitudinal patient record (LPR). PMID- 10124684 TI - A coaxial gas delivery system for laser bronchoscopy. AB - This paper discusses the development and implementation of a prototype coaxial gas delivery system for laser bronchoscopy. The design of the system is presented including a detailed description of the device's theory of operation and construction. The system's medical application in laser bronchoscopy is described. PMID- 10124686 TI - Data security. PMID- 10124687 TI - The buzzzzzz on subduing bees and wasps. PMID- 10124688 TI - The A Bee Cs of a real-life extrication. PMID- 10124689 TI - Line-of-duty death. When the unthinkable happens. PMID- 10124690 TI - Warning: improper Medicare billing may be hazardous to your fiscal health. PMID- 10124691 TI - Radiation: a rad response. PMID- 10124692 TI - The limitations of generic AIDS educational programs for the health professions. AB - Three major trends are driving the widespread need for continuing education in AIDS. First, with the spread of AIDS, increasing numbers of health care professionals are becoming involved in the care and treatment of AIDS, ARC and HIV positive individuals. Second, as the disease spreads beyond current AIDS epicenters, more persons with minimal information are required to have a baseline working knowledge of AIDS. Finally, the reluctance of many health care professionals to care for HIV-positive individuals, along with already existing staff shortages, limits access to care and makes the provision of responsive educational programs even more important. Generic programs to educate health professionals frequently lack sufficient specificity and sensitivity to address the needs of health professionals with varying levels of knowledge and role responsibility. This paper briefly summarizes the literature on the similarities and differences in knowledge and attitudes across and within professional groups. In addition, it presents specific research designed to provide initial direction for considering the circumstances under which health professionals, particularly nurses and physicians, may or may not profit from generic programs aimed at mixed levels and types of health care provider. PMID- 10124693 TI - A medical information networking system between practitioners and academia. AB - This paper reports on a one-year experience with an information networking system (MIS) between 47 rural practitioners and an academic center. Physicians were invited to phone in non-emergency clinical questions specific to daily practice needs to a telephone answering service located in the medical school library. Two hundred-forty questions triggered by patient visits, colleagues, local rounds, allied health or local professionals, and on-site administrative meetings were forwarded to the MIS. All inquiries were classified according to the International Classification of Disease-9th Revision-Clinical Modification, and categorized into three areas of practice: diagnostic/investigative, general treatment, and pharmacology (therapeutics). The paper outlines how specific practice questions are being screened and adopted for decisions relating to four current activities which assist the ongoing maintenance of competence: 1) CME program planning, 2) residency/undergraduate curriculum development, 3) individualized CME for specific practitioners and sites, and 4) future CME research. The physician inquiries represent true needs in rural medical practice and as such should be given high priority in programs and assessments addressing the maintenance of competence. PMID- 10124694 TI - Reading activities of registered nurses. AB - This national study was designed to gather baseline data about the reading activities of registered nurses. Questionnaires were administered by nurse continuing educators to subjects (N = 1406) at 44 sites in 25 states and the District of Columbia. In a week, the mean amount of time devoted to professional literature was four hours, 48 minutes (SD = 3.88) plus eight hours, 12 minutes (SD = 5.15) to general material. This translated to reading one hour and 51 minutes per day, slightly more than the average adult. Educational level, position, and memberships were the best predictors of how much time was spent reading job-related material that might lead to self-development and enhancement of nursing practice. PMID- 10124695 TI - An HMO had us on the ropes--but we won. PMID- 10124696 TI - Care for the poor? We found a solution. PMID- 10124697 TI - What it's like to be a doctor with AIDS. PMID- 10124698 TI - Don't be so sure it's child abuse. PMID- 10124700 TI - Turn your computer into a medical library. PMID- 10124699 TI - How rationing will really work. PMID- 10124701 TI - If this is cookbook medicine, you may like it. PMID- 10124703 TI - If Medicare ran baseball. PMID- 10124702 TI - We must reclaim the patients we've forgotten. PMID- 10124704 TI - The medical balancing act: controlling expenses vs. improving service quality. PMID- 10124705 TI - A legal primer for direct contracting. AB - The mystique of direct contracting has prevented many groups from formulating a direct contracting strategy, writes Keith Korenchuck, J.D., M.P.H., in this opening article. This article reviews several suggested ways that medical groups can contract directly with employers, and suggests how they can develop contractual arrangements to best represent their interests. PMID- 10124706 TI - Direct contracting: the future is now. AB - Recent years have seen increasing business concern over the cost of employee health care, according to authors John McCally and Roger Nauert. On average, 50 percent of employer profits are being absorbed by health care costs, thus direct contracting has now emerged as one of the major trends of the '90s and beyond. PMID- 10124707 TI - Corporate health initiatives. Restructuring the American health care system. AB - As we stand on the threshold of the 21st century, writes Ron Loeppke, M.D., M.P.H., corporate health is emerging as a cornerstone in the restructuring of the American health care system. Whereas traditional managed care models have been reactive, corporate health management is proactive, building on the best elements of managed care with increased emphasis on prevention and risk management. PMID- 10124708 TI - A multispecialty group practice response. AB - Employers want value from the health care system, according to author J. Paul O'Conner, and they define this as quality care at a low cost. In response to this pressure, O'Conner's organization created an exclusive provider organization which he describes in detail. PMID- 10124709 TI - Medical group practice and President Clinton's health reform proposals. AB - Back in 1991, author Thomas Weil, Ph.D., wrote a two-part article discussing the prospect of national health insurance. In his return visit to the subject, Weil has good news for group practice, and hard data to back up his claims. In addition, Austin Ross Jr., FACMGA, offers his many years of group practice experience through a commentary following Weil's article. PMID- 10124710 TI - How to approach managed care contracting in the 1990s. AB - Whether your group is considering contracting with an additional HMO or PPO, or thinking of negotiating for the first time, write E. Suzanne Scroggins, B.S.N., and Karen Brayer, M.S.H.S.A., there are several factors to consider before signing on the dotted line. This article outlines the issues that need to be evaluated and gives criteria to help groups analyze such contracts. PMID- 10124711 TI - Managed competition: what it might mean to medical groups. PMID- 10124712 TI - Coping with CLIA, Part 8. How to prepare for and survive a CLIA inspection. PMID- 10124713 TI - A tool to evaluate equipment purchases. PMID- 10124714 TI - Launching quality improvement in histology. PMID- 10124715 TI - Hardware for reading and duplicating bar codes. PMID- 10124716 TI - A second look at some clinical laboratory dogma. PMID- 10124717 TI - Which PC to buy in '93? PMID- 10124718 TI - Consumers to 'grade' HMO's services. PMID- 10124719 TI - NME execs take PR campaign on the road. PMID- 10124720 TI - NME lays off 183 in its rehab division. PMID- 10124721 TI - S&P downgrades ratings of debt of 9 N.J. hospitals. PMID- 10124722 TI - 2 Protestant groups to merge. PMID- 10124723 TI - Plan would let FTC approve acquisitions in Calif. county. PMID- 10124724 TI - Bill would broaden fraud and abuse laws. PMID- 10124725 TI - Ruling to have little effect on meetings--White House. PMID- 10124726 TI - Benefits package looms as flash point in debate. PMID- 10124727 TI - Construction & design survey. Construction key: keep options open. PMID- 10124728 TI - Managed competition will aid rurals--Ellwood. PMID- 10124729 TI - Variety of opinions surface on health benefits tax. PMID- 10124730 TI - Managed-care project studies may stall growth. PMID- 10124731 TI - Trade group offers reform plan. PMID- 10124732 TI - IRS: tax status not imperiled. PMID- 10124733 TI - Augusta hospital plans expansion. PMID- 10124734 TI - Investors sue Towers, chairman for fraud. PMID- 10124735 TI - Reform may require physician incentives. PMID- 10124736 TI - GAO lauds Rochester 'insights'. PMID- 10124737 TI - Merger to make largest Colo. HMO. PMID- 10124738 TI - Cedars-Sinai seeks to grow in size by 50%. PMID- 10124739 TI - S&P mulls cut of Rocky Mountain Adventist rating. PMID- 10124740 TI - AHA drafts legislation seeking federal antitrust exemptions. PMID- 10124742 TI - Can lobbyists represent tobacco and health? PMID- 10124741 TI - AHA fears wider use of Medicare rates. PMID- 10124743 TI - Reform may be tough sell--polls. PMID- 10124744 TI - HCFA method for auditing GME costs upheld by panel. PMID- 10124745 TI - Get past the current cost focus and concentrate on outcomes. PMID- 10124746 TI - For-profit hospitals waving good-bye to era of high prices. PMID- 10124747 TI - New Calif. system to seek managed-care pacts. PMID- 10124748 TI - Punta Gorda antitrust trial ends. PMID- 10124749 TI - 2 Ga. public systems pursuing affiliation. PMID- 10124750 TI - Outdated bylaws pose problems in specialty-care contracting. PMID- 10124751 TI - Long-used practices may boost potential for medication errors at hospitals, experts contend. PMID- 10124752 TI - New analysis product employs ICCS (International Classification and Coding System). PMID- 10124753 TI - Adventist profits down, but future's looking up. PMID- 10124754 TI - Proposed rule would require computer billing right away. PMID- 10124755 TI - Humana posts slight gains during last quarter as combined company. PMID- 10124756 TI - Medicaid managed care aids access but might not result in savings--study. PMID- 10124757 TI - Tenn. hospital challenges state's Medicaid provider tax. PMID- 10124758 TI - When patient meets provider--opportunities lost. AB - Healthcare customers demand the highest levels of service in all aspects of their healthcare experience. Sometimes, though, they do not receive the expected level of service. What are some of the critical customer service failures identified by patients, and what can health-care facility staff members do to rectify those failures? The following article presents passages (in italics) from one patient's recent experiences at a hospital. After each passage, the author analyzes the patient's encounters with failures in customer service. PMID- 10124759 TI - Consumer group urges government to monitor insurance policies. PMID- 10124760 TI - Consumers, policymakers offer LTC solutions. PMID- 10124761 TI - Successful marketing program requires planning, targeting. PMID- 10124762 TI - Regulatory improvements spur utilization of Medicare. PMID- 10124763 TI - Reduce legal risks through restraint reduction plan. PMID- 10124764 TI - Career ladder programs attract dedicated nursing staff. PMID- 10124766 TI - Assessing needs promotes better care for incontinent residents. PMID- 10124765 TI - Drug monitoring reduces risk to facility residents. PMID- 10124767 TI - 1991 LTC buyer's guide to products and services. American Health Care Association. PMID- 10124768 TI - A growth industry. Graduate programs in health care are expanding rapidly. AB - The debate of over health care reform is now front and center on the national stage. So this year, U.S. News has added four surveys of educational programs in health professions--health services administration, pharmacy, nursing and dentistry--to its study of America's Best Graduate Schools (tables, Page 79). Following, a brief report on enrollment trends in each area. PMID- 10124769 TI - Managing resources by protective management. PMID- 10124770 TI - Guiding staff through introspection. PMID- 10124771 TI - Medicare reassignment policy: the right to bill and be paid under Part B1. PMID- 10124772 TI - Stereotactic radiosurgery. Facility & staff requirements. PMID- 10124773 TI - New dynamics in outpatient cardiac care. PMID- 10124774 TI - Validity of the "Blue Book" utilization model for linear accelerator workload. PMID- 10124775 TI - How does service drive the service company? AB - "How Does Service Drive the Service Company?" presents commentators on Leonard A. Schlesinger and James L. Heskett's September-October article. Commentators include Michael R. Quinlan, Ron Zemke, Jim Snider, Dinah Nemeroff, Steven S. Reinemund, Robert Ayling, Karmjit Singh, James A. Perkins, Joseph E. Antonini, and Walter F. Loeb. PMID- 10124776 TI - Vendor discusses high-frequency ventilators. PMID- 10124777 TI - Overview: can the patient speak? PMID- 10124778 TI - Reusable personal protective equipment refutes savings claims of disposable counterparts. PMID- 10124780 TI - Perspectives. The standard benefit package: trade-offs in the making. PMID- 10124779 TI - 1993: a look ahead. PMID- 10124781 TI - Health care reform working groups. PMID- 10124782 TI - Perspectives. Managed competition: antitrust-buster? PMID- 10124783 TI - The use of benevolent power in patient care and education. AB - The use of benevolent power as a preferred patient-care strategy is discussed in relation to its maladaptive opposite--manipulation. Methods of enhancing the therapeutic value of patient care are discussed, as is the use of benevolent power in the educational setting. PMID- 10124784 TI - A proposed health model: a step before model confirmation. AB - Health marketers have devoted extensive conceptual and empirical effort toward explaining and predicting individuals' health-related decisions. This paper proposes a health behavior model by combining the health belief model and the theory of planned behavior model. Recent modifications of the Fishbein and Ajzen (1975) model are discussed and an extension is introduced to better explain goal pursuit. These revisions (Bagozzi and Warshaw 1990) are incorporated in the proposed model. PMID- 10124785 TI - Assessing the quality of health care: a consumerist approach. AB - Recent investigations show that nontechnical interventions influence patients' ratings of the quality of health care, and that these aspects of the medical encounter are as important to the patient as the technical aspects; perhaps more important. This paper adopts a consumerist approach and measures patients' perceptions of health care quality using a scale adapted from the consumer behavior literature (SERVQUAL). The study measures health care quality as well as five of its individual dimensions. The findings indicate that, for the whole sample, patients' ratings of overall quality as well as the ratings of four of the five dimensions of care are negative. Further analysis indicates that many individual aspects (scale items) are rated negatively by each of two age groups (25-65 and over 65 years old), but the gap between perceptions of the younger group and their expectations is greater than that of the senior group. The two dimensions of "assurance" and "empathy" are found to be the most discriminating dimensions between the two groups. Other analyses indicate that age, annual household income, and work status significantly relate to overall quality rating. Marketing and strategic planning implications of the results are discussed. PMID- 10124786 TI - The components of satisfaction with outpatient pharmacy services. AB - The true objective of a pharmacy manager is not just to measure satisfaction, but to improve it by identifying and meeting the needs of the patient. This study was undertaken with the objective of determining the relevant components of outpatient pharmacy service which impact the patient's perception of satisfaction, and to develop an on-going instrument to track satisfaction with pharmacy services over time. A survey was mailed to 391 outpatients. Simple correlation was used to identify the salient components of patient satisfaction. Multiple regression was used to determine the relative contribution of each of these components to overall satisfaction. Principle components analysis (PCA) provided the basis for delineating the underlying dimensions of which patient satisfaction is comprised. The two most meaningful factors derived from these data can be defined as professional communication and the physical and emotional well-being of the patient. By understanding the dynamics of the components of satisfaction, pharmacy managers can emphasize those areas which will produce a more satisfied patient, repeat patronage, and enhanced viability for the pharmacy. PMID- 10124787 TI - The instrumental role of product information: a study of warning labels for non prescription drugs. AB - The study extends work in informative labeling, fear appeals, and negative information effects. Respondents were given two labels from two packages, one of which contained the experimental treatment. Warning strength was manipulated at three levels: weak, medium, and strong. The data show that, unlike labels on prescription medications, non-prescription warning labels tend to discourage use of the product. Results have implications for information theorists, marketers, and public policy makers. PMID- 10124788 TI - The effect of consumer perceptions on generic OTC usage among the elderly. AB - The rise of generic alternatives to branded over-the-counter products in the U.S. posits new strategic positioning challengers to marketers. Health care marketers who employ an "imitation strategy" have captured market share by emulating market leaders' product attributes. This implicitly calls for an understanding of the influence that consumers' product perceptions have on their choice of OTC offerings. This study investigates the influence of an elderly sample's perceptions of generic OTC characteristics on their adoption behavior. PMID- 10124789 TI - Nursing home selection: replication, decision recency and strategic implications. AB - This work replicates the essence of prior studies of nursing home selection while paying particular attention to differences between recent and nonrecent decision makers. A number of strategic implications are presented for the marketing of a nursing home along the dimensions that are critical to consumers. PMID- 10124790 TI - Why are older patients and less educated patients less satisfied with health care quality? PMID- 10124791 TI - Marketing quality in nursing facilities. AB - Attempts to fill nursing home beds are an on-going process, with presentations being made to family members, prospective residents and professionals. This study was undertaken to determine what influences exist with the populations involved in these decisions. A questionnaire to five groups elicited values regarding the relative importance of ten components. While there were differences, many similarities were noted. Implications for how beds are marketed became evident. One was in targeting the marketing dollars based on special populations. Facilities are evaluated differently by families, social workers, nurses and others. This demonstrates the need for more detailed information. PMID- 10124792 TI - Enhancing operational efficiency in a health care organization. PMID- 10124793 TI - An applied master's degree curriculum for health services administrators in the 1990's. AB - Central Michigan University offers a Master of Science in Administration (MSA) degree with a concentration in Health Services Administration (HSA) to on-campus students and a large number of non-traditional students at about fifty off-campus locations throughout the continental United States and Hawaii. The degree and concentration emphasize a practical, applied course of study. The University recently undertook a curriculum review of the MSA degree and the HSA concentration with the goal of building on existing strengths and altering the curriculum to accommodate changing educational needs of future health services administrators. The review sought broadly-based input from alumni, employers, faculty/advisors, and a consultant. This ensured both that academicians' and practitioners' perspectives would guide discussions and that decisions would preserve the program's academic quality and applied nature. Generally the review did not create the sort of radical curricular change which some advisors and staff had first thought might happen. Instead it developed a consensus on curriculum content which reemphasized basic managerial skills; provided students additional preparation in cognitive skills of data gathering, analysis, synthesis, and communication; and strengthened strategic planning competencies. PMID- 10124794 TI - Have health care professionals adopted the marketing concept? AB - The marketing concept is a philosophical foundation of marketing which states that an organization's key task is to discover what target markets want and need, and to deliver the desired products and services with more satisfaction than does the competition. This study surveyed nurses, physicians and hospital administrators to determine the degree of acceptance of the marketing concept as a managerial orientation for hospitals. PMID- 10124795 TI - The potential for marketing in the clinical services area. PMID- 10124796 TI - Market signaling for physicians. AB - A Market Signal is a marketing activity that provides information beyond the mere form of that activity. Market Signals reveal levels of the unobserved. Signals occur in a variety of marketing phenomena: advertising, pricing, quality, competitive response to name but a few. In this paper we examine the use of market signals for physicians and provide a set of recommendations on how physicians can better utilize signals in their marketing efforts. PMID- 10124797 TI - A gift for Mom: an OB/GYN public relations project--a case study. PMID- 10124798 TI - A hybrid approach for managing a medical record facility information system. AB - The concept of totally computerizing an organization is appealing; however, this may not always be a practical solution. A medium size medical group, housing 64,000 medical records, located in a mid-eastern state was the basis of this study. The immediate problem was the development of a comprehensive medical records control system. The proposed hybrid solution provides automation with respect to controls while relying on manual methods for execution of process. PMID- 10124799 TI - Applying mail response enhancement techniques to health care surveys: a cost benefit approach. AB - A study of over 1200 persons gave insights into the effectiveness of different appeals in a mail survey for a health-care facility. The influences of financial incentives, contributions to charity and time appeals were studied. Not only was the practical effectiveness of the three different appeals investigated, the cost of obtaining the response rates with each was also shown. The range of response rates was from 25% to 67%. The average cost per return for the different methods ranged from $2.87 to $5.64. A method of testing for the potential bias in a survey is also presented. PMID- 10124800 TI - The NHS and the environment. Friends of the earth? PMID- 10124801 TI - The NHS and the environment. Money to burn? PMID- 10124802 TI - The NHS and the environment. Don't be court out. PMID- 10124803 TI - Green shoots. PMID- 10124804 TI - The generation game. PMID- 10124805 TI - Countdown to community care. Mountains to climb. PMID- 10124806 TI - It all depends. PMID- 10124807 TI - New managed care safe harbor regulations don't protect many mainstream managed care activities. PMID- 10124808 TI - Health care debate in Washington: hard realities lurk behind Clinton reform hoopla. PMID- 10124809 TI - Attacking the kickback violations of competitors. PMID- 10124810 TI - Gloom in the trenches. AB - Internists are deeply troubled--unappreciated by specialists and seemingly undervalued by patients, insurers and hospitals. PMID- 10124811 TI - Who's in charge here? AB - New external pressures on hospitals are transferring power and authority from doctors to administrators and directors. PMID- 10124812 TI - Doctor-hospital competition. PMID- 10124813 TI - Hospitals, doctors, global budgets. PMID- 10124814 TI - Doctors as employees. PMID- 10124815 TI - Volunteers and AIDS service agencies. PMID- 10124816 TI - The local Red Cross in time of disaster: characteristics and conditions of organizational effectiveness during the Loma Prieta earthquake and central Texas floods. AB - This discussion demonstrates that three interrelated activities should improve volunteer organizations' disaster capabilities. These factors include improved disaster planning, learning from related experiences, and improving interorganizational networks. These three activities can dramatically improve the local chapter's emergency response. Networking ought to be the first priority. Through the development of both formal and informal contacts, planning and experience potential become enhances. Without the support and involvement of volunteer organizations, an effective community-wide disaster response would be difficult, if not impossible. PMID- 10124817 TI - Senator rebuffs providers' plea for antitrust exemptions. PMID- 10124818 TI - Concerns over reform show up on Wall St. PMID- 10124819 TI - CEOs at mid-sized hospitals trail peers in other industries. PMID- 10124820 TI - HealthTrust earnings jump in second quarter. PMID- 10124821 TI - Acquisition-hungry HMA signs pact to buy 4 hospitals from Galen Health Care. PMID- 10124822 TI - NME posts 35% higher income in 3rd quarter as psych unit recovers. PMID- 10124823 TI - Task force starts putting on a public face; membership list promised, hearings begin. PMID- 10124824 TI - Reliable funding source crucial to success of rationing program. PMID- 10124825 TI - NME set to use psych-care guides. PMID- 10124826 TI - Lifetime quick to nix acquisition offer by Abbey Healthcare. PMID- 10124827 TI - Foundation's clinics face fight in N. Calif. PMID- 10124828 TI - HCA execs pocket millions with stock option payouts. PMID- 10124829 TI - Ore. waiver gives rationing a shot. PMID- 10124830 TI - Tenn. hospitals suing to block provider tax. PMID- 10124831 TI - The burning question. More hospitals are facing concerns about incineration, considering alternatives for disposing of their waste. PMID- 10124832 TI - Baxter admits mistake in boycott case. PMID- 10124833 TI - Re-employment will take hard work. PMID- 10124834 TI - Pharmacy temps have pluses, minuses. PMID- 10124835 TI - More bond deals, but fewer safeguards. PMID- 10124836 TI - Perspectives. Will an employer mandate sink small business? PMID- 10124837 TI - Efficient lighting within the health service. PMID- 10124838 TI - Low energy as part of a flexible strategy in hospital design. AB - It is well recognised that energy utilisation in hospitals often forms a significant element of the operation and revenue costs of such facilities. Whilst much attention continues to be focused on low energy, the importance of combining this within a flexible design strategy is often less well acknowledged. This paper highlights the need to consider energy when addressing flexibility in the design and planning of hospitals. It also shows how such an approach has been adopted in the UK's first low energy hospital, completed in 1990. PMID- 10124839 TI - Weaving together new alliances. Networking academic medicine and prepaid primary health care: a case study. PMID- 10124840 TI - Weaving together new alliances. Competition, collaboration and change: the emergence of California's new integrated delivery systems. PMID- 10124841 TI - Compensation trends of the 1990s. PMID- 10124842 TI - California hospitals' vision, values and conditions for health care reform. California Association of Hospitals and Health Systems. AB - The hospitals' vision is attainable, but only if the reforms adopted reconcile the dichotomies of universal access, expectations, increasing utilization and rising costs. Rather than defer to the government, California hospitals prefer the development of a meaningful private-public partnership. Incentives are needed which encourage responsible behavior from all parties. Balanced roles and responsibilities provide the best foundation for a long-term solution. By the year 2000, reforms can be implemented and the United States again can lead the world in health and health care. PMID- 10124843 TI - Personnel vacancy and turnover. PMID- 10124844 TI - The challenge of efficient clinical engineering. PMID- 10124845 TI - Weaving together new alliances. Community health networks: meeting the challenge of the 21st century. PMID- 10124846 TI - Weaving together new alliances. A developing model of a community care network. PMID- 10124847 TI - Forgoing life-sustaining treatment: limits to the consensus. Part 2. AB - While substantial progress has been made in reaching a moral and policy consensus regarding forgoing life-sustaining treatment, several holes exist in that consensus where more public discussion and moral analysis is needed. First, among patients who have not been found to be legally incompetent there is controversy over whether certain treatments can be refused. Controversies also remain over damages for treatment without consent, limits based on third-party interests and the ethical integrity of the medical profession, and cases where it cannot be agreed whether the patient is competent. Even greater dispute exists over care of incompetent patients. Perhaps the greatest gap in the consensus arises over limits to the use of the best interests standard. This article proposes replacing it with a "reasonableness standard" that takes into account disputes about what is literally the best for the patient and conflicts of interest between the patient and others. PMID- 10124848 TI - Philosophical foundations of respect for autonomy. AB - Understanding the philosophical foundations of the principle of respect for autonomy is essential for its proper application within medical ethics. The foundations provided by Immanuel Kant's principle of humanity and John Stuart Mill's principle of liberty share substantial areas of agreement including: the grounding of respect for autonomy in the capacity for rational agency, the restriction of this principle to rational agents, and the important distinction between influence and control. Their work helps to clarify the scope and role of the principle of respect for autonomy in health care delivery; its implications for truth telling, informed consent, and confidentiality; and its relationship to other moral principles, such as beneficence and distributive justice. PMID- 10124849 TI - Another Bioethics Commission? PMID- 10124850 TI - The Clinton healthcare plan. PMID- 10124851 TI - "You can make a difference". PMID- 10124852 TI - Operating system components--Part I. PMID- 10124853 TI - Planning a successful process improvement effort. PMID- 10124854 TI - Strategic planning. PMID- 10124856 TI - Security systems: malpractice insurance for healthcare organizations. PMID- 10124855 TI - Performance improvement: a strategy for improving financial strengths and operational efficiency. PMID- 10124857 TI - Patient-centered information systems planning. PMID- 10124858 TI - Management by planning: essential to continuous quality improvement. PMID- 10124859 TI - Testing coding skills as a pre-employment screening process. PMID- 10124860 TI - The FORE Library--past, present, and future. PMID- 10124861 TI - Pam Wear interviewed on radio talk show. Interview by Jack McClendon. PMID- 10124862 TI - National health care policy: the moral issues. AB - To be human is to frame projects in the face of ineradicable limitations. The beginning of sound health care policy is the recognition that one must accept some risks of death, suffering, and disability, and that one should forgo attempting to prevent death, suffering, and disability when the costs are high and the likelihood of success low. Sound health care policy requires recognizing the extreme burdens that would be incurred if one truly attempted to save lives at all costs. Framing realistic health care policy also requires taking account of the circumstance that being rich is positively correlated with living longer, and that the secular moral authority of the state to remedy this circumstance is limited. After 15 years of an all-encompassing health care system, Canada still had striking differences between the life expectancies of highest-earning and lowest-earning citizens. The second challenge for secular health care policy is: To what extent may the state forbid individuals, after they have paid their taxes, from using their private resources to buy better health care so they can live longer than the poor who lack such resources? Or should one focus instead on determining which interventions are most cost effective in narrowing the gap in life expectancy and morbidity statistics between the rich and the poor? PMID- 10124863 TI - Three-dimensional imaging in microsurgery. PMID- 10124864 TI - Compensation caps for medical malpractice. PMID- 10124865 TI - Getting involved in the legislative process: the do's and the don'ts. PMID- 10124866 TI - Electronic billing and related issues. PMID- 10124867 TI - The interface of quality management and the hospital information department. AB - Hospital leadership, the Joint Commission, third-party payors, health care researchers, and others are repeatedly recognizing the essential role of information management in their quality improvement objectives. The health information department must become more proactive in its acknowledgment of these responsibilities by instituting the continuous quality improvement model. This model will prevent proactiveness from turning into mere reactiveness. As suggested by Peter Senge in The Fifth Discipline, "all too often, 'proactiveness' is reactiveness in disguise. If we simply become more aggressive fighting the 'enemy out there,' we are reacting--regardless of what we call it. True proactiveness comes from seeing how we contribute to our own problems." PMID- 10124868 TI - Managing data integrity. PMID- 10124869 TI - The electronic medical record: a definition and discussion. AB - The health care industry has had limited success in achieving some degree of an EMR in the past several years, and the industry has the potential to move even farther in the next decade. As standards begin to emerge and technologies conform to those standards, the industry will begin to see the evolution of a totally electronic patient record. Standard interfaces and hardware platforms, with software products designed to meet a standardized market need, will become more prevalent. Multifunction workstations, voice recognition, and other technological advancements will simplify the data-entry process for clinicians. Legal statutes that support automated records will be established and accepted by the courts, and optical disk image processing systems will take off as the storage medium of choice for the next generation. Because the EMR can provide the benefits outlined here, the health care industry must work together to ensure the success of this vision. As leaders in the health care information management arena, we need to participate in the realization of this ideal for the betterment of our patients, our health care organizations, and the entire health care delivery system. PMID- 10124870 TI - Converting to an optical disk system. AB - Optical disk technology is a move to the future. It is an exciting time to brave the new frontiers and change from a manual to an optical disk system. Since the technology is so new in health care environments and because each facility is unique, there is no "right" way to do optical imaging. Opportunities flourish to "do it your way." The process is challenging and time consuming, but the rewards of providing health information users with a quality record system make the investment worthwhile. Complete, thorough planning and education will ease the transition to tomorrow's system. Stop dreaming, make a commitment, and move forward--optical disk systems in health care are achievable successes! PMID- 10124871 TI - Contract negotiations: preparation, process, and pitfalls. PMID- 10124872 TI - A cost-benefit analysis for materials management information systems. AB - The cost-benefit analysis provided the system planners with valuable information that served many purposes. It answered the following questions: Why was the CCF undertaking this project? What were the alternatives? How much was it going to cost? And what was the expected outcome? The process of developing cost-benefit the document kept the project team focused. It also motivated them to involve additional individuals from materials management and accounts payable in its development. A byproduct of this involvement was buy-in and commitment to the project by everyone in these areas. Consequently, the project became a team effort championed by many and not just one. We were also able to introduce two new information system processes: 1) a management review process with goals and anticipated results, and 2) a quality assurance process that ensured the CCF had a better product in the end. The cost-benefit analysis provided a planning tool that assisted in successful implementation of an integrated materials management information system. PMID- 10124873 TI - The role of the chief information officer in the health care organization in the 1990s. AB - During the next decade, the role of the CIO will change in two major areas: 1. The relative importance of the CIO as the person who translates business and clinical needs into information technology ideas will diminish. Although this portion of the CIO role will not disappear, this role will be increasingly filled by senior management, clinicians, and other members of the hospital staff. 2. The CIO role will need to shift from an emphasis on managing implementations and projects to developing and advancing the infrastructure. CIOs need to distinguish between the expression of the asset (the application portfolio) and the information technology infrastructure (the remaining four components of the asset). While being pressured to deliver more applications, they can fail to invest in and manage the infrastructure. This is a mistake. By neglecting management of and investment in the infrastructure (e.g., staff training and data quality) or by failing to take advantage of new technologies, they can hinder the ability of an organization to deliver superior applications. Poor data quality will cripple an executive information system and a too-permissive stance toward hardware and operating system heterogeneity will hinder the ability to deliver a computerized patient record. Although some management of the infrastructure is in place, in general it is insufficient. Few organizations have both a distinct data management function and a technical architecture plan, and also develop and enforce key technical, data, and development standards. This insufficiency will hinder their ability to effectively and efficiently apply their information technology infrastructure. The role of the CIO will evolve due to several powerful forces.(ABSTRACT TRUNCATED AT 250 WORDS) PMID- 10124874 TI - Review of information technologies for health care. PMID- 10124875 TI - Research review: pattern analysis for quality problems in medicine. AB - In conclusion, these results suggest that pattern analysis may provide a flexible and dynamic tool with which to sort cases prior to review, and evaluate changing medical practice patterns. Patterns analysis may also provide a way to avoid spending time and resources on cases with a low probability of quality problems. Lastly, pattern analysis promises to increase timely information and feedback to health care professionals and organizations. PMID- 10124876 TI - The changing landscape of human experimentation: Nuremberg, Helsinki, and beyond. PMID- 10124877 TI - Paying for undercompensated hospital care: the regressive profile of a "hidden tax". PMID- 10124878 TI - Toward an international standard of scientific inquiry. PMID- 10124879 TI - Tales of informed consent: four years on an institutional review board. PMID- 10124880 TI - The entitlement of Veterans Affairs medical patients to vulnerable population status for human medical research. PMID- 10124881 TI - Bite mark evidence: forensic odontology and the law. PMID- 10124882 TI - The nurse practitioner in malpractice actions: standard of care and theory of liability. PMID- 10124883 TI - Self-managed work teams are a great idea, but hard to sustain in patient care units: three hospital examples illustrate pros and cons. PMID- 10124884 TI - Health care reform. Six questions for President Clinton. PMID- 10124885 TI - Data watch. Snapshots from an employer database. PMID- 10124886 TI - Employers are using "episodes of care" to improve benefits. AB - Employers are turning to claims analysis models developed by consultants to streamline health benefits and to contain the cost of care. Measuring episodes of care is supposed to give employers a more precise picture of what health care costs. PMID- 10124887 TI - To control costs, First Chicago controls the data, too. PMID- 10124888 TI - Using claims data to expand a health promotion program. PMID- 10124889 TI - Projecting the impact of health promotion on medical costs. PMID- 10124890 TI - Employers go beyond HRIS (human resource information systems) to control health care costs. PMID- 10124891 TI - Coalitions pursue electronic networks. PMID- 10124892 TI - Pennsylvania scorecard focuses on quality. PMID- 10124893 TI - Toward a broader vision for data systems. PMID- 10124894 TI - Doctors under the knife. AB - With Bill Clinton's new reforms only a month away, the health-care system is on the operating table--and the doctors are under the knife. Americans have a love hate relationship with physicians: they like the care that doctors provide but hold them to blame for the nation's health-care mess. NEWSWEEK looks at how the culture of medicine may change, assesses doctors' fears--and examines the brave new world of HMOs. PMID- 10124895 TI - Inside the world of an HMO. How one California organization affects the lives of patients and doctors. PMID- 10124896 TI - We are not the enemy: a medical opinion. PMID- 10124897 TI - Civilian Health and Medical Program of the Uniformed Services (CHAMPUS); corrections to the CHAMPUS Diagnosis Related Group (DRG) payment system rates and weights--DoD. Corrections to notice of revised rates. AB - This document corrects an error that appeared in the notice of revised rates which was published on January 27, 1993, (58 FR 6254) and which revised the rates and weights to be used in the CHAMPUS DRG-based payment system effective for admissions occurring on or after October 1, 1992. It also clarifies the rates and weights to be used for two DRGs for which no rates and weights were calculated. PMID- 10124898 TI - Keeping health reform on a fast track. PMID- 10124899 TI - A survey of workload measurement systems: the occupational therapy manager's perspective. AB - Interest in measuring workload for budget specific purposes has increased in recent years as health care managers are being forced to cope with the demands of cost containment and fiscal accountability. This paper reports on a survey of senior occupational therapy managers of Ontario facilities accredited by the Canadian Association of Occupational Therapists (CAOT). Respondents were surveyed on their experiences with, and attitudes toward, occupational therapy workload measurement systems and the ability of these systems to assist in management activities. The survey found that most departments were using the National Hospital Productivity Improvement Program (NHPIP) system. Seventy eight percent of managers indicated they were somewhat or very satisfied with the system, but 60% also indicated that it did not adequately meet all of their management needs. In terms of desirable features of a revised workload system, 87% of managers reported wanting a system based on diagnostic or case mix group recording. Client variables (91%), physical and psychosocial aspects of client care (89%) and therapist variables (85%) were also rated as important factors to address in developing new workload systems. PMID- 10124900 TI - Surviving the management game: workload measurement systems in a cost-conscious environment. AB - Using a procedure-based occupational therapy workload measurement system developed at, and applied by, Sunnybrook Health Science Centre, this paper explores the objectives of such a system from the point of view of the occupational therapy manager. It also takes into account the synergistic relationship between the occupational therapist and the administrative/business aspect of health care, paying special attention to past and present trends in health-care accountability. In this paper it is argued that occupational therapy managers must relate their procedures and overhead costs to actual client care, if they are to be included in programme management and client costing. The process used by occupational therapy to describe its own procedures for the system is outlined. The system was then developed in conjunction with other institutional, financial and management tools for the client cost conversion process. By using a procedure based workload measurement system, occupational therapy is able to accurately describe client costing, thereby articulating our role in client care. PMID- 10124901 TI - Position statement. Vocational rehabilitation services in Canada. Canadian Association of Occupational Therapists. PMID- 10124902 TI - Position statement. Specialization in occupational therapy. Canadian Association of Occupational Therapy. AB - In summary, CAOT acknowledges the benefits of developing and recognizing specialization, however, in order to meet the demands of current and future health delivery systems, CAOT does not officially endorse the development of specialization within the occupational therapy scope of practice at this time. PMID- 10124903 TI - Client-centered practice: the true impact. AB - 1993 marks the tenth anniversary of the release of the Guidelines for the Client Centred Practice of Occupational Therapy which are now central to many clinical programmes and evaluation tools. This discussion paper presents some questions about how the model of client-centred practice is being applied by occupational therapists, and asks whether or not therapists clearly understand the implications of the model. The advantages of this model, such as the ability for the diverse definition of the term "client", its applicability to community practice, and the presentation of therapeutic challenges, are discussed. The author also provides her opinion about how the truly client-centred process should be applied. PMID- 10124904 TI - Revenge of the hippies. PMID- 10124905 TI - Back to basics: protect yourself! PMID- 10124906 TI - Listen up. PMID- 10124908 TI - Strength in numbers in nursing homes in New Hampshire. PMID- 10124907 TI - Strength in numbers in hospitals in California. PMID- 10124909 TI - Working with the 'Thirteeners'. PMID- 10124911 TI - The Phantom strikes again. PMID- 10124910 TI - Doctors don't give. PMID- 10124912 TI - Jump-starting the stalled campaign. PMID- 10124913 TI - Caring for elderly parents and adult children living at home: interactions of the Sandwich Generation family. AB - The study presented here analyzed the patterns of demands made on 66 middle-aged women by their elderly parents and their adult children who were living at home. Factor analyses of the reports of family interactions revealed the presence of five adult children-middle-aged parents interaction factors and four elderly parents-middle-aged parents interactions. These patterns were considerably more complex than previous studies of the Sandwich Generation suggested. As expected, socioeconomic status and health of the elderly parents were related to these family interaction factors. PMID- 10124914 TI - Cognitive predictors of suicide risk among hospitalized psychiatric patients: a prospective study. AB - This prospective study examined the utility of several cognitive variables as predictors of suicide risk among 79 hospitalized psychiatric patients. These variables included pessimism (measured by the Hopelessness Scale), perceived and actual problem-solving ability (indexed by the Problem-Solving Inventory and Means-End Problem-Solving test, respectively), and polarized thinking, self negativity, and construct system constriction and differentiation (derived from a repertory grid). Suicide risk was operationalized in terms of subsequent self report of suicide ideation and staff records of time spent on suicide precautions. Results indicated that hopelessness, self-negativity, and poor problem-solving performance functioned as reliable predictors of suicide risk, whereas self-evaluated problem-solving ability did not. Interestingly, constriction emerged as a significant inverse predictor across. PMID- 10124915 TI - Breaking with tradition. AB - The author discusses why healthcare security directors need to find more creative and innovative ways of providing cost-efficient services. Non-traditional partnerships, he notes, are needed. PMID- 10124916 TI - Blood-borne pathogens: new software cuts through record-keeping maze. AB - OSHA's stricter blood-borne pathogens standard includes stringent record-keeping requirements. Using the computer software that is now available can help make it easier to meet these requirements. PMID- 10124917 TI - The future of healthcare security management. AB - To survive in today's economic climate, security directors must also be good business managers. In this article, the author offers suggestions for achieving this goal. PMID- 10124918 TI - Security as a management service. AB - Noting that hospital security must be viewed as an element of management that supports professional patient care, the author presents a comprehensive overview of the various healthcare security functions from a service-oriented, management perspective. PMID- 10124919 TI - Planning for parking security as designer and operator. AB - This article examines parking security from the unique vantage point of a design professional and consultant who is also a parking facility owner and operator. PMID- 10124920 TI - UAB (University of Alabama at Birmingham) police and the IAHSS (International Association for Healthcare Security & Safety) experience. AB - Implementing both the IAHSS Basic Hospital Security Officer and Supervisory Training Programs provided benefits for UAB's Police Department that went far beyond the training itself. In this article, the experience initiating both programs is described. PMID- 10124921 TI - The utilization of learner-centered development in a proprietary security setting. AB - The author discusses the present role of proprietary security officers, their learning needs, and ways to train them through the application of learner centered development. PMID- 10124922 TI - Checking the personals. AB - The author offers a comprehensive approach to successfully conducting a thorough background investigation of all prospective employees. PMID- 10124923 TI - Healthcare security: the female officer. AB - What is the place of women officers in healthcare security? Where are they heading? And has there been any change for the better? The author offers some answers to these and other questions about the role of women in healthcare security. PMID- 10124924 TI - Selecting physical security equipment. AB - Examining the strengths and weaknesses of the various types of physical equipment currently available is the first step to intelligently selecting the equipment that will best meet your particular security needs. PMID- 10124925 TI - Security dogs cut crime. PMID- 10124926 TI - An employee-oriented security program that works. AB - Effective crime prevention requires continuous employee security awareness and involvement. The author describes one successful program that also includes patient and community participation. PMID- 10124927 TI - Prescription for prevention. AB - Using a case study, this article focuses on the importance of security training for non-security personnel and the impact on healthcare facilities that fail to plan for support from these employees. PMID- 10124928 TI - Wellness programs slow rising costs. AB - Actual cost-savings for company wellness programs may require several years, but such tangible savings as improved morale and decreased absenteeism are almost immediate. PMID- 10124929 TI - A well-trained staff is a key to success. PMID- 10124930 TI - The new JCAHO standards for information management. PMID- 10124932 TI - The problem of the loyal (but unproductive) employee. PMID- 10124931 TI - Pay levels and grades give way to new approach. PMID- 10124933 TI - Taking a different look at change. PMID- 10124934 TI - When being ill is illegal. Women and the criminalization of HIV. PMID- 10124935 TI - Reflections from the inside. Women's health in prisons. PMID- 10124936 TI - Holding faith with the sun--women, health, and justice. PMID- 10124937 TI - Managing risk: a priority in the Health Service. PMID- 10124938 TI - Uncorking the genie. PMID- 10124939 TI - Countdown to community care. Relative values. PMID- 10124940 TI - Vox pop. PMID- 10124941 TI - Be prepared. PMID- 10124942 TI - Decisions, decisions. PMID- 10124943 TI - Where managers don't exist. PMID- 10124945 TI - Fairytale ending? PMID- 10124944 TI - Why trusts need unions. PMID- 10124946 TI - Implementation of a computerized medication administration record. AB - Implementation of a computerized medication record reduces both medication errors and the time pharmacy and nursing services have to spend keeping records. A collaborative team approach to the development of the computerized medication record is integral to its success. The team at Day Kimball Hospital included representatives from departments who participated in goal-setting and problem solving. The collaborative team also addressed the basic problem areas common to the implementation of the project as well as follow up for the purpose of continuous quality improvement. This article provides insight to professionals who wish to implement a computerized medication record through the collaboration of a team. The outcome of the project is a safe medication administration document, which decreases the potential for medication errors and improves patient outcomes. PMID- 10124947 TI - Antibiotic surveillance: the results of a clinical pharmacy intervention program. AB - One of the major goals of any medical center is to provide safe, cost-effective drug therapy. To ensure rational antimicrobial therapy and control hospital drug costs, a criteria-based antibiotic surveillance program was developed. This method of antibiotic restriction provided exceptional cost savings in our institution. Clinical pharmacy interventions resulted in physician education and an 18% increase in compliance with the program criteria producing in a one-year period a $43,000 cost avoidance for antibiotic expenditures. PMID- 10124948 TI - Parenteral drug administration guidelines for the pediatric patient: one hospital's recommendations. AB - With the increasing use of intravenous drug therapy in the pediatric population, pharmacists are frequently faced with questions concerning appropriate methods of parenteral drug delivery. In some instances, these patients are also receiving parenteral nutrition solutions, and often have a limited fluid capacity caused by disease states such as congestive heart failure or renal insufficiency. Limited vascular access is also a frequent concern in the treatment of these patients. As a result, pharmacists are frequently asked whether a medication may be administered along with the PN solution. Although this practice is strongly discouraged, in many cases, especially in the pediatric patient, it is the only way to ensure that the patient is receiving adequate nutrition as well as appropriate drug therapy. Also, by administering medication with the PN solution, rather than interrupting the PN to administer medication, the patient is less likely to develop rebound hypoglycemia. The practice of administering medication through a central venous line intended for PN solutions is not without risks, however. Catheter sepsis and occlusion may result. PMID- 10124949 TI - Safety alert--resolve to work on these ten drug safety issues during 1993. PMID- 10124950 TI - Lilly Hospital Pharmacy Survey. Executive summary. PMID- 10124951 TI - How to implement competitive-cost benchmarking. AB - Companies in the cost- and price-conscious commodity field can achieve clear bottom-line gains through a detailed assessment of competitive alternates for use in purchasing negotiations, price setting, and development priorities. PMID- 10124952 TI - Benchmarking for strategic action. AB - By focusing on three key elements--customer expectations, competitor strengths and vulnerabilities, and organizational competencies--a company's benchmarking effort can be designed to drive the strategic planning process. PMID- 10124953 TI - Get middle managers involved in the planning process. AB - Senior managers have historically been reluctant to involve middle managers in strategy development. As this case study illustrates, however, once middle managers are included into the strategy loop, they can be a powerful force to bring about change. PMID- 10124954 TI - Learning from the best leads to superior performance. AB - Xerox Corp., one of the earliest US proponents of benchmarking, has institutionalized the practice in its organization. This had lead to fundamental changes in how Xerox manages suppliers and develops products. PMID- 10124955 TI - Prototyping: a key to managing product development. AB - Extended development cycles put companies at risk through loss of sales, margins, market share, and credibility as innovators. The author suggests constructing early-stage models to provide a dress rehearsal for new products and help companies develop products in less time. PMID- 10124956 TI - Marketing the by-products of development programs. AB - The Boeing Co., through two of its internal units, has been able to leverage the creativity of staff members and reap significant income from resources that might otherwise be underutilized. PMID- 10124957 TI - Partnering: entering the age of cooperation. PMID- 10124959 TI - The SSD's (social services department) management challenge. AB - Health services managers are used to organisational change, but social services departments have been addressing, and are still facing, major challenges associated with implementing the changes to community care provision. Norma Raynes gives a perspective on local authorities' culture and bureaucracy, which need to change if the community care revolution is to be sustained. PMID- 10124958 TI - The link between benchmarking and shareholder value. AB - Strategic performance can be linked to shareholder value by measuring the positive spread between a company's return on capital employed and the cost of capital. If managers see a significant performance gap in their spread, compared with that of a premier company, they should redefine their strategic goals. PMID- 10124960 TI - The cost of clinical placements. AB - Educational programmes for nurses and the allied professions have increasingly been located within the marketplace through the introduction of educational contracts. But the use of clinical placements and related costs are not addressed within such contractual arrangements. Dawn Forman and Jane Fox assess the advantages and disadvantages. PMID- 10124961 TI - Goal planning, needs assessment & advocacy. AB - The White Paper, Health of the Nation, and the Patients' Charter both seek to emphasise the importance of fully involving and informing patients about the treatment they receive. Much work on implementation of these documents has concentrated on achieving specific targets which, although essential, ignore the key managerial theme of changing behaviour, approach and attitudes in the staff/patient relationship and ensuring that patients are empowered through this relationship. Paul Kennedy and Nigel Pearce suggest that carefully planned and managed change through the use of a comparatively simple and well established approach has a major impact on the achievement of these initiatives. PMID- 10124962 TI - Multi-cultural health provision. AB - It has almost become a cliche now that the changes the NHS is currently undergoing are the most far reaching since its inception in 1948. Some say that the NHS and Community Care Act represents the greatest opportunity for improvement: Rosemary Gillespie looks at the means to better the NHS's poor record on provision for ethnic minorities. PMID- 10124963 TI - Mergers of healthcare facilities: impact upon materiel management. AB - Hospital mergers afford healthcare providers the chance to take advantage of economies of scale, integrate clinical, administrative and support functions, eliminate functional redundancies and redesign patient care delivery. This article explains how such advantages were realized, demonstrated through a hypothetical case based on information obtained from actual mergers. A corporate materiel management division was established, and centralized warehousing, product evaluation and purchasing instituted. Some management positions were eliminated or restructured and patient care services were closed, relocated, or opened among the various entities in the merger. Through these and other changes, the new healthcare system was about to realize about $1.7 million in one-time savings and expects savings in the seven digits over at least the next three years. The article concludes that as hospital mergers continue to increase, the position of corporate director of materiel management will evolve as the next logical career step for materiel management professionals. PMID- 10124964 TI - Hospitals in distress. Problems and solutions. AB - In the past five years the number of hospitals in financial distress has increased alarmingly. And though hospital administrators are feeling more optimistic now that their institutions will survive, they recognize the need to remain vigilant. It is important to recognize the warning signs of financial distress. Hospitals normally proceed through four stages of financial disintegration if no measures are taken to intercede: weak performance/condition, default, bankruptcy and dissolution. As the stages progress, fewer options for redress can be taken and loss of personnel and assets becomes inevitable. Materiel managers who regularly monitor key statistics, such as non-salary expenses per adjusted occupied bed, days in accounts payable, inventory dollars per adjusted occupied bed and so forth, can recognize the warning signs and take appropriate measures. Corrective actions can include reducing inventory levels, renegotiating contracts and leases, rebidding key contracts and supply items and extending purchase payment terms. A case study shows how a medical center experiencing weak performance implemented expense reductions in utilization, contracts, purchase costs/rebidding and inventory for substantial savings. PMID- 10124965 TI - Cost/benefit study of reusable and disposable OR draping materials. AB - A large metropolitan teaching hospital in Canada wanted to know if it should continue to use disposable drapes or return to reusables. In order to determine which choice would be more cost-effective, which would be more environmentally friendly and which would best meet the surgical team's needs while meeting infection control guidelines and other pertinent standards a study was conducted of the then present draping practices and costs. The study was done on the operating room, including inpatient and same day surgery drape usage. It included drape types, patterns of usage, volume of usage and draping practices. An analysis was made based on the actual costs and number of cases for 1990 and the estimated needs for the next year. Drape expenses included handling, storage, removal from user areas and disposal. The study resulted in the conclusion that, at that time, reusable surgical drapes were a viable alternative from an environmental perspective, but based on the information available, they were not considered to be financially competitive. PMID- 10124966 TI - Fetal monitors. ECRI. PMID- 10124967 TI - Assessing the quality of performance measures. PMID- 10124968 TI - Understanding how to label biohazards. AB - Every employee needs to be warned of the potential danger in handling biohazards. Without labels and color-coded bags and containers, our early warning system is defeated. We can significantly reduce the dangers to employees by using this warning system. Additionally, we should be aware of the appropriateness of bags, containers, storage units and other protective covers to ensure they fully protect employees from exposure to the contents, as well as meeting OSHA criteria. PMID- 10124969 TI - Healthcare providers overpaid--poll. PMID- 10124970 TI - Premier execs to discuss Baxter guilty plea. PMID- 10124971 TI - AMI posts 85% jump in 2nd-quarter profits. PMID- 10124972 TI - NME sees big savings through realignment. PMID- 10124973 TI - Omni Health Plan loss casts shadow on Sutter. PMID- 10124974 TI - Mathis gets 'friendly' grilling. PMID- 10124975 TI - New firm to reopen 2 rural hospitals, may buy others. PMID- 10124976 TI - Providers uneasy about lack of details in N.Y. reform plan. PMID- 10124977 TI - Specialty hospitals led Texas closure list. PMID- 10124978 TI - Pa. hospital settles charges. PMID- 10124979 TI - Competition drives up price of Tampa facility. PMID- 10124980 TI - Ariz. land deal fuels talk of Mayo hospital. PMID- 10124981 TI - Mixed signals given on price controls. PMID- 10124983 TI - Dispute raises price of hospital deal $4 million. PMID- 10124982 TI - FTC commissioners to hear Ukiah case. PMID- 10124984 TI - Involve doctors in building networks. PMID- 10124985 TI - Use reform tools in tandem, PPRC urges. PMID- 10124986 TI - More PPOs willing to take the risk. PMID- 10124987 TI - High school programs allow students to major in healthcare. PMID- 10124988 TI - Hospitals put wireless terminals to the test. PMID- 10124989 TI - Tax-exempt financing gets 'safe harbor' rules. PMID- 10124990 TI - Hospitals set merger in Davenport, Iowa. PMID- 10124992 TI - Calif. picks 19 health plans for small-group program. PMID- 10124991 TI - Providers scurry for capital after Towers' bankruptcy filing. PMID- 10124993 TI - Merger to form largest system in Mo. PMID- 10124994 TI - Integration gets another nod from IRS. PMID- 10124995 TI - Providers rank among top industries for layoffs. PMID- 10124996 TI - Abbey drops bid for Lifetime. PMID- 10124997 TI - State aid shift may force closure of all but one of LA County's six hospitals. PMID- 10124998 TI - Flurry of merger plans has eyes focused on Iowa. PMID- 10124999 TI - Bottom line shows improvement. PMID- 10125000 TI - Computer crashes costing hospitals millions--study. PMID- 10125001 TI - JCAHO signs pact for Indicator Monitoring System. PMID- 10125002 TI - White House rolls out plan to sell reform. PMID- 10125003 TI - Task force sketches the outline, but key decisions will have to wait. PMID- 10125004 TI - HHS' budget to be cut $3 billion over 5 years. PMID- 10125005 TI - Compromise needed for reform. PMID- 10125006 TI - Projects serving up a data smorgasbord. PMID- 10125007 TI - Illinois class-action suit targets staff-model HMOs. PMID- 10125008 TI - FHP restructures system in anticipation of reform. PMID- 10125010 TI - Hospitals use patient surveys to meet consumers' needs, get edge in pact negotiations. PMID- 10125009 TI - Companies' use of direct contracting expands into more specialized services. PMID- 10125011 TI - Fla. reform law to spur formation of provider systems. PMID- 10125012 TI - Anesthesia a sleeper for savings. PMID- 10125013 TI - Low interest rates fuel bond sales in first quarter. PMID- 10125014 TI - Managed-care bidding delayed. PMID- 10125015 TI - Risky ad business. Humorous TV spots boost referral calls with 24-hour appointment guarantees. Clarkson Hospital. PMID- 10125016 TI - Do-it-yourself managed care. Case study I: Randall's Medical Network. Case study II: Hershey's Managed Care Plan. AB - Employers, who pay for much of the healthcare in this country, are not waiting for government to restructure the healthcare system. In this cover story, PROFILES examines how two firms formed their own managed care networks to control healthcare cost and quality, and what hospitals did to become players. By understanding the employer' point of view, hospital marketers can better anticipate their needs and develop a marketing strategy to form closer relationships with employers, provide quality care at a lower cost, and increase their market share. PMID- 10125017 TI - 'Joint' venture boosts referrals. Hospital stems outmigration by promoting itself and orthopedic practice. Terre Haute Regional Hospital. PMID- 10125018 TI - Stepping toward quality service. Employee recognition program boosts patient satisfaction. Bristol Hospital. PMID- 10125019 TI - Retooling the baby factory image. Promotion of new center captures 'warm fuzzy' market. Fairfax Hospital. PMID- 10125020 TI - How to bring outpatients in. Campaign for new facility promotes warm, friendly image. Indiana University Medical Center. PMID- 10125021 TI - Hang out at the mall for your health. Health education center promotes wellness. Williamsport Hospital and Medical Center. PMID- 10125022 TI - Triumphing over cancer. Support program aids survivors and breaks down barriers with medical staff. University of Chicago Hospitals. PMID- 10125023 TI - Finding new families on the block. Direct mail package offers new residents reasons to use hospital. Mission Hospital Regional Medical Center. PMID- 10125024 TI - Classic cuisine: innovations in food service. PMID- 10125025 TI - Education, mobility keys to recruiting LTC nursing staff. PMID- 10125026 TI - Computer-aided total quality program lowers incontinence rates. PMID- 10125027 TI - Infusion therapy program requires nursing skill and knowledge. PMID- 10125028 TI - Disaster preparation promotes resident and employee safety. PMID- 10125029 TI - Medicare prospective payment can maximize reimbursement. PMID- 10125030 TI - Survey and enforcement proposal requires facility attention. PMID- 10125031 TI - Mobile dentist provides efficient on-site quality care. AB - Facilities should identify a professional who is sensitive to the needs of the nursing facility population and has advanced training or experience in dealing with geriatric or disabled individuals. PMID- 10125032 TI - Anticholinergics increase risk of adverse drug reactions in elderly. PMID- 10125033 TI - Different philosophies, services integral to assisted living. PMID- 10125034 TI - Defining long term care's role under managed competition. PMID- 10125035 TI - Why customer service counts. PMID- 10125036 TI - Computer-aided administration of a radiology equipment insurance program. AB - The Medical College of Georgia's radiology department has developed computer software that helps the department manage its radiology equipment insurance program. By providing clear menus and choice boxes instead of manual typing wherever possible, the software minimizes the time spent on data entry and management functions. In addition, the software helps track vendor invoices and unreimbursed claims, and maintains a service call log. It also provides a bar coded service ticket for use by in-house engineers. Completed tickets, which are copied and filed, have replaced ledger books. Furthermore, the software helps the department comply with JCAHO requirements, since service tickets link the documentation of quality control problems to their resolution. PMID- 10125037 TI - A practical guide for protecting personnel, pregnant personnel, and patients during diagnostic radiography and fluoroscopy. AB - The following article presents a comprehensive overview of the practical aspects of radiation protection for diagnostic radiology. The topics discussed include background radiation levels, typical exposure levels for radiologic technologists, risk estimates, the relationship between dose and effect, dose limits, personnel monitoring, protective devices, gonadal shielding, and the immobilization of patients. Special attention has been given to the concerns of pregnant personnel and pregnant patients. PMID- 10125038 TI - The pregnant technologist and magnetic resonance imaging. PMID- 10125039 TI - Integrating the needs of the individual and the institution in staff development. AB - This article describes how basic human needs and the needs of radiology departments can be integrated in a way that leads to personal and organizational growth. After discussing human and institutional needs, the author analyzes an advancement program used at one hospital and then presents a case study in effective staff development. PMID- 10125040 TI - OSHA recordkeeping guidelines for occupational injuries and illnesses. AB - The U.S. Department of Labor's Bureau of Labor Statistics administers the occupational injury and illness recordkeeping regulations established by the Occupational Safety and Health Act of 1970. Medical facilities must comply with the law's requirements. This article provides both an overview of the regulations and information on how to obtain the required instructions and forms. While some states administer their own occupational safety and health programs, they must adopt standards and enforce requirements that are at least as effective as federal requirements. PMID- 10125041 TI - Ancillary staffing and compensation. PMID- 10125042 TI - What's up, Doc? The heart of Clinton's health care reform is basic coverage for everybody. PMID- 10125043 TI - Employment references: defamation law in the clinical laboratory. AB - The law of defamation and the risks involved in issuing employment references are discussed. A hypothetical scenario is used to illustrate the legal standards governing the tort of defamation and to apply those standards to employment references. Practical suggestions for a "controlled reference" policy are provided, with the objective of allowing for responsible exchange of employment information and avoiding a defamation lawsuit. PMID- 10125044 TI - Problems in pathology personnel: an historical overview. AB - This article reviews the most important personnel problems facing pathology by focusing on the major segments of the personnel pipeline. Practitioners are retiring at an increasing rate. Inadequate numbers of newly trained pathologists are available to fill vacancies. Training program numbers continue to decline. Attrition of trainees is substantial. Recruitment of new trainees encounters significant barriers. The future of pathology will depend on how wisely we respond to these problems. PMID- 10125045 TI - Babies provide focus for quality improvement team. AB - The challenge of quality improvement (QI) is to take its principles and tools and apply them to active problems in the clinical laboratory. The authors describe a 2-year QI project in which the staff of the laboratory and the neonatal care unit (NCU) significantly improved the care of babies who undergo heelsticks to provide blood samples for laboratory testing. Examples of quality tools used during the project are provided. The success of the QI project is due to the consistent and ongoing efforts of both staffs to care passionately about their customers--the babies of the NCU. PMID- 10125046 TI - Using transportable skills. PMID- 10125047 TI - Health care in the next millennium: not business as usual! PMID- 10125048 TI - Managed competition set to restructure application portfolios. AB - The managed-competition reform plan favored by the Clinton administration is set to turn American healthcare delivery upside down. Information managers cannot afford to become nonchalant about the proposed changes. The imminent reforms will not be fads or trendy experiments. They will be fundamental and far-reaching. PMID- 10125049 TI - Washington mulls over managed-care reform options. AB - April 24, 1994, 10:35 a.m., EST ... the fateful moment when healthcare spending in America is predicted to reach the unbelievable $1 trillion mark. Managed care- or some version of the much-touted managed-competition proposal--is likely to be a part of cost-saving plans now spinning out of the beltway. Open systems governed by standards are the technological bywords of the future. PMID- 10125050 TI - PHOs (physician hospital organization) boast more cost-effective delivery of services. AB - The relatively new concept of physician hospital organizations is gaining strength in the managed-care world. PHOs exist to make and maintain contractual arrangements--especially between employer groups and healthcare providers--and provide information services, physician referrals, utilization-management services and more. PMID- 10125051 TI - CHIME (College of Healthcare Information Management Executives) board members 'tell Hillary' goals for healthcare I/S. Interview by Carolyn Dunbar. AB - At press time, the details of the Clinton administration's healthcare reform package were not yet public. Some information has been leaked, however, fueling speculation about the plan's exact points. Computers in Healthcare asked three board members of the College of Healthcare Information Management Executives what they thought the Clinton healthcare team should know about the information piece of the puzzle. PMID- 10125052 TI - Product overview. HotList--image management. AB - April's HotList features image management services. All data have been provided by individual vendors who responded to our survey questions. Computers in Healthcare has made an effort to contact all vendors within this market. See the 1993 Computers in Healthcare Market Directory, for complete listings. PMID- 10125053 TI - Medicare and Medicaid nursing facilities: charges to residents' personal funds. PMID- 10125054 TI - Special report on corporate/finance. It's time to re-evaluate your joint ventures! PMID- 10125055 TI - Disruptive practitioners: lack of cooperation justifies adverse action. PMID- 10125056 TI - A discharge survey of twenty day treatment program patients. AB - This article describes a discharge survey of patients who were preparing to leave a day treatment program. It developed out of staff interest in patients' beliefs about their preparedness for discharge and patients' view of their experience at the end of their treatment. PMID- 10125057 TI - Mobilizing affect: a possible effect of day hospital treatment for chronic psychiatric patients. AB - A study of 82 Psychiatric Day Hospital patients was undertaken to identify the program's specific effects on individuals with longer standing (i.e., chronic) psychiatric disability. Sociodemographic information and self-ratings, staff ratings and significant-other ratings were used to identify changes in functioning during the 3-week treatment as well as during the period 3 months after treatment. Findings suggest (1) that the Day Hospital patients were as seriously psychiatrically impaired as psychiatric inpatients, (2) that, as a group, they demonstrated a significant improvement in symptoms and functioning, and (3) that the more chronic patients displayed a distinctive pattern of decreased hostility and increased anxiety over the course of treatment. Findings are discussed in relation to the proposition that mobilizing the chronic patient's affect is an important factor in reengaging the therapeutic process. PMID- 10125058 TI - The building blocks of a quality day treatment program: the business plan. AB - This article undertakes two interrelated tasks in order to illustrate the business plan as a dynamic part of the day treatment planning process. To ensure an understanding of basic concepts, it walks the day treatment program planner through the elements of a generic business plan. Building upon this foundation, the paper provides the day treatment program planner with detailed information regarding the various uses to which the material gathered for the business plan may be employed. PMID- 10125059 TI - Understanding partial hospitalization through a continuity-of-care model. AB - This paper discusses the role of a partial hospital program for neurologically impaired children and adolescents on a continuum of service delivery. The effectiveness of a partial program in assisting transitions across treatment and community settings is critical in establishing and maintaining treatment gains. This innovative approach and model are reviewed and discussed within the context of an integrated system of care. PMID- 10125060 TI - Level of disrupted peer relations and poor self-esteem in children with behavior problems and the effectiveness of day treatment. AB - Children with disruptive behavior disorders often show deficits in peer relations and self-esteem, putting them at risk for later life psychiatric disorders. The prevalence of poor peer relations and low self-esteem in behavior-problem children, as well as the efficacy of an intensive day treatment program in addressing these deficits, was evaluated. Twenty-five normal-population (NP) children were matched sequentially by age and sex to 25 behavior-problem (BP) children who received day treatment. Groups were compared on measures of self esteem and peer relations. Pre-/posttreatment comparisons were made for the BP group on the same variables. Mann-Withney U tests showed that the BP group had significantly more problems in self-esteem and peer relations than the NP group. Their scores significantly improved with day treatment and were no longer different from those of the control group. The study indicates that children with behavior disorders present with more problems in peer relations and self-esteem. Intensive multimodal day treatment is an efficient approach for treating these difficulties. PMID- 10125061 TI - A prerequisite for reform: the need for enhanced ambulatory care data. AB - As the recent national election demonstrated, the desire for health care reform emanates from a diverse constituency. The same dynamics that helped foster the growth in ambulatory services--lower costs and improved patient access to emerging technologies--dictate that any significant reforms include an increased role for ambulatory services. The strong correlation between health reform and enhanced ambulatory care generates a need for policy makers to model ambulatory care payment and utilization alternatives accurately. Unless action is taken, these modeling efforts will be significantly hindered by the current status of ambulatory care data. As the nation enters this period of transition and change, it is necessary to consider a lesson learned during the ill-fated voyage of the Titanic. The dimensions of the entire iceberg (i.e., all health care services), not just the portion that is most readily seen (i.e., inpatient services) must be considered. Consequently, enhancement of the capability to collect and analyze ambulatory care data is an essential prerequisite. PMID- 10125062 TI - Knowing your costs: the key to financial success of ambulatory surgery centers under prospective payment. AB - The need for ambulatory surgery centers to have accurate cost accounting systems will only continue to grow in the years to come and such systems can only improve the quality of decisions made for these facilities. With the advent of prospective payment for ambulatory services and continued escalating health care expenditures by government and commercial payors, continued rate cutting can be expected. Therefore, ASCs must know their costs, be able to compare costs to payments, and be able to respond to this information accordingly. Consequently, a strong cost accounting system is an essential vehicle for ambulatory surgery centers that wish to successfully venture into the mid-1990s and beyond. PMID- 10125063 TI - Ambulatory encounter systems: implications for payment and quality. AB - Many key decision makers are looking to AESs solely for purposes of payment. This approach is unfortunate because many systems could be utilized for both payment and quality management purposes. It is important that the professional quality of care community be aggressive and document, through research and practical demonstration projects, how AESs can be used for both purposes. It is only in this manner that resource consumption can be both accurately analyzed and related to quality improvement. PMID- 10125064 TI - The development of outpatient prospective payment systems and the use of ambulatory patient groups by private insurers. AB - Private insurers will likely move to APGs rapidly because of the key advantages that APGs provide. Not only is it necessary to have an outpatient classification system to make utilization review, quality assurance, and customer reporting more meaningful, outpatient prospective payment provides a foundation for the controls on outpatient payments that insurers have been seeking. Because of outpatient volume increases and constraints on inpatient payments that have led hospitals to increase outpatient charges more rapidly, most insurers believe that outpatient payment levels are currently beyond their control. Introduction of an outpatient prospective payment system will shift control over outpatient payment increases from providers to insurers, as has been the case for many insurers who have adopted DRG payment for inpatient services. Once APGs are in place, annual increases in payment amounts will be determined through insurer-provider negotiation or through contractual approaches that limit payment increases to changes in a price index. PMID- 10125065 TI - A quality improvement process for ambulatory prospective payment. PMID- 10125066 TI - Policy issues in implementation of outpatient prospective payment. AB - The development of a classification system such as ambulatory patient groups represents a complicated, but primary, step in the long road to implementation. This article provides an introduction to two issues that have been the basis of significant discussion in the APG development process. PMID- 10125067 TI - Packaging outpatient services: the PACs (Products of Ambulatory Care) demonstration experience. PMID- 10125068 TI - Development and implementation of outpatient rates in New Jersey. PMID- 10125069 TI - Funding hospital-based emergency services. AB - In the final analysis, implementing the ED funding model will not generate additional dollars for hospitals; rather the funding model will function as a tool for reallocating existing health care dollars. This function is particularly important as government funding for health care is subjected to increasing financial restraint. As such, the ED funding model will serve to further the Acute Care Funding Plan principles of fairness and equity, a recognition of the unique funding requirements for ambulatory care, and the need to develop cost effective service delivery. Adherence to these principles is integral to maintaining the affordable, publicly administered national health care system Canadians have come to expect and cherish. PMID- 10125070 TI - The family in hospital critical-care waiting areas. AB - Draws parallels between the phenomenon of waiting as recorded in the Bible and waiting as experienced by families in a hospital context. Provides caregivers with typologies related to waiting and draws from them pastoral implications for praxis. PMID- 10125071 TI - Assessment of pastoral needs among medical outpatients. AB - Reports research findings on samples of hospital outpatients, hospital inpatients, and well persons from the community in an attempt to explore the content and extent of pastoral needs among medical/surgical outpatients. Analyzes and presents statistical data which lead to the conclusion that the spiritual needs of outpatients manifest greater similarity to healthy persons in the community than to hospital inpatients. Notes limitations of the study and discusses praxis implications for chaplains. PMID- 10125072 TI - The nature and extent of hospital competition in a government-funded health system. AB - A national study of Canadian hospitals assessed the perceived level and types of competition and the strategies pursued by these hospitals. Questionnaire data were obtained from chief executive officers in 715 hospitals, yielding a national response rate of 68%. Respondents indicated the perceived level of competition in the environment, the content of competition, and stated hospital strategies. Additional data were obtained on market share and hospital type. Close to half of the respondents indicated little or no competition in their environment, while 30% indicated substantial levels of competition. This represents a significant deviation from conventional wisdom about the Canadian health services environment. Respondents in hospitals with more than 75% of the market share were less likely to perceive competition than those with a smaller market share. CEOs in teaching hospitals and in hospitals located in larger communities reported higher levels of competition. Hospitals competed mostly for capital, programs, and staff; about a third of hospitals competed for patients and no differences were found by type of institution. Those hospitals in more competitive environments were more likely to indicate the use of diversification and horizontal integration as organizational strategies. PMID- 10125073 TI - Occupational stress in health service employees. AB - Levels of occupational stress were examined in 383 employees of various occupations in one health district, as a preliminary to devising a strategy to reduce the negative effects of stress in the workplace. In comparison with white collar and professional workers in industry, health workers reported significantly greater pressure at work, higher ratings of physical and mental ill health, lower job satisfaction, less internal control over their working environment but used more coping strategies. Approximately one in eight of the subjects has stress symptoms of equal magnitude to patients attending clinical psychology outpatient clinics. It was also found that job satisfaction and psychosomatic ill health were related to sickness absence amongst health employees. The implications of these findings and the consequent challenges facing health service managers are discussed. PMID- 10125074 TI - Keeping up with the Joneses: the influence of public and proprietary neighbours on voluntary hospitals. AB - Individual hospitals often share their markets with other nearby hospitals. In this paper we examine how a hospital's ownership and the ownership of its hospital neighbours influence the availability of selected services. The presence of a CT scanner and a newborn nursery were found to be associated with both hospital ownership (voluntary, proprietary, or public) and with the ownership of hospital neighbours. Voluntary hospitals with a proprietary neighbour were more likely to have a CT scanner. These findings suggest that the ownership configuration of local hospital markets is an important influence on patterns of service availability. PMID- 10125075 TI - The effects of for-profit multihospital system ownership on hospital financial and operating performance. AB - The financial and operating performance of independent not-for-profit hospitals acquired by US for-profit multi-hospital systems in 10 Southern states between the years 1978 and 1982 was explored. The impact of system ownership on acquired hospitals was investigated by comparing the average financial performance of hospitals in the two years immediately prior to acquisition to the average for 1984 and 1985 and by comparing changes in the performance of acquired hospitals with changes in matched independent facilities. Findings suggest that for-profit multi-hospital systems were able to improve many of the financial and operating problems of acquired facilities. In comparison to independent not-for-profit hospitals, acquired hospitals were found to increase access to long-term debt, make improvements to plant and equipment, improve profitability, and increase efficiency to a greater extent. Prices in acquired hospitals rose more than those in independents and liquidity decreased to a greater extent. PMID- 10125076 TI - Determining the skills training needs of NHS graduate general management trainees. AB - In 1986 a new graduate training program (GMTSI) was set up in the NHS for general management trainees. The completion of the two year program by the first intake of graduates in the summer of 1988 indicated that more thought needed to be given to identifying the skills and competence training needs in a program of this type. Accordingly, the NHS Training Authority commissioned Warwick Health Services Research Unit to carry out a study into the skills training needs of graduates entering the general management program. The methods adopted involved firstly group and individual semi-structured interviews with participants and managers to identify a wide range of possible skills and competences, and secondly a postal survey of all 230 trainees and mentors who had experience of the training program to help prioritize these skills. In this manner an extensive amount of information was collected on the preferred principal method of delivery for training in each of the 60 plus skills identified (district placement or management education centre), the optimal timing within the 22 month program for training in each of the skills identified and the relative importance of training for each skill. The present paper presents a selection of the study findings. Furthermore, it outlines the manner in which the project findings are being implemented in one education centre based regional consortium to provide graduate trainees with skills training geared to their immediate and short-term training needs. PMID- 10125077 TI - Hospital CEO turnover: modelling more or less durable places to work. AB - This study documents the rising rate of hospital CEO turnovers between 1978 and 1988, a trend that has accelerated since the introduction of Medicare's prospective payment system. Using data from the American Hospital Association, we identify characteristics of hospitals experiencing rapid CEO turnover. Results show that full utilization along with a positive operating margin can prolong the CEO's tenure but ownership and system membership specify the findings. For example, CEO turnover is higher in investor-owned, multihospital systems hospitals if they are small, if their costs are high and if they have recently joined a multi-hospital system. By contrast, in not-for-profit multihospital systems, turnover is higher if they have low occupancy and low operating margins. CEO turnover in not-for-profit, freestanding hospitals is higher in metropolitan areas and in the Western region of the US as well as in hospitals with low occupancy, low operating margins and lower costs per patient day. Governmental hospitals experiencing higher CEO turnover are small, metropolitan and tend to be located in any region except the Midwest. Many have recently joined a multi hospital system and have experienced low operating margins. PMID- 10125078 TI - Graduate recruitment in the future. AB - Many organizations face increasing difficulty, not to mention direct competition, in recruiting the appropriate quality and number of graduates. This paper examines the basic demographic position and then records the approaches organizations are taking to overcome the shortfall in graduate recruitment. Finally, some options and alternatives are considered. PMID- 10125079 TI - Health incentive systems and risk rating: do physicians become sentinels or shepherds? PMID- 10125080 TI - Health care: a prescription for change. PMID- 10125081 TI - Rx: managed competition. PMID- 10125082 TI - Communication techniques for HMO physicians. AB - A program utilizing a council of health professionals found three areas of significant importance in physician/patient communication: inquiry, instruction and empathy. Attention to these three areas can improve patient adherence and decrease patient anxiety. The result can be more satisfied patients. PMID- 10125083 TI - Prescribing for unlabeled indications. AB - Little is known about the practice of physicians prescribing drugs for unlabeled (off-label) indications (prescribing approved drugs for indications not listed/approved in the FDA New Drug Application). In order to learn more about this practice, a 17-item questionnaire was administered to 251 physicians, many of whom practiced in some form of managed care setting. Respondents were asked for which of several indications they would prescribe five specific drugs. Some of these indications were labeled (approved by the FDA) while others were not. In addition, respondents were asked to list drugs they thought were commonly used for unlabeled indications. Results indicated that 88% of the physicians used drugs for unlabeled indications. Nearly 25% prescribed off-label daily. Correlations between demographics and prescribing practices were conducted, and descriptive data on sources of information used for new drug uses are described. Efficacy and payment considerations make this subject important for policy and practice decisions. PMID- 10125084 TI - Evaluation of an early newborn discharge program. PMID- 10125085 TI - Feedback of clinical performance information. AB - Measurement of practice performance, increasing throughout the health care industry, can result not just in performance assessment, but in performance improvement. An important early step in achieving improvement is to feed back the performance information. This paper discusses how the content of the information and the process of the feedback itself can facilitate physicians' buying into and using the data to improve practice. PMID- 10125086 TI - An icon in distress ponders the future: compete or collaborate? IBM. Interview by William Andrew. AB - Bureaucratic, buttoned-down, big-box-based IBM, reeling from a record $5 billion loss in 1992, free-falling stock value, a $77 billion market value slide since 1978, layoffs that could downsize the giant firm from 406,000 employees in 1986 to 235,000 in 1993, now limps away from the 8-year era of CEO John Akers. His yet to-be-announced replacement, for what many people call the single most difficult job in the country, will inherit a set of heritage-based problems that might send even Lee Iaccoca running for cover. In an exclusive interview with Scott Roeth, Health Industry Marketing Director, IBM UNited States, contributing editor William Andrew, P.E., posed the following questions regarding IBM's commitment to the healthcare marketplace. Roeth's answers may prove insightful for HI's readers. PMID- 10125087 TI - Imaging workstations in the clinical areas at the University of Cincinnati Hospital. PMID- 10125088 TI - Instant image: scanning photos into the electronic medical record. PMID- 10125089 TI - Healthcare DIPs into optical. AB - The number of document imaging systems installed in healthcare facilities will approach 100 in 1993, according to a results of a recent study conducted by International Data Corp., Framington, Mass. That number represents an annual growth rate of 125 percent, up from a mere nine systems--valued at $4.85 million- installed in 1990. This robust growth rate is expected to moderate to 42 percent annually, to 189 systems worth $48.7 million, by 1995. PMID- 10125090 TI - Mammography information systems: a practical purchasing primer. PMID- 10125091 TI - Chart tracking systems: prerequisite to medical records automation. AB - In summary, automation of chart tracking is the place to begin full-scale medical record automation. Its collected data provides the framework for design and implementation of other systems, frees resources to use data to best advantage, and allows employees to make a comfortable transition from manual methods to computerized charts. A properly designed tracking system is the first step on the path to the electronic medical record. PMID- 10125092 TI - The evolution or picture archiving & communications systems. Mini PACS: picture perfect? PMID- 10125093 TI - Speed-of-light transactions: EDI's (electronic data interchange) paperless promise. PMID- 10125094 TI - Fiching for an alternative: optical disk archiving cost-justified. PMID- 10125095 TI - Charting a course toward the electronic medical record at Stanford. PMID- 10125096 TI - Simultaneous demands for chart information will drive new technologies. PMID- 10125097 TI - Right-to-know laws. PMID- 10125098 TI - Sporicidin update: are the government's regulatory teeth tearing a hole in industry? PMID- 10125099 TI - OSHA issues safety rule for confined-space entry. PMID- 10125100 TI - Medical waste treatment technology 4: MedAway-1. AB - This is the fourth in a series of articles on alternative methods of destroying tracked medical waste. While previous articles have featured technologies designed to handle large quantities of waste, here we describe a smaller, more compact system designed for use in a laboratory or small hospital setting. ECRI has not tested this system; our description of this device does not imply endorsement by ECRI or CHEM. PMID- 10125101 TI - Radical surgery. PMID- 10125102 TI - Boren revisions, asset transfer targeted. PMID- 10125103 TI - Untapped opportunities in non-metro markets. Small scale retirement communities work. PMID- 10125104 TI - What are the actual requirements for storing medical records in a long-term care facility? PMID- 10125105 TI - LTC financing uncapped. Capital begins to flow again. Interview by Jim Bowe. AB - For those who are patient and know where to look, financing for nursing homes shows signs of rebounding. Capital is slowly but surely making its way back into the long-term care industry after several lean years that forced many operators to put their expansion plans on hold while they waited for more favorable lending conditions. To get a fix on lenders' willingness to finance nursing homes, Contemporary Long Term Care recently interviewed Gary Veloric of J.G. Wentworth and Company, Inc., Philadelphia. Veloric, who is president and CEO of the merchant bank specializing in long-term care financing, has raised more that one half billion dollars over the last eight years for nursing home and retirement housing operators. The comments on the following pages are excerpts from that discussion. PMID- 10125106 TI - Retirement housing at home. Club offers services within members' residences. PMID- 10125107 TI - Weighing seniors' preferences. Retirement community survey proves valuable positioning tool. PMID- 10125108 TI - HMO. A new home for long-term care. PMID- 10125109 TI - Blue ribbon recipe. Experts share their advice for survey success. PMID- 10125110 TI - Proper plan of correction responses. PMID- 10125111 TI - New gains in the fight against pain. AB - Thanks to recent research, millions dogged by chronic pain are finding hope. One surprise: Surgery patients should give themselves painkillers whenever they need them. PMID- 10125112 TI - Transplant study supports "centers for excellence". PMID- 10125113 TI - Medical staff development: manpower or strategic plan? PMID- 10125114 TI - Physician recruitment: guidelines for a safer tomorrow. AB - As hospitals are challenged to recruit and retain qualified medical staff, they must continually consider the legal ramifications of their actions. Developing a physician-hospital alliance may conceptually be an excellent idea within a medical-service area, but rulings by the Office of the Inspector General and the Internal Revenue Service can challenge the decisions of hospital administrators and boards. Writing for the National Institute of Physician Recruitment and Retention, Roger G. Bonds and Michael R. Callahan address legal ramifications of physician-hospital alliances. PMID- 10125115 TI - Plan retreats on Clinton's health care reform bill(s). PMID- 10125116 TI - Dallas: cooperation for responsive health care. Interview by Donald E.L. Johnson. PMID- 10125117 TI - Patient satisfaction: what we know about and what we still need to explore. PMID- 10125118 TI - America's health care system and its future: the view of a despairing optimist. PMID- 10125119 TI - Production process substitution in maternity care: issues of cost, quality, and outcomes by nurse-midwives and physician providers. PMID- 10125120 TI - Strategic sensemaking and organizational performance: linkages among scanning, interpretation, action, and outcomes. AB - This study investigated the strategic "sensemaking" processes of scanning, interpretation, and action and how those activities are linked to organizational performance. Using path analyses on data from 156 hospitals, we tested the direct and indirect effects among these sensemaking processes and performance outcomes and developed a model of their relationships. In a more general sense, the research represents an attempt to provide insight not only into relationships between cognition and action, but also into the links between those fundamental processes and organizational performance outcomes. PMID- 10125121 TI - Effects of stressful job demands and control on physiological and attitudinal outcomes in a hospital setting. AB - We tested the job demands--job control model of stress with a group of 136 registered nurses. Significant interactions between subjective and objective measures of work load and a measure of perceived control predicting physiological and attitudinal outcomes indicated support for the model. In addition, objectively assessed job demands were significantly associated with blood pressure and cortisol levels. The model also predicted elevations in physiological responses after individuals left work, suggesting that potentially health-impairing reactions to jobs that have high demands and low controllability might carry over to home settings and thus pose a high risk of long-term health impairment. The results have implications for the role of personal control in occupational stress generally and for nurse-management practices specifically. PMID- 10125122 TI - When familiar is different. PMID- 10125123 TI - Contracting for radiologists in the new age of healthcare. PMID- 10125124 TI - Magnetic source imaging. A new method of brain analysis. PMID- 10125125 TI - Take two tablets and call me.... PMID- 10125126 TI - Radiosurgery. Orchestration of imaging and medical professionals. PMID- 10125127 TI - Job satisfaction among radiologic technologists in selected hospital imaging centers. PMID- 10125128 TI - Shaping delivery by sensitive measure. PMID- 10125129 TI - The connection between individual responsibility and mammography. PMID- 10125130 TI - The elderly healthcare consumer: a critical review of information source use and advertising recommendations. AB - A critical review of the literature is undertaken to examine the state of the art and degree of articulation of theories, methods, and findings between health care marketing and the traditional "generic" marketing literature as related to knowledge of information use by and advertising to the elderly consumer. Evaluative criteria suggestive of scientific rigor are applied to this domain as consistencies, discrepancies, and gaps are identified. Recommendations for future research are advanced. PMID- 10125131 TI - The relationship between technology and task design in hospital nursing units. AB - An empirical assessment of the use of the Hackman, Oldham, Janson, and Purdy (1975) implementing principles as a theoretical link between hospital nursing unit technology and job design is presented in this paper. While support for the implementing principles as an integrating mechanism was found to be weak, some insights into organization theory are noted and suggestions for future research resulting from this study are outlined. PMID- 10125132 TI - Comparison of subjective versus data base approaches for improving efficiency of operating room scheduling. AB - This paper compares subjective and four data-based models to estimate length of surgery for operating room scheduling systems. The four data-based models for predicting case block length are based on 1) procedure, 2) procedure and surgeon, 3) procedure and case complexity, and 4) procedure, case complexity, and surgeon. Data-based approaches performed better than subjective estimates. In establishing data-based standards it is more important to account for complexity of cases than for differences among surgeons. PMID- 10125133 TI - Managing the Fife ENT (ear, nose and throat) waiting list: the 1989 review of problems. AB - In-patient activity of Fife Ear, Nose and Throat (ENT) wards and of Fife ENT consultants are higher than the Scottish averages. Out-patient activity appears to operate at a lower level and hundreds of patients remain on the Fife waiting list for operations. An analysis of 731 patients on the ENT waiting list in 1989 showed that 15% had been waiting for over three years. Over 350 hours of theatre time and over 3,200 in-patient bed days would be required to clear this waiting list. Adopting a guillotine tonsillectomy operative procedure without anaesthesia would make a major contribution to a rapid reduction of the waiting list. Although this is reported to be quick, relatively painless and remarkably free from haemorrhagic complications, it appears not to be acceptable in our medical culture at the moment. A life table analysis suggests that Fife is failing to operate on patients at a rate compatible with the needs of the community: current trends of operating suggest that over one half of patients will be on the waiting list for operations three years after being placed on it. The Secretary of State's 1989-90 waiting list initiative, the appointment of an extra ENT consultant and the allocation of additional operating theatre time may help to resolve these difficulties. PMID- 10125134 TI - The reproduction of physician autonomy in Ontario medical group practice. AB - A belief exists about the advantages of group medical practice over solo practitioners. The paper through a survey of 105 group practices examines a number of organisational and operational factors. The results suggest that practices are not always organised in a way to maximise the benefits of group operation but are still characterised by an individualistic approach. PMID- 10125135 TI - The results of a study on certified sickness amongst nurses in a Welsh Health District. AB - There is a general impression given in the Occupational Health literature that certain socioeconomic variables are associated with increasing days lost from sickness absence. This writer does not wish here to take issue with these findings. Instead it is hoped to show that when certified sickness data for staff in a Health District is analysed in the search for associations between days lost and the variables age, sex, length of time in post, marital status and hours worked there is no overall convincing evidence that these variables are associated with more or less days lost by workers in the population from which these samples are taken. Calculations of the power of the study were made to compute the likelihood of the study of detecting a hypothesised degree of association as a "statistically significant" one assuming a critical p. value of 0.05. PMID- 10125137 TI - Strong interest in Canterbury nursing service. PMID- 10125136 TI - Maximising the benefits of competing non-core support services. AB - Sarah Meads is General Manager of Serco Health Services. In an earlier article "Transforming Support Services Through Competition", published in the September/October 1992 issue, she described the use of external competition to create incentives to transform support service functions. In this article she describes how competing single service contracts or simply combining services that appear functionally related, for example, cleaning and orderly services, is no longer enough if health service providers are serious about maximising the benefits of competition. This is because a superior result may be achieved through combining several support services under one single contract, or facilities management contracting, selected on the basis of delivering client outcomes. The ability to maximise the benefits relies on providers adopting a change in attitude and a relentless focus on client needs which is not constrained by existing organisational structure. PMID- 10125138 TI - Perinatal care crucial for very premature babies' later development. AB - Thanks to improved medical technology, babies born very prematurely now have a much greater chance of surviving than they used to. A research team from the University of Auckland and National Women's Hospital is examining the long-term effects of perinatal difficulties on children weighing under 1500g at birth. One major aim is to discover whether the increasing number of immature infants who survive has led to a greater proportion of children with problems. The group's findings indicate that this is not so. Dr Barton MacArthur (Education), Associate Professor Ross Howie (Paediatrics and National Women's Hospital) and Dr Anne Dezoete (MNational Women's Hospital, Child Development Unit) prepared this report on their cooperative research association. PMID- 10125139 TI - South Canterbury unit leads country with its breast screening programme. PMID- 10125140 TI - Bar coding hospital patients. PMID- 10125141 TI - Independence and flexibility--hospital trusts in Britain's new-style National Health Service. PMID- 10125142 TI - Health benefits from advanced materials technology. PMID- 10125143 TI - 'Babylog' system aids cot death research. PMID- 10125144 TI - The health of nations. AB - In his new book, "Fighting for New Zealand", Labour Leader Mike Moore focuses on the challenges of growth, jobs and economic prosperity, and offers his prescription for achieving progress. In this article, based on a chapter in the book titled "The Health of Nations", Mr. Moore argues the case for the advancement of New Zealand's public health system. He advocates creative use of new technology to emulate the pioneering vision that gave New Zealand such outstanding services as Plunket and school dental nurses. PMID- 10125145 TI - Emerging risks: inappropriately prolonged mechanical ventilation. PMID- 10125146 TI - New study identifies hazards for TQM teams. PMID- 10125147 TI - Avoiding TQM "land mines" in medical staff organizations. PMID- 10125148 TI - Baptist Memorial Hospital meets comprehensive child-care needs of employees. PMID- 10125149 TI - Age at migration, social connections, and well-being among elderly Hispanics. AB - This study employs data from the 1988 National Survey of Hispanic Elderly People to examine the impact of age at migration and social contacts on the self assessed health, functional disability, and life satisfaction of elderly Cuban Americans, Mexican Americans, and Puerto Ricans in the United States. The results indicate that the difficulties associated with immigration late in life undermine an older person's morale and interfere with the ability to perform basic activities of daily living. Although children are important sources of social support for all Hispanic groups, our findings also reveal important group differences in the use of other community social resources and their impact on health. Older Cuban Americans, in particular, appear to benefit from residence in ethnic enclaves in which they have largely duplicated their culture of origin. PMID- 10125150 TI - Sociodemographic and health characteristics of Anglophone Canadian and U.S. snowbirds. AB - Data from a survey of anglophone Canadian snowbirds wintering in Florida and one of U.S. snowbirds in the Texas Lower Rio Grande Valley are used to compare the two groups in terms of sociodemographics, chronic health conditions, and use of health services. The Canadians were younger and reported fewer chronic problems than did the U.S. snowbirds; Canadians aged 65 and over had a lower reported prevalence for four of five chronic conditions than did persons of the same age in the Canadian population. In contrast, the U.S. snowbirds had higher reports on four of the conditions than did U.S. Whites aged 65 and over. Hypotheses are suggested for future research, and methodological issues are discussed. PMID- 10125151 TI - Coping effectiveness in nursing home residents. The role of control. AB - The purpose of this study was to investigate the role of perceived control in the selection and effectiveness of coping strategies used by nursing home residents. A path analysis of a model of coping effectiveness was conducted using a cluster sample of 100 nursing home residents. Respondents were assisted in completing the Importance, Locus, and Range of Activities Checklist, the Jalowiec Coping Scale, two self-anchoring ladders measuring coping effectiveness, and an item measuring perceived health. Mental status was measured with the Pfeiffer Short Portable Mental Status Questionnaire. Results demonstrated that mental status and functional ability were positively related to perceived control (p < .01). Perceived health and the use of secondary control (e.g., prayer, getting help from family, and depending on others) were the only two variables positively influencing coping effectiveness (p < .01 and p < .05, respectively). Longitudinal studies are recommended to investigate these relationships as they evolve. PMID- 10125152 TI - Evaluation of the Drug-O-Matic automated dispensing system. AB - OBJECTIVE: To compare the time savings and accuracy rates of a manual dispensing system with the Drug-O-Matic (DOM), an automated tablet and capsule counter. DESIGN: In part one, phase A of this two-part study, a time trial measured the time of the prescription-filling process using the manual method. In part one, phase B, a time trial measured the time of that process using the DOM system. Part two of the study measured the accuracy of the DOM. RESULTS: The DOM requires 9 hours 42 minutes less per day than does the manual system. However, its accuracy causes some concern because we found a 14 percent discrepancy rate in terms of over- and underfills. CONCLUSIONS: Our initial experience with the DOM suggests significant time-savings potential compared with the manual method of prescription filling, and our institutional goal is to translate the time saved into other activities that will allow us to function as a free-standing pharmacy. A concern is the DOM's 14 percent discrepancy rate. Further studies are needed to confirm or challenge our initial findings. PMID- 10125153 TI - Educating patients' families on their level. AB - OBJECTIVE: To provide well-written, easy-to-read, comprehensible education materials without losing sight of their medical accuracy. PARTICIPANTS AND THEIR DUTIES: Employees from all hospital departments develop first drafts. A multidisciplinary committee, patient-education program (PEP), composed of a pharmacist, dietitian, respiratory therapist, radiology technician, medical illustrator, and inpatient and outpatient nurses facilitate these handouts. Laypeople critique the readability and experts evaluate content. METHOD: Patient education handouts are coded into one of seven divisions and tracked through the stages of writing, word processing, proofing by experts, proofing for readability, illustrating, printing, and distribution. PHARMACY PEP DESIGN: A medication template is used to standardize the format and general information that needs to be included in all medication education materials. CONCLUSIONS: Through better-written and more comprehensible educational materials, patients' families are able to understand the medical treatment being rendered, thereby easing stress and encouraging their participation in total care. PMID- 10125154 TI - ASHP (American Society of Hospital Pharmacists) accreditation standard for pharmacy technician training programs. PMID- 10125155 TI - When others must choose: deciding for patients without capacity. The New York State Task Force on Life and the Law. PMID- 10125156 TI - The Metropolitan New York Ethics Committee Network: coming together at a time of concern. PMID- 10125157 TI - Point and counterpoint. Should HECs report to the medical staff rather than to the administration, board of trustees, or other administrative office? Yes. PMID- 10125158 TI - Point and counterpoint. Should HECs report to the medical staff rather than to the administration, board of trustees, or other administrative office? No. PMID- 10125159 TI - Point and counterpoint. Should HECs and networks initiate regional, state, and national health policies to prevent recurring bioethical dilemmas? Yes. PMID- 10125160 TI - Point and counterpoint. Should HECs and networks initiate regional, state, and national health policies to prevent recurring bioethical dilemmas? No. PMID- 10125161 TI - Selected bibliography on HECs--1992. PMID- 10125162 TI - A paradigm shift for ethics committees and case consultation: a modest proposal. PMID- 10125163 TI - The nurse's role on the healthcare ethics committee. PMID- 10125164 TI - Perspectives. The Clinton budget: preventive health gets prime time. PMID- 10125165 TI - Perspectives. Retiree health benefits come under the knife. PMID- 10125166 TI - Perspectives. A looming tidal wave of need: long term care. PMID- 10125167 TI - Promoting family health. PMID- 10125168 TI - Medical mission. Children's Hospital and Health Center, San Diego, CA. PMID- 10125169 TI - Designing for children with AIDS. PMID- 10125170 TI - The effect of health care coverage on medical cost, utilization, and well-being of the aged. AB - The relationship of medical insurance, utilization and health status indicators was examined for 463 elderly individuals. The uninsured were less well and tended to utilize the health care system more often than those with more types of coverage. Need was found to be the best predictor of utilization. A profile describing those with above average levels of well-being also was developed. Methodological issues and health care policy recommendations are discussed. PMID- 10125171 TI - The priorities of the health care system vs. its financing: political realities vs. financial realities. AB - The impact of technology and the emphasis on tertiary specialty care have no inherent limits of cost escalation. Likewise, they dislocate health care resources since general and secondary care become more expensive as the impact of the high cost emphasis of health care trickles down to the costs of primary and secondary care. The change areas will involve: the principle of regionalization of specialty care and resident training, a uniform system of costs and reimbursements for all specialized medical and hospital care, the rationing of high technology specialty care and the application of prospective systems of payment to all institutional and physician specialty services. PMID- 10125172 TI - Selling virtue: ethics as a profit maximizing strategy in health care delivery. PMID- 10125173 TI - The Medicare lien--an equitable response to the Medicare funding problem. PMID- 10125174 TI - Health characteristics and utilization of public sector health facilities among migrant agricultural workers in Orange County, New York. AB - Publicly subsidized medical clinics were established to provide migrant farmworkers with minimal access to mainstream medical care. Nevertheless, migrant farmworkers delay treatment of health problems and refrain totally from use of medical facilities. The present study explores the health status and utilization of subsidized migrant clinics by farmworkers in a vegetable production county (Orange County) in upstate New York. Multivariate analysis indicated that economic resources, mental health status, health insurance coverage, language, education and utilization of acute care facilities are important predictors of these decisions. PMID- 10125175 TI - An analysis of trends in average length of stay in Maryland Hospitals, 1980-1988. AB - Nationally, the introduction of the Medicare Prospective Payment System (PPS) in 1983 caused a substantial change in average length of stay (ALOS) trends in hospitals. This resulted from an average decline in DRG-specific length of stay, partially offset by an increase in the relative contributions of DRGs with longer length of stay. The study finds that the interaction of these two opposing forces was present in Maryland as well as in the United States during the early and mid 1980's although Maryland was not under PPS. The analysis also indicates that these post-PPS ALOS trends tapered off gradually during 1985-1988, although the trends still continued to show the same pattern of movement. PMID- 10125176 TI - Healthcare reform: the problems and possible prescriptions. PMID- 10125177 TI - Alabama EMS: the state of the State 1993. PMID- 10125178 TI - Hospice. Increasing public familiarity a priority. PMID- 10125179 TI - CQI takes quality a step beyond. PMID- 10125180 TI - The benefits of a donor wall. PMID- 10125181 TI - TQM: a primer. PMID- 10125182 TI - A unique fellows program for up-and-coming fund raisers. PMID- 10125183 TI - A strong case well told is always the key to success. PMID- 10125184 TI - Prospect research: the whys and hows. PMID- 10125185 TI - Community care networks. PMID- 10125186 TI - Steam(boat)ing ahead. PMID- 10125187 TI - Demographics and the charitable estate planning marketplace. Part 1--The changing landscape of planned giving. AB - This award-winning article will appear in two parts. Part 1 examines demographic changes among older Americans and how such changes will, and should, affect planned giving programs. Part 2, which will appear n in the AHP Fall Journal, will more closely examine the various subgroups within the "mature market." PMID- 10125188 TI - Hillary Rodham Clinton Task Force moves to reform healthcare. PMID- 10125189 TI - Minnesota's experience working with a lobbyist. PMID- 10125190 TI - Electronic signature--as it is today. AB - Hospitals must change the way in which they provide care in order to survive in the changing healthcare environment. Some of these changes will be obvious while other changes will be challenged by both internal and external sources. It is to be expected when a major industry is in the middle of transition. The issues surrounding the use of autosignature programs exemplify this reaction. From this perspective, AHIMA believes current requirements and procedures must be critically questioned. Accrediting and regulatory agencies should actively engage in, and respond to, this conversation. PMID- 10125191 TI - Removal of calculi in the ureter, urinary bladder, and kidney. PMID- 10125192 TI - Fees for medical record copying--chaos revisited. PMID- 10125193 TI - Programming languages. PMID- 10125194 TI - Accelerated programs in health information management. PMID- 10125195 TI - Optical disk storage and health information management. PMID- 10125196 TI - Change is good: one hospital's experience with optical disk. PMID- 10125197 TI - Would we do it again? A deluge of paper prompted this Maine facility to go optical. PMID- 10125198 TI - Optical imaging system implementation: our experience. PMID- 10125199 TI - Health information department reorganization resulting from the implementation of optical imaging. AB - Our experience clearly demonstrates that transitional periods which include significant change can be very difficult. Nonetheless, we have described our organizational issues not to discourage, but to educate our readers. We are confident that the staffing changes, departmental reorganization, and other changes generated by the imaging system will have a positive impact on everyone. The institution will enjoy improved customer service and enhanced patient care. PMID- 10125200 TI - Optical disks--the beginning to the end of the paper trail! PMID- 10125201 TI - Starting up an imaging system: lessons learned. PMID- 10125202 TI - Patient health record imaging systems and the computer-based patient record. PMID- 10125203 TI - Physician record completion via imaging: one facility's experience. PMID- 10125204 TI - The technical evolution of document image processing. PMID- 10125205 TI - Implementation of electronic DRG attestation completion. PMID- 10125206 TI - Health care issues in the developing world. Interview by Matthew D. Pavelich. PMID- 10125207 TI - Can critical care be delivered humanely? AB - Technological advances have tremendously altered the nature of health care delivered to the critically ill. High-technology care should be balanced with a humanistic approach to meet the needs of the "whole person". Humanistic care can be fostered by cultivating open dialogue among patients, families, physicians, nurses, and other involved staff. PMID- 10125208 TI - Laboratory automation: a model. AB - Today's health care providers are keenly aware of the need to do "better with less" in an environment of shrinking resources. This article describes a process for automating laboratory services that is based on expertise, safety, productivity, and a set of guiding principles. The process used to create this model, which integrates people with the flow of information and materials, can be used to re-engineer any knowledge-based process. PMID- 10125209 TI - Creative solutions through utilization management. AB - In this second and concluding report on utilization management practices at Lions Gate Hospital in British Columbia, the authors outline various initiatives that improve efficiency and increase quality of care. Topics explored are laparoscopic cholecystectomy as an example of new technology that can save time and resources, a home IV therapy program, co-ordinating care by means of coordinated care mapping, and improving operating room efficiency through rigorous scheduling. PMID- 10125210 TI - Waste management: three R's (reduce, reuse, recycle) reduce waste, save money. AB - This article outlines the problems of waste disposal in health care facilities and offers practical ways to reduce, reuse, recycle, and compost waste in the health care setting. The author presents data on medical waste, gives alternatives to incineration, and describes recycling practices at various hospitals. PMID- 10125211 TI - Evolutions in hospital funding in Canada. AB - Although global funding continues to be the principal method used for hospital reimbursement in Canada, a number of provincial ministries of health have recently introduced supplementary funding approaches. These initiatives aim to replace the mentality of "what you spend is what you get" with a funding system that is based on what hospitals produce. This article compares such initiatives in British Columbia, Alberta, and Ontario. Aspects examined include the hospital "product", cost determination, incentives, the definition of equity, the figure of merit for funding, population-based funding, and quality. PMID- 10125212 TI - Report from The Centre for Quality in Governance. Reflecting the community's diversity. AB - In its ongoing effort to promote and ensure the highest quality of health care throughout Canada, the Canadian Hospital Association has entered into a partnership with The Centre for Quality in Governance, a Toronto-based non-profit organization formed in 1992. The Centre's mandate is to improve the effectiveness of organizations by researching and evaluating various aspects of governance. The following article, by R Scott Rowand, President and CEO or The Wellesley Hospital in Toronto, is the second of six Centre-generated reports that Leadership in Health Services will publish in 1993. PMID- 10125213 TI - Streamlining mail services. PMID- 10125214 TI - Patient-controlled analgesia: proven system needs guidelines. PMID- 10125215 TI - Data watch. The cost of providing health care. PMID- 10125216 TI - Indemnity plans costs rise while managed care prices moderate. PMID- 10125217 TI - Employee assistance programs expand to fit companies' needs. AB - Some companies are scaling back in-house EAPs and contracting for more services. Others are asking in-house EAPs to provide more. PMID- 10125218 TI - Cutting costs: it can be done. But at what price? AB - Through tough negotiating, an in-house doctor, and strict plan limits, Tamar Inns spent $745 per covered life on health care last year. Is it too low? PMID- 10125219 TI - Profiling systems aim to eliminate second-guessing of doctors. PMID- 10125220 TI - Measuring quality of preventive services. PMID- 10125221 TI - U.S. military enters the managed care battle. PMID- 10125222 TI - Seeing a bigger role for vision care. PMID- 10125223 TI - N.J. and N.Y. wrestle with charity care issue. PMID- 10125224 TI - EEOC (Equal Employment Opportunity Commission) AIDS caps rule is challenged. PMID- 10125225 TI - Clinton's brain trusters. PMID- 10125226 TI - Clinton's 1,100 decisions. PMID- 10125227 TI - Medicare and Medicaid programs; quarterly listing of program issuances and coverage decisions--HCFA. Notice. AB - This notice lists HCFA manual instructions, substantive and interpretive regulations and other Federal Register notices, and statements of policy that were published during October, November, and December of 1992 that relate to the Medicare and Medicaid programs. Section 1871(c) of the Social Security Act requires that we publish a list of Medicare issuances in the Federal Register at least every 3 months. Although we are not mandated to do so by statute, for the sake of completeness of the listing, we are including all Medicaid issuances and Medicare and Medicaid substantive and interpretive regulations (proposed and final) published during this timeframe. We also are providing the content of revisions to the Medicare Coverage Issues Manual published between October 1 and December 31, 1992. On August 21, 1989 (54 FR 34555), we published the content of the Manual and indicated that we will publish quarterly any updates. Adding to this listing the complete text of the changes to the Medicare Coverage Issues Manual allows us to fulfill this requirement in a manner that facilitates identification of coverage and other changes in our manuals. PMID- 10125228 TI - Delegations of authority and organization--FDA. Final rule. AB - The Food and Drug Administration (FDA) is revising the regulations to set forth the current organizational structure of the agency as well as the current addresses for headquarters and field offices. PMID- 10125229 TI - Delegations of authority and organization; Center for Drug Evaluation and Research--FDA. Final rule. AB - The Food and Drug Administration (FDA) is amending the regulations for delegations of authority relating to the approval of new drug applications (NDA's), abbreviated new drug applications (ANDA's), and their supplements to add the Deputy Director (Medical and Scientific Affairs), Center for Drug Evaluation and Research (CDER), to the list of officials authorized to approve certain NDA's, ANDA's, and their supplements for drugs for human use. In addition, FDA is adding authority to approve applications submitted under section 505(b)(2) of the Federal Food, Drug, and Cosmetic Act (the act) (505(b)(2) applications) to these officials. These authorities were given to FDA under section 505 of the act. PMID- 10125230 TI - Delegations of authority to the Commissioner of Food and Drugs--FDA. Final rule. AB - The Food and Drug Administration (FDA) is amending the regulations for delegations of authority to redelegate the authority of the Assistant Director for Health to make determinations to close advisory committee meetings to the public to the Commissioner of Food and Drugs (the Commissioner) and other agency heads. FDA is further redelegating this authority from the Commissioner to the Deputy Commissioner for Operations. PMID- 10125231 TI - Organization, functions, and authority delegations--FDA. Final rule. AB - The Food and Drug Administration (FDA) is amending the regulations for delegations of authority and organization and formal evidentiary public hearing to reflect a change in the organizational structure and the name of one of its Divisions. FDA is also correcting a typographical error. This action is being taken to improve the accuracy and clarity of the regulations. PMID- 10125232 TI - Delegations of authority and organization; National Childhood Vaccine Injury Act of 1986--FDA. Final rule. AB - The Food and Drug Administration (FDA) is amending the regulations for delegations of authority by adding new authorities delegated by the Assistant Secretary for Health to the Commissioner of Food and Drugs (the Commissioner). The new authorities are under certain provisions of the Public Health Service Act (the PHS Act) and of the National Childhood Vaccine Injury Act of 1986. The authorities added are being further redelegated, from the Commissioner to the Director, Center for Biologics Evaluation and Research (CBER), and the Associate Director for Policy Coordination and Public Affairs, CBER. PMID- 10125233 TI - Medicare and Medicaid programs; revaluation of assets; correction--HCFA. Correcting amendments. AB - This document contains corrections to final regulations (BPD-311-F) that were published September 23, 1992 (F.R. Doc. 92-22582) (57 FR 43906). The regulations describe new limitations on the valuations of assets acquired as the result of changes in ownership occurring on or after July 18, 1984. These changes affect hospitals and skilled nursing facilities under the Medicare program, and hospitals, nursing facilities, and intermediate care facilities for the mentally retarded under the Medicaid program. PMID- 10125234 TI - Redesignation of Contract Health Service Delivery Area--Indian Health Service, HHS. Final notice. AB - This notice advises the public that the Indian Health Service (IHS) is redesignating the geographic boundaries of the Contract Health Service Delivery Area (CHSDA) for the Grand Traverse Band of Ottawa and Chippewa Indians ("The Band"). The Grand Traverse CHSDA was comprised of Leelanau County in Michigan. This county was designated as the Band's CHSDA when the IHS published its updated list of CHSDAs in the Federal Register of January 10, 1984 (49 FR 1291). The redesignated CHSDA is comprised of six counties in the State of Michigan, i.e., Leelanau, Antrim, Benzie, Grand Traverse, Manistee, and Charlevoix. This notice is issued under authority of 43 FR 34654, August 4, 1978. PMID- 10125235 TI - Golden silence? AB - Elderly Americans would take a direct hit under President Clinton's economic plan. So why aren't they screaming? Maybe they hope Clinton will make it up to them in his health reform proposal. For political reasons, he'd probably like to. For budgetary reasons, he probably can't. PMID- 10125236 TI - The Left has its own prescription. PMID- 10125237 TI - Health lobby pushes past the Beltway. PMID- 10125238 TI - Health care's outside gang. PMID- 10125239 TI - Support for rural families of hospitalized infants: the parents' perspective. AB - The provision of family-centered care in the hospital arena has become a national commitment. Recognizing and supporting the family's role means evaluating whether attitudes, policies, and practices address the immediate and the long-term needs of the total family rather than just the current needs of the child. Results of a study to determine parents' perceptions of supportive services available in the hospital immediately following the birth of their child with special health care needs are reported. In-depth interviews with mothers living in rural areas were conducted. Mothers emphasized the importance of access to their child; the need for timely, honest, straightforward information about their child's condition and progress; the intense emotional reaction to the intensive care environment; and the importance of an early link to community-based early intervention services. Overall, parents conveyed the importance of recognizing the family as an integral part of the child. Implications and recommendations for family-centered services are discussed. PMID- 10125240 TI - Differential medication of child versus adult postoperative patients: the effect of nurses' assumptions. AB - We examined nurses' assumptions concerning children and analgesia that have been hypothesized to explain the differential medication of postoperative child and adult patients. One hundred fourteen nurses from various pediatric and adult inpatient units of a large, urban teaching hospital were included in the study. A questionnaire consisting of four vignettes describing two hypothetical postoperative situations involving a child and adult patient, questions concerning choice of analgesic and assessment of pain for the hypothetical patients, and questions concerning the nurses' assumptions about children and analgesia was distributed to each nurse. The findings illustrate a pattern of differential medication of hypothetical child relative to hypothetical adult postoperative patients. The belief that children feel less pain than adults and concern about respiratory depression were associated with nurses' analgesia decisions. PMID- 10125241 TI - A comparison of play behaviors in two child life program variations. AB - The purpose of this naturalistic study was to describe the play of children in hospital playrooms and to determine whether the type of child life program focus (i.e., playroom/group vs. nonplayroom/individual) impacts on the frequency and types of play behaviors exhibited. Despite differences in hours of availability, length of experience of staff, complexity of play spaces, and number of activities, the type of program focus was not found to affect significantly play frequency or type. There were, however, trends for more educative and therapeutic play to occur in the playroom-focused setting. Instead, child variables of gender and length of hospitalization were related to types of play exhibited, and the type of illness and whether the child was previously hospitalized were related to certain nonplay behaviors. Implications are drawn for additional study of play in child life contexts. PMID- 10125242 TI - Under one umbrella. A continuum of HIV service delivery. PMID- 10125243 TI - At-home options. Enhancing care for AIDS patients. AB - Mark is a 45-year-old man with advanced AIDS. His care partner, Gary, has a full time job in the design industry. A home care aide visits Mark five days a week for 10 hours at a time to provide personal care while Gary is at work. A visiting nurse sees Mark weekly and has taught Gary how to prepare Mark's ganciclovir infusion. Every six weeks Mark meets with a nutritionist, who evaluates his dietary status and advises Gary on purchasing high-calorie foods for Mark. In May Gary must attend a conference out of town and he is worried:who will care for Mark for those three days? Gary calls the At Home Options (AHOP) nurse and explains the situation. She arranges for nighttime nursing coverage for those three days, and ensures that Mark's home care aide can stay for the weekend. Gary is able to attend his conference and concentrate on his work, secure in the knowledge that Mark will be well cared for and that scheduled respite care, although not a benefit with traditional insurance, is covered through the AHOP program. PMID- 10125244 TI - Caring for the next generation of AIDS. AB - As the number of AIDS diagnoses grows among the heterosexual female population of the nation, so does the incidence of HIV in children. One agency's ongoing commitment to community needs prompted it to develop a plan to provide preventive and skilled home nursing care to children with HIV--the next generation of AIDS. PMID- 10125245 TI - Integrating mental health and home care services for AIDS patients. AB - Home-based psychological care for the HIV/AIDS population brings comprehensive treatment to patients and caregivers, plus telling research to the home care community. PMID- 10125246 TI - Nutritional care of the HIV client. AB - Patients with HIV infection are at risk for malnutrition from many causes--the disease itself, attendant infections, or medication side effects. There are strategies for the entire caregiving team to help these patients. PMID- 10125247 TI - It's never over. Addressing AIDS bereavement. AB - Informal caregivers of AIDS patients often exhaust their own resources over the course of caring for their loved one, only to be left with unresolved grief after the loved one dies. Home care professionals can help prepare informal caregivers for working through grief and point the bereaved toward community resources and support. PMID- 10125248 TI - Caregiver ethics. Walking the fine line. AB - Caregivers for AIDS patients find themselves drawn in to their patients' lives- sometimes inappropriately. Others find that to avoid this situation, they must maintain a distance they might not prefer. The difficulty in defining boundaries points out the need for support and counseling for this group of professional caregivers. PMID- 10125249 TI - Understanding AIDS. AB - This discussion of AIDS' history, its growth, its victims, its costs, and the medical community's latest efforts to combat it is the cornerstone of this issue of CARING, featuring some of the myriad ways in which home care and hospice are responding to the AIDS crisis. PMID- 10125250 TI - New Administration brings new hope for AIDS legislation. AB - Congress passed the Ryan White Act in 1990, yet its funding does not meet authorized levels. While the Act is a fine start in battling the AIDS epidemic, NAHC and the National Organizations Responding to AIDS (NORA), of which NAHC is a member, urge full funding of the Act as well as expanded home and community-based programs under the Act and other federal and state programs. PMID- 10125251 TI - AIDS patient writes final chapter of his life--on his own terms. AB - Care for persons with AIDS involves complicated and emotional factors. The many players in such cases--from physicians to home care aides to insurance companies- may confuse the most important issue: the patient's care. This case study illustrates how smoothly such a potentially difficult situation can proceed when all players share the same values. PMID- 10125252 TI - Call for reform. PMID- 10125253 TI - Three-part model manages care from admission through postdischarge. PMID- 10125254 TI - The role of care management in health care reform. PMID- 10125255 TI - Case assignment links social workers to physicians. PMID- 10125256 TI - Third-party payer places case managers on site. PMID- 10125257 TI - Volunteer caregivers support elderly. PMID- 10125258 TI - Restroom quality. A crucial component in facility image. PMID- 10125259 TI - Environmental carpet care technology for the 21st Century. PMID- 10125260 TI - Indoor air quality (IAQ). PMID- 10125261 TI - Why drug prices will go lower. AB - The industry's days of gargantuan earnings are gone forever. Why? Managed-care outfits are demanding price breaks, and generics are proving tough competitors. PMID- 10125262 TI - HCFA issues proposed regulations on physician incentive payments to reduce services. PMID- 10125263 TI - Special report on licensure, accreditation & CON. Federal regulation of fertility clinics is now a reality. PMID- 10125264 TI - Reducing the legal risks inherent in employee compensation surveys. PMID- 10125265 TI - O-C (Oleoresin-Capsicum) superior to mace? Security director seeks approval for use. PMID- 10125266 TI - An interview with: David G. Evans on employee drug testing. PMID- 10125267 TI - IAHSS, NSC offer safety training, certification for security officers. PMID- 10125268 TI - Special report. After experiencing an infant kidnapping: what three hospitals did. PMID- 10125269 TI - Hospital to install safes in patient rooms. PMID- 10125270 TI - How university interns participate in hospital security program. PMID- 10125271 TI - An interview with: Stephen Paliska on valet parking. AB - Stephen Paliska is general manager and co-founder, with his brother, Paul, of Professional Parking Services, Inc., based in Irvine, CA. The company has been in operation for eight years. PPS's 600 valets provide parking services for more than 80 clients, including hotels, shopping centers, restaurants, and hospitals. In this interview, Paliska discusses the benefits and some potential risks of valet parking and spells out how a training program for valet attendants should be carried out. PMID- 10125272 TI - Special report. Smoke-free policies: what works? what doesn't? AB - In the December 1992 issue, we reported on the new no-smoking regulations for hospitals instituted by the Joint Commission on Accreditation of Healthcare Organizations (JCAHO). To comply with JCAHO, all hospitals must have a no-smoking plan in effect by the end of 1993. All hospitals should have already taken some steps to formulated a policy by now. Many hospitals, on their own initiative or in anticipation of JCAHO, have had no-smoking programs in effect for some time. In this report, we'll review the relative success and failure of such programs and present some evaluations by hospital officials themselves of their programs to date. PMID- 10125273 TI - Search firms: how we work. AB - The executive search consulting business is built on an understanding of the forces driving the health care industry and an appreciation of the importance of the right person to an institution's success. We work closely with our clients in determining position and candidate criteria, and in screening and selecting candidates. We commit all findings to writing and keep our clients regularly and frequently updated. From the professionalism of our consultants to the details of the search process, we believe there is no substitute for high quality, cost efficient, and responsive service. PMID- 10125274 TI - CEO expectation: the Star Wars materiel manager of the 1990s, or C-3PO as role model. AB - Materiel-intensive expenditures account for a significant portion of all hospital costs, second only to salaries and wages, yet materiel managers may often be overlooked as key members of the management team. This is alarming since the potential exists for materiel managers to impact annual savings of hundreds of thousands of dollars by operating efficient departments. Materiel managers have a tremendous opportunity to enhance their image and improve hospital productivity in the coming decade. The challenges of the 1990s will stretch materiel managers' skills toward enhancing their professionalism and achieving the expectations of themselves and top management. If materiel managers will effectively utilize (C3)PO they will increase their educational levels, continue to learn new skills, maintain a customer-oriented management style, exercise creativity, develop and adhere to standards, and be proactive in their responsibilities. The benefits of their success will be felt by patients, hospitals, the industry, and materiel managers everywhere. PMID- 10125275 TI - Outplacement--nice or necessary? PMID- 10125276 TI - The modern health care materiel manager. AB - Today's successful materiel managers must possess a wide range of skills. They must above all be highly adaptable to change and influence others to accept rather than resist change. The role and responsibility of the materiel manager have expanded significantly, requiring higher levels of formal education. In conjunction with this, the quality of communication, both verbal and written, becomes essential. A high degree of human, conceptual, and technical skills must be employed to accommodate the many demands encountered. Finally, the successful materiel manager who feels confident and secure will hire others who do not mirror the manager's style, but rather allow for contrast of expression and technique. PMID- 10125277 TI - The materiel manager's role in executive management. AB - The ability to achieve advancement for materiel management is a potential that few have challenged and achieved. Reasons for this lack of growth vary in degree, but the opportunities in the 1990s will be tremendous. The political skill and team leadership ability expressed by materiel managers throughout hospitals will ultimately result in whether this challenge is met or not. Materiel managers will need certainly to change their perception of their own role, as well as the perception of hospitals, in order to achieve this. The road will be challenging, but with the winning attitude, skill building, and proven management ability, I believe that materiel managers will become successful in hospital executive management in the 1990s. PMID- 10125278 TI - Criteria-based performance reviews in a hospital materiel management department. PMID- 10125279 TI - Career planning and development. AB - The career planning process is often illustrated as the last step in an ever changing work environment. The technical, professional, managerial, and interpersonal skills to successfully perform and succeed in this rapidly changing work environment are essential. There is a very real and immediate threat that many of the professional skills that we have learned yesterday and today will be obsolete and insufficient to cope with the inevitable changes in the future. While most professionals are aware of the very real threat of skill obsolescence, few take the opportunity to do definitive career planning regarding their future. The career planning process is designed to help individuals examine their careers; evaluate their training and educational needs; and develop some specific action plans to maintain, enhance, and reevaluate the relevance of their professional and managerial skills in a work environment that values rapid change and adaptation. PMID- 10125280 TI - The self-assessment process. AB - The entire job or career search can best be illustrated as a ladder. With the bottom rung as the beginning of the job or career search process, the next rung in the self-assessment process is the preparation of an effective resume, and ultimately the top rung of the ladder, or the final objective, is securing the appropriate position. The goal in each step of the process is to understand yourself and to present yourself as positively as possible, to overcome any negative aspects that would inhibit a competitive job offer, and to be ultimately successful in the interview process. All of this must be achieved using the most effective, efficient method in the shortest possible time while still facing serious and aggressive competition. The long road ahead can be made easier and can make you stand out from the crowd if the sometimes difficult and time consuming groundwork provides your ladder with the foundation necessary to reach that top rung as a winner. PMID- 10125281 TI - Planning and implementation of a computerized inventory system in central service. AB - The computerization of any manual system must be carefully planned before a computer system is selected. An adequate record-keeping system must exist before conversion to a computerized system takes place. Once selected, the computer vendor must be able to provide what the customer requires. More importantly, the computer vendor must be able to provide support services after the system is implemented. User capabilities and acceptance must be considered, and each step of the implementation phase must be thoroughly communicated to all who will be affected. Finally, to provide the most accurate real-time information, files must be maintained and updated as changes occur. PMID- 10125282 TI - You're fired! What to do, how to cope, finding a new job. AB - If you find yourself out of a job, do not despair. It has happened to the best and the brightest; you are not alone. If you have never lost a job consider yourself fortunate, but do not become complacent. It very well could happen to you sometime soon. Be prepared. Watch for the signs. And if it happens, remain the professional you have always been. There is always another, and probably better, job awaiting you. PMID- 10125283 TI - An investment perspective for hospital materiel managers. AB - Materiel managers are making investments every time they authorize capital, supply, or personnel requisitions on behalf of their departments or organizations. While not as formal as external investments in securities or the like, internal investments are even more critical to the organization's success and carry the same fiduciary obligations. Generating an acceptable return is a necessity rather than an option as concerns internal investments; the same formal analysis that is applied to external investments should be extended to internal ones as well. Adopting an investment perspective is a critical first step in seeing internal initiatives as investments and obtaining an appropriate return. PMID- 10125284 TI - Empirical comparison of just-in-time and stockless materiel management systems in the health care industry. AB - Despite the limitations, this study is the first comparative empirical investigation of two relatively new materiel management systems applied in hospitals. The results show that hospital managers have significantly rated the possibility that more effective use of some materiel management resources can be achieved by adopting either a JIT or stockless system over conventional materiel management systems. PMID- 10125285 TI - CEO expectations of the pharmacist materiel manager. AB - The pharmacist possesses the knowledge and skills required of a materiel manager. The pharmacist must be willing to adapt to the materiel management environment. The resultant loss of certain clinical skills is inevitable. The pharmacist who does not accept this will not succeed. The CEO should expect this. PMID- 10125286 TI - Benchmarking: a technique for improvement. PMID- 10125287 TI - The crisis in primary care: residents speak out. PMID- 10125288 TI - ASIM's blueprint for rebuilding primary care. PMID- 10125289 TI - Quality is the key to controlling costs and increasing access. Interview by C. Burns Roehrig. PMID- 10125290 TI - The President's health reform: how are internists faring? PMID- 10125292 TI - Not waiting in the wings. PMID- 10125291 TI - Cooperation is the antidote to managed competition. PMID- 10125293 TI - A drowning internist cries out for help. PMID- 10125294 TI - Paying for health care reform. American Society of Internal Medicine. PMID- 10125295 TI - Primary care: the infrastructure for health care reform. PMID- 10125296 TI - Sow today, reap tomorrow. AB - A candid look at the state's student-age population; how THA and local hospitals are nurturing that resource; and how a hospital's culture can affect recruitment and retention today and tomorrow. PMID- 10125297 TI - The future supply of health care providers. Texas Health Policy Task Force. PMID- 10125298 TI - Foundation educates health care work force in the workplace. PMID- 10125299 TI - APGs (ambulatory patient groups) are on the way. PMID- 10125300 TI - Poor reception. AB - Patients who go private do so because their negative judgements of the NHS are based on media reports and hearsay, not facts or direct experience. To compete, say Joan Higgins and Rose Wiles, the NHS is going to have to unscramble its messages. PMID- 10125301 TI - Countdown to community care. Job sharing. PMID- 10125302 TI - Are you being served? PMID- 10125303 TI - Data briefing. Health and safety at work. National Association of Health Authorities and Trusts. PMID- 10125305 TI - The good the bad & the ugly. PMID- 10125304 TI - North West Thames. The shape of things to come. PMID- 10125306 TI - Too many cooks? AB - The large number of agencies attending major incidents like the Purley and Cannon Street rail crashes pose severe problems for good co-ordination. Bill New suggests ways of making the healthcare response more effective. PMID- 10125307 TI - Eeeaar we go again. PMID- 10125308 TI - Sound bites. PMID- 10125309 TI - Income generation. Old money? PMID- 10125310 TI - It's appealing. AB - The role of charity in the NHS is developing, but what are the rules governing the use of charitable funds? Pauline Smith reports. PMID- 10125311 TI - Pharmacy follies. AB - Stuart Anderson describes a national study which failed to find any significant differences between the economic performance of pharmacy services in public and private hospitals. PMID- 10125312 TI - Countdown to community care. A sticking plaster job. PMID- 10125313 TI - A voice in the wilderness. PMID- 10125314 TI - Quality counts. AB - The 'weak and ill-defined' standards of care imposed by the Registered Homes Act of 1984 have meant that quality of care in nursing homes is monitored unevenly or not at all, says Yumiko Arai. PMID- 10125315 TI - Death trap. PMID- 10125316 TI - The long goodbye. PMID- 10125317 TI - A better pill to swallow. AB - New pharmaceutical technologies, new drugs, new formulations of existing drugs and changing patterns of consumption are contributing to rising pressure on pharmaceutical budgets. But even as the NHS drugs bill hits a new high, politicians are giving notice that action must be taken to control costs. Managers will be able to do so only if they understand the implications. PMID- 10125318 TI - Code comfort. PMID- 10125319 TI - Data briefing. Varicose veins. National Association of Health Authorities and Trusts. PMID- 10125320 TI - Healthcare in Europe--France. A la carte. PMID- 10125321 TI - Descent into the depths. PMID- 10125322 TI - Soft cell. AB - A shake-up in the healthcare system at the western world's largest remand centre in New York City means sick prisoners are better off in jail, reports Peter Mason. PMID- 10125323 TI - Pharmacoeconomic series: Part I. Pharmacoeconomics and the evaluation of drugs and services. AB - The field of pharmacoeconomics is of growing interest to everyone from government policy makers to medical staff and administrators at hospitals and other managed care settings. This article reviews basic terminology and methodologic issues related to using pharmacoeconomics to evaluate drugs and services. Economic evaluation tools such as cost-benefit analysis, cost-effectiveness analysis, cost utility analysis, and cost-minimization analysis are described. The challenge for all clinicians is to use these economic evaluation tools to optimize the benefit to-cost ratio and resultant positive outcome of programs, services, treatments, or other interventions for the patient, the institution, and society. PMID- 10125324 TI - Productivity and quality assessment associated with conversion from i.v. to oral ranitidine. AB - At a university teaching hospital, a study was undertaken to evaluate the appropriateness of the intravenous form of ranitidine in adult patients. The assessment of the cost and quality considerations involved in the conversion of ranitidine therapy from intravenous to oral forms is presented here. PMID- 10125325 TI - Effect of preparation techniques on mixing of additives in intravenous fluids in nonrigid containers. AB - It has been observed that the procedures of some hospitals do not require any mixing after drugs are added to intravenous bags. Previous studies have shown that mixing often is incomplete in the absence of specific mixing procedures. It has been asserted that mixing is effected by normal handling of bags, and that mixing is sufficient if drug is added to "bottom up" bags, which are then inverted. In this study the extent to which mixing occurred on addition of KCl solution or water to intravenous bags as a function of bag and needle position, additive, speed of addition, and bag handling procedure was determined. Also determined was the extent to which mixing occurred spontaneously. Most important, we determined the effect of incomplete mixing on the concentration of drug actually delivered from the bags. It was concluded that mixing is critically dependent on many factors, and that an effective technique to achieve complete mixing is essential to assure homogenous solutions. The most effective method of mixing solutions in plastic infusion bags is to grasp the bag by its two ends and rapidly invert it twice. This "double inversion" mixing technique, a maneuver requiring only 2 seconds, assures complete mixing of intravenous solutions. PMID- 10125326 TI - Challenges facing pharmacy practice during Operation Desert Storm. AB - Many challenges face the pharmacist in a combat zone hospital. The 13th Evacuation Hospital, Wisconsin Army National Guard was deployed in support of Operation Desert Storm. Its mission before and during the ground campaign identified key areas where pharmacy involvement assisted in the provision of care. Special skills and subject areas were determined. This article reviews the authors' experiences and offers suggestions to aid pharmacy personnel in preparation for future deployment. PMID- 10125327 TI - Disposal of outdated anti-infective products. AB - After an unsuccessful search for guidelines to destroy outdated anti-infective products, a procedure was developed for pharmacy that uses currently available biohazardous materials. By using a blood/body-fluid absorbent, an inexpensive waste system was developed to avoid the negative public sentiment caused by use of public landfills and avoid the risk of disposing waste in hospital drainage systems. PMID- 10125328 TI - The physician strategies under payment reform affect hospital pharmacies. PMID- 10125329 TI - IV administration mix-ups. PMID- 10125330 TI - Emerging leaders 1993. The new problem-solvers. PMID- 10125331 TI - The do-it-yourself restructuring test. PMID- 10125332 TI - Concepts of community. PMID- 10125333 TI - Strange bedfellows. PMID- 10125334 TI - Creating healthier communities. Why managed competition won't work. PMID- 10125335 TI - Creating healthier communities. Seeing the vision, defining your role. PMID- 10125336 TI - Creating healthier communities. Can public health lead the way? PMID- 10125337 TI - Building healthier cities. Interview by Joe Flower. PMID- 10125338 TI - Healthier communities compendium. The Healthcare Forum. PMID- 10125339 TI - Creating healthier communities. "Where's the money?". PMID- 10125340 TI - A talk with The Healthcare Forum's incoming chair--John King. Interview by Karen Southwick. PMID- 10125341 TI - Andrew's not-so-excellent adventure. PMID- 10125342 TI - New pharmacy mandates and practice standards now taking effect under OBRA '90 deadline. PMID- 10125343 TI - Between a rock and a hard place: Clinton's health care reform plan navigates stormy seas. PMID- 10125344 TI - Prescription drug manufacturers get warning on prices. PMID- 10125345 TI - The impact of Clinton's health care reform plan on the managed care industry. PMID- 10125346 TI - California announces plan to convert its Medicaid program into a managed care system. PMID- 10125347 TI - Times change, but do business strategists? PMID- 10125348 TI - Pushing the right levers--the right way. PMID- 10125349 TI - Strategic planning unbound. AB - The strategic planner's role has not kept up with the demands of today's complex business environment. But catching up is the planner's responsibility. Become participative, missionary, and aggressively iconoclastic, and you can be a catalyst of positive change. Stay rooted in the past, and you're just an impediment. PMID- 10125350 TI - How to build a benchmarking team. PMID- 10125351 TI - Crisis management: forewarned is forearmed. AB - Big disasters remind executives that crisis communications is a critical part of strategic planning. But consciousness fades quickly, and with it, response time. Don't be caught unprepared. PMID- 10125352 TI - Food giant Sysco signs $25 million med/surg pact with Baptist Hospitals. PMID- 10125353 TI - Rebates drive contrast media prices. PMID- 10125354 TI - Groups dicker for price breaks as anesthetic gas goes multi-source. PMID- 10125355 TI - Operating room non-salary expenses per patient day. PMID- 10125356 TI - CHA's vision of a redesigned healthcare system. PMID- 10125357 TI - What will healthcare reform cost? PMID- 10125358 TI - Network unites payers, physicians, hospitals. System participants work together to improve access to care and to design cost-saving incentives. AB - Through Sacred Heart Health System (SHHS), Eugene, OR, physicians, payers, and hospitals are designing a network that will integrate care and improve access by reducing healthcare costs. Together, system members design cost-saving incentives and the products the system offers the community. They promote managed care as the most efficient means to coordinate care and reduce costs. All participants share in the risks of a capitated payment system. Since the system pulled together the payers, physician groups, and hospitals, many of these entities' management functions were consolidated at the system level to avoid duplication and reduce administrative costs. Bringing in physicians was the most difficult yet important aspect of forming a successful network. Working with two physician groups in the community, the system's sponsor-the Sisters of St. Joseph of Peace, Health and Hospital Services-developed the Physician Practice Board. The board, representing 300 physicians, meets weekly and makes recommendations on issues that affect physicians. SHHS also added innovative new functions such as an integrated medical cost management and continuous quality improvement program. Another key to success is a clinically oriented information system, which will allow the system to track patients once they leave the hospital. It also will provide a better understanding of what things have an impact on outcomes and will reduce paperwork. A portion of the system's revenue is designated for initiatives to improve access. And the system recently appointed a tack force on access to explore what they can do in cooperation with others in the community. PMID- 10125359 TI - A blueprint for community benefit. A CHA-AAHA (Catholic Health Association American Association of Homes for the Aging) document helps long-term care providers plan for and implement needed services. AB - A collaborative effort of the Catholic Health Association (CHA) and the American Association of Homes for the Aging, The Social Accountability Program: Continuing the Community Benefit Tradition of Not-for-Profit Homes and Services for the Aging helps long-term care organizations plan and report community benefit activities. The program takes long-term care providers through five sequential tasks: reaffirming commitment to the elderly and others in the community; developing a community service plan; developing and providing community services; reporting community services; and evaluating the community service role. To help organizations reaffirm commitment, the Social Accountability Program presents a process facilities can use to review their historical roots and purposes and evaluate whether current policies and procedures are consistent with the organizational philosophy. Once this step is completed, providers can develop a community service plan by identifying target populations and the services they need. For facilities developing and implementing such services, the program suggests ways of measuring and monitoring them for budgetary purposes. Once they have implemented services, not-for-profit healthcare organizations must account for their impact on the community. The Social Accountability Program lists elements to be included in community service reports. It also provides guidelines for evaluating these services' effectiveness and the organization's overall community benefit role. PMID- 10125360 TI - Long-term care survey reveals challenges. Facilities grapple with five broad issues, including changes in leadership and AIDS. AB - The Catholic Health Association's 1992 survey of Catholic long-term care (LTC) facilities identified five broad issues LTC facilities face in the 1990s: leadership, system affiliation, community programs, resident issues, and care of persons with AIDS. The transition to lay leadership presents new challenges to the relationship between LTC facilities and their sponsors. Despite the dominance of religious sponsors, an increasing number of laypersons are serving as healthcare administrators both in long-term and acute care. Thirty percent of respondents reported being affiliated with a multi-institutional system. This percentage has changed little in the past few years, although the number of facilities that are system members continues to increase at the fastest rate of any type of LTC facility. Only 27 percent of survey respondents said they provide educational or informational programs for persons in their communities. Thirty nine percent of system-affiliated LTC facilities reported offering such programs. One encouraging finding shows that 80 percent of facilities have written policies for living wills, 64 percent for designated proxy, and 86 percent for durable power of attorney for healthcare. LTC providers are struggling to determine their role in caring for persons with HIV and AIDS. Only 3.6 percent of respondents care for residents with AIDS. A major problem LTC administrators face is a fear of potential infection of staff or residents. PMID- 10125361 TI - A little help, a lot of independence. Retirement community advances the cause of aging with dignity. AB - Sometimes the elderly need only a little extra help to make it on their own. When this is the case, it behooves providers of healthcare and social services to meet those needs and allow these individuals to maintain the dignity of independent living as they age. At Resurrection Retirement Community, an independent living facility on Chicago's northwest side, the Garden Annex fills this niche in a unique model of independent living with additional services. Services include three meals a day in the common dining room, laundry service for household linen, and weekly maid service. Residents enjoy varied activities, exercise sessions, and socialization with friends and neighbors. They also have access to such amenities as daily religious services, a library, a beauty salon, and banking facilities. To live in the Garden Annex, prospective residents must meet certain physical and mental criteria and be able to function somewhat independently. In contrast to assisted living facilities, the Garden Annex does not provide nursing care or assistance with personal care. However, residents may take advantage of the continuum of care offered by Resurrection Health Care Corporation. They are afforded access to a medical center, a long-term care facility, and physicians' services. PMID- 10125362 TI - A spiritual tool. An assessment tool helps nursing homes meet residents' spiritual needs. PMID- 10125363 TI - Autonomy and care for the frail elderly. A one-year project identifies effective interventions for congregate housing residents. AB - In 1989 the St. Louis-based Cardinal Ritter Institute (CRI) conducted a demonstration project to determine how effective its interventions were in enabling the elderly to age in place. Preliminary screenings of persons at a congregate living site for the elderly revealed four major areas of concern: deficient knowledge of medication regimens, side effects, and purposes; need for basic social interaction; depression-related primarily to loneliness and isolation; insufficient knowledge of community resources. A multifaceted program developed by CRI staff helped alleviate many of these problems. The program's success shows that early identification of frail elderly at risk for losing their independence can guide interventions that allow them to age in place. PMID- 10125364 TI - Facilities strive to comply with new Act. The long-term effects of the Safe Medical Devices Act are still unknown. AB - Unlike previous medical device laws, the Safe Medical Devices Act of 1990 (SMDA), which became effective November 28, 1991 applies to "device-user facilities" such as hospitals and long-term care facilities. Final regulations are scheduled for release later this spring. The SMDA's primary goals are to: Ensure all devices currently in or entering the marketplace are safe and effective Enable the U.S. Food and Drug Administration (FDA) to learn quickly about serious problems with medical devices Remove defective devices (old and new) from the market To achieve these goals, Congress has given the FDA new review and enforcement powers, including the authority to impose fines on those in violation of the law. Incidents in which a medical device caused or contributed to the death, serious illness, or serious injury of a patient are referred to as medical device reportable (MDR) events. A user must report MDR deaths to the FDA and to the manufacturer (if known). Serious illnesses and serious injuries caused by or attributed to the use of a device must be reported to the device manufacturer or, if the manufacturer is unknown, to the FDA. Facilities must report MDR events to the FDA semiannually and maintain incident files for two years after reporting the MDR event. The FDA may assess civil penalties against parties that do not comply with the SMDA's reporting provisions. Healthcare facilities must develop and implement employee training and education programs to help physicians, nurses, and other allied health employees identify and report MDR events. PMID- 10125365 TI - Creative models of spiritual care. As healthcare delivery changes, pastoral care departments must explore alternative staffing approaches. AB - Recognizing changes are coming to the healthcare delivery system, pastoral care departments are developing a new vision of spiritual care. As they educate and hire staff, many directors are finding that alternative staffing approaches can help them make the transition. Flexible schedules for pastoral care professionals improve the care they deliver and enhance morale. Restructuring responsibilities within the department and giving some patient populations priority can be helpful. Some facilities share chaplains' time to minimize on-call burden; others are increasingly using supervised volunteers. Pastoral care givers who are specialists in areas such as mental health and chemical dependency can often perform certain functions traditionally performed by other professionals. By assigning chaplains to a product or service line, pastoral care departments can improve the continuity of care patients receive. As parishes' role in the healing ministry takes on new meaning, healthcare institutions' pastoral care staff can help initiate and develop new parish services or provide assistance that complements existing parish efforts. PMID- 10125366 TI - Promoting community health. PMID- 10125367 TI - Mercy Health System & Franciscan Health System. Forging a provider partnership to ensure high-quality healthcare. PMID- 10125368 TI - An aural assault. PMID- 10125369 TI - Academic EMS. A new school of thought? PMID- 10125370 TI - Educating the educator. PMID- 10125371 TI - On the ball behind the wheel. PMID- 10125372 TI - It can happen to you: the Montecalvo story. PMID- 10125373 TI - Squeezing seconds from an unstoppable clock. PMID- 10125374 TI - An open letter to ACHCA (American College of Health Care Administrators) members. PMID- 10125375 TI - Amenities that influence nursing home selection. AB - A survey of senior citizens living independently in two retirement communities reveal the factors that influence facility selection: mental and physical activities, comfort and security, personal services, conveniences and independence-promoting features. PMID- 10125376 TI - The best amenity: professional, caring, long-term staff. PMID- 10125377 TI - Amenities in long-term care: today and tomorrow. PMID- 10125378 TI - Nursing home quality: the administrator's responsibility. AB - Quality care in long-term care facilities has many facets. How can you as an administrator really get a handle on this complicated issue and think about quality productively? PMID- 10125379 TI - Competition comes to the CCRC (continuing care retirement communities): perspectives of community managers. AB - Are continuing care retirement communities (CCRCs) the wave of the future? This study shows how competition from hospitality corporations will change the face of this growing, and largely not-for-profit, industry. PMID- 10125380 TI - Maintaining self-esteem. AB - Self-esteem is essential for attempting new challenges, interacting with others and maintaining meaningful relationships. This author describes how her staff successfully enhances the self-esteem of its residents. PMID- 10125381 TI - The results are in: ACHCA's (American College of Health Care Administrators) 1992 membership survey. PMID- 10125382 TI - Quality and customers: a planning approach to the future of mental health services in a health maintenance organization. AB - Mental health service delivery is both a health care and business arrangement, and is accordingly impacted by national changes in both areas. HMO mental health services in the current health reform zeitgeist are being called on to provide more efficient, comprehensive integrated care. A planning effort is presented which is organized around (1) a quality improvement effort aimed at understanding who are the "customers" (patient, medical community, mental health staff, and client employer) and what they need and (2) coordination and integration with the HMO larger organizational plan and efforts. The unique benefits of staff model HMOs are discussed relative to mental health service. PMID- 10125383 TI - The structure of economic incentives in the Robert Wood Johnson/HUD Program on Chronic Mental Illness 1988. AB - This paper describes the financial arrangements put into place by cities participating in the Robert Wood Johnson Foundation's Program on Chronic Mental Illness. Descriptive information is given on the level of expenditure, the mix of revenues, and the terms under which local, federal, and Medicaid dollars are allocated to local programs. Data are presented on the use of state hospitals and the number of severely mentally ill individuals in treatment. These data are used to make observations on the initial stages of the demonstration. PMID- 10125384 TI - Long-term follow-up of rural involuntary clients. AB - A cohort of 72 persons who had entered a rural Oregon county's involuntary treatment system in 1979 through 1982 was followed for six years. While schizophrenia was the most frequent diagnosis, several other conditions were represented including adjustment disorders, organic mental disorders, and substance abuse. The majority (55%) of persons with organic mental disorders died as did 12% of the individuals with schizophrenia. The overall mortality rate was three times the expected figure (p = .002). During the follow-up period, only 39% of the initial cohort received treatment from a community mental health program whereas 28% were newly admitted (involuntarily) to a state mental hospital. Hospital recividism was most likely among individuals who had had prior involuntary treatment. At least in rural areas, the civil commitment system seems to serve both "infrequent" and "persistent" users. Infrequent users mainly have diagnoses of adjustment disorders and/or substance abuse. Persistent users chiefly have diagnoses of organic mental disorders, mood disorders, or schizophrenia. Modifying the involuntary treatment system to take account of this heterogeneous population's diverse needs is discussed. PMID- 10125385 TI - Variables affecting length of psychiatric inpatient treatment. AB - To discover whether variables such as gender, ethnicity, pay code, and diagnostic category affect length of psychiatric inpatient treatment, patient records for a recent 18-month period (January 1988 to June 1989) in a Midwestern teaching hospital setting were examined and statistically analyzed. Variables that emerged as related to length of stay are ethnicity, Axis I diagnosis of adjustment disorder, and presence of any Axis II diagnosis. Comparisons with length of stay statistics from an earlier period (1981) lead to conclusions about inpatient psychiatric services since the implementation of diagnosis related groups. Further, implications of this study's findings are discussed in relation to mental health service delivery. PMID- 10125386 TI - Quality planning for mental health. AB - This article describes quality improvement theory and its application in planning a major clinical initiative. The experience of the Harvard Community Health Plan in redesigning its mental health program is used to describe how theory can be translated into practice. A formal process is involved which relies heavily on the use of data in designing the program as well as evaluating its success. PMID- 10125387 TI - Consumer-operated drop-in centers: evaluation of operations and impact. AB - Research on self-help for consumers of psychiatric services has focused on the operation of voluntary groups and largely ignored service programs operated by consumers. This evaluation study focused on six consumer-operated drop-in centers, each established for at least two years. These centers served a combined total of 1,445 consumers and were funded as demonstration projects by the Michigan Department of Mental Health. Structured interviews of consumer-users of these centers indicated that the program was meeting its funding intents of serving people with serious mental illness and of creating an environment promoting social support and shared problem solving. Levels of satisfaction were uniformly high; there were few differences across centers. Issues that emerged for future policy and research considerations included funding constraints, enhancing accessibility (particularly for women and people needing frequent hospitalization), variable levels of support from catchment area community mental health agencies, and determining the long-term benefits of drop-in center participation. PMID- 10125388 TI - Perspectives on costs and cost effectiveness of ombudsman programs in four fields. Case 4: Hospital case (a client ombudsman) . PMID- 10125389 TI - Why doctors are getting poorer.... PMID- 10125390 TI - How to live with the Clinton taxes. PMID- 10125391 TI - Reporting on a colleague's conduct cost this doctor plenty. AB - When an ophthalmologist questioned another M.D.'s professional ethics, he found himself facing a protracted lawsuit--one with disturbing implications for all physicians. PMID- 10125392 TI - Medicine's "golden age" is over? Not for me! PMID- 10125393 TI - A whole new way to be sued? PMID- 10125394 TI - Ophthalmologists' earnings shrink. PMID- 10125395 TI - Are clouds closing in on the Rochester miracle? AB - Though costs are low and access is high, the city's heralded health system hasn't escaped spiraling inflation. And doctors in the region are weary of making sacrifices. PMID- 10125396 TI - Paging Mary Poppins. AB - Close to desperation, this doctor found the perfect caretaker for her children. Follow her hard-won guidelines, and you can too. PMID- 10125397 TI - Medicine is becoming just another job. PMID- 10125398 TI - Beware hidden traps in your hospital's bylaws. PMID- 10125399 TI - How I reversed an unfair UR denial. AB - When an insurer wouldn't pay for a drug his patient needed, the author let loose a barrage of letters. See what made them work. PMID- 10125400 TI - Managing termination. Part 1. Firing with the least trauma. AB - A termination can be almost as disturbing for the terminator as it is for the person about to become unemployed. Below are some practical suggestions on how to make the action as painless as possible for all parties involved. PMID- 10125401 TI - Implementing a successful bedside glucose program. PMID- 10125402 TI - Patience with patients: a must for outpatient labs. AB - It's the little things that make a big difference in how outpatients perceive their care and ultimately determine whether they will return for future services. Here's a light-hearted look at some outpatients who may seem all too familiar. PMID- 10125403 TI - Bar codes. Part 5. Wristbanding for positive patient ID. PMID- 10125404 TI - Managing your lab in a multicultural environment. PMID- 10125405 TI - How to upgrade your hard disk drive. PMID- 10125406 TI - Trustees tackle priorities. AB - Trustees at Michigan Hospital Association's member hospitals play a vital role in governing the many activities of Michigan hospitals. What are the top issues Michigan hospital trustees are addressing? Michigan Hospitals asked a variety of trustees and chief executives what those top issues would be. PMID- 10125407 TI - State's legislative process driven by committees. PMID- 10125408 TI - Catering to customers = investing in employees. PMID- 10125409 TI - Mission statements and the auxiliary. PMID- 10125410 TI - From vision to reality: a look at community care networks. PMID- 10125411 TI - The 1990s: a decade of transition. PMID- 10125412 TI - The admission department--"billers of the future". AB - As the turn of the century approaches, one fact is becoming clear: change will demand that healthcare managers must boldly go where no one has gone before. The place where change will be most prevalent will be the admission department. PMID- 10125413 TI - The impact of managed care contracts on the admission and registration process. AB - With increasing demand placed on the admission and registration process, hospitals are undergoing dramatic operational changes. These changes are necessary to maintain the vital cash flow of the hospitals. A major factor forcing hospitals to rethink the front line process in the admission and registration area is the impact of managed care. PMID- 10125414 TI - The polls: poll trends. AIDS--an update. PMID- 10125415 TI - Do the "Baby Doe" rules ignore suffering? PMID- 10125416 TI - Communicating with children. One neighbor's view. AB - Through play, children express feelings of anger, fear, and helplessness. Caring adults who understand the meaning of such play can help children in their efforts to cope with difficult situations, including life-threatening illnesses. PMID- 10125417 TI - Care of the dying child. The demands of ethics. AB - The identification of terminally ill children is a crucial task for e care providers--but one they resist. Acknowledgement of a child's impending death permits both family and caregivers to help the child come to terms with his or her "illness-reality." PMID- 10125418 TI - Pastoral care in Candyland. Maintaining power and life in a world of illness. AB - Wrestling with ghosts and staging fatal accidents with Matchbox cars allow a critically ill six-year-old to come to terms with the fears prompted by his illness. PMID- 10125419 TI - The case. What should Leah be told? AB - Fearing that his 18-year-old daughter will value her fertility more than her life, an Orthodox Jewish father implores physicians not to seek her informed consent for surgery for vaginal cancer. PMID- 10125420 TI - Commentary. An uninformed choice. AB - Judaism is wrongly blamed for exacerbating the dilemma facing this Orthodox patient and her family. In actuality, a vital and human halakhic tradition is a resource that can respect the daughter's autonomy while appropriately responding to her father's fears about her well-being. PMID- 10125421 TI - Commentary. Caring for Leah. AB - Noticeably absent from the ethics consultation is a sense of who the patient is and what her connections to her family, religion, and culture are. A group of Orthodox Jewish women discuss the case, trying to piece together a picture of Leah and the resources at hand to help her deal with this crisis. PMID- 10125422 TI - A discussion of medical malpractice and cesarean section. PMID- 10125423 TI - Expanding horizons: career opportunities in tissue banking. PMID- 10125424 TI - Sharps in healthcare laundry: what happens when an employee gets stuck? One textile rental operator shares his plant's experience. PMID- 10125426 TI - Favorable trend: low bond rates enable hospitals to save money. PMID- 10125425 TI - The primary care push. Teaching hospitals initiate programs to enhance their primary care physician base and help their communities. PMID- 10125427 TI - Long-term compensation: a retention incentive for CEOs. PMID- 10125428 TI - Changing expectations of hospital governance: Part one. PMID- 10125429 TI - Meeting outpatient care challenges. PMID- 10125430 TI - 'Ultimate' partnerships benefit community health care delivery. PMID- 10125431 TI - Problems or opportunities? It's a matter of perspective. PMID- 10125432 TI - Ethics committees: providing moral guidance in the hospital. PMID- 10125433 TI - Lawmakers, providers scrutinize Clinton's economic proposals. PMID- 10125434 TI - A picture of health. Clinton's plan to reform the health care system will require better data. PMID- 10125435 TI - Operational restructuring for patient focused care: the facility implications. AB - In the typical hospital, customer service lags behind clinical care. In spite of the promised efficiencies of quality control/quality assurance, costs have continued to soar, whilst the concept of patient focused care has been overlooked. More than 50% of costs are accounted for at 'operational level', due to historical trends towards centralization of ancillary services. Operational restructuring to emphasize 'patient focused' delivery of care implies a number of facility changes which are described below. PMID- 10125436 TI - The international health care challenge. "A vision for the future". PMID- 10125437 TI - A comprehensive assessment of Canadian health program guidelines: international health system implications. AB - A comprehensive assessment of the Health Program Guidelines (HPG) in Canada was undertaken between January to September 1992. This review examined the strategic effectiveness and operational efficiency of the guidelines under the auspices of a Federal/Provincial/Territorial Committee on Institutional and Medical Services (ACIMS). To assess the perceived needs for the guidelines, over 185 structured mail questionnaires were sent to a sample of health care agencies, institutions and organizations across Canada. A key informant approach was also used to assess the perceived effectiveness and efficiency of the guidelines. Based on the results of the questionnaires the findings and recommendations were made, that are relevant to the international health system community. PMID- 10125438 TI - Balancing profits with community benefits. PMID- 10125439 TI - How to avoid a taxing situation: IRS takes aim at tax-exempt hospitals. PMID- 10125440 TI - Humor in a hospital--that's a laugh. PMID- 10125441 TI - Hospital-physician contracting. PMID- 10125442 TI - Prevention and health promotion: a plan for Kentucky. PMID- 10125443 TI - Two shorter forms of the CES-D (Center for Epidemiological Studies Depression) depression symptoms index. AB - Brief measurement devices can alleviate respondent burden and lower refusal rates in surveys. This article reports on a field test of two shorter forms of the Center for Epidemiological Studies Depression (CES-D) symptoms index in a multisite survey of persons 65 and older. Factor analyses demonstrate that the briefer forms tap the same symptoms dimensions as does the original CES-D, and reliability statistics indicate that they sacrifice little precision. Simple transformations are presented to how scores from the briefer forms can be compared to those of the original. PMID- 10125444 TI - Do falls predict institutionalization in older persons? An analysis of data from the Longitudinal Study of Aging. AB - Data from the Longitudinal Study of Aging (LSOA) were analyzed to estimate the subsequent risk of institutionalization associated with a report of one or more falls, and to determine if the association is affected by controlling for demographic traits, chronic conditions, and disabilities present at baseline. Risk was estimated at two time points, 2 years and 4 years after baseline interview. A report of multiple falls at baseline was associated with an increased risk of institutionalization at both 2 years (odds ratio [OR] 3.1; 1.9 5.3) and 4 years (OR 2.6; 1.6-4.4) of follow-up. The risk was decreased but remained significant in a model controlling for age, sex, marital status, and selected chronic conditions associated with both report of falls and institutionalization. However, multiple falls were not significantly associated with institutionalization when measures of disability (number of difficulties with activities of daily living) were added to the model. These analyses suggest that multiple falls should be regarded as an important sentinel event to alert caregivers to the presence of underlying disease and disability that may require intervention. PMID- 10125445 TI - Length of stay in VA nursing homes. Comparative characteristics of brief-, medium , and long-stay residents. AB - To examine the patterns and determinants of length of stay among residents of nursing homes of the Department of Veterans Affairs (VA), the authors conducted a retrospective follow-up study of all persons (n = 4,918) admitted to VA nursing homes between October 1986, and April 1987, using computerized records of the VA. Brief-stay (< 1 month; n = 1,139) residents had most often had previous admissions to VA nursing homes and were usually discharged alive from the nursing home. Medium-stay (1-6 months; n = 1,947) residents were the least functionally impaired and most likely to receive rehabilitative services. Long-stay residents (> 6 months; n = 1,832) were older and more functionally impaired than other residents. Medium- and long-stay residents of VA nursing homes most resembled "short-" and "long-stay" residents among non-VA nursing home residents, respectively. Brief-stay residents may be persons admitted for "respite" services or may be serial users of both VA and non-VA health services. Further study of this population may identify opportunities to decrease "revolving-door" use of nursing home services. PMID- 10125446 TI - Fear of falling among the community-dwelling elderly. AB - To assess the incidence of falls and the prevalence, intensity, and covariates of fear of falling among community-dwelling elderly, the authors surveyed a random sample of 196 residents (> or = 58 years of age) of housing developments for the elderly in Brookline and Plymouth, Massachusetts. Forty-three percent reported having fallen in recent years, 28% in the last year. Of those who had fallen within the year prior to the interview, 65% reported injury, 44% sought medical attention, and 15% required hospitalization as a consequence of their fall(s). Fear of falling ranked first when compared to other common fears (i.e., fear of robbery, financial fears). Self-rated health status and experience of previous falls were significantly associated with fear of falling. Further analysis suggests that fear of falling may affect social interaction, independent of risks for falling. PMID- 10125447 TI - Estimates and determinants of valid self-reports of musculoskeletal disease in the elderly. AB - This study examined the extent and nature of bias associated with self-reported versus standardized physician-examination/assessment-based accounts of musculoskeletal disease in a sample of 406 persons chosen to represent an aging and dependency continuum. Prevalence of musculoskeletal disease based on standardized physician examination/assessments was 97%. Using the standardized findings as the criterion, the self-report underestimated prevalence by 16%. Overall, the results indicated that self-reports of musculoskeletal conditions by the elderly capture the vast majority of persons with painful or functionally significant disease and are most valid for persons from ages 65 to 74 but do not reflect the presence of asymptomatic joint pathology. Standardized physician examinations/assessments would more accurately determine the presence of risk factors in epidemiological studies of musculoskeletal disability. PMID- 10125448 TI - Failure to have prescriptions filled among Black elderly. AB - Despite extensive research on drug consumption and compliance with drug regimens within the geriatric population, little attention has been given to the failure to have prescriptions filled among elderly in general and Black elderly in particular. The prevalence and correlates of patients' failure to have prescriptions filled were investigated for a sample of 571 Black elderly. In terms of prevalence, 12.8% of this sample asserted that they had received a prescription from a physician and not had it filled during the 6 months period prior to interview. Multivariate logistic regression was employed to detect the significant predictors of this type of noncompliance. According to our data, failure to have prescriptions filled was significantly greater among Black elderly with higher levels of anxiety, those with lower levels of internal health locus of control, those who did not have prescription medication coverage through Medicaid, those who were currently using prescription medications, those who consumed greater numbers of over-the-counter medications, and those who reported more financial problems. Implications of these findings are discussed. PMID- 10125449 TI - Perspectives. Clinton and Congress: "satisficing" their way to health reform. PMID- 10125450 TI - A simple guide to building procurement. PMID- 10125451 TI - The concept of project sponsorship. PMID- 10125452 TI - Construction management. AB - Construction Management is fundamentally different from other forms of building procurement, including management contracting and should be seen as a 'professional management' service, recognising management as a skill in its own right, aside from contracting. It does expose the client to greater risk, of course, but a value judgement has to be made as to the benefit a client obtains from the system versus the risk profile of the system. PMID- 10125453 TI - Design and build: the state of the art. PMID- 10125454 TI - Major redevelopment for Dr Gray's hospital. PMID- 10125455 TI - Nurse management systems at Barnsley District General Hospital. PMID- 10125456 TI - EPA proposes new rules for refrigerant recovery. PMID- 10125457 TI - Cal-OSHA issues bloodborne pathogens citation. PMID- 10125458 TI - A time series study of the impact of eligibility expansion on Medicaid financing of births. AB - In a major reform addressing declines in coverage over the prior decade, Congress in 1986 allowed states to expand Medicaid eligibility to all pregnant women in poverty. However, at the outset of the expansions uncertainty existed as to whether eligibility expansion alone would result in greater coverage without aggressive outreach designed to bring more low-income pregnant women into the program. Using interrupted time series methods, the analyses presented in this paper show a significant increase in Medicaid financing of deliveries in two states that expanded eligibility and also made efforts to simplify application procedures and publicize the expansions. Policy implications of the findings are discussed. PMID- 10125459 TI - Study indicates mixed cost containment-efficiency results from PPS implementation. AB - The prospective Payment System (PPS) has put the nation's hospital industry at extreme risk of financial failure and closure. With the PPS in effect, hospital incentives changed from Medicare reimbursement maximizers to the development of programs and the implementation of organization changes which would control cost and encourage efficiency. Specifically, the Federal Government wanted to reduce or at least maintain at a constant level their cost for the Medicare program. PMID- 10125460 TI - Use of self-care by Hispanics: culture, access or need? AB - Hispanics have often been depicted as being avid users of traditional self-care who are skeptical of the formal health care system. This study used descriptive statistics and multiple regression analyses to examine the self-care practices of Mexicans and Puerto Ricans living in Chicago. The findings provide evidence that Hispanics are not excessive users of self-care and underutilizers of formal medical care. Though both groups used non-prescribed-home-treatments, they did so at rates comparable to those reported for the general population. PMID- 10125461 TI - Power, social support and HIV-related service use: the roles of community and homelessness. AB - Retrenchment of the Welfare State is often premised on the assumption that social support or community caring capacity can substitute for formal health and social services. We assert that the nature of this relationship depends on the nature of one's community. This paper examines social support and service use among gay and non-gay, homeless and domiciled people with HIV infection. In general, membership in the gay community is associated with greater use of formal services. Part of this relationship is explained, for homeless people, by one's level of access to social support. This suggests that, for this group, access to formal services can be improved by improving access to social support. Much of the relationship between membership in the gay community and use of services is not explained by social support and may be due to other factors such as the power of the gay community to create services for itself. PMID- 10125462 TI - Traumatic brain injury: the lag between diagnosis and treatment. AB - Ogburn described the "culture lag" between technology and attitudes, as people take time to assimilate new technologies, and new facts, into their worldviews. Traumatic brain injury is now a common diagnosis, thanks to neurosurgical expertise. Where thirty years ago mortality from head injuries was high, today mortality rates have improved dramatically; yet even while neurosurgeons spare thousands of people each year, our society struggles to develop appropriate rehabilitation protocols. To date, we are in the lag phase, between diagnosis and treatment. This paper discusses that lag, including reasons for the lack of an effective rehabilitation protocol (the paucity of funds for research, the nature of brain injuries per se), the reluctance of insurers to cover brain injury rehabilitation (the lengthy time involved in rehabilitation, the blurring between rehabilitation and long term care, the nature of experience-rated contracting to businesses for health care insurance, the burgeoning of proprietary brain injury rehabilitation centers), and the prospects for closing the gap in the near future. The paper concludes that preventive measures (seat belt laws, motorcycle helmet laws, laws for helmets in contact sports) allow policy-makers to confront the growing societal problem of the mounting census of head-injured, by avoiding that census and focusing instead on the prevention, or diminution, of future head injuries. PMID- 10125463 TI - Social work perspectives on human behavior. AB - This manuscript addresses recent developments in human behavior research that are relevant to social work practice. Specific items addressed are biological aspects of behavior, life span development, cognitive variables, the self-efficacy learning process, the perceptual process, the exchange model, group level variables, macro level variables, and gender and ethnic-racial variables. Where relevant, specific applications to social work practice are provided. PMID- 10125464 TI - An economic evaluation of the market for physicians' services: shortage versus surplus. AB - The paper examines the existence of a shortage or surplus in the market for physicians' services over time. The assessment is carried out within a framework provided by economic theory, and three basic indicators are utilized: earnings, rates of return to education, and quantity of work. The third indicator is examined in various forms including vacancies, weeks of work, and hours of work. The outcomes of this assessment do not support the existence of a surplus of physicians; rather, they are consistent with a shortage which appears to be growing. PMID- 10125465 TI - Living will legislation, nursing home care, and the rejection of artificial nutrition and hydration: an analysis of bedside decision-making in three states. AB - Although state living will legislation establishing the boundaries of unwanted medical intervention has become almost universal, many states define artificial nutrition and hydration as a basic comfort measure rather than extraordinary intervention. In addition, several states have legislation prohibiting its withholding or withdrawal under any circumstances. Despite the recent growth in public awareness and controversy concerning artificial nutrition and hydration, there is little known about the actual influence of prohibitive legislation on bedside decisions involving its withdrawal. An analysis is undertaken of nursing home decision-making concerning the withdrawal of artificial nutrition and hydration in three states with typical variation in living will legislation specific to its legality. Data from interviews with 140 nursing home directors of nursing service responding to hypothetical case vignettes suggest that living will laws prohibiting the withdrawal of artificial nutrition and hydration have little influence over bedside decision-making in nursing homes. Factors found to be determinate of the likelihood of the withdrawal of artificial nutrition and hydration include the competency of the nursing home resident and form of nursing home ownership. State context exerts a significant influence over the likelihood of artificial nutrition and hydration withdrawal, but not in a direction consistent with language of living will legislation. PMID- 10125466 TI - Practice and attitudes of primary care physicians in a rural southern state concerning HIV/AIDS patients. AB - In preparing for the development of a plan of care for persons with AIDS and other HIV related conditions, the HIV Services Planning Program, a joint effort of the Department of Family Medicine of the University of Mississippi Medical Center and the Bureau of Preventive Health of the Mississippi State Department of Health, conducted a survey of all primary care physicians throughout the state of Mississippi. The purpose of the survey was to determine health care services provided to persons with HIV/AIDS. Specific areas of interest included: (a) type of medical specialty; (b) location of primary practice; (c) services provided for persons with HIV/AIDS; and (d) utilization of universal blood and body fluid precautions, i.e., barrier techniques. Descriptive statistics were utilized in analyzing responses. PMID- 10125467 TI - IV drug use, dementia, and nursing home care for PWAs (persons with AIDS). AB - Despite the usual focus on daily costs, because PWAs have higher costs per day than other SNF residents, LOS and days of care are important cost indices. Data on LOS for 102 admissions and annual days of care for 90 PWAs show average 64-day LOS and 67 days of care. Regression analysis and survival analysis show dementias and IV drug use to mean longer LOS and more days of care. Higher PWA costs must be sustained over longer periods for PWAs with dementias and for IV drug users, who may claim increasing shares of the SNF care provided to PWAs. PMID- 10125468 TI - An analysis of Hong Kong's health policy. PMID- 10125469 TI - Employee benefit packages for part-time workers. AB - To successfully recruit and retain part-time workers in the decade ahead, managers will need to design more attractive employee benefit packages. This article examines which benefits part-time workers receive and value the most and which benefits they would like to receive. PMID- 10125470 TI - Predicting the future of medical transcription. PMID- 10125471 TI - The future is here today. PMID- 10125472 TI - Ergonomics: your chair and you. AB - In a profession such as medical transcription which requires sitting for prolonged periods of time, finding the right chair can be as important to your job performance as using the latest state-of-the-art technology. PMID- 10125473 TI - Improving budget control: a case study. PMID- 10125475 TI - White House reveals names of Task Force members. PMID- 10125474 TI - Bottom-up decision-making, continuous learning, and innovative partnerships underlie rural Muncy Valley Hospital's revitalization. PMID- 10125476 TI - Best ways to help the OR: survey of OR managers. PMID- 10125477 TI - Forging computer links when you have no tools. AB - Are stand-alone computers standing between you and vital inventory records? Experts respond to a typical hospital scenario. PMID- 10125478 TI - Playing the right cards: how to deal with an executive search firm. PMID- 10125479 TI - Automation helps CS track instrument use. PMID- 10125480 TI - Diverse team creates new OR materials system. PMID- 10125481 TI - TQM helps save money, patients' skin. PMID- 10125482 TI - Stats ... spending increases on supplies, instruments and pharmaceuticals for ambulatory care centers. PMID- 10125483 TI - Health care reform: its impact on you. PMID- 10125484 TI - Brand-new hospital builds materials and processing team from scratch. PMID- 10125485 TI - Hospitals have new options in off-site sterilization services. PMID- 10125486 TI - Stats ... basic job skills. PMID- 10125487 TI - Equipping to meet the EPA's silver recovery regulations. PMID- 10125488 TI - Striving for professional excellence: 14 traits of truly great CS (central service) managers. PMID- 10125489 TI - AHA comments to FDA on Safe Devices Act. PMID- 10125490 TI - Beyond price: services from furniture dealers. AB - Furniture dealers have a lot to offer. Here's how to make sure you get it. PMID- 10125491 TI - Quality improvement: achieving excellence in customer service. PMID- 10125492 TI - Centralized transport system combines savings and efficiency. PMID- 10125493 TI - Help support CFOs by balancing service and cost management. PMID- 10125494 TI - Stats. Majority of hospitals won't switch to 100% EtO. PMID- 10125495 TI - Glove allergy origin baffles scientists and materials managers alike. PMID- 10125496 TI - Getting ready to ID supply costs by DRG. PMID- 10125497 TI - Creating a strategic purchasing plan. PMID- 10125498 TI - OSHA standard prompts questions from CS. PMID- 10125499 TI - Common ground: building a strong partnership with your new boss. PMID- 10125500 TI - Hospital and vendor unite to create unique staff training partnership. PMID- 10125501 TI - Automated perpetual inventory in OR expected to save hospital $390,000. PMID- 10125502 TI - Taking the wraps off product packaging. PMID- 10125503 TI - ABC3: analyzing on-hand investment. PMID- 10125504 TI - Hospital reaps savings using 100 percent EtO sterilizer. PMID- 10125505 TI - Stats. What does it cost to clean an endoscope? PMID- 10125506 TI - Piecing together your own price forecast. PMID- 10125507 TI - Expanding the managerial role: how to be 'the best of all leaders'. PMID- 10125508 TI - Supplying ambulatory care centers from afar. AB - When your customers are located across town instead of down the hall, can you provide the service they deserve? Experienced materials managers offer their advice. PMID- 10125509 TI - Automation options for small hospitals. PMID- 10125510 TI - Rising TB incidence requires closer attention to prevention measures. PMID- 10125511 TI - Cutting a purchase order: little things can cost a lot. PMID- 10125512 TI - Hospitals and suppliers use TQM to eliminate excess. PMID- 10125513 TI - Managed care's impact on materials management. PMID- 10125514 TI - Storage: putting limited space to the best use. AB - It's a battle of wits in the war to gain storage space. Plus, storage systems fax poll: your chance to tell manufacturers about what you need in storage equipment. PMID- 10125515 TI - Stats ... how much purchasing clout do materials managers possess? PMID- 10125516 TI - Survey: how many staff members does it take to run CS? PMID- 10125517 TI - Materials managers get above-average pay hikes. PMID- 10125518 TI - Questions & answers. What is a materials manager's role in facility design? PMID- 10125519 TI - Stats ... nurses attitudes about personal safety on the job. PMID- 10125520 TI - Looking for safer needle devices: experts say the task is complex. PMID- 10125521 TI - Productivity: finding methods of measurement. PMID- 10125522 TI - Closed doors: CFC ban drives CS to plan new routes. PMID- 10125523 TI - Equipment budgets up; spending goes toward replacement. PMID- 10125524 TI - Altering the way care-givers think about linens can lower expense. PMID- 10125525 TI - Managing O.R. inventory may be easier than you think. PMID- 10125526 TI - Topping off the deal with value-added services. PMID- 10125527 TI - Rate your product analysis committee. PMID- 10125528 TI - How to standardize radiology supplies. PMID- 10125529 TI - Forms management: hospitals try using electronics to replace paper. PMID- 10125530 TI - Computer survey: gains made, but work remains. PMID- 10125531 TI - Sorting out problems in your mailroom. PMID- 10125532 TI - Patient-centered care changes focus of materials management. PMID- 10125533 TI - Redesigning a charging system: one hospital's experience. PMID- 10125534 TI - Stats. OR managers are sold on disposables--for now. PMID- 10125535 TI - Hospital 'field trip' turns fear of OSHA into 'healthy respect'. PMID- 10125536 TI - Staff survives 'shark attack,' gains new awareness of sharps disposal. PMID- 10125537 TI - CS survey: are you equipped? PMID- 10125538 TI - JIT (just-in-time) principles help Alta Bates cut OR costs. PMID- 10125539 TI - Meetings motivate staff to do the job right--the first time. Bureau of Business Practice. PMID- 10125540 TI - Environmental and safety issues to watch in '93. PMID- 10125541 TI - Cross-training cuts FTEs--and boosts morale. PMID- 10125542 TI - How to purchase safer needle devices. PMID- 10125543 TI - Replacing a sterilizer: plan ahead. PMID- 10125544 TI - Easing supply traumas in emergency units. PMID- 10125545 TI - Do receiving and sterile storage mix? Only with great care, say CS experts. PMID- 10125546 TI - Stats. Joint Purchasing Corp.'s supply prices forecast. PMID- 10125547 TI - Improving customer relations and telephone response in Abbott Northwestern Hospital's laboratory department. AB - PROJECT: Improve the Laboratory's phone answering process. Principals: Clinical and administrative laboratory staff and a telecommunications specialist. Process Improvement Method: Modification of model used by the National Demonstration PROJECT on Quality Improvement in Healthcare. Timeline: May 1991-present. RESULTS reported here: August 1991-July 1992. The team is currently reviewing a computerized voice processing system that will take requests to reprint lab reports, take outpatient lab orders directly from doctors' offices, and provide test results and information on test tube specification for specific blood tests. Key Findings or Improvements: More than half the calls to the Laboratory needed to be transferred to Microbiology. Alternative communication systems such as a computerized voice answering system and the hospital's computer network could be used in place of phones to transmit information to and from the Laboratory. RESULTS: With the installation of an automated answering system, calls to Microbiology are automatically re-routed and the number of incoming calls to the Laboratory have dropped. More lab requests and reports are being handled by computer. PMID- 10125548 TI - The challenge of operating within staffing budgets on the maternity unit at New England Memorial Hospital despite a fluctuating census. AB - PROJECT: Improve staffing policies and procedures on the Maternity unit to reduce the chronic practice of exceeding the budget for nursing hours per patient day (NHPPD). Principals: Maternity Service nursing staff and unit secretary. Process Improvement Method: Plan-Do-Check-Act. Timeline: Begun: March 1991. RESULTS reported here: FY 1992 (October 1, 1991-September 30, 1992). KEY FINDINGS: Patient census fluctuated dramatically from shift to shift. To staff the unit during peak times, nurses from other units were floated in, but many lacked sufficient obstetrics training. Conversely, at slack times, OB nurses were floated to other units. All the above factors resulted in nursing dissatisfaction as well as the Maternity unit exceeding its nurse staffing budget by 25 percent. Improvements: Unit-based staffing, which eliminated floating and increased ownership on the unit, was implemented, along with other changes in operations, policies, and procedures. A charge nurse position was created and implemented to coordinate activities between shifts. Staffing policies and procedures were clarified and updated. RESULTS: Nursing hours per patient day are now on budget, and nursing morale is also improved. PMID- 10125549 TI - Reducing the volume of reports filed after discharge in the medical record department at Abbott Northwestern Hospital. AB - PROJECT: Decrease the backlog of "late" medical reports--ie, those sent to the Medical Record Department after the patient has been discharged and the patient's medical record has been received in the Department. Principals: Three teams: one composed of supervisor and staff of the records processing area; one of staff members from the Reception area; and one of staff members from the Laboratory, Radiology, and Special Diagnostics departments. Process Improvement Method: 10 step model based on Deming's key principles. Timeline: Begun: December 1991. RESULTS reported here: June 1992-September 1992. KEY FINDINGS: The systems for routing inpatient medical reports were faulty, so staff from the nursing units and ancillary services often sent reports to the Medical Record Department when the patient was still in the hospital. The process for locating and retrieving a chart for late report filing was too lengthy and complex. RESULTS: The backlog of unfiled reports has been reduced from 35 inches to less than one-half inch (an unusual, but customer-oriented measure). The time needed to file one inch of reports has decreased from 2 hours to 1.25 hours. PMID- 10125550 TI - Improving the patient transfer process at Bellin Hospital. AB - PROJECT: To facilitate timely and efficient transfers of patients on the cardiac service. PRINCIPALS: Nursing staff from the intensive care (ICU), intermediate care (IMCU), and step down units. Process Improvement Method: VALUE PLUS+, a scientific, problem-solving model developed at Bellin that requires statistical thinking. Timeline: March 1990-August 1991. Key Findings or Improvements: Mid morning, early afternoon, and early evening are the ideal times for patient transfers; late morning and mid-to-late afternoon transfers should be avoided. Unit staff can plan transfers for preferable times by predicting the number of transfers from ICU and IMCU, based on a percentage of the previous day's census. RESULTS: The number of process steps to transfer a patient was reduced from 21 to 13. 80 percent of transfers now occur during three designated time periods. The role of transport staff has been expanded to free up nursing time. PMID- 10125551 TI - Improving the timeliness of emergency C-sections at Southwestern Vermont Medical Center leads to improved patient care and increased physician satisfaction. AB - PROJECT: Increase the hospital's vaginal birth after C-section (VBAC) rate by guaranteeing compliance with ACOG's 30-minute standard. PRINCIPALS: OB and OR nursing staff and physicians, and the director of laboratory services. Process Improvement Method: Plan-Do-Check-Act. Timeline: January 1991-July 1992. KEY FINDINGS: Lack of physician confidence in the hospital's system for handling emergency C-sections resulted in fewer trials of labor for women with a history of previous C-section. 70 percent of delays involved patient preparation for surgery, OR setup, or patient transport. Laboratory delays, not previously identified as a problem, in fact, were one of the root causes of delayed emergency C-sections. RESULTS: By performing tests in advance, lab time has dropped from 11 minutes to zero. Patient prep time has dropped from 9 minutes on average to 2.8. 88 percent of emergency C-sections have met ACOG's 30-minute guideline. PMID- 10125552 TI - Reducing linen usage at the Methodist Hospitals: changing from flat to fitted sheets benefits patients and bottom line. AB - PROJECT: Reducing waste associated with unnecessary linen use. Principals: Patient care directors from two hospital campuses, manager of the laundry department, and director of environmental services. Process Improvement Method: An organizational change model being applied throughout Methodist Hospitals, based on the work of Dr. Gerard Egan at Loyola University in Chicago. Timeline: Begun: January 1991. RESULTS reported here: August 1991-August 1992. Key Findings or Improvements: The hospital's routine bed-making policies, which called for changing sheets, mattress pads, and bedspreads daily, were wasteful and unnecessary. Patients disliked flat sheets that bunched up, and nurses spent valuable time having to constantly smooth the sheets. Product innovations made fitted sheets, previously rejected, a cost effective alternative. RESULTS: By switching to an "as needed" linen change policy, the Laundry Department received 1,296 fewer pounds of laundry per day and more than 473,000 fewer pounds per year, despite stable occupancy. The resulting cost savings were invested in the improved product (fitted sheets) and a new delivery system (sealed linen packs). Nurses report increased patient comfort from new sheets and reduced nursing time to straighten bunched sheets. PMID- 10125553 TI - An illustrative quality and performance report for the governing board. PMID- 10125554 TI - Principles for developing governance reports on quality and performance. PMID- 10125555 TI - A process for developing a Board quality and performance report. PMID- 10125556 TI - Performance evaluation and compensation: helping employees see the "big picture". PMID- 10125557 TI - Redesigning performance evaluation and compensation systems to support total quality. PMID- 10125558 TI - Streamlining the performance evaluation system: focus on people, not paperwork. PMID- 10125559 TI - Data watch. HMO vital statistics. PMID- 10125560 TI - After 20 years, HMOs are still challenged to deliver quality. PMID- 10125561 TI - Seeking the Rx for rising drug costs. PMID- 10125562 TI - The coming debate over a standard benefits package. PMID- 10125563 TI - UR accreditation raises questions among employers. PMID- 10125564 TI - Is it still home sweet home care? PMID- 10125565 TI - Should states experiment with reform? PMID- 10125566 TI - Reform should begin in our communities. PMID- 10125567 TI - Down to brass tacks. Hillary's plan is delayed--but the elements are coming into focus. PMID- 10125569 TI - Time to step back. PMID- 10125568 TI - Experimental states. A few local governments have their own ideas on health-care reform -- and some already work. PMID- 10125570 TI - Home improvement and structural alterations (HISA); increase in the limit for home improvement and structural alterations (HISA)--VA. Final regulations. AB - The Department of Veterans Affairs (VA) is amending its regulations that govern expenditures for home improvements or structural alterations for veterans. The Veterans' Medical Programs Amendments Act of 1992 authorized increases for home improvements or structural alterations from $2,500 to $4,100 for service connected veterans and from $600 to $1,200 for nonservice-connected veterans. This amendment will make the regulation consistent with the law. PMID- 10125571 TI - Encrypted signals. AB - Health care reform poses a classic litmus test on the role of government. Will President Clinton lean toward free-market principles, or will he take a more activist approach? Here's a guide to decoding the philosophical subtext of the plan that he's set to unveil soon. PMID- 10125572 TI - Rx: higher prices. AB - Prescription drug prices in the United States are some of the highest in the world, and U.S. trade officials and the American pharmaceutical industry are doing something about it. They're pressing for trade agreements that could raise drug prices in other countries. PMID- 10125573 TI - Occupational entrants in 1990-91. PMID- 10125574 TI - Worker tenure in 1991. PMID- 10125575 TI - Financial planning: a necessity for the '90s. AB - The changing face of healthcare demands a long-range strategic financial planning system. Yet who's responsible? The chief information officer or the chief financial officer? Reiff and Nelson provide a framework for CIOs to understand their CFO's needs. PMID- 10125576 TI - A comprehensive framework for I/S strategic planning. AB - Too often hospital information services departments fail to create a strategic plan or make, at best, a half-hearted attempt at it. And many times, sincere efforts are waylaid by poor preparation or inadequate communication with users and management. By applying a systematic planning methodology, however, many pitfalls can be avoided. PMID- 10125577 TI - Enterprise-wide network eliminates 'Tower of Babel'. AB - To plan an I/S strategy without sufficient communications capabilities omits a vital link to success. At Lehigh Valley Hospital in Allentown, Pa., information services experts are building a network foundation to support today's strategic plan as well as tomorrow's technology. PMID- 10125578 TI - Industry leaders earn Pioneer Award. AB - Computers in Healthecare announces four new Pioneers for 1993. They join a distinguished list of 17 CIH Pioneers who have received this honor since 1990. These new Pioneers, along with their Pioneer colleagues, will be honored May 12 at the 1993 Computers in Healthcare Conference and Exposition in Hilton Head, S.C. PMID- 10125579 TI - Service orientation: the I/S department's lifeline. AB - Sure, technical expertise is important. But without a positive, customer-oriented outlook, an otherwise competent information systems department will suffer, and may even fail. The director of Clinical Information Systems for Yale School of Medicine offers guidelines for an I/S department "attitude check." PMID- 10125580 TI - Hot list. Electronic data interchange. PMID- 10125581 TI - Financing the system. PMID- 10125582 TI - Terrorism hits home. AB - The terrorist bombing at New York's World Trade Center put the city's EMS system to the test. In this EMS exclusive, the incident commander provides a behind-the scenes look at one of the most challenging mass-casualty incidents in U.S. history. PMID- 10125583 TI - Through the eyes of a division commander. PMID- 10125584 TI - When injury strikes. AB - EMTs and paramedics who are injured on the job may wind up thousands of dollars in debt. In the first of an ongoing series of articles focusing on insurance, EMS examines the need for disability coverage. PMID- 10125585 TI - ED warfare. PMID- 10125586 TI - A close call. An ED nurse's training takes over when he and his coworkers are confronted by a gunman. PMID- 10125587 TI - From Russia with love. PMID- 10125588 TI - Statement of understanding. Confirming the major gift. PMID- 10125589 TI - The coming health care shakeout. AB - No matter what the Clintons do, this mammoth industry--even bigger than you think -is in for turmoil. A safe prediction: Plenty of people will lose their jobs. PMID- 10125590 TI - Heart institutes provide collaboration opportunities. PMID- 10125591 TI - Hospitals prepare for start of Oregon health plan prototype. AB - In March, the Clinton administration approved Oregon's controversial Medicaid rationing program, but said the state must revise its ranking of services to eliminate the possibility of bias against disabled people. Under the Oregon system, approximately 688 medical procedures and services were ranked according to their cost effectiveness. Based on projections of available funds, officials decided they wouldn't cover any treatment ranked below 568. But with the savings, the state will be able to provide Medicaid to the 120,000 Oregonians who now live below the poverty line, but don't receive Medicaid benefits. PMID- 10125592 TI - Legislators give Maine hospitals antitrust OK for collaboration. PMID- 10125593 TI - Strategic market analysis: an effective tool for collaboration. AB - If collaboration, not unrestrained competition, is part of the answer to containing health care costs, providers must choose their partners carefully. Competition won't disappear. It's here to stay. But many in our industry have come to the conclusion that increased collaboration is necessary to preserve community health care resources and prevent wasteful duplication of services and technology. Managed competition--a combination of government regulation and free markets--means simply that collaboration and competition will coexist in a new health care environment evolving toward integrated delivery systems of varying kinds. PMID- 10125594 TI - How to design a horizontal patient-focused hospital. AB - Work Imaging is an executive information system for analyzing the cost effectiveness and efficiency of work processes and structures in health care. Advanced Work Imaging relational database technology allows managers and employees to take a sample work activities profile organization-wide. This is married to financial and organizational data to produce images of work within and across all functions, departments, and levels. The images are benchmarked against best practice data to provide insight on the quality and cost efficiency of work practice patterns, from individual roles to departmental skill mix to organization-wide service processes. PMID- 10125595 TI - Reforms offer rare strategic opportunities to providers. PMID- 10125596 TI - Breaking rural health care paradigms leads to collaboration. Interview by Donald E. Johnson. AB - Strategic planning in a rural community is a challenge. Trying to predict the impact of federal health care reforms while undertaking a 30 million dollar capital construction campaign to consolidate two deteriorating hospitals into one new medical center could have been a nightmare. Health Care Strategic Management publisher Donald E.L. Johnson and Eastern New Mexico Medical Center president and chief executive officer James K. Knoble discuss the challenges of federal health care reforms and rural health care administration, and explore potential opportunities for collaboration and integration. PMID- 10125597 TI - An introduction to health care reform. PMID- 10125598 TI - Don't wait to gather ROI (return on investment) data. PMID- 10125599 TI - Higher quality care provided with case management. PMID- 10125600 TI - Happy employees are productive employees. PMID- 10125601 TI - Disparity found in the career attainments of black and white healthcare executives. PMID- 10125602 TI - Can a manager be a moral leader? PMID- 10125603 TI - Reform calls for new relationships. AB - By looking beyond a medication's acquisition cost and assessing its impact on hospital resource utilization, we can gain a more accurate picture of its true economic and clinical value. PMID- 10125604 TI - What healthcare can learn from TQM's past. AB - Common characteristics and management processes that have caused noteworthy increases in market share, customer satisfaction, and cost reduction can be attributed to TQM initiatives. These common management characteristics and processes include: senior management leadership, strategies centered on customer judgments, strategically aligned department measurements, and an environment that fosters learning. PMID- 10125605 TI - Quality improvement: coaching and learning. PMID- 10125606 TI - How TQM may change your job. Interview by Walter Wachel. PMID- 10125608 TI - College introduces government relations program. PMID- 10125607 TI - Strategic alliances ensure TQM's full potential. PMID- 10125609 TI - EDI (electronic data interchange) and patient-focused care. PMID- 10125610 TI - The economics of elevators: who's buying what? PMID- 10125611 TI - Hospital shapes up its cardiac care continuum with new fitness center. PMID- 10125612 TI - Worlds apart. U.S. health facilities donate equipment, supplies and expertise to beleagured hospitals in the former Soviet Union. PMID- 10125613 TI - Utilities and companies offer energy-management options. Part 2. PMID- 10125614 TI - How to document, evaluate, respond to space requests. PMID- 10125615 TI - Bar coding ensures timely fire-system maintenance. PMID- 10125616 TI - Educating ASHE members is a 40-year tradition. PMID- 10125617 TI - AIA (American Institute of Architects) releases new health care construction guide. PMID- 10125618 TI - Using volunteers in food-service areas: some tips. PMID- 10125619 TI - Unwanted birds: a not-so-funny cleanup problem. PMID- 10125620 TI - Empowerment and self-directed work groups: the new world of participative work and "no-boss" units. PMID- 10125621 TI - Sharing resources: choices in health care. AB - Across the world, health care continues to consume ever-increasing amounts of nations' wealth. Different societies are grappling with the problem of how to define and constrain the burgeoning demand on their resources. The DoH has stated that there should be no blanket ban on any service; some RHAs have sought a consensus among district health authorities and many district health authorities are setting out their own conclusions. If each purchaser is free to form a distinctive view on what constitutes need in their population, the range of available services, and balances within that range, may vary from place to place. Should society accept those variations? asks Adrian Bull. PMID- 10125622 TI - HIV awareness at work. AB - Shared personal and professional awareness of and commitment to HIV issues in employment prompted Sue Ellis and Liz Smart to set up a project which, through collaborative working between health promotion, personnel functions and trade unionists, would devise training materials to address employment issues and reduce concern about HIV infection in the workplace. PMID- 10125623 TI - Geriatric medicine. AB - Old age never harmed anyone - but the problems that may arise in the elderly of multiple illnesses, social isolation and poverty conspire to present clinicians and managers with a challenge: an increasing challenge, as the number of people over the age of 85 by the year 2000 will be in the order of a million. PMID- 10125624 TI - Management ... working day of a health services manager. AB - As an executive director of King's Healthcare, Heather-Jane Sears combines her responsibilities for the professional leadership of nursing and midwifery and quality improvement with general management. A typical day will combine all three elements, but always there is the need to provide a top-class service to patients - and to spot opportunities to expand the business. PMID- 10125625 TI - Administrative residencies and fellowships: investments that pay dividends. PMID- 10125626 TI - The philosophy of administrative fellowships. AB - The administrative fellowship, which has its roots in the origins of health administration education, had gone by the wayside as the programs became more oriented to the university setting, rather than the practice setting. The author makes the case that restoring the administrative fellowship to the standard course of study would close the gap he sees between practice and academia. He then states that opportunities to learn on the job in fields such as hospital consulting have dwindled and that administrative fellowships would help program graduates get the exposure to problems and the decision-making skills necessary to be competitive in the job market. PMID- 10125627 TI - The role of the generalist in health administration education programs. AB - Health administration education programs frequently have at least one faculty member who is a nondisciplinary specialist in health services rather than a member of a mainline discipline such as economics, psychology, or sociology. Such personnel perform valuable functions in research areas requiring multidisciplinary teams and extensive knowledge about health services delivery. Policy analysis, planning, organizational analysis, and program evaluation are examples of research areas where the generalist can be of value. Generalists may have more knowledge of health services than other faculty and thus can insure that research findings are realistic. Second, the generalists' broad orientation is conducive to interdisciplinary research. Third, they often are well suited to lead research teams. And finally, generalists are often better equipped to explain how research findings are useful in the practice of health administration, thus increasing the relevance of health administration programs. PMID- 10125628 TI - Preparing for accreditation: an opportunity for faculty development and curriculum renewal. AB - An approach to ACEHSA accreditation is described which turns this exercise into an occasion for faculty self reflection, development, and renewal. The carefully facilitated process examines the curriculum, its fundamental bases, processes, and products from multiple points of view including those of the faculty, current students, graduates, and employers. The process is derived from deliberative curriculum inquiry and results in curriculum specifications that are ordered by actual practice and truly understood and supported by faculty, students, and practitioners. Feedback from participants indicates that the carefully guided process of introspection turned a negative expectation surrounding the preparation for accreditation into a positive experience of faculty development and curriculum renewal. The process was improved across the two replications documented here. PMID- 10125629 TI - Challenges in improving the quality of undergraduate health administration programs. PMID- 10125630 TI - Deliberative curriculum inquiry and its application in the education of health service administrators. PMID- 10125631 TI - Educational effectiveness of the case method approach in health services administration education. PMID- 10125632 TI - PACS: sending images around the hospital as quickly as patients. PMID- 10125633 TI - Patient records in the information age. PMID- 10125634 TI - Coming to terms with the AIDS pandemic. PMID- 10125635 TI - 1992: job market in the doldrums. AB - Manufacturing continued to lose large numbers of jobs, and other industries had small employment declines; only services and government added substantially to their employment, but with weaker gains than in the 1980's. PMID- 10125636 TI - Expanded care to boost spending 10%. PMID- 10125637 TI - Adventist donation to settle Fla. lawsuit on asset transfer. PMID- 10125638 TI - Epic set to issue new debt to shed junk bond burden. PMID- 10125639 TI - Records subpoenaed from 2 NME facilities. PMID- 10125640 TI - Lifetime stalls annual meeting to study bids of Abbey, others. PMID- 10125641 TI - Physician group mulls shift to become a negotiating group. PMID- 10125642 TI - N.J. hospital group faces fallout from stance on reform law as it gears up for annual gathering. PMID- 10125643 TI - Four more Pennsylvania hospitals settle charges of filing false claims. PMID- 10125645 TI - 2 countries offer compatible budget model. PMID- 10125644 TI - Sales tax mulled to fund reform plan. PMID- 10125646 TI - Management to blame for '80s woes--CEOs. PMID- 10125647 TI - Purchasing groups say 'Hillary effect' overstated. PMID- 10125649 TI - Agencies diverge on bond rating trends. PMID- 10125648 TI - Hospitals move to hub of rural emergency care. In sparsely populated areas, facilities seek to coordinate the patchwork of services that brings help in time of need. PMID- 10125650 TI - Hospitals await details of GME funding overhaul. PMID- 10125651 TI - Trauma-care data base offers hospitals new quality comparisons. PMID- 10125652 TI - Who's a hospital employee? IRS gets specific. PMID- 10125653 TI - Defense Dept. OKs new managed-care plan. PMID- 10125654 TI - Florida physicians with stake in imaging centers refer 54% more patients--GAO study. PMID- 10125655 TI - Former LAC-USC exec to fight job change. PMID- 10125656 TI - Baxter posts $201 million in first-quarter profits. PMID- 10125657 TI - Boards take action against more bad physicians. PMID- 10125658 TI - HCA's 1st quarter net income rises 49%. PMID- 10125659 TI - Performance indicator work starts. PMID- 10125660 TI - Banks force NME execs to sell stock. PMID- 10125661 TI - UniHealth acquisition awaits IRS ruling. PMID- 10125663 TI - HIAA (Health Insurance Association of America)-led group starts ad push. PMID- 10125662 TI - Hospitals rip Stark proposal for two-year Medicare freeze. PMID- 10125664 TI - Management company loses 1, gains 1. PMID- 10125665 TI - Discount cataract project starts. PMID- 10125666 TI - FTC heads deny plea to delay Ukiah hearing. PMID- 10125667 TI - CNA acts to reclaim bargaining-unit control. PMID- 10125668 TI - Job bill defeat shows need for compromise. PMID- 10125669 TI - Enlisting the VA system in the health-reform offensive. Critics say it's too costly to keep separate, but veterans fight to preserve VA mission and make more of their number eligible. PMID- 10125670 TI - Lahey Clinic leads charge in battle for primary-care turf. PMID- 10125671 TI - Formulary can help hold down drug costs. PMID- 10125673 TI - Turnarounds earn two a Harvard visit as winners of Cain Award. PMID- 10125672 TI - Study links financial health with high marks on surveys. PMID- 10125674 TI - Rise in uncollectibles negates drop in receivables. PMID- 10125675 TI - SunHealth adds distributor to pump up the purchasing. PMID- 10125676 TI - VHA reports record profits in '92. PMID- 10125677 TI - W.R. Grace begins Home Intensive buyout. PMID- 10125678 TI - Middle class uninsured on the rise. PMID- 10125679 TI - The impending arrival of UB-92. AB - Amid discussion on various forms of electronic claims and new legislation related to administrative simplification, the National Uniform Billing Committee (NUBC) met in January to continue its progress toward implementation of the 1992 Uniform Bill (UB-92) on October 1, 1993. The full schedule saw the NUBC consider the "language" attached to the UB-92 form, the introduction of new codes, a review of the attachment situation, consideration of an official electronic format, and reflection on the current and future role of the NUBC. PMID- 10125680 TI - The dawning of a new age. The implantable insulin pump. PMID- 10125681 TI - Elderly empowerment. New rights and research are enhancing nursing-home life. PMID- 10125682 TI - The case for home care. Interview by Margaret Mannix. PMID- 10125683 TI - Serious mental illness and disability in the adult household population: United States, 1989. AB - The major significance of the current report is that it provides estimates and characteristics for that portion of the civilian SMI population living in households. Survey results show that approximately 3.3 million adult Americans have mental disorders that seriously interfere with one or more aspects of daily life and that about 2.6 million of these persons are currently limited in one or more functional areas. These results suggest that the household component of the SMI population is comprised of between 2.6 and 3.3 million adults, depending upon the criteria employed for inclusion. Undoubtedly, both of these numbers are conservative because of the likelihood of underreporting in the survey. Placed in the context of the entire adult population, these findings suggest that the SMI population can be conservatively estimated to include 4 to 5 million adult Americans, or 2.1 to 2.6 opercent of the adult population. In addition to the household population, it is estimated that 200,000 SMI persons are homeless on any given day (13). An additional 1 million to 1.1 million are residents of nursing homes (14), approximately 50,000 to 60,000 are patients of mental hospitals, and approximately 50,000 are inmates of State prisons (15). A major remaining need is to collect similar data on all SMI persons, whether their residence is a household, an institutional or noninstitutional group quarter, or some other setting, including streets and shelters. In order to formulate more effective national policy to address the needs of these disabled Americans, a need exists to examine the longitudinal relationship between course of disorder and functioning as they relate to service and program participation. PMID- 10125685 TI - American Laundry Digest distributors directory. PMID- 10125684 TI - Leadership instability in hospitals: the influence of Board-CEO relations and organizational growth and decline. AB - This study tested whether leadership instability--a systemic pattern of frequent succession in the top management position of an organization--was associated with sociopolitical structures that define the relationship between the board and chief executive officer (CEO), controlling for temporal patterns of the organizational life-cycle stage. In organizations that are not profit maximizing and subject to considerable uncertainty, such governance properties were hypothesized to affect leadership instability independent of organizational growth or decline. Results of regression analyses demonstrate strong main effects of board-CEO relations, net of the impact of organizational life cycle, on leadership instability. PMID- 10125686 TI - Ethicists provide input on health care reform. PMID- 10125687 TI - Ohio hospitals surveyed on interplay of PSDA and state law. PMID- 10125688 TI - Research Council's report on AIDS draws fire for insensitivity. PMID- 10125689 TI - Hearings open in Texas on rehabilitation services. PMID- 10125690 TI - New York moves to revamp policies on patients without capacity. PMID- 10125691 TI - Unconventional therapies vie for professional acceptance. AB - A five-part documentary entitled "Healing and the Mind," which aired on PBS-TV stations nationwide February 22-24, explored the roles of thoughts and emotions in illness and health. It also raised some interesting questions regarding the relationship between mainstream Western medicine and alternative forms of therapies that are considered by most to be outside the mainstream. The Moyers documentary is reviewed by Frank Sabatino in the February 20 issue of Hospitals magazine (pp. 66-72). A companion volume to the PBS series, also titled Healing and the Mind, has been published (1993, New York City, Doubleday, $25). The TV series is but one of a number of events that signal a growing awareness and interest in alternative approaches to medicine, and the relationship between those who support these approaches and those in the bioethics field will most likely become entwined, as the following articles show. PMID- 10125692 TI - Right-to-die debate continues in legislatures and courts. AB - Although right-to-die initiatives have failed in Washington and California in recent years, the issue will resurface in Ohio and New Hampshire later this year. In a Gannett News Service article published in the April 12 Chicago Sun-Times, Ross Goldstein, a San Francisco psychologist and "trend tracker," states that physician-assisted suicide will soon become accepted. He predicts a new form of doctor/manager will surface to help families decide whether to take this step and how to do so. "Baby boomers don't turn over authority to their doctors," he says. "When they reach the end state, they will expect to be part of the decision making team." For now, the debate centers around individual cases and two different approaches, as exemplified by two different proponents. On the one hand is Jack Kevorkian, who envisions a network of death doctors or "obitiatrists" practicing "medicine." On the other is Timothy Quill, who calls for more humane care for the dying and the legalization of physician-assisted suicide, but with strict guidelines and in the confines of a long-term doctor-patient relationship. The following articles look at reactions in Michigan toward Kevorkian and at a case in British Columbia that may reach the Supreme Court of Canada. PMID- 10125693 TI - Blood use in spinal operations in children. AB - This paper reports a retrospective analysis of blood use in 27 children undergoing major spinal surgery in Liverpool in 1990. Overall 133 units of blood were cross-matched, but only 60 units (45%) were used. The results of the analysis show a significant difference between the operative techniques used in elective spinal surgery. This hospital has now introduced new guidelines for the cross-matching of blood. PMID- 10125694 TI - The comparative costs of care using apnoea monitors and scales in families with a cot death. AB - This paper reports the findings from a programme, which provided support to families with a subsequent baby following a cot death. One hundred families participated in the study. Fifty families were randomly allocated apnoea monitors, and the remainder provided with scales and weight charts for daily weighing. The results show that the parents in both groups expressed equal satisfaction with their designated method. However, compared with families allocated scales, those using apnoea monitors attended the child health clinics more often, and the number of contacts with the paediatrician was increased. They also had slightly more home and general practitioner contacts and hospital admissions. The capital and running costs of providing monitors was also greater for this group. PMID- 10125695 TI - Childhood immunisation and family size. AB - This paper reports an investigation into the associations between the number of children in the family and the vaccination uptake performance of those children. Using data from child health computer system the pertussis vaccination status was studied in 3,694 children aged 12 to 14 months. The findings show a strong association between vaccination uptake and the number of children in the family. The uptake rates reduced steadily from 86% for families with only one child to 58% for families with five children or more. Children from larger families were not only less likely to complete their full course of pertussis vaccination, but were also vaccinated later. Logistic regression analysis, which allowed for other associated factors, estimated that one 'child unit' increase in family size decreases the odds of being vaccinated by a factor of 1.7 in rural and suburban families and 1.3 in inner-city families respectively. Health professionals involved with the immunisation service should use child health computer data to target their problematic populations more effectively to achieve high vaccination uptake rates. PMID- 10125696 TI - Huntington's disease--falling through the net. AB - A survey was undertaken in Leicestershire of 25 carers of patients suffering from Huntington's Disease. The needs of families suffering from a late onset hereditary disease cross many service boundaries, thus providing a challenge for service providers. The results of the survey show that the service provision for people caring for patients with this disease are poor, particularly the availability and difficulty in access of some services. Two of the carers' most basic needs were for better residential care for their relatives and access to a source of long-term follow-up. PMID- 10125697 TI - Pulmonary embolus and maternal mortality in the antenatal period--evidence of a trend? AB - An analysis of pulmonary embolus mortality data was undertaken to investigate a putative change in maternal mortality due to pulmonary embolism in the antenatal period of pregnancy. A comparison was made of mortality due to pulmonary embolus for pregnant and non-pregnant women of reproductive age in England and Wales in the four triennia from 1976. During this period the antenatal pulmonary embolus mortality rate remained unchanged, whereas a statistically significant decline in non-pregnancy related pulmonary embolus mortality was observed. A comparison of the mortality trends between the two groups found the difference to be statistically highly significant. These findings strongly suggest that, over the twelve years investigated, women in the antenatal period of pregnancy have not benefited from the reduced risk of death from pulmonary embolus enjoyed by their non-pregnant counterparts. PMID- 10125698 TI - Clinical audit of behaviour therapy training of nurses. AB - In health care training, professional examinations of competence test trainees' knowledge rather than their actual contribution to the improvement of patients' health. Clinical training programmes have the ultimate aim of improving patients' health, but rarely measure their success in attaining it. This paper provides an analysis of the results of clinical outcome for 2,032 patients treated during eight consecutive English National Board 650 courses, in which 68 nurse behaviour therapist trainees were trained at the Maudsley Hospital from 1978-91. The outcome of 668 patients treated in three recent courses (1987-91) is compared with that of 1,384 patients treated in five earlier courses (1978-86). Measures and diagnostic categories were similar over the whole study period. The trainees in 1987-91 achieved a similar health gain for most of their patients as did their counterparts in 1979-86, but this was achieved over a shorter time spent with each patient, and with greater effect in patients diagnosed as obsessive ruminators. These efficiency gains seem to reflect the incorporation into recent training of treatment advances in anxiety disorders. PMID- 10125699 TI - Is cost-awareness really improving? AB - The findings of a comparative study of cost awareness amongst particular groups of health service staff are reported. The study is a repeat of that undertaken in 1987 by Fairbrass and Chaffe. The findings are compared to assess how awareness of the cost of anaesthetic drugs, fluids and disposables has changed as a result of the publicity since 1987. Without prior warning, the study group were asked to estimate the cost of twenty-eight items. The results show that their degree of accuracy remains poor. Overall the tendency was to overestimate costs, whilst a small number of expensive items such as volatile agents were consistently underpriced. The results show that, over the last three years, there has been no significant change in the knowledge of cost awareness. At a time when the effective use of scarce resources is being emphasised, a staff programme of continuing cost awareness training is recommended. PMID- 10125700 TI - Medical and dental staffing prospects in the NHS in England and Wales 1991. AB - This article offers some background information to help junior doctors, and those who advise them, to make decisions about their future careers. Further information can be obtained from the Regional tables, which the Department of Health circulate to Regional Postgraduate Deans, Health Authorities and clinical tutors. All the information presented here is retrospective. Comparing this with the previous annual articles in this series may help you to assess the likely future prospects in your particular specialty. PMID- 10125701 TI - Pharmacists' perceptions and practices regarding the purchase of multisource pharmaceuticals. AB - This article describes the results of a survey of the perceptions and practices of pharmacists towards the purchase of multisource pharmaceuticals. A questionnaire was mailed to 1,000 randomly selected hospital pharmacists, 670 managed-care pharmacy directors, and 900 consultant pharmacists in June, 1991. Recipients were asked to provide educational background data, information on pertinent aspects of their work setting, and responses to a variety of questions about multisource pharmaceuticals. Of the 2,570 surveys mailed, 531 (20.7%) usable responses were received. Although not completely satisfied, pharmacists perceive the quality of multisource products to be better than 2 years ago. A variety of factors were found to influence purchasing decisions. Differences among the three groups were evident in several areas including: the importance of purchasing groups, institutional criteria, and patient preference. Overall, pharmacists made their decisions based on a number of issues, and attitudes among the three groups regarding the purchase of multisource products were quite similar. PMID- 10125702 TI - A comparison of patient-controlled and intramuscular morphine in patients after abdominal surgery. AB - This prospective, randomized study compared the effects of two methods of morphine administration after abdominal surgery in 62 adults. All patients were offered intravenous morphine in the Postanesthesia Care Unit. On the ward, one group (PCA-CI) received a continuous infusion of morphine that could be supplemented by a patient-controlled bolus every 10 minutes. The other group (IM) received intramuscular morphine (0.08-0.12 mg/kg) as often as every 3 hours when requested. During three postoperative interviews, patients were questioned about pain relief (visual analogue scale), adverse opioid effects, and satisfaction with the method of analgesia. Total dose of morphine (mg, mg/kg body weight), time to first oral analgesic medication, length of hospital stay, and cost were calculated following discharge. There was a wide interindividual variation in reported pain intensity and morphine usage in both groups. Comparison of both groups demonstrated no significant differences in analgesia, incidence of adverse opioid effects, 24 and 36 hour morphine dose, time to first oral analgesic medication, operating cost, and length of hospital stay. Patients in the PCA-CI group received a slightly greater dose of morphine in relation to body weight (24 hr, P = 0.03; 36 hr, P = 0.05) and reported a greater degree of satisfaction at each assessment (P = 0.005, P = 0.02, P = 0.01). These data support the greater patient satisfaction associated with patient-controlled analgesia but suggest that the wide range of reported pain scores and morphine requirements makes it difficult to demonstrate, in a small population, superior pain relief from patient-controlled analgesia when nurses are encouraged to administer intramuscular pain medication more effectively. PMID- 10125703 TI - Annual Pharmaceutical Manufacturers Directory--1993. PMID- 10125704 TI - AIDS drugs in development. Facts and comparisons. PMID- 10125705 TI - Evaluation of unclaimed prescriptions in an ambulatory care pharmacy. AB - Unclaimed prescriptions, that is, those filled but not obtained by the patient, may influence patient care and pharmacy operations. The authors' objectives were to 1) describe characteristics of unclaimed prescriptions and the patients for whom these prescriptions were written, and 2) compare and contrast characteristics of prescriptions never dispensed with those that were eventually dispensed. During the 8-week study, 180 patients with 224 unclaimed prescriptions were identified at the University of Michigan Hospital's Ambulatory Care Pharmacy. The most frequent categories of unclaimed prescriptions were skin/mucous membrane, central nervous system, and anti-infective medications. In 25.9% of cases of unclaimed prescriptions, they were telephoned in by a healthcare professional as new prescriptions. Overall, 64.3% were new, rather than refill, prescriptions. Approximately two thirds of the unclaimed prescriptions were eventually dispensed. Of the characteristics evaluated for differences between unclaimed prescriptions eventually dispensed and those never dispensed, only new versus refill prescriptions and class of medication were significantly different. Most unclaimed prescriptions were eventually dispensed after a delay. However, the types of medications involved suggest that these delays from initially unclaimed prescriptions could have resulted in problems. PMID- 10125706 TI - Multisource drugs: implications and concerns in the geriatric population. AB - The demand for high-quality, cost-effective pharmaceuticals has increased. Much of this demand has evolved as a result of rising healthcare costs, state and federal entitlement programs, and third-party drug benefit restrictions. Patent expirations and changing patient demographics, as well as recent contributory forces, have fueled the need for multisource drugs and led to their greater availability. Legislative attention focused on the Food and Drug Administration and Abbreviated New Drug Application approval has had a positive effect on the multisource industry. The public is assured an era of vigilance, continual quality assessment, and greater integrity in the multisource drug approval process. The elderly are a rapidly growing population of prescription drug users who can benefit from cost-effective pharmaceuticals, such as those offered by multisource drugs. However, concerns and issues have arisen regarding the use of multisource drugs in the elderly. This article reviews these concerns and places into perspective the role of multisource pharmaceuticals in this population. PMID- 10125707 TI - Quality care for life. A proposal for long term care financing reform. American Health Care Association. AB - Reform of the nation's health system will be incomplete unless the long term care needs of American families are addressed. While attention must be paid to the 37 million people who are uninsured, nursing home and other long term care must not be overlooked. Public opinion research conducted in February 1993 by The Gallup Organization confirms that this issue must be a high national priority: seven out of eight Americans (87%) believe that the White House and Congress should pay more attention to financing the cost of nursing home care. Their concern stems from the fact that the vast majority of Americans are not protected from the costs associated with long term care. Most at risk are the 3.5 million people who are 85 and over. They are by far the fastest growing segment of the American population. PMID- 10125708 TI - Repositioning long term care as anchor in health delivery system. PMID- 10125709 TI - Ethical decision making. Creating a framework for long term care. PMID- 10125710 TI - Homelike setting aids in creation of restraint-free environment. PMID- 10125711 TI - Cafeteria benefit plans offer options for providers, staff. PMID- 10125712 TI - Hazard communication standard protects employees from dangers. PMID- 10125713 TI - Nutritional assessments linked closely to resident well-being. PMID- 10125714 TI - Relocation support program promotes family participation. PMID- 10125715 TI - Admission standard contributes to long-term operating success. PMID- 10125716 TI - Provider 1993. Corporate Profiles. AB - As the long term care industry seeks out new products, new solutions, and new ways of providing quality care, it is important for long term care providers to know more about the companies they do business with. The following Corporate Profiles showcase information about leading companies in the long term health care industry. Some of the areas highlighted include: Mission of Company, History, Product Lines, Support Services. We hope you will find this information useful when making purchasing decisions, and we're confident you'll keep this issue of Provider as a handy reference guide. PMID- 10125717 TI - The surveying game. PMID- 10125718 TI - Data confidentiality--could this policy work for you? PMID- 10125719 TI - Perspectives. Reformers' next challenge: shaping the public will. PMID- 10125721 TI - Perspectives. Alternative medicine: a new look at ancient practices. PMID- 10125720 TI - Perspectives. "Other" Washington launches major health reform. PMID- 10125722 TI - Responding to the new reimbursement environment: the Jacksonville Orthopaedic Institute. PMID- 10125723 TI - The winds of change. PMID- 10125724 TI - Case management: emphasis on quality and cost control. PMID- 10125725 TI - Change, the time for opportunity. PMID- 10125726 TI - State efforts foreshadow challenges to health reform. PMID- 10125727 TI - Maximizing reimbursement "up front" with financial counseling. PMID- 10125728 TI - The access initiative "up front" contributions to billing, collections and cash flow. PMID- 10125729 TI - An "All-American" health reform proposal. AB - Reforming the U.S. health care system is frequently thought of in absolutist terms: managed competition versus rate regulation; federal versus state administration; and business mandates versus individual insurance purchases. While these choices must be resolved over the long run, the transition to a new health care system will take several years and require more flexible solutions. The "All-American" Deal offers just that. It requires individual households to be insured and allows businesses to voluntarily offer health insurance; relies on the federal income tax system to collect income-based premiums and transfer funds to states through risk-adjusted payments; and lets states manage the disbursement of funds for uninsured residents. PMID- 10125730 TI - Making health reform work without employer mandates. AB - Requiring employers to furnish health insurance may be a politically expedient way to expand coverage to the uninsured, but it will surely undermine economic competitiveness and contribute to greater unemployment at a time when the U.S. is struggling to regain its economic strength. In the present environment, a wiser course of action would require that individual households, not employers, become the entity responsible for obtaining health insurance. Under such a scenario, limits would be established on the percentage of after-tax income devoted to health insurance, subsidies would be granted to low-income individuals to purchase insurance, and a basic benefit package would be developed that limits payments to services meeting efficacy and cost-effectiveness criteria. PMID- 10125731 TI - Medical technology meets managed competition. AB - Medical technology is an integral part of health care, not an expensive add-on or afterthought. Therefore, technology policy must be consistent with the approach to health care reform. Our present market has failed to generate adequate information on new technologies and perverse economic incentives have led to overutilization. In managed competition, health plans, not government, are best suited to make most technology decisions. The federal government can provide a safety valve for specific coverage decisions and can facilitate the acquisition, evaluation, and dissemination of information on new technologies. PMID- 10125732 TI - DataLine. Health costs--the road less travelled. PMID- 10125733 TI - Taxing health benefits: snake oil ... or smart health policy? AB - Limiting the tax-free treatment of employer-paid health benefits is a cornerstone of managed competition, the health reform approach favored by the Clinton Administration. Organized labor argues that the idea is a double-whammy for wage strapped workers, while a leading academic calls it a good solution to one of the nation's worst public policies. PMID- 10125734 TI - Antitrust exemption: are health providers crying wolf? AB - Demands by health providers for relief from federal antitrust law have reached a new high as they examine the likely impact of managed competition on the way they do business. Indeed, the American Medical Association endorsed managed competition on the condition that doctors get an antitrust exemption; the Pharmaceutical Manufacturers Association recently said that drug makers needed to discuss prices before they could hold back increases. But the Federal Trade Commission, an independent agency, has shown no signs of revising its antitrust measures to reflect the enormous changes that lie before the health industry. PMID- 10125735 TI - How to bring primary care back to patients. AB - Reforming the health care system is too often thought of in the context of finding new financing methods to preserve the existing system. The nursing profession's agenda for health reform argues for a return to more basic values of consumer empowerment, access, primary care, prevention and self-care balanced with acute care. Family-care clinics based in schools, workplaces, and other community sites are an important element to this approach. The ever-worsening shortage of primary care providers can be solved by support of advanced practice nurses. PMID- 10125736 TI - States struggle with new ethical questions over the beginning, end of life. PMID- 10125737 TI - Small business wins big exemption in Kentucky health reform battle. PMID- 10125738 TI - States urge Federal support for capitated long term care programs. PMID- 10125739 TI - School-based health clinics now seen as key health site. PMID- 10125740 TI - Alabama's specialty hospitals. Their special concerns, special role in healthcare delivery. AB - Specialty hospitals represent an often-forgotten part of the healthcare delivery system. But rehabilitation, psychiatric and other specialty facilities have much in common with acute-care hospitals. Even as they fulfill their unique missions. PMID- 10125741 TI - HMOs under Clinton reforms may face bumpy road to growth. PMID- 10125742 TI - What will you spend for the new ethylene oxide blend? PMID- 10125744 TI - Buying PPE (personal protective equipment): consider employees' concerns. PMID- 10125743 TI - Poll: do you give internal customers a fair shake? PMID- 10125745 TI - Self-test can cut down on exposures to blood. PMID- 10125746 TI - Tougher glutaraldehyde requirements: what CS technicians need to know. PMID- 10125747 TI - Florida cardiac cath lab trims fat and saves more than $320,000. PMID- 10125748 TI - On-the-job satisfaction: a health care worker's 12-step program. PMID- 10125749 TI - Stats. Survey: materials workers aren't very happy on the job. PMID- 10125750 TI - Employee empowerment leads to excellence. PMID- 10125751 TI - Some basic rules provide direction. Strategic industry focus needed. PMID- 10125752 TI - Clinton makes his mark. Will it be a blueprint for the country? PMID- 10125753 TI - How does a facility benefit from a total quality management (TQM) program? PMID- 10125754 TI - Home is where the care is ... going. PMID- 10125755 TI - Specialization gains momentum. Assisted living provider adds head trauma care. PMID- 10125756 TI - Who knows what manana might bring. Mexico putting itself on the LTC map. PMID- 10125757 TI - Rebuilding. Neuro recovery unit instills hope. PMID- 10125758 TI - Off and running. Financial, academic support expands nursing pool. PMID- 10125759 TI - Compliance with the special care needs requirements. PMID- 10125760 TI - MDS (minimum data set) rules offer increased involvement in patient care issues. PMID- 10125761 TI - Education literature for Hispanic patients. AB - A patient tells his home health nurse through an interpreter that he does not understand the treatment consent form. The form is printed in English. The patient understands only Spanish. A young woman learned her child's home antibiotic therapy through a demonstration given in Spanish. She now wants to review the procedure to program the pump that controls the intravenous dose. The manual is printed in English. The young mother understands only Spanish. These examples reflect the growing communication problems facing home care workers who work in Hispanic communities. PMID- 10125762 TI - Cancer care at home. AB - A goal of home care for oncology patients is to establish a coordinated regimen of care among physicians, nurses, social workers, and pharmacists. This roundtable points out considerations of each role in caring for the cancer patient at home. PMID- 10125763 TI - The home care alternative: a cancer survivor's story. AB - The difference that home care makes in the life of a cancer patient is communicated most strongly by an individual survivor. A social worker recalls her positive home cancer treatment and describes her quest to help others travel the same path. PMID- 10125764 TI - Home chemotherapy. A mobile delivery system. AB - CareVan Medical Systems specializes in home chemotherapy, differing from other services in its physician involvement. CareVan provides increasing services and advantages to cancer patients receiving treatment at home. PMID- 10125765 TI - Conquering our oldest disease. New treatments, new research, new hope. AB - One of every five deaths in the United States is from cancer. This ubiquitous disease has been with us since before 1600 BC. Today new research and treatments offer new understanding and cures. PMID- 10125766 TI - Radiation therapy--implications for home care. AB - Home care professionals need to become more knowledgeable about radiation therapy in both the home and hospice setting. The knowledge will assist them to design a plan of care in collaboration with the radiation oncology team, patient, and family, thus meeting the patient's needs both during and after a course of treatment. PMID- 10125767 TI - Communicating with cancer patients & families. AB - Treating cancer comprehensively reaches far beyond physical needs. The home care setting may prove to be the most conducive to effective communication with cancer patients and families, a vital component of the holistic approach to cancer care- but it won't happen automatically. PMID- 10125768 TI - Working with children of cancer patients. AB - Through the use of verbal and nonverbal techniques, a social worker and music therapist have combined their fields into an integral therapeutic modality to provide patients with cancer and their children opportunities to experience intimacy in a time of crisis. Skilled verbal interventions and the sensitive application of the expressive and less threatening medium of music create a relaxed environment where families and patients may explore deeply and express freely. PMID- 10125770 TI - As the Boy Scouts say, "be prepared". PMID- 10125769 TI - Is your administrator or CEO interested in saving $? Recycling results in economic and environmental advantages. PMID- 10125771 TI - Pink flamingo gloves. PMID- 10125772 TI - Managing the medical infectious waste stream. PMID- 10125773 TI - Selecting a commercial hazardous disposal facility. PMID- 10125774 TI - Assessing hospital administrators' responses to prospective payment. A case study in New Mexico. AB - Few studies have assessed the relationship between hospital administrators' efforts at planning and subsequent performance of health care organizations. Nonetheless, planning is viewed as an important mechanism for aligning health services delivery efforts with community needs and operating constraints. When prospective payment (PPS) was first introduced, hospital administrators had little choice other than to plan how they would respond to the new reimbursement policies. However, it is unclear whether they actively undertook planning in an effort to address prospective payment and related pressures. This article presents a case study of rural New Mexico hospital administrators' efforts to respond to prospective payment. Two dimensions of planning effort by administrators--intensity and formality--are analyzed within rural hospitals during the PPS transition (i.e., 1983 to 1987) and after its full implementation (i.e., since 1988). The findings suggest that planning intensity during the PPS transition is associated with higher performance; notably, higher net patient care revenues, lower costs per patient day, higher operating margins, higher net income, and higher planning effectiveness. However, the strength of these associations weakened as PPS was fully implemented. Given the exploratory nature of this evaluative case study, the results should be viewed as preliminary until confirmed by larger studies. The implications for research that evaluates planning-performance relationships in the health care field are discussed. PMID- 10125775 TI - Gender and hospital resource use. Unexpected differences. AB - Several recent studies have explored gender differences in medical care that are not attributable to clinical characteristics. At an 880-bed teaching hospital between July 1987 and June 1990, we studied the importance of gender on two measures of hospital care: length of stay and ancillary service use. The latter was measured on a relative value unit (RVU) scale, based on an estimation of direct cost dollars. Neither mean age nor in-hospital mortality differed between the 9,102 women and 10,285 men. After case-mix adjustment, women stayed in the hospital 0.22 days longer than men (p = 0.01) but consumed 67 fewer RVUs (p = 0.01). This RVU difference dissolved when intensive care unit (ICU) stays were eliminated; men were 1.13 times more likely (95% confidence interval 1.07 to 1.19) to be placed in the ICU. Being married shortened length of stay and women were less likely to be married (51% vs. 68%; p < 0.001), but even within marital status subgroups women remained in the hospital longer than men. Whether this longer length of stay and less technologically intensive care for women reflects a difference in illness severity or physician gender bias requires further study. PMID- 10125776 TI - Reliability of Katz's Activities of Daily Living Scale when used in telephone interviews. AB - The reliability of a five-item Katz's Activities of Daily Living (ADL) scale collected by self-report telephone interview is presented. A random sample of 6,472 South Carolina residents over 55 years of age selected from a statewide population is used. Factor structure, Guttman properties, internal consistency reliability, Mokken's index of test homogeneity, and Spearman's coefficient of rank-order correlation are used to show that ADL data gathered by telephone interview are reliable. Because telephone interviewing methods are faster, cheaper, and safer they are recommended as a viable way for researchers, policymakers, and practitioners to gather ADL information. PMID- 10125777 TI - Evaluation of an intervention for staff in a long-term care facility using a retrospective pretest design. AB - It has been previously established that human service workers often suffer from emotional exhaustion, which has been conceptualized by Maslach and Jackson as burnout. Burnout may be a particularly great risk in workers providing long-term geriatric care. The current study evaluated the effects of a series of three 3 hour sessions designed to address team building, communication skills, self esteem, and stress management on a random sample of 51 of the 188 long-term care staff who participated. Using a retrospective pretest design, a statistically significant improvement from "then" to "today" was found for the three components of burnout: Depersonalization, Emotional Exhaustion, and Personal Accomplishment. Responses to an open-ended question about workshop effects corroborated the quantitative data, and effects noted were highly related to the defined objectives of the workshops. PMID- 10125778 TI - A controlled randomized response technique. AB - The randomized response survey technique appears to be suitable for studies of sensitive sexual behaviors, particularly in AIDS-related research. However, existing methods provide only estimates of group statistics, not of individual information. Additionally, the popular "unrelated question" approach requires the knowledge of the parameters of the unrelated question. In this article, a variation of the unrelated-question method is suggested for use. Specifically, it is suggested that the unrelated question be one to which the response is known to be "yes." Through this "controlled" approach, the raw data become a direct linear transformation of the response to the sensitive question, and thus can be used directly in regression and other analyses at the individual score level. The estimation of the parameters for the unrelated question is not necessary and the hesitation to provide a "yes" response found in the "forced choice" method is minimized. PMID- 10125779 TI - The use of a prepaid incentive to convert nonresponders on a survey of physicians. PMID- 10125780 TI - Management ethics for the health care supervisor. AB - Someone once described the difference between ethical and unethical behavior in these terms: After doing something ethical you feel good; after doing something unethical you feel bad. Not quite. Feelings have something to do with ethics but not everything. Feelings may legitimately play into the moral reasoning associated with senses of guilt and guiltlessness, but moral reasoning demands critical thinking if it is to be honest. The ability to think critically on moral issues, it is argued here, is a competence that must be exercised by all professionals. PMID- 10125781 TI - Beyond diversity. PMID- 10125782 TI - The health care supervisor and the early communication patterns of new employees: the uncertainty of assimilation. AB - Without a doubt, a supervisor's most valuable resources are the employees placed in trust with that supervisor. It is the challenge of every supervisor to focus the vast energies of this resource on accomplishing the mission of the organization. Within the context of new employees, what happens during those first days of employment may determine how well they will contribute, if at all, to accomplishing this organizational mission. While new employee assimilation has many factors that affect its success or failure, the nature of communication that occurs with the supervisor is critical. As was shown in this study, new employees do, in fact, have a specific set of communication needs of which the supervisor should be cognizant. PMID- 10125783 TI - Paying for long-term care: the present and the future. AB - With an increasing elderly population, the need for nursing home services will definitely increase. However, the number of Medicaid recipients probably will increase also. Even though revisions to Medicaid have occurred, reimbursement rates are still inadequate. Realistically, the government cannot afford to totally fund the care of the elderly. Plans to curb the costs of long-term care, such as private insurance and preadmission screenings, appear to be necessary. Perhaps some rationing of care will be necessary. If so, we will have a whole new set of problems with respect to ethical and moral issues. PMID- 10125784 TI - Helping survivors cope with sudden death. AB - Sudden death is extremely traumatic for survivors. Sudden death allows no preparation or special moments of farewell and thus leaves survivors with feelings of guilt as well as grief. Caring for survivors presents a challenge to the nurse and an opportunity to utilize strategies around a crisis intervention model that can assist survivors in coping. Helping survivors can be crucial in encouraging those who remain to experience successful bereavement and to cope with the loss. PMID- 10125785 TI - Successful superior-subordinate relationships require mutual management. AB - Although the superior-subordinate relationship is complex, it is filled with many opportunities for both to make the relationship meaningful and productive. Superiors' examination of their beliefs about subordinates as well as subordinates' determination of the bases of their assumptions about superiors address fundamental aspects of the relationship. Both the superior's and the subordinate's understanding of the complexity of authority lays the groundwork for reflective inquiry by superiors and risk taking by subordinates. In this competitive environment, without both good superiors and good subordinates organizations will suffer immensely. Acknowledging that the relationship requires careful management is the first step in making it mutually successful. PMID- 10125786 TI - Medication administration by non-RN personnel: a safe and cost-effective response to the RN shortage. AB - The results of this study strongly suggest that medication administration in the acute care community hospital setting can be safely and cost-effectively handled by non-RN personnel. In adopting such a strategy, an acute care institution can expect better utilization of existing RN resources and improved overall institutional quality, thus increasing the chances of long-term survival in the marketplace. In addition, the acute care institution can save money by avoiding unrestrained spending related to scarce RN resources (e.g., recruitment costs, agency use costs, and orientation costs due to high attrition). With society expecting more and higher quality services, hospital administrators may have an opportunity to offer the health care customer safer and less expensive medication administration services. PMID- 10125787 TI - Building supportive relationships with other supervisors. PMID- 10125788 TI - Bridging the gap: public policy and clinical criteria for competency. PMID- 10125789 TI - Ethical issues in the substantive and procedural aspects of research ethics review. PMID- 10125790 TI - Health science research ethics: a critique. PMID- 10125791 TI - Consent and minors. PMID- 10125792 TI - Building blocks. AB - Lynn Ashburner contrasts the way two FHSAs are facing the future: one by integration with the health authority; the other by retaining a separate identity. PMID- 10125793 TI - Strictly protocol. AB - In the north London borough of Haringey great strides have been taken to develop a protocol for handling extra-contractual referrals. Peter Whincup and Keyvan Zahir report. PMID- 10125794 TI - Accessible, acceptable, appropriate. AB - In the final article in the homelessness series, Carolyn Clark and Catherine George describe the development of a healthcare purchasing strategy. PMID- 10125795 TI - Parent power. AB - Giving parents responsibility for holding their children's health records has improved the quality of information, Jo Tew and Nadia Deadman discover. PMID- 10125796 TI - Risk management--an inspector calls. AB - Following recent health and safety legislation, the health service has been told to put its house in order. Some hospitals are moving fast, but others still have their heads in the sand bucket, reports Barbara Millar. PMID- 10125797 TI - Burning issue. AB - Unions are blazing angry about the anomalies in hospital fire safety regulations which are putting patients and staff at risk. Phil Cohen investigates. PMID- 10125798 TI - Transform or die. AB - Regions have an uncertain future in the new NHS. But if they make the right changes, they may yet play a key role, says Ann James. PMID- 10125799 TI - Dial M for management. PMID- 10125800 TI - Purchasing in practice. PMID- 10125801 TI - Raw deal. AB - Despite the New Deal, most junior doctors in Scotland work more than their contracted 83 hours a week without extra pay, writes Peter Bennie. PMID- 10125803 TI - Nursing by numbers. PMID- 10125802 TI - Healthcare in Europe. Market choices. PMID- 10125804 TI - Born to be boss. PMID- 10125805 TI - Data briefing. Healthcare in the U.S. National Association of Health Authorities and Trusts. PMID- 10125806 TI - Quality of life assessment: understanding its use as an outcome measure. AB - The limited available evidence of the effectiveness of many existing and emerging medical practices has led to the realization that health outcome data should be used in the evaluation of health care interventions. Interest in improving health outcome evaluation is increasing as a result of the need to balance the costs and benefits of medical technologies. Measures of health-related quality of life are receiving greater use in clinical studies. Quality of life measurement provides additional data for making clinical and health care policy decisions. In addition, there is growing awareness that in certain diseases, quality of life may be the most important health outcome to consider in assessing treatment efficacy. There are a number of methodological issues that must be considered in conducting or evaluating quality of life research. PMID- 10125807 TI - Fluconazole dosing in renal impairment: a drug usage evaluation. AB - Fluconazole is an antifungal agent available for oral and parenteral use. Drug dosage is based on the type and severity of infection, identity of the causative organism, the patient's renal function as determined by creatinine clearance, and response to therapy. To determine whether or not IV fluconazole was being dosed appropriately based on the above parameters, the pharmacy department at St. Joseph Hospital in Flint, Michigan, decided to perform a 3-month drug usage evaluation. As had been speculated, many fluconazole-treated patients were receiving inappropriate dosages. Specifically, renal function was not being taken into consideration in 30% of the cases. Additionally, 33% of patients received higher than necessary doses based on site and severity of infection. With the help of the P & T Committee, an educational program was implemented to assist physicians in the appropriate dosing of fluconazole. PMID- 10125808 TI - The impact of aging on health care expenditure in Sweden. AB - This study measures the impact of aging on health care expenditure in Sweden in 1970-1985 and the projected impact for 1985-2005. In addition, the distribution of health care expenditure over different age groups is analysed. The study shows that changes in population aging account for barely 13% of the total increase in health care expenditure during the period 1970-1985, and that is the combined effect of changes in population aging plus the faster increase in health care expenditure per capita in older age groups that governs the development of an increasing concentration of health care expenditure to older age groups. During the period 1976-1985 the per capita health care expenditure increased modestly for the ages 0-74, but 54% for persons older than 74 years. PMID- 10125809 TI - Can resident-centred inspection of nursing homes work with very sick residents? AB - This paper seeks to address the issue of whether a resident-centred inspection process can be effective in a nursing home environment dominated by residents who require high levels of care. Two fundamental criticisms of the current Australian monitoring process are its reliance on standards that are subjective resident centred standards and its reliance on the views of residents concerning the quality of care provided in the home. These criticisms are becoming all the more important as survival rates for the aged increase and the average level of disability of nursing home residents continues to worsen. Our data suggest that the resident-centred process, despite some difficulties, is both reliable and practical, regardless of the care needs of residents in the home. Data collected from inspection teams show that inspectors use a variety of sources to validate information, with residents being one component. These sources vary little in importance between homes with different levels of care needs or behavioural problems. Perhaps of more importance is the finding that a home's overall performance across 31 resident-centred standards is not affected by either the home's average level of total care needs or the number of residents with severe behavioural problems. There are some significant effects (in both directions) of resident disability on compliance with particular standards. Most notable is the finding that the standard requiring appropriate use of restraint is less likely to be met when there are large numbers of residents with high levels of disability or behavioural problems. PMID- 10125810 TI - Does experience improve hospital performance in treating patients with AIDS? AB - This paper examines how experience affects hospital performance in treating patients with AIDS. The most common life-threatening medical complication of AIDS is Pneumocystis carinii pneumonia (PCP). Studies of patients with PCP demonstrate that patients who received care at hospitals that were more experienced with AIDS had lower immediate mortality. These higher volume medical facilities did not use more resources but used resources more efficiently and provided better medical care. Better outcomes for experienced providers suggest three policy implications for improving quality of patient care: (1) create regionalized centers where large numbers of patients with a particular illness are treated; (2) encourage low volume providers to rapidly increase their experience; or (3) establish targeted educational programs for low volume providers. Historical review of experience with other medical problems such as tuberculosis indicate that one policy option, creating regional medical centers, did not have the desired effect of better patient outcomes. These facts support policies to provide targeted educational programs and opportunities for low volume facilities to rapidly increase their familiarity with AIDS. Outcomes could be improved by such policies. PMID- 10125811 TI - Unjustified use of the Quality of Well-Being Scale in priority setting in Oregon. AB - The Quality of Well-Being Scale (QWB) is an instrument for valuing health states on a continuum from unity (healthy) to zero (dead). While it seems safe to assume that the values have ordinal properties, there is neither theoretical nor empirical basis for claiming that they have the cardinal properties that are required in calculations of social benefit in cost-utility analysis. Failure to recognize this led the Oregon Health Services Commission to produce a QWB-based priority list with a number of counterintuitive rankings. A set of health state values based on upper end compression would have produced a list more in accordance with public preferences. PMID- 10125812 TI - The treatment and care costs of people with HIV infection or AIDS: development of a standardised cost framework for Europe. AB - A number of European studies have attempted to assess the treatment and care costs of people with HIV infection or AIDS. However, because of the different methods used, the various cost estimates produced are difficult to compare. This paper reviews several European HIV-AIDS costs studies and outlines the differences in methods used and where better approaches to cost estimation could have been adopted. The application of a standardised cost framework to new cost studies would improve the basis for making cost comparisons of models of care in different sites and countries and the identification of actual (rather than methodological) variations in costs across sites. The final part of the paper provides a discussion of the development and application of a standardised framework for assessment of the costs of HIV-AIDS treatment and care in Europe. PMID- 10125813 TI - Doctors and resource management: incentives and goodwill. AB - The increasing pressure on resources available for health care in many countries has led to a re-examination of the way in which resources are allocated and committed. One important and innovative option is for managers and doctors to collaborate formally in decision-making. This paper draws on experience of this approach in the UK National Health Service, in the Resource Management Initiative and suggests that its success or failure depends on the nature and strength of the incentives to the two sides to collaborate. PMID- 10125814 TI - Regional inequalities in health and health care in Finland and Norway. AB - One of the main health policy goals in Finland and Norway is to decrease regional differences in health status and in accessibility of health services. The purpose of this paper is to analyze how this policy has been implemented, how its goals have been achieved, and what the obstacles are to it. It is of special interest to assess whether the centralized Finnish planning system has been more successful in the implementation of this policy, than the more decentralized system in Norway. Of these two countries, only Norway has applied any objective computing criteria for assessing the relative need of health care resources in each province or municipality. Neither of these two countries is using any relevant statistical indicators to describe the present situation, or time related trends in regional inequities. According to available data the regional inequalities in health status and in the provision of health services have in both countries remained more or less unchanged over the last two decades. In future a more exact definition of the concept of equity, better methods for assessing the need for services, and an improved system of health statistics and indicators for monitoring progress in equity is needed. Also the potential of the health care policy in decreasing inequities in health should be questioned at a more fundamental level. PMID- 10125815 TI - Evaluating the policy role of the small area variations and physician practice style hypotheses. AB - The primary purpose of this article is to develop a framework for reinterpreting the role of physician practice style in the small area variations phenomenon. This phenomenon deals with the wide interarea variations in per capita use rates which have been found for many medical and surgical procedures. The variations have been interpreted by many to suggest that large amounts of unnecessary care are being provided. The variations and corresponding perceptions of unnecessary care have also led to a US health policy which is increasingly emphasizing patient outcomes research. I show, however, that most of the empirical studies of the variations phenomenon have inappropriately aggregated either across procedures or across market areas so as to obscure the role of practice style. Its role has also been obscured by the common failure to distinguish practice style from other determinants of utilization. As a result, small area methods can lead to substantial error in identifying procedures associated either with major differences in practice style or with substantial amounts of unnecessary care if all variation is attributed to practice style. PMID- 10125816 TI - Equipment performance testing: frequency & detail. PMID- 10125817 TI - Creating an effective clinical engineering team. AB - Creating an effective clinical engineering team is critical to: coordinating the functions of a multi-staffed CE department; working on a peer level with other departments of the hospital; and presenting a professional image within the hospital. This feature article defines the characteristics of an effective team, presents ways to create a CE team, and discusses the payoffs of a team approach. PMID- 10125818 TI - Strategies for technology management in clinical engineering. AB - Clinical and Biomedical Engineering managers are in a position to utilize their management skills and apply analytical strategies to identify and capture cost savings opportunities in their institutions. To do so, however, they may be required to expand their scope and extend beyond what may have been their traditional areas of responsibility. This paper examines how management skills, techniques, and strategies were applied to establish a program to manage the repair of rigid and flexible surgical scopes. The program resulted in substantial cost savings, as well as other significant quantitative and qualitative benefits, and further demonstrated the value of proper technology management in healthcare institutions. PMID- 10125819 TI - Review of scheduled performance assurance inspections. AB - The frequency of inspection of the authors' scheduled maintenance program was reviewed and modified, using the work of Fennigkoh (1989). This work extended to 2,700 devices located at four hospital sites supported by a regional service. These devices included all clinical equipment, including diagnostic imaging and renal dialysis. Review of the inspection frequencies was necessary as part of the quality assurance program and to ensure consistency between similar devices. Equipment was first evaluated according to four criteria to determine if it should be on the scheduled performance assurance program. These criteria included: equipment function, physical risk to patients, maintenance requirements, and incident or related history. The frequency of inspection of included devices was then assessed according to an algorithm that looked at device maintenance requirements and manufacturers' recommendations. Devices were scheduled for inspection once, twice or, in rare cases, four times per year. The quality of the inspection program was enhanced by a systematic review. As an added bonus, the required staffing resources to comply with the scheduled performance assurance declined by 29%. PMID- 10125820 TI - Focus on: University Hospital & Health Sciences Center SUNY at Stony Brook Biomedical Engineering Department. AB - Clinical Engineering is practiced within the Biomedical Engineering Department (BME) at University Hospital, a modern, 536-bed, tertiary care teaching hospital. The 30-member department delivers a full range of clinical engineering services within the Stony Brook academic medical center. Major clinical engineering advances have been made in the areas of technology management, productivity and cost effectiveness, medical device safety, education, and research. University Hospital provides care for 2.5 million people in Suffolk County and other parts of Long Island. PMID- 10125821 TI - How to locate & hire clinical/biomedical engineers, supervisors, managers & biomedical equipment technicians. AB - This article has described the process and the resources available for locating and hiring clinical/biomedical engineers, supervisors, managers, and biomedical equipment technicians. First, the employer must determine the qualifications for the position, including job titles, descriptions, pay scales, and certification requirements. Next, the employer must find qualified applicants. The most common way to do this is to use "outside" contacts, such as help-wanted advertising, specialized job placement agencies, schools and colleges, military resources, regional biomedical societies, and nationwide societies. An "inside" search involves limited internal advertising of the position and using personal referrals for candidates. Finally, the employer must screen the applicants. The position description is the obvious first step in this process, but there are other pre-screening techniques, such as employment testing. Interviewing is the most common way to hire for job positions, but the interviewer needs to know about the position and ask the right questions. Post-interview screening is a final step to help determine the best job-person match. PMID- 10125822 TI - The bottom line is outcome-based assessment. AB - The message being delivered to hospitals through the Joint Commission's Agenda for Change is that today's bottom line is not based on a listing of activities done, but rather, on what outcomes, what impact on community problems, what benefits these activities have achieved. It is important to see that outcome based evaluation methods, once adopted, do not degenerate into habitual production of largely ignored morbidity and mortality rates. Materiel managers must contribute a business-oriented understanding of costing and entrepreneurship while embracing a clinical-oriented goal of caring. PMID- 10125823 TI - Managing in uncertain times. AB - Radical change, often referred to as a paradigm shift, will occur in the wake of the United States healthcare reform effort currently underway. It will be value based, community-oriented and patient- and family-centered. These changes will pose great challenges for materiel management. The future will call for integrated healthcare delivery networks that will see hospitals lose their preeminence as providers and, subsequently, needed revenues. Strategies such as implementation of total quality management, and vendor and community partnering will become more pronounced. Materiel managers will see their role change to one of information gathering and disseminating. All healthcare managers will need new skills to help shape the future of healthcare delivery, including the ability to challenge assumptions, understand that there are alternative realities, anticipate business trends, and create and implement a vision of the future of their organization. PMID- 10125824 TI - Collaborative partnering: a new paradigm in materiel management. AB - Materiel managers have virtually unlimited opportunities to gain support through a measurable quality and service focus. This support can be achieved through organizational strategies, organizational development, customer service, advanced inventory management and purchasing systems, the power and use of information and, ultimately, mutually beneficial partnerships with distributors and manufacturers. PMID- 10125825 TI - Electronic, automatic sphygmomanometers. ECRI. PMID- 10125826 TI - The Patient Self-Determination Act and the JCAHO patient rights standards. PMID- 10125827 TI - Hospital pricing White Paper. Metropolitan Chicago Healthcare Council. AB - Hospital pricing issues are continuing to receive additional scrutiny on the part of government and the media. The hospital field has done a poor job of communicating their side of this issue. The Metropolitan Chicago Healthcare Council recently developed a Hospital Pricing White Paper to explain the complexities of hospital pricing. The purpose of the paper is to provide hospital staff with basic information that they could pass on to their key publics. A summary of the White Paper follows. PMID- 10125828 TI - Material safety data sheets. PMID- 10125829 TI - Service quality in the health care industry: how are hospitals evaluated by the general public? AB - This paper investigates the "expectations" aspect of service quality in the health care industry. Specifically, an examination is made of the importance of various hospital characteristics to consumers, the dimensionality of service quality, and the relative importance of these dimensions across demographic groups. The results suggest that the competency and the behavior of physicians are the most important characteristics in the minds of consumers. Moreover, it was found that hospitals are evaluated along: (1) interpersonal, (2) amenities, (3) capabilities, and (4) accessibility dimensions. These findings are consistent with previous research in this regard. Additionally, significant differences in the importance of these factors were found across respondent gender, age, income, and education. PMID- 10125830 TI - Market signaling in hospitals. AB - A Market Signal is a marketing activity that provides information beyond the mere form of that activity. Market Signals reveal levels of the unobserved. Signals occur in a variety of marketing phenomena: advertising, pricing, quality, competitive response to name but a few. In this paper we examine the use of market signals by hospitals and provide a set of recommendations by which hospitals can better utilize signals in the marketing of their services. PMID- 10125831 TI - Clinigraphics: using age demography and lifetime medical evaluation chronologies to estimate the market potential of the pre-Medicare age cohort. AB - While much emphasis has recently been placed upon serving the health care needs of the elderly, a powerful and profitable market exists within the pre-Medicare cohort (persons aged 45-64). The current and expected growth of this group over the next 20 years will create a boon of opportunity for health care providers. This article discusses these realities and introduces a construct, "clinigraphics," which represents a novel way of quantifying the impact of encouraging health evaluations to influence the consumption of health care services among this cohort. PMID- 10125832 TI - Hospital size and adoption of computer based hospital information technologies. PMID- 10125833 TI - Marketing the charitable image of the non-profit hospital. AB - Because of nonprofit hospitals' charitable contribution to communities, the great majority of these nonprofit hospitals deserve their tax-exempt status. In order for them to maintain this status, hospitals must promote their charitable image in the community. The hospital that is successful in promoting this image will benefit in several ways: 1. The citizens of the community will look on the hospital in a favorable light. 2. The local and state government officials will not feel compelled to vigorously pursue hospital tax dollars. 3. Those people in the community who need charity care will know of its availability. 4. New taxing legislation is less likely to be passed if the legislators know that their public is well educated on the benefits the hospitals provide. Over the years, the image of the hospital has become that of a business rather than that of a charitable service organization. The public has been inundated with information by the media on the business of healthcare rather than the social service role of the hospital. In order for nonprofit institutions to survive, they will need to communicate otherwise the public will remain ignorant, and the repercussions could be disastrous. PMID- 10125834 TI - Value marketing is the key activity for tomorrow's modern hospital. PMID- 10125835 TI - In search of superior hospital management: a comparative analysis. AB - In post-socialist Europe, the emergence of a consumer-oriented change in health care management will take time, given the outdated framework in which centralized systems stagnated over the years. Based on personal interviews in two European countries, this study compares the experience of hospital unit general managers (HUGMs) in England and hospital medical superintendents (HMSs) in post-socialist Malta. PMID- 10125836 TI - Employee decision making and the successful marketing of hospital wellness products. AB - Hospitals are beginning to pursue employee wellness services as a promising diversification opportunity. However, a marketing concept approach to new product development may be needed for hospitals to compete and succeed in this unique product area. A model of employee decision making relative to wellness offerings is presented here. The model can serve as a fundamental starting point in hospitals' adoption of a marketing concept approach to developing products for the employee wellness market. PMID- 10125837 TI - Physician recruiting and marketing: a summary guide for hospitals--Part one. PMID- 10125838 TI - The ethical imperative in hospital marketing decisions. PMID- 10125839 TI - Teaching patients the rules of managed care. PMID- 10125840 TI - Seven ways to make insurers pay you quicker. PMID- 10125841 TI - This simple form lets me give better care. PMID- 10125842 TI - Hospital stocks: back from the ICU. PMID- 10125843 TI - Premier may drop contracts with Baxter worth $250 million. PMID- 10125844 TI - Sutter, Sharp deny talk of combination. PMID- 10125845 TI - Cleveland initiative hands out report cards. PMID- 10125847 TI - N.J. plan limits number of hospitals. PMID- 10125846 TI - Vets say VA system will thrive in reform. PMID- 10125848 TI - Stocks slide as patient volume, prices fall. PMID- 10125849 TI - Tenn. debt ratings fare well. PMID- 10125850 TI - Mixed, confusing signals swirl around reform plan. PMID- 10125851 TI - Budget measure sets 2-year freeze for Medicare payments. PMID- 10125852 TI - GAO report hits organ allocations. PMID- 10125853 TI - Reform requires government assistance, not intervention. PMID- 10125854 TI - Doctors' orders: integrate. Physicians maneuvering to secure a key role in systems expected to dominate under reform. PMID- 10125855 TI - Eamer, Cohen quit posts as NME execs. PMID- 10125856 TI - Groups tell views of reform. PMID- 10125857 TI - Reform could be painful for niche vendors. PMID- 10125859 TI - Rural providers present recommendations. PMID- 10125858 TI - Clinton plan shifts malpractice liability to provider networks. PMID- 10125860 TI - New rule on stock options won't cause big stock hit. PMID- 10125861 TI - N.Y. official sees exec pay as reform target. PMID- 10125862 TI - Trial set to begin in Wis. defamation case. PMID- 10125863 TI - Undercharges more likely--report. PMID- 10125864 TI - Two hospitals to appeal rulings. PMID- 10125865 TI - AHA regional boards to report to Washington. PMID- 10125867 TI - White House reform proposal would eliminate CHAMPUS. PMID- 10125866 TI - Ex-Charter exec to receive $33 million in options, cash. PMID- 10125868 TI - Court rejects Geisinger request for tax break. PMID- 10125869 TI - Healthcare update ... alternative model of rural hospital. PMID- 10125870 TI - Hawaii seeks the nod to privatize Medicaid. PMID- 10125871 TI - OrNda to buy Florida Medical Center. PMID- 10125872 TI - Waive ERISA rule, N.Y. official urges House panel. PMID- 10125873 TI - Washoe closes rehab unit as hospital opens. PMID- 10125874 TI - Providers afraid reform could mimic single-payer plan. PMID- 10125875 TI - American Transitional opens two hospitals. PMID- 10125876 TI - Canada's laid off nurses catch on in Texas. PMID- 10125877 TI - Group makes recommendations to speed FDA device approvals. PMID- 10125878 TI - Hospitals must shift gears to treat chronic conditions. PMID- 10125879 TI - Provider-based managed-care plans continue growth trend. Annual survey shows HMOs and PPOs are healthy, well-prepared to play starring role in reform. PMID- 10125880 TI - AHA's tally of hospital closings drops again. PMID- 10125881 TI - Hospitals net same profitability in 1992. PMID- 10125882 TI - Reform may hurt pediatrics' ratings--S&P. PMID- 10125883 TI - Judge blocks hospital swap in Florida. PMID- 10125884 TI - Panel OKs disproportionate-share limits. PMID- 10125886 TI - Reform concerns cut marketing spending. PMID- 10125885 TI - Large investors keep confidence in Baxter. PMID- 10125887 TI - Olsten acquires Lifetime in $600 million deal to form largest home-care company. PMID- 10125888 TI - Emergency physicians group forms to gain greater representation. PMID- 10125889 TI - Daughters of Charity, Mullikin to affiliate. PMID- 10125890 TI - AHA plan offers antitrust immunity for facilities in integrated systems. PMID- 10125891 TI - Some projects put aside until reform is nailed down. PMID- 10125892 TI - Employers to shoulder cost of expansion of coverage. PMID- 10125893 TI - IRS investigates financial dealings of not-for-profits. PMID- 10125894 TI - Push to loosen antitrust laws gains ground. PMID- 10125895 TI - Columbia calls off hospital swap after judge's injunction. PMID- 10125896 TI - House panel endorses payment trim for disproportionate-share hospitals. PMID- 10125897 TI - Marketing's fundamental importance won't diminish in the new era of reform. PMID- 10125898 TI - Electronic billing entering new era. Switch to new forms will bring the process a giant step closer to true standardization. PMID- 10125900 TI - 2 Ky. systems discuss joint efforts. PMID- 10125899 TI - Public hospitals start push to get financial aid. PMID- 10125901 TI - Researchers invent way to adjust outpatient risk. PMID- 10125902 TI - Device failure reports triple. PMID- 10125903 TI - Growth in outpatient care reflected in managers' compensation--study. PMID- 10125904 TI - Vacancy rates jump for lab positions. PMID- 10125905 TI - Charity funds sought as budget stretcher. PMID- 10125906 TI - NME sells five more psychiatric hospitals. PMID- 10125907 TI - Report critical of Boston hospitals. PMID- 10125908 TI - United HealthCare to acquire Chicago HMO. PMID- 10125909 TI - Behavioral-care managers merge. PMID- 10125910 TI - New system now law in Wash. PMID- 10125911 TI - Questions shroud Minn. medical networks. PMID- 10125912 TI - Justice Dept. eyes Des Moines merger. PMID- 10125913 TI - Electronic switch-over 10 to 15 years off. PMID- 10125914 TI - Agencies assail VA pact overpayments. PMID- 10125916 TI - Second subacute-care group forms. PMID- 10125915 TI - New HHC bonds get BBB, Baa ratings. PMID- 10125917 TI - No place like home for low-cost long-term care, its lobbying advocates say. PMID- 10125918 TI - Groups lining up to batter reform ideas. PMID- 10125919 TI - Studies can't agree on administrative costs. PMID- 10125920 TI - Leadership will make reform work. PMID- 10125921 TI - Hospital chains survey. Not-for-profits lead rise in income growth. PMID- 10125922 TI - Lawmakers clamor for cap on entitlements. PMID- 10125923 TI - Responsibility for quality raises a turf issue. PMID- 10125924 TI - JCAHO to share information on organizations with public. PMID- 10125925 TI - Psychiatric hospitals survey. Bad news, falling profits hamper psych providers. PMID- 10125926 TI - Rehabilitation hospitals survey. For-profit chains' growth helps boost rehab industry. PMID- 10125927 TI - Providers like ruling allowing shift of costs for unpaid care. PMID- 10125928 TI - Nursing chains survey. Long-term-care chains post strong growth in subacute, specialty care. PMID- 10125929 TI - Retirement centers survey. Continuing care retains popularity, but capital remains a big hurdle. PMID- 10125931 TI - Illegal transfers continue--report. PMID- 10125930 TI - Ambulatory care survey. Outpatient-care providers notch another year of robust growth; rehab, dialysis among top gainers. PMID- 10125932 TI - Home care survey. Home infusion growth fosters advances for home-care firms. PMID- 10125934 TI - Overview of a system poised for change. PMID- 10125933 TI - The National Practitioner Data Bank: the first 18 months. AB - In response to a need for information on the quality of professional practice and a perceived threat to the preservation of the peer review process, as well as to concern about the cost to society of incompetent physicians, Congress passed the Health Care Quality Improvement Act of 1986. The Act established a legal basis for protecting peer review and quality assurance activities. It also established a national reporting system, the National Practitioner Data Bank (NPDB), which is intended to ensure that appropriate information is available to be used in the peer review process. PMID- 10125935 TI - The AMA faces down FDR and wins. AB - There are two types of change that can occur via federal health care legislation: expansion in access and cost containment. Without passing judgment on the advisability of legislative change, I will argue that federal legislation is unlikely to occur unless both the executive and the legislative branches of government are controlled by the Democratic party. I am not suggesting that the change is necessarily an "improvement," only that Democratic Party control is necessary, particularly as the change pertains to access. PMID- 10125936 TI - Specialty capitation and effectiveness assessment. AB - In 1988, the Southern Region of Blue Cross Blue Shield of Florida undertook a major initiative involving Health Options, Inc., its HMO subsidiary. The intent was to convert specialty contracting from a discounted fee-for-service methodology to capitated payment. Each specialty network is radically transformed into a freestanding IPA, independently incorporated and contracted to the plan for the provision of all included services. The project has financial and legal implications, and maintenance of quality and member satisfaction has been a paramount consideration. PMID- 10125937 TI - Physicians can benefit from a patient-focused hospital. AB - To maintain leadership in their markets, a few innovative hospitals, in the late 1980s, developed a revolutionary concept of health care delivery--patient-focused care. Results from pilot projects have shown a considerable increase in patient satisfaction and increased physician productivity. The patient-focused care model boasts faster turnaround times, increased bedside care by caregivers (especially nurses), and an overall increase in the quality of care provided by the staff. PMID- 10125938 TI - An organizational tool to enhance work motivation--Part I. AB - Increasingly, physicians, in both primary care and specialties, are gathering together into partnerships, single or multispecialty group practices, corporations, and HMOs. Many of physicians are becoming salaried employees of these organizations. As this trend increases, the physician, once pictured as an autonomous entrepreneur and decision-maker, is giving way to the salaried physician-employee, subject to the management and hierarchical structure of organizations. In the first of two articles, the author lays the background for the need for job satisfaction surveys of salaried physicians. PMID- 10125939 TI - Ensuring technological competence and leadership in medicine. AB - The author offers a proposal for a new system of technology assessment and introduction that would be more efficient and effective for patients, providers, and payers alike. The proposal is based on the conduct of outcomes research, with diffusion of new technology remaining limited until the results of the research are known. PMID- 10125940 TI - RBRVS: old concepts, bad press. AB - As health care finance has changed from a system of cash from patients to third party reimbursement, a variety of mechanisms have been devised to bring equity to the payment process. The latest payment mechanism for this purpose is the resource-based relative value scale system implemented by Medicare, which is now being adopted by other third-party payers. However, too many payers are pushing for discounts from providers at the point of adoption of the system, thus foiling the equity aspect of the system. PMID- 10125941 TI - Combining information about process and outcomes to improve clinical care. AB - For some managers, clinical quality improvement begins and ends with measuring the clinical outcomes of care. For others, analyzing and altering processes of care are the central focus. To remove quality improvement from the realm of guesswork, these approaches must be intertwined. In health care, this linkage has appeared elusive. Now, using decision theory, there is a way. PMID- 10125943 TI - Trustees and the integration of community health care. PMID- 10125942 TI - Become a leader in collaboration. PMID- 10125944 TI - Changing expectations of hospital governance: Part 2. PMID- 10125945 TI - Redefining the community hospital. PMID- 10125946 TI - New hospital partnership carves out role for community benefit. PMID- 10125947 TI - Are trustees financially savvy? PMID- 10125948 TI - The fine line between governance and administration. PMID- 10125949 TI - Managed competition: CBO (Congressional Budget Office) is wary. PMID- 10125950 TI - The composition of hospital boards: implications of health care reform. PMID- 10125951 TI - Health reform and the heavy hand. PMID- 10125952 TI - Recent trends in adolescent smoking, smoking-uptake correlates, and expectations about the future. PMID- 10125953 TI - Teenage tobacco use: data estimates from the teenage attitudes and practices survey, United States, 1989. PMID- 10125954 TI - Nurse practitioners in long-term care: perceptions of DONs. AB - Educator, counselor, advocate, consultant, collaborator and role model are a few of the hats that NPs wear. This study, from a DON's perspective, shows how NPs are ideally suited to care for an older population. PMID- 10125955 TI - Changing environment redefines joint ventures. PMID- 10125956 TI - Salvaging the "unsalvageables". EPIC Healthcare Group becomes a leader in the effort to privatize charity. PMID- 10125957 TI - Blue Cross of California goes for the gold--WellPoint Health Networks, Inc. AB - After a half-dozen years of bold, successful restructuring, a once nearly bankrupt Blue Cross of California launches a for-profit managed care organization. PMID- 10125958 TI - Anticipating reform, health insurers get creative. Canada-America health care plan; HIPC-like reform in Florida. PMID- 10125959 TI - Hospital panel testifies before White House Task Force. PMID- 10125960 TI - Managed competition: point/counterpoint. PMID- 10125961 TI - Recapturing individual precision. PMID- 10125962 TI - Health care legislation struck down by Federal courts. PMID- 10125963 TI - Hospital groups move up to centralized imaging. PMID- 10125964 TI - Establishing a technology assessment process. PMID- 10125965 TI - States continue to impact Clinton's health care agenda. PMID- 10125966 TI - Communication: the key to avoiding query and reporting standards violations. AB - Without carefully designed communication protocols, hospitals can fail to meet the query and reporting requirements imposed by the Joint Commission on Accreditation of Healthcare Organizations, the National Practitioner Data Bank, and state medical societies. This article tracks the history of the requirements, outlines current standards, and offers specific recommendations for operational procedures to avoid potential pitfalls. PMID- 10125968 TI - Nursing standards of patient care and standards of nursing practice--a practical approach. AB - With the revision of the Joint Commission on Accreditation of Healthcare Organizations (JCAHO) nursing standards in 1991, a new emphasis has been placed on the nursing standards of patient care and the standards of nursing practice (Claflin, 1990). These standards provide the basis for nursing care and the foundation for nursing's contributions to an interdisciplinary quality improvement program. This article will describe how nursing standards of patient care and standards of nursing practice have been developed and integrated into a nursing department's documentation plan and quality improvement program. PMID- 10125967 TI - The invaluable team member. AB - This article was written specifically to encourage hospitals that are initiating total quality management to include physicians at the beginning stages of the process. Including physicians from the outset can benefit the entire organization. Physicians, by the nature of their profession, have an important role in the quality of the patient care process. PMID- 10125969 TI - Utilization management of workers' compensation: outpatient physical therapy. AB - Workers' compensation insurance carriers are becoming aware of the potentially high cost of physical therapy. Utilization management of outpatient physical therapy by means of a precertification process is a relatively new development in workers' compensation. Physical therapy treatment plans are reviewed by peers to ensure that proposed care is appropriate and cost-effective and that past care has resulted in measurable, objective, functional progress. Treatment plans are thus either certified or noncertified, or changes are negotiated. Ongoing care is monitored to facilitate the patient's progress through appropriate phases of physical therapy toward "maximum medical improvement." PMID- 10125970 TI - Motivation: the most basic process in TQM/CQI. AB - Quality management professionals confront the challenge of motivating others to participate in the improvement of patient care. Producing this motivation frequently proves problematic. This article addresses the issue of motivation by presenting it as a process. Abraham Maslow's hierarchy of needs functions as the foundation of the process. A process model is used to demonstrate that satisfaction of the higher-level needs of esteem and self-actualization is required to produce true motivation. By understanding the process of motivation, we may become more effective in improving patient care. PMID- 10125971 TI - The role of the infection control nurse in quality management in the ambulatory care setting. AB - Due to the potential for increased HIV and hepatitis B transmission to all healthcare workers, the regulations and guidelines set forth by federal, state, and local government agencies for the prevention of these diseases and the protection of those in the healthcare industry are constantly updated. Because of the magnitude of these demands, the role of the infection control nurse (ICN) has become vitally important. The proper utilization of valuable staff resources will be a positive force in promoting the necessary quality of care to employers, employees, and clients. With the dedication of personnel who assist in the essential infection control function, the ICN can maximize protection of the clients and the staff by reducing their exposure to HIV and hepatitis B. PMID- 10125972 TI - Legislative forum: healthcare reform and the policy process--a clarion call to action. PMID- 10125974 TI - Representing the surgical specialty societies in Washington, DC. PMID- 10125973 TI - Interpreting your Medicare mortality rates. AB - Each year, hospitals are provided data on actual and predicted mortality rates for their Medicare patients. This article explains how the Health Care Financing Administration (HCFA) calculates the actual and predicted death rates, gives details on a method by which hospitals can determine if their actual death rates are significantly better or worse than HCFA's predicted death rates, and suggests a strategy for identifying opportunities for improvement when actual mortality rates are significantly different from predicted rates. PMID- 10125975 TI - Preliminary survey findings. Reusable vs. disposable laparoscopic instruments. PMID- 10125976 TI - Managed care and physician contracting skills: questions to ask. PMID- 10125977 TI - Out of apathy. PMID- 10125978 TI - Are you ready for the cure? AB - The Clinton health-care plan will soon be unveiled. Here is an inside look at what it contains so far. PMID- 10125979 TI - Civilian Health and Medical Program of the Uniformed Services (CHAMPUS); demonstration project--DoD. Notice of the implementation and operation of a health care demonstration project for CHAMPUS beneficiaries residing in selected base realignment and closure (BRAC) sites in Texas and Louisiana. AB - Section 9032 of the DoD Appropriations Act, 1993, requires CHAMPUS Reform Initiative (CRI) services to begin at the BRAC sites at Austin (Bergstrom Air Force Base) and Fort Worth (Carswell Air Force Base), Texas, and Alexandria, (England Air Force Base), Louisiana, by May 1, 1993. These sites will be referred to as the CHAMPUS Reform Initiative--Selected Base Realignment and Closure Sites (hereinafter referred to as CRI--BRAC). The Alexandria site will include the Fork Polk catchment area. Objectives of CRI--BRAC are: (1) Assurance of continuing beneficiary access to care: (2) a strengthening of quality assurance activities; and (3) controlling health care costs. In addition, the pharmacy benefits provided for in section 702(b) of the 1993 Defense Authorization Act will be implemented for DoD Medicare eligible beneficiaries. PMID- 10125980 TI - Federal performance standard for diagnostic X-ray systems and their major components--FDA. Final rule. AB - The Food and Drug Administration (FDA) is issuing a final rule on the Federal performance standard for diagnostic X-ray systems and their major components (the performance standard). Experience gained by FDA in administering the performance standard has shown the need for making these changes to clarify and simplify the performance standard, reduce the regulatory burden on affected manufacturers (without compromising the public health), and generally improve the effectiveness of FDA's regulation of diagnostic X-ray equipment. Elsewhere in this issue of the Federal Register, FDA is proposing to amend this final rule to revise limits on the maximum patient entrance exposure rate for fluoroscopy systems in the high level control mode and other modes of operation. PMID- 10125981 TI - Access to telecommunications equipment and services by the hearing impaired and other disabled persons--FCC. Final rule; suspension of rule enforcement. AB - This Order suspends enforcement of hearing aid compatibility for telephones required by section 68.112(b) (1), (3), and (5) of the Federal Communications Commission rules to be hearing aid compatible by May 1, 1993 for establishments with twenty or more employees and by May 1, 1994 for establishments with fewer than twenty employees. This action responds to an Emergency Request for Stay of section 68.112(b) filed by the Tele-Communications Association and is taken to give the Commission adequate time to evaluate serious issues raised in the Emergency Request involving costs of compliance and the feasibility of compliance with 47 CFR 68.112(b). PMID- 10125982 TI - Making ethics applicable in patient care settings. AB - The more complex modern medicine becomes, the more complex are the issues facing staff in health care facilities. The bioethics education committee at St. Joseph's Health Centre in London developed a unique short course in practical ethics for staff from several institutions. PMID- 10125983 TI - An experience of mission. PMID- 10125984 TI - Naming and claiming our unique character. AB - Thomas D. Maddix, CSC, the director of mission services for the Alberta Catholic Hospitals Foundation, comments on a report which clearly articulates in word and action our distinctive nature as denominational health care providers. If we wish to flourish in that role, we must show that difference in word and deed. PMID- 10125985 TI - New skins? For new wine. PMID- 10125986 TI - Managed competition: origins & implications. AB - It seems one can't read an article or watch a newspiece about health care reform without encountering the words managed competition. Where did the concept come from? What will it mean if it is implemented? This article discusses the basics of this plan. PMID- 10125987 TI - Testimony on managed competition. The Jackson Hole approach. Achieving effective cost control in comprehensive health care reform. PMID- 10125988 TI - Testimony on managed competition. The effects of cost control provisions on health expenditures. PMID- 10125989 TI - Testimony on managed competition. Expenditure limits and managed competition. PMID- 10125990 TI - Managed competition--blessing or curse? PMID- 10125991 TI - State health reform initiatives. They're calling it managed competition. AB - Several key states have already begun pursuing reform. What are their approaches to managed competition and how are they championing the inclusion of home care and hospice? PMID- 10125992 TI - Bridging cost & quality through patient outcome measurement. AB - In an environment of managed competition, statistical and graphic data about nurses' effects on patients, as documented by Outcome Concept Systems, will be invaluable support for home care. PMID- 10125993 TI - Outcomes management in a prospective pay system. AB - Patient outcomes are the true measure of quality care, making accountability clear and control possible. As seen in this example, managed care lends itself to the process of tracking outcomes. PMID- 10125994 TI - Health care reform. A position for home care. PMID- 10125996 TI - Home care coverage through HMOs. AB - As more home care agencies begin partnerships with HMOs, the industry needs to be aware of certain issues such as federal and Medicare regulations, concerns with employer-based HMOs, and what all this means for health care reform. PMID- 10125995 TI - Home infusion partners with managed care. AB - Managed care may play a large role in the reformed health care system. Home care of any kind provides a cost-effective means of health care and thus may be seen as a natural ally of managed care. In this example, a home infusion service demonstrates the ease of this alliance. PMID- 10125997 TI - Managed care--new legal challenges. PMID- 10125998 TI - Home care as an acute-care benefit. PMID- 10125999 TI - What's next for the President's plan. AB - Despite his troubled start, the odds that he can enact much of his budget program are stronger than you think. But sweeping health care reform won't fly this year. PMID- 10126000 TI - Enchanted forest. A designer and a carpenter create an "enchanted forest" in the pediatrics wing of a Baltimore hospital. PMID- 10126001 TI - An internist's perspective: putting doctors in charge. PMID- 10126002 TI - Curing our nation's health care crisis: what role for managed care? PMID- 10126003 TI - Raymond Scalettar, MD: speaking out at the AMA. Interview by C. Burns Roehrig. PMID- 10126004 TI - ASIM and health reform: knock, knock, knockin' on Clinton's door. PMID- 10126005 TI - Resident work hours revisited: a moral imperative. PMID- 10126006 TI - Spending limits on health care. American Society of Internal Medicine. PMID- 10126007 TI - Does managed care contain costs? PMID- 10126008 TI - The NHS and the law. On the catwalk. AB - It is very much a buyer's market and trusts and health authorities can call the shots when choosing a law firm, argues Julian Harris. PMID- 10126010 TI - The NHS and the law. TUPE or not TUPE? Transfer of Undertakings (Protection of Employment) Regulations 1981. PMID- 10126009 TI - The NHS and the law. A life and death issue. AB - What are the legal implications for managers when treatment is withheld or patients have refused consent? Joe Jacob reviews recent cases. PMID- 10126011 TI - The NHS and the law. Off the record. AB - To be found guilty of employing doctors not registered with the GMC is every personnel director's nightmare, says Paul Honigmann. PMID- 10126012 TI - The NHS and the law. Rites and wrongs. AB - The compensation system for medical negligence fails to satisfy victims, health professionals and managers. Bridgit Dimond examines the alternatives. PMID- 10126013 TI - Big brother. AB - Both purchasers and providers will need to change the way they hold patient records on computer, or they could find themselves in breach of the law. Michael Cross examines a report by the Data Protection Registrar. PMID- 10126014 TI - Post modernism. PMID- 10126015 TI - Lucky charms. PMID- 10126016 TI - Who's counting? PMID- 10126017 TI - The six o'clock shock. AB - Elderly people object to the early morning routines forced upon them in hospital, report Karen Luker and Karen Waters, who describe research carried out in a rehabilitation unit. PMID- 10126018 TI - At the cutting edge. AB - In the second of two articles, Jim Dukes and Rosemary Stewart look at how protocols can be implemented successfully. PMID- 10126019 TI - Teething troubles. PMID- 10126020 TI - Perpetual promotion. AB - Hospitals across Europe are participating in a network which extends their activities beyond clinical and curative services, write Steve Ashcroft and Paul Summersgill. PMID- 10126021 TI - Gain without pain. PMID- 10126022 TI - The collaborators. PMID- 10126023 TI - Hurricane Iniki--providing prescription service in a clinic. PMID- 10126025 TI - Healthcare 1995: what's next? PMID- 10126024 TI - The effect of oral communication on intravenous wastage: talk is cheap. AB - The authors describe decreases in wastage and return rates in their Pharmacy Service department in a 471-bed tertiary hospital. Through procedural changes in mixing and delivery schedules, stability updating, and daily communication with the Nursing Service, Pharmacy Service dropped from a 3.9% to a 1.44% wastage rate and from a 15.75% to an 8.2% return rate in a period of 17 months. The specific changes that led to this result are presented for consideration. The primary focus was on determining and noting accountability of involved staff members to decrease returns, missed treatments, and ultimately wastage of costly intravenous admixtures. The 0.9% wastage rate in the seventeenth month suggests that continued efforts may lead to further reductions. PMID- 10126026 TI - Influencing satisfaction for dental services. AB - A strong concern about consumer satisfaction characterizes the health care industry, reflecting, perhaps, the introduction of the marketing culture into this service industry. Consequently, consumer satisfaction with dental services has become the focus of several studies published in recent years. Past research has focused on two major issues: the initial choice of a dentist and continuity in dentist-patient relationships. The authors propose that consumer satisfaction with dental care is influenced by the variables waiting time, availability/convenience of care, pain management by dentists, costs, and continuity of care. They also hypothesize that demographic characteristics such as gender and age also influence consumer satisfaction. Implications for the management of dental practitioners are discussed. An abstract of this article was published in the 1992 AAAHCR Conference Proceedings. PMID- 10126027 TI - Consumer satisfaction and perceived quality of outpatient health services. AB - The authors examined factors related to consumer satisfaction and willingness to recommend the provider among 1,366 patients receiving examinations at a free standing medical imaging facility. The nontechnical (nonmedical) characteristics of the service encounter were drawn from three conceptual domains--staff behavior, atmospherics, and information--and two subjective judgments regarding the medical service itself: examination comfort and perceived worth. The authors hypothesized that all of these factors are related to increased consumer satisfaction and willingness to recommend the provider. Data collection was based on a service script, and factor analysis was used to organize elements from each domain into a map of consumer perceptions. Multivariate logistic regression indicated that items from each domain were significantly related to patient satisfaction and willingness to recommend the provider. PMID- 10126028 TI - Modeling physicians' prescribing decisions for patients with panic disorder. AB - The authors asked general and family practitioners to rate the importance of several items relating to the prescribing of drug products for patients with panic disorder. Physicians preferred to use benzodiazepines alone and in combination with antidepressants for treatment, regardless of the presence or absence of phobic avoidance. Adverse drug events, efficacy, and patient characteristics were found to be important considerations when physicians prescribe medication. Educational and promotional strategies for pharmaceutical manufacturers and marketers are discussed. PMID- 10126029 TI - Positioning hospitals: a model for regional hospitals. AB - In an age of marketing warfare in the health care industry, hospitals need creative strategies to compete successfully. Lately, positioning concepts have been added to the health care marketer's arsenal of strategies. To blend theory with practice, the authors review basic positioning theory and present a framework for developing positioning strategies. They also evaluate the marketing strategies of a regional hospital to provide a case example. PMID- 10126030 TI - Marketing prevention to elderly Medicare beneficiaries enrolled in an HMO. The San Diego Medicare Preventive Health Project. AB - A comprehensive marketing effort--using direct mail, telemarketing, and orientation seminars--to enroll elderly participants in a Medicare preventive health services demonstration project was undertaken in 1989. Out of the more than 11,000 eligible members in a large Medicare HMO plan in San Diego County, 1,800 (16.2%) agreed to participate. The authors describe the recruiting effort in detail and postulates reasons why the elderly resisted enrolling in the study. These results have important policy implications for the nation's Medicare program and are relevant to promoting other useful health care services in this population. PMID- 10126031 TI - Positioning health care services: yellow pages advertising and dental practice performance. AB - The authors empirically explored the relationship between positioning strategies and financial performance in dental practices. They analyzed data collected from a random sample mail survey of Oregon dentists in conjunction with data obtained in a content analysis of yellow pages advertising. The authors' analysis of usable responses from 264 general dentists in private practice reveals that they use a variety of positioning strategies and that the selection of a positioning strategy correlates significantly with financial performance. PMID- 10126032 TI - Measuring physician attitudes of service quality. AB - The quality of physician services is not yet included in the current Medicare Resource-Based Relative Value Scale (RBRVS) formula. Future RBRVS reimbursement calculations may incorporate a quality index. The authors' research sought to explore the applicability of SERVQUAL determinants when measuring physician perceptions of service quality. Process quality determinants, such as "Reliability," "Assurance," and "Empathy," were rated higher in relative importance by physicians than outcome quality determinants, such as "Core Medical Services," and six of the seven service quality determinants were rated higher by older physicians. Further analyses indicated that physicians' perceptions of health care service quality varied because of factors such as number of years in practice and gender. PMID- 10126033 TI - Riding high with Bed-Stuy (Bedford-Stuyvesant). PMID- 10126034 TI - South Central Volunteer Ambulance Corps. PMID- 10126035 TI - World Trade Center blast. A tall order for responders. PMID- 10126036 TI - Beyond the paper trail. Pen-based computing hits the streets. PMID- 10126037 TI - Fear in the workplace. PMID- 10126038 TI - Dispatch. In apple-pie order? PMID- 10126039 TI - 9-1-1 emergency ... putting EMS dispatch first online. PMID- 10126040 TI - The dispatch standard of care. A matter of principle? PMID- 10126041 TI - Changes to Appendix D: "Crosswalk Between the 1991 and 1993 Standards" from the 1993 Accreditation Manual for Home Care. Joint Commission on Accreditation of Healthcare Organizations. PMID- 10126042 TI - Limitations on hospital patient movement that constitute restraint. PMID- 10126043 TI - Psychiatric hospital improves patient rights services. PMID- 10126044 TI - 1991 performance--ten elements with highest contingency rates. PMID- 10126045 TI - Corporate values take on new meaning in QI environment. PMID- 10126046 TI - Access to provider performance information: an inevitable outcome. PMID- 10126047 TI - Field testing of 1994 survey process begins. PMID- 10126048 TI - Feedback reports making the rounds. Hospitals beta testing anesthesia and obstetrics indicators are first to receive reports. PMID- 10126049 TI - Guidelines developed for community health care research project. PMID- 10126050 TI - Agenda for Change Q&A: indicators and the IMS (indicator monitoring system). PMID- 10126051 TI - How effective is outdoor-based training in improving management behaviors: a health care application. AB - This study explores the impact of an outdoor-based training program on management behaviors at a major regional medical center. Sixteen managers attended a combination high and low "ropes" training course given in three phases over a one year period. This program was designed to increase trust and improve communications within the hospital. A number of group measures from previous research are examined, including trust, group awareness, group effectiveness, self-esteem, and bonding of the group. Empirical evaluations of these items were done prior to training and three months after training. Scales that tapped both interpersonal relations and communications were developed from interviews with previous participants, and were evaluated prior to training and six months after training. Behavioral observations were also used to evaluate the effectiveness of the program. Results indicate that the outdoor-based training program was effective in improving certain key behaviors within the group. While stressing the need for future research, this study strongly supports the further use of outdoor-based training programs in health care settings. PMID- 10126052 TI - Women's participation in community health education: an empirical study. AB - This study identifies reasons for participation in community health education and determines if selected sociodemographic variables correlate with reasons for participation. The subjects were women (N = 400) who had attended hospital-based health education programs in a midwest urban area. An instrument was developed containing 36 items describing the concept "reasons for participation." Factor analysis revealed six interpretable factors: social acceptance, professional/personal advancement, personal insight, personal satisfaction, fulfillment of responsibilities, and self-enrichment. Age, marital status, occupation, number of children, educational attainment, and family income correlated with three of the six factors. PMID- 10126053 TI - Education and marketing: a new link to productivity. AB - Now is the time for hospital educators to become business-oriented. A marketing mindset must be developed to target not only health care professionals, but also the community at large (Johnson, 1991). This article offers an innovative approach for educators to align their departmental functions with the hospital's mission of providing high-quality health care services. This task is accomplished by utilizing the education department as a marketing tool for the hospital. PMID- 10126054 TI - A reaction to 'education and marketing: a new link to productivity'. PMID- 10126055 TI - Medicine's Last Commandment. PMID- 10126056 TI - How to beat the beeper blues. PMID- 10126057 TI - Making sure your care doesn't get lost in translation. PMID- 10126059 TI - Malpractice juries throttle back on awards. PMID- 10126058 TI - Don't let HMOs bully you out of your fees. PMID- 10126060 TI - Rationing. Canada--the truth about queues. PMID- 10126062 TI - Medical school still doesn't prepare us to be doctors. PMID- 10126061 TI - Rationing. America--from de facto to explicit? PMID- 10126063 TI - Judges tell how to win--or lose--a malpractice trial. PMID- 10126064 TI - Make every minute count--without shortchanging patients. AB - Sparing over-long explanations is just one of the timesavers the author has worked out during 30 years of practice. Read on for other tricks of the trade. PMID- 10126065 TI - The cancer diagnosis that turned up an outrage. PMID- 10126066 TI - Sexual harassment: know the facts. PMID- 10126067 TI - TQM to the rescue. PMID- 10126068 TI - Bar codes, Part 6. Bar coding: the ideal system. PMID- 10126069 TI - Time and task management with a PC. PMID- 10126070 TI - Grim fairy tales about health costs. PMID- 10126071 TI - 1993 health guide. Top 10 health stories to watch. AB - A sea change seems likely in the way health care is delivered. In medicine, public health and nutrition, here's what else the year will bring. PMID- 10126072 TI - Dear Hillary. AB - Michael Vasquez, president of Health Care Expert Systems, Inc., attended a meeting the task force on healthcare reform. After the meeting, he sent the following letter to Hillary Rodham Clinton, to members of Iowa's Congressional delegation and to Steven Schroeder, M.D., of the Robert Wood Johnson Foundation, who moderated the discussion along with Clinton and HHS Secretary Donna Shalala. Vasquez said he was "concerned that the role of information systems was not adequately represented as part of the possible solution during the discussion." PMID- 10126073 TI - Impacts of computer down time. PMID- 10126074 TI - Measuring the benefits of bedside systems. PMID- 10126075 TI - Patient scheduling for competitive advantage. PMID- 10126076 TI - Patient identifiers: stumbling blocks or cornerstones for CPRs (computer-based patient records)? AB - As the computer-based patient record, or CPR, moves closer to reality, patient identification issues remain unresolved. A mechanism already in place would be the Social Security number, or SSN. But legal questions surround its use for specific identification purposes. And not everyone has one. Healthcare Informatics asked several people closely involved with computerizing patient records about alternatives to social security numbers. Their responses may prove enlightening. PMID- 10126077 TI - Protecting healthcare's core competencies: retaining clinical information management. PMID- 10126078 TI - Person-side terminals: the missing link in patient care information systems. Look doc, no wires... PMID- 10126079 TI - Point-of-care systems review. PMID- 10126080 TI - Developing Georgia's telemedicine network. AB - Passage of Georgia's Distance Learning and Telemedicine Act of 1992 resulted in a windfall of $50 million from telephone company over-earnings. Rather than refund the money to consumers, legislators created a fund to finance telecommunications projects in medicine and education. When Governor Zell Miller signed the Act into law more than a year ago, he said, "[It] will immediately catapult Georgia to the forefront of this nation in the use of advanced telecommunications to improve the quality of life of its people." The law also set the state's cable television and telephone companies at odds. Nancy Horne, executive director of the Cable Television Association of Georgia, said that her industry's broadband fiber and coaxial infrastructure is in place to provide the state with telemedicine capabilities, and that transmission of full motion video or high resolution diagnostic images could take hours over standard telephone lines. Representatives of telephone companies argue that new high-speed cell relay switching technology provides instantaneous communications. An appointed Board of Governors holds tightly to the strings that secure a purse containing the $50 million. No grants have yet been awarded. In the middle of the debate stands Georgia's Department of Administrative Services, which moderates the competition between the two industries. And, the Medical College of Georgia created a demonstration project based on telephone technology. Representatives of both institutions gave Healthcare Informatics their views on developments of telemedicine in Georgia. PMID- 10126081 TI - Mobile computing to the rescue. AB - One of the healthcare industry's greatest problems is the mass of information and paper it generates. As a solution, mobile computing applications offer a number of benefits. With some, the familiar "metaphor" of pen and pad makes them easy to use, so they require minimal training. These platforms allow entry of "unusual" forms of data such as signatures, drawings and annotations. Regardless of input methods employed, mobile computers mean instant access to crucial information from any location at any time. They eliminate redundant data entry and an accumulation of paper that may be lost or destroyed. Finally, they improve process control and result in better documentation and greater quality by gathering accurate information efficiently. Mobile and pen-based technologies promise greater access to better information, as well as opportunities to remove traditional information boundaries created by a hospital's walls--allowing caregivers access to information within and beyond the care facility. The following pages provide a brief look at mobile product offerings and projects targeting the healthcare industry. PMID- 10126082 TI - Security, durability & portable computers. PMID- 10126083 TI - California health reform decisions. PMID- 10126084 TI - Workers' compensation: a system out of control. PMID- 10126085 TI - Jury still out on DHS' Medi-Cal managed care plan. PMID- 10126086 TI - Canine visits booster patient morale. PMID- 10126087 TI - Acute-care vs. skilled-nursing facilities in rural and small hospitals. PMID- 10126088 TI - Rural hospitals in 1993: creating a brighter tomorrow. Issues and challenges. AB - In rural communities throughout America, issues of access, staffing and costs threaten the availability of health care services. Innovative strategies can help small and rural hospitals better serve their communities today and improve the outlook for tomorrow. PMID- 10126089 TI - Joint Commission works to improve survey process for small/rural hospitals. PMID- 10126090 TI - How cognitive factors influence way-finding. AB - Although research is still in its initial stages, this article addresses the performance of buildings in supporting the emergency egress behavior of occupants. PMID- 10126091 TI - Organizational structures and methods for controlling health care costs. PMID- 10126092 TI - Decision analysis, TQM help Medical Center of Delaware save millions in direct & indirect costs of materials management. PMID- 10126093 TI - Assessing your TQM program's impact. PMID- 10126094 TI - Health Care Reform Task Force members identified. PMID- 10126095 TI - Shaping a standard benefit package. All health organizations want to get to the core of the issue. PMID- 10126096 TI - What price mental health? AB - President Clinton aims to guarantee coverage not only to the severely disturbed but to all Americans. The cost, however, could be astronomical. PMID- 10126097 TI - An introduction to capitation. PMID- 10126098 TI - From doorkeeper to building manager: the changing role of the primary care physician. A fable. PMID- 10126099 TI - How fee-for-service groups are making the transition to capitation. PMID- 10126100 TI - Glossary of terms relating to managed care and capitation. PMID- 10126101 TI - Policy and practice: certified home health care in New York City. PMID- 10126102 TI - Homeless people and health care: an unrelenting challenge. PMID- 10126103 TI - Hospitals and the poor: strategies for primary care. PMID- 10126104 TI - At the bedside: innovations in hospital nursing. PMID- 10126106 TI - Being sick in Miami is costly, compared with other cities in the United States. PMID- 10126105 TI - Data watch. Family-friendly benefits. PMID- 10126107 TI - States see an increase in the number of home care agencies. PMID- 10126108 TI - Seven companies capture Merck/NMHCC (National Managed Health Care Congress) partnership awards. PMID- 10126109 TI - Monitoring drug compliance can reduce total medical plan costs. PMID- 10126110 TI - Navigating the direct contracting maze. PMID- 10126111 TI - What battles loom over Clinton's health care reform plan. PMID- 10126112 TI - Prenatal care: a small investment begets a big return. PMID- 10126113 TI - How insurers can regain buyers' confidence. PMID- 10126114 TI - Medicare and Medicaid programs; preadmission screening and annual resident review -HCFA. Final rule; correction. AB - In the November 30, 1992 issue of the Federal Register, we established requirements for preadmission and annual review of individuals with mental illness or mental retardation who are applicants to or residents of nursing facilities that are certified for Medicaid. We also established an appeals system for individuals who may be transferred or discharged from facilities or who wish to dispute a determination made in the preadmission screening and annual review process. This notice corrects typographical errors made in that document. PMID- 10126115 TI - Medical devices; reclassification and codification of microsurgical argon laser for rhinology and laryngology--FDA. Final rule. AB - The Food and Drug Administration (FDA) is announcing that it has issued an order in the form of a letter to HGM Medical Laser Systems, Inc., reclassifying the microsurgical argon laser for use in rhinology and laryngology from class III (premarket approval) to class II (special controls). The order is being codified in the Code of Federal Regulations as specified herein. PMID- 10126116 TI - Preventive care--how costly a reform? PMID- 10126117 TI - Greening the lab--case report. PMID- 10126118 TI - Statistics and indicators--a manager's best friends. PMID- 10126119 TI - Industry watch. Survey results. AB - The results of two recent surveys show that enthusiasm and support for reengineering information systems is slow to catch on among information professionals and top healthcare management. Caution--and even outright pessimism -remain over the speed with which a truly computer-based patient record will be implemented. Interest in open-systems solutions, however, is up sharply. PMID- 10126120 TI - Case management a must to survive managed care. AB - Fast, efficient access to patient information is now an essential management tool. Not only does it facilitate a streamlined approach to the continuum of care, but it also helps ensure the kind of quality that consumers are clamoring for. PMID- 10126121 TI - 1993 market directory supplement. AB - Computers in Healthcare offers a special supplement to the 1993 Market Directory, published in March. This addendum can be pulled out and placed in your regular Computers in Healthcare Market Directory. PMID- 10126122 TI - Case management. Dear I/S vendor. PMID- 10126123 TI - Product overview. Hot list: critical care/emergency room. AB - June's HotList features emergency room and critical care products. All data have been provided by individual vendors who responded to our survey questions. Computers in Healthcare has made an effort to contact all vendors within this market. See the 1993 Computers in Healthcare Market Directory, for complete listings. PMID- 10126124 TI - Controlling increases in the volume and intensity of medical services. AB - In their efforts to contain healthcare costs, employers are attempting to control volume and intensity (VI) of services growth. A new volume performance standard described in this article would allow employers to set annual VI growth targets with their network sponsors. PMID- 10126125 TI - Employer liability in the managed care setting. AB - Managed care may present legal risks for employers. To avoid potential liability, employers should engage in due diligence and carefully draft plan documents, vendor contracts and employee communications. PMID- 10126126 TI - Psychiatric treatment programs: the continuous services model. AB - With the inclusion of behavioral managed care in the design of many benefit plans, the delivery of psychiatric care has changed. The continuous services model offers advantages for both employers and employees who utilize mental health benefits. PMID- 10126127 TI - Health care reform: national, state and local directions. PMID- 10126128 TI - Informed flex decisions can make good benefits better. PMID- 10126129 TI - COBRA and tax implications of domestic partner coverage. PMID- 10126130 TI - It finally happened. Every EMS service and individual provider must prepare for the possibility of terrorist incidents. PMID- 10126131 TI - Preparing for terror. AB - Terrorists enjoy their exposure in the international press. Their acts and treats of violence are heralded in headlines and broadcast throughout the world. They purposely inflict damage in public places where there are large numbers of victims, with the potential for a great deal of destruction and debris. They intend to inflict economic loss, instill fear and disrupt everyday life, while at the same time believing their need to maim and kill is justified. Is it no wonder that the World Trade Center was a highly prized target? You must remember that terrorism involves the perpetrator's willful, calculated choice to use innocent victims as targets, and that the terrorist's acts are deliberate, systematic murders to inspire fear for political or criminal ends. As Brian Jenkins stated back in 1983, "terrorism is never a short-term event...you never really get over it...and its effects can't be buried or forgotten." Thus, our responsibility, as EMS providers, is to recognize the threat and refuse to be lulled into a sense of complacency. The United States is at risk, and our greatest threat may even come from our own ranks: political crusaders, activists, hate groups, drug merchants and gangs. The criminals, zealots, fanatics and extremists of the world will continue to believe their crusades and turf battles can be won through terrorist acts. It's up to us to respond effectively to the aftermath. PMID- 10126132 TI - Native needs. PMID- 10126133 TI - ED staffs underreport assaults by patients. PMID- 10126134 TI - Body, mind & spirit: total patient care. PMID- 10126135 TI - Food safety through hygiene. PMID- 10126136 TI - Purchaser-driven reform: who is at the wheel? PMID- 10126137 TI - Seamless. PMID- 10126138 TI - The purchaser-driven reformation in health care: alternative approaches to leveling our cathedrals. AB - Slowly mounting interest in the provider community in delivery system reform badly underestimates the extent to which major reconfiguration is already being engineered by aggressive purchasers. The once widely held view that provider sponsored integrated firms represent the ideal health care system is being challenged by purchasers who are crafting, through short- and long-term selective contracting, provider networks that offer many of the same advantages ascribed to integrated firms. Three alternative approaches to restructuring delivery systems are examined and appraised in terms of how each may or may not be able to satisfy purchaser demands. The relentless pursuit of better cost management will have profound consequences for health care providers and their managers. Major redeployment of resources will occur as the industry converts from a hospital centered to a continuum of care-centered management philosophy. PMID- 10126139 TI - A health plan that can work. AB - The vast U.S. medical system is already going through a radical change. The big question now is, will Bill Clinton's pending reforms speed it or impede it? PMID- 10126140 TI - Death and AIDS: a review of the medico-legal literature. AB - As there is still neither a known cure for the acquired immunodeficiency syndrome (AIDS) nor any vaccine to prevent infection with the human immunodeficiency virus (HIV), an AIDS diagnosis continues to denote a death sentence. One might think that approaching dying, death, and bereavement in the AIDS pandemic would be the same as with other terminal illnesses. However, that is not the case. No other single disease in the history of the American legal system has generated more litigation than this disease. This article examines some of the medico-legal issues associated with AIDS-related death such as estate planning, discrimination, insurance, long-term care, the right to die, and suicide as detailed in medical and legal discourse. PMID- 10126142 TI - Perspectives on confidentiality and privacy. PMID- 10126141 TI - Living and dying in the Jewish way: secular rights and religious duties. AB - This article compares and contrasts the modern American secular emphasis on individual rights and autonomous decision making in the "right to die" context with the traditional emphasis on obligation to others and to God found in Orthodox Judaism. The approach of Conservative and Reform Judaism to decision making about life-sustaining medical treatments also is explicated and used as the basis for posing a variety of questions regarding the proper balance and relative influence of religious and secular values for modern American Jews in grappling with the difficult ethical dilemmas posed by "right to die" scenarios. PMID- 10126143 TI - Confidentiality: a physician/bureaucrat's perspective. PMID- 10126144 TI - The application and scope of the proposed new law. PMID- 10126145 TI - Disclosure of medical information without consent: the patient's right to confidentiality. PMID- 10126146 TI - Access by patients to the clinical record. PMID- 10126147 TI - Confidentiality: a health record department perspective. PMID- 10126148 TI - Advanced technology in the health care sector: selected legal implications. PMID- 10126149 TI - Protection of quality assurance and peer review data. PMID- 10126150 TI - The post-capitalist executive. Interview by T George Harris. AB - For half a century, Peter F. Drucker has influenced senior executives across the globe with his rare insight into socioeconomic forces and practical advice for navigating often turbulent managerial waters. In his latest contribution to HBR, Drucker discusses the impact of the ideas in his latest work, Post-Capitalist Society, on the day-to-day lives and careers of managers. Drucker argues that managers must learn to negotiate a new environment with a different set of work rules and career expectations. Companies currently face downsizing and turmoil with increasing regularity. Once built to last like pyramids, corporations are now more like tents. In addition, businesses in the post-capitalist society grow through many and varied complicated alliances often baffling to the traditional manager. Confronted by these changes, managers must relearn how to manage. In the new world of business, information is replacing authority as the primary tool of the executive. And, Drucker advises, one embarks on the road toward information literacy not by buying the latest technological gadget but by identifying gaps in knowledge. As companies increasingly become temporary institutions, the manager also must begin to take individual responsibility for himself or herself. To that end, the executive must explore what Drucker calls competencies: a person's abilities, likes, dislikes, and goals, both professional and personal. If executives rise to these challenges, a new organizational foundation will be built. While a combination of rank and power supported the traditional organization, the internal structure of the emerging organization will be mutual understanding and trust. PMID- 10126151 TI - Uncovering your hidden occupancy costs. AB - Senior managers at large companies may not believe that they can have much impact on the "bricks and mortar" of their cost structure. They may even think that occupancy costs are too insignificant to worry about, too technical to analyze, and too fixed to control. But as real estate consultant Mahlon Apgar argues, occupancy costs can hurt a company's earnings, share value, and overall performance. On the other hand, every dollar saved drops straight to the bottom line. Shearson Lehman Brothers, for example, has found that it can save as much as $20 million annually by reducing occupancy costs in its branch offices and headquarters. Managing occupancy costs isn't easy. But it is timely. As companies strive to improve productivity by consolidating functions and downsizing staff, they are saddled with excess office space. Expansions abroad present completely different market conditions that put a premium on reducing occupancy costs. At the same time, the changing nature of work is challenging deeply held beliefs about the workplace, and, consequently, traditional expectations of office space are giving way to innovations that are less costly and more productive. To manage occupancy costs, managers must be able to identify their components, measure their impact, understand what drives them, and develop options to change them. Four basic tools help diagnose problems: a cost history, a loss analysis, a component analysis, and a lease aging profile. Understanding cost drivers like leasing, location, and layout can give executives the insights they need to reduce occupancy costs while improving the effectiveness of facilities to support day-to-day operations. PMID- 10126152 TI - Will architecture win the technology wars? AB - Success today flows to the company that establishes proprietary architectural control over a broad, fast-moving, competitive space, Charles R. Morris and Charles H. Ferguson claim in "How Architecture Wins Technology Wars" (March-April 1993). No single vendor can keep pace with the outpouring of cheap, powerful, mass-produced components, so customers have been stitching together their own local systems solutions. Architectures impose order on the system and make interconnections possible. An architectural controller has power over the standard by which the entire information package is assembled. Because of the popularity of Microsoft's Windows, for example, companies like Lotus must conform their software to its parameters to be able to compete for market share. Proprietary architectural control has broader implications for organizational structure too: architectural competition is giving rise to a new form of business organization. PMID- 10126153 TI - When times get tough, what happens to TQM? Case study. AB - When Mueller Chemical Company's biggest customer, Ameriton, demanded that MCC install a total quality management system five years ago, the effort seemed worth it. Morale improved dramatically at the German company, as did quality and productivity. But now, in this fictional case study, Ameriton has gone bankrupt. As a result, MCC has had to cut its work force, and senior managers are meeting to decide whether TQM should be part of the downsized MCC. Horst Koblitz, director of TQM, and Division Manager Eva Stichen both vote yes. Stichen's division, which never supplied Ameriton, has turned its process-control system into the company's best thanks to TQM. The division is more cost-efficient, product defects are nearly nonexistent, and its safety record is spotless. As Koblitz notes, Ameriton's failure is no reason to abandon all that MCC has built. Furthermore, shareholders and customers would think that MCC was panicking. MCC just needs to tailor its TQM program to a smaller organization. But CFO Georg Becker doesn't think MCC has the time or resources for fine-tuning. And as he sees it, that might be just as well. The distractions that came with TQM took MCC away from its goal of becoming the chemicals market leader in Europe. While the company organized teams, developed measurement systems, and filled out quality reports, its competitors took away much of the market share MCC was after. TQM was a good long-term approach, but it didn't come with a plan for MCC's current situation. And CEO and Chairman Dieter Mueller won't compromise; TQM must either stay or go.(ABSTRACT TRUNCATED AT 250 WORDS) PMID- 10126154 TI - What's the matter with business ethics? AB - The more business ethics secures its status in campuses across the country, the more bewildering it appears to actual managers. It's not that managers dislike the idea of doing the right thing. As University of Toronto Assistant Professor Andrew Stark argues, far too many business ethicists just haven't offered them the practical advice they need. Before business ethics became a formal discipline, advocates of corporate social responsibility claimed that the market would ultimately reward ethical behavior. But ethics and interests did not always intersect so fruitfully in the real world. And when they did not, managers were left in the dark to grope for the right ethical course. In the 1970s, the brand new field of business ethics came onto the scene to address this issue. Critical of the "ethics pays" approach, academics held that ethics and interests can and do conflict. Still, scholars took an equally unrealistic line. To them, a manager's motivation could be either altruistic or self-interested, but never both. In short, ethicists still weren't addressing the difficult moral dilemmas that managers face on a day-to-day basis, and only recently have they begun to do so. After some initial stumbles, ethicists are getting their hands dirty and seriously considering the costs of doing the right thing. Finally, a new business ethics is emerging that acknowledges and accepts the messy world of mixed motives. As a result, novel concepts are springing up: moderation, pragmatism, minimalism, among others.(ABSTRACT TRUNCATED AT 250 WORDS) PMID- 10126155 TI - The center-cut solution. AB - Timothy Firnstahl owns five successful restaurants in Seattle, but he recently came very close to owning none. In the early 1990s, he found himself, like so many restauranteurs, facing rising costs, inefficient management, and a recession. Confronting financial annihilation, Firnstahl had to act quickly: since he had no peripherals to trim, he cut off the head of his company. Remarkably, it worked. Firnstahl's problem was his new and innovative restaurant, Sharps Fresh Roasting. The heart of the Sharps concept was a unique long-roasting technique that made lean, inexpensive meats taste as juicy and delicious as fattier, expensive cuts. The process also lent itself to faster service and lower labor costs. But it wasn't working. Sharps wasn't breaking even, and his other restaurants couldn't make up the difference. He needed a solution fast. Firnstahl got his answer from Mikhail Gorbachev: slash the centralized command and liberate the company. In doing so, he would also transfer virtually all power and responsibility to his line managers. And after five months of intensive study and planning, he accomplished what he set out to do. He fired most of his corporate staff, empowered his restaurant managers with "100% Power and Responsibility," and, finally, undertook a massive promotion campaign. A year later, Sharps Fresh Roasting is the gold mine Firnstahl always believed it could be. He's done away with bureaucracy and turned business around in a down market. All this because his managers are managing themselves. PMID- 10126156 TI - Predators and prey: a new ecology of competition. AB - Much has been written about networks, strategic alliances, and virtual organizations. Yet these currently popular frameworks provide little systematic assistance when it comes to out-innovating the competition. That's because most managers still view the problem in the old way: companies go head-to-head in an industry, battling for market share. James Moore sets up a new metaphor for competition drawn from the study of biology and social systems. He suggests that a company be viewed not as a member of a single industry but as a part of a business ecosystem that crosses a variety of industries. In a business ecosystem, companies "co-evolve" around a new innovation, working cooperatively and competitively to support new products and satisfy customer needs. Apple Computer, for example, leads an ecosystem that covers personal computers, consumer electronics, information, and communications. In any larger business environment, several ecosystems may vie for survival and dominance, such as the IBM and Apple ecosystems in personal computers or Wal-Mart and K mart in discount retailing. In fact, it's largely competition among business ecosystems, not individual companies, that's fueling today's industrial transformation. Managers can't afford to ignore the birth of new ecosystems or the competition among those that already exist. Whether that means investing in the right new technology, signing on suppliers to expand a growing business, developing crucial elements of value to maintain leadership, or incorporating new innovations to fend off obsolescence, executives must understand the evolutionary stages all business ecosystems go through and, more important, how to direct those changes. PMID- 10126157 TI - Tailored logistics: the next advantage. AB - How many top executives have ever visited with managers who move materials from the factory to the store? How many still reduce the costs of logistics to the rent of warehouses and the fees charged by common carriers? To judge by hours of senior management attention, logistics problems do not rank high. But logistics have the potential to become the next governing element of strategy. Whether they know it or not, senior managers of every retail store and diversified manufacturing company compete in logistically distinct businesses. Customer needs vary, and companies can tailor their logistics systems to serve their customers better and more profitably. Companies do not create value for customers and sustainable advantage for themselves merely by offering varieties of goods. Rather, they offer goods in distinct ways. A particular can of Coca-Cola, for example, might be a can of Coca-Cola going to a vending machine, or a can of Coca Cola that comes with billing services. There is a fortune buried in this distinction. The goal of logistics strategy is building distinct approaches to distinct groups of customers. The first step is organizing a cross-functional team to proceed through the following steps: segmenting customers according to purchase criteria, establishing different standards of service for different customer segments, tailoring logistics pipelines to support each segment, and creating economics of scale to determine which assets can be shared among various pipelines. The goal of establishing logistically distinct businesses is familiar: improved knowledge of customers and improved means of satisfying them. PMID- 10126158 TI - All-applicant drug testing in hospitals: overcoming physician protests. PMID- 10126159 TI - Security management software: how it is used by two hospitals. PMID- 10126160 TI - To gain greater employee attention: stress personal security, safety. PMID- 10126161 TI - Special report. Making hospital parking safer--an update. AB - Like all 24-hour facilities that must provide parking for employees as well as for the public, hospitals are concerned about security for their parking garages and lots. Like malls, however, hospitals are particularly vulnerable to violent crime and criminals prone to violence because of their large percentage of female employees who leave work after dark. In previous issues, we have presented over a score of case histories on how different hospitals are dealing with the problems of parking security. In this report, we'll present some more examples. PMID- 10126162 TI - Hospital security provides input into planning new ER facility. PMID- 10126163 TI - Underground melting system removes snow and ice at Kansas hospital. PMID- 10126164 TI - Special report. The Los Angeles ER shootings, Part I: What happened--before, during, after. AB - The shootings of three doctors in a Los Angeles emergency room, and the subsequent hostage taking by the alleged assailant, received extensive national publicity and reportedly has had an impact on ER security at many hospitals--in California and elsewhere. In Part I of this report, we'll present details on what happened and what transpired afterward in connection with the hospital, Los Angeles County-University of Southern California Medical Center, and other California hospitals. Part II of this report, in our next issue, will deal with the event's impact on hospitals elsewhere in the country. PMID- 10126165 TI - Court rules for hospital in case of employee raped in parking lot. PMID- 10126166 TI - Get ready for changes in the Medicare Area Wage Index. PMID- 10126167 TI - Survey update: doctoring hospital perks to match physician preferences. PMID- 10126168 TI - Dynamic pay strategies for evolving health care organizations. PMID- 10126169 TI - Achieving effective cost control in comprehensive health care reform. The Jackson Hole "managed care managed competition" approach. AB - The managed competition approach was originated by Alain Enthoven, a professor at the Stanford University Graduate School of Business, in the late 1970s, and has since been refined by Enthoven and a group of colleagues meeting in Jackson Hole, Wyoming. This outline was presented by Enthoven at hearings on cost control in health care reform held by Senator Edward Kennedy (D-MA) in December 1992. PMID- 10126170 TI - California health care in the 21st Century. A vision for reform. AB - California Insurance Commissioner John Garamendi's proposal for revamping the state's health care system is considered by many to be an improvement on Alain Enthoven's version of managed competition because it separates insurance from employment and includes budgets and a single source of financing. Princeton sociologist Paul Starr, a prominent member of the national Health Care Taskforce, is a proponent of a similar plan on a national basis. This is an excerpt from the Executive Summary of the plan; in 1992 the California legislature approved a commission to study the proposal, only to have it vetoed by Governor Pete Wilson. PMID- 10126171 TI - Managed competition. An analysis of consumer concerns. Single-Payer Coalition for Health Security. AB - This analysis of managed competition was written by the Single-Payer Coalition for Health Security, a broad-based coalition of groups representing for the most part consumers of health care, including American Public Health Association; Church Women United; Citizen Action; Consumers Union; National Association of Social Workers; National Council of Senior Citizens; Neighbor to Neighbor; NETWORK: A National Catholic Social Justice Lobby; Oil, Chemical & Atomic Workers International Union; Older Women's League; Physicians for a National Health Program; Public Citizen; United Cerebral Palsy Associations; and United Church of Christ. What follows is a substantial excerpt from their working paper, issued in January 1993. PMID- 10126172 TI - View from the receiving end. PMID- 10126173 TI - Will managed competition work? PMID- 10126174 TI - Threats to consumers. PMID- 10126175 TI - Directions for health care reform. PMID- 10126176 TI - Managed competition: reform or retreat? Analysis, critique, alternatives. PMID- 10126177 TI - Questions and answers about managed competition. PMID- 10126178 TI - Managed competition and public health. Let's do the right thing. PMID- 10126179 TI - Survival of the fittest. The 'competition' model for health care. AB - The following are excerpts from an article first published in the Health/PAC Bulletin in 1981. This lengthy analysis was written in response to various proposals made during the late 1970s and early 1980s to unfetter the invisible hand of free-market competition in order to solve the nation's health care "crisis." Twelve years later...the health care "crisis" is considerably more grave, and it has become even more popular to wave the "invisible" hand in the hope it will go away. Twelve years later, the objections Sigelman raises have not gone away either, and his conclusions--that in the face of the competition model, the need is greater than ever for consumers to organize to compel providers to deliver services that respond to the needs of the community--is, unfortunately, prophetic. PMID- 10126180 TI - Managed competition. A guide to the thicket. PMID- 10126181 TI - Change the health care system? How UHCAN (Universal Health Care Action Network)! PMID- 10126182 TI - The American Health Security Act of 1993. AB - The American Health Security Act (S 491, HR 1200) was introduced in the U.S. Senate by Paul Wellstone (D-MN) and in the House of Representatives by John Conyers (D-MI) and Jim McDermott (D-WA), along with 54 co-sponsors. The legislation, which replaces and strengthens the 1992 bill proposed by former Rep. Marty Russo and Sen. Wellstone, presents a single-payer alternative to managed competition proposals. This summary is excerpted from material provided by Sen. Wellstone's office. PMID- 10126183 TI - Organizations for health care reform. AB - The following list is meant as a resource for grassroots organizing for health care reform. Many organizations are stepping up their efforts in response to the imminent announcement of the Clinton administration's health care reform proposals. There are three major national organizations working for the same goals in support of a single-payer system: Universal Health Care Action Network (UHCAN!), a network of health care reform groups with a national clearinghouse in Cleveland, Ohio; Citizen Action, with affiliates in more than 30 states; and Physicians for a National Health Program (PNHP), centered in Cambridge and Chicago and with local chapters in various states. There is also a national organization, Campaign for Health Security, working in support of the American Health Security Act of 1993 (S 491 and HR 1200), the Wellstone-Conyers-McDermott single-payer bill. Many states have health care campaigns supporting a single payer system, as do many progressive unions. PMID- 10126184 TI - Computing and the law. PMID- 10126185 TI - Health and efficiency. AB - Measuring efficiency is essential but purchasers and providers should treat the perverse incentives of the efficiency index with caution, warn John Appleby and Val Little. PMID- 10126186 TI - The five commandments. PMID- 10126187 TI - Wholly Romanian empire. PMID- 10126188 TI - Sexual harassment at work: issues and answers for health care administrators. AB - Sexual harassment is not new to the health care industry. What is new is that recent media attention has heightened awareness that sexual harassment is illegal. This fact, coupled with the substantial liability that employers may incur if they fail to control sexual harassment, mandates the need for outlining the major issues relative to sexual harassment in today's health care setting. This article gives particular emphasis to the fact that sexual harassment can be prevented by taking a proactive stance. PMID- 10126189 TI - Health care administration in the year 2000: practitioners' views of future issues and job requirements. AB - This research identifies the most important domains in health care administration (HCA) from now to the year 2000 and differentiates job skill, knowledge, and ability requirements necessary for successful management. Fellows of the American College of Healthcare Executives from about half of the United States responded to two iterations of a Delphi mail inquiry. Fellows identified 102 issues that were content-analyzed into nine domains by an HCA expert panel. Domains, in order of ranked importance, were cost/finance, leadership, professional staff interactions, health care delivery concepts, accessibility, ethics, quality/risk management, technology, and marketing. In the second Delphi iteration, Fellows reviewed domain results and rated job requirements on required job importance. Results indicated that while a business orientation is needed for organizational survival, an equal emphasis on person-oriented skills, knowledge, and abilities is required. PMID- 10126190 TI - Schmoozing with the enemy: conversations with employee benefits managers. AB - During the past decade, the role of private employers in the purchase of health benefits has assumed critical importance. Purchaser-provider relationships are almost certain to grow more contentious in the current climate of escalating costs and recrimination about the sources of this escalation. This study reports the findings of structured, in-depth interviews with a sample of employee benefits managers from medium- to large-sized firms. The study focused on how these managers approach the health benefits buying process. A key finding is the wide variation observed in the buying process among a relatively homogeneous group of employers. Several prescriptive implications for health services managers are derived from the interviews, including the critical need to promote expanded and improved provider-employer communication. PMID- 10126191 TI - Economic value added--a framework for health care executive compensation. AB - Health care executive compensation has come under recent scrutiny, partly because of efforts to contain health care costs in general and partly because of negative press given to executive compensation in the corporate world. This article extends beyond speculating what the basis of health care executive compensation should be and beyond presenting comparative compensation data often used to support compensation levels. It presents a sound economic framework on which executive compensation may be determined and evaluated--a framework to be used to supplement traditional bases of executive compensation in voluntary and investor owned hospitals. The economic value added (EVA) framework is built on the premise that levels of health care executive compensation should at least in part be based on the economic value that the executives themselves create for the organization. EVA is both a measure of value and measure of performance and offers a base for annual executive incentive compensation in addition to those traditionally used by hospital boards. PMID- 10126192 TI - Issues management: the other side of strategic planning. AB - Most health services organizations follow a strategic planning model that emphasizes organizational changes to adapt to the environment. This limited view overlooks the possibility of changing the environment to better suit the organization's goals. Health services leaders in particular are concerned because they have not been effectively engaged in dealing with external policy matters. A strategic issues management system provides an integrated approach to this responsibility and can be established by expanding current strategic management activities. Additional resources will be required for new analyses and interpretations and for more intense interaction with stakeholders, but these costs will be significantly less than the benefits realized from operation of an effective strategic issues management system. PMID- 10126193 TI - Assessing the viability of situationally driven segmentation opportunities in the health care market. AB - The impact of situational factors has typically been investigated in the context of goods marketing. Very few studies have investigated the influence of situational factors on services marketing. This study demonstrates the importance of situational influence on services marketing by delineating a consumer-based, situationally characterized competitive market structure for health care services. The competitive structure of the health care market is delineated in terms of the similarity/substitutability of the three-factor, situational characterizations of ten health care alternatives. The general marketing implications of the market-structure delineation procedure and the health care specific implications of the findings are discussed. PMID- 10126194 TI - Complying with the Patient Self-Determination Act: legal, ethical, and practical challenges for hospitals. AB - On 1 December 1991, the Patient Self-Determination Act became law. This Act requires certain health care providers to distribute information to patients concerning advance directives (i.e., living wills and health care power of attorney). The information must include a statement of an individual's rights under the law of the state where the care is being provided. In fact, the provider must actually promulgate written policies and procedures regarding compliance with the Act. The entire law is only a few paragraphs of legislation, and yet its legal, ethical, and practical effect for the health care provider is broad. This article is designed to discuss why the Act was promulgated, what its provisions are, how to comply with it, and what can occur if a health care provider fails to comply. PMID- 10126195 TI - All play and no work makes healing a fun chore in play pavilion. PMID- 10126196 TI - OSHA searches for right fit on its ergonomics standard. PMID- 10126197 TI - Roofing warranties: what does the fine print mean? PMID- 10126198 TI - Lighting experts: how to pick the best one for you. PMID- 10126199 TI - Nurse-call choice depends on area, layout and staffing. PMID- 10126200 TI - Pathogens rule: training, vaccines and follow-up. PMID- 10126201 TI - Staff input key to evaluate safer needle devices. PMID- 10126202 TI - Sound floor care plans create 'appearance peaks'. PMID- 10126203 TI - Plant operations, maintenance: who's buying what? PMID- 10126204 TI - Administration to business management. PMID- 10126205 TI - Reviewing the NHS IPR (individual performance review) scheme. PMID- 10126206 TI - Cutting the mustard and CRES (cash releasing efficiency savings). PMID- 10126207 TI - Management development for GPs and practice managers. PMID- 10126208 TI - Total quality management: involving staff in the search for perfection. PMID- 10126209 TI - Nurses' pay and the labour market. PMID- 10126210 TI - Management development for clinicians. The influence of organization structure. PMID- 10126211 TI - Tackling sickness: a manpower planning approach. PMID- 10126212 TI - Foley catheter prices on the rise. PMID- 10126213 TI - Long Beach, Alta Bates raise eyebrows with vendor switch. PMID- 10126214 TI - Northwestern Memorial takes numbers approach to tackle problem areas in materials management. PMID- 10126215 TI - Beware of high cost of hypoallergenic gloves. PMID- 10126216 TI - Hospitals keep buying, but are more cautious about upcoming capital equipment purchases. PMID- 10126217 TI - The patient as citizen. A common-good approach to medical treatment decisions balances the emphasis on patient desires. AB - Individualism plays too strong a role in the arena of treatment decision making, frequently to the exclusion of any other consideration. Using a common-good or community-based ethic as a framework for treatment decision making may provide appropriate balance to the emphasis on patient desires. Self-determination is a good that must be balanced with other goods. When it is not, to quote Daniel Callahan, "Self-determination runs amok." For example, in the state of New Jersey, individuals are permitted to choose the criteria to be used in determining that their own death has occurred. Some of the principles that may lead to a reasonable understanding of the patient's rights in a "patient-as citizen" ethical perspective are: Everyone has a legitimate claim to a basic level of healthcare. Everyone has a legitimate claim to respect for his or her refusal of recommended treatment. No one has a legitimate claim to nonbeneficial or futile treatment. No one has a legitimate claim to treatment that is being withheld as part of a just rationing system. No one has a legitimate claim to the ability to determine the medical criteria to be used for the diagnosis of his or her death. A just healthcare system is one in which individual desires for medical treatment beyond the basic level are accommodated whenever possible but not when they undermine the primary purpose of medicine to meet the basic healthcare needs of all persons. PMID- 10126218 TI - Long-term care and hospital collaboration. To survive in a reformed healthcare system, long-term care facilities can initiate hospital-based SNFs. AB - Establishing relationships with hospitals may be critical for long-term care facilities facing financial pressures and uncertain futures. One option is to initiate collaborative efforts to develop hospital-based skilled nursing facilities (SNFs). Hospitals, under pressure to move patients to less intensive settings and to diversify, are naturally drawn to long-term care as a related business where they can make limited personnel and financial commitments and extend their continuum of care. Before approaching hospitals to initiate collaborative efforts, long-term care providers should understand how they think and what their strengths and weaknesses are. Long-term and acute care providers have many options for collaboration, including management contracts and joint ventures. In a traditional management contract, the long-term care provider furnishes the administrator and a few key staff in exchange for direct reimbursement for those staff plus a management fee. Another option is for the long-term care facility to provide all the staff for a fee or percentage of revenue. Joint venture options are to form a subsidiary corporation to renovate a floor of the hospital or to have the hospital buy a large percentage of the long term care facility and share the profits. All these options have potential pitfalls, including differing financial expectations and the threat of unionization at the SNF. Nevertheless, for long-term care facilities struggling under reimbursement cutbacks and other pressures, the benefits may outweigh the risks. PMID- 10126219 TI - Creating the future. Nurses can shape their profession by getting involved in healthcare reform. AB - To remain relevant in a reformed healthcare system, nurses will have to redefine and remake themselves. Three aspects of the new healthcare age--megahospitals, managed care, and redefined professional roles--will have a significant impact on healthcare professions, including nursing. Across the United States hospitals are merging to form sophisticated networks that provide a continuum of care. Under this delivery model, nurses will play a variety of new roles and work collaboratively with the entire spectrum of health social service professionals. A related development--the growth of managed care--is an increasingly attractive option among large employers. It will also accelerate changes in the way healthcare professionals work. Managed care will force physicians to enter into appropriate group affiliations and hospitals to reconfigure themselves to meet the needs of a dynamic system that no longer requires yesterday's beds or management structures. The future will force healthcare professionals to go through regular, radical changes in their job requirements. But it will also allow nurses and others to emerge from their task-oriented past and take on work that requires them to think, judge, and intervene. PMID- 10126220 TI - Retaining nurses through conflict resolution. Training staff to confront problems and communicate openly can improve the work climate. AB - The way nurses resolve conflict may be leading them to quit their jobs or leave the profession altogether. Conflict is inevitable in a dynamic organization. What is important is not to avoid conflict but to seek its resolution in a constructive manner. Organizational conflict is typically resolved through one of five strategies: withdrawal, force, conciliation, compromise, or confrontation. A recent study of nurses in three different hospitals showed that the approach they use most is withdrawal. This might manifest itself in a request to change shifts or assignments and may lead to a job change and, eventually, abandonment of the field altogether. Given this scenario, changing nurses' conflict resolution style may help administrators combat the nursing shortage. Healthcare organizations must examine themselves to determine why nurses so frequently use withdrawal; then they must restructure work relationships as needed. Next, organizations need to increase nurses' awareness of the problem and train them to use a resolution style more conducive to building stable relationships: confrontation. Staff should also be trained in effective communications skills to develop trust and openness in their relationships. PMID- 10126221 TI - Returning Gospel values to nursing education. Catholic educators and institutions must make explicit the values on which their practices are based. AB - Although Catholic nursing education in the United States has traditionally instilled Gospel values in students, pressures from a secular culture are making it increasingly difficult to sustain this heritage. As the twenty-first century approaches, Catholic educators and healthcare administrators need to ask themselves whether Christian values still serve as the explicit basis of nursing service and education at their institutions. They must also ask what distinguishes graduates of Catholic nursing programs from those of other programs. The percentage of schools that are Catholic has remained roughly the same during the past 30 years, but in many cases these schools no longer instill Christian values. Although most programs offer courses in ethics, philosophy, and religion, few provide the value-laden experiences of the past. In fact, many instructors avoid addressing questions of values or ethics because they believe doing so would be a form of indoctrination. Catholic nursing education, like Catholic higher education in general, is becoming increasingly secular. To return Christian values to nursing practice and education, leaders need first to instill a sense of self-worth in nursing staff by letting them know they are valued and their efforts are appreciated. Leaders also need to emphasize the good their institutions do for their communities and make explicit the values on which their practices are based. PMID- 10126222 TI - On the right path. Collaborative case management makes nurses partners in the care-planning process. AB - The quality improvement movement in healthcare has given nurses a greater role in developing and implementing collaborative case management processes. In the case management model, nurses no longer simply take orders but actively participate in designing a plan of care. At Mercy Health Center, Oklahoma City, nurses play a leading role in the development of "clinical pathways," plans of care for a single diagnosis as directed by a specific physician or group of physicians. The pathways promote multidisciplinary, interdepartmental cooperation in patient care. Since August 1992, Mercy has developed clinical pathways for five inpatient and outpatient procedures, and more are being considered. Once a plan has been created, its key points are rewritten in lay terms and printed in a brochure for the patient. During the treatment, nurses and other healthcare professionals document when specific steps in the plan have been completed. In follow-up evaluations Mercy's steering committee for the collaborative care process has found that the clinical pathways have maximized quality, improved efficiency, increased patient satisfaction, and enhanced collaborative team practice. PMID- 10126223 TI - The pace of change. New roles and challenges redefine the nursing profession. AB - The speed at which a profession is changing can be gauged by the number of new roles its members play. By this measure, nursing has undergone a revolution over the past decade. Although nurses continue to devote much of their time to direct patient care, most of them also have roles as care planners, managers, educators, and even counselors. In many cases, moreover, nurses today do work and address problems that few would have identified as part of "nursing" 10 years ago. This photo essay presents three examples of nontraditional roles in nursing. PMID- 10126224 TI - Care of the dying: a Catholic perspective. Part IV: Theological, moral, and pastoral response--the transformation of suffering. Catholic Health Association. AB - People struggle to find meaning in suffering and death. In a culture that cannot depend on religious insights into suffering to address the deeper questions (e.g., Why me?), all kinds of interventions, even euthanasia and assisted suicide, may seem inevitable. Catholic healthcare providers can respond by offering patients, families, and care givers a vision of how suffering can be understood. Based on the power of divine love to transform suffering and death from absolute evils to personal triumphs, the moral principles the Catholic Church upholds can provide a hopeful perspective for healthcare professionals who care for the dying. Three principles support Roman Catholic teaching on conserving health and life: sanctity of life, God's dominion and human stewardship, and the prohibition against killing. These principles by themselves are insufficient as a moral or pastoral response to the care of the suffering and dying. Action is also required. Moral virtues must be reflected in ethical behavior and in pastoral practice so that we may enact our Christian vision in the face of suffering and death. Attention to our character as providers and our ethical practices is of grave importance in these days when euthanasia and assisted suicide are being promoted so aggressively. To carry on Jesus' healing mission by responding to human suffering and death, healing communities must embody virtues that bear convincing witness in both a personal and a corporate manner regarding the care of the dying. Three characteristics of a virtuous community stand out: interdependence, care, and hospitality. By being a virtuous community, we may be able to address many of the concerns that motivate people to consider euthanasia.(ABSTRACT TRUNCATED AT 250 WORDS) PMID- 10126225 TI - An investment in leadership. A system's three-year trainee program gives young executives a career head start. AB - The SSM Health Care System (SSMHCS), St. Louis, recently instituted a three-year leadership training program for new graduates in health administration. Participants spend one year in a rural facility, where they perform line and staff functions. They spend another year in a corporate staff role, gaining experience in areas such as finance, planning, marketing, human resources, mission and values, and regional operations. In the third year, participants concentrate on an area of their choice and begin to search for a permanent job within the system. SSMHCS sought candidates who: Were open to working in both urban and rural settings and were willing to relocate when necessary. Had the potential to move into a permanent managerial position within three years. Were willing to consider line and staff roles. Showed an interest and ability to work in the Catholic healthcare ministry. The advantage of the trainee program over traditional fellowships is that it gives the program participant a genuine start on a career rather than a mere extension of his or her education. For SSMHCS the opportunity to train young managers and administrators is an investment in the future. PMID- 10126226 TI - Marketing close to home. PMID- 10126227 TI - Saint Michael's Hospital. Employees benefit when mission effectiveness program focuses within. PMID- 10126228 TI - Gardeners versus mechanics: a case for primary care. PMID- 10126229 TI - Basic health benefits: deciding what to cover. PMID- 10126230 TI - Risk management in the Health Service. AB - Risk management is a relatively new concept in the National Health Service. David Bowden explains why, and describes what is being done to address this fundamental issue for all providers of health care. PMID- 10126231 TI - The changing role of CHCs (community health councils). AB - Peter Dunham and Sally Smith have experienced at first hand the changing role of community health councils and the opportunities that exist for collaborative working arrangements. Here, they define the progress that can be made in a relatively short period of time when empathy and trust exists between a CHC and its local health authority. PMID- 10126232 TI - Management ... working day of a health services manager. East Surrey Hospital and Community Health Services. AB - In common with many other trusts, East Surrey Hospital and Community Health Services is faced with a budget deficit that means staff redundancies are among the measures proposed to deal with it. For Gary Needle, Director of Service Development and Deputy Chief Executive, its back to the drawing board with the business plan -- but personnel issues and purchaser relationships need some careful handling. PMID- 10126233 TI - Professional autonomy and managed care in Dutch health centres: stakeholders' perceptions of a strategic option. AB - The on-going reforms of the Dutch health care systems call for the introduction of managed care elements. Health centres in the Netherlands already bear some resemblance to health maintenance organizations in the USA. However, managed care challenges provider autonomy, and the strategic development of managed care plans may be hampered by providers' perceptions. We draw a distinction between managed care within an insurance arrangement and managed care as a package of methods. Both options are evaluated as suitable for Dutch health centres, though with differences in terms of strategic logic and cultural fit. Lastly, some general conditions are formulated that should be considered before care management processes can be implemented. These include: specify clear objectives for introduction of managed care; strengthen corporate culture; develop internal motivation for change; develop a practice criterion with health centre professionals; reduce workloads in order to provide development time; and, promote better cooperation between general practitioners and specialists. PMID- 10126234 TI - Quality of care in decentralized primary care clinics: a conceptual framework. AB - In an attempt to provide high quality medical care, despite limited resources, health care providers in various countries have introduced decentralization into their health care services. It has been assumed that the delegation of authority to the local levels of the organization will enhance their ability to respond to local needs, and improve cost containment without compromising the quality of care. However, to date, few empirical studies have explored the relationship between decentralization and such projected outcomes. In this article we present a conceptual framework for analyzing possible consequences of decentralization on dimensions of quality of primary health care. We also suggest a framework for defining decentralization programs by their key components, and employ these frameworks to analyze a specific decentralization program being implemented in Israel's largest health maintenance organization (HMO). While we identify the dimensions most likely to be affected, we also conclude that data presently available do not permit a definitive prediction of whether the overall effect of decentralization on quality of care will be positive or negative. The potential reaction of a unit to the elements of change introduced by a decentralization program is influenced by the structural, cultural and management characteristics of that unit. Therefore, future attempts to decentralize health care organizations should be accompanied by close monitoring. PMID- 10126235 TI - Effects of payment changes on urgent/emergent admissions in rural and urban communities. AB - Reimbursement changes during the 1980s, particularly Medicare diagnosis-related group (DRG) reform and the growth of managed care, have squeezed hospital revenues available for cross-subsidizing care for uninsured patients and patients for whom marginal costs exceed marginal revenues. This study uses logistic regression with time and residence interactions to explore the impact of payment changes on rural versus urban patients' admission status (urgent versus nonurgent). Findings show that uninsured rural patients had a significantly higher probability in 1987 than they did in 1983 of being admitted to hospitals in an urgent/emergent condition. Findings also show incrementally higher probabilities for Medicare and Medicaid rural patients in 1987. Results are consistent with the view that cross-subsidization is no longer effective for covering uninsured rural care and that more direct subsidies may be necessary. PMID- 10126236 TI - The North Carolina obstetrics access and professional liability study: a rural urban analysis. AB - During the 1980s a rapid rise in the costs of malpractice coverage for obstetrical services caused many practitioners to stop delivering babies. Other factors also influenced the decision by physicians to exclude obstetrics from their practices, including: increases in malpractice claims made against obstetrical providers and the subsequent fear of being sued; closures of hospital obstetrics units; issues involving Medicaid; and the daily stresses inherent in providing obstetrical care. Rural areas were particularly vulnerable to these factors. North Carolina was not unlike other states in recognizing a severe drop in access to obstetrical services in many communities, and policies were proposed to address this problem through tort reform, malpractice subsidies, and Medicaid program expansion. The exodus of obstetrical providers seemed especially critical in rural areas, and this article presents a metropolitan-nonmetropolitan analysis of the results of a survey of all obstetricians and gynecologists active and licensed to practice in North Carolina. The analysis is focused on provider responses to proposed policies and also examines the clinical support networks for these physicians to determine if this might also be an area for future policy activity. Important differences were found between rural and urban providers in terms of intensity of obstetrical practice, adequacy of backup, Medicaid participation and caseload, ideas about tort reform, and recent changes in obstetrical practice. The results indicate that policies to increase demand or income can help solve the rural obstetrical access problem but that states should pay equal attention to the clinical support system for practitioners. PMID- 10126237 TI - Economic and health needs of Wisconsin migrant farm workers. AB - Migrant farm workers play an essential role in the planting and harvesting of crops in our agricultural production system. In the United States today, about 6 percent of the paid farm labor force "follow the crops" across the nation. This article reports on the economic and health care needs of migrant farm workers who travel from the border areas of Texas to Wisconsin each year. Surveys conducted in 1978 and 1989 show that this population remains in serious need of health care and access to financial assistance programs. During the 11-year interval between surveys, little change occurred in the health care status or use patterns of Wisconsin migrant workers, although housing and sanitary conditions in the work environment improved somewhat due to the passage of new federal regulations. This article discusses the problems and barriers that migrants continue to face and offers recommendations for government action. PMID- 10126238 TI - Stress and coping among Missouri rural and urban children. AB - A cross-sectional survey using a convenience sample of 157 Missouri rural and urban children (ages 8-13 years) yielded no significant differences in perceptions of stressors or use of coping strategies for dealing with those stressors between rural and urban children. The Feel Bad Scale and the Schoolagers' Coping Strategies Inventory measured the children's perceptions of stressors and use of coping strategies. Rural children experienced stressor levels equivalent to urban children, yet they were underserved in mental and physical health needs. The children studied reported self-care through coping strategies for management of their stressors. Longitudinal research is needed to identify the impact of stress and interventions on the health and behavior of children in rural settings. PMID- 10126239 TI - Health and well-being among rural Americans: variations across the life course. AB - This study uses data from the 1988 National Survey of Families and Households conducted by the University of Wisconsin to examine spatial variations in physical, mental, and social well-being among young, middle aged, and elderly American adults. Rural residents of all ages were found to consistently rate their physical health more poorly than nonrural residents. Both young and old rural adults also rated themselves less happy than nonrural residents. However, middle-aged and elderly rural residents appear better off on the majority of six other indicators of well-being, and this group reports the highest proportion of adults with no health impairments. Finally, rural residents of all ages possess distinct advantages in terms of several measures of social ties. PMID- 10126240 TI - Horizontal and vertical integration-diversification in rural hospitals: a national study of strategic activity, 1983-1988. AB - This study examines both the magnitude of and factors influencing the adoption of 13 horizontal and vertical integration and diversification strategies in a national sample of 797 U.S. rural hospitals during the period 1983-1988. Using organization theory, hypotheses were posed relating environmental and market factors, geographic location, and hospital characteristics to the adoption of horizontal and vertical integration and diversification. Results indicate that only one of 13 strategies was adopted by more than 50 percent of all rural hospitals during the study period, and that most of the directional hypotheses were not confirmed using Cox's proportional hazards models. In particular, environmental and market factors were unrelated to the strategies studied. Issues of methodology and theory are discussed; however, during an historically turbulent period, both relatively low levels of rural hospital strategic activities and lack of predictive power of the theory suggest caution in relying heavily on a policy for rural hospital survival that is dependent on individual market-oriented strategic behavior. PMID- 10126241 TI - Physician/hospital organizations in managed care contracting. PMID- 10126242 TI - The Fallon Healthcare System--its commitment to seniors. PMID- 10126243 TI - Managing risk in group practice. AB - As group practice confronts the threat of increasing competition, the prospect of health care reform, and the challenges of decreasing revenues and increasing costs, a reorientation in the management approach used by many groups must occur, writes Keith Korenchuk, J.D., M.P.H. Administrators must become proactive to manage the many risks confronting their groups. PMID- 10126244 TI - Employment discrimination and wrongful discharge. AB - The law and concepts applicable to the employment relationships between and within medical group practices have been evolving over a period of time in response to a number of factors. According to author David Yates, Esq., this evolution has been impacted by a revolution in the law applicable to employment relationships in general. His article is intended to help the administrator steer through this revolution. PMID- 10126245 TI - An overview of OSHA regulations. AB - While it is true that chances of an OSHA survey are low, OSHA representatives are placing top priority on employee complaints by investigating every one they receive. Author W.H. Heaton has learned from OSHA that employee complaints from medical practices are on the rise and describes in his article how to minimize group risk in this area. PMID- 10126246 TI - Protecting your group's financial assets. AB - On many occasions, groups overlook an important component of risk management, writes David Cooke, CPA, M.B.A. It's what accountants call internal controls, the processes specifically designed to minimize the risk of funds misappropriation and ensure accurate recordkeeping. Cooke explains how to put these controls into place. PMID- 10126247 TI - How a downsized computer produced upgraded results. AB - The gamble that a 16-physician primary care group could function on a PC-based system has paid off handsomely and promises to do so for years to come. The initial problems of our old system are well behind us. In bypassing the routine upgrade, we have scaled down to a new basic lower cost platform. The risks were substantial. The rewards were worth it. I still have trouble believing it works. We used to impress our colleagues and physician recruits with the sheer size of our computer system. Now we impress them by contrasting the old and new. The computer that occupies most of the room signifies are past. The personal computer is our future. PMID- 10126248 TI - New group formation and mergers. The qualification and implementation process. AB - Group practice formation and mergers can open a new--and sometimes very challenging--opportunity for the uninitiated, writes Robert Bohlmann, FACMGA. This article reviews the necessary steps for a successful merger or formation of a new group based on the collective experience of MGMA's Management Consulting team. PMID- 10126249 TI - Making accounts receivable analysis understandable. AB - Accounts receivable analysis is comprised of many factors which can often appear conflicting and confusing. S. Thomas Dunlap has developed a system that allows an administrator to get straightforward answers to this analysis problem which he describes in his article. PMID- 10126250 TI - Before you change the income distribution formula.... AB - Few issues get more attention in a group practice than physician income distribution, according to author Susan Cejka. With the growth in prepaid health plans, the need to restructure the compensation formula is greater than ever. Cejka's article describes how to successfully make these necessary adjustments. PMID- 10126251 TI - The 21 CFR (Code of Federal Regulations) online database: Food and Drug Administration regulations full-text. AB - The Code of Federal Regulations, Title 21 (21 CFR), contains the U.S. federal regulations for every product regulated by the Food and Drug Administration and Drug Enforcement Administration, including pharmaceuticals, veterinary products, medical devices, cosmetics, and foods. A new online database, 21CFR Online, now allows access to the full-text of these regulations as file CF21 on BRS and Data Star. In this article, the structure of the file is outlined; sample searches illustrate some of the features and content of the database. PMID- 10126252 TI - Death, dying and patients' rights. PMID- 10126253 TI - Caring for, not killing, an aging population. PMID- 10126254 TI - Euthanasia: an international perspective. PMID- 10126255 TI - Michigan legislature focuses on long-term care. PMID- 10126256 TI - Advocacy: it's what we do. PMID- 10126257 TI - Establishing community care networks. Affiliation benefits area residents. PMID- 10126259 TI - Shares of T2 Medical rise on buyout talk. PMID- 10126258 TI - On the edge of reform. PMID- 10126260 TI - Trustees vote to dismantle MetroHealth System merger. PMID- 10126261 TI - Boston hospitals, United HealthCare mull venture. PMID- 10126262 TI - Pa. governor submits healthcare legislation. PMID- 10126263 TI - As Clinton's plan gets prepped for the Hill, healthcare-reform sales job begins to coalesce. PMID- 10126264 TI - Clinton likely to blitz the public electronically. PMID- 10126265 TI - Kaiser's exemption questioned. PMID- 10126266 TI - Suit against NME dismissed. PMID- 10126267 TI - St. Luke's completes first phase. PMID- 10126268 TI - Idaho providers anticipate reform, discuss alliances. PMID- 10126269 TI - Mrs. Clinton launches salvo at providers. PMID- 10126270 TI - 3 Blues plans in Midwest envision merger to gain strength for reform. PMID- 10126271 TI - Battles expected in Senate over Medicare, Medicaid cuts. PMID- 10126272 TI - Hospitals ask managers to expand psych care to alternative settings. PMID- 10126273 TI - Provider groups entice independent practices through 'clinic without walls'. PMID- 10126274 TI - Businesses taking collective approach to cost containment. PMID- 10126275 TI - Partnership with physicians builds a sturdy foundation for hospital. PMID- 10126276 TI - City, system forge ahead on downtown complex. PMID- 10126277 TI - Premier to trim $50 million in Baxter purchases. PMID- 10126278 TI - Texas sets standard for not-for-profits. PMID- 10126279 TI - Moody's lowers ratings of five N.J. hospitals. PMID- 10126280 TI - Reports find charitable gifts to hospitals are on the rise. PMID- 10126281 TI - New York firm raises $15 million to buy stake in healthcare companies. PMID- 10126282 TI - Protocols tested for patients with HIV and TB. PMID- 10126283 TI - Groups eye likely reform components. PMID- 10126284 TI - Systems won't appeal blocked hospital swap. PMID- 10126285 TI - More partial programs available, but they're getting fewer patients. PMID- 10126286 TI - PACs boost gifts to congressmen by 36% in '91-'92. PMID- 10126287 TI - California plan hikes premiums, reduces payments to providers. PMID- 10126288 TI - HCFA audits of dialysis providers too lax--GAO. PMID- 10126289 TI - While a reform plan is still down the road, some managed-care firms are set to compete. PMID- 10126290 TI - AHA treads lightly in seeking law changes. PMID- 10126291 TI - White House Task Force considers hospital taxes. PMID- 10126292 TI - Reforming the system under such a deadline is perilous. PMID- 10126293 TI - Delivering corporate healthcare services. Companies are starting in-house medical clinics in efforts to save millions of dollars on their workers' healthcare bills. PMID- 10126294 TI - TB complicates how hospitals deal with AIDS. PMID- 10126295 TI - JCAHO establishes 'provisional' category. PMID- 10126296 TI - Methodist makes its peace with the tax man in Texas. PMID- 10126297 TI - More hospitals vie for foreign patients. PMID- 10126298 TI - Hospitals on road to data 'highways'. PMID- 10126300 TI - 2 St. Louis systems join after federal nod. PMID- 10126299 TI - Home-care franchises soar in popularity. PMID- 10126301 TI - Nurse, management shakeups hit Chicago. PMID- 10126302 TI - Study of Boston teaching hospitals 'flawed'. PMID- 10126303 TI - AHP agrees to settle 2 lawsuits. PMID- 10126304 TI - Healthcare Realty plans to raise $111 million through stock offering. PMID- 10126305 TI - AMA rips White House's liability plan. PMID- 10126306 TI - HCFA's boss says drastic new cuts could undermine reform. Interview by Lynn Wagner. PMID- 10126307 TI - RehabCare acquires management firm. PMID- 10126309 TI - Catholic Health Association. Bylaw change allows for-profits to join group. PMID- 10126308 TI - Survey to evaluate providers, 'health burden'. PMID- 10126310 TI - Columbia, Galen execs announce $3.2 billion merger that will form the nation's largest private chain. PMID- 10126311 TI - Outcry saves Medicare from full force of budget chopping. PMID- 10126312 TI - Hospital margins to plummet--analyst. PMID- 10126313 TI - Cost of Task Force unknown; best guess is about $1 million. PMID- 10126314 TI - NME, insurers break off settlement talks. PMID- 10126315 TI - Joint ventures. Collaborative push supersedes operators' ownership status. PMID- 10126316 TI - AHA trims another 42 positions. PMID- 10126317 TI - Home care shaping up as competitive necessity. PMID- 10126318 TI - Clinton aide discloses subsidy plan for teaching institutions. PMID- 10126319 TI - 3 Ohio Blues plans fight forced merger law. PMID- 10126320 TI - Hospital, manufacturer join forces to assess a 90-second blood test. PMID- 10126321 TI - Healthcare tops default list, but news is better between the lines. PMID- 10126322 TI - High court nixes back payment. PMID- 10126323 TI - Decentralized ORs report to service lines. PMID- 10126324 TI - OR exposure to electrosurgery smoke a concern. PMID- 10126325 TI - OSHA steps up action on waste anesthetic gases. PMID- 10126326 TI - Guidelines to address scope reprocessing. PMID- 10126327 TI - Nurse teams given authority to manage unit. PMID- 10126328 TI - Efficiency of evacuators depends on filtration system. PMID- 10126329 TI - Why we cannot agree on the direction of health reform: an exploration of American values. AB - Most of the articles in this series examine historical forces that have shaped American health care policy. This article will ask the reader to step back from the swirl of events that have led to a health care system that provides excellent care to many and minimal services to a substantial minority. The purpose of this article is to place often contradictory health policies within their philosophical context. Such an analysis can lead to an understanding of the reasons for the simultaneous appearance of both competitive and regulatory features in the American health care system. PMID- 10126330 TI - Clinical program renovation management. AB - The day-to-day management of medical practice is so heavily influenced by tactical imperatives that few physicians have the time to think strategically. Traditionally, the difference between tactics and strategy is not a major concern of most physician executives. The realm of tactics is the short run, when managers must make do with the fixed resources at hand. Strategy addresses the long run, when all resources and markets are variable. A tactical focus is understandable, maybe even acceptable, in industries where nothing challenges traditional approaches to production of an established product or service. However, medical care in the 1990s is changing so fast that a physician executive must devote an incredible amount of time and effort just to stay confused about what is going on. PMID- 10126331 TI - Moving from quality assurance to continuous quality improvement. AB - Though numerous proponents of the change from quality assurance (QA) to continuous quality improvement (CQI) have emphasized the drawbacks of the former and the advantages of the latter, there has been relatively little systematic consideration and comparison of the costs and benefits of each. A proper comparison is probably not possible, because the data seem to be lacking. Instead, much of the discourse has been based upon anecdotes, analogies from other industries, and unsupported assertions. This article grows out of a concern that, in making the switch from QA to CQI, we will discard or inadvertently lose much of value in QA and may not achieve many of the things that proponents expect CQI will accomplish. QA has served the health care field well. Its achievements ought to be preserved and built upon, not discarded. PMID- 10126332 TI - How physicians can create their future. AB - This article responds to the need for physicians to become proactive, using strategic planning to address changing conditions in the health care field. Strategic planning purposes are defined and a common process of strategic planning is presented. A case study analysis includes commentary on the need for planning, the context of planning in a larger system, process and procedure, a sample plan, benefits and actions to date, and future uses of the plan. Implications of this case of strategic planning for other physicians are discussed. PMID- 10126333 TI - Certain physician recruitment and retention activities found to be suspect. AB - A new "Fraud Alert" from the Office of Inspector General of the Department of Health and Human Services will cause hospitals to be especially circumspect in their dealings with actual and potential members of the medical staff. The authors analyze the alert and its potential impact on hospitals and physicians. PMID- 10126334 TI - But it has a CPT code. AB - In spite of ample evidence to the contrary, many health care professionals and others persist in believing that assignment of a CPT code signifies that a procedure is established as safe and effective. The author discusses why a CPT code should be viewed as signifying nothing other than the existence of the procedure. He also suggests that CPT codes should not be assigned until safety and effectiveness are ensured. PMID- 10126335 TI - MSO (medical services organizations)--the new new kid on the block? AB - In response to pressures on the practice of medicine, new practice management styles and organizations are being created to meet market demands. Managed care environments have encouraged the development of IPAs, closed panel HMOs, and other corporate structures to provide care for their patients. Early resistance of physicians to joining in administrative arrangements has now melted. Providers are beginning to adopt the philosophy of joining resources for survival and to improve market penetration. Physician executives must keep their minds open to the possibility that these provider-based organizations will occur even in the most unlikely places. PMID- 10126336 TI - Reducing health care costs: a case for quality. AB - Today, it is not quality or access but cost that has become the primary motivator for change in the U.S. health care delivery system. Cost, as the driver, has created a frenzy of nationwide activity, searching, examining, and testing any and all ways that offer promise of financial health care stability. And cost, not quality or access, is the principal motivator for the ever accelerating national health care policy debate. But there is a relationship between costs and quality that has to be addressed if quality is to be maintained. PMID- 10126337 TI - Quantitative evaluation of stance balance performance in the clinic using a novel measurement device. AB - This study was undertaken to test the clinical applicability of a novel device for measurement of stance balance performance. Samples were taken from hemiparetic patients (n = 27, age range 60-80) and of three groups of healthy subjects (24 subjects at ages 64-81, 13 at ages 27-50 and 24 aging 20-24 years). Stance was evaluated in six different positions incorporating two perturbing effects: visual deprivation and movements--linear and angular--of the base of support. Three variables were measured: sway and the values of the X and Y coordinates of the Center of Pressure. Concurrent validity of the system was assessed by comparing results with data of other works that tested comparable variables in similar populations and with already well established instrumentation. Repeatability of measurements was checked by performing all tests twice and comparing their results, as well as by calculating test retest reliability. The findings pointed to significant effects of vision and of movement of the base of support on sway, and to a significant difference between sway of hemiparetic patients and healthy subjects. The location of the COP in both the X and Y coordinates was not substantially influenced by the above effects. The agreement of the findings with existent knowledge indicates that the system is credible for measurement of body sway and of the location of the COP in various stance positions. PMID- 10126338 TI - The physiotherapist: appreciated but not well known. PMID- 10126339 TI - The lighter side of laser surgery. Sierra Nevada Memorial Hospital, Grass Valley, California. PMID- 10126340 TI - Consolidation brings identity crisis. St. Anthony's Health Center, Alton, Illinois. PMID- 10126341 TI - Helping consumers count the days. Community Health Systems, Inc., Jasper, Alabama. PMID- 10126342 TI - TB crisis. A neonatal intensive care nurse may have the disease. Albany Medical Center Hospital, New York. AB - Albany Medical Center Hospital's crisis team worked with state officials to keep parents, doctors, employees, press, and public informed until a neonatal intensive care nurse tested negative for TB. PROFILES shows you the press releases, press clippings, flow charts, in-house memos, letters to parents and physicians, and other documents that helped the hospital keep communication open. PMID- 10126343 TI - The insurance counselor is in. Crouse Irving Memorial Hospital, Syracuse, New York. AB - A New York hospital provides free medical bill assistance to anyone, saving clients money and building much goodwill. PMID- 10126344 TI - A match made in computers. Program invites nurses to design their ideal jobs. Albert Einstein Medical Center, Philadelphia. PMID- 10126345 TI - How to rest on your laurels. Not! Print ads and direct mail boost enrollment in hospital's PPO. St. Francis Hospital, Memphis, Tennessee. PMID- 10126346 TI - Letting the image do the talking. St. Vincent Infirmary Medical Center, Little Rock, Arkansas. PMID- 10126347 TI - Teaching employers to ask the right questions. Booklet helps hospital share quality and cost data. St. Joseph's Hospital of Atlanta. PMID- 10126348 TI - Shadyside makes room for money makers. Shadyside Hospital, Pittsburgh. PMID- 10126349 TI - Avoiding HMO liability for utilization review. AB - In this article, the author describes the potential liability of Health Maintenance Organizations for utilization review programs. Utilization review is used to determine whether certain medical treatment is necessary according to the standards of the HMO, and the HMO may decline to pay for treatments it deems unnecessary. If a doctor abstains from treatment because of this decision and the patient is harmed, the HMO may become the target of litigation. The author analyzes several recent cases and offers practical ideas for preventing and defending suits brought against HMO's for utilization review decisions. PMID- 10126350 TI - The Clinton health care plan: sound legislation or campaign rhetoric? PMID- 10126351 TI - Becoming politically active. PMID- 10126352 TI - Investing in our future. PMID- 10126353 TI - Health care reform for kids: why one size won't fit all. PMID- 10126354 TI - Medical accounts receivable--an underused asset for hospitals. PMID- 10126355 TI - Dialogue with the American people. PMID- 10126356 TI - An ounce of prevention ... saving lives and money with primary preventive care. Interview by Karen Gardner. PMID- 10126357 TI - Clinton's vaccine plan shifts from bold universal access to means testing. PMID- 10126358 TI - Clinton's master plan. Final decisions on health reform: how much it will cost and who pays. PMID- 10126359 TI - Money, Congress and health care. The medical industry wants a say in the coming debate--and is prepared to pay for it. PMID- 10126360 TI - Confidentiality. PMID- 10126361 TI - Access to MRI and cost containment. PMID- 10126362 TI - How to recruit and retain radiologic technologists. PMID- 10126363 TI - Interpreting the basic terminology & tenets of Medicare coverage policy. PMID- 10126364 TI - Radiology as a service. PMID- 10126365 TI - Developing a marketing action plan. PMID- 10126366 TI - Positive energy. Resurgens Orthopaedics, Atlanta, Georgia. PMID- 10126367 TI - Escalating risk: violence in the ED. PMID- 10126368 TI - Improved quality management of central lines demonstrates cost savings. PMID- 10126369 TI - Looking behind the outcome. PMID- 10126370 TI - Perspectives. In search of a malpractice cure. PMID- 10126371 TI - The ultimate system. PMID- 10126372 TI - "Getting better with information.". PMID- 10126373 TI - The purchaser's perspective. PMID- 10126374 TI - A member remembers: charter member Evelyn Vrendenburg Ryerson recalls early days. PMID- 10126375 TI - Reaching guidance counselors. PMID- 10126376 TI - Patient-focused redesign. PMID- 10126377 TI - The health information manager of the years 1993 to 2000. AB - With the introduction of the computer-based patient record, the role of "medical record director" will be changed to that of "health information manager." This piece argues that health information managers, as a result of their education and experience, are the most qualified to serve as administrators of the data banks that the new technologies will require. PMID- 10126378 TI - Coding, documentation and dollars. AB - Physicians would like to get reimbursed for the services they perform. Unfortunately, many of them are not very good at documenting what they do. The result is that physicians are being reimbursed far less than what they should be or are being asked to refund reimbursement for services they cannot substantiate. The financial impact to the physician's practice can be enormous. For many years, physicians have viewed HIM professionals as adversaries. There now exists the opportunity for HIM professionals to become allies with physicians by helping them obtain and maintain the reimbursement they are entitled to. Physicians have the need, and HIM professionals have the knowledge and skill. It is up to our profession to show them what we can do. PMID- 10126379 TI - "Building the infostructure"--a partnership. PMID- 10126380 TI - Managing the business of ambulatory care: the impact of reimbursement systems on hospital operations. PMID- 10126381 TI - Freestanding ambulatory surgery centers: a survey on health record practices and the utilization of credentialed health information management professionals. PMID- 10126382 TI - A meeting of the mindsets: chart completion vs. clinical pertinence. AB - The authors describe their hospital's success in addressing a delinquent record crunch. As a result of its program, the hospital reduced accounts receivable by 45 percent. PMID- 10126383 TI - Principles of patient-focused care. AB - The kind of improvement our health care system requires cannot be obtained by isolating a redesign initiative to any one of the patient-focused care principles. We need a more comprehensive effort that understands the complex interrelationships between the principles. This type of integrated strategy can reap enormous benefits, and it holds the key to addressing complex and profound deficiencies in the traditional operational and organizational structures of our health care institutions. PMID- 10126384 TI - Overcoming the barriers to implementing patient-focused care. AB - Potential barriers to implementing PFC sometimes seem enormous. Instead of orienting toward problems associated with implementing PFC, we can eliminate some of the barriers simply by focusing on and pursuing the ideal, "the seamless patient care experience." Fundamentally improving our health care delivery systems is not really a strategic option. It is our responsibility. We must do things better, faster, with more compassion, and at less cost. What evidence will demonstrate that your organization is becoming more patient-focused? Patients will not be inconvenienced because of "how the system works." They will consider your organization "best in class." They will know that the hospital's medical care and services will meet or exceed their expectations. Physicians and staff will feel more highly valued by the organization. Management empowers them by improving the systems they must use, providing ongoing training, and decentralizing the authority they need to deliver excellent medical care and satisfy patients' personal needs. Communication improves vertically and horizontally throughout the organization. The hospital becomes increasingly attractive to employers and HMOs. Reengineered processes result in increases in productivity. Better patient outcomes, at less cost, can be demonstrated. Occupancy rates stabilize or grow, utilization is carefully managed, and improvements in the bottom line strengthen the organization. How do we make these visions a reality? By committing to PFC and getting started right away. Just as "quality" is multidimensional, so must be our operating strategy. Patient-focused care is the model that will redefine the future of health care. PMID- 10126385 TI - The relationship between innovation and continuous improvement. PMID- 10126386 TI - Reengineering and networks: a critical combination for health care systems. PMID- 10126387 TI - Applying industrial reengineering techniques to health care. PMID- 10126388 TI - Case study. Mary Hitchcock Memorial Hospital. PMID- 10126389 TI - Case study. Abbott Northwestern Hospital. AB - Abbott Northwestern hopes to continue learning and sharing its lessons as the teams execute their plans. The results of Innovation are expected to include the following: Improved care for patients and their families. Improved working environment for employees. Improved service to other customers' needs. Improved operating costs. The hospital further expects to begin showing tangible results within the next year. Achieving these results requires implementation, and the implementation details are currently uncertain. Like an explorer crossing an uncharted ocean, Abbott Northwestern does not know exactly where and how it will land on the other shore, but it is surely committed to getting there. Having this chance to make a such a journey is frightening for most of those involved. For some, it is fear of the uncertainty of change, while for others, it is the fear of losing the comfort of the present system. And still others of us fear that we may not reach as far as we can. PMID- 10126390 TI - Case study. Northwestern Memorial Hospital. PMID- 10126391 TI - Women ready to bring excellence to CEO role. PMID- 10126392 TI - Mediation in labour relations. AB - The authors explain the concept of mediation, outline the mediator's multiple roles in resolving labour-relations disputes, and advocate the use of an innovative technique known as "Med-Arb". The latter combines mediation and voluntary arbitration in resolving collective bargaining impasses. The success of Med-Arb mediation depends upon the dispute's context, the history of past labour relations, and the mediator's expertise in employing suitable strategies. The authors also advocate further research into mediation and its relevance to the health care sector. PMID- 10126393 TI - Implementing QA in a rural setting. AB - This article examines the development and implementation of a quality assurance (QA) and risk management program in a small rural facility. The author reviews the literature on management techniques, outlines the development of a program in a health district in rural Manitoba, and refers to Wilson's Adult Learning Model and Lancaster's seven elements for staff motivation. An example of program standards is provided, as is a chart showing the relationships among the facility's QA committees. PMID- 10126394 TI - On the road to TQM: a new compensation model. AB - University of Alberta Hospitals, on its path toward an environment of total quality management (TQM), unexpectedly found itself addressing the issue of management compensation. As managerial staff from several departments became involved in the TQM initiative, it became clear that the hospital needed a unified approach to compensation. A committee, formed to investigate methods of appraisal and compensation, recommended a "competency modelling" approach developed by a management consulting firm. PMID- 10126395 TI - Focus on risk management. AB - With the Canadian Council of Health Facilities Accreditation's introduction of new standards on risk management in 1991, many health care facilities in Canada are re-evaluating their risk-management programs. This article outlines how Toronto's Mount Sinai Hospital established new objectives and developed administrative structures to consolidate and improve its risk-management practices. PMID- 10126396 TI - Sexual minorities seek responsive care. Interview by Matthew D. Pavelich. PMID- 10126397 TI - The role of the board in quality improvement. The Centre for Quality in Government. PMID- 10126398 TI - Cost benefits of the human resource department. PMID- 10126400 TI - New MSDS (material safety data sheets) format could make safety data easier to understand. PMID- 10126399 TI - Continuous quality improvement revisited. AB - The author re-examines the appropriateness of continuous quality improvement (CQI) management techniques in health care with reference to the stability of North America's work force, staff's difficulty in balancing new responsibilities with everyday tasks, the need to adjust after major change, the real value of group decision making, the proper use of analytical tools, the validity of "meeting customer expectations", cultural inconsistencies in evaluating CQI programs, and the tendency to focus on management techniques instead of larger issues in times of crisis. The author concludes that the health care field can utilize CQI most effectively by integrating its techniques into societal and organizational cultures. PMID- 10126401 TI - Minority purchasing program aims to strengthen community ties. PMID- 10126402 TI - Breaking away from on-the-job stress. PMID- 10126403 TI - 12 steps to EDI's (electronic data interchange) full advantages. AB - Only 50 hospitals in the United States are fully EDI-capable; the rest miss out on many benefits. Here's how to claim some of those benefits for your own health care facility. Plus, how bar codes have changed one hospital's way of doing business. PMID- 10126404 TI - Microsurgical instrument systems promote handling with care. PMID- 10126405 TI - Two hospitals switch purchasing strategies, for similar results. PMID- 10126406 TI - National Practitioner Data Bank; change in user fee--HRSA. PMID- 10126407 TI - Medicare program; fee schedule for physicians' services for calendar year 1993- HCFA. Correction of final notice with comment period. AB - This document corrects technical errors that appeared in the final notice with comment period published in the Federal Register on November 25, 1992 (57 FR 55914) entitled "Medicare Program; Fee Schedule for Physicians' Services for Calendar Year 1993." PMID- 10126408 TI - Recommendations for improving resident assessment. MDS (Minimum data set) revisions essential for computerization. PMID- 10126409 TI - Retirement community: the impact of low interest rates. A bust, not a boon, for many. PMID- 10126410 TI - Are ethics committees necessary? AB - Should long-term care facilities have an ethics committee? If so, why, and what are its responsibilities? PMID- 10126412 TI - The top 50 retirement housing communities. PMID- 10126411 TI - Assisted living reigns. AB - The opinions of 27 industry leaders in the proprietary and nonprofit sectors of the retirement housing business who are involved with the development, marketing, management, financing and delivery of health care provided important contributions to the 1993 State of the Senior Housing Industry Report. Participants on the Senior Housing Industry Advisory Panel are identified on page 99. Their insights and opinions form the basis for this industry evaluation. While this report represents a general consensus of opinions from the industry panelists, in reviewing this material one should consider these comments within the context of local market conditions and individual investment criteria. PMID- 10126413 TI - 1993 architectural design awards. AB - The 10th annual architectural design awards sponsored by Contemporary Long Term Care salute nursing homes and retirement communities that combine a flair for innovative living environments with a sensitivity to the needs of aging residents. These facilities represent the very best in elderly housing that prolongs independence while enhancing efficient operation. The 1993 winners are: King Health Center, U.S. Soldiers' and Airmen's Home, Washington, DC; The Terrace of Los Gatos, Los Gatos, CA; Walker Elder Suites, Edina, MN; The Jefferson, Ballston, VA; The Forum at Rancho San Antonio, Cupertino, CA. PMID- 10126414 TI - Back to basics. An inside look at care planning. PMID- 10126415 TI - Hostess programs that work. PMID- 10126416 TI - Healthcare foodservice report 1993. Getting ready for reform. Interview by Mitchell Schechter. AB - Hospital foodservice directors & dietitians are facing the greatest challenge of their careers -- to prepare, along with their institutions, for the most thoroughgoing reform of America's healthcare system ever proposed. Healthcare institutions across the country are seeking the means to offer enhanced patient services & gain competitive advantages by forming new alliances, new patient centered care systems & cost-reduction programs. To aid in these efforts, their foodservices are developing comprehensive cross-training schemes, inter departmental teams with other service groups & new ways to cut operating subsidies. Here's how five hospital foodservice departments are using cost controls, revenue building, quality management processes & enhanced efficiencies to help their institutions prepare for the changes ahead. PMID- 10126417 TI - Hospital-health and fitness centers promote wellness. PMID- 10126418 TI - Florida adopts a managed competition state system. PMID- 10126419 TI - Maryland requires carriers to provide coverage to all. PMID- 10126420 TI - Wash. steps up physician recruitment under reforms. PMID- 10126421 TI - Collaboration: choosing the right model and right structure. PMID- 10126422 TI - Investor-owned hospitals a buy. PMID- 10126423 TI - Reform brings opportunities for restructuring hospital systems. Interview by Donald E. Johnson. AB - Donna Shalala, Health & Human Services secretary, approved Oregon's Medicaid reform plan which will reduce the cost of health care services to the poor while expanding access to the state's 120,000 uninsured residents. Health coverage will not be provided for Oregonians below the federal poverty level who currently don't receive any Medicaid benefits. Health Care Strategic Management publisher and editor Donald E. L. Johnson and John King, president and CEO of Legacy Health System, Portland, discuss the ramifications of the Oregon Plan and the opportunities it provides for Oregon hospital systems. PMID- 10126424 TI - JCAHO's 1994 Standards Manual will feature quality refocus. PMID- 10126426 TI - Hospitals change their way of doing business. PMID- 10126425 TI - Policies and procedures that hinder efficiency. PMID- 10126427 TI - Assessing your technology needs. PMID- 10126428 TI - Maintaining service levels with fewer employees. PMID- 10126429 TI - Mortality rates within 360 days of admission to Medicaid reimbursed long-term care services. AB - Current long-term care (LTC) initiatives in many states are aimed at reducing cost by diverting certain members of the long-term care population into more cost effective home and community-based care. To date, very little has been done to monitor the subsequent mortality rates in these care situations. This project reports that approximately 35% of the individuals in a single admission cohort to Medicaid-reimbursed LTC in Virginia died within 360 days of their initial admission. When the data are separated by intermediate versus skilled levels of care and institutional versus community-based care settings, substantial differences in mortality rates between levels of care and care settings can be observed. PMID- 10126430 TI - Problems encountered in home health service delivery to persons with AIDS. AB - This paper discusses the problems encountered in delivering home health services to persons with AIDS (PWAs), based on telephone interviews conducted with administrators of 68 home care agencies located in 10 high AIDS prevalence areas nationwide. Lack of adequate insurance mechanisms was cited as a major barrier to serving PWAs. Some respondents indicated a greater potential for stress among staff treating PWAs, given the youth of this population, the intensity of illness manifestations, and the complexity of treatment regimens. Other difficulties that are especially prevalent among PWAs include the absence of informal caregivers, residence in unsafe areas, and patient and family drug abuse. Although many of the reported patient problems are not unique to PWAs, the frequency with which they occur in this population suggests a need for expanded public and private insurance coverage for custodial care, and for expanded availability of AIDS specific housing, if excessive hospitalization is to be avoided. PMID- 10126431 TI - Home care is where the heart is: the role of interpersonal relationships in paraprofessional home care. AB - While the provision of an adequate floor of wages and benefits for paraprofessional workers in the home care component of our long-term care system is desirable, efforts to provide it are curtailed by cost constraints. As a result, other factors which encourage the retention of an adequate home care workforce are all-important. Findings from a study of a representative sample of 487 paraprofessional home care workers in New York City indicate that the ability to develop close interpersonal relationships with home care clients and their families is one of the most attractive and rewarding aspects of the work. It is suggested that agencies focus on their roles in providing an optimum environment for the development of such relationships. PMID- 10126432 TI - Running as fast as they can: organizational changes in home health care. AB - During the 1980s, as the health care industry experienced what observers have dubbed a revolution, the home health industry also experienced its own transformation. Utilizing three organizational theories (neoinstitutional, resource dependency and population ecology), the authors report on a study of a probability sample of 163 home health agencies (HHAs) that were interviewed in 1986 and again in 1987 on the effects of Medicare policy changes including prospective payment (DRGs). This study tests hypotheses concerning the influence of environmental factors (e.g., state policy and characteristics of the local market) and organizational characteristics of the HHA (e.g., tax status and Medicare reliance) in explaining the propensity of HHAs to be (or become) parts of chains and/or multi-facility systems; and to develop particular types of interorganizational relations. The paper discusses the results in the context of public policy changes and the implications for future research and practice. PMID- 10126433 TI - Long term care arrangements for elderly persons with disabilities: private and public roles. AB - When private resources are defined broadly to include informal care as well as private expenditures, 73 percent of the elderly long term care population rely entirely on private resources for their care. The emphasis of current programs on institutional care directs public resources toward those with more serious disability and less family to care for them. Among those with four or five disabilities in ADLS, 35 percent of those without a spouse or children currently receive no public support, compared with nearly 80 percent of those with both a spouse and children. Thus, even if restricted to seriously disabled persons, a new program expanding public long term care financing would increase eligibility for public benefits disproportionately among those with greater informal care resources. PMID- 10126434 TI - Medicare home health reimbursement alternatives: access, quality, and cost incentives. AB - This paper presents a conceptual analysis of access, quality, and cost containment incentives created by several current and potential Medicare reimbursement methodologies. The alternatives examined are methods used by health maintenance organizations (HMOs) and three options receiving national policy consideration: prospective per-visit and per-episode payment, and "bundling." The analysis found better incentives (from a policy perspective) for HMOs with integral home health units than for HMOs using outside contractors. Of the other options, per-episode payment appeared most promising, but requires accurate case mix adjustments. All approaches also require quality assurance tailored to reimbursement incentives. Topics for further research and demonstrations are suggested. PMID- 10126435 TI - Personal response systems: an international report of a new home care service. Proceedings of First International Symposium on Emergency Response Services for Frail Persons Living Alone, held in Washington, DC, May 31-June 2, 1990. PMID- 10126436 TI - From alarm systems to smart houses. AB - The percentage of senior citizens in the Netherlands will rise in coming years. The expected percentage for the year 2010 of persons over age 65 in the total population is 15%. More persons over age 65 than ever before will continue to live in their own environment. Emergency response systems (ERS) can support independent living. The most common type of organization distributing ERS is a small, partly subsidized local alarm organization run by a social welfare office for the elderly. Government subsidy has been reduced in recent years which has motivated small organizations to join together into larger regional organizations in order to get a more solid financial base. On the other hand new semi commercial and commercial organizations have come into being. These developments are part of the growing importance of home care, leading to more medical applications of ERS. User satisfaction with ERS is high. Portable triggers can enhance the effectiveness of the system. However, many users do not wear the portable trigger when feeling well. Future technical developments will result in multifunctionality of ERS-devices. In the long term the hardware of today will be integrated in a multimedia home terminal replacing the telephone. The portable trigger will remain the only specific hardware at home for ERS. PMID- 10126437 TI - Mid-range technology: a New Zealand perspective. PMID- 10126438 TI - Community alarm systems in Scotland. PMID- 10126439 TI - Local authority and housing association perspectives on ERS in the United Kingdom. PMID- 10126440 TI - Alarms and telephones in emergency response--research from the United Kingdom. PMID- 10126441 TI - Community alarm systems. PMID- 10126443 TI - Public financing for personal response systems: a Federal viewpoint. AB - In sum, advocates for ERS have not made an overwhelmingly compelling case for ERS, on cost or human terms--why is it necessary that government explicitly cover ERS? Moreover, it is essential that advocates mobilize in the states and build allies, particularly in the LTC community. PMID- 10126442 TI - Personal response systems in the United States. AB - In summation, although Personal Response Systems are relatively new in the marketplace they have made tremendous inroads over the past fifteen years. The next decade presents some difficult problems for this country in terms of its aging population and the delivery of quality, cost effective health care to all who need it. In light of these problems, the PRS industry can offer viable solutions-solutions for the U.S. health care system in helping to control and reduce the cost of health care delivery; solutions for industry in attempting to meet their employee health care needs; solutions for families who are coping with the strains of eldercare; and most important, solutions for many people who, regardless of age, could not live independently without a Personal Response System. PMID- 10126444 TI - ERS as a community outreach service from a nursing home. PMID- 10126445 TI - Product design and social implications in a personal response program. PMID- 10126446 TI - Personal response services present and future. PMID- 10126447 TI - Services for the Danish elderly: the role of technical aids. PMID- 10126448 TI - General and specific aspects of emergency response systems in Denmark. PMID- 10126449 TI - Emergency response systems--the Canadian perspective. PMID- 10126450 TI - Structure, aims and prospects of PRS in Germany. AB - The development of ERS as an offering in the outpatient services sector is based on the consideration that the proportion of elderly people in the total population has enormously increased during the last few years and will continue to increase until the year 2000. Besides the necessary inpatient institutions, it is absolutely necessary to offer outpatient services to meet the needs and requirements of elderly, sick and handicapped people. This is also intended by the legislative bodies which have established by law the priority of outpatient services. ERS represents an important element of this general conception. One cannot do this without high quality standards. Furthermore, ERS must always be offered in connection with other outpatient social services. PMID- 10126451 TI - Emergency response systems in Israel. PMID- 10126452 TI - Recent trends of ERS in Japan. PMID- 10126453 TI - Drug and therapeutics committees: the relationships among structure, function, and effectiveness. AB - Reported are the results of a national study of Australian hospitals that assessed the effectiveness of drug and therapeutics committees (DTCs), identifies factors that influence effectiveness, and recommends methods to improve effectiveness. Data were collected by questionnaires sent to 184 hospital directors of pharmacy and a subset of 53 chairpersons of DTCs. Response rates were 88.6% and 84.9%, respectively. Membership, chairperson, secretary, meeting frequency, and decision-making functions were analysed by hospital bed numbers and compared with standard accepted literature criteria and previous study findings. A comparison of pharmacist and chairperson perception as to the weakest aspect of DTCs in attaining rational therapy revealed widely differing views, based on factors outside respondents' own control. Perceptions of resources required to overcome DTC weakness also varied between the two groups. No statistically significant association was found between the assessment of outcome of DTC activities (influence on pharmacy management, hospital policy, medical management, and prescribing) and structural variables such as DTC objectives, chairperson, reporting relationship, meeting frequency, and hospital size or type. The results challenge widely held assumptions of the association between DTC effectiveness and structural variables. Further study of structural and cultural variables, which might determine effectiveness, is required. PMID- 10126454 TI - Theory and analysis of typical errors in a medical setting. AB - Medical error is not a medical but rather a behavioral matter. In this article, the differences between errors and accidents are discussed in a theoretical manner. A discussion of some useful taxonomies is followed by suggestions on how to talk about an error. In brief, one must distinguish between the "mode" of a particular error (whether, for example, it is an omission or a substitution), the "expression" of the error (what is actually done in the work environment), and the "consequence" of the error (accident or discovery). Finally, there are suggestions about what can be done about errors and accidents. Some remedies are behavioral and depend on training in self-detection of error. Others depend on changes in the engineering and design of medical systems. The use of controlled vocabulary in prescription writing and in the communication of medical orders is strongly recommended. PMID- 10126455 TI - Assessing physician variability in parenteral nutrition orders given a set of patient parameters as a means of determining educational needs. AB - Diversity of physician training and experience results in variability of physicians' assessments of total parenteral nutrition needs for patients. The Surgery, Medicine, and Medicine Intensive Care team members at the Walter Reed Army Medical Center, Washington, DC, were asked individually to prescribe a parenteral nutrition order for a hypothetical patient with a given set of characteristics and laboratory parameters. The parenteral nutrition order form used provided the options of individualized or standardized total nutrient admixture/peripheral parenteral nutrition formulas. The variability of these orders was assessed and used as a basis for medical team education and individual prescriber counselling. PMID- 10126456 TI - Health reform costly to hospital pharmacies. PMID- 10126457 TI - Parenteral nutrition monitoring in hospitalized patients. PMID- 10126458 TI - Scientific and technical intelligence: the key to R&D. PMID- 10126459 TI - Brand management: only the strong survive. AB - Competition, consolidation, and couponing have made consumers savvier and brand loyalty shakier. As a result, nurturing the all-important brand demands a new level of creativity and an increased attention to strategy. Often it means a closer look at logos and package design. PMID- 10126460 TI - Productivity in the '90s. Lessons from the assembly line. AB - Defining the right product at the right moment is important. But how long it takes to develop and introduce that product can have a dramatic impact on both customer satisfaction and ROI. Here's a metaphorical approach to streamlining the process. PMID- 10126461 TI - Productivity in the '90s. Up and running. AB - When it come to building new facilities, time is money. Delays cost dollars, blunt your competitive edge, and leave you with a building that's obsolete before it opens. Here's how to use functional programming, process-oriented teams and good planning to keep your project on track and your company on budget. PMID- 10126462 TI - Productivity in the '90s. The outsourcing source book. AB - Why has outsourcing become a corporate litmus test? Is it the right move for your company? Who's doing it -- and why? Is it both efficient and cost-effective? How should you structure an outsourcing agreement? Here are some answers -- and a lot more questions to ask before you embark on an outsourcing adventure. PMID- 10126463 TI - Hikes reported in glove prices. PMID- 10126464 TI - Vanderbilt's rich stockless contract up for grabs. PMID- 10126465 TI - Recycling, long-term contracts paying major dividends for Toronto hospital. PMID- 10126466 TI - Purchasing differs at vertically-integrated hospital system. PMID- 10126467 TI - Hospitals attack mounting radiology expenses. PMID- 10126468 TI - Management key to cutting forms costs. PMID- 10126469 TI - Third-wave organizations: cross-functional teams and workplace democracy increase productivity and satisfaction. PMID- 10126470 TI - Managing diverse workforce will be essential in "rainbow" workplace. PMID- 10126471 TI - Leaders' guide to fostering enrollment and commitment. PMID- 10126472 TI - Using standard treatment protocols to manage costs and quality of hospital services. AB - The current health care environment has made it critically important that hospital costs and quality be managed in an integrated fashion. Promised health care reforms are expected to make cost reduction and quality enhancement only more important. Traditional methods of hospital cost and quality control have largely been replaced by such approaches as practice parameters, outcomes measurement, clinical indicators, clinical paths, benchmarking, patient-centered care, and a focus on patient selection criteria. This Special Report describes an integrated process for strategically managing costs and quality simultaneously, incorporating key elements of many important new quality and cost control tools. By using a multidisciplinary group process to develop standard treatment protocols, hospitals and their medical staffs address the most important services provided within major product lines. Using both clinical and financial data, groups of physicians, nurses, department managers, financial analysts, and administrators redesign key patterns of care within their hospital, incorporating the best practices of their own and other institutions. The outcome of this process is a new, standardized set of clinical guidelines that reduce unnecessary variation in care, eliminate redundant interventions, establish clear lines of communication for all caregivers, and reduce the cost of each stay. The hospital, medical staff, and patients benefit from the improved opportunities for managed care contracting, more efficient hospital systems, consensus-based quality measures, and reductions in the cost of care. STPs offer a workable and worthwhile approach to positioning the hospital of the 1990s for operational efficiency and cost and quality competitiveness. PMID- 10126473 TI - Building a strategic technology management program. AB - Strategic technology management decisions are one of the best opportunities for healthcare providers to positively meet clinical needs, patient expectations and competitiveness goals. Technology management must not be treated as an event (annual capital budgeting) but as a well-thought-out, long-range business plan. A strategic technology management team should be formed that includes all the key strategic business areas, plus ad hoc members from the clinical and biomedical engineering areas. Current and future needs should be assessed and the performance of the plan monitored. A plan will help achieve buy-in from clinicians and reduce unwarranted expenditures on technology. PMID- 10126474 TI - Options in information systems outsourcing. AB - Virtually any of the activities required to operate a hospital's information systems department can be outsourced, that is, performed by an outside firm. Outsourcing can be used as a business strategy to optimize resources to attain financial, tactical and strategic goals. Benefits include a smaller IS staff, reduced overhead and cost avoidance particularly in the area of capital equipment purchasing. However, outsourcing IS is not without risks and is not a panacea. It may even bring on its own challenges, particularly in managing expectations of in house personnel. Risks include loss of control, vendors with little or no experience with the hospital's operations and culture and dependence on vendors when in-house personnel cannot adapt. IS outsourcing hasn't got as much of a track record in health care as in other industries, but with the growing cost and complexity of hospital IS operations, outsourcing seems inevitable. PMID- 10126475 TI - Outsourcing data processing: planning for the disentanglement. AB - Outsourcing data processing operations may be considered a conventional acquisition transaction between a customer and supplier. The most distinctive feature of a DP outsourcing contract is that it involves complex issues relating to computer software and technology and, frequently, intense issues relating to employees. But, one must do more in order to provide for preservation of the integrity (and, therefore, the value) of the data center. The contract must include not just the sale of a facility to a supplier who will take over the operations, but also terms for reconveying the facility at a future date. Getting out of the arrangement can be very complex. Disentanglement can be made less complex however, if the customer and the supplier negotiate all or part of the disentanglement procedures during the original contract proposal. Know ahead of time the possible scenarios for when disentanglement may take place and know what to do during the contract negotiations and during the length of the agreement to keep track of each other's properties. Know also the risks involved in outsourcing DP operations, such as what happens when the supplier's business fails. Having the supplier set up a separate profit entity for your contracted business or using a lien on the data center properties may help avoid loss if such failure occurs. PMID- 10126476 TI - Breast pumps. ECRI. PMID- 10126477 TI - The continuous improvement-focused quality improvement plan. AB - The QI plan of a department or functional area is a statement of philosophy about quality improvement and a guide to doing quality improvement. In that sense, the QI plan is both a roadmap and a description of the journey. The form of the QI plan varies by organization and is a reflection of the individual style of the organization. The substance of the plan is important. QI plan developers who consider structure, process and outcome will generate a viable document that supports meaningful quality improvement. PMID- 10126478 TI - Dying patients: ethical issues and management perspectives. PMID- 10126479 TI - OSHA and the decontamination area. PMID- 10126480 TI - Scoring guidelines addressing smoking policy for the AMH, (Accreditation Manual for Hospitals). Volume II. Joint Commission on Accreditation of Healthcare Organizations. PMID- 10126481 TI - Scoring guidelines addressing smoking policy for the AMLTC, (Accreditation Manual for Long Term Care). Volume II. Joint Commission on Accreditation of Healthcare Organizations. PMID- 10126482 TI - We're the measurement people. PMID- 10126483 TI - Emergency power standards revised in most manuals. PMID- 10126484 TI - Documentation of fire drills simplified in AMH (Accreditation Manual for Hospitals). PMID- 10126485 TI - Home infusion therapy indicators must be considered. PMID- 10126486 TI - Taxation, regulation, and addiction: a demand function for cigarettes based on time-series evidence. AB - This work analyzes the effects of prices, taxes, income, and anti-smoking regulations on the consumption of cigarettes in California (a 25-cent-per-pack state tax increase in 1989 enhances the usefulness of this exercise). Analysis is based on monthly time-series data for 1980 through 1990. Results show a price elasticity of demand for cigarettes in the short run of -0.3 to -0.5 at mean data values, and -0.5 to -0.6 in the long run. We find at least some support for two further hypotheses: that antismoking regulations reduce cigarette consumption, and that consumers behave consistently with the model of rational addiction. PMID- 10126487 TI - Uncertainty and health care spending by the poor: the health capital model revisited. AB - This short theoretical paper examines health care utilization by the poor in the context of Grossman's (1972) health capital model. Earlier work has shown that uncertainty can reduce the attractiveness to the poor of health capital investments. This paper demonstrates that uncertainty can also have precisely the opposite effect. That is, while there may be cases in which it is excessively risky for the poor to invest in their health, there may also be cases in which the poor can ill-afford the risks that arise from not making timely investments in their health. PMID- 10126488 TI - Discounting health increments. PMID- 10126489 TI - On what basis should health be discounted? AB - The discount rate to be applied in health care programmes should be based on the time preference rate for health, and this same rate should be applied to costs as well. Due to the limited tradeability of health, when eliciting its time preference rate, the intertemporal choices must be framed in such a way as to resemble as closely as possible those facing health planners and decision makers. PMID- 10126490 TI - A theory of hospital waiting lists. AB - The noncooperative character of resource allocation in a national health service may contribute to excessive waiting lists. A theory of hospital waiting lists is derived from this idea. Waiting lists imply loss of efficiency; the hospital's resources are drawn away from medical work. Although there is scope for Pareto improvements, the structure of budget allocation may prevent these improvements from being achieved. Some reforms of the institutional structure are suggested. PMID- 10126491 TI - Heart transplantation in the Netherlands; costs, effects and scenarios. AB - The Dutch heart transplantation programme was subjected to a prospective economic evaluation and costs and effects with or without such programme were estimated. The no-programme estimates were derived from pretransplant patient data. Future projections of both options were based on micro-stimulation using additional data on severe heart disease prevalence and on multi-organ donation. Costs per life year gained are estimated at NLG 57,650 (quality adjusted: NLG 71,900). Sensitivity analysis showed these results to depend highly on long term incidence of costs and on quality of life after transplantation. PMID- 10126493 TI - Considering ER medicine? Read this first. PMID- 10126492 TI - Willingness to pay for antihypertensive therapy--further results. AB - A measurement experiment regarding willingness to pay for antihypertensive therapy is reported. A new type of binary willingness to pay question is used, that allows for different degrees of certainty with respect to the responses. Mean willingness to pay is derived from a simple expected utility model and estimated using maximum likelihood methods. The estimated parameters are highly significant, with predicted signs, and imply a mean willingness to pay of about SEK 800 ($130) per month. The explanatory power of the equation that only includes 'certain' yes/no responses is, as expected, much higher than that of the equation where only 'uncertain' responses are included. PMID- 10126494 TI - Will bad times be good for organized medicine? PMID- 10126495 TI - RBRVS has broken its promise to rural medicine. PMID- 10126496 TI - Is this the salvation of private practice? PMID- 10126497 TI - Will the Clinton plan end your malpractice woes? PMID- 10126498 TI - Comparison-shopping comes to medicine. PMID- 10126499 TI - I give Medicaid patients an ultimatum. PMID- 10126500 TI - This doctor's insurers left him hanging. PMID- 10126501 TI - Employees--a patient accounts manager's most important resource. AB - In many ways, employees are a patient accounts manager's most valuable resource. Emphasizing the important status of employees can help employers retain good employees as well as provide an atmosphere that aids recruitment efforts. PMID- 10126502 TI - Pay attention to the docs and nurses. PMID- 10126504 TI - Improving public health status: hospitals' challenge. PMID- 10126503 TI - Saving lives isn't cheap. PMID- 10126505 TI - Auxiliary extends hospitals' reach throughout state. PMID- 10126506 TI - Hospital child care centers: a national trend grows. PMID- 10126507 TI - A team approach to volunteer recruitment in New York City. PMID- 10126508 TI - Auxiliary tackles recycling efforts. PMID- 10126509 TI - Hospital employees are serving as minority mentors in schools. PMID- 10126510 TI - Using volunteers in food-service areas: a growing service need. American Hospital Association. PMID- 10126511 TI - Institutions and the transformation of personal values. Are the traditional values of caring and service in jeopardy? AB - Groups bring about changes in the values of their members in two main ways- through their organizational structures and through the identifications that individuals make with other group members. These two forces help to transform a member's personal values to the values of the group. In health care, it is widely believed that such a transformation is necessary to make health-care professionals more efficient in their jobs. However, the author suggests that this value transformation may be propelling health-care professionals away from the traditional mainstays of the profession--caring and service. To explore this idea, the author first discusses the relationship between individual values and group values. He then examines how value changes occur within a group by using two different examples of groups--the corporation (a good example of how organizational structure shapes the values of its members) and the mob (a good example of the role social identification plays in shaping the values of group members). The article concludes with an exploration of how values are transformed in a health-care setting and how this transformation may be negatively affecting the attitudes of health-care practitioners toward the goals of caring and compassion. PMID- 10126512 TI - Designing an effective recognition award program. Dispelling the myths. AB - Recognition award programs are effective when valuable symbolic awards are presented in a meaningful award ceremony. Valuable symbolic awards are more than just expensive merchandise. The best awards are functional jewelry or office/home accessories made of precious materials (such as gold and diamonds) that contain some form of symbolism, such as the company logo or colors. Meaningful presentations make employees feel genuinely appreciated and increase their job satisfaction and company commitment. The awards should be presented in the presence of coworkers by a higher-level manager who can articulate the employee's contribution to the company. A careless and casual award presentation can make employees feel demeaned and unappreciated. PMID- 10126513 TI - Quality management series. How we implemented TQM in our laboratory and our blood bank. AB - Our experience in laboratory and blood services at LDS Hospital within Intermountain Health Care (IHC) is evidence that the theories behind total quality management (TQM) can be implemented into daily work. Some of the changes and results we have seen are increased employee accountability, paradigm shifts, process improvements, assessment using tools and measurement, increased customer and employee satisfaction, and cost savings. Some areas of the new TQM culture that we have focused on and made tremendous strides in are education in continuous quality improvement (CQI), CQI teams, quality councils, vision setting, self-managed work groups, change of management style, and celebrating success. We have learned that changes in culture take time and patience; managers must be willing to change their style; the CQI process and tools must be used; building trust and aligning values are important; education is key; making mistakes is how we learn; a customer focus is vital; significant change follows finding root causes; and we must just do it and not worry about all the little details. To make the change to a TQM culture, an organization must have faith in its employees, educate them, and be customer focused! PMID- 10126514 TI - Challenging the future. Clinical laboratory automation: a paradigm shift. AB - Compared to other industries, implementation of automation in the health-care arena has been delayed. Changes in reimbursement methods are forcing hospitals and other health-care providers to provide more cost-effective services. Clinical laboratory services are essential to the support of newer medical technologies and therapies such as organ transplantation and chemotherapy. The current paradigm for clinical laboratory operations is based on a mix of batch and random access testing and is dependent on personnel. In this article, a new paradigm based on a factory automation model is described. Mechanisms to support the paradigm shift--including a proposal for the creation of a consortium to jointly fund a development operation--are also explored. A clinical laboratory platform prototype currently under development at the University of Nebraska Medical Center is also described. PMID- 10126515 TI - Abbott glycated hemoglobin. PMID- 10126516 TI - Cultural diversity. PMID- 10126517 TI - Changing roles, changing goals: team development in a competitive environment. PMID- 10126518 TI - A prescription for leadership excellence. PMID- 10126519 TI - Perspectives. Feds, States look for flexible health reform. PMID- 10126520 TI - Perspectives. Maryland reform seeks cost containment. PMID- 10126521 TI - The OSHA HAZWOPER (hazardous waste operations and emergency response) standard: compliance options for hospitals. PMID- 10126522 TI - University of Pittsburgh Medical Center policy and procedure manual. Management of terminally ill patients who may become organ donors after death. PMID- 10126524 TI - Ethical, psychosocial, and public policy implications of procuring organs from non-heart beating cadavers. PMID- 10126523 TI - Back to the future: obtaining organs from non-heart-beating cadavers. PMID- 10126525 TI - History of organ donation by patients with cardiac death. AB - When successful solid organ transplantation was initiated almost 40 years ago, its current success rate was not anticipated. But continuous efforts were undertaken to overcome the two major obstacles to success: injury caused by interrupting nutrient supply to the organ and rejection of the implanted organ by normal host defense mechanisms. Solutions have resulted from technologic medical advances, but also from using organs from different sources. Each potential solution has raised ethical concerns and has variably resulted in societal acclaim, censure, and apathy. Transplant surgery is now well accepted, and the list of transplant candidates has grown far quicker than the availability of organs. More than 30,000 patients were awaiting organs for transplantation at the end of March 1993. While most organs came from donors declared dead by brain criteria, the increasing shortage of donated organs has prompted a reexamination of prior restrictions of donor groups. Recently, organ procurement from donors with cardiac death has been reintroduced in the United States. This practice has been mostly abandoned by the U.S. and some, though not all, other countries. Transplantation has been more successful using organs procured from heart beating, "brain dead" cadavers than organs from non-heart-beating cadavers. However, recent advances have led to success rates with organs from non-heart beating donors that may portend large increases in organ donation and procurement from this source. PMID- 10126526 TI - Development of the University of Pittsburgh Medical Center policy for the care of terminally ill patients who may become organ donors after death following the removal of life support. AB - In the mid 1980s it was apparent that the need for organ donors exceeded those willing to donate. Some University of Pittsburgh Medical Center (UPMC) physicians initiated discussion of possible new organ donor categories including individuals pronounced dead by traditional cardiac criteria. However, they reached no conclusion and dropped the discussion. In the late 1980s and the early 1990s, four cases arose in which dying patients or their families requested organ donation following the elective removal of mechanical ventilation. Controversy surrounding these cases precipitated open discussion of the use of organ donors pronounced dead on the basis of cardiac criteria. Prolonged deliberations by many committees in the absence of precedent ultimately resulted in what is, to our knowledge, the country's first policy for organ donation following elective removal of life support. The policy is intricate and conservative. Care was taken to include as many interested parties as possible in an effort to achieve representative and broad based support. This paper describes the development of the UPMC policy on non-heart-beating organ donation. PMID- 10126527 TI - Statutory definitions of death and the management of terminally ill patients who may become organ donors after death. AB - The law stipulates that death is irreversible. Patients treated in accord with the Pittsburgh protocol have death pronounced when their condition might well be reversed by intervention that is intentionally withheld. Nevertheless, the protocol is in accord with the medical "Guidelines for the Determination of Death." However, the Guidelines fail to capture the intent of the law, which turns out to be a good thing, for the law embodies a faulty definition of death. The inclusion of "irreversible" in the legal definition makes that definition excessively demanding and out of step with the ordinary concept of death. On this basis the protocol is absolved of the moral but not the legal charge that it involves vivisection. PMID- 10126528 TI - The irreversibility of death: reply to Cole. AB - Professor Cole is correct in his conclusion that the University of Pittsburgh Medical Center (UPMC) protocol does not violate requirements of "irreversibility" in criteria of death, but wrong about the reasons. "Irreversible" in this context is best understood not as an ontological or epistemic term, but as an ethical one. Understood that way, the patient declared dead under the protocol is "irreversibly" so, even though resuscitation by medical means is still possible. Nonetheless, the protocol revives difficult questions about our concept of death. PMID- 10126529 TI - Are the patients who become organ donors under the Pittsburgh protocol for "non heart-beating donors" really dead? AB - The University of Pittsburgh Medical Center (UPMC) "Policy for the Management of Terminally Ill Patients Who May Become Organ Donors after Death" proposes to take organs from certain patients as soon as possible after expected cardiopulmonary death. This policy requires clear understanding of the descriptive state of the donor's critical cardiopulmonary and neurologic functional capacity at the time interventions to sustain or harvest organs are undertaken. It also requires strong consensus about the moral and legal status of the donor during dying and confirmation of death. There has been no need for the clarity and precision that this policy relies upon, and thus the needed research and conceptual work has not previously been generated. The empiric base and societal consensus are both too frail to provide justification for this policy at this time. PMID- 10126530 TI - Conflict of interest in the procurement of organs from cadavers following withdrawal of life support. AB - The University of Pittsburgh policy for procuring organs from non-heart-beating cadaver donors recognizes the potential for conflicts of interest between caring for a "hopelessly ill" patient who has forgone life-sustaining treatment and caring for a potential organ donor. The policy calls for a separation between those medical personnel who care for the gravely ill patient and those involved with the care of transplant recipients. While such a separation is possible in theory, it is difficult or impossible to attain in practice. However, such a separation of duties would be unnecessary if an arbitrator were appointed to monitor the proceedings as they take place on a case-by-case basis. In this way, the biases--real or potential--of the individuals involved could be identified, and the harmful effects of the unavoidable conflicts of interest could be minimized. PMID- 10126531 TI - Non-heart-beating organ donation: personal and institutional conflicts of interest. AB - While procurement of organs from donors who are not "brain dead" does not appear to pose insurmountable moral obstacles, the social practice may raise questions of conflict of interest. Non-heart-beating organ donation opens the door for pressure on patients or families to forgo possibly beneficial treatment to provide organs to save others. The combined effects of non-heart-beating donation and organ shortages at major transplant centers brought about by the 1991 United Network for Organ Sharing (UNOS) local-use organ allocation policy created potential conflicts, including the fact that candidates for organs become potential donors far more frequently than previously. Hospitals with a major emphasis on transplantation have economic and academic interests that may have been hurt by the relative organ shortage. Some may view non-heart-beating organ donation as a way to restore weakened programs and thus unconsciously compromise recognition of problems associated with non-heart-beating donation. PMID- 10126532 TI - Potential conflicts of interest generated by the use of non-heart-beating cadavers. AB - The non-heart-beating cadaver donor procurement process might come in conflict with the organ sharing system by diverting organs from potential recipients. It might also have a negative effect on public attitudes about transplantation. The process could start society down a slippery slope leading to extending donor criteria. Some of these scenarios are merely theoretical, but the procedure should be monitored to avoid such problems. PMID- 10126533 TI - Non-heart-beating donors of organs: are the distinctions between direct and indirect effects & between killing and letting die relevant and helpful? AB - This essay analyzes the principle of double effect and, to a lesser extent, the distinction between killing and letting die in the context of the Pittsburgh protocol for managing patients who may become non-heart-beating donors or sources of organs for transplantation. It notes several ambiguities and unresolved issues in the Pittsburgh protocol but concludes that neither the principle of double effect nor the distinction between killing and letting die (with the prohibition of the former and the allowance of the latter under some circumstances) erects insurmountable obstacles to the implementation of the protocol. Nevertheless, the requirement of the principle of double effect that the intended good effects outweigh the unintended side effects necessitates careful attention to the probable overall impact of the proposed policy on organ procurement, particularly because public mistrust plays such a significant role in limiting the number of organ donations. PMID- 10126534 TI - A polemic on principles: reflections on the Pittsburgh protocol. AB - The Pittsburgh protocol relies heavily on traditional moral distinctions, particularly the principle of double effect, to justify "managing" the dying process of a prospective organ donor in order to yield viable organs for transplantation. These traditional moral distinctions can be useful, particularly in casuistic or case-specific moral analysis, but their invocation here is unpersuasive, and potentially dangerous. The protocol relies on elaborate apologetics to avoid a candid confrontation with the moral challenge it poses- society's willingness to bring about the death of one patient (in isolation and with potential discomfort) in order to benefit another patient. Not only will this protocol fail to solve the problem it purports to address, it threatens to undermine the delicate social accommodations by which we distinguish the living from the dead, permissible "allowings to die" from impermissible killings, and those from whom organs may be removed from those whose bodies must remain inviolate. PMID- 10126535 TI - "An ignoble form of cannibalism": reflections on the Pittsburgh protocol for procuring organs from non-heart-beating cadavers. AB - The author discusses the ways in which she finds the University of Pittsburgh Medical Center protocol for procuring organs from "non-heart-beating cadaver donors" medically and morally questionable and irreverent. She also identifies some of the factors that contributed to the composition of this troubling protocol, and to its institutional approval. PMID- 10126536 TI - Policy issues in a non-heart-beating donor protocol. AB - The Pittsburgh protocol is ethically and legally acceptable as written, but more research is needed to determine if it can be implemented in ways that will observe the procedures that make it ethically acceptable. If so, its desirability as public policy will depend on the number of organs it is likely to generate and its effects on public attitudes toward organ donation generally. In the final analysis, the controversial aspects of this protocol concern symbolic issues about respect for the dead and near dead, rather than substantive concerns that real patient interests will be harmed. PMID- 10126537 TI - The telltale heart: public policy and the utilization of non-heart-beating donors. AB - The transplant community has quietly initiated efforts to expand the current pool of cadaver organ donors to include those who are dead by cardiac criteria but cannot be pronounced dead using brain-based criteria. There are many reasons for concern about "policy creep" regarding who is defined as a potential organ donor. These reasons include loss of trust in the transplant community because of confusion over the protocols to be used, blurring the line between life and death, stress on family members, and burdens imposed on health care providers when a long-standing policy regarding who can serve as a cadaver organ donor is unilaterally changed. While these concerns are not sufficient reason for abandoning efforts to broaden existing eligibility standards for cadaver donation, they are sufficient reasons for the transplant community to desist in changing existing standards without widespread professional and public discussion. PMID- 10126538 TI - The dead donor rule: should we stretch it, bend it, or abandon it? AB - The dead donor rule--that persons must be dead before their organs are taken--is a central part of the moral framework underlying organ procurement. Efforts to increase the pool of transplantable organs have been forced either to redefine death (e.g., anencephaly) or take advantage of ambiguities in the current definition of death (e.g., the Pittsburgh protocol). Society's growing acceptance of circumstances in which health care professionals can hasten a patient's death also may weaken the symbolic importance of the dead donor rule. We consider the implications of these efforts to continually revise the line between life and death and ask whether it would be preferable to abandon the dead donor rule and rely entirely on informed consent as a safeguard against abuse. PMID- 10126539 TI - Adjuvant chemotherapy for breast cancer: modest but clinically important benefits. PMID- 10126540 TI - The case against the use of adjuvant chemotherapy in breast cancer. PMID- 10126541 TI - A history of physician payment policies under Medicare. PMID- 10126542 TI - The AMA/Specialty Society RVS Update Committee (RUC). PMID- 10126543 TI - Medicare program; Essential Access Community Hospitals (EACHs) and Rural Primary Care Hospitals (RPCHs)--HCFA. Final rule. AB - These final rules set forth the requirements for designating certain hospitals as EACHs or RPCHs; the conditions that an RPCH must meet to participate in Medicare; and the rules for Medicare payment for services furnished by EACHs and RPCHs. These rules are necessary to implement sections 6003(g) and 6116 of the Omnibus Budget Reconciliation Act of 1989 (OBRA 89) and section 4008(d) of the Omnibus Budget Reconciliation Act of 1990 (OBRA 90). The amendments are intended to promote regionalization of rural health services in grant States, improve access to hospital and other health services for rural residents, and enhance the provision of emergency and other transportation services related to health care. PMID- 10126544 TI - Support workers or replacement workers in rehabilitation? PMID- 10126545 TI - Development of the Safety Assessment of Function and the Environment for Rehabilitation (SAFER) tool. AB - Increasing numbers of seniors are choosing to remain in the community; however statistics for in-home accidents indicate that the over-65 age group is at the greatest risk. The purpose of this article is to describe the Safety Assessment of Function and the Environment for Rehabilitation (SAFER) Tool, which was developed by occupational therapists to address the need for a comprehensive functional and environmental assessment tool to be used with the elderly in the community. It consists of 15 areas of concern arranged in a logical and sensitive manner, subdivided into 128 items or functions. All items must be addressed and if appropriate, checked off as a problem. The tool fulfills the requirements of being quick and easy to use and on completion, it provides clear directions for intervention and treatment. PMID- 10126546 TI - The helping relationship: the application of Carkhuff's model. AB - Research has shown that good interpersonal skills are a prerequisite for a helping relationship to be effective. Carkhuff's helping model provides a framework in which to examine the nature of the helping relationship. The core helper dimensions and phases of helping are outlined. It is suggested that by incorporating this model into occupational therapy practice the delivery of care will be enhanced. PMID- 10126547 TI - The Family and Medical Leave Act--key provisions and potential problems. AB - The recently enacted Family and Medical Leave Act requires larger employers to provide eligible employees with up to twelve weeks of unpaid leave for certain medical and family-related reasons. This article addresses who the law applies to; the circumstances when leave must be granted; how the leave period is supposed to be scheduled; various notice, scheduling, medical certification, and reporting requirements; reinstatement and continuation-of-benefits requirements; and other key provisions of the Act. The basic requirements of the Act are not complicated, but certain issues that are not addressed by the Act or its legislative history--such as what qualifies as a serious health condition justifying a leave, when an intermittent or reduced schedule leave may be taken and how such schedules are determined, and how differences with state family and medical leave laws are to be reconciled--will have to be resolved by administrative regulation or litigation. PMID- 10126548 TI - Yes--I want "Them" to live next door. PMID- 10126549 TI - A report card on HMOs. AB - Many Americans are scared to death about the care at HMOs. But a coast-to-coast Fortune survey turns up surprisingly impressive results. PMID- 10126550 TI - Recent developments in "experimental treatment" insurance cases. PMID- 10126551 TI - Special report on taxation. Bond update Part I: New IRS guidelines for contracts involving bond-financed property. PMID- 10126552 TI - Generators of hazardous substances can be liable for improper disposal by third parties. PMID- 10126553 TI - ERISA used to strike down state health care reform efforts. PMID- 10126554 TI - Watch out for: fake patients seeking treatment in order to obtain drugs. PMID- 10126555 TI - Security director finances infant EAS (electronic alarm system) system with outside help. PMID- 10126556 TI - How hospitals communicate with non-English-speaking patients. PMID- 10126558 TI - Product update: devices for detecting bombs. PMID- 10126557 TI - Special report. The Los Angeles ER shootings, Part II: What hospitals in other parts of the country are doing. AB - In the first part of this report, we related the shootings and subsequent hostage taking and its impact on Los Angeles County-University of Southern California Medical Center and other California hospitals. In this part, we'll focus on what a number of other security directors are doing to prevent such incidents and we'll report in some detail about the use of metal detectors. PMID- 10126559 TI - Are you ready for managed competition? Preparing your practice. PMID- 10126560 TI - Managed competition or mandated compromise? A subspecialist's perspective. PMID- 10126561 TI - A frank assessment of our future health care system. Interview by C. Burns Roehrig. PMID- 10126562 TI - Choice: the heart of a successful system. PMID- 10126564 TI - Forming an independent physicians organization: a checklist. PMID- 10126563 TI - For internists, isolation is risky business. PMID- 10126565 TI - Managed competition. American Society of Internal Medicine. PMID- 10126566 TI - Managed competition by any other name: will it smell as sweet for internal medicine? PMID- 10126567 TI - Developing leaders from within. AB - Now more than ever, hospital administrations and staff need to respond quickly and decisively as the rules of the game continue to change, or lose their competitive advantages. With the prospect of massive and radical reform of the health care system over the next 2-3 years, hospital managers and their staffs are going to be asked to integrate and implement more complex changes in shorter and shorter time frames. Externally driven changes in the structure and operation of hospitals will mean changes in individual job profiles, organizational performance measurements, patient care responsibilities, information systems and regulatory requirements, to name but a few. PMID- 10126568 TI - Narrowing the gap between theory and practice. PMID- 10126569 TI - New physicians have job offers to spare. PMID- 10126570 TI - Patient data system key to quality indicators. PMID- 10126571 TI - Managing hotel services. Moving the goalposts. AB - Contractors are starting to tread the legal minefield of TUPE--Transfer of Undertakings (Protection of Employment) Regulations 1981. But in future they may have to compete less on cost and more on quality. Phil Cohen reports. PMID- 10126572 TI - Managing hotel services. Polished performers. PMID- 10126573 TI - Blowing in the wind. AB - Faced with healthcare demands that outstrip budgets, how do HAs prioritise services? Ray Robinson suggests four major inputs all purchasers should take into account. PMID- 10126574 TI - I think, therefore I manage. AB - Thirty healthcare managers were asked about the moral assumptions underlying their attitudes to the job. Pat Haggard reports her findings. PMID- 10126575 TI - When I'm calling you .... AB - Discussion groups among sectors of the population often excluded from consultation homed in on healthcare needs, say Paul Duncan and Liz Higgins, looking at findings from Waltham Forest HA. PMID- 10126576 TI - Managing hotel services. Fresh ingredients. AB - An experimental project at Guy's Hospital to improve the quality and nutritional value of its food has involved some of the big names in cookery. Stella Yarrow reports. PMID- 10126577 TI - Dire straits. AB - Orthotics, the Cinderella of the NHS, needs a radical restructuring if it is to give patients the best serviice, argue Peter Bowker and colleagues. PMID- 10126578 TI - Keeping mum. AB - It takes patience and persistence to extract information from hospitals about their maternity care, as Jane Waterson discovered in her attempts to get answers from hospitals in Northern Ireland. PMID- 10126579 TI - You pays your money. PMID- 10126580 TI - Supplies, supplies. PMID- 10126581 TI - Comrades. AB - Four organisations have collaborated to produce a consensus statement on clinical management. The result, writes Alys Harwood, could lead to a revolution in patient care. PMID- 10126582 TI - Last gasp. AB - Next Monday's World No-Tobacco Day is also the last day on which smoking will be allowed in UK hospitals. Amanda Killoran and colleagues urge local health authorities to seize the initiative. PMID- 10126584 TI - Information for purchasers. Rich pickings. PMID- 10126583 TI - Information for purchasers. A wan-dering we will go. AB - The NHS is set to embark on its most ambitious computing project to date. Michael Cross reports on plans to link every health service computer in the country. PMID- 10126585 TI - Information for purchasers. My way. PMID- 10126586 TI - Pharmacoeconomic series: Part 3. Applying pharmacoeconomic and quality-of-life measures to the formulary management process. AB - P & T Committees were established as an institution's primary organizational tool for the development and maintenance of the formulary. Traditionally, P & T Committees have focused on the safety, efficacy, and acquisition cost of medications to be considered for formulary approval. Today, the impact of pharmaceuticals on patients' quality-of-life and total health care expenditures are increasingly important considerations to be weighed by P & T Committees. Pharmacoeconomic analyses and quality-of-life outcomes represent valuable contributions to the formulary decision-making and management process. PMID- 10126587 TI - Setting up an automatic pharmacist-initiated pharmacokinetic dosing service. AB - At Latrobe Area Hospital, a 300-bed teaching-community hospital, a unique pharmacokinetic program is in place that permits the pharmacist to initiate and adjust an aminoglycoside or vancomycin regimen and schedule serum drug concentrations and renal function lab tests without contacting a physician for verbal approval. To avoid the perception of pharmacist prescribing, a detailed policy and procedure protocol was written that defined each step conducted in the pharmacokinetic evaluation. Using this approach, the service was readily approved by the medical staff and put into practice. The program has been operational for more than 1 year and has met with high physician and nursing acceptance. Although not specifically studied, the quality of patient care was thought to be improved. PMID- 10126588 TI - Ambulatory care in Canada: lessons for America. PMID- 10126589 TI - Alternative funding and delivery models: practice and prospects in Ontario. PMID- 10126590 TI - Designed to serve: the New Brunswick Extra-Mural Hospital. AB - I see the scope for the Extra-Mural Hospital as a component of community care and of ambulatory care that is not yet nearly realized. Many opportunities lie ahead if we continue to approach them in a sensitive manner and if we remain cost conscious but patient centered. We must continue to work harmoniously with all other contributors to the health care system and strive to achieve our self appointed role of being a catalyst to bring about the ideal continuum of care that will be cost and care effective. PMID- 10126591 TI - Ambulatory care north of 60 degrees north latitude. PMID- 10126592 TI - Developing actual costs of patient services: the University of Alberta Hospitals. AB - Analysis of the costs of diagnostic and therapeutic services provided to patients yields a multitude of useful results: a sophisticated tool to assist in streamlining the underlying processes of patient care; an improved understanding of the nature and extent of case-based resource requirements; maximization of existing patient information collected through various feeder systems; a key step in the direction of measuring quality and the cost of quality, when linked to patient outcomes realization of the strategic significance of information management in today's complex, data-intensive health industry. PMID- 10126593 TI - Manitoba's single-entry system to long-term care. AB - A single-entry system does not solve all the problems related to continuity of care, but it gives physicians the opportunity to refer those who may be at risk of losing their capacity to remain in the community to professionals who are qualified to assess the situation, to have their patients who need help access the most appropriate resources, and to have the cooperation of the continuing care workers in providing high-quality care to their patients. PMID- 10126594 TI - Physicians' practice patterns: a reflection of personal values? PMID- 10126595 TI - Fee setting in Canada: controversy and solutions. AB - No province in Canada has implemented an RVG, although both Alberta and British Columbia are in the final stages. Many complications exist. There is concern that those sections within the medical association that feel they will be financially disadvantaged will attempt to prevent the implementation of the RVG. They may persuade the board of directors not to implement or perhaps to phase in the implementation so that they have time to adjust to lower revenues. Even with simulations being done to establish the potential impact on sections, there is no model that can predict what behavioral changes may take place after the RVG is implemented. With the medical associations controlling the fee, governments must be assured that medical services will be delivered in the same manner in which they were delivered before the RVG and the global budget were instituted. An analysis of the changes and their causes is an important aspect of the process. Factoring out the relationships will be challenging. PMID- 10126596 TI - Psychometric evaluation of pharmacology calculation test for hospital staff nurses. AB - Based on our evaluation, we believe this newly developed test is a reliable and valid instrument for measuring nurses' competence in performing pharmacological calculations. The overall conclusion that this test is reliable and valid is strengthened by the use of various different measures of both reliability and validity. Following completion of this evaluation study, we began to use this test with all newly hired nursing staff. We arbitrarily chose a cut-off score of 80 percent as the passing score. Individuals who could not pass on their first attempt were offered remediation and then allowed a second attempt. During the first three months of use, we tested 25 newly hired nurses. Of those, 20 were able to pass the pharmacological calculations test on their first or second attempt, with a mean score of 88.7. The score on the second attempt of the five who failed (all LPNs) was 53.0. These individuals were not allowed to actually work as nurses at our hospital. We have subsequently changed the policy to allow three attempts, using the three parallel versions of the test. Remediation is offered after the second failed attempt. This approach has reduced the time needed by the education department to remediate, but meets nursing managers' desire and need to help those who can succeed and become competent members of our staff. The test has not been in use at our institution for over two years and is administered to all nurses who provide patient care in our institution (including agency/travel nurses). It has been generally well received and we area convinced that it can accurately measure nurses' pharmacological calculation competence. PMID- 10126597 TI - Distance education and the citizens of Wisconsin -- narrowing the gap. AB - This article presents a program model for reaching parents of adolescents with hospital-based content and expertise. PMID- 10126598 TI - Shared resources: joint hospital sponsorship of continuing education. AB - Two competitive hospitals have successfully shared resources to present an annual interdisciplinary pharmacology symposium for the past 10 years. Hospitals can contain costs and create synergy by collaboration and shared resources. PMID- 10126599 TI - AIDS education: the SMAHEC (Southeastern Massachusetts Area Health Education Center) experience. AB - Massachusetts ranks 10th in the nation in numbers of reported AIDS cases. The state had 3,877 AIDS cases reported through June 1991. The Southeastern Massachusetts region consisting of 70 cities and towns totaling approximately 1,735 square miles has the second highest incidence of HIV infection of regions in the state. Total cumulative cases of full-blown AIDS in the region have numbered 406, approximately 14 percent of the state total. This article describes the experience of Southeastern Massachusetts Area Health Education Center, Inc. (SMAHEC) in implementing AIDS educational efforts. PMID- 10126601 TI - When does a medical expert become a hired gun? PMID- 10126600 TI - Florida: on the fast track to health-care reform. PMID- 10126602 TI - Managed-care plans you shouldn't join. PMID- 10126603 TI - What lessons should we take from Medicare?. Interview by Steve Murata. PMID- 10126604 TI - Class-action suit attacks HHS for failing to implement limits on hospitals' outpatient charges. PMID- 10126605 TI - Living Centers to acquire Vari-Care. PMID- 10126606 TI - Providers positioning for reform plan. PMID- 10126607 TI - Working conditions now contract issue. PMID- 10126608 TI - New AMA benefits package includes unlimited hospital stays, physician office visits. PMID- 10126609 TI - With its profits down, AMA raises dues 5%. PMID- 10126610 TI - Real estate firm hired to help AHA find new site for headquarters. PMID- 10126611 TI - Galen, Columbia merger has potential for pitfalls, promise. PMID- 10126612 TI - Merger to give doctors venture opportunities. PMID- 10126614 TI - Vladek wants to sweeten Medicare'risk'. PMID- 10126613 TI - Senate pulls back from massive Medicare reduction, but proposal cuts deeper than House version. PMID- 10126615 TI - To meet goals, reform must retain spirit of competition. PMID- 10126616 TI - California groups join for survival. Mullikin, HealthCare Partners exemplify trend of groups coming together to secure a place in the delivery system. PMID- 10126617 TI - Hospitals cut labor force in anticipation of reform. PMID- 10126619 TI - Calif. HMOs test versions of competing 'paperless' electronic claims networks. PMID- 10126618 TI - Report pegs global budget 5-year savings at $495 billion. PMID- 10126620 TI - Indicator system accepting all test pilots. PMID- 10126621 TI - New York's public system uses bond sale for building projects. PMID- 10126622 TI - AMA torpedoes White house's plan for malpractice revamp, but critics attack alternative. PMID- 10126623 TI - Sutter group trims pay, 52 specialists jump ship. PMID- 10126624 TI - IRS to step up bond scrutiny. PMID- 10126625 TI - Iowa-based integrated network forming. PMID- 10126626 TI - Ohio plan ending Blues ties. PMID- 10126627 TI - Boston hospital downgraded. PMID- 10126628 TI - Purchase of Damon seen as first wave of consolidations. PMID- 10126630 TI - Doc compensation needs change--study. PMID- 10126629 TI - 5 Nevada hospitals to live with 6% limit. PMID- 10126631 TI - Providers soon may have shot at award. PMID- 10126632 TI - Two AHA data base services to be shut down at year-end. PMID- 10126633 TI - First lady lets single-payer supporters have their say: reform blueprint stays fluid. PMID- 10126634 TI - HCFA delays release of data on mortality--maybe permanently. PMID- 10126635 TI - Minnesota unions challenge state's tax for health reform. PMID- 10126636 TI - Hillhaven to purchase last NME-owned homes for $112 million in cash. PMID- 10126637 TI - HHC asked to review contract with Baxter. PMID- 10126639 TI - Healthcare PACs increase donations as factions work to gain clout, beat limits. PMID- 10126638 TI - MCA head hit for sales forces. PMID- 10126641 TI - HCA hit for dubious claims, high executive compensation. PMID- 10126640 TI - Amid layoffs and protests, nurses talk of unionizing Tampa General. PMID- 10126642 TI - Ukiah asks high court to rule on FTC jurisdiction. PMID- 10126643 TI - Columbia may help Galen heal physician relations. PMID- 10126644 TI - San Diego area providers form network. PMID- 10126645 TI - Europe looks to U.S. for answers. PMID- 10126646 TI - Hospitals plan long-range for furnishings. PMID- 10126647 TI - Budget bills' provisions could hurt not-for-profits seeking physicians, execs. PMID- 10126648 TI - Systems scurry to find 'partners' for networks. PMID- 10126649 TI - Epic aims to trim expenses by $20 million. PMID- 10126650 TI - HealthTrust profit picture improves. PMID- 10126651 TI - A change in focus for CFOs. PMID- 10126652 TI - Voters giving thumbs down to taxes for hospitals. PMID- 10126653 TI - Continental Medical drops plans to build 30 facilities. PMID- 10126654 TI - House committee criticizes VA over women's healthcare. PMID- 10126655 TI - NovaCare to acquire RHCA. PMID- 10126656 TI - San Diego physicians join to ensure managed care reaches ethnic communities. PMID- 10126657 TI - Hospitals can and should improve efforts to form multicultural staff. PMID- 10126658 TI - Hospitals sock away cash out of fear that reform will hurt their finances. PMID- 10126659 TI - Health reform: setting the agenda for long term care. AB - The White House Task Force on National Health Care Reform, headed by First Lady Hillary Rodham Clinton, is expected to release its prescription for health care reform this month. From the outset, Clinton's mandate was clear: to provide universal coverage while reining in costs for delivering quality health care. Before President Clinton was even sworn into office, he had outlined the major principles that would shape the health reform debate. Global budgeting would establish limits on all health care expenditures, thereby containing health costs. Under a system of managed competition, employers would form health alliances for consumers to negotiate for cost-effective health care at the community level. So far, a basic approach to health care reform has emerged. A key element is universal coverage--with an emphasis on acute, preventive, and mental health care. Other likely pieces are employer-employee contributions to health care plans, laws that guarantee continued coverage if an individual changes jobs or becomes ill, and health insurance alliances that would help assure individual access to low-cost health care. What still is not clear is the extent to which long term care will be included in the basic benefits package. A confidential report circulated by the task force last month includes four options for long term care: incremental Medicaid reform; a new federal/state program to replace Medicaid; a social insurance program for home and community-based services; or full social insurance for long term care. Some work group members have identified an additional option: prefunded long term care insurance.(ABSTRACT TRUNCATED AT 250 WORDS) PMID- 10126660 TI - Nurse assistant evaluation program leads to increased competency. PMID- 10126661 TI - HCFA offers incentives to use automated payment systems. PMID- 10126662 TI - Resident transfer and discharge: practical tips for compliance. PMID- 10126663 TI - Understanding stages of dying guides caregiving support. PMID- 10126664 TI - Life experiences are shared in memoir writing program. PMID- 10126665 TI - 'Healthier communities' focuses on vision of good health. PMID- 10126666 TI - What'll ya have? AB - Before choosing a plan to finance healthcare, we must decide whether we consider ourselves subscribers or patients, Mr. Hage says. And we each must decide how healthy we are, because that determines how much we're willing to pay for medical coverage, he adds. In the article, Mr. Hage describes two proposed financing approaches and tells why he thinks both of them miss the mark. PMID- 10126667 TI - Partnership--the term of the '90s? Building a network of middle management. AB - In her latest column, Ms. Sjolseth describes how a group of middle managers at a hospital where she worked began holding regular, interdepartmental meetings. The partnership broke down departmental barriers, fostered teamwork and enabled the managers to identify and resolve problems more quickly than before. After recounting the group's accomplishments, Ms. Sjolseth provides tips on how radiology administrators can create middle management teams in their own facilities. PMID- 10126668 TI - Successful purchasing strategies involve radiology administrators, materiel managers and suppliers. AB - Radiology administrators and materiel managers need to improve their working relationship to increase productivity by reducing the cost of buying imaging supplies, the authors contend. Once the two parties have overcome communication problems and other obstacles, they can work with each other and with suppliers to develop win-win strategies. To maintain high quality patient care while cutting costs, the authors believe, facilities should develop a fully automated product program and strive to achieve greater product standardization. PMID- 10126669 TI - Job satisfaction in the medical imaging profession: alleviating the shortage of personnel. AB - The dramatic growth of the diagnostic imaging field has not been accompanied by a similar increase in trained personnel. As a result, a personnel shortage exists in nearly every area of diagnostic medical imaging. A study was conducted to examine job satisfaction among imaging personnel to determine what issues need to be addressed among current employees so that the field of diagnostic imaging may be made more attractive to potential imaging personnel. A total of 71 participants from four hospitals in a mid-size city in the southeastern United States completed a 29-question survey. Demographic characteristics and regression models were then used in statistical analysis. The models examined length of employment, work performance, salary, career advancement, and work environment. Significant factors found to relate to job satisfaction were: relationship with supervisor, opportunity for career advancement, job security, adequate staffing, and job stress. Prioritizing these concerns over other nonsignificant findings should promote job satisfaction and in turn alleviate the current shortage of diagnostic imaging personnel. PMID- 10126670 TI - Successful strategies for retaining and recruiting imaging specialists: a two year perspective. AB - Strategies for retaining and recruiting of imaging personnel must focus on job enrichment through personal and professional growth opportunities; support and recognition for continuing education activities that promote those goals; and compensation and benefit programs that are commensurate with increased expectations and responsibilities. In this article, the author describes the process used to develop and successfully implement a comprehensive, integrated strategic plan, whose central focus is a multi-modality career path. Also discussed are the benefits realized over the past two years in the Department of Diagnostic Radiology and Nuclear Medicine at Rush-Presbyterian-St. Luke's Medical Center in Chicago. PMID- 10126671 TI - Film loan policies of radiology departments. AB - Last year, the AHRA Southern Region Statistical Resource Committee surveyed its members about their departments' film loan policies. This article presents the results of that survey, providing information on such topics as lending original films, charging for copies, and protecting against liability. While there doesn't seem to be a standard approach to releasing films, survey findings suggest that liability issues and cost factors are of great concern in determining which policy should be adopted. PMID- 10126672 TI - AHRA survey. Staff utilization: Part I. AB - Part I of this AHRA membership survey reports on information relating to staff utilization in diagnostic radiology. The average volume of procedures per full time-equivalent staff is provided for technologists, physicians, clerical staff and transporters. Part II, to be published in the Summer issue, will provide reports on specialty areas in radiology. PMID- 10126673 TI - The duty to disclose AIDS: a two-way street. The landmark case of Diane Boulais. PMID- 10126674 TI - Should emergency readmissions be used as health service indicators and in medical audit? AB - This study examined the temporal relationships between index discharges from hospital and emergency readmissions in the area covered by the Oxford record linkage study in the years 1975-84. We report data on 204, 856 readmissions. Index admissions were grouped into elective and immediate categories and into medical and surgical specialty groups. The time intervals between elective prostatectomy or emergency appendicectomy and emergency readmissions were also examined as examples of specific operations. Readmissions clustered strikingly in the first few weeks following discharge. Over a third of emergency readmissions in the year following discharge occurred in the first four weeks. This close temporal proximity indicates that emergency readmissions are generally associated with the first index admission and therefore that emergency readmissions are appropriate topics for further investigation through health services research and medical audit. PMID- 10126675 TI - A task contingent model of medical practice organization. AB - The treatment of acute episodes of morbidities in hospitalized patients is a complex and uncertain task. To accomplish this task, physicians organize themselves into teams in an effort to overcome two constraints: the necessity to offer both complete care and continuous care. This study examines the extent to which the nature and size of medical teams is explained by task difficulty and task variability, which are two dimensions of task uncertainty. The results support globally the hypothesis that the organization of medical practice is contingent upon the nature of the task defined in terms of uncertainty. However, the results also suggest that the task contingent model should be adjusted to take into account the fact that formal organizational characteristics may have an a priori influence on team structure. PMID- 10126676 TI - Employees' views of their work experience in private hospitals. AB - Employees in 10 private for-profit hospitals responded to questionnaires regarding their work experiences, hospital facilities, and employer. Replicated results identified themes of employee opinions, including: Supervision, The Employer, Role Significance, Hospital Image, Competitiveness, Benefits, Cohesiveness, and Work Load. Only scores on the Role Significance scale differed between clinical and non-clinical respondents, with the former scoring higher. Survey methodology can be used to define an organization's culture from the employee's viewpoint. Their perception of this culture helps determine their behavior at work and their conveying the image of their facility in the community. The recent emphasis on quality improvement and 'bottom-up' management presents a particularly well-suited opportunity for the effective use of surveys. Quality improvement efforts involve employee groups which empower workers as active diagnosticians, internal consultants, and decision markers. Survey defined 'action levers' portray avenues along which such constructive efforts might be directed. Also, surveys identify themes through which management can evaluate organizational performance overall and department by department, building in means by which those responsible for units of the hospital can be accountable for achieving measurable results. PMID- 10126677 TI - Research note: reliability of self-report sickness absence data in the health service. AB - Rees and Cooper (1990) used self-reports of sickness absence during the previous six months as a dependent measure in a diagnostic survey of stress in one health district. Comparison of self-reports with actual sickness absence showed that it achieved a high level of association (0.95) and can be recommended as an alternative to actual sickness data in studies in which, for whatever reason, actual sickness absence is difficult to obtain. PMID- 10126678 TI - Introduction of hip ultrasonography to the neonatal services of a Fife District General Hospital. AB - Ultrasonography of the hip is a new technique which is said to assist in the diagnosis of neonatal hip disorders. The authors were unaware of any reports of formal evaluation of the introduction of this new technology into a District General Hospital. This study outlines several aspects of patient care before and after the introduction of neonatal hip ultrasonography to a Fife hospital as an adjunct to a neonatal orthopaedic clinic. After introduction of ultrasound the proportion of patients where the consultant was 'very confident' in the diagnosis increased by 29% (95% confidence intervals 9% to 49%); the proportion of children requiring three or more x-rays in the year following referral fell by 46% (95% confidence intervals 27% to 65%) and the proportion of children requiring five or more follow up attendances in the year following referral fell by 56% (95% confidence intervals 38% to 74%). Introduction of this technology has benefited patients by reducing their need to attend clinics and reducing their overall exposure to ionising radiation. There is a continuing need for ultrasonography to be provided in Fife neonatal orthopaedic outpatient clinics. PMID- 10126679 TI - TQM as a managerial innovation: research issues and implications. AB - TQM is a managerial innovation that is likely to have profound consequences on the delivery of health services. As an innovation, it is important that attention be given to the fundamental research issues associated with implementation and impact. Using a variance and process perspective, selected research issues are identified within organizations and among work units within these organizations. The variance perspective at both the organizational and work unit level considers the explanation of impact and adoption at a particular point in time. The process perspective considers the particular steps or events in the overall adoption process. The managerial implications for each perspective are discussed. PMID- 10126680 TI - Satisfaction with primary health care and confidence in general practitioners: an exploratory comparison of US and UK students. AB - This paper explores attitudes of university students towards two differently organised health services, ie the National Health Service in the UK and the more market oriented system in the US and analyses the level of confidence placed in primary care providers (GPs/family physicians) in both systems. Although major differences in the perception of the two health care systems are identified, hardly any differences emerge between the two countries in terms of the confidence patients place in their primary care providers. PMID- 10126681 TI - Toward the electronic medical record: in pursuit of an electronic Holy Grail in a cost conscious era. PMID- 10126682 TI - The development of a computerized information system for clinicians. AB - The need for information to support health care has changed dramatically over the last 100 years, but for most physicians, methods for obtaining it have not. Clinical practice is probably 10 years behind other industries in the use of computers to manage information. This article describes the design principles for a system now being used at Harvard Community Health Plan and some of the benefits of that system. PMID- 10126683 TI - Actual practice with Interpractice Systems: first experiences. AB - A new health center of Harvard Community Health Plan of Boston, MA, has been the test site for aspects of InterPractice Systems including the automated medical record, test and prescription ordering, results management, and home systems. Some of our staff had no prior computer experience, some had extensive experience. We have found the system to be valuable in accessing information quickly and efficiently. In addition, clinical, medication and test data can be manipulated and organized in new and powerful ways. Patient records are always legible and are accessible at multiple locations at the moment they are completed. Recording of information has not been a burden. Prescription ordering has been a success and ordering of laboratory and radiology tests is becoming more simplified. A pilot test of the home systems has been promising. The use of the system does not appear to interfere with the doctor-patient relationship. The system holds the potential of being used as a tool for clinical research and outcomes studies and as an aid in defining the efficient use of resources while continuously improving the quality of care our patients receive. PMID- 10126684 TI - The Patient Profile System: Group Health's first iteration of the automated medical record. AB - In 1988, Group Health, Inc., a large staff model HMO in the Twin Cities of Minneapolis and St Paul, MN, began upgrading its computer systems. This provided an opportunity for the organization to begin the development of its first automated medical record, called the Patient Profile System (PPS). This paper describes that effort. Discussed are the design, development, implementation, features and uses of the system. The reader considering a similar endeavor should have an idea of what this development process might entail within the framework of a large HMO. Although not embodying all the features that would be necessary for the fully computerized medical record, the PPS has proved to be a useful clinical tool. Lessons learned from the development and implementation of the PPS will help us reach the goal of fully automating the medical record. PMID- 10126685 TI - Computer "advice" aids in managing care of a population. PMID- 10126686 TI - A computerized radiology information system. PMID- 10126687 TI - Perspectives. Systemwide reforms needed to cure health ills. PMID- 10126688 TI - Annette Fox Haematology Unit, Ward 7, Bradford Hospitals NHS Trust. PMID- 10126689 TI - Sick building syndrome--know your ventilation rates. AB - To summarise, although the occurrence of sick building syndrome could be due to a range of causal factors, research shows that it is probable that low outside air intake volume and pollution generated by the ventilation system and the building contents play a role in producing its effects. This being so, it is important that the flow of outside air into the building and the distribution of fresh or mixed air around the interior are known and controlled. However it is difficult to control the flow rate by conventional means and the use of fixed minimum position dampers is not likely to maintain a minimum fresh air flow rate under most wind velocities. What is needed is a control system which relies on direct measurement of air flow rate connected to a modulated minimum outside air intake damper to provide a constant and verifiable volume of fresh air flow. Flow sensors also open up the possibility of direct measurement and control of return and mixed air volumes and of course the flow of air anywhere else in the system. PMID- 10126690 TI - Telemedicine is here. PMID- 10126691 TI - Meeting the needs of an ageing population. PMID- 10126692 TI - Telecommunications services and licensing in the NHS. PMID- 10126693 TI - Combustion in clinical incinerators. AB - Clinical incinerators are important combustion appliances which need to meet emission regulations of increasing severity. In present designs the principles of overfeed and underfeed ignition, well established for coal firing, do not appear to have been appreciated in the incinerator field. It is suggested that important advantages could accrue from using overfeed rather than underfeed ignition and complete rather than partial combustion in the primary chamber. PMID- 10126694 TI - Ecological control of hospital engineering operations. AB - Environmental protection must be accomplishable in a hospital. Thus the goals have to be set in such a way that they are achievable. The track towards a positive environmental balance should be passable, ie environmental protection has to be on the people's mind and not on some single persons'. Environmental protection in the hospital starts in the purchasing department. If hospitals show an environmentally conscious demand, the industry will react with the supply of non-polluting products in order to not lose this market sector. Medical and the remaining hospital services may contribute to the protection of the environment by avoiding, reducing, and recycling waste. The responsibility for environmentally protective measures, such as noise reduction, sewage- and waste treatment, and avoidance of air pollution lies with hospital engineering. Operations (measuring, controlling) and maintenance (inspecting, servicing, overhauling) have to be available, safe, and economical. Thus the ecological demands for operations control are identically satisfied. The only task of the administration remaining is to support environmental consciousness and practice of environmental protection, to distribute attained knowledge and to survey the developments. Good environmental practice has to quantify environmental protection in the hospital. PMID- 10126695 TI - Legionnaires disease infection control. PMID- 10126696 TI - Hygienic requirements for pool water. PMID- 10126697 TI - New regulations on water hygiene. Have you applied them? AB - 1. New legislation asks for a named manager to be responsible for water hygiene in buildings. 2. Two reports outline what is required. One, A Code of Practice, lays down a management framework. The other, a Guidance Note HS(G)/70 gives useful background information and proposes in detail what is expected. Valuable practical suggestions for existing plant are given too. 3. Every building should by now have a written risk analysis together with a description of the actions planned to minimise the risk of legionellosis (legionnaires disease or Pontiac fever). 4. Every building should by now have a written and signed log of its actions. 5. A summary of the actions required is shown at Figs 1 and 2. PMID- 10126698 TI - The American Hospital Association vision for health care reform: a summary. PMID- 10126699 TI - The ties that bind. Making the most of the board/physician relationship. PMID- 10126700 TI - The storm of the century. How some hospitals survived it. AB - The March snowstorm that hit Alabama is already the stuff of legend. It paralyzed businesses and travel, and left people trapped indoors wondering if the white stuff would ever melt. Hospitals were not immune to these problems, but the brave men and women who make Alabama's medical facilities what they are persevered and were there when their communities needed them. These are the responses we received from our call for snow stories and the heroes who kept the hospitals going. PMID- 10126701 TI - Flexible and performance budgeting for the nursing unit. PMID- 10126702 TI - Clinton plan takes shape, but financing still big unknown. AB - Global budgets...managed competition...price controls. Many of their features have filled in as Hillary Rodham Clinton's health care reform task force wraps up its work--six weeks late and counting. Based on the numerous details that have come out in the past few months, Health Care Reform Week has assembled the following round-up of provisions likely to be included in the coming reform plan. The information in based on HCR Week's interviews with government officials and industry representatives plus recent news accounts and statements by Clinton administration and congressional officials. One certainty is that whatever is in the plan President Clinton sends to Congress, legislators' approval will be heavily influenced by the proposals' cost feasibility. Advocates of the largest possible range of benefits in the health care package, for example [HCRW Special Report, 5/17/93], already are hearing from skeptical lawmakers. New benefits are "fine so long as we are willing to do one thing: pay for them. And pay for them now," says House Ways & Means Committee Chairman Dan Rostenkowski (D-Ill.). "There's been a long, unhappy record in this town of paying for today's benefits with tomorrow's dollars." Here's a wrap up of what's come out to date. PMID- 10126703 TI - Medicare's role in health care reform will vary state-by-state, new HCFA chief says. Interview by Carol Monaco. PMID- 10126704 TI - Health care. Way ahead of Bill. AB - Unable to wait any longer for federal reform, states and companies are launching their own programs to cut costs and extend coverage to more of those now uninsured. PMID- 10126705 TI - The promise of low osmolar contrast media: new data in cardiac angiography. PMID- 10126706 TI - Heart centers 2000. Part two: The challenge of change. PMID- 10126707 TI - Cath lab statistics in inventory control. PMID- 10126708 TI - Heart centers 2000. Part Three: The challenge of excellence. AB - Healthcare is becoming a mature market from the perspective of "product life cycle" analysis. Mature markets are distinguished by, among other things, expanding competition and increasing emphasis in the market on quality and cost. The cardiac market is the most mature of all aspects of healthcare and, as such, is the most competitive of all healthcare market segments. This is the third in a three-part series on heart centers of the future. The first part dealt with the trends in the cardiac market and the second part focused on the management of change. This article addresses excellence applied to the management of cardiovascular centers over the next decade. Because of the highly evolved nature of the cardiac market, competitive forces will require excellence in terms of service delivery, quality, cost and organization. PMID- 10126709 TI - Continuous quality improvement in the cardiology hospital product line: Part one. PMID- 10126710 TI - How a heart network can influence a cardiovascular product line. AB - The authors believe that a viable heart network program can give tertiary centers the competitive edge in cardiology marketing, can provide the opportunity to fine tune cardiovascular product lines and can position hospitals to meet the challenges of the next decade in healthcare. However, success will be determined by an institution's ability to carefully balance cost and quality issues. PMID- 10126711 TI - How to manage cardiovascular clinical outcomes in terms of quality and cost. AB - How does a hospital's cardiology/cardiovascular surgery program position itself as the cardiac healthcare provider of choice? This challenging question must be addressed by medical marketing and program administrators nationwide. PMID- 10126712 TI - Data watch. An HMO balance sheet. PMID- 10126713 TI - Enlisting employees in the battle to cut health care costs. PMID- 10126714 TI - Cleveland health quality initiative bears its first fruit. PMID- 10126715 TI - CalPERS: a model for health care reform? PMID- 10126716 TI - HMO quality assessment partnerships improve health care. PMID- 10126717 TI - Grappling with coverage for mental health. PMID- 10126718 TI - Midwest group develops CABG protocols. PMID- 10126719 TI - To cut costs, states develop networks of care. PMID- 10126720 TI - On ERISA protection, employers beware. PMID- 10126721 TI - Health care needs a proconsumer movement. PMID- 10126722 TI - Health-lobby mania. Clinton's reform is on hold, but the battle to win votes is well underway. PMID- 10126723 TI - Health maintenance organizations: qualification determinations and compliance actions for calendar year 1992, fourth quarter--HCFA. Notice. AB - This notice sets forth the names, addresses, service areas or modified service areas, and dates of qualification or expansion of entities determined to be Federally qualified health maintenance organizations (FQHMOs) during the period October 1, 1992 through December 31, 1992. Additionally, this notice sets forth compliance actions taken by the Office of Prepaid Health Care Operations and Oversight for the period October 1, 1992 through December 31, 1992. This notice is being published in accordance with our regulations set forth at 42 CFR 417.144 and 417.163, which require publication in the Federal Register of certain determinations relating to FQHMOs. PMID- 10126724 TI - The Family and Medical Leave Act of 1993--Wage and Hour Division, Department of Labor. Interim final rule; request for comments. AB - This document contains interim regulations implementing the Family and Medical Leave Act of 1993 called ("FMLA" or "the Act"). The Act is effective on August 5, 1993, six months from the date of its enactment. Where a collective bargaining agreement is in effect on August 5, 1993, the Act is effective when the collective bargaining agreement terminates or February 5, 1994, whichever is earlier. The purpose of these regulations is to set forth the requirements of Title I and Title IV of the Act. Title I applies to covered private employers and public agencies (except for most of the Federal Government, which is governed by Title II). Title IV of the Act primarily concerns the relationship between FMLA and other laws, as well as collective bargaining agreements and other employer plans and programs. PMID- 10126725 TI - Privacy Act of 1974; report of new system--HCFA. Notice of new system of records. AB - In accordance with the requirements of the Privacy Act of 1974, we are proposing to establish a new system of records, "Evaluation of the Medicare Case Management Demonstration" No. 09-07-0061 HHS/HCFA/ORD. We have provided background information about the proposed system in the "Supplementary Information" section below. Although the Privacy Act requires that only the "routine uses" portion of the systems be published for comment, HCFA invites comments on all portions of this notice. See "Dates" section for comment period. PMID- 10126726 TI - Medicare program; data, standards and methodology used to establish fiscal year 1992 budgets for fiscal intermediaries and carriers--HCFA. Final notice. AB - This notice is published in accordance with sections 1816(c)(1) and 1842(c)(1) of the Social Security Act which require us to publish the final data, standards and methodology used to establish budgets for Medicare intermediaries and carriers. It announces that we are adopting as final without revision proposed data, standards, and methodology used to establish Medicare fiscal intermediary and carrier budgets for the fiscal year (FY) 1992, beginning October 1, 1991. It also contains our response to public comments on the proposal. PMID- 10126727 TI - Department of Health and Human Services. Spreading its wings. PMID- 10126728 TI - Jobs that are growing and slowing. AB - In a sluggish labor market, many once lucrative occupations are being outmoded or redefined. Yet there are real opportunities--exciting ones--to be found. PMID- 10126729 TI - The jobs Americans hold. AB - How many Americans hold which jobs? What careers have futures? Grouped here are all the jobs employing more than 150,000 people--they include about 90% of U.S. workers--and the growth that the Bureau of Labor Statistics calculates for each. PMID- 10126730 TI - Medicare program implements fourth "scope of work" for peer review. PMID- 10126731 TI - Special report on taxation. Bond update. Part II: New guidelines and procedures concerning tax-exempt financing. PMID- 10126732 TI - Shooting kindles concern for hospital security. PMID- 10126733 TI - Should diet counseling take place in or out of the facility? PMID- 10126734 TI - Cooking at the speed of light. PMID- 10126735 TI - Patient-related education standards. PMID- 10126736 TI - Revenue-generating and contract customers. PMID- 10126737 TI - Management consultancy. If the price is right.... AB - The NHS has been a lifeline for recession-stricken management consultants. But as health service organisations learn from experience, are they becoming more discerning buyers, asks Stella Yarrow. PMID- 10126738 TI - Management consultancy. Trading places. AB - While the NHS appears strapped for cash, management consultancy seems flush with fast cars and expense accounts, but is it really like that? Barbara Millar asks those who have made the transition from one to the other. PMID- 10126739 TI - Management consultancy. Faith, hype and clarity. AB - When should managers trust consultants' advice about computer procurement? Michael Cross discovers new guidance. PMID- 10126740 TI - Management consultancy. Shopping around. AB - The NHS spends millions on management consultants but often has little idea of who to hire or how to get the best out of them. Philip Abbott shows how the health service can learn a few tricks from the private sector. PMID- 10126741 TI - Run for your money. AB - The DoH's efficiency index is criticised for being crude, biased and inaccurate. John Appleby, Trevor Sheldon and Aileen Clarke discuss NAHAT's consultation and suggest some improvements. PMID- 10126742 TI - Peak practices. PMID- 10126743 TI - Reach for the sky. AB - Amputee patients should aspire to higher levels of service from limb fitting centres, say Michael and Janet Limb and Michael Calnan. PMID- 10126744 TI - Right on. PMID- 10126745 TI - Giving employers what they want. Successful CEOs read warning signs. AB - Corporate executives are becoming activists in challenging the fundamentals of the healthcare delivery system and in developing standards for selective contracting. The actions they take could drive many providers from the market. PMID- 10126746 TI - Strategic recruitment needs executive leadership. AB - Healthcare executives must make a personal investment in physician recruiting. There's no replacement for a president or senior vice president sitting down with a physician and saying, "We need you." PMID- 10126747 TI - The phone is your friend. PMID- 10126748 TI - Cost-effective drug therapy. PMID- 10126749 TI - Ethics and impaired healthcare executives. AB - Healthcare executives are not expected to poorly manage their own health. When they do, they do more than diminish their own public image: They can also damage the public image of their organizations of employment. PMID- 10126750 TI - Making change happen. PMID- 10126751 TI - Managed care success stories: positioning yourself to manage in managed care. AB - Establishing strong partnerships with physicians, concentrating on the improvement of health rather than the treatment of illness, and moving patients efficiently through a continuum of care are just some of the keys to successfully managing in managed care. PMID- 10126752 TI - Physicians and managed care: practical ways hospitals can contribute to medical practice stability. AB - Running a medical practice in today's managed care environment is difficult even for seasoned physicians. In fact, it can turn a medical practice into a financial nightmare. Healthcare executives can help strengthen hospital-physician relations by offering physicians several management solutions to help stabilize and control their medical practices. PMID- 10126753 TI - Economic evaluation of osteoporosis prevention. AB - In this paper economic evaluation of osteoporosis prevention is discussed. So far economic evaluation in this area has been limited to cost-effectiveness analysis. Four cost-effectiveness analyses of osteoporosis prevention are reviewed. It is noted that the major problem with these studies is the lack of reliable and valid data to base the cost-effectiveness analyses on, which precludes clear-cut conclusions about the cost-effectiveness of osteoporosis prevention. The studies, however, form a basis for future cost-effectiveness analyses in this field and as new data become available it should be possible to improve the accuracy and precision of the analyses. Due to the methodological problems of cost effectiveness analysis and the decision-maker approach to economic evaluation, it is also argued that the contingent valuation (CV) method of measuring willingness to pay should be tested in this area. The CV method can be used both to value an actual treatment and the outcome of that treatment and the resulting amount can be compared with the costs (including the costs of externalities) to carry out cost-benefit analysis. It is concluded that a lot of work remains to be done in this area before economic evaluations can give a real contribution to policy, but such work may well be worthwhile due to the importance of this public health problem. PMID- 10126754 TI - WHO under stress: implications for health policy. AB - A crisis is increasingly challenging the authority and prestige of the United Nations' specialized agencies. Although the World Health Organization is still held in great repute, it has not escaped criticism. Member countries have expressed concern about WHO's bureaucratic procedures, costs, proliferation of meetings, reports, lack of budget transparency. Doubts have been cast on the effectiveness of some programmes. This paper argues that such criticisms must be understood within the context of the huge changes that have occurred since WHO was established in the late 1940s. There has been a major shift in the financing of WHO, with extrabudgetary funding now providing more than half the total budget, which has implications for policy influence within the Organization. Policy is also being decided within an increasingly political milieu. These changes put significant pressure on the Organization in a number of ways, and it is essential to generate a public debate about WHO's future role if the Organization is to retain the esteem within which it is generally held. This paper makes an initial contribution to that debate. PMID- 10126756 TI - Local variations in old age care in the welfare state: the case of Sweden. AB - Swedish local municipalities are responsible for the provision of social welfare, including old age care. Local autonomy is far-reaching, and local inequities are indeed great for all kinds of domestic and institutional care for the elderly. Not only coverage rates differ widely but also costs per citizen and spending per elderly person vary vastly. Numerous parameters of the political, economic and geo-social structure of the municipalities explain only very little of these local variations. It seems that local differences are often of long standing: this may explain why 'rational' indicators of needs and local capacity fail to explain much of the inequities. Yet, one factor of socio-political importance emerges as significant: the system of tax redistribution enforced on largely autonomous municipalities. PMID- 10126755 TI - A comparison of empirical models on determinants of infant mortality: a cross national study on Africa. AB - The goal of achieving health for all by the year 2000 has instigated numerous studies on the determinants of health. In this paper, we re-evaluate two models in which infant mortality--across twenty-eight low- and middle-income African states--is explained by socioeconomic, demographic, medical, environmental and political factors. The results indicate that the GNP per capita, school population as a percentage of the population under 19, population density and the percentage of the population with access to health care together explained 80% of the variations in infant mortality in the sample study. Apart from the GNP per capita and the school population as a percentage of the population under 19 which were negative and statistically significant, variables of importance for health policy, e.g. female literacy rate, water supply, food aid, calorie supply, health care expenditure and the degree of urbanization carried a negative sign but were nonsignificant. We interpreted the above thus: a reduction in infant mortality is feasible only with changes on diverse fronts rather than by marginal improvements in a few determining factors. A comparative test of the replicated model and our proposed model has shown that our model produced a better theoretical and statistical fitting than did the replicated model. PMID- 10126757 TI - Hospital bad debt in France: who does not pay? AB - Hospital bad debt commonly represents 4-5% of total patient revenue. We examined bad debts accrued by our hospital over a 10-year period from both a medical and sociodemographic perspective. We found that true medical emergencies represent 90% of 'bad debtors' admitted, and that, despite generalized medical insurance in France, a quarter of unpaid bills belong to French residents. We conclude with a proposal to limit individual hospitals' accountability for bad debt. PMID- 10126758 TI - Toward national health system guidelines in Canada: reflections of a comprehensive audit. AB - A comprehensive assessment of the Health Program Guidelines (HPG) in Canada was undertaken between January and September 1992. This review examined the strategic effectiveness and operational efficiency of the guidelines under the auspices of the Federal, Provincial and Territorial Committee on Institutional and Medical Services. To assess the perceived needs for the guidelines, over 185 structured mail questionnaires were sent to a sample of health care agencies, institutions and organizations across Canada; the response rate was over 80.5%. A key informant approach was also used to assess the perceived effectiveness and efficiency of the guidelines. Based on the results of the questionnaires, over 45 interviews and an extensive content analysis of key documents, recommendations were made that may be relevant to the Canadian health system community. PMID- 10126759 TI - Health work force planning in the 90s, Part II: Enough in the right place at the right time? AB - The focus of this discussion has been on achieving a distribution of health care professionals that meets the objective of making health services available to the total population. The need for a systematic approach to planning, not only for the health care work force, but for the system in general, has been recognized as the highest priority for the health care systems of industrialized countries for over a decade. Overall, the goal of health care work force planning the world over is "to provide the right type of education and training for the right number and type of people needed to render effectively and safely the right types of service when and where required by the population." What is needed is a readiness to evaluate existing service delivery models, to retain those found to be effective and efficient, and to re-direct resources from outdated or ineffective strategies into new approaches found to better meet this goal. We need to envision the health care work force as a whole; work toward making it as efficient as possible, and thereby maintain our national commitment to universal health care. PMID- 10126760 TI - Health care managers in British Columbia, Part II: Exploring future directions. PMID- 10126761 TI - Policies and procedures in the workplace: how health care organizations compare. AB - Many organizations are implementing programs and services to manage the human and economic costs of stress. A mail survey was conducted of 500 randomly selected Canadian organizations having at least 500 employees. The survey tapped four major areas: organizational policies and procedures for managing stress; programs and services offered; perceived benefits and constraints for the organization; and projected future directions in this area. Analyses of returns from 210 organizations-43 health and 167 non-health-revealed various findings. For example, over half of health care organizations have policies and procedures as opposed to less than half of non-health care organizations. Also, health care organizations place greater emphasis on smoking cessation, weight control programs and on stress management training. Although some Canadian organizations are addressing stress, much more could and should be done, especially by organizations that do not yet recognize the impact of stress on employees and their work performance. PMID- 10126762 TI - Change or business as usual? A challenge for health care leaders contemplating total quality management. AB - The authors describe Total Quality Management (TQM) as an organizational change strategy. Health care leaders who implement TQM only as a "program" may achieve limited success. Leaders who respond to incentives that motivate personal change, understand the dynamics of socioeconomic transformation and put people (especially employees) first can positively influence organizational culture leading to successful change. A leader self-examination is recommended to evaluate personal readiness for the change that TQM represents. PMID- 10126763 TI - Those who repeat history are doomed to condemn it. PMID- 10126764 TI - Governance of hospitals in Canada: a survey of business leaders who serve as hospital trustees. AB - The Caldwell Partners Amrop International, in the course of conducting executive search, are often in contact with business executives across Canada, many of whom serve as hospital trustees. Because of the concerns being expressed informally by these trustees, it was decided to conduct a formal survey. The University of Toronto's Department of Health Administration was involved in designing the survey instrument and tabulating the results. The survey's findings cover many governance issues, such as board size, composition, terms, representation, roles, mergers, evaluation, quality of care, research institutes, fiscal issues and government relations. PMID- 10126765 TI - Air rescue service gets new home in a hangar--away from the airport. PMID- 10126766 TI - ED violence: strategies for prevention and minimization. PMID- 10126767 TI - Risk management's role in health facility construction projects. PMID- 10126768 TI - Top product quality and proper use ensure paint job's durability. PMID- 10126769 TI - Asset management: how to pick the best automated system. PMID- 10126770 TI - JCAHO begins unannounced surveys this month. PMID- 10126771 TI - Handling patients safely cuts staff injuries, costs. PMID- 10126772 TI - Risks low if contaminated linen handled properly. AB - This is the first of a two-part article. The conclusion will appear in the August issue. PMID- 10126773 TI - Unhappy consumers of computer services litigate with their providers. PMID- 10126774 TI - Practical considerations in deciding when to report to the Data Bank. PMID- 10126775 TI - Guide for unique healthcare identifier model. PMID- 10126776 TI - The medical transcriptionist as medical editor. PMID- 10126777 TI - Evaluating provider effectiveness. AB - Purchaser and provider managers alike want to know that they are getting value for money; purchasers will require information about service effectiveness and cost effectiveness, and will increasingly monitor the extent to which provider planning strategies and management practices reflect the best use of this information. Catherine Kyle provides some guidelines for auditing effectiveness internally. PMID- 10126778 TI - The real costs of computerisation. AB - In the NHS hospital environment, people tend to be discouraged by the seemingly unsupported cost figures associated with IT. After the successful implementation of an IT system at the Wirral Hospital NHS Trust, IT Manager, Alan Spours, argues that cost figures have to be seen in the context of deliverable cost benefits and the ability of IT to offer significant returns in the form of improved levels of care. PMID- 10126779 TI - Marketing: its place in organisational structure. AB - As a result of the reforms, provider units have to compete for contracts from HAs and GPFHs; the function of marketing has an outside focus in understanding, communicating with and providing for customers, and the internal role of ensuring services meet customers' needs. Humphrey Bourne and Christine Miles examine the marketing role in the NHS. PMID- 10126780 TI - Contracting models for purchasing. PMID- 10126781 TI - Managing for health gain. AB - The concept of health gain is growing in the NHS; The Health of the Nation is the first national strategy to set targets for health gain. The initiative holds implications for change for NHS managers in the way in which they perceive their task and the way in which they manage. PMID- 10126782 TI - Management ... the working day of a health services manager. Guy's & St Thomas' Hospital Trust. AB - In March, Tim Matthews was appointed Chief Executive of Guy's & St Thomas' Hospital Trust, effective from 1 April. It's the largest trust in the UK, with a budget of 240m, and at the heart of developments in the capital. PMID- 10126783 TI - Managing cultural diversity in the workplace. AB - Cultural diversity is a strength of the American work force. Due to the increasing cultural diversity in the workplace, organizations find it in their best interest to move beyond affirmative action to effective management to achieve higher employee retention and develops an employee cultural mix that better matches the mix of the available labor force and customer base. To manage a diverse work force, managers need to have the proper tools, training and evaluation and monitoring programs. Important initiatives to successful management of cultural diversity include eliciting support and commitment from the board of directors, the CEO and other top management; organizing subcommittees to research and monitor demographic changes to determine what the organization's goals should be and to decide what changes are to be made. Employees must be trained to be aware of prejudices and how to manage their own actions. PMID- 10126784 TI - Making minority-owned, women-owned and small business contracting a reality. AB - While government agencies require businesses with which they contract to meet a specific quota for purchasing from minority-owned businesses, many hospitals are exempt from these requirements. Sutter Community Hospitals in Sacramento, CA, however, established a goal to purchase a certain percentage of their services, supplies and equipment from minority-owned, women-owned and small businesses. Several attempts to get a program off the ground met with failure due to problems with locating appropriate businesses and with excessive paperwork and requirements of government entities the hospital system tried to work with. Eventually, Sutter's Materials Management Department defined, in a simple format, what it considered these businesses to be. Without a complicated qualifying process, Sutter had added 74 minority-owned, women-owned and small business suppliers to its vendor list, and 34 are currently providing products and services to the hospitals. It is thus able to build community support, keep money spent by Sutter in the community and engender cultural conscientiousness and acceptance throughout its facilities. PMID- 10126785 TI - Steam sterilization costs: a guide for the central service manager. AB - The Nassau County Medical Center CS department, East Meadow, New York, was faced with a staff layoff and an increased workload. With some hard thinking and strong staff support, new processes/systems were designed to save time and money. These included outsourcing the sterilization of "easy" trays, instituting a case cart program and developing custom packs. In order to determine where savings could be had, it was first important to examine current costs. By breaking the costs of sterilization processing down into an average cost per load, a formula was developed that helped determine many additional cost comparisons for the department. For example, the cost analysis formula could be used by CS departments to determine the cost-effectiveness of off-site sterilization, to compare using disposable vs. reusable items and to determine costs for EtO sterilization and aeration. PMID- 10126787 TI - Intracranial pressure monitors. ECRI. PMID- 10126786 TI - Electronic forms: a next step in hospital automation. AB - Information consists of two parts, facts and communication. It is not enough for one person to know a fact; the fact must be communicated for it to be of any value to anyone else. Forms were invented to do just that--communicate facts in a systematic manner from one party to the next. Automating forms with computers on a local area network or a wide area network allows for hospital personnel to input a patient's information once and electronically share the information from one department to another, simultaneously. Switching from a paper-based forms system to a fully automated workflow forms system or combining the two can save a healthcare institution money, errors, time and even lives. The levels of an automated forms system include: electronic forms design, demand printing, typewriter replacement, intelligent forms, intelligent mail and true workflow automation. PMID- 10126788 TI - Handling hazardous waste. PMID- 10126789 TI - The death of quality? PMID- 10126790 TI - Spending by older consumers: 1980 and 1990 compared. AB - Estimates of expenditures and income suggest that today's older Americans have higher preretirement and pension earnings than their 1980 counterparts; this is especially true of those aged 65 to 74. PMID- 10126791 TI - Health care reform and the clinical laboratory. AB - Some say clinical laboratories are a significant cause of the ever-increasing cost of health care. How will they fare in the Clinton plan to reform the system? PMID- 10126792 TI - Coping with CLIA, Part 10. CLIA '88 penalties and how to avoid them. AB - If CLIA '67 penalties were lethal, CLIA '88 punishments are merely life threatening. With careful preparation, however, you can avoid suffering. PMID- 10126793 TI - Managing termination, Part 2. How to cope with being fired. PMID- 10126794 TI - Bedside testing, Part 3. Quality management of bedside glucose testing. PMID- 10126795 TI - Comprehensive orientation extends a warm welcome. PMID- 10126796 TI - Undercover 'shopping' to evaluate lab services. AB - Wonder what goes on at your outpatient labs when you're not there? This clever adaptation from the retail world can help you ferret out foul play and affirm first-rate employees. PMID- 10126797 TI - National Practitioner Data Bank: more guidelines, more problems. AB - The complex reporting requirements under the National Practitioner Data Bank are further complicated by numerous exceptions and conflicting interpretations. Even after two years of operation, many physicians and reporting entities are unfamiliar with the system and its problems. In an apparent attempt to clarify the requirements, the Department of Health and Human Services, in 1992, issued a supplement to its 1990 guidebook for users. Unfortunately, this supplement causes even greater confusion and fails to correct existing inconsistencies with respect to such critical issues as summary suspension and medical malpractice settlement reporting. PMID- 10126798 TI - Principles for the release of physician-specific health care data: balancing the interests of patients and physicians. AB - Many state health departments and other agencies have become involved in the collection and analysis of physician-specific health care data. Two states--New York and Pennsylvania--have released surgeon-specific data on the results of coronary artery bypass graft surgery, and the Health Care Financing Administration is considering the release of physician-specific health care data. This article discusses those developments and presents suggested guidelines for the collection, use, and release of physician-specific data. PMID- 10126799 TI - Health care reform and global budgeting. AB - Americans seem to have reached a consensus about the urgent need to devise a cost containment strategy that leaves intact a pluralistic health care system. One option is global budgeting--the imposition of a national health care budget with all-payer price controls. This article reviews the factual and legal bases for global budgeting and examines proposed mechanisms to cap expenditures or fix prices for all medical goods and services. Also discussed are the implications of financial restraints on a free market economy, the experiences of other countries attempting to control health care costs while providing universal coverage, the complications of global budgeting, and ways to safeguard medical excellence and innovation if global budgeting is adopted. PMID- 10126800 TI - Implementing total quality management: the role of the medical staff. AB - The American health care industry is currently in the process of adopting total quality management--a comprehensive, participative, and systematic approach to planning and implementing continuous quality improvement. Since all hospitals will soon be required to establish total quality management programs, physicians need to understand and adapt to this approach. This article describes the total quality management process for identifying and resolving problems in the health care system and the role of the medical staff in ensuring the success of that process. PMID- 10126801 TI - Physician negotiations with managed care plans: an antitrust primer. AB - In negotiating with third-party payers, physicians--whether acting independently or as members of independent practice associations--must proceed very cautiously to prevent antitrust exposure. This article describes a number of government investigations in this area and provides some specific "do's" and "don'ts" for avoiding the appearance of collective action that might be in violation of the antitrust laws. PMID- 10126802 TI - OIG (Office of Inspector General) fraud alerts and management advisory report can be useful. PMID- 10126803 TI - Physicians' union forming corporation to aid bargaining. PMID- 10126804 TI - AIDS panel seeks national plan, leadership. PMID- 10126805 TI - Corning ups the price in Damon bidding. PMID- 10126806 TI - Columbia-Galen merger to make new chain the nation's largest collection of local systems--study. PMID- 10126807 TI - Healthcare update ... Calexico Hospital. PMID- 10126808 TI - Coalition to help build support for framework of reform plan. PMID- 10126809 TI - Colo., Texas laws offer relief. PMID- 10126810 TI - Providers most concerned about Medicare update. PMID- 10126811 TI - Looming reform starting to affect executives' professional futures. PMID- 10126812 TI - Quick steps toward reform alienate physicians, and CEO pays the price. PMID- 10126813 TI - Nurses' pay raises slide for second year. Annual Hay/Modern Healthcare nurse compensation survey indicates hospitals are paying more attention to incentive plans. PMID- 10126814 TI - AHA studying bylaw changes to expand its leadership ranks. PMID- 10126815 TI - Missouri to deliver report card. PMID- 10126816 TI - Hospitals shouldn't shortchange AIDS prevention spending--experts. PMID- 10126817 TI - Calif. Blue Shield, UniHealth unveil proposal to merge. PMID- 10126818 TI - Harvard school, teaching affiliates enter talks. PMID- 10126820 TI - Empire head deflects blame for woes. PMID- 10126819 TI - 3 hospital groups in Fla. to integrate. PMID- 10126821 TI - AMI third-quarter net drops 83%. PMID- 10126822 TI - Community Psychiatric posts drop in earnings, revenues. PMID- 10126823 TI - Moody's downgrades NME rating. PMID- 10126824 TI - OrNda's third-quarter results back in black. PMID- 10126825 TI - Talking about choices: critical care interventions for the frail elderly. Proceedings of the Eleventh Annual PRIDE Institute conference,October 20, 1992. PMID- 10126826 TI - The Patient Self-Determination Act: an overview. PMID- 10126827 TI - Elements of the Health Care Proxy Act. PMID- 10126828 TI - New York's do not resuscitate law. PMID- 10126829 TI - Death and dying: a Chinese viewpoint. PMID- 10126830 TI - The Jewish perspective on death and dying: a multifaceted response. PMID- 10126831 TI - The Hispanic perspective on death and dying: a combination of respect, empathy, and spirituality. PMID- 10126832 TI - A black perspective on death and dying: comforting man on his spiritual journey. PMID- 10126833 TI - Patient choices and medical decision-making: the ideal versus the reality. PMID- 10126834 TI - The real world experience: death of homebound elderly persons. Views from emergency medicine: our problem. PMID- 10126835 TI - The real world experience: death of homebound elderly persons. A daughter's perspective: facilitating the proper care for elderly and frail parents. PMID- 10126836 TI - The real world experience: death of homebound elderly persons. The provider's perspective. PMID- 10126837 TI - The real world experience: death of homebound elderly persons. Staff views from the front lines. AB - If advance directives are implemented properly, this could, in the long term, be a vehicle for more appropriate utilization of health care services and health care technology. Yet in our own large agency we find few patients and families making the choice to have advance directives. This confirms that real change in this area is not being achieved through legislative or regulatory mandate but rather through an interactive process. Home care agencies are in a strong position to effect this change. Next we need to move beyond compliance and into an understanding of how advance directive requirements must be integrated with a patient, the family, and their culture, along with the ongoing relationships that evolve between the nurse and the patient over time. PMID- 10126838 TI - Ethical approaches to setting limits. PMID- 10126839 TI - Healthy thoughts from Silver Platers. PMID- 10126840 TI - Old wine in new bottles: the increased antitrust risk of hospital diversification. PMID- 10126841 TI - Office visits for otitis media: United States, 1975-90. AB - Data from the National Ambulatory Medical Care Survey show a steady increase in the number and rate of physician office visits for otitis media over the period from 1975 to 1990. The annual visit rate during this period more than doubled, and for children under age 15, increased 175 percent. Though the increase is greatest for males under age 2, there are substantial increases for males and females under age 15. Reasons for this dramatic increase are not readily apparent. Data from the National Health Interview Survey (NHIS), however, suggest that the increased visit rate may reflect an increase in the incidence of ear infections. According to NHIS data, the incidence of acute ear infections among the U.S. population increased by about 40 percent between 1982 and 1990, from 6.1 to 8.6 conditions per 100 persons per year. This compares with an increase of about 52 percent in the physician office visit rate for otitis media, from 1980 to 1990. (Because of gaps in data collection, it is not possible to compare precisely concurrent time periods.) The under 15 age group, which accounts for about 80 percent of otitis media physician office visits, experienced a 60 percent increase in office visit rate from 1980 to 1990. This parallels data from the NHIS that show a 60 percent increase in the incidence of acute ear infections among the under 17 age group from 1982 to 1990. The reporting of an acute ear infection in the NHIS does not necessarily equate to an incidence of otitis media, but the parallel increases in ear infection incidence and otitis media physician visits are mutually supportive and likely to be related. PMID- 10126842 TI - Health insurance and utilization of medical care for chronically ill children with special needs. Health of our nation's children, United States, 1988. AB - In summary, a substantial proportion of Hispanic and low-income chronically ill children with special needs have neither private insurance nor Medicaid coverage. Those who averaged the fewest doctor visits during the past year for their condition (such as black or low-income children) also tended to be more likely to be hospitalized. Children who did not live with a biological mother or biological mother and father were least likely to have been to a physician or to be taking prescribed medications for their condition. These analyses pinpoint chronically ill children with special needs who are likely to have the least access to routine medical care. Further research is warranted to estimate the probable impact of the differential nonresponse and underreporting by minority and low income respondents on these estimates. PMID- 10126843 TI - Trends in childhood use of dental care products containing fluoride: United States, 1983-89. PMID- 10126844 TI - Office visits to otolaryngologists 1989-90, National Ambulatory Medical Care Survey. PMID- 10126845 TI - Office visits to obstetricians and gynecologists: United States, 1989-90. PMID- 10126846 TI - American Laundry Digest buyer's guide. PMID- 10126847 TI - Product line management development & integration. PMID- 10126848 TI - New developments in vascular imaging. Spiral CT angiography. PMID- 10126849 TI - Issues & realities (or, it wasn't me, Mom!). AB - While the Sixties redefined the word revolution and the Seventies brought us free love, the Eighties heralded the decade of change. Change--an alteration, transformation, variation, modification, innovation, a different way of looking at and doing things. PMID- 10126850 TI - Positron emission tomography. Executive update. PMID- 10126851 TI - Pollution abatement & cost savings. Are they possible? PMID- 10126852 TI - Assessing the appropriateness of physician prescribing for geriatric outpatients. Development and testing of an instrument. AB - OBJECTIVE: In a randomized, controlled trial evaluating the impact of clinical pharmacists' consultations on physicians' prescribing decisions, a seven-member physician/pharmacist panel developed an instrument to characterize and quantify the full range of drug-prescribing problems. The instrument was tested for validity and reliability. SAMPLE: The instrument was applied in reviewing prescribing for 236 geriatric outpatients. METHODS: To ensure internal validity of the instrument, five panel meetings were devoted to reaching a consensus on procedures, categories, criteria, and scoring. Each case was evaluated independently by two reviewers and each drug in the regimen was evaluated for drug-drug interactions, dosage, schedule, allergic reactions, therapeutic duplication, use of drugs without established diagnoses, and inappropriate drugs for the patient's clinical conditions; discrepancies were adjudicated by the panel chairperson. Self-reported adverse effects of 60 study patients who were interviewed, and hospital readmissions of all study patients were used to test the external validity of the instrument. RESULTS: Inter-rater reliability improved over time, reaching a high of 97.1 percent after six months. A positive association was determined between the prescribing scores and the number of reported adverse effects (rho = 0.28, p = 0.02). Although the number of patients with drug-related hospital readmissions was too few to establish a significant association between the prescribing scores and readmissions, the findings were expected. CONCLUSIONS: Given current requirements for drug utilization reviews in hospitals, health maintenance organizations, and Medicaid programs, this instrument may prove to be very useful. PMID- 10126854 TI - Preparing for health care reform. PMID- 10126853 TI - Comparison of five inservicing methods in an intensive care nursery. AB - OBJECTIVE: Communicating to nurses new information on therapeutics or pharmacy procedures is a frequent challenge faced by most hospital pharmacists. Pharmacists should use the most efficient and effective methods to inservice nursing staff. The purpose of this study was to compare five methods of inservicing in a neonatal intensive care unit (NICU) to determine which method resulted in the greatest knowledge retention as assessed by a ten-question quiz. DESIGN: Various combinations of written guideline alone, verbal discussion by a pharmacist with and without a written guideline, and verbal discussion by a nurse with and without a written guideline were used to introduce nurses to the use of caffeine for apnea/bradycardia of the newborn. Each nurse completed a quiz to assess knowledge retention. The written guideline and quiz were prepared by a pharmacist. PARTICIPANTS: Forty-eight nurses participated in the study: (1) group 1 (n = 11) received the written guideline only (no verbal discussion); (2) group 2 (n = 14) received verbal discussion by a pharmacist plus a written guideline; (3) group 3 (n = 9) received verbal discussion by a nurse-educator plus a written guideline; (4) group 4 (n = 9) received verbal discussion by a pharmacist (no written guideline); and (5) group 5 (n = 5) received verbal discussion by a nurse educator (no written guideline). MAIN OUTCOME MEASURES: Mean quiz scores for all groups were compared and assessed using the Irwin-Fisher test for equality of binomial probabilities on all possible pairs of groups. RESULTS: Mean quiz scores for groups 1 and 3 were 10; for group 2, 8.6; for group 4, 9; and for group 5, 9.2. Using the Irwin-Fisher tests for equality of binomial probabilities on all possible pairs of groups, the probability of obtaining a perfect score on the quiz was the highest for groups 1 and 3 (p < or = 0.05). CONCLUSIONS: Within the limitations and the setting of this study, the two most effective methods of nursing inservice were a pharmacist-prepared written guideline followed by a quiz, and the written guideline plus a verbal discussion by a nurse-educator followed by a quiz. Use of these methods can reduce pharmacist inservice time and improve medication knowledge of the nurses and possibly reduce errors in the NICU. PMID- 10126855 TI - The 'difficult patient' case study: an innovative risk management training method. PMID- 10126856 TI - Bad faith claims: a new risk to managed health care plans. PMID- 10126857 TI - A risk manager's evolving experience with CQI. Interview by Barbara Challan. PMID- 10126858 TI - Risk reduction strategies for agency nurse programs. PMID- 10126859 TI - Risk issues in claims reported by 85 small hospitals. AB - According to one business adage, 20 percent of one's activity reflects 80 percent of one's success. Although few managers in small hospitals spend more than 20 percent of their time on credentialing and peer review, those activities are likely to have the most impact on preventing claims in small hospitals. Other strategies that may enhance these activities include redefining the types of services offered when professional staff, resources for new services, and staff education are scarce. Help with developing sound peer review and credentialing practices can be found through networking within professional organizations, in documents published by national organizations, and by using professional risk management services available through liability carriers. Devoting time to improving providers' documentation skills, monitoring key technical skills of health care providers, and analyzing patient flows from provider to provider and service to service are also likely to have an impact on losses in small hospitals. PMID- 10126860 TI - The risk manager's role in the institutional ethics committee. PMID- 10126861 TI - Final notice regarding section 602 of the Veterans Health Care Act of 1992 duplicate discounts and rebates on drug purchases--HRSA. Final notice. AB - Section 602 of Public Law 102-585, the "Veterans Health Care Act of 1992," enacted section 340B of the Public Health Service Act, "Limitation on Prices of Drugs Purchased by Covered Entities." Section 340B provides discounts on covered outpatient drugs to eligible entities. Section 340B(a)(5)(A) provides that a drug purchase shall not be subject to both a discount under section 340B and a Medicaid rebate under section 1927 of the Social Security Act. The Department is directed to establish a mechanism to assure that covered entities comply with this prohibition. The purpose of this notice is to announce the final mechanism to prevent duplicate discounts and rebates. The proposed mechanism was announced in the Federal Register at 58 FR 27293 on May 7, 1993. A comment period of 30 days was established to allow public comment on the proposed mechanism. Two comments were received. Both comments concerned issues involving implementation of the mechanism and did not raise substantive issues concerning the mechanism itself; therefore, we will address both comments in the Effective Date section. The mechanism, in its final form, is adopted as proposed. PMID- 10126862 TI - Psychosocial policies in hospitals serving children: comparative characteristics. AB - This investigation identified and assessed the extent to which hospitals are implementing psychosocial services to meet the needs of children and their families. Following up a similar survey in 1981, a comprehensive questionnaire was sent to the directors of pediatric nursing at pediatric hospitals and general hospitals with pediatric residency programs in the U.S. and Canada. Data were analyzed in a variety of ways to determine the relation between characteristics of pediatric hospitals and general hospitals; Canadian and U.S. hospitals; and hospitals with short, medium, and long lengths of pediatric patient stay. Overall, pediatric hospitals provided more psychosocial services than did general hospitals, and more of these services were implemented in 1988 as compared to 1981. No consistent trends were evident among hospitals when countries or lengths of pediatric patient stay were compared. PMID- 10126863 TI - A multidisciplinary approach to pediatric pain: an empirical analysis. AB - A comprehensive assessment and multidimensional approach are critical for optimal outcomes in pediatric pain management. The purpose of this article is to describe the structure, function, and results of a multidisciplinary pain team composed of individuals from nursing, pediatric medicine, and pharmacology. The team's activities, including individual consultation on a school age/adolescent unit, are described. PMID- 10126864 TI - Focus and impact of pharmacists' interventions. AB - All pharmacists' interventions were collected over a two-week period and were assessed for type and impact on patient care and medication costs. A total of 361 interventions were collected with a physician acceptance rate of 95.8 percent. Eighty-two of the 361 interventions were reviewed by seven physicians with 93 percent of those being judged to have had a positive effect on patient outcome, 7 percent were judged to have had no effect, while none reviewed were judged to be detrimental. Life-saving interventions were judged to have occurred in 8.5 percent of interventions, while 90 percent of the interventions were perceived to have resulted in improved quality of care and/or physician education. Cost analysis was performed comparing the difference of total medication costs (drug, pharmacy, nursing and drug assay costs) for a 24 hour period prior to and after the intervention occurred. The cost-avoidance over the two week period was calculated to be $679, representing a conservative estimate of an annual cost avoidance of $17,654. Costs not evaluated were those avoided due to increased quality of care, decreased adverse drug effects and decreased length of hospital stay. Pharmacists' interventions which represent only a portion of a pharmacist's responsibilities, improve the quality of patient care and result in cost avoidance. PMID- 10126865 TI - Obtaining a critical care pharmacist position: a marketing case study. AB - Marketing theory is used to explain how Pharmacy Department managers at a Vancouver-area hospital secured a new ICU pharmacist position in a period of severe fiscal constraint. Market segmentation, target marketing and pull marketing strategy were combined to obtain support for the new position. Improved drug information services for ICU nurses were promoted to Nursing Administration and enhanced pharmacotherapy monitoring was promoted to the two critical care physicians primarily responsible for patient care in the ICU. These physicians and Nursing Administration voiced their support for the new position to the V.P. of Nursing (the functional officer for Pharmacy), who then promoted the new position to Hospital Administration. A half-time DUR commitment by the ICU pharmacist was offered to Hospital Administration, expanding this already successful service and guaranteeing cost recovery for the new position. Hospital Administration approved the new ICU clinical pharmacist position in a budget which saw other hospital departments lose several positions. PMID- 10126866 TI - A pharmacoeconomic evaluation of clozapine in one patient. AB - Sandoz Canada Inc. began distributing clozapine in Canada under the Clozaril Support and Assistance Network (CSAN) in 1990. The costs associated with the required compliance to the CSAN program has prompted much debate regarding the ethical and clinical considerations in selecting patients to receive clozapine therapy. We undertook a one year cost-comparison analysis of clozapine therapy by assessing total mental health care costs for a patient with an extensive hospitalization history who was prescribed clozapine. Average yearly hospitalization costs were $17,413. The average yearly cost associated with clozapine therapy for this patient, with no hospital admissions was $8,411. The total health care cost for the year following initiation of clozapine was $17,828, compared to a cost of $68,423 in the year prior to clozapine, or $27,754 in an estimated average year. This case is representative of costs savings that can be achieved by using clozapine and breaking the institution-dependency of many schizophrenic patients. PMID- 10126867 TI - Public hospitals legislation in Ontario: a historical overview. PMID- 10126868 TI - The contemporary hospital board: what is it and what does it do? PMID- 10126869 TI - Hospitals as businesses. PMID- 10126870 TI - Back to the future: patients' rights and the report on a new Public Hospitals Act in Ontario. PMID- 10126871 TI - The hospital board: a staff nurse's perspective. PMID- 10126872 TI - The social contract: the known and the unknown. PMID- 10126873 TI - Pre-conditions for social contracts. PMID- 10126874 TI - The First Nations and the planning process. PMID- 10126875 TI - The social contract. AB - In summary, with respect to the proposed social contract: we are strongly in favour of increased public consultation. To be effective, the process must be 'customer friendly,' and therefore, we see the need for the local community panel to deal with all of the health care needs of that community. The hospital situated in that local community should take the lead role, on behalf of the total health care system, to ensure that the community's total health care needs are addressed. The District Health Council should play the key role of facilitator of the process, promoting collaboration between health care providers situated both within and outside of that local community. PMID- 10126876 TI - Access to hospital resources. PMID- 10126877 TI - Escapes by violent patients: what two mental hospitals are doing. PMID- 10126878 TI - How security can communicate better with management. PMID- 10126879 TI - Tips on meeting JCAHO safety management and life safety standards. PMID- 10126880 TI - Special report. New products that improve security of parking and perimeter areas. AB - An estimated 20 to 30% of crimes involving hospital security take place in parking lots and garages, as well as other outside areas. In this special report, we'll bring you up-to-date on a number of products that have been introduced to improve access control of such areas, as well as reduce or prevent theft or mismanagement by cashiers or parking attendants. PMID- 10126881 TI - Managing security and safety in North Dakota: one hospital's experience. PMID- 10126882 TI - Physician-hospital organizations: creating a partnership. PMID- 10126883 TI - Physician-hospital partnerships like "nitroglycerin truck". PMID- 10126884 TI - A physician-friendly strategy for hospital success. PMID- 10126885 TI - The ethics of health care rationing. PMID- 10126886 TI - Health reform leadership. Health care's human quotient. PMID- 10126887 TI - Hospitals in service to their communities ... Communication Station; Center for Good Help; Cherry Street Health Services. PMID- 10126889 TI - Partners in reform. PMID- 10126888 TI - Experimentation and risk. PMID- 10126890 TI - On the brink of reform. PMID- 10126891 TI - Mo. law to make rural clinics more viable. PMID- 10126892 TI - Tampa business group dives into insurance-pool initiative. PMID- 10126893 TI - Report says managed care costs the same as traditional insurance. PMID- 10126894 TI - Group practices fight change in self-referral exemption. PMID- 10126895 TI - HealthSpan pays $3 million over false claims. PMID- 10126896 TI - IPAs can be as efficient as staff HMOs--study. PMID- 10126898 TI - Pa. governor's transplant prompts change in policy. PMID- 10126897 TI - ImageAmerica, Health Images talking merger. PMID- 10126899 TI - 14 hospitals chosen for mentoring program. PMID- 10126900 TI - Rating downgradings outpace upgrades during second quarter. PMID- 10126901 TI - New York investment banker attempting all-cash bid to buy Galen, block merger. PMID- 10126902 TI - Task force legacy hinges on fate of reform plan. PMID- 10126903 TI - Bold action needed now to prop up primary care. PMID- 10126904 TI - Push reform on the local level. PMID- 10126905 TI - Diversification, take two. Hospitals are adding non-acute-care services to broaden their marketability and boost their appeal to healthcare buyers. PMID- 10126906 TI - Battle for outpatient business puts lab chains, hospitals to the test. PMID- 10126907 TI - HMOs hope to head off price controls. PMID- 10126908 TI - Omaha-area hospitals teaming up with insurers. PMID- 10126909 TI - Pa. school district files suit challenging enrollment policy. PMID- 10126910 TI - Blue Shield-UniHealth merger won't force course correction, rivals say. PMID- 10126911 TI - Nine N.J. hospitals suing Blues to block network. PMID- 10126912 TI - Competitors agree to consolidate obstetrics at one Minn. facility. PMID- 10126913 TI - Newly formed REIT plans public offering. PMID- 10126914 TI - Trying new tools: critical pathways, case management. PMID- 10126915 TI - Reform plan pushed back; big decisions still pending. PMID- 10126916 TI - Three hospitals among top places to work ... Baptist Hospital of Miami; Beth Israel Hospital, Boston; Methodist Hospital, Houston. PMID- 10126917 TI - Automation controls inventory, cuts costs. PMID- 10126918 TI - Spouses are source for kidney transplants. PMID- 10126919 TI - Managed competition expert explains how plan would change the system. PMID- 10126920 TI - The role of cordless phones in improving patient care. PMID- 10126921 TI - Improving patient outcomes following joint replacement surgery at Methodist Evangelical Hospital. AB - Project Overview: In 1989, orthopedic surgeons at Methodist Evangelical Hospital began looking at the various components of arthroplasty, a surgical procedure in which an entire joint or part of a joint is replaced with metal or plastic components, in an effort to maximize the value of such procedures in terms of clinical outcome, quality of patient care, and cost. KEY FINDINGS: The average length of stay has dropped from 11 days to 8.1 days, resulting in a savings of approximately $2,100 per patient. Preadmission autologous blood donations for total knee arthroplasty have been discontinued. By standardizing certain orthopedic implants, the hospital has been able to reduce its inventory and eliminate instrumentation and loaner fees--a savings of approximately $445,000 annually. PMID- 10126923 TI - The physician's role in continuous improvement. PMID- 10126922 TI - The Minnesota Clinical Comparison and Assessment Program: a resource for clinical quality improvement programs. AB - Project Overview: MCCAP is a voluntary, statewide initiative of more than 50 hospitals designed to improve patient outcomes by reducing variation among healthcare providers. Elective cholecystectomy, both open and laparoscopic, has been one area of focus. KEY FINDINGS: Physicians are particularly interested in information about patient care that they do not routinely receive in a standardized format, such as the time required for patients to return to normal activities. Patients who did not meet guideline criteria but who were given prophylactic antibiotics prior to surgery experienced the same, minimal infection rate as patients who received no antibiotics prior to surgery. Participating hospitals are shifting their focus from looking at average occurrence rates (LOS, resource use by procedure) to identifying appropriate resource use. Although 82 percent of elective cholecystectomies met guideline requirements, 25 percent of all patients continue to experience their most distressing symptoms six months after surgery. Many physicians continue to use routine intraoperative cholangiography; however, MCCAP's guideline did a good job of differentiating patients who were more likely to benefit from the procedure from those who were not. PMID- 10126924 TI - ScrippsHealth: quality planning for clinical processes of care. AB - Project Overview: In 1991, Scripps Memorial Hospital developed clinical pathways (called CareTracs) for four DRGs in cardiovascular surgery (DRGs 104, 105, 106, and 107) in order to stabilize those clinical processes, collect data on them, and make improvements. KEY FINDINGS: In the first six months the CareTracs were in place, lengths of stay decreased by 20 to 30 percent and charges were reduced by approximately 20 percent. Patients in DRG 107 (coronary artery bypass graft without cardiac catheterization), on average, now spend less time in ICU and are extubated sooner -- improvements that have, in turn, reduced the incidence of nosocomial pneumonia. PMID- 10126925 TI - Reflections on clinical improvement: the questionable role of clinical practice guidelines. PMID- 10126926 TI - How a board can learn from clinical quality improvement reports. PMID- 10126927 TI - Physician-directed therapeutic plan for large and small bowel procedures: a quality improvement project at St. Vincent's Medical Center. AB - Project Overview: St. Vincent's Health System sought to increase the efficiency of and decrease costs for care of patients undergoing large or small bowel procedures (DRGs 148 and 149), while maintaining or improving patient outcomes. A multidisciplinary, physician-led task force developed a physician-directed therapeutic plan that was implemented in January 1992. KEY FINDINGS: In 1992, the average cost per case for 188 patients in DRG 148 was $12,507, a 5.4 percent reduction from the 1991 cost (a 12.9 percent reduction when inflation is taken into account). Length of stay was reduced by nearly one day, from 15.48 days to 14.56 days. PMID- 10126928 TI - Applying critical pathways to neurosurgery patients at the University of Michigan Medical Center. AB - Project Overview: In April 1990, The University of Michigan Hospitals began a major, multidisciplinary project to standardize care processes in order to increase efficiency and reduce costs while maintaining the quality of clinical care. A team of nurses began the project by developing critical pathways for two neurosurgery procedures--lumbar laminectomy and transphenoidal pituitary tumor resection. The pathways were reviewed by physicians and other staff from other disciplines and were implemented in January of 1991. KEY FINDINGS: Data from the first 14 months show a decrease in patients' average lengths of stay in both the intensive care unit (ICU) and routine care unit. Costs and variance data are being analyzed and further improvements to the pathways are being made. Eleven critical paths are now being used for neurosurgery patients. In retrospect, participants learned that physicians should be involved at the earliest stages of critical pathway development and in the process of implementation. PMID- 10126929 TI - Quality of care developments. 1993 update. AB - This monograph offers an overview of quality of care developments at the federal and state government levels, as well as in the private sector. Although health care reform legislation focuses on access, costs, and delivery systems, initiatives involving the quality of care not only will continue but are included in most of the reform efforts being proposed and those already under way. At the federal level... At the Health Care Financing Administration (HCFA), publication of Medicare mortality data is delayed and the Peer Review Organization (PRO) program is undergoing a major change of emphasis under a "quality improvement initiative." The Clinical Laboratory Improvement Act (CLIA) has taken effect amidst controversy and further rulemaking is expected to correct flaws. The Agency for Health Care Policy and Research (AHCPR) is forging ahead with new practice guidelines while it starts to evaluate their effectiveness. Data on the patient outcomes in organ transplant centers, first published last year, now will be published on a regular basis. The National Practitioner Data Bank continues functioning amidst criticism and varying recommendations for change, from excluding information on small malpractice claims (e.g., less than $30,000) to opening up the data bank to the public (as proposed by Rep. Ron Wyden). Other federal developments include various quality-related reports from the Inspector General of HHS, the General Accounting Office, the Prospective Payment Assessment Commission, and the Physician Payment Review Commission, plus QI initiatives in Veterans Administration hospitals and the CHAMPUS programs. Among the states... Florida has included outcome data reporting and dissemination in its health care reform plan while Illinois struggles with whether physician-specific data will be made public. An innovative effort to test whether practice guidelines can reduce malpractice costs is underway in Maine, while Indiana began an outcome data project. Among accreditation agencies and associations... The Joint Commission is moving ahead with its Agenda for Change, including nationwide reporting of quality indicators and an expansion of accreditation to health care delivery systems and hospice programs. The American Medical Association and the American Hospital Association continue to support practice guideline development with education and research, while a number of hospitals and health systems are using comparative outcome data and clinical benchmarking to study and improve care. Conclusion... There is certainly some duplication of effort and the question of value (return on investment) must be raised given the cost of all these efforts. Without question, however, quality of care initiatives are omnipresent and challenging. PMID- 10126930 TI - Front-line ambassador. PMID- 10126931 TI - Advanced practice. PMID- 10126932 TI - Yesterday and tomorrow. PMID- 10126933 TI - Leading hospitals into the community. PMID- 10126934 TI - The nucleus of modern health care. PMID- 10126935 TI - Doing nursing right. PMID- 10126936 TI - The terrible imbalance: human organs and tissues for therapy--a review of demand and supply. PMID- 10126937 TI - Legislating AIDS away: the limited role of legal persuasion in minimizing the spread of the human immunodeficiency virus. PMID- 10126938 TI - Secrets revealed: the limits of medical confidence. PMID- 10126939 TI - Medical models and legal categories: an English perspective. AB - Medical paternalism has been criticised for its denial of patients' rights. Though defended on grounds of patient welfare, it can also be detrimental to that interest. English law has predominantly endorsed medical paternalism, and the criticism of this stance has centered on patients' rights. But within established legal categories there is very little scope for analysis based on the rights of patients, the assertion of which may, in any event, not be conducive to the maximisation of their welfare. This article is primarily concerned with cases arising from the hospital setting, the source of most medical litigation. Its purpose is to argue that an approach grounded in the doctor's responsibility for the patient's welfare, but which affords due respect for patients' rights, accords with legal principle. PMID- 10126940 TI - Law in search of a principle. PMID- 10126941 TI - Vindicating the patient's rights: a comparative perspective. PMID- 10126942 TI - No fault compensation for medical misadventure--Australian expression of interest. PMID- 10126943 TI - Statutory caps: an involuntary contribution to the medical malpractice insurance crisis or a reasonable mechanism for obtaining affordable health care? AB - A medical malpractice insurance crisis occurred in the mid-1970s and mid-1980s evidenced by escalating malpractice insurance rates and increasing numbers of malpractice claims. Insurance companies maintained that the increase in insurance rates was necessary because of the sharp rise in the number of malpractice lawsuits, astronomical damage awards, and ineffective mechanisms to prevent and to eliminate nonmeritorious claims. Physicians responded by forming their own insurance companies, cancelling high-risk procedures, and orchestrating intensive legislative lobbying for tort reform. Insurance companies, physicians, and the legislature collaborated efforts to resolve this medical malpractice crisis. A national debate erupted regarding the proper way to address the medical malpractice insurance crisis. Insurance companies and physicians pressured state legislatures to reform liability laws that, in their opinion, permitted recovery of excessive damage awards by plaintiffs. Consumer groups and lawyers suggested tighter regulation of the insurance industry. State legislatures, in an attempt to remedy the perception that injured plaintiffs were overcompensated for their injuries, enacted "tort reform legislation," which included statutory caps on damages recoverable in medical malpractice actions. As a result of the extensive lobbying effort by physicians and insurance companies, twenty-seven states enacted statutes limiting recovery of damages in medical malpractice lawsuits. Lawyers responded by challenging state malpractice legislation on constitutional grounds, alleging violations of federal and state equal protection and due process clauses and the Seventh Amendment right to a jury trial. Opponents of the cap also asserted violations of state constitution provisions such as the "open courts" provision or the "special legislation" clause. To date, the state courts have held that statutory caps are unconstitutional. Statutory caps and other tort reform measures are extremely important in light of proposed health care legislation entitled the Health Care Liability Reform and Quality of Care Improvement Act of 1992 [the "Health Care Bill"]. This Comment critically examines the constitutionality of statutory caps on damages in medical malpractice actions. It focuses on the public policy behind the caps and the constitutional issues embodied in limiting an individual's recovery. It also analyzes the impact of the Health Care Bill on statutory caps. Part I outlines the medical malpractice insurance crisis, describes the statutory reforms and discusses the public policy behind tort reform. Part II examines the constitutionality of statutory caps and summarizes the arguments of the proponents and the opponents of these caps. Part III discusses the Health Care Bill and its impact on medical malpractice legislation with respect to statutory caps. This Comment concludes that a compromise must be reached that addresses both the growing health care insurance crisis and the protection of individual rights. The Health Care Liability Reform and Quality of Care Improvement Act of 1992 attempts to achieve this compromise. PMID- 10126944 TI - Rulemaking: the National Labor Relations Board's prescription for the recurring pains of the health care industry. PMID- 10126945 TI - The antitrust laws and the medical peer review process. PMID- 10126946 TI - Beyond autonomy: judicial restraint and the legal limits necessary to uphold the Hippocratic tradition and preserve the ethical integrity of the medical profession. PMID- 10126947 TI - Bioethical catch-22: the moratorium on federal funding of fetal tissue transplantation research and the NIH revitalization amendments. AB - In 1988, a moratorium on the use of federal funds for fetal tissue transplantation research (FTTR) halted the promise of a cure for millions of Americans suffering from Parkinson's disease, diabetes, and other debilitating conditions. Since the moratorium began, private and international experimentation continues with mixed success. In the foreground, however, the debate rages over federal funding for fetal tissue transplantation from induced abortions into humans. In the House of Representatives and the Senate, the debate culminated with the passage of the National Institutes of Health (NIH) Revitalization Amendments. In addition to authorizing NIH programs, the $5.4 billion bill included measures designed to overturn the moratorium on federal funding for the transplantation research. Brimming with controversy, the bill was forwarded to the White House where it met President Bush's promised veto. The veto was sustained when the House failed to rally the two-thirds majority vote necessary to override a veto, leaving the moratorium intact and the controversy alive. Modified measures were introduced in both Houses of Congress, but a Senate filibuster in the last hours of the session foreclosed a second veto and placed the bill on the 1993 calendar. The field of fetal tissue research, currently a fraction of human health research but with the potential for a six billion dollar industry, is the focus of inevitable controversy. FTTR, as a sub-field, presents a volatile combination of the politics of abortion, the international research race, and the cries of millions of Americans suffering from Parkinson's disease and other crippling debilitations. Thus, using fetal tissue as a potential cure commands the interest and the passion of many. FTTR from induced abortions distinguishes itself from federally approved fetal tissue research because it connects a potentially beneficial health pursuit with a critically divisive moral issue of our day--abortion. By its very nature, FTTR cannot automatically enjoy the approval given to other research pursuits, primarily because at its very core lies an unresolved ethical issue. This issue is found in the connection between the procedures of aborting the fetus, harvesting the tissue, and transplanting it into a needy recipient. Unlike transplantation from ectopic pregnancies or spontaneous abortions, which are permitted by the ban, FTTR directly links decisions and procedures immersed in the moral controversy over induced abortion. This Comment outlines the debate over the transplantation research affected by the moratorium on the use of federal funds for FTTR. Whether fetal tissue from induced abortions should be procured for transplantation into humans, and if so, how its use can be regulated is a significant contemporary challenge for public policy makers. Part I of this Comment delineates the formation of public policy on the issue. Part II explains the content of the NIH Amendments as a new direction for public policy. Part III discusses the potential benefits and risks of federal funding of FTTR. Finally, part IV addresses whether the executive ban or the legislative measure is a sound, farsighted public policy. PMID- 10126948 TI - Health based exclusion grounds in United States immigration policy: homosexuals, HIV infection and the medical examination of aliens. AB - The 1990 Immigration Act formally removed homosexuality from its longstanding position on the list of health-based exclusion grounds in United States immigration policy. Since the early 1900s when health-based exclusion grounds were introduced, a long history of excluding homosexuals has persisted. While the 1990 Congress clearly intended to remove the homosexual exclusion, public support for this controversial new policy is tenuous. As the HIV/AIDS pandemic spreads out of control, prejudice against homosexuals runs deeper than ever in American society. Human Immunodeficiency Virus (HIV) is a recent addition to the list of dangerous contagious diseases for which aliens may be excluded from the United States. Compelling social and economic grounds support its inclusion. The nexus between HIV and homosexuality, however, raises questions as to the immigration status of homosexuals and other persons seeking entry into the United States who, although not infected, are at a high risk of contracting HIV> Although the exclusion of HIV-infected aliens may be a reasonable means of combating the spread of HIV within the United States, it must not be used as a rationale to exclude individuals who may be at risk of contracting HIV. The medical examination of aliens must be tailored to meet the 1990 Immigration Act's objective of preventing the exclusion of homosexuals. Section I of this Note examines the factors influencing United States immigration policy as it relates to homosexuals. Section II provides background information on United States immigration policy, including the origins of the power to exclude aliens from entry into the United States and the allocation of this power within the federal government. Section II also focuses on the procedures by which aliens are excluded for health-related reasons. Section III explores both the historic exclusion of homosexuals from entry into the United States and the repudiation of this discriminatory policy in the 1990 Immigration Act. After the rational bases for this policy are discussed, this Note concludes that the policy is rational in light of the overburdened United States public health system. Section IV criticizes, as unreasonably subjective, recent revisions to the medical examination procedure that grant examining physicians broad discretion to designate an alien excludable upon a finding of a "physical abnormality." PMID- 10126949 TI - Resource allocation and the beginning of life. AB - Like many other countries, Australia is increasingly being forced to face the spiralling costs of health care. Population increases, an aging population, and the high cost of many items of modern medical equipment and of medical care generally, have all contributed to the pressure on health care resources. Within this climate of resource scarcity, more and more questions are being asked about the prioritization of items of health expenditure. The aim of this article is to consider the claim of reproductive technology, prenatal care, and prenatal diagnosis on health care resources and to evaluate the balance between treatments and preventative measures. PMID- 10126950 TI - Resource allocation--the legal implications. AB - Problems of resource allocation in the many health systems throughout the world are increasingly urgent. Although some argue that the problem is not one of limited resources but of misallocation of resources that would be sufficient if properly used. Most writers agree that there are insufficient resources available to meet demand, requiring action to allocate limited resources. Extensive debate among ethicists, economists, and policy-makers is devoted to determining effective, efficient and equitable methods of allocating limited resources in response to potentially unlimited demand. This paper outlines the problem of resource allocation and examines a recent Australian case in light of the complex problems raised by the need to contain health care costs in a mixed public and private health care system. Legal tensions are created by the possibility that resource constraints may affect the physician's role in caring for the patient, with possible consequences in negligence. PMID- 10126951 TI - Creating a functional environment. AB - Staff at this facility found that redesigning a common area not only improves the facility's appearance, but actually raises residents' level of independence and functioning. PMID- 10126952 TI - Developing exercise programs for frail older adults: rethinking the need. AB - For ambulatory and non-ambulatory residents, exercise for even the frail elderly reap many benefits. The key to any successful exercise program, however, starts with the administrator. PMID- 10126953 TI - Independence through movement. AB - Two long-term care professionals talk about exercise programs in their facilities. PMID- 10126954 TI - Exercise options on land and in the water. PMID- 10126955 TI - Hearing health services in nursing homes: perceptions of administrators and audiologists. AB - A recent survey found that many residents lack adequate audiological services despite a high prevalence of hearing loss. Upgrading hearing health services is one way to dramatically improve quality of life. PMID- 10126956 TI - Dental health and long-term care residents. AB - Many residents are only dimly aware of oral health problems, one of the most prevalent chronic conditions facing older adults. Poor oral function can result in diminished oral intake, discomfort, and may have a negative impact on quality of life. PMID- 10126957 TI - Revising the rules of employment liability. AB - Employment-at-will is an employee relations law doctrine dating back to the mid 19th century in the U.S. Learn how to handle certain employment relations issues specific to long-term care. PMID- 10126958 TI - Tairawhiti assessment and support. PMID- 10126959 TI - Management during the health reform. PMID- 10126960 TI - Update on Pennsylvania's HC4 and the use of data in marketing hospital services. PMID- 10126961 TI - The clinical pertinence of the medical record. PMID- 10126962 TI - HEDIS (Health Plan Employer Data and Information Set) 2.0 to provide standard performance data for health plans. PMID- 10126963 TI - States take their own reform steps. PMID- 10126964 TI - Making the case for healthcare smart cards. PMID- 10126965 TI - Emergency drug therapy for a healthier bottom line. PMID- 10126966 TI - Aspects of CPRs (computerized patient record) & organizational redesign. PMID- 10126967 TI - Using databases in pharmacies. PMID- 10126968 TI - Rx '93--pharmacy systems review. Pharmacy automation: bitter pills? or spoonfuls of sugar? PMID- 10126969 TI - Outsourcing vs. insourcing: who has the answer? PMID- 10126970 TI - Michigan State Medical Society takes 'no position' on state law. PMID- 10126971 TI - PSDA status: good institutional compliance but little overall effect. PMID- 10126972 TI - Hospital establishes business ethics committee. PMID- 10126973 TI - A decade of Medicare's prospective payment system--success or failure? AB - The growth in Medicare spending for inpatient hospital services slowed following the implementation of the prospective payment system (PPS) due to a decline in admission rates and limits on payment increases. Hospital costs, however, have increased faster than payments. Rather than reducing costs further, hospitals responded by charging privately insured patients more than the costs of their care and developing new revenue sources. PPS also redistributed Medicare payments across hospitals and was associated with increased spending in other settings. The PPS experience leaves policymakers with some immediate challenges and provides insights for the development of health care reform initiatives. PMID- 10126974 TI - Competition and prospective payment: a new way to control health costs. AB - Health care costs must be controlled to finance the expanded eligibility and coverage promised during the Presidential campaign. As a practical reality, reforming the existing fee-for-service system is the only way that significant cost control can be achieved during the next four years. The expansion of the basic Medicare prospective payment system to all health care settings and to all payers, combined with price discounting and consumer incentives to use providers that discount, can form the basis of a competitive prospective payment system (PPS). A competitive PPS can bring down costs and complement managed competition and other ongoing cost-containment initiatives. PMID- 10126975 TI - The ABCs of HIPCs (health insurance purchasing cooperatives). AB - HIPCs, or health care purchasing cooperatives, are attracting widespread interest as a key element of the managed competition approach to health reform. HIPCs perform several useful roles for individuals and small employers unable to obtain health insurance coverage in the current system by spreading risk more evenly and purchasing coverage in a given region or market area. While HIPCs are generally associated with managed competition, they are also compatible with reform strategies that require employers to pay for coverage or those that provide incentives for expanded coverage. PMID- 10126976 TI - DataLine. Health costs wring U.S. budget dry. PMID- 10126977 TI - White House Task Force gears up for health reform battle. PMID- 10126978 TI - A national AIDS czar ... yes, we need one. PMID- 10126979 TI - A national AIDS czar ... no, we don't need one. PMID- 10126980 TI - Paying for long term care without breaking the bank. AB - As the U.S. population ages and major health care reform looms on the horizon, the search for new sources of financing for long term care has intensified. A key question is whether these resources should come from greater private contributions or from an expansion in public programs. The Partnership for Long Term Care, a new, state-supported public-private program, taps both sectors to protect those in need of chronic, long term care from impoverishment. The Partnership encourages people to plan for their long term care needs and uses Medicaid as reinsurance for those who purchase a certified policy. The four states that are participating in the Partnership have introduced a new form of means testing and better long term care financing options than currently exist. PMID- 10126981 TI - Lobbying groups gird for health reform. PMID- 10126982 TI - 24-hour coverage: a marriage of convenience for workers and employers. PMID- 10126983 TI - Certificate-of-need laws back in style again. PMID- 10126984 TI - Sunshine state pushes managed competition reforms. PMID- 10126985 TI - Minnesota takes first steps toward universal health plan. PMID- 10126986 TI - The mark of Zorro. PMID- 10126987 TI - What's wrong with this picture? AB - A look at a troublesome practice in patient care documentation that places a legal burden on medical transcriptionists and should be of concern to everyone in the profession. PMID- 10126988 TI - In super-competitive Minneapolis region, Park Nicollet's cross-functional clinical teams streamline outpatient care services. PMID- 10126989 TI - Benchmarking and zero-based budgeting result in $1.3 million annual savings at Chicago suburbs' Good Samaritan. PMID- 10126990 TI - Special report. State health plans: solo flights with turbulence ahead. PMID- 10126991 TI - Study: hospitals improve ability to track charges. PMID- 10126992 TI - In pursuit of logistics integration. PMID- 10126993 TI - What to expect if OSHA inspects. PMID- 10126994 TI - Tips for buying patient monitors. PMID- 10126995 TI - Using operational auditing to smooth systems in central service. PMID- 10126996 TI - When the boss criticizes: 14 steps to personal and professional growth. PMID- 10126997 TI - Sophisticated bidding process yields savings in hospital lab supplies. PMID- 10126998 TI - Is there a role for materials managers in supplying home care programs? PMID- 10126999 TI - Singing the Blue Cross blues. PMID- 10127000 TI - Health reform here and abroad. PMID- 10127001 TI - Electronic data interchange--a vision for health care. PMID- 10127002 TI - CPR systems--resuscitation for health care records. AB - The concept of computerized patient record systems is becoming increasingly popular in the home care field. What are the possibilities as caring is linked with computers in the age of automation? PMID- 10127003 TI - The electronic patient records solution. AB - Automation has been the solution for many business problems, yet few home care agencies have extended computerization beyond the traditional billing and financial functions to the clinical nursing process. Excessive nursing time spent in documentation is arguably the single biggest business problem facing the industry. Why haven't computers been accepted by home care clinicians? How could new advances in technology create virtually paperless home care nursing? PMID- 10127004 TI - Analyzing home care information system needs. AB - Where does an agency even begin to automate? What hardware is needed? What software will work? How large a system is needed? The answers to these questions are determined by the questions here--questions that should be asked before the details of software and hardware even come up. PMID- 10127005 TI - An alternate road home to electronic media claims. AB - All agencies are not large enough to make going electronic cost effective--yet automation is inevitable for health care. The Missouri Alliance for Home Care found a way to bring electronic claims to these smaller agencies. PMID- 10127006 TI - Looking for answers with automation. PMID- 10127007 TI - Automated accounts receivable management with EDI. PMID- 10127008 TI - Efficiency with software information systems under prospective pay. AB - In a prospective pay environment, efficiency is the bottom line for home care agencies. This need calls for software information systems that can do many tasks at once, cutting down on both staff time and potential errors, leading to better care for the patient. PMID- 10127009 TI - Successful computer conversion at U.S. HomeCare. AB - Several years ago one large home care company found itself in a situation many home care providers will undoubtedly face: its hardware system could not keep up with its growth. This article shows how the company overcame the situation. PMID- 10127010 TI - Highlights of the first national homecare agency & hospice inventory. AB - Automation of home care will certainly speed documentation and free time for more proactive duties. It will also facilitate data collection, which is important for identifying trends, utilization rates, and data sets for further data collection. PMID- 10127011 TI - Data collection efforts in New England. AB - Amid growing demands for statistical compilations about home care, the eight state home care associations of the National Association for Home Care's Region I ventured into the arena of data collection. What have they learned? PMID- 10127013 TI - Directory of computer vendors and services. PMID- 10127012 TI - Making numbers talk--promoting home care legislators. AB - The home care industry stands to gain a lot in the coming health care reform. To argue effectively for home care's inclusion in new health care legislation, the industry must present hard facts and figures. PMID- 10127014 TI - Life satisfaction of the home care client. AB - Improving the quality of life is one of the prime motivations for home care providers, but how much and what kind of improvement does home care actually offer? This research brings up questions that the industry may wish to address. PMID- 10127015 TI - A home care nurse residency program. AB - Hiring new graduate nurses into the home care setting is no longer a taboo. With a carefully scheduled learning program and ongoing supervision and support, this program has shown that recently graduated nurses can be good home care clinicians. PMID- 10127016 TI - Information technology boosts managed care's 'bottom line'. AB - Too often physicians, clinics and hospitals affiliated with managed-care organizations pick up the tab for procedures that should be considered shared risk. Information systems can save millions if they're geared toward catching these billing faux pas. PMID- 10127017 TI - Community health MIS: "They who have the data make the rules". AB - Community Health Management Information Systems could be a blessing or a curse, depending on your point of view. But make no mistake, these reform-mandated systems are coming. Will they signal an end to personal privacy as "Big Brother" peeks into everyone's health background, or a new era in information-rich medical care? PMID- 10127018 TI - Leading change: the '90s healthcare challenge. AB - The steps leading to healthcare reform are steep. They leave those who climb them gasping for breath mid-way on the journey. It's not that the steps are too complex or impossible to overcome, but that their depth and breadth is constantly changing. PMID- 10127019 TI - Product overview HotList. Financial decision support. AB - July's HotList features financial decision-support products. All data have been provided by individual vendors who responded to our survey questions. Computers in Healthcare has made an effort to contact all vendors within this market. See the 1993 Computers in Healthcare Market Directory for complete listings. PMID- 10127020 TI - M-based case-management system helps coordinate care for AIDS patients. AB - The notion of coordinating a patient's care requirements over time and over different agencies is not new. The technological potential and benefits of automating case management, however, are just now beginning to show, particularly in managing the care of AIDS patients with long-term needs. PMID- 10127021 TI - Managed-care pharmacy: an integrated MIS approach. AB - Administering a managed-care pharmacy means data, data and more data. Drug interactions, duplicate therapy and early refills need to be pinpointed. M Technology fills that prescription with ease. PMID- 10127022 TI - Science fiction becomes reality with M technologies. AB - Sophisticated data management--the ability to share information across geographical and technical boundaries via heterogeneous networks with seamless interoperability--was the stuff of science fiction just a few years ago. It is now a reality with M. Thomas Salander, vice chair of the M Technology Association and chairman of the MUMPS Development Committee, sets the scene and shows the way. PMID- 10127023 TI - A vision of tomorrow. PMID- 10127024 TI - Is stress killing New York's EMTs? PMID- 10127025 TI - Hot stuff. Clinical thermometry has come a long way. PMID- 10127026 TI - New radio service targets EMS communications. AB - The EMS community should commend the FCC for attempting to help relieve some of the frequency-congestion problems by adopting the EMRS. EMS users, however, should continue to advocate cost-effective solutions to EMS frequency-congestion problems. PMID- 10127027 TI - The disinfection dilemma: how to reduce cross-contamination and nosocomical infection. PMID- 10127028 TI - Meeting OSHA standards for exposure control. Do your employees know all they should? PMID- 10127029 TI - The regulatory impact of potentially infectious waste to healthcare facilities. PMID- 10127030 TI - Transforming dining areas. PMID- 10127031 TI - Hospital systems cluster programs and services. PMID- 10127032 TI - Galen-Columbia merger impacts 20 U.S. markets. PMID- 10127033 TI - Bridging the visions of competing Catholic health care systems. PMID- 10127034 TI - Window of opportunity for subacute services is small. PMID- 10127035 TI - Washington hospitals begin to strategically prepare for change. Interview by Donald E. Johnson. AB - In May, the governor of Washington signed the Health Services Act (SB 5304), which requires that all Washington state residents will have access to a uniform array of health care services by 1999. In 1995, employers will be mandated to provide insurance coverage to employees. The new law also provides for capping premiums that insurers can charge for health care plans. Richard Roodman, administrator for Valley Medical Center in Renton, Wash., discusses state health care reform with Donald E.L. Johnson, editor and publisher of Health Care Strategic Management. PMID- 10127036 TI - Informal networks: the company behind the chart. AB - A glance at an organizational chart can show who's the boss and who reports to whom. But this formal chart won't reveal which people confer on technical matters or discuss office politics over lunch. Much of the real work in any company gets done through this informal organization with its complex networks of relationships that cross functions and divisions. According to consultants David Krackhardt and Jeffrey Hanson, managers can harness the true power in their companies by diagramming three types of networks: the advice network, which reveals the people to whom others turn to get work done; the trust network, which uncovers who shares delicate information; and the communication network, which shows who talks about work-related matters. Using employee questionnaires, managers can generate network maps that will get to the root of many organizational problems. When a task force in a computer company, for example, was not achieving its goals, the CEO turned to network maps to find out why. He discovered that the task force leader was central in the advice network but marginal in the trust network. Task force members did not believe he would look out for their interests, so the CEO used the trust map to find someone to share responsibility for the group. And when a bank manager saw in the network map that there was little communication between tellers and supervisors, he looked for ways to foster interaction among employees of all levels. As companies continue to flatten and rely on teams, managers must rely less on their authority and more on understanding these informal networks. Managers who can use maps to identify, leverage, and revamp informal networks will have the key to success. PMID- 10127037 TI - How Bell Labs creates star performers. AB - How can managers increase the productivity of professionals when most of their work goes on inside their heads? Robert Kelley and Janet Caplan believe that defining the difference between star performers and average workers is the answer. Many managers assume that top performers are just smarter. But the authors' research at the Bell Laboratories Switching Systems Business Unit (SSBU) has revealed that the real difference between stars and average workers is not IQ but the ways top performers do their jobs. Their study has led to a training program based on the strategies of star performers. The SSBU training program, known as the Productivity Enhancement Group (PEG), uses an expert model to demystify productivity. The star engineers selected to develop the expert model identified and ranked nine work strategies, such as taking initiative, networking, and self-management. Middle performers were also asked what makes for top-quality work, but their definitions and ranking of the strategies differed significantly from those of the top performers. Taking initiative, for example, meant something very different to an average worker than it did to a star. And for the middle performers, the ability to give good presentations was a core strategy, while it was peripheral for the top engineers. Once PEG got underway, respected engineers ran the training sessions, which included case studies, work related exercises, and frank discussion. The benefits of the program were striking: participants and managers reported substantial productivity increases in both star and average performers. The PEG program may not be a blueprint for other companies, but its message is clear: managers must focus on people, not on technology, to increase productivity in the knowledge economy. PMID- 10127038 TI - Is this the right time to come out? Case study. AB - In this fictional case study, Adam Lawson is a promising young associate at Kirkham McDowell Securities, a St. Louis underwriting and financial advisory firm. Recently, Adam helped to bring in an extremely lucrative deal, and soon he and a few other associates will be honored for their efforts at the firm's silver anniversary dinner. George Campbell, vice president in mergers and acquisitions, is caught unprepared when Adam tells him that, after serious reflection, he has decided to bring his partner, Robert Collins, to the banquet. George is one of Adam's biggest supporters at the firm, and he personally has no problem with Adam being gay. But it is one thing for Adam to come out of the closet at the office. It is quite another to do so at a public company-client event. After all, Kirkham McDowell's client roster includes some very conservative companies--one of the country's largest defense contractors, for example. George is concerned with how Adam's openness about his sexual orientation will play with their clients and, as a result, how senior management will react. Adam has not come to George for permission to bring Robert to the dinner. But clearly Adam wants some sort of response. George has never faced sexual diversity issues in the workplace before, and there is no company policy to guide him. Just how negative an effect could Robert have on Adam's career with the firm and the firm's relationship with its clients? Isn't it possible that even the firm's most conservative clients will simply decide that Adam's choice of guest is a personal matter--not a business one?(ABSTRACT TRUNCATED AT 250 WORDS) PMID- 10127039 TI - Made in U.S.A.: a renaissance in quality. AB - In the opinion of some journalists and business leaders, Japan's preeminence in product quality is a direct consequence of lectures delivered 40 years ago in Tokyo by two Americans--W. Edwards Deming and Joseph M. Juran. According to Dr. Juran, this view is pure chauvinist nonsense. Despite the shoddiness of Japanese consumer goods before the war, the Japanese did have a quality tradition in the superb workmanship of certain ancient crafts and in the design and manufacture of their military hardware, which, at the outset of the war, was highly competitive with our own. It was just that the Japanese had never devoted engineering expertise, capital, or management attention to the quality of exportable consumer goods. The shock of losing the war changed that mind-set. When Dr. Juran first lectured in Japan in 1954, his audience consisted of 140 CEOs. He had given the very same lectures dozens of times in the United States, but never to top management. American CEOs concentrated their attention on financial reports. Quality was a discipline that they delegated to engineers and special quality departments. In Japan, senior executives took personal charge of managing for quality; trained their managers, engineers, and employees in quality methods; developed quality measurements; pursued quality change at a revolutionary pace; and kept at it year after year until, by the mid-1970s, Japan had passed the United States in quality manufacturing. The unsung heroes of the Japanese quality revolution were Japanese managers, not American experts. Now Dr. Juran sees the beginnings of a quality revolution in the United States as global competition drives managers to focus on their nondelegable responsibilities in quality management. PMID- 10127040 TI - From value chain to value constellation: designing interactive strategy. AB - In today's fast-changing competitive environment, strategy is no longer a matter of positioning a fixed set of activities along that old industrial model, the value chain. Successful companies increasingly do not just add value, they reinvent it. The key strategic task is to reconfigure roles and relationships among a constellation of actors--suppliers, partners, customers--in order to mobilize the creation of value by new combinations of players. What is so different about this new logic of value? It breaks down the distinction between products and services and combines them into activity-based "offerings" from which customers can create value for themselves. But as potential offerings grow more complex, so do the relationships necessary to create them. As a result, a company's strategic task becomes the ongoing reconfiguration and integration of its competencies and customers. The authors provide three illustrations of these new rules of strategy. IKEA has blossomed into the world's largest retailer of home furnishings by redefining the relationships and organizational practices of the furniture business. Danish pharmacies and their national association have used the opportunity of health care reform to reconfigure their relationships with customers, doctors, hospitals, drug manufacturers, and with Danish and international health organizations to enlarge their role, competencies, and profits. French public-service concessionaires have mastered the art of conducting a creative dialogue between their customers--local governments in France and around the world--and a perpetually expanding set of infrastructure competencies. PMID- 10127041 TI - Building a learning organization. AB - Continuous improvement programs are proliferating as corporations seek to better themselves and gain an edge. Unfortunately, however, failed programs far outnumber successes, and improvement rates remain low. That's because most companies have failed to grasp a basic truth. Before people and companies can improve, they first must learn. And to do this, they need to look beyond rhetoric and high philosophy and focus on the fundamentals. Three critical issues must be addressed before a company can truly become a learning organization, writes HBS Professor David Garvin. First is the question of meaning: a well-grounded, easy to-apply definition of a learning organization. Second comes management: clearer operational guidelines for practice. Finally, better tools for measurement can assess an organization's rate and level of learning. Using these "three Ms" as a framework, Garvin defines learning organizations as skilled at five main activities: systematic problem solving, experimentation with new approaches, learning from past experience, learning from the best practices of others, and transferring knowledge quickly and efficiently throughout the organization. And since you can't manage something if you can't measure it, a complete learning audit is a must. That includes measuring cognitive and behavioral changes as well as tangible improvements in results. No learning organization is built overnight. Success comes from carefully cultivated attitudes, commitments, and management processes that accrue slowly and steadily. The first step is to foster an environment conducive to learning. Analog Devices, Chaparral Steel, Xerox, GE, and other companies provide enlightened examples. PMID- 10127042 TI - Summing up. PMID- 10127043 TI - Attitude problem. AB - Robert Julian-Allen's hospital stay was notable for the carelessness and cruelty he saw and experienced. He thinks there are important issues for managers to address. PMID- 10127044 TI - Dear diary .... PMID- 10127045 TI - Data briefing. Equity. PMID- 10127046 TI - Antineoplastic agents: comparing off-label uses among authoritative drug compendia. AB - Unlabeled indications for antineoplastic drugs listed in the American Hospital Formulary-Drug Information, United States Pharmacopeia Dispensing Information Drug Information for the Health Care Professional (Volume 1), and the American Medical Association-Drug Evaluations were evaluated. Specifically, the total number of unlabeled and unique uses (ie, not listed in either of the other two compendia) of 35 antineoplastic drugs were compared. Using a nonparametric analysis of variance to evaluate the results, significant differences in both the average unlabeled indications per drug and unique unlabeled indications per drug were found among the resources checked. The implications of the study results on reimbursement by private insurance carriers of unlabeled antineoplastic drug use is discussed in this article. PMID- 10127048 TI - Whatever happened to user fees and the FDA's promise to expedite new drug approvals? PMID- 10127047 TI - Can extended dosing intervals reduce drug costs while maintaining patient care? PMID- 10127049 TI - Transformational leadership. The credibility factor. PMID- 10127050 TI - Transformational leadership. Systems thinking in action. PMID- 10127051 TI - Transformational leadership. The leader with the "beginner's mind.". PMID- 10127052 TI - Transformational leadership. Leadership competencies for physicians. AB - Physician leaders accustomed to operating as "captain of the ship" must now employ group leadership skills to inspire a shared vision, facilitate consensus and ease the transition to integrated systems. PMID- 10127053 TI - Reinventing our institutions. Interview by Joe Flower. PMID- 10127054 TI - Readings in transformational leadership. The three-act revolutionary drama. PMID- 10127055 TI - The merits of intentional scarcity. PMID- 10127056 TI - Bridges, not walls--building healthier communities. PMID- 10127057 TI - Managed care and managing ethics. PMID- 10127058 TI - Hospital breast-feeding practices in Ontario. AB - The breast-feeding practices of Ontario hospitals with live birth rates between 1,500 and 4,000 per year were assessed in 1989 by surveying hospital dietitians. The involvement of the dietitian and/or nurse in hospital based breast-feeding education was determined and differences in hospital practices where dietitians were or were not directly involved in breast-feeding education were assessed. Completed surveys were received from 42 dietitians (84% response rate) of whom 45.5% were directly involved in teaching breast-feeding classes. Practices that could be considered barriers to successful breast-feeding were found in 25% to 60% of the hospitals. The only significant difference between dietitian and nursing directed instruction was that plain water was less likely to be routinely offered to infants when dietitians were involved (p < 0.05). Dietitians will need to become more proactive within the hospital setting by working with health care team members in obstetrics to remove barriers to successful breast-feeding. PMID- 10127059 TI - From the Canadian Dietetic Association. Concept of dietetic practice and framework for undergraduate education for the 21st century. AB - Rapid change and marked diversity are expected to characterize the 21st century. If dietitians are to serve as change facilitators in this environment they will have to demonstrate greater flexibility and creativity, practise critical analysis and problem solving and employ creative thinking. Although provision of quality nutrition care will remain the unique contribution of dietitians, practitioners in the future will require a greater understanding of the impact of social, economic and political systems on food availability and food consumption and, in turn, health and well-being. Critical to the future practice of dietetics will be a greater understanding of research methodology, computer technology, quality improvement processes and risk management, principles governing learning and behaviour, personnel management and organizational behaviour, family and group dynamics, interpersonal communication and their application to dietetic practice. The Canadian Dietetic Association recently adopted a framework for the development of baccalaureate programs in dietetics designed to enable the dietetic practitioner to continue to make a unique contribution in the 21st century. The framework allows individual institutions the freedom and flexibility to plan programs that are compatible with their philosophy and organizational structure. In addition, it is predicted on the principle that a career in dietetics entails a lifetime commitment to education, of which the baccalaureate program is only the beginning. PMID- 10127060 TI - Physical fitness and athletic performance: joint position of the Canadian Dietetic Association and the American Dietetic Association. PMID- 10127061 TI - Does marketing relate to hospital profitability? AB - The authors examine the relationship of hospitals' marketing activities- including the use of market intelligence activities, interfunctional coordination activities, and organizational responsiveness activities--to financial performance. The results suggest it would be valuable to hospital marketing managers to adopt a data-driven, proactive management style that incorporates a teamwork emphasis to improve their hospital's financial performance. PMID- 10127062 TI - Waiting in the emergency room: how to improve patient satisfaction. AB - The authors conducted a field experiment in which emergency-room patients of a metropolitan hospital were either given or not given an expected waiting time to see a physician. Patients were then surveyed through the mail on their satisfaction and perceptions of service quality. The results revealed that satisfaction levels were higher when patients believed that they had received information on expected waiting time. Regression analysis revealed that service quality dimensions of trust, responsiveness, and staff service were significant predictors of patient satisfaction. In addition, satisfaction was independently influenced by whether patients' prior timeliness expectations were confirmed. The authors discuss the results in terms of the concept that the situational context of the service may influence the quality dimensions that most affect consumer satisfaction. PMID- 10127063 TI - Consumer illness careers: an investigation of allergy sufferers and their universe of medical choices. AB - The concept of the consumer illness career with a focus on allergies is introduced and developed by the authors in terms of a trajectory of five stages over time, the related product-service unities or constellations--including health care treatments and remedies--and various situational and trait factors that influence the course of a consumer's response to his or her disease. Next, they investigate the career's holistic nature and thematic content in an in-depth study of allergy sufferers. The study indicates that allergy sufferers engage ina wide range of strategic behaviors and choices associated with coping with their allergies, much of which can be captured in terms of patterned themes. Finally, the authors offer research, managerial, and public policy implications. PMID- 10127064 TI - Linking core competencies to customer needs: strategic marketing of health care services. AB - Firms often are encouraged to develop expertise, or core competencies, that lead to innovative products and services. The authors present a market research study that enabled a health care service provider to link its core technological competencies to customer needs. Although potential customers did not explicitly value the technology itself, links could be made between technological competencies and more valued service dimensions such as communication flows, meeting deadlines, and staff responsiveness. Improving strategic marketing and service quality delivery can be realized through market research linking customer needs to a firm's core competencies. PMID- 10127065 TI - How physicians make referrals. AB - The physician is an important gatekeeper in the "buying" process for many health care services. Consulting physicians and tertiary care hospitals depend on physician referrals for much of their patient volume. A field survey of more than 1,000 physicians uncovered their attitudes and choice criteria pertaining to referrals. Physician referral attitudes are used as a basis for creating four physician segments. The authors explore attitude and behavioral differences among the four segments and discuss several physician marketing implications. PMID- 10127066 TI - Nursing home capital reimbursement: issues for education of health care administrators. PMID- 10127067 TI - The nature and significance of stakeholder management in long-term care facilities. PMID- 10127068 TI - Competitive strategy in the market for nursing home services: a managerial perspective. PMID- 10127069 TI - Ethics education in long-term care: the Decisions Near the End of Life program. PMID- 10127070 TI - Medicaid payment policies for nursing home care: case mix, access, and heavy care. PMID- 10127071 TI - Teaching long-term care administration with the case study method. PMID- 10127072 TI - Caring administration. PMID- 10127073 TI - Evaluation of medical staff using fiscal factors: economic credentialing. PMID- 10127074 TI - Data on employee physician profiling. PMID- 10127075 TI - The electronic chart: keeping it confidential and secure. PMID- 10127076 TI - Exclusive contracting: the original economic credentialing. PMID- 10127077 TI - The Oregon Plan: an ethical solution to the health care crisis? PMID- 10127078 TI - Health care rate regulations: the need for a reinvigorated "takings" analysis. PMID- 10127079 TI - Quality assessment in the '90s: legal implications for hospitals. PMID- 10127080 TI - The child and the chaplain in the mental health hospital: a clinical impression. AB - Describes some characteristics of certain learning disabilities in children and how a chaplain can provide effective pastoral care to the dysfunctional child. Notes through clinical vignettes how a chaplain can communicate God's love and faithfulness to children who suffer from attention deficits and hyperactivity disorders. PMID- 10127081 TI - PROs and the health care quality improvement initiative: insights from 50 cases of serious medical mistakes. PMID- 10127082 TI - Managed care for preventive services: a review of policy options. AB - In summary, the managed care system we propose for preventive services is designed to limit the potential for overcare under FFS payment and for undercare under capitation and comprehensive fixed fees. It bases payment on the provision of a complete set of preventive services, thus limiting the tendency of physicians to provide only the relatively high-profit services, such as screening tests, while neglecting the lower-profit services, such as counseling. It also allows primary care providers to outsource selected services to lower-cost providers, such as laboratories, health educators, and counselors, and community based health promotion programs, thus encouraging greater efficiency. In addition, the proposed system funds both primary and high-risk preventive case management to ensure that individuals receive preventive services appropriate to their age, sex, and risk factors. Finally, the proposed system monitors the use of preventive services, relying on physician reminders to stimulate the appropriate provision of preventive care and denying payment for unauthorized care. Existing research suggests that none of the individual strategies for managed care can be expected to achieve all of the goals of managing and promoting the appropriate use of preventive services as defined by the U.S. Preventive Services Task Force (1989). To be most effective, we conclude that the strategies need to be coordinated and integrated into the current health care delivery practices of HMOs, PPOs, and point-of-service plans. In addition, the strategies require additional provider training in preventive care. With this support, the proposed model has the potential to improve quality, control costs, and increase the appropriate use of preventive care. While many of the individual components of the proposed managed care model have been evaluated for preventive services, a great deal more research is needed to evaluate the effect of combining these elements into a coordinated and comprehensive approach to managing preventive care. Research is also needed on workable ways to invite people not currently receiving medical care into the health care system to receive preventive care. To inform policy development, the impact of the proposed managed care model--both on preventive services utilization for specific screening, immunization, and counseling services, and on total health care costs and patient health status outcomes--needs to be evaluated. PMID- 10127083 TI - Defining underinsurance: a conceptual framework for policy and empirical analysis. PMID- 10127084 TI - The patient satisfaction process: moving toward a comprehensive model. PMID- 10127085 TI - Did the Supreme Court just do you a favor? AB - By permitting depreciation of patient lists, the judges gave both buyers and sellers of medical practices a chance to make a better--but not great--deal. PMID- 10127086 TI - What the Medicare fraud squad looks for in claims. PMID- 10127087 TI - Guidelines spread, but how much impact will they have? PMID- 10127088 TI - 12 Houston hospitals to underwrite study on area health needs. PMID- 10127089 TI - Revised budget plan would keep L.A. County hospitals from closing. PMID- 10127090 TI - Calif. hospital replaces 51 striking nurses. PMID- 10127091 TI - Baxter sees 5% drop in operating income. PMID- 10127092 TI - Hearings begin on rules for Fla. health plan. PMID- 10127094 TI - FTC says dental group restrains trade. PMID- 10127093 TI - Tax referendum could be fatal to key components of Wash. plan. PMID- 10127096 TI - Tokos to take another tumble. PMID- 10127095 TI - 7 hospitals save $14 million on flat-rate billing for heart surgery. PMID- 10127097 TI - Advisers to Congress say national healthcare budget idea could work. PMID- 10127098 TI - Reform blueprint crowded out, maybe until '94. PMID- 10127099 TI - JCAHO decision to share data is welcome, but long overdue. PMID- 10127100 TI - It's time to add cost-effectiveness to the healthcare reform equation. PMID- 10127101 TI - A tug of war over taxes. States, feds looking at same revenue sources to finance their healthcare agendas. PMID- 10127102 TI - The Rockford file: fact finding in aftermath of a failed merger. PMID- 10127103 TI - Des Moines hospitals feel effects of flood. PMID- 10127104 TI - Computers, networks help Intermountain integrate. PMID- 10127105 TI - At M.D. Anderson, specialists read minds before they write software. PMID- 10127106 TI - Methodist tracks huge volume of patient comings and goings. PMID- 10127107 TI - State associations' changes on deck often just a reshuffling. PMID- 10127108 TI - Bond sales continue brisk pace in 2nd quarter. PMID- 10127109 TI - Healthcare PAC contributions climb 20%. PMID- 10127110 TI - Provider groups voice support for Elders. PMID- 10127111 TI - Humana, Principal Health expand into new markets through acquisition deals. PMID- 10127112 TI - HMOs join to blanket New England. PMID- 10127113 TI - Pa. hospitals agree, sort of, to payment pact. PMID- 10127115 TI - 3 Minn. hospital groups seek closer ties. PMID- 10127114 TI - Miami-area facilities form alliance to get in shape for state reform. PMID- 10127116 TI - New Empire CEO wants to limit choice for some. PMID- 10127117 TI - 37 plans come to rescue of D.C. unit. PMID- 10127118 TI - Colo. merger to be revised. PMID- 10127120 TI - Limit seen to Medicare cuts in budget. PMID- 10127119 TI - New organ sharing approach planned. PMID- 10127121 TI - Single-payer advocates take the offensive. PMID- 10127122 TI - Legal issues prompting change in hospitals' habits. PMID- 10127123 TI - HCFA proposes paying physicians less for services they provide in the hospital. PMID- 10127124 TI - Mo. hospitals help neighbors deal with floods. PMID- 10127125 TI - Policyholders sue La. Blues plan. PMID- 10127126 TI - Baxter earnings climb 6.5%. PMID- 10127127 TI - Access, quality of care in VA system like a 'lottery'. PMID- 10127128 TI - Court hits Alaska program for inadequate payments. PMID- 10127129 TI - Hawaii wins approval for Medicaid waiver. PMID- 10127130 TI - Kaiser, SEIU local reach tentative 3-year pact to end 4-month dispute. PMID- 10127131 TI - 'Military health plans' eyed. PMID- 10127132 TI - Freeze effects 'hard to predict'. PMID- 10127133 TI - Organ distribution needs clear rules and incentives. PMID- 10127134 TI - Not-for-profits lure investors. PMID- 10127135 TI - HCA earnings climb 13% in 2nd quarter. PMID- 10127136 TI - NME gains profit, loses two directors. PMID- 10127137 TI - Getting past superficial changes to achieve real organizational growth. PMID- 10127139 TI - Demand for disposables likely to rise in home care. PMID- 10127138 TI - Physician groups selling old receivables to funding companies to raise cash. PMID- 10127140 TI - New York is the winner, New Jersey the loser in decision on MSA changes. PMID- 10127141 TI - Pension counseling may be inadequate. PMID- 10127142 TI - Billing and accounts receivable: fundamentals for improvement. AB - If a healthcare facility's accounts receivable operation is experiencing problems, the patient accounts manager should survey all areas of his or her responsibility to determine the best method of resolving the difficulties. One effective technique to reduce billing problems is to take a proactive--not reactive--approach. If mistakes can be corrected before they get out of control, and if the patient accounts manager can ensure that claims will not be denied, a healthcare facility's accounts receivable should remain in good condition. PMID- 10127143 TI - Color aptitude in facility design enhances autonomy, attitude. PMID- 10127144 TI - Successful rehabilitation program rests on service utilization. AB - An effective rehabilitation strategy is built upon three fundamentals: translating resident needs into delivered services, managing occupancy and marketing programs, and utilizing existing reimbursement mechanisms to ensure profitability of the venture. PMID- 10127145 TI - Correctly classifying employees helps facilities avoid tax pitfalls. PMID- 10127146 TI - Elements of psychiatric treatment plan reduce behavioral difficulties. PMID- 10127147 TI - Assisted living. FHA mortgage insurance is smart answer to industry boom. PMID- 10127148 TI - Informed research participation preserves resident rights. PMID- 10127149 TI - Home care as an effective option to institutional care for the Medicaid-eligible elderly population: a pilot study of cost and operations. PMID- 10127150 TI - Helping consumers to select an appropriate long-term care insurance policy. AB - Consumers who purchase long term care insurance policies can get good value for their money but there are several residual risks. Advisers have an important responsibility to make sure that their clients fully understand these risks. We recommend that consumers who are appropriate candidates for long term care insurance take into account the following guidelines: Make sure that a policy is bought from a well-known, financially secure company that has an A.M. Best Company rating of A or A+ or at least an A rating from Standard & Poor's. Avoid companies that have a history of consumer complaints, post-claims underwriting, high agent commissions, high lapse rates, or abuses in the Medigap market. Buy a policy with level premiums but understand that in the absence of explicit rate guarantees, premiums may be increased in the future. Seek policies that are guaranteed renewable, explicitly ensure fair access to policy upgrades, provide protection in case of late premium payments, and guarantee protection from potential changes in government benefits. PMID- 10127151 TI - A consideration of the role of care partners in long-term care for the frail elderly. PMID- 10127152 TI - Informed consent and the health-care proxy. PMID- 10127153 TI - Community by community: ensuring early access to care. PMID- 10127154 TI - Enhancing community relations in a health reform environment. PMID- 10127155 TI - Diversity in hospital management--a diagnosis and prescription. PMID- 10127156 TI - Pre-crisis management: protecting the hospital's image. Informed communication with the public is a key step in a crisis. PMID- 10127157 TI - Tension wanes between most hospitals and medical staffs. PMID- 10127158 TI - Managed care: where--and how--will hospitals fit in? PMID- 10127159 TI - The need for diversity on the board. PMID- 10127160 TI - Insurers skeptical of health reform. PMID- 10127161 TI - How can we achieve racial equality? Study finds disparity in careers of health care executives. PMID- 10127162 TI - America's best hospitals. PMID- 10127163 TI - The local alternative. A community hospital can be a high-quality option. PMID- 10127164 TI - The 16 specialties. From AIDS to urology, 554 sources of outstanding care. PMID- 10127165 TI - Management is performance: strategies for client-centered practice in social service organizations. AB - The political nature of human services is a given. The multiple constituency dilemma coupled with the retrenchment of the 1970s and 1980s has led to a great gulf separating managers from clients, and managers from front-line personnel. These political factors have been reinforced by management theory and the blind adoption of "state-of-the-art" management technologies developed in business and the military, and the separation has gained legitimacy. The result is less than optimal service, a dissatisfied workforce, and continued attacks for being inefficient, self-serving, and ineffective. The purpose of this article is to portray an alternative form of human service management. Its vision places clients center stage in our organizations and places the manager as the director and producer. It accepts the premises that "management is the principle engine of progress" (Levitt, 1976) and that management is performance. It then lays a foundation for client-centered management by presenting four principles for social service administrators who desire to adopt this perspective in their daily practice. An elaboration of the skills and methods of client-centered management can be found in a recently published text (Rapp & Poertner, 1991). PMID- 10127166 TI - An integrated model for continuous quality improvement and productivity improvement in health services organizations. AB - The health services paradigm with respect to quality has shifted to that of conformance to requirements (the absence of defects) and fitness for use (meeting customer expectations and needs). This article presents an integrated model of continuous quality improvement (CQI) (often referred to as total quality management) and productivity improvement for health services organizations. It incorporates input-output theory and focuses on the CQI challenge--"How can we be certain that we do the right things right the first time, every time?" The twin pillars of CQI are presented. Achievement of both will result in productivity improvement and enhancement of the health services organization's competitive position. PMID- 10127167 TI - A taste of our quality. AB - High Point Regional Hospital Laboratory was awarded special recognition in the areas of customer service and human resources for the 1992 CLMA Quality Management Award. This article describes several programs and helpful hints in an effort to share information with other laboratories. These programs and strategies worked for us. We would welcome your ideas in return. PMID- 10127168 TI - The vendor/laboratory manager relationship: some practical negotiation tips. AB - We negotiate practically every minute of the day with ourselves, as well as with spouses or loved ones, family members, friends, bosses, and coworkers. Skilled negotiators search for the common good, present accurate information, create alternatives, and strive for agreements that are fair to all concerned. Those who use misinformation and manipulation to win their short-term positions fail to build long-term relationships. Developing a positive attitude toward negotiating involves experience, recognizing the negotiating mechanism, evaluating decisions, and correctly determining when to stop negotiating and move on. Negotiations between suppliers and laboratory managers are used in this article to illustrate these processes. PMID- 10127169 TI - A vision for world-class quality in health care. AB - When we talk about world-class health care, we are finding that we are in a position where the purchasers of our services find there is little or no value for the health-care dollars they are spending. Even the father of American Quality, W. Edwards Deming, has listed the high cost of health care as one of the seven deadly diseases, so we know that we are in trouble. According to a 1989 study, the public tells us that 32% of the time the value of health care they receive is good to excellent, and 65% of the time it is fair to poor. When we look at what our physicians say, 76% of them believe that we get good value for health-care dollars as opposed to 23% who think it is fair to poor. As I have been thinking about what world-class quality would mean, one of the things that comes to mind is the fact that health care is now consuming 15% of the gross national product. We are approaching an expenditure level of one trillion dollars. If our results were good, we could feel comfortable resting on our laurels, because for those we serve in the American health-care system, we serve them very well. But our results are not good. We are 23rd in the world in infant mortality, and we are 16th in the world for life expectancy. The real tragedy in the American health-care system is that 37 million Americans are uninsured. Obviously this cannot continue.(ABSTRACT TRUNCATED AT 250 WORDS) PMID- 10127170 TI - Goal of the reforms is to provide better and more quality care. PMID- 10127171 TI - Strategic partnerships--a whole new approach to reviewing non-core support services. PMID- 10127172 TI - Mentor-based management development: the Napier Hospital initiative. PMID- 10127173 TI - Complexity of change--achieving social equilibrium beyond the restructuring of health services in New Zealand. AB - Initial and exploratory research (Driscoll, 1993) demonstrates that most of the general public and health professionals have not moved out of Lewins (1951) first stage of unfreezing when attitudes to the current health reforms are appraised. People are bewildered with continual change process in the health system. Any potential benefits are being lost in the perception of loss. The new "managers" with the responsibility of reforming an overworked health system may discover the biggest achievement will be to change attitudes of clients and health professionals so that there can be a renewed, revitalized team approach to a system confident of delivering a quality service. PMID- 10127174 TI - Significant achievements of area health boards: report on a survey of senior managers. PMID- 10127175 TI - The introduction of the older patient's problems in the medical visit. AB - In this study of 100 diabetes patients 60 years old or older making return medical visits, 56% of patients reported one or more important medical problems that were never raised with their doctor. Sixty percent of patients reported important psychosocial problems that were never raised. One quarter of all patients were not able to raise even modest agendas of medical problems during the visit. These gaps in doctor-patient communication potentially reduce the effectiveness of medical care by failing to address symptoms of treatable conditions that impact functional status and quality of life. PMID- 10127176 TI - Age differences in the breast cancer management of rural women. AB - This article describes the effect of age on the pattern of access to breast cancer care among rural women diagnosed in 1986-1989. Cases were identified by the Illinois State Cancer Registry and information on breast cancer management was obtained through review of hospital records and physician survey. Case follow back was more than 99% complete. State-of-the-art breast cancer management was defined by the Physician Data Query (PDQ) and included diagnostic evaluation, prognostic evaluation, and stage-specific definitive treatment. The data did not indicate age differences in bilateral diagnostic mammography, performance of hormone receptor assays, radiation therapy, and stage-appropriate treatment. Tumor staging and axillary node dissection did differ by age with significant negative trends in the multivariate model. Also, women younger than 55 years were the most likely to receive separate diagnostic biopsy, limited surgery, and chemotherapy, whereas women 55 to 74 years were most likely to receive hormone therapy. Although rural populations may experience barriers to some aspects of state-of-the-art breast cancer management, age does not always exacerbate them. PMID- 10127177 TI - Health reform insight. Single payer proponents riding health reform crest. PMID- 10127178 TI - Perspectives. Primary care moves into prime time. PMID- 10127179 TI - Perspectives. Strapped governments eye nonprofit hospitals. PMID- 10127180 TI - State of flux: adapting IS to support a care continuum. PMID- 10127181 TI - Predicting regional enterprises: IS implications. PMID- 10127182 TI - Great gravitation: supporting decisions with mainframe data on PCs. PMID- 10127183 TI - Problem solving & recovery: a solution for distributed IS environments. PMID- 10127184 TI - CIO forum. Should IS professionals be certified? PMID- 10127185 TI - Trends in healthcare computing. PMID- 10127186 TI - Concentrating on platform flexibility: saving the expense of intelligent hubs. PMID- 10127187 TI - Why outsource patient financial functions? PMID- 10127188 TI - Putting it all together: integration tools. PMID- 10127189 TI - At the corner of HIS Avenue & Memory Lane. PMID- 10127190 TI - The leading healthcare information systems vendors in America. PMID- 10127191 TI - High anxiety: surviving a vendor shakeout. PMID- 10127192 TI - System failure: your rights & remedies. PMID- 10127193 TI - Test driving Iowa's FDDI superhighway. AB - Iowans soon will communicate in a new light: the Iowa Communications Network is a statewide fiber optic network that can change education, and hopefully healthcare, in the state. Users at five Iowa hospitals will enjoy direct access to the ICN because of their affiliated School of Nursing programs. Preparations at Iowa Methodist Medical Center for educational programming over the ICN will put most of the components in place that will be used during a July 22, 1993, demonstration. PMID- 10127194 TI - A sense of urgency: state governments and health care in the 1990s. AB - Unless President Clinton induces Congress to move exceedingly quickly to roll Medicaid into some larger reform scheme, his administration will be under heavy pressure to free states to pursue their own health care reform agendas. At that juncture, the most likely casualty would be the ERISA preemption. PMID- 10127195 TI - New Jersey's health care system reforms. AB - As New Jersey grappled with the huge burden of uncompensated hospital care, a diverse group of organizations banded together to develop a unique private sector response to the immediate crisis and a long-term strategy for comprehensive reform of the state's health care system. PMID- 10127196 TI - Necessity gives birth to health care reform in Florida. PMID- 10127197 TI - No new state tax: universal health care coverage for children in Florida. AB - Florida, which this year passed a sweeping health reform measure, is considering use of a Medicaid expansion option to revamp health care delivery for its children. PMID- 10127198 TI - State legislation inhibiting the operation of managed care pharmacy programs increases costs. AB - Managed care has become integral to major health care reform proposals; yet state legislatures are increasingly asked to enact laws that would inhibit its growth. An HIAA/Wyatt Company study examines the impact that such restrictive measures have on managed care's effectiveness. PMID- 10127199 TI - Fixing the individual health insurance market. AB - The individual health insurance market is in crisis. Among the possible options for reform, a managed competition approach offers the broadest, most comprehensive solution. PMID- 10127200 TI - Primary care physicians: increasing demand, shrinking supply. AB - Any serious proposal for reforming the U.S. health care system must include a consistent, coherent national policy for increasing the supply of primary care physicians. PMID- 10127201 TI - Introduction: health care reform and the benefits manager. PMID- 10127202 TI - Special issue on state health care reform: our future "national" system? PMID- 10127203 TI - Managed care: why is it "better". AB - Of the health care "solutions" available today, only managed care is capable of earning health care a competitive role in the nation's consumer-driven marketplace. PMID- 10127204 TI - Incentives and cost containment in primary care physician reimbursement. AB - The goal of capitation is to place gatekeepers at financial risk for the services the deliver. However, third party payers should provide gatekeepers with some type of protection against random and systematic risk transfer. Gatekeeper physicians' other alternative is to reduce this risk on their own by actively marketing services to healthier individuals and creating barriers to care for their sicker patients. Thus, the proper balance of risk transfer will result in the most cost-efficient, quality gatekeeper networks. However, even with the right balance of risk transfer, capitation may provide incentive for some physicians to withhold necessary services to further increase their profit margins-making quality of care a key concern. Thus, practice guidelines should be developed to ensure quality is not affected. These guidelines afford explicit criteria on how gatekeepers should respond in specific clinical situations. PMID- 10127205 TI - Epilogue: health care reform and productivity. AB - Only a health care system that balances the best interests of consumers with those of employers and government payers will ultimately provide quality care at manageable costs. These need not be opposing interests. PMID- 10127206 TI - Comprehensive state health reform initiatives. AB - Policy makers, consumers, providers and purchasers of health care will do well to pay close attention to the many comprehensive health care reform initiatives under consideration by state legislatures. PMID- 10127207 TI - Prescription drug benefits: Rx for cost management--commentary. PMID- 10127208 TI - American Health Information Management Association position statement. Issue: national coding quality. PMID- 10127209 TI - Regulatory update ... implications for health information management professionals. PMID- 10127211 TI - Dynamic designing. PMID- 10127210 TI - Contemporary issues in HIM. The application layer--III. AB - We have seen document preparation systems evolve from basic line editors through powerful, sophisticated desktop publishing programs. This component of the application layer is probably one of the most used, and most readily identifiable. Ask grade school children nowadays, and many will tell you that they have written a paper on a computer. Next month will be a "fun" tour through a number of other application programs we find useful. They will range from a simple notebook reminder to a sophisticated photograph processor. Application layer: Software targeted for the end user, focusing on a specific application area, and typically residing in the computer system as distinct components on top of the OS. Desktop publishing: A document preparation program that begins with the text features of a word processor, then adds the ability for a user to incorporate outputs from a variety of graphic programs, spreadsheets, and other applications. Line editor: A document preparation program that manipulates text in a file on the basis of numbered lines. Word processor: A document preparation program that can, among other things, reformat sections of documents, move and replace blocks of text, use multiple character fonts, automatically create a table of contents and index, create complex tables, and combine text and graphics. PMID- 10127212 TI - Case-mix measurements for understanding and managing healthcare institutions. AB - This article will characterize the clinical classification systems which may be utilized in healthcare institutions by illustrating their use in data analysis and management, demonstrating current examples of reimbursement, and detailing recent research trends in clinical classification systems. The systems discussed are diagnosis related groups (DRGs), DRG systems adjusted for patient severity, and ambulatory patient groups (APGs). PMID- 10127213 TI - Managing the business of ambulatory care: the emerging role of health information managers. PMID- 10127214 TI - Pre-billing DRG reviews set new standard. AB - When and how you do DRG review is critical. This piece offers tips on hiring consultants who can help you provide this financially important service. PMID- 10127215 TI - What is this thing called managed care? PMID- 10127216 TI - The health information management gold mine--your current staff. PMID- 10127217 TI - Coding errors, quality, and guidelines. PMID- 10127218 TI - CQI in policy implementation: advance directives. AB - Recognition of patients' rights is growing in the healthcare field in this country, as is recognition of the need for advance directives. Advance directives are documents that indicate treatment choices and preferences made by an individual while he or she is still competent. Through the use of continuous quality improvement (CQI) tools and the development of a CQI team, the author's facility was able to implement the important process of having patients complete advance directives. PMID- 10127219 TI - Does your board of trustees really know your hospital? AB - Hospital governing boards should be regularly and adequately informed of the important aspects of care rendered in their institutions. Such information must be provided in a concise and logical format that is easily understood by lay trustees and useful to their efforts to provide the most efficient, safest, and highest-quality care possible. This article offers a proposal for presenting quality information to hospital boards. PMID- 10127220 TI - Role clarification: a quality improvement survey of hospital chaplain customers. AB - The following article describes a quality improvement survey that examined the role nurses, patients, and patients' families expect the hospital chaplain to play when they use the chaplain's services. The results of the questionnaire suggest that patients and nurses sometimes see the role of the chaplain differently. There are times when nurses readily call a chaplain to help with a problem on a unit. There are other times when nurses are reluctant to ask for the chaplain, but patients would be most appreciative of the chaplain's presence. This article explores these situations and gives suggestions for ways to use a chaplain's expertise more effectively. PMID- 10127221 TI - Improving outcomes in hip fracture patients: using QA tools in a skilled nursing facility physical therapy clinic. AB - This article focuses on hip fractures and their treatment. The common problem of hip fractures is examined demographically and in terms of its impact on healthcare costs. The use of quality assessment and improvement techniques in SNF based physical therapy clinics is proposed as a tool to improve treatment outcomes. PMID- 10127222 TI - Sharing financial information with doctors: making it work. AB - Physicians are becoming increasingly aware of how their practice patterns affect the financial viability of their practices and of the hospitals in which they work. Programs of diagnosis-related group (DRG) analysis may be used not only to educate physicians but to provide data for physician-directed efforts to reduce variations in practice patterns and deal with physicians whose practice habits may be counter to cost-effective, high-quality care. A combination of early, extensive physician involvement and subsequent multidisciplinary interaction will ensure the development of and adherence to cost-effective, high-quality patient care. PMID- 10127223 TI - The role of the HMO risk manager in medical malpractice cases--Part I. AB - In an HMO's defense against a medical malpractice lawsuit, a risk manager faces questions and issues which are different from those raised in the defense of a traditional healthcare provider. While many of the established issues apply, there are also new statutes, regulations, and case decisions that are unique to HMOs. The result is a new and rapidly changing field. This is the first of a 2 part article. PMID- 10127224 TI - Collaborative care: a quality improvement and cost reduction tool. AB - Collaborative care is a system of patient care delivery that focuses on the achievement of outcomes within effective and appropriate time frames and resources. It addresses the entire episode of illness, bridging all clinical settings in which the patient receives care. Through the collaborative efforts of multiple caregivers, a plan of medical care is mapped out that results in a clinical path. The clinical path can improve satisfaction levels for patients, nurses, rehabilitation staff, and physicians by establishing a method of reinforcement for everyone involved in efficient delivery of care. PMID- 10127225 TI - Trauma services at Fairfax Hospital: an educational externship. PMID- 10127226 TI - The Commission on Cancer and the American Cancer Society: partners in cancer control. PMID- 10127227 TI - Black, white, and shades of gray: a new approach to malpractice dispute settlement. PMID- 10127228 TI - Continuous quality improvement in the cardiology hospital product line: Part two. PMID- 10127229 TI - Cardiovascular technician advancement program: recognition of clinical expertise. PMID- 10127230 TI - Enhancing outcomes with case management. PMID- 10127231 TI - Wiping out heart disease before the year 2000: an obtainable goal, a prediction for the future. PMID- 10127232 TI - Healthcare reform debate intensifies over cost controls. PMID- 10127233 TI - The health-care crisis hits home. PMID- 10127234 TI - Medicare program; payment for customized wheelchairs--HCFA. Final rule. AB - This final rule responds to comments we received on an interim final rule relating to payment for customized wheelchairs that was published on December 20, 1991 (56 FR 65995). The interim rule set forth the Secretary's criteria that a wheelchair must meet to be considered a customized item and allowed for a payment for the purchase of customized items based on the carrier's case-by-case determination. This rule establishes the interim rule as a final regulation with one change. The change is based on our review and consideration of the public comments. EFFECTIVE DATE: This final rule is effective on July 30, 1993. PMID- 10127235 TI - Medicare and Medicaid programs; recognition of the Joint Commission on Accreditation of Healthcare Organizations standards for home care organizations- HCFA. Final notice. AB - This final notice recognizes accreditation by the Joint Commission on Accreditation of Healthcare Organizations (JCAHO) for home health agencies (HHAs) that wish to participate in the Medicare or Medicaid programs. As a result of this recognition, HHAs accredited by JCAHO are deemed to meet the Medicare conditions of participation for HHAs to the extent described in this notice. This final notice sets forth certain specific requirements with which JCAHO must comply to maintain Medicare and Medicaid recognition of its HHA accreditation program. PMID- 10127236 TI - Medicare program; revised designation of states in which Medicare SELECT insurance policies may be issued--HCFA. Notice. AB - Section 4358(c) of the Omnibus Budget Reconciliation Act of 1990, provides for the designation of 15 States in which Medicare supplemental insurance policies (commonly referred to as "Medigap" policies) may be approved for issuance as Medicare SELECT policies during the period January 1, 1992 through December 31, 1994. This notice announces two revisions in the list of States designated under this authority. PMID- 10127237 TI - Civilian Health and Medical Program of the Uniformed Services (CHAMPUS); partial hospitalization--DoD. Final rule. AB - This final rule establishes a CHAMPUS benefit for partial hospitalization and makes corrections and clarifications on other mental health issues resulting from implementation of recent legislative changes. The partial hospitalization benefit is being added at the request of Congress to improve the availability of mental health services under CHAMPUS. The intent is to provide a needed service at a lower cost than the full hospitalization rate, and allow more efficient use of resources for needed mental health care. Facilities must be certified and enter into a participation agreement with CHAMPUS and obtain the required preauthorization prior to admitting CHAMPUS patients. Applications for facility approval may be obtained from the Director, OCHAMPUS, or a designee. PMID- 10127238 TI - Medicare program; schedule of limits on home health agency costs per visit for cost reporting periods beginning on or after July 1, 1993--HCFA. Notice with comment period. AB - This notice sets forth a revised schedule of limits on home health agency costs that may be paid under the Medicare program. As required by section 1861(v)(1)(L)(iii) of the Social Security Act (the Act), these limits are based on the current hospital wage index. PMID- 10127239 TI - Medicare and Medicaid programs; quarterly listing of program issuances and coverage decisions--first quarter 1993--HCFA. Notice. AB - This notice lists HCFA manual instructions, substantive and interpretive regulations and other Federal Register notices, and statements of policy that were published during January, February, and March 1993 that relate to the Medicare and Medicaid programs. Section 1871(c) of the Social Security Act requires that we publish a list of Medicare issuances in the Federal Register at least every 3 months. Although we are not mandated to do so by statute, for the sake of completeness of the listing, we are including all Medicaid issuances and Medicare and Medicaid substantive and interpretive regulations (proposed and final) published during this timeframe. There are no revisions to the Medicare Coverage Issues Manual this quarter. However, two notices were published in the Federal Register during the first quarter of 1993 that announced changes made to the Medicare Coverage Issues Manual before to January 1, 1993. PMID- 10127240 TI - Federal employees health benefits program; limitation on inpatient hospital charges and FEHB program payments--OPM. Final rule. AB - The Office of Personnel Management (OPM) is issuing final regulations that implement section 7002(f) of the Omnibus Budget Reconciliation Act of 1990. The law sets a limit on the charges and Federal Employees Health Benefits Program (FEHBP) benefit payments for certain inpatient hospital services received by a retired enrolled individual. These regulations finalize interim regulations that defined a retired enrolled individual and set forth the circumstances under which the limit on charges and FEHBP benefit payments take effect. PMID- 10127241 TI - Monopoly medicine? AB - "Integrated" health plans, which tie together doctors, hospitals and other services, are being touted as a remedy for the nation's ailing health system. But in Minnesota, where such plans are relatively well established, a side effect has appeared: a rash of mergers and acquisitions that could undermine competition in the health care market. PMID- 10127242 TI - New association to serve subacute care programs. American Subacute Care Association. PMID- 10127243 TI - Expense reduction: the catalyst for value. Value engineering benefits sponsors, residents. PMID- 10127244 TI - Low occupancy casts a pall over the market. Reimbursement rates compound problems. PMID- 10127245 TI - Initiating and maintaining a customer service program. PMID- 10127246 TI - Imminent danger. Surge in lawsuits jeopardizes providers. PMID- 10127247 TI - Word-of-mouth marketing. Fine dining builds census. PMID- 10127248 TI - Somewhere over the rainbow ... managed care offers big opportunities for LTC. PMID- 10127249 TI - Fund-raisers get the wheels turning. Residents pitch in to purchase buses. PMID- 10127250 TI - A welcomed addition to the rehab team. Specially trained aides are a big plus. PMID- 10127251 TI - Glass ceiling or going rate? Salary survey finds most DONs in same range. PMID- 10127252 TI - Do not resuscitate orders. PMID- 10127253 TI - Public relations and development: beyond the conflict. AB - Public relations must continually foster a good public image in the community. Without a positive image, development efforts will not succeed. PMID- 10127254 TI - Health stocks that should escape Hillary's scalpel. PMID- 10127255 TI - Hospital resumes abortions; seeks to protect administrators. PMID- 10127256 TI - Professor Harold Risk on post-accident interviews. PMID- 10127257 TI - Special report. Dealing with disasters: what hospitals learned from recent crises. AB - In times of crisis, hospitals are relied on to provide simultaneous emergency treatment to a large number of victims of natural disasters, accidents, or other traumatic events. Sometimes the hospital itself faces a crisis situation. Hospital officials recognize that the only way to continue providing patients with the best care possible in dire circumstances is through the activation of an effective disaster plan. "Disaster planning is something that cannot be planned enough," says Louis Gasbarro, president of the International Association for Healthcare Security and Safety (IAHSS) and security and safety director at Tampa General Hospital, Tampa, FL. "There's no such thing as over-planning or over drilling. You must have a written plan known by all people, all departments, all personnel in the building. Everyone has to know their role." This special report will look at several events that brought an influx of patients to hospitals around the country, the disaster plans that were implemented, and what hospital officials learned from those experiences. PMID- 10127258 TI - Cancer program development: is your hospital ready? AB - According to a recent survey of 1,779 U.S. hospitals, nearly 50 percent intend to expand their oncology programs in the next two years (Sandrik 1990). Also, the membership of the Association of Community Cancer Centers (ACCC), an organization of community-based oncology programs, has quadrupled in the last decade (ACCC 1991). These facts indicate that a growing number of community hospitals are continuing to develop organized cancer programs. This two-part article answers the questions, "Why should a hospital consider expansion of oncology programs?" "When is a hospital ready for a major commitment to oncology?" "How does a hospital go about such a development?" "What components should be considered in the development process?" Part I will address the first three questions and part II will address the final one. PMID- 10127259 TI - Stigmatization of the psychiatric patient: future perspectives for healthcare professionals. AB - This article offers some explanations for the mismanagement of the patient who has a psychiatric history but enters the healthcare system for treatment of a medical disorder, and it explores the perceptual differences among the various hospital personnel who interact with the psychiatric patient in the hospital. By examining relevant research on cognitive processes, the author discusses the impact that thought habits have on the formation of these perceptual differences. She concludes by offering a resolution to the problem of stigmatization. PMID- 10127260 TI - Managing hospital quality performance in two related areas: patient care and customer service. AB - The Joint Commission on Accreditation of Healthcare Organization's new emphasis on continuous quality improvement provides hospitals with an opportunity to enhance both customer service as well as patient care. Both are expected by patients and delivered by providers. Patient care is the core product; customer service augments it by adding value and providing the opportunity for a competitive advantage. This article discusses issues for administrators to consider before including customer service as a component of continuous quality improvement and then presents methods for bringing about change. PMID- 10127261 TI - Pay for performance in hospitals. PMID- 10127262 TI - Reducing costs: who really wants to? PMID- 10127263 TI - One state's approach to global budgeting: a view from Vermont. PMID- 10127264 TI - Arranged marriage: Clinton and Congress aim to wed budgets and markets. PMID- 10127265 TI - Speculating on health system reform. Interview by C. Burns Roehrig. PMID- 10127266 TI - Rebuilding primary care: is the message finally getting through? PMID- 10127268 TI - Dying directives, dilemmas and costs. PMID- 10127267 TI - The meanness of Medicare, or why does my back hurt? PMID- 10127269 TI - Free choice of physician. American Society of Internal Medicine. PMID- 10127270 TI - Do global budgets make sense for the U.S. health system? PMID- 10127271 TI - Managed care is in your future. AB - Though Texas has been slower than most other large states to move into managed care, it is gaining ground. According to the Texas Health Maintenance Organization Association, 1.2 million Texans were enrolled in HMO plans in January 1990. Three years later, 1.5 million had signed on--a 24 percent increase. State enrollment in other managed care plans, which aren't required to file reports with state regulatory agencies, was estimated to be 6.9 million (41 percent of Texans) in 1991, according to Blue Cross/Blue Shield. While these state enrollment figures are large, the most recent numbers available indicate that Texas hospitals have a long way to go. A 1991 AHA survey found that 259 Texas hospitals (47 percent of those surveyed) do not have contracts with HMOs or PPOs. With changes coming at break-neck speed, how can these hospitals position themselves to survive and prosper in the managed care world? This month, HealthTexas presents three examples of hospitals and health care systems that have successfully made the transition to managed care. Their stories illustrate three very different approaches--developing a network, direct contracting, and establishing a health plan. And, those who have led these ventures offer advice to help other hospitals make the transition a little easier. PMID- 10127272 TI - A wider perspective for viewing medical staff credentialing. PMID- 10127273 TI - Rain check ... selecting, planning, implementing and evaluating audit projects. PMID- 10127274 TI - Personal services. AB - Dutch experience seems to show that a liberal societal attitude to sex and sexuality encourages young people to be more confident in asking for the contraceptive services they need, writes Elinor Thompson. PMID- 10127275 TI - Management information systems. Divine and rule. PMID- 10127276 TI - Management information systems. Executive toys. PMID- 10127277 TI - Management information systems. Hey, big spender ... signature verification system. PMID- 10127278 TI - You've been framed. PMID- 10127279 TI - Talking shop. PMID- 10127280 TI - Mid-life crisis. PMID- 10127281 TI - Time machine. PMID- 10127282 TI - Hospital information systems. Hissssssssbang! PMID- 10127283 TI - Top teams. PMID- 10127284 TI - Inward bound. PMID- 10127285 TI - Turf wars. PMID- 10127286 TI - Alternative medicine. PMID- 10127287 TI - Is anybody there? PMID- 10127288 TI - The illusion of control and the importance of community in health care organizations. AB - The complexity of our health care environment and organizations requires a management style that moves beyond control to empowerment. Even though this complexity minimizes our ability to control events, many organizations are still preoccupied with the illusion of control. This restrains the performance of our health care organizations. Some of the contributing factors supporting this illusion are bureaucracy, scientific methodology, individualism, and our confusion of management with leadership. The concept of "community" is discussed from an organizational perspective. It is suggested that we can improve the performance of our organizations by rediscovering the values of community. PMID- 10127289 TI - Quality improvement for a hospital patient transportation system. AB - This article describes a method for organizing and staffing a hospitalwide patient transportation system in such a way as to minimize patient waiting times. The method stems from a quality improvement project and includes a centralized communication system, a queuing model to determine staffing requirements, and a computerized data collection and monitoring system. A case study demonstrates improvements in waiting times, costs, and customer satisfaction. PMID- 10127290 TI - Restructuring military health care: the winds of change blow stronger. AB - The Military Health Services System is an enormously complex enterprise, consisting of more than 400,000 personnel in the active, reserve, and civilian workforce, operating 148 hospitals and over 800 medical and dental clinics worldwide, and serving nearly 9 million beneficiaries. Expenditures on military health care activities will exceed $15 billion in 1993. Yet many people in leadership positions in government--both inside and outside the Department of Defense--question whether the current organization of the Military Health Services System is appropriate to accomplish the Department's medical missions. Some insiders have observed that having three military medical services is having two too many--that a single "purple" medical service, or at least a single management structure such as a Defense Health Agency, would better meet military mission requirements as the Defense Department undergoes post-Cold War downsizing. One of the most pressing challenges facing military health care managers is how to best organize resources to provide timely access to quality care and achieve economies at a time when civilian health care is itself in turmoil. This article provides a long-awaited update on the spirited debate over the need to reorganize the Military Health Services System--and the prescriptions ordered so far to cure the system's perceived organizational ills. PMID- 10127291 TI - Report on beginning and early career development: 1992. Joint Task Force of the American College of Healthcare Executives and the Association of University Programs in Health Administration. PMID- 10127292 TI - Hospital survival in a competitive environment: the competitive constituency model. AB - Organizational theory is extended to develop a method for administrators to assess hospital effectiveness in a competitive environment. First, the literature pertaining to organizational effectiveness and survival is synthesized to show the lack of consideration for the effects of competition. Second, the article integrates the effects of competition on organizational effectiveness through a competitive constituency model. A step-by-step procedure is proposed to apply the theory in an organizational setting. The model explicitly addresses differences in power relations between hospitals, their competition, and their stakeholders. The relative nature of effectiveness is explored by comparing the hospital to its competition using criteria developed through specific goals of stakeholders. The distinction between managerial and organizational effectiveness constructs is clarified. Finally, the practical application of this model is demonstrated by assessing the effectiveness of a hospital in the competitive environment of Seattle, Washington, where two hospitals have recently closed. PMID- 10127293 TI - Service recovery in health services organizations. AB - Service recovery is defined as that part of quality management designed to alter the negative perceptions of dissatisfied consumers and to ultimately maintain a business relationship with these consumers. This article explores the theoretical and operational implications of service recovery in health services organizations. A framework that defines the range of possible service recovery actions is presented. Next, the benefits of and obstacles to service recovery in health services firms are discussed, and solutions for overcoming these obstacles are presented. Finally, the critical components of an effective service recovery program are described, and an agenda for empirical research on the efficacy of service recovery activities is proposed. PMID- 10127294 TI - Comparing low-severity hospital admissions in IPA HMOs and indemnity-type programs. AB - This study compares the proportion of low-severity hospital patients in independent practice association (IPA) HMOs and indemnity-type programs. The length of stay of such low-severity patients is also studied. Admissions of IPA patients under age 65 to ten hospitals are compared with admissions to the same hospital of patients covered by Blue Cross and Blue Shield plans or commercial insurance programs. Admissions to the adult medical service for the eight most frequently occurring DRGs with 5 percent or more patients in the low-severity category are included. A Logit model of the probability of low-severity admission controlling for age, sex, DRG, and hospital shows no significant IPA effect. However, a multiple regression model shows that the IPAs have significantly lower average length of stay for these low-severity patients. PMID- 10127295 TI - The determinants of hospital profitability. AB - Although numerous studies related to hospital costs and financial condition have been conducted, no studies have specifically attempted to identify the underlying determinants of hospital profitability. If these factors are identified, hospital executives can focus their efforts on those aspects of operations that most affect profitability, and public policymakers can gain insights into the potential effects of alternative policy decisions on hospital financial viability. Our study uses multiple regression analysis with 22 hypothesized profitability determinants as independent variables and five profitability measures as dependent variables. The data set consists of 1989 data from 169 investor-owned and private not-for-profit general acute care hospitals in the state of Florida. The results provide evidence that selected managerial and patient-mix variables are predictors of profitability. Structural factors that are beyond the control of managers (organizational and community characteristics) appear to be less important in influencing profitability. These findings may be viewed positively by hospital executives since it appears profitability is not dictated by organizational or market factors but more strongly influenced by factors that, to some extent, can be influenced by hospital policies and practices. PMID- 10127296 TI - Utilization care plans and effective patient data management. AB - This article introduces the concept of a utilization care plan (UCP) for supporting the communication of data required for effective utilization review and utilization management. Utilization review is a process of measurement that compares the performance of a ward, department, or entire facility against accepted criteria to identify resource use shortfalls. Utilization management is the deliberate action by third party payers to ensure that shortfalls in resource utilization are minimized. Critical to the success of utilization management is effective data communication; utilization review data must be accurate, complete, accessible, timely, and coordinated. Computer-based UCP systems can remind caregivers when and what services should be provided to patients and also monitor the portion of those services that should be administered during each phase of a patient's therapy. Deviations from the UCP system template constitute variances that can be documented and highlighted in a friendly automated system that ensures highly accurate and extremely timely concurrent utilization information. Some implications of using UCP systems for future research and practice are also discussed. PMID- 10127297 TI - Documentation of clinical and cost-saving pharmacy interventions in the emergency room. AB - Hospital pharmacists have shown clearly their benefit in patient care by intervening to improve the drug use process. In this era of cost containment, hospital administrators are likely to fund only those programs that clearly improve patient care or reduce costs. To demonstrate the impact on a hospital budget and to justify a position or service, documentation of improvement and generation of a cost-savings report is essential. This article discusses the types and methods of clinical and cost-saving interventions that are made in a busy inner city university trauma center's emergency department, and the methods by which our data are collected. PMID- 10127298 TI - Application of quality improvement techniques to the reduction of turnaround time for "STAT" and "ASAP" orders. AB - This project educated a multidisciplinary team on the techniques of continuous quality improvement, which were then used to analyze the total medication cycle process in order to reduce the total turnaround time for STAT and ASAP orders. Members were trained in the appropriate analytical techniques, developed flow charts of the medication cycle, and developed and conducted a study of the turnaround time for STAT and ASAP orders. Three data collections were obtained: 1) baseline, 2) after flagging orders and medications to help quickly identify both, and 3) after implementation of guidelines for physicians to properly use the terms STAT and ASAP. The interventions seem to have resulted in system improvement based upon an overall decrease in turnaround time (70% for STAT orders, 54% for ASAP orders). The majority of the medication cycle time was on the patient care unit after medication delivery. Problems with the process were identified and recommendations made for future quality improvement teams. PMID- 10127299 TI - Impact of clozapine on medication use in a state hospital. AB - Medical records of 90 consecutive patients who started clozapine were reviewed to see how this drug is being used with other psychotropic medications and to evaluate what impact it has had on the drug regimens of these patients. Data from up to 6 months before to 12 months after clozapine's initiation was included. The percent of patients receiving medications for antipsychotic side effects decreased from 86% 6 months prior to clozapine to 13% 12 months after. The use of benzodiazepines decreased from 43% to 23% during this time period as did lithium use from 57% to 17%. While 28% of the patients were receiving carbamazepine prior to starting clozapine, no patients remained on this drug concurrently with clozapine. The average number of psychiatric medications per patient decreased from 3.39 +/- 1.37 6 months prior to clozapine to 1.61 +/- .83 at month 12. Concern for drug interactions along with clozapine's reduced incidence of extrapyramidal side effects and increased efficacy contributed to the reduction in medication use observed. PMID- 10127300 TI - Home care standards for hospitals. PMID- 10127301 TI - Is HCQIA (Health Care Quality Improvement Act of 1986) protecting peer review from antitrust claims? PMID- 10127302 TI - Are transplanted organs being allocated unfairly and illegally? PMID- 10127303 TI - The home infusion industry: patients' angel or their ruthless plunderer? PMID- 10127304 TI - Tide turning against autologous bone marrow transplants in federal appellate courts. PMID- 10127305 TI - End of cold war frees FBI to target health care fraud and abuse. PMID- 10127306 TI - New Florida health reform plan is first large-scale test of Clinton's managed competition theory. PMID- 10127307 TI - Restoration of parking structure puts need for its replacement in park. Columbia Hospital, Milwaukee, WI. PMID- 10127308 TI - Are we there yet? PMID- 10127309 TI - Clean restrooms: an issue of quality as well as image. PMID- 10127310 TI - EPA proposes to move up CFC phaseout dates. PMID- 10127311 TI - Fire officials' input strengthens fire safety plans. PMID- 10127312 TI - Hiring quality employees: a pre-crisis action plan. PMID- 10127313 TI - Collecting, transporting and storing soiled linen. PMID- 10127314 TI - Economics report. What hospitals think of contract "hotel" services. PMID- 10127315 TI - Tech-ploitation: the new manufacturing credo. PMID- 10127316 TI - A strategy for communicating change. PMID- 10127317 TI - Up close and personal. AB - Has the mass market really fragmented, or has technology just given us the tools to break it apart? Either way, American business has hung its hat on the database and moved towards the ultimate in niche marketing: building relationships with individual consumers. Here's how to find them, what to say, and how to work this new approach into your strategic thinking. PMID- 10127318 TI - Why quality initiatives fail. PMID- 10127319 TI - IT (information technology): the sequel. AB - As Information Technology enters its second era, it's encountering a paradigm shift that mirrors changes in the corporation itself. With no respect for traditional boundaries, it's breaking down walls and hierarchies--and, in the process, becoming an increasingly valuable strategic tool. PMID- 10127320 TI - The big-bang-for-your-buck theory. AB - Do it right, and your investment in information technology can have all sorts of strategic payoffs. Do it wrong, and you'll be paying, dearly, for nothing. Here's a guide to evaluating IT and measuring its impact. PMID- 10127321 TI - Star tech. AB - The mission? To sensibly go where many have gone before--into the realm of information technology, where applications often outnumber sound business reasons to use them. If you've never been, don't believe everything you hear. Mainframes may be useful after all, and even widespread technologies don't hold all the answers. PMID- 10127322 TI - Don't get mad--get computerized. PMID- 10127323 TI - Cephalosporin prices falling. PMID- 10127324 TI - Hospital pharmacists work to contain high drug costs. PMID- 10127325 TI - Hospitals using new medical waste disposal methods to save money, environment. PMID- 10127326 TI - Controlling postage expenses as easy as 1,2,3. PMID- 10127327 TI - Hospital shaves orthopedic losses, lengths of stay with patient-demand matching program. PMID- 10127328 TI - A credible, effective force for Catholic healthcare. PMID- 10127329 TI - The leadership challenge: imagine new relationships. PMID- 10127330 TI - Antitrust law may be a barrier to collaboration. PMID- 10127331 TI - Meeting mission challenges in IDNs. Through integrated delivery networks, organizations can continue their ministry and extend its reach. AB - Whatever the final shape of healthcare reform, providers and sponsors are already collaborating with each other in various network arrangements. As they pursue these arrangements, they are asking questions about their role in a reformed system and whether the networks they participate in will strengthen their mission and ministry. Documents published about five years ago by the Catholic Health Association (CHA) and the Commission on Catholic Health Care Ministry provided the rationale for CHA's proposal to form integrated delivery networks (IDNs) as part of a national healthcare reform plan. The documents called for a continuum of care with comprehensive community- and institution-based services and challenged Catholic healthcare leaders to work for a healthcare system that guarantees access to the needy and most vulnerable in society. The central task for administrators today is to determine whether participating in an IDN enables Catholic healthcare providers to fulfill their original mission and purpose. To determine this, organizations must clarify their mission and evaluate their beliefs. They must also develop a shared vision of motives and goals among everyone with whom they collaborate. IDNs' success in furthering the healthcare ministry will depend on leaders' ability to ensure that new corporate cultures which arise in cooperative ventures and arrangements support Catholic values and mission. In making the transition to a new environment, leaders should remember that aspects of IDNs support many of the goals of the Catholic healthcare ministry. PMID- 10127332 TI - Board members with a mission. A system board makes community needs its business. AB - The system board of the Sisters of Charity of the Incarnate Word Health Care System (SCH), Houston, has been a leader in moving the system from a competitive model to one that is mission driven. By clearly articulating the mission, vision, and beliefs that are central to SCH, the board established a values-based framework for linking future challenges to tradition, thereby encouraging continuation of the original spirit and call of the founding sisters. In 1987 the SCH board initiated the concept of systemwide community mission projects by directing healthcare facilities to develop projects that address the needs of local vulnerable populations. And in 1991 the SCH board called for the establishment of charity programs and services that directly respond to local community needs. It ordered a systemwide, multiphased community needs assessment at the local level. The mission projects that resulted focus on primary prevention, education and counseling, and information and referral services. The board has taken other actions that demonstrate its community-centered perspective in ensuring the system's commitment to mission. For example, when an inner-city hospital in Houston closed, the board appointed a task force to determine what the community identified as its most urgent unmet need. The result is a program to address the needs of vulnerable older adults. And in 1992 the SCH board approved the appointment of a capital process review team. It now takes a more global social accountability view when allocating funding. PMID- 10127333 TI - Portal to the community. Dedicating a facility to ambulatory and long-term care completes the continuum for a New Jersey system. AB - In 1989 Cathedral Healthcare System, Orange, NJ, began a strategic planning process that culminated in a decision to create a continuum of care. Converting one of its three hospitals from an acute care to an ambulatory care facility gave Cathedral an opportunity to address fiscal realities and at the same time further develop its continuum of care. The converted hospital (Saint Mary's in Orange) would be a key component of a full continuum of care for area residents. Saint Mary's would also serve as a portal of entry to the system's services. The community's need for affordable, accessible healthcare has been well documented. Converting Saint Mary's to alternative uses was one approach the system could take to better meet the needs of this underserved population. In addition to providing ambulatory care, Cathedral will be transforming the acute care beds into much-needed long-term care beds. The conversion will enable Saint Mary's to meet the needs of a growing aging population. PMID- 10127334 TI - Lessons from abroad on healthcare reform. Universal access and cost constraint work in Canada and in Germany. AB - Neither the single-payer Canadian healthcare system nor the multipayer German healthcare system is a totally appropriate model for the United States. But we can learn something by studying both. Nations such as Canada and Germany use global budgetary target approaches, which have been shown to be more effective in controlling healthcare costs than the United States' micromanagement methodology of allocating resources. As Congress decides on a basic comprehensive benefit package, it must keep in mind that a universal, comprehensive plan results in a significant additional demand for healthcare services, as seen in Canada and in Germany. The Canadian and German healthcare systems encourage consumers to select their physicians and hospitals. Germany has a distinct separation of community based, fee-for-service physicians and hospital-based salaried doctors. This arrangement causes difficulty in providing continuity of patient care. PMID- 10127335 TI - Conscience clauses offer little protection. Most are deficient, and many have been met with hostile judicial interpretations. AB - Although the federal government and most states have enacted laws protecting healthcare providers' rights to refuse to provide or participate in procedures to which they have moral or religious objections, most such laws are deficient and many have been met with hostile judicial interpretations that have diminished their scope and strength. Deficiencies found in nearly all conscience clause laws include limitations on the specific conduct or procedures protected, restrictive definitions of the healthcare providers covered, and inadequate implementing procedures and remedies. Most conscience clause statutes fail to provide more than token protection for healthcare providers' rights of conscience. Increasing duress on healthcare providers who assert rights of conscience can be expected from three sources. First, some medical schools have considered refusal to participate as a negative factor in the admission process. Second, greater financial pressures on the American healthcare system may cause nonmonetary factors to be sacrificed to the exigencies of the moment. Third, all healthcare reform plans propose an increase in the federal government's role in providing healthcare. At present, the only federal statutory protection for healthcare providers' rights of conscience covers participants in only a few federal programs, is poorly conceived, and is sorely inadequate. PMID- 10127336 TI - Technology assessment. PMID- 10127337 TI - Technology assessment. PMID- 10127339 TI - A primary response to healthcare reform. PMID- 10127338 TI - Healing through humor. PMID- 10127340 TI - Mental healthcare for seniors. PMID- 10127341 TI - Mental healthcare for seniors. PMID- 10127342 TI - St. Joseph Healthcare System. Partners in care. PMID- 10127343 TI - Hope in the heart. PMID- 10127344 TI - 1993 survey of salaries & responsibilities for hospital biomedical/clinical engineering & technology personnel. AB - The Journal of Clinical Engineering has conducted its eighth annual survey of the salaries paid to biomedical/clinical engineering and technology personnel in U.S. hospitals. This paper reports the salary and work responsibility data obtained from 1,497 professionals in relationship to: Certification; Region of the U.S.; Teaching versus Nonteaching Facilities; Years of Experience; Education; Union Membership; and Gender. Data are included on Wage Increases and Job Responsibilities. Data are as of 12/31/92 and are compared to 12/31/91. Last year, new job categories were introduced for the overall department or group Director or Manager and the BMET Specialist. The average BMET I has 3.1 years of experience and earns $24,418 +/- $4,615 (Std. Dev.). The average BMET II has 6.8 years of experience and earns $29,853 +/- $5,782. The average BMET III has 13.3 years of experience and earns $37,205 +/- $6,269. The average BMET Specialist has 13.9 years of experience and earns $42,808 +/- $9,420. The average BMET Supervisor has 13.4 years of experience and earns $39,206 +/- $7,709. The average Clinical Engineer has 9.1 years of experience and earns $40,121 +/- $8,242. CE Supervisors have an average 12.1 years of experience and an average salary of $47,353 +/- $15,501. The overall group or department Director or Manager has 15.7 years of experience and earns $51,237 +/- $16,381 on average. Wages are the highest on the East and West Coasts. Again this year, the lowest wages were in the Southeast. BMET wages advanced up to 4.6%, year to year. The highest quartile of Director/Managers now earns between $56,000 and $212,000 per year. Certified individuals variously earn up to $7,995 more than noncertified. PMID- 10127345 TI - Mind your manners. Courtesy is a big part of the job. PMID- 10127346 TI - New national alliance aims to unite EMS. PMID- 10127347 TI - Expecting the unexpected. PMID- 10127348 TI - Dodging bullets. Gang violence and EMS. PMID- 10127349 TI - Chasing fear from the workplace. PMID- 10127350 TI - Caught in the crossfire. EMS encounters of the violent kind. PMID- 10127351 TI - Tips on defusing a violent situation. PMID- 10127352 TI - 1993 ambulance manufacturers directory. PMID- 10127353 TI - Speak up or put up. Don't get left out of health care reform. PMID- 10127354 TI - EMS, Rambo and Barney Fife. PMID- 10127355 TI - Access to health care. PMID- 10127356 TI - The day after an AIDS vaccine is discovered: management matters. PMID- 10127357 TI - The economic impact of state restrictions on abortion: parental consent and notification laws and Medicaid funding restrictions. PMID- 10127358 TI - Costs and benefits of HIV-1 antibody testing of donated blood. AB - Costs and benefits of the testing protocol for screening donated blood for the HIV-1 virus are evaluated. Estimates are made of the number of HIV-1 infections and cases of AIDS prevented in a year by blood testing, as well as the costs of providing this risk reduction. The risk reduction provided by alternative tests such as the HIV-1 antigen test is also discussed. The value of the risk reduction provided by blood testing is generated utilizing willingness-to-pay value-of-life estimates. The findings indicate that the present testing protocol is cost beneficial and support the FDA decision not to recommend the HIV-1 antigen test for use in donor testing. Policy decisions concerning present and future testing protocols are discussed, and implications for broadening our model to include indirect benefits of donor testing are evaluated. PMID- 10127359 TI - It starts with you ... the volunteer administrator. PMID- 10127360 TI - The malpractice-reform idea that won't go away. PMID- 10127361 TI - Joint ventures become even riskier. PMID- 10127362 TI - Are fraud investigators going overboard? PMID- 10127363 TI - What medical families make--and how they spend it. PMID- 10127364 TI - Will med schools solve the primary-care shortage? PMID- 10127365 TI - The Fallon Healthcare System--clinical approaches to serving the frail elderly. PMID- 10127366 TI - Integrated delivery systems reposition for reform. AB - As policy-makers debate the ultimate design for health care reform, the pace of change in the fundamental structure for health care financing and delivery is accelerating, writes John Cochrane. State governments, employers, HMOs, insurers, hospitals, physicians and vendors are aggressively changing the way they are organized and do business. Cochrane's message to anyone involved in health care: "The revolution is now!" PMID- 10127367 TI - Academic medical centers and managed care plans: can an association be mutually beneficial? AB - The history of collaborative and mutually beneficial associations between academic medical centers and managed care plans is not one of sterling successes, according to author Wilson Graves, M.A., M.P.A. Still, there are major trends developing which, despite the antithetical nature of medical academia and managed care, provide a rationale for mutually beneficial associations. PMID- 10127368 TI - Point-of-service plans--the risks and rewards. PMID- 10127369 TI - The need for ambulatory medical necessity review in multispecialty groups. AB - With the proliferation of HMOs, PPOs and other managed care payment methodologies which demand quality and efficiency, there is a shift from hospitals to clinics that creates the need for ambulatory care medical necessities review (utilization management). It is predicted that by the year 1995, 90 percent of all insured patients will be in a managed care system of some kind, thus the pressures to develop ambulatory care utilization review will likewise increase. Although there is some development in outcome measurement methodologies, currently there is an immediate need for UR techniques in the ambulatory care setting, techniques which are somewhat similar to traditional hospital methodologies. However, instead of the focus being case-by-case analyses, the large multispecialty group practice must rely on techniques which focus their review on large volumes of small services. Development of methodologies to influence and improve quality and efficiency is occurring in multiple areas. These methodologies are making inroads into the ambulatory setting and going far beyond traditional hospital UR. As Christian Ramsey Jr., M.D., notes, three methodologies are: 1. outcomes measurement; 2. data/information; and 3. continuous quality improvement (CQI) techniques. Indeed, the winds of demand for medical services are blowing in the direction of ambulatory care settings. Multispecialty group practices, like the sails of a ship, will catch this wind. To steer a course in the direction of improved quality and efficiency, the medical group practice must implement methodologies in ambulatory medical necessity review.(ABSTRACT TRUNCATED AT 250 WORDS) PMID- 10127370 TI - Succeeding under capitation. PMID- 10127371 TI - Independent practice associations: risk contracting, financial controls and processes. AB - The decision to enter into risk contracting with a health plan should be carefully considered. With today's pressure to control health care costs, an IPA's financial position can change rapidly. Even small numbers of enrollees can precipitate losses of hundreds of thousands of dollars over a few months if utilization and costs are not carefully projected and monitored. Prudent contracting to limit the IPA's downside risk in a new contract's early years is the most effective tool for preserving financial stability. However, the IPA must also develop sophisticated claims processing and financial reporting systems to ensure consistent payment practices and enable management to identify problem areas rapidly. Contracts with physician providers must allow the IPA flexibility in implementing administrative withholds and in renegotiating rates with short lead times. PMID- 10127372 TI - Successful implementation of Medicare risk contracting. AB - With the information resources available today, groups can better determine whether they possess the ingredients for success with regard to risk contracting, write Molly Zelley, M.P.A., and Christy Bell. For those that do, Medicare risk contracting can be a vehicle for developing comprehensive, cost-effective new approaches for attracting and providing health care to this increasingly significant segment of the population. PMID- 10127373 TI - Rate structuring in managed care contracts demands detailed information. AB - In summary, managed care contracts are being written in a variety of ways, versions of capitation and discounted fee-for-service being only two of them. If you can't generate all of the information needed to negotiate, you need to step back and take another look at your management information system. Managed care is here. It was "just around the corner" yesterday! PMID- 10127374 TI - Negotiated wage changes in government, 1992. PMID- 10127375 TI - Employer and occupational tenure: 1991 update. PMID- 10127376 TI - Directory of professional organizations. PMID- 10127377 TI - Is your chemical hygiene plan OSHA-proof? PMID- 10127378 TI - The role of the clinical lab in tissue banking. PMID- 10127379 TI - How to build supervisors' management skills. PMID- 10127380 TI - A focus on quality--the library's role in occurrence screening. AB - One of the highest priorities in today's hospitals is the provision of quality care to patients. The medical librarian has an increased responsibility to furnish quality information to the medical staff. Traditional methods of reference service continue to work well, but it is increasingly important for librarians to become more directly involved in hospital quality assurance (QA) activities. Occurrence screening is one system of QA where the librarian can make a difference. PMID- 10127381 TI - Foundation loses to Aetna over CHAMPUS contract. PMID- 10127382 TI - 285 firms sign up for Calif. purchasing pool. PMID- 10127383 TI - Va. hospital profits continue sharp rise with 27% jump in '92. PMID- 10127384 TI - Bill would exempt hospitals from antitrust. PMID- 10127385 TI - Providers' share of fraud cases rises--survey. PMID- 10127386 TI - Affiliation of Hitchcock, Cooley indicative of new Northeast trend. PMID- 10127388 TI - Partnership mulled to build new La. facility. PMID- 10127387 TI - Beverly reports 24% increase in net income. PMID- 10127389 TI - St. Petersburg, Fla., systems plan community needs study to set extent of affiliation. PMID- 10127390 TI - Education revamp eyed for reform plan. PMID- 10127391 TI - Talk of job cuts may hinder reform. PMID- 10127392 TI - Time for hospitals, medical staffs to consider a divorce. PMID- 10127394 TI - Providers appear victorious in minimizing Medicare cuts. PMID- 10127393 TI - A proving ground for managed competition. PMID- 10127395 TI - Galen-Columbia merger plan getting close look from feds. PMID- 10127396 TI - Computing the effects of global budgeting. PMID- 10127397 TI - Mutual fund will let hospitals, charities in Mass. gain access to funds for small projects. PMID- 10127398 TI - AAMC seeks public-private fund for medical education. PMID- 10127399 TI - Hospital chief execs say they're satisfied with JCAHO's job. PMID- 10127400 TI - Bill would let states privatize Medicaid. PMID- 10127401 TI - Pa. to implement new payment plan. PMID- 10127402 TI - Denver public hospital loses another 28 nurses. PMID- 10127404 TI - J.P. Morgan to sell 5.7 million HCA shares. PMID- 10127403 TI - Lutheran General selling contracts to execs. PMID- 10127405 TI - McGaw appeals VA decision to dismiss bid. PMID- 10127406 TI - Variety of factors hobble supply industry. PMID- 10127407 TI - A new role for ambulatory care: managing the system. AB - Buffeted for many years by the winds of financial pressures, the American health care system is in severe disarray. The major components of this system are expending resources on maintaining their traditional roles in order to serve a public that cannot afford all of them. These elements, namely the hospital industry, the insurance industry, and physicians, are trying to achieve a measure of profitability in a system that seems to have little profit to yield. Perhaps the time has arrived for a restructuring of the basic system in order to reward quality and efficient management rather than to perpetuate systems becoming increasingly irrelevant. PMID- 10127408 TI - Study tour examines health care systems in Germany, Holland--Part I: A comparison of three health care systems. AB - In October 1992, the American College of Physician Executives sponsored a study tour to Berlin, Germany, and Amsterdam, Holland. Meetings were held with government officials, third-party payers, and providers, and onsite visits were made at hospitals, clinics, and academic centers. The purpose was to study the health care delivery system in those countries and to share some insights with the countries' hosts on the U.S. system. Beginning in this issue of the journal, 5 of the 10 study tour participants describe their impressions of the tour and of the health care systems in the countries that were visited. This first report compares the health care delivery systems of the United States, Germany, and Holland. In subsequent reports, the German and Dutch health care systems will be described in greater detail and the ability of the United States to adopt European health care systems will be assessed. PMID- 10127409 TI - Informed decision making: the new paradigm. AB - Health care cannot survive in its present form. It is becoming unaffordable for a large share of the country's population. Its quality and effectiveness inexplicably vary between communities and across time. With all these problems, the process of health care can be understood. All that are needed are good, basic data; its access, management, and analysis; and then presentation of facts and observations. Together, these functions describe the translation of data into information--the field of medical informatics. Information about such management concerns as clinical efficiency (which largely is related to appropriateness and cost-effectiveness) and about the realities of day-to-day medical practice can be used to improve the value of health care. Informed decision making is based solely on confidence that, given the right information and understanding, we can all make the right decisions. The right decisions mean better patient acceptance and satisfaction, a sense of value enhancement by payers, and support of the Hippocratic tradition. PMID- 10127410 TI - Care for all: 10 reforms that could save the system. AB - The many problems of medical care in the United States have been stated and restated. These problems have evolved over the years and cannot be attributed to one or even a few causes. Most proposals for change are for single problems and their remedy will not produce meaningful reform, much less stop medical inflation. Today's problems are yesterday's solutions. There are 10 reforms that, if accomplished, could bring fairness, cost accountability, and financial controls to the health care system, while retaining competition and choice. PMID- 10127411 TI - Reinvigorating stalled CQI efforts through physician involvement. AB - Continuous quality improvement (CQI), loosely synonymous with total quality management (TQM), was designed for the comparatively simple world of industry. Now that the gurus of CQI have attempted--originally with full support of the Joint Commission on Accreditation of Healthcare Organizations (JCAHO)--to apply the industrial CQI model to hospitals, they've noticed something: The model doesn't work, and hospital CQI programs are faltering enough to persuade the Joint Commission to scale back its CQI accreditation requirements. One major shortcoming behind the performance to date of CQI in hospitals: Physicians don't fit into the industrial model of CQI. Physicians are too important, and too many programs are stalled, to continue to implement CQI as though physicians don't exist. The techniques described here should help to reinvigorate faltering programs, giving hospital management a chance to "do it right the second time." PMID- 10127412 TI - The private practitioner in hospital quality assurance. AB - External forces continue to dictate the necessity of delivering high-quality health care along with methods of proving that the claimed quality is attained. Gone are the days when both the institution and its practitioners could answer quality questions simply by stating that they were delivering excellent health care to their patient population. The federal government, via the Health Care Financing Administration, and the Joint Commission on Accreditation of Healthcare Organizations (JCAHO) are mandating that institutions prove, without question, that they are delivering health care of the highest quality. The essential key to attaining these goals is cooperative private practitioners. PMID- 10127413 TI - The health care system should produce health. AB - Reform of the U.S. health care system along the lines to be proposed by the Clinton Administration will not be an easy task, and it will not be accomplished quickly. A fundamental objective of the changes should be a health system whose purpose is improvement in the health of U.S. citizens, and not just the provision of services to all. This column is jointly edited by Kevin M. Fickenscher, MD, and David A. Kindig, MD, PhD, chair and member, respectively, of the College's Forum on National Health Policy. Dr. Fickenscher is participating in various advisory capacities on health care in the Clinton Administration, and Dr. Kindig is Senior Advisor to HHS Secretary Donna Shalala. PMID- 10127414 TI - Provider satisfaction: an analysis based on expectation. AB - Provider organizations will need to be in closer touch with their medical staffs in order to successfully anticipate and react to the many changes that lie ahead in the financing and delivery of health care services. This will mean understanding both physicians feelings and expectations. If you were asked today how satisfied your physicians are with your HMO, what would be your reply? How would you know? This staff-model HMO conducted a formal survey of its physicians to determine their expectations of the organization and their level of satisfaction with their work and environment. Such a tool is recommended for others interested in maintaining good relations with their physicians. PMID- 10127415 TI - Physician self-referral on the fast track. AB - One of the most hotly debated areas of health care fraud and abuse has been the prohibition on physician self-referral. Now, this prohibition is limited to physicians referring patients to clinical laboratories in which they have an ownership interest and for which the services are reimbursed under the Medicare program. However, this law may be expanded to include other health care services to which physicians cannot refer, as well as to other federal programs and private payers. While Congress works toward this end, many state governments have already taken the lead in expanding the prohibition beyond clinical laboratories and the Medicare program. "Health Law" is a regular feature of Physician Executive contributed by Epstein, Becker, and Green. Mark Lutes of the firm's Washington, D.C., offices serves as editor of the column. PMID- 10127416 TI - Will retiree health benefits survive FAS 106? AB - Recent months have seen dramatic public announcements about retiree health care coverage. General Motors recorded a $24 billion quarterly loss this year, due almost entirely to a one-time charge for future retiree health care costs. Other major employers have also reported sudden staggering losses, along with plans to decrease or stop retiree health coverage entirely. Some of these companies have been taken to court. The headlines also identify a culprit--an obscure accounting requirement, Financial Accounting Standard 106. To understand how an accounting rule can have such a profound effect on both the health care of our seniors and the financial strength of American industry, it is necessary to understand how employers pay for their retirees' care, how new accounting rules governing these costs can threaten a company's survival, and how employers are changing their employees' health coverage to meet these threats. PMID- 10127417 TI - Medicare and Medicaid: the first successful effort to increase access to health care. AB - The passage of Lyndon Johnson's health care legacy, Medicare and Medicaid, in 1965 represents the last time that health reform legislation expanding access to care was successfully proposed and implemented in the United States. Access, of course, represents only half the pie in health reform, the other part being the organization of the health care system. There has never been any major legislation passed through both houses of Congress and signed by a President that changed the organization and delivery of health services. It seems certain that President Clinton will propose legislation dealing with both access to and organization of our health care system. Though it may not have seemed so at the time, President Johnson had it easy compared to the challenges confronting President Clinton. PMID- 10127418 TI - Effects of medical practice structure on resource use. AB - The drive to national health care reform has made a central issue of variations among physicians in the use of resources to treat similar cases. While much research exists on this issue, little of it concentrates on the impact of practice structure on resource use. In this column, the author comments on that research. This column is intended as a point of ongoing analysis of health services research of importance to physician executives. The column is edited by John Kralewski, PhD, who heads the Institute for Health Services Research at the University of Minnesota. PMID- 10127419 TI - UNIfying a corporate family. Hologram, annual report, and employee store help UniHealth cement corporate bonds. UniHealth America, Burbank, CA. PMID- 10127420 TI - Careful fun in the sun. Hospital measures UV rays and issues skin cancer advisories. M.D. Anderson Cancer Center, Houston, TX. PMID- 10127421 TI - Living on easy street. Corporations and employees line up to donate. Frazier Rehab Center, Louisville, KY. PMID- 10127422 TI - Charity begins at the hospital. PMID- 10127423 TI - Storefront program breaks barriers to care for the poor. Schumpert Medical Center, Shreveport, LA. PMID- 10127424 TI - Mobile clinic reaches farm and factory workers. Grady General Hospital, Cairo, GA. PMID- 10127425 TI - Selling small town, U.S.A. Direct mail piece treads fine line to deliver nostalgia. Prairie Lakes Hospital, Watertown, SD. PMID- 10127426 TI - Hospital food worth paying for. Healthy frozen dinners at an affordable price draw many residents to hospital. Canonsburg General Hospital, PA. PMID- 10127427 TI - A phone number for doctors only. Referring physicians get special attention with 800 number, office visits, and privileges. Saint Thomas Hospital, Nashville, TN. PMID- 10127428 TI - Bigger isn't always better. Campaign uses negative factory image to boost small hospitals past large competitors. Edmond Regional Medical Center, OK. PMID- 10127429 TI - When the going gets tough ... fierce competition drives hospital to market physicians and minor emergency clinic. Memorial Hospital, Chattanooga, TN. PMID- 10127430 TI - Health care awaits reform. PMID- 10127431 TI - Praying in our own behalf. Toward the revitalization of petitionary prayer. PMID- 10127432 TI - Sparing the knife. Clinton's health care plan won't rip into America's weak job growth. PMID- 10127433 TI - Corporate connections. Mergers are on the rise, but unlike deals of the '80s they aren't debt laden. PMID- 10127434 TI - The art therapist's role in working with hospitalized children. PMID- 10127435 TI - Attitudes count (no matter what your job). PMID- 10127436 TI - IAHTM (International Association of Hospital Textile Management) celebrates 25th anniversary. PMID- 10127437 TI - Soulasthenia: the condition of healthcare's personality. PMID- 10127438 TI - Lead & follow. Employee value systems. PMID- 10127439 TI - A descriptive study of healthcare ethics consultants in Canada: results of a national survey. AB - As part of a project to examine health care ethics consultation in Canada, we surveyed individuals who were considered by themselves or others to play a significant role in health care ethics consultation. Since one goal of the project was to examine the education and abilities necessary for consultants, we sought to determine the qualifications and skills currently possessed by persons considered to be ethics consultants. For the purposes of the questionnaire, 'health care ethics consultation' was defined broadly to include consultation on ethical issues in clinical care or in clinical research, ethics consultation to Clinical Ethics Committees, Research Ethics Committees, and policy formulation committees in health care institutions; 'clinical ethics work' was defined more broadly still to include, in addition to the above, ethics education, administration, research and writing on bioethics other than the above, and public speaking. Three hundred and fifty questionnaires were sent to individuals and institutions across Canada that were thought to have some involvement in health care ethics consultation. Two hundred and fifty-three questionnaires were returned for a response rate of 72%. This report presents initial findings of the study and attempts to provide a comprehensive overview of the current state of ethics consultation within Canada. The survey examines demographics, educational background, time spent on ethics, institutional affiliations, approaches to the role of consultation, research related issues, and attitudes toward certification. Of the 253 questionnaires returned, 162 were completed by individuals who indicated that they provided some kind of ethics consultation. Of these, 43 indicated that they spent 30% or more of their time in clinical ethics work. These individuals are quite heterogeneous in background, training and activities, and while the great majority of them are based in an academic setting (university or teaching hospital), many act as resources to community hospitals, long-term care facilities and other organizations. Finally, the survey found that respondents' views on the advisability of certification for those offering ethics consultation were split evenly between those in favour of and those against certification. This report serves, then, as a reference point for studying the roles, responsibilities, training and accreditation of ethics consultants in health care. PMID- 10127440 TI - Feminist health care ethics consultation. PMID- 10127441 TI - Case notes and charting of bioethical case consultations. AB - In summary, the usual elements of a typical health care ethics consultation note might reasonably accommodate the needs and expectations of relevant parties, and would therefore include: 1. identification of the relevant ethical issues, questions, or dilemmas; 2. reference to any relevant facts--medical, nursing, social, psychological, spiritual, legal, political, etc.; 3. a prioritized list of recommendations to improve coordinated care; 4. a clear and concise articulation of relevant arguments, wtih specific reference to the list of recommendations as well as to the institution's overall ethos; 5. a contextual statement, identifying the perceived degree of consensus or support for the recommendations and conclusions, as well as any inherent agendas. PMID- 10127442 TI - Point and counterpoint. Should HECs involved in case review have a healthcare ethics consultant? AB - What level of bioethics expertise (1) must an HEC involved in case review have to ensure full discussion of the complexities of cases in an emotionally supportive manner, and to educate healthcare professionals about relevant moral aspects of these cases? Is there a necessary level of bioethics expertise required to ensure that discussions of ethics are sensitive to relevant community values as well as to legal context and constraints? In this article, three positions are explored: one requiring a healthcare ethics consultant, one arguing that some level of training of all committee members is adequate, and another which claims that multidisciplinarity and community representation without specific education is sufficient. PMID- 10127443 TI - Pain, competency and consent. PMID- 10127444 TI - The Ethics Committee Network of South Central Ontario (Canada). PMID- 10127445 TI - National health expenditures, 1991. AB - Spending for health care rose to $751.8 billion in 1991, an increase of 11.4 percent from the 1990 level. National health expenditures as a share of gross domestic product increased to 13.2 percent, up from 12.2 percent in 1990. The health care sector exhibited strong growth, despite slow growth in the overall economy. This combination resulted in the largest increase in the share of the Nation's output consumed by health care in the past three decades. In this article, the authors present estimates of health spending in the United States for 1991. The authors also examine reasons for the unusually large growth in Medicaid expenditures and highlight recent trends in the hospital sector. PMID- 10127446 TI - What affects rural beneficiaries use of urban and rural hospitals? AB - Analysis of the Medicare provider analysis record (MEDPAR) data during fiscal years 1984 through 1989 indicates that the proportion of rural Medicare beneficiaries hospitalized in urban hospitals has remained constant during the prospective payment system (PPS). Much of the use of urban hospitals by rural beneficiaries during this period was to obtain specialized care or surgery, as suggested by the analysis, and is consistent with historical patterns of referral of rural patients. Thus, the bypassing of rural hospitals by rural beneficiaries for treatment in urban hospitals has probably not increased during PPS. PMID- 10127447 TI - Measuring inpatient and outpatient costs: a cost-function approach. AB - In this article, the authors estimate a multiple-output cost function for a sample of 2,235 hospitals during the period 1984-88 to disaggregate total costs into inpatient and outpatient components. The results suggest that outpatient cost growth is roughly proportional to that of inpatient cost, despite much higher relative growth in revenues and utilization on the outpatient side. The stability in the outpatient/inpatient cost ratio implies that the increase in the outpatient-to-inpatient utilization ratio was offset by a decline in their relative unit costs. PMID- 10127448 TI - Do hospitals behave like consumers? An analysis of expenditures and revenues. AB - Hospitals adjust expenditures to be a constant proportion of their revenues. An unexpected 10-percent change in hospital revenue generates a 3.5-4.8 percent expenditure change (in the same direction) the year it occurs, with declining changes thereafter (10 percent in total). Non-profit and government hospitals adjust expenditures about 80 percent of the way toward their longrun change near the end of the third year of the revenue change; for-profit hospitals do this at the end of the fourth year. Hospitals with revenue increases make an 80-percent adjustment toward the end of the third year; those with revenue declines do so near the end of the fourth year. PMID- 10127449 TI - Contributions of case mix and intensity change to hospital cost increases. AB - The 28-percent change in average Medicare inpatient cost per case between 1984 and 1987 is decomposed into three components: input price inflation, changes in average cost within diagnosis-related groups (DRGs) (intensity), and changes in the distribution of cases across DRGs (case mix). We estimate the contributions of technology diffusion and outpatient shifts to within-DRG and across-DRG cost changes. We also use California data to estimate the contribution of changes in the quantity of services provided during a stay. The factors examined account for approximately 80 percent of the real increase in average cost per case. PMID- 10127450 TI - Are PPS payments adequate? Issues for updating and assessing rates. AB - Declining operating margins under Medicare's prospective payment system (PPS) have focused attention on the adequacy of payment rates. The question of whether annual updates to the rates have been too low or cost increases too high has become important. In this article we discuss issues relevant to updating PPS rates and judging their adequacy. We describe a modification to the current framework for recommending annual update factors. This framework is then used to retrospectively assess PPS payment and cost growth since 1985. The preliminary results suggest that current rates are more than adequate to support the cost of efficient care. Also discussed are why using financial margins to evaluate rates is problematic and alternative methods that might be employed. PMID- 10127451 TI - Evaluation of the grant program for rural health care transition. PMID- 10127452 TI - Medicare prospective payment without separate urban and rural rates. AB - The elimination of urban-rural differences in the Medicare prospective payment system (PPS) standard rates implies a need to re-examine all the PPS payment adjustments. Refinements for case mix, outliers, and the wage index can make a significant contribution to avoiding payment disparities in a single-rate system. However, changes in the adjustments for teaching and disproportionate-share (DSH) hospitals are also needed. The typically urban location of these hospitals makes it difficult to balance PPS payments and costs among major groups of urban and rural hospitals without some form of higher payment for all hospitals located in large urban areas. PMID- 10127453 TI - Geographic classification of hospitals: alternative labor market areas. AB - Medicare hospital payments are adjusted to reflect variation in hospital wages across geographic areas by grouping hospitals into labor market areas. By only recognizing the average wage in an area, Medicare encourages hospitals to contain costs. Labor market area definitions have recently received renewed attention because of their impact on hospital payments. Alternative labor market areas were evaluated using several criteria, including ability to explain wage variation and impact on payment equity. Rural labor market areas can be improved using county population size; however, further research on urban labor market areas is needed. PMID- 10127454 TI - Measuring teaching intensity with the resident-to-average daily census ratio. AB - This article analyzes a change in the measure of teaching intensity when calculating Medicare's indirect medical education (IME) adjustment: It looks at the potential for replacing, in the denominator of the ratio, beds with the average daily census (ADC). Among the findings are: (1) Hospitals with small teaching programs would benefit from this switch more than hospitals with larger programs because of their generally lower occupancy rates, (2) The adjustment formula currently used for the capital prospective payment system (PPS) would alleviate this effect relative to the adjustment formula used for the operating PPS, (3) Although ADC appears to vary more on average, the weighted average rates of change in the resident-to-ADC ratios for a matched group of teaching hospitals are equal to the rates of change for the resident-to-bed ratios. PMID- 10127455 TI - Assessing the FY 1989 change in Medicare PPS outlier policy. AB - In fiscal year (FY) 1989, Medicare changed its rules for paying for extremely long or expensive hospital stays called "outliers." We compared outlier payments in FYs 1989 and 1988, after adjusting for other simultaneous policy changes. We found that the new policy succeeded in targeting more outlier payments to the most expensive cases and to the hospitals suffering larger prospective payment system (PPS) losses and in reducing hospital financial risk. Using time-series analyses, we show that the policy change had no measurable effect on the timing of discharges or on the concentration of expensive cases in urban government owned hospitals. PMID- 10127456 TI - How recalibration method, pricing, and coding affect DRG weights. AB - We compared diagnosis-related group (DRG) weights calculated using the hospital specific relative-value (HSRV) methodology with those calculated using the standard methodology for each year from 1985 through 1989 and analyzed differences between the two methods in detail for 1989. We provide evidence suggesting that classification error and subsidies of higher weighted cases by lower weighted cases caused compression in the weights used for payment as late as the fifth year of the prospective payment system. However, later weights calculated by the standard method are not compressed because a statistical correlation between high markups and high case-mix indexes offsets the cross subsidization. HSRV weights from the same files are compressed because this methodology is more sensitive to cross-subsidies. However, both sets of weights produce equally good estimates of hospital-level costs net of those expenses that are paid by outlier payments. The greater compression of the HSRV weights is counterbalanced by the fact that more high-weight cases qualify as outliers. PMID- 10127458 TI - Provider 1993 LTC (long term care) buyer's guide. PMID- 10127457 TI - Medicare dependent hospitals: who depends on whom? AB - Small rural hospitals with a large proportion of Medicare patients currently receive special treatment as Medicare dependent hospitals (MDHs) under the prospective payment system (PPS). Other high Medicare hospitals (HMHs)--both urban and rural--have sought to have the additional per case payments extended to them. Current utilization patterns, the availability of alternative facilities, and the socioeconomic and demographic characteristics of the service areas were examined to determine whether either the current MDH or alternative HMH targeting criteria identify hospitals whose closure might impair access to care for Medicare beneficiaries residing in their service areas. Neither MDHs nor HMHs are substantially different from other hospitals in terms of providing access. While some individual MDHs or HMHs might be considered essential access facilities, alternate criteria should be developed to identify these facilities regardless of the proportion of their patients attributable to the Medicare program. PMID- 10127459 TI - Assisted living comes of age. PMID- 10127460 TI - Nutrition guidelines identify elements of quality care. PMID- 10127461 TI - Eye for detail boosts achievement in acquisitions marketplace. PMID- 10127462 TI - Family Medical Leave Act imposes new responsibilities on employers. PMID- 10127463 TI - Infection control program requires ongoing surveillance. PMID- 10127464 TI - Savvy management critical to community's success. PMID- 10127465 TI - Providers beware: congressional budget axe is poised. PMID- 10127466 TI - The evolution to utilization control. PMID- 10127467 TI - Emerging risks: IV infusion therapy--a hidden risk throughout the hospital environment. PMID- 10127468 TI - Connecticut quality coalition proves quality transcends traditional business boundaries. PMID- 10127469 TI - Perspectives. Global budgets: defined by the details. PMID- 10127470 TI - Congress seeks nearly $63 billion in Medicare and Medicaid cuts. PMID- 10127471 TI - Contractual advice. PMID- 10127472 TI - Health estate master planning. PMID- 10127473 TI - Fire alarm system without alarm. PMID- 10127474 TI - Life safety systems in UK hospitals. AB - The type of systems covered here are not just speculative ideals but practical, working products installed in an ever increasing number of UK hospital establishments. Some sixty major hospitals have had systems supplied by my own company, very similar to those described, over the previous five year period. In addition, systems supplied by other competent companies show us that this trend is not just 'Technology for Technology's sake' but an important step forward in alarm management strategy. PMID- 10127475 TI - Electrostatic discharge and its effect on nurse call equipment. PMID- 10127476 TI - Mineral insulated metal sheathed cables--a new twist. PMID- 10127477 TI - CHEM's review of PC-based environmental management tools: Part I--Databases. PMID- 10127478 TI - ASTM (American Society for Testing Materials) issues emergency standard test methods for protective-clothing. PMID- 10127479 TI - Small business and health care. AB - The key spokesman for the National Federation of Independent Business warns of the economic dangers involved in reform measures that do not consider their effects on small business. PMID- 10127480 TI - Physicians debate change in health care. Can medicine survive health reform? PMID- 10127481 TI - Physicians debate change in health care. A healthy challenge for health care. PMID- 10127482 TI - Medicare wage index changes. PMID- 10127483 TI - Managing an aging health care marketplace. PMID- 10127484 TI - Organized labor fights back. PMID- 10127485 TI - What happened to the union campaigns? PMID- 10127486 TI - The complexities of acquiring a physician's practice. PMID- 10127487 TI - Washington State health plan--a model for the country? PMID- 10127488 TI - Hospital IS integration and health reform. PMID- 10127489 TI - Trust will decide reform battle. PMID- 10127490 TI - The hospital as the high involvement organization. PMID- 10127491 TI - A user-friendly HCFA. AB - New HCFA Administrator Bruce Vladeck discusses reshaping of the cumbersome bureaucracy the agency has become. He promises a more efficient and responsive Health Care Financing Administration. PMID- 10127492 TI - Why more cost-sharing won't slow Medicare spending. AB - In considering ways to slow the growth in Medicare expenditures, policymakers have concluded that increasing point-of-service cost-sharing for patients will reduce demand for health services. Under the current system, Medicare beneficiaries faced with increased cost-sharing can reduce their demand for services or purchase additional private insurance. New data from the 1991 Medicare Current Beneficiary Survey show that high-income persons protect themselves from out-of-pocket costs by purchasing private supplemental insurance. Surprisingly, the data also reveal that many low-income persons also purchase private insurance, demonstrating that the elderly--whatever their income level- consider supplementary insurance more of a necessity than a luxury. Thus, it appears that increased beneficiary cost-sharing would have a limited effect on Medicare spending growth. PMID- 10127493 TI - Aggressive regulator or passive price-taker: what role should HIPCs (health insurance purchasing cooperatives) play? AB - Despite extensive variations on the theme, managed competition continues to be the favored model of federal and state governments in crafting health reform. A critical element in managed competition is the establishment of health insurance purchasing cooperatives (HIPCs), which band together the collective buying power of individuals or employers to give them market "clout". Policymakers must decide whether they want a HIPC to be an aggressive regulator--using its power to force changes among health plans--or a passive price-taker that contracts with plans meeting key criteria. PMID- 10127494 TI - Abortion services and President Clinton's health plan: two views. Yes, keep abortion services in Clinton health plan. AB - President Clinton has indicated he will include abortion services as a covered benefit in his upcoming health reform proposal. Two national leaders with opposing views debate the political and strategic wisdom of that approach. PMID- 10127495 TI - Abortion services and President Clinton's health plan: two views ... no, abortion isn't a health care service. PMID- 10127496 TI - Turning swords into plowshares: lessons from the military health system. AB - Policymakers are searching everywhere for examples of how best to reform the nation's health care system. A major reform model from an unexpected quarter--the U.S. military--is making great strides forward and contains many of the ingredients in the national reform debate: global budgeting, pooled-payer funding, private industry competition, managed care, prevention, and reallocation of resources. PMID- 10127497 TI - DataLine. Health groups shop for reform with big political contributions. PMID- 10127498 TI - Grading health care's Gucci-Gulch gang. AB - The term "special interest group" has never conjured up warm and fuzzy feelings, and certainly not among the pseudo-populist Clinton Administration as it tries to pull off health reform. But when these groups aren't using their lobbying muscles to kill or reshape legislation, they can genuinely help lawmakers understand the real-world effect of policy changes big and small. That's why the editorial staff of the Journal of American Health Policy decided to pass judgment on a dozen key health lobbying groups in its 1993 Report Card. Grades reflect the groups' impact on the legislative process, willingness to compromise, perceived level of integrity, and grass-roots organizing. As with previous report cards, we have graded on a curve. PMID- 10127499 TI - From DRGs to deregulation: New Jersey takes the road less traveled. AB - Following a 1992 court ruling that declared New Jersey's system of financing uncompensated care unconstitutional, the state radically changed its 12-year-old hospital payment system that pioneered the use of diagnostic-related groups (DRGs). In its place, New Jersey lawmakers approved a package of reforms that lets hospitals set their own charges and collect bad debts, uses the state's unemployment insurance trust fund to pay for charity care, and reforms the individual and small group insurance markets. Immediate results of the law include new subsidies for inner-city hospitals, lower bond ratings, and hospital layoffs. PMID- 10127500 TI - Legal group looks for uniformity in life-and-death treatment choices. PMID- 10127501 TI - Feds, states divvy up duties in health care reform. PMID- 10127502 TI - "Other Washington" passes major health reform. PMID- 10127503 TI - Texas links charity care, hospital tax-exempt status. PMID- 10127504 TI - Health care policymakers in Washington. PMID- 10127505 TI - The public dissemination of physician-specific mortality data: who has the right to know? PMID- 10127506 TI - MDs can and should do their own coding of claims: here's how. PMID- 10127507 TI - Clinician safety. A synopsis of the report of the American Psychiatric Association Task Force on Clinician Safety. PMID- 10127509 TI - Materials management, central service weeks help build team spirit. PMID- 10127508 TI - Chairman-elect designate eyes the future of health care and the AHA. Interview by Mary A. Grayson. AB - Gail L. Warden, president and CEO of Henry Ford Health System, Detroit, has been named chairman-elect of the American Hospital Association. He will become chairman of the board of trustees in January 1995. In many ways, Warden is the right man at the right time to head the AHA. His integrated system is described as light-years ahead of others in health care. This, plus his background as president and CEO of Group Health Cooperative of Puget Sound, Seattle, makes him one of the field's leading experts on managed care. Warden shared his vision of the future with Mary A. Grayson, Materials Management in Health Care's editorial director. PMID- 10127510 TI - Materials helps repaint financials from red to black. PMID- 10127511 TI - Here's a new twist: cut OR inventory before taking count. PMID- 10127512 TI - How to buy the best nurse-call system. PMID- 10127513 TI - ASHMM links hospitals to provide comparative performance data. PMID- 10127514 TI - Five steps to a better case cart system and reduced OR inventory. PMID- 10127515 TI - Stats. New data base offers product price comparisons. PMID- 10127516 TI - Data watch. 1993 B&H readership poll results. PMID- 10127517 TI - For most employers, cost sharing solves some problems of retiree benefits costs. PMID- 10127518 TI - Employers to Clinton: proceed cautiously on reform. PMID- 10127519 TI - Health care reform: a blow to jobs and wages? PMID- 10127520 TI - Employees are paying more for health benefits. AB - Our readers say they are asking their employees to pay more for health care and and are using a variety of methods to shift costs to workers. PMID- 10127521 TI - Government purchasers see value in managed care. AB - The County of San Diego and the Massachusetts Department of Mental Health are providing access to the indigent--and cutting their costs through managed care programs. PMID- 10127522 TI - Using flexible benefits as a communications tool. PMID- 10127523 TI - Iowa employers defend data effort. PMID- 10127524 TI - States expand coverage for children. PMID- 10127525 TI - Health reform must include prevention. PMID- 10127526 TI - Medicare program, health maintenance organizations: technical amendments--HCFA. Final rule with comment period. AB - This rule amends the HCFA regulations that pertain to prepaid health care to provide for uniform use of certain terms throughout part 417, simplify, clarify, and update content that pertains to the furnishing of health care services by, and the organization and operation of, Federally qualified health maintenance organizations (HMOs); and redesignate certain sections, correct internal crossreferences, and make minor conforming changes to ensure internal consistency. These are technical and editorial changes intended not to change the substance of the rules but rather to make it easier to find particular content and to better ensure uniform understanding of the regulations. The purpose of redesignations is to free section numbers in areas where it is necessary to insert new provisions (in logical order) to reflect changes in the Public Health Service Act. PMID- 10127527 TI - Hurricane Andrew. Gold Coast Home Health Services disaster/hurricane planning. PMID- 10127528 TI - Hurricane Andrew. Ninja nurses of Marion County in tent cities. PMID- 10127529 TI - Hurricane Andrew. Dialysis amidst devastation. PMID- 10127530 TI - Hurricane Andrew. Recouping physically. PMID- 10127531 TI - Hurricane Andrew. Responding to posttraumatic stress syndrome. PMID- 10127532 TI - Long-term effects of Hurricane Andrew. PMID- 10127533 TI - The power of volunteers in disaster relief. AB - Hurricane Andrew, one of the worst natural disasters in American history, brought out the spirit of caring in medical personnel as volunteers from all over the country came to aid the hurricane's victims. The following is an example of how one massive relief effort can make a difference in thousands of lives. PMID- 10127534 TI - Channeling home care expertise in disaster relief. AB - After a disaster hits, home care personnel have the instinct to run out immediately and help as many people as possible. Yet they can be most effective if they are part of an organized relief effort within the community. This article gives an idea of who the other players are and how they can best work together. PMID- 10127535 TI - One muddy, explosive week in Louisiana home care. AB - A disaster by definition is never expected; two disasters are almost beyond definition. Yet the agency that had to react to two disasters in one week turned its response into preparation for the next disaster--or two. PMID- 10127536 TI - Earthquake! AB - Who in their right mind would see a natural disaster as an opportunity? One agency does see earthquakes as opportunities to improve its service to rural and hard-to-reach patients. This earthquake preparedness plan is an ongoing process, evaluated and updated even when there isn't a call for true preparedness. PMID- 10127537 TI - Learning from experience. A mental health response to the northeaster of 1992. AB - The lessons learned from one tragedy can be used to ease the trauma of another. VNA Home Care drew upon its experience with a 1990 fire to help the victims of the 1992 northeaster cope with their losses and fear. PMID- 10127538 TI - The monster in the woods. Responding to the East Bay fire. AB - One agency decided to fight fire with earthquake when it applied its hard-won knowledge of disaster relief to community efforts during and following the East Bay fire. By drawing on its experience with the earthquake of 1989, Vesper Hospice of the East Bay and Vesper Home Health Agency were able to tame the "monster in the woods." PMID- 10127539 TI - Providing home care during civil unrest. AB - The Visiting Nurse Association of Los Angeles responded to the possibility of civil unrest during the Rodney King trial by drafting a plan for disaster readiness. Both management and staff worked together to prepare the agency for the continuation of services during civil unrest or other possible disasters. PMID- 10127540 TI - Service in the snow. Maintaining care in rural California. AB - The amount of snow that falls in the Sierras is proof that all is not sunshine in rural northeastern California. Isolation and road closures were just two of the challenges that one home care agency was able to surmount with careful planning. PMID- 10127541 TI - West coast windstorm. Saving the pharmaceuticals. AB - On Inauguration Day, the west coast experienced a devastating windstorm that cut off power across Washington state, interrupting countless procedures, including the provision of home care services. Two agencies rallied when called. Their stories provide insight into dealing with unforeseen disasters and inspiration in working together with colleagues and community. PMID- 10127542 TI - West coast windstorm. Ventilator dependent--without power! PMID- 10127543 TI - Hurricane Andrew. The role of home care in disaster relief. PMID- 10127544 TI - Disaster strikes the caregivers. A lesson for managers. AB - The caregiving team is the core of effective management practice. Home care managers need to remember that caring for the caregivers--seeing them as victims as well as care providers and allowing them the same time for shock, grief, and recovery--allows those folks to carry on with the business of home care. PMID- 10127545 TI - Small and isolated. The solution is community. AB - In areas where access to clients is difficult to begin with, emergencies require that home care staff concentrate on providing assistance in their own neighborhoods. Even that takes advance planning, which should turn on the key point of community involvement and education before any disasters occur. PMID- 10127546 TI - Roanoke Memorial Hospitals' home health services discharge planning process. AB - As the health care industry focuses on continuous quality improvement in the context of reform, discharge planning plays an integrated role in the delivery of care. This process optimally is initiated upon patient admission to the acute care facility. As the role of home care continues to expand, however, home care providers must develop and initiate a discharge planning process. PMID- 10127547 TI - The limited liability company: an alternative business form. PMID- 10127548 TI - The advantages of the "spoken" menu. PMID- 10127549 TI - Understanding percentiles. PMID- 10127550 TI - A new way to look at meal equivalents. PMID- 10127551 TI - The future of health care information systems. PMID- 10127552 TI - Special needs of adult critical care units. AB - This article has highlighted some of the specific needs of adult critical care units and the role that both the nurse manager and materiel manager play in today's changing health care system and environment. The key to success in meeting the specific needs of critical care patients lies in open communication and collaboration between the materiel management department and the department of nursing. The challenges are many, yet cooperation and an understanding of one another's needs can do much to create successful relationships within critical care settings and ensure optimal patient safety. PMID- 10127553 TI - Inventory management for cardiac catheterization labs: the Princeton-Baptist Medical Center experience. AB - Several issues must be considered for implementation in order to decrease inventories and make them more manageable. Physician consensus on products, strict vendor control by the department manager, setting and maintaining low par levels, inventorying stock daily, negotiating just-in-time deliveries, conservation-minded staff, and working in concert with central supply and materiel management personnel are steps that when employed correctly can lead to more manageable inventories in cardiac catheterization departments. If these steps are implemented, they will enhance the liquidity of the department and ultimately that of the medical center. PMID- 10127554 TI - Six honest serving men. AB - The practice of medical-surgical nursing is "a dynamic, evolutionary process" and the proliferation of health care technology has been instrumental in its evolution. This proliferation and the goal of quality patient care in medical surgical nursing practice are unlikely to change. However, the provision of quality care depends on the use of appropriate technology. Nurses and materiel managers working collaboratively can identify and promote the use of appropriate health care technology by applying the framework of technology assessment. This framework is analogous to Kipling's six honest serving men (They taught me all I knew); Their names are What and Why and When And How and Where and Who. The Elephant's Child What, Why, and When advise selective and judicious use of appropriate health care technology. How, Where, and Who reaffirm knowledgeable and proficient use with registered nurses, the patients' "link with the personal, human world within an impersonal, electronic world." Together, the six honest serving men emphasize that the primary purpose of health care technology is the improvement of human health "from the individual level through and including national health policy." PMID- 10127555 TI - Balancing clinical priorities in an era of diminishing resources. AB - By learning to ask both manufacturers and clinicians why a technology is needed, how it compares to the existing technology, and whether it will eliminate the need for the existing technology and by demanding specific answers, much more rational decisions can be made, which will be in the best interests of the community the hospital serves. Materiel managers can play a key role in fostering this process. In addition, by helping department managers develop long-range multiyear plans, materiel managers can help hospitals better manage their existing assets and make better long-term purchasing decisions. PMID- 10127556 TI - The emerging roles of computers in materiel management. PMID- 10127557 TI - Materiel management practices and inventory productivity. PMID- 10127558 TI - Is there a marriage between productivity and quality? AB - What we have been reviewing is a workplace ethic of excellence, a management philosophy that has at its core a creative orientation that encourages diversity of vision that drives risk taking, participation, and collaborative employee endeavors within the context of shared rewards. To achieve this ethic of excellence in an industry battered by socio-eco-political and ethical hurricanes, we need to be genuflecting at the altar of opportunity and engaging in brainstorming, not only about the future, but also how we are going to get there. We need to abandon the reflex of engaging in crisis management. Health care management must assume the role of coach, mentor, and visionary, thus shedding the inane propensity to move along the comfortable road of bureaucracy, cynicism, redundancy, and control. Our future lies in a proactive, organizationally integrated, customer-oriented, and enabling environment that delivers high quality standards that maximize productivity. Therefore, in a world of change, there must be a marriage between quality improvement and productivity through implementation of QIPP processes and culture. PMID- 10127559 TI - Join the club. PMID- 10127560 TI - The F words ... focused, fast, flexible, friendly, and fun. PMID- 10127561 TI - Fair assessment. PMID- 10127562 TI - Screen test. PMID- 10127563 TI - Special report. Crime and the NHS. PMID- 10127564 TI - Checks and balances. PMID- 10127565 TI - Remote control. PMID- 10127567 TI - Data briefing. Complementary medicine. National Association of Health Authorities and Trusts. PMID- 10127566 TI - After Allitt. PMID- 10127568 TI - Home rules. PMID- 10127569 TI - Buyer beware. PMID- 10127570 TI - Why it pays to pay more. PMID- 10127571 TI - Marketing. Not just a pretty picture. PMID- 10127572 TI - Market values. PMID- 10127573 TI - Data briefing. Steptoe ... and sons ... and daughters. National Association of Health Authorities and Trusts. PMID- 10127574 TI - Pharmacist monitoring of drug therapy in patients with abnormal serum creatinine levels. AB - Because of possibly drug-related adverse events that occurred in renal patients, a program was developed to routinely monitor renal patients to ensure that all prescribed drugs and dosages conformed to standard clearance-adjusted regimens. Summary laboratory reports were surveyed daily, patients with abnormally elevated serum creatinine values were noted, and reviews of patients' medication profiles and orders were performed at least daily. The pharmacist was made responsible for judging if renally-eliminated drugs were used appropriately. If the pharmacist deemed that a change was needed, the prescribing physician was contacted by telephone or in person. From January 1990 through December 1992, a total of 627 patients with renal impairment were monitored. Among these patients, 233 changes in drug therapy were implemented as a direct result of pharmacist assessment and subsequent physician contact. The most common changes were dosage decreases. Medications requiring changes most often were antimicrobial agents, accounting for 55% of all interventions. A retrospective assessment of interventional efficacy, performed through focused evaluation of 20 randomly selected cases, revealed no direct evidence of either therapeutic failure or drug toxicity in patients for whom pharmacist-directed changes were made. Pharmacist monitoring can have a beneficial influence on the care of renal patients. PMID- 10127575 TI - Computer-assisted use of tracer antidote drugs to increase detection of adverse drug reactions: a retrospective and concurrent trial. AB - The authors found that a concurrent review of use of antidote drugs commonly used for the treatment of adverse drug reactions is an effective method for identifying such reactions. Computer-assisted detection helped rule out false positives and decrease the number charts to be screened, thereby reducing the time needed to find adverse drug reactions. PMID- 10127576 TI - Benefits of clinical pharmacy services in a community hospital. AB - The purpose of this analysis was to itemize the long term cost-avoidance and benefits of the Clinical Pharmacy Program at York Hospital and compare them to the cost of the program. It was assumed that the major actual reduction in drug cost would occur within the first year of clinical activities. Therefore, to determine the long term benefits, the hypothetical cost-avoidance of drug expenditures were calculated for the subsequent years after the clinical programs were instituted. For fiscal year 1991 these significant benefits amounted to an estimated monetary cost-avoidance of $416,000, a reduction in numerous hours in preparations and administration of 39,000 IVs, and numerous non-quantifiable benefits. The cost of the program in fiscal year 1991 for the pharmacist and administrative salaries related to the Pharmacy Clinical Program was approximately $140,000. Thus, the Clinical Pharmacy Program was cost-effective at York Hospital. PMID- 10127577 TI - Unannounced surveys. PMID- 10127578 TI - The role of alumni in making a program highly successful. PMID- 10127579 TI - Graduate education in health information systems: having all your eggs in one basket. AB - Until recently, the technological evolution of information systems (IS) within the health care field has been relatively slow and sporadic in comparison to IS development in other industries. With the growing proliferation of powerful computers and personal workstations among health professionals, the advancement of IS technologies in the health care field has great potential. Hence, there is increasing pressure to integrate IS curricula into graduate level health administration education. This article combines earlier IS curricula from both the management and health care perspectives into an integrated framework for the development of a graduate education program in health information systems (HIS). The framework divides the HIS field into three modules: (1) HIS technologies and applications; (2) HIS theories and methodologies; and (3) HIS administration and impacts. This framework is also applied to the structuring of a master's level course for training generalists in HIS with a strong emphasis on the planning and management of hospital information systems. PMID- 10127580 TI - The humanities and health management education. PMID- 10127581 TI - Analysis of job functions of top level nurse executives in acute, home, and long term care: implications for education. AB - The purpose of this study was to strengthen the empirical base for nursing administration curricula by analyzing the current job functions of top level nurse executives in acute, long-term, and home care settings. The survey of job functions was designed to identify the relative amount of "time spent" and "importance" attributed to the job activities of nurse executives. Course content areas providing preparation for key job responsibilities are identified, and recommendations for curriculum design are discussed. PMID- 10127582 TI - Constructing gerontological curricula for health administration. PMID- 10127583 TI - Erasmus University: an innovative program in health care policy and management. PMID- 10127584 TI - The standard issues. PMID- 10127585 TI - The legal issues. PMID- 10127586 TI - The marriage of EDI and electronic imaging. PMID- 10127587 TI - Reengineering medical record processing. PMID- 10127588 TI - Thoughts on levels of microbial cleanliness and on validating disinfection procedures. AB - Efforts of the European Committee of Standardization (CEN) and the International Organization for Standardization (ISO) to harmonize production standards for medical devices have brought to the fore the need to standardize definitions and names for different levels of microbial contamination as well as validation procedures for microbial inactivation. Spaulding's categories of medical devices (critical, semi-critical and noncritical items) suggest that different levels of cleanliness can be accepted. Current terminology is imprecise and does not provide the necessary information to the user. A more appropriate one is needed. So are methods to validate microbial inactivation processes to lower levels of cleanliness than sterility. In Sweden, a couple of validation studies have been performed on bacterial inactivation in automatic washing machines which disinfect through a final hot water or steam rinse. However, more studies need to be done, especially on viral inactivation. PMID- 10127589 TI - Central service in Siberia. AB - In 1992, eight healthcare professionals from United Hospital in Grand Forks, North Dakota spent six weeks in Ishim, in the Siberian region of Russia, on a medical information exchange to observe the methods of healthcare delivery, assess the needs of medical facilities and share technical advice where applicable. Ishim's CS workers were anxious to learn how to better utilize the resources they had--which were few. Supplies were so limited that CS workers were provided little personal protective equipment; there were not even gloves available for handling contaminated instruments in the washing and decontamination areas. Ishim's facility reprocessed virtually everything, including tongue depressors and surgeons' gloves. The CS department cleaned, assembled and sterilized instruments for Ishim City Hospital's OR and for the city's 28 clinics. When United's representatives returned to the U.S., they formed a supply committee to procure instruments and other needed materials for the Russian hospital and clinics. PMID- 10127590 TI - Information systems and inventory control: what you don't know might hurt you! AB - Computerized information systems use in material management is expected to increase over the next decade. The goal of computerization is to improve information and productivity. However, without a through understanding of materiel management inventory control techniques implemented through the software, meeting this goal is questionable at best. Using computerized information systems inefficiently by ignoring a significant number of the system's recommendations, using inaccurate data, circumventing procedures or using the wrong set of inventory control techniques can create a poor environment for decision-making. Material managers need to understand each inventory control technique available through their computerized system, their associated underlying assumptions and the implications of each on the quality and usefulness of information generated. PMID- 10127591 TI - Enteral feeding pumps. ECRI. PMID- 10127592 TI - Healthcare reform update. PMID- 10127593 TI - Containing waste. PMID- 10127594 TI - Here's your degree. Now fork over $130,000. PMID- 10127595 TI - Can this profligate Blue find a way out of the red? PMID- 10127596 TI - Coping with tougher times. New office technology lets you get more done faster. PMID- 10127597 TI - Business to doctors: show us you're doing it right. PMID- 10127598 TI - Floodwaters continue to pressure hospitals. PMID- 10127599 TI - 'Any willing provider' laws post threat to reform--trade groups. PMID- 10127600 TI - Marketers seek to boost their value to hospitals in preparation for reform. PMID- 10127601 TI - Clean air an issue during electrosurgery. PMID- 10127602 TI - Hospital's health-agency haven is good for business. PMID- 10127603 TI - JCAHO plans targets for subacute providers. PMID- 10127604 TI - ACHE weighing revamp for dues and membership. PMID- 10127605 TI - NME to shutter psych facility in Fort Worth. PMID- 10127606 TI - Horizon bids for Greenery. PMID- 10127607 TI - State agency's ruling sets back plans of for-profit chain Quorum to acquire not for-profit hospital. PMID- 10127609 TI - Budget cuts disappoint provider groups. PMID- 10127608 TI - Cleveland Clinic Hospital, 7 for-profit facilities form healthcare alliance in Fla. PMID- 10127610 TI - Plan to prod states to act. PMID- 10127611 TI - Summit Medical Center seeking affiliation partner. PMID- 10127612 TI - Ark., Ga. hospitals sign with HMO firm. PMID- 10127613 TI - Adventist's suit to stop deal a rare foray into the courts. PMID- 10127614 TI - Creditors OK Healthcare International revamp. PMID- 10127615 TI - Rochester coalition plans spending cap. PMID- 10127616 TI - Hospitals enter ventures to woo docs, not to meet communities' needs--GAO. PMID- 10127617 TI - Healthcare update ... Cedars-Sinai Medical Center. PMID- 10127618 TI - Competition severs U.S. Surgical's hold. PMID- 10127619 TI - Coalitions test healthcare value and performance. PMID- 10127620 TI - Non-mainstream groups long for reform. PMID- 10127621 TI - Charter confirms talks over possible sale or spinoff of its 10 acute-care hospitals. PMID- 10127622 TI - Pa. workers' comp reform ends charge-based program. PMID- 10127623 TI - Budget provision to permit N.Y. surcharges. PMID- 10127624 TI - Firm expands to open center in Mexico City. PMID- 10127625 TI - 2 more states give hospitals antitrust aid. PMID- 10127627 TI - Market opening up to the non-traditional. PMID- 10127626 TI - Movie world's health system plays key role. PMID- 10127628 TI - One-day N. Calif. strike is delayed. PMID- 10127629 TI - Presbyterian plans to trim beds, staff. PMID- 10127630 TI - New York Blues plans to act as 'clearinghouse'. PMID- 10127631 TI - Hospitals get first lady's pledge that they'll get antitrust relief. PMID- 10127632 TI - Adventist won't be getting Kissimmee hospital if sale required--Columbia's Scott. PMID- 10127633 TI - Grace gets FDA OK to import equipment. PMID- 10127634 TI - Two Texas systems form alliance. PMID- 10127635 TI - Methodist begins casting to net managed-care pacts. PMID- 10127636 TI - AdvaCare to restructure debt. PMID- 10127637 TI - Counterattack by 3 bidders holds up Pentagon's choice for managed-care contract. PMID- 10127638 TI - Quorum to buy Charter facilities. PMID- 10127639 TI - Newly expanded Olsten seeking hospital partners. PMID- 10127640 TI - Medicare changes off budget, in doubt. PMID- 10127641 TI - Trustees to bear burden of reform. PMID- 10127642 TI - The fight against fraud. As the number of healthcare cases climbs, investigators make comparisons to S&L scandal. PMID- 10127643 TI - HCFA, New Jersey hospitals settle dispute. PMID- 10127644 TI - Oregon governor's signature to launch rationing program. PMID- 10127645 TI - Hospital union elections tally lowest since '89. PMID- 10127646 TI - Board postpones decision on adding 'independents'. PMID- 10127647 TI - Convention attendance down 37% from 1992. PMID- 10127648 TI - Targeting prevention programs to OR blood exposure patterns. PMID- 10127649 TI - Heart centers face closer scrutiny, tougher standards. PMID- 10127650 TI - Precautions reduce risk of latex reactions. PMID- 10127651 TI - CPT (current procedure terminology) coding and patient accounting: controlling the process and improving billing efficiency. AB - As outpatient volumes increase in hospitals across the country, more and more coding responsibilities are being placed with the patient accounts department. Both registration and outpatient billers are involved in assigning current procedural terminology (CPT) codes for surgery and emergency room procedures, as well as maintaining the hospital's chargemaster. Often these responsibilities are assigned without regard for the level of coding expertise and degree of clinical knowledge of the personnel involved, which can lead to significant loss of reimbursement and untimely billing delays. This article addresses common problems and offers suggestions for improving coding, minimizing problems, and increasing billing efficiency. PMID- 10127652 TI - Teamwork, accurate coding open doors to opportunity. PMID- 10127653 TI - TQM, systems thinking and the monkey fist. AB - To successfully implement total quality management (TQM), management must embrace change. Mr. Hage explains that managers face the challenge not only of learning new information, but of changing the way they think, if they are to take full advantage of TQM. In addition to learning new techniques, a commitment to involving all members of the organization in the new techniques is required. Mr. Hage offers a provocative analogy from the animal world to help illuminate this new territory for managers. PMID- 10127654 TI - Key elements in managing effective meetings. AB - As hospitals across the country implement QI strategies, associates find themselves spending increasing amounts of their time in group meetings, identifying and solving problems. Mr. Olivares offers detailed advice about how to plan and run effective meetings, skills which we all should acquire to maximize our productivity. PMID- 10127655 TI - Using quality focus teams in the diagnostic imaging department. AB - Quality Focus Teams (QFTs) have become a very effective and popular tool used to address quality issues and improve service. With the recent movement toward total quality management (TQM), or continuous quality improvement (CQI), these teams can play an important role in patient care and the quality of service provided by your department. While teams are not a new concept, they have gained a new popularity in the healthcare field by focusing on service quality. Such teams have been referred to in the past as quality circles or management teams, and were used primarily by manufacturers to address quality issues and implement improvements. They were usually brought together to address a specific problem or crisis. QFTs, on the other hand, usually go a step further by addressing ways of continually improving service or care, even in the absence of a crisis or obvious problem. With the increasingly competitive environment in healthcare and the demands to maintain the highest level of quality possible, QFTs should be a part of every department. This article will provide radiology managers with the basic information needed to begin developing, using and benefitting from QFTs. PMID- 10127656 TI - Capital acquisition teams. AB - Mr. Sutherland is Director of Diagnostic Imaging at Mount Clemens General Hospital, where teams of employees are responsible for researching and acquiring capital equipment. In this article, Mr. Sutherland explains the process and the benefits to be gained. PMID- 10127657 TI - Radiology information systems help radiology departments operate more efficiently. AB - Many department managers identify radiology information systems (RIS) as one way to increase efficiency and reduce expenses. Ms. Rowe explains various ways that an RIS can help you compete in an increasingly competitive marketplace, handle higher patient volume and fulfill requirements for recording and transferring patient information. PMID- 10127658 TI - Selection and integration of a radiology information system. AB - A comprehensive and reliable computer-based RIS can significantly improve patient care. The authors present case studies that illustrate different approaches to selection and implementation of an RIS. Detailed coverage is given to criteria for the RIS, the selection process, integration with hospital information systems and planning for the future. PMID- 10127660 TI - Health assessment, community needs guide hospital planning. PMID- 10127659 TI - AHRA survey. Staff utilization: Part II. AB - Part II of this AHRA membership survey reports on information relating to staff utilization in computed tomography, ultrasound and magnetic resonance. The average volume of procedures per full-time-equivalent staff is provided for technologists, clerical staff and physicians. Part III, to be published in the fall issue, will provide reports on radiation therapy and nuclear medicine. PMID- 10127661 TI - Strikes may pose greater threat. PMID- 10127662 TI - Board backs community benefit. PMID- 10127663 TI - Providers and business leaders converge to restructure health care. PMID- 10127664 TI - TQM and the CEO evaluation. PMID- 10127665 TI - Practice acquisition: partnership for mutual survival. PMID- 10127666 TI - Today's board, tomorrow's world: six steps to effective trusteeship. PMID- 10127667 TI - Collaboration: the next logical step. PMID- 10127668 TI - All health care is local: the importance of political advocacy. Interview by Karen Gardner. PMID- 10127669 TI - How to write an effective letter to your legislator. PMID- 10127670 TI - Computerised care plans: provoking a quiet revolution. AB - The Illawarra Area Health Service has been experimenting with use of computerised nursing care plans. Microcomputer software has been successfully tested in several wards and the intention is to move to implementation which will probably involve porting the software to the area-wide mainframe. The technology was recently extended to multidisciplinary care planning using the managed care/critical pathways approach. This paper describes the development process and some of the initial results. PMID- 10127671 TI - International trends in health services. PMID- 10127672 TI - Making the transition from health professional to manager. AB - Health professionals who make a career change into a managerial role frequently find that the adjustment is a difficult one. Often they are not well prepared for the new role. They find that the world of the manager is different in a number of ways from the professional world they have known, and the skills required for effective performance are also different. This preliminary study, which involved interviews with a number of professionals who have made the transition, highlighted the adjustments they had to make and the transition difficulties they experienced. Attention is drawn to a number of ways in which health professionals can be assisted to develop into effective managers. PMID- 10127673 TI - Rejoinder. PMID- 10127674 TI - The National Health Service reforms as an electoral issue in the United Kingdom. AB - The implementation of National Health Service (NHS) reforms left the Conservative Government with a major electoral problem. As Britain approached the 1992 general election, opinion polls revealed a popular perception that the Conservatives were planning to privatise the NHS. This perception was both fuelled and acted upon by the Labour Opposition which, at its 1991 annual conference, signalled its intention to make the health service a major item on the electoral agenda. In this article several issues associated with popular perceptions of the health reforms are explored including increased levels of copayment, the language of commerce, entrepreneurial activities within the NHS, and 'opting out'. The ways in which the Labour Party sought to place health on the electoral agenda are examined, together with the response of the government. Labour sought to portray the reforms as creeping privatisation while the Conservatives dismissed this as a crude propaganda ploy and have stressed their commitment to a more effective NHS. It is argued that the British experience exemplifies the perennial problems for any government seeking to introduce substantive changes to a national health system in a partisan political environment: the need to explain changes and legitimize them, and the danger that reforms will be politicized by an opposition eager for issues with immediate popular impact. PMID- 10127675 TI - Patient satisfaction: methodological issues and research findings. AB - Patient satisfaction plays a significant role in the health care process. It influences the health care seeking behaviour of patients, compliance with treatment and the health outcomes of patients. The use of ill-conceived and limited patient satisfaction questionnaires, in conjunction with inadequate methods of administration, have contributed to the poor reputation of patient satisfaction as an indicator of the quality of health care services. This paper addresses some of the methodological issues related to the measurement of patient satisfaction and describes validated and reliable tools which are available for use by hospitals in Australia. Research findings discussed demonstrate that patients are able to evaluate validly and reliably the quality of both clinical and non-clinical aspects of health care services. Australian health care organisations should implement patient satisfaction as a quality indicator and thereby actively seek to improve the health outcomes of their patients. PMID- 10127676 TI - Is public hospital pathology worth preserving? AB - Public hospital pathology departments are perceived to be inefficient, in terms of cost-effectiveness of performing tests, when compared to the private sector. Is there a place for public hospital pathology to be contracted out to the private sector? This paper critically examines the worth of public hospital laboratories in terms of the service provided and their role in teaching and research. It concludes that there is a place for maintaining the public hospital pathology system. However, the public hospital laboratories need to become much more financially accountable. Steps have to be taken to reduce costs. Budgets should reflect the volume of tests performed with due allowance for teaching and research. The departments also have to develop an academic excellence that sets them apart from the private sector. PMID- 10127677 TI - The Yale Cost Model and cost centres: servant or master? AB - Cost accounting describes that aspect of accounting which collects, allocates and controls the cost of producing a service. Costing information is primarily reported to management to enable control of costs and to ensure the financial viability of units, departments and divisions. As costing studies continue to produce estimates of Diagnosis Related Group (DRG) costs in New South Wales hospitals, as well as in other states, costs for different hospitals are being externally compared, using a tool which is usually related to internal management and reporting. Comparability of costs is assumed even though accounting systems differ. This paper examines the cost centre structures at five major teaching hospitals in Sydney. It describes the similarities and differences in how the cost centres were constituted, and then details the line items of expenditure that are charged to each cost centre. The results of a comparative study of a medical specialty are included as evidence of different costing methodologies in the hospitals. The picture that emerged from the study is that the hospitals are constituting their cost centres to meet their internal management needs, that is, to know the cost of running a ward or nursing unit, a medical specialty, department and so on. The rationale for the particular cost centre construction was that cost centre managers could manage and control costs and assign responsibility. There are variations in procedures for assigning costs to cost centres, and the question is asked 'Do these variations in procedures make a material difference to our ability to compare costs per Diagnosis Related Group at the various hospitals?' It is contended that the accounting information, which is produced as a result of different practices, is primarily for internal management, not external comparison. It would be better for hospitals to compare their estimated costs per Diagnosis Related Group to an internal standard cost rather than the costs from other hospitals. This is because there are differences in cost centre construction and standardisation of cost centre definitions will not meet the information needs of internal management. Also capabilities and capacities of accounting systems vary greatly and uniformity will take a long time to achieve, if ever. PMID- 10127678 TI - Perspectives. Veterans' health care: can it survive reform? PMID- 10127679 TI - Hospital leaders oppose harmful budget cuts. PMID- 10127680 TI - Waste not, want not. An innovative plan for recycling and reusing medical waste debuts in Southern California. PMID- 10127681 TI - Developing new hazardous waste plans. PMID- 10127682 TI - The renewable hospital. AB - While medical technology and reimbursement policies continue to change, the hospitals that are supposed to change with them are increasingly outdated. In recent years, hospital architects have begun adopting designs aimed at preventing obsolescence. PMID- 10127684 TI - Neighborhood scale. Children's Hospital, Oakland, CA. PMID- 10127683 TI - Innovations in quality. AB - To strengthen their operations many hospitals have embraced total quality management (TQM) strategies used by companies throughout the world. California Hospitals examines how some of these hospitals have used TQM to improve clinical outcomes, cut costs, boost staff morale and increase patient satisfaction. PMID- 10127685 TI - Total quality management: measuring costs of quality. PMID- 10127686 TI - Working together to create change. PMID- 10127687 TI - Ten major educational issues. PMID- 10127688 TI - Test your alliance knowledge. PMID- 10127690 TI - Us and them. PMID- 10127689 TI - Contemporary issues in HIM. The application layer--IV. AB - Productivity tools can greatly simplify our day-to-day work around the office. Many of these tools are inexpensive and can be "test driven" before they are purchased. However, a word of warning is in order. One of the most common ways computer viruses are spread is via shared software. If you are going to sample the myriad of programs available on computer bulletin boards and that friends have given you, practice safe computing. Before installing any new software, use a virus checker to make sure the new software is not contaminated. It should be noted that there have even been a few cases where reputable software vendors have shipped software that was contaminated with a virus. Finally, as networks of computers proliferate, you can expect to see growth in the quantity and quality of groupware. As we become more dependent on the computer to store all kinds of information, we will need better tools to carefully manage the distribution of, and access to, that information. Sharing documents presents another problem that will be discussed in next month's article: security. Computer security has been a concern of computer scientists for many years. Now with the advent of computer based medical records, it has a direct impact on the health information management field. PMID- 10127691 TI - Correlation between birth order and leadership. PMID- 10127692 TI - Leadership--vehicle to total quality? PMID- 10127693 TI - Odyssey 2000--a journey of change. PMID- 10127694 TI - Recruitment and retention leadership. PMID- 10127695 TI - Burnout and turnover potential among department leaders. PMID- 10127696 TI - Health information management skills inventory summary. PMID- 10127697 TI - Clinical information systems: why now? PMID- 10127698 TI - The future of clinical information systems: one hospital's perspective. AB - Developing advanced clinical information systems is a complex and arduous task. The pressures on the health care delivery system make the task imperative. Because of such a system's complexity, its potential to alter radically the practice of medical care, and the magnitude of the required investment, health care delivery organizations would be well served by a thoughtful determination of the perspectives, philosophies, and strategies that will govern the approach to this task. This article has presented a description of the results of the deliberations of the leadership of one organization, the Brigham and Women's Hospital. The ideas and activities described should prove useful to other organizations engaged in their own deliberations. PMID- 10127699 TI - Using integration technology as a strategic advantage. AB - The underlying premise of the Managed Competition Act previously cited is that through managed competition providers will be forced to lower care costs while increasing the level of positive care outcomes. Because it may also be that tomorrow's hospitals will find a severe rationing of technology, what can they do to prepare? Most of the systems in place today already have built within them all the necessary potential to address this premise and technology requirement with no change, no conversion, no expense for new equipment and software, and no disruption in day-to-day operations, just a little re-engineering. Today, however, these systems are similar to a 20-mule team pulling in different directions: all the power is there, but the wagon remains motionless and totally unable to reach its objective. It takes a skilled wagonmaster to bring them together, to make the mules work as a cohesive unit, to make the power of 20 mules greater than the sum of 20 mules. So it is and will be for the hospital of tomorrow. System integration is no longer a question of whether but of when. Those hospitals that use it today as a strategic advantage will be in a better position tomorrow to use it as a competitive strategic advantage in an environment that will reward low cost and high positive care outcomes and will penalize those that cannot compete. The technology is already here and economically within reach of nearly every hospital, just waiting to be used. The question that must nag all of us who want to make the health care system of America better is, Why not make the when now? Rich Helppie, president of Superior Consultant Company, summarized the solution well: The old ways will not give way to the new overnight. The re-engineering process in healthcare must evolve. Compared to the last 20 years, however, such evolution may appear to be a massive, forthright, complete, comprehensive, drastic and rapid revolution. Survival is the name of the game, and for healthcare organizations to survive, they must join the re-engineering revolution. When that happens, the "Americanized" health care system might look like the community network shown in Figure 7, which is a networked integration of all the systems used in the community working together and exchanging information, with hospitals exchanging information with other hospitals and sharing it with physicians, clinics, laboratories, radiology centers, universities, employers, payors, and governmental agencies.(ABSTRACT TRUNCATED AT 400 WORDS) PMID- 10127700 TI - The search for a competitive edge: building a new conceptual framework for health care information. PMID- 10127701 TI - Health care-oriented telecommunications: the wave of the future. AB - This article has examined the impact that telecommunications technologies may have on the way in which health care services are delivered. A number of scenarios of how that might occur were discussed. Some of these scenarios are already being realized. Telemedicine, for instance, is being used in certain geographic regions of the United States. Various community health information networks are in the developmental stages or at varying degrees of operability. Two such networks in Colorado and Wisconsin were offered as examples. The impact of these developments on confidentiality and security of patient information, issues central to the responsibilities of health information managers, has been discussed. These technological advancements will have consequences for health information managers in other ways, too. The types of tasks that are performed and how those tasks are performed related to storing and retrieving information will be different in the future. In the transition period, blurring of job functions may occur as different types of practitioners strive to carve their niche in the electronic environment. For instance, as electronic patient records are linked to bibliographic databases of medical literature, where do the responsibilities of health information managers end and medical librarians begin? The best way to ensure a position on the health care team of the future is to recognize the opportunities provided by this dynamic period in health care. PMID- 10127702 TI - Electronic databases and privacy protection: issues for a free society. AB - More efficiently managed programs of health insurance claims processing and remittance with reduced costs and paperwork burdens hold out the potential for increased benefits to subscribers and health insurers alike. The computer/telecommunications systems and databases by which these efficiencies may be realized also hold great promise for improved services in other arenas. Early and candid recognition of the equally great potential for danger and abuse in those systems and the technology can guide the development and implementation of appropriate and necessary safeguards to individual privacy and to a democratic society in concert with system design. PMID- 10127703 TI - Research review: use of keyless data entry in medical record departments. AB - This survey indicates that, although substantial computerization of MRD functions was found among survey respondents, use of KDE technologies is very limited. Opportunities exist for medical record practitioners to selectively exploit KDE technology where it can speed data entry and improve data accessibility and availability for patient care, billing, and the like while maintaining or improving accuracy. Appropriate incorporation of KDE technologies into medical record processing could thus benefit all participants in patient care--including MRDs, hospitals, patients, payors--a win-win situation found too infrequently in any setting. PMID- 10127704 TI - Legal review: auto-authentication of medical records raises verification concerns. AB - In summary, federal and state laws require hospitals and practitioners to be accountable for the accuracy and completeness of medical records. The inevitable introduction of computer systems into the process of authenticating medical records evokes novel legal issues. Any computer system that does not require the review of reports after they are transcribed raises serious concerns regarding accountability for the accuracy and completeness of those documents. While federal and state laws have recognized that a signature on a document may be made by electronic or other means, regulatory and accrediting agencies restrict the auto-authentication of medical records. Systems have been proposed that would require the practitioner to see the report and would restrict the final signature authority to the practitioner after his or her review. These systems are likely to be closely scrutinized by regulatory authorities but may ultimately receive their approval. Currently, however, any system that does not require the physician to review and affix his or her signature to each document after reviewing the document creates serious risks for the health care facility implementing that system. Whether future changes in applicable laws will allow more flexibility for such systems is by no means certain. PMID- 10127705 TI - Physician involvement in clinical efficiency efforts produces long-term gains at University of Massachusetts Teaching Hospital. PMID- 10127706 TI - Research points to five likeliest traps for hospitals implementing Deming TQM principles. PMID- 10127707 TI - Why wait for Hillary? PMID- 10127708 TI - Delegations of authority/claims for cost of medical care and services--Department of Veterans Affairs. Final regulations. AB - The Department of Veterans Affairs (VA) has amended VA regulations to increase the settlement and waiver authority delegated to officials within the Office of the General Counsel and District Counsels. This change follows increased authority delegated by the Department of Justice to heads of departments and agencies of the United States. PMID- 10127709 TI - Health maintenance organizations: qualification determinations and compliance actions during the period January 1, 1993 through March 31, 1993--HCFA. Notice. AB - This notice sets forth the names, addresses, service areas or modified service areas, and dates of qualification or expansion of entities determined to be Federally qualified health maintenance organizations (FQHMOs) during the period January 1, 1993, through March 31, 1993. Additionally, this notice sets forth compliance actions taken by the Office of Prepaid Health Care Operations and Oversight for the period January 1, 1993, through March 31, 1993. This notice is being published in accordance with our regulations set forth at 42 CFR 417.144 and 417.163, which require publication in the Federal Register of certain determinations relating to FQHMOs. PMID- 10127710 TI - Establishment of a public docket for medical device/radiological health policy statements and operating procedure guides--FDA. Notice. AB - The Food and Drug Administration (FDA) is announcing that it is establishing a public docket for policy speeches, policy statements, and standard operating procedure guides pertaining to product evaluation and regulatory enforcement for its medical device and radiological health programs. The docket will operate on a 1-year trial basis and will serve both as a repository for critical policy documents generated by the Center for Devices and Radiological Health (CDRH) and as a public display mechanism for access by representatives of the industry and other interested persons. This action is one element of an overall communications initiative to ensure uniform and timely access to important information. PMID- 10127711 TI - Current good manufacturing practice in manufacturing, processing, packing, or holding of drugs; revision of certain labeling controls--FDA. Final rule. AB - The Food and Drug Administration (FDA) is amending the current good manufacturing practice (CGMP) regulations for human and veterinary drug products to revise certain labeling control provisions. Specifically, the final rule defines the term "gang-printed labeling," specifies conditions for the use of gang-printed or cut labeling, exempts manufacturers that employ automated 100-percent labeling inspection systems from CGMP labeling reconciliation requirements, and requires manufacturers to identify filled drug product containers that are set aside and held in an unlabeled condition for future labeling operations. These changes are intended to reduce the frequency of drug product mislabeling and associated drug product recalls. PMID- 10127712 TI - New retirement community development still possible. Credible concept plan is critical. PMID- 10127713 TI - How does a long-term care facility initiate an in-house abuse investigation? PMID- 10127714 TI - Upping the ante. Consultant pharmacists playing a good hand. PMID- 10127715 TI - Capturing proper Medicaid payment. PMID- 10127716 TI - T.B. in LTC: always a threat. Identifying infected residents is critical. PMID- 10127717 TI - Computers empower nurses. Data keeps quality in check. PMID- 10127718 TI - Documenting resident assessment protocols. PMID- 10127719 TI - The synergy between facility and community-based services. PMID- 10127720 TI - Client/server power attracts healthcare markets. AB - Client/server architecture has become the darling of I/S professionals. The intelligence is spread among several processors, creating enormous flexibility. But are C/S systems easier, cheaper and faster than the good old mainframe? Not quite yet. PMID- 10127721 TI - CIH honors pioneers. AB - Attendees paid tribute to the contributions of four healthcare information management leaders during the 1993 Computers in Healthcare Pioneer Awards Banquet May 12. Marion Ball, Ed.D., presided over the celebration honoring Ralph Korpman, M.D., Warner V. Slack, M.D., Donald Lindberg, M.D., and John E. Gall, Jr. PMID- 10127722 TI - Hotlist. Healthcare outsourcing services. AB - August's HotList features healthcare information system outsourcing services. All data have been provided by individual vendors who responded to our survey questions. Computers in Healthcare has made an effort to contact all vendors within this market. See the 1993 Computers in Healthcare Market Directory for complete listings. PMID- 10127723 TI - Showdown in Alabama. Nurses fight to ban EMTs and paramedics from working in the ED. PMID- 10127724 TI - Firestorm. The Waco tragedy. AB - When the Feds stormed Branch Davidian cult leader David Koresh's Waco compound in April after a 51-day stalemate, EMTs were prepared for the worst--and that's what they got. PMID- 10127725 TI - The (almost) real thing. PMID- 10127726 TI - Suits happen. AB - Does your agency have enough malpractice insurance to protect you if you're involved in a lawsuit? Many EMTs are taking matters into their own hands. PMID- 10127727 TI - Bag 'em quietly? Should we bother transporting patients after unsuccessful ACLS (advanced cardiac life support)? PMID- 10127728 TI - "Something blew up". Disaster response is doomed without interagency coordination and effective communications. PMID- 10127729 TI - Getting ready to go 'smokeless'. PMID- 10127730 TI - Licensure: 21 more states to go. PMID- 10127731 TI - A shift in philosophy. Milwaukee County (WI) Mental Health Complex. PMID- 10127732 TI - St. Jude cafeteria. St. Jude Children's Research Hospital, Memphis, Tennessee. PMID- 10127734 TI - Physicians joining groups; 40% grads are salaried. PMID- 10127733 TI - Why we need more doctors. AB - Granting health benefits to 37 million uninsured Americans will inflate demand for doctors--who are already stretched to the limit. The result: soaring prices and long waits. PMID- 10127735 TI - Med schools and research hospitals mixed on general practitioner shortages. PMID- 10127736 TI - Five practical steps for improving collaboration in health care. PMID- 10127737 TI - Collaboration and integration can protect sub-acute services. Interview by Donald E.L. Johnson. AB - An integrated system, from the perspective of Ronald L. Smith, president of Harris Methodist Health System in Fort Worth, Texas, is a system that combines financing, management, primary care, ambulatory care, pharmaceutic services, and home health care in all areas. In his interview by Donald E.L. Johnson, editor and publisher of Health Care Strategic Management, Smith believes that as hospital bottom lines get thinner and more difficult to obtain, there will need to be mergers and/or collaborations to minimize over-capacity in an area. PMID- 10127738 TI - Managing risk--a priority in the Health Service. PMID- 10127739 TI - In the pink? AB - Most first-wave trusts produced annual reports to be proud of. But, as Ron Hodges discovered, the few which failed to meet the mark provide an object lesson in how not to do it. PMID- 10127740 TI - Public image limited. PMID- 10127741 TI - No placement like home. PMID- 10127742 TI - Scarborough Fair. AB - Stuart Harris and Jackie Morton describe a project which transformed a dilapidated council house in an underprivileged area of Scarborough into a multi faceted health centre. PMID- 10127743 TI - The champions. PMID- 10127744 TI - Early learning. AB - Cost information is crucial to purchasers and providers of community services but producing reliable costings is easier said than done. Ann Netten reports. PMID- 10127745 TI - Kids' stuff. AB - The Department of Health guidance on staffing child health services undermines the purpose of the internal market, claims Frank Ledwith. PMID- 10127746 TI - War and peace. AB - Mary Black describes the superhuman effort required to evacuate patients from the shattered city of Sarajevo. But, she says, what its people really need is an end to the fighting. PMID- 10127747 TI - Raised voices. PMID- 10127749 TI - PMA (Pharmaceutical Manufacturers Association) finances grassroots coalition to fight changes in Medicaid formularies. PMID- 10127748 TI - Initiation of a clinical pharmacology consult service as a formulary management tool. AB - Establishment of a multidisciplinary clinical pharmacology consult service (CPCS) can be an important adjunct to a successful formulary management system. This article describes the model of a CPCS developed at the University of California Davis Medical Center. The CPCS provides patient-specific consultations, serves a leadership role in directing the medical staff toward hospital-wide drug usage guidelines for high cost pharmaceutical agents, and enforces the P & T Committee adopted criteria on selected high-cost or high risk agents. The mission of the CPCS is to provide the P & T Committee with a multidisciplinary mechanism to educate health care providers, improve patient care, establish drug usage criteria, and enforce those criteria. PMID- 10127750 TI - Physician self-referrals: Stark pushing total ban on physician ownership and self referral deals. PMID- 10127751 TI - Tailoring traditional hospital tax-exemption tests for new integrated health care systems. PMID- 10127752 TI - Physician relationships with health maintenance organizations cause antitrust problems. PMID- 10127753 TI - Statistical sampling: case law favors Medicare's use of controversial cost containment methodology. PMID- 10127754 TI - Protective equipment prices plummet. PMID- 10127755 TI - Owen launches service providing electronic snapshots of medical-surgical supply prices. PMID- 10127756 TI - The challenges of selecting an appropriate barrier. PMID- 10127757 TI - Partnering: creating a new model of physician-hospital collaboration. PMID- 10127758 TI - Careers: to be forgotten or managed? AB - Managers need new skills to plan their own careers and health services organisations will benefit from attending to the career opportunities available to their staff, according to Dr Alison Baker and Dr David Perkins. PMID- 10127759 TI - IT for care, efficiency and cultural change. AB - A successful information technology (IT) strategy will not be a cure-all. It can, however, be a major facilitator to bringing about management and cultural change. Neil Spencer-Jones outlines how this was achieved at Ashworth Special Hospital. PMID- 10127760 TI - Rheumatology. AB - Arthritis disables more people than all other diseases and injuries put together. Given the high cost of some of the techniques used for rheumatoid arthritis, the long-term nature of the disease and the growth in demand, it is increasingly important to pose and answer questions of cost effectiveness and priority important to clinician and manager alike. PMID- 10127761 TI - 'Tomlinson' in Scotland. AB - The Management Executive (ME) in Scotland has recently announced that between 3000 and 7000 acute sector beds are to be lost in Scotland by the year 2001, for many of the same reasons that the Tomlinson report recommended beds be cut in London. Health boards are developing plans to restructure hospital services but issues of public and professional support for the plans they produce, and questions of funding, will determine the final outcome. PMID- 10127762 TI - Management ... working day of a health services manager. Blackpool Wyre & Fylde CHC. AB - Knowing the health services from previous work experience is an asset when representing the interests of patients. But how to do this in a comprehensive way is always a problem, says Margaret Bode, Chief Officer, Blackpool Wyre & Fylde CHC. PMID- 10127763 TI - The issue's one of confidentiality. PMID- 10127764 TI - The handy handle. PMID- 10127765 TI - Break the chains that blind. Keeping sight of your EMS career goals. AB - Who controls your working life? Who is in the driver's seat of your EMS career? Do dead-end positions, poorly run organizations, frustrating managers, and family and financial commitments have you stuck in a rut? If so, there is something you can do. By following some basic steps, you can overcome these obstacles and reclaim your career--one that is fulfilling and satisfying. PMID- 10127766 TI - Industrial EMS. PMID- 10127768 TI - EMS organizations and associations. AB - This is your guide to the people and groups that make up EMS and its related fields. Whether you use them for information, networking or support, these organizations can help your EMS career. PMID- 10127767 TI - Schmoozing, sucking up & suit wearing. Zen and the art of advancing your EMS career. AB - A smile can go a long way ... A professional attitude is everything ... Don't be an Eddie Haskell. These tips and more from a guru of the three S's. PMID- 10127769 TI - Bachelor's degree programs in EMS. PMID- 10127770 TI - Paramedic educational programs. AB - The following is a list of paramedic programs accredited by the Committee on Allied Health Education and Accreditation (CAHEA) of the American Medical Association and the Joint Review Committee on Education for the EMT-Paramedic (JRCEMT-P). Information is current as of March 10, 1993. PMID- 10127771 TI - Paramedics--the next generation. PMID- 10127772 TI - Agency in health care: getting beyond first principles. AB - This paper is concerned with the application of the theory of agency to health care. It is argued that the basic theory of agency raises more questions than it provides answers when it is applied to the doctor-patient relationship. More research is needed into the nature of both the patient's and the doctor's utility functions. Only then can we begin to devise optimal incentive structures to encourage doctors to take adequate account of patient preferences. PMID- 10127773 TI - Do drunk drivers pay their way? A note on optimal penalties for drunk driving. AB - This paper uses a simple framework to describe optimal penalties for drunk driving, and reviews available data to judge current policies against this standard. The analysis suggests that policies should be designed so that the penalties paid by drunk drivers equal the value of the increased risks drunk drivers impose on others. Current penalties appear to be too lenient, implying that current levels of drunk driving are too high. PMID- 10127774 TI - Economic incentives, health status and health services utilisation. AB - The impact on utilisation of differential public entitlements to free health services is analysed, using data for a large sample of Irish households. GP visiting rates are seen to be significantly higher for those on low incomes whose costs are covered by the State than for those who pay for such care, having controlled for other characteristics including health status. The importance of taking differences in health status into account in attempting to distinguish the effects of economic incentives is shown both for GP visits and hospital stays. PMID- 10127775 TI - Elasticity estimates from a dynamic model of interrelated demands for private and public acute health care. AB - This paper investigates the private/public mix in acute health care provision in the UK. It uses an interrelated shares model derived from a translog function combined with dynamic adjustment. Using prices for public care constructed from NHS waiting lists, the insurance cost of private care and the retain price index, impact, intermediate and long run elasticities of demand for private and public care are obtained. The role of hospital consultants and of an aging population are also considered. PMID- 10127776 TI - But health can still be a necessity .... PMID- 10127777 TI - What does the demand curve for medical care measure? AB - In summary, we stand by our method of using the consumer's willingness to pay for medical care to measure consumer surplus. We have not doubt that consumers' decisions will change as the science of medical effectiveness improves and results are disseminated to consumers and physicians. However, we never expect to see an exact correspondence between consumers' decisions and experts' advice. We believe that measurement of consumer welfare should be based on the consumer's valuation of the advice, not the advice itself. Finally, we note that if there is an inefficiently low level of information in medical care markets, the solution is to inform consumers, not to insure them fully. PMID- 10127778 TI - Demand curves, economists, and desert islands: a response to Feldman and Dowd. PMID- 10127779 TI - Evaluating welfare losses in the health care market. AB - According to traditional welfare analysis, consumers facing a price increase forego consumption of the least valued units of a commodity. Studies, such as the Rand HIE, show that patients decrease their consumption of all types of health care when faced with a price increase for health care. From this observation, Thomas Rice (1992) concludes that traditional welfare analysis is inadequate for evaluating insurance-related welfare losses in health care. In this note, I argue that it is not traditional welfare analysis which is inadequate, but the method of assigning marginal valuations to units of health care. PMID- 10127780 TI - A model is only as good as its assumptions: a reply to Peele. PMID- 10127781 TI - Alcohol advertising bans and alcohol abuse. AB - Henry Saffer [Saffer (1991) Journal of Health Economics 10, 65-79] concludes that bans on broadcast advertising for alcoholic beverages reduce total alcohol consumption, motor vehicle fatalities, and cirrhosis deaths. A reexamination of his data and procedures reveals a number of flaws. First, there is evidence of reverse causation: countries with low consumption/death rates tend to adopt advertising bans, creating a (spurious) negative correlation between bans and consumption/death rates. Second, even this correlation largely disappears when the estimates are corrected for serial correlation. Third, estimates based on the components of consumption--spirits, beer and wine--mostly indicate that bans are associated with increased consumption. PMID- 10127782 TI - Alcohol advertising bans and alcohol abuse: reply. AB - Young reexamines the work first presented in Saffer (1991) on the relationship between alcohol advertising bans and alcohol use. While there are several interesting possibilities for extending Saffer (1991), Young fails to provide any new insights. Most of his paper is devoted to recreating my data and results. He tries to extend my work with three new specifications. Each of these new specifications is flawed. His errors include a inappropriate application of fixed effects models, inappropriate dependent variables, and incorrect serial correlation computations. The results of these errors are a series of inconsistent advertising ban coefficients. He concludes that these inconsistent results are evidence that advertising bans have no effect of alcohol abuse. It might be better to at least provide a series of consistent regression models before coming to any conclusions. PMID- 10127783 TI - How much preventive care can we afford? PMID- 10127785 TI - Dismiss a patient, invite a lawsuit? PMID- 10127784 TI - Has Medicare really nixed private contracts with patients? PMID- 10127786 TI - If this is managed competition, it just might work. PMID- 10127787 TI - Industry employment and the 1990-91 recession. PMID- 10127788 TI - Nursing station order entry for hospital computers. AB - Tired of illegible labels, unlabeled specimens, and frantic phone calls asking what happened to specimens? This lab was and devised a system to allow test ordering and label printing from nurse stations. PMID- 10127789 TI - Starting a laboratory recycling program. AB - The author's hospital makes money--and saves 34 trees a month--recycling paper. Here are five steps to help you start a similar program. PMID- 10127790 TI - Refining and using Lotus 1-2-3, Part 2. Using Lotus 1-2-3 to assist with indicator monitors. AB - Spreadsheet database tables provide accuracy and flexibility for analysis of indicator monitors and afford substantial time savings. The ease of data rearrangement allows for better detection of patterns, more accurate comparisons against accepted threshold values, and enhances the laboratorian's ability to make recommendations. PMID- 10127791 TI - Insurer's malpractice rates indicate stability. PMID- 10127793 TI - Vendell completes bond exchange. PMID- 10127792 TI - More suits filed against T2 on behalf of shareholders. PMID- 10127794 TI - Law revision sought to free money to keep LA clinics open. PMID- 10127795 TI - New tack tried to gain ER renovation funds. PMID- 10127796 TI - Payment revisions to hurt children's hospitals--study. PMID- 10127797 TI - Rescue plan approved for Mutual Benefit. PMID- 10127798 TI - Plan to build office building sparks suit, citizen protests. PMID- 10127799 TI - Four NME board members leaving; former VP files discrimination suit. PMID- 10127800 TI - NME suing 19 insurers for $250 million. PMID- 10127801 TI - JCAHO speeding development of standards for integrated networks. PMID- 10127802 TI - Governors hear business-based reform plan. PMID- 10127803 TI - Disproportionate-share limits loosened. PMID- 10127804 TI - Reform outlook offers food for thought. PMID- 10127805 TI - Motives questioned in hospitals' moves. PMID- 10127806 TI - Columbia sells hospital; merger stays on track. PMID- 10127807 TI - Spohn, Epic plan integrated system in Corpus Christi to counter Columbia. PMID- 10127809 TI - Study shows price savings in food services managed by outside firms--sometimes. PMID- 10127808 TI - Most hospitals slow to join with group practices. PMID- 10127810 TI - Long odds face below-grade ratings. PMID- 10127811 TI - Post-reform healthcare stocks to resemble utilities--analyst. PMID- 10127812 TI - AmHS rebuffs VHA offer of 'heightened collaboration'. PMID- 10127813 TI - Baxter officials work to minimize fallout from actions taken by VA. PMID- 10127814 TI - Losing CHAMPUS bidders sue government to halt pact. PMID- 10127815 TI - Medicare reviewers lack time, training--GAO. PMID- 10127816 TI - UniHealth planning to relinquish its majority stake in PacifiCare. PMID- 10127817 TI - An overview of the objective structured clinical examination. AB - The objective structured clinical examination (OSCE) is an examination format with particular emphasis on examining clinical skills. It has been developed for the last 10-15 years in the medical field and, during the past five years, there has been some development in the nursing profession. The use of OSCE in physiotherapy is just beginning. This paper is an overview of this examination format. A description of OSCE is followed by consideration of various aspects, including standardized patients, raters, the validity and reliability of the exam, and the educational impact. The OSCE is credible as a test of clinical competence, but reliability is perhaps lower than would be optimal for a licensure examination. Combining an OSCE with a multiple choice exam may have desirable effects on student learning and have acceptable reliability levels. A survey of the 13 Canadian schools of physiotherapy conducted to ascertain the current level of usage showed only two schools currently using the OSCE in their programs. PMID- 10127818 TI - Blowing the whistle on faulty medical products. PMID- 10127819 TI - Operation health care. States across the country are in sync with Clinton's impending reforms. PMID- 10127820 TI - Who does your hospital counsel work for? PMID- 10127821 TI - Records management. PMID- 10127822 TI - The Family and Medical Leave Act. PMID- 10127823 TI - Hydraulic theory and the hospital-nursing home system. PMID- 10127824 TI - Security. It's a state of mind. PMID- 10127825 TI - Senate GOP drafts sweeping reform plan. PMID- 10127826 TI - Perspectives. Trauma care: preparing for the worst. PMID- 10127827 TI - Physician access to the HIS--cost-effective, quality patient care demands it. PMID- 10127828 TI - JCAHO's new info. management standards. PMID- 10127829 TI - Automating home care. Technology's impact on home healthcare providers. PMID- 10127830 TI - Vendor partnering yields progress toward the computerized patient record. PMID- 10127831 TI - Remaining profitable in a capitated home healthcare market. PMID- 10127832 TI - Telecommunications needs in the home care environment. PMID- 10127833 TI - Shopping for home healthcare systems. PMID- 10127834 TI - Financial parameters for buying a medical office information system. Investing in technology. PMID- 10127835 TI - Winning IS strategies in practice management. PMID- 10127836 TI - Hospital service areas and Medicaid access in Maryland. AB - The study defines a service area (rather than a market area) of an individual hospital. Based on patient origin data, algorithms have been developed to select zip codes on the basis of their contributions to a hospital's discharges, and their ability to fulfill a contiguity principle along with a dependence criterion. The service area concept is also used to evaluate the performances of hospitals in terms of the access to care for Medicaid patients. The analysis shows that the hospital's performance in serving Medicaid patients does not significantly depend on its location, nor does it matter whether it is the only hospital in its jurisdiction. PMID- 10127837 TI - Communication and level of AIDS knowledge among homeless African-American mothers and their children. AB - One hundred and thirty residents and their children from eight transitional living shelters in the midwest participated in a study designed to assess their level of knowledge about HIV/AIDS, concerns about susceptibility to the virus, patterns of general communication, and level of comfort in discussing sexual and HIV/AIDS related matters within the family unit. Overall, parents and children demonstrated significant misinformation about HIV/AIDS and did not perceive themselves as being at risk for contracting the virus. Parents who possessed more formal education were more knowledgeable about HIV/AIDS, sexuality, and reported greater levels of parent-child communication. Parents who possessed higher levels of self-esteem indicated that they discussed sexual topics with their children more than parents with lower levels of self-esteem and that when sexual matters were discussed the mother was the agent of communication. PMID- 10127838 TI - Immunization of Mexican migrant farm worker's children, on site at a day care center in a rural Tennessee county: three successful summers. PMID- 10127839 TI - How well is debt managed by nonprofits? AB - Little is known about why nonprofits accrue debt, how much they owe, and whether the funds they borrow are used productively. This article distinguishes between productive, problematic, and deferred debt. Employing a data base representative of 114,726 tax-filing charitable nonprofits in the United States in 1986, it examines the pervasiveness of nonprofit debt and the relation between this debt and nonprofit financial health. The analysis finds that over 70 percent of the nonprofits hold debt, the distribution of this debt is highly concentrated, and the level of debt and leverage varies with asset size and type of activity. Nonprofits with higher leverage and absolute debt levels are financially healthier than those with lower levels. While the analysis does not determine whether financially stronger nonprofits are better able to borrow, the results support the view that borrowing in the nonprofit sector is economically efficient. PMID- 10127840 TI - The double-edged sword of social service contracting: public accountability versus nonprofit autonomy. AB - The increased role of government contracts in the funding of nonprofits has heightened tensions as governments seek accountability and nonprofits seek to preserve autonomy. Considering both sides of the contract market this article suggests that the threat of government funding is exaggerated. Nonprofits are attractive contractor options because of their experience and trustworthiness. Governments should recognize that excessive intrusions limit the advantages of the nonprofit sector. At the same time, nonprofits should be conscious of the implications of public funding, just as they must be of other sources of funding. PMID- 10127841 TI - Co-op students bolster health services as volunteers. Interview by Matthew D. Pavelich.. PMID- 10127842 TI - Consent to treatment: myths and realities. AB - In the last 10 years, court rulings have questioned the validity of current practices of obtaining consent to treatment. Consent is sought to protect health institutions and staff from litigation. This is no guarantee of protection, however, if the consent process has consisted merely of obtaining the patient's signature on a consent form without full disclosure. This article looks at the inconsistency of current consent practices and outlines ways to improve the legal standard for obtaining consent to treatment. PMID- 10127843 TI - Patient restraint: a new philosophy. AB - In 1992, The Toronto Hospital (Western Division) established a safety task force to examine the ethics of restraining patients. The task force developed tools to assess the need for restraint in consultation with other disciplines, the patient, and family. A six-week pilot study evaluated restraint devices and tested assessment methods for patients whose behaviour puts them or others at risk of injury. A subsequent study found that these assessment tools were applicable to the ICU setting. PMID- 10127844 TI - A conflict of interest policy for hospitals. AB - As the environment in which community hospitals operate becomes ever more complex, the opportunity for conflict of interest between the hospital and members of its governing board increases. This article examines the duties and responsibilities of hospital trustees and the ways in which hospitals can identify and manage conflict of interest. PMID- 10127845 TI - Newfoundland responds to change. AB - The authors recount how Newfoundland's health care system accommodated severe fiscal restraint imposed by the provincial government in 1990. By outlining the role of the Newfoundland Hospital and Nursing Home Association and other provincial health partners, the authors contend that dialogue and cooperation are key to successful reform. Newfoundland's health care community developed specific objectives, guidelines for restructuring, and a province-wide perspective to help reduce the effect of funding cuts. PMID- 10127846 TI - Public speaking: a tool for career advancement. AB - Health care managers and executives find themselves with increasingly limited career prospects in today's financially restricted environment. How can a knowledgeable professional advance in his or her career? The author suggests public speaking as an excellent means to promote career advancement. The article suggests how to develop ideas for a speech and offers tips on presentation techniques. PMID- 10127847 TI - The board's role in leading change. Centre for Quality in Governance. AB - In its ongoing effort to promote and ensure the highest quality of health care throughout Canada, the Canadian Hospital Association has entered into a partnership with The Centre for Quality in Governance, a Toronto-based non-profit organization formed in 1992. The Centre's mandate is to improve the effectiveness of organizations by researching and evaluating various aspects of governance. The following article, by Frank J. Norman, is the fourth of six Centre-generated reports that will be published by Leadership in Health Services. PMID- 10127848 TI - Preparing for political dialogue. PMID- 10127849 TI - Cancelling a physician's hospital privileges. PMID- 10127850 TI - Hospitality services generate revenue. AB - An increasing number of hospitals are undertaking external revenue-generating activities to supplement their shrinking budgets. Written at the request of Leadership, this article outlines an example of a successful catering service -- a money-generating business that more Canadian hospitals could profitably consider. PMID- 10127851 TI - Budget reconciliation: $56 billion in Medicare cuts ... and more. PMID- 10127852 TI - Healthy, wealthy and fraudulent. PMID- 10127853 TI - Cleveland and Cincinnati: can releasing quality data make friends and influence care? PMID- 10127854 TI - Outcomes data: publishing the right stuff. PMID- 10127855 TI - The public interest in publishing quality information. PMID- 10127856 TI - Presenting quality measurement data to the public. PMID- 10127857 TI - The effect of quality assurance on flight nurse documentation. AB - This study was developed to evaluate if a structured quality assurance program has an effect on nursing documentation. A randomized, retrospective audit of records was conducted from 1985 to 1989, and in November 1987, a structured QA program was initiated for flight nurses. Each chart was audited for completeness of 69 elements from seven categories: administrative information, patient history, physical exam, management plan, vital signs, medications and intravenous access. A comparison of audit results was conducted before and after the QA program was initiated. A total of 224 charts were audited, 123 before the QA program and 101 after. There was statistically significant improvement in 4 of 13 administrative, 5 of 7 history, 21 of 31 physical exam, 2 of 6 management, 2 of 2 vital signs, 0 of 4 medication, and 0 of 6 intravenous access elements. Twenty five of 35 categories that did not show improvement had initial completion rates greater than 90 percent. The significant improvement in documentation by flight nurses after a formal QA program was initiated lead the authors to conclude that QA benefits air medical programs by providing a mechanism to improve documentation. PMID- 10127858 TI - Recidivism in a helicopter emergency medical service. AB - This study was designed to determine the frequency of recidivism (patients using a service more than once for the same or different disease episodes) in a helicopter emergency service, with the premise that high levels of recidivism may constitute grounds for improving quality of care or patient education programs. A retrospective chart review was performed on records from June 1985 to September 1990. Patients were included if they required helicopter transport on more than one occasion for either different disease episodes (true recidivists) or for multiple transports during a single hospital admission. Twenty-one (0.6%) of the 3,543 patients transported were true recidivists and 20 (0.6%) patients required secondary transport during the same admission. Of the latter group, 17 secondary transports were within 24 hours of admission. This study showed that recidivism in this helicopter emergency service is low. Patients who were air transported more than once for the same illness or injury within a 24-hour period occurred in less than 1% of transports, well within the helicopter program's pre-established less than 2% threshold. PMID- 10127859 TI - Air medical transport of patients from offshore oil and gas facilities. Historical accident data and initial experience. AB - The offshore petroleum exploration and production industry (OSI) is isolated from traditional means of access to emergent health care and may benefit from the unique attributes of helicopter air medical transport. This study was undertaken to review the incidence of OSI-related incidents, injuries and deaths, and report the initial experience of a civilian hospital-based helicopter air transport program in the evacuation of offshore patients. It was learned that the mean annual incidence of major OSI accidents from 1980 to 1986 was 19.1 (+/- 7.0). Mean annual mortality and reported injury were 14.7 (+/- 7.6) and 36.7 (+/- 25.4) patients respectively. Fires and explosions were the most frequently reported events at 62 per year (+/- 11.5/year). Nine OSI patients were evacuated by helicopter during the study's eight-month pilot period (seven for trauma and two for medical illness). One of the nine patients had been exposed to a potentially hazardous substance, requiring changes in the air medical team's operations, aircraft and equipment. The study shows that the offshore petroleum environment is ideally suited for air medical transport, as injuries are common and medical illnesses are to be expected. However, air medical programs operating offshore must deal with additional regulatory requirements and develop operational procedures to ensure safety during these flights. PMID- 10127860 TI - Laboratory and flight tests of medical equipment for use in U.S. Army Medevac helicopters. AB - When used in an air medical setting, medical equipment designed for use in hospitals can fail from the stresses of in-flight use, or they interfere with critical rotor-wing aircraft systems. From January 1989 to June 1992, 34 medical devices, including monitor/defibrillators, infusion pumps, vital-signs monitors, ventilators and infant transport incubators, were tested under extreme conditions of temperature, humidity, altitude and vibration (MIL-STD 810D). Electromagnetic emissions and susceptibility were measured (MIL-STD 461C and 462), and human factors were evaluated. The devices were flight tested in a UH-60 MEDEVAC helicopter. Thirty-two percent of the medical devices failed at least one environmental test, and 91% of the devices failed to meet electromagnetic interference standards. Failures included excess conducted and radiated emissions and susceptibility to radiated emissions. Five (15%) of the devices were judged unsuitable for use in the UH-60 MEDEVAC helicopter. Testing is critical to discover the ability of a medical device to perform in the harsh rotor-wing MEDEVAC environment. Failure of a device or interference with aircraft systems can result in loss of a patient or aircrew. PMID- 10127861 TI - The effect of disinfectants on 2024-T3 aluminum in the air medical helicopter. AB - A principle structural component of helicopters is 2024-T3 aluminum alloy. This alloy has been designed for use in areas requiring high strength-to-weight ratios, but it is susceptible to corrosion damage. The air medical helicopter is frequently exposed to bloodborne pathogens, dirt, intravenous solutions and a variety of other contaminants. The amount of damage to the helicopter that can be caused by the use of cleaners and disinfectants has been raised as an area of concern for the safety of the helicopter, crew and patients. In a controlled study, 2024-T3 alclad aluminum strips were placed in 120-ml glass jars that were filled with 60 ml of solution and then sealed. The solutions used were disinfectants, cleaners and water (both tap and distilled). The strips in solution were placed in a controlled oven at 140 F for 100 hours to simulate long term damage from immersion, vapors and heat. On examination, many strips were discolored and corroded. Only one solution caused no apparent damage, and only one caused slight vapor damage. As a result of the study, one of the solutions has been designated for use. The results have been used as examples for flight team members on the costly damage that can result from inappropriate use of these substances. A cleaning policy and procedure has been developed to ensure adequate protection from chemical exposure while protecting all team members from the dangers of bloodborne pathogens. PMID- 10127862 TI - Use of airframe and avionics options: who has them and what do pilots want? PMID- 10127863 TI - Specialized certification program for flight nurses. National Flight Nurses Association position paper. PMID- 10127864 TI - Role of the registered nurse in BLS air transport. National Flight Nurses Association position paper. PMID- 10127865 TI - A scoring system for evaluating the condition of transported neonates. AB - A scoring system for the evaluation of the clinical status of transported small premature infants was modified to make it applicable to the evaluation of both premature and term infants. Blood glucose concentration, systolic blood pressure, blood pH and PO2, and body temperature were assessed and given scores of 0, 1 or 2 for abnormal, borderline and normal values, respectively. The scoring system was used for quality assurance studies of changes in patient status during transport from community hospitals to the neonatal intensive care unit and proved useful in identifying inadequate attention to body-temperature maintenance. The scoring system showed an improvement in the criterion after changes in clinical monitoring and management of body temperature were instituted. An additional use of the scoring system was for the identification of specific problems in neonatal stabilization in referring community hospitals. PMID- 10127866 TI - Pulse oximetry during helicopter transport. AB - The study objective was to determine if pulse oximetry readings obtained during helicopter transport were indicative of subsequent arterial blood-gas measured saturations. A prospective study design was chosen. Data were gathered on a convenience sample of patients 18 years and older not under cardiopulmonary resuscitation; 101 patients were used for the study. Pulse oximeter readings of oxygen saturation and heart rate were recorded along with simultaneous vital signs. Arterial saturation in blood gases drawn in the emergency department were added to the patient record. Improper functioning of the pulse oximeter was recorded on 10 (9.9%) of the patients. No correlation was found between the probe type and the documented problems (PHI = 0.009). The pulse oximeter saturation readings were not significantly different from arterial saturation in blood gases when compared by paired samples t-test (t = 0.880, p = 0.383). There was also no significant difference between the patient's heart rate sensed by the pulse oximeter and the simultaneous palpated pulse rate. Percent saturation readings by repeated measures were statistically different (p < 0.05) showing a minimal improvement in saturation over time. Based on this study's findings, the authors feel the pulse oximeter can be a valuable adjunct to patient care during helicopter transport. PMID- 10127868 TI - Directory of air medical services. PMID- 10127867 TI - Product & service guide. PMID- 10127869 TI - When is air medical service faster than ground transportation? AB - The purpose of this study was to mathematically define a distance or travel-time interval in which air medical evacuation would benefit the patient more than ground transport. The authors derived mathematical formulas from known variables (ground travel, extrication and rendezvous times) and fixed averages (on-scene time, lift-off time, and speeds) and used those formulas to test actual flights for appropriateness. The formulas were: [formula: see text] where Y = ground travel time; R = rendezvous time; Z = extrication time; D = distance to scene (km); and X = air travel time. The formulas provide a guide to prospectively determine the legitimacy of air medical transport. They can also be used retrospectively as a guide for quality assurance purposes. During this study of 123 consecutive scene flights, helicopter benefitted all the entrapped patients but only one-third of non-entrapped patients. Of 44 flights from areas with known ground times, helicopter transport benefitted 14 of 16 entrapped, five of 16 non entrapped, but only three of 17 rendezvous. PMID- 10127870 TI - True costs of air medical vs. ground ambulance systems. AB - The economic model created in this paper replaces the existing University of Massachusetts Medical Center's New England Life Flight (NELF) helicopter ambulance service with a ground ambulance system to investigate comparative costs. The model is based on a less than 30-minute response time to the patient, similar medical team staffing and equal service area. The annual budgetary cost of the replacement ground network is $3,804,000 while the helicopter ambulance costs are $1,686,500 (based on 1991 dollars). The cost per patient transported is $4,475 for the ground system and $2,811 for the helicopter system. The comparison finds that the commonly held notion that condemns helicopters as an excessively expensive technology for patient transport is incorrect. Future research to address intermediate alternatives using similar analytical technology assessment techniques is recommended. PMID- 10127871 TI - Clinton administration targets diagnostic services for sharp cuts. PMID- 10127872 TI - The ethics of "free". PMID- 10127873 TI - Administrative case study: digital imaging upgrade versus system replacement. PMID- 10127874 TI - Quality managed care: possibility, reality or oxymoron? PMID- 10127875 TI - Perfusion and medical malpractice: taking a good look at the Captain of the Ship Doctrine. PMID- 10127876 TI - Data watch. An inside look at workers' compensation. PMID- 10127877 TI - To reduce spending, more employers establish on-site health care clinics. PMID- 10127878 TI - The results are in: drug testing saves money. PMID- 10127879 TI - Will 24-hour coverage solve the workers' comp puzzle? PMID- 10127880 TI - 4 cost containment strategies that work. PMID- 10127881 TI - GE sheds light on managed care's impact on health. AB - To get the most value from its health plans, GE used functional outcomes to measure the health status of its workers. PMID- 10127882 TI - States vs. the feds: who gets control? PMID- 10127883 TI - Washington readies for managed competition. PMID- 10127884 TI - Too soon to panic. AB - Health Care: The small-business lobby says Clinton's mandatory plan will kill off jobs. But Mom and Pop may end up breathing easier. PMID- 10127885 TI - Medicare and state health care programs: fraud and abuse; amendments to OIG exclusion and CMP authorities resulting from the Medicare and Medicaid Patient and Program Protection Act--Office of Inspector General (OIG), HHS. Final rule. AB - This document amends a technical error that appeared in the final rule, which amends the OIG exclusion and CMP authorities, published on January 29, 1992 designed to implement section 2 of the Medicare and Medicaid Patient and Program Protection Act, along with other conforming amendments. The final rule is designed to protect program beneficiaries from unfit health care practitioners, and otherwise improve the anti-fraud provisions of the Department's Medicare and State health care programs. PMID- 10127886 TI - Medical devices; device tracking--FDA. Final rule; suspension of effective date; notification of status under the Safe Medical Devices Act; technical amendments. AB - The Food and Drug Administration (FDA) is announcing that it is suspending the effective date of the final rule on device tracking that appeared in the Federal Register of May 29, 1992, until August 29, 1993. The agency is also announcing that the revised proposed rule is now a final rule by operation of law. Further, the agency is amending the regulations to make certain technical amendments. This action is being taken to implement requirements of the Safe Medical Devices Act of 1990 (the SMDA) and the Medical Device Amendments of 1992 (the 1992 amendments). PMID- 10127887 TI - Paying for miracles. AB - Many economists have fingered technology as a major culprit in spiraling health care costs. But who should decide whether new medical devices and procedures are cost-effective? PMID- 10127888 TI - Claustrophobia in magnetic resonance imaging. AB - Patients who are claustrophobic can present many difficulties during an M.R.I. exam. The author examines the causes of claustrophobia, distinguishes between normal fear and phobia, and gives practical advice to help patients who experience claustrophobia during an M.R.I. exam. PMID- 10127889 TI - Exposure reduction through faster speed film-screen systems and a review of A.L.A.R.A. (as low as reasonably achievable). AB - One of the most talked about and recognized practices for dose reduction is the "as low as reasonably achievable" (A.L.A.R.A.) concept initiated by the International Commission on Radiological Protection. Many new technologists, however, are neither familiar with the concept nor recognize how important their part is in its implementation. In addition, some experienced technologists may need to refresh their knowledge of certain practices and how they relate to the A.L.A.R.A. concept. This article reviews the literature and presents new data on exposure technique reduction through film-screen speed combinations. The latest 250- and 600-speed film-screen combinations were obtained from leading manufacturers and tested to determine what new techniques would provide adequate radiographs using lower exposures. Comparisons were made between the 100- and 250 speed systems and the 400- and 600-speed systems. These comparisons were objectively based on aluminum stepwedge exposures measured by densitometry and subjectively based on exposure of 3M phantoms utilizing the newly established techniques with the higher speed film-screen system compared to the original techniques using the lower speed film-screen system. It was found that using a 250-speed system instead of a 100-speed system will reduce exposure dose by 36 to 60 per cent; using a 600-speed system in place of a 400-speed system exposure dose is reduced by 31 to 63 per cent. There is no apparent loss of resolution for either film-screen combination. PMID- 10127890 TI - Parental visitation in the post-anesthesia care unit: a means to lessen anxiety. AB - Programs that assist parents and children with coping during hospitalization may minimize the emotional trauma of hospitalization and improve both child and family well-being. The purpose of this study was to determine the effect of parental visitation in the Post-Anesthesia Care Unit (PACU) on pre- and postoperative anxiety levels of pediatric patients and parents. Sixty-eight patient-parent pairs were enrolled in the study: 20 before implementing parental visitation and 48 following implementation. Although no differences were found in children's anxiety levels pre- to postoperatively, the anxiety levels of parents who visited their children in the PACU were significantly lower postoperatively. PMID- 10127891 TI - Parent preparation for the NICU-to-home transition: staff and parent perceptions. AB - Thirty-four nurses who were employed more than 20 hr per week in a neonatal intensive care unit (NICU) at a midwestern teaching hospital participated in a survey on discharge teaching. The survey consisted of 43 topics on which parents may or may not receive instruction prior to their baby's discharge from the NICU. For each topic, nurses were asked how important the topic is for parents to learn about prior to discharge, whether parents in the NICU are currently receiving instruction on the topic, and who among the NICU staff is responsible for instruction on the topic. Data obtained from this survey were compared to data obtained from a similar survey conducted 18 months previously with parents in the same NICU. Nurses rated the majority of topics in the survey as being very important for parents to learn about prior to their baby's discharge. For many of the items, a significant discrepancy existed between the percentage of nurses reporting the topics that were routinely taught and the percentage of parents who actually recalled learning about the topics. Suggestions on ways to improve the effectiveness of discharge teaching are provided. PMID- 10127892 TI - The impact of lifestyle health risk on the bottom line: a case study. AB - As the Lifestyle Advantage study continues, HPS expects to follow the utilization trends for a consistent group of participants and nonparticipants, maintaining full confidentiality. Several key issues will be addressed in the process: As the participation rate increases, will the claims payment gap between participants and nonparticipants be reduced? Can a company hope to see a return on an investment in a health promotion program? If so, over what period of time? Finding answers to these questions will contribute to the larger issues of long term health care cost containment and health care reform. PMID- 10127893 TI - The effect of the federal Family and Medical Leave Act upon employee benefits. AB - FMLA will substantially influence the administration of employee benefits. The plan sponsor, trustees, plan administrator and collective bargaining parties must make a number of policy decisions. These include employer reporting and contribution procedures, settlement of eligibility questions, delinquency procedures, coordination with COBRA, substitution of vacation and sick leave rights and procedures, restrictions on participants working during leave, procedures for the non-forfeiture of accrued benefits and restoration of benefits. After the policy decisions are made and the procedures are established, the proper notices and caveats must be communicated to plan participants, and the plan must update the SPD. Each of the policy decisions, administrative procedures and participant communications must be carefully thought out before implementation. Plan sponsors, trustees and plan administrators should seek the help, advice and assistance of the plan's professional advisers. PMID- 10127894 TI - Health care utilization analysis with today's information technology. AB - Health care utilization information is an essential resource for the benefits manager. To be meaningful, the data must be easily accessible and available on a timely basis. PMID- 10127895 TI - Making employees partners in the health care purchasing decision. AB - Bringing employees into the health care purchasing decision as informed consumers allows employees and employers to work together to purchase high-quality, cost effective care. PMID- 10127896 TI - Contracting with specialty PPOs: new cost containment options. AB - Specialty PPOs are gaining in popularity as health care payers realize they offer many of the same opportunities for cost savings and quality assurance as hospital and physician PPOs. Physical therapy service is an example of a likely candidate for a specialty PPO. PMID- 10127897 TI - Workers' compensation reform in Oregon: a success story. PMID- 10127898 TI - Managing work schedules with database software. PMID- 10127899 TI - Protecting employees in hot environments. PMID- 10127900 TI - Tracking patient costs in the year 2000. PMID- 10127901 TI - The top 10 trends in philanthropy. PMID- 10127902 TI - Implementing practice guidelines through clinical quality improvement. AB - The American health care delivery environment is changing. As provider-at-risk payment strategies become increasingly dominant, they will force health care providers to replace old strategies that measured and managed revenues with new strategies that measure and manage costs. Quality improvement (QI) theory provides a set of tools to do exactly that--to understand, measure, and manage health care delivery processes and their associated costs. As a methodology for process management, QI theory merges case management, practice guidelines, and outcomes research into a single coordinated effort. It appropriately redirects management focus to care delivery processes, rather than to physicians. It also defines and illustrates a set of principles by which health care administrators can constructively team with physicians to find and document the best patient care outcomes at the lowest necessary cost, using QI-based practice guidelines as a decision support and measurement tool. PMID- 10127903 TI - Improving quality of care with practice guidelines. AB - In sum, I believe that we know how to develop good practice guidelines today, even though we currently invest paltry sums to do so. Well-constructed guidelines can have a substantial positive impact on quality. By focusing on problems of overuse, costs can be reduced as well. Implementation of guidelines is an absolutely central step in the application of this important quality improvement tool. Practitioners of continuous quality improvement require few external incentives to capitalize on the value of guidelines in the effort to improve quality and are likely to experience their full potential benefit. They may require some prodding to address problems of overuse. Others will need additional inducements. Using reimbursement to reward the attainment of high quality, publishing data on provider performance on various quality measures, and recognizing the salutary effect of adherence to guidelines on liability can provide such incentives. PMID- 10127904 TI - Should we be implementing untested guidelines? PMID- 10127905 TI - The relevance of practical experience to American hospitals. PMID- 10127906 TI - Quest for quality or cost containment. PMID- 10127907 TI - Futurism and the health care supervisor. AB - In countless ways, the United States is looked at as a model by much of the world. In the new corporate environment, decision making must be fast and accurate, dictating in turn that accurate information must flow faster. Information systems can absorb the side effects of change and interactive process developed to assess, define, and agree to a new set of work relationships. The strategic use of information and information systems is a mindset to which all members of the organization need to acculturate themselves. It should be set in each of the work teams, the organization, and its managers as a way of thinking, not merely a job or a task at hand. Experimenting with alternative designs and various management techniques in the 1990s may lead to a prosperity in the next century. Futurism may help us get there. PMID- 10127908 TI - Reconsideration of the quality circle process as a contemporary management strategy. AB - The quality circle group problem-solving process contains the potential for finding solutions to today's health care challenges. It provides the mechanism to integrate the strongest problem-solving capabilities of both managers and staff. If the complex challenges that are occurring daily as well as those that have been carried forth from the last decade are to be solved, it is evident that there is a need to find a mechanism to combine the best and brightest insights of both managers and staff. The quality circle process is one such mechanism. Health care supervisors are invited to reconsider this process as a contemporary management strategy that blends in well with the current movement toward continuous quality improvement. PMID- 10127909 TI - Optimism, self-image, and self-esteem. AB - Optimism is worth striving for. It may prolong your life. Our self-image is determined early in life, largely by what our parents have told us. Self-esteem is based on self-efficacy, self-respect, acceptance by others, and by our own subconscious mind. PMID- 10127910 TI - Employee suggestion programs: the rewards of involvement. AB - Successful ESPs are the products of a great deal of effort by managers, administrators, teams, individuals, and reviewers, who are all striving to achieve the goals of increased profitability and enhanced employee involvement. A review of the literature indicates that there are several prescriptions that will increase the likelihood of a successful ESP (see the box). Today's American business prophets sound ceaseless calls to arms in the name of "world class performance," "global competitiveness," "total quality management," and a variety of other buzz terms. A burgeoning industry has evolved that promises, through speeches, teleconferences, seminars, and consulting contracts, to teach American organizations how to achieve excellence. In the face of a sputtering economy and unrelenting competitive pressure, today's managers must translate these laudatory ideals into hands-on reality without sacrificing the firm's profit margin to experimentation. If any idea can help an organization achieve improvement through a workable program, then that idea and that program deserve real consideration. An ESP represents an opportunity to tap the intelligence and resourcefulness of an organization's employees, and by doing so, reap significant cost savings. Those companies and managers that have an ESP program uniformly list economic advantages first when describing the benefits of their employee suggestion programs. But there is another deeper and longer term benefit inherent in an ESP. These programs allow employees to become involved in their organization; they drive deaccession to lower levels, they give employees more responsibility, they foster creative approaches to work, and they encourage creativity in pursuit of company goals.(ABSTRACT TRUNCATED AT 250 WORDS) PMID- 10127911 TI - Training opportunities and educational requirements for the nurse manager. AB - It seems inevitable that hospitals must supplement the formal education of its nurse managers. To do this most effectively, hospitals must conduct a formal needs analysis to accurately assess the training needs of the nurses. Perhaps more importantly, an adequate evaluation of all training activity should be conducted to ensure that the trainee has actually learned what is taught; the trainee is satisfied with the training; the trainee has retained the information over time; and the trainee has transferred that training to the job. Since many hospitals report investing a great deal of time and money in these programs, it would be extremely beneficial to them to carefully assess the strengths and weaknesses of their training programs. If the program is not having its intended effect, the hospitals need to know exactly where the deficiencies are and how to correct them. By doing this, nurses will receive the kind of training that will help them to manage effectively in a variety of situations. PMID- 10127912 TI - Do you know that one of your employees is looking for a new employer? AB - Turnover of employees is a natural event. It is sometimes a relief when a particular employee leaves the office. On the other hand, the cost of losing any employee can be high because of the costs related to lost productivity, training, and the time required for recruiting a replacement. Because of these cost elements, it makes sense to try to delay an employee's departure. By "buying time," the manager can minimize the time required to recruit a replacement and possibly even redistribute the workload among current employees before the job hunting employee leaves the organization. This approach allows the manager to control the situation. Sometimes it is better to let the employee leave immediately upon submitting a resignation if this will avoid disruption in work flow or the "chemistry" among the rest of the employees. Some employees become negative in their behavior patterns once they decide to leave the organization. The knowledge that an employee is looking for a new position is vitally important information to a manager. The clues provided by the job-hunting employee can go a long way toward maintaining the stability of the work force and the effectiveness of the manager in achieving the goals of the organization. PMID- 10127913 TI - RN to BSN: avoiding the pitfalls. AB - The RN who returns to school has unique characteristics that must be considered if the educational experience is to be positive. The stress an RN feels when returning to school can be addressed by using a combined approach that involves faculty and student working together. Rather than a "tacked on" experience in order to fulfill degree requirements, the experience can be challenging and exciting and provide the RN the opportunity to grow personally and professionally. PMID- 10127914 TI - Implementing total quality management in the medical practice: managing the transition. AB - TQM has a place in the medical practice. While it will require that the practice deal with the many barriers to change in the practice, the results can be significant. Increased patient satisfaction, lower costs, improved quality of work life, and increased productivity can enhance the working of a practice at a time when there are significant pressures on the practice and physicians. TQM may indeed be a way for a practice to take more control of this changing environment rather than being controlled by it. PMID- 10127915 TI - Process management: two control charts. AB - It is not at all surprising that many persons avoid involvement in statistical process control. The statistical procedures developed in industry to monitor production processes are somewhat different from those employed in biostatistics and social science applications. Many find it difficult to adjust to these procedures and to apply statistical process control techniques to situations in health care settings. Not everyone involved in a QI process, however, needs to become versed in statistical process control techniques. At the Indiana University Medical Center several persons from different hospital departments have volunteered to form a cadre of internal statistical process control consultants. The group has come to be known by some as the statistical process control "think tank." No doubt a small group of individuals who are interested in statistics, quality control, and computers can be found in most hospitals. While it is necessary that the large majority of managers and supervisors in any health care organization are knowledgeable about process management and control charts at the concept level of understanding, it takes a relatively few to understand and use such control charts. As internal consultants, these few persons can provide technical assistance when such aid is needed. PMID- 10127916 TI - Marketing home health care medical services: the physician's view. AB - The authors surveyed physicians serving the Jackson, Mississippi home health care market. They identified problems and studied physician perceptions regarding services provided by home health care agencies, private duty nursing agencies, and durable medical equipment suppliers. Respondents perceived home health care as providing: (1) increased patient satisfaction, (2) greater patient convenience, (3) earlier discharge, and (4) lowered patient costs. They least liked: (1) lack of control and involvement in the patient caring process, (2) paperwork, (3) quality control potential, and the possibility that patient costs could increase. Two sets of implications for health care marketers are presented that involve both national and regional levels. Overall results indicate that a growing and profitable market segment exists and is being served in an effective and socially responsible manner. PMID- 10127917 TI - Investigating differences in choice decisions for physicians, dentists and lawyers. AB - This paper presents findings from a study investigating differences in the importance of nineteen criteria in the choice of professionals from three professional groups--physicians, dentists, and lawyers. Knowledge is the most important for all three groups but is less so for doctors. Discussions about the problem and its treatment are both less important for dentists. Six characteristics of professional service providers are used to explain differences. PMID- 10127918 TI - Issues in the consumer choice of health care coverage plans. AB - Developing and implementing successful marketing strategies for prepaid health care coverage plans is becoming an important issue as managers of these plans struggle to remain competitive in the market place. This paper provides insight into the reasons why consumers make choices among varying types of health care coverage plans. Some suggestions are made to plan managers for incorporating these results into the development of marketing strategies for prepaid health care coverage plans. PMID- 10127919 TI - Health care coverage and costs in small business: an exploratory study. AB - Health coverage and health care costs continue to frustrate employers, employees, and public policy makers. Controlling escalating health costs, improving coverage for the uninsured, and providing retiree health care are all important to the small employer. This study was undertaken to investigate the availability and extent of health care coverage and to assess the effects of health care costs on small firms. The results revealed that the percentage of small firms offering health benefits totaled 58 percent. The availability of group health insurance increases as firm size increases. Small employers cited insufficient profits, high insurance costs, and unavailable group coverage as the primary reasons for not offering health benefits. The results also indicated that the vast majority of small firms opposed a mandated employer-provided health coverage and suggested that small businesses should pool together to form groups to reduce the cost of health care coverage for small firms. PMID- 10127920 TI - Elder consumer preferences of marketing strategies in the human services. AB - The marketing of health and social services to the aged is a relatively recent phenomenon. To explore the role of the older consumer in service marketing, a national analysis of preferred marketing methods in gerontological programs was carried out. Eighteen focus groups comprised of senior center participants (mean = 73.8 years) in six metropolitan areas was conducted (n = 220). Findings document considerable consensus across gender, ethnic, socio-economic, and racial cohorts. Preference was expressed for personal/direct forms of marketing. Regardless of age or level of infirmity, subjects identified with images of active and healthy elders. Sharp distinctions were drawn between marketing conducted by for-profit and not-for-profit organizations, as well as between marketing with a "selling" purpose versus that which is primarily informational. Results lead to recommendations for elder service providers on mounting a meaningful program of marketing initiatives. Supported by a grant from the AARP Andrus Foundation. PMID- 10127921 TI - Assessing the feasibility of risk contracted HMOs for the elderly: applying the marketing concept. PMID- 10127922 TI - Implications of the baby bust generation upon the health care market. AB - Implications of the Baby Boomers upon the American society are well known. However, the effects of its successor generation, the Baby Busters, have not been as well documented nor reviewed. The next twenty years (1990-2010) will see the fabric of American society unfolded and rewoven as this phenomenon undergoes its place in history. It is not too early to examine the implications of the Baby Bust phenomenon. This study examines the implications and consequences of the Baby Bust for Health Care Marketers. PMID- 10127923 TI - Future pharmacists and public initiatives to control retail drug prices: a political economy framework. AB - While pressures mount for public policy makers to intercede in the pricing structure of pharmaceutical products, most pharmacists remain reluctant to substitute generic equivalents for branded drugs. This study suggests that pharmacist' aversion to external factors embedded in their channel environments. An adaption of the political economy paradigm reflects the complexity of the pharmaceutical channel relationships. PMID- 10127924 TI - Brand name changes help health care providers win market recognition. AB - As the healthcare industry continues to recognize the strategic implications of branding, more providers will undertake an identity change to better position themselves in competitive markets. The paper examines specific healthcare branding decisions, the reasons prompting brand name decisions and the marketing implications for a change in brand name. PMID- 10127925 TI - Changing competition in health care marketing: a method for analysis and strategic planning. AB - As the cost and importance of healthcare continue to increase, competition in the medical industry is taking new forms and becoming more intense. The driving trends behind this competition are analyzed in the framework of Porter's Five Forces of Competition Model. The authors then discuss how the widely accepted strategies of cost, differentiation, focus, and domestication can be utilized to counter the implications of these trends and how to capitalize on opportunities in medical practice in the 1990's. PMID- 10127926 TI - Geographic aggregation of health data: a comparison of alternatives for 1990 and beyond. PMID- 10127927 TI - Health demography comes of age. AB - The U.S. health care industry has been hampered in the development of a mature marketing function in part due to characteristics unique to the industry. These characteristics include a lack of market data, poorly developed market research techniques, and a poor understanding of consumer behavior within the industry. Some of the deficiencies are being addressed through the development of an emerging field that is being referred to as "health demography." Health demography and those who have begun to refer to themselves as health demographers are drawing from the fields of demography, epidemiology, biostatistics, and the social sciences to formulate a new discipline uniquely related to the needs of today's health care marketers and planners. Those involved with health demography are developing databases and models for application to concrete problems in health care delivery. The development of this field is contributing to the advancement of the state of marketing in health care and serving to reduce many of the barriers that have retarded the development of a mature marketing function within the health care industry. PMID- 10127928 TI - Consumer perceptions of medical information sources: an application of multidimensional scaling. AB - Multidimensional scaling is widely used in marketing research to characterize the perceived relationships among a set of consumer products. The technique is also well suited to study a number of issues that are of interest to health care marketers. This paper explains multidimensional scaling and provides an illustrative example of a health care application. In the research study reported here, the perceptions of various sources of medical information give important insights to a health care organization that is designing a new medical information service for consumers. Other potential applications of the technique for health care marketing are also explored. PMID- 10127929 TI - Fostering collaboration by understanding physician behavior: the cancer program perspective. AB - To build collaborative relations with physicians, which are particularly desirable in cancer programs, hospital administrators must first understand the intrinsic differences between the ways physicians and hospital administrators operate. Administrators' failure to understand physicians' behavior can hamper the development of such programs. Relations between physicians and hospitals have traditionally been good, and while hospital administrators and physicians have approached health care from different perspectives, their activities have generally been mutually supportive. Over the last decade, however, health care payment reform has exacerbated differences in hospitals' and physicians' goals and expectations, and these differences have begun to threaten the traditional collaborative relationship between hospitals and physicians. This report is intended for hospital administrators who wish to strengthen their relationships with their physicians and thereby develop a more comprehensive approach to the delivery of cancer care services. It identifies specific physician behavioral tendencies and analyzes their potential impact on the delivery of patient centered cancer care. It also examines the ways physicians' attitudes and behaviors develop, as well as the reasons physicians may find themselves in conflict with other health care providers. Finally, it reviews current factors affecting physician/hospital relations and suggests ways hospitals and their medical staffs can develop mutually supportive, collaborative activities. PMID- 10127930 TI - 3 St. Louis hospitals plan third area network. PMID- 10127931 TI - Sutter, CHW continue legal sparring. PMID- 10127932 TI - Firm that owns La. hospital files for bankruptcy. PMID- 10127933 TI - Quorum's annual profit increases 253%. PMID- 10127934 TI - Paracelsus bond sale to finance expansion. PMID- 10127935 TI - Columbia negotiating for two K.C. hospitals. PMID- 10127936 TI - FBI probes turnpike pact awarded to Ohio Blues. PMID- 10127937 TI - Idaho Blues move to cap payments. PMID- 10127938 TI - Feds raid NME headquarters, hospitals. PMID- 10127939 TI - AHA reports show losses totaled just $14,000 in 1992. PMID- 10127940 TI - T2 news worsens with poor earnings. PMID- 10127941 TI - Keane acquires assets of PHS. PMID- 10127942 TI - Insurance companies' AIDS costs hit $1.4 billion. PMID- 10127943 TI - 4% of hospitals offer AIDS insurance--survey. PMID- 10127944 TI - '$1 million' treatment for Siamese twins reignites cost debate. PMID- 10127945 TI - ServiceMaster acquires VHA Long Term Care. PMID- 10127946 TI - Deficit bill expands bans on self-referrals. PMID- 10127947 TI - White House rips firm's reform-cost estimate. PMID- 10127948 TI - Contract managers gearing up for reform. PMID- 10127949 TI - Fla. hospitals to fight plan's rules. PMID- 10127950 TI - Hospitals learn lessons from Andrew. PMID- 10127951 TI - Recruitment rules require close study. PMID- 10127952 TI - Utah employees' health plan aims for wiser, thriftier patients. PMID- 10127953 TI - System sells receivables to make investments. PMID- 10127954 TI - REITs expected to benefit from change in tax rules. PMID- 10127955 TI - Legislation extends SHMOs through '97. PMID- 10127956 TI - A successful approach to installment plans. AB - Using installment plans as a method of reimbursement for healthcare services can be a preferred, though sometimes controversial, option for many healthcare facilities. The following is an overview of what healthcare financial managers should look for in choosing an installment plan. PMID- 10127957 TI - Setting a national agenda: the quality-payment link. AB - True quality requires that providers continually update the state of nursing facility practice. State and national nursing facility associations must be at the forefront of this effort as stewards of quality. PMID- 10127958 TI - Total quality management. Orchestrating the changes in long term care. PMID- 10127959 TI - Establishing facility guidelines promotes appropriate care planning. PMID- 10127960 TI - Intervention skills defuse potential crisis situations. PMID- 10127961 TI - Promoting residents' eating skills optimizes quality of life. PMID- 10127962 TI - Focusing on strategic issues produces measurable change. PMID- 10127963 TI - Final DEFRA (Deficit Reduction Act of 1984) rules define latitude for purchase, reimbursement. PMID- 10127964 TI - Medical device reporting form may create liability issues. AB - A primary concern for nursing facilities in today's litigious climate centers on whether reports mandated by the SMDA will haunt facilities by prompting civil litigation by residents injured in device-related incidents. PMID- 10127965 TI - Activity room design, equipment impact programming success. PMID- 10127966 TI - Development approaches unique in rural communities. PMID- 10127967 TI - Computer applications in health care. AB - Computers are playing an ever-increasing role in health care. Computer-based medical records can improve data access, retrieval, output, decision support, and quality assurance. The author discusses computer innovation in medical record keeping, laboratory data reporting, and drug delivery. PMID- 10127968 TI - Liability issues arising from hospitals' use of temporary supplemental staff nurses. PMID- 10127969 TI - Health reform's bitter honey pot. PMID- 10127970 TI - Nobody asked me, but.... PMID- 10127971 TI - Color it healthy. Health Central, Orlando, FL. PMID- 10127972 TI - Will an OSHA inspector nail you? PMID- 10127973 TI - Hospital-physician relationships: a hurdle on the road to reform. PMID- 10127974 TI - CHA task force helps managers make values-based decisions. PMID- 10127975 TI - Catholic healthcare ministry's key role in healthcare reform. PMID- 10127976 TI - A framework for comprehensive healthcare reform. The Catholic Bishops of the United States. PMID- 10127977 TI - Practice parameters benefit all. Patient management strategies improve outcomes for patients, lower costs for payers. AB - Practice parameters, patient management strategies designed to help physicians make clinical decisions, can eliminate thousands of unwarranted medical procedures each year, resulting in greater satisfaction for patients and lower costs for payers. But physicians have yet to adopt many recently issued parameters. The enthusiasm with which they embrace newer guidelines depends on their views concerning the expertise of the sponsoring organization and the participants in the group that developed the parameter. Practice parameter development is costly. Before creating a practice parameter, it is a good idea to find out if a parameter already exists that can be modified for local use, or if one is being developed elsewhere. Some think inertia is a major obstacle to carrying out practice parameter guidelines. Others believe healthcare professionals' opposition is a more substantial roadblock. Some physicians believe practice parameters threaten their autonomy and the art of their practice. Pressure from patients to use certain procedures can also be an obstacle. Practice parameters work best if developed by authoritative physician specialty organizations. Implementation needs to be backed up with continuing education and feedback. PMID- 10127978 TI - Wellness in the healing ministry. AB - Wellness has gained a foothold in most healthcare delivery systems because of its focus: Keeping people well is the ultimate goal of a healthcare system. Three generations of wellness models have evolved over the past 16 years. First generation wellness efforts focus on reducing health risks. Hospitals have developed programs and services to improve customers' and employees' health status. And corporations are lowering health risks by offering employees worksite fitness centers, cholesterol and other screenings, and smoking-cessation programs. Second-generation wellness efforts link wellness to benefits. Hospitals and corporations have implemented health incentive programs, structured to reward people for maintaining low ranges in their controllable health risk factors. Third-generation wellness efforts show that connectedness can improve health. Such efforts emphasize the importance of spiritual and emotional well-being as an inextricable part of physical health and healing. Today prayer and support groups, guided imagery, and prayerful meditation are becoming more mainstream. Such wellness approaches encourage persons to think and care for themselves more holistically. PMID- 10127979 TI - Retooling for community benefit. AB - Healthcare providers today must have a mission of service both to the individual and to the community. In 1990 the Hospital Community Benefit Standards Program (HCBSP) was launched as a demonstration project to begin the process of defining the elements that constitute community benefit. The HCBSP standards are that a hospital (1) evince a significant organizational and operational commitment to a community benefit process, (2) plan and implement projects and activities that address specific community public health needs, (3) cultivate and maintain relationships with other organizations to foster community benefit, and (4) foster an internal environment that encourages everyone in the organization to participate in community benefit programs. The following elements are important to an effective community benefit program: Governing board involvement CEO understanding and commitment A key senior manager to coordinate An explicit commitment of human and financial resources An epidemiologic data base describing a defined community or population A mechanism for bringing together people in the organization interested in community benefit A mechanism for facilitating dialogue between hospital leaders and representatives from the community A method of linking community benefit processes to outcomes PMID- 10127980 TI - Ethical issues of unconventional therapies. PMID- 10127981 TI - Linking individual and organizational wellness. AB - In addition to intervening when workers have substance abuse or stress problems, many hospital employee assistance programs (EAPs) now include a wellness component that emphasizes prevention and organizational wholeness. The EAP at St. Joseph's Hospital & Medical Center, Paterson, NJ, has taken a number of steps to improve its responsiveness to employees' needs and promote constructive organizational changes. To meet increasing requests for mental health services, St. Joseph's EAP implemented a short-term (up to 12 sessions) counseling program that focuses on problem-solving techniques. The EAP has also used feedback from clients to address organizational issues. For example, a survey that revealed differences between managers' and employees' perceptions of managers' leadership skills has led St. Joseph's to consider development of further workshops to train managers on how to be more effective leaders. And in response to complaints from nurses about a lack of communication with physicians, St. Joseph's invested $8,000 to implement nursing support groups and seminars to enhance nurse physician collaboration. Additional EAP activities include consulting services for other corporations and help for employees in overcoming financial barriers to access to healthcare and social services. As budgets tighten, effective marketing of EAPs will be essential to their continued growth. In particular, EAP administrators must learn how to document the strategic and financial benefits of their programs. PMID- 10127982 TI - The value of spiritual health. AB - Spiritual health is that aspect of our well-being which organizes the values, the relationships, and the meaning and purpose of our lives. Patients and healthcare professionals alive have experienced a growing recognition of the importance of spiritual health as a foundation for physical health and well-being. As a reformed healthcare system places greater emphasis on etiology and prevention as opposed to relief of symptoms, creative and holistic partnerships between the medical profession and spiritual care givers can and will emerge. In studying the etiology of illnesses, healthcare providers must examine the underlying social problems of the day: violence, divorce, unemployment, and a host of other factors that lead to disintegrating relationships. In the past many physicians and nurses refrained from discussing spiritual matters with patients. But given the importance of the relationship between physical and spiritual well-being, providers must make spiritual assessments at the time of any triage. The medical record needs to include references to the patient's spiritual history. And healthcare institutions must seek partnerships with community organizations and leaders to monitor the effects of societal issues that lead to physical and spiritual distress. PMID- 10127983 TI - Holistic retreats. A New Jersey medical center responds to community needs. AB - Through Lourdes Wellness Center, sponsored by Lourdes Medical Center, Camden, NJ, religious and laypersons from across the nation can experience holistic spirituality retreats. In holistic spirituality, a person reverences his or her whole self as an expression of and a way to God. Retreats offered through the Wholistic Retreat Program are geared to demonstrate the Christian and Franciscan perspective of the holiness of all creation. Some retreatants say the liturgies are the core of the holistic spirituality retreats, rich in their use of symbol, music, and word. Meals served at the retreats are a celebration of color, texture, and fragrance. Movement and exercise options are always available. Staff from Our Lady of Lourdes Medical Center often come to test retreatants' cholesterol levels, assess their life-styles and health, and provide information on health, fitness, and additional health screenings. Lourdes wellness retreats have a bright future as people increasingly turn to spirituality, preventive care, and alternative ways of healing in our high-stress society. PMID- 10127984 TI - Antitrust and IDNs (integrated delivery networks): how far can we go? AB - Since the 1970s, the outcomes in antitrust actions against healthcare facilities have become significantly more predictable. But there are still differences of opinion among healthcare providers and antitrust enforcers as to how far antitrust enforcement activities should go. Antitrust enforcement involves a determination of reasonable and unreasonable activities, rather than the application of clear rules. This can lead to confusion over what is legal and may inhibit providers from engaging in collaborative efforts. Intent is very important in antitrust matters. A cooperative venture's effect on the consumer is the primary factor in the enforcers' consideration of whether it is reasonable. Thus well-planned and appropriate healthcare ventures will succeed in most places. Congress has been considering the antitrust implications of healthcare reform. To date, however, there is no consensus on what antitrust laws need changing, if any, or whether new definitions or exemptions could address the problem. Integrated delivery networks (IDNs), the central feature of many healthcare reform proposals, could raise many classic antitrust concerns. Antitrust enforcers' interest in these arrangements will vary according to their effect on competition. Any attempts to establish IDNs will need to also ensure clear language exists regarding the reach of antitrust laws. PMID- 10127985 TI - An opportunity for positive change. We have the history, experience, and will to preserve a Catholic presence in healthcare. AB - The charitable acts of women religious in response to the needs of the communities in which they settled is one of the great chapters in the history of the Church in America. But in the past two decades providers have had to contend with extraordinary changes in the healthcare environment. The Catholic healthcare mission was rooted in concern for the poor. Should Catholic healthcare providers withdraw from this field in which they have had such a significant presence and have contributed so much, or be driven from healthcare by the fiscal consequences of fidelity to mission? Instead, through its reform proposal, the Catholic Health Association has recommended that Catholic providers become advocates of change. However, even if change, such as universal access to healthcare, is achieved, we shall still have a society in which there will be many poor people. The challenge will be to see that healthcare for the poor does not become poor healthcare. Although the changing urban environment presents enormous challenges to providers, the Catholic healthcare ministry is a significant presence in urban areas. Widespread poverty accompanied by behavioral problems and social breakdowns are significant factors affecting healthcare and healthcare costs. Drug addiction; AIDS; teenage pregnancy; homelessness; the deterioration of the family; and generations of unemployment, anomie, abuse, and violence, which are often most acute in concentrated neighborhoods of poverty, challenge the ability of Catholic hospitals to meet their community's needs. Catholic providers today have a real opportunity to bring about positive changes in healthcare. They have the history, experience, and will to preserve a Catholic presence in the provision of healthcare. PMID- 10127986 TI - New challenges for public relations professionals. PMID- 10127987 TI - Misericordia Hospital. Internships offer young people a chance for a better life and community. PMID- 10127988 TI - Catholic identity and the shape of reform. PMID- 10127989 TI - Health care reform. Searching for values that define goods in health care. PMID- 10127990 TI - Hospitals establish policies to limit futile care. PMID- 10127991 TI - PSDA impact watered down by misperceptions of directives. PMID- 10127993 TI - New organ allocation policies come under ethical fire. PMID- 10127992 TI - Community ethics committee models start to emerge. PMID- 10127994 TI - New ideas offered on sources and payment for organs. PMID- 10127995 TI - The doctor as double agent. AB - American doctors in the 1990s are being asked to serve as "double agents," weighing competing allegiances to patients' medical needs against the monetary costs to society. This situation is a reaction to rapid cost increases for medical services, themselves the result of the haphazard development since the 1920s of an inherently inflationary, open-ended system for funding and delivering health care. The answer to an inefficient system, however, is not to stint on care, but rather to restructure the system to remove the inflationary pressures. As long as we are spending enormous resources on an inherently inefficient and inflationary system we cannot justify asking doctors to withhold beneficial care to save money for third-party payers. Doing so serves a largely political agenda and endangers the patient-centered ethic that is central to medicine. PMID- 10127996 TI - Double agency and the ethics of rationing health care: a response to Marcia Angell. AB - The arguments against doctors as "double agents" that are presented by Marcia Angell in the preceding article do not defeat the core justification for rationing some relatively high-expense, low-benefit care, and they do not enable us to conclude that clinicians should be barred from any active, substantive role in decisions to limit that care. They do, however, reveal several important conditions that need to govern cost-conscious medial practice in order to preserve an ethic of fidelity to patients: insurers' profits and providers' incomes must be fair, providers must inform patients of any economic reasons that lead to the foregoing of care, and "direct incentive" arrangements must not be used to contain costs. PMID- 10127997 TI - Using stories to assess values and establish medical directives. AB - While still developing in Germany, a consensus has emerged in the United States on the use of advance directives for guiding future medical decision making. This article outlines three phases in the evolution of advance directive forms--the legal phase, the checklist phase, and the story phase. The story-based approach is discussed as the best method for assessing patient values and incorporating them into advance directives, and a story-based advance directive form, which has been developed and tested during the past two years, is presented. PMID- 10127998 TI - Genetics and just health care: a Genome Task Force report. PMID- 10127999 TI - Genetic testing and genetic screening. PMID- 10128000 TI - Sprinklers prevent tragedy in two health care facility fires. AB - Compliance with code requirements, activation of sprinkler systems, and proper staff actions saved lives in two recent Massachusetts fires. PMID- 10128001 TI - Collaboration between acute and continuing care facilities: a network approach to providing quality care. AB - As the cost of healthcare has increased and the treatment time for chronic mental health problems has shortened, a gap in service of continuing care programs was identified by staff at a Veterans Administration (VA) hospital in Texas. The continuing care programs were already established in a facility some distance away from the referring hospital. The program that was developed focused efforts toward establishment of an intrahospital and interfacility network to provide maximum rehabilitation for veterans at reduced cost. PMID- 10128002 TI - Integration of quality improvement with existing quality assessment/quality management processes. AB - Quality assessment/quality management and quality improvement are two highly visible areas that are helping to change the healthcare system in the 1990s. In this article, the authors describe how quality improvement can enhance the current quality assessment/quality management program in a hospital. PMID- 10128003 TI - The role of the HMO risk manager in medical malpractice cases--Part II. AB - This is the second part of a 2-part article. In part I, the author provided an overview of HMO laws, including the application of statutes and regulations. In part II, the author focuses on liability theories against HMOs and defense theories in their favor. All of the "traditional" theories apply in addition to new ones, resulting in evolving laws that are challenging for the risk manager. PMID- 10128004 TI - The hospital patient representative: a key player in quality improvement. AB - A national survey of hospital patient representatives was conducted to identify and analyze basic demographic and occupational data for patient representatives. A total of 387 randomly selected U.S. hospitals were surveyed with a response rate of 66% (256 hospitals). Only 172 responses were completed appropriately. Of those who responded appropriately, we found the typical patient representative to be a female between 30 and 50 years old, with a bachelor's degree and about 6 years of experience as a patient representative. The majority of the respondents held a positive view of their role as the liaison between the patient and the administration as well as a facilitator for patients, families, staff, and administration problem solving. Several of the respondents stated that patient representatives strive to meet the needs and expectations of patients through their role as liaison with the administration. This role has a positive and crucial impact on improving the quality of care in healthcare organizations. PMID- 10128005 TI - Facilitating effective healthcare policy formulation. AB - Health policy is increasingly shaped by national, state, and local public advisory committees. Health professionals selected to serve on these committees must be prepared to deal not only with considerable amounts of data, but also with widely varying interpretations of those data. In addition, they must be prepared to deal with different political and personal perspectives, including those of nonhealth professionals. The successful management of that broad range of professional and cultural diversity affects the extent to which different perspectives are successfully integrated into final committee recommendations. This article offers suggestions to future advisory committee members on facilitating effective healthcare policy formulation. PMID- 10128006 TI - Legislative forum: states take initiative on healthcare reform. PMID- 10128007 TI - Quality improvement approach to nursing care planning: implementing practical computerized standards. AB - Care planning continues to be be an integral part of nursing, yet it is often criticized by professionals as time-consuming, repetitious, and inconsistent. This problematic situation prompted the development and implementation of an interdisciplinary automated care-planning system that interfaces with a preexisting data base. The advantages of the system include standardization of care, consolidated documentation, provision of patient education tools, shared responsibility during the patient's length of stay, and minimal cost. Evaluation of the system demonstrated quality improvement in the documentation of patient education and compliance in meeting JCAHO nursing process standards. PMID- 10128008 TI - Prognosis: fewer jobs. PMID- 10128009 TI - Fortress Bethesda. AB - Critics within and outside the National Institutes of Health say that NIH's central administration is hostile and defensive and needs to be shaken up. They hope a new director will do just that. PMID- 10128010 TI - Health care debate: a sneak preview. PMID- 10128011 TI - Fire! AB - Do you take an active role at fire scenes, or do you sit in your ambulance, peering through the windshield, until victims are extricated? EMS providers can make significant contributions at fire scenes. Here's a look at the response do's and don'ts. PMID- 10128012 TI - Surviving the hot zone. PMID- 10128013 TI - Flirting with trouble. If a patient exhibits sexually suggestive behavior, keep your cool. PMID- 10128014 TI - With clear vision. PMID- 10128015 TI - Selling service. PMID- 10128016 TI - Waste management strategies that save money and reduce risk. PMID- 10128017 TI - New legislation changes legal requirements concerning consent to treat incompetents. PMID- 10128018 TI - Rethinking the role of the trustee. PMID- 10128019 TI - New technology conserves energy, saves money. PMID- 10128020 TI - Breaking health care barriers. PMID- 10128021 TI - How the new Family and Medical Leave Act affects employee health leave and benefits. PMID- 10128022 TI - Federal action necessary to save retiree plans. PMID- 10128023 TI - Reducing retiree medical costs through utilization management. PMID- 10128024 TI - Health care benefits cuts are landing employers in court. PMID- 10128025 TI - The new American hospital: creating an internal reform strategy. PMID- 10128026 TI - Alltel acquiring TDS for $80 million. PMID- 10128027 TI - Columbia on the fast track. With its merger complete, the new company seeks acquisitions so it can dominate markets. PMID- 10128028 TI - Mass. guidelines clarify law on hospital mergers. PMID- 10128029 TI - Reform plan said to limit program growth. PMID- 10128030 TI - Dialysis provider Ren posts $3 million loss in 2nd qtr. PMID- 10128031 TI - Hospital can't change mind to get more money. PMID- 10128032 TI - Another battle flares between rival systems in Memphis market. PMID- 10128033 TI - Healthcare reform to mean tough choices for everyone. PMID- 10128034 TI - Effective compromise could give consumers vote on reform tack. PMID- 10128035 TI - NME execs say firm's secure, but S&P cuts rating. PMID- 10128036 TI - NME exec pay, severance raises ire. PMID- 10128037 TI - 1993 up & comers. AB - The achievements of the healthcare industry in the 21st century will depend on the quality of its leadership. In recognition of the contributions of the new generation of healthcare executives, MODERN HEALTHCARE salutes its 1993 Up & Comers. They are a group of healthcare professionals, all 40 or younger, who have refused to be restricted by the ways of the past. Instead, they have contributed to efforts to improve the quality of medical care, expand access to the system and reconfigure the delivery system. The group, whose accomplishments are outlined in the following pages, were selected from a field of nearly 50 candidates nominated by MODERN HEALTHCARE's editorial staff and magazine readers. PMID- 10128038 TI - Health Net, Qual-Med to merge in deal valued at $775 million. PMID- 10128039 TI - Data bases used for outpatient decisions. PMID- 10128040 TI - Hospital execs take lessons from other industries. PMID- 10128041 TI - PPS adjustment for '94 to lower capital payment rate by 9.3%. PMID- 10128042 TI - Fla. backs down on data collection rule. PMID- 10128043 TI - Women today and the women's movement. PMID- 10128044 TI - Evolution of the duty to warn--one state's experience. AB - OBJECTIVE: There exist, in many jurisdictions, confusion and uncertainty with regard to the legal duty of pharmacists to warn their patients of the potential risks of their medication. Review of the legal evolution of this duty in one state with recent experience is instructive. DATA SOURCES: Published opinions of the Tennessee Court of Appeals. CONCLUSIONS: The cases are consistent with the idea that if the pharmacist warned about risks that had a reasonably foreseeable potential of occurring, then there would be no liability. PMID- 10128045 TI - Evaluation and financial impact of imipenem/cilastatin dosing in elderly patients based on renal function and body weight. AB - OBJECTIVE: To evaluate the financial impact of adjusting imipenem/cilastatin (IC) dosages in elderly patients based on estimated creatinine clearance (Cl cr) and body weight. DESIGN: Retrospective cost-savings analysis. SETTING: A 500-bed, university-affiliated, tertiary-care hospital. MAIN OUTCOME MEASURES: All courses of IC administered to patients over age 60 during a four-month period were retrospectively assessed for appropriateness based on both dosing interval and dosage. Manufacturer's guidelines for adjusting the IC dosage based on estimated CL cr and body weight were used to define appropriate dosing. The cost savings that could have been realized by appropriately adjusting IC dosage was calculated for the study period and extrapolated to project an annual cost savings. RESULTS: Only 37 percent of patient days of therapy and 32 percent of therapy courses were judged as appropriate based on both dose amount and interval. The projected annual cost savings that could have been realized by appropriately adjusting IC dosage based on estimated Cl cr and body weight was $11,500. CONCLUSIONS: Adjustment of IC dosages in elderly patients based on estimated Cl cr and body weight can result in significant cost savings. PMID- 10128046 TI - Technician education and training programs. PMID- 10128047 TI - Perspectives. Medicaid waivers pave a pathway for reform. PMID- 10128048 TI - A day in the life of a member of medical records staff. PMID- 10128049 TI - In the fast lane. PMID- 10128050 TI - The work of the National Casemix Office. PMID- 10128051 TI - CHEM's review of PC-based environmental management tools: Part II--Compliance programs. PMID- 10128052 TI - Training requirement for transport of etiologic agents takes effect October 1, 1993. PMID- 10128053 TI - Sterilizer incident illustrates importance of emergency preparedness. PMID- 10128054 TI - The next generation of fund raisers. PMID- 10128055 TI - Demographics and the charitable estate planning marketplace. Part 2--Targeting the mature market. PMID- 10128057 TI - Quick tips for preventing (and dealing with) job loss. PMID- 10128056 TI - Job loss: consider it pure joy! PMID- 10128058 TI - Are you really listening? PMID- 10128059 TI - Reshaping philanthropy and your development effort for the 21st century. PMID- 10128060 TI - Our response to change. PMID- 10128061 TI - Shall we dance? PMID- 10128062 TI - Hitting the corporate target. PMID- 10128063 TI - Canadian health care system faces growing economic challenges. PMID- 10128064 TI - Germans reexamine health care system. PMID- 10128065 TI - Enterprise liability as an alternative to tort reform. PMID- 10128066 TI - Reusable vs. disposable laparoscopic instruments. PMID- 10128067 TI - Practice expenses. PMID- 10128068 TI - Patient-focused care on a tight budget prepares two smaller hospitals for continued success in capitation environment. PMID- 10128069 TI - The Christ Hospital, Cincinnati, participates in 14-institution cost effectiveness comparison. PMID- 10128070 TI - Professional stereotyping can stall good efforts--but there's a cure. PMID- 10128071 TI - Dive into waste reduction: start by buying smart. PMID- 10128072 TI - Above-average pay hikes continue, but not for long. PMID- 10128073 TI - Error-free linen handling. PMID- 10128074 TI - Poll: CS (central service) has varying responsibility for patient care equipment. PMID- 10128075 TI - How do your laundry and linen operations stack up? PMID- 10128076 TI - Caring for neighbors: an examination of nonresident use of New York City hospitals. AB - In 1989, almost 10 percent of all patients--or nearly 100,000 patients- hospitalized at facilities located in New York City were not city residents. Nonresidents are attracted to the city by the prestige and expertise of the city's hospitals; they are more likely than residents to require the hospitals' most sophisticated and specialized services, ranging from transplantation and coronary bypass surgery to treatment of malignant conditions. The largest numbers of nonresident patients, however, receive care for conditions that are relatively routine, care which would seem to be generally available at suburban hospitals. Although New York City hospitals continued to serve a substantial number of patients residing outside the city, the flow of nonresident patients seems to be slowly diminishing, particularly at the city's academic medical centers. (The specialty hospitals, on the other hand, seem to be attracting an increasing share of nonresident patients.) This decline occurred despite the one-third increase in population since 1960 in the New York State counties surrounding the city. To complicate matters, many New Yorkers are leaving the city for care. Almost 40,000 New York City residents were admitted to hospitals elsewhere in New York State, and perhaps another 20,000 to 40,000 may be receiving hospital care in other states. These trends have obvious implications for the city's hospital in their dual role as leaders in advanced and sophisticated medical care and as providers of vital patient care services to the city's population. The most highly specialized services can maintain clinical expertise and remain financially viable only if a sufficient number of patients can be attracted from throughout the metropolitan area and beyond. Likewise, the city's hospitals can be confident of fulfilling basic patient care needs only as long as New Yorkers do not look elsewhere for care. With the myriad pressures on our hospitals, the challenge of keeping them inviting and responsive will be formidable, but the construction of modern facilities, emphasis on patient-centered care, cultivation of strong relationships with communities and practitioners, and careful monitoring of patient flows and patient satisfaction should help the city's hospitals continue to attract patients, both from within the city and beyond the city limits. PMID- 10128077 TI - Diffusion of information in medical care. PMID- 10128078 TI - Medical care costs: how much welfare loss? PMID- 10128079 TI - The national health care phobia. AB - Opinion: Clinton's plan for 'managed competition' won't work. A look at a misunderstood alternative that could provide inexpensive, first-rate care. PMID- 10128080 TI - Medicaid program; limitations on provider-related donations and health care related taxes; limitations on payments to disproportionate share hospitals--HCFA. Final rule. AB - This final rule clarifies HCFA's policies concerning provider related donations and health care related taxes. In addition, this final rule revises regulations with regard to disproportionate share hospital spending limitations. This final rule amends an interim final rule that was published in the Federal Register on November 24, 1992. The interim final rule established in Medicaid regulations limitations on Federal financial participation (FFP) in State medical assistance expenditures when States receive funds from provider-related donations and revenues generated by certain health care-related taxes. The interim final rule also added provisions that establish limits on the aggregate amount of payments a State may make to disproportionate share hospitals for which FFP is available. The provisions of the interim final rule were required by the Medicaid Voluntary Contribution and Provider Specific Tax Amendments of 1991. PMID- 10128081 TI - Medicaid program; limitations on aggregate payments to disproportionate share hospitals; Federal Fiscal Year 1993--HCFA. Notice. AB - This notice announces the final Federal fiscal year (FFY) 1993 individual State allotments for Medicaid payments made to hospitals that serve a disproportionate number of Medicaid recipients and low-income patients with special needs. The final FFY 1993 State DSH allotments published in this notice supersede the preliminary FFY 1993 DSH allotments that were published in the Federal Register (57 FR 55261) on November 24, 1992. PMID- 10128082 TI - Hiring spree. AB - Jittery players in the health care reform debate have signed up a multitude of lawyers, lobbyists, political consultants, pollsters and public relations experts. And the real action hasn't even started. PMID- 10128083 TI - Ethics and occupational therapy practice. AB - Professional ethics are guiding principles which are intended to orient the individuals within the profession, ensure our clients best interests and to protect the profession itself and its position in the public mind. Professional ethics are the rules we use to make certain that each therapist is operating in a fashion which protects the integrity of our profession and hence the viability of all occupational therapists. Our professional ethics, in addition to our special training and acquired skills, explain our profession to the health care community and those patients whom we serve. Professional ethics are a method by which our membership defines itself and guides its members throughout their career. Professional ethics ensure a place of trust within the Canadian health care system for those who choose to practice occupational therapy. PMID- 10128084 TI - Health promotion, occupational therapy and multiculturalism: lessons from research. AB - Principles of occupational therapy practice make the profession an important potential partner in health promotion initiatives for immigrant groups. Health promotion embodies the principles of self-definition of health needs by target groups, and working with a community in initiating and supporting programmes. This paper discusses the implications of an exploratory study of the daily activities of immigrant Indo-Canadian mothers for translating health promotion principles into practice. The research process and an analysis of interviews conducted with the women suggest factors to consider in using a health promotion framework with immigrants who have experienced social and economic dislocation through the immigration process. Discussion of household structure, divisions of labour, childcare strategies, and parenting concerns raises issues requiring particular attention in sharing occupational therapy skills and knowledge with ethnocultural communities. PMID- 10128085 TI - Healthcare reform issues for home care. Focus groups set the stage. AB - The National Association for Home Care (NAHC) has involved its members in studying and influencing the directions for health care reform. To this end, NAHC appealed to the expertise of its members. Home care and hospice representatives- administrators, providers, and policymakers--met throughout the summer at NAHC's offices in a series of focus groups to discuss health care reform and its effect on home care. This article highlights some of the reports from those focus groups. PMID- 10128086 TI - Health care reform enters the home stretch. AB - What are the solutions the President's Task Force on Health Care Reform is considering for home care and hospice coverage? How will Americans pay for this coverage? This article looks at how the plans are shaping up and what the President's solutions are likely to be for universal health and home care. PMID- 10128087 TI - And health care for all--America speaks out through HealthRIGHT. AB - In pressing for health care reform, physicians, drug companies, and hospitals all have well-funded lobbies. HealthRIGHT, an endeavor of the National Association for Home Care, seeks to fill a void in the health care reform debate by giving the American people a voice in the political process. HealthRIGHT is the people's lobby. PMID- 10128088 TI - Providing universal access is not easy. AB - In whatever reform system legislators develop, states may be given leeway in what they do to provide for their residents. Vermont is one of those states that will strive for universal access. What have been the pitfalls so far as the state develops its own system? PMID- 10128089 TI - Family care-giving & health care reform. AB - The need of family caregivers for respite services needs to fit within the framework of health care reform. Specific recommendations and guidelines for respite services were developed by a coalition of family caregivers, health care professionals, and community leaders. PMID- 10128090 TI - The Long-Term Care Management Institute. Seeking better services through improved management. AB - All aspects of long-term care delivery can be positively influenced by improvements in the way services are managed. This unique institute at a small college was created to enhance and improve the delivery of long-term care services by focusing on long-term care management. PMID- 10128091 TI - Reform must include home care & hospice. AB - Inadequate access to acute health care and long-term care is the single most devastating problem facing America. This problem will only get worse unless prompt action is taken. Reform legislation must address the need for access both to basic health care coverage that includes home care and hospice services and to a comprehensive array of long-term care services based on home care. Without federal reform, health care costs will continue to increase while access to basic services and long-term care services deteriorates. Congress should make the most of the current climate of support for change and make health care reform a top priority for action next year. PMID- 10128092 TI - A TQM model for home care coordination & provider partnering. AB - Quality Improvement Teams can identify areas of customer dissatisfaction and raise coordinators' and caregivers' awareness of problems. Through home care coordination--whereby an expert home care nurse develops partnerships with key referral sources and facilities--they improved services and built both market share and service excellence into the wellness continuum. PMID- 10128093 TI - The Center for Home Care Policy and Research. AB - Home care is the fastest growing sector of health care. A nerve center for research and development can become an integral part of tracking home care's expanding role in society, in turn enabling industry leaders to guide policymakers in the direction of making home care a swing point for health care reform. PMID- 10128094 TI - The two faces of development. AB - An intrinsic connection exists between mission and money. As both are extended to their maximum point, the institution can role through its life effectively. PMID- 10128095 TI - Solid to the core. PMID- 10128096 TI - Blues and hospitals form integrated and collaborative community partnerships. PMID- 10128097 TI - Integrated systems: subspecialists as capitated primary care physicians? AB - The shortage of primary care physicians, the shifting roles of specialists and abundance of subspecialists are challenging hospital alliances. In the new world of managed care and managed competition, where providers assume financial risk for overutilization, management must discard traditional measures of profitability and focus on adding value. Hospitals are taking steps to become accountable health partners in smaller to mid-sized markets (two or three hospitals) by sponsoring community based direct contracting managed care networks. This type of system helps providers offer employers a local managed care alternative that is better able to demonstrate quality of care, and to control utilization through capitation and other pricing strategies. PMID- 10128098 TI - Rochester health care system. Rochester collaboration a big success and weakening. PMID- 10128099 TI - No model integrated or collaborative systems. PMID- 10128100 TI - Long term services provide care for elderly population. PMID- 10128101 TI - South Florida alliance allows new comprehensive area partnerships. Interview by Donald E. L. Johnson. PMID- 10128102 TI - Salary levels of health care security directors still low, surveys find. PMID- 10128103 TI - Medical center: from armed in-house staff to unarmed contract security. PMID- 10128104 TI - An interview with: Robert W. Overman of Guardsmark on his company's drug testing and screening program. PMID- 10128105 TI - Assaults on employees: what two hospitals are doing to upgrade security. AB - In March, a 34-year-old cleaning employee was attacked and raped in knifepoint in an office area of SUNY Health Science Center University Hospital, Syracuse, NY. The attack occurred at 11:20 p.m. in an outpatient hematology clinic that is closed at night. The victim reported that the assailant asked for directions to another section of the hospital, and, instead of leaving the area, followed her down a hallway to an unoccupied office are, where he cut her on the hand and a leg, before exiting the hospital through the emergency room. In April, a 37-year old employee at St. Bernardine Medical Center, San Bernardino, CA, was assaulted in a first-floor bathroom at 5 a.m. by an attacker who ripped her clothing and kicked her several times in the stomach before she fought him off, preventing her own rape. Her attack was similar to a December incident involving a 30-year-old hospital technician who was raped in a second-floor restroom at 2 a.m. Police originally suspected that both attacks may have been committed by a hospital employee, but Vicky Wilson, assistant administrator, says that assumption has changed. "We've fully cooperated with the police investigation and reviewed all of our former and current files, and, at this point, the police don't feel that any of the employees--either former, within the last two or three years, or current employees--are a likely suspect." Although the hospitals are 3,000 miles away from each other, the incidents are related in that they involve attacks upon employees and because each hospital took immediate action to upgrade security. In this report, we'll review in detail what they did. PMID- 10128106 TI - Fear of crime by employees: how two services have responded. PMID- 10128107 TI - Using process action teams to solve problems. PMID- 10128109 TI - Ofhealth. PMID- 10128108 TI - Board games. PMID- 10128110 TI - Softly, softly ... health technology assessment. PMID- 10128111 TI - Greek myths. PMID- 10128112 TI - Links between services. Stamp of approval. PMID- 10128113 TI - Links between services. Mind your language. PMID- 10128114 TI - Links between services. Supporters' clubs. PMID- 10128115 TI - Lyme cordial. PMID- 10128116 TI - Goal! PMID- 10128117 TI - Organizational and administrative factors influencing the adoption of consortia programs by rural hospitals. AB - This study was designed to assess the effects of various hospital and environmental characteristics on the involvement of rural hospitals in forming and governing consortia and adopting consortia programs. The study focused on the 127 hospitals that are members of the nine rural consortia developed by grants from the Robert Wood Johnson Foundation during 1989 under its Hospital-Based Rural Hospital Consortia Program. Hospital involvement in the formation and governance of the consortia was found to be far less than expected for these grass-roots organizations. Only 38 percent of the administrators said that their hospitals were involved in developing the consortia, and 44 percent said that they played a role in determining the program menu. Governing board and medical staff involvement was even more limited. Program adoption rates were found to be related to both the types of programs offered by the consortia and the characteristics of the hospitals. In general, greater involvement of physicians and governing board members in hospital decisions was found to enhance program adoption rates, but the influence varied by type of involvement in the hospital and program content. PMID- 10128118 TI - Rural hospital administrators and strategic management activities. AB - This study examines the association of characteristics of rural hospital administrators and the adoption of seven strategic activities in a national sample of 797 U.S. rural hospitals during the period 1983-1988. Based on the premise that managerial activities can affect organizational change, we test five hypotheses relating head administrator characteristics to strategic adaptation, controlling for environment-market and hospital-related variables. Bivariate analysis of the strategic adoption showed a positive association with administrative turnover and a negative association with head administrator age. Multivariate logistic regression showed that only high levels of turnover were associated with strategic activities, net of control variables. The implications of these findings and the lack of predictive power of other rural hospital administrator characteristics--especially affiliation with the American College of Healthcare Executives--are discussed within the context of a "strategic management policy" for rural hospitals. PMID- 10128119 TI - CEO turnover in rural northwest hospitals. AB - This study examines rates of and reasons for turnover among administrators from 148 rural hospitals in four northwestern states. Data were obtained from a survey of CEOs who left their positions between 1987 and 1990 and from a survey of board members from those same hospitals. During the study period, 85 CEO turnovers occurred at 78 hospitals. High-turnover hospitals were generally smaller than those facilities with fewer turnovers. The annual rate of CEO turnover was 15 percent in 1988 and 16 percent in 1989. The reasons for turnover most often cited by those in their positions for less than four years were due to: seeking a better position elsewhere, an unstable health care system, conflict with hospital board members or with medical staff, and inadequate salary. High levels of self reported job satisfaction and job performance by turnover CEOs contrasted to the much lower performance evaluations reported by hospital board members. Nearly three out of four board members indicated they would not rehire their departed CEOs. CEOs perceived their professional weaknesses to center on deficiencies in leadership and financial skills as well as problems with physician, hospital board, and community relations. PMID- 10128120 TI - Physician satisfaction with rural hospitals. AB - This study examines factors leading to physician satisfaction with small rural hospitals. Interviews were conducted with 122 rural physicians using a standardized survey instrument. The relationship between the independent variables and the dependent variable, hospital satisfaction, are described and tested using chi-square and discriminant analysis. The findings of this study revealed that no demographic variables appeared in the chi-square, and only age appeared in the discriminant analysis. Practice factors impacting hospital satisfaction included practice satisfaction (both in the chi-square and discriminant analysis) and years at current location (only in the chi-square). Hospital-related factors affecting hospital satisfaction included administrative responsiveness (strongest association); administration accessibility, communication with administration, and nursing skill and knowledge in the chi square; and administrative responsiveness, nursing skill and knowledge, and technology in the discriminant analysis. PMID- 10128121 TI - Public-private partnership organizations in health care: cooperative strategies and models. AB - Value-adding partnerships have emerged as a preferred strategy of private health care providers to achieve high-quality, low-cost provider status. This same strategy can be applied by public sector providers through the creation of public private partnership organizations (3POs). Strategies to build 3POs between local governments and their medical communities currently under development are outlined. The conceptual and practical aspects of implementing 3POs are presented. PMID- 10128122 TI - Measuring charitable contributions: implications for the nonprofit hospital's tax exempt status. AB - Since 1985, some nonprofit hospitals have tried to measure the magnitude of their charitable contributions in order to protect themselves from challenges to their nonprofit tax-exempt status. Using a sample of 562 Catholic nonprofit hospitals, this research shows that these charitable contributions may be defined and measured in several different ways, each having methodological advantages and disadvantages. The data indicate that charity care contributions vary widely, are unequally distributed across the sample of hospitals, and are influenced by the characteristics of the people in the local community and not by the characteristics of the health care delivery system. These findings suggest that legislators may be correct when questioning the rationale for the tax-exemption accorded to virtually all nonprofit hospitals. Further, it suggests that nonprofit hospital administrators can protect the tax-exempt status of their hospital by emphasizing the charitable contributions it makes by absorbing the unreimbursed costs from Medicare and Medicaid. PMID- 10128123 TI - The treatment perspectives of physicians, citizens, and state legislators. AB - This study addresses the dilemma of physicians to act both as an agent of their patients and as an agent of society. We contrasted the perceptions of physicians, citizens at large, and state legislators about 11 topics related to physician decision making regarding the management of care for seriously ill patients. Significant and interpretable differences were found between physicians and citizens, although there were no differences between these two groups and the state legislators. However, even the obtained differences were fewer and smaller than expected. These results suggest that lay, legislative, and medical viewpoints may be less at odds with each other than the literature would suggest, and reaching an accord on at least some aspects of health policy may not be as difficult as generally is assumed. PMID- 10128124 TI - The patient representative role and sources of power. AB - Because the 1990 accreditation standards of the Joint Commission on Accreditation of Healthcare Organizations call for the establishment of patient grievance procedures, this study examines the possibility of patient representatives serving in that capacity. Members of the National Society of Patient Representation and Consumer Affairs were surveyed to examine current roles of patient representatives--in particular, their handling of complaints, the types and sources of their power, the potential for conflict of interest as an institutionally employed advocate, and requirements for and barriers to successful job performance. The study reveals a great variation in the activity profiles of patient representatives. Additionally, it shows that the staff in place is professionally capable of moving in many directions and that departments have become the patient grievance mechanisms called for by the Joint Commission, depending on the hospital's management philosophy as reflected in allocation of authority and resources. PMID- 10128125 TI - Remuneration of GP services: time for more explicit objectives? A review of the systems in five industrialised countries. AB - The paper examines the nature and use of GP remuneration systems as instruments of health policy in five different countries--Australia, Canada, Denmark, Norway and the UK. Since doctors are not naturally efficient, they need to be encouraged to adopt efficient practices. The paper indicates that while there are great differences in the nature and level of remuneration across the five countries, there is little evidence that policy-makers in these countries have given adequate thought to how to use remuneration to influence the activities of GPs. In all five countries except the UK the objectives of GP services are somewhat vague and largely non-operational. The designs of the remuneration systems seem directed more towards deciding doctors' income levels and controlling public expenditure than towards meeting health care objectives. The remuneration for similar services varies widely across the five study countries. There is a need to clarify what the objectives of general practice are and thereafter to experiment more with GP remuneration systems to determine how best to get doctors to meet these objectives efficiently. PMID- 10128126 TI - Foreign medical graduates and U.S. physician supply: old issues and new questions. AB - Recent increases in the number of foreign medical graduates (FMGs) in U.S. hospital-training positions raise new questions about the future role of FMGs in U.S. medicine. Despite an historical surplus of physicians, forces such as greater demand for resident house officers, stabilization in undergraduate medical education enrollment, increase in demand for medical services, growth in both the number of women in medicine and physician employment in group practices, and continuing imbalances in the distribution of physicians favor FMG migration to the United States. Health system reform must be sensitive to the historical, current, and future role FMGs play in medical care delivery, especially in regard to service in underserved areas, specialties, and employment settings. PMID- 10128127 TI - The trade-off between severity of illness and treatment effect in cost-value analysis of health care. AB - Social appreciation of health care programs is a function of the severity of the patients' initial state as well as of treatment effect. Prioritising on the basis of cost-per-QALY misses the former point. The trade-off between severity and treatment effect can be expressed in terms of equivalence of numbers for different outcomes. The present study suggests that this trade-off can be modeled mathematically with reasonable accuracy. A table that expresses social equivalence numbers as a function of severity and treatment effect could be used together with guidelines for adjusting for age, duration and risk to estimate the social value of any outcome. In this valuation, saving a young person from dying to a life as healthy (= 1 SAVE) is suggested as the unit of measurement. Cost per SAVE may then be useful as a guiding criterion in prioritising. PMID- 10128128 TI - Central and Eastern European health care financing: report of a visit. PMID- 10128129 TI - Pharmaceuticals and public policy: learning from the New Zealand experience. AB - Pharmaceuticals provide a useful analytical prism through which to view a wider range of policy issues in the health arena. The fundamental characteristics of pharmaceuticals are shared by many other health care items and raise important policy questions in five key institutional areas: the market, science, the State, the professions, and the public. In one way or another the key policy issues raised in each one of these areas concern fundamental questions of restraint and regulation: the ability of the market to exert the normal disciplines of price competition on pharmaceuticals; the extent to which the claims of intellectual property conflict with the norms of scientific advance; the reconciliation of the different functions of the State, particularly in the management of risk; the efficacy of traditional mechanisms of self-regulation and peer review in the health professions; and the implications of pharmaceuticals for broader questions of social control. These issues are illustrated from the recent experience of a country, New Zealand, that has undergone major deregulation and restructuring of State activities. Conclusions are drawn for policy development in the pharmaceuticals area. PMID- 10128130 TI - Doing the splits: contracting issues in the New Zealand health service. AB - The purchaser-provider split is an integral part of the New Zealand and UK health care reforms. The split is seen as an opportunity to introduce competition by increasing the number of players. The assumption is that competition among providers, purchasers or indeed funders, increases efficiency and provides more consumer choice. This paper looks at the issue of contracting in the New Zealand health services within the framework of transaction cost analysis. It examines evidence about the effects of formal contracting rather than the more traditional, informal negotiations that take place within a hierarchy. A number of potential problems with an indiscriminate provider split are highlighted and the conclusion drawn, that the outcome of such a split is likely to be more unpredictable than official expectations. In the absence of pilots, monitoring the implementation will be critically important to be able to compare the outcomes of different ways of organising the health care system. PMID- 10128131 TI - Design/build approach puts new cancer care center on a 'fast track'. Medical Center of Central Massachusetts. PMID- 10128132 TI - Health care construction in the 1990s. AB - Need proof that health care construction is booming? Just look at the model (below) of Northwestern Memorial Hospital's $580 million replacement facility, to be built in the heart of Chicago. PMID- 10128133 TI - Planning. PMID- 10128134 TI - Design. AB - How can you put more of the 'patient' in patient-focused care? Give patients a say up front when it comes to the design of your health facilities. PMID- 10128135 TI - Construction. AB - Health facilities often prefer to use local companies on building projects--but what if those firms lack expertise? The construction-management approach offers a solution. PMID- 10128136 TI - OSHA focuses on pathogens-standard compliance. PMID- 10128137 TI - Facility management degrees: worth the effort? PMID- 10128138 TI - Protecting against the dangers of laundry's heat. PMID- 10128139 TI - Health care construction: where's it headed in the '90s? PMID- 10128140 TI - "Agenda for change". PMID- 10128141 TI - The BMET (biomedical equipment technician) career. AB - This feature article provides an overview of Biomedical Equipment Technician (BMET) careers. Job descriptions and career paths are given for BMET Is, IIs, IIIs, Equipment Specialists and Supervisors, including actual examples of career paths taken by BMETs "in the field." The usual educational requirements for each career are discussed, as well as internship programs such as the one at University Hospital in Stony Brook, New York. The Wentworth Center for Clinical Engineering (Boston) is given as an example of a collaborative BMET educational venture involving hospitals, industry, and students. BMET certification is discussed as a professional option. Finally, BMET careers in industry, shared services and government are described. PMID- 10128142 TI - Biomedical engineering--education & industry: an Australian perspective. AB - Biomedical Engineering education requires a multidisciplinary approach. To achieve satisfactory results from biomedical undergraduate courses, the development of longer programmes incorporating the life sciences and formal hospital or scientific and medical industry-based clinical experience programmes is needed. The B.Sc./B.E. five-year, combined-degree satisfies these requirements. Undergraduate programmes should be supported by parallel postgraduate programmes. A postgraduate engineering master's programme, by coursework and minor thesis, formulated in collaboration with professional groups and designed to be presented within a hospital or scientific medical industry environment, is required by industry. These education programmes need to be supported by a research (Ph.D and engineering master's with major thesis), hospital and industry infrastructure, which may take the form of a "Centre for Biomedical Engineering." PMID- 10128143 TI - OSHA's bloodborne pathogens standard: enforcement, compliance and comment. AB - More than a year ago, federal OSHA's Bloodborne Pathogens standard, legislation designed to reduce worker exposure to bloodborne pathogens such as HIV and HBV, became law. Many healthcare facilities were using personal protective equipment (PPE) or had some form of Universal Precautions (which the law requires) in place before the law took effect. Healthcare providers interviewed said that the addition of the widespread use of water-retardant gowns formed the biggest change in their PPE program. Education and training on the standard lagged, and these provisions in the law were the ones most frequently cited by OSHA. Provisions for free hepatitis B vaccination and post-exposure follow-up were also found wanting during OSHA inspections. Opinion on the need for the law differs. PMID- 10128144 TI - Taking up the gauntlet: accepting the challenge of glove evaluation. AB - Cost-conscious purchasers may wonder what glove is best suited for the maximum number of applications. The Food and Drug Administration requires that products released for marketing meet the ASTM standards, which were developed by industry strictly to standardize production. Glove characteristics, such as length and cuff features, size, gauge, flexibility and elasticity, donning lubricants, sterility and color must be considered, and fact separated from mis-conceptions. A glove-related issue causing concern is allergic responses to latex and chemical substances used in the glove manufacturing process. Reactions to gloves can be categorized as irritation, delayed hypersensitivity and immediate hypersensitivity, all of which reflect different underlying causes. Industry, concerned consumers and the FDA are looking for ways to lower the allergen content in gloves. Glove deterioration and chemical permeability problems usually result from various environmental factors and improper use. Despite concerns about viral permeability of gloves, the literature indicates that intact gloves serve as adequate barriers to viruses. Controlling gloves costs requires their appropriate use. PMID- 10128145 TI - Needlestick injuries among critical care nurses before and after adoption of universal precautions or body substance isolation. AB - A small, self-selected sample of Canadian acute-care hospitals participated in an analysis of their critical care nurses' needle disposal practices and needlestick injury experience before and after adopting new Universal Precautions or Body Substance Isolation infection control strategies. Covert observation of disposal practices, review of employee health injury reports and direct survey of the nurses indicated that employee health records documented fewer injured nurses during a thirty-day period (2.3% of 929 nurses in 33 hospitals) than was found by surveying nurses directly (3.5% of 312 nurses in 11 hospitals; only 36% of these injuries had been documented in employee health records). Injury rates in only one of eleven hospitals indicated appreciable needlestick risk reduction after adopting Universal Precautions or Body Substance Isolation, and an association between reduced needle recapping and reduced needlestick injury was not evident. Rates of injury found in this research remain commensurate with rates reported before the era of Universal Precautions and Body Substance Isolation. These findings suggest that new strategies have not had significant impact on healthcare workers' greatest source of exposure to bloodborne pathogens. PMID- 10128146 TI - Impact of a needleless intravenous system in a university hospital. AB - Needlestick injuries are a serious, but preventable problem in the healthcare industry. Industry has developed better devices to protect the healthcare worker. This study evaluates the impact of a "needleless" intravenous system on needlestick exposures and whether the increased cost of this new system could be justified. Exposures were defined and injury reports analyzed retrospectively and following introduction of the needleless IV system. This study indicates that the introduction of a needleless IV system can significantly reduce the number of IV related injuries that occur in an institution, and is economically feasible. Other categories of exposure (needle-related, related to other sharps, and trash related) also showed a drop, whereas exposure from the disposal of sharp devices into needle boxes showed a significant increase. This seems to support other findings that in-room needle-box containers have not thus far reduced the number of injuries related to sharps disposal. PMID- 10128147 TI - Oxygen monitors. ECRI. PMID- 10128148 TI - OSHA's citation system. PMID- 10128149 TI - Special issue on the 1994 Accreditation Manual for Hospitals. PMID- 10128150 TI - Changes to the 1993 MHM "Quality Assessment and Improvement" chapter. PMID- 10128151 TI - Changes to the 1993 MHM Appendixes A and B1. PMID- 10128152 TI - Home care accreditation program receives deemed status. PMID- 10128153 TI - Hospital turns tentative nonaccreditation into accreditation with commendation. PMID- 10128154 TI - Measurement key to Agenda for Change and health care reform. PMID- 10128155 TI - Community health care delivery project completed. PMID- 10128156 TI - Flash sterilization should be used only in emergency situations. PMID- 10128157 TI - Myth and reality in the rural health service crisis: facing up to community responsibilities. AB - Rural communities, rural advocacy organizations, and policy makers persist in perpetuating two serious but related misconceptions, namely: (1) The continuing deterioration of health services in most rural communities is primarily the result of forces and factors outside of the communities themselves, and (2) the solution to reverse this deterioration will come mainly from changes in reimbursement and other types of public policy initiatives. Overemphasis on the role of external factors has created a serious imbalance in programs, resources, and policy efforts, including those supported by the NRHA, resulting in inadequate national efforts and resources to foster community-based solutions. Suggested solutions include: (1) application by communities of a proven set of principles for organizing and developing local health services, and (2) creation of a national network to promote such community-based solutions. PMID- 10128158 TI - Enhancing the representation of rural areas in the National Medical Expenditure Survey. AB - This study examines the issues associated with enhancing the representation of rural areas in the National Medical Expenditure Survey (NMES). It reviews alternative definitions of rural areas and describes the classification schemes considered for future cycles of the NMES. A review of the NMES sample representation in rural areas and an examination of the analytical capabilities and limitations of the current design for deriving health care estimates of the rural population is provided. The options presented in this article would extend the analytical capacity of the NMES to permit estimates of rural areas of the national classified by census region, by gradations of rural classification, and for individuals residing in rural frontier counties. PMID- 10128159 TI - Health insurance coverage in U.S. urban and rural areas. AB - This study examines the health insurance coverage of the nonelderly population in U.S. urban and rural areas in 1989, using data from the March 1990 Current Population Survey conducted by the Bureau of the Census. Access to coverage was assessed by classifying all persons by family employment status and income. Rural residents had less access to coverage than urban residents but were only slightly less likely to be insured. In comparison to urban residents, fewer rural residents obtained coverage through employment, and more purchased private coverage outside the work place. The differences in coverage by family employment status and income were generally much greater than the differences by place of residence. PMID- 10128160 TI - The benefits of telephone-access medical consultation. AB - A major disadvantage of rural medical practice is the limited reserve of consultative options. To determine the perceived clinical utility and educational impact of the West Virginia University Medical Access and Referral System (MARS), a 24-hour prompt telephone-consultation service, a mailed questionnaire was administered to 303 West Virginia clinicians who had used MARS for infectious disease problems. The overall questionnaire response rate was 62 percent. Callers included family practitioners (35%), medical specialists (32%), surgical specialists (13%), pediatricians (11%), obstetricians (5%), and nonphysicians (4%). Major referral questions posed were therapeutic (60%), diagnostic (48%), and epidemiologic (10%) in nature. On a scale of 1 (not useful) to 5 (very useful), survey responders rated the overall clinical usefulness of MARS as either a 4 (22%) or 5 (76%). Callers felt that MARS consultation assisted in accurate case diagnosis in 80 percent of cases, and aided in successful therapeutic management of 96 percent of cases. An educational benefit was reported by 96 percent of responders. Physicians located in more rural, underserved areas tended to use MARS to a greater degree than colleagues in more populated, medically accessible areas (P < 0.005). These findings suggest that an academic telephone-access consultation program can be a clinically relevant and educational consultative tool for practicing clinicians, especially those located in rural areas. PMID- 10128161 TI - Hospitals are facing financial crisis. AB - Hospitals in Japan are facing serious financial crisis, with many establishments going bankrupt one after the other from rising costs of salaries and general expenses. The future is dark for the hospital business. Presented in this article are what the author considers indispensible measures for resetting the hospitals on their feet. PMID- 10128162 TI - Issues of health services in aging societies. PMID- 10128163 TI - Future hospitals from the viewpoint of "hospital geography". AB - The aim of this paper is to discuss what future direction will be indicated for Japanese healthcare buildings. The paper falls into two parts. Brief comparative study between USA and Japan is described in Part I, because current Japanese health care system was influenced a great deal at the first stage of its development since the end of the World War II, and it will be necessary to understand the fact at first. In Part II, the concept of "Hospital Geography" will be proposed as a new point of view for planning of healthcare buildings in 21st century. PMID- 10128164 TI - Is systematization of medical care possible in Japan? PMID- 10128165 TI - A review of the present emergency medical care system in Japan. AB - EMT's in the United States initiate emergency treatment including patient resuscitation at accident locations. Such treatment has only recently become available in Japan. In 1992, Emergency Life Support Technicians (ELT's) became available in Japan. ELT's can now implement emergency treatment similar in scope to that of EMT's in the United States. We expect the rate of lifesaving resuscitation and subsequent rehabilitation will improve dramatically. The triage decision making process is designed to aid in choosing appropriate health care facilities. The highest available level of medical expertise should be brought into the triage decision making process. Throughout Japan, improvements in the emergency medical care system are being made in an ongoing process. The Tokyo Fire Department in particular has made great progress in updating and improving its system. It continues to investigate possible innovations which could lead to further improvements. PMID- 10128166 TI - Developments in the delivery of emergency care in Japan and the present state of our hospital's emergency care. AB - Japan is far behind Western nations in emergency care, such as the United States where paramedics are placed under the M-ICU system and France in which the SAMU system is in force. This paper is an attempt to introduce developments in the delivery of emergency care in the Japanese rural setting and the present state of emergency care delivered at our hospitals, while checking them against national policy. PMID- 10128167 TI - The research trend of life sciences in Japanese universities based on literature database search. AB - We searched literature databases regarding the four Japanese universities that published the highest number of life science papers. The databases used in this study were MEDLINE and EMBASE. As a result, there was a 30% difference in the number of papers among the four universities. PMID- 10128168 TI - The impact of an increased number of the foreign inpatients to the rural public hospital of Japan. AB - A rapid inflow of the foreign laborers into Japan has become obvious since a couple years ago when a serious shortage of labor had to be repaired urgently. A sudden increased number of the foreign inpatients had resulted in the problems for a rural public hospital, which sought sound solutions for them. Difficulty in communication with those whose mother tongue was not English, was one of them. Though it was not serious yet, a payment for medical care they had received, had been a burden both for them and for the hospital. This was because there was not private health insurance available for them. Asymptomatic infectious disease such as pulmonary tuberculosis was another problem, for which a routine physical examination would be required before or immediately after their entry into Japan. PMID- 10128169 TI - Ultrasound in fetal diagnosis and therapy. AB - Ultrasonic diagnosis is indispensable in perinatal medicine. The applications are; 1) diagnosis of early pregnancy, 2) diagnosis of fetal life, 3) diagnosis of pregnancy weeks by fetal crown rump length, 4) evaluation of fetal growth by biparietal diameter, femur length, abdominal size, or estimated fetal weight, 5) detection of early abnormalities in blighted ovum, fetal death, hydatidiform mole, ectopic pregnancy, etc., 6) diagnosis of fetal anomalies, e.g. anencephaly, hydrocephaly, neck hygraoma, diaphragmatic hernia, congenital heart disease, intestinal obstruction, renal anomalies, obstructive uropathy, etc., 7) diagnosis of fetal diseases, e.g. hydrops fetalis, 8) diagnosis of placenta previa, hydramnios, oligohydramnios, cord coiling, excessive cord twisting, 9) detection and prediction of fetal compromise by fetal and uterine blood flow velocity wave forms, 10) further precise diagnosis by transvaginal sonography, 11) interventional ultrasound in genetic diagnosis with amniocentesis and chorionic villi sampling, fetal blood sampling with cordocentesis, 12) detection of fetal hypoxia by ultrasonic fetal monitor, fetal actocardiogram, and ultrasonic Doppler flowmetry. PMID- 10128170 TI - National statistics on multiphasic health testing (Human Dock, AMHTS)--with special reference to annual changes in the last eight years. AB - The present paper discusses the results of an 8-year nationwide survey of multiphasic health testing (MHT) since 1984, referring to the changes with time in the rates of detection of cancers and abnormalities as risk factors for adult diseases. 1) The numbers of hospitals with human dock and institutions with AMHTS answering the questionnaire increased from year to year, with a growth to match in the number of subjects receiving MHT. In 1991, the number of such subjects reached 1,730,000. 2) The relative frequencies of cancers by organs were the stomach greater than the colon greater than the lungs in each of the 8 survey years. The frequency of gastric cancer decreased by 16.7% in the 8 years, while the frequency of colonic cancer increased by 16.3% in the same period. The frequency ratio of gastric to colonic cancer in 1991 was, therefore, 10:6. The proportion of early cancers to cancers detected by MHT was nearly 80% in both gastric and colonic cancers. The high rates of detection of early cancers indicate the utility of MHT. 3) The frequencies of six abnormalities (obesity, impaired glucose tolerance, hepatic dysfunction, hypertension, hypertriglyceridemia, and hypercholesterolemia) as risk factors for adult diseases tended to decrease from year to year. However, when the country was divided into 7 districts to determine regional differences in the frequencies of six abnormalities, it was found the the frequencies of hepatic insufficiency and hypercholesterolemia, in particular, had been increasing form year to year in the northern parts (Hokkaido and Tohoku districts) of Japan and in the southern parts (Kyushu and Shikoku-Chugoku districts). 4) The results of the nationwide survey suggests that regional differences in the health conditions of the nation should be taken into consideration in implementing measures against colonic cancer and life guidance in future MHT. PMID- 10128171 TI - Building areas of hospitals in Japan and distribution of areas by department- 1980's. AB - (1) Areas of entire hospitals which have been continuously increasing in the past 30 years are finally showing signs for slowing down. The areas of the hospitals completed in the 1980's were generally 50 to 80 m2 per bed. (2) The distribution of the nursing department to the entire hospitals in area ratio ranges from 30 to slightly more than 40%, or higher than 35% in most cases. The actual areas of the nursing department has surpassed 20 m2 per bed in a considerably large number of hospitals. (3) The area ratio of the outpatient department tends to concentrate to about 12%. Of this percentage, in almost all hospitals, the proportion of the emergency division was less than 2%. (4) As in the 1970's, the diagnostic and treatment facilities were within the range of 18 to 22% in the majority of the hospitals. The distribution shifted to ratios higher than the previous survey. The distributions for the various sections are as follows: 1) Specimen test rooms 3 to 5% 2) Physiological examination rooms slightly below 1% to slightly above 2% 3) X-ray diagnosis rooms about 4% 4) Radiation therapy rooms about 1% 5) Nuclear medicine rooms about 1% 6) Operating department 3 to 5%, 2 to 3 m2/bed 7) Delivery suite less than 1% 8) Rehabilitation department 1 to 4% 9) Hemodialysis suite about 1% (5) The area ratios of the supply department dispersed substantially between 12 and 25%. About 70% of the hospitals remained in the range of 15 to 20%. The ratios of the various sections in the department are as follows: 1) Pharmacy: slightly less than 2% to slightly less than 3% 2) Central sterile and supply department: about 2% 3) Blood bank: installed in hospitals with more than 500 beds 4) Kitchen: slightly more than 2% to slightly more than 3%, 1.5 to 2.5 m2/bed 5) Laundry: less than 1% 6) Central storage and material hundling unit: about 1% 7) Mechanical plant: 5 to 13% (6) The administration department allocates 7 to 14% of its area to the management division and 2 to 6% to the welfare division. PMID- 10128172 TI - Guess who's being called on to rescue Medicaid? PMID- 10128173 TI - Would you buy malpractice insurance from these men? PMID- 10128174 TI - Rationing. What we can learn from Europe. PMID- 10128175 TI - If doctors can't die with dignity, who can? PMID- 10128176 TI - Save big on equipment and supplies. PMID- 10128177 TI - More providers make S&P's AA list. PMID- 10128178 TI - Reform to pressure hospitals--Moody's. PMID- 10128179 TI - Former Humana lobbyist Atkins to plead guilty to buying lawmaker's vote. PMID- 10128180 TI - Neb. CON review panel nixes sale of not-for-profit to Quorum. PMID- 10128181 TI - Government targets fraud in home infusion industry. PMID- 10128182 TI - Former chief halts attempt to acquire T2. PMID- 10128183 TI - Baxter's changes may benefit hospitals. PMID- 10128184 TI - Abbey to pay $197 million for Total Pharmaceutical. PMID- 10128185 TI - Federal lab probe may aid hospitals. PMID- 10128186 TI - Community Health buying Mo. facility. PMID- 10128187 TI - HHC to expand women's services. PMID- 10128188 TI - Mass. providers call off merger. PMID- 10128189 TI - 2 New Orleans hospitals to merge. PMID- 10128190 TI - Seattle system eyes affiliation with Blue Shield plan that's the largest insurer in Wash. PMID- 10128191 TI - Fla. HMOs expected to join to compete in new system. PMID- 10128192 TI - Northeast medical groups making their own plans. PMID- 10128193 TI - 2 large Miss. providers to affiliate. PMID- 10128194 TI - New IRS documents give guidance in forming systems. PMID- 10128195 TI - VA, HCFA already on 'reinvention' route. PMID- 10128196 TI - Reform, if done right, will save through efficiency, not rationing. PMID- 10128197 TI - Filling up beds no longer the name of the system game. PMID- 10128198 TI - New plan a boost for home, long-term care. PMID- 10128199 TI - Reform plan's pieces falling together. PMID- 10128200 TI - Managers see roles changing in the rush to cut hospital costs. PMID- 10128201 TI - Philadelphia hospital succumbs to its market. PMID- 10128202 TI - Kaiser, Blues team up to expand assessment program. PMID- 10128203 TI - Healthcare update ... Voluntary Hospitals of America. PMID- 10128204 TI - PacifiCare unit to boost Medicare business. PMID- 10128205 TI - Delta Airlines to develop network, clinic to keep health costs from soaring. PMID- 10128206 TI - Managed care tensions on the rise. PMID- 10128207 TI - GOP offers its own health plans. PMID- 10128208 TI - Administration campaigns for health plan as details reach, enrage providers. PMID- 10128209 TI - 2 Ohio hospitals settle false claims charges. PMID- 10128210 TI - 3 hospitals settle 'dumping' charges. PMID- 10128211 TI - Tenn. providers rip payment rates. PMID- 10128213 TI - Johns Hopkins med school 'team' to restructure physician practice. PMID- 10128212 TI - MMA to battle antitrust laws that hinder physician groups. PMID- 10128214 TI - Alliance Imaging restructuring to include layoffs. PMID- 10128215 TI - Specifics of the Clinton reform plan. PMID- 10128216 TI - New antitrust guidelines give providers a partial victory. PMID- 10128217 TI - Free for all. Shriners, Scottish Rite children's hospitals expect their mission to continue under reform. PMID- 10128218 TI - Kaiser planning to boost point-of-service options. PMID- 10128219 TI - Ore. groups hustle to form partnerships. PMID- 10128220 TI - Quality of information on plans' 'report cards' getting low marks. PMID- 10128221 TI - Wash. launches probe of state's Blues plans. PMID- 10128222 TI - Despite reform, long-term care outlook's up. PMID- 10128223 TI - JCAHO revenues, profits still rising. PMID- 10128224 TI - Methodist offers early retirements. PMID- 10128225 TI - R.I. hospital's employees await NLRB action on union elections. PMID- 10128226 TI - Warning on global health budgets. PMID- 10128227 TI - Managed care and antitrust--a guide for provider-sponsored PPOs. PMID- 10128228 TI - Executive salaries: the red herring of health care reform. PMID- 10128229 TI - The first two years. Dick Davidson talks about the AHA, health networks and reform. Interview by Mark M. Hagland. PMID- 10128230 TI - Do new trustees understand what makes health care field unique? PMID- 10128231 TI - Rural trustees join 'HIT' teams' (hospital impact teams) health reform advocacy efforts. PMID- 10128232 TI - CEO succession planning--a critical step for TQM hospitals. PMID- 10128233 TI - Hospitals reap reform's dividends. PMID- 10128234 TI - Explaining hospital costs isn't easy. PMID- 10128235 TI - Incentive compensation: rewarding the executive and the institution. PMID- 10128236 TI - 1993 HAVE (Hospital Awards for Volunteer Excellence) award winners. PMID- 10128237 TI - Designing the hospital gift shop. PMID- 10128238 TI - Breaking down barriers. Cambridge Hospital ensures access to care for diverse community groups. PMID- 10128240 TI - Health care reform for kids: why one size won't fit all. PMID- 10128239 TI - Two years ... and counting. Interview by Mark M. Hagland. PMID- 10128241 TI - Wouldn't you like to be a Pepper, too? PMID- 10128242 TI - Spiral computed tomography angiography vs. conventional angiography. Efficiency & cost factors. PMID- 10128243 TI - Malpractice insurance: a benefit or a liability? PMID- 10128244 TI - Developing a community hospital oncology program. PMID- 10128245 TI - New ultrasound technologies promote better and faster diagnoses. PMID- 10128246 TI - Health reform insight ... details of the plan in White House document. PMID- 10128247 TI - Perspectives. Medical technology: can we stop the "arms race"? PMID- 10128248 TI - Pen-based nutrition system improves neonatal intensive care. PMID- 10128249 TI - Matching marrow donors & recipients: downsized system helps save more lives. PMID- 10128250 TI - Poised for change: installing an enterprise-wide LIS. PMID- 10128251 TI - Protecting labs from spikes & dirty power. PMID- 10128252 TI - Starts & stops: lab automation takes 15 years. PMID- 10128253 TI - America's 10 most computer advanced laboratories. PMID- 10128254 TI - Links to physicians as requirements of reform? PMID- 10128255 TI - Using quality management techniques to select an LIS. PMID- 10128256 TI - Achieving the benefits of instrument-to-LIS interfaces. PMID- 10128257 TI - Guarding against glitches in LIS implementations at 34 sites. PMID- 10128258 TI - Research, outsourcing, rightsizing & reform: one vendor's expectations. Interview by Bill Childs. PMID- 10128259 TI - The shape of change to come. PMID- 10128260 TI - The use of volunteerism in indigent health care. PMID- 10128261 TI - Using incentives to motivate women to seek prenatal care: an effective outreach strategy. AB - Expanded Medicaid eligibility and case-managed care have contributed to improved birth outcomes and reduced Medicaid expenditures in Alabama. In 1990, 26.5 percent of all women delayed entry to care until the fourth month of pregnancy or later. Additionally, more than 1,000 women in the state received no care at all. In many of these cases, women perceived prenatal care as unimportant or unnecessary until later in pregnancy. As a result, the Alabama Medicaid Agency developed Healthy Beginnings, an incentive and awareness program which utilizes coupons to motivate women to seek prenatal care. Pregnant women can receive the coupon book (worth about $300) simply by dialing a toll-free number. To take advantage of the free gifts and discounts, expectant mothers must visit a private physician or health clinic and have their coupons validated monthly. The project was initiated in August, 1990, and already there is clear evidence that the use of incentives represents a viable outreach strategy to motivate poor and uninsured women to seek care. In the program's first year, more than 20,000 women received the coupons, of which 78 percent were Medicaid recipients, uninsured or in a presumptive (Medicaid) eligibility period. Focus group studies, field visits and a survey were used to evaluate the effectiveness of the new program. Preliminary data analysis has revealed that the incentive program may be a significant factor in motivating women to seek early and continuous prenatal care. PMID- 10128262 TI - Consequences of alternative programs to cover the uninsured in central southern states. AB - The lack of health insurance represents a significant barrier to timely, preventive medical services. In addition, certain providers risk financial viability as their uncompensated care burdens worsen. These issues are particularly troublesome in southern states because the population is disproportionately represented by greater numbers of poor uninsured individuals. This study examines the consequences of three alternative proposals to reduce the number of uninsureds in five southern states. Program 1 raises the AFDC income eligibility threshold to the federal poverty level. Program 2 drops Medicaid categorical eligibility requirements in favor of a poverty-level income standard. Program 3 requires employers to insure all employees, and their dependents, who work 25 hours or more per week. Surprisingly, Program 1 produces a modest 16 percent reduction in the uninsured. Programs 2 and 3, however, reduce the uninsured population by 41 and 57 percent, respectively. Nonetheless, these last two programs reach very different income groups. Program 2 captures all the poor uninsureds whereas Program 3 includes 40 percent of this same population. From this analysis it is clear that a combination of these programs would be necessary to effectively cover the uninsured. PMID- 10128263 TI - Prohibition of preventive health care: an analysis of Medicaid non-reimbursement for indigent women. AB - This paper presents a policy analysis of the impact of prohibiting Medicaid reimbursement funding for tubal ligations by indigent women, under 21 years of age. Because this population is dependent upon Medicaid funds, the freedom of self determination is limited. The current policy does not provide any alternative to the age rule, even if the patient is infected with a life threatening disease, such as human immunodeficiency virus (HIV). The policy, therefore, creates serious problems for those individuals who choose to prevent a pregnancy under certain life-threatening circumstances. As the incidence of AIDS continues to increase, the absence of an age alternative for tubal ligations will become a problem of increasing practical and statistical significance. The conceptual framework for the analysis of Medicaid nonreimbursement for tubal ligations, with respect to age demands was adopted from the work of Gilbert and Specht, 1986. Four dimensions of choice are addressed: (1) the bases of social allocation, (2) the nature/type of social provisions, (3) the delivery system and (4) finances. Although all areas will be addressed, the major emphasis will be placed on social allocation. PMID- 10128264 TI - Health promotion and disease prevention: a survey of rural family physicians. AB - Family and general practice physicians deliver comprehensive health care over time and are well suited to promote health and prevent disease. Prior studies of preventive medicine routines have tended to address a limited number of the recommended practices. The purpose of this study was to: (1) estimate the level of primary care physician compliance with the wide range of physician recommendations in Healthy People 2000: National Health Promotion and Disease Prevention Objectives for the Year 2000 and (2) identify practice characteristics associated with performance of preventive health care. Full-time family and general practice physicians, located in rural Mississippi towns of 5,000 to 10,000, were selected for the study. Of 94 eligible physicians, 81 were surveyed (73 surveys completed on site and 8 surveys returned by mail). The physicians treated a mean of 35 patients per day, with a disproportionate number of elderly patients. Limited physician time was ranked by physicians as the greatest obstacle to preventive medicine. Physicians were found to practice more preventive medicine in the adult and elderly patients than in the children and adolescents. Cancer, cardiovascular, and infectious disease risks were well addressed, with little attention directed toward occupational and environmental (e.g., lead, firearm, automobile) risks. Two practice characteristics were consistently associated with higher preventive medicine scores: an assigned preventive medicine staff member and preventive medicine flow charts. This information, obtained in a medically underserved area, may be used to assist physicians in meeting the Healthy People 2000 objectives. More research is needed to identify effective approaches for health risks that were not well addressed in physician offices. PMID- 10128265 TI - A chronic disease prevention program. AB - In a pilot chronic disease prevention program at the Hinds County Health Department in Jackson, Mississippi, 1030 patients were evaluated with yearly complete physical evaluation, Pap Smears, screening mammography, and other appropriate tests and procedures. The patients were also provided with nutritional and healthy lifestyle education. The study lasted for 3 1/2 years. It was done in conjunction with a pre-existing hypertension program. Although the benefits of the educational effort were more intangible in the relatively short period of time of the study, it is significant that mammography identified eight (8) occult breast cancers. We believe this pilot study only touches the surface of what could be done with more extensive preventive measures. PMID- 10128266 TI - Country living: rural approach to teenage pregnancy. PMID- 10128267 TI - Use of readily available data for identifying local health care needs and resources. AB - Health departments everywhere are struggling to balance shrinking resources against increasing requests for services. According to the Institute of Medicine report, The Future of Public Health, one of the barriers to solving public health problems is "... disjointed decision-making without necessary data and knowledge ..." (p. 107). Leadership of the Middle Tennessee Region of the Tennessee Department of Health have addressed this issue by developing a practical, usable data base from which to consider the needs and resources of the region. PMID- 10128268 TI - Comprehensive mental health benefits: a sound investment. AB - Mental health and substance abuse disorders are as prevalent among Americans as disorders affecting physical health; therefore, no comprehensive health reform program can be enacted that does not include coverage for mental health services. While some fear the cost consequences, benefit costs of these services have actually grown more slowly than for those of general medicine. Several changes in how mental health services are delivered and financed can ensure access under a reformed health system. PMID- 10128269 TI - Changing health needs of the elderly demand new policies. AB - As the U.S. population ages, the use of costly medical technology, especially in the last days of life, has been cited as a major factor contributing to our spiraling health care costs. Yet a growing body of evidence indicates that fewer elderly are disabled and that many survive--even thrive--after treatment of a serious illness or condition. The current debate over Medicare funding cutbacks needs to reflect the reality that high-technology care for the elderly is not inappropriate or wasteful in and of itself. In addition, policymakers should take into account the decreasing numbers of elderly people with disabilities by redirecting long term care resources toward quality community-based care, which can contribute to more timely, effective, and affordable treatment of major diseases. PMID- 10128270 TI - Taking the patient's view of health reform. AB - To many, health reform seems to consist entirely of enormous changes in how the nation's medical bills will be paid. In reality, sweeping social changes will also accompany reform, including new ways of obtaining a patient's medical history and an end to traditional barriers to health care access. Changes must be made in the nonfinancial elements of the U.S. health system for reform to make a positive difference in patients' lives. PMID- 10128271 TI - Setting the record straight--I. PMID- 10128272 TI - Setting the record straight--II. PMID- 10128273 TI - DataLine. Low U.S. vaccination rates get a booster shot. PMID- 10128274 TI - The opportunity to do better: lessons old and new from Germany's health system. AB - As the U.S. undertakes national health reform, it would do well to consider both the old and new lessons offered by Germany's century-old universal health system. "Old" principles include an explicit national policy, shared financial responsibility, universality of coverage, and structured financing. New lessons, which are more concerned with operational strategies, include societal affordability, budgets, supply side restrictions, and volume controls. PMID- 10128275 TI - Clinton asks governors for bipartisan support as health reform debate begins. PMID- 10128276 TI - New court rulings threaten managed care's restrictive hiring, contracting practices. PMID- 10128277 TI - Volunteer State joins ranks of health reform movement. PMID- 10128278 TI - Communities launch needle exchange programs to curb HIV infection rates. PMID- 10128279 TI - New Jersey insurers eye new market reforms. PMID- 10128280 TI - Small businesses' changing views on health reform. AB - Our national sample of 750 randomly chosen firms with fewer than 50 employees reveals surprising findings about the traditional views of small business on health care reform. A substantial segment of the small business community is sympathetic to health care reform, including such controversial measures as mandating that all employers contribute to the coverage of their workers, limits on health care spending, and altering the tax treatment of employer contributions for health insurance. Without premium savings, fewer than half of small businesses support the concept of health insurance purchasing cooperatives. With premium savings, a majority support it. PMID- 10128281 TI - Q & A: AHA's Dick Davidson. AB - Alabama hospitals face an array of complex challenges and questions as the nation moves toward health care reform. We recently asked Dick Davidson, president of American Hospital Association, to explain some key aspects of AHA's position on reform and how it relates to the Clinton administration's proposal. PMID- 10128282 TI - Alabama facilities seek certification to become ... baby-friendly hospitals. PMID- 10128283 TI - PC system configurations for today's MT. AB - The proliferation of high-tech, low-cost PCs has made it easier to break into the world of personal computing. There are many very satisfactory systems available for today's consumer for around $1500 to $2000. My initial hardware recommendation for a system set-up for the individual medical transcriptionist or office environment is shown in Figure 1 below. PMID- 10128284 TI - Preparing for evolving technologies. AB - It's not always enough to possess basic word processing skills--the medical transcriptionist who can work with various software applications is at an advantage in today's job market. PMID- 10128285 TI - Total quality management: cost accounting specifics. Part 2. PMID- 10128286 TI - Preliminary summary of proposed Clinton health care reform plan by House of Representatives staff. PMID- 10128287 TI - Ready to operate. AB - Clinton's plan would cover everyone. Here's how it would work and what it will cost you. PMID- 10128288 TI - Behind closed doors. AB - The inside story of how Bill and Hillary Clinton fashioned the health-care plan. Their own aides often battled over the Clintons' approach. PMID- 10128290 TI - The role of the flight paramedic in the prehospital environment. NFPA (National Flight Paramedics Association) position paper. PMID- 10128289 TI - Is air medical scene response for illness appropriate? AB - The purpose of this study was to determine the appropriateness of air medical scene response for illness. The study consisted of a retrospective chart review of a two-helicopter urban air medical transport program with a transport volume of 1,700 flights annually. During the study period, January 1988 through March 1990, 68 patients were transported by helicopter from scene of illness to a tertiary care facility. In cases in which patients could be managed appropriately locally, air transport was deemed unnecessary. Of the 68 patients with illness, 40 were males and 28 were females; the average age was 39.2 years (from a range of 0 to 93). The average transport time was 46.3 minutes. Dispatch diagnoses were cardiac arrest (20), seizure (14), myocardial infarction (8), overdose (6), stroke (5), labor (4), respiratory distress (3) and miscellaneous (8). The discharge (final) diagnosis was different from dispatch diagnoses in 10 patients (14.7%). Fifty-four patients (79.4%) required no tertiary care, and 30 of them were discharged from the emergency department or were pronounced dead there or at the scene. The results of the study indicate air medical response to scene of illness did not appear justified in this study. Transport should be local, by ground, with subsequent tertiary care being arranged as needed. Further prospective study is warranted. PMID- 10128291 TI - A comparison study of chest tube thoracostomy: air medical crew and in-hospital trauma service. AB - Chest tube thoracostomy (CTT) is not frequently performed by non-physician staffed air medical crews (AMC) due to concern regarding safety, efficiency and training requirements. This study compared two groups of patients requiring CTT, one group with insertion performed by an AMC and the other by a physician trauma service (TS) in the emergency department on patient arrival. The CTT of 172 patients managed at a Level I trauma center between October 1988 and September 1990 were reviewed. Seventy-two patients were managed by the AMC and received CTT in a prehospital setting; the air medical personnel placed the chest tube cleanly in all cases. Chest tubes placed by AMC were removed within 48 hours of transport to minimize infection risk. One hundred patients requiring CTT in the hospital setting were randomly selected from the trauma registry during a similar time span. The study compared the patients' Injury Severity Scores (ISS), and trauma scores, any placement complications and the overall mortality. While the AMC often treated patients with higher acuity, as reflected by ISS and trauma scores and overall higher mortality, the rate of complications between CTT performed by AMC and TS was similar. Appropriately trained AMC can safely perform CTT without putting patients at increased risk. PMID- 10128292 TI - The use of consumer-satisfaction surveys by an air medical program. AB - Surveys were distributed to referring and receiving hospitals or to EMS agencies that used the air medical service. The respondents were asked to evaluate the dispatcher's, pilot's and flight crew's professionalism and courteousness on a Likert scale and through written comments. Phase 1 of the survey distribution was discontinued after problems were encountered due to the distribution process. Phase 2 consisted of the air medical program mailing surveys directly to the referring and receiving facilities or to the EMS agencies. In terms of courteousness and professionalism, 90% of the respondents' answers fell within the strongly agree to neutral range. Questions regarding pilots and dispatchers were often left unanswered. Two areas were identified as needing further work on the part of the medical flight crew: follow-up with referring hospitals on patient outcome and identification of flight physicians vs. flight nurses. PMID- 10128293 TI - 1993 program survey. PMID- 10128294 TI - Preventing and controlling inadvertent IFR (instrument flight rule encounters). AB - Inadvertent instrument flight rules (IFR) encounters are some of the most harrying conditions a pilot can experience. They also result in the highest percentage of death from helicopter crashes. Yet, inadvertent IFR can be prevented to some degree, and if encountered, it can be conquered and survived. Pilots must have strong identities but also must follow strict rules as to when they can and cannot fly. Training, such as following the "four Cs"--control, climb, course and confess--and instruments can bring pilots through inadvertent IFR successfully, but legal questions remain. PMID- 10128296 TI - Data watch. A sample of cost-cutting strategies. PMID- 10128295 TI - Air medical transport literature, 1988 to 1991. PMID- 10128297 TI - Believe it or not: employees are paying less today for their health care benefits. PMID- 10128298 TI - Informal poll shows vast differences in employer spending on employee benefits. PMID- 10128299 TI - Survey: managed competition favored as a reform model. PMID- 10128300 TI - UR: from cost cutting to managing care. PMID- 10128301 TI - Looking to manage care more closely. PMID- 10128302 TI - Bringing claims administration home. PMID- 10128303 TI - More employers reject double health coverage for two-income families. PMID- 10128304 TI - What's good for business is the Clinton plan. PMID- 10128305 TI - Land of the Titans. PMID- 10128306 TI - IRS breakthrough for foundations. PMID- 10128307 TI - Making strategic choices. AB - Many decision factors enter into making the right strategic choices in today's healthcare environment. Physicians have their perspective. Hospital managers may have a different perspective. Having worked on both sides of the equation, this author suggests that the successful design of an integrated healthcare system will depend on the ability of each to understand the other's agenda. Physician needs aren't necessarily incompatible with those of an organization and vice versa. Cultural differences aren't necessarily cast in stone. If hospital managers can develop an understanding of the physicians' decision factors and tailor a program around the key issues, there will be a greater likelihood of success. At the same time, physicians who are considering an alignment with a health system will need to understand what it will take to make the organization successful. The personal futures of these physicians may be at stake once they are in an integrated relationship. Finally, integrated systems will have new decision criteria for formulating strategy. Both sides should look forward to addressing mutual interests in creative ways. PMID- 10128308 TI - Organizing to manage risk. PMID- 10128309 TI - The primary care physician shortage. PMID- 10128310 TI - Can specialists & hospitals survive? PMID- 10128311 TI - Repositioning for the coming reforms. PMID- 10128312 TI - The "clinics without walls" controversy. AB - We began this article with the report from the Washington-based Health Care Advisory Board that "clinics without walls" are a "recipe for failure". But the analysis we've done indicates that the so-called "clinics without walls" may become the single most frequent format for new medical groups throughout the country. In some markets, hospitals and physicians simply don't have a viable alternative. The "clinic without walls" concept may just be a half-way house for fully integrated groups. If it is, then failures among "clinics without walls" should be viewed as simply failures of groups to gel. They shouldn't be viewed as the failure of a model for integration. In fact, any attempts by physicians to organize in our highly volatile industry should be viewed as a positive. The organizing physicians at least have a shot at survival and are not waiting to become casualties of managed care or healthcare reform. The variations in the three models we analyzed all seem to boil down to the extent the individual physician trades independent decision-making for the benefits of the larger group structure. In the adjacent table, we've attempted to highlight key issues and the decision-making authority in each of the three models. We've also suggested objectives that can be achieved when decision making authority is delegated by the physicians to a central board and management. Very clearly, it's important to address all of the issues in the table early in forming a "clinic without walls".(ABSTRACT TRUNCATED AT 250 WORDS) PMID- 10128313 TI - Indianapolis: hospitals buy the practices. PMID- 10128314 TI - New fraud & abuse tax issues. PMID- 10128315 TI - Minneapolis: hot-bed of managed competition. PMID- 10128316 TI - The tax exempt clinic. PMID- 10128317 TI - Geisinger: in search of a common culture. PMID- 10128318 TI - New Mexico "clinic without walls". PMID- 10128319 TI - Henry Ford: after 80 years. PMID- 10128320 TI - Revolution continues in Northern California. PMID- 10128321 TI - Minnesota's integrated service networks. PMID- 10128322 TI - Models for physician-hospital integration. PMID- 10128323 TI - The Minneapolis business coalition RFP. PMID- 10128324 TI - Friendly Hills: a new concept for network development. PMID- 10128325 TI - Behind closed doors: the reform task force. AB - Other outside groups undoubtedly have influence in the reform task force process. The Jackson Hole Group is the most frequently named. The overall impression left by this internal document, however, is that the available knowledge and experience-base on these complex issues is not being used. It's not necessarily a process that everyone inside buys off on either. The March 26th issue of the Wall Street Journal reported," ... conviviality can't mask the tensions as the May deadline for the plan approaches. Although scores of House and Senate staffers are participating in the task force deliberations, they give widely different accounts of their actual contributions, and control rests with those outside Congress ... Ways and Means staffers, for example, have kept their distance. PMID- 10128326 TI - New criteria for foundation exemptions. PMID- 10128327 TI - CalPERS: "muscle-power" or health reform? PMID- 10128328 TI - Oregon: a marketplace in transition. PMID- 10128329 TI - The Clinton solution. AB - Twelve days before Bill Clinton was to address Congress and the nation, the leaked disclosure of his plan for health-care reform ignited the debate about the issue that will define his presidency. Newsweek assesses the president's plan- and looks at what it will mean for you. PMID- 10128330 TI - Back to smoke and mirrors. What the plan and Reaganomics have in common. PMID- 10128331 TI - Medicaid program; eligibility and coverage requirements--HCFA. Notice of delay of effective dates and compliance dates. AB - This notice delays by an additional 6 months the effective dates of the final rule with comment period on Medicaid Eligibility and Coverage Requirements published January 19, 1993, in the Federal Register (58 FR 4908). It also extends the compliance dates for this rule in light of the delay in the effective dates. PMID- 10128332 TI - Medicare and Medicaid Programs; quarterly listing of program issuances and coverage decisions--second quarter 1993--HCFA. Notice. AB - This notice lists HCFA manual instructions, substantive and interpretive regulations and other Federal Register notices, and statements of policy that were published during April, May and June of 1993 that relate to the Medicare and Medicaid programs. Section 1871(c) of the Social Security Act requires that we publish a list of Medicare issuances in the Federal Register at least every 3 months. Although we are not mandated to do so by statute, for the sake of completeness of the listing, we are including all Medicaid issuances and Medicare and Medicaid substantive and interpretive regulations (proposed and final) published during this timeframe. There are no revisions to the Medicare Coverage Issues Manual this quarter. PMID- 10128333 TI - Medicare program; changes to the hospital inpatient prospective payment systems and fiscal year 1994 rates--HCFA. Final rule with comment period. AB - We are revising the Medicare hospital inpatient prospective payment systems for operating costs and capital-related costs to implement necessary changes arising from our continuing experience with the system. In addition, in the addendum to this final rule with comment period, we are describing changes in the amounts and factors necessary to determine prospective payment rates for Medicare hospital inpatient services for operating costs and capital-related costs. These changes are applicable to discharges occurring on or after October 1, 1993, unless the statute provides otherwise. We are also setting forth rate-of-increase limits for hospitals and hospital units excluded from the prospective payment systems. Finally, we are implementing certain changes in the hospital inpatient prospective payment systems resulting from the enactment of the Omnibus Budget Reconciliation Act of 1993 on August 10, 1993. PMID- 10128334 TI - Medical devices; medical device distributor reporting; opportunity for comments- FDA. Final rule; opportunity for comments. AB - The Food and Drug Administration (FDA) is announcing an opportunity for public comments on the final rule on medical device distributor reporting, which is published elsewhere in this issue of the Federal Register. The medical device distributor reporting tentative final rule became final on May 28, 1992, by operation of the Safe Medical Devices Act of 1990 (the SMDA), as amended by the Medical Device Amendments of 1992 (the 1992 amendments). Although not required to do so, FDA realizes that there may be issues not previously considered, such as technical issues on specific provisions, and therefore is providing this additional time for comment. If changes are warranted by comments, FDA will make further changes in the rules. PMID- 10128335 TI - Medical devices; medical device distributor reporting--FDA. Final rule; notification of status under the Safe Medical Devices Act; confirmation of effective date. AB - The Food and Drug Administration (FDA) is announcing that the tentative final rule on medical device distributor reporting that appeared in the Federal Register of November 26, 1991 (56 FR 60024), is now a final rule by operation of law. This final rule requires distributors to submit reports to FDA and to manufacturers, of deaths, serious illnesses, and serious injuries related to medical devices and to submit reports to manufacturers of certain malfunctions that may cause a death, serious illness, or serious injury, if the malfunction were to recur. The final rule also changes the reporting standard for certain distributors that are importers, and changes the definition of the term "serious injury" to conform to a recent statutory amendment. In issuing this final rule, FDA is announcing that the tentative final rule relating to adverse event reporting requirements for distributors, including importers, has the status of a final rule, as of May 28, 1992, by operation of law under the Safe Medical Devices Act of 1990 (the SMDA), as amended by the Medical Device Amendments of 1992 (the 1992 amendments), and is setting forth the regulations reflecting those requirements. FDA is also amending the regulations, based on consideration of comments on the November 26, 1991, tentative final rule, to require distributors to register their facilities and to list their devices with FDA. PMID- 10128336 TI - Health maintenance organizations: organizational structure and services--HCFA. Correction notice. AB - This document corrects regulatory citations in the preamble of a notice of proposed rulemaking that we issued in the Federal Register on July 15, 1993 (56 FR 38170). The notice proposed to amend the HCFA regulations governing requirements for health maintenance organizations that are Federally qualified (FQHMOs) to incorporate changes made by the Health Maintenance Organization Amendments of 1988 pertaining to the definition of an FQHMO, requirements for providing physician services as basic health services, and requirements for fiscal soundness and insolvency protection. PMID- 10128337 TI - Federal employees health benefits program; coverage of temporary employees--OPM. Interim rule with request for comments. AB - The Office of Personnel Management (OPM) is issuing interim regulations to clarify the eligibility of temporary employees to continue their Federal Employees Health Benefits (FEHB) coverage when they become compensationers. These regulations are necessary to distinguish between retirement as an employee annuitant and "retirement" as a compensationer. OPM is also issuing regulations to allow temporary employees an opportunity to change health plans if their salary is insufficient to pay the premium withholdings, to show the effective date of such an enrollment change, and to provide for the termination of these employees' enrollment if they do not change health plans. PMID- 10128338 TI - Reporting health care practitioners to state licensing boards--VA. Final rule. AB - This document sets forth the policy of the Department of Veterans Affairs (VA) for reporting physicians, dentists, and other health care professionals to State licensing boards under authority of the act captioned "Veterans' Administration Health-Care Amendments of 1985" (the Act) and other authority. The intended effect of this policy is to cooperate with State licensing boards for the purpose of promoting better health care. PMID- 10128339 TI - Clinton's inscrutable health plan ... may be no one's fault but his own. PMID- 10128340 TI - Middle-of-the-road vehicle. PMID- 10128341 TI - Utilization management strategies: defining the environment and setting the stage. PMID- 10128342 TI - The global dimension of reporting. PMID- 10128343 TI - Hell hath no fury like a renegade sprinkler. PMID- 10128344 TI - Retirement community. Pricing supported by value not cost. PMID- 10128345 TI - Turmoil in the heartland. Reimbursement litigation continues. PMID- 10128346 TI - Leave of absence: who's responsible? PMID- 10128347 TI - Medicaid takes the plunge into assisted living. Cash-strapped states turn to nursing home alternative. Interview by Jim Bowe. PMID- 10128348 TI - Payments for the head of the house. 1993 retirement housing directors salary survey. PMID- 10128349 TI - Faulty building codes. Seniors housing design needs more latitude. PMID- 10128350 TI - Caring for the combative. Restraint reduction adds to the challenge. PMID- 10128351 TI - Beware of discriminatory advertising. Seniors housing providers face rigid requirements. PMID- 10128352 TI - Nutrition: at what price? PMID- 10128353 TI - Ergonomically correct lifting. OSHA cracks down on unsafe conditions. PMID- 10128354 TI - Quality of care standard for medications. PMID- 10128355 TI - The power of partnerships. PMID- 10128356 TI - Who is my community? PMID- 10128357 TI - The value and cost of hospital residency training. PMID- 10128358 TI - Workload and cost-benefit of hospital pharmacy residents. AB - The workload performed by three hospital pharmacy residents during typical clinical rotations was quantified then subjected to cost-benefit analysis. Daily activities and interventions were recorded on standardized forms for a four-week period. The cost of a resident to provide direct patient care services was compared to that of a staff pharmacist. In addition, the balance of the residents' salary and partial salaries of any pharmacists spending time with the residents were included in the cost analysis. The interventions were analyzed for their impact on patient care and potential cost avoidance by an external review committee. Collectively, more than 660 hours were recorded. Fifty-two percent of hospital time was spent on education-related activities and 32 percent on the provision of clinical services. Thirty interventions were submitted to a review panel of three physicians. Of the 90 evaluations, 76 percent were considered to have a positive impact on patient care, 22 percent no effect, and two percent a potentially detrimental effect. In one case, reviewers thought that hospitalization could have been prolonged had the intervention not occurred. Cost benefit analysis yielded a ratio of 1.4 to 1 in favour of the residents. While the major benefit of a residency program is the perceived long-term benefit to the profession and patients, this study suggests that even during their residency year, hospital pharmacy residents provide cost-beneficial clinical services. PMID- 10128359 TI - Polyvinylchloride containers do not influence the hemodynamic response to intravenous nitroglycerin. AB - In-vitro evidence of sorption of nitroglycerin (NTG) to polyvinylchloride (PVC) containers suggests that these containers may deliver less nitroglycerin to the patient than glass containers. Sorption of NTG to the PVC container may result in hemodynamic changes in the patient when a fresh solution of NTG is prepared and administered from a PVC container. This study was designed as a prospective, randomized trial to measure the hemodynamic response in patients receiving NTG in glass or PVC containers, during the first hour after a container exchange. Patients admitted to the coronary care unit in a University hospital with chest pain considered to be due to unstable angina or acute myocardial infarction were eligible. Patients who received other vasoactive drugs within one hour of container exchanges were excluded. Systolic and diastolic blood pressures, and heart rate were measured at baseline and at intervals for one hour following a container exchange. Twenty patients completed the study. There were no significant changes with time in either group (ANOVA, p > 0.05) with respect to systolic, diastolic, or mean arterial blood pressure or heart rate. No chest pain occurred during the 60 minutes following the container exchange in either group. We conclude that NTG can be administered safely and effectively in PVC containers to patients with unstable angina or acute myocardial infarction. However, it remains possible that changes in hemodynamic status could occur in patients on NTG if a change in container type (i.e., from PVC to glass or vice versa) is made during the course of therapy. PMID- 10128360 TI - Medication use patterns in HIV-positive patients. AB - Patients with HIV infection or AIDS often receive several medications for treatment or prevention of their primary disease and/or associated complications. The objective of this study was to document patterns of drug use in an HIV positive, outpatient population. Data were collected via one-on-one interviews with 26 HIV-positive patients; prescription and non-prescription drug use, adverse drug reactions and drug allergies were recorded. Anti-retroviral therapy was received by over 90 % of the patients. Over 90% of patients were on anti infective agents, commonly cotrimoxazole or dapsone, while 27% received acyclovir. At least 70% of patients used three or more prescription medications concurrently. Every patient reported self-medicating with at least one over-the counter (OTC) product and over half used three or more OTC products concurrently. Adverse reactions, mainly attributable to zidovudine, were reported by over 80% of patients. Non-compliance was a common drug-related issue; over 70% of patients omitted drug doses. In conclusion, the use of multiple medications in the ambulatory HIV-positive patients presents the health care team with potential drug-related problems that may ultimately affect the efficacy and toxicity of therapy. Thus pharmacists may play an active role in the provision of direct care to these patients. PMID- 10128361 TI - Multisite Lutheran General uses information systems to create care continuum. PMID- 10128362 TI - Don't wait for Washington: the impact of reform. AB - One of the country's top industry analysts says that predicting the timing and outcome of President Clinton's healthcare reform package is as risky as betting a year's salary on a high-stakes poker game. His best advice? Start now to build infrastructure and invest in I/T. PMID- 10128363 TI - LIS technologies must grow into the 21st Century. PMID- 10128364 TI - 'Top 10' LIS vendors jockey for position. AB - The laboratory information system market remains volatile despite a "flattening out" in overall sales, says industry consultant and analyst Sheldon I. Dorenfest. Vendors that were giants just a few years ago have been felled by smaller competitors, but no company can afford to rest easy in its current position. PMID- 10128366 TI - Laboratory products. AB - This month's HotList is one of 1993's most comprehensive listings. Laboratory information products are the focus--just in time for September's Clinical Laboratory Management Association conference. PMID- 10128365 TI - Laboratory systems failure: the enemy may be us. AB - Vendors might not always be to blame when laboratory information systems fail to meet expectations. Too often, those who use the system haven't devoted the time or resources to create a system that meets their needs, or truly learn a system that may already have all the bells and whistles necessary for success. PMID- 10128367 TI - Employee hazard communication requires actual communication. PMID- 10128368 TI - Beyond access to medical care. Pursuit of health and prevention of ills. AB - This essay expands the public discourse on reform of health care. It examines the meaning of health, societal requirements for attaining health and preventing ills, and values and goals to guide health policy reform. The essay suggests a universal model of health and development in human societies, according to which levels of health and of human development and levels of ill health and of human underdevelopment tend to reflect, and to vary with, the extent to which people can meet their intrinsic needs in the context of the social, economic, and political institutions of their societies and the dominant values that shape these institutions and their dynamics. It applies this model to an examination of health in the United States and reveals that the extent to which people can realize their intrinsic needs is limited and that their health and development are, consequently, unsatisfactory. The essay also examines implications of this analysis for policy development and advocates transformations of our social, economic, political, and cultural institutions in ways conducive to the fulfillment of everyone's intrinsic human needs. This could be achieved by enacting an Economic Bill of Rights in line with President Roosevelt's proposals and the standards of the United Nations' Universal Declaration of Human Rights. PMID- 10128369 TI - Consumer-focused data collection in prevention program evaluation. Rationale and illustrations. AB - This article presents a rationale for consumer-focused data collection at multiple points in the process of prevention program evaluation. Recommended procedures include data collection on consumer responses to various recruitment strategies and consumer preferences for specific program delivery features. Following the general rationale for use of these procedures, a summary description of their relationship with existing approaches to program evaluation is presented. Finally, illustrations of consumer-focused data collection procedures applied during several phases of an ongoing program evaluation project are provided. PMID- 10128370 TI - Experiencing satisfaction and stress as an AIDS care provider. The AIDS caregiver scale. AB - Health care workers (n = 342) completed items examining their emotional experiences working with HIV-positive patients. Factor analysis produced two subscales: Personal Satisfaction and Emotional Stress. A subset of these care workers (n = 251) claimed increased stress and depression after 6 months. In a second study, 91 volunteer AIDS caregivers ("buddies") completed the inventory and the Attitude Toward AIDS Scale. Satisfaction subscores were related to frequent contact and Stress subscores were related to length of illness of persons with AIDS. Satisfaction subscores were related negatively to prejudice towards PWA, social discrimination against PWA, and positively to pro-attitudes toward PWA. Stress subscores were related to social discrimination and punishment for PWA. PMID- 10128371 TI - The interpretation of averages in health professions research. An empirical examination. AB - A potential misinterpretation regarding measures of central tendency was identified in several health sciences textbooks presenting basic statistical procedures. The misinterpretation involves measures of central tendency derived from skewed unimodal sample distributions. The reviewed textbooks state or imply that in asymmetrical distributions the median is always located between the mode and mean. An example is presented illustrating the fallacy of this assumption. The mean and median will always be to the right of the mode in a positively skewed unimodal distribution and to the left of the mode in a negatively skewed distribution, but the order of the mean and median is impossible to predict or generalize. The assumption that the median always falls between the mode and mean in the calculation of coefficients of skewness has implications for the interpretation of health sciences research. PMID- 10128372 TI - Better performance appraisals. PMID- 10128373 TI - The vegetarian opportunity. PMID- 10128374 TI - High-tech healthcare foodservice. PMID- 10128375 TI - The flood ... foodservice directors in the Midwest test their endurance during one of the worst floods this century. AB - The summer of 1993 will be remembered as the time when record amounts of rain flooded the Mississippi and its tributary rivers, causing one of the decade's worst natural disasters. Accounts from the hard-hit Des Moines area exemplify what many foodservice operators and their staff did to help their customers and neighbors struck by the disaster. PMID- 10128376 TI - Lot quality assurance sampling for monitoring immunization programmes: cost efficient or quick and dirty? AB - In recent years Lot quality assurance sampling (LQAS), a method derived from production-line industry, has been advocated as an efficient means to evaluate the coverage rates achieved by child immunization programmes. This paper examines the assumptions on which LQAS is based and the effect that these assumptions have on its utility as a management tool. It shows that the attractively low sample sizes used in LQAS are achieved at the expense of specificity unless unrealistic assumptions are made about the distribution of coverage rates amongst the immunization programmes to which the method is applied. Although it is a very sensitive test and its negative predictive value is probably high in most settings, its specificity and positive predictive value are likely to be low. The implications of these strengths and weaknesses with regard to management decision making are discussed. PMID- 10128377 TI - HCFA revises exceptions to prohibition against reassignment of Medicare claims. PMID- 10128378 TI - Special report on health care delivery systems. Limiting anti-abortion activities at medical clinics. PMID- 10128379 TI - Auto-authentication of medical records: the risks still outweigh the benefits. PMID- 10128380 TI - Employee participation committees: a union in sheep's clothing? PMID- 10128381 TI - Solving the problem of problem employees: before and after hiring. PMID- 10128382 TI - Upgrading community also improves security at Chicago hospital. PMID- 10128383 TI - An interview with: Dale Miller on protecting health care information: the role of the security director. PMID- 10128384 TI - Interdisciplinary cooperation to combat health care violence: still a long way to go. AB - Hesitancy in the past on the part of JCAHO, AMA, ACEP, and other influential health care industry organizations to even recognize that a need for security exists is giving way to voiced concern about increasing violence directed at physicians and other health care professionals, as well as patients. However, the industry's movers and shakers still profess a hands-off approach when it comes to working together with security professionals to take specific steps to reduce violence. Nevertheless, there has been some progress, albeit slow, by physicians and other professionals in drawing on the experience and expertise of security professionals. In this report, we'll bring you up to date on the current status of interdisciplinary cooperation, including some examples of actual cooperation between security directors and two other health professionals--social workers and mental health officials--to spot persons prone to violence before they act. PMID- 10128385 TI - The attitudes toward the elderly questionnaire. PMID- 10128386 TI - The New York City shared aide program (cluster care): a model for the future. AB - In order to combat rapidly escalating home health care costs, New York City and State have inaugurated a "shared aide" program in which home attendant "teams," as opposed to individual aides, serve large groups of elderly clients who live in close proximity (e.g., at senior housing sites), thus reducing the aide-to-client ratio. Using New York City as a model, this paper examines the premises underlying the shared aide concept--the program's objectives, methodology, advantages/disadvantages to home care workers and clients, and, most importantly, its potential, if implemented nationwide, for cost containment and a corresponding substantial reduction in the Medicaid budget. PMID- 10128387 TI - Case management: opportunities for service providers. AB - The notion of using case managers to coordinate care and services to the elderly has become increasingly popular. Case management appears to be seen by some as the route to reform and rationalization of the financing and provision of services. Little systematic research can be cited in making claims for its organization, efficacy or efficiency, yet opinions in this regard abound. Research and demonstration projects provide some insights but few conclusions to support the rhetoric of case management. Case management principles are enunciated and program options flow from them. A case is made for flexibility of organization and sensibility of provision. PMID- 10128388 TI - Caregivers of frail elderly and medically fragile children: perceptions of ability to continue to provide home health care. AB - The purposes of this study were to compare the characteristics and support systems of caregivers of frail elderly and medically fragile children and to determine what factors discriminated between caregivers who could (and could not) continue to provide home health care. Caregivers of children were significantly more likely (chi 2 = 52.30)2), p = < .0000) to report that they were managing OK than caregivers of frail elderly. They also reported receiving more support and assistance from formal and informal sources, although in general, less than 30% of the caregivers received any help. Five variables (Mental impairment of the elder, poor physical and mental health of the caregiver, high monthly caregiving related expenses, and use of paid in-home assistance) explained 35% of the variance between caregivers of frail elderly who were managing OK and those who were unable to continue to manage. Six variables (physical and mental impairment of the child, physical health of the caregiver, feeling like there were no alternative providers, time demand and lack of assistance from others) explained 26.57% of the variance between caregivers of children who were managing OK and those who were unable to continue to manage. The findings suggest that a strong objective stressor, combined with a lack of personal and social resources are associated with caregivers' perceptions that they cannot continue to manage home health care. PMID- 10128389 TI - Non-profit and for-profit organizations in home care services: a comparative analysis. AB - The paper analyzes differences in the organizational, structural and strategic behavior of Non-Profit Organizations and For-Profit Organizations in Israel which provide home care services for the frail elderly. In contrast to other studies which have analyzed differences between institutions delivering various social services in the profit and non-profit sectors, this paper focuses on those organizations supplying home care services in the community. The findings suggest that NPO's have qualitative and operational advantages over FPO's. PMID- 10128390 TI - Inside looking out. PMID- 10128391 TI - Merger on the Orient Express. PMID- 10128392 TI - Hope against hype. PMID- 10128393 TI - Strategic planning for the management of biotechnologic products: development of a biotech committee. AB - Strategies and tactics for managing biotechnologic products are critical to cope with the increasing number and cost of such products. One strategy is to develop a biotech committee to formulate long-term goals for managing biotechnologic products and to evaluate controversial or extremely expensive new products and recommend their formulary status to the P & T Committee. Involvement of the P & T Committee is crucial to establish strict criteria and monitors to ensure the appropriate and cost-effective use of these products. Involvement of the pharmacy department is also essential to detect usage patterns and reimbursement profiles of approved biotechnologic products in the hospital, as well as their potential financial impact on the hospital's budget. PMID- 10128394 TI - Cost-effective management of DUE (drug utilization evaluation) policy through a pharmacy clerkship. AB - In order to maintain an active, ongoing drug utilization review program without the expense of added staff, the pharmacy department in a 554-bed county teaching hospital set up a clerkship program for fourth-year pharmacy students. The procedure for establishing the clerkship and the results of two evaluations monitored by the students are presented. PMID- 10128395 TI - Changes for the ACHE credentialing program. AB - For the first time, members of the American College of Healthcare Executives who meet specific professional and educational criteria may use the credential "CHE" (Certified Healthcare Executive) following their names. Other notable changes include the creation of the Diplomate status and regulations allowing healthcare executives direct admission into the College's credentialing program. This insert is designed to give you a brief overview of the College's revised credentialing program. PMID- 10128396 TI - An interview with the College's 1993-94 chairman. Interview by Walter Wachel. PMID- 10128397 TI - Partnership study examines roles and working relationships of board chairmen, CEOs, and medical staff presidents. PMID- 10128398 TI - When in doubt, deal yourself out. AB - Self-dealing by hospital board members is the exception, not the rule. However, all board members are likely to be subjected to internal, external, and personal forces that could influence their decision making. To protect themselves and the hospitals they govern, trustees need to take a step back and say: "Are we doing what's best for the organization?" PMID- 10128399 TI - The College's latest task force report examines new patterns in education, practice, and career development. PMID- 10128400 TI - Collaborating for the future. PMID- 10128402 TI - Grassroots involvement in healthcare reform. PMID- 10128401 TI - Avoiding sexual harassment in the workplace. PMID- 10128403 TI - Getting the most out of pharmacoeconomics. PMID- 10128404 TI - The 1970s: realignment. AB - This year marks the American College of Healthcare Executives 60th year of service as a professional society. To celebrate the occasion, the column "In Review" will be features in Healthcare Executive throughout 1993. This issue features highlights from the 1970s. PMID- 10128405 TI - CQI progress reports: the dashboard approach provides a better way to keep board informed about quality. AB - Once continuous quality improvement is under way, nearly all healthcare organizations send progress reports to the board. Typically, however, the board gets a potpourri of data--from written and oral reports of quality improvement projects to clinical outcome measurements, and customer satisfaction data. That's why top executives are trying to determine more precisely what information trustees and other leaders really need. One solution is a "dashboard" of critical indicators based on the organization's strategic plan. PMID- 10128406 TI - Disclosure of HIV status--a surgeon's responsibility? PMID- 10128407 TI - Providers beware: employer self-insured health plans may increase risk of nonpayment of claims. PMID- 10128408 TI - Standards of care: an innovative approach. AB - Clinical nutrition services at the Henderson General Division of Hamilton Civic Hospitals has taken a unique approach to standards of care. The Henderson General Division Standards of Care (HGDSC) focus on important issues in the evaluation of care including the goals, intensity and outcome of care. The HGDSC are based on populations defined by the level of nutrition care required and can easily be applied to patients with multiple medical and nutritional concerns. The standards operate under the premise that the process and intensity of care are determined by the goals of care. Thus, the standards assist in the delivery of equitable care to patients of similar nutritional risk. The goal-oriented focus of the standards is a benefit as the impact of nutrition care can be measured using the goals of care as expected outcomes. Outcome measures are considered important in the measurement of quality care since they focus on the patient's health status after intervention. The changing focus of health care in hospitals makes the identification of valid process criteria a priority for clinical dietitians. The purpose of this article is to provide insight into the unique features of the HGDSC and to explore the benefits of standards that focus on the goals and outcomes of nutrition care. PMID- 10128409 TI - Auditing the nutrition content of patient charts: one hospital's perspective. AB - Chart audits are traditionally based on patient charts categorized by disease. An alternate approach, using categorization by four types of nutrition care intervention, has been developed by University Hospital. This paper describes the process followed, criteria developed and the results of two complete chart audits. It was shown that nutrition profile forms improved documentation. Overall norms increased significantly from 81.5% to 90% (p < .05). Discussion centres on the evolutionary process from quality assurance to continuous quality improvement. PMID- 10128410 TI - Suture prices are falling. PMID- 10128411 TI - Standardization saves hospital $327,000 in cath lab supply costs. PMID- 10128412 TI - Health networks: hospitals, physicians, and insurers must get on board now or miss the train. PMID- 10128413 TI - Ambulatory care: a decade of change in health care delivery. AB - While the need to realign the continuum and change the delivery system is one of the many factors driving health care reform, it is clear that a major transformation of the delivery system is already under way and that ambulatory care and home care are at the forefront of that movement. This trend is likely to continue regardless of the pace of health reform. PMID- 10128414 TI - Health care reform and emergency department services. AB - EDs are the access of last resort for many Americans, and cost-driven reform initiatives that restrict ED utilization could deter people from seeking necessary and timely medical services. The experience in Canada under universal coverage suggests that major reform could lead to a substantial increase in ED utilization, especially in view of the relative shortage of primary care physicians in the United States. Many hospitals could face short-term overcrowding problems that compromise the quality of care provided in EDs, and rural hospital EDs face specific and unique problems relative to competition and cost efficiency. Integration of emergency services into comprehensive health delivery systems under the concept of managed competition is essential to ensure access and cost-effective delivery of services. The hospital ED may well serve as an important focal point in the development of alternative physician-hospital relationships. PMID- 10128415 TI - Primary care. PMID- 10128416 TI - Is an ounce of prevention worth a pound of cure? Disease prevention in health care reform. PMID- 10128417 TI - Health care reform in Chicago: melding global thought with local action. PMID- 10128418 TI - Ambulatory nursing: facing the future. PMID- 10128419 TI - Health maintenance organizations: critical issues raised by restructuring delivery for health systems reform. AB - In sum, the potential that managed care will grow under health systems reform creates an opportunity for the HMO industry but also serves as a challenge and a threat. Faced with greater scrutiny and growing demands, HMOs increasingly are being forced to demonstrate their potential and live up to their expectation. At the same time, the changing nature of the health care system creates a challenge for HMOs. Cost pressures create needs to review the entire delivery system, including the ambulatory component, with a focus on enhancing cost-effectiveness. Greater visibility also creates demands; growing market penetration argues for the creation of a new paradigm to define an appropriate structure for public accountability and management. Finally, the transformation of an HMO industry into a managed care industry is not without its risks as HMO performance becomes evaluated not only against itself but as part of the performance of the broader managed care industry in which HMOs have become embedded. PMID- 10128420 TI - Implications and lessons for reform. PMID- 10128421 TI - Home care prospects in an era of health care reform. PMID- 10128422 TI - Postgraduate management development. PMID- 10128423 TI - Varieties of managerial learning. PMID- 10128424 TI - Lifelong learning in health services administration: what must we do differently? PMID- 10128425 TI - An interview with Peter Vaill. Interview by Jeptha Dalston and Lawrence Prybil. PMID- 10128426 TI - Issues in management development for health services executives. PMID- 10128427 TI - Contemporary management development programs: a view from Canada. PMID- 10128428 TI - The roles and responsibilities of university programs in health administration in the provision of management development programs. PMID- 10128429 TI - Career development: a professional and personal responsibility. PMID- 10128430 TI - A perspective on management development in small and rural health care facilities. PMID- 10128431 TI - A perspective on management development in a multi-unit health care system. PMID- 10128432 TI - The relationship between strategic planning and management development. PMID- 10128433 TI - Strengthening the linkages between health care financing and health care delivery through management development efforts. PMID- 10128434 TI - Avoiding obsolescence: assessing need and shaping strategies for management development. AB - The purpose of this article is to focus on the goals of management development and to describe a variety of techniques that should be considered by health care executives in meeting their personal management development needs as well as the organization-wide needs of their institutions. Strategies for needs determination and resources available to accommodate those needs are discussed. PMID- 10128435 TI - Total quality management? Oh, we tried that, but it didn't work. PMID- 10128436 TI - Pick the right person using the assessment center process. PMID- 10128437 TI - My northern exposure. How I survived an assessment center. PMID- 10128438 TI - The face of AIDS. AB - As she reached into the car, something sharp scraped her glove, but she did not pause.... Three months later, the test came back positive. Now she's living with HIV. PMID- 10128439 TI - Sorry, proof required. The importance of documenting exposure. PMID- 10128440 TI - The San Francisco shootings. PMID- 10128441 TI - A needle through my bubble. PMID- 10128442 TI - It's a training program. What great coaches know. PMID- 10128443 TI - JEMS' 8th annual buyers' guide. PMID- 10128444 TI - The cost of depression-complicated alcoholism: health-care utilization and treatment effectiveness. AB - Clinical and epidemiologic evidence suggests that alcoholism complicated by concurrent or a lifetime history of depression is slower to remit and more prone to relapse than uncomplicated alcoholism. Consequently, alcoholics with a history of depressive illness, on average, are likely to use more health care and to have higher treatment costs than those without depression complications. This article contrasts evidence of the suitability of three models for predicting the impact of depression on an alcoholic's health-care use: a null model (assuming no differences), a cumulative-effect model (arguing for a linear increase associated with comorbid depression), and a synergistic model (wherein alcoholism complicated with depression is qualitatively as well as quantitatively different than uncomplicated alcoholism). To test these models, health-care costs and utilization of 491 "pure" alcoholics (those with no history of depression diagnosis) and 199 depression-complicated alcoholics, who received alcohol treatment while enrolled in a self-insured health-care program of a major U.S. manufacturing company, were compared. Results are discussed in terms of the implications for cost containment and the likelihood of relapse among the depression-complicated alcoholism group. PMID- 10128445 TI - A reexamination of the reported decline in partial hospitalization. AB - This study examines recent trends in the organization of partial-hospitalization services in the United States. Contrary to two recent reports describing declining support for partial hospitalization, data from the National Institute of Mental Health's Inventory of Mental Health Organizations reveal that the number of "partial-care" providers increased by 20% between 1984 and 1988, with increases occurring among privately and publicly funded programs. However, there has been a 56% decline in the average length of stay, with both privately and publicly funded programs showing proportional shifts to more acute care. An increase in the number of long-stay "day care" programs may be attributable to educational and rehabilitation programs that report as partial-care providers. Future study is proposed to create a better typology of partial-hospitalization programs. PMID- 10128446 TI - The evolution of mental health services: partial hospitalization as a case example. AB - Controversy exists regarding the current status, merits, and future of partial hospitalization. Originally conceptualized as one of the least restrictive modalities for treating acutely ill or highly impaired individuals in the community, these functions increasingly are being addressed by rehabilitation programs and assertive or intensive outpatient treatments. At the same time, third-party payers, such as managed-care firms, are extending coverage for the partial-hospital modality. We use the current debates about the merits of this modality to identify potential forces that impede and promote the evolution of mental health services. Specifically, we use this case example to illustrate four prevailing myths about the manner in which services evolve. PMID- 10128447 TI - Managed care and academic psychiatry. AB - Managed care, with its emphasis on cost effectiveness, case review, and treatment guidelines, has become a major influence on the delivery of mental health care and on the field of psychiatry. Given the importance of academic psychiatry in producing future psychiatrists and shaping their attitudes toward managed care, two separate surveys of chairs of 125 medical school departments of psychiatry were conducted. The surveys, completed in 1989-90 and 1991-92, indicate a trend toward accepting the usefulness and importance of managed care. PMID- 10128449 TI - Turnaround time, Part 1. Turnaround time down sharply, yet clients want results faster. AB - In 1980, a 3-hour turnaround time was acceptable to most clinicians. This year, according to MLO's latest national survey, they want results in closer to an hour. PMID- 10128448 TI - The 'consumer-as-provider' initiative. AB - The National Institute of Mental Health has provided funding in Region I (New England) to several technical assistance centers: the Center for Community Change through Housing and Supports (Vt.); the Human Resource Association of the Northeast (Mass.); and the recently funded National Empowerment Center (Mass.). These federally funded projects are focused on guiding the mental health field toward a more consumer-driven system. The authors have been involved with these organizations and also provide consultation along with Northern Rhode Island Community Mental Health Center (NRICMHC) staff and consumers to other counties and states on improving services for adults and children with longer-term psychiatric problems. The consulting team for NRICMHC has encountered some communities where the hiring of current or former consumers appeared to present a "quick fix" for system problems rather than a reflection of more fundamental changes in attitudes and programs. Based on the authors' personal and family experiences, as well as their work experiences, they have reexamined some of the conventional wisdoms in the rapidly evolving area of "consumers as providers." PMID- 10128450 TI - Turnaround time, Part 2. Stats too high, yet labs cope. AB - Up to 65% of respondents' workload is ordered Stat, and lab staff view clinicians and nurses as resistant to changing that strategy. MLO's national survey examines Stat necessity and utility. PMID- 10128451 TI - Using analytical tools to make big decisions. AB - How many decisions in an ordinary day do you make on automatic pilot? Here's a six-step, sure-fire way to size up any situation and make the right move. PMID- 10128452 TI - Developing a more effective training program. AB - The key is an orientation checklist of procedures that defines required levels of competency and records each level a new employee achieves. PMID- 10128453 TI - Change, Part 3. Strategies for handling imposed changes. PMID- 10128454 TI - A troubleshooting guide to quality control. PMID- 10128455 TI - Computer technology of the not-too-distant future. AB - In summary, I think we have all seen great strides made in the practice of laboratory medicine and in the sophistication of laboratory computer systems. Now we find ourselves in an era of increasing regulatory scrutiny and decreasing reimbursement, and face new data and information challenges. But I believe that laboratorians have been and will continue to be pioneers in the incorporation of information systems technology into their profession. PMID- 10128456 TI - OSHA's bloodborne pathogens standard: a review of physician office compliance after the first year. AB - In May 1993, medical practices for the first time were required to review their bloodborne pathogens programs for compliance with a 1991 standard issued by the Occupational Safety and Health Administration. The standard has a commendable purpose--to enhance the protection afforded workers exposed to potentially infectious materials. Yet its requirements have caused fear and confusion among physicians. This article details the provisions of the bloodborne pathogens standard and outlines some of the reasons physicians have found its implementation troublesome. PMID- 10128458 TI - The emerging status of practice parameters. AB - Practice parameter use has grown significantly in recent years. As discussed in this article, the development of parameters continues to expand at both the state and federal levels. It is likely that practice parameters will play a role in health care reform, although the extent of that role is not yet clear. PMID- 10128457 TI - AIDS and the health care professional: 1993 update. AB - The last several years have brought vigorous debate over the rights and responsibilities of physicians and other health care professionals afflicted with acquired immune deficiency syndrome or infected with the virus that causes it. A number of significant cases have been decided, and several professional groups have rendered opinions on how to handle this volatile issue. As the crisis grows, the law continues to evolve. This article provides an overview of the case law and professional opinion as it stands in mid-1993. PMID- 10128459 TI - Medical staff contracting: legal issues in physician-hospital arrangements. AB - This article--the third in a series analyzing the physician-hospital contracting process from the physician's perspective--addresses the legal issues involved in physician-hospital arrangements, including those arising under federal and state illegal remuneration, antitrust, and tax laws. New applications of these issues to physician-hospital organizations and practice management/practice acquisitions by hospitals are also addressed, as well as other recent hospital efforts to maximize the benefits to be gained from the physician-hospital relationship. PMID- 10128460 TI - New guidelines for physician contracts with tax-exempt hospitals. PMID- 10128461 TI - Why the medical staff as we know it will cease to exist. PMID- 10128462 TI - Assessing the risks of managed care participation: a practical analysis. AB - Given existing market conditions and the prevailing political winds, it is likely that managed care participation will become increasingly important to physicians and physician groups in the years ahead. To avoid the potential pitfalls, physicians must be aware of the business and legal risks inherent in managed care and should carefully evaluate those risks prior to entering into any proposed managed care contract. PMID- 10128463 TI - For-profits, Wall St. edgy over global caps, price monitoring. PMID- 10128464 TI - Long-term care to evolve. PMID- 10128465 TI - Fed's hand in healthcare. PMID- 10128466 TI - Premium caps, growth will strain HMOs. PMID- 10128467 TI - Top board has oversight. PMID- 10128468 TI - Extent of tort reform hit. PMID- 10128469 TI - Clinton starts reform quest. PMID- 10128470 TI - Military eyes revenues. PMID- 10128471 TI - Integration to get a boost, but systems quake at possible cost. PMID- 10128472 TI - Providers' rush to integrate is expected to accelerate. PMID- 10128473 TI - Antitrust relief seen as minimal. PMID- 10128474 TI - Drugs, technology use get extra attention in reform plan. PMID- 10128475 TI - State health officials indicate they'd like a few more answers. PMID- 10128476 TI - Plan will shift quality focus to consumer-oriented factors. PMID- 10128477 TI - Effort to boost primary care to thrust government into GME. PMID- 10128478 TI - Outpatient services viewed as cost-saver. PMID- 10128479 TI - Reform plan brings both hope, fear to rural hospital executives. PMID- 10128480 TI - Ambitious Clinton reform plan needs a healthy dose of reality. PMID- 10128481 TI - Group purchasing evolution. PMID- 10128482 TI - Clinic, system form Cleveland network. PMID- 10128483 TI - HHS unveils new, narrow 'safe harbor' regulations. PMID- 10128484 TI - Hospitals gain as employers' partners. PMID- 10128485 TI - More non-docs join medical staffs. PMID- 10128486 TI - Computers enlisted in critical care. PMID- 10128487 TI - Hallmark's $80 million issue to mark latest step in turnaround. PMID- 10128488 TI - Ukiah attorney to use new antitrust rules. PMID- 10128489 TI - Closure of six hospitals helps Community Psych post 93% jump in profits. PMID- 10128490 TI - AHA considers sale of insurance subsidiary. PMID- 10128491 TI - Consultants, attorneys expect boom as they help with reform. PMID- 10128492 TI - Hillary Clinton stumps for reform in congressional panel hearings. PMID- 10128493 TI - Primary-care docs get big raises, but pay lags. PMID- 10128494 TI - Adventist/Sunbelt to sell facility in Punta Gorda, Fla. PMID- 10128495 TI - Employers doubt reform's promises--poll. PMID- 10128496 TI - Long-term-care advocates fear cuts. PMID- 10128497 TI - Ky. hit by three suits on Medicaid cuts, taxes. PMID- 10128498 TI - AMI adds to ambulatory services; one-time charges hurt bottom line. PMID- 10128499 TI - Columbia's newest hospital opens; expansion planned. PMID- 10128500 TI - What we've learned from DRGs. PMID- 10128501 TI - Reform has a big effect in Britain. PMID- 10128502 TI - Considering the risks of change. PMID- 10128503 TI - California to bar self-referrals. PMID- 10128504 TI - Two federal antitrust decisions signify shift in industry's favor. PMID- 10128505 TI - Interest groups turning to ads to make pitch for, against reform. PMID- 10128506 TI - Hospitals post slight gains in operating margins. PMID- 10128507 TI - NME mauled over exec pacts, legal woes. PMID- 10128508 TI - Salary survey: OR managers see raises slip. PMID- 10128509 TI - ASC (ambulatory surgery centers) managers see smaller salary increase. PMID- 10128510 TI - Self-directed work teams empower staff. PMID- 10128511 TI - What to wear when going outside to smoke. PMID- 10128512 TI - Florida leading way in health care reform. PMID- 10128513 TI - Valuing cultural diversity in the workplace. PMID- 10128514 TI - A Uniform Bill 1992 group study. AB - The implementation date for the Uniform Bill of 1992 (UB-92) is October 1, 1993. The following group study--originally presented as part of the Health Services Administration graduate program at the Medical University of South Carolina's College of Health Administration and Policy and in workshops offered by HFMA's South Carolina Chapter and the South Carolina Hospital Association--is designed as an educational tool for familiarizing seasoned and novice patient accounts professionals with the many changes involved with implementing UB-92. PMID- 10128515 TI - Free-flow style stars in kitchen design awards. PMID- 10128516 TI - The warranty of sperm: a modest proposal to increase the accountability of sperm banks and physicians in the performance of artificial insemination procedures. PMID- 10128517 TI - Who's in good hands? What Clinton's health reform plan would do--and to whom it would do it. PMID- 10128518 TI - Desperate for doctors. PMID- 10128519 TI - A 'gumbo approach' to health care. PMID- 10128520 TI - Who really is it that has to bite the bullet? Firing is a form of economic homicide. PMID- 10128521 TI - The new urban healthcare coalition. PMID- 10128522 TI - Lost in space. PMID- 10128523 TI - Nuclear hotshots. Vendors explore ways to improve images. PMID- 10128525 TI - Reform seen cutting marketing's role. PMID- 10128524 TI - Marketing strategies. Part 2: Resources & targets. AB - This is the second in a series of articles concerning the marketing of a radiation oncology center. This month, we concentrate on patients and how they are influenced. PMID- 10128526 TI - Faces behind reform ... architects, innovators, movers & shakers. PMID- 10128527 TI - Privacy rights and HIV testing in the hospital setting: a medicolegal quagmire for administrators. AB - The results of HIV testing must protect public health while preserving individual rights against unnecessary intrusions. To determine whether actual risks justify mandatory testing and reporting, the best possible objective medical information must be considered. Legislators and courts must not cave in to public sentiment and fears. Courts must scrutinize HIV testing legislation carefully to ensure that the legislative history is accurate and the primary goal is concern for public health, not for discriminating or creating scapegoats. PMID- 10128528 TI - Medical waste management. Regulatory issues and current legal requirements. AB - The effective management of medical wastes poses a broad range of complex, unresolved questions. Definitions for "medical waste" and "infectious waste" must be clarified. Although news media coverage has drawn attention to aesthetic problems raised when medical wastes wash up on beaches, the possibility of significant health and environmental risks presented by such wastes must not be neglected. Many states have passed laws regulating various parts of the medical waste management process. A major new federal law, the Medical Waste Tracking Act of 1988, also has been enacted. Extensive research must be undertaken to seal existing gaps in knowledge affecting medical waste management. The public and generators of medical wastes must be educated about attendant issues and legal requirements. As further research is pursued, regulatory programs should be developed based on the best available data. PMID- 10128529 TI - Administration health official resigns to become CDC chief. PMID- 10128530 TI - Materiel management and employee safety costs. PMID- 10128531 TI - Medicare DRGs and post-hospital care for the elderly: does out of the hospital mean out of luck? AB - This article reports findings from a multistate study of the effects of medical cost containment policy, particularly the Medicare DRG (Diagnosis Related Groups) reimbursement policy, on community-based services for the elderly. The study findings reveal that since the implementation of DRGs, more older clients in poorer states of health are seeking posthospital care services. Greater client demand and illness acuity is leading to increases in service refusals to vulnerable clients and the creation of agency waiting lists. The majority of agency directors attribute the declining health status of clients to DRG reimbursement. PMID- 10128532 TI - Perspectives. The hospital role in post-discharge planning. PMID- 10128533 TI - Preparing now for OSHA's blood-pathogens proposal. PMID- 10128534 TI - Developing a formal policy for the management of blood and body fluids in an outpatient setting. AB - "Is it necessary for the average outpatient facility to develop a formal policy for handling blood and body fluids?" is a question medical group administrators have come face-to-face with over the past several years. It became clear to the author of this case study that something had to be done to ensure the safety of both his organization's employees and the patients they cared for. PMID- 10128535 TI - Body substance isolation: a comprehensive method for infection control. AB - BSI, which incorporates universal precautions, is an alternative to traditional isolation techniques. The author addresses common concerns of laboratorians and suggests ways to adapt CDC and OSHA standards to the community hospital setting. PMID- 10128536 TI - Project grants for preventive health services; sexually transmitted diseases research and demonstration--CDC. PMID- 10128537 TI - Real cause for concern in infection control. AB - All these new regulations are going to cost hospitals millions of dollars per year to comply. If we could get the doctors and nurses to just wash their hands after each procedure and to keep our hospitals cleaner (with more staff), we could accomplish a lot toward getting us out of all these new regulations. To finish, here is something for you to think about. To my knowledge (reported to APIC at its national meeting), there has been only one case of hospital acquired infection of record in the last 20 years related to the handling of infectious waste. PMID- 10128538 TI - CDC/OSHA guidelines for HIV-exposed employees. PMID- 10128539 TI - Issues at the interface of pharmacy and the law: a bibliographic review. PMID- 10128540 TI - The law of the workplace. PMID- 10128541 TI - Hospital resales of pharmaceuticals purchased at discriminatory prices. PMID- 10128542 TI - Drugs for the intentional termination of pregnancy. PMID- 10128543 TI - Direct-to-consumer advertising of prescription pharmaceuticals: strategic issues for the pharmaceutical industry. PMID- 10128544 TI - Team building: technique for strengthening the pharmacy team. PMID- 10128545 TI - Failures in organization development: a focus on change agents and their responsibility. PMID- 10128546 TI - Incineration, Part II: Regulation and politics. PMID- 10128547 TI - Strategic planning for patient-specific clinical pharmacy services. AB - Planning for the development, implementation, or redirection of new or existing clinical pharmacy services necessitates that several key issues be addressed. Managers must submit to critical subjective and objective evaluation of their departmental practices as a first step to the development of a strategic plan to meet goals for pharmacy practice. Strategic plans must address the mission of the department and clearly define the management systems and practice model that will achieve that mission. The strategic plan must be structured for the purpose of obtaining organizational commitment to the strategic goals and to the programs and resources that will allow those goals to be realized. PMID- 10128548 TI - Professional autonomy in the practice of pharmacy. PMID- 10128549 TI - Defining departmental mission. AB - Mission statements have long been recognized by corporate America as a way to define an enterprise. The necessary business orientation of the health care industry requires that hospitals and hospital departments define their scope of services and reason for existence. The accelerating reprofessionalization affecting departments of pharmacy requires the same. "Improving the quality of patient care" can no longer represent a euphemism for simply reacting to external factors or acting on a whim without clear meaningful intent. Professional departments and hospitals must demonstrate a sense of direction and purpose and be able to justify costs to a budget-conscious management and skeptical public. Mission statements are not substitutes for a clearly defined sense of professional mission. However, well-constructed mission statements contribute to clarity of departmental and professional purpose and effective achievement of goals. PMID- 10128550 TI - Managing clinical pharmacy services by integrating drug information and dispensing. AB - Managing clinical pharmacy services in the 1990s will remain a challenge. Planning appropriate services, matching resources to workload and needs, and meeting the rapid changes in hospital diversification requires substantial pharmacy management knowledge and expertise. A key step in meeting these challenges is integrating the pharmacist's responsibilities for drug information and drug dispensing. This step ensures the provision of the highest quality clinical and distributive pharmacy services. Patient care demands it. Pharmacists will achieve their full potential if drug dispensing and information are provided as one comprehensive service. PMID- 10128551 TI - Managing clinical pharmacists and clinical pharmacy services. AB - One of the ironies in the use of power in today's management setting is that the manager of workers at a high level of readiness is actually giving more power to subordinates as a leadership strategy. Indeed, the empowered manager may achieve goals by shifting responsibility from the manager to the employee, providing a vision for subordinates, providing resources when possible, and providing the freedom to accomplish organizational goals. The challenge for the manager is to determine employee level of readiness and to assess that readiness for different assignments and varying responsibilities. Given the proper situation, the manager may paradoxically gain power (influence over others) by giving others a high degree of responsibility for their actions. PMID- 10128552 TI - Developing staff into clinical practitioners. AB - Developing clinical skills in pharmacy staff is a process that can enhance the services of a pharmacy department and improve the professional development and interest of the staff. Staff should be included in the development of a clinical philosophy and a training and ongoing development program that will achieve the desired goals should be planned. An MBO process may help to track the individual pharmacist's progress. Knowledgeable, motivated staff are the key ingredient in achieving success in providing pharmacy services. PMID- 10128553 TI - Adaptive approaches to the implementation of new clinical services: a case study of neonatal ICU pharmacy services. PMID- 10128554 TI - Observations on the management of a clinical department. AB - Successful management of a contemporary pharmacy department requires a unique blend of skills. Perhaps one way to concisely describe the principal role of a manager of a clinical department is as one of advocacy. The manager must be an advocate for the patient, as a member of a clinical profession. The manager must be an advocate for the profession, in the belief that the profession has a unique contribution to make to patient care. The manager must be an advocate for the department in a hospital or institutional organization that is administratively compartmentalized and in which limited resources are available. Finally, the manager must be an advocate for the institution, having accepted the role of employee. Advocacy requires understanding the divergent points of view held by managers and professionals; the acceptably selfish interests of sick patients who are unconcerned with issues of autonomy, cost, and efficiency; and the ultimate goal of health care institutions. This is not an impossible challenge to achieve, but it calls forth the best in people who are to be successful. PMID- 10128555 TI - How to deal with AIDS in the work place. PMID- 10128556 TI - An analysis of decision making in discharge planning. AB - A repeated-measures design was used to examine medical professionals' discharge planning strategies. Physicians, residents, nurses, and social workers were presented with 16 hypothetical case scenarios and asked to: (1) rate the appropriateness of four discharge options (nursing home, community nursing, adult day, and outpatient clinic care), and (2) select the most appropriate discharge plan for each case. Four within-group variables were included in the scenarios: physical impairment, caregiver availability, follow-up required, and patient compliance. Decisions were greatly influenced by caregiver availability. When a caregiver was available, respondents preferred community-based options (i.e., community nursing care or outpatient clinic); if the case involved complications (i.e., severe physical impairment, heavy follow-up, noncompliant patient), they considered community nursing care more appropriate than outpatient clinic. When a caregiver was unavailable, respondents preferred institution-based options (i.e., nursing home or adult daycare); if there were complications, they considered nursing home more appropriate than adult daycare. PMID- 10128557 TI - Home-care agencies offer bonuses for business. PMID- 10128558 TI - Experts disagree on new AIDS guidelines. AB - A Centers for Disease Control gathering address AIDS transmission by healthcare workers, but discussion was hampered by sketchy details of the case that triggered the meeting--a dentist reportedly transmitting AIDS to a patient--and by differing opinions among the 70 health profession representatives attending. PMID- 10128559 TI - Measuring and monitoring health care. AB - The era of assessment and accountability is upon us. The health care system is being asked to measure and monitor medical care in terms that are meaningful to patients and society. Hopefully, this effort will allow us to construct a medical care system that will achieve the safe, efficient, effective, and appropriate use of medical resources in the most cost-effective and humane manner possible. Pharmacists must become familiar with the technology and terminology of outcomes measurement. Quality of life and functional status will become an integral part of our everyday practice as we expand our definition of the therapeutic goal for drug therapy. Isolated physiologic goals such as DBP or cardiac output are neither broad enough nor meaningful in terms of what our patients expect from treatment. If we have not changed their lives through the relief of symptoms, prevention of complications, and increased longevity, is it a favorable outcome? This new era creates a new set of expectations for technology assessment and standards development that has implications for pharmacy. Eddy suggests that any medical policy statement, whether in a journal, national meeting, or pharmacy and therapeutics committee be accompanied by the following information: a list of the medical and economic outcomes considered in implementation of such a policy or standards, an estimate of what will happen to the above outcomes if the policy or standards are followed, and all supporting empiric evidence for such estimates. PMID- 10128560 TI - Ensuring quality in a pharmacy department. AB - An action plan for QA can guide a pharmacy department through reappraisal of existing QA activities and implementation of a QA plan that documents the activities of the department, focuses on the patient, and meets the requirements of reviewers external to the department. The involvement of line-level personnel along with a commitment from department managers must operate in conjunction with each other to sustain the effort. Documentation should be a byproduct of activities already performed. Survey readiness should improve and very little lead time should be required for an on-site visit. PMID- 10128561 TI - Stimulating improved patient care: the Joint Commission's Agent for change. AB - Agenda for Change development and testing work now underway will lead to implementation over the next several years of improved accreditation tools: standards focused on key governance, managerial, clinical, and support activities essential to achieving good outcomes; a national database of performance indicators that helps the Joint Commission and accredited organizations monitor and improve patient care and outcomes; survey methods that better assess the organization's engagement in continuous improvement of key processes; and accreditation reports and decisions that are more informative, more balanced, and more helpful in stimulating organizational change. Creating these tools will promote more effective collaboration between the Joint Commission and health care providers in service of the mutual goal of enhancing patient care quality. Successful implementation of quality improvement ideas and methods by all health care professionals is the major challenge for the 1990s. PMID- 10128562 TI - Quality of life considerations in the treatment of hypertension. AB - Only recently have practitioners recognized the potential effects of antihypertensive agents on quality of life. Unfortunately, few studies have been conducted to assess the effects of the newer antihypertensive agents. The introduction of four first-line antihypertensive agents permits further individualization in the selection of therapy, which will minimize adverse effects and increase the potential for prescribing a better tolerated drug regimen. Until large, well-controlled, randomized studies are conducted evaluating the effect of these antihypertensive agents on quality of life, practitioners must continue to rely on factors such as mechanism and duration of action, efficacy, side-effect profile, and cost to maximize antihypertensive efficacy and patient acceptance of therapy. A practitioner's heightened awareness for the side effects of antihypertensive agents, and the subtle quality-of-life changes that they may elicit will enable them to monitor more effectively and adjust therapy as necessary. This may increase the possibility of patients' compliance with their long-term treatment and ultimately improve patient outcome. PMID- 10128563 TI - Outcome assessment: functional status measures as therapeutic endpoints for heart failure. AB - The role of measures of patients' functional status during chronic heart failure is to bridge the outcome information gap between physiologic assessments and the goal of medical care, which is to prolong the patient's life with minimal disability due to the syndrome and subsequent health care. The methods of rigorously developing and applying patient questionnaires as outcome measures will be unfamiliar to many health care providers. Many health care providers trained with different perspectives probably have an incredulous view of patient evaluations. What have we accomplished, though, if patients cannot perceive a net benefit from our services? In the final analysis, the patients' outcome assessments, collected in a systematic and unbiased manner, rather than the proxy measures used by health care providers, are the bottom line. PMID- 10128564 TI - Outcome assessment of pain: functional status measures and quality of life as therapeutic endpoints. AB - These studies and others will provide tools for cancer treatment centers to integrate pain management into comprehensive care strategies. Pharmacists in all health care settings where the cancer patient with pain is being treated should take leadership roles in the improvement of therapeutic outcomes. This leadership is essential, because drug therapy remains the mainstay of palliation. PMID- 10128565 TI - Outcome assessment: functional status measures and quality of life as therapeutic endpoints in oncology. AB - There is now agreement among most authorities regarding the need for a global measure of outcome in cancer clinical trials and guarded enthusiasm for incorporation of these. The next step--selection of existing instruments or development of new ones--appears to represent the current state of affairs. There is an urgent need for additional research into the meaning of life and health that the diagnosis of cancer generates. There are obvious dangers in relying on scales that do not reflect the patient's perception of quality of life. A number of instruments are available, and some of these are adequate in selected contexts. Poor psychometric testing and absence of evidence of predictive validity of existing or newly developed instruments may be expected to lead to false negative findings, however, when the impact of treatments on quality of life are compared. Following instrument development will be the incorporation of questionnaires into study design, which will represent a large task for many individuals. And last, but probably most important, we will have to determine how the results of QOL trials will be interpreted. The first important step towards incorporation of QOL/functional status as outcome measures in cancer clinical trials has occurred. To reach this goal will undoubtedly require a positive commitment from both medical and research staffs. PMID- 10128566 TI - Coronary artery bypass surgery: outcome assessment. AB - Improvement in quality of life following coronary artery bypass surgery is a function of a number of complex variables. This outcome, based on objective medical and subjective social criteria, must be assessed to determine the success of this financially expensive surgical intervention for management of patients with coronary artery disease. The majority of patients undergoing coronary artery bypass surgery demonstrate, at least early on, an improved quality of life. Subsets of patients have also been shown to have improved survival. With new surgical techniques aimed at improvement in flow to the areas of ischemic myocardium, even better results can be expected. Future studies will determine the extent of this improvement in quality of life over time and will serve to predict for which patients early surgical intervention will be most beneficial. PMID- 10128567 TI - Quality improvement: from theory to practice. AB - Paul Ellwood, talking about the American health care delivery system, said: "When you're spending half a trillion dollars, you ought to know what works." Given the fiscal constraints facing American health care, and given the concerns of quality erosion and the emerging technologies with their associated costs, we'd better heed his advice. We cannot beg the cost issues surrounding us. There is a cost to poor quality and we cannot afford it anymore. PMID- 10128568 TI - Pharmaceutical care and patient outcomes: notes on what it is we manage. AB - The decisions described above and the issues introduced here must be demonstrated when a pharmacist chooses to provide pharmaceutical care, or when a manager decides to create a patient-focused pharmaceutical care system for the purpose of contributing to positive patient outcomes and preventing negative patient outcomes. Indeed, it is reasonable to argue that in any pharmaceutical care system where patient outcomes are seen as the primary focus, managers are in urgent need of a rationally based pharmacotherapeutic plan that includes the fundamentals of effective, safe pharmaceutical care. Clearly, this is what they must implement, document, and evaluate in order to further develop and legitimize their areas of responsibility. PMID- 10128569 TI - Infection control: making it work. PMID- 10128570 TI - The subacute care patient: hospital responses to the challenge. PMID- 10128571 TI - Parkside to cut facilities. PMID- 10128572 TI - Should HIV-infected health workers be restricted? PMID- 10128573 TI - Managed care pharmacy service. PMID- 10128574 TI - Drug utilization review: signals for prescribers, pharmacists, and patients. PMID- 10128575 TI - Long-term care pharmacy services: a new dimension of pharmacy practice. AB - Pharmacists providing care to patients must have a commitment to quality patient care, have well-developed operations systems, possess refined clinical skills, and be able to effect excellent communication with the clinical and administrative staff. These attributes of pharmacy practice should exist in both the acute care and long-term care settings. Pharmacy practice in the long-term care setting, a unique position due to the everchanging definition of long-term care, may best be referred to as an alternative site for the application of contemporary pharmacy distribution and clinical systems for patient care over an extended period. PMID- 10128576 TI - Ethical issues associated with managed care pharmacy services. AB - The authors' purpose in raising these issues and questions is not to provide answers for the profession. We recognize that answers must be derived from a process that includes input from many individuals, and from many sectors of the profession. We also recognize that the pharmacist practicing today realizes that the health care system is changing. We believe that the code of ethics supporting our profession must be revised to reflect these changes to provide more meaningful guidance for pharmacists confronting difficult contemporary issues and dilemmas. We have tried to show that pharmacists working in the HMO setting may face unique problems that must be considered by a revised code of ethics. We are pleased that APhA has begun this process of revision. PMID- 10128577 TI - Ethical dilemmas and the hospital pharmacist. PMID- 10128578 TI - Management of pharmacotherapy: the role of pharmacy as quality assurance. PMID- 10128579 TI - Managed care pharmacy services: proactive management of costs of absenteeism and turnover. PMID- 10128580 TI - Workplace redesign: meeting the challenge of change while living within your resources. AB - It is 9 months after reconfiguration, and it is safe to say that the operation is a success. The quality of distributive service provided by the department has improved. Pharmacists and technicians report a higher degree of job satisfaction, and the dimension and quality of the clinical programs now cannot be compared with before. Future plans are to evaluate technician order entry as a means of further increasing pharmacists' time for clinical activities. This must be accomplished in a manner that ensures appropriate concurrent monitoring and screening of orders with compromising patient therapy. The department also is planning follow-up surveys that address the staff's attitudes regarding the reconfiguration. Recognizing change as a dynamic process, we plan to continue involving the entire pharmacy staff in the planning and implementation of future change. While we as managers were able to recognize the need for global change, it is our staff who helped us identify specific changes that led us to the needed skill mix adjustment. It is also essential that the staff understand that resources are limited and that is why compromise is sometimes necessary. PMID- 10128581 TI - Contracting by managed care systems for pharmaceutical products and services. AB - The health care delivery system has received criticism because of its rapidly increasing costs. In an attempt to control costs, the administrators of managed care organizations are searching for cost control mechanisms. Thus, the administrators of managed care organizations appear to be searching carefully for any alternative method to lower the cost of delivering medical care to plan members. In this environment pharmacists must be extremely careful to study the cost of providing prescription services to managed care organizations, because they will be constrained by the obligations indicated in the contractual relationship. Any decisions to provide pharmaceutical services should be studied in detail after careful discussion with administrators of a managed care organization. Only after a careful analysis should a pharmacist make a decision to offer or not offer pharmaceutical services to a managed care organization. PMID- 10128582 TI - ARC West. An addiction recovery center designed by Salsano Associates. PMID- 10128583 TI - Comprehensive Care ads don't promise easy cures. PMID- 10128584 TI - 2 agencies downgrade Lutheran General debt. AB - Lutheran General's decision to sell off money-losing substance-abuse treatment centers wasn't enough to prevent downgradings of its debt by Moody's Investors Service and Standard & Poor's Corp. PMID- 10128585 TI - Nursing practice in the next decade: the impact on nursing and pharmacy systems. AB - Nursing practice in the year 2000 will occur within more regulated health care systems, with a much higher focus on the cost and the quality of the service that is delivered. Patients will have more complex illnesses and treatment regimens that will require that nurses have appropriate levels of education, experience, and clinical specialization. The nursing work force will change in its nature, cost, and composition. Nurses will operate in flatter organizations and within productive multiprofessional and technical work groups that operate as flexible, self-directed teams. New clinical practice models will be operational, and they will be adapted to the unique work and environment of each patient care unit. Practice will be restructured to incorporate clinical and nonclinical support. Work redesign and restructured practice environments will be essential to meeting the requirements for the future. Patients with complicated illnesses will continue to move through hospital systems at high speeds. Treatment regimens will be extremely complex. The requirement will be to emphasize high-quality and affordable care, while minimizing errors and complications. Technology will provide new challenges, new excitement, new dilemmas, and new demands. The ethical dimensions of care will become ever more challenging. The pharmacological aspects of treatment will gain in prominence. Mutual respect and mutual support will be the hallmarks of the nursing and pharmacy interface in the year 2000. PMID- 10128586 TI - Communications at the pharmacy-nursing interface. AB - The next evolutionary step at the pharmacy-nursing interface is the implementation of a new patient care delivery model to enhance quality and contain costs. In addition, increasingly sophisticated biotechnology drugs and drug delivery systems will require close communication and collaborative practice between pharmacy and nursing. The effective communication interface already established will form the foundation for an even closer relationship and for working together effectively and efficiently in the constantly evolving health care environment. Indeed, regardless of what the future may hold, effective communications and resultant teamwork will continue to strengthen the achievement of patient care goals and ensure a bright future for both departments. PMID- 10128587 TI - The effective pharmacy-nursing committee. AB - The Saint Joseph's Hospital Pharmacy-Nursing Committee sees a long list of pharmacy-nursing and drug distribution system problems still to be addressed and has no worry about running out of new business. In fact, increasing controlled substances accountability, creating a more reliable and timely process for moving intravenous fluid pumps through the inpatient system, and implementing a pharmacy based, patient-controlled analgesia program across all of the hospitals' wards are three major issues now being addressed by the committee. At Saint Joseph's Hospital there is not a lot of unnecessary handwringing or undue stress over major pharmacy-nursing issues. Issues do exist, but there is also an experienced Pharmacy-Nursing Committee with a good track record of being able to resolve major issues. The committee takes on problems in a healthy and confident atmosphere of trust in both profession's skills and competencies. There is a respectful knowledge of each discipline's professional responsibilities and a full awareness that a quality patient drug system requires pharmacy and nursing elements working closely together. Wrestling with the heavy, modern-day, hospital pharmacy-nursing drug distribution system issues at this facility actually can be fun as a result of the confidence, camaraderie, and empathy that exists within the Pharmacy-Nursing Committee. PMID- 10128588 TI - Perspectives on pharmacy-coordinated drug administration programs. AB - This article has described the history, operation, and impact of a pharmacy coordinated drug administration program that existed for 20 years. It enabled pharmacy to reduce medication errors and expand its clinical role. It is not clear whether medication error rates have increased or will increase as a result of transferring this responsibility back to nursing. The clinical programs have been well established, so that their existence no longer depends on the program. Recent audit results suggest that pharmacy-nursing relations are not as good. PCUDDA programs still have a logical place in organized health care settings, particularly in view of the nursing shortage and nursing salaries. The program has clearly proven to be safe and effective and to reduce the incidence of medication errors. It is also likely to reduce cost. It is unfortunate that decisions about programs such as PCUDDA are often made on the basis of professional turf and politics rather than on patient care and economic factors, which should be the basis for such decisions. PMID- 10128589 TI - Patient education: a multidisciplinary approach to influence patient compliance. AB - The Department of Pharmacy and Nursing should collaborate on a consistent basis to proactively implement and evaluate the patient education program. Although many hospitals educate their patients, the systems can often be fragmented. Unanswered questions may include how and where the education takes place, the method of documentation, and who specifically educates the patient. Selection of the best media for educational materials requires that the broad array of printed (i.e., manuals, programmed texts, booklets) and nonprint material (i.e., videotape, motion pictures, etc.) be considered. A multidisciplinary patient education committee facilitates the program at MSKCC. Approximately 50 chemotherapy fact cards have been used at MSKCC for six years. This program has yielded positive perceptions from patients as well as from the pharmacy and nursing staff. Future trends will probably include widespread use of interactive patient education programs to provide indexing, order entry, and documentation of patient education materials. PMID- 10128590 TI - A cooperative approach to implementing automated medication distribution. PMID- 10128591 TI - Pharmacy's role within a multidisciplinary, patient-focused model for health care. AB - In establishing a good multidisciplinary practice plan at Moffitt, the most critical points have been identified as follows: The patient's primary nurse must coordinate the patient's care. Good communications and a shared medical record are absolutely crucial. A clear understanding of basic responsibility for each profession is established via credentialing, inservices, and multidisciplinary policies. Authority to create care plans and document progress and recommendations must be universal across all professions. Patients and students should be the common focus; therefore, it is the results or outcome, not who provided the service, that is important. Nursing tells pharmacy it is wonderful, because it helps them and shares a concern for the patient. Pharmacy tells nursing the same thing for the same reasons. Occurrence reports reflect a collaborative spirit, seeking to resolve patient-related problems rather than cast blame. The two groups have not become generic health care professionals, as each profession has inherent capabilities that should be used. Nor has there developed a defensiveness that will prevent a nurse from interceding in traditional pharmacy issues, or a pharmacist in nursing issues. Statistically, it is not known whether Moffitt's staff has become more effective in providing patient care; however, the members of the team believe it to be true, and the patients exhibit trust in them. The future will be uncertain in health care. A multidisciplinary approach appears essential for optimal patient care and for forecasting and managing the complex administrative and economic issues that will continue. The staff at Moffitt believe that team synergy is a necessary component of a strong future. PMID- 10128592 TI - Role changes at the pharmacy-nursing interface: Kimball Medical Center. AB - The original goals and objectives of the CST program have been realized. Medication safety, control, accountability, and utilization efforts of decentralized satellite pharmacists have been brought to fruition. A career ladder has been created for the pharmacy technician. This has enabled the Department of Pharmaceutical Services to recruit, retain, and develop an exceptionally competent and proficient technical staff. The pharmacy has earned a new found respect from the nursing division. A greater awareness of its staff's positions as drug experts and information resources has evolved. Credibility has been established for additional pharmacy programs and proposed clinical activities. Pharmacists and technicians have gained an in-depth understanding of the procedures, problems, and challenges of the nursing services, which has enabled a bridge of understanding and a common bond of team effort to be built between the two departments. PMID- 10128593 TI - A team approach to patient care in the medical intensive care units at Robert Wood Johnson University Hospital. AB - The MICU offers the pharmacist and the pharmacy technician an exciting opportunity to participate meaningfully in direct patient care. Cost containment will continue to be an important issue in the 1990s. The pharmacist must promote optimal therapeutic decision making and decrease the incidence of adverse drug reactions to get the patient better and out of the unit as quickly as possible. The pharmacist will ensure that patients receive the safest, most cost-effective therapy without compromising the quality of care. The pharmacist and pharmacy technician can collaborate with MICU nurses to create a safe and efficient flow of medications. Time management by nurses becomes much more efficient when they are able to benefit from the interactions of pharmacists and pharmacy technicians as described in this article. PMID- 10128594 TI - Creating the optimal nursing-pharmacy interface: a strategic plan for the pharmacy manager. AB - These strategies certainly do not represent an exhaustive list of the possibilities. They cover some of the major issues and reflect observed elements that exist in institutions that enjoy frequent positive interactions at the pharmacy-nursing interface. Anecdotal observations and comments confirm that in such institutions there exists greater efficiency in the drug-use process, greater job satisfaction, and better patient care than in those institutions where there are strained relationships at the pharmacy-nursing interface. The remaining articles in this issue provide specific examples to document these benefits. The pharmacy manager who makes a concerted, proactive effort to use some of the information in this article and the others to establish a positive, highly interactive pharmacy-nursing interface will experience these same rewards. Progress may occur more slowly in some institutions due to long-standing difficulties. Pharmacy initiatives may be viewed with skepticism. In these situations, actions speak much louder than words; demonstrate change (e.g., decentralization) on a pilot basis without additional resources to generate a groundswell of acceptance at the grassroots level. This will in turn contribute to a much more serious consideration of any proposal that does include increased resources or reallocation of resources (from nursing to pharmacy). No matter how difficult or frustrating it might be to implement these strategies, the potential results are worthy of the efforts. PMID- 10128595 TI - Current list of laboratories which meet minimum standards to engage in urine drug testing for federal agencies--ADAMHA. Notice. AB - The Department of Health and Human Services notifies Federal agencies of the laboratories currently certified to meet standards of subpart C of Mandatory Guidelines for Federal Workplace Drug Testing Programs (53 FR 11979, 11986). A similar notice listing all currently certified laboratories will be published during the first week of each month, and updated to include laboratories which subsequently apply and complete the certification process. If any listed laboratory's certification is totally suspended or revoked, the laboratory will be omitted from updated lists until such time as it is restored to full certification under the Guidelines. PMID- 10128596 TI - Current list of laboratories which meet minimum standards to engage in urine drug testing for federal agencies--ADAMHA. Notice. AB - The Department of Health and Human Services notifies Federal agencies of the laboratories currently certified to meet standards of subpart C of Mandatory Guidelines for Federal Workplace Drug Testing Programs (53 FR 11979, 11986). A similar notice listing all currently certified laboratories will be published during the first week of each month, and updated to include laboratories which subsequently apply for and complete the certification process. If any listed laboratory's certification is totally suspended or revoked, the laboratory will be omitted from updated lists until such time as it is restored to full certification under the Guidelines. PMID- 10128597 TI - When the doctor gets infected. Medical workers who harbor the AIDS virus may face new rules. AB - Growing public anxiety has prompted federal officials to consider a controversial shift in policy: asking medical workers to take tests for HIV infection. PMID- 10128598 TI - Directory of federal offices. AB - This Directory of Federal Offices is an aid in your endeavors to obtain information from the federal government. It will hopefully eliminate some routing from one wrong department to another. Don't surrender if you don't succeed on the first try; the federal government spends billions of dollars on healthcare research and produces volumes of extremely valuable information. You simply need the secret to getting through the federal maze, and the information is yours. This directory lists major departments and offices, followed by their specific areas of expertise. It should help get you going in the right direction. PMID- 10128599 TI - Perspectives. AIDS & health workers: CDC's thorny dilemma. PMID- 10128601 TI - A rural hospital closure revisited. PMID- 10128600 TI - Developing and evaluating a departmental universal precautions policy. AB - Universal precautions have been proposed by various organizations, and are now being enforced by the Department of Labor's Occupational Safety and Health Administration (OSHA). This article is designed to serve as a guide for the radiology manager in implementing universal precautions. PMID- 10128602 TI - Hospital Infection Control Practices Advisory Committee; establishment--CDC. Notice of establishment. PMID- 10128603 TI - Using drug-usage evaluation to improve drug use. AB - Quality and the issues that surround its assessment and accountability are complex matters requiring thoughtful analysis and action. The translation of concept into practice evades most practitioners, because the detail of how to accomplish the transition has been missing. Drug-usage evaluation may not be the ultimate answer. The concept has inherent limitations. However, well constructed, systematic DUE programs that focus on enhancing patient care, establishing effective communication networks, and containing constructive intervention methods can help improve drug use. Drug-usage evaluation can be an important link between process and outcome evaluation. For pharmacists, DUE is an opportunity to use their expertise and existing clinical practice to begin to develop a pharmaceutical care system. Drug-usage evaluation is a step in the right direction. The profession should move decisively to play an active role in improving patient outcomes. PMID- 10128604 TI - Organizing for drug-usage evaluation. AB - Because QA is the chief interest of the Joint Commission, hospital pharmacists must strive to have a well-organized DUE plan and process. However, merely satisfying a Joint Commission surveyor is not a good enough reason to invest in the DUE process. DUE is deceptively complex and labor intensive for hospital and medical staff alike. A better reason to plunge into DUE is to enable pharmacists to concurrently monitor pharmacotherapy, to intervene on behalf of patients, and to positively affect patients' therapeutic outcomes. Thereby, DUE really fits pharmacy's responsibility for pharmaceutical care. PMID- 10128605 TI - Collaborating with physicians in the drug-usage evaluation process. AB - The Joint Commission requires that DUE be performed by the medical staff with pharmacy department participation. To gain physician acceptance of the DUE process, it must be promoted as a means of ensuring quality care and improved patient outcomes, employing an educational rather than punitive approach. Peer interaction is the ideal method to enforce and reenforce desired practices. The pharmacy department can play a major role in ensuring appropriate prescribing practices by reporting information, serving as an educational resource, facilitating physician participation, and overseeing the DUE process. PMID- 10128606 TI - A departmental model for drug-usage evaluation. AB - Using the departmental approach, the DUE process has been streamlined to involve one pharmacy discipline (e.g., etomidate, adult surgery), two or more disciplines (e.g., gamma globulin, adult medicine and pediatrics), or all disciplines (e.g., parenteral ranitidine evaluation) based on the extent of the drug-usage problem. The following advantages have been realized as a result of the departmental approach to DUE: the ability for all staff pharmacists to have input in the direction of the DUE program. At the Clinical Pharmacy Committee meetings, all pharmacists are given the opportunity to recommend drugs for usage evaluation. When a number of drug-usage problems are identified, DUEs are prioritized based on the workload of the pharmacists and the scope of the potential drug-use problem. the provision of service-specific evaluations of drug therapy. In addition to meeting the Joint Commission's regulations for DUE, these evaluations allow for each service to examine its individual compliance with the established standards. Service-specific action plans can then be developed to correct any deviations from acceptable practice. the ability to focus the evaluation on those patient populations primarily affected by the potential drug-use problem. the ability to maintain a systematic, ongoing DUE program while maintaining a service specific approach to pharmacy practice. The satellite pharmacists have developed specialty or division-specific practices in pediatrics, adult medicine, or surgery. Using the matrix approach, pharmacists can contribute to DUE while maintaining a specialty practice. PMID- 10128607 TI - Cooperative approaches to medication error management. PMID- 10128608 TI - A systems approach to the problem of missing medications. AB - Overall, the systems approach employed in this study has significantly decreased the frequency of missing medication requests on one pharmacy satellite by 38 percent. The most dramatic impact came from the systems-change phase of the study. While the pharmacy personnel-change phase did not contribute to the overall reduction in missing medications, there was a large decrease in missing medications due to discrepancies between the nursing MAR and the pharmacy profile. This study has prompted further investigation into the p.r.n. drug distribution subsystem. PMID- 10128609 TI - Drug-usage evaluation in the community hospital. AB - All hospital pharmacists can contribute to their medical staff's responsibility in completing effective DUR. The means available and practice environment for each setting will dictate specific methods to successfully complete DUR. It is not always necessary to have the most advanced systems or automated technology to make an impact on a DUR program. Often a simple, common sense approach to DUR can produce surprisingly effective results. PMID- 10128610 TI - Limited resource approach to drug-use review. PMID- 10128611 TI - Drug-usage evaluation: traditional versus outcome-based approaches. AB - The use of outcome assessment with DUE can provide more detailed information on the impact of drug therapy on the overall health status of the patient, rather than just the narrow view of the drug-prescribing process within the institution. These studies may justify additional pharmacists to help in the selection of drugs and their potential to affect overall quality patient care. In addition, the Joint Commission is recommending that measurement of health outcomes is important in QA. The Joint Commission has stated in their Agenda for Change program "that patient outcomes are influenced by all activities of a health care program." The Joint Commission plans to develop standards that "describe in functional terms what the key jobs are that need to be done to produce good patient outcomes." The major problem with adding outcome measures in the assessment of DUE programs is the evolutionary nature of the available technology to measure these patient outcomes. Incorporation of outcome measures into DUE programs can provide measures of the impact of drug therapy on the patients' HQOL. This HQOL is potentially a better reflection of patient outcomes and the assessment of quality of care. PMID- 10128612 TI - AIDS rules show political side of ethical intentions. PMID- 10128613 TI - Health care groups debate curbing workers with HIV. PMID- 10128614 TI - Prospective payment system and other effects on post-hospital services. AB - The effects of the prospective payment system and other factors on the use of post-hospital services were investigated for four groups of diagnostically related Medicare discharges. Effects on specific services and total Medicare payments were analyzed at the beneficiary level using a Tobit regression technique. The utilization data base consisted of more than 30,000 discharge episode records for the years 1981-86. The post-hospital period for each Medicare beneficiary encompassed the 60 days following discharge from the hospital. Influences on both the level and timing of health care services during this period were appraised. The influence of the prospective payment system was measured through the financial impact and risk that it imposed on the discharging hospital. PMID- 10128615 TI - Providers walk a two-way street on the issue of blood-borne diseases. AB - All health care professionals involved in invasive procedures should be mandatorily tested for the human immunodeficiency virus (HIV) and chronic hepatitis B, and make their status known to their patients, this infectious diseases specialist says. PMID- 10128616 TI - The CDC guidelines. Interview by C. Burns Roehrig. AB - The chairman of the National Commission on AIDS provides her observations on the recent Centers for Disease Control conference on AIDS transmission between health care workers and patients. PMID- 10128617 TI - HIV-infected health workers: how should we proceed? AB - Mandatory testing may seem to be a solution at first glance, but many thorny and problematic issues could arise in the long run. Instead, more emphasis needs to be placed on maintaining the highest standards of infection control practice. PMID- 10128618 TI - Health care groups show opposition to mandatory testing. PMID- 10128619 TI - Infected physicians: what are the ethical and legal standards? AB - The law addressing the area of physicians infected by blood-borne diseases is very new and sometimes vague. It remains important, though, to ask how patients can be protected from real risks without excluding competent and safe practitioners. PMID- 10128620 TI - Adequacy of discharge plans for elderly patients. PMID- 10128621 TI - New York Times offers unofficial glimpse at draft CDC guidelines on AIDS testing. PMID- 10128622 TI - Panel sees no need to revise HIV practices. PMID- 10128623 TI - Waves of protest greet review of AIDS guidelines; panic, privacy and protection of patients cited. PMID- 10128624 TI - Fine-tuning the key notes. PMID- 10128625 TI - The HIV-infected clinician: to exclude or not to exclude? PMID- 10128626 TI - The destination and dependency of patients discharged from care of the elderly units in the West Midlands. AB - Between November 1988 and January 1989 a prospective survey was undertaken on patients aged 65 years and over who were discharged from the care of geriatricians in seven District General Hospitals. The survey aimed to provide a regional perspective on patient dependency by relating dependency at discharge to the discharge destination. The findings show that the majority of patients were relatively independent and most returned home. A significant number of the very dependent patients were discharged to the community with private residential and nursing homes making an important contribution to the placement of highly dependent patients. PMID- 10128627 TI - CDC gathers opinions on HIV restrictions. No mandatory worker testing, health groups say. PMID- 10128628 TI - Psychiatric services in a managed care world. PMID- 10128629 TI - Controversy brews over guidelines for AIDS-infected health care workers. PMID- 10128630 TI - Health Concepts trimming rural, outpatient services. PMID- 10128631 TI - Practice guidelines and drug-usage evaluation. AB - Currently, there is a great deal of interest in the development of practice guidelines for medical care that will be more rigorous and clinically sound than what is available today. With the impetus of federal legislation mandating such an approach, it may continue to develop into a significant movement in the medical arena. Pharmacy managers should be aware of developments in this area, particularly as they relate to appropriateness of drug therapy and drug utilization review. The result may eventually be an evolution from drug utilization review programs to diagnosis-based, outcome-focused interdisciplinary systems for QA. Even with the development of practice guidelines as described, there will continue to be a need for competent pharmacy practitioners to ensure appropriate pharmaceutical care. With the increasing acuity of patients in the health care system and the rapid development of new drugs and technologies, the role of the institutional pharmacist in ensuring optimal patient care will be more important than ever. PMID- 10128632 TI - A novel comprehensive DUE program--five years of experience. AB - A comprehensive program has been developed to evaluate prescribing practices in diverse drug therapy categories and in all areas of the institution. Input for topic selection comes not only from the pharmacy department, but also from QA, medical staff, and nursing. The development of monitoring criteria and review of the results by the P&T Committee, Medical Executive Committee, and other key medical staff members, promotes ownership of the program by the medical staff. The benefit of this ownership is active support for the program and participation in peer review. Overall, the results of this cost-effective program include limited use of broad spectrum antibiotics, select prescribing of high-risk drugs, and focused educational efforts to improve quality of patient care. The primary goal for the future of the program is to develop criteria and documentation mechanisms for reporting measurable clinical outcomes. In making the transition, it is important to use the success and impact of the current program as the foundation. This is particularly true for the concurrent monitoring program and its immediate feedback mechanism. The major challenge will be evaluating negative clinical outcomes and developing corrective actions as well as documenting the positive outcomes and the avoidance of negative outcomes of the current program. To meet this challenge, the DUE program must be integrated with all other institutional QA programs. Although a difficult task, this is a significant yet necessary step in the right direction for assuring optimal patient care. PMID- 10128633 TI - Drug-usage evaluation and the patient-care pharmacist: a synergistic combination. AB - The Joint Commission requires a continuous monitoring program to assure quality pharmaceutical care. The only way to achieve compliance with this standard is to enlist the help of the patient-care pharmacists. Equally important to the pharmacy manager is the way a DUE program can benefit the patient-care pharmacists. The key to an effective program is to assist the patient-care pharmacists in taking responsibility for the quality of drug therapy provided to their patients. Through education, encouragement, and recognition, the DUE Coordinator can elevate the practice of the patient-care pharmacists. The outcome is a synergistic program that enriches the practice of the patient-care pharmacists who, in turn, enrich the quality of pharmaceutical care received by their patients. PMID- 10128634 TI - Use of computerized databases for drug therapy quality management. AB - Although this paper has focused primarily on use of hospital-based databases for DUE purposes, the defunct Medicare Catastrophic Coverage Act did have provisions for ongoing prospective screening for drug interactions and adverse reactions among community Medicare prescriptions. The key to the proposed system was a point-of-service system that would have linked all Medicare pharmacies to a centralized database. This database would have been used for claims processing as well as quality management purposes. Many DUE functions at this time involve labor-intensive retrospective reviews that do not directly benefit or protect the particular patient involved. The future direction of DUE activity is concurrent screening that actively protects the patient from inappropriate prescribing. Use of computerized databases to assist in that process is a necessity. PMID- 10128635 TI - An adverse drug reaction reporting system as an integral part of a drug-usage evaluation program. AB - The Adverse Drug Reaction program at CSMC identifies patients whose charts have been encoded with an ICD-9 code of E930 through E949, inclusively. Incidences per drug or drug category have permitted the Department of Pharmacy, acting through the Pharmacy and Therapeutics Committee, to review patient charts, identify trends and risk factors, and subsequently develop usage criteria for DUE studies. It is hoped that these activities will result in an improvement in usage of these drugs and a reduction in adverse drug reactions to them. PMID- 10128636 TI - Drug-usage evaluation: a system for the prospective evaluation of antibiotic utilization in minimum inhibitory concentration documented infections. AB - Large hospitals appear to have advantages in using specialized clinical practitioners to provide prospective reviews on drug therapy. Using the PRMC pharmacy service as a model, a prospective DUE program can be duplicated in small hospitals with four or five fulltime pharmacists. The minimal requirements are a microbiology laboratory, administrative support, and a pharmacy service committed to providing prospective patient oriented care. PMID- 10128637 TI - Integration of drug-usage evaluation with a quality assurance program. AB - "If it ain't broke, don't fix it" is a classic quote that is still heard. Although health professionals strive for continuous improvement in the understanding, prevention, and treatment of pathology, they commonly ignore the system for health care delivery. DUE provides an effective mechanism for continuous examination of the system and improvement of patient outcome as it relates to drug therapy. The movement toward integration of DUE and clinical profiles will bring the Medical Center closer to realizing the ultimate goal of total quality care. PMID- 10128638 TI - Clinical strategies in drug therapy selection: an application of "counter detailing". AB - These projects have realized significant control of drug costs while also serving as a basis for future project implementation. In general, communication through the P&T, medical department heads, and senior hospital administrators has positively impacted on the ability to achieve these cost savings. The forms of communication have incorporated written and posted information along with oral presentations for the purposes of enhancing positive and progressive service in the cost-efficient delivery of pharmacotherapy. PMID- 10128639 TI - A survey of current operations and future plans for ambulatory pharmacy services. AB - Survey results indicate that the number of hospital-based ambulatory pharmacies in the survey area is increasing substantially. By the end of 1989, there would have been a 71 percent increase in the number of hospitals providing ambulatory pharmacy services in this region. This assumes that those hospitals in the planning stages of developing ambulatory pharmacy services completed their plans. While the number of hospital-based ambulatory pharmacies is on the rise, there has been a concurrent increase in the number of services provided by the pharmacies already in operation. There has been a 38 percent increase in the number of services provided by these pharmacies since the inception of DRGs. The services that have been added are primarily specialized services including home TPN compounding, intravenous antibiotic compounding, intravenous chemotherapy compounding, medical supplies, and durable medical equipment. It is likely that these services will continue to increase in the coming years as home therapies continue to become more advanced. The study also indicates that most hospital based ambulatory pharmacies in this region are operated as nonprofit entities. A trend toward for-profit pharmacy operations was anticipated, and this is still anticipated as more ambulatory pharmacy operations become separate entities from inpatient services. Future studies of this type should monitor this possible trend. Most hospital-based ambulatory pharmacies are owned by the hospital or a hospital affiliate. More than half of respondents reported their ambulatory pharmacies are located within the inpatient pharmacy of the hospital. As the trend toward separate ambulatory pharmacy operations increases, it would not be unusual for the pharmacies to be operated by for-profit affiliates of the hospital or outside contractors. Barker predicts that hospital-based ambulatory pharmacies could become units of major drug store chains in the future. This is another area that is worthy of future studies of hospital-based ambulatory pharmacy operations. Overall, the results of this study indicate that hospitals in this region have not remained static since the inception of DRGs. There seems to be a dynamic period of change evolving in the delivery of health care services in this region. The demographic section of this study reveals that the majority (more than 70 percent) of the hospitals surveyed are operating fewer numbers of beds for inpatient services since ther inception of DRGs. The length of time that patients remain in the hospital for inpatient services is decreasing, resulting in decreased demand for inpatient beds.(ABSTRACT TRUNCATED AT 400 WORDS) PMID- 10128640 TI - More about needlesticks. PMID- 10128641 TI - After-care phone calls to patients improve care and public relations. PMID- 10128642 TI - Case management approach at St. Peter's gives patients a "care manager". PMID- 10128643 TI - State legislatures consider bills dealing with HIV-infected health care providers in face of CDC inaction. PMID- 10128644 TI - CDC issues voluntary HIV-testing guidelines. PMID- 10128645 TI - Hospital asks HIV-infected physician to resign. PMID- 10128646 TI - Update: exposure to aerosol pentamidine. AB - Pentamidine, a drug administered in aerosol form to AIDS patients suffering from Pneumocystis carinii pneumonia (PCP), has come under heavy fire from hospital unions and others of late. Pentamidine presents a twofold occupational risk: first, there is exposure to the drug itself, which, according to many healthcare workers, is a respiratory irritant with potential long-term consequences; second, there appears to be some evidence that working in pentamidine therapy areas increases the potential of exposure to respiratory pathogens, especially tuberculosis (TB). PMID- 10128647 TI - Rent flap leads to bankruptcy court. PMID- 10128648 TI - Public opinion about AIDS before and after the 1988 U.S. government public information campaign. AB - In October, 1987, the Centers for Disease Control mounted a massive public information campaign to alert the public to the dangers of AIDS and to provide information about its transmission and prevention. Using data from two Gallup surveys, one just before the campaign began and the other several months after its conclusion, we examine changes in public information and misinformation about transmission, in concern about AIDS as an epidemic, and in reported behavior to avoid exposure to AIDS. We conclude that although some changes in knowledge did take place, these were essentially a continuation of trends beginning before the public information campaign and continuing well after its conclusion. For these and other reasons, we argue that the effects of the campaign on public information were minimal. However, between 1987 and 1988 there was a small but statistically significant increase in reported condom use, an increase paralleled by increased condom sales between 1986 and 1988. In addition, there was a substantial increase in the number of people expressing concern about AIDS as an epidemic for the population at large. The campaign may well have contributed to both of these changes. PMID- 10128649 TI - Should you worry about getting AIDS from your dentist? PMID- 10128650 TI - Long-term care consortiums set the pace in Pennsylvania. PMID- 10128651 TI - The forgotten benefits of nursing home placement. PMID- 10128652 TI - Manawatu-Wanganui Area Health Board. PMID- 10128653 TI - CDC advises restrictions on exposure-prone procedures. PMID- 10128654 TI - Gaps in endoscope reprocessing practices. PMID- 10128655 TI - Microcomputer software needs for home care services: similarities to and differences between hospital inpatient systems. AB - A home care computer system and database manager designed specifically for the needs of home care are needed in a time when documentation requirements are many and qualified personnel are few. Home care software allows these clinicians to provide consistent data, minimize mathematical errors, handle the complex reimbursement system, and maximize the efficiency of the organization's professional, administrative, and clerical staff. Good quality patient care and time management are critical to providing high quality, cost-effective, parenteral therapy home care in the 1990s. This system and the user training program are designed to accommodate both the experienced home care provider and the novice, inexperienced provider. The Specialized Clinician also carries out reimbursement, thus eliminating the major cause of failure of inexperienced start up home infusion care programs. PMID- 10128656 TI - The development of an order processing and communications system: the developer's perspective. PMID- 10128657 TI - Nonprogramming relational database primer: a case study--pharmacist intervention audits. AB - Using a database product has never been easier. The above example may appear to be complicated, but the Alpha Four software program guides you at every step. You have to decide what you wish to accomplish, then set up the program to handle the task. Alpha Four (or any other nonprogrammable relational database) can also be used for formulary management, investigational drug accounting, personnel management, inventory, purchase order requisitions, etc. Some drug distribution systems provide access to the patient records and clinical information. If you learn how to operate a database manager, you can create reports that may not be available from the vendor. Computers have reduced the workload required for drug distribution. The future of pharmacy practice is headed toward a highly automated setting. New roles for the pharmacist may include the provision of information from the point of admission to discharge and possibly continued follow-up. This will all be an automated process with the pharmacist as a key resource person. If you do not learn how to control the computer systems you work with, they will eventually control you. You do not have to be an expert to learn how to use a database application. If computer applications are not already part of your professional responsibilities, they soon will be. PMID- 10128658 TI - QARx: the quality assurance prescription. AB - The QARx program provides the necessary tools for organizing and effectively implementing a quality assurance program for a pharmacy department that truly offers the ever-elusive potential for creating an environment that promotes on going quality improvement for the department. Eventually there will be a plethora of criteria sets available so that a pharmacist will be able to just choose the pertinent indicators from the shelf (if you choose not to create your own). There is an option to import criteria sets from the utilities menu, and the availability of pertinent sets should provide an attractive option for actually selecting certain readily available sets of indicators, monitors, and outcomes to be automatically imported into your existing quality assurance plan. This program is a must for any department manager trying to organize and orchestrate an effective quality assurance program in a health care institution. For more information about QARx, contact the American Society of Hospital Pharmacists, Special Projects Division, 4630 Montgomery Avenue, Bethesda, MD 20814, (301) 657 3000. PMID- 10128659 TI - Hospital pharmacy computer applications. PMID- 10128660 TI - Facsimile machines for medication order transmission. AB - The use of facsimile machines for medication order transmission has improved turnaround time and provided benefits for the Department of Pharmacy Services and the hospital. As a result of this program pharmacists have more time and more opportunities to improve drug therapy because they no longer have to travel to patient care units or handle patient charts for the purpose of order entry. Pharmacists will have even more time when technicians have been fully trained to carry out medication order entry. Important also is the ability for nurses to FAX rather than hand carry urgently needed orders to the pharmacy satellites. The use of FAX machines in this manner lowers the cost of patient care and makes this technology available for other purposes as well. It is becoming increasingly clear that pharmacists, as well as others, can utilize modern technology such as this to maintain and improve services in the presence of a cost-containment environment. PMID- 10128661 TI - Legal and ethical issues in the practice of reuse. PMID- 10128662 TI - Recommendations for preventing transmission of human immunodeficiency virus and hepatitis B virus to patients during exposure-prone invasive procedures. Centers for Disease Control. AB - The Governor's Subcommittee on AIDS has prompted the periodic publication of articles in the Bulletin in an effort to broaden surgeons' understanding of this significant health problem. The availability of information related to this disease has expanded significantly in recent years, and those in the health care profession have been able to assimilate this information and deal realistically with the problem as it begins to fall into proper perspective. We recognize that much information is not yet available and that, therefore, rational decision making is limited by lack of data. Unfortunately, the disease continues to stimulate undue sociopolitical interest as witnessed by the recent action taken by our national Senate, by media attention, and by public reaction to this attention. Thoughtful insights and decision making have not been hallmarks of the current scene. Following are the long-awaited "Recommendations for Preventing Transmission of HIV and Hepatitis B Virus to Patients During Exposure-Prone Invasive Procedures," which were released recently by the Centers for Disease Control, Atlanta, GA. The recommendations are being criticized by some individuals as being either too limited or too excessive. They bear heavily on surgeons, and on the medicolegal climate in which we practice. No matter how you regard the CDC recommendations, we all recognize the universal precautions must be emphasized and followed. The ACS Subcommittee on AIDS is formulating recommendations to be made to the Board of Regents at our 1991 meeting in October. Your comments would be welcomed. PMID- 10128663 TI - Women & HIV/AIDS in the United States. ACT UP Women's Network. AB - Women are one of the fastest-growing groups of people infected with HIV. Because the Centers for Disease Control's classification of AIDS does not recognize women specific HIV-related opportunistic infections, however, women are not accurately represented in national statistics. Consequently, they are virtually excluded from AIDS clinical research. PMID- 10128664 TI - HIV liability & disability services providers: an introduction to tort principles. AB - Mental health and developmental disability services providers are concerned that liability issues regarding worker and client exposure to HIV have not been adequately addressed. By developing policy specifically in the areas of education, infection control practices, and confidentiality, providers may minimize findings of liability and protect patient rights. PMID- 10128665 TI - Health care professionals with AIDS: public health or public relations concern? AB - Testing--whether voluntary or mandatory--for HIV among workers is one of the biggest concerns at this time in the health care industry. While most health officials and governing bodies agree that the risk of transmission from worker to patient is negligible, many believe that voluntary testing is beneficial. The question is, beneficial to whom--the patient, the worker, or the employing agency or facility? PMID- 10128666 TI - 7 Parkside centers sold or shuttered. PMID- 10128667 TI - Grappling with CDC guidelines for HCWs. PMID- 10128668 TI - Isomorphism and external support in conflicting institutional environments: a study of drug abuse treatment units. AB - Using institutional theory, we developed predictions about organizational units that moved from an environment making consistent demands to one making conflicting demands. Many community mental health centers have diversified into drug abuse treatment. The units providing those services face conflicting demands from the traditional mental health sector and the new drug abuse treatment sector about which clients to serve, how to assess their problems, and who should provide treatment. We propose that in response to such demands these units will adopt apparently conflicting practices. Also, isomorphism with the traditional sector will be positively associated with external support from parent mental health centers and other actors in the mental health sector. Results generally support those predictions. PMID- 10128669 TI - Politics and poker--two game plans shape up in AIDS-control strategy. AB - A line from the song 'Politics and Poker,' from the Broadway musical Fiorello, goes: 'Neither game's for children, either game is rough. Decisions, decisions, like who to pick, how to bet, how to play, how to call a bluff.' Events in recent months, leading up to and following the release of CCD's recommendations for preventing transmission of HIV to patients by health care workers, can be characterized as a nation playing both games in trying to deal with undefinable or unexplainable risks of AIDS transmission. The nation seems split between those who favor politically astute (though not necessarily logically or ethically sound) solutions, and those who believe that HIV-infected practitioners must make decisions on testing, disclosure, and changes in practice based on a rational assessment of each individual case--factoring in the odds of viral transmission, the chance of losing a career, the interpretation of risk, adherence to stringent infection control technique, timing, patient confidence, and peer support. Ether one is a gamble. This special issue of Hospital Ethics takes a look at the politics and poker of AIDS testing and disclosure, with special attention to the kinds of advice being offered to hospitals as they develop policies on infected health care workers. PMID- 10128670 TI - AIDS fears spur proposals to protect patients, healthcare workers. PMID- 10128671 TI - HIV guidelines 'flawed'--surgeons. PMID- 10128672 TI - Operational changes help Mediplex's profitability. AB - After regressing under the control of Avon Products, the Mediplex Group is back with its original managers. In only one year, they've taken several steps to bring about a rebound by the chain of skilled-nursing, rehabilitation, psychiatric and substance-abuse treatment facilities. PMID- 10128673 TI - Full day of service to teen dependency needs. PMID- 10128674 TI - AIDS-infected health care workers guidelines: Congress and CDC struggle for policy consensus. PMID- 10128675 TI - OSHA, CDC issues rules on infection control. PMID- 10128676 TI - The right to know. Ethical issues related to mandatory testing of healthcare workers for HIV. AB - To prevent transmission of human immunodeficiency virus (HIV) from patient to healthcare professional, in 1987 the Centers for Disease Control (CDC) put forth guidelines requiring the use of gloves and sometimes masks when treating all patients in exposure-prone situations. Recently, however, the spotlight has shifted as a result of tragic events in Florida when patients of a dentist who died of AIDS were found to be infected with the virus. The question now is whether patients have a need and right to know if a health-care professional is HIV positive. In July 1991 the CDC called for voluntary testing of dentists and physicians who perform "exposure-prone procedures." Also in that month, a proposal in the Senate called for testing all healthcare professionals who perform infection-prone procedures and incarceration of HIV-positive professionals who do not reveal their condition. Later, a similar bill was introduced in the House. Neither of these bills passed, but a joint action by the Senate and House did result in legislation that suggests, but does not require, testing of care givers, following the CDC guidelines or a substitute measure. Professional societies have opposed the CDC guidelines because making a list of exposure-prone procedures would heighten fears, when the risk of transmission is actually small. Also, the guidelines might drive HIV-positive professionals to hide their conditions. Finally, the testing would not be totally effective because of the time lapse between infection and the ability to detect it.(ABSTRACT TRUNCATED AT 250 WORDS) PMID- 10128677 TI - How doctors really feel about AIDS testing. PMID- 10128678 TI - Statement on the surgeon and HIV infection. American College of Surgeons. PMID- 10128679 TI - Discharge planning: a nursing responsibility. PMID- 10128680 TI - AIDS and the health care worker--a physician's perspective. AB - The issue of physician health has been highlighted recently by the public's concern about the possibility of contracting AIDS from an HIV-positive health care practitioner. This article examines some of the applicable standards on physician health issues, recent cases and incidents involving HIV-infected practitioners, the new CDC guidelines for preventing HIV transmission to patients, and the consequences to, and responsibilities of, the HIV-positive physician. PMID- 10128681 TI - States must adopt guidelines for HIV infected HCWs. PMID- 10128682 TI - Do we have to document pharmacotherapeutic interventions? AB - We have suggested that some pharmacotherapists may resist documentation because they view it as administrative intrusion rather than an essential component of continuity of care. In the final analysis, it is also a matter of the pharmacotherapist's belief. Pharmacists must understand what it is that they contribute, and must believe that it is both valuable and unique. It is not just an information management function--they are making patient-specific decisions and must be willing to be held accountable for their outcome. The pharmacy manager must also believe that such a responsible decision-making role represents that preferred future for the profession. Unfortunately, because many pharmacy managers have never truly functioned in such a role, developing such a belief system is difficult at best. The hospital administrator must also be made to believe that the contribution of the pharmacist to patient care not only extends beyond materials management but represents an entirely separate professional function. This will not occur simply through documentation of interventions. Yes, we believe that it is necessary to document pharmacotherapeutic interventions, however, not for the reasons that it is most frequently demanded. PMID- 10128683 TI - Clinical pharmacy interventions: an optimum way to accomplish positive patient care outcome. AB - In this age of demand for optimum quality of care and shortened length of patient stay in the hospital, the opportunities for clinical pharmacy interventions are enormous. Pharmacists, with their unique background in clinical therapeutics, can make a significant difference in patient outcome. As in our case, initially there may be some skepticism among some of the physicians about the intent of pharmacy interventions. However, pharmacists' continual striving for improvement of quality of care can persuade skeptical physicians to consider pharmacists as their allies in achieving optimum quality of care. At our institution, our consistent approach has resulted in support from our physicians. Continuous feedback from managers to staff pharmacists (our monthly performance review feedback program) also helps to continue consistency of the program. The recent focus of the Joint Commission on optimum quality of care has also created an arena of tremendous opportunities for pharmacists to work with the physicians and other health care professionals to accomplish excellence in quality of care. PMID- 10128684 TI - Documenting the provision of pharmaceutical care. AB - There is a growing importance and need for the documentation of the clinical work done by the pharmacist in providing pharmaceutical care. The data provided by documentation of care are critical to the effective and efficient transition from a product-based profession to a patient-care, service-based profession, especially during a period of great scrutiny of resource utilization in the hospital industry. Intervention documentation can serve both to document the provision of pharmaceutical care to individual patients and to provide critical information to managers to justify and expand the level of service provided. PMID- 10128685 TI - Documenting the clinical interventions of pharmacists. AB - The need to justify continued and expanded clinical services persists in the current climate of concern over the high costs of health care; thus, documentation of the clinical interventions of pharmacists is vital. Time is a limited commodity, and an intervention reporting system must be as efficient as possible. A system that can be integrated into departmental and institutional quality assurance activities is a necessity; the capability of sharing the information with other hospital committees and departments is also an important consideration. PMID- 10128686 TI - Development of a computerized pharmacy therapeutic recommendation tracking program. AB - Several important lessons were learned during this pilot project. First, the timely feedback of results, in the form of a concise report, to the pharmacists documenting the recommendations was very useful and aided in their future participation in the program. Second, the design of the database that restricted the data entry person to choose from a list of scrollable choices enhanced the utility of the database for reporting purposes. Future work is needed to facilitate data entry by the pharmacist recording the recommendation. PMID- 10128687 TI - Using clinical intervention documentation. AB - The clinical intervention reporting system that we are using at our facility provides pharmacy management, hospital management, and the quality improvement committee with valuable information. Pharmacy management can use the interventions to motivate, train, and evaluate pharmacists, as well as justify full-time equivalent employees. Hospital management can use the data in the budgeting process, in physician credentialing, and as a part of the medical center's cost containment efforts. The quality improvement committee can use the data in drug selection for DUEs, as well as for information in clinical privileging. Now pharmacy can say with confidence, "We are documenting it; we are doing it." PMID- 10128688 TI - Pharmacist interventions in a decentralized unit dose system. AB - In our hospital, the decentralized pharmacists, on a daily basis, are documenting their cost-saving and therapeutic interventions. The cost savings for the first six months in 1991 totaled $45,862. The therapeutic interventions for these six months totaled 2,087. These interventions have a direct impact on the quality of patient care, while at the same time providing input into economics of patient care. The pharmacist interventions at our hospital can be documented and measured, and they do have an impact on physician prescribing habits. PMID- 10128689 TI - Documentation and assessment of pharmacist-initiated drug therapy interventions. AB - In conclusion, the development of an efficient system to document pharmacist initiated drug therapy interventions has been successful. The system has been incorporated into the pharmacy quality assurance program and is being used to evaluate the provision of pharmaceutical care. Finally, the system has been incorporated into the clinical services drug-use evaluation program and is being used to evaluate individual physician prescribing practices. PMID- 10128690 TI - The next step in clinical intervention programs. AB - Pharmacists should incorporate and modify existing clinical intervention programs to document pharmacists' effects on patient care and quality drug-therapy management. We have already demonstrated the pharmacist's role in drug cost savings through the intervention programs, and now QIP can assist us in taking the next step in providing quality patient care. If we endorse the principles of pharmaceutical care, we must assume the responsibility for documenting our value as pharmacists in managing drug therapy in patients. The clinical intervention programs will deemphasize the value of drug cost analysis and emphasize effects on patient-care outcome. We believe that facilitating positive patient outcomes will decrease overall health care costs. As managers, we must assist our pharmacists in endorsing this concept by developing our programs to show the maximum benefit of their efforts in the patient-care arena. PMID- 10128691 TI - Implementation, justification, and expansion of ambulatory clinical pharmacy services. AB - In response to the current trends in health care utilization and provision, The UMHC Department of Pharmaceutical Services has as part of its mission the provision of comprehensive pharmaceutical services to its ambulatory patients. To achieve this, the Department began the process of identification of need and the provision of these services. Simultaneously, the Department is conducting research to document the impact that pharmacists can have on the cost and quality of care when they are actively involved in the therapeutic management of patients treated in the ambulatory setting. PMID- 10128692 TI - CompCare slashes loss to $1.6 million. PMID- 10128693 TI - Pendulum swings away from patient to health care worker protection. AB - In the complicated and highly emotional atmosphere surrounding the issue of AIDS transmission, what may seem reasonable and reassuring to patients does not always seem reasonable to the medical community. This point was raised again with the death on December 8 of Kimberly Bergalis, who was infected by her dentist during a tooth extraction. It continues to play out in recent actions of health care organizations and in studies of physician fears and responsibilities in treating AIDS patients. The following article summarizes these events. PMID- 10128694 TI - Health Concepts files for Chapter 11 protection. PMID- 10128695 TI - The infection connection. Rules & regs. AB - Gone are the days of ED personnel telling EMTs/paramedics to "wipe some disinfectant" on an abrasion that's been exposed to the hepatitis-B virus. PMID- 10128696 TI - Special report. Controls for AIDS-infected health care workers: an update. AB - In the wake of public concern and increased litigation about infected health care workers transmitting the AIDS virus to their patients, professional and government agencies--including the American Medical Association (AMA), the Centers for Disease Control (CDC), and the American Dental Association (ADA)- have recently issued guidelines on self-policing and safety procedures to their members, and threatened strict sanctions to those who disregard them. Even tougher is the bill which was overwhelmingly approved by the United States Senate in July. Sponsored by Senator Jesse Helms (R-NC), the bill formally makes it a crime carrying a 10-year prison sentence and a fine for AIDS-infected doctors, nurses, and dentists to treat patients without first warning them that they have an infectious disease. In this report, we'll review the new guidelines and how they are expected to impact the health care industry. We'll also present recent developments in AIDS-related litigation that could affect safety and security directors, risk managers, or anyone with managerial responsibility for hospital safety. PMID- 10128697 TI - Charting the rapid rise of subacute care. AB - In recent years, healthcare entrepreneurs have found subacute care to be a profitable niche. They also fill a large gap for hospitals, which have been forced by market pressures to discharge patients quicker and sicker. While subacute facilities offer a less expensive alternative to acute care, some critics charge they skim off the best patients. PMID- 10128698 TI - Drug-resistant tuberculosis comes back as growing threat to healthcare workers. PMID- 10128699 TI - Pharmacy staff training and development: upside-down thinking in a changing profession. AB - We suggest that the most fundamental change in staff development that must occur is recognition of the need for a professional belief system as the basis for any pharmaceutical care activity. Values derived from fundamental moral ideals and professional beliefs foster the development of attitudes and behaviors. It would be wrong to suggest or imply that such a change need only occur in postbaccalaureate training. The development of personal and professional value systems in existing primary professional training programs is inadequate--we do not yet do enough to develop people before they enter practice. Nevertheless, to say that this failure of the professional education system precludes us from taking action within professional departments is unwise. The primary skills that must be developed during the next decade involve the ability of the practitioner to competently make informed, patient-specific decisions necessary for effective pharmaceutical care. Such decisions are made not only on the basis of a practitioner's knowledge but on the basis of his or her beliefs and values as well. The practitioner also must be willing to assume responsibility for the consequences of those decisions. The pharmacist who professes to deliver pharmaceutical care can no longer be shielded by assigning to the physician the ultimate responsibility for the patient's drug-therapy outcomes. Facilitating the development of a value system and attitude that enhance the pharmacist's ability to make such decisions must be a principal focus of staff training and development in the coming years.(ABSTRACT TRUNCATED AT 250 WORDS) PMID- 10128700 TI - Hospital pharmacy staff development programs in Ohio. AB - Although staff development programs have been used to implement clinical services in Ohio hospital pharmacies, the majority of clinical services have been implemented without the use of staff development programs. The results of this study show that less than half of Ohio hospital pharmacy departments provide staff development programs. In those hospitals where the programs were provided, the average number of clinical services implemented through staff development was not significantly different from the average number implemented without these programs. Nor was there a significant difference in the average number of clinical services implemented through staff development between small hospitals (199 beds or less), medium hospitals (200 to 399 beds), and larger hospitals (400 or more beds); between government (city, county, or state) and private, nonprofit hospitals; and between hospitals whose staff development program coordinators were directors and hospitals whose coordinators were not directors. For the majority of departments that provided staff development programs, certification or testing of pharmacists was not required before providing clinical services. Results from the survey indicated that certification may not be necessary for all clinical services. Commitment to staff development programs in terms of management support and participation, awarding of continuing-education credit, and use in pharmacist performance evaluations was demonstrated by no more than 34 percent of all departments that responded. Financial commitment to these programs was low. Overall, since less than half of the departments reported providing staff development programs, the level of commitment to staff development appeared to be low. PMID- 10128701 TI - Work as a central life interest: an explanatory investigation of an unexplored concept. PMID- 10128702 TI - The management concerns of hospital pharmacy directors. AB - In conclusion, this research shows that pharmacy directors in Chicago hospitals face problems on several fronts, though not all are of equal importance. Of particular interest is that, contrary to theoretical expectations, the directors do not consider problems involving relationships with other organizational actors to be extremely important. This issue (as well as others raised here) needs to be investigated in broader and deeper terms. The issue carries important implications, especially in a health care environment that should encourage innovation and negotiation among the professional members of provider organizations. PMID- 10128703 TI - A framework for evaluating the work of pharmacists. AB - This article reviews the major appraisal methods used in health care organizations and offers a competing "systems model" for conducting performance appraisals in pharmacy departments. The value of the proposed appraisal system is that it reminds management not to view the area of performance appraisal as "keep it simple." Rather, management should recognize that performance appraisal should be viewed as a system (more correctly, a subsystem) that interacts with and affects all parts of a pharmacy department's drug use system. The performance appraisal system is complex and dynamic, requiring a significant resource commitment from management and all workers within the department. PMID- 10128704 TI - Medicare's prospective payment system: a critical appraisal. AB - Implementation of the Medicare prospective payment system (PPS) for hospital payment has produced major changes in the hospital industry and in the way hospital services are used by physicians and their patients. The substantial published literature that examines these changes is reviewed in this article. This literature suggests that most of the intended effects of PPS on costs and intensity of care have been realized. But the literature fails to answer fundamental questions about the effectiveness and equity of administered pricing as a policy tool for cost containment. The literature offers some hope that the worst fears about the effects of PPS on quality of care and the health of the hospital industry have not materialized. But because of data lags, the studies done to date seem to tell us more about the effects of the early, more generous period of PPS than about the opportunity costs of reducing hospital cost inflation. PMID- 10128705 TI - Public Health Service, Centers for Disease Control; statement of organization, functions, and delegations of authority--HHS. PMID- 10128706 TI - Write-downs, charges devastate Comprehensive Care's 3rd quarter. PMID- 10128707 TI - AAMI releases new guidelines for flash sterilization. PMID- 10128708 TI - Sterility assurance replaces expiration dating. AB - OR Manager is examining sacred cows in the OR--practices blessed by time that do not necessarily improve patient outcomes. We'll give you the information you need to decide whether these sacred cows should be retired. PMID- 10128709 TI - Disease prevention and the CDC. Interview by C. Burns Roehrig. AB - As director of the Centers for Disease Control (CDC) in Atlanta, William L. Roper, MD, leads the agency of the U.S. Public Health Service responsible for promoting health and preventing disease, injury and premature death. Before coming to CDC in March of 1990, Dr. Roper, a pediatrician, served as a health care adviser for two presidents throughout the 1980s and as head of the Health Care Financing Administration (HCFA) from 1986 to 1989. Reflecting recently on the various roles he has played, Dr. Roper spoke with C. Burns Roehrig, MD, editor of The Internist: Health Policy in Practice about the CDC and its efforts to prevent the spread of AIDS, hepatitis and other diseases. PMID- 10128710 TI - Determining the formulary status of quinolone antibiotics: one institution's approach. AB - Streamlining antibiotic therapy--ie, simplifying regimens, route of administration, or both--is necessary in the modern treatment of hospitalized patients with infectious diseases. Due to their pharmacokinetic profiles and comparative efficacy and safety, the quinolone class of antibiotics is an ideal class for which to direct streamlining efforts. Including only one agent of this class on the formulary, however, is inadequate. Having several quinolones available, and thus expanding the local hospital market for them, enables more physicians to be contacted and educated by manufacturers' sales representatives as part of the hospital's antibiotic management program. By assisting in the education efforts, pharmaceutical representative help to conserve hospital resources, both in terms of cost and personnel. In addition, having more than one supplier of quinolones encourages competition, which favors price reductions. PMID- 10128711 TI - Comprehensive Care sells first facility to REIT; 4 more planned. PMID- 10128712 TI - Drug-resistant TB worries health officials. PMID- 10128713 TI - From the CDC: the Laboratory Performance Information Exchange System. PMID- 10128714 TI - Sterling Healthcare to buy four Indiana hospitals. PMID- 10128715 TI - Abbott asks providers to return recalled antibiotic for credit. PMID- 10128716 TI - Tuberculosis: controlling the risks to healthcare workers. PMID- 10128717 TI - Fund raising for chemical-dependency treatment programs. PMID- 10128718 TI - Testing health care workers for AIDS. PMID- 10128719 TI - Special report. The new TB epidemic hits hospitals: causes, transmission, precautions. AB - Once considered a disease of the past, tuberculosis (TB) is spreading rapidly throughout the United States, with a particular concentration in hospitals located in major urban centers. Of special concern to health care professionals are the growing number of cases of employees and patients who have become infected with hospital-based TB in the last year. Even more alarming is the appearance of a new, deadly, multidrug-resistant (MDR) strain of the disease. In this report, directed at hospital safety and risk managers, we will cover how tuberculosis is spread throughout hospitals; who is susceptible; and what infection control procedures, safety equipment, and inservice education are recommended by experts. We'll also detail the infection control methods in use at the National Jewish Center for Immunology and Respiratory Medicine, Denver, CO- the hospital considered to have the highest standard in the nation of tuberculosis treatment and control. PMID- 10128720 TI - Utilization of outpatient mental health services after inpatient alcoholism treatment. AB - It is generally agreed that use of aftercare services following discharge from alcoholism treatment is optimum for patients to achieve long-term recovery. However, the quantity and duration of utilization of such services in non experimental settings are generally unknown. Using secondary data sources, we studied 5,635 alcoholics completing formal extended inpatient treatment and 1,860 alcoholics discharged from brief inpatient hospitalizations in Department of Veterans Affairs medical centers. Weekly use of outpatient mental health services (OPMH) prior to hospital admission was equally low for both patient groups (approximately 2-3% of patients) until four weeks prior to admission, at which time OPMH use increased, particularly for the extended treatment group. In the four weeks after discharge, use of OPMH services was substantially higher for patients with extended treatment compared to those with brief hospitalizations (40% vs. 18%), with 22% of patients completing treatment utilizing such services in the first week after discharge. Utilization steadily decreased until only 8% and 4% of both groups, respectively, were using OPMH services at the end of six months after discharge. Study results suggest the need to examine barriers to outpatient mental health utilization after discharge as well as interventions to increase compliance with long-term aftercare. PMID- 10128721 TI - Alcoholism treatment, severity of alcohol-related medical complications, and health services utilization. AB - In efforts to contain costs and efficiently allocate resources, evaluation studies in alcoholism have increasingly assessed the effect of treatment on the use of health services through comparisons of treated and untreated alcoholics. The success of this approach requires that evaluators identify and adjust for differences between these two groups, thereby decreasing the likelihood that health utilization outcomes are attributed to the effects of treatment when in fact they may be related more to unidentified group differences. Using a sample of 63,873 hospitalized alcoholics, this study focused on one critical group difference, the severity of alcohol-related medical complications. Comparisons between treated alcoholics who either completed alcoholism treatment or detoxification only and untreated alcoholics with either primary medical/surgical or psychiatric diagnoses demonstrated the following: (a) untreated alcoholics with medical/surgical diagnoses were more likely to have severe alcohol-related medical complications than the other groups; (b) a positive linear relationship between health services utilization in the previous year and the severity of medical complications existed for all groups, except untreated alcoholics with psychiatric diagnoses; and (c) untreated alcoholics with psychiatric diagnoses with the most severe complications used fewer health services than any of the other three groups. Differences between treated and untreated alcoholics in both severity of medical complications and previous health utilization patterns demonstrate the need to identify and adjust for these factors in evaluation studies that examine the outcomes of alcoholism treatment. PMID- 10128722 TI - The CD-ROM experience at Loma Linda: the issues of training, logistics, and creative financing. AB - Since the end of 1987, the Medical Center and University libraries at Loma Linda have progressed from stand-alone CD-ROM-based workstations for access to MEDLINE to networked CD-ROM access to a variety of databases. T.O.M.M.I. (Total Online Medical Material Integration) is a CD-ROM-based wide area network linking the Loma Linda University Medical Center, Loma Linda University, and other entities in Loma Linda, California. T.O.M.M.I., a microcomputer-based system, represents the implementation of IAIMS at Loma Linda. In addition to discussing the issue of "downsizing" campus-wide information networks, this article focuses on the issues of training, handling of logistical problems, and the use of creative financing. PMID- 10128723 TI - CLMA position on HIV/HBV testing of health-care workers. Clinical Laboratory Management Association. AB - In February 1991, CLMA's National Affairs Committee (NAC) developed a proposed position statement on mandatory HIV/HBV testing of health-care workers. The proposed statement was submitted to the 24-member National Affairs Reactor Panel and, based on their input, appropriate revisions were made. In May 1991, CLMA surveyed the full membership, and, as a result, the following position was adopted. Ninety-six percent of the members responding agreed with principles 1, 2, and 3; 88% agreed with 4, 5, and 6. NAC members include Royal A. Crystal, Chair; Linda D. Bielitzki, J.D., Vice Chair; Michael G. Bissell, M.D., Ph.D.; Earl C. Buck; Michael A. Maffetone, D. A.; Timothy Murray; Laurence J. Peterson; Marianne C. Watters; and Martha A. Feichter, National Affairs Analyst. PMID- 10128724 TI - An examination of adverse drug event monitoring practices in U.S. hospitals. AB - Unfortunately, the reasons for respondents' negative attitudes and perceptions toward ADE monitoring are not entirely clear because they generally are not related to time or staff constraints. There was some indication that poor medical record documentation was a contributing factor; however, this problem can be addressed through education of physicians and nurses as to the importance of capturing and reporting ADE data. Other research has demonstrated that substantial effort and diligence are required on the part of all members of the health care team to capture ADEs consistently. Fortunately or unfortunately- depending on the perspective--the motivation and at least the initial energy to establish and maintain an effective ADE monitoring program have to come from the pharmacy department. The greatest fear is that many pharmacists simply will be apathetic to the issue and not devote the time and energy necessary to capture and process ADE information effectively. PMID- 10128725 TI - An evaluation of interventions designed to stimulate physician reporting of adverse drug events. AB - A frequent complaint among health care professionals about ADE reporting programs is that they never know what happens to the information they took the time and effort to report. In the Mississippi ADE program, physicians appreciated the feedback they were provided--in letter form--indicating the ultimate disposition of the reported information. Also, a regular newsletter summarizing the number and types of reports and the drugs involved was well received. This vehicle was also used to educate physicians about new drugs on the market that warranted closer scrutiny. Reminder posters placed at strategic points around the hospital and periodic inservices on the program are effective in maintaining a level of awareness about the importance of ADE monitoring and its impact on the quality of care. PMID- 10128726 TI - A successful community hospital program for monitoring adverse drug reactions. AB - All health care professionals are responsible for reporting ADRs. The physician records these events in the patient's medical record. In the monitoring program at Meriter Hospital, pharmacy responsibilities include review and assessment of all reported ADRs. When appropriate, the ADR is reported to the FDA. The pharmacy department maintains ADR statistics, reports quarterly to the P&T committee, and disseminates information to appropriate hospital committees and departments. The P&T committee supports the ADR monitoring program and policy. This committee reviews all ADRs and recommends action plans. The ADR monitoring program has successfully increased the number of ADRs reported, and actions resulting from ADR reports have had a positive impact on patient care. PMID- 10128727 TI - Reporting adverse drug reactions is everyone's business: an adverse drug reaction reporting program that works. AB - Macomb Hospital Center's ADR reporting program has increased interdisciplinary problem solving in the medication use process. Heightened awareness of ADRs has developed throughout the hospital. Issues identified through the ADR program mirror those found in the DUE process. A strong ADR reporting program is an integral part of quality management in organized health care settings. PMID- 10128728 TI - Criteria-based adverse drug reaction reporting and the use of a relational database. AB - The criteria-based ADR reporting program at Shands Hospital has been successful. When the Joint Commission reviewed this program in January 1991, they were satisfied that it met their standards. Efforts are now focusing on improving the capture of ADRs, which will make the information available from the database even more valuable. Data from Shands Hospital will contribute to postmarketing surveillance, patient care, and staff education, and these data will influence drug usage evaluations and the formulary. Observations will be used to recommend alternate therapies to prevent ADRs as well as methods to manage reactions should they occur. The listing of criteria has facilitated the reporting of ADRs at Shands Hospital, and communication of the information has been greatly enhanced by the ADR database. Efficiency has been improved as a result. PMID- 10128729 TI - A continuous quality improvement team approach to adverse drug reaction reporting. AB - Crossfunctional teams can generate more new ideas, concepts, and possible solutions than does a department-based process alone. Working collaboratively can increase knowledge of teams using CQI approaches and appropriate tools. CQI produces growth and development at multiple levels resulting from involvement in the process of incremental improvement. PMID- 10128730 TI - A pharmacy-coordinated, multidisciplinary approach for successful implementation of an adverse drug reaction reporting program. PMID- 10128731 TI - Using the discharge process as one method to capture adverse drug reaction reports. AB - Adverse drug reaction reporting programs must be constantly improved to remain successful. Using a combination of techniques that foster voluntary reporting from all disciplines--while providing routine feedback to the reporters--creates an environment that promotes better patient care through knowledge and education. The success of the ADR program at Mid-Maine Medical Center is based on this philosophy, and the program is really a system of programs. Capturing ADR reports through the discharge process, which is the cornerstone of the program, has proven very successful. PMID- 10128732 TI - Leadership orientations of hospital pharmacy directors. AB - This research is intended to improve understanding of the leadership orientations of hospital pharmacy directors. The results of the study suggest that these pharmacy directors have not assumed leadership roles within the network of social relationships in the organization. One explanation is that descriptive theories are of little relevance to current practice. Another explanation is that these pharmacy directors are not prepared to value and to be competent at leadership roles. In the absence of measures of effectiveness, these results are difficult to evaluate in terms of the need to cultivate leadership skills in pharmacy directors. Nevertheless, cultivating such skills may be desirable because the pharmacy directors participating in this study perceive that they are less prepared to engage in relationships with people external to the pharmacy department than with members of the department. Enhanced competence would create the potential for higher perceived value and may yield shifts in actual behavior. PMID- 10128733 TI - Addressing blood and body fluid spills: conserving time and resources during surface disinfecting. AB - As new issues and areas of concern arise in the health care industry, such as the potential transmission of HIV and HBV, adaptive measures will continue to be developed to assist health care professionals in their mission to provide expert medical care for patients and safe environments in which to practice. Health care institutions must commit to exploration of the advances in infection control that employ improved measures to manage the cleaning and disinfecting of spill incidents involving blood and/or body fluids and the disinfecting of contaminated surfaces. Together, product manufacturers and health care workers will discover new ways to save time, money, and resources. The goal for health care administrators should be to focus on products that stress simplicity, efficiency, cost containment, and, most important, the safety of staff and patients. PMID- 10128734 TI - Perspectives. Tuberculosis: the "white plague" rises. PMID- 10128735 TI - Developing a model of discharge planning based on patient characteristics. AB - Previous research using hypothetical case scenarios has suggested a model of decision making in discharge planning involving at least two steps. The first is to assess the availability of a caregiver, and the second is to examine the complexity of the patient's situation regarding follow-up care needs, physical functioning, and compliance. The combination of these factors then influences the choice of discharge option. The present study attempted to validate and extend the model using actual cases in a retrospective chart review. The four variables of the original model correctly classified 68% of patients by discharge type and accounted for 29% of the variance. An expanded model that included chore assistance, living situation, caregiver availability, medical need, and patient age was able to account for an additional 19% of the variance in the discharge plan. PMID- 10128736 TI - CompCare replaces CEO, raises cash. PMID- 10128737 TI - AIDS wars. AB - At the Centers for Disease Control, director William L. Roper battles the deadly AIDS epidemic and other rising health hazards. But critics say political interference sets back the effort to stem AIDS. PMID- 10128738 TI - Isolation-room ventilation critical to control disease. PMID- 10128739 TI - Experts question effectiveness, cost of new TB-control guidelines. PMID- 10128740 TI - Patient advocates uneasy about CDC suggestion for wider HIV testing. PMID- 10128741 TI - The importance of medical records in disaster epidemiology research. PMID- 10128742 TI - Centers for Disease Control statement of organization, functions, and delegations of authority--PHS. PMID- 10128743 TI - Implementing an automatic fluoroquinolone therapeutic interchange program in a community hospital. AB - A community hospital developed an automatic therapeutic interchange program for fluoroquinolone antibiotics. After considering efficacy, available formulations, and cost, this P&T Committee selected ciprofloxacin (Cipro) as the class representative for formulary use. The steps taken to implement this automatic therapeutic interchange policy are presented. PMID- 10128744 TI - Pharmaceutical care: new management and leadership imperatives. AB - The management imperatives for pharmaceutical care concern themselves with complexity, while leadership imperatives are concerned with effecting change. Both "species" of action are needed to support the paradigm shift associated with pharmaceutical care. Pharmacy managers must be the architects and engineers of the new dimensions of complexity associated with pharmaceutical care while also serving as zealots of change for pharmaceutical care within their departments and hospitals. In the final analysis, departments of pharmacy do not practice pharmaceutical care. They are, however, the borne fruit of pharmacy managers and leaders who provide for an appropriate environment inclusive of resources and systems necessary for individual pharmacists to make the commitment to making pharmaceutical care a reality. PMID- 10128745 TI - Paradigm shifts: theories, models, and tools. AB - There are many theories and connected tools that have proven to be particularly effective in influencing paradigm shifts. This article has introduced some of each. References listed are useful sources for detailed information. What seems to be clear is that managers should be explicit about the way they characterize their organization. This influences how one measures organizational effectiveness and the selection and application of theories and tools for creating change. The attempt of this article has been to introduce this as a conceptual framework and point to some practical applications in changing organizational thinking. PMID- 10128746 TI - Evolving to provide pharmaceutical care without additional resources in a university hospital. AB - Our department is committed to a process of continuous quality improvement focusing on delivering the best possible pharmaceutical care services. Three committees, each with representation from pharmacists and pharmacy technicians from all areas of the department, were convened in 1991 to 1992 to further identify areas for service enhancement and to plan for the future. Based on the recommendations of these committees, further expansion in ambulatory services is a priority. Other changes will include further automation of the drug distribution system, examination of the role of the pharmacy technician, development of an automated patient-care system with direct physician order entry, computerized documentation of clinical interventions, and reaffirmation of the role of the pharmacist as the professional responsible for proper use of medications at UMHC. PMID- 10128747 TI - Quality improvement in the use of medications through a drug use evaluation service. AB - Continuous quality improvement methods have the potential to improve processes that cross several disciplines. The medication system is one in which coordination of activities between physicians, pharmacists, and nurses is essential for optimal therapy to occur. DUE services can play an important role in helping to ensure that patients receive high-quality pharmaceutical care. It is necessary for pharmacy managers to review the structure, goals, and outcomes of their DUE programs to ensure that they are consistent with a philosophy of continuous improvement in the quality of drug therapy. PMID- 10128748 TI - Reorganizing to provide pharmaceutical care. AB - We feel the reorganization has enabled us to position the department and, more importantly, the individual practitioner to achieve a practice model that approaches the pharmaceutical care paradigm. As a result of the reorganization, our department is now structured around patient care and has in place teams of pharmacists, technicians, and managers who have the potential to be proactive and collaborative with other health care professionals to improve the drug therapy outcomes of our patients. PMID- 10128749 TI - Supporting pharmaceutical care through automation. AB - With increased use of automation in pharmacy operations, traditional roles for technicians, staff pharmacists, and managers will be altered. Demands will be for higher order skills, use of information, and technical expertise. The technologies available offer the promise of accurate and reliable distribution and administration of products, enabling pharmacists to assume accountability for medication use in patients and for the outcomes of pharmaceutical care. PMID- 10128750 TI - Leading transformations of a professional function: the challenges of managing uncertainty. PMID- 10128751 TI - Tuberculosis control in hospitals. Technical Panel on Infections within Hospitals, American Hospital Association. AB - Below is a Technical Briefing on Tuberculosis Control in Hospitals elaborated by the Technical Panel on Infections within Hospitals, in January 1992. Several hospital outbreaks of multiple drug-resistant tuberculosis among HIV-infected persons underscore the need for immediate attention to TB infection control measures to prevent transmission in hospitals. This Technical Briefing recommends specific TB control measures that should be implemented in all hospitals. PMID- 10128752 TI - Long-stay older patients in acute hospitals: are they bed blockers? AB - This analysis of the use of acute hospitals by older people identifies the extent of long stays by elderly patients and the eventual outcomes of these stays in terms of separations to residential care or the community. The effect of casemix on length of stay and differences associated with location of hospital are also discussed. Less than 0.5% of all acute hospital inpatients are older people who could be considered nursing home type patients. These patients use some 9% of all acute bed days and, in most cases, these beds would otherwise be unoccupied. It is unlikely therefore that they are 'blocking' beds that could be used to relieve waiting lists. PMID- 10128753 TI - Hundreds of patients seek AIDS tests after hospitals disclosures, CDC ups number of patients infected by Florida dentist. PMID- 10128754 TI - AIDS. Expanded definition lauded. PMID- 10128755 TI - Healthcare recognizing gay and lesbian needs. AB - A growing number of hospitals nationwide are marketing inpatient, outpatient and referral programs targeted specifically at lesbians and gay men, groups many hospitals are recognizing as underserved. Meanwhile, meetings of healthcare professionals are increasingly incorporating gay healthcare concerns in their agendas, and national gay and lesbian groups are seeking a stronger voice in the healthcare reform debate. PMID- 10128756 TI - Bloodborne pathogen regulation increases survey scrutiny. PMID- 10128757 TI - Legal implications of HIV: testing, confidentiality and privacy. PMID- 10128758 TI - Changing with the times: reconfiguring a mental health facility in response to changing market conditions. AB - A 130-bed private mental health hospital in Ann Arbor, Michigan, was a state-of the-art, progressive facility when it was built in 1986. Since then, changing reimbursement patterns and the shift from inpatient to outpatient services have led to an organizational and physical reconfiguration of the facility to accommodate both mental health and chemical dependency programs. This paper describes the original design of the building and how it was modified in 1990 to achieve organizational objectives and enhance patient care. PMID- 10128759 TI - Implementing a HACCP (Hazard Analysis of Critical Control Points) Program. PMID- 10128760 TI - Group targets variations in state law. PMID- 10128761 TI - An overview of total quality management: applications for health care systems. AB - Unless we are willing to take a long-term look in terms of the implementation of TQM in our health care system, TQM will not work. QI is badly needed in health care, but quality is a slippery concept and requires continuous monitoring and commitment from all of us who embrace it. However, the suggestions provided in this article may assist in adopting and implementing such programs. Furthermore, the articles that follow in this issue will show how the concepts incorporated in the implementation of the TQM process can be successfully applied to a health care setting. PMID- 10128762 TI - Total quality management: one way to get started. AB - Continuous QI requires our hospitals to undergo a fundamental change in values, beliefs, and ways to manage. Process improvement changes must start with senior managers, who create the environment for continuous improvement and then enable department managers and employees to improve their processes. Persistent poor quality does not respect organizational boundaries, and HQIP provides an opportunity to manage all the resources necessary to make improvements. As pharmacy managers, we must identify processes under our control that can be continuously improved based on documented customer judgments. We must stop asking employees to work harder in a flawed system and empower them to improve those processes within their control. It may be easy to become frustrated if it seems to take a long time to implement TQM. Remember, transforming our departments and hospitals will not happen overnight. We are embarking on a new style of leadership and management, one that will help pharmacies implement our pharmaceutical care vision. PMID- 10128763 TI - Total quality management: defining a process for quality improvement. AB - An effective total quality management system is the outcome of a well-defined process for QI. The Toledo Hospital seven-step QI process provides a systematized, databased approach to problem solving. The process has been shown to work for all types of QI teams throughout the hospital. PMID- 10128764 TI - Total quality management: the results of quality improvement teams. PMID- 10128765 TI - Developing a customer-driven approach to quality improvement systems. AB - The development of a DCP in the manner presented previously has allowed for a consistent definition of customer needs and expectations within a pharmacy service. By applying this approach it has allowed the department to address the controversies associated with the identification of key customers and has also allowed a balance to be achieved between internal and external forces. From our analysis it is clear that the pharmacy department has a critical role in establishing a customer service philosophy that is key to the overall success of the institution's quality goal. It is also clear that pharmacy services cannot truly be developed without a customer service philosophy central to their design and implementation. In an era where drug expenditures represent an ever increasing portion of corporate budgets, the pharmacy's ability to deliver goods and services that are customer and quality focused will be critical to organizational survival. The time has come to put ego aside and critically analyze whether or not a quality service is being delivered that meets a true customer need. PMID- 10128766 TI - Lessons learned in developing a total quality management process. AB - While the barriers to TQM implementation are many and the lessons learned can be very painful, we are convinced the results are well worth the effort. TQM implementation is a long term strategic approach and while results can be fairly quick, organizational cultural change and strategic redirection take time. Progress can be very slow. By reducing waste, rework, and variation we can both improve quality and reduce cost. The ultimate goal of TQM is to have organizational members using the quality tools in their daily work life. As an increasing number of health care organizations move through the four phases of implementation, sharing lessons learned can help us understand how to evaluate our quality processes and sustain the improvement process. PMID- 10128767 TI - Development of clinical guideline for smoking prevention and cessation with Centers for Disease Control--AHCPR. PMID- 10128768 TI - Latest AIDS fears allayed. PMID- 10128769 TI - AHA to CDC: base TB rules on facts, not fears. PMID- 10128770 TI - Barriers to mental health care for Hispanic Americans: a literature review and discussion. AB - The Hispanic American population, the second largest and fastest growing minority population in the United States, faces barriers to access to both medical health and mental health care. This paper examines both financial and cultural barriers to utilization of mental health care services; it is a broad review of the literature and is not intended to be comprehensively detailed. The research review suggests that the financial barrier is a major determinant of mental health service access for Hispanic American populations. Also, nonfinancial barriers such as acculturation are examined. A two-part plan is suggested to reduce both financial and nonfinancial barriers. Very little literature on utilization of substance abuse services was found; suggestions for further research are thus proposed. PMID- 10128771 TI - CDC downplays NIOSH advice on respirators for TB. PMID- 10128772 TI - Centers for Disease Control; statement of organization, functions, and delegations of authority--PHS. PMID- 10128773 TI - The MICROCON: portable protection from TB? PMID- 10128774 TI - Improving the quality of work and productivity through the self-designing team concept: the case of Sunset-Kaiser's drug and alcohol dependency program. PMID- 10128775 TI - Substance-abuse centers. PMID- 10128776 TI - Emergency hospital admissions and readmissions of patients aged over 75 years and the effects of a community-based discharge scheme. AB - This paper reports the results of a retrospective review which analysed emergency admissions and readmissions of elderly patients to a district general hospital. All patients received standard after-care allocated by the community health and social services departments following referral by hospital staff. In addition, half of the cohort was randomly allocated to receive care attendant support for a maximum of 12 hours a week for two weeks following the first and any subsequent discharge from hospital. The effect of this additional community support on emergency readmissions was also reviewed. The findings show that the patients randomly allocated to receive the modest domiciliary after-care service were less likely to have another emergency readmission or multiple readmissions. The results suggest that patients over 75 years-of-age, living alone, or having two or more emergency admissions within six months, should have a domiciliary assessment and follow-up after hospital discharge. PMID- 10128777 TI - Evolving CompCare has 2nd-quarter profit. PMID- 10128778 TI - Minimizing risk in discharges to subacute care facilities. PMID- 10128779 TI - Cost appropriateness: can we $afford$ another Medical Waste Tracking Act? AB - Medical waste has, with each passing year, become a subject of greater and greater concern for the general public, legislative bodies, and the healthcare industry. Regulations have been passed and governing organizations created to set the problem right. These actions have cost the healthcare industry (and thus the public) exorbitant amounts of money. But is the panic wrongly focused, and is money being spent on the wrong things? This article discusses these issues and makes some eye-opening revelations about the medical waste crisis. PMID- 10128780 TI - Hurricane Andrew health outcome in Louisiana. PMID- 10128781 TI - Transitional care: redefining long-term care for a managed care marketplace. PMID- 10128782 TI - Long-term care hospitals manage longer-stay "outliers". PMID- 10128783 TI - Chains put on new face ahead of looming reform. PMID- 10128784 TI - ESA Model 3010B Lead Analyzer. PMID- 10128785 TI - Countdown to community care. No place like home. PMID- 10128786 TI - Advisory Committee on the Prevention of HIV Infection. Notice of establishment of subcommittees of the CDC Advisory Committee on the Prevention of HIV Infection- CDC. PMID- 10128787 TI - Taming the tuberculosis threat. PMID- 10128788 TI - Pharmacy-based investigational drug services: a national survey. AB - At the end of the survey, respondents were asked whether their departments planned to make changes affecting the IDS within the next one to two years. Fifty nine percent had made plans, and most of these plans included an expansion or streamlining of investigational services. Thirty-five percent planned to increase the scope of services offered, or extend present services to cover areas previously not reached, such as a specific medical service, or an outpatient clinic. More than 39 percent planned to begin using computers in the operation of the IDS, or expand their present use of computers. Twenty-six percent planned to increase staffing in some way; these plans included designating a staff pharmacist to handle study drugs and budgeting a few hours per week, hiring a pharmacist, nurse, technician, or student, or adding clerical help. Five institutions (less than 2%) planned to scale back services; this was due to budgetary cuts in three hospitals and one hospital closure, but in one case, plans were to limit enrollment of new patients to hours when a pharmacist is available. Clearly, many factors are involved in the operation of an IDS. The information obtained from this survey is by no means a complete list of the services that may be provided; however, the information and ideas gathered from this survey were useful in planning for service expansion at St. John's Hospital. It is hoped that this information might be useful to other pharmacists and pharmacy administrators as well. PMID- 10128789 TI - Marketing an investigational drug service. AB - The customer survey was a useful tool for marketing the IDS. It provided guidelines for making decisions about the best use of limited human and material resources. Analyzing the results of the survey provided new priorities and directions for the IDS. These results were then used in conjunction with pharmacy financial and operational data to focus on areas of greatest importance to the customers and the pharmacy. Physicians should not be reluctant to pursue compassionate use treatments because of the administrative programs responsibilities that accompany such programs. Every patient should have the opportunity to benefit from alternative therapies that are investigational. For the quality of patient care to be maintained or even enhanced when studies are conducted, nurses must be well trained. The marketing survey fulfilled its purpose of identifying service gaps and allowing us to improve our services. PMID- 10128790 TI - A perspective on investigational drug management. AB - The increasing prevalence of pharmacy-based IDSs is raising the awareness of sponsors to the value of involving pharmacists in the design and conduct of drug studies. We have participated in several privately sponsored multicenter studies that required pharmacy participation as a condition of site participation. Government agencies (i.e., NIAID) now require and fund pharmacy involvement in their research. PMID- 10128791 TI - Using a hospital mainframe computer for pharmacy investigational drug study management. PMID- 10128792 TI - An investigational drug service at a pediatric hospital. PMID- 10128793 TI - The pharmacist as an active member of the institutional review board. PMID- 10128794 TI - In search of objective measurement in performance appraisal. PMID- 10128795 TI - Is productivity coming into its own--again? PMID- 10128796 TI - The supervisor's performance appraisal: evaluating the evaluator. AB - The focus of much performance appraisal in the coming decade or so will likely be on the level of customer satisfaction achieved through performance. Ultimately, evaluating the evaluator--that is, appraising the supervisor--will likely become a matter of assessing how well the supervisor's department meets the needs of its customers. Since meeting the needs of one's customers can well become the strongest determinant of organizational success or failure, it follows that relative success in ensuring these needs are met can become the primary indicator of one's relative success as a supervisor. This has the effect of placing the emphasis on supervisory performance exactly at the point it belongs, right on the bottom-line results of the supervisor's efforts. PMID- 10128797 TI - Broadened definition increases AIDS cases 200%. PMID- 10128798 TI - Ramsay to open five units by '94. PMID- 10128799 TI - Methicillin-resistant Staph aureus. In this era of resistant organisms, it's vitally important for you to comply with the infection-control procedures set forth by the CDC. PMID- 10128800 TI - Preliminary cost-effectiveness analysis of an AIDS vaccine in Abidjan, Ivory Coast. AB - A preliminary assessment was made of the cost-effectiveness of a hypothetical AIDS vaccine in Abidjan, Ivory Coast. A total cost of $20,079 per HIV positive case in the Ivory Coast was projected by estimating the indirect and direct costs of infection. The HIV vaccine was then estimated to increase by $5.28; the costs of a fully immunized child (plus costs of the vaccine). After using this data and taking into account that at least 5% of a cohort of vaccine-eligible infants would become HIV positive at approximately age 26, a cost-benefit analysis was undertaken varying cost, efficacy rates for the hypothetical vaccine and HIV seroprevalence rates in order to indicate at what price per individual dose of vaccine would it stop being cost-beneficial. Furthermore, the basic model was expanded to include vaccinating young adults and the added benefits associated with decreased HIV transmission especially in individuals with high risk behavior. The model was expanded to examine the effects of a changing discount rate. Because of the tremendous economic burden due to AIDS, the prospective vaccine costs at which there is no economic benefit were higher than expected. PMID- 10128801 TI - So you thought you were admitted? A Medicare trap is snaring hospital patients. PMID- 10128802 TI - Queen Mary Hospital, Hanmer, looks forward to exciting future. PMID- 10128803 TI - Surveillance, containment are key to controlling TB in the elderly. PMID- 10128804 TI - Legislative forum ... Comprehensive HIV Prevention Act of 1993. PMID- 10128805 TI - New directions in long term care. The emergence of subacute care. AB - Health care providers are entering an era of change. While the national system of health care delivery undergoes radical reform, the demographics of the American public are changing. So are their care needs. In the wake of these changes, long term care providers are reassessing their role in the care continuum and carving out new niches to fill the diverse needs of the people they serve. Explains Paul Willging, executive vice president of the American Health Care Association (AHCA), "To solve the health care crisis and to curb spiraling health care costs, providers must participate more fully in the continuum--from providing less sophisticated to heavy skilled care." Subacute care and assisted living, relative newcomers to long term care, are likely to become mainstays of the continuum for frail and elderly Americans. PMID- 10128806 TI - Special report on patient care. CDC issues new recommendations for HIV testing and counseling for patients in acute care settings. PMID- 10128807 TI - Retroviruses: a general overview. PMID- 10128808 TI - Hospital-based home care integral to seamless service. PMID- 10128809 TI - Integrated subacute care: 20% of your patient days. AB - New strategies are changing the profile of subacute care, and patients are beginning to move out of the hospital into subacute or home care services. It's a money-losing proposition for hospitals, writes Donald E.L. Johnson. PMID- 10128810 TI - Pharmacist clinical intervention program. AB - Our efforts have helped us demonstrate the positive impact of pharmaceutical care for patients. Our experience with the Clinical Notes section of our computer system leads us to recommend that such capabilities be sought in all pharmacy computer systems. A significant advantage to avoiding paper-based systems for documenting and collecting information relevant to clinical interventions, ADRs, DUE data, and patient outcomes has been proven in our institution. Various ways to categorize intervention data have been reported in the literature. We recommend clinical intervention categories be based on the eight categories of drug misadventuring so that data from different hospitals can be tabulated or compared. The success of our system is that it is one system rather than many systems. The importance of pharmacist documentation demands that it be simple, efficient, and painless, or it will be nonexistent. PMID- 10128811 TI - Hospital mainframe computer documentation of pharmacist interventions. AB - The hospital mainframe computer pharmacist intervention documentation system described has successfully facilitated the recording, communication, analysis, and reporting of interventions at our hospital. It has proven to be time efficient, accessible, and user-friendly from the standpoint of both the pharmacist and administrator. The advantages of this system greatly outweigh manual documentation and justify the initial time investment in its design and development. In the future, it is hoped that the system can have even broader impact. Intervention/recommendations documented can be made accessible to medical and nursing staff, and as such further increase interdepartmental communication. As pharmacists embrace the pharmaceutical care mandate, documenting interventions in patient care will continue to grow in importance. Complete documentation is essential if pharmacists are to assume responsibility for patient outcomes. With time being an ever-increasing premium, and with economic and human resources dwindling, an efficient and effective means of recording and tracking pharmacist interventions will become imperative for survival in the fiscally challenged health care arena. Documentation of pharmacist intervention using a hospital mainframe computer at UIH has proven both efficient and effective. PMID- 10128812 TI - Use of hand-held computers to record and analyze intervention data. AB - Using the Wizard to document clinical activities has been well received by the clinical staff. What had previously been a dreaded task has become an ongoing part of daily activities. The revised Clinical Activity Log also provided the staff pharmacists with an easier method of documenting their clinical activities. The task of inputing the information from the staff pharmacists' paper logs into the computer is time consuming and is currently being done by the clinical staff. Procurement of additional Wizards for the staff pharmacists to use in the central pharmacy and satellite pharmacies is currently being considered. Using the Wizard has enabled the clinical staff to document clinical activities into the computer database in an ongoing manner throughout the day. Documentation has increased and is now more complete. Productivity is being monitored. Physician responses and patient outcomes are now being documented. Most importantly the computerized system allows for easy retrieval of the documented information for evaluation so that tracking and trending can be done and we can thereby continue to improve the quality of pharmaceutical care being provided. PMID- 10128813 TI - Documentation of clinical interventions in nutritional support. AB - The implementation of this documentation system has been a success. The SPF pharmacists' participation has been excellent. All of the original objectives have been met. The results collected have been responsible for more than validating the clinical functions of the pharmacists. They have been used to create CQI indicators, improve the work flow in the IV room, and enhance the evaluation process. The pharmacists work as a team to ensure that all interventions are documented. The results obtained, including numbers and trends, are reported on a monthly basis to the NSCPS, the sterile product formulation manager, and the director of Pharmacy Services. Although the documentation is considered to be a requirement for the pharmacists, they are continually encouraged through constant feedback from the managers. This feedback included individual recognition for exceptional interventions and reports of the impact of the interventions on pharmacy service. The biggest problem with the present system was the time-consuming task of entering the data into the Paradox computer database. This will soon be resolved by the implementation of a bar code system to automate this process. The pharmacists will be able to document the information from the interventions with a hand-held bar code wand. At the end of each day, the information can be automatically downloaded into the Paradox computer database. PMID- 10128814 TI - How to assemble a patient-centered pharmacy QI program. AB - The QI program is patient driven. The question "How does this monitoring affect the patient?" is central to decisions on designing indicators. Time spent on the various levels of quality assessment in the Pharmacy QI Committee is proportional to patient impact. Personnel time devoted to concurrent review of dosing and drug interaction overrides, drug information response accuracy, and therapeutic drug monitoring reflects the importance the Pharmacy Department places on maintaining a drug therapy safety net. The patient is central to the pharmacy QI program. The spirit of the Joint Commission's standards is met; acceptable documentation completes the requirements. PMID- 10128815 TI - Interventions: a quality assessment tool for the pharmacy department and the medical staff. AB - The intervention tracking system at Texas Children's Hospital has evolved from a simple log to a pocket book of check-off forms requiring minimal writing. Information gathered from the intervention data has progressed from merely notification that a call was made to tracking numbers and types of interventions to including the pharmacists in the information loop. Pharmacists are assured that the time spent documenting interventions provides data for medical staff QI, pharmacy QI, and feedback to themselves as well. No documentation is wasted; no separate data collection is required. Intervention categories with medical staff approved indicators are treated as a concurrent DUE. Depending on the rate of acceptance of pharmacists' recommendations, physicians, pharmacists, or both are targeted for education. Analysis of the acceptance rate may also indicate the need for systems changes more profoundly affecting one or the other of the groups. PMID- 10128816 TI - Applying total quality management to a pharmacist intervention program. AB - Intervention documentation continues to be a valuable tool for both documenting pharmacist impact on patient care and justifying new clinical pharmacy services. Utilizing TQM principles to improve documentation has yielded many long-term benefits. Not only has intervention documentation been streamlined, but pharmacists at the staff level were an integral part of the changes that were made and the improvements to come. Their familiarity with the pitfalls of the former system provided solutions to the problems that might have been overlooked without their input. PMID- 10128817 TI - Correlation of employees' perception of workload with workload indicators. AB - In this study, the measurement of perception of pharmacists' workload did not correlate well with any workload indicators studied. Generally, census on the study date correlated well for pharmacy technicians working in various areas of the pharmacy. If it is agreed that perception of workload is the real measure of activity--that is, how busy the employees believe it is--then the indicators used in this study are not useful. Similar research using other indicators is warranted. PMID- 10128818 TI - Marketing guidelines for providers of mental health and chemical dependency services--responding to changes in the packaging and purchase of behavioral health benefits. AB - In summary, the mental health and chemical dependency market has changed to the point that providers and programs of any type can no longer survey financially without well-developed marketing strategies--including a conscious decision about target markets and niches within those markets. Behavioral health providers and programs need to thoroughly evaluate their internal resources, along with possible market niches, in order to develop these strategies. PMID- 10128819 TI - The community's role in preventive health management: an empowerment model. PMID- 10128820 TI - Antibiotic therapy: what to consider when treating geriatric patients. AB - The epidemiology, etiology, clinical manifestations, diagnostic approach, and therapeutic choices may be quite different for infections that occur in elderly patients compared with those that occur in younger adults. Given these variables, it is essential for clinicians who care for older patients to understand how to prescribe antibiotics appropriately for this population. This article examines the unique characteristics of infections in the elderly as well as provides recommendations on the use of specific antibiotic agents commonly used to treat infections in geriatric patients. PMID- 10128821 TI - Exposed? Now they have to tell you. PMID- 10128822 TI - CompCare's woes continue. PMID- 10128823 TI - An analytical framework of physician productivity and variation in utilization. AB - The utilization of medical services by patients is an important determinant of doctor productivity, but this factor does not appear to have been given much attention in previous studies. In order to answer the question of why is there a wide variation in doctor output at low level medical facilities in China, an analytical framework of doctor productivity and utilization is developed. The simulation model is used to produce data that can be analyzed by such a framework. Great uncertainty about patient flows is one reason for the average lower and varying doctor productivity in lower level health facilities. Until uncertainty can be reduced, more flexibility is needed at the lower level to cope with changing utilization patterns and patient characteristics. The management by doctors of non-patient care activities (preventive programmes, medical research, teaching, and administration) is crucial to any approach to using doctor resources more effectively and efficiently. PMID- 10128824 TI - Measuring hospital workload in general medicine. AB - The study described here used routine data sources to consider three aspects of hospital workload-volume and case-mix of inpatients; volume of outpatients; and volume of procedures. PMID- 10128825 TI - Planning health care for people with HIV infection and AIDS. AB - In recent years planners of health services have been urged to design a comprehensive range of services which are responsive to the needs of people with HIV infection and AIDS and those who might be worried about HIV transmission. Models of care have been tried and tested and pilot services which aim to inform the development of the services scrutinised. Though in general this community care is seen as the preferred option with adequate backup support from acute services. More than anything, there is a recognition that the service must be responsive to local needs. Because patterns of HIV infection and prevalence of AIDS are so variable there is no substitute for the systematic development of timely local knowledge as the basis of local planning. PMID- 10128826 TI - Forecasting areawide hospital utilization: a comparison of five univariate time series techniques. AB - Time series analysis is one of the methods health services researchers, managers and planners have to examine and predict utilization over time. The focus of this study is univariate time series techniques, which model the change in a dependent variable over time, using time as the only independent variable. These techniques can be used with administrative healthcare databases, which typically contain reliable, time-specific utilization variables, but may lack adequate numbers of variables needed for behavioral or economic modeling. The inpatient discharge database of the Department of Veterans Affairs, the Patient Treatment File, was used to calculate monthly time series over a six-year period for the nation and across US Census Bureau regions for three hospital utilization indicators: average length of stay, discharge rate, and multiple stay ratio, a measure of readmissions. The first purpose of this study was to determine the accuracy of forecasting these indicators 24 months into the future using five univariate time series techniques. In almost all cases, techniques were able to forecast the magnitude and direction of future utilization within a 10% mean monthly error. The second purpose of the study was to describe time series of the three hospital utilization indicators. This approach raised several questions concerning Department of Veterans Affairs hospital utilization. PMID- 10128827 TI - The impact of the changing healthcare environment on the attitudes of nursing staff: a longitudinal case study. AB - Attitude surveys of registered nurses were conducted in 1984 (just prior to implementation of prospective payment) and in 1989 (after implementation of changes responsive to prospective payment and increased competition) in an academic medical center. Results indicate more negative attitudes toward hospital administration, pay and promotional opportunities in 1989. However, overall job satisfaction, job variety, job market alternatives, participation in decision making, and intention to leave were unchanged while job variety and perceptions of job market alternatives were more positive in 1989. Implications for health care management and future research are discussed. PMID- 10128828 TI - Effects of price regulation on stock returns of publicly traded companies in the healthcare industry. AB - During the 1980s, governmental changes were enacted to suppress the rising costs of healthcare. The primary forms of legislation were the implementation of the Prospective Payment System (PPS), the passage of Deficit Reduction Act and the proposal to shift capital costs to a prospective payment system. The main emphasis of the study is to examine the price reaction of hospital management companies for the above governmental changes. Using an intervention analysis, the findings show that the market reacted negatively at the passage of PPS and the future proposal to implement capital costs on a prospective basis for hospital management companies. In addition, hospital management companies level of risk increased for all the key event dates. PMID- 10128829 TI - The primary care debate. PMID- 10128830 TI - The promise of HMOs: primary care, prevention, research and education. AB - The contributions of HMOs to research and education are important in the generation of knowledge for policy development and for training physicians to meet the needs of populations. While prepaid group practices that were the prototypical HMOs added important new information about the organization and delivery of health services, the new generation of managed care organizations has not been involved in either research or teaching. Issues that are particularly amenable to research in HMOs include the appropriate balance between primary care providers and specialists, criteria for referral from primary care to specialty services, the contributions of preventive care to health, and the testing of alternative strategies to achieve the four important characteristics of primary care practice. HMOs could also make important contributions to medical education by exposing students and residents to quality of care assessments and to practice based research, as well as to the special challenges and rewards of population based medical care. PMID- 10128831 TI - Late registration for prenatal care in a high-risk population. AB - Late registration for prenatal care prevents many of the benefits of regular care from accruing to mother and fetus. For a high-risk, indigent population, this deficit becomes additionally important. We surveyed all patients presenting for care after 15 weeks gestation to elicit specific reasons for late registration, in an attempt to improve quality of care. PMID- 10128832 TI - Alpha interferon and hepatitis B and C. An integrated approach using practice guidelines. AB - Utilizing the techniques of total quality management, a team designed a clinical guideline for the use of alpha interferon as a treatment for patients with chronic hepatitis. The team included TEMINEX staff, a primary care physician, the plan's internal gastroenterologist, and its university-based consultant gastroenterologists. A synopsis of the available published research data and clinical opinion (a draft TEMINEX report) was used to focus discussions. The final TEMINEX report represented consensus on patient selection criteria and treatment regimens. All members of the team agreed to a review and approval process. Although quantitative data concerning the effects of guideline implementation are not yet available, it appears that the concerns of all members of the team have been satisfied. Patient selection criteria supported by the results of well-designed research are in place. Appropriate candidates for alpha interferon therapy receive expedited treatment and the plan's internal monitoring processes are more efficient. Primary care physicians and consultant gastroenterologists feel that they made positive contributions both to the quality of care and to the consensus development process. PMID- 10128833 TI - Psychotherapists in the HMO. AB - Managed care is becoming a significant force shaping the development of contemporary mental health treatment. In order to understand how the HMO affects practice style, 294 psychotherapists (psychologists, psychiatrists, social workers, and others) responded to objective and open-ended questions about psychotherapy models, psychotherapy orientation, practice habits, quality of work, work conditions, stresses, burnout and its prevention, graduate training, evolution of practice style and the development of self as a person. A tentative "composite sketch" of the typical HMO therapist is developed. Practical applications of the findings are discussed, and advice and recommendations are offered to the beginning HMO therapist. PMID- 10128834 TI - Group psychotherapy in an HMO. AB - Group psychotherapy is often the treatment of choice with appropriate patients, because of its clinical utility and efficacy as well as possible cost effectiveness. Common elements of short-term group therapy are reviewed, and different forms of group therapy practiced within the HMO context are discussed. Attention is also called to the value of group therapy for providing cost sensitive treatment to more chronically impaired psychiatric patients who may require extended supportive care. The relationship between various health care delivery structures (staff/group versus IPA/PPO models) and the provision of group treatments is emphasized, as is the importance of developing a group therapy program as part of a comprehensive mental health service. PMID- 10128835 TI - Decentralized pharmacists in an HMO. PMID- 10128836 TI - A physician's commitment enhances health promotion. PMID- 10128837 TI - Clusters: a new style of organization. AB - Hierarchy is under siege; managers and employees alike are tired of its rituals, lack of real communication, and delays in decision making. With computer technology now available to diffuse information widely in organizations, many people feel the issue is not where you are, but what you accomplish, that counts. In this article, the authors present the underpinnings of a new organizational form--one that challenges the fundamentals of hierarchy to enable businesses to better meet employee needs and a cost-conscious economic reality. PMID- 10128838 TI - Resolving ethical dilemmas about privacy and confidentiality. Guidelines for decision making. AB - Ethical dilemmas are, by the very fact of being dilemmas, situations in which the right action is not immediately evident. A significant number of the ethical dilemmas faced by health-care and other professionals include respect for privacy or confidentiality as one of the values involved. To say that a situation represents an ethical dilemma is not to say that it is unresolvable; nor is it to say that any single resolution is as good as another. Rather, ethical dilemmas can be resolved adequately and consistently by applying a clear framework of analysis and guidelines for decision making. In this article, I describe ways of thinking about privacy and confidentiality that make ethical concerns related to these values more manageable. Despite the pluralistic nature of our society, the systematic study of contemporary ethical issues has led to some widely supported approaches for resolving ethical dilemmas. Although it would be exaggerating to claim full consensus among ethicists on what follows in this article, it is not exaggerating to say that the perspective represents a common approach to understanding privacy and confidentiality obligations and that many find these guidelines helpful in addressing specific situations. PMID- 10128840 TI - Bio-Rad Diamat. PMID- 10128839 TI - Managing the multi-cultural laboratory, Part II: Tools for managing the differences. AB - This second article provides practical advice from managers in a variety of industries who have first-hand experience as multi-cultural managers. It will help laboratory professionals make practical application of two conceptual models in managing their culturally diverse employees. The advice covers such areas as performance standards, interpersonal skills, language issues, and other management practices. The first article explained what is meant by "culture" and featured the research-based model set forth by Dutch social psychologist and management consultant, Dr. Geert Hofstede. His four dimensions of culture (Power Distance, Masculinity/Femininity, Individualism/Collectivism, and Uncertainty Avoidance) provide a useful framework for assessing the different values, attitudes, and behaviors exhibited by those of different cultural backgrounds. In this article, abbreviated reference tables are presented that make these cross cultural data more useful for management decision making. Laboratory supervisors can use both the models and the advice to challenge their own built-in cultural biases and to meaningfully interpret some of the attitudes and behaviors of culturally diverse coworkers and employees. PMID- 10128841 TI - Effective career ladders. AB - Motivation, quality improvement, productivity enhancement. These are just some of the benefits of an effective career ladder program. The key term here is effective. It is easy for laboratory personnel to stagnate professionally if they do not have a career ladder program, but it is even easier for them to become frustrated--even cynical--over a program that fails to live up to its expectations to encourage, support, and reward professional advancement. If you have been looking form some ideas to get your own career ladder program off the ground, the following responses from your colleagues may help as CLMR asks: What makes your career ladder program effective? PMID- 10128842 TI - CLMA's quality leadership journey: an interim report. PMID- 10128843 TI - A cure for health costs. PMID- 10128844 TI - Managing holistic improvement. AB - In the rush to stay in tune with the rapid pace of change, many organizations are now implementing total quality management (TQM)--often without first examining whether they are ready to take full advantage of what this approach has to offer. Indeed, if TQM is implemented as a quick fix (for example, getting everyone involved in learning tools and techniques, forming continuous improvement teams across departments and disciplines, and then expecting all employees to make significant improvements in the way they serve their customers) when, in fact, there is mistrust, defensive communication, little teamwork across work units, conflicting strategic signals, fragmented organizational structures, and a reward system that ignores performance, virtually any TQM program is likely to fail. Rather than putting more and more pressure on employees to improve--when they cannot because of all these roadblocks--organizations might first consider identifying and then removing their systemic barriers to success with a completely integrated program. Once the necessary foundation for TQM has been established, all employees will be able--and willing--to work together to improve their processes, products, and services for the benefit of their customers. PMID- 10128845 TI - The lab test: a tale of quality. AB - Customers expect a minimum standard of quality from the goods and services they purchase. When they judge the total quality, however, they demand a whole lot more. PMID- 10128846 TI - Economics of outreach testing in the hospital laboratory: Part II. AB - This discussion of the decision points and results in the development of three hospital outreach programs continues with two case studies--a small hospital (50 beds) laboratory in a rural community and a failed outreach program in a 100-bed hospital in a community of 50,000. Guidelines and basic requirements for launching an outreach program are also provided. PMID- 10128847 TI - Reduction of errors in laboratory test reports using continuous quality improvement techniques. AB - The techniques of continuous quality improvement have been applied to the problem of wrongly addressed clinical laboratory test reports. Over a 6-month period, flow charts of the process of producing test reports were created, the error rates of incorrectly addressed test reports were established, and the root causes of these errors were identified and progressively removed. A 17-fold sustained reduction in the rate of incorrectly addressed test reports was achieved with faster turnaround time, no significant expenditure of funds, and no changes in staff, equipment, or the laboratory information system. PMID- 10128848 TI - HIV reporting. PMID- 10128849 TI - The False Claims Act and clinical laboratories. AB - In its efforts to fight fraud, the government has turned increasingly to the civil False Claims Act. The Act imposes triple damages plus monetary penalties against those who defraud the federal government. The Act also encourages whistleblowers to report fraud by offering the prospect of large bounties. This article describes the False Claims Act, its qui tam provision dealing with whistleblowers, and the application of the Act to clinical laboratories. PMID- 10128850 TI - i-STAT point-of-care blood analyzing system. PMID- 10128851 TI - An international view. What are laboratory operations like in your country? PMID- 10128853 TI - Basic ingredients of success for community trusts. PMID- 10128852 TI - Community mental health services. PMID- 10128854 TI - Telemedicine--future hi-tech medical service in New Zealand? PMID- 10128855 TI - Privacy of health information. PMID- 10128856 TI - First NZ private hospital to offer fully integrated medical services at one site. PMID- 10128857 TI - Children's Health Camps still needed. PMID- 10128858 TI - 24-hour medical services planned at Te Kuiti Hospital. PMID- 10128859 TI - Labour's plan to improve health services. PMID- 10128860 TI - The SunHealth Alliance: benchmarking trendsetters. PMID- 10128861 TI - Communication networks: THINQ (The Healthcare Information Network for Quality) links TQM/CQI thinkers. PMID- 10128862 TI - The future of utilization management/review. PMID- 10128863 TI - Reinventing the PRO. PMID- 10128864 TI - Hypoxemia on the general care floor. PMID- 10128865 TI - Nursing home compliance with the Patient Self-Determination Act: does Jewish affiliation make a difference? AB - This paper reports on a mail survey of Jewish nursing homes nationally regarding their compliance with the federal Patient Self-Determination Act that became effective in December, 1991. Data is presented about the extent to which institutions' religious affiliation has influenced their advance directive policies and the procedures they have adopted to implement those policies. A content analysis of written advance directive policies used in Jewish nursing homes is presented also. PMID- 10128866 TI - Ethics in the spirit of hospitality. PMID- 10128867 TI - The ethics committee as a "community of concern": a reflection on the Accountability of Bioethics Committees and Consultants. PMID- 10128868 TI - Should HECs be available to review the ethics of business decisions taken by the institution's board of trustees, physicians' group, or the institution's administration? Yes. PMID- 10128869 TI - Should HECs be available to review the ethics of business decisions taken by the institution's board of trustees, physicians' group, or the institution's administration? No. PMID- 10128870 TI - Should HECs audit compliance with institutional policies and enforce sanctions for violations? Yes. PMID- 10128871 TI - Should HECs audit compliance with institutional policies and enforce sanctions for violations? No. PMID- 10128872 TI - Clinton delivers health reform strategy. PMID- 10128873 TI - The Clinton prescription for an ailing health system. PMID- 10128874 TI - Turf wars: lawmakers elbow over reform bill. PMID- 10128875 TI - Perspectives. The Grand Old Party and health reform. PMID- 10128876 TI - Perspectives. Saying the unsayable: health care rationing. PMID- 10128878 TI - Perspectives. Teen pregnancy: too late to bolt the door. PMID- 10128877 TI - Perspectives. Lessons from abroad in long term care. PMID- 10128879 TI - Extracorporeal shock-wave lithotripsy. PMID- 10128880 TI - Notable X-ray installations. PMID- 10128881 TI - Back on track. Leading a hospital turnaround. AB - Taking a failing hospital from the brink of financial ruin and turning it into a thriving, profitable entity takes more than a dose of good luck. It takes a strong leader who has the vision, determination and skill to execute a successful turnaround and put that hospital back on track. In addition to addressing financial factors, an effective leader will promote a good working relationship between the hospital management, board, staff, patients, caregivers and community members. Following are seven California hospitals that have all faced financial crises in recent years. These hospitals have made the transition out of the red and into the black with the kind of leadership that relies on trust, teamwork, common sense and ingenuity. PMID- 10128882 TI - Integrated health care calls for an integrated insurance program. PMID- 10128883 TI - Out of the morass: a two-step prescription for making health care work. PMID- 10128884 TI - Rural hospital leaders take their message to Washington. PMID- 10128885 TI - State legislative action: the year in review. PMID- 10128886 TI - States' perspectives on health reform. PMID- 10128887 TI - Cost + flexibility = key to state health care reform. PMID- 10128888 TI - '93 state legislative survey. PMID- 10128889 TI - Lessons from the budget battle. PMID- 10128891 TI - Employee education and grass roots at CIGNA. PMID- 10128890 TI - An interim report on HCFA's price bundling project. PMID- 10128892 TI - Managing an aging health care marketplace: Part 2. AB - This is the second part of a two part series on the business implications of an aging marketplace. In part one, we were encouraged to be aware of the business implications of the physical, psychological and behavioral changes that cause values, perspectives and needs to change. In part two, the author reveals the strategies necessary for successful organizational change. PMID- 10128893 TI - Controls--by any other names--are still controls. PMID- 10128894 TI - Taking the first step toward system reform. AB - Small companies and individual Americans have an extraordinarily difficult time finding health insurance they can afford. And, even when they do, annual premium increases quickly force them to shop for a new policy. Reforms of the small market insurance field should include requiring insurers to sell a policy to anyone who wants to buy one; requiring insurers, after six months, to cover all costs incurred because of preexisting medical conditions; and regulating annual premium increases. Two standard "MEDPLANS" would be offered at prices ranging from $75 to $100 a month. PMID- 10128895 TI - The national health insurance conundrum: shifting paradigms and potential solutions. AB - For nearly a century, federal lawmakers have debated the pros and cons of national health insurance. Despite surges of interest, a consensus for such action does not exist. With political camps divided a "hybrid" solution is needed. Such a plan would involve both the government and the private sector, featuring a single payer system, creation of a basic benefit package, voluntary incentives to purchase insurance that gradually move to a mandatory system, and a progressively financed public program to cover those who fall through the cracks. Presidential leadership will be necessary to gain action. PMID- 10128896 TI - New Medicare capital regulations: a capital idea? AB - Proposed regulations by the Health Care Financing Administration would add hospitals' capital costs to Medicare's prospective payment. The logic behind the move is flawed by a lack of empirical data regarding hospitals' capital spending decisions. And the proposal errs in not including leased equipment and facilities, post-transition assistance to capital-needy hospitals, and the cost of insurance, taxes, license, royalty fees, and related organizations' capital costs of depreciable assets not located on the hospital's premises. Since capital represents 10 percent of hospital spending, the government would be better off developing innovative approaches to solve cost problems. PMID- 10128897 TI - Hospital profits, a misleading measure of financial health. AB - Over the 1984-1988 period, Massachusetts hospitals complained that operating revenues, regulated by state and federal governments, were inadequate and caused significant declines in profitability. Poor profitability provided a persuasive basis for hospitals' successful lobbying for additional revenues, as well as the rationale for laying off workers and reducing unprofitable programs serving community needs. However, an alternative approach to measuring hospital financial health in the state indicates that the industry was healthy enough to significantly expand capital assets and to accumulate hundreds of millions of dollars of discretionary cash. More effective measures of financial performance are needed to inform policymakers and analysts of the financial health of hospitals. Analysis of cash flow statements provides important insights for proper interpretation of income statements and balance sheets. PMID- 10128898 TI - The Bush Administration in search of a health policy. AB - As a candidate, George Bush proposed a plan to help the uninsured get health coverage; promised improved care for minorities, the young, and the poor; and said he'd address the health care costs squeezing the middle class. As President, he appointed a black educator/physician to his Cabinet to head health efforts; he told the Office of Management & Budget to hold down health care inflation; and he appointed two commissions to study the uninsured. But, where's Bush's health policy? PMID- 10128899 TI - DataLine. America's health: the color gap. PMID- 10128900 TI - A report from the front line: policy & politics in health reform. AB - With federal action on health care reform at a standstill, states are faced with the choice of waiting for Washington or moving ahead. But states will have a hard time taking action in the face of economic problems and the need for additional revenues to address the problems of the uninsured. Grass roots advocacy is essential to put health care reform on the political agenda at all levels. Key elements of reform include allocating responsibility for payment and establishing methods of cost control. States have achieved limited success in controlling costs and expanding access but a federal framework is necessary if real progress is to be made. PMID- 10128901 TI - Lobbying myths and realities. AB - "Hired guns" and big campaign contributions don't do the trick when industry or interest groups want to influence the course of health policy. A concentration on local matters--jobs and economic impact--gets a message across. Lobbyists should not limit their efforts to a small group of well-placed lawmakers. Any Member of Congress can help achieve your goals if you make your case. PMID- 10128902 TI - Oregon health initiative moves ahead. PMID- 10128903 TI - Ohio hunts for agreement on health reform. PMID- 10128904 TI - The financial evolution of hospitals and the zero-base budget approach. PMID- 10128905 TI - American Health Information Management Association. Position Statement. Issue: roles of health information managers and coders in patient-focused care. AB - Patient-focused care is a new model of care delivery organized around the patient instead of the hospital structure. Care is provided by multi-disciplinary teams of healthcare workers on the patient care unit. As many services as possible are brought to the patient, rather than taking the patient to a decentralized department. Successful models have demonstrated increased operational efficiency and greater levels of satisfaction among patients, physicians, and staff members. Administrative tasks done in a variety of departments may be assigned to a member of the care team. Such tasks may include patient registration; insurance verification and financial arrangements; and medical record assembly, analysis, abstracting, and coding. Given the different educational levels and prior training administrative team members may have, careful consideration must be given to assignment of the medical record abstracting and coding functions. The quality of clinical data submitted by all providers in the US is critically important to the future of the nation's healthcare system. Under prospective payment systems, the accuracy of clinical data abstracting and coding has a significant impact on healthcare facilities. But the need for accurate clinical data goes beyond payment systems. As more and more clinical data are being captured and maintained in databases across the country, for uses that may be yet unknown, it is essential that such data be collected consistently and accurately. To assure the quality and validity of health information, only trained, experienced coders should abstract and code the data.(ABSTRACT TRUNCATED AT 250 WORDS) PMID- 10128906 TI - American Health Information Management Association. Position Statement. Issue: the Joint Commission's unannounced surveys. AB - The Joint Commission on Accreditation of Healthcare Organizations (JCAHO) has begun conducting unannounced surveys of a random sample of accredited organizations in the mid-point of their accreditation cycles. These surveys focus on problem areas identified by accreditation surveys conducted the previous year. The American Health Information Management Association (AHIMA) firmly supports this change in Joint Commission accreditation procedures and believes the result will benefit patients and providers alike. Unannounced surveys by the Joint Commission, state departments of health, and others give providers an opportunity to validate their ongoing commitment to quality care. HIM professionals, who are committed to the ongoing provision of optimal patient care, should take the lead in supporting this concept and actively promoting its value to their colleagues and their communities. PMID- 10128907 TI - Clinton unveils health reform plan. PMID- 10128908 TI - Clinical Data Abstraction Centers. PMID- 10128909 TI - Clinton budget bill makes healthcare changes. PMID- 10128910 TI - Grass roots recruitment. Reaching out to the young. PMID- 10128911 TI - Why alternative care settings? PMID- 10128912 TI - HIM professionals in home care: they must march to the beat of a different drummer. PMID- 10128913 TI - The Bailey-Boushay House: an AIDS facility. AB - Currently, the cost of caring for an AIDS patient in a nursing facility is about half as much as for the same services provided in a hospital. With the current emphasis on reducing the cost of healthcare, the Bailey-Boushay House serves as a model for others interested in providing specialized care for AIDS patients in a similar setting. If similar facilities are planned there will be opportunities for health information managers to participate in planning for a new, or remodeling an existing, facility. Only an individual's imagination will limit the possibilities. PMID- 10128914 TI - The health information manager in a residential treatment facility: an innovator, a change agent, an educator. PMID- 10128915 TI - Physician's offices: the brightest spots in the healthcare universe. PMID- 10128916 TI - Hospice: the final frontier. PMID- 10128917 TI - Professional challenges and opportunities in long term care. PMID- 10128918 TI - Medical rehabilitation: challenges in managing health information of the specially challenged. PMID- 10128919 TI - Roles of health information managers and coders in patient-focused care. PMID- 10128920 TI - American Health Information Management Association. Position Statement. Issue: childhood immunizations. PMID- 10128921 TI - Practice applications of closing a medical record department. PMID- 10128922 TI - Legal issues in closing a medical record department. PMID- 10128923 TI - Contemporary issues in HIM. The application layer. AB - In the early years of computing, manufacturers usually sold general purpose computer systems to their customers. These systems had only a minimal set of software components. End users normally would have to work with analysts, programmers, and operators to get applications developed and executed. Personal computers, workstations, or terminals connected to larger timeshared systems, are readily available to many computer users. Multitudes of new software packages allow these employees themselves to utilize computer resources. Such packages typically are grouped together as an application layer on top of the OS. In this article, we looked at one important component of that layer--information management systems. We will look at more applications in the next two articles. PMID- 10128924 TI - Securing effective media contacts. PMID- 10128925 TI - The health information manager as lawmaker. AB - The authors argue that the economic well-being of the healthcare industry depends on the work of its health information managers. These managers will play a critical role in guiding the transformation to electronic records and in shaping the laws that will govern these records. PMID- 10128926 TI - The role of the health information management department in hospital risk management. AB - The HIM department plays a great part in risk management. With appropriate risk management safeguards, the threat of medical malpractice claims can be reduced. This article discusses the use of the medical record in the risk management process. PMID- 10128927 TI - Veterans Health Administration develops national health care plan (NHCP). AB - The Veterans Health Administration faces some strong shifts in the demographics of its healthcare patients. This article sets out the VHA's plan to provide the comprehensive care that the veterans will need. Healthcare networks underlie the national plan. PMID- 10128928 TI - Optical imaging the "Right" way. AB - Optical imaging systems can help lead the way to the computer-based patient record. This article addresses several security clearance issues that these systems raise and tells how one facility responded to them. PMID- 10128929 TI - Challenges for the health information management curriculum. AB - An effective education in health information management must focus on critical thinking and dynamic classroom relationships, not rote memorization and passive learning. This article lays out this challenge facing modern educators and offers criteria against which programs can be measured. PMID- 10128930 TI - The effects of computer monitoring on the medical transcriptionist's performance and stress. AB - This study serves to evaluate the effects of computer monitoring on the performance of medical transcriptionists. The results of the study show that performance increases in the monitored state but that perceived levels of stress decrease in the monitored state. Previous studies are discussed in light of health information managers' use of monitoring technology to increase the effectiveness of medical transcriptionists. PMID- 10128931 TI - Quality management forces computerization decisions. AB - It is unlikely the quality management program of the future will be able to effect quality improvements without sophisticated information management tools, one of which is the computer. While computerization is not required by the Joint Commission's Performance Assessment and Improvement Standard nor the Information Management Standard, both standards compel organizations to improve their information system capabilities. If the hospital quality management office attempts to survive without computerization, its ability to manipulate the many data elements required for measurement, assessment and improvement will be severely limited. Begin now to plan your computerization strategy. PMID- 10128932 TI - 1993 AHIMA software guide. PMID- 10128933 TI - Medical records: a fascinating journey. PMID- 10128934 TI - American Health Information Management Association Position Statement. Issue: authorship. PMID- 10128935 TI - How will the new functional 1994 standards be surveyed? PMID- 10128936 TI - Computer security. AB - Many factors are contributing to any increased awareness of and interest in computer security. This article has described two aspects of computer security, identification of users and cryptography as a tool for data security. We looked at a number of ways to verify the identity of a user, including things a person knows, has, or is. Combinations of techniques were considered as a means of increasing security. Next, we looked at some simple examples of cryptosystems, including the rail fence cipher (a transposition technique), and the Caesar cipher (a substitution technique). Two computer systems were described, DES (a product cipher), and RSA (a cipher based on exponentiation and the mod operation). PMID- 10128937 TI - Obstacles to computerizing the patient record. PMID- 10128938 TI - Electronic medical record systems as a basis for computer-based patient records. AB - In summation, some document imaging systems offer the capability to form what may be called electronic medical record (EMR) systems. These systems are adaptations of current paper-based record management systems into the digital environment, but they offer far more capabilities than strictly archival, historical functions. Some of the capabilities that create EMR systems will also be necessary for development of CPRs, these capabilities are listed as follows: mass storage and image management; direct capture, storage, and retrieval of digital information (native format); large volume, high-speed, client-server networks; multi-media information management; high-power, flexible database tools; workflow process software; flexible, full function security; user customizable features; and alerts and reminders. Selection and implementation of document imaging systems should, at present, be undertaken with great care to insure that the platform may be utilized to form an electronic medical record with a clear migration path to the CPR. PMID- 10128939 TI - The integration of existing specialized clinical information systems into a computer-based patient record. PMID- 10128940 TI - Shared word processing on a local area network (LAN): do the benefits outweigh the risks? PMID- 10128941 TI - Hand-held and pen-based computing: empowering technology for the computer-based patient record. PMID- 10128942 TI - The impact of automated medical record tracking systems on the ability to reduce staff--a research study. PMID- 10128943 TI - The transition from signature to authorship. PMID- 10128944 TI - Expanding the role of the medical record department. PMID- 10128945 TI - Preparing for the future: job redesign. PMID- 10128946 TI - Congress at work: an overview of the legislative process. PMID- 10128947 TI - ADR (alternative dispute resolution) mechanisms for medical liability claims: an overview of state and federal proposals. PMID- 10128948 TI - State-level health care initiatives pose new problems for surgeons. PMID- 10128949 TI - Scheduling pediatric appointments: a case for business process improvement. PMID- 10128950 TI - A pragmatic approach to nurse scheduling. PMID- 10128951 TI - Computerized staff scheduling: opportunities and obstacles to success. AB - Staff scheduling can be a process fraught with failure, drudgery, and frustration. While computerization of staff scheduling can greatly enhance the process, computerization alone is not a panacea. Successful scheduling depends on the existence of effective management systems, including FTE and position control, proper request management, well-defined data, and work-flow and time line management. The best espresso in the world requires good coffee beans. PMID- 10128952 TI - Patient-centered ambulatory care scheduling. PMID- 10128953 TI - Building a patient scheduling system. PMID- 10128954 TI - A staff scheduling system in a long-term facility. PMID- 10128955 TI - Centralized outpatient appointment center. PMID- 10128956 TI - Automated patient and staff scheduling in a managed care environment. PMID- 10128957 TI - Operations improvement at University of Maryland Medical System helps "reinvent the academic hospital" over long term. PMID- 10128958 TI - Acute care design: emerging trends. PMID- 10128959 TI - Design research: cross-cultural sensitivities in design. PMID- 10128960 TI - Design research: defining & conveying design value. PMID- 10128961 TI - Design research: ambulatory clinic design--the case of dialysis facilities. PMID- 10128962 TI - Design technology: selecting appropriate colors for healthcare. PMID- 10128963 TI - Design technology: environmental fragrancing. PMID- 10128964 TI - Design technology: beyond silence--music as environmental design. PMID- 10128965 TI - Healing environments: healing by design--therapeutic environments for healthcare. PMID- 10128966 TI - Healing environments: creating a total healing environment. PMID- 10128967 TI - Acute care design: developing a new healthcare delivery model through collaboration. PMID- 10128968 TI - Healing environments: environmental awareness & healing. PMID- 10128969 TI - Healing environments: the human experience. PMID- 10128970 TI - Long-term care design: 16 solutions to implement on Monday morning. PMID- 10128971 TI - Long-term care design: the new generation. PMID- 10128972 TI - Healthcare design competition. Bennett Cancer Center at Stamford Hospital; interactive lighting proposal; bedside control module; child's playstation; Medifacs. PMID- 10128973 TI - Healthcare environment awards. Department of Cardiothoracic Surgery, Columbia Presbyterian Hospital; Woodside Place, Presbyterian Medical Center. PMID- 10128974 TI - Product design competition. Bentwood Rose chair; Prescriptions for Healthcare carpeting, Nuts & Bolts fabric; Concert flooring; Series 21000 seating. PMID- 10128975 TI - Exemplary healthcare facilities. PMID- 10128976 TI - Acute care design: San Diego Children's Hospital & Health Center addition. PMID- 10128977 TI - Keynote address: the new generation of healthcare & design. PMID- 10128978 TI - Acute care design: the new generation. PMID- 10128979 TI - Ambulatory care design: emerging trends. PMID- 10128980 TI - Ambulatory care design: the integrated medical campus. PMID- 10128981 TI - Ambulatory care design: exploring the dimensions of change. PMID- 10128982 TI - Ambulatory care design: the new generation. PMID- 10128983 TI - Art for health: emerging trends. PMID- 10128984 TI - Art for health: the art of healing--St. Joseph's Hospital. PMID- 10128985 TI - Art for health: the new generation. PMID- 10128986 TI - Design research: emerging trends. PMID- 10128987 TI - Supply meets demand: hospital to tie critical paths, purchasing. PMID- 10128988 TI - From sticky methods to bundled charges: the change process. PMID- 10128989 TI - Point-of-use inventory in cardiac cath labs. PMID- 10128990 TI - Crucial issues in critical care consumables. PMID- 10128991 TI - Health reform will give department managers closer ties with the CEO. PMID- 10128992 TI - Effective reprocessing: a key to instrument longevity. PMID- 10128993 TI - Lots of second opinions. Clinton's plan is heading for an operating room full of lobbyists. PMID- 10128994 TI - Picture of health. PMID- 10128995 TI - Out in the cold? Clinton hates to mention it, but some rationing of care is likely with reform. PMID- 10128996 TI - Here comes Doctor No. PMID- 10128997 TI - Healthy dissent. PMID- 10128998 TI - Quality improvement principles power new strategic and financial planning process. PMID- 10128999 TI - Using TQM to forge customer-driven strategic planning. PMID- 10129000 TI - Total quality, strategic planning, and community benefit: are they compatible or contradictory? AB - Strategic planning has traditionally been a business activity, in which an analysis of market forces and organizational mission leads to major business goals for the future, from new programs and services to entirely new facilities, systems, and even new organizational models. The integration of TQM principles focuses strategic planning more on meeting the needs and expectations of customers and less on emulating the competition, and it aligns strategic initiatives with improvement efforts. In this Perspective, William Corley says that, once TQM and strategic planning have been integrated, the next phase is both necessary and inevitable: focusing strategic planning and improvement efforts around community health needs. But what will it take to make the paradigm shift? PMID- 10129001 TI - How well does your organization's strategic planning process reflect total quality philosophies? A management assessment and planning tool. PMID- 10129002 TI - Data watch. Health care benefits: a historical perspective. PMID- 10129003 TI - Employers shun HMOs to retain employee choice. AB - While health reform has focused on HMOs, employers favor a middle ground with point-of-service plans. Consumer acceptance of health networks will be gradual, they argue. PMID- 10129004 TI - Eleven steps to health reform. PMID- 10129005 TI - Making health care work in rural communities. AB - Rural employees are experimenting with purchasing cooperatives to reward local providers for delivering cost effective care. Two rural communities share their attempts to improve and quality of local health care delivery. PMID- 10129006 TI - Employers give managed competition a new spin. AB - Redefining managed competition, employers adopt group purchasing and competitive bidding for provider services. The common underpinning is rewarding quality and efficiency. PMID- 10129007 TI - The case for a new cooperative spirit. PMID- 10129008 TI - Health reform: employers lead the way. PMID- 10129009 TI - Clinton's hard sell. PMID- 10129010 TI - But what does it mean for me? PMID- 10129011 TI - Muddling through the message. Health care: why you can't tell the players without a program. PMID- 10129012 TI - Another taxing dilemma. Health-care reform: can Clinton make the numbers add up? PMID- 10129013 TI - Medicaid program; qualified family members--HCFA. Final rule. AB - Under the Aid to Families with Dependent Children (AFDC) program, certain States may elect to limit the number of months of benefits provided to families who are eligible by reason of the unemployment of the principal wage earner. This final rule ensures that States that exercise this option continue to provide Medicaid to qualified family members beyond the time when AFDC ends solely because of the State's election of a time limit. This final rule conforms the regulations with sections 1902(a)(10)(A)(i)(V) and 1905(m) of the Social Security Act, as added by section 401(d) of the Family Support Act of 1988. PMID- 10129014 TI - Civilian Health and Medical Program of the Uniformed Services (CHAMPUS); fiscal year 1994 updates--Office of the Secretary, DoD. Notice of updated mental health per diem rates. AB - This notice provides for the updating of hospital-specific per diem rates for high volume providers and regional per diem rates for low volume providers; the updated cap per diem for high volume providers; and the beneficiary per diem cost share amount for low volume providers to be used for FY 1994 under the CHAMPUS Mental Health Per Diem Payment System. PMID- 10129015 TI - Medicare program; criteria and standards for evaluating intermediary and carrier performance during FY 1994--HCFA. General notice with comment period. AB - This notice describes the criteria and standards to be used for evaluating the performance of fiscal intermediaries and carriers in the administration of the Medicare program beginning October 1, 1993. The results of these evaluations are considered whenever HCFA enters into, renews, or terminates an intermediary agreement or carrier contract or takes other contract actions (for example, assigning or reassigning providers of services to an intermediary, or designating regional or national intermediaries). This notice is published in accordance with sections 1816(f) and 1842(b)(2) of the Social Security Act. We are publishing for public comment in the Federal Register those criteria and standards against which we evaluate intermediaries and carriers. PMID- 10129016 TI - Civilian Health and Medical Program of the Uniformed Services (CHAMPUS); reimbursement of providers, claims filing, and participating provider program- Office of the Secretary, DoD. Final rule. AB - This final rule implements provisions of the Department of Defense Appropriations Act, 1993, section 9011, which limits increases in maximum allowable payments to physicians and other individual professional providers (including clinical laboratories), authorizes reductions in such amounts for overpriced procedures, provides special procedures to assure beneficiary access to care, and establishes limits on balance billing by providers. Also, the final rule implements a provision of the National Defense Authorization Act for Fiscal Year 1992 that requires providers to file claims on behalf of CHAMPUS beneficiaries, builds into the CHAMPUS Regulation provisions that have been in effect for several years regarding the Participating Provider Program, and implements a new approach for CHAMPUS reimbursement for ambulatory surgery. PMID- 10129017 TI - Health maintenance organizations; exclusion of gamete intrafallopian transfer and zygote intrafallopian transfer as basic health services--HCFA. Notice. AB - This notice informs the public of the determination by the Administrator of the Health Care Financing Administration that gamete intrafallopian transfer and zygote intrafallopian transfer are unusual, infrequently provided, and not necessary for the protection of individual health. This determination permits Federally qualified health maintenance organizations to exclude these services from the basic health services they must provide to their members. PMID- 10129018 TI - Civilian Health and Medical Program of the Uniformed Services (CHAMPUS); fiscal year 1994 updates--DoD. Notice of updated partial hospitalization per diem rates. AB - This notice provides for the updating of per diem rates for both full-day and half-day CHAMPUS Partial Hospitalization Programs for fiscal year 1994. PMID- 10129019 TI - Health maintenance organizations; qualification determinations and compliance actions during the period April 1, 1993, through June 30, 1993--HCFA. Notice. AB - This notice sets forth the names, addresses, service areas or modified service areas, and dates of qualification or expansion of entities determined to be Federally qualified health maintenance organizations (FQHMOs) during the period April 1, 1993, through June 30, 1993. Additionally, this notice sets forth compliance actions taken by the Office of Prepaid Health Care Operations and Oversight for the period April 1, 1993, through June 30, 1993. This notice is being published in accordance with our regulations set forth at 42 CFR 417.144 and 417.163, which require publication in the Federal Register of certain determinations relating to FQHMOs. PMID- 10129020 TI - 1993 Muriel Driver Lecture. Occupational therapy's social vision. AB - Occupational therapy has tremendous, unfulfilled potential. The lecture critically analyzes that potential in light of occupational therapy's social vision. The analysis is built on emerging views of occupational therapy's core philosophy of client-centered practice using the ordinary occupations of daily life as a form of therapy. Critical analysis shows that foundational features of occupational therapy are consistent with foundational features of social justice. However, analysis also shows that occupational therapy's social vision is narrowed to comply with dominant community, managerial and medical approaches to disability and aging. Given therapists' good intentions, critical analysis is unnerving, but it provides a guide for transforming practice and developing occupational therapy's potential. PMID- 10129021 TI - Involving clients in programme evaluation and research: a new methodology for occupational therapy. AB - Eliciting client satisfaction with services has become common in mental health settings and in the planning of service delivery systems. It is also compatible with the client-centred practice of occupational therapy. The traditional approach to collecting satisfaction information involves staff interviewing clients using questionnaires developed by staff. However, there is often a lack of variability in responses and the vast majority of clients report being satisfied. A review of the literature reveals that these favourable reports may be a result of social desirability and of clients being interviewed by treatment providers who have the power to give or withhold care. This paper reviews the relationship between occupational therapy and client involvement, examines the rationale for involving clients in programme evaluation and research, reviews the limitations with traditional methods of collecting information about client satisfaction, and discusses how clients are involved in evaluation and research in today's mental health care setting. PMID- 10129022 TI - Clinical programme management: a model of promise? AB - As professionals working within a rapidly changing health care environment, it becomes critical to recognize alternatives for the management of clinical services to maximize the use of resources. However, it is also critical to remain constantly aware of the needs of valued and valuable employees, ensuring that the quality of working life is considered whenever any decisions are being made which will affect the work place. This paper reviews some of the literature related to decentralized structural models for health care institutions, and details the selection and implementation of one model in a major teaching hospital. The process of development from the initial idea through to the actual operationalization of a clinical programme management model is outlined, providing a critique of strengths and weaknesses of the model in the context of this particular organization. PMID- 10129023 TI - Managing diverse occupational therapy resources in a creative, corporate model. AB - Two occupational therapy departments were amalgamated into a corporate whole and charged with the development of a workable, corporate structure. The departmental model which was developed served to enhance the concepts of quality of working life, employee autonomy, management team and quality circle theory. This paper provides a background from business and organizational literature, and outlines the development of the departmental model, in concert with the adoption of the client-centred model of occupational performance as a department basis for practice. This development was taking place concurrently with larger, institutional changes into a decentralized clinical programme management model. Discussion highlights the level of staff satisfaction with the changes, areas of concern during the development of the system and plans for the future growth. During this period of massive and critical change in the delivery of health care services, there has been a trend in restructuring health care institutions towards decentralized models. This paper will describe the experience of one occupational therapy department in developing an innovative departmental structure involving participatory management amalgamation. It is believed that the experience of the past occupational therapy work units with one viable option for a renewed management model. Staff skill sets can be maximized and optimal potential realized while faced with inevitable resource shrinkage and service reorganization. PMID- 10129024 TI - Facing the competitive side of home care. AB - As home care continues to increase in popularity, so increases the competitive pressure on home care agencies. The key to agency success is solid relationships with the people and organizations with whom they conduct business. PMID- 10129025 TI - Quality--a natural incentive for working together. AB - Agencies must work together to present a united front in advancing home care as a major player in the new health care arena. Improving the industry from the ground up through both cooperation and competition using Total Quality Management substantiates the claim that home care is the way to go for the '90s. PMID- 10129026 TI - Maintaining a focus to increase competitiveness. AB - If articulated well, an agency's vision will lead personnel to provide the best service possible. This internal vision increases the competitive abilities of the agency in the marketplace. PMID- 10129027 TI - Continuous quality improvement in home care: do it right the first time. AB - Continuous quality improvement is a movement from the standard definitions of quality, which looked back at work already done, to a method of prevention. This involves defining and meeting customer needs, leading to exemplary service. But this increase in competitive ability has to start from cooperation within the agency--cooperation for prevention. PMID- 10129028 TI - Cooperation in competition--e pluribus unum. AB - For health care reform to be successful for the home care industry, the watch words are cooperation in competition. With all agencies presenting a unified front, home care and hospice may become leaders in the health care of the next century. PMID- 10129029 TI - Cooperation within--the patient care team advantage. AB - As the demand for post-hospital health care increases, one home care agency has developed a referral process that makes the transition from hospital to home as smooth as possible for both patients and health care professionals. PMID- 10129030 TI - Genesys Health System--collaboration for consolidation. AB - The story of Genesys Health System's heritage and mission dates back to the 1600s with the Sisters of St. Joseph. For more than three centuries the Sisters have devoted their lives to caring for and healing people in need, however appropriate and wherever necessary. St. Joseph Hospital has provided health care to the community since its establishment in the 1920s when the Sisters brought their mission to Flint. PMID- 10129031 TI - Curaflex finds its niche. AB - Rather than being a jack of all trades, one company decided to become master of one: infusion therapy. By working collaboratively with the community and experts in the field to develop programs to serve patients and the community, Curaflex has become a top competitor in the field. PMID- 10129032 TI - Cooperation or competition? Collaboration between home care & case management. AB - The home care industry has had an up-and-down relationship with case management. This article presents models of collaboration that are successful in facilitating positive patient outcomes. PMID- 10129033 TI - The PACE (Program of All-Inclusive Care for the Elderly) model--success in cooperation. AB - The Program of All-Inclusive Care for the Elderly (PACE) received high marks when it was evaluated. This article describes how a multidisciplinary team can work together for the sake of comprehensive care. PMID- 10129034 TI - Monthly cost reporting--cooperating & competing through sound financial management. AB - In today's competitive environment, home care agencies need sound financial management not only to compete but to survive. Using the Medicare Home Health Agency Cost Report as a tool, any home care agency can assess its relative strengths and weaknesses quickly and consistently. PMID- 10129035 TI - Home office cost reporting. AB - Diversified agencies may provide a broad range of services, such as private-duty nursing, hospice, and infusion therapy. How can such an agency make sure amidst complicated operations that it is operating at peak efficiency? PMID- 10129036 TI - Home care standards--a necessity for quality. AB - The benefits of accreditation are twofold: by adhering to national standards individual agencies can improve the quality of the care they provide and gain recognition in their communities, in turn bolstering the entire industry's image. The accreditation programs of both the Joint Commission on Healthcare Accreditation and the Community Health Accreditation Program offer guidance on internal quality assessment--a must for any agency's success. PMID- 10129037 TI - Strategic focus. A game plan for collaboration in a competitive marketplace. AB - How can home care agencies brace for the coming changes and not only survive health care reform, but thrive in it? Collaboration is an effective tool for gaining competitive advantage in the marketplace. PMID- 10129038 TI - Dorenfest 3000+ Database enters restless seventh year. AB - The seven-year itch may have struck the founder of one of the most comprehensive information systems databases for healthcare in the country. The database itself has undergone substantive changes, and, what is more, Sheldon Dorenfest is looking for partners. PMID- 10129039 TI - Hospital saves with bedside point-of-care system. AB - Do bedside and point-of-care systems actually deliver on their promise of reducing operating expenses while helping improve the overall quality of healthcare? And how does a healthcare facility quantify associated "productivity" improvements to prove cost savings? These are two critical issues that healthcare providers face in implementing a bedside or point-of-care (POC) system. Barnes Hospital, St. Louis, is a 1,000 bed member facility of the Barnes-Jewish Inc./Christian Health Services integrated health system. Barnes Hospital has indeed seen significant cost savings as a result of a POC project. PMID- 10129040 TI - On the edge of healthcare reform. AB - The chief executive officer and president of Bayfront Medical Center, St. Petersburg, Fla., says healthcare providers must use information tools to demonstrate quality at comparably low costs. There's not enough time to wait for the reform landscape to change. Decisionmakers must act now. PMID- 10129041 TI - What hospitals expect today from clinical systems. AB - Technology will always be a factor in hospital information system buys. But customers are increasingly looking for vendors that create a sincere, responsive sales relationship. In the end, the quality of support and understanding users receive can make or break a sale. PMID- 10129042 TI - Product overview hotList. Electronic medical records. AB - October's HotList features electronic medical record systems. Because there are a number of components associated with electronic medical records and limited space, only those companies that claim to have a comprehensive medical electronic medical records system are included in this list. Firms offering only components of the medical record, ancillary systems, consultant services, storage systems or other products not comprising a complete electronic medical record were asked not to submit information for this particular HotList. All data have been provided by individual vendors who responded to survey questions. Computers in Healthcare has made an effort to contact all vendors within this market. See the 1993 Computers in Healthcare Market Directory for complete listings. PMID- 10129043 TI - Good training has never been more important. PMID- 10129044 TI - The pendulum swings both ways...TB--old disease, new headache. PMID- 10129045 TI - Education. The key to management in the '90s. PMID- 10129046 TI - AIDS in the workplace. PMID- 10129047 TI - Non-profit software directory. PMID- 10129048 TI - FDA finds new ways to speed treatment to patients. PMID- 10129049 TI - User fees to fund faster reviews. PMID- 10129050 TI - Women & AIDS. PMID- 10129051 TI - Health reform: let's do it right. AB - Look inside Clinton's plan, and you can find the elements of a sleek, market based system--but his proposed price controls could crush it. PMID- 10129052 TI - Congress's fight over your future. AB - In the lobbying battle of the decade, America's most powerful interests will reshape Clinton's health proposal. Here's what's likely to happen. PMID- 10129053 TI - Why CEOs aren't buying the plan. AB - In an exclusive poll, they mostly say they accept Clinton's goal of universal health care. But they're deeply skeptical of his approach and fear its effects. PMID- 10129054 TI - Foundations give added incentive for collaboration. PMID- 10129055 TI - Planning for the future of behavioral health services. AB - Psychiatric and chemical dependency services are increasingly being delivered through managed care with greater emphasis on ambulatory and outpatient treatments. Inpatient facilities can preserve their involvement in behavioral health services by actively developing a managed care product line. This article describes the nature of change in behavioral services, what competitive behavioral health providers will look like in the future, and the actions hospital administrators should be taking now. PMID- 10129056 TI - Integrated systems face major hurdles, regulations. AB - As the Clinton health care reform plan is debated, hospitals are preparing their revised strategic plans. Donald E.L. Johnson looks at integrated health care delivery systems in light of state and federal regulations. PMID- 10129057 TI - Strategy and the art of reinventing value. AB - In "From Value Chain to Value Constellation: Designing Interactive Strategy" (July-August 1993), Richard Normann and Rafael Ramirez argue that successful companies increasingly do not just add value, they reinvent it. The key strategic task is to reconfigure roles and relationships among a constellation of actors- suppliers, business partners, customers--in order to mobilize the creation of value in new forms and by new players. What is so different about this new logic of value? It breaks down the distinction between products and services and combines them into activity-based "offerings" from which customers can create value for themselves. But as potential offerings become more complex, so do the relationships necessary to create them. As a result, a company's strategic task becomes the reconfiguration and integration of its compentencies and customers. Normann and Ramirez provide three illustrations of these new rules of strategy. IKEA has blossomed into the world's largest retailer of home furnishings by redefining the relationships and organizational pratices of the furniture business. Danish pharmacies and their national organization have used the opportunity of health care reform to reconfigure their relationships with customers, doctors, hospitals, drug manufacturers, and with Danish and international health organizations.(ABSTRACT TRUNCATED AT 250 WORDS) PMID- 10129058 TI - Crime in hospitals 1986-1991--the latest IAHSS surveys. AB - Highlights of the results of the annual IAHSS surveys on crime in hospitals for 1990 and 1991 are reviewed. Additional information is presented in 19 tables. These include a table comparing survey results for the years 1986-1991, plus detailed tables on 1991 results in selected categories. PMID- 10129059 TI - The use of off-duty police as additional security in an emergency department setting. AB - The author discusses the use of off-duty police officers to reduce violence in a hospital's emergency room. He provides the results from an assessment of the program. PMID- 10129060 TI - Health care security management: cross-cultural perspectives on communications skills, training and competencies. PMID- 10129061 TI - Personal protection devices: a case for noisemakers. AB - The author explores alternative methods for preventing and responding to an attempted assault and presents a convincing argument for the use of noisemakers. PMID- 10129062 TI - Managing the evacuation of a child care center. AB - The author gives the case history of an evacuation of a child care center and its temporary location at his medical center. Advance planning, he says, is the key to any emergency. PMID- 10129063 TI - Change in the health care field: confronting the issues. AB - Economic survival is a primary concern today of businesses and institutions alike, and change as a strategy of survival is occurring at a rapid pace in the health care field. This article may be useful as a starting point for understanding the concept and its implications. PMID- 10129064 TI - Security + service = total quality management. PMID- 10129065 TI - Accident investigations: how to ask why. AB - With a little psychology and a lot of common sense, says the author, you can get more out of interviews with accident witnesses. Don't be tempted to speculate on an accident's cause before you hear all the testimony. PMID- 10129066 TI - Long distance telephone fraud and abuse. AB - The article discusses the difference between abuse and fraud, the cost of fraud to a business, how fraud is accomplished, and ways to combat long distance fraud. PMID- 10129067 TI - A team approach to fraud prevention. AB - The author discusses the importance of a fraud prevention program and why a team approach--auditor plus security loss prevention manager--works in the healthcare industry. PMID- 10129068 TI - Justifying budget requests for FTEs. PMID- 10129069 TI - The New York State Security Guard Act of 1992--a summary. PMID- 10129070 TI - A tonic for hospital security. AB - Changing times require innovative responses from hospital administrators and their staffs. The author relates how the success of the security program at his hospital shows the benefits of a nontraditional, supportive approach to security. PMID- 10129071 TI - Gaining a competitive edge through benchmarking. PMID- 10129072 TI - Standards, benchmarks, and benchmarking in total quality management. PMID- 10129073 TI - Acute care management in a long-term care facility. PMID- 10129074 TI - New proposed standards for JCAHO's 1995 manual. PMID- 10129075 TI - Organizational leadership in hospitals. AB - Hospitals face very dynamic environments and must meet diverse needs in the communities they serve and respond to multiple expectations imposed by their stakeholders. Coupled with these variables, the fact that leadership in these organizations is a shared phenomenon makes organizational leadership in them very complicated. An integrative overview of the organizational leadership role of CEOs in hospitals is presented, and determinants of success in playing this role are discussed. PMID- 10129076 TI - Increasing the effectiveness of healthcare managers. Horizontal and vertical information linkages. AB - In the healthcare industry, there is an increasing number of managers who operate clinics geographically separated from the administration and from other managers. Physical distance creates barriers to communication and also inhibits psychological attachment to the healthcare organization. This can result in dysfunctional management styles, with managers appearing passive, overly independent, or isolated. By choosing the best communication medium as well as the most appropriate information linkages, the administrator can improve the effectiveness of managers. Specific intervention strategies are offered for correcting dysfunctional behaviors in healthcare settings. PMID- 10129077 TI - Creating a satisfying practice setting for physicians. The experience of a hospital-based group practice. AB - Medical groups are challenged to develop a satisfying context for physicians to deliver patient care. This article reports on the efforts of the Lovelace Medical Center and the Lovelace Clinic, P.C. (professional corporation), in Albuquerque, New Mexico, to create a distinctive environment for its medical staff members. A job-design model is examined wherein core job characteristics and physician growth-need strength influence critical psychological states and satisfaction. The results of this longitudinal study suggest that from the perspective of primary care physicians, the practice setting at Lovelace has improved markedly between 1984 and 1990. In addition, fewer changes were observed for specialists, ostensibly due to extremely favorable perceptions of the practice setting at Lovelace during this time period. The implications of these results point primarily to the value of consciously designing and periodically monitoring the practice environment within medical groups. PMID- 10129078 TI - Achieving smoke-free hospitals. Tips for administrators. AB - Almost thirty years have passed since the surgeon general of the United States released the first report on the effects of smoking (U.S. Department of Health, Education, and Welfare 1964). Over the ensuing years, further reports have expanded our knowledge of the widespread physiological effects of tobacco smoke and those at greatest risk (U.S. Department of Health, Education, and Welfare 1979; U.S. DHHS 1987, 1991, 1992; American Medical Association 1989). Subsequently, there has been a dramatic decrease in the number of smokers; more than thirty-six million Americans have quit smoking since the surgeon general's report (U.S. DHHS 1987, 7). Supporting this trend are the surgeon general's national health objectives for the year 2000 to achieve smoke-free work environments (Koop 1985). All of these trends contribute to current efforts to make hospitals smoke-free environments. PMID- 10129079 TI - Information technology and managed care. AB - Information processing in the managed care marketplace is becoming increasingly complicated and expensive. Managed care organizations are finding that the ability to process information effectively and efficiently is the only way to maintain a competitive edge. This article provides an overview of information needs and system requirements from the perspective of healthcare providers. It offers information about computer software, electronic data interchange and databases, as well as brief case reports on some of their uses. PMID- 10129080 TI - How immigration laws affect hospitals. AB - The Immigration Nursing Relief Act of 1989 (INRA) fundamentally altered the system by which healthcare facilities obtain temporary (H-1A) working status for foreign-born nurses. Its follow-up, the Immigration Act of 1990 and its 1991 amendments, modified the immigration process with respect to all employers of foreign-born temporary professional workers (H-1B). PMID- 10129081 TI - Healthcare reform: a contrarian's view. PMID- 10129082 TI - National health reform. Fact finding vs. truth finding. PMID- 10129083 TI - With all due respect. Seccombe Design Associates re-invents senior living at the Stratford in San Mateo, California. PMID- 10129084 TI - A search for quality and value in health care. Cincinnati initiative targets physician-specific data. AB - In response to double-digit health care inflation, Cincinnati employers joined forces to compare costs and outcomes at the city's hospitals. Here's how one hospital is using physician-specific data to improve quality and keep costs down. PMID- 10129085 TI - How the Blues are using health care data. AB - Insurers are investing in information technology to provide the data that are essential to the management of their delivery systems. A Blue Cross and Blue Shield medical director explains some practical applications, including outcomes evaluation, provider selection and practice pattern comparisons. PMID- 10129086 TI - Women physicians make slow but steady progress. Interview by C. Burns Roehrig. AB - The chair of the American Medical Association's Women in Medicine Advisory Panel discusses the obstacles that women physicians continue to face--and the contributions they are making to the profession. PMID- 10129087 TI - Congress and internal medicine: how'd they do? PMID- 10129088 TI - What information do consumers need? A conversation with Shoshanna Sofaer, DrPH. Interview by Diana Madden. AB - Under a reformed health care system, what information will help consumers evaluate health care providers and plans? A member of the White House health care task force provides her perspective. PMID- 10129089 TI - Legal issues in caring for the abused spouse. PMID- 10129090 TI - Community intervention: the value of teamwork. PMID- 10129091 TI - Taking HCFA into a new era of reform. Interview by C. Burns Roehrig. PMID- 10129092 TI - Clinton's health plan: what does it mean for internists? PMID- 10129093 TI - Point-of-service option would preserve choice. PMID- 10129094 TI - Information technology brings us to the threshold of a new era. PMID- 10129095 TI - The necessity of reform. American Society of Internal Medicine. PMID- 10129096 TI - Practice guidelines and their ethical implications. PMID- 10129097 TI - Domestic violence: making realistic interventions in a primary care setting. PMID- 10129098 TI - In these hallowed halls. Health care and the 73rd Texas Legislature. AB - The sunset review of 20 health agencies and a package of legislation addressing psychiatric, chemical dependency and rehabilitation hospitals were high profile issues during the 73rd Texas Legislature. However, funding for health and human services presented the greatest challenge to hospital advocates. PMID- 10129099 TI - 1993-1994 Texas Hospital Association leadership guide. PMID- 10129100 TI - Trustees must broaden focus as market changes. PMID- 10129101 TI - Health/PAC and the uncertainty principle. PMID- 10129102 TI - Coming full circle. Lessons from health care organizing. PMID- 10129103 TI - Make-up in the morgue. Liberal reform and American health care. PMID- 10129104 TI - 'To make a difference'. The Lincoln Collective. AB - The Lincoln Collective was born in 1970 as a grassroots effort of health and community workers to start the kind of nonhierarchical community-oriented program described in this article. The idea of two residents who were already at Lincoln Hospital, the notion was given official approval because of the influx of young, American-trained physicians and nurses it would bring. But, as the experiment was advertised by word of mouth to members of the Student Health Organization, the Medical Committee for Human Rights, and other health workers involved in antiwar activities, the hospital, administration got more than it bargained for. PMID- 10129105 TI - The leap to health care reform. Starting from a different place. PMID- 10129106 TI - The more things stay the same ... the evolution of the hospital dinosaurs. PMID- 10129107 TI - Notes of a slow learner. Homelessness in the past decade. PMID- 10129108 TI - Letting their voices be heard. The role of legal advocacy in working for social justice. PMID- 10129109 TI - Health/PAC. 25 years of fighting for health & social justice. PMID- 10129110 TI - The rise of the health care consumer. PMID- 10129111 TI - From transplant recipient to health care access advocate. PMID- 10129112 TI - Do something about women's health. Now. WHAM! (Women's Health Action and Mobilization). PMID- 10129113 TI - Random thoughts of a health activist. PMID- 10129114 TI - We have seen the enemy. It isn't us. PMID- 10129115 TI - What we've learned about containing health care costs. PMID- 10129116 TI - The health care reform two-step. One forward, two back. PMID- 10129117 TI - Arising from the ashes. The new health reform movement. PMID- 10129118 TI - Are you on the bus or off? PMID- 10129119 TI - Time to think about winning. PMID- 10129120 TI - The experience of Health/PAC. Interview by Walter J. Lear. PMID- 10129121 TI - Round table ... management development. AB - Management development in the NHS has reached a hiatus, yet there are no apparent moves from the centre to address this. The Journal brought together senior figures from the four dedicated management development providers in an informal round table discussion, chaired by Rob MacLachlan, to open the debate. PMID- 10129122 TI - Ghostbusters. PMID- 10129123 TI - Captive market. PMID- 10129124 TI - Ifs and butts. PMID- 10129125 TI - No view from the bridge. PMID- 10129126 TI - Doors of perception. PMID- 10129127 TI - Simply sausages? PMID- 10129128 TI - Measure for measure. PMID- 10129129 TI - No more corporate fudge. PMID- 10129130 TI - Home truths. PMID- 10129131 TI - Street talk. PMID- 10129132 TI - Village people. PMID- 10129134 TI - Lifetime costs of treating AIDS patients decreasing. PMID- 10129133 TI - Data briefing. Yardstick for health. PMID- 10129135 TI - How to use structured decision making in developing therapeutic, cost-effective formulary systems. AB - The formulary decision-making process must evolve from a system which places a greater emphasis on the financial factors to one which includes therapeutic and patient outcomes. Ideally, all available options and possible consequences of a decision--economic as well as clinical--should be examined by P & T Committees. In this article, three methods to assist in formulary selection and management activities are described: the inventory management approach, the cost accounting approach, and the criteria-based protocol approach. All three methods have a place in the overall development and management of an effective therapeutic formulary system. PMID- 10129136 TI - How effective are antibiotic streamlining programs in reducing length of stay and cutting hospital costs? PMID- 10129137 TI - Health care reform: pharmaceutical industry sees itself as 'whipping boy'. PMID- 10129138 TI - Therapeutic drug monitoring: an assessment of current practices at Fremantle Hospital. PMID- 10129139 TI - Pharmacy labeling practices; comments on pharmacy labeling methods. PMID- 10129140 TI - Prescription assistance programs: options for assisting the uninsured and underinsured. AB - The objectives of the study were to determine the prevalence of indigent patient or reimbursement assistance programs for prescription drugs sponsored by the pharmaceutical industry and to collect data describing them. A questionnaire was mailed to 121 manufacturers or marketers of prescription drugs selected from the 1990 edition of the Red Book and 1991 edition of the Physicians' Desk Reference. The availability of free drug to qualified indigent patients or the availability of experts to solve reimbursement issues was then ascertained. The general application procedures and features of both types of programs were documented. The authors found that indigent patient and reimbursement assistance programs are offered for many products by numerous pharmaceutical companies, although not always on a formal basis. Of the 69 (57%) companies responding to the survey, 46 (67%) offer indigent patient assistance programs and 31 (45%) offer reimbursement assistance programs. Application procedures and services provided vary considerably between companies. These findings suggest that the pharmaceutical industry is a potential source of assistance in procuring drugs for the indigent or underinsured patient populations and a resource for resolving insurance issues. It is essential to contact a sponsor to determine current program availability and application procedures. Further study is required to appraise the merit of such programs. PMID- 10129141 TI - Timeliness of medication administration in hemodialysis inpatients: drug use evaluation. AB - Inpatients at the Albany Medical Center Hospital in Albany, New York are transported from their ward to the hemodialysis unit for their dialytic procedures. The time involved is several hours. An investigation into the timeliness of medication administration during this off-the-ward period was prospectively conducted. Twenty-eight dialytic procedures (for eight different patients), including 127 scheduled medication administrations, were included in the final data. A total of 108 (85%) of audited medication administrations were given more than 1 hour early, 1 hour late, or not at all. Recommendations for corrective action are proposed. PMID- 10129142 TI - Imipenem-induced seizure: a case of inappropriate, excessive, and prolonged surgical prophylaxis. AB - Imipenem-cilastatin is a broad spectrum antibiotic that is generally used for antibiotic-resistant hospital-acquired infections. Imipenem has been reported to cause CNS toxicity including seizures in 1.5-10% of patients. The authors present a case in which imipenem, inappropriately utilized for surgical prophylaxis in excessive doses (1 gram every six hours) and for a prolonged period of time (24 days), induced a tonic-clonic generalized seizure in a patient with no history of seizure activity. The identification of this ADR lead to a number of clinical and administrative actions within our institution. Drug-induced seizures have occurred and will continue to occur as healthcare professionals exceed recommended dosing guidelines to treat critically ill patients. As pharmacists, it is extremely important to use therapeutic drug monitoring and pharmaceutical care principles to assist physicians in individualizing drug regimens for our patients to prevent these ADRs from occurring, thereby significantly effecting patients' outcomes. PMID- 10129143 TI - Quality improvement indicators for hospital/home care pharmacy. PMID- 10129144 TI - Development of a methylprednisolone protocol for use in acute spinal cord injuries. AB - Acute spinal cord injury is a serious medical condition that results in 10,000 new cases of paralysis each year. Initial physical damage to the spinal cord is followed by chemical damage, resulting in cell death and scar tissue formation. Methylprednisolone therapy has proven effective in suppressing the chemical damage, particularly when started within 8 hours of injury. A protocol developed by the Pharmacy Department at Methodist Medical Center in Dallas, Texas, is described. This protocol facilitates accurate, efficient preparation and administration of this emergency therapy. The protocol takes advantage of the pharmacist's unique expertise to lessen the risk of calculation errors and mistakes in preparation, by providing a tailored drug admixture for administration at a fixed flow rate. The protocol and a sample of the pharmacy work sheet are presented. PMID- 10129145 TI - Managing the growth of healthcare costs. PMID- 10129146 TI - The future of the Joint Commission. PMID- 10129147 TI - Drafting warnings for medical products: practical considerations for minimizing litigation. PMID- 10129148 TI - Recent legal developments affecting medical device manufacturers. PMID- 10129149 TI - Should patients have access to national physician malpractice records? PMID- 10129150 TI - Economics in the new NHS. PMID- 10129151 TI - Introduction to economics in the new NHS. PMID- 10129152 TI - Setting priorities in the new NHS: can purchasers use cost-utility information? AB - It could be argued that the success of the new NHS depends, to some extent, on the production of accurate cost-utility information. This raises questions about the quality of this information, whether it can be transferred from one study setting to another and whether such information can reasonably be used 'at the negotiating table'. The quality of some studies is open to question. Some agreement is needed on issues of principle and more work is required to make cost utility analyses more applicable locally. PMID- 10129153 TI - Contracts: problems and prospects. AB - This article focuses on the important role played by contract prices in the new NHS. The power of prices to both inform and misinform the allocation of resources is highlighted. Orthopaedic surgery is used as a case study to indicate not only the obstacles to prices leading to improvements in efficiency but also the substantial scope for the prices set to convey valuable information on relative costs. Whether the purchaser-provider split will lead to an improved use of scarce resources will depend on several factors. One of the most important of which will be the development of sophisticated contracts embodying accurate price information. PMID- 10129154 TI - Teaching and research in hospitals: implications for the NHS reforms. AB - In this paper the implications of the support of undergraduate medical education and research for the new NHS market are examined. Inaccuracies in current methods of distribution of the Service Increment for Teaching and Research (SIFTR) and Additional Cost of Teaching and Research (ACTR) monies will have adverse effects. Receipt of too much money results in providers' care being unfairly subsidised while receipt of too little results in providers bearing an unfair burden of the cost of teaching and research. Results are reported from a study in the north east of Scotland with regard to the feasibility of obtaining more accurate estimates of the costs to the NHS of supporting teaching and research. The choice is between potentially accurate, but cumbersome and costly, systems of data collection or the continuation of the current, more arbitrary, approach of allocating monies. A combination of the two is recommended. PMID- 10129155 TI - Creating a market: an economic analysis of the purchaser-provider model. AB - The focus of this paper is the extent to which the purchaser-provider split and the creation of a market in the provision of health care can be expected to bring about greater efficiency within the new NHS. The starting point is a theoretical discussion of markets and competition. In particular, emphasis is placed upon the economic model of perfect competition. It is argued that because of the existence of externalities, uncertainty and a lack of perfect information, an unregulated market in health care will almost certainly fail. In view of this, the imperfect provider markets of monopoly and contestable markets, which are of particular relevance to health care, are discussed. A description of the new health care market and the principal actors within it is followed by an evaluation of the new health care market. It is argued that in view of the restrictions to competition that exist between providers, some form of price regulation will be necessary to prevent monopolistic behaviour in the hospital sector. Regulation of purchasers is also suggested as a means of improving efficiency. It is concluded that competition may be a necessary condition for increased efficiency in health care provision, but is not sufficient in itself. Other incentives in the hospital sector are necessary to assist the market process and to enhance its impact on efficiency. PMID- 10129156 TI - Extra-market incentives in the new NHS. AB - This paper focuses upon a number of features of the NHS reforms which are external to the new market created by the purchaser-provider split. Initially, the market and the problems associated with its operation are examined. Particular consideration is given to the extent to which these problems are likely to hinder the achievement of the Government's objective of improved efficiency in the NHS. Each of the provider, purchaser and consumer sectors of the market is then examined more closely in relation to the extra-market incentives present. It is argued that these incentives do have the potential to complement the purchaser-provider split in encouraging improvements in efficiency. However, in several instances, the incentives are either the wrong incentives or are too weak to have any real impact in changing behaviour. In conclusion, it is argued that there is a need for more direct incentive structures to be introduced if improvements in efficiency are to be realised. PMID- 10129157 TI - The way to economic prescribing. AB - Concern about the size of the NHS drugs bill in the UK has resulted in three main policy initiatives by government: regular increases in prescription charges, the introduction of restrictions on the range of prescribable drugs, and the implementation of prescribing budgets. This paper argues that such policies, whilst reducing the NHS drugs bill, have given little consideration to the efficiency of prescribing. Other policy options are considered which may reduce the NHS drugs bill in ways more consistent with efficient prescribing. PMID- 10129158 TI - General practitioners and the new contract: promoting better health through financial incentives. AB - In this paper the changes in payment of general practitioners in the UK, introduced in the 1990 contract, are described in detail. The effects of the changes on the structure of general practitioners' incomes is discussed. More emphasis on capitation payments may increase preventive activity in general practice, but, depending on the level at which the capitation fee is set, could lead to shifting of patients to other sectors in the health care economy. Target payments appear to have been successful in increasing the numbers of smears taken. It is clear that doctors respond to financial incentives, but what is not clear is whether their responses will always be in the way intended or lead to more efficient practice. PMID- 10129159 TI - Prevention in primary care: the annual assessment of elderly people. AB - The recent reforms of the NHS have clearly emphasised the potential role of prevention in reducing mortality and morbidity. The specific focus of this paper is the preventive aspects of the new GP contract, and in particular the contractual obligation on GPs to offer an annual assessment to all patients within their practice aged 75 years and over. In reviewing the literature for evidence pertaining to the assessment of elderly people, it is argued that there are a number of unresolved issues which raise certain question marks over the Government's decision to include such assessments in the GP contract. The most fundamental of these issues is whether the costs of such screening are justified by the associated benefits. Other issues relate to the organisation of the assessments. In an attempt to cast some light on these unresolved issues, the results from a recent national survey of GPs in Scotland are presented. The results do not allow a categorical statement to be made on whether or not the assessments are worthwhile per se. However, they do help to clarify the current state of screening elderly people in general practice. In the light of this, directions for future research into the screening of elderly people are suggested. PMID- 10129160 TI - Dental care in the NHS: reforms with teeth? AB - Dental services in the UK are currently undergoing a period of major upheaval. This paper examines recent policy initiatives with respect to patient charges, dentists' remuneration, information and patient choice, the supply of dental personnel, and the prevention of dental diseases. It is argued that changes in dentists' remuneration and the greater use of auxiliary personnel are likely to improve efficiency, whereas changes in patient charges are not. Water fluoridation remains the most efficient and equitable means of promoting dental health. PMID- 10129161 TI - Caring for people efficiently. AB - The UK government's plans and objectives for community care in the 1990s are examined. The objective of providing care in the community 'wherever possible' is unlikely to be efficient unless the costs and benefits of providing such care are accounted for. Even if it were efficient to provide more care in the community, the mechanisms aimed at ensuring the transfer of funds have been inadequate in terms of encouraging such an objective. These same principles (i.e. the need to assess costs and benefits) should be applied to the design of individual packages of care in the community, when the costs and benefits of carers' time become more important. Case management offers the opportunity to assess individual circumstances which is necessary for the design of efficient packages of care. However, case management is likely to suffer from the problems of fragmentation which makes organisation of flexible packages of care difficult. PMID- 10129162 TI - The new NHS in a global context: is it taking us where we want to be? AB - In this paper, the new NHS is put in a global context, comparing the UK internal market arrangements with changes occurring in other health care systems. An assessment is made of whether the new UK NHS will result in more efficient and equitable health care provision than the 'old' NHS. Regarding financing of health care, most countries seem to be moving in the direction of NHS or public insurance-based systems. New Zealand and The Netherlands are among the few countries attempting to inject competition into health care financing. There is a greater move, globally, towards competition in the provision of services. In terms of allocative efficiency and equity, we believe that, on balance, the new NHS will bring no improvement. Indeed, in terms of equity, it may be detrimental. If there is any improvement, it is likely to be in technical efficiency. PMID- 10129163 TI - WV child care facility: a key staff recruitment and retention benefit. West Virginia University Hospitals. PMID- 10129164 TI - Ready to byte the bullet? PMID- 10129165 TI - Designed-in flexibility allows new facilities to change with times. PMID- 10129166 TI - Health facilities not exempt from HAZWOPER (Hazardous Waste Operations and Emergency Response). PMID- 10129167 TI - How to manage participatory-style meetings. PMID- 10129168 TI - Ice-melting products: solid advice on a slick topic. PMID- 10129169 TI - Exactly how do your laundry and linen operations stack up? PMID- 10129170 TI - A (dining) room with a view: cafeteria takes advantage of grounds. PMID- 10129171 TI - Energy management for the '90s: where can you turn to for help? PMID- 10129172 TI - CAFM (computer-aided facility management) in health facilities: 3 case studies in success. PMID- 10129173 TI - 10-step program ensures sound roof maintenance. PMID- 10129175 TI - Employees who smoke: still a smoldering issue. PMID- 10129174 TI - ANSI (American National Standards Institute) standardizes material safety data sheets. PMID- 10129176 TI - Staff-awareness program nets big linen savings. PMID- 10129177 TI - Feel the burn: incinerator's steam powers laundry that's shared by 3 WI hospitals. PMID- 10129178 TI - Groundskeeping, landscaping: who's really buying what? PMID- 10129179 TI - Safe harbors or empty harbors? PMID- 10129180 TI - Why doesn't performance pay work? AB - Examines performance pay as a means of motivation in the health sector, and indicates possible reasons for its ineffectiveness. Points out that there are various means of motivating employees, with pay being just one of these. Suggests that this is the reason why performance pay has little impact. Concludes that the NHS is about to implement performance pay within its system. Predicts that this may be problematic. PMID- 10129181 TI - The supply of orthotist prosthetists. The application of workforce projection techniques in determining future national training places. AB - Discusses the application of workforce planning techniques in the context of "target" levels of demand and uses a study of the future supply of orthotists and prosthetists as an example. Describes the derivation of an appropriate model, the quantification of the labour market for the profession, and an analysis of the characteristics of the workforce. Information was gathered through two surveys and from discussions with relevant organizations. PMID- 10129182 TI - Heatherwood in the community. AB - Describes the background to the launch of a community marketing initiative by the Heatherwood and Wexham Parks Hospitals Trust. Managers recognized the need to involve the community in the work and development of Heatherwood Hospital, Ascot, Berkshire. A variety of activities, targeted at particular audiences, were undertaken resulting in both heightened awareness within the community and a very positive improvement in the morale of staff within the hospital. Describes the formation of a representative steering group and the range of activities. PMID- 10129183 TI - Empowerment: Holy Grail or a blinding case of the obvious? AB - Suggests that the route to "excellence" is through the empowerment of workers, but argues that this might become problematic within the health care sector. Examines the development of empowerment as a concept. Points out four difference types of worker--the rebel, the mainstay, the high performer and the miserable sod, and their possible reactions to empowerment. Proposes way of adapting the negative characteristics of these workers in implementing empowerment. Concludes that future action should be based on the introduction of empowerment rather than its discussion. PMID- 10129184 TI - Pay and nursing performance. AB - Discusses the merits and demerits of performance-related pay (PRP) with respect to nursing in the NHS but concludes that justification for it remains unproven through the absence of hard evidence in support of its efficiency. Sees previous experience of the practicalities of implementing PRP and the fear that it will be neither cheap nor effective in solving "productivity" problems as hostile to its introduction in the NHS. PMID- 10129185 TI - Take forward your human resource agenda: manage performance and reward. AB - Examines managing performance as an integrated, dynamic process, involving strategic decisions, people value, management of change and communication. Concludes that it is better to be a learning company than an excellent company, as this leads to commitment to employee development, which in turn leads to managing human resources effectively, therefore managing their reward and performance. PMID- 10129186 TI - Support for newly qualified entrants to the speech and language therapy profession. Implications for managers. AB - Reports on a survey of 1990 and 1991 graduates entering the speech and language therapy profession in the UK and on the experiences of six new therapists in one "good practice" area, Ayrshire and Arran Health Board. Results show that new therapists were given a great deal of help and support from professional managers, and valued it highly. They chose posts which offered a mixed client load and good induction packages. Pre-service training reflected work carried out in service, but all client groups had not been accessed during training. Issues relating to throughput and case-load management required most support. They made successful personal adaptations to the work environment, and managers found them effective overall. Calculates the costs of supporting new therapists. Highlights the need to maintain professional support and discusses the potential difficulties involved in doing so in relation to NHS reforms. PMID- 10129187 TI - A strategic approach to human resource planning in nursing. AB - In Britain, Canada and the USA, a chronic shortage of registered nurses has existed since World War II. This situation is predicted to become worse. Reviews both the general and nursing literature in human resource planning, and recommends a system which can be build up step by step and individualized for each nursing department. The core planning activities are a planning database, demand forecasting, supply forecasting, variance analysis and forecasting, and recruitment policies. PMID- 10129188 TI - Listening to older patients. AB - This article presents findings from focus-group research conducted by Age Wave, Inc., a marketing services, research and consulting firm focusing on the 50+ market. The research is part of a comprehensive study on the aging-readiness of acute-care hospitals, sponsored by Baxter Healthcare Corporation. The findings discussed here are based on focus groups conducted in April 1993 with recently discharged 50+ patients in 10 major metropolitan/nonmetropolitan areas throughout the country. While findings from focus groups should be considered directional rather than absolute, the views of an expert panel confirm many of the observations and experiences of these older hospital patients. PMID- 10129189 TI - The human factor. AB - Though theoretically elegant, some expected health-system reforms could taste like bitter medicine to many patients. PMID- 10129190 TI - What patients really want. PMID- 10129191 TI - Devout observances. AB - A noted commentator suggests that Americans revere activities that reformers call "waste" or "mismanagement." PMID- 10129192 TI - Patients and communities. AB - In 1992, Chicago's Mount Sinai Hospital Medical Center was awarded the Foster G. McGaw Prize for outstanding community service. This article describes Mount Sinai's commitment and some of the programs that led to its receiving the prize, which is funded by The Baxter Foundation and administered by The Hospital Research and Educational Trust of the American Hospital Association. PMID- 10129193 TI - Caring for the whole patient. AB - Caring for the whole patient requires as much understanding and commitment from managers as it does from physicians and nurses. PMID- 10129194 TI - States lead way in healthcare reform. PMID- 10129195 TI - The ABCs of electronic data interchange. PMID- 10129196 TI - Aligning IDNs' (integrated delivery networks) financial interests with communities' best interests. PMID- 10129197 TI - Quality management of human resources. Providers should begin by focusing on education, performance management, and reward systems. AB - For a quality management transformation to occur, a healthcare organization must focus on education and development, performance management, and recognition and reward systems during the first years of implementation. Education and development are perhaps the most important human resource management functions when implementing quality management principles and processes because behavioral changes will be required at all organizational levels. Specific programs that support an organization's quality management effort will vary but should include the conceptual, cultural, and technical aspects of quality management. The essence of quality management is to always satisfy the customer and to continuously improve the services and products the organization offers. The approach to performance management should therefore rely on customer feedback and satisfaction. An organization committed to quality management should base its performance management approach on customer orientation, process improvement, employee involvement, decision making with data, and continuous improvement. Managers and trustees are being challenged to provide innovative recognition and reward systems that reinforce the values and behaviors consistent with quality management. Such systems must also be aligned with the behaviors and outcomes that support the philosophy, mission, and values of the Catholic healthcare ministry. The following components should be considered for a recognition and reward system: base pay, incentives, benefits, and nonmonetary rewards. PMID- 10129198 TI - Integrated delivery networks. Integrating services for the elderly. Collaboration improves long-term care providers' ability to care for the elderly. PMID- 10129199 TI - Nursing's renaissance. An innovative continuum of care takes nurses back to their roots. AB - Nurses in the Tucson area are not only serving persons in hospitals but also caring for them in their homes and neighborhoods and teaching them how to maintain their health. Three nursing programs--community nursing centers, home health services, and nurse case management--are part of the nursing continuum of care within Carondelet Health Care. Promoting clients' optimal wellness level, helping them maintain their highest level of functioning, preserving their dignity and independence, and enhancing their self-care are the goals of the Carondelet Community Nursing Centers. Nurse practitioners monitor clients' blood pressure and cholesterol and blood sugar levels and can test for episodic problems. Carondelet Home Health nurses teach clients about disease processes, symptom management, and medications; assess or monitor a patient's condition; care for wounds, and coordinate services such as physical therapy, occupational therapy, and home-delivered meals. Persons are usually referred to home health as they are discharged from the hospital. In addition to helping clients with psychosocial problems, nurse case managers perform traditional nursing functions like monitoring and teaching about medications. Nurse case management clients include the frail elderly or persons who have at least one of the following: a chronic disease that is causing steadily declining health; a terminal illness; an acute episode that requires monitoring and support; care-giver stress; or an inability to cope, as evidenced by anxiety, depression or substance abuse. Services for such clients will gain prominence in a reformed healthcare system. PMID- 10129200 TI - Women and children first. A Catholic provider reconnects with its communities by offering programs for women and children. AB - To help persons in their communities, especially women and children, overcome barriers to healthcare, subsidiaries of Bala Cynwyd, PA-based Mercy Health Corporation of Southeastern Pennsylvania sponsor programs that reach out to area residents. After a 1990 community needs assessment, Misericordia Hospital became more aware of the poor state of maternal and infant healthcare services in West Philadelphia. Today a revamped obstetrics/gynecology department offers a range of outpatient clinical and support services. The certified nurse midwife program, Misericordia on Motherhood, offers prenatal care, nutrition counseling, parenting classes, and social services. The WeeCare program, launched by Mercy Health Plan in 1991, is a perinatal risk-reduction program to help change the perception that pregnancy does not require medical intervention. Misericordia Hospital is meeting children's healthcare needs through a school-based primary care center at the Samuel B. Huey Elementary School, West Philadelphia. Mercy Health Plan's Immunization Outreach Program ensures children receive necessary immunizations. To prevent breast cancer, women can turn to Misericordia Hospital and Mercy Health Plan's Breast Cancer Screening and Outreach Program. The program's goal is to ensure that women recognize the importance of their own health and to educate them about early breast cancer detection. PMID- 10129201 TI - From assessment to action. A hospital-community coalition provides needed services to children. AB - In December 1991 St. Mary Hospital, Port Arthur, TX, began a three-phase procedure to provide underserved persons in the community better access to care. The process began with a community needs assessment, after which St. Mary developed a hospital-community coalition to plan and implement programs to address identified needs. The needs assessment revealed two underserved populations: racial and ethnic minorities, and youth in two separate categories (below five years old, and from five to the teen years). The top needs were for greater access to healthcare and an increase in primary care services. Having determined that St. Mary Hospital was better equipped to address the lack of primary care, the needs assessment team forged a coalition with community leaders and providers. Collaborative efforts led to the opening of three primary care clinics for children in 1993. The hospital also participated in a task force that identified and alerted the parents of more than 3,800 Port Arthur children in need of Early and Periodic Screening and Developmental Testing. St. Mary is currently working on a plan to contact the family of every Port Arthur child at the age of three months to ensure immunizations are current and a relationship has been established with a healthcare provider. PMID- 10129202 TI - Community clinic offers access to care. A system and a city collaborate to care for an immigrant population. AB - The Southwest Community Health Clinic (SCHC) has been providing free preventive healthcare to the poor residents of its Houston neighborhood since June 1991. Sponsored by the Sisters of Charity of the Incarnate Word Health Care System and the city of Houston, the clinic invites healing through hospitality, unlike many free clinics. The family-focused clinic takes a multidisciplinary team approach to preventive healthcare. The staff of approximately 30 healthcare professionals provides prenatal and pediatric care; immunizations; tuberculosis screenings; and a variety of social services for patients' physical, emotional, and spiritual needs. SCHC's well-child program screens children from birth through age five for physical and developmental problems. Clinic staff teach and guide parents on their children's health. The program stresses early identification of developmental delays and disabilities, with referral to appropriate services. SCHC has also implemented a tuberculosis testing program to prevent spread of the disease. Persons who test positive are referred to the City of Houston Department of Health and Human Service's chest clinics for follow-up and treatment. Community outreach is a major ingredient of SCHC's preventive healthcare program. A community health advocate, who is familiar with the cultures, traditions, and languages of the population being served, identifies families needing care and supports their access and use of healthcare services. PMID- 10129203 TI - Evangelization through institutional sponsorship. Education and experience in the congregation's tradition can move the laity to full partnership in the ministry. AB - Sponsors' efforts to empower lay leaders to carry on the Catholic healthcare ministry can be understood as a process of evangelization, or the proclamation of the Gospel to Christians and non-Christians in order to awaken and nourish faith. By involving the laity in the operation of their institutions, sponsors assume an evangelizing posture. To ensure the continuation of their ministry, sponsors share with the laity their history, charism, and values. They thus set a standard on which institutions can base their own mission and values. Catechetics, or religious instruction, is another aspect of evangelization. For sponsors, catechesis takes place through governance and mission integration activities. The sacraments are also important to evangelization. Through prayer before a board meeting, the use of paraliturgy during the commissioning of new board members, or the eucharistic liturgy, sponsors raise people's awareness of the sacred even in the midst of workplace routine. Sponsors themselves need continual evangelization. As congregations help the laity carry out the Church's healing mission, they are also called to examine how they sponsor. PMID- 10129204 TI - Mercy: an insufficient motive for euthanasia. Catholic ethical tradition requires that we temper our motives with reason and care before acting. AB - Some experts argue that acts of assisted suicide and euthanasia are ethically appropriate because they are merciful. Compelling though it is, this argument is not sufficient for determining the morality of these acts. The ethical tradition that calls for mercy has never suggested that mercy is, by itself, a sufficient criterion for determining an act's moral appropriateness. Human motives are rarely, if ever, pure and objective. For that reason, our ethical tradition has insisted on tempering motives with reason and care. The criteria for determining when it is merciful to assist in another's suicide or engage in an act of euthanasia are, for all practical purposes, impossible to define. Commonly writers refer to a person's hopeless condition to justify the merciful response of assisted suicide or euthanasia. But unless we can agree on whether hopelessness is an objective or subjective reality, and until the criteria to define this reality are evident, it is difficult to see how assisted suicide or euthanasia can be a careful and reasoned expression of mercy. Only by examining one's intention can one judge whether an act that may appear to be merciful in a hopeless situation is appropriate. "Intention" refers to the reasoned decision or judgment one makes about a goal and the means used to achieve that goal. Even if we cannot control our emotional response (our motives) in a particular situation, we can control our judgment (our intentions). Within our moral tradition, we can be sure we are being merciful in a careful and reasoned way when we intend to protect and promote the good of life.(ABSTRACT TRUNCATED AT 250 WORDS) PMID- 10129205 TI - Heads-up campaign promotes injury prevention. PMID- 10129206 TI - Leadership for mission: a key agenda for the 1990s. PMID- 10129207 TI - Sisters of Mercy Health System. Taking the measure of quality. PMID- 10129208 TI - The first Rodney King verdict: a chaplain's response. PMID- 10129209 TI - Safe Medical Devices Act: management guidance for hospital compliance with the new FDA requirements. AB - The Safe Medical Devices Act of 1990 (Public Law 101-629) was signed by President George Bush almost three years ago on November 28, 1990. The law expanded the Food and Drug Administration's (FDA) authority to regulate medical devices and grew out of congressional concerns about the FDA's ability to quickly learn when a medical device caused an adverse patient event, and to ensure that hazardous devices are removed from hospitals and other health care facilities in a timely manner. The Safe Medical Devices Act is an extension of the Medical Device Amendments of 1976, which imposed production, distribution, and sales rules on medical device manufacturers. It gives the FDA the legal authority to directly regulate the use of medical devices in health care facilities. Among the Safe Medical Devices Act's provisions are specific requirements for hospitals, health professionals, and other users of medical devices to report patient incidents involving medical devices to the manufacturer and to the FDA if a device caused or contributed to a serious injury, death, or other "adverse experience." Adverse experiences are defined by the FDA to include concussions, fractures, burns, temporary paralysis, and temporary loss of sight, hearing, or smell. Hospitals have been required to comply with this provision of the law, called user reporting, since 1991. Hospitals are also required to participate in tracking certain medical devices whose failure could result in a serious adverse health outcome. The law requires distributors and manufacturers of specific devices to adopt a method for device tracking. Hospitals are required to cooperate with and provide device manufacturers with information about patients with permanently implantable devices and life-sustaining and life-supporting devices used outside device user facilities. The law also gives the FDA the authority to designate other devices subject to tracking if the agency determines such tracking is warranted to preserve the patient's health. This provision of the law is called device tracking. Device tracking became effective on August 29, 1993. This special report addresses some of the major questions about implementing user reporting and device tracking in hospitals. Over the past two years the FDA has issued a series of rules and regulations that have caused a great deal of confusion and misunderstanding. Some of the law's provisions are straightforward; however, some basic issues and rules--such as the definition of a reportable event--are unclear. While there are still some open questions about the reporting and tracking requirements, the following is the best information available at this time.(ABSTRACT TRUNCATED AT 400 WORDS) PMID- 10129210 TI - Mission impossible? PMID- 10129211 TI - Auditing for fund-holding success. AB - Five papers on aspects of fund-holding practice management were entered into the Practice Managers' Forum at the joint IHSM/Radcliffe Medical Press First National Practice Managers' Conference, of which this contribution was judged the best. Its author, Miranda Lonsdale, received the Radcliffe Award for the presentation. PMID- 10129212 TI - General practitioners at the crossroads. AB - As practices take on fund-holding status, GPs are thrown into a new management role/ According to Ross Hamilton and Fiona Shepherd, there is some doubt whether current medical training provides the skills for this. PMID- 10129213 TI - Management ... working day of a health services manager. Manchester FHSA. AB - Sue Beaumont is GP Fund Holding Development Manager for Manchester FHSA, covering a population of over 505,000 and over 100 practices in an inner-city area. Newly appointed after a seven-year absence from the NHS, she has an interesting perspective on the reforms. PMID- 10129214 TI - Not your ordinary ride-along. Resident physicians experience EMS firsthand. PMID- 10129216 TI - Cultural countershock. From the ED to the Red Sea. PMID- 10129215 TI - Operation EMS. Uniting forces in Saudi Arabia. PMID- 10129217 TI - Canadian EMS. How does it fit? PMID- 10129218 TI - Back to basics. Equipment goes mostly low-tech at the 1993 EMS Today exhibition. PMID- 10129219 TI - Soak that 'scope. Cleaning laryngoscope blades. PMID- 10129220 TI - Confessions of a CAAS (Commission on Accreditation of Ambulance Services) reviewer. PMID- 10129221 TI - A second opinion ... attempt to rationalize an unethical practice. PMID- 10129222 TI - Bottom-up capital fund allocations. AB - Departments at Silver Cross Hospital in Joliet, IL, had requested over $10 million dollars worth of equipment or renovations. The capital budget committee, made up of senior-level managers, determined that only $4 million was available. It was apparent that the capital process needed to allocate some level of funding to all the different constituencies to meet a variety of demands. Thus, seven special fund allocation categories that were created. Once a dollar limit was set for each category, it was no longer necessary or appropriate for the committee to determine which item or departments had greater needs or merit. The selection process was based upon continuous quality improvement principles in order to improve the decision-making process and push the decision down to the lowest practical level. A procedure called "choice analysis" was used to make the process as impartial as possible. The result was greater staff understanding and acceptance of the decisions that were made. PMID- 10129223 TI - Recommendations for TB respiratory protection. AB - After a long decline, tuberculosis is making a comeback. Because of this risk, several government agencies have developed in-depth recommendations designed to minimize the transmission of tuberculosis. 1990 CDC guidelines have formed the basis for most current recommendations, but those guidelines are undergoing revision. Great controversy surrounds the recommendations, particularly in the area of respiratory protection. According to NIOSH, the inability to adequately fit-test and fit-check disposable respirators is a major flaw that could compromise their ability to protect the wearer. OSHA has been enforcing guidelines for occupational exposure to TB under several existing standards, especially its respiratory protection standard (29 CFR 1910.134), and is currently enforcing the use of dust/mist/fume respirators. The agency can be expected to issue a National Compliance Directive upgrading required respiratory protection to HEPA filters. The author recommends implementing recommendations for appropriate administrative and engineering controls and using low maintenance, reusable, half-face elastomeric respirators with disposable filter cartridges for employees in identified high-risk, exposure situations. PMID- 10129224 TI - Flash sterilization and instrument tape--an experimental study. AB - A letter appearing in the AORN Journal questioned whether flash sterilization is appropriate for instruments coded with color identification tape. The reply stated that porous, colored tape required a longer time to penetrate and sterilize the area beneath, and thus if it should peel off, the zone beneath might not be sterile. This conclusion was, as far as we can determine, reached by intuitive reasoning and not by experimental evidence. Therefore, the following experimental approach was undertaken to test the hypothesis. Spores on discs were placed between the color-code tape and a metal instrument. Exposure to heat (135 degrees C) and time (3 min.) was in a gravity displacement sterilizer. We then determined whether spore kill has been achieved. The test organism was B. stearothermophilus. None of the discs that were in contact with the instruments while being sterilized showed any growth. Thus, it appears that sterility can be achieved on the instrument surfaces that are beneath color-code tape in three minutes. PMID- 10129225 TI - Understanding benchmarking. AB - In order to meet the challenges facing health care today, organizations are turning to new approaches. Benchmarking is one such approach. Benchmarking is externally driven, encouraging organizations to look outside their own walls to learn from others and achieve exemplar performance. Organizations can benchmark within their own systems, against competitors, against "best-in-class" companies in the same general industry and against "best-in-class" companies in different industries. A four-step approach to benchmarking includes planning, collecting information, analyzing results and adapting and improving. A benchmarking study team composed of the process owner and other users of the process conducts the study. Application of benchmarking to healthcare materiel management is particularly appropriate, since many materiel management processes occur in other industries and, therefore, best practices outside the healthcare industry may be adapted. The practice, through growing in other industries, is still very new in health care. PMID- 10129226 TI - A cost-effective alternative to air therapy bed rentals. AB - Rental products are often a large expense in healthcare institutions. Desert Samaritan Medical Center in Mesa, AZ, took a look at the equipment rental dollars being spent on air therapy beds to determine if a new approach could result in significant cost savings. They identified the potential purchase and in-house maintenance of air therapy devices as an opportunity to increase productivity and service levels while simultaneously reducing expenses. After conducting a thorough product evaluation of various products, the institution purchased four portable mattress replacement systems, four beds complete with air therapy, in bed scales and dynamic blowers and continue to rent air-fluidized therapy beds on an as-needed basis. Duties for supplying, cleaning and maintaining the equipment were shared between Materials Management, Patient Transport, Environmental Services, Clinical Engineering and Plant Services and Nursing. The hospital has realized a $90,000 expense reduction as a result and improved patient outcomes. PMID- 10129227 TI - Disinfecting units/sterilizing units, liquid, flexible endoscope. ECRI. PMID- 10129228 TI - Some guidelines for choosing a tool of quality. PMID- 10129229 TI - Business espionage: a trend coming to health care? PMID- 10129230 TI - Frequent OSHA bloodborne pathogens citations. PMID- 10129231 TI - Falsification of information policy. JCAHO. PMID- 10129232 TI - Confidentiality and disclosure policy. JCAHO. PMID- 10129233 TI - Early survey policy. JCAHO. PMID- 10129234 TI - Hospices next for joint commission accreditation through home care program. PMID- 10129235 TI - Multidisciplinary approach used to improve infant care. AB - Many of the implemented changes have required the rewriting of standards of care and policies, as well as the education of staff. Staff education was addressed through a variety of approaches, including one-hour inservice training sessions and eight-hour courses. In the final analysis, the multidisciplinary QA committee has had a significant impact on improving the processes involved in caring for infants with RDS. Because of this success, committee members have acknowledged that all aspects of patient care may be examined and changes implemented when caregivers keep an open mind and are willing to change the way "things have always been done." This commitment to examine all aspects of care and to implement change has been, for Presbyterian Hospital, the key to genuine quality improvement. As a result of these and other efforts, Presbyterian Hospital has improved the care given to all of its patients. In March 1992, the hospital received accreditation with commendation. PMID- 10129236 TI - Joint Commission creates opportunities for feedback from accredited organizations. PMID- 10129237 TI - MedWatch targets reporting of serious adverse events. PMID- 10129238 TI - Joint Commission to help create order in performance measurement arena. PMID- 10129239 TI - AMAHC contains new standards for 1994. PMID- 10129240 TI - One nurse executive--or two--can be responsible for function. PMID- 10129241 TI - Is an "ideal" service institution image the same for all referral sources? The case of chemical dependency treatment programs. AB - In a competitive market like chemical dependency treatment, segmenting the professional referral market according to an "ideal" service image may offer a service institution a strategic advantage. Results of this study suggest that while different professionals in a referral market may attach differential importance to the same service feature, a favorable or unfavorable "image" seems to encompass how well both the professional and the professionals' client are treated by the service institution. PMID- 10129242 TI - Hospital successes and failures indicate change in hospital marketing. AB - Marketing has become an essential management function for hospitals during the past decade. A number of changes have occurred in hospital marketing as they have progressed through the marketing adoption process. A survey of Hospital CEOs reporting hospital successes and failures in the area of marketing have recently placed emphasis on sales and advertising based upon marketing research programs thus indicating entrance into the "Integrated Tactical Marketing" phase. This study also indicates that a few hospitals have entered the "Strategic Marketing Orientation" phase while future plans reported by the CEOs provide evidence that this trend is likely to continue. PMID- 10129243 TI - A cross-sectional analysis of hospital profitability. AB - This study used logit regression to discriminate between profitable and non profitable hospitals. The specified model worked best for voluntary hospitals, and the classification results were consistently higher for profitable hospitals than for non-profitable hospitals. Only one financial variable, the operating margin, was consistently significant in each regression equation. The results challenged the "general consensus" that operating efficiency is uniform across control categories. Teaching status was found to have a significant and positive effect, but only for voluntary hospitals. Lastly, the results indicate that uncompensated care is a major concern for voluntary hospitals. These findings raise the question of whether reimbursement rates under PPS should incorporate local factors. They also indicate that hospital management style does not and will not model business operations. As such, hospital managers may be unable to dramatically change a hospital's level of profitability. PMID- 10129244 TI - The relationship between consumer attitudes and frequency of advertising in newspapers for hospitals. PMID- 10129245 TI - Nurse attendee purchasing patterns. AB - Retention of nursing professionals is crucial in responding to the increasing demand for and complexity of nursing care. Augmenting the decision-making role of nurses is one important retention-related strategy. Purchasing patterns reflect one aspect of nurses' decision-making role. National meetings provide nurses with an opportunity to investigate educational and employment options, as well as to preview technological advances in patient care products and supplies. Yet, the purchasing patterns of nurses related to the marketing of patient care supplies, or educational material at national meetings have rarely been acknowledged or researched. This study investigated the purchasing patterns of nurse attendees as revealed at a national meeting and how attendance influenced purchasing input following the meeting. The study addressed differences in purchasing patterns between specific groups of nurse attendees, as well as the relationship between meeting attendance motivators and purchasing patterns. A descriptive methodology utilizing participant observation at four national nursing meetings and mail survey in four phases was used to determine if there were: (1) identifiable purchasing patterns for nurses attending specific nursing-organization sponsored national meetings, (2) differences in purchasing patterns between nurse attendees from these meetings, (3) differences in self-reported post-meeting purchase input, and (4) relationships between meeting attendance motivators and purchasing patterns. The findings demonstrate that nurse attendee purchasing patterns can be identified and do vary among nursing groups. Nurse attendees at specialty meetings were more likely to act as specifiers, have a more dominant role in purchasing and were more likely to influence product purchases than were nurse attendees from generalist meetings. Self-reports of post-meeting purchasing input demonstrated that nurse attendees utilized information gained at national meetings in subsequent patient care product selections, product utilization and specification of new products/equipment/protocols for trial within the practice site. Positive relationships between meeting attendance motivators and purchasing patterns were most evident for those nurse attendees with greater purchasing involvement and influence. PMID- 10129246 TI - Enhancing the usefulness of quadrant analysis in hospitals: a marriage with discriminant analysis. AB - This paper first looks at traditional quadrant analysis as used in contemporary research. Next, we show an extension to include multiple brands on the same quadrant chart--again consistent with current practice. Then, multiple discriminant analysis results are merged with the quadrant chart data. This makes the resultant chart even more actionable. While the example uses health care data, the methods outlined can be used in other segments of the service industry, as well as for more tangible products. The only limit is the researcher's imagination. PMID- 10129247 TI - Predicting the health care environment for hospitals in the '90s. PMID- 10129248 TI - The relationship between hospital marketing orientation and CEO satisfaction with the marketing function. AB - Although hospitals are placing more focus on the marketing function, there is still dissatisfaction reported by CEOs with the marketing function in hospital settings. The authors investigate the relationship between the marketing orientation of a hospital and CEO satisfaction with marketing. It was found that in those hospitals that are truly marketing oriented, CEO satisfaction with marketing is very positive. PMID- 10129249 TI - Decision making in health care institutions: the health care practice paradigm. AB - Based on research reported in the health care literature, this paper adapts Blake and Mouton's (1985) two dimensional Managerial Grid to develop a model called the Health Care Practice Paradigm. The paradigm postulates two primary dimensions to represent the behavior of health care providers and practitioners: (1) patient orientation and (2) task orientation. To illustrate the usefulness of this approach, a study of the decision making processes of dietitians with respect to a new product was conducted. Based on a national sample of dietitians, the findings suggest that health care orientation of the dietitians is a better predictor of attitudes toward trying a new product than traditional demographic factors such as hospital size. Key implications for health care providers targeting new products toward hospitals and other health care institutions are highlighted. PMID- 10129250 TI - Making use of value marketing in today's hospital. PMID- 10129251 TI - Health care clusters in hospitals: the market audit and frameworks for planning. AB - Many hospitals are turning to cluster relationships to gain the benefits of diversification without the troubles of increased capital costs and management conflicts. The goal of healthcare clusters is to provide a continuum of care to a defined geographic region through integration of referral and payment systems. To aid in successful planning for healthcare clusters, a market audit and frameworks for examining the current healthcare market are presented. PMID- 10129252 TI - Hospital patient satisfaction: correlates, dimensionality, and determinants. AB - This paper investigates the correlates, dimensionality, and determinants of patient satisfaction in the hospital health care encounter. All of the individual hospital characteristics assessed were found to be significantly related to patient satisfaction. The findings suggest that patients evaluate hospital service quality along four distinct dimensions. The relative importance of these four factors in predicting overall satisfaction, in descending order, is: (1) physician/capabilities, (2) nurses/staff, (3) amenities, and (4) accessibility. In combination, these four factors explain 63 percent of overall patient satisfaction. PMID- 10129253 TI - Using the critical incident survey to assess hospital service quality. AB - This survey was designed to determine "standards of excellence" in hospital services as defined by (a) former patients, (b) physicians, (c) hospital employees, and (d) corporate insurance subscribers. One hundred forty-seven (147) patients, 188 employees, and 20 corporate subscribers were interviewed by telephone, and 52 physicians were interviewed in their offices. The interview consisted of a single question: "Can you think of a time when, as a patient/employee/employer/physician, you had a particularly satisfying or dissatisfying experience with a local hospital?" Reported incidents were reviewed, and 239 "critical incidents" were identified. These incidents were classified into 12 descriptive categories relating to the underlying factors in the incident reports. Six focus groups were later held with participants segregated by the population pool they represented. These groups were asked to develop definitions of "excellence" in hospital service quality and standards for service which would "exceed expectations." The focus groups created 122 standards of excellence, which were classified into 43 categories. Overall, the largest percentages of corporate, physician, and employee critical incidents were classified as "Administrative Policy" issues. Patients most often reported "Nurturing" incidents as critical to their perceptions of hospital service quality. PMID- 10129254 TI - Organ transplantation in religious, ethical and social context: no room for death. PMID- 10129255 TI - Organ donation: a Catholic and interfaith perspective on its ethical warrants and contemporary public policy concerns. PMID- 10129256 TI - Identity, role, and task: a core perspective on pastoral care with cardiothoracic transplantations. PMID- 10129257 TI - The discerning heart: the Psalms as pastoral resource in ministry to potential organ recipients and their families. PMID- 10129258 TI - Theological reflections on organ donation and transplantation. PMID- 10129259 TI - Organ transplantation and tissue donation: a theological look. AB - The author's position is that the work of organ donation and transplantation and tissue donation over the past forty-five years is in need of theological reflection. Some profound events and processes are involved in transplantation as the human family engages in a quest for wholeness. Different religious traditions Jewish, Catholic, Eastern Orthodox, and Protestant-view the use of organs for transplantation differently. General attribution theory is adapted as a perspective on organ transplantation. PMID- 10129260 TI - The heart transplant recipient-coordinator relationship: reactions to the transplant process. PMID- 10129261 TI - The influence of psychosocial factors in the heart transplantation decision process. PMID- 10129262 TI - Waiting: pastoral care to the cardiac bridge to transplant patient. PMID- 10129263 TI - Contesting the boundary between life and death: organ transplantation and the identity of the Christian community. PMID- 10129264 TI - Are there any limits to scarcity? PMID- 10129265 TI - Hard at death's door. PMID- 10129266 TI - The clinical rhombus revisited: learning through resistance and change. AB - Illustrates via the monitoring of an actual unit of Clinical Pastoral Education the reality of the clinical rhombus--a conceptual model that depicts the complex psychological and social nature of the learning environment. Shows how CPE supervisors utilize the clinical rhombus intentionally and unintentionally. Uses a case study to demonstrate the critical and creative possibilities for change when the rhombus is related to the project of pastoral formation. PMID- 10129267 TI - Stillborn studies: ministering to bereaved parents. AB - Provides a detailed description of six days in the lives of a couple whose first baby was stillborn. Offers a running commentary on the events, feelings, and behaviors of doctors, nurses, chaplain, family, and all those touched by the trauma of having a stillborn child. PMID- 10129268 TI - Death by default. PMID- 10129269 TI - Comment. Defining the right to die. PMID- 10129270 TI - Professional advancement of social scientists within schools of medicine. PMID- 10129271 TI - The organization of medical care services: toward an integrated theoretical model. PMID- 10129272 TI - Managing the local economy: implications for medical care. PMID- 10129273 TI - An integrated analytic framework for evaluation of hospital information systems planning. PMID- 10129274 TI - Is doctors' hard work paying off? PMID- 10129275 TI - Should you tape informed-consent discussions? PMID- 10129276 TI - Computerize your office? Five hard-won lessons. PMID- 10129277 TI - It's time for doctors to face the truth about AIDS. PMID- 10129278 TI - A bloodied medical board fights for a comeback. PMID- 10129279 TI - Why I hound patients for follow-up. PMID- 10129280 TI - Setting up a foolproof follow-up system. PMID- 10129281 TI - The liability most doctors overlook. PMID- 10129283 TI - How hospitals are "doctor-shopping". PMID- 10129282 TI - What if someone has an MI in your office? PMID- 10129284 TI - High marks (mostly) for Medicare carriers. PMID- 10129285 TI - Is this the biggest pension break in years? PMID- 10129286 TI - Keep the UR monitors off your back. PMID- 10129287 TI - A new or renovated office pays a double reward. PMID- 10129288 TI - Practice costs: doctors apply the shears. PMID- 10129289 TI - Will administrative savings really pay for health reform? PMID- 10129290 TI - How much of your good will has evaporated? PMID- 10129291 TI - What the Clinton health plan means to you ... panel discussion. PMID- 10129293 TI - What worked for Japan could work for you. PMID- 10129292 TI - Organized medicine sees more to fear than to praise. PMID- 10129294 TI - Preparing staff for the challenge of serving seniors--the Fallon approach. PMID- 10129295 TI - Managed care trends reported to PEER (Performance Efficiency Evaluation Report). PMID- 10129296 TI - National health care and the grammar of management. AB - Managers working for the many various interest groups involved in health care reform will necessarily have to make adaptations, according to author Tad Dunne, Ph.D. Thus, Dunne examines some philosophical assumptions about what managers really manage along with some proposals on how to successfully implement the new health care plan, whatever form it ends up taking. PMID- 10129297 TI - The impact of RBRVS on this group practice. AB - Given the importance of the resource-based relative value scale (RBRVS) on group practice, it is important to analyze the emerging data from Medicare. In this article, authors Troy Pickens, CPA, and Walter Jones, Ph.D., look at the current and anticipated payment patterns for their practice as well as trying to determine the actual impact of RBRVS on reimbursement levels. PMID- 10129298 TI - Draconian buyers and Spartan suppliers: the harsh realities of a managed care world. AB - In this article, authors Robert Hurley, Ph.D.,and Jon Thompson, M.S.P., report results of a survey involving interviews with employee benefits managers. The results are notable in that they reveal purchasers in the process of challenging many of the fundamental assumptions regarding buying medical benefits and the services of medical professionals. PMID- 10129299 TI - Government policies on a collision course. Health cost containment and the antitrust laws. AB - The Sherman Act, passed in 1890, was initially enacted to break up the huge "trusts" of that era, writes Donald Mooney, but it has been used more frequently as a weapon in the government's war to slow mounting health care costs. In this era of mergers, acquisitions and joint ventures, groups need to be readily aware of the laws regarding antitrust. PMID- 10129300 TI - The darker side of networking--price fixing. AB - Author Harry Ray, in his article, addresses the two areas where networking activities of health care providers can amount to illegal price fixing--when providers band together to negotiate with third party payers and when fee or price information is shared. PMID- 10129301 TI - Development of an income/cost analysis system. PMID- 10129302 TI - Is reducing administrative costs the answer? PMID- 10129303 TI - Collaboration works in Northern Michigan. PMID- 10129304 TI - Re-defining ourselves to meet the challenge of the future or living in the Enchanted Land of Change. PMID- 10129305 TI - Auxiliaries and the "bottom line". PMID- 10129306 TI - From busyness to results. PMID- 10129307 TI - The ethics of health care cost containment. PMID- 10129308 TI - Michigan's health care reform: out of the frying pan and into the fire. PMID- 10129309 TI - Whose genes are these anyway?: familial conflicts over access to genetic information. PMID- 10129310 TI - Court relieves insurer of $22.4 million judgment. PMID- 10129311 TI - Hospitals form coalition to fight Medicaid, Medicare reductions. PMID- 10129312 TI - HCFA, large Minn. HMO spar over SHMO rates. PMID- 10129313 TI - High court case to test definition of supervisor. National Labor Relations Board vs. Health Care & Retirement Corp. of America. PMID- 10129314 TI - Feds to study HCA-Columbia merger, but experts foresee few problems. PMID- 10129315 TI - HCA-Columbia merger fueling talk about prospects for success. PMID- 10129316 TI - HealthTrust signs letter to buy system with 3 hospitals in Utah. PMID- 10129317 TI - 9 rural hospitals in Okla. form network with HMO. PMID- 10129318 TI - CHA reform agenda finds an ally in Clinton plan. PMID- 10129319 TI - Despite administration connections, child health advocates seek reform aid. PMID- 10129320 TI - Merger expected to hasten consolidation in Florida. PMID- 10129321 TI - Reform's impact on people lacking in news stories--study. PMID- 10129322 TI - VA must attract veterans with improved quality to survive under reform. PMID- 10129323 TI - 'Stark II' to cause changes for physicians in ventures. PMID- 10129324 TI - Integrating the incompatible. PMID- 10129325 TI - Bipartisan reform compromise touted. PMID- 10129326 TI - Plan's effects on jobs contested. PMID- 10129327 TI - Insurers adding own medical staffs. PMID- 10129328 TI - Firms pitch services to practices. PMID- 10129329 TI - Hospital data paint picture of profitability. PMID- 10129330 TI - Drugmakers' price plan ruled to be price-fixing by agency. PMID- 10129331 TI - N.Y. considers voiding Baxter contracts. PMID- 10129332 TI - Snags delay UniHealth-Blue Shield merger. PMID- 10129333 TI - Mo. hospitals traded to strengthen markets. PMID- 10129334 TI - Rural system merges with regional hospital. PMID- 10129335 TI - Rural Hospital Association relocating to Washington to be closer to the action. PMID- 10129336 TI - Property-tax battles enter final phase. PMID- 10129337 TI - Reform options, opposition still surfacing. PMID- 10129338 TI - Hospitals calculate lost revenue under reform. PMID- 10129339 TI - New program to promote primary care. PMID- 10129340 TI - Talks stall in VA health chief debacle. PMID- 10129341 TI - Study to examine clinical integration. PMID- 10129342 TI - Entitlement spending cuts seen as essential. PMID- 10129343 TI - Credit upgrades increase, for now. PMID- 10129344 TI - Surprise visit puts facility's accreditation in jeopardy; other hospitals also cited. PMID- 10129345 TI - Going public. Government-sponsored hospitals court patients by expanding primary care. PMID- 10129346 TI - Administration's plans for care of illegal aliens questioned. PMID- 10129347 TI - Public hospitals fear erosion of funding, patient base--experts. PMID- 10129348 TI - GAO taking up-close look at hospital executive compensation. PMID- 10129349 TI - Counties seek assurances under reform. PMID- 10129350 TI - Justice Dept. to study N.H. merger. PMID- 10129351 TI - Uncertainties over reform fail to slow healthcare bond sales in the third quarter. PMID- 10129352 TI - Calif. pension fund seeks HMO price cuts. PMID- 10129353 TI - GAO seeks strong federal oversight of psych providers. PMID- 10129354 TI - SHMO program to expand as HCFA tabs new managers. PMID- 10129355 TI - Bard admits lying to FDA. PMID- 10129356 TI - Reform 'unity' dissolves into partisanship. PMID- 10129357 TI - NME totaling costs of psych woes. PMID- 10129358 TI - HCA battles giant tax bill. PMID- 10129359 TI - OrNda posts year-end profits by improving 1992 acquisitions. PMID- 10129360 TI - Competing unions battle for Pennsylvania nurses. PMID- 10129361 TI - N.Y. hospital's nurses win pact with no-layoff clause. PMID- 10129362 TI - Healthcare inflation slows, but how long will it last? PMID- 10129363 TI - Hill-Rom faces second antitrust investigation. PMID- 10129364 TI - Authorities investigate Caremark venture for kickback violations. PMID- 10129365 TI - Providers addressing AIDS on case-by-case basis, not by strategy. PMID- 10129366 TI - Baxter's net income drops 20%. PMID- 10129367 TI - Fears about job losses not warranted--research group. PMID- 10129368 TI - AMA slams antitrust guidelines. PMID- 10129369 TI - Menorah Medical turns to local system, spurns Columbia's advances. PMID- 10129370 TI - Taking on risk. Competition honors savvy managers who save money by focusing on prevention ... Florida State Hospital, Buffalo (N.Y.) General Hospital. PMID- 10129371 TI - Info networks to be integral in reform. PMID- 10129372 TI - CFC ban may catch some napping. PMID- 10129373 TI - Despite big pay raises for primary-care docs, specialists are top revenue producers. PMID- 10129374 TI - JCAHO will make survey summary 'grid' available to public in 1994. PMID- 10129375 TI - Group releases latest list of 'questionable' docs. PMID- 10129376 TI - Moody's reviews Oregon hospitals. PMID- 10129377 TI - Sorting out the differences in hospitals' profit figures. PMID- 10129378 TI - 3 drug firms to cut thousands of jobs. PMID- 10129379 TI - Study measures turnover time at hospitals, ambulatory units. PMID- 10129380 TI - New Manual has major changes for 1994 surveys. PMID- 10129382 TI - Surgery chapter omits circulating duties. PMID- 10129381 TI - Compliance with universal precautions high in OR. PMID- 10129383 TI - How credit cards can help improve hospital collections. PMID- 10129384 TI - Lessons from the Soviet health care system. AB - The United States and the former Soviet Union have historically organized health care delivery systems according to totally different paradigms. These two divergent approaches have constituted a kind of natural experiment. At the present time, our systems may be becoming more alike, with the former Soviet system decentralizing and even experimenting with forms of medical insurance. Our system, on the other hand, has become much more regulated and, if some have their way, would become increasingly monopsonistic. At this critical point, it may be useful to learn from each other's experiences as we plan for the future. PMID- 10129385 TI - Empowering indigenous health workers through management training. AB - A program to improve the provision of health services to Aboriginals and Torres Strait Islanders will include a management training segment for the indigenous populations. PMID- 10129386 TI - Searching for a new paradigm in health care delivery. AB - The cartoon character Pogo, uttering his now famous line, "We have met the enemy and it is us," might well have been referring to the dilemmas that we face today in American health care. A major source of our current difficulties in solving these admittedly complex problems lies in our way of thinking about, or conceptualizing, health care and health care delivery. We are caught in an old paradigm that is simply not adequate for dealing with the health care delivery problems of the '90s, not to mention those of the 21st Century. PMID- 10129387 TI - Truman and the medical profession: replay or lesson for the nineties. AB - This article describes the first serious effort on the part of an American president to enact national health insurance (NHI). President Truman considered his inability to enact NHI the single most important defeat during his presidency. While a variety of factors led to the demise of NHI, three are most notable. The dynamic interplay of these factors, integrated with references to the current accelerating debate over national health reform, will serve as the focus for this seventh article in a series on historical efforts to enact national health reform in the United States. PMID- 10129388 TI - Small area variation in the use of health care resources. PMID- 10129389 TI - Protecting hospital records from discovery. AB - One of the more burdensome tasks confronting hospital administrators and defense counsel in hospital liability cases is attempting to protect sensitive or confidential information contained in hospital records. Plaintiffs' counsel continue to refine and broaden document requests as they become more sophisticated and experienced, learning about additional categories of documents that may be helpful to their cause. There are conditions that protect documents from discovery, but the rules of privilege are complicated and are frequently misunderstood. PMID- 10129390 TI - TQM: a paradigm for physicians. AB - Change, even when for the better, is always accompanied by apprehension and even outright fear. It is therefore not surprising to hear health care workers, especially physicians, expressing their concerns about this "new" management philosophy through a spectrum of reactions that vary from skeptical or grudging acceptance to outright dismissal of all of the new "alphabet soup" associated with TQM. PMID- 10129391 TI - Implementing TQM in a medical school department. AB - In a modest way, our medical school department has succeeded in applying continuous quality improvement and TQM methods to its ambulatory practice. We are close enough to our experience not to have forgotten what Rosabeth Moss Kanter calls the "messy, mistake-ridden, muddling stage." This article is a narrative of some of our stumbling attempts to change the way our practice works. The lessons we have learned are relevant to other ambulatory practices, both inside and outside the academic world. PMID- 10129392 TI - Bundling services saves everybody time. AB - From a practical viewpoint, the close relationships among utilization review, quality assurance/improvement, infection control, discharge planning, social services, and medical records makes it impossible to separate them. Case management combines these traditionally isolated hospital functions into one department in order to perform many related functions simultaneously. It provides a much more effective and efficient method than can be accomplished by the traditional institutional approach. PMID- 10129393 TI - A survey of physicians in a large group practice. AB - Job satisfaction surveys among physicians, a recent phenomenon, are a very important managerial tool to determine the work motivation needs of physician employees. The first MD Job Survey was done in 1984 by Lichtenstein on physicians employed by prisons. The largest survey of salaried physicians to date has been the 1987 Health Services Research Center of Chapel Hill survey of physicians employed in group practices. Currently, individual group practices are surveying their staffs with job satisfaction questions in order to enhance the work environment. PMID- 10129394 TI - All roads lead to Rome. PMID- 10129395 TI - Expert opinion's role in assessment. AB - How many articles start off by extolling the randomized clinical trial as the pinnacle of scientific evidence? The next sentence typically confronts the practical reality that randomized trials are simply not feasible in most cases. In the absence of definitive trials, technology assessment methodologies have been forced to rely on various types of observational studies--prospective cohort, case control, retrospective studies, cross-sectional and case studies- and a certain component of expert opinion/group judgement, as expressed either in the published medical literature or by the assessors themselves. PMID- 10129396 TI - A guide to the upcoming health reform debate. AB - AT the 1992 ACPE National Institute, several hundred physician executives actively participated in a debate on three competing visions for the health care system in the United States. This new column in the journal attempts to further this process by providing information on policy positions of relevance to College members. While the College does not advocate a particular position, the College encourages individual members to contact the interest group of their choice and get involved in the health policy debate. In this first column, one of the proposals currently being discussed is summarized. PMID- 10129397 TI - A historic, geographic, cultural, and economic guide to Australian health care. AB - This is the first in a series of articles that will explore the health care systems of countries around the world. To begin the series, the President of the Royal Australian College of Medical Administrators describes the current status of the health of his country's people, its health care delivery system, and how it has responded to historic, geographic, cultural, and economic factors that characterize the growth and development of Australia. PMID- 10129398 TI - Physician payment in Canada, Germany, and the United States. AB - As the debate about reforming the U.S. health care system intensifies, interest has focused on three alternative delivery systems: the predominantly private sector model in the United States, the provincial-government health insurance model of Canada, and the social insurance model of Germany. The organization of physician payment is an important part of all these health care systems. To maintain an affordable system that delivers high-quality care, payment to physicians must be sufficient to attract and maintain an able group of doctors, while not exceeding an amount that the country can afford. In this article, these three systems will be examined, and an attempt will be made to apply the lessons learned from Germany and Canada to the direction of physician payment reform in the United States. PMID- 10129399 TI - Quality improvement's new focus yields quantitative results. AB - Health care quality improvement methods are now undergoing fundamental change. The emphasis is shifting from inspection of physician practices to continuous improvement of clinical processes validated by quantitative results. This change is long overdue. Traditional quality assurance methods that operate retrospectively and alienate physicians are not useful in a marketplace where quality and cost control are a matter of survival. Physician practices are only as good as the institutional processes they rely upon, and any quality improvement method that alienates physicians is doomed. Quality improvement is impossible without the support of physicians, because true improvement is driven and quantified by clinical data. Physicians are needed to interpret that data. PMID- 10129400 TI - Reporting quality of health care to the board. AB - The reporting of quality of health care to the governing board has long been an enigma. Now we are in the midst of a revolution in health care, as we shift our focus from solely the clinical performance of individuals to a broader scope of assessing and improving all activities around patient services and patient care- i.e., management outcomes integrated with clinical outcomes to help identify opportunities to improve patient care. In addition, apprised of corporate liability for the quality of care provided in health care organizations, governing boards are raising questions and demanding more information. To maintain this high degree of interest in quality of health care, information should be restricted to what the board needs to know. This article will be confined to the hospital's organizationwide quality system of monitoring and evaluating. While medical staff credentialing and privileging are also board responsibilities and quality management activities should be used in the privileging and credentialing process, they will not be addressed in this article. PMID- 10129401 TI - Issues to consider in internalization of a service. AB - In a staff-model HMO, the demand for services may be greater in one area than in another. Services with little demand and/or high cost are usually contracted to an external provider or institution. Equipment purchases or renovation of a facility to accommodate a new service sometimes go hand in hand with internalizing a service, and capital budgeting is an integral part of the process. The decision on when it is feasible to internalize services has to be considered on two levels: service and finance. This article will look at what issues affect the organization on these two levels and will consider the cost benefit and legal issues that need to be considered when making such a decision. A work sheet that may be used as is or modified is included. PMID- 10129402 TI - Reducing health care costs using claims adjudication software. AB - An important area for reduction in health care costs is incorrect coding of physician services. Current software systems provide high-volume, consistent claims review with substantial savings for payers. The third generation of such systems offers comprehensive coverage across clinical disciplines, across individual claims, and across an entire history of claims. It is likely that these systems will be useful to both nontraditional payers, such as physician groups and hospital-based networks, and traditional payers seeking to reduce costs and enhance competitiveness. PMID- 10129403 TI - Improving clinical decisionmaking as a means of achieving cost-effective medical care. AB - Published research related to physicians' clinical decisions shows that many interventions have been only marginally effective. In this column, John Kralewski comments on that research. The column is intended as a point of ongoing analysis of health services research of importance to physician executives. The column is edited by Dr. Kralewski, who heads the Institute for Health Services Research at the University of Minnesota. PMID- 10129404 TI - Health reform for small population areas. AB - There has been criticism of the managed competition model in terms of its impact on rural areas. It is suggested that the approach simply won't work for providers in rural areas and that an adjustment will be necessary. The author, acknowledging the flaw, proposes changes that will make competition work better for all providers. This column is jointly edited by Kevin M. Fickenscher, MD, and David A. Kindig, MD, PhD, chair and member, respectively, of the College's Forum on National Health Policy. Dr. Fickenscher is participating in various advisory capacities on health care in the Clinton Administration, and Dr. Kindig is Senior Advisor to HHS Secretary Donna Shalala. PMID- 10129405 TI - National health reform advocates retrench and prepare for Medicare. AB - With the failure of President Truman's efforts to pass compulsory health insurance for all, national health reform (NHR) advocates began to redirect their political attention to a politically powerful group of Americans who were simultaneously vulnerable from a health care point of view--the elderly. This effort culminated in the passage of Medicare under President Johnson. This article will focus on antecedents to passage of Medicare that can be found in the Eisenhower and Kennedy administrations. It will also discuss other facets of health reform proposals from the Eisenhower administration. While most proposals never became law, the legislative intent of many of them--outlawing cancellation of policies, a minimum standard health benefit package, establishment of regional health authorities, preference for prepayment plans, and establishment of a reinsurance pool administered by the federal government--is currently under active discussion by the Clinton health reform task forces. PMID- 10129406 TI - A silicon speakers' bureau. Franklin Square Hospital Center, Baltimore, MD. PMID- 10129407 TI - Equal opportunity heart problems. St. Michael's Medical Center, Newark, NJ. PMID- 10129408 TI - Stormy weather aids addicts. Regional West Medical Center, Scottsbluff, NE. PMID- 10129409 TI - The wellness wave. PMID- 10129410 TI - Success means giving business what it wants--results. Preventive Health Systems, Cincinnati, OH. PMID- 10129411 TI - Corporate wellness won't work without the workforce. Saint Francis Hospital, Hartford, CT. PMID- 10129412 TI - Won't you be my neighbor? When a tax battle threatens, hospital leaps to aid community. Lancaster General Hospital, PA. PMID- 10129413 TI - Around the world without a disease. Lovelace Occupational Medicine, Albuquerque, NM. PMID- 10129414 TI - A bear a day keeps tears away. Baystate Medical Center, Children's Hospital, Springfield, MA. PMID- 10129415 TI - Keeping ahead of the pack. Woman's Hospital, Baton Rouge, LA. PMID- 10129416 TI - Quality of Life Award. Provider salutes the winners. AB - Provider showcases six facilities that promote autonomy and independence through resident care/services programming and design. This year's winning entries include four resident services programs that strive to maximize resident potential and two facility designs that capture the spirit of utilizing the environment to promote resident well-being. PMID- 10129417 TI - Inflation indicators play critical role in payment system design. PMID- 10129418 TI - Complying with PSDA requirements protects resident, staff rights. PMID- 10129419 TI - Risk management decreases incidence of falls, wandering. PMID- 10129420 TI - Socialization is focus of facility exercise program. PMID- 10129421 TI - Autologous blood recovery. A guide for health care providers. AB - Autologous blood recovery devices have taken on new importance in the effort to conserve finite resources of blood products in the face of ever-growing demand. By incorporating this technology in the vascular, orthopedics, and cardiovascular arena, substantial savings of blood will be realized. The expanded utilization of autologous blood recovery will enable an already burdened blood supply system to continue to provide an adequate source for our patients. It will also help assuage our patients' fears by limiting their exposure to homologous products and the attendant risk of infection by blood-borne pathogens. PMID- 10129422 TI - Automating the medical practice--promise and peril. AB - Pick up any newspaper or news magazine and chances are that an article on health care reform will be prominently featured. While we await the details of the plans for reform, we can divine some major implications. With certainty, one of these will be the need to access and integrate vast amounts of patient and provider data. These medical data, in electronic form, will fuel the interplay between provider, hospital, government organizations, and private health care management. These data will be used: to drive the outcome studies that will examine medical resource consumption; to track prescribing practices; to facilitate patient follow-up; and to monitor wellness programs. In short, data management will be an unseen, but very present, companion to all our practice decisions. The successful medical practitioners in the coming era will be those whose practices have an electronic infrastructure that allows comprehensive medical record keeping, inclusive of patient charting, billing, coding, scheduling, and data reporting to third parties. PMID- 10129423 TI - The cross-cultural group: a multilingual, multicultural group. PMID- 10129424 TI - Japan's experience in long-term home health care of the elderly. AB - Due to increasing national health expenditure and an aging society, Japan in the 1980s started to reinforce home health care, going beyond her long-time investment in institutional care. Since 1983, a sequence of policies was issued focused mainly on frail elderly care. In support of this governmental approach, a variety of enterprises and charity activities have flourished. Now, however, in the midst of a worldwide recession, rationing as health policy is under reconsideration and has an influence on health care for minorities, including the elderly. In Japan, home health care is under review and a new service system was initiated in April 1992. In this article, the newly inaugurated community-based home visiting nursing scheme is introduced together with a short history of elderly care and related business activities in Japan. Feasibility of the new scheme is discussed and compared with the previous version of home visiting nursing, which had its base in hospitals. PMID- 10129425 TI - Practice parameters for home health care: facilitating appropriate physician involvement. PMID- 10129426 TI - Recognizing and responding to elder maltreatment. PMID- 10129427 TI - Youth exchanging with seniors: a rural Texas program. PMID- 10129428 TI - Assessing the needs of persons of advanced age: the Weston, Massachusetts Council on Aging "over 80" outreach survey. PMID- 10129429 TI - TQM: making it work for you. PMID- 10129431 TI - Clinton's careful health care shuffle. PMID- 10129430 TI - Surgical lasers. PMID- 10129432 TI - Healing words, looming battles. Health care politics: how the big fight will play out. PMID- 10129433 TI - A guide to health reform. AB - Answers in plain English to almost everything you ever wanted to know about the Clinton initiative--and how it could affect the medical care you get. PMID- 10129434 TI - Living with health reform. Families in four top-flight managed care plans give their views. PMID- 10129435 TI - 'I want peace of mind for families'. Clinton tackles some of the queries you posed. PMID- 10129436 TI - Why we need health reform. PMID- 10129437 TI - The visible hand. Clinton's health reform could alter prospects for millions of enterprises. PMID- 10129438 TI - Could Clinton's plan pay for itself? PMID- 10129439 TI - The art of staying alive. AB - Resuscitation attempts usually fail. Cooling the brain may be the future of emergency medicine. PMID- 10129440 TI - The voluntary dissemination of performance information by health care organizations. AB - This paper examines the factors that influence the voluntary dissemination of performance information by health care organizations. A model of information dissemination is developed and tested using data on Health Maintenance Organizations. The empirical findings suggest that health care organizations disseminate information on their performance because there are collective-good benefits resulting from dissemination, particularly when the product or organizational innovation is unfamiliar to some purchasers. The findings also suggest that the competitive structure of the local health care market influences the dissemination decision, with health care organizations more likely to disseminate information about their performance in relatively competitive markets. PMID- 10129441 TI - Inefficiencies in physician practices. AB - Explosive growth in spending on physician services in the 1980s has focussed the attention of policymakers and researchers on inefficiencies in physician practices. This chapter surveys the recent literature on inefficiencies in physician practices and provides a review, critique, and synthesis of empirical findings. The major emphasis is on measurement and estimates of economies of scale in physician practices. The paper concludes with a discussion of limitations of current knowledge and methods, and directions for future research. PMID- 10129442 TI - The behavior of multihospital chains in increasingly competitive California hospital markets: pro- or anti-competitive? AB - In previous literature, no evidence of competitive advantage has been found from hospital affiliation with chains. In this paper, the role of chains in hospital adaptation to a more competitive environment is examined further. Two dimensions of hospital behavior are examined: the propensity to engage in contractual arrangements with insurers, and the effect of a changed competitive environment on preferred acquisition targets by chains. We find evidence that chains behave pro-competitively in the short run, and discuss policy implications of the observed market restructuring in the longer run. PMID- 10129443 TI - The chiropractic services market: a literature review. AB - This article surveys the economic literature on chiropractors. Chiropractors provide a substantial amount of care for those with various neuro-musculo skeletal disorders and represent the fastest growing segment of the professional health services market. Yet the study of the profession has been neglected in the health services research literature. The goals of this article are to take stock of the existing literature and data sources. After providing background information, including recent developments in antitrust, I merge various data sources to assess the growth of expenditures for chiropractic care and the proportion of the population using this care. Other data sources and features are also described. I conclude with a discussion of the significance of further research on the profession to existing policy efforts to contain costs and improve health care delivery. PMID- 10129444 TI - Rural hospital closures: an inquiry into efficiency. AB - The relationship between efficiency and rural hospital closure was examined by comparing the efficiency of nongovernment short-term general rural hospitals that closed in 1988 to that of their counterparts that remained opened. A similar comparison was made between the efficiency of open and closed urban facilities. Although no relationship between efficiency and closure was demonstrated, an examination of the surpluses and shortages in production among inefficient hospitals revealed that inefficient closed hospitals in both rural and urban areas experienced a lack of demand for inpatient services. Furthermore, a threshold value of 21 or 22 inpatient discharges per bed per year was identified as being related to closure regardless of whether a hospital was operating efficiently or not. PMID- 10129445 TI - HMO and PPO growth and hospital utilization and payment: a recursive model. AB - A recursive model of growth of Blue Cross and Blue Shield Plan Health Maintenance Organization (HMO) and Preferred Provider Organization (PPO) membership share is used to analyze total hospital utilization and payments per thousand insured members over an eight year study period, 1980 through 1987. Results indicate a strong, significant relationship between previous year Plan payments and current year growth in HMO membership share. Additional results suggest that Blue Cross and Blue Shield Plans experienced significant reductions in utilization and payments rates resulting from PPO membership share gains and not from HMO membership share gains. PMID- 10129446 TI - Firearms, firearms injury, and gun control: a critical survey of the literature. AB - Firearm-related deaths are a major health problem in the United States. Legislation limiting the ownership, sale and use of firearms often is proposed as a means of reducing firearm-related deaths. There is a substantial and growing literature on the epidemiology of firearm-related death, as well as numerous studies grounded in the social sciences. Many of these directly address the issue of the impact of gun control on death rates. This paper provides a survey of existing knowledge of the effects of gun control legislation on firearm-related homicide, suicide, and unintentional fatal injury rates. We identify several major gaps in the literature that need to be addressed in future research. PMID- 10129447 TI - Medical care price indexes: theory, construction & empirical analysis of the US series 1927-1990. AB - The historical development of price indexes as wage adjustment mechanisms is reviewed, as is the theory of aggregation and methods for dealing with quality and technological change. The construction of the U.S. Bureau of Labor Statistics (BLS) Medical Care Price Index (MCPI) is detailed. ARIMA analysis of the MCPI for the period 1927-1990 indicates that; (i) the MCPI is largely a damped and delayed function of the CPI, with an average lag of 8 months; (ii) medical care prices rose 2-4 percent faster than the all-items CPI since 1950, but not for 1927-1950; (iii) health expenditures are affected primarily by the general CPI, with little independent effect of specifically medical prices. The MCPI is a reliable measure of changes in consumer prices with strong construct validity. However, it was not designed for use as a deflator of medical expenditures, and is misleading when erroneously employed in that unintended role. The price/quantity duality and linear expenditure function which form the basis of Laspeyres price indexes are not applicable to nonconcatenable goods such as insurance or medical care. In these complex transactions, quality dominates quantity, fixed prices are replaced by reimbursement and professional judgement, and the assumption of additive separability required to use the price index as a deflator of health expenditures is not valid. PMID- 10129448 TI - Is your organization ready for change? AB - This article is part of a series written for those who wish to bring about broad, permanent improvements in their organization; those who are "change managers." The subject is change management: Why is change necessary? How to approach it from an overall systems point of view? What are the most important organizational preconditions for any real change to occur? Eight key conditions you should have as a platform for change are listed in this first article. One of these is what Mr. Hilton calls "Business Process Analysis (BPA)." In the second article, this exciting methodology will be discussed. For those of you who prefer the "how to do it" over the theory, this is for you. Then, in November's issue, the benefits of BPA will be shown to have incredible leverage for the change manager and serve as a basis for sound Management Information System Planning, Corporate Restructuring, Process Reengineering, Budgeting, Departmental Productivity Improvement Programs, and Pay-for-Performance Programs. If you fancy yourself a change manager, from CEO to Junior Analyst, you will not want to miss reading this series. PMID- 10129449 TI - The new urban healthcare coalition. Part 2. PMID- 10129450 TI - The Medicare payment provisions of OBRA 1993. Drawing the line on healthcare spending. PMID- 10129451 TI - After the deluge. PMID- 10129452 TI - The leading edge of mammography. PMID- 10129453 TI - The American College of Radiation Oncology--socio-economic and political roles. PMID- 10129454 TI - Seeing the unseen. PMID- 10129455 TI - New views from the reading room. PMID- 10129456 TI - Desperately seeking solutions: rationing dilemmas in health care. AB - Rationing health care is high on the policy agenda in many countries as the demand for care apparently outstrips supply. There are calls for the public to become more actively involved in determining priorities along the lines of the Oregon experiment in the United States. In Britain rationing has always been a feature of the National Health Service (NHS) although it has become implicit rather than explicit. The NHS reforms, principally the purchaser-provider separation, is making rationing much more explicit. The paper reviews the debate in Britain and concludes that there are no quick fixes or simple panaceas to a complex issue. It questions the extent to which the public can or should be involved in deciding who should or who should not get treated and argues that doctors have a central role to play in finding a better way of allocating resources effectively. PMID- 10129457 TI - Hospitalisation of children under 15 years in Victoria. AB - OBJECTIVE: To determine whether the separation rate from the hospital for children aged 0-15 years in Victoria was higher for those resident in the country area of the State in comparison with the metropolitan area and, if it was, to investigate possible explanations. DESIGN: Discharge data from all public hospitals in Victoria for children aged 0-15 years for the financial years 1988 89, 1989-90 and 1990-91 were analysed with detailed analysis being done on the 1990-91 data set. Discharge rates were determined according to the local authority area of residence. Patients were grouped according to Diagnosis Related Groups (DRGs) version 5. RESULTS: Children living in the country area showed a separation rate of 50 per cent greater than that for the metropolitan area. Separation rates for local authority areas were remarkably constant over the three years. Country local authority areas with the highest separation rates had separation rates for asthma and bronchitis (DRG 98), almost four times that of metropolitan residents, and for otitis media and upper respiratory infection (URI), a rate almost ten times that of metropolitan residents. CONCLUSION: It is suggested that variation in medical practice was the most likely explanation for the observed differences. PMID- 10129458 TI - DRGs as management information or reimbursement method. AB - Diagnosis Related Groups (DRGs) can be used either as a system of management information or as a method of funding hospitals. They cannot be used as both, for the incentives which are generated if hospitals are reimbursed by DRG encourage misclassification and game playing. It is argued that the major problem facing the Australian hospital system is social, not technical, efficiency. Funding by casemix focuses on the latter. If efficiency of either sort is to be improved, managers and clinicians need a common language which links casemix to cost and outcome. Used as a management information system, DRGs meet this need, but to do so effectively they should not be burdened with the additional responsibility of hospital reimbursement. PMID- 10129459 TI - Auditing and accountability within the public hospital system: the need for structural reforms. AB - A recent report by the Independent Commission Against Corruption (ICAC) in NSW highlighted that some accounting controls for cash handling in public hospitals are inadequate. Given the number of public hospitals in Australia and the amount of cash being handled, it is essential that efficient accounting and auditing systems are established for these activities. This paper examines several major shortcomings in cash-handling methods used by NSW public hospitals and outlines how the system may be improved. The authors are currently developing a national survey to extend this analysis. PMID- 10129460 TI - Privacy Act 1993. Health sector perspective. PMID- 10129461 TI - Facilities management contracting: the key to effective change management. AB - Facilities Management Contracting is a catalyst for developing high performance individuals and teams to deliver value for money in today's demanding funding environment. It is a key to unlocking individuals' creativity, and learning, through effective change management strategies, and to developing organisational processes and structures to promote this. Sarah Meads, General Manager of Serco Health Services, explores how health providers could make more effective use of Facilities Management Contracting to release the potential that already exists within their organisations by thinking of Facilities Management as a change management tool. Serco Health Services is the division of Serco Group NZ Limited responsible for assisting healthcare providers to review and manage a wide range of non-core support services. PMID- 10129462 TI - Political parties' health policies. National's major changes now in place; Labour's health policy; the Alliance's health policy. PMID- 10129463 TI - Choosing the right management training for you. PMID- 10129464 TI - Home support services for the future. PMID- 10129465 TI - Developing a critical path for clinical paths. PMID- 10129466 TI - The principles and practice of Hartford Hospital's patient-centered redesign program. PMID- 10129467 TI - Infusion pump redesign: nursing and radiology lead the way. PMID- 10129468 TI - Why are elderly people not using advance directives? AB - Although advance directives for health care are widely advocated, usage rates among the elderly are low. Reported is a study testing comparative educational strategies to increase the use of advance directives among elderly persons ages 65 to 93. Follow-up interviews (n = 293) with intervention participants and controls showed that only 1 of 6 different strategies increased use. Neither lack of information nor simple procrastination were found as primary barriers to completion of advance directives. Most intervention participants preferred to defer to family surrogates and avoid executing advance directives. Level of education was a factor in use. Proposed is a restructuring of the advance directives process to accommodate elderly persons' wishes to authorize family members for surrogate health decision making, a policy that would assist the majority of people, including those who either wish to avoid or fail to execute advance directives. PMID- 10129469 TI - Pathways to hospital death among the oldest old. AB - Using the 1986 National Mortality Followback Survey (N = 2,090), this research examines the conditions under which the oldest old (85+ years of age) are discharged from a nursing home to enter and die in a hospital as well as the conditions under which community dwellers enter and die in a hospital. Given the need to plan for health services for this growing population and the recent policy changes in length of hospital stay, this analysis focuses on pathways leading to a hospital death. Results suggest that the factors that influence site of death are necessarily quite distinct for those who have entered the institutional long-term care system versus those who have not. Among institutionalized patients, the incidence of an acute condition appears to precipitate hospitalization, whereas among community dwellers, the presence of a social support network and the decedent's race are the only salient factors predicting hospital death. Implications are discussed. PMID- 10129470 TI - Perspectives. Business and health reform: holding fast to the reins. PMID- 10129471 TI - Perspectives. Performance measurement: health reform's hope or hype? PMID- 10129472 TI - Health reform insight. HCFA unveils proposed Medicare spending cuts. PMID- 10129473 TI - Perspectives. Mental health care: reconciling parity and prejudice. PMID- 10129474 TI - The visionary CIO: encouraging the dramatic difference. PMID- 10129475 TI - Never leave your wingman: a pilot's guide to IS project management. PMID- 10129476 TI - The battle for doctors' desks: on-ramps for EDI superhighways. PMID- 10129477 TI - Picture archive & communications system standards: the DEFF (Data Exchange File Format) vs. DICOM (Digital Image Communications in Medicine) dilemma. PMID- 10129478 TI - Dueling with the paper dragon. PMID- 10129479 TI - RIS review 1993. State of the market. AB - According to the vendors who supply them, cost justification seriously impedes the selection and implementation of a radiology information system, also called an RIS. Forty companies' executives, who provided information about their systems for Healthcare Informatics' 1993 RIS survey, also indicated what they believe are the primary benefits of a radiology system. They ranked results reporting at the top of the list and inventory control at the bottom. PMID- 10129480 TI - A retail argument for PC networks. PMID- 10129481 TI - The three Rs for CPR (computer-based patient record) implementation: regulations, reengineering & rightsizing. PMID- 10129482 TI - Radiology information system brings big savings to small facility. PMID- 10129483 TI - Preserving the privacy of computerized patient records. PMID- 10129484 TI - An electronic medical record--delivering benefits today. PMID- 10129485 TI - Medicare claims system knows a character when it sees one. PMID- 10129486 TI - Alternative sources of energy--wind turbine generators. PMID- 10129487 TI - Reduced energy costs at Hammersmith Hospital. PMID- 10129488 TI - Borehole water may not be so cheap. PMID- 10129489 TI - CHP (combined heat and power) in the health sector. PMID- 10129490 TI - The pro's and con's of gas turbine CHP (combined heat and power). PMID- 10129491 TI - 'The first low energy hospital--clients view'. PMID- 10129492 TI - Preventing TB transmission in the microbiology lab. PMID- 10129493 TI - Special issue: OSHA and EPA compliance. PMID- 10129495 TI - Life support for cervical-level quadriplegia questioned. PMID- 10129494 TI - Allocation of resources--to treat or not to treat, and who shall beg the question? AB - Two separate clusters of events in recent months have spurred public discussions over the questions of how and to what degree the public should be involved in resource allocation decisions. In England, a group of physicians unilaterally decided to deny bypass surgery to heavy smokers, and in the United States, uninsured parents of conjoined twins elected to seek separation of the twins despite heavy odds against their survival, raising questions of whether health care reform will stymie such decisions in the future. PMID- 10129496 TI - Physician-patient relationships frame ethical issues. PMID- 10129497 TI - Report provides ethics recommendations for health care executives. PMID- 10129498 TI - Definition of futility no longer a purely medical decision. AB - Efforts to come to grips with defining the conditions and boundaries of futile treatment continue to emerge in professional and lay discussions. One clear underlying premise that is taking hold is the idea that such definitions of futility are no longer the sole purview or responsibility of the medical establishment. PMID- 10129499 TI - 'Media stars' in assisted suicide debate spur legislative response. AB - The paths taken by Drs. Jack Kevorkian and Timothy Quill, though very different, both carry messages that fuel not only the debate over assisted suicide but also the larger state initiatives for active euthanasia. The following articles update the activities surrounding these spokesmen. PMID- 10129500 TI - Why does workers' compensation pay more for health care? AB - An analysis shows that health care providers charged substantially larger amounts for treatment of workers' compensation cases than for the treatment of similar patients insured by Blue Cross. PMID- 10129501 TI - Medical benefit costs in Canadian workers' compensation programs: a comparative perspective. AB - Increases in medical benefit costs in the workers' compensation programs of Canada and the United States bear some relationship to the institutional environment of health care and workers' compensation in the two countries. PMID- 10129502 TI - An overview of medical cost containment in workers' compensation. AB - Use of medical cost-containment strategies in workers' compensation is increasingly common and varies in design and enforcement. An evolution toward managed care is observed, particularly in the private sector. PMID- 10129503 TI - Labor Department regulations for Family and Medical Leave Act. AB - Interim regulations issued by the Department of Labor provide employers with significant guidance on compliance with the Family and Medical Leave Act. PMID- 10129504 TI - Health care costs in workers' compensation. AB - Although the costs of both the medical and indemnity components of workers' compensation have increased substantially in the past several years, the costs of medical benefits grew far more dramatically. PMID- 10129505 TI - The cost of treating injured workers: the changing workers' compensation landscape. AB - To better understand the impact of changing health care delivery on the workers' compensation system and the cost of treating injured workers, the author examines the program within the context of recent environmental changes--including the likely impact of managed care. PMID- 10129506 TI - What states are doing to control health insurance costs. AB - Like other employers, state governments are struggling with continued health care cost increases. A 50-state survey reveals that these large public employers are actively attempting to control the cost of their plans while ensuring quality and a commitment to their employees' overall good health. PMID- 10129507 TI - The U.S. experience with sprinklers: who has them? How well do they work? PMID- 10129508 TI - Clinton's tooth-fairy financing. AB - Even President Clinton's supporters say his proposal to finance health reform is politically unrealistic. It's that--and more. His plan to raise $441 billion over five years would reduce services to elderly and poor Americans, assumes savings unmatched anywhere in the Western world, and ignores the federal government's dismal track record in forecasting what new benefits will cost. PMID- 10129509 TI - The Senate Republican prescription. AB - Senate Republicans agree with President Clinton that the nation must insure its citizens and control spiraling health costs. But those goals can't be achieved through costly new mandates that will thwart economic growth or regulatory burdens that impair quality. Here's how that balance can be struck. PMID- 10129510 TI - The Clinton plan: how does it play for governors and states? AB - Many of the nation's governors are moving from short-term cost cures of the 1980s to sweeping health reform laws. States' ability to remain flexible in how they undertake reform remains a critical concern to governors as they size up the Clinton health plan, especially its call for a national budget. PMID- 10129511 TI - White House places its bet on health security message. PMID- 10129512 TI - And now, a word from the "other Washington".... AB - One of a handful of states to enact sweeping health reform, Washington State sees consistency between the Clinton plan and its 1993 law. But some aspects of the Clinton plan could pose problems. PMID- 10129513 TI - DataLine. Who are the uninsured? Census data paints diverse picture. PMID- 10129514 TI - Single payer health care--the 100 percent solution. AB - Unlike President Clinton's plan, we don't have to guess whether single payer health care will work--we know it does. It's also less disruptive, less costly, and is easy to understand and administer. PMID- 10129515 TI - Policymakers take new AIDS education tack. PMID- 10129516 TI - From gridlock to the goal line: a best case scenario for health reform. PMID- 10129517 TI - Doctors and lawyers square off on Clinton malpractice plan. PMID- 10129518 TI - This is Kansas? Commission backs single payer health reform plan. PMID- 10129519 TI - California doctors and lawyers eye likely malpractice battle. PMID- 10129520 TI - Vermonters balk at reform options. PMID- 10129521 TI - Wall St. reaction: the sky isn't falling after all. PMID- 10129522 TI - Clinton charts health reform course. PMID- 10129523 TI - The Clinton plan: with malice toward none and health security for all. AB - President Clinton's health reform proposal brings together the means generally associated with conservatives--market competition--to achieve the ends advocated by liberals--health security for all Americans. Exactly how the White House, Congress, and the American public reach consensus is open to negotiation and compromise. But certain fundamental principles such as universal coverage and cost control are not. PMID- 10129524 TI - The quality of patient care documentation. AB - Medical transcriptionists can attest to the accuracy of their transcription, but they cannot attest to the accuracy of patient or provider identification. The quality of patient care documentation can only be attested to by provider review and signature, i.e., through authentication. PMID- 10129525 TI - AAMT (American Association for Medical Transcription) position paper. Providers' signatures. AB - Medical transcriptionists are medical language specialists who transcribe dictated patient reports. They interpret and edit raw data (dictation) in as complete, clear, consistent, and correct a manner as possible. Medical transcriptionists can attest to the accuracy of their transcription; they cannot attest to the accuracy of the dictation on which it is based. Patient care and well-being are at risk if proper attention is not given by the healthcare provider to the content of the patient record before the provider's signature is affixed. The provider's signature communicates accuracy of record content that only the provider can give; thus, delegation of authority to affix signatures is inappropriate and should not be allowed. PMID- 10129526 TI - The impact of motivation and incentive programs on financial budgets. PMID- 10129527 TI - Managed care accreditation: the process and early findings. AB - Health maintenance organizations (HMO)s are taking center stage in our nation's move toward healthcare reform. Issues such as quality, cost, and access to healthcare are critical to consumers; the managed care industry provides care at a significantly more affordable cost than does traditional fee-for-service medicine. Although national surveys show that HMO members are extremely satisfied with the level of service and care they receive, managed care organizations still strive to demonstrate their commitment to quality. As healthcare industry leaders and major customer groups attempt to establish measurable performance standards, the emergence of the National Committee for Quality Assurance (NCQA) has enhanced the ability of managed care organizations (MCOs) to demonstrate excellence by way of accreditation. PMID- 10129528 TI - Applying total quality management to the medical practice. AB - Total quality management (TQM) has the potential to help medical practices in the transition to a healthcare system that is more demanding in terms of both higher quality and lower cost. Incorporation of TQM principles, however, must be based on creating skills in the areas of teamwork, communication, and problem solving. The potential gain will be seen in improved patient satisfaction, increased revenue as a result of more accurate billing, clearer understanding of costs and outcomes, better clinical documentation, and enhanced staff productivity. PMID- 10129529 TI - The quality improvement process: one approach to education. AB - Quality improvement (QI) is a practice now expected of the healthcare industry. The Joint Commission on Accreditation of Healthcare Organizations has incorporated continuous QI into its standards; furthermore, the implementation of QI is a major challenge facing healthcare institutions today. The authors describe the educational approach taken by one institution as it implemented the QI process in a facility that recently merged three acute care hospitals and explain the necessary commitment and structure for a successful QI program. The importance of the educational process cannot be overemphasized. PMID- 10129530 TI - There's more to quality improvement than a name change. AB - Improvements in the healthcare delivery system cannot be sustained over time until quality improvement (QI) methods and techniques are widespread and completely understood. The professional disciplines of quality assurance and continuous quality improvement (CQI) can work synergistically to produce the desired outcomes needed in today's highly competitive healthcare industry. PMID- 10129531 TI - Monitoring of universal precautions as a factor in patient and staff safety. AB - Quality improvement (QI) monitoring of universal precautions at the author's facility appeared to indicate that although personal protective equipment is always available and staff are increasingly aware of the need to protect themselves, compliance with medical center practices remained inconsistent. The use, throughout the QI program at the medical center, of appropriate indicators to monitor for sharps incidents and body fluid splashes continues to highlight the need for innovative activities to help staff achieve more optimal compliance with medical center policies. Causes for noncompliance are examined using a problem-solving approach accompanied by various continuous quality improvement (CQI) tools. Root causes are explored with the intention of providing support rather than blame for the findings. Outcomes of activities that were implemented to improve compliance with medical center policies and practices are highlighted. PMID- 10129532 TI - Legislative forum: HEDIS 2.0: a standardized method to evaluate health plans. PMID- 10129533 TI - Incorporating the USAF Flight Center's TQM plan in a hospital. AB - A total quality management (TQM) plan has been instituted by the United States Air Force Flight Test Center at Edwards Air Force Base. To determine the feasibility of implementing the same basic TQM plan in a district hospital, a joint industry-government team was established. Five areas of concentration were selected for review: infrastructure, methodology, training, strategic plan, and a "Quality Bill of Rights." The TQM "infrastructure" is intended to match and complement the existing organizational structure and chain of command, not to supplant it. As the overall plan seemed well-adapted for implementation in a hospital setting, a three-phase implementation approach was identified that included conceptual planning, initial training and goal setting, and full-scale implementation. Each phase is described in terms of objectives, staffing, and timing requirements. PMID- 10129534 TI - The American College of Surgeons and physician payment reform--a review. PMID- 10129535 TI - Washington update on trauma issues. PMID- 10129536 TI - The 1992 ACOG survey. Professional liability: is gender a factor? PMID- 10129537 TI - Medical liability reform and the federal government. PMID- 10129538 TI - Patient care information systems and physicians: the transition from technology icon to health care instrument. AB - We have discussed several important transitions now occurring in PCIS that promise to improve the utility and availability of these systems for the average physician. Charles Babbage developed the first computers as "thinking machines" so that we may extend our ability to grapple with more and more complex problems. If current trends continue, we will finally witness the evolution of patient care computing from information icons of the few to clinical instruments improving the quality of medical decision making and care for all patients. PMID- 10129539 TI - Enhancing the cost-effective practice of medicine: the physician's perspective. AB - Data-driven process improvement, such as that at Harper Hospital described earlier, requires several critical elements. First, data must be readily available, accurate, timely, and easy to analyze. Over 200 charts and graphs were produced at Harper Hospital to support the work of the five teams. Often, teams met weekly and data had to be accessed, analyzed, and turned around in five working days. Without the right systems, this is impossible. Second, accuracy of data and accessibility are issues. Sometimes, data are not accessible because of disparate systems or databases, or because they are not collected in a format to support analysis. An example of the latter occurred at Harper Hospital when it was discovered that surgical OR supplies were billed at one inclusive rate and that the detail data were not collected in an automated system. Manual analysis could not be done in the time frame required and momentum was lost. Next, timeliness is an issue when physicians are asked to make decisions using dated data. For most purposes, data should be no more than three months old. Ideally, two weeks should be the limit. Some hospitals are making new data available hourly. Trends change too rapidly, lengths of stay shorten, new antibiotics are introduced, new treatments are available, and reimbursement changes too often to use old data for decision making. Lastly, tools should be readily available to bring the story from the numbers. Graphs, charts, and statistics need to be used much more often and in more imaginative ways. As the health care information industry makes databases more user-friendly, physicians will understand and regain their potential to use medical science to improve the lives of their patients. PMID- 10129540 TI - Communicating with physicians: one hospital's approach. AB - Experience with the PAL program has demonstrated that it takes approximately six months to one year for a PAL relationship to build trust and open communication. By the end of the sixth month, the relationship is usually established to the point that the physician and office staff voluntarily call on the PAL manager with concerns requiring attention. Riverside continues to explore ways to build and strengthen the PAL Program. At a recent hospital managerial conference, managers and physicians discussed the hospital-physician relationship and collaborated on ways to improve communications and alliances with the medical staff. In addition, hospital-sponsored social events that provide opportunities for physicians and PAL managers to interact outside the workplace have been introduced and well received. As the health care delivery system undergoes transformation and implementation of the computerized patient record becomes a reality, the PAL Program will serve as a foundation in the establishment of new programs and relationships between the hospital and the medical staff that will ensure Riverside's future success in the marketplace. PMID- 10129541 TI - One positive impact of health care reform to physicians: the computer-based patient record. AB - The health care industry is an information-dependent business that will require a new generation of health information systems if successful health care reform is to occur. We critically need integrated clinical management information systems to support the physician and related clinicians at the direct care level, which in turn will have linkages with secondary users of health information such as health payors, regulators, and researchers. The economic dependence of health care industry on the CPR cannot be underestimated, says Jeffrey Ritter. He sees the U.S. health industry as about to enter a bold new age where our records are electronic, our computers are interconnected, and our money is nothing but pulses running across the telephone lines. Hence the United States is now in an age of electronic commerce. Clinical systems reform must begin with the community-based patient chart, which is located in the physician's office, the hospital, and other related health care provider offices. A community-based CPR and CPR system that integrates all providers within a managed care network is the most logical step since all health information begins with the creation of a patient record. Once a community-based CPR system is in place, the physician and his or her clinical associates will have a common patient record upon which all direct providers have access to input and record patient information. Once a community level CPR system is in place with a community provider network, each physician will have available health information and data processing capability that will finally provide real savings in professional time and effort. Lost patient charts will no longer be a problem. Data input and storage of health information would occur electronically via transcripted text, voice, and document imaging. All electronic clinical information, voice, and graphics could be recalled at any time and transmitted to any terminal location within the health provider network. Hence, health system re-engineering must begin and be developed where health information is initially created--in the physician's office or clinic. PMID- 10129542 TI - F:?DOCS?DOCS--physicians and automation. AB - While a paperless system may not be commonplace today, strides are being taken by groups such as CPRI to ensure the development of such a system. Several hospitals and clinics are moving toward or have implemented paperless or limited paper environments using patient-centered systems where charting is performed at the "bedside" of the patient through sophisticated software and hardware systems. Such systems will continue to evolve until the ATM of patient care is created. At that time, patients' access to their own information will be an acceptable phenomenon, physician use of computers will be commonplace, acceptance that adjunct knowledge bases must be coupled with the human skills of the physician, and test redundancy will be considered intolerable. These steps will contribute to the cost reductions needed to truly "reform" health care and create a value added product for the United States. PMID- 10129543 TI - Performance improvement review: implementation of total quality in medical information services. AB - The University of Michigan Medical Center (UMCC) has received national recognition for its leadership role in total quality management (TQM). In 1990, UMMC was awarded the third annual Commitment to Quality Award presented by The Healthcare Forum (San Francisco) and Witt Associates, Inc. (Chicago). This award is the only national award for quality given to health care organizations in the United States. This article discusses the evolution of the total quality process (TQP) at a large academic teaching center and the implementation of that process into Medical Information Services (MIS) daily work environment. PMID- 10129544 TI - Research review: refined diagnosis-related groups--a new perspective on patient classification. PMID- 10129545 TI - Informed clinical management: decision support systems and physicians. AB - In addition to providing value today, information systems should pave the way for greater systems' value tomorrow. An organization that begins now to transform its administrative decision support system into a clinically oriented decision support system has taken one significant step in the direction of the future. PMID- 10129546 TI - Why the new Hospital for Sick Children was built. Interview by Matthew D. Pavelich. PMID- 10129547 TI - Continuous quality improvement in Canadian health care organizations. AB - A survey of Canadian health care organizations indicates growing interest in the philosophy and methods of continuous quality improvement (CQI). Most organizations are still in the early stages of learning and applying CQI. Although CEOs have been learning about CQI and have been participating in quality councils, they are less involved in using and teaching CQI techniques. Major obstacles reported in developing quality improvement are lack of time, limited resources, lack of training, and pressures to deal with other changes. Only a few organizations question the value of developing quality improvement, and many who have not yet adopted CQI say they intend to do so. PMID- 10129548 TI - Political views on health care reform. Bloc Quebecois; Liberal Party of Canada; New Democratic Party; Progressive Conservative Party of Canada; Reform Party of Canada. PMID- 10129549 TI - The new look of health facility design. AB - Recent changes to our health care system are affecting priorities in the design of hospital facilities. Architects are now more often consulted to renovate or retrofit facilities than to design and build new ones. Using case studies, this article outlines the principal points to consider when renovating or retrofitting a health care facility. PMID- 10129551 TI - The benefits of patient-focused care. PMID- 10129550 TI - Bed utilization: a regional trial. AB - In mid-1992 a bed utilization study was implemented in four hospitals in Cape Breton. Over four months, 260 patients and charts were reviewed using the Appropriateness Evaluation Protocol (AEP). Results suggested that 21.5 per cent of the population was inappropriately admitted, had inappropriate days of care, or both. Pros and cons of the AEP were identified, and plans for implementing the AEP, together with clinical questions, have been endorsed by Cape Breton's Regional Services Committee. A subsequent study, to be published in the next issue of Leadership, discusses a review of the discharge planning process in Cape Breton Region. PMID- 10129552 TI - Report from The Centre for Quality in Governance. Criteria for choosing a chief executive officer. PMID- 10129553 TI - Cataloguing patient education materials. PMID- 10129554 TI - From chrome bedrails to pastel walkers: changes in design for seniors. AB - The author explores a new philosophy of design--with reference to assistive devices for the elderly--that promotes comfort, ease of use, and safety. By re examining long-held assumptions about the needs and desires of the elderly, designers of assistive devices can pin down some of the elusive aspects of comfort, privacy, and security. The author also outlines ways of contributing to designers' understanding of the needs of the elderly and offers advice on locating information about specialty products. PMID- 10129555 TI - Memphis' huge Baptist Memorial fast-tracks institution-wide case management for quality and efficiency gains. PMID- 10129556 TI - Seven barriers to work re-engineering for patient-centered care. PMID- 10129557 TI - Developing a procedure for serious medical device problem reporting. PMID- 10129558 TI - Minimizing risk in the management of intellectual property. PMID- 10129559 TI - The 'paperless' physician office: a risk management perspective. PMID- 10129560 TI - Medical technology risks: looking beyond the obvious. PMID- 10129561 TI - Medical devices: a risk management perspective. PMID- 10129562 TI - How the Family and Medical Leave Act of 1993 will affect health care facilities. PMID- 10129563 TI - How will drug and device makers fare under Clinton's reform plan? PMID- 10129564 TI - Power failure lights up spirit of cooperation between hospitals. PMID- 10129565 TI - Recycled X-ray fixer saves on chemicals, fines. PMID- 10129566 TI - Debunking myths in materials management. PMID- 10129567 TI - Unused equipment can generate dollars instead of gathering dust. PMID- 10129568 TI - Hospital system's EtO consolidation adds new meaning to "central" service. PMID- 10129569 TI - Stats. A snapshot view of radiology non-labor expenses. PMID- 10129570 TI - Oxygen, please. As he delays turning it into law, Clinton loses momentum for his plan. PMID- 10129571 TI - "Please help us". AB - Clinton finally presents his detailed health-care plan, but he faces an uphill fight, thanks to critics in Congress and increasing public opposition. PMID- 10129572 TI - 1993 annual transport statistics and transport charges survey. PMID- 10129573 TI - The response of scene call volume to prehospital education. AB - INTRODUCTION: Transport of injured patients directly from a scene to a trauma center improves survival of patients and shortens their length of stay in the hospital. This paper studies the relationship between education presentations to prehospital personnel and scene call volume. The education sessions emphasize safety issues and how, when, and why to call for air medical transport. METHODS: The town and date of scene flights were compared to the town and date of flight nurse presentations and aircraft demonstrations. The length of time from a presentation to a scene call for each town was determined, and a cumulative frequency graph was drawn. Epidemiologic curves of presentations and calls were drawn for each town. Based on these graphs, observations of a relationship were obtained. RESULTS: There were 65 scene calls to 27 towns that had no education programs. There were 880 scene calls to 90 towns that had 235 education programs. There were 21 towns that received a total of 41 presentations and never initiated a scene call. The results show that scene call requests are more likely to occur within three months of a presentation. Individual town analysis shows variability of response to education programs. CONCLUSION: Prehospital provider education programs increase scene call volume, but this effect seems to last for three months. On a town-by-town basis there are many other determinants of scene call volume. PMID- 10129574 TI - Emergency air medical transport of U.S.-citizen tourists: 1988 to 1990. AB - STUDY OBJECTIVE: To study the epidemiology of U.S. citizens who become ill or injured while on vacation outside the United States and are transported back to the United States by emergency air medical transports. DESIGN: A retrospective self-reported survey covering a study period of three years (1988-1990) of air medical transport services in the United States. SETTING AND TYPE OF PARTICIPANTS: All members of the Association of Air Medical Services (AAMS) who operate either rotorcraft within range of non-U.S. territories (excluding Canada) or who operate fixed-wing aircraft in the United States. INTERVENTIONS: None. RESULTS: There were a total of 796 cases reported by AAMS members during the study period. Males comprised 61% of the cases. Unintentional injury accounted for 44% (n = 351) of the patients transported. Acute myocardial infarctions, angina and post-cardiac arrest cases comprised 15% (n = 141) of the total cases. Infectious diseases other than pneumonia comprised slightly more than 1% (n = 11) of the total cases. There were 12 gunshot wounds and one stab wound, comprising 1.6% (n = 13) of the total cases. Mexico, the Virgin Islands, and the Bahamas were the top three sites of transport origin, accounting for 59% of the cases. Fixed-wing transport accounted for 90% of the reported flights. CONCLUSIONS: This survey reveals a previously undescribed portion of travel-related morbidity and mortality. Injury prevention needs greater emphasis when travel advice is given by physicians and other travel medical services. Air medical transport is an important aspect of the care of acutely injured or ill U.S.-citizen tourists. PMID- 10129575 TI - Impact of healthcare reform on cardiovascular services. PMID- 10129576 TI - Comparative imaging technologies in the cardiac catheterization laboratory. AB - Evaluation of digital technology in the cardiac cath lab has introduced a desire to extend these technologies into electronic storage capability. Cine film is the current standard for image archiving because it meets the most important requirements of superior resolution, long-term stability, universal viewing and single-patient unit record capabilities. The major limitations of film include serial viewing (versus random access) and its incompatibility with computer techniques, such as quantitative angiography. Manufacturers and vendors have introduced several archiving alternatives that address the limitations of film. These options currently require trade offs and/or compromises in image quality, longevity, cost and numerous other requirements. Investments in alternatives should be made after comprehensive review of the expected productivity gains, anticipated media, equipment and supporting service cost improvements and prospective technological enhancements. This article has introduced a number of the issues that should be considered in comparing archiving media. As technology evolves and standards are developed, this task will become easier. In the meantime, no system to date has been able to achieve the existing advantages of film while overcoming its limitations. PMID- 10129577 TI - Medicine: attention to the old with the new. Keynote address. PMID- 10129579 TI - "The American Health Security Act" is unveiled. PMID- 10129578 TI - The effect of personal values on the management process. PMID- 10129580 TI - Global pricing for cardiac care: hard lessons for physicians and hospitals. AB - The challenges associated with global contracting are becoming apparent as more experience is gained. Contracts held by an open medical staff hospital provide an ever-changing equation. High-cost physicians can join the staff and alter the cost and quality outcomes that the hospital and physicians may anticipate. Also, physicians want to have assurances on how fee distribution is determined. For these reasons, some physicians are developing private contracting vehicles that assure their future. Managed competition is encouraging these creative models to respond to the market demands of payers; in some markets, these vehicles are creating the demand. It is important for both physicians and hospitals to be open to new creative models. Hospitals that insist on controlling the situation decrease its potential success. Flexibility ensures the ability of both entities to respond to new market demands. From the payer perspective, global contracting represents predictability of price and dependability of service. It encourages an economic relationship of dependence between a hospital and its physicians. Utilization of service is no longer the payers' problem; instead, the provider is asking the questions and managing the situation to assure that both quality and economic efficiency outcomes are achieved. PMID- 10129581 TI - One healthcare organization's successful strategy for dealing with managed care: global pricing. PMID- 10129582 TI - Holding out for a digital solution. PMID- 10129583 TI - Employee-administrator relationships. Part one: Leading employees through restructuring. PMID- 10129584 TI - Data watch. Mid-sized employer health plan costs. PMID- 10129585 TI - How new alliances are changing health care. AB - As organized systems of care begin to dominate many markets, concerns grow that they will become monopolies and continue to emphasize high-tech care. PMID- 10129586 TI - The debate begins on health reform. PMID- 10129587 TI - Solutions for small businesses. PMID- 10129588 TI - What happens to ERISA under health care reform? PMID- 10129589 TI - Creative management helps cut employee disability costs. PMID- 10129590 TI - Retaining freedom of choice in a managed care plan. PMID- 10129591 TI - Mass. group to HMOs: limit rate increases. PMID- 10129592 TI - Rulings show need for employee education. PMID- 10129593 TI - Minnesota reform faces ERISA challenge. PMID- 10129594 TI - Why small employers should lead the way. PMID- 10129595 TI - The "physician equity" model. PMID- 10129596 TI - MSOs (management services organization) and "clinic without walls". PMID- 10129597 TI - Health care: how we got into this mess. PMID- 10129598 TI - The Clinton cure: reinventing health care. PMID- 10129599 TI - Healthtown, U.S.A. AB - The landscape of health care is about to change. Under the Clinton proposal every American will choose one of three basic kinds of health plan--HMO, fee-for service or a combination. The big questions are how much you will pay and how you will choose your doctors. Lost already? Here's a tour of Healthtown, U.S.A. PMID- 10129600 TI - 'A walk in space'. The health plan is a brilliant political document, but take another look at the numbers. PMID- 10129601 TI - Gender wars. Inside the White House, it was the women against the men over mental health benefits. PMID- 10129602 TI - The power of sin. How the liquor and beer lobbies vied to limit the tax hit on their industries. PMID- 10129603 TI - What high tech can't accomplish: beyond the Clinton plan. PMID- 10129604 TI - Gray nineties. Don't stop thinking about tomorrow--the longevity revolution is already underway. PMID- 10129605 TI - Our fear of dying. PMID- 10129606 TI - Waiting for a bedside miracle? Health care: why there's still no legislation. PMID- 10129607 TI - Don't be afraid of the health debate. PMID- 10129608 TI - 'Big sister' and critics. AB - Health care: Clinton is ready to negotiate, but Hillary continues her crusade for converts, hoping to silence opponents and avoid compromise. She is failing on both fronts. PMID- 10129609 TI - The Clinton sales campaign. PMID- 10129610 TI - Health care: an all-points alert. PMID- 10129611 TI - Sources of health insurance and characteristics of the uninsured. Analysis of the March 1992 Current Population Survey. AB - Eighty-three percent of nonelderly Americans and 99 percent of elderly Americans (aged 65 and over) were covered by either public or private health insurance in 1991, according to EBRI tabulations of the March 1992 Current Population Survey (CPS). The March 1992 CPS is the most recent data available on the number and characteristics of uninsured Americans. In 1991, 16.6 percent of the nonelderly population--or 36.3 million people--were not covered by private health insurance and did not receive publicly financed health assistance. This number compares with 35.7 million in 1990 (16.6 percent), 34.4 million in 1989 (16.1 percent), and 33.6 million in 1988 (15.9 percent). The most important determinant of health insurance is employment. Nearly two-thirds (64 percent) of the nonelderly have employment-based coverage. Workers were much more likely to be covered by group health plans than nonworkers (71 percent versus 40 percent). Even though workers and members of their families were more likely to be covered by health insurance than nonworkers, 85 percent of the uninsured lived in families headed by workers in 1991, primarily because most people lived in families headed by workers. More than 60 percent of uninsured were in families headed by full-year workers with no unemployment. Nearly all persons who were covered by an employment based-plan received at least some contribution to that plan from their employer. The estimated average annual contribution among those receiving a contribution to employee or family plans was $2,129. Although many individuals in poor families are covered by public health plans, that coverage is far from universal. In 1991, only 52 percent of the nonelderly with income below the poverty line were covered by a public plan--49 percent by Medicaid. The number of children who were uninsured in 1991 was 9.5 million, or 14.7 percent of all children, compared with 9.8 million or 15.3 percent of all children in 1990. Twenty-three percent of children were covered by public health insurance, with 21 percent being covered by Medicaid. In 11 states and the District of Columbia, more than 20 percent of the population was uninsured in 1991. These states and their uninsured rates were the District of Columbia (30.3 percent), Texas (25.3 percent), New Mexico (24.5 percent), Louisiana (23.8 percent), Florida (23.5 percent), Mississippi (22.1 percent), Oklahoma (22.1 percent), Nevada (21.8 percent), California (21.7 percent),Arizona (21.1 percent), Alabama (20.6 percent), and Idaho (20.6 percent). PMID- 10129612 TI - Health care reform: managed competition and beyond. AB - Since the election, the health care reform debate has focused on three broad features: implementation of managed competition, changes in the tax treatment of health insurance, and the imposition of budget caps or targets. The basic element of managed competition is the creation of sponsors who act as collective purchasing agents for large groups of individuals. One of the potentially most politically difficult issues in implementing any health care reform proposal is likely to be defining the minimum standard benefit package. It will determine the costs society bears, the income of providers, the health of many individuals, and the attributes of a workable health care reform package. Managed competition is intended to foster competition among health plans on the basis of cost and quality. The measures of quality actually employed in the health care system will determine in large part the incentives faced by insurers, providers, and consumers. The problem of adverse selection is potentially the most important issue in reforming the health insurance market. If individuals can opt not to purchase health benefits, poorer risks will be more likely to purchase health insurance than good risks, and at minimum the price of these benefits will be higher than would otherwise be the case. Managed competition requires that individuals share at least some of the financial consequences of their choices among health plans. As a result, most managed competition proposals change the tax code by limiting the exclusion of employer contributions to health insurance from worker's taxable income. Changing the health insurance market, mandating employer health benefits, and changing the tax code may have significant effects on the health care delivery system, but they are unlikely to reduce health care cost inflation in the near term. One of the proposals for restraining the growth in health care costs is the imposition of a budget on the amount spent on health care services. The combination of the constraints placed on federal governmental action by the budget and the significant political problems involved in reaching a consensus on the important elements of health care reform may limit the ability of the federal government to implement national health care reform in the near term. As a result, individual states may be encouraged by the federal government to continue to experiment with their own health reform programs. PMID- 10129613 TI - Making choices: rationing in the U.S. health system. PMID- 10129614 TI - Health care rationing: the public's perspective. PMID- 10129615 TI - Rationing health care in other countries. PMID- 10129616 TI - How does Japan do it? Universal health insurance coverage in Japan. PMID- 10129617 TI - Issues in global budgeting. PMID- 10129618 TI - All-payer rates: bringing order to the health care market. PMID- 10129619 TI - The use of gatekeepers and fee schedules to allocate resources. PMID- 10129620 TI - Explicit rationing/the Oregon proposal. PMID- 10129621 TI - Hospital pricing: cost shifting and competition. AB - The issue of cost shifting has taken on enormous policy implications. It is estimated that unsponsored and undercompensated hospital costs--one measure of cost shifting--has totaled $21.5 billion in 1991. The health services research literature indicates that hospitals set different prices for different payers. However, the empirical evidence on hospitals' ability to raise prices to one payer to make up for unsponsored care or lower payments by other payers is mixed at best. No study has concluded that hospitals have raised prices to fully adjust for such actions. The extent of cost shifting is limited by the market. When a hospital has market power, it is able to set prices above marginal costs. However, when a buyer has enough patient/subscribers and a willingness to direct them to particular providers based on price considerations, hospitals have less flexibility in raising prices above costs. Thus, the extent of cost shifting is limited by the market. Cost shifting is not as easy as it may have been in the past because the nature of hospital and insurer competition has changed radically in the last decade. While hospital quality, services, and amenities still matter, some buyers are increasingly concerned about the price they pay. Evidence from studies of PPO and HMO negotiations with hospitals suggests that hospitals' market power is eroding, at least in some areas. In areas with relatively few hospital competitors and little PPO or HMO activity, Medicaid and Medicare price reductions and uncompensated care burdens will be partially absorbed by higher prices paid by private payers. In more price sensitive markets and in markets in which prices to private payers have risen to those commensurate with the market power of local hospitals, such cost shifting will not occur. A market-based approach in hospital pricing requires an explicit policy for the uninsured. In a competitive market, a hospital that traditionally cared for the uninsured by spending some of its profits on them will be unable to do so, at least to the same extent as it did in the past. Increased competition in health care without consideration of the uninsured will decrease the uninsured's access to care. PMID- 10129622 TI - Flexible benefits, choice, and work force diversity. AB - This Issue Brief evaluates the prevalence of flexible benefits plans and their ability to achieve cost management goals and to meet the needs of diverse employee groups. In addition, it examines flexible benefits plans' current legislative and regulatory status and typical plan design features. Sec. 125 of the Internal Revenue Code allows employers to provide employees with a choice among benefits, including moving otherwise taxable cash compensation to the pre tax purchase of benefits, without requiring them to include the value of the noncash benefits in their adjusted gross income unless they choose taxable options. Although the percentage of full-time employees in medium and large private establishments who are eligible for cafeteria plans has not increased appreciably, the percentage of employees eligible for freestanding flexible spending accounts (FSAs) nearly tripled between 1988 and 1991. Generally, the proportion of employers sponsoring cafeteria plans or FSAs increases with employer size. Recent surveys show that 27 percent of employers with 1,000 or more employees offered choice-making plans in 1991, 48 percent of firms offered health care FSAs, and 54 percent offered dependent care FSAs, either in conjunction with cafeteria plans or as a stand-alone option. Ten percent of full time employees in private firms employing 100 or more workers were eligible to participate in cafeteria plans in 1991. Only 5 percent of full-time employees in state and local governments and 1 percent of similar employees in small private establishments were eligible for cafeteria plans in 1990. Recent Bureau of Labor Statistics' surveys show that, among full-time employees, 27 percent in private establishments with 100 or more employees, 28 percent in state and local governments, and 6 percent in small private establishments were eligible to participate in freestanding FSAs. In 1992, 21 percent of eligible employees contributed to a health care FSA, and only 3 percent of eligible employees contributed to a dependent care FSA. Contributions to health care FSAs averaged $651, and those to dependent care FSAs averaged $2,959. National health reform could have a significant impact on these plans if the tax treatment of health benefits is changed. Taxation of health benefits in excess of a standard benefits package would fundamentally reduce the ability to use FSAs. PMID- 10129623 TI - Demographic and employment shifts: implications for benefits and economic security. AB - This Issue Brief examines factors affecting the population's age distribution and composition, such as mortality rates, fertility rates, and immigration. In addition, it examines factors affecting labor force composition, such as immigration, increased labor force participation of women, and retirement trends, and discusses the potential impact of these changes on publicly financed programs: Medicare, Medicaid, Social Security, and federal employee retirement systems. The discussion also highlights the implications of these population and labor force changes on employers, employees, and retirees. The elderly population -now 31.8 million, representing 12.6 percent of the population--is projected to experience tremendous growth between 2010 and 2030, when the baby boom generation reaches age 65, rising from 39.7 million, or 13.3 percent of the population, to 69.8 million, or 20.2 percent of the population. Growth in the elderly population has implications for retirement and health care systems. Population projections suggest that the traditionally pyramid-shaped work force, with a proportionately greater number of younger workers than older workers, will be replaced with a more even age distribution. Consequently, significant and continued modifications to benefit packages, such as changes in compensation structures in which earnings automatically rise with age, are likely to occur. Women's labor force participation began to accelerate in the mid-1950s, rising 75 percent among women aged 25-44 in 1991, although there is some indication that this growth may be flattening. With women comprising a greater part of the labor force, employers will be encouraged to develop and implement programs to better accommodate their needs. Increased life expectancy, a decreased percentage of entry level workers, changes in Social Security's normal retirement age from 65 to 67, and employer plans to raise the normal age of retirement or provide incentives to delay retirement, could raise the average age of retirement. However, other factors, such as poor health, other sources of retirement income, and individual preferences for retirement, could still dominate the retirement decision. The combination of increased average life expectancy guaranteeing more years of retirement to finance and rising dependency ratios increases the future cost of Social Security financing. Medicare financing is also an important policy issue because the program is projected to experience financial difficulties in the short term, resulting from explosive health care costs. In addition, Medicaid expenditures are consuming increasing amount of shrinking state budget resources- a large portion of which is used to finance nursing home care for a growing elderly population. PMID- 10129624 TI - The role of the health care sector in the U.S. economy. AB - This Issue Brief discusses factors that contribute to the growth of health care expenditures and the reasons that many individuals, employers, and policymakers consider health expenditures too high. In addition, it describes various industries that make up the health care delivery system and their role in the U.S. economy as employers, producers, exporters, and suppliers of research and development. The report also discusses the economic implications of rising health care expenditures for individuals, employers, and the federal government and the potential impact of proposed health care reform on the health care sector and the U.S. economy as a whole. Health care delivery industries such as pharmaceuticals and medical equipment suppliers have higher than average research and development levels, in addition to a positive balance of trade. Moreover, while the total number of jobs in the private sector declined between 1990 and 1993, the number of jobs in the relatively high paid health services sector continued to grow. In aggregate, employer spending on health care represents only 6.6 percent of total labor costs. In comparison, wages and salaries represent 83 percent of total labor costs. Consequently, the growth rate of health care expenditures has a smaller impact on the growth rate of total compensation than does the growth rate in wages and salaries. Using job multipliers developed by the U.S. Department of Commerce, it is estimated that the 18,600 health care services jobs in Rochester, Minnesota in 1993 created another 32,000 jobs in the area. Any contraction of the health care sector in cities that have a large concentration of employment in health services would result in reduced employment in restaurants, retail stores, janitorial services, and other local businesses. EBRI's simulations estimated that between 200,000 and 1.2 million workers could become unemployed as a direct result of a mandate that employers provide health benefits to their employees, assuming that wages and salaries did not adjust at all. Others find that approximately 50,000 individuals would lost their jobs, assuming that wages and other labor costs adjust downward to completely account for increased costs. As is apparent, the estimates of job loss (and of the total costs of the policy) are extremely sensitive to the assumptions used in the simulation. PMID- 10129625 TI - Medicare program; Essential Access Community Hospitals (EACHs) and Rural Primary Care Hospitals (RPCHs)--HCFA. Correction of final rule. AB - This notice corrects two technical errors in the regulations text we published on May 26, 1993 in a document entitled, "Essential Access Community Hospitals (EACHs) and Rural Primary Care Hospitals (RPCHs)." PMID- 10129626 TI - Program exclusions: September 1993--HHS. Notice of program exclusions. PMID- 10129627 TI - Medicare program; demonstration project to develop a uniform cost reporting system for hospitals--HCFA. Final rule. AB - This final rule responds to public comments on the August 25, 1989, interim final rule with comment period that established a demonstration project to develop a uniform cost reporting system for hospitals under the Medicare program. Under that rule, all hospitals in the States of California and Colorado were required to participate in the demonstration project. In addition, since the demonstration project ended on June 29, 1992, this final rule removes the relevant provisions from the Code of Federal Regulations. PMID- 10129628 TI - Civilian Health and Medical Program of the Uniformed Services (CHAMPUS); DRG revised rates--DoD. Notice of DRG revised rates. AB - This notice provides the updated adjusted standardized amounts, DRG relative weights, outlier thresholds, and beneficiary cost-share per diem rates to be used for FY 1994 under the CHAMPUS DRG-based payment system. It also describes the non regulatory changes made to the CHAMPUS DRG-based payment system in order to conform to changes made to the Medicare Prospective Payment System (PPS). PMID- 10129629 TI - Medical devices; reclassification and codification of natural nonabsorbable silk surgical suture--FDA. Final rule. AB - The Food and Drug Administration (FDA) is announcing the reclassification and codification of natural nonabsorbable silk surgical suture. FDA issued an order in the form of a letter to the manufacturer reclassifying the device from class III (premarket approval) into class II (special controls). Accordingly, FDA is amending the regulations as set forth below. PMID- 10129630 TI - Cost of hospital and medical care and treatment furnished by the United States; certain rates regarding recovery from tortiously liable third persons--OMB. PMID- 10129631 TI - Ok, here's the Clinton plan: now what? PMID- 10129632 TI - A 'sleeper' awakens to health reform. PMID- 10129633 TI - Budget law complicates health plans. PMID- 10129634 TI - As Clinton sells health care reform ... he's ready to unveil the villains. PMID- 10129635 TI - Political power and the health care manager. PMID- 10129636 TI - How much information can certified nursing assistants (CNAs) provide to residents or family members when they ask about a medical condition? PMID- 10129637 TI - A helping hand and a hand to help. Time-exchange program restores neighborhood concept. PMID- 10129638 TI - Subacute provider profile survey identifies sponsors and specialties. PMID- 10129639 TI - Conquering the TQM learning curve. PMID- 10129641 TI - Nutritious and fulfilling. Improving residents' eating habits benefits all. PMID- 10129640 TI - Pre-funding CCRC refunds: the reliable alternative to resales. PMID- 10129642 TI - Defensive wound care. Management program minimizes inevitable breakdowns. PMID- 10129643 TI - Facility admission agreements considerations. PMID- 10129645 TI - For long-term success, modernize. PMID- 10129644 TI - Take time for a '20-second sprint'. PMID- 10129646 TI - Stable environment nets few transfers. PMID- 10129647 TI - How often should TB tests be given, and who should authorize them? PMID- 10129648 TI - Long-term concerns. The industry reacts to Clinton's plan to reform the health care system. PMID- 10129649 TI - Time peace. Putting a clamp on worker's comp claims keeps dollars on the clock. PMID- 10129650 TI - File it! PMID- 10129651 TI - The new old. A Richfield, Ohio, convent was converted into a nursing home for nuns. AB - In previous generations, Catholic nuns were traditional caregivers at nursing homes. But today, with fewer women entering the orders, it is the nuns who require care. PMID- 10129652 TI - Storm of the eye. Macular degeneration: the forgotten plague. PMID- 10129653 TI - Give falls the slip. A comprehensive fall-prevention program will minimize resident injuries and save money, too. PMID- 10129654 TI - Be careful with questions about money. PMID- 10129655 TI - Products and services directory. PMID- 10129656 TI - Reduce stress while improving performance. AB - In summary, employee empowerment is a necessary component of the corporate culture because it increases productivity and the rate of employee retention. It simultaneously diminished employee job stress and associated costs. PMID- 10129657 TI - Consequences of aging in place. PMID- 10129658 TI - Cost centers are a moving target. PMID- 10129659 TI - Ins and outs of intrafacility transfers. PMID- 10129660 TI - Keeping individuals and an industry afloat. LTC insurance engenders divergent views. PMID- 10129661 TI - 1993 Interior design awards. Four Courts Senior Center, Louisville; Cuyahoga County Nursing Home, Cleveland; Sunshine Villa, Santa Cruz; Liberty Heights at Northgate, Colorado Springs. PMID- 10129662 TI - Service coordinators show the way. New personnel at HUD projects welcomed by tenants and staff. PMID- 10129663 TI - Number crunching for caregivers. PMID- 10129664 TI - Getting started. IV therapy strengthens census. PMID- 10129665 TI - Facility liability for independent contractors. PMID- 10129666 TI - Ulysses in Minnesota: first steps toward a self-binding psychiatric advance directive statute. PMID- 10129667 TI - Information becomes lifeblood of reform. Interview by Carolyn Dunbar. AB - The healthcare information systems industry holds the key to successful implementation of the proposals issued by the White House Task Force on Healthcare Reform, says John S. Silva, M.D., chairman of the Task Force Information Systems Working Group, in this exclusive Computers in Healthcare interview. PMID- 10129668 TI - I/S interoperability a must in tomorrow's complex healthcare environment. AB - In the coming age of community health networks, healthcare information systems will have to communicate quickly and easily. Standards must be accepted and endorsed by the healthcare I/S industry if this necessary goal is to be achieved, and visionary healthcare organizations must be willing to take the first steps toward adopting these new systems. PMID- 10129669 TI - Local delivery systems need strong I/S strategy. AB - The advent of "local delivery systems" now occurring throughout the nation will require a new applications portfolio for successful providers. These applications must address the key needs of the provider and patient community, including hospital information systems, physician practice systems, managed-care and insurance systems, electronic data interchange and the automated patient record. Any less just won't do. PMID- 10129670 TI - Healthcare reengineering via network technologies: a critical combination. AB - The forces unleashed by reengineering can be expected to demand dramatic increases in the volume and speed of communications technologies. This observation is based on the premise that "information is power," and consequently, more information is more powerful. PMID- 10129671 TI - Product overview hotlist. Integration tools. Part 1. AB - November's HotList features integration tools. Due to the number of vendor offerings in this area, the second half of the Integration Tools HotList will appear in our December issue. All data have been provided by individual vendors who responded to survey questions. Computers in Healthcare has made an effort to contact all vendors within this market. See the 1993 Computers in Healthcare Market Directory for complete listings. PMID- 10129672 TI - JCAHO calls for collaboration among disciplines. PMID- 10129673 TI - TQM in discharge planning: who is the customer? PMID- 10129674 TI - Reemphasizing the tenets of managed care. PMID- 10129675 TI - Hospital-community partnerships: dinosaurs or work horses? PMID- 10129676 TI - The transitional rehabilitation program: a collaborative discharge planning resource. PMID- 10129677 TI - The continuing care committee: enlisting the power of provider relationships. PMID- 10129678 TI - Program profiles: networks in the making. PMID- 10129679 TI - Homeless veterans regain independence through network of clinical and social services. PMID- 10129680 TI - Critical patients, critical choices. PMID- 10129681 TI - The papal chase. The Pope's visit: a "mass" gathering. AB - When Pope John Paul II visited Denver, CO, in August, members of the city's EMS community volunteered to provide coverage at special events. But no one anticipated the tens of thousands of medical emergencies that occurred, overwhelming EMS resources. In this special feature, Dottie Schulte, RN, MS, and Denis M. Meade, EMT-P, offer a behind-the-scenes look at how EMS professionals coped during the unprecedented religious experience. PMID- 10129682 TI - Funnel crowd. PMID- 10129683 TI - One man's tough choices on prostate cancer. AB - It's the No. 2 cancer killer in men--and it will strike almost every male who lives long enough to get it. But when a seasoned science journalist was diagnosed with it, doctors gave him confusing and contradictory advice. In his painful journey through the maze, he learned that where doctors disagree--as they do over how to treat many life-threatening diseases--an educated patient can help educate them. PMID- 10129684 TI - Hospitals-communities integrate in pilot study. PMID- 10129685 TI - Integrated health care. Reorganizing the physician, hospital and health plan. PMID- 10129686 TI - Combining service marketing and strategic alliances in health care. AB - With or without federal health care reform to impact the delivery of health care services in the U.S., hospitals must commit to service marketing and strategic alliances as a fundamental business strategy. Service marketing not only differentiates the provider, but with the proper programs in place, it may actually facilitate the formation of strategic alliances. The combination of these strategies will be particularly effective in preparing for any health care policy change. PMID- 10129687 TI - Dept. of Justice and FTC open the door for greater collaboration. PMID- 10129688 TI - Vertical integration may be the most expensive strategy. PMID- 10129689 TI - Health care study on industry perspective on health reform. The Boston Consulting Group. AB - Many senior health care executives support President Clinton's health care reform objectives, although they question the government's ability to execute reform and control escalating health care costs, according to a survey released by The Boston Consulting Group. The survey also revealed that the majority of those interviewed endorse managed competition and believe that universal coverage is the right goal to pursue. Seventy-five CEOs or senior executives at some of the nation's largest teaching and community hospitals, HMOs, pharmaceutical companies, and medical suppliers were interviewed by The Boston Consulting Group for the survey. PMID- 10129690 TI - The road to reform: Clinton's health care proposal. PMID- 10129691 TI - Tax exemption criteria for integrated delivery systems. PMID- 10129692 TI - Antitrust laws: considerations but not barriers to integration. PMID- 10129693 TI - A practical approach to hospital-physician affiliations. PMID- 10129694 TI - Special issue on integrated delivery systems. PMID- 10129695 TI - Structural and legal issues in the formation of integrated delivery systems. PMID- 10129696 TI - How 'fast track' ERs improve security, reduce potential for violence. PMID- 10129697 TI - Parking cashier, register surveillance pays off for Temple University. PMID- 10129698 TI - How security is changing at John Hopkins. AB - William McLean, CHPA, is security director at Johns Hopkins Medical Institutions, Baltimore, MD. Formerly chief of security with the Baltimore City Department of Hospitals, McLean has worked in health care security at the director level for 15 years. He also spent eight years with the Baltimore City Police Department. At Hopkins, officials recently decided to overhaul the $7 million security operation because of increasing crime. In this interview, McLean talks about some of the changes. PMID- 10129699 TI - Special report. Update on EAS (electronic article surveillance) systems: protecting against patient wandering, infant abduction, property theft. AB - Concern about wandering patients and infant abduction on the part of hospitals has sparked renewed interest in Electronic Article Surveillance (EAS) systems. Such systems had their origins in department stores and libraries where they are almost universally used. They also have applications in hospitals for preventing the theft of supplies and equipment. A number of companies provide EAS products for the health care field. How do you select the system that is best for your needs? "Talk to users. Pick out a number of profit and non-profit hospitals to get their views," advises Ted Algaier, vice president, marketing and sales, Innovative Control Systems, Inc., Waukesha, WI. "Examine the history of the company or vendor to determine if it understands the health care market and find out if the product really works." In this report, we'll review a number of EAS systems currently on the market, and present information on how they work, how effective they are, and costs involved. Also included are comments from users who have installed such systems. PMID- 10129700 TI - Electrical shocks from respirators. PMID- 10129701 TI - 1994 JCAHO transition standards. PMID- 10129702 TI - Managing reorganization. PMID- 10129703 TI - Teams: when and when not to use them. PMID- 10129704 TI - Stress for success: it can increase productivity. PMID- 10129705 TI - Making tough decisions about telemetry monitoring. AB - Telemetry monitoring, when used effectively and appropriately, is beneficial and plays an important role in enabling primary caregivers to provide optimum care for their patients. However, it is frequently used ineffectively and inappropriately, which can be extremely costly for hospitals. In this era of health care reform, careful review of this technology and analysis of telemetry utilization can avoid unnecessary expenditures or abuse. PMID- 10129706 TI - Issues of materiel management in the neonatal intensive care unit. AB - Managing NICUs can be a challenge not only to the unit manager, but also to those allied areas that provide supplies and services to the unit. If patient census and acuity fluctuate, then the challenge is doubled by the need to maintain a high degree of flexibility in personnel, supplies, and facilities to meet patients' needs. It is necessary that communication among managers occurs so that the equipment and supplies needed to meet physiologic and developmental demands of these vulnerable clients can be achieved efficiently and effectively. PMID- 10129707 TI - Respiratory care. AB - In summary, the field of respiratory care has witnessed a continuum of accelerating change in its first half century of existence as a health care profession. These changes were effected by internal change agents as well as external forces in the health care arena. Based upon a health care system undergoing a near cataclysmic pace of change in a time of multifocal and critical inspection, it is anticipated that the field will undergo an even more dramatic change in its scope and direction in the next 50 years. With the guidance and assistance of administrators, medical staff, and partner departments, the respiratory care department should continue to function as an integral part of the hospital organization. PMID- 10129708 TI - Total quality improvement. AB - External customers are those who come to the institution to use the services. If these people are not satisfied, the institution will not be accredited, patients will not return, and the institution will receive bad press--thus hurting the institution's image--and physicians will go to other institutions. Patients certainly are looking for value for their dollar in receiving quality services. Third party payors measure and set prices on services rendered. Conservation of resources is the focal point of the modern health care industry. TQI is a vehicle that will bring major departments together to focus on these issues. When department heads are given the power to make decisions and the ability to negotiate with other departments, much headway will be made. Coordination of goals and the understanding of other departmental issues will allow for multidisciplinary decision making that will affect the institution's future. PMID- 10129709 TI - Pressure ulcers and materiel management: cost-effective prevention and care. AB - In summary, it's important for the materiel manager to have an understanding of the clinical aspects of pressure ulcers. By understanding how ulcers are staged, treated, and prevented, the materiel manager will have a better idea why certain products are needed and how they are used to reduce overall patient costs. Specialty beds, replacement mattresses, and high-end overlays represent a significant cost--approximately $500,000 to $1 million based on studies cited in this article. Further proven by research is the fact that these costs can be reduced by carrying out utilization plans with specific criteria for patient selection. Finally, materiel managers can be key coordinators in the entire process since they are often on the front lines in any institution's cost containment efforts. PMID- 10129710 TI - Getting to go in managed care. AB - The challenge for leadership and the required changes are great. Our personal limitations include a limited view of the world and the threat of an overwhelming risk if one gets too far out on the limb. "Getting to go" will open up new and strange territories that will provide opportunity and failure for leaders. Capable leaders will pursue the opportunity. Threatened leaders will resist the change. For those leaders who feel that the managed care existing today provides the most cost-effective, quality outcome for the individual, his or her sponsor in the community, they will go no further. Unfortunately for many of us, managed care means a third party trying to micromanage patients (deductions, authorizations, and so on), employers (claims, incentives, and so forth), and providers (approvals, forums, payment, tricks, and the like). Providers need to go ahead and master efficient care. We owe that to the community and the third party nightmare of administrative overkill must be laid to rest. For those healthcare leaders who believe that managed care as a system focused on improving the health status of our communities is superior to our existing system, their individual goals and leadership focus must be changed accordingly. We cannot sit by idly and wait for the system to change us. Instead our obligation is to lead our organizations toward a new era in health care. PMID- 10129711 TI - Managed competition. AB - People don't like change. That includes materiel managers, administrators, and clinical providers. Managed competition or managed care will work if, and only if, the American professions and the American public recognize the value of highly educated and qualified clinical and nonclinical providers and if the health care industry responds in kind. PMID- 10129712 TI - Keeping health care close to home. PMID- 10129713 TI - New legislation to affect hospitals. PMID- 10129714 TI - A vital link in rural health care. PMID- 10129715 TI - DataPulse offers power of information. AB - Armed with the information provided by DataPulse reports, hospital management can quickly tell how their hospital compares with other Texas hospitals. The information in these reports makes questions about the competitiveness of hospital charges, expenses, staffing levels and accounts receivable easier to answer. PMID- 10129716 TI - Reflections on a rural health sabbatical. PMID- 10129717 TI - Meeting community needs in an ever-changing environment. PMID- 10129718 TI - Pearls of wisdom. PMID- 10129719 TI - Heart to heart. PMID- 10129720 TI - As time goes by. PMID- 10129721 TI - Excising customs. PMID- 10129722 TI - Energy management. Good housekeeping. PMID- 10129723 TI - Energy management. More than just hot air. PMID- 10129724 TI - Energy management. Watt next? PMID- 10129725 TI - Women in management. Can you hear the sound of breaking glass? PMID- 10129726 TI - The odd couple? PMID- 10129727 TI - Just what the doctor ordered. PMID- 10129728 TI - On the seamy side. PMID- 10129729 TI - Time out. PMID- 10129730 TI - Wish you were here? PMID- 10129731 TI - Women in management. Role up, role up. PMID- 10129732 TI - Sweet and sour charity. PMID- 10129733 TI - Nurse management. Going for growth. PMID- 10129734 TI - Nurse management. Loud, louder, loudest. PMID- 10129735 TI - Involving patients & consumers. Health management guide. AB - Everyone agrees, in principle, on the need to make health services more responsive to the views of users. While some progress has been made, an enormous gap still exists between political and managerial rhetoric, and the reality in most places. Yet some health service providers have found ways to give patients a more meaningful say in their treatment and care, and some organisations- purchasers and providers--have made real progress in involving patients and the community in planning and monitoring services. This Health Management Guide surveys changing attitudes and official policy towards involving patients and consumers, and describes some of the most promising practical initiatives in different parts of the NHS. PMID- 10129737 TI - Women in management. Women on the edge of a workforce breakthrough. PMID- 10129736 TI - Full circle. Interview by Annabelle May. PMID- 10129738 TI - Accidents will happen. PMID- 10129739 TI - Spot the nurse leader. PMID- 10129740 TI - Joining forces. PMID- 10129741 TI - The sound of silence. PMID- 10129742 TI - Women in management. Her master's voice. PMID- 10129743 TI - Long-term care. Regulation issue. PMID- 10129744 TI - Long-term care. The buck stops here. PMID- 10129745 TI - An ounce of compassion. PMID- 10129746 TI - Reducing need and demand. PMID- 10129747 TI - The mainstreaming of alternative medicine. PMID- 10129748 TI - Healthy people, healthy worksites. PMID- 10129749 TI - On wellness. An overview and compendium of health promotion and disease prevention initiatives and readings. PMID- 10129750 TI - Working out for the best. PMID- 10129751 TI - Powers of the mind. Interview by Joe Flower. PMID- 10129752 TI - The iron triangle and the chrome pentagon. AB - Like the arms race, the healthcare system is built on a framework of incentives driven by fear and finance--also like the arms race, it will not admit to piecemeal reform. PMID- 10129753 TI - The longest wave. AB - Some managers and consultants are being accused of "fad surfing"--riding the crest of the newest panacea and then paddling out just in time to ride the crest of the next one. PMID- 10129754 TI - Women executives say their time is near--if not already here. AB - Despite apparent gains by women in healthcare management, the infamous glass ceiling still exists according to leading search firm executives and female CEOs. Today, however, there are cracks in the glass ceiling that are giving way to new opportunities. PMID- 10129755 TI - Making the right moves to get to the top. AB - It's no secret that there are fewer top slots available for healthcare executives in hospitals today. So if you have your sights set on the number one or two spot, it's never too soon to plot your course of action. PMID- 10129756 TI - Health information networks: connecting your healthcare organization to the future. PMID- 10129757 TI - Mentoring in the 1990s. AB - The value of mentoring cannot be overstated and healthcare executives must continue to keep pace and create a climate for this most important management tradition. PMID- 10129758 TI - Examining hiring practices. AB - An organization's awareness of its ethical obligation to its employees and potential employees is the first step in ensuring fair treatment of job candidates. PMID- 10129759 TI - Redefining retirement. AB - Retirement is another phase and not an endpoint in one's career. Therefore, planning for it is much like planning for a job change or a career change. PMID- 10129760 TI - The 1980s and 1990s: moving forward. AB - This year marks the American College of Healthcare Executives' 60th year of service as a professional society. To celebrate this occasion, the column "In Review" has been featured in Healthcare Executive throughout 1993. This final column features highlights from the 1980s and a preview of the 1990s. PMID- 10129762 TI - Healthcare Executive 1994 directory of executive search firms. PMID- 10129761 TI - New tax law highlights. The Omnibus Budget Reconciliation Act of 1993. PMID- 10129763 TI - American College of Healthcare Executives. Ethical policy statement. Organizational ethical mechanisms. PMID- 10129764 TI - American College of Healthcare Executives. Ethical policy statement. Educational training in ethics for healthcare executives. PMID- 10129765 TI - Hot careers in healthcare. PMID- 10129766 TI - Systems of donor transfer. AB - The development of medical knowledge has resulted in a demand in society for donor organs, but the recruitment of donor organs for transplantation is difficult. This paper aims to provide some general insights into the complex interaction processes involved. A laissez-faire policy, in which market forces are relied on, is not acceptable from an ethical and legal point of view in most western European countries. Especially at the demand side of the exchange of donor organs, commercialism is to be opposed. We judge the use of commercial incentives at the supply side less unacceptable in theory but not feasible in western European countries. Since market forces are deemed unacceptable as instruments for coordinating demand and supply of donor organs, donor procurement has to be considered as a collective good, and therefore governments are faced with the responsibility of making sure that alternative interaction and distribution mechanisms function. The role of organ procurement agencies (OPAs) in societal interaction concerning postmortem organ donation is described using a two-dimensional conceptualisation scheme. Medical aspects of living organ donation are described. An international comparative description of legal systems to regulate living organ donation in western European countries completes this survey. PMID- 10129767 TI - Improving the implementation of cost recovery for health: lessons from Zimbabwe. AB - In the current debate over health financing policy in developing countries, governments are increasingly focusing on cost recovery--having patients pay part or all of their health care costs--as a way to mobilize more resources for health, improve equity by selectively charging the wealthy, and increase efficiency by encouraging reinvestment of fee revenues into cost-effective primary care. Zimbabwe offers an important example of a country with a tradition of levying fees in government health facilities, but where enforcement became lax in the 1980s. In 1991, policymakers resolved to resuscitate and strengthen cost recovery, as part of a broader economic reform program. This paper discusses the strengths and weaknesses of Zimbabwe's cost recovery system, its potential for improvement, and the obstacles to change in revising the fee structure and billing and collection procedures. It argues that cost recovery can help to achieve Zimbabwe's health objectives, but only in conjunction with other measures to redirect public spending to essential public health and clinic care and improve the efficiency of government services. The paper finds that during the 1980s, the fee schedule became badly misaligned with actual medical care costs and created distortions in patient referral patterns. Billing and collection were also weak, because of deficiencies in personnel and information systems and lack of incentives for revenue generation. The paper concludes that if key steps were taken to raise the collections-to-billings ratio, recover fees from privately insured patients, and adjust fees in line with medical cost inflation, recoveries could increase fourfold, from 5% to 20% of government spending for clinical care. At the same time, access to government health services for the poor could be maintained by improving exemption procedures. PMID- 10129768 TI - The influence of technology assessments by advisory bodies on health policy and practice. AB - Assessments of 45 health technologies undertaken by Australian advisory bodies are considered in terms of the effect they have had on health care policy. The conduct and impact of the assessments was influenced by selection of topics, timing, other inputs to policy formulation and changes to policy areas and assessment agencies. Seventeen of 26 detailed assessments appear to have influenced policy, with greatest impact occurring when the technology was being introduced and there was collection of local primary data. Continued requests for the assessment reports suggests a possible longer term educational effect. All nine appraisals of proposals for nationally funded centres were influential, but the influence of guidelines for superspecialty services is less clear. Factors decreasing the influence of assessments included limitations of available policy instruments, lack of consensus between governments and professional groups and pressure of more urgent matters on the policy process. PMID- 10129769 TI - Institutional responses to Medicare's prospective payment system. AB - The introduction of Medicare's prospective payment system (PPS) meant an important change in the environment of US hospitals. The new payment system was expected to improve clinical and non-clinical efficiency in hospitals. A case study in a non-profit Pennsylvania hospital was performed to analyse the impact of PPS on hospital services. The hospital responded to PPS by a twofold strategy. First, attempts were made to achieve effective cost containment by improving the efficiency of intermediate and final outputs. Here special attention is paid to the activities of the DRG coordinator and the Utilization Review Committee and to the activities of nurses in their role as case manager. The second strategy was directed at revenue enhancement, initially mainly by shifting more costs to non Medicare patients and later by trying to strengthen the position of the hospital in the local health care market. This second strategy was considered more important than the strategy of cost containment. With respect to organizational structure and policy-making, the following changes can be observed: a growing importance of strategic management; more integrated hospital-physician relationships; and the development of an adequate medical information system and a medical records department. PMID- 10129770 TI - Tracing the missing link between nursing workload and case mix groups: a validation study. AB - This paper reports on the creation of a nursing workload data base of over 40,000 inpatient records by the Hospital Medical Records Institute (HMRI). During the 1989-90 fiscal year, five Ontario hospitals (four teaching, one community) reported total hours of nursing on the HMRI abstract along with standard clinical and demographic information. The accuracy of nursing workload data varied across hospitals and seemed to reflect differences in how data collection was implemented. When the data base was grouped by Case Mix Groups (CMGs), analysis demonstrated that patterns of resource utilization in nursing workload and length of stay were similar across CMGs. Results of this analysis indicate that the nursing workload component of the Resource Intensity Weight may be useful for estimating a hospital's nursing costs by CMG. PMID- 10129771 TI - Revisiting physician impact analyses: predicted versus observed hospital resource use. AB - In order to determine the accuracy of predictions made using Physician Impact Analysis (PIA), a comparison was undertaken of predicted versus actual resource use for 10 new physician specialists at a southern Ontario community hospital. The predictions were done from 1987 to 1989 using methodology recommended by the Ontario Hospital Association (OHA) and available at that time. This included (1) Hospital Medical Records Institute data and (2) a hospital service department survey. A comparison was made between PIA predictions and actual physician resource utilization data gathered in 1991. There was little agreement between the two. The usefulness of PIA rests largely on its ability to generate accurate predictions about a new physician recruit's number of cases and hospital resource use. However, because this research was undertaken in only one community hospital, further evaluation of the PIA process is recommended. PMID- 10129772 TI - Hamilton Health Sciences Laboratory Program: a provider developed model for hospital, university and community laboratory services. AB - Clinical Laboratory Sciences are under pressure to reduce the number of tests and cut staff and supply costs. The ability of academic centres to continue to deliver high quality service, teaching and research is threatened. In difficult economic times imaginative strategies are needed to look for solutions which will permit continued advancement in academic and clinical standards. Rationalization of service and cost-effective use of resources are not new concepts; however, there is a scarcity of models which have been developed and promoted by the providers of laboratory services, rather than those imposed by governments and other paying agencies. A model developed and evolved over the last two decades by The Hamilton Health Sciences Laboratory Program (HHSLP) is outlined. PMID- 10129773 TI - Staff participation in administrative decision-making. AB - Victoria Hospital Corporation in London has adopted a collaborative management model that involves the participation of medical, union and non-union staff in the administrative decision-making process within predetermined parameters. Reactions have been favourable from all sides--positive feedback from the groups involved and minimal negative public response to the sensitive decisions made concerning downsizing. Early indicators suggest increasing further the participation of union and non-union staff in decision-making on multiple levels, but with clearly defined "boundaries of responsibility." PMID- 10129774 TI - Case mix management: a cautionary note. AB - Using data from a study that involved 500 U.S. acute care hospitals, the author examines the relationship between the profitability of Diagnostic Related Groups (DRGs) and their DRG weight, and the similarity/difference of the most/least profitable DRGs across hospital types. Hospital administrators are cautioned that to engage in case mix management, they must use a management information system that provides the data necessary for determining the cost of treating each patient type within their own institution, not information derived from other facilities or other systems. PMID- 10129775 TI - More than "bandaids": emotional support and education during the downsizing process. AB - This paper illustrates the importance of giving emotional support and education to patients, families, staff and managers at The Queen Elizabeth Hospital, Toronto during the Spring 1992 downsizing effort. The Queen Elizabeth Hospital is a 601-bed, two-site facility which provides complex specialized rehabilitative and supportive care, teaching and research, as well as specialty programs in rehabilitation, geriatric service, geriatric psychiatry and long-term care. Downsizing at The Queen Elizabeth Hospital meant the consolidation and closure of 82 long-term beds, on one nursing unit at each site, to offset a projected budget deficit of $5.4 million. Internal restraint over the past year and during the budget process reduced this deficit to $2.8 million, thus necessitating further downsizing consideration. Background information includes a review of the recent downsizing literature. This paper describes the informal and formalized support activities that took place during the two-month process and the educational sessions that were provided on a regular basis. It gives specific attention to methodology and rationale. The authors also make recommendations for the successful implementation of a downsizing process which can be beneficial to any health care setting involved in bed closure. PMID- 10129776 TI - Keys to effective regional health planning--an organizational behaviour approach. AB - Given its political appeal, economic logic and community-based focus, regional planning has re-emerged as a significant strategic initiative in our shifting health care system. As regional planning becomes more prevalent in Canada, it is increasingly necessary to establish a framework of sound organizational behaviour principles in which it can succeed. These principles--which relate to human relations and group interactions--are especially relevant in a complex undertaking such as regional health planning which is often encumbered by stakeholder self-interest, philosophical differences and a tradition of autonomy and independent initiative. PMID- 10129777 TI - Nursing facility design offers residential look, feel--inside and out. Sunbelt Living Center Apopka, FL. PMID- 10129778 TI - Beyond interior design. AB - Your challenge today is to maximize the therapeutic potential of the health care environment. But do you and your staff really understand what that means? PMID- 10129779 TI - Experience and vision critical when picking an interior designer. PMID- 10129780 TI - Correct placement enhances artwork's healthful benefits. PMID- 10129781 TI - JCAHO manual phases out 'departmentalization'. PMID- 10129782 TI - Positive attitudes, listening skills boost morale. PMID- 10129783 TI - Signage: key (but not only) wayfinding element. PMID- 10129784 TI - Medical technology: who's really responsible for what? PMID- 10129785 TI - Hospitals begin cutting non-ionic contrast agent use. PMID- 10129786 TI - I.v. solution prices stabilize. PMID- 10129787 TI - Prices for many diagnostic coronary catheters falling fast. PMID- 10129788 TI - Columbia hits ground running, inks two national pacts. PMID- 10129789 TI - Smaller groups reap big rewards by fashioning pacts with smaller vendors. PMID- 10129790 TI - Clinton's health plan: politics and State responsibility. PMID- 10129791 TI - A life-and-death decision: the Lakeberg twins. PMID- 10129792 TI - Untangling healthcare competition. AB - Traditional approaches to competition may be inappropriate for healthcare providers. Neoclassical economics makes the implicit assumption that a single actor embodies consumption, compensation, and benefit from a transaction. In healthcare, this assumption does not hold. Instead, such actions are accomplished by three separate actors--consumers (physicians), customers (third-party payers), and clients (patients). A hospital simultaneously competes in three arenas. Hospitals compete for physicians along a technological dimension. Competition for third-party payers takes on a financial dimension. Hospitals compete for patients along a marketing dimension. Because of the complex marketplace interactions among hospital, patient, physician, and third-party payer, the role of price in controlling behavior is difficult to establish. The dynamics underlying the hospital selection decision--that is, the decision maker's expectations of services and the convenience of accessing services--must also be considered. Healthcare managers must understand the interrelationships involved in the three pronged competitive perspective for several reasons. This perspective clarifies the multiple facets of competition a hospital faces. It also disentangles the actions previously fulfilled by the traditional single buyer. It illuminates the critical skills underlying the competition for each audience. Finally, it defines the primary criterion each audience uses in sorting among hospitals. Recognition of the multifaceted nature of competition among healthcare providers will help demystify market behavior and thereby improve internal organizational communication systems, managers' ability to focus on appropriate activities, and the hospital's ability to adapt to changing market conditions. PMID- 10129793 TI - Church law's role in collaborations. Principles to guide Catholic healthcare providers contemplating new arrangements. AB - To ensure the success of collaborative arrangements between Catholic and non Catholic organizations, Catholic providers are advised to look at Church law in canonical and civil documents and at the role of Church law in arrangements between parties. First, Catholic healthcare providers should identify persons subject to Church law as they become engaged in apostolic activities such as providing healthcare on behalf of the Church. They need to distinguish among physical persons, moral and juridic persons, and associations of the faithful and other persons. To verify whether a party is a juridic person, Catholic healthcare providers must turn to historical documents. When cooperative arrangements are made between parties, they must consider a number of elements of Church law if the work is to remain Catholic. These include acquired rights and obligations, administration of temporal goods, observance of moral teachings, and respect of applicable legislation. The law places no limits on the types of arrangements that religious institutes can enter into. However, when cooperative arrangements are being considered between Catholic and non-Catholic religious institutes, the moral issues involved must be taken into consideration. In such arrangements all parties should clearly determine beforehand common purposes, structures, and rights and obligations involved, so that there will not be any misunderstandings along the way. PMID- 10129794 TI - Today's ethics committees face varied issues. A CHA survey reveals committees' functions, authority, and structure. AB - In a survey of Catholic Health Association member hospitals, 92 percent indicated they have formal ethics committees at their institutions. Sixty-two percent said their ethics committees were formed between 1983 and 1989. The survey found that current ethics committees are still committed to their traditional roles- education, policy development, and case review--but the education is directed to more diverse audiences than in the past. Support for medical and nursing staffs may be emerging as another possible function of ethics committees. The issues that precipitated the formation of institutional ethics committees have become more complex. In particular, questions involving the appropriate use of technology, the renewed awareness of patients' rights, changing relationships among healthcare providers, and conflicting social values have continued to require the intervention of ethics committees. However, the frequency with which respondents said their committees provide case consultations seems lower than it should be if committees were used to their full advantage. The institutional ethics committee can play a part in enlarging the current healthcare reform debate and promoting moral values. It can address such important questions as, Should the well-being of individuals take precedence over the well-being of communities? PMID- 10129795 TI - Learning to pay attention. An ethics study group refocuses on issues affecting long-term care residents' daily lives. AB - In 1991 the Sisters of Charity Healthcare Systems (SCHCS), Cincinnati, established an ethics study group for its long-term care facilities. The group was originally organized to address end-of-life treatment decisions, but it soon found that the daily lives of people by and for whom such decisions would be made were worthy of attention in their own right. Autonomy had been a topic of group discussions early on. Once reinterpreted in the context of long-term care, it became the pivotal value for the group. One key to the group's progress was identifying intrinsic and extrinsic factors that distract care givers' attention from issues of concern to residents. Members found that state and federal regulations, as well as constraints on medical treatment by payers such as Medicare and Medicaid, often ignore the human dimension in terms of which the elderly's needs and preferences can be framed. Rigidly defined roles and routines also blunt care givers' sensitivity to residents' concerns. The group is currently developing a program of in-service ethics education and training. Designed in four modules, the program will focus on the following topics: protecting and enhancing resident rights, staff issues and professionalism, talking about death and dying, and staff-physician issues. PMID- 10129796 TI - A measure of growth. A system's corporate ethics committee assesses its accomplishments and future direction. AB - In 1992 the Sisters of Mercy Health System (SMHS) Corporate Ethics Committee (CEC) developed a three-step evaluative process of the system's ethics programs. The evaluation consisted of a retrospective review of the minutes of CEC meetings since the committee's inception, an oral evaluation with current CEC members, and a written assessment of the committee's performance by current and former members. In the open discussion, 86 percent of participants indicated that the system needs the CEC because it facilitates in-depth examination of ethical issues and provides important research and consulting services to the system executive. Respondents completing the written evaluation indicated that the CEC's dominant strength is the diversity of its membership, which includes trustees, physicians, ethicists, nurses, administrators, managers, and chaplains. More than 57 percent of respondents reported the CEC has achieved all six of its goals, which included education, articulation, decision making, policy development, program development, and evaluation. A review of the CEC evaluation suggests that the committee has moved beyond the development stage and entered a period of active growth. CEC members have made great strides in educating themselves, and the committee must now consider whether to broaden its focus by developing its knowledge base and skills for bioethical education and policy recommendations. The CEC is currently testing an ethical decision-making model it recently developed. PMID- 10129797 TI - Parish nursing: a system approach. Suggestions for planning and implementing parish partnerships. AB - The Parish Nurse Program at Chicago-based Resurrection Health Care Corporation (RHCC) sponsors partnerships between the corporation and parishes in the Chicago area to provide holistic, preventive healthcare services; access to appropriate resources; and witness to Jesus' healing mission. In RHCC's program, a parish nurse's role includes acting as a personal health counselor, discussing health concerns with parishioners and visiting them at home, in hospitals, and in nursing homes. The parish nurse also serves as a health educator, referral source for community resources, and facilitator for volunteer and support groups. The first step in introducing a parish nurse program is alerting staff within the organization and the surrounding community about the program. One way the parish nurse program director can do this is by developing a communications plan with the system's marketing and public relations staff. Members of a parish nurse program steering committee, the system's vice president for mission effectiveness, and professional peers should then work together to create supporting documents (e.g., job descriptions and pay grades) and an implementation plan. After the program basics are in place, partners can be sought and assessed. When a partnership is established, recruitment and orientation of the parish nurse begins. Once hired, the parish nurse should participate in the system's and the parish's orientation and continuing education sessions. A parish nurse with no previous experience as such should meet with an experienced parish nurse to get advice on interacting with parishioners and hospital and parish staff. PMID- 10129798 TI - Helping patients receive medical benefits. Collaboration between hospitals and legal services assists providers and low-income Kansans. AB - In Kansas, legal services lawyers have teamed up with Catholic healthcare administrators to help uninsured and underinsured hospital patients receive healthcare benefits from programs for which they may be eligible. The project- Hospital Patient Assistance Program--provides comprehensive assistance in establishing a patient's eligibility for medical benefits. Hospital participation in the program is simple. When business office or admissions staff discover that a self-pay patient has been registered with the program, they refer the patient to Kansas Legal Services; Inc. (KLS). KLS staff members try to determine if the patient is eligible for benefits from any of a number of programs, including Medicaid, Medicare, and Crime Victims Assistance. If KLS finds no programs for which the patient is eligible, it does not accept the case and notifies the hospital. Hospitals participating in the program have found that many accounts they previously wrote off as not collectible can be paid. Since the program began in 1990, participating hospitals have realized almost $8 million in payments from various benefit sources. PMID- 10129799 TI - Clinton plan means opportunity for the Catholic healthcare ministry. PMID- 10129800 TI - A hospital that is all heart. PMID- 10129801 TI - Holy Spirit Hospital. Teaming up for patient-focused care. PMID- 10129802 TI - A positive view of lobbying. PMID- 10129803 TI - Tax-exempt healthcare in a reformed system. PMID- 10129804 TI - Sr. Coyle presents CHA's position on President's healthcare reform proposal. PMID- 10129805 TI - Medical imaging equipment service in Kaiser Permanente, Northern California. AB - As the largest department in Biomedical Engineering, Medical Imaging Services (MIS) provides comprehensive equipment service for all imaging modalities in Kaiser Permanente, Northern California Region. MIS is customer-focused and committed to exploring better ways to deliver service, control costs and implement business strategies to meet customers' changing needs. Service extends beyond conventional preventive/corrective maintenance to include technology assessment, regulatory compliance, education and training, and managed vendor relationships. Program enhancements include film processor and solutions service, a second-source parts program, and a machine shop. In recent years, operations expanded to the Kaiser Permanente Northwest Region. Significant savings are available to any healthcare organization willing to embrace a new, expanded view of equipment management. PMID- 10129806 TI - Radiology maintenance--circle of quality assurance. AB - The term Quality Assurance in Radiology expresses a commitment to superior performance--superior performance from the equipment, operators, management, service providers, and all others who share responsibility for patient care in radiology. The diagnostic imaging equipment must function to its optimum capabilities throughout its life cycle. Quality assurance requires all personnel to possess a sense of urgency and concern for the customer who, in the final analysis, is the patient. This paper discusses a proposed model called the Circle of Quality Assurance. Properly implemented by well-trained personnel under good management, the author believes such programs will assure diagnostic quality images while reducing costs, enhancing patient throughput, and ensuring patient and operator safety. PMID- 10129807 TI - Radiology capital asset management. AB - Radiology administrators are expected not only to take on the ultimate accountability for meeting the needs and challenges of present day-to-day operations, but also to plan for the future. Computer Aided Facility Management (CAFM), as a tool, enables radiology managers to obtain up-to-date data to manage their services. Using Autocad on a unix-based minicomputer as the graphical base generator and integrating information from a MUMPS-based minicomputer, the CAFM process can define areas to be studied for productivity and life cycle costs. From an analysis of radiology service, management was able to make solid judgement calls for equipment replacement and facility project renovation to effectively manage radiology resources. PMID- 10129808 TI - Technology in radiology: advances in diagnostic imaging & therapeutics. AB - Nearly 100 years from its birth, radiology continues to grow as though still in adolescence. Although some radiologic technologies have matured more than others, new applications and techniques appear regularly in the literature. Radiology has evolved from purely diagnostic devices to interventional technologies. New contrast agents in MRI, X ray and ultrasound enable physicians to make diagnoses and plan therapies with greater precision than ever before. Techniques are less and less invasive. Advances in computer technology have given supercomputer-like power to high-end nuclear medicine and MRI systems. Imaging systems in most modalities are now designed with upgrades in mind instead of "planned obsolescence." Companies routinely upgrade software and other facets of their products, sometimes at no additional charge to existing customers. Hospitals, radiology groups and imaging centers will face increasing demands to justify what they do according to patient outcomes and management criteria. Did images make the diagnosis or confirm it? Did the images determine optimal treatment strategies or confirm which strategies might be appropriate? Third-party payers, especially the government, will view radiology in those terms. The diagnostic imaging and therapy systems of today require increasingly sophisticated technical support for maintenance and repair. Hospitals, radiology groups and imaging centers will have to determine the most economic and effective ways to guarantee equipment up-time. Borrowing from the automotive industry, some radiology manufacturers have devised transtelephonic software systems to facilitate remote troubleshooting. To ensure their fiscal viability, hospitals continue to acquire new imaging and therapy technologies for competitive and access-to-services reasons.(ABSTRACT TRUNCATED AT 250 WORDS) PMID- 10129809 TI - Device tracking: user facility responsibilities. AB - The purpose of FDA's device tracking regulations is to ensure that tracked devices can be traced from the device manufacturing facility to the person who receives the benefit of the device, that is, the patient. Although the manufacturer has the responsibility for establishing and monitoring the tracking program for their devices, the user facility has a key responsibility in assuring its success. The FDA initially identified 21 devices that require tracking and recently added two more to the list. This paper discusses the tracking system and the responsibilities of the manufacturer and the user facility. Information on each of the initial 21 devices to be tracked is presented, including device nomenclature, description, potential health risks, panel classification and regulation number, risk class, ECRI number, and references. PMID- 10129810 TI - Health networks: hospitals, physicians, and insurers must get on board now or miss the train. PMID- 10129811 TI - Rehabilitation in the 1990s: growth prospects, health reform, and outcomes management. PMID- 10129812 TI - Identifying the health conscious consumer. AB - Individuals who lead a "wellness-oriented" lifestyle are concerned with nutrition, fitness, stress, and their environment. They accept responsibility for their health and are excellent customers for health-related products and services. Those who lack a wellness orientation are identified as higher health risks and become candidates for health promotion program intervention. The authors report a new scale by which to measure the wellness-oriented lifestyle. Scale development procedures are detailed, followed by information from five studies that support its validity. The authors suggest ways health care marketers may use the Wellness Scale to segment and target potential customers and position their products and services. PMID- 10129813 TI - Assessing the effects of donor knowledge and perceived risk on intentions to donate blood. AB - The need for blood is an important concern to society as a whole. However, many fears associated with the blood donation process inhibit donors from giving. The authors employ structural equations methodology to assess the effects of donor knowledge and perceived risk on the intentions of 430 active and inactive donors to give blood. Results suggest that donor knowledge increases the perceived risk of donating blood and that perceived risk decreases the frequency that donors intend to give. Research and managerial implications for developing marketing strategies to retain existing blood donor pools are discussed. PMID- 10129814 TI - Marketing health care to employees: the structure of employee health care plan satisfaction. AB - Providing cost-contained comprehensive quality health care to maintain healthy and productive employees is a challenging problem for all employers. Using a representative panel of metropolitan employees, the author investigates the internal and external structure of employee satisfaction with company-sponsored health care plans. Employee satisfaction is differentiated into four meaningful groups of health care benefits, whereas its external structure is supported by the traditional satisfaction paradigms of expectation-disconfirmation, attribution, and equity. Despite negative disconfirmation, employees register sufficiently high health care satisfaction levels, which suggests some useful strategies that employers may consider implementing. PMID- 10129815 TI - Understanding consumers' preferences for dental service. AB - Previous researchers typically have used attitude and opinion surveys to investigate consumers' perceived importance of dental services attributes. These approaches do not require consumers to trade-off among different attributes, however. The authors use conjoint analysis to analyze consumers' preferences for dental services described by a set of 24 attributes, examining the relative importance as well as the trade-off among these attributes. They also illustrate how dental care providers can use the results from conjoint analysis to tailor their offerings to meet the needs of different segments. PMID- 10129816 TI - Is product-line management appropriate for your health care facility? AB - Although many hospitals have adopted product-line management as a management tool, questions remain about its applicability in the health care industry. Using a national sample, the authors examine the impact of product-line management on operating results and profile hospitals in which product-line management has been associated with higher performance. Their study reveals the circumstances under which product-line management is likely to be the most successful. PMID- 10129817 TI - Patient callback program: a quality improvement, customer service, and marketing tool. AB - The authors developed, implemented, and evaluated a callback program in which hospital patients are contacted three weeks after discharge to resolve clinical or service concerns. Of the more than 2,000 patients contacted during the initial pilot test, 6% said they had a clinical concern and were promptly directed to a physician's office. A randomized/controlled study comparing a control group of patients (who were not called) to an experimental group (called) shows that several satisfaction measures increased positively within the experimental group. The authors conclude that the Patient Callback Program contributes to more effective clinical care and to perceptions of higher customer service. PMID- 10129818 TI - Program development in Australia: 1956-1991. PMID- 10129819 TI - Health policy and management: the case study method. PMID- 10129820 TI - The policy context of health services administration education through outcomes assessment. AB - Effectively evaluating preparation programs for health services administrators is important for program providers, trainers, future employers, the health care system, and the American public. Because the methods employed for evaluation do not exist in a vacuum, policy formation with respect to learner outcomes assessment is a critical concern for all those interested in health care management issues. During the 1990s, the prevalent trend in evaluation is "assessment," which emphasizes performance-oriented outcomes rather than traditional testing approaches. This article examines the evolving role of assessment from a higher education policy perspective. Current trends and issues in general education, teacher testing, and nursing home administrator preparation are brought to bear on the problem of how to implement the goals of assessment. Realistic expectations of assessment are subsequently offered. PMID- 10129821 TI - Health services management manpower and education: outlook for the future. AB - There is much concern about administrative costs in health care. But little has been written on the market for health managers. This article discusses Bureau of Labor Statistics data estimating a total of 362,500 health managers in the United States in 1990 and projections showing an increase to 517,800 in 2005. The article further discusses the composition of health care employment in terms of settings and functions, and evaluates the implications of a rapidly changing market for health administrators. The authors conclude that sufficient demand exists for AUPHA programs to produce more graduates, but that curriculum should be revised and should place greater emphasis on efficient production of health services. This will provide qualitative differentiation and give health management training a competitive advantage over business and other educational backgrounds. PMID- 10129822 TI - An educational approach to improving physician-administrator relations. PMID- 10129823 TI - Advanced concepts and applications in health policy and administration: developing and implementing an integrative experience. PMID- 10129824 TI - The health administration residency in Saudi Arabia: a multinational program. PMID- 10129825 TI - To AZT or not to AZT. PMID- 10129826 TI - When do you call? Air medical transport for illness. AB - When a motorcycle and pickup truck collide, hurling three victims across the roadway, and the closest hospital is 35 minutes away, it is fairly obvious that air medical evacuation is needed. But what if the call is for a patient with "pain," whose breathing is a little labored, whose heart sounds are slightly abnormal and who is just not responding to treatment? The closest hospital--if there's not traffic--is about 25 minutes away. Do you request a helicopter and risk a medically unnecessary call, or do you load the patient and transport him by ground, hoping his condition doesn't deteriorate too rapidly? PMID- 10129827 TI - Air transport for illness. Is it appropriate? PMID- 10129828 TI - If you could feel what I feel. Learning to care for the elderly. AB - It's a familiar scene for any EMS responder who has transported nursing home residents. The room is filled with people apparently suffering the various afflictions of time: those with problems hearing, seeing, walking, feeding and expressing themselves, and performing the simple, everyday tasks younger people ordinarily do without conscious effort. Some people are in wheelchairs. Others hobble about on canes or crutches. PMID- 10129829 TI - Global positioning system. New directions in ground/air communications. AB - The use of helicopters for on-scene emergency response has become an important part of the EMS system. In fact, air transport of advanced-level personnel to the scene of accidents and the rapid transport of patients to acute-care facilities frequently have been lifesaving. PMID- 10129830 TI - EMS and the Midwest floods. Responding to the disaster that wouldn't quit. PMID- 10129831 TI - New Jersey providers deluge Missouri town with help. PMID- 10129832 TI - Resuscitating the health care system. What will the American Health Security Act mean for EMS? PMID- 10129833 TI - Preplanning for an MCI (mass casualty incident). PMID- 10129834 TI - EMS at the Democratic National Convention. PMID- 10129835 TI - Mass casualty: Pope's Denver visit causes mega MCI (mass casualty incident). PMID- 10129836 TI - 1993 EMS salary survey. PMID- 10129837 TI - Should physicians be permitted to 'balance bill' patients? AB - This paper studies the efficiency effects of physician fees when the insurer (possibly the government) pays a fee for each procedure, and the doctor may supplement the fee by an extra charge to the patient, a practice known as 'balance billing.' Monopolistically competitive physicians can discriminate among patients on the basis of both price and quality. Equilibria with and without balance billing are compared. The paper analyzes and recommends a new fee policy, a form of payer 'fee discrimination.' PMID- 10129838 TI - The effect of higher rural interstate speed limits in alcohol-related accidents. AB - This research analyzes the effect which recent speed limit increases on rural interstate highways have had upon accidents that are alcohol-related. Although there has been considerable work on the separate highway safety effects of higher speed limits and alcohol-related accidents, surprisingly little work has explicitly examined the relationship between them. Based upon extensive county wide data on alcohol-related accidents and several theoretically important determinants of these accidents for the state of Indiana and over the period 1981 through 1989, fixed effects models were estimated. For the state as a whole, the analysis finds that the increase in rural interstate speed limits increased alcohol-related accidents and the magnitude of the effect was statistically significant. In addition, the relaxed speed limit led to a significant redistribution of alcohol-related accidents away from higher speed environments and towards lower speed environments. With few exceptions, this was true for every type of alcohol-related highway accident examined. PMID- 10129839 TI - QALYs (quality-adjusted life-years) versus HYEs (healthy years equivalents) AB - This paper explores the claim that QALYs are liable to misrepresent consumer preferences and hence lead to decision-makers choosing options which are not those preferred by the public. It also considers the claim that HYEs do not suffer from this defect. We argue that none of the examples offered to date demonstrate the alleged tendency of QALYs to misrepresent preferences. We also show that HYEs are identical to QALY scores obtained from a time tradeoff experiment and therefore that the assumptions about preferences underlying HYEs are just as restrictive as those underlying TTO-based QALYs. PMID- 10129840 TI - Economics, health and health economics: HYEs (healthy-years equivalent) versus QALYs (quality-adjusted live-year) AB - This paper responds to Culyer and Wagstaff's (CW) and Buckingham's (B) arguments. We refute their claim about the equivalence of HYEs and QALYs; they fail to distinguish between choice under uncertainty and under certainty. CW assume that all individuals have a specific form of utility function, which yields their conclusion of equivalence. B's arguments confuse the measurement technique and the utility theory from which it stems; his argument about the normative superiority of the QALY construct is inconsistent with economic thinking. The HYE, by being compatible with the principles of economics, is superior to the QALY for economic evaluations of health care interventions. PMID- 10129841 TI - Who pays for mandated health insurance benefits? PMID- 10129842 TI - The determinants of the hospitalization of nursing home residents. PMID- 10129843 TI - Using consumer choice to create a national health care system. PMID- 10129844 TI - Major-risk national health insurance: a better way for the health sector. PMID- 10129845 TI - Universal access to health care: a practical perspective. AB - Policy disconnected from economic reality is bad policy. Neither government financed health insurance nor an employer mandated health insurance approach are in the national interest. Higher national priorities compel a reallocation of resources from consumption to investment. This need not, however, cause an abandonment of efforts to deal with the problems of the uninsured and other health reforms. Successful health care reform is achievable provided it is responsive to higher priorities for economic growth. A strong economy and the production of wealth are indispensable to economic justice. Toward this end, a program of universal access is proposed whereby families and individuals are required to pay for their own health insurance up to a fixed percentage of disposable personal income before public payments kick in. Government's chief role is to establish a standard package of cost-effective benefits to be offered by all insurance carriers, the cost of which is approximately 40 percent less than conventional insurance coverage because of the elimination of reimbursement for clinically non-efficacious and cost-ineffective services. Public financing is relegated to a residual role in which subsidies are targeted on the needy. Much of the momentum for cost control is transferred to consumers and private insurers, both of whom acquire a vested interest in obtaining value for money. Uniform rules for underwriting, eligibility, and enrollment practices guard against socially harmful practices such as experience rating and exclusion of preexisting conditions. The household responsibility and equity plan described herein could free up as much as $90 billion or more for public investment in economic growth and national debt reduction while assuring access to health care regardless of ability to pay. Economic revitalization will be assisted by changes in household savings. With health care no longer a free good and government social programs concentrated on the truly needy, individual propensity to save will increase, thereby enlarging the pool of capital for financing investments in economic growth. Putting more responsibility for health care financing on households with an ability to pay also serves to reinforce and expand the work ethic. Privatizing responsibility by severing health insurance from the workplace connection improves the geographic and occupational mobility of labor, diminishes employer tendencies to discriminate against hiring the disabled and older employees, and eliminates a major source of labor unrest.(ABSTRACT TRUNCATED AT 400 WORDS) PMID- 10129846 TI - Congress and the politics of compulsory health insurance. PMID- 10129847 TI - Novice to expert: an application of the Dreyfus model to management development in health care. AB - It has been the intent of the authors to describe a management development method which has as its basis a way to differentiate methods for skill development based on levels of skill acquisition. The intent is to provide an efficient and effective framework within which management development can occur as well as to test the utility of the Drefus model in the critical arena of developing management talent in health care environments. Further work and experience with both the model and the skills identified will continue. PMID- 10129848 TI - AIDS case management: a study of an innovative health services program in Palm Beach County, Florida. PMID- 10129849 TI - Have you ever considered ... five alternative ways to build a volunteer program. PMID- 10129850 TI - Senior volunteerism policies at the local level: adaptation and leadership in the 21st century. AB - This study explores several key senior volunteerism policy issues that need to be addressed from a local perspective in order to meet the challenges of the twenty first century. Using inputs from a national survey of Voluntary Action Centers, prominent volunteer agencies in the United States, this study examines the impact of the national economy on senior volunteerism, the status of funding, the relationship between local senior volunteerism and employment, the role of risk management, and the affect of an aging society of senior volunteerism. PMID- 10129851 TI - The direct service volunteer and voluntary board member: what are the roles and responsibilities? AB - The role of the direct service volunteer on the voluntary board is explored and its organizational structure is examined to determine if it facilitates the flow of information from volunteers. The study questions whether volunteers can effectively communicate their suggestions and concerns about volunteer and organizational needs given the structure imposed by Board Member Manual procedure. A two-way relationship via the Voluntary Advisory Committee is suggested where political participation through the committee can give volunteers a political structure to express opinions pertinent to volunteer causes and clear lines of communication between staff, volunteers, and the leadership can be established. PMID- 10129852 TI - The key to the boardroom door: policies for volunteer programs. AB - Writing and updating policies for volunteer programs is a key strategy to gain the attention and recognition of board and senior administrators for volunteer programs and for managers of volunteers. Further, in light of the recent and rapid growth in volunteering and in the complexity of volunteer work itself, policy development has become an indispensable element in risk management and liability reduction. Managers of volunteers are encouraged to involve their boards and CEOs in policy development. Building the framework of beliefs, values, and rules through policies will ensure both safe and satisfying involvement for the volunteer, and effective service for the client. PMID- 10129853 TI - Older women who volunteer: tapping a valuable woman resource. AB - Older women are increasing in number and are the gender who most often volunteer. Thus, an increasing pool of older women volunteers may be forthcoming. Keeping these women satisfied can serve them and the people they serve. The 119 women in this study range in age from 60 to 93, are racially diverse, and are most often low-to-middle income. For these women, volunteer satisfaction and retention relate to interaction on the job, recognition for their work, and meeting their own expectations. Methods for meeting these needs are suggested. PMID- 10129855 TI - What new doctors are earning. PMID- 10129854 TI - Practice documents. Unless they're current, they're worthless. PMID- 10129856 TI - Job-related education and training: their impact on earnings. AB - A worker's education and an appropriate job requiring education or training are significant determinants of earnings; qualifying training and training taken to improve skills play different roles in the workplace, but both contribute to greater earnings. PMID- 10129857 TI - The emerging role of the technical consultant. PMID- 10129858 TI - Competency assessment in the transfusion service. PMID- 10129859 TI - Setting a climate for motivating your staff. PMID- 10129860 TI - How we beat the phlebotomy shortage. PMID- 10129862 TI - Surgical Care, Medical Care plan $1 billion merger. PMID- 10129861 TI - Handling romance in the lab. PMID- 10129863 TI - GAO cites VA for long waits. PMID- 10129864 TI - Retooled reform proposal handed off to Congress; hospitals criticize fixes. PMID- 10129865 TI - Most hospital execs say staff will be first to go if facilities have to cut operational costs. PMID- 10129866 TI - Public squeamish about data privacy. PMID- 10129867 TI - Two Houston systems to merge. PMID- 10129868 TI - Atlanta clinic may serve as model. PMID- 10129869 TI - Study for Columbia hits not-for-profits. PMID- 10129870 TI - Lawmakers jockey for position to have a say on reform bill. PMID- 10129871 TI - Long-term-care facts must be addressed. PMID- 10129873 TI - NME appears close to selling businesses that aren't linked to the medical surgical field. PMID- 10129872 TI - New and improved. Eighth annual competition honors architectural projects that build on changes in healthcare delivery. PMID- 10129874 TI - Profs tab NME as Columbia's next target. PMID- 10129875 TI - Hospitals made to justify marketing's worth. PMID- 10129876 TI - Healthcare securitization emerges as trend. PMID- 10129877 TI - Calif. fires force hospital closures. PMID- 10129878 TI - FTC probes hospital merger. PMID- 10129879 TI - Chicago-area Catholic facilities eye network. PMID- 10129880 TI - Ruling against N.Y. surcharges raises more ERISA questions. PMID- 10129881 TI - AMI, not-for-profit set Ala. alliance. PMID- 10129882 TI - Catholic facilities study networks. PMID- 10129883 TI - Change in drug packaging angers hospitals. PMID- 10129884 TI - Cheap leases ruled invalid in Calif. anti-kickback case. PMID- 10129885 TI - Study--downsizing causes more deaths and paperwork. PMID- 10129886 TI - White House intensifies counterattacks. PMID- 10129887 TI - Reform prompts S&P to redefine 'hospital system'. PMID- 10129888 TI - Neighboring hospitals in court over PPO spot. PMID- 10129889 TI - 11 rurals sign pacts with Brim. PMID- 10129890 TI - Drugmakers may join ad attack. PMID- 10129891 TI - Organizations need to pick right aim. PMID- 10129892 TI - Summit may be seeking acquisition of larger Epic to create 52-hospital chain. PMID- 10129893 TI - Goldman Sachs scores again as adviser on merger. PMID- 10129894 TI - Caring for the community. Hospital programs provide a lifeline for the inner cities, but only a few are to be found. PMID- 10129895 TI - Projects try for Defense grants. PMID- 10129896 TI - Cell infusion may help cut costs, aid efficiency of immune treatments. PMID- 10129897 TI - Local battles erupt as HMOs jockey for market share. PMID- 10129898 TI - Medical Care America nixes merger. PMID- 10129899 TI - Settlements proposed in case against HME ventures. PMID- 10129900 TI - Study shows hospitals in group were profitable. PMID- 10129901 TI - Decision aids cost-shifting. PMID- 10129902 TI - UniHealth, Blue Cross cease merger talks. PMID- 10129903 TI - AMI sues Epic over bonus plan. PMID- 10129904 TI - Many facilities lax on advance directives. PMID- 10129905 TI - UniHealth, Blue Shield plan was 'premature'. PMID- 10129906 TI - Congress' moves to trim deficit threaten healthcare reform. PMID- 10129907 TI - Judge orders release of task force documents. PMID- 10129908 TI - Study--mergers cut costs, services, increase profits. PMID- 10129909 TI - JCAHO publishes software specs for data extraction, transfer to indicator system. PMID- 10129910 TI - Wildfires prompt hospitals to call in reinforcements. PMID- 10129911 TI - Patient to pay worker in settlement. PMID- 10129912 TI - First lady asks AAMC for support; group questions GME financing. PMID- 10129913 TI - Justice Dept. letter clears collaboration. PMID- 10129914 TI - Antitrust exemptions opposed. PMID- 10129915 TI - Point-of-service plans slow to catch on in Detroit. PMID- 10129916 TI - Data bank access still in reform plan. PMID- 10129917 TI - Physician groups set to oppose two provisions in reform plan. PMID- 10129918 TI - Ill. Blues will require specialists to follow clinical practice rules. PMID- 10129919 TI - Financial estimates for reform plan to be hard to make--CBO head. PMID- 10129920 TI - Hospitals improve accounts receivable performance--report. PMID- 10129921 TI - Oct. medical inflation surpasses CPI. PMID- 10129922 TI - Federal program helps clinics become roaring business. PMID- 10129923 TI - Feds checking for 'glass ceilings'. PMID- 10129924 TI - Wavering Medicare helps, hinders rural hospitals. PMID- 10129925 TI - Studies predict reform's impact on Calif. PMID- 10129926 TI - Trend toward provider score cards grows. PMID- 10129927 TI - NME settles 59 suits involving Texas facilities. PMID- 10129928 TI - New Orleans hospital loses appeal; new survey set. PMID- 10129929 TI - CEOs see passage of reform but doubt plan can do it all. PMID- 10129930 TI - Proposed Medicare reductions would fall hardest on hospitals. PMID- 10129931 TI - Privacy fears place another hurdle in path of reform. PMID- 10129932 TI - Chicago-area system starts after 4 years of discussion. PMID- 10129933 TI - Largest N.J. health plan forms. PMID- 10129934 TI - Baxter defines restructuring plans. PMID- 10129935 TI - OrNda, AHM to merge in $400 million deal. PMID- 10129936 TI - $30 million gift to finance Texas hospital's new center. PMID- 10129937 TI - San Diego County decision not to pay for illegal aliens' care to cause loss at facility. PMID- 10129938 TI - Authorities investigating La. hospitals on charges they got high Medicaid pay. PMID- 10129939 TI - FDA expanding its antitrust review by asking for detailed information on proposed Columbia-HCA merger. PMID- 10129940 TI - Public hospitals fear funding gap after disproportionate payments end. PMID- 10129941 TI - Tax exemptions questioned in reform talk. PMID- 10129942 TI - New management styles, skills will be prerequisite. PMID- 10129943 TI - Time to put info system in order? PMID- 10129944 TI - MCA to mull 'realistic' bids--Steen. PMID- 10129945 TI - N.J. Blues sue Trenton facility for alleged patient overcharges. PMID- 10129946 TI - Pain group certified without exam. PMID- 10129947 TI - Rural home care effectiveness to be studied. PMID- 10129948 TI - Don't keep employees in the dark, execs told. PMID- 10129949 TI - Systems' credits being consolidated, too. PMID- 10129950 TI - Bishop fighting to block sale of Catholic hospital to HealthTrust. PMID- 10129951 TI - Congress nears passage of Medicare bill. PMID- 10129952 TI - Health care reform excites, worries nurses. PMID- 10129953 TI - Experts discuss merits of surgical masks. PMID- 10129954 TI - Capsule of the Clinton health care reform plan. PMID- 10129955 TI - Prescription for health reform: the President's plan. PMID- 10129956 TI - Preventing infection. A guide for long term care. PMID- 10129957 TI - Saluting the 1993 Nurse Scholarship Award Winners. AB - The James D. Durante Nurse Scholarship Awards are presented each year by the National Foundation for Long Term Care to licensed practical nurse students and registered nurse students working in long term care settings. Here are the 20 winners of 1993 and excerpts from their essays. PMID- 10129958 TI - Smoke-free environments protect resident rights, promote safety. PMID- 10129959 TI - Final per diem rules clarify charges to resident funds. PMID- 10129960 TI - Proactive strategies may prevent union organizing activities. PMID- 10129961 TI - Program links greater mobility with creative encouragement. PMID- 10129962 TI - OT kitchen focuses on special needs to promote self-care. PMID- 10129963 TI - The challenges for providers: safety, regulation, freedom. PMID- 10129964 TI - Tools of the specialist. Automatic implantable cardioverter defibrillator. PMID- 10129965 TI - Women and the work of caring. AB - In the U.S., care for chronically dependent people is done mostly by family and friends, with only sporadic community support. Though such unpaid caregiving work -the bulk of it performed by women--constitutes an enormous subsidy to the national welfare, the contribution is undervalued, and the negative practical consequences for caregivers seldom recognized. PMID- 10129966 TI - Response: an alternative for Miss B. PMID- 10129967 TI - Response: not gender but economics. PMID- 10129968 TI - Response: who will care? PMID- 10129969 TI - Response: honoring identity. PMID- 10129970 TI - Response: recognizing the caregiver. PMID- 10129971 TI - Response: no room for hierarchy. PMID- 10129972 TI - Our bodies, our families. The family's role in organ donation. AB - The 1968 Uniform Anatomical Gift Act--in keeping with a legal (and medical) concern for individual autonomy--bypassed the family in establishing the legal requirements for cadaveric organ donation, but current practice wisely recognizes a role for families in the decision making. PMID- 10129973 TI - The selling of organs, the sharing of self. AB - Hailed as a possible solution to the chronic shortage of transplantable organs, a commercial market raises a host of practical and policy problems. More important, it fails to give due respect to the body, the medium through which the self is revealed to the world. PMID- 10129974 TI - The case: voices. AB - Six caregivers comment on the aftermath of a patient's disabling stroke. Their remarks about the patient and his family situation reveal much about the dynamics of the hospital hierarchy--and, incidentally, the difficulty of uncovering the "facts." PMID- 10129975 TI - Commentary: Ms. Lubell's complaint (a fictional clinical record) AB - Imagining a case from the viewpoint of a family member rather than of the patient redirects moral attention to issues overlooked when the patient is the focus of concern. PMID- 10129976 TI - Overview: "the whole story". AB - Narrative ethics calls for "thick" description, but even a very detailed story, one that includes a number of viewpoints, will not necessarily point the way to an easy answer, a right answer, or a happy ending. PMID- 10129977 TI - The patient-physician relationship in an era of scarce resources: is there a duty to treat? PMID- 10129978 TI - Continuing education credits for the CST certified first assistant. PMID- 10129979 TI - A pharmaceutical care challenge: recruiting, training, and retaining pharmaceutical care practitioners. AB - We do not claim to have all the answers when it comes to implementing an ideal pharmaceutical care model. We are not even sure what all the characteristics of such a model should be. We have recognized, based on our interpretation of the model, that meeting the demands of pharmaceutical care will require changes and advanced skills in our staff. We continue to work in creating an environment where the concept of pharmaceutical care can flourish. Our department has focused on defining and then providing pharmaceutical care through individual practitioners and patient care teams. More employee empowerment with less management control was the key to facilitating initial phases in our pharmaceutical care model. A successful orientation process has further enhanced our abilities to hire new graduates and/or experienced practitioners for our open positions. We believe we have taken some significant first steps toward recruiting, training, and developing our staff to become competent and satisfied with their newly developing role as pharmaceutical care practitioners. PMID- 10129980 TI - Advanced human resources planning. AB - Programs developed to advance the careers of pharmacy staff members are important tools to attract and retain qualified staff members. Integration of career development with the advancement of the department's efforts to achieve pharmaceutical care are integral for the future success of the department. Design of programs for all major positions/classifications should be considered. These programs must be developed in concert with the employees affected. In the future, these programs can demonstrate enhanced outcomes for patient care by ensuring appropriately trained and credentialed employees. This will require a commitment to advanced human resources planning. PMID- 10129981 TI - Hiring pharmacists and technical personnel: Part 1: Recruitment. PMID- 10129982 TI - Hiring pharmacists and technical personnel: Part 2: Interviewing. AB - Interviewing job candidates is a key duty of pharmacy managers. A structured, focused review of application materials, an interview planned in advance, and the use of multiple interviewers can lead to an effective interview. The planned process can lead to the selection of employees who will stand the test of the organization over time and meet the goals and needs of the employee as well. PMID- 10129983 TI - Hiring pharmacists and technical personnel: Part 3: Orientation and training. AB - Training new employees is an important and necessary component of the creation of a team to provide pharmacy services. A structured, focused review of application materials, a tailored training program planned in advance, and the use of multiple trainers can lead to an effective training program and a satisfied, productive new employee. The planned training program leads to a consistent approach to physician, nurse, and patient customers and sets expectations for skills, interaction, behavior, and quality that are the basis of a long-term relationship. Employees may continue this training process over the entire course of their career. A well-designed training program will also provide portable skills and meet the goals and needs of the employee as well. PMID- 10129984 TI - Health centers and hospital partnerships: a nucleus of community networks. PMID- 10129985 TI - The AHA's chairman-elect designate discusses integration and reform. Interview by Mary Grayson. PMID- 10129986 TI - Hospital leaders predict tighter finances, need for new initiatives. AB - National health care reform legislation will affect hospitals in ways as dissimilar as hospitals themselves. How prepared are they? Hospitals & Health Networks, in conjunction with Premier Hospitals Alliance, Westchester, IL, surveyed 402 CEOs and chief operating officers to gauge their responses to anticipated changes and garner their opinions on how reform will affect their hospitals. PMID- 10129987 TI - The real meaning of partnerships. PMID- 10129988 TI - Coordinating and communicating care in the hospital of the future. PMID- 10129989 TI - Breaking down barriers: ensuring access for diverse communities. PMID- 10129990 TI - Changing the face of governance. PMID- 10129991 TI - Ambassadors of health care reform. PMID- 10129992 TI - Putting the focus on health. Wellness centers energize hospital and community. PMID- 10129993 TI - Budget law's spending curbs on Medicare take effect. PMID- 10129994 TI - Hay survey: reform spurs shift in compensation strategies. PMID- 10129995 TI - Georgia gets a shot of love. Scottish Rite Children's Medical Center and The Atlanta Project team up to immunize the city's children. PMID- 10129996 TI - What trustees should know about the Family and Medical Leave Act. PMID- 10129997 TI - Choosing well: a strategy for making good decisions. PMID- 10129998 TI - An amateur's primer on bond issues. PMID- 10129999 TI - Clinton's reform plan: an Rx for change. PMID- 10130000 TI - Community needs help keep technology in perspective. Interview by Karen Gardner. PMID- 10130001 TI - Wonks at play: the new health plan. PMID- 10130002 TI - 1994 career guide. The changing professions. PMID- 10130003 TI - Cashing in on health reform. PMID- 10130004 TI - Painting therapy: a Swiss experience for people with mental retardation. PMID- 10130005 TI - Retirement: the last day on the job. PMID- 10130006 TI - Turnarounds & rightsizings. Lessons in leadership. PMID- 10130007 TI - Business process analysis. Part 2. AB - We are addressing in this three part series, the challenge of making lasting, logical and linked improvements in your organization, aided by fresh, comprehensive and almost certainly unique, new view(s) of your organizational system. Preparing your organization for this type of needed "reinvention" of the organizational system can be better assured if some, preferably all, of the conditions listed in Figure 1 are present. These were introduced and discussed in last month's article. The last item in Figure 1 refers to a "Business Process Map" of the organization. Chances are that you have never encountered this term and only have a vague idea of what is meant by it. Explaining the basis of this evaluative approach is the purpose for this article. Next month, we will show ho useful this insight can be in many strategic decision areas of your business. PMID- 10130008 TI - Reform's impact on medical imaging. PMID- 10130009 TI - Managed care and structural change. PMID- 10130010 TI - The impact of the Clinton Administration policies on the health of the healthcare industry. PMID- 10130011 TI - Introductions at upcoming RSNA highlight move toward cost effectiveness and patient throughput. PMID- 10130012 TI - Damn the torpedoes, full speed arrears. PMID- 10130013 TI - Transformation of a radiology department. PMID- 10130014 TI - Shifting perspective. A systems-based approach to change. PMID- 10130015 TI - Marketing strategies. Referring physicians. Part 3. PMID- 10130016 TI - Health reform insight. Forecasting health costs: first, cross your fingers. PMID- 10130017 TI - Perspectives. Health reform and the poor: empty promises or a promising blueprint? PMID- 10130018 TI - American Health Information Management Association. Position Statement. Issue: position statements. PMID- 10130019 TI - American Health Information Management Association. Position statement. Issue: patient cards. AB - In its simplest form, a patient card is a credit card sized record made of paper or plastic that contains identification information. A card may contain additional information, such as insurance or limited health information. Of the many technologies available, chip cards and optical cards are best suited for use in healthcare. If their expense can be justified and nation-wide standards established, cards could help improve timely access to basic health information such as demographic, insurance, and basic medical information needed for emergency treatment. Technology may permit a patient's entire longitudinal (lifetime) health history to be maintained on a card, but this should not be the only source of the longitudinal record. To assure its accessibility to legitimate users throughout the healthcare system, the longitudinal health record must be a computer-based patient record maintained on a controlled access network. PMID- 10130020 TI - American Health Information Management Association. Position statement. Issue: physician signatures on attestations. AB - Currently, payment under Medicare's prospective payment system requires that a physician sign an attestation statement on each Medicare patient, attesting to the diagnoses and procedures recorded for that patient. This requirement places a significant administrative burden on both healthcare facilities and physicians, without adding any value to the claims process. AHIMA believes this requirement should be eliminated. Physicians should continue to be responsible for recording complete, accurate, and timely information (including final diagnoses and procedures) in the patient's health record. Healthcare facilities and their health information management professionals should be held responsible for reporting complete and accurate diagnoses and procedures based on official coding guidelines and documentation in the patient's health record. Sufficient penalties exist for healthcare facilities and physicians who submit fraudulent claims, without subjecting all physicians and healthcare facilities to this administrative burden, which adds unnecessarily to the cost of healthcare. PMID- 10130021 TI - Postoperative complications. PMID- 10130023 TI - Patient cards and the electronic data highway. PMID- 10130022 TI - Reliable computer systems. AB - In this article, we looked at some decisions that apply to the design of reliable computer systems. We began with a discussion of several terms such as testability, then described some systems that call for highly reliable hardware and software. The article concluded with a discussion of methods that can be used to achieve higher reliability in computer systems. Reliability and fault tolerance in computers probably will continue to grow in importance. As more and more systems are computerized, people will want assurances about the reliability of these systems, and their ability to work properly even when sub-systems fail. PMID- 10130024 TI - Networking providers--data highways of the '90s. PMID- 10130025 TI - Smart cards: a versatile technology applied to OB/Gyn services. PMID- 10130026 TI - Combining EDI (electronic data interchange) and the electronic patient record: the information infrastructure that is needed for healthcare. PMID- 10130027 TI - Healthcare reform = information reform. PMID- 10130028 TI - A report on the activities of the Health Identification Card Technical Advisory Group (TAG) of the Workgroup on Electronic Data Interchange (WEDI). PMID- 10130029 TI - Patient cards: don't leave home without them? PMID- 10130030 TI - New Joint Commission standards: management of information roles of health information management professionals. PMID- 10130031 TI - Authorship equals accountability. PMID- 10130032 TI - The professional exchange program: walk a mile in my shoes. PMID- 10130033 TI - Clinical informatics as a medical subspecialty. PMID- 10130034 TI - Contrasting acute care and long-term care information systems needs. AB - Information systems in nursing facilities have their own set of requirements. While these may appear to be less complex than those required of acute care systems, they offer their own series of traps and pitfalls and the information systems manager should be wary of vendors who suggest that acute care systems can be readily modified for long-term care usage. Well-designed and implemented long term care applications demand the same challenges to integration as do acute care products. Information provided by these systems must be designed to support not only the routine transactions of the facility, but also the strategic planning necessary for intelligent management decision making. It is not sufficient in this era to record and replay data. Data must be synthesized into meaningful summaries in order to be effectively used by executives. [7] This is also true for clinicians. Assessment data are increasingly used to position a patient in a case-mix or reimbursement group. Whereas acute care revolves around DRGs and ICD 9 codes (soon to be ICD-10), long-term care uses a patient review instrument (PRI), resident assessment protocols (RAPs), and resource utilization groups (RUGS). The successful information systems manager will have all of these measures at his or her disposal by financial class, insurance class, and days receivable if eyes are kept on the goal of planning all of the systems with equal care and an eye to the future. PMID- 10130035 TI - Integrating information systems for enhanced efficacy and outcomes management. PMID- 10130036 TI - Innovations in anesthesia pre-screening through data systems and telecommunications. AB - In summary, the anesthesia pre-screening concept along with the supporting computer systems allow for fingertip nursing informatics, data collection, and retrievability, providing the continuity of care so emphasized in health care today. Departmental efficiency is maximized in both processing and communicating the patient information for the caregivers through the up-to-the-minute accuracy and safety built into the data system. At this point in APS implementation, the scope of cost-savings has yet to be fully identified, yet the perception is that it is quite substantial. At the same time, recent research results confirm our hypothesis that the personal touch provided by APS phone screening and individual case management has improved patient safety, convenience, and satisfaction along with overall effectiveness. Since the CAPS system will grow in scope and complexity over the next few years, the system will be migrated to a clientserver configuration. Although "client-server" may be an overused term, its potential for improved data accessibility, integrity, and raw processing throughput is great once the field solidifies in this area. The addition of graphical user interfaces and natural language facilities will further enhance the ease of use of the system. In the near term, an on-line version of the Physician's Desk Reference will be added for use during patient calls. This computerized version offers speed as well as a more comprehensive searching ability as opposed to its tree-based cousin. PMID- 10130037 TI - Voice-recognition technology applied to nursing documentation. PMID- 10130038 TI - A vision of clinical informatics. PMID- 10130039 TI - A new era for clinical systems unfolds. PMID- 10130040 TI - Very bad blood. AB - The discovery of HIV-tainted plasma in Germany raises alarm about the ability to ensure safe supplies worldwide. PMID- 10130041 TI - Fasting for the right to die. Jack Kevorkian. AB - Dragged, literally, to jail for helping people kill themselves, Jack Kevorkian goes on a hunger strike. PMID- 10130042 TI - Access: the most critical issue facing reform. AB - In the present reform environment, businesses can effectively work with insurers and provider networks to construct and monitor a basic benefits design that would enlist the public more fully in providing universal health care. PMID- 10130043 TI - Health care crisis needs new approaches, not more dollars. Interview by Debra Mamorsky. AB - An economist and analyst of public policy explains why medical spending accounts, a multitiered health care system, and elimination of government mandates would help solve the nation's health care crisis. PMID- 10130044 TI - A plan to overcome resistance to managed care. AB - A managed-care plan is attempting to reverse New Yorkers' negativity toward managed care. The focus is on giving consumers adequate information and access to allow them to make prudent health care choices. PMID- 10130045 TI - Cost control without compromising quality of care. AB - By focusing on creative options that meet the varied health care needs of a wide range of members, a multiemployer purchaser of health care in California is able to provide quality care at affordable prices to public employees. PMID- 10130046 TI - Managed Health Care Association update. AB - Recent MHCA projects--on outcomes measurement, managed-care plan performance, and managed-care accreditation--will have a significant impact on the reformed U.S. health care system. PMID- 10130047 TI - Psychiatric hospitalization and managed care in conflict. AB - The managed-care concurrent review process often results in denied or limited coverage of psychiatric inpatient care due to reviewers' misconceptions about psychiatric hospitalization and in an effort to achieve savings. For employers, such decisions may cost more in the long run. PMID- 10130048 TI - Clinton's six-point reform program. AB - Congressional approval of the president's ambitious plan for rebuilding the U.S. health care system will depend on creating coalition in both the House and the Senate and on modifications that preserve the program's over-arching goals while incorporating aspects of other proposed reform plans. PMID- 10130049 TI - Patient satisfaction and the cost/quality equation. AB - Measuring patient satisfaction with health care treatment and delivery and making necessary adjustments can pay back big dividends to employers, payers, and providers in the form of cost savings and improved quality of care. PMID- 10130050 TI - A new system for health benefits communications. AB - Without adequate information about their health plans, consumers cannot make the best decisions about their health care. A new approach to health benefits communications provides employees with timely, accurate, complete information that allows them to make cost-effective health care choices. PMID- 10130051 TI - Social context of the health care system. PMID- 10130052 TI - Physicians' resistance to claims automation. PMID- 10130053 TI - Cost-cutting opportunities through direct contracting. AB - In summary, high-quality mental health care can be made affordable and obtainable for the average employee or dependent. The goal of ensuring ethical and appropriate mental health and substance abuse services can be achieved. The consequences of inadequate mental health services are higher usage of medical services and lower levels of employee satisfaction and performance. The direct contract approach offers the most viable alternative to achieving a sound, ethical, and cost-effective mental health care benefits program. Finally, in an era of rapid health care reform, it is important to ensure that the contracted provider group keeps fully abreast of and in compliance with emerging regulatory trends. PMID- 10130054 TI - Effect of managed care on providers. PMID- 10130055 TI - HMO performance assessment: group practice strategies and considerations. AB - Provider evaluation of HMO contracts is a complicated process. The issues are best examined by separating the process into financial, administrative, marketing, and provider relationship areas. Team negotiating by the provider group is a tactic that is effective in dealing with complex risk factors, reinsurance, pharmacy, pools, carve-outs, and nonfinancial enhancements. PMID- 10130056 TI - Hospital managed care performance standards. AB - If hospitals do not establish their own managed care direction and contracting performance standards, they will inevitably find themselves in a reactive position. This must be avoided as managed care is one of the few payor segments that hospitals still have the opportunity to influence. PMID- 10130057 TI - Southern California Edison's performance standards: an employer's key to quality care delivery. AB - One of the most significant lessons learned from this process is that setting objectives with performance standards is the key to continuous quality improvement. The critical differences between health administration and health management are threefold: (1) performance standards are developed with clarity, (2) care delivery is monitored and measured against these standards, and (3) improvements are made based on information from these measurements. PMID- 10130058 TI - PPO and HMO performance factors: insurance company evaluation criteria. AB - A venture into managed care should be done only following the proper amount of due diligence. The goal should be to select the most effective managed care organization with the flexibility to meet long-term needs and the mission to work on an ongoing basis to improve service and managed care performance. Unfortunately, all too often purchasers do not demand critical information from managed care service providers. As a result, poor quality organizations have prospered and delivered less than satisfactory results. In fact, it is not unusual that savings from discounts are more than offset by increased use of health care services because of poor utilization management. It is important to be aware that use of the appropriate selection methods and monitoring performance on an ongoing basis are best done by dedicated professionals. They are also resource intensive and require a sophisticated systems capability. Since resources and systems involve significant investment, the most appropriate course for purchasers is to play the role of educated consumers. Detailed documentation should be demanded from all potential service providers to ensure that due diligence and ongoing management are in fact performed. The health care management staff at ITT Hartford is often told by managed care vendors that few other purchasers perform thorough review. It is imperative that managed care be scrutinized at least as closely as any important business venture. PMID- 10130059 TI - Provider selection standards as a quality indicator. AB - There are many lessons that PPOs and their clients have learned during the past decade. Data are essential. Few claims administrators have invested the capital or resources to capture other than minimal data--many capturing only the elements required to produce a reimbursement check. The more extensive the data collection, the greater the potential for improving quality. The best way to assure the delivery of high quality health care is to implement a rigorous selection process, preferably prior to granting membership. In an ideal world, selection can lead to the elimination of many aspects of managed care so that the focus can be placed on physicians whose practice style yields lower quality and higher costs. The ability to implement CQI in a PPO is limited only by the ingenuity of the reviewer and the data. Most importantly, the past decade has proven the basic tenet of managed care--quality health care is cost-effective health care. PMID- 10130060 TI - Quality evaluation in a managed care system: comparative data to assess health plan performance. PMID- 10130061 TI - Selecting affiliates for a national HMO network: developing and implementing performance standards. AB - The evaluation process was developed for a specific, unique purpose. The subsequent success of the network and the performance of its HMOs in satisfying member and employer requirements lend support to the assertion that this was an effective approach. That success has also allowed the HMOs to benefit from national network affiliation through increased membership and revenue. The network offers its affiliates the prospect of making a transition from local HMOs to a national health care delivery system over the coming years. PMID- 10130062 TI - VIP interview: Alain C. Enthoven, Ph.D. AB - Alain C. Enthoven, Ph.D., is the Mariner S. Eccles Professor of Public and Private Management in the Graduate School of Business at Stanford University. He hold degrees in Economics from Stanford University, Oxford University (where he was a Rhodes scholar), and the Massachusetts Institute of Technology. Professor Enthoven has been an articulate advocate for restructuring the health care system. His far-reaching proposals on "consumer choice health plans" and "managed competition" in the 1930s established an intellectual framework for much of the current debate on national health policy. As a leader of the Jackson Hole Group, he favors internal market reform and employer tax incentives as the most effective means to control unnecessary medical costs. PMID- 10130063 TI - Operator service access and pay telephone compensation rules--FCC. Final rule. AB - In its Memorandum Opinion and Order on Reconsideration, the Commission affirms certain aspects of the Second Report and Order and makes a number of modifications. First, the Commission affirms its holding that interexchange carriers (IXCs) must pay competitive payphone owners (PPOs) compensation in the amount of $6 per month per payphone. Second, the Commission modifies the Second Report and Order to allow IXCs to avoid the obligation to pay compensation if they do not receive access code calls from payphones to which they are not presubscribed. Third, the Commission affirms its decision to use to toll revenue standard for apportioning compensation among those IXCs required to pay. Fourth, the Commission clarifies in a number of respects its requirements pertaining to the customer-owned coin-operated telephone (COCOT) lists provided by local exchange carriers (LECs) to IXCs. In addition, the Commission denies Allnet's Application for Review of a decision by the Common Carrier Bureau relating to the list of IXCs required to pay compensation. The Commission's Memorandum Report and Order on Reconsideration ensures that PPOs receive fair compensation for the service they provide in originating interstate access code calls from their payphones. PMID- 10130064 TI - Civilian Health and Medical Program of the Uniformed Services (CHAMPUS); partial hospitalization--DoD. Final rule; delay of grace period. AB - This document is to advise interested parties that the Director, OCHAMPUS is extending the grace period for partial hospitalization programs (PHPs) already accredited under the Joint Commission on Accreditation of Health Care Organizations (JCAHO) general hospital standards to obtain JCAHO accreditation under the Mental Health Manual. Due to the number of PHPs requesting JCAHO accreditation, an extension of the grace period is needed to allow sufficient time for PHPs to receive the mandatory JCAHO accreditation. PMID- 10130065 TI - OK, stick out your tongue and say 'taxes'. PMID- 10130066 TI - All together now. AB - Integrated health plans, in which doctors, hospitals and insurers join forces to manage care, are a cornerstone of the "managed competition" approach to health care reform. But it's not clear that these longtime adversaries are ready to work together--or that consumers will be happy if they do. PMID- 10130067 TI - AIDS in the workplace: Part II. Working with afflicted employees. PMID- 10130068 TI - Slow growth for noncommercial foodservice. PMID- 10130069 TI - Cleaning up your act. PMID- 10130070 TI - Healthcare reform: second opinions. If you must insure part-timers. Part 1. AB - One of the central goals of the Clinton healthcare reform proposal is to provide insurance coverage for all Americans. This will be possible largely by requiring all employers to pay insurance for all their employees, including part-timers. The proposed plan requires all employers to offer full medical benefit packages to any employee who works more than 30 hours a week, and to cover employees who work 10 to 30 hours a week on a prorated basis. The following are foodservice operators' opinions on how this legislation, if passed, will affect their operations. PMID- 10130071 TI - FM reports. Healthcare. PMID- 10130072 TI - The 1993 FM Award for Humanitarian Service presented to the Total Food Service Direction Team. PMID- 10130073 TI - Into the mouths of babes. AB - As a growing number of institutions & corporations offer childcare to their employees, new opportunities are opening up for foodservice directors & dietitians. PMID- 10130074 TI - How dangerous is truth in employment references? AB - For many years the amount of information flowing in employment references diminished in reaction to threats of legal action caused by a growing number of laws protecting individual rights. The result was that many organizations would share little or no reference information. In recent years, however, a new threat has arisen: the spectre of legal action for negligent hiring stemming from an organization's failure to fully check job candidates' backgrounds. Therefore, a sensible and responsible approach to reference checking is needed, applying to both requesting and dispensing information, in which information that flows is based on job performance and compliance with policy and is objective, verifiable, and furnished without malice or bias. PMID- 10130075 TI - The capital expenditure process for the health care supervisor. AB - Competition for health care capital dollars has increased as third-party and government reimbursement decreases, patient volume decreases, and alternative services increase. Given this rationing situation, it is more important than ever that the health care supervisor carefully document and present a capital expenditure request. This request should outline skillfully the benefits and costs of undertaking a new service or replacing an old asset. A supervisor who can quantify the costs and benefits of a project and utilize one of the four common capital budgeting techniques: payback period, net present value, profitability index, or internal rate of return, will certainly be taking a step in the right direction for ensuring a serious evaluation of his or her proposal. This article attempts to explain this process using both narrative and quantitative examples. PMID- 10130076 TI - Supporting operational decision making. AB - The collection and processing of information is a source of power. This fact is true especially in the health care industry. The apparent lack of information related to operational decisions in the health care industry is cause for concern. Data envelopment analysis (DEA) provides information regarding efficiency of resource utilization. This article reports on the use of DEA to measure relative technical efficiency of nursing units and the level of association between efficiency scores and the presence of selected operational characteristics. We found a statistically significant association between efficiency and two of the selected characteristics. Although nursing units are used to illustrate the application of the technique, DEA can be applied to any operational unit of a health care organization. However, we conclude that information systems and a minimum data set are essential to optimizing utilization of a such techniques. PMID- 10130077 TI - Reflections on total quality management and health care supervisors. AB - Total quality management (TQM) has become an integral process in service delivery for many health care organizations. This article reviews the fundamental concepts underlying TQM and how TQM is relevant to health care supervisors. In many respects TQM represents a contemporary approach to supervising innovation and change, to analytically solving customer problems, and to implementing continuous quality improvement. Several strategies are examined that health care supervisors can adopt for improving service quality, including cultivating a climate for innovation, motivating by example, leading staff to do what is right and to tolerate no service delivery errors, retraining staff, developing control systems, and creating barrier-free organizations. These strategies are examined from the perspective of achieving continuous improvement in health care settings. PMID- 10130078 TI - Coping with employee departures. AB - Resignations should be treated as minicrises. The highly structured procedure for handling employee exists described in this article can be effective in reducing employee turnover problems. Employees are recipients of your supervisory service, and therefore are your clients and should be treated as such. Suggestions are offered for maintaining staff efficiency during transitions and for conducting effective exist interviews. PMID- 10130079 TI - The health care delivery system in the year 2000: nursing care for the societal client. AB - The health care delivery system is defined as a societal entity consisting of all persons in the country capable of acting responsibly, and is seen as a client requiring nursing care. Using the nursing process (assessment, diagnosis, planning, intervention, and evaluation), the author determines a NANDA-approved diagnosis of body image disturbance and offers a care plan with the year 2000 as a time limit for short-term goals. PMID- 10130080 TI - Are your students prepared for a visit from the Joint Commission? AB - The Joint Commission on Accreditation of Healthcare Organizations 1991 standards added emphasis on the nursing care agencies provide. When previous standards required the organization to demonstrate whether it had the means of providing good patient care in place, the new standards require that delivery of competent care can be verified. All nursing students must be knowledgeable of these standards because they provide a significant amount of nursing care and are present in health care organizations in significant numbers. This requires administrative planning between nursing schools and agency staff. This planning needs to include orientation of agency staff to educational objectives for each level of student and orientation of students to the agency and its policy and procedure manual. PMID- 10130081 TI - Employee discipline: a changing paradigm. AB - To increase the receptiveness of health care supervisors to a broader meaning of discipline and to simulate investigation of nontraditional methods of encouragement to employees who fail to meet minimum standards of conduct and thereby negatively affect the quality of patient care, a subjectively realistic view of the implications of the traditional punitive disciplinary paradigm is presented. Through the use of a case study, the authors present, explain, and apply the contemporary concept of discipline without punishment as first described by J. Huberman. PMID- 10130082 TI - Internal and external forces affecting management compensation. AB - Increasing media scrutiny, eventual implementation of health care reform, and proliferation of TQM/CQI programs are significantly affecting health care management compensation programs. Trustees are insisting that management pay be based on definitive performance standards and are becoming increasingly resistant to the annual increase that is no longer sacrosanct. Philosophical conflicts regarding compensation are developing between CEOs and boards. These external and internal factors will require managers to reassess their attitudes toward their own and subordinate's compensation. Managers, at all levels, will have to adjust to pay determination factors and practices that differ from those to which they have been accustomed. PMID- 10130083 TI - Supportive housing. PMID- 10130084 TI - Phoenix rises. Believing that one's environment makes a difference, Conrad Levenson takes on the job as design czar for Phoenix House. PMID- 10130085 TI - Understanding Clinton's health plan: beyond political language. PMID- 10130086 TI - Futile care. Physicians should not be allowed to refuse to treat. Point. AB - Eighteen years after the era of Karen Ann Quinlan, the debate over futile care has shifted. Now some patients are asking for treatment that care givers believe to be useless. In virtually all cases of so-called futile care, the real disagreement is not over whether a treatment will produce an effect; it is over whether some agreed-on potential effect is of any value. An obvious reason to resist providing care believed to be futile is that is appears to consume scarce resources and therefore burden others. However, for care that affects the dying trajectory but appears to most of us to offer no benefit, the proper course is for society--not clinicians--to cut patients off. Under certain circumstances patients should have the right to receive life-prolonging care from their clinicians, provided it is equitable funded, even it the clinicians believe the care is futile and even if it violates their conscience to provide it. Society is not in a position to override a competent patient who prefers to live even if life prolongation is burdensome. For incompetent patients, if a clinician believes a treatment is actually hurting a patient significantly, he or she may appeal to a court to have it stopped. A society that forces people to die against their will produces more offense than one that forces healthcare providers to provide services that violate their conscience. And medical professionals have a social contract with society to control the use of medical, life-prolonging technologies.(ABSTRACT TRUNCATED AT 250 WORDS) PMID- 10130087 TI - The concept of futility. Patients do not have a right to demand medically useless treatment. Counterpoint. AB - Traditionally, applying the principle that physicians do not provide treatments when the interventions at their disposal do not produce medical benefits has been relatively straight-forward. However, with the growing importance of patient autonomy and informed consent in treatment decisions, ethicists must now balance this principle with the principle of patient self-determination. A patient's right to choose or refuse treatment is limited by the physician's right (and duty) to practice medicine responsibly. Bizarre or destructive choices made by a patient are not sacrosanct simply because the patient made them. In some cases, physicians may choose not to act on patient decisions that appear to be unreasonably destructive. Physicians also have a right to refuse to provide futile treatments (i.e., interventions that might be physiologically effective in some sense but cannot benefit a patient). Patients themselves have a right to provide input into what would constitute a "benefit" for them, but physicians should be able to decide when a particular treatment is futile based on their knowledge of the treatment's effects and its likely impact on a patient's quality of life. Ethical rules covering futility can be developed based on socially sanctioned standards of rationality and traditional physician-based values. Clarifying the concept of futility and establishing defensible ethical policies covering futility are important steps toward eliminating unhelpful, medically inappropriate practices. PMID- 10130088 TI - Involving physicians in TQM. To gain physician support for quality management, hospital administrators must treat physicians as customers. AB - The process of integrating physicians into a hospital's total quality management (TQM) program is not simple. Physicians will not view TQM as an acceptable strategy in the absence of a positive working relationship with hospital managers. Physicians must see hospital managers as colleagues who can help improve their medical practices both in efficiency and patient care. The first step in involving physicians in TQM is creating an environment that enhances physician relationships. The CEO should be actively involved with the medical staff, and senior hospital managers should work at cultivating physician relationships. Physician needs and the centrality of the physician-management relationship should enter into every management discussion. Also, managers must solicit physician feedback regularly. Managers can introduce physicians to TQM by accompanying them to off-site TQM programs for a few days. Managers should also coordinate a continuing education program at the hospital, inviting a physician to address medical staff about TQM. Physicians are more likely to respond positively to one of their peers than they would to a consultant or business manager. Managers should then invite hospital-based physicians to participate on TQM interdisciplinary teams to resolve a problem chosen by the senior medical staff. The problem should be one that promises to be a quick fix, thereby ensuring demonstrable success of TQM and allaying any doubts. After an initial demonstration of TQM's success, the cycle is repeated. A year or two later, managers should invite off-site clinicians to join interdisciplinary teams on issues important to them. PMID- 10130089 TI - Integrated delivery networks. Critical relationships in integrated delivery. Four integrating forces and four key relationships crystallize the vision. PMID- 10130090 TI - Relationships with other providers. Integrated delivery network, St. Louis; Synergon Health System, Chicago. PMID- 10130091 TI - Integrated delivery networks. Relationships with community. St. Mary's Hospital, Rochester, NY. PMID- 10130092 TI - Integrated delivery networks. Relationships with physicians. Mercy Health Services, Farmington Hills, MI. PMID- 10130093 TI - Integrated delivery networks. Relationships with payers. Sisters of Providence Health System, Portland, OR; Mercy Healthcare Sacramento, CA. PMID- 10130094 TI - Integrated delivery networks. A system for the future. Genesys Health System designs and builds a patient-focused care delivery network. AB - St. Joseph Hospital, Flint, MI, formed Genesys Health System in 1981, affiliating with five area hospitals and a number of other healthcare organizations. In 1983 the system closed one of the hospitals. Genesys Health System's vision is described as a three-legged stool, with the integrated delivery system as the seat. That system balances on three legs: a strong primary and specialty care physician network; a financing, or insuring, mechanism; and a revolutionary hospital and delivery system with a full continuum of services across a range of institutional and home settings. Genesys has two physician joint ventures that will eventually become one as Genesys member hospitals' medical staffs merge. Member physicians are already linked by a common computer system and risk-sharing mechanisms. The physician-Genesys joint ventures have contractual arrangements with various managed care organizations. The system serves more than 50,000 persons enrolled with HealthPlus of Michigan and virtually all the 10,000 enrolled patients of Blue Care Network, the Blue Cross health maintenance organization. After evaluating the community's needs, Genesys Health System decided to build a new hospital; 439-bed Genesys Regional Medical Center at Health Park is scheduled to open in 1997. The new hospital will be the first in the United States to be designed and built using patient-focused care concepts. PMID- 10130095 TI - Recent integrated delivery activities. PMID- 10130096 TI - Healthcare for the homeless. A public health agency, a business, and a Catholic provider open a clinic. AB - In some communities, hospital emergency departments are the only places that provide healthcare services to homeless persons. In Dayton, OH, homeless persons have another option--the Samaritan: A Healthcare Clinic for the Homeless. The clinic is a collaborative venture involving the area's public health department, a Fortune 500 business, and a Catholic hospital. In 1991 Dayton's public health department, the Combined Health District (CHD) of Montgomery County, received an anonymous $50,000 donation to provide primary healthcare services to homeless persons. With the goal of generating a number of stakeholders to invest in the community (which would translate into additional volunteers and donations), CHD asked Good Samaritan Hospital, Dayton, if it would become a partner in launching the clinic. Good Samaritan agreed, seeing this as an opportunity to provide a much-needed community service and to fulfill its mission of providing care to the area's needy citizens. In addition, the project was consistent with the hospital's increased focus on primary care. Sponsors of the Samaritan: A Healthcare Clinic for the Homeless anticipate three outcomes resulting from this collaborative effort. First, the cost of healthcare for Dayton's citizens should decrease. Second, providing healthcare services to the homeless enhances the possibility of breaking the cycle of homelessness. Finally, it is critical that healthcare for the homeless become a community focus. PMID- 10130097 TI - Southern hospitality. PMID- 10130098 TI - The ambiguous ethics of involuntary treatment for the elderly. PMID- 10130099 TI - The protection of values must be a priority when setting policies. PMID- 10130100 TI - Catholic Managed Care Consortium. Strength and support in numbers. PMID- 10130101 TI - A vision for Ukraine's future. PMID- 10130102 TI - Single specialty capitations. PMID- 10130103 TI - CRAHCA (Center for Research in Ambulatory Health Care Administration)--your research resource. AB - CRAHCA serves as a broad-based research resource for the study of medical practice management. In their article, Steven S. Lazarus, Ph.D., associate executive director, and Anna M. Bergstrom, research director, outline many of the projects undertaken by the Center in its 20 years and some of the significant publications and findings that have resulted from them. PMID- 10130104 TI - Ahead of its time: CRAHCA (Center for Research in Ambulatory Health Care Administration)--20 years old. AB - Former MGMA associate director and administrative research director for CRAHCA, Mary Alice Krill, Ph.D., FACMPE, was there at the Center's beginning. In her article, she offers her unique perspective on what has become one of the most important medical practice management research centers in the country, focusing on the early organization and how it has evolved over the past two decades. PMID- 10130105 TI - CRAHCA (Center for Research in Ambulatory Health Care Administration): member involvement leads to practical applications. AB - The research undertaken by CRAHCA results in many new techniques and ideas being adopted by medical practice managers. However, it is not merely a one-way street. In this article, six group practice managers respond to questions about how they have used and been involved with research activities the Center has developed. PMID- 10130106 TI - RBRVS: it's not just for Medicare anymore. The potential impact on your practice. AB - The impact of resource-based relative value scale (RBRVS) on group practice spurred this study by Randa Degerness, DDS, MBA, MHSA, and CRAHCA. The author explains two variables resulting from the study, the break-even conversion factor and percent variance, and their bearing on switching to an RBRVS-based fee schedule. PMID- 10130107 TI - PEERing into the past--trends documented in the performance efficiency evaluation report. AB - PEER--the performance efficiency evaluation report--is a quarterly data reporting service produced by CRAHCA. Authors Eric J. Anderson and David N. Gans, MHA, explain how PEER was utilized to discover whether capitated HMO groups achieved higher revenues with lower utilization than non-prepaid groups. PMID- 10130108 TI - Competitive strategies for faculty practice plans in the 1990s. AB - The upsurge in clinical revenue of faculty practice in academic centers over the last decade may be succumbing to RBRVS growth in managed care plans. Author Alan M. Zuckerman, FAAHC, investigates this possibility in his article. PMID- 10130109 TI - Referring physician database: the cornerstone of a successful marketing program. AB - In the language of authors Thomas Dunlap and Hedy Rogers, increased competition, "turf wars" and shifting demographics have made developing a keen competitive edge vital to growing and maintaining group practice income. They present the referring physician database as one method for satisfying the needs of a group's customer base. PMID- 10130110 TI - Integrated health care systems: the key characteristics. AB - Cooperation among the traditionally adversarial factions of physicians and hospitals has arisen in the early 1990s to develop the integrated health care system. Authors Dean C. Coddington, Keith D. Moore and Elizabeth A. Fischer explain how these two groups have been joined in the integration by an unlikely participant: health plans. PMID- 10130112 TI - How Clinton health plan would modify CLIA regs. PMID- 10130111 TI - Fallon health care systems: the role of social services in managing the care of the elderly. PMID- 10130113 TI - Preparing for the lab of the 21st century. PMID- 10130114 TI - Optical disk archiving: the coming revolution in data management. PMID- 10130115 TI - Using a call-processing system to increase productivity. PMID- 10130116 TI - Improving specimen collection by making a training video. PMID- 10130117 TI - In pursuit of used equipment. PMID- 10130119 TI - Hospitals whose merger failed now seeking new affiliations. PMID- 10130118 TI - Getting the most out of your old LIS (laboratory information system). AB - In summary, the lack of a large budget for information systems should not prevent laboratories from getting as much as possible from existing systems. Consideration of all possibilities can pay large dividends with little upfront expense. PMID- 10130120 TI - Merck-Medco merger boosts druggists' anger about pricing levels. PMID- 10130121 TI - 3 states may ally to face reform. PMID- 10130122 TI - Triad in default on bonds. PMID- 10130123 TI - Document envisions large national board. PMID- 10130124 TI - Budget-cutting bill killed, but issue far from dead. PMID- 10130125 TI - EDI group issues savings report. PMID- 10130126 TI - Work group makes Fla. data recommendations. PMID- 10130127 TI - Advisory panel makes GME recommendations. PMID- 10130128 TI - Santa Rosa disputes profit figures contained in article. PMID- 10130129 TI - Groups fight to clarify consumers' bills. PMID- 10130130 TI - Hospital profits rise to 6.2%--AHA report. PMID- 10130131 TI - Drug industry officials receive warmer welcome. PMID- 10130132 TI - Diagnostic imaging targeted for change. Common practices challenged; field eyed for cost cutting, capitation. PMID- 10130133 TI - IRS may get intermediate sanctions. PMID- 10130134 TI - IRS probes universities with hospitals. PMID- 10130136 TI - Physician-hospital groups to be studied. PMID- 10130135 TI - Hospitals slowing purchases of MRIs--survey. PMID- 10130137 TI - New methods to increase payments, cut paperwork could be in the cards. PMID- 10130138 TI - Look north for primary-care docs. PMID- 10130139 TI - Growth in managed care pressures other sectors. PMID- 10130140 TI - Savings cited in OrNda, AHM deal. PMID- 10130141 TI - New Columbia/HCA headquarters choice could hinge on one hospital. PMID- 10130142 TI - NME touts new worker ethics program. PMID- 10130143 TI - Twice as many execs foresee declines in capital expenditures. PMID- 10130144 TI - Vendors promote retooled PACS. PMID- 10130145 TI - Ruling may prevent self-insured plans from denying coverage. PMID- 10130146 TI - Mayo, Deere join forces to spread plan to Des Moines. PMID- 10130147 TI - Hospital profits jump 18% in '92. PMID- 10130148 TI - Summit Health joins OrNda, AHM in 48-hospital merger agreement. PMID- 10130149 TI - Universal leans on 2 stellar performers. PMID- 10130150 TI - Osteopathic hospital group changes name. PMID- 10130151 TI - Study contends reform plan would hurt urbans more. PMID- 10130152 TI - Ads use not-for-profit's exemption as leverage for sale. PMID- 10130154 TI - Intermediary process seen to be at risk. PMID- 10130153 TI - Hospitals see expense growth slowing. PMID- 10130155 TI - Key to reforming healthcare lies in keeping everyone in the system fully accountable. PMID- 10130156 TI - Mergers. Two-hospital towns try togetherness. Healthcare reform has competitors turning to collaboration, consolidation. PMID- 10130157 TI - Justice Dept. queries Iowa hospital merger. PMID- 10130158 TI - President's plan gets high marks from seniors, consumer groups. PMID- 10130159 TI - Hospitals achieve first rate service. Medical University of South Carolina Medical Center, Charleston; Flower Hospital, Sylvania; Community Medical Center, Toms River. PMID- 10130160 TI - Patient satisfaction data a valuable tool for most hospital execs--survey. PMID- 10130161 TI - Steps toward standardization raise questions about priorities. PMID- 10130162 TI - Not-for-profits may try REIT for financing. PMID- 10130163 TI - NME lays off 34 managers, closes psych division offices. PMID- 10130164 TI - 3 home infusion companies announce plans to merge. PMID- 10130165 TI - Court's action may lead to more suits by hospitals. PMID- 10130166 TI - Primary-care docs not a large part of most PHOs--study. PMID- 10130167 TI - Digital house calls. How to get medical advice via computer. PMID- 10130168 TI - Perspectives. The AMA: not going gently into a new day. PMID- 10130169 TI - An initial step toward Medicare administrative simplification. PMID- 10130170 TI - Outcomes, benchmarking and TQM. PMID- 10130171 TI - Health care reform--focus on the Hill. AB - The U.S. Congress is considering six major health care reform alternatives. Here is a close look at the plans and what their authors are saying about them. PMID- 10130172 TI - The Clinton health proposal: as details emerge, legal issues surface. PMID- 10130173 TI - Antitrust--pre-merger compliance. AB - On September 15, the U.S. Department of Justice and the Federal Trade Commission issued joint antitrust guidelines to enhance health care industry understanding of antitrust enforcement policy in six topic areas. The guidelines represent a statement of federal antitrust enforcement policy. The guidelines do not change existing law and are not binding on private antitrust litigants or the courts. According to the guidelines, the agencies will not challenge a merger between two general acute-care hospitals where one of the hospitals (1) has an average of fewer than 100 licensed beds over the three most recent years, (2) has an average daily inpatient census of fewer than 40 patients over the three most recent years and (3) is more than five years old. With regard to hospital mergers that fall outside of the safety zone, traditional antitrust merger analysis will apply. PMID- 10130174 TI - Campaigning or governing? PMID- 10130175 TI - Medicaid and national health reform. PMID- 10130176 TI - 1993 health care reforms at the state level: an update. AB - Health care system reform was one of the foremost political issues throughout 1993. While the Clinton Administration developed and proposed a national reform plan, many states enacted laws that call for altering the way in which health care is delivered to their residents. The following article examines health care reform legislation that was enacted at the state level in 1993. It focuses on managed competition plans, plans that seek to expand access to health insurance or to control health care expenditures, and plans that are aimed at reforming Medicaid and other state programs. Because so many states considered or enacted some type of health care reform legislation in 1993, this article provides an overview of the more significant reforms that became law, but it is not intended to serve as a comprehensive review of all state-level health care reforms. PMID- 10130177 TI - Special report: health reform proposals introduced: ACS testifies. PMID- 10130178 TI - Surgical flow sheets: improving practice efficiency. PMID- 10130179 TI - Health Information Management Association of Australia. Submission to Casemix Implementation Project Board February 1993. PMID- 10130180 TI - Severity of illness: how do we measure it and how does it relate to casemix? AB - Severity of illness (S.O.I.) systems have traditionally been a useful clinical tool for measuring the physical effects of disease on the patient, planning treatment and predicting outcomes. However, they are now becoming a useful management tool to help explain and justify above average treatment costs within casemix classes and are of particular value for large tertiary referral hospitals which tend to treat more severely ill patients. There are three different categories of S.O.I. and several different systems and approaches for measuring it. All have their uses as analytical tools for categorising patients so as to maximise the homogeneity within casemix classes and make any Output or Casemix based Funding System based on such classes more equitable. PMID- 10130181 TI - Financial issues in health. Part 1. Medicare Mark III. PMID- 10130182 TI - HIMAA workforce survey 1991/1992. AB - In 1991, and again in 1992, the Health Information Management Association of Australia (HIMAA), formerly Medical Record Association of Australia (MRAA), distributed a Workforce Survey to all members to collect information about the demographic, professional and employment characteristics of HIMAA members. There was a response rate 66.8% in 1991 and 40% in 1992, which rise to 80.9% in 1991 and 51.7% in 1992 for responses from full members. The collection will continue on an annual basis, providing a cumulative database and the opportunity for trend analysis. PMID- 10130183 TI - One MRA's (medical record administrator) experience of converting alphabetical filing to terminal digit filing. PMID- 10130184 TI - Pick a method, any method--quality activities and casemix funding. PMID- 10130185 TI - Parker Hannifin's health benefits program: self-management. PMID- 10130186 TI - Pacific Bell's evolution to managed care. PMID- 10130187 TI - Options for small employers. AB - Although offering health benefits is very expensive, many employers (small, medium, and large) make health care purchasing decisions based on very little information. This is largely because employers have not taken the time to learn how to be knowledgeable health care purchasers. Higher health care costs result when employers: purchase programs and services that employees and their dependents do not need and seldom use; pay (unknowingly) for services not offered in their benefit plan; accept and pay for ineffective cost containment programs that increase (not decrease) health care costs (remember that cost containment is a business in itself); make standard recommended changes (e.g., increased copays or deductibles) to their benefit plans, hoping to reduce costs (the result has been higher costs for too many employees); fail to assess whether health plans and insurance companies have effective internal quality and cost management programs; use financial incentives to encourage employees and dependents to enroll in managed care plans without examining whether the health plan or insurer used quality criteria, high standards, and capable processes in developing provider networks. (Capable processes consistently deliver quality products or services.) Most health plans and insurance companies have chosen providers based on their willingness to discount their charges, which places all parties (health plans or insurance companies, employers, and patients) at risk. Most of the problems listed above could be avoided if small employers based their health care purchasing decisions on information obtained from a careful analysis of needs and expectations.(ABSTRACT TRUNCATED AT 250 WORDS) PMID- 10130188 TI - Product specification: the fifth discipline of health care. AB - In any given year, less than 50 percent of the total eligible population takes advantage of illness benefits. This certainly raises the issue of undercare. By specifying the periodic examination schedule for screening and preventive care, the product specification approach to quality medicine can preclude underservice of the beneficiaries. In addition, protocols and practice guidelines for care should lead to increased quality of care and better treatment outcomes. Elimination of the need for inspection will have a significant effect on the excessive administrative costs in the system, and the electronic medical record will eliminate duplication, provide for electronic fund transfer, and minimize administrative costs. Improved quality and lower costs will probably result from integrating the fifth discipline of product specification into health management. PMID- 10130189 TI - The Magic Kingdom of managed care and managed competition. PMID- 10130190 TI - The challenge of documenting managed care cost savings and performance. AB - It is not too late for managed care to turn this situation around because the debate over health care reform and managing change is ongoing. It remains to be seen whether managed care companies will support independent third parties (i.e., researchers) in analyzing proprietary data and making value judgments about their effectiveness. There is a perception among managed care organizations that potentially negative findings could damage them in the marketplace. Nonetheless, smart organizations use negative findings as new opportunity targets for service improvement and product refinement. To what extent will managed care companies voluntarily release accurate data on performance factors in order for researchers to conduct cross-company analyses? Perhaps competitive markets such as managed care are not consistent with voluntary data sharing. On the other hand, mandatory reporting will not ensure data accuracy either. It is up to the managed care industry itself to develop a cooperative approach to data collection, analysis, and dissemination. PMID- 10130192 TI - Managed care and cost savings. PMID- 10130191 TI - The impact of managed care on costs and health spending. PMID- 10130193 TI - Managed care: costs, evidence, and interpretation. PMID- 10130194 TI - Can health care reform rely on managed care? PMID- 10130195 TI - A new approach to managed care. PMID- 10130196 TI - The managed care solution: let the patients decide. PMID- 10130197 TI - Managed competition in Minnesota. AB - The state of Minnesota Employee Group Insurance Program is one of the longest operating examples of the managed competition approach to health insurance purchasing. The program, now in its fifth year of managed competition, has achieved many of the outcomes projected by managed competition theorists, including significant savings in health care costs and expansion of managed care in rural areas. The program's experience may offer insights into the potential success of managed competition in other settings. PMID- 10130198 TI - The impact of managed competition on national health expenditures. PMID- 10130199 TI - Creating the market under managed competition: getting there will not be half the fun. AB - To develop a framework for managed competition, implementers of health care reform will need to encourage the development of a large number of new AHPs. If experience with the rapid growth in HMOs that occurred in the late 1980s can serve as a guide, it would be expected that many new IPAs will form and that their development will occur at different rates in different communities, depending in part on the supply of medical resources and population demographics. There is evidence from past studies that new IPA entrants can stimulate the price competition desired by health care reformers. Lower bid prices were submitted by plans in the AHCCCS program in markets where new IPAs were competitors. IPAs also can fail, however, particularly at low enrollment levels. Implementers need to be concerned about the political and operational consequences of AHP failures during the early stages of health reform. If managed competition is to contain costs, implementers will need to develop effective policies to stimulate AHP entry, to oversee the performance of new AHPs during initial periods of low enrollment, and to protect consumers from any adverse consequences of AHP failures. It is possible that a large number of failures could occur among newly formed AHPs and that such failures could undermine the confidence of the public in managed competition. This would probably lead to calls for the replacement of managed competition with a more centrally managed and closely regulated health care system. PMID- 10130200 TI - VIP interview: Stuart H. Altman, Ph.D. PMID- 10130201 TI - Civilian Health and Medical Program of the Uniformed Services (CHAMPUS); specialized treatment services; nonavailability statements; peer review organization program; supplemental care--DoD. Final rule. AB - This final rule: establishes a Specialized Treatment Services Program, under which CHAMPUS beneficiaries in need of certain highly specialized medical care will be referred to specially designated national or regional, military or civilian treatment facilities; revises a number of procedures applicable to the CHAMPUS Peer Review Organization program; and expands reliance on CHAMPUS payment rules and procedures for purposes of the supplemental care program, which applies to services provided by civilian providers to active duty members and certain other patients referred by military providers. PMID- 10130202 TI - Medicare program; monthly actuarial rates and monthly supplementary medical insurance premium rates beginning January 1, 1994--HCFA. Notice. AB - As required by section 1839 of the Social Security Act, this notice announces the monthly actuarial rates for aged (age 65 or over) and disabled (under age 65) enrollees in the Medicare Supplementary Medical Insurance (SMI) program for calendar year 1994. It also announces the monthly SMI premium rate to be paid by all enrollees during calendar year 1994. The monthly actuarial rates for 1994 are $61.80 for aged enrollees and $76.10 for disabled enrollees. The monthly SMI premium rate for 1994 is $41.10. PMID- 10130203 TI - Hospice nursing. Daily challenges, daily rewards. AB - What makes a hospice nurse different from other nurses? How is a hospice nurse different from a home care nurse? Frequently described by the public as "angels of mercy," how do American hospice nurses provide care as part of the hospice interdisciplinary team? PMID- 10130204 TI - Volunteer hospice offers unique & special services. AB - Two types of hospices exist: medical and volunteer. Medical hospices are constrained by Medicare regulations. Volunteer hospices fill in the gaps that those regulations leave, providing flexible, supportive care. The community that is served by both medical and volunteer hospice programs offers truly comprehensive care to the dying and their families. PMID- 10130205 TI - Coming of age. Hospice Services of Howard County. AB - From its beginnings 15 years ago as a small, grassroots group of volunteers, Hospice Services of Howard County has grown into a thriving business organization serving clients in one of the fastest growing counties in the state. Having gained Medicare certification this fall, the organization has finally realized its dream of becoming a full-service hospice. PMID- 10130206 TI - We are our brother's keeper. AB - York House Hospice is another hospice started on a small scale and making great accomplishments in hospice care. This author worked for some time as a thanatologist with a hospital. When the hospital closed, the author determined to open a hospice for AIDS patients. York House Hospice is a paradigm of the hard work and spirit of hospice. Here is the story of its beginning. PMID- 10130207 TI - Starting a hospice program--a financial perspective. AB - Questions of handling risk, cost reporting, and allocating resources must be answered before a home care agency can consider itself financially prepared. Careful planning will ensure a successful future. PMID- 10130209 TI - Wayside Hospice--a shared program model. AB - Two home care agencies came together to bring hospice to their local communities. By pooling their resources and personnel under one umbrella program, they were able to expand their service offerings, knowledge, and expertise, yet keep costs down. The result is the personification of the saying, "Caring is sharing." PMID- 10130208 TI - The hospice phenomenon. In its second decade under Medicare. AB - In the decade since the passage of the Medicare Hospice Benefit in 1983, hospice has gained acceptance and status in the community. What lies in store for hospice in its second decade? PMID- 10130210 TI - Caring for hospice patients. In a nursing facility. AB - Hospices across the nation have successfully developed hospice programs to serve residents in nursing facilities. Three major principles have been identified as key to the programs' success: the nursing facility is considered to be the patient's own home, the nursing facility's staff are the patient's extended family, and that same staff are members of the expanded hospice team. PMID- 10130211 TI - Holding their own with pediatric hospice. AB - Hospice is an excellent realm of care for helping pediatric patients and their families through the tragedy of life cut short. The commitment in time and resources is great but, as the experience of one agency has shown, a special program for pediatric hospice care can serve an entire community. PMID- 10130212 TI - Positive aspects of hospice social work. AB - Hospice social workers are important members of the hospice team. They deal with many issues, including logistics such as appointments or drawing up a will, as well as more complex issues such as the recurrent nature of denial. How can workers better understand and deal with their challenges? PMID- 10130213 TI - The road to recovery from grief and bereavement. AB - As much as death is part of the life cycle, so is grief for those who must face it and for those who are left behind. Hospice workers can alleviate sorrow and facilitate healing if they understand the many facets of grief. PMID- 10130214 TI - Keep it clean: environmental audits of home care agencies. AB - Many home care agencies have never considered the environmental impacts of their practice, but as federal and state agencies intensify enforcement of environmental regulations, the home care agencies that do not take heed may find themselves assessed for damages and fined, if not sanctioned. An environmental audit is one way to keep tabs on keeping things clean. PMID- 10130215 TI - A new outlook for rehabilitation: creative art therapy. AB - Each year illness, accidents, and age leave thousands of people homebound and feeling as though their lives are over. Within each person, however, is the seed of creativity that, when nurtured through creative art therapy, can bloom to vastly improve the quality of health and life, regardless of the individual's physical limitations. PMID- 10130216 TI - Healthy from the start. Home care for newborns. AB - With hospital stays for childbirth averaging only 24 to 36 hours, most mothers return home exhausted and with little or no knowledge of potential health problems in their newborns. Two hospital nursery nurses founded a home care agency that provides in-home followup visits and parenting education to decrease the risk of infant illness and smooth the transition from hospital to home. PMID- 10130217 TI - Therapeutic parenting--a program for home care. AB - There is evidence that inadequate parenting in early childhood, combined with socioeconomic risk factors, can contribute to intellectual deficits, character disorders, and antisocial behaviors in children. Early intervention home care services can circumvent these problems. PMID- 10130218 TI - Pediatric HIV infection--a growing challenge for home care. AB - The physical, psychological, and social impact of HIV infection in children places enormous demands and stresses on their families. Home care programs can help coordinate the services for these families. PMID- 10130219 TI - Asthma in children--an interactive home care approach. AB - Asthma is the most common reason for children to require the services of a home care agency. One agency has developed a preventive and interventive pediatric asthma program to standardize the care provided to their pediatric asthma patients. PMID- 10130220 TI - Home apnea monitoring. A systems approach to the family's home care needs. AB - Parents who bring home an infant requiring constant home apnea monitoring often face a stressful situation with their child's medical difficulties and their own financial concerns. The home care nurse must be aware of the difficulties facing these families to offer the necessary support and education. PMID- 10130221 TI - Home care protocols for pediatric tracheostomy patients. AB - Pediatric tracheostomy patients can present a challenge to their families and the nurses who care for them, but careful planning and an eye toward the future turns the challenge into a reward. PMID- 10130222 TI - Pediatric home care--designing unique care for kids. AB - There is a growing need for pediatric home care services but selecting a provider is difficult. Pediatric home care calls for special abilities and qualifications, for numerous reasons. PMID- 10130223 TI - Affair of the heart. Pediatric cardiac homecare. AB - Technology has made it possible for children who are born with heart disease and defects to live. Careful home care coordination has made it possible for these children to live at home. For the families involved, that makes all the difference. PMID- 10130224 TI - New home care choices for children with special needs. AB - Ten years ago, children with complex medical conditions remained hospitalized; five years ago they could choose from hospital or home care. Now families and professionals caring for children with complex conditions have many choices regarding the best setting for their child's care. PMID- 10130225 TI - Medically fragile children. Public schools can accommodate them. AB - One public school system has found a way to integrate medically fragile children into the daily life of school--by calling on the services of a local home care agency. PMID- 10130226 TI - Database tracking for pediatric home infusion outcomes. AB - Until now national data-collection efforts for home infusion therapy have focused on adult patients, but as the number of children and infants who receive home infusion increases, so does the need for tracking their outcomes. Several pediatric home care directors met the challenge by creating the National Pediatric Home Care Database. PMID- 10130227 TI - Pediatric home care & public policy. AB - As children with disabilities and chronic illnesses live longer and benefit from medical and technical advances, their need for pediatric home care increases. This article outlines ways in which advocates of children's health can rally support for home care in the community and with their legislators. PMID- 10130228 TI - Pediatric resources in the United States. AB - Home care practitioners who work with children find themselves in a unique position to offer help and guidance to their patients' parents and families. At times this help may call for the involvement of national organizations that can provide information on the issues concerning both family and home care practitioner. Readers may wish to share these resources with their clients. PMID- 10130229 TI - Memory books: helping children cope with loss. AB - Children who have a parent or significant family member who is ill or dying or who has died handle their grief in different ways. Memory books have helped keep children mentally healthier and kept them at home rather than being hospitalized for the behaviors by which they express their grief. PMID- 10130230 TI - Taking the work out of paperwork in parent-child health. AB - Paperwork is a fact of life. That doesn't mean that completing it has to be a long, arduous process. The system described in this article offers ease of use and frees up nurses' time for the art of caring. PMID- 10130231 TI - Managing risk--a priority in the Health Service. PMID- 10130232 TI - High anxiety. PMID- 10130233 TI - Women in management. A woman's ceiling: a man's floor. PMID- 10130234 TI - Out of Africa. PMID- 10130235 TI - Agency for Health Care Policy and Research: improving health care through guidelines and outcomes research. AB - The Agency for Health Care Policy and Research (AHCPR), a part of the Public Health Service, was set up to fund and conduct research on the effectiveness and appropriateness of health care, facilitate development of clinical practice guidelines, assess health care technology, and undertake widespread dissemination of research findings and clinical guidelines. In this exclusive interview with Hospital Formulary, AHCPR Administrator J. Jarrett Clinton discusses how the Agency carries out its research responsibilities and describes how clinical practice guidelines are developed. PMID- 10130236 TI - Clinton's breakthrough drug committee: will it stifle new drug development? PMID- 10130237 TI - Trends in cardiac care: contractions, concentration, collaboration. AB - Cardiovascular services is entering an age of contraction and concentration. The number of programs and the growth in inpatient procedures have topped out and the presence of significant excess capacity has become apparent. During the next five years, there will be heightened pressures to simultaneously decrease the overall number of cardiac procedures performed and, on the part of individual providers, increase procedure volume in order to achieve economies of scale and high levels of quality. It is likely that the number of health care organizations with OHS programs and PTCA may be cut to 500 by the year 2000, significantly influencing the redistribution of cardiac services along regional lines. The public, government, and private payers have embarked on a quest for value; and in the future they will only purchase services from providers demonstrating high-quality outcomes and average, or below average, charges. HCFA's Cooperative Cardiovascular Project is typical of the direct continuous quality improvement and management initiatives that will be implemented to monitor appropriateness, outcome quality, and resource utilization through the application of clinical practice guidelines (CPGs) and data on the treatment of AMI, PTCA, and CABG surgery. A more indirect, managed care approach by purchasers to obtaining higher value can be seen in the Medicare Participating Heart Bypass Center Demonstration project, the federal government's first big step into selective specialty care contracting for clinical service on a package price basis. Several different types of private initiatives have been used to achieve wider distribution of service while maintaining high program volumes and high-quality care through collaboration and the formation of interhospital linkages. Although some of these have included collaborative programs to encourage voluntary community-based planning and discourage the duplication of services, the payers demand for value (cost/quality) and the organizational leverage of the regional health alliances will accelerate the process and spur the formation of a smaller number of high volume invasive programs. Large invasive programs will continue to formalize interhospital linkages to provide an integrated set of services in a layered system of cardiac care.(ABSTRACT TRUNCATED AT 400 WORDS) PMID- 10130238 TI - The impact of managed care on diagnostic imaging. PMID- 10130239 TI - Linking the delivery of health care to service population needs: the role of the epidemiologist on the health care management team. AB - Historically, in the United States, the practice of most epidemiologists has been oriented toward the public health needs of persons living in communities, and has focused on the determination of rates of disease, risk factors for disease, and evaluating prevention and screening efforts. Continuous profound changes in demographic patterns throughout the world, increases in the rates of many chronic and communicable diseases and disabling conditions, and payer constraints all test the ability of health systems managers to provide quality health care. Over time, managers of health systems will recognize that the most cost-effective strategies will be derived from a population-based perspective. With this viewpoint, the epidemiologist can be a pivotal link in assisting the management team to align the delivery of health care services more effectively with the needs of populations targeted for services, either those residing in communities or those currently receiving services by a system, organization, or an individual provider. This article will describe the increasing role of the epidemiologist in health care organizations and illustrate the functions of the epidemiologist on the health care management team based upon the author's own experience at Rush Presbyterian-St. Luke's Medical Center, an academic health care center in Chicago, Illinois. PMID- 10130240 TI - Applications of epidemiology in the operation and marketing of managed care plans. AB - This article discusses the background and use of epidemiology by managed care plans. The relevance of the outcomes-oriented approach used in epidemiology is explained with regard to operational and marketing decisions. Examples from the research literature are provided that illustrate the types of decisions that can benefit from epidemiologic input. Finally, the implications for health services administration training are discussed. PMID- 10130241 TI - Epidemiologic indicators of health status to guide health care management decision making. AB - Health objectives, developed by the United States Department of Health and Human Services, were published recently in the document entitled Healthy People 2000: National Health Promotion and Disease Prevention Objectives. They were developed to guide national and local health policy toward actions to increase the health of the nation. To effectively apply these objectives locally, epidemiologists and health planners must work together. Through collaboration, the Healthy People 2000 objectives can be prioritized to guide health policy and planning on a regional basis. The purpose of this study was to assess certain health status indicators in southwestern Pennsylvania to determine whether it was likely that the year 2000 targets would be met if trends from the past 20 years were to continue. The following mortality rates were analyzed: heart disease, homicide, breast cancer, colon cancer, lung cancer, suicide, motor vehicle accidents, work related injury, and infant mortality. In addition, incidence of the following diseases was evaluated against the year 2000 targets: gonorrhea, primary and secondary syphilis, measles, tuberculosis, and AIDS. By employing epidemiological principles and considering strategic planning needs, it is possible to prioritize some of the health care needs in local areas for the next decade. PMID- 10130242 TI - Service management: an epidemiological model of health services organization. AB - The New Zealand health system is undergoing a major paradigm shift. Services and programs have largely replaced hospitals and other institutions as the basic organizational framework, with each service having an epidemiologically defined responsibility for the provision of integrated personal and public health services for the population it serves. Primary health care as the infrastructure service is being implemented in some areas. These changes are being reinforced by the National Government's continuing reform process in which population-based and funded regional health authorities are purchasing all health services--primary, secondary, personal, public, acute and continuing--from a capitated and capped budget based on meeting the health needs of their populations. PMID- 10130243 TI - The successful health services management development program. PMID- 10130244 TI - Teaching health care law: an interdisciplinary approach. PMID- 10130245 TI - Teaching health services quality management: a health services research approach. PMID- 10130246 TI - Teaching ethics in health care administration: a course profile. PMID- 10130247 TI - Assessment of the managerial functions in primary health care settings. PMID- 10130248 TI - Managerial epidemiology: the basic science for health reform. PMID- 10130249 TI - We found something much better than an answering service. PMID- 10130250 TI - Office insurance you can--and can't--live without. PMID- 10130251 TI - Can specialists really turn into generalists? PMID- 10130252 TI - This could end the rural doctor shortage. PMID- 10130253 TI - Public clinics where doctors like practicing. PMID- 10130254 TI - Why you should touch your patients. PMID- 10130255 TI - It's getting harder to collect your fees. PMID- 10130256 TI - Medical Care opens finances to SCA. PMID- 10130258 TI - N.J. network to tout primary care. PMID- 10130257 TI - Hawaii mulls statewide alliance. PMID- 10130259 TI - Reform plan seeks state flexibility. PMID- 10130260 TI - AMA backs off on support for employer mandate. PMID- 10130261 TI - FTC OKs Calif. radiology network. PMID- 10130262 TI - National information network launched. PMID- 10130263 TI - Treatment denial payment set. PMID- 10130264 TI - Transitional Hospitals busy with purchases, conversions. PMID- 10130265 TI - Fickling buys rest of Beech Street. PMID- 10130266 TI - Medica, HealthSpan merge to form largest system in Minnesota. PMID- 10130267 TI - Move unites 2 largest hospitals in Mass. PMID- 10130268 TI - Tax law change to raise cost of reform lobbying. PMID- 10130269 TI - Consumers hold key to reform. PMID- 10130270 TI - Subacute care feeds need to diversity. PMID- 10130271 TI - GAO: execs' pay matches responsibility. PMID- 10130273 TI - Managers see information as side-benefit of new products. PMID- 10130272 TI - Study sees pain in payment cuts. PMID- 10130274 TI - Wage rate dispute less than neighborly. PMID- 10130275 TI - AMA report slams practice of using nurses, not doctors, as primary-care providers. PMID- 10130276 TI - Physicians fear changes despite big hikes in '94 scale. PMID- 10130277 TI - Group won't make counter offer for purchase of NME rehab hospitals. PMID- 10130278 TI - Suburban Cleveland hospital merges with University Hospitals. PMID- 10130279 TI - Lessons from the Australian system. AB - International experiences are becoming more relevant as the Clinton Administration searches for answers to America's health care problems. While interest is focused on the Canadian and European experiences, a brief look at far away Australia offers some potentially useful insights. PMID- 10130280 TI - The coming alliance revolution in health care. AB - Like it or not, the health care profession is being "shifted" into a revolutionary new world. The question is not will it change but rather how will it change? Who will determine its fate? What form will these changes take? What are the best alternatives for physicians, institutions, health care workers, insurers, employers, and, most importantly, patients? Some of the changes will come from government mandate, others from market forces. To understand what the future might bring, we should look at both the driving forces behind the changes and how other industries have responded to similar forces. An important consideration for health care professionals will be how, if at all, the concepts of collaboration and cooperation that are inherent in networking and alliances will guide their planning. PMID- 10130281 TI - Building a vertical provider system. AB - There is probably no geographic area in the United States in which the health care environment is more turbulent than that of Southern California. Long before President Clinton's proposals began serious national debate on health care reform, a massive provider-driven realignment of the system was occurring in that region of the country. Multispecialty medical groups have generally led the way and have acquired ever larger managed care populations through merger and acquisition of other groups and practices. Hospitals, hampered by large fixed capital bases, have struggled to reinvent themselves as cost-effective and primary care-friendly environments in order to be attractive to managed care physicians. Almost ignored in this reconfiguration has been the university teaching hospital. This article discusses one attempt to reconcile contractually an integrated, capitated, and managed care-oriented health care system with an academic medical center in a strategic alliance. PMID- 10130282 TI - Health care economics is changing--the law is sure to follow. AB - Law is intimately related to economics. As the economic relationships in a market change, the legal landscape evolves accordingly. Even if no health care reform is enacted at the federal level, ever-increasing portions of today's managed indemnity sector will convert to plans constraining enrollee choice and seeking to deliver cost-effective care through risk-sharing relationships (both corporate and contractual) with providers. This is inevitable, given employer and federal government pricing demands, and it is changing the face of health care law. If federal reform is enacted and/or the systems adopted in Minnesota, Maryland, Washington, and Florida (to name a few) are replicated elsewhere, the legal concerns of physicians and other providers will shift even more dramatically. In this article, some of the legal fall-out from these economic developments is discussed. PMID- 10130283 TI - Quality improvement in the era of health reform. AB - More and more scrutiny is certain for the health care field. The intense interest in medical quality management that has been a factor in the field for many years is certain to increase under any reform that the system undergoes. This is a unique opportunity for physician executives to play a leading role in the future course of health care delivery. The alternative of their involvement will be almost total control of the issue by regulators. PMID- 10130284 TI - Elements of the American Health Security Act of 1993. AB - Over the past several decades, there has been a plethora of proposals that were developed in response to the ongoing debate on how best to solve the problems of the American health care delivery system. In the past decade, calls for modification of our health system have become even more resonant, as measures to control rising costs were unsuccessful and access to basic services was diminished for many Americans. The most recent addition to the list of proposals for modifying the health care system is the American Health Security Act of 1993, introduced by President Clinton in September 1993. This article will examine the position of the Clinton Administration on health reform and the core elements of the reform package. PMID- 10130285 TI - What's ahead on quality: the managed care perspective. AB - Without question, the most important processes occurring in managed care that can be expected to affect quality are accreditation and the effort to obtain and compare uniform information on quality of care across health care organizations, in short, to create "report cards." For both processes, 1993 was an extremely productive year, and 1994 promises to be even more so. These two processes fit hand-in-glove--one is designed to determine that managed care organizations are equipped to serve the public and to implement better health care programs, while the other is designed to help them understand and improve their own performance. Although, in the short run, managed care organizations may view both these efforts as additional costs, in the long run, both should lead to a better industry and to better care for the public. PMID- 10130286 TI - Quality management in ambulatory care: the future is now. AB - Ambulatory care has always been a stepchild. Hospitals have been and are the focal point of quality activity. Traditionally driven by Joint Commission decree and more recently inspired by market forces, hospitals find the resources to do quality. It was quality assurance in the '80s. It is quality management in the '90s. Some of this activity has oozed out into ambulatory care, but not much. We in ambulatory care have been too busy producing as many patient visits as possible in an environment of limited resources. All that is now changing. As ambulatory care becomes more and more important in the overall health care delivery scheme, medical quality management in this environment will also take on greater significance. Leading the way will be the electronic medical record. PMID- 10130287 TI - The marriage of medicine and computers. AB - Although computers, in one form or another have been around for several decades, they have only recently acquired the power, the simplicity of operation, and the cost-effectiveness to make their widespread application in health care a reality. But a reality it is, and no manager can be successful without a working understanding of how computers and information technology mesh with the information needs of health care delivery. Computer literacy is no longer a nice add-on--it is a basic weapon in every health care professional's armamentarium. PMID- 10130288 TI - Changes in the practice of medicine. AB - In constructing this report, the author interviewed physicians to ask them how the practice of medicine has changed and what changes bother them most. She also talked to physician executives to find out how they were managing an increasingly disgruntled group of doctors. Four changes in the professional environment that physicians face dominated these conversations--lowered income, loss of control, the threat of litigation, and greatly increased paperwork. This article is a summary of comments in these four areas. PMID- 10130289 TI - Recognizing the power of diversity. AB - "The trouble with the future is that it usually arrives before we are ready for it." While Arnold H. Glasgow did not have diversity in mind when he made this statement, his thought is relevant to that topic nevertheless. In fact, almost everything in the health care environment of the 1990s is fluid, making the future a question mark. Among these changes is the demographic composition of students entering medical school and of patients. Consider the following. While 14 percent of today's physicians are people of color, that number increases to 25 percent for current medical students. In the past 10 years, the number of female physicians has seen the largest percentage growth, followed by American Indians, Blacks, and Hispanics. Physician executives who have vision and energy can capitalize on this demographic revolution and convert diversity into a competitive advantage once its boundaries are understood. PMID- 10130290 TI - Managing diversity in the workplace. AB - Recognizing and dealing with cultural diversity has become a critical issue in health care because of the growing numbers of women, minorities and foreign-born physicians and patients. To avoid a culture clash, physician executives have become more aware of the differences and are working to find ways to help the staff interact more effectively with each other and with patients. PMID- 10130291 TI - Ethics in the management of health care organizations. AB - This article introduces the topic of ethics in the management of health care institutions and provides a glimpse at how issues of ethics have grown in recent years and are apt to be applied in the future. Ethics and some of its basic conceptual and practical tools are defined. A brief history of the ethics of managing health care institutions, a crucial context for understanding the contemporary ethics of health care institutions, is provided. What has changed in the past 10 years and how those changes have resulted in the ethical heterogeneity of contemporary health care institutions is discussed. Finally, some preventive ethics strategies for the management of health care institutions are suggested. PMID- 10130292 TI - Altering specialty balances. AB - In an on again, off again pattern, the numbers and distribution of physicians have been of policy concern since the passage of Medicare and Medicaid in the '60s. After a hiatus in the '80s, these issues are a significant part of the current health reform agenda, appearing in one form or another in many of the proposals already offered. If the solutions found this time are to have lasting effects, however, it is critical that the issues are carefully shaped and that those making policy are certain that agreement has been achieved on the basic terms that characterize the issues. This column is jointly edited by Keven M. Fickenscher, MD, Chair, and David A. Kindig, of the College's Forum on National Health Policy. PMID- 10130293 TI - Medical care in the United States--an update. PMID- 10130294 TI - Clinton's reform plan: an Rx for change. PMID- 10130295 TI - Elizabeth Shire's helping hands. Interview by Jill L. Sherer. PMID- 10130296 TI - A not-so-retiring physician. Interview by Jim Montague. PMID- 10130297 TI - Reform and the invisible poor. PMID- 10130298 TI - Board backs community benefit study in Connecticut. PMID- 10130299 TI - Consumers will have the last word on health care reform. PMID- 10130300 TI - Rural elders living alone have poor health profile. PMID- 10130301 TI - Trends and tactics for the 1990s. PMID- 10130302 TI - 2013: the hospital is not a place. PMID- 10130303 TI - The AHA's new chairman-elect Gail Warden. PMID- 10130304 TI - Pharmacist reimbursement and healthcare reform. PMID- 10130305 TI - Innovative nuclear pharmacy service. A comprehensive management plan for clinical investigations. AB - OBJECTIVE: To provide an overview of the investigational nuclear pharmacy service at the Medical University of South Carolina. DATA SOURCES: References were selected from published bibliographies of nuclear pharmacy and hospital pharmacy articles and from specific-topic searches of the MEDLINE computerized database (all languages, through 1992). STUDY SELECTION: Studies of clinical pharmacy functions that were considered relevant to the specialty practice of nuclear pharmacy were chosen. DATA EXTRACTION: Studies were reviewed for internal consistency and appropriateness. DATA SYNTHESIS: Data on the clinical impact of nuclear pharmacy services do not exist. CONCLUSIONS: Based on our experience in establishing an investigational drug service, we conclude that nuclear pharmacists should take an active role in clinical investigations. The outcomes of this kind of involvement are very rewarding. PMID- 10130306 TI - The Medicare hospice benefit: the effectiveness of price incentives in health care policy. AB - This article examines the implications of fixed-price reimbursement of providers for access to hospice care by Medicare beneficiaries. Hospices that are offered higher reimbursement rates by Medicare are found to be more likely to become certified to provide care under the Medicare Hospice Benefit program. Each $1.00 increase in the daily routine home care rate raises the probability of certification by 1.7%. In turn, the Hospice Benefit increases access to hospice care by enabling Medicare-certified facilities to serve more patients than they would if they were noncertified. However, care must be taken to set reimbursement rates appropriately. Failure to correctly adjust reimbursement rates for the real costs of certification across different parts of the country leads to disparities in hospice certification and differential access to hospice care for Medicare beneficiaries. PMID- 10130307 TI - A disposal of clinical waste--alternative strategies. PMID- 10130308 TI - The incineration technology available. PMID- 10130309 TI - Design and construction of the Hammersmith Hospital energy centre. PMID- 10130310 TI - Admitting in the patient focused care environment: one institution's experience. PMID- 10130311 TI - Trends in long term care. PMID- 10130312 TI - Reduction in length of stay through strategic measurement and implementation of alternate site programs. PMID- 10130313 TI - Who makes the rules? PMID- 10130314 TI - Health reform part of imposing legislative lineup. PMID- 10130315 TI - Career ladders. PMID- 10130316 TI - Integration of clinical & financial systems. PMID- 10130317 TI - The Cleveland Clinic Foundation's reduction in length of stay benchmarking and opportunity days. PMID- 10130318 TI - IRS crackdown: employee vs. independent contractor status for physicians. PMID- 10130319 TI - EMS comes of age. PMID- 10130321 TI - Comparison of major health care reform bills. PMID- 10130320 TI - Health reform: the President's turn. Clinton gives much-awaited address to Congress. PMID- 10130322 TI - HMOs invest in health promotion and learn to target their efforts. PMID- 10130323 TI - A patient-focused approach to measuring the quality of cardiac care. PMID- 10130324 TI - Hospitals and physicians collaborate to improve systems for cardiac care. PMID- 10130325 TI - Improving cardiac care: beyond institutional walls. PMID- 10130326 TI - Contribution of air medical personnel to the airway management of injured patients. AB - INTRODUCTION: Air medical services are being pressured to demonstrate their value. Airway management is the first priority of care when treating injured patients in the prehospital setting. Injured patients with decreased Glasgow Coma Scale (GCS) are candidates for advanced airway procedures and air medical transport. RESEARCH QUESTION: The purpose of this study was to determine the extent of air medical crews' contributions to the airway management of the injured patient in the prehospital setting. METHOD: A study of adult (age > 12 years) injured patients encountered in a field setting, whose GCS on the arrival of the air medical crew was < or = 8, was conducted for 21 months (Feb. 1, 1991 Oct. 31, 1992). RESULTS: During the study period, 174 patients who met the criteria were transported by the air medical crew. All but one received advanced airways including oral tracheal intubation, nasal tracheal intubation or cricothyrotomy. Of those, 68 (39%) of these procedures were completed by ground personnel (ground group), and 105 (61%) were completed by the air medical personnel (air group). The mean GCS for the ground group was 3.69 and for the air group was 4.69. The distributions were significantly different (Wilcoxon Rank Test p = 0.0002). Nineteen percent (13/68) of the patients whose airways were successfully managed by the ground personnel had a GCS of 5 to 8, as did 44% (46/105) of the air group's patients. The groups' patients were not significantly different in age or sex distribution. CONCLUSION: Properly trained air medical personnel positively contribute to the prehospital care of injured patients by establishing definitive airways in patients with higher GCSs. PMID- 10130327 TI - Use of the esophageal stethoscope in pediatric transports. AB - INTRODUCTION: Monitoring cardiac and respiratory function during helicopter transports can be difficult, so the authors devised a study of the esophageal stethoscope for pediatric patients. SETTING: The study was conducted at Pediflite in Tennessee, which transports between 250 to 300 pediatric patients every year. MATERIALS AND METHODS: A disposable esophageal stethoscope was used as an adjunct to other monitoring systems in intubated patients. Prior to transport, the stethoscope was placed orally by the respiratory therapist and advanced to the point where heart sounds are heard best, at which point breath sounds can also be heard clearly. The device's ear piece easily fit under the crew member's headphones, which block helicopter noise. Three sizes of stethoscope are available: a 6 French for patients 1 day to 4 years old, a 9 French for those 4 to 12 years old, and an 18 French for patients 12 years of age or older. RESULTS: The esophageal stethoscope was used in 55 patients ranging in age from newborn to 18 years. Eighteen of 55 (33%) had multiple trauma or closed head injury, and 14 of 55 (25%) suffered respiratory failure. The esophageal stethoscope proved to be easy to place, had a low risk of complications and allowed continuous access to breath sounds. In addition, the ability to hear heart tones was minimally affected by noise or vibration. CONCLUSION: Due to its ability to continuously monitor breath sounds, endotracheal tube obstruction or displacement can be rapidly detected by the esophageal stethoscope. Also, if there is failure of the cardiopulmonary monitor, heart sounds can be continuously monitored. The esophageal stethoscope is a simple but potentially valuable tool in pediatric and neonatal transports for monitoring respiratory and cardiac status. PMID- 10130328 TI - Air medical transport: what the family wants to know. AB - INTRODUCTION: The needs of family members of intensive care unit patients are well-documented, but there is little published about the specific needs of family members of air medical patients. PURPOSE: This study was devised to identify family member's information needs regarding air medical transport. METHODS: Using a descriptive correlational design, 100 family members of air medical patients completed a 14-item Likert-format questionnaire. Each item addressed an information need and asked how important the information was to the family member and how much of this information they received. RESULTS: The information needs most frequently ranked as very important related to the patient's condition, the patient's admitting unit at the receiving hospital, and being able to see the patient prior to flight. Information most frequently received by the family related to the patient's condition. CONCLUSION: Flight crews need to be cognizant of families' needs and develop ways to improve communication with the family to meet those needs. PMID- 10130329 TI - 1993 communications survey. PMID- 10130330 TI - Supply-side and demand-side cost sharing in health care. PMID- 10130331 TI - Can health insurers survive? PMID- 10130332 TI - The ultimate model for integrated healthcare? PMID- 10130333 TI - Quality management. The blind man and the elephant. PMID- 10130334 TI - 150,000 and counting: the implementation of a computer-assisted retrieval microfilm system. PMID- 10130335 TI - Ethics, DRGs and medical record administrators. AB - Medical record administrators in the United States have documented a range of ethical problems which they have experienced as a result of the advent of DRGs. This paper considers the similarities and differences between the Australian and United States experience of DRGs, and the implications of these for Australian medical record administrators. Some ethical problems are described, and it is argued that these problems relate particularly to power imbalances between medical record administrators and other health professions. PMID- 10130336 TI - The development of clinical information systems (casemix) in Hong Kong public hospitals. PMID- 10130337 TI - The evolution of organisational structures--one hospital department's experience. PMID- 10130338 TI - Financial issues in health care, Pt II. The New Zealand health reforms. PMID- 10130339 TI - Optical imaging systems--the future of medical record storage. AB - This paper explains the processes which were undertaken to solve the problem of lack of storage for medical records at Logan Hospital. The paper contains analysis of why optical disk proved to be the most appropriate storage medium, and the system components of an Optical Disk System. A detailed description of how the Optical Imaging System has been structured and the processes which make the Optical Disk System a major part of the hospital's Health Information System is provided. The paper also discusses the much talked about legal side of optical imaging. Lastly the paper explains the future plans of Logan Hospital's Medical Record Storage System. PMID- 10130340 TI - Information technology and health information management. PMID- 10130341 TI - Improving health care with computerised records. AB - University researchers have begun a $400,000 computer-based project which could revolutionise the way Australian GPs keep patient records and in the long term improve patient care and health planning. PMID- 10130342 TI - Cost-cutting ideas: prescription drugs. PMID- 10130343 TI - Monitoring program reduces workers' compensation costs. AB - A computer-based monitoring program combined with medical consultation effectively controlled workers' compensation costs in the Phoenix area and, as a result, is being expanded statewide. PMID- 10130344 TI - Specialty PPO helps a hospital "think like a business". AB - Borgess Medical Center's application of "clinical pathing" has enabled the institution to take a business approach to its operating procedures that has proven highly effective in achieving cost savings and improving delivery of services. PMID- 10130345 TI - Can managed-care concepts work for Medicaid? AB - Can managed care be used to control rising health costs in the Medicaid market? The answer involves key legal issues, including eligibility and benefits standards, safe-harbor rules, and antitrust considerations. PMID- 10130346 TI - Expanding formulary and drug-use review programs. AB - Enlisting the support and participation of physicians is vital if formulary and drug-use review programs are to achieve their full potential for cost savings and quality improvement. PMID- 10130347 TI - Federal official discusses reform. Interview by Debra Mamorsky. AB - The administrator of the Health Care Financing Administration discusses managed competition, the cost concerns of small and large employers under such a program, and what benefits managers must do in response to health care reform. PMID- 10130348 TI - Role model: a company plan to contain costs. AB - To contain medical costs, Salomon Brothers is implementing a number of managed care initiatives, coupled with a comprehensive health promotion program for employees and their families. PMID- 10130349 TI - Human resources managers in managed-care organizations. PMID- 10130350 TI - Outpatient plans help treat mental health costs. PMID- 10130351 TI - A guide to ERISA-covered plans. PMID- 10130352 TI - Need for integrated data in pharmacy benefits. PMID- 10130353 TI - How one coalition influences health care policy. PMID- 10130354 TI - Quality prerequisites for providers, purchasers, and payors. PMID- 10130355 TI - Managing quality--the strategy for survival. AB - Everywhere I go today, health care management is saying all the latest words- total quality management, continuous quality improvement, benchmarking, critical pathways--but most are doing the same old stuff. Saying it and doing it are quite different. What has worked in the past will not be good enough for the future. Making the change is not optional, it is the price of admission to the marketplace. PMID- 10130356 TI - Total quality management: rhetoric and reality. AB - TQM in health care today is still more rhetoric than reality. Changing the typical health care organization's culture and installing the infrastructure needed to support TQM will be expensive and time consuming, and will require a new technology of health care quality control that is still developing. TQM will achieve its considerable potential only if management stays the course, invests the time and money--and reins in Ruby and her ilk. PMID- 10130357 TI - Making payors part of total quality management. AB - Providers can begin to work with payors by adopting a commitment to quality, by defining quality as satisfying customer requirements, and by identifying payors as customers. Cooperation is enhanced when dialogue between hospitals and payors is initiated early on in the development of new programs and procedures. This is a necessary step for discussing how to improve reimbursement and service agreements. A working partnership between provider and payor brings both quality and better value to the patient. PMID- 10130358 TI - The quality encounter between purchasers and providers: what to ask and how to answer. AB - It is not easy to lay prejudices aside, to find and face the facts, and to let the chips fall where they may. There is no need to wait for improvements in technology before beginning to use outcomes monitoring to guide the business exchange between purchasers and providers. Although future technological improvements will greatly improve the capacity to use objective data to differentiate among providers and to identify strengths and weaknesses within a health care organization, reasonable methods are available today to undertake these important tasks. All that is needed is the courage and willingness to embrace them. The future belongs to purchaser and provider organizations that are willing to seek enlightenment rather than blame. PMID- 10130359 TI - Practical strategies for implementing continuous quality improvement. AB - The strategies for implementing these components will vary for individual health care organizations. It should be apparent that implementation of continuous improvement theories is a complex undertaking which requires a long-term effort to be successful and improve performance. PMID- 10130360 TI - Continuous quality improvement in health care. AB - CQI is most effective when it focuses performance on chronic, critical problems and identifies the "vital few" performance benchmarks. CQI in any health care setting depends on early success, on clear lessons learned, and on the feeling of achievement and "moving forward" that this engenders throughout the organization. If there is a secret formula, it is an initial successful project. PMID- 10130361 TI - Two quality improvement teams: strategies and scores. PMID- 10130362 TI - Strategic planning applied to quality in asthma management for children. AB - This strategic plan translates the HCHP vision statement into a working plan for one major clinical condition--asthma in children. It is a working plan for clinicians and managers across specialties and levels. The results of the projects will improve in a measurable way significant clinical practice and outcomes, in keeping with the FY 1993 strategic goals. PMID- 10130363 TI - Education and training: mission through total quality management. AB - Planning for 1994 to 1996 is underway with a focus on innovative, system-wide approaches to clinical and nonclinical quality improvement needs for FHSC's customers. TQM is a pivotal point in the system's future as a health care provider. As part of the TQM process, gaining knowledge and imparting it to employees is, in itself, a continuing journey. PMID- 10130364 TI - VIP interview: Paul M. Ellwood, Jr., M.D. AB - Paul Ellwood, Jr., M.D., is president of Health Outcomes Institute, a nonprofit health policy research organization, and President of the Jackson Hole Group in Teton Village, Wyoming, a health care reform policy think tank. He has been called one of the most important figures in American health care in the last half century. Dr. Ellwood has been a leader in introducing competition into the marketplace through health maintenance organizations (HMOs) and preferred provider organizations (PPOs); encouraging the business coalition movement; developing medical staff-hospital joint venture approaches to integrating health delivery, and installing the Outcomes Management System for payors, patients, and providers. He is now concentrating on working with health care leaders of the Jackson Hole Group to devise and implement The 21st Century American Health System, a comprehensive proposal for health care policy reform in the private and public sectors. Their objective is to ensure universal insurance coverage, managed competition, and health outcomes accountability. PMID- 10130365 TI - Go ahead, bust some chops. PMID- 10130366 TI - Germany's tainted blood. PMID- 10130367 TI - Paying for universal care. PMID- 10130368 TI - Medicare program; self-implementing coverage and payments provisions: 1990 legislation--HCFA. Confirmation of final rule. AB - This document confirms our revisions to Medicare regulations published on August 12, 1992 (57 FR 36006). The revisions conformed the regulations to certain self implementing provisions on coverage of services and payment requirements. The provisions were included under the Omnibus Budget Reconciliation Act of 1990, the Omnibus Budget Reconciliation Act of 1989 and the Medicare Catastrophic Coverage Act of 1983. We also respond to the comments we received on the revisions to the regulations. PMID- 10130369 TI - Medicare program; inpatient hospital deductible and hospital and extended care services coinsurance amounts for 1994--HCFA. Notice. AB - This notice announces the inpatient hospital deductible and the hospital and extended care services coinsurance amounts for services furnished in calendar year 1994 under Medicare's hospital insurance program (Medicare Part A). The Medicare statute specifies the formulae to be used to determine these amounts. The inpatient hospital deductible will be $696. The daily coinsurance amounts will be: (a) $174 for the 61st through 90th days of hospitalization in a benefit period; (b) $348 for lifetime reserve days; and (c) $87 for the 21st through 100th days of extended care services in a skilled nursing facility in a benefit period. PMID- 10130370 TI - Ready for relaunch? PMID- 10130371 TI - Patient advocacy: whistle blowing and other professional activities. 42nd Welch Memorial Lecture. PMID- 10130372 TI - The Canadian National Calibration Reference Centre for In-Vivo Monitoring: thyroid monitoring. Part I: The national inter-comparison programme. AB - This article is the first part of a five-part series covering various aspects of occupational thyroid monitoring. The Canadian National Calibration Reference Centre for In-Vivo Monitoring conducts a thyroid inter-comparison programme that now includes more than 100 facilities. The scope of the programme, begun in 1988, has greatly expanded in the last two years following a considerable effort to locate and inform facilities. This article presents the details of the programme, its results, and the lessons learned. Subsequent articles will discuss sources of errors, methodology, instrumental configuration, and counting geometry optimization. PMID- 10130373 TI - A survey of selected issues involving pharmacy technician training in Canada. AB - A non-random, snowball sampling technique was used to survey eleven Canadian pharmacy technician training programs and thirteen pharmacy regulatory and voluntary bodies on issues surrounding pharmacy technicians. A 100% response rate was achieved in the questionnaires which targeted issues such as nomenclature, certification, accreditation, and education of pharmacy technicians. Survey results indicate that while many provincial pharmacy regulatory boards have addressed issues such as the nomenclature and workplace role of pharmacy technicians, there is a lack of consensus and discussion in the areas of certification, accreditation, and responsibility for continuing education. PMID- 10130374 TI - A concurrent cefuroxime use evaluation in pediatric patients. AB - A concurrent evaluation of cefuroxime use in pediatric patients is described. From March 5, 1991 to May 15, 1991, the use of cefuroxime in pediatric patients was evaluated. The pediatric liaison pharmacist collected clinical information about each patient prescribed cefuroxime and assessed the therapy according to pre-established criteria for use. When therapy did not meet criteria, the pharmacist could intervene by speaking with the prescribing physician. The Coordinator, Drug Use Evaluation (D.U.E.) Program and a pediatrician, reviewed the data collection forms to assess whether therapy met criteria and the outcome of pharmacist-physician interactions. Thirty-five pediatric patients were prescribed cefuroxime during the concurrent evaluation. All courses were empiric. Community-acquired pneumonia accounted for 21 treatment courses in which cefuroxime was prescribed with 18 of these deemed to meet the criteria. It was also prescribed empirically in otitis media (eight cases), meningitis (two cases). Overall, seventy-seven percent of therapeutic courses of cefuroxime were found to meet established criteria for use. The pediatric clinical pharmacist intervened in six therapeutic courses which did not meet criteria. Three of these interventions resulted in a change of therapy for the patient. PMID- 10130375 TI - Computerized integration of pharmacy and laboratory data: a prototype model. PMID- 10130376 TI - MedWatch. On lookout for medical product problems. PMID- 10130377 TI - Patterns and meanings of prayer in hospice caregivers: an exploratory study. AB - An exploratory study was conducted into the role of prayer in the personal and professional lives of caregivers to the dying. Background questionnaires were completed by 78 counselors, doctors, nurses, and volunteers who were associated with hospice programs in Arizona. Semistructured interviews were then conducted with 24 men and women who were selected randomly from the pool of questionnaires. Most of the caregivers described themselves as being very religious. The typical caregiver makes frequent use of prayer as a means of helping her/himself to cope with the stresses and challenges encountered in hospice work. These prayers are most often private, spontaneous, and improvised, rather than reiterations of formalized prayer texts. The caregivers seldom pray with patients and family, or petition God for particular interventions. Essentially, prayer is considered to be a vital but personal way of maintaining the person's own hope, strength, and wisdom. Comparisons are made with a related study of prayer behavior and attitudes conducted with participants at a national conference of the Association for Death Education and Counseling. PMID- 10130378 TI - Bereavement and mourning in pediatric rehabilitation settings. AB - Developmental changes in children's acquisition of death concepts and in their emotional reactions are reviewed. Moderating variables that may affect the nature of grieving processes after parental or sibling death are discussed, including circumstances of the loss, prior experience with death, and the child's cognitive functioning. Pragmatic issues (such as when and how to inform children of parental or sibling death) regarding bereavement and mourning in children with acquired brain injuries are reviewed and illustrated by means of case studies. Special challenges to rehabilitation professionals who must deal with these issues (including the concurrent treatment of secondary losses, cognitive deficits, and organic personality changes) are discussed. PMID- 10130379 TI - Exempt hospitals face expanded obligations to provide charity care. PMID- 10130380 TI - Special report on labor and employment and taxation. Will you pay the taxman now or later? PMID- 10130381 TI - Do health care providers have a duty to retain and preserve foreign objects they remove from patients? PMID- 10130382 TI - Drug usage evaluation: clarithromycin as sequential therapy. AB - A drug usage evaluation (DUE) of the new macrolide antibiotic clarithromycin was conducted at Christ Hospital and Medical Center, an 824-bed community teaching hospital in Oak Lawn, Illinois. The purpose of this DUE was to determine whether clarithromycin was being used as early sequential therapy following other parenteral antimicrobials as recommended by the Pharmacy and Therapeutics Committee. PMID- 10130383 TI - Alternative ways of facilitating nutritional support without a nutrition support team. AB - In the absence of a formal nutritional support team, a group of physicians, pharmacists, dietitians, and nurses at the authors' institution organized to devise alternative ways to facilitate nutritional support. The efforts of this group led to the redesign of the Pharmacy Department's parenteral nutrition order form into a clinical tool for the prescribing physician, and the development of a system for daily patient monitoring by dietitians and pharmacists for patients receiving specialized nutritional products. The delivery of parenteral nutrition was also streamlined to coordinate with the daily patient monitoring. A future goal is to increase three-way communication and teamwork among the physicians, dietitians, and pharmacists. These methods may be practical alternatives to facilitating nutritional support without the benefit of a support team. PMID- 10130384 TI - An approach to preventing methotrexate prescribing errors in rheumatoid arthritis. AB - Methotrexate is an effective treatment for rheumatoid arthritis and is fairly well tolerated by patients when used appropriately. However, errors do occur due to a lack of awareness of the normal dosage range and potentially serious dose related side effects of methotrexate among physicians, pharmacists, and nurses. The approach taken by one hospital to prevent methotrexate prescribing errors includes daily monitoring of methotrexate by a pharmacist, building caution flags in the order loading program of the pharmacy computer system, and educating healthcare professionals to heighten awareness when prescribing, dispensing, and administering methotrexate for rheumatoid arthritis. At the hospital, since the institution of these policies and education of pharmacists, nurses, and physicians, there have been no incidents of methotrexate prescribing errors. PMID- 10130385 TI - A system for documentation of pharmacist interventions with incorporation into performance and quality improvement plans. AB - Budgetary constraints have compelled hospital administrators to take a more discerning look at the role of the pharmacist within the healthcare team. In 1991, financial difficulties and hospital-wide cutbacks at Northern Michigan Hospital resulted in the loss of pharmacy personnel. Consequently, the department has increasingly found it necessary to document the clinical activities of the pharmacists and their potential effect on patient care. To document therapeutic interventions, two forms specific to this activity were developed. These forms allowed evaluation of both the quantity and quality of interventions. The authors realize it is essential for pharmacists to not only maintain, but to continually update their knowledge base to be prepared for the future. A staff development program was developed to help meet the educational needs of the pharmacists. This article describes how therapeutic interventions were integrated into the quality improvement and performance plans to help motivate staff to continually improve their pharmacy practice skills at this institution. PMID- 10130386 TI - How to write effective business letters: scribing information for pharmacists. AB - Pharmacists frequently write letters but lack specific training on how to do it well. This review summarizes strategies for improving business correspondence, emphasizes basic writing guidelines, and offers practical advice for pharmacists. The first steps for effective communication are careful planning and identifying the main message to be conveyed. The purpose for writing should be stated in the opening paragraph of the letter. To ensure a successful outcome, actions needed should be clearly summarized and visually highlighted. The tone of the letter should reflect a reasonable speech pattern, not the cryptic writing found in many scientific papers. The layout of the letter should be inviting, which is readily achievable through judicious use of word processing. Many delivery options are available, such as traditional postal services, express mail, and facsimile transmission. Readers are encouraged to test these basic writing principles and decide for themselves whether these recommendations affect the success of business correspondence. PMID- 10130387 TI - Career planning: what to say when the recruiter calls. AB - Professional recruiters often contact pharmacists about changing jobs. Through their relationship with employers and their knowledge of changing job trends, recruiters can place pharmacists into rewarding, uncommon positions. However, choosing a recruiter is like choosing a doctor or lawyer; you must ask the right questions. Finding a recruiter you enjoy working with is a good first step toward proper career management. PMID- 10130388 TI - JCAHO requirements for IV rooms. PMID- 10130389 TI - The toad at the edge of the world. PMID- 10130390 TI - Technology & the end to entitlement. PMID- 10130391 TI - Rewriting the human prospect. PMID- 10130392 TI - Preventable deaths. PMID- 10130393 TI - Population and health. PMID- 10130394 TI - The power of chaos. Interview by Joe Flower. PMID- 10130395 TI - The architecture of integration. PMID- 10130396 TI - Magic moments--Williamsport Hospital & Medical Center. A profile of the 1993 Commitment to Quality Award winner. PMID- 10130397 TI - Outcomes research necessary for successful health care reform. PMID- 10130398 TI - State hospital cooperation acts: are they sufficient antitrust shelter for hospital collaborations? PMID- 10130399 TI - Recognizing Medicare hospital payments appeal opportunities: falling into the 'GAAP' (generally accepted accounting principles). PMID- 10130400 TI - 'Dynamic compaction' of site's unstable soil allows room to expand. PMID- 10130401 TI - The future ain't what it used to be. AB - Base salaries for all health care managers will rise an average of 4.0 to 4.5 percent from 1993 to 1994--less than in previous years. Why the slowdown? PMID- 10130402 TI - Dry scrubbers help meet air, water requirements. PMID- 10130403 TI - 'Career ladder' improves support staff's success. PMID- 10130404 TI - How to store medical waste when space is tight. PMID- 10130405 TI - Drinking fountains: accessibility, lead remain key concerns. PMID- 10130406 TI - Community health assessment. The first step in community health planning. AB - Hospitals face a paradigm shift: from planning service delivery to population based community health planning. Comprehensive community health planning is a two step process: assessment and action, in that order. Assessment identifies community problems and resources; action follows planning, which determines which of those problems should be addressed with which resources. This paper provides an overview of the community assessment process. The first challenge in launching a community health initiative is to identify and recruit partners drawn from the ranks of prominent community organizations, such as school boards, public health agencies, and elected officials. The best enlistment strategies are those that empower persons outside the hospital to take visible control. Defining the community is the first step in analyzing the community. It is important that everyone involved in the assessment process agree on the definition, which should take in those characteristics that make the community unique, including its social systems, environmental factors, and demographics. The next step in the process is developing a community health profile, a set of key community indicators or measures that will help you set priorities, document successes and failures, and monitor trends. There are a number of models available to consult in developing indicators, whether traditional, medically oriented determinants of health or broader parameters, such as housing and public safety. Criteria for selecting indicators include validity, stability and reliability, and responsiveness. Most indicators will be developed using secondary, or already existing, sources of data, such as census data, Medicare and Medicaid files, police records, and hospital admission and exit records. Conducting the community assessment involves putting together a list of problems to be solved and a list of available resources, both of which can be compiled using the same four-step process of gathering and analyzing data: obtaining community input, identifying problems already being addressed, consulting with professional experts, and analyzing existing data. Demographics are one way of analyzing data; another is using a "community scoreboard" that groups causal factors into four categories: lifestyle, environment, human biology, and health services. Once the community assessment is complete, planning and implementation of programs can begin. At the same time, it is essential to mobilize the community to support your initiative. Again, you must look beyond the hospital walls to build a constituency for change, to community leaders in education, employment, transportation and recreation, housing, and the physical environment, as well as health education and preventive services.(ABSTRACT TRUNCATED AT 400 WORDS) PMID- 10130407 TI - Where more of your income is coming from. PMID- 10130408 TI - Lured by the promise of a new career? Read this first. PMID- 10130409 TI - How the wheels of "justice" nearly destroyed an innocent doctor. PMID- 10130410 TI - My nursing-home patients come to me. PMID- 10130411 TI - Finally: Congress gets serious about promoting primary care. PMID- 10130412 TI - What the new tax law does to your practice. PMID- 10130413 TI - How intrusive can a PPO be? Ask this doctor. PMID- 10130414 TI - From "turfism" to teamwork across lines. PMID- 10130415 TI - Upper Peninsula hospitals: from autonomy to alliance. PMID- 10130416 TI - "But what do you do?". PMID- 10130417 TI - Mercy adds hospital in Des Moines. PMID- 10130418 TI - Primary-care requirement urged for disproportionate-share funds. PMID- 10130419 TI - Stark bill would give IRS broader authority. PMID- 10130420 TI - IHS CEO planning new nursing home company. PMID- 10130421 TI - Provider groups show support for mandate to counter AMA. PMID- 10130422 TI - NME settles with insurance firms for $89.9 million. PMID- 10130423 TI - HealthTrust joins suit to fight for hospital. PMID- 10130424 TI - Proposed guidelines for TB control are too onerous, provider groups tell CDC. PMID- 10130426 TI - Premier Anesthesia cools pact efforts. PMID- 10130425 TI - 40 hospitals, 7,000 physicians teaming up to form New Jersey's largest provider sponsored HMO. PMID- 10130427 TI - Give states help to achieve reform--report. PMID- 10130428 TI - Colo. panel urges state action. PMID- 10130429 TI - Number of hospital mergers slips in '92, expected to rise for '93. PMID- 10130430 TI - VA to reconsider McGaw bid for 5-year pact for IV supplies. PMID- 10130432 TI - 1993 year in review. Call to reform. PMID- 10130431 TI - Scrutinized hospitals tout their case when first lady drops by. PMID- 10130433 TI - Healthcare political contributions up 22%. PMID- 10130434 TI - Hospital revenue to fall--study. PMID- 10130435 TI - Expect compromise, surprises in reform, history's lessons show. PMID- 10130436 TI - Cutting down. Hospitals' labor costs are top target, annual human resources survey shows. PMID- 10130437 TI - Orange County, Calif., docs forge group, become a force. PMID- 10130438 TI - HEDIS (Health Plan Employer Data and Information Set) standards get upgrade. PMID- 10130439 TI - New financial rules likely to increase burden, costs. PMID- 10130440 TI - Union of two Boston hospitals could become case study in consolidation. PMID- 10130441 TI - When baby brings lower back pain. Physical therapy helps pregnant women fight back pain. Rehabilitation Center of Colorado Springs. PMID- 10130442 TI - Marketing by the numbers. Outcome and charge data give three hospitals an edge over their competitors. PMID- 10130443 TI - Getting personal. Small town's letter writing campaign and attention to detail draw doctors. Canby Community Health Services, MN. PMID- 10130444 TI - Data collection effort produces booklet for consumers. Boone Hospital Center, Columbia, MO. PMID- 10130445 TI - Data teach consumers to compare rehab hospitals. Rehabilitation Hospital of Indiana, Indianapolis. PMID- 10130447 TI - How to make the most of black and white. Vassar Brothers Hospital, Poughkeepsie, N Y. PMID- 10130446 TI - Media campaign spurs consumers to ask for data. Mercy Heart Institute of Pittsburgh, PA. PMID- 10130448 TI - Doing more with less. Lake Hospital System, Inc., Painesville, OH. PMID- 10130449 TI - Be wise and immunize. State-wide coalition uses media and direct mail to encourage parents to immunize children. Children's Hospital, Denver, CO. PMID- 10130450 TI - TV gets to the heart of the matter. Show spurs calls for heart test and booklet on shopping for heart care. Milton S. Hershey Medical Center, PA. PMID- 10130451 TI - A wellness weekend. Women give high marks to spa getaway at hotel. Baptist Medical Center of Oklahoma, Oklahoma City. PMID- 10130452 TI - Out with the old. ... system scraps old hospital and boosts census by moving and building new facility. Health Central, Orlando, FL. PMID- 10130453 TI - Developing and empowering quality teams. AB - The authors' radiology department recently found that assorted problems had accumulated over time into a long to-do list. Mr. Keen and Ms. Fegley describe the process they followed to implement continuous quality improvement and develop task force teams to address particular problems. PMID- 10130454 TI - Using quality improvement to manage the installation of capital equipment. AB - The traditional process for capital equipment installation in healthcare settings is often not managed to maximum effectiveness. Cost overruns from unplanned construction or from construction change orders are frequently caused by breakdowns in communications between architects, equipment vendors, building contractors, and managers of healthcare services. Through the use of a continuous quality improvement philosophy, it is possible to redefine the installation process and thereby enable the healthcare facility to streamline the costs of capital acquisition. PMID- 10130455 TI - Cost reduction programs for capital asset management. AB - Mr. Bluemke argues that healthcare institutions should include capital asset management in their CQI/TQM programs to gain the best cost reduction from those programs. He cites a recent survey of hospital executives that asked which of the potential benefits of capital asset management programs would have the most value for their institutions. Mr. Bluemke believes that cost reduction can be better achieved by hospitals finding more efficient ways of doing business than through government intervention. PMID- 10130456 TI - Five-year agreement for equipment acquisition. AB - A three-hospital system in western Canada had decided to replace its old imaging processing equipment but wrestled with the most effective way to purchase it. As Mr. Clark describes in this practical guide to the process, the hospitals combined their buying power, negotiated a long-term agreement and found a supplier committed to total quality management. PMID- 10130457 TI - AHRA survey. Staff utilization: Part III. AB - Part III is the final installment of the 1993 AHRA membership survey on staff utilization and includes results for radiation therapy, nuclear medicine, interventional/angiography and cardiac catheterization. The information includes the volume of procedures and numbers of FTEs in departmental areas and comparisons with results reported from a similar survey of AHRA members conducted in 1989. PMID- 10130458 TI - A bitter financial pill. Hospitals merge to improve their health, but patients may not benefit. PMID- 10130459 TI - A matter of degree: job skills for human service administrators. AB - A small but important literature discusses which degrees and which skills are "best" for human service administrators. This research surveys current human service administrators to determine their views. The MSW administration degree, while seen as useful at the entry and middle levels of management, falls behind both the MBA and the MPA at top levels. Skills considered important are very similar at all levels of management, although managers of nonprofits had higher expectations for skill level in many areas than did managers at government agencies. Implications for schools of social work are discussed. PMID- 10130460 TI - Gender similarities of social work managers. AB - The purpose of this research was to determine if men and women social work administrators can be distinguished from one another by their work behaviors or their attitudes about work priorities. In addition, this prior question is addressed: To what degree is the state of knowledge in social work administration based on research that excludes women managers? Data from two independent samples of directors of hospital social work departments are examined as well as seven years of empirical research published in Administration in Social Work. The authors found that women and men social work managers are quite similar in their use of time and their perceptions of the priority of various organizational goals. Also, they found that the growing empirical research record is based on samples that consistently included women, and generally more than half of the samples are women. After offering an explanation of the findings, the authors propose a research agenda for those interested in social work administration. PMID- 10130461 TI - Implementing new linen programs. AB - Columnist Carl Shusterman contends that managers shouldn't lose hope if their ideas meet with resistance. This shouldn't stop you from making recommendations. PMID- 10130462 TI - Two owners face new facts of life. AB - Two diverse non-profit clients see big changes in the world in which they operate. Can the Philadelphia Zoo maintain its status as one of America's best zoos in the face of leadership changes and a prolonged economic slump within its community? And how will Kaiser Permanente, a health-care giant, meet the challenges of universal "managed" care? PMID- 10130463 TI - 1994 construction outlook: Dodge/Sweet's finds bright spots for 1994. AB - Constrained by the excesses of the previous decade and tepid performance in the general economy, the rebound by construction from its 1990-91 downturn could best be described as subdued and selective. Single-family housing led the way before faltering this year, and only scattered help has come from the industry's other sectors. The big question facing construction at the end of 1993 is whether the current recovery is in danger of stalling or, put differently, does it have the stamina to become more broad-based? PMID- 10130464 TI - Perspectives. Managed health care comes of age. PMID- 10130465 TI - Perspectives. 1993: a year of hope and worry. PMID- 10130466 TI - Eating the elephant one bite at a time. PMID- 10130468 TI - Solving the connectivity issues of merger mania. PMID- 10130467 TI - Communications the way the doctors ordered. PMID- 10130469 TI - Selecting the right integration toolset. PMID- 10130470 TI - Standards for telemedicine: Boon? Or boondoggle? PMID- 10130471 TI - Expert rules enhance scheduling efficiencies. PMID- 10130472 TI - Turning toward data uniformity: how open systems put healthcare in command. AB - Recent programming and design techniques result in the benefits of flexibility in system selection and reduced system cost. Open systems and the use of relational database managers with structured query languages allow the healthcare industry to set standards in database design, content and access, if it chooses. Such standards would facilitate creation of applications that could be interchangeable among vendors because basic functions remain constant. This interchangeability equates to flexibility in selecting specific applications, which then can be based on the best match of features required or desired, instead of compatibility with a vendor's system. The goal of reduced costs can be achieved since interface programs would not have to be written to integrate other vendors' software. PMID- 10130473 TI - Can we talk? A low-cost solution when the answer is "no". PMID- 10130474 TI - Telemedicine: a new paradigm. AB - Technological innovations sometimes compel paradigm shifts. Two decades ago the CT scanner was one such phenomenon: It quickly and absolutely transformed medical practice. A marriage of medicine and telecommunications could engender a similar transformation. The timing surely is favorable, as pressing requirements of healthcare reform coincide with the flowering of telecommunications technologies. PMID- 10130475 TI - Planning for the future with a fiber-based multimedia network. PMID- 10130476 TI - Proactive hospital teleservices. PMID- 10130478 TI - Should reform of the healthcare system include information systems reform? InfoCare asks members of its editorial advisory board. PMID- 10130477 TI - The 10 best networked healthcare facilities in America. PMID- 10130479 TI - Mile-high tech: paramedics & pen computers. PMID- 10130480 TI - A joining of forces. The promise of community health information management systems (CHIMSs). AB - Every time you buy a bag of Frito-Lay corn chips, information regarding your purchase becomes part of a customer database within hours. America's snack food "needs" are analyzed and decisions are made about filling the shelves of every corner convenience store in the nation with exactly the right product. This system has saved the company more than $20 million a year through increased efficiency. But when you buy a diagnostic test to identify a potentially life threatening condition, results can remain unavailable for days. If we can bring computerized efficiencies to marketing corn chips, why aren't we doing it for healthcare? Imagine--managers of community health systems who know their customers' needs so precisely that they "fill the shelves" of local "convenience health stops" with exactly the right services to maximize the health of the customers. As a by-product, they save a few million dollars per year in costs. Managers of other industries use information technology to deliver the right product or service to customers at just the right time, to differentiate their services by adding value, to compete effectively on cost and/or quality. Many members of the healthcare industry, where only 2.6 percent of expenditures go to information systems (compared to 5 percent in manufacturing and 7 percent in banking) and where the basic unit of work--the patient record--is still a manual process, are years behind in their thinking about how information systems can make their business better. PMID- 10130481 TI - Evaluating managed care's special telecommunications needs. AB - Right now, managed care is a vast cosmic soup. But whether its ultimate form is the result of a bureaucratic big bang or a series of small industry explosions, one thing seems clear: telecommunications is the framework upon which managed care will be built. Managed care's primary players--purchasers, providers and payors--have already discovered the unifying power of telecommunications within their respective worlds. However, as the three worlds collide, an entirely new set of special telecommunications needs arises. And most of these needs can be distilled into three basic requirements: bigger networks, faster networks and smarter networks. PMID- 10130482 TI - Designing MIS systems for measuring outcomes: reform's balancing act. PMID- 10130483 TI - American Health Information Management Association. Position Statement. Issue: disclosure of health information. AB - Health information is used for a variety of legitimate purposes, including patient care, quality review, education, research, public health, and legal and financial interests. Regardless of the use or users, patients must be assured that the information they share with healthcare professionals will remain confidential. To protect patients' privacy rights, each healthcare facility must develop policies and procedures for disclosure of health information in accordance with federal and state laws. Careful consideration must be given to any disclosure of health information. Confidential information should be disclosed only as needed for continuing care or upon written authorization by the patient or his legal representative or where such disclosure is authorized by federal or state law, subpoena, or court order. PMID- 10130484 TI - American Health Information Management Association. Position statement. Issue: redisclosure of health information. PMID- 10130485 TI - The Health Information Modernization and Security Act introduced in Congress. PMID- 10130486 TI - Understanding obstetrical coding. PMID- 10130487 TI - Contemporary issues in HIM. Costs of ownership. AB - Cost of ownership includes (among others) initial cost, cost of operation, cost of maintenance, and cost of training. Two important components of initial cost are the cost of design and the cost of manufacturing. In this article, we have looked at how factors other than initial cost affect the total cost of ownership of a product. We also discussed how trade-offs can affect performance and cost. Before making any decision on purchasing a complicated new system, the user needs to evaluate the total cost of ownership to determine which product to buy. Unfortunately, it is not always easy to find all the information needed to make these decisions. PMID- 10130488 TI - The electronic future of health information: strategies for coping with a brave new world. PMID- 10130489 TI - Protecting the confidentiality of peer review information. PMID- 10130490 TI - Confidentiality today: where do you stand? PMID- 10130491 TI - Building respect for confidentiality through education. PMID- 10130492 TI - Confidentiality, professionalism, ethics and the student. PMID- 10130493 TI - (AHIMA) American Health Information Management Association. Medical record uses. PMID- 10130494 TI - American Health Information Management Association. Position Statement. Issue: disclosure of health information relating to adoption. PMID- 10130495 TI - Senate Republican health care reform plan. PMID- 10130496 TI - What every manager needs to know about the Family and Medical Leave Act. PMID- 10130497 TI - Networks shake the world of materials management. PMID- 10130498 TI - Changes run deep in relationships with sales reps. PMID- 10130499 TI - Custom pack program saves jobs, money. PMID- 10130500 TI - Safe Devices II: meeting the Act's tracking portion. PMID- 10130501 TI - Remade beds look new, are cheery--and cut costs. PMID- 10130502 TI - He's the man with the too popular plan. Congressman Jim Cooper. PMID- 10130503 TI - Data watch. HMO vital statistics. PMID- 10130504 TI - Mid-sized employers report single-digit increase in health benefit cost during 1992. PMID- 10130505 TI - What they're saying about the Clinton health reform plan. Panel discussion. PMID- 10130506 TI - Controlling the cost of branded drugs. AB - Formularies are no longer used merely to cut costs. The new emphasis is on providing appropriate pharmaceuticals at the most cost-effective price. PMID- 10130507 TI - For mental health cost problems, see a specialist. AB - Separating mental health care from other benefits helps keep costs down while improving treatment, experts say. PMID- 10130508 TI - Employers fear power of purchasing alliances. PMID- 10130509 TI - The problem with purchasing pools. PMID- 10130510 TI - Why we should foster health promotion. PMID- 10130511 TI - HEDIS 2.0: a precursor to national report cards for health plans. PMID- 10130512 TI - Paying for health care: a national panorama. PMID- 10130513 TI - Data watch. Health reform barometer--what employers think. PMID- 10130514 TI - 3 low-tech solutions to high-cost problems. PMID- 10130515 TI - What's ahead in 1994? PMID- 10130516 TI - Case study: Indian Industries takes aim at employee health risks. PMID- 10130517 TI - Will reform bite into dental coverage? PMID- 10130518 TI - The side effects of health reform. PMID- 10130519 TI - A lesson in influencing an insurer. PMID- 10130521 TI - Reform isn't waiting for Washington. PMID- 10130520 TI - Don't let a court interpret your plan. PMID- 10130522 TI - World class health care. AB - This article summarizes research findings on the roles of management approach and vision, delivery system design, human assets, advanced technology, and performance assessment in generating world class health care organizations. PMID- 10130523 TI - The leader's role in implementing total quality management. AB - Quality experts state that ineffective leadership can hinder and even destroy efforts to implement total quality management (TQM). However, they rarely discuss the specific actions leaders should take in implementing TQM and when leaders should take them. This article discusses a four-phase TQM implementation model that includes specifications for leadership actions at each step. PMID- 10130524 TI - Providing leadership to a decentralized total quality process. AB - Integrating total quality management into the culture of an organization and the daily work of employees requires a decentralized leadership structure that encourages all employees to become involved. This article, based upon the experience of the University of Michigan Hospitals Professional Services Divisional Lead Team, outlines a process for decentralizing the total quality management process. PMID- 10130525 TI - The future is continuous quality improvement. AB - The SSM Health Care System is a Catholic, not-for-profit, multihospital health care system with headquarters in St. Louis, Missouri. Sister Mary Jean Ryan, FSM, the President and Chief Executive Officer, has led the implementation of continuous quality improvement (CQI) throughout the system since 1990. This article presents excerpts from a speech Sister Ryan delivered at the system's annual leadership conference in 1990. Sister Ryan delivered this speech at the conclusion of a retreat where the principles of CQI were introduced to the SSM Health Care System leadership. The editors believe this inspiring speech provides insight into the kind of leadership needed to successfully implement quality management. PMID- 10130526 TI - Toward effective customer-supplier relationships. AB - Baxter Healthcare Corporation, a worldwide supplier to hospitals, has been using the principles of total quality management to improve their products and services as well as reshape relationships with customers. This article enumerates what suppliers and hospitals need in order to make mutually beneficial relationships possible and presents three examples of Baxter's work in this area. PMID- 10130527 TI - Teaching tomorrow's health care leaders. AB - Business school curricula have traditionally emphasized functional skills for people who will work in functional departments and general management skills for people who will organize interdepartmental work. Recently, some business schools have begun to develop programs that teach cross-functional work and team skills to functional specialists. Students educated in such programs will be well prepared to meet the new challenges that health care organizations will face. PMID- 10130528 TI - Tutorial: management and planning tools of TQM. AB - While most leaders recognize the value of good planning, most lack the experience and methods to do it systematically. As a result, group planning efforts are often frustrating, generating plans that are shallow and poorly understood by those who must carry them out. The seven management and planning tools are a set of easy to use, systematic methods from the quality management literature that can help planning teams in the same way that the familiar quality improvement tools like flow charts and histograms aid problem-solving teams. PMID- 10130529 TI - QMHC interview: Alan C. Brewster, M.D.. Interview by Marie E. Sinioris. AB - Information systems for severity-of-illness measurement and case mix adjustment are at the cutting edge of health care quality technology. The rapid rise of these systems in the past decade has paralleled hospital needs for better data on clinical processes and the burgeoning need among health care customers for better data on clinical outcomes and the relative performance of providers. The dual nature of the demand is fueling what promises to be a decade of growth for the developers of severity systems. To get a better handle on the status of these software-based tools, QMHC interviewed Alan C. Brewster, M.D., Vice Chairman and cofounder of MediQual Systems, Inc., and a principal developer of the widely used MedisGroups system. PMID- 10130530 TI - Draft Guidelines for Preventing the Transmission of Tuberculosis in Health-Care Facilities, Second Edition; notice of comment period--CDC, PHS, DHHS. Notice. AB - This notice is a request for comment and review of the draft document entitled Guidelines for Preventing the Transmission of Tuberculosis in Health-Care Facilities, Second Edition prepared by the Centers for Disease Control and Prevention. PMID- 10130531 TI - Civilian Health and Medical Program of the Uniformed Services (CHAMPUS); DRG revised rates--DoD. Correction. PMID- 10130532 TI - Medicare program; granting and withdrawal of deeming authority to national accreditation organizations--HCFA. Final rule. AB - This rule implements section 1865(a) of the Social Security Act, as amended by sections 2345 and 2346 of the Deficit Reduction Act of 1984 and section 6019 of the Omnibus Budget Reconciliation Act of 1989. The amendments expand the types of providers and suppliers of services that we may consider to meet conditions of participation or certification, nursing home requirements, or conditions for coverage by virtue of their accreditation by a national accreditation program; these providers and suppliers are also subject to validation surveys. The rule also extends confidentiality to accreditation surveys, other than home health agency surveys, done by accreditation programs in addition to the Joint Commission on Accreditation of Healthcare Organizations, except that we may disclose survey and related information to the extent that such information relates to an enforcement action we take on the basis of accreditation survey findings. The rule also provides for: the release to, and use by, HCFA of all accreditation surveys and other relevant information even if a provider or supplier is not subject to a validation survey; the removing of deemed status of a facility based on a validation survey, an accreditation survey, or other information related to either; and appeal procedures for denied or withdrawn approval. PMID- 10130533 TI - Uniform administrative requirements for grants and agreements with institutions of higher education, hospitals and other non-profit organizations--OMB. Final revision to OMB circular A-110. AB - Office of Management and Budget (OMB) Circular A-110 provides standards for obtaining consistency and uniformity among Federal agencies in the administration of grants and agreements with institutions of higher education, hospitals, and other non-profit organizations. OMB issued Circular A-110 in 1976 and, except for a minor revision in February 1987, the Circular contains its original provisions. To update the Circular, OMB established an interagency task force to review the Circular. The task force solicited suggestions for changes to the Circular from university groups, non-profit organizations and other interested parties and compared, for consistency, the provisions of similar provisions applied to State and local governments. The revised Circular reflects the results of these efforts. PMID- 10130534 TI - Response to the report on the study of the role and use of support personnel in the rehabilitation disciplines. PMID- 10130535 TI - Occupational therapists chart a course through the health record. AB - The absence of clear and practical guidelines for documenting on the health record often makes charting a disorganized and unsatisfying experience for occupational therapists. Like the health record, the occupational therapy process is structured to reflect a problem solving process that promotes clinical reasoning. The model described in this paper was developed to reflect the occupational therapy process as identified in the Occupational Therapy Guidelines for Client-centred Practice and proposes an additional section on problem naming. It is viewed as an open loop through which the client may move one or more times while learning to cope with change until enough momentum is gathered to move into adaptation. Emphasis is placed on naming and validating each problem with the client, and negotiating responsibilities and expected outcomes. This feedback loop summarizes the steps required to practice occupational therapy from a client centred stance. Occupational therapists who develop competence in using this model, chart in an organized, client-centred, and therefore more satisfying manner. PMID- 10130536 TI - Occupational therapy guidelines for client-centred practice: impact study findings. AB - The Guidelines Impact Study investigated use and usefulness of the guidelines for client-centred practice produced in the 1980's by the Department of National Health and Welfare and the Canadian Association of Occupational Therapists. This paper outlines the study, summarizes findings, and discusses implications for revising and updating the Guidelines. Qualitative interview data from key informants across Canada were incorporated into a quantitative survey of a 5% sample of CAOT members. Data reveal variable use of the Guidelines, with greatest use in acute care and rehabilitation services; and mixed interpretations of the Model of Occupational Performance, particularly 'environment' and 'spiritual component'. Recommendations include: clarification of the purpose and audience of revised Guidelines; national consultation during updating to include diverse forms of practice; and rethinking the Model of Occupational Performance as a dynamic model. Updated Guidelines should include both generic concepts and specific applications for different types of occupational therapy practice. PMID- 10130537 TI - Family-centeredness of the Children's Health Care journal. AB - The extent to which authors of Children's Health Care articles showed increased attention to the elements of family-centered care following the publication of Shelton, Jeppson, and Johnson's (1987) book Family-Centered Care for Children with Special Health Care Needs was examined. A total of 223 parent-oriented and family-oriented articles published during the 1980 to 1991 period were analyzed. The findings showed greater incorporation of family-centered notions into published articles after versus before publication of the Shelton et al. book, although the year in which changes occurred and the magnitude of the changes were quite variable for different elements of care. In cases where increased attention was paid to the elements of care, different subsets of elements were more likely to be attended to by different authors. PMID- 10130538 TI - Health professionals' attitudes toward parent participation in hospitalized children's care. AB - This study explored the relation of personal and professional characteristics to the attitudes of health professionals toward parent participation. A random sample of members of the Association for the Care of Children's Health completed the Parent Participation Questionnaire. Attitudes were more accepting in subjects who were parents (p < .01), ever married (p < .05), educators (p < .01); older (p < .01), more experienced (p < .01), and/or had a higher level of education (p < .01). Health professionals need to develop means of creating positive attitudes that are not based solely on an individual's characteristics. These, however, can be mediated through several strategies--for example, role modeling, sharing, and education. PMID- 10130539 TI - Effects of labels of infant health and gender on parent ratings of a preterm infant. AB - This study extends previous investigations of prematurity prejudice by manipulating labels of infant health status and infant gender in a 2 x 2 factorial design. Eighty-eight parents of young children born prematurely viewed a videotape of a preterm infant on an apnea monitor and then completed ratings of premature infant behavior, attractiveness, general health, and caregiving. Analyses of variance yielded significant results only on the General Health scale with a significant main effect for infant health. The health status bias did not globally influence all perceptions. Implications for clinical practice are discussed, and future research directions are outlined. PMID- 10130540 TI - The overestimation of adherence to pediatric medical regimens. AB - We evaluated the accuracy of primary health care providers' predictions of parents' adherence to their children's short-term antibiotic regimen and a scheduled follow-up appointment. Adherence predictions were compared with objective measures of the parents' adherence. Providers were poor predictors of nonadherence, greatly overestimating the percentage of parents who would be adherent. Nonadherence is typically addressed by applying adherence improvement strategies to all patients. Recent pediatric research, however, suggests that applying contingency-based interventions for adherent patients can result in later nonadherence if the strategies are withdrawn. Inaccurate predictions of adherence will result in many nonadherent patients not receiving a needed intervention. The results indicate the need for strong behavioral predictors that result in more accurate identification of patient nonadherence to guide further applications of adherence improvement strategies. PMID- 10130541 TI - Employer initiatives to examine cost and quality in health care. AB - Actions by private sector employers as well as moves by federal and state agencies have begun the process of integrating cost and quality in health care decision making. PMID- 10130542 TI - An overview of the potential impact of the National Health Care Task Force on workers' compensation. PMID- 10130543 TI - New issues in long-term care. AB - Employer sponsorship of long-term care programs is a growing trend, one that is likely to continue, no matter what direction national health care reform takes. PMID- 10130544 TI - What should be done now with retiree health benefit prefunding? AB - At least in its early stages, health care reform is not likely to signal the end of concerns about retiree health benefits. Employers may want to explore prefunding as a practical approach to the problem. PMID- 10130545 TI - TV or not TV? PMID- 10130546 TI - A river runs through it. PMID- 10130547 TI - Hot nights in the city. PMID- 10130548 TI - Hot off the press. PMID- 10130549 TI - Hooked on hatred. PMID- 10130550 TI - Serendipity and pseudoscience. A look at health-related program evaluation. AB - This article presents a discussion of the pitfalls of sloppy science as it is applied to the evaluation of human service programs. The differences are examined between use of the scientific method and trial-and-error approaches to assessment. The major requirements for sound research are presented, as are the pitfalls and shortcomings associated with a less rigorous approach. PMID- 10130551 TI - A strategy to encourage the evaluation of health education programs. AB - In the face of health educators' reluctance to evaluate their programs and the absence of suitable rewards or punishments to encourage such evaluations, a materials-based strategy to reduce the aversiveness of program evaluation is proposed. PMID- 10130552 TI - Prevalence of chronic fatigue syndrome-related symptoms among nurses. AB - Chronic Fatigue Syndrome is an illness that is characterized by debilitating fatigue and a group of other related symptoms. Few epidemiological studies have been conducted, and none have focused on a nursing population. The present study is the first to assess the prevalence of Chronic Fatigue Syndrome-related symptoms in a sample of nurses. Demographic characteristics, symptoms, and possible prevalence rates are presented and discussed. When using both narrow and more inclusive criteria to define this symptom complex, higher rates of this disorder were found than in previous epidemiological studies. The implications of these findings are discussed. PMID- 10130553 TI - Continuing education on teaching skills for health professionals. Evaluation of training the trainers. AB - Effective Patient Teaching (EPT), a health professions continuing education course, improves educators' teaching skills when presented by its developers. This study aimed to determine whether others could teach EPT with similar effectiveness. Four nurse managers who provide staff training and supervision for multiple hospital diabetes care units presented EPT to health care professionals at seven such sites; another seven served as controls. The evaluation included observations of trainers conducting EPT programs in the field, teaching skills ratings of health professionals in both groups, and knowledge test administered to patients. Six months after training, teaching skills scores of health professional EPT participants were better (p < .05) than controls. The EPT program improves participants' teaching skills and maintains these effects in field settings, when presented by faculty not involved in its development. PMID- 10130554 TI - Using qualitative methods to evaluate health service delivery in three rural Colorado communities. AB - Qualitative and quantitative methods can be used simultaneously for hypothesis generation and testing. A pilot study was conducted in 1991 in three rural Colorado communities to clarify health service delivery problems related to cancer. The analysis focused on the perceptions of three types of respondents in each community related to whether cancer was a major problem, whether health services were adequate in their community, and what perceived solutions could be implemented. Respondents included community influentials, health care providers, and cancer patients or family members. Semistructured phone interviews were used to collect perceptions of these community members. Transcripts from the three communities were combined, coded, and tallied. Several distinct themes emerged from the analysis. These included: cancer was a major problem; public and provider education was needed; community systems and support to identify and solve health problems were lacking; medical networking needed to be expanded; transportation was a problem for remote communities; inability to pay for services was a problem for rural communities. Most respondents identified the problems as relevant to other chronic and acute diseases as well as cancer. This method identified the critical problems for the majority of the people without losing sight of the outlier responses. PMID- 10130555 TI - San Francisco success story: merging hospitals and increasing giving. AB - Pacific Presbyterian Medical Center and Children's Hospital of San Francisco not only pulled off a major merger but they raised total annual giving by nearly 20 percent to $9.4 million. PMID- 10130556 TI - Leadership for change: the rest of the story. PMID- 10130557 TI - Challenges of leadership in an era of health care reform. AB - Health care leadership has never been more difficult than in the past decade--and the next ten years promise to be even more demanding. As a new era for health care emerges, organizational leaders will be required to manage increased levels of risk, uncertainty, and rapid change. Successful chief executives will be those who recognize and nurture intangible leadership qualities including knowledge of self, commitment to service, and depth and breadth of vision. With the continued shift away from hospital inpatient care, health care leaders will be called on to develop multipurpose delivery systems that move from a market-based to a community-based focus and deliver high quality services in a cost-effective manner. Several leadership themes will unfold in the midst of health care reform, including: exploiting change for the good of the organization and community; serving as educator, communicator, and comforter to divergent constituencies; and reestablishing a balance between short-term goals and long-term vision. PMID- 10130558 TI - Leadership in a time of strife and change. PMID- 10130559 TI - Leading in the midst of a revolution. PMID- 10130560 TI - Companies hate the health plan. AB - After a close look at President Clinton's proposal, many employers conclude they'd be stuck paying for a huge new entitlement they could not afford. PMID- 10130561 TI - PHOs: the past or the future of physician alliance strategies? PMID- 10130562 TI - Hospitals must prepare for the paradigm shifts to managed care. Interview by Donald E. L. Johnson. AB - About one of every six Americans presently get their health care from a managed care organization. Choice, quality and cost containment can only be ensured through managed care, according to Philip M. Nudelman, president and chief executive officer of Group Health Cooperative of Puget Sound. Donald E.L. Johnson, publisher and editor of Health Care Strategic Management, discusses the various roles that hospitals and their administrations play in moving a health care organization into an integrated care organization during a period of state and federal health care reform. PMID- 10130563 TI - Health reform and jobs: revisiting health staffing issues. PMID- 10130564 TI - Health care reform bill has 85% chance of passing, but .... PMID- 10130565 TI - Possible infant abduction foiled by 'best protected' maternity unit. PMID- 10130566 TI - An interview with: Charlie Pierce on the use of covert CCTV. AB - Charlie Pierce is the founder and president of LRC Electronics Company and LTC Training Center, Davenport, IA. He has 18 years of field, office, seminar, and shop experience in the closed-circuit television industry and frequently lectures about CCTV issues. In this interview, he discusses the use of CCTV technology for covert surveillance applications, the available technology, and the legal ramifications. PMID- 10130567 TI - Why your hospital's cost of waste disposal/treatment may be too high. PMID- 10130568 TI - Special report. Hospitals and parking security: shoring up a major crime locale. AB - Parking lots, parking structures, and adjacent perimeter areas--grounds, walkways, and public streets--account for a substantial portion of crimes committed in hospitals. Hospital security directors participating in the most recent International Association for Healthcare Security and Safety (IAHSS) Annual Crime Survey (for 1991) reported that 68% of incidents of armed robberies took place in parking and adjacent areas; 62% of vandalism incidents; 56% of rapes; 38% of burglaries; 34% of sexual assaults; 33% of robberies. Parking and adjacent areas registered lower but important frequencies of other crimes- homicide, 19%; simple assault, 16%; theft, 14%. Some 1,042 incidents of auto theft, a crime with virtually 100% occurrence in parking areas, were reported by the 284 hospitals participating in the 1991 survey. In the IAHSS 1989 survey, some 315 hospitals reported 667 incidents of vehicle theft indicating that this should be an area of growing concern. Additionally, a review by the newsletter Parking Security Report of major large dollar lawsuits for negligent security that came before state and federal appeals courts in the 1980s found that 27% of them were based on incidents that took place in parking areas. Clearly, parking security represents a major challenge for hospitals, demanding time, personnel, equipment, and dollars. In previous issues, we have presented a number of case history articles on how individual hospitals are dealing with the problem. In this report, we'll review what a number of other hospitals are doing to harden their parking security setups. PMID- 10130569 TI - Measuring clinical nutrition services performance. PMID- 10130570 TI - Screening services for improving organizational performance. PMID- 10130571 TI - Physician payment and cost containment: perspectives from the U.S. and abroad. PMID- 10130572 TI - The impact of Medicaid adoption of the Medicare fee schedule. AB - In this article, the authors simulate the effects on Federal and State Medicaid expenditures of increasing Medicaid fees to Medicare fee schedule (MFS) levels. Strict adoption of the MFS by the States would increase total Medicaid spending by approximately 4 percent, $2.5 to $2.9 billion. Because Medicaid fees vary across States, so does the impact of adopting the MFS. Medicaid spending would increase significantly in some wealthy States with large Medicaid populations and in a few small, relatively poor States. Some States currently pay more than the MFS for obstetrical services. If these fees continued at higher levels for obstetrical care, total Medicaid spending would increase by $3.5 to $4.0 billion. PMID- 10130573 TI - An update on physician practice cost shares. AB - The 1988 physicians' practice costs and income survey (PPCIS) collected detailed costs, revenues, and incomes data for a sample of 3,086 physicians. These data are utilized to update the Health Care Financing Administration (HCFA) cost shares used in calculating the medicare economic index (MEI) and the geographic practice cost index (GPCI). Cost shares were calculated for the national sample, for 16 specialty groupings, for urban and rural areas, and for 9 census divisions. Although statistical tests reveal that cost shares differ across specialties and geographic areas, sensitivity analysis shows that these differences are small enough to have trivial effects in computing the MEI and GPCI. These results may inform policymakers on one aspect of the larger issue of whether physician payments should vary by geographic location or specialty. PMID- 10130574 TI - Allocating practice expense under the Medicare fee schedule. AB - Currently, relative value units for practice expense are determined under the Medicare fee schedule (MFS) using historical physician charges. This seems inconsistent with the goal of a resource-based fee schedule. A specialty resource based method of determining practice expense payments is presented and simulated here. The method assumes that, for each service, the payment for practice expense should be the same proportion of the total payment as actual physician practice expenses are of total practice revenues. A comparison with the approach developed by the Physician Payment Review Commission (PPRC) shows similar fees, but the specialty-based method proposed here requires no data beyond what is already employed in the MFS. PMID- 10130575 TI - Health insurance and the elderly: data from MCBS (Medicare Current Beneficiary Survey). AB - This article shows the supplemental insurance distribution and Medicare spending per capita by insurance status for elderly persons in 1991. The data are from the Medicare Current Beneficiary Survey (MCBS) and Medicare bill records. Persons with Medicare only are a fairly small share of the elderly (11.4 percent). About three-fourths of the Medicare elderly have some form of private insurance. The share with Medicaid is 11.9 percent, which has increased recently as qualified Medicare beneficiaries (QMBs) started to receive partial Medicaid benefits. In general, Medicare per capita spending levels increase as supplemental insurance comes closer to first dollar coverage. When the data were recalculated to control for differences in reported health status between the insurance groups, essentially the same spending differences were observed. PMID- 10130577 TI - Business, households, and governments: health spending, 1991. AB - Governments have been thrust to the forefront of health care reform efforts as growth in government health care costs was faster than growth in all other sponsor sectors in 1991. In the business sector, real health care costs per worker have risen 65 times faster than real wages and salaries per worker during the past 26 years. Households continue to devote 5 percent of income after taxes to health care, the same percentage for the last 8 years. This article presents data supporting these findings, and an analysis of health care spending by each sponsor sector. PMID- 10130576 TI - Effects of selected cost-containment efforts: 1971-1993. PMID- 10130578 TI - How do Medicare physician fees compare with private payers? AB - Under the new fee schedule, Medicare physician fees are 76 percent of private fees. Consistent with the intent of payment reform, Medicare physician fees more closely approximate private fees for visits (93 percent) than for surgery (51 percent) and in rural areas as compared with large metropolitan areas. Variation in private fees across the country is considerably greater than it is for Medicare fees. Consequently, Medicare fees are most generous in areas that compare least favorably with the private market because private fees in these areas are well above average. These results shed light on the impact of the fee schedule and on the implications of using Medicare payment methods as part of a broad-based health reform. PMID- 10130579 TI - Medicaid coverage for HIV-positive individuals demonstration. PMID- 10130580 TI - Staff-assisted home dialysis demonstration. PMID- 10130581 TI - Health Outcomes Institute is established. PMID- 10130582 TI - Physician fee levels: Medicare versus Canada. AB - Adjusted for differences in purchasing power and practice expenses, Canadian physician fees are, on average, 59 percent of Medicare fees. The general perception that Medicare fees are low is the result of comparison with U.S. private fees, not to the much lower Canadian fees. In the context of the current U.S. health care system, lowering Medicare fees to Canadian levels could jeopardize access to care by Medicare beneficiaries. However, if all payers used the same fee schedule, fees that differed substantially from those currently used by private insurers might be viable. PMID- 10130583 TI - Price controls: on the one hand ... and on the other. AB - Controlling health care costs requires that limits be placed either on prices, quantities of services, or both. Prices are measurable and more easily controlled than is quantity and, consequently, health care cost containment has frequently focused on mechanisms for controlling prices. Regulatory approaches, however, may create market distortions and change access patterns. An alternative approach to controlling prices is to restructure the market for health services to encourage greater price competition among providers. Because this type of health reform has not previously been attempted, there is much more uncertainty about the outcome of market-oriented approaches than for direct regulatory control over prices. PMID- 10130584 TI - Global budgeting in the OECD countries. AB - Many of the Organization for Economic Cooperation and Development countries use global budgeting to control all or certain portions of their health care expenditures. Although the use of global budgets as a cost-containment tool has not been implemented in the United States in any comprehensive way, recent health care reform initiatives have increased the need for research into such tools. In general, the structure, process, and effectiveness of global budgets vary enormously from country to country, in part because the underlying social welfare system of each country is unique. PMID- 10130585 TI - Physician payment reform under Medicare: monitoring utilization and access. AB - The Omnibus Budget Reconciliation Act (OBRA) of 1989 brought about significant changes in physician payment policy under Medicare. A major component of physician payment reform was the implementation on January 1, 1992, of the Medicare fee schedule (MFS). The Secretary of Health and Human Services is required to monitor and report annually on the impact of the changes in physician payment on access to and utilization of health care services. This article provides an overview of the 1993 Report to Congress. First, the article discusses the changes made in physician payment policy as well as the complexities involved in assessing the effects of the MFS. Next, the article discusses the approaches that were implemented in the Health Care Financing Administration (HCFA) to generate timely data to monitor and evaluate the impact of physician payment reform on Medicare beneficiaries. Last, the article describes six analyses that were designed to provide differing perspectives for understanding the impact of the OBRA 1989 physician payment changes on access and utilization. Some of the most salient results of these analyses are presented, including preliminary data from the first year during which the MFS was in effect. PMID- 10130586 TI - Monitoring access following Medicare price changes: physician perspective. AB - In this article, the author examines changes in Medicare beneficiaries' access to services following the Omnibus Budget Reconciliation Act of 1987 "overpriced" procedure price reductions from the physician perspective. Three measures of physician availability remained essentially constant: number of physicians treating beneficiaries or performing overpriced procedures; average Medicare caseload; and average share of a physician's Medicare practice comprised of those who are poor and not white. Physician practice characteristics were examined and provided evidence of continuing participation in Medicare: Average Medicare revenue increased 10 percent, and average volume of all services increased. However, physicians with the largest fee reductions or who were the most financially dependent on the procedures did not change overpriced procedure volume. PMID- 10130587 TI - How to survive in a restructured health care system. PMID- 10130588 TI - Offering constructive alternatives to the President and Congress. ASIM. PMID- 10130589 TI - Fire fighting. PMID- 10130590 TI - Drop the dead duck. PMID- 10130591 TI - Women in management. Single-sex appeal of an all-female group. PMID- 10130592 TI - Get it right the first time. PMID- 10130593 TI - The electronic office. It sounds good on paper. PMID- 10130594 TI - The electronic office. In the twinkling of an eye. PMID- 10130595 TI - The learning curve. PMID- 10130596 TI - Off screen blues. PMID- 10130597 TI - The appliance of science. PMID- 10130598 TI - Absent friends. PMID- 10130599 TI - Birth rights. PMID- 10130600 TI - What about the workers? PMID- 10130601 TI - Theatre of the absurd. PMID- 10130602 TI - IT management consulting. A problem shared ... is a problem halved. PMID- 10130603 TI - IT management consulting. Six of the best? PMID- 10130604 TI - Movers and shakers. PMID- 10130605 TI - Short measures. PMID- 10130606 TI - Blessed respite. PMID- 10130607 TI - Creating organized delivery systems: the barriers and facilitators. AB - An organized delivery system is a network of organizations that provides or arranges to provide a coordinated continuum of services to a defined population and is willing to be held clinically and fiscally accountable for the outcomes and the health status of the population served. As such, organized delivery systems are at the center of efforts to implement health care reform. Based on analysis of 12 such systems, this article identifies key characteristics that influence what organized delivery systems are able to do, outlines the major obstacles or challenges to achieving greater levels of integration, and then discusses a number of approaches for effectively dealing with these obstacles. PMID- 10130608 TI - Conceptualizing and measuring integration: findings from the health systems integration study. AB - Given the pressures for health care reform, interest in the concept of integrated or organized delivery systems as a means to offer more coordinated cost-effective care is growing. This article has two primary objectives: (1) to clarify the different types of integration associated with the notion of an organized delivery system, and (2) to share the results from an ongoing study of 12 organized delivery systems. The findings indicate a moderate level of integration overall, particularly in the areas of culture, financial planning, and strategic planning. The study found that corporate staff respondents perceive their systems to be more integrated and effective than do operating unit managers, and that some functional integration areas are positively associated with both physician system and clinical integration that, in turn, are positively related to each other. Overall, perceived integration was found to be positively associated with perceived effectiveness. PMID- 10130609 TI - Coordinating patient care services in regional health systems: the challenge of clinical integration. AB - Regional health systems attempting to achieve the vertical integration of health services ultimately must achieve clinical integration. The thesis of this article is that vertical integration in health care involves the coordination of inputs (equipment, supplies, human resources, information, and technology) and intermediate outputs (preventive, diagnostic, acute, chronic, and rehabilitative services) to attain the end goal of optimal personal health. Given this perspective on vertical integration, the coordination of specialty services and primary care within a system structure--that is, the clinical integration of patient care--is central to the realization of vertically integrated regional health systems. Institution-level and environmental factors that facilitate and challenge the attainment of clinical integration are elucidated, and a set of clinical integrating mechanisms are outlined with presentation of real-world examples of those mechanisms. The analysis concludes by summarizing the next steps in realizing the vision of clinically integrated, regional systems of health care. PMID- 10130610 TI - Patient-focused care: key principles to restructuring. AB - Patient-focused care (PFC) is a unique patient care delivery model that is becoming more popular in today's hospitals. Bishop Clarkson Memorial Hospital in Omaha, Nebraska, was one of the first hospitals to implement PFC. Clarkson used four principles to guide its pilot unit implementation--grouping similar patient populations, moving services closer to the patient, broadening staff skills, and simplifying processes. The four principles and their implementation are described; preliminary results are reported. PMID- 10130611 TI - Hospital characteristics: can an audit be predicted? AB - Each year Medicare-participant hospitals submit a cost report to the Health Care Financing Administration (HCFA) to settle their reimbursement claims. These reports are subject to audit, and a decision by HCFA to audit can be costly to the auditee. This article uses data from 6,270 cost reports filed in 1986 to explore the factors related to the probability of an audit. Logistic regression equations are estimated to examine how hospital characteristics influence the chance of audit. The results suggest that audit probability can be predicted with reasonable accuracy by a hospital's bed size, ownership type, teaching status, function, proportion of Medicare inpatient days, and geographic location. PMID- 10130612 TI - Home health care referrals following hospital discharge: communication in health services delivery. AB - Interinstitutional communication in the delivery of health services is fundamental to continuity of patient care. The purpose of this investigation was to describe the information transferred in the formal home care referral of elderly clients by hospitals and to describe selected organizational and medical condition characteristics that may affect referral content. Results indicated that approximately half of the information recommended by the literature was actually transmitted in the referral form. This information was composed primarily of background and medical data with some nursing care and almost no psychosocial data. More data were transferred when standardized written forms were used, when smaller hospitals provided the information, and when the home health agency was affiliated with the hospital. PMID- 10130613 TI - Health care coalitions: an emerging force for change. PMID- 10130614 TI - Management implications of physician practice patterns: strategies for managers. PMID- 10130615 TI - Patient counseling detects prescription errors. AB - Medication errors are part of almost every pharmacist's professional life. They are a consequence of the behavioral habits developed by pharmacists to fill prescriptions efficiently. Outpatient prescription errors at an Indian Health Service pharmacy were reviewed. Mistakes detected after pharmacists had signed off on prescription accuracy were recorded. The errors were separated into two groups: 1) those detected during patient counseling, and 2) those reported after patients left the pharmacy. Patient counseling was the intervening event between the pharmacist's accuracy check and the patient's departure from pharmacy. The review of errors showed that of 323 reported mistakes, 286 (89%) were detected during patient counseling and subsequently corrected. Patient counseling appears to be a valuable tool for intercepting medication errors before they leave the pharmacy. The interactive environment created during the patient encounter probably improves concentration and allows previously overlooked mistakes to be noticed. Pharmacists should be encouraged to develop error detection strategies that are a natural part of the counseling process. PMID- 10130616 TI - Effect of implementing a cancer chemotherapy order form on prescribing habits for parenteral antineoplastics. AB - Effect of implementing a cancer chemotherapy order form on prescribing habits for parenteral antineoplastics. The purpose of this study was to determine whether the use of a cancer chemotherapy order form improved prescriber inclusion of necessary prescription information to minimize errors for parenteral antineoplastics when compared to orders written on standard treatment-order forms. Standard treatment order forms and the newly developed chemotherapy order forms were examined for differences in completeness of the following 13 prescription components: diagnosis, height, weight, body surface area, start date and time, dosage (e.g., mg/m2), dose (mg), solution diluent (drips only) and volume (drips only), infusion rate (drips only), route (i.e., IV push or IV drip), frequency of administration, and total number of scheduled doses. The results demonstrate a significant improvement in completeness of necessary prescription information when cancer chemotherapy was ordered by physicians using a chemotherapy order form compared to a standard treatment order form. Importantly, the availability of various prescription components such as height, weight, and dosage may be used by the pharmacist to verify physicians' calculations of body surface area and dose and thereby reduce the chance of serious medication dosage errors. An additional benefit of the new form is a reduction in the time pharmacists spend clarifying orders. PMID- 10130617 TI - Development, implementation, and results of a successful multidisciplinary adverse drug reaction reporting program in a university teaching hospital. AB - The development and implementation of an active adverse drug reaction reporting program in a university teaching hospital is described. The progression from a solely voluntary system to a multidisciplinary program consisting of both voluntary and involuntary components is discussed. A total of 1,011 adverse reactions were reported between July 1, 1988 and July 22, 1992. The most common reaction reported was rash. Antibiotics were most commonly implicated in the reactions reported. As a single agent, digoxin was involved most frequently. Voluntary reporting by physicians, nurses, and pharmacists accounted for approximately 24% of the adverse reactions reported. Occurrence screening by the Quality Assurance department produced approximately 76% of the reports. PMID- 10130618 TI - Patients' perceptions of pharmaceutical services offered by an ambulatory clinic pharmacy. AB - The importance that patients place on various patronage motives and service offerings of an ambulatory pharmacy associated with a university hospital was studied. Questionnaires were distributed to 193 patients and 8 pharmacists employed at the pharmacy. The patient questionnaire contained a list of 13 patronage motives and 18 service offerings. Respondents rated the importance of each patronage motive in their decision to visit the pharmacy and their view of the importance of each pharmaceutical service offering on an anchored scale (1 = not important, 5 = very important). The pharmacist questionnaire included the 18 service offerings. Pharmacists rated their perceptions of the importance patients place on each service. The response rates were 52.8% for patients and 100% for pharmacists. Patients indicated acceptance of insurance plan, availability of prescription medication, and presence of a knowledgeable pharmacist as the most important patronage motives. Ability to call in refills by telephone and various interactions with the pharmacist were identified as the most important service offerings. The results showed congruence between the pharmacists' perceptions of important patient services and the importance patients actually place on the services. Understanding the importance of patronage motives and service offerings is necessary in the development of marketing activities to attract new patients and retain current patients. PMID- 10130619 TI - American immunization policies: actions speak louder than words. PMID- 10130620 TI - Sinking reimbursements yield lower intraocular lens prices. PMID- 10130621 TI - Med-surg chargeables show decline. PMID- 10130622 TI - Hey, lookie here, lookie here! PMID- 10130623 TI - Supporting the bereaved. Field notification of death. PMID- 10130624 TI - EMS meets grunge. EMS coverage of Lollapalooza 1993. PMID- 10130625 TI - Directory of national associations. AB - Associations have proven to be valuable clearinghouses of information, centers for educational enrichment and switchboards for making connections between practitioners of a given profession. The healthcare central service and materiel management professions are represented by four national associations: the American Society for Healthcare Central Service Personnel (ASHCSP), the International Association of Healthcare Central Service Materiel Management (IAHCSMM), the American Society for Hospital Materials Management (ASHMM), and the Health Care Material Management Society (HCMMS). Within these associations you will find groups of people who have interests and goals similar to yours. Pursue your interests together--join an association! PMID- 10130626 TI - 1993 corporate profiles. AB - Some of the companies in this year's Corporate Profiles section you know and use; some may seem familiar; but all of the companies are important to you as healthcare supply managers. This detailed overview of the history, sales and service, product lines, new technology and future plans of each corporation is brought to you as a service from JHMM, to be used as a review, an update and a resource throughout the year. PMID- 10130627 TI - Results of the 1993 survey of the healthcare materiel management and central service professions. AB - Our 1993 professional survey showed materiel managers gearing for change, as they expect to see their ranks decrease in number but gain influence. Central service managers seem to be warily watching CS contract services. Salaries increased more for materiel managers than CS managers, though both showed some losses in some regions. Bed size again had a direct bearing on compensation, and those who made more tended to have more benefits. Benefits were lost by 14 percent of materiel managers and 21 percent of CS managers. Few of either group changed jobs. Materiel managers again reported in the largest numbers to finance and CS to materiel management, though this reporting structure seems to be weakening. Education gains were up for both groups, and membership to one or more associations was high for both groups. Materiel managers seem more satisfied with their jobs than they did last year, but CS managers seem decidely less satisfied. PMID- 10130628 TI - The magic of writing. AB - The work of our daily lives leaves little time for the "accomplishment and recreation" of writing. Yet, writing accomplishes a vital service by connecting people with the world around them. It is possible to experience the joy of writing by developing some mastery of it. All writing begins with an idea; always consider that the problems you tackle today may be worth writing about tomorrow. You must collect research if you are to flesh out your ideas and get them onto paper. You will also need writing implements, a tape recorder and language references. When building an article, it helps to have an outline. You need to block off time devoted only to writing and set a deadline. A first draft is for getting ideas down on paper, and revisions are done to refine the presentation. Work on properly organizing and editing your material. Good word and sentence rhythm, carefully drawn word pictures, the use of pronouns to develop reader identification and buy-in and compelling leads and conclusions are some ways to make your writing more interesting. PMID- 10130629 TI - Directory of education. AB - One of the most important tools to career building and personal satisfaction is education! And there are a wide variety of ways for you to get it. Some are available through your professional associations (see the "Directory of National Associations" for more information on those), others are available through correspondence courses, on-site courses at local colleges and universities, seminar programs of associations, vendors and seminar groups, and still others are available in audiovisual formats. We've assembled a list of educational offerings that should be of interest to you and your colleagues. There may be others offered in your area, so contact your local institutions of higher learning to take advantage of what they have--or to develop a course with them! PMID- 10130630 TI - Directory of resources. AB - This directory contains almost 300 entries of publications, publishers, electronic informational sources, professional association and consultants that all provide pertinent information for the healthcare material manager, central service personnel and others charged with managing healthcare equipment, supplies and services. PMID- 10130631 TI - Directory of Federal offices. AB - This year the Directory of Federal Offices has been updated to include additional publication/catalog resources, most available free of charge. Also, included are some additional offices dedicated to AIDS, infection control and medical device problems. The directory lists major departments and offices, followed by their specific areas of expertise. It should help get you going in the right direction. PMID- 10130632 TI - Cross-reference corrections for the 1994 Accreditation Manual for Hospitals (AMH). PMID- 10130634 TI - Smoking allowed in hospital building 'shelter'. PMID- 10130633 TI - Hospitals improve care using indicator data. PMID- 10130635 TI - The health care reform debate begins. PMID- 10130636 TI - Preparing for Joint Commission survey can be fun. PMID- 10130637 TI - Who are the Joint Commission's customers? PMID- 10130638 TI - IMSystem Technology Task Force assists in implementation. PMID- 10130639 TI - Standards development: a three-phase collaborative effort. PMID- 10130640 TI - Dividing income fairly: it's easier than you think. PMID- 10130641 TI - What big practices can learn from small ones. PMID- 10130642 TI - Would you be better off working for a hospital? PMID- 10130643 TI - Houston hospitals sign with group. PMID- 10130644 TI - Owens & Minor, Stuart Medical don't foresee merger challenge. PMID- 10130645 TI - VHA adopts formula to determine each member's distributor fees. PMID- 10130646 TI - VHA wins battle for Barnes-Jewish/Christian. PMID- 10130647 TI - Wis. employers group picks JSA Healthcare to develop new system. PMID- 10130648 TI - Horizon-Greenery merger on hold. PMID- 10130649 TI - Federal investigation welcome, Independence Blue Cross says. PMID- 10130650 TI - Mich. Blues facing federal probe. PMID- 10130651 TI - Healthcare may cost $1 trillion in '94--report. PMID- 10130652 TI - Pentagon to reopen Calif. medical contract. PMID- 10130653 TI - N.Y. ordered to repay nursing home cuts. PMID- 10130654 TI - New York hospitals get rate hike. PMID- 10130655 TI - Hospitals need to look at IPNs (integrated provider networks) through doctors' eyes. PMID- 10130656 TI - Physician net income rises at twice the rate of inflation in 1992. PMID- 10130657 TI - 2 Baxter heads exit, restructuring continues. PMID- 10130658 TI - Preparing for what's ahead. AB - With healthcare reform on the horizon, healthcare companies and providers are positioning themselves for a new environment in which cost-effective medical treatment is the Holy Grail. Not only will providers be required to measure the efficiency of their treatments, but all parties in the medical-care delivery system will need to share financial risk. In the following pages Modern Healthcare staff members look at how specific industry segments are preparing to face the changes expected during the rest of the 1990s. Industry experts also express their views. PMID- 10130659 TI - FTC investigating N.J. hospital purchase. PMID- 10130660 TI - IRS grants exemption to Mont. delivery system. PMID- 10130661 TI - Buyers being wary, survey shows. PMID- 10130662 TI - Boards give approval to merger of Regency and Care Enterprises. PMID- 10130663 TI - Toledo's Riverside, Ohio Blues to form integrated organization. PMID- 10130664 TI - 2 Miami-area hospitals discussing ventures. PMID- 10130665 TI - Regulators cracking down on flash sterilization. PMID- 10130666 TI - ORs join the move to 'seamless organizations'. PMID- 10130667 TI - Interdisciplinary in-room turnover time activities. PMID- 10130668 TI - CDC drafts new guidelines on tuberculosis. PMID- 10130669 TI - The human factor. Unmasking staff potential. PMID- 10130670 TI - Sexual rights policies emphasize freedom, privacy, respect for all. PMID- 10130671 TI - Records confidentiality is top issue in American health care system. PMID- 10130672 TI - Planning key care strategies for people with AIDS. PMID- 10130673 TI - Pharmacist is link to improved systems, quality, and outcome. PMID- 10130674 TI - Improved physician reimbursement eliminates barriers to service. PMID- 10130676 TI - States tackle health care reform. PMID- 10130675 TI - Walking a thin line: distinguishing between research and medical practice during Operation Desert Storm. PMID- 10130677 TI - First assistant job analysis and exam content outline development. AB - The work of the job analysis panel and the content outline development committee laid the foundation for the first assistant certifying examination. The content outline is used throughout the examination development process by item writers, item reviewers, and the examination review committee, as well as during the test assembly processed. Because of the work of the job analysis panel and the content outline development committee, the certifying examination program for first assistants is both valid and legally defensible. A job analysis and a revision of the content outline based on that job analysis should be conducted every 3 to 5 years to ensure the examination continues to accurately reflect the current state of the job of a first assistant. PMID- 10130678 TI - Proper care and handling of the flexible endoscope. PMID- 10130679 TI - Establishing value through pharmacoeconomics: the emerging third objective in clinical trials. AB - Establishing the value of a new medicine by applying the tools and methods of pharmacoeconomics has become an important third objective in many clinical trials. The pharmacoeconomic investigator conducting research in clinical trials must understand and conform to the rules and procedures governing the clinical trial process. This article addresses some of the vital yet often overlooked details associated with conducting pharmacoeconomic research in clinical trials. The protocol, the informed consent form, the data collection instruments, the study initiation, and the final study report are all discussed. Additionally, limitations of the study results are reviewed. PMID- 10130680 TI - Obtaining pharmacoeconomic data in health care organizations. AB - The article illustrates the process and techniques of obtaining or collecting pharmacoeconomic data in various health care organizations, focusing on hospitals, physicians' offices, and pharmacies as the research settings. The role that pharmacoeconomic data have in the decision-making process as well as the perspective of the decision maker are also discussed. The three primary components needed to conduct a complete pharmacoeconomic analysis (clinical outcomes, humanistic outcomes, and economic outcomes) are described in relation to the health care organization. The strengths, weaknesses, advantages, and disadvantages of such data are discussed. Various databases that are accessible within each organization are also outlined. PMID- 10130681 TI - Incorporating pharmacoeconomic principles into hospital pharmacy practice. AB - Cost analysis, cost containment, and cost reduction are realities in today's health care environment. Discussions of cost must also include an analysis of the consequences of economic decisions so that a balanced perspective can be presented to health care decision makers. The basic principles of pharmacoeconomics can be used to provide information about the cost and consequences of therapy. To ensure a high quality of pharmaceutical care, it will become necessary to use this scientific information to make therapeutic decisions and recommendations. PMID- 10130682 TI - Relationship between practice guidelines, formulary management, and pharmacoeconomic studies. AB - Pharmacy and therapeutics committees can use pharmacoeconomic and outcome studies as tools to evaluate and implement clinical guidelines for patient care. Results of studies help optimize the clinical effects and control the costs of drug therapy. Such data also assist in positioning products in competitive environments. A four-part classification of research studies is offered as an aid to strategic research planning. PMID- 10130683 TI - The use of pharmacoeconomic data in formulary selection. AB - Pharmacists are encouraged to improve their knowledge and use of pharmacoeconomic data in formulary selection. The formulary selection process has changed significantly in recent years. Among its most significant uses is its potential for cost containment strategies. An overview is presented of the origin as well as the potential impact of pharmacoeconomic data. The need to balance the economic benefit with the clinical advantages for any proposed new drug for formulary inclusion remains the most critical decision to be made by pharmacists. PMID- 10130684 TI - Pharmacoeconomics: a managed care perspective. AB - Managed care pharmacy organizations have the responsibility to promote high quality cost-effective health care that provides value to their enrolled populations. Application of management interventions that reduce the inappropriate use of medications and enhance the appropriate use of medications that improve patient outcomes and the cost effectiveness of care can help meet these responsibilities. To accomplish these management objectives, managed care pharmacy organizations should aggressively apply the results of pharmacoeconomic studies and, where possible, participate in the conduct of these studies. PMID- 10130685 TI - Applying decision analysis to pharmacy management and practice decisions. AB - Decision analysis, a structured approach to decision making, is presented and applied to a typical management situation. Decision analysis is an explicit, quantitative, and prescriptive approach to choosing among alternative outcomes. It engenders in the decision maker an analytical viewpoint, the need to structure the various courses of action and the resultant consequences of the actions, to assess the degree of uncertainty of the actions occurring, and to value the preferences for the alternative outcomes. Literature examples of using pharmacy related decision analysis are provided, including its use in formulary additions, cost-effectiveness analysis, drug therapy evaluation, therapeutic drug monitoring, and health policy issues. PMID- 10130686 TI - Updating skills: pharmacoeconomics as continuing education. AB - With the increased numbers of pharmacoeconomic trials being conducted and reported, the practicing pharmacist will need to apply this information in formulary decision making. The review provides suggestions about readily available pharmacoeconomic continuing education opportunities for the practitioner. Examples of printed materials, home study programs, and meeting presentations are discussed. A combination of approaches is recommended. PMID- 10130687 TI - Keeping the doors open. PMID- 10130688 TI - CHINs (community health information networks): infrastructure for the future. PMID- 10130689 TI - Ethics: the missing piece of reform. PMID- 10130690 TI - Antitrust: stage 1 of health reform. PMID- 10130691 TI - Community boards increase hospitals' responsiveness. PMID- 10130692 TI - 'Stark II' limits physician referrals, but may help hospitals. PMID- 10130693 TI - Looking back on 1993--a great ride. PMID- 10130694 TI - Bioethics--a language for communication. Interview by Karen Gardner. PMID- 10130695 TI - When in doubt, deal yourself out. AB - Self-dealing by hospital board members is the exception, not the rule. However, all board members are likely to be subjected to internal, external and personal forces that could influence their decision making. To protect themselves and the hospitals they govern, trustees need to take a step back and ask: Are we doing what's best for the organization? PMID- 10130696 TI - Medical clinics ... Mayo Clinic. PMID- 10130697 TI - Breakthroughs in long term care design. AB - In summary, here is what design is trying to accomplish in long term care facilities: Functional access; Privacy as entitlement; Sensory optimization to improve vision and hearing; Reduced walking and wheeling distances that still allow people to be mobile; Effective or functional placement of space and equipment; The option of smaller scale, so neither residents nor staff feel like they are hanging out with a unit full of, perhaps 68, people all the time; Flexibility and adaptability PMID- 10130698 TI - Do quality report cards make a difference? The New York and Pennsylvania experience with releasing physician-specific outcomes. PMID- 10130699 TI - Selecting the best to be the best: how to gain a competitive edge for your organization, Part I. AB - This article describes the benefits of good hiring and the costs of poor hiring in a health-care environment. The elements of an effective hiring process are delineated and discussed, including job descriptions; position specifications; the advantages and disadvantages of hiring from within or outside of the organization; and job application, resume, and telephone screening. Part II will focus on compensation considerations; the selection interview; legal issues in hiring; letting candidates know the results; and orientation of new employees. Keys for success in each of these areas are provided. An outline of the steps in a selection interview as well as specific do's and don'ts in interviewing are provided. The point is made that the selection of a new employee is one of the most important processes in the effective management of any health-care organization. Yet, it is often done in haste, with a sense of urgency and with insufficient attention to the demands of the job, the specific nature of the organization, and the less tangible but critical aspects of the applicants. PMID- 10130700 TI - The employment interview: avoiding the traps with effective strategies. AB - Selecting well-qualified employees has become increasingly difficult for employers. Legal complaints citing discrimination and negligent hiring have made interviewers and organizations more vulnerable than ever. Also, predicted declines in the skill levels of employees will continue to make it difficult for interviewers to select applicants who best match job requirements. These difficulties can be traced to a variety of traps that often lead to poor hiring decisions. The authors describe the traps interviewers face and highlight actions that can be taken by interviewers to avoid these traps and to improve the effectiveness of their interviewing and employee selection decisions. PMID- 10130701 TI - CQI in action in the central laboratory. AB - Total quality management and continuous quality improvement are important tools for survival in today's turbulent economy. The George Washington University Medical Center (GWUMC) has initiated institution-wide training in total quality improvement. The FOCUS-PDCA process is one specific instrument used at GWUMC to pursue the goal of total quality. The FOCUS-PDCA acronym stands for: Find a process to improve; Organize a team that knows the process; Clarify current knowledge of the process; Understand the causes of process variation; Select the process improvement; and then Plan, Do, Check, Act. The FOCUS-PDCA process was used to solve a real-world problem in the Central Laboratory of GWUMC. Dramatic improvement in the success rate of phlebotomists resulted, and the percent of "unable to draw" events decreased from more than 5% to less than 1%. PMID- 10130702 TI - Restrictions on the future employment of employees. PMID- 10130703 TI - Ciba Corning Biotrack 512. PMID- 10130704 TI - Managed care. AB - Health-care reform has become a national mandate. Managed care and managed competition have been reinforced by the Clinton health-care reform plan. What type of health-care delivery system can laboratory managers expect to be part of in the near future? We asked laboratory managers who are currently involved in those types of systems. The result is a two-part As We See It. In part one, we will cover physician partnerships and the system laboratory as we ask: What can the laboratory community expect from a managed-care environment? PMID- 10130705 TI - Knowledge and skills needed for collaborative work. AB - The need for collaboration and cooperation in health care delivery is not news. But one of the first requests often made by leaders and others promoting collaborative work in organizations is for a "facilitator course." As the authors developed more knowledge about the real need, they understood that many of the barriers to collaborative work and learning in organizations can be reduced only by the top leaders, not by expert facilitators. The central knowledge that leaders need to support collaborative work is appreciation of work as a system. PMID- 10130706 TI - Mentoring: the evolving role of senior leaders in a TQM environment. AB - This article reviews the effort to implement total quality management (TQM) at West Paces Medical Center. The author concludes that management behavior must shift from a control-oriented style to a mentorship style. A mentor is a leader capable of instilling creative inquisitiveness at all levels of the organization through the development of a shared vision and personal dedication to the widespread use of the principles and tools of TQM. PMID- 10130707 TI - Enhancing hospital cash flow through improved medical records processing. AB - This article reviews a team-based effort to improve the performance of a key business process at Christ Hospital in Cincinnati. The quality improvement team reduced the time required to complete medical records following patient discharge. This effort had a major impact on the hospital's cash flow. PMID- 10130708 TI - Achieving performance breakthroughs in an HMO business process through quality planning. AB - Kaiser Permanente's Georgia Region commissioned a quality planning team to design a new process to improve payments to its suppliers and vendors. The result of the team's effort was a 73 percent reduction in cycle time. This team's experiences point to the advantages of process redesign as a quality planning model, as well as some general guidelines for its most effective use in teams. If quality planning project teams are carefully configured, sufficiently expert in the existing process, and properly supported by management, organizations can achieve potentially dramatic improvements in process performance using this approach. PMID- 10130709 TI - Enhancing quality improvement team effectiveness. AB - Quality improvement teams are different from other work groups in their purpose, leadership, membership, training, procedures, and dynamics. To have effective quality improvement teams, health care organizations must focus on six key process variables, with particular attention to group dynamics. Quality improvement teams progress through the "traditional" stages of team development- forming, storming, norming, and performing--with a "special stage" of closing. Within each stage, there are two core dimensions--team process ("relationship" issues) and the project itself ("task" issues)--and critical tasks that need to be performed by the Quality Council, team members, team leader, and the facilitator. PMID- 10130710 TI - Beyond quality improvement teams: sociotechnical systems theory and self-directed work teams. AB - Increasingly, businesses are reporting successful implementation of self-directed work teams. In health care, team-based structures in both clinical and nonclinical areas are now rapidly emerging. This paper describes the linkage between the literature of sociotechnical systems theory and current applications of self-directed work teams, and outlines the organizational processes used to design and implement them. Several examples of self-directed work teams in industry and health care systems are provided. As much of the existing literature on self-directed work teams is from industry, there is a need for case reports and further research on their current applications in health care systems. PMID- 10130711 TI - Tutorial: quality improvement project models. AB - Quality improvement teams function best when all team members agree to a unifying model to guide their effort. Unfortunately, there are many quality improvement project models to choose from in the literature. And while it seems that they are quite different, all effective models are built on the same conceptual base. In this tutorial, we will explain these basic concepts and then show how to use them to examine and enhance our understanding of some widely used models. We will also discuss the need for these models, describe how teams can learn from projects that followed different models, and provide guidance to organizations that are choosing one. PMID- 10130712 TI - QMHC interview: Peter R. Scholtes [by Marie E. Sinioris]. AB - Peter R. Scholtes has a unique perspective on what it takes to build a world class quality organization: A transformation of the relationships, environment, and dynamics within and between individuals and groups throughout an organization. He brings an organizational development perspective to quality management and, in particular, to the approach and practices advocated by W. Edwards Deming. This interview explores Mr. Scholtes' in-depth understanding and sometimes controversial views on quality improvement teams, team training, and performance appraisal. PMID- 10130713 TI - Making the case for EDI. AB - The 1993 chair of the Health and Human Services' Workgroup for Electronic Data Interchange's Financial Implications Technical Advisory Group predicts big savings from EDI under the Clinton healthcare reform plan. A cost/benefit analysis by the TAG foresees net cumulative savings from EDI of $42 billion by the turn of the century. PMID- 10130714 TI - CIH survey confirms communications networks as vital healthcare technologies. AB - The results of the Computers in Healthcare Networking Survey show a continued strong interest in networking technology, with accompanying real dollar investment now and in the future. Some skepticism remains, however, over what community networks and regional networks are all about and what will be needed to maintain them. PMID- 10130715 TI - Ten questions worth asking about mobile computing. AB - "Mobile," or perhaps "nomadic," are the watchwords for the style of information management fast coming to the healthcare sector. No, mobile technology in healthcare is not to be confused with cellular-phones. Mobile computing goes where the user goes ... to the patient. PMID- 10130716 TI - Memorial Sloan-Kettering cures paperwork problems with document imaging. AB - The world's largest cancer center, New York's Memorial Sloan-Kettering, is finding concrete efficiencies--and real savings--by implementing "OSCAR" the Optical System Controlling Administrative Records. The system now handles more than 2.7 million documents, including patient accounts and medical records. PMID- 10130717 TI - Trend or fad? Acquisitions rock healthcare I/S industry. PMID- 10130718 TI - Product overview hotlist. Integration tools. AB - December's HotList features the continuation of our integration tools buyer's guide begun in November. All data have been provided by individual vendors who responded to survey questions. Computers in Healthcare has made an effort to contact all vendors within this market. See the 1993 Computers in Healthcare Market Directory for complete listing, or look for the new 1994 Market Directory scheduled for release in February. PMID- 10130719 TI - CHIM (Center for Healthcare Information Management) survey shows confidence in EDI, CPR technologies. PMID- 10130720 TI - How do you get them & keep them? Recruitment and retention of key hospital leadership. PMID- 10130721 TI - Meeting the challenge of adolescent health care in a group practice HMO. AB - The Teen and Young Adult Health Center of Kaiser Permanente was designed to meet the challenge of adolescent health care by providing a constellation of services, including routine medical care, as well as services related to sexuality and reproduction, violent behavior, and emotional and mental health. We have made health care available, accessible, and acceptable for teens and young adults. We are evaluating the results of these efforts regarding health, morbidity, and mortality, and would urge other HMOs to explore offering these services to their adolescent and young adult members. PMID- 10130722 TI - Center stage. Educational theatre. PMID- 10130723 TI - Adolescent mental health consultation. PMID- 10130724 TI - HEADS-SET. A tool for testing adolescent risk. PMID- 10130725 TI - Positive Moves: a teen weight management program. PMID- 10130726 TI - A multidisciplinary teen clinic. Focus on care to young women. PMID- 10130727 TI - A recurring nightmare. An opinion about health care reform. PMID- 10130728 TI - Group Health Cooperative's community services initiative. AB - Service to the broader community is an important component of Group Health Cooperative's (GHC's) tradition, values, and mission. The role and potential of community services in a staff model HMO requires consensus, careful planning and communication, and attention to results. This paper describes GHC's efforts to define, implement, and sustain its community services initiative. PMID- 10130729 TI - Perspectives. Health care spending to hit new high: $1 trillion. PMID- 10130730 TI - First Lady praises California for work in health care debate. AB - Hillary Rodham Clinton called California's health care delivery system a model for the nation during a live teleconference at the CAHHS Annual Meeting Oct. 13 in San Diego. In her first-ever address before a state hospital association, the first lady told nearly 1,000 people that California "has its own place of honor in the health care debate" and praised the state for being "years ahead of Washington (D.C.) in recognizing what's right about American health care." What follows is the transcript from her address. PMID- 10130731 TI - Stanford's new information system hopes to improve clinical efficiency. AB - When Stanford University Hospital's 300-work-station clinical database is functional sometime around 1995, hospital staff will have ready access to every piece of information relevant to a patient's medical record. Eventually, clinicians will be able to view patient X-rays on the computer, track trends and more. PMID- 10130732 TI - Balancing employee relations with health care reform. PMID- 10130733 TI - From safety zone to war zone: hospital violence. PMID- 10130734 TI - Critical incident stress debriefing. Stress management program succeeds in San Francisco General Hospital's emergency department. PMID- 10130735 TI - Home care role will expand in reformed system. PMID- 10130736 TI - California hospitals in the 21st century: reshaped by capitation, consolidation and collaboration. PMID- 10130737 TI - 25 ways to save a bundle. PMID- 10130738 TI - Buyer's guide to HRIS. PMID- 10130739 TI - Prescription for managing health-care costs. PMID- 10130740 TI - Evaluate health plans. AB - For most benefits administrators, this program probably does not automate a function they are now doing manually, but it does bring a consultant/broker function in-house (although this is only one of many such functions). In some organizations, particularly smaller ones that might skimp on analysis of their health plans before negotiating carrier rate changes each year, it might mean that such analysis actually does take place. But it you are a benefits administrator who has been performing yearly, manual evaluations of your plans, be very careful about trying and demonstrating this software. If you think you might not be granted approval by management to purchase it, you may wish you didn't know how well it works. PMID- 10130741 TI - Work monitored electronically. PMID- 10130742 TI - Employees are paying for poor health habits. AB - Realizing that corporate America may have limited control over how and when medical services are delivered, employers are beginning to attack the demand side of the health-care equation. That is, improving employee health status should result in a lower demand for medical services. However, to realize significant medical-claims savings, employers must encourage the least healthy employees both to enroll in work-site health-promotion programs and to permanently change their health-risk behaviors. One way to accomplish these objectives is to shift more financial risk onto employees by redesigning the company's medical benefit plan. As the 1990s progress and as medical costs continue to spiral upward, we are bound to observe greater employer involvement in employees' life-styles, both at work and at home. The bounds of discrimination and privacy laws will be tested as companies employ more restrictive policies and benefit plan designs to encourage employees to modify current poor-risk behaviors. PMID- 10130743 TI - Employee benefits buyer's guide. PMID- 10130744 TI - HRIS benefits software buyer's guide. PMID- 10130745 TI - Self-audits. First step in TQM. AB - In the fall of 1987, West Paces Medical Center (WPMC), a 294-bed hospital in Atlanta, made a commitment to a new way of management, one that would make it a learning organization. The commitment would not be just to a higher quality of service, but would be a change in the way of doing business. The three components included in the hospital's quality improvement process were customer mindedness, process mindedness and statistical mindedness. West Paces employees concentrated on understanding customers and their needs, learning how they should perform each day to satisfy those needs, and routinely measuring the improvements made in daily processes. Led by Vicki S. Davis, director of quality resources, WPMC implemented, in November 1987, a program based on W. Edwards Deming's quality management method. One year later, 54 department managers had been trained in quality improvement. Davis shares her account of the quality improvement process on the following pages. PMID- 10130746 TI - CDC issues draft TB guidelines: OSHA issues enforcement policy. PMID- 10130747 TI - Assisted suicide. Kevorkian debate blurs the border between judicial and legislative law. AB - Staying current with the day-to-day drama surrounding Jack Kevorkian is nearly impossible for a bimonthly newsletter, but several significant events are worth exploring--rulings on the constitutionality of Michigan's law barring suicide assistance, the impact of the 20th Kevorkian-assisted suicide of a physician, and the public's response to the book Final Exit. PMID- 10130748 TI - Human experimentation. United States and Canada decide to slow down human reproduction research. AB - Louise Brown, the world's first "test-tube" baby, celebrated her 15th birthday on July 25. Three months later, the whole field of in vitro fertilization and human embryo research was thrown into a tizzy. Public reaction in response to embryo cloning experiments in the United States brought a halt to the research project, and the release of a set of recommendations by an expert panel in Canada called for limits on embryo tests and experimentation. Each event contains the same underlying message--it's not nice to meddle with Mother Nature. PMID- 10130749 TI - Health care reform. Ethicists speak out on reform tactics and strategies. AB - President Clinton's health care reform package has been sent to Congress where it is expected to become a focus for target practice. Whether it remains a cohesive effort or becomes riddled with holes remains to be seen. The following articles show the importance of ethical considerations in reformulating the nation's health care system. PMID- 10130750 TI - Advance directives. Living wills touted as a way to cut health costs. PMID- 10130751 TI - Religion and ethics. Catholics reflect on their identity in future health care alliances. AB - The development of integrated delivery networks under health care reform will entail a shift away from focusing on how to manage individual institutions to creating new relationships among provider and community organizations that have previously held unshared visions and values. The Catholic Health Association, St. Louis, has recognized the need for network sponsors to "be able to articulate the nonnegotiables for the Catholic ministry, yet be flexible to choose between having any presence and having presence through the power to influence." What exactly is negotiable will be put to the test in the near future, as the following articles point out. PMID- 10130752 TI - Ethics consultation. Study shows wide variability in consultants' recommendations. PMID- 10130753 TI - The morality of induced delivery of the anencephalic fetus prior to viability. AB - In situations where anencephaly is diagnosed and where the mother's life or health is threatened Roman Catholic hospitals are faced with the dilemma of waiting until viability before inducing the fetus, thus potentially putting the mother at further risk. According to most Roman Catholic ethicists, induced delivery before viability is contrary to the Church's prohibition of direct killing of the innocent. The authors propose for discussion a reconsideration of this position in the case of the anencephalic fetus and conclude that taking the life of such a fetus does not constitute an attack on its personal dignity and therefore is morally permissible. PMID- 10130754 TI - Procuring organs from a non-heart-beating cadaver: a case report. AB - Organ transplantation is an accepted therapy for major organ failure, but it depends on the availability of viable organs. Most organs transplanted in the U.S. come from either "brain-dead" or living related donors. Recently organ procurement from patients pronounced dead using cardiopulmonary criteria, so called "non-heart-beating cadaver donors" (NHBCDs), has been reconsidered. In May 1992, the University of Pittsburgh Medical Center (UPMC) enacted a new, complicated policy for procuring organs from NHBCDs after the elective removal of life support. Seventeen months later only one patient has become a NHBCD. This article describes her case and the results of interviews with the health care team and the patient's family. The case and interviews are discussed in relation to several of the ethical concerns previously raised about the policy, including potential conflicts of interest, the definition of cardiopulmonary death, and a possible net decrease in organ donation. The conclusion is reached that organ procurement from non-heart-beating cadavers is feasible and may be desirable both for the patient's family and the health care providers. PMID- 10130755 TI - The cost of ethics legislation: a look at the Patient Self-Determination Act. AB - The Patient Self-Determination Act (PSDA) requires hospitals to ask patients upon admission whether they have an advance directive. Although the PSDA has received extensive criticism, little attention has been paid to the cost of the law, either during its legislative course or following its implementation. Nonetheless, several tangible and intangible costs are associated with the PSDA. Such costs may be incurred by different parties. This paper examines the costs and benefits of the PSDA and illustrates the extent of some of its tangible costs. The incremental start-up cost for one institution's response to the PSDA is estimated to be $49,304 ($1.31 per admission) and the total implementation cost of the program to be $114,528. In addition, the national incremental start up cost for hospitals to implement the PSDA is estimated to be between $43,625,114 and $101,569,922. Finally, the potential implications of the PSDA for future governmental health care ethics regulation are discussed. PMID- 10130756 TI - Human growth hormone: the dilemma of expanded use in children. AB - In the specialized area of pediatric endocrinology, the use of human growth hormone (hGH) both for children who have a growth hormone abnormality and for the treatment of non-hGH-deficient children who are short is a current clinical reality that raises important ethical questions. Generally speaking, the use of hGH for those children who are clearly lacking it is an efficacious intervention based upon established clinical criteria. The use of hGH for children who are short, but have no growth hormone abnormality is ethically and clinically more controversial. The moral conundrum of how to gain knowledge about new medical treatments that may be beneficial to children while, at the same time, ethically enrolling them in clinical trials with placebo arms in order to gain such knowledge will continue to be a contentious issue in the conduct of research and in the delivery of health care. In addition, there are questions about what ought to be studied and whether a physical characteristic such as short stature ought to be viewed as a circumstance of less than optimal health. PMID- 10130757 TI - The social and ethical implications of universal access to health care in Russia. AB - The availability of free health care to all citizens has been regarded as a great achievement of the Soviet society. In recent decades, however, decreased funding of the state-run health care system has led to a deterioration in the quality and quantity of available medical equipment and services. More than 50 percent of the Russian population is dissatisfied with the health care system and the attitudes and moral standards of their health care providers. This article discusses the degree, nature, and some of the causes of the public's dissatisfaction and concludes with a preliminary look toward the future of the Russian health care system. PMID- 10130758 TI - Solemn oath of a physician of Russia. PMID- 10130759 TI - Working on the Clinton Administration's Health Care Reform Task Force. PMID- 10130760 TI - Bioethics consultation. PMID- 10130761 TI - On a probabilistic set covering model for diagnosing psychiatric disorders. AB - Correct diagnosis and treatment of the patients attending a hospital is the foremost requirement if that hospital is to be a profitable proposition. F.T. DeDombal achieved 70% reduction in unwanted surgeries and almost 100% reduction in delayed surgeries in cases of acute abdomen through computer-aided diagnosis. Similarly, R. Boom et al proved an increase in the professional efficiency of internees in diagnosing cases of jaundice, acute abdominal pain & upper G.I. bleeding after they started using computer. N.G. Rao reported diagnostic accuracy of 94% for various types of anemias with the use of expert system developed by him. Johri & Guha showed an enhancement of performance of non-expert clinician in tackling psychiatric disorders from 64% to 86%. Many developed countries have developed data bases for studying the epidemiological patterns of various diseases for future health planning and combating strategy. Another advantage of computer based diagnosis is that it will provide uniformity for defining diseases, symptoms & signs which is very important for pursuing medical research. A very simple methodology is described in this paper which can provide data driven as well as heuristic driven approach to medical decision making. To start with, this approach has been used to analyse psychiatric disorders but can be implemented elsewhere with the same efficiency. PMID- 10130762 TI - Role of social marketing in health care. PMID- 10130763 TI - Designing health care organisations for excellence. PMID- 10130764 TI - Inventory management of medical store of a superspecialty hospital. PMID- 10130765 TI - Functional status of bio-medical engg. departments in tertiary care hospitals--a comparative study. AB - The Bio-medical Engineering departments of two major hospitals having high-tech equipment needed for routine day to day patient care were compared with respect to their staffing pattern, proficiency, frequency of failure of major and minor equipment and predictable/non-predictable 'Down time' of the selected equipment using non-parametric statistical test. The study shows that Bio-medical Engineering Department (BME) of our Institute though not full fledged as compared to Hospital 'B' however showed better results in bringing down the down time both in major, minor equipment. The major cause of failure of equipment in both the hospitals was found to be rough handling, the need for imparting training to physicians, nurses, paramedical personnel dealing with bio-medical equipment and its role in preventive maintenance is discussed. Based on the study recommendations were made for preventive maintenance, purchase policy and linked to the policy of administration. Recommendations were made to bring down the Down time to acceptable limit though not for complete elimination. PMID- 10130766 TI - A study of disposal of hospital wastes in a rural teaching hospital. AB - The present study was carried out in order to observe and analyse the waste disposal patterns in a 500 bedded, multidisciplinary hospital located in a rural area. The hospital under study is a teaching hospital attached to a Medical college and has been functioning for over ten years. Data were collected by means of pre-structured interviews and on-the-spot observations of the various stages in the waste disposal chain. It was observed that the hospital does not have a documented wastes management and disposal policy. The disposal of wastes is not properly supervised and is exclusively entrusted to the junior most staff from the house keeping department. The disposal of all categories of hospital wastes, in general, leaves much to be desired and even pathological wastes were observed to be disposed off, on the open ground with scant regard to aesthetic considerations. Both the internal as well as external transportation of hospital wastes were found to be far from satisfactory. PMID- 10130767 TI - Universal precautions--a critical review. AB - The route of HIV transmission are now well defined. For health care workers the major occupational risk is from parenteral exposure to infected blood or other body fluids. To prevent such exposures, it would be prudent for HCWs to assume that all patients are potentially infected and a set of precautions applicable universally be followed in contacts with all patients. The provisions of "Universal Precautions" apply to blood, CSF, genital secretions and all body fluids. It is essential that barrier protection and washing of hands be practiced, body fluids be handled with care, correct sterilization and disinfection procedures be followed and a suitable system of waste disposal be evolved. Although the Universal Precautions have been useful in abating some of the more extreme behavior associated with treating AIDS patients and in establishing a rational approach to infection control, some of the recommendations have not been found to be efficacious or cost effective. Preventive measures recommend on the basis of demonstrated efficacy and aimed at routes of exposure that represent true risk are needed. The risks for occupational infection with blood borne pathogens have been a source of concern for health care workers (HCWs) because of their frequent and often substantial exposure to patient blood and body fluids. HCWs have long been identified as a group "at risk" for occupationally acquired Hepatitis B infection. With the development of acquired immunodeficiency syndrome (AIDS) epidemic, both HCWs and policy makers have become increasingly concerned about occupational risk from blood borne infections.(ABSTRACT TRUNCATED AT 250 WORDS) PMID- 10130768 TI - Role of tertiary care hospitals in primary health care. PMID- 10130769 TI - Selective versus comprehensive PHC (primary health care). PMID- 10130770 TI - Flexible budgeting and variance analysis: why leave staff nurses in the dark? PMID- 10130771 TI - Beyond hospital walls: restructuring for the future. PMID- 10130772 TI - Community health care and health promotion. AB - Health-promotion-based home care can be viewed in the context of the worldwide transition from an industrial to a global service society and the World Health Organization definitions of health and health promotion. Accordingly, British Columbia's Capital Region has adopted a number of innovative approaches to promote health, shift care to the home and use resources more appropriately. PMID- 10130773 TI - Health care lessons from Thailand. AB - Thailand's health care system incorporates the private and public sectors. The government regulates health care through a system of capping, which protects its interests while providing a climate for competition. As a result, the private sector has developed and implemented some interesting concepts in health care as it turned to prevention, hospital care alternatives, neighbourhood-based ambulatory care and home care. The author suggests that Canada could benefit by examining some of Thailand's innovations. PMID- 10130774 TI - International activist pursues partnerships in fight against tobacco epidemic. Interview by Matthew D. Pavelich. PMID- 10130775 TI - A hospital and community in partnership: "case management coordinated care model in a community setting.". AB - Eighteen months ago, a small Ontario community hospital teamed up with Home Care to develop and implement a system of care delivery that would provide quality care within existing financial obligations and constraints. This article describes why the model, "Case Management Coordinated Care Model in a Community Setting," was chosen, how it works and how it is evaluated. Readers are encouraged to examine the successful implementation of this new collaborative concept of care, given today's limited funds and mandate to improve the use of community and hospital resources. PMID- 10130776 TI - Discharge planning in Cape Breton Region: standardizing the process. AB - In the fall of 1991, Cape Breton's Regional Services Planning Office conducted an exploratory study of discharge planning within the region. The review compared the personnel involved in the discharge planning process and noted the strengths and weaknesses of the discharge procedures in the region's hospitals. The study recommended the development of a uniform discharge planning information tool and a common matrix for collecting discharge information for all the hospitals in the region. The recommendations were subsequently addressed by a utilization subcommittee established in February 1992. The results were the development of a regional discharge planning form, a guide for implementation and a suggested approach to improving hospital bed utilization within the region. PMID- 10130777 TI - Walking the talk: how effective boards accelerate performance. Interview by Elizabeth Preiss, Ron Shulman, and Patrick O'Callaghan. AB - The interviews demonstrated the belief that boards are accountable for ensuring the effective performance of their organizations. A board's obligation and authority is not limited to recruiting, appointing and replacing the organization's CEO and officers. It must also guide, shape, improve and reward what people do on the job. Performance management is not a simple process. It depends on a number of contributing factors operating in concert. To perform well, people must understand what is expected of them, their work context and their role. They must receive appropriate feedback on how they are doing from someone whom they respect and trust, someone with insight into their jobs and authority to manage them. The board's ability and obligation to contribute leadership, to be the primary force steering the organization, rests on the effectiveness with which it is able to play the performance management role. PMID- 10130778 TI - U.S. health system reforms offer opportunities for Canada. PMID- 10130779 TI - Alive and Well: a new initiative in health promotion. PMID- 10130780 TI - Patients first: small hospitals in Ontario favour patient-focused care. AB - Is patient-focused care the model of the future? In 1993, CEOs of selected small hospitals across Ontario were asked if the patient-focused-care model is used in their facilities and, if so, to provide examples of some of the activities involved. This article presents a summary of the study's findings, discusses the model's merits and challenges for implementation, and offers several recommendations to assist hospitals contemplating the introduction of this model of health care delivery. PMID- 10130781 TI - Efficiencies and humane healing culture define restructuring at St. Charles tertiary-care center, Bend, Oregon. PMID- 10130782 TI - Medicare program; withdrawal of the Provider Reimbursement Review Board Hearing Manual--PRRB, HHS. Notice. AB - This notice announces that the Provider Reimbursement Review Board (PRRB) Hearing Manual is obsolete in its entirety. The PRRB Hearing Manual is no longer necessary because the applicable procedures for the processing of appeals are contained in chapter 2900 of the Provider Reimbursement Manual. PMID- 10130783 TI - Medicare program; required laboratory procedures for rural health clinics--HCFA. Final rule with comment period. AB - This rule revises the range of laboratory tests rural health clinics (RHCs) are required to provide in order to meet the Medicare conditions of participation. We are eliminating tests not classified as waived under the Clinical Laboratory Improvement Amendments of 1988 (CLIA). RHCs that elect to furnish tests not waived under CLIA must comply with CLIA requirements as specified in regulations on Laboratory Requirements and will receive appropriate payment for covered laboratory services. We are making these changes because the CLIA program introduced participation requirements that may cause some RHCs to withdraw from the program, creating a shortage of available medical care in some areas. PMID- 10130784 TI - Physician performance standard rates of increase for federal fiscal year 1994 and physician fee schedule update for calendar year 1994--HCFA. Final notice with comment period. AB - This notice announces the calendar year (CY) 1994 updates to the Medicare physician fee schedule and the Federal fiscal year (FY) 1994 performance standard rates of increase for expenditures and volume of physicians' services under the Medicare Supplementary Medical Insurance (Part B) program as required by sections 1848 (d) and (f), respectively, of the Social Security Act. The physician performance standard rates of increase for Federal FY 1994 are 8.6 percent for surgical services, 10.5 percent for primary care services, 9.2 percent for other nonsurgical services, and 9.3 percent for all physicians' services. The fee schedule update for CY 1994 is 10.0 percent for surgical services, 7.9 percent for primary care services, and 5.3 percent for other nonsurgical services. This notice also references the surgical and nonsurgical designations for new and revised procedure codes in the Physicians' Current Procedural Terminology, to be used in applying the CY 1994 updates and for establishing and measuring expenditures under the MVPS for FY 1994. These designations appear in Addendum C of the final rule with comment period entitled "Medicare Program; Revisions to Payment Policies and Adjustments to the Relative Value Units under the Physician Fee Schedule for Calendar Year 1994 (BPD-770-FC)," published elsewhere in this Federal Register issue. The new and revised surgical and nonsurgical designations are subject to public comment. In addition, this notice addresses public comments on the "initial" procedure-specific list of surgical services published in our November 25, 1992, notice. PMID- 10130785 TI - Process for health care technology assessments and recommendations for coverage- AHCPR. PMID- 10130786 TI - Statement of organization, functions, and delegations of authority--HCFA. PMID- 10130787 TI - Winners and losers. AB - The health care reform debate has entered a politically explosive new stage: figuring out which Americans would come out ahead and which would pay more under Clinton's plan. PMID- 10130788 TI - Here a quack, there a tax. PMID- 10130789 TI - On-site continuing education: one big step for small laboratories. AB - This report describes a new approach to continuing education which has been demonstrated to be effective in a number of small community hospital laboratories in a remote rural setting. PMID- 10130790 TI - Congress takes aim at Clinton plan. PMID- 10130792 TI - Strategic planning is imperative for '94. PMID- 10130791 TI - LTC insurance faces funding, controls. PMID- 10130793 TI - Are there any known benefits in offering happy hour at a long-term-care facility? PMID- 10130794 TI - 1993 multi-facility operators survey. Riding the bull. AB - The nation's largest chains are responding to an improved economy by acquiring properties to bolster their growth, according to this year's CLTC survey of multi facility operators. PMID- 10130795 TI - Order of Excellence awards. AB - We again honor a distinguished quartet of long-term-care providers with the Order of Excellence. This year's inductees--two skilled-nursing facilities and two retirement communities--were evaluated for their performance in nine categories by industry colleagues from across the U.S. All About Life Rehabilitation Center, Fond du Lac, WI; The Pediatric Center at Plymouth House, Norristown, PA; Marshall Manor, Marshall, VA; Mt. San Antonio Gardens, Pomona, CA. PMID- 10130796 TI - Customizing continence. Providers are learning that diapers aren't the only answer. PMID- 10130797 TI - Don't mix up specialized services. Program dictates for mentally ill and retarded residents can be difficult to sort out. PMID- 10130798 TI - Little changes can cause big delays. PMID- 10130799 TI - Heroes in home care & hospice. PMID- 10130800 TI - Community health nursing--shelter from the storm. AB - The East Coast experienced a debilitating storm just before Christmas 1992. Nurses went above and beyond the call of duty to care for their community; from their exemplary work, one agency developed a policy to prepare the entire community so that the next disaster won't be a disaster. PMID- 10130801 TI - The VNA (visiting nurse association) and SCP (senior companion program) program: a natural partnership. AB - Senior companions can be the eyes and ears of a visiting nurse association, with companions turning into friends and offering the nurturing and emotional support that VNAs may not have time to provide with the ever-increasing demand for home care. PMID- 10130802 TI - Paying tribute to our heroes. PMID- 10130803 TI - The third age in the Third World in the third millennium. AB - The international community is coming to the realization that in Third World countries the aging population is not a burden but a resource to aid society in many ways. In the Dominican Republic one program has tapped elders' resources to fill a need otherwise left gaping. PMID- 10130804 TI - Empirical evidence on the deep pockets hypothesis: jury awards for pain and suffering in medical malpractice cases. PMID- 10130805 TI - Slip resistant floor cleaner & treatment. PMID- 10130806 TI - The changing incidence of chronic lung disease. AB - This paper reports an examination of the incidence of chronic lung disease in premature infants admitted to the neonatal intensive care unit at Liverpool Maternity Hospital. From January 1980 to December 1989 details were obtained for these infants such as gestation, weight, sex, survival to discharge and ventilatory support received. The findings show that a total of 242 infants had developed chronic lung disease; one-third of these were born in 1988 or 1989. Logistic regression suggests that chronic lung disease was significantly associated with being male, low birthweight, low gestation, surviving to discharge, and being born in 1988 or 1989. Among infants at 'high risk' of this condition, mortality had significantly decreased and the incidence had significantly increased. This increase is not fully explained by changes in the population admitted during the last decade. A rising workload should be anticipated in terms of the specialised follow-up and care required by these babies. PMID- 10130807 TI - Perception of need for child psychiatry services among parents and general practitioners. AB - Previous research has found the prevalence of child psychiatric disorder in the general population to be between 7% and 25%, and higher among attenders at some general practitioners' surgeries. This survey examines the perception of need among general practitioners and parents of general practice attenders, and compares this with the prevalence of disorder found using the Rutter A Questionnaire for Parents. The results support claims that the services for children with psychiatric disorders are inadequate. However, many children with disorders are presented to other professionals by their parents. Ways to extend the service synergistically to meet some of the unmet need are discussed. The need for further research to be undertaken, which would effectively target such scarce resources, is identified. PMID- 10130808 TI - Patient advocacy: psychiatrists' perspectives. AB - This paper describes the responses of senior psychiatrists in Wales to a questionnaire exploring their knowledge and beliefs about patient advocacy. The results suggest mainly pro-advocacy attitudes; respondents who had not met advocacy groups involving their own patients holding attitudes almost as positive as those who had. However, despite these findings, further research is required to define the specific benefits of advocacy before further resources are diverted to the development of such services. PMID- 10130809 TI - Purchasing services for end stage renal failure: the potential and limitations of existing information sources. AB - Renal replacement therapy services already consume considerable health service resources and, as patient stock levels rise and unmet need continues to be identified, the pressure to spend more on renal services will increase. Purchasers of services must decide how to respond to these pressures, and a clear assessment of need and the effectiveness and efficiency of services are key issues when contracts are being developed for such services. This paper reports an examination of the quality and potential of information currently available from routine data sources to support the contracting process. The results expose gaps in current knowledge and identify areas for future research. Locally, purchasers should consider surveying their population to identify the incidence of renal disease, including the reasons for any unmet need. Nationally, research is required to investigate the following: the relationship between ethnicity and the development of renal disease; the criteria for allocating patients to the alternative treatment modalities; and the treatments in terms of their costs and cost-effectiveness. PMID- 10130810 TI - The relationship between a severity of illness indicator and mortality and length of-stay. AB - One important determinant of the cost and outcome of medical care is the severity of illness; there is no routinely available severity measure used in the United Kingdom. An American clinical information system, Medisgroups, was used to allocate 2,279 general medical patients to one of five admission severity groups in an English teaching hospital. The results showed a highly significant association between increasing severity and both length-of-stay and mortality. However, a further analysis of patients in the ten most common Diagnosis Related Groups showed that diagnostic group alone accounted for about twice the amount of variation explained by severity. The addition of severity to Diagnosis Related Groups only gave a very small rise in the overall explanatory power. These results are broadly consistent with those from larger American studies, which suggest that severity of illness at admission may not be as important as widely supposed in explaining variations in length-of-stay and mortality. PMID- 10130811 TI - Does labour substitution occur in district general hospitals? AB - A survey of 31 district general hospitals found a large variation in hours of medical and nursing time available per inpatient episode in general medicine and its associated specialties. These differences could not be attributed to case-mix variation or severity. The application of weightings to different grades of nursing and medical staff had little effect on either the rankings of hospitals by staff hours per episode, or the overall degree of variation in staffing levels. The results show no evidence to suggest that hospitals with relatively low levels for one category of staff are compensated by relatively high levels of another. It would appear that those hospitals with high levels for one category of staff are also well provided for the others. This evidence of inequality may reflect historic patterns of resource allocation that recent manpower policies might seek to redress. Studies of the relationship between staffing levels and quality of patient care should be undertaken before adopting a policy of labour redistribution. PMID- 10130812 TI - An evaluation of the Northumberland Infectious Disease Report. AB - An evaluation of the quarterly Infectious Disease Report for Northumberland was undertaken by postal questionnaire. The response to the survey was encouraging, suggesting that this method of communicating local information is not only acceptable, but also effective and perceived as having a positive impact on practice. PMID- 10130813 TI - Evaluation of Communication Aid Centres in England and Wales. AB - This paper reports the findings of an evaluation (funded by the Department of Health) of six Communication Aid Centres established in 1983. The evaluation was undertaken to assess the effectiveness of these Centres in meeting their set objectives, and to examine service costs and client satisfaction. The findings show that the work of each Centre was effective in meeting its stated objectives, but that the work of individual Centres reflected its own specialised interests. Two problems with current funding arrangements were highlighted. First, the need to replace the original funding by locally based finance, and second, the funding of communication aids for clients. The findings also show that the specialist service provided by these Centres can be managed at costs per person assessed at, or below, non-specialist services in health districts. Client satisfaction with the services provided by the Centres was high. PMID- 10130814 TI - In search of inspiration. PMID- 10130815 TI - Enriching the golden years. Eldercare foodservice report 1993. PMID- 10130816 TI - Important Medicare and Medicaid changes in OBRA '93. PMID- 10130817 TI - Special report on health care delivery systems and reimbursement. Proposed safe harbors provide limited guidance to providers. PMID- 10130818 TI - Health care antitrust guidelines clarify enforcement policy. PMID- 10130820 TI - Health-care lighting. PMID- 10130819 TI - Health care is hot. PMID- 10130821 TI - Design research. In a first-ever research initiative, Interiors looks at primary healthcare. PMID- 10130822 TI - Dream into reality. NBBJ creates a unique hospital especially for children. Children's Hospital & Health Center, San Diego. PMID- 10130823 TI - Meditative power. University of California San Diego Medical Center. PMID- 10130824 TI - A corporate mood. National Health Laboratories, New York City. PMID- 10130825 TI - Managed design. PMID- 10130826 TI - Washington's reform proposals: the debate begins. PMID- 10130827 TI - UB-92 transition period underway. PMID- 10130828 TI - Bridging the parallel interests of physicians and hospitals. PMID- 10130829 TI - The bottom line. PMID- 10130830 TI - Don't you sometimes wish you were better informed? PMID- 10130831 TI - Doing the rumba. PMID- 10130832 TI - Financial management. Mixed marriages. PMID- 10130833 TI - Financial management. Quid pro quo. PMID- 10130834 TI - Health care providers' financing faces obstacle course in Clinton reform plan. PMID- 10130835 TI - What happens to Medicare and Medicaid under the Clinton reform plan? PMID- 10130836 TI - Managed competition, antitrust, and the Clinton health reform plan: too modest a proposal. PMID- 10130837 TI - Clinton administration's new antitrust guidelines duck many important issues. PMID- 10130838 TI - Clinton's health care reform proposal: promising but structurally flawed. PMID- 10130839 TI - Can price and regulatory controls replace free market competition in the drug industry? PMID- 10130840 TI - OBRA '93 limits on physician referrals and Medicare cuts: a taste of what's to come? PMID- 10130841 TI - Fraud and abuse elements in Clinton health reform plan: overkill or needed ammunition? PMID- 10130842 TI - Prospects for health policy. PMID- 10130843 TI - Rurality and resource allocation in the UK. AB - Unlike many other countries, the health and health care of rural populations are not often seen as specific concerns by the United Kingdom's health service. This paper considers the present ways in which resource allocation within the National Health Service takes account of rural areas and highlights a number of inconsistencies. It goes on to discuss ways in which rurality could influence future resource allocation formulas, and identifies priorities for future research. PMID- 10130844 TI - Cost of illness studies in health care: a comparison of two cases. AB - Cost of illness (COI) studies describe the economic burden of disease on society. In this article a standard procedure for a COI study is developed, including the explicit definition of the disease, choice of relevant variables and appraisal of direct and indirect costs. COI studies can be incidence-based or prevalence based. The adjustment of cost figures for time preferences and the performance of a sensitivity analysis are presented. The standard methodology is applied to diseases in two different areas. The first disease category is dyspepsia, a complaint with a rather somatic background. The second is schizophrenia, a mental syndrome. In performing COI studies in practice, however, researchers are forced to deviate, in many aspects, from the theoretical standards. In this article these choices, and the reasons behind these choices, are explained. Furthermore, we discuss certain problems regarding the reluctance to make a diagnosis regarding certain diseases, the reliability and the validity of the sources used and the absence of certain figures. The value of the information derived from COI studies for policy-making is assessed. PMID- 10130845 TI - Cost-effectiveness of a tobacco 'quit and win' contest in Sweden. AB - Tobacco is one of the major causes of premature deaths in the world, and any effort to improve the cost-effectiveness of smoking cessation is worth while. The costs and effects in years of life saved (YLS) were estimated for a tobacco 'Quit and Win' (Q&W) contest in Sweden. The contest was conducted during the autumn of 1988 and included two strategies: a national mass media strategy and an organizational strategy for Stockholm County. A total of 12,840 people participated in the Q&W contest. The model for analysis included programme effects and programme costs, and the data was presented in (YLS). Both effects and costs were discounted. Data about non-smoking participants after 12 months and the number of spontaneous quitters was based on random samples of participants and of the general population, respectively. The programme costs included intervention as well as evaluation costs, e.g. costs of personnel, campaign materials, distribution, prizes for the contest, rent and administration and overhead costs for the project group and the collaborating organizations. The cost per YLS varied between US$188 and US$1222. The Q&W contest, as a method of helping tobacco users quit, compares favourably with most preventive and treatment programmes, and the method seems to be quite an effective way for society to use scarce resources. PMID- 10130846 TI - Policy elements as predictors of smoking and drinking behaviour: the Dutch Cohort Study of secondary schoolchildren. AB - Changes in smoking and drinking behaviour in relation to policy and economic variables were investigated among Dutch secondary schoolchildren in two measurements. The response rate was 82% during the second measurement. In bivariate analyses the policy variables 'pressure by tobacco advertising' and 'incorrect knowledge about dangers of tobacco consumption' and the economic variables 'money' and 'free availability from parents' predicted weekly smoking (among all respondents), and 'the experienced anti-smoking campaigns' predicted weekly smoking (among non-smokers during the first measurement). Only the economic variables predicted weekly drinking. A general and a specific theory of different mechanisms were designed to investigate whether these predictors are independent of other influences. We assumed that changes in smoking and drinking behaviour are predicted at three levels: (a) previous behaviour, (b) socio demographic variables and (c) possible causes and intermediary factors. In multivariate analyses, only the prediction of weekly smoking by 'experienced anti smoking campaigns' and weekly drinking by economic variables remained significant. The findings are relevant when policy priorities are developed. PMID- 10130847 TI - Does expenditure on pharmaceuticals give good value for money?: current evidence and policy implications. AB - Drugs are becoming a particular target for health care cost containment measures, as part of the increasing pressure to improve the value for money from the use of health care resources. This has led to an exponential growth in the number of economic evaluations of pharmaceuticals, many of which have been funded by pharmaceutical companies. A review of the existing literature on economic evaluation of pharmaceuticals was conducted in order to classify studies and to document their results. The review identified 85 evaluations, published between 1986 and 1991, that were suitable for analysis. In most published studies it was found that in the treatment or prevention of a disease, a drug intervention was more cost-effective than no intervention and, in a number of cases, drug interventions were at least as cost-effective as other forms of intervention. In evaluating the published evidence it is important to note that positive studies are more likely to be published and that the quality of study methods varies. However, the studies can be of use to policy makers with an interest in securing more value for money, although economic assessments should be applied equally to all health technologies. PMID- 10130848 TI - Assessing the effectiveness of quality assurance. AB - Traces the origins of the fashion for quality assurance and discusses the requisites of a quality assurance strategy. On the basis of a Department of Health funded study in England and Wales in 1989, draws attention to the wide range of activities which have been swept into the quality assurance net, the striking differences between the factors cited as constraining or facilitating the development of quality assurance, and the abysmal lack of data on cost or resources or to any systematic monitoring and evaluation. Suggests that the purchaser-provider split may have worsened the situation. PMID- 10130849 TI - Take forth your human resource agenda--manage performance and reward. AB - Suggests that managing performance should not just be a once-a-year appraisal of people, but should be a dynamic process integrating the various aspects of organizational and human resource management, including staff appraisal and development, as well as quality, standards, targets and outcomes, etc. Points out that the best route to organizational success is through people, and that service industries particularly are highly dependent on people to achieve the business goal. States that managing performance is achieved by managing change and communication, motivating and developing, and equipping the organization with the skills needed to move forward successfully. Integrating into the overall strategy, performance links inextricably with reward, job design, workforce profiling, competences and development. To be a learning company needs commitment to employee development--this, in turn, means commitment to managing human resources effectively, therefore managing reward and performance. PMID- 10130850 TI - Clinical management. The case of the consultant psychiatrist. AB - Review the management role of consultant psychiatrists in the light of recent NHS reforms. Tries to identify the needs of clinicians and their patients and what is causing dissatisfaction within the profession. Examines various reforms. Concludes that although difficult, the care leadership within the psychiatric area should lie with the consultant psychiatrist who should have the experience necessary in order to define the qualifications and care necessary for each patient. PMID- 10130851 TI - HIV/AIDS. Some organizational and managerial issues. AB - Discusses factors emerging from research into the management and organizational processes involved in developing services for HIV/AIDS which affected the speed and character of the response made by health authorities. An early response was promoted by perceived high local prevalence, an existing service infrastructure, and high status individuals "championing" the issue and helping to foster a mobilizing sense of crisis. Responses were shaped by the diverse interests and perspectives of those developing services; the lack of established guidelines for treatment and service delivery; and ring-fenced funding. The idiosyncratic nature of initial service development has sometimes made later strategic choices difficult. Argues that if the momentum of service development is to be sustained, HIV/AIDS needs to be integrated into mainstream service provision and managers need improved information about local prevalence and the evaluation of service initiatives. PMID- 10130852 TI - Meeting the needs of new parents. AB - Details recent research carried out into the needs of new parents. Details the findings, and discusses the broad recommendations, which are that there is a need to review parent education and develop a strategy for change so that the benefits from contact with, and expenditure on these clients can be maximized. PMID- 10130853 TI - The great urban outdoors. AB - The Great Urban Outdoors is a management development exercise with a difference. Most outdoor exercises take place in an "unfamiliar" rural setting. This one is set in an urban environment, which is reasoned to have an air of unfamiliarity to many health care managers. Stresses the need to clear learning objectives and active tutoring. For this exercise, proposes a framework based on a model of managerial leadership. Explains how the location and tasks to be carried out can be varied to suit the participants. Particular stress is laid on the debriefing phase, to ensure that the learning objectives have been met and can be applied to real health care challenges. PMID- 10130854 TI - Health care and higher education. The time diary approach for management development. AB - Discusses a project which aimed to determine the employee development needs of Plymouth Polytechnic and Derriford Hospital NHS senior technicians. Using the time diary approach, it revealed employer and employee variance in opinions over desired managerial competences and variance in the training needs for the two organizations. In the case of NHS technicians it was possible to define areas where provision of a new training scheme would be beneficial. Their counterparts in higher education revealed a much lower degree of interest in the provision of external assistance to develop their managerial skills further. Concludes that the Polytechnic would need to implement structural changes to the work environment before introducing any new training schemes for technical staff. PMID- 10130855 TI - Commentary on health care reform and opportunities for dietitians. AB - Health care in Canada is driven by global economic pressures. Financing solutions will be found through a national strategy for effective quality management of the health care delivery system. Achieving quality effectiveness will demand a new level of accountability and participation in planning from both users and providers. Restructuring and reform will support a shift from disease treatment and from traditional institutions to health promotion and primary care prevention in community based settings. Along with the shift in focus and delivery systems will be new opportunities for dietitians in new roles and in new settings. The specialized knowledge of dietitians, nourishing people under all life's circumstances, is highly valued by society. Now is not a time when dietitians can afford to be passive about our preferred role in the health system. This is a time to learn new skills and to move beyond the role boundaries of the past. This is a time to invest in research that leads to cost-effective, accountable practices. PMID- 10130856 TI - Early postoperative feeding--results of a North American survey. AB - Early postoperative feeding (EPOF) practices among North American institutions were investigated using a survey questionnaire to obtain descriptive information regarding the overall utilization and criteria used to identify candidates for EPOF. EPOF was defined as the initiation of enteral nutrition support two to 48 hours postoperatively in major abdominal and thoracic surgical patients. Two hundred and ninety-seven questionnaires were mailed; 170 were completed. Sixty nine (41%) institutions reported using EPOF. Feeding was initiated less than 12 hours postoperatively in 16% of centres; 84% reported EPOF 13-48 hours postoperatively. The majority (88%) of institutions did not have a specific nutritional guideline for determining which patients should receive EPOF. Objective and subjective nutritional indices, degree of preoperative malnutrition and type of surgery were considered by 23% of respondents when determining the need for EPOF. Percent weight loss, albumin and the anticipated postoperative NPO were considered the most reliable objective indices while decreased dietary intake, cachexic appearance and anorexia were considered the most reliable subjective indices. The results reveal that less than 50% of institutions surveyed use EPOF in major abdominal and thoracic surgical patients and the criteria used to identify candidates for EPOF were found to be variable. PMID- 10130857 TI - An assessment of the need for a dietitian in an out-patient HIV clinic. AB - People suffering from the acquired immunodeficiency syndrome (AIDS) often experience involuntary weight loss and malnutrition. Altered body composition, recurrent opportunistic infection and a decline in immune function are associated with the progression of the human immunodeficiency virus (HIV) infection to AIDS. The factors that might affect nutritional status in AIDS are numerous and include a reduced food intake, increased metabolism, malabsorption and the acute phase response to infection. It is not clear what difference nutritional intervention can make to the progression of the disease. However, there is a consensus that it has an important role to play during the course of the disease. A report was compiled to assess the requirement for a dietitian in an HIV Clinic (the Southern Alberta Clinic) and the role of the dietitian in that position. Nutritional and anthropometric data were collected from medical records. In addition, Clinic physicians were sent a questionnaire. It was found that clients, when seen by the dietitian, had lost weight and had more gastrointestinal symptoms and a lower CD4+ lymphocyte count than the average Clinic patient at their initial Clinic visit. The report recommended that all Clinic staff use body mass index as a screening tool for referral to the dietitian and that good nutrition be promoted by the Clinic as an important part of the care of the HIV infected person. The assessment recommended a 0.4 full-time equivalent position within the Southern Alberta Clinic. PMID- 10130858 TI - MedWatch: FDA's new medical products reporting program. PMID- 10130859 TI - Focus on: The Methodist Hospital, Houston, Texas, Biomedical Instrumentation Department. AB - The Methodist Hospital in Houston, Texas, is a 1,527-bed, tertiary care teaching hospital that is both a national and international referral center for medical care in many medical and surgical specialties. The Biomedical Instrumentation Department provides services throughout the hospital in all aspects of clinical equipment management and clinical engineering. With 29 employees and an annual budget of $2.1 million, the department enhances efficiency in the delivery of quality medical care. PMID- 10130860 TI - Focus on: Thomas Jefferson University Hospital, Department of Biomedical Instrumentation. AB - Technology management services at Thomas Jefferson University Hospital are provided by two distinct cost centers: The Department of Biomedical Instrumentation and Jefferson Biomedical Shared Services. The in-house division of the Department of Biomedical Instrumentation (BMI) provides clinical engineering services to the hospital, a 717-bed, tertiary care facility. BMI supports traditional patient care instrumentation, as well as dialysis machines, anesthesia machines, lasers, and the neonatal extracorporeal membrane oxygenation (ECMO) systems. In addition, the department supports over 3,000 personal computers and associated peripherals, and provides research, design, database support, device evaluation, incident investigation, and product problem investigation services. Jefferson Biomedical Shared Services, an integral component of the Department of Biomedical Instrumentation, offers a shared services program to local area hospitals. It has a current client list of 11 major healthcare institutions with annual revenues approaching $3,000,000 per year. PMID- 10130862 TI - Development of a computerized equipment management program at Children's Hospital "Bambino Gesu" of Rome, Italy. AB - The main activities of the Clinical Engineering Service at the Children's Hospital "Bambino Gesu" of Rome, Italy and the computerized system developed in house for electromedical equipment management are described here. The approach recently adopted and implemented for an objective cost/benefit evaluation of the equipment installed at the hospital is also described. The program outputs appear to be effective tools, both in evaluating maintenance costs and workload increases from new equipment installations and, more relevantly, in comparing similar equipment from different manufacturers during prepurchase evaluation. PMID- 10130861 TI - Meeting the educational needs of clinical equipment users. AB - Training equipment users to operate medical equipment effectively and safely is one of the most important and difficult tasks of clinical engineers. As medical equipment proliferates and becomes more complex, the task of education also becomes more difficult. The Joint Commission on Accreditation of Healthcare Organizations (JCAHO) requires that all equipment users be trained annually in proper operating procedures for the equipment they use and that the training be documented. Therefore, each hospital must develop educational programs to meet those needs. This paper illustrates the use of an interactive computer-assisted instruction (CAI) program, entitled EquipTeach, to provide an effective, standardized and cost-effective method of training equipment users at the John Dempsey Hospital of The University of Connecticut Health Center in Farmington, Connecticut. PMID- 10130863 TI - National health reform: the restructuring of American health care. PMID- 10130864 TI - Winners and losers under national health reform. PMID- 10130865 TI - Competing proposals for health reform from Republicans and Democrats. PMID- 10130866 TI - Politics and economics of health care finance: a symposium. Introduction. PMID- 10130867 TI - The politics and economics of health care finance: tough questions and no easy answers. PMID- 10130868 TI - A primer on managed care. PMID- 10130869 TI - Public and private strategies for reforming long-term care. PMID- 10130870 TI - The politics and economics of dependent children's mental health care financing: the Oklahoma paradox. PMID- 10130871 TI - Patient-centered ethics for health services managers. PMID- 10130872 TI - Health care administration and outcomes management. PMID- 10130873 TI - How many cooks will spice health reform? PMID- 10130874 TI - How doctors really feel about the Clinton health plan. PMID- 10130875 TI - Health-care stocks that will profit under reform. PMID- 10130876 TI - When a patient threatens to sue a colleague. PMID- 10130877 TI - Medicare payments: what's new for 1994. PMID- 10130878 TI - Where doctors treat the poor for free. PMID- 10130879 TI - The American work force: 1992-2005. Industry output and employment. AB - Projections show services providing more than half of new job growth; in goods production, construction adds jobs, while manufacturing employment declines. PMID- 10130880 TI - The American work force, 1992-2005. Occupational employment: wide variations in growth. AB - The economy is expected to continue generating jobs for workers at all levels of education and training; service workers are projected to be the largest group, while professional specialty is expected to be the most rapidly growing group. PMID- 10130881 TI - Quick retrieval of analyzed specimens. PMID- 10130882 TI - Installing a performance planning and results system. PMID- 10130883 TI - LMIP (Laboratory Management Index Program): the next generation in productivity measurement. PMID- 10130884 TI - Automating training records. PMID- 10130885 TI - Indiana delays $60 million in planned Medicaid cuts. PMID- 10130886 TI - State Medicaid directors protest abortion directive. PMID- 10130887 TI - Antitrust ruling to stand. PMID- 10130888 TI - Ruling favors Minn. providers. PMID- 10130889 TI - Columbia wants to punch up gains with computerization. PMID- 10130890 TI - IVAX set to acquire McGaw in $40 million stock swap. PMID- 10130891 TI - Columbia to build $35 million orthopedic hospital in Houston. PMID- 10130892 TI - Antitrust horror story" more fiction than fact? PMID- 10130893 TI - Suit may force changes in management contracts. PMID- 10130894 TI - Mental health companies ally. PMID- 10130895 TI - Sun Healthcare to buy Mediplex Group in deal worth about $320 million. PMID- 10130896 TI - Reform resolution. Congress is poised for the monumental debate that will decide healthcare's future. PMID- 10130897 TI - Epic posts higher losses, gives execs lower bonuses. PMID- 10130898 TI - Health plans face pressure to find 'report care' criteria that will make the grade. PMID- 10130899 TI - Concern about diseases fuels moves to conserve blood. PMID- 10130900 TI - Flow of financings points to primary care's importance. PMID- 10130901 TI - Ind. town's only acute-care hospitals may merge. PMID- 10130902 TI - 2 R.I. hospitals join forces. PMID- 10130903 TI - Patient accounts and CQI--one department's experiences. AB - When people think of the quality revolution in health care, most probably will not consider the patient accounts area as the leader. Patient accounts professionals seeking to rectify this reputation need to encourage healthcare facility management staff to pay more attention to the monthly volume of patient complaints. Customer satisfaction levels can be controlled by a CQI-invested patient accounts department that effectively manages the patient billing process. PMID- 10130904 TI - The implications of program management for professional and managerial roles. PMID- 10130905 TI - From matrix management to pure program management: an evolution or a revolution? PMID- 10130906 TI - Application of a program management model in rehabilitation services in an acute care facility. PMID- 10130907 TI - Job turnover and regional attrition among physiotherapists in northern Ontario. AB - Results of an initial study indicated that the most significant factor affecting retention for Physiotherapists in Northern Ontario was perceived opportunity for career development. A follow-up study was completed two years later to determine: 1) actual job turnover and regional attrition among physiotherapists in Northern Ontario; and 2) the predictive validity of variables identified in the first study regarding job turnover and regional attrition. Job turnover occurred in 29.5% of those sampled and the regional attrition rate was 12%. Discriminant function analysis revealed factors affecting job turnover and regional attrition including professional experience, practice location, opportunity for career development and size of community of residence. Based on previous intention, indicated by participants, follow-up revealed that the initial study correctly predicted 77.5% of those who changed their jobs and 74.1% of those who left Northern Ontario. Identified factors provide direction for the development of strategies for recruitment and retention of physiotherapists. PMID- 10130908 TI - Effect of weekend physical therapy treatment on postoperative length of stay following total hip and total knee arthroplasty. AB - Postoperative length of stay (LOS) may be affected by more intensive physical therapy following surgery. This study was designed to assess whether LOS could be affected by weekend physical therapy following surgery in patients who had undergone total hip arthroplasty (THA) or total knee arthroplasty (TKA). Weekend coverage for these patients was made possible by increased staffing in the Physical Therapy Department. The study group consisted of 84 patients who had undergone THA or TKA and had physical therapy treatment the weekend following surgery. The Control group consisted of 53 patients who had undergone THA or TKA prior to the implementation of the weekend intervention program. A retrospective chart audit was used to obtain pertinent information about control group patients. In the total sample mean LOS following weekend therapy (10.84 days) was significantly different (p < 0.05) from mean LOS prior to implementation of the study (12.28 days). Significant decreases in postoperative LOS were also found within the two subgroups of patients who had undergone THA and TKA. The results indicate that physical therapy treatment the weekend following THA or TKA significantly decreases postoperative LOS when physical therapy resources are increased to accommodate this increase in coverage. PMID- 10130909 TI - Robotic automation of medication-use management. AB - In the October 1993 issue of Physician Assistant, we published "Robots for Health Care," the first of two articles on the medical applications of robotics. That article discussed ways in which robots could help patients with manipulative disabilities to perform activities of daily living and hold paid employment; transfer patients from bed to chair and back again; add precision to the most exacting surgical procedures; and someday carry out diagnostic and therapeutic techniques from within the human body. This month, we are pleased to offer an article by Sharon Enright, an authority on pharmacy operations, who considers how an automated medication-management system that makes use of bar-code technology is capable of streamlining drug dispensing, controlling safety, increasing cost effectiveness, and ensuring accurate and complete record-keeping. PMID- 10130910 TI - A decade of progress in continuity of care. PMID- 10130911 TI - Long-term care and the minority elderly. PMID- 10130912 TI - R&I's 1993 job$ survey. PMID- 10130913 TI - JCAHO: setting the standard for quality health care. PMID- 10130914 TI - Healthcare finance and economics. AB - This article is a wide-ranging overview of the field of healthcare financing, health economics and the development of financial management. It vividly demonstrates that all healthcare systems have too many demands and too few resources, and that problems can manifest themselves in different forms depending on the precise funding structure of the health service concerned. PMID- 10130915 TI - Health policy in a changing world. AB - Perhaps never has the world changed--politically, economically and socially--as much as it is at present. With this in mind, Dr Beske asks how can adequate healthcare provision be guaranteed world-wide, and how can intensive co-operation to combat the inequity of health care be achieved? It is well known that the level of health care differs greatly throughout the world, but the author draws the conclusion that 'The organization of the health service is one of the tasks of each country. But just as solidarity is demanded on a national level, international solidarity is also required'. PMID- 10130916 TI - Project-managing the commissioning of the Chelsea and Westminster Hospital. AB - Feasibility studies to establish the reality of planning, designing and building a major new (650-bed) general teaching hospital on a restricted urban site in a time-scale of five years--instead of the more usual time-scale of twelve or more years for a similar UK National Health Service building--commenced almost six years ago. These studies constituted the groundwork for the birth of the new Chelsea and Westminster Hospital. This article discusses the process and time span of the commissioning and occupation of this new hospital, and deals specifically with the problems encountered. PMID- 10130917 TI - Clinical quality assurance: practice parameters. PMID- 10130918 TI - The health of the world's children: reality and prospects. AB - For the children of some of the world's poorest and most populous countries things are getting better. Aids education and control programmes coupled with the spread of political democracy are the main reasons for the sharp fall in infant and child mortality rates. The health of the world's children and why it has improved in some parts of the world--and why it has deteriorated in others--are observed and discussed by the author from an economic, health, political and social point of view. PMID- 10130919 TI - Getting maximum from your hospital bed--by reducing preoperative stay. PMID- 10130920 TI - Organization of infection control program. PMID- 10130921 TI - Standardisation of timings for general surgical operations--its applications in hospital planning and management. PMID- 10130922 TI - Principles and practice of medical audit (medical care evaluation). AB - 1. Medical audit is a philosophy in the field of medical science which has reached to an advanced stage of practice in Western World, but yet to reach and percolate into Indian medical community. 2. Of late, community is getting increasingly aware of its health rights, gradually community participation in health matters including quantum and quality of case, has started increasing. Thus community leaders have started demanding for quality of medical care and accountability of those, responsible for delivery of medical care at various levels. 3. Medical audit or Evaluation of medical care is an answer to ensure the quality of care. But there are misgivings and distrust about medical audit due to its terminology. 4. There is need to education the medical, nursing and paramedical staff regarding medical audit and its sole purpose of self education and improvement of patient care activity. The present paper spells out fundamentals of medical audit, its scope and limitations. PMID- 10130923 TI - Protective efficiency of gloves. PMID- 10130924 TI - Approaches to employees grievance handling in hospitals. AB - A grievance is a discontent or dissatisfaction caused by various reasons in hospitals. The grievances affect the individual performance and poor quality of services inspite of high investment on highly qualified manpower and sophisticated technology. The grievances can be identified by direct observation, grievance procedure, gripe boxes, open door policy and exit interview etc. The grievances need proper and prompt handling at the level of occurrence. A four stage method is suggested for successful handling of grievances. PMID- 10130925 TI - Health systems research (HSR)--a tool of management in maternal and child health. PMID- 10130926 TI - Health care challenge in coal mines community. AB - The present paper depicts salient features of environment and living conditions with the comparison of various diseases prevalent among underground coal miners, surface workers, asbestos mine workers and general population of Jharia-Dhanbad coalfield as conducted by CMRS during the past few years. The investigations on coal miners' community comprise of different morbid conditions with respiratory (22%), Pneumoconiosis (11.6%), Skin (35%), Eye (29%), Intestinal parasitic infestation (44.6%), Anaemia (42%), Immunostatus (V.D.R.L. Positive-19.9%), Status of injuries and Blood pressure, Water-borne diseases, housing facilities and excreta disposal. The paper also includes the analysis of disease pattern obtained from hospital records of two coal mines which depicts 19.1%, 24.7% and 16% members of coal miners' families suffering from disorder with respiratory, gastro-intestinal and fever respectively. With speedy industrialization of the country, the mining of coal resource comes first in the chain of socio-economic development. The speedy human industrial activities are based on 80% steam, metallurgical and thermal electrical energy which hinges on coal wings. The coal has also gradually occupied all the phases of social life, our clothes, books, newspapers, cooking gas, chemical paints, dye stuff, oil phenyl, Benzene, Naphthalene, Coal tar, scents and various types of unaccountable products come out from coal derivatives and pushed to serve in the today's market for our daily exigencies. Every day one finds a new coal based industry is coming up in the area. The coal is utilized in two hundred ways in our various walks of social life.(ABSTRACT TRUNCATED AT 250 WORDS) PMID- 10130927 TI - Evaluation of post-operative stay after inpatient major surgery--a prospective study. AB - The present study was carried out at a single surgical unit of AIIMS, to evaluate the risk and benefit of short post-operative stay in adult population after inpatient surgery under general anaesthesia for various intra-abdominal, Genitourinary, breast and thyroid disorders including emergency procedures. The age of the patients ranged from 17-71 years. Patients with minor surgical procedures were excluded from the study. A total number of 138 patients were included in the study comprising of Test group. The patients were discharged within 5 days of the operative procedure. There was no major morbidity or mortality related to early discharge. The mean duration of postoperative length of hospital stay was 5.25 days in test group of patients as compared to 10.20 in control group of patients. In conclusion therefore, short hospitals stay following major procedures is safe and effective in reducing the cost of hospital care to the patient and hospital both. PMID- 10130928 TI - Physical planning parameters in setting up super specialty hospitals/medical centres under present day challenges. PMID- 10130929 TI - Hospitals as health centres. AB - As a signatory to the Alma-Ata Declaration in 1978, the Government of India is committed to taking steps to provide 'Health for All' to its citizens by 2000 AD. We have agreed to adopt the primary health care approach, for achieving the goal of HFA. In this context, it is very essential to redefine the role of hospital. It will not be possible to achieve the goal-HFA unless, hospitals start functioning as health centres. This paper discusses in details how a hospital can function as health centre. PMID- 10130930 TI - Evaluation report on DH and HM course (training cum contact programme). PMID- 10130931 TI - Managerial issues and prospectives towards meeting the hospital requirements and challenges by 2000 A.D. PMID- 10130932 TI - Managerial approach for the control of AIDS infection in hospitals. PMID- 10130933 TI - Is a patient a consumer? PMID- 10130934 TI - Study of utilisation of elevators in a teaching hospital. PMID- 10130935 TI - Activity sampling of nurses of a sub-acute ward of a large hospital. AB - A study was conducted in a 43 bedded subacute family ward of a large hospital to find out the adequacy and efficiency of its nursing service. Activity analysis in respect of nurses was carried out by Activity Sampling Technique. The study revealed that out of 334 activities, observed, 78 (23.3%) were non-productive, whereas 256 (76.7%) were productive. Out of the productive activities, 148 (44.3%) were for direct patient care mainly comprising of 46 (31.1% for carrying out technical procedures, 36 (24.32%) for determining patients' needs, 20 (13.15%) for preparing patients for various procedures and 15 (10.14%) for assisting in technical procedures. Number wise the nurses were found to be adequate. PMID- 10130936 TI - Future planning of mortuaries in Delhi. PMID- 10130937 TI - Eye camps--providing medical coverage to the under privileged. AB - The eye camps make a very important contribution to both curative and preventive eye health care. In addition to serving the under privileged they also lessen the burden on the existing hospitals. Planning of such camps has been described vis-a vis description of three camps done in far-flung areas. PMID- 10130938 TI - Operation research in delivery of health care & community welfare in Gumla District of Chhotanagpur Region, Bihar. PMID- 10130939 TI - Surveillance system for hospital acquired infection. PMID- 10130940 TI - Long-term health care planning: a need for financial and mental wellness. AB - Personal wellness not only is a matter of physical well-being. It is also based on financial security and planning. This is the case in making decisions about one's own personal health care system provisions. Each person has the right to decide about his or her health care system prior to becoming disabled and unable to make such decisions. In the case of incurable disease and comatic existence or needing life support, a person should have signed powers of attorney and living wills that will be adhered to when the need arises. This article will present these personal financial health care system provisions. PMID- 10130941 TI - An evaluation of the Australian government's policy of access and equity strategy in selected localities. AB - Australia is a country of 17 million people from diverse cultural and racial backgrounds. To respond to this diversity, the Australian Commonwealth Government in 1986 announced an Access and Equity Strategy as part of the Agenda for a Multicultural Australia. The Strategy was evaluated in 1991, and included five locality studies which assessed the implementation of the Strategy from the perspective of target groups of Aboriginal and non-English speaking people (NESB). This article describes this evaluation and the development of the Australian multicultural policy within which the Strategy is conceived. The findings and recommendations from the locality studies provide case examples of government wide policy development and implementation processes. PMID- 10130942 TI - Access to primary care among young African-American children in Chicago. PMID- 10130944 TI - Gold Book/Buyer's Guide 1994. Companies; product section; geographic section; 800 telephone numbers; fax numbers. PMID- 10130943 TI - Wealth transfer through voluntary death. AB - Today, the hopelessly ill who are insured must choose between futile treatment and prolonged morbidity. Legalizing physician-assisted death for the hopelessly ill would broaden patient choice and conserve scarce resources. To ensure that the saved resources will not be re-channeled to more futile treatments for other hopelessly ill patients, those who choose dignified passage should be allowed to determine how the saving from their refusal to a prolonged death is to be re deployed. Converting projected entitlements into death benefits at a discount would not only reduce health-care and retirements costs but improve allocation of scarce resources. PMID- 10130945 TI - 1994 emergency medical services state and province survey. AB - This 1994 Emergency Medical Services State and Province Survey gives you the most complete collection of data we've ever provided. Listings include 50 states, the District of Columbia, the Virgin Islands and 10 Canadian provinces. Our sincere thanks to the many people who responded to our request for information. PMID- 10130946 TI - Emergency medical services. Organizations. PMID- 10130947 TI - The ethicist. AB - The 1990s seem drawn for major changes in the U.S. health care delivery system. After a quarter century of piecemeal changes to compensate for the cost dislocations caused by passage of the federal Medicare and Medicaid programs, legislators, moved by a high level of demand from buyers, third-party payers, and consumers, are at last positioned for some structural revamping. Nothing is certain, however, as evidenced by the shifting deadline for introduction of the current Administration's approach to solutions. In this article, the author uses a fictionalized scenario to imagine the status of our health care system in the year 2000. As in 1990, much will remain to be done, even if much will have been accomplished. PMID- 10130948 TI - What will future historians say about the Clinton health reform act. AB - In a series of articles that began in the March-April 1992 issue of Physician Executive, the author has provided historical background on the debate that currently rages on the nature and course of national health reform. In addition to tracing past efforts to expand access to health care for Americans, Dr. Goldfield has provided unique insights into the American political process and into the American psyche. In this final article in the series, Dr. Goldfield provides his personal assessment of what the chances for real reform of the health care delivery system are and his views on what that reform will ultimately look like. He calls himself a skeptic, not a cynic, saying that the likelihood of meaningful change is small, given the numerous proponents of the status quo. PMID- 10130949 TI - An integrated model for measuring management performance. AB - A model of organizational performance measurement that compels attention to the proper balance among quality, cost, and access; takes into account patient perceptions; produces clear targets for continual quality improvement (CQI); yields easily understood graphical displays; and captures health care organizations in simultaneous operation across the functions of cost, quality, and access was designed for the 22 medical treatment facilities of the Strategic Air Command. Such a tool provides practitioners, payers, and patients a range of information--from systemwide, facility, clinical service, and practitioner specific insights on current performance to resource forecasts and easily understood targets for CQI. This case study shows that integrated performance modeling may be useful in examining many health management and reform issues. PMID- 10130950 TI - Information technology enters the doctor's office: Part I--Six design and implementation lessons. AB - Because of a trend toward increased cost escalation outside of the hospital, in the ambulatory care setting, Metropolitan Life Insurance Company initiated an Ambulatory Utilization Review ("AUR") program in 1986. This is an overview of the lessons learned since that time. Some of what was learned was simply--or not so simply--"how to," the subject of this first article in a two-part series. Once this deceptively difficult technology was understood, there were two additional categories of lessons to learn: the extent of expected program results and some unexpected results. This second set of lessons is reviewed in Part II of the article. PMID- 10130951 TI - Reforming the South African health care system. AB - South Africa's success in reforming its health care delivery system will depend very largely on its success in reforming its shattered political and economic structure. In this article, the author describes the social, political, and economic factors that dominate the South African scene and suggests the alternative courses that are available to bring the country out of its apartheid past. Both South Africa and its internal and external critics will have to approach the task with patient understanding and flexibility to achieve lasting and satisfactory results. PMID- 10130952 TI - Study tour examines health care systems in Germany, Holland--Part II: The German system. AB - In October 1992, the American College of Physician Executives sponsored a study tour to Berlin, Germany, and Amsterdam, Holland. Meetings were held with government officials, third-party payers, and providers, and on-site visits were made at hospitals, clinics, and academic centers. The purpose was to study the health care delivery system in those countries and to share some insights with the countries' hosts on the U.S. system. In a series of reports that began in the July issue of the journal, 5 of the 10 study tour participants describe their impressions of the tour and of the health care systems in the countries that were visited. In the first report, the health care delivery systems of the United States, Germany, and Holland were compared. In this report, the German system is analyzed in greater detail. PMID- 10130953 TI - Pharmaceuticals in Australia: priorities in a teaching hospital. AB - In spite of rigorous government programs for control of the pricing and dissemination of pharmaceutical products in Australia, the list of new drugs continues to grow and prices to increase. To regain control over drug usage at Royal Adelaide Hospital, the Hospital Drug Committee developed a rating method that judged drugs on the basis of their cost-benefit to patients. The ratio of a total quality score to a total cost score becomes the determinant of additions to the hospital formulary. The background for the Australian approach to pharmaceuticals and the new evaluation technique at the teaching hospital are described in this report. PMID- 10130954 TI - Revenue models in managed competition. AB - As physicians and medical centers move into a changing reimbursement era, it is valuable for physician executives to have tools to help physicians understand the relationships among costs, revenues, and utilization. These relationships differ within the fee-for-service, prepaid, and managed fee-for-service revenue models. This article describes these different revenue models and highlights the benefits and issues associated with each model. PMID- 10130955 TI - The last public trust: inner city hospitals and the provision of sanctuary. PMID- 10130956 TI - The benefits of business process mapping. AB - We believe that you should view an organization as an integrated organism. Treating parts of this organism without first understanding the whole and how the parts interrelate leads to suboptimal solutions. "Reinventing" an organization requires fresh, objective, new insights. We believe Business Process Analysis and its associated "mapping" is a superior approach to corporate improvements because of: 1. Its emphasis on business processes. 2. Its organization-wide approach. 3. The discipline of requiring process definitions and building the matrices (mapping) required. 4. The involvement of all decision makers. 5. Its usefulness in so many vital areas of management. We know that, given proper top management support and a proper implementation, valid and acceptable improvements will result. PMID- 10130957 TI - Play a speaking part in your organization's financial picture. PMID- 10130958 TI - Counting down to RSNA. PMID- 10130959 TI - P.T. Barnum lives! PMID- 10130960 TI - MDIS (Medical Diagnostic Imaging Support): the new standard in filmless imaging. PMID- 10130961 TI - Teleradiology: meeting the challenge of the '90s. AB - Despite spectacular scientific advance and contributions to patient care, radiology stands at a frightening crossroads in its 100-year history. Economic and political changes endanger the fundamental principles of patient care, research, and teaching and threaten to dismantle the subspecialized expertise that characterizes our great academic medical institutions. In response, we should be creative and find new ways to exploit this expertise in an effort to maintain clinical and research excellence. Teleradiology can be used to improve the quality and decrease the cost of medical care at home and abroad--meeting the challenge of the 1990's. Teleradiology and other telemedical applications can benefit from the nation's investment in telecommunications infrastructure. The enabling technologies to provide teleradiology services are available and the feasibility of performing primary interpretations has been established. We offer our experience and plans as a model for diversifying and strengthening the academic radiology department of the future. PMID- 10130962 TI - ACR-NEMA DICOM support for exchange media: a report on the activity of Working Group V. PMID- 10130963 TI - To manage by objective you must understand the objective. PMID- 10130964 TI - Physician involvement in marketing imaging services. PMID- 10130965 TI - Fulfilling referring clinicians' needs. AB - We have come to expect autonomy and accountability only to ourselves. This is a false paradigm. Poor service encourages a do-it-yourself spirit or a search for an alternate provider. We must recognize, however, that addressing quality does not begin with fixing an individual problem. This process must begin with redefining quality. This will require better communication and teamwork. PMID- 10130966 TI - Planning care for elderly people using the balance of care model. AB - Planning health and social services for client groups has become an integral part of the planning process within the United Kingdom. The Department of Health's microcomputer model--Balance of Care--attempts to analyse different policies for the care of the elderly and to assess the consequences of such policies in terms of the resources required. This paper shows how the model operates using data from a survey of elderly people in Northern Ireland. An attempt is also made to introduce economic principles into the decision making process. Attention is drawn to the economist's definition of costs and how this can differ from the public expenditure concept of costs. A further area of interest is the process of allocating people to specific types of care. The economic approach points to the need to make explicit valuations of the benefits of various services against a background of costs. Within this context, the Balance of Care model can be used to consider various scenarios and as such is a useful tool in the decision making process. PMID- 10130967 TI - Towards a formalization of quality in health care contracts. AB - The paper explores ways of how measurable indicators of quality of health care might be specified in health care contracts of NHS providers. The paper assesses the likelihood of defining formal outcome-related indicators. If outcome-related indicators are not measurable, then process or input-related quality indicators should be used as a second best choice. These should have certain desirable properties. The paper spells out these properties and points to examples. PMID- 10130968 TI - Hospital capital structure decisions: theory and practice. AB - The paper explores capitalisation decisions within the hospital sector. This is done theoretically by examining the appropriateness of capital structure theory of hospitals and also in a real world context of soliciting the views of hospital chief financial officers. The ways in which capital decisions are made is described and the relationship of practice to theoretical models discussed. PMID- 10130969 TI - Physician influence in interorganizational relationships between academic medical centers and community hospitals. AB - This study analyzes cooperative interorganizational relationships (IORs) between two different types of health care organizations. It proposes a power perspective analysis to better understand why IORs which represented many rational advantages to both partners were so difficult to realize in practice and often with only modest results. Hypotheses are tested explaining how physicians, as groups, exert important controls and can largely determine the results that can be realized in any IOR aimed at modifying medical education and patient referrals. PMID- 10130970 TI - Assessing the effectiveness of communication in organisations: the communication audit approach. AB - Within the past decade there has been an enormous growth of interest in the field of organisational communication. Numerous books, book chapters and journal articles have been devoted to this topic. However, much of this output has been at the level of common sense exhortation, has tended to be anecdotal, or at best has been based upon the personal experience of the authors. Certainly within the UK there has been little hard empirical research into the nature, flow and functions of communication within organisations. This paper proposes the introduction of a much more systematic methodology for the study of such communication, based upon what is known as the 'communication audit' approach. This approach is fully explained and the main methods employed in communication audits outlined, together with their relative advantages and disadvantages. It is also pointed out that audits are now widely employed to measure performance in other spheres of the organisation, such as finance, and it is argued that the implementation of this system to measure communication performance is therefore long overdue. The benefits for organisations of carrying out audits are highlighted and suggestions are made about possible future directions for research in this area. PMID- 10130971 TI - Emerging risk: failure to detect hearing disability in newborns. The problem: lack of screening programs for "normal" newborns. PMID- 10130972 TI - Futile v. terminal care: is there a difference? PMID- 10130973 TI - A tool that makes sense in the "data rush" era. PMID- 10130974 TI - A national survey of ethics committees in state mental hospitals. AB - In June 1992, a national mail survey was directed to 204 state inpatient psychiatric institutions. This study was implemented following the 1992 Joint Commission on Accreditation of Healthcare Organizations (JCAHO) requirement that hospitals put in place some means with which to address ethical issues. The goals of the study were: 1. to examine state mental hospital characteristics and their response to the JCAHO requirements; 2. to describe healthcare ethics committee (HEC) composition, function, and role; 3. to study patient and family access to a HEC; and 4. to discover ethical issues most frequently addressed. The survey response rate was 71%. Of the 145 responders, 62 had HECs in place, and 53 were in the process of implementing HECs. There were no differences between JCAHO accredited institutions and non-accredited facilities with regard to having HECs. Physicians accounted for 22% of HEC membership, followed by nurses (15%), and administrators (12%). Twenty-six percent of facilities systematically notified patients about existence of the HEC; 71% of facilities had no patient request for HEC services in the last year. A patient's danger to others, and resuscitation policy were issues most frequently (23%) heard by HECs. PMID- 10130975 TI - The PSDA and treatment refusal by a depressed older patient committed to the state mental hospital. AB - Since 1991, the Patient Self-Determination Act (PSDA) has required all health care institutions that receive Federal funds to inform patients upon admission of their rights to make decisions about medical care and to execute advance directives. Implementation of the PSDA presents a special challenge for state mental hospitals. The relevance and possible negative therapeutic impact of discussing end of life decisions at the time of an acute psychiatric admission has recently been raised in the literature. Other ethical dilemmas arising from the interplay between mental illness and informed consent for medical treatment, particularly for older patients committed to state mental hospitals, have been highlighted by the PSDA. In this article we discuss some of the issues raised by implementation of the PSDA in this setting. PMID- 10130976 TI - Clozapine rationing in a state mental hospital: reviewing a HEC's case consultation. AB - Clozapine (Clozaril) is a new, powerful, costly anti-psychotic medicine, with a possible serious side effect (agranulocytosis) that entails weekly blood monitoring. In a three hundred bed state mental hospital that is allotted thirty clozapine slots (high costs effectively rationing this drug), a woman with schizophrenia responds minimally to this medication. Her attending physician wishes to withdraw the medicine and give it to another patient with schizophrenia on the ward who might have a better response. The woman's family threatens to make a public outcry. Both the attending physician and the family ask the HEC for a consult. PMID- 10130977 TI - Ethics and value strategies used in prioritizing mental health services in Oregon. AB - The authors describe the ethical considerations underlying the inclusion of mental health services into a prioritized health care system. The Oregon Health Plan is a process for defining and delivering basic health services to an entire state. As the plan was developed, the mental health community needed to decide whether or not to participate in the process and, if so, how. Lengthy discussions among mental health consumers, family members, and providers led to a strategy that emphasized the integration of mental health and chemical dependency services into a comprehensive and universal health care program. This approach appears to have achieved relative parity for mental health. PMID- 10130978 TI - Ethics networks and mental health care: overcoming the stigma. PMID- 10130979 TI - The transfer of patients' ethics information among cooperating institutions: a future function of ethics networks. AB - With increasing use of ethics resources by health care teams, the number of patients transferred from one care setting to another who may have had ethics consultations is rising rapidly. There has been virtually no discussion in the ethics literature and no experience in our community addressing questions concerning the continuity of ethics care and the transfer of ethics information. Our ethics committee faced the following questions during a recent consultation. Should there be continuity of ethics care between institutions? If so, what should be the nature of the communication? How is continuity best accomplished? Do ethics consultants or committees incur additional liability following the transfer of care? Where should the boundaries of confidentiality be drawn? How can existing health care ethics networks facilitate continuity of ethics care? We address these ethical and logistical questions and hope to encourage others to report their views on these issues. PMID- 10130980 TI - Should expertise in bioethics be required for serving on a HEC? Yes/No. PMID- 10130981 TI - Should HEC's concurrent case review recommendations always be recorded in each patient's records? Yes/No. PMID- 10130982 TI - Perspectives. TennCare's "shock therapy" worries doctors, patients. PMID- 10130983 TI - Perspectives. All together now--Congress seeks elusive reform compromise in '94. PMID- 10130984 TI - EPIC (European Prototype for Integrated Care). Integrated care of the elderly. PMID- 10130985 TI - Overview of electronic health record (EHR). PMID- 10130986 TI - Toward an electronic patient record. PMID- 10130987 TI - Identity numbers. PMID- 10130988 TI - Take HEART: meeting the info needs of executives. PMID- 10130989 TI - Real-time, 3-D simulations: improving OR efficiencies & outcomes. PMID- 10130990 TI - Leading healthcare consultants speak out. Interview by Bill Childs. AB - In 1993 American consulting firms worked overtime helping executives of healthcare delivery systems cope with recent developments and anticipate coming events. From vertical integration to mergers and acquisitions, from reengineering to downsizing, it appeared that industry activity amounted to full employment for consultants. Recently Bill Childs, Healthcare Informatics' editor-in-chief and market observer, took the opportunity to visit with two leaders in the healthcare consulting field--Jim Reep, Chairman of First Consulting Group, Long Beach, Calif., and Richard Helppie, CEO of Superior Consultant Co., Farmington Hills, Mich.--and record their views of the state of the industry and their visions for its future. Excerpts from their discussions follow. PMID- 10130991 TI - Closing the healthcare gap: putting the patient in the picture. PMID- 10130992 TI - An emerging paradigm: open systems for multi-entity provider organizations. PMID- 10130994 TI - Reform's impact on health info networks. PMID- 10130993 TI - Health security card: missing link? Or political gimick? PMID- 10130995 TI - National health care: a global perspective. PMID- 10130996 TI - Business responds to elder-care needs. AB - Every day more than 5,600 people in the United States celebrate their 65th birthday. Parent care, like child care, is increasingly becoming a business issue. PMID- 10130997 TI - Around-the-clock medical coverage. AB - Marrying workers' compensation and health insurance plans to reduce administrative workloads and get a firm grip on expenses. Can it work? PMID- 10130998 TI - Mechanical systems for health care facilities. PMID- 10130999 TI - Barefoot doctors vs. Scroogecare. PMID- 10131000 TI - Personality types of flight crew members in a hospital-based helicopter program. AB - PURPOSE: To determine the personality preferences of flight crew members in a hospital-based helicopter emergency medical service (HEMS) using the Myers-Briggs Type Indicator (MBTI), and to differentiate and compare these preferences between crew specialties and a historical control population. METHODS: A prospective cohort study was conducted of all active crew members (nurses, respiratory therapists and pilots) in a hospital-based flight program. Data collected included the results of the MBTI, gender, age and years of flight experience. RESULTS: Crew members were represented by 14 of 16 possible MBTI personality types, with three types predominating. For each crew specialty, extroversion preferences predominated over introversion, and perceiving characteristics predominated over judging characteristics. Differences existed by crew specialty for the sensing-intuition and thinking-feeling dimensions. CONCLUSIONS: A personality typology has been established for individual and group preferences within one hospital-based HEMS program. This data begins to develop a data base and an investigative protocol for understanding some of the human factors regarding flight programs. Future research should focus on expanding the data base and exploring specific crew interactions based on additional diagnostic and evaluative methodologies. PMID- 10131001 TI - Controlled trial of an intravenous fluid warmer. AB - INTRODUCTION: In critically ill patients (e.g., trauma victims) prevention of hypothermia is an important goal. Infusion of warm fluids has been addressed in the hospital setting, but not in the air medical transport setting. PURPOSE: The purpose of this study was to test the efficacy of an intravenous (IV) fluid warming device that is well-suited for the air medical transport environment. METHOD: The warmer studied was used with IV fluid heated to approximately 38 degrees C (100 degrees F) and evaluated in environmental temperatures of -16 degrees C (3 degrees F), 2 degrees C (36 degrees F), and 22 degrees C (72 degrees F). The warmer group was compared to a control group of similarly treated IV fluids without a warming device. Temperatures were measured at baseline, 15, 30 and 60 minutes. RESULTS: The 30- and 60-minute fluid temperatures were higher in the warmer than in the control group for all three environmental temperature settings. At 15 minutes, fluid temperatures were higher in the warmer group for the 2 degrees C and -16 degrees C, but not the 22 degrees C, environments. There was no significant drop in temperature in the warmer group in the 22 degrees C and 2 degrees C settings, but a decrease was noted in the -16 degrees C environment. There was a significant drop in the control group at all temperatures tested. CONCLUSION: The IV fluid warmer tested effectively maintains the temperature of warmed IV fluids in temperatures above 2 degrees C. At -16 degrees C there was significant heat loss, but the loss was significantly less when compared to the control group. PMID- 10131002 TI - Avionics and airframe options: current usage and future plans. AB - The 1994 Avionics and Airframe Survey was sent to 178 chief or lead pilots of helicopter emergency medical services (HEMS) programs in October 1993, and 100 (56%) were returned. Sixty-four programs (64%) reported that they operate one helicopter exclusively for EMS, 24 (24%) operate two, and 12 (12%) reported using three or more aircraft. Interestingly, the reported percentage of programs with two or more exclusive helicopters continues to rise, increasing by 5.6% to 36%. PMID- 10131003 TI - Effect of an in-flight helicopter environment on the performance of ALS interventions. AB - INTRODUCTION: Patients transported by air ambulance are often critically ill and, thus, have a relatively high likelihood of requiring advanced life support (ALS) measures during transport. Despite this fact, the ability of the air medical crew to perform ALS interventions efficiently while in flight has not been investigated. SETTING: The study was conducted with BO 105 and BK 117 helicopters and a ground transport unit at a university hospital-based air ambulance service. METHODS: Ten flight nurses were timed performing various ALS tasks while in flight in each aircraft and in the ground ambulance. Mean times for performance of each task in the aircraft and in the ground unit were analyzed using Dunnett's method for analysis of multiple means; alpha was set at 0.01. RESULTS: Times required to perform all ALS tasks were significantly increased in the BO 105 setting compared to the setting of the BK 117 or the ground ambulance (p < 0.01). Times for performance of interventions in the BK 117 did not differ significantly from corresponding times in the ground setting. CONCLUSION: It appears that the environment of the BO 105 may impose limitations on the timely performance of certain ALS interventions. PMID- 10131004 TI - The dynamics of power in health care. PMID- 10131005 TI - The new antitrust "safe-harbors". PMID- 10131006 TI - The role of CQI in the strategic planning process. AB - This article describes the strategic planning process used to define the health care needs of a region and to prepare Henry Ford Health System (HFHS) to meet the needs of the 21st century. It presents key applications of continuous quality improvement in the development and implementation of the strategic plans for HFHS; explains how HFHS adapted the Deming/Shewhart cycle of continuous improvement for the purpose of improving its planning process; and delineates how the strategic planning, financial planning, and quality planning processes have been integrated. PMID- 10131007 TI - Strategic planning in health care: methods and applications. AB - This article reviews planning methods currently being used by health care organizations to meet current challenges and investigates the relationship of these planning methods to total quality management. It suggests that planning methods that stress the achievement of objectively defined and measurable outcomes directly related to organizational priorities are superior to methods that emphasize as endpoints the implementation of programs (processes) without direct measurement of their effectiveness. Finally, it provides an overview of planning practices within the ScrippsHealth system. PMID- 10131008 TI - Integrating strategic planning and quality management in a multi-institutional system. AB - Integrating total quality management (TQM) into the strategic planning process of a multi-institutional health system is a high priority. Through the strategic plan, system leadership gives TQM concepts prominence and visibility and provides strategic directions for their implementation. The Sisters of Providence Health System recently developed an approach to integrating TQM into its System Strategic Plan. Implementation priorities include more formalized direction for TQM by the system board, intensive TQM educational programs, greater consistency of quality information and outcome measures, and more focused attention to patient needs. PMID- 10131009 TI - Improving the strategic planning process at Alliant Health System. AB - Starting in 1986, Alliant Health System initiated a total quality management process. While strategic quality planning was not a focus initially, it became apparent that Alliant would not achieve major organizational objectives without such focus. Starting in 1989, Alliant initiated a rigorous strategic planning process. The result was alignment of the quality improvement activities in the organization, heightened management accountability, and integration of quality goals with financial incentives. This article recounts the continuing efforts to improve strategic quality planning from the point of view of the person responsible for implementing TQM at Alliant. PMID- 10131010 TI - Strategic planning for hotel operations: The Ritz-Carlton Hotel Company (Part I). AB - The Ritz-Carlton Hotel Company won the Malcolm Baldridge National Quality Award in 1992. One key to its success is its strategic planning process. This two-part article reviews the Ritz-Carlton's approach to strategic planning. In particular, it describes (1) the role of senior leadership in the planning process and (2) the specific activities that are associated with plan development and implementation. PMID- 10131011 TI - Computer software for health care CQI. AB - The transition from quality assurance to continuous quality improvement (CQI) demands a basic change from centralized to decentralized information management. In CQI, front-line staff can use personal computer (PC) software skills to manage, analyze, and act on process-related information. Information services departments play a key role in this transition by, among other things, selecting software that optimally supports the PC-based work carried out by CQI teams. A review of typical CQI team software requirements and of available PC software suggests that Microsoft Excel 4.0 is a nearly ideal software platform to support CQI teams. PMID- 10131012 TI - Total quality management in health care: taking stock. AB - Total quality management (TQM) is gaining momentum in health care. The experiences of pioneering organizations provide insights into the hurdles that many organizations face in implementing TQM. Based on their observations of these pioneers, the authors conclude that there are six key success factors for TQM in health care. This article reviews the success factors, considers the common obstacles to achieving them, and looks at some of the future directions for TQM in health care. PMID- 10131013 TI - Tutorial: implementing hoshin planning at the Vermont Academic Medical Center. AB - Hoshin planning is a systems approach to strategic planning. It is a step-by-step process for building consensus on the vital few strategic areas within which breakthroughs must occur if an organization is to meet and exceed the needs of its customers. The seven management and planning tools are the implements of the hoshin process. They provide the means for generating, deploying, and auditing the strategic work of the organization. This tutorial describes the use of hoshin planning and the seven management and planning tools to build a strategic plan for the Vermont Academic Medical Center, including lessons learned and plans for improvement. PMID- 10131014 TI - QMHC interview: Paul B. Batalden, M.D.. Interview by Marie E. Sinioris. PMID- 10131015 TI - How professionals view their patients. PMID- 10131016 TI - Kangaroo care. AB - Kangaroo Care--skin-to-skin contact between parent and baby--is becoming a popular adjunct to the routine, technology-driven care provided to premature babies in neonatal intensive care units (NICUs) across the country. Research suggests that Kangaroo Care is safe and that it is therapeutic for the infant and parent alike. The purpose of this article is to review the Kangaroo Care Program at Brigham and Women's Hospital and to illustrate how it meets the needs of parents of premature infants. PMID- 10131017 TI - Patient-based quality measurement systems. AB - Continual improvement of health care can be accelerated and evaluated by the development of patient-based measurement systems. This article provides (1) design principles to guide the development of patient-based measurement systems; (2) a specific, yet flexible method for designing and testing patient-based measurement systems; and (3) real-world examples of patient-based systems that offer a glimpse of the future. These systems can provide direct measures of successes and failures, strengths and weaknesses, and improvements and declines in the provider's capacity to produce desired health outcomes at a cost that represents value. PMID- 10131018 TI - Using patient reports to improve medical care: a preliminary report from 10 hospitals. AB - This article describes the early activities of the Picker/Commonwealth Program for Patient-Centered Care and reports results from a study of 10 hospitals trying to develop better ways of providing patient-centered care. Reported problems were relatively infrequent, but several problems occurred as often as in an earlier national study of acute care hospitals. Academic medical centers and other teaching hospitals tended to have more problems than nonteaching hospitals, but there was great variability within hospital types. The article discusses ways patient reports can be used to improve the quality of hospital care. PMID- 10131019 TI - The internal customer. AB - To realize the full potential of CQI, the needs of internal customers throughout the health care organization must be met. This is best done through a collaborative customer-supplier dialogue, where suppliers take the initiative to understand their internal customers' needs and make their own requirements clear. Unfortunately, physicians--the most critical group of internal customers--are unaccustomed to collaborative efforts and are often unwilling to participate in CQI training. The solution is to use the customer-supplier dialogue to understand physicians' unique needs so that they can be trained effectively and drawn into the CQI process. PMID- 10131020 TI - Continuous improvement in health care: transforming the hospital department. AB - Each department in a hospital is given the responsibility of managing its own day to-day work. For the hospital as a whole to change, the individual departments must undergo a similar change. As each department aligns itself with the purposes of the whole organization, synergy is created and the hospital gradually, incrementally, becomes a new kind of place to give and receive care. PMID- 10131021 TI - Strategic planning for hotel operations: The Ritz-Carlton Hotel Company (Part II). AB - The Ritz-Carlton Hotel Company won the Malcolm Baldrige National Quality Award in 1992. One key to its success is its strategic planning process. In this second part of a two-part article, Stephen Shriver concludes his review of the Ritz Carlton's approach to strategic planning. Shriver begins by outlining some key steps in plan development and goes on to describe how the Ritz-Carlton disseminates, implements, and evaluates the plan. PMID- 10131022 TI - Assessing the needs of breast cancer patients and their families. AB - Patient needs have long been elicited only through the use of customer satisfaction surveys, which unfortunately are not designed to obtain the in-depth information needed to guide the improvement of health care services. Through the use of the integrative group process and the help of many patients and hospital staffs, we developed a needs assessment survey for women with breast cancer. This article outlines this process and the results and discusses how we used these results to create a computer program designed to help women with breast cancer and their families. PMID- 10131023 TI - Tutorial: using Microsoft Excel for health care CQI. AB - The transition from QA to CQI in health care calls for decentralized data collection and analysis in conjunction with the use of personal computers to support CQI team activities. In this article, we discuss recent advances in PC software and hardware technology that make possible revolutionary changes in health care quality data management. We also present detailed examples of how to use Microsoft Excel 4.0 as a single software platform to support commonly used CQI tools and analyses. PMID- 10131024 TI - QMHC interview: Donald M. Berwick, M.D.. Interview by Marie E. Sinioris. PMID- 10131025 TI - Not my health care. PMID- 10131026 TI - Medicare program; intermediary and carrier checks that are lost, stolen, defaced, mutilated, destroyed or paid on forged endorsements--HCFA. Final rule with comment period. AB - This rule revises the Medicare regulations governing the procedures for replacing checks issued by our fiscal intermediaries and carriers that are lost, stolen, defaced, mutilated, destroyed, or paid on forged endorsements. Each State already has an established legal process for pursuing a claim for recovery of the amount of a check paid on a forged endorsement, and it is inefficient and ineffective to provide duplicative Federal requirements. These regulations stipulate that any replacement or reclamation proceedings will be carried out in accordance with the applicable State law and that a replacement check will not be issued until Medicare has made recovery on the proceeds of the original check. However, we will continue to reissue checks that have not been negotiated. PMID- 10131027 TI - Accompanying the dying patient--the doctor's role. AB - Yvon Bureau, president of the "Responsable jusqu'a la fin" foundation, spoke at the annual congress of the Quebec section of the College of Family Physicians of Canada. A social worker, Bureau spoke as if he were a doctor and asked some important questions as to what would be his relationship to his patient. His insights can be applied to anyone who works with those who are dying or terminally ill. PMID- 10131028 TI - A pastoral approach to psychiatric care. AB - Rev. Gerard Gingras is the chaplain and Lise Savoy-Malenfant, a pastoral care worker at the Centre hospitalier Robert-Giffard in Beauport, Quebec. They provide some insight into the unique techniques needed to minister to those who have a psychiatric illness. PMID- 10131029 TI - The added value of Catholic health care. AB - Thomas D. Maddix, CSC, the director of mission services at the Alberta Catholic Hospitals Foundation, looks at the values which should be the backbone of any Christian health care ministry. He challenges us to live those values. If we do not, he says, a Catholic health ministry has no right to exist. PMID- 10131030 TI - Towards a ministry of care. AB - Rev. Ralph L. Kleiter, pastor of the parish of the Holy Spirit in Saskatoon, has 30 years of experience in both urban and rural parishes. He believes that the parish can work in partnership with other groups and health care delivery systems to provide a comprehensive ministry of care for all parishioners. PMID- 10131031 TI - The outlook for 22 industries. PMID- 10131032 TI - History's lessons for health care costs. PMID- 10131033 TI - The public/private mix and human resources for health. AB - This paper examines the general question of the public/private mix in health care, with special emphasis on its implications for human resources. After a brief conceptual exercise to clarify these terms, we place the problem of human resources in the context of the growing complexity of health systems. We next move to an analysis of potential policy alternatives. Unfortunately, a lot of the public/private debate has looked only at the pragmatic aspects of such alternatives. Each of them, however, reflects a specific set of values--an ideology--that must be made explicit. For this reason, we outline the value assumptions of the four major principles to allocate resources for health care: purchasing power, poverty, socially perceived priority, and citizenship. Finally, the last section discusses some of the policy options that health care systems face today, with respect to the combinations of public and private financing and delivery of services. The conclusion is that we need to move away from false dichotomies and dilemmas as we search for creative ways of combining the best of the state and the market in order to replace polarized with pluralistic systems. The paper is based on a fundamental premise: The way we deal with the question of the public/private mix will largely determine the shape of health care in the next century. PMID- 10131034 TI - Medical technology and inequity in health care: the case of Korea. AB - There has been a rapid influx of high cost medical technologies into the Korean hospital market. This has raised concerns about the changes it will bring for the Korean health care sector. Some have questioned whether this diffusion will necessarily have positive effects on the health of the overall population. Some perverse effects of uncontrolled diffusion of technologies have been hinted in recent literature. For example, there is a problem of increasing inequity with the adoption of expensive technologies. Utilization of most of the expensive high technology services is not covered by national health insurance schemes; examples of such technologies are Ultra Sonic, CT Scanner, MRI, Radiotherapy, EKG, and Lithotripter. As a result, the rich can afford expensive high technology services while the poor cannot. This produces a gradual evolution of classes in health service utilization. This study examines how health service utilization among different income groups is affected by the import of high technologies. It discusses changes made within the health care system, and explains the circumstances under which the rapid and excessive diffusion of medical technologies occurred in the hospital sector. PMID- 10131035 TI - The future of cardiology--a call for collaboration. PMID- 10131036 TI - For-profit ventures pose access and capacity problems. PMID- 10131037 TI - Effect on employers' costs difficult to measure, says GAO. PMID- 10131038 TI - Community Health Group starts emergency room diversion project. PMID- 10131039 TI - Genesys Health System--a study in integrated delivery. PMID- 10131040 TI - Planning assumptions for hospital strategists. PMID- 10131041 TI - Product update: products for getting rid of unwanted birds and bird droppings. PMID- 10131042 TI - Training off-duty police for emergency department roles. PMID- 10131043 TI - Special report. Revising your fire safety plans. AB - Every hospital has a fire safety plan, although some fail to update their plans when circumstances change, such as when the facility is refurbished or new fire protection equipment is added, or when new wings bring in additional patients and staff. Others may fail to develop new education programs to heighten staff awareness of what is expected of them during a fire and to train employees to meet those expectations. In this report, we'll examine the new fire safety plans at two Massachusetts hospitals and the revisions they made to address these issues. We'll offer suggestions for effectively evaluating and revising your own fire safety plans. PMID- 10131044 TI - Hiring security contractors: problems, misconceptions still exist. PMID- 10131045 TI - Proposed health care reform includes changes in hospital liability. PMID- 10131046 TI - Market forces take the lead in health care reform. PMID- 10131047 TI - Bringing wellness to the people. PMID- 10131048 TI - Texas hospitals join in effort to "immunize by two". PMID- 10131049 TI - How is your hospital affected? PMID- 10131050 TI - Reform survival strategies. AB - Healthcare reform. How will it really affect you and your organization? To find out how some healthcare executives are responding to the Clinton healthcare reform plan, we talked with ACHE affiliates from investor-owned and not-for profit systems and long-term care, managed care, and rural hospital settings. Here's what they had to say. PMID- 10131051 TI - The impact of reform on executive careers. PMID- 10131052 TI - The managed care executive of tomorrow: well-rounded, razor-sharp. PMID- 10131053 TI - Ensuring fair termination procedures. AB - Throughout the discharge process, it is the healthcare executive's responsibility to act in the organization's best interest while ensuring that the employee is treated fairly. PMID- 10131054 TI - Cost, quality, and reform. AB - In this era of change, hospitals and physicians must work closely together to identify new ways to respond to cost and quality issues. PMID- 10131055 TI - Career development strategies for minorities. AB - Search consultants say they have difficulty identifying qualified minority candidates. Here are some suggestions for minority healthcare executives looking to advance their careers. PMID- 10131056 TI - An early lesson in healthcare reform. AB - The interdisciplinary approach and focus on the continuum of care applied to the hospital's drug utilization evaluation provide examples of the perspective needed to succeed within the framework of healthcare reform. PMID- 10131057 TI - Action steps to enhance minority opportunities. AB - There is much work to be done to enhance minority opportunities in healthcare administration. Through ACHE efforts and the commitment of individuals, healthcare executives can improve career opportunities for their minority colleagues. PMID- 10131058 TI - Inside the Clinton healthcare reform plan: an interview with Judith Feder. Interview by Walter Wachel. PMID- 10131059 TI - Measuring case mix and severity of illness in Canada: case mix groups versus refined diagnosis related groups. AB - This study compares the effectiveness of Case Mix Groups (CMG*) groups and Refined Diagnosis Related Groups (RDRG) in reducing Canadian length of stay (LOS) variability. The effectiveness of the two case mix grouping methodologies was assessed with a common data base, 282,459 abstracts with ICD-9 CM diagnosis codes reported to the Hospital Medical Records Institute (HMRI) from January to March 1989. Death, signouts, transfers to or from acute care institutions and cases with an outlier LOS ("atypical" cases) were excluded from the analysis. HMRI utilization management reports to acute care hospitals use a data base defined in this way. On the basis of the variance reduction statistic (R2) from ordinary least squares regression analysis, CMG groups were found to be slightly more effective than RDRGs in reducing LOS variability. R2 statistics were 45.7 and 43.8 for CMG groups and RDRGs, respectively. Within subgroups of cases, CMG groups were found to be markedly more effective with the newborn/neonate group and to a lesser extent with non-surgical cases. The severity of illness categories within RDRGs did not, over all "typical" cases in the data base, yield more homogeneous groups of cases than CMG groups, which have half the number of categories. The value of tailoring severity measurement to Canadian medical practice and Canadian diagnosis coding is highlighted. PMID- 10131060 TI - Patient-focused care: the systemic implications of change. AB - Continuous quality improvement and customer identification have become pivotal concerns for modern management. It is evident that much past activity in health care has been narrowly focused, technologically based and of unknown efficiency. Identifying the patient as primary and overarching customer for health service organizations serves to simplify, refocus and redesign institutions so that resources and personnel are organized and allocated based on patient-care needs. Health care facilities can, accordingly, be ranked on the basis of their commitment and achievement with regard to patient-focused care. Quality becomes a matter of providing excellent and efficient medical care and satisfying the demands of the larger patient experience. Redefining the organization in the context of patient need profoundly changes the work place, creating less rigid, flattened organizational structures and emphasizing leadership rather than managerial activities. PMID- 10131061 TI - The merger that wasn't: lessons for senior administrators. AB - A turbulent health care environment has prompted some hospitals to consider integrating services and in some cases merge entirely. Fundamental lessons may be learned by studying how an attempted merger between Women's College Hospital and The Toronto Hospital in Toronto failed--despite board and senior executive support. Clarity of purpose, involvement of essential external and internal stakeholders, rational analysis, ideological fit and political expediency are a few key elements to consider. Once initiated, changes of this magnitude may take on a life of their own with often unpredictable results. PMID- 10131062 TI - Rural health services: the need for quality leadership. PMID- 10131063 TI - Resource utilization groups (RUGs): defining chronic care, rehabilitation and nursing home case mix in Canada. AB - The two major purposes of this study were: (1) to evaluate Resource Utilization Groups (RUGs III) as a unified method for classifying all residential, chronic care and rehabilitation patients at the St. Joseph's Health Centre, London, and (2) to compare the potential funding implications of RUGs and other patient/resident classification systems. RUGs were used to classify a total of 336 patients/residents in residential, extended care, chronic care and rehabilitation beds at the Health Centre. Patients were also concurrently classified according to the Alberta Long Term Care Classification System and the Medicus Long Term Care System. Results show that RUGs provide relatively more credit for higher acuity patients than do the Alberta or Medicus systems. If used as a basis for funding, chronic care and rehabilitation hospitals would be entitled to more funding (relative to residential/nursing homes) under RUGs than under the other two patient classification mechanisms. PMID- 10131064 TI - New cancer center's design complements its cutting-edge care. John and Mary Pappajohn Clinical Cancer Center. PMID- 10131065 TI - The JCAHO's Agenda for Change in 1994 and beyond: more of the same ... just totally different. AB - Beginning this month, health facility managers and their institutions will begin to feel the effects of the JCAHO's conversion from task- to performance-based accreditation standards. How rocky is the road ahead? PMID- 10131066 TI - Noise hampers healing and curbs productivity. PMID- 10131067 TI - OSHA issues its enforcement guidelines for TB. PMID- 10131068 TI - Decentralizing supply carts boosts productivity. PMID- 10131069 TI - How building systems, age affect health care energy costs. PMID- 10131070 TI - Sustaining excellence. PMID- 10131071 TI - Appreciating diversity. PMID- 10131072 TI - Conditions for consensus. PMID- 10131073 TI - Rhetoric and reality. PMID- 10131074 TI - Managing the emerging organization. PMID- 10131076 TI - Needle and syringe prices down by 2.3%. PMID- 10131075 TI - Public hospitals as paradigm. PMID- 10131077 TI - Controlling cardiac cath lab non-salary expenses. PMID- 10131078 TI - Controlling non-salary expenses in the nursery. PMID- 10131079 TI - CEO materials management survey: nuts and bolts still count. PMID- 10131080 TI - A professional medical ethic: Drane and Coulehan's response. PMID- 10131081 TI - Physicians, not priests: Veatch and Spicer's response. PMID- 10131082 TI - Violence: a public health epidemic. PMID- 10131083 TI - Integrated delivery networks. Rural partnership improves access to care. PMID- 10131084 TI - Canadians write a new Rx for healthcare. Canada's healthcare system is not a panacea, but it raises interesting issues for the United States. AB - The Canadians have been impressive in delivering universal healthcare access and high-quality care. Operating under global budgets set by provincial governments, Canadian hospitals have prudently managed available resources to meet community needs. A weakness of this single-payer system, however, is its inability to effectively coordinate and integrate services delivered by hospitals, physicians, and other providers. As the U.S. health system faces stringent cost containment with President Bill Clinton's proposal, significant savings are expected of U.S. hospitals. New alliances constrained by global budgets might require healthcare services managers to operate under a disparate set of assumptions and incentives. Before making such a transition, we can learn from the experiences of our Canadian colleagues. The challenges for both nations in the remaining years of this century will be drawn primarily from the effective macromanagement controls of the Canadian system and the lessons being learned from the U.S. managed care networks. This will occur as each nation strives to provide a more effective, less costly, integrated delivery of healthcare services. PMID- 10131085 TI - Catholic hospitals and community benefit activities. A comparative inventory of policies and programs reveals a wide range of services. AB - Results from a 1990 survey of 595 acute care, short-term, U.S. Catholic hospitals help identify and describe the most and least common community benefit activities and propose ways Catholic healthcare providers can become more involved in their local communities. The response rate for this mailed, self-administered questionnaire was 72 percent (n = 429). The survey data indicated that Catholic hospitals engaged in a variety of healthcare efforts in their local communities. These efforts ranged from occasional activities (e.g., delivering food baskets to the needy at Christmastime) to sponsoring long-term programs (e.g., continuing case management). To expand involvement throughout the community, hospitals can do the following relatively low-cost tasks: Have volunteers visit area residents in their homes and report their findings. Sponsor focus groups (facilitated by graduate students from area colleges and universities) that include the various community members. Assess the human needs of the communities that surround the hospital. Graduate students may conduct preliminary studies to identify the scope and variety of community healthcare needs. PMID- 10131086 TI - Planning for community benefit. A seven-step process helps providers define and address important needs. AB - The Catholic Health Association's (CHA's) Standards for Community Benefit ask Catholic healthcare organizations to show their commitment to addressing community needs. The standards call on providers to stress the importance of community service in a variety of contexts--from their statements of philosophy and values to the decisions made in their board and executive staff meetings. At the heart of the Standards for Community Benefit is the requirement that an organization's governing body adopt a community benefit plan. The community benefit plan can help orient staff, physicians, and volunteers to the facility's charitable role. A provider can also use a completed plan to elicit community members' views on the organization's interpretation of community needs, its priorities, and performance. Not-for-profit healthcare organizations can prepare a community benefit plan by completing the following steps: Restate the organization's mission and commitment Define the community being served Identify unmet community needs Determine and describe the organization's leadership role Determine and describe the organization's community service role Seek public comment on the plan Prepare a formal, written community benefit plan. PMID- 10131087 TI - Assessing community needs. A system's six-step approach yields tangible results. AB - To respond to the changing needs of the communities it serves, the Sisters of Mercy Health System-St. Louis (SMHS) is committed to implementing and advocating for innovative health and social services that improve the health and quality of life of communities the system serves. One means to achieve these ends is the Agenda for Social Accountability. As part of this agenda, each of the system's strategic service units (SSUs) performs a community needs assessment. Phase one of the assessment consists of six steps: 1. Assign administrative responsibility 2. Review available data 3. Obtain information on community health status 4. Interview community leaders 5. Summarize results in a draft report 6. Incorporate conclusions into the strategic plan Many of the system's SSUs have completed the first cycle of the social accountability agenda and are exploring new initiatives for phase two. SMHS is investigating the idea of assessing the functional status of representative samples of community members as another method of measuring health status. And its primary research is broadening to include written surveys and focus groups with select audiences. PMID- 10131088 TI - Revitalized commitment to community. A community benefit plan helps a hospital be a good neighbor. AB - Three years ago St. John Hospital and Medical Center, Detroit, made a commitment to strengthen its community relationships and reaffirm its mission of serving those in need by following the Catholic Health Association's Social Accountability Budget. While implementing the program, administrators were surprised to learn the hospital was already participating in many community programs for which it received little or no reimbursement. They also discovered that the hospital had no formal, written charity care policy even though St. John provided more than $14 million in uncompensated care annually. To learn what the needs of the surrounding community were, the hospital went to the clergy, who overwhelmingly identified the needs of the elderly as the number-one priority. A close second was supporting the basic family unit. Other concerns included basic family needs, safe neighborhoods and schools, and teen pregnancy. Although the hospital realized it could not do all that was needed, it felt obliged to be a leader in seeing that the needs were met and drew up a community benefit plan that documented the problems and the solutions. The hospital did what it could and worked with other organizations to address needs such as housing for the elderly, affordable and accessible healthcare, neighborhood improvement and safety, and family services. PMID- 10131089 TI - Systems collaborate for a healthier community. A Community Health Advisory Board focuses on immunization. AB - The Community Health Advisory Board (CHAB), Pierce County, WA, involves four healthcare systems--Franciscan Health System, MultiCare Medical Center, Group Health Cooperative of Puget Sound, and Good Samaritan Hospital--that have joined forces with other providers in an innovative attempt to better serve their community. An evaluation by representatives of New York University's Hospital Community Benefit Standard Program prompted St. Joseph Medical Center, Tacoma, WA, to bring major providers together in a coordinated effort that could reach community residents in need. At their first meeting in November 1992, CHAB members agreed on a purpose: to facilitate collaboration between healthcare providers throughout the county to develop programs and services that improve the health status of community residents. In January 1993 CHAB members selected a "quick success" project: a program aimed at increasing immunization levels to 90 percent for two-year-old children in the county. In February 1993 CHAB members committed the "best and brightest" to the Immunization Task Force, naming experts in planning, nursing, community health, education, and marketing. When the Immunization Task Force assessed the project, they realized that the "quick success" program would not be accomplished so quickly. CHAB has had to address underlying problems to make higher immunization levels sustainable. In March 1994 members will evaluate the immunization program's process, status, and structure; data on immunization levels; and the group's demonstrated ability to cooperate. PMID- 10131090 TI - Mission denied, mission restored. Improved communications turn an immunization program into a success. PMID- 10131091 TI - Long-term benefits. A retirement community grows by reaching out to area residents. AB - At St. Leonard Center, a retirement community in Dayton, OH, community benefit programs are such a critical part of daily operations that the organization could not continue to flourish without them. Founded in 1983, the center now serves more than 600 persons. St. Leonard offers independent living arrangements, as well as assisted living and skilled nursing care. From its beginning the center has depended on collaborative arrangements with local churches, agencies, and other organizations. As the center has grown, it has continued to work with others to enhance services to its clients and to local residents. Recent arrangements with St. Elizabeth Medical Center in Dayton have enabled the center to offer home healthcare, as well as outpatient and inpatient rehabilitation. Integrated pharmacy, medical supply, and laboratory services are also available, and a systemwide management information system is currently under development. St. Leonard Center also reaches out to local elderly residents through adult day care and respite programs, as well as through its Senior Network, a resource center (cosponsored by St. Elizabeth) with about 25,000 enrollees. The center also offers three special educational programs for children. PMID- 10131092 TI - Leading the way to community health. PMID- 10131093 TI - Planning for reform. PMID- 10131094 TI - Is integrated delivery healthcare's breakpoint? PMID- 10131095 TI - Guidelines for minimal data security measures for the protection of computer based patient records. PMID- 10131096 TI - The changing managed care market. AB - A continuum of managed care options has evolved reflecting differing health care market characteristics. Alternative health plans are increasing, outdistancing the "gold standard" staff model HMOs. A dizzying array of options, however, has led to considerable confusion. Direct contracting has evolved as a way for employers to understand what they are paying for and to managed costs. Increases in managed care, and a degree of financial distress, will encourage the development of integrated networks. National reform is unlikely to convert today's loosely structured system to a fully integrated system overnight, but will stimulate managed care in markets sooner than otherwise expected. PMID- 10131097 TI - Managed care innovation and new product development. AB - This article explores recent innovative activity by managed care payor plans nationwide with particular emphasis on emerging, new relationships between the plans and their purchasers, enrollees, provider panels, and competitors. Because they already practice what advocates of health care reform are now preaching, many managed care plans are leading the charge to transform our health care delivery and financing systems. PMID- 10131098 TI - Ambulatory care groupings: when, how, and the impact on managed care. AB - This article explores case-mix adjustment systems in the ambulatory care environment as applied by managed care firms. An overview of ambulatory care groupings or ambulatory case-mix systems is given, and the special case-mix adjustment needs of managed care companies are reviewed. Generally, two types of ambulatory care grouping systems are available: encounter-based and population based. Case examples of three managed care companies that are currently investigating the use of population-based case-mix systems are used to demonstrate the possible use of such systems in the managed care environment such as physician profiling and capitation rate setting. PMID- 10131099 TI - The role of managed care in integrated delivery networks. AB - Health care reform, especially if as anticipated via a capitated payment system, will lead providers to integrate the services they provide to the community with those of other organizations. Vertical integration strategies, such as the formation of physician-hospital organizations, and horizontal integration through alliances and holding companies, are the primary vehicles that hospitals and other providers will use to establish integrated networks. By including insurers and primary care physicians in the network and developing information systems to support the delivery of high quality, cost-effective services, the networks can offer a full continuum of care and minimize service duplication. PMID- 10131100 TI - Evaluating opportunities for direct contracting between employers and physician hospital organizations. AB - Employers seeking to reduce health care expenditures are turning to direct contracting as a way to control provider cost increases. In a direct contract, the participation of third parties is minimized. The health care provider and a corporate buyer directly negotiate a price agreement for the delivery of health care services. However, as managed care penetration increases, the ability of hospitals and physicians to assume risk while providing high quality, cost effective care will be paramount. Physicians and hospitals who choose to work together may find a physician-hospital organization an effective vehicle to meet the current and future market challenges of direct contracting. PMID- 10131101 TI - Development of physician networks. AB - This article provides a brief overview of the development of physician networks. The continued progression of managed care and the advent of managed care-based health care reform at the state and national level have escalated the development of physician networks. This article reviews the potential purposes and objectives for forming a physician network as well as the different desired characteristics such as geographic access, network size and composition, and targeted physician characteristics that are important in the network's development. PMID- 10131102 TI - Medicaid managed care: problems and promise. AB - Medicaid spending is an increasing burden on already stressed state budgets. The states find themselves trapped between these growing costs and mounting pressure to ensure access of the underserved to health care services. States are hopeful that managed care is the answer to meeting the seemingly diametric needs of reducing costs while increasing access. However, evidence of performance measured in cost, access, and quality, and financial viability is inconclusive. Nevertheless, there have been some successes and, clearly, Medicaid managed care has potential. The unanswered question is the extent to which states can meet the diverse challenges of both Medicaid and managed care and tap that potential. PMID- 10131103 TI - Advanced pricing strategies for hospitals in contracting with managed care organizations. AB - This article provides both a conceptual overview of pricing health care services and two pricing strategy examples. The overview addresses the underlying concepts of pricing, the factors that influence it, and the risk continuum of pricing approaches. The pricing strategy examples highlight some of the issues and considerations involved in pricing services in a changing health care market. Because the payors of health care will continue to shift economic risk to the providers of health care, the examples emphasize the importance of managing risk. PMID- 10131104 TI - Hospital executives: perceptions of skills and experiences desired in health care graduates. AB - The modern health care organization is a complex entity with numerous stakeholders having divergent interests. Managing these complex organizations requires individuals with a variety of skills. In this study, an assessment of the academic preparation, skills, and experiential learning desired in health care graduates was made. To determine the perception of executives, a 16-item questionnaire was developed and distributed to over 587 hospital executives. The data showed a significant correlation (.001) between the responses of the executives regarding a preference for individuals with a master's degree with a health specialty and a preference for individuals with some experiential learning activities. The findings showed a strong preference among executives for hiring a health graduate with a master's in health administration. Although there were some limitations to this study, the hospital executives responded positively to questions regarding a preference for individuals with health care management degrees and experiential learning over persons without these experiences. PMID- 10131105 TI - Toward effectiveness assessment of health management education in Canada. AB - A growing theme in the management education literature is that of effectiveness assessment. Integrated effectiveness assessment systems represent an important challenge in health management education in Canada. This article examines the service effectiveness paradigm that evolved from comprehensive auditing developments in the public domain. It presents an integrated model of effectiveness assessment systems and the barriers that currently impede its full development and implementation in Canada. Finally, the evolving effectiveness assessment challenge--which will fundamentally change health management education in Canada--is examined. PMID- 10131106 TI - The search for value: a quality improvement cycle linking process, outcomes, and patient satisfaction. AB - American industry has been implementing continuous quality improvement (CQI) for several years. The business community and accrediting organizations are applying pressure to health care organizations to implement CQI to assure the delivery of cost-effective, quality health care services. In their rush to embrace the demands of industry, health care organizations must realize that many within their ranks long ago adopted the philosophy of CQI without calling it by name. The key is to adapt the concepts of CQI to existing quality improvement efforts rather than simply following a new recipe. By looking primarily at hospital systems like administration and finance, health care organizations may not be significantly addressing the clinical system. Consumers, however, want patient care to be addressed immediately. The author reflects on his experience that process improvement, not personnel change, is the key to successes in health care management. PMID- 10131107 TI - Health care financial management curriculum content: views of practitioners and academics. PMID- 10131108 TI - The academy and the field of practice: an organizational effectiveness perspective on the issues. PMID- 10131109 TI - Accounting education for health service managers: finding out what they need to know. PMID- 10131110 TI - How do health care managers use new information to increase organizational performance? PMID- 10131111 TI - Do we need more help in managing our death? A look at physician-assisted suicide. AB - Notes the unrest surrounding questions related to the management of dying and identifies the varieties of modes of assisted suicides and euthanasia approaches. Points out the pros and cons of physician-assisted suicide and offers biblical and theological critiques of the perspectives and practices. Concludes that it is easier to embrace an idea in theory than to put it into practice but that, despite all the complications implicit in and resulting from physician-assisted suicide, the practice needs to be legalized and become part of the growing need to manage death in this technological age. PMID- 10131112 TI - A liturgical journey at Wesley Woods: worship experiences within an inpatient geriatric psychiatric unit. AB - Provides guidance to caregivers who hope to assist mentally ill elderly people in their spiritual development. Describes a particular therapeutic milieu, a theological rationale, and a worship program intended to meet the liturgical needs of aging people admitted as psychiatric inpatients. Includes clinical vignettes to illustrate what was learned in the implementation of this particular worship program. PMID- 10131113 TI - Shifting paradigms--CARE 2000: a chaplain's perspective. AB - Sketches a caregiving project designed to be patient-focused by educating and training a cadre of multi-skilled health care workers called Clinical Partners, Technical Partners, Service Partners, and Administrative Partners. Observes that this new paradigm expands the role of the chaplain and involves him or her in a variety of services necessary in the attempt to focus on patient needs. PMID- 10131114 TI - Hospital governance and quality of care: a critical review of transitional roles. PMID- 10131115 TI - The demand for physician services in a changing health care system: a synthesis. PMID- 10131116 TI - Can administrative data be used to compare the quality of health care? PMID- 10131118 TI - FHP, TakeCare agree to merge. PMID- 10131117 TI - Plans' execs may vote to allow public ownership. PMID- 10131119 TI - Domestic device consumption up 7% in '93--HIMA report. PMID- 10131120 TI - Agencies near decisions on two hospital mergers. PMID- 10131121 TI - S&P downgrades double its upgrades. PMID- 10131122 TI - Straub wants to launch its own HMO in Hawaii. PMID- 10131123 TI - With Epic, HealthTrust faces 2nd turnaround challenge. PMID- 10131124 TI - Bard suspended from federal pacts. PMID- 10131125 TI - Ind. hospital touts 'report card' results, pledges to improve. PMID- 10131126 TI - VA faces employee cuts, budget woes. PMID- 10131127 TI - National centers of excellence can have an impact on reform. PMID- 10131128 TI - Governance survey. Board examination: hospital boards lack ethnic and gender mix, a survey shows. PMID- 10131129 TI - Healthcare picket lines increase in '93. PMID- 10131130 TI - Refinancings continue brisk pace. PMID- 10131131 TI - Employer mandate likely--HCFA chief. PMID- 10131132 TI - PPI shows hospital inflation isn't as bad as CPI suggested. PMID- 10131133 TI - 1 of 2 academic cases advances. PMID- 10131134 TI - Psych values fall, NME charge shows. PMID- 10131135 TI - Report: top 100 offer guidance. PMID- 10131136 TI - IOM study suggests 'fairness doctrine' for data bases. PMID- 10131137 TI - Deal may include subacute CON. PMID- 10131138 TI - Diversicare sells subsidiary. PMID- 10131139 TI - FTC checks Columbia/HCA market. PMID- 10131140 TI - Business group forms health alliance. PMID- 10131142 TI - Calif. quake shakes hospitals' ability to provide care to victims. PMID- 10131141 TI - Executive pay not related to hospital performance--study. PMID- 10131143 TI - VA seeks radiation test records. PMID- 10131144 TI - Dispute over MOB rent ends quietly. PMID- 10131145 TI - VA to streamline construction to help health system compete. PMID- 10131146 TI - Welfare reform push may slow health plan passage. PMID- 10131147 TI - Health managers must make preparing for disaster a priority. PMID- 10131148 TI - Disasters hamper suppliers. PMID- 10131149 TI - Medicare electronic bill plan eyed. PMID- 10131151 TI - Buying groups not consolidating--study. PMID- 10131150 TI - Cost of paradise. Critics say Hawaii's much-touted health plan has an expensive price tag. PMID- 10131152 TI - Hospitals upping the ante in bidding for primary docs. PMID- 10131154 TI - Academic merger in Pa. strives to save. PMID- 10131153 TI - Reclassification plan to be scrapped. PMID- 10131155 TI - Medical Care sells Critical Care for $175 million. PMID- 10131156 TI - R.I. hospitals vote to show accreditation reports to public. PMID- 10131157 TI - N.Y. budget cuts target Medicaid. PMID- 10131158 TI - Pa. tax battle to go to court; officials refuse payment option. PMID- 10131159 TI - Medical and lifestyle approaches to cardiovascular rehabilitation. AB - A distinguished panel of PAs discusses the medical approach to cardiac care utilizing more traditional methods of treatment, such as surgery and pharmacology, and the lifestyle approach, which emphasizes changes in diet, exercise, and a program of stress reduction. This Physician Assistant Forum examines the role of each program in clinical practice as well as the benefits, costs, and limitations of each approach. PMID- 10131160 TI - Emerging technologies in bedside monitoring. Ensuring the adequate nutrition of critically ill patients. AB - This article examines the contribution of bedside calorimetry and nitrogen balance monitoring to the nutritional support of critically ill patients who are not served by the standard formulas. It describes the types of instruments available and discusses their usefulness in specific cases. The article closes with pointers on how a critical care metabolic service can be established and worked into a hospital's existing systems. PMID- 10131161 TI - Women of color and health: issues of gender, community, and power. PMID- 10131162 TI - Good news, bad news. PHO survey reveals surprises. PMID- 10131163 TI - Planning for a successful PHO. PMID- 10131164 TI - Collaboration: the human factors that determine success. PMID- 10131165 TI - Voluntary governance--the key to local control of health care. PMID- 10131166 TI - Survey: what impact will reform have on retirement plans? PMID- 10131167 TI - PHOs make a splash: case studies. Two Florida hospitals are succeeding in making the PHO model work. PMID- 10131168 TI - Who's out there? PMID- 10131169 TI - Hospitals and physicians form stronger links. PMID- 10131170 TI - Will universal coverage affect tax-exempt status? PMID- 10131171 TI - A laundry's reincarnation. Hospital Cooperative Laundry, Denver, CO. AB - It started out as an off-site hospital laundry, then was leased to a commercial operator, now it is a cooperative plant that serves several accounts in the Denver area. See what makes Hospital Cooperative Laundry tick. PMID- 10131172 TI - 1994 preview. AB - What can you look forward to in the coming year? We asked leaders in several segments of the laundry industry to polish up their crystal balls, mutter a few incantations and give us their best guess on what the coming year has in store for launderers. PMID- 10131173 TI - A review of hospital boards of management in rural Western Australia. AB - The primary aim of the study described in this paper was to review the place of hospital boards in the delivery of public sector health services in rural Western Australia. Specific issues explored included the demographic characteristics of country hospital boards, board roles and functions, and mechanisms for evaluating performance. While most board members and administrators perceived management control of boards to be about equally shared between them, over 90 per cent of board members felt they did not have sufficient skills to adequately discharge their board responsibilities. PMID- 10131174 TI - Client feedback--development of an instrument for psychiatric inpatients. AB - A client feedback instrument and method has been developed to improve service delivery to psychiatric inpatients. Results indicate that the strongest cause of patients believing they can cope with life out of hospital is the quality of communication between staff, followed by communication with staff and satisfaction with the centre overall. A secondary finding was that good response rates can be achieved and reliable data can be gathered from psychiatric patients. Further development options and potential application to other psychiatric hospitals are discussed. PMID- 10131175 TI - Hospital acquired rota virus infection: the economics of prevention. AB - Nosocomial rota virus infection results in costs to patients (for example, delayed procedures) and to hospitals (for example, additional bed-days, and ward closures if an epidemic occurs). This paper analyses the economic efficiency of using a preventive measure--a high antibody milk supplement--in a hospital for children. The cost of implementing this program is compared with the benefits of avoiding nosocomial rota virus infection. The results of the study suggest that, taking a range of realistic values for the most significant variables, the use of the supplement would be cost-effective. PMID- 10131176 TI - FROGS (Far North Regional Obstetric and Gynaecological Service)--the development of a specialist outreach service. AB - The Peninsula and Torres Strait Health Region of Far North Queensland is a vast area with a widely scattered population. The Far North Regional Obstetric and Gynaecological Service (FROGS) is a cost-effective outreach service which provides equitable access to specialist care for remote people and aims to address many of the significant problems of women's health care in this region. PMID- 10131177 TI - Improving health service management education: the manager speaks. AB - This paper uses health service manager judgements to discuss educational approaches and environments suitable to the development of required competencies and reports barriers to and opportunities for competency development. Practising managers were found to recognise and value the educational contributions made by academic programs, health service organisations and professional associations to the development of professional competence. Academic programs are seen as the appropriate vehicle for developing conceptual, analytical, problem solving and communication competencies that require considerable maturation time. Health service organisations are seen to have a key role in promoting professional competence through maintaining a culture conductive to encouraging managers to undertake further education, supported by appropriate system strategies. Professional associations are regarded as appropriate sponsors for promoting knowledge and skill update in relation to current issues in management through short courses, conferences and timely educational meetings. Wherever possible, collaboration between professional and educational organisations was seen to be desirable. PMID- 10131178 TI - Perceptions of responsibility for the care of the aged in six Australian communities. AB - The influence of cultural values on beliefs as to who is responsible for the care of frail aged people was examined in a survey of 371 health practitioners from the Chinese, German, Greek, Italian, Arabic-speaking and Anglo Australian communities. All communities attributed a major responsibility to government. The communities differed significantly in their perceptions of the role of community, ethnic and religious organisations, and the family in providing care. There were marked community differences in the perceptions of which family members have the major responsibility to provide care. PMID- 10131179 TI - Providers react cautiously to Clinton's Medicare plans. PMID- 10131180 TI - Financial self-sufficiency through operating revenue at two adult day centers. AB - This article reports on two not-for-profit adult day centers which became fully self-supporting from participant fees. The intent is to show that financial self sufficiency solely from operating revenue for such programs is possible. PMID- 10131181 TI - Physician-hospital partnerships need to be crafted with care. PMID- 10131182 TI - Preparing for healthcare reform. PMID- 10131183 TI - The evolution and development of clean air systems for surgery. PMID- 10131184 TI - Health structures and hospital techniques throughout the world. Measures taken by the IFHE (International Federation of Hospital Engineering). PMID- 10131185 TI - Day care unit--Epsom General Hospital. AB - The project took 12 months from start of design to handover of the building, including all enabling works, with the construction period being from October 1992 to May 1993. The building contract value was L650,000, the main contractor being E Martin & Sons Ltd. The ventilation subcontractor was C A Goodwin Ltd, the electrical subcontractor was Cowleys Sanitary and Heating Engineers Ltd. Since opening its doors on 12 July 1993 the Day Case Unit has seen approximately 700 patients and a further 300 patients have been assessed. PMID- 10131186 TI - Library Association Medical Health and Welfare Libraries Group, 1978-1992. AB - A review of the evolution of the Library Association Medical Health and Welfare Libraries Group relating its organization, administration and activities to its key objectives. PMID- 10131187 TI - Security in health service libraries--a survey in North West Thames Region. AB - My aim is to discuss the results of a survey of health service libraries in North West Thames Region undertaken in November 1990 as part of a more detailed study of library security. Widely varying patterns of losses were discovered. The ways in which librarians have tried to resolve these problems are described and a number of possible solutions are proposed. A brief review of the literature is also included. PMID- 10131188 TI - Environmental issues in property acquisition and transfer. PMID- 10131189 TI - Radiology departments take green approach with silverless film. PMID- 10131190 TI - Signs of the times. AB - For the MT who experiences downsizing, it usually means hitting the keyboard faster and compromising quality. PMID- 10131191 TI - A solution to an age-old problem: the missing report syndrome. AB - A look at how one medical transcription department solved the problem of missing discharge summaries without requiring physician redictation. PMID- 10131192 TI - MTCP (Medical Transcriptionist Certification Program) to institute Code of Conduct Policy. PMID- 10131193 TI - Results of the first written core certification exam. PMID- 10131194 TI - Putting the pieces in place for regional integration. Sisters of Providence, Portland, restructures itself in preparation for a capitated environment. PMID- 10131195 TI - Process improvements boost patient satisfaction and quality at Stanford University Hospital. PMID- 10131196 TI - Product committees: from gatekeepers to facilitators. PMID- 10131197 TI - Up, down or flat--prices are still worth watching. PMID- 10131198 TI - How to diagnose and treat conflict within your department. PMID- 10131199 TI - What's wrong when materials and accounting records don't agree? PMID- 10131200 TI - A case of sterilization wrap swap. PMID- 10131201 TI - Stats. Few OR staff wear "liquid-proof" gowns. PMID- 10131202 TI - Why Clinton blew his cool. PMID- 10131203 TI - System profile. Sharp HealthCare, San Diego, California. PMID- 10131204 TI - System profile. Sutter Health, Sacramento, California. PMID- 10131205 TI - System profile. UniHealth America, Burbank, California. PMID- 10131206 TI - Visionary systems design quality into their integrated care networks. PMID- 10131207 TI - Building a culture of participation in a vertically integrated, regional health system. PMID- 10131208 TI - Developing quality- and customer-focused credentialing criteria for physicians in integrated healthcare systems. PMID- 10131209 TI - System profile. Presbyterian Healthcare Services, Albuquerque, New Mexico. PMID- 10131210 TI - Case study of how a coalition finds solutions. AB - A coalition formed by employers in Connecticut provides a case study of how businesses around the country can solve health care problems. Rather than turning to extensive government regulation, this is a solution developed in the private sector. PMID- 10131211 TI - A model for regulating managed competition. AB - Adapting proven regulatory mechanisms from the Federal Reserve System and the Clean Air Act to a managed-competition-based health care system may provide a consistent nationwide framework for health care delivery and financing that takes into account the role of the states. PMID- 10131212 TI - Employers need Clinton plan details clarified. Interview by Debra Mamorsky. PMID- 10131213 TI - Managing the claims denial appeals process. AB - Beyond the traditional, flawed approaches to managing the claims denial appeal process, managed care organizations can avoid spending excessive time and effort by creating a system that satisfies key success criteria. PMID- 10131214 TI - How specialty contracts achieve savings. AB - Preferred provider organization contracting for specialty care has become increasingly attractive for health care payers now taking a second look at expanding their role in cost containment. PMID- 10131215 TI - Technology's role in a new health care system. AB - Employers that will prosper under a revamped health care system will be those that plan and lobby for redesign of medical and flexible benefits and equip themselves with advanced technology to manage reform changes. PMID- 10131216 TI - How employers can prepare for reform. AB - Employers can best prepare for a reformed health care system by tracking modifications to Clinton's plan and by arming themselves with key information on their work force and on their capacity to adapt to change. PMID- 10131217 TI - Questions employers should ask about managed care. AB - Managed care may be the best way to control employee health plan costs, but employers should qualify any plan they are considering to ensure that it will deliver what it promises. PMID- 10131218 TI - Employers worry over Clinton's plan. PMID- 10131219 TI - Impact of reform on small businesses. PMID- 10131220 TI - Benefits experts react to reform. PMID- 10131221 TI - New standard for pharmacy benefits. PMID- 10131222 TI - Federal financial participation in state assistance expenditures; federal matching shares for Aid to Families With Dependent Children, Medicaid, and aid to needy aged, blind, or disabled persons for October 1, 1994 through September 30, 1995--HHS. Notice. AB - The Federal Percentages and Federal Medical Assistance Percentages for Fiscal Year 1995 have been calculated pursuant to the Social Security Act (the Act). These percentages will be effective from October 1, 1994 through September 30, 1995. This notice announces the calculated "Federal percentages" and "Federal medical assistance percentages" that we will use in determining the amount of Federal matching in State welfare and medical expenditures. The table gives figures for each of the 50 States, the District of Columbia, Puerto Rico, the Virgin Islands, Guam, American Samoa, and the Northern Mariana Islands. Programs under title XIX of the Act exist in each jurisdiction; title IV-A programs in all jurisdictions except American Samoa and the Northern Mariana Islands; programs under titles I, X, and XIV operate only in Guam and the Virgin Islands; while a program under title XVI (AABD) operates only in Puerto Rico. The percentages in this notice apply to State expenditures for assistance payments and medical services (except family planning which is subject to a higher matching rate). The statute provides separately for Federal matching of administrative costs. Sections 1101(a)(8) and 1905(b) of the Act, as revised by section 9528 of Public Law 99-272, require the Secretary of Health and Human Services to publish these percentages each year. The Secretary is to figure the percentages, by formulas in sections 1101(a)(8) and 1905(b) of the Act, from the Department of Commerce's statistics of average income per person in each State and in the Nation as a whole.(ABSTRACT TRUNCATED AT 250 WORDS) PMID- 10131223 TI - Medicare program; changes to the hospital inpatient prospective payment systems and fiscal year 1994 rates; correction--HCFA. Final rule; correction. AB - In the September 1, 1993, issue of the Federal Register (FR Doc 93-21026) (58 FR 46270), we revised the Medicare hospital inpatient prospective payment systems for operating costs and capital-related costs to implement necessary changes arising from our continuing experience with the system. Additionally, in the addendum to that final rule, we announced the prospective payment rates for Medicare hospital inpatient services for operating costs and capital-related costs applicable to discharges occurring on or after October 1, 1993, and set forth update factors for the rate-of-increase limits for hospitals and hospital units excluded from the prospective payment systems. This notice corrects errors made in that document. PMID- 10131224 TI - Requirements for accrediting bodies of mammography facilities--FDA. Interim rule with request for comments. AB - The Food and Drug Administration (FDA) is issuing regulations to implement the Mammography Quality Standards Act of 1992 (MQSA), which requires the establishment of a Federal certification and inspection program for mammography facilities; regulations and standards for accrediting bodies for mammography facilities; and standards for mammography equipment, personnel, and practices, including quality assurance. This rule establishes procedures for application to FDA for approval as an accrediting body and requirements and responsibilities of such bodies. This action is being taken to assure adequate and consistent evaluation of mammography facilities on a nationwide level and to help assure their compliance with quality standards. The agency requests comments on the contents of this document. PMID- 10131225 TI - Quality standards and certification requirements for mammography facilities--FDA. Interim rule with request for comments. AB - The Food and Drug Administration (FDA) is issuing regulations to implement the Mammography Quality Standards Act of 1992 (the MQSA), which requires the establishment of a Federal certification and inspection program for mammography facilities; regulations and standards for accrediting bodies for mammography facilities; and standards for mammography equipment, personnel, and practices, including quality assurance. This rule establishes requirements for certification of mammography facilities, including quality standards for mammography. This action is being taken to assure safe, accurate, and reliable mammography on a nationwide basis. The agency requests comments on the contents of this document. PMID- 10131226 TI - Medicare and Medicaid programs; quarterly listing of program issuances and coverage decisions--third quarter 1993--HCFA. Notice. AB - This notice lists HCFA manual instructions, substantive and interpretive regulations and other Federal Register notices, and statements of policy that were published during July, August, and September of 1993 that relate to the Medicare and Medicaid programs. Section 1871(c) of the Social Security Act requires that we publish a list of Medicare issuances in the Federal Register at least every 3 months. Although we are not mandated to do so by statute, for the sake of completeness of the listing, we are including all Medicaid issuances and Medicare and Medicaid substantive and interpretive regulations (proposed and final) published during this timeframe. No revisions to the Medicare Coverage Issues Manual were published during the third quarter of 1993. PMID- 10131227 TI - Approval of the Commission on Office Laboratory Accreditation--HCFA. Notice. AB - This notice announces the approval of the Commission on Office Laboratory Accreditation (COLA) as an accrediting organization for clinical laboratories under the CLIA program. We have found that the accreditation process of this organization provides reasonable assurance that the laboratories accredited by it meet the conditions required by Federal law and regulations. Consequently, laboratories that voluntarily become accredited by COLA in lieu of receiving direct Federal oversight and continue to meet COLA requirements would meet the CLIA condition level requirements for laboratories and therefore are not subject to routine inspection by State survey agencies to determine their compliance with Federal requirements. They are, however, subject to validation and complaint investigation surveys. PMID- 10131228 TI - Feds will create LTC niches. PMID- 10131229 TI - Limits are the key to the future. PMID- 10131230 TI - Plan ahead to capitalize on the future. PMID- 10131231 TI - What significant changes can LTC providers anticipate in the next decade? PMID- 10131232 TI - Provider 2001. Capitalizing on the continuum of care. PMID- 10131233 TI - Provider 2001. Community-based care. PMID- 10131234 TI - Provider 2001. Subacute care. PMID- 10131235 TI - Provider 2001. Ventilator care. PMID- 10131236 TI - Provider 2001. Wound care. PMID- 10131237 TI - Provider 2001. Assisted living. PMID- 10131238 TI - Provider 2001. Home care. PMID- 10131239 TI - Provider 2001. Managed care. PMID- 10131240 TI - Provider 2001. Recruitment. PMID- 10131241 TI - Provider 2001. Patient assessment. PMID- 10131242 TI - Focus of long-term care will shift. PMID- 10131243 TI - Technology to streamline pharmacies. PMID- 10131244 TI - Going ... going ... gone? Federal Emergency Management Agency. AB - Bashing the Federal Emergency Management Agency (FEMA) has become routine among EMS providers. The time has come for the agency's day of reckoning. Here's a look at the Congressional bills designed to build a better FEMA. PMID- 10131245 TI - Clinton's agenda for business. PMID- 10131246 TI - Why health costs can keep slowing. PMID- 10131248 TI - Special report on licensure, accreditation and CON. JCAHO keeps pace with changing face of health care. PMID- 10131247 TI - Liability of health care workers aware of fraudulent billing practices. PMID- 10131249 TI - IRS discusses integrated delivery systems issues. PMID- 10131250 TI - Health Security Act will dramatically alter employer health care burdens. PMID- 10131251 TI - New rules on charitable contributions. PMID- 10131252 TI - Implementing competency legislation for health care. PMID- 10131253 TI - A legal examination of computerized health information. PMID- 10131254 TI - The Canadian Charter as a barrier to unwanted medical treatment of pregnant women in the interests of the foetus. PMID- 10131256 TI - Drug interactions. PMID- 10131255 TI - Total quality service. PMID- 10131257 TI - Total quality management in the HMO environment. AB - Increasing numbers of healthcare organization are turning to total quality management (TQM) to contain costs and improve quality. This article describes the implication of TQM for health maintenance organizations. PMID- 10131258 TI - A trend analysis of financial accounts. From TEFRA to PPS 7. AB - This article presents a time trend in financial accounts, starting with the introduction of the prospective payment system (PPS) to its seventh year (PPS 7). The financial accounts are analyzed by hospital ownership and bed size. Applying the index-number trend series analysis, our findings show that large for-profit facilities had higher operating income than other large ownership groups. In contrast, the three small ownership groupings we studied incurred an operational loss. PMID- 10131259 TI - Helping physicians cope with RBRVS. AB - Hospital administrators have long recognized the importance of strong ties with medical staff. Implementation of the resource-based relative value scale (RBRVS) has disrupted the normal practice of physicians and has placed renewed stress upon the hospital-physician relationship. Hospital administrators can use their expertise to help physicians offset revenue losses incurred under this payment reform. Such an approach is logical and will benefit all parties involved, because it will enhance physician-facility relations and augment facility credibility. In this article, RBRVS is examined in terms of its impact on physicians, hospitals, and the relationship between the two. Financial management strategies are identified that can assist physicians to increase practice efficiency and cost containment to remedy potential revenue reductions caused by the implementation of RBRVS. PMID- 10131260 TI - The new healthcare audit guide. Its impact on hospitals and hospital reporting. AB - Extensive changes in the healthcare environment prompted the AICPA to issue a revised guide to auditing and accounting for healthcare entities. This guide's revisions brought significant changes to how healthcare organizations report financial items regarding revenue, expenses, bad debt, and charity care. This article studies how providers have implemented the required reporting changes and attempts to gauge the effects of this implementation on provider business-office procedures, internal financial reporting, and costs. PMID- 10131261 TI - Compensation self-restraint and self-preservation. PMID- 10131262 TI - "Gotcha covered". Puzzling out the mysteries of health insurance benefits coverage. PMID- 10131264 TI - Strained legacy. Part 1. PMID- 10131263 TI - Made in heaven? PMID- 10131265 TI - Second sight. PMID- 10131266 TI - Women in management. Moving out of middle management into the fast lane. PMID- 10131267 TI - The JCAHO Agenda for Change: what changes in pharmacy and P & T activities do you need to prepare for in 1994? AB - The Joint Commission on Accreditation of Healthcare Organizations has made serious strides toward a more meaningful accreditation process through the development of the "Agenda for Change." New, functionally oriented standards began to appear in the Accreditation Manual for Hospitals (AMH) in 1993. The greater effect of functionally oriented standards is occurring with the introduction of the 1994 AMH and will continue with the introduction of additional new standards in 1995. Discussed in this article are the JCAHO standards that are being introduced in 1994. These include further development of the director's responsibilities and medication use standards as well as new standards involving the assessment of patients and the management of information. Medication use indicators--which will become a required part of the accreditation process in 1996--are also presented. PMID- 10131268 TI - How might cost effectiveness, quality of life, and outcomes data be used by government regulators? PMID- 10131269 TI - Don't do her wrong. PMID- 10131270 TI - Ten trends in women's health. PMID- 10131271 TI - A profile of women in healthcare management. PMID- 10131272 TI - Women's services in an accountable health plan. PMID- 10131273 TI - Population and women's health. PMID- 10131274 TI - On women's health. Health herstory--a compendium of resources. PMID- 10131275 TI - Caring for the whole woman. Interview by Joe Flower. PMID- 10131276 TI - Re-engineering women's services. PMID- 10131277 TI - The power of primary care. PMID- 10131278 TI - 21st century vision. Award-winning Hackley Hospital and Mercy Health Plan chart a new, healthy future. PMID- 10131279 TI - Public and private imperatives of Greek health policies. AB - Health care in Greece has historically developed into a multi-tier system, a mosaic of public and private providers of services covering the members of occupational social insurance organizations. In 1983 PASOK's socialist government established a unified National Health System. The aim was to arrest the growth of the private sector and promote the public sector to a dominant position. The socialist legislation has recently been reviewed by a conservative government that aims at a competitive mixed market of public and private providers. The growth of private health care, however, is not solely a matter of political support but also of new opportunities for profitable investments that arise from a shrinking public sector under economic and fiscal constraints. PMID- 10131280 TI - Setting health care priorities in Sweden: the politician's point of view. AB - In this report, the results of interviews with sixty local health care politicians in southern Sweden will be presented. It is evident from the material that despite their formal responsibility, the politicians are of the opinion that other actors exert greater influence upon the allocation of resources. They do not think that health care expenditure need be extended, whereas fields such as care of the elderly and preventive medicine ought to receive extended contributions at the expense of other publicly financed activities such as general mammography and in vitro fertilization. Somewhat more than a third of the politicians hold that the goal stipulated in the Swedish Health Care Act, i.e. to provide good health and care on equal terms, has not been fulfilled. Their attitudes towards priority criteria such as personal responsibility, age, life expectancy, parenthood and productivity differ from case to case, and there is no clear-cut consensus. However, approximately half of the respondents agree wholly or partly that a person who promises to alter his or her unhealthy habits should be treated before someone who does not make such a promise. The same applies to the principle that those employed ought to be given priority in operating queues, and in consequence of this utility perspective there are also increased demands upon the physicians to take economy into consideration in treating an individual patient. PMID- 10131281 TI - 'Bed-blockers': delayed discharge of hospital patients in a nationwide perspective in Sweden. AB - Between 1989 and 1992 the number of 'bed-blocking' patients in Sweden decreased from 15 to 7% according to national registers containing approx. 4000 patients. Part of this reduction can be explained by the 1992 Elderly Reform, which placed economic responsibility for bed-blockers on municipalities. However, the decrease began before the economic reform, implying that other factors are also involved, such as access to alternative institutional beds and other forms of care. An in depth study of one district has provided a description of these often elderly patients, their heavy hospital utilization both before and after the bed-blocking period and their mortality. Nearly half the patients were dead within a year. Bed blocking is a poorly defined concept requiring urgent discussion. Other related topics to which attention should be drawn are the administrative costs of economic control systems and efficient utilization of public resources as a whole. PMID- 10131282 TI - The value of early discharge: dispelling some myths. AB - Our objective in this paper is to assess the value of early discharge schemes following the economic evaluation of three such schemes in New South Wales, Australia. An early discharge programme for obstetric patients, a fractured hip management programme and a continuing community cancer care programme were evaluated. The results of the economic evaluation of these schemes are discussed in the light of four commonly held beliefs about the value of early discharge: that early discharge schemes succeed in reducing length of stay, that early discharge schemes save money, that the welfare of patients is not reduced by early discharge and that early discharge schemes are cost-effective. The caution expressed by previous authors about the perceived advantages of early discharge schemes is still warranted. PMID- 10131283 TI - NHS reforms and resource management: whither the hospital? AB - This paper considers whether resource management (RM) as currently constituted in the National Health Service (NHS) is likely to fulfil its aim of efficiency. For the individual hospital RM has two key features: changes in managerial structure and changes in information systems. The paper assesses the extent to which the hospital behavioural model that implicitly underlies RM can be judged to reflect well the actual behaviour of hospitals. It is noteworthy that in the RM literature there is no explicit statement about the assumed underlying behaviour of the NHS hospital. Here the author selects the Harris model of hospital behaviour as providing the best explanation of internal hospital organisation. Harris represents the two lines of authority, physicians and administrators (managers in the present-day NHS), as two firms within the hospital structure, each with its own managers, objectives and constraints, making this model particularly appealing as a basis for analysing RM. Using this model the paper concludes that RM alone and as currently constituted will not be successful in promoting efficiency, because the structural and cultural mechanisms put in place by RM will not sufficiently affect physician behaviour. PMID- 10131284 TI - Health care 1994: top ten trends for the era of health reform. PMID- 10131285 TI - EMS providers in America's 200 most populous cities. PMID- 10131286 TI - State EMS directors. PMID- 10131287 TI - Information resources. PMID- 10131288 TI - Go wash your hands! PMID- 10131289 TI - Mother, may I ...? AB - If you've been working in EMS for much more than a week, the title of this column probably evoked some sort of visceral response from you--and not a positive one. The phrase "Mother, may I...?" has long been attached to EMS systems that require EMTs and paramedics to call their base hospitals prior to performing most interventions or delivering medications. Where the rub comes in is that most field people I know would prefer a little more leeway, something like a "Mother, I'm going out now" type of system. PMID- 10131290 TI - Wounded by violence. Can a KISS (Kids, Injuries, and Street Smarts) make it better? AB - Last year, Tyrone Sinkler, 16, and Ian Moore, his 17-year-old buddy, were gunned down in the hallway of their New York City school by a disgruntled classmate. For many EMTs and paramedics, this tragedy would have just added to the helplessness we feel when we go on calls in which children kill children. But for some New York City EMS (NYC*EMS) personnel, this incidence added fuel to their fire of determination to prevent such violence. Through a program called KISS (Kids, Injuries and Street Smarts), which coincidentally was poised to begin about the same time as the Sinkler and Moore tragedy, NYC*EMS personnel strive to reduce traumatic injuries to adolescents. PMID- 10131291 TI - TB: return of an old scourge. AB - In recent years, several hundred health care workers nationwide have contracted tuberculosis after being infected on the job; at least 16 of those workers have developed multidrug-resistant strains of the disease, and at least five of them have died. TB is alive and well--and EMS providers need to know what it is and how to protect themselves from it. PMID- 10131292 TI - What is a HEPA (high-efficiency particulate air) respirator and what does it have to do with me? AB - As of Jan. 6, HEPA respirators have everything to do with you. They affect how you perform your job or run your EMS service. And they definitely affect your service's bottom line. Whether you're a street provider, the president of an ambulance company or a fire chief, you need to know about TB exposure and HEPA respirator regulations. PMID- 10131293 TI - OSHA policies and procedures for TB protection. PMID- 10131294 TI - EMS in the United States. 1994 survey of providers in the 200 most populous cities. PMID- 10131295 TI - Developing community-based program alternatives for the seriously and persistently mentally ill elderly. AB - The deinstitutionalization movement in the United States has traditionally neglected the rehabilitation potential of the seriously mentally ill elderly. With the proliferation of the elderly population, unique programs and community based settings must be created and expanded to meet the mental health needs of this population in a cost-effective and humane manner. The mental health continuum presented is a model composed of programs that target the seriously mentally ill elderly in a variety of community placements including residential treatment facilities, nursing homes, retirement homes, and permanent housing. PMID- 10131296 TI - Characteristics of older adults referred to a psychiatric emergency outreach service. AB - Although older adults typically underutilize mental health services, problems associated with dementing illnesses, chronic medical illnesses, affective disorders, social isolation, and multiple medication use, among other phenomena, have increased referrals of the elderly to psychiatric emergency services. The present study reviewed characteristics of elderly adults referred to a psychiatric emergency outreach/screening service. Of all individuals for whom a referral was made, 24% were aged 60 or older. Among those older adults referred, 63% were seen by screening service personnel; 37% did not meet screening criteria or voluntarily sought mental health services. Diagnoses of individuals evaluated included dementia (27%), affective disorders (27%), schizophrenia (16%), psychosis (12%), alcohol abuse (7), and diagnosis deferred (11%). Findings highlight the limited options available for mental health care of the aged. PMID- 10131297 TI - An administrator's dilemma: keeping the innovative mental health and aging programs alive after the grant funds end. AB - Too often innovative and successful mental health and aging programs terminate when external funding sources end. This article describes one such project that has survived and even flourished well beyond the grant period. The original program is set forth, and changes in both the type of services offered and in the clientele are reviewed. The rationale for deviations from the original model are highlighted. Expansion, contraction and reexpansion of the range of services offered, as well as factors that impeded and enhanced program survival, are noted. The critical role of administrative leadership, vision and support for geropsychiatric services and staff is emphasized. PMID- 10131298 TI - Mental health services for nursing home residents: what will it cost? AB - The Nursing Home Reform Act of 1987 requires nursing homes to provide basic mental health services for all residents and to give active mental health treatment, a set of specialized mental health services, to those residents who are admitted with a serious mental illness. This article examines the potential size of the nursing home population who will require mental health services, its demographic composition, and the facilities in which these individuals reside using the Institutional Population Component of the National Medical Expenditure Survey. Estimates of the potential costs of providing monthly psychotherapy and pharmacological management to this population in nursing homes indicate that the mandate will have significant financial effects on nursing facilities. Conclusions about how the requirements for maintaining the mental and psychosocial well-being of nursing home residents may affect the future of nursing home care and mental health care are considered. PMID- 10131299 TI - A comparison of perceptions regarding the process of institutional placement. AB - The use of institutional placement in juvenile justice, mental health, and child welfare continues to be widespread. Yet there is little information about the decision-making processes connected with the choice of this alternative for adolescents. Focus groups were held with administrators, staff, and youth in a variety of institutional placements. The discussions of these groups were qualitatively analyzed for content regarding the factors that motivated reliance on placement in institutional care and the effects of policies to regulate this practice. Agreement about the diversity of adolescents in institutions, the difficulties of (but necessity for) preventive interventions with families, and possible causes for reliance on institutional care emerged. Differences about the risks and benefits of institutional placement were noted. PMID- 10131300 TI - The therapeutic value of fees: what do practitioners believe? AB - Theorists have proposed that out-of-pocket fee payment helps clients benefit from psychotherapy. 159 staff members of a public mental health agency completed a fee attitude survey. Aggregate results indicated neutral beliefs. Significant differences appeared by gender, population served, and organizational role. Women were less likely than men to endorse TVF beliefs. Addiction services staff held strongest TVF beliefs, child and adult mental health staffs were neutral, and victim services staff rejected TVF beliefs. Clinical service providers were less likely to endorse TVF concepts than were clinicians in management roles, and non clinical support staff held the strongest TVF beliefs. By understanding the relationships between fee attitudes, organizational role, and populations served, mental health administrators may be better able to manage changes in fee procedures. PMID- 10131301 TI - Consumer evaluation of an ecobehavioral program for families with children with developmental disabilities. AB - The purpose of this research was to conduct a consumer evaluation of Project Ecosystems, an in-home ecobehavioral program serving families with children with developmental disabilities. A consumer satisfaction questionnaire was designed and validated to examine process, programmatic outcome, and to assess perception of staff performance across consumer groups. The questionnaires were distributed to parents, careproviders, Regional Center workers who provided the referrals to Project Ecosystems, and other professionals who worked with Project Ecosystems' staff. The questions were divided into process, outcome, and staff performance so each element could be separated in the analysis. The data suggest considerable satisfaction from the consumers of Project Ecosystems' services. PMID- 10131302 TI - Mental health planning and problem-solving in the 90s: satisficing rather than optimizing during a time of turbulence. AB - This paper describes one aspect of a community demonstration project in Rochester, New York, which attempted to downsize a state hospital while expanding community services for individuals with serious mental illnesses. In order to successfully transfer resources from the institution to the community, private sector administrators and planners needed to modify some of their original plans based on the realities, constraints and politics of public sector systems. It is suggested that this type of compromise is well documented in systems theory and is of importance to mental administrators and planners as we try to serve more needs with the same or fewer resources during the decade of the 90s. PMID- 10131303 TI - Adequate access to posthospital home health services: differences between urban and rural areas. AB - The health care environment in rural areas changed dramatically in the 1980s. Policy-makers are concerned that these changes have reduced access to care among residents of rural areas. This study measures adequate access to Medicare home health services and determines whether it differs for urban and rural beneficiaries. Adequate access to care is measured by whether a patient with a specific health condition received a level of skilled services predetermined as appropriate for that condition. The predetermined levels of care were developed in an earlier study and were found to correlate with adverse outcomes. This study focused on patients with diabetes mellitus and surgical hip procedures to concentrate on access to skilled nursing services and physical therapy services. To conduct the analysis, a data base was constructed that included both patient utilization and health status data, drawing on three different data sources: Medicare hospital claims data, Medicare home health bill record data, and home health plan of treatment data from patients' utilization review forms (forms 485 and 486). The analysis samples consisted of 404 patients with diabetes and 876 patients who had surgical hip procedures. Significant differences were found between urban and rural areas in access to home health services. The largest differences were found in access to physical therapy services, but differences in access to skilled nursing services also exist. The data suggest that the availability of skilled care services may cause these differences. PMID- 10131304 TI - Urban/rural differences in health service utilization by elderly persons in the United States. AB - This paper presents the results of a longitudinal analysis of differences between urban and rural elderly persons in the use of hospital, nursing home, and physician services. Multivariate logistic and Tobit utilization models were estimated with data from the National Center for Health Statistics' Longitudinal Study of Aging (a national survey of more than 5,000 elderly, 70 years of age and older) and health resource data from the Bureau of Health Professions' Area Resources File. The research investigated the independent effect of residential location on both the frequency of service use and the likelihood of using a service over the period 1984-1986. Under a trichotomous definition of urban/rural residency and controlling for differences in predisposing, enabling, and need characteristics, the analysis revealed that the utilization pattern of hospital, nursing home, and physician services was unrelated to either rural or urban residential location or the availability of health resources in those areas. PMID- 10131306 TI - Uncle Sam gets serious about alternative medicine. Interview by Steve Murata. PMID- 10131305 TI - Predicting the receipt of employer-sponsored health insurance: the role of residence and other personal and workplace characteristics. AB - Americans without health insurance constitute a significant public policy concern. Previous research has demonstrated that rural Americans are more likely to be without coverage. Beyond documenting this comparative disadvantage, however, current research has two specific deficiencies: studies have not examined whether the factors that predict the receipt of employer-sponsored health insurance are equivalent across residence categories, and few studies have used a multivariate framework to examine the predictors of the receipt of health insurance. Using data from the 1987 National Medical Expenditure Survey, the influence of residence is examined along with other variables known to be associated with an increased likelihood of receiving health insurance from an employer (specifically, seven employee and six workplace characteristics). At a bivariate level, an individual's place of residence did affect the probability of receiving health insurance from an employer, with nonmetropolitan workers least likely to receive such benefits. The influence of the employee and workplace characteristics on receipt of insurance, however, did not vary significantly by place of residence. In a multivariate model, six employee and six workplace characteristics were identified as significant predictors. These findings do not refute the existence of important residential differences in health insurance coverage, rather, they suggest that the differences are due to identifiable population and workplace characteristics that vary in their distribution by residence. PMID- 10131307 TI - Changing the way doctors treat the seriously ill. PMID- 10131308 TI - Can a computer tell how good a doctor you are? PMID- 10131309 TI - If you capitate FPs, then capitate specialists. PMID- 10131310 TI - How insurers try to curtail doctor visits. PMID- 10131312 TI - Are the doctor chains a good investment? PMID- 10131311 TI - Should you sell your practice to Wall Street? PMID- 10131314 TI - NPO (nothing by mouth) requirement challenged; clear liquids may be OK. PMID- 10131313 TI - How the Clinton plan would judge your performance. PMID- 10131315 TI - Small hospital OR survey: staffing is biggest problem. PMID- 10131316 TI - Turnover time data show times vary most in the hospital setting. PMID- 10131317 TI - Study shows low compliance with universal precautions. PMID- 10131318 TI - 'Systems thinking' helps avoid the short-term fix. PMID- 10131319 TI - Perioperative educators have role in TQM. PMID- 10131320 TI - Small rural hospitals collaborate to share supplies, equipment. PMID- 10131321 TI - Reorganization of a patient financial services department. AB - The patient accounts department at Richland Memorial Hospital recently completed a reorganization process. This process took approximately four months to complete and involved retraining 46 full-time employees (FTEs) and creating five new positions in the department. PMID- 10131322 TI - Reduction of accounts receivable through total quality management. AB - On October 1, 1990, The Miriam Hospital in Providence, R.I., converted to a new computer system for patient accounting applications and on-line registration functions. The new system automated the hospital's patient accounting, registration, and medical records functions and interfaced registration with patient accounts for billing purposes. PMID- 10131323 TI - From the lab to the kitchen. PMID- 10131324 TI - The Pharmaceutical Access and Prudent Purchasing Act of 1990: Federal law shifts the duty to warn from the physician to the pharmacist. PMID- 10131325 TI - From science to evidence: the testimony on causation in the Bendectin cases. AB - Critics of American tort law often question the ability of lay jurors to make factual determinations in trials involving complex scientific evidence. In this article, Professor Sanders attempts to refocus tort reform debate by studying how trial procedures themselves contribute to jurors' inability to properly assess scientific evidence. Professor Sanders' analysis centers on trials involving Bendectin, a drug which plaintiffs have claimed caused birth defects in the children of mothers who took it during pregnancy. After noting that the weight of scientific and federal judicial opinion concludes that plaintiffs cannot establish a causal link between Bendectin use and birth defects by a preponderance of the evidence, Professor Sanders analyzes the transcripts of six Bendectin trials to determine why jury verdicts do not comport with the weight of scientific and judicial opinion. Based on his conclusion that trials are incapable of adequately conveying the weight of scientific opinion to a lay jury, he evaluates the ability of various trial reform proposals to ameliorate this problem. Finally he recommends adopting proposals that would facilitate jurors' understanding of scientific evidence and lead to verdicts consistent with the weight of scientific opinion. PMID- 10131327 TI - Health reform insight. Making political hay of the health "crisis". PMID- 10131326 TI - Perspectives. Medisave accounts: one small step toward health reform. PMID- 10131328 TI - Perspectives. A nonprofit or a for-profit health system: does it matter? PMID- 10131329 TI - Now what do I do? Information management in the TQM age. PMID- 10131330 TI - How to successfully manage an external agency inspection. PMID- 10131331 TI - The liability risk of patients who fall. PMID- 10131332 TI - Physical restraints in hospitals: risk management's reduction role. PMID- 10131333 TI - Placental examination as a risk management tool. PMID- 10131334 TI - The role of accreditation in quality oversight and improvement under healthcare reform. AB - Quality measurement and management are key components of the administration's healthcare reform proposal, and translating outcomes information into "report cards" for healthcare consumers and purchasers will create a "final common pathway to public accountability," according to Dennis S. O'Leary, MD, and Paul M. Schyve, MD, senior spokesmen for the Joint Commission on Accreditation for Healthcare Organizations. While the nature of the accreditation process as it currently exists may well change, the authors insist that the measurement and monitoring process that is ultimately adopted must include both performance standards and outcomes measures. PMID- 10131335 TI - Health reform and the quality assurance imperative. AB - The administration's blueprint for healthcare reform contains a number of positive features, including a national healthcare information database, quality "report cards," and state-based patient complaint offices. Missing from the plan, however, is "an active quality monitoring system that holds health plans and providers publicly accountable for improved performance," says Andrew Webber, Executive Vice President of the American Medical Peer Review Association, the national association of Peer Review Organizations (PROs). His antidote includes the creation of an independent, state-based network to coordinate quality assurance activities; a program to monitor compliance with practice guidelines; and a quality foundation to measure, manage, improve, and oversee quality. PMID- 10131336 TI - Administrative simplification: healthcare reform and TQM. AB - Administrative simplification is a key element of the Clinton healthcare reform proposal. Healthcare leaders, however, "cannot lay the entire burden of administrative simplification on outsiders," says Ellen J. Gaucher, Senior Associate Director of The University of Michigan Hospitals. There are numerous opportunities to use the principles of total quality management to improve operational and financial performance in healthcare organizations. PMID- 10131337 TI - Quality management and consumer protection under the President's health reform plan. PMID- 10131338 TI - The Health Security Act's quality management and oversight requirements. AB - The Quality Agenda, a regular feature of THE QUALITY LETTER, offers practical models and information that leaders of healthcare organizations can adapt and use. This month, the Quality Agenda examines the quality management and oversight provisions of the Health Security Act, including a new National Quality Management Council to spearhead the development of quality measurement and improvement efforts. Readers can obtain a complete copy of the 1,343-page Health Security Act from the Government Printing Office (202/783-3238) for $45. PMID- 10131339 TI - Healthcare reform and its impact on data collection and dissemination. AB - Making quality- and outcome-related information available to healthcare consumers and purchasers is a central tenet of the Health Security Act, and few in healthcare oppose this provision of the Act--in concept, says Robert Hartley, MD, MBA, Vice President, Christian Health Services. Consumers and purchasers need such information to make informed choices about their healthcare options. However, the Act does not make clear how or by whom quality measurement data are to be collected and disseminated, nor by what criteria healthcare providers will be held accountable. PMID- 10131340 TI - The Health Security Act: a complex and costly prescription for healthcare reform. AB - The crafters of the Administration's Health Security Act recognize the need for "fresh approaches" to measuring and improving the quality of the American healthcare system, believes David Sundwall, MD, Vice President and Medical Director of American Healthcare Systems, an alliance of 40 multihospital healthcare systems. He has concerns, however, about the complexity of the Clinton proposal--especially with regard to its data requirements--and the significant financial investments that will be required for the plan to succeed. PMID- 10131341 TI - Human tissue intended for transplantation--FDA. Interim rule; opportunity for public comment. AB - The Food and Drug Administration (FDA) is issuing an interim rule to require certain infectious disease testing, donor screening, and recordkeeping to help prevent the transmission of AIDS and hepatitis through human tissue used in transplantation. The regulations are effective upon publication. FDA is taking this action in response to growing concerns that some human tissue products are being offered for transplantation use without even the minimum donor testing and screening needed to protect recipients against human immunodeficiency virus (HIV) infection and hepatitis infection. The new regulations require all facilities engaged in procurement, processing, storage, or distribution of human tissues intended for transplant to ensure that minimum required infectious disease testing has been performed and that records documenting such testing for each tissue are available for inspection by FDA. The regulations also provide authority for the agency to conduct inspections of such facilities and to detain, recall, or destroy tissue for which appropriate documentation is not available. PMID- 10131342 TI - Hospital and community pharmacists' attitudes towards clinical pharmacy. AB - This longitudinal study compared the attitudes of the Class of 1983 at the University of Toronto toward clinical pharmacy seven years after graduation with those they expressed at the point of graduation in 1983. Over three quarters of the original class responded by indicating agreement or disagreement with statements (on a 5-point scale) about clinical pharmacy in 1983 and 1989. While there was little difference between those who became hospital pharmacists versus those who became community pharmacists at the point of graduation, seven years later, the hospital pharmacists were significantly more favourable than their colleagues toward drug consulting aspects of clinical pharmacy. The community pharmacists were significantly more favourable than their colleagues toward patient counselling aspects of clinical pharmacy. It is concluded that the work setting has influenced these different preferences for how the ideal of clinical pharmacy is interpreted. We offer a possible explanation for the consistently positive, if divergent, orientations towards the ideal of clinical pharmacy. PMID- 10131343 TI - Survey of sterile product compounding practices in Canadian hospital pharmacies. AB - Improper preparation of sterile products by hospital or community pharmacies may have serious consequences. Recent reports of deaths or injury to patients as a result of receiving products that were contaminated during their preparation in a pharmacy have highlighted the importance of maintaining good sterile compounding practices. Efforts are now underway to develop revised guidelines for the compounding of sterile products in order to minimize the potential for future recurrence of similar incidents. This survey study was undertaken to provide background data on current sterile products compounding practices and procedures in Canadian hospital pharmacies. It was also anticipated that these data would be helpful in identifying issues that needed to be addressed in the new guidelines. Surveys were distributed to 700 Canadian hospitals with 50 or more beds. Responses from returned surveys were entered into and analyzed using the database program RBase. A total of 306 hospital pharmacies responded, with 200 indicating that sterile products were compounded within their department. The information provided by respondents provides insight into the types of sterile products being prepared in Canadian hospitals, the training background of staff involved in sterile product preparation, the type of facilities and equipment used for compounding these preparations, and the quality control/quality assurance procedures that are in place in hospital pharmacies. The information arising from this survey underscores the need for comprehensive guidelines or standards with respect to sterile product compounding, and the need for improved training of personnel involved in sterile product compounding. The results should be of interest to hospital pharmacy administrators, pharmacy regulatory bodies, and government agencies responsible for assuring the safety of pharmaceutical products used in patient care. PMID- 10131344 TI - Management considerations to implementing pharmaceutical care. AB - Progressing towards the goal of PC requires a fundamental change to pharmacy practice. Strong leadership and management skills will be needed to facilitate this change. Even with enthusiastic and capable staff, implementation of the PC model will require considerable effort. Changes to the department's mission statement and organizational structure will be required. From this beginning, an action plan for the department can be developed. This plan includes the training of individuals and/or recruiting the necessary personnel. An ongoing education program, as well as determining the value of your service, is required. With successful implementation the PC model will lead to the acceptance of the pharmacist's role as the person responsible for identifying, preventing, and resolving drug-related problems. PMID- 10131346 TI - Can the luster be restored? PMID- 10131345 TI - Implementation of an aminoglycoside order review process in a central dispensary. PMID- 10131347 TI - An image to take us into the 21st century. PMID- 10131348 TI - John M. Eisenberg, MD: advocate for primary care. Interview by C. Burns Roehrig. PMID- 10131349 TI - Do we really want--or need--comprehensive reform? PMID- 10131350 TI - Are we abandoning primary care? PMID- 10131351 TI - 'Merger mania' and the small-group practice. PMID- 10131352 TI - The Clinton plan and Medicare. American Society of Internal Medicine. PMID- 10131353 TI - Why don't people like doctors any more? PMID- 10131354 TI - Researching quality: GPIN (Group Practice Improvement Network). PMID- 10131355 TI - Practice parameters and outcomes measurement: managing for quality. AB - Defining practice standards (parameters) and measuring the results derived from them is the key to quality management. Jeanine Barlow, M.P.H., CRAHCA project director, interviewed several medical practices about parameters and developed some assessments and recommendations to be considered when instituting parameters/outcomes management. PMID- 10131356 TI - Hope for the future--tools for success. AB - In light of rapid changes, there is hope that medical practices can keep up. Authors Mary Ann Moore, M.S., M.P.H., and Sherry Anderson Delio, M.P.A., H.S.A., explore the role that leadership plays in improving practice quality through the establishment of practice management programs. PMID- 10131357 TI - A winning game plan for QI. AB - Authors Robert L. Boyle, Jr., M.P.H., FACMPE, James G. Shaw, M.B.A., and Diane Stewart describe how to put a quality improvement program into practice by identifying key internal processes, selecting an improvement program, identifying what to improve and developing a review method. They also present results from the first year of their quality improvement process. PMID- 10131358 TI - A small medical group's journey toward total quality management. AB - Steven M. Shufro, executive director of Concord Hillside Medical Associates, in Concord, Mass., documents the first year of the group's implementation of a quality program and what the results were. He includes a look at the organizational context of the group, the development of the program and how the Harvard Community Health Plan, the largest pre-paid HMO in New England, assisted them. PMID- 10131359 TI - Applying total quality management (TQM) to health care administration. AB - Author Neil S. Fleming, Ph.D., ASQC, C.Q.E., approaches quality management from a more theoretical perspective, relating it to dimensions of predictability and responsiveness. He couples these with achieving the optimal balance between prevention, appraisal and failure with the goal of producing the lowest possible total quality costs. PMID- 10131360 TI - How customer satisfaction can influence clinical outcome in a back specialty clinic. AB - Determining what defines quality is the aim of the study produced at the Texas Back Institute. Bob Reznik, M.B.A., vice president of the institute, presents a methodology for measuring the outcomes of clinical care and relating it to physician performance on a variety of levels. PMID- 10131361 TI - What's wrong with total quality management? AB - There is nothing inherently wrong with TQM, says author C. Thomas Yarington, Jr., M.D. The problems come when management does not fully support the total integration of the practice into the quality improvement effort. PMID- 10131362 TI - Physician practice and feedback of information. PMID- 10131363 TI - Strategic responses of academic medical centers to the growth in ambulatory care. AB - Alan M. Zuckerman, M.A., FAAHC, executive vice president of Chi Systems Inc., examines how academic medical centers are faring as ambulatory care becomes an increasing reality in this country. He presents geographic and integration strategies for these centers to maintain an economic edge as their markets shrink. PMID- 10131364 TI - Anatomy of an affiliation. AB - Affiliations are a big part of the future of health care. In this article, Brian D. Eason presents a chronology of how an affiliation was born, highlighting the problems, success and lessons learned from the process. PMID- 10131366 TI - Baxter takes charge, posts big loss. PMID- 10131365 TI - Homedco and Abbey among companies that have viewed T2's books. PMID- 10131367 TI - Caremark reports strong growth. PMID- 10131368 TI - FDA continuing probe into dialysis deaths. PMID- 10131369 TI - Del. panel urges reforms based on current system. PMID- 10131370 TI - Kansas, Colorado scale back efforts. PMID- 10131371 TI - W.Va. gov unveils reform package. PMID- 10131372 TI - New York hospitals would lose big in first years of reform, study says. PMID- 10131373 TI - Accounting error may force hospital sale. PMID- 10131374 TI - Upheaval lessens value of ratios--S&P. PMID- 10131375 TI - JCAHO action spotlights networks. PMID- 10131376 TI - NAPH first to endorse Clinton plan. PMID- 10131377 TI - Clinton revs up reform push in State of the Union speech. PMID- 10131378 TI - Problems, yes, crisis, no--Dole. PMID- 10131379 TI - Health Net told to hold payments. PMID- 10131380 TI - Crusade helps gain approval for Kan. hospital transplant program. PMID- 10131381 TI - Summary of major healthcare reform bills. PMID- 10131382 TI - Feds approve merger in two-hospital N.H. town; Colo. deal awaits decision. PMID- 10131383 TI - Contract management. Firms see pressure, not profits. PMID- 10131384 TI - Getting away for a while may be best way for busy execs to go. PMID- 10131385 TI - AHA peruses federal budget for alternatives to health cuts. PMID- 10131387 TI - Businesses enlist caregivers' aid to collect healthcare information. PMID- 10131386 TI - Group trade organizations merging. PMID- 10131388 TI - Long-ignored hospital stocks outpacing other equity indices. PMID- 10131389 TI - S&P affirms ratings for physician groups, plans. PMID- 10131390 TI - Quake leaves 34 facilities in need of razing or repair. PMID- 10131392 TI - Mayo to cut 450 through attrition. PMID- 10131391 TI - HealthEast plans include layoffs. PMID- 10131393 TI - Study questions estimates of psych benefit cost. PMID- 10131394 TI - Forecast by the foremost. PMID- 10131395 TI - Bordering on the possible. Can U.S. health reform learn from Canada? PMID- 10131396 TI - 1994 equipment & service guide. PMID- 10131397 TI - Integration, accountability and decentralisation of Crown Health Enterprise decision making. AB - New Zealand is possibly moving further than any other western country in achieving a decentralised, integrated, accountable and population-based health system. However, this progress owes as much or more to the reforms implemented through the area health board system, particularly general and service management, than the current reform process. Services have largely replaced hospitals as organizational entities. The leading edge of CHE service development should not be high-tech services but primary health care (PHC). Progressive CHEs are implementing a PHC service as a structure for managing their own PHC services and to begin the necessary dialogue with GPs and other non-government PHC providers. PMID- 10131398 TI - Patient management system for Nelson/Marlborough. PMID- 10131399 TI - Thames Hospital enjoys savings with decentralised energy complex. PMID- 10131401 TI - The New Zealand health survey. PMID- 10131400 TI - Health professional workforce planning in 'The Age of Unreason'. PMID- 10131402 TI - Fellowship opens transitional home. PMID- 10131403 TI - Risk management receives attention in Capital Coast Health. PMID- 10131404 TI - Canterbury laboratories at the forefront. PMID- 10131405 TI - Midland Health meets women to discuss maternity recommendations. PMID- 10131407 TI - NCQA releases HEDIS 2.0 standards. Quality monitoring group prepares to test report card measures. PMID- 10131406 TI - An overview of the CRISP (Consortium Research on Indicators of System Performance) project. Consortium tests indicators of integrated system performance. PMID- 10131408 TI - Arizona medical center's Alpha network gives ICU staff instant access to radiologic films. PMID- 10131409 TI - Health care reform. The implications for quality, risk & cost management. PMID- 10131410 TI - The new revolution in quality management. Computer-based patient records. PMID- 10131411 TI - The health care purchasing dilemma for American business. PMID- 10131412 TI - Health alliances: the coalition perspective. PMID- 10131413 TI - Managing the communication of the employer's promise of benefits. PMID- 10131414 TI - New benchmarking capabilities using publicly available discharge data. PMID- 10131415 TI - American Health Information Management Association. Position statement. Issue: healthcare reform--information systems and the need for computer-based patient records. AB - Timely, reliable information is a critical part of healthcare reform. The Clinton Administration's current proposal would streamline health information through the use of standard forms and data definitions and establish a nationwide electronic highway to link health records and exchange needed information. Information would be captured, retained, and transmitted as a routine byproduct of patient care. These goals can be achieved only through broad implementation of the computer based patient record (CPR). The CPR will contribute to more effective and cost efficient care through (1) ready access to longitudinal (lifetime) health information; (2) support for continuous quality improvement; (3) easy access to clinical knowledge bases; and (4) patient participation in health documentation and disease prevention. The technology exists to implement the CPR, but further work is needed to develop the necessary standards and security mechanisms. The American Health Information Management Association is committed to working with applicable state and federal agencies, professional associations, accrediting agencies, voluntary standards organizations, and the Computer-Based Patient Record Institute (CPRI) to achieve the information management objectives of the current health care reform plan. With their expertise in health information systems and strong commitment to patient privacy, health information management professionals can make significant contributions to the development, implementation, and ongoing security of national and state health information networks. PMID- 10131416 TI - AHIMA testifies regarding need for federal legislation. PMID- 10131417 TI - American Health Information Management Association. Position statement. Issue: quality management and improvement in healthcare reform. AB - Healthcare providers have long been proponents of high quality, cost-efficient patient care services. The healthcare reform plan proposed by President Clinton acknowledges these long-standing priorities through the formation of a nationwide healthcare Quality Management Program. Implementation of an effective Quality Management process in all sectors of healthcare services will require dedication and innovation from all members of the healthcare team, including health information management professionals. Providers must accept responsibility for collecting reasonable data to develop reliable and statistically valid quality and performance measures. Healthcare consumers must shoulder the responsibility of interpreting the data accurately and using it responsibly. The American Health Information Management Association (AHIMA) and the members of its Quality Assurance Section are committed to working with applicable state and federal agencies, professional associations, and accrediting agencies to achieve the quality and performance measurement objectives of healthcare reform. Through these alliances, AHIMA and the Quality Assurance Section can assist the nation's healthcare providers, health plans, health alliances, and consumers in making sound judgments about quality and cost. PMID- 10131418 TI - Perfecting press releases. PMID- 10131419 TI - Software engineering tools. AB - We have looked at general descriptions and illustrations of several software development tools, such as tools for prototyping, developing DFDs, testing, and maintenance. Many others are available, and new ones are being developed. However, you have at least seen some examples of powerful CASE tools for systems development. PMID- 10131420 TI - American Health Information Management Association. Position statement. Issue: streamlining regulatory activities. PMID- 10131421 TI - Will coders' fortunes change under capitation? Arizona's glimpse of the future. PMID- 10131422 TI - The Florida Health and Insurance Reform Act of 1993. PMID- 10131423 TI - Both Washingtons deal with healthcare in 1993. PMID- 10131424 TI - Reform in Tennessee--friend or foe? PMID- 10131425 TI - Clinical practice guidelines and critical paths--roadmaps to quality, cost effective care (Part I). AB - Clinical practice guidelines and critical paths have gained widespread acceptance in recent years. Part I of this article will examine clinical practice guidelines, or practice parameters, and their application to patient care. Part II (in the February issue of JAHIMA) will look at multi-disciplinary care plans known as critical paths and how they can incorporate clinical practice guidelines. Health information management professionals can play an important role in implementation and ongoing evaluation of these clinical tools. PMID- 10131426 TI - 1994--AHIMA moves to "Vision 2000". PMID- 10131427 TI - FORE acquires library automation software system. PMID- 10131428 TI - AHIMA code of ethics and bylaws. Bylaws amended, October 1993; Code of Ethics amended, 1991. PMID- 10131429 TI - The 1994 Medicare fee schedule. PMID- 10131430 TI - Statement on surgical residencies and the educational environment. American College of Surgeons, Graduate Medical Education Committee. PMID- 10131431 TI - Health care. Crisis? What crisis? PMID- 10131432 TI - Pat's healthy gripe. PMID- 10131433 TI - Some winners, some losers on health costs under Clinton plan. PMID- 10131434 TI - Data watch. A profile of outcomes research. Results from a survey of 102 managed care plans, September 1993. PMID- 10131435 TI - Jockeying for position. PMID- 10131436 TI - Truth in numbers. PMID- 10131437 TI - How managed care measures up. PMID- 10131438 TI - Refurbishing home care. PMID- 10131439 TI - Puget Sound's hopes ride on group buying. AB - A Washington State purchasing co-op is offering a private sector solution to health reform. But failure to convince legislators of the need for competition could mean the end of the alliance. PMID- 10131441 TI - What health care costs. PMID- 10131440 TI - HMOs are poised to lead. PMID- 10131442 TI - Quality of care in private nursing homes: improving inspection. AB - Describes how the 1984 Registered Homes Act has been implemented at the DHA and operational levels, concentrating on the monitoring of care in private nursing homes. It can be seen that, perhaps due to the unspecific nature of the Act, there are significant differences between the DHAs, in terms of the degree of importance attached to quality of care. However, at the operational level, this issue was considered to be more salient, although still reliant on the discretion of each individual inspection officer. Puts forward a three-point plan for strengthening inspection practices. PMID- 10131443 TI - Marketing: can there ever be a real exchange of values in the Health Service? AB - Offers many new ideas in the field of marketing, and argues that marketing is a complex, strategic thought process, based on an exchange of customer-related values. A new model of need and want is offered, and developed into a strategic framework which considers the functional and perceptual nature of what is loosely termed "the delivery of care". Argues that, in marketing terms, strategic focus in the NHS can only be achieved by getting close to the mind of the customer. PMID- 10131444 TI - Purchasing quality: the South Lincolnshire approach. AB - Describes the authority's strategy, recording system, visiting programme, and guide to monitoring. Describes four developments in detail which South Lincolnshire's review of its quality monitoring approach has stimulated. The strategy identifies three levels of monitoring activity: an overview, a means of identifying when closer monitoring is indicated, and causes for concern; a selective view, a means of assessing the severity of causes for concern; and an investigative view, to examine and identify solutions to confirmed problems. Explains how the strategy identifies corporate responsibility for quality monitoring, and how this may be achieved; how the "monitoring matrix" enables a comparative overview of each provider's compliance to purchaser standards. An up to-date record of progress on individual standards is constantly available. Quality monitoring visiting can be hit or miss. The South Lincolnshire approach attempts to minimize this through the management of the visit and the use of a pocket guide to monitoring. The guide's objective is to provide a practical guide to monitoring. An attempt has also been made to unveil some of the mystique surrounding quality. PMID- 10131445 TI - MAAGs (Medical Audit Advisory Groups): the Eli Lilly National Clinical Audit Centre. AB - Outlines the framework for promoting audit in general practice, created as one part of the health service reforms. Medical Audit Advisory Groups (MAAGs) were set up in each district with the aim of participation in audit of all general practitioners by April 1992. The activities undertaken have included those recommended by the Department of Health; the most significant of these being the appointment of lay facilitators who are able to assist general practitioners and primary care teams co-operate over efforts to improve the quality of care, and may offer one means of introducing some of the methods of total quality management into general practice. Discusses the problems which remain: audit is not yet sufficiently systematic, interface audit with secondary care is at a very early stage, the ways to involve managers and patients in audit remain to be clarified, and there is little evidence of the consequences of audit in terms of improved care. The Eli Lilly National Clinical Audit Centre has been set up within the Department of General Practice, University of Leicester, in order to address these issues. PMID- 10131446 TI - Analysis of data as information: quality assurance approach. AB - Describes a prototype module for data analysis of the healthcare delivery system. It consists of three main parts: data/variable selection; algorithms for the analysis of quantitative and qualitative changes in the system; and interpretation and explanation of the results. Such a module designed for primary health care has been installed on a PC in the health manager's office. Data enter the information system through the standard DBMS procedures, followed by calculating a number of different indicators and the time series, as the ordered sequences of indicators, according to demands of the manager. The last procedure is "the change analysis" with estimation of unexpected differences between and within some units, e.g. health-care teams, as well as some unexpected variabilities and trends. As an example, presents and discusses the diagnostic pattern of neurotic cases, referral patterns and preventive behaviour of GP's teams as well. PMID- 10131447 TI - Towards integrative audit: a partnership for quality. AB - Outlines the gradual process which led to the development of the Sunderland Integrative Audit System. Centred around the Patient's Charter rights and standards, the various modules used together form a patient-centred, multidisciplinary approach to audit that can be used to monitor a contract, clinical directorate or specialty. Founded on the principle that health care is a complex, interactive process, the system seeks to establish the extent to which the patient experiences an "integrated" service by examining the interfaces between departments, professionals and services. Extensive piloting in diverse fields has found the system capable of being used in a variety of hospital and community settings. PMID- 10131448 TI - Devising a multidisciplinary audit tool. AB - Discusses the audit processes in health care from the existing perspectives and argues the need to extend the current unidimensional approaches which include medical, clinical and managerial quality. Argues that one way of expanding these approaches is to develop an audit instrument based on the views of service users. The implementation of audit has been a process with regional variations, which have created centres of excellence and centres where there is very little happening. Considers elements that are involved in devising an audit tool which is based on customers' perceptions of service quality, and reports on an empirical study which is still in progress and which aims to develop a tool which is effective, efficient and based on patients' views. PMID- 10131449 TI - Quality assurance and internal organizational communications. AB - Reviews the relationship between internal communication in organizations and the effective delivery of service. Illustrates how quality internal communications can reduce the levels of uncertainty experienced by staff, especially at times of change, and describes a methodology--the communication audit--whereby organizations can monitor and evaluate quality in this sphere. Explains the core steps involved in implementing this type of audit and itemizes the main data collection tools. PMID- 10131450 TI - Quality assurance: a prescription for success. AB - Provides a theoretical and practical overview of one organization's total quality management initiative. Concentrates particularly on the pursuit and achievement of registration against the quality assurance standard BS 5750/ISO 9002. The organization is a public sector trading agency providing a financial internal audit service to a range of clients within the NHS. PMID- 10131451 TI - QUDOS: a quality assurance system for health care. AB - Describes a system of quality assurance for use by either purchasers or providers of health care services. The system has been in operation since 1991 and is compatible with registration to BS 5750. PMID- 10131452 TI - An approach to consumer feedback in an out-patient specialty service. AB - Details an approach to consumer feedback in an out-patient specialty service. Outlines the approach to undertaking a consumer survey and how feedback from people using the Genito-Urinary Medicine services can be obtained. The aim of the survey was to assess the level of individual/personal care. Gives the objectives and methodology, main findings and recommendations, together with a cost benefit analysis of the work. PMID- 10131453 TI - QALYs (Quality Adjusted Life Years): a nurse's view. AB - Examines the political and ideological significance of measures of quality of life, specifically Quality Adjusted Life Years (QALYs). Briefly reviews recent developments in the debate surrounding the economic and political functions of quality of life measures. The dialectic between conceptions of the quality of life and the implicit realpolitik of socio-economic pressures, ecological conditions, political ethos and cultural norms and expectations, is conceived as a powerful means for the critique of our aspirations concerning health. Argues that existing approaches to assessing quality of life, in denying this dialectic, have jeopardized their potential contribution to the planning, implementation and evaluation of health are policy. Resource allocation challenges us to develop openly ideological strategies and measures. PMID- 10131454 TI - Beyond resource management: towards total quality. AB - Suggests that health organizations which have successfully introduced devolved management by involving clinicians are reaching a position where they can move forward beyond "Resource Management" towards managing in a total quality way. This is not an in-depth explanation of TQM (which in itself is rarely understood) but a brief examination of how health organizations can move towards becoming total quality organizations. The trend to decentralize the management of clinical services in hospitals is seen in many countries across the world and where well established, the natural evolution has been towards total quality management. PMID- 10131455 TI - The effective management of occupational health and safety: the requirement for accreditation for quality in the Health Services. AB - It is becoming increasingly important for providers of health care to manage the health and safety of their workforce effectively. In the competitive world of health care, organizations seeking accreditation for quality are having to allot greater importance to health and safety than in the past. The manager of occupational health services for West Birmingham Health District, which has recently applied for Trust status, explores some of the reasons for this. PMID- 10131456 TI - Quality assurance in nursing care: from inspection to opportunity. AB - Describes alternative approaches to quality assurance in nursing and traces the historical shift from one approach to the other; quality as inspection to quality as opportunity. Early proselytizing approaches were superseded by an emphasis on quantitative measurement and attempts at "objective" evaluation which involved the development of the generic audit. More recently, the move has been towards locally developed audit and standard setting. PMID- 10131457 TI - Changing the measure of quality in the NHS: from purchasing activity to purchasing protocols. PMID- 10131458 TI - Quality, the patient's charter, and primary care. PMID- 10131460 TI - Agreeing criteria for audit of the management of induced abortion: an approach by national consensus survey. AB - OBJECTIVE: To obtain a national consensus view of suggested criteria for good quality care in induced abortion to serve as a basis for standards for audit to assess current clinical practice. DESIGN: Postal, questionnaire survey assessing consensus agreement with criteria identified from a literature review and refined by an invited panel of four gynaecologists and the gynaecology audit project in Scotland (GAPS) committee. SETTING: Scotland. SUBJECTS: All 132 practising consultant gynaecologists. MAIN MEASURES: Overall level of agreement with each of 20 suggested audit criteria. RESULTS: 121 completed questionnaires were received (response rate 92%), of which 119 were returned in time for analysis; 107 came from consultants who practised abortion routinely and were included in the analysis. Nineteen of 20 suggested criteria were validated by an overall balance of agreement. The most strongly supported criterion (agreement score +93) was for ascertaining rhesus status of the woman and prophylaxis after abortion, if indicated. The only criterion to elicit a negative agreement score (-27) was that dilatation and evacuation is the best method of abortion at 12-15 weeks' gestation. The ranked and prioritised criteria resulting from this exercise are being used within a national audit project. CONCLUSIONS: A postal questionnaire survey among interested clinicians resulted in a good response rate and enabled the audit criteria to be validated and ranked more objectively and among more clinicians, than would have been possible by group discussion. PMID- 10131459 TI - Evaluating a policy of reduced consultant antenatal clinic visits for low risk multiparous women. AB - OBJECTIVES: To evaluate a change in antenatal care policy to reduce antenatal clinic visits, whereby low risk multiparous women were managed by the primary care team and seen at booking and at 41 weeks' gestation at the consultant antenatal clinic. DESIGN: Comparative study of low risk multiparous women retrospectively identified through the Oxford obstetric data system and cared for by three consultants who changed their policy (group A) or three consultants who maintained their routine care (group B). SETTING: Oxfordshire Health District. SUBJECTS: 2153 low risk multiparous women (1079 group A, 1074 group B) booked for consultant care at John Radcliffe Maternity Hospital between August 1985 and July 1987. MAIN MEASURES: Comparison of pregnancy outcomes, satisfaction with care, and clinic waiting times, during one year before and after the policy change (year 1, year 2). RESULTS: The proportion of women in group A with only one or two consultant clinic visits increased from 19.9% to 57.9% between years 1 and 2 (p < 0.001). Clinic waiting times did not improve. Of five perinatal deaths in group A, one (from postmaturity) could possibly be attributed to the policy change. The proportion of women reaching 42 weeks' gestation rose from 4.7% to 9.2% (p < 0.01); the proportion fully satisfied with their care rose from 68.4% to 82.1% (p < 0.025). No such changes were seen in group B. CONCLUSIONS: The change in policy was successful in reducing hospital antenatal clinic visits. The exercise identified dilemmas around evaluating changes in antenatal care settings. IMPLICATIONS: Criteria to test policy objectives should be selected carefully and rare events assessed prospectively in order to detect problems early. PMID- 10131461 TI - Incompleteness and retrieval of case notes in a case note audit of colorectal cancer. AB - Hospital case notes are a crucial source of data but are subject to two major biases: incompleteness of data and non-retrieval. To assess these biases in relation to colorectal cancer a study was performed of all cases of colorectal cancer listed in the Thames cancer registry in patients resident in one of four districts in South Thames regions with a diagnosis in 1988. Five medical record sites were involved. Retrieval rate for all case notes for districts combined was 80%. In two districts the rates were too high for further investigation; in the other two respectively patient survival and whether treatment was given were positively associated with retrieval. Among the four districts incompleteness of notes ranged from 38% to 62% for staging, 8% to 40% for treatment, and 70% to 25% for diagnostic tests. Information about treatment was missing in 3% to 20%; survival data were omitted in less than 5%. In all districts completeness of case notes was inadequate and in some non-retrieval compounded the problem. Missing data reduce the quality of cancer registry data and potentially undermine interpretation of epidemiological studies and evaluation of care. Further research is warranted into the standards and resourcing of medical records departments and their effects on retrieval and data quality. Structured proformas could be applied across specialties to identify missing items in case notes, to identify areas where standards are required, or to audit notes where standards have already been agreed. A staging protocol to set standards for colorectal cancer has been adopted in one district, and a prospective audit is being established. PMID- 10131462 TI - Audit of patients' awareness of ophthalmic diagnoses. AB - Providing information to patients about their medical condition and treatment options is important in medical management. To assess patients' knowledge of their ocular disease, prognosis, and treatment a questionnaire based survey was performed. 219 patients selected by random systematic sampling during six months from patients attending general ophthalmic clinics in Selly Oak Hospital, Birmingham, were questioned and 217 questionnaires were analysed. The findings showed that patients' knowledge of their diagnosis depended on their condition: patients with common conditions such as glaucoma and cataract had a better understanding of their condition, its treatment, and prognosis compared with patients with rarer conditions such as retinal detachment or patients with multiple diagnoses. In all, 152 patients (70%) wanted more information about their condition; 49 (23%) did not (although 12 (25%) had attempted to obtain information); and 16 (7%) were undecided. In view of the few patients with a precise understanding of their ophthalmic diagnosis and prognosis and the majority's wish for access to further information, that access needs improvement and different modes of disseminating the information should be implemented. PMID- 10131463 TI - Purchasing for quality: still in the starting blocks? PMID- 10131464 TI - Audit in general practice: where do we go from here? PMID- 10131465 TI - Medical audit: in need of evaluation. PMID- 10131466 TI - Audit and the team: an interview with the Adelaide Medical Centre team. Interview by Richard Baker. PMID- 10131467 TI - Introducing new cost effective treatments into the NHS. Surfactant treatment for premature babies: who cares enough to pay? PMID- 10131468 TI - Long term care for elderly people. PMID- 10131469 TI - View from Scotland ... general practice audit. PMID- 10131470 TI - The president's tough choice ... abortion. PMID- 10131471 TI - Hey doc, you got great legs. Medicine: sexual harassment and women doctors. PMID- 10131472 TI - Sources of health insurance and characteristics of the uninsured. Analysis of the March 1993 Current Population Survey. AB - This Issue Brief/Special Report examines the extent of health insurance coverage in the United States, the characteristics of the uninsured population by employment status, firm size, industry, income, location, family type, gender and age, race and origin, and education, as well as how the uninsured population has changed over the last several years. Eighty-three percent of nonelderly Americans and 99 percent of elderly Americans (aged 65 and over) were covered by either public or private health insurance in 1992, according to EBRI tabulations of the March 1993 Current Population Survey (CPS). The March 1993 CPS is the most recent data available on the number and characteristics of uninsured Americans. In 1992, 17.$ percent of the nonelderly population--or 38.5 million people--were not covered by private health insurance and did not receive publicly financed health assistance. This compares with 36.3 million in 1991 (16.6 percent), 35.7 million in 1990 (16.5 percent), 34.4 million in 1989 (16.1 percent, and 33.6 million in 1988 (15.9 percent). The most important determinant of health insurance coverage is employment. Nearly two-thirds of the nonelderly (62.5 percent) have employment based coverage. Workers were much more likely to be covered by employment-based health plans than nonworkers (71 percent, compared with 40 percent). A primary reason for the increase in the number of uninsured between 1991 and 1992 is a decline in employment-based coverage among individuals (and their families) working for small firms. Forty-two percent of the additional 2.2 million individuals without coverage between 1991 and 1992 were in families in which the family head worked for an employer with fewer than 25 employees. The number of children who were uninsured in 1992 was 9.8 million, or 14.8 percent of all children. This compares with 9.5 million and 14.7 percent in 1991. The increase in the number and proportion of uninsured children was partially offset by an increase in the proportion of children with Medicaid. In 12 states and the District of Columbia, more than 20 percent of the population was uninsured in 1992 (table 3). These states and their uninsured rates were Nevada (26.6 percent), Oklahoma (25.8 percent), Louisiana (25.7 percent), Texas (25.7 percent), the District of Columbia (25.5 percent), Florida (24.2 percent), Arkansas (23.5 percent), California (22.2 percent), South Carolina (20.8 percent) and Alabama (20.1 percent). PMID- 10131473 TI - Employment in industries. AB - Detail on wage and salary employment, the service-producing sector--health business, and retail trade in particular--and the goods-producing sector. PMID- 10131474 TI - Employment in occupations. AB - Detail on the major occupational groups--projected employment, educational attainment, and median earnings. Information about the occupations that are growing fastest, adding the most jobs, or providing the most openings. And a look at the fastest growing jobs requiring different levels of education. PMID- 10131475 TI - Standardizing assessment improves practice. PMID- 10131476 TI - Collaboration on discharge record improves emergency care of mentally ill. PMID- 10131477 TI - Referrals to hospital-owned businesses: recording patient choice. PMID- 10131478 TI - General guidelines for recording patient care. PMID- 10131479 TI - Preadmission planning for adoption. PMID- 10131480 TI - The colonization of the womb. PMID- 10131481 TI - Reflections: past, present, future. PMID- 10131482 TI - Management of clinical staffing. PMID- 10131483 TI - Presbyterian Hospital food court. Presbyterian Hospital, Albuquerque, New Mexico. PMID- 10131484 TI - Challenge: how to improve patient satisfaction. PMID- 10131485 TI - Challenge: how to improve nursing homes' 'quality of life'. PMID- 10131486 TI - Shiley saga leads to improved communication. AB - Certain heart valves manufactured by Shiley, Inc., turned out to have increased fracture rates. Alerting doctors and patients to this problem has changed the way FDA expects manufacturers to communicate significant risks with medical devices. PMID- 10131487 TI - Access Health Marketing. Remedy: educate the patient. AB - Access Health Marketing is providing a radical cure for the feverish rise in medical costs. It's counseling patients over the telephone to help them make their own health care decision. PMID- 10131488 TI - Overcoming barriers to TB prevention and treatment. PMID- 10131489 TI - There is such a thing as a free lunch. Social policy in the Clinton health plan. PMID- 10131490 TI - Survival of the safety net. A look at Clinton's health care plan. PMID- 10131491 TI - Mental health in the Clinton plan. Corporate dictatorship in therapy. PMID- 10131492 TI - A cost comparison of Canadian and U.S. hospital pharmacy departments. AB - The average Canadian hospital in 1990, with an almost 11-day average length of stay compared to 7.3 days in U.S. hospitals, had an average expense per discharge of $2,720 less than similar U.S. facilities. With the health reform debates underway, this large discrepancy estimated at $84.2 billion per annum for the United States, stimulated interest in undertaking a comparative analysis of pharmacy department expenses in medium-size and teaching hospitals in these two nations. If U.S. acute care facilities could have curtailed their hospital pharmacy and drug discharge cost to correspond to Canadian averages, an estimated $4.6 billion might have been saved in the United States in 1993. Reductions in these expenses could be influenced by how closely our health reform plan eventually follows the Canadian global budgetary target model and whether the U.S. pharmaceutical industry is forced to reduce its wholesale drug prices. PMID- 10131493 TI - Comprehension of antibiotic instructions in an outpatient Malaysian practice. AB - Patients may not comply with antibiotic instructions because they do not understand them. The aim of this study was to assess outpatients' ability to comprehend their antibiotic prescription labels. Two hundred and five subjects on oral antibiotic regimens from an outpatient clinic and pharmacy of a district hospital were selected in this survey. All patients were interviewed by trained clinical pharmacy students. They were asked to read the labels and then how they would take their antibiotics. The results show that 119 (58.1%) patients could interpret the label. Forty-nine (23.9%) patients knew the name of antibiotics and interpreted the directions of use correctly. One hundred sixteen (56.6%) subjects were able to recall the auxiliary information. However, only 44 (21.4%) patients were able to comprehend complete antibiotic instruction. This study demonstrates that a significant proportion of patients could not interpret the labeling instruction. The comprehension level of patients was low and significantly associated (P < 0.05) with the ability of patient to read the label contents. These observations illustrate the need for physicians and pharmacists to provide antibiotic instructions and review these instructions with the patient. PMID- 10131494 TI - Let the health reform debate begin. PMID- 10131495 TI - Four-story mall helps consolidate obstetrics and outpatient services. PMID- 10131496 TI - Engineering controls and TB: what works? How well? AB - OSHA's recent decision to enforce the CDC's TB-control guidelines is forcing facilities to implement engineering controls--despite a lack of hard data on what works best. PMID- 10131497 TI - The Agenda for Change: performance focus alters JCAHO's survey process. AB - Starting this year, the new performance improvement (PI) standards set by the Joint Commission on Accreditation of Healthcare Organizations take effect. Under PI.l, officials at all accredited health facilities are required to institute a "planned, systematic, organizationwide approach to designing, measuring, assessing and improving its performance." This shift to a performance focus is a cornerstone of the JCAHO's Agenda for Change, a 7-year-old initiative that is rapidly transforming the accreditation process for health care institutions. But what the this PI focus mean to health facility managers like you? And how will the Joint Commissions's new performance improvement focus affect your health care institution's chances of passing its next accreditation survey with flying colors? To find out, we asked experts in the field. We printed some of their answers in last month's issue; the rest appear here. PMID- 10131498 TI - Parking structures, wayfinding: around and around we go. PMID- 10131499 TI - DuPont/HFM forum on carpet in health care facilities. AB - DuPont and Health Facilities Management magazine invited 20 national experts to Dalton, GA--the carpet-manufacturing capital of the world--last year to take part in Dupont's first-ever Forum on Carpet in Health Care Facilities. During the two hour roundtable discussion, moderated by DuPont's C. Jack Murph and HFM's Michael Hemmes, ender-users, interior designers and carpet mill representatives talked about the aesthetic, economic and performance aspects of using carpet in health care settings. Here's an edited version of what they said. PMID- 10131500 TI - Little wiggle room in OSHA confined-spaces rule. PMID- 10131502 TI - How will health system reform affect big-ticket spending? PMID- 10131501 TI - Improved linen handling cuts risks, ups efficiency. PMID- 10131503 TI - Q & A ... number of patches allowable on reusable linen wrappers and the number of times a reusable cloth wrapper can be reused. PMID- 10131504 TI - How changes in healthcare delivery will impact materiel management. AB - Materiel management personnel undoubtedly believe that in the past they have done all within their power to cut costs, increase efficiency and comply with their facility's productivity requirements. However, with healthcare reform and associated changes, it will be necessary for them to develop additional creative ideas--and implement innovative information system solutions--to improve the materiel management operations. EDI and decentralized inventory management at remote locations will become prominent as health care continues to move out of the hospital. Closer working relationships with physicians and other providers in coordinated networks to match cost-effective products to improved clinical outcomes will occur. And with additional regulation, materiel managers can, ironically, expect increased demand for documentation. PMID- 10131505 TI - Reducing costs through electronic data interchange. AB - The times have never been riper for an investment in EDI to pay off for healthcare providers. As suppliers attain their implementation goals for electronic purchase orders, they are expanding their EDI capabilities. One area which seems to be attracting considerable attention is the entire contracting cycle, where there are numerous opportunities for reducing administrative costs and improving accuracy. A detailed example using a buying group's contract cycle shows how EDI can be used at every step of the way, from request for quotation to funds transfer and monthly purchase summaries. EDI can be implemented at any level, from PC to mainframe. Implementation is not cheap and integration may not be easy, but the benefits can justify the cost. The first step to successful implementation is to identify and quantify, throughout the entire organization, reengineering opportunities in which EDI can be used. Two industry organizations, the Health Industry Distributors Association (HIDA) and the Healthcare EDI Corporation (HEDIC) have taken leadership roles in simplifying the implementation process. PMID- 10131506 TI - Planning for advanced EDI operations in materiel management--a case study. AB - Florida Hospital, a 1,462-bed organization in five locations in the central Florida area, wanted to implement an EDI system that would take redundancies, paper and FTEs out of their system. They hired a consultant to educate them about EDI and help them put together an EDI business plan. They decided to implement three initial transaction sets for a price catalog, purchase orders, and PO acknowledgments. Requesting departments will be able to order routine items directly from vendors via EDI. Future transaction sets will include advance ship notice with price (857) that will generate a receipt off of which the hospital will pay, and electronic funds transfer. Translation and communication software for their mainframe system was chosen to accommodate both the most and least electronically sophisticated trading partners, and negotiations/education on doing business with the hospital via EDI are ongoing. PMID- 10131507 TI - Product matrix. Patient-centered care the IS/MM response. AB - No single MMIS vendor has the total solution to meet the needs of patient centered care. Addressing it should be one of their top priorities, since this is not fleeting fancy, but rather a new era of healthcare delivery. Elements that will be necessary include: increased communication between care centers and materiel management; electronic ordering and purchasing of goods with prime vendors; the ability to relieve inventory and charge patients without intruding on the care of the patient; the ability to track extensive usage data per care center and nurse server. Usage data can be employed during price negotiations and provide materiel management with important "gatekeeping" information. The more usage data that materiel management has, the more bargaining power will exist with the prime vendor, distributor and care center. It is important to note, however, that information must be concise and easy to obtain. Graphical information has more impact and provides the best visual guide for the materiel manager. A 400-page document containing the month's usage will not "cut it" anymore--if it ever did. The transference and reduction of inventory from the warehouses to the care center probably presents the biggest obstacle for materiel management and nursing. The more work that can done upfront by the prime vendor (such as separating the purchased items into bin-type devices for delivery to specific care centers), the faster the goods can be administered to the patient. With care mapping, the items may even be broken down further, based on case mix information. The items could, and sometimes actually are, stored in the patient's room. It is a nurse's dream to have at his or her fingertips all the supplies needed at the time of request. One key for MMIS in realizing this dream is to track and monitor the on-line, real-time information. In fact, some companies' business is providing immediate inventory replacement information using bed-side terminals. I believe everyone--materiel management, nursing, and information systems--must collaborate and be open to new roles in order to ensure the success of patient-centered care. PMID- 10131508 TI - Ethical issues in intelligence gathering. AB - Unless healthcare reform changes circumstances dramatically, you will feel some pressure to know and report the activities of your competitors. This is especially true for materiel managers because of the sheer number of contacts they have. PMID- 10131509 TI - Developing departmental procedures. PMID- 10131510 TI - Getting a second chance to make a first impression. PMID- 10131511 TI - Workplace drug testing: two cautionary cases. PMID- 10131512 TI - Integrating CQI and QA. PMID- 10131513 TI - A strategy for supply cost savings. AB - A collaborative team effort and a new software program helped this hospital lab to come in $47,500 under budget on supply expenses. PMID- 10131514 TI - Performance feedback: the crown jewel of communication. PMID- 10131515 TI - PT (proficiency testing) surveys: monitoring corrective action. PMID- 10131516 TI - Deriving INRs (international normalized ratios) with customized tables. PMID- 10131518 TI - NAPHS, in bid to broaden base, lures small hospitals and other interest groups. PMID- 10131517 TI - Charter, Universal among bidders for NME hospitals. PMID- 10131519 TI - Studies renew price-curb talk. PMID- 10131520 TI - Florida bill pushes indigent care. PMID- 10131521 TI - Clinton appeals for hospitals' help. PMID- 10131522 TI - Ariz. medical school plan criticized. PMID- 10131523 TI - Coastal agrees to capitation. PMID- 10131524 TI - Program divides care, links hospitals. PMID- 10131526 TI - Time has arrived for the hard sell. PMID- 10131525 TI - FTC nixes merger in 2-hospital town. PMID- 10131527 TI - Network formation--is it deja vu all over again? PMID- 10131528 TI - Teaching hospitals face hard lessons. PMID- 10131529 TI - $1 million budgeted for reform push. PMID- 10131530 TI - HCIA recognition is a PR bonanza for top hospitals. PMID- 10131531 TI - Rural facilities tap telemedicine. PMID- 10131532 TI - Index shows rising hospital strength. PMID- 10131534 TI - Philly Blue Cross, Graduate in HMO link. PMID- 10131533 TI - Quicker payment trend continues. PMID- 10131535 TI - Quake damage worsening. PMID- 10131536 TI - Health reform outlook. PMID- 10131537 TI - Healthy competition--surviving in a changing environment. PMID- 10131538 TI - Provider surveys top chains. PMID- 10131539 TI - Financing climate heats up. PMID- 10131540 TI - The TB watch. PMID- 10131541 TI - Pharmacy update. An AIDS challenge. PMID- 10131542 TI - Good news, bad news. The future viability of the long term care industry is at stake as health reform unfolds. PMID- 10131543 TI - Companies to watch. PMID- 10131544 TI - The big picture. R&I's 1994 foodservice industry forecast. PMID- 10131545 TI - Mandatory HIV testing and the character of medicine. AB - Proponents of mandatory HIV testing for patients and providers may not be giving adequate attention to the problems associated with such tests: violations of confidentiality, false negatives, reduced compliance with universal precautions, and misuse of resources. PMID- 10131546 TI - Does "no" mean "yes"? The continuing problem of Jehovah's Witnesses and refusal of blood products. AB - The law maintains that the choice of competent adult Witnesses not to receive blood products must be respected. Yet many care providers believe that Witnesses, when actually faced with a life-threatening emergency, want their stated choice to be overriden--which permits them to evade the spiritual consequences of their unstated preference. PMID- 10131547 TI - A promise of cheap home care. PMID- 10131548 TI - Office visits to psychiatrists: United States, 1989-90. PMID- 10131549 TI - Satisfaction not guaranteed. PMID- 10131550 TI - Cut your linen costs "just in time". PMID- 10131551 TI - Healthcare reform poses unanswered questions. PMID- 10131552 TI - Seasonal migration and health care. AB - This article examines health care use and issues among seasonal migrants in an urban setting in the Sunbelt. The study, based on a survey of 230 American and Canadian snowbirds in Phoenix, Arizona, complements previous research on health care use among Canadian snowbirds in Florida. Our results show that health care use among seasonal migrants in Phoenix is substantial, and it varies by citizenship (American vs. Canadian), age, number of winter visits, and length of winter stay. We argue that health care use is symptomatic of social and emotional attachments to the winter residence that develop and deepen over a period of years. Phoenix snowbirds view their lifestyles as healthy, they are adept in adjusting to health decrements, and the majority plan to continue spending time in both their summer and winter residences as long as their health permits. PMID- 10131553 TI - Investigating patterns of service use by families providing care for dependent elders. AB - The behavioral model developed by Andersen in 1968 was used to investigate patterns of support service use by families caring for dependent elders. It was hypothesized that differences in background or predisposing factors that serve to define caregivers (e.g., spouse vs. adult-child) would interact with need factors to influence the use of "discretionary" support services (e.g., adult day care), but not influence the use of "nondiscretionary" services (e.g., hospitalization). Information was obtained on the use of eight different support services from a sample of 503 caregiving dyads. Caregivers were either spouses or adult children of the dependent elder. The results supported the hypotheses derived from the behavioral model and indicate that, among caregiving families, it is important to consider not only the type of service, but who is assessing the need for that service. PMID- 10131554 TI - Health and inequalities among the oldest old. AB - The elderly, and especially the oldest old, have generally been overlooked in research on social class inequalities in health. On the basis of nationally representative data from Sweden for the age group 77 to 98 (N=537), we have been able to demonstrate clear differences in health between social classes. These inequalities were found both for men and women. It should be noticed, however, that the patterns of class differences varied depending on the health indicator used. The often employed global measure of self-rated health showed the smallest class gradient when controlling for age and sex, whereas larger differences were found with more concrete and descriptive measures such as peak flow rate. PMID- 10131555 TI - Contradictions in case management: client-centered theory and directive practice with frail elderly. AB - New long-term care legislation and managed care legitimate case management for gatekeeping and advocacy for frail elderly. Qualitative in-depth interviews with case managers who are social workers and nurses were used to address the question: To what extent is client-centered theory reflected in case management practice? Differences between reported client-centered theory and directive practice were identified by five themes: (a) client wishes versus system constraints; (b) the paradox of working to keep clients home versus the perceived inevitability of nursing home placement; (c) client centeredness versus the case manager's care plan; (d) client self-determination versus strategies of persuasion; (e) informing the client about case management versus the reality of practice. Ethical implications, competing demands, and environmental constraints are discussed. Suggestions are made to better integrate client-centered theory with directive practice. PMID- 10131556 TI - Healthcare reform and its impact on information systems. PMID- 10131557 TI - JCAHO standards & systems integration: five years & counting down. PMID- 10131558 TI - Under reform: the top 10 challenges facing IS executives. PMID- 10131559 TI - Computer-based patient record systems--a planned evolution. PMID- 10131560 TI - New opportunities for NHS librarians and information scientists. AB - The recent fundamental transformation in government policy on the National Health Service has far-reaching implications for all types of health-care information provision and use. This paper highlights the new opportunities, as well as the major issues, these developments have generated. PMID- 10131561 TI - Making the case to fund networked access to electronic information services. AB - The establishment of a local area network can greatly widen access to an organization's electronic information services, create improved conditions for staffing the delivery of these services and improve training and user support. Such a project is, however, expensive to fund. This article describes the approach taken at the Royal Free Hospital School of Medicine to secure funds for networking MEDLINE on hard disk and other information services. The importance of close collaboration between library and computer departments in planning and promoting a project of this nature is emphasized. PMID- 10131562 TI - Libraries, postgraduate medical education and the management of change. AB - The changes surrounding the funding of postgraduate medical and dental education are outlined and the funding implications for libraries considered. The management of this period of change is vital if all players are to appreciate the advantages of implementation, not least cost-effectiveness. In conclusion three problem areas in the post-reform NHS are identified and briefly discussed: the need for access and provision of information to all; development of regional librarian role across all regions to ensure effective co-ordination of resources; a national policy which will integrate national, regional and unit structures for the delivery of health-care information needs to be developed. PMID- 10131563 TI - Survey of library and information use by health-care students. AB - The study compares and contrasts the usage and views of three groups of health care students (Pre-Project 2000, Project 2000 and BSc Occupational Therapy) on their library facilities. A literature review is included which underpins the importance of libraries for health-care students. Data was compiled from survey responses. The results demonstrate which libraries the students use, how often they use them, what they do in the libraries, and the stock used. They also show the level of student confidence and the services used. The implications of the study for future provision are considered. PMID- 10131564 TI - Reader activity in a multidisciplinary health sciences library: a case study at St George's Library. AB - This paper reports on a survey of user activity in a London teaching hospital with a multidisciplinary health sciences library. Library users were asked to complete a simple survey form on each visit to the library over a week long period. Information was required to help establish a formula for funding. The user survey examined reasons for visiting the library, frequency of visits, length of visit and also asked for comments and suggestions. Finally there is discussion regarding the effectiveness of the survey in terms of the practical framework utilized and of the gains obtained. PMID- 10131565 TI - Nurses--their information needs and use of libraries: the views of some librarians. AB - An overview of the information needs of nurses is followed by a description of the findings of the Information Seeking Behaviour of Nurses Project. A brief comparison is made with the perceptions that librarians have of nurses' information-seeking activity followed by a more detailed discussion of the ways that librarians consider that nurses' use of libraries could be improved. It is concluded that library provision and use can be improved only by co-operation between nurses, students, educators, librarians and managers. PMID- 10131566 TI - Collaborations between investor-owned and nonprofits. PMID- 10131567 TI - States readying for national health reform. PMID- 10131568 TI - What's going on in the real world. AB - The health care marketplace has worked its magic, inspiring health care providers to transform strategies and operations from often inefficient and costly care and services to streamlined, often cooperative, integrated delivery systems. Transformation--a far better word than reform. The need to "reform" implies past failures, as in "reform school" for the unruly, even wicked child. A "transformation," however, implies re-invention, possibly of something that worked well already. Well, but not well enough. In the case of health care in the United States, even the most jaded observer will agree that our medical care system--including medical and pharmaceutical research and development--is the greatest gift this country has given to itself. Its quality is the benchmark for every society on earth. And yet--Happy New Year! Time moves on, and what worked well can work better, can be perfected, exquisite. It can also be exquisite while affordable. PMID- 10131569 TI - A tale of two cities: health system reform in Little Rock and Houston. AB - Health care providers are not waiting for federal legislation to pass Congress before getting on with the business of reforming health care. Here is a close-up of provider-generated health system reform in a large and a small city where things are happening in the marketplace. PMID- 10131570 TI - The DoD arrives just-in-time. AB - Here's how the Department of Defense is using EDI and a just-in-time prime vendor program to add competition to its procurement process. PMID- 10131571 TI - No more enemies lists. PMID- 10131572 TI - Understanding your market group can boost managed care enrollment. New York will enroll 30-million Medicaid patients in managed care. PMID- 10131573 TI - The U.S. Army is using inner-city trauma units as a training ground for its battlefield physicians. Army doctors take on medical battles in D.C. PMID- 10131574 TI - Culture shock: two medical schools grapple with new demands for primary care doctors. AB - By nearly any standard--federal research dollars, faculty credentials, and student career plans--the medical schools of East Carolina University and Johns Hopkins are as different as day and night. But both agree that Washington's efforts to boost the number of generalist physicians are inadequate. PMID- 10131575 TI - Putting a price tag on training new doctors. AB - The nation's teaching hospitals depend heavily on $5.2 billion in annual federal payments for graduate medical education, but few of them know what portion pays for patient care and what portion supports teaching activities. Because hospitals and medical schools will continue to confront funding cutbacks under health reform, they must learn how to quantify the revenue and expenses associated with each activity to receive adequate compensation. PMID- 10131576 TI - How much does the public know about health reform? AB - With federal action on major health reform set to take place in 1994, a recent survey of 1,200 adults found major gaps in Americans' understanding of what the problems are or how major legislative proposals would address them. While the public is primarily concerned about how health reform will affect them personally, their current lack of knowledge heightens the impact that political advertising, media coverage, and public education campaigns will have. PMID- 10131577 TI - Countdown to health reform begins with differences galore. PMID- 10131578 TI - Using report cards to grade health plan quality. AB - Judging the quality of health care that a plan delivers so consumers can make informed purchasing decisions is at the heart of the major federal health reform proposals. Health care "report cards" are an important step in this direction. But they cannot, by themselves, inform consumers or improve health system performance. PMID- 10131579 TI - Controlling the rate in community rating--experts aren't sure how. AB - What premiums states pay under community rating will be determined by how much they spend on health care. But it's not clear how spending is affected by prices, utilization, disease rates, and behavior. The answers will test Americans' commitment to one another. PMID- 10131580 TI - DataLine. Cutting through the smoke of a new cigarette tax. PMID- 10131581 TI - High tech, low yield: doctors' use of medical innovation. AB - American physicians' tendency to test too much and do too much is a major force in the rapid diffusion of medical technology. To manage medical technology humanely and responsibly, we must establish a basis for assessing the benefits and costs that will enable us to make rational coverage and payment decisions. We must also devise a means of holding providers of care accountable for weighing the benefits and costs in using the technology. PMID- 10131582 TI - The 103rd Congress: productivity at last? PMID- 10131583 TI - Courts tighten liability link between doctors and hospitals. PMID- 10131584 TI - Battle begins to make TennCare plan reality. PMID- 10131586 TI - Premium increases down, profits up for HMOs. PMID- 10131585 TI - Wisconsin mired in competing reform bills. PMID- 10131587 TI - The role of business process reengineering in health care. AB - Business process reengineering (BPR) is a management philosophy capturing attention in health care. It combines some new, old, and recycled management philosophies, and, more often than not, is yielding positive results. BPR's emphasis is on the streamlining of cross-functional processes to significantly reduce time and/or cost, increase revenue, improve quality and service, and reduce risk. Therefore, it has many applications in health care. This article provides an introduction to the concept of BPR, including the definition of BPR, its origin, its champions, and factors for its success. PMID- 10131588 TI - Success factors for automated systems in the clinical environment: the MUSC (Medical University of South Carolina) experience. AB - In today's dynamic health care environment, efficient, easy, and cost-effective access to patient information is crucial for clinical decision making. The Medical University of South Carolina's experience as alpha site for development of an open architecture clinical information system (OACIS) served as a catalyst for unprecedented organizational change in this 600-bed tertiary care teaching and research facility. This article reviews the steps in the process of preparing the hospital environment for successful testing and implementation of OACIS. PMID- 10131589 TI - Streamlining birth certificate processing with technology. AB - To transform the birth certificate process, a total quality management approach was adopted by San Jose Medical Center. An innovative solution using technology resulted in dramatic gains in productivity. The case study summarizes the methodology used to achieve measurable performance improvement. This reengineering demonstration reveals the positive results achievable when the strengths of staff skills, environment, and procedures are maximized. PMID- 10131590 TI - Reengineering along departmental product flowlines. AB - This article describes how a medical records department responded to relocating, upgrading a departmental computer system, incorporating severity of illness abstracting, and implementing continuous quality improvement techniques by reengineering along department flowlines over a five-year period. Areas of the department that were restructured were storage and retrieval, record completion, and data collection and reporting functions. PMID- 10131591 TI - Advances in documentation: the impact of service and empowerment. AB - Chart completion is a controversial issue in most health care facilities, impacting chart availability for both patient care and timely billing purposes. A collaborative approach empowering HIS and medical staff professionals yielded significantly better service for patients, physicians, and the billing department at The Milton S. Hershey Medical Center, Hershey, Pennsylvania. The result is the beginning of a trend in team empowerment that continues to improve patient care and financial performance. PMID- 10131592 TI - Development of an interinstitutional resident record completion policy. AB - Seven hospitals in the Dayton, Ohio area collaborated in the development of generic record completion policies to assist with orientation of medical school residents. A uniform delinquent record policy was also developed, which defined the steps that would be taken if records remained incomplete. The interinstitutional policies resulted in a more cooperative atmosphere among residents, the medical school, and the hospitals, which contributed to improved quality of documentation and a decrease in the number of delinquent records by as much as 70 percent. PMID- 10131593 TI - Making better use of health care information. AB - Effective use of health care information holds the promise of improved care and reduced health costs. A number of challenges must, however, be met. Incentives for using information must be introduced. A code of practice for using patient data to allay confidentiality concerns is needed. An institution is needed to accelerate the development of health information standards. Awareness must be raised about the opportunities provided by more effective use of information. Champions are needed to create the required information-intensive infrastructures. PMID- 10131594 TI - Reengineering and improving the information-intensive work of patient tracking for inpatients and outpatients. AB - This article describes a CQI-driven effort to reengineer the tracking procedures for both inpatients and outpatients, refined to the extent that they have been identified as "best practices." The goal was to shift the work paradigm from a departmental focus to one that accepts work as a network of processes, but also to prepare for the new era of the electronic medical record, moving computer record keeping far closer to the point of care, requiring more precise recording of patient location. PMID- 10131595 TI - Research review: computer tools for health information management at a substance abuse treatment agency. AB - The process of computerizing the Quantitative and Qualitative Record Analysis functions in a Joint Commission on Accreditation of Healthcare Organizations (JCAHO) accredited substance abuse treatment facility is presented. Consultants analyzed the manual Quantitative and Qualitative systems, assessed computer resources, and developed and installed computerized systems. The computer programs produce uniform reports used by the agency's various monitoring and evaluation committees. The programs significantly reduced the amount of personnel and consultant time devoted to these tasks. During the first year of operation, this reduction in time saved the agency $3,900. PMID- 10131596 TI - Making outcomes work: the Florida story. PMID- 10131597 TI - How a "common enemy" strategy hides dysfunction in hospital management. PMID- 10131598 TI - Want to keep your job? Shape your own career path. PMID- 10131599 TI - Comparing the cost of reusable and disposable packs. PMID- 10131600 TI - Gauging ROI on computer systems. PMID- 10131601 TI - Choose your moves in negotiating. PMID- 10131602 TI - Choosing and using the best PC software for CS business needs. PMID- 10131603 TI - Ordering inventory for ambulatory clinics: a formula for success. PMID- 10131604 TI - Four steps for turning irate callers into satisfied customers. PMID- 10131605 TI - Development of a pregnancy policy for air medical personnel: an administrative approach. AB - Pregnancy of air medical personnel poses a unique challenge for the administration of air medical services. Pregnant staff vary in their approach to individual pregnancy and their desire to continue flight duties. Administrators are limited to actions that ensure optimal care for the patient regardless of the caregivers' health or condition. Air medical programs must balance what is acceptable for patient care and safety with what are legally acceptable practice restrictions. The Staff For Life helicopter service uses experts in obstetric care to evaluate the pregnant staff members' abilities to perform pre-determined physical duties associated with air medical care. A signed consent form acknowledging risk factors associated with air medical care ensures that the flight staff member has had a frank and honest discussion with her physician. The obstetric evaluation and consent form confirm for program administration a pregnant flight staff member's ability to function within her role and removes all ambiguity from the process. PMID- 10131606 TI - A review of drug use during air medical transport to optimize an air ambulance formulary. AB - INTRODUCTION: The advent of air medical transport has pushed the delivery of critical care medicine into the prehospital arena. As a result, a wide variety of pharmacologic agents must be available in the air medical setting. PURPOSE: The purpose of this study was to conduct a retrospective review of drugs used during air medical transport to allow a streamlining of the air ambulance formulary. METHODS: All flights completed since the inception of the study's helicopter air ambulance program in 1985 through September 1991 were analyzed to determine which medications were used in flight. Drugs were counted if they were administered while in flight for either a scene or interhospital transport. RESULTS: Review of 2,694 flights showed that 45 individual drugs had been routinely carried during the study period. Many of these agents were administered fewer than five times during the six years, and 10 drugs were not used at all. CONCLUSION: As a result of this investigation, the formulary for our air medical transport service was modified. The authors recommend similar critical audits of drugs carried in flight be performed by other air ambulance services. PMID- 10131607 TI - Airline advisory nursing. AB - The commercial airliner cabin is a specialized environment, usually pressurized to an equivalent of 2,438-meter pressure altitude. Such an altitude can adversely affect people prone to hypoxia. Preflight attention to this and other problems by an advisory nurse (AN) can minimize or prevent in-flight emergencies. The AN can also facilitate travel for passengers with medical needs by being familiar with airline policies and federal regulations. By educating the patient/passenger, health care providers and airline personnel, the safety, comfort and dignity of all concerned can be maximized. PMID- 10131608 TI - 1994 annual cardiovascular reference source. PMID- 10131609 TI - Northern California: crucible of change. PMID- 10131610 TI - Is CALPERS (California Public Employees Retirement System) a HIPC (health insurance purchasing cooperative)? AB - California's big Public Employees' Retirement System has been touted as the nation's best example of managed competition. But evidence suggests that it has plenty room for improvement. PMID- 10131611 TI - Market forces slow healthcare costs. PMID- 10131612 TI - Alain Enthoven: father of managed competition. Interview by Mike Pulley. PMID- 10131613 TI - Into battle with total quality management. PMID- 10131614 TI - Community care: the quality issue explored. PMID- 10131615 TI - Quality management in health care environments. PMID- 10131616 TI - Deliberate self-harm: an audit of a service to patients. PMID- 10131617 TI - Quality audit in gynaecology. PMID- 10131618 TI - The service-intensive nature of home infusion therapy: Part II. AB - The author presents a detailed, two-part discussion of the types and intensity of various services that are essential to the provision of home infusion therapy. In doing so, it is hoped that the reader obtains a better understanding of the critical role that these services play in the provision of home infusion therapies. PMID- 10131619 TI - Image development for health care firms. AB - This article addresses image development and how patients, organizational members, and society formulate a particular image of an organization that provides health care services. A framework is presented that describes how corporate image is shaped by the marketplace, the corporation, and professionalism. Also described are some suggestions for identifying corporations that have the image of community leaders and how other companies can strategically position themselves to improve their corporate image. PMID- 10131620 TI - A user's guide to Medicare risk. PMID- 10131621 TI - Capitation adjustments for physician risk. AB - Based on available data from the Health Insurance Association of America and the Group Health Association of America, about 9% of all primary care physician-based compensation was through capitation in 1990. By the turn of the century, more than 20% of such payment will be in the form of capitation. The author discusses how capitated arrangements can be negotiated so that the fairest rates result. Also described is the importance of developing practice pattern guidelines to ensure that capitation payment does not adversely affect patient quality of care. PMID- 10131622 TI - National health reform's administrative simplification: effect on managed care. AB - The President's health care reform proposal contains numerous points of interest to the managed care industry. His intention to streamline claims forms and simplify health care administration seems a siren call for the greater use of electronic data interchange to reduce waste. PMID- 10131623 TI - The Canadian health care system: what happens when there's no more money? AB - As a result of Canada's sluggish economic growth, it is becoming too weak to sustain its $47.6 billion health care system. Patients are faced with having to pay for a number of medical services that were once free, hospitals must confront the possibility of being shut down as governments concentrate services in fewer facilities, thousands of health care workers are being laid off and others face the threat of losing their jobs, and the number of physicians is being controlled. PMID- 10131624 TI - Patient-centered asthma care: a community-based multidisciplinary model. AB - In this first part of a three-part series, the authors discuss a treatment program for patients with chronic, severe asthma. Of all chronic diseases, asthma has proven to be one of the most expensive--financially, physically, and psychologically. Although the symptoms are usually reversible, they can be severe if left untreated. Physicians, nurses, and case managers across the country are recognizing the total value of treatment at "centers of excellence." In referring their toughest asthma cases to these centers, health care professionals and patients alike are experiencing the positive benefits received from a patient centered, multidisciplinary approach. PMID- 10131625 TI - Kaiser Permanente of Ohio's Encounter System. AB - In 1988, Kaiser Permanente of Ohio began planning for the development of a cost effective electronic medical record system for ambulatory care. If created the "Encounter System," a multifunctional ambulatory clinical database to enhance physician practice, perform quality assurance evaluations, help with physician management, and improve the care of its patients. The author discusses the functions of this successful electronic database and how it evolved. PMID- 10131626 TI - Quality management: implementing incentive plans. AB - Many prominent health care organizations that have embraced the concepts of total quality management have not altered their traditional philosophical approaches of managing compensation through base pay administration. How exactly does one incent individuals to participate in the total quality management process through their paycheck? This article offers some specific models that human resource managers may use to accomplish this goal. PMID- 10131627 TI - Nursing homes and HMOs: the new partnership in managed care for the elderly. AB - The author identifies a variety of arrangements being implemented between nursing homes and HMOs using, in particular, the experience of an LTC provider, Walker Methodist, Inc. These arrangements range from becoming an HMO-preferred nursing home provider to HMO ownership of nursing homes. The benefits and risks of each arrangement from the LTC provider's perspective are highlighted. PMID- 10131628 TI - Prescription drug benefits in a managed care plan: balancing quality and costs. AB - As health care expenditures increase, managed care plans are placing increasing scrutiny on quality of care and cost issues. If a managed care prescription drug benefit program is well designed, however, pharmaceuticals can help decrease the use of other health care services. The result is a healthier bottom line that balances quality and costs. Ultimately, a sound drug benefit in a managed care program will reduce the need for surgical interventions, shorten or eliminate hospital stays, improve overall quality of life, and increase productivity. PMID- 10131629 TI - Equity and health of ethnic minorities. PMID- 10131630 TI - Routine data: a resource for clinical audit? PMID- 10131631 TI - What do we mean by appropriate health care? Report of a working group prepared for the Director of Research and Development of the NHS Management Executive. PMID- 10131632 TI - Assessing quality of nursing care. PMID- 10131633 TI - Preschool child health surveillance. PMID- 10131634 TI - Cholesterol screening and cholesterol lowering treatment. PMID- 10131635 TI - View from The Netherlands. PMID- 10131636 TI - Integrated patient records: another move towards quality for patients? PMID- 10131637 TI - Pharmacists and prescribing: an unrecorded influence. PMID- 10131638 TI - Referrals for coronary angiography in a high risk population. AB - OBJECTIVES: To examine variations in referral for coronary angiography within Northern Ireland and relate these to local death rates from coronary artery disease (ICD rubrics 410-414). DESIGN: A descriptive retrospective analysis of aggregate hospital activity data for 1979-88 and corresponding mortality rates in the local population. SETTING: Two regional referral hospitals and 26 local district council areas. PATIENTS: 5173 patients aged 35-74 years with an underlying diagnosis of ischaemic heart disease, whose records contained complete information on their age, sex, and home address. MAIN MEASURES: Age-standardised angiography rates and corresponding standardised death rates derived from the registrar general's reports. RESULTS: Among the 26 constituent district council areas there was significant heterogeneity in the angiography rates, ranging from 62 to 335/100,000 in men and from 7 to 62/100,000 in women (likelihood ratio statistic 856 and 359 respectively). There was no significant association between these angiography rates and the local death rates from ischaemic heart disease. CONCLUSION: The results suggest a non-uniform threshold for referral for angiography. IMPLICATIONS: Clinicians need to examine the appropriate indications for referral for invasive investigation. PMID- 10131639 TI - Use of laboratory testing for genital chlamydial infection in Norway. AB - OBJECTIVE: To assess the use of laboratory tests for genital chlamydial infection in Norway. DESIGN: Questionnaire survey of general practitioners' practice in chlamydial testing, retrospective survey of laboratory records, 1986-91, and prospective study of testing in one laboratory during four weeks. SETTING: All 18 microbiological laboratories in Norway (4.2 million population), including one serving all doctors in Vestfold county (0.2 million population). SUBJECTS: 302 general practitioners. MAIN MEASURES: GPs' routine practice, methods used for testing, 1986-91, and sex specific and age group specific testing in 1991. RESULTS: 201(69%) GPs replied to the questionnaire: 101(51%) would test all women younger than 25 years at routine pelvic examination, 107(54%) all girls at first pelvic examination, 131(66%) all pregnant women, and 106(54%) all men whose female partner had urogenital complaints. Nationwide in 1986, 122,000 tests were performed (2.9 per 100 population); 10% were positive and 51% were cell culture tests. In 1991, 341,000 tests were performed (8.0 per 100 population); 4.5% were positive and 15% were cell culture tests. 13,184 tests were performed in Vestfold in 1991 (6.6 per 100 population). The age group specific rates (per 100 population) among women were: age 15-19 years, 22.0(95% confidence interval 18.2 to 25.8); 20-24 years, 47.2(42.1 to 52.3); 25-29 years, 42.3(37.1 to 47.5); 30-34 years, 29.8(25.4 to 34.2); and 35-39 years, 12.5(9.5 to 15.5). CONCLUSIONS: GPs use liberal indications for testing. The dramatic increase in testing, especially by enzyme immunoassays, in populations with a low prevalence of infection results in low cost effectiveness and low predictive value of positive tests, which in women over 29 years is estimated as 17-36%. IMPLICATIONS: Doctors should be educated about the limitations of enzyme immunoassays in screening low prevalence populations, and laboratories should apply a confirmatory test to specimens testing positive with such assays. PMID- 10131640 TI - Referral of patients to an anticoagulant clinic: implications for better management. AB - The quality of anticoagulant treatment of ambulatory patients is affected by the content of referral letters and administrative processes. To assess these influences a method was developed to audit against the hospital standard the referral of patients to one hospital anticoagulant clinic in a prospective study of all (80) new patients referred to the clinic over eight months. Administrative information was provided by the clinic coordinator, and the referral letters were audited by the researchers. Referral letters were not received by the clinic for 10% (8/80) of patients. Among the 72 referral letters received, indication for anticoagulation and anticipated duration of treatment were specified in most (99%, 71 and 81%, 58 respectively), but only 3% (two) to 46% (33) reported other important clinical information (objective investigations, date of starting anticoagulation, current anticoagulant dose, date and result of latest international normalised ratio, whether it should be the anticoagulant clinic that was eventually to stop anticoagulation, patients' other medical problems and concurrent treatment. Twenty two per cent (16/80) of new attenders were unexpected at the anticoagulant clinic. Most patients' case notes were obtained for the appointment (61%, 47/77 beforehand and 30% 23/77 on the day), but case notes were not obtained for 9% (7/77). The authors conclude that health professionals should better appreciate the administrative and organisational influences that affect team work and quality of care. Compliance with a well documented protocol remained below the acceptable standard. The quality of the referral process may be improved by using a more comprehensive and helpful referral form, which has been drawn up, and by educating referring doctors. Measures to increase the efficiency of the administrative process include telephoning the clinic coordinator directly, direct referrals through a computerised referral system, and telephone reminders by haematology office staff to ward staff to ensure availability of the hospital notes. The effect of these changes will be assessed in a repeat audit. PMID- 10131641 TI - The clinical process and the quality process. AB - Quality management methods in health care organizations require the active participation of physicians. Many organizations are successfully using a variety of methods to support this involvement, building on the underlying intellectual similarity between clinical practice to improve the health of individuals and quality management to improve processes of work. Important similarities include the scientific combination of theory and fact, the avoidance of blaming, the systematic analysis of variation, the use of experiments, the refinement and use of measurement, and the development of an extended professional community. PMID- 10131642 TI - Continuous quality improvement and physician training. AB - Continuous quality improvement (CQI) is a system of management that permits individuals to develop an organized approach to improvement. The fundamental tenets of CQI are applicable at the bedside and in the training of residents because they permit the development of a consistent approach to clinical variability and uncertainty. When the principles of CQI are applied to the daily practice of medicine, they not only enhance the educational process but also provide a framework for the continuing quest for knowledge. In that context, these principles can provide a continuing stimulus and challenge to physicians and can enhance the patient-physician relationship that lies at the core of any effort to integrate CQI into patient care. PMID- 10131643 TI - Improving the patient evaluation process in a cardiovascular and interventional radiology department. AB - Brigham & Women's Hospital (BWH) has adopted total quality management (TQM) to increase productivity and efficiency and to improve the quality of patient care services. This article reports on a quality improvement project in the department of radiology designed to improve the process of pre-procedure workup of patients referred for cardiovascular and interventional radiology (CVIR) procedures. The project was initiated, led, and conducted by a physician. PMID- 10131644 TI - Integrating providers into quality improvement: a pilot project at one hospital. AB - Brigham and Women's Hospital initiated a study of the quality of care centering on self-reporting of potential medical injuries by providers. The goal of the study is to decrease the incidence of such injuries through a continuous quality methodology that integrates providers into the identification phase and incorporates all hospital employees in the development of new practices. This article provides an overview of the investigation methodology and discusses the conceptual relationships between clinical epidemiological analyses and industrial quality improvement. PMID- 10131645 TI - Continuous quality improvement in the clinical setting: enhancing adoption. AB - Our ability to involve physicians in Continuous Improvement depends on our understanding of (1) professional norms and behaviors, (2) how organizational structures and systems affect physicians, and (3) basic adoption processes within health care organizations and by their professionals. PMID- 10131646 TI - An introduction to critical paths. AB - A critical path defines the optimal sequencing and timing of interventions by physicians, nurses, and other staff for a particular diagnosis or procedure. Critical paths are developed through collaborative efforts of physicians, nurses, pharmacists, and others to improve the quality and value of patient care. They are designed to minimize delays and resource utilization and to maximize quality of care. Critical paths have been shown to reduce variation in the care provided, facilitate expected outcomes, reduce delays, reduce length of stay, and improve cost-effectiveness. The approach and goals of critical paths are consistent with those of total quality management (TQM) and can be an important part of an organization's TQM process. PMID- 10131647 TI - Robust design: a new tool for health care quality? AB - Robust design is a powerful technique for developing processes that produce desirable outcomes, even in the presence of factors that cannot be controlled or cannot be controlled economically. In the past 12 years several leading high technology manufacturing companies in the United States have applied robust design methods with considerable success. This article discusses the basic concepts of robust design and speculates on how these ideas might be applied to health care quality management. PMID- 10131648 TI - Tutorial: introduction to control charts. AB - Variation in outcome is a natural result from any complex biological or production process. Unfortunately, this variation can cloud our decision making and lead us to take inappropriate action. The control chart is a basic quality management tool that helps managers and clinicians make statistically sound decisions when analyzing outcome data from processes. In this tutorial, we will illustrate the problems inherent in taking action based on data that displays variation. We will then develop the statistical foundation for control charts and show an example of its use to analyze data from a pharmacy process. PMID- 10131649 TI - QMHC interview: Robert M. Heyssel, M.D.. Interview by Marie E. Sinioris. AB - In 1991, US News and World Report rated The Johns Hopkins Hospital as the best hospital in the country. Its survey of physicians revealed that Hopkins is perceived to be at or near the top in 13 of the 15 specialties studied. For the past three years, The Johns Hopkins Health System has been taking a hard look at the nonclinical aspects of health care delivery. Surveys of patients, physicians, nurses, and employees have revealed a litany of frustrations that can interfere with the delivery of excellent care. To focus on these issues, Hopkins launched a systemwide total quality management (TQM) process in 1989. Dr Robert M. Heyssel and other senior executives provided leadership that has been essential to the initiation and maintenance of the TQM process at The Johns Hopkins Health System. TQM has been associated with impressive results in several areas. In addition, more than 500 people have received intensive training in the use of statistical tools and teamwork. An additional 900 people are scheduled to attend this program in the future. PMID- 10131650 TI - Continuous quality improvement and hospital epidemiology: common themes. AB - Recently, many have begun to explore the possibility of using analytical methods associated with continuous quality improvement in the efforts to improve health care. Central to this paradigm is the proposition that such analytical methods can be used to identify and react to variations in the processes and outcomes of care. These methods and principles are remarkably similar to those employed by hospital epidemiologists. This article explores the similarities between these fields in an attempt to bring together leading thinkers in both disciplines. PMID- 10131651 TI - Health care's war of words. PMID- 10131652 TI - The guns of February. PMID- 10131653 TI - A new generation gap. PMID- 10131654 TI - How Tennessee has managed care. PMID- 10131655 TI - Who's in charge? AB - President Clinton's health care reform plan avoids the appearance of government control by diffusing and delegating authority to a host of new institutions. The net result, ironically, may be a system that is less accountable to the public than one in which government's role is clearer. PMID- 10131656 TI - Health agents fighting for survival. PMID- 10131657 TI - Health lobby cranks up its postage meter. PMID- 10131658 TI - Getting it right on health care plan. PMID- 10131659 TI - Let the deal making begin. PMID- 10131660 TI - An industry in pain. AB - The pharmaceutical industry, buffeted by marketplace changes and unprecedented political pressure, is far from united as it heads into the mother of all lobbying battles. PMID- 10131661 TI - Ready, aim, reform. AB - Now that President Clinton has finally submitted the details of his massive plan to overhaul the nation's health care system, the legislative and political challenges that confront Capitol Hill lawmakers--especially Democrats--seem steeper than ever before. PMID- 10131662 TI - Itching for a fight? AB - The Health Insurance Association of America complains that the White House has made it a scapegoat in the health reform debate. But the trade group's brawl with the Administration has also been a rallying point for a badly divided industry. PMID- 10131663 TI - No room at the inn for reform? PMID- 10131664 TI - Construction cleanup. Advice from those who've been there. PMID- 10131665 TI - Planning, communication, ... and patience. PMID- 10131666 TI - A blueprint for construction. Building buildings that are maintainable. PMID- 10131667 TI - Recycling: when the market matures. PMID- 10131668 TI - Putting it on the line. PMID- 10131669 TI - Nutritional intervention & AIDS. PMID- 10131670 TI - At St. Luke's-Roosevelt, the only constant is change. PMID- 10131671 TI - Challenge: how to reduce costs. PMID- 10131672 TI - Challenge: how to test new equipment, food & service styles. PMID- 10131673 TI - Solving the puzzle of planned giving. PMID- 10131674 TI - The magic of a million: who says employees can't raise a million? PMID- 10131675 TI - The key to planned-giving success: stay in the box. PMID- 10131676 TI - Universal coverage may challenge nonprofit status. PMID- 10131677 TI - Should your hospital implement patient-focused care? PMID- 10131678 TI - GAO report targets administrative costs that Medicare shouldn't cover. PMID- 10131679 TI - Can this process control health care costs? PMID- 10131680 TI - Colorado proposes cost containment despite success of consolidation efforts. PMID- 10131681 TI - Lack of uniformity in state approaches to protecting peer review confidentiality. PMID- 10131682 TI - Resolution of disputes and civil enforcement under the proposed Health Security Act. PMID- 10131683 TI - The costs of lobbying just got more expensive. PMID- 10131684 TI - ED uses risk assessment tool for predicting violent patient behavior. PMID- 10131685 TI - See increased acceptance of delay-release hardware for exit doors. PMID- 10131686 TI - 'Safe 'N Secure' enables security professionals to exchange information. PMID- 10131687 TI - How hospital uses 3-D parking to protect cars, staff, employees. PMID- 10131688 TI - Dealing with disasters: how hospitals responded to sulfuric acid leak, tornado, floods. AB - Disasters can strike at any time, with or without warning. While all hospitals have emergency preparedness plans, anticipating every effect of a crisis on the hospital, staff, and surrounding community can be difficult. This special report will examine the response of hospitals to three disasters--an acid leak in California, a tornado in Virginia, and the summer flooding in the Midwest--and the lessons learned from those crises. PMID- 10131689 TI - Surviving the new site visit process. PMID- 10131690 TI - Separating food and nutrition services. PMID- 10131691 TI - The development of a comprehensive medical-surgical distribution agreement. AB - The selection of a medical-surgical distributor has become one of the most important decisions made by a hospital materiel manager today. It is therefore critical that before a distributor is selected a clearly defined development process and master plan be established. This master plan should contain, at a minimum, (1) a comprehensive strategic plan, (2) a detailed request for proposal, and (3) a detailed project implementation schedule. A well-structured, well executed plan will help to ensure that the best distributor is selected and that the best possible distribution agreement is designed. PMID- 10131692 TI - Improving levels of service through enhanced distribution techniques at Newark Beth Israel Medical Center. AB - In an effort to reduce cost and improve service, Materiels Management Distribution Services, in cooperation with a prime vendor, created a distribution method unique to the needs of Newark Beth Israel Medical Center. The project combined the vendor's expertise and ability to "deliver direct" to an internal hospital location by product group with the distribution staff's ability to complete the process and deliver the merchandise to the final destination in an expedited manner. This article provides a contract template that can be adapted for other collaborative efforts and highlights the components of a successful program: electronic data interchange, verification of usage and par, reconfiguration of space, direct pallet delivery, and some basic indicators of success. PMID- 10131693 TI - The use of statistical techniques in par-level management. AB - The total quality management movement has allowed the reintroduction of statistics in the materials management workplace. Statistical methods can be applied to the par level management process with significant results. PMID- 10131694 TI - Health care reform and the hospital supply chain. AB - With health care reform, hospitals will be differentiated in the marketplace by how well they manage the costs of services. Because products will be market priced, hospital materiel managers will have to minimize all other related acquisition costs. The key opportunities will be in changing processes to eliminate non-value added administrative, supply chain, and process activities and their attendant costs. PMID- 10131695 TI - Beyond just-in-time: the UCLA Medical Center experience. AB - This article is a narrative description of how and why the UCLA Medical Center arrived at the point of a vendor-managed supply distribution program. The article outlines a historical perspective of supply distribution and places UCLA in that framework. It goes on to summarize the UCLA Medical Center model both for stock and nonstock distribution. A new program overview outlines the Owens & Minor commitment to UCLA, and there is a short discussion of AXIOMM, the UCLA Medical Center computer purchasing program. PMID- 10131696 TI - Implementing a new inventory management system. AB - Determining the type of inventory management system to use in a hospital depends as much on one's technical abilities as its does with the culture of the institution and the vendor's capabilities. PMID- 10131697 TI - In search of a big enough stick to tame the wild operating room inventory beast. AB - This article discusses the many aspects of a prime vendor relationship with a medical-surgical distributor. It outlines features or value-added services that should be included when a hospital embarks on a new prime vendor relationship or tries to improve an existing one. PMID- 10131698 TI - Implementing structure and control over unofficial inventories in a multispecialty group practice. AB - Materiel managers have been in control of most aspects of the supply chain except for the inventories of the end users, which account for 70 percent of the inventory supply dollars. When the Materials Manager at Lexington Clinic in Lexington, Kentucky, was approached by the Clinic's Chief Executive Officer to implement cost containment measures, the Materials Manager seized the opportunity to implement a six-step program aimed at controlling those supply dollars. Through requisition training, enforcing approval levels, limiting the number of requisitioners, and establishing par levels on floor inventories, the clinic's "unofficial" inventory supply dollars were reduced by 7 percent in the first 12 departments where the par levels were established. The program was hailed as a tremendous success and a positive experience for everyone, from nurses to warehouse clerks. PMID- 10131699 TI - Justification of a point-of-use inventory management system. AB - Pyxis--an automated dispensing and inventory control system that provides supply management at point-of-use--helped us reduce supply expenses and improve productivity. PMID- 10131700 TI - Exchange cart and par level supply distribution systems: form follows function. AB - This article examines the various types of distribution systems, such as exchange cart, par level, and just-in-time, to assist material managers in controlling costs and maximizing patient care. PMID- 10131701 TI - A reusable diaper evaluation within a children's hospital. AB - An evaluation of reusable diapers appears to hold promise for reducing costs and environmental waste within a children's hospital setting. Many factors, including economic, clinical, environmental, and logistical concerns, were considered in this study, which shows cost comparisons and survey assessment results from four separate alternatives. Although reusable diapers may be considered to be a better environmental choice, there are currently not enough overriding incentives to make a switch at this time. PMID- 10131702 TI - Controlling inventory in a small specialty hospital. AB - Controlling inventory in a small specialty hospital has many parallels to controlling inventory in a large, acute care hospital. However, in a specialty hospital, there seems to be a plethora of specialty items that must always be on hand in ample supply. To achieve a significant inventory reduction, a strategic plan was developed that revolved around training sessions with the materiel management team, meetings with key hospital staff, and the establishment of two prime vendor contracts. In 1991, the annual inventory value in the general storeroom was approximately $2.3 million; in 1992, the inventory value was $1.6 million, and the projected inventory value for 1993 is $1.2 million. Implementing a just-in-time program to control inventory is best achieved through a collaborative effort with all of the materiel management team feeling a sense of contribution as well as receiving recognition from hospital administration. PMID- 10131703 TI - Off-site materiel management. AB - Supplies for a chronic dialysis unit are critical to operations. Planning, training, and computer-assisted database management allow for successful management of supply purchasing, inventory control, receiving, and record-keeping by a technician without any prior materiel management experience. PMID- 10131704 TI - Overview of the Medicare program. PMID- 10131705 TI - Medicare and Medicaid statistical supplement. PMID- 10131706 TI - Supplementary medical insurance benefit for physician and supplier services. PMID- 10131707 TI - End stage renal disease. PMID- 10131708 TI - A description of Medicaid-covered services. PMID- 10131709 TI - Medicare program expenditures. PMID- 10131710 TI - Recent trends in Medicaid expenditures. AB - Total net Medicaid expenditures exceeded $94 billion in FY 1991, with 5 states accounting for more than 40 percent--New York, California, Massachusetts, Pennsylvania, and Texas. Nationally, inpatient and institutional long-term care payments each comprise about one-third of Medicaid spending. Medicaid expenditures have grown rapidly. From 1987 to 1991 they nearly doubled, greatly exceeding the expenditure growth for Medicare and private health insurance. This growth has been unevenly distributed. Expenditures increased by 125 percent or more in 12 States during this period, but an equal number of States had increases below 75 percent. Although expenditures grew the most slowly in institutional long-term care, this still comprises the largest payment category. Spending for inpatient services, community long-term care, insurance payments, and services not otherwise classified had the fastest rate of growth. By 1995, projected Federal expenditures for Medicaid will exceed $100 billion, approximately equal to those for Medicare in 1991. Health care inflation, State program decisions, and Federal mandates all affect the growth in Medicaid expenditures. Legislative changes have expanded coverage of pregnant women, infants, and children, and also have increased Medicaid payments of Medicare premiums and cost sharing for the elderly and disabled. Other Federal mandates raised nursing home standards and expanded EPSDT services. Legislative requirements and court challenges caused some States to increase provider payment rates. Some States developed alternative financing arrangements to accommodate the fiscal demands of higher expenditure growth. Requirements for DSH payments allowed States to use Medicaid to offset State support of public hospitals. Provider taxes and donations permitted States to increase Medicaid payments without having to raise other revenues or place an economic burden on providers. These arrangements were significantly curtailed by legislation passed in 1991. PMID- 10131711 TI - Payment, administration, and financing of the Medicaid program. PMID- 10131712 TI - Changes in Medicaid nursing home beds and residents. PMID- 10131713 TI - Hospital insurance short-stay hospital benefits. PMID- 10131714 TI - Skilled nursing facilities. PMID- 10131715 TI - How payment systems drive change in health care delivery. PMID- 10131716 TI - Hospitals alter structure, workforce to prepare for future. PMID- 10131717 TI - Network profile. Memorial Healthcare System. PMID- 10131718 TI - Perspectives on purchasing. PMID- 10131719 TI - How to be street wise. PMID- 10131720 TI - Data briefing. Can't complain. PMID- 10131721 TI - Resource management. Different by tradition. PMID- 10131722 TI - Resource management. The long and the short of it. PMID- 10131723 TI - Providing a personal service in the Trent Region. AB - Reports evaluation of the Trent Regional Health Authority's "Providing a Personal Service" initiative, one of the first major quality management strategies in the NHS. The evaluation highlights the key elements which supported this initiative and suggests some ways in which its progress can be sustained. Many of the comments are applicable to other approaches to quality management. PMID- 10131724 TI - The three Cs of staff counselling. AB - Describes why and how a staff counselling service was set up at Shropshire Health Authority. Details the different phases of its development and the problems encountered. PMID- 10131725 TI - Measuring management training. Two new instruments. AB - Seeks to enhance the measurement of training; describes the development of psychometrically sound and practical measures to assess outcomes relating to in service management training within a National Health Service District. Develops legitimate measurement tools and demonstrates the positive effects of two specific programmes in relation to behavioural change and participant satisfaction. Further work is required to establish how to monitor the effects of the action learning process in terms of cognitive development. PMID- 10131726 TI - BS (British Standards) 5750: the message for managers. PMID- 10131727 TI - Teamwork brings TQM to health care. Lessons from three years of team activity. AB - Looks at the Swedish American Hospital institutions in Rockford, Illinois, USA which serves 700,000 people. The system incorporates four clinics, three smaller hospitals and 230 physicians over a metropolitan area. Observes how the Juran influence has improved the process and discusses triumphs and failures of the system. PMID- 10131728 TI - Management development and change in a demanding health care environment. AB - The problems facing many US health care organizations may prove critical for survival for many of them. Outlines the nature of the problems: increased patient demand, tensions among personnel, technological innovation, cost-conscious purchasers of care, the need to improve cost-efficiency, and barriers to change within organizations. This last presents a number of problems that may often seem intractable and are peculiar to this type of organization. PMID- 10131729 TI - Strategies for improving corporate philanthropy toward health care providers. AB - The authors report the results of a survey examining corporate donation behavior relative to the health care industry. The findings suggest that, despite the poor economic conditions of recent years, companies have continued to make substantial contributions--particularly to the health care industry--and that the single most identifiable factor influencing the availability of funds in any given year was the company's expected earnings in that year. Additionally, the authors suggest criteria that influence whether a company donates to a particular organization as well as the expected benefits and methods of recognizing donations. Finally, they discuss preferred solicitation methods along with marketing implications for the health care industry. PMID- 10131730 TI - Referral physician marketing. AB - Marketing of specialist services to referring physicians can be highly effective at influencing referral patterns if the referring physician's needs are taken into account. Furthermore, it is possible to generate referrals from nonreferring physicians by approaching them correctly. The ideal approach is for a specialist to treat non-referring physicians as though they referred the patient, even when they didn't. This practice allows the specialist to demonstrate communications service quality in a non-aggressive, non-sales context. The United Weight Control case study summarizes the impact of a referral-generation strategy with "before" and "after" analyses of the strategy's cost and effectiveness. PMID- 10131731 TI - Continuous quality improvement of emergency services. AB - The authors describe a five-year continuous quality improvement program that monitors inpatient and outpatient satisfaction with emergency services offered by a multi-institutional health care system. The program provides managers with the information to develop detailed plans for service improvement and suggests ways to appraise performance and recognize personnel. PMID- 10131732 TI - Measuring service quality and its relationship to future consumer behavior. AB - The authors adapt the SERVQUAL scale for medical care services and examine it for reliability, dimensionality, and validity in a primary care clinic setting. In addition, they explore the possibility of a link between perceived service quality--and its various dimensions--and a patient's future intent to complain, compliment, repeat purchase, and switch providers. Findings from 159 matched-pair responses indicate that the SERVQUAL scale can be adapted reliably to a clinic setting and that the dimensions of reliability, dependability, and empathy are most predictive of a patient's intent to complain, compliment, repeat purchase, and switch providers. PMID- 10131733 TI - Religious affiliations and consumer behavior: an examination of hospitals. AB - The author re-examines the conclusions of an earlier study which contends that religious affiliation of a hospital is important in influencing hospital selection and contributes to overall patient satisfaction. In this new survey, patients ranked religious affiliation low in importance when choosing among hospitals. However, hospitals of a particular religious affiliation were more likely to be recalled, preferred, and selected by people of the same religious affiliation. Furthermore, on quality-of-care measures, religious affiliation influenced hospital evaluations. PMID- 10131734 TI - Dissecting the patient stay in the UK. AB - A method of analysing the factors which contribute to the length of stay in England as an acute medical in-patient has been developed, and applied in both real-time and cross-sectional studies. The major factors delaying discharge were found to be the time taken to respond to treatment and the actions of agencies other than the acute medical unit of the hospital. Areas where improvement could be made have been identified and some changes implemented. The system can be applied to monitor the effect of such changes. PMID- 10131735 TI - Defining excellence in health service management: evidence from an international study. AB - Health service executives are striving to implement the best managerial practices amid the major turbulence and restructuring which is prevalent in many health care systems today. All too often, guidance about what the best practices are needs to be sought from studies contained within the general management literature. It is problematical whether this literature is applicable to health service organizations. This article reports the results of a study which examined the views of 93 executives in 14 hospitals in Britain, Canada and the United States about what constitutes managerial excellence. The hospitals were selected on the basis of their reputed success in health service management. Using grounded theory methodology, eight factors of excellence were derived from the interview data which were supplemented by data made available from hospital documentation supplied by participants. The results of this study are compared with those of Peters and Waterman (1982). This is the most frequently cited study of managerial excellence in the general management literature. The main conclusions drawn are that a current definition of health service management excellence has been identified; there was a high degree of unanimity among participant executives about the constituents of success and excellence in health service management; and, that there are some marked differences between this definition of excellence and that propounded by Peters and Waterman (1982). The implications of this definition of excellence for health service executives are discussed. PMID- 10131736 TI - The field coaching program. Ride-alongs that work. PMID- 10131737 TI - Hitting close to home. Domestic violence and the EMS responder. PMID- 10131738 TI - Helping the battered woman help herself. PMID- 10131739 TI - Skills for the skills examiner. PMID- 10131740 TI - EMS in the pueblos. AB - Imagine creating a movie by excerpting scenes from "Dances With Wolves," splicing it with footage from "Code 3" or "Emergency Response" and then flavoring the script with the mystery of a Tony Hillerman novel. A film producer would probably find it quite difficult to choreograph a finished product from such a compilation of material. To hundreds of Native American EMS providers, however, such a movie is played out every day in Indian country. And with this movie come some real life problems, including trauma, which is the number-one cause of premature death among Native Americans. But a high trauma rate is just one of the challenges facing tribal EMS responders. There's also prolonged response and transport, the problems involved in maintaining the unique culture and standard of care, the challenges of tribal EMS administration and EMS education of Native American students, and the unsure future of Native American EMS. Beyond that, there's the fact that EMS is a s unique to each Indian reservation as are the cultures of the native peoples who reside on these lands. Yet while no two systems are alike, most tribal EMS providers face similar challenges. PMID- 10131741 TI - Where everybody knows your name. EMS in Ak-Chin, Arizona. PMID- 10131742 TI - NHTSA's (National Highway Traffic Safety Administration) National Native American EMS assessment and how to implement it without money. PMID- 10131743 TI - Ground transport of the intra-aortic balloon pump patient. PMID- 10131744 TI - Strategies for nurse aide job satisfaction. AB - With average turnover costs equaling four times an employee's salary, administrators cannot afford to lose nurse aides. This study explored why aides leave and ways to improve your facility's work environment. PMID- 10131745 TI - Satisfaction on the job: the "value" factor. PMID- 10131746 TI - Retaining CNAs in long-term care. PMID- 10131747 TI - Do nurses' aides aid nurses or residents? Identifying the tasks they perform. AB - A recent study shows that nurse aides perform mostly nonmedical tasks including those associated with activities of daily living. Based on these findings, the author provides recommendations for understanding and defining the nurse aide's role. PMID- 10131748 TI - Resistance to change: understanding the aides' point of view. AB - Nursing home units are subcultures of the entire facility, with values, attitudes and norms that are passed from aide to aide. Changes in work routines may threaten your workers' effectiveness. Helping your nursing staff adapt will always remain a challenge. PMID- 10131749 TI - Nursing home aides' work and family connections. AB - In order to maintain a productive workforce, organizations must acknowledge that many employees, particularly nurse aides, perform full-time care giving, both on and off the job. Competing demands between work and family can affect job performance, quality of care and bring on burnout. PMID- 10131750 TI - What you should know about the Family and Medical Leave Act of 1993. AB - Every long-term care administrator needs to be thoroughly informed on all aspects of the Act and must update policy procedures to guarantee compliance. The potential penalties here are horrendous. PMID- 10131751 TI - Some practical advice for the new nursing home administrator. PMID- 10131752 TI - Ramsey pricing and supply-side incentives in physician markets. AB - In this paper, I develop a theory of optimal prices using a relative value scale where there are fixed costs of medical practice. I consider a regulator constrained to set prices in excess of marginal cost, in markets where physicians can create demand at the margin. Under these conditions, basing prices on physician costs alone is shown to be suboptimal. Instead, prices should anticipate the behavior of physicians by setting profit margins highest for services least susceptible to demand creation. This is equivalent to a form of Ramsey pricing, used in this case to minimize the deadweight loss of oversupply. PMID- 10131753 TI - Determinants of interest rates on tax-exempt hospital bonds. AB - The aim of this paper is to examine the determinants of interest rates on tax exempt hospital bonds. The results highlight the potential and actual roles of Federal and state policy in the determination of these rates. The shift to a Prospective Payment System under Medicare has subsidized the borrowing costs of some hospitals at the expense of others. The selection of underwriters by negotiation rather than by competitive bidding results in higher interest rates. The Federal tax act of 1986 raised the cost of hospital debt by encouraging bond issues to contain call features. PMID- 10131754 TI - Drinking and schooling. AB - We employ the National Longitudinal Survey of Youth data to explore the effect of youthful drinking on years of schooling and on the likelihood of college graduation. Our instruments for youthful drinking include the state beer tax and the minimum purchase age. Reduced form equations are also estimated. Our results indicate that heavy drinking in high school reduces the average number of years of schooling completed following high school. Other things equal, students who spend their high school years in states with relatively high taxes and minimum age are more likely to graduate from college. PMID- 10131755 TI - Equity and equality in health and health care. AB - This paper explores four definitions of equity in health care: equality of utilization, distribution according to need, equality of access, and equality of health. We argue that the definitions of 'need' in the literature are inadequate and propose a new definition. We also argue that, irrespective of how need and access are defined, the four definitions of equity are, in general, mutually incompatible. In contrast to previous authors, we suggest that equality of health should be the dominant principle and that equity in health care should therefore entail distributing care in such a way as to get as close as is feasible to an equal distribution of health. PMID- 10131756 TI - On the decision rules of cost-effectiveness analysis. PMID- 10131757 TI - Changing the problem to fit the solution: Johannesson and Weinstein's (mis) application of economics to real world problems. PMID- 10131758 TI - The malpractice shootout in Washington. PMID- 10131759 TI - Health-cost outlook: only a bit less grim. PMID- 10131760 TI - Sometimes doctors should butt out. PMID- 10131761 TI - How to gain leverage with a health plan. PMID- 10131762 TI - For doctors and hospitals, where's the line between loyalty and competition? PMID- 10131763 TI - Administration tips hand on new CLIA changes. PMID- 10131764 TI - Fighting the TB dragon. AB - As the battle to stem the transmission of tuberculosis rages, OSHA and the CDC have joined forces to increase awareness of this adversary and improve occupational safety practices. PMID- 10131765 TI - A rural lab's response to CLIA's personnel standards. PMID- 10131766 TI - Reducing turnaround time for ABGs in the ICCU. PMID- 10131767 TI - Report card test starts without United. PMID- 10131768 TI - Changes for tax-exempts will raise costs, group warns. PMID- 10131769 TI - Antitrust guidelines' first test benefits for-profit chain. PMID- 10131770 TI - CBO estimates stagger Clinton plan. PMID- 10131771 TI - Industry follows, fears the leader. PMID- 10131772 TI - T2 agrees to 4-way merger that will create 2nd-largest home infusion company. PMID- 10131773 TI - Conn. eyes changes in state policy. PMID- 10131774 TI - White House plays down execs' veto. PMID- 10131775 TI - Vet groups hit budget's VA cuts. PMID- 10131776 TI - UniHealth plan gets IRS nod. PMID- 10131777 TI - Georgia providers line up networks. PMID- 10131778 TI - Chicago Catholic network eyed. PMID- 10131779 TI - Illinois Blues take over Michigan auditing. PMID- 10131780 TI - K.C. hospital keeping suitors at bay. PMID- 10131781 TI - Talks on as Indiana cutbacks start. PMID- 10131782 TI - Hospital-physician computer link needed. PMID- 10131783 TI - Ameritech looking to make acquisitions. PMID- 10131784 TI - Temblor shook more than just structures. PMID- 10131785 TI - FTC still mulling HealthTrust deal. PMID- 10131786 TI - Pueblo merger opponent still wary. PMID- 10131787 TI - Perhaps America can learn a healthcare lesson abroad. PMID- 10131788 TI - Spending more on computers to help keep costs in line. PMID- 10131789 TI - Technology isn't always to blame. PMID- 10131790 TI - Canadian health system running a fever. PMID- 10131791 TI - TakeCare open to other offers. PMID- 10131792 TI - Two Mass. hospitals get buyout bids. PMID- 10131794 TI - Cleaning up 'dirty' power. PMID- 10131793 TI - HMOs strive to prove savings, battle HCFA payment system. PMID- 10131795 TI - The big-money merger game finds banks lined up to lend. PMID- 10131796 TI - Fair can help staff learn about new technology. PMID- 10131797 TI - Internship program helps recruit nurses to the OR. PMID- 10131798 TI - No-heat surgical device uses ultrasonic motion for cutting. PMID- 10131799 TI - Flexible OR eyewear policy okay, OSHA says. PMID- 10131800 TI - Health care reform challenges OR managers. PMID- 10131801 TI - Health care reform For the OR, cost cutting, possibly lower volume. PMID- 10131802 TI - Top surgery center consolidates services. PMID- 10131803 TI - OR's QI team focuses on supply chain. PMID- 10131804 TI - OR automation pushes into intraop charting, integration. PMID- 10131805 TI - Tests evaluate barrier effectiveness of gowns. PMID- 10131807 TI - Making management reports work for you. PMID- 10131806 TI - Hospitals linking 'islands of automation'. PMID- 10131808 TI - Hospitals respond to Trade Center bombing. PMID- 10131809 TI - Sedation policy monitoring must go beyond OR. PMID- 10131810 TI - Cataract guideline downplays surgery, tests. PMID- 10131811 TI - AORN leads effort to define infectious waste. PMID- 10131812 TI - Computer linkages help to streamline care. PMID- 10131813 TI - Paperless patient accounting: fact or fantasy? AB - Hospital staff at Morton Plant Hospital in Clearwater, Florida, were "drowning in a sea of paper." The 715-bed facility (the fifth largest hospital in the state of Florida) was producing an average of 19,000 patient bills per month and the patient accounts department was "going down for the third time." Over 50,000 active files covered over 170,000 square feet of shelf space. Eight file clerks spent over 750 hours each month retrieving and filing the department's documents. Warehouse storage space costs were high, customer satisfaction was low, and misplaced files were causing reimbursement delays. (It could take weeks to recover or rebuild a missing file, resulting in patient dissatisfaction and poor reimbursement follow-up.) PMID- 10131814 TI - Helping snorers get their ZZZs. Print campaign steers patients to hospital's new sleep disorders lab. Inland Valley Regional Medical Center, Wildomar, CA. PMID- 10131815 TI - The marriage of hospitals and doctors. PMID- 10131816 TI - Pharmacy mix-up brings crisis. York Hospital/York Apothecary, PA. PMID- 10131817 TI - A PHO gives birth to an HMO. Akron City Health System, OH. PMID- 10131818 TI - Group practice extends hospital's reach. Portland Adventist Medical Group, OR. PMID- 10131819 TI - When age brings confusion. Mission Bay Hospital, San Diego, CA. PMID- 10131820 TI - Hooking up to cable. Kennedy Memorial Hospitals-University Medical Center, Cherry Hill, NJ. PMID- 10131821 TI - Asking-A-Nurse in person. Franchise moves to shopping mall to increase community contact. Mercy Health System, Janesville, WI. PMID- 10131822 TI - Team teaching a healthcare lesson. Three hospitals produce free video to help employers control medical costs. PMID- 10131823 TI - LIFENET/INTERNET and the health science librarian. AB - The Medical Library Center of New York, a cooperative library agency for the health sciences, developed a program to offer an electronic communications system (LIFENET) with access to the Internet for its members. Information on documentation and training as well as statistics on the subsequent use of the system and of the Internet are discussed in the article. Specific examples of how health science librarians are using the system include bibliographic verification, reference, research on integrated library systems, production of duplicate journal lists, and professional activities such as electronic mail and discussion groups (listservs). PMID- 10131824 TI - The surgical technologist and ethics. PMID- 10131825 TI - Preceptorship: a gift that keeps on giving. AB - As certified surgical technologists, you have tremendous influence over the entire function and effectiveness of your operating room because you bring stability due to longevity and are the preceptors for new and potential employees in your area. As one involved with teaching operating room nursing and surgical technology over the past 30 years, I feel strongly that preceptors hold the key to both the staying power and performance standards of the operating room staff because they serve as role models for success or failure. PMID- 10131826 TI - TQM and the surgical technologist: the opportunity. PMID- 10131827 TI - The AHA's NOVA awards. Making collaboration work. PMID- 10131828 TI - The top 10 questions to ask about a major construction project. PMID- 10131829 TI - Use and abuse of golden parachutes. Severance packages are designed to protect CEO risk takers and leaders. PMID- 10131830 TI - When renovation is the best option. PMID- 10131831 TI - Hospitals and communities create 'wise' environments. PMID- 10131832 TI - Hospital upheaval: coping with institutional adversity. PMID- 10131833 TI - The effective leadership team. PMID- 10131834 TI - Why are health costs really rising? PMID- 10131835 TI - Toward community care networks. PMID- 10131836 TI - Medicare: on the sidelines of reform. PMID- 10131837 TI - A pained ambivalence. PMID- 10131838 TI - Sizing up the other plans. PMID- 10131839 TI - Precious principles of health reform. PMID- 10131841 TI - Rx for health care reform. PMID- 10131840 TI - Dialysis by the numbers. Better monitoring might keep more kidney patients alive. PMID- 10131842 TI - Updated duckling. Primary care clinic, Oakland Children's Hospital, CA. PMID- 10131844 TI - Perspectives. Can the Federal Employees' Health Program survive the wiles of health reform? PMID- 10131843 TI - Substitutions and rebates: questionable materiel management practices in HMOs? PMID- 10131845 TI - Perspectives. Physicians and hospitals joining forces to stake out market share. PMID- 10131846 TI - Demographics of today's woman surgeon. PMID- 10131847 TI - Medical ethics in today's society. PMID- 10131848 TI - Cost savings from information technology in U.S. health care reform: insights from modeling. PMID- 10131850 TI - Health care reform: a strategist's guide. PMID- 10131849 TI - How JCAHO, WEDI, ANSI, HCFA, and Hillary Clinton will turn your systems upside down. AB - JCAHO, WEDI, ANSI, HCFA, the Clinton Administration health care reform task force, and other local, state, and national organizations are having a major impact on the health care system. Health care providers will become part of larger health care organizations, such as accountable health plans (AHPs), to provide health care services under a managed care or contracted fee-for-service basis. Information systems that were designed under the old health care model will no longer be applicable to the new health care reform system. The new information systems will have to be patient-centered, operate under a managed care environment, and function to handle patients throughout the continuum of care across a multiple-provider organization. The new information system will require extensive network infrastructures operating at high speeds, integration of LANs and WANs across large geographic areas, sophisticated interfacing tools, consolidation of core patient data bases, and consolidation of the supporting IS infrastructure (applications, data centers, staff, etc.). The changes associated with the health care reform initiatives may, indeed, turn current information systems upside down. PMID- 10131851 TI - A cooperative effort to probe information technology's pivotal role in health care reform. PMID- 10131852 TI - Integrating information systems to support regional health care organizations. PMID- 10131853 TI - Computer-supported coordination of medical and social services. PMID- 10131854 TI - A realistic strategy to achieving managed care automation. PMID- 10131855 TI - Life under state-mandated reform: one employer's experience. PMID- 10131856 TI - Information management implications of federal health care reform. PMID- 10131857 TI - 'The change professional': a job description. PMID- 10131858 TI - Coordinating transitions in care for improved perinatal outcomes: the RIMM (Reduction in Infant Morbidity and Mortality) Project. PMID- 10131859 TI - 'We don't just kiss you good-bye!': home visitor program prevents child abuse. PMID- 10131860 TI - Perinatal substance abuse: a rural network. PMID- 10131861 TI - Safe discharge of infants: the case of substance-abusing families. PMID- 10131862 TI - Influenza immunisation: policies and practices of general practitioners in England, 1991/92. AB - A large questionnaire survey of general practices in England to determine the most recent policies, perceptions, and procedures for influenza immunisation, and the extent to which individual practice characteristics were related to levels of vaccine distribution, was conducted during January and February 1992. The results indicate that the proportion of practices with influenza immunisation policies has increased considerably since the mid 1980s. However, some notable shortcomings remain and practice characteristics appear to have little influence on vaccine delivery, suggesting that other factors may also be important. PMID- 10131863 TI - Comparison of the quality of patient data collected by hospital and departmental computer systems. AB - The quality of patient data routinely collected in hospitals is rarely assessed, though by repute it may often be incomplete and inaccurate. To explore their completeness and accuracy, patient data separately collected by a hospital Patient Administration System (PAS) and by a departmental Clinical Information System (CIS) used by clinicians were compared. The results indicate that, although both systems appear to record reliably demographic and administrative data, PAS data are more complete than CIS data. Moreover clinicians and medical records staff seem to use classifications of diagnoses and procedures in profoundly different ways. More attention should be paid to the need to assess and improve data quality. The development of a shared database, used and validated by medical records staff and clinicians alike, may be the best way to achieve this. PMID- 10131864 TI - Appointment as a staff grade doctor: success or failure? AB - This paper describes the characteristics of applicants for the first cohort of staff grade posts in an English health Region based on extraction of data from the curricula vitae and application forms of all doctors who applied for such posts over a two year period. 374 doctors applied for 34 staff grade posts in the 16 health Districts of the Northern Region from 1 January 1989 to 31 December 1990. The mean number of applicants for each post was 11, with a mean age of 43 years and a mean time since qualification of 18 years. One-third of the applicants had a higher qualification; about a quarter had passed the first part of an examination for such a qualification or had a Diploma, and nearly one-fifth of applicants did not possess any higher qualification. Between specialties there was wide variation in the time spent by applicants in each grade of their previous posts. Applying the criteria to identify 'stuck doctors' as set out in the national medical manpower plan Hospital Medical Staffing: Achieving a Balance: Plan for Action revealed wide variations within and between specialties. The criteria proposed in Achieving a Balance may not be adequate to identify 'stuck doctors', a finding which has clear implications for national medical manpower policy. PMID- 10131865 TI - Integrating the single homeless into mainstream general practice. AB - This paper describes the findings from a programme in central Nottingham, which aimed to provide non-institutionalised health services to single homeless people. The results show a high degree of acceptance of the programme by such people. It is argued that involvement in existing mainstream health services is particularly appropriate for the growing number of young people who are homeless, and for whom there is hope of rehabilitation within the community. PMID- 10131866 TI - Medical audit: the problem of missing case-notes. AB - This paper reports the results of a case-note audit undertaken to detect the antenatal risk factors found at the initial booking visit, including the subsequent clinical action taken. From a total of 2,139 case-notes of women booked via an obstetric computer system, and delivered between March 1990 and March 1991, 136 (6.4%) were missing. The results showed that these 136 mothers experienced significantly worse delivery outcomes, ie higher incidence of perinatal death; preterm labour; a baby with a low Apgar score and low birth weight. There was also a higher incidence of perinatal death and babies with a low Apgar score for women booked manually compared with those booked via the computer system. These results show that many audit procedures may be the subject of substantial bias due to the problem of missing information. The extended use of a computer-based medical record system should help to resolve this problem, although hybrid information systems can themselves be biased. PMID- 10131867 TI - New horizons in post-marketing surveillance. AB - Post-marketing surveillance is the process of monitoring and evaluating the safety of marketed medicines using a variety of methods. However, many doctors believe that post-marketing surveillance has a more limited meaning, ie an observational study of a new medicine sponsored by a pharmaceutical company. Although such studies were performed extensively in the United Kingdom during the 1980s, few have been published. Their purpose was to study large populations of users in ordinary practice with the aim of identifying hazards that had been missed, because clinical trials were too small, too short or did not always reflect real life. To some extent these studies have now fallen into disrepute, both on scientific grounds and because they have often been thought to be a thinly-disguised promotional exercise. The purpose of this article is to examine some of the previous problems with post-marketing surveillance and to propose new directions for the future. PMID- 10131868 TI - Prophylactic antibiotics at caesarean section do not reduce costs. AB - A prospective audit of 200 patients was undertaken to determine the effectiveness of prophylactic antibiotics at caesarean section in reducing the cost of postnatal care. The main outcome measures were the cost-effectiveness of this treatment in reducing the cost of care and incidence of infection. The results show that the routine administration of prophylactic antibiotics had no significant effect on infection rates, the prescribing of puerperal antibiotics or the duration of stay in the postnatal period. The total cost of antibiotics in the prophylaxis group was over four times that in the non-prophylaxis group. The results of this study suggest that routine administration of antibiotics at caesarean section does not reduce the costs of care in the puerperium. PMID- 10131869 TI - The last resort? Bed and breakfast accommodation for mentally ill people in a seaside town. AB - There have been few studies about the seaside hotel accommodation provided for mentally ill people in the United Kingdom, despite its extensive use. This paper reports the findings of a survey in Southend, which compared living conditions and residents in bed and breakfast accommodation with those in sheltered accommodation for mentally ill adults. The results show that the mentally ill residents of bed and breakfast accommodation were living in less attractive and less well maintained surroundings. They were not only more likely to have been recently discharged from a psychiatric unit, but also had less contact with the range of community mental health services. Residents in bed and breakfast accommodation were, however, closer to local amenities, such as day centres and parks, than the control group. Staff practices were less restrictive in bed and breakfast accommodation than in the majority of sheltered homes; homes employing psychiatric nurses allowed residents the most freedom. These findings support the need for more accommodation of an acceptable standard for those people discharged from psychiatric units. Local liaison schemes between health workers responsible for the continuing care of mentally ill people and the landlords of bed and breakfast accommodation could improve the quality of life for these residents. PMID- 10131870 TI - Demand for hospital services following admission with suspected myocardial infarction in 1983 and 1989. AB - Formulation of business plans by National Health hospitals requires information on likely demands for the services they provide. Two cohorts of patients admitted to the Nottingham hospitals in 1983 and 1989 with suspected myocardial infarction were sampled to determine the workload implications due to initial in-hospital tests, subsequent readmission and outpatient investigations. The results show that attendance in the first year after discharge related principally to cardiac problems, while in subsequent years non-cardiac problems predominated. An estimation of the total workload, based upon 1,000 patients admitted in 1989, suggests that demands for hospital services in the following year include over 4,000 electrocardiographs, 1,400 chest X-rays and 18,000 laboratory tests, and only 118 exercise tests and 37 cardiac catheterisations. Admission with suspected myocardial infarction makes great demand on hospital services in the year after discharge. Any change in practice, which increases the potential demand for cardiac investigations, could have important financial implications for Nottingham hospitals. PMID- 10131871 TI - The inappropriate use of acute hospital beds in an inner London District Health Authority. AB - The requirement for District Health Authorities to assess the health care needs of their population implies that they must consider how well acute hospital care meets these identified needs. This study, which was conducted in an inner London health district, identified that 123 (14.6%) patients were perceived by medical and/or nursing staff to be inappropriately located in an acute bed. This group was dominated by patients aged 65 years or above, those in general and geriatric medicine, those with a length of stay of 30 days or more, and those with high levels of physical and mental dependency. The main reasons for patients being labelled as 'inappropriate' were the need for non-acute health services (eg rehabilitation, terminal care etc), a need for nursing home places or because of social or housing problems. Five months after identification, the notes of 100 of the 123 inappropriate patients were traced. Retrospective classification of these notes using the more 'objective' Oxford Bed Study Instrument showed that 97 patients were still defined as inappropriate. Details of the length of inappropriate stay were available for 74 patients who accrued 7,519 inappropriate bed days at a cost of 836,547 pounds. These patients are an illustration of the potential failings of current health and social care systems and highlight the need for imaginative care solutions which bridge this divide. PMID- 10131872 TI - Dependency, quality and staffing of institutions for elderly people. AB - There have been dramatic changes in residential and nursing care of elderly people in the community over the last decade. Despite this, little is known about how these institutions compare in terms of: the quality of care they provide to residents; the dependency of the residents; or the manpower levels and qualifications of the staff employed. This study was undertaken with the aim of comparing the public and private sectors providing care to elderly people. A random selection of institutions was invited to participate, including private residential and nursing homes, Social Services homes and National Health Services long-term care wards. The findings show that the dependency of residents in the public sector was greater than in the private sector, with more mentally confused, incontinent and socially disengaged residents in the public sector. The staff to resident ratio in public institutions did not differ significantly from the private sector. Overall scores of quality of care were similar. Nevertheless, these scores masked important differences between the sectors, eg poorer buildings and facilities characterised the National Health Service units. Fewer activities and therapies, but a better ambience, was noted in the private nursing homes. These results suggest that the outcome of a policy to transfer the most heavily dependent patients from the care of the public sector could increasingly burden the private sector. This would result increase the proportion of highly dependent residents, with no clear provision for improved staff ratios, quality of care or training of staff. PMID- 10131873 TI - Fast forward. PMID- 10131874 TI - Perspectives on purchasing. Public ally no. 1? PMID- 10131875 TI - Labouring the point. PMID- 10131877 TI - 1993 new drug approvals. PMID- 10131876 TI - How to develop a successful DUE (drug usage evaluation) program: experience of a teaching medical center. AB - A drug usage evaluation (DUE) program was successfully implemented in a busy teaching medical center within 12 months of adding a full-time coordinator. The success of this program was due largely to its approval by hospital administration, the recruitment of a pharmacist with the necessary background, and the creation of a structure and process that encouraged participation by leaders of the medical staff. Although the primary objective of hiring the coordinator was to meet Joint Commission on Accreditation of Healthcare Organizations requirements for accreditation, another achievement was confirmed cost savings. Techniques used in selecting DUE subjects and the steps taken in implementing and managing the program are presented. PMID- 10131878 TI - Universal coverage, drug issues: how do competing health care reform bills compare? PMID- 10131879 TI - New ERISA provision expands group health coverage for children. PMID- 10131880 TI - Why health care parties should mediate rather than litigate. PMID- 10131881 TI - Computerizing medical records: is uniform federal law needed to guard patients' privacy? PMID- 10131882 TI - 'Covenants not to compete' gain vital new importance in era of health care acquisitions. PMID- 10131883 TI - Psychiatric specialty clinics: do they weed out comorbid depression and anxiety? AB - The concept of comorbidity of anxiety and depression was examined as it relates to specialty clinics, a growing trend as mental health care providers attempt to compete for patients and provide efficient and specialized treatments. Twenty nine patients from an anxiety clinic were compared with 23 patients from a mood disorders clinic in a university-based outpatient setting. Axis I diagnoses obtained by structured clinical interview for DSM-III-R were generally consistent with each specialty clinic. Incidence of diagnosable comorbid anxiety and mood disorders was not significantly different for the two clinics and within the range cited (11-78%) in several other studies drawing from various patient populations. Similarly, in comparing self-reported symptoms on three rating scales using Student's tests, authors found elevated symptoms of both depression and anxiety in both clinic populations. The importance of addressing the needs of patients with co-occurring diagnoses and symptoms within a specialty clinic is discussed as it pertains to treatment and research. PMID- 10131884 TI - New and borrowed strategies for mental health systems in the decade of the 1990s. AB - Use of the paradigm shifts advocated by futurists and the supporters of total quality management can facilitate access to new options for mental health systems. New views and innovative systems, however, become difficult to maintain in the context of increasingly rapid and unexpected change occurring in the environment. One strategy that can be employed is the use of leverage, a term usually associated with finance or politics. PMID- 10131885 TI - Risk factors for psychiatric inpatient assaults on staff. AB - The risk of psychiatric patient assaults on staff members is increasing yearly, with resultant increases in employee victim suffering, medical expense, and lost productivity. Traditionally considered a clinician responsibility, the management of patient violence also has important administrative implications. This article presents a review of the risk factors associated with violence that includes the characteristics of patients who assault but adds the characteristics of employee victims of such assaults as well as contextual variables. Additional data from a two-year study of a peer-help crisis intervention program for employee victims of patient assaults are included. The mental health administrative implications of this approach are outlined. PMID- 10131886 TI - Measuring resource use in economic evaluations: determining the social costs of mental illness. AB - Concern over costs associated with mental disorders has led to an increase in the number of economic evaluations of treatment interventions; unfortunately, methods for measuring resource use have not kept pace with this concern. Although it is well-known that a significant proportion of the costs associated with mental illness are for resources other than treatment, program evaluators and researchers often count only treatment costs in cost-effectiveness comparisons. Further, existing methods for measuring resource use are plagued by faulty assumptions about resource use, poor validity and reliability, and difficulties quantifying resource use. The authors discuss these problems and suggest five ways of improving measurement of nontreatment resources: clarifying assumptions, using multiple data sources, flexible data collection strategies, methods for improving the accuracy of recall, and an episodic approach to measurement. PMID- 10131887 TI - The residential needs and preferences of persons with serious mental illness: a comparison of consumers and family members. AB - This study reports on a systematic statewide effort to determine the residential needs and preferences of two important groups: primary consumers of mental health services and family members of consumers. Two comparable surveys regarding the residential needs of consumers were conducted. In all, 314 consumers and 459 family members participated in the survey. A comparison of the preferences of family members and consumers suggests that family members more often prefer congregate living situations and more staff support than do consumers. Consumers more often express a desire to reside by themselves without staff and without other persons who are mentally ill. While the direct comparison of preferences from these two constituencies has limitations, these data do suggest significant variability in needs and preferences voiced by consumers and their family members; discrepancies that need to be addressed by mental health policymakers and planners. PMID- 10131888 TI - Considerations in predicting mental health care use: implications for managed care plans. AB - Managed care plans and other health care providers face a difficult task in predicting outpatient mental health services use. Existing research offers some guidance, but our knowledge of which factors influence use is confounded by methodological problems and sampling constraints. Consequently, available findings are insufficient for developing accurate predictions, which managed care plans need in order to formulate fiscally responsible service delivery contracts. This article reviews the primary data sources and research on ambulatory mental health services. On the basis of this review, the probability and intensity of outpatient visits are estimated. The primary predictors of use are also examined because they may help managed care plans forecast use by a given population or group of enrollees. Gender, age, race, education, health status, and insurance coverage are several variables surfacing as statistically significant predictors of use. The implications for planning capitated mental health services are discussed. PMID- 10131889 TI - The mental health of Asian and Pacific Island elders: implications for research and mental health administration. AB - According to the 1990 census, the highly diverse Asian and Pacific Islander (API) American population has doubled in size from 1980 to 1990, and is now the nation's fastest growing minority group. Several studies have documented this population's comparative underuse of mental health services. A review of recent studies on the mental health of Asian and Pacific Island elders identifies a number of risk factors and protectors. Elder APIs appear to have poorer mental health compared to white counterparts, but not the poorest mental health within their own ethnic group. Within-group differences emerge, with recent immigrant groups and colonized populations appearing as most at-risk for mental health problems. A critical variable on this population's mental health status appears to be socioeconomic status,and yet an analysis of other demographic variables, notably nativity and gender, remain contradictory. A research agenda is proposed and implications for mental health administrators are suggested. PMID- 10131891 TI - A longitudinal study of the impact of changing public policy on community mental health client residential patterns and staff attitudes. AB - Three studies of perceived residential needs and community residential patterns of adults with severe and persistent mental illness over a period of 12 years are used to assess the effect of changing public policy in this area. During a period in which public policy shifted from advocacy of congregate living in treatment settings to independent living in generic community housing, there were significant changes in community residential patterns and in the attitudes of case managers. Clinical and demographic data collected in the most recent survey provides a much more complete profile of the community living situation of adults with severe and persistent mental illness than was previously available. PMID- 10131890 TI - Cultural barriers to mental health care delivery in Alaska. AB - Geographically diverse providers from all mental health disciplines attended a recent conference in Anchorage and discussed cultural barriers to the delivery of mental health care in Alaska. Based on their knowledge, experience, and perceptions, this article describes barriers contributed by the mental health care delivery system as well as those contributed by the American Indian and Alaska Native cultures. American Indians and Alaska Natives are experiencing deculturation, outmigration, alienation, distrust, and despair. The difficulties at the interface between Alaskan mental health care providers and consumers indigenous to Alaska have implications for administrative and clinical endeavors in culturally diverse settings elsewhere. Progress in this area will require special administrative skills. PMID- 10131892 TI - Managing change in an interdisciplinary inpatient unit: an action research approach. AB - This case study describes the application of the action research model to managing change in an interdisciplinary inpatient unit. Special attention is given to potential resistances to the process and methods for addressing these. A needs assessment instrument assessing 40 program domains produced the initial data from which direction for change was derived. Active participation by all members in each phase of the process was found to contribute positively to the development and implementation of change efforts. Results indicate that the use of the model coupled with participation by the client group promoted positive staff morale, open communication, lower staff turnover, team problem solving, and improved goal attainment. PMID- 10131893 TI - A study of provider perceptions of individuals with dual disorders. AB - Human service workers devote a great deal of time in preparing to serve clients. The majority of this preparation is focused in one direction, with exposure to a limited type of client. The growing population of individuals with dual disorders of mental illness and substance abuse challenges this tradition in training, in that these clients pose unique, multiple, and overlapping characteristics, symptomatology, and behaviors requiring a synthesis of training approaches. Based on survey data collected in a county in New York State, this study discusses how providers from various agencies view individuals with dual disorders and proposes coordination and training efforts that can be designed to respond to providers' treatment concerns. PMID- 10131894 TI - The state of the art in OR product standardization. AB - Product standardization has been a problem in the OR. Product evaluation and standardization exists on a house-wide and OR-specific level at most institutions. Surgeons play some role in the process, though how much depends on the institution. Clinical trials must be conducted to avoid having surgeons or nurses revert to their old products during the trial. Physician preference still plays a major role in preventing standardization from taking place. But strategies that reduce--not eliminate--product choices, combined with purchase contract compliance and cost/usage data can help standardization efforts succeed. PMID- 10131895 TI - Information systems support for OR product standardization. AB - A critical reason why many healthcare institutions cannot effectively standardize OR products is that they cannot access necessary information. An OR information system that manages, tracks and generates documentation on OR inventory is an important answer to implementing change. At least four key areas any information system should address in order to make standardization a reality are 1) clinical preference, 2) supplying a changing case mix, 3) product usage data and 4) vendor performance. OR information systems operate on various hardware platforms. Users have more software choices than ever before, because connectivity issues have been effectively solved through the development of standard electronic transaction sets. PMID- 10131896 TI - Operating room cost awareness committee. A model for collaboration. AB - Kaiser Santa Rosa (KSRO), a small facility in the Kaiser Permanente health maintenance organization, was found to have an unfavorably high non-payroll cost per surgical hour as compared with other Kaiser facilities. An Operating Room Cost Awareness Committee was formed to address the problem and has now become a standing committee at KSRO. The committee is composed of surgeons, nurses, materiel management personnel and administrative representatives. Through a spirit of cooperation and the authority to approve and deny all OR supply requests, the committee has been able to bring its OR costs in line with other Kaiser facilities. PMID- 10131897 TI - Partnering. A cooperative approach to dietary procurement. AB - The Toledo Hospital has initiated many innovative quality programs. One initiated with the dietary department involved turning its wholesaler into a partner to provide better-quality products, lower costs and better service. Specific requirements were established in each of these areas including guaranteed mark ups, price caps and performance reports. The hospital and the wholesaler also do joint negotiating with product manufacturers. Through these and other strategies, the hospital has reduced purchase prices for food items by over 4%, drastically reduced administrative costs of procurement and lead time, increased inventory turns to over 80 and given the dietary department a single resource for "one stop shopping." PMID- 10131898 TI - Defibrillators, automatic, external. ECRI. PMID- 10131900 TI - Will fee-for-service go the way of Marcus Welby? PMID- 10131899 TI - A surefire way to lure a young doctor. PMID- 10131901 TI - When your parents need help managing their money. PMID- 10131903 TI - Problem doctors aren't ignored here. PMID- 10131902 TI - The Clinton plan ignores our real health-care problems. PMID- 10131904 TI - House panel votes to restore most of VA personnel cuts. PMID- 10131905 TI - Mental health providers find a financing formula minus the usual red tape. PMID- 10131906 TI - Justice Department probes Iowa hospitals' partnership pact. PMID- 10131907 TI - Texas suit charges patient 'headhunting'. PMID- 10131908 TI - 5 agencies to tackle fraud in Texas. PMID- 10131909 TI - Church groups ally for reform plan. PMID- 10131910 TI - AHA seeks grass-roots reform push. PMID- 10131911 TI - ProPAC wary of spending cuts. PMID- 10131912 TI - Iowa hospitals seek fiber-optic network link. PMID- 10131913 TI - Orthopedic group aims to reduce prices by sharing data, clout. PMID- 10131914 TI - Ruling sought on 'hospital without walls'. PMID- 10131915 TI - Southern Ill. providers to form network. PMID- 10131916 TI - VHA group eyes network in NYC area. PMID- 10131917 TI - Columbia's Fla. syndication deal done. PMID- 10131918 TI - Columbia faces limits in 6 counties. PMID- 10131919 TI - Wash. merger passes fed muster but doesn't escape state scrutiny. PMID- 10131920 TI - Hospital profit rise gets steeper. PMID- 10131921 TI - Quorum seeks public stock offering. PMID- 10131922 TI - Epic buy to require bond, stock sales. PMID- 10131923 TI - Many docs mull early retirement--survey. PMID- 10131924 TI - Rivals rip Iowa hospital's report card. PMID- 10131925 TI - It's Louisville, Ky., for Columbia/HCA. PMID- 10131926 TI - CEOs, chairs view roles differently. PMID- 10131927 TI - Hospitals' purchasing sets record. PMID- 10131929 TI - Merger frenzy in California picks up pace. PMID- 10131928 TI - Purchasing forecast sees price moderation. PMID- 10131930 TI - N.J. hospitals seek back payments. PMID- 10131931 TI - New FDA regs to boost blood prices. PMID- 10131932 TI - Medical Care feels safe from buyout. PMID- 10131933 TI - Coram seeks to dominate alternate-site services. PMID- 10131934 TI - Older Calif. hospitals vulnerable to quakes. PMID- 10131935 TI - Kaiser repositions managers in Colorado, Georgia as it strives to retain enrollment. PMID- 10131936 TI - Florida Blues, medical group ask for a year wait to expand Chiles' Healthy Homes plan. PMID- 10131937 TI - Use of benefit mandates debated. PMID- 10131938 TI - Probe shows no link in fumes cases. PMID- 10131939 TI - AIDS czar points to need for universal coverage. PMID- 10131940 TI - Medical education in reform draws attention. PMID- 10131942 TI - Merger of two Mass. hospitals a step closer to completion. PMID- 10131941 TI - Network formation may be cooled by rising capital costs. PMID- 10131943 TI - No shortage of suitors for Hilton Head Hospital. PMID- 10131944 TI - Care on wheels grows as inner-city remedy. PMID- 10131945 TI - Clinton reform plan raises quality questions, CEOs say. PMID- 10131946 TI - Hospitals splurge on selling efforts. PMID- 10131947 TI - Information gets to the point without wires. PMID- 10131948 TI - CPC finds room to grow in Britain. PMID- 10131949 TI - Feds probe if Baxter used illegal incentives. PMID- 10131950 TI - Need for better outcomes data underlined by new survey on healthcare computerization. PMID- 10131951 TI - Software vendors integrating products. PMID- 10131952 TI - Ind. hospital group sues state over Medicaid cuts. PMID- 10131953 TI - 'Pork' weighs down VA budget--vet advocates. PMID- 10131954 TI - Metropolitan Hospital first to join New York's 'Goods for Guns' drive. PMID- 10131955 TI - Focus turning toward managed care. PMID- 10131956 TI - Stanford move to aid 1-stop shoppers. PMID- 10131957 TI - Clintons seek groups' support in reform fight. PMID- 10131958 TI - Balanced budget debate begins amid fear over impact. PMID- 10131959 TI - Other reform plans to get some hits. PMID- 10131960 TI - Let market forces work on docs. PMID- 10131961 TI - Hospitals taking aim to curb gun violence. PMID- 10131962 TI - Kidnapped kids a possible nightmare. PMID- 10131963 TI - U.S. HomeCare looking for partner. PMID- 10131964 TI - United HealthCare buys Ramsay-HMO. PMID- 10131965 TI - Link not expected between health reform, crime. PMID- 10131967 TI - Ruling against Va. hospital upheld. PMID- 10131966 TI - Violence rips at hospitals' aura of invulnerability. PMID- 10131968 TI - Emulating best children's services. PMID- 10131969 TI - Foundations target violence programs. PMID- 10131970 TI - Company signals financial woes ... U.S. Surgical Corp. PMID- 10131971 TI - Healthcare profits rise 23% in 4th quarter. PMID- 10131972 TI - Mass. license clears Horizon-Greenery deal. PMID- 10131973 TI - Quake-damaged St. John's vows to reopen for business by building smaller facility. PMID- 10131975 TI - Oklahoma City facilities form system. PMID- 10131974 TI - Missouri plan reforms insurance by creating delivery networks. PMID- 10131976 TI - N.Y.'s HHC cuts jobs, spending to trim budget. PMID- 10131977 TI - Mo. hospitals await word on waste rules. PMID- 10131978 TI - 6 facilities still closed from quake. PMID- 10131980 TI - Ethix report card is a first for PPOs. PMID- 10131979 TI - Dialysis provider REN's profits fall; RTC reports gains. PMID- 10131982 TI - Dems join assault on Clinton plan. PMID- 10131981 TI - Fla. bill sets charity-care minimum. PMID- 10131983 TI - Miss. Blues suing state official. PMID- 10131984 TI - Data base tracks acquisition costs. PMID- 10131985 TI - Mental health benefit may cost less. PMID- 10131986 TI - Premier renews pact with Baxter. PMID- 10131988 TI - 4 exec groups discuss collaboration. PMID- 10131987 TI - Hospitals' drug spending slows. PMID- 10131989 TI - Maine leaders drop push to pass state health reform plan. PMID- 10131990 TI - Minn. officials want to delay network start. PMID- 10131991 TI - Business keeps on Clinton plan. PMID- 10131992 TI - Looking beyond cost. PMID- 10131993 TI - Abortion targeted in reform debate. PMID- 10131994 TI - Committee urges simplified plan for GME financing. PMID- 10131996 TI - Market forces dictate group growth. PMID- 10131995 TI - Good relations with press pay dividends. PMID- 10131997 TI - Big two's control of market to change supply industry. PMID- 10131998 TI - Mental health pacts test hospitals' mettle. PMID- 10131999 TI - Long-term-care firms eye Columbia ties. PMID- 10132000 TI - Legislative panel in Hawaii approves reform project study. PMID- 10132001 TI - The ergonomic workplace. Charting a course for long term care. PMID- 10132002 TI - High costs of restraints. PMID- 10132003 TI - Subacute care. Defining the challenge. PMID- 10132004 TI - A question of authority. PMID- 10132005 TI - CQI: problems to solutions. PMID- 10132006 TI - Total quality: a new era in nursing. PMID- 10132007 TI - Acquisitions: on the rise. PMID- 10132008 TI - Residential living. The client of the decade. PMID- 10132009 TI - Protection or pink slips--pro/con. PMID- 10132010 TI - The malpractice crisis and the rate of actual malpractice. AB - In summary, the major concern of healthcare providers regarding malpractice should be its impact on patient welfare and its reduction to an irreducible minimum, rather than concern for physicians' insurance, etc. Medicine, rather than acting defensively, should provide leadership in reducing the malpractice toll on patients. Primary remedial steps should involve the prevention of patient injury and/or death. Actual malpractice is an enormous public health problem with a yearly morbidity of approximately 350,000 patients, and a yearly mortality of approximately 50,000 patients. Effective measures would not only save lives and improve patient welfare but would eliminate enormous healthcare expenditures. The way to reduce malpractice costs, direct and indirect, is to reduce malpractice. PMID- 10132011 TI - The impact of healthcare reform: finding the new opportunities for private medicine. PMID- 10132012 TI - Reimbursement & revenue coding. PMID- 10132013 TI - Rural hospitals: challenges & opportunities. PMID- 10132014 TI - Telemedicine as virtual hospital: fiber optics roadways for medical care. AB - Fiber optics--pulses of brilliant light flashing through glass highways--are transforming the medical world by merging diagnostic radiology and communication technologies. We are moving into a technological age when nearly instantaneous transmission of large blocks of information will soon make live, long distance medical consultations commonplace. One of the best applications for that speed and capacity of information transfer is radiographic data, including images, exams, data and teleconsulting. PMID- 10132015 TI - The importance of educational standards in getting the most out of your ultrasound equipment. PMID- 10132016 TI - Marketing strategies. Part 4: Payers. PMID- 10132017 TI - Selecting the best to be the best: how to gain a competitive edge for your organization, Part II. AB - This is the second part of a two-part article on finding and hiring the best employees for your organization. Part I discussed costs of poor hiring, benefits of good hiring, elements of an effective hiring process, the job description, hiring from within versus outside the organization, the job application, resume screening, telephone screening, and salary considerations. Part II will discuss the selection interview, legal issues in hiring, and the orientation process. PMID- 10132018 TI - Uninvited intervention in a patient rights issue. PMID- 10132019 TI - Managed care. AB - Many say 1994 will be the year for health-care reform, but those in the thick of the current health delivery system know that 1993 has already brought many sweeping reforms. These reforms will be studied, refined, and tailored for the national plan. What types of reforms are laboratorians seeing now? What kinds of changes can we expect in the upcoming months and years? We asked laboratory managers those very questions. The result has been a two-part As We See It. In the last CLMR, we covered physician partnerships and the system laboratory. In this issue, we will cover alliances with hospitals and laboratory cost reductions as we ask: What can the laboratory community expect from a managed-care environment. PMID- 10132020 TI - The measurement mandate: report card day is coming. PMID- 10132021 TI - Writing a proposal for determining patient decisional capacity. PMID- 10132022 TI - An assessment of a formal ethics committee consultation process. PMID- 10132023 TI - The HEC and conflicts of interest in the health care environment. PMID- 10132024 TI - The ethics committee: providing education for itself and others. PMID- 10132025 TI - A bioethics fellowship: training the HEC leaders of tomorrow. PMID- 10132026 TI - Grappling with ethical issues in solid organ transplantation cases. PMID- 10132027 TI - Healthcare ethics committees, dialysis, and decisionmaking. PMID- 10132028 TI - Guidelines for patient refusal of life-sustaining treatment. Cleveland Clinic Foundation. PMID- 10132029 TI - Report on OSHA's 1993 activities in the healthcare arena. PMID- 10132030 TI - OSHA issues HAZWOPER (Hazardous Waste Operations and Response) instructions. PMID- 10132031 TI - Pulse oximetry sensor recycling cuts Utah hospital's costs. AB - A Utah hospital has cut some of its costs with a reprocessing program for disposable pulse oximetry probes. The hospital expects to save up to $120,000 annually. Some hospitals may already reuse disposable devices, but they could better manage reuse by developing written policies and procedures, the hospital says. PMID- 10132032 TI - ProPac's study of Medicare per capita expenditures. PMID- 10132033 TI - New ventures and target profits. PMID- 10132034 TI - American Health Information Management Association. Position statement. Issue: clinical practice guidelines and critical paths--roles of HIM professionals. AB - With the advent of managed care and healthcare reform, clinical practice guidelines and critical paths have become important tools in the delivery of high quality, cost-effective healthcare. Their use results in better communication and collaboration among caregivers, more efficient use of resources, and more consistent patient care. Health information management (HIM) professionals support these efforts through the provision of information needed to develop sound, workable critical paths that incorporate recommendations from clinical practice guidelines. With their expertise in health information systems and quality management, HIM professionals should serve as key members of the multidisciplinary teams that develop, implement, and refine these tools. PMID- 10132035 TI - American Health Information Management Association. Position statement. Issue: managing health information relating to infection with the human immunodeficiency virus (HIV). PMID- 10132036 TI - Congress considers healthcare reform proposals. PMID- 10132037 TI - Contemporary issues in HIM. Software engineering--what does it mean to you? AB - There have been significant advances in the way we develop software in the last two decades. Many companies are using the new process oriented approach to software development. Companies that use the new techniques and tools have reported improvements in both productivity and quality, but there are still companies developing software the way we did 30 years ago. If you saw the movie Jurassic Park, you saw the perfect way not to develop software. The programmer in the movie was the only person who knew the details of the system. No processes were followed, and there was no documentation. This was an absolutely perfect prescription for failure. Some of you are probably familiar with the term hacker which describes a person who spends hours sitting at a terminal hacking out code. Hackers have created some outstanding software products, but with today's complex systems, most companies are trying to get away from their dependence on hackers. They are instead turning to the process-oriented approach. When selecting software vendors, don't just look at the functionality of a product. Try to determine how the vendor develops software, and determine if you are dealing with hackers or a process-driven company. In the long run, you should get better, more reliable products from the latter. PMID- 10132038 TI - Health information management professionals in demand. PMID- 10132039 TI - Implementation of voice recognition technology at Provenant Health Partners. PMID- 10132040 TI - The new role of transcription systems in the computer-based patient record. PMID- 10132041 TI - Negotiating healthcare systems contracts: strategies for success. PMID- 10132042 TI - Clinical practice guidelines and critical paths--roadmaps to quality, cost effective care (Part II). PMID- 10132044 TI - HIM survey spotlights diverse group with common concerns. PMID- 10132043 TI - No consensus on E codes. PMID- 10132045 TI - Community health networks: a health information management solution and a technical solution. PMID- 10132046 TI - The promise of birth centres. AB - The authors argue that birth centres provide quality maternity care to healthy childbearing families at a lower cost than traditional hospital-based obstetrical services. They review the findings of two studies relating to birth centres in British Columbia: a survey of interest in birth centres among women of childbearing age and a survey of providers' opinions about possible features of a birth centre. Forces for and against the implementation of birth centres across Canada are identified. PMID- 10132047 TI - In search of balance in continuing care. Interview by Matthew D. Pavelich. PMID- 10132048 TI - Streetproofing people and property: security upgrades at the Hospital for Sick Children. AB - Following a recent building program at Toronto's Hospital for Sick Children, a number of security upgrades were implemented both inside and outside of the hospital complex. Drawing on technology to ensure the safety of its patients, staff, visitors and property, the hospital's new security system includes pull stations, closed-circuit cameras, door access control and individual signalling devices. PMID- 10132049 TI - Hospital security: from role statement to standards. PMID- 10132050 TI - Board evaluation and effectiveness: models, components and perspectives. AB - Health facility boards are being challenged to increase their effectiveness in the face of the changing health care environment. To this end, accreditation standards require boards to develop methods of evaluating their governing function and performance. During a survey of governance issues, the authors interviewed a group of health service executives with respect to board evaluation at their facilities. The responses yielded insights relating to models and components of evaluation, board missions and policies, mentoring programs and trustee education and orientation. PMID- 10132051 TI - Mentoring: it's for women, too. PMID- 10132052 TI - Breast-feeding: are hospitals encouraging new mothers to reach for the bottle? PMID- 10132053 TI - New mothers try out non-selective menu. PMID- 10132054 TI - How much do we really know about workplace sexual harassment? PMID- 10132055 TI - The Oak Tree Centre: initiatives for HIV-infected women, children, youth and families. AB - The Oak Tree Centre (Women and Family HIV Care Project) is designed to address the needs of women, youth, children and families affected by HIV infection in British Columbia. It is a conjoint project of the Women's Health Centre and British Columbia's Children's Hospital. Community involvement and the participation of individuals living with HIV infection continue to be vital components of the project. The ultimate goal is to enhance clinical and psychosocial care, and education, research and prevention initiatives for HIV infected women, youth, children and families in British Columbia. PMID- 10132056 TI - Closing the door. AB - States no longer can afford to provide illegal immigrants with the health care and education federal law says they deserve. PMID- 10132057 TI - Point of view: documenting results is the key. AB - The technology is currently available to collect data from many sources. The challenge is to use these data to demonstrate that health care can be accessible, cost effective, and high quality--all at the same time. PMID- 10132058 TI - Information management. PMID- 10132059 TI - Point of view: documentation of quality should be simplified. PMID- 10132060 TI - First Chicago's integrated health data management computer system. PMID- 10132061 TI - Managed information: managed care's last best chance? PMID- 10132062 TI - Health data analysis and reporting: organization and system strategies. PMID- 10132063 TI - Information and decision support in managed care. AB - Employers are increasingly purchasing health care benefits based on value, as it relates to both current and future needs, and they are seeking managed care partners who are committed to continuous quality improvement. They realize that meaningful health care information provides an essential foundation to support the development and implementation of future strategies, rather than allowing change to occur by chance. The success of a managed care strategy depends on the employer's ability to monitor plan performance routinely and target opportunities for improvement; the managed care organization's commitment to maintain cost effective, quality-conscious provider networks; and the providers' willingness to change their practice patterns to improve quality and outcomes. PMID- 10132064 TI - Is health care reform a software problem? PMID- 10132065 TI - Where are the data? AB - As benefit plan managers approach the problems of health care cost in a more businesslike manner, the need for accurate, timely, and complete information will increase dramatically. Those data needs should encourage every plan administrator to assure that the requisite quantity and quality of data are being collected and made available. In the future, it will be considered a dereliction of duty to stop there without assuring that the data are being studied and used to better manage the plan. The absence of such decision support virtually guarantees waste of plan assets. PMID- 10132066 TI - The digital hostage takers' syndrome: reflections on the computer-based patient record. PMID- 10132067 TI - Physician office-based information systems for managed care plans. AB - Three problems must be overcome before an ideal information system can be implemented. First, such setups are costly. For a group of 7 to 10 physicians, the price will be upwards of $100,000. Physicians must therefore weigh this cost against the direct economic benefit of personnel savings and the indirect benefit of enhanced information accuracy. Second, the culture of the organization must be assessed and found to be supportive before implementing any of these recommendations. If the information system is to function optimally, physicians must be willing to participate in the data entry. Some entry functions are no more onerous than filling out a superbill. Other tasks, such as completion of referrals, may require use of a keyboard--an activity that is foreign and distasteful to many practitioners. It is axiomatic, but necessary, to state that if the physicians will not use the system, it should not be purchased. Third, most sophisticated businesses have an administrator who understands the structure of information flows and the functions of the data system. The system described here requires the attention of such a person, who will manage the information and troubleshoot problems. If a group is small, the administrator may be able to accomplish this task; if it is large, the function may need to be assigned to a full-time manager with backup support staff. Three future developments may mitigate these problems. First, with increasing competition among hardware and software vendors, the price of these systems may decrease to a more affordable level. For the setup described, however, such pricing may be several years away.(ABSTRACT TRUNCATED AT 250 WORDS) PMID- 10132068 TI - Assessing the financial performance of health maintenance organizations: tools and techniques. PMID- 10132069 TI - Vermont's landmark health reform law: combining organized systems of care with global budgeting. PMID- 10132070 TI - VIP interview: Richard Averill and Michael Jay Kalison. PMID- 10132071 TI - Why clinical research needs medical audit. PMID- 10132072 TI - Selection for oesophagectomy and postoperative outcome in a defined population. AB - OBJECTIVE: To measure the extent of use of, and perioperative mortality from, oesophagectomy for carcinoma of the oesophagus, and to examine the association between oesophagectomy and long term survival. DESIGN: Retrospective cohort study of cases of oesophageal carcinoma notified to the Thames Cancer Registry. SETTING: South East Thames and South West Thames health regions. PATIENTS: 3273 patients first registered with carcinoma of the oesophagus during 1985-9, 789 of whom were excluded because of incomplete data, leaving 2484 (75.9%) for further analysis. MAIN MEASURES: Treatment of oesophagectomy, mortality within 30 days of oesophagectomy, and duration of survival from date of diagnosis to death, according to patient and tumour characteristics. RESULTS: Oesophagectomy was performed in 571(23.0%) patients. Its use decreased with increasing age (odds ratio (95% confidence interval) 0.935(0.925 to 0.944) per year) and was less common for tumours of the middle or upper third of the oesophagus than the lower third (0.56(0.42 to 0.75)). The proportion of patients undergoing oesophagectomy varied threefold among the 28 districts of residence. The perioperative mortality rate was 15.1(86/571) (12% to 18%); it increased with age (odds ratio 1.05(1.02 to 1.08) per year) and for tumours of the middle or upper third of the oesophagus compared with the lower third (2.52(1.31 to 4.84)). Long term survival was slightly higher for patients undergoing oesophagectomy (0.5% v 0.2%). CONCLUSIONS: Despite a high perioperative mortality rate patients selected for oesophagectomy showed better long term survival than those who were not, suggesting that clinical judgements used in selection were independent markers of a better prognosis. The nature of this selection needs to be more completely characterised to permit a valid evaluation of outcome of oesophagectomy. PMID- 10132073 TI - Safe working practices and HIV infection: knowledge, attitudes, perception of risk, and policy in hospital. AB - OBJECTIVES--To assess the knowledge, attitudes, and perceptions of risk of occupational HIV transmission in hospital in relation to existing guidelines. DESIGN--Cross sectional anonymous questionnaire survey of all occupational groups. SETTING--One large inner city teaching hospital. SUBJECTS--All 1530 staff working in the hospital in October 1991 and 22 managers. MAIN MEASURES--Knowledge of safe working practices and hospital guidelines; attitudes towards patients with AIDS; perception of risk of occupational transmission of HIV; availability of guidelines. RESULTS--The response rate in the questionnaire survey was 63% (958/1530). Although staff across all occupational groups knew of the potential risk of infection from needlestick injury (98%, 904/922), significantly more non clinical staff (ambulance, catering, and domestic staff) than clinical staff (doctors, nurses, and paramedics) thought HIV could be transmitted by giving blood (38%, 153/404 v 12%, 40/346; chi 2 = 66.1 p < 0.001); one in ten clinical staff believed this. Except for midwives, half of staff in most occupational groups and 19% (17/91) of doctors and 22% (28/125) of nurses thought gloves should be worn in all contacts with people with AIDS. Most staff (62%, 593/958), including 38% (36/94) of doctors and 52% (67/128) of nurses thought patients should be routinely tested on admission, 17% of doctors and 19% of nurses thought they should be isolated in hospital. One in three staff perceived themselves at risk of HIV. Midwives, nurses, and theatre technicians were most aware of guidelines for safe working compared with only half of doctors, ambulance, and paramedical staff and no incinerator staff. CONCLUSIONS--Policy guidelines for safe working practices for patients with HIV infection and AIDS need to be disseminated across all occupational groups to reduce negative staff attitudes, improve knowledge of occupational transmission, establish an appropriate perception of risk, and create a supportive and caring hospital environment for people with HIV. IMPLICATIONS--Managers need to disseminate policy guidelines and information to all staff on an ongoing basis. PMID- 10132074 TI - An audit of distribution and use of guidelines for management of head injury. AB - Ensuring effective distribution of guidelines is an important step towards their implementation. To examine the effectiveness of dissemination of a guidelines card on management of head injury and determine its usefulness to senior house officers (SHOs), a questionnaire survey was performed in May 1990, after distribution of the cards in induction packs for new doctors and at postgraduate lectures and displaying the guidelines in accident and emergency departments and wards. A further survey, in March 1992, assessed the impact of modifying the distribution. All (175) SHOs working in general surgery, accident and emergency medicine, orthopaedics, and neurosciences on 1 February 1990 in 19 hospitals including two neurosurgical units in Northern region were sent self completion questionnaires about awareness, receipt, use, and perceived usefulness of the guidelines. 131 of 163(80%) SHOs in post responded (median response from hospitals 83% (range 50%-100%)). Over three quarters (103, 79%) of SHOs were aware of the guidelines and 82(63%) had ever possessed a guidelines card. Only 36(44%) acquired the card in the induction pack. 92%(98/107) found them useful and 81% (89/110) referred to them to some extent. Owning and carrying the card and referring to guidelines were associated with departmental encouragement to use the guidelines. Increasing the displays of guidelines in wards and departments and the supply of cards to consultants in accident and emergency medicine as a result of this survey did not increase the number of SHOs who received cards (52/83, 63%), but more (71/83, 86%) were aware of the guidelines. The guidelines were welcomed by SHOs and used in treating patients with head injury, but their distribution requires improvement. Increased use of the guidelines may be achieved by introducing other distribution methods and as a result of encouragement by senior staff. PMID- 10132075 TI - Improving quality of drug use through hospital directorates. PMID- 10132076 TI - Assessing introduction of spinal anaesthesia for obstetric procedures. AB - To assess the impact of introducing spinal anaesthesia for obstetric operative procedures on use of general anaesthesia and quality of regional anaesthesia in a unit with an established epidural service a retrospective analysis of routinely collected data on method of anaesthesia, efficacy, and complications was carried out. Data were collected from 1988 to 1991 on 1670 obstetric patients requiring an operative procedure. The introduction of spinal anaesthesia in 1989 significantly reduced the proportion of operative procedures performed under general anaesthesia, from 60% (234/390) in 1988 to 30% (124/414) in 1991. The decrease was most pronounced for manual removal of the placenta (88%, 48/55 v 9%, 3/34) and emergency caesarean section (67%, 129/193) v 38%, 87/229). Epidural anaesthesia decreased in use most significantly for elective caesarean section (65%, 77/118 v 3% 3/113; x2=139, p<0.0001). The incidence of severe pain and need for conversion to general anaesthesia was significantly less with spinal anaesthesia (0%, 0/207 v 3%, 5/156; p<0.05). Hypotension was not a problem, and the incidence of headache after spinal anaesthetic decreased over the period studied. Introducing spinal anaesthesia therefore reduced the need for general anaesthesia and improved the quality of regional anaesthesia. PMID- 10132078 TI - Avedis Donabedian: an interview. Interview by Richard Baker. PMID- 10132077 TI - Improving quality of health care: the role of public health medicine. PMID- 10132079 TI - Missing link in the audit cycle. PMID- 10132080 TI - The outcomes agenda: contribution of the UK clearing house on health outcomes. PMID- 10132081 TI - Towards measurement of outcome for patients with varicose veins. AB - OBJECTIVE: To develop a valid and reliable outcome measure for patients with varicose veins. DESIGN: Postal questionnaire survey of patients with varicose veins. SETTING: Surgical outpatient departments and training general practices in Grampian region. SUBJECTS: 373 patients, 287 of whom had just been referred to hospital for their varicose veins and 86 who had just consulted a general practitioner for this condition and, for comparison, a random sample of 900 members of the general population. MAIN MEASURES: Content validity, internal consistency, and criterion validity. RESULTS: 281(76%) patients (mean age 45.8; 76% female) and 542(60%) of the general population (mean age 47.9; 54% female) responded. The questionnaire had good internal consistency as measured by item total correlations. Factor analysis identified four important health factors: pain and dysfunction, cosmetic appearance, extent of varicosity and complications. The validity of the questionnaire was demonstrated by a high correlation with the SF-36 health profile, which is a general measure of patients' health. The perceived health of patients with varicose veins, as measured by the SF-36, was significantly lower than that of the sample of the general population adjusted for age and a lower proportion of women. CONCLUSION: A clinically derived questionnaire can provide a valid and reliable tool to assess the perceived health of patients with varicose veins. IMPLICATIONS: The questionnaire may be used to justify surgical treatment of varicose veins. PMID- 10132082 TI - Purchasing care for people with HIV infection and AIDS. PMID- 10132083 TI - Managing depression in primary care. PMID- 10132084 TI - View from Germany. PMID- 10132085 TI - Who will get the best health care? PMID- 10132086 TI - Ensuring equal medicine: a view from one woman in congress. PMID- 10132087 TI - Learning to treat women patients: practical advice for internists. PMID- 10132088 TI - Can the AMA bridge the gap between the specialties?. Interview by C. Burns Roehrig. PMID- 10132089 TI - Reform and bureaucracy: getting beyond the rhetoric. PMID- 10132090 TI - Where is competition taking us? PMID- 10132091 TI - The circus that is our malpractice system. PMID- 10132092 TI - Without a point-of-service mandate, the promise of 'choice' is a sham. American Society of Internal Medicine. PMID- 10132093 TI - The proposed health alliances. American Society of Internal Medicine. PMID- 10132094 TI - Women's health care: is American medicine failing on many fronts? PMID- 10132096 TI - Leadership and moral purpose. AB - Max O. De Pree is Chair of the Board of Directors of Herman Miller, Inc., Zeeland, Michigan. The following Leon I. Gintzig Commemorative Lecture was delivered at the American College of Healthcare Executives Congress on Administration in March 1993. Portions of this address were previously delivered as the Distinguished Executive Lecture at Purdue University, 21 August 1992. Interested readers are encouraged to read De Pree's books, Leadership Is an Art (1989) and Leadership Jazz (1992). PMID- 10132095 TI - Improving the financial viability of primary care health centers. AB - This article presents findings from a national demonstration program to improve the long-term financial viability of small not-for-profit primary care health centers. The program initiatives and their implementation are described in some detail. A standard pre/post study design was used to measure the impact of the initiatives on general outcome measures, financial ratios, and the utilization of management techniques. Overall, demonstration centers showed improvement over the study period. Notable short-term improvements included significant growth in the volume of patient visits and increased profit. Observed changes also revealed an increased use of sophisticated management techniques, expected to positively affect longer-term financial health. The findings suggest that improving the financial viability of health centers need not be expensive. PMID- 10132097 TI - Selecting international markets: lessons from for-profit hospitals. AB - As growth potential in the U.S. market declines and regulatory constraints increase, providers of health-related services may look increasingly to international opportunities as a way to supplement the lost domestic market. In this article, critical factors bearing on the decision to compete in international markets are identified. Existing theories of multinational competition are expanded to provide a framework for analyzing international competition. Applied in the context of the proprietary hospital industry, the critical factors governing both the selection of foreign markets and mode of entry are proposed to be host country receptivity and market growth potential. PMID- 10132098 TI - Hospital markups: responses to environmental pressures in Pennsylvania. AB - The practice of cost shifting has stirred interest in hospital pricing policy. This study examined the determinants of the markup ratio, a summary measure of the hospital's pricing policy, in Pennsylvania acute care hospitals. The results indicate that severity of illness and the proportion of revenue earned from Medicare and Medicaid were the most important factors influencing markups. Other significant factors included extensive teaching activities and county per capita income. PMID- 10132099 TI - Recruiting and employing foreign nurse graduates in a large public hospital system. AB - Recruiting foreign nurse graduates (FNGs) is one way hospitals--particularly those in the nation's inner cities--are responding to the periodic and cyclic shortages that characterize the labor market for registered nurses. Until now, little was known about the overall efficacy of this strategy. This article reports the findings of an 18-month study of the recruitment and employment of FNGs by the New York City Health and Hospitals Corporation. Although considerably more expensive to recruit than domestic nurses, FNGs have higher retention rates than U.S.-educated nurses and possess other characteristics that make them desirable recruits for hospitals experiencing a nursing shortage. PMID- 10132100 TI - Capitalizing on the recession's effect on hospital RN shortages. AB - The recent economic recession and slow-paced recovery have contributed to dampening out the shortage of hospital-employed registered nurses (RNs), a shortage that has persisted since the mid-1980s. While national unemployment rates remain relatively high and continue to exert economic pressure on RNs to maintain high levels of employment activity, hospital and nurse executives now have an opportunity to make strategic investments in the organizational infrastructure supporting nursing because once the economy rebounds, RN shortages could easily resurface. PMID- 10132101 TI - Innovation and restrictive conformity among hospital employees: individual outcomes and organizational considerations. AB - Two factors characterize innovative organizational climates as perceived by nonmanagerial hospital employees. The first, innovation, comprises perceptions about the consequences or contingencies (e.g., punished, ignored, rewarded) of such proactive activities as implementing new ideas, questioning established methods, and communicating with other departments and the supervisor. The second, restrictive conformity, comprises perceptions about the consequences of risk aversive, conflict-avoidant activities that suggest dysfunctional conformity (e.g., "sticking to the rules no matter what"). Positive personal outcomes- greater role clarity, organizational involvement, and satisfaction, and lower role conflict and willingness to leave the organization--are associated with innovation; negative personal outcomes are associated with restrictive conformity. The dialectical tension between conformity and innovation is discussed in terms of loose coupling and a reward systems perspective. PMID- 10132102 TI - The integrated inpatient management model's clinical management information system. AB - The rising cost of health care has increased the call for cost control. The pressing need to control cost, coupled with the increase in managed care and prospective payment, has placed new urgency on administrators and clinicians to work collaboratively in providing efficient and effective care. We have developed the Integrated Inpatient Management Model (IIMM) to assist in this collaborative effort. We describe the IIMM's clinical information system that provides decision support to both administrators and clinicians. This clinical information system is the information backbone for the development and monitoring of practice guidelines or critical pathways. An integrated information system of this type is essential if hospitals are to prosper during the next decade. PMID- 10132103 TI - Determinants of hospital-based substance abuse treatment programs. AB - Experts agree that treatment is the best solution to substance abuse problems. As the societywide problem of drug and alcohol dependence increases, so does the need for treatment programs. Research has shown that many hospitals have entered into the substance abuse treatment program business because a need for quality programs exists and because an alcohol and a substance abuse treatment product line has the potential for increasing sagging revenues. This article addresses the question of what types of hospitals are likely to engage in providing inpatient and/or outpatient treatment programs. The results indicate that organizational size (measured by the number of beds) is the best predictor of treatment service provision for both inpatient and outpatient settings, with larger hospitals being more likely to provide substance abuse programs. A need for additional chemical dependency treatment programs does not appear to be the primary motivating factor for hospitals developing this service. Rather, it seems hospitals provide these programs for other reasons--as part of providing a full array of services, as an average toward achieving organizational goals, as a means of sustaining a competitive advantage, or as a strategy for maintaining the same level of service as the competition. PMID- 10132104 TI - Generic drug prices rose 3.4% in '93. PMID- 10132105 TI - Emergency department non-salary expenses. PMID- 10132106 TI - Congress and healthcare reform: divisions and alliances. PMID- 10132107 TI - Integrated delivery networks. The partnering process. PMID- 10132108 TI - The power of mission. PMID- 10132109 TI - Workplace diversity: a leadership challenge. Managing diversity is a social, financial, and moral imperative. AB - Fostering workplace diversity is about building an organizational culture that embraces personal differences and encourages heterogeneous persons to work together toward a common end. Setting in motion the transition to a more inclusive and productive workplace is an uncommon challenge and the primary responsibility of leaders, especially in Catholic healthcare. The origins of diversity can be found in creation itself. Not only are we united as a people of God and as members of the body of Christ, we are bound together through our shared humanity. Three values are especially relevant to promoting diversity in the workplace: respect for human dignity, the common good, and distributive justice as participation in the common good. Economic incentives strengthen the theological and moral motives for developing a diverse work force. Organizations' financial success will depend ultimately on how well diversity is integrated into the organizational culture. As a process, managing diversity enables healthcare leaders to discover new ways to develop the potential of all employees and at the same time improve performance and production. At the heart of managing diversity lies the reform of internal systems, structures, and processes. Managing diversity also requires the transformation of the organization's culture. Initiatives that are useful for setting a positive future course include conducting a cultural audit, establishing a cultural diversity task force, and putting in place a diversity "champion" who is accountable directly to the chief executive officer. PMID- 10132110 TI - Mission in a time of transition. Mission leaders' unique skills can help CEOs prepare their organizations for integrated delivery. AB - To get a perspective on how the mission role has evolved over the past few years, the Catholic Health Association surveyed a sample of mission leaders at Catholic acute care facilities throughout the United States. Most respondents (86 percent) were women religious, and the majority had advanced degrees in some area of religious studies. They indicated that an ideal education for a mission leader would include preparation in theology, ethics, or spirituality, as well as business or healthcare administration. The majority of mission leaders answering the survey ranked themselves high in their ability to influence their organization's chief executive officer. They consistently identified their key role as integrating values and mission into the daily life of the organization. The majority of respondents (95 percent) said they were responsible for mission in acute care. Other important areas of responsibility included home care, hospice, long-term care, and outpatient care. Most respondents reported extensive involvement with the ethics function at their facilities, and they also had an active and vital role in continuous quality improvement efforts. Mission leaders felt their skills uniquely qualify them to assist organizations making the transition to integrated delivery. Their experience in collaboration, communication, and team building can be crucially important as organizations adjust to the demands of a new delivery system. PMID- 10132111 TI - A response to euthanasia initiatives. AB - The outcome of the physician-assisted suicide and euthanasia debate will profoundly influence physicians' role in society, the kind of society we become, and the way physicians and patients relate to one another. Three forces account for the move to physician-assisted suicide and euthanasia: an abuse of scientific advancement, a new political philosophy, and the erosion of religious consensus. The relationship between patients and physicians has often been understood as a convenant with rights on patients' part and duties on physicians' part. Physicians' duties in this covenantal relationship are to act for patients' good (a positive duty) and to do no harm (a negative duty). Euthanasia and assisted suicide are morally wrong because, as the Judeo-Christian ethic teaches, human beings are creatures of God and have only stewardship, not dominion, over life. But in our pluralistic society, which seems to lack consensus on religion, on communal responsibility, and on common values, one cannot argue against mercy killing and assisted suicide on theological grounds. Our society generally agrees, however, that a discussion of values may take place in the language of moral philosophy, a language that expresses right reason. PMID- 10132112 TI - Futility, autonomy, and informed consent. AB - If clinicians deem a treatment medically futile, is it appropriate to mention such a treatment to patients? Do healthcare professionals violate informed consent if they do not offer patients an opportunity to decline futile treatments? The notion of futility involves an assessment of patient best interest--both short-term and long-term therapeutic benefit for a patient and the community in which he or she intends to survive and flourish. Although survival interests may be construed as long term, a treatment that offers survival without any promise of flourishing is not the goal of medicine and is futile. Flourishing requires some cognitive and affective function. The goal of informed consent practices is to ensure that patients accept the benefits of treatment with cognizance of the burdens and risks. Given the impact of illness on the emotional and psychological states of patients and their families and their resultant vulnerability, the omission of futile options from treatment plans is logical and exemplifies the best of paternalistic behavior. The claim that requests for futile treatment must be honored is based on a perverse understanding of patient autonomy. Rational medicine demands that patients' requests be reasonable from a clinical perspective, as well as from a subjective one. The practice of informed consent can be implemented as a balance between these two interests. PMID- 10132113 TI - Conscientious objections to reform. PMID- 10132114 TI - Changing the way we care for the dying. AB - Systemic healthcare reform provides an opportunity to make care of the dying more humane, less technology based. Dying persons should neither be ignored when technologies prove futile nor be handed over too hastily to professional and institutional care. Perhaps dying should be reclaimed and, where possible, taken back into the home, family, and community. Caring appropriately for dying persons is made difficult today by a number of factors. Americans' death-denying attitudes drive much of what healthcare professionals do in both acute and long term care settings. Frequently, the emphasis is on curative and rescue interventions to the neglect of all else. Finally, the U.S. family has become increasingly unable or unwilling to care for a dying family member at home. The potential for significant reform of the healthcare system may change the way care is rendered to dying persons. Catholic healthcare providers should be leaders in reshaping the way dying persons are cared for. First, ethics committees should formulate, promulgate, and implement policies delineating the appropriate use of life-sustaining interventions. Second, long-term care givers need to overcome the troubling tendency to transfer dying persons to acute care facilities when death is imminent. Third, hospice services should be available and their use encouraged. Finally, representatives from Catholic healthcare should work with parishes to encourage the faith community to share in the responsibility of providing home care for dying persons. PMID- 10132115 TI - The genetic revolution: force behind a more ethical healthcare system?. Interview by Judy Cassidy. PMID- 10132116 TI - Conflicts of interest in fund development. PMID- 10132117 TI - A new vision for trustees. PMID- 10132119 TI - Key provisions of the major healthcare bills. PMID- 10132118 TI - Mission statements: politically correct or countercultural? PMID- 10132120 TI - Restoring intimacy to the physician-patient relationship. PMID- 10132121 TI - Working the truth and perfecting the moment for physicians and patients: a serious challenge for information systems. AB - Most of us can remember the crowning sense of elegance we occasionally felt when we solved a very difficult geometry problem. We linked the proof to the postulates. It was almost like calling on history or the elders to stand silently with us in the flurry of our moment. We "worked truth." I'd like to capture a little of that same "working truth" and apply it in a very unlikely spot: information systems and information technology. It is time to go back and look at the basic postulates of knowledge and responsibility and truthfully apply them in the health care interchange between doctor and patient and make sure that our systems add to and even create an elegance so that the basic relationship of physician and patient in healing can flourish. PMID- 10132122 TI - Computer-based patient records: a building block for health care reform. AB - The fundamental need for better information management capabilities in health care is at risk of being overlooked in the proposals for major national changes aimed at providing health security, controlling costs, enhancing quality, and expanding access for citizens. In addition to these proposed macro changes (e.g., universal access, guaranteed benefit package, national health board, regional health alliances), successful reform will require transformation of health care delivery at the micro level. We must overcome provider-dependent variations in clinical practice patterns, in quality of performance, and in costs of services. We must ensure movement toward appropriate care rather than simple rationing. Individual health care professionals and institutions must acquire and use tools that will enable them to provide their services cost-effectively with consistent results. We must be able to assess and ensure value--i.e., appropriateness, effectiveness, and cost--of health services, apply that knowledge in each and every patient encounter, and track the impact of clinical decisions through an analysis of aggregated databases. PMID- 10132123 TI - Clinical information systems in the academic medical center. AB - Introducing new clinical information systems at an academic medical center presents unique challenges related to: Academic infrastructure. Diversity. Communication. The purpose of this article is to describe these special challenges and strategies used at the University of Michigan Medical Center (UMMC) in response. After numerous discussions with colleagues at other academic institutions, we believe that these challenges are remarkably similar at many if not most academic medical centers across the country. PMID- 10132124 TI - Health care organizational uses of information technology. AB - Let's say that, by having read the many inspiring articles on medical informatics in this issue of Physician Executive, you are now ready to move ahead with some serious applications of information systems in your organization. Or, you were already a believer in the usefulness of information technology (IT), and are wondering how to proceed. What types of systems should your organization be looking at to acquire or build? How should you get to there from here? Perhaps you'll find what you're looking for in what follows--an initial roadmap through organizational "IT Land." PMID- 10132125 TI - Preparing for managed competition. AB - Without the demands of managed competition or economic incentives to control costs, providers have little reason to invest in systematic data analysis about their patients. Information technologies in the hands of health care managers and physician executives primarily are tools for cost control, and, if cost control is not an important issue for them, they do not learn how to do it. The rules of the game have already changed for providers where managed care dominates the medical community and will change for the entire nation under managed competition. Managed competition gives providers strong incentives to identify the costs of care and unnecessary variations in those costs, to introduce new processes of care to reduce unnecessary administrative and clinical costs, to implement practice guidelines to reduce variations in outcomes of care, and to document statistics indicating excellent quality. PMID- 10132126 TI - The Republican task force health reform proposal: loyal opposition or bipartisan collaboration? AB - In the November-December issue of Physician Executive, Drs. Fickenscher and Kindig explored the major elements of the Clinton health reform initiative, the Health Security Act of 1993. Although the Clinton proposal represents one of the major health reform proposals presently before Congress, it is by no means the only proposal. Over the next several issues, this column will provide an overview of other major proposals pending before Congress that will receive serious consideration in the coming months. PMID- 10132127 TI - Joint antitrust enforcement policy: a first step, but questions remain. AB - The Department of Justice and the Federal Trade Commission have jointly issued statements of antitrust enforcement policy" in six health care areas. In addition, the agencies have committed themselves to responding to any request for more specific guidance in the six areas within 90 days. Although the conduct in the request must be proposed, not actual, the new expedited review period is nevertheless a potentially attractive option not previously available. PMID- 10132128 TI - Community rating--an approach that works. AB - How our current system works and what changes need to be made are the subjects of intense scrutiny by policy makers today. One of the primary areas of concern with our present health care system is its accessibility to the average American, in terms of both price and ability to obtain insurance. With an estimated 37 million Americans without health care insurance, and countless others severely underinsured, this issue will lie at the core of any health care reform that results from the current debate. One possible approach to the uninsured problem that might alleviate the situation is community rating. PMID- 10132129 TI - An integrated approach to home health care. PMID- 10132130 TI - The application of future technologies to medical informatics. AB - Physician: "Condyloma, Toxoplasmosis, Blepharoplasty, and Fibroadenoma." Technoguru: "Pardon?" Physician (referring to "PCDR, Physician's Computer Desk Reference): "Carrier Sense Multiple Access, Spread Spectrum, Application Programming Interface, and Clustered Indexes." Technoguru: "Oh, now you're talking! How many do you want?" Until such time as computer scientists holding degrees in medicine become de rigueur, there will inevitably be conversations such as these. A pediatrician friend once told me that he could teach me in 30 days what I would need to know to handle 95 percent of the cases he sees. To handle the other 5 percent would still require 8 years of postgraduate medical education. The corollary for the application of technology is that I can teach you how to use a personal computer, and even to do a little programming, but to build a robust, mission-critical system for a production health care environment, well, back to school you go. PMID- 10132131 TI - Are you ready for virtual organizations? AB - Success, and maybe even survival, in the future will go to those health care organizations that can respond to constant and rapid change in a timely fashion. And timely doesn't mean what it once did. Years and months may no longer be a satisfactory response time. Even weeks may not always do. Opportunities will have to be seized quickly, or they will disappear forever. One possible answer to the leaden nature of most bureaucratic, hierarchical organizations may be a new kid on the block--the virtual organization. Formed solely to work on a single opportunity, these organizations can be used to position the parent organizations for almost any conceivable change. PMID- 10132132 TI - Is the American health care delivery system ready for change? AB - In October 1992, the American College of Physician Executives sponsored a study tour to Berlin, Germany, and Amsterdam, Holland. Meetings were held with government officials, third-party payers, and providers, and on-site visits were made at hospitals, clinics, and academic centers. The purpose was to study the health care delivery system in those countries and to share some insights with the countries' hosts on the U.S. system. In a series of reports that began in the July issue of the journal, 5 of the 10 study tour participants describe their impressions of the tour and of the health care systems in the countries that were visited. In this final report, the implications of the German and Dutch systems for reform of the U.S. health care system are discussed. PMID- 10132133 TI - The role of organizational ethics committees. AB - Health care services are increasingly provided in an atmosphere that is fractured by conflicting ethical concerns. This trend had been most noticeable in institutional settings. In response, hospitals have for many years had ethics committees. Their purpose has been to guide providers, patients, and families when decisions with ethical implications have to be made. The shift in focus within the health care delivery system away from hospitals and more to managed care systems and to domination of decision making by primary care providers suggests that expansion of the ethics committee concept may be advisable. PMID- 10132134 TI - Information technology enters the doctor's office: Part II--Six lessons about intended ... and unintended ... results. AB - Part I of this article ("Six Design and Implementation Lessons," Physician Executive, Sept.-Oct. 1993, pp. 46-50) described an ambulatory utilization review (AUR) program designed and implemented by Metropolitan Life Insurance Company and reviewed some of the lessons learned over the past five years. Those lessons pertained to the tasks of inventing a new information technology to measure and evaluate ambulatory care and some of the practical implementation issues associated with review of 30,000 small dollar value claims per day in 19 claim offices nationwide. This article turns to the basic purpose of AUR--to review the medical necessity and appropriateness of ambulatory utilization. One lesson learned about AUR in this context is that AUR works: savings from the program outweigh costs by almost 5:1. The more important lessons, however, stem from understanding how the savings are achieved, and what some of the other unintended benefits of the program are. PMID- 10132135 TI - Medical resource allocation: rationing and ethical considerations--Part I. AB - The United States' system of high-quality but expensive and poorly distributed medical care is in trouble. Dramatic advances in medical knowledge and procedures, combined with soaring demands created by growing public awareness, the cost of private hospital and medical insurance, and Medicare and Medicaid, are burdening the medical care delivery systems. The costs of medical care have reached levels that can no longer be sustained. Government officials, insurance planners, labor leaders responsible for union health care benefits, and ordinary citizens are questioning whether it is acceptable to limit health care based on economic considerations. If health care is deemed a social good, the method of allocation must be addressed. Unless society decides that other priorities of the infrastructure are to be subjugated to health service delivery, difficult decisions will be forced upon us, consciously or by default. The discussion in this two-part article explores the ethical considerations of the more formalized approaches to resource allocation that presently exist in our society. PMID- 10132136 TI - Ounces of malpractice prevention. AB - The source of malpractice claims, contrary to widely held views, is not simply improper or inadequate medical care. In the majority of cases, malpractice litigation ensues because of negative nonclinical factors and the incidence of an unexpected result in medical treatment. High on the list of nonclinical causes are faults in the physician-patient relationship. Patients who are unhappy with the manner in which they have been treated by physicians are much more likely to sue when the outcome is even moderately untoward. Key to reducing the incidence of malpractice suits is helping physicians understand that attention has to be paid to their behavior. PMID- 10132137 TI - Defining the health care product to ensure quality and manage costs. AB - The frenzy of health care reform activity now led by the Clinton Administration's American Health Security Act of 1993 might end in the worst of all possible outcomes: a new government entitlement program financed by business and a global budget. Unbridled entitlement could drive utilization of benefits to the maximum and, with a budget cap, guarantee rationing. So far, the administration has talked about expanding access and controlling costs--not about the health care product. Given the threat that change poses for vested interests, time will undoubtedly lapse before final implementation of a new system. Unless physicians involved in health management seize the opportunity during this window of opportunity to help shape the future of health care delivery, the likelihood of preserving the U.S. health care delivery system as we know it will be dim indeed. PMID- 10132138 TI - Health of the foreign-born population: United States, 1989-90. AB - The health status of immigrants is of vital interest to health policy planners as the number of immigrants in the United States increases. This report has shown that, overall, foreign-born persons had better health than the U.S.-born population, although this health advantage varied by length of residence in the United States. In virtually every measure of health status, and with regard to almost every sociodemographic characteristic, the most recent immigrants were healthier than foreign-born persons who have lived in the United States 10 years or more as well as healthier than the U.S.-born population. Immigrants who had lived in the United States 10 years or longer were generally healthier than U.S. born adults, although the differences were not as striking as between recent immigrants and the native-born population. These findings may be explained in several ways. First, recent cohorts of immigrants may have been healthier than earlier cohorts of immigrants at the time of immigration. If so, as their duration of residence in the United States increases, they will continue to be significantly healthier than native-born persons. Second, earlier cohorts of immigrants may have been as healthy as recent cohorts at the time of immigration, but their health has deteriorated with increased duration of residence in the United States. This suggests that immigrants had or acquired physical conditions or behaviors that put them at risk in their new environment or that access to health care has been limited. It also suggests that more recent cohorts of immigrants could experience a similar deterioration of health as their duration of residence in the United States increases. Finally, these findings may reflect a combination of these influences or other factors not considered. To understand these patterns will require additional research, including comparative studies of the health of immigrants in the United States with the health of nonmigrants (stayers) in the countries of immigrant origin. PMID- 10132139 TI - Health reform insight. CBO's review of Clinton bill gives ammo to each side. PMID- 10132140 TI - Perspectives. The FY95 budget for HHS: tough medicine while waiting for the cure. PMID- 10132141 TI - Levels of accountability questioned in aid-in-suicide provisions. AB - Michigan backs off from condemning Kevorkian while second thoughts emerge on both sides of the Atlantic over the Netherlands' narrowly passed euthanasia bill. All in all, however, the physician is still seen as the only appropriate agent for assisted suicide, as the following articles point out. PMID- 10132142 TI - Respect and representation: the two crises for faith in medicine. PMID- 10132143 TI - Ethicists address various issues on the ethics of reform. AB - After a slow start at the gate, ethics seems to be gaining on other interest groups (financing, restructuring, etc.) in vying for attention in the race for health care reform. Although still far removed from the inside track, ethics may yet prove to be a dark horse capable of moving toward a more central presence, and of being an important contender in the final choice of a health reform program. PMID- 10132144 TI - Past radiation experiments may lead to new efforts for informed consent. PMID- 10132145 TI - Confusion reigns over purpose and process in bioethics education. PMID- 10132146 TI - Locus of the moral community gets new examination. AB - Ethics consultation, and indeed the whole field of bioethics, is built on the premise that everyone would benefit from the insights of others when facing ethical problems or issues. Who those others should be and how their insights should be shared is currently the focus of serious debate, as the following articles show. PMID- 10132147 TI - Forced intervention cases take different lines of argument. AB - Within a month's time Chicago courts heard two cases dealing with forcing procedures upon unwilling women. Although the outcomes of these cases were similar (refusal to legally force the procedures), the arguments used took different paths and considered different issues. PMID- 10132148 TI - Oral antibiotic usage in hospitalized patients. AB - With the introduction of the fluoroquinolones, oral antibiotic usage is becoming an increasingly important issue. The medical record of 119 patients receiving oral antibiotics at a university hospital were reviewed to examine demographics and patterns of usage. The population was predominantly female and below 50 years of age. Urinary tract infections were most common followed by infections of the respiratory tract and skin and skin structure. The majority of usage was empiric in nature. The most commonly prescribed antibiotics were trimethoprim/sulfamethoxazole, cephalexin, and ampicillin/amoxicillin. Monotherapy with an oral agent was observed in 82% of the cases. Intravenous antibiotics were administered prior to oral therapy in 61% of the patients studied. The authors observed a trend from combination intravenous therapy to single-agent oral therapy. Of the patients discharged on an oral antibiotic, 84% received a prescription for the agent originally prescribed for them in the hospital. Tracking of oral antibiotic inpatient use is effective at assessing major trends in usage. PMID- 10132149 TI - Patient-controlled analgesia in burn patients: a critical review of the literature and case report. AB - Although patient-controlled analgesia has been well documented as effective in various types of patients, it has not been adequately studied in burn patients. In this paper, the authors review the literature on PCA in burn patients and present two cases. Flaws in most published studies make it difficult to determine the efficacy of PCA in burn patients. Both the literature and experience indicate that many patients with acute burns are not suitable candidates for PCA. The cases illustrate the different methods patients may use to achieve adequate analgesia with PCA. Both patients and nurses face a steep learning curve in using PCA for management of procedural pain in burn care. PMID- 10132150 TI - The provision of pharmaceutical care in a Veterans' Affairs Medical Center outpatient HIV clinic. AB - Recognizing the unique needs and demands of HIV-infected patients, it was decided to implement pharmaceutical care in a VAMC outpatient HIV clinic. Services provided to the patients by the pharmacist include drug information, medication counseling with the help of educational handouts, and drug-related problem identification and resolution. The pharmacist also serves as a liaison between the patient and the VAMC outpatient pharmacy if conflicts arise. Services provided to the other members of the HIV clinic team include the provision of drug information and participation in clinical research. In addition, the HIV clinic provides a training site for pharmacy practice residents and Doctor of Pharmacy students on their ambulatory care rotation. PMID- 10132151 TI - Annual pharmaceutical manufacturers directory--1994. PMID- 10132152 TI - Pharmaceutical care plans. What does the Joint Commission require regarding pharmacy care plans? PMID- 10132153 TI - Freedom of choice. AB - This is the second in an occasional series of columns examining the ethics side of health-care reform. The first, "A Matter of Principle," appeared in the September/October 1992 issue. PMID- 10132154 TI - Telecognition for improving health. PMID- 10132155 TI - Possible futures, preferable futures. PMID- 10132156 TI - Railways of the nineties. AB - What killed the railways was that they were run by people who really liked choo choos. This also is the Achilles' heel of hospitals. They are run by people fascinated with big white buildings and all they contain. PMID- 10132157 TI - Designing healthy spaces. PMID- 10132158 TI - The new, glorious profession. Interview by Joe Flower. PMID- 10132159 TI - Scientific decisionmaking. PMID- 10132161 TI - The vision thing. PMID- 10132160 TI - In pursuit of integration. PMID- 10132162 TI - Contracting out in NZ: evolutionary or revolutionary? Lessons from the UK experience. AB - Despite the worldwide trend to Facilities Management Contracting and the documented improvements in organisational efficiency, the NZ health sector has yet to grasp the benefits of awarding a single contract to manage a comprehensive range of services. This appears contradictory for an industry which has considerable assets tied up in supporting its core business and is under huge pressure to reduce costs and improve service. NZ is therefore faced with two options: an "evolutionary" route which could take us over a decade to achieve the same benefits as they are currently enjoying in the UK NHS, or "revolutionary" route, taking a quantum leap forward, both in the way contracts are specified and the way services are structured and managed. In this article Sarah Meads, General Manager of Serco Health Services, takes a look at how New Zealand health providers could learn from the NHS experience of contracting out since the introduction of Compulsory Competitive Tendering in 1983. Serco Health Services is the division of Serco Group NZ Limited responsible for assisting healthcare providers to review and manage a wide range of non-core support services. It shares resource and expertise with similar divisions working with the NHS and health-care organisations in Hong Kong. PMID- 10132163 TI - To re-use or dispose: can safety be guaranteed? PMID- 10132164 TI - Study focus on health of unemployed teenagers. PMID- 10132165 TI - Managed primary health care: the key to the health reforms? PMID- 10132166 TI - A computerized method to monitor appropriateness of care. PMID- 10132167 TI - Using detailed billing data to develop critical paths. AB - In summary, billing data can provide valuable information that is key to critical path development. The data can easily be retrieved and analyzed without time consuming medical record review and will help focus development efforts on treatment patterns that can have the greatest impact on patient care. This impact will vary from hospital to hospital depending on the objectives of the critical path development and educate developers in the process. PMID- 10132168 TI - University Hospitals develop benchmarks for patient satisfaction. PMID- 10132169 TI - Perspectives. Swedes test capitalist waters in new health systems reform. PMID- 10132170 TI - Perspectives. America's teaching hospitals: descending the Ivory Tower. PMID- 10132171 TI - Perspectives. Home health care: what price security? PMID- 10132172 TI - Health reform insight. Ways & Means health panel moves reform debate forward. PMID- 10132173 TI - Perspectives. Reproductive rights: will the debate engulf reform? PMID- 10132174 TI - Partnerships against pain and poverty. Privatizing a public service. How the Peach Tree Clinic went from near closure to model health care program. PMID- 10132175 TI - A matriot's dream: health care for all. Art for social change. PMID- 10132176 TI - The health care solution: understanding the crisis and the cure. AB - Following is Part I of an excerpt from the soon-to-be released book, "The Health Care Solution: Understanding the Crisis and the Cure" by CAHHS CEO/President C. Duane Dauner. Dauner paves the road to reform in his book by providing a step-by step solution to ending the nation's health care crisis. PMID- 10132177 TI - The computer age comes to parenting. PMID- 10132178 TI - An unlikely pairing in Sacramento expands health partnership options. AB - An affiliation between Sacramento's Methodist Hospital and Mercy Healthcare Sacramento has industry-watchers talking about potential new health care relationships between religious and community-sponsored hospitals and health systems. PMID- 10132179 TI - The California model: do the state's existing health alliances work? AB - "Managed competition" has become synonymous with President Clinton's plan to control costs and expand medical care to all Americans. California's extensive experience in managed care will show the nation how the concept works in reality. PMID- 10132181 TI - California hospitals set public policy goals. California Association of Hospitals and Health Systems. PMID- 10132180 TI - Seven major health reform proposals before Congress. PMID- 10132183 TI - Howard's villa. Howard Hughes Medical Institute, Chevy Chase, MD. PMID- 10132182 TI - Partnerships against pain and poverty. Neighborhood project offers hope. PMID- 10132184 TI - Healthcare in the electronics age. PMID- 10132185 TI - Using regression analysis to determine variable costs. PMID- 10132186 TI - American Health Information Management Association. Position Statement. Issue: retention of health information. AB - Patient health information must be available to meet the needs of continued patient care, legal requirements, research, education, and other legitimate uses. While there are no federal laws currently that outline time frames for the retention of health information, many states do have specific requirements with which providers must comply. Each healthcare provider should develop a retention schedule for patient health information that meets the needs of its patients, physicians, researchers, and other legitimate users and complies with legal, regulatory, and accreditation requirements. Providers should develop guidelines that specify what information should be kept, the time period for which it should be kept, and the storage medium (paper, microfilm, optical disk, magnetic tape, or other). PMID- 10132187 TI - American Health Information Management Association. Position Statement Issue: core references for health information management professionals. PMID- 10132188 TI - Contemporary issues in HIM. Information highways and byways--the Internet. PMID- 10132189 TI - Creating spectacular special events. PMID- 10132190 TI - The transformation of education: electronic classrooms of the future. PMID- 10132191 TI - Transforming yourselves: pathways from medical records to health information management. PMID- 10132192 TI - Can medical transcription be taught in the classroom? AB - The results of the concentrated transcription program provided objective information that gives credibility to both sides of the transcriptionist training debate. In addition, the results provided the objective data needed to support changes in the curriculum. Students who are exposed to solid classroom teaching, coupled with enough opportunities to develop and practice transcription skills, have a better chance for success than those who rely solely on classroom instruction or solely on experience or on-the-job training. It is clear that increasing the number of hours of actual transcription results in an increase in the productivity and accuracy of the student's medical transcription. PMID- 10132193 TI - The Kuwait project: training Kuwaiti students in health information management at the University of Central Florida. PMID- 10132194 TI - Results of certification examination survey. PMID- 10132195 TI - StUdents + eduCators + Clinical supErviSorS = SUCCESS. PMID- 10132196 TI - Alternative options for earning continuing education credit. AB - The HIM professional has traditionally been a highly motivated self-starter and a good detective. Today, the profile of the average HIM professional is that of a well-educated person, eager to learn more, who recognizes the necessity of keeping his or her skills up-to-date, and who is willing to take advantage of nontraditional options to further personal and professional goals. All these attributes can be put to good use in developing whatever alternative educational methods are appropriate to the most independent of persons. PMID- 10132197 TI - An apples-to-apples comparison: standard units of work measure for medical transcription. PMID- 10132198 TI - Authorship: a status report. PMID- 10132199 TI - CCS (Certified Coding Specialist) examination--year 2 results. AB - Candidate performance on the 1993 CCS examination is very comparable with performance on the 1992 examination. While there was a slightly higher rate of passing on the 1993 examination, it is believed this is due to more potential candidates understanding the specialized nature of the examination and self evaluating their preparedness. Consistent results across time are important to demonstrate the reliability and validity of the certification program. AHIMA strongly supports the coding specialization, and believes it is important to maintain standards of excellence in order to have the CCS credential convey to the public the value of the coding skill it recognizes. PMID- 10132200 TI - Computer support for continuous quality improvement. AB - Continuous quality improvement (CQI) methodology is predicated on data-based decision making, using both statistical and nonstatistical data tools. The current generation of commercially available quality management computer software does not integrate the basic CQI tools. A variety of off-the-shelf programs can be used to supplement the resource needs of CQI methodology. PMID- 10132201 TI - Implementing total quality management and reshaping delivery systems in a community hospital. AB - In today's healthcare marketplace, leadership requires more than the delivery of technologically sophisticated patient care. Leadership can be accomplished only by an organization energized with a mission that focuses on providing high quality, technologically sophisticated, and cost-effective primary healthcare. The paradigm shift to total quality management at the authors' not-for-profit community hospital involved not only the adoption of the philosophy, tools, and techniques espoused by quality experts, but also a restructuring of the organization from a hierarchical format to one focused on the patient. PMID- 10132202 TI - Implementation of a managed care model in an acute care setting. AB - The center of attention in recent nursing literature has been on the evolution of outcome-based care. This concept has emerged as an array of models that includes patient-focused care, case management, and managed care. All these approaches to redesigning patient care have a basic goal: to deliver quality care in a timely manner by using appropriate resources. The program at St. Margaret Mercy Healthcare Centers focused on the staff nurse as the multidisciplinary team member who would be responsible for coordinating patient care. This type of model, in which the pathway is initiated at the staff level, is called managed care. Managed care, as defined by Zander, is unit-based care that is organized to achieve specific patient outcomes within fiscally responsible time frames or lengths of stay (LOS) while using resources that are appropriate in amount and sequence to the specific case type and to the individual patient (1988a). PMID- 10132203 TI - Recommendations for optimizing an infection control practitioner's effectiveness in an ambulatory care setting. AB - As the trend toward ambulatory care increases, the infection control practitioner's (ICP) role and responsibilities in this setting are continually expanding. Implementation of mandated governmental regulations, such as the Occupational Safety and Health Administration (OSHA) Bloodborne Pathogen Standard, has markedly increased the ICP's workload. Analysis reveals that much of the ICP's time is being spent on clerical tasks that encompass a variety of nonclinical functions. Clerical support would allow the ICP to use his or her time to implement essential components of an infection control program in the most cost-effective manner. PMID- 10132204 TI - Developing a proactive approach to medication error prevention. AB - Medication administration and the prevention of medication errors have been identified by quality management professionals and consumers alike as an area of healthcare that needs quality improvement. A proactive multi-disciplinary approach taken by nursing and pharmacy at the author's acute care teaching hospital has resulted in a significant improvement in the medication administration process and in reduced medication errors. Improved quality data management resulted in more effective action planning. The reporting format of medication errors was changed based on trends, and severity evaluation was implemented. System problems were more easily identified due to increased information about the medication errors. As a result, staff education and training could be more specific, and thus, more meaningful. Additionally, jointly developed quality management studies provided the foundation for effective improvement strategies and efficient system changes. PMID- 10132205 TI - Legislative forum: the proposed American Health Security Act quality initiative. PMID- 10132206 TI - Applying a systems perspective to quality improvement training. AB - Over the past decade, public and private healthcare organizations across the United States have been struggling to implement the principles of total quality management to improve service delivery and operating efficiency. Despite large investments in time and money, these organizations often are disappointed with the return on investment. This article argues that by failing to apply a systems perspective to organizational change efforts, well-intentioned executive staff members and training professionals unknowingly collaborate to ensure the failure of the quality initiative they hope will create a more effective and efficient organization. PMID- 10132207 TI - You can be prepared when JCAHO visits. AB - Preparations for Joint Commission on Accreditation of Healthcare Organizations (JCAHO) surveys are rarely described in the literature. This article is intended to provide much-needed information on survey preparation processes, not only to Department of Veterans Affairs medical centers, but also to all hospitals undergoing surveys of biopsychosocial delivery of care. Beginning in 1995, JCAHO will apply biopsychosocial reviews to all assessments of patients. Facilities whose preparations include those detailed in this article will be better prepared for such reviews. PMID- 10132208 TI - The Alliance/HPPC role in three federal reform proposals. Institute for Health Policy Solutions. PMID- 10132209 TI - Restructuring the total quality way--corporate quality leaders share their experiences. Interview by Lisa M. O'Rourke. AB - The pharmaceutical firm The Upjohn Company and the electronics giant and Malcolm Baldrige National Quality Award winner Westinghouse Electric Corporation have grappled with the challenge of keeping TQM on track during recent restructuring efforts. What these organizations have learned from the experience--as described here by Nicholas Andreatis, MD, Vice President of Upjohn's Corporate Quality Center, and Carl Arendt, Manager of Total Quality Services for Westinghouse's Productivity and Quality Center--can help healthcare organizations that are faced with the same challenges. PMID- 10132210 TI - Managing organizational change: the Symmes story. PMID- 10132211 TI - Major organizational change and quality: an emerging partnership. PMID- 10132212 TI - Evaluating a management recommendation to downsize: guidelines for leaders. PMID- 10132213 TI - Managing the change: seven strategies for maintaining morale and commitment to quality. PMID- 10132214 TI - Washington State: a reform test site. PMID- 10132215 TI - University medical centers. A case study of "town & gown" integration. PMID- 10132216 TI - California debate brewing over full risk capitation contracts. PMID- 10132217 TI - MIS priorities for MSO's (management services organization) & clinics without walls. AB - Organized and efficient systems that are responsive to the needs of the medical group, hospital and management services organization are at the heart of successful integrated healthcare systems. Unfortunately, selecting the right systems solution can be a time-consuming and difficult process, at best. The problems are many. First, not all management services organizations look alike. Some are limited in scope and function. Others offer an expansive menu of services to the participating groups and physicians. Second, the level of sophistication of clinic or MSO personnel evaluating systems varies. Often, hospital systems personnel with little experience in the practice management arena are assigned the job of evaluating practice systems. Third, the budget for a data processing system may be limited. The process of forming an MSO and organizing a group without walls may be very expensive. Unless adequate budgeting is done in advance, only limited funds may be left for investment in systems. Lastly, identifying viable systems which are available can be an arduous undertaking. Literally, hundreds of possible systems are available. Unfortunately, few sources offer comprehensive information on each system suitable for proper evaluation. This has led many organizations to strategically design and develop their own physician network solutions and options using such applications as 4th generation data base language. According to Mick Bassell of Partners in HealthCare, a systems consulting group in San Rafael, CA., "a request for proposal process is usually the best way to identify systems that meet the group's needs, weaknesses and strengths. This should be done before vendors are asked to supply information about various computer systems. Developing a good RFP is a building process for both the MSO and group which will help them to jointly identify, organize and prioritize system requirements." PMID- 10132218 TI - Reform models require strong information access. PMID- 10132219 TI - Computerized system offers quality at less cost. AB - A new computer-based practice-management approach offers the potential to create an efficient "team approach" promising efficient, cost-effective healthcare for a larger volume of patients. PMID- 10132220 TI - Henry Ford's CEO talks reform. Interview by Carolyn Dunbar. AB - Gail Warden, CEO of Michigan's forward-thinking Henry Ford Health System, envisions a new information-based healthcare system as he looks toward his impending leadership of the American Hospital Association. PMID- 10132221 TI - Reform demands strategic action at the regional level. AB - Those who understand the primary forces driving reform are in a better position to survive the transformation underway. To succeed, organizations must use this knowledge and act strategically at the regional level. PMID- 10132222 TI - HotList. Managed-care systems. PMID- 10132223 TI - 1994 market directory issue. PMID- 10132224 TI - Tapping in to new technology. Close links to patients at home. AB - This telecommunications system contacts home care patients automatically for followup using clinically developed software and a standard touch-tone phone. This system could help control costs by allowing health professionals to monitor patients' progress without unnecessary visits. PMID- 10132225 TI - Cardiac care--the newest treatment in home care. AB - As home care expands its capabilities, more conditions, such as heart disease, will be treatable at home. Home cardiac care encompasses many conditions, from short term to terminal. PMID- 10132226 TI - High-tech cardiac home care. An emerging delivery system. AB - The high cost of cardiac care and the increasing number of cardiac patients make high-tech care at home an increasingly attractive option for patients and caregivers. The latest advances in medicine and technology are transforming cardiac home care into more accessible, sophisticated care with fewer trips to and from the hospital. PMID- 10132227 TI - Heart-smart home care with cardiac clinical specialists. AB - Cardiac care is an expanding sector of home care. As with other specialty fields in the industry, clinical nurse specialists who have extensive knowledge of this particular arena can greatly benefit both their patients and their agencies. PMID- 10132228 TI - Occupational therapy. Making stroke patients feel at home. AB - Stroke may be one of the results of heart disease. Stroke victims returning from the hospital face obstacles they did not imagine even during rehabilitation therapy in the hospital. PMID- 10132229 TI - The Well Spouse Foundation. Support for silent partners. AB - In health care the focus is consistently on the patient. Spouses of chronically ill and/or disabled patients tend to become invisible, although they do so much to provide care. Finally an organization has been established to support their needs and cares as well. PMID- 10132230 TI - Easing the transition to high-tech home care. AB - Nurses newly employed in high-tech home care face several transitional stressors when coming from another setting. The findings of a small group study have implications in the recruitment and retention of nurses in high-tech home care. PMID- 10132231 TI - Options available for retirees if benefits are not offered. AB - Employers are increasingly concerned about the costs of providing retiree health care benefits. While they await the details of health care reform legislation, alternatives to plan sponsorship are available. PMID- 10132232 TI - An update on the future of Medicare in Canada. AB - In Canada, as in most other nations, the health care system faces many challenges. The experience of New Brunswick may foreshadow changes to come. PMID- 10132233 TI - Domestic partnership benefits. AB - Employers extending health insurance coverage to "domestic partners" of employees must be concerned with issues related to design, administration and cost as well as possible tax consequences. PMID- 10132234 TI - Better benefit administration--through electronic data interchange (EDI). AB - Electronic data interchange (EDI), used by businesses around the world for electronic purchase orders, invoices and payments, offers promising applications for benefit administration. PMID- 10132235 TI - Health care and philanthropy: where are we headed? AB - Peering into health-care's future means examining social, economic and political issues. Knowing what's coming will help development professionals deal with this new world. PMID- 10132236 TI - Cross-functional teams in health care organizations. AB - Cross-functional teams in health care organizations provide a comprehensive view of problems and are highly useful in designing and implementing improvements in work processes. Several potential obstacles may impede team progress, but these can be overcome. Cross-functional teams must develop norms that guide the interactions of team members. Individual team members must display behaviors that serve task accomplishment and team spirit. The promise of cross-functional teams for health care organizations is great. These promises, however, will not be fulfilled without the positive support of health care supervisors. PMID- 10132238 TI - A supervisor's checklist: absenteeism. PMID- 10132237 TI - Getting along with the "difficult" physician. AB - Satisfactory relationships between physicians and nurses are of vital importance to effective patient care. In fact, physician-nurse relationships even have been related to numbers of patient injuries in the hospital. Understanding the etiology of physician-nurse communication patterns and having a working knowledge of strategies to utilize when a "difficult" physician is encountered can facilitate physician-nurse communication. Positive communication can promote the development of healthy physician-nurse relationships. PMID- 10132239 TI - Understanding microbiological concepts and computerized surveillance: enhancing professional practice. AB - This article describes a research study that explored whether registered professional nurses, when exposed to an experimental educational intervention that consisted of a simulated patient environment with staged microbiological concepts relating to reservoirs of infection and BOSS surveillance data reports, retain the concepts of microbiology and can apply these concepts in clinical practice. The design of this research project was quasi-experimental with triangulation of a qualitative dimension as all experimental group participants were interviewed at the completion of this study. Implications concerning nursing curricula and inservice education programs in health care facilities are discussed. PMID- 10132240 TI - How the Fair Labor Standards Act affects your staffing. AB - The Fair Labor Standards Act allows exemption of professionals from overtime pay. However, this is often disregarded, and professional staff are compensated as nonexempt employees. The workweek definition then assumes increased importance as it may be a determining factor in the cost and availability of staff. This article discusses how altering the workweek may improve staffing. Various schedules are exhibited, and staffing and overtime pay implications of each are discussed. PMID- 10132241 TI - How to break down tasks so they don't break you: coping with overwhelming demands on your time. AB - Everyone, in every profession, seems to have too much to do and too little time to do it all. This seems to be even more true in the health care setting, where change is constant. Health care supervisors can become so overwhelmed with tasks that are expected of them that they have no idea of where to even begin. Rather than thinking about everything that must be done, the one single task strategy describes how you can break down your overwhelming tasks into manageable steps. PMID- 10132242 TI - Patient satisfaction in VA medical centers and private sector hospitals: a comparison. AB - For the first time, we have data that can validly compare the satisfaction level of inpatients in Department of Veterans Affairs (VA) medical centers and private sector hospitals. It shows the satisfaction levels to be very similar. Since the VA will soon be changing its survey, this has been a very short time window. It may never recur. In addition to the general finding, there are some interesting comparisons regarding specific questions. For example, satisfaction with VA physicians, who are salaried and assigned to patients, is just as high as satisfaction with private physicians who are paid by fee and selected by the patient. This would seem to be critical information in the debate over U.S. health care reform. PMID- 10132243 TI - Implementing total quality management in the health care industry. AB - Health care organizations across the nation have begun instituting quality improvement programs in order to meet the demands of improving service and clinical quality in health care. The implementation process requires time, effort, and money in order for the health care organizations to learn who their customers are and what they want. The results, which sometimes are not recognized until after a two- to three-year period, include reduced costs by cutting waste and complexity and by doing things right the first time. Still, there are many challenges in adapting total quality management (TQM) to public organizations such as the health care industry. This article discusses the founding principles of TQM and how they are applied in implementing TQM to enhance quality in health care organizations. This article also forecasts the future of TQM implementation in public health care. PMID- 10132244 TI - Supervisors' concern for staff: opportunities and outcomes. AB - Numerous ideas are constantly surfacing on how to manage organizations better. As health care supervisors familiarize themselves with these concepts and consider implementing new strategies, it is important not to forget the basics. This is especially true when considering staff motivation. The value of demonstrating personal concern, or consideration, for staff is examined from the perspective of transformational leadership. It has been suggested that transformational leaders are visionary and demonstrate concern for individual staff members. The association of leader support for personal concern with enhanced job attitudes is analyzed and then illustrated in several health care supervisor situations. A case study of these relationships is presented for a home health agency. The results point to the value of supervisors actively demonstrating concern for staff. PMID- 10132246 TI - A supervisor asks: "a problem with volunteers". PMID- 10132245 TI - The reality of perception in employee relations: "If it looks like a duck ...". AB - In employee relations, perception is as important as reality. What the employee perceives is generally what the employee believes and acts on. Employee perceptions are shaped by many factors, prominent among them organizational roles, supervisory styles, and communication styles. Employee perceptions cannot be ignored, even when they are known to be incorrect, because they are factual to the employees. Further, perceptions can be controlled to a considerable extent through effective supervision. The supervisor needs to become aware of the power of perception, learn what circumstances are likely to cause incorrect perceptions, learn how to manage employee perceptions to the extent possible, and always approach perception as the perceiver's reality. PMID- 10132247 TI - A prescription for security. AB - The author discusses how the upgrading of the security system at the emergency services unit of Henry Ford Hospital, Detroit, MI, helped to manage the environment and give employees a sense of control. PMID- 10132248 TI - Emergency room security: commonsense measures. AB - The author discusses how a highly trained, multidisciplinary health care team can defuse ER confrontations and prevent the occurrence of violent incidents. He provides examples from the ER setup at Stanford University Medical Center. PMID- 10132249 TI - One hospital's response to the fight against domestic violence. AB - The author discusses the vital role his hospital plays in the fight against domestic violence--the Project Safe Refuge and the Safe Refuge Advocate. PMID- 10132251 TI - Developing trust through conflict resolution. PMID- 10132250 TI - Healthy security at Children's Hospital. PMID- 10132252 TI - How to purchase a photo identification system. PMID- 10132253 TI - Crime scene investigation in the healthcare environment. PMID- 10132254 TI - Infant abduction: conducting a mock security department drill. AB - In this article, the author provides a mock security department drill of an infant kidnapping at his hospital. Operational concerns and valuable recommendations in reacting to such a crisis scenario are then given. PMID- 10132255 TI - Making hospital parking safer: how hospitals are dealing with some very serious security problems. AB - Securing the safety of patients, visitors, and employees in a hospital's parking facility is the first line of defense against crime. An estimated 20-30% of all serious criminal incidents occur in parking areas. Some of the largest judgments against hospitals for negligent security have come from lawsuits resulting from parking lot incidents. PMID- 10132257 TI - Fighting back. PMID- 10132256 TI - A nightmare in the afternoon. AB - Too often, a healthcare security or safety department will receive local publicity only when an incident results in injuries or fatalities. "Routine" actions that prevent tragedies are often ignored. This article, however, is an example of positive recognition by the fire-fighting community of the professionalism exhibited by a healthcare facility in response to a fire in a patient's room. It appeared in the Volume 3, Number 1, 1993 issue of the Fire Fighters Digest, published in Dartmouth, Nova Scotia. PMID- 10132258 TI - Perspectives on purchasing. Private lessons. PMID- 10132259 TI - Can GPs reach the high Cs? PMID- 10132260 TI - The cost of care. PMID- 10132261 TI - Project management. AB - High priority projects need to be treated as more than just another element in the normal managerial process if they are to be implemented on time, achieve their quality targets, and finish within budget. Achieving this discipline is the object of 'project management'--an approach which uses special control structures and management techniques to make things happen. Can this approach help your organisation move faster with strategically important one-off projects? This Health Management Guide looks at why project management is necessary, explores a number of case studies where it has been used successfully in the health services, and identifies the key points to bear in mind when adopting this approach. PMID- 10132262 TI - Finding the facts. PMID- 10132263 TI - Happy ever after. PMID- 10132264 TI - Perspectives on purchasing--fearless quest. PMID- 10132265 TI - Viol bodies. PMID- 10132267 TI - Defrauding AIDS patients: federal felony statute may be necessary to curb multiplying scams. PMID- 10132266 TI - Legal medicine for sexual harassment of health care workers. PMID- 10132268 TI - Kaiser's tax-exempt status challenged by union, Medi-Cal. PMID- 10132269 TI - Pro-physician MSOs (management services organizations): a winning managed care strategy. PMID- 10132270 TI - Insurance denial for head and spinal cord injuries: stacked deck requires health care reform. PMID- 10132271 TI - CQI trends & transitions. PMID- 10132272 TI - Learning to walk the leadership talk? PMID- 10132273 TI - Using criteria to evaluate healthcare reform plans. PMID- 10132274 TI - Public policy statement. The challenge of healthcare reform: an American College of Healthcare Executives Perspective. PMID- 10132275 TI - Look before you leap into practice acquisitions. AB - Given the pressures of healthcare reform, making the right decisions about the acquisition of physician practices is even more critical. Healthcare executives must proceed according to a plan or they could suffer financial, political, and professional consequences later on. PMID- 10132277 TI - Finding the CQI CEO. PMID- 10132278 TI - American College of Healthcare Executives. Professional policy statement. Terms of employment for healthcare executives. PMID- 10132276 TI - Ethical issues in managed care. PMID- 10132279 TI - Is your quality initiative in trouble? PMID- 10132280 TI - Measuring the success of CQI. PMID- 10132281 TI - Healthy communities: reducing need (and costs!) by promoting health. PMID- 10132282 TI - Models for the "healthy community" concept. PMID- 10132283 TI - Take Care of Yourself. The Healthtrac program for health improvement. PMID- 10132284 TI - Merger mania: this is the year it will reach you. PMID- 10132285 TI - Make your practice irresistible to health plans. PMID- 10132286 TI - Introducing health sciences librarians to the Internet. AB - The Internet is no longer just for the adventurous explorers or the technical experts--it has found its way into the mainstream of librarianship. New users are coming onto "the net" in droves. A wealth of information is currently available dealing with the mechanics of the Internet and there are general guides to the available resources. More work needs to be done, however, in developing subject specific materials. This paper will report on the strategy that Scott Memorial Library, Thomas Jefferson University, has employed to develop staff skills and awareness and to take advantage of the resources and opportunities that the network provides for the health sciences community. PMID- 10132287 TI - Sources of information on postgraduate medical training programs--update. AB - This is an update of an earlier article listing directories, journal articles, and general books that aid the librarian, resident, or medical student in finding information on residency and fellowship programs. The article also gives suggestions for building a file of program catalogs related to residencies, fellowships, and clerkships and related materials. PMID- 10132288 TI - Comparison of CINAHL, EMBASE, and MEDLINE databases for the nurse researcher. AB - The purpose of this research was to determine which of three databases, CINAHL, EMBASE or MEDLINE, should be accessed when researching nursing topics. The three databases were searched for citations on topics selected by three nurse researchers and the results were compared. For the search of nursing care literature on a medical condition, it was helpful to search both CINAHL and MEDLINE. CINAHL provided the majority of relevant articles for the second search, on computers and privacy, but inclusion of MEDLINE and EMBASE enhanced retrieval somewhat. The search on substance abuse in pregnancy, not restricted to nursing literature, retrieved better results when searching both MEDLINE and EMBASE. Due to the nature and distribution of the nursing literature, it is especially important for the searcher to understand and respond to the focus of the researcher. PMID- 10132289 TI - Security for microcomputers in public areas. PMID- 10132290 TI - Test your library's marketing IQ. PMID- 10132292 TI - Community forums flourish with "Just Caring". PMID- 10132291 TI - Health care reform: where we have been, where we are going. PMID- 10132293 TI - Michigan Hospital Association community survey: summary of selected findings. PMID- 10132294 TI - From "we-they" thinking to organizational perspective. PMID- 10132295 TI - Auxilian loyalties: don't take them for granted! PMID- 10132296 TI - Michigan hospital medians. Center for Healthcare Industry Performance Studies. PMID- 10132297 TI - Helping our communities understand reform options. PMID- 10132298 TI - Ark. rivals battle over bid. PMID- 10132299 TI - FHP gets TakeCare with better bid. PMID- 10132300 TI - HCFA reorganizes to aid managed-care oversight. PMID- 10132301 TI - HMOs join to vie for contracts that move Calif. Medicaid patients to managed care. PMID- 10132302 TI - Stark plan enters muddled reform path. PMID- 10132304 TI - W.R. Grace set to become 3rd-largest home infusion provider in purchase deal. PMID- 10132303 TI - Diversicare sells subsidiary to continue home-care push. PMID- 10132305 TI - Suppliers feeling effects of Columbia. PMID- 10132306 TI - Many hospitals still lacking in TB preparation. PMID- 10132307 TI - Conn. hospitals want rate-setting system cut. PMID- 10132308 TI - Reform won't succeed without managing demand for services. PMID- 10132309 TI - HealthTrust battles over acquisitions in 3 states. PMID- 10132310 TI - Barbakow portrays NME's effort to peddle hospitals as part of its acute-care plan. PMID- 10132311 TI - JCAHO hits a wall with plan on indicators. Hospitals balk at costly and inefficient program to measure clinical outcomes. AB - The Joint Commission on Accreditation of Healthcare Organizations is poised at a key point in its history. Decisions that will be made this year by the JCAHO, hospitals, purchasers and the government will determine what role the JCAHO will play under a reformed national healthcare system. This cover story is the first installment of a two-part status report on the JCAHO. The first part examines the development of the JCAHO's clinical indicator monitoring system and its acceptance by hospitals and others, and the ability of the system to improve patient care The second part, to be published in an upcoming issue of Modern Healthcare, will focus on the JCAHO's efforts to position itself for reform. PMID- 10132312 TI - OrNda merger on track despite earnings news. PMID- 10132313 TI - Reform, bond default link seen. PMID- 10132314 TI - PPOs pursue new links with providers. PMID- 10132315 TI - Blues lose in bid to keep Mich. Medicare contract. PMID- 10132316 TI - 6 hospitals conditionally accredited. PMID- 10132317 TI - Missouri Baptist in BJC merger deal. PMID- 10132318 TI - NLRB order against Beverly voided. PMID- 10132319 TI - Nurses oppose cuts, cite concerns for poor. PMID- 10132320 TI - HHS warns: pay group practices fair prices. PMID- 10132321 TI - VA opts to raze damaged hospital. PMID- 10132322 TI - Bills that limit HMO autonomy win nods in Florida legislature. PMID- 10132323 TI - Employer mandate remains as panel debates Stark plan. PMID- 10132324 TI - Computerized records often vulnerable. PMID- 10132325 TI - Big rise in AIDS cases puts more strain on providers. PMID- 10132326 TI - Kan. court upholds M.D. employment. PMID- 10132327 TI - Ind. to solicit charity-care reports. PMID- 10132328 TI - W.Va. hospital cleared in antitrust case. PMID- 10132329 TI - Clinton plan employer mandate hit. PMID- 10132330 TI - As care delivery evolves, facility design must change. PMID- 10132331 TI - AHM, OrNda and Summit shareholders set to vote on merger of companies. PMID- 10132332 TI - Construction & design survey. Architects and builders optimistic, even in the face of healthcare reform. PMID- 10132333 TI - Hospital feels heat from ruling on management-employee committees. PMID- 10132335 TI - Baltimore's Helix, Good Samaritan set merger agreement. PMID- 10132334 TI - Columbia's partnership strategy. PMID- 10132336 TI - Three hospitals form network to compete in Denver region. PMID- 10132337 TI - Big merger in Indianapolis moves ahead. PMID- 10132338 TI - St. Luke's may join K.C. network. PMID- 10132339 TI - U.S. Surgical's layoff count grows. PMID- 10132340 TI - Utah hospitals, feds settle charges. PMID- 10132341 TI - Ala. hospital may dispute rivals' merger. PMID- 10132342 TI - 2 Joplin, Mo., hospitals plan merger after talks with 3rd fail. PMID- 10132343 TI - 3 Calif. systems set to create regional healthcare network. PMID- 10132344 TI - Iowa merger gets fast federal OK. PMID- 10132345 TI - K.C. VNA merging with hospital system. PMID- 10132346 TI - Stark plan OK pushes reform forward. PMID- 10132348 TI - A nudge, not (yet) an order in Mass. PMID- 10132347 TI - Boston hospitals create parent firm to complete deal. PMID- 10132349 TI - Miss. links CON, community benefit. PMID- 10132350 TI - Bidding heats up for Fla. hospital. PMID- 10132351 TI - Shareholder suit against Sierra is settled. PMID- 10132352 TI - Clinton's plan is nearly dead, ideas still alive. PMID- 10132353 TI - HealthTrust, Holy Cross may battle with FTC to rescue Utah deal. PMID- 10132354 TI - Hospital closings down. PMID- 10132355 TI - Wis. insurer suing physicians in reversal of typical roles. PMID- 10132356 TI - The JCAHO's agenda for expansion. AB - The Joint Commission on Accreditation of Healthcare Organizations is poised at a key point in its history. Decisions that will be made this year by the JCAHO, hospitals, purchasers and the government will determine what role the JCAHO will play under a reformed national healthcare system. This is the second installment of a two-part status report on the JCAHO. The first part appeared March 14. PMID- 10132357 TI - Use of imaging agents underscores extent of battle to control costs. PMID- 10132359 TI - Governance issues, state deadline halt Maine merger talks. PMID- 10132358 TI - Long-term hospitals do well, but face challenges. PMID- 10132360 TI - Creating community care networks: issues and opportunities. Report of the 1993 National Forum on Hospital and Health Affairs, held in Durham, North Carolina, May 19-21, 1993. PMID- 10132361 TI - Creating community care networks: issues and opportunities. PMID- 10132362 TI - Opportunities to create networks now. PMID- 10132363 TI - Will there be a place for providers who opt out? PMID- 10132364 TI - What are the next steps? Panel discussion. PMID- 10132365 TI - Defining a community in a metropolis. PMID- 10132366 TI - Defining a community in a nonurban area. PMID- 10132367 TI - Defining a community in communitywide terms. PMID- 10132368 TI - Initiating the network under provider ownership. PMID- 10132369 TI - Initiating the network as a joint venture. PMID- 10132370 TI - Initiating the network with a third party. PMID- 10132371 TI - Legal issues. PMID- 10132372 TI - Attitudinal issues with hospital trustees. PMID- 10132373 TI - Attitudinal issues with CEOs. PMID- 10132374 TI - Attitudinal issues of physicians. PMID- 10132375 TI - Financial issues: incentives for providers and patients. PMID- 10132376 TI - Opportunities to create networks now. PMID- 10132377 TI - Opportunities to create networks now. PMID- 10132379 TI - Shaping tomorrow, today: AHA's national reform campaign. PMID- 10132378 TI - Measuring satisfaction with organizations. Predictions from information accessibility. AB - The study explored the process through which customers assess their satisfaction with service organizations. Our theoretical analysis suggests that when a general satisfaction question appears after questions about specific domains were asked (SG order), the earlier questions increase the accessibility of both positive and negative information. In contrast, when a general satisfaction question appears prior to any other question (GS order), negative information is more accessible than positive information. On the basis of these differences in accessibility we predicted (1) greater asymmetry in the impact of positive and negative information on the general satisfaction response in the GS order, (2) higher correspondence between domain-specific satisfaction and general satisfaction in the SG order, and (3) higher levels of general satisfaction in the SG order. These predictions were supported in analyses of customers' responses in a national survey of satisfaction with the Israel Telecommunication Corporation (Bezeq). PMID- 10132380 TI - Putting patients first. Hospitals work to define patient-centered care. PMID- 10132381 TI - The AHA: policy, advocacy and the tools for reform. PMID- 10132382 TI - Searching for new investments. PMID- 10132383 TI - Creating tomorrow's vision today. PMID- 10132384 TI - Hospital earns advocacy award. PMID- 10132385 TI - Negotiation can avert litigation. PMID- 10132386 TI - The hows and whys of conducting a community needs assessment. PMID- 10132387 TI - Understanding what your community needs. First, listen to what they want. PMID- 10132388 TI - Harry, Louise and health alliances. PMID- 10132389 TI - Confidentiality reexamined: negotiating use of art by clients. PMID- 10132390 TI - It's almost spring cleaning time. PMID- 10132391 TI - Cost of inappropriate use of ciprofloxacin in ambulatory care. AB - OBJECTIVE: To determine the incidence of inappropriate ciprofloxacin use and the resulting cost thereof in ambulatory care. DESIGN: Retrospective cost analysis. SETTING: Ambulatory care clinic of a Department of Veterans Affairs Medical Center. PATIENTS: One hundred thirty-seven ambulatory patients prescribed ciprofloxacin during March, April, and May 1992. Forty-six patient charts were available for review. MAIN OUTCOME MEASURE: Indications for ciprofloxacin use were determined from chart review. RESULTS: Chart review of 46 of the 137 patients prescribed ciprofloxacin during the three-month study period indicated that only 8 (17 percent) had infections that were appropriately treated with this antibiotic. If 550 patients had received ciprofloxacin that year (figure extrapolated from the three-month totals), the cost of prescribing would have been $29,260. This study indicates that $20,500 per year could be saved by prescribing equally efficacious oral antibiotics. CONCLUSIONS: Restricting ciprofloxacin use to its proven indications in the ambulatory setting may result in considerable cost savings to medical centers. PMID- 10132392 TI - Can computing curb runaway workers' compensation claims fraud? PMID- 10132393 TI - Helping member providers become EDIable. PMID- 10132394 TI - Merger offers IS managers flexibility & less stressful integrating, downsizing, & outsourcing. Interview by Bill Childs. AB - A merger between two multi-million dollar IS firms in July 1993 created a company with $315 million in sales and a sharp focus on healthcare. National Healthtech Corp., parent firm of MRI, brought the focus to the deal. And Dallas-based Affiliated Computer Services, a data services provider to financial, commercial and healthcare organizations, brought telecommunications and outsourcing expertise. Bill Childs, editor-in-chief, recently spoke with the two firms' principals--Richard A. Montgomery, CEO of National Healthtech Corp., and Steve Carpenter, senior VP of ACS and COO of NHC. Excerpts from their conversation follow. PMID- 10132395 TI - Adopting the "check-writer's" perspective: managing care in its highest form. PMID- 10132396 TI - The missing variable: ensuring a positive ROI (return on investment). AB - In summary, the business value of IS technology is a function of its role in the organization's business strategy. Value can be assigned to expected benefits from the technology. But, the validity of that determination depends on developing a plan to fully and appropriately use the technology, reengineer operations and embrace a new way of doing business. The need for IS technology in today's healthcare environment is unquestioned. Realizing the full business value of IS technology is the issue. Will it be treated as an expense to be minimized, or as a strategy for the future? A strategy embraced as part of the new evolving healthcare delivery system will result in your investment in IS technology truly being an investment in the future. PMID- 10132397 TI - Selection & installation activities: integrating system implementations--by the numbers. PMID- 10132399 TI - America's most computer advanced healthcare facilities. PMID- 10132398 TI - Interface gateways: defining the solutions. AB - In summary, an interface gateway is able to quickly create and support relationships. In the healthcare environment of the 1990s, organization executives will be faced with an exponential increase in the number of provider, payor and employer alliances, affiliations and acquisitions. One of the recurring requirements in this scenario is the need to share information. Most of the data standards in existence today do not address the vast interface requirements of these organizations. However, the capabilities, flexibility and capacity of interface gateways can allow these relationships to be created and supported in a fraction of the time that conventional methods require. PMID- 10132400 TI - Securing a bridge to the CPR: clinical data repositories. PMID- 10132401 TI - CHIN (Community Healthcare Information Networks) Association launched. PMID- 10132402 TI - Why managed care needs encounter-based systems. AB - In the past, hospital information systems were designed and continuously altered to bring greater sophistication and functionality to patient accounting systems activities. Key components were focused on inpatient activities, which accounted to 80 percent or more of the organization's revenues. As a result, much of the information available for an inpatient care record is based on financially oriented data that was created for reimbursement and charge capture. PMID- 10132403 TI - How will healthcare reform change the design of contract management technologies? PMID- 10132404 TI - IS: the neural nexus. Why you should consider information systems as the central nervous system of an integrated healthcare network. AB - Until now, utilization of information systems in America's healthcare industry has been anything but scientific. And individual healthcare providers have managed to deliver the world's best healthcare services despite lousy information systems, lack of clinical outcomes data, lack of adequate service costing data and lack of customer satisfaction data. The key to the scientific improvement of the health status of a community health network is the acquisition and application of knowledge, which we believe to be wholly dependent upon scientifically designed clinical information systems. We've got some work to do. PMID- 10132405 TI - Communication issues for building community health information networks. PMID- 10132406 TI - Annual managed care systems review. Behold the beast. AB - Remember the story of the three blind men, each confronted by a different part of an elephant? Asked to describe the object in front of them, they each described the part they could touch. In his quest to survey more than 100 managed care systems vendors, author John R. Murray discovered that defining managed care is very much like describing an elephant without seeing the entire beast: Each company's definition is based on its niche and product offering to the market. PMID- 10132407 TI - How do you compare? Survey of facilities management in the NHS. PMID- 10132409 TI - Healthy savings with CHP (combined heat & power). PMID- 10132408 TI - A new beginning. PMID- 10132410 TI - Progress on joint venture schemes in clinical waste management. PMID- 10132411 TI - Are you prepared for the next disaster? PMID- 10132412 TI - Violence against healthcare providers: hospital responsibilities. PMID- 10132413 TI - Maneuvering for reform. PMID- 10132414 TI - Negotiating risk in managed care contracting. PMID- 10132415 TI - The changing faces of healthcare: cultural diversity and its impact on access management. PMID- 10132416 TI - Achieving simplicity and savings in healthcare: an example. PMID- 10132417 TI - Shifting the focus to primary and preventive care. New Jersey launches healthcare reform. PMID- 10132418 TI - The evolution of healthcare organizations. PMID- 10132419 TI - How healthcare access management can facilitate an organization's approach to managed care. AB - Healthcare Access Managers can positively influence the success of their facility's interaction with managed care and recipients of services by applying their knowledge of sound business practices. Most managed care companies are eager to build these positive working relationships in their respective market areas. A positive approach can result in a win/win situation for all parties involved in the delivery of services. PMID- 10132420 TI - Developing unit prices in a managed care environment. PMID- 10132421 TI - Opportunities in reorganization. PMID- 10132422 TI - Charge profiles, RBRVS data and pre-estimates: a lesson in fee setting. AB - The author describes a method of setting reimbursement levels that--especially when combined with a physician negotiation program--may be the most effective cost-control mechanism of any with its level of simplicity. PMID- 10132423 TI - Health promotion in Taft-Hartley plans. AB - Rates of adoption of health promotion programs among New York State's Taft Hartley plans are lower than among 64 large firms and a national sample of worksites with at least 50 employees. Statistically significant differences in adoption rates are found between Taft-Hartley plans and large firms, but the differences are not attributable to plan size or the number of worksites per plan. PMID- 10132424 TI - Family support benefits: individual utility and organizational outcomes. AB - How much do employees value the various family support benefits offered by employers? A recent survey finds a correlation between employees' perceived utility of certain benefit programs and job satisfaction and performance. PMID- 10132425 TI - U.S. high-rise fires: the big picture. AB - In the past, efforts to track fire experience in high-rise buildings have been less than systematic. Now, for the first time, we can provide an overall perspective on the problem. PMID- 10132426 TI - Two approaches to better outcomes at lower cost. Crawford Long, Atlanta, and Mercy/Unity, Minneapolis. AB - Crawford Long, Atlanta, and Mercy/Unity, Minneapolis, tailor care guideline implementation to their own organizational environments. PMID- 10132427 TI - Flattening an organization for cost and quality gains. Suburban Hospital, Bethesda, Maryland. PMID- 10132428 TI - Employee--administrator relationships. Part two: Dealing with employees who resist change. AB - Human resistance is most often the biggest and most difficult obstacle to overcome if restructuring is to be successful. Since organizational change efforts often run into some form of human resistance, it merits a more focused look. PMID- 10132429 TI - Cath lab credentialing ... it's not just for nurses anymore! AB - Despite the many ups and downs, departmental credentialing for the CCL is a success and is here to stay. There is no difference with respect to performance expectations for RNs and CVTs in our lab. The differences between professional nursing and technical staff lie in their approaches to direct patient care. Nurses offer a holistic approach to care delivery in the cath lab, while CVTs approach care from a procedure-oriented viewpoint. It is our belief that the blending of these two approaches offers the highest quality of patient care and teamwork in this highly stressful environment. Our staff demonstrates that RNs and CVTs work well together and form a cohesive team because they not only share information, but also teach each other necessary skills. Credentialing provides objective documentation to support their efforts and hard work. PMID- 10132430 TI - Informal study shows new perfusion catheter reduces balloons per case. PMID- 10132431 TI - Knowledge is power: a guide to fact-based managed-care negotiations. AB - Signing a managed-care contract does not have to be an unnerving experience, as long as a practice administrator or physician is armed with the right information. PMID- 10132432 TI - Surviving the health care storm. PMID- 10132433 TI - How to evaluate managed care. PMID- 10132434 TI - What reforms physicians want. Interview by Debra Mamorsky. AB - An executive vice president of the American Medical Association says that while physicians across the United States have mixed reviews of the President's proposal, they are basically looking for stability and predictability in a new system. PMID- 10132435 TI - Successful collaboration: the Cincinnati initiative. AB - Private-sector initiatives, like the one launched in Cincinnati, have significantly improved the management of health care programs. The initiatives were made through voluntary hospital and physician practice changes without new contract restrictions, price controls, legislative mandates, and utilization management. PMID- 10132436 TI - How purchasers can improve plan performance. PMID- 10132437 TI - A brief guide to today's major health reform proposals. PMID- 10132438 TI - Elder care: the employee benefit of the 1990s? AB - Long-term care is costing companies significantly in lost employee productivity. Case management services offer employers a way to ease the burden for employees with relatives who are chronically disabled and minimize disruption at work. PMID- 10132439 TI - Ways to reduce mental health costs. PMID- 10132440 TI - Cultivating relationships in a capitated environment. PMID- 10132441 TI - Why outsource data management. PMID- 10132442 TI - What employers can do now. PMID- 10132443 TI - Asthma care map for decision making. AB - In the second part of a three-part series on patient-centered asthma care, the authors describe the eight critical elements of multidisciplinary care management for patients with moderate to severe asthma. PMID- 10132444 TI - Managing the termination of a hospital system from your provider network: a case study. AB - In 1992, a decision was reached by Medica Choice, a large open-access HMO with over 350,000 members, to terminate their contact with a large five-hospital system. In this article, the authors discuss the details of this termination, identify the organizational strategies for successfully managing the contract termination of a major hospital system from a health plan's provider network, attempt to identify the possible pitfalls in managing such a transition, and offer suggested guidelines for tactical planning for similar situations. PMID- 10132445 TI - Responding to health care reform: how managed health care providers can manage major change overload. AB - Multiple pressures for clinical, administrative, economical, and political change face providers today. To cope with a changing society and health care delivery system, change management skills have become essential for survival. However, implementing and managing organizational change demands a level of expertise that is, unfortunately, not readily found in many managed health care organizations. In this article, the author addresses the importance for providers to understand the process of change implementation. PMID- 10132446 TI - The reform effort has already been successful. AB - These are certainly the most exciting times our industry has ever experienced; for the most part, they are just beginning. Consolidation, mergers, acquisitions, and probably a few hostile takeovers are looming on the horizon. The encouraging theme in all of this is that reform is already taking effect. The innovation and creativity being applied through the partnerships and networks being created suggest that our system will transform itself. The transformation will bring about improvements that will emphasize competition, quality, and accountability, which is what the managed care industry has been focused on all along. PMID- 10132447 TI - Outcomes research, analysis, and dissemination: the federal government's role. AB - The Agency for Health Care Policy and Research (AHCPR) is responsible for medical outcomes research, analysis, and dissemination of results. The AHCPR's largest funded studies are the Patient Outcome Research Teams (PORTs). The results of the prostatic disease PORT show wide variations in practice patterns and provide insights into the reasons for and solutions to these variations. Managed care plans are using this information to educate patients and providers about the risks and outcomes associated with various treatment options. Early findings indicate positive results in terms of patient satisfaction and reduced treatment costs. PMID- 10132448 TI - Managed health care plans: sheep in wolves' clothing. AB - The gatekeeper is the ambassador of managed care, a cost-effective, quality advocate. The gatekeeper is one of the most effective management tools available to managed care organizations and patients today. However, there is little evidence proving this positive cost-benefit. Furthermore, managers lack the understanding and information about how gatekeepers operate and why certain decisions are made. The authors discuss what they believe is the real promise of managed care. PMID- 10132449 TI - Cost-effective treatments for substance abuse: avoid throwing the baby out with the bath water. AB - State-of-the-art treatment of alcoholism is not the 12-step process developed by Alcoholics Anonymous, not intensive inpatient treatment, and not necessarily aggressive outpatient management. According to the authors, there is even controversy today as to whether alcoholism should be treated as if it is indeed a "disease". PMID- 10132450 TI - A case study: using members' values to increase plan awareness. AB - Consumer awareness of a health plan is the direct result of name recognition and overall health plan identity. After many name changes and transitioning ownerships, Greater Atlantic Health Service found that its membership was waning, and a lack of consumer awareness of the HMO was a substantial part of the problem. PMID- 10132451 TI - Involving users of health care services: moving beyond lip service. PMID- 10132452 TI - Clinical guidelines: acceptance and promotion. PMID- 10132453 TI - Team working: the key to implementing guidelines? PMID- 10132454 TI - Problems with implementing guidelines: a randomised controlled trial of consensus management of dyspepsia. AB - OBJECTIVE: To determine the feasibility and benefit of developing guidelines for managing dyspepsia by consensus between general practitioners (GPs) and specialists and to evaluate their introduction on GPs' prescribing, use of investigations, and referrals. DESIGN: Randomised controlled trial of effect of consensus guidelines agreed between GPs and specialists on GPs' behaviour. SETTING: Southampton and South West Hampshire Health District, United Kingdom. SUBJECTS: 179 GPs working in 45 practices in Southampton district out of 254 eligible GPs, 107 in the control group and 78 in the study group. MAIN MEASURES: Rates of referral and investigation and costs of prescribing for dyspepsia in the six months before and after introduction of the guidelines. RESULTS: Consensus guidelines were produced relatively easily. After their introduction referral rates for upper gastrointestinal symptoms fell significantly in both study and control groups, but no significant change occurred in either group in the use of endoscopy or radiology, either in terms of referral rates, patient selection, or findings on investigation. No difference was observed between the control and study group in the number of items prescribed, but prescribing costs rose by 25% (from 2634 pounds to 3215 pounds per GP) in the study group, almost entirely due to an increased rate of prescription of ulcer-healing agents. CONCLUSION: Developing district guidelines for managing dyspepsia by consensus between GPs and specialists was feasible. However, their acceptance and adoption was variable and their measured effects on some aspects of clinical behaviour were relatively weak and not necessarily associated with either decreased costs or improved quality of care. PMID- 10132455 TI - Use of health care services after stroke. AB - OBJECTIVES: To describe the use of care before and after stroke and to evaluate equity in access to health care services after stroke. DESIGN: Cross sectional study. SETTING: The Netherlands. PATIENTS: 382 patients living in the community who had been admitted to hospital with a stroke six months before. MAIN MEASURES: Sociodemographic status and functional health status according to The Barthel index, Rankin scale, and sickness impact profile, assessed during interview, and general practitioner (GP) characteristics obtained by postal questionnaire. Univariate and multivariate analyses of the relation between patient and GP related factors and use of care. RESULTS: Compared with the period before stroke the use of care six months after stroke increased significantly, especially use of physical therapy, home help, and aids. Multivariate analyses showed that impaired functional health increased the use of care (range in odds ratios 1.6 to 6.7). Compared with younger patients, elderly patients were more likely to have home help (odds ratio 2.9) and aids (2.4) but less likely to receive therapy (0.4), psychosocial support (0.5), and an appreciable amount of care (0.5). Being female (1.7), living alone (4.0), and whether the GP was informed about patients' discharge (2.2) increased the use of home help. Higher financial income (2.8) and having a male GP (3.2) contributed to use of therapy. Emotional distress (1.6), living protected (3.2), and living alone (1.7) accounted for psychosocial support. CONCLUSIONS: Although older age, lower income, and poor discharge information to the GP decreased the use of some types of care, there is equity in access to care after stroke, primarily determined by needs in terms of functional health status and predisposing factors such as living arrangement and social circumstances. IMPLICATIONS: Patient oriented studies focusing on care processes and care outcomes in terms of subjective needs, perceived care deficits, and satisfaction with care are still required. PMID- 10132456 TI - Hospital pharmacists' participation in audit in the United Kingdom. AB - OBJECTIVE: To investigate systematically participation in audit of NHS hospital pharmacists in the United Kingdom. DESIGN: Questionnaire census survey. SETTING: All NHS hospital pharmacies in the UK providing clinical pharmacy services. SUBJECTS: 462 hospital pharmacies. MAIN MEASURES: Extent and nature of participation in medical, clinical, and pharmacy audits according to hospital management and teaching status, educational level and specialisation of pharmacists, and perceived availability of resources. RESULTS: 416 questionnaires were returned (response rate 90%). Pharmacists contributed to medical audit in 50% (204/410) of hospitals, pharmacy audit in 27% (108/404), and clinical audit in only 7% (29/404). Many pharmacies (59% (235/399)) were involved in one or more types of audit but few (4%, (15/399)) in all three. Participation increased in medical and pharmacy audits with trust status (medical audit: 57% (65/115) trust hospital v 47% (132/281) non-trust hospital; pharmacy audit: 34% (39/114) v 24% (65/276)) and teaching status (medical audit: 58% (60/104) teaching hospital v 47% (130/279) non-teaching hospital; pharmacy audit 30% (31/104) v 25% (68/273)) and similarly for highly qualified pharmacists (MPhil or PhD, MSc, diplomas) (medical audit: 54% (163/302) with these qualifications v 38% (39/103) without; pharmacy audit: 32% (95/298) v 13% (13/102)) and specialists pharmacists (medical audit: 61% (112/184) specialist v 41% (90/221) non-specialist; pharmacy audit: 37% (67/182) v 19% (41/218)). Pharmacies contributing to medical audit commonly provided financial information on drug use (86% 169/197). Pharmacy audits often concentrated on audit of clinical pharmacy services. CONCLUSION: Pharmacists are beginning to participate in the critical evaluation of health care, mainly in medical audit. PMID- 10132457 TI - Developing role of medical audit advisory groups. AB - OBJECTIVES: To investigate the approaches to audit of different medical audit advisory groups (MAAGs) and to consider the implications for evaluation of their activities and their developing role in the light of new priorities for clinical audit. DESIGN: Qualitative study based on semistructured interviews. SETTING: 15 family health services authority (FHSA) districts in two English health regions. SUBJECTS: MAAG chairpersons and support staff and FHSA general managers and medical advisors in each district, totalling 68 subjects. MAIN MEASURES: Structures and activities of MAAGs; perceptions of the MAAG's role and its achievements compared with the initial brief in a health circular in 1990. RESULTS: The approaches of different MAAGs varied considerably: some concentrated on promoting audit and others were involved in a wider range of development activities. MAAGs assessed their progress in various different ways. The importance of collaborative working was recognised, but few interface audit projects had been undertaken. MAAGs had little contact with other quality assurance activities in the FHSA, and FHSA involvement in the MAAG strategy was variable, although MAAGs were taking steps to improve communication with the FHSA. CONCLUSIONS: Major differences exist in the approaches taken by MAAGs and the roles they fulfil, which will make evaluation of their effectiveness a complex task. Already MAAGs are responding to changing expectations about audit and pressure for closer links with management. PMID- 10132458 TI - Clinicians' satisfaction with a hospital blood transfusion service: a marketing analysis of a monopoly supplier. AB - One of the objectives of the NHS reforms is to improve customer focus within the health service. In a study to assess the quality of customer service provided by the Edinburgh and South East Scotland Blood Transfusion Service a 19 item questionnaire survey of the main clinical users of the service was performed to ascertain their satisfaction, measured on a 5 point anchored scale, with important aspects of the service, including medical consultation, diagnostic services, blood and blood components or products and their delivery, and general satisfaction with the service. Of 122 clinicians in medical and surgical disciplines in five hospitals in Edinburgh, 72 (59%) replied. Fourteen (22%) indicated dissatisfaction with any aspect of the medical consultation service, owing to inadequate follow up of clinical contacts and unsatisfactory routing of incoming calls. Diagnostic services were criticised for the presentation, communication, and interpretation of results. The restricted availability of whole blood, the necessity to order platelets and plasma through the duty blood transfusion service doctor, and the use of a group and screen policy, attracted criticism from a small number of clinicians. Ten of 68 respondents expressed dissatisfaction with delivery of blood and components to the wards and theatres. The findings indicate that the clinicians served by this blood transfusion service are largely satisfied with the service. Changes are being implemented to improve reporting of laboratory results and measures taken to improve liaison with clinicians. PMID- 10132459 TI - Achieving health gain through clinical guidelines. I: Developing scientifically valid guidelines. PMID- 10132460 TI - US and UK health care reforms: reflections on quality. PMID- 10132461 TI - The developing role of community hospitals: an essential part of a quality service. PMID- 10132462 TI - Health status, outcome, and attributability: is a red rose red in the dark? PMID- 10132463 TI - Services for people with stroke. PMID- 10132465 TI - View from France. PMID- 10132464 TI - Brief interventions and alcohol use. PMID- 10132466 TI - Infection control during construction: planning is key. AB - With many hospital facilities under almost constant renovation or construction, the importance of planning precautions to protect surrounding areas from infection has never been greater. This document explains how one hospital campus plans for such precautions, and presents a case study on the issue. PMID- 10132467 TI - Health care facilities management compensation comparison. American Society for Hospital Engineering. AB - Periodically, ASHE undertakes a study of its membership in order to collect demographic member information, gauge its service to the membership, and track member perception of association activities. The 1992 membership survey included a strong emphasis on job function, which produced information on compensation by job function. What follows in this document are the results of that survey--the average compensation by job function within various other factors such as geographic location, organization type/size, experience, education, and several other criteria. PMID- 10132468 TI - TB control in the hospital environment. AB - Tuberculosis is again on the rise in the United States. Several outbreaks of TB in hospitals have heightened interest in the development and use of mechanisms that prevent the spread of this airborne pathogen. Controlling the spread of TB to hospital patients, workers, and others can be accomplished through various administrative engineering and design controls, and infection control programs, as recommended by the Centers for Disease Control and Prevention (CDC). The hazard of TB is real, but workers, patients, and visitors can be protected by implementing programs that guard against the diseases spread in the hospital environment. PMID- 10132469 TI - Electrical standards compendium. AB - The objective of this compendium is to assist ASHE members in determining which electrical safety requirements pertain to their hospitals. Relevant requirements in consensus standards on hospital electrical safety are summarized in annotated form. The requirements contained in the different standards are grouped by area of the hospital and by topic. PMID- 10132470 TI - Permit-required confined spaces. AB - The focus of the new Occupational Safety and Health Administration Standard: Permit-Required Confined Spaces (29 CFR 1910.146) is to protect workers who enter and work in areas with immediate health or safety risk from toxic, explosive, and/or asphyxiating atmospheres. The rule mandates that employers identify all permit-required confined spaces in their workplaces, prevent unauthorized entry into them, and develop a program to protect workers during authorized entry. Included in this standard are requirements for the content, issuance, and retention of entry permits; the provision of standby attendants; arrangements for rescue and other emergency services; the communication of hazards to workers (including contractors' employees); and appropriate training and equipment for authorized entrants, attendants, and entry supervisors. PMID- 10132471 TI - Hospital generator sizing, testing, and exercising. AB - With the NFPA 99 and JCAHO requirements for minimum loads on generators during testing, hospital engineers are finding that oversized standby generators can mean operational problems. This document explains the oversized generator problem, including the code changes that gave birth to the problem. Some practical suggestions for sizing generators are then provided. PMID- 10132472 TI - Developing a request for proposal for a telecommunications system. AB - Because the quality of service and support of telecommunications systems in hospitals ultimately impacts patient care, selecting the vendor can be a significant process. Outlined in this document are the steps that should be taken before installing a new telecommunications system. Recommendations are given on how to prepare a request for proposal, how to narrow the list of bidders, and how to determine what's important to the hospital in selecting a vendor. PMID- 10132473 TI - Quality improvement for utilities management. AB - Utilities management has become a complex function in today's health care facility. Quality improvement, along with trending occurrences with utility equipment, will help the facilities manager reduce the amount of maintenance service calls due to recurring problems. This document will show examples of trending problems and their resolutions. PMID- 10132474 TI - The impact of aging infrastructure and site on facility planning. AB - Infrastructure analysis should be a basic component of the facility master plan and specific information concerning the site and facility must be collected, evaluated, and analyzed at each phase of development of the master plan. The interpretation of such information can significantly impact the visibility of design solutions, department locations, construction phasing, and costs. This paper identifies the information to be collected, its potential impact on the master plan, and the facility manager's role during the planning process. PMID- 10132475 TI - Health reform and employee health benefits programs. AB - The impact of health reform on employee health benefits programs could be dramatic. Depending on the health reform program adopted, employers could face significant new regulatory and economic burdens in operating employee health benefits programs or could find themselves greatly relieved of such burdens. President Clinton's proposal, in particular, would dramatically alter today's practices. This article focuses on how the Clinton proposal would change employee health benefits programs. Although President Clinton has indicated a willingness to compromise, his legislation may prove to be a house of cards, with all provisions interdependent. Employers should study all pending proposals carefully and weigh in on the debate so as to ensure that lawmakers are fully educated before making potentially irreversible decisions. PMID- 10132476 TI - Does EMS belong in the fire service? AB - For years, EMS was treated as public safety's neglected stepchild. But as fire suppression responses decrease, EMS is now a hot property--and everyone seems to want a piece of the action. Can EMS flourish under the auspices of the fire service, or are private and third-service systems the way to go? EMS provides a comprehensive report on the current national mind-sets. PMID- 10132477 TI - "Down, boy!". PMID- 10132478 TI - E. coli. PMID- 10132479 TI - The maul of the wild. Animal attacks can produce significant trauma. AB - Wild-animal attacks are almost an anachronism in our day and age. They remind us that humans can still be food or prey. Cougar attacks, though rare, produce significant trauma. Characteristic patterns of injury and wound infection should be appropriately identified and treated. As we protect wild-animal species and acknowledge their right to share territory, interactions--and possibly attacks- are likely to increase. Awareness, education, knowledge and prevention, rather than the elimination of animal populations, may be the best way to control wild animal attacks on humans in the future. PMID- 10132480 TI - The reliability of peer assessments. A meta-analysis. AB - A meta-analysis of studies examining the interrater reliability of the standard practice of peer assessments of quality of care was conducted. Using the Medline, Health Planning and Administration, and SCISEARCH databases, the English-language literature from 1966 through 1991 was searched for studies of chance corrected agreement among peer reviewers. The weighted mean kappa of 21 independent findings from 13 studies was .31. Comparison of this result with widely used standards suggests that the interrater reliability of peer assessment is quite limited and needs improvement. Research needs to be directed at modifying the peer review process to improve its reliability or at identifying indexes of quality with sufficient validity and reliability that they can be employed without subsequent peer review. PMID- 10132481 TI - Access to health care. A conceptual framework and its relevance to health care planning. AB - Despite some serious past efforts to clarify its multiple dimensions and meanings, access to health care has remained a rather elusive concept, hampering the work of health care policymakers and professionals as they endeavor to effect meaningful health care reform. This article provides perhaps the most detailed clarification of the access concept, especially the crucial linkages among the various access dimensions, and presents a comprehensive conceptual framework for evaluation and planning activities as they relate to people's access to health care services. The proposed conceptual model recognizes access as the outcome of a process involving the interplay between the characteristics of the health care service system and of potential users in a specified area, and moderated by health care related public policy and planning efforts. An elaborate typology of access, incorporating four pairs of access dimensions, is also derived. This atomization of the concept allows us to focus on specific aspects of the access to health care problem, and to develop precise outcome indicators of health system performance for evaluative purposes. Further, it enables the access concept and its pertinent dimensions to be put into proper perspective when assessing the health care access situation in a specific national or regional context. The relevance of the proposed access model and the typology to health care planning in general, and to spatial planning of health care service systems in particular, is also discussed. PMID- 10132483 TI - LA earthquake shakes foodservice foundations. PMID- 10132482 TI - Evaluating physician impact analysis. Methods, results, and uses in Ontario Hospitals. AB - Physician impact analysis (PIA) is a planning tool intended to bring greater predictability to hospital medical staff resource planning by providing a means to predict the impact of a new or replacement physician's practice profile on a hospital's clinical program priorities, staffing resources, and costs. Two key methods advocated to undertake PIAs are the Department Survey Method and the Hospital Medical Records Institute Case-Mix Groups/Resource Intensity Weights Methods developed by the Hospital Medical Records Institute. This article discusses issues related to the methods, results, and uses of PIA information in Ontario hospitals. Further evaluation of the PIA process is recommended to increase our understanding of both the strengths and limitations of this planning tool. PMID- 10132484 TI - Promoting healthful dining. PMID- 10132485 TI - The cafeteria at Scottish Rite Children's Medical Center, Atlanta, Georgia. PMID- 10132486 TI - Challenge: how to direct a management change. University Hospital, Newark, NJ. PMID- 10132487 TI - Challenge: how to please residents in a kosher facility. Jewish Rehabilitation Center for the Aged of the North Shore, Swampscott, MA. PMID- 10132488 TI - Cashing in on vending. PMID- 10132489 TI - Managed cooperation, not competition: a proposal for implementing national health reform. AB - National health reform should be implemented in a policy framework that encourages cooperation--not competition--to promote efficiency while extending universal coverage. "Managed cooperation" is defined here as a national health system built on collaborative efforts between purchasers, providers, consumers, and government through voluntary collective action, like the structural cooperation seen in the Japanese economy between government and the private sector. Six partnerships are encouraged: (1) government-industry, (2) purchaser provider, (3) physician-hospital, (4) public-private data sharing, (5) consumer provider, and (6) community health. Structural and legal barriers to cooperation, such as antitrust and malpractice reform, should be reduced or eliminated to encourage collaborative initiatives under national health reform. PMID- 10132490 TI - The un-managed competition revolution. PMID- 10132491 TI - The collaborative paradigm: a fragile bridge over the abyss between the two cliffs of government intervention and the free market. PMID- 10132492 TI - Collaboration versus competition: letting the natural order work. PMID- 10132493 TI - Skilled nursing facilities focus on gerontology care. PMID- 10132494 TI - Pueblo hospitals must look for new ways to compete, collaborate after FTC blocks deal. PMID- 10132495 TI - Physicians and managed care can thrive in the 21st century, says Chi Systems. PMID- 10132497 TI - Pilgrim Health Care Network provides capitation for joint ventures in New England. PMID- 10132496 TI - JSA Healthcare Corp. contracts to develop integrated family health system. PMID- 10132498 TI - San Diego's Scripps Clinic and Memorial Hospital merger based in managed care. PMID- 10132499 TI - HMO stock options good for hospitals? PMID- 10132500 TI - GAO reports on public/private elder care partnerships. PMID- 10132501 TI - How new control center has improved security at Valley Medical Center. PMID- 10132502 TI - What may be involved in an executive protection training program. PMID- 10132503 TI - Special report. PBX and voice mail fraud: what it is and how to protect against it. AB - As automation technology advances, so does the savvy of the criminal mind. And because the human factor is becoming more and more removed from costly operations such as telecommunications, scammers are even more difficult to track--in most cases leaving nothing but anonymous dial tones for clues. In this report, we will examine two types of telecommunications theft--PBX and voice mail fraud--as well as other scams capable of bilking thousands of dollars from hospital telecommunications budgets. PMID- 10132505 TI - Health care reform changes role of food and nutrition manager. PMID- 10132504 TI - Shelters for smokers: some questions to ask before going ahead. PMID- 10132506 TI - Self-managed teams. PMID- 10132507 TI - Seeing the benefits of integration. PMID- 10132508 TI - Recruiting physicians in safe harbors. PMID- 10132509 TI - Health care workers will define reform success. PMID- 10132510 TI - Rising Medicaid costs continue to strain Texas' budget. PMID- 10132511 TI - What does business expect from health care providers? PMID- 10132512 TI - Hats on! Health system reform will mean more responsibilities. AB - Health system reform will mean organizational consolidation, increased teamwork, new types of facilities and broader job responsibilities. Will you be able to handle all that? PMID- 10132513 TI - What happened? Controlling project budgets and costs. PMID- 10132514 TI - PM (preventive maintenance) and prompt repair key to HVAC system success. PMID- 10132515 TI - How (and why) to set up a facilitywide TB program. PMID- 10132516 TI - Fire prevention in laundry ductwork: some tips. PMID- 10132517 TI - Support staff aid care as in-house interpreters. PMID- 10132518 TI - Patient-escort/transport services: who does how much? PMID- 10132519 TI - Most surgical packs rise by 1.4%. PMID- 10132520 TI - Landmark capitated supply pact nears signing. PMID- 10132521 TI - Non-salary expenses in nuclear medicine. PMID- 10132522 TI - Ambulatory health campus: the "lite" hospital of the future. PMID- 10132523 TI - Strategies for "phase three" ambulatory care growth. PMID- 10132524 TI - A high-demand forecast for ambulatory care growth. PMID- 10132525 TI - Workers' compensation. PMID- 10132526 TI - Women in group practice: growing opportunity in the midst of challenge. AB - While opportunity for women in health care administration is greater than before, author Carrie Gianino contends that there are still barriers that must be breached. She argues that some of those barriers are self-imposed, others are constructed by others. PMID- 10132527 TI - Challenges for women in health administration. Past, present and future. AB - Yevonne J. Childers reports on a focus group of women practice executives. The group explored different barriers to professional success and how to circumvent those limitations with suggestions like being yourself, seeking educational opportunities and looking and acting professional. PMID- 10132528 TI - Profile of the 1990s woman clinic manager. AB - Peg L. Stone updates two previous papers with an unflinching look the female membership of Medical Group Management Association and whether or not their numbers are well represented in association governance and member organization leadership. PMID- 10132529 TI - Women in health care: roles women practice managers fill in management. Interview by Joseph W. Mitlyng, Jr.. PMID- 10132530 TI - A diagnosis of discrimination. Women physicians and the glass ceiling. AB - Author Christy Sebastian writes about some of the limits facing women physicians, from the glass ceiling on down. She relates the limits faced by women physicians to the gender differences--both subtle and blatant--evident in society as a whole. PMID- 10132531 TI - What do women want? Practices must meet the new and emerging needs of female physicians. AB - A call for change is issued by the author, Susan Cejka, for medical practices to start addressing critical needs for their female physicians. She tackles some of the myths about what women in the practice want and sheds light on the realities. Cejka also offers some suggestions of what medical practices can do to better serve their female physicians. PMID- 10132532 TI - Health care reform starts with primary care. AB - Under the Clinton health care reform plan, primary care physicians will be the gatekeepers of the health care system. Patrick E. Kapsner, FACMPE, writes about how the primary care physician will be a part of managed competition and how they will interrelate with specialty practices. PMID- 10132533 TI - Introducing teamwork in physician groups: a case study. AB - Authors Thomas N. Tavantzis, Ed.D., Carla J. Krasnik, M.B.A., M.S.N., and A. Douglas Bender, Ph.D., try team building as a basis for increasing quality and performance in a medical practices. Through the use of the Myers-Briggs Type Inventory, physicians were better able to understand their interrelationships and build more of a team feeling in the practice. PMID- 10132535 TI - Is integrating a health care system like raising a family? PMID- 10132534 TI - Physician employment practices in the medical group. Age discrimination in employment. AB - Ronald L. Dent, C.P.A., and Steven L. Thomas, Ph.D., explore age discrimination issues in medical practices: how older physicians are being squeezed out. The authors also investigate the laws that are in place to protect older physicians from losing their jobs because of their age. PMID- 10132536 TI - New OSHA rules for TB prevention are controversial. PMID- 10132537 TI - California hospitals, ORs respond to earthquake. PMID- 10132538 TI - Reusable textiles, with new look, make OR comeback. PMID- 10132539 TI - Experienced RNs elusive for rural hospitals. PMID- 10132541 TI - Benchmark study identifies top 100 hospitals. PMID- 10132540 TI - Shared leadership empowers all departments in the hospital. PMID- 10132542 TI - Decision on surgical textiles requires careful analysis. PMID- 10132543 TI - The rest of the spectrum: alternatives to managed competition. AB - In the November-December 1993 and January 1994 issues of Physician Executive, Kevin Fickenscher, MD, and David A. Kindig, MD, PhD, described the Clinton health reform plan and the Senate Republican Task Force proposals. At either end of the political spectrum are other proposals that are options to the managed competition model. This entry in the column is the last in a series that outlines the major proposals pending before Congress. It and the others are intended to highlight the major elements of the proposals, not their details. "A Matter of Policy" is jointly edited by Drs. Fickenscher and Kindig of the College's Forum on Health Policy. PMID- 10132544 TI - Medical resource allocation: rationing and ethical considerations, Part II. AB - The proliferation of medical technology during the past decade has doubtless surpassed that of any other recent period. We have witnessed and are continuing to witness rapid advances in human genetic engineering, reproductive technology, and biomedical intervention in the life process. Our population has benefitted from this technology as a result of its ability to extend the life of individuals, particularly the elderly sector of our society. This technological proliferation has caused philosophers, physicians, engineers, and policy strategists to focus upon questions of ethics and mortality relating to their application. In approaching the ethics of rationing, consideration must be given to both the deontological concepts of the individual and the utilitarian principles of societal preservation. This article continues a discussion of the issues of resource allocation that was begun in the February 1994 issue of Physician Executive. PMID- 10132545 TI - Transfer of ownership: antidote to closure. AB - In the 1990s, many hospitals will continue to be confronted with financial, regulatory, and medical staff issues that threaten their survival. Inadequate reimbursement, HCFA certification problems, and aging medical staffs are just a few examples of the many difficult issues health care institutions face today and that have contributed to the phenomenal number of failing hospitals. Failing hospitals must consider all their options, such as turnaround process, modification of service mix, change to a specialty hospital, transfer to a new owner, or closure. Selection of the most appropriate option hinges on the hospital's goals and mission, its need in the community, and its owner's and sponsor's desire or ability to continue in the health care business. This article will discuss the transfer of ownership option. PMID- 10132546 TI - IRS offers safe harbor in physician employment contracts. AB - Last year, the Internal Revenue Service (IRS) issued Revenue Procedure 93-19 (Rev. Proc. 93-19), which provides guidelines regarding service and other contracts involving facilities financed with tax-exempt bonds. Rev. Proc. 93-19 creates four "safe harbors" for certain contracts signed by tax-exempt organizations that will not jeopardize the organizations' tax-exempt bond interest. Those guidelines and methods for complying with them are the subject of the following article. "Health Law" is a regular feature of Physician Executive contributed by Epstein Becker & Green. Mark Lutes of the law firm's Washington, D.C., offices serves as editor of the column. PMID- 10132547 TI - Mandated benefits: a misguided effort. AB - The U.S. Congress is toying with the creation of universally mandated benefits for health care, most specifically in the health care reform proposal offered by the Clinton Administration. The notion of mandated benefits has already become a part of the health care scene in insurance and managed care plans. Instead of benefiting U.S. citizens as a whole, however, mandated benefits are likely to result in a reduction in health care accessibility and quality. The reason is that mandated benefits consume a continuously growing portion of the health care pie. Deming demonstrated that quality brings lower costs, but to obtain quality we must commit adequate resources. The free allocation of resources is negated by mandated benefits. PMID- 10132548 TI - Psychiatric home care: a new tool for crisis intervention. AB - The cost of psychiatric care has been rapidly increasing in recent years. Between 1984 and 1987, there was a 46 percent increase in psychiatric hospitals beds and a 60 percent increase in psychiatric units in general hospitals. This reflected a recognition by many health care systems that psychiatric patients were a good source of revenue. With this push toward more and more inpatient programs, crucial aspects of psychiatric care were left behind. Specifically, the limitations of inpatient therapy have not been recognized. Within the past five years, a new program has been developed and pioneered to use home care to prevent psychiatric hospitalizations and to also prevent the difficult transitions for psychiatric patients. Over a two-year period, this program was studied for its impact on the quality and cost of psychiatric care. PMID- 10132549 TI - A falls and balance clinic for the elderly. AB - A Falls and Balance Clinic for the elderly has been developed with the aim of identifying those at risk of subsequent falls, and recommending intervention strategies to reduce this risk. The physical and functional status of 149 clients referred to the Clinic are reported. Neurological and musculoskeletal pathologies were identified as the cause of falls in the majority of clients. Measures of gait velocity and stride length, and ability to stand on one leg were markedly reduced compared with normative data for healthy elderly. A number of other measures of balance, strength, and function are also reported. The results of a questionnaire about home environment indicated that only 28% of those referred had been assessed in their own home in the previous year. Home environment was considered a potential risk in a further 28% of clients and a home visit was instituted in these cases. Other intervention strategies included referral for further investigations (36%), Day Hospital (33%), provision of a home program of balance or strengthening exercises (27%), and medication change (15%). Issues related to the establishment, operation and long term evaluation of the effectiveness of a specialist Falls and Balance Clinic for the elderly are discussed. PMID- 10132550 TI - The national physiotherapy workload measurement system. PMID- 10132551 TI - Getting ready for reform. AB - Most hospitals and radiology departments are feeling the pressure of increased competition and consumerism. Mr. Bouchard discusses trends and possible solutions, and provides lists of practical strategies administrators can use to cope with financial repositioning. PMID- 10132552 TI - Patient-centered care through consolidation of outpatient services. AB - Prior to an innovative consolidation, it could take two hours to complete outpatient testing at the Ephraim McDowell Medical Center in Danville, Kentucky. Outpatients were subjected to time-consuming journeys through the hospital to find different departments. Frequently, they lost their way and entered restricted areas of the hospital. A quality improvement (QI) team was formed to implement a consolidation plan that had been developed by the radiology administrator and approved by upper management. In the end, three outpatient services were integrated into one location, greatly simplifying the process for patients and increasing efficiency for all. The consolidation was accomplished by reconfiguring existing space. It was open for service just two months after the QI team was formed. Outpatient testing can now be completed in 30 to 40 minutes. PMID- 10132553 TI - Managed care: imaging issues and impact. AB - The advent of managed care and capitation is dramatically changing our imaging management focus away from centralized inpatient services toward a decentralized ambulatory environment. In many ways, managed care is a response to an industry unwilling to meet the essential needs of its customers. Success in the new climate will depend on our ability to accept the reality of our future, strategically position our services and take absolute control of our costs. Without exception, every imaging department must respond to these challenges; no one will be exempt. This presentation combines data from national experts with the "Minnesota experience" and describes the impact on imaging services. PMID- 10132554 TI - Revisiting confidentiality. AB - Ms. Grumbine updates guidelines all hospital employees should follow to ensure confidentiality for co-workers and visitors, as well as for patients and their families, with specific examples from radiology. She also describes a new confidentiality program designed to involve staff throughout her institution in re-energizing and expanding the hospital's existing policies. PMID- 10132555 TI - Radiation safety regulations--the evolution and development of standards. AB - This article describes the development of radiation protection standards, including laws covering equipment, personnel and patients, from a historical and evolutionary standpoint. Laws for the safe use of equipment, guidelines for occupational exposure and means of patient protection are developed from reports and recommendations of national and international organizations. In the United States, some of these laws operate at the federal level and others at the state level. This process is not always well-understood due to the number of organizations involved. This article outlines the process for the radiology manager. PMID- 10132556 TI - Excerpts from Maintaining Radiation Protection Records. National Council on Radiation Protection and Measurements. AB - This is the first of a three-part series of articles from a report by the NCRP, to be reprinted in successive issues of Radiology Management. The report offers practical recommendations for establishing a radiation safety program. Different aspects of record-keeping, an essential part of all radiation safety programs, will be highlighted in each article. The introduction and a chapter on the systematic generation of records are included in this issue. PMID- 10132557 TI - What's wrong with this picture? AB - According to Mr. Hage, when the government tries to measure economic output, "the 1930's mentality sticks like bubble gum to the sole of a shoe." He is alarmed that the current debate about healthcare reform is based on economic data derived from antiquated methods of analysis and that we are "rocketing into the 21st century with our eyes firmly fixed on the rear-view mirror." PMID- 10132558 TI - How much coverage for mental illness? Many want full benefits; others fret over costs. PMID- 10132559 TI - Office visits to cardiovascular disease specialists: United States, 1989-90. PMID- 10132560 TI - Office visits to general surgeons 1989-90, National Ambulatory Medical Care Survey. PMID- 10132561 TI - Long-stay patients in short-stay hospitals. AB - In 1980 and 1990, only 4-5 percent of patients in short-stay hospitals were hospitalized for more than 3 weeks. The number of discharges and days of care for these long-stay patients were lower in 1990 as compared with 1980, but they continued to use more than a quarter of all hospital days in 1990. Long-stay patients were more likely than all patients to be 65 years of age and over and have Medicare as their expected principal source of payment. For long-stay and all patients, private insurance covered smaller proportions of discharges and days of care, and Medicaid covered larger proportions in 1990 than in 1980. Long stay patients were more likely than all patients to be discharged dead or transferred to other hospitals or nursing homes. Long-stay and all patients were more likely to be transferred at discharge in 1990 than in 1981. The Northeast Region had a larger proportion of long-stay patients than of all patients, and that proportion increased from 1980 to 1990. The proportion of long-stay discharges and days of care in the Midwest decreased during this period. In 1980 and 1990, more than 50 percent of the discharges and days of care for long-stay patients were for diseases of the circulatory system, mental disorders, neoplasms, or injury and poisoning. Despite the overall decreases in hospital use by long-stay patients, their discharges and days of care increased significantly from 1980 to 1990 for diagnoses such as septicemia, psychoses, and miscellaneous complications of surgical and medical care. Over time, decreases were seen in long-stay discharges and days of care for a variety of diagnostic categories, including malignant neoplasm of trachea, bronchus, and lung; diabetes mellitus; and fracture of the neck of the femur. Long-stay patients had a higher rate of procedures per 1,000 discharges in 1990 than in 1980, and a higher rate than all patients in both years. Approximately half of all the procedures performed on long-stay patients in 1980 and two-thirds in 1990 were miscellaneous diagnostic and therapeutic procedures, operations on the cardiovascular system, or operations on the digestive system. The rates of numerous procedures, especially diagnostic tests, increased for long-stay and all patients from 1980 to 1990. PMID- 10132562 TI - Firearm mortality among children, youth, and young adults 1-34 years of age, trends and current status: United States, 1985-90. PMID- 10132563 TI - Drug utilization in office practice. National Ambulatory Medical Care Survey, 1990. PMID- 10132564 TI - Office visits to urologists: United States, 1989-90. PMID- 10132565 TI - Overview of home health and hospice care patients. Preliminary data from the 1992 National Home and Hospice Care Survey. PMID- 10132566 TI - Human immunodeficiency virus antibody testing in women 15-44 years of age: United States, 1990. PMID- 10132567 TI - Firearm and motor vehicle injury mortality--variations by state, race, and ethnicity: United States, 1990-91. PMID- 10132568 TI - National Hospital Ambulatory Medical Care Survey: 1992 emergency department summary. PMID- 10132569 TI - Human resources management and structures: CEO perceptions and practices. PMID- 10132570 TI - Implementation of nutrition care service development plan at Banning Memorial Hospital: a case study. AB - Health care service markets in general and hospital care service markets in particular are characterized by many competitive developments. Hence, hospital marketing managers are forced to respond to these emerging competitive pressures. However, in formulating appropriate marketing management strategies, hospital managers need to have detailed knowledge about consumers and their behaviors in the marketplace. This paper focuses on the Nutrition Care division of the Department of Nutrition Service at a hospital and its venture into new service development. This case study is intended to emphasize the significance of acquiring adequate knowledge of customers in the health care services industry. It particularly emphasizes the critical role that this type of information concerning customer behavior plays in the development and implementation of an appropriate business expansion strategy. Furthermore, the aim of this case study is to help the reader to relate the acquired marketing information to the problem at hand, and make the appropriate marketing management decision. PMID- 10132571 TI - A demand function for the New York abortion market. PMID- 10132572 TI - Perspectives. CalPERS: an aggressive stance toward purchasing gets results. PMID- 10132573 TI - Perspectives. The Peachtree State strolls toward health reform. PMID- 10132574 TI - How hospital ownership affects access to care for the uninsured. AB - This article addresses the effect of hospital ownership on the delivery of service to uninsured patients. It compares the volume of uninsured patients treated in for-profit and nonprofit hospitals by regarding hospital ownership and service as endogenous. Instrumental variable estimates are used to predict the percentage of patients who are uninsured, controlling for hospital ownership and service. The study shows that when for-profit and nonprofit hospitals are located in the same area, they serve an equivalent number of uninsured patients, but for profit hospitals indirectly avoid the uninsured by locating more often in better insured areas. PMID- 10132575 TI - The role of the health record administrator in total quality management. PMID- 10132576 TI - LANS, WANS and VANS--networking made simple. PMID- 10132577 TI - "Edifact or fiction". PMID- 10132578 TI - Reforming healthcare design. PMID- 10132579 TI - TennCare up and running. AB - Tennessee's brand new program is the first of its kind tried by any state to bring managed care and Medicaid together. Here are the details of the model program along with expert opinions of the possible outcomes. PMID- 10132580 TI - TennCare: a consumer's view. PMID- 10132581 TI - TennCare: the physician view. PMID- 10132582 TI - Woodland Community Hospital. PMID- 10132583 TI - Measuring America's opinions on health reform. PMID- 10132584 TI - Are you prepared to contract? (Part II). Things to consider when negotiating with HMOs. PMID- 10132585 TI - Single-payer strategy. PMID- 10132586 TI - Computer assisted E.R. diagnosis. PMID- 10132587 TI - Health reform may create its own bureaucracy .... PMID- 10132588 TI - Patient choices, family interests, and physician obligations. AB - Recent articles in biomedical ethics have begun to explore both the relevance of family interests in treatment decisions and the resultant ramifications for physicians' obligations to patients. This article addresses two important questions regarding physicians' obligations vis-a-vis family interests: (1) What should a physician do when the exercise of patient autonomy threatens to negate the patient's moral obligations to other family members? (2) Does respect for patient autonomy typically require efforts on the part of physicians to keep patients' treatment decisions from being influenced by family considerations? A series of clarifications about the concept of autonomy is also presented. PMID- 10132589 TI - Women and health research: a report from the Institute of Medicine. PMID- 10132590 TI - NFPA Journal buyers' guide 1994. Fire protection and fire service reference directory. PMID- 10132591 TI - How Clinton's health benefit package compares to today's employer-sponsored plans. AB - Will you and your employees be better or worse off under the Clinton Health Security Act? A national survey of nearly 2,000 large and small businesses finds that a few workers will pay a lot less and receive a lot more insurance coverage than they receive today, while those who lose ground will just be a little worse off. PMID- 10132592 TI - Keeping medical records private in the electronic information age. AB - Americans put a high priority on the confidentiality of medical records, but today's paper-based system offers few safeguards. Congress must address privacy and confidentiality concerns when it takes up health reform this year. PMID- 10132593 TI - Federal health reform--the same as it ever was? PMID- 10132595 TI - States eye no-fault insurance as medical malpractice remedy. PMID- 10132594 TI - New strategies for paying retiree health care costs. AB - Adequately funding the costs of retiree health care--both by individuals and employers--is essential to the nation's financial stability. But health reform bills, including the one proposed by the Clinton Administration, would fund these costs out of current revenue, creating an enormous future taxpayer liability. No matter what reform plan Congress passes, lawmakers should offer savings plans that encourage Americans to fund these benefits while they're working. PMID- 10132596 TI - States putting the brakes on comprehensive reforms. PMID- 10132597 TI - Swedes test capitalist waters in new health system reforms. AB - While most Swedes say they're satisfied with their socialized health care system, problems ranging from long waits for surgery to a growing federal deficit have prompted health officials to inject some elements of American-style managed care and competition. Reforms include abandoning central primary care clinics in favor of allowing patients to choose a family physician; privatizing some hospitals; and separating health financing from delivery. PMID- 10132598 TI - Outcomes research: high hopes, low yield? AB - The bulk of the nation's health services research has been redirected toward patient outcomes research conducted by the U.S. Agency for Health Care Policy and Research. But those expecting dramatic changes from the agency's work are likely be disappointed. One reason is the tendency to seize upon clever new theories as solutions to intricate problems, such as the inflated expectation that managed care will reap huge cost-savings. PMID- 10132599 TI - Single payer proposals alive and well in many states. PMID- 10132600 TI - More states adopt health alliances; see problems with voluntary system. PMID- 10132601 TI - Show-Me State takes modest reform route. PMID- 10132603 TI - CBO forecasts industry winners, losers under Clinton health plan. PMID- 10132602 TI - States rebel against Federal abortion orders. PMID- 10132604 TI - Up or down, medical prices don't matter--spending does. AB - The political battle over whether the recent drop in the medical care price index lessens or dramatizes the need for health reform is useless. In America's health care industry, prices are not meaningful, quality improvements go unmeasured, and relationships to other goods are distorted--all of which renders the medical care price index almost a worthless tool for policymakers. What the country needs is a new index, one that measures total health care spending. PMID- 10132605 TI - Surgeons make public policy. PMID- 10132606 TI - Our second responsibility in trauma care. A new clause in the social contract. PMID- 10132607 TI - Our malpractice problem: perspectives of an expert witness. Interview by Karen Sandrick. PMID- 10132608 TI - Surgery in the '90s and beyond: young surgeons voice concerns and satisfactions. PMID- 10132609 TI - Special report. Ahead of the curve: business alliances reform health markets. PMID- 10132610 TI - Staff jailed in western-style roundup now 'wanted' as good requisitioners. PMID- 10132611 TI - OR supply survey: whose job is it anyway? PMID- 10132612 TI - Custom pack bids may save $100,000: a pre-bid analysis. PMID- 10132613 TI - Can't get no satisfaction? Certify your suppliers. PMID- 10132614 TI - Materials management a plus in dietary. PMID- 10132615 TI - Sick of 'whine and jeez' parties? Here's how to convert complainers. PMID- 10132616 TI - Save a bundle with new supply-management method. PMID- 10132617 TI - Quality team ensures best management of OR instruments. PMID- 10132618 TI - Why is a little water such a big deal? PMID- 10132619 TI - Stats. Patient-escort/transport services:who does how much? PMID- 10132620 TI - Correlation of the RTS (Revised Trauma Score) and RAPS (Rapid Acute Physiology Score) in rotor-wing prehospital care. AB - INTRODUCTION: The Rapid Acute Physiology Score (RAPS) has been applied to patients transported by air, but not correlated with commonly used prehospital indices. The authors desired to determine the correlation between RAPS and Revised Trauma Score (RTS). Correlations between RAPS and RTS in patients with non-trauma ills were also investigated. METHODS: Eight-hundred forty-four consecutive patients transported by helicopter were retrospectively evaluated. Demographics, origin of transport, nature of illness, RTS and RAPS were recorded. RTS vs. RAPS scores were graphed using sunflower technique and correlation was calculated using Spearman Rank-Order Correlation Coefficients (SCC). Alpha was set at < or = .05. RESULTS: Sunflower plots revealed wide ranges of RAPS at like RTS values in less severely ill or injured patients. SCC analysis revealed statistically significant (p < .05) correlations for all patients and for subgroups of prehospital trauma, prehospital medical, interfacility trauma and interfacility medical patients. Degrees of correlation varied between groups, with agreement being strongest in prehospital trauma and weakest in interfacility trauma patients. CONCLUSIONS: We conclude that RTS and RAPS scores exhibit significant correlation in a variety of patient populations. The wide range of RAPS seen at like RTS values suggests that RAPS may be a more sensitive indicator of physiologic status in patients transported by air. PMID- 10132622 TI - Data watch. New data show single-digit cost increases. A survey of 2,395 employers by Foster Higgins. PMID- 10132621 TI - A computer-based simulator for air ambulance system analysis, design and optimization. AB - INTRODUCTION: Little is known about how best to quantitatively measure air medical system performance and optimally manage air medical emergency medical services start-up, operation and growth. Moreover, very little has been done to produce and distribute relevant tools for these critical tasks. SETTING: A hypothetical system modeled on the Ontario, Canada, air ambulance operation. METHODS: A user-friendly, high-performance computer simulation tool for air ambulance system design, quality management and optimization was developed. In this report, the authors describe the simulator's basic structure and method of operation and present the initial findings for application to the Ontario air ambulance system. The tool tested the hypothesis that if shorter patient transfer times positively influence patient survival and higher aircraft performance, as measured by block speed, has a positive correlation with aircraft direct operating costs, then there is a pattern of "best matching" between aircraft performance, flight economics and patient survival probability for the system. RESULTS: In the Ontario air ambulance system, an additional outlay in direct operating costs of $100 per flight yields an improvement in system quality, as measured by an improvement of 1% to 30% in the predicted patient survival probability, depending on the reference cohort and the efficacy of the life support procedures administered by the air crew. DISCUSSION: A notable feature of this model is that it separates the impact of air medical transport on patient survival from subsequent measures undertaken at the emergency department after delivery to the trauma center. The current needs of the air medical transport industry, combined with the progress to date, suggest that computer-based simulators can be a powerful, cost-effective means of extracting meaning from air medical data and applying the results to productive ends. PMID- 10132623 TI - Health care costs moderate in 1993. PMID- 10132624 TI - Using data to improve quality. PMID- 10132625 TI - Piecing together the plan. Congress faces some tough decisions as it puzzles over six plans. PMID- 10132626 TI - A wellness program or a bitter pill? PMID- 10132627 TI - The looming shadow of regulation. PMID- 10132628 TI - Making a dent in specialty care costs. PMID- 10132629 TI - Is there a crisis? Absolutely! PMID- 10132630 TI - Diluting the effect of the Blues. PMID- 10132631 TI - Is the death of UM greatly exaggerated? PMID- 10132632 TI - Health reform: the missing story. Critics in fright wigs mislead you about the Clinton plan. PMID- 10132633 TI - Brigham and Women's teams PACS, RIS technologies. PMID- 10132634 TI - 'Soft wall' technologies coming closer to home. PMID- 10132635 TI - Satellite video system aids offshore treatment. PMID- 10132636 TI - HotList. Case-management tools. AB - March's HotList features information systems designed to assist case managers. All data have been provided by individual vendors who responded to survey questions. Health Management Technology has made an effort to contact all vendors within this market. Of 213 vendors contacted, 26 responded as offering case management-tool products. A full contact list may be requested by contacting HMT Editorial at (303) 220-0600. See the 1994 Health Management Technology Market Directory for complete listings. PMID- 10132637 TI - Physical plant staffing for health care facilities. AB - No single set of guidelines exists or even applies for determining physical plant staffing for each and every health care facility. However, one possible method is outlined in this document, with procedures to apply to most situations. The method should also help provide justification for staffing needs, and includes the results of a nationwide survey on the issue. PMID- 10132638 TI - The internal environmental audit: a practical plan for hospitals. AB - While environmental regulation is by no means a new concept, growing concern about environmental issues has led to an unprecedented amount of legislation in recent years. Violations of environmental laws can result in severe civil actions and in some cases may even lead to criminal sanctions. Today more than ever, health care facilities should develop and maintain an environmental management system that ensures compliance with applicable laws and regulations, and minimizes exposure to environmental liabilities. The environmental audit plan described in this document is designed as part of a facility's ongoing efforts to manage issues and address legislation related to the physical environment of the health care facility. PMID- 10132639 TI - Safe Medical Devices Act of 1990: current hospital requirements and recommended actions. AB - Since the Safe Medical Devices Act of 1990 was signed into law, a great deal of confusion has surrounded it. This document reviews the current status of user reporting and device tracing--including the MEDWatch program--and the status of the final regulations. In addition, readers will learn what it all really means for hospitals and what incidents must now be reported to the FDA. PMID- 10132640 TI - Managing mercury: simple, effective methods for cleaning up small spills. PMID- 10132641 TI - Risk managing the medical waste exposure: strategies for device manufacturers. PMID- 10132642 TI - The changing world of medical packaging. PMID- 10132643 TI - States address mixed waste disposal. PMID- 10132644 TI - States pursue waste reduction strategies. PMID- 10132645 TI - Minimizing and managing low-level radioactive waste. PMID- 10132646 TI - The impact of the radioactive waste crisis on medical applications. PMID- 10132647 TI - Managing mercury: viewpoints from inside the hospital. PMID- 10132648 TI - The State of New Mexico assists hospitals in source reduction. PMID- 10132649 TI - Indoor air quality in hospitals. AB - In summary, prevention through a proactive air quality monitoring program is far more desirable than dealing with an actual sick building. Regardless, there are effective, rational approaches for diagnosing sick buildings. In the upcoming years, it is inevitable that extensive air monitoring will be required, not only in hospitals but in all commercial buildings. PMID- 10132650 TI - New regulations for New York. PMID- 10132651 TI - 1994 Joint Commission standards: focus on informed decision making. PMID- 10132652 TI - Life cycle analysis of health-care packaging and materials. AB - By quantifying the indirect as well as the direct environmental consequences of a health-care product or packaging, LCA can provide valuable information for decision making by consumers and manufacturers. Yet, as noted above, it is only one component in the overall decision-making process. PMID- 10132653 TI - The impact of regulation on managing medical waste in New York City. PMID- 10132654 TI - Designing products with the environment in mind. PMID- 10132655 TI - Electro-thermal deactivation: one approach to comprehensive medical waste management. PMID- 10132656 TI - Environmental evaluation of a hospital parking deck addition. PMID- 10132657 TI - Assessing packaging compatibility with the environment. PMID- 10132658 TI - Managing patient wastes: taking your program to the next level. PMID- 10132659 TI - OSHA to use general duty clause to enforce CDC guidelines during pendency of TB rule-making petition. PMID- 10132660 TI - Closing the loop: buying recycled and for recyclability. PMID- 10132661 TI - Recycling at Mayo Medical Center. PMID- 10132662 TI - How parents cope with the experience of neonatal intensive care. AB - Thirty-two mothers and 25 fathers described their coping efforts during the initial weeks of their preterm infants' hospitalization in a neonatal intensive care unit. Utilizing procedures developed by Lazarus and Folkman (1984) in which coping is linked with a specific stressful event, parents reported what they did to cope with the stressor they perceived to be the most stressful. They also completed the Ways of Coping Questionnaire (Folkman & Lazarus, 1988). Results showed that there were similarities and differences in the types of coping strategies used by mothers and fathers. In addition, factors such as neonatal morbidity and appraisal of control were differentially associated with the use of certain types of coping strategies. Implications for future research and clinical practice are discussed. PMID- 10132663 TI - Stress appraisals of hospitalized school-age children. AB - This study investigated the influence of health status as acutely or chronically ill, gender, and trait anxiety on the stress of 82 hospitalized children ages 8 through 11. Two aspects of stress were examined: (a) the specific events appraised as stressful, and (b) the appraised stressfulness of the global event of hospitalization. Findings indicated that chronically ill children identified more intrusive events and acutely ill children identified more physical symptoms as stressful; children with high levels of trait anxiety were more likely to appraise hospitalization as stressful. Gender did not have a significant influence on stress. PMID- 10132664 TI - Psychological preparation for pediatric oncology patients undergoing painful procedures: a methodological critique of the research. AB - Hypnosis and cognitive-behavioral packages are effective in preparing pediatric oncology patients for bone marrow aspiration and lumbar puncture. However, the relative efficacy of different preparations has not been determined, and potent components of preparation packages have yet to be identified. Further, factors hypothesized to moderate effectiveness of preparation (e.g., cognitive development) have not been investigated. Finally, due to a failure to employ process measures, the extent to which hypothesized mediators of behavior change (e.g., self-efficacy) are modified by preparation is unclear. Following an overview of empirical investigations, we make recommendations for addressing these limitations in future research. PMID- 10132665 TI - Learning to live with the Family and Medical Leave Act. AB - Many issues surround the Family and Medical Leave Act of 1993. Employer concerns focus on eligibility, lost work hours, and the conditions of granting leave. Employees would like to know what their new rights are, how the Act affects their benefits, and what documentation they must present to demonstrate a need for leave. Both agency administrators and home care workers will find clarification here. PMID- 10132666 TI - The President's health care reform plan. A NAHC analysis. National Association for Home Care. AB - President Clinton's health care reform plan represents an ambitious effort to expand access to care and restrain the growth in health care costs. Both goals are served by the greatly expanded home care and hospice benefits that the plan would afford. Under the President's plan, home care and hospice benefits are included in the federally guaranteed basic benefits package that would be provided to all Americans and legal residents. In addition, the plan creates a new federal program for long-term home care services for the severely disabled. Medicare benefits are also enhanced to provide coverage for home infusion therapy. The increased reliance on home- and community-based services would bring a paradigm shift away from institutional care toward home-based care for individuals with acute and long-term care needs. The President seeks to achieve these goals by building on the current employer-based system of health insurance. This approach was chosen because it was believed to be the least disruptive of the various financing mechanisms available, but it would require the use of a finely tuned system of subsidies to avoid damaging small employers and the economy. In summary, NAHC believes this program is an excellent starting point for a serious debate of health care reform inasmuch as it meets the three major objectives established by the membership: the plan would keep Medicare intact, require a basic benefits package that includes home care and hospice services, and create a new long-term care program based on home- and community-based care. PMID- 10132667 TI - Health care reform. National Association for Home Care 1994 legislative blueprint for action. PMID- 10132668 TI - HEART (Health Equity and Access Reform Today) Bill offers alternative to Clinton plan. PMID- 10132669 TI - Comparison of major health care reform proposals. Issues important to home care and hospice. AB - The National Association for Home Care prepared this side-by-side analysis of the major health reform proposals that had been introduced as of mid-January. Our primary intent is to explain how these various plans address the association's positions on health care reform issues. PMID- 10132670 TI - Long-term care is health care--include it in reform. AB - Studies show that the majority of Americans favor long-term care as an essential benefit in any health care package. This article examines current health care reform legislation and urges legislators and the public to demand long-term care as a necessary ingredient in health care reform. PMID- 10132671 TI - How the Health Security Act will affect small businesses. AB - Many home care agencies operate as small businesses, and certainly they have many questions beyond policy areas--in particular about how health care reform will impact their operation. The Small Business Administration has answers to those questions. PMID- 10132672 TI - Home care & managed care--prospective partners. AB - Health care reform will soon be upon both home care and managed care. Can the two industries meet and accomplish their mutual goal of providing cost-effective, high-quality care? PMID- 10132673 TI - Rationing or triage? The fate of the homebound aged. PMID- 10132674 TI - Chemotherapy waste reduction through shelf-life extension. AB - Minimization of total drug expenditures within the health care system, without affecting patient outcome has become a rational goal in today's economic, environment. The objective of this study was to observe the effect of extending the shelf-life for three chemotherapy medications, [doxorubicin, epirubicin and mitoxantrone] on wastage of these medications. Prior to and following the introduction of new, longer, shelf-lives for these three medications, prospective, non-randomized, unblinded four-month chemotherapy wastage audits for all chemotherapy medications were completed at 18 institutional sites within Ontario (six Ontario Cancer Treatment and Research Foundation clinics, ten Ontario hospitals and two preparation sites in a large cancer treatment centre). Data were provided by 18 sites in 1989 but from only 12 sites in 1990. Ten of the 12 sites extended their shelf-lives for each of doxorubicin, epirubicin and mitoxantrone, and on average, waste at these sites was reduced to less than 1% of the 1989 total for epirubicin, less than 15% for doxorubicin and 35% for mitoxantrone. Many sites eliminated waste entirely for these drugs. For sites which did not extend their shelf-lives, the waste remained unchanged. We conclude that appropriate extension of the shelf-life for chemotherapy medications can reduce waste, and is a relatively simple method of reducing expenditures without affecting health outcomes or adding additional complications to IV chemotherapy. PMID- 10132675 TI - Documentation by pharmacists in the health care record: justification and implementation. PMID- 10132676 TI - Measurement of insulin wastage in five Ontario hospitals. AB - This study was designed to determine the extent of insulin wastage and the extrapolated cost of wastage for Ontario hospitals. The five hospitals in the study were chosen to include differences in patient mix and drug distribution systems. Beginning and ending inventories of all insulin types were taken spanning a six-week period. The quantity of insulin dispensed and wasted during this time period was recorded. Partial vials were measured using a calibrated scale. Wastage was calculated as insulin discarded divided by the amount of insulin used in the time period. Insulin wastage averaged 34.1%. This was equivalent to up to $8,000 a year for the largest hospital surveyed and translates to an estimated cost of $360,000 a year in all Ontario hospitals. Therefore, hospitals should estimate their insulin wastage and seek ways to reduce it. The pharmaceutical industry should be encouraged to develop cost effective insulin delivery systems. PMID- 10132677 TI - Staying ahead of the competition. PMID- 10132678 TI - Fixing Clinton's health care plan. PMID- 10132679 TI - Rural health care under the Health Security Act. PMID- 10132680 TI - Department of Justice Antitrust Division ok's provider contracting network. PMID- 10132681 TI - Regulation won't solve our workforce problems. PMID- 10132682 TI - Why we need government regulation. Interview by Diana Madden. PMID- 10132683 TI - A look at federal proposals to regulate the workforce. PMID- 10132684 TI - Using computers to help internists master medical information. Interview by C. Burns Roehrig. PMID- 10132685 TI - Congress and health care: predictions and priorities. PMID- 10132687 TI - Personal responsibility for health care costs. American Society of Internal Medicine. PMID- 10132686 TI - Payment inequities present a challenge to internists. PMID- 10132688 TI - Regulating the supply of internists: whose hand should be on the spigot? PMID- 10132689 TI - Special report. Human resources. AB - A new survey reveals the changing shape of human resource departments. Why call in management consultants? Shirley Giles reports. The standard payroll system is being challenged by moves towards integrated payroll and personnel programs. Barbara Millar examines staff support schemes. Trusts are tightening up on relocation packages. PMID- 10132690 TI - Payroll pitfalls. PMID- 10132691 TI - Perspectives on purchasing--local and vocal. PMID- 10132692 TI - Slim pickings. PMID- 10132693 TI - Medication noncompliance: an issue to consider in the drug selection process. AB - Patient medication noncompliance is a major public health problem that represents a significant cost to our health care system. Health care professionals--through counseling programs, and the pharmaceutical industry--through various improvements in drug products, have helped to improve medication noncompliance. Yet, additional research needs to be conducted on noncompliant behavior and into methods to improve it. All health care professionals, particularly those involved in selecting and guiding drug therapy decisions, need to be made aware of the costs to the health care system that result from noncompliance. PMID- 10132694 TI - A continuous quality improvement program for phenytoin i.v. AB - The P & T Committee at Latrobe (Pa.) Area Hospital conducted a drug use review of i.v. phenytoin, which lead to revised guidelines for the use of i.v. loading doses of this agent. The reasons for the study, its results, and the actions taken are presented below. PMID- 10132695 TI - Use of severity-indexed medication error reports to improve quality. AB - A severity-indexed medication error reporting system using data from voluntary incident reports has provided enough information to target opportunities for quality improvement. Reports are ranked by severity and categorized by error type, system breakdown, drug category, and nursing unit. Specific reports are generated for review by different quality improvement committees in the hospital. Based on these data and the actions of these quality improvement committees, four problem areas in medication use have been identified. Recommendations for improvements have been made to solve problems with late IV antibiotic doses, narcotic errors, anticoagulant errors and transcription errors. Two of these initiatives have resulted in objective improvement. Two others are being actively pursued to resolve medication related problems. PMID- 10132696 TI - Impact of a clinical pharmacist on cost saving and cost avoidance in drug therapy in an intensive care unit. AB - The authors performed a study to document the impact of a clinical pharmacist on cost saving and cost avoidance in an intensive care unit, and to evaluate the cost saving and avoidance to justify additional clinical pharmacist positions. Over 13 consecutive 5-day weeks, a clinical pharmacist with 50% teaching responsibility documented time spent and all interventions that impacted the cost of drug therapy. Both cost avoidance and cost saving were documented on change in route, change in dosage, change to another drug, discontinuation of therapy, discontinuation of therapeutic duplication, discontinuation of inappropriate therapy, notification of pharmacy of discrepancy, and improper drug-level monitoring avoidance. Cost analysis was calculated based on acquisition costs. The final cost saving was derived from adding cost avoided and cost saved minus pharmacist salary for the time spent in conducting the study. A total of 310 interventions were documented during the 13 weeks (65 days) of the study. The final cost saving was $79,723, which would extrapolate to an annual savings of $318,891. Although 31.3% of interventions involved change of dosage, interventions involving change to another drug (13.9%) had the largest economic impact ($62,527). The majority (85.4%) of the savings involved costs of medications saved (actual dollars saved rather than avoided). The authors concluded that the clinical pharmacist had a significant impact on the cost of drug therapy in the intensive care unit and that the cost of additional clinical pharmacist positions should be justified. PMID- 10132697 TI - Pharmacy mass casualty disaster plan implemented after the train wreck. AB - The involvement of a hospital pharmacy department in a mass casualty disaster revealed strengths and weaknesses of the department's disaster response plan. Effective communication and notification within the pharmacy department and the need to plan to have pharmacists in the triage area to determine patients' lost medications are important areas that the department had not practiced in disaster drills. PMID- 10132698 TI - Clinical pharmacy services in an intermediate care facility for the mentally retarded. AB - The impact of a focused drug regimen review process based on clear objectives and of interdisciplinary team cooperation is described. By shifting from a pharmacy departmental focus, which was primarily on drug distribution activities, to a broader agenda that promotes pharmacists as clinicians, inroads were made in reducing medication doses per resident, decreasing nursing time spent in medication administration, and decreasing pharmacy expenses in this residential facility for the developmentally disabled. PMID- 10132699 TI - Assessment of pharmaceutical care needs in an ambulatory setting. AB - The authors assessed the perceived pharmaceutical care needs of ambulatory pharmacy patients based on their demographic characteristics and desired service mix. A questionnaire was given to repeat ambulatory pharmacy patients for 30 consecutive weekdays during April and May 1992 to assess patient satisfaction with current and future services. A total of 152 surveys were completed by patients while waiting for prescriptions to be filled. Overall, responses were favorable considering the existing level of services provided by pharmacists. More than 70% of all respondents were in favor of talking with a pharmacist about their prescriptions, receiving easy to understand advice on potential problems, and having their prescriptions thoroughly explained. Current dispensing services were also viewed as highly satisfactory by a majority of respondents. However, some patients apparently need more information regarding convenience services. Such information helps establish a profile of ambulatory patients so that an optimal service mix can be provided. PMID- 10132700 TI - The new survey process and input into standards development. PMID- 10132701 TI - Reengineering--it's totally radical. AB - Reengineering. What does it really mean? How does it work? Where do you begin? And, if it's as great as it's cracked up to be, why does it fail more often than not? PMID- 10132702 TI - Reengineering--united we stand. AB - The strategist must manage the organization as a system of interrelated pieces by pulling together all the individual elements and helping them reach a common goal. PMID- 10132703 TI - Reengineering--setting a course for radical change. AB - When you pull up anchor and start reengineering, the seas can look a little rough. Here's what the strategist can expect when retooling some of the typical business processes that make up an average company: manufacturing, sales, information technology, back office/support services, and human resources. PMID- 10132704 TI - Shake, rattle & roll: 24 revolutionary technologies. PMID- 10132705 TI - The strategist's software directory. AB - With so many off-the-shelf software packages on the market, how do you know which are the real planning tools? Here's an annotated list that takes a hard look at how these programs help you analyze situations, generate ideas, and craft solutions to strategic problems. PMID- 10132706 TI - Implementing the Safe Medical Devices Act in a hospital. AB - Implementation of the Safe Medical Devices Act (SMDA) by a "medical device user facility" requires the introduction of new responsibilities, processes, and accountabilities. The complexity of a program will vary with the number of devices included, as well as the medical activities of the particular facility. The implementation of the SMDA is described in a 145-bed, acute care, county hospital, along with some of the practical problems and solutions associated with its implementation. Both the event reportability section and the tracking section of SMDA have been implemented. The greatest difficulty in the event reportability section lies in the ambiguous definitions that determine event reportability. This ambiguity may be clarified when the final regulations are published. In respect to device tracking, questions remain unanswered that relate to the manufacturer-facility interface and disposition of explanted devices. PMID- 10132707 TI - Monitoring pacemaker patients. AB - This feature article provides a basic discussion of how pacemakers function and how physiologic ECG monitors detect pacemaker rhythms. The most common environmental conditions that can adversely affect pacemaker detection are described, along with clinical techniques that can be used to ensure optimum pacemaker detection. PMID- 10132708 TI - Computerized long-term trending of respiratory parameters. AB - This paper presents a program that analyzes data recorded from a Puritan-Bennett 7200a mechanical ventilator. The program generates graphs of major ventilatory parameters, as well as the derivatives of the parameters, such as respiratory rate and minute volume with respect to time. The program also creates a series of reports that summarizes setting changes, alarm violations and resets, and lung mechanics maneuvers during the process of respiratory therapy. These graphs and reports provide clinicians with information, which was not captured for review before, in an organized format allowing them to easily identify trends and, in some cases, events that may affect the patient. The results of a clinical study are also presented. The study was designed to determine the effect of routine patient care on the primary and derived respiratory data so that a correct interpretation of the recorded data could be made. The study showed that the data acquisition program was not sensitive to routine bedside activities, and some significant events, such as patient disconnects, are identifiable in a timely manner and with good accuracy. PMID- 10132709 TI - Putting on your EMS face. PMID- 10132710 TI - Pen-based computing and EMS. The Denver experience. PMID- 10132711 TI - Electronic visions. The future of EMS communications is now. PMID- 10132712 TI - The state of solid state. AB - This talk about future communications technology is all well and good, but what about the things we already have? What's going on with current technology? And if things are going to change, what will the transition be like? For an overview, JEMS talked to a group of EMS communications experts: Bruce Jackson, president of EMSAT: Advanced Technology for EMS, in the Los Angeles area; Mark Johnson, chief of Alaska's EMS Section, chairman of the National Association of State EMS Directors' Communications Committee; and Steven Buckley, communications and facilities planning manager of the Warner Group, a public safety communications consulting company in Woodland Hills, Calif. The following summarizes their views on current issues and their projections for the near future. PMID- 10132713 TI - The Los Angeles earthquake response "system". People doing what they had to do. PMID- 10132714 TI - Icy response. Bitter cold freezes 23 states. PMID- 10132715 TI - Assessment-based prehospital care? PMID- 10132716 TI - Liquid oxygen. A new look for an old companion. PMID- 10132717 TI - Ethics and financing: overview of the U.S. health care system. AB - An overview of the financing decisions that occurred with the U.S. health system during the past five decades was presented in relation to the ethical issues which gave rise to and resulted from those financing decisions. This health system evolved from decision-making grounded in altruism through increasing the access and supply of resources to a position of caution and financial prudence. Recently the decision-making became grounded in pragmatism with the realization that attempts to provide everyone with all possible health services on demand cannot be achieved. Financing decision have resulted in a health care system based on acute care and sophisticated technology but with too many hospital beds and physicians, both geographically maldistributed. Since this acute care system has been successful in preventing premature deaths, our population now lives longer and develops chronic illnesses which require different interventions; the system has neglected to focus on prevention and adequate care for long-term diseases. It has created a growing population of uninsured who are unable to afford health care when illness occurs. Alternative strategies were discussed at three levels of the health system. At the overall system level, the following was proposed: consistent application of ethical principles most appropriate to allocation decisions and the creation of health policy which encompasses chronic care and disease prevention components. At the organizational level, health administrators and local community leaders must cooperatively address local health issues; medical education should focus on long-term care and disease prevention; and medical practice should reduce variation in treatment patterns. At the population level, healthy lifestyles must be encouraged in addition to the development of alternative reimbursement plans to maximize access to health care. Davis and Rowland (1990:298) have stated that our nation's image is strained" ... as a just and humane society when significant portions of the population endure avoidable pain, suffering and even death because of an inability to pay for health." These are turbulent times in health care but addressing the ethical issues at many levels may lead to successful alternatives and ultimately to a workable health strategy for this country. PMID- 10132718 TI - Technology, the biggest health-care cost-driver of all. Can we curb its rise? PMID- 10132720 TI - The wrong way to discourage specialization. PMID- 10132719 TI - An HMO tried to make me buy my patients. PMID- 10132721 TI - AMI targets Memphis, reports gains. PMID- 10132722 TI - After year of uncertainty, HealthSpan decides to keep shareholder role in VHA. PMID- 10132723 TI - Antitrust exemptions opposed. PMID- 10132724 TI - Ads play a role in debate on reform. PMID- 10132725 TI - PAC contributions from providers, insurers rise 22%. PMID- 10132727 TI - Baptist, St. Luke's plan merger in San Antonio. PMID- 10132726 TI - Ruling could mean millions for hospitals. PMID- 10132728 TI - Texas healthcare firm acquires plans to reopen Detroit facility. PMID- 10132729 TI - Consumers are comparing prices as they shop to pick HMOs in hot markets--study. PMID- 10132730 TI - Troubled CareNetwork gets pact from largest teacher union in Wis. PMID- 10132731 TI - Claim denials disparities cited. PMID- 10132733 TI - Mass. medical center, HMO in effort to beat prices of competitors. PMID- 10132732 TI - Reports allege savings, deficit woes. PMID- 10132734 TI - W.Va. pulls back from reform action. PMID- 10132735 TI - Columbia/HCA's Fla. hospital buy sparks Sarasota affiliation talks. PMID- 10132736 TI - Groups back clearer fraud laws. PMID- 10132737 TI - Stark bill may limit satellite sites. PMID- 10132738 TI - Some sectors to see earnings sag. PMID- 10132739 TI - Small hospital gets big help in novel deal. PMID- 10132741 TI - Psych chain Ramsay adding rural clinics. PMID- 10132740 TI - Corporate giving slowly shrinking. PMID- 10132742 TI - In a long-delayed report, U.S. Surgical details large fourth-quarter loss in 1993. PMID- 10132743 TI - United HealthCare, Cigna mavericks on report cards. PMID- 10132744 TI - Illinois hospitals seek revamp of crumbling trauma network. PMID- 10132745 TI - Details of reform bill loom large. PMID- 10132746 TI - Measure seeks uniform provider rates. PMID- 10132747 TI - JCAHO, Agenda for Change ready to meet needs of reformed system. PMID- 10132748 TI - The systematic approach. Physician-hospital collaborations increase, work to capture managed-care contracts. PMID- 10132750 TI - Medicare, Medicaid budgets believed safe from more cuts. PMID- 10132749 TI - Fla. signs software contracts. PMID- 10132751 TI - San Antonio systems: no longer lone stars. PMID- 10132752 TI - Coincidence? Special interests' surveys often reinforce positions. PMID- 10132753 TI - Information systems. Fourth-quarter sales surge turns 1993 totals around; patient care systems lead. PMID- 10132754 TI - With Quorum going public, can Brim be far behind? PMID- 10132755 TI - The last hurdles to administrative simplification. AB - The shift to a fully electronic patient accounting/claims processing environment is nearing the final hurdles. There have been plenty of ups and downs to get to this point, but jumping these final hurdles will take quite a bit of effort. If the last hurdles on this important path are cleared, the race will be won. PMID- 10132756 TI - Subacute care: the LTC link. PMID- 10132757 TI - Going high tech: automation puts providers on the fast track. PMID- 10132758 TI - The home care debate. PMID- 10132759 TI - Provider software buyer's guide. AB - To help long term care providers find new ways to improve quality of care and efficiency, Provider magazine presents the fourth annual listing of software firms marketing computer programs for all areas of nursing facility operations. On the following five pages, more than 80 software firms display their wares, with programs such as minimum data set and care planning, dietary, accounting and financials, case mix, and medication administration records. The guide also charts compatible hardware, integration ability, telephone numbers, company contacts, and easy-to-use reader service numbers. PMID- 10132760 TI - HUD financing guarantees rewards. PMID- 10132761 TI - Bridging law and ethics. PMID- 10132762 TI - Prescription for quality. PMID- 10132763 TI - Partnerships for care. PMID- 10132764 TI - Top health-care chains. PMID- 10132765 TI - Of suicide machines, euthanasia legislation, and the health care crisis. PMID- 10132766 TI - No room at the inn: a snapshot of an American emergency room. AB - The emergency rooms of American hospitals have frequently become the principal suppliers of nonurgent primary care to the under- and uninsured. Canvassing published reports and using original data obtained from a representative urban hospital, Erik Olson examines the demographics of the American emergency room and analyzes its finances. The costs of providing primary care are shifted, to the extent possible, to those who can pay. The result is escalating health care costs and a deterioration of quality of care due to overcrowding, leading some hospitals to close their emergency rooms and others to turn away ambulances or "dump" patients who still require critical care. Mr. Olson explains that state antidumping laws and the federal COBRA statute have been ineffective at stemming these practices in the face of severe economic pressure to continue them. Pointing out that emergency rooms are an excessively expensive method of treating uninsured nonemergency patients, he proposes a system of primary care clinics created through a public/private partnership between municipalities and existing private health care providers. The partnership is designed to maintain a high standard of care at the clinics. As an incentive to stimulate the appearance of such clinics, a tax would be imposed on private health care providers; the tax on a given provider would be reduced to the extent that provider subsidizes a local primary care clinic that offers universal coverage, regardless of insurance status. Because the existence of such clinics would reduce inefficient use of hospital emergency rooms, in the long run hospitals should find it less expensive to finance local primary care clinics than to continue to sustain unreimbursed expenses due to improper use of their emergency departments. PMID- 10132767 TI - Model for health reform. The University of Washington excels in primary care training as well as research. PMID- 10132768 TI - Volunteering in long-term care: things to consider. PMID- 10132769 TI - AHA launches national health care reform advocacy campaign. PMID- 10132771 TI - State volunteer leaders redefined. PMID- 10132770 TI - Why are health costs really rising? The answers are complex. PMID- 10132772 TI - Taking the lead ... with hospital management strategies. PMID- 10132773 TI - Moving forward to shape the debate. PMID- 10132774 TI - Coming to terms with ethical issues. Interview by Karen Gardner. PMID- 10132775 TI - Mature hospice field takes its place in the mainstream. PMID- 10132776 TI - Volunteers bring personal touch to hospice care in their communities. PMID- 10132777 TI - Toward community care networks. PMID- 10132778 TI - Office visits to dermatologists: National Ambulatory Medical Care Survey, United States, 1989-90. PMID- 10132779 TI - AIDS knowledge and attitudes for 1992. Data from the National Health Interview Survey. AB - In 1992, levels of knowledge about the major modes of human immunodeficiency (HIV) transmission remained high in all sociodemographic groups examined. Knowledge about other aspects of acquired immunodeficiency syndrome (AIDS) was more variable with older and less educated adults generally being less knowledgeable. Changes in knowledge between 1991 and 1992 included: An increase from 86 to 95 percent in the proportion who had heard the AIDS virus referred to as "HIV" An increase from 15 to 22 percent in the proportion of young adults (18 29 years of age) who planned to be tested in the next year An increase from 13 to 17 percent in the proportion of adults who had a coworker, relative, or friend with AIDS An increase from 69 to 75 percent in the proportion of parents of 10-17 year-olds who had ever discussed AIDS with their children. PMID- 10132780 TI - Patient protocols. PMID- 10132781 TI - Organizing audit: strategy for development of nursing and midwifery audit in Wales. PMID- 10132782 TI - Quality catering at King's. PMID- 10132783 TI - Quality health care: identifying and meeting customer needs. PMID- 10132784 TI - The Sigma Project. AB - The Sigma Project, underway in a number of health care settings across Trent Regional Health Authority, is making dramatic productivity gains and improvements in the quality of care. The Project is being spearheaded by a number of Trust chief executives and unit general managers. PMID- 10132785 TI - A study of quality teams in the NHS. PMID- 10132786 TI - Memphis Business Group on Health: a model for health care reform and cost containment. AB - A market-driven, community-based, competitive health care model has effectively assisted Memphis employers to achieve their cost containment and health care reform objectives. Members of the Memphis Business Group on Health joined forces and successfully implemented a variety of programs and services that resulted in dramatic cost savings and reform of health care delivery systems. Programs included development of a purchasing alliance for negotiating contracts for hospital, medical, workers' compensation, psychiatric, and substance abuse care and other service and product options. Utilization management programs focused on appropriate consumption of resources and intensive management of critical cases. While increases in per employee costs averaged 14.7 percent per year for five years nationally, members of the Memphis Business Group on Health held their increases to an average of 6 percent per year. PMID- 10132787 TI - Small group reform politics and the real world: Cleveland's Council of Smaller Enterprises. AB - The Clinton Administration's efforts at health care reform are somewhat hamstrung by a lack of working analogues, i.e., a scarcity of examples of what effective reforms might look like. While several excellent models of effective small group reform exist, the environment in which these living models operate and the tough decisions they have made to adapt to respond to the environment, have rendered them less than perfect. Rather than rely on these working models for guidance on both the promise and the limitations of health care reform, Administration officials appear to have chosen instead to highlight the models' inadequacies and discuss in a very general way how a government-based model might perform better. Instead of being guided by existing reality, government officials have chosen to attempt to reinvent it. The experience of one of the nation's largest and most successful purchasing cooperatives shows that workable reform will come not from broad vision or elegant models but from obsessive attention to the details in the real world. PMID- 10132788 TI - The Cincinnati initiative. AB - Nationwide, purchaser coalitions are forming to use their buying clout to reform the delivery of health care. In Cincinnati, a collaborative effort between purchasers and providers is producing profound changes in the local health care market. After the first year in operation, data show a significant overall decrease in length of stay (LOS), a return to single-digit inflation, and intriguing changes in provider practice patterns. These results have been achieved through voluntary hospital and physician practice pattern changes without additional contractual allowances, price controls, or utilization management imposed by the initiative. This article explores the development of the Cincinnati initiative, results to date, lessons learned, and future implications. PMID- 10132789 TI - The fundamental forces shaping U.S. health care and how to respond to them. AB - The fundamental economic, social, and technological forces currently reshaping the health care system will have a profound impact on managed health care. The successful organization of the future will implement procedures now that respond to these forces. PMID- 10132790 TI - Regional health care systems: implications for health care reform. AB - Not only should there be payment reform, but health care delivery should be redesigned to achieve the triple goals of access to services, quality improvement, and cost control. The authors review the forces that have formed multihospital and health care systems in the past, and the seven stages that health care systems traverse toward competency. They briefly discuss the implications of those realities for reform implementation. One premise is that the natural evolution of such health care systems toward competency will take a longer time than most nonproviders expect. PMID- 10132791 TI - Using global budgets in the United States. AB - This article discusses the range of possibilities regarding how global budgets for health care spending might be used in the U.S. and the global budget designs that provide the most and least cost control. The article is a condensation of one chapter of the author's recently published special report, Getting Ready for Global Budgets. PMID- 10132792 TI - Partnership, not empowerment, creates excellent organizations. AB - Over the last decade empowerment has been offered as a prescription for creating excellent organizations. This article suggests that empowerment is inadequate and offers partnership as the guiding principle for organizational change. Empowerment efforts focus on giving employees more power in decision making. The results of such efforts have often been disappointing. Partnership focuses on increasing participation within the context of agreed on objectives with each person having a vested interest in achieving these outcomes. Practical implications for health care organizations are presented. PMID- 10132793 TI - An electronic network strategy for managed care. AB - Electronic networks, which allow payors and providers to send and receive clinical and financial information directly from their computers, must be established to gain efficiency in health care reform. Standards are being built for the various types of health care transactions, with large-scale pilot programs testing how feasible and practical these networks actually will be. A great deal of development still needs to take place, but there are immediate benefits that can be realized for managed care companies that are prepared to move data electronically. PMID- 10132794 TI - A community quality initiative for health care reform. AB - In 1989, the Madison Area Employers Health Care Coalition conducted a feasibility study for the purpose of finding solutions to common health care concerns. The study revealed three conclusions: (1) there was little or no price competition among providers; (2) employers lacked useful data and information regarding health care costs and outcomes; and (3) employers and employees lacked basic health care consumerism. These conclusions led to the development of a health care purchasing group in the spring of 1990 with the formation of the Employers Health Care Alliance Cooperative (The Alliance). The conclusions outlined above became the cornerstone of the services offered by The Alliance, which include provider contracting, data collection, and consumer education and advocacy. The Alliance also developed the community quality initiative, a partnership of employers, health care consumers, and providers committed to using continuous quality improvement methods. PMID- 10132795 TI - Physician reimbursement in Medicare risk contracting. AB - The Medicare population remains largely unmanaged despite its increasing cost burden. With a few notable exceptions, health maintenance organizations (HMOs) have historically avoided serving this expensive segment. In many cases, the inability to control costs results from failing to understand the importance of specialist reimbursement mechanisms. This article examines the importance of these mechanisms and describes how to successfully capitate specialty physicians in a Medicare risk program. The article also includes a case study on a successful capitation agreement between an HMO and a specialty group. PMID- 10132796 TI - Employer demands lower cost. AB - A case study of premium negotiations between a health maintenance organization (HMO) and an employer group is presented. The employer HMO and employer had a well-established relationship for several years. In the fourth year of consecutive double-digit rate increases, the employer demanded a decrease in premiums. The ensuing negotiations included the employer's mandate of the HMO to make operational changes to effect cost reductions. The HMO was able to provide sufficient evidence supporting its position in the rate increase and subsequently a premium increase of 5 percent was negotiated. The case study is followed in subsequent articles by the opinions and commentary of executives in the managed care industry. PMID- 10132797 TI - The health maintenance organization: guilty of complacency. AB - This critique indicts the health maintenance organization (HMO) for failure to respond to its most basic marketplace, partnership, and business obligations. Management competence is to blame; selective contracting, product development, and standardized practice patterns are nonexistent. It will be difficult for this HMO to become appropriately focused and action oriented rapidly. PMID- 10132798 TI - The health maintenance organization must focus on maximizing value. AB - Managed care organizations (MCOs) must make certain changes in their relationships with their customers and providers in order to remain viable in today's competitive market. MCO boards and management need clarity regarding their commitment to value maximization versus status quo preservation, and they will need to develop long-term, partnership-type relationships. PMID- 10132799 TI - When the physician's plan becomes the customer's health maintenance organization. AB - A major customer of a health maintenance organization (HMO) demands more accountability and a drastic reduction in pricing. The crisis creates an opening for the management of a physician-sponsored HMO to make substantial improvements in its managed care capabilities. The article outlines practical strategies and tactics to meet the customer's demands and seize the opportunity to change. PMID- 10132800 TI - Provider and subscriber education: the key to survival. AB - Any employer's demand for a 20-percent reduction in price is unrealistic and unreasonable. A new mindset is required and can only be achieved through intensive subscriber and physician education about the reality of health care costs. PMID- 10132801 TI - Hospital waste management that saves money--and helps the environment and improves safety. PMID- 10132802 TI - Comprehensive regulated medical waste management plan adopted by New Jersey. PMID- 10132803 TI - Regulation and management of asbestos-containing materials in hospitals. PMID- 10132804 TI - Implementing the medical waste air toxics regulations in New York State: a case study. AB - Over the past several years, the subject of air toxics has received a great deal of public attention. Starting with the Right-To-Know requirements imposed on industry under Title III of the Superfund Amendments and Reauthorization Act of 1986 and continuing with the Clean Air Act Amendments of 1990, the regulatory atmosphere governing quantification and, ultimately, control of these pollutants has never been more complex. In addition to the significant costs that these regulations have had and will continue to have on industry, public awareness and participation in the industrial community has also increased. This has led to a symbiotic relationship; one, however, that is sometimes strained. Although the public generally agrees with every attempt taken to reduce toxic air pollutant emissions, the NIMBY (Not In My Backyard) syndrome has become so widespread, that it often prevents an environmentally beneficial project from being realized. For example, the creation of regional medical waste incineration facilities, many of which propose state-of-the-art air pollution control equipment, has been met with much opposition from public interest groups. As a result, older, less efficient, facilities continue to operate, exacerbating today's air pollution problems. The implementation of more stringent air pollution regulations, such as Part 219-3, will force these older facilities to evaluate expensive retrofit options or find alternate methods of disposing of their medical waste. For many smaller facilities, where expensive air pollution control equipment would be cost prohibitive, the only alternative is to find another facility that has excess capacity.(ABSTRACT TRUNCATED AT 250 WORDS) PMID- 10132805 TI - Environmentally friendly inks for medical packaging. PMID- 10132806 TI - Packaging needs of central service departments: a survey. PMID- 10132807 TI - Cure waste: one hospital's formula for success. PMID- 10132808 TI - Source reduction at a rural hospital. PMID- 10132809 TI - Medcycle offers opportunities for nurses as front-line recyclers. PMID- 10132810 TI - The impact of technology on infectious waste processing. PMID- 10132811 TI - Reducing waste in the operating room. PMID- 10132812 TI - Permitting of alternative treatment technologies. PMID- 10132813 TI - Supreme Court holdings benefit landfill and incinerator operators. PMID- 10132814 TI - What is happening to incineration? PMID- 10132815 TI - The road to nonincineration treatment of medical waste. PMID- 10132816 TI - State permit requirements for alternative treatment technologies. PMID- 10132817 TI - Avoiding joint-employer status. PMID- 10132818 TI - States target incinerators, training. PMID- 10132819 TI - REMEDY: medical equipment for the developing world. PMID- 10132820 TI - Finding the most effective waste management treatment. PMID- 10132821 TI - Serious about standards. PMID- 10132822 TI - Antineoplastic drug waste management. PMID- 10132823 TI - Hospital waste and white collar criminals. PMID- 10132824 TI - The RCRA responsible corporate employee doctrine. PMID- 10132825 TI - States define infectious waste. PMID- 10132826 TI - Microwave technology: a feasible disposal option? PMID- 10132827 TI - The role of accreditation in the regulation of health-care facilities. PMID- 10132828 TI - Keeping an eye on the contractor. PMID- 10132829 TI - Alternative technology activity. PMID- 10132830 TI - Hospital administrators should contemplate CERCLA (Comprehensive Environmental Response, Compensation, and Liability Act) liability. PMID- 10132831 TI - Bloodborne pathogens: verifying compliance. PMID- 10132832 TI - Medical waste facility siting considerations. PMID- 10132833 TI - California's innovative guidelines for treatment alternatives. PMID- 10132834 TI - Waste minimization techniques for hazardous waste. PMID- 10132835 TI - Criminalization and enforcement of environmental laws. PMID- 10132836 TI - The politics of a regional medical waste facility. PMID- 10132837 TI - Minnesota proposes permanent rules for medical waste. PMID- 10132838 TI - Workplace safety and health committees challenged. PMID- 10132839 TI - A high-tech boost for environmental services. PMID- 10132840 TI - Window on Washington ... HR 963: Local Government Waste Control Act. PMID- 10132841 TI - New York City sets milestone. PMID- 10132842 TI - Limiting superfund exposure. PMID- 10132843 TI - Getting from here to there, Part II: Case study of a regional medical waste facility. PMID- 10132844 TI - Nurses and environmentally responsible clinical practice. Interview by Alison Ormsby. PMID- 10132845 TI - South Carolina adopts alternative treatment technology requirements. PMID- 10132846 TI - Source reduction and the disposables vs. reusables debate. PMID- 10132847 TI - An investigation of promotional mix considerations for mail-order prescriptions: facilitating the market's acceptance of a partial health care-cost remedy. AB - While the U.S. health care system is confronted by a daunting assortment of problems, the foremost crisis almost certainly involves the excessive costs of health care. Mail-order prescriptions offer a modest, albeit worthwhile, measure of relief from high health care costs. This study investigates the information search behaviors and product perceptions that characterize current users and nonusers of mail-order prescriptions. Implications and recommendations concerned with the development of promotional strategies for mail-order prescriptions are derived from the findings. PMID- 10132848 TI - Primary health care marketing in the U.K.: marketing for services. PMID- 10132849 TI - Health care in the United Kingdom: suggestions for replication in the United States. AB - This paper attempts to explain the trends in health care in the United Kingdom in terms of environmental factors, consumer preferences, and other factors influencing the socialized medicine delivery system. This paper, which is based on a literature review as well as interviews with British consumers, further explains the problems faced by the National Health Service (NHS) and the feasibility of such a system in the United States. PMID- 10132850 TI - An analysis of the value of marketing to non-profit organizations: the case of child safety. AB - This paper considers a broad spectrum of literature concerning the limitations and value of applying marketing management principles from the private sector to public or non-profit organizations. The Child Accident Prevention Foundation of Southern Africa is used as a principle case-study. The authors conclude that there is much to be gained from applying a more systematic approach, providing one adapts business strategies to more complex social environments and objectives. Since both marketing and social issues share the challenge of 'sensitivity serving and satisfying human needs,' (Kotler, 1983 p 272) there are also some instances where business can learn from the experience of social organizations in attempts to influence human behavior. PMID- 10132851 TI - Consumer factors affecting the delivery of quality health care services. PMID- 10132852 TI - Positioning health services: a mapping approach. AB - The proliferation of different kinds of health services has created a "clutter" in the industry making it difficult to distinguish between different product/service offerings. This often leads to fuzzy positioning in the market which helps neither the firm providing a health service nor the potential consumers. In this paper we propose the use of map representations to provide health care managers with diagnostic information about the market and to assist them in their service design and positioning tasks. Empirical analysis of a real life objective data set is employed to illustrate the appropriateness of the proposed mapping approach for the health insurance industry. The paper also emphasizes the difference in the characteristics and implications of non-price scaled vs. price scaled maps in the context of health care marketing. PMID- 10132853 TI - Marketing a dental practice in light of AIDS anxiety in patients. PMID- 10132854 TI - Implementing marketing strategy (Part four). AB - Every organization must monitor and evaluate the performance of its marketing strategies. The health care marketer must continually develop effective measures related to outcomes so that marketing efforts can be justified and garnish the support and resources they deserve. A major task for the marketing executive for the next decade is to develop marketing strategies and prove that those strategies are being met and that they help the health care organization carry out its objective to meet its mission. PMID- 10132855 TI - The anti-referral movement in health care. PMID- 10132856 TI - Identifying and removing the barriers to strategic marketing planning within medical practices. AB - Physicians practice in a constantly changing environment, exacerbating the need for strategic marketing planning. The evolution of marketing planning within the medical industry parallels that of other industries in some respects, yet, in most instances it has not reached the level of sophistication necessary to be an effective tool. There are distinct barriers that impinge upon the marketing planning process within medical practices. Identifying and removing those barriers can facilitate the implementation of strategic marketing planning within medical practices, thereby contributing to their future viability in the market. PMID- 10132857 TI - Marketing animal facilitated therapy. AB - Animal Facilitated Therapy (AFT) is the therapeutic use of the human-animal bond to improve a patient's physical and emotional health. It is an emerging treatment modality that is gaining acceptance among medical practitioners and healthcare administrators. Medical care has traditionally focused on the clinical well-being of the patient. But it is now widely recognized that emotional health is an integral part of physical health. Many patients have unmet psychological and emotional needs that affect their ability to heal and to maintain health. Because some animals have the capacity for interrelationships with people, companion animals can provide an adjunct to traditional therapies. For many patients, particularly those having long-term disabilities, the interaction with an animal fills important emotional needs which can improve mental and physical health. AFT often works when other therapeutic modalities have failed. It gives health professionals an alternative method for reaching patients who are depressed or who have withdrawn from social intercourse. AFT can be used in a variety of situations and settings. Programs are often staffed by trained volunteers and can be implemented and maintained at a relatively low cost. Marketing Animal Facilitated Therapy must focus on creating awareness about the health benefits derived from the human-animal bond, stimulating demand for animal therapy programs in healthcare settings, and generating funding for operating expenses and replication of services. PMID- 10132860 TI - Environment issues. Green gauges. PMID- 10132859 TI - Environmental issues. The long arm of the law. PMID- 10132861 TI - Environmental issues. Burning issues. PMID- 10132862 TI - Environmental issues. Power steering. PMID- 10132863 TI - Management development. The right stuff. PMID- 10132864 TI - Perspectives on purchasing. Banking on knowledge. PMID- 10132865 TI - Fundholding. Readies reckoner. PMID- 10132866 TI - Maternity. Local delivery. PMID- 10132867 TI - Appraising local needs. PMID- 10132868 TI - Data briefing. London's healthcare. National Association of Health Authorities and Trusts. PMID- 10132869 TI - Back to basics. PMID- 10132870 TI - Small change. PMID- 10132871 TI - Perspectives on purchasing. Ready, steady, go. PMID- 10132872 TI - Community health councils. In search of a role. PMID- 10132873 TI - Policymakers must be candid about the costs of reform. PMID- 10132874 TI - System analyzes readiness for integrated delivery. PMID- 10132875 TI - Advanced Institute offers framework for continuous learning. PMID- 10132876 TI - How to approach Catholic identity in changing times. Catholic Health Association of the United States. AB - The Catholic healthcare ministry is at a challenging moment in its history. Not only is the ministry called to continue to be authentic to its own self, but the ministry also has the opportunity to communicate the richness and universality of its values to others. In response to our members' genuine concerns, the Catholic Health Association of the United States (CHA) has prepared this document to support our members in the expression of their Catholic identity in new forms of healthcare service. PMID- 10132877 TI - Vital links for today and tomorrow. With one stage of MIS development complete, an integrated delivery network looks to the future. AB - Over the past four years, Provenant Health Partners (PHP), Denver, has been developing and implementing a management information system to meet the organization's current needs. The system consists of the following information networks: Internal management; Electronic claims processing; Purchasing; Physician communications; Clinic communications; Physician practices; Other hospitals,offnaged health. In the past, PHP used the system primarily for traditional management and control purposes. Recently, however, the organization has extended the use of its data outputs to include internal and external marketing purposes as well. Clinical, service, and management quality data are now tracked and shared with internal and external constituents. PHP is also working to develop a health information system for the future. Such a system will include all the components of the current management information system, but will also facilitate effective health management of populations enrolled in the organization's integrated delivery network. PMID- 10132878 TI - Rural connections. Iowa hospitals are establishing communications link to better serve rural areas. AB - The Sisters of Mercy Health Corporation, with 14 hospitals in Iowa, and the Mercy Health Centers of Central Iowa, with 13 hospitals in the state, believe fiber optic technology may provide solutions to the inadequacies inherent in the rural healthcare delivery system. Since 1989, Iowa has committed more than $100 million toward the development and installation of a statewide fiber-optic communication network. The Iowa Communication Network (ICN) was originally envisioned as a means of providing voice, data, and interactive video capabilities to state government agencies, libraries, schools, and colleges. Currently, only hospitals with medical education programs are authorized to use the network, but others are expected to be allowed to soon. Realizing the potential benefits telemedicine and the ICN posed, in June 1993 the Sisters of Mercy Health Corporation and the Mercy Health Centers of Central Iowa jointly established the Midwest Rural Telemedicine Consortium (MRTC) to enhance rural residents' access to primary healthcare through integrated communications systems. The MRTC is trying to secure federal funding to conduct a demonstration project in eight hospitals. The project's goal is to determine how the use of telemedicine applications, specifically fiber optic applications, affects access, quality, and costs in providing specialty healthcare services to rural patients. PMID- 10132879 TI - Building a patient record system. New information technologies will support development of patient-focused care. AB - As part of its plan to build a regional integrated healthcare delivery network, Genesys Health System, Flint, MI, has been developing a computerized patient record (CPR). The CPR will give users throughout the system immediate access to diagnostic studies, treatment information, discharge summaries, operative reports, x-rays, and other patient information. Before considering technical aspects of the system, healthcare executives considering implementation of a CPR should examine business and clinical issues to determine what they want to accomplish with the CPR. The Genesys information system is being designed with the following goals in mind: Organizing based on patient needs; Allocating resources at the point of care; Working as a broadly skilled, empowered staff; Delegating authority and accountability; Using technology to enable patient focused care within the context of the system vision. Genesys envisions a CPR system that brings together records from such sources as emergency rooms, outpatient clinics, community service organizations, physicians offices, care teams, managed care companies, and financial systems. Genesys's use of care plans for specified procedures and diagnoses will enable it to use exception-based documentation of care delivered, whereby only departures from the protocol or unexpected outcomes are recorded. PMID- 10132880 TI - Toward a just policy on healthcare rationing. Ethical principles must inform the debate concerning the distribution of services. AB - Perceptions of inequity and excess have given rise to a debate over whether policymakers should consider some form of rationing as a means of achieving a more just healthcare system. Three factors will be critical in determining whether the policies ultimately developed will be just and equitable. First, participants must grasp relevant facts involving the current distribution of healthcare services in the United States. Second, the debate must be based on a clear understanding of who has ultimate responsibility for making decisions regarding healthcare rationing. Finally, those committed to implementing a just approach to the issue must ensure that ethical principles relevant to policy making are clear to everyone and affect the debate's outcome. The controversy over whether to ration healthcare services obscures the fact that healthcare is, in reality if not in policy, rationed now. A key advantage of promoting formal public policy decisions about the provision and limitation of healthcare services is that it shifts responsibility for these decisions from providers to society. Applying four classic bioethical principles to the question of rationing can also help ensure implementation of an appropriate public policy on healthcare rationing. For the debate on rationing to be meaningful, it must be conducted in a way that respects and promotes participants' autonomy. Policymakers should also observe the principle of nonmaleficence, which dictates that their policies not harm those they affect. A proper rationing policy should also fulfill the criterion of beneficence (i.e., actively promote the good of others). Last, such a policy should conform to the principle of justice by being fair and impartial. PMID- 10132881 TI - Congressional staff retreat underlines the need for universal coverage. PMID- 10132882 TI - Forging a future for nursing. A system's nurse executives collaborate to create a strategic plan. AB - In early 1991 the Nurse Executives' Council (NEC) of the Seattle-based Sisters of Providence Health System completed a survey assessing the effectiveness of patient care delivery processes and gauging the extent to which nurses participate in planning programs and services. Later that spring the NEC reviewed the survey and made a preliminary identification of nursing strategic issues. To complement this internal survey, in fall 1991 the council was given an overview of the external environment as it relates to nursing. The council also formed three committees--Strategic Planning/Bylaws, Human Resources, and Productivity- to address concerns that surfaced in the internal assessment survey process and to help design a document outlining the council's strategic plan for system nurses. After working with the NEC liaison, the Strategic Planning/Bylaws Committee drafted a plan for review by NEC members before submitting it for approval by appropriate bodies within the organization. The final plan, unveiled at the fall 1992 NEC meeting, identifies four key strategic issues for nursing, including the need to: Develop nursing leadership; Maximize human resources; Coordinate client and patient care over a continuum of healthcare services; Demonstrate fiscal stewardship. PMID- 10132883 TI - An LA hospital settles a shook-up community. PMID- 10132884 TI - Medical staff development: into uncharted territories. PMID- 10132885 TI - A framework for improving the performance of health care organizations. AB - This performance improvement framework incorporates several key assertions: Performance means what is done and how well--what jobs are done to provide health care and how effectively they are carried out. Joint Commission standards manuals are being reorganized to address the most important governance, management, clinical, and support functions. The effect of an organization's performance of these functions is reflected in patient outcomes, in the cost (or efficiency) of its services, and in patients' and others' perceived satisfaction. Patients and others judge the quality of health care based on health outcomes (and sometimes on their experiences with the care process and level of service provided). Patients, purchasers, regulators, and other stakeholders expect and use quantitative/explicit data and qualitative/implicit perceptions to judge quality and value of health care. The framework for improving performance describes a global model for organizations that intend to be diligent, rigorous and effective in their pursuit of excellence. Its three components--external environment, internal environment, and operational improvement methodology--are not a "cookbook" of required activities. Rather, they represent a synthesis of important concepts, organizational characteristics, management techniques, and scientific tools and methods that together make continuous improvement possible. This improvement framework poses major challenges to health care organizations. These challenges include becoming more patient-focused, redesigning care processes, promoting collaborative teamwork, systematically measuring and assessing performance, and encouraging risk-taking and experimentation. Nonetheless, the ability to proactively and effectively manage quality is the only way that organizations will be able to survive and prosper in the face of stringent resource constraints and ever-increasing demands for better health outcomes.(ABSTRACT TRUNCATED AT 250 WORDS) PMID- 10132887 TI - QI principles can serve health care organizations well. PMID- 10132886 TI - IMSystem starts up with 10 indicators. PMID- 10132888 TI - Leaders must set priorities for organizational performance. PMID- 10132889 TI - Health Security Act emphasizes performance measurement. PMID- 10132890 TI - Continuous planning key to achieving accreditation with commendation. AB - In summary, survey preparation should be more than preparing for an inspection. Preparation should result in improving patient care outcomes as identified through the system's mission and vision, and by all of the people working within the organization through education, planning, and defining quality. PMID- 10132891 TI - Group Health Cooperative. Why can't other HMOs work as well as this one? PMID- 10132892 TI - Why you may need a professional managing your office. PMID- 10132893 TI - Are we asking too much of gatekeepers? PMID- 10132894 TI - The biggest push yet toward global fees. PMID- 10132896 TI - What's the CPT code for compassion? PMID- 10132895 TI - Got the urge to merge? You're not alone. PMID- 10132897 TI - How to make Washington listen to you. PMID- 10132898 TI - Firms join as Team Health. PMID- 10132899 TI - N.Y.'s HHC outlines plans for job cuts, system overhaul. PMID- 10132900 TI - Guthrie system bonds under review by S&P. PMID- 10132901 TI - New England HMOs, employers proceed with 'report card'. PMID- 10132902 TI - Even on break, Congress pressed on reform. PMID- 10132904 TI - Finance error pushes exec out. PMID- 10132903 TI - NME discusses bank debt as it hires firm to downsize. PMID- 10132905 TI - Proposal would reopen Mass. hospital. PMID- 10132906 TI - Chicago-area hospitals may link to compete. PMID- 10132907 TI - FTC studies affiliation of top 2 Providence facilities. PMID- 10132908 TI - Prestigious McKinsey sets sights on NME fix. PMID- 10132909 TI - A merger reaps unexpected savings. PMID- 10132910 TI - Pentagon alters CHAMPUS program. PMID- 10132911 TI - Hospital sets Maryland's first capitation deal. PMID- 10132912 TI - Hospital to pay for care at home for teen in coma. PMID- 10132913 TI - High court to hear case on Medicare payments. PMID- 10132914 TI - HMO settles out of court; investors appear relieved. PMID- 10132915 TI - Managed care must do more to truly manage specialty care. PMID- 10132916 TI - Even HCA loss can't dim luster of healthcare's premier incubator. PMID- 10132917 TI - New 'sanctions' may aid hospitals. PMID- 10132918 TI - Price competition hits prices of some expensive devices. PMID- 10132919 TI - U.S. Healthcare 'report cards' expanded to primary-care docs. PMID- 10132920 TI - Adventist/Sunbelt selling Florida hospital to HMA. PMID- 10132921 TI - AmeriHealth fights credit crunch. PMID- 10132922 TI - Charter plans to sell $300 million in bonds. PMID- 10132923 TI - Physicians find ownership in Columbia/HCA systems limits investment options. PMID- 10132924 TI - Conn. ends price controls--sort of. PMID- 10132925 TI - Payer pressures putting squeeze on HMO profits--study. PMID- 10132926 TI - Cardiac MRI. PMID- 10132927 TI - Franchising allows continued diffusion of cardiac cath technology. PMID- 10132928 TI - Planning for the hospital of the future. AB - The trade-offs between quality of care, operational efficiency, convenient patient access, physician productivity, and initial capital costs should be considered in evaluating functional relationships, dedicated versus shared facilities, and the creation of decentralized, satellite services. With rapidly changing technology, new payment initiatives, and uncertainties about various healthcare reform measures, planning for the healthcare campus of the future should involve an integrated process of clinical program planning, operations planning, and facility planning to ensure that new or renovated facilities are both flexible and promote operational efficiency well into the twenty-first century. PMID- 10132929 TI - Refinancing to manage costs. A critical strategy for surviving in today's transitional healthcare marketplace. PMID- 10132930 TI - Technical aspects of fiber optics networks. Part 2. PMID- 10132931 TI - FDA's mammography facility quality assurance program. AB - To summarize, the key features of the MQSA program are: To operate lawfully after October 1, 1994, a mammography facility must be certified by FDA as providing quality mammography services. For a facility to be certified, it must be accredited by a federally-approved private nonprofit or state accreditation body. To be accredited, the facility must undergo periodic review of its clinical images and meet federally-developed quality standards for personnel qualifications, quality assurance programs, and recordkeeping and reporting. To maintain its certification, the facility must pass an annual inspection conducted by federal or state personnel. If congress grants FDA authority, the agency will establish interim standards initially but will eventually replace them with more comprehensive final standards. After October 1, 1994, mammography facilities unable to comply with the quality standards in effect at a given time will not be permitted to continue in operation. FDA believes that once the comprehensive standards and inspection program are in place, the goal of assuring all women access to quality mammography will soon be reached. PMID- 10132932 TI - Implications of licensure of medical physicists. A study in risk management and quality improvement. Part 1. PMID- 10132933 TI - The greening of radiology. PMID- 10132934 TI - Stark reality: new federal law forces changes in hospital/physician contracts. PMID- 10132935 TI - How do you get them & keep them? Recruitment and retention of key hospital leadership. Part II. PMID- 10132936 TI - An evidence-based approach to evaluating and improving clinical practice: guideline development. AB - Group Health Cooperative of Puget Sound has developed a model for evaluating and improving clinical practice based on an explicit, evidence-based approach. It is designed to identify gaps between current and optimal practices, and to bring about changes in physician behavior so that health care outcomes (health status, patient satisfaction, provider satisfaction, cost/utilization) are maximized. This model stresses the importance of a rigorous process in looking objectively at evidence in working to improve outcomes. Discrete tools have been developed which help teams move successfully from problem identification to the ongoing evaluation and improvement of a new clinical practice. PMID- 10132937 TI - Reform in Washington state. AB - The Washington State Healthcare Reform Act of 1993 is in the early stages of implementation. The barriers to implementation and the impacts on HMOs like GHC are an example of the types of issues that will be faced (or are being faced) by other similar organizations throughout the country. The most dramatic observation is that the pace of change is far more rapid than our organization has experienced in recent years; and that pace of change is likely to continue for years to come. PMID- 10132938 TI - Implementation of an advance directives program in an HMO. AB - In 1992, Group Health Association (GHA), an HMO in the Washington, DC, metropolitan area, under the auspices of its Ethics Forum, undertook a major and ongoing project to educate its medical staff and patient members about the advantages and uses of advance directives. The following article describes how this project was implemented. PMID- 10132939 TI - Effective case management in managed mental health care: conditions, methods and outcomes. AB - Case management methods were utilized after changing from a "provider network" to a "staff model" mental health center serving approximately 30,000 HMO enrollees. This change allowed for tighter systems and case management, interdisciplinary coordination, longitudinal evaluation of clients and measures of quality assurance, staff productivity and cost savings. Effective case management conditions and methods were implemented that ensured immediate accessibility, broad-ranging evaluation and triage, use of both psychiatric and operational diagnosis, proper matching of client with therapist, group, and setting; coordination of the roles of various support systems and use of proven treatment and case management methods. The change to this staff model case management system resulted in 38.8% cost savings while delivering high-quality, accessible service. PMID- 10132940 TI - An orientation program for mental health providers. PMID- 10132941 TI - Bereavement support in the HMO. PMID- 10132942 TI - Building social skills in school-age children. PMID- 10132943 TI - The roadmap for clinical quality. AB - The Roadmap for Clinical Quality at Group Health Cooperative (GHC) of Puget Sound is a patient-focused, population-based, systematic, organizational effort designed to identify and improve key clinical processes for GHC enrollees. The underlying premise is that by improving clinical care processes and decreasing unnecessary practice variation, health, cost and patient satisfaction outcomes will improve, thereby increasing the value of the GHC product. Key clinical processes targeted for system-wide improvement are those for which there is demonstrable evidence that improving the care process will result in improved health outcomes and/or decreased cost. PMID- 10132944 TI - Zero-base budgeting: contain costs and improve organizational performance. PMID- 10132945 TI - Understanding liability issues in managed care. PMID- 10132946 TI - Making sense of quality assurance. PMID- 10132947 TI - RISCing (reduced instruction set computing) the future on hardware. PMID- 10132948 TI - Barcoding in the lab: achieving error-free efficiencies. PMID- 10132949 TI - Better capabilities, lower costs: standards, fiber & interfaces. PMID- 10132950 TI - LIS review 1994. 8th annual state-of-the-lab. AB - 1993 was a year of turmoil, uncertainty, restructuring and consolidation in the laboratory information systems industry. There were mergers and acquisitions among both vendors and buyers, major product announcements, looming healthcare reform: it was an interesting year. PMID- 10132951 TI - Making a critical change for the better. PMID- 10132952 TI - Materials management moves to software: just in time. PMID- 10132953 TI - Technology in the lab: a client/server case study. PMID- 10132954 TI - The standard answer. PMID- 10132955 TI - Special report. The Ways & Means Health Subcommittee bill: simpler than Clinton ... but plenty of government. PMID- 10132956 TI - Payer-provider partnerships. PMID- 10132957 TI - Turmoil in the Twin Cities. PMID- 10132958 TI - Salesmanship isn't leadership. On health-care reform, the Clintons have confused the two. PMID- 10132959 TI - The age before miracles. PMID- 10132960 TI - The infertility trap. PMID- 10132961 TI - The morning after. AB - The National Abortion and Reproductive Rights Action League is battling a slump in revenues and sagging public interest in its cause, just as it gears up for a major fight over health care reform. PMID- 10132962 TI - Flunking economics? AB - Economists are in revolt over President Clinton's health care reform proposal. Many contend that the Administration is abandoning free-market principles and embracing price controls that could have disastrous consequences. But others argue that traditional rules of supply and demand don't apply to the health care sector. PMID- 10132963 TI - Into the swamp. AB - Take the most ambitious and complicated domestic policy initiative in decades. Toss it into a morass of big egos, weak leadership and deep-seated internal conflicts. Welcome to the congressional debate on health care reform. PMID- 10132964 TI - Guiding it through. AB - Some relatively little known Members of Congress and an even less visible group of aides are playing important behind-the-scenes roles in the health care reform debate. PMID- 10132965 TI - Can this patient be saved? PMID- 10132966 TI - No score so far in health care game. PMID- 10132967 TI - Stress fractures. AB - President Clinton has lambasted "special interests" for opposing his health care reform proposal. But interest groups are under enormous pressure, and many are badly splintered as Congress takes up the issue. And you can't always judge what they want by what they say. PMID- 10132968 TI - Clinton's demographic bedevilment. PMID- 10132970 TI - Labor and Democrats: together again. PMID- 10132969 TI - And the winner is ... Bill Clinton. PMID- 10132971 TI - Computerization of clinical laboratories and health care facilities: Making decisions in transition. Part I: General considerations. AB - In summary, it is perhaps appropriate to reflect on the transition zone that health care finds itself in now. Federally and provincially funded Royal Commission reports and health surveys over the last thirty years have all drawn a number of similar conclusions. Some of these are particularly important to keep in mind as major investments in hospital and laboratory information systems are made. First, it is known that health care providers and services are not distributed evenly throughout the country and that there is uneven utilization of services. Second, the "health" in health care is not defined in purely medical terms. Health is a function of genetic background, personal choices and behaviors like diet and exercise, socioeconomic conditions like housing, family situations, education, and employment, and the physical environment in which an individual lives and works. Governments at all levels now use this concept of health when determining policy and funding. Third, a change of emphasis has occurred from the traditional hospital-centered model to one that is community based. How well will your laboratory and facility responding to the inevitable changes to funding and consumer utilization? How well does the HIS/LIS vendor understand the circumstances affecting your organization and what agreements can be made to ensure future system support? How will an increase in profile-type testing and reflexive testing be handled to minimize disruptions to work flow and productivity? How can analytical instrument selection change the whole focus of the laboratory operation and impact on other areas? Will the traditional terms "in patient" and "out patient" still apply, or will a term somewhere in the middle evolve?(ABSTRACT TRUNCATED AT 250 WORDS) PMID- 10132972 TI - Canadian Institute for Health Information. PMID- 10132973 TI - The use of a multi-test MOT disc for the identification of Escherichia coli as a cost-containment strategy. AB - A multi-test enteric screen MOT disc was evaluated as an alternate, cost effective and expedient method to the bioMerieux Vitek GNI card for the identification of Escherichia coli. Of the 321 lactose-fermenting organisms tested in this study, 268 were identified as E. coli by the bioMerieux Vitek GNI card. The MOT disc identified 247 of these 268 strains of E. coli within five hours of isolation and a further 16 strains after 16 to 24 hours. The MOT disc can be used to identify the majority of typical E. coli isolates in a timely, cost-effective manner. PMID- 10132974 TI - Creutzfeldt-Jacob disease decontamination of tissues and contaminated materials. AB - Although CJD is certainly infectious, like other unconventional viruses (slow viruses) it demonstrates a low potential for transmissibility to humans who are exposed accidentally to infected material. This may be due to a low dose of prion exposure or to reasons which are unknown at this point. When effective decontamination techniques are available, the processing of tissue from a suspected or confirmed case of CJD can be handled with confidence. Careful application of techniques makes the possibility of acquiring the disease remote, while not interfering with the diagnosis and care of patients. PMID- 10132975 TI - Resource management and the CQI process. PMID- 10132977 TI - Long-term-care software showcase 1994. Advertising supplement. PMID- 10132976 TI - The RT--a multi-skilled professional. Part I: Talent assessment & inspiration. PMID- 10132978 TI - Providers face major Hill battle over Boren. PMID- 10132979 TI - What can be done to improve residents' autonomy? PMID- 10132980 TI - Choices: the ethics of dying pose new challenges for caregivers. PMID- 10132981 TI - Best of the bad. The Clinton plan's not great, but it may beat the alternatives. PMID- 10132982 TI - The power of pastimes. PMID- 10132983 TI - Huntington's. Few programs are in place for victims of this devastating disease. PMID- 10132984 TI - Check termination rules in managed-care contract. Part two of a two-part series. PMID- 10132985 TI - Mammography facilities must meet quality standards. PMID- 10132986 TI - Community policing part of hospital's new security approach. PMID- 10132987 TI - How management firm secures medical center parking facility. PMID- 10132988 TI - Special report. After shooting incidents: hospitals take different security measures to deal with ED violence. AB - Violent incidents in hospital emergency facilities, whether at the hospital itself or in nearby facilities, have been serving as catalysts for administrators to take immediate steps to create a safer environment for staff and patients. In this report, we'll give details on the events that spurred the upgrading of security at five medical centers and what specific steps are being taken. PMID- 10132989 TI - Bivens actions not allowed against peer review organizations. PMID- 10132990 TI - Right to die. New law and policy issues appear while old ones remain unresolved. PMID- 10132991 TI - Prescription drug pricing: do competitive forces operate in the pharmaceutical marketplace? PMID- 10132992 TI - Perspective: antitrust litigation by aggrieved physicians. PMID- 10132993 TI - Protecting the "frustrated eloper". PMID- 10132994 TI - Controlling exposure and exposing control. PMID- 10132995 TI - How SCUs (specialty care units) help residents with mental health problems. AB - Do elderly persons with mental health problems respond better to care in segregated or integrated environments? To find out, the Manitoba government constructed two, ten-bed specialty care units for residents with behavior problems. PMID- 10132996 TI - Acute care in a geriatric facility: five years at Baycrest Centre. AB - Although most long-term care facilities cannot always evaluate and treat their residents during acute, intercurrent illnesses, it is possible to design systems that allow for effective care without transfer. PMID- 10132997 TI - Making friends at Friendship Corner. AB - Originally recognized as a way to help recruit and retain employees, on-site child care gives the facility a homelike, family atmosphere that benefits everyone who works or lives there. PMID- 10132998 TI - Elopement--exposure and control. AB - A reasonable response for a nursing home to make to minimize elopement exposure is to: 1. Establish a written elopement risk-management plan. 2. Establish a written screening criteria for what characteristics make a high-risk eloper. 3. Educate the staff so they are better able to identify and respond to residents who are potential elopers. 4. Ensure that the staff is quick to investigate any activated door alarms. 5. Keep all stairwells alarmed. 6. Keep normal exit alarms activated on all but a minimum number of egress points and use alternate controls on non-alarmed doors. 7. Critique the plan through "elopement drills" or after actual occurrences and refine the plan if needed. With this type of organized approach, nursing home facilities can continue to offer home-like environments while minimizing the liability exposure that elopement represents. PMID- 10132999 TI - Rural hospital inpatient surgical volume: cutting-edge service or operating on the margin? AB - Surgical services are an important part of modern health care, but providing them to isolated rural citizens is especially difficult. Public policy initiatives could influence the supply, training, and distribution of surgeons, much as they have for rural primary care providers. However, so little is known about the proper distribution of surgeons, their contribution to rural health care, and the safety of rural surgery that policy cannot be shaped with confidence. This study examined the volume and complexity of inpatient surgery in rural Washington state as a first step toward a better understanding of the current status of rural surgical services. Information about rural surgical providers was obtained through telephone interviews with administrators at Washington's 42 rural hospitals. The Washington State Department of Health's Commission Hospital Abstract Recording System (CHARS) data provided a count of the annual surgical admissions at rural hospitals. Diagnosis-related group (DRG) weights were used to measure complexity of rural surgical cases. Surgical volume varied greatly among hospitals, even among those with a similar mix of surgical providers. Many hospitals provided a limited set of basic surgical services, while some performed more complex procedures. None of these rural hospitals could be considered high volume when compared to volumes at Seattle hospitals or to research reference criteria that have assessed volume-outcome relationships for surgical procedures. Several hospitals had very low volumes for some complex procedures, raising a question about the safety of performing them. The leaders of small rural hospitals must recognize not only the fiscal and service benefits of surgical services--and these are considerable--but also the potentially adverse effect of low surgical volume on patient outcomes. Policies that encourage the proper training and distribution of surgeons, the retention of basic rural surgical services, and the rational regionalization of complex surgery are likely to enhance the convenience and safety of surgery for rural citizens. PMID- 10133000 TI - Contracting for emergency room coverage by rural hospitals. AB - Obtaining adequate physician availability remains a challenge to many rural communities. To ensure 24-hour emergency room physician coverage, many rural hospitals contracted for emergency room services from out-of-area and/or local physician. Survey findings for 99 rural and rural referral Iowa hospitals addressing the nature, extent, and cost of contracting physician coverage of the emergency room are presented. While nearly two-thirds of the hospitals reported contracting for at least some emergency room coverage, the extent and costs of contracts vary widely. Advantages and disadvantages of contracting for emergency room services are discussed. PMID- 10133001 TI - Determinants of physician vacancy rates in rural hospitals. AB - This study examines the determinants of physician vacancy rates in rural hospitals from the perspective of the rural hospital administrator. Data on community characteristics, hospital characteristics, and hospital recruitment strategies are examined for 50 rural hospitals in Kentucky using questionnaire and archival data. Physician vacancy rates in this sample were quite high (mean of 37 percent). Results indicate lower physician vacancy rates in hospitals with a chain affiliation. In addition, the "job shopping" model for physicians decisions on where to practice (Johnson, 1978) is supported. Hospitals that target physician candidates with more work experience display lower physician vacancy rates. Generally, hospital characteristics were more significant predictors of physician vacancy rates than were community characteristics. Implications for rural hospital physician recruitment/retention strategies are discussed. PMID- 10133002 TI - The health of rural homeless women with young children. AB - More than 30 percent of the homeless are families with children; however, little is known about these families, particularly rural homeless mothers with children. The purpose of this study was to describe the characteristics of rural homeless mothers, their physical and mental health, and their health care practices. A descriptive cross-sectional design was used to study a sample of 76 rural mothers with children younger than age 13. An interview schedule and the SCL-90-R were used to collect data about these families. The majority of the families had been homeless for more than four months, 46 percent were woman-headed, 17 percent of the mothers reported having a physical health problem, and only 3 percent had scores on the SCL-90-R that were indicative of needing additional evaluation for possible mental health problems. The use of drugs was higher than expected, which puts both the mothers and their children at risk for health problems. PMID- 10133003 TI - An expert panel approach to assessing the rural implications of health care reform: the case of the Health Security Act. AB - The policy arena is hungry for objective information regarding the potential effects of comprehensive national and state health care reform. Such information reduces the dependence of policy-makers on information generated solely by advocacy groups and serves as a checkpoint for such information. Unfortunately, the academic community is often unable to mobilize its resources quickly enough to help meet this information need. This article describes one model for overcoming this difficulty. When the time frame is especially short, academic expertise can be brought together in the form of an expert panel. However, for such an approach to be effective, it must be carefully configured and orchestrated. Critical ingredients include much preparatory groundwork, a well defined framework and methodology for conducting the policy analysis, and a professional facilitator. The Rural Policy Research Institute used such an approach to analyze President Clinton's Health Security Act shortly after the initial blueprint was released (but before the legislative language was released). The consensus of the expert panel was that the Health Security Act would, on balance, represent an improvement over today's rural reality. However, a number of troubling aspects were noted. First, the Act's emphasis on primary care and nonphysician providers is a double-edged sword. While these are precisely the types of providers needed in rural areas, the short-run effect may be to create increased competition for such providers from urban areas.(ABSTRACT TRUNCATED AT 250 WORDS) PMID- 10133004 TI - Medicaid drug utilization review: a critical appraisal. PMID- 10133005 TI - Peer review organizations: scientific challenges in HCFA's health care quality improvement initiative. PMID- 10133006 TI - The impact of individual and contextual factors on nursing care and the implementation of AHCPR practice guidelines. PMID- 10133007 TI - Physician-nurse relationships in clinical settings: a review and critique of the literature, 1966-1992. PMID- 10133008 TI - Application of decision analysis in antibiotic formulary choices. AB - OBJECTIVE: To introduce the reader to the fundamentals involved in using decision analysis as a tool in evaluating the associated costs and effectiveness of comparable therapeutic agents. DATA SOURCES: Currently available literature citations were used to provide the reader with basic references whose purpose is to provide a step-by-step approach for using Decision Analysis in conducting a cost-effective comparison of three commonly used antibiotics. Data were gathered from a previously conducted retrospective chart review where the three antibiotics were used for either prophylactic, empiric, or documented infections. Although this study was limited by its retrospective nature, the reader can use the data to appreciate the fundamentals of decision analysis. CONCLUSIONS: The continually changing climate in healthcare and the added visibility of pharmacologic agents in the treatment and prevention of disease has increased pressure on pharmacy departments to provide therapeutic agents that are cost effective. Decision analysis can be used to compare therapeutic agents, in terms of financial as well as clinical outcomes, in a structured fashion that all members of the health care team can understand. The application of Decision analysis is appropriate for many therapeutic agents, not just antibiotics. PMID- 10133009 TI - Perspectives. Children's hospitals: gambling on the future. PMID- 10133010 TI - Perspectives. Any willing provider battles heat up in states. PMID- 10133011 TI - Costing medical libraries: the feasibility of functional cost analysis. AB - As a result of organizational changes in the National Health Service (NHS) there is a need for a coherent costing model for NHS libraries, particularly for the smaller libraries based in postgraduate medical centres. One possible model is functional cost analysis, whereby all costs are assigned to library functions representing services to users, such as loans from stock, interlibrary loans, enquiry services, etc. Using data from a 1991 survey of postgraduate centre-based libraries in the North West Thames (NWT) Region of the NHS, the feasibility and appropriateness of functional cost analysis is examined. PMID- 10133012 TI - Charging for library and information services in medical libraries: a review of the literature and a survey of current practice. AB - A summary of some of the issues concerned with charging for library services (particularly information services and services provided by medical libraries) is given. The results of a survey carried out in July 1992 are presented. The survey asked respondents to indicate which library services they charged for, the level of charges and the extent to which charges to those outside the organization and those within it differed. Twenty-five libraries (response rate of 69%) replied to the survey. Some further areas for research and discussion are indicated. PMID- 10133013 TI - Information audit: whose line is it anyway? AB - With the current pace of organizational change within the NHS there is a growing need to examine how information is contributing to business objectives. A valuable tool in this information management review process is the 'information audit'. This paper describes an information audit conducted for a Regional Health Authority. The management and methodology of the project are presented in detail together with the implications for the subject organization and ensuing opportunities for health information professionals. PMID- 10133014 TI - Building a safer hospital. What are the hospital's responsibilities? PMID- 10133016 TI - OSHA cites hospital for failure to protect workers against exposure to tuberculosis. PMID- 10133015 TI - Controlling ambient biohazards; what you can't see can hurt. AB - The effective control of ambient biohazards is clearly a team effort. This team includes the EM, the risk manager, the infection control practitioner, purchasing, facilities management, and others. Control measures relate to many different risk factors, such as the environment at the healthcare facility, the healthcare personnel, the procedure, the use of certain devices, or the actual infection host (patient). Usually, only environment-related risk factors are of concern to the EM. For fungal infections, such as Aspergillus, CDC recommends that control of environmental risk factors requires routine maintenance of hospital air-handling systems and the rooms of immunosuppressed patients, as well as extra protection designs when there is new construction. This can be very costly. For Legionella infections, CDC recommends proper design, placement, and maintenance of cooling towers; routine maintenance of water-supply systems; and when contaminated water supplies are identified, appropriate decontamination. CHEM believes that the CDC recommendations are a good way to control these ambient biohazards, but is concerned about some of the costs to meet all the Aspergillus recommendations. Hospitals must weigh costs before proceeding, especially with Category II recommendations that are only "suggested for ... many hospitals." For example, at facilities with no cases of infection, if following the CDC recommendations means that filters need to be changed and ducts cleaned more frequently than usual, the costs may not be worth it. On the other hand, if there have been a series of confirmed cases of nosocomial Aspergillus pneumonia, the cost of HVAC retrofitting or using a portable HEPA filtration systems may be worth it.(ABSTRACT TRUNCATED AT 250 WORDS) PMID- 10133017 TI - Health plans predict success, change. PMID- 10133018 TI - The proposals: how they compare ... major health reform proposals. PMID- 10133019 TI - When the media call. How hospitals deal with the spotlight. PMID- 10133020 TI - Is Alabama ready for reform? PMID- 10133021 TI - Using cost accounting data to develop capitation rates. PMID- 10133022 TI - American Health Information Management Association. Position statement. Issue: managing health information in facility mergers and acquisitions. AB - Healthcare facility mergers and acquisitions are becoming more common as the industry consolidates. Many critical issues must be considered in mergers and acquisitions, including the management of patient health information. In addition to operational issues, licensure, regulatory, and accreditation requirements must be addressed. To ensure availability of health information to all legitimate users, patient records should be consolidated or linked in the master patient index. A record retention policy should be developed and implemented to meet user needs and assure compliance with legal, regulatory, and accreditation requirements. If health information from closed facilities will be stored for a period of time, its integrity and confidentiality must be preserved, and it must be readily accessible for patient care. The compatibility and functionality of existing information systems should be assessed, and a plan should be formulated for integration of the systems to the extent possible. Such integration may be essential for the organization to successfully meet the demands of integrated delivery systems. Existing databases should be maintained in an accessible form to meet anticipated future needs. PMID- 10133023 TI - American Health Information Management Association. Position statement. Issue: protecting patient information after a closure. AB - Patients trust their healthcare providers to respect their privacy, maintain the confidentiality of their health information, and assure its availability for their continuing care. When healthcare facilities close or medical practices dissolve, providers must be concerned with the protection of health information. Procedures for disposition of patient records must take several factors into consideration, including: state laws regarding record retention and statutes of limitation; state licensing standards; Medicare requirements; federal laws governing treatment for alcohol and drug abuse (if applicable); guidelines issued by professional organizations; and the needs and wishes of patients. In some states, a state archive or health department will store health records from closed facilities. Generally, state regulations recommend records be transferred to another healthcare provider. If a healthcare facility or medical practice is sold to another healthcare provider, patient records may be considered assets and included in the sale of the property. If a facility closes or a practice dissolves without a sale, records should be transferred to another healthcare provider which agrees to accept the responsibility. If this is not feasible, records may be archived with a reputable commercial storage firm. Before records are transferred to an archive or another provider, patients should be notified, if possible, and given an opportunity to obtain copies of their health information. This may be done by publishing a series of notices in the local newspaper. Regardless of the archival method used, the provider must assure that the integrity and confidentiality of the patient health records will be maintained and that the records are accessible to the patient and other legitimate users. PMID- 10133024 TI - Institute of Medicine report addresses privacy issues. PMID- 10133025 TI - The "other" healthcare reform proposals pending in Congress. PMID- 10133026 TI - CPT coding: integumentary system. PMID- 10133027 TI - What can you expect during your onsite survey? AB - The world of accreditation is in constant change, and as health information management professionals, we should always embrace change. New standards and survey procedures provide us with new goals, outlooks, ways to increase the quality of patient care, and opportunities to mentor the hospital staff including the medical staff and governing board. I encourage you to evaluate, amend, and build on the information contained within this article. Remember that talking to your peers about their experiences and working as though your survey is tomorrow is your best bet for superior survey results. Who knows, you could receive an unannounced survey. PMID- 10133028 TI - Contemporary issues in HIM. The Internet. Part II. AB - The services and resources available on the Internet are immense and growing daily. In this and last month's article I have only scratched the surface of what is available. I have given two references that I have found very useful while learning about the Internet. I highly recommend both. However, if you would rather look for other books or articles, they are plentiful. In a recent newspaper, I saw seven books that had "Internet" in the title advertised by one book store. There were books for PC users, Mac users, and UNIX users. Lack of information is definitely not an excuse for not checking out the Internet! PMID- 10133029 TI - Organizational change: reengineering the workflow. PMID- 10133030 TI - Electronic data interchange (EDI): an enabler of financial business process reengineering. PMID- 10133031 TI - Reengineering--impact on organizational culture. AB - There is no question that reengineering impacts organizational culture. In the case of a community-based hospital, it becomes more than just changing the culture--a new culture must emerge. However, cultural change does not have to be negative. The empowerment of reengineering causes employees to think beyond their jobs and to begin seeing their roles in the organization. At first, reengineering appeared to be in direct conflict with CQI principles and the organization's culture. However, culture, no matter how positive or strong, cannot threaten organizational survival. Survival demands the emergence of a new culture. The grassroots nature of CQI and reengineering can create an opportunity to improve labor relations, develop more effective work processes, and assure long-term viability in a rapidly consolidating industry. PMID- 10133032 TI - Bowen Family Systems Theory: a theoretical framework for organizational change agents. PMID- 10133033 TI - Managing the health information department through a merger. PMID- 10133034 TI - Making the transition to CIO: building your skills. PMID- 10133035 TI - AIDS volunteers and their motivations: theoretical issues and practical concerns. AB - Volunteers and volunteer organizations are critical elements in society's response to the HIV epidemic. This article reviews a model of the volunteer process that draws on psychological theory and methodology and incorporates concerns of individual volunteers, volunteer organizations, and society at large. An inventory for assessing the motivations of AIDS volunteers is introduced. The findings from a survey of volunteers working in AIDS organizations around the United States speak to their motivations, their choices of volunteer roles, and their decisions about quitting or continuing service. Based on these findings, a detailed set of recommendations for effective volunteer recruitment, assignment, and retention is offered. PMID- 10133037 TI - Surgical practice in rural communities: the view from the trenches. PMID- 10133036 TI - A guide to journal articles on strategic management in nonprofit organizations, 1977 to 1992. AB - This article is a guide to over a hundred journal articles on strategic management in nonprofit organizations, published from 1977 to 1992 in nineteen leading general management or nonprofit journals. The guide provides brief summaries of articles, organized into widely accepted strategic management topic areas and research categories. The article indicates areas where substantial foundations of knowledge exist and where such bases are lacking. It distinguishes between works on general nonprofit management and those on empirical research. PMID- 10133038 TI - Physicians explore options in a changing health care marketplace. PMID- 10133039 TI - Reflections on the evolution of malpractice law. PMID- 10133040 TI - Statement on laser surgery. American College of Surgeons. PMID- 10133041 TI - Surgical practice in rural communities: challenges and opportunities. AB - I have attempted to point out some problems that face the surgeon in a rural practice as well as some of the advantages of living in a rural community. Surgical residents may find that a career choice in rural surgery merits their attention and consideration because the apparent obstacles can be readily overcome, and practice in a rural area can be intellectually and professionally challenging and rewarding. PMID- 10133042 TI - Compensating physicians in a mixed fee-for-service/capitated practice. PMID- 10133043 TI - Quality and physician compensation: performance-based incentives in managed care. PMID- 10133044 TI - Strategies for ensuring access and appropriate utilization under managed care. PMID- 10133045 TI - HEDIS (Health Plan Employer Data and Information Set) indicators and quality report cards. PMID- 10133046 TI - The effect of an in-flight, emergency training program on crew confidence. AB - INTRODUCTION: Despite some progress, the air medical transport profession continues to experience widely publicized accidents that result in injuries and death to crew members and patients. An air medical crew member's experience, training and confidence may affect his or her ability to deal effectively with an in-flight emergency, and may also affect his or her behavior before and after the emergency. SETTING: A hospital-based, rural rotor- and fixed-wing program flying approximately 890 flights per year. Seventy-seven percent of these flights are interfacility. METHODS: A pretraining survey evaluated the experiences of air medical crew members and pilots. A 20-question assessment tool based on a 5-point Likert scale evaluated how confident the individuals were in their ability to react to in-flight emergencies. An extensive in-flight emergency training program was then conducted. Personnel were asked to complete the same questionnaire one month and six months after the training. RESULTS: On the pretraining questionnaire, flight crew members with neither prior training nor actual experience in in-flight emergencies showed the lowest level of confidence. Those with prior training, actual in-flight emergency experience or both, responded with higher levels of confidence. The mean confidence scores of the study participants increased from 82 pretraining to 89 at one month post-training and remained at the increased level six months after training. CONCLUSIONS: A training program focusing on in-flight, aircraft-related emergencies can increase the crew's confidence during such situations. This increase in confidence is most noticeable in those without previous training or experience and is maintained for at least six months. Several other benefits occur from the training program. PMID- 10133047 TI - 1994 annual transport statistics and transport fees survey. PMID- 10133048 TI - Using benchmarking techniques to improve efficiency and quality in cardiology services: Part one. AB - The benchmarking process highlights the need for the cardiology profession to create industry-accepted indicators to measure clinical and nonclinical effectiveness in cardiology programs. PMID- 10133049 TI - Reform: a test of management fundamentals. AB - The structure of the country's healthcare system is obviously far from being an easy one to understand. The challenge is upon the healthcare industry to carefully and systematically assess what works and what should be enhanced. PMID- 10133050 TI - Technology changes stall decisions on digital archive standards. PMID- 10133051 TI - Inventory management an integral part of the cath lab. PMID- 10133052 TI - Hospital spending and staff slashed as market forces and healthcare reform drive change. PMID- 10133053 TI - The benefits of managed dental care. PMID- 10133054 TI - The recovery of Bay State Health Care. AB - Blue Cross and Blue Shield of Massachusetts acquired Bay State Health Care after the HMO's tumultuous downturn. The case study described herein provides a useful lesson in the moves that must be made, particularly in an era of health care consolidation and intensive competition, to maintain health plan stability and reinforce its position in the marketplace. PMID- 10133055 TI - Which came first, the impetus for integrated health care systems or the impetus for health care reform? Which will be accomplished first, and is one dependent on the other? Expert opinions. PMID- 10133056 TI - An individualized, comprehensive asthma care treatment program. AB - In the conclusion of a three-part series on patient-centered asthma care, the authors describe the program developed at National Jewish Center for Immunology and Respiratory Medicine. Beginning at the time of diagnosis, the interdisciplinary intervention team works in tandem with the patient and family to build confidence, skill, and motivation in self-management. PMID- 10133058 TI - Moving Medicare enrollees to managed care plans. PMID- 10133057 TI - Medicaid managed care: can health plans survive on the government's payments? AB - The Clinton plan's emphasis on market-driven managed competition, coupled with ever-increasing Medicaid costs, has placed the U.S. health care system on the threshold of significant change. By limiting the growth of premiums, the plan will encourage insurers to negotiate managed care contracts with providers. In this article, the authors discuss how individual states, faced with increasing costs and stretched budgets, have attempted to administer Medicaid programs within a managed care system. PMID- 10133059 TI - Health care demand management. AB - Health care costs, rising prohibitively, are related in part to the magnitude of the illness burden (need) and to the services requested (demand), which in turn are related in part to preventable illness and to inconsistent and unproductive requests for utilization. A broadened model of health promotion is suggested by the author, with the twin goals of health improvement and of cost reduction. The model includes health risk reduction goals and selected screening tests, but also includes cost-focused features. Eight such programs have recently been proven to reduce medical costs by 20%, potentially representing savings of $200 billion annually, but such programs are not yet widely disseminated. PMID- 10133060 TI - The transformation of PPOs under health care reform: strategies for survival. AB - Preferred provider organizations have effectively blended the supply-side utilization control strategy and the demand-side cost-sharing strategy and have become the most prevalent form of managed care in the United States. Preferred provider organizations have successfully controlled health care costs for many employers; nonetheless, the very existence of many PPOs is threatened by the Clinton Administration's health care reform proposal. This article examines alternative strategies that might be employed by PPOs to survive the challenges posed by health care reform. PMID- 10133061 TI - Everything you ever wanted to know about capitation analysis but were afraid to ask. AB - Prepaid health plans need capitation analysis to predict costs and set premium rates. Capitation analysis allows health plans to identify the source of cost overruns, set utilization targets, and structure risk arrangements. In this article, the author explains the role of capitation analysis in today's managed care environment. PMID- 10133062 TI - The latest developments in alternative and emerging medical waste treatment technologies. AB - With the almost constant change in medical waste treatment processes--including the introduction of new systems and technologies--it's hard to stay current on developments with existing and new treatment processes. This paper presents a discussion of the most recent developments in alternative medical waste treatment, and includes data and descriptions of different vendors based on extensive research. PMID- 10133063 TI - Who should rightfully decide whether a medical treatment necessarily incurred should be excluded from coverage under a health insurance policy provision which excludes from coverage "experimental" medical treatments? PMID- 10133064 TI - Privacy Act of 1974--HCFA. Notice of a matching program--between HCFA and the Wisconsin Bureau of Workers' Compensation--HCFA will receive information from the state concerning work-related injuries and diseases. AB - Section 1862(b)(2) of the Social Security Act (42 U.S.C. 1395(b)(2)) prohibits Medicare payment with respect to any item or service to the extent that payment has been made, or can reasonably be expected to be made promptly, under a workers' compensation law or plan of the United States or a State. HCFA has developed a model agreement to be used in negotiating individual agreements with State Workers' Compensation Boards. The agreement will allow HCFA to seek recovery of identified mistaken payments that are the liability of workers' compensation agencies. The matching report set forth below is in compliance with the Computer Matching and Privacy Protection Act of 1988 (Pub. L. 100-503). PMID- 10133065 TI - Medicaid program: computer matching and privacy protection for Medicaid eligibility--HCFA. Final rule. AB - This final rule revises regulations concerning the income and eligibility verification system (IEVS) under the Medicaid program. It implements provisions of the Computer Matching and Privacy Protection Act of 1988 and the Computer Matching and Privacy Protection Amendments of 1990. These laws improve the oversight and procedures governing the disclosure of personal information used in computer matching programs and protect the privacy and due process rights of individuals whose records are exchanged by these programs. PMID- 10133066 TI - Medicare program; Medicare secondary payment--HCFA. General notice. AB - This notice provides guidelines for complying with 42 CFR 411.25, which provides that certain third party payers for health services furnished to Medicare beneficiaries must furnish certain information to Medicare intermediaries and carriers when they learn that Medicare made primary payment for services for which the third party payer has made or should have made primary payment. The notice also informs third party payers that they should contact HCFA if they wish to discuss arrangements for exchanging, on a voluntary basis, data about beneficiaries for whom the third party payer has a primary payment obligation under the Medicare Secondary Payer (MSP) provisions of the Medicare law. The third party payers affected by this notice are workers' compensation plans and insurers; all liability and no-fault insurers, including automobile insurers; and group health plans under certain circumstances, including plans which are self insured and/or self-administered. If the group health plan, or workers' compensation plan is self-insured and self-administered, the employer must provide the notice; otherwise the insurer, underwriter or third party administrator must give the notice. This description of information third party payers must furnish is intended to help ensure that, in accordance with the Medicare law, Medicare pays only secondary to primary coverage of third party payers. PMID- 10133067 TI - Medicaid program; freedom of choice waiver; conforming changes--HCFA. Interim final rule with comment period. AB - This interim final rule amends existing Medicaid regulations on freedom of choice waivers granted under section 1915(b) of the Social Security Act (the Act) to conform them to the amendments made to the Act by sections 4604 and 4742 of the Omnibus Budget Reconciliation Act of 1990. This rule: Specifies that the Secretary may not waive the requirement that the State plan provide for adjustments in payment for inpatient hospital services furnished to infants under one year of age, or to children under 6 years of age who receive these services in disproportionate share hospitals. Extends to any provider participating under a section 1915(b)(4) waiver the same prompt payment standards that apply to all other health care practitioners furnishing Medicaid services. This rule also makes technical changes in the regulations relating to a recipient's free choice of providers of family planning services and cost-sharing requirements under waivers. PMID- 10133068 TI - Medicaid program; limitations on aggregate payments to disproportionate share hospitals: federal fiscal year 1994--HCFA. Notice. AB - This notice announces the preliminary Federal fiscal year (FFY) 1994 national target and individual State allotments for Medicaid payment adjustments made to hospitals that serve a disproportionate number of Medicaid recipients and low income patients with special needs. We are publishing this notice in accordance with the provisions of section 1923(f)(1)(C) of the Social Security Act (the Act) and implementing regulations at 42 CFR 447.297 through 447.299. The preliminary FFY 1994 State DSH allotments published in this notice will be superseded by final FFY 1994 DSH allotments to be published in the Federal Register by April 1, 1994. PMID- 10133069 TI - Annual update of the HHS poverty guidelines--HHS. Notice. AB - This notice provides an update of the HHS poverty guidelines to account for last (calendar) year's increase in prices as measured by the Consumer Price Index. PMID- 10133070 TI - Civilian Health and Medical Program of the Uniformed Services (CHAMPUS); coverage of screening mammography and Papanicolaou (PAP) tests, certified marriage and family therapists, and requirements for coverage and reimbursement of services of physicians in teaching settings--Office of the Secretary, DoD. Final rule. AB - This final rule revises the exclusions and limitations of the CHAMPUS regulation pertaining to preventive care and unnecessary diagnostic tests not related to a specific illness, injury, or definitive set of symptoms, to allow coverage for screening mammography and PAP tests on a preventive basis initially following the recommended guidelines of the American Cancer Society as a basis for coverage. The final rule also removes the requirement for physician supervision and referral for certified marriage and family therapists; requires all certified marriage and family therapists to accept CHAMPUS payment as payment in full; ensures that the relationship of certified marriage and family therapists is consistent with other mental health practitioners with comparable education and training; protects the CHAMPUS beneficiary from incurring added out-of-pocket costs for care rendered that is not part of the current CHAMPUS mental health benefits package; and better defines the specific requirements of existing CHAMPUS policies for coverage and reimbursement of services of teaching physicians and physicians in training. EFFECTIVE DATE: This part is effective February 22, 1994.(ABSTRACT TRUNCATED AT 250 WORDS) PMID- 10133071 TI - Medicare program: revisions to criteria and standards for evaluating intermediaries and carriers--HCFA. Final rule. AB - This rule issues technical amendments to Medicare regulations intended to simplify and improve our system for evaluating the performance of fiscal intermediaries and carriers in the administration of the Medicare program. Currently, we evaluate intermediaries using performance criteria and standards announced in an annual notice in the Federal Register. We are clarifying the methodology for establishing these criteria and standards. For consistency, we establish comparable regulation requirements for the evaluation of carrier performance. These revisions are published in accordance with sections 1816(f) and 1842(b)(2) of the Social Security Act which require us to develop standards, criteria, and procedures to evaluate an intermediary's or carrier's overall performance. PMID- 10133072 TI - Medicare, Medicaid, and CLIA programs; personnel requirements for cytotechnologists--HCFA. Final rule with comment period. AB - This rule amends certain personnel requirements for cytotechnologists that perform testing in laboratories subject to the requirements of the Clinical Laboratory Improvement Amendments of 1988 (CLIA). We are providing an adequate period of time for individuals to gain the necessary 2 years experience performing cytology testing which is currently included in two of the provisions for qualifying as a cytotechnologist. Also, we are extending the time for individuals to either meet the educational qualifications by virtue of completing training in an approved cytotechnology training program or be certified by an approved organization. We are making these changes to prevent the loss of qualified personnel in the field of cytotechnology. PMID- 10133073 TI - Medicare program; elimination of additional payments for administrative and general costs of hospital-based home health agencies--HCFA. Final notice with comment period. AB - In accordance with section 13564(b)(1) of the Omnibus Budget Reconciliation Act of 1993, this final notice with comment period provides that the payment add-on for the administrative and general costs of hospital-based home health agencies (HHAs) is eliminated. This notice also explains the effects of this provision on the methodology used in calculating the HHA cost limits. PMID- 10133074 TI - Medicare program: schedule of limits for skilled nursing facility inpatient routine service costs--HCFA. Final notice with comment period. AB - This final notice with comment period provides that there will be no changes in the skilled nursing facility (SNF) cost limits for cost reporting periods beginning during Federal fiscal years 1994 and 1995 and that the add-on for administrative and general costs of hospital-based SNFs is eliminated. This notice announces provisions of the Omnibus Budget Reconciliation Act of 1993 that affect the schedule of limits on SNF routine service costs for which payment may be made under the Medicare program and explains the effects of these provisions on the methodology used in calculating the SNF cost limits. PMID- 10133075 TI - Attestations by facilities using nonimmigrant aliens as registered nurses--DOL. Final rule. AB - The Employment and Training Administration (ETA) and the Wage and Hour Division of the Employment Standards Administration (ESA) of the Department of Labor (DOL or Department) are publishing final regulations governing the filing and enforcement of attestations by facilities seeking to use nonimmigrant aliens as registered nurses under H-1A visas. The attestations, required under the Immigration and Nationality Act, pertain to substantial disruption in the delivery of health care services, absence of adverse effect on wages and working conditions of similarly employed registered nurses, payment of wages to nonimmigrant alien nurses employed by the facility at wage rates paid to other registered nurses similarly employed by the facility, taking timely and significant steps designed to recruit and retain U.S. nurses in order to reduce dependence on nonimmigrant alien nurses, absence of a strike or lockout, and giving appropriate notice of filing. Facilities are required to submit these attestations to DOL as a condition for being able to petition the Immigration and Naturalization Service (INS) for H-1A nurses. The attestation process is administered by ETA, while complaints and investigations regarding the attestations are handled by ESA. PMID- 10133076 TI - Medicare program; changes to the requirement for annual physician acknowledgement of physician attestation responsibilities--HCFA. Final rule with comment period. AB - Existing Medicare regulations require a hospital to obtain, on an annual basis, from each attending physician, a signed acknowledgement that the physician understands the penalty for misrepresenting the information on an attestation statement relating to principal and secondary diagnoses and major procedures performed on patients. This final rule with comment period eliminates the requirement for an annual acknowledgement statement and instead requires that a physician sign an acknowledgement statement only upon being granted admitting privileges at a hospital. The purpose of this change is to reduce the paperwork burden associated with processing claims under Medicare. PMID- 10133077 TI - Health maintenance organizations: qualification determinations and compliance actions during the period July 1, 1993, through September 30, 1993--HCFA. Notice. AB - This notice sets forth the names, addresses, service areas or modified service areas, and dates of qualification or expansion of entities determined to be Federally qualified health maintenance organizations (FQHMOs) during the period July 1, 1993 through September 30, 1993. Additionally, this notice sets forth compliance actions taken by the Office of Prepaid Health Care Operations and Oversight for the period July 1, 1993 through September 30, 1993. This notice is being published in accordance with our regulations at 42 CFR 417.144 and 417.163, which require publication in the Federal Register of certain determinations relating to FQHMOs. PMID- 10133078 TI - Medicare program; aggregation of Medicare claims for administrative appeals- HCFA. Final rule. AB - Medicare beneficiaries and, under certain circumstances, providers, physicians and other entities furnishing health care services may appeal adverse determinations regarding certain claims for benefits payable under part A and part B of Medicare. For administrative appeals at the carrier or intermediary hearing level or administrative law judge (ALJ) level and for any subsequent judicial review, the amount remaining in dispute must meet or exceed threshold amounts set by statute. Section 1869(b)(2) of the Social Security Act permits claims to be aggregated to reach the ALJ hearing threshold amounts. This final rule establishes a system of aggregation under which individual appellants have one set of requirements for aggregating claims and two or more appellants have a different set of requirements for aggregating claims. PMID- 10133079 TI - Medicare and Medicaid programs; quarterly listing of program issuances and coverage decisions--fourth quarter 1993--HCFA. Notice. AB - This notice lists HCFA manual instructions, substantive and interpretive regulations and other Federal Register notices, and statements of policy that were published during October, November, and December of 1993 that relate to the Medicare and Medicaid programs. Section 1871(c) of the Social Security Act requires that we publish a list of Medicare issuances in the Federal Register at least every 3 months. Although we are not mandated to do so by statute, for the sake of completeness of the listing, we are including all Medicaid issuances and Medicare and Medicaid substantive and interpretive regulations (proposed and final) published during this timeframe. We are also providing the content of revisions to the Medicare Coverage Issues Manual published between October 1 and December 31, 1993. On August 21, 1989 (54 FR 34555), we published the content of the Manual and indicated that we will publish quarterly any updates. Adding to this listing the complete text of the changes to the Medicare Coverage Issues Manual allows us to fulfill this requirement in a manner that facilitates identification of coverage and other changes in our manuals. PMID- 10133080 TI - Implementation of provisions of the Ryan White Comprehensive AIDS Resources Emergency Act regarding emergency response employees--CDC. Final notice. AB - The Ryan White Comprehensive AIDS Resources Emergency (CARE) Act (Pub. L. 101 381) includes provisions for emergency response employees (EREs) who may be exposed to potentially life-threatening disease during the course of an emergency. This notice sets forth the final list of diseases to which these provisions apply; final guidelines describing circumstances under which exposure to listed diseases may occur; and final guidelines for determining whether an exposure to the listed diseases has occurred. The final list of diseases and guidelines incorporate comments received by CDC on a draft list and guidelines (57 FR 54794, November 20, 1992). PMID- 10133082 TI - Statement of organization, functions, and delegations of authority; substructure reorganization of the Health Care Financing Administration. PMID- 10133081 TI - Medicare program; coverage of epoetin (EPO) used by competent home dialysis patients--HCFA. Final rule. AB - This final rule adopts as final the interim final rule that provided for Medicare coverage of EPO used by ESRD beneficiaries who dialyze at home and are competent to use the drug without medical or other supervision and established criteria for selection of patients that can be considered "competent" and for monitoring of the patients who are selected. It also makes minor changes in response to public comments on the interim rule. The interim rule was necessary to implement section 4201(d)(1) of the Omnibus Budget Reconciliation Act of 1990 (OBRA '90). The purpose of the amendments is to facilitate use of EPO at home, while ensuring that such use of the drug is safe. PMID- 10133083 TI - Medicare program; payment for preadmission services--HCFA. Interim final rule with comment period. AB - This interim final rule specifies that inpatient hospital operating costs include certain preadmission services furnished by the hospital (or by an entity that is wholly owned or operated by the hospital) to the patient up to 3 days before the date of the patient's admission to that hospital. These provisions implement amendments made to section 1886(a)(4) of the Social Security Act by section 4003 of the Omnibus Budget Reconciliation Act of 1990. PMID- 10133084 TI - Medicaid program; deduction of incurred medical expenses (spenddown)--HCFA. Final rule with comment period. AB - This final rule with comment period permits States flexibility to revise the process by which incurred medical expenses are considered to reduce an individual's or family's income to become Medicaid eligible. This process is commonly referred to as "spenddown." Only States which cover the medically needy, and States which use more restrictive criteria to determine eligibility of the aged, blind, and disabled, than the criteria used to determine eligibility for Supplemental Security Income (SSI) benefits (section 1902(f) States) have a spenddown. These revisions permit States to: Consider as incurred medical expenses projected institutional expenses at the Medicaid reimbursement rate, and deduct those projected expenses from income in determining eligibility; combine the retroactive and prospective medically needy budget periods; either include or exclude medical expenses incurred earlier than the third month before the month of application (States must, however, deduct current payments on old bills not previously deducted in any budget period); and deduct incurred medical expenses from income in the order in which the services were provided, in the order each bill is submitted to the agency, by type of service. All States with medically needy programs using the criteria of the SS program may implement any of the provisions. States using more restrict criteria than the SSI program under section 1902(f) of the Social Security Act may implement all of these provisions except for the option to exclude medical expenses incurred earlier than the third month before the month of application. PMID- 10133085 TI - Centers for Disease Control and Prevention; statement of organization, functions, and delegations of authority--PHS. PMID- 10133086 TI - Quality paraprofessional home care. AB - Home care aides are often said to be the core of the caregiving team, but their treatment and compensation may leave something to be desired. These paraprofessionals are the front-line workers in home care; for clients to perceive home care as quality care, the job of the home care worker itself must be restructured. PMID- 10133087 TI - Relationships: home care aides' perceptions of their interactions with community health nurses. AB - Home care aides are important members of the home care team, yet they may sometimes feel ignored by the nurses with whom they share patient care. This study shows that communication and strong nurse-aide relationships are essential to effective home care. PMID- 10133088 TI - The home care nurse as case manager. PMID- 10133089 TI - Training for the transition to case management in home care. AB - Hospital nurses who wish to enter home care offer a gold mine of clinical skills. The only thing missing is case management experience. How can agencies help nurses acquire this last commodity and take the final step to home care? Training programs may be the answer. PMID- 10133090 TI - Physical therapists in home care--yesterday, today & tomorrow. AB - As more and more patients head home for rehabilitation they call on physical therapists to help speed recovery from physical disability or to help them adjust to limited mobility. Physical therapists provide a much-needed service and are increasingly taking on an expanded role as part of the home care team. PMID- 10133091 TI - Funding alternatives for home care agencies. AB - Finding new and creative ways to raise money for home care agencies swept up in the turbulence of health care reform can present quite a challenge. With Medicare and Medicaid up for grabs in the ongoing federal budget battle, where can agencies turn to ensure funding for the care so many people need? PMID- 10133092 TI - The increasing role of the pharmacist in home care. AB - Home infusion therapy is a dynamic, relatively new field for pharmacy. Major factors contributing to its growth include cost savings compared to inpatient care, new ambulatory device technologies, and strong patient preferences to receive care in their own homes. PMID- 10133093 TI - The physician's role in Boston University's Home Medical Service. AB - At one time home care was the norm for medical care, with physicians traveling from one patient's home to another. Today it's a different story--very few physicians make house calls. Boston University, however, has included home care in its curriculum for medical students, priming them to take part in geriatric and community medicine when they graduate. PMID- 10133094 TI - Landing the executive job: how to prepare for employment in the '90s. AB - The 1990s have been an era of transition for much of the American workforce as companies change with the times. Executives in home care have been dealing with change as well. The authors polled executives and executive recruiters to discover their secrets for success in today's job market. PMID- 10133095 TI - Beyond the health services industry: other industries that employ health workers. PMID- 10133096 TI - Carrot and stick: state mechanisms to influence private provider behavior. AB - The behavior of private sector health care providers will depend critically on the environment within which they operate. A bewildering array of possible regulatory and incentive setting structures exist. Most developing countries have the basic legislation for regulation, but there are frequently difficulties in enforcing such controls. While process aspects of quality of care regulation are often the responsibility of professional organizations, these organizations may have limited incentives to be active in ensuring high quality medical car.e There has been less experience with the use of incentives to encourage appropriate behavior amongst private providers: this appears a promising area for further work. Above all, adequate information is essential both for the enforcement of regulations and the application of incentive mechanisms. PMID- 10133097 TI - The potential of health sector non-governmental organizations: policy options. AB - Non-governmental organizations (NGOs) have increasingly been promoted as alternative health care providers to the state, furthering the same goals but less hampered by government inefficiencies and resource constraints. However, the reality of NGO health care provision is more complex. Not only is the distinction between government and NGO providers sometimes difficult to determine because of their operational integration, but NGOs may also suffer from resource constraionts and management inefficiencies similar to those of government providers. Some registered NGOs operate as for-profit providers in practice. Policy development must reflect the strengths and weaknesses of NGOs in particular settings and should be built on NGO advantages over government in terms of resource mobilization, efficiency and/or quality. Policy development will always require a strong government presence in co-ordinating and regulating health care provision, and an NGO sector responsive to the policy goals of government. PMID- 10133098 TI - Contracting out of health services in developing countries. AB - Contracting out is emerging as a common policy issue in a number of developing countries. The theoretical case for contracting out suggests many advantages in combining public finance with private provision. However, practical difficulties such as those of ensuring that competition takes place between potential contractors, that competition leads to efficiency and that contracts and the process of contracting are effectively managed, suggest that such advantages may not always be realized. Most countries are likely only to contemplate restricted contracting of small-scale non-clinical services in the short term. Prerequisites of more extensive models appear to be the development of information systems and human resources to that end. Some urban areas of larger countries may have the existing preconditions for more successful large-scale contracting. PMID- 10133099 TI - The World Bank. PMID- 10133100 TI - Evaluation of suicide intervention effectiveness. AB - Considering the prevalence of suicide and other forms of self-injurious behavior, it is ironic that relatively little attention has been paid to the training of mental health workers in suicide intervention. Still less effort has been spent in evaluating the effectiveness of such workers or the agencies in which they serve. We review the evaluation strategies that have been used to assess the process and outcome of suicide intervention, ranging from macroanalyses of the impact of crisis services on suicide rates in the community to microanalyses of the competence of individual suicide interventionists. Particular attention is paid to the Suicide Intervention Response Inventory, a self-administered test of suicide counseling skills whose validity, reliability, and practical utility suggest the benefit of its use in a broader range of research and applied settings. The advantages and disadvantages of each evaluation strategy are discussed, and guidelines are offered for the sophistication of future research and program evaluation efforts. PMID- 10133101 TI - Regulation and legislation of the dying process: views of health care professionals. AB - Because of radical changes that have been effected by medical advances in the process of dying, it is now frequently necessary for patients to make an explicit decision on whether to forego life-prolonging medical therapies. We report physicians' and nurses' perceptions of the need for, feasibility of, and value of regulations and legislation to govern the dying process. In-depth, semistructured interviews were conducted with a sample of 20 physicians and 20 nurses at a large teaching hospital. There was little unanimity in their attitudes toward whether it is advisable or feasible to devise adequate legal safeguards for physicians and nurses who assist patients to hasten their deaths. Some believed such regulations were needed, but others believed they would seriously compromise good patient care. There was also disagreement as to who should develop guidelines. There was, however, clear opposition among most participants to the involvement of lawyers in the process of clarifying the content of regulations and legislation on the dying process. PMID- 10133103 TI - Surviving layoffs. PMID- 10133102 TI - Hostess system increases patient satisfaction. PMID- 10133104 TI - Long-term care: emerging trends. PMID- 10133105 TI - Trends in Medicaid nursing home reimbursement: 1978-89. AB - Medicaid nursing home reimbursement is of concern because of implications for nursing home expenditures. This article presents data on State Medicaid nursing home reimbursement methods, ratesetting methods, and average per diem rates, refining earlier data and updating through 1989. A trend in the early 1980s toward adopting prospective systems played out by the end of the decade. There were trends, however, toward casemix methods, which may increase access for high need patients, and toward cost-center limits on nursing, which may provide incentives to lower quality care. Analysis supports previous findings that prospective systems allow greater control over increases in rates. PMID- 10133106 TI - Simulating the fiscal and distributional impacts of Medicaid eligibility reforms. AB - About 43 percent of nursing home costs are paid by Medicaid for the poor and for those who spend-down assets to qualify for Medicaid. We estimate the costs and distributional impacts of changes in the Medicaid asset test and the effect on the number of people spending down to Medicaid eligibility levels. Increasing asset thresholds from $2,00 to $12,000 would cost less than $4 billion, reduce spend-down rates, and increase the proportion of people eligible for Medicaid on admission to a nursing home. Even after such a change, about 80 percent of Medicaid benefits accrue to individuals with incomes less than $10,000. PMID- 10133107 TI - Resident medical care utilization patterns in continuing care retirement communities. AB - This article presents the findings of an evaluation of medical care service utilization by two elderly cohorts: one living in continuing care retirement communities (CCRCs) and the other living in traditional community settings. CCRC residents' overall use of Medicare-covered medical services did not differ significantly from that of the traditional community-residing elders. Both groups incurred annual per capita expenditures of approximately $2,000. In their last year of life, however, CCRC residents displayed significantly lower expenditures for hospital care ($3,854 versus $7,268) but higher expenditures for Medicare or non-Medicare-covered nursing home care ($5,565 versus $3,533). PMID- 10133108 TI - Evaluating the predictive validity of nursing home pre-admission screens. AB - This article demonstrates a method for evaluating the predictive validity of nursing home pre-admission screens (PAS) by using measures of predictive validity adapted from the field of epidemiology. Our approach estimates how well as PAS performs in identifying the "who but for" population of the Medicaid home and community-based services waiver programs for the frail elderly. The methodology's usefulness in screen revision is also illustrated. PMID- 10133109 TI - Containing use and expenditures in publicly insured long-term care programs. AB - British Columbia and Manitoba have the most developed and comprehensive publicly financed long-term care (LTC) programs in North America. For U.S. policymakers, these programs are large-scale natural experiments with public LTC insurance. During the 1980s, both provinces successfully contained the growth of public expenditures on nursing homes, and one province successfully contained the growth of public expenditures on home support services, adjusting for population growth. Because provincial cost-control methods are similar to those that some States already use, it is likely that managers could contain the growth of public expenditures once a publicly insured U.S. LTC program was implemented. The level of public expenditure would depend partly on the level of compensation for LTC sector personnel, which is relatively low in the United States. PMID- 10133110 TI - Comparison of rural and urban skilled nursing facility benefit use. AB - In this article, differences in use of Medicare's skilled nursing facility (SNF) benefit in urban and rural areas are examined. Using SNF benefit bills from 1987, the study finds that there appear to be systematic differences by residential location both in the level of use of the benefit and in whether enrollees are admitted to nursing homes and hospital swing beds. Rural Medicare enrollees use the SNF benefit at a rate that is 15 percent higher than the rate for urban enrollees. Furthermore, the swing-bed program appears to play a critical role in providing access to post-acute care for the rural elderly. In rural areas, almost 29 percent of all SNF benefit admissions are to swing beds. PMID- 10133111 TI - Rural and urban differentials in Medicare home health use. AB - This article addresses whether the use of Medicare home health services differs systematically for rural and urban beneficiaries. It draws on Medicare data bases from 1983, 1985, and 1987, including the Health Insurance Skeleton Write-Off (HISKEW) files and the Home Health Agency (HHA) 40-percent Bill Skeleton files. It presents background information on rural and urban beneficiaries and contrasts the use rates, visit levels and profiles, episodes of home health use, and primary diagnoses in rural and urban areas. The results point to higher home health use rates in urban areas and to a narrowing of the urban-rural use differential from 1983 to 1987. Rural home health users receive on average three more visits than their urban counterparts, with many more skilled nursing and home health aide visits. However, rural enrollees are much less likely than urban enrollees to receive medical social service or therapeutic visits, even after controlling for primary diagnosis. These findings point to the need for further analysis to understand the consequences of these differences. PMID- 10133112 TI - Medicare home health: a description of total episodes of care. AB - The purpose of this study was to present descriptive information on the characteristics of 2,873 Medicare home health clients, to quantify systematically their patterns of service utilization and allowed charges during a total episode of care, and to clarify the bivariate associations between client characteristics and utilization. The model client was female, 75-84 years of age, living with a spouse, and frail based on a variety of indicators. The mean total episode was approximately 23 visits, with allowed charges of $1,238 (1986 dollars). Specific subgroups of clients, defined by their morbidities and frailties, used identifiable clusters of services. Implications for case-mix models and implications for capitation payments under health care reform are discussed. PMID- 10133113 TI - Access and use of health services by chronically mentally ill Medicaid beneficiaries. AB - This article has two objectives: to quantify the access and utilization of services received by chronically mentally ill Medicaid recipients, and to compare service utilization and access under prepayment and fee-for-service (FFS) payment. The study setting is Hennepin County (Minneapolis), Minnesota, where 35 percent of Medicaid recipients were randomly assigned to receive services from prepaid plans. An algorithm was developed to identify recipients with chronic mental illness, resulting in 739 study participants, split approximately evenly between prepayment and FFS Medicaid. Data were collected through in-person surveys at baseline, and after 1 year. We found slight improvements in the majority of access measures studied and no significant decreases in the use of inpatient or outpatient services for enrollees in prepaid health plans. The results support efforts to expand the use of prepaid health plans to meet the needs of non-institutionalized chronically mentally ill Medicaid beneficiaries. PMID- 10133115 TI - R&D. Famous for 15 minutes?. Interview by Annabelle May. PMID- 10133114 TI - Quality assurance for a program of comprehensive care for older persons. AB - Quality assurance (QA) for comprehensive programs like the Program of All inclusive Care for the Elderly (PACE) requires a special strategy. The assessment phase should be capable of looking across the usual subdivisions of care to recognize the contributions of various disciplines, and to focus on the effects of that care on the patient. Measures should thus include both problem-specific and patient-focused elements. The tracer technique which follows the care of specific problems provides an opportunity to look at both the process and outcomes of care. An outcomes focus which looks at patient functioning as well as condition-specific parameters can include specific sentinel events whose presence suggests untoward developments. Quality assurance implies more than assessment. It represents a commitment to act responsibly on the information obtained to improve the care rendered. It includes a strategy for proactive involvement where caregivers are prompted to consider pertinent information in a timely fashion, and a retrospective remedial approach where the data are analyzed and presented in a format that can be readily understood and which suggests next steps to improve care. PMID- 10133116 TI - Perspectives on purchasing. Band-aid. PMID- 10133117 TI - Managing change. Reformed characters. PMID- 10133119 TI - HSJ product profile. Product news. PMID- 10133118 TI - Vital statistics. PMID- 10133120 TI - Perspectives on purchasing. Cabbages and things. PMID- 10133121 TI - Health promotion. Eat, drink, and be merry. PMID- 10133122 TI - Accountability. Paperchase. PMID- 10133123 TI - Perspectives on purchasing. Every day in every way. PMID- 10133124 TI - Health promotion. Local sensitivities. PMID- 10133125 TI - Data briefing. Evaluating the reforms. National Association of Health Authorities and Trusts. PMID- 10133126 TI - Enhancing the role of physicians in the cost-effective use of pharmaceuticals. AB - The appropriate use of pharmaceuticals, like much else in medicine, is receiving increased public scrutiny. Health care practitioners are looking for ways to reduce costs without negatively influencing quality of care. This article reviews methods for physicians and pharmacists to work together to implement cost effective prescribing practices and assess clinical outcomes. These methods include educational initiatives, administrative programs to restrict ordering practices, use of formularies and prescribing guidelines, financial incentives, and programs that support physician and pharmacist collaboration. PMID- 10133127 TI - Cost-effectiveness study of nitrate therapy using a decision analysis methodology. AB - The cost-assessment technology of decision analysis was applied to isosorbide dinitrate (ISDN), the standard therapy for angina; isosorbide mononitrate (ISMO), approved mid-1992; and nitroglycerin patches to measure the effect of economics on clinical practice and administrative choices. The evaluation was conducted to illustrate the utility of this method for decision makers in various sectors of the health care system, including physicians, pharmacy benefit administrators, formulary committees, and manufacturers. Findings indicate that despite a higher unit cost for ISMO, total anticipated treatment costs with this new long-acting nitrate are lower than those associated with ISDN (28%) and nitroglycerin patch (16%) therapy in patients with stable angina, and ISMO requires less dosing titration and is associated with fewer tolerance effects. PMID- 10133128 TI - Patient controlled analgesia: evaluation of pain management and patient outcome. AB - A study was conducted to evaluate patient response to patient controlled analgesia (PCA) devices. All patients were interviewed for this concurrent study. A survey was also taken with the nursing staff for their assessments regarding PCA therapy and comparison of outcomes between morphine and meperidine use. Our goal was to see what improvements could be made in pain management and patient therapy wherever possible. PMID- 10133129 TI - What strategies can be tried to keep costs of antibiotics and other high-priced drugs from becoming true budget busters? PMID- 10133130 TI - The resource implications and service outcomes of genetic services in the context of DNA technology. AB - The use of DNA technology has transformed genetic counselling services for single gene disorders. For conditions such as Duchenne muscular dystrophy and cystic fibrosis, both of which cause severe morbidity and premature death, DNA tests mean that individuals can be told with greater certainty whether they are carriers of a genetic trait and of the likelihood of their having a child affected by the disorder. This paper presents the findings of an evaluation of the resource implications and service outcomes of genetic services in the context of DNA technology (DNA services). Results are based on data collected over a 4 year period from three large genetics centres throughout the United Kingdom. Our conclusions are that for the conditions for which they are commonly used, and as a regionally based service, DNA services are effective and relatively inexpensive. For severe conditions, and for neurological disorders, although tests will not alter family size plans the demand for tests during pregnancy will be high and the results will have a significant impact on individuals' decisions regarding the continuation of their pregnancies. For conditions of variable severity, those that start late in life or are amenable to treatment, the demand for tests is likely to be low. In comparison with the general population we found a greater existence of psychological side effects amongst counsellees. These effects were linked to individuals having a close relative, usually a child, already affected by a disorder rather than being a consequence of the genetic counselling process. PMID- 10133131 TI - The effect of a patient charge and a prescription regulation on the use of antihypertension drugs in Limburg, The Netherlands. AB - On 1 February 1983 a patient charge was introduced for prescription drugs for persons insured under the Dutch Sickness Funds Insurance Act. The charge consisted of a co-payment of NLG 2.50 per prescription item up to a maximum of NLG 125 for each family per calendar year. In the period before the introduction of the charge a prescription regulation was in force. For the majority of drugs this rule directed that each prescription item should be for a dosage of not more than 30 days. The prescription regulation was officially introduced on 1 January 1981 and ceased with the introduction of the charge. The effect of both measures on the use of antihypertension drugs in Limburg was investigated in an interrupted time-series analysis. Both the prescription regulation and the charge appeared to have an effect on the number of prescription items per insurant and the number of units delivered per prescription item. However, neither measure resulted in a reduction in the number of units delivered per insurant or the number of 'defined daily doses' (DDDs) per insurant. These findings suggest that neither measure resulted in a decrease in the inappropriate or appropriate use of antihypertension drugs. PMID- 10133132 TI - Health care expenditure in the Nordic countries. AB - International comparisons of health care expenditure are associated with many different kinds of problems. One type of problem is due to heterogenous definitions and to difficulties with conversion to common prices. Such problems are present also if one selects homogeneous countries as, for example, the Nordic countries, which have a similar GDP per capita and social system. In this paper we compare the health care expenditure in the Nordic countries to illustrate the significance of these problems in international comparisons. We also correct the latest available OECD statistics for local nursing homes, which are not included in health care expenditure for Denmark but are included for the other Nordic countries, and also for the care of the mentally retarded, which is not included in health care expenditure for Denmark or, after 1985, for Sweden. In addition, comparisons of health care expenditure are presented with different currency conversion factors. The comparisons show, for example, that Sweden has a higher expenditure share of gross domestic product (GDP) than Denmark, even after corrections have been made, but that the difference between the countries becomes considerably smaller, from 37% higher expenditure for Sweden without correction to 12-15% after correction. PMID- 10133133 TI - The impact of laparoscopic cholecystectomy in Canada and Australia. AB - The introduction of laparoscopic cholecystectomy in Canada and Australia has been associated in each country with an increase in the rates of all cholecystectomies following a period where these had remained constant. Estimated costs of cholecystectomies to health programs declined by about 13% in Canada after the laparoscopic procedure became widely available, and about 2% in Australia. Days lost to patients because of surgery, and associated costs to them, decreased in each country. Neither country is realising the potential savings through use of laparoscopic cholecystectomy because of the increase in the number of procedures. The utility of these additional operations remains unclear. These trends associated with the advent of laparoscopic cholecystectomy suggest the need for caution in the introduction and application of other minimal-access surgery techniques. PMID- 10133134 TI - Dimensions of health system reform. AB - During recent years there has been a growth of worldwide interest in health system reform. Countries at all levels of economic development are engaged in a creative search for better ways of organizing and financing health care, while promoting the goals of equity, effectiveness, and efficiency. Together with economic, political, and ideological reasons, this search has been fueled by the need to find answers to the complexities posed by the epidemiologic transition, whereby many nations are facing the simultaneous burdens of old, unresolved problems and new, emerging challenges. In order to better understand reform attempts, it is necessary to develop a clear conception of the object of reform: the health system. This paper presents the health system as a set of relationships among five major groups of actors: the health care providers, the population, the state as a collective mediator, the organizations that generate resources, and the other sectors that produce services with health effects. The relationships among providers, population, and the state form the basis for a typology of health care modalities. The type and number of modalities present in a country make it possible to characterize its health system. In the last part, the paper proposes that health system reform operates at four policy levels: systemic, which deals with the institutional arrangements for regulation, financing, and delivery of services; programmatic, which specifies the priorities of the system, by defining a universal package of health care interventions; organizational, which is concerned with the actual production of services by focusing on issues of quality assurance and technical efficiency; and instrumental, which generates the institutional intelligence for improving system performance through information, research, technological innovation, and human resource development. The dimensions of reform offer a repertoire of policy options, which need to be enriched by cross-national comparison of experiences and rigorous social experimentation. Maybe then reform will be a more systematic effort, and nations will be better able to learn from each other. PMID- 10133135 TI - Blood ties: accountability for blood quality in New Zealand. AB - Blood donations are 'gifts' that do not fit easily into a more market-oriented health care system. The new commercial organisational arrangements in New Zealand for the collection, manufacture and distribution of blood and blood products are compared in this paper with the old organisational arrangements. The particular case of screening blood for hepatitis C is examined. A socio-legal framework, which looks at the regulation of social institutions, is used to explore the different ways in which people have tried to maintain the quality of blood and blood products, both in New Zealand and internationally. One conclusion drawn is that blood production and distribution cannot be commercialised without affecting supply and quality. PMID- 10133136 TI - Health care in Canada: a system in turmoil. AB - Canada, in common with most countries, is re-examining its health care system. The main reasons for the reappraisal are the rising cost of health care and the growing unease that the cost is fast outstripping the capacity of the tax base to support it. This paper examines the way in which Canada's provinces are attempting to meet this health care challenge. It does this from two perspectives: first, through a consideration of the steps taken to control and/or cut costs and, second, by an exploration of the developing debate about rationing. The paper concludes with some comments about the potential policy implications of such issues. PMID- 10133137 TI - The use of prescription charges. AB - This paper makes a contribution concerning the effectiveness of the direct payment for drugs by the patient through a review of the most important empirical US and UK contributions. It confirms that the demand for prescription drugs, and even the demand for OTC to a lesser extent, is reduced by a direct contribution from the patient. The price elasticities which measure the scope of the decrease of drug consumption, range however at low levels from -0.1/or -0.2 to -0.6 [1]. In order to be able to draw some policy conclusions from these studies, the health analyst will also want to have clinical or quality assessments of the changes of consumption or the health conditions of the patient. Some of the works reviewed offer some preliminary answers, but on a limited share of the population (the Medicaid population in the USA). Applied to some non-essential medications, however, this type of work highlights the phenomena of substitution between drugs, lack of change in overall drug use and uncertain changes in the quality of prescribing. This review paper will allow the policy makers to discuss some areas of change for various types of direct payments of the patient, and the use of unique versus selective schemes. PMID- 10133138 TI - Annotated bibliography. Dependency: conceptualization and strategies. PMID- 10133139 TI - Key operating and financial ratios for Alberta hospitals. AB - Comparative financial and operating ratios in Canadian hospitals are examined to reveal sources of increased efficiency. The study involved 70 Alberta hospitals, which were divided into three groups: teaching hospitals, regional hospitals and smaller rural hospitals. Data were obtained from HS-1 and HS-2 reports. Hospitals across Canada can calculate their own ratios to give them a general idea of how they compare with the hospitals in this report. PMID- 10133140 TI - Resource intensity weighing and case mix grouping: assumptions and implications for health service performance evaluation. AB - The use of Resource Intensity Weights (RIWs*) for equity funding and utilization management assumes validity of the cost estimates, reliability of the patient categorization scheme, equivalence of the bases for cost comparison, and equity of the subsequent resource distribution. This paper examines these assumptions, and concludes that caution must be taken when using the current RIWs and Case Mix Groups (CMGs*) for resource allocation and performance evaluation purposes. RIW has represented a milestone in the history of Canadian health care product costing and management. It would be prudent for health care professionals at the operational level to provide structured and continuing feedback that can contribute to the validation and refinement of these valuable management tools. PMID- 10133141 TI - Organizational renewal and strategic planning: a winning combination. AB - Several approaches to organizational renewal have been described, but few are reported for health care institutions in Canada. In contrast, approaches to strategic planning in health care facilities have been well documented. From our experience over the past six years, the theory and practice of organizational renewal complement the focused activities of strategic planning. This combination can be an effective means to enhance organizational performance, employee commitment and a shared vision among the various stakeholders within the hospital and community. This article outlines the process and benefits that can accrue through such efforts. It demonstrates how the investment of organizational renewal strategies can produce sustainable, operational and strategic planning benefits for community hospitals. PMID- 10133142 TI - Leadership without bosses: shared leadership in the creation of a health network. AB - After province X's Minister of Health announced that health administration would be regionalized, administrators from two hospitals, a health unit and a nursing home planned a health network. In planning the network, the participants looked beyond their own facilities as being separately governed and separately funded organizations. This study investigates the exercise of shared leadership in order to increase the understanding of the nature of leadership and the meanings attributed to leadership activity by the various participants. PMID- 10133143 TI - New patient care tower offers a lot more service, even with 26 fewer beds. Children's Hospital Medical Center, Cincinnati. PMID- 10133144 TI - Come blow your horn. PMID- 10133145 TI - Programming: basic but key building-design step. PMID- 10133146 TI - New options for old carpet: reclaim, recycle and reuse. PMID- 10133147 TI - Green lights audits help spot lighting deficiencies. PMID- 10133148 TI - Case study in collaboration: FM (facility management) + ES (environmental services) = AST (area service technician) position. PMID- 10133149 TI - TB mask rules leave some health facilities gasping for help. PMID- 10133150 TI - Specialized detectors cut risk of dryer-exhaust fires. PMID- 10133151 TI - Health reform to link middle managers, CEOs more closely. PMID- 10133152 TI - Bits on bytes: computer-aided design software. PMID- 10133153 TI - HMO/insurer-provider partnerships: creating the "ultimate model" for hospitals, physicians and HMOs/insurers. PMID- 10133154 TI - The managed care triad: new roles for HMOs/insurers, hospitals, and physicians. PMID- 10133155 TI - The most integrated market in America: Minneapolis-St. Paul. PMID- 10133156 TI - Blues are merging and repositioning for managed care. PMID- 10133157 TI - Applying stakeholder analysis to health care administration education. AB - Demographic trends and budgetary constraints at many universities suggest that education will not be "business as usual" in the next several years. Academic programs in health care administration can enhance their ability to respond to these challenges by implementing stakeholder analysis as part of their strategic planning process. This article delineates the stakeholder groups which typically influence programs in health care administration and presents a systematic manner of analyzing their relationships to the program in terms of values and beliefs, power, cooperative potential, and likely issues. Actions to strengthen relationships with each stakeholder group are noted. Finally, the utility and limitations of stakeholder analysis are discussed. PMID- 10133158 TI - What health administrators should know about the law. AB - Health care administrators in private and public organizations are currently faced with stringent demands, limits, and program requirements imposed by state and federal law. In the wake of impending health care reform, regulation and governmental oversight will only increase, and affect virtually everything health administrators do. Consequently, health administrators must receive meaningful education regarding the sources and structure of the legal system and the system's resulting impact on health administration. This article examines legal training currently offered to future health administrators, explores the legal knowledge and skills health administrators need to effectively perform their duties, and proposes an approach for teaching health law, which is designed to provide students not only with education regarding the structure and underlying policies of the legal system, but also with an opportunity to apply legal principles under conditions that replicate the environment of a health care organization. PMID- 10133159 TI - The status of experiential learning among graduate programs in health administration. AB - Today's programs in health administration are faced with dramatic changes both from within the university and from the field of practice. These changes include new criteria for accreditation by ACEHSA, recent volatility in the market-place for new graduates, charges of separateness between university programs and the field of practice, and tightening of university budgets. One issue affected by these changes is the role and value of experiential learning in the graduate curriculum. This article reports on a survey of AUPHA member programs regarding the status of experiential learning in their programs. PMID- 10133160 TI - Managing health services organizations with an educational mission: the case of Canada. AB - Teaching hospitals represent a major segment of the Canadian health system, accounting for a disproportionate number of beds, patient days, and separations. Thus, although only six percent of hospitals are classified as teaching hospitals, they are responsible for about 36 percent of total hospital operating expenses. While affiliation with a medical school presents unique opportunities for the teaching hospital and increases its prestige, there are clear costs associated with affiliation. Administrators have less control over resource allocation decisions, including the types of teaching programs offered. Teaching hospitals cannot unilaterally design their own teaching programs around specialties and subspecialties of their own choosing; decisions related to teaching programs have a direct impact on the services provided by the hospital and may negatively affect the hospital's ability to fulfill its patient care mission. As education budgets are constrained, teaching hospitals are expected to assume outstanding teaching-related expenses. Teaching hospitals are also expected to shift some of their teaching to alternative settings, such as the community. Thus, teaching hospital administrators will require a strong background in finance as well as negotiation and political skills. PMID- 10133161 TI - Management competencies in health for all/new public health settings. AB - Competency-based health management research, commonly undertaken by educationalists, has tended to draw upon the attitudes and beliefs of managers from the curative, institutional/bureaucratic health care sector. With traditional health care priorities being questioned in many industrialized countries, and in particular with greater attention being paid to the concepts underlying the "Health for All" (or what is known in Australia perhaps more commonly as the "New Public Health") movement, there would seem to be a need to broaden competency-based research to incorporate the attitudes of practitioners managing non-curative health services and programs. To this end an exploratory qualitative research project involving New Public Health managers in a series of semi-structured focus sessions was undertaken. The discussions were transcribed and analyzed to identify and isolate the features perceived to be essential for effective New Public Health practice and its management. While consensus was not apparent even on definitional issues, certain qualities were seen as necessary in the effective public health manager. In particular "key figure" attributes- charisma, commitment, and drive--were rated highly, as were the abilities to function in a loosely regulated environment while at the same time dealing with bureaucratic processes. PMID- 10133162 TI - Breaking through the tunnel: developing a course in ecosystems and health care management. PMID- 10133163 TI - Health politics and policy: survey of U.S. health administration courses. AB - In summary, the vast majority of graduate health administration programs in this country offer a course in health politics and policy. Most of these courses are conducted as a seminar involving class discussions, guest speakers, and student projects. Aside from these generalizations, there is little consensus regarding such matters as course content, objectives, textbooks, and readings. The findings of this survey indicate a crying need in health administration education for a basic textbook or collection of readings on health policy and politics. Such a text should cover the following: 1. Basic information on United States politics and government: our constitutional framework; the presidency; the legislative process; the role of the judiciary; state and local governments; etc. 2. Late 20th century United States political culture: why Americans hate politics and distrust politicians; government as "part of the problem"; the role of the media; the role of lobbyists; campaign financing; increased us of initiatives and referenda; etc. 3. Comparisons of the United States health care system to systems in other countries: Canada, Great Britain, Sweden, Germany, etc. 4. Case studies on traditional health policy issues: Hill-Burton, planning, cost versus access, risk segmentation, rationing, health ethics, etc. 5. Bibliography of suggested readings. A textbook or anthology of this type would provide a solid foundation for a health policy course. Instructors could then add discussion of current events, guest speakers' presentations, and selected readings on emerging issues such as health care reform. In this way the course could be grounded in sound political science theory while also meeting the students' needs for practical insights into health policy issues of the day and their own role as health care executives in influencing the outcome of those policy debates. PMID- 10133164 TI - The management school connection. PMID- 10133165 TI - Survivor guilt in cancer patients: a pastoral perspective. AB - Defines survivor guilt and relates it to cancer patients' issues of meaning making, feelings of responsibility, and need for restitution. Notes the spiritual dimension of survivor guilt and indicates ways in which pastoral caregivers might serve as both learners and as spiritual guides in meeting these existential factors implicit in survivor guilt phenomena. PMID- 10133166 TI - From the valley of the shadow of death: a group model for borderline patients. AB - Describes a pastoral group for patients with borderline personality disorder. Offers a theoretical justification for providing such troubled individuals with access to spiritual as well as to traditional biopsychosocial treatment resources. PMID- 10133167 TI - Pastoral counseling in a hospice: have you considered it? AB - Claims that hospices provide a challenging setting for pastoral counselors but one in which they do not appear to be practicing. Offers some personal experiences of working in a hospice and urges counselors to become more involved in this form of specialized ministry. PMID- 10133168 TI - Hospital gets favorable ruling. PMID- 10133169 TI - Neb. lawmakers pass bill providing antitrust relief. PMID- 10133170 TI - JCAHO undecided on disclosure format. PMID- 10133171 TI - GAO finds trends in group referrals. PMID- 10133172 TI - Hospital suppliers getting ready to plug in new ordering system. PMID- 10133173 TI - Epic shareholders to get a say on execs' compensation package. PMID- 10133174 TI - Analysts cheer NME fraud settlement. PMID- 10133175 TI - CPC shrinks its operations in Texas. PMID- 10133176 TI - Fla. sues federal government over immigrant costs. PMID- 10133178 TI - Long-term care middle ground sought. PMID- 10133177 TI - Rating firms say health issues are 'under pressure'. PMID- 10133179 TI - Integration rush won't aid areas most in need of care. PMID- 10133181 TI - AHA taking close look at accreditation. PMID- 10133180 TI - FTC may sue to stop Fla. acquisition. PMID- 10133183 TI - AHA plans study of work force under reformed health system. PMID- 10133182 TI - Top priorities. Minority executives look for results from the growing interest in diversifying healthcare management. AB - It's still a predominantly white, male world in the executive suites at most hospitals and healthcare systems. While trade groups and minority organizations are working to change that equation, continuing industry consolidation could mean fewer opportunities. PMID- 10133184 TI - Beverly expanding service offerings by buying subacute firm. PMID- 10133185 TI - More bad docs cited in 1993--boards. PMID- 10133186 TI - Maryland project enters 'so-what' phase. PMID- 10133187 TI - Bond sales hit the brakes as rates rise. PMID- 10133189 TI - St. Louis system builds medical group. PMID- 10133188 TI - Congress questions dire reports, works to advance reform. PMID- 10133190 TI - AHA seeks buyer for HPIC subsidiary. PMID- 10133191 TI - Hospital swap suits firms' goals. PMID- 10133192 TI - Bell Atlantic sells healthcare systems division to Boston firm. PMID- 10133193 TI - Medicare rate hike revisions sought. PMID- 10133194 TI - Fee caps in Florida could save insurers, patients $200 million. PMID- 10133195 TI - Pa. high court ruling aids hospitals. PMID- 10133196 TI - Towers head indicted on charges of skimming. PMID- 10133197 TI - State officials bolster Fla. merger. PMID- 10133198 TI - Hospitals lose leverage with Ukiah dismissal. PMID- 10133199 TI - Pa. hospital settles tax dispute. PMID- 10133200 TI - Lawmakers still far apart on reform plan. PMID- 10133201 TI - Medicare data misleading--ProPAC chief. PMID- 10133202 TI - Mass. hospital seeks a buyer after deal ends. PMID- 10133204 TI - JCAHO drops standards marketing firm. PMID- 10133203 TI - HANYS studying accreditation needs. PMID- 10133205 TI - Mass. bills target provider fund. PMID- 10133206 TI - ProPAC studying financial links between physicians, hospitals. PMID- 10133207 TI - Sorting out subacute care. Subspecialty's surge has feds, states seeking proof of the product's promises. AB - Subacute care has become one of the fastest growing subspecialties in healthcare, a veritable gold mine of revenues, thanks in part to higher government reimbursement. But the surging profits are prompting the feds and states to take a closer look, and analysts are warning providers not to rush into the market. PMID- 10133208 TI - Collaboration, not merger, in works for physician group organizations. PMID- 10133209 TI - ESOPs fuel acquisitions and motivate employees. PMID- 10133210 TI - Pay plans need a redesign--survey. PMID- 10133211 TI - Merger helps OrNda win analysts' interest. PMID- 10133212 TI - Quorum to sell more hospitals. PMID- 10133213 TI - Calif. Adventist systems join forces. PMID- 10133214 TI - St. Joseph eyeing network. PMID- 10133216 TI - AMI and partners win Hilton Head bid. PMID- 10133215 TI - VHA posts profit, shortens name. PMID- 10133217 TI - Columbia/HCA set to buy oldest Fort Worth hospital. PMID- 10133218 TI - Californians seek vote on single-payer plan. PMID- 10133219 TI - CBO sees $19 billion from tax cap. PMID- 10133220 TI - Definition of healthcare changing. PMID- 10133221 TI - Inside events unraveled T2 buyout. PMID- 10133222 TI - Hospital elections continue decline. PMID- 10133223 TI - Mississippi cancels contract with Medicaid third-party administrator. PMID- 10133224 TI - Chamber stands against mandate. PMID- 10133225 TI - Employer mandate a top concern in several alternate reform plans. PMID- 10133226 TI - Ohio physicians face inquiries over MRIs. PMID- 10133227 TI - N.J. hospitals face instability--report. PMID- 10133228 TI - Iowa lawmakers OK telemedicine bill. PMID- 10133229 TI - Mich. market may see second merger. PMID- 10133230 TI - Ark. hospital forgoes JCAHO. PMID- 10133232 TI - Health pros ally against violence. PMID- 10133231 TI - Mo. facility hits accreditation denial. PMID- 10133233 TI - Americans unhappy with system--poll. PMID- 10133234 TI - Alliances for HMO growth. AB - With the accelerating trend toward managed care, health providers and insurers are scrambling to form exclusive arrangements that will allow them to capture a larger slice of the managed-care market. A Modern Healthcare survey confirms growth in HMO and PPO enrollment, revenues and earnings. PMID- 10133235 TI - FTC going to court on Fla. acquisition. PMID- 10133236 TI - New name, goal for drug group. PMID- 10133237 TI - Can NCI cancer centers still thrive under managed care? PMID- 10133238 TI - Some hospitals seeking change in basis for payments to suppliers. PMID- 10133239 TI - Bond issuers face tougher disclosure rules. PMID- 10133240 TI - Red Cross to centralize control of blood centers. PMID- 10133241 TI - Hepatitis proves a greater threat than HIV. PMID- 10133242 TI - Is it time to shorten the five-minute scrub? PMID- 10133243 TI - Questions and answers about tracking program. PMID- 10133244 TI - Internal tracking system eases employee burden. PMID- 10133245 TI - Hospital expands tracking system to comply with law. PMID- 10133246 TI - Manager cuts inventory in supply room shake-up. PMID- 10133247 TI - New coalition to address issues of medical waste management. PMID- 10133248 TI - Procedure-specific precautions best for OR? PMID- 10133249 TI - Network helps ORs track, prevent exposures. PMID- 10133250 TI - What will the future be like for patient accounts managers? AB - Patient accounts managers should prepare for their professional futures by critically examining their strengths and weaknesses and using the results of this examination to build on the strengths and correct the weaknesses. They then should tailor their career plans to fit their best estimates of the healthcare environment of the future. PMID- 10133251 TI - The more things change ... Catholic hospital bought by state uses ad campaigns to reassure physicians and consumers. University Hospital, New Orleans, LA. PMID- 10133252 TI - Letting patients track their care. Three hospitals use critical paths to improve communications with patients and their families. PMID- 10133253 TI - CareTrac sets Scripps apart from pack. ScrippsHealth, San Diego, CA. PMID- 10133254 TI - A corporate good neighbor. Hospital's new entrance blossoms into park for a troubled neighborhood. St. Anthony's Hospital, St. Petersburg, FL. PMID- 10133255 TI - Telling consumers about critical paths. Presbyterian Hospital, Charlotte, NC. PMID- 10133256 TI - Making critical paths fun for kids. Shriners Hospital For Crippled Children, Greenville, SC. PMID- 10133257 TI - News a hospital can use. Media coverage equals $187,000 worth of advertising. Morton Plant Hospital, Clearwater, FL. PMID- 10133258 TI - Home on the plains. Large hospital uses print ads to teach consumers about its role as rural referral center. Asbury-Salina Regional Medical Center, Salina, KA. PMID- 10133259 TI - Many hands make light work. Hand sculptures and tracings personalize hospital expansion. Robert Wood Johnson University Hospital, New Brunswick, NJ. PMID- 10133260 TI - All in the family. High-profile events and information focus on families to boost market share for hospital and physicians. Edward Hospital, Naperville, IL. PMID- 10133261 TI - Have nurses, will visit. Good Samaritan Hospital, Lebanon, PA. AB - Hospital cross-trains staff nurses to follow patients home, boosting visits and revenues and cutting costs. PMID- 10133262 TI - State of the cart. AB - Food on wheels: it's here, there and everywhere. But while some operations rev up cart expansion plans, others have shifted into low gear. Here's an update on that '90s phenomenon: mobile merchandising. PMID- 10133263 TI - Linking incomes and outcomes. Health systems proceed despite hurdles. PMID- 10133264 TI - Why should hospitals keep their tax-exempt status? PMID- 10133265 TI - Shake-up: earthquakes and reform. PMID- 10133266 TI - Are you ready for national reform? PMID- 10133267 TI - Clamor over subacute care creates adversaries--and new partners. PMID- 10133268 TI - Choosing your own physician. PMID- 10133269 TI - Letter to the chairman of the board: reflections on CEO evaluations. PMID- 10133271 TI - Why attend the Leadership Forum? PMID- 10133270 TI - Why CEO employment contracts? PMID- 10133272 TI - A system that 'walks the talk'. Using improved community health status for CEO evaluation and compensation. Interview by Karen Gardner. AB - Crozer-Keystone Health System, with corporate headquarters in Media, PA, is relatively new. The system was formed in 1990 to integrate four hospitals- roughly 1,160 acute care beds--five long-term care facilities, skilled nursing facilities and personal care facilities. According to President and CEO John C. McMeekin, the system comprises "very aggressive" programs in senior wellness, geriatric care, women's and children's health, behavioral medicine and psychiatric substance abuse. And it also has a large managed care organization that was undertaken as part of a joint venture with members of the hospitals' medical staff. The system is still defining itself, and perhaps that's why it has been willing to venture into an area that is virtually unique among health care organizations: using community health status indicators as part of the CEO's annual evaluation and compensation. Recently, Trustee editor Karen Gardner spoke to McMeekin and board Chairman Richard W. Billings about a major community needs assessment project that the system undertook in 1991 and how it is using the results of that study. PMID- 10133273 TI - Carving up the health care market. PMID- 10133274 TI - Patient protocols: commissioning, design and use. AB - The author begins by considering existing definitions of 'protocol' and related terms and later develops this into a discussion of how they work. Among other things, we learn from this article that methods of designing protocols have a significant influence on their implementation, creating a problem for organizations attempting to introduce protocols to promote uniform treatment. While the advantages and disadvantages of protocols are summarized, such a summary is to some extent unrevealing. It has to be appreciated that medicine is practised by social groups governed by informal arrangements which protocols may disturb. Furthermore, by making medical procedures explicit protocols may open up social and moral problems which have previously been concealed. PMID- 10133275 TI - The needs and preferences of hospital staff and the scope of design. AB - The problem of matching the results of hospital design to needs and expectations of its staff has become exceedingly complex. Although it is easy to classify staff needs and preferences, we must go further than that; we must examine if and how they are incorporated in the processes of creating the appropriate hospital environment. All too often these processes--the ever-turning cycle of identifying problems, needs-briefing-designing and evaluating--deviate from the pathways of comprehensive, logical and sensible tactics. The author discusses the reasons for this. PMID- 10133276 TI - The primary healthcare/hospital interface. AB - In this paper, the author attempts to review the changing relationship between primary care and hospital care. In doing so, he draws on recent experience in the UK which has sought to strengthen the role of primary care services. This has centred on a new employment contract for general practitioners (GPs) and the introduction of the GP fundholding scheme. Both reforms represent a radical change from past practice and illustrate both the opportunities and the risks involved in introducing new financial arrangements in the primary care sector. Not only does he comment on UK experience, but he also make brief references to broader trends in health services reform in various other countries, giving the speech a truly international dimension. PMID- 10133277 TI - Using quality assurance to meet the challenge of economic change. AB - The processes of quality assurance address a range of issues relating to the economics of hospital management. Size of hospital, role delineation, types and quantities of services delivered can all be analysed from a quality assurance perspective. Quality assurance processes can then be used first to identify and then to facilitate the introduction and implementation of economic changes in health services delivery. PMID- 10133278 TI - Repair for a broken market: the medical service company. AB - Sky-rocketing costs are fueling debate over whether market mechanisms can work for the healthcare services industry. The market for health care certainly seems to be broken. Value is decreasing, services are fragmented and costly transactions among providers are exacting a great toll in efficiency and service. Perhaps ironically, this situation presents a golden opportunity for providers who understand that the market is merely responding to the combined stimuli of inflated demand and excessive regulation. We believe that Medical Service Companies, which unite physicians and hospitals under one corporate roof, can reduce market friction, improve the responsiveness of providers and provide better value than traditional provider organizations. PMID- 10133280 TI - American Laundry Digest distributors directory. A state by state listing of companies that distribute laundry equipment (E), supplies (S), or other goods and services (O). PMID- 10133279 TI - Characteristics of elderly home health patients: preliminary data from the 1992 National Home and Hospice Care Survey. PMID- 10133282 TI - Epidemiological and managerial challenges in the workplace. PMID- 10133281 TI - Current needs for comprehensive occupational health services support for employers. AB - The most valuable resource for most employers is their personnel. Maintaining the health and effective work performance of employee groups is enhanced by a strong and well-delivered occupational health program. Employers' needs in this area include access to urgent care services for on-plant medical problems that occur, regulatory compliance assistance, and medical specialty consultation to identify the contribution of workplace exposures to employee health. This article identifies aspects of each wherein community ambulatory care facilities may assist employers to optimize the health of their work force, provide important and cost-effective medical services, and ensure compliance with legal and regulatory health obligations. The enhancing functions of both high-quality medical care for individuals and the use of population-directed medical programming and diagnosis using epidemiology are illustrated. PMID- 10133283 TI - Occupational health services in Germany and the use of routine data for epidemiology and management: example from the chemical industry. AB - The basis of German legislation concerning safety at work and health protection is the "dual system": The State and the Employment Accident Insurance Funds are responsible for prevention, rehabilitation, and compensation. The employer can select between several types of occupational medical service. BASF--a major chemical company--serves as example. The Medical Information System of the Occupational Medical and Health Protection Department of BASF is an important tool for management decisions, that is with regard to the introduction of employee assistance or wellness programs, for decisions for preventive measures, or for improvement of service management. PMID- 10133284 TI - Epidemiological surveillance: a management tool for occupational health. AB - Epidemiological surveillance represents a practical and intuitive approach to preventing occupational disease and injury, yet it is underutilized in health care management. Through the systematic analysis of employee occupational health data, the epidemiological surveillance approach allows prompt identification of potential workplace hazards, identifies high-risk groups for targeting preventive efforts and provides a mechanism for evaluating interventions. Often, epidemiological surveillance can utilize existing data resources, making it a cost-effective tool. Epidemiological surveillance should be valuable in supporting management decisions relating to health promotion and disease prevention programs, as well as basic clinical needs of employees. PMID- 10133285 TI - An approach for conducting epidemiological surveillance in industry. AB - There are three unresolved issues in epidemiological surveillance: 1) should surveillance be hypothesis generating, 2) how much effort should be put into the design and data collection of a surveillance project, and 3) can useful surveillance be done with questionable data? It is concluded that epidemiological surveillance should be approached as an epidemiology study that examines the potential association between specific exposure and disease. This would include 1) a feasibility study to determine if surveillance on a particular subject is possible, 2) a detailed protocol, and 3) plans for data reduction, interpretation of findings, and worker communication. Epidemiological surveillance must be well planned and resourced to be used as a screening mechanism for occupational illness or injury excess, monitoring the health of workers exposed to specific substances, or setting priorities for future special studies. PMID- 10133286 TI - Development of a multidisciplinary research clinic for patients with work-related upper extremity disorders. AB - The health care reform debate has focused attention on the need for outcomes research performed in ambulatory care settings. In this article, the authors describe the development of a research clinic focusing on symptomatic, functional, and vocational outcomes of patients with work-related upper extremity disorders. The authors describe the programmatic and research challenges associated with performing such research and emphasize the need for balancing the research and clinical agendas. Research efforts in this setting require careful consideration of the patient selection process and allocation of sufficient time for the clinical staff to collect and record essential research data. PMID- 10133287 TI - Managing measurable and perceived risk in the occupational setting. AB - The occupational health clinic frequently has an important role to play in the communication of workplace risks to employees. Effective communication can be facilitated through a clear understanding about the nature and amount of actual risk. Unfortunately, epidemiologists and other health researchers are often reluctant to interpret the quantitative measures of risk that they report in their studies. This article describes various epidemiological risk measures including measures of disease frequency, measures of disease association with exposure, interaction, and measures of attributable risk, and how they are derived. Recommendations for effective risk communication are given. PMID- 10133288 TI - Ethical issues in providing occupational health services. AB - In the rush to capture new segments of the health care market, occupational health services have become an attractive "product line" for some provider groups. However, providers may not appreciate the significant ethical dimensions of delivering occupational health services. The environment of the workplace gives rise to competing goals, interests, and expectations and creates thorny ethical issues for health care providers. It is important that providers develop a framework for recognizing and addressing these ethical issues and the influence of their own and other parties' values on their decision-making processes. PMID- 10133289 TI - Quality of occupational medicine in ambulatory care. AB - The prevention of occupational disease and injury requires focusing on the spectrum of services that would effectively contribute to prevention as well as the quality of constituent services. The broadest spectrum of services includes primary, secondary, and tertiary prevention and requires a team of professionals from medicine, nursing, industrial hygiene, and safety engineering. There are impediments to ensuring both the quality of care provided by individual professions and access to a broad array of services. Ensuring quality may be more dependent upon the spectrum of services utilized than in the variability of quality of any provider of care. PMID- 10133290 TI - A participatory approach to worksite health promotion. AB - A review of literature suggests that individual, social, and organizational factors are important to consider in the development of worksite health promotion programs. This article describes a conceptual framework that integrates these factors. The implications of this framework for the development, implementation, and evaluation of worksite health promotion programs and the results of an intervention based on this approach are presented. The results from this study highlight the importance of active employee involvement in all stages of worksite health promotion programs. The findings also indicate that programs need to address the causes, not just the symptoms, of stressful working conditions. PMID- 10133291 TI - Evaluating worksite health programs. AB - Worksite health enhancement programs utilize screening and early disease detection or risk reduction as health promotion activities. Objectives for these include improving the health and productivity of employees and reducing health care costs. However, critical questions about the effectiveness of programs should be answered before managers initiate these activities. Issues include accuracy of measurement and subject classification, adequate use of comparisons and follow-up in evaluation studies, and evidence of cost effectiveness. PMID- 10133292 TI - Patient attitude towards waiting in an outpatient clinic and its applications. AB - Patient waiting time in outpatient clinics is often the major reason for patients' complaints about their experiences of visiting outpatient clinics. Therefore, patient satisfaction with waiting time plays a crucial role in the process of health quality assurance or quality management. This paper reports the results of a survey on patient attitude towards waiting in an outpatient surgery clinic. Generally patients appear reasonably satisfied if they wait no more than 37 minutes when arriving on time, and no more than 63 minutes when late for appointments. Patients coming up to 15 minutes early are prepared to take full responsibility for the extra waiting caused, but the patients coming even earlier intend to be seen earlier and are only prepared to wait 15 minutes longer than otherwise. The potential applications of patient attitude towards waiting in the quality assurance process, ie setting up waiting time limits and designing patient dispatching rules, are also discussed. PMID- 10133293 TI - The financial awareness of managers in the reformed NHS. AB - Managers in the NHS are facing financial reforms which will impact greatly on their role. In general terms, service managers tend to be functionally trained and their financial awareness has not been a pre-requisite for their selection. Their ability to respond to their new role requirements is therefore untested, but it represents a crucial factor in the success of the reforms. This article examines the financial awareness of a group of managers who need financial skills, drawn from a range of work categories. The results indicate that there is room for the managers in the sample to improve their financial awareness, and reports that significant differences between work categories may be expected. However, the managers expressed satisfaction with the financial information they received although this information could be better presented. Given the increased complexities of financial information produced in the reformed NHS, these managers will require further training if they are to fulfil their new role to their true potential. PMID- 10133294 TI - Do formal controls always achieve control? The case of triage in accident and emergency departments. AB - Triage is the term used to describe the formal process of assigning urgency categories to patients arriving in a hospital accident and emergency department. This paper uses insights from literature on management control, medical sociology and nursing to illuminate the results of a research study comparing formal triage with an informal prioritisation process carried out by nurses. Topics discussed include whether triage is a bureaucratic process, whether it allows nurses' intuition to be expressed, whether it masks the urgency of the condition of the small number of seriously injured or ill patients, and whether responsibility for decisions on urgency should be separated from responsibility to act on those decisions. It is concluded that managers must consider these questions in the light of arrangements in their own hospital; departmental layout as well as the nursing staff's experience and commitment need to be taken into account. PMID- 10133295 TI - An American macromanaged health care system? AB - The implementation of President Clinton's proposed health reform plan that ensures universal access and relatively comprehensive health insurance benefits to over 250 million Americans would have a significant impact on their hospitals, physicians, and other health care providers. With this projected coverage, the 36.7 million Americans now uninsured would demand an additional volume of services. It is doubtful, because of this nation's trade and budget deficits, that any significant increases in expenditures for health will be made available from the public sector. Therefore, providers in the US will need to deliver significantly more care with a minimal increase in total reimbursement. These conclusions are further supported by the experiences of the Canadian and the German macromanaged health care systems that provide considerably more hospital and physician services per person per year than the US at a lesser cost per discharge and percentage of their respective nation's gross domestic product. America may be heading toward macromanaged global budget targets, but for political and other reasons President Clinton's health reform plan will be implemented with a multi-payer, managed competition approach. PMID- 10133296 TI - An empirical basis for the formulation of strategic external communication objectives at a local level. PMID- 10133297 TI - Modeling two dimensions of patient satisfaction: a panel study. AB - Measurement of patient satisfaction is an essential part of health outcome assessment. The purpose of this study is (a) to compare the stability of an aggregate summary measure and two separate summary measures of patient satisfaction; and, (b) to examine causal effects between two separate summary measures at two points in time. Data were collected from 1,451 Medicare HMO beneficiaries. In conclusion, (a) separate summary measures are recommended for constructing the measure of patient satisfaction and (b) moderate causal relationships and cross-lagged effects between the patient satisfaction measures of qualify of care and access to care were found. PMID- 10133298 TI - Unrecognised structural implications of casemix management. AB - This paper takes issue with some conceptual and hence practical shortcomings which underlie current attempts to use casemix methodologies in bringing medical clinicians within the writ of management. The reform programme is grounded in an instrumental conception of organisation which construes the conduct and structuring of relationships in a hospital as being the product of its alleged purposive character and its formal design features. Accordingly, it is assumed that improving hospital efficiency and effectiveness requires no more than recasting formal authority structures and introducing information systems which will extend management's capacity to surveil and control the performance of clinical work. The paper argues that this conception of hospital organisation and what is required to achieve reform, ignores institutional pre-requisites which underpin management in industrial and commercial settings and denies evidence about a range of factors inherent in the prevailing organisation of medicine which militate against efforts to extend the writ of management over hospital based medical work. PMID- 10133299 TI - Health reform and the quality imperative: one organization's vision. PMID- 10133300 TI - Hospital uses "report card" as entry to dialogue with employers. PMID- 10133301 TI - Economic credentialing--a new measure of quality or putting profit ahead of care? PMID- 10133302 TI - Pain and the use of health services among the elderly. AB - This study examined pain management strategies and the relationship of pain to the use of health services in a sample of community-resident Canadian elderly. Analyses with the Andersen-Newman framework of need, enabling and predisposing variables revealed that pain did not make an incremental contribution to explaining service use. Traditional measures of need for services accounted for the majority of explained variance in health service use. The substantial number of participants who were found to be coping with chronic, frequent pain relied on themselves as much as formal health services for dealing with their pain. The most common coping style for these pain sufferers was a combination of analgesics and accepting mild pain as part of daily life. This combination of medical intervention and attitudinal factors appears to make the coping process very manageable. PMID- 10133303 TI - Correlates of disruptive behaviors in nursing homes. A reanalysis. AB - This study reexamines factors associated with the occurrence of disruptive behaviors using a representative sample of nursing home residents in Rhode Island in 1984-1985. Four indicators of disruptive behaviors are examined using multivariate methods: evidence of any disruptive behaviors, abusive behavior, wandering, and noisiness. Results are compared with the 1989 study by Jackson et al., which was based on the same data. Findings indicate that the likelihood of exhibiting disruptive behaviors in nursing homes increases with the severity of cognitive impairment, ADL dysfunction, and incontinence, and decreases with immobility. Immobility not only is negatively associated with wandering behavior, but with other behaviors as well. Women are less likely to be abusive. In contrast to the earlier study, which did not use multivariate methods, age and communication problems are not related to disruptive behaviors. PMID- 10133304 TI - Do characteristics of informal caregivers affect the length of hospital stay for frail elders? AB - Studies examining the length of hospital stay for the very old rarely include characteristics of the informal caregiver as potentially explanatory variables. This study expanded a frequently used conceptual model of health services use to include caregiving factors as enabling variables. Data were collected from a representative sample of frail elders who had been hospitalized in the previous 18 months (n = 181) and their primary informal caregivers. The findings indicate that elders whose primary caregiver was a coresiding offspring had shorter hospitalization than elders whose offspring caregiver lived in different households. These data indicate that the amount of variance explained by this conceptual model is increased when social factors are included as explanatory variables. PMID- 10133305 TI - Perspectives. Nursing tackles new roles in changing health system. PMID- 10133306 TI - The CFA (continuous feed auger)--a technology for sterilising infectious waste. PMID- 10133307 TI - Legal issues for clinical waste producers. PMID- 10133308 TI - Incineration--rotary kiln technology. PMID- 10133309 TI - Home is where the heart is. PMID- 10133310 TI - Sutter SeniorCare: capitated managed care for the frail elderly. PMID- 10133311 TI - Building ties to the community with outpatient geriatric services. PMID- 10133312 TI - Management compensation trends in the hospital community. PMID- 10133313 TI - National health care plan must contain medical liability reform. PMID- 10133314 TI - The health care solution. AB - Following is Part II of an excerpt from the recently published book, The Health Care Solution: Understanding the crisis and the Cure, by C. Duane Dauner. Dauner paves the road to reform in his book by providing a step-by-step solution to ending the nation's health care crisis. Part I can be found in the January/February edition of California Hospitals magazine. PMID- 10133315 TI - The Northridge earthquake. Planning and fast action minimize devastation. PMID- 10133316 TI - Court decisions side with continued treatment of medically futile cases. AB - Confusion reigns in the care of two medically futile cases as one state's supreme court requires hospitals to ask the local state attorney's office to arbitrate conflicts between "acceptable medical treatment and the patient's wishes," and another court applies the federal Emergency Medical Treatment and Active Labor Act (EMTALA) to require a hospital to stabilize an anencephalic child's respiratory distress. PMID- 10133317 TI - Will health reform provide for the needs of vulnerable populations? AB - States are increasingly turning to managed care as a means of coping with exploding Medicaid costs (see Emily Friedman's article in the March 16 JAMA, pp. 875-78). Many managed care proposals depend on employer-based insurance as the primary source of financing health care reform. Debates continue, however, over the ability of both to provide adequate care for the diverse sets of populations in the United States. PMID- 10133318 TI - Recent studies examine economic impact of advance directives. AB - For the past two decades, society has assumed that advance directives will eventually lead to a more cost-effective use of health care resources. Two recently reported studies come to differing conclusions on this matter. PMID- 10133319 TI - New China policy stirs memories of U.S. eugenics history. PMID- 10133320 TI - Formal ethics course shows little impact on perspective. PMID- 10133321 TI - MDs voice similar rationales for treatment withdrawal and euthanasia. AB - Although the withdrawal of treatment and active euthanasia are viewed as two different processes with two different objectives, the conditions under which these actions are justified by physicians have much in common, as the following articles on two new surveys show. PMID- 10133322 TI - Fudging of cancer data undercuts public trust as well as science. PMID- 10133323 TI - Consumers, complaints, and professional discipline: a look at medical licensure boards. PMID- 10133324 TI - Studies of transfer trauma in nursing home patients: how the legal system has failed to see the whole picture. PMID- 10133325 TI - A taxing tale: unconstitutional conditions and abortion subsidy. PMID- 10133326 TI - Implementing a case management program in a large city hospital. PMID- 10133327 TI - The role of CQI in the new strategic planning model for hospitals. PMID- 10133328 TI - Taming the tiger: the economics of health care reform. PMID- 10133329 TI - TB respirators: what's required and what isn't. PMID- 10133330 TI - Understanding labor costs is key to working smarter. PMID- 10133331 TI - Nurses and materials managers duck job barriers. PMID- 10133332 TI - Play a greater part in buying capital equipment. PMID- 10133333 TI - Boots, stockings--and the bottom line. PMID- 10133334 TI - Pacemakers and leads: a team process for cost reduction. PMID- 10133335 TI - Pneumatic tube systems: still moving along. PMID- 10133336 TI - Fin de siecle medicine. Avoiding the unintended consequences of health care reform. PMID- 10133337 TI - How to share the burden. Long-term care reform in the 1990s. PMID- 10133338 TI - Paying the right price. What the United States can learn from health care abroad. PMID- 10133339 TI - Have PPOs lost the right to choose? PMID- 10133340 TI - Data watch. The Clinton plan's effect on health costs. Results from a survey of 526 human resource executives, November 1993. PMID- 10133341 TI - The quandary of retiree coverage. PMID- 10133342 TI - 3 strategies for managing retiree costs. Employers are using point-of-service plans, flexible benefits, and Medicare-risk HMOs. PMID- 10133343 TI - Pulling together. By buying in groups, employers are changing how health care is delivered in many markets. PMID- 10133344 TI - Safety in numbers. Employers that join workers' comp insurance pools reap the benefit of reduced premiums and safer workplaces. PMID- 10133345 TI - How providing more care costs less. Johns Hopkins' managed care plan offers prompt access to high-quality treatment and, after the first 18 months, reduced costs by 31%. PMID- 10133346 TI - Domestic partner benefits are catching on ... slowly. PMID- 10133347 TI - Raising the health status of HMO members. Several HMOs are using a statistical model to measure access, morbidity, and utilization. PMID- 10133348 TI - Weighing the value of prevention. PMID- 10133349 TI - Florida mandates managed Workers' Comp. PMID- 10133350 TI - Getting help can be the biggest challenge. PMID- 10133351 TI - Employers take action in the fight against depression. PMID- 10133352 TI - Helping to eliminate stress in the workplace. PMID- 10133353 TI - Data watch. Depression affects millions. PMID- 10133354 TI - The consequences of depression. PMID- 10133355 TI - Common road blocks to national accounts pharmaceutical programs. AB - The large managed care customer represents concentrated purchasing power and product access to a large patient population. Contracting will continue to grow, and a large portion of product purchases will be under the agreements negotiated, implemented, and supported by the pharmaceutical company's national accounts department. The national accounts department will need to receive support from the organization if it is to do the job successfully. PMID- 10133356 TI - Is success spelled g-a-t-e-k-e-e-p-e-r? AB - The President's health care reform proposal will require a point-of-service (POS) mandate for any managed care organization seeking to serve as an accountable health plan. However, POS plans have not been proven to contain costs, and may in fact, contribute to continuing health care cost escalation. A study was performed by a managed care organization to evaluate whether the use of gatekeepers in POS plans is associated with lower health plan costs. PMID- 10133357 TI - Minimizing bias in industry-sponsored outcomes research. AB - Industry-sponsored research is receiving a considerable amount of attention from public policy makers and private sector decision makers on issues such as bias, objectivity, ethical conduct, and methodological standards. In the case of outcomes research, industry sponsorship often carries the burden of perceived bias and lack of creditability simply because the research has direct, transparent linkages with drug marketing activities. There are, however, widely accepted principles for conducting and assessing good outcomes research, and these should be followed regardless of the funding source and regulatory initiatives. PMID- 10133358 TI - The challenge of managed care in rural West Virginia. AB - West Virginia faces a particularly difficult challenge in organizing its health care system for managed care. The rural nature of the state, the shortage of primary care practitioners, few large employers, and the predominant role played by federal and state health care purchasers have hindered managed care development in the state. The crisis in the cost of health care and discussions of health care reform have now created interest in developing prepaid managed care by both payers and providers. In the last three years, several initiatives have paved the way for a more organized approach to the delivery of health care. This article describes the current health care environment in West Virginia and the efforts underway to prepare for system change. PMID- 10133359 TI - The future of managed care drug formularies. AB - Ten years ago, United HealthCare created its drug formulary for IPA-model HMOs. Formularies have been in place in large staff- and group-model plans since the 1970s. Dr. Navarro reflects on how far formularies have come and predicts where they will lead in the future. PMID- 10133360 TI - A new model for a smoking cessation program: adding compliance efforts and provider education to the mix. AB - MetroHealth, through the coordination of the Pharmacy Department, wanted to establish a smoking cessation program that would provide appropriate and cost effective therapy. Requirement of patient participation in behavioral modification programs in conjunction with nicotine replacement therapy and continuous provider education allowed the program to attain its goals. The authors describe the nuts and bolts of establishing such a program. PMID- 10133361 TI - HEDIS (Health Employer Data and Information Set): are we finally comparing apples to apples? AB - The release of HEDIS 2.0 late last year was a milestone in the movement towards quality measurement of health plans. The pilot project to produce a credible report card that is comparable among health plans is already underway. Will HEDIS 2.0 finally give employers what they desperately need--a reliable measurement tool on which to base health plan decision making? PMID- 10133362 TI - Advance patient directives: preserving consumer choice. AB - In the first of three articles, the authors discuss the public policy issues addressed by advance patient directives, including the Cruzan case and decision making standards for incompetent patients. PMID- 10133363 TI - Patient satisfaction surveys and multicollinearity. AB - The measurement of patient satisfaction is now an integral part of hospital market research. Just as consumer satisfaction is a function of the extent to which providers do things right, the value of consumer-oriented market research is directly related to whether the research itself is done right. The use of poorly designed consumer research instruments, no matter how well executed, can cause multicollinearity among the independent variables, which, in turn, can result in misleading conclusions. PMID- 10133364 TI - Experimental design in health care. AB - Design of experiments (DOE) is a collection of statistically based methods for testing multiple process improvement ideas after a quality improvement team has made initial improvements to remove defects and stabilize the process. Although experimental design techniques are not new, their use in improving administrative processes has not been fully exploited. Anderson Area Medical Center, located in Anderson, South Carolina, used classical quality improvement methods and DOE to significantly decrease patient dissatisfaction with emergency room services from an average of 27 percent to 6 percent. PMID- 10133365 TI - Clinical evaluation units: a research agenda. AB - A new model for evaluating quality rests on the tripod of outcomes research, practice pattern analysis, and the tenets of continuous quality improvement. The hospital-based locus for this tripod could be clinical evaluation units. This article describes the conceptual framework, study design, and research challenges associated with an ongoing project whose purpose is to assess the current status of these clinical evaluation units in academic medical centers nationwide. PMID- 10133366 TI - Health care benchmarking: a team approach. AB - The management tool of benchmarking, widely used in industry for more than a decade, is today being adapted for health care organizations. Hospitals and other health care providers are developing ways to compare their practices, processes, and resulting outcomes with other organizations in order to discover "best practices." This article describes a team approach to health care benchmarking and details several projects being conducted by hospitals in The SunHealth Alliance. The examples include benchmarking for both operational and clinical processes. PMID- 10133367 TI - Using measurement and feedback to reduce health care costs and modify physician practice patterns. AB - Rising health care costs coupled with an inability to determine what constitutes value in the delivery of health care services lead a group of Cincinnati health care purchasers to seek answers and solutions. The formation of a collaborative effort that includes both purchasers and providers is producing profound changes in the Cincinnati health care market. After one year in operation, data show a significant overall decrease in length of stay, a return to single-digit inflation, and intriguing changes in provider practice patterns. PMID- 10133368 TI - Techniques for understanding the customer. AB - Who are the customers and what do they want? Every health care employee sometimes serves as a supplier providing input to an activity and sometimes as the recipient of the activity. This article explains the Kano model, which distinguishes between expected quality, one-dimensional, quality, and exciting quality. It also introduces Quality Function Deployment and the Customer Window, two tools for understanding and prioritizing customer demands. PMID- 10133369 TI - Health care from the perspective of a patient: theories for improvement. AB - The future of health care will depend on the ability of providers to produce health services that satisfy the needs of all customers at prices they can afford. This implies both innovation and improvement of quality. Quality has to start with the provider. The patients do not know what they want, although they are fast learners and can judge what they have received. Patient feedback is important, but it is only a small part of the many facets of transformation needed in health care. Improvement involves prediction and prediction depends on theory. This article describes some theories for improvement based on a patient's hospital experience. PMID- 10133370 TI - Tutorial: planning for data collection. Part I: Asking the right question. AB - While data collection is fundamental to any scientifically based effort, health care improvement teams often report that it is one of the most frustrating aspects of their work. Groups that do succeed in gathering some data can also sometimes find that the data they have worked so hard to obtain does not really help them or deepen their understanding of the process. The root of many of these problems can be traced to insufficient planning for data collection and to fundamental misunderstandings about the eventual goals of such studies. In this tutorial, we will explore a systematic way of thinking through the planning for data collection that will result in a higher probability of generating useful information. PMID- 10133372 TI - The changing health care delivery system. An EBRI/ERF (Employee Benefit Research Institute/Education and Research Fund) policy forum. PMID- 10133371 TI - QMHC interview: Stuart H. Altman, Ph.D.. Interview by Marie E. Sinioris. AB - An internationally recognized authority on health policy, Stuart H. Altman, Ph.D., is a key player in the debate on health care reform and the deliberations of the White House task force on health care policy. QMHC interviewed Dr. Altman to get an inside look at the status of the Administration's much awaited plan to overhaul the health care system. The interview covered a range of topics, including the elements of reform, the prospects for managed care, the implications of a standard benefits package, and the role of quality in the reform debate. PMID- 10133373 TI - President Clinton's proposal and the impact on the health care delivery system. PMID- 10133374 TI - The changing health care delivery system. Perspective of insurers. PMID- 10133375 TI - The changing health care delivery system. Perspective of providers. PMID- 10133376 TI - The changing health care delivery system. Perspective of employers. PMID- 10133377 TI - Reforming the health care delivery system. AB - The health care delivery system is evolving rapidly. There have been changes in the way health care is financed, the types of treatments available, the sites of care, and the physician patient relationship. These changes have resulted primarily from reactions to health care cost inflation. Health care reform is likely to accelerate some of these changes. The threat/promise of health care reform has already accelerated the consolidation of the health care services market. Health care reform is likely to reduce the number of insurers, increase the number of Americans in managed health care plans, increase the number of physicians in group practice, change provider income, and in general make the health care delivery system more concentrated and vertically integrated. PMID- 10133378 TI - The changing health care delivery system. Perspective of consumers. PMID- 10133379 TI - Inova embarks on mammoth information systems plan. PMID- 10133380 TI - Contract-management systems: the next addition to your application portfolio? PMID- 10133381 TI - HotList: electronic data interchange. PMID- 10133382 TI - HIMSS/HP survey targets reform, outcomes, networks, budgets. PMID- 10133383 TI - Impact of OSHA bloodborne-disease rule. PMID- 10133384 TI - Illinois acts to regulate medical waste. PMID- 10133385 TI - The race to comply. PMID- 10133386 TI - The road to RCRA reauthorization. PMID- 10133387 TI - The importance of meeting standards of care. PMID- 10133388 TI - The role of disposables in waste management. PMID- 10133389 TI - Patient focused care team design. Critical aspects of a cost-effective design strategy. AB - It is the critical, yet largely unknown aspects of Patient Focused care team design--the "how" of a design process--which make LRMC's "Care Pairs" a ground breaking innovation rather than just a distinctive-sounding name. Unfortunately, many hospital leaders of Patient Focused Care programs know the "what" of LRMC's "Care Pairs" but very little, if anything, about this "how." To create Patient Focused care teams which are "right" for your own institution, you must quantify the Costs of Continuity, Competency and Compartmentalization and their associated benefits. Without these informed trade-offs, you and your hospital will be forced to live with someone else's Patient Focused care team design. In summary, it is what you don't know about LRMC's "Care Pairs," not what you do know, that is important to your Patient Focused Care program. Hospitals just beginning to implement Patient Focused Care must understand this "how" if they are to design effective care teams which optimize the performance of their initial unit(s) within their unique environments. Hospitals like LRMC with established Patient Focused Care units must also periodically draw upon this "how" or they face the very real danger of having their Patient Focused care team design(s) become outdated, less effective and eventually detrimental. Or, said another way: "The man who does not read good books has no advantage over those who cannot." Mark Twain. "An out-of-date Patient Focused hospital has no advantage over those which remain unrestructured." The PFCA. The three critical aspects of Patient Focused care team design explored in this article are just the tip of the iceberg.(ABSTRACT TRUNCATED AT 250 WORDS) PMID- 10133390 TI - Effectively managing pronounced seasonality. Taking the offensive against the onslaught of the dreaded "season". PMID- 10133391 TI - Getting the economic gains where and when you need them most. AB - Often, even before the vision for the restructured hospital is completed, talk begins about "which area to implement first" and "how many areas to tackle." Certainly, there are many considerations in making these decisions such as, the political mood with physicians and staff, synergy with changes already on the books, areas which are vacant and easily renovated, and more. However, these decisions may limit the alternatives for your Economic Change Strategy. They may even implicitly set it for you. And, as such, they should be taken very seriously because they directly impact the when and how much of your economic gains from restructuring. Want to get the most economic gains from restructuring? Define your Performance, Operational, Cultural and Economic Change Strategies and keep them in sync. And you won't be betting the farm that chance will do that for you. PMID- 10133392 TI - Picking the right change strategy. The importance of proper fit. PMID- 10133393 TI - Six lessons learned for greater success. AB - These six lessons learned for greater success with your Patient Focused communications can help keep your cultural change process in sync with your operational change process. Of course, there are other key elements of the former, including: formal Patient Focused educational programs; restructured Human Resources "systems" (e.g., job descriptions and compensation programs); and migration toward greater organizational empowerment and more self-directed work teams. Still, your Patient Focused communications campaign will spearhead the cultural change process. As such, it will have the opportunity to make the very first impact. Basically, your communications can make or break your Patient Focused Care program from Day One. It's up to you--learn the lessons learned by others and your organization may follow the words of Marx rather than those of Brand: "Workers of the world, unite (on behalf of your Patient Focused Care program)!" Karl Marx.p6 "Workers of the world, fan out (in formation against your Patient Focused Care program)!" Stewart Brand. PMID- 10133394 TI - The evolutionary development of patient focused managers. AB - Those of us who have chosen to embark on this journey into the world of Patient Focused management sometimes refer to our experience as a wild roller coaster ride. It is probably an accurate analogy since many of us have found the amplitude of the highs and lows to be quite extreme. Most of us came prepared with what we thought was a great deal of knowledge about management and leadership in an acute care setting. As we have moved through this process, we have found ourselves starting over and beginning to accept completely new paradigms. Although this has been, for many of us, the greatest challenge of our careers, I believe it has also been the greatest opportunity for growth. PMID- 10133395 TI - Helping hospitals spread the word about their patient focused care programs. PMID- 10133396 TI - Designing patient focused reward systems. PMID- 10133397 TI - What do you want to be? The strategic question behind your patient grouping decision. AB - How you group your patients has a lot to do with your strategic goals. It is the first step in creating an "operations strategy" that fits with your external strategy. As the Concentric Rings diagram suggests, the rest of your organizational design is based on this key decision. In today's changing environment, answering the question "What do we want to do?" is the first step. Your answer to this question could drastically shift your priorities and influence your trade-offs during your Patient Focused restructuring efforts. It is, however, only the first step. More than ever before, driving your overall strategy into your restructured design will be the key to your success and will "make or break" your Patient Focused program. PMID- 10133398 TI - Patient focused care and total quality management. A marriage made in heaven. PMID- 10133399 TI - Dimensions of successful service redeployment. AB - "Service redeployment" is one of the primary action steps in restructuring hospitals toward a more patient focused future. By helping identify and avoid "departmental decentralization," these key dimensions of successful service redeployment can help ensure that Patient Focused Care programs do it right and institutions benefit from bringing services closer to patients. These benefits will continue to grow and aid institutions as long as service redeployment decisions are periodically updated through continuous improvement efforts. PMID- 10133400 TI - Performance indicators. Defining and evolving the "right" measures of restructuring success. AB - In summary, it is important to define the "right" set of performance indicators to monitor the success of your Patient Focused restructuring program. Keep these indicators to the vital few--those reflecting the hospital's quality, service, environment and economic performance--rather than falling into the potential trap of the trivial many. Be sure to define many of these indicators in the customers' terms, not necessarily your own. Your Patient Focused program will mature across four primary eras--The Vision, The Plan, The Reality and The Journey. Several important aspects of your performance indicators must evolve along with it if they are to facilitate rather than hinder progress. This should happen naturally. However, it is always wise to keep an eye on these evolutions to ensure they aren't stifled by traditional paradigms, lingering biases and lack of attention. Defining and evolving the "right" performance indicators for your Patient Focused Care program will not only provide valid measures of success, but actually contribute to greater success as well! PMID- 10133401 TI - Helping hospitals spread the word about their patient focused care programs. Helping professionals "see" their future contributions. AB - In summary, any communications plan must meet two critical requirements if it is to successfully rally professional support for your patient focused care program. First, it must explicitly present a "vision" of the future role of professionals within your patient focused hospital. Neither your program nor these professionals benefit from them having to deduce their own future roles. Second, it must reorient the way in which these professionals view their roles. Today's almost demeaning, task-oriented view needs to be replaced with one attuned to the unique contributions professionals make now and in the future. By helping professionals "see" their future contributions, effective communications can keep your patient focused care program out of the grave and in perfect health for years to come. PMID- 10133402 TI - How much do you have to save to make a profit on restructuring? AB - "I can't afford to restructure my hospital!" The truth is that you may not be able to afford not to restructure! Yes, there are up-front financial investments required to lift your institution to a new level of performance. But these investments can be dwarfed by the returns achieved when more and more of your personnel dollars go to caring for patients, and less and less go to perpetuating the red-tape and bureaucracy which plagues the modern American hospital. PMID- 10133403 TI - Getting the most for your education dollar. AB - Hospitals are spending 33 cents on every dollar for the Patient Focused education of their organizations. By following a few simple guidelines, you can shop smart and get more for your educational dollar. Someone once said, "The greatest learning is through the learning of others." This handful of guidelines represent the collective experiences of hospitals around the country as each strives for an ever more successful yet cost-effective Patient Focused education for their organization. Let their experiences be your best teacher. What about the other 67 cents. In future columns of Dollars and Sense, we will explore ways to help you be a smart shopper of facility renovations, equipment purchases, consulting services, project management and several other categories of typical Patient Focused restructuring expenditures. PMID- 10133404 TI - The highs and lows of birthing babies. Managing highly-variable patient demand. PMID- 10133405 TI - To pilot or not to pilot, that is the question. Choosing your first step in restructuring? Look before you leap! AB - To pilot, or not to pilot, that is the question! Don't allow yourself in your eagerness to restructure to fall victim to taking this decision too lightly. Sometimes establishing a pilot of a restructured environment is indeed the best way to go--particularly when the advantages of a pilot are the key hurdles to overcome toward broad acceptance and support for hospital-wide restructuring at your institution. However, implementing a pilot can also be a big step off of a short pier if the value of these advantages pale in comparison to the disadvantages. Sure, you may need to restructure one unit/area at a time for strategic or other reasons. And you always have the prerogative to pull the plug if things go south. But be aware of the important difference between the "first unit" of many and a "pilot" approach to restructuring. Like everything else associated with successful restructuring, understanding the crucial trade-offs behind the "to pilot, or not to pilot" decision can determine whether your restructuring initiative is off to a flying start, or a long way from starting to fly. PMID- 10133406 TI - Picking the right change strategy. The best of both worlds--Part II. PMID- 10133407 TI - High performing self-directed work teams: what are they and how do they work? PMID- 10133408 TI - Establishing a rock-solid foundation. Part I of III: Exploring the common pitfalls in patient focused restructuring. PMID- 10133409 TI - List of designated primary medical care health professional shortage areas (HPSAs); list of withdrawals from primary medical care HPSA designation--HHS. Notice. AB - This notice provides two lists. The first is a list of all areas, population groups, or facilities designated as primary medical care health professional shortage areas (HPSAs) as of August 31, 1993. Second is a list of previously designated primary medical care HPSAs that have been found to no longer meet the HPSA criteria and therefore are being withdrawn from the HPSA list. HPSAs are designated or withdrawn by the Secretary of Health and Human Services (HHS) under the authority of section 332 of the Public Health Service Act. PMID- 10133410 TI - Notice of interest rate on overdue debts--HHS. PMID- 10133411 TI - Attestations by facilities using nonimmigrant aliens as registered nurses- Employment and Training Administration and Employment Standards Administration, Labor--Final rule and amendment and announcement of effective date. AB - On January 6, 1994, the Employment and Training Administration (ETA) and the Wage and Hour Division of the Employment Standards Administration of the Department of Labor published final regulations governing the filing and enforcement of attestations by health care facilities seeking to use the services of nonimmigrant aliens as registered nurses under H-1A visas. At that time, ETA submitted the information collection requirements to the Office of Management and Budget (OMB) under the Paperwork Reduction Act of 1980. This document amends the January 6, 1994, Federal Register document to display the OMB control numbers and announces the effective date for the sections containing information collection requirements for which OMB approval has been received. PMID- 10133412 TI - Medicare program; partial hospitalization services in community mental health centers--HCFA. Interim final rule with comment period. AB - This rule sets forth the coverage criteria and payment methodology for partial hospitalization services in community mental health centers. The purpose of this rule is to establish regulations governing this coverage under the provisions of section 4162 of the Omnibus Budget Reconciliation Act of 1990. PMID- 10133413 TI - Medicaid program; eligibility and coverage requirements--HCFA. Notice of delay of effective dates and compliance dates. AB - This document delays by an additional 6 months the effective dates of the final rule with comment period on Medicaid Eligibility and Coverage Requirements published January 19, 1993, in the Federal Register (58 FR 4908). It also extends the compliance dates for this rule in light of the delay in the effective dates. This delay will give the administration additional time necessary to fully review the policies in these regulations. PMID- 10133414 TI - Amendment of the fee exemption for federal, state and local government employees- DEA, Justice. Final rule. AB - This final rule limits the exemption from payment of application fees for registration or reregistration to Federal, state, or local government operated hospitals or institutions. This will eliminate the need for DEA to dedicate manpower or other resources to controlling abuse of the fee exempt status. PMID- 10133415 TI - Medicare program: data, standards and methodology used to establish fiscal year 1993 budgets for fiscal intermediaries and carriers--HCFA. Final notice. AB - This notice is published in accordance with sections 1816(c)(1) and 1842(c)(1) of the Social Security Act which requires us to publish the final data, standards and methodology used to establish budgets for Medicare intermediaries and carriers. It announces that we are adopting as final, and responds to comments about, the data, standards, and methodology we proposed to use to establish Medicare fiscal intermediary and carrier budgets for the fiscal year (FY) 1993, beginning October 1, 1992. PMID- 10133416 TI - Ready for action, waiting for Clinton. PMID- 10133417 TI - Three tough tests awaiting Clinton. PMID- 10133418 TI - What health care crisis? PMID- 10133419 TI - Voters have last word on hot issues. PMID- 10133420 TI - Fieldwork education: a shared supervision model. AB - This paper describes how McMaster University, Department of Occupational Therapy implemented a shared supervision model during an adult physical health block clinical placement, in two fieldwork settings in Hamilton. Five students were assigned to each of the clinical facilities and spent time with the group supervisors and clinical preceptors to meet their learning needs. The objectives, implementation process, training and orientation process, learning and evaluation process, and outcome of this project are discussed. The shared supervision model appears to be a viable alternative supervision model in fieldwork education. PMID- 10133421 TI - Performance evaluation of occupational therapy students: a reliability study. AB - The Performance Evaluation of Occupational Therapy Students (PEOTS) is an instrument designed to evaluate the clinical competence of occupational therapy students. The purpose of this study was to carry out a preliminary evaluation of the inter-rater and test-retest reliability of the PEOTS. Thirteen occupational therapy students, completed a one week placement at one of four facilities. Two occupational therapists supervised each student and evaluated performance using the PEOTS on day three and day five of this placement. The results indicated that the instrument has good inter-rater reliability. Test-retest reliability was difficult to evaluate since learning was a confounding factor. These preliminary findings support the use of the PEOTS as an evaluation tool. Further research, however, is needed to establish test-retest reliability and internal consistency of the PEOTS. PMID- 10133422 TI - Student placements in administration. AB - From 1988-1993 the Occupational Therapy Manager at St. Joseph's Health Centre in London, Ontario provided nine block placements with a major focus in administration. The administration placements and the results of a questionnaire completed by the students are discussed. Strengths of the placement and suggested areas of change are included, using a Continuous Quality Improvement Framework. Suggestions regarding the future direction of administration placements are presented. PMID- 10133423 TI - Maintaining a balance in service and education in a climate of fiscal crisis. AB - Doubling enrollment in the undergraduate occupational therapy programme at McMaster University was introduced in a climate of fiscal crisis. This paper will discuss the creative implementation of a Quality Circle Model in the Occupational Therapy Department at Chedoke-McMaster Hospitals, Hamilton, Ontario, which promoted concerted staff participation and self management development in light of increased student learning needs. An alternate model of Clinical Supervision was examined. The impact of this proactive, problem solving approach will be addressed and may encourage application in other occupational therapy settings. PMID- 10133424 TI - Position statement. Coordination of occupational therapy services. Canadian Association of Occupational Therapists. PMID- 10133425 TI - Restraint-free care benefits patients. PMID- 10133426 TI - Nursing homes and their users seek quality stamps of approval. PMID- 10133427 TI - Clintons court seniors on health plan. PMID- 10133428 TI - Budget clips housing for elderly. PMID- 10133429 TI - Seniors housing reflects improved economy. PMID- 10133430 TI - Unshackling the elderly. The use of restraints is now politically incorrect. PMID- 10133431 TI - Seniors press for longterm care. PMID- 10133432 TI - DON of the year. June Anderson and Rita Hoey. AB - Two women who have demonstrated particular talents in adapting to the evolving longterm-care industry have been selected as Contemporary Long Term Care's 1994 DONs of the Year. June Anderson, honored in the category of nursing homes with over 130 beds, has been a leader in steering Mission Skilled Nursing and Subacute Center in Santa Clara, Calif., into subacute care and in developing progressive techniques in care planning. Rita Hoey, named in the category of nursing homes with 130 beds or less, has employed a hands-on approach to staff management and has combined discipline with empathy to foster a spirit of team work and staff loyalty at Glendale Nursing and Rehabilitation Center in Naugatuck, Conn. PMID- 10133433 TI - Just passing through. This innovative evaluation unit stresses teamwork to place patients in less-costly facilities or return them to their homes. PMID- 10133434 TI - Subacute units need to be aware of standards. PMID- 10133435 TI - Longterm-care financing flows from new sources. PMID- 10133436 TI - Female trouble. Do EMTs treat women differently? PMID- 10133437 TI - All in the family. PMID- 10133438 TI - What every EMT needs to know about rape. PMID- 10133439 TI - Earthquake. AB - On January 25, 1 week after the most devastating earthquake in Los Angeles history, the Southern California Hospital Council released the following status report: 928 patients evacuated from damaged hospitals. 805 beds available (136 critical, 669 noncritical). 7,757 patients treated/released from EDs. 1,496 patients treated/admitted to hospitals. 61 dead. 9,309 casualties. Where do we go from here? We are still waiting for the "big one." We'll do our best to be ready when Mother Nature shakes, rattles and rolls. The efforts of Los Angeles City Fire Chief Donald O. Manning cannot be overstated. He maintained department command of this major disaster and is directly responsible for implementing the fire department's Disaster Preparedness Division in 1987. Through the chief's leadership and ability to forecast consequences, the city of Los Angeles was better prepared than ever to cope with this horrendous earthquake. We also pay tribute to the men and women who are out there each day, where "the rubber meets the road." PMID- 10133440 TI - Staffing methodologies: there are no simple answers. PMID- 10133441 TI - Cleanology: the evolution of cleaning. PMID- 10133442 TI - Mergers and acquisitions. A healthcare case study. PMID- 10133443 TI - 1994 N.E.H.A. salary survey. PMID- 10133444 TI - Cafeteria takes center stage at Wake Medical Center. PMID- 10133445 TI - A cost-reduction catalog. PMID- 10133446 TI - Dietitians as preferred providers. PMID- 10133447 TI - Morton Plant dining room. Morton Plant Hospital, Clearwater, Florida. PMID- 10133448 TI - Challenge: how to provide foodservice during a renovation. Solution: construct a temporary cafeteria. PMID- 10133449 TI - Challenge: how to make employees more productive. Solution: vary their duties on a daily basis. PMID- 10133450 TI - Hospital marketing analysts becoming strategic planners. PMID- 10133451 TI - For some patients, the best primary care doctor is a subspecialist. PMID- 10133452 TI - Positioning internists in managed care: new challenges for generalists and subspecialists. PMID- 10133453 TI - Can the Clinton plan get past these congressional hurdles?. Interview by Diana Madden. PMID- 10133454 TI - Getting back to basics on health system reform. PMID- 10133455 TI - Some misgivings about managed care. PMID- 10133456 TI - Gatekeeper: guide or guard? PMID- 10133457 TI - Ethics and clinical practice guidelines. PMID- 10133458 TI - Coordinator or consultant? Managed care intensifies debate over internists' roles. PMID- 10133459 TI - The challenge from within. PMID- 10133460 TI - Network profile. Presbyterian Healthcare System. PMID- 10133461 TI - Failure mode and effects analysis: a novel approach to avoiding dangerous medication errors and accidents. AB - It is time that hospitals realize that human error is inevitable and must be anticipated. A technique developed in the aerospace industry and known as "failure mode and effects analysis" involves identifying mistakes that will happen before they happen, and determining whether the consequences of those mistakes would be tolerable or intolerable. This article shows how this practice can be adapted to a hospital environment by using a continuous quality improvement approach. Examples show how actual fatal errors can be prevented. PMID- 10133462 TI - The use of failure mode effect and criticality analysis in a medication error subcommittee. AB - Failure Mode Effect and Criticality Analysis (FMECA) is the systematic assessment of a process or product that enables one to determine the location and mechanism of potential failures. It has been used by engineers, particularly in the aerospace industry, to identify and prioritize potential failures during product development when there is a lack of data but an abundance of expertise. The Institute for Safe Medication Practices has recommended its use in analyzing the medication administration process in hospitals and in drug product development in the pharamceutical industry. A medication error subcommittee adopted and modified FMECA to identify and prioritize significant failure modes in its specific medication administration process. Based on this analysis, the subcommittee implemented solutions to four of the five highest ranked failure modes. FMECA provided a method for a multidisciplinary group to address the most important medication error concerns based upon the expertise of the group members. It also facilitated consensus building in a group with varied perceptions. PMID- 10133463 TI - Target drug monitoring: a cost-effective service provided by staff pharmacists. AB - A concurrent drug use evaluation program that improves patient care while meeting JCAHO requirements was designed and implemented. Integration of staff pharmacists into the program has been an important component. The net annual savings of the program for H2 antagonists and cephalosporins was $16,756. The net annual cost of the program if all drugs were studied throughout each quarter would be $1,336. The program essentially pays for itself, meets medication use standards for JCAHO, and may save significant healthcare costs if potential drug misadventures are avoided. PMID- 10133464 TI - Getting the most out of low-dose syringe prefilling of a high-cost biotechnology agent. AB - The recent increased usage of high-cost biotechnology agents has placed a tremendous impact on the hospital pharmacy budget. One approach in improving cost containment is to minimize waste during the preparation of these agents. This is particularly practical and possible in the process of low-dose syringe repackaging of Sargramostim (GM-CSF) used for the treatment of neutropenia. In search of ways to reduce waste, this study looked into the dos and don'ts of repackaging this agent in syringes. Decreased waste is very significant if GM-CSF is properly reconstituted with bacteriostatic water for injection and if a syringe equipped with a permanently attached needle is used. Another 10% of the solution from each vial could be saved if the solution is withdrawn with a technique involving the vial in a right-side-up position. PMID- 10133465 TI - Improving organizational performance. PMID- 10133466 TI - Let the health reform debate begin. PMID- 10133467 TI - Ground-breaking supply pact grows in Texas. PMID- 10133468 TI - GPOs hold down lab test kit prices. PMID- 10133469 TI - Larger hospitals show greatest increase in food service non-salary expenses. PMID- 10133470 TI - Hospital saves with recycled disposable probes, but safety questions persist. PMID- 10133471 TI - Minnesota affiliation awash in savings opportunity. PMID- 10133472 TI - Most Foley catheter prices unchanged. PMID- 10133473 TI - Critical care non-salary expenses per patient day. PMID- 10133474 TI - Cost restraints forcing tough protective equipment choices. PMID- 10133475 TI - A radical future for health authorities? AB - The ethos of the NHS reforms has forced mergers between district health authorities, and alliances with family health services authorities. Alan McNaught highlights some of the advantages created and the problems caused, and suggests some ways of dealing with 'merger mania'. PMID- 10133476 TI - Dear Hillary.... AB - As Hillary Clinton worked on the reforms of the US health system, three University of Minnesota fellows, Meeta Pherwani, Craig Hostetler and Sarah Miller, offered her some advice based on their experience with the NHS. PMID- 10133477 TI - The business of skill-mix. PMID- 10133478 TI - Ethics in health services management. AB - Many managers are challenged by what they see as significant ethical issues within their own areas of responsibility, in the behaviour of others around them, and in the structures of the organisations and policies within which they work. PMID- 10133479 TI - Personal development planning. AB - Since the introduction of general management into the NHS in 1985, greater emphasis has been placed on managing the service through clearly defined objectives. Jill Sandford and Christine Rollin describe Lifespan Healthcare's personal development plan for managers, and report on some of the benefits it has brought the organisation. PMID- 10133480 TI - Management ... working day of a health services manager. Glan Clwyd NHS Trust, Wales. PMID- 10133481 TI - Cooperation. An alternative to consolidation or bankruptcy. AB - With all the recent consolidation and doomsaying within the EMS industry, the music from the movie "Jaws" is likely playing a constant refrain in the minds of many smaller EMS providers. The word from the consolidators--those large companies buying up small and midsized ambulance services--is that health maintenance organizations (HMOs) soon will be purchasing EMS and other "out-of hospital" services and that since HMOs are for-profit institutions, they will be looking for the least expensive EMS delivery system. The consolidators and others with a stake in the new order assert that cost-effective services can only be produced by large national EMS companies; smaller companies will be left out in the cold. But will they? PMID- 10133482 TI - From mom and pop to big business. The ambulance industry consolidates. PMID- 10133483 TI - House calls. Making politics work for you. AB - The term "lobbyist" often brings up images of smoke-filled back rooms and dirty dealings, but the average person lobbies for some type of cause every day, whether drumming up support for a new project at work, for being promoted or just for getting a spouse to agree to paint the house a new color. In this era of health care reform, it's time to promote EMS as a viable health care entity by using these lobbying skills to make the politicians listen. You can bet that other health care groups are lobbying right now, and if you don't do it, EMS will be left out in the cold. PMID- 10133484 TI - Treatment without transport. Expanded-scope concept gains momentum. PMID- 10133485 TI - Why AIDS prevention programs don't work. PMID- 10133486 TI - What we don't know about health care reform. PMID- 10133487 TI - A prescription for better prescriptions. PMID- 10133488 TI - The Association for Volunteer Administration and professionalization of the field: suggestions from a survey for the membership. AB - This article analyzes results from a comprehensive survey of members of the Association for Volunteer Administration (AVA), conducted in 1992-93. Two-thirds of the membership completed the mail questionnaire. The article elaborates findings from the survey in the areas of: professional background of members, their position in volunteer administration, their volunteer programs, interest in research in the field, and attitudes toward their work, organization, and profession. The concluding section discusses implications of the findings with respect to the AVA and professionalization of the field. PMID- 10133489 TI - Seniors as volunteers and their training. AB - Supposedly, seniors have a good deal of discretionary time at their disposal, but so far, they form a much smaller proportion of the volunteer force than their numbers in the total population might lead us to expect. Yet they undoubtedly have much that they could contribute in terms, for example, of experience and accumulated skills. What might their contribution be, in fact? What do those who do volunteer contribute now? What training, if any, do they require and what do they actually receive? Do organizers underestimate their capacities and the contribution they might be persuaded to make? PMID- 10133490 TI - How effective in your training of volunteers? AB - This work addresses one of the basic concepts of volunteer management, a three level program for training volunteers. The author addresses the need for an appropriate amount of training, the important categories of training for volunteers and the use of volunteers as trainers of other volunteers. She presents a perspective of training of volunteers which is applicable to many types of organizations utilizing volunteers and to a diversity of volunteer services. The author's direct and simple approach to this aspect of volunteer management serves as a reminder of the important part training plays in the volunteer experience. PMID- 10133491 TI - Psychosocial support: a crucial component for the successful management of AIDS volunteers. AB - A multidisciplinary approach in the support of AIDS volunteers is discussed employing three dimensions: educational, social and psychological. This approach was developed by the Foundation for Interfaith Research and Ministry (FIRM) in Houston, Texas, to combat volunteer burnout and attrition often exhibited by volunteers when serving clients with AIDS and other chronic, debilitating diseases. An examination of the specific goals and tasks required of volunteer managers/coordinators to utilize this approach are outlined. Although these three components of support were implemented for AIDS volunteers, they can easily be modified to suit virtually any type of volunteer environment and are appropriate tools to enhance a variety of volunteer settings. Ideas and suggestions as to how this psychosocial model of support can be adapted for an organization's use are included. PMID- 10133492 TI - Make sure that hospital can live up to its promises. PMID- 10133493 TI - Where doctors fit in those new hospital networks. PMID- 10133494 TI - The best single tool for motivating your staff. PMID- 10133495 TI - Think today's ethical issues are tough? Just wait. Interview by Anita J. Slomski. PMID- 10133496 TI - Avoiding managed care's liability risks. PMID- 10133497 TI - Finally: doctors win big against a malpractice insurer. PMID- 10133498 TI - Study disputes control of 10 USTF hospitals. PMID- 10133499 TI - Everyone is covered in Minn., but who gets bill still at issue. PMID- 10133500 TI - Study: Medicare pays to train too many specialists. PMID- 10133501 TI - Merger bridges markets, products. PMID- 10133502 TI - Three Ill. hospitals collaborate on plan. PMID- 10133503 TI - Abortion issue enters reform deliberations. PMID- 10133504 TI - New bill modifies Clinton health plan. PMID- 10133505 TI - Not-for-profit's switch hinges on court ruling. PMID- 10133506 TI - Insurance co-ops set up in N.Y. PMID- 10133507 TI - EHS efforts lauded by Healthcare Forum. PMID- 10133508 TI - Feds halt check on 'prudent buyer' clause. PMID- 10133509 TI - Judge acquits Blues board member. PMID- 10133510 TI - Wash. Blues' pay, perks draw criticism. PMID- 10133512 TI - 6 Ill. hospitals' bond ratings fall. PMID- 10133511 TI - Seattle acute-care hospital converting to long-term care. PMID- 10133513 TI - Hospital deals jump in fourth quarter. PMID- 10133514 TI - Infractions trimmed from 95 to 1, but hospital faces accreditation loss. PMID- 10133515 TI - Reform may force hospital closures. PMID- 10133516 TI - Make practice guidelines informative, not punitive. PMID- 10133517 TI - Homeward bound. Hospitals look to home-care programs as they search for opportunities to expand and diversify. AB - The number of hospitals operating home-care programs has leveled off, but interest in their possibilities is rising. Hospitals once again are looking to home care as they search for opportunities to expand and diversify their services. PMID- 10133518 TI - Two Florida systems to fight federal suit against merger. PMID- 10133519 TI - Columbia/HCA closing Fla. hospital. PMID- 10133520 TI - Primary care needs research. PMID- 10133521 TI - Controversy surrounds role of cryosurgery. PMID- 10133522 TI - Covering the risks of capitation. PMID- 10133523 TI - SEC adds to delay in Coram deal. PMID- 10133524 TI - New rules on therapy only fuel dispute. PMID- 10133525 TI - Companies link in deal that spans coasts. PMID- 10133526 TI - Custom accounts receivable modeling. AB - In hospital and clinic management, accounts are valued as units and handled equally--a $20 account receives the same minimum number of statements as a $20,000 account. Quite often, the sheer number of accounts a hospital or clinic has to handle forces executives to manage accounts by default and failure- accounts mature on an aging track and, if left unpaid by patients, eventually are sent to collections personnel. Of the bad-debt accounts placed with collections agencies, many are misclassified as charity or hardship cases, while others could be collected by hospital or clinic staff with a limited amount of additional effort. PMID- 10133527 TI - Maintaining patient accounts performance during downsizing. AB - Patient accounts managers and chief financial officers (CFOs) are facing difficult issues during this current period of change in health care. The realities of today's lower rates of reimbursement and the uncertainties of healthcare reform have forced hospital management teams to reduce costs strategically to maintain adequate financial performance. One method often employed is "downsizing"--reducing staffing levels. Even those facilities that have not found it necessary to reduce staff through a formal layoff plan must seriously evaluate whether or not to replace employees who retire or terminate voluntarily. Patient accounts departments that have not yet been forced to downsize should be prepared for such an event; those that are currently struggling to maintain performance as a result of downsizing can improve their operations by addressing certain key areas. PMID- 10133528 TI - Twelve questions to ask about your outcomes monitoring system--Part I. AB - Outcomes monitoring is an integral part of any decision maker's information resources--the cornerstone of a provider's commitment to quality improvement or of a purchaser's strategy for seeking value. In their eagerness to obtain useful information about provider performance, purchasers and consumers naively may accept flawed evaluations and thereby create perverse incentives for providers that undermine the very qualities they wish to foster. Inaccurate or misleading information about provider performance will lead managers to reward the wrong behavior and so induce more of it. Inaccurate information also can discourage better providers whose performances are not recognized and can lead all providers to distrust and denounce clinical monitoring in general. When these things happen, the great value of outcomes monitoring systems as a tool for quality improvement is lost. PMID- 10133529 TI - Preparing to tack: when physicians change careers. AB - Because of the progressive health care revolution that gives all the power to the managed care insurance companies, the usurpation of physician autonomy, and the replacement of the physician-patient relationship with HMO policies, doctors are looking at other career choices. Many doctors have never considered life after medicine and have made no plans for that time in their future. Despite their ample education, some doctors say, "I don't know how to do anything else. I am trapped in this system, and I can't get out. If I knew what else I could do, I would definitely change careers." Many doctors feel that it is too late in their lives to make such a change. However, it is becoming more and more acceptable to switch or modify a medical career. A number of physicians have switched careers successfully without disgrace and have discovered that there is indeed a life after the first career choice. It isn't always easy, but it can be done. PMID- 10133530 TI - The health care system has an eating disorder. AB - The health care system crisis has been proclaimed and analyzed so much by economists, policy analysts, politicians, business executives, and journalists that the key statistics and phrases are becoming as familiar as the lyrics of a popular song-14 percent of the GNP goes to health care, 37 million Americans lack health insurance, too many specialists and not enough primary care physicians, etc. What I have not found is a comprehensive assessment of how the health care system got so sick. The different social science specialists focus on their respective symptoms or organs, but do not propose therapies to treat the entire organism. Ilya Prigogine's Theory of Dissipative Structures (now old hat since he won the Nobel Prize in 1977) demonstrated that self-organizing systems, be they health care systems or individual patients, respond in similar ways to the demands of illness and growth. Therefore, a clinical correlation for the health care system may have more than poetic appeal. I would like to offer the following clinical analogy for what ails our health care system. PMID- 10133531 TI - The medical examiner and deaths in the hospital setting. AB - There has been a perceived increase in the number of medical negligence claims in recent years. The modern metropolitan medical examiner is increasingly called upon to deal with numerous medical, legal, social, and ethical issues. Nowhere is the role of the medical examiner more important than in the investigation of deaths related to surgical, diagnostic, anesthetic, or therapeutic procedures. Medical examiners have an important role in the investigative process. Through utilization of the offices and services of the medical examiner, questions raised by families, physicians, and other hospital employees may be satisfactorily answered a priori, and litigation may therefore be averted. PMID- 10133532 TI - Bracing for enforcement. PMID- 10133533 TI - The stock market boom. PMID- 10133534 TI - Bon appetite: a nutritious guide to health in long term care. PMID- 10133535 TI - A blueprint for care. Clinical practice guidelines are the newest approach to control quality of care and outcomes. PMID- 10133536 TI - The financial path to managed care. PMID- 10133537 TI - OSHA sets new direction. PMID- 10133538 TI - Subacute care. Preparing for a new market. PMID- 10133539 TI - Residential living. Operational success. PMID- 10133540 TI - Opportunity or threat? Is assisted living an opportunity for growth in the long term care field or a threat to the traditional nursing facility provider? Pro. PMID- 10133541 TI - Opportunity or threat? Is assisted living an opportunity for growth in the long term care field or a threat to the traditional nursing facility provider? Con. PMID- 10133542 TI - A continuum of care. PMID- 10133543 TI - Stock check. PMID- 10133544 TI - Payment design strategies. PMID- 10133545 TI - Ethical challenges. Making difficult decisions. PMID- 10133546 TI - Bolstering the balance sheet. PMID- 10133547 TI - Treating depression. PMID- 10133548 TI - 1994 corporate profiles. AB - As the long term care industry seeks out new products, new solutions, and new ways of providing quality care, it is important for long term care providers to know more about the companies they do business with. The following Corporate Profiles showcase information about leading companies in the long term health care industry. Some of the areas highlighted include: Mission of Company, History, Product Lines, Support Services. We hope you will find this information useful when making purchasing decisions, and we're confident you'll keep this issue of Provider as a handy reference guide. PMID- 10133549 TI - NRA (National Restaurant Association): no health-care mandates. PMID- 10133550 TI - Human equality and assistance in suicide. PMID- 10133551 TI - The masks of medicine. Medical relationships in epidemics. PMID- 10133552 TI - Salary negotiations: getting the pay raise you've earned. PMID- 10133553 TI - Nursing efforts to define UAPs (unlicensed assistive personnel) impact surgical technology. PMID- 10133554 TI - Patient-centered care: the jury is still out. AB - The patient-centered care model needs to retain a central focus on the patient. Process and system interfaces are key areas where alignment on behalf of the patient is required. Often, the current system is out of control. Departmental infrastructure and the need for resource reallocation must be assessed. No blueprint exists for implementing patient-centered care, although many incremental patient-focused initiatives are already underway. Impact on patients must be the balancing factor. PMID- 10133555 TI - Systems analysis and work redesign to meet patient care objectives. AB - This article defines a process to reconfigure and streamline patient care services in an acute care hospital. Multidisciplinary teams use quality improvement methods and team process to challenge and redefine current work activity in order to achieve financial savings and service improvements. PMID- 10133556 TI - Patient-focused work redesign: hospital and pharmacy department restructuring. AB - Patient-focused care is a new way of doing business in hospitals. Work redesign initiatives can be an opportunity or a threat to established pharmacy structures. Seizing the opportunity, pharmacy departments can use redesign efforts to implement pharmaceutical care. Key features of a redesign initiative include vision development, objective setting, and defined operating strategy elements. This article describes the process used in a patient-focused care initiative at MultiCare Medical Center and its Department of Pharmacy Services, Tacoma, Washington. PMID- 10133557 TI - Patient-focused care and pharmaceutical care: how do they organizationally work together? AB - As health care reform takes shape, many challenges face hospital pharmacists. An opportunity exists to combine the principles of patient-focused care and pharmaceutical care to restructure the pharmacy department. The goal of restructuring is to increase the amount of time pharmacists spend providing pharmaceutical care to patients. PMID- 10133558 TI - Involvement of a pharmacy department in a hospital's transition to patient centered care. AB - This article will describe our hospital's transition to a patient-centered care environment as a response to rising costs within the hospitals and a desire to improve the quality of patient care through systems improvement. The involvement of pharmacy managers in the new organizational structure will be detailed, as well as their new roles and responsibilities as care center leaders. The traditional pharmacy management structure has been replaced by a team approach to decision making and problem solving. Challenges exist to the pharmacy managers as they reorganize to accommodate new responsibilities within the care centers. Opportunities exist within this setting to support pharmaceutical care. PMID- 10133559 TI - Human resource management in patient-centered pharmaceutical care. AB - Patient-centered care may have the pharmacists and technicians reporting either directly or in a matrix to other than pharmacy administration. The pharmacy administrative people will need to be both effective leaders and managers utilizing excellent human resource management skills. Significant creativity and innovation will be needed for transition from departmental-based services to patient care team services. Changes in the traditional methods of recruiting, interviewing, hiring, training, developing, inspiring, evaluating, and disciplining are required in this new environment. PMID- 10133560 TI - Automation support of patient-focused care. AB - The use of automation in hospital pharmacies is essential to support the concept of patient-focused care. Patient-focused care principles are defined, and the positive effect automation can have on supporting these principles is discussed. Automated technologies supporting drug distribution, sterile product production, prescription filling, and point of care information systems are summarized. Drug distribution technologies include distribution to and from the patient care area, distribution of medication to the patient, inventory control, controlled substance systems, and documentation of medication administration. Finally, a comprehensive automated technology system at a university teaching hospital is described. PMID- 10133561 TI - The financial impact of investigational drug services. AB - The pharmacy-based investigational drug service plays an important role in the clinical research process. Investigators and sponsors often rely on the research pharmacist to assure drug accountability and to assist in educating staff about drug studies, reporting adverse reactions, and providing drug information. While many pharmacy departments across the country have established investigational drug services, there is an increasing need to justify these services from a financial perspective. Our pharmacy department currently provides investigational drug services for over 100 protocols. We have established a fee-for-service billing mechanism, but only 61% of our protocols are drug-company or investigator sponsored, which reimburse for pharmacy services. As a result, we are unable to collect all operating costs through our billing mechanism. Many protocols, however, are sponsored by the National Cancer Institute (NCI), which provides free drugs for cancer protocols. Some NCI drugs are also on the market, so the hospital experiences savings in drug costs when patients are placed on certain NCI protocols. When we combine direct costs recovered through billing with the indirect cost savings from dispensing "free drugs, we find that the total benefit of operating an investigational drug service more than outweighs the cost of operating the service. PMID- 10133562 TI - Work restructuring overview and implications for pharmacists. AB - Patient-centered work restructuring reduces costs and improves quality by helping hospitals make better use of high-skilled professionals in an environment that requires few non-valued activities in fulfilling patient clinical and support needs. Described in this article are the critical elements of core process reengineering, several principles of patient-centered care, the implications for pharmacy, and the pharmacist's role in the new environment. The goal is to increase the amount of time pharmacists spend in clinical decision making, education, and monitoring to help expedite patient recovery, shorten lengths of stay, and improve utilization effectiveness. PMID- 10133563 TI - Case study: from system to network. PMID- 10133564 TI - Benchmarking: a tool in the quest for improved clinical quality. PMID- 10133565 TI - Are you ready to take your hospital into the 21st century? PMID- 10133566 TI - A guide to physician recruitment. PMID- 10133567 TI - Governance fingerprints: survey shows trustee trends and practices. PMID- 10133568 TI - Planning for implementation: 1997. PMID- 10133569 TI - The power of vision. PMID- 10133570 TI - Looking beyond hospital walls. PMID- 10133571 TI - Networking--making the hard decisions. PMID- 10133572 TI - Death on trial. The case of Dr. Kevorkian obscures critical issues--and dangers. PMID- 10133573 TI - Too close for comfort: OSHA confined spaces regulations. PMID- 10133574 TI - OSHA modifies hazard communication rule. PMID- 10133576 TI - Clinton's plan: DOA? PMID- 10133575 TI - Meeting the challenge of cost containment: a case study using variance analysis. PMID- 10133577 TI - "Grass roots reform" Massachusetts-style. PMID- 10133578 TI - Painless cuts in the O.R. PMID- 10133579 TI - The state of the innovation: the outlook for patient focused restructuring. PMID- 10133580 TI - Exploring the economic aspects of patient focused restructuring. AB - Six "general truths" form our economic foundation for Patient Focused restructuring. They address the level and timing of the costs and savings associated with implementing Patient Focused Care. They have not always been anticipated nor welcomed by hospitals pursuing Patient Focused Care, but they have always appeared on those doorsteps just the same. This first edition of DOLLARS AND SENSE shares this foundation with you as the stepping stone to further exploration of the economic aspects of Patient Focused restructuring. This foundation establishes the general "rules of the game" by which your own Patient Focused Care program will be played. Know these rules and you will have within your control the ability to bend and stretch them to suit your particular needs and to maximize the financial gains your hospital achieves through Patient Focused restructuring. PMID- 10133581 TI - Product line management. Formalizing clinical product lines as part of patient focused restructuring. AB - Patient Focused Care is entirely consistent with clinical Product Line Management. In fact, as with Patient Focused Care and CQI/TQM, these two initiatives are better together than apart. To take advantage of this opportunity, you may have to modify your existing mechanism for Product Line Management. But the added benefits of more successful Product Line Management will make any modifications a temporary distraction. Down goes the perceived hurdle. PMID- 10133582 TI - Picking the right change strategy. Slow and steady wins the race. AB - In summary, the slow, participative change process worked well. The power of the staff's involvement overcame the hospital's mistakes. The Steering Team "finessed" the problem of resistance to multi-skilling by creating a system that encouraged the desired behaviors without demanding them. By setting more realistic boundaries and acting more decisively, the Steering Team could have made the process even smoother. PMID- 10133583 TI - Medicare program; diagnosis codes on physician bills--HCFA. Final rule. AB - This final rule implements certain provisions of section 1842(p) of the Social Security Act regarding diagnosis codes on physician bills. Under this final rule, each bill or request for payment for a service furnished by a physician under Medicare Part B must include appropriate diagnostic coding for the diagnosis or the symptoms of the illness or injury for which the Medicare beneficiary received care. PMID- 10133584 TI - Civilian Health and Medical Program of the Uniformed Services (CHAMPUS); continued health care benefit program--DoD. Interim rule. AB - This rule establishes a Continued Health Care Benefit Program (CHCBP) for certain DoD health care beneficiaries who lose eligibility for health care in the Military Health Services System (MHSS). It provides for use of the CHAMPUS benefit structure and CHAMPUS rules and procedures for the CHCBP and seeks public comments on our plan to implement the Continued Health Care Benefit Program. PMID- 10133585 TI - Attestations filed by facilities using nonimmigrant aliens as registered nurses- Employment and Training Administration, DOL. Notice. AB - The Department of Labor (DOL) is publishing, for public information, a list of the following health care facilities which plan on employing nonimmigrant alien nurses. These organizations have attestations on file with DOL for that purpose. PMID- 10133586 TI - A model for holistic staff development. AB - In this article the authors describe a holistic staff development model to assist organizations meet their strategic goals. The principles of this conceptual model are generic and can be applied to both service- and business-oriented organizations. The advent of specialization has significantly affected all industries. There has been great growth in individual disciplines, but the result has been loss of integrity of the whole. The authors believe that holistic education, for the purpose of staff development, can help personnel connect individual and corporate goals. Such consolidation fosters close connections between personnel and their organization by integrating practices among individuals and widening their scope. PMID- 10133587 TI - Supreme Court actions in anti-abortion protest cases. PMID- 10133588 TI - Financial support for graduate medical education under the Clinton Health Security Act. PMID- 10133589 TI - The interaction between emergency transfer law and managed care: providers between a rock and a hard place. PMID- 10133590 TI - Special report on reimbursement and health care delivery systems. HCFA publishes health care quality improvement system guidelines for state Medicaid managed care programs. PMID- 10133591 TI - Criminal enforcement under the proposed Health Security Act and H.R. 3355: shades of things to come. PMID- 10133592 TI - "Fear of AIDS" cases lead to uncertainty in dealing with HIV-infected practitioners. PMID- 10133593 TI - HIV and hatred. Hazardous to your health. PMID- 10133594 TI - 'Mama Might Be Better Off Dead.' The human face of health care. AB - When we set out to review 'Mama Might Be Better Off Dead: The Failure of Health Care in Urban America" (Chicago University Press, 1993), former Chicago journalist Laurie Kaye Abraham's chronicle of one poor, urban family's battle to obtain health care, we discovered two things. First, the author had done a better job in her Introduction of briefly conveying what this rather singular book is all about than we might expect from a traditional review. Second, even in that short synopsis, Laurie Kaye Abraham had succeeded, in graphic terms that statistical and rhetorical abstractions cannot match, in showing why providing health insurance for the poor is not the same as providing health care and why any health reform plan that continues to ignore the needs of the poor will be doomed to failure. For these reasons, and with the publisher's permission, we are reproducing that Introduction here in full. PMID- 10133595 TI - M.D.s must give nurses expanded role in primary care to achieve national health reform goals. PMID- 10133596 TI - Medical savings accounts cut corporate health costs, promote employee wellness. PMID- 10133597 TI - Clinton health reform plan sinking: will Stark reform plan replace it? PMID- 10133598 TI - After Hawkeye and Hot Lips: contracts between hospitals and emergency room physicians. PMID- 10133599 TI - Driving forces behind integration: weigh your options. AB - Collaborative relationships between hospitals and physicians can take many forms. Before you choose your strategy, consider the benefits and drawbacks of each. Many of America's hospitals and physicians are rushing to integrate their services through a variety of collaborative options. Their haste has been encouraged by many factors. Before hospitals and physicians react to the driving forces around them, they should carefully consider the pros and cons of four types of collaborative options: 1. management service organizations, 2. physician hospital organizations, 3. practice acquisition models, 4. equity models. PMID- 10133601 TI - Building effective physician relationships. PMID- 10133600 TI - Essentials for PHO success. PMID- 10133602 TI - Networking strategies that work. PMID- 10133603 TI - Analyzing provisions of major healthcare bills. PMID- 10133604 TI - Balancing professional and personal priorities. PMID- 10133605 TI - American College of Healthcare Executives. Ethical policy statement. Medical records confidentiality. PMID- 10133606 TI - American College of Healthcare Executives. Professional Policy statement. Evaluating the performance of the hospital CEO. PMID- 10133607 TI - Leading a diverse healthcare workforce. PMID- 10133608 TI - M.D. hospital integration: staying on course. Successful CEOs read warning signs. PMID- 10133609 TI - R&I Ivy Awards. New York University Medical Center, Food and Nutrition Services. PMID- 10133610 TI - Comprehensive care networks. Hospital collaboration avoids costly competition. PMID- 10133611 TI - MRI vs. angio. A comparison of costs and efficiency. PMID- 10133612 TI - UltrasoundAngio. Primed for clinical mainstream. PMID- 10133613 TI - Implications of licensure of medical physicists. A study in risk management and quality improvement. Part 2. PMID- 10133614 TI - Options in teleradiology. PMID- 10133615 TI - Changes in attitude, changes in latitudes. PMID- 10133617 TI - Survey results question CPR privacy. PMID- 10133616 TI - Pharmacy morality. II: The darkside of alternative medicine. PMID- 10133618 TI - Optical imaging & the computer-based patient record: a step in the right direction? PMID- 10133619 TI - CQI & emergency room document imaging. PMID- 10133620 TI - RF (radio frequency) technology & New Jersey in January. PMID- 10133621 TI - Pros: telemedicine--saving South Carolina resources. PMID- 10133622 TI - Cons: telemedicine--the babeling tower. PMID- 10133623 TI - A marriage of convenience: physician system resides at the home of the HIS. PMID- 10133624 TI - Managing evolving "documents": how imaging fits. PMID- 10133625 TI - A sampling of document imaging/COLD (computer output to laser disk systems) vendors and their 1993 installations. PMID- 10133626 TI - Patient cards: a cure for health information? PMID- 10133628 TI - Developing patient satisfaction. PMID- 10133627 TI - How to avoid the solution trap. PMID- 10133629 TI - No place like home. Hospitals discover the benefits of home health. PMID- 10133630 TI - Alabama voices in healthcare reform. PMID- 10133631 TI - Employment practices and the dignity of the MT (medical transcriptionist). PMID- 10133632 TI - Healthcare reform and confidentiality. PMID- 10133633 TI - The supply of volunteer labor: the case of hospitals. AB - Little is known about the labor market for volunteers, but even less is known about the supply of volunteers to particular industries. This article examines the supply of volunteer labor to one industry, hospitals, and the choices that volunteers make among hospitals with different ownership attributes. Survey data of volunteers at four hospitals located in Madison, Wisconsin, are used to estimate the importance of a number of factors influencing people's willingness to volunteer at hospitals. We found that job opportunities in the labor market and tax rates affect the supply of volunteers. We also found that volunteers are not indifferent to the type of hospital at which they volunteer; a federal government hospital, a nonprofit state-owned teaching hospital, and other nonprofit hospitals were not perfect substitutes in the eyes of individual volunteers in our study. PMID- 10133634 TI - Made in Canada health reform. PMID- 10133635 TI - The 1994 [Canadian] federal budget and health care: a first look. PMID- 10133636 TI - Mount Sinai Hospital's journey into TQM. AB - Toronto's Mount Sinai Hospital commenced its total quality management journey in the late 1980s as a complement to its extensive experience in quality assurance. This article focuses on Phase I--the process of setting up teams. This phase includes project nomination and selection; team membership selection and education; and the quality improvement process. The authors share the lessons they learned during the course of the journey and present the directions that TQM at Mount Sinai will take in the future. PMID- 10133637 TI - Competencies: your edge in a tough job market. PMID- 10133638 TI - Comprehensive utilization management: the Whitby Psychiatric Hospital model. AB - One of the main thrusts of the 1990s is increased accountability in the provision of medical and psychiatric services. In response to the pressure to provide more cost-effective services, several initiatives have been implemented to reduce expenditures in health care settings while improving quality of patient care. the most recent introduction of such initiatives is utilization management. Whitby Psychiatric Hospital's comprehensive utilization management program provides a model that can be adapted to any health care facility. PMID- 10133639 TI - New Brunswick's expanding frontiers in hospital governance. Interview by Matthew D. Pavelich. PMID- 10133640 TI - The quality quest. PMID- 10133641 TI - Overcoming language barriers: making a start. PMID- 10133642 TI - One hospital's success with medication budget control. AB - In the era of major restraint of health care spending in Ontario, the Ottawa General Hospital, a 530-bed adult tertiary care facility, initiated a series of programs aimed at reducing their drug costs by $500,000 over 18 months; the goal was achieved in 12 months. This success is attributed to the collaboration of key medical staff, the pharmacy department and senior administration. Overall, quality of care was unaffected and was perhaps improved. PMID- 10133643 TI - Getting it right on health care reform. PMID- 10133644 TI - Assessing the progress of TQM in US hospitals: findings from two studies. PMID- 10133645 TI - Quality improvement: moving down the path toward successful organizationwide integration. PMID- 10133646 TI - Strategy forum: how to get results from a TQM initiative. PMID- 10133647 TI - Using care process models to improve quality while controlling cost. PMID- 10133648 TI - Interhospital transfer of cardiac patients: does air transport make a difference? AB - INTRODUCTION: The purpose of this study was to compare the outcome of interhospital transported cardiac patients for whom bias in selecting transport mode was removed due to helicopter unavailability. METHODS: Patients with the diagnosis of unstable angina or myocardial infarction who underwent transport by ground only because helicopter transport was not available, were compared to patients transported by helicopter. Patients were matched by gender and referring hospital. Ninety-six patients were studied and both groups were comparable in age, diagnosis, Killip classification, treatment with thrombolytics and post transport procedures. RESULTS: There were no statistically significant differences between the groups for mean ICU days (5.3 air vs. 3.5 ground) and mean hospital days (9.9 vs. 8.2, respectively). No differences were detected in the proportions of deaths within 72 hours of arriving at the receiving institution (1/48 air vs. 0/48 ground), but air transportation was associated with more total deaths (9/48 vs. 1/48, respectively). CONCLUSION: It appears that the interhospital transport of cardiac patients by air offers no outcome advantage over ground transport. PMID- 10133649 TI - Improved flight following through continuous quality improvement. AB - INTRODUCTION: Flight following is a key component of an air medical transport service's safety program. National standards require conscientious adherence to flight following. EastCare monitored its compliance with internal flight following requirements for three years. SETTING: EastCare is a single-helicopter, hospital-based air medical transport service located in a rural region of the southeastern United States. It has a full-time staff of flight nurses, pilots and communications specialists. METHODS: A continuous quality improvement (CQI) process was initiated to delineate specific areas requiring improvement. These areas were discussed at the air medical service's monthly CQI meetings. RESULTS: In 1989, the communications specialists achieved flight following intervals of < or = 15 minutes in 98% of attempts. In 1990 and 1991, the frequency of flight following intervals of < or = 15 minutes were 98.8% and 99.6%, respectively. The CQI process pointed out educational requirements, technological problems and other areas for improvement. CONCLUSION: The use of a structured CQI process for this service directly contributed to consistently strong compliance in the frequency of flight following. PMID- 10133650 TI - Directory of air medical services. PMID- 10133651 TI - Case studies. After reviewing past procedures, three hospitals, an HMO, and an employer found compelling reasons to use guidelines. PMID- 10133652 TI - The value of outcomes. PMID- 10133653 TI - Building guidelines. PMID- 10133654 TI - The future of guidelines. PMID- 10133655 TI - Data watch. Appropriateness and the effect of guidelines. PMID- 10133656 TI - Quality costs less. PMID- 10133657 TI - An employer model for reform. AB - A few years ago, a coalition of Twin Cities employers met to design a high quality, affordable health care package for their employees. Today, they are promoting their model not only to their employees and their families but to their community and across the country as well. PMID- 10133658 TI - Hospitals differ on expectations of reform. Interview by Debra Mamorsky. AB - Health care reform will be played out in different ways at different institutions, predict two physicians who should know. One runs a large university hospital, the other heads up a small community institution, and their views are notable for their differences as well as for their agreements. PMID- 10133659 TI - Reducing workers' compensation costs. AB - Employers can reduce their workers' compensation costs by encouraging internal communication and education before and after injuries occur. Comprehensive workers' compensation programs can be developed by integrating the management of employee benefits and workers' compensation claims. PMID- 10133660 TI - Health plan ordered to pay high penalty. AB - Litigation on the basis of wrongful denial of medical benefits can literally cripple a health plan. If it can happen at Health Net, it can happen to almost any plan. PMID- 10133661 TI - How courts view experimental treatments. AB - The consequences of lawsuits brought by patients to obtain insurance coverage for autologous bone marrow treatment for breast cancer illustrate the problems that arise when health plans seek to exclude "experimental" treatments. PMID- 10133662 TI - Work now for effective health care changes. AB - Although it seems increasingly unlikely that health care reform as proposed by the Administration will pass, some sort of reform is likely. Employers must not stand by silently as this critical debate unfolds. PMID- 10133663 TI - What happens to retirees after health care reform? AB - The advent of health care reform may cause older workers, no longer fearful of losing health benefits, to leave their jobs. Employers that want to retain these valuable employees may ultimately need to upgrade pay and benefits. PMID- 10133664 TI - Teaching employees how to get the most from an HMO. PMID- 10133665 TI - Why centers of excellence are gaining momentum. PMID- 10133666 TI - Patient could not sue insurer for denying coverage. PMID- 10133667 TI - Cost-management solutions for health care. AB - Employers do not need the new math to compute that health care reform equals increased costs. Faced with this dilemma, they are exploring cost-management solutions to keep up with reform and at the same time keep down costs. PMID- 10133668 TI - What's it take to be a top CIO?. Interview by Michael L. Laughlin. PMID- 10133669 TI - Chief information officers now earn competitive wages. PMID- 10133670 TI - Software cuts facility costs at NEMC (New England Medical Center, Boston). PMID- 10133672 TI - Hotlist. Strategic management tools. PMID- 10133671 TI - 1994 Health Management Technology market directory supplement. PMID- 10133673 TI - Eliminating patient dumping: a proposal for model legislation. PMID- 10133674 TI - Meeting the Clean Air Act requirements. PMID- 10133675 TI - Department biohazardous waste audits. PMID- 10133676 TI - The EPRI (Electric Power Research Institute) Healthcare Initiative. PMID- 10133677 TI - A summary of state activity on medical waste management. PMID- 10133678 TI - Antineoplastic drug waste management: an EPA perspective. AB - In conclusion, the federal requirements for antineoplastic drug waste management presented in the original article published in the Regulatory Analyst during February 1993 have been clarified and supplemented by this discussion. Because state regulations are often more stringent than their federal counterparts, the appropriate state agencies should be consulted for final regulatory determinations on antineoplastic drug waste management. PMID- 10133679 TI - Healthcare providers and their suppliers form coalition ... Healthcare Resource Conservation Coalition. PMID- 10133680 TI - Planning for environmental needs in hospital renovations. AB - In summary, when developing or renovating a hospital facility, one should: Review federal, state and local waste handling requirements. Plan for efficient and adequate storage. Remember routing--keep it simple--consider secondary storage requirements. Choose vendor(s) wisely--minimize liability--know the "final storage" site of the waste. Stick to the basics of recycling and know the real costs of additional recycling--educate employees as to the realities of recycling -enhance recycling by purchasing items with post-consumer components. PMID- 10133681 TI - New treatment technology debuts in California. PMID- 10133682 TI - Bulk blood disposal--should HIV be considered? PMID- 10133683 TI - Healthcare reform and medical waste management: this changes everything. PMID- 10133684 TI - Retrofit of hospital incinerators to meet new standards. PMID- 10133685 TI - Medicaid program; limitations on aggregate payments to disproportionate share hospitals: federal fiscal year 1994--HCFA. Notice. AB - This notice announces the final Federal fiscal year (FFY) 1994 national target and individual State allotments for Medicaid payment adjustments made to hospitals that serve a disproportionate number of Medicaid recipients and low income patients with special needs. We are publishing this notice in accordance with the provisions of section 1923(f)(1)(C) of the Social Security Act (the Act) and implementing regulations at 42 CFR 447.297 through 447.299. PMID- 10133686 TI - Same players, new teams in health debate. PMID- 10133687 TI - Health lobby hiring spree continuing. PMID- 10133688 TI - Five who hold the key to health bill. PMID- 10133689 TI - Children's hospitals become independent regional centers. PMID- 10133690 TI - John Deere and Mayo establish strategic alliances between payers and providers. PMID- 10133691 TI - Physician-hospital integration and direct contracting in managed care programs. AB - Requirements for new physician-hospital relationships will include common vision and values, a sound business plan, new organizational and governance structures, and an innovative approach to all operating systems. PMID- 10133692 TI - Implementing vertical integration and the role of marketing at Lutheran General. PMID- 10133693 TI - Business Health Services increases markets for Morton Plant Hospital in Clearwater, Fla. PMID- 10133694 TI - Could you ally rather than buy, merge or die in integrated health care services systems? PMID- 10133695 TI - Evaluating and marketing efficient physicians toward competitive advantage. PMID- 10133696 TI - Home health, nursing homes take patients from hospitals. AB - The fast-growing home health agencies and nursing homes are taking acute and subacute patients from the nation's hospitals, but their labor costs are soaring. And personnel problems may slow their growth, writes Donald E.L. Johnson PMID- 10133697 TI - Hospital CEOs say managers need specialized skills to survive market. PMID- 10133698 TI - On adolescence and informed consent. PMID- 10133700 TI - Moving toward patient-focused care. PMID- 10133699 TI - Patient and staff abuse: rights, expectations, options and policies. PMID- 10133701 TI - A do-it-yourself benchmarking system. PMID- 10133702 TI - Medicare and Medicaid managed care: issues and evidence. PMID- 10133703 TI - Border crossing for physician services: implications for controlling expenditures. AB - In this article, the authors explore geographic border crossing for the use of Medicare physician services. Using data from the 1988 Part B Medicare Annual Data (BMAD) file, they find that there is substantial geographic variation across both States and urban and rural areas in border crossing to seek services. As might be expected, there is more border crossing among smaller geographic areas than among States. Predominantly rural areas tend to be major importers of services, but urban areas, on average, export services. Border crossing tends to be greater for high-technology services such as advanced imaging, cardiovascular surgery, and oncology procedures. These results suggest that expenditure-control policies applying to States or metropolitan areas should incorporate adjusters for patients' current geographic patterns of care. PMID- 10133704 TI - Medicaid, welfare dependency, and work: is there a causal link? AB - Medicaid exerts a strong "pull" on potential welfare recipients, increasing the probability that a number of single mothers will apply for and stay on welfare in order to be covered by Medicaid. However, the availability of private health insurance coverage exerts a strong positive influence on women's decisions to work and a strong negative effect on welfare participation rates. If private insurance coverage were as comprehensive as Medicaid and readily available at all jobs, its impact on promoting work would be substantially greater than is the impact of Medicaid in promoting the use of welfare. PMID- 10133705 TI - Trends in Medicare health maintenance organization enrollment: 1986-93. AB - This study examines Medicare health maintenance organization (HMO) enrollment under the Tax Equity and Fiscal Responsibility Act (TEFRA) of 1982 (Public Law 97 248) from 1986 to 1993. It shows that there was moderate growth in the number of Medicare beneficiaries participating in the TEFRA risk program, reaching 1 in 20 beneficiaries in 1993. Medicare HMO enrollment is heavily concentrated in a few large plans, resulting in heavy concentrations geographically. California and Florida accounted for over one-third of Medicare HMO enrollees. One-half of the States have no Medicare HMO enrollment and one-fifth of the States have fewer than 15,000 Medicare HMO enrollees. PMID- 10133706 TI - Omnibus Budget Reconciliation Act of 1993 (Public Law 103-66). AB - On August 10, 1993, the President signed into law the Omnibus Budget Reconciliation Act (OBRA) of 1993 (Public Law 103-66). Following are summaries of the Medicare, Medicaid, and other relevant provisions. PMID- 10133707 TI - Report to Congress. COBRA Medicare prevention demonstration. PMID- 10133708 TI - Risk adjustment for a children's capitation rate. AB - Few capitation arrangements vary premiums by a child's health characteristics, yielding an incentive to discriminate against children with predictably high expenditures from chronic diseases. In this article, we explore risk adjusters for the 35 percent of the variance in annual out-patient expenditure we find to be potentially predictable. Demographic factors such as age and gender only explain 5 percent of such variance; health status measures explain 25 percent, prior use and health status measures together explain 65 to 70 percent. The profit from risk selection falls less than proportionately with improved ability to adjust for risk. Partial capitation rates may be necessary to mitigate skimming and dumping. PMID- 10133709 TI - Medicaid case management: Kentucky's Patient Access and Care Program. AB - Since 1981, States have been experimenting with Medicaid managed care programs to improve access and continuity of care and to contain costs by reducing inappropriate and unnecessary utilization. To determine the impact of primary care case management (PCCM) on utilization, the authors examine data from the Kentucky Patient Access and Care program (KenPAC). Using monthly utilization data from 1984 to 1989 and an interrupted time-series research design, the authors find that PCCM reduces the use of independent laboratory, physician, emergency department, and outpatient hospital services. PCCM does not appear to affect utilization of inpatient hospital services or prescription drugs. PMID- 10133710 TI - Do health maintenance organizations work for Medicare? AB - Since 1985, the Health Care Financing Administration (HCFA) has encouraged health maintenance organizations (HMOs) to provide Medicare coverage to enrolled beneficiaries for fixed prepaid premiums. Our evaluation shows that the risk program achieves some of its goals while not fulfilling others. We find that HMOs provide care of comparable quality to that delivered by free-for-service (FFS) providers using fewer health care resources. Enrollees experience substantially reduced out-of-pocket costs and greater coverage. However, because the capitation system does not account for the better health of those who enroll, the program does not save money for Medicare. PMID- 10133711 TI - Design of a prospective payment patient classification system for ambulatory care. AB - The Ambulatory Patient Group (APGs) are a patient classification system that was developed to be used as the basis of a prospective payment system (PPS) for the facility costs of outpatient care. This article will review the key characteristics of a patient classification system for ambulatory care, describe the APG development process, and describe a payment model based on the APGs. We present the results of simulating the use of APGs in a prospective payment system, and conclude with a discussion of the implementation issues associated with an outpatient PPS. PMID- 10133712 TI - Home care workers' assessment of differences between nonprofit and for-profit organizations delivering home care services to the Israeli elderly. AB - This paper presents research findings analyzing home care workers' assessment of the differences between nonprofit and for-profit organizations delivering home care services to Israel's frail elderly. The study focuses in particular on the workers' motives for choosing a particular employer, their empowerment, the training and enrichment programs available to them, and their perceptions of organizational fairness and performance. Nonprofit organizations received higher evaluations from workers than did for-profit organizations and invested more in the management of human resources. PMID- 10133713 TI - Low back injuries among home health aides compared with hospital nursing aides. AB - Data were collected from all incident reports of low back injury during 1984-1986 among nursing aides at one hospital and home health aides at two agencies in the Baltimore-Washington area. Respective rates of injury were 5.9/100 FTE's and 15.4/100 FTE's (p < 0.001). A majority of injuries occurred during patient related, planned activities and without the use of lifting equipment. Forty percent of the events occurred at the bedside. Eighty-eight percent of home health aides were working alone compared with 39 percent of NAs. Ergonomic interventions may be an effective strategy to reduce injuries, since 50 percent of the events involved lifting and pushing/pulling activities. PMID- 10133714 TI - Nursing home queues and home health users. AB - Home health market growth suggests the need for models explaining home health utilization. We have previously explained state-level Medicare home health visits with reference to nursing home markets. Here we introduce a model whereby state level Medicare home health use is a function of nursing home queues and other demand and supply factors. Medicare home health users per state population is negatively related to nursing home bed stock, positively to Medicaid eligibility levels and to Medicaid nursing home recipients per population, as well as to various other demand and supply measures. This explanation of home health users explains previously-reported findings for home health visits. The findings support the argument that home health use is explained by factors affecting lengths of nursing home queues. PMID- 10133715 TI - Volume and distribution of AAA sponsored services and service use by disabled older adults. AB - Recent studies have suggested that a lower availability and lesser range of formal long term care services may, in part, explain lower rates of formal service use by older rural as compared to older urban residents. Studies of residence differences in the availability of Area Agency on Aging sponsored services, however, have not adjusted measures according to the size of service populations. This study assesses the volume of personal and home care services available to a national sample of disabled older persons through Area Agencies on Aging (AAA) and shows that nonmetropolitan respondents have a greater volume of AAA sponsored services available per capita than metropolitan respondents. Moreover, in general, per capita service availability ratios are not associated with formal service use over a two-year period among 2,800 disabled noninstitutionalized older adults. The importance of gathering data on services available at the community level in order to more effectively assess the role of social context in service use is discussed. PMID- 10133716 TI - The posthospital experience of elderly Medicare home health users. AB - This study describes the home health experience of 295 Medicare elderly persons following hospitalization. While a subset of persons improved medically and functionally during the home health service period, some declined on one or both dimensions and many showed not change. The most heavily utilized, non-Medicare, services were personal care and homemaker/chore, reflecting the functional needs of some posthospital elderly. One-fifth of Medicare home health users were reinstitutionalized or died during the service period. Those discharged to home had a range of continuing service needs, both medical and functional, after home health discharge. PMID- 10133717 TI - Assuring the quality of in-home supportive services: an evolving challenge. AB - This article reports on the Ohio Quality Assurance Project, a two year demonstration. The project developed a model quality assurance system for in-home supportive services funded by Title III of the Older Americans Act including home health aide, personal care, homemaker, transportation and escort, home delivered meals, chore and home maintenance services. Using four planning and service areas in the state of Ohio comprising over 40 countries, the project developed, implemented and evaluated quality assurance standards and monitoring activities for Older Americans Act services. In addition, a second part of the project included in-depth case studies with consumers receiving in-home care. PMID- 10133718 TI - Cancer home care in Montana. AB - Availability of health care services in sparsely populated areas may be limited by fewer health care organizations and geographic separation. The purposes of this study were to identify unmet needs of individuals and families managing cancer in rural areas and examine cancer-related home care in rural areas. Issues of staffing, caseloads and service area for home health agencies (HHAs) and hospices were examined. HHAs registered with the Montana Association of Home Health Care Agencies and licensed hospices in Montana were mailed questionnaires with 92% of the HHAs and 90% of the hospices returning the questionnaires. Health providers identified a variety of unmet needs including personal care and respite. Agencies were small with approximately four full-time equivalent registered nurses for HHAs and one full-time equivalent registered nurse for hospices. Similarly, caseloads were also small with an average of 50 clients per month for HHAs and 11 clients per month for hospices. HHAs and hospices had large service areas with two of the HHAs each serving seven counties. Implications of these findings for research and practice are discussed. PMID- 10133719 TI - Public's perceived need for adult day care versus actual use. AB - The public's knowledge of a perceived need for adult day care is presented. Information was obtained from a stratified, random sample of 1,913 households from a geographical area representing approximately one million people or 374,365 households. 28% of respondents met the ADL and care need criteria and 46% of respondents knew about adult day care. From these factors it is estimated that 1.25% of all households would have an adult member who would need and use adult day care. Survey results are then compared with actual use of adult day care for the same geographical area and time period. Utilization experience is much lower than perceived need. The paper analyzes the effect of lack of knowledge and limited transportation on under-utilization. PMID- 10133720 TI - Registered nurse employment in Ontario home care programs. AB - The utilization of Ontario home care program services has expanded dramatically in recent years, resulting in increasing demand for, and greater employment of, registered nurses in such programs. This paper examines the employment of registered nurses in Ontario home care programs, through registrant data collected by the College of Nurses of Ontario between 1984 and 1989. A sociodemographic and employment profile of home care program nurses is presented (contrasted with registered nurses in other employment settings), along with an analysis of the mobility of registered nurses to and from Ontario home care programs over the five-year period. PMID- 10133721 TI - Home health service utilization by Hispanic elderly immigrants: a longitudinal study. AB - Based on a longitudinal study of Hispanic elderly immigrants, factors associated with use of home health services (HHS) were examined. Interviews were conducted in a community study of 156 Hispanic elderly immigrants in 1983 and again in 1988 with 76 survivors using the Older Americans Resources and Services (OARS) questionnaire. Predisposing and illness level factors were significantly related to the use of HHS, however, enabling factors were not significant. A discriminant analysis indicated that a set of variables (gender, age, physical health, mental health, ADL function and Self Assessed Health) accounted for 54% of the variance. The strongest discriminators in use of home health services were age, ADL function and Self Assessed Health. PMID- 10133722 TI - Correlates of caregiver strain in home health care. AB - Family caregivers (N = 183) caring for persons admitted to home health care agencies in Washington State were interviewed regarding their perceived caregiver strain. Perceived subjective strain was found to be significantly related to factors beyond home health care agency control such as age of the caregiver, sex of the care receiver, and the caregiver's health. Objective strain, however, was significantly related to factors such as the care receiver's functional status, types of tasks with which they require help, the number of caregiver hours spent performing these tasks, and the number of days the care receiver spends in bed. It is hypothesized that agencies can reduce perceived objective strain by improving patients' functional independence through nursing and therapy visits. PMID- 10133723 TI - Fly me, I'm tropical. AB - Leprosy, malaria and jigger fleas are all in a week's work for London's Hospital for Tropical Diseases. But some fear that the internal market could bring its 170 year history to a close, reports Annabelle May. PMID- 10133724 TI - The only way is up. PMID- 10133725 TI - Power to the people. PMID- 10133726 TI - Flexible friends. PMID- 10133727 TI - Hard centres. PMID- 10133728 TI - Renovated space, skywalk 'reconnect' blood bank with surgical suites--4 floors up. Presbyterian Hospital, New York City. PMID- 10133729 TI - Disaster preparedness. Ready for earth, air, fire and water (and who knows what else)? AB - Already the 1990s might be described as a decade of disasters: From the devastation of hurricanes on the East Coast to the havoc of floods in the Midwest to the destruction of earthquakes and civil unrest on the West Coast, the past few years clearly show that disasters can strike anywhere--and at any time. For health facilities caught in the middle of these crises, emergency preparedness means much more than just meeting the basic requirements of the Joint Commission on Accreditation of Healthcare Organizations or complying with state and local regulations. Rather, for most health facilities, preparing for disasters is an integral part of ensuring that they can continue to provide adequate, high quality patient care under almost any circumstances. This report, the first in a series of articles, examines how health facility managers coped once they found themselves in the midst of major disasters, what lessons they learned about emergency preparedness as a result of their experiences, and what others can learn from these difficult situations. PMID- 10133730 TI - Roof consultants and contractors: who's really responsible for what? PMID- 10133731 TI - How (and why) to save trees during construction work. PMID- 10133732 TI - EPA updates its recent actions on sterilants made by 4 firms. PMID- 10133733 TI - ES departmental managers: why their work is so challenging now. PMID- 10133734 TI - Five-step plan helps reduce the risks of patient transfer injuries. PMID- 10133735 TI - In-house construction departments: an update. PMID- 10133736 TI - The two-curve problem: high-risk challenges face those who plan a hospital's future. PMID- 10133737 TI - Trustees need to re-examine priorities and assumptions--from one trustee who's been through it. PMID- 10133738 TI - Catch-22: conflicting legal mandates leave trustees difficult choices. PMID- 10133739 TI - A wake-up call for trustees? Recent events at some well-known organizations show the importance of accountability. PMID- 10133740 TI - To focus on shaping the future, many hospital boards might require a radical overhaul. PMID- 10133741 TI - Total quality management in health care. AB - Total quality management (TQM), continuous quality improvement (CQI) and quality control are terms that are becoming very familiar to workers in the health care environment. The purpose of this article is to discuss these terms and the concepts they describe. The origins of TQM and the keen interest in its application to the health care environment today are addressed. In other environments, TQM has shown significant increases in productivity while increasing effectiveness. Its application to the health care environment is the provision of the best possible care through continuously improving service to meet or exceed the needs and expectations of the customer. The customer in the health care environment could be the patient, staff, physician and community serviced by the hospital. Characteristics of the new organizational structure are reviewed. Established techniques and processes are commonly used to identify process-improvement opportunities to assist the manager in continuously evaluating quality trends. PMID- 10133742 TI - CDA members' perceptions of the value of the National Nutrition Month campaign. AB - A random sample of 10% of active Canadian Dietetic Association (CDA) members, stratified by province, was surveyed by telephone to determine perceptions of the purpose and value of Nutrition Month, factors hindering and facilitating participation, and opinions about the future direction of the campaign. Of the 439 eligible participants, 392 (89%) were contacted and 371 (85%) completed the 23-question interview. Using a 0-10 scale, respondents rated the campaign's effectiveness in raising public awareness of our profession ( x +/- SD = 5.8 + 1.9) and in educating the public about nutrition (6.7 +/- 1.6). The majority (96%) believed the Nutrition Month campaign benefits our profession as a whole and provides opportunities for personal growth (72%). However, most (76%) also believed that there are drawbacks or limitations, notably that the campaign is time-consuming (26%) and has limited reach (20%). Members feel strongly that Nutrition Month is an appropriate activity for CDA (96%) and that the campaign should remain in some form (80%). The most frequently suggested change was to increase publicity/media (22%). These results will assist CDA in planning future campaigns. PMID- 10133743 TI - Determining optimal work surface height for Surrey Memorial Hospital food service workers. AB - In anticipation of extensive kitchen renovations at Surrey Memorial Hospital, the median elbow height was determined for a group of 49 food service workers. From this measurement, an optimal range for work surface height of 824 mm to 874 mm was determined. This range is lower than that recommended by some ergonomics experts, and lower than the work surface height of much of the existing equipment in Patient Food Services. Work surface height should be considered when equipment is selected or modified as one possible measure to reduce the physical strain of food service work. PMID- 10133744 TI - Paying for universal coverage: employer or individual mandates? PMID- 10133745 TI - Integrated delivery networks. Clinics add to Wisconsin network's continuum of care. PMID- 10133746 TI - Nurturing the nurturers. PMID- 10133747 TI - Granting authority to a new policy. A community benefit services policy becomes part of the general business strategy. AB - Bon Secours Health System's new strategic plan and community benefit services policy integrates the planning, budgeting, evaluating, and reporting of community benefit services into management processes at the same level of authority as other operational activities. The strategic plan of Bon Secours Health System, headquartered in Marriottsville, MD, documents the system's mission, operating principles, vision, and five goals, one of which is to improve the communities' health status. The community benefit services operating policy requires that the Bon Secours Health System chief executive officer (CEO) and each local system CEO and nursing home administrator form a multidisciplinary local work group to be responsible for community benefit services. Each local work group assesses the needs of its community within the framework of the annual planning process. Determining what services are needed and how to deliver them is relatively easy. The difficult task is determining which of the many needs to address. What a community lacks may be the result of poor or inadequate public policy. For example, its priority may not be healthcare. In these situations healthcare providers may be best able to serve the community by providing indirect support to social service providers or by advocating for change. The community benefit services operating policy provides a standard approach to match the community's priority needs with the institution's resources and produce a measurable improvement in health status. PMID- 10133748 TI - Inner-city clinics enable a ministry to continue. A Minnesota congregation expands its acute care ministry in order to serve the poor. AB - In 1991 the St. Paul Province of the Sisters of St. Joseph of Carondelet formed Carondelet LifeCare Ministries (CLM) to ensure that the poor and underserved in the Minneapolis-St. Paul area have access to affordable healthcare. The sisters decided that they could best serve this population by going directly to them, opening health clinics in neighborhoods throughout the metropolitan area. The first of CLM's St. Mary's Health Clinics began operations in January 1992. Since then, 10 clinics have opened to persons in poor and medically underserved neighborhoods, and CLM plans to establish a network of 15 to 20 health clinics within the next year. The clinics, which are staffed primarily by volunteers, offer primary, basic, intervention care. Patients are referred, when necessary, to specialty and subspecialty physicians. Clinics are initially open for one-half day per week, and hours are expanded as need dictates. The clinics served 2,689 patients in 1993, two-thirds of whom were women and children. Patient ethnic mix is representative of the demographics of the metropolitan area. Clinic volunteers work a minimum of four hours a month. A core paid staff--consisting of a director of nursing, a staff nurse, and a clinic coordinator--recruit volunteers and oversee daily operations. St. Mary's Health Clinics provide a variety of educational programs to prepare volunteers for their work. PMID- 10133749 TI - A source of hope for at-risk youth. A hospital's community outreach efforts provide an alternative for troubled teens. AB - In 1990 St. Bernardine Medical Center, San Bernardino, CA, initiated a mission project to reach out to youth and families in the hospital's service area. Increased unemployment, escalating crime, and a failing social structure had left many San Bernardino residents with few resources for breaking out of a cycle of crime and poverty fostered by their environment. Responding to the results of a community needs assessment, St. Bernardine mission project planners decided the project's first program should target at-risk youth. Collaborating with the San Bernardino County Probation Department, St. Bernardine began offering a variety of services to youth in the probation department's Regional Youth Educational Facility, which houses boys between the ages of 16 and 18, and the Kuiper Youth Center, which houses girls between 11 and 18 years old. Realizing that a truly effective program would have to maintain contact with youth after they left these facilities, St. Bernardine expanded its outreach efforts to include at-risk families as well. The mission project's 12-week Parenting Re-entry Program builds parenting skills by addressing a variety of topics, including values clarification, communication skills, and positive reentry into the community. In addition to the Parenting Re-entry Program, St. Bernardine, through its Family Focus Center, offers counseling services, an information referral library, and a Teen Focus Component that features evening basketball, a drama club, and other healthy alternatives for teens. PMID- 10133750 TI - The new trustee. In a transformed healthcare system, board members will have to expand their skills. AB - In a future that will involve new accountabilities, greater risks, and more adaptability, board members must learn to function well at three levels: They must retain the grand vision of what their organization can be. Their strategies must be effective enough to enable them to win more battles than they lose. They must oversee without meddling, approve without operating, and steward their resources with care and compassion for their institution's employees and patients. The financial pressures that exist at every level of our operations can make it difficult for board members to keep focused on their institution's mission. Board members must also grapple with increased government intervention, blurred institutional boundaries, more powerful insurers, and conflicts between institutions and physicians. To perform well in such an environment, board members must focus on their unique role in institutional governance. In addition, they must understand the organization's mission, be aware of the changes brought about by new financial incentives for providers, learn to work well with diverse institutions, and understand the concerns of physicians in a changing healthcare scene. Trustees must also be aware that changing goals and incentives will require healthcare providers to adopt a new, prevention-oriented approach to healthcare delivery. PMID- 10133751 TI - The challenge of reform. One trustee's perspective. PMID- 10133752 TI - Mentoring program guides new hospital trustees. A religious institute ensures trustee orientation is mission and value based. AB - In 1990 the Sisters of Charity began offering a mentoring program to ensure that sisters who serve on boards of its sponsored institutions can fulfill their commitment to effective stewardship. For participating healthcare facilities, the program offers an assurance that their trustees will have a clear direction, common information, and a mission- and value-based orientation process. The new trustees gain a basic understanding of their role and responsibilities as trustees, including the ministerial dimension. Mentors in the program benefit by refreshing their understanding of issues facing trustees. Participants in the mentoring program must meet the criteria for all trustees and demonstrate a special commitment to the congregation's mission and philosophy. The mentors are selected on the basis of their experience, availability, and commitment to the congregation's mission and philosophy. After participating in at least one board meeting, the new trustees, along with their mentors, attend an orientation seminar that focuses on sponsorship's history, purposes, principles, and policies and the system's services, roles, and functions. A second seminar is held nine months later for evaluation and follow-up. In addition, the mentors and trustees meet regularly before and/or after each board meeting to discuss pertinent issues, board dynamics, and the new trustee's participation. PMID- 10133753 TI - Ministering to persons who face death. Practical guidance for care givers of persons making end-of-life treatment decisions. AB - It is time care givers learn how to minister effectively and sensitively to those making end-of-life treatment decisions. To do so, care givers need to be aware of the various meanings death and dying hold. Culture, religion, past experiences with death and dying, and current situations can all influence the way persons perceive death and dying. Sensitivity to who the patient and family are, to how they perceive the disease or illness, and to how this perception influences their ability to achieve their life goals is a critical care-giving skill. Sensitivity, however, need not result in value neutrality or tolerance. Care givers should not be mindless executors of patient or family demands. Care givers must learn to talk honestly with patients and families about how a particular disease is most likely to progress and about the types of decisions they are likely to need to make. And then care givers need to present options, remaining sensitive to the patients' beliefs, values, and interests. Persons who care for the dying will face three types of patients, who will require different types of responses. The three types are patients who welcome death, patients who accept death, and patients who fight death. For all types of patients, care givers must keep the care patient centered and responsive to patients' priorities; facilitate informed decision making; promote communication among the patient, family, and healthcare team; support autonomous decision making; mediate conflicts; and offer spiritual counseling. PMID- 10133754 TI - Creative responses to community need. PMID- 10133755 TI - (Catholic Health Association) project identifies core leadership competencies. PMID- 10133757 TI - CHA project identifies core leadership competencies. PMID- 10133756 TI - An ethical analysis of human resource issues. PMID- 10133758 TI - The new manager. PMID- 10133759 TI - Involving users in health care. AB - The publication of Caring for People, The NHS and Community Care Act 1990, and The Patient's Charter, placed involving users at the forefront of discussions concerning the future organisation and management of health and social care services. Ray Higgins describes the evaluation of an advocacy project and the challenges for managers it presented. PMID- 10133760 TI - US health care. Missing links. PMID- 10133761 TI - A case for a code of ethics. AB - Ethical dilemmas in business and health have become a familiar topic over recent times. Doubts remain, however, as to whether a code should be produced and the recently issued IHSM consultation paper argues the case for "a statement of primary values" rather than a code of ethics. In a second article on the subject, Paul Bayliss examines the importance of having a code, looks at some of the contextual issues and suggests an approach to producing one. PMID- 10133762 TI - Management ... working day of a health services manager. North Staffordshire Hospital. AB - Physiotherapy needs to change to be relevant and appropriate to the delivery of health care in the future: departments in acute units will become smaller as therapists' expertise is required in the community. Sue Jackson, Physiotherapy Manager, North Staffordshire Hospital, describes the first steps in this culture change--and other professional and human resource issues. PMID- 10133764 TI - Difficult decisions. Respecting a patient's right to refuse treatment. PMID- 10133763 TI - The NHS internal market: economic aspects of its medium-term development. AB - With the re-election of the Conservative Party in the United Kingdom in April 1992, it is now likely that the major reforms of its National Health Service as outlined in the 1989 White Paper--Working for Patients--and embodied in the 1990 National Health Service and Community Care Act will be implemented to completion. This article examines the reforms as a re-structuring of incentives facing agencies within the internal market for health care, and forecasts how agency behaviour is likely to change as a result of such re-structuring. Medium-term implications of the reforms for hospitals, general practitioners and patients are derived. A number of problems in the continued development of the internal market are anticipated. PMID- 10133765 TI - To focus on the forest. Recognizing the value of early defibrillation despite isolated failures. PMID- 10133766 TI - Pulse oximetry in the field. A breath of fresh air? PMID- 10133767 TI - Hand-held pulse oximeters. Another toy to make your life easier? PMID- 10133768 TI - Pulse oximeters. Saving more than lives. PMID- 10133769 TI - Slaying the hepatitis dragon. A study of fire department vaccinations for hepatitis B and C. PMID- 10133770 TI - Setting a standard. Utstein style helps measure performance of a semiautomatic external defibrillation program. PMID- 10133771 TI - The origins of Utstein. PMID- 10133772 TI - Don't be a dummy. Staying safe with mannequin training. PMID- 10133773 TI - As a matter of facts. PMID- 10133774 TI - A new approach to alcoholism detection in primary care. AB - This article describes a model that brings together the chemical dependency, mental health, and primary care services of a staff model HMO for the purpose of establishing a primary care clinic-based program to assist physicians in early detection of chemical dependency and frequent psychiatric disorders. The model creates a partnership between a master's-level professional social worker (MSW) and a designated family physician from the clinic. Their focus is on provider education, consultation, and on assisting patients with referrals to the appropriate services. Parameters of success include changes on referral patterns, use of the MSW's services, and clinic satisfaction. In addition, there are indications that early intervention has had a positive impact on subsequent use of other health care system's resources. PMID- 10133775 TI - The costs of schizophrenia in Puerto Rico. AB - Mental illnesses generate social costs by reducing the productive capacity of manpower and increasing government and private expenditure in mental health services. The social costs associated with a mental illness depend on several factors: the level of impairment caused; the type of specialized service required, such as medical treatment; the chronicity of the disorder; and the age of onset of the disorder. Finally, the total cost to society depends on the size of the population affected by the disorder. Results confirm those of other research, which has found schizophrenia to be a costly illness. Annual loss of income represents 3.7% of the annual gross national product of the island. The expenditures for mental health services are 26.8% of the total budget of the Mental Health Secretariat. The large human capital cost caused by the disorder justifies more funds for research and treatment for people who are schizophrenic. PMID- 10133776 TI - Outcome of treatment for alcohol abuse and involvement in Alcoholics Anonymous among previously untreated problem drinkers. AB - A sample of 515 initially untreated problem drinkers was followed for one year after contacting alcohol information and referral or detoxification services. At a one-year follow-up, participants had self-selected into one of four groups: no treatment (24%), Alcoholics Anonymous (AA) only (18%), outpatient treatment (25%), and residential or inpatient treatment (32%); some outpatients also attended AA, and some inpatients also attended AA and/or outpatient programs. These four groups were compared on changes in drinking-related variables, other aspects of functioning, and stressors and resources over the follow-up year. Also examined were associations between amount of treatment and outcomes at one year. All four groups improved on drinking and functioning outcomes but changed less on stressors and resources. Although individuals who received no help improved, persons in the two treatment and the AA-only groups improved more, particularly on drinking-related outcomes. Inpatients were more likely than outpatients or AA only participants to be abstinent; otherwise, type of intervention had few differential effects. More AA attendance was associated with abstinence among AA only, outpatient, and inpatient group members. Among outpatients and inpatients, more formal treatment was associated with abstinence and improvement on other drinking-related outcomes. PMID- 10133777 TI - Collaborative needs assessment for child mental health program development. AB - A needs assessment for child mental health program development involving a collaboration between a state university clinical psychology training program and a coalition of publicly funded child-serving agencies is described. The benefits of the joint research effort for all partners are highlighted as well as the lessons learned about the processes of such a partnership. Application of the results included curricular modifications to the university's training program, the addition of new programming and the improvement of existing services to address child mental health needs, and interventions to increase community awareness of available services. PMID- 10133778 TI - A collaborative system of care for youth with severe emotional disturbances: an evaluation of client characteristics and services. AB - The closing of a state children's psychiatric hospital resulted in the mandated development of a regional children's mental health system for youths with severe emotional disturbances. The purpose of this article is to describe the demographic profiles and service usage patterns of youths enrolled in this system (Project youths) compared with random samples of non-Project youths involved with the mental health system. Data were obtained from two existing statewide databases (508K and MHIS). The 508K database revealed that Project youths (n = 393) were significantly older, had more severe functional impairments, more out of home placements, lower functional abilities, and were ill longer than non Project youths (n = 747). Using the MHIS database, service usage patterns were assessed over time, across groups, and across the six local mental health authorities (LMHAs). Project youths (n = 266) received more case management, emergency, day treatment, and inpatient services than did non-Project youths (n = 262) and there were significant increases in case management and residential services over time. Differences among the LMHAs were found in all service types. Findings from this study indicated that Project youths were the most severely disturbed in the mental health system and received the most services. This study demonstrates the usefulness of analyzing existing statewide data in evaluating mental health systems. PMID- 10133779 TI - Record linkage in a regional mental health planning study: accuracy of unique identifiers, reliability of sociodemographics, and estimating identification error. AB - Assembling information about individuals over time allows health managers and researchers to describe the progression of diseases, the care history of individuals and the sequences of care episodes that potentially result in improving individuals' health status. However, current mental health statistics generally focus on sets of events rather than groups of individuals making it impossible to distinguish between two different persons being admitted and the same person being admitted twice. Accurate figures on treatment prevalence cannot be generated and multiservice users across time or across agencies will inflate the statistics used to plan needed services. The capacity to link consistently defined bits of information together is critical to developing a reliable information system. This article examines the adequacy of using unique identifier codes to accomplish linkage by focusing on one example of record linkage that incorporates mental health information from both community and institutional sectors in one region of Ontario, Canada. Findings indicate that unique "cradle to grave" identifiers do not guarantee accuracy if manual transcription is involved. PMID- 10133780 TI - County mental health directors' evaluation of a statewide intensive case management program: the New York State experience. AB - Case management is increasingly recommended as part of an overall strategy for serving individuals with severe mental illness. The New York State Office of Mental Health developed such a program in 1988, with county mental health directors the key players in its development and operationalization. This article reports the results of a statewide survey administered by the authors to these directors 3 1/2 years after the program's implementation to determine its degree of success. Overall, the program was viewed as effective for individual clients, particularly those most in need of services. However, with respect to overall systems change, there was more variability in results. In general, a combination of strategies to reduce fragmentation within the mental health system and increase collaboration between service providers should be considered by state mental health authorities. PMID- 10133781 TI - Group process and success in meeting the Joint Commission on Accreditation of Healthcare Organizations review. AB - Attention to and use of group process with hospital staff can contribute significantly to success in preparing for and passing a review by the Joint Commission on Accreditation of Healthcare Organizations. Group format, key elements, stages of group development, factors to facilitate group work, and the role of the leader are addressed. PMID- 10133782 TI - HBO's acquisition of Ibax continues consolidation trend. PMID- 10133783 TI - Columbia seeking new joint venture. PMID- 10133784 TI - Drug firms grow with acquisitions, ready for reform. PMID- 10133785 TI - Groundbreaking deal links Johns Hopkins with U.S. Healthcare. PMID- 10133786 TI - Healthcare tab? Numbers subject to change. PMID- 10133787 TI - Report sees peril for New York HHC. PMID- 10133788 TI - HealthTrust, Holy Cross work with FTC to complete Utah deal. PMID- 10133789 TI - Not-for-profit hospitals see 1.9% increase in cash gifts. PMID- 10133790 TI - Agencies reviewing Continental debt. PMID- 10133791 TI - Charter planning more acquisitions. PMID- 10133792 TI - Quorum reports record earnings. PMID- 10133793 TI - Florida, feds file lawsuit to block hospital merger. PMID- 10133794 TI - PPRC urges small fee hike for surgeons. PMID- 10133795 TI - CEO would rather retire than fire. PMID- 10133796 TI - Mississippi lets smaller hospitals apply for CONs. PMID- 10133797 TI - Blues broaden scope of tax-exempt battle. PMID- 10133798 TI - Cooper-Breaux bill gets mixed review from CBO. PMID- 10133799 TI - Keeping a focus on hospital staff critical in era of change. PMID- 10133800 TI - A second opinion on PROS. PMID- 10133801 TI - The future starts now for regional data link-ups. PMID- 10133802 TI - Catholic systems seek changes at JCAHO. PMID- 10133803 TI - HMOs seek more safeguards as medical groups integrate. PMID- 10133804 TI - After snag, HealthTrust seals Epic buy. PMID- 10133805 TI - Feds probing Michigan merger. PMID- 10133806 TI - Kaiser benchmarking study to identify best practices. PMID- 10133807 TI - Reengineering in health care means starting from scratch. Interview by Pat Patterson. PMID- 10133808 TI - Managed care bringing changes to Seattle hospitals. PMID- 10133809 TI - Small facilities among 'top 100' in the nation. PMID- 10133810 TI - Staff starts from scratch in designing new center. Greater Baltimore Medical Center, MD. PMID- 10133811 TI - A high-priced hookup. AB - The convenience of home infusion is a godsend. But abuses abound. PMID- 10133812 TI - 1992 summary: National Hospital Discharge Survey. PMID- 10133813 TI - The fast track: when to get off. PMID- 10133814 TI - The healthcare industry as administration sees it. PMID- 10133815 TI - Recent mergers pose new challenges for food service managers. PMID- 10133816 TI - How Minister sees health service future. PMID- 10133817 TI - Random survey shows public's attitude to health services. PMID- 10133818 TI - How other countries administer residential care for the elderly. PMID- 10133819 TI - Health service could benefit from greater use of standards. PMID- 10133820 TI - Lottery grant aids research on reconstructive skull surgery. PMID- 10133822 TI - Health reform insight. Should individuals shoulder the health care burden? PMID- 10133821 TI - Hospital midwifery--where to now? Management challenges and options for hospital midwifery after the amendment and health reforms. PMID- 10133823 TI - Perspectives. The single payer solution: now, later, or never? PMID- 10133824 TI - Perspectives. Physicians in training eye new world of health reform. PMID- 10133825 TI - Perspectives. AIDS vaccines: a flickering light at the tunnel's end. PMID- 10133826 TI - The evolution of the Joint Commission's nursing standards. AB - The Joint Commission requirements have had a major impact on both the delivery and evaluation of nursing care in hospitals. This article discusses changes in the Joint Commission nursing care standards from 1953 through 1991 and the relationship between the Joint Commission and organized nursing. PMID- 10133827 TI - Medical staff functional reviews: from committees to functions. AB - The Joint Commission on Accreditation of Healthcare Organizations requires medical staff members to provide effective mechanisms to monitor and evaluate the quality of patient care and to improve organizational performance. Many healthcare facilities choose to meet this requirement through structured committees such as those on surgical case review, blood usage, medical record review, and pharmacy and therapeutics. This article describes a streamlined alternative to medical staff committees and explains how intensive and screening evaluations can be improved by using the most significant data. PMID- 10133828 TI - Reporting quality improvement data by key functions: one step closer to continuous quality improvement. AB - Medical care systems must demonstrate that they provide cost-effective, quality care if they are to remain viable in the wake of healthcare reform. A basic premise of continuous quality improvement is that an organization can measure and improve the performance of key functions (a group of goal-directed processes). Accordingly, the Joint Commission on Accreditation of Healthcare Organizations has been restructuring its accreditation manual, moving from department-specific standards to functional standards. In early 1992, our hospital began reporting quality improvement data by key functions rather than by service. As a result of this change, departments communicated and worked together better and more interdisciplinary efforts occurred, resulting in some dramatic improvements in the quality of care. PMID- 10133829 TI - Implementing TQM/CQI at rehabilitation hospitals: a survey. AB - The quality movement in healthcare is here to stay. Total quality management (TQM) and continuous quality improvement (CQI) approaches are no longer considered fads or transitory trends; they are being woven into the very fabric of hospital operations. What has been unclear, however, is the extent to which the underlying TQM/CQI philosophy, tools, and techniques are being implemented and whether hospitals are noticeably changing as a result of TQM/CQI programs. The results of a study of 14 rehabilitation hospitals indicate that the rehabilitation setting is a natural one for TQM/CQI but that these settings are just beginning to implement the needed structures and processes and to use the relevant tools and techniques. PMID- 10133830 TI - Evaluating voluntary certification programs. PMID- 10133831 TI - Applying quality improvement tools to quality planning: pediatric femur fracture clinical path development. AB - Quality improvement tools that integrate clinical and financial data provide a statistical basis for quality planning and cost containment. Clinical path development results in an operational guideline for optimizing quality and efficiency. Implementation provides the means for delivering value. This article describes a step-by-step process in which quality improvement tools were used to develop a pediatric femur fracture clinical path at the author's hospital. PMID- 10133832 TI - Integration of outcomes improvement system in ambulatory care at Kaiser Permanente. Children's asthma outcomes model demonstrates effectiveness. PMID- 10133833 TI - Anticipating hospital closures via simulation. Results from Northern California study lend tools and lessons for other urban/suburban city-regions. PMID- 10133834 TI - AHA 'action packs' help hospital workers take charge of change. PMID- 10133835 TI - Suppliers' top reform strategy: cooperate in supply chain realignment. PMID- 10133836 TI - JCAHO's new angle on accreditation has positive slant. PMID- 10133837 TI - Device design with reprocessing in mind. PMID- 10133838 TI - Cutting the cost of carelessness. PMID- 10133839 TI - Get the best from workers: how to manage participatory-style meetings. PMID- 10133840 TI - Cold sterilant update: EPA acts on efficacy test results. PMID- 10133841 TI - Asset management: pumping the maximum return out of IV equipment. PMID- 10133842 TI - Stats. 1994 prices? Don't expect much change. PMID- 10133843 TI - Oh noooo! The public grows fearful of Clinton's plan and shows little faith in alternatives. Is reform doomed this year? PMID- 10133844 TI - Hospitals. AB - Anticipating health care reform and seeking a marketing edge over competitors, hospitals are forming alliances with other providers. PMID- 10133845 TI - Pharmaceutical industry. AB - Manufacturers are under continuing pressure to reduce prices. To improve profitability, some have entered joint ventures with other manufacturers or with distributors. PMID- 10133846 TI - Managed care organizations. AB - To prepare for health reform, HMOs are joining together, acquiring hospitals and provider groups, and developing data to demonstrate quality and cost effectiveness. PMID- 10133848 TI - The state of health care in America. PMID- 10133847 TI - Federal government. AB - Medicare and Medicaid are trying to cut program costs. Other federal agencies are working on disease prevention and improving the nation's medical care. PMID- 10133849 TI - The state of health care in America. PMID- 10133850 TI - Physicians. AB - Physicians are adapting to managed care. Tomorrow's doctors will be encouraged to enter primary care and will be exposed to more practice settings. PMID- 10133851 TI - State governments. AB - States have set up purchasing groups, mandated community rating, and set limits on health care costs among other programs to improve health care. PMID- 10133852 TI - Employers. AB - By shifting employees into managed care, demanding accountability from providers, and negotiating in groups, employers have helped lower their health care costs. PMID- 10133853 TI - Health care technology. PMID- 10133854 TI - Progress and promise. AB - Efforts to control costs and improve quality are working. Now Congress will determine how best to control future health care costs and extend care to the nation's uninsured. PMID- 10133855 TI - Integrating TQM and patient focused care. United they stand--divided they fall. PMID- 10133856 TI - Helping hospitals spread the word about their patient focused care programs. Communicating effectively with physicians. PMID- 10133857 TI - Effective education for patient focused staff. To be successful, you must fill the wide "gaps" between today's capabilities and tomorrow's needs. AB - In summary, your staff's Patient Focused education must be realigned to their unique clinical, non-clinical and multidisciplinary needs if a restructuring program is be successful. Without this realignment, traditional education services will be inadequate to meet these needs and your program may eventually fail. Perhaps Naisbitt and Auburdene said it best: "By identifying the forces pushing the future, rather than those that have contained the past, you possess the power to engage with your reality." Filling the wide "gaps" between today's educational capabilities and tomorrow's educational needs is essential to making your Patient Focused vision a reality at your hospital. PMID- 10133858 TI - The art & science of patient reaggregation. The gains you do and do not realize tomorrow depend upon the strategy you pursue today. PMID- 10133859 TI - Legal issues in home care--1994. AB - Expanding home care services opens the industry to legal considerations from every angle. This article serves as an overview to this issue of CARING, touching on salient points of the legal issues important to home care providers. PMID- 10133860 TI - Is it safe to go to work anymore? AB - Violence occurs with increasing frequency in all types of workplaces, and employers may end up paying the price for it. Employers do have some responsibility to protect both workers and clients but employers can reduce risks by preparing preventive strategies. PMID- 10133861 TI - Managing risk to minimize liability. AB - Agencies undoubtedly face increased chances of investigation, yet risk management may be as simple as keeping good records and following standard operating procedures. One pilot program exemplifies how this can reduce an agency's liability exposure. PMID- 10133862 TI - Prohibited practices & safe harbors--a legal quagmire. AB - Judging by the number and scope of laws they enact, legislators seem convinced that all health care entities need strict supervision via limits and prohibitions. This means that every contract a home care agency enters into needs thorough review and evaluation for numerous things. PMID- 10133863 TI - Fraud & abuse in managed care--what does it mean for home care providers? AB - Managed care and home care are both increasingly popular as market and regulatory forces push payors and providers to reduce costs. The reform initiatives that have given rise to the increase in both these services, however, have also increased scrutiny of fraud and abuse. What do home care providers need to be aware of to protect themselves? PMID- 10133864 TI - When the caregiver has HIV: early intervention through home care. AB - Many informal caregivers of AIDS patients, by virtue of being or having been their sexual partners, are infected with HIV but are not yet sick. Home care providers have an excellent opportunity to educate these caregivers during home visits. PMID- 10133865 TI - Antitrust & health care reform. AB - In a reformed health care delivery system, home care providers will find themselves working in and with purchasing cooperatives, joint ventures, and networks. In this environment, antitrust issues surround contracts and network formation and may place roadblocks in the way of providers' attempts at competitive positioning. What are those roadblocks? PMID- 10133866 TI - Home care networks, alliances, & acquisitions. AB - Experts indicate that managed competition will be a factor in reformed health care delivery. In such an environment agencies need to strengthen their financial bases, possibly by connecting with other providers, and numerous legal questions can arise. PMID- 10133867 TI - Sexual harassment issues in home care: what employers should do about it. AB - Recent court decisions and public scandals have brought sexual harassment to the forefront of workplace issues. Home care employers may face legal liability if they do not establish firm guidelines prohibiting sexual harassment and train employees to recognize and avoid this problem. PMID- 10133868 TI - Legal ramifications of per visit pay. AB - Agencies that pay their employees on a per visit basis may not be aware of all the legal intricacies involved: exempt vs. non-exempt status, fee basis, minimum wage, overtime, and more. Agencies should consult legal advice before seeking the advantages of per visit pay arrangements. PMID- 10133869 TI - Physician relationships under Stark II: will anything change? AB - This article examines the differences between the pre-existing prohibition on home care certifications (the "certification regulations") and the Stark II requirements to determine whether Stark II will have any effect on home care agencies. PMID- 10133870 TI - Surviving your first OSHA inspection. AB - With the inception of the bloodborne pathogens standard, home care agencies are more likely to undergo an inspection by the Occupational Safety and Health Administration. What should employers know, and how can they always be prepared for the startling announcement of an OSHA inspection? PMID- 10133871 TI - Needed: a conceptual model for a comfortable death. AB - Research in the literature clearly shows that suicide is a significant problem for the elderly who are ill. Through a definite plan of therapy, hospice team members can help these patients develop a technique of conscious dying. PMID- 10133872 TI - Medical and dental staffing prospects in the NHS in England and Wales 1992. AB - This annual article is intended to help young doctors and dentists make informed decisions about their career paths, in the light of the current prospects of obtaining a career post in any specialty. Regional details of the national figures presented here may be obtained through individual Regional postgraduate deans, Health Authorities and clinical tutors. This article summarises the most recent figures available, and comparison with previous articles in this series may help to identify employment trends. PMID- 10133873 TI - Peripheral and central parenteral nutrition: a cost-comparison analysis. AB - The concept that total parenteral nutrition (TPN) has to be administered centrally is increasingly recognised to be mistaken: for most patients, peripheral parenteral nutrition provides satisfactory nutritional support. Use of the peripheral route avoids the risks of central venous cannulation--but is it more cost-effective? In a randomized clinical study we examined the costs of TPN in 51 patients who underwent a mean of 8 days of intravenous feeding and conclude that the use of peripheral parenteral nutrition may lead to cost savings. PMID- 10133874 TI - Coronary thrombolysis: still too little too late? AB - We reviewed the case records of 109 consecutive patients with a definite diagnosis of myocardial infarction, admitted through the accident and emergency department of an inner-city general hospital to identify delays in referral to hospital, admission to the coronary care unit, and start of thrombolysis. Of the 109 patients, only 28 (26%) received streptokinase (the only thrombolytic drug used at this hospital), and at least 47 (58%) of the remaining 81 who should have benefited from it did not. However, the proportion of patients given streptokinase improved significantly after publication of the Second International Study of Infarct Survival (ISIS 2) study results. The average delay from onset of symptoms to presentation at the accident department was over 3 hours, with a further 1 hour in-hospital delay before administration of streptokinase. This study revealed considerable underuse of thrombolytic therapy in cases where treatment was clearly indicated, but this picture improved substantially during the period of audit. PMID- 10133875 TI - Assisting elderly people with medication--the role of home carers. AB - In 1991, home carers in Derbyshire were asked to participate in a questionnaire survey in order to estimate the demand for home carers to assist elderly clients with specific medication tasks. The results indicate that 17% of regular clients require assistance with medication, and that 86% of home carers are expected to assist with at least one medication task. Home care aides received considerably more requests than home helps to assist with such tasks. The findings are discussed in relation to the way home carers perceive 'personal care'. The type of personal care tasks that home carers are expected to perform should be more clearly defined, and the findings highlight the importance of providing pharmaceutical advice and training to home carers. PMID- 10133876 TI - Changes in preventive medicine among general practitioners, 1984-1990. AB - Baseline data on screening and health education were collected in 1984 from a national survey of general practitioners (GPs), and two groups of GPs who responded to this first survey were followed-up by a second postal questionnaire sent out in July 1990. One group comprised doctors who previously had a low involvement with screening and health education in 1984 (low-involvement group [LIG]), and the other doctors with high involvement (high-involvement group [HIG]). The results from the 1990 survey indicated that the HIG were still more committed to screening and health education than the LIG, but the differences between the two groups had greatly diminished. In 1990 similar proportions of both groups were expecting to receive payments for screening, child health surveillance and health promotion clinics under the new GP contract. PMID- 10133877 TI - The Gospel Oak project 1987-1990: provision and use of community services. AB - This longitudinal survey of elderly people examines morbidity and service usage. 705 elderly people who lived in their own homes were interviewed as part of the Gospel Oak project in 1987/88, and in 1990, 524 (74.3%) were re-interviewed--90 (12.8%) had died, 51 (7.2%) had moved and 40 (5.7%) refused a follow-up interview. The results indicate that 60% of residents (1987/88 and 1990) had been in contact with community services within the month before the survey. Respondents with depression were mostly in contact with the health service, those with dementia were in contact with social services. Long-term activity-limited people had high contact with both services, although this finding was less likely among newly activity-limited people. Multiple service-users from the first survey were likely to be either dead, or high service-users in 1990. Low service-users tended to continue to be low service-users. New users were generally living alone, aged around 70 years and had been relatively healthy previously. Respondents who stopped using services were generally younger, mostly women, and possibly depressed. People who had never been service-users, were generally younger and healthier. Information on community services performance is inadequate to ensure targeted, efficient services, and this survey gives detailed information to help planning and resource allocation. PMID- 10133878 TI - Community leg ulcer clinics: cost-effectiveness. AB - This study investigates the cost-effectiveness and efficacy of a new service provided by community leg ulcer clinics, and compares it with treatment in existing hospital-based venous ulcer care clinics. Data were provided prospectively from district nurses and retrospectively from patients. Success in treatment was assessed as a percentage of ulcers completely healed after 12 weeks of treatment, analysed by the up-table method. Treatment success of 22% at 12 weeks using existing methods compared with 80% in community clinics. Costs were estimated to be 433,600 pounds and 169,000 pounds respectively. These findings indicate that community leg ulcer clinics were more effective and less expensive than the previous system of care. PMID- 10133879 TI - Neonatal hypoglycaemia: changing attitudes in the Northern Region. AB - There has been a recent resurgence of interest in the significance of moderate hypoglycaemia in neonates; although old assumptions have been questioned, there are insufficient data for new and authoritative guidelines to be published. This longitudinal study was designed to test the hypothesis that there have been changes in attitudes among those caring for newborn babies in the 18 maternity units in one health Region. The data were collected by questionnaire in 1986 and 1991, and responses were complete. The results showed a significant shift to higher values in the definition of hypoglycaemia over the five years, in association with a tendency to feed babies earlier--although some units had not altered their policies. PMID- 10133881 TI - IT update/networking. High wires and safety nets. PMID- 10133880 TI - IT update/multimedia. Colour supplements. PMID- 10133882 TI - Non-executives. You are in my power. PMID- 10133883 TI - Dr Know. PMID- 10133884 TI - Women in management. Firm, but unfair? PMID- 10133885 TI - Hospital discharge. Going by the book. PMID- 10133886 TI - Market testing. Test match. PMID- 10133887 TI - Fundholding. Mythical monster. PMID- 10133888 TI - Maternally grateful. PMID- 10133889 TI - Managing risk--a priority in the Health Service. PMID- 10133890 TI - Joint commissioning. Born in the USA. PMID- 10133891 TI - Positive feedback. PMID- 10133892 TI - Ethnic monitoring. King's evidence. PMID- 10133893 TI - Women in management. Why women in the NHS don't get a share of the action. AB - The survey was designed to give a representative picture of staff attitudes across the South East Thames region. A key intention of the survey was to collect information from all staff groups and locations. Questionnaires were sent out during September and October 1992 to a random sample of women and men. By the close of the survey, 1,886 usable questionnaires had been returned from members of the survey sample, representing a response rate of 43 per cent. In addition, 512 questionnaires had been received from volunteers. The analysis presented in the report is based on 2,398 survey respondents, 18 per cent of whom were men. PMID- 10133894 TI - NHS and the law. Transfer deals. PMID- 10133895 TI - NHS and the law. Use your initiative. PMID- 10133897 TI - NHS and the law. The price of failure. PMID- 10133896 TI - NHS and the law. Buyers' market. PMID- 10133898 TI - Clinical management. Money under the mattress. PMID- 10133899 TI - Long term care. How far can you go? PMID- 10133900 TI - French lessons. PMID- 10133901 TI - Data briefing ... Japan. PMID- 10133902 TI - Concurrent ceftazidime DUE with clinical pharmacy intervention. AB - Ceftazidime use at our institution, a 580-bed county teaching hospital, has steadily increased since its addition to the formulary in 1986. In response to this increased use and because the institutional antibiogram showed increased resistance by Pseudomonas aeruginosa (from 10 to 28% resistant), the P & T Committee requested that a drug use evaluation (DUE) of ceftazidime be conducted. Analysis of this retrospective pilot study showed that 87% of ceftazidime use was inappropriate. To further evaluate ceftazidime use, to identify problems not assessed during retrospective review, and to correct problems while patients were receiving the drug, a concurrent ceftazidime use evaluation was conducted. The methods and results of the concurrent review are presented below. PMID- 10133903 TI - Industry must communicate value and contribution of drugs to Congress and public. PMID- 10133904 TI - The 1994 Emerging Leaders are decisive young healthcare executives who have already made a difference. Rising stars. PMID- 10133905 TI - Helplessness and goodness. PMID- 10133906 TI - What creates health? Part 1. AB - What creates health? Individuals and Communities Respond is a three-part study conducted in 1994 by The Healthcare Forum in cooperation with the National Civic League and DYG, Inc. Funded in part by the W.K. Kellogg Foundation and The Healthcare Forum's Healthier Communities Partnership, the study puts health and healthcare into a larger context by probing public values around quality-of-life and community health concerns. It delineates public expectations and concerns about their communities and about leadership at a community and a national level. The findings from Part 1, the National Study, are discussed below. Part 2, a series of Community Forums, and Part 3, a Healthier Communities Index, will be covered in upcoming issues of the Journal. This brief preview of the Executive Summary highlights some major findings of the research and their implications for national, community and healthcare leaders. The principal findings. PMID- 10133907 TI - Looking upstream. PMID- 10133908 TI - From garden peas to the global brain. PMID- 10133909 TI - Choices for a sustainable future. PMID- 10133910 TI - From city to city. PMID- 10133911 TI - A worldwide movement for health. Interview by Joe Flower. PMID- 10133912 TI - Partnerships for health. PMID- 10133913 TI - On healthier communities. Pioneering communities. The Healthcare Forum. PMID- 10133914 TI - A visit with The Healthcare Forum's incoming chair. Interview by Steve Heilig. PMID- 10133915 TI - Stanching the bloodshed. PMID- 10133916 TI - Mastering the transition to capitation. PMID- 10133917 TI - Go with the flow. PMID- 10133918 TI - Can we restrict the health care menu? AB - The case of Britain's National Health Service is used to illuminate the cross national debate about whether the availability of health care should be restricted and, if so, how this should be done. Traditionally, the NHS relied on implicit rationing by clinicians within budgetary constraints set by government. However, the logic of the 1989 reforms appeared to require explicit decisions about the packages of health care to be provided to local populations. In practice, purchasers have refused to define such packages. Explicit rationing remains very much the exception. Exploring the reasons for this suggests that defining a restricted menu of health care, by adopting a cost-utility approach and excluding specific procedures or forms of treatment on the Oregon model, is only one of many policy options. There is a large repertory of policy tools for balancing demands and resources, ranging from diluting the intensity of treatment to its earlier termination. Given that health care is characterised by uncertainty, lack of information about outcomes and patient heterogeneity, it may therefore be more 'rational' to diffuse decision-making among clinicians and managers than to try to move towards a centrally determined menu of entitlements. PMID- 10133919 TI - The influence of system factors upon the macro-economic efficiency of health care: implications for the health policies of developing and developed countries. AB - This paper aims to clarify the global association of system factors with the attainment of health policy goals, through economic analyses of cross-country data. In the case of OECD (the Organization for Economic Co-operation and Development) data for 1990, the variation in total expenditure on health among 24 countries can be explained by various factors including Gross Domestic Product (GDP). Among these, the variables representing the level of public sector involvement through social protection or public-private mix within a health care system, such as the Public-to-Total Expenditure Ratio, Coverage Rate and Public Cost Sharing, are significantly negative when factors such as GDP are controlled. This suggests that countries attaining higher equity or accessibility are in a better position to gain higher cost-containment or macro-economic efficiency. The results of this study may be helpful for developing countries searching for a long-term health care system as well as for developed countries facing health care system reforms. PMID- 10133920 TI - Dutch home care: towards a new organization? AB - As in all western countries the demand for home care in the Netherlands is rapidly growing. Reduced institutionalization in hospitals and nursing homes, combined with an increasing number of elderly people, have led to new groups of patients, with complex and diverse problems, to be cared for in their home settings. To meet this new demand, it is argued, comprehensive home care arrangements are needed. Development of such arrangements was the target of 12 demonstration projects that were part of the 'National Home Health Care Programme'. This article presents the results of an evaluation study of the Programme, with special attention to factors favouring the development of comprehensive home care arrangements and its effectiveness. PMID- 10133921 TI - Privatization of the medical market in socialist China: a historical approach. AB - A Socialist-Market Economy was defined as a target model for China's economic reform by China's 14th National Congress in 1992. Such an innovative change in China's more than a decade long economic reform has brought both new challenges and opportunities for its health care system reform as it moves toward a market determination mechanism and involvement of the private sector. A better understanding of the nature and history of the Chinese private medical market and its dynamic socio-economic environment would certainly shed a great deal of light onto the accomplishments of the health care reform. Research in this area, however, is almost non-existent at either national or international levels. The present study attempts to fill this gap by providing a comprehensive assessment of both historical and prospective development of the Chinese private medical market. Three stages are defined to present the tortuous development of this market over the last four decades, coupled with our critiques of the underlying merits and problems. Predictions are also made on the future perspective of the private market, and its possible impact and role in shaping the reform of the entire Chinese health care system. The government's role as well as its future strategy to cope with the issues surrounding Chinese health care reform are also summarized. The study concludes with five health policy recommendations aimed at facilitating China's health care reform via more market-oriented determination of resources allocation, production, and distribution, coupled with promotion of the private sector's involvement while minimizing its potential adverse side effects. PMID- 10133922 TI - Trends in hospital resource utilization by HIV-infected persons, January 1987 June 1990. AB - Trends in the utilization of various hospital resources by HIV-infected persons between January 1987 and June 1990 have been studied to support health care planning. Data on 126 asymptomatic and symptomatic HIV-infected persons have been recorded at a patient level and analyzed at half-yearly intervals. At a hospital level, increasing utilization trends were observed. At the patient level, a decreasing utilization intensity was measured for admissions, inpatient days, inpatient diagnostic examinations, and outpatient consultations. Increasing utilization intensity was measured for care during admissions. A constant utilization intensity was observed for outpatient diagnostic examinations and inpatient medication days. Use of interventions tended to increase at the end of the study period. Discriminating between trends in the utilization of different hospital resources can improve the management of hospital health care demands of HIV-infected people. PMID- 10133923 TI - Strategic management of a continuum of care. AB - Why would an organization want to undertake the changes required to be a continuum of care? Because providers of residential and long-term nursing care that continue to function in isolation may survive, but they will not thrive in the 21st century. PMID- 10133924 TI - The nursing home industry's "wake-up call". PMID- 10133925 TI - Meeting community needs. PMID- 10133926 TI - Policy development and quality of care. PMID- 10133927 TI - The onerous impact and cost of regulation. PMID- 10133928 TI - How do we get there from here? PMID- 10133929 TI - Options for LTC financing reform: public and private insurance strategies. AB - Private insurance is likely to grow but will probably play only a modest role in financing nursing home and home care. Given the limits of the private sector, greater attention should be given to reforming our public programs. PMID- 10133930 TI - Debating the social insurance model. PMID- 10133931 TI - Future trends, health care reform and the outlook for long-term care. PMID- 10133932 TI - Options for long-term care financing reform: a view from the inside out. AB - The goals for any proposal for long-term care financing reform must include the development of a deliberative, organized and coordinated structure of consistent benefits and service capacity that is accessible to individuals with administrative simplicity and operating certainty for providers. The best way to achieve these program goals is to foster a radical new system that relies on the maximum use of private long-term care insurance. Elimination of the Medicaid program as the primary funding vehicle for long-term care and federalization of all nursing home and home care services will serve as an interim measure until private options are developed and in place. A continued federal role will be needed for maximum risk pooling, standard setting and acting as the stop-loss reinsurer and ultimate safety net for those outside the reach of the private market. Certain interest groups, including the state governors and the advocacy groups on women's issues have unique roles to play in shaping the coming debate. The shifts in thinking and in behavior change needed to commit to such a vision will not be easily achieved. Long-term care is as much about roles, relationships and responsibilities as it is about health, illness, rules or regulations. These inherent and intimate characteristics of long-term care mandate a clear vision of what the system should look like and very deliberate steps to devise and to enact the progressive reforms necessary to meet the coming demand. Reasonable people will differ about the appropriate mix of public and private responsibilities in any system to provide long-term care.(ABSTRACT TRUNCATED AT 250 WORDS) PMID- 10133933 TI - Ethical and legal issues in long-term care: food for futuristic thought. AB - The nursing home is a community, albeit an artificial one, where strangers come together. Ethicists are now giving thought to the nature of that community and the obligations of people within it to each other. PMID- 10133934 TI - Law and quality in long-term care. PMID- 10133935 TI - Redefining long-term care, personal choices and "futile care". PMID- 10133936 TI - Long-term care 2010: speculations and implications. AB - The days of "business as usual" are over. In tomorrow's world of long-term care, success will depend on understanding where the industry is headed, having a vision of the future and developing the wherewithall to change. PMID- 10133937 TI - Ambulatory surgery centers best practices for the 90s. AB - Outpatient surgery will be the driving force in the continued growth of ambulatory care in the 1990s. Providing efficient, high-quality ambulatory surgical services should therefore be a priority among healthcare providers. Arthur Andersen conducted a survey to discover best practices in ambulatory surgical service. General success characteristics of best performers were business-focused relationships with physicians, the use of clinical protocols, patient convenience, cost management, strong leadership, teamwork, streamlined processes and efficient design. Other important factors included scheduling to maximize OR room use; achieving surgical efficiencies through reduced case pack assembly errors and equipment availability; a focus on cost capture rather than charge capture; sound materiel management practices, such as standardization and vendor teaming; and the appropriate use of automated systems. It is important to evaluate whether the best practices are applicable to your environment and what specific changes to your current processes would be necessary to adopt them. PMID- 10133938 TI - Skill-based job descriptions for sterile processing technicians--a total quality approach. AB - Rochester General Hospital in Rochester, NY, included as part of its total quality management effort the task of revising job descriptions for its sterile processing technicians as a way to decrease turnover and increase job satisfaction, teamwork and quality output. The department's quality team developed "skill banding," a tool that combines skill-based pay with large salary ranges that span job classifications normally covered by several separate salary ranges. They defined the necessary competencies needed to move through five skill bands and worked with the rest of the department to fine-tune the details. The process has only recently been implemented, but department employees are enthusiastic about it. PMID- 10133939 TI - Easy order system for materials services customers. AB - At the Hospital of Saint Raphael in New Haven, CT, the system for identifying and delivering items requested in between regular deliveries to patient care units was not efficient. The Materials Services Center (MSC) staff was frustrated at having to second-guess the needs of the medical floors, and the nursing staff was irate over the number of errors in the supplies they received. In addition, floors were borrowing supplies from each other, and the charges were being lost in the shuffle. The Materials Services Department solved the problem by developing a catalog and order transaction forms that matched requests with standard item numbers and descriptions. Customer satisfaction is way up and lost charges are way down as a result. PMID- 10133940 TI - Suction regulators. ECRI. PMID- 10133941 TI - Ethical issues in healthcare reform: the experts and the public compared. AB - Those of us in the healthcare industry have done a good job in demonstrating the value of our services in relationship to other activities government might undertake. We have done less well in recognizing the demands of individuals to make decisions about their own lives and the healthcare benefits they want. We continue to believe we know best, even to the point that we distrust the public to make appropriate decisions on their own behalf. A major part of freedom is the opportunity to learn from mistakes. When professionals restrict our freedom to choose, we all lose important rights. As the various bills make their way through Congress, we should look beyond our healthcare blinders and see that the public will reject industry-driven plans with almost the same level of suspicion given to the government and business. PMID- 10133942 TI - Instrument care and handling. PMID- 10133943 TI - Managed care is taking over the Rx market. PMID- 10133944 TI - "They're all dead.". PMID- 10133945 TI - More companies let 'experts' second-guess doctors' claims. PMID- 10133946 TI - When health plans don't want you anymore. PMID- 10133947 TI - Closing your practice: start planning years ahead. PMID- 10133948 TI - Medicare reimbursement at 43 percent of private rates? PMID- 10133949 TI - Staying within those antitrust "safety zones". PMID- 10133950 TI - Why your income is where it is now--and where it's going. Interview by Steve Murata. PMID- 10133951 TI - When doctors buy into their own hospital. PMID- 10133952 TI - Employed OBGs: even further ahead in the earnings race. PMID- 10133953 TI - A health insurer demands more records? Make it pay. PMID- 10133954 TI - "Doctors should take control of the health system". Interview by Stephen K. Murata. PMID- 10133955 TI - I've seen the future of health reform. It doesn't work. PMID- 10133956 TI - Is your partner in trouble? You'd better find out. PMID- 10133957 TI - Who's listening? Everybody within earshot. PMID- 10133958 TI - What you should know before going into geriatrics. PMID- 10133959 TI - The best practice builder? Hint: you use it every day. PMID- 10133960 TI - 'Any-willing-provider' laws targeted. PMID- 10133961 TI - Charter, NME deal delayed by FTC. PMID- 10133962 TI - Hospital exec appeals to JCAHO to consider costs. PMID- 10133963 TI - Malpractice insurance cost dip won't last--AMA. PMID- 10133964 TI - HBO banks on software firm. PMID- 10133965 TI - Change in governance urged for D.C. General. PMID- 10133966 TI - Cook County (Ill.) scaling back plans. PMID- 10133967 TI - Virginia hospital drops suit over PPO exclusion. PMID- 10133969 TI - Talks, Breaux reversal push reform forward. PMID- 10133968 TI - Heart attack care needs review--study. PMID- 10133970 TI - Fla. hospital's battle with FTC continues. PMID- 10133971 TI - Restraining order delays merger of two Fla. systems. PMID- 10133972 TI - Hospital total profit margins hit 5.5%, highest since mid-1980s. PMID- 10133973 TI - Pa. hospital closes with $43 million debt. PMID- 10133974 TI - Psychiatric hospitals. Psych chains endure another chaotic year. PMID- 10133975 TI - Rehabilitation hospitals. Larger for-profits lead solid growth in rehab. PMID- 10133976 TI - Long-term care. Existing nursing homes propel strong revenues. PMID- 10133977 TI - Retirement centers. CCRCs see slow growth, challenges in HMO care. PMID- 10133978 TI - Calif. Health Network recruits 3 new systems. PMID- 10133979 TI - Ambulatory care. Outpatient care growing both in numbers, scope. PMID- 10133980 TI - Home care. Home-care revenues soar to $5.1 billion via mergers. PMID- 10133981 TI - Ambulance companies the latest target of mergers, acquisitions. PMID- 10133982 TI - Results of the CLMA membership survey on laboratory information systems. AB - This article presents the results of the CLMA membership survey concerning Laboratory Information Systems. A variety of factors are discussed, including purchase and maintenance cost of systems, user satisfaction, staffing requirements, processor location and control, applications installed, and interfacing to the Hospital Information System. PMID- 10133983 TI - Quality improvement team uses FOCUS-PDCA method to reduce laboratory STAT volume and turnaround time. AB - How quickly do you turn around "STAT" laboratory requests? Do delays in processing STATS cause delays in deciding patient treatment protocols? Do these delays increase your patient's length of stay? The authors describe a situation in which morning STATS were delayed because of a large volume of patient requests. This article looks at the use of continuous quality improvement tools to improve this persistent laboratory problem. It explains FOCUS-PDCA, the method, and describes its application to reduce total STAT requests from 37% to 27% and to improve their turnaround time by 67%. PMID- 10133984 TI - An older employee's poor performance. PMID- 10133985 TI - To communicate more effectively on the telephone--avoid the five forbidden phrases. PMID- 10133986 TI - Cytyc Corporation ThinPrep processor. PMID- 10133987 TI - A successful laboratory outreach program. AB - Many economists say the recession is ending--if not over already. Those of us in health care are still facing trying times, and health-care reform may be just around the corner. Many hospitals are developing or enhancing laboratory outreach programs to ease their financial burdens. In the first of a two-part "As We See It," CLMR spoke with expert laboratorians who discuss the need for an outreach program and who should be involved in its development, as well as how hospital laboratories can establish the proper business culture to run a successful program. We asked: How do you develop and operate a successful laboratory outreach program? PMID- 10133988 TI - Teamwork in health care: opportunities for gains in quality, productivity, and competitive advantage. What works, what doesn't, and why. AB - Wholesale political, economic, and social change is pressuring health-care organizations to reinvent themselves as they enter a new arena of managed competition. Survival is at stake. Will belt-tightening efforts, combined with structural changes and strategic alliances, achieve the necessary improvements in efficiency and help to secure an adequate patient base? It seems reasonable to expect that health-care institutions can realize the major gains in quality, productivity, efficiency, and competitive edge that organizations in the manufacturing and service industries have enjoyed for the past several years. It seems like a logical next step for health-care organizations to deploy proven methods--such as work redesign, team-based structures, and empowered workforces- that have helped to restore competitiveness to many industrial and service firms. This article describes how to organize teams at all levels and accelerate their development to achieve important organizational objectives--such as improving quality, productivity, and efficiency--while increasing employee satisfaction. Pioneering workplace innovations are reviewed to demonstrate how high-involvement teams integrating strategic planning, research, and health-care delivery processes are not only possible but highly desirable. Enhanced quality, improved productivity, greater efficiency, and employee satisfaction all translate to an undeniable competitive advantage. PMID- 10133989 TI - This may hurt a bit. Congress begins to ask why the U.S. subsidizes insurance coverage for those at the top of the heap. AB - Congress begins to ask why the U.S. subsidizes insurance coverage for those at the top of the heap. PMID- 10133990 TI - The development of clinical audit: use of a "quality web" constructed for a community dental service. AB - If clinical audit revolves around concepts of quality, then there is need to examine the basis of quality and thereby clinical audit as traditionally defined by health-care organizations. Basing quality on patients' stated needs is often insufficient. Gives an expanded view. Health-care consumers should not be confused with the term customers, and professional staff should be ready to consider patients' needs before those of any organization. In order to handle this wider view of quality in health care, describes the concept and construction of a quality web. Suggests that either by constructing their own quality web, or adapting the model given, clinical managers could adopt a broader perspective to quality and audit in the service they provide. PMID- 10133991 TI - Continuous quality improvement in an acute hospital: a report of an action research project in three hospital departments. AB - Describes an action research project to improve quality in three hospital departments including operating theatres, X-ray, and medical records. The approach combined quality assurance (QA) or audit methods with those of continuous quality improvement (CQI) or TQM. The intention was to bring about improved organizational performance through an emphasis on bottom-up rather than top-down methodology, and to assess the relative effectiveness of different quality strategies being used within the hospital. Baseline studies of organizational climate and of patient perceptions enabled evaluation of effectiveness. Provides a description of the background to various health-care quality strategies, and argues that several perspectives are required if all stakeholders (e.g. policy makers, professionals, patients, and managers) are to be satisfied. Describes the responses of staff, superiors and professionals and recommendations offered for more effective quality strategy implementation. PMID- 10133992 TI - The successful application of medical offset in program planning and in clinical delivery. AB - Medical cost offset was discovered in the health maintenance organization (HMO) setting over 35 years ago and was used not only to justify the earliest instances of the inclusion of mental health treatment as a benefit, but also was used in program design and development. With the new emphasis on outcomes research, medical cost offset remains a viable method of conducting nonintrusive studies of efficacy, efficiency, and quality. Through the use of the research design described, an early HMO delivery system developed 68 focused, target behavioral interventions that years later became the basis for emerging managed mental health care. PMID- 10133993 TI - Mental health services under health reform: the less government, the better. AB - Federal and state governments are now rapidly preparing to restructure the delivery and financing of health care services in the United States. Unfortunately, the bureaucratic structures promised under managed competition do not acknowledge the successes of private sector "market-regulated" programs. A needlessly costly and burdensome system could evolve that will undermine the goals of improved access and quality of care. PMID- 10133994 TI - Managed mental health--community mental health revisited? AB - Despite the considerable differences between them, community and managed mental health care have much in common, particularly with regard to their values and objectives. While their differences in such things as auspice and funding may be more apparent than their commonalities, both community and managed mental health emphasize alternatives to hospitalization, continuity of care, and responsibility for a defined population. Neither managed nor community mental health care was welcomed by a mental health establishment that resisted change, although the source of the opposition was somewhat different. Inflated expectations led to disenchantment with community mental health care and could well have the same effect on managed mental health. PMID- 10133995 TI - Expanding the "Q" (quality) word. AB - It is time to move from quality individually defined--"excellence in clinical practice"--to quality socially defined--"excellence in clinical practice combined with accessibility, affordability, positive clinical outcomes and patient satisfaction." Only through such a systemic, matrix approach to quality can the mental health industry meet the needs of the patient population. PMID- 10133996 TI - How will computerization revolutionize managed care? AB - Computerization of behavioral health care information systems is revolutionizing how payors, managed care companies, and providers exchange information. In this article, an imaginary scenario is depicted of how patient data will be accessed and communicated to facilitate care management of behavioral health care services in the near future. PMID- 10133997 TI - Public managed care: developing comprehensive community support systems in Massachusetts. AB - Massachusetts has harnessed taxpayer dissatisfaction with government to support change. Restructuring has permitted the Department of Mental Health to shift resources from state hospitals to comprehensive community support systems, the foundation for the Department's public managed care initiative. A commitment to psychosocial rehabilitation principles and consumer choice have produced radical change in the delivery and composition of mental health care services. While quality and utilization management programs provide the infrastructure to ensure accountability, quality, and cost effectiveness, education and the building of partnerships support planning and promote progress. PMID- 10133998 TI - Brief therapy for managed mental health companies: becoming a learning organization. AB - Nearly all of the services offered through managed behavioral health care companies are brief or time effective in nature. It is often the view of these companies that many of their providers have insufficient backgrounds in doing such treatment and have been trained in longer, less efficient modes of service delivery. Although this is often the case, what is frequently not recognized is that most managed behavioral health care companies themselves lack knowledge and clarity about such therapies. We address the critical need for behavioral health care companies to become learning organizations focused on research and development and internal as well as external training in time-efficient therapies. Such activities will allow for creativity and enhancement of the substance abuse and mental health care areas. PMID- 10133999 TI - Are competing psychotherapists manageable? AB - Behavioral health care faces major overhauling. The twin objectives of improved access and greater efficiency require reorganization of the delivery system from a disjointed array of competitors to an integrated continuum of collaborators. Ironically, the motif for achieving such a change is that of competition. This article questions reform through market forces alone and suggests a guided five step process: guaranteeing the right to necessary care, regionalizing resources under capped budgets, replacing fee-for-service reimbursement with prospective payment, aligning continuing education requirements with performance-defined gaps in knowledge, and funding professional retraining. Shared accountability is proposed as an alternative to the problematic ethic of competition. PMID- 10134000 TI - Practitioner ethics and managed care. AB - Mental health services provided through a managed care company cause some serious ethical concerns for providers and potentially for licensing boards. Confidentiality, record keeping, abandonment of patients, and informed consent are a few of the major issues confronting providers and the patients with whom they work. The importance of these issues for providers and the need for managed care companies and their employees to pay more attention to these ethical problems are covered in this article. PMID- 10134001 TI - From managed care to cooperative care. AB - The difficulties manifested between managed care and its practitioners are formidable but not inevitable. A change in the perception of practitioners toward managed care will need a concerted effort on the part of both the provider and the industry, realizing there is more to gain by working together. The author reports two examples of cooperative care. These did not happen on their own. Rather, perceptions were changed in the only way perceptions are really changed: through results. This article is optimistic that, by persons of vision on both sides, there can be a move from managed to cooperative care. PMID- 10134002 TI - Myths and potentials. AB - The struggle over health care reform in the United States pits two powerful myths against one another. The first myth, long held and strongly entrenched, promotes the illusion that the existing health care nonsystem allows broad freedom of choice and access to uniformly available, compassionate, component health providers. The second myth posits a new illusion. It suggests that competing organized care systems, under economic pressures for cost containment, will assure broad freedom of choice and access to uniformly available, compassionate, competent health providers. Both myths deny reality. PMID- 10134003 TI - Using law, research, professional training, and multidisciplinary collaboration to optimize managed care. AB - Managed health care has great potential for improving access to health care, improving quality of service, and moderating costs. Increased collaboration among health professions could ensure adequate human resources and expertise to meet service needs under universal health care. Collaboration is the only mechanism that enables the range of scientific and technological developments among the professions to be applied to health care needs. This article briefly illustrates the potential for revisions of law, application of research, professional collaboration, and focused training to maximize the effectiveness of managed care. PMID- 10134004 TI - Medical costs, Medicaid, and managed mental health treatment: the Hawaii study. AB - In a randomized, prospective design with Medicaid enrollees, managed mental health treatment reduced medical services costs and utilization by 23 to 40 percent relative to control groups. For enrollees with chronic medical diagnoses, managed treatment reduced medical costs by 28 to 47 percent, while medical costs for fee-for-service enrollees increased by 17 percent. For enrollees without chronic medical diagnoses, traditional fee-for-service also reduced medical costs by about 20% but used three times as many outpatient visits. Costs of managed treatment were recovered in 6 to 24 months, suggesting that managed mental health treatment should be incorporated in health reform initiatives. PMID- 10134005 TI - Can mental illness be prevented under managed care? AB - Ideally, managed care should force a focus on all the issues involved in prevention and treatment. Unfortunately, the decisions in managed care are based on costs, along with the intervention techniques, as the most important criteria in choice of treatment. Medical treatment accounts for only 10 percent of health. To find a solution means working together, making the goal "healthy people in a healthy community." Programs such as the Healthy Cities initiative, not managed care, are more likely to realize this goal. PMID- 10134006 TI - Mental health's contribution to the financial performance of a utilization management program. AB - Analysis of a national utilization management program covering approximately 3.4 million individuals from 1989 through June 1993 indicates that while only 6% of all hospitalizations were for a primary psychiatric or substance abuse diagnosis, over 44% of the program savings are accounted for by concurrent mental health utilization management. The cost of performing mental health utilization management is significantly greater than the cost of providing medical, surgical, and maternity management, but returns on investments are significantly greater for psychiatric and substance abuse than for these other diagnostic areas. Implications for health care reform inclusion of full mental health benefits are discussed. PMID- 10134008 TI - VIP interview: John D. (Jay) Rockefeller IV, United States Senator. AB - John D. (Jay) Rockefeller IV has proudly served the people of West Virginia for nearly 30 years. After coming to the town of Emmons in 1964 as a VISTA worker, Jay Rockefeller made the Mountain State his home. In 1966, he was elected to a two-year term in the West Virginia House of Delegates. He then served four years as Secretary of State, three years as President of West Virginia Wesleyan College, and eight years as Governor of West Virginia. In 1984, he was elected to the United States Senate and was reelected in 1990. PMID- 10134007 TI - How hospitals can use internal benchmark data to create effective managed care arrangements. AB - Hospitals are now adopting benchmarking techniques, along with total quality management techniques, in order to provide employers with detailed data and process comparisons with hospital competitors. Traditionally, employers have relied on inpatient price and length of stay as primary measures of hospital performance. However, successful hospital benchmarking can expand those measures to include additional factors such as quality, value, and outcome. This article describes how hospitals can use internal benchmark data to create effective managed care arrangements with employers. PMID- 10134009 TI - A lesson in dying well. Aging: Nixon's living will becomes a model. PMID- 10134011 TI - Drug-use evaluation. PMID- 10134010 TI - Health reform: examining the alternatives. AB - This Issue Brief examines the major issues of the health reform debate. The issues that must be resolved before reform can be enacted include: allocation of health care resources, universal coverage versus universal access, composition of risk pools, employer and individual mandates, and distribution of health care services' costs. This report also contains short descriptions and analyses of the following proposals: McDermott-Wellstone, Clinton administration, Cooper-Breaux, Chafee-Thomas, Michel-Lott, Nickles-Stearns, and Gramm. Proposals without an individual mandate will not achieve universal coverage. An individual mandate raises significant enforcement issues. An employer mandate will not achieve universal coverage by itself. Depending on the number of hours an employee must work to be included in a mandate, an employer mandate could potentially extend health insurance coverage to as many as 85 percent of the currently uninsured. Each individual has a risk of needing health care services. Restructuring the health insurance market is accomplished by changing the way individuals and their risks are pooled. The composition of these risk pools will determine the costs of health insurance and the distribution of these costs. The theory behind medical saving accounts is that the market for health insurance currently leads to health care cost inflation because many events covered under most health insurance plans are not truly insurable. There are two issues involved in medical savings accounts--the impact on low-income individuals and individuals' ability to evaluate the quality of care they receive. The present market does not provide individuals with adequate information for assessing the quality or effectiveness of medical care. Among the critical issues in health reform is how to reduce the rate of health care cost inflation. The effect of proposals that impose explicit budget caps or price controls on health care cost inflation can be more easily estimated than other means of controlling costs if it is assumed that the political will exists to hold these caps and price controls at the levels set in the proposal. It seems unlikely that shortages or queues would develop in the near term if a single-payer health system were enacted. Currently, the U.S. health care system is characterized by overcapacity. In the longer term, however, with restrictions on hospitals' access to new technology and funds to invest in new equipment and beds, shortages and queues might develop. PMID- 10134012 TI - Outcomes management. PMID- 10134013 TI - HCFA cleans up survey procedures. PMID- 10134014 TI - How will you merge managed care into your company's operations? PMID- 10134015 TI - 1994 software buyers' guide. PMID- 10134016 TI - Check out managed-care contracts before you sign. Part one. PMID- 10134017 TI - Ventilator programs meet managed-care needs. PMID- 10134018 TI - Putting faith into action. PMID- 10134019 TI - Evergreen Health Centre. PMID- 10134020 TI - Cutting your losses. PMID- 10134021 TI - At the Fernald School: kitchen, management changes herald the future. PMID- 10134022 TI - Challenge: how to improve satisfaction among maternity patients. PMID- 10134023 TI - Getting health alliances right. PMID- 10134024 TI - Differences in the scalability of formal and informal in-home care of urban elderly. AB - Differences in the scalability of formal and informal in-home care to elderly are examined. A Guttman scale showed that exclusive use of informal in-home care was hierarchically scalable, but not when services were provided by any formal sources. There was some clustering of formal services, for example, a large number of those who received meals also used homemaker services. However, a large number of those who received nursing did not receive personal care. There was no overall pattern to the use of formal services. Implications of these findings as related to service planning and delivery are discussed. PMID- 10134025 TI - Family caregivers of post-hospitalized older persons and persons receiving hospice: similarities and differences. AB - The study reported here explored similarities and differences between 103 family caregivers of older persons who had been discharged from the hospital and 70 caregivers of terminally ill older persons receiving hospice care. Caregiving variables were selected for examination based on role theory. Major findings include: hospice caregivers provided significantly more personal care and medically related tasks, significantly fewer transportation tasks, and worried less than the post-hospitalized sample. Otherwise, the two groups were strikingly similar. Similar patterns of correlations for the two groups were also found. PMID- 10134026 TI - Venous access device utilization in home care settings. AB - Home infusion therapy is the fastest growing segment of home care, yet little is known about the utilization of various venous access devices in the home. This study reports pioneering data from thirty seven hospital-based, community-based and home infusion pharmacy agencies across the country which provide home infusion therapy services. Venous access device utilization data for adults and children are compared and differences among agency types of home care providers are analyzed. Significant patient device utilization differences among different provider types and age groups are discussed in terms of their implications for clinicians, educators, policy makers and researchers. PMID- 10134027 TI - ADL dependent people may also be sick: neglect of the "home health" population in the home care debate. AB - Fear of large new public outlays have muted debate over recent proposals to expand subsidized supportive (non-medical) home care services for the elderly. Data from the billing portion of the 1984 National Long Term Care Survey demonstrate that of the approximately one million community-dwelling elderly persons whose chronic functional impairments would make them eligible for many proposed home care programs, nearly one third (31%) received services from a home health agency over a 12-month period. Since home health agencies provide substantial amounts of supportive services to enrollees, it is estimated that between three and six million non-medical visits are provided annually to chronically functionally impaired persons through home health agencies. These existent services should be taken into account in predicting the incremental public service burden and costs of proposed supportive home care programs. PMID- 10134028 TI - Leadership and quality of working life in home health care. AB - Home health care has undergone startling changes in the past decade and, in the process, become a strategically important ingredient of health care delivery. However, the question remains whether home health care organizations can deliver the benefits anticipated for integrated care delivery systems. The answer to this question depends to a great extent on whether home health care organizations build vibrant, visionary leadership capable of transforming organizations and motivating staff to deliver high quality and low cost services. This paper examines a case study of transformational leadership as it relates to the quality of working life for nurses, homemakers, and staff. The findings indicate that leader behaviour is strongly associated with homemakers', and to a lesser extent staff members', job satisfaction, job involvement, and propensity to remain with the organization. These job attitudes have been shown to be related to higher job performance. The implications for leadership in home health agencies are discussed. PMID- 10134029 TI - Working conditions in home care: a survey of Washington state's home care workers. AB - Home care services make it possible for millions of older Americans to continue living in the community. Such services may enhance the recipients' quality of life while providing essential respite to family caregivers. But while there has been increasing recognition of the burden borne by the predominantly female family caregivers, there has been less attention to the plight of the home care workforce. With the growth of the home care industry, the burden of care has to some extent shifted from one category of female caregivers to another. This paper, based on a survey of 16 agencies and 1,900 workers, examines the employment conditions of home care workers in Washington state. The study reveals a pattern of harsh working conditions, low wages, and few benefits. The findings raise questions about the ethics and efficacy of government policies that are based on the exploitation of home care workers. PMID- 10134030 TI - Increasing home health service referrals, boon or bane? AB - Discharges to home health services (HHS) increased dramatically for the elderly after Medicare's prospective payment system (PPS) was enacted in October 1983. A longitudinal study of fourth quarter South Carolina discharge abstracts from 68 of 71 short term acute care hospitals in the state were analyzed to appraise hospital responses to implementation of this significant change in Medicare's reimbursement system. PPS caused shifts in hospital practices as financial incentives radically changed from a cost-based system that encourages expenditures to a PPS that evokes conservation of resources within a hospital stay. In so doing, the "output" (i.e., discharge) changed. One of those changes observed was an increase in referrals to HHS. Apparently, capping the amount reimbursed for a particular diagnosis left the more resource-intensive patient vulnerable and in want of care on discharge. Demand for HHS rose significantly (+47% in 1983; +234% by 1985). Though a HHS referral may be appropriate during the recuperative phase of an illness, questions arise as to hospital motivation. The HHS referral represented the most resource-intensive, but arguably unprofitable segment. Had hospitals sought earlier discharges to "protect their bottom line" as reimbursement essentially was capped? Was a referral to HHS appropriate to meet the existing patient-care needs that remained? Did HHS offer a more cost-effective substitution for care formerly provided the patient in the hospital? What provider and consumer characteristics are at risk and why? Both consumer and provider concerns need to be addressed. Answers to these questions are most critical to future health care reform. Allocation decisions of scarce resources need to be grounded in realistic expectations drawn from appraisals of what does and does not work in the health care market. PMID- 10134031 TI - Rural case management: a pilot study. AB - The long term goal of this research is to improve the quality, effectiveness and efficiency of home and community-based services for rural long term care clients. Case management has been espoused as one method to improve services. Long term care case management models have been tested in urban areas with good results, but it is not known to what extent these models are applicable to the special circumstances of rural home and community-based care. The purposes of this pilot study are: 1. To describe case management in long term home health care as practiced in rural Kentucky. 2. To analyze case management for factors that promote or impede effective and efficient delivery of long term home health care for older rural Kentuckians. 3. To propose a model appropriate to case management in long term home health care for older rural Americans. PMID- 10134032 TI - Elders' out-of-pocket payment for community-based long-term care. AB - This research describes characteristics of community living elders aged 71 and older with long-term care (LTC) needs who pay out-of-pocket for community-based LTC. Community living elders with higher incomes, more friends and non-child relatives outside the home, and greater ADL or IADL needs are more likely to purchase LTC than those without these characteristics. Also the lack of sufficient numbers of children outside the home to provide assistance tended to result in the use of out-of-pocket paid services. Paying for LTC is not associated with the extent of disability experienced. This study clarifies the characteristics of those in need who currently pay out-of-pocket for community LTC as a basis for examining the inadequacies of current LTC financing. PMID- 10134033 TI - Health care mergers and acquisitions. How new federal laws prohibiting physician self-referrals affect integrated delivery systems. PMID- 10134034 TI - Health care mergers and acquisitions. Overview: who are the players and what are their needs? PMID- 10134035 TI - HMO mergers: we've only just begun. PMID- 10134036 TI - Competing in a merger and acquisition era: how much is a medical practice worth? PMID- 10134037 TI - Special strategies sidestep legal, regulatory obstacles to health care mergers and acquisitions. PMID- 10134039 TI - The "Minnesota plan" for developing physician clinics without walls. PMID- 10134038 TI - Independent physician organizations: medical networks put physicians in control of managed care. PMID- 10134040 TI - Personal value structures and AIDS prevention. Are safe-sex messages reaching high risk groups or merely preaching to the converted? AB - After a decade, years of battling acquired immunodeficiency syndrome (AIDS), the spread of this disease still represents one of the most important issues facing health care officials today. Even though many individuals have changed their sexual behavior since becoming aware of AIDS, a group of high-risk young adults has not. The authors explore the relationship between personal value structures and low-risk vs. high-risk sexual behavior. The findings offer health care officials insight into effectively targeting AIDS prevention communications to the high-risk segment. PMID- 10134041 TI - How consumers choose health insurance. AB - The authors used choice-based conjoint analysis to model consumers' decision processes when evaluating and selecting health insurance in a multiplan environment. Results indicate that consumer choice is affected by as many as 19 attributes, some of which have received little attention in previous studies. Moreover, the importance of the attributes varies across different demographic segments, giving marketers several targeting opportunities. PMID- 10134042 TI - Modeling patient satisfaction and service quality. AB - The authors attempt to clarify and extend the conceptualization and measurement of consumer satisfaction and service quality in health services. Although the two constructs serve as cornerstones in the design and implementation of health care marketing strategies, a literature review suggests that satisfaction and service quality are currently difficult to distinguish--both conceptually and operationally--in health care settings. The findings from two studies conducted by the authors to distinguish the nature of these two important constructs within a health care marketing context reveal that a nonrecursive relationship between service quality and patient satisfaction may account for much of the conflicting evidence in the literature. PMID- 10134043 TI - Convenience or calamity? Pharmaceutical study explores the effects of sample frame error on research results. AB - Survey results of a nationwide sample frame did not differ from those of a statewide sample frame with respect to questions that were professional/procedural in nature or that dealt with putative industry knowledge. However, on questions that were attitudinal in nature, the sample frames differed significantly. Because of this, the authors conclude that using a geographically narrow convenience sample may or may not result in frame error, depending on the information being sought. PMID- 10134044 TI - Academy for Health Services Marketing of the American Marketing Association. Resource guide. PMID- 10134045 TI - HMO quality reports: time for marketers to get involved. PMID- 10134046 TI - Turning volunteers into patients--and vice versa. PMID- 10134047 TI - CLIA national survey, Part 2. Dealing with inspections and paperwork under CLIA. PMID- 10134048 TI - Electronic data transfer for hospital lab outreach programs. PMID- 10134049 TI - Paradigm shifts in microbiology. PMID- 10134050 TI - Managing employee pay the new way. Part 2: Pay strategies. PMID- 10134051 TI - Using artificial intelligence in the laboratory. PMID- 10134052 TI - The Southeast Florida AIDS Information Network: a community outreach, specialized information system. AB - In the years ahead, end-user instruction will expand from the current models of curriculum- and institution-based programs for teaching MEDLINE to include outreach programs to unaffiliated users for teaching specialized database searching. The Southeast Florida AIDS Information Network (SEFAIN), a community based information system targeting health care providers in a tri-county area, is an example of this new model. The components of SEFAIN and the results of the outreach and educational programs are presented. The advantages of these programs to both providers and librarians are highlighted. Comparisons are drawn between end users who take specialized information courses and those who take MEDLINE courses or no courses. These data will assist librarians in the justification and development of specialized information systems. PMID- 10134053 TI - Defining what instructional librarians need to know about information technologies. PMID- 10134054 TI - Circuit librarianship: a twentieth anniversary appraisal. AB - The twentieth anniversary of circuit librarianship is a fitting occasion to reflect on its history and success. The tradition of circuit riders is traced and the hallmarks and achievements of circuit librarian programs are described. Providing information services to remote health professionals has been a longstanding concern of medical librarianship, and it is presently a major focus of the National Library of Medicine. It is suggested that widespread adoption of circuit librarianship would not only satisfy the information needs of unserved health professionals but could enhance the image of the profession given the centrality of the librarian, not the library, in this model. PMID- 10134055 TI - Analysis of the use of reference services in an academic health sciences library. AB - In 1991, the Reference and Information Services staff of the Alfred Taubman Medical Library at the University of Michigan gathered data on the use of the reference desk, including the frequency and types of assistance requested by different user groups throughout the year. Recommendations based on the results of this study led to improved service as well as more efficient use of staff resources. PMID- 10134056 TI - Creative ways to locate MeSH subheading information. AB - Locating notes about MeSH subheadings can be one of the most difficult aspects of MEDLINE searching. When used with Medical Subject Headings (MeSH), subheadings serve to limit or define the focus of a heading. National Library of Medicine (NLM) indexers, staff members who enter the MeSH indexing into the database, use subheadings freely. They do follow indexing conventions and savy searchers need to be aware of how to obtain basic subheading information to assist in search formulation. There are a number of methods which may be used in order to view subheading use notes. This column will provide an overview of some alternatives to locating such information. PMID- 10134057 TI - Reaching NLM through the Internet. AB - Currently, many of the electronic services are still new, and there may be a need for further fine-tuning and changes. Having separate electronic addresses for each service rather than having one centralized address will make it easier for NLM to identify and isolate questions or problems. The Appendix summarizes the commands and addresses mentioned in this article. PMID- 10134058 TI - The yin/yang of management. AB - American management is being turned upside down. The corporate ladder now starts at the top and goes to the bottom of the inverted corporate pyramid. Workers are now supported by management, and, in the language of customers and suppliers, the employees are the customers of the CEO. Workers are exhorted to focus on process over outcome, and teamwork has replaced work by goal-oriented individuals. Central offices are giving up control, pushing decision making closer to workers involved in processes. This shift in management philosophy has been provoked and maintained by western reaction to Japanese success at adopting and adapting the principles of management introduced by Americans in the 1920s. PMID- 10134059 TI - The implications of practice guidelines for physician medical malpractice liability. AB - Medical practice guidelines are increasingly coming into use, and as more and more physicians are presented with guidelines to follow in the delivery of health care, the question arises of whether these guidelines will become instruments for imposing greater medical malpractice liability on physicians. This column will briefly describe what guidelines are, how they are developed, and how they have been and may be used in litigation against physicians, hospitals, and other health care institutions. As hospitals and managed care organizations continue to implement guidelines, the role these guidelines play in malpractice cases can be expected to increase. It appears, however, that, although guidelines will contribute to the establishment of the standard of care by which a physician's actions will be measured, they are not likely to become the standard that all physician treatment decisions must meet. PMID- 10134060 TI - Twelve questions to ask about your outcomes monitoring system--Part II. AB - Commercial and customized outcomes monitoring systems designed to assess the results of care, whether clinical outcomes or resource use, are not all of equal value or equally appropriate for every use. In creating each system, its developers had to make critical decisions about such matters as definitions of outcomes for study, selection of patients, selection of data elements, methods and timing of data collection, and method of analysis and reporting. Each system represents a unique set of choices that were made. This series of two articles presents answers to 12 questions that will help users understand the basic workings of an outcomes monitoring system--to be able to distinguish good systems from the mediocre and the bad, and to make wise use of a system already in operation. In addition to the six questions presented in the April 1994 issue of Physician Executive, the following six questions are of critical importance in determining a system's value to you and your organization. PMID- 10134061 TI - How to fight the regulator glut: the role of the HCFA-type survey. AB - More and more hospitals in this country are being threatened by the removal of their Health Care Financing Authority (HCFA) Medicare Certification. A perception of competitiveness among HCFA, the Joint Commission on Accreditation of Healthcare Organizations (JCAHO), and other organizations has heightened this concern. This unpleasant situation has provoked many hospitals to prevent any type of regulator decertification. One of the practical methods of prevention is the use of a HCFA-type survey. These surveys prepare institutions for unexpected, unarmored review by regulators and should be part of the quality improvement (QI) process even in institutions with limited resources. This article discusses the means to accomplish the HCFA-type survey. The development of the survey process involves institutional commitment, hospital policy and procedures, a department review schedule, selection of review personnel, preparation of review personnel, record keeping, and department education. PMID- 10134062 TI - An overview of managed care in state Medicaid programs. AB - The National Governor's Association predicts that Medicaid will account for 28 percent of total state spending in 1995, double the 1991 level. During 1992, total Medicaid enrollment reached 31.6 million beneficiaries, up 4.7 million (17.5 percent) from 1991. The total expenditure of $118.2 billion in 1992 was up 25 percent from the 1991 level of 94.5 billion. A recent General Accounting Office (GAO) report, revealed that, in 1990, 43 percent of 99 million emergency department visits were for minor ailments. From 1985 to 1990, Medicaid emergency department visits increased 34 percent, compared to 19 percent growth in all emergency department visits. A Department of Health and Human Services Inspector General Report on Medicaid recipient emergency department usage recommended that states develop a comprehensive initiative to reduce nonemergency usage of the emergency department, including increased implementation of managed care options. During 1992, 42 states used some type of Medicaid cost containment measure, with managed care being the most frequent choice. PMID- 10134063 TI - Risk management in an IPA setting--Part I. AB - Over the past several years, HMO enrollment has grown the most in independent practice association (IPA) and network models. HMOs in general have expanded as a means to control the cost of health care. Key customers, including large employers and government agencies such as the Health Care Financing Administration (HCFA), require such control. IPA and network models retain a greater sense of choice on the part of participating physicians and patients than do closed-panel group- or staff-model programs. As physician and patient choice increases, however, the HMO's control over health care diminishes. Thus, customers require HMOs to manage health care. The HMO must market, develop delivery systems, meet regulatory requirements, and make profits. It must control both the quality and the cost of health care. Doing so without the level of control found in staff-model HMOs has created unique challenges for IPA HMO managers. IPA-model HMOs adapt quality improvement programs to this lesser level of control. Staff-model HMOs and hospitals closely link quality assurance to risk management. Programs designed to improve quality will naturally also reduce the risk of providing care below standards. This relationship is less clear in IPA- and network-model HMOs, in which the HMO does not provide the care. Thus, IPA model quality improvement programs often do not address their risk management implications. This two-part article examines the differences between staff-model and IPA-model HMOs in liability and in ability to manage risk. In the first part, the nature of the risks is described. In the next issue of the journal, the management of those risks will be discussed. PMID- 10134064 TI - Managing provider networks through expert systems: use of patterns of treatment to address overutilization. AB - Among the most important contributors to rising health care costs is excess utilization of services. Sophisticated clinical criteria, encoded as an expert system in software, allow identification of probable excess utilization in large claims data sets. These systems can be used to adjudicate claims, resulting in direct cost savings, or to profile physicians and other providers, facilitating creation and maintenance of networks. These systems are used by traditional payers to promote quality, control costs, and enhance competitiveness and are beginning to be used by nontraditional payers, such as physician groups and hospital-based networks. PMID- 10134065 TI - The current clinical revolution. Applications of gene therapy in treatment of disease. AB - A major technological revolution is on the horizon that promises cures for inherited diseases such as cystic fibrosis, sickle cell anemia, muscular dystrophy, hemophilia, leukocyte-adhesion deficiency, and Gaucher's disease. This revolutionary technology also promises effective treatments for acquired diseases such as cancer and AIDS. The technique is gene therapy and it has already been used in humans. Some applications raise ethical considerations that not only affect the individual who is treated but have implications for future generations as well. PMID- 10134066 TI - Tuberculosis: the silent killer. PMID- 10134067 TI - Suture materials: the surgeon's selection. PMID- 10134068 TI - Liability issues in social work administration. PMID- 10134069 TI - The impact of liability concerns on intraorganizational relationships. PMID- 10134070 TI - Challenging human service organizations to redefine volunteer roles. PMID- 10134071 TI - Special insert. Accountability in reform: comparisons of major health reform proposals April 1, 1994. PMID- 10134072 TI - Blues of Iowa use claims data bases to investigate asthma prevalence and treatment. PMID- 10134073 TI - Implementation of a needleless intravenous access system at the University of Virginia Hospital. PMID- 10134074 TI - University hospital network evaluation of needleless i.v. systems. PMID- 10134075 TI - Health reform and accountability for quality. PMID- 10134076 TI - Perspectives. PPRC comes up to bat with reform recommendations. PMID- 10134077 TI - Health reform insight. Doctors and insurers battle over health system control. PMID- 10134078 TI - Perspectives. The hospital work force: changing with the times. PMID- 10134079 TI - Health reform insight. Moynihan unveils reform "starting point" for finance. PMID- 10134080 TI - Perspectives. Medicare Part C: an old idea takes new shape. PMID- 10134081 TI - Planning and public inquiries. PMID- 10134082 TI - Design and build as a method of procurement for the healthcare industry. PMID- 10134083 TI - Safety on construction sites--employers and designers are now liable. PMID- 10134084 TI - Comments in respect of Health, Technical Memorandum 2014, Abatement of Electrical Interference. PMID- 10134085 TI - Contracts and commissions for the NHS estate. PMID- 10134086 TI - The research quandary. PMID- 10134087 TI - American Health Information Management Association position statement. Issue: Documentation timeliness. PMID- 10134088 TI - AHIMA transcription guide--1994. PMID- 10134089 TI - American Health Information Management Association position statement. Issue: Facsimile transmission of health information. AB - Facsimile (fax) machines offer a means of immediate exchange of written health information. However, the use of fax machines opens up avenues for loss of patient privacy if confidential information is misdirected or handled improperly upon receipt. Because of this, AHIMA recommends fax transmission of health information only when the original paper record or mail-delivered copies will not meet the needs of immediate patient care. The sensitive information contained in health records should be transmitted via facsimile only when: (1) urgently needed for patient care or (2) required by a third-party payer for ongoing certification of payment for a hospitalized patient. Routine disclosure of information to insurance companies, attorneys, or other legitimate users should be made through regular mail or messenger service. Unless otherwise prohibited by state law, information transmitted via facsimile is acceptable for inclusion in the patient's health record. PMID- 10134090 TI - Congress and healthcare reform. PMID- 10134091 TI - Developing an information management plan. AB - Developing a good information management plan is a major project, but it can be accomplished by taking small incremental steps and making sure your team stays focused. Several good things will be produced as a result of your hard work. Your patients will ultimately receive better care due to the availability of more timely information. The hospital will gain cost effectiveness when the information is integrated. Society as a whole will benefit from the sharing of unidentifiable patient information through research. PMID- 10134092 TI - Agency for Health Care Policy and Research: an important player in healthcare reform. PMID- 10134093 TI - Contemporary issues in HIM. Wireless LANs. AB - Wireless LANs are a relatively new form of network whose popularity is growing rapidly. Although they probably will not completely replace wired networks, wireless LANs can fill several important niches in network applications. In this article, we looked at rationales for wireless LANs, discussed several broad categories of wireless applications, and described two transmission techniques currently dominant in wireless networks. We then reviewed several different wireless network structures and wireless hardware connections, and looked at ranges and transmission rates. The article closed with a presentation of some relevant considerations regarding wireless LANs. PMID- 10134094 TI - Productive public relations. PMID- 10134095 TI - Managing the human side of change. PMID- 10134096 TI - Ergonomics: a buy-in strategy for effective management development change. PMID- 10134097 TI - Multisource assessment increases healthcare employee satisfaction. PMID- 10134098 TI - Reengineering--starting with a clean slate. PMID- 10134099 TI - Implementing the new Joint Commission information management standards: one hospital's approach. AB - The Information Management Council is a beginning for truly managing information in our facility. We recognized the need for such a group and have defined its membership and focus. We have identified data collection in our facility and are now addressing redundant data collection. We also are reviewing the purpose of the data collection to see if the reports are still needed, and if key information for measuring quality of care is collected. Finally, we reviewed and instituted procedures to protect the confidentiality of computerized data. These efforts have brought us into compliance with the Joint Commission's 1994 information management standards. In addition, we have saved both time and money by eliminating duplicate or obsolete data collection. We also are more aware and in control of the data we currently collect and better able to define and collect the information that is essential to our business. As an HIM professional, I found leading this process to be a natural extension of my responsibilities. HIM professionals are knowledgeable about information systems and user needs, familiar with the Joint Commission survey process, committed to protecting patient confidentiality, and providing timely, accurate information. Managing information is a critical function that needs our expertise and our leadership. PMID- 10134100 TI - Opportunity for application of information technology: a case study of Kuwait. PMID- 10134101 TI - American Health Information Management Association position statement. Issue: Data quality. PMID- 10134102 TI - Fair Health Information Practices Act. PMID- 10134103 TI - Healthcare reform battle continues--AHIMA is an active participant. PMID- 10134104 TI - Joint Commission activities. IM.2: confidentiality, security, and integrity. AB - Confidentiality of data and information has always been at the center of the HIM profession. We have been advocates and educators for years. We must not abandon this practice. It is more important now than ever. I would like to close with a challenge. Be an ambassador for confidentiality--educate others. PMID- 10134105 TI - Contemporary issues in HIM. Kerberos--security for sensitive data. AB - Kerberos is a software package designed to enhance distributed computing security through the use of computerized tickets. In this article, we have looked at Kerberos data elements and protocols, and illustrated their use in a small example system. This and other security measures will be necessary to ensure privacy of patient records in the future. PMID- 10134106 TI - The Henry Ford Health System corporate data store. PMID- 10134107 TI - The Michigan Birth Defects Registry: development and operation. PMID- 10134108 TI - Multi-registry databases used as an outcome management tool. PMID- 10134109 TI - Transforming data into usable information: generating rate-based information. PMID- 10134110 TI - Data: which states have it? AB - Data is king. Data is power. Data is the path to quality. Quality is what our patients want and deserve. Do you use your hospital data to its fullest potential? Do you compare your data to others? Are you improving? If not, you need to investigate ways to fully utilize your data. PMID- 10134111 TI - Development of medical records in the Kingdom of Saudi Arabia. PMID- 10134112 TI - Professionalism and cancer care. PMID- 10134113 TI - Impending health care legislation: its impact on surgical workforce and residencies. PMID- 10134114 TI - Resources for optimal care of the injured patient--1993. PMID- 10134115 TI - Statement of the American College of Surgeons regarding clinical trials. PMID- 10134116 TI - The "Group of 100". PMID- 10134117 TI - The PPRC: 1994 update. AB - The health care debate will continue throughout much of the summer in the legislative committees and subcommittees of Congress. Both the American College of Surgeons and the PPRC will participate in that process through invitations to testify on many of the issues discussed in this article. The author will begin his third three-year term on the PPRC in July 1994, and will continue to express the concerns of the surgical community to that body. Thus, your comments and opinions are always appreciated. PMID- 10134118 TI - The COC (Commission on Cancer): its roots and destiny. PMID- 10134119 TI - Project REMEDY (recovered medical equipment for the developing world): helping our colleagues around the world. PMID- 10134120 TI - Statements on Emerging Surgical Technologies and the Evaluation of Credentials. American College of Surgeons. PMID- 10134121 TI - An insider's view of integrated health care. Interview by Diane Schneidman. PMID- 10134122 TI - The Clinton reducing plan. PMID- 10134123 TI - The health care nose-counters. The secret to breaking the congressional logjam. PMID- 10134124 TI - Developing a facility strategy. AB - Successful planning for capital investment relies upon the ability of the management team to establish a cogent and comprehensive direction for facility development. The selection of an appropriate strategy integrates multiple issues: mission, service needs of the community, the external environment, the organization's ethos, current physical resources, operational systems, and vision. This paper will identify and discuss key components and data integral to formulating a facility strategy that outlines the basic direction for developing a facility master plan. The process itself will be presented as a working methodology that can be applied to the organization's resources and vision to generate a coherent facility strategy. PMID- 10134125 TI - Final notice regarding section 602 of the Veterans Health Care Act of 1992 entity guidelines--PHS. Final notice. AB - Section 602 of Public Law 102-585, the "Veterans Health Care Act of 1992," enacted section 340B of the Public Health Service Act, "Limitation on Prices of Drugs Purchased by Covered Entities." Section 340B provides that a manufacturer who sells covered outpatient drugs to eligible entities must agree to charge a price that will not exceed the amount determined under a statutory formula. The purpose of this notice is to inform interested parties of final program guidelines regarding eligible covered entities. PMID- 10134126 TI - Federal performance standard for diagnostic x-ray systems and their major components--FDA. Final rule. AB - The Food and Drug Administration (FDA) is issuing a final rule to amend the Federal performance standard for diagnostic x-ray systems and their major components (the performance standard). The amendments revise the limits established for maximum patient entrance exposure rates for fluoroscopic x-ray systems during high-level control and other modes of operation. The revisions are being made due to concerns regarding excessively large radiation exposure rates on some fluoroscopic x-ray systems. In addition, an inadvertent error is being corrected to improve the accuracy of the regulations. PMID- 10134127 TI - Impact of a target drug monitoring program on the usage of clindamycin. AB - The use of parenteral clindamycin at the Health Sciences Centre had not been amendable to traditional cost containment strategies. Clindamycin was targeted through a Target Drug Monitoring (TDM) Program to improve its appropriate use. A retrospective audit was conducted to serve as a baseline. In the concurrent phase, the TDM pharmacist reviewed and assessed clindamycin cases based on approved criteria. Those cases which failed to meet the criteria were targeted in order to convert clindamycin to alternative agents. The concurrent TDM program reviewed 339 cases of clindamycin over a 32-week period, of which 76 cases (22.4%) failed to meet the criteria and were targeted. Of the 76 recommendations, 48 (63.2%) were accepted. Cost-avoidance due to direct intervention was approximately $16,000 annualized compared to $28,000 estimated from the retrospective audit. Fiscal year-end antibiotic usage indicated a dramatic decline (32%) in clindamycin use. Net savings of $37,600 were attributed to modification of physician prescribing. The TDM program was successful in identifying areas of inappropriate clindamycin use and correcting them by direct interaction with the prescriber(s). PMID- 10134129 TI - Health care reform. The issues that drive the debate. PMID- 10134128 TI - A vancomycin drug use evaluation and economic analysis in a cancer treatment centre. AB - Princess Margaret Hospital is a 140-bed university affiliated cancer treatment centre. Vancomycin was the only formulary agent available for the treatment of methicillin-resistant gram-positive organisms. The high cost and potential toxicity of this drug warranted a closer examination of its use. The purpose of this study was to evaluate vancomycin use and to determine the economic impact when it was used contrary to newly developed hospital guidelines. A sample of 100 vancomycin orders was randomly selected from all prescriptions filled in 1992. The indication, dose, and duration of therapy for each order were compared against the hospital guidelines. The cost savings associated with altering the sample of prescriptions to meet hospital guidelines were then determined. Nine percent of the prescriptions were for nonapproved indications. The actual dose used did not meet criteria in 32% of cases and the length of therapy was beyond the approved duration in 45% of the orders. If the cases had been altered to meet the guidelines then a total savings of $13,581 would have been realized. The projected savings for the entire year (1992) would have been $100,907. The critical problem areas in vancomycin prescribing were the duration of therapy and dose. The results have provided the impetus to initiate a hospital wide prospective Drug Utilization Evaluation (DUE) study to optimize vancomycin prescribing. The program costs would be easily covered by the expected savings. PMID- 10134130 TI - Grass-roots groups: the town criers of health care reform. AB - If the myriad federal and state proposals for health care reform sometimes confuse those who provide health care, they often are even more mysterious to private citizens, whose tax dollars will invariably support a reformed system and who will be the ultimate purchasers of the care that it delivers. Some states are attempting not only to demystify the process for their residents but also to engage them in the reform debate. The following article, reprinted with permission from the November-December 1993 issue of State Government News, describes several such activities. It was brought to DPU's attention by Michelle Champoux, a social worker/consultant who has been active in the Vermont Ethics Network that the article describes. PMID- 10134131 TI - State-based reform: its implications for discharge planning. PMID- 10134132 TI - Continuing to care in changing times. Keynote address. AB - While oral presentations do not always translate well into print, the enthusiastic response of the audience to Bill Tietjen's keynote address to the 14th Discharge Planning Symposium, Oct. 23, 1993, prompted DPU to put this editorial maxim to the test. Considering the relevance of the symposium's theme to the upheavals that health care reform will invariably impose, we offer Tietjen's keynote address here, in a somewhat shortened version to accommodate the print medium. PMID- 10134133 TI - Health care reform. Examining the options for practice. PMID- 10134134 TI - Empowering employees through health care education: changing attitudes and behavior. PMID- 10134135 TI - Controlling utilization through a selective participation PPO. AB - A selective participation PPO, which blends the fee-for-service payment system with the HMO concept, may offer an effective approach to controlling dental care costs. PMID- 10134136 TI - Administrative costs for multiemployer welfare plans--a Midwest construction industry study. PMID- 10134137 TI - Outcomes management: a guide to a new language. PMID- 10134138 TI - Institutional pest management: current trends. AB - Insecticides and rodenticides will always be valuable tools in the pest control professional's battle against insect and vertebrate pests. But preventing and controlling pests in today's commercial and institutional facility has less to do with simply applying pesticides than it once did. Whether you are designing a pest control plan--or deciding which outside pest control contractor to hire- keep in mind that the best plan is not necessarily the one with the lowest price tag. Choose a service plan that includes pest exclusion, thorough inspections, and sanitation as first lines of defense against pests. Above all, make sure that the pest control plan you choose allows for plenty of communication between facility management and the people doing the actual pest control work. PMID- 10134139 TI - Violence in health care: institutional strategies to cope with the phenomenon. AB - Violence permeates every aspect of society, including the health care organization. Appropriate health care organizational response to the phenomenon of violence requires recognition that the emergence of violence is associated with patient, staff, situational, and environmental variables, and it is predictable in most instances. Effective management of violent patients requires comprehensive organizational policies, procedures, and protocols, combined with periodic staff training and retraining. Health care organizations and their personnel need to be knowledgeable about pre-assaultive clinical symptomatology, modification of staff behaviors and environmental factors with the goal of reducing the potential for violence, therapeutic interventions during both pre assaultive and violent phases of patient behavior, and quality assurance and risk management issues implicit in managing violent patients. PMID- 10134140 TI - Promoting the development of nurses' presentation and publication skills. AB - When nurses share their clinical knowledge with others through presentations and publications, new ideas emerge that could result in improved patient care. Nurses also gain opportunities for professional recognition and advancement through such pursuits. Managers are in a strategic position to promote the development of presentation and publication skills. This article describes a three-phase model that can help managers utilize appropriate strategies and resources to facilitate skills development. Each phase of development is designed to increase skill level, confidence, and experience. With managerial support, this model can help nurses learn to communicate effectively with colleagues through presentations and publications. PMID- 10134141 TI - Burnout and the nursing profession. AB - The nursing profession is extremely stressful. Career nurses are at risk of burnout from long-term exposure to overwhelming demands. The process of burnout creates serious consequences for both employees and their organizations. The employee with burnout can experience serious emotional and physical problems that can potentially lower productivity. Although the process of burnout has been examined, little has been done to determine the organizational and individual features that may distinguish between low, moderate, and high levels of burnout. This article attempts to explain the process of burnout, different levels of burnout, and organizational and attitudinal factors that may affect burnout. If specific job-related factors increase the likelihood of burnout, then the modification of these factors might actually decrease the incidence of burnout. PMID- 10134142 TI - Self-managed teams: the reality and the promise. AB - The success of self-managed teams depends on many factors. This article highlights issues related to effective team work in health care, including literature reports and interviews with nurse executives about the use of self managed teams in health care. Challenges for the future are presented. PMID- 10134143 TI - Termination of life-sustaining medical treatment: who should exercise a patient's right to die? AB - Due to changes in the medical field introduced by the biotechnological revolution that enable physicians to prolong a patient's life artificially, courts are increasingly being called on to resolve disputes between the families of incompetent patients and the hospitals and medical personnel who are caring for them. This article discusses the significant court decisions involving the right to die and analyzes the various legislative responses to this issue. It concludes that an individual who desires to determine the timing of his or her own death should execute a living will, coupled with a durable power of attorney or proxy directive. This method is the best currently available to control medical care, even in the event of future incompetence. PMID- 10134144 TI - Managing diversity. AB - The U.S. work force is becoming increasingly diverse as the 20th century approaches. Statistics prove that most organizations are experiencing gender, culture, and age diversity within their labor forces. All managers and leaders must accept this diversity and work to handle it effectively. This article examines the current literature concerning management of diversity and its implications for the health care profession. Gender, culture, and age diversity and the potential problems that may arise with each are also addressed. Reasons to manage diversity are offered, as well as methods of managing diversity for both the manager and the chief executive officer. PMID- 10134145 TI - Case management: managing the nurse case manager. AB - Nurse executives and nurse managers have become proactive in response to the health care crisis by creating and implementing innovative health care delivery models such as nursing case management. Nursing case management utilizes a nurse as case manager and the unit-based system of managed care to achieve financial and clinical outcomes for target patient groups. Nurse managers can support the nursing case management model best by practicing good managerial skills, developing a participative style of leadership, and empowering the nurse case manager. PMID- 10134146 TI - If I could do it all over again. AB - Real life experiences were used to put together this list of steps to be followed during the planning and implementation of a formal MRP II planning and control system. Project management and organizational skills are critical to the success of the project. The implementation plan is carried out by a project team and subcommittees with the support of top management. Cost/benefit analysis and performance measurements need to be monitored to ensure that business objectives continue to be met. PMID- 10134147 TI - How to unlock the benefits of MRP (materiel requirements planning) II and Just-in Time. AB - Manufacturing companies need to use the best and most applicable parts of MRP II and JIT to run their businesses effectively. MRP II provides the methodology to plan and control the total resources of the company and focuses on the processes that add value to their customers' products. It is the cornerstone of total quality management, as it reduces the variability and costly activities in the communication and subsequent execution of the required steps from customer order to shipment. JIT focuses on simplifying the total business operation and execution of business processes. MRP II and JIT are the foundations for successful manufacturing businesses. PMID- 10134148 TI - How to get top management support for MRP (materiel requirements planning) II. AB - Getting top management support for materiel requirements planning (MRP) is not impossible. When senior management supports the effort, the success rate skyrockets and companies experience results that improve their bottom-line performance. This article describes a step-by-step process for gaining top management's commitment to the effort. PMID- 10134149 TI - The path to successful MRP (materiel requirements planning) package selection. AB - The vendor demonstration is usually nothing more than a glorified sales presentation and is of little value in judging how close a fit a software package is to your company's requirements. In order to turn the demonstration from a sales pitch into a tool for determining if the package meets your requirements, you must take control of the demonstration. The way to take control is to tell the vendor exactly what you expect to see during the demonstration and that the package will be judged on whether it is shown to meet each of your requirements. The way to tell the vendor what you want to see is by use of a "script." By using a scripted demonstration, the presentation becomes a tool in the selection process. PMID- 10134150 TI - MRP (materiel requirements planning) II education: a team-building experience. AB - Conestoga Wood Specialties, a leader in the woodworking industry, is constantly striving for continuous improvement in manufacturing and service. Recently, the company embarked on a major MRP II education effort that served as a framework for team building. This team building concept has carried over into other aspects related to the business, such as the formalization of the sales and operations planning meeting. At Conestoga Wood, it is recognized that successful team building is necessary to achieve and maintain world-class performance. PMID- 10134151 TI - MRP (materiel requirements planning) II: successful implementation the hard way. AB - Many manufacturing companies embark on MRP II implementation projects as a method for improvement. In spite of an increasing body of knowledge regarding successful implementations, companies continue to attempt new approaches. This article reviews an actual implementation, featuring some of the mistakes made and the efforts required to still achieve "Class A" performance levels. PMID- 10134152 TI - MRP (materiel requirements planning) II implementation: a case study. AB - Manufacturing resource planning (MRP II) is a powerful and effective business planning template on which to build a continuous improvement culture. MRP II, when successfully implemented, encourages a disciplined yet nonthreatening environment centered on measurement and accountability. From the education that accompanies an MRP II implementation, the employees can better understand the vision and mission of the organization. This common goal keeps everyone's energy directed toward the same final objective. The Raymond Corporation is a major materiels handling equipment manufacturer headquartered in Greene, New York, with class "A" MRP II manufacturing facilities in Greene and Brantford, Ontario and an aftermark distribution facility in East Syracuse, New York. Prior to the implementation of MRP II in its Greene plant (from 1988 through 1990) good intentions and hard work were proving to be less than necessary to compete in the global market. Certified class "A" in February 1990. The Raymond Corporation has built a world-class organization from these foundations. PMID- 10134153 TI - Read my lips--no more late deliveries. AB - Over 70,000 materiel requirements planning (MRP) and manufacturing resource planning (MRP II) systems have been implemented in this country in the last 20 to 30 years. Yet the question many of the companies who own these systems are asking is, "Was it worth it?" Less than a third of the companies are answering in the affirmative. Two key differences between the satisfied and the not-so-satisfied companies are (1) support to the user community and (2) management involvement in the day-to-day use of the system. Without these two items, the improvements brought about by an MRP or MRP II system will most likely be mediocre at best. PMID- 10134154 TI - The people side of MRP (materiel requirements planning). AB - A montage of ideas and concepts have been successfully used to train and motivate people to use MRP II systems more effectively. This is important today because many companies are striving to achieve World Class Manufacturing status. Closed loop Materiel Requirements Planning (MRP) systems are an integral part of the process of continuous improvement. Successfully using a formal management planning system, such as MRP II, is a fundamental stepping stone on the path toward World Class Excellence. Included in this article are techniques that companies use to reduce lead time, simplify bills of materiel, and improve schedule adherence. These and other steps all depend on the people who use the system. The focus will be on how companies use the MRP tool more effectively. PMID- 10134155 TI - Integrating MRP (materiel requirements planning) into modern business. AB - Time is the commodity of the '90s. Therefore, we all must learn how to use our manufacturing systems to shorten lead time and increase customer satisfaction. The objective of this article is to discuss practical ways people integrate the techniques of materiel requirements planning (MRP) systems with just-in-time (JIT) execution systems to increase customer satisfaction. Included are examples of new ways people use MRP systems to exemplify the process of continuous improvement--multiple items on work orders, consolidated routings, flexing capacity, and other new developments. Ways that successful companies use MRP II for planning and JIT for execution are discussed. There are many examples of how to apply theory to real life situations and a discussion of techniques that work to keep companies in the mode of continuous improvement. Also included is a look at hands-on, practical methods people use to achieve lead time reduction and simplify bills of material. Total quality management concepts can be applied to the MRP process itself. This in turn helps people improve schedule adherence, which leads to customer satisfaction. PMID- 10134156 TI - Integrating MRP (materiel requirements planning) II and JIT to achieve world class status. AB - The concepts and principles of using manufacturing resource planning (MRP II) for planning are not new. Their success has been proven in numerous manufacturing companies in America. The concepts and principles of using just-in-time (JIT) inventory for execution, while more recent, have also been available for some time, and their success in Japan well documented. However, it is the effective integration of these two powerful tools that open the way to achieving world class manufacturing status. This article will utilize a newly developed world class manufacturing model, which will review the aspects of planning, beginning with a business plan through the production planning process and culminating with a master schedule that drives a materiel/capacity plan. The importance and interrelationship of these functions are reviewed. The model then illustrates the important aspects of executing these plans beginning with people issues, through total quality control (TQC) and pull systems. We will then utilize this new functional model to demonstrate the relationship between these various functions and the importance of integrating them with a total comprehensive manufacturing strategy that will lead to world-class manufacturing and profits. PMID- 10134157 TI - Capacity management: get the level of detail right. AB - The objective of this article is to outline the three main stages of manufacturing planning where capacity analysis is employed and to highlight the differences in approach and level of detail required for capacity analysis at each stage. Capacity management is not a single discipline or function. Rather, the term takes on meaning within the context of the planning job it is supporting. There are significant differences between the objectives and output of each planning stage and consequently, there is a need to adjust the approach and level of detail employed in capacity analysis and scheduling depending on the stage. In effect, the typical manufacturing company doesn't have one planning or capacity management challenge; it has several. Thus, when seeking solutions to planning or capacity problems, a company must first decide which problem it wants to attack and then select the peopl/tool combination best suited to handle the level of detail involved. PMID- 10134158 TI - War games: using MRP (material requirements planning) audits to pinpoint problems and keep the competitive edge. AB - In today's world, it is a challenge just to stay in business, let alone remain competitive in a specific industry. We will show you how to pinpoint MRP II problems and attack them through self-assessment audits. You will discover the secrets of breaking down barriers between Master Schedulers, Material Planners, Production Control Planners, and the Manufacturing Line. Self-assessment audits are one way to take care of your planning functions before outside auditors take care of them for you. PMID- 10134159 TI - Artificial intelligence: boon to practice or threat to autonomy?. Interview by Diana Madden. PMID- 10134160 TI - How one medical center uses informatics to improve value. PMID- 10134161 TI - Training internists to be humanistic and cost-effective. Interview by C. Burns Roehrig. PMID- 10134162 TI - Fighting the curve balls early in the Congressional season. PMID- 10134163 TI - Alice-in-Wonderland health reform. PMID- 10134164 TI - How do you measure a good internist? PMID- 10134165 TI - The physician workforce needs more than a shuffle and a split. PMID- 10134166 TI - An internist's checklist for choosing an office computer. PMID- 10134167 TI - Breaking down the barriers to computerizing your practice. PMID- 10134168 TI - Community care. Breaks in the chain. AB - Tension and conflict between GPs and social services have dogged community care reforms. Bob Hudson suggests how the links can be strengthened. PMID- 10134169 TI - Fundholding. A fund of good ideas. PMID- 10134170 TI - Primary care. Performing arts. PMID- 10134171 TI - The pharmacy as part of an integrated hospital information system: a focus on benefits. AB - An integrated hospital information system benefits not only the pharmacy but also each department within a hospital, including the physician and patient. The Composite Health Care System (CHCS) is a fully integrated healthcare information system that has been developed for the Department of Defense's medical treatment facilities. CHCS provides modules for Patient Administration, Patient Appointment Scheduling, Radiology, Laboratory, Pharmacy, and Physician/Nursing Order Entry and Results Retrieval, which serve to integrate inpatient wards, clinical services, administrative departments, and remote outpatient clinics. CHCS provides an integrated patient profile to care givers throughout the medical facility, improving the quality of their clinical decisions. The integrated hospital information system also helps to coordinate the delivery of patient care and automates many interdepartmental transactions, which allows for more efficient use of resources and increases the turnaround time for delivery of services. This article focuses on the system's pharmacy component to demonstrate the benefits realized with an integrated hospital information system. PMID- 10134172 TI - Improved total parenteral nutrition therapy management by a nutritional support team. AB - This study was performed to identify and document the benefits associated with a multidisciplinary consult-based nutritional support team. The adequacy of nutritional support and incidence of metabolic complications were prospectively studied in 28 adult patients receiving total parenteral nutrition in a large private tertiary care institution during a 2-week period. Estimated daily caloric and protein requirements were met significantly more often in patients followed by our NST than in control group patients. Chloride and bilirubin abnormalities occurred significantly less often in the NST group than in the control group. The incidence of blood urea nitrogen, creatinine, and glucose abnormalities were also decreased in the NST patients, but these differences were not statistically significant. Patients followed by the NST were more likely to receive adequate nutrition and experience fewer metabolic abnormalities than when TPN therapy was guided solely by a physician. PMID- 10134173 TI - Milestones in immunologic history, antiquity to 1919. PMID- 10134174 TI - Hospitals face aftershock from health reform. PMID- 10134175 TI - Development of a computerized controlled substances system. AB - Maintaining controlled substances records are a required and tedious task. A computerized system was developed to meet both pharmacy and nursing needs. The original system consisted of several notebook binders that were tabbed to separate different controlled substances. Pharmacy was constantly dealing with transcription errors and incorrect calculations. In the computerized program, each controlled substance was assigned its own file and mnemonic. The computer allowed for entries and maintained a running inventory. The troubleshooter pharmacist's role was redefined to oversee of the entire system, to have sole access to the entire system, and to maintain a weekly inventory. Improvements also were made in the nursing procedure, which provided a sufficient stock of controlled substances. A new, consolidated nursing form also was devised. The primary reason that the computerized system is successful is that it accommodates the needs of both nursing and pharmacy. PMID- 10134176 TI - Prospective patient-controlled analgesia quality assurance: one year's experience. AB - The goal of this project was to develop a prospective patient-controlled analgesia (PCA) quality assurance (QA) program and evaluate its impact on patient care. Initial elements selected for inclusion into the QA were: patient satisfaction, pain relief, clarity of instructions, respiratory rate, and nausea and vomiting. Standards were initially set at 100% with the exception of nausea and vomiting, which was 90%. Preliminary evaluation in 26 patients indicated initial standards were unrealistically high. Standards were revised to 90% for all elements except respiratory rate, which was left at 100%. Nausea and vomiting were eliminated from the QA because it was difficult to establish a cause and effect relationship with narcotic. Data were collected through patient interviews and chart reviews on a bimonthly basis. Cumulative data on 297 patients revealed standards were met in all categories. Two systematic problems identified early in the QA were that there was no recording of respiratory rate and there was a high incidence of unclear instructions. As a result of pharmacist interventions, outcomes improved. Patient outcomes with PCA therapy can be improved using a prospective PCA QA program. Pharmacy Department's without resources for daily monitoring of PCA patients should consider implementing a prospective PCA QA program. PMID- 10134177 TI - Combating pharmacist shortage through labor certification. AB - Several solutions, ranging from increased technician duties to salary raises, automation, and increasing job satisfaction, have been presented in the literature as methods of assuaging the pharmacist shortage. Although a significant portion of pharmacy graduates from American pharmacy colleges are foreign nationals, no marketing strategies have been elucidated in the retention and recruitment of foreign nationals through labor certification. Labor certifications are generally approved by the Secretary of Labor if the following factors have been verified: 1) there are not sufficient United States workers who are able, willing, qualified, and available for employment; and 2) the employment of the foreign national will not adversely affect the wages and working conditions of U.S. workers similarly employed. When properly understood, the labor certification process is a test of the job market where foreigners, by virtue of their skills and qualifications, attain certification which subsequently leads to permanent residency (green card). The objective of this report is to elucidate the tedious yet effective method of retaining American educated foreign nationals through labor certification. PMID- 10134178 TI - Developing and implementing guidelines to promote appropriate use of fluconazole therapy in an AIDS clinic. AB - A retrospective and concurrent drug use evaluation for fluconazole in an outpatient AIDS clinic is described. Eighty-eight patient charts were reviewed in the evaluation during an 8-week period, and 72 patients were studied in the concurrent evaluation for a period of 5 weeks. A set of preestablished fluconazole usage and dosing guidelines was developed by the clinical pharmacist and the chairman of the antimicrobial subcommittee/chief of infectious disease and approved by the pharmacy and therapeutics committee. Patients who did not meet these guidelines were those being treated for oropharyngeal and esophageal candidiasis. The use of fluconazole was not indicated in 43 of 54 (80%) patients in retrospective evaluation and 31 of 39 (79.5%) patients before clinical pharmacist intervention in concurrent study. If guidelines had been followed during the retrospective evaluation, cost savings would have been $295 per day, which adds up to $16,520 for 8 weeks. In the actual evaluation, the cost savings with pharmacist intervention for 5 weeks was $5,460, which can be extrapolated to annual cost savings of $65,520. PMID- 10134179 TI - Milestones in immunologic history: 1920 to 1959. PMID- 10134180 TI - The unhealthy uninsured. PMID- 10134181 TI - Washington State mandates long-term care in its healthcare reform plan. PMID- 10134182 TI - Catholic hospitals treat increasing numbers of patients with AIDS. PMID- 10134183 TI - Interest group politics determines power players in reform debate. PMID- 10134184 TI - Systems merger will help preserve a Catholic presence in Baltimore. PMID- 10134185 TI - Not-for-profits' role in a reformed system. AB - As head of the White House task force that helped to craft President Bill Clinton's healthcare reform proposal (the Health Security Act), First Lady Hillary Rodham Clinton demonstrated her determination that reform result in a system that has caring and service at its center. In an address a year ago at the Catholic Health Association assembly, she stressed the administration's goal of providing the security of healthcare coverage to everyone in the United States. Saying the current complex, disjointed system "fragments the care people receive," the First Lady applauded programs that reach out to underserved populations and strengthen the country's healthcare infrastructure. In this interview with Health Progress, Mrs. Clinton discusses tough issues in achieving the system she envisions and the role of Catholic healthcare organizations in a reformed system. Here are her remarks. PMID- 10134186 TI - Leadership for the Catholic healing ministry. A CHA study identifies key competencies of outstanding leaders in Catholic healthcare. PMID- 10134187 TI - A model for future healthcare leadership. CHA's competency study provides a practical tool for leadership development. AB - The Catholic Health Association's (CHA's) study "Transformational Leadership for the Healing Ministry: Competencies for the Future" is a powerful tool for the identification and development of leaders in Catholic healthcare. The study can help executives measure their own performance against a standard of excellence and establish goals to improve their performance. Trustees can use the study to establish policies for identification, assessment, development, and career planning for senior executives. Sponsors might consider the competencies as they intensify collaboration in ministry with lay colleagues by encouraging leadership development or as they participate with trustees in the selection of executives. The model presented in CHA's study is dynamic and adaptable to the leadership needs of various organizations. It should not yield a homogenized view of the "ideal" leader in the Catholic ministry. Nor should it encourage elitism or invidious comparisons between leaders or organizations. PMID- 10134188 TI - A synergy of values. Catholic healthcare leaders must implement their organization's mission and model its values. AB - Catholic organizations need to select, develop, and retain healthcare leaders who dedicate themselves to carrying on the Church's healing ministry and the work begun by those who have preceded them. Persons entrusted to carry on Jesus' healing mission perform their duties out of a sense of commitment to the ministry and a love for the persons with whom they work and whom they serve. They recognize a synergy between their own values and the values of the healthcare organizations they lead. Dedication to leadership in Catholic healthcare can be viewed from three perspectives: the Bible and selected documents of the Catholic Church; the transfer of responsibility for Catholic healthcare from religious congregations to evolving forms of sponsorship; and the implications for the selection, development, and retention of healthcare leaders, both lay and religious. Servant-leadership is an integral part of the religious tradition that underlies Catholic healthcare. As cooperation increases between healthcare providers, third-party payers, employers, and other healthcare agents. Catholic healthcare organizations are challenged to reassert a mission and values that will enable healthcare in the United States to be delivered both compassionately and competently. PMID- 10134189 TI - How to honor operations. Healthcare leaders have a new role in the changing system. AB - Healthcare executives are no longer present as coaches, leaders, or the visible personification of their institutions' values. Instead, they are engaged in a battle for survival, immersed in the compelling changes required to design a better delivery system. "Honoring operations" is a poignant phrase to describe a sum of intangibles that adds up to the moral goodness within many Catholic and mission-driven organizations. The coordination of care and excellence for those we serve happens at a microscopic level. It happens nearly, but not totally, independent of managers' delusions that they make it happen. Healthcare leaders' most powerful act is to value the intangible gifts of those who carry out the tasks that add up to today's complex healing. By honoring operations, healthcare executives sustain excellence at the microscopic level, which is where it counts for the patient. Some suggestions for honoring operations are establishing inviolate core rituals of honor, forming one-on-one relationships with physicians, maintaining a core presence, communicating in the language of meaning, and speaking on the value of good medicine and good caring. PMID- 10134190 TI - Delivery reform tops executives' concerns. Healthcare leaders focus on the move toward consolidation. Roundtable discussion. PMID- 10134191 TI - The IRS looks closely at homes for the aging. Organizations must be prepared to face increased scrutiny on tax-exempt status and financing. AB - Tax-exempt status has long been perceived as appropriate for the traditional retirement home (i.e., congregate housing and life-care facility), which serves the elderly and typically experiences low profit margins. An organization that is both organized and operated exclusively for religious, charitable, scientific, literary, or educational purposes or for testing for public safety may qualify for tax-exempt status under Internal Revenue Code section 501(c)(3). The Internal Revenue Service uses the generic term "homes for the aging" to include all forms of retirement housing facilities (except nursing homes that solely provide the highest level of nursing care). A home for the aging that qualifies under section 501(c)(3) (through satisfaction of the organizational and operational tests) will qualify for charitable status for federal tax purposes if it operates to satisfy the following basic needs of aged persons: suitable housing, healthcare, and financial security. In general, not-for-profit organizations recognized as exempt under code section 501(c)(3) may be eligible for tax-exempt financing to develop a home for the aging through the issuance of tax-exempt bonds. Effective tax exemption planning is a necessary part of the business planning process by sophisticated not-for-profit organizations that own and operate (or desire to own and operate) charitable homes for the aging and similar housing facilities serving the elderly. The benefits of exempt status remain attractive for many such organizations. The challenge of obtaining and maintaining that status is becoming far more burdensome. PMID- 10134192 TI - New facility offers comprehensive, convenient care. PMID- 10134193 TI - Avoiding "unnecessary" healthcare services. PMID- 10134194 TI - Catherine McAuley Health System. Respecting and celebrating cultural diversity. PMID- 10134195 TI - A Catholic case for healthcare reform. PMID- 10134196 TI - A survey of CE/BMET attitudes. AB - This article presents the results of a survey designed to assess current Biomedical/Clinical Engineering attitudes. Issues discussed include separating biomedical/clinical services from engineering/maintenance services; certification; factors affecting salary levels; and whether technicians should use the "engineer" title. The opinions presented are meant to stimulate discussion among individual BMETs and CEs, and within clinical engineering departments. PMID- 10134197 TI - Update on methods & simulators for evaluation of noninvasive blood pressure monitors. AB - The development of methods and simulators for evaluating noninvasive blood pressure (NIBP) monitors has been dynamic during the past few years. As a complement to a previous review paper in this journal, several additional developments are reported in this paper. These include evaluation methods developed in Australia, the United States and Europe, as well as NIBP simulators developed in Germany and the United States. PMID- 10134198 TI - Use of maintenance insurance to minimize costs. AB - Hospitals are under tremendous pressure to compete for growth and survival. Increasing focus on the importance and criticality of cost containment has placed a much greater emphasis on the need to improve the cost effectiveness of healthcare facilities. All Clinical Engineering departments will be faced with intense financial pressures from administrators. In the area of equipment maintenance, besides four traditional approaches, maintenance insurance is a relatively new approach. It can be an effective method to save significant amounts of money for the hospital, depending on how it is administrated, cooperation of the authorized departments, the role of the administrator and choice of insurance carriers. PMID- 10134199 TI - Trends in health care computing. PMID- 10134200 TI - Technology management process. PMID- 10134201 TI - A survival guide for implementing new health care technology. PMID- 10134202 TI - Telemedicine on the move: health care heads down the information superhighway. AB - Telemedicine has drawn increasing attention as one of the emerging new service delivery vehicles that will run on the information superhighway. In reality, remote diagnosis and consultation through the application of telecommunications technology have been practiced for many years. But advances in technology and reform imperatives to extend access beyond traditional boundaries are pushing telemedicine into new applications. This is evidenced by the explosion in the number of pilot projects begun within the last 12 months. While demonstrating telemedicine's growing capabilities--for education and administration, as well as medical practice--these projects also raise a number of legal, clinical, and technical questions that must be answered before government and other payers will routinely reimburse for remote services. Academic and industry consortia are springing up to deal with the most compelling issues, including documenting telemedicine's safety and efficacy, developing uniform data and transmission standards, and determining the minimum resolution needed to maintain the integrity of clinical transmissions. Almost every type of medical specialty has proved amenable to performing evaluations via telemedicine links; however, specialties with less direct patient contact, like radiology and pathology, are generally identified as better candidates for telemedicine interactions. The telemedicine equipment required for these consults ranges from the simple to the ultra-sophisticated, depending on the type of system used and its clinical application. The most common system configuration involves a base station in the main facility where specialists and other consultants are housed and a number of remote referral sites. Consults are performed by interactively sharing voice, video, or image data. Increasingly, systems are being introduced that use easy-to learn, intuitive displays and controls. Systems also require the use of any number of different communication media including land-based wire networks, high speed fiberoptics, microwave links, or satellite transponders. Quantum leaps in telemedicine performance are being made constantly, many being swept along as a result of intensified interest in developing similar consumer and business services that are destined for the new information highway. In addition to information infrastructure projects, telemedicine has also recently benefitted from the effects of defense reinvestment, political interest in cost-reducing technologies, increased availability of funding for pilot projects, and the emergence of multifacility, multitiered, integrated delivery systems. Technical, financial, and logistical factors, which had once worked against telemedicine feasibility, are suddenly shifting to rapidly propel telemedicine technologies out of investigational settings and into mainstream clinical practice. PMID- 10134203 TI - Computer systems. Which system for GPs? AB - With over 100 systems to choose from, buying a computer system for use in general practice can be a difficult and arduous task. The Department of Health provides some guidelines to try and ease the problem, but there is very little empirical evidence which buyers can use to help them make decisions. Cathy Bakewell and Peter Turnbull describe some research which might help. PMID- 10134204 TI - Accrediting health records. AB - Efficient and effective patient care can be dependent upon the quality, as well as accessibility and timeliness, of medical records. Dina Tetlow outlines a health records accreditation programme in the south west. PMID- 10134205 TI - Hospital records--asset or liability? AB - Health records of different sorts have been shown--in one region--to cost 13m pounds a year, and to take up 10 miles of shelving. Across one region, records would take up the length of the M4. Terry Gould and colleagues describe a project to establish some protocols for sensible record keeping. PMID- 10134206 TI - Reforming health care in The Netherlands. AB - Health reforms in The Netherlands have been introduced into a very different environment but with similar aims: efficient, effective, high quality care that addresses the needs of individual patients. Anne-Marie te Maarssen and Richard Janssen outline progress so far. PMID- 10134207 TI - Management ... working day of a health services manager. Plymouth Community Services NHS Trust. AB - Rae Wallin is Director of Personnel, Plymouth Community Services NHS Trust, a trust with 2000 staff and a budget of 40m pounds. Ideally, work and home life are strictly compartmentalised but this does not always happen in practice; there is a challenge in balancing the needs of both. Senior managers are under enormous pressure in today's NHS; for women, Opportunity 2000 has not yet really changed things. PMID- 10134208 TI - How self-referrals can go sour. The travails of T2 and its doctor investors. PMID- 10134209 TI - How liability fears inflate health costs. PMID- 10134210 TI - We demand a lot from our staff--and get it. PMID- 10134211 TI - Our happy switch to HMO employment. PMID- 10134212 TI - Health reform: who's waiting on the Feds? PMID- 10134213 TI - Get the news media on your side. PMID- 10134214 TI - Traveling the information superhighway. AB - What is this highly publicized but somewhat mysterious information superhighway, and what are its implications for health care? This article will spell out how the concept of the information superhighway will dramatically change the flow of information, and how it could effect virtually every household, every business, and every hospital in the United States. PMID- 10134215 TI - Community forum provides citizens with a voice. AB - Catherine McAuley Health System provides a first-hand account of what exactly is involved in sponsoring a community forum on health care reform. For those interested in learning from the experience of others, this article will provide an opportunity to get a real insider's perspective. PMID- 10134216 TI - The politics of health care reform. PMID- 10134217 TI - The Rural Health Project: Michigan's rural communities test health care reform. AB - Learn about a new community development project for rural health and the MHA Michigan Health Care Institute's involvement in housing and administering this $1.5 million rural community-based project. PMID- 10134218 TI - "There's gold in them there halls!". PMID- 10134219 TI - 1994: the health reform puzzle comes together. AB - Policy decisions to help the health care reform puzzle come together in the upcoming year require key information about hospitals and health care. The information contained in this year's annual data article illustrate the current status and the historical trends in hospitals and health care in Michigan. In addition, issues surrounding health care reform and measures of health status in Michigan are highlighted. PMID- 10134220 TI - Columbia/HCA signs another not-for-profit. PMID- 10134221 TI - Mass. plan guarantees quality. PMID- 10134222 TI - Midwest Blues' merger called off. PMID- 10134223 TI - N.J. Blues entering new markets. PMID- 10134224 TI - Catholic hospital, private facility in Mass. closer to consolidation. PMID- 10134225 TI - Kan. hospital plans merger with competitor. PMID- 10134226 TI - Kan. psychologist, clinic indicted. PMID- 10134227 TI - Neb. judge reverses CON denial. PMID- 10134228 TI - Indiana cuts await ruling. PMID- 10134229 TI - Regional networks proposed for N.Y. PMID- 10134230 TI - Rosty's woes may not sink reform. PMID- 10134231 TI - Study details Cooper plan's impact. PMID- 10134232 TI - Not-for-profits up for grabs by the giants. AB - Continuing the consolidation in healthcare, hospitals that for decades have been the cornerstones of the not-for-profit sector--teaching facilities, Catholic hospitals and other church-affiliated institutions--are for the first time considering deals with for-profit chains. PMID- 10134233 TI - O'Leary gets vote of confidence. PMID- 10134234 TI - N.C. physicians in seller's market. PMID- 10134235 TI - Air ambulances, hospitals renegotiate. PMID- 10134236 TI - Quality assessment strategy should be applied consistently. PMID- 10134237 TI - Receivables management firm melds 2 foundering companies. PMID- 10134239 TI - Execs' opinion of JCAHO slips. PMID- 10134238 TI - Nurses' labor rights narrowed. PMID- 10134240 TI - Cost increase rate slows--survey. PMID- 10134241 TI - Columbia, MCA deal to attract more docs. PMID- 10134242 TI - Surgical Care Affiliates seeking other partners. PMID- 10134243 TI - Pa. chain makes $44 million deal. PMID- 10134244 TI - Connecticut law would establish office to study universal coverage. PMID- 10134245 TI - High court ruling may aid public hospitals. PMID- 10134246 TI - Congress halts VA reorganizing plan. PMID- 10134247 TI - Calif. Blue Cross plans to give $100 million to charity in 1994. PMID- 10134248 TI - O'Leary to visit Tenn. rural hospital group. PMID- 10134249 TI - NRHA (National Rural Health Association) Foundation campaign begins. PMID- 10134250 TI - Will Rosty's lesser role reduce likelihood for reform? PMID- 10134251 TI - Beverly shareholders nix lawsuit disclosure. PMID- 10134252 TI - HCFA revises labor-market plan. PMID- 10134253 TI - New definitions, perceptions needed in healthcare debate. PMID- 10134255 TI - Information systems. Vendor consolidations can slash high cost of selling. PMID- 10134254 TI - Church puts faith in system mergers. AB - The trend toward consolidation isn't passing Catholic healthcare facilities by, but they face unique concerns in teaming with non-Catholic partners. Catholic hospital leaders are striving to follow church directives and keep focused on their mission. PMID- 10134256 TI - AHA schedules moves for August. PMID- 10134257 TI - Dallas council may sue for lost funds. PMID- 10134258 TI - Town meetings a new outlet for hospitals. PMID- 10134259 TI - Venture capitalists up interests in niche healthcare services firms. PMID- 10134260 TI - 30% of HMOs reviewed earn full accreditation--NCQA (National Committee for Quality Assurance) PMID- 10134261 TI - Calif. sues U.S. over illegal alien care. PMID- 10134262 TI - Computer vendor buys DuPont unit. PMID- 10134263 TI - Lab giant Corning buys competitor. PMID- 10134264 TI - To complete Utah deal, HealthTrust may divest planned anchor hospital. PMID- 10134265 TI - Houston providers mull affiliations. PMID- 10134266 TI - Mass. providers chip in to fund primary care. PMID- 10134267 TI - State wage-index changes look iffy. PMID- 10134268 TI - GHAA readies push to educate Congress on managed care. PMID- 10134269 TI - Judge overrules Miss. CON approval. PMID- 10134270 TI - Feds may reinstate plea bargain. PMID- 10134271 TI - Cleveland hospital will pay $500,000 to settle fraud case. PMID- 10134272 TI - VA considers options to reduce personnel. PMID- 10134273 TI - As HMOs know, the key is customer satisfaction. PMID- 10134274 TI - Group insurance. AB - Health insurers that traditionally have been dominant in the indemnity business are bypassing partnerships with hospitals and physicians and are building their own medical groups. The new relationships bring benefits for all parties. PMID- 10134275 TI - Mandates imperil reform effort. PMID- 10134276 TI - Creation of new HMOs picks up steam, fueled by reform, market forces. PMID- 10134277 TI - Restraint on use of antibiotics urged. PMID- 10134278 TI - For-profit hospitals back FTC in Fla. case. PMID- 10134279 TI - AHA works to slow dues increases. PMID- 10134280 TI - St. Louis system grows with merger. PMID- 10134281 TI - N.J. health information network in works. PMID- 10134282 TI - States fuss over Boren. PMID- 10134283 TI - Nurses step to the fore in reform efforts. PMID- 10134284 TI - Tax options for buyers. PMID- 10134285 TI - Advertising's legal headaches. PMID- 10134286 TI - A look at subacute. PMID- 10134287 TI - Enhancing staff skills. PMID- 10134288 TI - The home care dilemma--pro/con. PMID- 10134289 TI - Do you need a consultant? PMID- 10134290 TI - What do new physicians want? Security and improved lifestyles drive physician recruiting. PMID- 10134291 TI - Merger plans--when to go public. PMID- 10134292 TI - Trustees and PCs: the computer will be the board's best friend. PMID- 10134293 TI - Internal vs. external management of your hospital's investments. PMID- 10134294 TI - Shedding light on board practices. PMID- 10134295 TI - Integration affects physician income: survey. PMID- 10134296 TI - Taking charge of our future. PMID- 10134297 TI - Americans favor market-driven reform, according to phone survey. PMID- 10134298 TI - The whole is greater than the sum of its parts. Two leading academic medical centers form a health care system. Interview by Karen Gardner. PMID- 10134299 TI - Wanted: conscientious trustees for ongoing political advocacy. PMID- 10134300 TI - Dealing with that 'corporate culture thing'. Can post-merger corporate cultures successfully integrate? PMID- 10134301 TI - Healthcare reform poses unanswered questions. PMID- 10134302 TI - Tip of the iceberg. PMID- 10134303 TI - Progressive cerebral dysfunction in a 17-month-old child. PMID- 10134304 TI - Response from the ethics committee of Wolfson Children's Hospital (Jacksonville, Florida) AB - In summary, our HEC believes that the medical staff and family made an appropriate decision to withdraw therapy following a thorough procedural review. However, we also believe that had the HEC been reapproached on learning that the medical resident's comments were overheard, the unwanted and unnecessary governmental intrusion could have been avoided. Government intervention in this case led to legal entanglements as well as unwanted publicity. In the end, the parents' decision was upheld by the child protection agency and the courts. A more timely re-review with the HEC might have prevented a five-week delay in carrying out an ethically appropriate and permissible decision. PMID- 10134305 TI - Point and counterpoint. Do HECs have a responsibility to the non-medical community rather than only to the institution, physician, and patient? PMID- 10134306 TI - Ethics committees in Greece. PMID- 10134307 TI - Hospital ethics committees in practice: the case review function of four HECs in Connecticut. PMID- 10134308 TI - Case consultation: paying attention to process. PMID- 10134309 TI - Maternal-fetal conflict: a role for the healthcare ethics committee. PMID- 10134310 TI - When information is key to survival: breathing life into respiratory care. PMID- 10134311 TI - 1994 P.O.C. review. New technologies mean a cable-free future for point-of-care systems. PMID- 10134312 TI - The impact of clinical decision support on managed care. PMID- 10134313 TI - Technology on the move: eliminating paper at the point of care. PMID- 10134314 TI - Open systems architecture: how to make it work. PMID- 10134315 TI - Systems integration: does it benefit the physician user? PMID- 10134316 TI - Lock it up but don't throw away the key. Lockout/tagout: the second most common OSHA violation for healthcare facilities. PMID- 10134317 TI - Hospitals and local emergency planning. PMID- 10134318 TI - Why medical savings accounts deserve a closer look. AB - Dismissed as a luxury only for the young or wealthy, medical savings accounts could be used by a majority of Americans--who are neither poor or chronically ill -to make cost-conscious choices about their health care. Current federal tax laws and insurers' inability to sell catastrophic group coverage policies pose obstacles to their widespread use and should be removed. PMID- 10134319 TI - The Health Reform Consensus Act: proceed with caution. AB - Congress must seize the opportunity President Clinton has created to make some long-needed changes to the nation's health system. But we can't afford the expensive and experimental measures contained in the Clinton bill or in the other measures now being debated in Congress. What we can do this year is pass measures that revamp the insurance market, expand access to the uninsured through community health centers, eliminate administrative burdens, and reform our medical malpractice and antitrust systems. PMID- 10134320 TI - Medicare Part C: tossing another cost cap into the ring. AB - Rejecting the Clinton Administration's call for mandatory health alliances, a key congressional panel recently passed a bill that expands the Medicare program to cover low-income and uninsured Americans. While some have criticized the bill's cost-containment provisions, the panel agreed that universal coverage cannot be achieved without a national health budget. PMID- 10134321 TI - Gaps in Medicare doctors' fees narrow: other disparities grow. PMID- 10134322 TI - Do health reform polls clarify or confuse the public? AB - No wonder Americans are confused about which health reform proposal would best solve the country's needs. Many opinion polls conducted this year by the major news networks have focused on the public's approval of specific elements in the Clinton health plan, while ignoring its perception of the problem and alternative solutions. For polls to offer useful information to policymakers, pollsters must determine what the public wants, what it knows, and what paths it favors to reach those goals. PMID- 10134323 TI - Americans compare managed care, Medicare, and fee-for-service. AB - Are all health plans created equal? A recent survey of 1,000 adults queried Americans about their experiences with managed care, the Medicare program, and traditional fee-for-service medicine. Most Americans said they generally are content with their arrangements, but Medicare patients reported the highest level of satisfaction. Managed care consumers said they are generally pleased with their care, but they reported some problems with their specialist care. Overall most Americans are not looking for a completely new health care system. PMID- 10134324 TI - Employers size up state health reform solutions. AB - Large employers are not the enemy of health reform some make them out to be. But they are worried about how to comply with the proliferation of newly enacted state reform laws and what impact a federal health reform law is likely to have. PMID- 10134325 TI - Gridlock in Vermont sends worrisome message to Congress. PMID- 10134326 TI - States take closer look at medical savings accounts. PMID- 10134327 TI - Virginia okays coverage for experimental cancer coverage. PMID- 10134328 TI - Filling the gaps: the role of public health departments under health care reform. AB - The nation's public health system can take credit for many of this century's improvements in life expectancy. But public health has been forced to take a back seat to high-technology medicine, reducing its funding and clout among local, state, and federal policymakers. For health reform to achieve the goals of cost containment and universal access, the nation's public health system must be strengthened and work in partnership with the medical care system. PMID- 10134329 TI - Home health care riding high. PMID- 10134330 TI - Hillary Clinton isn't thinking about cost accounting. PMID- 10134331 TI - Introduction of innovations in hospital cost accounting to Medicare rate setting for improved cost containment. PMID- 10134332 TI - Data watch. Prescription drug plans. Rx coverage and cost-cutting options. PMID- 10134333 TI - What doctors want. PMID- 10134334 TI - Shifting gears. PMID- 10134335 TI - Physician-driven care. PMID- 10134336 TI - 4 ways to improve your prenatal program. PMID- 10134337 TI - Courts support HMO restrictions. PMID- 10134338 TI - Five steps to lower costs. PMID- 10134339 TI - The dynamics of market reform. PMID- 10134340 TI - California's Fresno: a smaller metropolitan community with big city dynamics. PMID- 10134341 TI - Advance patient directives: assessing the alternatives. AB - Whereas the Patient Self-Determination Act is a significant step in the right direction, there are ethical, legal, and medical questions yet unresolved. In this second installment of a three-part series, the authors describe the options available to patients. PMID- 10134342 TI - Meeting the information system demands of the future through outsourcing. AB - As managed care organizations work to meet the rigorous data and information requirements of a rapidly evolving health care system, many are recognizing the need to out-source their computer operations. Developing a cost-effective, efficient approach to outsourcing is a challenge to many organizations. This article offers an in-depth view of outsourcing as it relates to the managed health care industry as well as criteria for selecting an outsourcing consultant or vendor. PMID- 10134343 TI - Who treats medical conditions more cost efficiently? AB - Total costs in HMOs are 10% to 40% below those in indemnity plans; however, investigators have not examined the types of medical conditions that HMO providers treat more cost efficiently than indemnity providers. The present study was designed to evaluate if managed care health plan specialists treat complex conditions as cost efficiently as the HMO primary care providers treated the less complex conditions and, if not, why? PMID- 10134344 TI - Natural disasters: how to resume operations and prioritize your infrastructure. AB - Earthquakes! Floods! Hurricanes! How is a managed care organization to cope with both delivering health care to its members and maintaining the integrity of its organization? This first article of a two-part series, prompted by the recent spate of natural disasters, discusses how a managed care organization can recompose itself so that it may optimally deliver care to the many people in need after such a catastrophe. PMID- 10134345 TI - The evolving pharmacy benefit market. AB - The growing number of pharmacy benefit management companies (PBMCs) signal the most significant trend in the pharmacy benefit marketplace in many years. The evolution of this industry has made pharmacy benefit management available to smaller health plans and self-insured employers alike. However, the growth of PBMCs has spurred more competition, and profits in the industry are becoming harder to attain. This setting should provide fertile ground for the continuing evolution of entities that offer pharmacy benefit management. PMID- 10134346 TI - Is Medicare contracting right for your managed care organization? AB - Americans older than 65 years represent the fastest-growing segment of the population. Today, the elderly comprise 12% of the population but account for one third of health care spending. By the turn of the century, they will use half of these resources. Ironically, the elderly have been affected little by the managed care revolution; only 2.6 million have enrolled in HMOs that have contracts with the federal Medicare program to provide comprehensive health services to that population. In this article, the author explains the different types of Medicare managed care contracts, the advantages of these contracts, and how to succeed in this growing area of opportunity. PMID- 10134347 TI - Health care reform's effect on home care: strategies for survival. AB - Home care is expected to thrive under President Clinton's health care reform proposal, growing from a $12.1 billion business in 1995 to $18.8 billion by the year 2000. While the home care industry grows, both public and private payers will be increasing their interest in reviewing home care services provided and billed. Home care companies must prepare for a future that includes increased interaction with managed care plans. In this article, the authors discuss strategies for home care providers to succeed in a managed care environment. PMID- 10134348 TI - Characteristics of the part-time work force. Analysis of the March 1993 Current Population Survey. AB - The purpose of this Issue Brief is to present a comprehensive description of part time work and part-time workers. The report describes trends in part-time employment; characteristics of part-time workers; health, pension, and other benefits available to part-time workers; and the advantages and disadvantages of part-time work to employers and employees. The report also identifies public policy issues stemming from the increase in the number of part-time workers. The number of part-time workers increased from 10.8 million to 20.7 million between 1969 and 1993, an increase of 91.7 percent, representing 24.6 percent of the growth in the work force. Full-time employment rose 51.4 percent, from 59.2 million to 89.6 million, representing 75.4 percent of new entrants. While the part-time work force increased 91.7 percent between 1969 and 1993, growth as a proportion of the total work force has been minimal, rising from 15.5 percent in 1969 to 18.8 percent in 1993, a 3.3 percentage point increase over this 24-year period. Voluntary part-time workers represented 70.6 percent of all part-time workers in 1993, compared with the 29.4 percent classifying themselves as involuntary part-time workers. Between 1969 and 1993, the voluntary part-time work force grew from 9.0 million to 14.6 million, an average annual increase of 2.0 percent. The involuntary part-time work force increased from 1.8 million to 6.1 million, an average annual increase of 5.2 percent. Of the 28.9 million part time workers in 1992, 71 percent received health insurance from one or more private sources. More than one-half (52 percent) received coverage through an employment-based plan, and 19 percent through another private source. By comparison, 81 percent of full-time workers received coverage from a private source: 73 percent through an employment-based plan and 8 percent from another private source. Just over one in five, or 21 percent, of part-time workers were uninsured; 16 percent of full-time workers were without health insurance. While the likelihood of a part-time worker being uninsured is 5 percentage points higher than for full-time workers, there are more full-time workers uninsured (16.4 million full-time workers were uninsured in 1992, compared with 5.9 million part-time workers).(ABSTRACT TRUNCATED AT 400 WORDS) PMID- 10134349 TI - The duty of social workers to refer for medications: a study of field instructors. PMID- 10134350 TI - Putting the horse first: the practical value of philosophical analysis. PMID- 10134351 TI - Cultural differences and the practice of medicine. PMID- 10134352 TI - Oregon's experiment. AB - Oregon's systematic design for universal access to health care, known as the Oregon Basic Health Services Act, has provoked heated debate over its rationale, plan and process. It is a novel attempt to address inequities in the distribution of health care for those below the federal poverty level. Its controversial nature compels more informed discussion to guide further analysis. Accordingly, this report is primarily descriptive, aiming to provide a clear synopsis of the Oregon project's history, complex methodology, and strengths and weaknesses. PMID- 10134353 TI - Going off the dole: a prudential and ethical critique of the healthfare state. AB - The present 'healthfare' state in the United States is neither practically nor morally justified. The nation currently fails to provide adequate access to health care for tens of millions of uninsured citizens. To suggest that the United States' half-million physicians should provide their care as charity is an inadequate solution. The transfer of assets from the 'haves' to the 'have-nots' through taxation in a 'healthfare state' undermines human compassion, and fails to respect minimal moral requirements. However, alternative strategies are possible. During the next 20 years health care could come to be financed on the basis of sound quasi-libertarian moral and prudential principles. In the interim deliberate political action is required to achieve novel health policy, available and affordable job and career training, and universal employment. It is possible to achieve universal access to adequate health care while sustaining individual choice, and at the same time to reduce or virtually eliminate taxpayer-subsidized health care. This approach would, in time, eliminate the healthfare state and eventually encourage and even require citizens to go off the healthfare dole. PMID- 10134354 TI - Choosing core health services in The Netherlands. PMID- 10134355 TI - Communitarian illusions: or why the Dutch proposal for setting priorities in health care must fail. AB - This article accounts for the failure of the Dutch Government Committee on Choices in Health Care to develop useful criteria of necessary care by which to set health care priorities and ration resources. The Government Committee has been inspired by philosophers who think that allocation problems cannot be solved without placing broad moral questions about the good life, and about the place of health and illness in our lives on the public agenda. The fruitless attempts of the Committee to formulate an effective notion of essential care, based upon a community-oriented perspective of health, shows why the communitarian approach is bound to fail. Questions about essential health care cannot be answered on a macro-level. The only way to get some reasonable control over day-to-day health care allocation decisions in hospitals and institutions is by trying to understand the history, laws, habits and contingencies of what is going on between doctors and patients. Such an understanding can be gained by developing a relational and biographical view on the doctor-patient relationship. PMID- 10134356 TI - Health care reform in the United States. AB - The need for change in the system of health care delivery in the United States has finally emerged as a political issue alongside continuing budget deficits, a growing national debt, declining educational outcomes, and decreased competitiveness of American business in the global economy. The two most pressing health care problems at the present time are rapidly increasing costs and lack of access to the system. A more distant but potentially more recalcitrant problem is the ageing of our population. This paper outlines and discusses some of the options for reform which are currently under consideration in the United States. PMID- 10134357 TI - Rationing in The Netherlands: the liberal and the communitarian perspective. AB - In the discussion on rationing health care in The Netherlands, a fundamental tension emerges between two ethical perspectives: liberalism and communitarianism. A Dutch government committee recently issued a report opting for a community-oriented approach. This approach proves less communitarian as compared to the views on rationing elaborated by Callahan. Moreover, the community-oriented approach is conceptualised in such a way that it seems compatible with some basic aspects of the liberal account of a just society. PMID- 10134358 TI - From evolution to revolution: restructuring the New Zealand health system. AB - After a number of years of evolutionary changes to the New Zealand health system, the government announced a radical restructuring of all publicly funded health services in July 1991, to be implemented on 1 July 1993. The primary features of these changes are a splitting of the purchaser and provider roles, and a restructuring of health services along more business-like lines. The proposals have been highly contentious and have attracted little support from within the health sector. This paper outlines the reasons for and nature of the reforms and explores some of the issues behind the changes. These include problems of pricing services for purchasing purposes, the potential conflict between financial and social objectives, and questions of accountability of purchasers and providers. Considerable uncertainty surrounding these and other issues means that any potential efficiency gains cannot be guaranteed. The costs of the reform process have, however, already been high, both in financial terms and in terms of their impact on the morale of health workers. PMID- 10134359 TI - The spare embryo--a red herring in the embryo experimentation debate. AB - Whenever embryo experimentation is discussed, the question of whether it is preferable to use spare or specifically produced ('research') embryos for destructive embryo experimentation always enters the debate at some stage. This question is analysed, and it is suggested that the distinction is morally uninteresting, but rhetorically useful for both sides in the debate. It is further suggested that part of the force of this distinction is caused by the fact that it is parasitic on a real moral distinction based on the degree to which the gametes used in the experiment are obtained by explicit or implicit coercion. PMID- 10134360 TI - Health care law ... focus on consent. PMID- 10134362 TI - The nature of nursing. PMID- 10134361 TI - Nursing in Japan. PMID- 10134363 TI - Who should be responsible for a nation's health? PMID- 10134364 TI - To market-led Ministers of Health. PMID- 10134365 TI - Real government required. PMID- 10134366 TI - Risk perception, addiction, and costs to others: an assessment of cigarette taxes and other anti-smoking policies. AB - This paper offers a relatively comprehensive assessment of government anti smoking policies (both taxation and other regulatory measures). I conclude that interventions to engender in smokers and prospective smokers an accurate perception of tobacco's health risks are justified, that except in the case of adolescents addiction by itself does not justify intervention beyond providing adequate information, that the proper goal of tobacco taxation policy should be to recoup only the extra costs that smokers place on others (at most a $1/pack tax on cigarettes), and that passive smoke's imposition of harm on unconsenting others strongly supports at least the development of a safe-to-others smokeless cigarette, if not direct intervention. PMID- 10134367 TI - Health promotion and lay epidemiology: a sociological view. AB - In this paper two fears about health promotion are identified. The first concerns the ability to choose between proliferating expert advice, and the second concerns the fear of government interference in personal life. The paper goes on to outline the current place of health promotion in British health policy, and to discuss the relevance of recent research on health beliefs. The paper argues that work on 'lay epidemiology' has been overlooked by both critics and supporters of health promotion. From this vantage point the fears about health promotion can be seen to be exaggerated. PMID- 10134368 TI - The purpose-process gap in health promotion [corrected]. AB - In the development of health promotion theory to date insufficient attention has been paid to the question 'What is the end to which health promotion is directed?' A distinction can be made between purpose (end) and process (means to end) and if no clear account of purpose exists to illuminate how process contributions relate to its achievement, then health promotion's claim to be a practical discipline is weak. Although 'well-being' is frequently cited as the essence of health promotion, a view of 'well-being' which goes much beyond the intuitive has yet to emerge. Retention of 'well-being' as purpose requires a specific account which allows health promotion's claim to practicality to be clearly demonstrated. In discussing the form such an account would need to take, purely hedonistic conceptions of 'well-being' are discounted and the development of an 'objective' account, in which 'capacity for self direction' would form the key focus, is suggested. PMID- 10134369 TI - A constructed dilemma about health promotion: a reply to Alan Cribb. PMID- 10134370 TI - BNHS (British National Health Service) age rationing: a riposte to Bates. PMID- 10134371 TI - The use of numbers in ethical analysis. PMID- 10134372 TI - Behind the Wall paper. PMID- 10134373 TI - Political challenge or political veneer? PMID- 10134374 TI - Health care in the courts. R v Sulman; R v Prentice; R v Adomako. PMID- 10134375 TI - Treating mentally incapacitated adults. PMID- 10134376 TI - Intensive care: who should decide? PMID- 10134377 TI - International comparisons of health care systems: Part one. What constitutes a health care system? PMID- 10134378 TI - Let the buyer beware!: An open letter to Europe's health ministers, analysts and policy makers. PMID- 10134379 TI - Ethics/human values curricula in US medical schools: results of a recent survey. PMID- 10134380 TI - State reforms in long term care: budgets, waivers, and state initiatives as catalysts. PMID- 10134381 TI - Funding for the creative arts therapies. PMID- 10134382 TI - The Elder Housecall program at Johns Hopkins. PMID- 10134383 TI - Hospice for aged persons without cancer: the experience of the Hampshire County (MA) hospice. AB - Hospice is an option for patients with terminal illness of all types. The advent of the Medicare hospice benefit has led to a rise in numbers of hospice programs as well as hospice expenditure. Terminal care provided through hospice has a demonstrable cost advantage over conventional terminal care. This difference may dissipate as Medicare hospice expenditure continues to rise. An individual hospice program can define its mission within broad guidelines. A program electing to serve all terminally ill patients regardless of diagnosis can occasionally expect to be cast in the role of long term care-provider when six month survival is exceeded. Precision in prediction of six-month survival would benefit patients and remove one major obstacle to participation by many primary care physicians. Prognostic techniques are being developed that, thus far, have proven no better than physician judgement in assigning risk or predicting survival. Hospice may provide a setting for clinical research of prognostication. The interdisciplinary team can facilitate hospice care and provide support to individual team members. Care of terminally ill non-cancer patients may require added human resources and alteration of team structure to cope with increased service needs and lengths of stay which may be likely to exceed those of cancer patients. PMID- 10134384 TI - Poverty among the elderly. PMID- 10134385 TI - The Canadian National Calibration Reference Centre for In-Vivo Monitoring: thyroid monitoring. Part III: A basic calibration procedure for thyroid monitoring. AB - This article is the third of a five-part series covering various aspects of occupational thyroid monitoring. This article introduces the basic concepts required to understand the procedure for determining the counting efficiency of a thyroid detector. The B.R.M.D. thyroid-neck phantom is used as the calibration source. A procedure for personnel monitoring is also discussed and the concept of Minimum Detectable Activity (MDA) is introduced. The last two articles in this series discuss energy calibration, counting system optimization based on a single channel analyzer and placement error minimization. PMID- 10134386 TI - How does a nursing facility prepare to care for AIDS patients? PMID- 10134387 TI - AIDS: the unwelcome visitor. AB - AIDS beds are still hard to find outside of a few big cities, because operators are concerned that the stigma of the disease will cause them to lose staff members and geriatric residents. But as the epidemic worsens, more facilities will be expected to admit persons with AIDS. Caregivers who have begun to address the unique social and medical needs of this patient group have experienced satisfaction in helping those truly in need. PMID- 10134388 TI - All mixed up. In more closely matching payments to services provided, case-mix systems pile on the paper work. PMID- 10134389 TI - SHMO-mentum (social health maintenance organizations). Feds experiment with home care benefit models. PMID- 10134390 TI - Arresting the spread of drug-resistant microbes. PMID- 10134391 TI - Personal attention. Two companies test using certified nursing assistants as primary caregivers. PMID- 10134392 TI - Fashioning a successful psychiatric transfer. PMID- 10134393 TI - AIDS patients challenge caregivers. PMID- 10134394 TI - Family affairs. AB - It's no secret that your job is stressful, forcing you to deal with tragedy and death on a regular basis. You've become good at what you do because you pay attention to details and care about people. Most of the EMS providers I've known dedicate untold hours to their work, usually in addition to the regular jobs they hold. Their communities need them to be ready at a moment's notice when the pager sounds. Someone is in crisis. A life may hang in the balance-a life they may save. But what about the family that's left behind as you run out the door-yet again? How do your spouse/significant other and kids cope with whatever emotional state you're in when you return home? While your stress may be evident, their distress may be overlooked. What price do they pay to live with you? These questions were addressed during several workshops my colleagues and I conducted for EMS providers and their families. Many of the problems and frustrations identified in this article were shared by EMTs' family members who attended. PMID- 10134395 TI - Oh, say, can you hear? PMID- 10134396 TI - Priorities in extrication. PMID- 10134397 TI - War in Gotham City. PMID- 10134398 TI - Taming the Medicare monster. PMID- 10134399 TI - Beyond the integration of public health and medicine. PMID- 10134400 TI - The integration of public health and medicine. AB - President Clinton's American Health Security Act proposes to reform and integrate the medical care and public health service delivery systems. Historically, there have been examples of efforts to integrate public health and medical activities. Yet, while many have acknowledged the inherent value of such an integrated approach to improving health, the fact is that these efforts have had only limited success. The "new deal" President Clinton has proposed for these health institutions is examined in this context. If the notion of integration is taken seriously--that is to mean the extent to which each system's diverse activities complement each other, fitting together to form an integrated whole--then it will not be easy to achieve. Review of the "visions" of public health and medicine and of examples of efforts to integrate public health and medicine in this country suggest five conditions that must be met if successful integration is to be achieved. While the resources necessary to integrate public health and medicine are great, of equal importance is the acceptance of a shared vision of an integrated health care system, and of the respective roles and responsibilities of public health and medical care in that system. The benefits to our nation's health of proceeding in this way, however, are enormous. As we move into the twenty-first century, an integrated system of public health and medical care services is our nation's best hope for not only improving the health of all our citizens, but for closing the "health gap" between socioeconomically disadvantaged groups and the rest of the population. PMID- 10134401 TI - Public health in the new American health system. PMID- 10134402 TI - A national architecture for integration. PMID- 10134403 TI - JCAHO accreditation of integrated delivery networks. PMID- 10134404 TI - Special report on health care delivery systems and medical staff relationships. Peer review in the era of integrated delivery systems: it's time for some massive paradigm shifts. PMID- 10134405 TI - Changes in federal regulation of tax-exempt hospitals on the horizon. PMID- 10134406 TI - Medicare tightens rules on payment for psychiatric partial hospitalization services. PMID- 10134407 TI - Financial management. Change management. PMID- 10134408 TI - Financial management. Accounting for health. PMID- 10134409 TI - Financial management. Private pioneer. PMID- 10134410 TI - Research in practice. Getting a grip. PMID- 10134411 TI - Wheelchair prescribing. A heavy load. PMID- 10134412 TI - Purchasing. Burning ambition. PMID- 10134413 TI - Chaplaincy. Moved to tears. PMID- 10134414 TI - The hospital community benefit standards program and health reform. AB - This article suggests that the community hospital can be an important key to health reform at the local level; that community benefit guidelines are acceptable to hospitals and community leaders in a 49-site national demonstration program; and that these guidelines can prove useful for communities in moving toward health reform. Types of community involvement by hospitals are categorized, and examples of each type are developed. Community benefit programs can be a promising approach to effectively respond at the local level to the problems of poor health status, lack of access to care, and increasing health care costs. Addressing financing of care without attention to changes in the delivery system will not lead to effective health reform. PMID- 10134415 TI - What do we want and what do we get from not-for-profit hospitals? AB - The tax exemption for not-for-profit hospitals has been subject to many recent challenges, in part related to concerns over whether these hospitals provide sufficient levels of community benefits to merit tax exemption. Computing the value of community benefits for California hospitals as the sum of uncompensated care, education and research, net income, money-losing services, and price discounts from for-profit hospitals reveals that 20 to 80 percent of hospitals would have met various recommended community benefits standards. There is a clear need for hospitals and their communities to establish dialogues on what levels of community benefits are appropriate. PMID- 10134416 TI - Factors affecting charity care and bad debt charges in Washington hospitals. AB - Uncompensated care has become a major issue in hospital finance as the number of uninsured persons has increased and hospital revenues have declined. Uncompensated care charges have two components--charity care and bad debt--that are distinct conceptually but often are commingled in hospital accounting practice. Data on charges assigned to charity care and bad debt in 1987 for 82 short-stay hospitals in Washington were merged with data from the 1987 Medicare Cost Report and AHA Annual Survey. The regression analyses performed indicate that the determinants of the percent of charges for charity care, bad debt, and total uncompensated care differ and suggest that bad debt should be isolated from charity care when estimating a hospital's level of effort in providing care to indigent patients. PMID- 10134417 TI - "How much do you get paid if I volunteer?" Suggested institutional policy on reward, consent, and research. AB - Pharmaceutical companies often ask practicing physicians to conduct phase IV or postmarketing research on new drugs. Companies pay physicians to enroll their patients and report dosage and side-effect information. Postmarketing research embraces a multibillion dollar effort at promotion and familiarization, but subjects' informed consent to it normally does not include physician reward. Improving investigators' financial status while increasing medical risks to phase IV subjects is ethically unsound, especially if subjects are unaware of investigators' rewards. We suggest a model policy and guidelines that affirm subjects' need for informed consent, investigators' need for recognition and support, and institutions' need to protect patients from undisclosed risk and relations. PMID- 10134418 TI - Hospital closure: an efficiency analysis. AB - Logistic regression analysis was used to test the hypothesis that market forces have led to recent hospital closures. Specifically, inefficient and underutilized hospitals in competitive markets were hypothesized to be at greater risk for closure. While past studies used crude measures of hospital efficiency to predict closure, this study used data envelopment analysis to construct an efficiency index. Mixed support was found for the market forces hypothesis; however, contrary to expectations, inefficient hospitals were not shown to be at increased risk for closure. In fact, efficiency proved to be a weak, but positive, predictor of closure. PMID- 10134419 TI - Distinguishing service quality from patient satisfaction in developing health care marketing strategies. AB - The marketing function in health care is increasingly becoming strategic in nature. The quality of care provided and the level of patient satisfaction are emerging as the core of many marketing strategies in health services as a means to achieve a distinctive competency in ever-more competitive markets. Therefore, it is not surprising that few issues have generated more discussion in both practitioner and research circles. Nonetheless, according to the health services literature, service quality and patient satisfaction have confounded many, the outcome of which may be an inability of health care managers to effectively derive, implement, and control marketing strategies. This article identifies emerging literature that assists in overcoming these limitations. PMID- 10134420 TI - Situational determinants of the delegation of authority among hospital senior executive officers. AB - This field study examined the relationship between hospital senior managers' delegation and task importance, the senior managers' trust in their subordinates, and their perception of subordinates' levels of skills. The responses of 32 hospital CEOs or senior executives were compared with the responses of their three most important subordinate managers (for a total of 96 subordinates). Trust scores were uniformly high with little variation, and most of the tasks studied were delegated frequently or occasionally. Although delegation was positively related to the managers' perception of their subordinates' skills, it was not related to the importance of the tasks. These findings confirmed the importance of situational factors in delegation and raised serious questions about senior managers' maximization of the scarce and costly resource that their management staff represent. PMID- 10134421 TI - Product-line evaluation of graduate medical education program costs. AB - This article reports the results of an innovative application of traditional multivariate approaches to estimating hospital costs in order to support product line evaluation of graduate medical education (GME) program costs among the clinical departments and teaching facilities of a nationwide, federal multi institutional system. Department-level data for 1988, 1989, and 1990 were used to estimate a multiple regression model of total costs per disposition for the specialties of medicine, surgery, obstetrics/gynecology, orthopedics, psychiatry, and pediatrics. Systemwide and facility-specific GME program costs per disposition were estimated for each specialty on the basis of dependent variable scores predicted by the regression model. Measures of case-mix intensity, facility bed size, department staff size, clinical specialty, GME status, teaching intensity, operating efficiency, and regional variation each made statistically significant contributions to the explained variance in total costs per disposition, and yielded an adjusted R2 of .701. Estimates of total costs and GME costs per disposition revealed substantial variation among clinical specialties, both systemwide and within specific facilities. The results of these techniques, their usefulness for enhancing executive ability to evaluate costs of GME programs as product lines, and their implications for public policy regarding hospital payments are discussed. PMID- 10134422 TI - Get off the bill hook. AB - In an increasingly strict financial climate increasing income is just as important as reducing costs, and so is increasing the speed at which income is collected. Tom Jones, of health care management consultants, McLean Jones McCarthy, provides some tips on how managers can deal with debtors, manage an efficient finance directorate--and get off the bill hook. PMID- 10134423 TI - Should managers have a code of conduct? AB - Much attention is currently being given to values and ethics in the NHS. Issues of accountability are being explored as a consequence of the Cadbury report. The Institute of Health Services Management (IHSM) is considering whether managers should have a code of ethics. Central to this issue is what managers themselves think; the application of such a code may well stand or fall by whether managers are prepared to have ownership of it, and are prepared to make it work. Paul Bayliss reports on a survey of managers' views. PMID- 10134424 TI - Costing shared care. AB - Growing interest in shared health care schemes over the last decade has received additional impetus with the introduction of GP fund holding and the internal market in health care provision. Ken Buckingham and colleagues report on the relative costs of such a scheme for asthma in comparison with the costs of conventional outpatient care. Data was collected during a randomised controlled trial of shared or integrated care for patients with chronic asthma, who had been referred to a hospital outpatient clinic. PMID- 10134425 TI - Management ... working day of a health services manager. Leicester General Hospital. AB - The challenge for the year ahead is to implement a largely decentralised pharmacy service, seeing an improved service and benefits to patients. Bob Wilson, Pharmacy Services Manager, Leicester General Hospital describes how the team will go about it. PMID- 10134426 TI - Investing in your people--improvement from within. PMID- 10134427 TI - A decent proposal. Management and field providers improve quality together. PMID- 10134428 TI - Drowning prevention. A case study in EMS epidemiology. AB - A central theme for EMS systems is the reduction of death and disability from emergency illnesses and injuries, with most systems focusing exclusively on treatment to fulfill their missions. Unfortunately, this has often resulted in the neglect or complete disregard of prevention, which actually may be the more powerful intervention strategy. Yet hopefully, as EMS systems begin to learn and embrace the principles of continuous quality improvement (CQI) in their organizational cultures, the advantages of prevention vs. treatment will become more apparent and internally recognized. PMID- 10134429 TI - Centralized administrative services management. AB - Virtually every hospital has imposed guidelines or controls on one or more administrative service expenses. However, the actual deployment of such strategies is often voluntary, decentralized, disjointed and episodic. An alternative approach is to cluster administrative elements across hospital departments and make them the responsibility of a dedicated manager. This approach treats administrative services as an organizing principle with uniform, predictable standards of service and cost. Customer requirements for products and services are met without the need for them to physically manage that process. Materiel managers can demonstrate a leadership role by applying their professionalism and know-how to a set of products and services traditionally ignored or dealt with in an uncoordinated manner. While some initial resistance can be expected as traditional barriers are disassembled, the results should be very rewarding for the hospital and materiel manager alike. PMID- 10134430 TI - Integrating voice, data, and paging technologies to enhance information services. AB - The University of California at San Francisco Medical Center has made a commitment to upgrade its information and telecommunications systems infrastructure. One of the several projects being undertaken by the Medical Center, the Intelligent Console Project, demonstrates how integrating different systems, databases and technologies can improve the quality and accessibility of information, while reducing costs and stream-lining administrative activities. The Intelligent Console acts as an interface mechanism for the several constituent systems and data-bases of the Medical Center and provides a single, front-end control console by which operators can support communications using standardized procedures. Much paperwork has been eliminated and operator training and scheduling streamlined. Equipment consolidation has also freed up space at the Medical Center. PMID- 10134431 TI - Outfitting your hospital for the new wave of robots. AB - Automated materials handling systems have provided dramatic labor savings and efficiency benefits to healthcare facilities. A growing trend is the use of a new breed of service robots that provide automated materials handling without major modifications to the existing building. The robots navigate through hallways, go through doors and ride elevators using a computerized controller that contains a layout of each floor of the hospital; the robots do not rely on any type of physical track to guide them on their way. The robots are programmed to pick up or deliver supplies to nursing stations or other departments, and determine the best route. Purchase and rental options exist at a substantial savings over human labor. PMID- 10134432 TI - Infusion pumps, patient-controlled analgesic. ECRI. PMID- 10134433 TI - Healthcare reform update and Medicare reductions. PMID- 10134435 TI - CS: central service/customer service. PMID- 10134434 TI - The business of business. PMID- 10134436 TI - Payment levels and hospital response to prospective payment. AB - Nearly ten years after the implementation of Medicare's Prospective Payment System (PPS), some of its major impacts remain hard to explain using existing economic models. We develop a simple model of the hospital's choice of intensity of care, which affects demand for admissions. The model suggests an important role for the level of prospective payment, independent of the effect of marginal incentives. Predictions from the model are compared first with aggregate utilization data from Medicare's PPS experience, and then with various hospital level studies which control for interhospital differences in reimbursement rates. PMID- 10134437 TI - Altruism and the value of statistical life: empirical implications. AB - In this paper the empirical implications of altruism for cost-benefit analysis of projects involving health changes are investigated. It is shown that a willingness-to-pay question allowing the respondent to state her total willingness to pay (irrespective of what reasons she may have for paying), subject to everybody else paying so as to stay at their initial levels of utility, produces, as a special case, the project evaluation rules derived by Jones-Lee (1991, 1992) and others. The implications of alternative formulations of the valuation question in a contingent valuation study are also explored. PMID- 10134438 TI - The threat of 'cream skimming' in the post-reform NHS. AB - The allocation of budgets to general practitioners to enable them to purchase selected hospital services has been one of the most imaginative elements of the recent National Health Service reforms in Britain. However, reliance on 'historic costs budgeting' has weakened the efficiency incentives of fund-holding, while perpetuating the large variations in resource use endemic in general practice. On the other hand, policy changes aimed to introduce elements of capitation funding, although welcome, raise the spectre of 'cream skimming'. The paper explores the potential for protection against 'cream skimming' offered by incorporating chronic health factors into the formula. PMID- 10134439 TI - Physician-induced demand for childbirths. AB - A controversial technique for testing the hypothesis that physicians induce demand involves two stage least squares (TSLS) regression analysis of cross section data on physician supply and utilization. This paper tests the power of TSLS by applying it where there is at most only a trivial amount of demand inducement--the demand for childbirths. We find 'evidence' of inducement of childbirths, calling into question the validity of the TSLS approach. This unlikely finding may be traced to at least two factors: The first stage regression is not identified and the second stage regression does not adequately address border crossing. PMID- 10134440 TI - Genetic testing: an economic and contractarian analysis. AB - Medical researchers are rapidly identifying the genetic causes of many diseases. Genes that increase the risk of contracting Alzheimer's, colon and breast cancer, Huntington's, cystic fibrosis and numerous other diseases have been identified. Genetic tests can reveal an individual's probable health status many years in advance of sickness. Many fear that this will lead to 'genetic discrimination' in the employment and health insurance markets. Solutions such as consent laws are impractical and create adverse selection problems. A new form of insurance, genetic insurance, can eliminate these problems and allow everyone to be insured. PMID- 10134441 TI - Health, addiction, social interaction and the decision to quit smoking. AB - The decision to quit smoking is treated as a choice under uncertainty in an empirical model that incorporates health, medical advice, addiction, and social interaction. Probit models are estimated for attempts and success in quitting with data from the Health and Lifestyle Survey. The results show a clear role for addiction, social interaction and current health status. The evidence on the effectiveness of medical advice is ambiguous. PMID- 10134442 TI - Reduction in in-patient hospital expenditures--end of the line? PMID- 10134443 TI - Outcomes research--it's not just for academic medicine. AB - Outcomes research has been viewed by many as appropriate primarily for academic research purposes. However, author Patrick S. Fahey, FACMPE, administrator of Sports Medicine Center, writes that due to health care reform, outcomes research will be important "because it addresses the issues of uncontrolled spending and inconsistent quality of care by redirecting incentives to control overuse, underuse and inappropriate use of medical services". PMID- 10134444 TI - Contract management--culprit or cure-all? PMID- 10134445 TI - Management Consultant Inc.--how to choose and use. AB - Robert C. Bohlmann, FACMPE, writes about what a management consultant is, how they should be evaluated and what they should be expected to do for the client. He also offers tips on determining costs and defines the engagement process in terms of scheduling, assessment, on-site activity and reporting, among others. PMID- 10134446 TI - Choosing and using a lawyer. What every medical practice administrator needs to know. AB - Attorney Nancy Crow, J.D., L.L.M., writes about some of the legal issues encountered by medical groups, such as business law, real estate and land use, taxes and employee benefits, among many others, and what types of attorneys are more appropriate for particular concerns. PMID- 10134447 TI - People hiring people they can trust. Selecting an architect. AB - Julie Luers, F.M.P., vice president, marketing director of Ellerbe Becket Construction Services, writes that hiring a consultant is essentially "buying" people and their skills. She offers tips on how to minimize risks. PMID- 10134448 TI - Selecting the right accountant for health care management. PMID- 10134449 TI - Critical variables in making organizational change a reality. AB - Daniel J. West Jr., Ph.D., FACHE, FACMPE, director of the graduate health administration program at the University of Scranton, Pennsylvania, writes that any change to part of the health care delivery system impacts the total system. Therefore, expertise is needed in a wide variety of functional areas to ensure that change occurs smoothly. PMID- 10134450 TI - Academic medical center survival tactic within healthcare reform--partnering. PMID- 10134451 TI - Health care trends lead to specialization of the MBA. AB - Four authors associated with St. Thomas University, John G. Reiling, M.B.A., John W. LaBree, M.D., Frederick J. "Fritz" Wenzel, FACMPE, and Carl Platou, M.B.A., write about how the changing nature of health care has fostered the need for a specialized Master of Business Administration in Medical Group Management degree program. PMID- 10134452 TI - Positioning for vertical integration through clinics "without walls". AB - Authors Bruce A. Johnson, J.D., M.P.A., and Darrell Schryver, D.P.A., offer the clinic without walls model as a transitory step to full vertical integration. They write that this model "may enable physicians to address the key issues associated with managed care and integration in a more gradual, controlled fashion. PMID- 10134453 TI - Collaboration is a way of life for Holland Community Hospital. PMID- 10134454 TI - Tribal warfare in organizations: turning turf battles into teamwork in hospitals. PMID- 10134455 TI - Put your legislator to work. PMID- 10134456 TI - It starts with trust--building organizational effectiveness in health care organizations. PMID- 10134457 TI - Creating a healthier home in Macomb County. PMID- 10134458 TI - Merging hospitals and the auxiliary. PMID- 10134459 TI - The foundation of reform--collaboration and competition. PMID- 10134460 TI - Columbia clashes with Ky. over taxes. PMID- 10134461 TI - Hallmark, Community OK $161 million merger. PMID- 10134462 TI - Former NME executive faces criminal charges. PMID- 10134463 TI - MetLife, Travelers form new company. PMID- 10134465 TI - Healthcare update ... debate over discounted drug prices. PMID- 10134464 TI - Chicago's EHS, Lutheran General agree on merger. PMID- 10134466 TI - HCFA tries to restrict subacute-care units. PMID- 10134467 TI - Reform talks take roller-coaster ride. PMID- 10134468 TI - Hospital becomes ambulatory facility. PMID- 10134469 TI - Iowa Blues, hospitals form statewide alliance. PMID- 10134470 TI - AHA appoints new JCAHO liaison. PMID- 10134471 TI - Not-for-profit groups voice support for Florida merger. PMID- 10134472 TI - Two Iowa hospitals to fight feds' suit against affiliation. PMID- 10134473 TI - 2 Fla. systems review antitrust settlement. PMID- 10134474 TI - Cape Coral execs fired for insubordination. PMID- 10134475 TI - Newest reform gambit triggers mixed opinions. PMID- 10134476 TI - Don't overlook image management. PMID- 10134477 TI - Hospitals served subpoenas in probe over medical devices. PMID- 10134478 TI - Legal challenges stall group's spinoff. PMID- 10134479 TI - Report: more health positions filled. PMID- 10134480 TI - Repriced options up top execs' pay. PMID- 10134481 TI - $24 million losses force AMA to cut costs. PMID- 10134482 TI - AMA delegates defeat resolution opposing Clinton healthcare plan. PMID- 10134483 TI - Cost pressures changing OR supply purchasing. PMID- 10134484 TI - Contracts with vendors cut costs sharply. PMID- 10134485 TI - Capitated payment shares risk between buyer and seller. PMID- 10134486 TI - Who is responsible? AB - Increasingly, life-and-death medical decisions are being made by executives and other nonphysicians whose primary responsibility in their institution is for the bottom line. Mr. Hage reminds us that along with that decision-making power comes responsibility for the lives of those affected. PMID- 10134487 TI - The impact of healthcare reform proposals on radiology practice. AB - Current healthcare reform proposals (especially the Clinton administration's Health Security Act) are daunting in their detail, scope and possible effect on radiology--daunting, but crucial for understanding the immediate future of the profession. Ms. Cahill reveals some of the most important proposed changes, the context within which they are framed and their implications. PMID- 10134488 TI - Improving patient care in MRI. AB - When the radiology department of a large midwestern medical center experienced scheduling problems in MRI, it looked for a way to avoid on-site cancellations and delays. Their solution was to assess patients and anticipate problems before patients arrived for their appointments. Ms. Benson describes the problem and the successful process of pre-exam screening now in place. PMID- 10134489 TI - Practical suggestions for improving MRI throughput and quality. AB - As the use of MRI increases, radiology managers and healthcare providers will need to use a variety of methods to decrease patient anxiety and minimize on-site cancellations. This article describes some practical methods and devices which can help patients tolerate lengthy exams in confining equipment, inspire return visits from repeat patients, and gain referrals from physicians and patients. PMID- 10134490 TI - Conscious sedation for imaging and interventional studies. AB - Some radiology patients may need medication to decrease anxiety and control pain. In this comprehensive article, the authors describe quality care for patients receiving conscious sedation, effective ways of delivering this service and detailed descriptions of the conscious sedation program at a northeastern university hospital. A valuable chart of recommended drugs, dosages, considerations and possible side effects is included. PMID- 10134491 TI - Buyer's guide to preowned imaging equipment. AB - Although preowned imaging equipment can be the answer you need, acquiring it can be bewildering. Administrators face a wide range of machines (each with its own history), anxiety about availability of warranties and service, and a host of eager salesmen with sundry allegiances. Mr. Dole reviews the questions administrators should ask as they pursue preowned equipment, and describes success that can be had in this endeavor. PMID- 10134492 TI - Excerpts from "Maintaining Radiation Protection Records." National Council on Radiation Protection and Measurements. AB - This is the second in a three-part series of articles reprinted from a report by the NCRP. Different aspects of record-keeping, an essential part of all radiation safety programs, will be highlighted in each article. The chapter on radiation protection program records is presented in this issue. PMID- 10134493 TI - Health reform's federalist face-off. PMID- 10134494 TI - Outpatient services addition. St. Luke's Medical Center, Milwaukee, WI. PMID- 10134495 TI - M.R.I. Center, Alexandria, LA. PMID- 10134496 TI - Extended-care facility. St. Thomas-Elgin General Hospital, St. Thomas, Ontario. PMID- 10134497 TI - Cancer center. Saint Francis Hospital and Medical Center, Hartford, CT. PMID- 10134498 TI - How reform is shaping up. PMID- 10134499 TI - Dance of healing. Le Bonheur Children's Medical Center, Memphis, TN. PMID- 10134500 TI - Health reform insight. Kennedy panel moves on health reform. PMID- 10134501 TI - Perspectives. Insurance market reform: too little or just enough? PMID- 10134502 TI - Perspectives. Privacy goes public: protecting medical records. PMID- 10134503 TI - Telemedicine comes to California. PMID- 10134504 TI - Prevention and potentiation: two new dimensions of American health care. PMID- 10134505 TI - Rural hospitals join challenge to make hospitals safe. PMID- 10134506 TI - The U.S. and England 'meet in the middle'. Interview by Anne Mercer Larson. PMID- 10134507 TI - United Kingdom and Sweden on the verge of health care reform. A Walker Fellowship Report. PMID- 10134508 TI - Trust is the prescription for hospital/physician relations under health care reform. AB - Hospitals are reacting to health care reform by forming collaborative physician/hospital organizations and other ventures. The success of these new partnerships depends on what shape the reformed system takes and establishing trust between all players. PMID- 10134509 TI - Removing practice barriers. AB - Representatives of the American Nurses Association (ANA) and the American Medical Association (AMA) met recently to discuss issues of mutual interest to the professions, particularly in light of changes that may occur with health care reform. As a result, a joint definition of nurse-physician collaboration was developed. This definition, along with recommendations that the two associations enter into a continuing dialogue, is an important first step on behalf of the two health care professions. It represents a shared commitment to the American consumers of health care in a time in which it is critically needed. PMID- 10134510 TI - An era of mutual respect. AB - Nurses are skilled, dedicated and compassionate professionals. They are irreplaceable members of the American health-care team. Collaboration among health care professionals has enhanced the quality of care our patients receive. PMID- 10134511 TI - HCFA to add measure of severity to DRGs. Part I. AB - HCFA plans refinements to its DRG system of Medicare provider reimbursement incorporating a measure of severity of illness. This first of a series of articles offers specifics of HCFA's current thinking along with its methodology and reasons for the refinements. Part two, to be published in the July/August 1994 issue, will present additional analyses plus an analysis of what effect the proposed changes will have on hospitals. Following HCFA's adoption of the refinements, Health Systems REVIEW will report on the result of provider input and the final form of the new DRG system. PMID- 10134512 TI - Community hospital computer links distant physicians. PMID- 10134513 TI - New "mental models" for credentialing and peer review. PMID- 10134514 TI - Timing the "deal" is crucial to lasting reform. PMID- 10134515 TI - States continue down the road to health reform. PMID- 10134516 TI - The need for health care reform. PMID- 10134517 TI - The health care industry's challenge. PMID- 10134518 TI - One premium fits all? PMID- 10134519 TI - Accreditation of networks and HMOs. PMID- 10134520 TI - What to expect during the new survey. PMID- 10134521 TI - Hospital accreditation in 1994: the Joint Commission applies TQM to the survey process. PMID- 10134522 TI - Setting priorities for improvement. PMID- 10134523 TI - An analysis of the 1994 standards: how much is enough? PMID- 10134524 TI - Implications of the Indicator Measurement System. PMID- 10134525 TI - Informed consent for pregnant helicopter air medical personnel. PMID- 10134526 TI - Use of an air medical helicopter in a trauma prevention program. AB - Trauma is acknowledged as the leading cause of death in the United States in those under 45 years old, with the automobile being particularly lethal and costly. Preventive teaching is a component of any injury reduction program, and health care providers are becoming more actively involved in such efforts. The Mercy Air Ambulance medical team has developed a mock vehicle-collision demonstration, which is staged at area high schools shortly before graduation. The program is a joint effort of several agencies and services. It stimulates the arrest of the responsible driver, the rescue and subsequent air medical transport of two injured students and the death of a fourth student. Not only does this program educate the students in an entertaining fashion, but it results in valuable training for the multiple agencies and individuals who participate in the actual response to motor-vehicle collisions. PMID- 10134527 TI - Health care trouble. PMID- 10134528 TI - Managing the mind. PMID- 10134529 TI - Rethinking health care. The main goal should be to control costs, not create universal insurance. PMID- 10134530 TI - TOXNET's windows of opportunity open through M Technology. PMID- 10134531 TI - Reader survey asks who controls costs with I/S. PMID- 10134532 TI - Online systems complicate I/S capacity planning. AB - The days are fundamentally gone when healthcare information is posted in batches. Online systems have totally changed the I/S picture. Departments trying to plan for demand have a much harder job of it, but help is available. PMID- 10134533 TI - HotList. Financial decision-support tools. PMID- 10134534 TI - Process for determining need for updates of clinical practice guidelines--AHCPR. AB - The Agency for Health Care Policy and Research (AHCPR) announces a process for determining when updates are needed of AHCPR-supported clinical practice guidelines. The process consists of obtaining information about new scientific evidence or new technologies, soliciting opinions from the public, and convening a public meeting to receive relevant information. Comments on the process are invited. PMID- 10134535 TI - Proposed methodology for establishing priorities for health care technology assessments--AHCPR. AB - The Agency for Health Care Policy and Research (AHCPR) announces a proposed methodology to be used for establishing priorities for health care technology assessments conducted by AHCPR's Office of Health Technology Assessment (OHTA). The methodology consists of weighted criteria, which are based on a study by the Institute of Medicine, statutory requirements, and the results of a public meeting held by the Technology Assessment Task Force of AHCPR's National Advisory Council on Health Policy, Research, and Evaluation. PMID- 10134536 TI - Choosing a direction for success in private care. AB - Advances in technology and changes in reimbursement policies undoubtedly will prompt providers of private pay services to seek new services to provide. Before making any decisions, however, an agency must analyze its operation: does it encompass service delivery with low administrative costs or does it demand high costs and cash reserves? The new opportunities down the road are dictated by such factors. PMID- 10134537 TI - Home care coverage improvements anticipated under health care reform. AB - Health care reform will affect home care and hospice providers in ways that are as yet unclear. One thing that is certain, however, is that reform will open new doors for providers under both federal and private reimbursement systems. This review of current coverage and existing opportunities gives a background from which providers can look to the future. PMID- 10134538 TI - The challenges of running a private-duty home care agency. PMID- 10134539 TI - Psychiatric home care: an overview. AB - Psychiatric home care provides a vital service to those who need it, yet it is largely unregulated and underfunded. The growing patient preference for home care, however, ensures a bright future for this specialty. PMID- 10134540 TI - Psychiatric home care documentation. Doing psych but talking med-surg language. AB - When documenting psychiatric home care, agencies must be careful to describe their services in acceptable Medicare language. One home care agency has created a documentation system that is virtually denial-proof for eligible patients. PMID- 10134541 TI - Mental health resources in the United States. AB - Mental illness often carries a stigma that can inhibit recovery. To overcome misunderstanding and ignorance, many national organizations have made it their mission to educate the public about mental illness. Several of these organizations offer support for those with mental illness and their caregivers; others serve to keep mental health professionals abreast of recent advancements in the field. Readers may wish to share these resources with their clients. PMID- 10134542 TI - Ensuring survival--expansion into nontraditional services. AB - Health care reform will affect every home care agency--that much is certain. One way agencies can brace themselves for the coming winds of change is through diversifying their services. PMID- 10134543 TI - Breaking home care tradition with home repairs and other services. AB - In reaching out to provide comprehensive care to the elderly in its community, the VNA of Texas saw a need for nontraditional services such as home repair. Customer satisfaction with the services led the agency to expand to other arenas, but just how cost effective has it been? PMID- 10134544 TI - The start-up of a private-duty agency. AB - The decision to create a new agency is a tough one to make, but once the determination is made, the challenges and rewards will keep administrators on their toes. One agency's path from inception to establishment may provide foresight to those interested in starting an agency of their own. PMID- 10134545 TI - Validating interpretive arguments for licensure and certification examinations. AB - To validate the interpretation assigned to test scores is to support the rationale for this interpretation. The interpretations for licensure and certification tests involve a sequence of inferences, or an argument, leading from the test score to decisions about licensure or certification. This article examines several possible interpretive arguments for licensure and certification test scores and analyzes the evidence required to support each type of argument. Particular attention is given to a competency-based argument that involves a sequence of several inferences leading from test scores to statements about competence, and then to conclusions about expected performance in practice. Decisions about licensure or certification are based on expected performance in practice. PMID- 10134546 TI - Research on standards for professional licensure and certification examinations. AB - The purpose of this article is to outline an agenda for research on standards for professional licensure and certification examinations. To avoid confusion, scores are defined as content-based decisions about the correctness of responses, and standards refer to the educational/social decisions about how many questions need to be answered correctly to pass. Standards are the focus of this article. The two major types of standards, relative and absolute, are described and the major standard-setting methods for each are presented. Some of the published results in four different areas are reviewed: (a) basis of the judgements, (b) efficiency of the process, (c) group effects, and (d) content and expertise effects. Topics for future research in all four areas are identified. PMID- 10134547 TI - Validation of professional licensure examinations. Professions theory, test design, and construct validity. AB - Although the unitary view of test validity has gained support recently, it has real limitations where professional licensing examinations are concerned. A strategy for validation of professional licensure tests requires modifying conventional approaches in three ways. First, a theory of professions must be incorporated into the test development process so as to acknowledge the social character of professions. Second, the importance of test design in the validation of licensing tests should be enhanced. Third, the concept of construct validation must be expanded to accommodate the special features of content that inhere to professional licensure testing. Methods for accomplishing these three things are described and the implications of these and other views discussed. PMID- 10134548 TI - Is the public being protected? Prevention of suboptimal medical practice through training programs and credentialing examinations. AB - Governments have traditionally looked to the medical profession for leadership in health planning and have charged the profession with the responsibility of establishing and monitoring standards of medical practice. Training program accreditation and licensure/certification exams have been used as the primary methods of preventing unqualified individuals from entering medical practice. Despite the critical nature of the decision made at the time of licensure/certification, there is no information about the validity of these examinations for predicting subsequent practice and health outcome. In this article, the assumptions implicit in the current use of licensing/certifying examinations are identified, the relevant evidence is reviewed, and the implications of this evidence for current methods of measurement are discussed. PMID- 10134549 TI - Narratives of construct validation. AB - This article presents a critique of the social and political context in which the idea of construct validation developed. It outlines the rhetorical as well as the empirical and philosophical dimensions of the concept. Finally, the essay offers an alternative viewpoint for the conceptualization of construct validation and links it to current treatments of the topic by members of the measurement community. PMID- 10134550 TI - A research agenda for licensing and certification testing validation studies. AB - The set of articles appearing in this issue of Evaluation & the Health Professions provides an in-depth examination of the validation process for licensing and certification test score decisions. The winter 1990 issue of Educational Measurement: Issues and Practice also contains an excellent set of articles about licensing and certification tests. These special editions are much needed because these kinds of testing programs are increasing in numbers and aim to ensure public safety, promote growth of professions, and positively affect the careers of persons dedicated to serving in these professions. This article will comment on issues raised by the authors of these articles. But before doing this, a context is described that affects these issues. PMID- 10134551 TI - A case study: making it to the money chair. PMID- 10134552 TI - Relationship capital: philanthropy's store of value. PMID- 10134553 TI - Prospecting (Part two): Picking the right gift to ask for. PMID- 10134554 TI - Choice of physician: a realistic goal for reform? PMID- 10134555 TI - How valid are the claims about health care costs? PMID- 10134557 TI - Should everyone use the Medicare rates? PMID- 10134556 TI - Helping internists avoid the malpractice mess. Interview by C. Burns Roehrig. PMID- 10134558 TI - Rational rationing: Oregon's plan preserves choice and controls cost. PMID- 10134559 TI - What will it take to cover the uninsured? PMID- 10134560 TI - Creating your place in the future. PMID- 10134561 TI - THA survey indicates growing interest in PHOs. PMID- 10134562 TI - To be the best. AB - Like many other health care organizations, Irving Healthcare System focuses on quality, cost effectiveness and efficiency. We are willing to do what is necessary to provide the best quality care possible, secure our future position in health care and make our organization an efficient and effective one. PMID- 10134563 TI - Network profile. Scott & White. PMID- 10134564 TI - How secure are your patient records? PMID- 10134565 TI - How can physicians increase practice profitability? PMID- 10134567 TI - Complaints. Ever so sorry. PMID- 10134566 TI - Trusts. Confusion and control. PMID- 10134568 TI - Purchasing information. The wizards of Oz. PMID- 10134569 TI - Public health. Expanding & contracting. PMID- 10134570 TI - Fundholding. Knowing me, knowing you. PMID- 10134571 TI - Contracts. Unfinished business. PMID- 10134572 TI - Organ donation. Transplant traumas. PMID- 10134573 TI - Purchasing. What the doctors ordered. PMID- 10134574 TI - Patient's Charter. Different strokes. PMID- 10134576 TI - Consumer surveys. Question time. PMID- 10134575 TI - South Africa. Cape of Good Hope. PMID- 10134577 TI - Drug sampling: legislation proposed; industry receptive to ending practice. PMID- 10134578 TI - How OSHA's response to workplace violence will affect health care facilities. PMID- 10134579 TI - Health reform speeds shift to tax-exempt integrated managed care plans. PMID- 10134580 TI - Competition among hospitals in the United States. AB - The value added by acute-care hospitals is in the form of specific procedures (therapy, operations, testing) and the bed care necessary to make the procedures effective. When more than one hospital exists in a local area (defined in many studies as a radius of 15 mi/24 km) they compete for market share, since greater market share has a positive effect on economies of scale, utilization rates, learning curves and levels of quality. Competition is not only with other hospitals (and 75% of all hospitals do have a competitor within 24 km), but also with doctors who now perform some procedures in their offices, and with specialized clinics. The first strategy is to attract physician allegiance since they act as gate-keepers, directing patients to specific hospitals. This is done through personal amenities, professional amenities and enhancement to personal prestige and income. This competition for physician allegiance has a direct effect on utilization rates (doctors want spare capacity to suit their needs), on the range of services and facilities offered (doctors want more support), and on length of stay (doctors want longer stays). All of these increase the hospital's costs. The second strategy is to enter into contracts with third-party payers who will direct their clients to specific or preferred hospitals. The negative effect is that in competitive markets such payers may be able to bargain prices down. However, hospital differentiation makes it difficult for payers to make complete substitutions among them. As well, since the payers compete for clients, they often use hospital alliances as a selling point and therefore are often cooperative rather than confrontational in their negotiations. One tactic used by hospitals is to stress quality of service. But since quality in health care is hard to measure, patients are often unable to make direct assessments of alternatives. Hospitals therefore often 'signal' quality in various ways which may, and often do, increase hospital costs. (Some of these signals also attract physicians). Price is not a major element in competition. Most other strategies and tactics raise hospital costs and therefore price. Pressure from payers is turned back through differentiation (preventing substitution) and hospital-payer alliances for clients. Health care comes in too many packages to allow effective price competition. A final tactic is to increase the range of services or facilities offered. Enhanced services attract doctors by offering more support; attract some patients direct; and help to recapture market share lost to specialized clinics.(ABSTRACT TRUNCATED AT 400 WORDS) PMID- 10134581 TI - The market reform of the New Zealand health care system searching for the Holy Grail in the Antipodes. AB - Everywhere there is a recognition that the delivery of health care is ineffective and inefficient and that these unpleasant outcomes are a product of the perverse incentives inherent in all health care systems. In New Zealand the Government documented the defects of the health care system and has introduced radical competitive market reforms, with a purchaser-provider split, in the belief that these will improve the system's performance. The nature of these reforms, centred on the purchaser-provider divide, is similar to changes introduced in the Netherlands, the UK, Sweden, Israel and Russia. The reforms which have been introduced in New Zealand are evaluated in terms of the eight major problems its Government sought to eradicate. It is shown that instead of mitigating these problems the reforms may worsen them, with the system becoming fragmented and less equitable. The move away from a single (tax) source of funds (i.e. the single pipe) may make cost control more difficult. The Government is seeking to address the issue of information generation to facilitate market trading but it is not clear how effectiveness and efficiency data will be produced in adequate volume and quality, let alone how it will be used to change producers behaviour. Many of the problems identified by the New Zealand Government are significant and in need of resolution. However whilst the political imperative may require immediate action, the economic case for these reforms is quite poor. Incremental change, with careful evaluation, would 'inform' policy change with knowledge of the attributes of competing management mechanisms and reward systems. Instead there is the too familiar combination of political assertions and an unwillingness to measure the impact of change, behaviours which may create the causes for the advocacy of the next 'redisorganisation' of the health care system. PMID- 10134582 TI - Attitudes to prevention among HIV-infected patients: the case of specific prophylaxis for Pneumocystis carinii pneumonia. AB - Despite a consensus on the need for Pneumocystis carinii pneumonia (PCP) prophylaxis for HIV-infected patients with fewer than 200 CD4+ lymphocytes/mm3, the number of cases of PCP has remained stable, and about 70% involve patients who are not receiving prophylaxis. The aim of this study was to determine why these patients are not covered by prophylaxis. It was based on a retrospective analysis of semidirective interviews with 32 patients who developed PCP while not receiving prophylaxis. The reasons given were a lack of knowledge of risk factors for HIV infection, the fear of HIV testing, unawareness of the existence of PCP prophylaxis, a refusal to see a doctor in the absence of symptoms, unwillingness to be monitored and in four cases a failure of the doctor to prescribe prophylaxis. PMID- 10134583 TI - Quality assurance in health care. From a traditional towards a modern approach. AB - This review article is about some recent developments in quality assurance in health care. A traditional and a modern approach are distinguished. The traditional approach is marked by a medical perspective and quality is defined as a property of medical care. Development of standards and criteria and inspection of conformance to them is the guiding principle for traditional medical quality assurance. The modern approach is marked by a strong influence of industrial principles on medical quality assurance. Industrial principles provide a new theory upon which medical quality assurance can be based. Aspects of care which are associated with the perceived quality are identified and are legitimate objects of medical quality assurance. The guiding principle is to influence experiences of (internal or external) customers by modelling the care according to clarified expectations. The university hospital of Maastricht provides an example of how modern principles of quality assurance are put into practice. PMID- 10134584 TI - Self-referral and self-payment in Danish primary care. AB - This study aims at characterizing the group of people who want to have the right to consult any general practitioner or practising specialist without referral on condition of part self-payment, as opposed to the group of people who choose to be registered with a general practice that offers free services but controls further access to the health care system. All adults or a 10% sample of those listed in nationwide Danish registers were examined cross-sectionally for social and demographic factors and utilization of primary and secondary health care. A minority, which totals 3% of the population, chose free choice of doctor and part self-payment. On average, this group is older and has a higher income. Its mortality and its utilization of general practice and hospital services are lower, and its use of practising specialists is higher, than the majority. Among the persons who chose free choice and self-payment, the pattern of utilization is more likely to be due to a wish for free choice and for specialized medical care than to high morbidity. Dissatisfaction caused by restrictions on self-referral to specialists can be met by offering an option of a parallel system of free choice of doctor on condition of part self-payment. PMID- 10134585 TI - Case-based hospital financing: the case of Norway. AB - Several European countries are experimenting with new ways of organising and financing the hospital sector. This paper discusses the present Norwegian reform, where a system of fixed grants is replaced by a combination of payment per case and fixed grants. Initially implemented in four hospitals only, the decision to move to a full-scale reform will be based on the evaluation of this pilot project. The paper presents two alternative hypotheses on how a system with case based financing will influence the performance of hospitals. Given that hospitals adjust passively to the constraints imposed by the financing system, increased efficiency is to be expected. If hospitals and hospital owners (i.e. the counties) interact in a game dominated by the hospital, however, the efficiency of the hospital will not be influenced by the financing system. We argue that the design of the pilot project limits the possibility of discriminating between these two hypotheses. Nevertheless, a comparison of key variables in the pilot hospitals with a set of reference hospitals indicates that the change of financing system has not had any substantial effect on hospital efficiency. Thus we are inclined to believe that hospitals in fact are able to set the level of efficiency independent of whether they are financed by fixed grants or a payment per case. PMID- 10134586 TI - Explaining cost variations in DRGs 'Acute Myocardial Infarction' by severity of illness. AB - The empirical relationship is analyzed between the severity of illness and costs of medical care for 464 patients classified into DRGs 121-123, Acute Myocardial Infarction (AMI), in the University Hospital, Maastricht. Severity of cardiac and cardiovascular disorders characteristic of acute myocardial infarction is defined and operationalized in a sense that closely resembles the clinical practice of cardiologists. The effect of the severity of illness on DRG cost variations is studied separately for the costs of acute care (such as thrombolytic therapy, cardiac catheterization and percutaneous transluminal coronary angioplasty (PTCA)), length of hospital stay, costs of intensive nursing care at the coronary care unit (CCU) and the costs of ECGs, laboratory tests, echocardiography, exercise tests and drugs. For AMI patients, severity of illness measured by specific clinical criteria is found to give better predictions (higher R2) for costs of medical care than the DRG classification. PMID- 10134587 TI - Compliance with practice guidelines: clinical autonomy revisited. AB - The development of practice guidelines is gaining popularity in both North America and Europe. This review article explores the different reasons behind guideline development, the methodologies used and the effects assessed so far. Experience since 1982 with a guideline development programme at CBO is discussed in more detail. The consequences guidelines have for professional autonomy are discussed, and it is concluded that guidelines can enforce professionalization as well as accountability and efficiency when developed within the framework of a consistent goal-method-effect scheme and applied as an integral part of professional quality assurance activities. PMID- 10134588 TI - Search for a critical appraisal of EuroQol: a response by the EuroQol group to Gafni and Birch. PMID- 10134589 TI - Management development. The MESOL (Management Education Scheme by Open Learning) experience. AB - Explores and attempts to reconcile some of the differences between traditional professional and academic management qualifications and those based on the NVQ competence model. Based on the experience of Universities and Higher Education institutions delivering open learning MESOL materials to the UK health and social care sector, focuses on the different assessment methodologies used by each. Concludes that it is necessary to differentiate clearly between the traditional input/knowledge-based model and the competence-based approach of the NVQ. This will allow candidates to contextualize and consolidate learning in the workplace prior to revisiting their performance at a later date. PMID- 10134590 TI - Positioning the human resource business using service level agreements. AB - Explores the introduction and development of Service Level Agreements (SLAs) in relation to Human Resource Departments. Considers approaches to SLAs and highlights four dimensions necessary for the completion of an SLA. Stresses that Human Resource Specialists should have a thorough understanding of how directorates and other departments relate to one another to provide added value in terms of contribution to the organizational outcomes. Suggests the idea of adding value is an integral part of the SLA process which ensures that it operates as a means to an end and does not become an end in itself. Examines the degree of devolved freedom given to a department to seek work or sell its products outside its Trust/Unit. Scrutinizes the format of SLAs and concludes that the benefits of SLAs for users of Human Resource Departments and the benefits to the Human Resource Departments are similar. PMID- 10134591 TI - Expectations of general practice: gateways and bridges. AB - Looks at the role of the GP in today's Service and examines some of the organizational and motivational problems which have to be overcome before general practice can be confident of delivering to the strategic expectations of the NHS. They are designed to raise the level of debate for more long-term, practical support for general practice organizations. The issues involved have been researched both qualitatively and quantitatively and are grounded in a context of change. Includes excerpts from general practice profiles developed during research projects, consultancy projects and case study development work--large and small partnerships, single-handed practices, established and "bidding" fundholders, and significantly different practice populations. These are supported by the results of questionnaires circulated to over 2,500 doctors and practice managers and the views and work of others researching and practising in primary care. PMID- 10134592 TI - Seamless service. AB - Describes the process used by the Mater Infirmorum Hospital in Belfast in 1992 to achieve high quality care (seamless service), motivate staff to deliver and measure performance. Aims of the project included focusing the organization on the customer, improving teamwork and motivation. Opinions of staff, patients and GPs were examined and key issues for improvements were identified. Interface from every single interaction between Mater and customers was measured, taking into account customer perception of service, and staff perceptions of service. Data collection methods included taped interviews, video vox pops and questionnaires. Concludes that a mismatch was found between service offered and service required. Workshops launched ongoing activities and a small steering group designed a series of management forums to gain future support. PMID- 10134593 TI - Managing people: the breakfast menu. AB - Discusses an exploratory study of the impact of NHS reforms on the management of staff. Argues that "management" has moved from a view that staff should be provided with a secure and comfortable working environment to "labour" being viewed simply as a factor of production. The result seems to be an unprecedented sense of alienation among significant numbers of NHS staff. Proposes possible ways forward. The first focuses on the "means", accepting that the "ends" of the NHS will, for the foreseeable future, be dominated by the market. The second examines more closely the market-driven, business "end" or purpose and challenges the unitary view of the NHS Trust as a coherent business entity. Beyond these short- to medium-term responses, concludes that a return to a somewhat more flexible and less hard-edged human resources philosophy is a longer-term investment as the labour market tightens and skilled staff become scarcer in the later 1990s. PMID- 10134594 TI - Characteristics of successful health care organizations. The HR dimension. AB - Considerable attention is being given in the UK to the issue of identifying "what is it" that makes for success in health care organizations. The HAY Group has developed a worldwide database on the key human resource issues that are linked to success. Outlines some of the research. Drawing mainly on data from the USA, Canada, UK, Australia and The Netherlands, the research finds clear evidence of successful agencies adopting a strategic approach to the issues and then undertaking specific activities in organization design, management culture, rewards and management characteristics. Identifies a series of good practices and trends, and organizations can assess their own current position on a number of dimensions. PMID- 10134595 TI - What should professional personnel qualifications certify? AB - Current and foreseeable challenges facing the UK's National Health Service are calling for new personnel management roles and responsibilities for both line managers and human resource professionals. The existing system of training for human resource professionals needs to change to support these new performance expectations. Identifies seven features of a more appropriate system and four key themes. Discusses the potential contribution of National Vocational Qualifications (NVQs) and the need for a new relationship between NHS employers, academics and learners. Draws conclusions for the training of all professionals who may work in the future NHS. PMID- 10134596 TI - Price survey. Glove prices rise by just 1.5%. PMID- 10134597 TI - More responsibilities raise non-salary expenses in environmental services area. PMID- 10134598 TI - Primary care networks: the integrators of care in an integrated delivery system. PMID- 10134599 TI - Eight models for organizing PCNs. PMID- 10134600 TI - Market report: ambulatory growth is driving PCNs. PMID- 10134601 TI - The technology application process. PMID- 10134602 TI - Supplier certification for health care. AB - Supplier certification is an ongoing, formalized improvement process between a customer and a supplier. Ideally, suppliers and healthcare organizations will become extensions of one another, allowing for achievement of significant quality improvement over the long haul. There are six steps to implementing the process: 1) learning the process, 2) building a team, 3) defining objectives, 4) identifying evaluative criteria, 5) developing a measurement system and 6) selecting suppliers. For different levels of certification--defined by specific criteria--the customer receives more benefits and the supplier receives larger incentives. PMID- 10134603 TI - New technologies for laboratory productivity. AB - The laboratory at St. Joseph Hospital in Kirkwood, MO was experiencing serious inefficiency problems and worker frustration because of its aging wet reagent clinical chemistry analyzers. The hospital replaced the three machines with two complementary Kodak analyzers as a part of a dry slide purchase/equipment lease program and implemented a laboratory information system that interfaces the analyzers with the hospital information system. Among other benefits, test results availability has improved 30%, worker training has gone from two weeks to two to three days and maintenance problems have been eliminated. PMID- 10134604 TI - A computerized dispatch system that really delivers. AB - In 1990, Victoria Hospital in London, Ontario undertook a review of its Central Portering Department. The department's name was changed to Distribution Services and its need for more efficient servicing of customers led to the search for a computer system to replace the manual dispatch operation. After failing to find an existing system, the hospital contracted to develop its own system, called Vic Tracker. The system categorizes and prioritizes requests and produces various activity reports. Response time has improved 50% on average, and improved efficiency and a pre-booking feature has resulted in a decrease of approximately 100 calls per day. PMID- 10134605 TI - Circulator assist units, intra-aortic balloon. ECRI. PMID- 10134606 TI - Healthcare reform: beginning the ethical debate. PMID- 10134607 TI - HC reform update and drug discounting. PMID- 10134608 TI - Central service safety. PMID- 10134609 TI - The impact of healthcare trends on imaging products and services. AB - Key factors in healthcare reform--cost, access to care and quality of care--all have implications for diagnostic imaging. Technology is moving rapidly toward being able to provide images quickly, frequently in digital form to radiologists located in other departments or offsite. Film-based imaging still provides the highest resolution currently available and is the most appropriate option for many situations, such as mammography. Hybrid systems that combine film-based capture with electronic image storage and delivery have also been introduced for situations that require simultaneous review by remote clinicians. Healthcare systems will demand equipment that features open architecture and adheres to industry standards. Healthcare providers will form alliances with imaging equipment and consumable suppliers whose products and services offer advantages in quality, productivity and efficiency that lead to an overall decrease in costs. PMID- 10134610 TI - Achieving the promise of PACS today. AB - Picture archiving and communication systems (PACS) were introduced in the 1980s as the ultimate solution for managing radiological films, but technical limitations and high costs prevented all but a few well-funded institutions from experimenting with PACS. Today, technology is catching up with the early vision of PACS. Partial-PACS solutions can be applied to specific departmental needs and be part of a planned migration toward filmless radiology. The most prevalent PACS solutions today are teleradiology reading stations that enable a department to deliver images over the telephone lines to on-call radiologists' homes, but other applications are growing rapidly. Benefits include more timely patient treatment, increased productivity, elimination of lost films and reduced costs in labor, film and supplies. Each facility must carefully weigh the objectives for a PACS solution and perform a careful cost/benefit analysis before acquiring a system. PMID- 10134611 TI - Choosing a digital imaging upgrade over a system replacement. AB - Recently, St. Luke's Episcopal Hospital and Texas Heart Institute (SLEH/THI) in Houston evaluated its capital equipment strategy and chose to retrofit nine of its eleven cardiac catheterization laboratories with a digital upgrade for less than two-thirds the cost of a single laboratory replacement. In order to take advantage of budgeted funds, the selection and purchase had to be finished in a seven-month period. A multidisciplinary team was formed to do the technology assessment that led to the choice to upgrade rather than replace. A team consensus was reached on which vendors to trial. Written surveys filled in by physician and technician users who trialed the equipment were tallied to make the final equipment choice. Materiel management played a crucial role in cutting the necessary red tape to meet the purchase deadline. PMID- 10134612 TI - Evaluation of the Plazlyte Sterilization System at the Richmond Hospital, Richmond, B.C. AB - Ethylene oxide mixed with chlorofluorocarbons has been the sterilant of choice for heat- and pressure-sensitive instruments and equipment in most Canadian and U.S. healthcare facilities. A pending July 1, 1994 ban on CFCs in British Columbia propelled the Greater Vancouver Regional Hospital District (GVRHD) to seek out any new available technologies to replace EtO sterilization. AbTox Plazlyte Sterilization System, which employs a proprietary, low-temperature gas plasma in conjunction with vaporized peracetic acid chemistry to provide terminal sterilization of instruments and devices, appeared very promising. A task force was formed at the Richmond Hospital to develop and implement a clinical isolate test protocol of the system. Following the three-month trial, the results showed the system to be effective in sterilizing all clinical isolates and compatible with the materials tested. There has also been improved product throughput. The Richmond Hospital now uses one Plazlyte sterilizer to process all items formerly processed using EtO. PMID- 10134613 TI - X-ray film duplicators. ECRI. PMID- 10134614 TI - Quality by design. PMID- 10134615 TI - Cleaning in decontamination. PMID- 10134616 TI - Hospital integrates oncology indicators into cancer program. PMID- 10134617 TI - Hospital redesigns staff education processes. Uses multidisciplinary team approach. PMID- 10134618 TI - Communication efforts expanded for hospital accreditation process. PMID- 10134619 TI - Agenda for Change objectives stay the course. PMID- 10134620 TI - Small hospitals big on indicators. PMID- 10134621 TI - Laboratory surveys required in 1994. Few changes in survey process. PMID- 10134622 TI - Three bills take the lead in legislative reform efforts. PMID- 10134623 TI - Are closed-panel PHOs on the way? PMID- 10134624 TI - Health reform: just where do internists stand? PMID- 10134625 TI - How lawyers win those big "pain and suffering" awards. PMID- 10134627 TI - Bad apples: state boards do the most pruning ever. PMID- 10134626 TI - The big gamble capitation forces on you. PMID- 10134628 TI - Why you should watch the Senate Finance Committee. PMID- 10134629 TI - Therapy billing under scrutiny. PMID- 10134630 TI - Incontinence: targeting treatment approaches. PMID- 10134631 TI - Opening markets abroad. PMID- 10134632 TI - Financing flexibility. PMID- 10134633 TI - Cracking down on fraud. PMID- 10134634 TI - Creative financing alternatives. PMID- 10134635 TI - The new pharmacist. PMID- 10134636 TI - A new approach to quality. PMID- 10134637 TI - Citizenship behavior and social exchange. AB - This article develops and empirically examines a social exchange model of organizational citizenship behavior. An employee's trust in a supervisor is proposed to mediate the relationship between procedural fairness in the supervisor's decision making and employee citizenship. Data from 475 hospital employees and their supervisors were consistent with our model. We discuss future research directions. PMID- 10134638 TI - High cost contrast material. PMID- 10134639 TI - The transformation of radiology. PMID- 10134640 TI - View of healthcare. PMID- 10134641 TI - Positioning for the future while operating in the meantime. PMID- 10134642 TI - Risky business. PMID- 10134643 TI - Peer review in a quality assurance program: a physician acceptance model for a teaching hospital service. PMID- 10134644 TI - The experience of a breast mass CQI team. PMID- 10134645 TI - How good is your billing service? Part 1. PMID- 10134646 TI - Contemporary issues in HIM. The application layer--II. PMID- 10134647 TI - Contracts are catching on. Contests for emergency department deals spur changes in management firm practices. PMID- 10134648 TI - Induced delivery of anencephalic fetuses: a response to James L. Walsh and Moira M. McQueen. AB - James Walsh and Moira McQueen accurately conclude that the early delivery of anencephalic fetuses is morally acceptable, but the reasoning they use to reach that conclusion is flawed. First, the principle of double effect does not require a weighing of good and evil, but rather seeks a sufficient reason for tolerating the physical evil indirectly intended. Second, the principle of double effect requires a clear distinction between physical and moral causality. Third, the Catholic moral tradition will not admit direct and intended killing of the innocent. Rather, early delivery of anencephalic fetuses is permissible because of the pathology associated with delivery of anencephalic fetuses at full term. Thus, the early delivery of an anencephalic infant is acceptable if the purpose of the moral act is avoiding a pathological condition on the part of the mother. PMID- 10134649 TI - An empirical investigation of procurement contract structures. AB - This article presents a model of procurement contracting with asymmetric cost information and investigates whether two of the model's predictions are consistent with actual contracts between hospitals and California's Medicaid program. The article first tests for the presence of a fixed-price payment region where Medicaid's payments are independent of hospitals' actual (but unobservable) production costs and then tests whether the size of the fixed-price region depends upon expectations about hospitals' costs. To conduct these tests, the article must first estimate hospitals' "unobservable" costs attributable to Medicaid patients. The article finds evidence of a fixed-price region but cannot confirm that the size of the fixed-price region depends upon expectations about hospitals' costs. PMID- 10134650 TI - NHS Administrative Register piloting project. PMID- 10134651 TI - Auditing the health service. PMID- 10134652 TI - Guide to good practice in medical records. PMID- 10134653 TI - Medical records and the IT revolution. PMID- 10134654 TI - Reinvigorated Holy Cross Hospital tots up rapid quality, financial gains. PMID- 10134655 TI - Benchmarks of success for 100 "top" hospitals identified in research by HCIA/Mercer. PMID- 10134656 TI - Planning guide. Materials Management and Central Service Weeks. Opportunities to build great teams. PMID- 10134657 TI - Allergens spur hospitals to offer latex-free care. PMID- 10134658 TI - Shopping around: supply prices trend downward. PMID- 10134659 TI - New considerations in furniture and cart purchases. Ergonomics: save workers' backs without breaking the budget. PMID- 10134660 TI - New strategies in buying transport, storage products. PMID- 10134661 TI - Closing the skills gap: one hospital's approach. Greater Southeast Community Hospital, Washington, DC. PMID- 10134662 TI - Costly instrument repairs got you down? Chart your own solution. PMID- 10134663 TI - Ask these questions before buying new sterilization technologies. PMID- 10134664 TI - Stats. Supply management in surgical services departments. PMID- 10134665 TI - The patient has not been informed: a proposal for a physician conflict of interest disclosure law. PMID- 10134666 TI - Helping to find the "hidden cancer". PMID- 10134667 TI - One laboratory service to be created at the Victoria General and Camp Hill hospitals. PMID- 10134668 TI - The laboratory technologist: a consumer of chemical cocktails? PMID- 10134669 TI - Career. Part II--US laboratory employment: still an option. PMID- 10134670 TI - Canadian Institute for Health Information: founding members. PMID- 10134671 TI - Personal autonomy of the terminally ill. PMID- 10134672 TI - Take control of quality! AB - Transport media were developed to maintain the viability and to prevent the overgrowth of organisms in a specimen for bacterial culture. Is what you expect what you get when you purchase transport media from a manufacturer? This article explores some of the reasons why the buyer should beware. PMID- 10134673 TI - Subacute unit design should convey message. PMID- 10134674 TI - Not-for-profits must plan for the 21st century. PMID- 10134675 TI - How can a patient-care plan be made more meaningful? PMID- 10134676 TI - Is subacute care right for you? This proverbial pot of gold isn't for everyone. PMID- 10134677 TI - Buyers, capital sources warm up to senior housing. AB - This is the third year that Contemporary Long Term Care, in conjunction with Senior Housing Investment Advisors, Inc., has prepared the Seniors housing Industry Review and Forecast Report. The perspective of 20 industry experts who are involved in various aspects of the business comprise the basis for this evaluation of seniors-housing trends and future investment potential. When reviewing this report, one should consider the comments within the context of local market dynamics and individual investment criteria. PMID- 10134678 TI - 1994 retirement-housing survey. Retirement housing: the top 40. PMID- 10134679 TI - 1994 Architectural Design awards. Windemere Nursing & Rehabilitation Center, Martha's Vineyard; Harold & Patricia Toppel Center for Life Enhancement, Miami; Westminster Place, Oakmont, Pa. AB - At the 11th annual Architectural Design Awards, sponsored by Contemporary Long Term Care, the following projects were singled out for their innovative designs: New nursing home with 130 beds or less: Windemere Nursing and Rehabilitation Center on Martha's Vineyard. New nursing home with more than 130 units: Harold & Patricia Toppel Center for Life Enhancement, Miami, Fla. Renovated retirement center with 150 beds or less: Westminster Place, Oakmont, Pa. No awards were given in one nursing-home and three retirement-center categories. The competition was held on March 20 in the offices of Backen Arrigoni & Ross of San Francisco. Following is an overview of the competition and a narrative on each of the three entries honored for notable innovations in design. PMID- 10134680 TI - Who's in charge? DONs' management skills are challenged when subacute units enter the picture. PMID- 10134681 TI - Assessing the care plan. PMID- 10134682 TI - Beware of vendors bearing gifts. PMID- 10134683 TI - Managing scabies infestations. PMID- 10134684 TI - Creating a new paradigm based on employee satisfaction. PMID- 10134685 TI - Qualifications of an executive housekeeper. PMID- 10134686 TI - A method for continuous improvement. PMID- 10134687 TI - Smart equipment purchasing. PMID- 10134688 TI - Critical pathways. PMID- 10134689 TI - Challenge: how to boost employee morale while educating customers. St. Luke's Medical Center, Cleveland, OH. PMID- 10134690 TI - Challenge: how to improve residents' quality of life. Cedars Nursing Care Center, Portland, ME. PMID- 10134691 TI - How to hire team players. PMID- 10134692 TI - What to do when the axe falls. PMID- 10134693 TI - Consolidation strategies that pay off. 1994 healthcare foodservice report. PMID- 10134694 TI - Hospitals adopt intensive programs for diabetic patients to avoid high inpatient costs. AB - Just over a year ago, a 24-year-old man walked into a free health screening at Palmyra Medical Centers in Albany, Ga., complaining of weight loss, unending thirst and frequent urination. A quick blood test revealed the man was diabetic, with an alarming hemoglobin A1c level of 20.1. After six months of intervention, the man's hemoglobin dropped to an excellent rating of 7.1 and his physician is now ready to take him off insulin, said Layne Cox, program manager of the Diabetes Treatment Center at Palmyra, a Columbia/HCA hospital. While health fairs of yesterday were used to attract patients into the hospital, today's outreach programs are measured by success stories such as this. The goal now is to keep patients healthy and out of the hospital to reduce costs to managed care plans and health-care providers at risk through capitation contracts. PMID- 10134695 TI - Phone services help control patient demand, reducing unnecessary utilization. PMID- 10134696 TI - Successful networks will manage indirect health costs for employers. PMID- 10134697 TI - Capitation crucial to IHS (integrated healthcare system) success. Few hospitals in position to form an IHS. PMID- 10134698 TI - NME prepares for expansion in key markets. PMID- 10134699 TI - Lewin shows how MCO (managed care organization), IHS (integrated healthcare system) competition will cut costs. PMID- 10134700 TI - Health systems trying to fulfill data needs look to Sachs Group, Inforum. PMID- 10134701 TI - First reactions to 1995 JCAHO standards. PMID- 10134702 TI - Evaluating outcomes of nutrition services. PMID- 10134704 TI - Automated payroll deductions provide continued benefits. PMID- 10134703 TI - Being a team player for a coach who is playing on the other team. PMID- 10134705 TI - Wasting your assets--how to make better use of the NHS estate. AB - The impact of the health reforms together with other developments will mean that the 24 billion pounds NHS estate will undergo the most fundamental change since the days of Florence Nightingale. Against this background it is more important than ever that the utilisation of the estate is improved and that the NHS learns how to make the best use of private sector investment, says John Locke, Chief Executive of NHS Estates. PMID- 10134706 TI - Tracking beliefs and values. Leicester Royal Infirmary experience. AB - The turbulent environment in which NHS hospitals operate today necessitates a fundamental rethink of business principles. Not all organisations have a mission statement and although the benefits are controversial, it has become an increasingly important issue. An audit carried out at The Leicester Royal Infirmary provides a pointer as to how managers can gauge whether staff are familiar with the hospital's philosophy and how they feel about it. Brain Godfrey reports. PMID- 10134707 TI - How to improve the management of theatre time. PMID- 10134708 TI - London's healthcare: image and substance. PMID- 10134709 TI - Competence in health management qualifications. AB - A special report on health management qualifications detailed the number of management qualifications. One aspect which deserves additional mention is the use of accreditation of prior learning (APL) which is a growing feature of management qualification courses. Sue Balderson and John Knibbs describe their research into the use of APL as part of an NHS trust's management development strategy. PMID- 10134710 TI - Do NHS managers compare well against the national average? PMID- 10134711 TI - Geographic imbalances of physician supply: an international comparison. AB - This study was undertaken to compare geographic imbalances of physician manpower in developed and developing countries and to evaluate the success of policies designed to alleviate the imbalances. Data were drawn from a mail survey of countries conducted by the World Health Organization, from national statistical summaries, and from published information on national policies and programs. Information was available from 26 developing countries and 15 developed countries. Among developing countries, the degree of urbanization and rural economic development appeared to be the most important determinants of the level of geographic imbalance. Among developed countries, those with very high overall physician/population ratios tended to have the least degree of imbalance, but this effect was not consistent. At the national level in most countries, the effect of policies or programs specifically designed to redistribute physician manpower appeared to be limited. PMID- 10134712 TI - A strategy to increase the number of urban family practice resident physicians who enter rural practice. AB - Physician geographic maldistribution is a problem in the United States health care system. Innovative strategies are needed to entice resident family physicians training in the larger, more numerous suburban and urban training programs to practice in rural areas upon completing their training. This paper describes a strategy used at St. Elizabeth Medical Center Family Practice Residency Program, Dayton, OH, to encourage rural practice. In the St. Elizabeth plan, the interested family practice resident moonlights in a rural practice provided by the local county hospital. The county medical staff covers the resident physician's practice during the frequent absences. The residency program faculty provide on-site supervision, telephone back-up coverage, and practice consultation. The county hospital provides billing services; the resident physician retains 100 percent of collections. The resident physician gains exposure to the knowledge, skills, and attitudes needed in rural practice. Upon completion of residency training, the physician remains in practice and is not required to pay back any expenses incurred by the hospital. Two resident physicians participate currently; three others have expressed interest in practicing in the community. A similar plan might work in parts of the United States where, like Ohio, training programs and rural communities are not far apart. PMID- 10134713 TI - Birth outcomes to rural Illinois residents: is there a crisis? AB - In recent years, the supply of obstetric services in rural areas has been a concern. At the same time, the demand for such services has been affected by the reduction in population and economic base. This article explores the extent of these trends in Illinois and whether they have led to a deterioration in amount of prenatal care and birth outcomes. Using birth certificate and infant death data for residents of rural Illinois counties in 1983 and 1988, prenatal care and birth outcomes for each year are compared within rural areas and to the rest of the state, as well as between the two time periods. Although rural residents began prenatal care later, they obtained similar qualities of care as their urban counterparts. The data revealed no adverse impact on birth outcomes of residing in increasingly rural areas, nor was there a deterioration during the time period. An attempt was made to identify rural counties that lost providers and/or facilities and those that gained them. Although such a classification scheme is subjective, similar results ensued. While indirect costs such as time and effort to obtain care may have increased, at 1988 levels of care availability there was no crisis in Illinois. PMID- 10134714 TI - Physician recruitment in rural Canada: programs in New Brunswick, Newfoundland, and Nova Scotia. AB - This paper examines programs used in the Atlantic provinces of New Brunswick, Newfoundland, and Nova Scotia to recruit and retain physicians in rural areas. The provinces have many similarities but have unique characteristics that have shaped recruitment methods. The total number of physicians in each province has grown at a faster rate than the population. Each has problems attracting physicians to underserved areas, although the magnitude of the problems vary. The data for this paper were gathered from documents available from various agencies in each province and a series of personal interviews conducted in the spring of 1993. The provinces have chosen different avenues in attempting to solve the maldistribution of physician resources, ranging from regulatory methods in New Brunswick to moves in Newfoundland to encourage graduates of the province's medical school to locate in the rural areas and lessen the dependence on foreign medical graduates. Nova Scotia, with fewer areas needing physicians, has been able to focus its efforts on selected locations. Reviewing the methods used in the three provinces provides an insight into the attempts to solve the shortage of physicians in rural areas. PMID- 10134715 TI - Market shares for rural inpatient surgical services: where does the buck stop? AB - Utilization of surgical services by rural citizens is poorly understood, and few data are available about rural hospitals' surgical market shares and their financial implications. Understanding these issues is particularly important in an era of financially stressed rural hospitals. In this study information about rural surgical providers and services was obtained through telephone interviews with administrators at Washington state's 42 rural hospitals. The Washington State Department of Health's Commission Hospital Abstract Recording System (CHARS) data were used to measure market shares and billed charges for rural surgical services. ZIP codes were used to assign rural residents to a hospital service area (HSA) of the nearest hospital, providing the geographic basis for market share calculations. "Total hospital expenses" from the American Hospital Association Guide were used as a proxy for hospital budget, and the surgical financial contribution was expressed as a ratio of billed surgical charges to total hospital expense. For rural hospitals as a whole, 21 percent of admissions and 43 percent of billed inpatient charges resulted from surgical services. In 1989, 27,202 rural Washington residents were hospitalized for surgery. Overall, 42 percent went to the closest rural hospital, 14 percent went to other rural hospitals, and 44 percent went to urban hospitals. The presence of surgical providers markedly increased local market shares, but a substantial proportion of basic surgical procedures bypassed available local services in favor of urban hospitals. For example, about one-third of patients needing cholecystectomies, a basic general surgery of low complexity, bypassed local hospitals with staff surgeons.(ABSTRACT TRUNCATED AT 250 WORDS) PMID- 10134716 TI - Differences in the use of health services by metropolitan and nonmetropolitan elderly. AB - This study examined the importance of place of residence on the elderly's use of health services through Andersen's framework of health service utilization. The study found that nonmetropolitan elderly, both farm and nonfarm, make fewer physician visits than their metropolitan counterparts. This difference is not explained by differences in their predisposing or need characteristics. No residential differences were found in the number of short-term hospital stays or in the number of days of bed disability. No evidence was found that nonmetropolitan elderly substitute days of bed disability for physician care or for hospital stays. Also, little residential variation was found in the effect of predisposing, enabling, and need factors on physician use. The most likely explanation for the observed differences in physician use is the shortage of physicians in nonmetropolitan areas. However, without the ability to attach contextual information to national data on health status and service use, the relative importance of access to services cannot be adequately addressed. PMID- 10134717 TI - Local factors affecting the tendency to bypass local hospitals for inpatient mental health care: an exploratory analysis. AB - Using the records of 2,171 rural residents of Illinois who received inpatient treatment for mental illness or substance abuse, this paper examines factors that influence the tendency to seek service from a distant rather than a local hospital. Results indicate that the age and insurance coverage of the individual, the per capita income of the community area, surrogates for the service orientation of the local hospital and the proximity of the patient's residence to an urban center are significant influences. With the exceptions of drug abuse requiring detoxification or other symptomatic treatment, drug abuse accompanied by comorbidity and psychosocial disorders, psychosis, and childhood disorders, the primary diagnosis of the individual failed to have a significant effect on the propensity to bypass local sources of inpatient treatment. PMID- 10134718 TI - Urban and rural differences in health insurance and access to care. AB - This study considers differences in access to health care and insurance characteristics between residents of urban and rural areas. Data were collected from a telephone survey of 10,310 randomly selected households in Minnesota. Sub samples of 400 group-insured, individually insured, intermittently insured, and uninsured people, were asked about access to health care. Those with group or individual insurance were also asked about the costs and characteristics of their insurance policies. Rural areas had a higher proportion of uninsured and individually insured respondents than urban areas. Among those who purchased insurance through an employer, rural residents had fewer covered benefits than urban residents (5.1 vs 5.7, P < 0.01) and were more likely to have a deductible (80% versus 40%, P < 0.01). In spite of this, rural uninsured residents were more likely to have a regular source of care than urban residents (69% versus 51%, P < 0.01), and were less likely to have delayed care when they thought it was necessary (21% versus 32%, P < 0.01). These differences were confirmed by multivariate analysis. Rural residents with group insurance have higher out-of pocket costs and fewer benefits. Uninsured rural residents may have better access to health care than their urban counterparts. Attempts to expand access to health care need to consider how the current structure of employment-based insurance creates inequities for individuals in rural areas as well as the burdens this structure may place on rural providers. PMID- 10134719 TI - Medicine with a woman's touch. Women's clinic uses surveys to design patient friendly policies and services. Women's Health Center, Mason City, IA. PMID- 10134720 TI - Streetwise managed care. Six hospitals collaborate to improve access and healthcare for Medicaid patients. Health Partners of Philadelphia. PMID- 10134721 TI - Looking for a few good doctors. How two recruiters find physicians and keep them happy. PMID- 10134722 TI - Retention equals practice marketing. Nebraska Methodist Health System Inc., Omaha. PMID- 10134723 TI - Recruiting is in the details. Quincy Medical Group, IL. PMID- 10134724 TI - When I'm 64. Experiential sensitivity program helps employees treat older people with patience and understanding. Santa Monica Hospital Medical Center, CA. PMID- 10134725 TI - Managed care can be fun. Media campaign to employers and consumers puts hospital in the managed care race. Borgess Health Alliance, Kalamazoo, MI. PMID- 10134726 TI - When patients can't hear. Clinic for hearing impaired breaks barriers to care. Hermann Hospital, Houston, TX. PMID- 10134727 TI - A Cold War thaw. Sister relationship with Russian hospital spurs donations and much goodwill. St. Joseph's Hospital, Parkersburg, WV. PMID- 10134728 TI - Let the hospital do the walking. People line up for award-winning walking program that promotes fitness and health education. Manchester Memorial Hospital, CT. PMID- 10134729 TI - Democrats do or die on health care. PMID- 10134730 TI - A checkup for health costs. Medical inflation is in remission, but the prognosis is guarded. PMID- 10134731 TI - Toward a consensus for health care reform: the use of focus group interviews. AB - Ten focus group interviews were conducted, with each group representing a different constituency of a regional health care system. Among the groups, there appeared to be similar visions of what the system should be, and similar assessments of the status quo and future trends. But there were differences about what barriers to reform exist and what compromises among the constituencies are necessary. Every group stated the need to educate the public about healthy behaviors, self-reliance, and responsible use of health care resources. PMID- 10134732 TI - US nursing-home population composition in the PPS-era. AB - This paper uses the 1987 National Medical Expenditure Survey-Institutional Population Component baseline public use data to compare US nursing-home population residents who were admitted in years adjacent to the 1982 Tax Equity and Fiscal Responsibility Act (TEFRA). This Act has been associated with claims of hospitals discharging Medicare patients quicker and sicker in order to gain financially under the prospective payment system (PPS), which would change the composition of nursing-home populations. The working hypothesis was that if PPS had an effect on the composition of nursing-home populations, those admitted during the PPS-era would have more reported deficits than those who were admitted in the pre-PPS period. Although the data are cross-sectional it was expected that differences in trends could be observed. The data do not show any general change in the composition of nursing-home populations that could be attributed to PPS. The explanation is that while PPS may have a discernible effect on short stayers, there have not been any clear effects to date on the long-stayer population represented by these data. PMID- 10134733 TI - The creation and evolution of the new health authorities: the challenge of purchasing. PMID- 10134734 TI - A causal modeling approach to institutionalization. AB - A causal model of the institutionalization process is presented. Path analysis and logistic regression are performed on NHIS Longitudinal Study of Aging data. Based on initial analysis, the model is revised and re-evaluated. Convergent results support significance for four of five proposed predictors. Results are similar for men and women. Findings suggest unidentified factors are important to nursing home admission and that attention should be given to the process of decision-making that leads to admission. PMID- 10134735 TI - General and functional level health care managers: neither 'manage' very much. AB - This paper reports the results of a study of 40 (20 paired general and functional level managers) in 20 health care organizations. The managers were personally interviewed and were asked to supply additional self-coded data from calendar entries, telephone logs, and in/out baskets. The results of this study indicated that health care managers, like their business counterparts, spend most of their time performing tasks other than traditionally defined management functions. In fact, major portions of the typical day of general and functional managers are spent exchanging routine information, processing paperwork, and interacting with others. As the studies have confirmed with regard to business managers, the health care general managers in this study focused much of their attention on issues and events external to the organization. The information sources they valued most were primarily external to the organization. The functional managers, by comparison, were more oriented to internal issues and information sources. In general, this study indicated that the patterns of managerial work in health care organizations are similar to those in business organizations and that managers in both settings spend half their time doing things that are not 'managerial' in nature. PMID- 10134736 TI - Effective teamwork and productivity conferences. AB - The popularity of various types of team building has grown dramatically in recent years, but many organizations have invested large amounts of time and money for little practical benefit. The growth of team-building activities has been characterized as "management by best-seller." This article examines the long-term impact of a number of team-building activities in terms of their positive effects on both employees and the work situation. Assessments are made of outward bound activities, empowerment programs, discussions of best-selling business books, motivational speakers, and group retreats to examine working relationships. A case study is then presented of a well-planned and structured retreat for a hospital. A group of about 75 supervisors and managers identified the strengths and problems of the hospital, analyzed the causes of the effectiveness and ineffectiveness of each department and the entire hospital, and proposed specific changes to improve teamwork and productivity. Conditions needed for the success of this approach were discussed. PMID- 10134737 TI - Flexible management: strategies for the changing workforce. AB - In the year 2000, managers will supervise employees whose career aspirations differ drastically from their own. Success not only will be measured by salary and status, but will be tied to a person's family relationships. Twenty years ago, most managers were not concerned with the family problems of their subordinates. This notion is now out of date. The family responsibilities of staff have a direct effect on the company's productivity. An employee who is worried about the care of an elderly parent, or concerned with the safety of a preteen home alone after school, is unlikely to give full attention to the task at hand. Flexible management is a cost-effective way of dealing with these issues. Managers who have the skills to be flexible and the strategies to work with employees for a win-win situation will reduce distractions and tardiness and gain productivity and loyalty. PMID- 10134738 TI - Using personal checklists to facilitate TQM. PMID- 10134739 TI - Creating a high-performance team through proactive management. AB - Numerous articles, business consultants, and scholars argue that high-performing management teams lead to higher productivity in organizations. Unfortunately, few managers are able to successfully develop such teams in their organizations. This article outlines the five strategies that define proactive management and produce high-performing teams. PMID- 10134740 TI - Implementing laboratory testing into a shared network. PMID- 10134741 TI - Improved organization and vertical integration of our health-care system. PMID- 10134742 TI - The Gotterdammerung of the large independent laboratories: has the fat lady sung, yet? PMID- 10134743 TI - Does your strategic plan identify critical health-care issues? PMID- 10134744 TI - Service and value: the decommoditization of laboratory services and the impact of managed care. PMID- 10134745 TI - Nothing to fear but fear itself: the EM's (environmental manager) role in communicating risk. PMID- 10134746 TI - Vacuum pumps and water treatment. PMID- 10134747 TI - Latex sensitivity among healthcare workers. PMID- 10134748 TI - The incidence of mandated maternity benefits. AB - I consider the labor-market effects of mandates which raise the costs of employing a demographically identifiable group. The efficiency of these policies will be largely dependent on the extent to which their costs are shifted to group specific wages. I study several state and federal mandates which stipulated that childbirth be covered comprehensively in health insurance plans, raising the relative cost of insuring women of childbearing age. I find substantial shifting of the costs of these mandates to the wages of the targeted group. Correspondingly, I find little effect on total labor input for that group. PMID- 10134749 TI - Justice and the inclusion of women in clinical studies: an argument for further reform. AB - Our society's practice of inadequately representing women as subjects of clinical research is unjust, not only because it results in inequalities in the quality and availability of care that have a detrimental impact on women's health, but also because it is linked to women's oppression. Although recent policy changes help to resolve the problems, more must be done. Additional remedies for the injustices of our society's research practices are proposed. PMID- 10134750 TI - Religious perspectives on bioethics, Part I. PMID- 10134751 TI - Reflections on unethical experiments and the beginnings of bioethics in the United States. AB - The author offers personal reflections on the development of research ethics in the United States, primarily during the 1960s. He explores the efforts of the pioneers in the field of human experimentation ethics to raise and discuss issues such as the value conflict between the acquisition of knowledge and respect for the autonomy of research subjects and the crucial importance of disclosure in the informed consent process. PMID- 10134752 TI - The impact of HIV infection on society's perception of clinical trials. AB - All international codes of research ethics and virtually all national legislation and regulation in the field of research involving human subjects project an attitude of protectionism. Written with the aim of avoiding a repetition of atrocities like those committed by the Nazi physician-researchers, calamities like the thalidomide experience, or ethical violations like those of the Tuskegee syphilis study, their dominant concerns are the protection of individuals from injury and from exploitation. In recent years, however, society's perception of clinical research has shifted dramatically. Now, largely as a consequence of the efforts of the AIDS activists, clinical research is widely perceived as benign and beneficial. Although this shift in attitude has resulted in some important improvements in research policies and practices, this new perception is just as wrong-headed as was the earlier excessive protectionism. It is necessary to maintain a balanced perspective; our policies should encourage the conduct of ethical research while maintaining the vigilance necessary to safeguard the rights and welfare of the subjects. PMID- 10134753 TI - Healthcare reform is already behind the times. PMID- 10134754 TI - Documentation: burden or blessing? PMID- 10134755 TI - A perspective on point of care systems. AB - Point of care technology is finally being accepted in health care organizations. Portable wireless computers and database interoperability are facilitating this acceptance. Using point of care devices, caregivers can access and input patient data whenever, wherever, and however required. This technology will improve patient data access, improve quality, and reduce costs of health care. PMID- 10134756 TI - Integrated patient-centered computing: operations optimization for the 21st century. AB - Over the last few years, health care providers have increasingly recognized that health care is an information business. In fact, the restructuring now being contemplated by many in the context of reform cannot be done without proper information management support. The unfortunate concentration of the health care industry over the last 20 years on administrative and financial data capture has obscured the fact that the important focus should be on patient care and health care operations information. Information on patient care has, unfortunately, largely been relegated to the paper chart and other ad hoc pieces of paper. New systems should focus on health care operations optimization, with specific design features to address failings in the paper system. To be successful, such systems must be integrated and patient centered. This is especially clear in the new enterprise-based world of health care delivery, where patients are the only common factor among venues. Health record professionals, the primary caretakers of patient care information, should be deeply involved in helping institutions move to this new world. PMID- 10134757 TI - Using an integrated point of care system: a nursing perspective. AB - Nurses at LDS Hospital, Salt Lake City, Utah, have had the ability to document patient data and nursing care on a bedside computer for over nine years. This ability has had numerous ramifications for the medical record, nursing practice, and clinical decision making. This article is an effort to describe how and why certain decisions were made, the implications of these decisions, mistakes that were made and their solutions, and the tremendous impact on clinical decision making and improved patient outcomes that is only beginning to be realized by computerization of the medical record. PMID- 10134758 TI - Implementing an automated documentation system: lessons learned. AB - Converting from a manual charting system to an automated charting system is a complex and difficult change. This article discusses project planning tips, training tips, and implementation tips that can make this change a successful one. PMID- 10134759 TI - Point of care and patient privacy: who is in control? AB - Public and patient access to medical records has been severely limited through policies limiting physical and timely access and intellectual understanding of content. New expectations of patient/public access and control have arisen accompanying the new paradigms of health care delivery and health information (computer-based patient records). Examples from these new paradigms are personalized and presented in information system contexts from bedside to community settings. Patient and family involvement in care delivery, education, assessment, and control of privacy are explored. A personalized confidentiality/security/privacy module of the computer-based patient record is suggested. PMID- 10134760 TI - Education review: applied medical informatics--informatics in medical education. AB - The importance of informatics training within a health sciences program is well recognized and is being implemented on an increasing scale. At Chicago Medical School (CMS), the Informatics program incorporates information technology at every stage of medical education. First-year students are offered an elective in computer topics that concentrate on basic computer literacy. Second-year students learn information management such as entry and information retrieval skills. For example, during the Introduction to Clinical Medicine course, the student is exposed to the Intelligent Medical Record-Entry (IMR-E), allowing the student to enter and organize information gathered from patient encounters. In the third year, students in the Internal Medicine rotation at Norwalk Hospital use Macintosh power books to enter and manage their patients. Patient data gathered by the student are stored in a local server in Norwalk Hospital. In the final year, we teach students the role of informatics in clinical decision making. The present senior class at CMS has been exposed to the power of medical informatics tools for several years. The use of these informatics tools at the point of care is stressed. PMID- 10134761 TI - Innovation review: Iliad--a medical diagnostic support program. AB - An expert diagnostic system, iliad, can prove useful to a health care provider as a personal consultant. iliad can suggest relevant diagnoses, give advice regarding cost-effective workup strategies, and explain relationships of findings to diseases. Engineering medical knowledge to perform such tasks is now possible with the help of a personal computer, providing every physician's office with a new and exciting way to learn and practice medicine. PMID- 10134762 TI - Research review: implementing change in the work redesign process. AB - Recent technological and management innovations have placed increasing pressure on health information managers to become change agents in their respective health care organizations. This article focuses on how different groups of health care employees perceive and adapt to change. Findings suggest the way change is perceived and inculcated into daily routines is dependent on past experiences with change. To successfully implement change, therefore, management should take a personal rather than structural approach. PMID- 10134763 TI - Legal review: a case study from California--the sharing of peer review information between hospitals and nonhospital providers. AB - You are the chief executive officer of Friendly Neighbor Medical Center, an acute care hospital. On your desk is a letter from your counterpart at The Behemoth Clinic, a large local medical group that not only is very active in managed care contracting in your service area, but also has an important relationship with your hospital. Behemoth has requested extensive access to Friendly Neighbor's peer review files and patient records in order to investigate the care provided by one of Behemoth's physicians. You happen to be aware that the physician has been the subject lately of peer review scrutiny at your hospital, and you would like to cooperate with Behemoth. Can you do so without jeopardizing the legal confidentiality protections available to your hospital's peer review records, not to mention the peer review process generally? PMID- 10134764 TI - Risk management and medical practice guidelines: what is risk management's proper role? PMID- 10134765 TI - 11 years of million-dollar medical malpractice claims in Ohio. PMID- 10134766 TI - Underground storage tanks: managing the hidden liability exposure. PMID- 10134767 TI - Bending a promise. PMID- 10134768 TI - A sick boy says "enough!". PMID- 10134769 TI - Using benchmarking techniques to improve efficiency and quality in cardiology services: Part two. AB - Hospital administrators have accepted the challenges of operating under a capitated or total fixed payment system under managed care. Part of that challenge for managers is the dramatic shift from being revenue producers to being cost managers. Benchmarking a complete DRG process is one way to compare which hospitals are providing the highest-quality care at the lowest cost. PMID- 10134770 TI - Surviving and thriving in the '90s: a formula for success. AB - The old role of the leader/manager giving commands and maintaining strict control is giving way to a new role of coach and facilitator. A balance of effective leadership and efficient management, plus knowing when to focus on each, is critical in order to thrive in the 1990s. PMID- 10134771 TI - The organization of heart services. Part one: The elements of the successful heart services organization. AB - The most successful heart programs have been able to bring together the interests of the physicians and the hospital and its personnel in such a way that the practitioners determine that their individual interests are best met through the program. PMID- 10134772 TI - Reform and the new role of cardiovascular medicine. PMID- 10134773 TI - Data watch. A snapshot of HMO coverage. PMID- 10134774 TI - Report cards: Part 1: Are health plans making the grade? PMID- 10134775 TI - Risk-sharing. PMID- 10134776 TI - Long-distance medicine. Telecommunication promises to deliver better care. But will it cut the nation's health bill? PMID- 10134777 TI - Getting more mileage from EAPs. PMID- 10134778 TI - Breaking with tradition. By covering non-traditional treatments and naming an advisory board to monitor quality, IBM cut its mental health costs substantially. PMID- 10134779 TI - The argument for an employer mandate. PMID- 10134780 TI - Houston group goes against the grain. PMID- 10134781 TI - Now is the time to prepare. To avoid unpleasant surprises later, here's how employers can get ready for health reform. PMID- 10134782 TI - Questions and answers on employee benefit issues. AB - This Issue Brief addresses 19 topics in the areas of pensions, health insurance, and other benefits. In addition to the topics listed below, the report includes data on the prevalence of benefits, tax incentives associated with benefits, lump sum distributions, number of private pension plans, pension coverage rates, 401(k) plans, employer spending on group health insurance, self-insured health plans, employer initiatives to reduce health care costs, and employers' response to the retiree health benefits accounting rule, and flexible benefits plans. In 1992, U.S. employers (public and private) spent $629 billion for noncash benefits, representing nearly 18 percent of total compensation, excluding paid time off. In 1992, 71 percent of the 50.1 million individuals aged 55 and over received retirement benefits, including distributions from private and public pensions, annuities, individual retirement accounts, Keoghs, 401(k)s, and Social Security. Among the 76 percent of all private pension plan participants who participated in a single plan, 30 percent named a defined benefit plan as their pension plan type, 58 percent named a defined contribution plan as their pension plan type, and 12 percent did not know their plan type. Private and public pension funds held more than $4.6 trillion in assets at the end of 1993. The 1993 year-end assets are more than triple the asset level of 1983 (nominal terms). According to the Congressional Budget Office, U.S. expenditures on health care were expected to have reached $898 billion in 1993, up from $751.8 billion in 1991, an increase of 19.4 percent in nominal terms. PMID- 10134783 TI - Effect of language of interview on the validity and reliability of psychological well-being scales. PMID- 10134784 TI - Measuring the Monday blues: validation of a job satisfaction scale for the human services. PMID- 10134785 TI - Mandated reporting and child abuse fatalities: requirements for a system to protect children. PMID- 10134786 TI - Social network map: some further refinements on administration. PMID- 10134787 TI - Of markets, technology, patients and profits. AB - In this paper I: (1) Describe something of the present situation in the United States and briefly contrast this with the state of affairs in other nations of the industrialised world. I emphasise health care but also allude to other social conditions: health care is merely one institution of a society and, just as do its other institutions, the system of health care reflects the basic world-view of that society. (2) Sketch the world-view and the philosophy which underwrites the use of a market system in distributing what are acknowledged to be critically important social goods like health care and higher education. I show that a well functioning market can indeed be useful when it comes to distributing some, but not when distributing other goods. (3) Suggest that when competition and the market are used to 'regulate' health care, technology--instead of being used to benefit patients--is apt to be used primarily to maximise individual profit: it becomes a weapon between what is often painted as 'warfare' among health care providers and institutions. I argue that this state of affairs is based on an undue emphasis upon the demands of individual freedom to the detriment of the community. Finally (4) I suggest an alternative approach to balancing individual with communal interests, an approach which is neither based on a predominance of one with neglect of the other, nor on a dialectic balance between them, but rather upon an approach which sees both individual and communal interests as modifying forces in a complex homeostatic balance.(ABSTRACT TRUNCATED AT 250 WORDS) PMID- 10134788 TI - The changing blueprints of the British NHS: the White Papers of 1944 and 1989. AB - It has recently been pointed out that the 1989 White Paper Working for Patients, which provides the basis for the current reforms of the British National Health Service, has some common features with the 1944 White Paper A National Health Service, which was the unadopted model for the service produced by the Wartime Coalition Government. Moreover, it is likely that the Conservatives, if elected in the 1945 General Election, would have introduced a service based on a modified version of the 1944 document. We can compare these two blueprints to shed some light on Conservative thinking on health care over a period of nearly 50 years. There are some similarities in terms of the notions of purchaser and provider, contracts and pluralism. However, there are striking contrasts, notably in their attitude towards planning versus competition and local democracy versus patronage. It is claimed that the profound differences outweigh the apparent similarities and consequently the two blueprints show the discontinuity rather than the continuity of Conservative thinking on health care. PMID- 10134789 TI - Responsibilities and rationalities: should the patient be blamed? Paper one: The distinction between prospective and retrospective responsibility. PMID- 10134790 TI - Responsibilities and rationalities: should the patient be blamed? Paper two: Rationality, harm and risk. PMID- 10134791 TI - Is caring a viable component of health care? AB - The attitudes and behaviours that constitute caring affect both the quality of the patient's experience and the outcomes of medical care. They can be identified and can be nurtured or discouraged by the structures of organisation and financing within which health care is provided. They have costs, so their viability is threatened as pressures increase to make health care more economically efficient. Yet the value of caring behaviour may justify what is necessary to sustain it. This issue deserves prompt and extensive debate as health care systems undergo revision throughout the world. PMID- 10134792 TI - The poverty of management. PMID- 10134793 TI - Analysing nursing analysis. PMID- 10134794 TI - International comparisons of health care systems: Part two. Medical travellers as 'system builders'. PMID- 10134795 TI - Operations research survey and computer simulation of waiting times in two medical outpatient clinic structures. AB - Outpatient services are increasingly recognised as an important component of health care provision and may be improved through the application of modern management techniques. We have performed a time and role audit of consultation and waiting times in two medical clinics using different queuing systems: namely, a serial processing clinic where patients wait in a single queue and a quasi parallel processing clinic where patients are directed to the shortest queue to maintain clinic flow. Data collected were used to construct a computer simulation of patient flows in clinic. Assessment of patient satisfaction in the clinic process was determined using a self-administered questionnaire. Mean waiting time was shorter in the quasi-parallel processing clinic: 26 (SD 17) minutes compared with 36(24) minutes in the serial processing clinic. In the serial processing clinic 61% of patients waited more than 30 minutes compared with 41% in the quasi parallel processing clinic. In the serial processing clinic 8% of 142 patients surveyed complained of the time spent waiting. The computer simulation we produced was able to determine waiting times with different clinic structures. The simulation showed that reductions in waiting time up to 30% might be achieved by changing our serial processing clinic to a quasi-parallel processing one. Performance of medical outpatient clinics can be improved by examining and changing clinic management. Computer simulation of outpatient clinics offers a means of assessing the impact of such changes on waiting time in clinic and on waiting lists. PMID- 10134796 TI - To the Chairman of the UK General Medical Council. PMID- 10134797 TI - Teaching ethics within the medical curriculum. PMID- 10134798 TI - Post-socialist health care: an aimless transition? PMID- 10134799 TI - Washington's five-ring circus. PMID- 10134800 TI - Health care: so where's the crisis? PMID- 10134801 TI - Workload measurement: A survey of computerized data collection. AB - The results of a national survey which examined current computer usage and occupational therapist direct entry of Workload Measurement Data is presented. Results indicated an almost equal distribution of departments using computers versus not using computers. A variety of software packages are used for the purposes of collecting workload measurement data, but the majority of departments use customized in-house programmes. The most common method of data entry was a clerk in a central location, however, a number of departments are considering a switch to therapist direct entry. Advantages and disadvantages of both methods were described by survey respondents. PMID- 10134802 TI - Partners in growth: implementing family-centered changes in the neonatal intensive care unit. AB - Although there are several forces driving changes with regard to parents within neonatal intensive care units (NICUs), they all culminate in the ideals represented in family-centered care. This article examined the variables that are perceived by parents to be barriers to their assumption of parental roles while their infants were hospitalized in the NICU. Data were used to support and implement pragmatic changes in program development and service delivery within the NICU. PMID- 10134803 TI - Parental opinions about attending parent support groups. AB - Parent support groups are often a routine part of the services provided to families who have children with special health care needs. Often times, however, the groups are poorly attended, despite expressions of interest from parents. A survey of 45 families was conducted to examine who participates, why, and what factors encourage attendance. This article describes the survey responses and offers suggestions regarding utilization of the results for those planning parent support groups. PMID- 10134804 TI - Certification, education encouraged in this facility. St. Mary's Hospital, West Palm Beach, FL. PMID- 10134805 TI - TQM--fad or reality? PMID- 10134806 TI - The constitutional law of abortion in Germany: should Americans pay attention? PMID- 10134807 TI - Health care system reform. PMID- 10134808 TI - Hospital market structure, hospital competition, and consumer welfare: what can the evidence tell us? PMID- 10134809 TI - Health care joint ventures and the antitrust laws: a guardedly optimistic prognosis. PMID- 10134810 TI - The specialty boards and antitrust: a legal perspective. PMID- 10134811 TI - Liability of medical institutions for the negligence of independent contractors practicing on their premises. PMID- 10134812 TI - Patenting Dr. Venter's genetic findings: is the National Institutes of Health creating hurdles or clearing the path for biotechnology's voyage in the twenty first century? PMID- 10134813 TI - Cultural models and the future of bioethics. PMID- 10134814 TI - Practice parameters as a shield against physician liability. PMID- 10134815 TI - Patient and physician autonomy: conflicting rights and obligations in the physician-patient relationship. AB - In sum, beneficence and autonomy must be mutually re-enforcing if the patient's good is to be served, if the physician's ability to serve that good is not to be compromised, and if the physician's moral claim to autonomy and the integrity of the whole enterprise of medical ethics are to be respected. PMID- 10134816 TI - Commentary. A practicing physician's view. PMID- 10134817 TI - Informed consent--must it remain a fairy tale? PMID- 10134818 TI - Ethics, institutional complexity and health care reform: the struggle for normative balance. PMID- 10134819 TI - Physician-hospital integration in a community hospital: a case study. AB - Over the past 20 years, the hospital environment and physicians' relationships with hospitals have changed dramatically. Hough has presented a concise description of this relational evolution. He describes hospitals during the period 1900 to 1975 as physicians' workshops; 1976 to 1985, hospitals were physicians' competitors; 1986 to 1995, hospitals have been and will be physicians' suitors; and, from 1996 on, Hough sees hospitals as physicians' partners. At St. Joseph Health System, we have already taken strong moves toward the final scenario envisioned by Hough. In this article, the author describes the historical underpinnings and the methodologies of the system's planning and implementation processes for new arrangements with staff and community physicians. PMID- 10134820 TI - Risk management in an IPA setting--Part II. AB - In the first part of this two-part article, the author explored the nature and significance of differences in the levels of risk in IPA and network managed care settings. In this concluding part of the article, he describes and assesses methods that may be undertaken by the IPA-model HMO to control and minimize risk elements. In short, what follows are the elements of a risk management program in such an environment. PMID- 10134821 TI - Mexican system a mix of public and private providers. AB - The following article is one of a series that deal with the provision of health care services around the world. Other countries in the series include Canada, Germany, Italy, Japan, the Netherlands, and the United States. Countries scheduled for coverage in the series include Austria, France, Singapore, Spain, and the United Kingdom. The countries are described using a grid of characteristics so that comparisons may be made more easily. All of the analyses, along with further comparative data, will be gathered into a freestanding book to be published later in the year. Dr. Mendoza serves as the editor for the project. PMID- 10134822 TI - A guide to evaluating managed care companies. AB - Managed care has gradually been replacing the traditional way in which doctors and patients interact. These changes are taking place at an increasing pace, which strongly suggests there will be a dramatic trend to managed care programs. It has become imperative to understand the business of medicine beyond the traditional "business manager" tasks of setting fees, analyzing tax consequences, and balancing the check book. Providers may be hard pressed to maintain the quality of care they feel comfortable giving as the regulations of managed care exert their pressures. A rational, systematic approach to evaluate managed care firms is presented in this article. Additional criteria will have to be added as new ideas for managed care evolve. Physicians and practices must make decisions concerning the level of their participation, depending on a variety of factors, some more sensible than others. PMID- 10134823 TI - Why health triggers won't work. PMID- 10134824 TI - Bad blood. PMID- 10134826 TI - Wairau Hospital goes live with ORA*CARE. PMID- 10134825 TI - Crown Health Enterprises fact and fiction. PMID- 10134827 TI - New funding system for post-entry clinical training. PMID- 10134828 TI - The search for quality information. PMID- 10134829 TI - Nurses' innovative collective employment contract wins massive support from staff involved. PMID- 10134830 TI - Health reforms trigger major upgrade for Smith & Nephew. PMID- 10134831 TI - Risk management issues in the use of iodinated radiopaque contrast media. PMID- 10134832 TI - Indiana Hospital Association develops comparative outcome profile. PMID- 10134833 TI - Putting power quality in the hospital mainstream. PMID- 10134834 TI - R2: risk management and reimbursement--developing a program for office medical record reviews. PMID- 10134835 TI - Perspectives. End game: Congress prepares for health reform vote. PMID- 10134836 TI - Special supplement: a guide to committee-passed health reform bills. PMID- 10134837 TI - Perspectives. Costs of treating immigrants prompts backlash by states. PMID- 10134838 TI - Perspectives. Cost-cutting alliances bloom across the U.S. PMID- 10134839 TI - Physician-assisted suicide. Legal rulings skirt around ethics of aid-in-dying. AB - Kevorkian's acquittal of violating Michigan's assisted-suicide ban and a federal court's ruling that Washington state's ban on assisted suicide is unconstitutional say more about the inability of the judicial process to provide clear guidance through ethical quagmires than they do about ethical issues at hand, as the following articles explain. PMID- 10134840 TI - Care of the dying. Studies look for humane ways of withdrawing treatment. AB - Applying the principles of decision making to end-of-life situations has been discussed at length in the medical ethics literature, but published accounts of actual experiences encountered when life-sustaining interventions are withdrawn have been limited. Once the decision is made to withdraw treatment and the goal of care shifts from cure to palliation, attention must be given to the clinical and ethical processes involved in extricating patients from their high-tech dependencies. The following articles summarize the work of several groups that are trying to define what ought to be done on behalf of these patients. PMID- 10134841 TI - Bishop calls for halt in dispensing morning-after pill for rape victims. PMID- 10134842 TI - Discussions of values reappear in health reform debate. PMID- 10134843 TI - No decision yet on national ethics advisory board. PMID- 10134844 TI - Nixon and Onassis deaths move public toward advance directives. PMID- 10134845 TI - Human experimentation. Hospitals caught in conflicting agency regs on informed consent. PMID- 10134846 TI - Cataracts: diagnosis and treatment. PMID- 10134847 TI - Communication standards for healthcare applications: Health Level 7. PMID- 10134848 TI - Joint Commission on Accreditation of Healthcare Organizations: scoring performance-focused functional standards. PMID- 10134849 TI - Health data: disclosure, protection, and privacy. PMID- 10134850 TI - Health information to support health reform. PMID- 10134851 TI - Uniformity and administrative simplification--is that a light at the end of the tunnel? PMID- 10134852 TI - Information technology as an enabler of health system reform. PMID- 10134853 TI - The Canadian healthcare system. PMID- 10134854 TI - Measuring and improving performance: a practical approach to implementing a productivity program. AB - Developing, implementing, and maintaining a productivity program are basic tenets of good management. While it does require time and commitment, a well-designed program is well worth the time investment. Increasingly, health information management professionals will be expected to monitor productivity and streamline work processes to help assure efficient, cost-effective support for patient care. PMID- 10134855 TI - Update on the Fair Health Information Practices Act of 1994. PMID- 10134856 TI - An explanation of the 1994 Medicare reimbursement. PMID- 10134857 TI - A bloody clash of egos. PMID- 10134858 TI - AIDS. In one community, silence equals death. Thousands of deaf Americans have never learned the details about HIV and AIDS and their ignorance is killing them. PMID- 10134859 TI - My world now. Life in a nursing home, from the inside. PMID- 10134860 TI - Rationing health care. PMID- 10134861 TI - Taking back their health care. PMID- 10134862 TI - Reagan's revenge. PMID- 10134863 TI - Self-assessment and resolution of indoor air quality problems. AB - Indoor air quality (IAQ) problems have their origins in many different generating sources within facilities. General categories of these sources include building systems, processes and procedures, management, employees, and outside influences. Knowing how to identify the source(s) is the only way to resolve IAQ issues. This paper discusses methods that can be used by facilities managers and safety managers in hospitals to conduct a self-assessment to address IAQ complaints so that the problems can be quickly and adequately resolved. PMID- 10134864 TI - Paying the bill. AB - Businesses are in revolt over President Clinton's proposal to require employers to underwrite their workers' health coverage. But it won't be easy to find another way to provide universal coverage without higher taxes. PMID- 10134866 TI - A grim prognosis for Clinton's bill. PMID- 10134865 TI - An order that didn't take. PMID- 10134867 TI - The business lobby's dissenting voice. PMID- 10134868 TI - Back to the future. PMID- 10134869 TI - The big sell. AB - When President Clinton finally unveiled his plan to overhaul the nation's health care system last October, he was riding high in the polls and the early reviews were promising. What went wrong? PMID- 10134870 TI - Total quality training in the hospital setting. AB - Total quality management requires a commitment to continuous quality improvement and a complete transformation of a healthcare organization's operations. An ongoing process, it prescribes training at all levels of an organization's hierarchy as well as the routine evaluation of the training programs' quality. PMID- 10134871 TI - The use of market research to design healthcare offerings. A case study of a senior citizen community. AB - With a growing elderly population, there is little argument that the healthcare system in the United States must understand the needs and wants of its elderly consumers. This is especially important in a rural community where services can be limited and access to these services is difficult for consumers. Marketing research is one way in which rural healthcare facilities can gain market information not only to enhance their product offerings, but also to ensure that proper and sufficient services are provided. This article presents a case study of a long-term healthcare facility using marketing research. PMID- 10134872 TI - Dealing with the flood crisis of 1993. A medical center's account. AB - On Saturday, 10 July 1993, Iowans were assaulted by the greatest natural disaster in the state's history when virtually all rain-swollen rivers and creeks in the Midwest spilled over their banks. In Des Moines, the Iowa Methodist Medical Center was suddenly surrounded by flood waters and stripped of power, water, computer, and telephone communication. Striving to deliver quality patient care in the face of the crisis, medical staff, administrators, and employees at the center achieved recovery in record time. PMID- 10134873 TI - The healthcare volunteer. AB - Every year, volunteers contribute billions of dollars worth of time to the healthcare industry. Despite their contributions, however, little is known about who these volunteers are, what they do, why they volunteer, as well as the costs and benefits they bring to institutions. This article examines these and other characteristics of the healthcare volunteer. PMID- 10134874 TI - The relative effectiveness of three reminder letters. On making and keeping mammogram appointments. AB - One hundred fifty women who had previously had at least one mammogram were sent one of three prompt letters informing them that they were due for screening. The letters were either reassuring, anxiety provoking, or the standard hospital prompt. Based on a review of the literature, we hypothesized that the reassuring letter would be most effective in motivating women to schedule and keep appointments, the anxiety-provoking letter would produce an intermediate level fo compliance, and the standard hospital letter would be least effective. Our hypothesis was partially supported. Overall, 45% of the women in the study scheduled mammogram appointments. This included 54% of those who received the reassuring letter, 42% of those who received the anxiety provoking letter, and 38% of those who received the standard letter. Although the results were in the predicted direction, the results of a chi-square test indicated that differences among groups were not statistically significant. When the dependent measure was number of appointments kept, rather than scheduled, however, significantly more women who received the reassuring letter actually kept their appointments compared with those who received the standard hospital letter. Subsequent analyses suggested that having a family history of breast cancer, receiving a reassuring letter, and being older than 50 years were important factors in scheduling appointments. PMID- 10134875 TI - Personality hardiness, work-related stress, and health in hospital nurses. AB - Personality hardiness is a set of beliefs about oneself and the world one lives in. Hardier persons take control of their lives, believe that commitment to goals will result in positive outcomes, and perceive daily stressors as challenges. Hardiness has been linked with less stress and fewer health problems among various occupational groups. This study found that among 237 hospital nurses, work-related stress and emotional exhaustion were associated with greater health problems in the form of anxiety, depression, and somatic complaints. Hardier nurses reported less work-related stress, less emotional exhaustion, and less anxiety, depression, and somatization. This article discusses considerations for strengthening future studies concerned with the relationships between personality hardiness, work-related stress, and health in nurses. PMID- 10134876 TI - Dr. Jack and his death machine. PMID- 10134877 TI - Tax exemption. Challenge and opportunity for not-for-profit hospitals. AB - As healthcare reform is debated over the next several years, not-for-profit hospitals will see increased challenges to their tax-exempt status. Over the past forty years, the requirements for maintaining a tax-exempt status have undergone numerous changes. In the last several years, several states have challenged the right of hospitals to maintain this desired status. As we move toward the mid 1990s, it will be critical for not-for-profit hospitals to demonstrate and communicate their commitment to charitable endeavors. PMID- 10134879 TI - Network profile. East Texas Medical Center Regional Healthcare System. PMID- 10134878 TI - Volunteerism--alive and well in Honduras. PMID- 10134880 TI - Managed care check up program: the physician's perspective. PMID- 10134881 TI - Collaboration: Book II. PMID- 10134882 TI - IT (information technology) update. PMID- 10134883 TI - Mother Russia. Health in Russia. PMID- 10134884 TI - Joint working--union trouble. PMID- 10134885 TI - Patient's charter--worth the wait. PMID- 10134886 TI - Communications--hard news. PMID- 10134887 TI - The waste land. PMID- 10134888 TI - GP training--screen test. PMID- 10134889 TI - Rehabilitation--selling points. PMID- 10134890 TI - How we keep score. PMID- 10134891 TI - Leading clinical quality improvement. The tyranny of piecework. Political and practical milestones, Part 1. PMID- 10134892 TI - Leading clinical quality improvement. Using patient-based information to rapidly redesign care. PMID- 10134893 TI - Leading clinical quality improvement. Six pointers for implementing guidelines. PMID- 10134894 TI - Leading clinical quality improvement. Give it time. PMID- 10134895 TI - New yardsticks. Interview by Joe Flower. PMID- 10134896 TI - Outcomes measurement: a way to measure value. PMID- 10134897 TI - Building the high-performance accountable health plan. PMID- 10134898 TI - The boundaryless organization. PMID- 10134899 TI - Communities that are making a difference. Heart, Body and Soul, East Baltimore, MD; Orleans County Human Services Council, Medina, NY. PMID- 10134900 TI - An evaluation of program management: the West Park Hospital experience. AB - Program management as a way to structure hospital management has been attracting growing interest. Numerous hospitals are introducing it. West Park Hospital was one of the first hospitals to adopt program management in 1991 and mount a rigorous evaluation of the new approach, one which relied on external evaluators. This article reviews the emergence of program management in the hospital sector and reports on the evaluation of West Park's experience. PMID- 10134901 TI - Careers in health care management, Part 1: Attainment, expectations and aspirations. AB - The authors conducted a questionnaire survey of health care managers in Canada to learn more about their careers, work experiences and attitudes; and to determine whether their careers differed by such factors as sector of employment, gender, years of experience, education and family status. Major findings include: in teaching and community hospitals, men are more likely to fill chief executive officer (CEO) positions and women tend to be in middle management positions. More men than women in CEO positions reported incomes in the top range ($105,000). Men in CEO and senior management positions are more likely to be married and have children under 16 years of age living at home. Slightly more women than men were clinicians before becoming managers. Most respondents aspired to CEO or senior management positions. Implications for human resources practices are discussed. PMID- 10134902 TI - Introducing data into the health policy process: developing a report on the efficiency of bed use in Manitoba. AB - The Manitoba Centre for Health Policy and Evaluation (MCHPE) is a university based centre funded by the provincial government to provide analyses for use in policy development and management of the health care system. At the government's request, the MCHPE undertook an analysis of bed use in the major hospitals in the province. This article reviews the formulation, execution and delivery of the project to illustrate how health services researchers, administrative data and key actors in the health care system can interact in the policy process. PMID- 10134903 TI - French-language health care services in Ontario. AB - The French Language Services Act, 1986 has had an impact on the provision of health care services in Ontario. The Ontario Ministry of Health's implementation of French-language services is examined in light of three criteria: permanency, quality and accessibility of services. Issues are raised around the measurement and creation of demand for services; the health human resources shortage; health care priorities; what constitutes a high quality service; and the influence of the political and economic climates. The continuing challenge is to provide permanent and accessible high quality French-language health care services within an ailing health care system. PMID- 10134904 TI - Re-engineering: a prescription for hospitals. AB - Previously applied mostly in large, private sector corporations, "re-engineering" is fast becoming a tool that hospitals can use to break away from the old to find a new and better way of doing things. Re-engineering, however, first requires strong leadership which is committed to employee involvement and re-inventing the process design to meet the needs of the customers. Once the transition has been completed, the processes and the organization must continue to be managed differently. This article reviews the processes involved in re-engineering, and discusses the implementation of the initiative at the Sunnybrook Health Science Centre in Toronto. PMID- 10134905 TI - Better late than never: on-site library provides information to everyone. PMID- 10134906 TI - Dear season: an interview with OSHA chief Joseph A. Dear. Interview by Ellen Weisman. PMID- 10134907 TI - U.S. Secretary of Labor Robert Reich urges Senate lawmakers to undertake OSHA reform. AB - Congress is considering reform of the 25-year-old Occupational Safety and Health (OSH) Act. Earlier this year, U.S. Secretary of Labor Robert Reich expressed his support of the Senate's OSHA reform bill (S. 575) in a statement before the Senate's Committee on Labor and Human Resources. Here is part of what he said. PMID- 10134908 TI - Ohio hospital first to take its place on OSHA's workplace safety honor roll. PMID- 10134909 TI - PCBs & mercury: the terrible twins of lighting disposal. Containing waste PCB. First of two parts. PMID- 10134910 TI - Performance vs. appearance. Resilient floors' hard image bounces back in health care. PMID- 10134911 TI - Paint. Don't gloss over supplier communication or overall product quality--inside or out. PMID- 10134912 TI - Proper flagpole maintenance allows you to fly the stars and stripes forever- almost. PMID- 10134913 TI - External agency visits: how to manage them successfully. PMID- 10134914 TI - Rags to riches: software helps facilities clean up linen losses. PMID- 10134915 TI - Tired of 'whine and jeez' parties at work? Coping with complaints. PMID- 10134916 TI - Mailrooms: a little planning equals much efficiency. PMID- 10134917 TI - Measuring outcomes of nutrition intervention. AB - Along with other health care professions, The Canadian Dietetic Association is promoting outcomes assessment among its members. Defining outcomes and determining their measurement is a continuous process. Outcomes can refer to any consequence of health care, including changes in health status, knowledge, or behaviour. Establishing the link between the outcome and the interventions that led to it is important, but can be difficult. This is especially the case for the dietetic profession, in that nutrition status is often affected by factors other than our nutrition intervention. We reviewed the work of other professional associations: the American Dietetic Association, Canadian Association of Occupational Therapists, Canadian Physiotherapy Association, Canadian Psychological Association, and Canadian Nurses Association. All have formed expert committees or task forces to come to grips with the questions of outcome measurement relevant to their profession. All have found the process difficult and time-consuming. Many health professions are moving toward the position voiced by the CNA: using outcome information they will try to do what they do better, further, they will question whether they should be doing it. PMID- 10134918 TI - Nutritional quality of foods served in contracted second level lodging homes. AB - The food served in contracted Second Level Lodging Homes (SLLH) in Hamilton Wentworth was studied to assess compliance with current by-law standards, make recommendations about nutrition standards and identify educational needs. Dietitians collected food frequency data in 62 SLLH and recorded food served during one day. Only 44% of homes provided the minimum servings recommended by 1982 Canada's Food Guide. Recommended nutrient intakes for ten nutrients were met by 20% of homes. Provision of therapeutic diets was inconsistent. The study indicates the need for better nutritional standards and strategies to ensure SLLH residents access to sufficient, nutritious and personally acceptable food. PMID- 10134919 TI - Sensory evaluation of oral nutritional supplements: a comparison of patient and dietitian preferences. AB - The choice of oral nutritional supplements (ONS) is typically made by a formulary committee without patient input. The purpose of this study was to determine if significant differences arose in the following two areas: (1) in preference of ONS between patients and dietitians/dietetic interns; and (2) between ONS from different companies as detected by either patients or dietitian/dietetic interns. ONS in the 1.0 kcal/mL and 1.5 kcal/mL lactose-free category from five companies, in all flavors, were randomly evaluated by 392 patients and 34 dietitians/dietetic interns. Each product was evaluated using a seven-point hedonic scale. When more than one brand of the same flavor was present, products were than ranked in order of preference. There were significant differences between patients and dietitians/dietetic interns in their evaluation of 7 of the 13 product lines. Significant differences were also found between same-flavored products of equal caloric density produced by different companies. Since the patients typically rated the ONS as more acceptable when a difference did exist, it would appear unnecessary for formulary committees to test products on the patient population on a regular basis. PMID- 10134920 TI - Capitation: the new food chain of HMO-provider payment. PMID- 10134921 TI - Questions linger in choice of thrombolytics. PMID- 10134922 TI - EMI problems on the rise. PMID- 10134923 TI - Technology tracking, transition, and transfer. PMID- 10134924 TI - Health system reform in former socialist countries of Europe. AB - The health systems of all the former socialist countries of Europe are in the midst of far-reaching reform. The process is still in the early stages but certain patterns of finance and provision are beginning to emerge in a number of countries. All are implementing payroll-based social insurance while some are beginning to restrict entitlement to those contributing. There is a danger the process of restructuring will leave many without adequate insurance cover. Market solutions are being introduced in many countries to improve the efficiency of provision. Assuming the administrative cost is not too great, this may improve choice and quality of personal care. It is, however, unclear how far these solutions will tackle the fundamental public health problems endemic in these countries today. Those countries that have been slower to implement reform may benefit from learning from the successes and failures of the pioneers. PMID- 10134925 TI - Health care reforms in the French hospital system. AB - The French health care system, like other health care systems, entered the 1990s in a state of flux. During the 1980s, attempts to curb health care expenditure had a limited impact with the liberal and pluralist values of the health system undermining reform strategies. In 1991 the French government introduced a new hospital reform which had four main strands: rationalizing public and private health care provision; introducing a medical logic into the hospital service; increasing hospital autonomy and strengthening participation and involvement in the hospital system. However, these reforms left untouched the financing of the health service. Consequently there remains a need for a more fundamental reform of the management and financing of the French health care system. PMID- 10134926 TI - Internal market reforms of health care systems and the allied health professions: an international perspective. AB - Fundamental reshaping of the organization of health services is occurring in publically funded health care systems introducing internal market reforms. Management of clinical activity and the introduction of competition through contract-based processes has concentrated on the impacts on medicine and nursing. This article reports early experiences of the consequences of restructuring on the allied health professions from a five-country fieldwork study. Data suggest that decisions on new organizational structures for allied health professions are likely to effect their potential to participate competitively in the market reforms of health care systems. PMID- 10134927 TI - Rapid assessment of an African district health system. Test of a planning tool. AB - Occasional rapid health care system assessments are potentially useful for planning, for monitoring health care systems development over time, and for comparing health systems in different areas. With the decentralization of health sector management, for example in Kenya, there is a growing need of such assessments at district and sub-district levels. Can rapid assessments be conducted at affordable cost at these levels? What variables and methods are feasible? This paper reports on a rapid health system assessment conducted in rural Kenya during 1991. It required the completion at each health facility of a self-administered questionnaire which included questions on resources, health care programmes, management, service output, and prominent problems. It also included interviews with officers in charge of each health institution in the sub district and an examination of records and reports available at each facility. The paper presents the range of issues addressed, the indicators used, the methods applied, the problems encountered, the costs of the assessment, and a small selection of the findings. We conclude that the assessment model is manageable at district level with modest planning and analysis support from central level. Field staff need more precise instructions for completion of the questionnaire, and more population-based estimates need to be calculated. Reassessment taking place every 3-5 years should be adequate for monitoring the process of change in the local health care system. PMID- 10134928 TI - Quality assurance management methods applied to a local-level primary health care system in rural Nigeria. AB - Introduction. Management of primary health care (PHC) systems in less developed countries is often impeded by factors such as poorly trained personnel, limited financial resources, and poor worker morale. This study explored the ability of local-level PHC supervisors in rural Nigeria to use quality assurance (QA) management methods to improve the quality of the PHC system. Methods. PHC supervisors from Bama Local Government Area were trained for 3 days in the use of QA methods and tools. The supervisors targeted the supervisory system and the health information system (HIS) for improvement. Health worker performance in diarrhoea case management was assessed, using a simulated case, to measure the impact of supervision. A HIS audit assessed data collection forms used by 17 PHC facilities. Gaps in quality were monitored over a 2-month study period and flaws in work processes were modified. Results. PHC supervisors introduced a checklist during monthly visits to facilities to monitor how workers managed cases of diarrhoea. Performance in history-taking, physical examination, disease classification, treatment and counselling improved over the evaluation period. The HIS audit found that a variety of reporting forms were used at PHC facilities. After HIS reporting was standardized, the number of health facilities using a daily disease registry significantly improved during the study period. Conclusions. QA management methods were used by PHC supervisors in Nigeria to improve supervision and the HIS. QA management methods are appropriate for improving the quality of the PHC in Nigeria and in other less developed countries where at least a minimal PHC infrastructure exists. PMID- 10134929 TI - Managing public services in the 1990s. President's lecture. Keele University, MBA (Health Executive) Alumni Association. AB - The management of public services in the 1990s raises a number of central issues which require to be resolved. On the one hand, efficiency and effectiveness require attention, as in the 1980s or indeed anytime. On the other hand, the distinctive nature of public (and governmental) services needs to be recognized or reasserted. This Keynote Address to the Keele University, Centre for Health Planning and Management MBA (Health Executive) Programme Alumni Association by Howard Davies, Director General of the Confederation of British Industry, sets out some key principles based on the 'British Debate' which are nevertheless generalizable in a number of cases to a wholly international audience. PMID- 10134930 TI - Health services reforms: political and managerial aims--an international perspective. AB - Health policy everywhere is in flux. In marked contrast with the impenetrable orthodoxy and inaction characteristic of past decades, health policy currently is in the midst of large-scale upheaval. Many of the fundamental assumptions and principles that long guided health-sector development are in the process of being turned upside down. Whether a country is rich or poor, it matters not. Virtually every country either has or is contemplating major reforms in its provisions for the organization and financing of health services. Moreover, the differences in health services structure which divided nations, are becoming smaller--to the point where formerly shunned international exchanges now are considered useful mediums for the exposition of common tensions and the exploration of choices for adapting health care to complex and new economic realities. PMID- 10134931 TI - Decentralization of management responsibility: the case of Danish hospitals. AB - This article examines a specific management reform at three hospitals in a Danish county. Management reform at the hospital level implies a decentralization of responsibility and power to the departmental level. Along with increased responsibility and power, departments get the message: keep your budgets and keep your output level. This preliminary analysis indicates that departmental budgets can be a way of containing costs in clinical departments. Non-staff expenditures especially are subjected to reductions. The system still seems to 'favour' doctors and nurses, but less than in a system with traditional budgetary institutions. The behaviour of the top-management teams shows that the output constraint is not seriously meant. Departments are allowed to reduce capacity, with declining output, with the knowledge of the top-management team. The declining output makes it easier to departments ceteris paribus to keep within their budgets. And that makes it easier for the top-management team to keep the overall hospital budget. The obligation to keep the overall hospital budget is thus an important criterion of success in the eyes of the political masters of hospitals. PMID- 10134932 TI - A critical analysis of recent Canadian health policy: models for community-based services. AB - As part of the thrust by Health and Welfare, Canada, to strengthen community health services, the National Health Research and Development Program commissioned a series of literature reviews. I undertook to review organizational models for community-based services, but said that this would be done in the context of the developing organization of the national health insurance program. With the help of colleagues I examined the literature from a number of different viewpoints. This article will present our findings on the development of policy and will trace the difficulties in making a shift towards providing more care in the community. We found that organization theories were helpful for explaining developments in the health service as a whole and the place of community-based services within it. We were able to use these theories to analyse efforts at restructuring. They provide explanations for the concurrent existence of policies of rationalization and cutbacks with policies of expansion in the area of health promotion. PMID- 10134933 TI - Crowded outpatient departments in city hospitals of developing countries: a case study from Lesotho. AB - 'Overuse' of hospital outpatient departments in urban areas of developing countries is perceived as a problem by many health planners. The World Health Organization is promoting advanced health centres, or 'reference centres', as part of a strategy to develop urban health systems and to reduce primary contact care at hospitals. However, hospital-based information to assist city health service planning is limited in many countries. This study examined user characteristics, patient flow and prescribing quality at the national referral hospital in Maseru, Lesotho, using simple and replicable methods. The study found that most users were self-referred and came from the city. The majority of respondents were aware of their local health centre but reported they would normally use the hospital when they were ill. Examination of patient flow showed that, on average, patients spent a total of 3.7 h waiting. Quality of care was compromised by a tendency to over-prescribe, particularly antibiotics and sedatives. The study suggests that in Maseru, the perception of 'overuse' is due to congestion and that improved patient flow management will reduce the numbers of patients waiting. Quality of care could be strengthened by regular audit of prescribing practices by clinicians in the hospital. PMID- 10134934 TI - A team approach to OR environmental issues. AB - At Munroe Regional Medical Center in Ocala, FL, an effective partnership between Materials Management and the Operating Room was begun by building consensus around a shared concern--minimizing the Operating Room's impact on the environment. To accurately evaluate cost-in-use issues, Materials Management and the OR needed a better understanding of each other's processes, procedures and decision-making criteria. Materials Management observed surgical procedures to understand product requirements, and OR personnel were given financial information on such matters as group purchasing and disposal costs. After considering all the data, the MM/OR team decided to continue using single-use polypropylene gowns rather than switch to reusable gowns. Success in this endeavor led the team to institute a disposable wrap recycling program. Lasting benefits of the collaboration include higher cost consciousness among clinicians, open communications, greater supplier accountability for cradle-to-grave cost estimates and team building. PMID- 10134935 TI - Reducing pacemaker costs while preserving choice: a partnership that worked. AB - Over the last ten years, separate and repeated attempts by Cardiology Management, Materials Management, and physicians to effectively reduce pacemaker costs had led to limited successes of short duration. Issues of physician choice, clinical application of advancing technology and long-term relationships with a variety of vendor representatives had usually conspired to overwhelm any incremental inroads into manufacturers' pricing structures. A collaborative review of past practices resulted in the creation of a multi-disciplinary task force charged with two goals: maintain physician choice and reduce costs. In the resulting process, no manufacturer was eliminated, vendors accepted all of the risks and received no guarantees of market share, and device specifications were matched to clinical indications in a preferred device matrix. The task force met both of its goals as evidenced by a 18.9% decrease in annual expenditures for pacemakers and by a 27% shift in device use based upon physician choice. PMID- 10134936 TI - Carpet choices for healthcare facilities. AB - Carpet as a floorcovering choice in healthcare facilities is increasing in popularity. Technological advances have made carpet an appropriate choice not only for common areas and offices, but also for patient rooms. Color options are diverse, and can serve patient care concerns, such as orientation for patients with Alzheimer's disease. Carpet performance is related to its density, construction and fiber/yarn type. Many carpet types have antimicrobial treatments to aid in reducing the propagation and spread of microorganisms. Carpet is also tested for emissions of volatile organic compounds based on industry criteria. Proper maintenance is essential to maintaining carpet appearance and useful life. PMID- 10134937 TI - Infusion pumps, ambulatory. ECRI. PMID- 10134938 TI - Care and handling of equipment. PMID- 10134939 TI - Perceptions and practices of registered nurses regarding pastoral care and the spiritual need of hospital patients. AB - Reports the findings of a questionnaire survey designed to examine the impact of pastoral care on patient care and job satisfaction of registered nurses (N-280) employed in a metropolitan hospital. Suggests that educational strategies be explored as a way of broadening the perspectives of nurses regarding reasons for consulting pastoral care departments. PMID- 10134940 TI - Managed care arrangements: barriers to cost savings potential. PMID- 10134941 TI - Health insurance and medical practice organization in Canada: findings from a literature review. PMID- 10134942 TI - The prisoner's dilemma: an obstacle to cooperation in health care markets. PMID- 10134943 TI - Great expectations: an analysis of four strategies. PMID- 10134944 TI - Now look who's courting primary-care doctors. PMID- 10134945 TI - The DNR case that almost exploded in my face. PMID- 10134946 TI - What you should bargain for in a restrictive covenant. PMID- 10134947 TI - How business is flattening health costs. PMID- 10134948 TI - Linking the laboratory with future techs. AB - How do you further staff development, boost recruitment efforts, enhance public awareness of the lab, and provide an educational resource for teachers all on a micro budget? Introduce the lab to your school system. PMID- 10134949 TI - Negotiating a compensation package. Part 3: Pay strategies. PMID- 10134950 TI - Starting a flow cytometry user group. PMID- 10134951 TI - Higher costs in HMO-land. PMID- 10134952 TI - Study compares quality measures. PMID- 10134953 TI - Ready organization for managed care. PMID- 10134954 TI - Vendors question fees of purchasing groups. PMID- 10134955 TI - PHOs need physician subgroups--study. PMID- 10134956 TI - Medical savings accounts drawing interest. PMID- 10134957 TI - Mass. community-benefit guidelines omit targets. PMID- 10134958 TI - Parkland wins 1994 McGaw prize. PMID- 10134959 TI - Business group wins decreased HMO premiums. PMID- 10134960 TI - Pa. case ends in unique settlement. PMID- 10134961 TI - Feds may seek more deals like Fla. pact. PMID- 10134962 TI - Florida town sues Columbia to block hospital's closure. PMID- 10134963 TI - Quorum to proceed with Neb. deal. PMID- 10134964 TI - Integrated system in Lowell, Mass., abandoned over debt. PMID- 10134965 TI - Congress seeks reform compromise. PMID- 10134966 TI - Iowa, Nebraska hospitals form alliance to enhance service delivery, cut costs. PMID- 10134967 TI - New episodes, starring Harry and Louise. PMID- 10134968 TI - Florida public hospital negotiating 40-year lease with not-for-profit system. PMID- 10134969 TI - AHA warns hospitals of HHS probe. PMID- 10134970 TI - Deal sparks physician uproar. PMID- 10134971 TI - Medicare claims made by N.Y. Blues disputed. PMID- 10134972 TI - Incremental reform gains acceptance in Congress. PMID- 10134973 TI - Minn. reform works--survey. PMID- 10134974 TI - Baxter-Allegheny contract means shared savings when product consumption falls. PMID- 10134975 TI - East Texas hospitals team up to build network. PMID- 10134976 TI - AHA relocation triggers staff cuts. PMID- 10134977 TI - JCAHO asks for hospitals' patience. PMID- 10134978 TI - Study sees missed savings by Fla. HMOs, hospitals; FHA cites improvements. PMID- 10134979 TI - Reform bill includes capital assistance. PMID- 10134980 TI - Omega-Health Equity merger would form 5th-largest REIT. PMID- 10134982 TI - OrNda's California network could become a case study for hospital chain mergers. PMID- 10134981 TI - Suit filed against Towers names advisers as participants in fraud, responsible for investors' losses. PMID- 10134983 TI - Rehability approves deals, enters subacute-care field. PMID- 10134984 TI - Former Summit chairman plans to sell OrNda shares. PMID- 10134985 TI - La. ponders novel way to plug its 'dispro hole'. PMID- 10134986 TI - USTFs (Uniformed Services Treatment Facilities) 4% less costly in markets shared with Defense facilities. PMID- 10134987 TI - St. Louis system launches data integration project. PMID- 10134988 TI - CliniCom buys home-care vendor. PMID- 10134989 TI - Insurers ask halt of Blues' bid to buy fund. PMID- 10134990 TI - Toledo hospital rebuffed in court bid. PMID- 10134992 TI - Anti-patient-dumping rules issued at last. PMID- 10134991 TI - Connecticut hospitals report significant drop in C-sections since '86. PMID- 10134993 TI - Associations re-evaluating role at both regional and state levels as hospitals merge and affiliate. PMID- 10134994 TI - 4 killed, 23 wounded in Wash. rampage. PMID- 10134995 TI - Homedco's earnings up 19% in 2nd quarter. PMID- 10134996 TI - For role in Coram merger, T2's Sweeney receives multimillion-dollar deal. PMID- 10134997 TI - Indians seek supplemental funding. PMID- 10134998 TI - Columbia/HCA sells hospital, discusses network syndication. PMID- 10134999 TI - Public Citizen criticizes JCAHO. PMID- 10135000 TI - GAO study contradicts buying cooperatives' image in reform debate. PMID- 10135001 TI - Gatekeepers of capitation. AB - As CFOs walk the financial tightrope in the move from fee-for-service to capitated delivery, their roles are changing. They're now being charged with providing the data, systems and strategies needed to stretch fixed treatment dollars. PMID- 10135002 TI - Aetna lawsuit dismissal marks another managed-care victory over any-willing provider laws. PMID- 10135003 TI - Blues association lifts its ban on for-profit plans. PMID- 10135004 TI - Plans for new Chicago hospital criticized. PMID- 10135005 TI - New report shows healthy gains at Pa. hospitals. PMID- 10135006 TI - NME to pay fine of $379 million. PMID- 10135007 TI - Ways and Means passes measures despite opposition. PMID- 10135008 TI - New kinds of investor ownership to emerge from this era of change. PMID- 10135009 TI - Bridging the gap: healthcare reform and illegal aliens. AB - As the cost grows for providing healthcare to the at least 3.8 million undocumented immigrants in this country, leaders in many states are calling for more aid from the federal government. But have legislators crafting reform forgotten this billion-dollar minority? PMID- 10135010 TI - Ways and Means OKs plan; panel may forfeit universal coverage. PMID- 10135011 TI - Entrepreneur launches newsletter that targets home-care marketers. PMID- 10135013 TI - AHA's Lord outline priorities. PMID- 10135012 TI - Bond insurers feeling the heat as deals dwindle. PMID- 10135014 TI - Tenn. execs remain unswayed. PMID- 10135015 TI - Medical school cost ban upheld. PMID- 10135016 TI - Pa. hospitals announce network collaboration. PMID- 10135017 TI - AMI has no comment on rumors. PMID- 10135018 TI - Columbia/HCA plans new ventures. PMID- 10135019 TI - APHA (American Public Health Association) wants $30 billion of healthcare budget. PMID- 10135020 TI - Rulings force PPOs to prove shared risk. PMID- 10135021 TI - Horizon profits up 149% for quarter. PMID- 10135022 TI - Five hospitals placed on probation. PMID- 10135023 TI - Hospitals shouldn't be expected to achieve perfect scores: Vladeck. PMID- 10135024 TI - Reform showdown likely over universal coverage. PMID- 10135025 TI - AmeriHealth faces proxy fight. PMID- 10135026 TI - Competing Chicago networks try to strengthen market shares. PMID- 10135027 TI - Ohio town's only two hospitals plan merger. PMID- 10135028 TI - Regional home-care firms grow with deals. PMID- 10135029 TI - Cape Coral (Fla.) Hospital sues 3 former execs over use of funds. PMID- 10135031 TI - Columbia/HCA plans new Florida hospital. PMID- 10135030 TI - AHA to address accountability issues. PMID- 10135032 TI - CBO report refutes drug industry's fear of reform hurting R&D. PMID- 10135033 TI - Senate plan easier on not-for-profits. PMID- 10135034 TI - Cohen seeks tough anti-fraud laws. PMID- 10135035 TI - Hospital-medical school alliances shifting. PMID- 10135036 TI - JCAHO's relevance is in question. PMID- 10135037 TI - How much are physicians making? 1994 physician compensation. AB - An increasing number of physicians today are employees. And when salaries are negotiated, they, along with employers, are often armed with the latest compensation surveys. The result: controlled growth in what physicians are making. PMID- 10135038 TI - The Internet goes visual on the Web. PMID- 10135039 TI - HHS probe stirs device controversy. PMID- 10135040 TI - Calif. slows managed Medicaid expansion. PMID- 10135041 TI - Sales of tax-exempt bonds plummet. PMID- 10135042 TI - HHS subpoenaed defibrillator makers. PMID- 10135043 TI - Kaiser releases HEDIS information. PMID- 10135044 TI - Independent Wis. hospital seeks link. PMID- 10135045 TI - New reimbursement rules unfair, say N.J. hospitals. PMID- 10135046 TI - Salick signs first capitated oncology contract. PMID- 10135047 TI - Switch to capitation means long-term financial risk for hospitals, Fitch reports. PMID- 10135048 TI - Illinois providers prepare for new 'Medicaid HMO' plan. PMID- 10135049 TI - Baxter, Duke to share risk. PMID- 10135050 TI - Tough road ahead for nurse panel. PMID- 10135051 TI - Ky. hospital settles patient-dumping charges. PMID- 10135052 TI - HealthTrust settlement requires sell-off. PMID- 10135053 TI - Gebbie's departure is evidence of Clinton's AIDS policy problems. PMID- 10135054 TI - Lilly's acquisition of PCS provides new tool for sales. PMID- 10135055 TI - Malpractice reform remains in limbo. PMID- 10135056 TI - Ingredients for successful integration. PMID- 10135057 TI - New PORT (Patient Outcomes Research Teams) studies to further examine physician practices. PMID- 10135058 TI - Reform may lift tax-exempt debt cap. PMID- 10135059 TI - Group seeks moderate reform plan. PMID- 10135060 TI - Mass. hospital settles with feds over false billing. PMID- 10135062 TI - Catholic system drops out of Hilton Head deal. PMID- 10135061 TI - NME axes staff, keeps $27 million jet. PMID- 10135063 TI - Meeting with La. hospital execs is latest stop for JCAHO's O'Leary. PMID- 10135064 TI - Atlanta systems OK merger. PMID- 10135065 TI - N.Y. teaching hospital jilts school. PMID- 10135066 TI - Network formed in southwest Pa. PMID- 10135067 TI - A records retention primer. AB - Today's healthcare financial managers are faced with the challenge of controlling costs and providing quality care while maintaining the necessary records to comply with government requirements and observe sound business practices. PMID- 10135068 TI - An introduction to Internet for medical professionals. AB - This article is a wonderful description of what I think is the most remarkable communication and information system ever devised. INTERNET is literally a world of data, dialogue, and discourse on any topic imaginable, right at your fingertips. I invite all PAs to begin to explore the world of interpersonal computing via INTERNET. I am putting together a list of PAs with E-Mail accounts to provide a forum for sharing information and linking PAs with common interests. PMID- 10135069 TI - Hospital health reform and the surgical technologist. PMID- 10135070 TI - Home testing for HIV. PMID- 10135071 TI - Quality and efficiency: driving forces on Minnesota's integration speedway. PMID- 10135072 TI - A cut by any other name .... PMID- 10135073 TI - Selling or merging your hospital: the most difficult decision. PMID- 10135074 TI - Health care reform--handling consumer questions. PMID- 10135075 TI - Deferred giving: the trustee's role. PMID- 10135076 TI - Education: interest and impact. PMID- 10135077 TI - Don't overlook philanthropy. PMID- 10135078 TI - Quality: the right way to control costs. PMID- 10135079 TI - Prepare for change. As systems mature, parent boards are taking control of quality responsibilities formerly reserved for local boards. PMID- 10135080 TI - Health reform's agonizing endgame. PMID- 10135081 TI - Helping Hands meets the nutritional needs of patients. PMID- 10135082 TI - 'Tools for Change' can help hospitals in health care reform-building process. PMID- 10135083 TI - What does your community need? First, listen to what your community wants. PMID- 10135084 TI - Health needs for persons over age 65. PMID- 10135085 TI - Choosing your own physician. PMID- 10135086 TI - Consumer poll: guaranteed coverage outweighs MD choice. PMID- 10135087 TI - NY hospital teaches indigent teen mothers valuable lessons. PMID- 10135088 TI - Hospitals can advocate for measures to reduce pathology of gun violence. PMID- 10135089 TI - The comparative advantage of NGO (non-governmental organizations) in the health sector--a look at the evidence. AB - Attention being given to the development of an appropriate public/private mix in health-care delivery should not exclude the role of non-governmental organizations (NGOs). There is a widely accepted thesis of NGO comparative advantage over government, but evidence to support this thesis is generally more anecdotal than analytical. This paper considers evidence available in the literature and from field research in southern Africa, especially with regard to efficiency, innovation and reaching grass-roots communities. The paper concludes that the comparative advantage of the NGO sector needs to be analysed in relation to both the private for-profit sector and the public sector. PMID- 10135090 TI - The HIV-tuberculosis time bomb: how can hospitals in developing countries cope? AB - The treatment of the ever-increasing number of people in developing tuberculosis as a consequence of the AIDS epidemic is becoming a new challenge in hospitals. Policies are needed that will ensure high detection anc cure rates, especially of the adult smear positive pulmonary tuberculosis case--the main cause of transmission. Decisions may be required on: case management procedures; counseling; prioritizing in-patient care; out-patient-based supervised care, where feasible; identifying human, material and financial resources to cope with the HIV-related tuberculosis epidemic. PMID- 10135091 TI - The future and long-range planning of healthcare services: a Saskatchewan perspective. AB - The Canadian health system is built upon five key principles: universality; accessibility; comprehensibility, public administration; and portability. Since the 1960s, the primary feature of the Canadian health system has been the universal provision of 'insured' services without direct cost to consumers. Funding for Canadian health care is derived primarily from the federal and provincial governments. Through this funding arrangement, the Canadian health system is primarily a 'public' enterprise in that the majority of funding is derived from taxation at either the federal or provincial level. Since its inception, this model of health coverage has been very popular with the Canadian public, since it provides all citizens with reasonable access to the insured services and accommodates the portability of those services. The model has also provided some measure of cost containment, primarily as a result of its public administration. However, the Canadian model in its present form has several significant shortcomings which has precipitated a need for change. The author discusses these. PMID- 10135092 TI - Survey of obstetric services. The American Hospital Association, 1992. Executive Summary. PMID- 10135093 TI - A discharge planning patient information system. AB - A computerised patient information system aimed at improving the administration of discharge planning of patients with complex care requirements is described. The system was developed in two major acute general hospitals and has been operational since 1988. The system also transparently records key information about bed utilisation by patients awaiting a variety of discharge outcomes, including rehabilitation and permanent residential care. The extent of bed utilisation by patients awaiting residential care as measured by this system was compared with the results obtained by the conventional method of measuring this phenomenon in Australia--Nursing Home Type bed-days. The Nursing Home Type approach underestimated bed utilisation by this group of patients by 50 per cent, and failed to identify more than 60 per cent of the patients who were recommended for permanent residential care. PMID- 10135094 TI - A survey of Sydney adults about the conduct of medical research. AB - A representative sample of the adult Sydney population was surveyed and asked for their opinion on medical research. The community was found to support research, within certain limits. Those limits depended on the individual therapeutic benefit and the degree of invasiveness of the research. Stricter limits were identified for child research. PMID- 10135095 TI - Cancer statistics in Australia. PMID- 10135096 TI - A new look at national medical workforce strategy. AB - The efforts of governments in medical workforce policy have been unimpressive, and this has had serious consequences. Political compromise, theoretical error and administrative laxity have all contributed. It is demonstrated that market evidence, viewed through the prism of orthodox price theory, allows useful prescriptions to be made. These can be implemented through vigorous continuing maintenance and adjustment work on the Commonwealth Medical Benefits Schedule, together with periodic adjustments to rates of undergraduate and specialist medical education and training. PMID- 10135097 TI - Report of first year's operation of an ortho-geriatric service. AB - An ortho-geriatric service operated by Bundoora Extended Care Centre and Preston and Northcote Community Hospital was established in 1991 to improve rehabilitative care and discharge planning of elderly hip fracture patients. 123 patients were treated during the first year of the service's operation. There was a 25 per cent reduction in the acute hospital length of stay, an increased proportion of patients discharged home and a decreased need for post-acute rehabilitation in comparison to figures for 1989, leading to a substantial reduction in the total number of bed-days occupied in the hospital system as a whole by hip fracture patients. An ortho-geriatric service is an effective means of helping to improve both patient and hospital centred outcomes for a condition which will be seen ever more commonly in the future. PMID- 10135098 TI - IVF (in-vitro fertilisation): the need to evaluate value for money. AB - This paper reviews literature from an economic viewpoint concerning the costs and benefits of the in-vitro fertilisation (IVF) program in assisting reproduction. A number of economic studies that have been carried out in Australia and elsewhere are documented. These studies have tended to adopt a narrow definition of outcome of treatments concentrating solely upon the birth of an infant. However, such an outcome occurs in only a minority of cases and the most likely outcome is the failure to have a child. It is argued that an accurate representation of outcomes of treatment should include the psychological and health effects experienced by all couples who participate in the program, not only those who are successful in achieving conception. PMID- 10135099 TI - Predicting the unpredictable: issues for output-based funding in psychiatric services. AB - In this study a number of important issues relating to diagnosis related groups and psychiatry are highlighted. Retrospective analysis of admissions to a rural psychiatric admission unit was undertaken utilising two differing approaches to statistical analysis. Results revealed that diagnosis alone is not highly predictive of cost. However, when linked to other variables, greater explanation in variation of length of stay was achieved. Data from social variables yielded sufficiently interesting results to warrant further investigation. The authors conclude by reporting the resultant groups from the classification analysis and offer some suggestions for further research. PMID- 10135100 TI - A proposal to establish an Office of Healthcare Education in Ethics and Law (HEEAL). PMID- 10135101 TI - Different profiles for the institutional ethics committee in The Netherlands. PMID- 10135102 TI - Point and counterpoint. Should incompetent patients (and their families) be provided professional advocates for an HEC concurrent case review? PMID- 10135103 TI - Point and counterpoint. Should HECs make de facto binding decisions? AB - It is evident that HEC decisions are de facto binding. Our challenge is to recognize the implications of these decisions for patient care. As a result of the passage of the Patient Self-Determination Act and the recent JCAHO rules mandating dispute resolving mechanisms for ethical issues, case review by ethics committees will undoubtedly have an even greater influence on patient care. Therefore, health care institutions and their medical staffs must strive to find the best way to use the inherent powers of hospital ethics committees to enhance patient care decisionmaking. PMID- 10135104 TI - Long-Term Care Coalition of the Orange County Bioethics Network (California) PMID- 10135106 TI - Surviving workplace stress. PMID- 10135105 TI - Walkie-talkies and cellular telephones: the hazards of electromagnetic interference in hospitals. AB - This article presents an overview of the effects of electromagnetic interference (EMI) on medical devices, with emphasis on portable telecommunication devices. In addition, the authors discuss existing voluntary national and international standards and policies governing the use of cellular telephones and walkie talkies in hospitals, possible solutions to the susceptibility of medical devices to EMI, and recommendations to lessen EMI's potentially hazardous effects. PMID- 10135107 TI - Professional advisory committee: a new initiative in governance. AB - In her article, the author describes the establishment of a professional advisory committee by the board of trustees of the Sisters of Charity of Ottawa Health Service. This new initiative gives the organization's professional disciplines a direct voice on the board and embraces a spirit of openness. PMID- 10135108 TI - Minimizing the impact of a hospital strike. AB - The 1991 nursing strike in Manitoba lasted 31 days and affected 87 facilities. In professionally based health care facilities, such work stoppages can cause lasting conflicts. Simply returning to business as usual is not realistic. St. Boniface General Hospital was the first affected facility in the province to formulate a formal strike recovery process. PMID- 10135109 TI - The challenge of the nineties: physicians as team players. PMID- 10135110 TI - Health care reform in Oregon. AB - Oregon has led the United States in asking the difficult questions regarding what constitutes basic health care benefits. Oregon's experience in attempting to answer the question "what are basic health care benefits?" offers some learning opportunities for Canada in the face of diminishing financial resources and health care reform. PMID- 10135111 TI - Between nations: delivering services on an island native reserve. Interview by Matthew D. Pavelich. PMID- 10135112 TI - Shared services: low temperature sterilization of instruments and supplies. PMID- 10135113 TI - Team approach to charting: medical staff join in. AB - At British Columbia's Prince George Regional Hospital, collaboration between the hospital's chief of medical staff and its manager of health records has resulted in more meaningful, accurate, timely and complete patient records. The hospital departed from the traditional process of deficiency flagging to physician ownership and ultimate accountability for medical charting. PMID- 10135114 TI - Is Ontario sacrificing residents' needs to affordability? PMID- 10135115 TI - Health Security Act of 1994. Draft outline for Senate Finance Committee Chairman's mark. AB - Here's the complete draft outline for reform legislation presented by Senate Finance Chmn. Daniel Moynihan. As reported two weeks ago, the document represents Moynihan's first steps toward bipartisan compromise and is the starting point for committee discussions now underway. PMID- 10135116 TI - Is this the last best hope? PMID- 10135117 TI - Making health reform work: the view from the states. PMID- 10135118 TI - "Prairie grass roots" reform. PMID- 10135119 TI - Physician-hospital integration Ramsey Clinic-style. PMID- 10135120 TI - One hospital's road to waste minimization. AB - There are many new and exciting waste minimization programs being offered to healthcare facilities. Companies are now making reusable operating packs and gowns that are more efficient than disposables. The selling point is that the system will save healthcare money! The reusable programs do save disposal costs for an institution. Shore Memorial has scheduled a trial evaluation for reusable operating room linens to begin May 1, 1994. The concept has not been difficult to sell to physicians and staff. Perhaps this is because people are generally more aware of their environment and the reasons why it should be protected. The hospital will also be evaluating an IV bottle and bag recycling program. The New Jersey Department of Environmental Protection Agency has given approval to proceed with this type of recycling program, and Shore Memorial is in the process of scheduling this trial program with a local vendor. Waste reduction and recycling in healthcare settings will continue to be challenging because of the diversity of the wastestream and the changing environment facing healthcare. Certainly, healthcare has as much of a responsibility to the well-being of patients as it does to keeping the environment healthy. Returning to the "old way" of doing things, such as reusables, does not have a negative impact on people, but it does have an impact on the environment. Shore Memorial believes it is moving in the right direction with its waste minimization program to make a positive environmental impact. PMID- 10135121 TI - Operator training--a requisite for retrofit systems. PMID- 10135122 TI - New NCCLS (National Committee for Clinical Laboratory Standards) laboratory waste management guideline. PMID- 10135123 TI - Health and Human Services policy for protection of human subjects research--HHS. Final rule. AB - The Department of Health and Human Services (HHS) is amending its Human Subjects Protection regulations to rescind the provision requiring prior review and advice from an Ethical Advisory Board for research applications and proposals involving in vitro fertilization (IVF) of human ova as a prerequisite to funding by HHS and its components. The provision was nullified by the National Institutes of Health Revitalization Act of 1993. The regulations are being amended to reflect this statutory nullification. Institutional Review Board (IRB) review and approval of applications and proposals involving in vitro fertilization (IVF) of human ova continues to be required in accordance with other provisions of the Human Subjects Protection regulations. Furthermore, the Secretary may still exercise the option of seeking advice from an Ethical Advisory Board on ethical issues, including IVF, raised by research applications and proposals. PMID- 10135124 TI - Medicare Program; physician performance standard rates of increase for fiscal year 1994 and physician fee schedule update for calendar year 1994--HCFA. Correction of final notice with comment period. AB - This document corrects an error that occurred in the calculation of the fiscal year 1994 Medicare volume performance standard for surgical services and that appeared in the final notice with comment period published in the Federal Register on December 2, 1993 (58 FR 63856) entitled "Medicare Program; Physician Performance Standard Rates of Increase for Fiscal Year 1994 and Physician Fee Schedule Update for Calendar Year 1994." This notice also corrects a typographical error in a date. PMID- 10135125 TI - Notice regarding section 602 of the Veterans Health Care Act of 1992 inclusion of outpatient hospital facilities--PHS. Notice. AB - Section 602 of Public Law 102-585, the "Veterans Health Care Act of 1992" (the "Act"), enacted section 340B of the Public Health Service Act ("PHS Act"), "Limitation on Prices of Drugs Purchased by Covered Entities." Section 340B provides that a manufacturer who sells covered outpatient drugs to eligible entities must sign a pharmaceutical pricing agreement (the "Agreement") with the Secretary, Department of Health and Human Services, in which the manufacturer agrees to charge a price for covered outpatient drugs that will not exceed the amount determined under a statutory formula. Section 340B(a)(4) lists the entities eligible to receive discount outpatient drug pricing (i.e., certain disproportionate share hospitals (DSHs) and PHS grantees). The definition of a disproportionate share hospital found in section 340B(a)(4)(L) provides criteria to determine which such hospitals are eligible to participate in the program. However, the definition does not include criteria to determine which outpatient facilities (including off-site or satellite clinics) working in conjunction with the eligible hospital would be considered part of the hospital for purposes of eligibility for section 340B drug discounts. The Office of Drug Pricing, which administers this program with PHS, is proposing certain procedures to determine which outpatient hospital facilities are included as part of an eligible disproportionate share hospital. PMID- 10135126 TI - Assistant Secretary of Defense for Health Affairs--DoD. Final rule. AB - This document revises the responsibilities, functions, relationships, and authorities of the Assistant Secretary of Defense for Health Affairs ASD(HA). The principal revision, the assignment of the Health Affairs functions under the Under Secretary of Defense for Personnel and Readiness is consistent with Section 903 of the FY 1994 Defense Authorization Act. PMID- 10135127 TI - Medical and dental reimbursements rates for period April 1, 1994 through September 30, 1994 (fiscal year 1994)--DoD. PMID- 10135128 TI - Medicare and Medicaid programs; Medicare-Medicaid coverage data bank requirements: preliminary guidance--HCFA. Notice. AB - This notice informs the public about section 1144 of the Social Security Act, which is self-implementing, and provides preliminary guidance to employers who are required to report information about all individuals covered by group health plans to a newly established Medicare-Medicaid Coverage Data Bank. Information in the data bank will be used to help identify situations where employer group health plans are responsible for making primary payments for services received by Medicare or Medicaid beneficiaries. This notice provides: information on the background and legislative authority for the data bank; definitions of key terms; reporting requirements; the identity of entities that are required to, or may, report; reporting dates; penalties for noncompliance; and methods of reporting. PMID- 10135129 TI - Respiratory protective devices--NIOSH. Notice of proposed rulemaking. AB - This proposed rule addresses NIOSH's and the Department of Labor/Mine Safety and Health Administration's (MSHA) certification requirements for respiratory protective devices. Specifically, the proposal would replace existing MSHA regulations with new public health regulations, while also upgrading current testing requirements for particulate filters. This action is the first of a series of modulates which will, over the next several years, upgrade current respirator requirements. This modular approach will allow improvements to be implemented on a priority basis as well as facilitate adaptation to new requirements by the manufacturers and users of respirators. Except for the particulate-filter requirements, most requirements of existing regulations would be incorporated into the new regulations without change. The proposed testing requirements for particulate filters would significantly improve the current approach to evaluating the effectiveness of an air-purifying respirator's filter to remove toxic particulates from the ambient air, updating existing provisions to be consistent with two decades of advances in respiratory protection technology. The certification of air-purifying respirators under these proposed requirements would also enable respirator users to select from a broader range of certified respirators that meet the current performance criteria recommended by CDC for respiratory devices used in health-care settings for protection against Mycobacterium tuberculosis, the infectious agent that causes tuberculosis (TB). This Notice also announces an informal public meeting on the proposed rule, as indicated below. Elsewhere in this issue of the Federal Register, MSHA is publishing a proposal to remove existing regulations at 30 CFR part 11, which would be made obsolete by a final rule resulting from this proposed rule. PMID- 10135130 TI - Providing choice in home care services. AB - A 1993 Louis Harris and Associates poll shows that not only do clients prefer home care, but they are more satisfied when they have a say in their care, including who performs the care, when they receive it, and how they receive it. The next step is for policymakers to understand and act on this information. PMID- 10135131 TI - Salary basis of payment for overtime exemption. AB - Often employers' problems in complying with the Fair Labor Standards Act salary basis of payment rules arise from their paid time off policies. Although it is possible to write policies that apply to both exempt and nonexempt employees, such policies are complex, and agencies may need to review their compliance with these rules. PMID- 10135132 TI - Transforming QA to QM--one agency's approach. AB - One agency has designed a quality management program that goes beyond traditional quality assurance. Their approach ensures that patients and the agency are satisfied with the quality of care. PMID- 10135133 TI - Top priority: major donor research. PMID- 10135134 TI - The real action in health care. AB - It's not taking place in the White House or Congress. The show to watch is the boisterous, free-market affair, precipitated by employers fed up with rising medical costs, and carried on by insurers and HMOs scrapping for turf. PMID- 10135135 TI - Use of advance directives: a social work perspective on the myth versus the reality. AB - The Directive to Physician (previously called Living Will) and Durable Power of Attorney for Healthcare Decisions documents are usually signed in the belief that one's wishes will be carried out in the future. Often, however, physicians and families discover that the documents are vaguely worded or leave the patient's intent and legal standing unanswered. Two additional documents that may aid the decision-making process are the Durable Power of Attorney for Healthcare Decisions and the Medical Ethics Decision Form. As important as such documents may become in the future, perhaps even more important will be the process individuals will go through defining what quality of life means to them by specifying their values and beliefs to their families and physicians before they face a crisis situation. Each individual has the right to choose or refuse medical treatment--the current struggle is for each individual to articulate his or her wishes based on a personal definition of quality of life set forth in a clear and legal framework. PMID- 10135136 TI - A comparative study of family bereavement groups. AB - Although many authors have advocated the use of bereavement support groups, little research has been done comparing groups that differ in their structure and membership. We conducted such research on five bereavement support groups offered in the Montreal area and report preliminary findings from three of them. These three groups serve widows, family survivors of suicide, and family survivors (other than parents) of the death of a family member by cancer. Although members of all groups tended to report strong satisfaction with their group experience, both the reasons for joining a group and the most valuable aspects of the group experience varied as a function of group setting and objectives. PMID- 10135137 TI - Federal Trade Commission drops challenge to California hospital acquisition. AB - The significance of patient outmigration patterns, third-party payor reaction, and post-merger cost savings have been regularly argued by defense counsel and hospitals as important consideration in the antitrust evaluation of hospital mergers. The reliance placed by the Commission on these factors in its Ukiah decision is a welcome confirmation that the antitrust agencies are increasingly sensitive to these aspects of hospital mergers, reflecting a more sophisticated understanding of the health care market than was suggested by the staff's more mechanical evaluative approach. Hospitals and their counsel should therefore prepare for and document these factors if they anticipate antitrust agency scrutiny of a proposed acquisition or merger. PMID- 10135138 TI - Special report on reimbursement. Medicare and Medicaid false claims prosecutions: your clerk's mistake can subject you to criminal penalties! AB - A number of steps are available to individual and institutional providers to minimize exposure under the new wave of enforcement activity. The first is education: learn what rules apply in your setting and share that knowledge with management and line employees. Second, undertake an independent compliance review to identify and resolve any existing exposure, including voluntary disclosure to the authorities, if appropriate. Third, institute an ongoing program to communicate to all employees not only the content of applicable rules, but also the genuine commitment of management to ensure continuing compliance above other concerns. PMID- 10135139 TI - Principles of state health reform: many states not willing to wait for federal reform. AB - Despite the simplicity of the basic objectives of health care reform-- greater access at manageable cost, these goals have not yet been achieved at either the federal or state level. One explanation may be that the American people are not willing to make the sacrifices that are probably necessary to achieve universal access to health care: increased taxes or redirection of governmental expenditures, limitation of choice in providers, and perhaps some form of rationing (which in fact already exists, by limiting access of the uninsured and some of the poor). What, then, are the prospects for meaningful national health care reform in the near future? While the answer to this question remains unclear, there is no doubt that providers across the country are likely to face an unprecedented array of state health care initiatives over the next few years, whether or not federal legislation is enacted. To prepare for this upcoming legislative activity, providers must remain aware of state legislative activity as it evolves. PMID- 10135140 TI - Use of registry employees can pose legal problems. AB - In view of the potential legal liability to which a recipient entity can be exposed when using registry employees, some care must be taken in drafting registry contract services and in modulating the recipient entity's behavior towards the registry personnel. The following steps should generally be taken by health care establishments purchasing registry services to minimize such exposure: (1) Ensure that the registry treats its personnel as employees and complies with all applicable employment law obligations, including state and federal employment tax requirements, workers' compensation laws, and any state law wage and hour requirements in the recipient's state. (2) If using an out-of state registry, make sure that the registry also has workers' compensation insurance in the recipient's state and complies with that state workers' compensation laws. (3) Make sure that termination decisions regarding registry employees are not made for reasons that violate any federal anti-discrimination laws. (4) Provide in the registry agreement for full indemnification by the registry to the recipient. (5) Ensure that the registry is solvent and has adequate insurance to honor its indemnification obligation. (6) Obtain a warranty from the registry that it carefully screens all of its employees before hiring them. (7) Expressly state in the registry agreement that the registry has the right to discipline and supervise the personnel it refers. (8) Do not reject registry personnel for reasons that would be improper with respect to the facility's own employees, e.g., race, sex, age, religion, disability, etc. PMID- 10135141 TI - Managed care's growth and your future. Interview by C. Burns Roehrig. PMID- 10135142 TI - Congress and managed care: who will take the bows? PMID- 10135143 TI - There's a third revolution under way. PMID- 10135144 TI - A second look at the single-payer plan. PMID- 10135145 TI - The Patient Protection Act. American Society of Internal Medicine. PMID- 10135146 TI - How a collaborative task force can assist in managing biotechnology products. AB - The rapid expansion of biotechnology-derived pharmaceuticals into the health care system presents new challenges and concerns in formulary selection, development of usage guidelines, and budgeting. A DUE/QA pharmacy network and a hospital association in a metropolitan area formed a Biotechnology Task Force, whose goals included: developing a forum for practitioners and administrators to exchange information; applying a strategy for evaluating and predicting usage patterns; promoting educational endeavors; and developing database technology to assist institutions with usage monitoring. The task force successfully educated health care professionals and administrators about the ramifications of biopharmaceuticals. Having this process defined will prove beneficial for future evaluation of other biopharmaceuticals. PMID- 10135147 TI - Oral solid dosage forms that should not be crushed: 1994 revision. AB - This revision and update of an article published previously in Hospital Pharmacy (1992; 27:690-699) alerts healthcare practitioners about medications that should not be crushed. This list serves those who dispense and administer medications so that potential problems associated with disruption of special pharmaceutical formulations may be prevented. Products are identified that should not be crushed and for which a similar liquid form is available. PMID- 10135148 TI - Total quality management in action: pharmacy system changes to decrease medication incidents and increase clinical services. AB - During a monitoring of risk management indicators (incident report analysis), a trend of increasing medication incidents was noted from 1987 to 1990. The medication ordering process was tracked using a flow chart, and, using an interdisciplinary team, the transcription system was targeted for corrective action. A "roving pharmacist" system was devised, with a resultant 63% decrease in the reported medication incident rate from 1990 to 1993. PMID- 10135149 TI - Milestones in immunologic history: 1960 to 1994. PMID- 10135150 TI - The internet. AB - The pharmacist's role in healthcare is changing. With increased use of automation for drug delivery, the pharmacist's role is becoming more of an information provider. Many tools are available to aid in that role not the least of which are computers and, by extension, the computer network called the Internet. This network provides the opportunity for people to communicate via E-Mail and a means of downloading useful software that is located in other computers. In short, there is a great wealth of information available on the Internet and knowing how to find and access it is a very useful and powerful skill to learn. PMID- 10135151 TI - Are all of the national health care reform bills resting on shaky numbers? PMID- 10135152 TI - Courts beginning to address confidentiality of physicians' credentialing records. PMID- 10135153 TI - Antitrust reform: many changes possible, but no immediate changes foreseen. PMID- 10135154 TI - Sharpening your executive competencies. PMID- 10135155 TI - Reengineering ... beyond incremental change. PMID- 10135156 TI - Strengthening your physician base. PMID- 10135157 TI - Career survival gear. AB - Once upon a time, a career in healthcare administration was a series of rites of passage: resident, assistant administrator, associate administrator, COO and, finally, CEO. Today, the healthcare executive's career path is not so well defined. PMID- 10135158 TI - Revenue enhancement and cost analysis. PMID- 10135159 TI - Developing public policy competencies. AB - The importance of demonstrating competency in today's public policy environment cannot be overstated. In fact, the ability of a healthcare organization to make competitively sound strategic business decisions based on its public policy acumen may be key to its survival. PMID- 10135160 TI - The executive's role in clinical matters. PMID- 10135161 TI - Transformation of American healthcare in the post-reform era. PMID- 10135162 TI - Medical innovation meets healthcare reform. PMID- 10135163 TI - Leaders affirm Health Progress's direction, pose future challenges. PMID- 10135164 TI - Ethical downsizing. Managers must focus on justice and human dignity. AB - It is vital that leaders and managers focus on justice and human dignity in the workplace when faced with the possible need to downsize. First, administrators should clearly identify the goals of work force reduction, evaluate their importance, and consider whether they could be achieved through other means. Once they have made the decision to downsize, top managers must clearly communicate the reasons and the goals to those responsible for identifying the employees affected. Employees selected for layoff should be identified on the basis of the articulated goals for work force reduction, whenever possible. When this is not clear, the tough decisions can be based on a variety of factors: "across-the board" reductions; employee abilities, qualifications, and performance; diversity goals; seniority; or multiple criteria. It is also important to respect human dignity in the layoff process. Affected employees should be informed in advance and given an honest explanation for the layoff. Ordinarily, they should be encouraged to work until the effective date. All employees need a clear and honest explanation of the reasons for and the expected effects of the layoff. There should be a stress on the free flow of information, without an effort to control it. How downsizing is handled says a lot about the nature of an organization and its leadership. Ethical downsizing is, first of all, a refusal to deny the complexity of the issues and evidence of the organization's commitment to justice and human dignity. PMID- 10135165 TI - Improving care, reducing costs. Careful planning and ongoing education are key to a successful care management program. AB - Introduced in 1990, the care management program at St. Peter's Medical Center, New Brunswick, NJ, has had a growing impact on the facility's operations and bottom line. To introduce the program, care managers and nursing administrators conducted in-services for nurses and other personnel. At the same time, the vice president for nursing and the project director for care management introduced the concept to members of the medical staff likely to admit patients who fell into the care management population. Once selected, St. Peter's care managers go through an extensive orientation program consisting of three weeks of classroom instruction and three weeks of on-the-job training. Classroom training emphasizes business skills necessary to facilitate effective utilization of resources while ensuring that patients' needs and concerns are understood and addressed. On-the job training helps new care managers apply the St. Peter's care management model. This careful preparation, along with continuing education for all practitioners, has helped win support throughout the facility for the care management approach. The St. Peter's care management department currently employs eight nurse care managers who help coordinate care for 16 diagnoses. PMID- 10135166 TI - CHA gives firm "no" to mandated insurance coverage for abortion. PMID- 10135167 TI - The story: a primary spiritual tool. Stories can be a healing power in the dying process. AB - Recounting the events of one's life is therapeutic, particularly if the storyteller has the opportunity to share feelings, as well as factual content. Inherent in each person's story is the key to healing. Sensitive listening and dialogue can help dying persons discover connections between their own stories and those in the Scripture. In addition, when a person is in denial regarding a life-threatening illness, dreams can often provide a means to unlocking the unconscious. As Jesus used images from nature and symbols from everyday life, so, too, can care givers use analogies to get to the heart of the matter. Another source of healing is the original story, which can help a patient and family see their situation in a new light. Humor, used appropriately, can be a redemptive gift. Finally, when unfinished business has been completed and issues of forgiveness resolved, there is little left but to celebrate the life of the dying person. The story can thus be therapeutic, diagnostic, a source of healing, a means of fostering reconciliation, and an occasion for celebration. PMID- 10135168 TI - Pastoral care's role in a reformed system. Pastoral care professionals need to promote the spiritual dimension of healing throughout the continuum of care. AB - The emerging structure of healthcare delivery is challenging many elements of traditional pastoral care. With these changes, how can pastoral care professionals be on the cutting edge of tomorrow's pastoral care ministry? Pastoral care givers must understand that the individual with holistic needs will be at the center of the reformed healthcare system. All providers will share the responsibility and financial risk of providing high-quality care to each client. Pastoral care departments will need to develop systems to objectively measure the quality of their spiritual and religious care services, as well as patient or client satisfaction. Pastoral care professionals must take the lead in developing a vision of spiritual care that reflects the new paradigm of integrated delivery. They must also share the vision of integrated spiritual care with opinion leaders who can be advocates for an expanded vision of pastoral and spiritual care within the network. Ideally, faith communities should be centers for care, healing, and wellness, with hospitals as extensions of those communities. Within such a network, pastoral care givers can organize programs, workshops, and retreats around spirituality and wellness as part of the faith community's mission. In addition, pastoral care professionals can help clients learn about themselves and their life-styles and make healthier choices. Pastoral care givers need to recognize that within brokenness there is also wholeness, wisdom, and new opportunities. When we are free of our own agenda, we can empower others. Together, with God's grace, pastoral care givers can shape a new future and make it happen. PMID- 10135169 TI - Market response systems: a community interface. PMID- 10135170 TI - Timken Mercy Medical Center. Teaching teens life-affirming values. PMID- 10135171 TI - Healthcare reform: people or profits? PMID- 10135172 TI - Tax-exempt hospitals' increasing burdens. PMID- 10135173 TI - A 1993 update on biohazards affecting clinical engineers and BMETs. AB - In late 1993, a survey was sent to the subscribers of the Journal of Clinical Engineering to determine: (1) if employers were responding to the biohazards protection needs of BMETs and CEs; (2) if personal protective equipment was being utilized; (3) if occupational exposure perceptions and concerns had changed since a previous survey four years ago; and (4) if educational efforts targeting BMETs and CEs were still needed. The 267 respondents were divided into four groups according to certification status and job title. Results showed that employers were doing an excellent job of providing personal protective equipment, but 50% of the BMETs and CEs chose not to use it. Even though though the occupational exposure illness and disability rate increased to 21% from the 1989 survey rate of 18%, BMETs and CEs still feel confident in their abilities to recognize potential biohazard problems based on visual clues, which can be an error in judgement that can lead to serious adverse effects including illness, disability, or death. PMID- 10135174 TI - Focus on: Woodland Heights Medical Center, Biomedical Department. AB - The Biomedical Engineering department of Woodland Heights Medical Center provides both emergency and scheduled medical equipment maintenance. Throughout the growth of the community and the acquisition of advanced, state-of-the art technology, the biomedical staff have endeavored to sharpen necessary skills and expand services in an effort to meet the equipment and user needs in a growing market. An unusual combination of medical repair technology and the management of total hospital risk has resulted in the creation of a new department. PMID- 10135175 TI - Laser safety in health care facilities: a national standard of Canada. AB - CSA Standard Z386, Laser Safety in Health Care Facilities, was designed by the consensus process and is intended to minimize the health and safety hazards associated with the operation of medical laser systems. During its development, every effort was made to project where laser technology would be in the future. The specific requirements of the standard include a classification system; procedures to reduce the physical, chemical, and biological hazards; duties of a laser safety committee and officer; engineering, administrative and procedural controls; risk management and quality assurance; training and education; and acquisition and acceptance of lasers. Thus, this standard has a wider scope than other standards on laser safety. The standard has been well received within Canada's healthcare community. PMID- 10135176 TI - 1994 survey of salaries & responsibilities for hospital biomedical/clinical engineering & technology personnel. AB - The Journal of Clinical Engineering has conducted its ninth annual survey of the salaries paid to biomedical/clinical engineering and technology personnel in U.S. hospitals. This paper reports the salary and work responsibility data obtained from 1,335 professionals in relationship to: Certification; Region of the U.S.; Teaching versus Nonteaching Facilities; Years of Experience; Education; Union Membership; and Gender. Data are included on Wage Increases and Job Responsibilities. Data are as of 12/31/93 and are compared to 12/31/92. The average BMET I has 3.7 years of experience and earns $25,464 +/- $4,838 (Std. Dev.). The average BMET II has 7.3 years of experience and earns $31,217 +/- $6,069. The average BMET III has 13.2 years of experience and earns $38,095 +/- $6,187. The average BMET Specialist has 14.3 years of experience and earns $43,017 +/- $9,322. The average BMET Supervisor has 14.2 years of experience and earns $41,194 +/- $7,844. The average Clinical Engineer has 8.4 years of experience and earns $42,392 +/- $7,630. CE Supervisors have an average 13.1 years of experience and an average salary of $47,403 +/- $9,561. The overall group or department Director or Manager has 15.5 years of experience and earns $52,245 +/- $13,567 on average. Wages are the highest on the East and West Coasts. The lowest wages are in the Southeast and Southwest. BMET wages advanced up to 5.1%, year to year. The highest quartile of Director/Managers now earns between $59,000 and $101,000 per year. Certified individuals variously earn up to $5,188 more than noncertified. PMID- 10135177 TI - Peripheral artery disease: nonsurgical treatments offer the elderly more mobility at less cost. PMID- 10135178 TI - Facilitating a community service focus. PMID- 10135179 TI - Minimum quality standards for mammography facilities. PMID- 10135181 TI - Technology and the learning organization. PMID- 10135180 TI - Technology temptations and tactics. PMID- 10135182 TI - Alternate output devices: the new direction in imaging. PMID- 10135183 TI - In health care reform, who cares for the community? AB - Health care reform has again focused the issues of ownership and mission of organizations in the health care field. Some believe that universal entitlement will eventually make both charitable patient care and the nonprofit form of organization obsolete. Others believe that special treatment of nonprofit organizations does not depend on charity at all; rather that the nonprofit form has social value in and of itself. The authors reflect a different point of view. They suggest that with reform, community benefit as the modern expression of a charitable mission will become ever more important in achieving the nation's health care goals. They believe that nonprofit organizations will continue to be entitled to special treatment only if their missions and programs extend beyond care of patients and entitled populations to focus also on care of communities. Any health organization's investment in disciplined community initiatives encompasses all the people in targeted communities, including those served by competing organizations. Without tax exemption, an organization committed to community care initiatives will be at a competitive disadvantage under the proposed community rated capitation payment system. Rather than abandoning the community benefit standard for tax exemption, health care reform calls for more systematic management of community care initiatives by nonprofit organizations and also of tax-exemption eligibility by the IRS. PMID- 10135184 TI - Community benefit: a first and second generation approach. AB - Seven years ago, leaders at Community Medical Center in Toms River, NJ, made a decision to forge a new direction in health care delivery--to look beyond just the physical health care needs of the community and also address nutrition, housing, social support, environment, and educational needs. Today, Community Medical Center serves as a national model for how a community benefit initiative can work. In this article, the authors talk about the rationale behind the hospital's community benefit initiative, the evolution of the process over first and second generations, and points of learning for hospitals wishing to take the lead in improving the health status of their communities. PMID- 10135185 TI - Collaborative partnerships involving the community. AB - Riverside Methodist Hospitals in Columbus, OH, is the 1,063-bed flagship hospital of the U.S. Health Corporation. Riverside depends on collaborative activities to carry out its mission to improve the health status of the community, and credits the collaborative spirit to a top-down leadership philosophy. To strengthen the concept of collaboration, education and experiential training are provided to board members, medical and executive staff, and employees to demonstrate the interrelatedness between the hospital and other systems in the community. Collaboration is a process which can be learned by any individual or organization. As Riverside's experience demonstrates, choosing collaborative partners carefully and using several key strategies facilitate successful collaborative efforts. PMID- 10135186 TI - The measurement of community benefit: issues, options, and questions for further research. AB - Community benefit from a conceptual perspective can be traced to the philanthropic and humanitarian spirit that dominated the earliest foundations of the hospital as a social institution. However, the measurement of community benefit is a recent development and one rarely addressed in the literature in any detail. This article outlines the various concepts integral to community benefit measurement that must be taken into account for a program to demonstrate community accountability in an era where hospitals and health care institutions are increasingly required to evaluate and document their value to society. The perspective taken is that of a practicing health care executive. The use of the discussed concepts will assist health care executives and their staff in designing and evaluating programs, and will also assist academics in preparing students for this important professional responsibility. PMID- 10135187 TI - Healthier babies in Twin Falls, Idaho: a case study. PMID- 10135188 TI - Using science and the community as a system for improving human well-being: an analysis of Healthier Babies in Twin Falls, Idaho. PMID- 10135189 TI - A teaching note on community benefit--a case study. PMID- 10135190 TI - Community care networks and health care reform. Interview by Anthony R. Kovner. PMID- 10135192 TI - More hospitals seek doctor alliances to curb costs. PMID- 10135191 TI - From Pemsel's case to health security: community benefit comes of age. A review of standards developed by the Voluntary Hospitals of America, the Catholic Health Association, and the Hospital Community Benefit Standards Program. PMID- 10135193 TI - If managed-care execs could design a health-reform plan ... PMID- 10135194 TI - Telling patients more will save you time. PMID- 10135195 TI - The very best way to organize patient records. PMID- 10135196 TI - How many third parties will buy into RBRVS? PMID- 10135197 TI - Pay strategies. Part 1. Toward a new pay strategy. PMID- 10135198 TI - Implementing a pediatric phlebotomy protocol. PMID- 10135199 TI - A do-it-yourself orientation program for the new lab supervisor. PMID- 10135200 TI - If you always wanted to be a commissioned officer. PMID- 10135201 TI - Does training increase employee retention? PMID- 10135202 TI - EDI (electronic data interchange): an acronym to watch. PMID- 10135203 TI - Grant makes holistic link. PMID- 10135204 TI - AmHS, VHA compete for purchasing pacts. PMID- 10135205 TI - Needs of community drive reform efforts in western Pennsylvania. PMID- 10135206 TI - Any-willing-provider measure vetoed. PMID- 10135207 TI - Reform plans advance amid D.C. confusion. PMID- 10135208 TI - Coram team may not last--analysts. PMID- 10135209 TI - Capital expenditure law creates rift in Wisconsin. PMID- 10135210 TI - Caps on spending ineffective--GAO. PMID- 10135211 TI - JCAHO loses property-tax exemption. PMID- 10135212 TI - N.Y. network members announced. PMID- 10135213 TI - Ohio Blues buy into deal with Cleveland provider. PMID- 10135214 TI - Merger creates leading firm in hospital psychiatric services. PMID- 10135215 TI - Hospital stocks make healthy gains. PMID- 10135217 TI - Physicians group seeking a savior with deep pockets for St. Louis-area hospital. PMID- 10135216 TI - 1st qtr. merger deals up 21%. PMID- 10135218 TI - Provider groups fear 'worst of all worlds'. PMID- 10135219 TI - Risky PHOs' winning bet. AB - Integrated delivery systems are bearing much of the risk under capitation, and some would like to accept even more. Becoming an insurer, however, brings questions of regulation and access to patients. Many PHOs will find the move too big a gamble. PMID- 10135221 TI - New study rates success of integration strategies. PMID- 10135220 TI - Begin with the end result when building a system. PMID- 10135222 TI - Capitation puts hospitals in the insurance business. PMID- 10135223 TI - Community needs defines integrated system links. PMID- 10135224 TI - Setting priorities is key to healthier community. PMID- 10135226 TI - Equipment service firm probed. PMID- 10135225 TI - Information technology gains speed, precision. PMID- 10135227 TI - Small Ill. hospital faces big battle over control. PMID- 10135228 TI - Execs must be flexible in shifting industry. PMID- 10135229 TI - Legal questions abound for providers, executives. PMID- 10135230 TI - AHA's relocation results in layoffs for 54 workers. PMID- 10135231 TI - Hospital group's new chief aims to broaden membership ... Hospital Council of Southern California. PMID- 10135232 TI - Abbey reports 6% drop in profits. PMID- 10135233 TI - Minority work-study sites selected by AHA. PMID- 10135234 TI - New charges in Cape Coral dispute. PMID- 10135235 TI - AIDS-care plan to reduce costs ... Midway Hospital Medical Center, Country Villa Service Corp. PMID- 10135237 TI - R.I. hospitals receive FTC go-ahead to join. PMID- 10135236 TI - Health Policy Board appointed in response to Kentucky reform law. PMID- 10135238 TI - Price of HealthTrust buy questioned. PMID- 10135239 TI - Billion-dollar deal raises eyebrows ... FoxMeyer Corp. PMID- 10135240 TI - American HomePatient grows with big purchase from rival. PMID- 10135241 TI - Surgical Care posts 25% gain in 2nd qtr. profit. PMID- 10135242 TI - In N.Y., hospitals fret about reform. PMID- 10135243 TI - Reform camps in Congress bidding for the undecided. PMID- 10135244 TI - Integrated Health earnings climb 65%. PMID- 10135245 TI - Psych hospital outpatient services grow, but add revenue--study. National Association of Psychiatric Health Systems. PMID- 10135246 TI - Too much compromise threatens to take life out of healthcare reform. PMID- 10135247 TI - Open meetings case set for trial ... healthcare task force. PMID- 10135248 TI - Vets enter late plea for moderate reforms. PMID- 10135249 TI - Disinformation overload. AB - Lawmakers and special-interest groups are working with the government as well as private consulting groups to bolster their reform positions with statistics. Experts, however, fear the barrage of healthcare reform research will only add to the public's confusion. PMID- 10135250 TI - Programs, ad campaigns reach out to members of ethnic communities. PMID- 10135251 TI - Public offerings are entering a tougher market. PMID- 10135252 TI - NME execs ponder future, report $429.9 million loss. PMID- 10135253 TI - JCAHO unveils simplified rating system. PMID- 10135254 TI - Surveys bring few surprises ... JCAHO. PMID- 10135255 TI - Breakfast speeds up at St. Mary's. PMID- 10135256 TI - Can failure be a blessing in disguise? PMID- 10135257 TI - American Laundry Digest buyer's guide. Manufacturers directory and product listings. PMID- 10135258 TI - Oasis of healing. Hi-Desert Medical Center, Joshua Tree, California. PMID- 10135259 TI - Decision support systems in the QI environment. PMID- 10135260 TI - Customer-focused scheduling for outpatient services. PMID- 10135261 TI - Preparing for health care reform: basic strategies. PMID- 10135262 TI - What makes young HMO physicians satisfied? AB - While much attention has been paid to the effect of managed care on patient outcomes and health care costs, little attention has been focused on the ways in which managed care affects the satisfaction of physicians. Examination of the practice and career satisfaction of 189 young physicians practicing in group and staff model HMOs finds high levels of satisfaction. More than 82% are satisfied with their current practice. The most important factor influencing physician satisfaction appears to be the extent of perceived autonomy. Neither the number of hours worked per week nor yearly income were strongly associated with decreases in satisfaction. The fact that minority and female physicians report less satisfaction with some dimensions of practice raises important issues for HMO physicians and managers. PMID- 10135263 TI - Physician burnout: recommendations for HMO managers. AB - If HMOs are to remain viable, they will have to control and eliminate conditions that contribute to the burnout of their physicians. Based on the belief that interventions should be based on a thorough understanding of how an HMO affects burnout, physicians in a large, prepaid group practice were asked to respond to objective and open-ended questions about their background and career, work conditions, professional autonomy, patient care, and stress and well-being. Findings about burnout prevalence, factors related to burnout, and burnout outcomes are presented and used as a starting point for a discussion of possible interventions. PMID- 10135264 TI - The joy of doctoring. AB - What makes doctoring joyful? Important issues may involve the organization and management of the practice setting; the physician needs to focus on the human aspects of doctoring as well. PMID- 10135265 TI - Finding satisfaction in the practice of medicine. AB - This author believes that physicians approaching their middle years of practice are better able to experience the art as well as the science of medicine. Questions are posed to help the physician find more joy and satisfaction in practice. PMID- 10135266 TI - An evidence-based approach to evaluating and improving clinical practice: implementing practice guidelines. AB - Clinical practice guidelines can improve health care outcomes, but they are only as effective as their implementation. We present a framework for implementing practice guidelines that begins by identifying the forces driving and restraining the adoption of the guideline. Strategies for changing physician behavior that strengthen the driving forces and weaken the restraining forces can then be incorporated into a comprehensive implementation program. Nine strategies for changing physician behavior are presented, based on a review of the literature and organizational experience at Group Health Cooperative of Puget Sound. In designing an implementation strategy, it is essential that the resources allocated to implementation are commensurate with the improvement in outcomes expected from the successful implementation of the guideline. All implementation programs should include plans for measuring outcomes to allow for continuing improvement. Guideline implementation, evaluation and improvement efforts are most likely to be successful when they are part of an explicit, evidence-based process for evaluating and improving clinical practice. PMID- 10135267 TI - Laparoscopic cholecystectomy: a new technology cost analysis. AB - The introduction of a new technology, laparoscopic cholecystectomy, into an HMO is discussed. Anticipated savings in hospital costs associated with the procedure's short length of stay were offset by higher costs related to performing the procedure. Expensive, disposable equipment necessary to perform the procedure and the hospital charges for this equipment offset the potential savings of shortened hospital stays. A higher cholecystectomy procedure rate was also observed after laparoscopic cholecystectomy was introduced. A prospective agreement with the hospital regarding charges for this procedure might have resulted in less expense for the procedure. PMID- 10135268 TI - New HMO physician training program. PMID- 10135269 TI - Retirement--the call to ARMS (Association of Retired Medical Staff). PMID- 10135270 TI - 1st annual survey issue ... healthcare products and services. PMID- 10135271 TI - Unlocking the information vault. AB - With a multitude of departmental information systems, executives find it difficult to make well-informed decisions affecting cost or to change physician behavior. A well-conceived EIS is alleviating such difficulties at many organizations. PMID- 10135272 TI - Managing information: today's integrated healthcare enterprises. AB - Managed care forces healthcare providers to focus simultaneously on costs and outcomes. To support the new priorities, providers are creating new business models, moving rapidly to merge, and forming alliances. The industry is witnessing the rise of integrated healthcare delivery systems that encompass hospitals, physician groups, ambulatory clinics, HMO and PPO plans, and other provider facilities. PMID- 10135273 TI - The consumer revolution arrives. Using smart customer service to attract, educate, & retain satisfied members & lower costs. AB - Across the country, managed care organizations pursue ways to enhance customer service and maintain member satisfaction, without breaking the bank by authorizing unnecessary services. One method gaining popularity is reducing customer demand for inappropriate services through education. Approaches include welcome-to-the-plan calls, member education, automated and in-person answer lines, and 24-hour telephone coverage. Several firms have recognized the need for such services, and offer them to HMOs on an outsourcing basis, with generally positive results. PMID- 10135274 TI - Using provider practice profiles as preventative care for medical costs. AB - In an era of escalating healthcare costs, healthcare organization managers are looking for new ways to be cost-effective. With the advent of mandated reform, we need to understand how physicians are treating patients, and the cost of that care, to stay competitive. The topic of provider practice profiles has been prominent lately, as indicated by an article and editorial in the Mar. 3, 1994 issue of New England Journal of Medicine. At Community Care Network Inc., or CCN, we have been studying practice patterns for nearly five years. PMID- 10135275 TI - Washington Hospital center's EIS (executive information system) success. PMID- 10135276 TI - Business dynamic software: state of the art financial systems. PMID- 10135277 TI - Big new uses for the patient room small screen. PMID- 10135278 TI - Tying it all together. PMID- 10135279 TI - Creating a "Top 100" HIS firm: the lessons of history. PMID- 10135280 TI - Snapshots, reminders & flowsheets--the angles of a repository. Case study. PMID- 10135281 TI - Growing down--from mainframe to mini-sized financials. PMID- 10135282 TI - Meeting the "real-world" needs of long-term care. PMID- 10135283 TI - Measuring the benefits of an integrated HIS. PMID- 10135284 TI - Use of a water conditioner to control the aquatic environment of cooling towers and evaporative coolers. PMID- 10135285 TI - Heat rejection systems. PMID- 10135286 TI - The role of the medical engineer in today's hospitals. PMID- 10135287 TI - The role of ventilation systems in the prevention of hospital infection. PMID- 10135288 TI - Application of the just-in-time philosophy in health care organizations. PMID- 10135289 TI - Collaborative care: pathways to quality outcomes. AB - In 1990, The Memorial Hospital at Easton, Maryland, Inc., a not-for-profit 183 bed rural community hospital, recognized a need to explore alternative patient care methods or approaches to improve the continuity of care, focus on healthier patient outcomes, and contain costs. The concept of collaborative care became the focus for patient care delivery. Multidisciplinary teams were established to coordinate patient care activities for patient populations process. Plans of care, referred to as critical pathways, identify intermediate goals and interventions, providing guidance for the patient, family, and healthcare providers as they work to achieve quality outcomes. As the patient progresses along the critical pathway, variances from the established goals are monitored and become the focus of quality reviews. PMID- 10135290 TI - Competency assessment and performance improvement for healthcare providers. AB - This article discusses the implications of designing a comprehensive competency assessment program for healthcare providers. Increased liability for providers, institutions, and liability carriers is providing the impetus for change. Current methods to evaluate competency are limited; most methods include requirements that simply validate licensure and credentials. This article discusses the literature that supports methods for evaluating competency by assessing skills and proctoring. The author proposes a three-part model to ensure that competency assessment and performance improvement is the mainstay of an organization's quality management program. The model includes (a) a skills assessment inventory, (b) a standards review to promote compliance, and (c) a peer review program. Included are samples from two comprehensive skills inventories designed for orientations for physicians and nurses. PMID- 10135291 TI - Physician integration in the CQI process: a beginning. AB - Continuous quality improvement (CQI) is vitally important to professionals in the field of healthcare quality. Many of us have met the challenge and have successfully introduced CQI principles to the employees in our hospitals. However, physicians, who play a key role in our hospitals, have not, for the most part, been directly involved in hospitals' organizational education efforts. This article focuses on involving physicians in the CQI process. It explains the approaches that were used to inform them about CQI principles, to encourage their feedback, and to elicit their participation in the hospitalwide quality improvement program. PMID- 10135292 TI - Interdisciplinary collaboration in the special care unit--Part I. AB - Quality improvement (QI) activities in special care units can serve as a model of interdisciplinary problem identification and resolution for organizations that are moving from service-specific QI activities to organizational-wide activities. The transition from distinct unit-based QI activities to an interdisciplinary collaborative model at the Carl T. Hayden Veterans Administration Medical Center began with recognition of problems that were identified during a Joint Commission survey of the special care units. Process improvements were made that resulted in improved interdisciplinary collaboration between the special care units, and a successful follow-up Joint Commission survey. PMID- 10135294 TI - Legislative forum: healthcare reform concerns. PMID- 10135293 TI - Perspective: comparing two-sample tests and control charts. AB - For the task of monitoring a process, detecting change, and making correct attributions on a continuous basis, there is no better tool than the control chart, particularly where the data set is large and permits subgrouping. By using this technique, staff will get quicker answers or will have a smaller data requirement, and will arrive at more valid conclusions than with the two-sample method. (The two-sample approach is typically used when the data are not produced or collected in sequence is unknown. This, however, may reflect a weakness in the data collection process.) In addition, we believe that the control chart approach is as simple as the two-sample approach. Once the control limits and zones are established, the plot of points can be maintained by personnel who need to do no more than plot a rate on a weekly (or a daily) basis. The control chart rules properly focus laboratory and QA personnel on change. Control chart procedures are statistical tests of special cause and need no further significance tests. Those using control charts need to be aware of three important points: 1. Control limits are not standards or thresholds and cannot be derived from these concepts. Control limits are a statement about the current natural variation in the process. 2. The type of chart to be used should depend upon the type of data being evaluated. (Finison et al., 1993).(ABSTRACT TRUNCATED AT 250 WORDS) PMID- 10135295 TI - Employing a systems approach to customer satisfaction. AB - The need to meet customers' expectations is one of the driving forces in healthcare today. Organizations can achieve this goal most effectively by using rational and systematic problem-solving approaches. This article describes systems theory as a problem-solving method that analyzes and implements customer satisfaction data to produce the desired result of increased customer satisfaction levels and economic growth. PMID- 10135296 TI - The impact of ownership form and regulatory measures on firm behavior: a study of hospices. AB - This article examines differential responses to the Medicare hospice benefit across ownership types. The analysis reveals little difference in costs or quality of service among government-owned, for-profit, and nonprofit hospices. However, there are significant differences in the numbers of patients served by ownership status. The results are consistent with the hypothesis that nonprofit hospices are patient maximizers, not profit maximizers in disguise who are aiming to circumvent the nondistribution constraint. A comparison of these results with those in the hospital and nursing home industries leads to the conclusion that Medicare regulations and the predominance of Medicare revenues in an industry induce similar outcomes in cost and quality across ownership types. PMID- 10135297 TI - Annual aircrew survey. PMID- 10135298 TI - The cost-effectiveness of air medical helicopter crash survival enhancements. An evaluation of the costs, benefits and effectiveness of injury prevention interventions. AB - OBJECTIVE: This study evaluates EMS helicopter-injury reduction interventions and associated costs for survivable crashes. Specific injury categories evaluated include head injuries, spinal injuries and thermal injuries. The benefits and costs of the preventive interventions are evaluated through cost-effectiveness analyses that provide a basis for informed safety-enhancement decisions for EMS helicopter operators, based on the most cost-efficient interventions. METHODS: The incidence and type of injuries experienced by EMS helicopter occupants were determined, and future risk of injury was estimated. Then the costs of those injuries, as well as the costs of the preventive interventions, were determined so estimates could be made of the cost benefits of the injuries prevented. Estimates were made regarding current levels of injury prevention interventions already in the field and their effectiveness in preventing injury. RESULTS: Improvements can be made to reduce the risk of injury to medical crew and pilots in survivable crashes. Nomex uniforms, helmets, and energy-absorbing seats (EAS) for medical crew members all prove cost-effective in reducing preventable injuries in survivable crashes. CONCLUSION: Emergency medical service helicopter occupants should wear fire-resistant uniforms and helmets, and medical crew members should have EAS systems when available. These EAS systems also are recommended for pilots, although they were not shown to be cost-effective based on the projections developed in this study. PMID- 10135299 TI - Costing for quality--a case study. PMID- 10135300 TI - Service protocols. PMID- 10135301 TI - Improving the quality of service in an out-patient department. PMID- 10135302 TI - Establishing continuous quality improvement in a Hong Kong hospital. PMID- 10135303 TI - Quality Assurance (BS 5750) in social services departments. PMID- 10135304 TI - Converging implementation strategies in commercial TQM initiatives: implications for the NHS. PMID- 10135305 TI - How technology can improve the quality of care. PMID- 10135306 TI - A new frontier for prescription drug services. AB - To help payers and patients achieve the full value of their prescription drug benefit, the next frontier of managed pharmacy services will be improving individual health outcomes, raising employee productivity and lowering a plan's overall medical costs. PMID- 10135307 TI - Cost management for disability benefits. PMID- 10135308 TI - Making mental health services affordable. AB - The prevalence of mental health problems is far more than what is perceived by the general public. The billions of dollars of lost productivity due to mental health problems and the affect of mental health on total health costs cannot be ignored. PMID- 10135309 TI - Incentives for a better health care system. PMID- 10135310 TI - Health care for rural areas. PMID- 10135311 TI - The new generation of wellness plans. AB - The newest wellness programs have become savvy about success. They deliberately link health promotion with health benefits, a strategy sure to enhance their image and their impact. PMID- 10135312 TI - Four companies find solutions to rising costs. PMID- 10135313 TI - A model health care system. PMID- 10135314 TI - How to pay for the uninsured. PMID- 10135315 TI - Rethinking corporate health care strategies. PMID- 10135316 TI - Is there an alternative to a National Health Board for Technology Assessment? AB - The National Health Board, a lynchpin of the managed competition philosophy of health reform, would perform a necessary function in regards to technology assessment for clinical decision making. However, would such an agency have what it takes to provide adequate turnaround, and nonbiased decision-making ability to play this crucial part of the reform process? PMID- 10135317 TI - The hospice movement: growth as an alternative, not integrated movement. AB - The hospice was originally a rest place for travelers. Today, hospice care refers to care for the terminally ill and their families. Hospice care has evolved in the last 30 years; it now comprises an array of services, including home care, special hospital programs, and new autonomous hospices--to care for the terminally ill. The author discusses the beginnings of hospice care and addresses the rapid progression of this model of long-term care delivery. PMID- 10135318 TI - Managed care in Eastern Europe: an opportunity for U.S. firms. AB - Health care in Eastern Europe is in transition; the former state-run health systems are in shambles. This article describes elements of these systems, discusses transition problems, such as corruption, and suggests areas in which American firms can prosper. Problems with capital development and red tape will need to be overcome. However, the quality of physician training is high, and many doctors are eager to work with American institutions to emulate their standards of care. Their need for training in Western management techniques is quite apparent. The author suggests that managed care organizations can be established rapidly if local partners are included in their development. PMID- 10135319 TI - Advance patient directives: are they worth it? AB - The Patient Self-Determination Act became effective in December 1991. After two complete years of experience, data are emerging to indicate how implementation of the Act has affected the issues of patient autonomy and cost containment. In this third article of a series on advance directives, the authors conclude that the preliminary results of their study are consistent with other studies recently completed that demonstrate the favorable effect of the Act on enhancing patient autonomy and containing the costs of health care. The authors suggest a basic study design for replication and adaptation by others, encourage more uniformity by researchers in future studies to more precisely measure the effect of the Act, and briefly describe the expansion of their continuing study. PMID- 10135320 TI - Patient care during natural disasters. AB - Delivering health care requires careful coordination on normal workdays, but during a natural disaster, the organization's planning and management can be sorely tested. The most crucial aspect to consider during a natural disaster is patient care; plans have to prepare for such an event in advance. In this article, the author discusses how some HMOs around the country have coped with providing care for patients during natural disasters and offers some key strategies for successful patient care delivery. PMID- 10135322 TI - A conversation with Roger Greaves. PMID- 10135321 TI - Managing prescription drug costs: a case study. AB - Pharmacy costs in most private insurance companies and public concerns have risen over the past several years. To address the problem of increased expenditures in its government employee pharmacy program, the State of New York sought bids from outside vendors to help it control pharmaceutical costs. The following is a case study of the tools the state employed in that effort. Over time, both prescription drug coverage and mental health and substance abuse benefits were carved out of the medical plan and are now provided under free-standing programs. In order to participate, an independent pharmacy must accept a discount of 10% off the average wholesale price of brand name drugs and 25% off the average generic price of generic drugs. PMID- 10135323 TI - Progress, sort of. Health reform: is that a light at the end of the tunnel, or Bob Dole's grin? PMID- 10135324 TI - Enhancing the quality of life for the frail elderly: Rx, the poetic prescription. PMID- 10135325 TI - Art therapy with the frail elderly. AB - The use of art engages frail oder persons in a unique way. Art therapists recognize the creative source in the elderly and strive to involve them in the creative process. The art therapist combines the media of the visual artist with assistance in art skills to enable the older person to make meaningful expressions of emotion despite deteriorating functional ability. Supportive and therapeutic art interventions augment the skills and assets that many older persons retain. Effective art therapy sessions may be brought to older persons in their homes or in the day programs they attend. Through art therapy, the frail elderly learn new ways to express and interpret life situations, to communicate perspectives and respond to the difficulties before them. PMID- 10135326 TI - Music and music therapy for frail noninstitutionalized elderly persons. PMID- 10135327 TI - Adult day care programming and supportive therapies for the frail elderly: how to do it and how to pay for it. PMID- 10135328 TI - Commentary: national health insurance and its relationship to long term care. PMID- 10135329 TI - Long-term home health care for the aged: the West Penn (Allegheny County, PA) Hospital Home Visit Program experience. PMID- 10135330 TI - Evolution of the creative arts therapies for the frail elderly. PMID- 10135331 TI - Medicare program; self-implementing coverage and payment provisions: 1993 legislation--HCFA. Final rule with comment period. AB - This rule updates Medicare regulations to conform them to certain self implementing provisions on coverage of services and payment requirements under the Omnibus Budget Reconciliation Act of 1993 (OBRA 93). OBRA 93 was enacted on August 10, 1993 and several of the cited changes to the statute are already in effect and the others will be shortly. We are also implementing a related provision of the Omnibus Budget Reconciliation Act of 1990 (OBRA 90) as necessary for consistency and clarity of the OBRA 93 provisions. PMID- 10135332 TI - Medicare program; uniform electronic cost reporting system for hospitals--HCFA. Final rule with comment period. AB - This final rule with comment period implements the provisions of section 4007(b) of the Omnibus Budget Reconciliation Act of 1987, as amended by section 411(b)(6) of the Medicare Catastrophic Coverage Act of 1988, which require the Secretary to place into effect a standardized electronic cost reporting system for all hospitals under the Medicare program. Under this final rule with comment period, all hospitals are required to submit their cost reports, for hospital cost reporting periods beginning on or after October 1, 1989, in a uniform electronic format. The Secretary may grant a delay or a waiver of this requirement where implementation could result in financial hardship for a hospital. PMID- 10135333 TI - Medicare program; changes to the hospital inpatient prospective payment systems and fiscal year 1994 rates--HCFA. Final rule. AB - On September 1, 1993, we published a final rule with comment period that implemented certain changes in the hospital inpatient prospective payment systems resulting from the enactment of the Omnibus Budget Reconciliation Act of 1993 on August 10, 1993. This final rule responds to public comments on that publication. PMID- 10135334 TI - The 1992-2005 job outlook in brief. AB - What's up? Docs, as well as most other occupations, according to BLS's latest economic projections, which are revised every 2 years. Here's the most recent look into the future employment of 250 occupations. Bonus #1: An overview of the outlook for the major occupational groups. Bonus #2: Major trends since 1950 and some uncertainties about the future. Bonus #3: Information on job competition, whenever possible. PMID- 10135335 TI - True Blue. PMID- 10135336 TI - Huh? ... OSHA's new guidelines on tuberculosis. PMID- 10135337 TI - Rail rescue. Putting the multiple injury plan to the test. AB - When an Amtrak train derailed in Boise, ID, last November, EMS providers implemented the Multiple Injury Plan. EMS recaps the disaster response, chronicling extrication/rescue efforts and patient assessment/management. PMID- 10135338 TI - Who are "they"? And how do they operate? PMID- 10135339 TI - A clinically based service limitation option for alternative model rural hospitals. AB - Alternative model rural hospitals are designed to address problems faced by small, isolated rural hospitals. Typically, hospital regulations are reduced in exchange for a limit on the services that alternative models may offer. The most common service limitation is a limit on length of stay (LOS), a method with little empirical or conceptual support. The purpose of this article is to present a clinically based service limitation for alternative model rural hospitals, such as the rural primary care hospital. The proposal is based on an analysis of Medicare discharges from rural hospitals most likely to convert and the judgments of a technical advisory panel of rural clinicians. PMID- 10135340 TI - Lessons for states in inpatient ratesetting under the Boren Amendment. AB - Encouraged by a 1990 Supreme Court decision, Medicaid providers have challenged State inpatient ratesetting methodologies under the Boren Amendment. Procedurally, State assurances to the U.S. Department of Health and Human Services (DHHS) that payment rates meet the Amendment's requirements must be supported by findings based on a reasonably principled analysis. Substantively, rates may fall within a zone of reasonableness, but courts have differed in interpreting and applying the Amendment's terms. Although some courts have found special studies and written findings unnecessary, States that undertake economic analyses to support their findings are more likely to withstand judicial scrutiny. Several applicable economic analyses are proposed. PMID- 10135341 TI - Medicare inpatient physician charges: an econometric analysis. AB - To control Medicare physician payments, Congress in 1989 established volume performance standards (VPS) that tie future physician fee increases to the growth in expenditures per beneficiary. The VPS risk pool is nationwide, and many observers believe it is too large to affect behavior. VPS could be modified by defining a separate risk pool for inpatient physician services and placing each hospital medical staff at risk for those services. Using a national random sample of 500,000 Medicare admissions, we explore the determinants of medical staff charges and comment on the policy implications. Multivariate analysis shows that charges increase with case mix and bed size but, surprisingly, decrease with the level of teaching activity. The teaching result is explained by the substitution of residents for physicians in these hospitals. PMID- 10135342 TI - Social/health maintenance organization and fee-for-service health outcomes over time. AB - Evaluating the performance of long-term care (LTC) demonstrations requires longitudinal assessment of multiple outcomes where selective mortality and disenrollment, if not accounted for, can give the appearance of reduced (or enhanced) efficacy. We assessed outcomes in social/health maintenance organizations (S/HMOs) and Medicare fee-for-service (FFS) care using a multivariate model to estimate active life expectancy (ALE). S/HMO enrollees and samples of FFS clients in four sites were analyzed and outcome differences assessed for a 3-year period. Results provide insights into S/HMO performance under different conditions and, more generally, into evaluating LTC demonstrations without randomized client and control groups. PMID- 10135343 TI - A comprehensive payment model for short- and long-stay psychiatric patients. AB - In this article, a payment model is developed for a hospital system with both acute- and chronic-stay psychiatric patients. "Transition pricing" provides a balance between the incentives of an episode-based system and the necessity of per diem long-term payments. Payment is dependent on two new psychiatric resident classification systems for short- and long-term stays. Data on per diem cost of inpatient care, by day of stay, was computed from a sample of 2,968 patients from 100 psychiatric units in 51 Department of Veterans Affairs (VA) Medical Centers. Using a 9-month cohort of all VA psychiatric discharges nationwide (79,337 with non-chronic stays), profits and losses were simulated. PMID- 10135344 TI - An evaluation of pediatric-modified diagnosis-related groups. AB - Pediatric-modified diagnosis-related groups (PM-DRGs) were designed to describe more accurately than DRGs differences in severity of illness and charges across pediatric patients. We report on an evaluation of PM-DRGs for use in prospective payment systems (PPSs). Data on pediatric discharges (i.e., patients 17 years of age or under) from 5 States and a national sample of 43 hospitals were used. PM DRGs explained substantially more variation in resource use at the discharge level and hospital level. PM-DRGs improved classification of neonatal discharges by concentrating them into fewer categories and measuring birth weight more precisely. PMID- 10135345 TI - Excluded facility financial status and options for payment system modification. AB - Psychiatric, rehabilitation, long-term care, and children's facilities have remained under the reimbursement system established under the Tax Equity and Fiscal Responsibility Act (TEFRA) of 1982 (Public Law 97-248). The number of TEFRA facilities and discharges has been increasing while their average profit rates have been steadily declining. Modifying TEFRA would require either rebasing the target amount or adjusting cost sharing for facilities exceeding their cost target. Based on our simulations of alternative payment systems, we recommend rebasing facilities' target amounts using a 50/50 blend of own costs and national average costs. Cost sharing above the target amount could be increased to include more government sharing of losses. PMID- 10135346 TI - Inpatient transfer episodes among aged Medicare beneficiaries. AB - Examination of data derived from Medicare provider analysis and review (MEDPAR) discharge records for 152,337 transfer episodes of aged Medicare beneficiaries indicates that aged Medicare transfer patients have initial stays comparable to non-transfers in terms of length of stay, case-mix intensity, and total charges. During the final part of the transfer episode, however, transfers are clearly more intense cases than non-transfers. Patients treated for stroke or cardiovascular conditions are more likely to be transferred than other Medicare aged inpatients. The transfer episodes examined appear to reflect clinical considerations based primarily on patient need for specialized care. PMID- 10135347 TI - Patient focused care. Health management guide. AB - Finding the holy grail which will deliver high quality care at lower cost is every NHS manager's dream, especially during times of severe resource constraint and intense competition. Reorganising units to provide 'patient-focused care' can, it has been claimed, make them simpler and slimmer, cutting costs and wasted time, while increasing patient and staff satisfaction. How is patient-focused care being implemented in the NHS, and how successful has it proved so far? Could it help your unit? This Health Management Guide looks at how patient-focused care originated and how it works, exploring a number of sites where it is in use, and identifying key points to consider before adopting a 'patient-focused' approach. PMID- 10135348 TI - Board development. The dream team. PMID- 10135349 TI - Community care. Wrong way home. PMID- 10135350 TI - Ambulance services. Casualty of the 1990s. PMID- 10135351 TI - Substitution. A switch in time. PMID- 10135352 TI - The impact of health care reform on technology. PMID- 10135353 TI - FDA issues regulations on certification requirements for mammography facilities. PMID- 10135354 TI - Paradigm shift means opportunity for new technology. PMID- 10135355 TI - Decision making and technology. PMID- 10135357 TI - OB/Gyn leads the malpractice hit list. PMID- 10135356 TI - Information, market government, and health policy: a study of health data organizations in the states. AB - Information is essential to the success of market-oriented policies. Information on health care costs and quality is collected and distributed by state governments through health data organizations (HDOs) to enhance competition and lower costs in the medical industry and to improve consumer choice among medical alternatives. This article examines the information collected, produced, and distributed by state health data organizations in Colorado and Pennsylvania. Findings reveal that information was not the objective determinant of choice and competition as market-oriented policy designers had hoped. Nor did market oriented bureaucracies produce and distribute data readily accessible for public choice. Instead, information produced and distributed by these HDOs was the result of political and bureaucratic exercises that conform much more to classic interest group policymaking and captured bureaucracies than to contemporary market-oriented government ideals. The findings underscore the extraordinary difficulties facing federal-level policy designers as they contemplate introducing market-oriented health care policies on the national level. PMID- 10135358 TI - I'm a gatekeeper--and proud of it. PMID- 10135359 TI - When doctors are caught between dueling clinical guidelines. PMID- 10135360 TI - Farm out practice work? It's making more sense. PMID- 10135361 TI - Will uniting with a hospital jeopardize your pension plan? PMID- 10135362 TI - Against the grain: some database delivery issues at an academic health sciences center. PMID- 10135363 TI - Integration, interface, and the enterprise. PMID- 10135364 TI - Knowledge-based information management: implications for information services. AB - The 1994 Joint Commission on the Accreditation of Healthcare Organizations (JCAHO) standards for information management will change the way health care librarians respond to JCAHO accreditation surveys and may affect the way libraries are managed. This article will highlight the changes in the standards and the new opportunities they offer. Implications for library operations and the challenges inherent in working with the new Accreditation Manual for Hospitals (AMH) are also explored. The long-awaited 1994 Joint Commission on the Accreditation of Healthcare Organizations (JCAHO) Accreditation Manual for Hospitals (AMH) is now on most hospital library shelves. As expected, librarians will find that the section on Professional Library Services (the PR chapter) has disappeared and that the standards previously in that section are now incorporated in part into the new Management of Information, or IM chapter. Although this method of grouping standards may be new to many health sciences librarians, the incorporation of library services into IM may actually provide many more opportunities for librarians than the previous method of addressing library services separately. PMID- 10135365 TI - Bureau chief reflects from the reform front. PMID- 10135366 TI - Beware of the 'ego triangle'. PMID- 10135367 TI - A profit by any other name would still give hospitals the fits. AB - Surplus. Excess revenue. Money for reinvestment. Hospitals would have you call it anything but profit. However, they are generating more of it than ever before. Colorado hospitals, for example, including Lutheran Medical Center in Wheat Ridge, left, are posting their highest earnings in several years. PMID- 10135368 TI - American Home bids $8.5 billion to buy New Jersey drug company. PMID- 10135369 TI - Laundry company founder reclaims troubled division of Amsco International. PMID- 10135370 TI - Affiliation boom, battle for county hit K.C. PMID- 10135371 TI - Lack of new antibiotics refuted by recent study. PMID- 10135372 TI - Oregon Medicaid plan expanding at rapid pace. PMID- 10135373 TI - CEOs confirm importance of partnerships. PMID- 10135374 TI - Contract brings expertise, turnaround. PMID- 10135375 TI - OSHA's strict interim TB guidelines result in steep finds for hospitals. PMID- 10135376 TI - CEO turnover drops to 13.9% in '93--ACHE. PMID- 10135377 TI - Group files for bankruptcy after suit. PMID- 10135378 TI - Hospital chairman rebuts retirement story on CEO. PMID- 10135379 TI - High charges, mortality linked. PMID- 10135380 TI - Case could be worth $100 million to hospitals. PMID- 10135381 TI - Senate plan adds to reform confusion. PMID- 10135382 TI - Report critical of Calif. exec's spending. PMID- 10135383 TI - Medical Care's 2nd-quarter profit up 5%. PMID- 10135384 TI - Minn. hospitals make antitrust pact. PMID- 10135385 TI - AHA to conduct in-house study of work force. PMID- 10135386 TI - Caremark faces kickback charges. PMID- 10135387 TI - Geisinger ruling may mean fewer tax exemptions. PMID- 10135388 TI - Former Epic subsidiary set for growth. PMID- 10135389 TI - Government to accept new managed-care bids. PMID- 10135390 TI - Hospital firms outpace industry in 2nd quarter. PMID- 10135391 TI - More hospitals packaging transplants. PMID- 10135392 TI - Conn. hospitals seek to void taxes, fearing ERISA lawsuits. PMID- 10135393 TI - N.J. Hospital Alliance seeking charity-care reimbursements. PMID- 10135394 TI - Imaging companies set their sights overseas. PMID- 10135395 TI - Imaging firms' earnings differ in second quarter. PMID- 10135396 TI - Allina deal shows market trends. PMID- 10135397 TI - Coram names new president, begins growth plan with HMSS acquisition. PMID- 10135398 TI - Former Charleston, S.C., rivals open dialogue on affiliation. PMID- 10135399 TI - Groups form desktop health networks. PMID- 10135400 TI - St. Louis hospital forges links to integrate care. PMID- 10135401 TI - SunHealth aims to help partners form networks. PMID- 10135402 TI - Keeping a Catholic identity. PMID- 10135403 TI - VHA set to take executives to the school of successful strategies for integration. PMID- 10135404 TI - Groups win grants for outreach programs. PMID- 10135405 TI - NIOSH alerts ORs to excessive nitrous oxide levels. PMID- 10135406 TI - Reengineering gives nurses new opportunities. PMID- 10135407 TI - ORs streamline patient care, control resource utilization. PMID- 10135408 TI - Are you complying with equipment standard? PMID- 10135409 TI - Surgical technologists hail changes in JCAHO standards on circulating. PMID- 10135410 TI - The 1994 400 ... top growth leaders. PMID- 10135411 TI - Untangling universal coverage. PMID- 10135412 TI - Forming, storming, norming, and performing with CQI. PMID- 10135413 TI - The evolving role of the senior healthcare executive. PMID- 10135414 TI - Universal scale goniometer for plain film, CT, MRI, and ultrasound measurement. PMID- 10135415 TI - How good is your billing service? Part 2. PMID- 10135416 TI - Perspectives. Rhode Island tries to do the "RIte" thing. PMID- 10135417 TI - The new Mayo Clinic. AB - One of our most distinguished physician-led medical institutions prepares for health care delivery in the 21st Century, embracing an aggressive strategy of vertical integration that is working. Here is a story that illustrates that market forces are the consumers' best friend. PMID- 10135418 TI - Group purchasing--competing with the big guys. PMID- 10135419 TI - HealthTrust's internal approach. PMID- 10135420 TI - AMI--Joint Commission multihospital survey process. PMID- 10135421 TI - HCFA to add measure of severity to DRGs. Part II. AB - This is the second of a three-part series on the Health Care Financing Administration's (HCFA) refinement of its Diagnosis Related Groups system incorporating a measure of severity of illness. Part 2 continues with information from the agency that administers the Medicare program. Part 3, to be published in our September/October 1994 issue, will present expert opinions on what effect HCFA's changes will have on hospitals across the U.S. PMID- 10135422 TI - Federal court's decisions will clarify the Health Care Quality Improvement Act. AB - Peer reviewers are anxiously awaiting the decision of the U.S. Court of Appeals for the Ninth Circuit in two antitrust cases. Both cases, Smith v. Ricks and Fobbs v. Holy Cross Health System Corp., were fully briefed and argued on the same day earlier this year, and the decisions are expected sometime this summer. In both matters, the court is expected to flesh out the meaning of the Health Care Quality Improvement Act of 1986, commonly known as "HCQIA." Based on contemporary press accounts of the parties' oral arguments before the court, however, it is uncertain whether the decisions will strengthen or weaken medical staff peer review. PMID- 10135423 TI - Single-payer health plan on California ballot. PMID- 10135424 TI - Elder choice and health care costs. AB - While strategists struggle with the dilemmas of health care, they seem to overlook a practice that might simultaneously relieve the suffering of elder patients and limit the costs of their treatment. If elder patients were given a clear opportunity to choose, many might reject the costly procedures that keep them breathing in misery during the last weeks, months, and even years of their survival. Other elders who see the clouds of debility approaching might be freed of the dread of endless imprisonment in a nursing home. Empowering elders to make these choices does not require changes in law, but only changes in how we provide and finance care. PMID- 10135425 TI - Grassroots--"The Music of Democracy". PMID- 10135426 TI - One size doesn't fit all. AB - As a company changes in scope and character, so must its information systems. Here is a case of a multitude of risks and gains by a large hospital supplier that was spun off from its parent and decided to convert from the world of a large mainframe computer to networked personal computers. PMID- 10135427 TI - Making EDI work in claims processing. PMID- 10135428 TI - Subacute care: rehab's dilemma. PMID- 10135429 TI - Culture of visible support for staff and customers underlies TQM gains at 302-bed Butler Memorial. PMID- 10135430 TI - Streamline management to reduce costs and strengthen leadership. PMID- 10135431 TI - Bill's revival hour. PMID- 10135432 TI - Measuring and improving community health. PMID- 10135433 TI - A dashboard for community health improvement. PMID- 10135434 TI - Resources and tools ... community health improvement. PMID- 10135435 TI - On health care: start over. PMID- 10135436 TI - Health care reform: 10% legislation and 90% implementation. PMID- 10135437 TI - Policy issues in the health care reform debate. PMID- 10135438 TI - A pragmatic approach to health care reform. PMID- 10135439 TI - Variation in outpatient procedure rates in Canadian teaching hospitals. AB - OBJECTIVE: To determine the variation in the rate at which specific procedures are performed on an outpatient basis in Canadian teaching hospitals. DESIGN: An index of outpatient activity was developed using the ratio of expected-to-actual performance, with the expected performance representing empirical, exogenous criteria. SETTING: Canadian teaching hospitals. RESULTS: The index indicated whether the hospital, or group of hospitals, of interest is equally, more, or less active than the comparison group. The results show that Canadian teaching hospitals were 3% less active than Canadian nonteaching hospitals and Alberta teaching hospitals were 22% less active than all Canadian teaching hospitals. Individual teaching hospitals in Alberta were 21% more, 40% less, 9% less, 44% less, 8% less, 39% less, 20% less, and 2% less active than all other Alberta teaching hospitals. CONCLUSIONS: If variation in the use of less costly treatment modalities represents variation in quality as in Donabedian's unifying model, the results show considerable variation in quality across the generally accepted leaders in the medical care field. By comparing teaching hospitals with other teaching hospitals the difference in the patient severity level is minimized. The decision regarding the delivery modality represents only one decision in the complex decision matrix faced by physicians in the treatment episode. Given the considerable variation demonstrated in this study, the task of developing protocol, standards, or guidelines in order to reduce variation over the total treatment episode will be enormous. PMID- 10135440 TI - Assessment of comorbidity: a review. AB - Eleven clinical comorbidity indices are reviewed with attention to the development of improved assessment of comorbid conditions. Elements that are critical to the indices are reviewed, including their applicability, their inclusiveness, their validation, their correlations with outcomes of interest, their inclusion of functional assessment, their inclusion of severity assessment, and their simplicity. Improved assessment of comorbidity will enable better understanding of the processes and outcomes of medical care. PMID- 10135441 TI - Assistive algorithms for exposure management--Part II: Mycobacterium tuberculosis, meningococcemia, and measles. PMID- 10135442 TI - Quality health care--what does it mean and how will we know it? The Geisinger Medical Center and Health Plan. PMID- 10135443 TI - Does health care reform require killing managed competition? PMID- 10135444 TI - Managing for performance at Kaiser: health analytics or organization design? PMID- 10135445 TI - Getting out of the box: the role of leadership. AB - I have explained two models. The first describes moving out of the current box into an area which may enable superior performance. It is here we can achieve new competitive advantage and build competitive position. The second model suggests ideas for implementing organizational change. For organizational leaders, only one thing is certain: change will happen. Executives should examine situations in which changes were attempted but failed to succeed. Were business process changes made without making the necessary management process changes or vice versa? Alone, neither one will unlock the business box. PMID- 10135446 TI - Quality: are you sure you know what it means? PMID- 10135447 TI - The iron triangle of health care reform. PMID- 10135448 TI - Medicare program; participation in CHAMPUS and CHAMPVA, hospital admissions for veterans, discharge rights notice, and hospital responsibility for emergency care -HCFA and OIG. Interim final rule with comment period. AB - We are revising requirements for Medicare participating hospitals by adding the following: A hospital must provide inpatient hospital services to individuals who have health coverage provided by either the Civilian Health and Medical Program of the Uniformed Services (CHAMPUS) or the Civilian Health and Medical Program of the Veterans Administration (CHAMPVA), subject to limitations provided by regulations that require the hospital to collect the beneficiary's cost-share and accept payment from the CHAMPUS/CHAMPVA programs as payment in full. A hospital must provide inpatient hospital services to military veterans (subject to the limitations provided in 38 CFR 17.50 ff.) and accept payment from the Department of Veterans Affairs as payment in full. A hospital must give each Medicare beneficiary (or his or her representative) at or about the time of admission, a written statement of his or her rights concerning discharge from the hospital. A hospital (including a rural primary care hospital) with an emergency department must provide, upon request and within the capabilities of the hospital or rural primary care hospital, an appropriate medical screening examination, stabilizing treatment and/or an appropriate transfer to another medical facility to any individual with an emergency medical condition, regardless of the individual's eligibility for Medicare. The statute provides for the termination of a provider's agreement for violation of any of these provisions. These revisions implement sections 9121 and 9122 of the Consolidated Omnibus Budget Reconciliation Act of 1985 (as amended by section 4009 of the Omnibus Budget Reconciliation Act of 1987), section 233 of the Veteran's Benefit Improvement and Health Care Authorization Act of 1986, sections 9305(b)(1) and 9307 of the Omnibus Budget Reconciliation Act of 1986, sections 6003(g)(3)(D)(xiv), 6018 and 6211 of the Omnibus Budget Reconciliation Act of 1989, and sections 4008(b), 4027(a), and 4027(k)(3) of the Omnibus Budget Reconciliation Act of 1990. PMID- 10135449 TI - Critical pathways produce tangible results. PMID- 10135450 TI - Questionnaire design workshop helps market researchers build better surveys. PMID- 10135451 TI - Hospital uses cardiac outcomes data to alter physician practice patterns. PMID- 10135452 TI - Hospitals using mapping data to plan network coverage. PMID- 10135453 TI - Thorough system integration results in better financial performance. PMID- 10135454 TI - Total cost management on the horizon for providers, MCOs. PMID- 10135455 TI - Patient databases reveal crucial information about potential network partners. PMID- 10135456 TI - Mandatory reporting of sexual abuse under the Regulated Health Professions Act. PMID- 10135457 TI - Potential legal liability in the allocation of scarce health care resources. PMID- 10135459 TI - Clinical staffing patterns. AB - When choosing a method of calculating clinical staffing, you should evaluate several models and collect data to determine what your current staffing pattern is providing. You should also evaluate your service performance to determine whether you are doing the correct tasks. If you have the data to compare your staffing to your facility standards of care and several other comparable facilities, you will have a greater confidence level when you report that your staffing is based on requirements for efficient services to meet your patient needs. PMID- 10135458 TI - Making competition in health care work. AB - Health care reform in the United States is on a collision course with economic reality. Most proposals focus on measures that will produce one-time cost savings by eliminating waste and inefficiency. But the right question to ask is how to achieve dramatic and sustained cost reductions over time. What will it take to foster entirely new approaches to disease prevention and treatment, whole new ways to deliver services, and more cost-effective facilities? The answer lies in the powerful lessons business has learned over the past two decades about the imperatives of competition. In industry after industry, the underlying dynamic is the same: competition compels companies to deliver constantly increasing value to customers. The fundamental driver of this continuous quality improvement and cost reduction is innovation. Without incentives to sustain innovation in health care, short-term cost savings will soon be overwhelmed by the desire to widen access, the growing health needs of an aging population, and the unwillingness of Americans to settle for anything less than the best treatments available. The misguided assumption underlying much of the debate about health care is that technology is the enemy. By assuming that technology drives up costs, reformers neglect the central importance of innovation or, worse yet, attempt to slow its pace. In fact, innovation, driven by rigorous competition, is the key to successful reform. PMID- 10135460 TI - Too much inventory? How do you know? AB - How much inventory does a company need to support its business goals? Companies must consider what effect their inventory investment decisions have on the strategic direction of their business. Too often, a company's investment decisions are carried out not by the company's strategists, but by individuals who are unaware of the strategic direction of the business. PMID- 10135461 TI - What materiel people need to know about quality. AB - W. Edwards Deming has said that "Price without a measure of quality has no meaning." Materiel people must become intimate with the quality needs of their organization and ask their suppliers for that quality and insist on appropriate measures to ensure that quality. The burden of proof of goodness must be on the supplier. PMID- 10135462 TI - MRP II (material requirements planning): one year later. AB - This article addresses the continued need for the behavior change process that must be managed long after materiel requirements planning (MRP II) implementation. Mason & Hanger, Pantex Plant is the final assembly and dismantlement facility for all United States nuclear weapons. On October 1, 1990, Mason & Hanger implemented a full production cutover to MRP II. One year later, following class A certification, the MRP II implementation team is still actively managing the change process through education and training programs and overall continuous improvement initiatives. Actual behavior change problems are identified together with the proven solutions implemented in a government-owned, contractor-operated facility environment. Performance measurements ranging from senior management planning to shop floor accomplishments and cost variance reports are shown as normal management tools used to identify target improvement areas. PMID- 10135463 TI - No excuses: forecasting can be managed. AB - Originally written for manufacturers, the forecasting concepts presented in this article are easily applied to a hospital or health care facility with a supply function or central distribution center. Forecasting can offer a method of managing the control of medical supplies, pharmaceuticals, or maintenance items. A statistical based forecasting approach with seasonality testing could be useful in analyzing patient census data, calculating trends, and then recommending staffing levels. Cost containment and efficiency of operations are priorities in any industry. Forecasting the demand of medical supplies and services in today's hectic health care environment can have a significant effect on both customer service and financial results. The bottom line is happy patients and healthy profits. PMID- 10135464 TI - How "the best" companies use MRP (materiel requirements planning) and just-in time for successful manufacturing. AB - A study of production planning and control methods used in six leading companies found that a blending strategy is more effective than reliance on a single system. The blending of just-in-time and materiel requirements planning and other approaches allowed companies to select methods that best fit the unique characteristics of their production environments. PMID- 10135465 TI - From chaos to control: winning the war. AB - This article illustrates how a small manufacturing facility in the Midwest undertook the process of an MRP II implementation and ultimately gained class A status at a true make-or-break time in its history. The control that was gained throughout the entire process has helped create a winning environment and will continue to strengthen our position as we move toward world-class excellence. PMID- 10135466 TI - How to reduce your inventory: a real world case study. AB - This case study describes the use of a performance analysis system at the Safety Products Division of Mine Safety Appliances Company, which contributed to the reduction of excess inventories by more than $8,000,000 during the first two years of implementation. PMID- 10135467 TI - Sales and marketing's partnership role in class A MRP II (material requirements planning). AB - As the material and requirements planning (MRP) II process has evolved, many companies have discovered that the process is greatly enhanced when the entire business participates. The sales and operations planning process is the forum for the businesswide decisions concerning sales, production, and inventory. Sales and marketing must be integral parts of these decision-making activities. PMID- 10135468 TI - Against all odds! You still can upgrade and reimplement an MRP II (material requirements planning) system. AB - This article illustrates the three key elements necessary when reimplementing a closed-loop manufacturing system. The first is to accept the paradigm of people's fear of being changed. The second is to devise a methodological process to define the overall tasks, identify roles, and determine an organized approach. The third is to involve and receive commitment of all players to ensure that predefined tasks are completed on schedule. PMID- 10135469 TI - The great American turnaround through teamwork visioning. AB - Product and process quality are no longer sufficient to ensure operational excellence, regardless of enterprise. Quality is now a given with latent customer satisfaction the mission. Breakthrough excellence will occur only when individual attitude and behavior toward customer sensitivity and satisfaction become an obsession, a way of team life. PMID- 10135470 TI - Taking care of the customer. AB - Taking care of the customer while running an efficient manufacturing operation is a challenge. This article describes the success one contract manufacturer had in developing a customer service department to manage a growing and diverse customer base. Balancing customer and plant requirements during a period of organizational change is discussed. PMID- 10135471 TI - Controlling inventory performance in a just-in-time environment. AB - This article will enable the reader to: 1) discover how to implement a cycle counting system to ensure inventory accuracy, 2) learn how to modify a cycle counting system to be successful in a point-of-use/backflush system, and 3) discuss the roles of production, materiel, engineering, and quality in a successful just-in-time cycle counting system. PMID- 10135472 TI - The next strategic weapon: continuous replenishment planning. AB - In this age of rapid technology change, we are searching for that strategic weapon to have in our arsenal that will help us maintain our competitiveness. This article will show how continuous replenishment planning, with the recent developments in communication technology, has enabled two companies to concentrate on the strategic issues of business partnering. PMID- 10135473 TI - Management consultancy. Consultants under fire. PMID- 10135474 TI - Management consultancy. PR: beyond the slick image. PMID- 10135475 TI - HSJ product profile--the definitive buyers guide for health service managers. Product news. PMID- 10135476 TI - Management consultancy. The outsiders. PMID- 10135477 TI - Management development. How to be top. PMID- 10135478 TI - US healthcare. A star-spangled system. PMID- 10135479 TI - Quality. Roads to recovery. PMID- 10135480 TI - Public health. Down the drain? PMID- 10135481 TI - Prostate cancer: new hope, new controversy. PMID- 10135482 TI - Technology monitoring. PMID- 10135483 TI - Childhood diseases. They're not child's play. PMID- 10135484 TI - AED (automatic external defibrillators) algorithms. The "shocking" truth. AB - Automatic external defibrillators (AEDs) have proven to be successful tools against sudden cardiac death since the 1970s. They operate on a simple premise- using a device with a built-in algorithm in a computer chip to "read" a persons's electrocardiogram (ECG) and, if necessary, advise or deliver a shock to bring the person back to a normal rhythm. When first introduced, these devices used various methods of collecting ECG's and detecting ventricular fibrillation (v fib) and ventricular tachycardia (v tach), two treatable dysrhythmias. PMID- 10135485 TI - Pursuing performance. New specs for ambulances and fleet managers. AB - It seems so easy. A call comes in, you get in the ambulance, strap on the seatbelt and turn the key. But there's much more that goes into building the hunk of metal you're sitting in. Each part must meet a design or performance specification. But who sets up these specifications and why? Is it all geared to help you get your patient to the hospital quickly but safely? And what challenges await the maintenance person who must keep that hunk of metal running--and running well? This article will answer some of those questions, but we hope it prompts you to ask even more. PMID- 10135486 TI - Crisis and opportunity. PMID- 10135487 TI - The research scorecard. PMID- 10135488 TI - Cost analysis of three low-temperature sterilization systems at Saint Barnabas Medical Center. AB - To avoid the heavily increasing costs of ethylene oxide, and with the imminent demise of 88/12 EtO at the same time that heat-sensitive endoscope use was on the rise, Saint Barnabas Medical Center in Livingston, NJ was urgently interested in choosing among low-temperature sterilization alternatives currently available. They decided to compare the costs of 100% EtO with the 88/12 system and a new, low-temperature hydrogen peroxide gas plasma system (HPGP) called STERRAD. The HPGP system proved to be less expensive overall than either EtO system due to quicker total cycle times, lower utility use and virtually no regulatory compliance issues. The hospital was also satisfied that the system effectively sterilized the items on which it was used. PMID- 10135489 TI - A novel test model for routine microbiological control of automated washer/disinfectors for flexible endoscopes. AB - Concerns exist about effective methods for endoscope cleaning, disinfection and sterilization. The aim of this study was to establish a model for controlling the function of automatic washer/disinfectors for flexible endoscopes under routine conditions. The team developed a dummy endoscope channel system representing two complete gastroscopes and a colonoscope, with channels joined together and fitted with adaptors to allow the models to fit into different washer/disinfectors. The models were artificially contaminated with various combinations of four test organisms and coagulating blood and run through test cycles in different washer/disinfectors. A total of 24 test runs were performed. The reduction of a given microbial burden by at least five log steps is an established measure of efficacy of a decontamination procedure. When the two challenge tests (45 channels) and the six positive controls are excluded, only 13/309 channels (4.2%) failed the proof of efficacy. In contrast, the failure rate in the challenge test was 65.3%. The difference of the final bioburden is statistically significant. The data suggest this test model could be regarded as a first step in rational and reliable biological control of flexible endoscope reprocessing. PMID- 10135491 TI - Change and quality. AB - In the culture of most healthcare organizations, change is described by anecdotes or represented by new structures such as buildings. Change in the systems and processes that enable work in healthcare organizations often goes unmeasured and underreported. PMID- 10135490 TI - Sterilization containers. ECRI. PMID- 10135492 TI - Developing a procedure tray system. PMID- 10135493 TI - An internal marketing approach to total service quality: a guide for practitioners. AB - For many organizations, the emphasis today is the development of total service quality. To achieve these goals, organizations must not only apply the marketing concept to external targets, but also plan and control internal facets of their operations. The purpose of the present article is to develop the rationale for Total Service Quality (TSQ) based on an Internal Marketing Approach (IMA) as well as to posit the steps necessary to implement an IMA. PMID- 10135494 TI - Marketing mental health care in the 1990s. PMID- 10135495 TI - Just-in-time: implications for the hospital industry. AB - The Just-In-Time system is an operations technique that was developed in Japan and became a growing trend in U.S. industry. JIT applications are relatively new to the hospital industry. Entry into a JIT arrangement requires a good deal of forethought and planning prior to implementation. Hospitals, in order to profitably implement JIT, must commit to a limited number of suppliers, share "vital" information about their operations, and importantly, remove functions they are presently performing as the supplier provides additional services. Introducing JIT in hospital operations involves more than simple edicts from management. If implemented correctly, it has the ability to slash costs, increase productivity levels, utilization of equipments, reduce the need for certain indirect labor, such as material handlers and increase profits. PMID- 10135496 TI - Physician promotions: a doctor's perspective. PMID- 10135497 TI - Down home at the hospital. PMID- 10135498 TI - Customer driven ambulatory healthcare services facility design. PMID- 10135499 TI - Sniffle care--in home care for sick children. PMID- 10135500 TI - A modeling approach to hospital location for effective marketing. AB - This paper develops a mixed integer linear programming model for locating health care facilities. The parameters of the objective function of this model are based on factor rating analysis and grid method. Subjective and objective factors representative of the real life situations are incorporated into the model in a unique way permitting a trade-off analysis of certain factors pertinent to the location of hospitals. This results in a unified approach and a single model whose credibility is further enhanced by inclusion of geographical and demographical factors. PMID- 10135501 TI - A multivariate analysis of choice criteria for hospitals. AB - This study determines the choice criteria used by consumers in selecting a hospital and provides information useful to hospital administrators in planning and implementing marketing efforts directed toward potential consumers. The findings suggest that physical plot, previous experience with the hospital, location of hospital, overall cost, and reputation of the hospital were important factors in selecting a hospital. PMID- 10135502 TI - A multidisciplinary approach to value-added medical care. PMID- 10135503 TI - A normative model of hospital marketing decision making. AB - A hospital marketing model is proposed for use as a framework for applying marketing strategy and concepts to hospitals. The cells of the model, primarily summarizing the many decisions of the marketing management process as can be applied to hospitals, are justified by the health care marketing literature. PMID- 10135504 TI - Ethics, profit and patients: when pharmaceutical companies sponsor medical meetings. AB - A series of dynamic changes underway in Washington could transform the manner in which physicians learn of new pharmaceutical therapies. The potential impact of these changes is likely to significantly affect the manner in which physicians learn about and prescribe medications for years to come; the ultimate effect on patient care has yet to be measured, however. PMID- 10135506 TI - HealthTrust adds one hospital, sheds two. PMID- 10135505 TI - Marketing strategy determinants in rural hospitals. AB - Rural hospitals confront an inauspicious environment due to changes in patient reimbursement and medical practice. Facing a situation of declining revenues, marketing presents an option for rural hospitals to adapt to the growing constraints. This paper analyzes the determinants of marketing strategy emphasis in rural hospitals. The conceptual model adopted in this study predicts that prior performance and contextual variables explain marketing strategy emphasis. The relationships are examined in a case study of rural New Mexico hospitals. Results suggest that prior performance and several contextual variables explain variations in marketing strategy emphasis. In particular, higher gross patient revenues are associated with more emphasis on television and radio advertising. Furthermore, rural New Mexico hospitals with high numbers of licensed beds and medical staff members, or that are affiliated with a chain organization, place greater emphasis on market research and market planning. The implications for marketing practice in rural hospitals are discussed. PMID- 10135507 TI - Pa. insurer to buy M.D. group. PMID- 10135508 TI - Panel weighs entitlement cuts. PMID- 10135509 TI - 4th qtr. losses for Continental. PMID- 10135510 TI - Managed care changing Dallas market. PMID- 10135511 TI - FTC requests more data from MCA, Columbia/HCA. PMID- 10135512 TI - Third hospital to join Iowa's largest system. PMID- 10135513 TI - Hawaii systems conclude talks. PMID- 10135514 TI - N.Y. teaching hospitals may link. PMID- 10135515 TI - First week of Senate debate fails to diminish reform chaos. PMID- 10135516 TI - Quorum contract raises ruckus in Ohio county. PMID- 10135517 TI - New service to screen integration consultants. PMID- 10135518 TI - Senate panel blasts Blues. PMID- 10135519 TI - Minorities institute lands sponsors. PMID- 10135520 TI - 'Comforting' designs urged. PMID- 10135521 TI - Congress urged to lift cap on bonds. PMID- 10135522 TI - Earthquake measures debated in Calif. PMID- 10135523 TI - Nurse shortages needn't be inevitable. PMID- 10135524 TI - Acquisitions tip scales. PMID- 10135525 TI - Alaska hospital loses a round in nursing dispute. PMID- 10135526 TI - Bond disclosure guidelines adopted. PMID- 10135527 TI - AdvaCare rejects deal, signs Medaphis pact. PMID- 10135528 TI - Caremark acquires major network. PMID- 10135529 TI - Provider 1994 LTC buyer's guide. The directory of long term care products & services. PMID- 10135530 TI - Smoke, mirrors, and subchapter S. PMID- 10135531 TI - Caring for the younger resident. PMID- 10135532 TI - Breaking the barriers to restraint reduction. PMID- 10135533 TI - Transfer and discharge dilemmas. PMID- 10135534 TI - Stopping sexual harassment. PMID- 10135535 TI - Nurse management 2000. PMID- 10135536 TI - LTC's new ventures. PMID- 10135537 TI - Subacute care. Signing on the dotted line. PMID- 10135538 TI - Residential living. One-stop shopping. PMID- 10135539 TI - Can a voucher system work? Pro. PMID- 10135540 TI - Can a voucher system Work? Con. PMID- 10135541 TI - Is the public ready to decide? PMID- 10135542 TI - Why single payer is still our best bet. PMID- 10135543 TI - Building community involvement in health care. PMID- 10135544 TI - Self-help and the new health agenda. PMID- 10135545 TI - Alternative health movements. PMID- 10135546 TI - Why violence is a health-care priority. PMID- 10135547 TI - If our government really cared about health. PMID- 10135548 TI - Perspectives. Business retreats on comprehensive health reform. PMID- 10135549 TI - Basics of salary negotiation. PMID- 10135550 TI - MTs: past, present, and future. PMID- 10135551 TI - Is medical transcription sexist? PMID- 10135552 TI - Healthcare Privacy Protection Act. PMID- 10135553 TI - Health reform update. PMID- 10135554 TI - New developments in International Classification of Diseases. PMID- 10135555 TI - The basics of EDI (electronic data interchange): a pathway to the information highway. AB - With EDI, patients such as Jane Russo can focus not on the time-consuming and often confusing business of benefit coordination, but on getting well. Similarly, the registration clerk's job is simplified thanks to a single electronic link that provides the information needed to perform his or her job accurately and efficiently. The health information management department can use EDI to maintain authority over the release of information and make the process of transferring patient information more expeditious. As EDI further evolves into the clinical arena, it will enhance care providers' access to longitudinal patient clinical records. In addition, the information highway will provide access to better information for quality assessment, outcomes management, and the development of clinical guidelines. With access to the information highway, healthcare providers, payers, and employers can take an evolutionary leap in their efforts toward coordinating truly patient-centered, high-quality care. PMID- 10135556 TI - The information highway to a healthcare Utopia: dream or possibility? PMID- 10135557 TI - The electronic information highway ... how do we get there and who wants to drive? PMID- 10135558 TI - Telemedicine and CHINs (Community Health Information Networks): interviews with two experts. Interview by Tanya Freeman and Barbara Southern. PMID- 10135559 TI - Looking ahead to the year 2010: future applications of the electronic information highway. PMID- 10135560 TI - An organizational model for data access and management--work in progress. PMID- 10135561 TI - Creating original HIM Week celebrations. PMID- 10135563 TI - Everything is sweetened by risk. PMID- 10135562 TI - What will we be? PMID- 10135564 TI - Versatility buoys HIM professionals during healthcare change. PMID- 10135565 TI - Surfin' the 'Net: a health information management tour of cyberspace, Part I. PMID- 10135566 TI - Urges standardized transcription units. PMID- 10135567 TI - Who owns the patient anyway? PMID- 10135568 TI - Data watch. What they're saying about health reform. Results from B&H's health reform survey. PMID- 10135569 TI - The power of education. PMID- 10135570 TI - Paying more for less. The B&H surveys health reform. Part 1. PMID- 10135571 TI - Reform. What will emerge? PMID- 10135572 TI - With health care, is bigger better? PMID- 10135573 TI - Waiting for Uncle Sam. PMID- 10135574 TI - When plan summaries are inadequate. PMID- 10135575 TI - The trouble with carve outs. PMID- 10135576 TI - "East meets West". AB - For most of the 70s and 80s, the East was considered to be the center of hospital rate regulation and the West the center for free-market competition. Managed care in the East was "home grown" and large, national public companies generally stayed away from these markets. But, in a fascinating shift amid a great deal of turbulence, the East is starting to look at lot like the West. Economics are driving reforms and the best move for lawmakers is to stay out of the way. The train has already left the station. Perhaps the most frightening thing about the most recent Group Health Association data is that the President comes from a state with less than 3% HMO penetration. Many of his trusted advisors come from that state, including physicians who report on the home front. PMID- 10135577 TI - Battlefield New Jersey. AB - Although hard-nosed in its impact on New Jersey providers, the Blues strategy in this state is very coherent. Sure, there was a strong reaction from physicians and hospitals and a lot of emotionalism. But here we have a good example of a decisive insurer leveraging a dominant market position. Perhaps a year from now we'll see whether any of the recent provider organizing attempts have been successful in countering the Blues. The April 1993 decision by BCBSNJ to eliminate a third of its contract hospitals and physicians was the catalyst for transforming this state. The organizing attempts of physicians and hospitals catalyzed BCBS to enter the delivery side. But, its possible that the information network venture could bring these waring parties back together. Who knows at this point? The key to success of any strategy is how well it is implemented. PMID- 10135578 TI - "Hot" markets. PMID- 10135579 TI - Creativity and quality. AB - Edward de Bono's work helped shatter the theory that creativity is a talent possessed only by a gifted few who can see beyond current paradigms. His seminal work in The Mechanism of the Mind and later in Lateral Thinking established the theory that creativity is a skill that can be developed and enhanced through structured training and teaching. The editors of QMHC invited Dr. de Bono to share his thoughts on the relationship between creativity and quality. In this essay, he presents his views on possible limitations of traditional quality improvement thinking and demonstrates the importance that creativity plays in enhancing quality improvement efforts. PMID- 10135580 TI - Reengineering the organization: an approach for discontinuous change. AB - Improvement will be constrained by the function-based organizational model found in most health care organizations. Most components of the typical organization are driven by the concept of division of labor. The organization needs to challenge the underlying assumptions and reengineer from top to bottom. Reengineering, a disciplined approach to breakthrough change, is complementary to continuous improvement but has several major differences. This article explores the need for reengineering, the essential components of reengineering, how it relates to other approaches to change, ideas on when reengineering is necessary, and the challenges related to reengineering an organization. PMID- 10135581 TI - Influencing physician behavior with CQI: a case study. AB - Health care reform will require unprecedented levels of cooperation among physicians, health care administrators, and other providers in order to ensure high-quality, affordable care for all. At the University of Massachusetts Medical Center, CQI techniques helped engage physicians in an effort to substantially alter ordering patterns to cut costs and achieve quality goals. PMID- 10135582 TI - Creating a culture of innovation and quality at 3M. AB - Through over 90 years of trial and error, 3M has developed a culture that effectively supports both quality and innovation. This article discusses some of the historical events that helped form this culture; the relationship between innovation and continuous quality improvement; and some of the philosophies, practices, and policies that provide for the day-to-day care and feeding of the innovator at 3M. PMID- 10135583 TI - Eastman Kodak Company's experience with TQM in hospitals. AB - Many companies in American industry have been practicing the methods of total quality management (TQM) for over a decade. Some of these companies are providers of health care products. Health care businesses, particularly hospitals, can benefit from their supplier relationships by learning what their vendors know about the principles and techniques of TQM. This article explores what one such supplier, the Eastman Kodak Company, has learned about implementing TQM for fast and meaningful results, using the lessons from its own experience and from consulting with some of its customer hospitals. PMID- 10135584 TI - Using empowerment to make quality work in health care. AB - Is TQM dead in health care? If it is alive and well, what role does quality improvement play in managing the changes that come with health care reform? William Byham and Greg Nelson begin this article by presenting results from a recent international study on TQM, outlining factors common to successful and unsuccessful quality initiatives. The key to success? Organizations must improve how people work as much as what they do in their work, and that means empowering people to improve processes. Easier said than done, say Byham and Nelson. Empowerment requires culture change and training. People first need the right environment to work differently, then the skills, knowledge, and techniques to participate in and influence the quality process. PMID- 10135585 TI - Creating, improving, and innovating. AB - Technological innovations have fundamentally changed the science and practice of medicine. Increased awareness of the need to enhance processes and systems supporting delivery of safe, accessible, affordable health care has sparked an interest in creativity and innovation as essential skills in quality management. This article considers four points regarding the role of creativity and innovation in health care quality management: Creativity and innovation are essential skills in improving and enhancing health care processes and health care delivery systems; creativity is a personal characteristic that can be enhanced; innovation, the legacy of creativity, begins with values-centered design; and innovations emerge in many sizes and forms. PMID- 10135586 TI - Tutorial: directed creativity. AB - While we recognize the need for creative approaches to nagging problems and new opportunities, generating practical new ideas is often a challenge. Many people have convinced themselves that they are simply not creative thinkers; they can only marvel at those who seem to possess "the gift." However, research over the last few decades in the field of cognitive science has indicated that the capacity for creative thought is a basic mental ability that we all possess. We will review these new theories about creativity and discuss actions that we can take to direct our thoughts towards novel ends. PMID- 10135587 TI - QMHC interview: Karl Albrecht. Interview by Marie E. Sinioris. AB - For over a decade, Karl Albrecht has helped health care and other organizations focus on creating superior value for customers. In his books Service America! and The Only Thing That Matters, he developed a model of organizational improvement called Total Quality Service that is tailored to service organizations. One of the principles underlying this model is that service industries are fundamentally different from manufacturing industries. Thus, the approach to quality improvement in services should not be based on a manufacturing mentality. QMHC interviewed Karl Albrecht to catch up with his latest thinking on value creation, leadership, and innovation in health care and elsewhere. PMID- 10135588 TI - The health promoter and the enchanted castle. PMID- 10135589 TI - Bad faith and victim-blaming: the limits of health promotion. AB - Two models of the relationship between individual behaviour and health status are examined. On the Freedom Model, the individual is presumed to be capable of free choices including many that have important health consequences. Freedom entails accountability. Thus individuals can be held responsible for health conditions that result from choices they have made. To hold otherwise--to refuse to acknowledge the freedom and responsibilities of individuals--is bad faith. On the Facticity Model, behaviour is a result of facts--genetic and environmental- beyond an individual's control. There is little or no freedom; people are the bodies and roles they inherit. Important among these facts is socio-economic position since it determines much of behaviour and resulting health status. Many people who are poor and lack education also suffer from poor health. To blame their poor health on their behaviour is to blame people already victimized by their circumstances. The relationships of these two models to health promotion are explored. Though conflicting in theory, some justice can be done to each model in the practical world of health promotion by appealing to the freedom in individuals in health education and to the facts that shape individuals in other health promotion and health care contexts. PMID- 10135590 TI - On the nature and ethics of health promotion. An attempt at a systematic analysis. AB - This paper attempts to analyse the notion of health promotion and related conceptual issues within an action-theoretical framework. The purpose is both theoretical and ethical. The paper provides a taxonomy as well as a system for classifying various types of health promotion. This system is inspired by Professor G H von Wright's theory of action explanation. The theoretical framework is used in the ethical part of the paper where some major ethical dilemmas in health promotion are analysed. Particular attention is paid to the use of manipulation and force in health promotion. An attempt is made to define when such measures are justified in various health enhancing contexts. PMID- 10135591 TI - Visibility and the just allocation of health care: a study of age-rationing in the British National Health Service. AB - The British National Health Service (BNHS) was founded, to quote Minister of Health Aneurin Bevan, to 'universalize the best'. Over time, however, financial constraints forced the BNHS to turn to incrementalist budgeting, to rationalize care and to ask its practitioners to act as gatekeepers. Seeking a way to ration scarce tertiary care resources, BNHS gatekeepers began to use chronological age as a rationing criterion. Age-rationing became the 'done thing' without explicit policy directives and in a manner largely invisible to patients, to Parliament, and to the public. The invisibility of the practice, however, violates the publicity principle that John Rawls and other philosophers believe essential to fairness. BNHS invisible age-rationing practices are thus a test case of the principle that fairness presupposes publicity; they raise the question: is it possible to preserve equitability in a system that uses non-public criteria to allocate scarce resources? To seek an answer, published data on access to end stage renal disease (ESRD) treatment in Britain and the European Community (EC) are analysed. Among the findings are: that BNHS age-rationing acts as an excuse for denying care to those most likely to need ESRD treatment; and is, moreover, arbitrary and inequitable. It is further argued that no age-rationing policy can sustain visibility, and that, if the BNHS is to be fair to its patients, it must reform its present age-rationing practices, replacing them by a publicly visible, outcome-based rationing policy that rations either in terms of QALYs or triage categories. PMID- 10135592 TI - Ageism in British renal units: a view from inside the system. PMID- 10135593 TI - Rationing by age: a short philosophical comment. PMID- 10135594 TI - Bioethical blind spots: four flaws in the field of view of traditional bioethics. AB - In this paper it is argued that bioethics has tended to emphasise: 'high tech' areas of medicine at the expense of 'low tech' areas such as psychiatry; problems arising in treatment at the expense of those associated with diagnosis; questions of fact at the expense of questions of value; and applied ethics at the expense of philosophical theory. The common factor linking these four 'bioethical blind spots' is a failure to recognise the full extent to which medicine is an ethical as well as scientific discipline. Once this is acknowledged it leads to a full field bioethics in which the different areas are mutually complementary. In particular, it paves the way for a fruitful two-way exchange between the more abstract aspects of philosophical theory and the contingencies of day-to-day clinical work. The arguments of the paper are illustrated with recent work on the abuse of psychiatry. PMID- 10135595 TI - Bioethical blind spots: a brief commentary. PMID- 10135596 TI - The strange quest for the health gain. PMID- 10135597 TI - Health care rationing and the courts. PMID- 10135598 TI - Nursing feature: in defence of the medical model. PMID- 10135599 TI - Targeting health gain--new horizons for health promotion. PMID- 10135600 TI - Costly health care: a lesson from New Zealand. PMID- 10135601 TI - Why health economics is economical with the truth. PMID- 10135602 TI - Open letter to the nursing profession ... personnel staffing. PMID- 10135603 TI - Health promotion ethics: a practical necessity. PMID- 10135604 TI - Methods of determining the prevalence of changes in vital signs among internal medicine inpatients. AB - OBJECTIVE: To investigate the prevalence of changes in vital signs and methods of summarizing these changes. DESIGN: A survey of vital sign values for all eligible inpatients over a three-day period. PATIENTS: All 91 patients who remained for an entire three-day period in January 1991 on 1 of 11 nonintensive care internal medicine units in the medical center. RESULTS: Prevalence of changing vital signs varied by type of vital sign, inpatient unit, and method of computation. A method of computation that relies on daily extreme vital sign values. Pulse rates and blood pressure were more variable than respiratory rates. CONCLUSIONS: Mean daily pulse rates and blood pressure may be useful for quality assessment purposes, whereas individual readings may be more appropriate for respiratory rates. Computation of expected rates of changing vital signs should be tailored to inpatient unit type. PMID- 10135605 TI - Use of severity-adjusted length of stay to modify physician practice patterns. AB - OBJECTIVE: To compare inpatient length of stay among physicians by testing a new method for severity adjusting length of stay. DESIGN: A retrospective validation study with prospective follow-up after an intervention. SETTING: A 531-bed community teaching hospital. PATIENTS: Three hundred randomly selected patients from the 30,861 patients discharged in 1990. INTERVENTION: A physician with a significantly prolonged severity-adjusted length of stay was counseled and then monitored for three months. RESULTS: The correlation between the number of comorbidities, complications, and manifestations of disease processes (CCMDPs) was R2 = 0.658, t = 23.96 (p = .001). One physician had an unusually high severity-adjusted length of stay, but lowered it after he was counseled and monitored for three months. CONCLUSIONS: The number of CCMDPs recorded on the hospital discharge abstract can be used as a severity index to adjust a patient's length of stay for illness severity. Using linear regression analysis, a picture of the severity-adjusted length of stay can be derived for physicians. Through counseling and monitoring, individual physicians' lengths of stay patterns may be reduced. PMID- 10135607 TI - Beyond total quality management. PMID- 10135606 TI - The role of the Maternal and Child Health Handbook system in reducing perinatal mortality in Japan. AB - OBJECTIVE: The purpose of this paper is to demonstrate the direct and indirect roles of the Maternal and Child Health (MCH) Handbook in promoting overall improvement in maternal health and child care and to attempt to clarify the relationship between the use of the MCH Handbook and the reduced perinatal mortality in Japan. Another important objective is to propose possible future applications of the MCH Handbook, especially with respect to the networking function of providing client-care provider feedback, and the exchange of health data between the authorities and relevant medical societies. RESULTS: Japan has achieved a decline in neonatal mortality in the 30-year period from 1960 to 1990, from 17.0 to 2.6 per 1,000 live births. There is a correlation between the ratio of the number of Handbooks distributed and the actual number of births and the perinatal mortality. CONCLUSIONS: The wide use of the MCH Handbook system seems to have played an important role in bringing about this reduction and in maintaining the figure as one of the lowest in the world. The reduction of perinatal mortality through the use of the MCH Handbook in this country suggests a similar possibility for application in other nations. The Handbook could aid in the early recognition of high-risk pregnancy and thus reduce inappropriate use of medical resources. The system, with the establishment of a feedback system between the client and the authorities via the care provider, may improve health care in such areas as maternal mortality, toxemia of pregnancy, and diabetes mellitus. PMID- 10135608 TI - Quality of medical care in Latin America: do it yourself versus caveat emptor. Is there really a choice? PMID- 10135609 TI - A spoken alliance. PMID- 10135610 TI - Quality: an improvement tool for the 21st century. PMID- 10135611 TI - Continuity and change in the quest for quality. PMID- 10135612 TI - Quality assurance is dead--long live quality improvement! (Or is it?). PMID- 10135613 TI - Monitoring the quality of health services. PMID- 10135614 TI - Continuous quality improvement: much-needed scrutiny. PMID- 10135615 TI - Hospital-based continuous quality improvement: a realistic appraisal. AB - OBJECTIVE: To evaluate the impact of a continuous quality improvement (CQI) multidisciplinary team process on emergency department admission times. DESIGN: Prospective observational intervention study. SETTING: A 349-bed tertiary care, university-affiliated, pediatric teaching hospital. RESULTS: The time from triage to departure from the emergency department (T1-T3) was reduced by 71 minutes, and the time from the decision to admit to departure from the emergency department (T2-T3) by 38 minutes following the planned interventions. There was no correlation between admission times and hospital inpatient census, number of emergency department admissions on a given day, or work shift. Medical patients were transferred to the wards more slowly than patients admitted by the general surgery service and several specialty surgical services once the decision to admit had been reached. No major adverse clinical outcomes could be attributed to expedited admissions. Physicians and nurses in the emergency department expressed improved satisfaction with the admissions process, while houseofficers on the wards were less satisfied. Parental satisfaction with the speed of admissions remained suboptimal. Additional potential problems with the application of CQI principles in an academic setting were identified. CONCLUSIONS: Although CQI is a promising approach to certain quality problems, a number of issues remain to be explored before full-scale implementation in academic centers can be endorsed. PMID- 10135616 TI - Epidemiology of bone fractures occurring during hospitalization. AB - OBJECTIVE: To investigate the incidence and epidemiology of nosocomial bone fractures. DESIGN: Observational, case series. SETTING: Tertiary care center. PATIENTS: All patients sustaining a fracture during hospitalization during the 18 month study period from July 1989 through December 1990. RESULTS: Twenty nosocomial fractures were identified. Twelve of these resulted from falls (3.5 fractures from falls/100,000 patient days). Fracture rates were higher on the neurology service than on other services. Patients who fell and sustained a fracture were significantly older than patients who fell but did not sustain a fracture (74 versus 58 years, respectively, p < .05). Falls occurring on weekends and holidays were approximately three times more likely to result in fracture than falls occurring on other days (p = .06). CONCLUSIONS: Nosocomial fractures were infrequent events but were more common in the elderly and in persons with significant neuropsychological impairment. Persons who sustained fractures during hospitalization were similar to those who fell and fractured bones in a community setting. PMID- 10135617 TI - Quality health care--what does it mean and how will we know it? The Lovelace Medical Center and Health Plan. PMID- 10135618 TI - Health care reform and quality. PMID- 10135619 TI - Focus on Japan: the myth of Japan's health care model. PMID- 10135620 TI - Focus on Japan: health care quality in Japan--the pros and cons. PMID- 10135621 TI - Bringing theory into practice--applying improvement thinking: Part I. PMID- 10135622 TI - There can be no quality health care where there is no access. PMID- 10135623 TI - Beyond total quality management. PMID- 10135624 TI - Organizational and employee predictors of outcomes of long-stay nursing home residents. AB - OBJECTIVE: Use three types of functional ability as predictors of nursing home patient outcomes. DESIGN: Best-subsets regression analysis. SETTING: 10 nursing homes. RESULTS: Initial functional ability was the most important predictor. Organizational variables such as workload, stress, and morale also explained some of the variance in patient outcomes. Characteristics of organizational structure predicted outcomes as well as employee self-reports and could be substituted for them without substantially reducing the explained variance. CONCLUSION: Future research projects should explore the causal relationship between structure and outcomes. PMID- 10135625 TI - Explaining cost variations in clinical trials using severity of illness measures. AB - OBJECTIVE: To determine the usefulness of severity of illness measures in explaining the variation in costs observed in economic analyses of clinical trials. METHOD: Hospital costs and three severity of illness measures (Medical Illness Severity Grouping System [MedisGroups], Acute Physiology and Chronic Health Evaluation [APACHE] II, APACHE III) were calculated for patients undergoing surgical management of gastrointestinal malignancies. Regression models were developed to determine the predictive ability of the severity of illness measures on total costs and length of stay of surgical patients. RESULTS: There was not a significant reduction in the cost variance among patients after correcting for severity with use of the MedisGroups score. APACHE II scores were a better predictor of total costs, although this relationship did not reach statistical significance. As a continuous variable, APACHE III scores explained $326 of extra cost for each point on the scale, and as a categorical variable, identified those patients who were most expensive to care for and with long lengths of stay. CONCLUSION: Neither MedisGroups nor APACHE II were found to be useful in explaining cost variations in a clinical trial. The APACHE III system was more useful in discriminating resource intensive patients. PMID- 10135626 TI - Quality in anesthesia care: lessons from industry and a proposal for valid measurement and improvement. AB - Quality anesthetic care is a goal fundamental to our tradition and our training, but defining and measuring quality in anesthesia presents special challenges. Industrial models of quality, especially those so fundamental to the re-emergence of post-war Japan, deserve careful study and are discussed at some length, but they clearly have limitations in understanding quality in anesthesiology. We suggest that most current quality efforts are inherently flawed. Whether or not they rigorously attempt to define quality, they are hampered by lack of data concerning outcomes and alternatives, as well as lack of distinction between quality and efficacy. Quality efforts in American medicine and anesthesiology seem mired in a "criterion of potential benefit," which is still central to many of our prescriptions for individual medical care. Current quality improvement efforts do not seem well suited to correct these flaws. Anesthetic care, and that of American medicine in general, is fragmented, enormously costly, and sometimes inappropriate or poor. Anesthesiologists are suspicious of current quality efforts to improve this care. The system often seems more geared to eliminate bad apples than to improve patient care. Because anesthesia is a specialty that facilitates care but seldom "cures," we face greater challenges in studying and defining quality than do other specialties. Because of this, it is imperative that several principles govern future quality improvement efforts in anesthesiology. First, a reasonable balance must be attained between study of outcomes and processes of anesthesia care. Second, anesthesia-specific severity of illness indexing must be developed. Third, and perhaps most important, anesthetic processes and outcomes must be reported on a national level. Fundamental to future quality efforts in our specialty, we believe, is the establishment of a protected National Anesthesia Outcome Registry. This article reviews the industrial and medical history of quality, its measurement and improvement, and attempts to apply principles learned over many decades to anesthesiology. PMID- 10135627 TI - Patient power: an essential ingredient of health care reform. PMID- 10135628 TI - Quality assurance in Germany: state of the art. PMID- 10135629 TI - Bringing theory into practice--applying improvement thinking: Part II. PMID- 10135630 TI - Quality health care--what does it mean and how will we know it? UniHealth America. PMID- 10135631 TI - A case of nosocomial frostbite. PMID- 10135632 TI - Needed: a curriculum in health care quality and resource management for the health professions. PMID- 10135633 TI - Building population data bases: lessons from a community project. AB - Observational data bases that tract patient outcomes and quality of life over long periods of time offer an alternative to traditional randomized clinical trials in assessing treatment effectiveness. This article reviews our experience building an observational database in a community setting. Thirty-eight urologists, radiation therapists, oncologists, and pathologists working at the five major hospitals in Hartford County, Connecticut, established a community based observational data base to quantify the risks and benefits associated with different treatment options for clinically localized prostate cancer. In addition to classic demographic data, the data base includes information concerning patient comorbidities, bowel and bladder function, sexual function, and quality of life captured both before and after medical intervention. Case finding is accomplished via a rapid case ascertainment system. As part of this system, a trained abstractor reviews all the pathology reports generated by each hospital on a weekly basis and forwards reports of prostate biopsies and surgical specimens to the study office within 1 week. Patients with positive prostate biopsies are contacted by a trained nurse registrar to gather additional information using a structured interview. Patient consent for this project is obtained at the time of biopsy in the participating physician's office. To date, biopsy reports have been obtained on 581 patients of whom 202 have been diagnosed with localized prostate cancer. Interviews have been conducted with 42 patients. Initial review of the data base shows that prostate biopsies in Hartford are being performed primarily on men aged 59 to 77 years, but ages range from age 45 to 93.(ABSTRACT TRUNCATED AT 250 WORDS) PMID- 10135634 TI - Discontinuity in the Health Care Financing Administration's published standardized mortality ratios due to underestimation bias across multiple admissions case selection methods. AB - Case counts below 50 can compromise the careful use of disease- or procedure specific standardized mortality ratio comparisons across small hospitals in predominantly rural areas. Linking data series where data are of the same quality and are continuous across the series is one way of handling the problem of small case sizes. Examination of three different annual reports of Health Care Financing Administration (HCFA) mortality findings for 1987 of one state's providers showed significantly lower actual and predicted mortality rates reported in 1989, compared with the same mortality rates reported about 1987 published in 1988 and 1987. One hypothesis for the downward trend is the change in case selection method used for constructing the mortality model from last discharge (used in 1987 and 1988 reports) to random selection of cases with multiple admissions (initiated in 1989). A test of both case selection methods is presented and shows the consequences of mortality model changes that create discontinuities with previously reported findings, changes that limit or at least need to be taken into account when linking current HCFA mortality data series with historic series. PMID- 10135635 TI - Generalizing the plurality method for forming hospital service areas. AB - The upcoming Health Care Financing Administration's Fourth Scope of Work for peer review organizations (PROs) envisions much use of geographic analysis of utilization rates and quality of care. Proper analysis of utilization rates requires each PRO to form multiple sets of hospital service areas. The method used most often in the literature is the plurality method. Because this method can create fractured service areas and can leave hospitals without a service area, the service areas and their associated hospitals often are reworked by hand. This last step drastically raises the effort required to form service areas and makes the method nonreproducible. This report defines the generalized plurality method for forming the hospital service areas that are central to the study of use patterns via small area analysis. This new method is a true generalization of the plurality method. Like the plurality method, it forms service areas by allowing geographic areas to "vote" for their preferred hospital. The generalization is achieved by allowing near-ties in the voting to cause clustering of hospitals. Hence it is a clustering algorithm that operates on both the geographic areas (sources) and the hospitals (destinations) at the same time. It is a nonhierarchical, nonagglomerative cluster method. There are several free parameters that may be chosen to adjust the effect of the clustering by adjusting the definition of a near-tie, as well as the sensitivity of the clustering to near-ties from sources with a small number of votes. This automated method enjoys many major advantages over the methods commonly appearing in the literature: it is completely reproducible, it is quick, and it does not require the a priori convening of a panel of experts. It thus can be applied easily to a wide variety of types of care that would not necessarily have the same service areas. PMID- 10135636 TI - Frequency and recognition of angiotensin-converting enzyme inhibitor-associated angioneurotic edema. AB - OBJECTIVE: To evaluate the frequency of association of angiotensin-converting enzyme (ACE) inhibitor therapy with angioneurotic edema and the frequency of correct diagnosis by treating physicians. DESIGN: Retrospective population-based chart review. SETTING: Medicare patients identified with 1991 and 1992 MEDPRO data set. RESULTS: 51 patients were identified from the MEDPRO data sets. Twenty four patients (47%) had ACE inhibitor-associated angioneurotic edema of whom 17 (71% of the subgroup) had the medication stopped. Twenty-nine percent of the affected patients were discharged still taking an ACE inhibitor. Twenty-six patients (51% of the total population) had non-ACE inhibitor-associated angioneurotic edema and one patient had an uncertain history. CONCLUSION: ACE inhibitor therapy is the number one cause of angioneurotic edema in our hospitalized patient population. Recognition of the association of this drug with the condition was not recognized in 29% of cases and the offending agent was continued upon discharge from the hospital. PMID- 10135637 TI - Using patient reports to measure health care system performance. AB - We developed a self-administered patient questionnaire that asks for data concerning the time to receive services (access to care), communication between providers (coordination of care), and follow up after tests and treatment (continuity of care). From these data, we construct rates of performance about the clinical management systems that support provision of these services. Rates of system performance are calculated for indicators using patients' responses to survey questions. These indicators add the number of patients reporting a problem of those patients who have encountered a particular clinical management system. Information derived from 3000 patient questionnaires is matched with data abstracted from health care medical records. The sensitivity and specificity of patient reports are being evaluated for all indicators classified as gold standards for medical records. Indicators considered gold standard items for patient reports are matched for agreement with any information contained in the medical record. Also, patient characteristics associated with accurate reporting is to be assessed using multivariate logistic regression models. PMID- 10135638 TI - A trial of structured implicit review of randomly selected peer review organization cases. AB - OBJECTIVE: In order to learn more about peer review's acceptability, efficiency, and reliability, we performed structured implicit review with and without use of a structured case review form on a random selection of peer review organization cases. METHODS: We compared the results between methods and with previously obtained review results. Twenty-five charts with physician review completed during the Health Care Financing Administration's Third Scope of Work were randomly selected for rereview. Eight physician advisors, none of whom had seen any of these charts previously, were divided into two groups. Both groups received identical formal instruction in the structured implicit review method. Half of the physicians used a structured review form when performing chart review. The other half did not use this form but completed their reviews using the previously used reporting form. Participating physicians were instructed in the structured review method as described by Rand Corporation. The review process was examined regarding acceptability and efficiency. Review results were analyzed for reliability regarding identification of adverse and potential adverse effects and identification of the source of quality concerns. RESULTS: Instructions regarding structured implicit review methods were understood easily and accepted by physician advisors. Use of the structured review form was less efficient, averaging 50% longer per review. There was no difference in the rate at which adverse events were detected. Potentially serious adverse events were found less often using structured review than in the original review. There was greater agreement among reviewers using the structured form than among those using the historic worksheet, but structured review using the Rand form identified fewer potentially significant adverse events than did the reviewers using the historic worksheets. CONCLUSIONS: Application of structured implicit review methods is clearly feasible for peer review organization case review. Use of a simple worksheet was more time efficient than use of a highly structured form. There was not only less variation in review results but also identification of fewer potentially significant adverse events when the highly structured form was used. Teaching the structured approach to chart review may be more important to obtaining good results than using a structured review form. PMID- 10135639 TI - The use of clinical parameters in an interactive statistical package to predict pathological features associated with local failure after radical prostatectomy for prostate cancer. AB - The capability of an interactive statistical package (ISP) to predict the patients whose pathologic findings at the time of radical prostatectomy for prostate cancer would require postoperative radiation therapy to prevent local failure is investigated. A retrospective review of the clinical pretreatment factors and pathologic findings of 174 patients with adenocarcinoma of the prostate treated from 1989 to 1993 with radical retropubic prostatectomy was performed and served as a knowledge base of the ISP. The pathologic findings of seminal vesicle involvement, gross transcapsular disease, and positive surgical margins are defined as outcomes associated with a high risk of local failure after radical prostatectomy and, thereby, requiring postoperative radiation therapy to decrease this risk. By using the pretreatment clinical factors including prostate-specific antigen (PSA), Gleason score, clinical stage, and endorectal magnetic resonance imaging (MRI) findings as input to the ISP, patients are identified from a test group of 50 cases with known pathologic outcome who would require postoperative radiotherapy to decrease local failure. Low- (0% to 33%), intermediate- (34% to 67%), and high-risk groups (68% to 100%) for pathologic features associated with local failure were predicted accurately (r > .95) by the ISP for the 50 test cases. Factors identified on univariate analysis by the ISP as significant predictors of local failure postoperatively include PSA > 20 (p < .001), clinical stage (p < .001), MRI finding of gross transcapsular disease (p < .001), MRI finding of seminal vesicle involvement (p < .001), and Gleason score (p < .003).(ABSTRACT TRUNCATED AT 250 WORDS) PMID- 10135640 TI - Reporting tools for clinical quality improvement. AB - To support clinical quality improvement (QI), effective quality analysis tools are essential. New strategies that we have incorporated into our routine assessment activities include comparative screening, clinical process benchmarking tables, and run charts for key quality indicators. To target areas for improvement, we use comparative screening. We have access to clinical data for 11 comparable medical centers. Currently, these data are used to identify our ranking relative to the others for mortality, readmission, and length of stay. Diagnosis-related groups and ICD-9-CM clusters serve as clinical groupings with defined minimal case volume requirements to ensure meaningful comparisons. These comparative reports permit our clinical leaders and hospital administrators to focus QI activities. Clinical process benchmarking involves peer-to-peer interfacility communication to identify those factors that create outstanding clinical performance. We successfully have used this tool to support process improvement in cardiac-surgery, administration of patient controlled analgesia, and respiratory therapy. Interdisciplinary QI teams identify the key investigative questions. Team members then contact their counterparts at similar facilities, which differ from our hospital in quality, based on empirical evidence or through comparative screening. The information that is obtained is collated in a tabular format, along with our own information, to permit easy identification of key clinical processes associated with better outcomes. Key quality and utilization goals at our hospital include reducing unplanned readmissions by 10%, achieving a 5% lower average length of stay, and not exceeding Health Care Financing Administration expected mortality rates in any clinical area.(ABSTRACT TRUNCATED AT 250 WORDS) PMID- 10135641 TI - Educating the provider community about the new role of the peer review organization. AB - This report suggests an educational format that has been used successfully in Michigan to introduce the Health Care Quality Improvement Initiative to the medical community. The activities related to pattern analysis and the Fourth Scope of Work will require a collaborative effort between the medical community and the peer review organization (PRO). To improve understanding by providers and practitioners of pattern analysis, the Fourth Scope of Work, and the new PRO requirements, a series of educational programs was designed. The first presentation in the educational series included information about the changes between the Third and Fourth Scope of Work as well as the new structure within the PRO responsible for the pattern analysis activities: the Center for Health Outcomes and Evaluation. Descriptions of the process to be followed in interactions between the Center and providers and practitioners also were included: For the second session, a hands-on exercise was created to introduce the concept of a pattern. The exercise included graphic representations of patterns and a worksheet format to encourage the user to find specific data points within tables and graphs, describe a pattern in hospital outcome data, and verify that the same outcome pattern appeared in subgroups of hospitals and physicians. The third component in the educational series was a demonstration of the interaction between the Center and a hospital participating in a cooperative improvement project. Hospital-specific and physician-specific data, with appropriate comparative data, were provided to an audience made up of hospital administrators, practicing physicians, and allied health personnel who then worked through the issues related to data validation, definition of a project, agreement on interventions, and remeasurement of the outcome under study. PMID- 10135642 TI - One peer review organization's experience in developing hospital peer groups. AB - The Health Care Quality Improvement Initiative is moving Medicare's quality improvement activities from review and action on individual cases to the analysis of patterns of care. A primary source for pattern analysis is the mortality data presented in the Medicare Hospital Information release. One of the requirements set forth by the Health Care Financing Administration is that peer review organizations classify hospitals into peer groups in order to compare mortality rates within and among groups. It is hoped that this type of analysis will lead to a better understanding of the relationship between process and outcome for a variety of medical conditions. This report describes the experience of one peer review organization in establishing hospital peer groups. PMID- 10135643 TI - Radical prostatectomy for localized prostate cancer: trying to define quality care. PMID- 10135644 TI - The impact of pharmacy discharge planning on continuity of care. AB - Maintaining high quality patient care following hospital discharge is essential for complete recovery and continued well-being. Historically, pharmacist participation in discharge planning has been minimal and has been frequently limited to last minute patient counselling. Hospital pharmacists can contribute to the continuity of patient care by summarizing changes made to a patient's therapy, their rationale, and future considerations in a discharge report to the family physician and/or community pharmacist. In this study, pharmacy discharge summaries were prepared for inclusion in the discharge report to the family physician. Summaries were also forwarded to the community pharmacist, where appropriate. Two types of pharmacy summaries completed were "Rationale for Inpatient Changes" (RIC) and "Recommendations for Future Changes" (RFC) summaries. Evaluation forms accompanying the summaries elicited very favourable responses. An independent review group of two physicians and two pharmacists rated the potential for reduction of patient mortality/morbidity as either marked, modest, minor or negligible; most of the summaries were evaluated as having a "modest" impact. Workload associated with preparation of pharmacy summaries would require additional pharmacy staff. Direct and indirect cost savings, including decreased drug costs and avoidance of drug complications and hospital readmissions, are associated with this service. PMID- 10135645 TI - The impact of formulary reservations on drug utilization: a controlled trial. AB - A controlled trial was conducted in two teaching hospitals (A and B), with similar case mixes to determine the impact of reservations, which were educational in nature, on the utilization of oral ciprofloxacin. Over a two-month period the health records of all the patients who received the drug were reviewed, and information on utilization and demographics of patients receiving the drug was recorded. As well, the number of admissions to the two hospitals over this period were compared. If culture and sensitivity (C & S) results were available, appropriateness was assessed in accordance with criteria for use established at site A; in the absence of C & S information, consensus by two microbiologists was used. Over the two-month period a total of 136 patients received ciprofloxacin at the two institutions. At site A, which had reservations, the number of patients who continued to receive ciprofloxacin upon admission was significantly decreased relative to site B, which did not have reservations (14% vs. 36% respectively, p = .029). As well, when assessed by total number of admissions to the institutions, the number of patients receiving ciprofloxacin at site A was less than site B (1.5% vs. 2.6% respectively, p = .003)). While the utilization was decreased at site A vs. site B, the proportion of patients with therapy deemed to be appropriate was not different between the two sites. Educationally based reservations are an effective formulary tool for optimizing drug utilization. PMID- 10135646 TI - Pharmacy technician refill checking: safe and practical. PMID- 10135647 TI - Street gangs: save yourself while saving a life. AB - Until the root causes of gang violence--poverty, unemployment, stressed families and lack of education--are addressed on a national level, the number of victims will continue to mount. By having a basic understanding of gang violence and its manifestations, you can try to ensure your own safety while saving lives. PMID- 10135648 TI - Staying a step ahead of the bad guys. PMID- 10135649 TI - Gun control. Is it the answer? No way! PMID- 10135650 TI - Gun control. Is it the answer? You bet! PMID- 10135651 TI - The gang's all here. PMID- 10135652 TI - Scene of the crime. PMID- 10135653 TI - Going to extremes. PMID- 10135654 TI - Safe and sound: Part 2. AB - Last month, Gary examined fundamental issues relating to computer security, including important administrative precautions. This month, the second installment in our two-part series explores physical and technological security measures. PMID- 10135655 TI - How to survive the coming reform in healthcare. PMID- 10135656 TI - Foodservice benchmarks given for teaching hospitals. PMID- 10135657 TI - Partnering for 'special' events. PMID- 10135658 TI - Challenge: how to lift pediatric patients' spirits on a holiday. PMID- 10135659 TI - Day care design. Mixed messages. PMID- 10135660 TI - Change. Stormy weather. PMID- 10135661 TI - Bury my heart at Jackson Hole. PMID- 10135662 TI - Though competition is not intrinsically unethical, some situations call for a different approach. PMID- 10135663 TI - Success and stewardship: toward a new competition in health care. PMID- 10135664 TI - Will Americans ever again ask: "Doctor, how much is this going to cost?". PMID- 10135665 TI - Reform proposals aim at a health-care system that no longer exists. PMID- 10135666 TI - Can competition cut the mustard? PMID- 10135667 TI - Laboratory medicine: a 25-year retrospective. PMID- 10135668 TI - Changing the way lab medicine is practiced at the point of care. PMID- 10135669 TI - An outreach program for home glucose monitoring. PMID- 10135670 TI - CLIA--Part 3. Is CLIA understood by clinical laboratorians? PMID- 10135671 TI - New challenges await at U.S. HomeCare. PMID- 10135672 TI - Tenn. hospital rejoins Blues plan. PMID- 10135673 TI - American Cyanamid accepts buyout bid. PMID- 10135674 TI - Mullikin buys Pacific Northwest group. PMID- 10135675 TI - Managed hospitals improve over time. PMID- 10135676 TI - La. abortion law puts funding in jeopardy. PMID- 10135677 TI - Interest rate hike helps bond market. PMID- 10135678 TI - Managed care may affect teaching hospitals' credit. PMID- 10135679 TI - Future acquisitions will decide success of Caremark deal. PMID- 10135680 TI - Mass. HMOs to form super network. PMID- 10135681 TI - Calif. officials fail to pinpoint source of fumes. PMID- 10135683 TI - Chicago-area health networks in flux. PMID- 10135682 TI - Groups want malpractice reform bills. PMID- 10135684 TI - New England states ready to launch electronic network. PMID- 10135685 TI - Minn. business groups to construct health plan. PMID- 10135686 TI - Bipartisan group at center of debate. PMID- 10135687 TI - Reserve fund drives Coram loss. PMID- 10135688 TI - JCAHO still the best option. PMID- 10135689 TI - The unique awards. Everyone's a winner. AB - Everyone's a winner when it comes to healthcare awards. Seems there's a contest- or several--for every segment of the field. But while many of the awards serve useful purposes, the sheer number of them indicates the industry may have become too satisfied with itself. PMID- 10135690 TI - Montana hospital uses court ruling to oust nurses' union. PMID- 10135691 TI - Road to recovery could include stop on Easy St. PMID- 10135692 TI - Employers push for input. PMID- 10135694 TI - Business taking note of providers' debt. PMID- 10135693 TI - Surgeons, managers vent differences. PMID- 10135695 TI - AHA keeps word, holds down execs' '93 salary increases. PMID- 10135696 TI - Humana Fla. HMO denied accreditation. PMID- 10135697 TI - HealthTrust-Holy Cross deal in Utah faces more protests. PMID- 10135698 TI - St. Louis businesses form buying group. PMID- 10135699 TI - Redefining the hospital. PMID- 10135700 TI - A basic benefits package: how basic ... and who decides? PMID- 10135701 TI - Planning for the future. PMID- 10135702 TI - Capitation: it's older than you think. PMID- 10135703 TI - CEO visibility: striving to build a presence outside the hospital. PMID- 10135704 TI - Putting a price tag on credentialing. PMID- 10135705 TI - Reinventing rural hospitals. PMID- 10135706 TI - Why we need community boards. PMID- 10135707 TI - The way it was. PMID- 10135708 TI - America's best hospitals. PMID- 10135709 TI - Best hospitals. Raising questions of care. AB - What should you do if finances--or geography or health plan rules--put a high ranked hospital out of reach? Good question. Here are some answers, along with other hypothetical questions related to hospital choice, access and cost. The responses, developed with the help of medical and consumer experts, are real. PMID- 10135710 TI - Best hospitals. The 16 specialties--from AIDS to urology, 114 hospitals that offer top care. PMID- 10135711 TI - National Hospital Ambulatory Medical Care Survey: 1992 outpatient department summary. PMID- 10135712 TI - Moderating effects of prior social resources on the hospitalizations of elders who become widowed. AB - In a prospective design, the effects of social resources before widowhood on changes in subsequent hospitalizations were compared for 86 married elders who became widowed over a 2-year period and 86 matched elders who remained married. Subjects were from the Established Populations for Epidemiologic Studies of the Elderly (Duke). Hospitalizations were used as an indicator of a serious health outcome whose report was unlikely to be biased by a widowed person's emotional state. The hypothesis that perceptions of inadequate social support from persons other than the spouse would exacerbate the effects of bereavement on hospitalizations was supported for elders who lacked close friends with whom to talk about private matters while still married; believing that no relative would provide such support and dissatisfaction with support tended to have the same effect. Inadequacies in social embeddedness (few contacts with friends, relatives, or children and being childless) had no significant moderating or main effects on change in hospitalizations. PMID- 10135713 TI - Examining the relationship between health locus of control and the use of medical care services. AB - Health locus of control, the extent to which one believes he or she can affect his or her health status, usually is viewed as one of the factors that predisposes individuals to use medical services. However, some social theorists outside the area of utilization studies suggest that locus of control beliefs also are consequences of health-related behaviors and events such as utilization. The authors address this issue by investigating the relationship between health locus of control and utilization of medical services in a sample of 298 elderly community-dwellers surveyed at three points in time. They found that health locus of control was affected by serious medical care encounters and that, for two dimensions of health locus of control, there was a reciprocal relationship between control beliefs and utilization. PMID- 10135714 TI - Health conditions and service utilization of adults with elder care responsibilities. AB - This study examines health conditions and health care services utilization rates of 628 caregivers and 6,599 noncaregivers age 50 or older who were members of Kaiser Foundation Health Plan in Northern California. Controlling for age, gender, and race, caregivers were more likely than noncaregivers to report backaches, insomnia, arthritis, rectal problems, and hearing problems; they were also more likely to report having two or more current health conditions of any kind. However, caregivers and noncaregivers did not differ significantly with regard to the number of outpatient medical visits or with regard to the number of outpatient psychiatry visits. PMID- 10135715 TI - Predictors of use of secondary carers used by the elderly following hospital discharge. AB - This research examines how caregiver-patient relationship (female spouses, and adult daughters and daughters-in-law) when cross classified with patient coresidence patterns explains the level of secondary carers' involvement among patients with newly added needs for assistance at home following hospital discharge. Among 196 primary caregivers (104 spouses, 92 daughters and daughters in-law), patient needs were divided into ADL and mobility limitations, and medical tasks. Secondary carer involvement was categorized into levels differing at two observations: one following discharge and a second 3 months later. Analyses focused on explaining the levels of involvement of secondary carers following hospital discharge and the changes in secondary carers' involvement between the two observations. The baseline and change analyses revealed that caregiver-patient relationship was more important than coresidence patterns or patients' demands in explaining assistance from secondary carers. The implications of these findings on caregivers' reactions and policies regarding home care are explored. PMID- 10135716 TI - The influence of the New York Quality Assurance System on casemix in nursing homes. AB - The New York Quality Assurance System (NYQAS) was designed to assure high-quality nursing home care in New York. Among its many incentives, NYQAS may change the likelihood that elderly with heavy-care needs will be admitted to nursing homes. This article addresses that hypothesis. Data for descriptive and multivariate analyses come from the RUGs-II Patient Review Instrument and the Medicare and Medicaid Automated Certification System files for 1986-1990. The descriptive analyses focus on functional ability in new nursing home residents before and after NYQAS. The multivariate analyses adjust for pre-NYQAS, RUGs-related trends in casemix, resident demographics, and nursing home characteristics that influence casemix. The results suggest a significant but small decrease in functional status at admission during the post-NYQAS era. PMID- 10135717 TI - Caregiver role appraisal and caregiver tasks as factors in ending caregiving. AB - This study focuses on factors related to why people with primary responsibility for providing care to ADL-impaired elderly persons ended their caregiving roles. Data are from the 1982 National Long-Term Care Survey and the Informal Caregiver Survey. Variables reflecting characteristics of care recipients and caregivers, caregiver role responsibilities, and appraisal of the caregiver role are investigated. Of particular interest is the influence of role responsibilities, such as number of ADL tasks, relative to appraisal of the caregiving role. The results indicate that factors other than role responsibilities are important in understanding who ends caregiving, and that risk factor profiles may prove a useful means of targeting caregivers at greatest risk of ending caregiving. PMID- 10135718 TI - Barriers to automation in health care settings. AB - Health information systems have changed little since the 1970s, and most are incapable of meeting the information demands of either their organization or outside organizations. Through literature reviews, interviews with staff in three hospitals, and a vendor study, the staff of Kunitz and Associates, Inc. examined barriers to implementing automated systems in hospitals. These barriers were found to be technical, organizational, and operational in nature and to involve issues of communication within the health care environment and between information system vendors and health care staff. Resolving these issues is dependent upon efforts by both the health care and technical communities. PMID- 10135719 TI - Computer-based patient records and changing physicians' practice patterns. AB - Computer-based patient records (CPRs) have been under development for more than a quarter of a century. In comparison to the traditional paper medical record, they offer a vast improvement in reporting, organizing, and locating clinical information; they can support clinical decision making; and they can be designed to coordinate and manage patient care. Research concerning these three functions is reviewed. Despite their demonstrated benefits, CPRs have met with limited acceptance among physicians. Barriers to their acceptance and ability to change practice behavior are discussed. Empirical studies that have used opinion leaders among physicians to encourage the use of a medical information system and to change practice behavior are reviewed. Finally, suggestions as to how to facilitate the development and adoption of CPRs are outlined. PMID- 10135720 TI - Reducing barriers to physician data entry for computer-based patient records. AB - Physician data entry and use of clinical workstations is one barrier to computer based patient records (CPRs). Often, clinicians do not understand the potential benefits of CPRs. For the benefits to be realized, however, clinical personnel must use the workstations for both data entry and retrieval. The article reviews recent experience with physicians' direct data entry. It summarizes benefits that clinicians have realized from such systems and also disincentives to their use. It concludes by discussing implementation strategies for enhancing the benefits and reducing the barriers. PMID- 10135721 TI - The electronic medical record in a research institution: competing constituencies in a publish or perish world. AB - The electronic medical record (EMR) has the potential to advance medical research by quantum leaps through improved, low-cost access to high-quality information. To the extent that the EMR enhances the status and power of researchers, it will be greeted with enthusiastic support. To ensure such an outcome, developers must resolve issues introduced by the EMR, such as the added burden of cost for research data, errors in interpretation of EMR-based research data, the introduction of bias into studies, responsibility for the accuracy of EMR-based data, and ownership of EMR-based data. PMID- 10135722 TI - Professional agendas and computer-based patient records: negotiating for control. AB - Professional groups approach the computer implementation process as an opportunity both to protect and enhance their ability to perform their work and to negotiate for arrangements that will further their professional agendas. The article examines and compares the professional agendas and negotiating positions of pharmacy and laboratory departments as examples of professional groups involved in the implementation of order entry systems. Findings showed a stronger stance taken by the pharmacy departments in both institutions to exercise as much control as possible over the order entry process. This stance is influenced by both task issues and professional agendas. Understanding the link between these professional agendas and the issues that arise during computer implementation can help guide similar negotiations as institutions adopt computer-based patient record systems. PMID- 10135723 TI - An investigation of barriers to computer-based patient record implementation. AB - A study was conducted to verify barriers to implementing computer-based patient record systems as perceived by a random sample of members of the American Health Information Management Association, the American Medical Informatics Association, and the Health Information Management and Systems Society. Study respondents were asked to identify the likelihood of their institution overcoming the barriers and which, if any, strategies would be most helpful in overcoming them. This article discusses the study results. PMID- 10135724 TI - Electronic signature of computerized patient records. AB - The article describes the computerized system developed and used at the Ohio State University Medical Center in Columbus, Ohio to affix a physician's signature electronically. The system electronically sends dictated reports (e.g., discharge summaries, history and physical examinations, and operative reports) and attestation statements to the physician for review. The physician selects the report individually and may approve or enter comments. Comments are forwarded electronically to medical information management. The article describes the fiscal intermediary's requirements and approval process and the impact on delinquent records and accounts awaiting attestation signature before billing. PMID- 10135725 TI - Education review: a graduate course in management information systems in health care. AB - The article presents and discusses a graduate course in managing information systems in health care delivery organizations. The article presents the course content, assignments, and syllabus and reviews the strengths and weaknesses of the course. PMID- 10135726 TI - Ohio hospital first to join OSHA's workplace safety honor roll. PMID- 10135727 TI - Common Category Database calls a scalpel a scalpel. Interview by John McCormack. PMID- 10135728 TI - Getting nurses involved in your product committee. PMID- 10135729 TI - Survey: stand-alone hospitals fade away. PMID- 10135730 TI - Find your department's rung on the ladder of sophistication. AB - How highly evolved is your materials management department? Those on the lower rungs of the evolutionary ladder have passive, non-strategic roles and simply react to input from other departments; those that have evolved to higher levels are more active and involved in the organization's strategic decisions. PMID- 10135731 TI - Is dirty linen your problem? you bet it is .... PMID- 10135732 TI - Stats. Using exchange carts in the ED: cost-effective--or not? PMID- 10135733 TI - Preventing medical device-related accidents: what the experts advise. PMID- 10135734 TI - The LIRR (Long Island Rail Road) shootings: how LI hospitals carried out disaster plans. PMID- 10135735 TI - Special report. Regulating security: what the new California and NY state laws require and how hospitals are responding. AB - Efforts on state and federal levels to mandate private security standards and training of security officers have received substantial boosts from laws recently passed in two of the nation's largest states--California and New York. Although the two laws differ substantially (California's is directed solely at hospitals, while New York's covers all areas of private security), it is likely that the provisions of both will increasingly find their way into legislation passed by other states and/or the federal government. Thus, all security directors, no matter where their institutions are located, may want to review this special report carefully. PMID- 10135736 TI - IT update. Small is difficult; all systems go. PMID- 10135737 TI - Complaints. Hidden depths. PMID- 10135738 TI - Market testing. What am I bid? AB - Walsall's experience of marketing testing for urology services was that it is a difficult, time-consuming but thoroughly worthwhile process. We believe that a much improved level of service will be available to Walsall residents, representing excellent value for money. Turning the spotlight on to this particular specialty resulted in local provider trusts showing increased willingness to address the clinical management and quality issues about which the HA had expressed concern. PMID- 10135739 TI - Town planning & health. Sick building syndrome. PMID- 10135740 TI - Data briefing. Asthma. PMID- 10135741 TI - Universal prescription drug coverage would increase Rx expenditures by 4 to 6%, CBO says. PMID- 10135742 TI - Pharmacoeconomic factors in the treatment of acute hypertension. AB - Strategies to minimize drug costs include physician education, restrictions on non-cost-effective agents, cost-awareness programs, benchmarking with other institutions, and increased physician-pharmacist collaboration. These measures are particularly adaptable to the treatment of acute hypertension, which is often associated with additional avoidable expenditures depending on management decisions. This article reviews the factors affecting the cost-effectiveness of the various agents used in treating acute hypertension, including dosage changes, adverse events, ancillary services, methods of administration, and dosage computation. PMID- 10135743 TI - Computer-assisted investigational drug information and testing mechanism for nurses. AB - The Joint Commission on Accreditation of Healthcare Organizations and the American Society of Hospital Pharmacists state that nurses should not administer investigational drugs to patients unless they can prove knowledge about the medication. Traditionally this obligation was met when the pharmacy provided nurses with investigational drug data sheets or access to computer files containing similar information. Our department of pharmacy was cited at a recent JCAHO inspection as being unable to show that nurses were knowledgeable about the investigational medications they were administering. The reviewer requested testing documents prepared by the pharmacy and completed by nursing staff showing the nurses' proficiency with investigational drug information. In response to the JCAHO inspection, the department of pharmacy proposed a quality assurance mechanism to provide investigational drug information and to determine nurses' comprehension and application of these data before they administer any investigational drug. Use of a hospital mainframe computer system to disseminate investigational drug information and test nurses is described. PMID- 10135744 TI - Pharmacoeconomic principles and methods: an introduction for hospital pharmacists. PMID- 10135745 TI - TB respirators: what's required (and what isn't) by OSHA's rules. PMID- 10135746 TI - You needn't build a better mousetrap to control pests. PMID- 10135747 TI - Don't want to succeed? Here are five steps to ensure failure. PMID- 10135748 TI - Economics report. In-house laundry/linen reprocessing: who does it? PMID- 10135749 TI - Structure solves parking problems while respecting community's sensitivities. West Allis Memorial Hospital, WI. PMID- 10135750 TI - Constructive change. AB - Strong, flexible strategic plans help health care organizations keep their facility-related goals in line during the health care reform process. PMID- 10135751 TI - Mastering disaster. What should you do when disaster strikes? Experts offer their best advice. Last in a series. PMID- 10135752 TI - First person: Marilee Miller on disaster planning for outpatient health facilities. PMID- 10135753 TI - Wheels of misfortune. Rethinking the use of traditional wheelchairs in long-term care settings. PMID- 10135754 TI - Refurbished beds offer like-new amenities at up to one-half off the price of new beds. PMID- 10135756 TI - ASHE to unveil its electronic network. PMID- 10135755 TI - Splish, splash. Water-treatment programs combat contaminants, corrosion and scale. PMID- 10135757 TI - ASHE takes a close look at its name. PMID- 10135758 TI - Re-focusing on our patients. A vision for excellence. PMID- 10135759 TI - An inspector calls. PMID- 10135760 TI - Information management--a board issue? AB - Everyone is tired of the negative press reports on information systems in the NHS. There are, in fact, a number of excellent initiatives in the service which are strategically driven by boards. However, evidence suggests that many boards have not yet taken full ownership of systems. In this rapidly changing and highly important area, there are practical steps they should be taking to ensure success, say IT consultants Ken Pett and Tony Scott. PMID- 10135761 TI - Forcing the market. PMID- 10135762 TI - Purchasers and providers. Staying together or drifting apart? PMID- 10135763 TI - Burnout: a challenge to healthcare in the 90s. PMID- 10135764 TI - L.A. County OKs contract for new garage; asbestos questions delay demolition. PMID- 10135765 TI - What are the major challenges in reducing the use of restraints? PMID- 10135766 TI - Hospital chains. Systems post 4th straight year of income growth. AB - Last year's merger mania and healthcare systems' aggressive cost-cutting contributed to the fourth straight year of increases in systems' operating margins, according to the 18th annual MODERN HEALTHCARE Multi-unit Providers Survey. PMID- 10135767 TI - Evaluating change: a simple technique for determining the statistical significance of proportional criteria. AB - A simple method to calculate statistically significant differences between proportions is presented to evaluate changes in quality assessment and utilization data. The authors believe that this calculation could be a valuable analytic method for evaluating changes in monitored criteria, particularly in the assessment of criteria measuring high-volume events. PMID- 10135768 TI - Managing patient demographics. AB - The Harvard Community Health Plan commissioned a cross-functional project team to improve the accuracy of the members' data base because inaccurate patient phone numbers and addresses were a major obstacle for clinicians seeking to provide high-quality service to patients. Accurate demographic information is essential to enable clinicians to contact patients quickly regarding lab results or follow up care. The team members applied a quality improvement problem-solving methodology that required them to focus on the few vital problems and to test problems using data analysis. As a result, the team saw firsthand that staff members were not to blame for the inaccurate demographic information; the problem was in the automated system that obtains, updates, and maintains the records. PMID- 10135769 TI - Quality management organizational structures: history and trends. AB - Quality management (QM), utilization management, and risk management each evolved in response to different external demands. Practices that evolved in response to the real or perceived influences of accreditors, regulators, and payers may be easier to modify if we understand their origins and can identify why those practices are or are not warranted in today's environment. Also, if an individual works exclusively in one of the three traditional areas of quality (QM, utilization management, and risk management), history provides insight into the demands faced by individuals working in the other two areas. Finally, history should be of interest as we prepare for another wave of healthcare reform, which may result in additional changes in our QM organizational structures. This article traces the roots of quality management, utilization management, and risk management for their impact on the organizational structure of hospitals, and summarizes the most common current design variations employed for different situations. PMID- 10135770 TI - Perspective: riddles wrapped in enigma. AB - Six decades of studies on healthcare quality have persisted in rendering the subject difficult to understand or explain to health researchers and policymakers. This article advances three hypotheses about why quality in healthcare is such an enigma. The first concerns problems with the conceptualization of quality. Issues of uncertainty embedded in quality are discussed in the second hypothesis. Finally, difficulties in understanding quality are discussed within a model offered by the sociology of deviance. The article highlights the contribution of each hypothesis and integrates them into a plausible explanatory framework for quality's elusive comprehensibility. PMID- 10135771 TI - Legislative forum: how to communicate with your legislators. PMID- 10135772 TI - Guidelines for a curriculum in healthcare quality and resource management. AB - Issues of quality pervade American society. Demands for accountability for the quality of and the resources utilized in delivering healthcare services are coming from consumer advocacy groups, regulatory agencies, third-party payers, and corporate purchasers of healthcare. To date, institutions of higher education do not consistently offer either adequate or coordinated programs to prepare healthcare professionals to assume the regulator role. Promoting quality is both a mandate and a legacy, and each professional will need to be involved to ensure continuing quality care for consumers. Active collaboration between academic, service, and professional organizations, as well as a strong commitment to the development and timely implementation of a suitable curriculum, are imperative. PMID- 10135773 TI - Risk managers: the problem and the solution? PMID- 10135774 TI - Controlling risks associated with standing ethics committees. PMID- 10135775 TI - Controlling the defense costs of malpractice. PMID- 10135776 TI - Employee claims: another liability exposure. PMID- 10135777 TI - The clinical practice parameters movement: the risk manager's role. PMID- 10135778 TI - Hospitals' vicarious liability for the acts of their attending and contract physicians. PMID- 10135779 TI - HCA depends on employee evaluations of quality patient care and conditions in the workplace. PMID- 10135780 TI - Respond now to erosion of employment at will. PMID- 10135781 TI - Quality merit badges and Olympian competition sustain employee involvement at Baptist Memorial Hospital, Memphis. PMID- 10135782 TI - Rethink executive compensation to fit your approach to TQM. PMID- 10135783 TI - TQM initiatives demand a new look at elements of compensation. PMID- 10135784 TI - Are we having fun yet? At Gaston Memorial Hospital, the answer is yes. PMID- 10135785 TI - Are middle managers healthcare's neglected heroes? PMID- 10135786 TI - Selecting a health benefits claims administrator. PMID- 10135787 TI - New literacy programs address job-specific problems and involve employees. PMID- 10135788 TI - AHA survey documents continuing personnel shortages in South and West. PMID- 10135789 TI - School-hospital partnerships address long-term shortages and involve employees ... Brigham and Women's Hospital, Boston. PMID- 10135790 TI - Organizations forge partnerships with hospitals to solve the crisis in education and training. PMID- 10135791 TI - Recognition drives quality improvement at Wake Medical Center. PMID- 10135792 TI - The HR professional's guide to a successful candidate visit. PMID- 10135793 TI - New England Medical Center integrates data into human resources decisions. PMID- 10135794 TI - United Health Services ties compensation to market conditions and future demand. PMID- 10135795 TI - Patient-focused care will transform human resources. PMID- 10135796 TI - Gainsharing programs demand planning, patience, and commitment. AB - This is the first of a two-part series on gainsharing programs. This article examines the recommendations of two consultants and one senior human resources executive. The second article, which will appear in the March issue, will present case examples of gainsharing programs from Sutter Health, Sacramento, California, and Waukeshaw Memorial Hospital, Waukeshaw, Wisconsin. PMID- 10135797 TI - Cross training and multi-skill development bring many rewards. PMID- 10135798 TI - Turnover can be managed proactively by applying a multi-stage model. PMID- 10135799 TI - Yale New-Haven program addresses training, employment, assessment, and community impact. PMID- 10135800 TI - How to choose an effective human resources consultant. PMID- 10135801 TI - Volunteers bring new spirit to the Ohio State University Hospitals. PMID- 10135802 TI - Catholic Health Corporation ensures values match in executive search. PMID- 10135803 TI - St. Joseph's Hospital and Medical Center, Phoenix, downsizes with employee and management input. PMID- 10135804 TI - Paid leave: an effective way to control absenteeism. PMID- 10135805 TI - Insurance investment contracts: how to determine if you're at risk. PMID- 10135806 TI - Awareness, anticipation, and preparation: a new strategic approach to labor relations. PMID- 10135807 TI - Study calls for new transformational competencies and values. PMID- 10135808 TI - Variable pay in healthcare: making the right choices. PMID- 10135809 TI - The flex/EPO (exclusive provider organization) plan: one way to hold the reins on healthcare costs. PMID- 10135810 TI - Incentive compensation: how to avoid the pitfalls. PMID- 10135811 TI - How you can trim your healthcare costs. PMID- 10135812 TI - Filling the void created by chief nurse executive vacancies through contract management. PMID- 10135813 TI - Quality demands the support of human resources executives. PMID- 10135814 TI - Novus Health Group builds 21st century management team through disciplined, step by-step process. PMID- 10135815 TI - Novus moves human resources function front and center. PMID- 10135816 TI - CEO search demands rigorous assessment of organization, board, outcomes, expectations, and management team. PMID- 10135817 TI - Management succession planning is planning for success. PMID- 10135818 TI - Human resources executives help employees balance professional and family needs. PMID- 10135819 TI - Lutheran General Health System integrates quality focus into human resources. PMID- 10135820 TI - Adoption benefits: a low-cost way to address employees' parenting needs. PMID- 10135821 TI - Special area makes breastfeeding easy for new mothers. PMID- 10135822 TI - Hospitals hurry to get on the family friendly bandwagon and offer child care services to employees. PMID- 10135823 TI - Quality environment leads to attitude shift on executive incentives at SSMHCS. PMID- 10135824 TI - Action learning drives quality initiative at Athens Regional Medical Center, Athens, Georgia. PMID- 10135825 TI - Prevent sexual harassment through policies, procedures, and promotion. PMID- 10135826 TI - Preceptor program gives nurses a reason to come and to stay ... St. Anthony's Hospital, St. Louis. PMID- 10135827 TI - How to reconcile starting salaries with compensation structures. PMID- 10135828 TI - Florida hospital gives employees financial incentive for staying fit ... Lee Memorial Hospital, Fort Myers. PMID- 10135829 TI - Multi-skilled practitioners receive evaluations based on outcomes. PMID- 10135830 TI - Miami hospital puts stress reduction lessons to good use in hurricane aftermath ... Baptist Hospital. PMID- 10135831 TI - HR department transformations demand involvement and vision. PMID- 10135832 TI - Electromation case forces HR executives to scrutinize employee committees. PMID- 10135833 TI - HR executive finds inspiration in European apprenticeships. PMID- 10135834 TI - Team proposals: jump starts for productivity, quality and employee involvement. PMID- 10135835 TI - Happiness is learning to fight fair and agree to disagree with your boss. PMID- 10135836 TI - HR professionals cite new and emerging trends, required skills, and quality involvement. Roundtable discussion. PMID- 10135837 TI - Family and medical leave act raises questions and opportunities. PMID- 10135838 TI - Catholic Health Corporation will distribute revised model policy on medical leave. PMID- 10135839 TI - HealthSpan's environmental assessment implies work redesign. PMID- 10135840 TI - Beth Israel and Baptist Hospital lauded in "The 100 Best Companies to Work for in America.". PMID- 10135841 TI - Freedom of expression through due process: critical components of TQM/CQI. PMID- 10135842 TI - Success sharing brings new spirit to Florida medical center ... Memorial Hospital, Ormond Beach. PMID- 10135844 TI - Organizational change will shape management compensation. PMID- 10135843 TI - St. Vincent Medical Center relies on peer grievance procedure to resolve employees' problems. PMID- 10135845 TI - Prepare now for the trends that will revolutionize healthcare human resources. Interview by Joyce Flory. PMID- 10135846 TI - Turning your human resources department into a profit center. PMID- 10135847 TI - Preparing for media scrutiny of executive compensation: the role of human resources. PMID- 10135848 TI - Getting your CFO to say yes requires a step-by-step process and hard data. PMID- 10135849 TI - Basic skill gaps call for new approaches to recruitment, assessment and training. PMID- 10135850 TI - Gainsharing helps employees at Indianapolis hospital feel like team members ... Deaconess Hospital, Evansville, IN. PMID- 10135851 TI - Florida hospital takes first steps toward self-directed work teams ... Cape Coral Hospital. PMID- 10135852 TI - Adding competencies is at the core of hospital's cross-training program ... Methodist Hospital of Indiana, Indianapolis. PMID- 10135853 TI - New England Medical Center creates new community service role for human resources. PMID- 10135854 TI - Pennsylvania hospital's management recruitment process paves the way for success ... Doylestown Hospital. PMID- 10135855 TI - Dingell frowns on 'pass-through' idea. PMID- 10135856 TI - How can facilities increase staff involvement? PMID- 10135857 TI - Reinventing assisted living. An age-old alternative takes on a new look. PMID- 10135858 TI - 1994 interior design awards. The Forum at Rancho San Antonio, Cupertino, Calif.; Southwood at Norwell, Mass.; James River Care Center, Springfield, Mo. PMID- 10135859 TI - On the road again. As facilities' mix of residents and patients grows more varied, transportation becomes less routine. PMID- 10135860 TI - Power to the people. Employees are calling some of the shots at Living Centers. PMID- 10135861 TI - Common problems, common salaries. DON salary survey reveals that you're not alone out there. PMID- 10135862 TI - OSHA: the other regulator. PMID- 10135863 TI - What a difference a year makes. Low cost capital has helped spark a flurry of mergers in the longterm-care industry. PMID- 10135864 TI - Deciding to rent or buy subacute equipment. PMID- 10135865 TI - How Stevens Memorial uses on-duty police for hospital security. PMID- 10135866 TI - Emergency planning pays off following Mobile Amtrak accident. PMID- 10135867 TI - Gasbarro: apply for healthcare risk manager certification now. PMID- 10135868 TI - Special report. The 1994 Southern California earthquake: its continuing impact on area hospitals and some lessons it can teach all hospitals on disaster preparedness. AB - The massive earthquake that rocked Southern California on January 17 left area hospitals facing both an influx of patients and heavily damaged facilities. Several hospitals were forced to shut down temporarily, although in most cases not before quake victims were triaged and other patients were safely transferred to other facilities. With damage totals still being calculated and repair projects just under way, several hospitals already are evaluating their response to the quake in an effort to be even more prepared should another disaster of that magnitude occur. This special report will provide an overview of the damages suffered by several hospitals; describe the role played by administrators and staff--particularly the security department--in the aftermath of the quake; and offer advice from hospital officials on how to best prepare for an earthquake or another natural disaster and how to function most effectively in the aftermath. PMID- 10135869 TI - Security's expanding role in dealing with domestic violence. PMID- 10135870 TI - Upgrading hospital parking security: patrols, escorts, CCTV, lighting. PMID- 10135871 TI - Boston U. upgrades med center's security; links two campuses via radio. PMID- 10135872 TI - CPO (Certified Protection Officer) and CSS (Certified Security Supervisor) programs: a progress report. PMID- 10135873 TI - Special report. TB and health care workers: the challenge for hospitals and their safety directors. AB - New federal regulations seeking to prevent tubercular infection of health care workers have created conflicts between unions and hospital administrators over the best and cheapest methods of reducing the threat. Though there has been dispute over the particulars, there has been little argument that some steps must be taken, particularly in urban areas, to control the spread of a disease that has rebounded in new and deadly forms in recent years. Most agree that one of the most effective ways to avoid infection is to train employees to identify new hospital arrivals who are likely to have active cases of TB. PMID- 10135874 TI - Hospital taps college work-study program to augment security force. Redlands Community Hospital, CA. PMID- 10135875 TI - The politics of health care benefits. PMID- 10135876 TI - Medical device regulation in Canada: direction for change. AB - The medical device regulatory programme in Canada was first instituted in 1975. Recently this programme underwent a review. This paper first describes the system of regulations as it has been administered by the Health Protection Branch of the government of Canada. The rationale for the establishment of the Medical Devices Review Committee, its deliberations and report are then discussed. Finally, the paper examines measures currently being taken to implement recommendations that will take the regulatory programme for medical devices in Canada into the twenty first century. PMID- 10135877 TI - Profitability of HMOs: does non-profit status make a difference? AB - This study, based on 163 HMOs, tests the hypothesis that the rates of return on assets (ROA) are not significantly different between for-profit and non-profit HMOs. It finds no statistical support for rejecting the hypothesis. The marked similarity in profitability is fully explained by analyzing methods of cost control and accounting, operational incentives and constraints, and price determination. The paper concludes that profitability is not a defining distinction in the operation of managed care. PMID- 10135878 TI - Economic development and the health care system in Hong Kong. AB - This article describes parallel developments of the Hong Kong economy and its health care system. The purpose is to illustrate how the Hong Kong health system evolved in response to external and internal pressures generated by economic prosperity. The Hong Kong system illustrates the importance of clear policy making in the face of these pressures. In particular, issues of investment, financing and distribution of health services are examined in relation to hospital cost control and service accessibility. In the past, health care costs in Hong Kong have been controlled at the expense of limited accessibility of health services. At present, Hong Kong policy-makers are faced with the challenge of maintaining a sharp focus on cost control as they face pressure to expand and improve health care coverage for the citizens. So far they have responded by emphasizing management efficiency through reorganization. It remains to be seen whether this strategy can be successful without passing increased health care costs to the consumers. PMID- 10135879 TI - What future WHO? AB - New actors on the international health scene have emerged, challenging WHO's leadership in global health. The role and functions of WHO have been questioned. Changes in financing have eroded the influence of the governing bodies. The Nordic countries, which together provide a considerable share of the total voluntary contributions to WHO, have recently made a number of studies of WHO, pinpointing weaknesses and proposing reforms. A slow reform process is also taking place within WHO. The main conclusions from these studies are analyzed and the areas with the greatest need for reform are studied. This paper presents proposals for the far-reaching reforms needed for WHO to recapture its leadership role in international health. PMID- 10135880 TI - Data base compares productivity. PMID- 10135881 TI - Group practice computing: the road to managing information. AB - Electronic information processing will have major implications for group practices in the near future, according to John T. Douglas, president and CEO of PD Medical Systems. Computer systems must be able to cope with electronic data interchange (EDI), electronic medical records (EMR) and outcome measurements to best serve groups under managed care. PMID- 10135882 TI - Strategic information systems. AB - Successful transformation to a regional health care delivery system, rather than independent group practices and hospitals, will depend on the strategic use of information technology. Frank T. Sample, president and CEO of Phamis Inc., writes that information systems will be essential for achieving business and care objectives. PMID- 10135883 TI - Advanced information support. Abstracting evidence from clinical practice research. AB - Suzanne M. Austin, M.H.A., and E. Andrew Balas, M.D., Ph.D., of the Health Services Management Program at the University of Missouri-Columbia, present research on exchange of information in clinical practices. Their findings have led them to develop an integrated knowledge base aimed at enhancing cognition and supporting action rather than increasing confusion and indecision. PMID- 10135884 TI - A short story: it is possible, are you ready for it? AB - EDI is in the future of the medical practice field. Frances F. Manning, FACMPE, presents one scenario with the story of a mother attempting to obtain health care for her daughter and encountering a vast federal network of data bases. Also, members respond on page 36 to Manning's vision. Donald J. Lloyd, FACMPE, writes that it is possible and calls for limiting the prospects of such a robotic system. Sam J.W. Romeo, M.D., believes that Manning could have gone even further on technological advances while pointing out the side benefits of such a system. PMID- 10135885 TI - The computer in the consulting room. What can it do for the physician? AB - Helen Mawhinney, M.D., of McLure, Moynihan and Associates and the University of California-Los Angeles, and Brad Dodge of Health Communication Services Inc., write about the use of computer-based medical records and their effects on patient care, decision making and data generation. PMID- 10135886 TI - Time to move to RBRVS? PMID- 10135887 TI - Becoming media savvy. PMID- 10135888 TI - A review of a pediatric neurology unit: fiscal administration. PMID- 10135889 TI - Activity-based costing. A medical group administrator's guide to strategic planning under capitation. PMID- 10135890 TI - Selecting and managing a professional consultant to a clinical laboratory. AB - Managers of clinical laboratories, like those in other complex organizations, will often seek the advice of external professional consultants to provide solutions to current problems. Optimizing the process of selecting and managing consultants to clinical laboratories is the topic of this article. A number of practical tips are offered, including a discussion of the use of nontraditional consultants. Special emphasis is placed on developing a request for proposal and evaluating responses to the request for proposal by the various consulting firms bidding for the engagement. The use of consultants in the health-care arena in general and clinical laboratories in particular will undoubtedly increase as financial and organizational challenges to the industry continue to proliferate. PMID- 10135891 TI - Decentralized testing in the '90s. A survey of U.S. hospitals. AB - Laboratory testing is increasingly moving out of the central laboratory and into other areas of the hospital. Many factors are driving this trend, but most revolve around the desire for prompt, medical decision making guided by quick, convenient on-site or decentralized testing using emerging new technologies. Although many theories exist about the viability of on-site testing, research on the subject has been minimal. This article reviews the results of a 1993 independent survey on decentralized testing among laboratory managers at U.S. hospitals and quantifies various aspects of this new movement within such institutions. PMID- 10135892 TI - The credibility factor. Credibility is the foundation of leadership. PMID- 10135893 TI - Whistleblowing. PMID- 10135894 TI - Mallinckrodt Sensor Systems GEM Premier. PMID- 10135895 TI - Issues for laboratory outreach programs. AB - As we saw in the last "As We See It," many hospitals have begun outreach programs. We explored why outreach programs are established, the steps needed to develop a program, and the way to establish the proper business culture in a hospital laboratory for running a successful program. In this issue we identify the new skills laboratory managers need to be outreach managers, show how some programs maintain a competitive advantage, and explain some of the effects health care reform will have on outreach services, as we ask: What are the requirements and issues involved in operating a successful laboratory outreach program? PMID- 10135896 TI - Productivity in the clinical laboratory. PMID- 10135898 TI - Tort reform takes a back seat to financing reform. PMID- 10135897 TI - Chicago hospitals begin work on nation's largest health information superhighway. PMID- 10135899 TI - Home health care agencies: Part 1--Liability and risk management issues. PMID- 10135900 TI - Health care reform: a new employer/employee "deal"? PMID- 10135901 TI - EAP/managed behavioral health care providers: how to get what you pay for. PMID- 10135903 TI - Prevention is better than cure. PMID- 10135902 TI - Perspectives. HMOs sustain a backlash from providers and lawmakers. PMID- 10135904 TI - Voice evacuation--putting the accent on safety. PMID- 10135905 TI - Oh my aching back: ergonomics in healthcare. PMID- 10135906 TI - UV versus TB: the jury is still out. PMID- 10135908 TI - Alabama hospitals: a story in pictures. PMID- 10135907 TI - Primary care recruiting in an era of healthcare reform. PMID- 10135909 TI - A bright idea for dim times. PMID- 10135910 TI - Health care report cards: will they make the grade? AB - "Outcomes data are meaningless or misleading unless they are adjusted for severity of illness, presence of comorbidities, documentation of advance directives, and other factors not under the control of providers," observes Ohio State University Professor Timothy Jost, JD. Health care analysts also contend that the time that is required to analyze, complete, and report data can lessen the value of those data. Currently, health care report cards often require several years to produce. Hence, the data that are reported may not accurately reflect a health plan's or other provider's current performance, which can be affected by changes implemented since the data were collected. Also, some experts question the value and wisdom of giving report cards to consumers, who may not understand what the reports are measuring. As UHC official Sheila Leatherman summarizes: "There is no agreement about who should receive the data, in what format, and with what kinds of interpretative materials." "Physicians and others who utilize health care report cards need to be aware of their limitations," summarizes Don Nielsen, MD, associate medical director and quality consultant with Kaiser Permanente. However, the burgeoning efforts at national, state, and community levels to develop report cards should not be ignored, he says. Dr. Nielsen recommends that surgeons and other physicians work with health plans and other entities that are developing report cards to identify limitations in health care measures and data systems and to create better measures of provider performance. PMID- 10135911 TI - Training surgeons to care for the injured: the general surgery model. PMID- 10135912 TI - ACS ad campaign promotes patient choice. PMID- 10135913 TI - Congressional groups draft health reform proposals. PMID- 10135914 TI - Implications of the JCAHO information management initiative for information systems. PMID- 10135915 TI - Living with the JCAHO's IM initiatives. PMID- 10135916 TI - The JCAHO and the information and management systems professional. PMID- 10135917 TI - Preparing for the JCAHO survey. AB - In summary, the future success of a health care organization's ability to meet changing JCAHO standards will be dependent on the integration of information throughout the organization. The growing demand for reliable and accessible data for all levels of staff has become a daily need in health care. One of the key questions that will be posed by future JCAHO surveyors will center on current abilities to integrate and send information from a variety of sources to those who need the data within the organization. Many organizations are planning and implementing strategic plans to create linkages between existing information systems and further the overall systems knowledge of all staff. PMID- 10135918 TI - Inside insights: the JCAHO in its own words. PMID- 10135919 TI - Management of information in performance-focused accreditation. PMID- 10135920 TI - Palomar Pomerado Health System employs "second generation" know-how to achieve patient-focused care. PMID- 10135921 TI - Health executive outlook. Have I stayed too long? PMID- 10135922 TI - Hitting the great divide. The abortion issue, mostly ignored for months, suddenly threatens the outlook for Clinton's plan. PMID- 10135923 TI - Going flat out. The Clintons launch a last big road show for health reform but show hints of their readiness to cut a deal. PMID- 10135924 TI - Air medical dispatch: guidelines for scene response. National Association of Emergency Medical Services Physicians. PMID- 10135925 TI - Criteria for prehospital air medical transport: nontrauma and pediatric considerations. Air Medical Services Committee of the National Association of EMS Physicians. PMID- 10135926 TI - Is oral endotracheal intubation efficacy impaired in the helicopter environment? AB - INTRODUCTION: Patients transported by helicopter often require advanced airway management. The purpose of this study was to determine whether or not the in flight environment of air medical transport in a BO-105 helicopter impairs the ability of flight nurses to perform oral endotracheal intubation. SETTING: The study was conducted in an MBB BO-105 helicopter. METHODS: Flight nurses performed three manikin intubations in each of the two study environments: on an emergency department stretcher and in-flight in the BO-105 helicopter. RESULTS: The mean time required for in-flight intubation (25.9 +/- 10.9 seconds) was significantly longer than the corresponding time (13.2 +/- 2.8 seconds) required for intubation in the control setting (ANOVA, F = 38.7, p < .001). All intubations performed in the control setting were placed correctly in the trachea; there were two (6.7%) esophageal intubations in the in-flight setting. The difference in appropriate endotracheal intubation between the two settings was not significant (chi 2 = 0.3; p > 0.05). CONCLUSION: Oral endotracheal intubation in the in-flight setting of the BO-105 helicopter takes approximately twice as long as intubation in a ground setting. The results support pre-flight intubation of patients who appear likely to require urgent intubation during air medical transport in the BO-105 helicopter. PMID- 10135927 TI - Monitoring the appropriateness of air medical transports. AB - INTRODUCTION: With pending changes in the health-care system, there are increasing pressures for each aspect of health care to justify its use. Several organizations, including the Association of Air Medical Services (AAMS), have published position papers listing appropriate indications for air medical services. Additionally, the Commission on Accreditation of Air Medical Services (CAAMS) specifies that air medical services monitor their flights for appropriateness. The purpose of this study was to determine how often the air medical transports by this program met at least one of the AAMS criteria. METHOD: The AAMS position paper was paraphrased into an equivalent checklist and a category, "None of the above criteria met," was added. Immediately after each transport, a flight nurse indicated on the checklist which criteria the patient met supported by documentation in the flight care record. RESULTS: During a one year period (March 1, 1992 through February 28, 1993), 558 patients were transported. Of these, 547 (98%) met at least one of the AAMS appropriate-use criteria. CONCLUSION: The AAMS "Appropriate Use of Air Medical Services" position paper provides a foundation to monitor the utilization of an air medical transport program, which can be used to meet both government payer requirements for justification and the CAAMS requirement for utilization review. PMID- 10135928 TI - Data watch. A popular cost cutting tool: flexible benefits. A survey of 2,448 employers. PMID- 10135929 TI - Purchasing alliances: the linchpin in the reform debate. PMID- 10135930 TI - How Twin Cities employers are reshaping health care. PMID- 10135931 TI - The stormy debate over mental health. PMID- 10135932 TI - Will flex survive? PMID- 10135933 TI - Florida group reaps single-digit increases. PMID- 10135934 TI - Facing domestic partner issues. PMID- 10135936 TI - Employee uniqueness gains in value through programs that focus on diversity. PMID- 10135935 TI - Data tools: the promise and the problems. PMID- 10135937 TI - What makes a successful and credible healthcare human resources executive? PMID- 10135938 TI - Gainsharing works in an culture of involvement and ongoing communication. PMID- 10135939 TI - Put your faith in Popcorn and surprise your employees by marketing to mood. PMID- 10135940 TI - Florida hospital takes multi-faceted approach to addressing work-family needs; partnership school forges community bond. PMID- 10135941 TI - Resolving the merit pay dilemma demands HR involvement in compensation philosophy. PMID- 10135942 TI - Six HR directors create new employee feedback model and process. PMID- 10135943 TI - New compensation program merges interests of two organizations. PMID- 10135944 TI - Developing a recruitment database calls for a multimedia approach. PMID- 10135945 TI - New demands call for changes in job analysis and job descriptions. PMID- 10135946 TI - Joint union-management policy committee quells labor problems at Michigan hospital. PMID- 10135947 TI - Making mergers and reorganizations work: Take action fast to combat emotional trauma. PMID- 10135948 TI - St. Joseph's Hospital, Phoenix, prepares the way for total pay. PMID- 10135949 TI - Tough employment laws beckon HR professionals to become "risk management officers.". PMID- 10135950 TI - Hospitals brace for healthcare reform. PMID- 10135951 TI - Fairfax, VA, hospital settles 'glass ceiling' case: a shift in U.S. labor policy? PMID- 10135952 TI - From mainframes to PCs: Washington hospital is glad it leaped. PMID- 10135953 TI - San Francisco hospital reports smooth sailing for domestic partner benefits. PMID- 10135954 TI - Unlike men, all salary surveys aren't created equal. PMID- 10135955 TI - Consortium helps Colorado employers meet their dependent care needs. PMID- 10135956 TI - Needs assessment at core of effective work/family programs. PMID- 10135957 TI - West Virginia medical center makes orientation a process, not an event. PMID- 10135958 TI - Information systems: HR's long-lost friend and colleague. PMID- 10135959 TI - Legal rules and bottom-line reasons for pre-employment testing. PMID- 10135960 TI - Norfolk, Virginia hospital takes the first steps toward work redesign with vision statements. PMID- 10135961 TI - Pre-retirement savings and investment counseling get high marks from HR pro's. PMID- 10135962 TI - Keeping people at the center of work transformation. PMID- 10135963 TI - Benefits not uniform in hospitals across the nation: survey. PMID- 10135964 TI - HealthSpan prepares for new post-merger generation of benefits. PMID- 10135965 TI - Merit increases slow but healthcare is open to innovations. PMID- 10135966 TI - Hospitals, awaiting healthcare reform, cite labor needs. PMID- 10135967 TI - Some nurses in New York now covered by unique no-layoff clause. PMID- 10135968 TI - HR plays a key role in downsizing at California hospital. PMID- 10135969 TI - Q&A: what HR can do to fight 'layoff survivor sickness'. PMID- 10135970 TI - Wages give way to job security, work redesign, as labor's greatest concerns. PMID- 10135972 TI - Retirement savings: too little, too late without HR's help. PMID- 10135971 TI - Reference checks for forecasting candidates' performance. PMID- 10135973 TI - Retirement-benefit costs may be immune from healthcare reform. PMID- 10135974 TI - Supervisors deserve tender loving care. PMID- 10135975 TI - How to make performance pay a reality. PMID- 10135976 TI - What the future holds for hospital employee benefits. Roundtable discussion. PMID- 10135977 TI - Voice response systems: merits and drawbacks for benefits administration. PMID- 10135978 TI - Q&A: where hospital HR and the total quality imperative intersect. PMID- 10135979 TI - Then and now: Florida hospital customizes a trailblazing TQM effort. PMID- 10135981 TI - Hospital strikes: know the law--and be prepared. PMID- 10135980 TI - Idaho VA targets dietetics & workers' compensation for team-based TQM approach. PMID- 10135982 TI - Promoting top employees to supervisor may be a dangerous leap of faith. PMID- 10135983 TI - Wellness gainsharing pays dividends at Providence General. PMID- 10135984 TI - Value of opinion surveys outweighs executives' most common objections. PMID- 10135985 TI - Q&A: Grouping hospital employees by salary eases 401(k) education. PMID- 10135986 TI - The jury isn't out on dispute resolution--hospitals say they prefer it to court. PMID- 10135987 TI - At Community Hospitals Indianapolis, job security isn't here today, gone tomorrow. PMID- 10135988 TI - Nonsupervisory staff at Milwaukee hospital get a jump start on managerial skills to thrive, survive. PMID- 10135989 TI - Q&A: pulling the plug on sexual harassment. PMID- 10135990 TI - Physician integration and the IPA-model HMO. AB - Recently, IPA-model HMOs have increased their interest in integration. Other HMOs throughout the country are considering employing physicians to supplement their networks of independent physician offices. However, will this arrangement be beneficial? PMID- 10135991 TI - Analyzing patterns-of-treatment data to provide feedback to physicians. AB - Physicians' practice patterns can be influenced through feedback programs. The purpose of this article is to define a methodology that provides the feedback information necessary to affect physicians' practice patterns, using data collected by a large multispecialty physician group and individualized feedback plans for primary care physicians. PMID- 10135992 TI - Assimilating the Medicaid HMO population. AB - The integration of the Medicaid population into a commercial health plan will present numerous delivery, logistical, and administrative challenges for many of the nation's HMOs. The author highlights some of the changes that may be necessary for HMOs to successfully adapt to and address the needs of these new customers. PMID- 10135993 TI - Characteristics of high-cost older adults who are newly enrolled in an HMO. AB - With membership in Medicare-risk HMOs increasing, health plans are attempting to develop mechanisms to identify seniors who are "at risk" for high utilization and therefore increased costs. Developed in 1991, the Secure Horizons Health Inventory is a self-administered survey that questions new HMO members on self perceptions of health, the presence of chronic conditions, functional limitations, prior health care utilization, and the availability of social support. Early identification will enable HMOs to develop appropriate interventions to manage the care of these members. PMID- 10135994 TI - Home infusion therapy meets managed care: confrontation or cooperation. AB - The relatively uncommon experience of patients using home infusion therapy but at relatively great expense has led to problems, sometimes confrontational, between managed care organizations and home infusion therapy providers. The principal barriers to smooth contracting relationships are described by the author, who also proposes ways to create a win-win environment. PMID- 10135995 TI - The Medicare secondary payer program and its potential effect on the managed care industry: Part II. PMID- 10135996 TI - Capitation risks for pharmacy services. AB - In summary, capitated contracts may be executed, but only in specific situations where there is excellent utilization history, an ability for providers to implement controls, and only between partners who are motivated to achieve successful long-term relationships generally do not work to reimburse individual pharmacies, although they may have limited application in the contracting with manufacturers, or for HMOs or PBMCs providing pharmacy benefit to plan sponsors. In any type of capitated relationship, the buyer and the seller must exercise extreme caution. PMID- 10135997 TI - Prescription drug capitation: risk versus reward. AB - The unpredictable past and future of the prescription benefit business has resulted in an acute interest by plan sponsors in the concept of capitation. Capitation is effectively an insurance policy, offered by the provider, which will guarantee the cost of the prescription benefit. Such guarantees relative to the cost of the plan are attractive to the sponsor because they minimize risk and facilitate rate setting for HMOs and PPOs--and facilitate budgeting for corporate sponsors. Is capitation a cost-effective win-win alternative to traditional average wholesale price-based arrangements? PMID- 10135998 TI - Winners and losers. PMID- 10135999 TI - Remember cost control. PMID- 10136000 TI - Chafee at the bit. How Clinton squandered the chance for universal coverage. PMID- 10136001 TI - MultiCare Health System saves millions of dollars through redesigned care. AB - When executives at MultiCare Health System in Tacoma looked at future business projections, they knew they could not wait for healthcare reform. They needed to start now on a dramatic change process that would prove crucial to controlling their spiking costs. PMID- 10136002 TI - Point-of-care system enable St. Mary's patient-care restructuring. PMID- 10136003 TI - Clinical information systems sharpen patient focus at Sharp Memorial Hospital. PMID- 10136004 TI - HotList. Integration tools. AB - July's HotList features integration tools. Although many information systems vendors build custom interfaces or provide links to integrated systems, the focus of this Integration Tools HotList is to discover those companies who deliver truly useful tools for integrating disparate systems. All data provided by individual vendors responding to survey questions. Health Management Technology made every effort to contact all vendors within this market. Of 50 vendors contacted, 28 responded as offering integration tools. A full contact list may be requested by calling HMT editorial at (303) 220-0600. See The 1994 Health Management Technology Market Directory for complete listings. PMID- 10136005 TI - Interim life safety. AB - The field of life safety was developed by concerned individuals looking for a common cause in the loss of life during fires. Creating a safe building environment became their goal, which was partially achieved by studying egress, stairs, fire detection devices, and general occupancy. As long as the building design remains unchanged, the integrity of life safety remains. However, as buildings are subjected to renovation (both planned and unplanned), the integrity of life safety may diminish during the project. This decrease in life safety resulted in the creation of interim life safety measures. This document examines appropriate interim life safety measures. PMID- 10136006 TI - Plastics recycling in hospital: an evaluation of current and future opportunities. PMID- 10136007 TI - Choosing among infectious medical waste alternatives. PMID- 10136008 TI - Healthcare Resource Conservation Coalition (HRCC) business plan. PMID- 10136009 TI - Keystone components to a successful partnership. PMID- 10136010 TI - Creating the model guidelines for states. PMID- 10136011 TI - Statement of organization, functions, and delegations of authority; reorganization of the Medicaid Bureau--HCFA. PMID- 10136012 TI - Medicare program: data, standards, and methodology used to establish fiscal year 1994 budgets for fiscal intermediaries and carriers--HCFA. Final notice. AB - This notice is published in accordance with sections 1816(c)(1) and 1842(c)(1) of the Social Security Act which require us to publish the final data, standards, and methodology used to establish budgets for Medicare intermediaries and carriers. In this notice, we respond to the comments received in response to our notice of October 5, 1993 and we announce the adoption of the proposed data, standards, and methodology that we used to establish the Medicare fiscal intermediary and carrier budgets for fiscal year (FY) 1994, beginning October 1, 1993, as final and without revision. PMID- 10136013 TI - National Practitioner Data Bank: change in user fee--HRSA. PMID- 10136014 TI - Medicare program; revisions to payment policies and adjustments to the relative value units under the physician fee schedule for calendar year 1994--HCFA. Correction of final rule with comment period. AB - This document corrects technical errors that appeared in the final rule with comment period published in the Federal Register on December 2, 1993 (58 FR 63626) entitled "Revisions to Payment Policies and Adjustments to the Relative Value Units Under the Physician Fee Schedule for Calendar Year 1994." PMID- 10136015 TI - Medicare and state health care programs: fraud and abuse, civil money penalties and intermediate sanctions for certain violations by health maintenance organizations and competitive medical plans--HHS. Final rule. AB - This final rule implements sections 9312(c)(2), 9312(f), and 9434(b) of Public Law 99-509, section 7 of Public Law 100-93, section 4014 of Public Law 100-203, sections 224 and 411(k)(12) of Public Law 100-360, and section 6411(d)(3) of Public Law 101-239. These provisions broaden the Secretary's authority to impose intermediate sanctions and civil money penalties on health maintenance organizations (HMOs), competitive medical plans, and other prepaid health plans contracting under Medicare or Medicaid that (1) substantially fail to provide an enrolled individual with required medically necessary items and services; (2) engage in certain marketing, enrollment, reporting, or claims payment abuses; or (3) in the case of Medicare risk-contracting plans, employ or contract with, either directly or indirectly, an individual or entity excluded from participation in Medicare. The provisions also condition Federal financial participation in certain State payments on the State's exclusion of certain prohibited entities from participation in HMO contracts and waiver programs. This final rule is intended to significantly enhance the protections for Medicare beneficiaries and Medicaid recipients enrolled in a HMO, competitive medical plan, or other contracting organization under titles XVIII and XIX of the Social Security Act. PMID- 10136016 TI - Medicaid program; home and community-based services and respiratory care for ventilator-dependent individuals--HCFA. Final rule with comment period. AB - This final rule with comment period expands coverage of Medicaid home and community-based services under the waiver provisions of section 1915(c) of the Social Security Act. This final rule also adds coverage of respiratory care services as an optional benefit under State Medicaid plans. These revisions and additions incorporate changes made by the Consolidated Omnibus Budget Reconciliation Act of 1985 and the Omnibus Budget Reconciliation Act of 1986 and respond to the public comments that we received as a result of the June 1, 1988, publication of a proposed rule. This final rule with comment period also incorporates self-implementing provisions of the Omnibus Budget Reconciliation Act of 1987, the Medicare Catastrophic Coverage Act of 1988, the Technical and Miscellaneous Revenue Act of 1988, and the Omnibus Budget Reconciliation Act of 1990 concerning home and community-based services, and makes other technical changes not specifically related to these statutes. PMID- 10136017 TI - Preventing the Spread of Vancomycin Resistance--A Report from the Hospital Infection Control Practices Advisory Committee prepared by the Subcommittee on Prevention and Control of Antimicrobial-Resistant Microorganisms in Hospitals; comment period and public meeting--CDC. Notice. AB - This notice is a request for review and comment of the draft document, Preventing the Spread of Vancomycin Resistance--A Report From the Hospital Infection Control Practices Advisory Committee (HICPAC) Prepared by the Subcommittee on Prevention and Control of Antimicrobial-Resistant Microorganisms in Hospitals. The draft document was prepared in collaboration with the National Center for Infectious Diseases (NCID), CDC, and representatives of the American Hospital Association, American Society for Microbiology, Association for Professionals in Infection Control and Epidemiology, Infectious Diseases Society of America, Society for Healthcare Epidemiology of America, and Surgical Infection Society. PMID- 10136018 TI - The added value of Catholic health care: continuing the discussion. PMID- 10136019 TI - A managed care system: linking efficiency with quality. PMID- 10136020 TI - Pluralism, tolerance and euthanasia. PMID- 10136021 TI - Tuberculosis management in the home setting. AB - After years of decline, tuberculosis is on the rise again. Home care personnel are in an excellent position to help stem the tide by monitoring compliance in their clients and taking precautions for themselves. PMID- 10136022 TI - The center of caring: adult day care & the VNA. AB - Day care services in conjunction with home care aide services provide a cost effective, humane solution to caregiver burnout and/or the possible financial and emotional devastation of institutionalization. One adult day care center makes the most of community resources, including the local VNA. PMID- 10136023 TI - Senior place at the VNA. AB - Adult day care enhances the lives of a diverse population that benefits from the socialization and stimulation provided in a structured therapeutic group setting. The key to a successful program is to individualize as much as possible the care to each client while taking into consideration the needs of his or her support system. PMID- 10136024 TI - A different approach to evaluating home care service costs. AB - Agencies looking to compete in tomorrow's care provider market need to consider not only cost per visit, but overall cost per patient. This study uses parts of the Medicare cost report to compare cost per patient in 17 agencies in Connecticut and Massachusetts. PMID- 10136025 TI - Physicians strive for violence-free society. PMID- 10136026 TI - Are there amateurs at your disaster? PMID- 10136027 TI - AIDS phobia. PMID- 10136028 TI - Losing the human touch. PMID- 10136029 TI - Missing in action. On any given day in the United States, 3%-7% of the EMS work force is absent. PMID- 10136030 TI - Wheelchair wash day. PMID- 10136031 TI - Selecting the right seating. PMID- 10136032 TI - Healthcare waste reduction for a cultural shift. PMID- 10136033 TI - Waste management in the medical field. PMID- 10136034 TI - Rekindling the flame. PMID- 10136036 TI - Picking the right gift: lapsed donors, monthly pledges and everybody else. (Part four). PMID- 10136035 TI - More than ever philanthropy is essential in health-care reform. PMID- 10136037 TI - Lessons from America's fastest-growing companies. PMID- 10136038 TI - "Any willing provider" laws. PMID- 10136039 TI - Special report on taxation and corporate/finance nonprofit/for-profit affiliations. PMID- 10136040 TI - The need for federal standards on confidentiality of medical records. PMID- 10136041 TI - State refusal to pay Medicare coinsurance and deductibles: the beginning of a trend? PMID- 10136042 TI - Crime in hospitals 1992--the latest IAHSS survey. AB - The latest IAHSS annual survey, for 1992, has been expanded to include responses by foreign hospitals and to make available state-by-state comparisons. The highlights of this study, presented here, reveal a number of continuing trends featured in the 1987-1991 studies, as well as some significant new trends. Some 32 tables are included. PMID- 10136043 TI - Electronic technology: building a safe and secure healthcare community. AB - Everyone in the healthcare community should work together to provide a safe and secure health environment for patients, staff, and visitors. The author discusses the use of CCTV, electronic tagging, and photo ID badges and access control and the role they play in making healthcare more secure. PMID- 10136044 TI - Lowering the cost of healthcare through an effective safety program. AB - Today there are many concerns about the seemingly "unrestrained runaway battle" with health care costs. The author discusses three trends that result in increased patient costs, as well as how to use engineering controls, education, and employee "openness" to reduce overhead costs in order to benefit the patient and the hospital. PMID- 10136045 TI - Emergency preparedness: a hospital disaster plan. PMID- 10136046 TI - Hospital security in the 21st century--a blueprint for survival. PMID- 10136047 TI - It may be time to redefine security as a "profit center" in the healthcare industry. AB - Security, say the authors, should be viewed as a profit center that protects the patients, staff, visitors, property, and assets of healthcare organizations from violent crime, injury, theft, or vandalism ... and the resulting devastating litigation. Security services, which protect the "bottom line," should be a central part of any healthcare organization. PMID- 10136048 TI - Violence in healthcare: suggested interventions and strategies. AB - This paper on violence in healthcare was presented at the American Academy of Nursing on November 15, 1993 in Washington, DC. The author provides a systems approach to dealing with the potential for violence, as well as an approach to dealing with a violent incident or aggressive behavior. PMID- 10136049 TI - Establishing security awareness guidelines in a hospital setting. AB - The author gives the results of a security initiative at a multi-site, inner-city healthcare facility. He discusses the framework of the security department as well as the results of a personal security survey. PMID- 10136050 TI - Security and human resource professionals fight violence in the workplace. AB - The author focuses on how security and human resources must work together to fight violence. He provides specific actions they can take to protect employees from violent people and violent actions. With the help of training, security technology, and prevention awareness, all employees can become active participants in the reduction of violence. PMID- 10136051 TI - Stress and the security supervisor. PMID- 10136052 TI - How can hospitals operate safely? AB - The author expresses his views on why the healthcare community must adopt preventive security policies and their liability if they fail to act. Facilities must invest in more qualified personnel and up-to-date equipment for the hospital security program. PMID- 10136053 TI - Aggressive behavior management for nurses: an international issue? AB - Aggression against health care workers is a growing international issue. Nurses are especially vulnerable to the problem by virtue of the time involved in patient care. There are currently few programs available to train nurses in managing aggressive behavior, says the author. This study was designed to measure the effectiveness of an aggressive behavior management inservice on nurses' levels of knowledge and feelings of safety and confidence. PMID- 10136054 TI - Reports. The profit and the gloss. PMID- 10136055 TI - Why travel broadens the mind. PMID- 10136056 TI - Minor injuries units. Cut and thrust. PMID- 10136057 TI - Data briefing. Outcomes. PMID- 10136058 TI - Cost-effectiveness ratios: in a league of their own. AB - There is an increasing tendency for papers appearing in the medical literature to propose or use league tables of cost-effectiveness ratios as a means of comparing health-care interventions. In this paper we identify what the information in cost effectiveness league tables tells us and how this is inadequate and inappropriate for addressing questions about improving efficiency in the use of resources at either the broad system level or at the individual care-group level. We present an alternative approach which provides decision makers with a practical way of deciding whether the adoption of a particular programme represents an unambiguous improvement in economic efficiency. PMID- 10136059 TI - Hospital financing in Norway. AB - The Norwegian block grant reform of 1980 replaced state reimbursements to hospitals by block grants allocated to counties according to objective criteria. The reform was accompanied by a general decentralization of budget authority to local level. The reform aimed to promote primary care, equalize the supply of health care across regions and give counties incentives to improve hospital efficiency. A decade later, the reform was reversed. The government has imposed restrictions which reduce the budget discretion of the counties and part of the block grant has been made dependent on the performance of the hospitals in the counties. The government has also issued a 'waiting-list guarantee' which states that patients who suffer from a serious disease are entitled to medical treatment within six months. This paper provides an overview of hospital financing in Norway during the last two decades and discusses why the block grant system did not fulfil the expectations of its architects. PMID- 10136060 TI - EPA issues an update on time frames for CFC, HCFC phaseouts. PMID- 10136061 TI - Paper and cloth towels found to be more hygienic than air dryers. PMID- 10136062 TI - Want to improve a department's image, morale? Let workers try. PMID- 10136063 TI - Use of contract 'hotel' services up from 1993. PMID- 10136064 TI - Little lobby's whimsical design puts big smiles on the faces of sick children. PMID- 10136065 TI - The new law of supplies & demands. PMID- 10136066 TI - "General hospital now boarding ...". PMID- 10136067 TI - Shhhhh! Sound strategies for noise control in health facilities. PMID- 10136068 TI - Burn, baby, burn. 10 basic tips for better incinerator operations. PMID- 10136069 TI - Electronically controlled doors help make security an open-and-shut case. PMID- 10136070 TI - PCBs & mercury: the terrible twins of lighting disposal. Containing waste mercury. Second of two parts. PMID- 10136071 TI - Patients who seek death. PMID- 10136072 TI - The people's movement for environmental justice. PMID- 10136073 TI - Universal coverage: health reform hot button. PMID- 10136074 TI - Integrated delivery networks--community support facilitates merger. PMID- 10136075 TI - Health reform in Germany. An American assesses the new operating efficiencies. AB - In 1993, responding to a $5.7 billion deficit among the country's third-party payers, the German parliament imposed mandatory global budgets for physician, hospital, dental, and pharmaceutical services. Although Germany had been able to maintain health spending at a lower rate than the United States, an excessive supply of health resources was beginning to drive prices higher. During the three years the global budgets are in place, German third-party payers (the "sickness funds") and providers will implement several fundamental reforms. These include: Reducing excessive supply of specialists Constraining the acquisition and utilization of expensive medical technologies Reducing the annual number of physician visits per person Reducing average hospital length of stay Integrating community- and hospital-based physician services Reducing payroll deductions for mandated benefits The 1993 reforms also impose a budgetary cap at the 1991 expenditure level for drugs prescribed by community-based physicians. In addition, the reforms call for the implementation of community-rated premiums and stipulate that Germans be able to select their sickness fund each year. Although the reforms make important changes, they leave the basic German healthcare system intact. It is difficult to imagine, moreover, that any of the reforms being implemented will in the foreseeable future place any major element of the health system in serious financial peril; in fact, they will help preserve the system. PMID- 10136076 TI - German reform a model for U.S. A reply to Thomas Weil. PMID- 10136077 TI - Residents first. A long-term care facility introduces a social model that puts residents in control. AB - Four years ago the leaders at Providence/Mount St. Vincent, Seattle, decided to scrap the traditional medical model of long-term care and create an environment directed by the residents. The traditional system in nursing homes is designed to foster dependence. Our new social model, in contrast, is almost entirely directed by resident preference and need, and it places a high value on human interaction. So far we are having the most success with our assisted living program, which is built into apartment living as part of the rent. All services are available to all residents when they need them. The residents are forming warm relationships with resident assistants, and the flexible, nonmedical help they receive allows them to age in place. The nursing center has been divided into "neighborhoods" of about 20 residents, each with its own staff. A cross-trained, highly capable staff is essential to support resident independence and choice. In one experimental neighborhood, nonmedical tasks that nurses have traditionally done are now being reallocated to resident assistants, who are paid half as much as nurses. The physical heart of every remodeled neighborhood will be a kitchen, as we strive to create a homelike environment. Purposeful activity is replacing therapy in a void. And residents with cognitive impairments are gradually being integrated with more cognitively aware residents. We believe that in the long run, resident-directed care will be less expensive than the medical model. PMID- 10136078 TI - Information for integration. A senior services program spurs development of a multi-hospital integrated network. AB - In 1985 St. Charles Hospital, Oregon, OH, and Mercy Hospital of Toledo, OH, launched a plan to jointly offer a continuum of services to area seniors. A multidisciplinary team of professionals from both hospitals decided that a membership program (titled the Senior Advantage Program) would be the most effective way to market the services and make them available. As part of the program's development, professionals from the two facilities created a personal computer-based software package that enabled them to capture and update information about Senior Advantage participants. The software program includes a detailed application form and a section for recording enrollees' service utilization. The program enables care givers to enter data when they interact with clients in any healthcare or community-based setting. To complement the personal computer software, a program to construct a central data base was written for the two hospitals' main computer systems. In 1991 St. Charles and Mercy hospitals joined two other facilities to form First InterHealth Network, a for-profit integrated delivery network. The Senior Advantage Program became the basis for the first package of services offered by First InterHealth. In 1992 the program became the catalyst for yet another collaborative venture, linking two rural Ohio Mercy hospitals to St. Charles and Mercy hospitals. The expanded network encouraged rural patients to remain within the Mercy network, utilizing inner-city and suburban Mercy-sponsored hospitals when appropriate. PMID- 10136079 TI - Continuum of care comes full circle. Adding hospice care allows a Denver system to better meet patient needs. AB - In November 1993 Hospice of Peace, a home hospice program in Denver, was reorganized under a new joint sponsorship of Provenant Health Partners and Catholic Charities and Community Services. Home hospice completes Provenant's continuum of healthcare. Based on the campus of Provenant Senior Life Center, Hospice of Peace employs multidisciplinary professionals who care for patients and their family care givers in their homes. Each hospice team works with a patient's physician and comes from a pool of primary care nurses, certified nurse assistants, social workers, counselors, pastoral care counselors, and specially trained volunteers and bereavement counselors. Respect for human life at all stages is the ethic behind the organizations' hospice efforts. Even at life's end, when aggressive medical treatment is no longer appropriate, healthcare professionals can enhance patients' quality of life and provide bereavement support to their loved ones. Just as Catholic healthcare addresses the spiritual component of healing, so it addresses the spiritual component of dying. PMID- 10136080 TI - Collaborative efforts support poor elderly. A nursing center teams up with area churches to care for the elderly in their homes. AB - In many communities across the United States today, churches and hospitals are forming alliances to better serve the needs of the elderly. Bon Secours Hospital Villa Maria Nursing Center in North Miami, FL, sponsors programs that deter institutionalization. Villa Maria took these efforts one step further in September 1990 with the development of Project Good Help, a church-based outreach program that provides support services to help the poor, frail elderly continue independent living in the community. Villa Maria has coordinated the project with churches because they share a sense of mission. Only churches in areas where many needy elderly persons live are selected to participate in Project Good Help. Areas that lack services are given priority. Project Good Help often coordinates with other professional social service agencies to provide assistance. Catholic Community Services, for example, focuses on nutrition, and Project Good Help focuses on assessing unmet social service needs. The two community groups refer clients to one another. Project Good Help demonstrates that the healthcare and church communities can work together in innovative ways to provide cost-effective community service when they share a mission of caring for the poor and the elderly and are mutually supportive. PMID- 10136081 TI - Alternative medicine complements standard. Various forms focus on holistic concepts. AB - Western or conventional medical practices are founded on the principle of Newtonian physics; the body is viewed as a large clock whose broken parts are fixed or replaced. The placebo effect, hypnosis, psychoneuroimmunology, and spontaneous remission have recently inspired researchers to look beyond this mechanistic model toward a new paradigm of greater understanding regarding the entity we call "human beings." The premise of alternative medicine, based on the paradigm of whole systems, suggests that human beings are more than physical bodies with fixable and replaceable parts; they are a complicated network of pulsating energy frequencies often described in terms of a human aura. Western researchers now call this "the human energy field." Homeopathy, acupuncture, polarity healing, and the healing power of touch are only a few of the more common branches of holistic medicine that unite body, mind, and spirit for optimal health. The U.S. Congress has appropriated more than $2 million to the National Institutes of Health to research the validity of alternative or complementary medicines. In light of proposed changes in the healthcare system, alternative medicine may eventually be incorporated into the American structure of healthcare delivery. Proponents of holistic medicine agree that various forms of alternative medicine should be used to complement, rather than compete, with, the current accepted standard of healthcare. PMID- 10136082 TI - A futuristic healthcare delivery campus. PMID- 10136083 TI - Ethics and information systems: making values explicit. PMID- 10136084 TI - Relief for technophobic CEOs. PMID- 10136085 TI - Shared Corporate Ethics Committee. Two systems collaborate to enhance decision making. PMID- 10136086 TI - CHA study shows that incremental reforms are costly, dangerous. PMID- 10136087 TI - House calls to the homeless. PMID- 10136088 TI - Practice management comes of age. PMID- 10136089 TI - GP fundholding--half a good policy. AB - GP fundholding has arguably achieved more desirable changes in health provision than any other facet of the health service reforms, but as a policy it remains incomplete and deeply flawed. The challenge is to build on the policy without losing the considerable positive achievements of the scheme. Christopher Fewtrell describes how North Derbyshire Health Authority approached this complex policy dilemma. PMID- 10136090 TI - It's quicker by tube. PMID- 10136091 TI - Costing and competition. AB - Working for patients established a new system of contracts between providers and purchasers of healthcare, with prices based on full costs, avoiding cross subsidization. The new regime necessitates greatly improved costing systems, to improve the efficiency of service provision by creating price competition between providers. Ken Bates and Stan Brignall argue that non-price competition also occurs, with providers 'differentiating' on quality of service/product, flexibility or innovation. PMID- 10136092 TI - Out of the moral comfort zone. PMID- 10136093 TI - An ordinary life. The Northern Ireland experience. AB - The contraction of long stay psychiatric and mental handicap hospitals in Northern Ireland started later than in England and is proceeding more slowly. So far, the process appears to be a carefully planned one. Michael Donnelly and Nicholas Mays report. PMID- 10136094 TI - Home is where the quality is. PMID- 10136095 TI - Assessment of patient satisfaction as part of a physician performance evaluation: the Fallon Clinic experience. AB - Patient satisfaction surveys were used as part of the physician evaluation process in a 300-member physician group practice with a largely health maintenance organization (HMO) patient population. The surveys were incorporated into the review process at the request of physicians who wanted to be evaluated by patients. Results were shared with physicians to identify problem areas for improving patient care. One year later, follow-up surveys showed improvement in patient ratings of participating physicians. In addition, physicians indicated that the surveys significantly improved the evaluation process. PMID- 10136096 TI - Analyzing the content of physicians' medical practices. AB - For many large physician groups, about 75% of all revenues come from capitation contracts. These groups may reduce the variable expenses of patient care by conducting medical outcome studies. Physician groups will obtain the most benefit for their limited research dollars by focusing outcomes research on prevalent medical conditions. The purpose of this study is to provide a comprehensive analysis of the content of physicians' medical practices. We found that 21 diagnostic clusters defined 70% or more of the episodes treated by primary care physicians. For specialists, no more than eight diagnostic clusters were needed to define the majority of their practices. Outcomes research should initially focus on abdominal pain, acute lower respiratory infections, cataracts, cholelithiasis, congestive heart failure, diabetes mellitus, external abdominal hernias, ischemic heart disease, low back pain, maternity care, menstrual disorders, otitis media, peptic diseases, prostate cancer, psychotic episodes, renal calculi, seizure disorders, and thyroid diseases. PMID- 10136097 TI - Interventions to improve patient appointments in an ambulatory care facility. AB - Failed patient appointments in ambulatory care may result in decreased revenues. The purpose of this study was to determine if patient reminders would affect the "no-show" rate of a medical ambulatory care setting. Patients of 10 physicians participated in a 6-week study. Patients were randomly assigned to one of three groups: 2 weeks of appointment reminder postcards, 2 weeks of appointment reminder phone calls, and 2 weeks of no intervention. Chi-square analysis revealed significant differences between the control group and the two groups receiving interventions. Patient reminders may be a mechanism to decrease the no show rate in ambulatory care. PMID- 10136098 TI - Implementing continuous quality improvement in primary care: implications for preventive services. AB - The implementation of CQI must be done in a manner that capitalizes on the challenges of primary care, including the professional autonomy of the physician, the availability of data, issues of cost and efficiency of service, and the expanding role of patient expectations in quality care. Analysis of these factors is based on an ongoing study designed to help community-based primary care practices increase the utilization of prevention and early detection services offered to patients. PMID- 10136099 TI - Profiling of health care professionals, quality improvement, and ambulatory case mix systems: a commentary on the article by Douglas Cave. AB - Success of managed care programs is dependent on accurate risk-adjusted profiling of physician utilization and quality. The profiling can be utilized for either adjustment of capitation or feedback to physicians. Currently available tools are useful for feedback but not for capitation. PMID- 10136100 TI - The computerization of health care: can patient privacy survive? PMID- 10136101 TI - Health care reform: summary of the Clinton administration's health reform plan: American Health Security Act of 1993. PMID- 10136102 TI - Balancing confidentiality and liberal discovery: a unified approach to discovery disputes over HIV information. PMID- 10136103 TI - Ascending liability and attribution: corporate concerns for the 1990s. PMID- 10136104 TI - The psychotherapist-patient privilege in the federal court system. PMID- 10136105 TI - Bloodborne pathogens--is OSHA one step over the line? PMID- 10136106 TI - HIV blood test counseling guidelines. PMID- 10136107 TI - The tax status of vertically integrated health care delivery systems. PMID- 10136108 TI - Update: fraud and abuse and Stark laws. PMID- 10136109 TI - Health care reform: the Clinton proposal and congressional counterproposals--Part I. PMID- 10136110 TI - Health care reform: the Clinton proposal and congressional counterproposals--Part II. AB - Note: Part I of this Article appears in the January 1994 issue of the JOURNAL OF HEALTH AND HOSPITAL LAW (V. 27, No. 1). Part II continues discussion of the potential effects of reform for the structure and financial security of various types of health care providers; identifies some possible effects of reform on health care facility operations; and describes proposed amendments to existing law appearing in various reform proposals. PMID- 10136111 TI - Boren Amendment litigation: an analysis. PMID- 10136112 TI - Multispecialty group practice liability and the continuous course of treatment doctrine. PMID- 10136113 TI - The constitution and clinic protests: the battlefield of abortion rights adversaries. PMID- 10136114 TI - The legal implications of medical practice guidelines. PMID- 10136115 TI - Obligations of state Medicaid programs to pay Medicare cost-sharing amounts for low-income Medicare beneficiaries. PMID- 10136116 TI - Arbitration or litigation: efficacy and fairness in resolving medical malpractice disputes through arbitration proceedings. PMID- 10136117 TI - The practice standard of care and liability of managed care plans. PMID- 10136118 TI - Give residents tax facts that save them money. PMID- 10136119 TI - Take advantage of the financial times. PMID- 10136120 TI - How to integrate risk management and quality assurance. AB - While implementing a coordinated quality assurance/risk management program requires resources, primarily for training, it's hard to match the dual benefits of improved resident care and strong protection for your facility's financial resources. PMID- 10136121 TI - When problems aren't easily solved. AB - In summary, it is essential and beneficial for long-term care facilities to seek help from ombudsmen during all phases of investigation related to resident/facility conflict. This vital relationship helps create more humanized institutions that are committed to residents' involvement in the total life of the facility, and to help residents pursue their personal interests without undue hindrance or unnecessary impediments. PMID- 10136122 TI - "Grandma, please"! AB - An intergenerational telephone reassurance line for latchkey children helps them cope with being home alone and keeps the volunteer older adults in the mainstream. PMID- 10136123 TI - Cardiovascular, oncology, trauma care indicators approved. PMID- 10136124 TI - New standards and accreditation process target health care networks. PMID- 10136125 TI - Joint Commission indicators help win managed care contract. PMID- 10136126 TI - One hospital's experience in redesigning an excellent patient education program. PMID- 10136127 TI - President's column ... testimony to the Subcommittee on Health, House Ways and Means Committee on February 1, 1994. PMID- 10136128 TI - A view from the top. PMID- 10136129 TI - Three groups join IMSystem as quality partners. PMID- 10136130 TI - 24-hour notice to precede random, unannounced surveys. PMID- 10136131 TI - Can malpractice really be kept out of court? PMID- 10136132 TI - Look who's guarding the gate to specialty care. PMID- 10136133 TI - How one group of specialists is coping with capitation. PMID- 10136134 TI - Are we Hippocrats or hypocrites? PMID- 10136135 TI - Do you really know the person you're hiring? PMID- 10136136 TI - Setting the right price for your practice. PMID- 10136137 TI - Talk about death with healthy patients? I always do. PMID- 10136138 TI - Ameritech readies healthcare unit. PMID- 10136139 TI - Finalists chosen for Chicago CHIN. PMID- 10136140 TI - Tally delayed in board dispute. PMID- 10136141 TI - EPA emission limits face AHA opposition. PMID- 10136142 TI - Federal judge pushes back date for Iowa hospitals' antitrust trial. PMID- 10136143 TI - Health Net, provider consortium agree to five-year capitation deal. PMID- 10136144 TI - Talks are last hope for reform. PMID- 10136145 TI - Infant's AIDS case underlines need for hospitals' vigilance. PMID- 10136146 TI - Vendors buy their way into market. PMID- 10136147 TI - HHS' fourth fraud alert puts spotlight on drug companies. PMID- 10136148 TI - Calif.-based Sharp taps Mexican markets. PMID- 10136150 TI - Deadline this week for wage index comments. PMID- 10136149 TI - N.J., Pa. physician groups starting own health plans. PMID- 10136151 TI - Academic centers await reform outcome. PMID- 10136153 TI - AHA seeks test run on star rating plan. PMID- 10136152 TI - Shareholder fights AmeriHealth's deal to merge with firm. PMID- 10136154 TI - Columbia/HCA backs hospital's expansion. PMID- 10136155 TI - Hospitals hold line on nuclear medicine. PMID- 10136156 TI - Group's plan aims to cut deficit. PMID- 10136157 TI - Nurse panel not a federal initiative. PMID- 10136158 TI - Columbia/HCA to buy first Neb. hospital. PMID- 10136159 TI - Noncompete clause dropped in Fla. PMID- 10136160 TI - Panel rules in physicians' favor. PMID- 10136161 TI - 'Safety zone' for networks expected in new guidelines. PMID- 10136162 TI - When protesters come calling. PMID- 10136163 TI - States look to regulate quality. PMID- 10136164 TI - Managed care complicates bill collections. PMID- 10136166 TI - How to make the OR a 'learning organization'. PMID- 10136165 TI - Controversy prompts revision of AAMI's flash sterilization standard. PMID- 10136168 TI - Small rural hospitals meet efficiency goals. PMID- 10136167 TI - New techniques needed as CFCs are taken off market. PMID- 10136169 TI - Hospital mixes collaboration, case management. PMID- 10136170 TI - How managers can evaluate new sterilization technologies. PMID- 10136171 TI - Teamwork fosters successful, pleasing environment for patient accounts employees. AB - If a patient accounts manager can cultivate teamwork successfully--if he or she can "tear down the walls" and "open up the lines of communication"--a positive and productive working environment can be created. Too often, though, invisible barriers exist within a patient accounts department: One area is in conflict with another area, representatives from each area blaming the other for high receivables and low cash flow. If this situation exists, the atmosphere it creates ultimately is reflected in every employee's performance. Further, if a patient accounts manager is engulfed by this atmosphere, his or her support staff certainly will be affected adversely. PMID- 10136172 TI - Improving "medical necessity" acceptance by health care providers and consumers. AB - A major problem for patients and providers has existed since establishment of peer review and authorization agency medical necessity guide lines, because physicians and patients who receive denial of proposed procedures and tests on the basis of so called "medical necessity" presume that the authorization agency considers the proposed procedure or test to be medically unnecessary, meaning of no health value to the patient. This may well not be the case. Both providers and consumers can be expected to be more accepting of negative authorization decisions if the principles of continuous quality improvement are brought to bear on the authorization process. PMID- 10136173 TI - Changes to National Practitioner Data Bank reporting--effective or not? AB - Unless a physician has been living in another galaxy far, far away with Luke Skywalker, he or she is aware of the National Practitioner Data Bank. On March 31, 1994, the Department of Health and Human Services (HHS) announced that each practitioner can now place in the Data Bank a six-hundred character "rebuttal" of a report, without formally disputing the factual accuracy of the report. Does this change make the Data Bank fair? Not really. It is a step in the right direction, but further reform is needed. "Health Law" is a regular feature of Physician Executive contributed by Epstein Becker & Green. Mark Lutes of the law firm's Washington, D.C., offices serves as editor of the column. PMID- 10136174 TI - A manual for managed care physicians: why needed, how developed, and how used. AB - This article describes the development of and rationale for a "Physician Manual" in a managed care setting. The article begins with introductory information on the use of similar documents in industry generally and then provides background information on the author's organization. The contents of the manual are given in outline form, with additional details provided as necessary. The need to regard the manual as a "living" document is emphasized, and probable reasons for change are noted, along with recommendations for intervals at which review and change are appropriate. PMID- 10136175 TI - I get paid fast; what about you? AB - The process of billing an insurance company for health care services has changed radically. In the past few years, the emphasis has been on automation. The change is fueled by the opinion of cost containment experts who claim that automation will help reduce costs in the U.S. health care delivery system. Key to success for the provider in adapting to this change will be understanding the coding used in the billing process and following standards of accuracy and fairness. This article is not intended to represent the adjudication rules of any particular insurance company. It is the result of experience as a practicing surgeon and as a consultant in the health care field. PMID- 10136176 TI - Bringing baby home: a comprehensive case management program for obstetrical services. AB - Originally presented to the Society of Home Health Care Management of the American College of Physician Executives at its November 16, 1993, meeting in Tucson, Ariz., the program described in this article was the winner of the College's 1994 Innovations Award in Medical Quality Management, sponsored by Merck Sharp & Dohme. The program shows the potential of case management for both improvement in the quality of care and containment of costs for a managed care population with a substantial Medicaid segment. This article is part of a continuing series on innovative programs in home health care. PMID- 10136177 TI - Physicians and economics: a commentary. AB - This article discusses the physician in the United States in relationship to economics. Because economics forms the basis of most of the debate concerning health care in this country, it is important to look at the physician's background, position, and future as they relate to this important area. Eight economic encounters met by the physician are considered: the physician's relationships with knowledge, patients, peers, hospitals, medical technology, malpractice, managed care, and the future. The purpose is to encourage discussion and introspection and to suggest possible future avenues of education and training to address more completely the economic necessities that now are so closely entwined with the profession. PMID- 10136178 TI - Magazine style meets the annual report. Morton Plant Hospital, Clearwater, FL. PMID- 10136179 TI - Toned-down report supports excellence theme. AvMed-SantaFe, Gainesville, FL. PMID- 10136180 TI - Weathering natural disasters. How two hospitals steered communications and public relations through a hurricane and an earthquake. Santa Monica Hospital Medical Center; Baptist Hospital of Miami. PMID- 10136181 TI - Balancing safety and service. Visitor ID program reduces disturbances 43 percent. Northeast Alabama Regional Medical Center, Anniston. PMID- 10136182 TI - What identity crisis? Corporate style manual gives healthcare system brand name. MeritCare Health System, Fargo, ND. PMID- 10136183 TI - Putting a freeze on cancer. Community hospital promotes cryosurgery to consumers, physicians, and community. Underwood-Memorial Hospital, Woodbury, NJ. PMID- 10136184 TI - A quality clearinghouse. Resource center provides staff expertise and materials and tracks system-wide team projects. Lutheran General HealthSystem, Park Ridge, IL. PMID- 10136185 TI - Attention to detail pays off. Screenings increase 30 percent after hospital offers same-day test results. Canonsburg General Hospital, PA. PMID- 10136186 TI - Choosing Dr. Right. Network invites employers and individuals to pick its doctors during open enrollment. Southern California Healhcare Network Medical Foundation, Glendale. PMID- 10136187 TI - Electroconvulsive therapy. AB - Electroconvulsive therapy (ECT) has evolved into a useful treatment alternative for a select psychiatric patient population. With thorough knowledge of ECT and judicious candidate selection, positive therapeutic responses can be achieved with minimal risk of complications. ECT, in its state-of-the-art application, offers certain severely-ill psychiatric patients a treatment option that can provide immediate results. PMID- 10136188 TI - New emphasis on strategic planning. AB - Increasingly, administrators will need to rely on aggressive and ongoing planning processes to stay abreast of changes in healthcare. Mr. Bouchard asserts that "strategic planning can help us manage inevitable change" and describes various approaches to planning. He includes a list of questions to help you examine your current practices and supplies a sample strategic plan to prompt ideas and get you started with your plan. PMID- 10136189 TI - Outcomes research: too good to be true. AB - For the past five years, a government agency has used outcomes research techniques in an attempt to discover which medical interventions produce the best results. Mr. Hage doubts the efficacy of the approach and examines the debate about whether outcomes research is a cost-effective way to evaluate clinical techniques. PMID- 10136190 TI - Climbing the ladder: evolution of a clinical advancement program. AB - Clinical advancement programs have been popular in nursing for years and have only recently permeated allied health disciplines, including radiography. In this article, the author explores the evolution of a clinical advancement program at his institution, involving radiographers of all disciplines and sonographers. The evolution of the program at Riverside Methodist Hospitals over the last three-and a-half years is explored as a follow-up to the article "Approaching Clinical Advancement in Radiology," published in Radiology Management 13.4, fall 1991. PMID- 10136191 TI - Preparing radiology staff to meet service goals: a training model. AB - This article describes a model used to train radiology staff in customer service relations at a large southeastern medical center. Information about the needs of the radiology department and staff was acquired through quantitative and qualitative assessments. The primary goal of the training was twofold: 1) to develop employee awareness of customer expectations and 2) to develop problem solving skills to respond to customer service related issues. Instructional methods compatible with adult learning were used and training results were assessed. Positive changes in employee attitudes and behaviors are described and recommendations for training development and implementation are discussed. PMID- 10136192 TI - The view of a select group of leaders in radiology administration regarding the baccalaureate graduate of the future. AB - Radiology administrators are experts able to provide radiography educators with the input they need to produce competent graduates. This article reports on the view of a group of leaders in radiology administration regarding the need for, and the skills needed by, baccalaureate graduates in radiography to meet the needs of the future. In general, there was support for the baccalaureate graduate as an adjunct to the two-year graduate, although some felt that baccalaureate programs would provide inadequate technical preparation. The results of this research were used in a strategic plan for the development of a new baccalaureate program in radiography. PMID- 10136193 TI - Transporting acutely ill patients: a framework for radiology. AB - Concern grew at Ms. Doherty-Simor's institution about the proper care and monitoring of inpatients traveling to the radiology department for exams after hours and on weekends, when radiology nurses were not usually available. In this article, she reports on the findings of a special task force, proposed solutions and the resultant improvements to patient care. PMID- 10136194 TI - Annual return rates to mammography facilities by women age 50 and older. AB - Data were collected at multiple mammography facilities to determine the use of inreach strategies for asymptomatic women age 50 and older and the annual return rates for screening by this age group. Interviews with 26 facility managers indicated that the majority use a reminder strategy. Using chart audits in a subset (n = 10) of the facilities of 475 randomly-selected patients, the return rate in 1991 (of patients seen in 1990) averaged 41% within 18 months after the 1990 appointment. Those data suggest that mammography providers, as well as the women they serve, could benefit from interventions to encourage annual mammograms. PMID- 10136195 TI - Excerpts from "Maintaining Radiation Protection Records". National Council on Radiation Protection and Measurements. AB - This is the last in a three-part series of articles reprinted from a report by the National Council on Radiation Protection and Measurements (NCRP). Section 5, "Workplace Records," is reprinted below. The Introduction and Section 2, "Guidance for Systemic Generation and Retention of Records Relating to Radiation Protection," were reprinted in the winter 1994 issue of Radiology Management, and Section 3, "Radiation Protection Program Records," appeared in the spring 1994 issue. PMID- 10136196 TI - AHRA survey. Part II: Job content and survey comparisons. AB - The AHRA Statistical Resource Committee presents the results of a recent survey of members about their job satisfaction, responsibilities, benefits and salary. Part II includes data and analysis of job content and comparison with prior surveys for administrative directors of radiology. Part III will focus on chief technologists and will be published in the fall issue of Radiology Management. PMID- 10136197 TI - R&I 400: segments. The 400 by segment. AB - This ranking shows how companies that made the 1994 R&I 400 placed within their segments. The top segment, burgers, showed 7.0% growth over last year. Contractors, while again No. 2, lost 8.4%, the biggest loss of ground among the segments this year. Pizza (which split this year from Italian) still managed to place as the No. 3 segment. For the second year running, recreation increased more than any other segment--up 28.6%. Segment reports detailing trends and company news begin after this ranking on p. 32. PMID- 10136198 TI - R&I 400: Health Care. Turmoil continues in health care. PMID- 10136199 TI - Balancing OR staff and patient rights in the face of HIV. PMID- 10136200 TI - Safe handling of antineoplastic drugs. AB - Managers should be aware of the hazardous properties of antineoplastic drugs and of the procedures and equipment commonly recommended to provide a safe working environment for employees, patients, and visitors. Compliance with the many published guidelines should help ensure passage of the inevitable Occupational Safety and Health Administration (OSHA) or Joint Commission inspection. Acute and chronic toxicities of the antineoplastic drugs, the potential for exposure in the workplace, and the basic guidelines for safe handling of these agents are reviewed. PMID- 10136201 TI - Managing oncology research protocols. AB - Oncology research protocol management is important for the effective execution of clinical trials with oncology patients. Clinical trials explore investigational drug safety, efficacy, and effectiveness. Investigational drugs have not received approval for widespread use and marketing by the Food and Drug Administration (FDA). The National Cancer Institute (NCI) has several branches concerned with investigational drug procurement, distribution, and recordkeeping of investigational cancer chemotherapy agents. Before an investigational drug is approved by the FDA for marketing in the United States, it must undergo several phases of pre-clinical and clinical trials. The Institutional Review Board (IRB) must review and approve clinical trials to ensure that studies meet legal, ethical, and scientific standards. The principal investigator (PI) takes responsibility for the clinical trial. Informed consent must be obtained from subjects before they may participate in clinical trials. The informed consent form is reviewed by the IRB. The investigational drug storage, accountability, ordering, distribution, and drug information dissemination process is improved with a pharmacy-coordinated investigational drug service. PMID- 10136202 TI - Oncologic emergencies. AB - Early recognition and prompt control are the two major factors in dealing with oncologic emergencies. The most common emergencies are tumor lysis syndrome, hypercalcemia, spinal cord compression, and superior vena cava syndrome. Emergencies in cancer can occur at any stage of the disease process or its treatment. It is very important that caregivers are able to recognize and manage these emergencies; serious complications can arise if they are not treated promptly. PMID- 10136203 TI - Chemotherapy administration. AB - The administration of cancer chemotherapy is a unique combination of scientific exercise and clinical practice. The clinical practice involves the holistic care of a human being whose cancer and normal physiology are unique. The scientific exercise includes the manipulation of doses, combinations, and administration schemes of the small number of chemicals known as chemotherapy. Bringing science and clinical practice together to formulate a treatment plan that offers the most favorable outcomes and that minimizes short- and long-term toxicities is a challenge. This article discusses the scientific rationale for various methods of chemotherapy administration and outlines the specific clinical steps necessary to achieve the most safe and efficacious administration plan possible. PMID- 10136204 TI - An overview of chemotherapy toxicities. AB - Understanding the toxicities associated with cancer chemotherapeutic agents is essential to pharmacists involved in the clinical management of oncology patients. Anticipation of various treatment-related toxicities may provide the opportunity for pharmacists to develop intervention strategies that could minimize or eliminate an expected side effect of chemotherapy such as myelosuppression, nausea, or emesis. Effective management of chemotherapy toxicities may lead to decreased lengths of stay in the hospital or administration of chemotherapy in the outpatient setting. This article addresses the onset of chemotherapy toxicities, the major organ system toxicities, and the management of many of these chemotherapy-induced toxicities. Chemotherapy dose modifications are discussed as well as maximum lifetime doses and the use of prophylactic medications to prevent various side effects. PMID- 10136205 TI - Stumbling into a deal. The president triggers a sudden scramble to push health care reform through Congress. PMID- 10136206 TI - How Medicare hits you where you live. PMID- 10136207 TI - Construction outlook. Recovery: gradual, extended, but still on track. PMID- 10136208 TI - Details. A slim tower packages multiple functions. New York University Medical Center. PMID- 10136209 TI - Place of healing. Minneapolis Pathways, MN. PMID- 10136210 TI - Rural hospital services in the southern region. PMID- 10136212 TI - New safety flooring enhances the working environment. PMID- 10136211 TI - Four new operating theatres and emergency department for Hutt Hospital. PMID- 10136213 TI - The Rainbow: a working model of health for the new environment. PMID- 10136214 TI - Employment issues associated with the delivery of home care. PMID- 10136215 TI - Ambulatory care quality measurement project final report issued. PMID- 10136216 TI - Cellular phones and radio transmitters in hospitals: what are the risks? PMID- 10136217 TI - Joint Commission approves fifteen new indicators for IMSystem. PMID- 10136218 TI - Perspectives. Public health: an unsung hero at risk. PMID- 10136219 TI - Perspectives. Try, try again: what's next for health care reform? PMID- 10136220 TI - Perspectives. Children's health care: dim prospects for a bright future. PMID- 10136221 TI - Investigating staff accidents--worth the effort? PMID- 10136222 TI - BMS (Bristol's Southmead Hospital) allows fewer to manage more while using less. PMID- 10136223 TI - Information--communication needs towards 2000. PMID- 10136224 TI - Completion of major new development at the National Hospital for Neurology and Neurosurgery. PMID- 10136225 TI - Printopia--how not to be short sighted when choosing a printer. PMID- 10136226 TI - Datapro at London hospitals. PMID- 10136227 TI - Fully integrated communications systems help achieve greater efficiencies in hospital administration. PMID- 10136228 TI - Key committees complete healthcare reform--AHIMA recommendations included. PMID- 10136229 TI - Joint Commission PTACs discuss a number of issues. PMID- 10136230 TI - Working together to improve clinical training for students and continuing education for HIM employees. PMID- 10136231 TI - Hospital-based training for health information practitioners. PMID- 10136232 TI - Developing an HIM department employee training program for our future. PMID- 10136233 TI - A virtual, longitudinal medical and insurance record. PMID- 10136234 TI - ASTM (American Society for Testing Materials) continues to work on CPR (computer based patient record). PMID- 10136235 TI - The use of facsimile (fax) machines to transmit medical information. PMID- 10136236 TI - 1994 AHIMA awards. PMID- 10136237 TI - Using data to manage capitation risk. PMID- 10136238 TI - Reducing managed care risk through better communication. PMID- 10136239 TI - Managing the risks of managed care. PMID- 10136240 TI - Managed care and emergency care: a risk management perspective. PMID- 10136241 TI - The 95% solution. As Clinton's reform heads for a cliffhanger, he turns it over to George Mitchell. PMID- 10136242 TI - Impending shortages dictate need for human resources strategic planning. PMID- 10136243 TI - Health One downsizes. PMID- 10136244 TI - CDC AIDS guidelines require tracking. PMID- 10136245 TI - Computers individualize training in infectious diseases. PMID- 10136246 TI - Hospitals ride the outsourcing wave. PMID- 10136247 TI - Using tests to hire the best--and avoid the rest. PMID- 10136248 TI - Injury prevention means less pain, big gain for New York hospital. PMID- 10136249 TI - Value-based comp: beyond the fold at Desert Hospital. PMID- 10136250 TI - A 21st-century glimpse at hospital labor needs. Roundtable discussion. PMID- 10136251 TI - In-house surveys at Riverside Methodist are flexible, routine. PMID- 10136252 TI - Petitions for union elections at hospitals post five-year increase, NLRB says. PMID- 10136253 TI - Internal surveys an ideal way to measure service expectations. PMID- 10136254 TI - Audit in prisons: views from outside and inside. PMID- 10136255 TI - Is choice of general practitioner important for patients having coronary artery investigations? AB - OBJECTIVE: To determine whether particular sociodemographic characteristics of patients with stable angina affected their general practitioners' (GPs') decisions to refer them for revascularisation assessment. DESIGN: Postal questionnaire survey. SETTING: Collaborative survey by the departments of public health medicine in each of the four health boards in Northern Ireland, serving a total population of 1.5 million. SUBJECTS: All (962) GPs. MAIN MEASURES: The relation between GPs' referral decisions and patients' age, sex, employment status, home circumstances, smoking habits, and obesity. RESULTS: 541 GPs replied (response rate 56%). Most were "neutral" towards a patient's sex (428, 79%), weight (331, 61%), smoking habit (302, 56%), employment status (431, 80%), and home circumstances (408, 75%) in making decisions about referral. In assigning priority for surgery most were neutral towards the patient's sex (459, 85%), employment status (378, 70%), and home circumstances (295, 55%). However, most GPs (518, 95%) said that younger patients were more likely to be referred, and a significant minority were less likely to refer patients who smoked (202, 37%) and obese patients (175, 32%) and more likely to refer employed patients (97, 18%) and those with dependents (117, 22%) (compared with patients with otherwise comparable clinical characteristics); these views paralleled the priority which GPs assigned these groups. The stated likelihood of referral of young patients was independent of the GPs' belief in ability to benefit from revascularisation, but propensity to refer and perception of benefit were significantly associated for all other patient characteristics. CONCLUSION: GPs' weighting of certain characteristics in reaching decisions about referral for angiography is not uniform and may contribute to unequal access to revascularisation services for certain patient groups. PMID- 10136256 TI - Audit of thrombolysis initiated in an accident and emergency department. AB - Early thrombolytic therapy after acute myocardial infarction is important in reducing mortality. To evaluate a system for reducing in-hospital delays to thrombolysis pain to needle and door to needle times to thrombolysis were audited in a major accident and emergency (A and E) department of a district general hospital and its coronary care unit (CCU), situated about 5 km away. Baseline performance over six months was assessed retrospectively from notes of 43 consecutive patients (group 1) transferred to the CCU before receiving thrombolysis. Subsequently, selected patients (23) were allowed to receive thrombolysis in the A and E department before transfer to the CCU. The agent was administered by medical staff in the department after receiving oral confirmation of myocardial infarction from the admitting medical officer in the CCU on receipt of fax transmission of the electrocardiogram. A second prospective audit during six months from the start of the new procedure established time intervals in 23 patients eligible to receive thrombolysis in the A and E department (group 2b) and 30 ineligible patients who received thrombolysis in the CCU (group 2a). The groups did not differ significantly in case mix, pre-hospital delay, or transfer time to the CCU. In group 2b door to needle time and pain to needle time were reduced significantly (geometric mean 38 min v 121 min (group 2a) and 128 min (group 1); 141 min v 237 min (group 2a) and 242 min (group 1) respectively, both p < 0.0001). The incidence of adverse effects was not significantly different. Nine deaths occurred (six in group 1, three in group 2b), an in-hospital mortality of 9.9%. Thrombolysis can be safely instituted in the A and E department in selected patients, significantly reducing delay to treatment. PMID- 10136257 TI - Comparative hospital databases: value for management and quality. AB - OBJECTIVES: To establish an accurate and reliable comparative database of discharge abstracts and to appraise its value for assessments of quality of care. DESIGN: Retrospective review of case notes by trained research abstractors and comparison with matched information as routinely collected by the hospitals' own information systems. SETTING: Three district general hospitals and two major London teaching hospitals. PATIENTS: The database included 3905 medical and surgical cases and 2082 obstetric cases from 1990 and 1991. MAIN MEASURES: Accessibility of case notes; measures of reliability between reviewers and of validity of case note content; application of high level quality indicators. RESULTS: The existing hospital systems extracted insufficient detail from case notes to conduct clinical comparative analyses for medical and surgical cases. The research abstractors at least doubled the diagnostic codes extracted. Interabstractor agreement of about 70% was obtained for primary diagnosis and assignment to diagnosis related group. These data were sufficient to create a comparative database and apply high level quality indicators designed to flag topics for further study. For obstetric-specific indicators the rates were comparable for abstractors and the hospital information systems, which in each case was a departmentally based system (SMMIS) producing more detailed and accessible data. CONCLUSIONS: Current methods of extracting and coding diagnostic and procedural data from case notes in this sample of hospitals is unsatisfactory: notes were difficult to access and recording is unacceptably incomplete. IMPLICATIONS: Improvements as piloted in this project, are readily available should the NHS, hospital managers, and clinicians see the value of these data in their clinical and managerial activities. PMID- 10136258 TI - Improving information given to patients before endoscopy: a regional audit. AB - To improve the information given to patients before endoscopy an audit was performed in 16 of 18 endoscopy units in Northern region. Details of current endoscopy information leaflets provided by the 16 respondents were discussed by nurses and consultants from the participating units, and a standard, including 12 separate items, was agreed. Each unit was provided with a comparison of its current leaflet with the standard, which highlighted areas for potential improvement. Six months later the participating units were again asked to provide details of the information; 13 replied, 11 of which had produced new leaflets and two which were in the process of doing so. In the initial survey only 35% (range 8-67%) of the items in the standard were included in the leaflets. Particular omissions were an indication of risks of procedures (three units), notification of follow up procedures (two), details for obtaining the results of the endoscopy (five), advice for people with diabetes (two) and providing a contact number for the endoscopy unit (four). In the repeat audit all 11 units had made changes to their leaflets and, overall, 80% of the items were included. Through this simple audit the range of information given to patients attending for endoscopy in the region has improved. PMID- 10136259 TI - Clinical guidelines: proliferation and medicolegal significance. AB - Guidelines seeking to influence and regulate clinical activity are currently gaining a new cultural ascendancy on both sides of the Atlantic. Statutory agencies may be charged with developing clinical guidelines, and civil courts, in deciding actions in negligence, could be influenced by standards of care expressed in guideline statements. Clinical guidelines are not accorded unchallengeable status: they have been subject to careful scrutiny by British and American courts to establish their authenticity and relevance. In the United States, compliance with clinical guidelines cannot be used as a defence against liability if a physician's conduct is held to have been negligent, and third party organisations can be held liable if their clinical guidelines are found to be a contributory cause of patient harm. Guidelines have not usurped the role of the expert witness in court. The importance the law attaches to customary practice means that atypical or bizarre guidelines are unlikely to be accepted as embodying a legally required standard of clinical care. PMID- 10136260 TI - Achieving health gain through clinical guidelines II: Ensuring guidelines change medical practice. PMID- 10136261 TI - All or nothing on health care. PMID- 10136262 TI - Will reform bankrupt us? PMID- 10136263 TI - With or without you. Mergers: forget Washington. Wall Street is reforming health care. PMID- 10136264 TI - Medicare program; periodic interim payments for hospitals and other providers- HCFA. Final rule. AB - This final rule responds to public comments on the January 21, 1988 final rule with comment period that implemented section 9311 of the Omnibus Budget Reconciliation Act of 1986. The January 21, 1988 rule described the circumstances under which the periodic interim payment (PIP) method is available for services furnished by hospitals and other providers. PMID- 10136265 TI - Uniform administrative requirements for grants and agreements with institutions of higher education, hospitals and other non-profit organizations, and with commercial organizations, foreign governments, organizations under the jurisdiction of foreign governments, and international organizations--DOL. Final rule. AB - The Department of Labor is issuing these regulations pursuant to the requirements of the Office of Management and Budget (OMB) Circular No. A-110 (Revised), which provides standards for obtaining consistency and uniformity among Federal agencies in the administration of grants and agreements with institutions of higher education, hospitals, and other non-profit organizations. This rule also applies to the Department of Labor's grants to commercial organizations, foreign governments, organizations under the jurisdiction of foreign governments and international organizations. OMB issued Circular A-110 in 1976 and, except for a minor revision in February 1987, the Circular remained unchanged until revised in 1993. To update the Circular, OMB established an interagency task force to review the Circular. The task force solicited suggestions for changes to the Circular from university groups, non-profit organizations and other interested parties and compared for consistency the provisions of similar provisions applied to State and local governments. The revised Circular and these regulations reflect the results of these efforts. PMID- 10136266 TI - Cost of hospital and medical care and treatment furnished by the United States; certain rates regarding recovery from tortiously liable third persons--OMB. PMID- 10136267 TI - Management of continuous quality improvement. PMID- 10136268 TI - Adapting quality management principles to a not-for-profit hospital. Case 1. PMID- 10136269 TI - Implementing a continuous quality improvement program. Case 2. PMID- 10136270 TI - Creating a continuous improvement environment within a functionally organized medical center. Case 3. PMID- 10136271 TI - A hospital system's CQI training for its CEOs. Case 5. PMID- 10136272 TI - Administrative grand rounds: a piece of the continuous quality improvement puzzle. Case 6. PMID- 10136273 TI - Implementing continuous quality improvement in a military hospital. Case 7. PMID- 10136274 TI - Initiating a common process for continuously improving key systems that affect customer satisfaction. Case 8. PMID- 10136275 TI - Consumers' expectations of quality and how hospitals meet them. Case 9. PMID- 10136276 TI - Formalizing quality management and continuous improvement in an organization where everyone is perfect. Case 10. PMID- 10136277 TI - The systematic improvement of services between a healthcare system and a national supplier. Case 11. PMID- 10136279 TI - Management of continuous quality improvement. Bibliography. PMID- 10136278 TI - Using CQI to improve patient food service. Case 12. PMID- 10136280 TI - Management of continuous quality improvement. Introduction. PMID- 10136281 TI - Chinese health behaviour: breaking barriers to better understanding. AB - Research into health behaviour among people of Chinese ethnic origin in Britain has been piecemeal and provides an inadequate basis for health prevention initiatives. A better understanding to direct future research and to facilitate the development of new health prevention initiatives among the Chinese community might be achieved by use of the Health Action Model. PMID- 10136282 TI - Audit of coding in gastrointestinal endoscopy. AB - The accuracy of the coding of gastrointestinal endoscopic procedures at Llandough Hospital was audited over 12 months. Although the endoscopy unit kept its own records, none of the staff were initially aware of the coding system used for endoscopic procedures for subsequent hospital activity analysis. Conventional typed discharge summaries were usually inadequate for coding purposes, and there was considerable variation in the proportion of procedures coded. Changes made to improve the accuracy and completeness of coding for endoscopic procedures were seen to be effective in a follow-up study. PMID- 10136283 TI - Health-related behaviour in Wales, 1985-1990. AB - This study looked at recent changes in Wales in four health-related behaviours: smoking, alcohol consumption, diet and physical activity. Data are drawn from three large-scale surveys conducted across Wales in 1985, 1988 and 1990. The results show a reduction in smoking prevalence between 1985 and 1990 among men and women, and a growing trend towards healthier eating, with reduced frequent consumption of salt and foods high in saturated fats. Encouraging progress towards healthier living has been made, but the results also indicate the extent of the remaining challenge: greater progress is particularly needed to encourage participation in exercise, and to reduce the numbers of people who drink alcohol in excess of recommended sensible limits. PMID- 10136284 TI - Protective wear and instrument sterilisation/disinfection in UK general dental practice. AB - The 18,000 United Kingdom general dental practitioners registered for National Health Service (NHS) practice were surveyed in July 1991 to assess their current use of protective gloves, eyewear and masks, and instrument sterilisation. Nearly 7,000 (6,588) valid responses were obtained immediately; of these, 70% of practitioners wore gloves routinely for clinical work, but only 14.5% donned new gloves for each patient. About 60% wore protective eyewear routinely or all the time but 12% never wore eye protection, and only 36% of practitioners used masks. Autoclaves or chemical solutions were the most popular methods to disinfect handpieces, but less than half the respondents stated that handpieces were sterilised or disinfected after each patient use. Most respondents (81%) routinely used autoclaves for sterilisation of other instruments. Although the response rate to the questionnaire was low, the results indicate that, despite the risks of, and publicity about, cross-infection, a substantial number of NHS dental practitioners may not adequately disinfect or sterilise their equipment between patients. PMID- 10136285 TI - Pertussis immunisation in children with a family or personal history of convulsions: a review of children referred for specialist advice. AB - Recent guidelines recommend that children with a family or personal history of convulsions should receive all vaccinations. To determine vaccination status and adverse events following vaccination, questionnaires were sent to the general practitioners of 83 children referred for specialist advice between January 1988 and June 1991 in Redbridge Health Authority. Details of consultations within seven days of vaccination, and of any subsequent neurological or developmental problems were collected. Follow-up data were obtained for 77 of the 83 children (93%); 66 of whom had a family history, and 11 a personal history, of convulsions. Of the 66 children with a family history of convulsions, 57 received pertussis-containing vaccines, of whom one child was reviewed for a possible neurological event. Of the nine remaining children who received diphtheria tetanus (DT) only vaccine, two children were reviewed for possible neurological events. Of the 11 children with a personal history of convulsions, nine received pertussis-containing vaccines and two received DT vaccines; none had any further neurological event. At late follow-up, none of the 77 children vaccinated had developed recurrent convulsions or any other neurological or developmental problems. Children with a family or personal history of convulsions who are given pertussis-containing vaccines seem unlikely to suffer adverse events or long-term neurological sequelae, and should be considered for all routine vaccinations in line with current recommendations. PMID- 10136286 TI - Reports on confidential enquiries into maternal deaths: an audit of previous recommendations. AB - An audit of facilities recommended to be available in consultant obstetric units (COUs) in the United Kingdom (UK) received responses from 248 (95%) of all 260 COUs. Of the respondents, 86% were on the site of an acute general hospital, 76% had an intensive therapy unit on site, and 87% had a blood bank on site. Eighty two per cent had a protocol for management of massive haemorrhage, and 91% had a local protocol for the management of severe pre-eclampsia/eclampsia. The development of Regional protocols and advisory centres for the management of hypertensive disorders is at present fragmentary. Purchasers and providers should give urgent attention to correcting remaining deficiencies, and the availability of recommended facilities and protocols should be taken into account when units are assessed for recognition for training. PMID- 10136287 TI - A 'compass' for general practitioner prescribers. AB - This paper records the result of research and development in interrogating a general practitioner prescription pricing database to provide customised analysis for every practice. The system 'COMPASS' (Computerised On-line Monthly Prescribing Analysed for Science and Stewardship) is described, and identifies instances where each practice might improve cost-effectiveness and scientific rationality in prescribing. One hundred and two such instances are interrogated. This initial COMPASS report is then supplemented by screening the database to show a practice's: 1. range of drugs used--an excessive range should be discouraged. 2. use of drugs often used imprecisely--eg, antibiotics. 3. predicted prescribing cost--based on practice demography. 4. use of drugs with very limited GP value--eg, peripheral vasodilators. Northern Irish fundholding general practitioners are finding COMPASS valuable in planning improvement in cost-effectiveness and quality. PMID- 10136288 TI - Twenty-five years of development in general practice. PMID- 10136289 TI - Postgraduate medical education in the NHS: increasing effort and impact through 25 years. PMID- 10136290 TI - The new NHS: challenges and opportunities for medical and nursing education. PMID- 10136291 TI - How to disarm health care's hidden bomb. PMID- 10136292 TI - The new worker elite. PMID- 10136293 TI - Paying attention to basics can make or break a merger. PMID- 10136294 TI - Physician practice association gains appeal. Medical Group Management Association, Denver, CO. PMID- 10136295 TI - Multi-leveled PHOs fulfill market needs. PMID- 10136296 TI - Understanding HEDIS (Health Employer Data Information Set) can help providers attract health plan contracts. PMID- 10136297 TI - Making the transition to a new environment requires forethought and planning. PMID- 10136298 TI - Commercial DRG contracts help providers adjust to capitated reimbursement. PMID- 10136299 TI - Assume insurance reforms, not health care reform. PMID- 10136300 TI - Hospital provides contract security for nearby rehab facility. PMID- 10136301 TI - Watch out for: bombs and bombers. PMID- 10136302 TI - How hospital overcame community's security fears about new garage. PMID- 10136303 TI - How perimeter security keeps hospital crime rate low in high-crime area. PMID- 10136304 TI - Special report. Upgrading security: hospitals opt for new equipment; new approaches; heavy investments in additional patient, employee protection. AB - An increasing number of hospitals are taking steps to prevent the violence that plagues both urban and rural areas from spilling over into their emergency rooms and nursing units. Four facilities--Duke Medical University Center, Durham, NC; Children's Hospital, Columbus, OH; Ingalls Hospital, Harvey, IL; and University Medical Center, Las Vegas, NV--have recently installed new equipment or implemented innovative security procedures in an effort to better protect patients and employees. Although the price tag for additional protection is often high, officials at the hospitals agree that providing a safe environment is worth the investment. PMID- 10136305 TI - Khallid Muhammad at Riverside Hospital: what happened. PMID- 10136306 TI - Staffing redesigned to fit new facilities. PMID- 10136307 TI - Monitoring nutrition intervention outcomes. PMID- 10136308 TI - Revenue-producing clinical nutrition services. PMID- 10136309 TI - Benefits reported from cashless cafeteria. PMID- 10136310 TI - Controlling the cost of nurse recruitment: an administrator's challenge. AB - One of hospital administrators' many challenges is the recruitment of nursing staff. This article explores eight hospitals' recruitment strategies as well as these methods' direct and indirect costs. It also provides suggestions for administrators on how to improve their recruitment procedures. PMID- 10136311 TI - Facility planning and development in Latin America. AB - Since the mid-1980s, the author has been involved in the development of healthcare facilities in the Caribbean and Latin America. This article highlights his experiences to date and provides insights relative to the many challenges U.S. developers and contractors might encounter when exporting U.S. healthcare expertise to Caribbean and Latin American countries. PMID- 10136312 TI - Managing biomedical waste in Ontario: a regional approach. AB - The lack of landfill space, public perceptions, the escalating costs of disposal, and other factors have created a controversial environment for the disposal of healthcare waste. In the province of Ontario, a proposal has been made that aims to make Ontario self-sufficient in its management of healthcare waste through the use of regional incineration facilities. This article examines this proposal as well as other available options for Ontario's healthcare facilities. PMID- 10136313 TI - The role of clinical engineers in hospitals: essential or expedient? AB - This article explores the capabilities of those technicians and clinical engineers who manage biomedical equipment. Equipment technicians maintain the equipment in hospitals and may participate in some basic equipment management. Clinical engineers, on the other hand, may augment this management effort in equipment-intensive hospitals by designing the specifications and procedures needed to integrate equipments into properly working systems and to maintain them under local conditions. In addition, clinical engineers can improve equipment management by providing an engineering viewpoint to such areas as technology assessment, computer applications, quality improvement, and in-service education. PMID- 10136314 TI - Right to die--duty to die. The growing debate over scarce resources. PMID- 10136315 TI - Employee alcoholism in the healthcare setting. AB - Alcoholism is the United States's most serious drug problem. Within the health services, it is detrimental to the function of an organization as well as its employees. This article examines alcoholism in the healthcare organization and offers suggestions on how health services administrators can manage employees who demonstrate alcoholic symptoms. PMID- 10136316 TI - Learning disabilities. Moving out. PMID- 10136317 TI - Carers. A careful match. PMID- 10136318 TI - Research ethics. As plain as can be. PMID- 10136319 TI - Community hospitals. Cottage industry. PMID- 10136320 TI - Data briefing. The future. PMID- 10136321 TI - Managing risk. A priority in the Health Service. PMID- 10136322 TI - Patient satisfaction. Happy talk. PMID- 10136323 TI - Needs assessment. On the waterfront. PMID- 10136324 TI - Contracting. A leap in the dark. PMID- 10136326 TI - Internal audit. Called to account. PMID- 10136325 TI - Information management. Has HISS run out of steam.... PMID- 10136327 TI - Guernsey. Island remedies. PMID- 10136328 TI - Outreach clinics. The special branch. PMID- 10136330 TI - Consumer audit. Eye opener. PMID- 10136329 TI - Go with the flow. PMID- 10136331 TI - Drug information. Made to measure. PMID- 10136332 TI - User involvement. Open plan. PMID- 10136334 TI - Communications. On the record. PMID- 10136333 TI - Management fashions. Flights of fancy. PMID- 10136335 TI - Cancer services. Caring for cancer. PMID- 10136336 TI - Mental health staffing. The secret service. PMID- 10136337 TI - Nurse management. Pulling power. PMID- 10136338 TI - Elderly health needs. Wise words. PMID- 10136339 TI - Exercise. Gain without pain. PMID- 10136340 TI - A time to die. PMID- 10136341 TI - Primary care development. Family values. PMID- 10136342 TI - Care management. Mix and match. PMID- 10136343 TI - Organ donation. A matter of life and death. PMID- 10136344 TI - Management development. Out of the shadows. PMID- 10136345 TI - Antibiotic therapy in 1994: mechanisms of resistance. AB - Drug-resistant organisms are appearing with increasing frequency. Of particular concern are drug-resistant strains of enterococci, streptococci, and pneumococci. Bacteria use several adaptive mechanisms to thwart the actions of antimicrobials, including enzymes, alterations in cell membrane permeability, export of antibiotics from the cell, alteration of molecular structures, and transfer of resistance to other species. Countering the effects of resistance requires judicious use of antibiotic therapy and a clear understanding of the biologic mechanisms involved. PMID- 10136346 TI - DUEs for the '90s: multicentered, outcome-oriented. AB - The likely development of healthcare alliances and affiliations will create a logical role for multicentered DUEs that study treatment regimens or indications in a healthcare system made up of several institutions. Such a study is under way in New Jersey, involving 15 hospitals. The DUE is evaluating usage patterns of ticarcillin/clavulanate and two other broad-spectrum antibiotics. A multicenter DUE presents challenges, such as the need for additional resources and for consensus among disparate elements; but this methodology also opens up expanded roles for pharmacists, including participation in quality assurance activities. PMID- 10136347 TI - Current issues in the selection and use of broad-spectrum antibiotics. Roundtable discussion. PMID- 10136348 TI - Losers. AB - This is the third in an occasional series of columns concerning ethics issues in healthcare reform. The first, "A Matter of Principle," and the second, "Freedom of Choice," appeared in the September/October 1992 and March/April 1993 issues, respectively. PMID- 10136349 TI - Paradigms in progress, Part 1. Perverse economics. PMID- 10136350 TI - The illusive logic of integration. PMID- 10136351 TI - Balancing the budget at the bedside. PMID- 10136352 TI - Physician incentives in a managed care world. PMID- 10136353 TI - Political and practical milestones in clinical quality improvement, Part 2. Meeting society's root needs. PMID- 10136354 TI - Healthcare heresies. PMID- 10136355 TI - Reshaping the American hospital--a compendium on patient-focused care. PMID- 10136356 TI - The smell of success. PMID- 10136357 TI - Technology, medicine & health, Part 1. The complexities of tomorrow's medicine. PMID- 10136358 TI - Sound mind, sound body. Interview by Joe Flower. PMID- 10136359 TI - Changing course. 1994 Commitment to Quality Award. PMID- 10136360 TI - Visions: the futures of the heart. PMID- 10136361 TI - Communicating the vision. PMID- 10136362 TI - Making strategic planning vision-driven process. PMID- 10136363 TI - Administrative tools for operationalizing a continuum of care for children and youth with severe emotional disturbance. AB - Critical administrative functions in operationalizing a system of care approach to service delivery include: defining and selecting clients to be served, planning and developing responsive services, and ensuring that services are provided in the most therapeutic and least restrictive family and community-based environments. This article presents an overview of several administrative strategies and mechanisms developed by the Continuum of Care for Emotionally Disturbed Children in South Carolina to carry out these functions. Administrative tools are described, as well as the assumptions underlying their development. Evaluation methods, which include analyzing existing client data, surveying parents, and conducting research within a public/academic partnership, are also briefly described. PMID- 10136364 TI - Public sector financing of community-based services for children with serious emotional disabilities and their families: results of a national survey. AB - This article presents the results of a survey of all state directors of mental health programs for children on the agreement with and use of financial policies and practices which promote home- and community-based mental health care for children and adolescents and their families. Whereas only five states reported the implementation of all the financial mechanisms feasible in their states, a majority of states reported the use of mechanisms such as federal funds, state resources and incentives, and flexible funds to encourage the development of community-based care. Results also indicated that states with a local form of government or local district or board that served as the local mental health authority tended to have more of the community-based financial practices in place than did states that contracted directly with providers at the local level. PMID- 10136365 TI - Monitoring outcomes of services to children and youths with severe emotional disorders: an economical follow-up procedure for mental health and child care agencies. AB - Human services have been slow to develop and implement procedures for measuring the outcomes they are committed to achieve with clients. This is as true in child mental health and child care services as in other services. A method is described for getting follow-up data on youngsters with severe maladjustment (emotional disturbance, behavior disorder) at modest cost, yet high relevance. The method is part of the program monitoring and evaluation conducted routinely by the Pressley Ridge Schools and involves telephone interviews with each youngster and others during the summer of the year after the youngster's discharge from treatment. The process yields two kinds of reports with different functions: quantitative summaries of data and individual narratives that sketch each youngster's experience. The method, developed over eight years, has had favorable effects on the agency's services. PMID- 10136366 TI - Development of clinical methods for utilization review in psychiatric day treatment. AB - When a time-limited day treatment program was reconfigured to serve individuals with long-standing psychotic disorders, the number of treatment episodes exceeding six months rose to 70%. To justify this concentration of resources, the program needed methods to identify individuals for whom sustained treatment was appropriate. This report describes development of utilization review methods adapted to publicly funded day treatment of individuals with serious mental illness and training of clinicians in new documentation skills. Data from three years of operation suggest that symptom severity is not a reliable indicator of medical necessity in day treatment. As expected with a clinically based system, a composite measure of benefit and medical necessity indicators weighted toward functioning in living, learning, working, and socializing environments predicted physician reviewer denial of continued day treatment, but length of stay did not. PMID- 10136367 TI - Evaluating mental health care reform: including the clinician, client, and family perspective. AB - This article suggests one direction that theory building might take to develop a stronger conceptual foundation needed to test the effect on clients of reforms in the financing and organization of mental health care delivery systems. The authors recommend that health status outcomes be measured from three perspectives: the client, who can best report his or her own subjective experience of illness; the clinician, who is the best source of information about the client's disease; and the family, which is the best source of information about the effects on members' health status of caring for a mentally ill family member. The authors also recommend that measurement of health status should be multidimensional. PMID- 10136368 TI - PRN Pool in a mental health center setting. AB - Midtown Mental Health Center/Memphis and Shelby County Emergency Mental Health Services, Inc., is a community mental health center located in the downtown area of Memphis/Shelby County, Tennessee, a large urban metropolitan area. The center established a temporary pool of employees for each center program to provide coverage of critical positions. The PRN Pool is designed to minimize disruptions to client services during employee absences. The article outlines the benefits to the center, the employees, and the consumer. PMID- 10136369 TI - Having fits over retrofits. PMID- 10136370 TI - Alternate care sites. The challenges for GPOs, suppliers and materiel management. AB - As the United States healthcare delivery system evolves, the alternate care site market is creating challenges and opportunities for materiel managers, groups and alliances. To be effective, an alliance or GPO must provide value. Many network integrators are setting up wellness and "telephone triage" programs to keep people from entering the continuum of care at all. Alternate care sites will face the same cost constraints presently being felt in many hospitals. GPOs and alliances will therefore have to provide value to these sites in ease of use, meaningful benefits, easy administration, and working with the network and distributors. Materiel managers can play an important role by developing product standardization among sites, rationalizing distribution to sites by using one or perhaps two distributors to serve all of the alternate site providers in the network, using group contracts to lower acquisition prices and providing greater services. PMID- 10136371 TI - Changing the supply system paradigm. AB - Since revenues are fixed for a growing majority of patients, healthcare providers need to develop creative mechanisms for fixing and reducing costs in all aspects of their operations. Froedtert Memorial Lutheran Hospital in Milwaukee, WI, wanted to find a supply distributor, or distributors, interested in becoming our partner to accomplish five main objectives: 1) stabilize current supply costs at or below current line item pricing, 2) reduce supply costs per unit of patient service, 3) consolidate a broad range of supply sources to achieve economies of scale and more cost-efficient systems, 4) reduce supplier line item profit margins in exchange for broader market share within the hospital, and 5) establish a mutual commitment to supply cost measurement and control that evolves from the current focus on line item pricing to a system of procedure or unit of service pricing and cost control. Froedtert selected one prime vendor after an RFP process. Material Management will manage and monitor the program, with primary supply recommendations to come from the medical staff, nursing services and the Product/Service Analysis Committee. PMID- 10136372 TI - Mattress evaluation for long-term care facilities. AB - Patients spend more than a third of their hospital time in bed and considerably more than that if they are residents in a long-term care facility. When our facility, Fair Acres Geriatric Center, a 911-bed long-term care facility in Lima, PA, noticed increasing losses of our standard mattresses, we decided to evaluate new products. We listed very important criteria (bacteria resistance, flame retardation, self-deodorization and comfort and resiliency) and important criteria (stain resistance, cost and warranty) and then brought in three standard mattresses for our staff to evaluate. We were able to procure a mattress that met our criteria and halved our costs in the process. PMID- 10136373 TI - Lights, ultraviolet, germicidal. ECRI. PMID- 10136374 TI - Healthcare reform and the common good. PMID- 10136375 TI - Sterile storage standards. PMID- 10136376 TI - AMH completes transition to important functions. PMID- 10136377 TI - Does sedation constitute anesthesia? PMID- 10136379 TI - Staff competency is foundation of excellent care. PMID- 10136378 TI - President's column ... testimony delivered to the Subcommittee on Health, House Ways and Means Committee, on February 1, 1994. PMID- 10136380 TI - How surveyors assess staff competency. PMID- 10136381 TI - Doctors' earnings take a nosedive. PMID- 10136382 TI - Sometimes patients' rights are wrong. PMID- 10136383 TI - Facing burnout? Try this. PMID- 10136384 TI - I hired a male nurse for my OBG practice. PMID- 10136385 TI - Doctors keep the lid on fees. PMID- 10136386 TI - Just how short can hospital stays be? PMID- 10136387 TI - Is this group an illegal doctor monopoly? PMID- 10136388 TI - Is the malpractice data bank going public? PMID- 10136389 TI - K.C.-area health depts. seeking new roles. PMID- 10136390 TI - PHOs on the rise at children's hospitals--survey. PMID- 10136391 TI - Defense probe may involve Picker. PMID- 10136392 TI - Extensive consolidations continue in drug industry. PMID- 10136393 TI - Houston Methodist to lay off 600. PMID- 10136394 TI - AmHS to accept for-profits into membership fold. PMID- 10136395 TI - Plan would do little to cover uninsured--CBO. PMID- 10136396 TI - Providers attempt to rescue reform. PMID- 10136397 TI - California hospital disputes JCAHO's accreditation denial. PMID- 10136398 TI - Negotiating the road to reform. PMID- 10136399 TI - 1994 Up & Comers. AB - This year's Up & Comers are blazing a trail to the healthcare system of the year 2000 and beyond. Modern Healthcare profiles some rising stars, all 40 or under, in the new generation of healthcare executives who refuse to be bound by the past as they plan for the future. PMID- 10136400 TI - FTC OKs settlement in Santa Cruz case; private suit pending. PMID- 10136401 TI - Arguments heard in Cape Coral case. PMID- 10136402 TI - Proposed merger in Missouri under FTC antitrust scrutiny. PMID- 10136403 TI - Dubious tactics used to sell TennCare. PMID- 10136404 TI - CHIN makes vendors work together. PMID- 10136406 TI - Columbia/HCA adds large hospital. PMID- 10136405 TI - Hospitals assess managed care's effect on outlook. PMID- 10136407 TI - Columbia/HCA settles with Fla., agrees to close 50-bed hospital. PMID- 10136408 TI - Hospitals fear anti-abortion group's request. PMID- 10136409 TI - Managed-care execs get an academy. PMID- 10136410 TI - N.C. hospital agency links up with hospital. PMID- 10136411 TI - Foundation wins CHAMPUS contract. PMID- 10136412 TI - Not-for-profits win Utah case. PMID- 10136413 TI - HMO makes case for NCQA in Washington. PMID- 10136414 TI - JCAHO seeks inclusion in state reform legislation. PMID- 10136415 TI - Labor Department probes Blues' billing. PMID- 10136416 TI - Acute-care hospitals convince HCFA to nix payment change. PMID- 10136417 TI - Academic med center touts its comeback through an ad blitz. PMID- 10136418 TI - N.C. Baptist charges highest--survey. PMID- 10136419 TI - Giant drug companies put pressure on purchasers. PMID- 10136420 TI - Pair convicted in Kan. referral bribery case. PMID- 10136421 TI - Texas docs take lead in forming groups. PMID- 10136422 TI - HMO targets new markets. PMID- 10136423 TI - Long-term care gets watered down. PMID- 10136424 TI - Physician recruiting changing with the times. PMID- 10136425 TI - Senate liberals pose modest reforms. PMID- 10136426 TI - Guidelines to focus on task delegation. PMID- 10136427 TI - Calif. providers taking wrong tack. PMID- 10136428 TI - Good Samaritan, FTC settle 4-year dispute. PMID- 10136429 TI - Hospitals' antitrust woes may be unfounded--GAO. PMID- 10136430 TI - A blue streak for managed care. AB - The nation;s Blue Cross and Blue Shield organizations have taken the lead in managed care. Enrollment in their 76 HMOs recently reached 7.6 million. By exploring the opportunity to go public and other options, the plans are looking for even more growth in the field. PMID- 10136431 TI - Academic centers vie for research dollars. PMID- 10136432 TI - Providers boost immunization efforts. PMID- 10136433 TI - Hitchcock deal may be sign of things to come. PMID- 10136434 TI - 3rd-largest M.D. group formed through merger. PMID- 10136435 TI - Government may be losing in 'Medicare recapture' deals. PMID- 10136436 TI - Feds investigate 'partnership' in two-hospital city. PMID- 10136437 TI - Ga. to vote on antitrust amendment. PMID- 10136438 TI - Group seeks end of a merger. PMID- 10136439 TI - New cancer center to anchor network. PMID- 10136440 TI - Firms interpreting data for integration. PMID- 10136441 TI - Phoenix system reorganizes again. PMID- 10136442 TI - Calif. nurses file suit to stop work redesign. PMID- 10136444 TI - IRS issues warning on use of PHOs. PMID- 10136443 TI - Health Systems to acquire Conn. HMO firm. PMID- 10136445 TI - 60 K.C. docs forming multispecialty group. PMID- 10136446 TI - Mass. wants to examine more insurance fraud. PMID- 10136447 TI - Spending on preventive care urged. PMID- 10136448 TI - Congress running out of steam on efforts to pass health reform. PMID- 10136449 TI - Fla. hospitals drop trauma licenses. PMID- 10136450 TI - Report examines docs. PMID- 10136451 TI - Calif. legislation seeks HMO reforms. PMID- 10136452 TI - Physicians drive Northeast integration. PMID- 10136453 TI - More coverage for new devices urged. PMID- 10136454 TI - Build network properly and customers will come. PMID- 10136456 TI - Calif. Blue Cross to become for-profit. PMID- 10136455 TI - Time running out for reform. AB - When the reform debate heated up last year, countless hours were spend deciding whether to repair the healthcare system in one sweep or to take small steps over several years. Now, the debate is whether to tackle some small steps or do nothing at all. PMID- 10136457 TI - Federal agency set to grade providers. PMID- 10136458 TI - JCAHO abandons star rating system. PMID- 10136459 TI - Cooperative care acutely less costly. PMID- 10136460 TI - Philanthropies take closer look at grant requests. PMID- 10136461 TI - Chains find loophole in salary cap law. PMID- 10136462 TI - SunHealth to go cooperative. PMID- 10136463 TI - JCAHO offends execs with hard sell. PMID- 10136464 TI - Columbia/HCA to sell facility in Alaska to settle FTC charges. PMID- 10136465 TI - Community Health sees merger savings. PMID- 10136466 TI - HCFA gives Florida conditional waiver. PMID- 10136467 TI - New association formed in Calif. PMID- 10136469 TI - Small-business insurance plan formed. PMID- 10136468 TI - Industry criticism leads JCAHO to devise star-system alternative. PMID- 10136470 TI - Ohio doc with ties to Caremark faces kickback charges. PMID- 10136471 TI - Military moving to managed care. PMID- 10136472 TI - Champion adds two psych hospitals. PMID- 10136473 TI - Referendums to decide fate of two-hospital Wash. system. PMID- 10136474 TI - Another mega-merger in works. PMID- 10136475 TI - Calif. firms fight workers' choice initiative. PMID- 10136476 TI - Colo. firms fight workers' choice initiative. PMID- 10136477 TI - Ky. systems collaborate. PMID- 10136478 TI - Four-hospital system eyed in Ohio. PMID- 10136479 TI - HealthSouth purchases ReLife for $180 million. PMID- 10136480 TI - N.Y. hospitals pursue link by forming joint corporation. PMID- 10136481 TI - Radiation Care mulls assets sale. PMID- 10136482 TI - Reform engine stalls on Hill. PMID- 10136483 TI - Hospital settles with emergency docs. PMID- 10136484 TI - Ruling in Kaiser case supports HMOs' right to withhold care. PMID- 10136485 TI - Ark. providers fear loss of tax. PMID- 10136486 TI - Kan., HCFA in tiff over copayments. PMID- 10136487 TI - Physician fails to gain control of Ill. hospital. PMID- 10136488 TI - N.Y. union deal saves jobs but cuts costs. PMID- 10136489 TI - Mass. nurse survey ignites battle. PMID- 10136490 TI - Medicare fails on managed care. PMID- 10136491 TI - Medicare fee hikes may again have surgery bias. PMID- 10136492 TI - Buying groups seek compliance. AB - Purchasing groups are trying harder than ever to entice hospitals into buying a greater percentage of products through group contracts, and to tackle the old obstacle of contract compliance, according to Modern Healthcare's 1994 purchasing survey. PMID- 10136493 TI - Hospital acquisitions, mergers up in 2nd qtr. PMID- 10136494 TI - Hospital earnings growth slowing. PMID- 10136495 TI - Primary-care docs see incomes rise. PMID- 10136496 TI - The Internet to track recycling options. PMID- 10136497 TI - Develop a personal strategic plan. PMID- 10136498 TI - HealthSouth exec starts own REIT. PMID- 10136499 TI - Rural Colo. hospital at odds with JCAHO. PMID- 10136500 TI - Subacute's savings potential. PMID- 10136501 TI - Quality of life award. Provider salutes the winners. PMID- 10136502 TI - New directions. Providers diversify to meet a myriad of needs. PMID- 10136503 TI - Acquisitions on the rise. PMID- 10136504 TI - Subacute and civil liability. PMID- 10136505 TI - What's your threshold? PMID- 10136506 TI - Good medicine for providers. PMID- 10136507 TI - Wanted: a new attitude. PMID- 10136508 TI - Interrupted stories, interrupted lives. AB - In attempting to manage their practices efficiently, doctors may not allow seriously ill patients enough time to sort out their feelings and raise important questions. What is at stake here is not information about prognosis and treatments but the very survival of the soul. PMID- 10136509 TI - Making room for alternatives. AB - Alternative healing is an idea whose time has come, and 1993 was the critical year for that recognition. So believes internist David Edelberg, founder of the Chicago Holistic Center. There patients can see one of four allopathic physicians as well as practitioners in 37 additional therapies, including acupuncture, infant massage, homeopathy, nutrition counseling, and Ayurvedic medicine. PMID- 10136510 TI - The case. Bad care, good care, and spiritual preservation. AB - A cancer patient learning to walk again finds that his relationships with his two physical therapists affect his recovery. One woman gives hope as well as instruction. He advises healers to meet their patients as equals, "to take down as many barriers as they can, give away as many distancing privileges as possible." PMID- 10136511 TI - The terrible adventure of rehabilitation. AB - Friendship with patients, caregivers are taught during their professional training, is to be avoided. Yet the capacity for friendship--to be "a person who emerges in her personhood and not simply as a professional"--may be crucial to effective therapy. PMID- 10136512 TI - Listening carefully. AB - The inept physical therapist is unable to be with her patient, unable to "move on from the 'I' to a 'we.'" The effective therapist helps the patient make friends with his body and with the cosmos and leaves room for the patient's struggle with the questions of life's meaning brought to the fore by serious illness. PMID- 10136513 TI - Restoring healing to health care. PMID- 10136514 TI - The Governance Symposium--Part II. A new context for trustees. AB - Today you are a hospital trustee. If health care reform doesn't scare you away, tomorrow you could be governing a system, a network, a physician/hospital organization, or a community hospital that belongs to one of these other entities. managed care will change your priorities, your responsibilities, and the expectations others have of you as well as the health care delivery system. To learn more about the trustee's role in a reformed health care system, the American Hospital Association and Trustee recently convened a governance symposium (see the list of participants on the opposite page). The first part of the discussion from that symposium was presented in the August issue (see "Quantum leap," page 6). The second part focuses on the issues of board accountability and compensation and realigning incentives for the future. PMID- 10136515 TI - Real change hinges on collaboration. PMID- 10136517 TI - New emphasis on retirement plans. PMID- 10136516 TI - A big impact on a small budget. PMID- 10136519 TI - Eight myths about for-profit systems. PMID- 10136518 TI - Facing the investor-owned challenge: collaboration or competition? PMID- 10136520 TI - Hospital board: what's in a name? PMID- 10136521 TI - Compensation via integration. Hay survey: integration efforts enhancing links between pay and performance. PMID- 10136522 TI - Clinton's failing political health. PMID- 10136523 TI - It's not as simple as taking a blood test. PMID- 10136524 TI - An overview of home health and hospice care patients: preliminary data from the 1993 National Home and Hospice Care Survey. PMID- 10136525 TI - The influence of "individualism". PMID- 10136526 TI - Stopping the drain of dollars spent on breast cancer. PMID- 10136527 TI - Ten commandments without Mr. DeMille. PMID- 10136528 TI - Optical archiving conversion. PMID- 10136529 TI - Point and counterpoint. Should HECs consider financial costs of care during case review? PMID- 10136530 TI - 1994 Buyers' Guide. PMID- 10136531 TI - Competition for patients spurs hospitals' concern for serving the customer. AB - Competition for patients is spurring a growing number of hospitals to think about customer satisfaction. They're investing in surveys and service audits to gauge their performance, make improvements, and provide data to employers, insurers and patients. PMID- 10136532 TI - The borders of health promotion--a response to Nordenfelt. AB - Nordenfelt has presented a very useful philosophical analysis of the nature and ethics of health promotion. The first section of this paper is a response to the starting point of that analysis--the equation of health promotion with health promotion action. It is argued that this starting point leads to a serious ambiguity, and that this ambiguity is characteristic of other writing about health promotion, including that of the WHO. The second section of this paper explores the implications of this ambiguity, as it appears in the wider health promotion literature, for drawing the borders of health promotion. PMID- 10136533 TI - New regs require preparation. Re-evaluation of antipsychotic drug use is imperative. PMID- 10136534 TI - Physician assistants in ophthalmology: a national survey. AB - Fifty-two physician assistants employed in ophthalmologic practice throughout the United States were identified. Demographic and role-delineation data from 40 PAs agreeing to participate in the study were collected by questionnaire and telephone interviews. The data indicated that the majority of ophthalmologic PAs are employed in large practices that specialize in cataract and radial keratotomy procedures and that those practices are primarily located in the Southeast and Gulf regions of the United States. The authors conclude that most PAs are being utilized appropriately by ophthalmologists, that more formalized educational and credentialing programs may be necessary for the future, and that PAs can be positive adjuncts to ophthalmologic practice. PMID- 10136535 TI - Treating sexual assault victims. A protocol for health professionals. AB - Sexual assault victims require a multidisciplinary approach encompassing emotional, medical, and forensic care. Evaluation should include general and genital examinations, collection of forensic specimens, and culturing for sexually transmitted diseases. Obtaining a complete history is not only medically and legally crucial, but also can be a valuable therapeutic activity. Antibiotic prophylaxis, postcoital contraception, and testing for human immunodeficiency virus should be offered. An understanding of the rape trauma syndrome is the foundation for providing emotional support. The need for follow-up evaluation and counseling should be stressed. PMID- 10136536 TI - Violence prevention: a challenge for health care practitioners. AB - Interpersonal violence has reached epidemic proportions in the United States. Principles of preventive medicine can be applied to help curb the growing rates of assault, murder, and rape. Health care providers should become leaders in the fight against violence. Physician assistants can encourage their national, state, and local organizations to develop specific educational programs. Individual PAs should become involved at the community level, as well as maintain a high index of suspicion with patients, and be prepared to offer counseling as needed. PMID- 10136537 TI - The ability of PAs to solve patients' psychosocial problems. A preliminary report on patient expectations. AB - Patient expectations of physician assistants constitute a relatively unexplored field. A survey was designed to evaluate the expectations that patients have of PAs faced with a patient's psychosocial problems. The survey was distributed in 1987 to four practices that employ PAs in south central Kansas. Selected patients were surveyed for their expectations of the PA in dealing with a series of personal, social, psychological, and health-related items. Results indicated that patients expected the PA to be involved with these problems, but did not expect the PA to be an expert. PMID- 10136538 TI - PA utilization on a pediatric bone marrow transplant unit. AB - Operating without residents or fellows in continuous attendance, The University of Iowa Hospitals and Clinics Pediatric Bone Marrow Transplant Unit utilizes PAs to assume primary responsibility for patients and to assure continuity of care. Major tasks assigned to the PAs include evaluation and assessment, writing notes and orders, and clinic follow-up. Basic PA training in pharmacology, physiology, and pathology has proved to be a sufficient background, supplemented by extensive on-the-job training; a knowledge of hematology is helpful. Severity of illnesses being treated contributes to burnout, which is addressed by staff support groups. This PA utilization model is strongly recommended for other such wards. PMID- 10136539 TI - Clinical skills problems. A valid instrument for assessing competence? AB - Physician assistants are required to take the clinical skills problems (CSP) portion of the National Certifying Examination administered by the National Commission on Certification of Physician's Assistants (NCCPA). No comparable section exists in entry-level physician certification examinations because studies have shown that this type of examination is neither a valid nor a reliable indicator of clinical competence. A published account of the studies used to implement the CSP portion of the National Certifying Examination contained serious flaws, calling the research into question. Denial of certification based solely on failure on the CSP portion of the National Certifying Examination could be challenged legally. The CSP is invalid and unreliable, and should be eliminated. PMID- 10136540 TI - U.S. Supreme Court says no. PMID- 10136541 TI - Multiskilled health practitioners. Applications to group practice. AB - Multiskilled health practitioners (MSHPs) may be used to reduce costs and increase the availability of services for group practices. There are a variety of possible competency combinations for MSHPs, many of which are unique to the needs of specific health care facilities. Examples of MSHPs as well as employer and employee perceptions of multiskilled needs relevant to health care delivery and applications to the group practice setting are presented. PMID- 10136542 TI - The malpractice suit. What to know from the start. AB - Once the immediate visceral reaction to being slapped with a malpractice suit has subsided, it's time to assess the situation and prepare for the impending legal battle. A successful outcome is more likely if you remain calm; call your insurance company immediately; familiarize yourself with your rights and obligations; cooperate fully with your lawyer; and help to secure credible, credentialed experts to testify on your behalf. PMID- 10136543 TI - Physician assistants and nurse practitioners: needed more than ever. PMID- 10136544 TI - How do physician assistants practice in your HMO? PMID- 10136545 TI - Education of physician assistants, nurse midwives, and nurse practitioners for rural practice. PMID- 10136546 TI - HIV roundtable. Strategies to enhance professional awareness and involvement, Part I. AB - Despite extensive public attention to the social and medical problems associated with HIV infection and AIDS, many clinicians remain largely uninvolved in public health and patient counseling programs aimed at preventing infection and getting patients into treatment. Suggestions to enhance professional involvement include improved schooling and continuing medical education; increased liaison and exchange of information among the various groups working with AIDS patients and at-risk populations; and programs to help clinicians confront their own feelings and concerns relating to AIDS. PMID- 10136547 TI - Reducing costs with formulary limitation of H2-receptor antagonists in a community hospital. AB - Cost containment has become a major issue for all hospital pharmacies. At Carney Hospital, a 366-bed community hospital, where H2-receptor antagonists accounted for 10% of a $1.5 million total drug budget, the search for cost savings led to a move from an open to a limited formulary for the H2-receptor antagonists. Cimetidine and ranitidine, the two most widely used agents of this class, are considered equivalent in terms of safety and efficacy. Prior to formulary limitations, however, most H2-receptor antagonist orders were written for ranitidine, the more expensive agent. Carney Hospital, a member of the Daughters of Charity hospital purchasing group, was able to participate in an advantageous H2-receptor antagonist cost agreement by limiting its formulary to cimetidine. After the first 9 months of the closed formulary program, Carney had realized cost savings of $33,220. At that time, cimetidine accounted for 96% of all parenteral H2-receptor antagonist orders, testifying to physician satisfaction with this agent. Finally, 85% of the parenteral cimetidine orders were written q8h, which was essential to the success of the cost savings program. PMID- 10136548 TI - HIV roundtable. Strategies to enhance professional awareness and involvement. Part II. AB - Despite extensive public attention to the social and medical problems associated with HIV infection and AIDS, many clinicians remain largely uninvolved in public health and patient counseling programs aimed at preventing infection and getting patients into treatment. Suggestions to enhance professional involvement include improved schooling and continuing medical education; increased liaison and exchange of information among the various groups working with AIDS patients and at-risk populations; and programs to help clinicians confront their own feelings and concerns relating to AIDS. PMID- 10136549 TI - Study of antipsychotic drug use in long-term care facilities. AB - We chose to conduct this study because neuroleptic use has not been well defined in nursing homes. To our knowledge, it represents the only attempt at implementing the AIMS procedure in a group of nursing homes. We have provided evidence for what appears to be reasonably typical use of antipsychotic medication in skilled and intermediate care facilities. Senility and dementia were the most common diagnoses noted for neuroleptic recipients. Inservice education had little, if any, impact on antipsychotic drug use. Efforts to reduce the incidence of inappropriate use of neuroleptics should be aimed at physicians. We do feel that nursing and administrative staff are now more aware than previously of the dangers of indiscriminate use of these drugs. We feel that, because of our efforts, nursing staffs are better able to detect the presence of TD in their geriatric residents. If our sample of patients is representative of the entire population of institutionalized elderly, the overall rate of neuroleptic-induced TD may be lower than once thought. Similarly, the use of regularly scheduled neuroleptics in this population may be lower. PMID- 10136550 TI - Schizophrenia drug test: antitrust tying violation? PMID- 10136551 TI - The debate over Medicare reimbursement. PMID- 10136552 TI - Counseling patients with HIV infection. AB - With the human immunodeficiency virus (HIV) still spreading rapidly throughout the nation, all health care professionals must be skilled not only in the technical aspects of management, but also in patient counseling. Patients are concerned about deteriorating health and the prospect of death, but also about treatment options and financial problems related to the disease. Clinicians who provide counseling must be familiar with these concerns as they explain the medical options to patients and help patients work through the stages of adjustment. PMID- 10136553 TI - Clinical monitoring guidelines for neuroleptic and antidepressant drugs. Central State Hospital, Milledgeville, Georgia. AB - A description of clinical monitoring guidelines for neuroleptic and antidepressant drugs is presented. These guidelines were developed for use at a large, state-operated psychiatric facility to provide a framework for standardized monitoring and use practices for all residents being treated with these drugs. The guidelines include information related to routine monitoring for all residents as well as specific guidelines for monitoring residents in high risk groups. PMID- 10136554 TI - Prescribing and usage patterns of two antihypertensive agents: a comparison of terazosin and enalapril. AB - The prescribing and usage patterns of two antihypertensive agents, terazosin (Hytrin) and enalapril maleate (Vasotec) were analyzed and compared over a 6 month study period, using data from the PDS Alpha Data Base. The study analyzed several variables for both physician prescribing patterns and patient responses. Overall, the two agents performed equally well during the study period, with 6 month retention rates (% of patients who continued to take the same medication) of approximately 60%. Although both drugs are judged to be good candidates for first-line antihypertensive therapy, it was observed during the study that family practitioners write considerably more prescriptions for terazosin than enalapril, while internists write more enalapril prescriptions. We concluded that these differences in prescribing and usage patterns were largely attributable to the manufacturers' marketing strategies and to how various physicians perceive the two agents, rather than to actual clinical differences between them. PMID- 10136555 TI - Measuring the financial productivity of physician assistants. AB - The first formal physician assistant (PA) program began at Duke University 25 years ago, write David M.S., and Kenneth Harbert, M.H.A., PA-C. Since then, PAs have become widely utilized in the medical field, yet little has been done to measure their financial contribution. The authors provide a methodology and framework for groups to measure the financial productivity of their PAs. PMID- 10136556 TI - Hospital physician assistants: past, present and future [corrected]. AB - Expansion of the roles of PAs into the hospital setting has been the most significant recent trend in the healthcare field's use of these professionals. Initially intended to be primary-care providers, PAs have moved into the institutional domain with ease and in large numbers to assume roles as medical and surgical inpatient house-staff and as assistants to specialists and subspecialists. In most instances, they have adapted to these types of roles without formal training beyond the normal two-year educational period. PAs in hospitals have been proven to maintain or improve the existing level of quality and access to medical care, have been shown to be cost-effective in the delivery of inpatient services, and have displayed extensive clinical versatility among the various medical disciplines. Hospitals' use of PAs came about through changing forces in the health-personnel supply pool and mandated adjustments in the patterns of graduate medical education. Employing PAs has permitted hospitals to maintain the required levels of patient care in a cost-effective way, has allowed residency programs to balance the numbers of specialty-trained physicians, and has thereby contributed to a more balanced supply of specialists in overcrowded fields. The use of PAs has also contributed to increasing the continuity of care on hospital services and to measures that enrich the quality of residency education for physicians in training. To accommodate PAs as inpatient providers, medical-staff bylaws have been amended to recognize the education and expertise of PAs and to provide their institutional sanction to perform inpatient duties under the supervision of physicians.(ABSTRACT TRUNCATED AT 250 WORDS) PMID- 10136557 TI - Using common sense to reduce antipsychotic drug use. PMID- 10136558 TI - HIV roundtable. Professional perspectives. AB - As the HIV epidemic escalates, concern is mounting over the implications of infection among health care workers. Should all medical professionals be tested? Should supervisors and/or patients be notified if the results are positive? Should the infected PA continue to practice? What about performing surgery? Should he or she be considered impaired? And what about the long-term stress of working with HIV patients? Experts discuss the AAPA's latest recommendations, and share suggestions on prevention and patient care with the audience. PMID- 10136559 TI - 1992 career guide. Best jobs for the future. Salary survey. AB - The best news many workers are looking for when annual review time rolls around this year is that they'll have a job for the foreseeable future. A raise? That's surely hoping for too much. Indeed, some 10 percent of the organizations surveyed by the Wyatt Co., a compensation and benefits consulting firm in New York, have frozen wages this year. About 3 percent plan to do the same in 1992. But salaries have clearly been pummeled harder in some industries than in others. The paychecks of people who work in the retail trade and in the building materials and equipment industry, for example, have barely kept pace with inflation this year. Next year promises more of the same. Those in the legal field, by contrast, enjoyed raises of 8 percent in 1991, and nurse-anesthetists averaged 10 percent. Across the board, salaries in 1991 went up 5.5 percent. But businesses are cynical about the economy's prospects, says Wyatt compensation expert Marsha Cameron, and their planned raises for 1992 average only 5.3 percent. To determine where a profession pays best, U.S. News, in conjunction with Wyatt, took a look at what 18 jobs pay on average at the entry, senior professional and middle manager levels in five regions of the country. The salaries come from Wyatt's survey of more than 3,500 organizations across the United States. New graduates in software engineering may want to send their resumes to Texas and Colorado, for example, where starting salaries, at $34,200, average $6,200 more than in Alabama and Georgia.250+ PMID- 10136560 TI - Rational selection of H2-receptor antagonists for the hospital formulary. Roundtable discussion. PMID- 10136561 TI - Strategy for developing a safe and cost-effective H2-receptor antagonist program. AB - The pharmacy staff of a community tertiary-care hospital evaluated efficacy and safety before addressing cost considerations in the transition to a capitation program with cimetidine as the preferred H2-receptor antagonist. Safety concerns were resolved by permitting the use of an alternative drug certain patients considered to be at high risk. Despite initial resistance to mandatory participation in the program, the physician and nursing staffs have grown supportive, and the annual cost savings, which include the costs of labor and supplies as well as acquisition, have been substantial. PMID- 10136562 TI - Criteria-based DUE aids in selection of preferred agent. AB - The combination of a criteria-based drug utilization evaluation and a comprehensive drug literature review can be effectively used to reach therapeutically sound, cost-efficient formulary decisions. This report describes the approach to evaluating the available H2-receptor antagonists used by the Pharmacy & Therapeutics Committee of Memorial Medical Center, a 550-bed, community-based teaching hospital affiliated with the Southern Illinois University School of Medicine in Springfield. PMID- 10136563 TI - Multidisciplinary education ensures successful formulary conversion. AB - Anticipating and preparing for objections to formulary changes is essential to the success of policies set by Pharmacy & Therapeutics Committees. At the University of Kentucky Medical Center, a 461-bed teaching hospital, an intensive educational plan was under way well before the hospital converted from ranitidine to cimetidine as the preferred formulary H2-receptor antagonist. PMID- 10136564 TI - Retrospective analysis of formulary restriction demonstrates significant cost savings. AB - Concurrent and retrospective analyses of drug use may be needed to ensure that formulary conversions are achieving the desired results. The department of pharmaceutical services at Botsford General Hospital, a 325-bed community teaching hospital in Farmington Hills, Mich., analyzed the impact of a formulary H2-receptor antagonist conversion and demonstrated that quality of care was maintained with significant cost savings achieved. PMID- 10136565 TI - PA reports on Hastings Center ethics fellowship. AB - Physicians Assistants are faced with ethical dilemmas every day in the course of their medical practice. The author studied current ethical dilemmas facing PAs at the Hastings Center, a bioethics research institute in New York. A description of this institute and a discussion of the researcher's findings are detailed. PMID- 10136566 TI - Crime in hospitals 1989--additional information from the most recent IAHSS (International Association for Healthcare Security & Safety) survey. PMID- 10136567 TI - Team up against antipsychotics. Interdisciplinary program reduces utilization. PMID- 10136568 TI - Physician extenders increase healthcare access. AB - To ensure rural residents access to primary care services, Saint Vincent Hospital and Health Center, Billings, MT, operates five physician-operated clinics, located between 8 and 81 miles from Billings. Two of the clinics are in communities that are not large enough to sustain a physician practice, so they are staffed by certified physician assistants (PA-Cs). Licensed and practicing with supervision of a physician, PAs provide a variety of patient care services in virtually every medical specialty and environment. One-third of the nation's PAs work in primary care health professional shortage areas, providing services comparable to those of a family practitioner. National studies reveal a high degree of satisfaction among both consumers and supervising physicians regarding the level of care provided by PAs. Professional liability claims against PAs are fewer than those against physicians, probably because of the higher degree of communication and attention patients receive as a result of the team approach. PAs can increase patient contact hours, decrease waiting times, and improve access to care overall. In addition, PA utilization is a cost-effective approach to healthcare delivery. PMID- 10136569 TI - Professional challenges in the coming decade. AB - Last month, as part of our observance of the 15th anniversary of Physician Assistant journal, members of our Editorial Board offered their views on turning points in the history of the PA profession. In this issue, we jump from the past to the future, with perspectives on the main crises or changes facing the profession in the coming decade. You may agree or disagree with these viewpoints. Diversity of opinion keeps the PA profession dynamic and strong--which is exactly why Physician Assistant journal provides an open forum for letters and guest editorials. PMID- 10136570 TI - Outcome factors in patient education. AB - Patient education requires a thorough knowledge of the subject and accurate assessment of patient abilities, readiness, and motivation. The teaching process involves agreement between the PA and the patient on what is to be learned and a clear, hands-on presentation that uses visual and other aids as appropriate. Feedback is essential, both from the PA in the form of correction and rewards and from the patient to draw attention to areas that need further clarification. As it can be extremely difficult to persuade a patient to modify his/her lifestyle over the long term, repetition and a flexible approach are vital. PMID- 10136571 TI - Tissue transplantation. The PA's role in donation and recovery. AB - The use of musculoskeletal and soft-tissue allografts for reconstructive procedures has become routine. The demand has doubled over the past several years, and will surely continue to rise. However, the availability of allografts has not kept pace with this demand. Physician assistants, by virtue of their position on specialty teams and their commitment to community service, can play a leading role in increasing the availability of allografts through the identification, evaluation, and referral of appropriate donor candidates to local recovery agencies. PMID- 10136572 TI - Advance directives. AB - Hospitals and health care professionals nationwide have been busy dealing with a new federal law, the "Patient Self Determination Act." Recent court rulings regarding a patient's right to determine his or her wishes for life-sustaining treatment have many health care professionals responding to new legal and ethical questions from patients. PMID- 10136573 TI - Eliminating chemical restraints through proper prescribing. PMID- 10136574 TI - Pharmacy-coordinated, multidisciplinary adverse drug reaction program. AB - To date, the stated program objectives have been met. There is a heightened awareness of ADRs, and the program has had a positive impact on patient care. More work is needed in the prevention of ADRs as opposed to their tabulation. Future educational efforts will focus on how reporting suspected ADRs can positively impact patient care. PMID- 10136575 TI - New drug guidelines restrict use of psychoactive medications. PMID- 10136576 TI - Preventing tetanus, influenza, and pneumococcal infection in adults. AB - Immunization remains the most cost-effective tool in preventive medicine. Many adults should receive seven immunizations: influenza, pneumococcal, measles, rubella, and hepatitis B vaccines and tetanus and diphtheria toxoids. This article will focus on the use of immunizations in adults to prevent tetanus, diphtheria, influenza, and pneumococcal disease and on some of the barriers and solutions to adequate immunization. Physician assistants can play a crucial role in preventing infectious diseases by organizing effective screening programs and routinely administering appropriate vaccines to their patients. PMID- 10136577 TI - Is there a role for physician extenders in nursing homes? PMID- 10136578 TI - Must America look to non-doctors for primary care?. Interview by Mark Holoweiko. PMID- 10136579 TI - Medicare clamps down on physician-assistant claims. PMID- 10136580 TI - PAs and technology--partners in progress. PMID- 10136581 TI - Medical staff membership. An elusive privilege for PAs. AB - While PAs may be familiar with their hospitals' medical staffs and may even be members or affiliate members of a medical staff themselves, substantial benefits can be gained from a greater understanding of the scope of medical staff operations and the potential involvement of PAs. A medical staff is more than a group of practitioners who have been granted clinical privileges in a given institution; it is also a legal entity that formulates policy directly affecting the clinical practice, compensation, and job security of providers within its purview, including PAs. For these reasons, PAs need to keep informed of medical staff decisions and should seek representation in some capacity on the medical staffs of the hospitals in which they practice. PMID- 10136582 TI - The determinants of utilization of nonphysician providers in rural community and migrant health centers. AB - The use of nonphysician providers, such as nurse practitioners, physician assistants, and certified nurse midwives, in rural areas is critically important due to the continued primary care access problems. This study examines the major factors influencing the use of nonphysician providers in rural community and migrant health centers based on a 1991 national survey of the centers. This study demonstrates that the employment of nonphysician providers in rural community and migrant health centers is significantly influenced by both supply and demand factors. Among supply factors, there is a significant and positive relationship between the number of total staff and the number of nonphysician providers employed. There is a significant but inverse relationship between the number of physicians and the number of nonphysician providers employed, indicating nonphysician providers primarily serve as substitutes for physicians in rural community and migrant health centers. The supply of nonphysician providers, as measured by the number of affiliated training programs, is significantly related to the employment of nonphysician providers. The demand variable, geographic location, and the centers' staffing policies are also significant determinants of the use of nonphysician providers. PMID- 10136583 TI - Laptop computers in health care. PMID- 10136584 TI - Using cost accounting techniques in the total quality management framework. PMID- 10136585 TI - The relationship of antipsychotic drug use, behavior, and diagnoses among nursing home residents. AB - Nursing homes have been criticized for frequent use and possible misuse of psychoactive agents. These issues are of clinical concern and policy relevance, especially since the passage of the Omnibus Budget Reconciliation Act (OBRA) of 1987. Using a sample of 419 residents, the authors examined the relationships among antipsychotic drug (AP) use, behavior, and mental health diagnoses. Only 23.2% of the residents were administered APs on a routine and/or "as-needed" basis. Based on the Multidimensional Observation Scale for Elderly Subjects (MOSES) ratings, AP users were more irritable, disoriented, and withdrawn than were nonusers. Also, AP users demonstrated agitated behaviors more frequently. Notably, AP users and nonusers differed significantly in terms of documented mental health diagnoses. Among AP users, 70.1% had documented dementia, 8.3% were psychotic or had other psychiatric disorders, and 21.6% had no mental health diagnoses. In contrast, the majority of nonusers had no mental health disorders. Logistic regression revealed that diagnostic factors, frequency of agitation, level of withdrawal, and marital status were significant predictors of AP use. PMID- 10136586 TI - Potential drug interactions with H2-receptor antagonists in intensive care unit patients. AB - This study's objectives were to identify the incidence of potential histamine-2 receptor antagonist drug interactions in a population of critically ill patients and to identify those at greatest risk for drug interactions. A literature review was completed to identify medications documented to interact when administered concomitantly with histamine-2 receptor antagonists. Data were prospectively collected on 277 consecutive patients admitted into the cardiac care units, medical intensive care units, and surgical intensive care units of two teaching hospitals. The mean age was 55 +/- 16.4 years and one or more organ insufficiency was identified in 52.7% of patients. At least one potential drug interaction was found in 81.6%, with an average of 1.57 potential interactions occurring per patient. Cardiac care unit and medical intensive care unit patients had significantly more potential interactions with drugs having narrow therapeutic indices (P < 0.03). Also, cardiac care unit patients received significantly more medications documented to interact with ranitidine alone or both cimetidine and ranitidine (P < 0.003). Patients admitted to an intensive care unit and receiving a histamine-2 receptor antagonist may require more frequent monitoring because of the potential for drug interactions. PMID- 10136587 TI - Physician assistant impairment issues. A primer on an important professional/peer review issue. AB - Like other health professionals, PAs must deal with the issue of impairment. An impaired practitioner is one who is unable to practice medicine with reasonable skill and safety because of physical or mental illness, including age-related impairment, loss of motor skills, and substance abuse. Because PAs practice under the supervision of licensed MDs, they face unique problems when their supervisor is impaired. The AAPA's Code of Ethics and Strategic Plan both stress the responsibilities of individual PAs and PA organizations to address impairment issues. The suggested model for self-regulation is the disciplinary/grievance model, which allows the profession to meet its ethical and legal responsibilities regarding quality, competent health care while providing a compassionate, caring program for impaired PAs/supervisors. PMID- 10136588 TI - The PA (physician assistant) way. PMID- 10136589 TI - New models for PA advancement. Forum discussion. AB - Many PAs are grappling with the problem of how to best advance their careers. In this roundtable, the participants discuss traditional methods of advancement and examine the need for new models. PMID- 10136590 TI - Hospital restructuring under health care reform: a prescription for survival. PMID- 10136591 TI - How "physician extenders" can strength your practice. AB - A physician assistant or nurse practitioner will free you for more complex--and renumerative--care. And you can hire one for only about a third of the cost of adding another doctor. PMID- 10136592 TI - Our military heritage. AB - The decade of the sixties was one of dramatic change in American culture. Looking back, the change that had the most effect on readers of this journal was the creation of the physician assistant profession. The original members of our profession were all former military medical corpsmen. This article provides a brief overview of this military heritage. PMID- 10136593 TI - Extending a healing hand. Geisinger Medical Center, Danville, PA. PMID- 10136594 TI - Strategies for improving patient compliance. AB - Achieving patient compliance in taking prescribed medications is a formidable challenge for all clinicians. As PAs, we have daily opportunities to communicate with patients and improve their compliance. An office-based compliance program, combining patient education and behavior-modification components, can be beneficial in this regard. Strategies for improving compliance include giving clear, concise, and logical instructions in familiar language, adapting drug regimens to daily routines, eliciting patient participation through self monitoring, and providing educational materials that promote overall good health in connection with medical treatment. PMID- 10136595 TI - Nonphysician providers and limited-license practitioners: scope-of-practice issues. AB - The medical community recognizes that nonphysician providers are attempting to position themselves to assume larger, more independent roles in the new health care system. The American Medical Association (AMA) addressed this issue at its 1993 annual meeting of the house of delegates with the adoption of a resolution to study the role of mid-level practitioners. A report responding to the resolution was presented at the AMA's 1993 interim meeting of the house of delegates. The focus of the report was solely on the scope of practice of nurses; PAs were not included because they work under the supervision of physicians by law, and the American Academy of Physician Assistants has declared that it has no intention of seeking independent practice from physicians. The report reviews the qualifications and roles of a variety of APNs, and determines that "care by physicians does not equate to care delivered by nurses, allied health professionals, or nontraditional caregivers." It also states that substitution of physician care by nonphysicians raises questions of patient safety, competence of therapeutic decision, and fragmentation of care. The AMA report concludes that "physician care is based on cognitive and technical skills that are shaped by a unique education and experiences to form a foundation of clinical knowledge that allows physicians to decide what needs to be done across the wide variety of human maladies; that is irreplaceable by anyone with lesser training." PMID- 10136596 TI - Keeping track: the role of PAs in the surveillance and management of enteric infections. AB - Surveillance of communicable diseases is of primary importance in controlling disease in the community and providing the basis for determining at-risk populations, disease trends, and morbidity and mortality rates. On a larger scale, surveillance data aid health planners in determining priorities and programs from the local to the international level. This article describes the surveillance process and its implications for PAs in their daily practice, as well as the management of common reportable enteric diseases and control measures. PMID- 10136597 TI - Personal protective equipment in helicopter EMS. AB - For a variety of reasons, air medical crews continue to be exposed to situations that can bring about severe personal injury or death. Despite recommendations from the Federal Aviation Administration and the Association of Air Medical Services, the use of personal protective equipment among air medical crews is not uniform or universal. Helmets have been shown to decrease morbidity and mortality from head injury, the most common form of injury in a helicopter crash. Flame retardant clothing may likewise improve the outcome of an in-flight or post-crash fire and should include gloves. Additional consideration should be given to the appropriate undergarments. Protective footwear can also decrease injuries to air medical crews. PMID- 10136598 TI - Demand rising for medicine's rarest birds. AB - The prognosis from most quarters is that the U.S. health care delivery system is moving inexorably toward managed care. The final form that managed care takes under whatever health reform measure finally takes shape in Washington is still in doubt, but it is clear that care will be managed in the future. It also seems increasingly clear that the system evolving will require more primary care providers, and that they will occupy some very key decision-making roles in the clinical firmament. In this article, staff writer Donna Vavala brings together the thoughts and predictions of several health care leaders on this critical topic in medical management. PMID- 10136599 TI - Role of physician extenders on the managed care team. AB - The use of physician extenders seems to be assured as health care reform efforts unfold at both the state and federal level. Movement to fixed budgeting and capitated reimbursement systems will encourage providers to be cost efficient whenever possible, and will accelerate the use of extenders as well as other lower cost allied professionals. As a spokesperson for Oregon's Sisters of Providence Health System said, "We have stopped investing in acute care. Our system is spending $30 million to ... establish ambulatory care settings. We need to prepare for increased numbers of patients in HMOs, more physicians who are employees, and the increased use of physician extenders." Proponents of physician extenders point to the fact that they charge less than physicians for similar services. Truly, several studies on the subject indicate that this assumption is correct. For example, a study from the Journal of Nurse Practitioners indicates that the cost of an office visit to see a nurse practitioner compared with a physician ranged from about 10% to 40% less depending on the nature of the visit (i.e., family, pediatric, gerontology, mental health, etc.). Another study has revealed that the average nurse practitioner in a family practice setting makes an annual salary of $43,600, compared to a family practice physician who makes over $110,000. While such statistics are compelling, they may not tell the entire story. For example, a study which compared APNs and primary care physicians indicated that the nurse practitioner saw fewer patients per week and spent significantly more time with each patient.(ABSTRACT TRUNCATED AT 250 WORDS) PMID- 10136600 TI - Non-physician providers. PMID- 10136601 TI - A pharmacoeconomic analysis of IV H2-receptor antagonist use in 40 hospitals. AB - The objectives of this study were to determine (1) the expenditures of hospitals for IV histamine2-receptor antagonists (H2-RA), and (2) the cost savings that might be realized if only a single IV H2-RA was purchased for use. Forty hospitals provided data about purchase prices for each IV H2-RA dosage form purchased (cimetidine, ranitidine, and famotidine), the number of each dosage form used during the 12-month study period, purchase price and extent of usage for supplies, labor costs for preparing and administering IV H2-RAs, and IV H2-RA dosage schedules. The study showed that most hospitals were spending more money for IV H2-RAs than necessary given the pricing structures of the three products available to them at the time of this study. Also, that significant cost savings could be realized if a single H2-RA was used exclusively. PMID- 10136602 TI - The primary question. PMID- 10136603 TI - The cost-effectiveness of the switch towards more expensive antihypertensive drugs. AB - A switch from treatment with diuretics and beta-blockers to treatment with the more expensive ACE-inhibitors and calcium-antagonists has been noted in the hypertension field. The aim of this paper was to analyse the cost-effectiveness of this switch towards more expensive antihypertensive drugs in Sweden. The upper limit of the cost-effectiveness of ACE-inhibitors and calcium-antagonists compared with diuretics and beta-blockers was estimated by assuming that ACE inhibitors and calcium-antagonists achieve the epidemiologically expected risk reduction for coronary heart disease. The incremental cost per life-year gained varies between approximately SEK 50,000 and approximately SEK 6,000,000 ($1 = SEK 6) in the different patient groups analysed. It is concluded that ACE-inhibitors and calcium-antagonists may be potentially cost-effective in some patient groups at a high risk of coronary heart disease. Since an improved risk reduction has not been demonstrated in clinical trials, however, ACE-inhibitors and calcium antagonists cannot at present be recommended for hypertension treatment in any patient groups unless treatment with diuretics and beta-blockers is contraindicated. PMID- 10136604 TI - Physician extenders in managed care: reducing risk through supervision and credentialing. PMID- 10136605 TI - The gatekeeper in managed care. PMID- 10136606 TI - The composition of NHS trust boards. PMID- 10136607 TI - The initial 18 months of an NHS trust board. PMID- 10136608 TI - The impact of trusts on the management of the NHS. PMID- 10136609 TI - Trusts: the reasons to be cautious. PMID- 10136610 TI - Purchaser/provider relationships: current practice and future prospects. PMID- 10136611 TI - A provider perspective. PMID- 10136612 TI - A purchaser perspective. PMID- 10136613 TI - NHS trusts in practice. Conclusion. PMID- 10136614 TI - Database transcription for quality review and outcomes studies. PMID- 10136615 TI - Clinical pathways improve organizational performance. PMID- 10136617 TI - Health reform insight. And they're off! Senate debates reform. PMID- 10136616 TI - Pathway development at University of Cincinnati Hospital. PMID- 10136618 TI - Perspectives. Vaccines for Children program: bad policy or start-up glitches? PMID- 10136619 TI - Perspectives. Doctors sue to fight economic credentialing. PMID- 10136620 TI - Perspectives. Insurance agents: they won the battle, but the war goes on. PMID- 10136621 TI - Perspectives. Managing risk continues to confound policymakers. PMID- 10136622 TI - Perspectives. HCFA's mortality data: what do they say about quality? PMID- 10136623 TI - Methodist's migration path to the future. AB - As a result of work through the Care Data consortium in cooperation with Iowa Methodist and University of Chicago Hospitals, Methodist has implemented: an open systems integration strategy, a clinical repository, and clinician-centric access and distribution of information. The Care Data consortium gave rise to a new breed of automation that meets the needs of both ends of the clinical automation spectrum: migrating an integrated, single-vendor solution to an open systems integrated repository to users of a distributed, best-of-breed approach. PMID- 10136624 TI - 10 commandments: negotiating HIS (hospital information system) contracts. PMID- 10136625 TI - Reform report: CHIME, CHIM & HIMA speak with one voice. PMID- 10136626 TI - WANs all over this LAN. PMID- 10136627 TI - 1994 HIMSS/Hewlett Packard leadership survey results. PMID- 10136628 TI - The making of a Healthcare Informatics "most computer-advanced facility". PMID- 10136629 TI - Adding zip to existing technology--"hybrid" document imaging at Emory. PMID- 10136630 TI - Complying with JCAHO's IM standards. PMID- 10136631 TI - Linking providers for competitive advantage. PMID- 10136632 TI - Perspectives on JCAHO's indicator measurement system. PMID- 10136633 TI - Is "best-of-breed" for the dogs? PMID- 10136634 TI - It's better to integrate than to separate. PMID- 10136635 TI - Data processing: prenuptials for a happy marriage. PMID- 10136636 TI - Critical pathways: high roads to better patient care. PMID- 10136637 TI - When LIS meets HIS: refining the design of an order entry process. PMID- 10136638 TI - America's 10 most computer advanced laboratories. PMID- 10136639 TI - Online is on-target for lab TQM. PMID- 10136640 TI - "Appropriate" health information: insights gleaned in Great Britain. PMID- 10136641 TI - Physicians as front-end users of CHINs (community healthcare information networks). PMID- 10136642 TI - Nurses as primary care providers: an old idea whose time has come. PMID- 10136643 TI - Care 2000--a patient-focused care model. PMID- 10136645 TI - Medi-Cal patients continue to climb. PMID- 10136644 TI - What will the future hold for nursing? PMID- 10136646 TI - Social accountability: an ongoing commitment to community health. PMID- 10136647 TI - Sports medicine goes back to school. PMID- 10136648 TI - Waste management. Bagging the disposable mentality: hospital waste management ideas for the 1990s. PMID- 10136649 TI - Integrated delivery systems. Managing the risk of capitation. PMID- 10136650 TI - The use of ephemera with particular reference to blood and organ donation: a review of sources. AB - Emphasis has been placed upon a study of the use made of ephemera such as leaflets, pamphlets and booklets by non-professional staff working in British statutory organizations such as health authorities, community health councils and family health services authorities as well as voluntary organizations such as charities, citizens' advice bureaux and patient participation groups. Publicity methods and the use made of ephemeral materials by those statutory and voluntary organizations involved in recruiting and retaining blood and organ donors is highlighted. Research findings confirm that patients, carers and others, wish to receive comprehendable and appropriate health information. Ephemera provided in support of this need are not comprehensive in subject coverage and lack any standardization of format. In particular, great care needs to be taken with the design of leaflets, pamphlets and booklets. Ephemeral materials are difficult to locate and obtain, and no bibliographical centre exists to coordinate and support existing activity by identifying, acquiring, storing, advertising and distributing such health care material. Marketing and publicity skills, and much time and effort are required to rectify this deficiency, and thus to satisfy the needs of consumers. PMID- 10136651 TI - Dissemination: implementing the findings of research. AB - There is an increasing interest in dissemination among researchers, policy makers and information scientists. Dissemination, in the context of health services, can be taken to mean the process of implementing the findings of research. Currently there is a considerable delay in the adoption of evidence on the effectiveness of interventions by professionals in the NHS and other health systems. The development of research designs such as randomized control trials, which can provide the most reliable information on the efficacy of interventions, is a crucial but partial step in the quest to place clinical practice on a more scientific basis. Systematic overviews of interventions bring together the relevant evidence to provide overall estimates of the effectiveness of health service interventions. However, there remains the difficulty of bringing them to the attention of health professionals in a manner which will enable them to improve the effectiveness of their clinical practice. The research evidence suggests that effective dissemination will depend upon using multiple means to communicate key messages rather than a single measure or 'magic bullet'. Information professionals have a role in ensuring the key research evidence is promoted, and that it is as reliable as possible. PMID- 10136652 TI - Health Facts Information Centre, Frenchay Hospital, Bristol: five years 1988 1992. AB - The Health Facts Information Centre at Frenchay Hospital, Bristol was officially opened in March 1988. It provides information in lay terms about illness and self help groups for patients, the public and health professionals. Enquiries are made by letter, telephone or personal visit. PMID- 10136653 TI - Unmet needs for health information: a literature review. AB - This paper explores the recent literature on unmet needs for health information, giving an overview of some of the research that has been carried out since Kempson's review and study in 1987. Many of the studies looking at health information needs have been approached from a narrow focus of individual information needs for specific services, with limited research into the views of the general public. The greatest demand for health information appears to be in the area of specific diseases and medical conditions with limited demand for information on the availability and quality of care. These findings may be a reflection of the narrow focus of much previous research and/or the limited availability of health information on access and quality. The paper argues for the need to look widely at the health information needs of households and families at all stages of health and illness, taking into account the interrelationship of needs and the social context in which such needs are, or are not perceived. PMID- 10136654 TI - Does EtO have a future in hospitals? PMID- 10136655 TI - Healthcare reform: a Congressional primer. PMID- 10136656 TI - Hot enough for you--what about the others? There could be an OSHA inspection for heat stress in your future. PMID- 10136657 TI - Patient refusal of food and water--a way out of the aid-in-dying debate? PMID- 10136658 TI - Articles address issues of integrated systems, authority, and payment. AB - Ethics committees are continually challenged by matters of identity. Does its membership reflect a fair representation of health care disciplines? Does the committee have the institution's or the patient's best interests at heart? Just when ethics committees seem to be getting a handle on these matters, the political environment is changing, with more hospitals becoming involved in managed care systems. So the question persists, but at a different level. The following articles summarize various ideas being proposed as solutions. PMID- 10136659 TI - AMA opinion on anencephalic donors renews heated debate. PMID- 10136660 TI - Consent evades consensus. AB - A problem area certain to become a tough nut to crack in years to come is the extension of patient rights and autonomy to a more stringent level within the informed consent process in situations covering education, research, and epidemiology. Recent events and reports indicate at least an acknowledgment of some specific issues that need attention, as the following articles show. PMID- 10136661 TI - Ethical questions under managed care begin to surface in the literature. AB - Defining the specific ethical issues anticipated under integrated health care delivery systems is difficult for several reasons: (1) We don't know with certainty what structures, processes, and rules will be in place, and (2) the lines of authority and accountability are still unsettled. Despite these unknowns, everyone seems fairly certain that managed care processes within a structure of managed competition will be permanent and prominent fixtures in the reformed environment of health care. The following articles summarize three recent articles on life under managed care. The first two reflect the concerns of physician-ethicists, and the third makes an effort to think of ethical obligations at the organizational level. PMID- 10136662 TI - The re-engineering solution. PMID- 10136663 TI - Current market realities and you. PMID- 10136664 TI - The debate over financing health system reform. PMID- 10136665 TI - Acute care to rehab: earlier discharges, better outcomes. PMID- 10136666 TI - Healthcare access service models. PMID- 10136667 TI - Private bioethics forums: counterpoint to government bodies. PMID- 10136668 TI - Retiree medical--round 2. AB - The second round of changes resulting from FAS 106 will be less dramatic than the first. But employers can anticipate that overall retiree health care costs will be reduced, averting the need to increase pensions or other retiree benefits. A fixed dollar benefit design will justify a lower accounting cost. PMID- 10136669 TI - The future financing of Medicare. AB - Regardless of the timing and the type of federal action to reform the nation's health care system, the Medicare program's financial problems must be addressed soon. Serious concerns exist about both the Hospital Insurance and the Supplementary Medical Insurance portions of the program. PMID- 10136670 TI - The effectiveness of budget targets and caps in the German ambulatory care sector. PMID- 10136671 TI - Utilization management and data acquisition: a case study. AB - The more a company knows about the source and nature of its health care costs, the more likely it is to make good cost-effective decisions. Three different companies, with the help of health care management vendors, were able to make significant health cost savings by organizing their data in creative ways. Combining different sources of cost data enabled them to answer questions they could not have answered through any single source. PMID- 10136672 TI - Pattern-of-treatment differences among primary care physicians in alternative systems of care. AB - In a recent study, the average treatment pattern of HMO-based primary care physicians is found to be significantly less expensive than that of indemnity based primary care physicians. This difference is because the HMO-based physicians' style of medical practice is less hospital-intensive. PMID- 10136673 TI - Group health exclusions for experimental procedures--commentary. PMID- 10136674 TI - Estimating the real number of chronically uninsured. AB - Opponents of universal coverage argue that 37 million uninsured Americans exaggerates the "health care crisis" because most are uninsured for just a short time. But new estimates show that 54 percent of America's uninsured live for more than two years without insurance and three out of four live without coverage for more than a year. PMID- 10136675 TI - Two studies, one conclusion: employer health insurance eroding. PMID- 10136676 TI - Pharmacies take uniform price demands to court. PMID- 10136677 TI - Patient Protection Act: investing in patient care, not corporate profits. PMID- 10136678 TI - Fee-for-service medicine, not patients, come first in AMA bill. AB - The American Medical Association, as presented on the opposing page, wants to protect patients from managed care's profit-oriented approach. That view is disingenuous, say insurance executives, who argue an opposing view on this page. PMID- 10136679 TI - Health reform recedes as campaign issue in 1994 elections. PMID- 10136680 TI - An AIDS vaccine: a flickering light at the end of the tunnel. AB - Ten years ago, federal officials predicted that an AIDS vaccine was just around the corner. Today--millions of dollars and scores of research trials later--AIDS researchers at the National Institutes of Health are deciding whether to test two promising AIDS vaccines. This time, officials aren't promising a quick fix. PMID- 10136681 TI - DataLine. Lower Medicaid costs, stronger economy strengthen state budgets. PMID- 10136682 TI - Designing an integrated drug benefit for the elderly. AB - The elderly are hit hard by high out-of-pocket expenses for medicines, but a stand-alone pharmaceutical benefit could cost the country billions and still not improve older Americans' quality of care. Such a benefit should be coordinated with patients' overall medical benefits. A systems-based pharmaceutical benefit is financially feasible through a combination of premiums and cost sharing, market-driven price reductions, and cost savings achieved through integrated managed care programs and improved outcomes. PMID- 10136683 TI - Grading the Clinton administration's health care team. AB - Where health reform ends up this year--or next--is anyone's guess. But no one can dispute the enormous role the Clinton White House has played in getting the ball rolling. Even the Clintons' most ardent foes (and there are more than a few) acknowledge that the President and First Lady Hillary Rodham Clinton deserve enormous credit for putting the complex issue high on the public and political agenda. With those extra-credit points safely assured, the editorial staff of the Journal of American Health Policy is grading the efforts of 10 top health officials in the Clinton Administration. Our 1994 report card reflects individuals' leadership ability, credibility in dealing with the public, willingness to compromise, and role in improving health care for all Americans. PMID- 10136684 TI - Insurance reform may be sure bet, but will it work? PMID- 10136685 TI - Election fears, lobby group pressures cause states to abandon reform ship. PMID- 10136686 TI - States sue federal government over immigrants' health costs. PMID- 10136687 TI - Health alliance bandwagon rolls on into uncharted territory. PMID- 10136688 TI - Drug industry finds new partners in cost-containment quest. PMID- 10136689 TI - How much does defensive medicine cost? AB - Many key health reform bills in the 103rd Congress include proposals to overhaul the medical malpractice system. One of the factors motivating such legislation is the practice of defensive medicine, or care that does not benefit the patient and is provided solely to avoid malpractice claims. Estimating the costs of defensive medicine is difficult because of the many conflicting and overlapping motivations facing physicians. Although our estimates delineate a wide range of potential savings, systemwide savings from aggressive malpractice reform could approach $41 billion over five years. PMID- 10136690 TI - A brief look at productivity measurement. PMID- 10136691 TI - The costs of teaching primary care in an ambulatory care setting--a hypothetical case study: Wagner Hospital. PMID- 10136692 TI - Reimbursement issues in managed care contracting. PMID- 10136693 TI - Risk, risk, who's got the risk? AB - There are no pat solutions for creating ideal risk-sharing arrangements. The next several years will require a great deal of effort at designing equitable deals that create desired incentives for all parties. The key issue is that in a hospital's rush to position itself for survival, it should not lose sight of the importance of structuring arrangements so that risk can be shared and all parties have desirable incentives. PMID- 10136694 TI - America's changing health care landscape: challenges and opportunities for professional fund raisers. PMID- 10136695 TI - Accountability, program performance, and profitability. Part 2: Comparative analysis, profitability, and forecasting. AB - Part 1 of this article, which appeared in the AHP Spring Journal, examined ways to measure the performance of fund development programs. Part 2 provides additional tools for demonstrating the efficiency, effectiveness, and profitability of these same fund development programs. PMID- 10136696 TI - Probate: the silent thief. PMID- 10136697 TI - Mother Nature prompts foundation to take 'first step' toward 21st Century. PMID- 10136698 TI - The case for health care philanthropy. AB - Health care organization trustees and CEOs are in a unique position to know and affect the delivery of health care services to their communities. They are the natural developers and guardians of a community's health care resources. This role can be strengthened through education, and a broader understanding among trustees and CEOs about their critical influence on philanthropy for hospitals, medical centers, hospices, long-term care institutions, and all health-related organizations. PMID- 10136699 TI - Giving your personal best. PMID- 10136700 TI - Caregivers and contributions: attitudes of nurses toward philanthropy. PMID- 10136701 TI - A regional hospital association's approach to clinical pathway development. AB - Sixteen hospitals from the Northeastern New York Hospital Council tested the theory that clinical pathways are an essential component of the integrated quality assessment process. Clinical pathways served as a transition to the holistic, process-oriented approach of quality improvement. The clinical pathways that they developed included preadmission, hospitalization, and postdischarge care needs. Respect and trust established among the hospitals in the consortium were evidenced by the cooperation and collaboration of the participating hospitals. This regional approach to care resulted in increased patient and staff satisfaction, positive patient outcomes, and a decrease in length of stay. PMID- 10136702 TI - Interdisciplinary collaboration in the special care unit--Part II. AB - Collaborative interdisciplinary patient care is enhanced as healthcare professionals in special care units work to implement Joint Commission on Accreditation of Healthcare Organizations' standards for improving organizational performance. This second part of a two-part article provides a practical approach to developing a process action team to review the care of patients receiving mechanical ventilation. As a follow-up to the development of one special care unit committee, this was an important step in the transition from multidisciplinary, discipline-specific care to interdisciplinary, collaborative care. PMID- 10136703 TI - Quality assessment and clinical research: a collaborative approach. AB - Obtaining physician commitment to and continued involvement in quality assessment activities can be difficult. Some physicians view quality assessment as a bureaucratic morass that fails to improve patient care. However, by combining quality assessment and clinical research, insight into practice patterns can be obtained and physicians might be more likely to express interest in quality assessment issues. We reviewed medical records of patients at our hospital on peritoneal dialysis (PD) to determine the rate of free air found in normal PD patients. This was compared to PD patients with known gastrointestinal perforation; free intra-abdominal air has been described as a sign of gastrointestinal perforation. Documentation of free air and its significance in radiology reports were noted. Fifty-nine of 59 (100%) cases had available radiology reports. Documentation of free air was present in only 5 of 23 (22%) cases, and its significance was noted in the same 5 of 23 (22%). These results were communicated within the hospital, and a subsequent improvement in free-air detection, documentation, and reporting--both oral and written--was noted by the clinical service. The documentation of radiological findings is a frequently used monitor in radiology quality assessment. Our study identified a clinical and documentation problem, quantified the deficiency, and took steps toward improvement while simultaneously performing clinical research. We conclude that quality assessment and clinical research can coexist and serve to improve clinical practice while encouraging physician involvement in quality assessment programs. PMID- 10136704 TI - Performance improvement: one model to reduce length of stay. AB - Dedicated quality professionals are tired of quick fixes, Band-Aids, and other first-aid strategies that offer only temporary relief of nagging problems rather than a long-term cure. Implementing strategies that can produce permanent solutions to crucial problems is a challenge confronted by organizations striving for continuous performance improvement. One vehicle, driven by data and customer requirements, that can help to solve problems and sustain success over time is the storyboard. This article illustrates the use of the storyboard as the framework for reducing length of stay--one of the most important problems facing healthcare organizations today. PMID- 10136705 TI - Simple statistical measures for analyzing categorical data. AB - The proportions of patients undergoing a given procedure or experiencing a specific health outcome often are important in studies of healthcare quality. Run charts are a nonstatistical method for evaluating changes in these proportions or rates over time. Simple epidemiological methods for comparing rates between two groups allow statistical comparison of rates between two time periods. The chi square test measures the statistical significance of differences in rates between two groups. Practical aspects of the use of these statistics and interpretation of their results are discussed and illustrated in this article, with realistic examples originally prepared by the author for a drug usage evaluation study. Readers with appropriate software and hardware may request a simple spreadsheet from the author to calculate many of the analyses described in the article. PMID- 10136706 TI - Legislative forum: healthcare reform legislation's route through congress. PMID- 10136707 TI - Current topics in obstetrical risk management--Part I. PMID- 10136708 TI - Any willing provider legislation: an overview of state laws. PMID- 10136709 TI - Essential equipment for ambulances. Committee on Trauma, American College of Surgeons (revised, March 1994). PMID- 10136710 TI - Statement of the American College of Surgeons on Advance Directives by Patients. "Do Not Resuscitate" in the operating room. PMID- 10136711 TI - Hiring an attorney: why, when, who, how, and how much. PMID- 10136712 TI - Can cost containment be learned in a surgical residency? PMID- 10136713 TI - Family physician hospital privileges: a new approach. PMID- 10136714 TI - Your financial health: are you caring for it as you should? PMID- 10136715 TI - Changing the guard: how the Mewburn Veterans Centre received new owners. AB - The consolidation of programs and services is currently of great interest in Canadian health care. This article describes the process that was used to transfer a 146-bed continuing care centre from one hospital organization to another. Leadership, team work, structure and communication were found to be the keys to success in dealing with the many problems and complexities of a facility transfer. PMID- 10136716 TI - Competition in health reform: not for me, thanks. PMID- 10136717 TI - Consolidation of patients awaiting placement: a two-year review. AB - Toronto's Wellesley Hospital retrospectively reviewed the effectiveness of consolidating long-stay patients within one environment where they were cared for by an integrated interdisciplinary team. The study found that this approach resulted in cost-effective care, improved patient outcome, improved bed utilization and prevention of unnecessary institutionalization. The model is universal and easily reproducible. PMID- 10136718 TI - Governance models within multi-institutional systems. AB - The differences in governance models for multi-institutional systems are primarily related to the number of governing boards within a given system. This article presents those models with a corporate level governing board that maintains ultimate legal responsibility for the system. Although this is a complex issue, the needs of the patients and communities the affected organizations serve must be at the forefront of all discussions. PMID- 10136719 TI - Maude Barlow says Council of Canadians aims to defend public health care. Interview by Matthew D. Pavelich. PMID- 10136720 TI - Competition in the British National Health Service. AB - British National Health Service reforms seek to maintain the right to health care regardless of ability to pay. They involve internal market disciplines, including competition, though services remain free at the point of use. Hospitals, with greater independence, will concentrate on acute care. Family doctors and community health services get wider responsibilities and direct access to funds. Individuals are encouraged to adopt healthy lifestyles. PMID- 10136721 TI - Health Care Reform Week's comparison of major Congressional reform legislation. PMID- 10136722 TI - Materials and accounting win tug-of-war with pesky invoices. PMID- 10136723 TI - Materials managers go above and beyond the call of duty. PMID- 10136724 TI - Infection control inspires new mix of respiratory supplies. PMID- 10136725 TI - Storage planning: make the most of limited space. PMID- 10136726 TI - Twice around: savings in the used telecom marker. PMID- 10136727 TI - Supply channels: right mix = lowest total cost. PMID- 10136728 TI - Doing more with less: new supply program cuts total delivered costs. PMID- 10136729 TI - Cost and performance of hospital telecommunications functions. PMID- 10136730 TI - As wireless communications grow, so do invisible risks to patients. PMID- 10136731 TI - Rules for winning the health care sales game. PMID- 10136732 TI - Is CS fit or fat? Benchmarking data shows your condition. PMID- 10136733 TI - 1994 materials management performance indicators survey. PMID- 10136734 TI - Focus forecasting: using computers for inventory control. PMID- 10136735 TI - Materials managers earn their grades from hospital execs. AB - The 1994 Survey on CEO/CFO Satisfaction With and Expectations for Hospital Materials Management provides an inside look at how hospital executives size up their materials management departments. The survey of 143 hospital CEOs and CFOs conducted by Kowalski-Dickow Associates, a materials management consulting firm based in Milwaukee, sheds light on executives' perceptions of the performance, characteristics and future of materials management. Materials managers can use the information to begin--or enhance--communications with senior management. The study was completed in cooperation with the American Society for Healthcare Materials Management and Materials Management in Health Care. Funding for the survey was provided by the American Sterilizer Company (AMSCO), Erie, PA; General Medical Corp., Richmond, VA; Kimberly-Clark, Roswell, GA; Milcare/Herman Miller, Zeeland, MI; and Owens & Minor, Glen Allen, VA. PMID- 10136736 TI - Towels vs. hot air: it's not a dry debate. PMID- 10136737 TI - Minisurveys: inventory software, gloves. PMID- 10136738 TI - Checking out. With all hope vanished for universal health care, Bill Clinton will settle for less. But how much less? PMID- 10136739 TI - Health care. Better off dead? PMID- 10136740 TI - Down for the count? PMID- 10136741 TI - Managing quality: the next five years. AB - Over the past five years, the principles and tools of quality management have gained a foothold in healthcare, but evaluated in terms of actual breakthroughs in results, the movement has not demonstrated its value as an antidote for America's troubled healthcare delivery system. By reemphasizing their investments in eight critical areas, healthcare leaders can accelerate the pace of improvement and set the stage for fundamental systemic change. PMID- 10136742 TI - Using systems thinking to extend continuous quality improvement. AB - Traditional CQI tools have proven effective in improving discrete processes, but the strengths of these tools often render them inappropriate to improve complex systems made up of multiple processes. After finding that CQI tools failed to reduce emergency department waiting times, a QI team applied systems thinking tools and learned that the cause of delays was rooted in interrelationships among processes, such as the impact on laboratory testing when emergent and routine patients arrived back to back. Computer modeling allowed the team to reject some quick fixes--such as adding ED beds--that simulations showed would be ineffective. By reorganizing patient flow and automating hospitalwide bed control, the team so far has reduced waiting times 19 percent and increased patient satisfaction despite an increase in census. PMID- 10136743 TI - The challenges of implementing quality improvement in small rural hospitals. AB - In the five years since launching its QI initiative, Mason General Hospital has dealt with many of the challenges that commonly arise in healthcare organizations during TQM implementation, including involving physicians and training staff. It also had to address a host of issues common to small rural organizations. At first glance, one might suspect that the move toward QI would be easier in a small organization because there are fewer leaders to orient, fewer people involved in work processes, and fewer levels of management. In fact, the small organization presents special challenges, including limited staff and financial resources, high turnover rates in key medical staff leadership positions, and small sample sizes. The strategies used by Mason General Hospital to respond to these and other challenges provide a model for small rural healthcare organizations. PMID- 10136744 TI - Department deployment: integrating quality improvement into day-to-day management. AB - Despite the time and resources that The George Washington University Medical Center (GWUMC) put into training and forming QI teams, QI staff found that CQI was not being used to carry out critical day-to-day departmental functions. In other words, CQI didn't affect the way staff did "real work." In response, the medical center developed an approach that integrates CQI with departmental leadership, structure, culture, and work routine. With the help of a coach, willing departments at GWUMC choose from a series of 155 activities that they complete at their own pace (eg, setting departmental CQI goals, developing a departmental mission). The department deployment process moves staff through three levels of increasing sophistication and maturity with CQI methods: awareness, understanding, and bonding. It is intended to make quality a habit for staff, or a part of the organizational mind set, rather than an isolated "project." This article will describe how the department deployment approach was developed, its philosophical underpinnings, and its methodology and tools. Then, an example will illustrate how one hospital department--social work and utilization case management--successfully used this approach. PMID- 10136745 TI - Quality improvement in long-term care. AB - Creating a culture or environment in which total quality can take root is a challenging undertaking for most healthcare organizations. It requires staff at all levels to acquire new skills and problem-solving techniques and apply them in their daily work processes. Change is rarely easy, and it can become all the more difficult in facilities where budgets are strained, staff turnover is high, patients require special attention, and computer-assisted data collection and analysis is still in its infancy. Such is the situation in many long-term care facilities. Some forward-thinking state organizations, long-term care facilities, and national associations are developing strategies to address these issues. Admittedly, these efforts are still in their infancy, but early reports indicate that TQM has the potential to produce results in this field as it has in other healthcare settings. PMID- 10136746 TI - Improving the operating budget process at Abbott Northwestern Hospital. AB - To set an example for the organization, the senior management team at Abbott Northwestern Hospital used quality tools and techniques to improve a highly visible, problematic system--the operating budget process. Team members narrowed the root cause to a faulty, nonintegrated assumption process and identified additional problems, such as inadequate communication, unclear accountabilities, and lengthy timetables. Then, the team streamlined the budget process from a 6 month to a 10-week cycle, which aligned the process with one of the organization's shared quality goals--reducing cycle time. RESULTS: Cycle time was reduced by 60 percent, from an average of 6 months to 10 weeks. Budget accuracy, which is measured by how close initial budget submissions come to targeted net income projections, improved by $12 million or 500 percent. The amount of rework, which is measured by the number of budget revisions made prior to Board approval, dropped from eight revisions to four. Overall satisfaction and familiarity with the budget process increased by 40 percent among managers and supervisors. PMID- 10136747 TI - Increasing the value of cardiac care: the Dartmouth approach. AB - A cardiac services team at Dartmouth-Hitchcock Medical Center (DHMC) launched multiple efforts to improve the quality and value of their services. The team developed a critical path for coronary artery bypass grafting (CABG) and tracked important clinical outcomes, such as mortality rates and wound complications. The team also studied the patient's view of the process. Staff used focus groups and surveys to distill the "voice of the customer" into six quality characteristics and developed methods to better involve patients in clinical decision making and evaluation of treatment efficacy. RESULTS: CABG mortality declined from 5.7 percent in 1992 to 2.7 percent in 1994, 16 months after the critical path was developed. Mean total intubation time for patients following open-heart surgery was reduced from 22 hours to 14 hours. Median postoperative length of stay decreased from seven days to six for elective CABG patients. The number of patients discharged in five days or less increased from 20 percent to 40 percent. Readmission to the hospital following discharge remained stable, despite the shorter length of stay. PMID- 10136748 TI - Redesigning the nursing care delivery system at Fairfax Hospital. AB - The redesign of the nursing delivery process at Fairfax Hospital is occurring from the top down and the bottom up. Nursing leaders have identified improvement opportunities that all units are addressing, such as reevaluating skill mix. At the same time, each inpatient nursing unit is redesigning its own processes to meet customer requirements. For example, the postpartum unit shifted to a "wellness" approach. Nurses reduced the amount of time spent in reassessing patients and are focusing instead on those things their patients are concerned about, such as teaching new mothers how to care for their babies. RESULTS: Customer research revealed that patients, physicians, and nurses wanted family centered care from competent, caring clinicians. Flow charts identified many improvement opportunities that were common across all nursing units, such as reducing the time nurses spend reporting between shifts. Nurses are more empowered to make local decisions. Additional quantitative results are being tracked for this relatively recent effort. PMID- 10136749 TI - Designing a home infusion therapy service at Scott and White. AB - A quality planning team at Scott and White used Juran planning techniques to design a coordinated, cost-effective method for providing home infusion therapy to patients. The team translated customer needs into important product and process features and then designed a home infusion program to meet those features. RESULTS: The program was implemented in late June and is expected to increase customer satisfaction, contain costs, and provide improved coordination of care by all providers. Quantitative results are being tracked. Based on this team's apparent success, two other planning teams have been formed and are nearing completion. PMID- 10136750 TI - Improving the case cart process at Abbott Northwestern Hospital. AB - An interdepartmental team at Abbott Northwestern Hospital, in Minneapolis, audited surgical case carts for three months to determine why a large percentage were incomplete or incorrectly filled. After discovering a shortage of specific supplies and instruments and an unavailability of staff at times when case carts needed to be filled, the team designed specific interventions that almost doubled the number of completed carts. RESULTS: Case cart completeness increased from 50 percent to 93 percent. The number of trips staff made to case carts to add missing items was reduced by 20 percent, saving more than $40,000 per year in labor costs. The level of physician and staff frustration decreased, and communication and cooperation among the operating, central processing, and instrument departments greatly improved. PMID- 10136751 TI - Reducing delays in the CT scanning process at Bloomington Hospital. AB - Over a two-month period in 1992, a team in the Radiology Department at Bloomington Hospital recorded the number and types of delays that occurred in the computer tomography (CT) scanning process. Using the Pareto principle, the team identified two root causes for delays--equipment failure and insufficient information collected at scheduling. Appropriate interventions were identified, and the number of delays decreased dramatically. RESULTS: The number of delays in the CT scanning process decreased from a median of 19 per day to 2. Staff overtime hours decreased from a median of 87 per month to 46. The time patients spend waiting to receive a CT scan decreased from an average of 20 minutes to 30 minutes to 0 to 10 minutes. Patients are scheduled for a scan within one day's notice, as opposed to one week previously. Complaints from patients, physician offices, and other customers decreased dramatically. Morale and empowerment improved among staff. PMID- 10136752 TI - Taming the supplies and inventory process at Westmead Hospital. AB - In July 1991, a team within the Clinical Chemistry Department at Westmead Hospital used control charts and other statistical tools to analyze the supplies and inventory process. No single major problem was discovered. Instead, the team found many small problems causing delays and inefficiencies in the process. By developing and implementing multiple solutions, the team was able to streamline the process and reduce the number of principal suppliers. RESULTS: The number of principal suppliers was reduced by two-thirds. The average number of "urgent" orders, which add extra steps to the purchasing process, was reduced by three quarters. The mean turnaround time for common clinical chemistry laboratory tests improved by 8%. PMID- 10136753 TI - Improving the total hip replacement process at University of Alberta Hospitals. AB - In October 1988, the University of Alberta Hospitals (UAH) embarked on a Value Improvement Process (VIP) study, a forerunner to the hospital's total quality management (TQM) initiative, to improve the total hip replacement procedure. Cost analysis and comparisons with similar hospitals helped a cross-functional team identify 12 areas for improvement. The team significantly decreased costs and length of stay by standardizing preoperative procedures, decreasing the number of suppliers providing prosthetic devices, and implementing other improvements. RESULTS: The overall cost of performing a total hip replacement decreased 21.2 percent. Preoperative length of stay decreased 48.1 percent, and postoperative length of stay decreased 9.4 percent. Total expenditures on orthopedic units involved in the study decreased 20.3 percent. Length of stay for all orthopedic patients also decreased from 8.6 days to 7.47 days. The number of open beds decreased 7.7 percent. The level of staff satisfaction with the study averaged 4.9 out of possible score of 5. PMID- 10136754 TI - Fostering the leadership of a continually improving healthcare organization. AB - Governing board members and other healthcare leaders naturally want to see their organizations improve, but they often have difficulty connecting leadership functions to daily work in the organization in order to produce improvement. This article offers a framework, including a series of self-assessment questions, to help leaders foster continual improvement within their organization. Such improvement becomes possible when people join professional knowledge with a new body of knowledge called improvement knowledge. Continual improvement results when leaders enable everyone in the organization to build new knowledge, to test changes in daily work, and to learn from these tests. Essential to building and applying knowledge in this way are a leadership policy that fosters a shared sense of purpose and promotes learning, tools and methods that accelerate the development of new knowledge and improvement, and systematic strategies for building and applying that new knowledge to the process of daily work, and to the functions of leadership itself. PMID- 10136755 TI - Helmet use: what message are we sending to patients? AB - INTRODUCTION: Multiple studies have demonstrated that the use of helmets by helicopter personnel saves lives and reduces morbidity. However, papers continue to cite potential adverse reaction from patients and the public as a justification for air medical personnel not wearing the helmets. PURPOSE: This study was conducted to determine how patients transported by helicopter react to helmets worn by air medical personnel. METHODS: Fifty-one adult patients with a Glasgow Coma Scale score of 15 were surveyed regarding their reaction to helmet use by air medical personnel. RESULTS: While the respondents had various concerns about the aircraft and flying, none had a negative reaction to the helmet use. CONCLUSION: Helmet use does not have a negative effect on patients, and such a putative effect should not be used to justify the avoidance of by air medical personnel. PMID- 10136756 TI - The American Society for Testing Materials F-30 Committee on EMS. AB - The American Society for Testing Materials (ASTM) F-30 Committee on Emergency Medical Services (EMS) began creating voluntary consensus standards for EMS including air medical transport in 1984. The F-30 Committee is composed of more than 200 members who represent both the "producers" and the "users" of EMS. Approximately 10 of the 39 standards published by the F-30 Committee either deal directly or indirectly with air medical programs. The standards are refined through yearly evaluation and reviewed in detail every four years. Due to concerns with the ASTM process, several of the initial members resigned in 1988. Changes made to the scope and practice of the F-30 Committee have resulted in some of these participants returning to the process. New standards must be developed only after a "needs assessment" demonstrates that such a standard should exist. Relevant pre-existing standards must be reviewed. Clinical practice has been excluded from the work of the F-30 Committee. Air medical programs may participate as members of the F-30 Committee for a nominal yearly fee, which provides members with an updated book of standards. Meetings are held biannually. The Guide for Establishing the Qualifications, Education and Training of EMS Aeromedical Patient Care Providers is approaching its four-year review, and a number of other standards, which are of particular interest to the air medical community, are currently under development. PMID- 10136757 TI - 1994 Air Medical Program Survey. PMID- 10136758 TI - Thriving, not just surviving: the new rules for success in cardiovascular medicine. PMID- 10136759 TI - The organization of heart services. Part Two: Structural alternatives for the successful heart services organization. AB - This article provides a framework of the various models currently available to form a heart institute that is designed to enhance the position of the providers with managed care and other third-party payers. Each model has components that are similar: Governance and management are provided by an advisory board or steering committee. The board is typically comprised of representatives of both the physicians and the hospital. Daily management is provided by a professional manager, such as an executive director. The ability of the model to locate, negotiate and enter into contracts for the providers is determined by the amount of integration of services provided by the participants. Each of the models discussed in sequence represents increasing integration; therefore, the cardiac IPO has more integration--particularly if it offers a new service such as capitation to the market--than the service-line approach. The ICHO has the most integration of the models presented. This form of organization will be addressed more completely in Part Four of this series. Part Three will discuss PHO models in-depth as well as address certain legal requirements that should be considered when developing a new, integrated PHO entity. PMID- 10136760 TI - Reducing costs and preserving physician choice: creating a partnership that works. AB - The partnership between the medical staff, administration and materials management achieved its goals of cost reduction and preservation of physician choice. They were successfully achieved because a number of things occurred: Vendors reduced the cost of every device sold to the hospital; physicians moved their marketshare by choice in the direction of the preferred list; physicians supported the process and participated actively in the cost-reduction. It was clear that market competition worked very favorably in the hospital's effort to achieve its goals. Saint Vincent Hospital also learned that a number of hospitals who received its blind survey results were also able to impact positively on their own cost-savings efforts--an additional, if unexpected, benefit. This first step toward cooperative cost reduction was indeed a success. PMID- 10136761 TI - Child Health Center maps route to preventive cardiology. PMID- 10136762 TI - A guide to health care reform. PMID- 10136763 TI - Symposium on health care reform. PMID- 10136764 TI - Issues every plan to reform health care financing must confront. PMID- 10136765 TI - Universal health insurance in the Clinton plan: coverage as a tax-financed public good. PMID- 10136766 TI - Public finance principles and national health care reform. PMID- 10136767 TI - Two improvements on the Clinton framework. PMID- 10136768 TI - A skeptic's view of global budget caps. PMID- 10136769 TI - Data watch. Employer-sponsored health coverage. PMID- 10136770 TI - Report cards, Part 2: How hospitals measure up. PMID- 10136771 TI - Four cost-cutting strategies. PMID- 10136772 TI - The remaking of the Blues. AB - As the nation's largest health insurer, the Blues must adapt to the new world of health care. The question is, What course are they charting to to become part of the solution. PMID- 10136773 TI - The next problem: implementing reform. PMID- 10136774 TI - Iowa encourages local solutions. PMID- 10136775 TI - States test Medicaid reforms. PMID- 10136776 TI - The any-willing-provider scourge. PMID- 10136777 TI - How can hospitals survive? PMID- 10136779 TI - Friendly Hills sold to CareMark. PMID- 10136778 TI - New Hampshire. The Granite State begins to shake. PMID- 10136780 TI - Comparative audit between hospitals: the example of appendectomy. AB - How useful are routine, comparative audit systems? To attempt to answer this question, data from a system in North West Thames were used. A common procedure was selected (appendectomy) and data supplied by 17 surgeons between January and June 1990 were analysed. Aspects of the case-mix, clinical management, diagnostic accuracy and patient outcomes for the surgeons were compared. A total of 401 patients had been treated. All aspects of care varied between surgeons: mean age of patients (19-36 years), proportion of female patients (30-75 per cent), mean length of stay (2.1-7.1 days), prophylactic antibiotic use (0-85 per cent), diagnostic accuracy (40-100 per cent) and incidence of wound infections (0-4 per cent). As a result of the small sample sizes (mean number of cases per surgeon was 23.6) few of these differences were statistically significant. In addition, there were some doubts about the accuracy of some of the data. If such methodological difficulties can be overcome, comparative audit systems offer a practical and useful way of uncovering unusual clinical practices and generating hypotheses for evaluative research. PMID- 10136781 TI - Hand-held computers in clinical audit: a comparison with established paper and pencil methods. AB - The performance of hand-held computer terminals was compared with that of paper and pencil data collection methods. The study was carried out on two wards, with a comparative study in the medical audit unit at Rampton Hospital, one of three special hospitals managed by the Special Hospitals Service Authority. These were analysed, focusing on time factors, error rates, ease of use and financial implications. Findings showed that the electronic system saved time, reduced staffing costs and errors and had unit-wide potential. The electronic data collection contributed to a cost-effective and flexible data-processing system for use in auditing. PMID- 10136782 TI - Care of the elderly and occupational health for staff in local nursing homes: quality issues. AB - Describes a questionnaire sent to 11 of the 66 nursing homes in the Brighton Health Authority to compare the quality of care provided. These homes care for 242 patients (representing 13 per cent of the 1,728 places in Brighton nursing homes). Questions dealt with residential environment, occupational health, care and control of medicines, clerical services, procedures for prevention and control of infection, etc. Results are discussed and recommendations for further improvements made. PMID- 10136783 TI - Quality of life as an indicator of outcome in the treatment of cancer patients: the purchaser perspectives. AB - Evaluation of treatment can be seen as part of a wider concern to measure quality of care, as well as about the need to monitor and improve the effectiveness of services. Quality of life issues will be of increasing interest to those involved in the commissioning of health-care services. Cancer is used to illustrate how the quality of life of patients, both during and after treatment, can be measured and the information used by purchasers to consider the relative effectiveness of different methods of treatment. This in turn can inform the overall purchasing strategy of commissioning agencies. PMID- 10136784 TI - Medical audit and the role of the facilitator. AB - Describes how the Buckinghamshire Medical Audit Advisory Group have approached the introduction of medical audit in primary care. Outlines how the original facilitator model, which proved so successful in encouraging initiatives in coronary heart disease prevention, is now being used to encourage and promote quality initiatives using medical audit techniques. Explores use of the audit cycle and emphasizes the importance of teamwork in enabling change to occur. Outlines the special personal and professional skills required to work in the increasingly complex and dynamic arena of primary care, with a description of how the National Facilitator Development Project has taken on board these educational needs. PMID- 10136785 TI - Libraries' textbook approach to total quality. PMID- 10136786 TI - Hilton's home away from home. PMID- 10136787 TI - Quality is...never having to say that the laundry is shut! PMID- 10136788 TI - Making customers trendy. PMID- 10136790 TI - Bank's "quality" effort makes sound business sense. PMID- 10136789 TI - Sun, sea, sand and service. Club Med's bid for total quality--providing holidays as close to perfection as possible. PMID- 10136791 TI - The bank that likes its customers to say yes. PMID- 10136792 TI - Cohesive corporate values provide focus. PMID- 10136793 TI - The importance of leadership. PMID- 10136794 TI - The missing ingredient? PMID- 10136795 TI - Making complaints pay. PMID- 10136796 TI - Strategies for service quality. Addressing the issues of management and quality. PMID- 10136797 TI - Capturing the customer's voice. PMID- 10136798 TI - Not resting on its laurels. Federal Express was founded in 1973 and now employs 90,000 people. PMID- 10136799 TI - Total quality in the real world. PMID- 10136800 TI - Delight customers--distance competitors. PMID- 10136801 TI - Inflight philosophy. A tight customer focus has helped SIA (Singapore Airlines) to become a major airline. PMID- 10136802 TI - The perfect smile. Active employee involvement is a critical part of the TQM Programme. PMID- 10136803 TI - Customer service can reap rich rewards. PMID- 10136804 TI - Case mix, risk adjustment, reinsurance, and health reform. AB - Case mix measures represent the fundamental tool that measures clinical differences in groups of patients. It is important to be careful how these measures are used, as quality of care delivered to patients is at stake. Risk adjustment methodologies are excellent for physician profiling if one adopts them as the first step in the quality improvement process. Differences in hospital or primary care practice profiles, adjusted for the case mix measures, often reveal quality improvement opportunities. This first step is the easy part. The hard part comes in working together with the health care team to determine the sources for these differences. After identifying and implementing solutions, the quality improvement process just continues. As benefits true commitment to quality improvement, risk assessment methodologies will only improve. In turn, this will provide the health care team with a greater ability to deal with "treasures" uncovered by applying case mix measures. PMID- 10136805 TI - Designing and using case mix indices. AB - Any assessment of clinical care in which provider performances will be compared to norms requires adjusting for differences among patient populations. Basic issues that must be addressed include: (1) specification of the population that will be adjusted for case mix; (2) selection, definition, and weighting of factors that will be used to determine case mix; (3) validation of the proposed case mix indices; and (4) application of indices to samples of interest. The authors consider each of these issues, using illustrations from the Greater Cleveland Health Quality Choice Project and other outcomes monitoring projects. PMID- 10136806 TI - Understanding your managed care practice: the critical role of case mix systems. AB - Successful implementation of managed care programs requires an understanding of case mix and severity of illness. This article summarizes the state of the art for both inpatient and outpatient services. PMID- 10136807 TI - Applying population-based case mix adjustment in managed care: the Johns Hopkins Ambulatory Care Group system. AB - When analyzing medical utilization or other health care-related measurements across provider panels, case mix adjustment is required because "illness burden" is often unevenly distributed across these patient populations. This article develops the rationale for case mix adjustment and walks readers through the case mix adjustment process using the Johns Hopkins Ambulatory Care Group (ACG) Case Mix System as a model. The ACG system is a population-oriented patient classification tool based on diagnoses assigned by providers and found in payors' data systems. The system categorizes patients according to illness burden. It does not categorize visits, encounters, or episodes. ACGs adjust for case mix differences in the analysis of ambulatory, laboratory, pharmacy, and total health care service delivery. PMID- 10136808 TI - The need for alternatives to capitation under managed care. AB - Health reform requires the merging of traditional insurance and health financing tools. At the center of this intersection may be the need for risk adjustment of capitated payments. For ambulatory services ACGs and capitation are but one possible fate for provider payment in a managed care-dominated future. It is the authors' opinion that such an approach fails to meet the demands of risk adjustment as well as other needs related to provider payment under managed care and health reform. PMID- 10136809 TI - Patient case mix measurement using outpatient drug dispense data. AB - This article outlines issues concerned with the development of case mix measurement using outpatient drug dispense databases, particularly as this method is being explored at Kaiser Permanente. Development is oriented to a population based measure that emphasizes identification of major chronic diseases, such as diabetes, heart disease, hypertension, and asthma. Examples illustrate potential applications in the areas of utilization management and resource allocation. Questions concerning the integrity of this method--that is, how reliably the method represents population morbidity--are addressed. PMID- 10136810 TI - A case study in APR-DRGs: the Greater Southeast Community Hospital experience. AB - The need for accurate, valid, and reliable severity data has taken on increasing importance over the last several years. The impact of managed care has been particularly significant, with many conditions once treated on an inpatient basis now being managed in the outpatient setting or admitted to the hospital only after the condition has progressed to a more advanced stage. The results has been an increasingly sicker inpatient population. Both hospitals and managed care organizations need data that will measure the impact of case mix complexity and severity on outcomes. This case study reviews one health care system's experience in finding a severity system that would have the acceptance of its medical staff. The study also reviews the analytic methodology by which severity-adjusted data are used to improve utilization and quality. PMID- 10136811 TI - Applications of statistical process control in health care. AB - Statistical process control (SPC), most commonly applied in manufacturing industries, will be demonstrated to have applicability in health care. In particular, the use of a patient classification system such as DRGs that identify hospital end products can assist in the use of SPC and process improvement. An overview of SPC is given, followed by two case studies presented to demonstrate the use of SPC. Lastly, some ideas on teaching SPC to health care workers are outlined. PMID- 10136812 TI - Blue Shield of California outpatient payment program. AB - Faced with major increases in the cost of outpatient medical care, Blue Shield of California initiated an effort to develop and implement a prospective payment system that could be used for contracting with hospitals and freestanding facilities. Utilizing an outpatient classification system designed to categorize outpatient visits with similar clinical characteristics as well as similar resource consumption, Blue Shield introduced a negotiated case rate system of payment for outpatient surgical care. This article will review the background of the project, the methodology used to implement the system, and the results achieved from its implementation. PMID- 10136813 TI - VIP interview: Tom J. Elkin. PMID- 10136814 TI - Implementation of a provider credentialing/recredentialing process and development of a physician profile in an IPA-model HMO. AB - The process of credentialing and recredentialing providers in health plans is time-consuming and universally hated by doctors, but it is essential to maintaining the quality of the health care plan. It also can yield information about the quality of service provided in general by the network of physicians, as one IPA-model plan discovered. PMID- 10136815 TI - An overview of the predominant health care reform proposals. PMID- 10136816 TI - Appeals: the last word. AB - Appeals of denied precertifications have not received much attention from the managed care industry, in part because of ERISA's favorable liability climate. However, recent court cases, new accreditation standards, and increased incentives to physicians to economize on resource use may compound the risk inherent in commonly used appeals practices for both standard and investigational protocols. This article will review some common but high-risk appeals practices and suggest low-cost protocols that can virtually eliminate risk while increasing enrollee satisfaction. PMID- 10136817 TI - Using an appeals panel to mediate mental health care UR disputes. AB - The certification of admission and lengthy psychiatric hospitalizations raises fundamental issues related to the appropriateness of treatment. The author presents several case examples to illustrate how an appeals panel resolves disputed utilization review decisions regarding inpatient psychiatric treatment. PMID- 10136818 TI - Integrated health management delivery systems. PMID- 10136819 TI - Disease management: a new approach to health care. AB - The public's growing frustration with the illogic and inefficiency of America's fragmented health care system is driving us towards a new model of care: disease management. Forward thinking providers, payers, and product manufacturers are positioning themselves to succeed in a health care system increasingly oriented around preventing and treating diseases. The author discusses this approach to health care delivery and addresses the key players in this new environment. PMID- 10136820 TI - Continuous quality improvement and the utilization management process. AB - How does a managed health plan create a formalized utilization management program using quality improvement processes? One HMO is going through this process, trying to keep a Byzantine project simple through Deming's teachings. The author recounts this managed care organization's experiences. PMID- 10136821 TI - Case-mix adjustment, claims data quality, and physician profiling. AB - On the surface, there are many ways in which case mix may be considered, but the key to any successful system often lies below the surface, in the way in which the available data feed the systems, and in the operational environment in which the output is to be used. This article will review terminology used in case-mix adjustment and profiling techniques, highlight some dangerous (and avoidable) data pitfalls, and emphasize reasonable goals that can be achieved through the use of case-mix adjusted profiling. PMID- 10136822 TI - Evidence for validity of a health status measure in assessing short term outcomes of cholecystectomy. AB - OBJECTIVE: To assess the validity of the Nottingham health profile (NHP) as an indicator of short term outcome of cholecystectomy. DESIGN: Prospective assessment of outcome. SETTING: One teaching hospital. Patients--161 consecutive patients admitted for cholecystectomy between January 1989 and September 1990. MAIN MEASURES: Patients' reported symptoms and self assessed NHP scores before cholecystectomy and at follow up at three and 12 months (76 patients); assessment before admission (19). RESULTS: Complete data were obtained preoperatively and at three months' follow up from 154 patients; seven did not respond to the follow up questionnaire. 76/84(90%) patients in the study 12 months or more answered the 12 month follow up questionnaire; eight did not respond. Significant changes in score before and at three months after the operation were observed for four of the six dimensions: energy (35.34 v 19.53, p < 0.0001), pain (27.38 v 9.8, p < 0.0001), sleep (26.99 v 17.51, p = 0.0002), and emotional reactions (16.12 v 7.56, p = 0.001). The mean scores for 76 patients followed up at three and 12 months showed little subsequent change. Scores in readmitted patients were all significantly higher, suggesting poor health. Patients with five reported symptoms had significantly worse scores for all dimensions. Scores were similar before cholecystectomy whether the questionnaire was completed before or after admission. CONCLUSION: The NHP is an appropriate tool for monitoring changes in health after cholecystectomy. PMID- 10136823 TI - Improving management of asthma: closing the loop or progressing along the audit spiral? AB - OBJECTIVE: To assess whether the management of asthma has improved from three consecutive surveys. DESIGN: Retrospective case note survey of acute asthma admissions in 1983 and 1989; case notes selected from 1985-6 survey of prospectively identified patients to include only patients with a final discharge code of asthma. SETTING: A large city teaching hospital. Patients--101 patients with acute asthma as the primary diagnosis in 1983; 85 in 1985-6; and 133 in 1989, 14 of whom were subsequently transferred elsewhere. MAIN MEASURES: Conformity with a checklist of important aspects of the process of asthma management including initial assessment, treatment, supervision, and discharge and review arrangements. RESULTS: All patient groups were similar in age, smoking habit, and stay in hospital and, as an objective guide to severity of asthma, had similar initial pulse rates. Major improvements occurred in management: by 1989, 119(90%) patients were treated with oral corticosteroids (69(68%), 67(79%) in 1983, 1985-6 respectively) and 109(82%) with oxygen (62(61%), 51(60%)) (both p < 0.001). 114(86%) had regular recording of peak flow measurements (53(52%), 54(64%); p < 0.001), and 103/119(86%) were discharged taking oral corticosteroids (66(65%), 63(74%); p < 0.01). Significantly fewer patients, however, had their regular inhaled corticosteroid treatment increased on discharge (38/119(32%) v 53(52%), 39(46%); p < 0.01), but more were receiving high dose inhaled treatment on admission. CONCLUSIONS: The management of asthma improved significantly, and the normal practice of doctors has changed in an area of practice with longstanding problems. PMID- 10136824 TI - Clinical complaints and their handling: a time for change? AB - OBJECTIVES: To assess the performance of the hospital complaints procedure for complaints proceeding to peer review and the quality of responses to complainants. DESIGN: Retrospective study of data on clinical complaints proceeding to peer review during 1986-91 from clinical records, correspondence, reports of the complaints investigations, and expert review of written responses to complainants. SETTING: Northern Regional Health Authority, covering three million people. SUBJECTS: All 71 clinical complaints investigated to the third stage of the hospital complaints procedure and a sample of 65 written responses to complainants. MAIN MEASURES: Characteristics, duration, and outcome of complaints; findings of peer review; and quality of written responses at various stages in the procedure as evaluated by an expert panel against eight agreed criteria. RESULTS: The median duration of a complaint investigated through all stages of the procedure was 381 days. The longest median stages were those involving attempted resolution locally (131 days) and in which peer review was being arranged (113 days). More complaints alleging failure of communication were upheld by peer review (46/59, 78%) than those alleging misapplication of clinical skills (20/98, 20%) or failure to initiate appropriate investigations or treatment (8/32, 25%). Written responses commonly fell below the standards agreed by the expert panel. CONCLUSIONS: The hospital complaints procedure takes too long and its final peer review stage may not demonstrate sufficient impartiality. The written responses suggest that criticism is not welcomed as a way of improving service. IMPLICATION: The clinical complaints procedure needs to be reformed to ensure true accountability to patients. PMID- 10136825 TI - Management of coeliac disease: a changing diagnostic approach but what value in follow up? AB - OBJECTIVE: To assess the management of patients with coeliac disease in relation to a change in diagnostic method from jejunal suction biopsy to endoscopic biopsy. DESIGN: 16 item questionnaire survey of consultant members of the British Society of Gastroenterology. SUBJECTS: 359 consultant physician and gastroenterologist members of the society. MAIN MEASURES: Type of routine biopsy; repeat biopsy after gluten withdrawal; gluten rechallenge; follow up measurements; screening for malignancy; and methods of follow up, including special clinics. RESULTS: 270(70%) members replied; 216(80%) diagnosed coeliac disease routinely by endoscopic duodenal biopsy, 30(11%) by jejunal capsule biopsy, and the remainder by either method. Only 156(58%) repeated the biopsy after gluten withdrawal, though more did so for duodenal than jejunal biopsies (134/216, 62% v 13/30, 43%; p < 0.02). Follow up biopsies featured more duodenal than jejunal biopsies (133/156, 82% v 23/156, 15%; p < 0.02). Regular follow up included assessments of weight (259, 96%) and full blood count (238, 88%) but limited assessment of serum B-12 and folate (120, 44%) and calcium (105, 39%) concentrations. Routine screening for malignancy is not performed, and there are few specialist clinics. 171(63%) respondents thought that patients should be followed up by a hospital specialist and 58(21%) by family doctors. CONCLUSIONS: The practice of diagnosing coeliac disease varies appreciably from that in many standard texts. Many patients could be effectively cared for by their family doctor. IMPLICATIONS: The British Society of Gastroenterology should support such management by family doctors by providing clear guidelines for them. PMID- 10136826 TI - Use of an east end children's accident and emergency department for infants: a failure of primary health care? AB - OBJECTIVE: To ascertain why parents use an accident and emergency department for health care for their infants. DESIGN: Prospective one month study. SETTING: One accident and emergency department of a children's hospital in the east end of London. SUBJECTS: Parents of 159 infants aged < 9 months attending as self referrals (excluding infants attending previously or inpatients within one month, parents advised by the hospital to attend if concerned about their child's health, infants born abroad and arrived in Britain within the previous month). MAIN MEASURES: Details of birth, postnatal hospital stay, contact with health professionals, perceptions of roles of community midwife and health visitor, and current attendance obtained from a semistructured questionnaire administered in the department by a research health visitor; diagnosis, discharge, and follow up. RESULTS: 152(96%) parents were interviewed, 43(28%) of whom were single parent and 68(45%) first time mothers. Presenting symptoms included diarrhoea or vomiting, or both (34, 22%), crying (21, 14%), and feeding difficulties (10, 7%). Respiratory or gastrointestinal infection was diagnosed in 70(46%) infants. Only 17(11%) infants were admitted; hospital follow up was arranged for 27(20%) infants not admitted. Most (141, 94%) parents were registered with a general practitioner; 146(27%) had contact with the community midwife and 135(89%) the health visitor. CONCLUSION: Most attendances were for problems more appropriately dealt with by primary care professionals owing to patients' perceptions of hospital and primary health care services. IMPLICATIONS: Closer cooperation within the health service is needed to provide a service responsive to the real needs of patients. PMID- 10136827 TI - Quality from the management perspective. PMID- 10136828 TI - Total joint replacement: implication of cancelled operations for hospital costs and waiting list management. AB - OBJECTIVE: To identify aspects of provision of total joint replacements which could be improved. DESIGN: 10 month prospective study of hospital admissions and hospital costs for patients whose total joint replacement was cancelled. SETTING: Information and Waiting List Unit, Musgrave Park Regional Orthopaedic Service, Belfast. PATIENTS: 284 consecutive patients called for admission for total joint replacement. MAIN MEASURES: Costs of cancellation of operation after admission in terms of hotel and opportunity costs. RESULTS: 28(10%) planned operations were cancelled, 27 of which were avoidable cancellations. Five replacement patients were substituted on the theatre list, leaving 22(8%) of 232 operating theatre opportunities unused. Patients seen at assessment clinics within two months before admission had a significantly higher operation rate than those admitted from a routine waiting list (224/232(97%) v 32/52(62%), x2 = 58.6, df = 1; p < 0.005). Mean duration of hospital stay in 28 patients with cancelled operations was 1.92 days. Operating theatre opportunity costs were 73% of the total costs of cancelled total joint replacements. CONCLUSION: Patients on long waiting lists for surgery should be reassessed before admission to avoid wasting theatre opportunities, whose cost is the largest component of the total costs of cancelled operations. PMID- 10136829 TI - Evaluation of audit of medical inpatient records in a district general hospital. AB - OBJECTIVE: To evaluate an audit of medical inpatient records. DESIGN: Retrospective comparison of the quality of recording in inpatients' notes over three years (1988, 1989, 1990). SETTING: Central Middlesex Hospital. MATERIALS: Random sample of 188 notes per year drawn systematically from notes from four selected one month periods and audited by two audit nurses and most hospital physicians. MAIN MEASURES: General quality of routine clerking, assessment, clinical management, and discharge, according to a standardised, criterion based questionnaire developed in the hospital. RESULTS: 1988 was the year preceding the start of audit in the hospital, 1989 the year of active audit with implicit and loosely defined criteria, and 1990 the year after introduction and circulation of explicit criteria for note keeping. There was a significant trend over the three years in 21/56 items of the questionnaire, including recording of alcohol intake (x2 = 8.4, df = 1, p = 0.01), ethnic origin (x2 = 57, df = 1, p = 0.001), allergies and drug reactions (x2 = 10, df = 1, p = 0.01) at admission and of chest x ray findings (x2 = 8, df = 1, p = 0.01), final diagnosis (x2 = 5.6, df = 1, p = 0.025), and signed entries (x2 = 11.3, df = 1, p = 0.001). Documentation of discharge and notification of discharge to general practitioners was not significantly improved. CONCLUSIONS: Extended audit of note keeping failed to sustain an initial improvement in practice; this may be due to coincidental decline in feedback to doctors about their performance. PMID- 10136831 TI - Ward pharmacy: a foundation for prescribing audit? AB - OBJECTIVES: To determine the extent and nature of prescription monitoring incidents by hospital pharmacists and to derive a performance indicator to allow prescription monitoring to be compared among hospitals in North West Thames region. DESIGN: Survey of all self recorded prescription monitoring incidents for one week in June 1990. SETTING: All (31) acute hospitals in the region with pharmacy departments on site, covering 10,337 beds. SUBJECTS: 210 pharmacists. MAIN MEASURES: Number of prescription monitoring incidents recorded, their nature, and outcome; a performance indicator of prescription monitoring (incidents/100 beds/week) and its variation according to specialty and site. RESULTS: 3273 prescription monitoring incidents were recorded (median 89 per hospital, range 3-301), the most common being related to the dose and frequency of administration of the drug (933 incidents, 29%). These incidents led to alterations of prescriptions on 1611 occasions; the pharmacist's advice was rejected on 81. The greatest number of prescription monitoring incidents/100 beds/week by specialty was recorded for intensive therapy units (median 75); the medians for medicine and surgery were 32 and 21 respectively. This performance indicator varied 20-fold when analysed by site, values ranging from 3.6 to 82.1 (median 29.8). CONCLUSIONS: Hospital pharmacists play a large part in monitoring and improving prescribing, and most of their interventions are related to the basics of prescribing. They therefore have a role in medical audit, working with clinicians to identify prescribing problems, and to set standards and monitor practice. A performance indicator of prescription monitoring incidents/100 beds/week allows comparison of pharmacists' activities among sites and may be a valuable tool in auditing them. PMID- 10136830 TI - Survey of outpatient sputum cytology: influence of written instructions on sample quality and who benefits from investigation. AB - OBJECTIVES: To evaluated quality of outpatient sputum cytology and whether written instructions to patients improve sample quality and to identify variables that predict satisfactory samples. DESIGN: Prospective randomised study. SETTING: Outpatient department of a district general hospital. PATIENTS: 224 patients recruited over 18 months whenever their clinicians requested sputum cytology, randomized to receive oral or oral and written advice. INTERVENTIONS: Oral advice from nurse on producing a sputum sample (114 patients); oral advice plus written instructions (110). MAIN MEASURES: Percentages of satisfactory sputum samples and of patients who produced more than one satisfactory sample; clinical or radiological features identified from subsequent review of patients' notes and radiographs associated with satisfactory samples; final diagnosis of bronchial cancer. RESULTS: 588 sputum samples were requested and 477 received. Patients in the group receiving additional written instructions produced 75(34%) satisfactory samples and 43(39%) of them one or more sets of satisfactory samples. Corresponding figures for the group receiving only oral advice (80(31%) and 46(40%) respectively)were not significantly different. Logistic regression showed that radiological evidence of collapse or consolidation (p<0.01) and hilar mass (p<0.05) were significant predictors of the production of satisfactory samples. Sputum cytology confirmed the diagnosis in only 9(17%) patients with bronchial carcinoma. CONCLUSIONS: The quality of outpatients' sputum samples was poor and was not improved by written instructions. Sputum cytology should be limited to patients with probable bronchial cancer unsuitable for surgery. IMPLICATIONS: Collection of samples and requests for sputum cytology should be reviewed in other hospitals. PMID- 10136832 TI - Audit: the third clinical science? AB - In summary, we believe that if clinical audit is accepted and prosecuted as the third clinical science, it has the potential to deliver substantial benefits to patients and health professionals. PMID- 10136833 TI - Promoting change in clinical care. PMID- 10136834 TI - Accreditation in general practice. PMID- 10136835 TI - Purchasing for quality: the providers' view. Introduction. PMID- 10136836 TI - Purchasing for quality: the providers' view. Purchasing care for patients with acute myocardial infarction. PMID- 10136837 TI - Enhancing effective and acceptable purchaser and provider decisions: overview and methods. PMID- 10136838 TI - Population screening for osteoporosis to prevent fractures. PMID- 10136839 TI - Impact of an interest in asthma on prescribing costs in general practice. AB - OBJECTIVE: To examine the effect on total prescribing costs and prescribing costs for respiratory drugs for practices with at least one general practitioner with a special interest in asthma. DESIGN: Postal questionnaire survey. SETTING: General practitioners in England and Wales. SUBJECTS: 269 members of the General Practitioners in Asthma Group, of whom 103 agreed to participate. MAIN MEASURES: Individual practitioners' and their practices' PACT prescribing costs from the winter quarters of 1989-90 compared with average costs for their family health services authority (FHSA) and a notional national average of all FHSAs combined. RESULTS: The response rate was 57%; the average total prescribing costs for the practices of the 59 respondents were significantly lower than those of their respective FHSAs (mean difference 505 pounds per 1000 patients per quarter (95% confidence interval -934.0 to -76.2, p = 0.022) and lower than the national average. The average prescribing costs for respiratory drugs for the practices were significantly greater than those for their FHSA (195 pounds per 1000 patients per quarter (84.4 to 306.0, p = 0.001) and the national average. Both types of costs varied widely. CONCLUSION: An interest in asthma care in general practice is associated with higher average prescribing costs for respiratory drugs but no increase in overall prescribing costs compared with those for respective FHSAs and national averages. IMPLICATIONS: FHSAs and their medical advisors should not examine high prescribing costs for individual doctors or one therapeutic category but in the context of practice total costs. PMID- 10136840 TI - Audit in general practice: students and practitioners learning together. AB - OBJECTIVES: To describe and evaluate the use of medical audit in general practice as an educational activity shared by undergraduate medical students and general practitioners. DESIGN: A descriptive study, evaluated by a questionnaire survey of all participating practices and by results of completed student projects on general practice audit topics during three weeks in the first year of completed projects (1990-1). SETTING: One university department of general practice, collaborating with 18 general practices in contract with Liverpool Family Health Services Authority. PARTICIPANTS: 150 medical students, working in groups of two to six, and the general practitioners with whom they worked in 18 practices. MAIN MEASURES: The nature of topics proposed by practices and chosen by the students; methods of audit used by students; reported effects of the audits on the practices; general practitioners' opinions of the projects' usefulness to the practice. RESULTS: The range of topics was wide, and both quantitative and qualitative methods were used. Fifteen of the 18 questionnaires sent out were completed. Six practices reported that the final project had changed substantially after joint planning with the students. Two thirds (10) attached high value to the audits and were making changes in the delivery of care as a result. CONCLUSIONS: Medical audit "project work" by medical undergraduates is an effective tool for motivating students to learn and can lead to change in the clinical setting in which it occurs. IMPLICATIONS: By meeting the learning needs of both undergraduates and established practitioners audit project work has wider application within medical education. PMID- 10136841 TI - Planning for quality in the NHS breast screening programme. PMID- 10136842 TI - Practical experiences in auditing patient outcomes. PMID- 10136843 TI - Establishment of UK clearing house for assessing health services outcomes. PMID- 10136844 TI - Formal rehabilitation after stroke. PMID- 10136845 TI - View from New Zealand ... recent changes in New Zealand's health care system. PMID- 10136846 TI - Quality of nursing: a European perspective. PMID- 10136847 TI - Health outcomes: a challenge to the status quo. PMID- 10136848 TI - Importance of sensitivity to change as a criterion for selecting health status measures. AB - OBJECTIVE: To assess the sensitivity to change over time of four health status instruments in relation to patients with rheumatoid arthritis. DESIGN: Observational three month study of four self assessed instruments (arthritis impact measurement scales (AIMS), health assessment questionnaire (HAQ), Nottingham health profile (NHP), functional limitations profile (FLP)). SETTING: One rheumatology unit. PATIENTS: 101 patients with definite or classic rheumatoid arthritis. MAIN MEASURES: Change scores for dimensions of instruments, as determined by effect size (mean change in score/baseline standard deviation of variable) and conventional rheumatological measures, at baseline and after three months. RESULTS: Change scores for comparable dimensions (mobility, activities of daily living, household, pain, mood or emotion, and social scales) of the instruments were compared among 30 patients who considered their health status to have improved over three months. For all dimensions of health status the magnitude of change varied considerably according to the instrument. Maximum range in effect size was for social scales (AIMS 0.06, NHP 0.24, FLP 0.60). No single instrument seemed consistently to show the most change over all dimensions. CONCLUSION: Selection of health status instruments for audit or evaluation may have a considerable impact on the pattern of results obtained, and the "responsiveness" of such scales should be as carefully examined as their reliability and acceptability when selecting outcome measures. PMID- 10136849 TI - Audit of bronchial artery embolisation in a specialist respiratory centre. AB - OBJECTIVE: To audit the use of bronchial arteriography and embolisation for controlling haemoptysis. DESIGN: Retrospective review of radiological and clinical data. SETTING: Brompton and National Heart Hospitals. PATIENTS: 35 patients with severe pulmonary disease in whom 58 bronchial arteriograms were obtained between 1 January 1984 and 31 December 1989 with the intention of bronchial artery embolisation for controlling haemoptysis. MAIN MEASURES: Rate of technical success and cessation of haemoptysis; detailed evaluation of patients, particularly those with major haemoptysis (> 100 ml expectorated blood); and retrospective assessment of the appropriateness of the procedure in each. RESULTS: 58 procedures were performed, nine of which were unsuitable for detailed analysis. Nine procedures were for minor haemoptysis, which subsequently recurred, and 40 for recent major haemoptysis in 26 patients with cystic fibrosis (16) aspergilloma (six), bronchiectasis (three), and an unknown diagnosis (one). The median total volume of haemoptysis in the episode before the procedure was 680 ml (range 270-2200 ml). Embolisation was technically successful in 33/40 procedures, in 17 of which, however, major haemoptysis recurred within 10 days of the procedure, leaving 16 clinically and technically successful procedures in 15 patients. Five patients (three with aspergilloma, two with cystic fibrosis) died of haemoptysis despite attempted embolisation. CONCLUSION: Success rate of bronchial artery embolisation was 40%(16/40). IMPLICATIONS: Bronchial artery embolisation is probably not justified for minor haemoptysis or when performed more than one week after a major haemoptysis. Repeat arteriograms during a single period of haemoptysis are seldom useful. With these criteria 43% fewer procedures would have been performed with no loss of clinical benefit. PMID- 10136850 TI - Paediatric home care in Tower Hamlets: a working partnership with parents. AB - OBJECTIVES: To describe the first two years of a paediatric home care service. DESIGN: Observational cross sectional study, 1989-91. SETTING: One inner London health district. PATIENTS: 611 children referred to the service; 50 children selected from those referred during the first year, whose parents were interviewed and whose general practitioners were invited to complete a questionnaire. MAIN MEASURES: Description and costs of service; views of parents and general practitioners of selected sample of children. RESULTS: In its second year the team received 303 referrals and made 4004 visits at a salary cost of 98000 pounds, an average of 323 pounds/referral and 24 pounds/visit. This represented a referral rate of 3.2% (258/7939) of inpatient episodes from the main referring hospital between 1 December 1989 and 30 November 1990. Of all referrals to the service, 343(56%) came from hospital inpatient wards. The service was used by disadvantaged and ethnic minority families. The children's parents (in 28(61%) families) and the home care team did a wide range of nursing tasks in the home. Parents of 47(94%) children sampled agreed to be interviewed, and those of 43(91%) found the service useful; guidance and support were most commonly appreciated (33, 70%). Parents of 25(53%) children said that hospital stay or attendance had been reduced or avoided. Parents and general practitioners disagreed on clinical responsibility in 10 children, and communication was a problem for some general practitioners. CONCLUSIONS: The service enabled children to receive advanced nursing care at home. Clinical responsibility should be agreed between parents and professionals at referral. PMID- 10136851 TI - Playing by the rules ... PMID- 10136852 TI - Uncertainty in medicine: can it be reduced? PMID- 10136853 TI - Measuring patient satisfaction for audit in general practice. PMID- 10136854 TI - Development of patient satisfaction questionnaires: I. Methodological issues. AB - OBJECTIVES: To develop a method for conducting postal surveys of patients' views and experiences of general practitioner care and to produce an off the shelf tool for general practice audit. DESIGN: Prospective study of performance of two patient questionnaires assessing accessibility to services (questionnaire 1) and interpersonal aspects of care (questionnaire 2) in comparing general practices. SETTING: Five general practices in Newcastle upon Tyne. PATIENTS: 3800 patients aged 16 and over, 1900 randomly drawn from family health services authority lists for each practice (questionnaire 1) and 1900 drawn from practice records (questionnaire 2). MAIN MEASURES: Response rates and technical evaluation of performance of the questionnaires (reliability, item nonresponse, ineligible response, sensitivity, and validity). RESULTS: Response rate for questionnaire 1 was 77% (range 69% to 83%) and to questionnaire 2, 82% (77% to 86%). Analysis of respondents and nonrespondents showed that significantly more women, people aged 65 or more, and those consulting in the past six months returned the questionnaires. Technical evaluation indicated good face validity and content validity and good internal consistency. CONCLUSIONS: A standardised off the shelf tool for audit was developed, and it will be a valuable model for future audits in general practice. PMID- 10136855 TI - Development of patient satisfaction questionnaires: II. Collaboration in practice. PMID- 10136856 TI - Registrars' and senior registrars' perceptions of their audit activities. AB - OBJECTIVES: To ascertain the level and quality of audit activity among junior doctors, their attitudes to audit, and their views on its educational value. DESIGN: Postal questionnaire survey in April 1991. SETTING: Yorkshire region. SUBJECTS: All 610 registrars and senior registrars recorded as employed in the region. MAIN MEASURES: Grade, current specialty, details of last audit participated in and its educational usefulness, and attitude to audit. RESULTS: 255 (41.8%) completed questionnaires were returned, 148 from registrars and 101 from senior registrars; grade was not indicated in six. 27 respondents were in general medicine, 26 in general surgery, 30 in anaesthetics, and 36 in psychiatry; other specialties had fewer than 20 respondents. About a fifth (54) of respondents, most in psychiatry (19/36, 53%), had not participated in audit. Among the 201 who had participated, the audit topics covered most components of care (access to services (47, 23%), communication (51, 25%), and appropriateness (158, 79%) and effectiveness (157, 78%) of treatment); only 84 (41%) audits set standards, and in only half of them had the doctors been involved in doing so. Doctors responsible for gathering data and those responsible for collating and reporting data found their experience significantly less useful than those who were not. 172 (86%) respondents considered that audit had helped patient care. Suggested improvements to the educational value of audit were mostly for better methods but included requests for less "witch hunting," better feedback, more training, more time, and more participation by consultants. CONCLUSIONS: The educational value of audit to junior doctors could be improved by better audit methods, guidance, and feedback. PMID- 10136857 TI - Need to measure outcome after discharge in surgical audit. AB - OBJECTIVE: To assess the accuracy of outcome data on appendicectomy routinely collected as part of a surgical audit and to investigate outcome in the non audited period after discharge. DESIGN: Retrospective analysis of audit data recorded by the Medical Data Index (MDI) computer system for all patients undergoing emergency appendicectomy in one year; subsequent analysis of their hospital notes and notes held by their general practitioners for patients identified by a questionnaire who had consulted their general practitioner for a wound complication. SETTING: One district general hospital with four consultant general surgeons serving a population of 250,000. PATIENTS: 230 patients undergoing emergency appendicectomy during 1989. MAIN MEASURES: Comparison of postoperative complications recorded in hospital notes with those recorded by the MDI system and with those recorded by patients' general practitioners after discharge. RESULTS: Of the 230 patients, 29 (13%) had a postoperative complication recorded in their hospital notes, but only 14 (6%) patients had these recorded by the MDI system. 189 (82%) of the patients completed the outcome questionnaire after discharge. The number of wound infections as recorded by the MDI system, the hospital notes, and notes held by targeted patients' general practitioners were three (1%), eight (3%), and 18 (8%) respectively. None of 12 readmissions with complications identified by the hospital notes were identified by the MDI system. CONCLUSIONS: Accurate audit of postoperative complications must be extended to the period after discharge. Computerised audit systems must be able to relate readmissions to specific previous admissions. PMID- 10136858 TI - Failure of many ophthalmologists to use lasers safely. AB - In 1990, after the detection of impairment of colour discrimination in laser operators, the College of Ophthalmologists recommended safety guidelines for the use of lasers. We measured the effectiveness of these guidelines and their impact on ophthalmological practice in the United Kingdom. Previously, in ophthalmologists not following the guidelines, there was a deterioration in colour discrimination after a laser session. No such deterioration was found in 10 ophthalmologists tested who adhered to the guidelines, but their colour discrimination was significantly worse than that of controls. Replies to a questionnaire disclosed that one third of senior ophthalmologists were unaware of the practices recommended. PMID- 10136859 TI - Dimensions of quality revisited: from thought to action. PMID- 10136860 TI - Need for moral audit in evaluating quality in health care. PMID- 10136862 TI - The audit process and medical organisation. PMID- 10136861 TI - Implementing guidelines in general practice care. PMID- 10136863 TI - Family planning services. PMID- 10136864 TI - Issues of quality in providing services for subfertile couples. PMID- 10136865 TI - "Quality quarantine": a call for less professional isolation. PMID- 10136866 TI - Setting standards: from passing fashion to essential clinical activity. PMID- 10136867 TI - Diabetes care: who are the experts? AB - OBJECTIVES: To identify issues that patients and professionals consider important in diabetes care and differences in their priorities for care and to determine patients' and professionals' judgements of the relative importance of their chosen priorities. DESIGN: Structured group interviews using the nominal group technique. SETTING: Five district health authorities on Tyneside. SUBJECTS: Five nominal groups: expert (seven), non-expert (seven) health care professionals; insulin dependent (four), non-insulin dependent patients (eight); and carers of diabetic patients (eight). MAIN MEASURES: Items important in diabetes care to each nominal group (themes of care), ranked into a series of "top 10" items for each group, and allocated a score according to relative importance to individual members; scores were standardised by individual weighting and group weighting for comparison within and between groups. RESULTS: Patients and professionals agreed that information given to patients, interaction between professionals and patients, patient autonomy, and access were important for good diabetes care, but the importance assigned to each differed. Thus the professionals emphasised empathy and aspects of good communication and patients the desire to know enough to live a "normal" life. Differences were also found within the patient groups; these related to changes in patients' needs at specific points in the development of their illness and in their orientations to care. CONCLUSION: Patients differ from professionals in their orientation to diabetes care, and they can, and should, be involved in setting priorities for care. Since these priorities are dynamic further work is needed to explore the nature of patient satisfaction with diabetes care. PMID- 10136868 TI - Development of indicators for quality assurance in public health medicine. AB - OBJECTIVES: To develop structure, process, and outcome indicators within a quality rating index for audit of public health medicine. DESIGN: Development of an audit matrix and indicator of quality through a series of group discussions with public health physicians, from which self administered weighted questionnaires were constructed by a modified Delphi technique. SETTING: Five Scottish health boards. SUBJECTS: Public health physicians in the five health boards. MAIN MEASURES: Indicators of quality and a quality rating index for seven selected service categories for each of seven agreed roles of public health medicine: assessment of health and health care needs in information services, input into managerial decision making in health promotion, fostering multisectoral collaboration in environmental health services, health service research and evaluation for child services, lead responsibility for the development and/or running of screening services, and public health medicine training and staff development in communicable disease. RESULTS: Indicators in the form of questionnaires were developed for each topic. Three types of indicator emerged: "global," "restricted," and "specific." A quality rating index for each topic was developed on the basis of the questionnaire scores. Piloting of indicators showed that they are potentially generalisable; evaluation of the system is under way across all health boards in Scotland. CONCLUSION: Measurable indicators of quality for public health medicine can be developed. PMID- 10136869 TI - Audit of deaths in general practice: pilot study of the critical incident technique. AB - OBJECTIVE: To develop and pilot a method for conducting an audit of deaths in general practice by the critical incident technique. DESIGN: Prospective use of the technique within a primary health care team, with the aid of a facilitator, to analyse the events surrounding patients' deaths. SETTING: One inner city academic general practice. PARTICIPANTS: Practice team, comprising general practitioners, trainee, practice manager, practice nurse, and attached health visitor and district nurses. MAIN MEASURES: Identification and classification of critical incidents associated with the case studies of eight recently decreased patients in the practice and subsequent impact on the practice. RESULTS: Among the eight case studies, 57 critical incidents were identified (mean 7.1 per case, range 2 to 15). A failure of communication was the most common factor identified in incidents giving rise to concern, but positive factors in patient care were also identified. Changes in practice included developing protocols for follow up of bereaved relatives and carers and a checklist to ensure completion of administrative follow up tasks resulting from the patient's death; cases of recent deaths and terminally ill patients were reviewed monthly. The practice team found the method acceptable and felt that the discussions had provided useful opportunities for reflecting on their role in patient care. CONCLUSIONS: The critical incident technique fulfils the needs of an audit of deaths in general practice; however, further evaluation based on more cases from different practices is now required. PMID- 10136870 TI - Factors influencing default at a hospital colposcopy clinic. AB - OBJECTIVE: To identify factors reducing compliance at diagnosis, treatment, and review stages among women referred with abnormal cervical smears to a hospital colposcopy clinic. DESIGN: Retrospective analysis of sociodemographic data from hospital notes of the attenders and defaulters during one year (1989-90) and prospective collection of information by structured interviews of a sample of defaulters and attenders during five months (May-September 1990). SETTING: One hospital colposcopy clinic. PATIENTS: 238 women defaulting on two consecutive occasions and 188 attending regularly (retrospective analysis) and a subset of 40 defaulters and 24 attenders (interview sample). MAIN MEASURES: Sociodemographic data and interview responses about attitudes, behaviour, choice, accessibility cultural understanding, communications, and emotional response. RESULTS: 22 (12%) women defaulted at diagnosis, 24(13%) at treatment, 39(21%) at the first check up after treatment, and 84(45%) at the review stage; 19(10%) defaulted from the first check up after diagnostic examination revealed no need for treatment. Age and social class differed between the two groups. 181(76%) defaulters were under 30 compared with 91(48%) attenders; 14(6%) compared with 41(23%) were over 40(p < 0.001). The proportion of women in social classes 4 and 5 was 33%(20/60) for defaulters and 21%(25/120) for attenders (p < 0.05) and unemployed was 66%(158/238) and 36%(68/188) respectively. 63(28%) defaulters were pregnant compared with 11(6%) attenders (p < 0.001). More defaulters came from gynaecology or antenatal clinics. Most defaulters (93%) had child care responsibilities and they knew and understood less about colposcopy. Their explicit reasons for defaulting included child care commitments and fear and their implicit reasons lack of understanding, inaccessibility of information, and staff attitudes. CONCLUSIONS: Compliance may be improved by promoting women's understanding of treatment and encouraging health professionals to develop a service more sensitive to the various needs of women in different socioeconomic groups. PMID- 10136871 TI - Development of clinical guidelines in a health district: an attempt to find consensus. AB - OBJECTIVE: To formulate consensus based guidelines for antenatal care in a health district. DESIGN: Prospective formulation of draft guidelines by a working group of consultant obstetricians and general practitioners with an obstetric interest, canvassing opinions of all GPs in the district by questionnaire, and revision and final circulation of the guidelines. SETTING: One health district. SUBJECTS: All 160 GPs in the district and members of the working party. MAIN MEASURES: Questionnaire responses to specific proposals within the draft guidelines for managing anaemia, antepartum haemorrhage, and hypertension. RESULTS: 136 GPs responded (response rate 85%); responders and nonresponders did not differ in age, sex, or presence on obstetric list. Overall they favoured more conservative management than suggested in the guidelines. For example, only 38% (44/116) prescribed iron routinely and 34% (38/113) referred to hospital for haemoglobin concentration of < or = 10 g/l; 10% referred women unnecessarily for oedema unassociated with proteinuria; and 20% managed active bleeding progressing to old brown staining as an urgent admission. The guidelines were revised according to the relative weight of the views obtained. CONCLUSION: Establishing guidelines is mainly a political process. Canvassed views influenced guidelines most when internal disagreement existed within the working party. IMPLICATIONS AND ACTION: Regular revising of the guidelines is planned, which, in conjunction with repeating the questionnaire to monitor changing practice, will allow a long term district wide clinical review. PMID- 10136872 TI - Reducing bruising after venepuncture. AB - Bruising after venepuncture is undesirable. To verify an apparent increase in bruising after introducing a new venepuncture system in a small district general hospital and to improve the venepuncture service two prospective audits of the incidence and severity of bruising after venepuncture were performed in two groups of 100 consecutive inpatients undergoing venepuncture by phlebotomists. In the first audit bruising was detected in 45 patients, of whom 34(76%) had bruises > 100 mm2 in area. After modification of the technique, whereby the phlebotomists ensured that haemostasis had been attained before leaving the patient, bruising was significantly reduced, occurring in 25 patients only 9 of whom (36%) had bruises > 100mm2 in area (both p < 0.01) in the second audit. Monitoring of standards and simple modification of technique resulted in significant reduction in incidence and severity of bruising, improving the quality of the venepuncture service. PMID- 10136873 TI - The Lichfield Lecture. Quality assurance in health care: consumers' role. PMID- 10136874 TI - Building teams for effective audit. PMID- 10136875 TI - Educational potential of medical audit: observations from a study of small groups setting standards. PMID- 10136876 TI - Diabetes care. AB - Providing good quality diabetes care is complex but achievable. Many aspects of the care do not require high tech medicine but, rather, good organisation. Diabetes is a costly disease, consuming 1500 pounds per diabetic patient per year versus 500 pounds on average for a non-diabetic member of the population in health service costs. Investment now in good quality diabetes care is sound: patients will benefit from a better quality of life associated with a reduced incidence of the complications of diabetes and the direct costs to the health service in treating these complications and the indirect costs to employers will be reduced. Physical and clinical assessments--measurements of blood glucose and glycosylated haemoglobin concentrations, weight, and blood pressure and assessment of eyes, kidneys, feet, and heart--are clearly important, but quality must include consideration of people and their reactions to life and diabetes--a lifelong entanglement--for which much more support should be provided. PMID- 10136878 TI - A readers' forum on health care. PMID- 10136877 TI - Death rattle for health reform. PMID- 10136879 TI - Health care reform. The lost chance. PMID- 10136880 TI - The rise of cyberdoc. PMID- 10136881 TI - Health reform on life support. PMID- 10136882 TI - Baby boomers in retirement: what are their prospects? AB - This Issue Brief examines the baby boomers' retirement income prospects by analyzing trends in the elderly's income and pension participation among workers; examining saving behavior and critically evaluating studies of the adequacy of the boomers' saving; and looking at tenure trends, lump-sum distribution preservation, and changes in Social Security benefits. Since the mid 1970s, the real median income of individuals aged 65 and over has increased 18 percent. Sources of income have shifted, with employment-based pensions increasing and earnings and asset income decreasing as a proportion of income. The boomers' prospects are partly dependent on participation in employment-based retirement plans. After decreases in the sponsorship rates, participation rates, and vesting rates of workers during the 1980s, all three percentages increased during the early 1990s. Data do not support the perception that the U.S. work force is becoming increasingly mobile. Tenure levels for prime age workers in the 1980s and beginning of the 1990s were higher than those of previous decades. Still, in response to competitive pressures, employers may not offer the security of paternalistic benefit packages as in the past. Various studies have reached different conclusions regarding the adequacy of the boomers' financial preparation for retirement. Evidence indicates that boomers, in general, will enjoy a retirement standard of living exceeding that of their parents. It is less clear whether they will maintain a standard of living in retirement comparable to that of their working years. To the extent they are willing to tap housing wealth, they would appear at this early stage to be in good shape. Federal fiscal policy decisions will impact boomers by affecting their disposable income today, and thus their ability to save, as well as the benefits they will receive in retirement through Social Security and Medicare. The boomers are 17 to 35 years away from age 65. Given heterogeneity of the boomers, research is needed to identify what specific groups within the generation are at risk and the magnitude of that risk. Groups that would now appear to be at risk to some degree include non-homeowners, the less educated, the single, and the youngest boomers. PMID- 10136883 TI - Employment-based health benefits: analysis of the April 1993 Current Population Survey. AB - The April 1993 CPS differs from the March 1993 CPS in a number of respects. The April 1993 CPS supplement surveys only workers, whereas the March CPS examines the noncash benefits received by all Americans. The April CPS asks workers about health coverage in the week in which the questions were fielded, whereas the March CPS asks about coverage in the preceding year. In April 1993, there were 112.5 million civilian American workers between the ages of 18 and 64 with jobs. Eighty-two million (73 percent) of them worked for an employer that sponsored a health insurance plan, and 65 million (58 percent of all workers) participated in their employer's health plan. About one-third of workers at firms with fewer than 10 employees had employers who offer health benefits; about one-quarter of all of the workers in these firms participated in their employer's plan. Conversely, 94 percent of workers at firms with more than 1,000 employees had an employer who sponsored health benefits, and over 77 percent of these workers participated in their employer's plan. There are 16.5 million American workers whose employers sponsored health benefits but who did not participate in these benefits. Over one half of these workers (8.5 million) chose not to be covered. Another 36 percent of these workers (5.9 million) did not participate because they were ineligible or denied coverage. Over 66 percent of the ineligible workers did not participate because they were part-time, contract, or temporary workers. Another 26 percent had not yet completed a probationary period. Among the reasons that those who chose not to participate in their employer's coverage, the vast majority (75 percent) stated they were covered by another health care plan. Twenty-nine percent stated that they chose not to purchase coverage because it was too costly or that they did not need or want the coverage. In 1993, there were 16.7 million workers with no health insurance coverage. The vast majority of these workers (95 percent) were employed by private employers. Sixty-six percent of the workers with no health insurance coverage were self-employed or worked for firms with fewer than 100 employees. PMID- 10136884 TI - Distributive effects of benefits and taxes. AB - In light of the growing federal deficit, pressure is mounting to cut federal spending. If the budget for social security programs is cut, who will suffer? This article presents the results of a study that investigated the degree to which taxes and public income transfers change the level of income, the degree of inequality in income distribution, and the poverty rates of various demographic groups. Major findings are that public income transfers are more powerful than taxes in equalizing the income distribution and that poverty reduction through non-means-tested transfer programs is more effective among elderly people, white people, and people in married-couple families, whereas poverty reduction through means-tested transfer programs is more effective among nonelderly people, black people, and people in female-headed families. Implications for social work practice are discussed. PMID- 10136885 TI - Nomadic device acceptance remains slow in healthcare. AB - The healthcare industry's attempt to build a better mousetrap by reengineering the clipboard has left the industry surprisingly bogged down in wireless technology. Developing an electronic device that can collect point-of-care information with the mobility, ease of use and overall simplicity of the clipboard is challenging the way care has been delivered for more than a century. PMID- 10136886 TI - HotList. Nomadic/wireless communications. PMID- 10136887 TI - University of Iowa links rural providers. PMID- 10136888 TI - Whither WEDI (Workgroup on Electronic Data Interchange) now? PMID- 10136889 TI - Laboratorians climb aboard the online bandwagon. PMID- 10136890 TI - Laboratories begin to learn open-systems approach. PMID- 10136891 TI - HotList. New laboratory software products. PMID- 10136892 TI - Electromagnetic interference: causes and concerns in the health care environment. AB - In the past 15 years there has been a dramatic increase in the number of radio frequency emission sources that have entered medical treatment areas. Personal computers, digital pagers, hand-held radios, cellular phones, and wireless input devices have all become more prevalent in the contemporary clinical environment. Because of the productivity gains these devices promise, it is unlikely that the use of electronic instrumentation and wireless technologies will diminish--in fact greater uses are projected. Along with the benefits these devices provide, they also create a greater opportunity for increased electromagnetic interference among devices. It is important that engineering and professional staff are aware of some of the complex interactions these devices can create. Managing this emerging problem should be a concern for the medical community. Engineering staff should be able to communicate effectively with medical staff, patients, and visitors regarding potential interactions and how to recognize them and mitigate their consequences. PMID- 10136893 TI - Liability in the absence of a traditional physician-patient relationship: what every "on call" doctor should know. PMID- 10136895 TI - A new approach to hospital food service. PMID- 10136894 TI - The meaning of "gourmet" is changing. PMID- 10136896 TI - Pre-cautions can prevent problems. PMID- 10136897 TI - Make up air systems prove necessary for worker comfort. PMID- 10136898 TI - Temperature monitoring prevention saves pounds of food poisoning cure. PMID- 10136899 TI - Pediatric hospital cuts costs with new juice packaging. PMID- 10136900 TI - Food service with an Italian twist. Pizza and pasta in hospital food service. PMID- 10136901 TI - Waste management programs here today for foodservice institutions. PMID- 10136902 TI - NRA (National Restaurant Association) Education Foundation stresses food safety. PMID- 10136903 TI - Convection steamer. Health care facility focuses on innovative and quality foodservice. PMID- 10136904 TI - Sodexho brings innovation and teamwork to major new accounts. PMID- 10136906 TI - Survey reveals foodservice trends. PMID- 10136905 TI - Portion control: a way to control costs. PMID- 10136907 TI - What's for lunch? Hospitals serve quality meals within budget constraints. PMID- 10136908 TI - Delegations of authority and organization; Center for Devices and Radiological Health--FDA. Final rule. AB - The Food and Drug Administration (FDA) is amending the regulations for delegations of authority relating to general redelegations of authority from the Associate Commissioner of Regulatory Affairs to certain FDA officials in the Center for Devices and Radiological Health (CDRH). The redelegation provides these officials with authority to grant or deny certain citizen petitions for exemption or variance from medical device tracking requirements. This action is being taken to facilitate expeditious handling of citizen petitions. FDA is also issuing a conforming amendment to the medical device tracking regulations to make the regulations consistent. PMID- 10136909 TI - Medicare and Medicaid programs; approved information collection requirements- HCFA. Final rule with comment period. AB - This final rule updates our display of approved control numbers for the collection of information that have been assigned to HCFA by the Office of Management and Budget (OMB). OMB regulations require each agency to include the approval numbers in the agency's rules. PMID- 10136910 TI - Medicare program; revisions to payment policies and adjustments to the relative value units under the Physician Fee Schedule for calendar year 1994--HCFA. Correction. PMID- 10136911 TI - Health maintenance organizations: qualification determinations during the period January 1, 1994 through March 31, 1994--HCFA. Notice. AB - This notice sets forth the names, addresses, service areas or modified service areas, and dates of qualification or expansion of entities determined to be Federally qualified health maintenance organizations (FQHMOs) during the period January 1, 1994 through March 31, 1994. This notice is published in accordance with our regulations at 42 CFR 417.144 and 417.163, which require publication in the Federal Register of certain determinations relating to FQHMOs. PMID- 10136912 TI - Medicare and Medicaid Programs; quarterly listing of program issuances and coverage decisions--first quarter 1994--HCFA. Notice. AB - This notice lists HCFA manual instructions, substantive and interpretive regulations and other Federal Register notices, and statements of policy that were published during January, February, and March of 1994 that relate to the Medicare and Medicaid programs. Section 1871(c) of the Social Security Act requires that we publish a list of Medicare issuances in the Federal Register at least every 3 months. Although we are not mandated to do so by statute, for the sake of completeness of the listing, we are including all Medicaid issuances and Medicare and Medicaid substantive and interpretive regulations (proposed and final) published during this timeframe. We are also providing the content of revisions to the Medicare Coverage Issues Manual published between January 1, and March 31, 1994. On August 21, 1989 (54 FR 34555), we published the content of the Manual and indicated that we will publish quarterly any updates. Adding to this listing the complete text of the changes to the Medicare Coverage Issues Manual allows us to fulfill this requirement in a manner that facilitates identification of coverage and other changes in our manuals. PMID- 10136913 TI - Criteria for use of blue "Star of Life" for emergency medical services. National Highway Traffic Safety Administration. Notice. AB - This notice amends NHTSA's guidelines for the authorized use of the blue "Star of Life" symbols for emergency medical services. Comments received in response to an earlier notice suggested uses for this symbol that were not considered when these guidelines were first developed. These amendments are intended to provide additional flexibility to the States within the purposes for which the blue Star of Life was originally registered as a certification mark. PMID- 10136914 TI - Program exclusions: July 1994--OIG. Notice of program exclusions. PMID- 10136915 TI - Medicaid program; eligibility and coverage requirements--HCFA. Final Rule. AB - This final rule withdraws regulations setting forth a mandatory budgetary method for determining financial eligibility for individuals who are not receiving or deemed to be receiving Federal cash assistance but whose financial eligibility for Medicaid is being determined through the application of financial criteria of the Aid to Families with Dependent Children (AFDC) program. These regulations were previously issued as part of a final rule with comment period originally published on January 19, 1993, and were to be effective October 18, 1994. This final rule also makes conforming technical changes, as a result of this withdrawal, to the remainder of the January 19, 1993, final rule and reaffirms the August 18, 1994, effective date of this remaining part. These changes are being made as a result of consideration of public comments received. PMID- 10136916 TI - Medical facility construction and modernization; requirements for uncompensated services for persons unable to pay--PHS. Final rule. AB - The rules below revise the rules currently governing how certain health care facilities, assisted under Titles VI and XVI of the Public Health Service Act, fulfill the assurance given in their applications for assistance that they would provide a reasonable volume of services to persons unable to pay for such services. The revisions below amend the rules to permit facilities that provide substantial free or below cost medical services but nonetheless cannot receive credit for such services under current requirements with an alternative method of compliance that will enable them to fulfill their uncompensated services obligations. PMID- 10136917 TI - Letter to manufacturers of blood establishment computer software products--FDA. Notice. AB - The Food and Drug Administration (FDA) is publishing a letter sent to known manufacturers of blood establishment computer software products. In the letter, FDA advised these manufacturers that it considers these computer software products to be devices under the Federal Food, Drug, and Cosmetic Act (the act) because these products aid in the prevention of disease by identifying unsuitable donors and preventing the release of unsuitable blood and blood components for transfusion or for further manufacturing use. The letter, accompanied by a registration package and device listing was intended to notify manufacturers of the requirements of the act, to facilitate registration of these manufacturers as medical device manufacturers, and to further ensure the safety of the blood supply. PMID- 10136919 TI - Code blue for health care reform. PMID- 10136918 TI - Going halfway. AB - Many lawmakers are shying away from performing radical surgery on the health care system and are opting instead for what appears to be a low-risk treatment of incremental reforms. But half-remedies and inaction carry their own risks. PMID- 10136920 TI - The Canadian National Calibration Reference Centre for In-Vivo Monitoring: thyroid monitoring. Part IV: Optimizing a counting system that uses a single channel analyzer. AB - This article is the fourth of a five-part series covering various aspects of occupational thyroid monitoring. This article describes the energy calibration of the monitoring system with particular emphasis on techniques for optimizing a system that is based on a single-channel analyzer, or any system that does not have a multi-channel analyzer. These systems cannot directly show the operator the photopeak of the calibration source. The article also briefly discusses quality control and problem solving. PMID- 10136921 TI - Competency-based certification project. Phase I: Job analysis. AB - The Canadian Association of Medical Radiation Technologists (C.A.M.R.T.) is transforming its existing certification process into a competency-based process, consistent with the knowledge and skills required by entry-level radiography, radiation therapy and nuclear medicine technology practitioners. The project concurs with the change in focus advocated by the Conjoint Committee on Allied Medical Education Accreditation. The Committee supports new accreditation requirements that, among other things, place more emphasis on competency-based learning outcomes. Following is the first of three papers prepared by the C.A.M.R.T. to explain the project and the strategy for its implementation, focusing respectively on each phase. This paper discusses Phase One: the job analysis. PMID- 10136922 TI - Have we created barriers to inter-provincial mobility? PMID- 10136923 TI - The occupational therapist as an expert analyst on the cost of future health care in legal cases. AB - The purpose of this paper is to explain the legal criteria the court follows when awarding monies to an injured individual for Cost of Future Care. It also describes the role of, and procedures used by, the occupational therapist in analyzing future care costs for the court's consideration. It describes the benefits to the client, the legal system and society arising from the occupational therapist's expertise, and the role the therapist plays in obtaining information related to the client's case from other professionals. PMID- 10136924 TI - Assessing ability to drive following an acute neurological event: are we on the right road? AB - Every day in Canada occupational therapists are asked to assess clients with neurological impairments and to provide recommendations to provincial licensing bureaus regarding the individual's fitness to drive. These decisions have great impact on the client and on society. In this paper we briefly review the findings that have been published regarding the assessment of individuals with neurological conditions who wish to resume driving. In addition, a description of the tools commonly used to assess individuals is provided, along with where available, the measurement properties of each. Finally, the Driving Evaluation Service of a physical rehabilitation centre is described. PMID- 10136925 TI - Position statement. The role and use of support personnel in the delivery of occupational therapy service. Canadian Association of Occupational Therapists. AB - CAOT endorses the inclusion of support personnel in the delivery of occupational therapy services. It is recognized that a wide range of roles and responsibilities exist for support personnel which will meet the objectives of future health and social service delivery undertaken by health care reform. Careful elaboration and clarification of roles, accountability, supervision requirements as well as nationally developed standards for training of support personnel will facilitate responsible deployment and integration of support personnel in the health labour force. PMID- 10136926 TI - Position statement. Health reform. Canadian Association of Occupational Therapists. PMID- 10136927 TI - Hatch bill meets nursing homes' needs. PMID- 10136929 TI - How can facilities improve mental-health services? PMID- 10136928 TI - Managed care hits retirement industry. PMID- 10136931 TI - Policing home care. How much should the government regulate home care? PMID- 10136930 TI - Trapped. Depression can be a permanent affliction unless caregivers recognize and treat it. PMID- 10136932 TI - Computerized caring. Computerizing the MDS (Minimum Data Set) will prove positive in other aspects. PMID- 10136933 TI - Regulators are allies, not antagonists. PMID- 10136934 TI - Parenting and child distress during cancer procedures: a multidimensional assessment. AB - We examined the relationship between children's distress during invasive cancer procedures and parent anxiety, parent disciplinary attitudes, and parent behavior during the medical procedure. Sixty-six children with cancer and their parents were evaluated during a routine bone marrow aspiration. Significantly higher levels of distress were obtained for young (under age 8) versus older children. Patterns of relationships with parent variables also varied by age. Anxious parents of young children reported relying on less effective discipline strategies. They also were less reassuring prior to to medical procedure. Age differences in the correlations between child distress and parenting are discussed in terms of developmental differences in children's dependence on caregivers for emotional regulation and control. Implications for clinical distress reduction programs are also discussed. PMID- 10136935 TI - Parenting satisfaction and efficacy among caregivers of children with diabetes. AB - This study assessed parenting satisfaction and efficacy in 53 parents of children with diabetes and 39 parents of physically healthy children. In addition, the relationship between parenting self-esteem and perceptions of child behavior, child age, disease duration, and metabolic control were examined. Parents of children with diabetes reported significantly lower levels of parenting satisfaction and efficacy compared to parents of healthy children, and their negative parental cognitions are most influenced by perceptions of more internalizing child problems, shorter diabetes duration, and poorer metabolic control. Parenting self-esteem was significantly inversely correlated with both internalizing and externalizing child behavior problems for parents of healthy children. The clinical implications of poor parental cognitions and directions for future research are highlighted. PMID- 10136936 TI - The paradigm shift: behavioral home care. AB - Home care agencies looking to compete in today's competitive market must learn to target their services to market niches and to keep their eyes on marketplace trends. This article examines the changes occurring in behavioral home care and how agencies can tailor their services to their communities. PMID- 10136937 TI - Policy issues in physician reimbursement. AB - As physicians become increasingly involved in home care, the issue of their reimbursement arises with increasing frequency and intensity. Currently most physician services for home care are not reimbursable; HCFA, however, is reconsidering. PMID- 10136938 TI - Teaching home care to physicians during residency. AB - Residency is a pivotal time in a physician's education when lifetime patterns are often established. Thus, during residency physicians need to learn about home care and--more than just learn--become enthusiastic and committed to this type of health care. What can medical schools do to instill these values? PMID- 10136939 TI - The status of home care training for physician assistants. AB - Homebound individuals represent a medically underserved and rapidly growing population. Nonphysician practitioners--physician assistants and nurse practitioners--in the home care setting afford increased availability of and access to medical services by homebound patients. PMID- 10136940 TI - Physician education in home care. AB - Home care is a neglected area of study for most medical students. One home care agency has developed a clerkship model with a local university to teach its students about this fast-growing segment of health care. PMID- 10136941 TI - Home care agencies & the physician customer: effective communication. AB - As health care moves to the outpatient setting, home care providers are in a critical position to influence physician practice patterns. An effective communication plan that facilitates the exchange of information between the home care provider and its physician customers will bridge the customer service gap and strengthen the relationship between the physician and the provider. PMID- 10136942 TI - Physician partnerships: creating winning strategies for better relationships. AB - In an effort to provide better service to the community, one home care agency developed a partnership program with its referring physicians. Physicians appreciate the reduced paperwork and fewer phone calls, and nurses enjoy a more equal partnership with the physicians. PMID- 10136943 TI - A biopsychosocial model for comprehensive care of the elderly. AB - This commentary, coauthored by the National Association for Home Care 1993 Physician of the Year, points out the interwoven nature of society. Home care can play an important role in that society, if the industry acts together. PMID- 10136944 TI - Physician marketing--an ethical strategy. AB - Attracting physicians to work with home care providers has proven lucrative for those providers willing to jeopardize their morals and even their legal status. There is a better way, however, and that revolves around physician education and disclosure of agency information. PMID- 10136945 TI - Physicians, palliative care, & health care reform. AB - As hospice programs have grown, they somehow left physicians out of the loop. As the health care system faces reform proposals and eventually undergoes changes, physicians need to be more involved in what happens to hospice care. PMID- 10136946 TI - Guidelines for developing a new standard in hospice care. AB - Hospice care has been overlooked by many in the medical community. This is partly due to the nature of medical training; it could be overcome by the development of industry guidelines by which to measure quality of care. PMID- 10136947 TI - The class of '90: one year after graduation. PMID- 10136948 TI - Job market profile of college graduates in 1992: a focus on earnings and jobs. PMID- 10136949 TI - After the fall: physical therapy assistants and aides. PMID- 10136950 TI - The clinical effects and cost-avoidance of a change in perioperative bronchodilator use. AB - The clinical effects and financial impact of a change in prescribing habits from routine to occasional use of perioperative bronchodilators, following the presentation of drug information, were assessed retrospectively by comparing the outcomes of patients admitted for major thoracic surgery. Eighteen of 24 (75%) patients in Period A (prior to change) received salbutamol bronchodilator therapy versus 10 of 17 (59%) in Period B (following the change) (p = .448). Of the patients who did receive salbutamol aerosols, the mean dose in grams per patient was greater in Period A than in Period B (6.85 +/- 5.96 vs. 2.64 +/- 4.44 respectively p < 0.05). Two patients from Period A and one from Period B were receiving digoxin prior to admission. In the remaining patients, 5 of 22 (23%) in Period A and 1 of 16 (6%) in Period B developed atrial fibrillation requiring digoxin (p = .36). The proportion of patients with obstructive airways disease (OAD) who developed an arrhythmia was not different between the two groups. However, in those patients without OAD an arrhythmia was reported in 9 of 16 patients (56%) receiving salbutamol, versus only 1 of 11 (9%) of those not receiving it (p = 0.032). The number of days patients were hospitalized during Period A and Period B were 10.2 +/- 4.97 and 9.4 +/- 3.68 respectively (p = 0.85). A potential average cost-avoidance of $68.46 per patient could be realized with this new practice. We conclude that a change in prescribing habits had no adverse clinical outcome and resulted in a considerable cost-avoidance. PMID- 10136951 TI - How pharmaceutical controls worked in one Ontario hospital. PMID- 10136952 TI - Evolution of discharge planning in rehabilitation: a perspective. PMID- 10136953 TI - Utilization review and discharge planning: integration maximizes benefits. PMID- 10136954 TI - Continuing care partnership: seamless services to COPD patients. PMID- 10136955 TI - Changes in practice intensify need to engage families in discharge planning. PMID- 10136956 TI - The changing role of the family in treatment: a review and some strategies. PMID- 10136957 TI - Program profile: a take-along patient record. PMID- 10136958 TI - Rightsizing: hospital-community collaboration to reduce inpatient beds. PMID- 10136959 TI - OSHA's new personal protective equipment standard--a potentially significant enforcement tool. PMID- 10136960 TI - The Family and Medical Leave Act of 1993: what does it mean for your organization? AB - The Family and Medical Leave Act (FMLA) requires that employers with 50 or more employees located within a 75-mile radius of a worksite be granted 12 weeks of unpaid leave. This article summarizes the arguments for and against mandated leave, describes the main tenets of FMLA and suggests how employers can implement FMLA leave in a manner favorable to both the employer and the employees. PMID- 10136961 TI - A maturing benefit: eldercare after a decade. PMID- 10136962 TI - Health promotion/wellness for multiemployer funds. PMID- 10136963 TI - Where's God? PMID- 10136964 TI - Prehospital prayer? PMID- 10136965 TI - From here to eternity. Most of us bury our feelings about death. PMID- 10136966 TI - The good old days. PMID- 10136967 TI - OSHA: What is it? And how does it work? PMID- 10136968 TI - The effects of scheduled intern rotation on the cost and quality of teaching hospital care. AB - We studied the effect of scheduled intern rotations on the cost and quality of inpatient care at one teaching hospital. For all discharges from the internal medicine service between 1980 and 1986, we identified 1,705 rotation patients and 3,141 no-rotation patients. Using linear or logistic regression analysis to control for baseline differences, we evaluated for the effect of rotation. We found that rotation was significantly related to longer length of hospital stay, b = 0.341 days, p = 0.001, and higher hospital charges (for log charges, b = 0.053, p = 0.016. Hospital deaths, nursing home placements, and 30-day readmissions were not significantly related to rotation, p > 0.1. These results suggest that the systematic discontinuity induced by scheduled intern rotations may be another source of increased health care costs experienced at teaching hospitals. PMID- 10136970 TI - Support components make the system at The New York Hospital. PMID- 10136969 TI - Assessing employee attitudes in a community-based AIDS service organization. AB - This study surveyed employees of the Comprehensive AIDS Program of Palm Beach County, Florida, a community-based AIDS service organization, to understand employees' motives for working for the organization and their attitudes toward their jobs, the organization, its clients (persons with AIDS), and governments. The study revealed that the primary reasons employees work for the organization are a desire for personal involvement in the AIDS fight and the personal lifestyle and/or feeling of each employee. These employees were highly motivated, showing some very positive attitudes toward their jobs, organization, and clients. On the other side, these employees reported concern for future funding of their organization and unhappiness with both federal and state governments' role in the fight against AIDS. Based on these findings, the authors discuss implications for the management of AIDS service organizations, the quality of the AIDS service delivery system, and the future development of AIDS service organizations. PMID- 10136971 TI - Computer integration, Part I. PMID- 10136972 TI - How to host a hotline. PMID- 10136973 TI - Challenge: how to provide cost-efficient outpatient meals. Solution: prepare a boxed meal service. PMID- 10136974 TI - How to give the gift of hospitality. Great customer service. AB - Whether it takes the form of greeting customers with a smile, redressing a diner's grievance or conducting special kitchen tours, providing customer service has become the number-one priority in foodservices coast to coast. Operators share tips & training methods that are helping staffs provide the hospitable services today's customers are demanding. PMID- 10136975 TI - Computer integration, Part II. PMID- 10136976 TI - Challenge: how to address the special nutritional needs of patients & local community members. PMID- 10136977 TI - Management without frontiers: health system convergence leads to health care management convergence. AB - Health care managers and policymakers throughout the industrialized world are faced with a variety of new challenges at the same time that traditional constraints on action are becoming ever more restrictive. These pressures have stimulated a variety of health care reforms involving four different strategies for change: cost-containment efforts, quality and administrative efficiency improvements, cost-shifting efforts, and the adoption of market-related concepts from the private sector. These changes are leading to convergence among health systems, as seen by the reforms underway in the Netherlands, Germany, and the English component of the United Kingdom's National Health Service. This in turn will create convergence in the problems and issues faced by health care managers. Issues such as hospital contracting, managed mental health care, primary care gatekeeping, and four others are explored to illustrate how American managers can learn from the experiences of colleagues in other industrialized nations. A final section identifies common themes for health care executives in this period of global convergence. PMID- 10136978 TI - Health care management in the global village. PMID- 10136979 TI - Limits to the predictive value of trends in European health reform. PMID- 10136980 TI - Managed care systems vs. health care trends. PMID- 10136981 TI - Cash is king. AB - Cash is so important that a hospital or other business can operate at a loss as long as it does not run out of cash. A business must close even if it is operating at a profit if it has no cash. Bills are paid against cash and not net income. The most important source of cash in a hospital is accounts receivable. If the chief financial officer manages receivables well, everything else seems to be manageable. Cash is often misunderstood and confused with profits. Cash is critical everyday, while profits are never critical. PMID- 10136982 TI - Hospital clinical career advancement programs: comparing perceptions of nurse participants and nonparticipants. AB - The study reported in this article describes nurse participants and nonparticipants in hospital clinical career advancement programs (clinical ladders) and compares perceptions in relation to program intrinsic outcomes, needs, and criteria for level advancement. A stratified random sample consisted of 120 participants and 480 nonparticipants drawn from 1,769 clinical nurses employed full time at five regional general hospitals. The findings suggest that nurses' demographic characteristics do not influence program participation status and that clinical advancement programs have limited impact upon job enrichment designed to recruit and retain clinical nurses providing direct patient care. Program participants (106; 88.3 percent) differed significantly at the .05 level from nonparticipants (385; 80.2 percent) on each factor area measuring perceptions of clinical advancement programs. PMID- 10136983 TI - Effects of staff-patient relations training on employees and their feelings about their work. AB - This article describes a study in which 16 health care workers participated in a two-hour staff-patient relations training session that was held once weekly for three weeks. Training included discussions of empathy, anger, stress management, effective communication, managing irate or difficult patients and families empathetically, and the concept of "positive stroking." The participants were given a pretest and posttest of program content and they also completed a five item Likert scale survey. The patients rated themselves as overall improved in five areas of self-evaluation. The scores were significantly improved in the posttest group. There was a high correlation between "before" and "after" scores. PMID- 10136984 TI - Collective bargaining practices in the health care industry: an empirical analysis. AB - The study described in this article focuses on the effects of collective bargaining on the health care industry. Due to the wide range of bargaining groups authorized to become unionized in the health care industry, this study concentrates on how collective bargaining affects the nurses in hospitals. The authors also surveyed a number of administrators and nurses in several hospitals in the midwestern part of the United States to secure their opinions about the effect of the union on their profession. The results of the survey are presented. Finally, the authors summarize related themes and interesting points from the literature and the surveys and provide recommendations. PMID- 10136985 TI - What scares patients about the hospital. AB - Hospitalization usually disrupts a person's privacy, autonomy, life style, roles, and finances. This article discusses the anxieties a patient can experience related to future uncertainties, insufficient information, fear of personal incompetence, being exposed to hospital rumors, and anticipated pain. Interventions to reduce patient anxiety are suggested. PMID- 10136986 TI - A comparison of occupational stressors in selected allied health disciplines. AB - Work-related stressors have been linked to a number of diseases, both physical and psychological. Previous studies have revealed that the stressful occupational components are particularly apparent in health care occupations. Occupational sources of stress in three allied health disciplines--nuclear medicine technology, radiologic technology, and medical technology--were studied over the last three years via responses from approximately 500 practitioners. The top five stressors in each discipline were as follows: nuclear medicine technology- equipment malfunctions, add-on examinations, uncooperative physicians, lack of staff, and uncooperative patients; radiography--disrespectful physicians, inadequate pay, unnecessary examinations, lack of staff, and lack of respect; and medical technology--equipment breakdown, poor management practices, difficult coworkers, lack of time, and exposure to human immunodeficiency virus. It is crucial for administrators and fellow health care professionals to be aware of and address those areas of job-related stress that may impact the quality of patient care and the well-being of the allied health professional. PMID- 10136987 TI - Getting maximum value from employee teams--and keeping them legal. AB - Today's increasing emphasis on participative management is tending to bring more employees into problem-solving processes and giving them more voice in how they do their work. As a natural consequence of such changes, more is being done with employee teams. However, in some areas of potential involvement, employee teams can be seen as intruding on the territory of labor unions, so there is a constant risk of a given employee team being ruled an illegal labor organization. This problem, actually existing as long as the National Labor Relations Act has been with us but only recently forced into prominence by the Electromation Decision of late 1992, can be solved through observance of sensible guidelines for team organization and operation. PMID- 10136988 TI - A supervisor asks: "Working with and around physicians". PMID- 10136989 TI - Integrated systems will score with early capitation strategy. PMID- 10136990 TI - Patient satisfaction research fastest growing product for National Research Corporation. AB - Interest in National Research Company's patient satisfaction product and Healthcare Market Guide is booming. Find out what this Lincoln, Neb.-based research firm offers hospitals and other health care providers. PMID- 10136991 TI - Landing doctors takes more than money. AB - Competition for primary care physicians has gone from an amateur hobby to a professional sport in the past three months, with hospitals fighting each other, managed care companies and even employers for this valuable resource. The winners have learned that it takes money and a lot more to land the doctors. PMID- 10136992 TI - Building integrated systems. The seven C's to successful collaboration. PMID- 10136993 TI - Antitrust regulators push partnership as alternative to hospital merger. AB - In the past, antitrust regulators seemed to favor mergers that would result in cost efficiencies and were not opposed by third-party players. A recent decision about a proposed merger of two Florida hospitals, however, changed that stance, writes Linda R. Blumkin, partner in the New york law firm of Fried, Frank, Harris, Shriver & Jacobson. PMID- 10136994 TI - HMOs will enroll more people, slash utilization. PMID- 10136995 TI - Better care for poor helps Dallas hospital. PMID- 10136996 TI - Hospitals assess community health needs. PMID- 10136997 TI - Crisis centers and their role in treatment: suicide prevention versus health promotion. AB - Suicide is a major health problem. In the industrialized nations, it remains among the 10 leading causes of death. There has been a massive effort to reduce suicide mortality through establishment of prevention centers. These centers have proliferated despite a lack of evidence concerning their efficacy. The development and evaluation of suicide prevention centers, primarily community based, telephone interventions, are discussed. The evidence regarding the effectiveness of suicide prevention centers and the presence of a causal relationship between exposure to crisis counseling and a reduction in suicide rates is reviewed. Some cautions and recommendations are made. Finally, a model of health promotion program planning and evaluation is examined in the context of suicide prevention. PMID- 10136998 TI - Consent and experiments with the dying. PMID- 10136999 TI - State legislative approaches to regulating coverage for experimental procedures. AB - As addressed in past issues of the Newsletter, the Employment Retirement Income Security Act ("ERISA"), 29 U.S.C. sections 1001 et seq., limits the ability of states to regulate the terms and conditions of group health plans. See Newsletters, Vol. 8, No. 6, June 1993, at 6 and 23; Vol. 8, No. 1, January 1993, at 7; Vol. 7, No. 2, February 1992, at 13; Vol. 6, No. 11, November 1991, at 3. Under ERISA, states cannot mandate that self-insured group health plans or employers provide specific types of coverage. Metropolitan Life Ins. Co. v. Massachusetts, 471 U.S. 724, 105 S.Ct. 2380 (1985). Such mandates are enforceable only as to insurance companies and HMOs, and only to the extent that they are deemed to "regulate insurance." Id. As a result, state legislative attempts to regulate experimental treatment insurance coverage have largely been limited to health plans that are not self insured. Given the inconsistent handling of experimental treatment insurance coverage by both insurance companies and courts across the nation, state legislatures have demonstrated that they are ready to address this matter themselves. However, unless ERISA is amended to afford employees with self-insured plans the same protections as those with insured plans, such state efforts will not be able to resolve the problem for all citizens. PMID- 10137000 TI - Special report on patient care. HCFA finally issues patient-dumping regulations. AB - EMTALA has always been an especially worrisome law for providers because its requirements are both sweeping and vague, with potentially drastic penalties for violations. The new regulations remove only some of the law's vagueness. As with previous EMTALA amendments, all United States hospitals, as well as emergency department physicians and other doctors who see patients in the emergency department, should carefully review their internal policies regarding patient ++ transfers in light of the new regulations. For example, hospitals must have an internal policy for following up on suspicious transfers, as failure to detect an inappropriate transfer can now potentially result in a Medicare decertification action. Also, hospitals with specialized services (e.g., burn units or shock trauma units) should review their policies on receiving transfer patients in light of the greater specificity of the new regulations. Finally, because of the confusing new requirements regarding ambulance services, all hospitals should review their relationships with and policies regarding, ambulance services and ambulance diversion. PMID- 10137001 TI - Tort reform proposals: a toolbox for change. AB - Tort reform is controversial because of the need to balance cost considerations with the legitimate needs of plaintiffs who have suffered malpractice injury. In addition, proponents and opponents of the different proposals often formulate their positions based largely on anecdotal evidence and concerns of special interest groups rather than careful studies. As a result, it may be some time before malpractice reform is addressed comprehensively at the federal level, leaving the states to their own reform devices. PMID- 10137002 TI - Finding a lasting cure for U.S. health care. AB - In "Making Competition in Health Care Work" (July-August 1994), Elizabeth Olmsted Teisberg, Michael E. Porter, and Gregory B. Brown ask a question that has been absent from the national debate on health care reform: How can the United States achieve sustained cost reductions while at the same time maintaining quality of care? The authors argue that innovation driven by rigorous competition is the key to successful reform. A lasting cure for health care in the United States should include four basic elements: corrected incentives to spur productive competition, universal insurance to secure economic efficiency, relevant information to ensure meaningful choice, and innovation to guarantee dynamic improvement. In this issue's Perspectives section, eleven experts examine the current state of the health care system and offer their views on the shape that reform should take. Some excerpts: "On the road to innovation, let us not forget to develop the tools that allow physicians, payers, and patients to make better decisions." I. Steven Udvarhelyi; "Health care is not a product or service that can be standardized, packaged, marketed, or adequately judged by consumers according to quality and price." Arnold S. Relman; "Just as antitrust laws are the wise restraints that make competition free in other sectors of the economy, so the right kind of managed competition can work well in health care." Edward M. Kennedy "Biomedical research should be considered primarily an investment in the national economic well-being with additional humanitarian benefits." Elizabeth Marincola. PMID- 10137003 TI - How NY hospital security maintained VIP privacy despite media pressures. PMID- 10137005 TI - Theft of video equipment from parking garages. PMID- 10137004 TI - An interview with: Joseph R. Coppola on security at Johns Hopkins Medical Institutions. PMID- 10137006 TI - What you should know about background checking services. PMID- 10137007 TI - Special report. Hospital security and employee child care centers: keeping the children safe and the hospital less vulnerable to liability. AB - Hospitals and colleges, with their large work forces of parents who work odd hours, were pioneers in offering on-site child care services, and they continue to be in the forefront among American employers. Security departments are sometimes called on to provide extra measures of safety and protection against liability concerns, but many experts say they could be doing much more. In this report, we'll spell out what the liability problems are and how security departments can help. PMID- 10137008 TI - Comparing data to establish systems that work. PMID- 10137009 TI - Achieving schedule flexibility. PMID- 10137010 TI - Patient-focused care--a comparison study. PMID- 10137011 TI - Disease demarketing: the college AIDS challenge. AB - The college population is an important target group for AIDS risk behavior demarketing. While college students appear to be factually knowledgeable they reportedly often engage in high-risk sexual behaviors. This study sheds light on this incongruity by investigating free association images of AIDS and the salient emotions revealed about the disease. The results suggest that students perceive strongly the finality of the disease with fear and sadness representing the most salient emotions. However, men and women may need to be treated as distinct demarketing and promotional targets. Males and females differ in their image of AIDS which may necessitate developing different promotional messages for each of them in order to more effectively influence attitudinal and behavioral change. PMID- 10137012 TI - Prospecting for customers in the small employer market: the experience of Arizona Health Care Group. AB - The findings of this study provide an interesting profile of the small employer "prospects" for prepaid health plans, where a prospect is defined as an employer that responds to a mass mailing effort with a request for information and further contact. About 60% of these prospects already have insurance, with 40% having group insurance. Therefore, a substantial portion of prospects are seeking to replace their existing health benefit package with a different one. Of those who do not offer existing insurance, the most common reason is that it is "too expensive" or the employer is "not profitable." A very small proportion do not offer insurance because they do not qualify for it due to medical underwriting considerations. Prospects tend to be larger than non-prospects in terms of sales, but employ lower wage employees, on average. About half of prospects are in service industries, a proportion typical of small employers in general. Somewhat surprisingly, most prospects have been in operation for over five years. They are not new firms attempting to establish their benefit packages. This is consistent with the findings on gross sales, suggesting that some maturity is necessary before an employer considers offering group health insurance as a benefit. The prepaid plans in this study also appeared to target established employers for their marketing efforts. In responding to questions about their attitudes towards health insurance, over one-quarter of prospects indicated that they would be unwilling to offer insurance at rates so low that they would not normally apply to the coverages offered by prepaid plans. Thus, although they were "prospects" by the study's definition, they were unlikely to eventually contract with prepaid plans. Those prospects that had offered insurance previously, but had discontinued it, tended to cite premium increases as the reason. This suggests that prospects among small employers are likely to be very price sensitive, and that further prescreening of prospects by phone, during which premium levels are discussed, might be cost-effective in following up leads from mass mailings. The study data also suggest the importance of quick follow-up for mass mailing leads, as the drop-off in recall and interest appears to be substantial. About half of the prospects interviewed stated that they were unaware of AHCG, although they or someone in their business had returned a mailer requesting more information. In addition to their implications for marketing to small employers, the results of the study appear to have broader policy implications as well.(ABSTRACT TRUNCATED AT 400 WORDS) PMID- 10137013 TI - Serving patient needs while implementing cost effectiveness programs in health care administration. AB - The rising costs of health care have focused administrators' attentions on controlling expenses rather than patient needs and preferences. This paper describes a method by which administrators can assess possible cost effectiveness of alternative therapies that may be preferable to patients. PMID- 10137014 TI - Older consumers' perceptions of health care information sources: the effect on search behavior. AB - Substantial evidence has been developed regarding the identity of health care information sources preferred by the elderly. However, this research has not empirically investigated why a given source might be more or less important to this segment. To address this gap, this research investigates OTC-health care information sources in terms of their credibility, expertise and associated risk. Differences in perceptions of these characteristics across the derived information source types are then examined across heavy and light users of OTC medications. PMID- 10137015 TI - The media/information richness model as prescription for some health care service ills. AB - Because consumers are demanding more and better information from their health care providers, improving effectiveness and efficiency of communications is one way that health care providers can gain a competitive edge. The authors propose that health care communication effectiveness and efficiency can be improved by using the Media/Information Richness Model (MIR) in planning service delivery systems. PMID- 10137016 TI - The effect of scale form choice on psychometric properties of patient satisfaction measurement. AB - One hundred and fifty nine subjects responded to one of three differently labeled 5-point scale forms of patient satisfaction measurement: Likert-type scale form (1 = Strongly Agree, 5 = Strongly Disagree); Mixed scale form (1 = Very Satisfied, 5 = Very Dissatisfied); and Expectational scale form (1 = More Than I Expected, 5 = Less Than I Expected). A well-known patient satisfaction instrument developed by Ware and colleagues (Ware, Snyder, and Wright, 1976) was utilized to manipulate the scale form effect. The psychometric properties of each scale form was analyzed. The findings indicated generally comparable satisfaction data generated by each scale form as well as comparable measures of reliability. The Likert-type scale form has shown advantage in reducing leniency (relatively high satisfaction scores) over the mixed and expectational scale forms. PMID- 10137017 TI - Price: a market signal of quality in health care insurance policies? AB - Choosing a good quality health insurance policy is important for most individuals in this country. The choice task is however, made quite complicated by the existence of many alternative policies which are each characterized by multiple attributes. This paper examines whether the price (i.e., premium) of a health insurance plan can give a reliable signal about the objective quality level of the plan. Empirical analysis of real-world data shows that overall, price is positively correlated with such quality. Statistical significance tests are conducted to separately evaluate such correlations for different categories of health insurances. Finally, the empirical results are used to indicate implications for consumer decision making. PMID- 10137018 TI - Understanding innovation in social service delivery systems. AB - Progress in the social services is driven by innovation. It depends on the ability of social work researchers and practitioners to find innovative solutions to the problems they face. Innovation entails the creation, adaptation, and adoption of new approaches to service delivery. The most fundamental type of innovation is the creation of a new service product. However, innovations in the way services are delivered are equally important. This paper provides a model for understanding innovation in social services. PMID- 10137019 TI - Aspects of consumer search for health information: a framework for structuring information problems. AB - Consumer search for health information is the focus of increasing scholarly activity and administrative thinking. It has drawn attention in many circles of inquiry including marketing, health-care, and public policy. Because of this widespread attention, the literature is rather fragmented and therefore research problems are not easily defined. This paper presents an integrative framework to help formulate health information problems more precisely and to distinguish important areas for continued research efforts. Three major aspects of consumer search for health information are identified: sources, effort, and topics. These aspects- and the interrelationships among them--comprise the framework. Related research can be categorized and synthesized, and then critical gaps in the research streams become more evident. Furthermore, the framework can be applied to particular information problems to both clarify the issues and to communicate those issues to health care managers and relevant constituencies. Applied examples discussed in this paper are: (1) direct-to-consumer advertising, (2) telephone information services, and (3) hospital mortality data. PMID- 10137020 TI - Conflicting values. PMID- 10137021 TI - A corporate point of view. Taking a distinct approach to health-care fabric, Linda Thompson relied on her instincts to develop PallasCares. PMID- 10137022 TI - A studied approach. DesignTex's Envirotex 6 health-care fabric collection reflects research that indicates patients' special requirements for color and pattern. PMID- 10137023 TI - Finding solutions. Raynes Rail, a true universal design, incorporates audio and touch tools for the visually impaired and the able-bodied. PMID- 10137024 TI - Shedding light on color. Laurie Zagon's Bauhaus-derived color theory applied to health-care environments embraces the healing quality of full-spectrum color. PMID- 10137025 TI - Intermediate chairs. Rejecting the characterization of patients as either ambulatory or non-ambulatory, ADD introduces seating that fills the needs of those in-between. PMID- 10137026 TI - The making of a medical library. Steelcase Healthcare's Context systems aid in the re-building of a health-care facility's over-flowing medical records department. PMID- 10137027 TI - The public needs protection from so-called 'alternatives'. PMID- 10137029 TI - Looking for a rational way to control costs. Interview by C. Burns Roehrig. PMID- 10137028 TI - An internist in the world of alternative medicine. PMID- 10137030 TI - Better pay and fewer hassles: a regulatory agenda. PMID- 10137031 TI - Board certification: its use and misuse. PMID- 10137032 TI - An internist's comments on OB-GYN and primary care. PMID- 10137033 TI - Arbitration panels are the key for tort reform. PMID- 10137034 TI - Medicare and budget cutting. American Society of Internal Medicine. PMID- 10137035 TI - Why patients choose alternative medicine. Interview by Diana Madden. PMID- 10137036 TI - Hospitals looking to a managed care future. PMID- 10137037 TI - State review process established for hospital cooperative agreements. PMID- 10137038 TI - West Texas hospitals come together in an HMO. PMID- 10137039 TI - Is there an information superhighway? PMID- 10137040 TI - Collaboration: the sequel. PMID- 10137041 TI - Clinical audit. Secret garden. PMID- 10137042 TI - Resourcing primary care. Real lessons from paper budgets. PMID- 10137043 TI - Mental health. A problem shared .... PMID- 10137044 TI - Child abuse. Being there. PMID- 10137045 TI - Outsourcing. Outside chance. PMID- 10137046 TI - Managing the market. Anarchy rules. PMID- 10137047 TI - Support workers. Cast in a supporting role. PMID- 10137048 TI - Patient's charter. Charter challenge. PMID- 10137049 TI - US healthcare. Once upon a time in America. PMID- 10137050 TI - Using mass media communication for health promotion: results from a cancer center effort. AB - Administrators at a cancer center initiated a program they hoped would reduce exposure to the sun, and therefore the incidence of skin cancer. They also hoped for association of the value of the program with their institution. Research measuring the impact of the program showed that it reached more than one million individuals in three cities, and that awareness of the program was associated with behaviors expected to reduce the risk of skin cancer. In its home city, the program was associated with the sponsoring hospital by 22 percent of those who said they were familiar with it; association in other cities was significantly lower. PMID- 10137051 TI - Knowledge and self-reported use of universal precautions in a university teaching hospital. AB - This article reports a study of knowledge and self-reported use of universal precautions by professionals (individuals on the medical staff, in nursing service, in the laboratory, and in the social service, pastoral care, and respiratory care departments) and nonprofessionals (individuals working in the dietary and environmental services departments) in a university teaching hospital. Nonprofessional workers were found to be less knowledgeable about universal precautions than were professional workers. Appropriate use of universal precautions significantly correlated with a worker's perceived risk of exposure (positively correlated), the belief that HIV is easy to "catch" (negatively correlated), and the extent of the worker's involvement with HIV infected patients (positively correlated). Use of universal precautions was not found to be significantly correlated with belief in universal precautions as a reasonable way to protect oneself from contracting HIV in the workplace. Recommendations are made for increasing appropriate use of universal precautions. PMID- 10137052 TI - Classifying quality initiatives: a conceptual paradigm for literature review and policy analysis. AB - This article presents a conceptual paradigm by which health care executives and other interested parties can classify and organize the extant literature on quality improvement in health care. The paradigm also has utility as an operational tool by which health care managers may locate conceptually their own institutional efforts at quality improvement within the realm of possible action. PMID- 10137053 TI - Adding nursing facility beds: impact on hospital nonacute care. AB - The study evaluated the impact of admitting 235 nonacute patients who had been backed up in hospitals to new nursing facility beds in the metropolitan area of Syracuse, New York, during a 12-month period. The data indicated that these admissions reduced the hospital nonacute census by 53 percent and produced substantial declines in numbers of nonacute patients with postacute stays longer than one month and with Medicaid as principal payer. Numbers of patients waiting for Medicaid eligibility were not affected by admissions to the new beds. The data also indicated that substantial numbers of new admissions were required to generate these changes. PMID- 10137054 TI - Differences in perceptions of hospital marketing orientation between administrators and marketing officers. AB - Hospital administrators have been struggling for more than a decade to determine the role and proper position for marketing and marketers within their organizations. Results of a study now confirm the expected--administrators and their chief marketing officers do not see the same marketing actions being conducted for their hospitals. The consequence of such perceptual differences in marketing orientation for the role of marketers within the hospital are significant and are discussed in this article. Of particular importance is the finding that the marketing behaviors of the organization as identified by line managers correlate strongly with both revenues (r = .6r for inpatient revenue) and occupancy levels (r = .44). Additionally, it was found that as little as a 10 percent improvement in a hospital's marketing orientation is associated with a $25 million increase in total net patient revenues and an 8 percentage point increase in occupancy rate. PMID- 10137055 TI - Educational and geographic career pathways of rural vs. urban hospital administrators. AB - Information on academic and geographic career patterns was obtained through a survey of 93 urban and rural hospital administrators in the State of Washington in 1990 (90 percent response rate). A greater proportion of urban than rural administrators had advanced degrees (93 versus 74 percent). While the most common career pathways were "always urban" (39 percent) and "always rural" (20 percent), there was little support for the presumption that hospital administrators use rural positions as stepping stones into urban careers. PMID- 10137056 TI - Adopting information technology in hospitals: the relationship between attitudes/expectations and behavior. AB - The purpose of this field study was to measure the influence of three factors on the adoption of information technology in a health care setting--namely, attitudes toward using the technology, subjective norms or beliefs about others' expectations, and perceived voluntariness. Approximately 77 percent of the variance of intent to use the technology was explained by three attitude variables (beliefs related to perceived relative advantage and compatibility with previous work patterns as well as result demonstrability), and one variable associated with subjective norms (influence of a senior policymaker, the director of nursing). Use of this model may provide insights for administrators managing the process of information technology implementation in health care. PMID- 10137057 TI - Activity-based costing for hospitals. PMID- 10137058 TI - Reinventing health care delivery. PMID- 10137059 TI - How to develop critical paths and prepare for other formulary management changes. AB - Changes occurring in the health care marketplace are changing the way clinicians are managing patients. Cost, quality, and efficiency of care are increasingly being focused upon. One patient care management strategy that keeps these three factors in mind and is growing in popularity is the use of critical paths. This article describes the 7-step critical path development process followed by clinicians at Hartford Hospital. Additionally, the effect of health care marketplace changes on the formulary decision-making process, P & T Committee structure and function, and new drug development is also presented. PMID- 10137060 TI - Managing high cost and biotech drugs: two institutions' perspectives. AB - A proactive and multidisciplinary approach is used at The University of Texas MD Anderson Cancer Center to forecast the effect of new biotechnology and other high cost agents prior to their commercial availability. Protocols, practice guidelines, and drug-use policies are developed to promote cost-effective use of these agents. To promote optimal utilization, two pharmacoeconomic strategies are used: cost reduction and drug performance. An economic impact analysis is performed on pending drug protocols, which includes hospital cost, patient billing, and estimates of insurance reimbursement denial risk. The management of biotechnology drug usage at the University of Pittsburgh Medical Center is through the drug advisory program (DAP). DAP is an organized, multidisciplinary program comprising numerous drug usage review functions including drug information, therapeutic evaluation and modification, drug morbidity and surveillance, and an investigational drug service. The objective of DAP is therapeutic efficiency, which has as its key elements efficacy, low toxicity, and low cost. The actual work of DAP takes place via multiple subcommittees and task forces whose recommendations are forwarded to the P & T Committee. These multidisciplinary groups ensure the involvement of the appropriate specialists in therapeutic decisions and, therefore, successful implementation of the recommendations. PMID- 10137061 TI - How to tie a drug therapy improvement program to physician credentialing. AB - The pharmacy staff and the management information system specialist at St. James Hospital and Health Centers, a 472-bed community medical center located in Chicago Heights, Illinois, developed a computer program for documenting the drug use patterns of physicians. This program was not only helpful in improving the appropriate use of medications within the institution, it was also tied to the prescriber credentialing process. How the program evolved as well as the cost savings/cost avoidance achieved as a result of the drug therapy improvement process is presented. PMID- 10137062 TI - Educational effort and CQI program improves ordering of serum digoxin levels. AB - In a 289-bed, acute-care, non-tertiary-care regional referral center, a continuous quality improvement educational effort successfully improved ordering of serum digoxin levels. Following a determination that physicians were not requesting serum digoxin levels correctly, the P & T Committee issued a letter describing appropriate wording of orders for serum digoxin levels. The number of incorrectly ordered serum digoxin levels requested dropped significantly over a 49-month period as a result of the intervention described below, which also resulted in cost savings. PMID- 10137063 TI - Strategic management of therapeutic advances: experience with colony-stimulating factors. AB - Recent therapeutic advances offer significant opportunities for improved patient outcomes while challenging our ability to deliver these outcomes in a cost effective manner. This report describes the strategies for managing such advanced therapies--specifically, the recently introduced colony stimulating factors (CSFs)--that have been adopted at Cedars-Sinai Medical Center. Based on the principles of Continuous Quality Improvement (CQI), our approach begins with a multidisciplinary task force that develops and continuously refines guidelines for use of these agents. To provide immediate feedback when physician orders do not conform to the guidelines, the pharmacist notifies a physician expert, who promptly contacts the prescriber for a discussion of the case and how the guidelines do or do not apply. Since the introduction of CSFs, cost per admission has declined from $983 to $729 (26%) for oncology patients and from $737 to $281 (62%) for HIV patients. Although it is impossible to rigorously establish how much of this decrease has resulted from our proactive management strategy, costs have consistently decreased following each task force intervention. PMID- 10137065 TI - Eligibility of non-infusion medications for home care; verification of prescriptions. PMID- 10137064 TI - Investigational drug tracking: Phases I-III and NDA submissions--Part I. AB - The author catalogs over 800 investigational drugs/biologicals currently in Phase I, II or III clinical trials or drugs/biologicals submitted to the FDA as new drug applications. The list assists in predicting when new drugs will be marketed. The entries include generic/chemical name, investigational drug number, synonyms, trade names, manufacturers, clinical trial status, predicted approval year, indications or drug class, whether the drug has been developed through biotechnology, and references. Entries were gleaned from medical journals, stock market analysis publications, and the Pharmaceutical Manufacturers Association's Medicines in Development Series. The list is alphabetized by the generic/chemical name or investigational drug number and cross-indexed by the trade name and synonyms. The list reflects those drugs which were not FDA approved as of April 15, 1994. Part I includes the trade name and synonym cross-indexes and the beginning of the main alphabetical listing by generic/chemical name or investigational drug number. PMID- 10137066 TI - Subacute care facilities: enormous cost savings raise health reform issues. AB - In summary, there is every reason to believe that subacute care providers will ultimately achieve their goal of reducing the cost of those subacute care services that are currently being furnished in the high-cost acute care setting. The degree to which this goal will be achieved, however, will depend upon the level of acceptance of subacute care within the public and private sectors of our health care system. Such acceptance will be greatly facilitated by thoughtful consideration of the economic impact of subacute care services on the health care system as a whole, and its ability to adapt to whatever changes are instituted as a result of the ongoing debate over health care reform. Further, anticipating and responding to concerns relating to the cost and quality of subacute care services will not only lend credibility to the subacute care movement, but will insure its place in the our soon-to-be-reformed health care system. PMID- 10137067 TI - Is Orphan Drug Act compromise near? PMID- 10137068 TI - The leadership challenge of integrated delivery systems. PMID- 10137069 TI - Effective partnerships with long-term care providers. PMID- 10137070 TI - Ensuring your continued career success. PMID- 10137071 TI - Ethics and the governing board. PMID- 10137072 TI - Public policy statement development. PMID- 10137073 TI - American College of Healthcare Executives. Public policy statement. Access to healthcare. PMID- 10137074 TI - Putting the lead back in leadership. PMID- 10137075 TI - An interview with the College's 1994-95 Chairman. Interview by Walter Wachel. PMID- 10137076 TI - Introduction to health care reform in New Zealand. PMID- 10137077 TI - New Zealand health care: a background. AB - New Zealand, its people and health care services are described, followed by a discussion of (i) the role of government and non-government agencies in the funding, provision and purchasing of health care and (ii) persistent problems in the health care system. The authors argue that recent New Zealand health care reforms represent a significant deviation from past policies. However, to have any prospect of being judged as successful, the reforms must address difficulties in the funding, purchasing and provision of health care that are not new but have been features of New Zealand health care over many years. PMID- 10137078 TI - The impact of the new subsidy regime in general practice in New Zealand. AB - The first substantial change in the New Zealand health care reforms was the introduction in February 1992 of a new subsidy and charging regime in general practice. The paper reports on a comparison of data collected before and after the changes, drawing on GP-patient encounter information. Overall, seasonally adjusted levels of utilisation were maintained in the stage before the introduction of the new regime, declined 15% immediately following the changeover and stabilised thereafter. All patient groups were affected by the decline. Although the elderly were temporarily exempt from the changes, their consultations fell by 10%. Utilisation among beneficiaries--minor gainers from the changes--dropped by 30%. Children were more affected overall, adults less so. There was also some suggestion of greater falls for the lowest socio-economic groups. Activities under the direct control of the practitioner--prescribing and the ordering of tests--showed either little turbulence or no clear pattern of change. It is concluded that, although primary care subsidies and charges had been reshaped to favour poorer people, six months after the introduction of these changes there had been no corresponding redistribution of medical care consumed. Indeed, there is a suggestion that some of the groups ostensibly the target of increased assistance may have been adversely affected by the overall decline in utilisation. PMID- 10137079 TI - Public health and the reforms: the New Zealand experience. AB - The main aim of a national public health service is to conserve and improve the population's health. The health service reforms introduced in 1992 proposed the establishment of a Public Health Commission, which was to be responsible for health monitoring, public health policy advice and the purchase of public health services. These reforms, implemented in 1993, while emphasising a purchaser provider separation also earmarked a budget for public health activities to be administered by the Commission. Such protection of funding is unusual. Public health activities span a wide range of measures to protect and promote health as well as to prevent disease. Many of these measures have been, and will continue to be, carried out at a local level. The results of some of these measures are not usually seen in the short term. Improvement of the population's health also requires proactive measures which are outside the traditional health service. The demonstration of quantifiable benefits to the public's health from such measures may require an even longer term. It is mainly in this area of activity, however, that the achievements of the Commission will be judged. Beginning with a short summary of the history of public health services in New Zealand, this paper looks briefly at the events that led to the establishment of the Public Health Commission, before moving on to describe its achievements to date, the challenges it faces and its impact on public health service provision. Based on such observations and an analysis of the strengths and weaknesses of the Commission, the paper attempts an appraisal of the public health function in the reformed health service, a function that will almost certainly be observed with interest in other countries. Certain ways of improving the public health function are outlined in the conclusions. PMID- 10137080 TI - Maori health and the health care reforms. AB - Maori participation in the 1991 health care reforms is considered against the background of their involvement in health reforms since the turn of the century. Throughout this period Maori have consistently sought autonomous health care. Traditional indigenous healers have provided healing for Maori as they have for other indigenous people, such as Aborigines, Pacific Islands people and Canadian Indians. Maori, including western health care professionals, submitted that healers should be included among the health care services personnel providing core health services. They argued this on the basis of their health status and of their rights with respect to the Treaty of Waitangi. The influence of the 1977 WHO resolution, concerning the role of traditional healers in attaining 'Health for All by the Year 2000', is considered in relationship to Maori health initiatives and how the 1991 health care reforms may impact upon them, and the bicultural policy that has guided Maori health developments over the last decade. Evaluating Maori health and the health care reforms in terms of Maori participation, the status of traditional indigenous healers and the future of Maori health initiatives leaves Maori in no doubt that they have some hard work ahead to maintain the position they held prior to the reforms. PMID- 10137081 TI - The management of health care: a model of control. AB - This paper is aimed primarily at those involved in managing and implementing management structures in health services. It is concerned with the replacement of historical management structures with 'proven' private sector structures. It is argued that a major problem with the private sector models introduced in New Zealand is that they fail to recognise the levels of uncertainty inherent in the diagnosis and treatment of illness. The Gibbs Report criticisms of existing management practices are discussed, criticisms that were based strongly on the Griffiths Report. A model of organisational control is outlined, based on Ouchi's concepts of market, bureaucracy and clan. This model is used to evaluate two major structural changes: the introduction of general management and the involvement of clinicians in clinical directorates. It is argued that success or failure of health service management reform depends on a greater recognition of the underlying uncertainties involved in medical practice. PMID- 10137082 TI - A reflection on the New Zealand health care reforms. AB - What route should be taken in reforming health services? Is there a single best route? These issues are addressed in this final paper in this series on the New Zealand health care reforms. It is suggested that there are probably more ways of getting things right and that these ways are potentially relevant in many countries. The paper also looks at the specific messages that emerge from the New Zealand reforms not only for New Zealand but also for policy-makers in other countries either in the process of reform or contemplating reform. PMID- 10137083 TI - Reform of the New Zealand health care system. AB - This paper provides an overview and analysis of New Zealand's health care reforms. It describes the basic features of the health care system and identifies some important problems and pressures for reform. The 1991 health care reforms are outlined and considered in terms of their impact on the efficiency and equity of the health care system. Several policy issues are identified that must be addressed if the benefits of the reforms are to be realised. PMID- 10137084 TI - Core services and priority-setting: the New Zealand experience. AB - Like people in other countries, New Zealanders have been struggling with the issue of how to decide which health services should be delivered and to whom. The government has established a Core Services Committee to advise on core services, that is, those health care and disability support services to be made available on affordable terms and without unreasonable waiting time. Such a core has a similar role to a standard package of benefits within a managed competition framework. Services not in the core would be left to individuals' own responsibility. Specific objectives for a core are to promote accountability of purchasers, to make explicit the services that are core and those that are not, to promote an efficient and equitable allocation of resources, to limit government expenditure on health care and to involve the public in decision making. A number of different options for defining a core are identified, and the work undertaken so far is discussed. The original concept of a core has not been implemented in New Zealand. The Core Services Committee has established broad priorities and facilitated a series of consensus development conferences to provide advice on the effectiveness of services. Some of the committee's recommendations have been incorporated into policy guidelines, which set out what the government expects of purchasers. These guidelines include priority areas for health gains, service obligations and principles for purchasing. Service obligations are not sufficiently detailed to meet the specific objectives of a core and do not meet equity objectives, as they allow in effect each of the four purchasers to develop their own core of services. The key issue for the government now is to decide whether to allow RHAs flexibility in determining their own priorities or whether a national approach to efficiency and equity is to be preferred. PMID- 10137085 TI - Shopping for health: purchasing health services through contracts. AB - The 1993 New Zealand health service reforms were based on the purported efficiencies of the purchaser/provider split. Purchasers are required to contract for services that will maintain, improve and restore the health of the populations they serve. The purchasing role, which requires the development of contracting skills as well as the setting of strategic directions and priorities, is new and as yet poorly developed. This paper describes the role of purchasing agents in setting priorities, the different approaches that are being taken to contracting for services and some of the problems that have arisen in the first year of contracting. It explores the trade-off that is evident between the potential for improving efficiency through contestable contracting and the need to minimise transaction costs associated with the contracting process. The purchasers' accountability to the public and the Minister is analysed in the broader political context of the purchasers' role in shaping a public health service and improving the health of the population. PMID- 10137086 TI - New Zealand's health providers in an emerging market. AB - Services have almost completely replaced hospitals as the organisational units in the reformed New Zealand health care system. Within the secondary service provider sector service management, the decentralisation of general management to budget-holding clinical groupings has been an important factor in achieving a population focus, cost containment, accountability and integration. It is being further developed within the 23 newly formed Crown health enterprises (CHEs), the main providers of secondary, hospital and related services. The CHEs are evolving roles beyond a narrow definition of 'providers', taking initiatives to collaborate with other providers, or rejecting those elements of competition that might interfere with effective local co-ordination of services. Service management is also being extended to the demand-driven, fee-for-service primary care sector, where inflation-adjusted expenditure over the last decade has grown at more than 6%, compared with zero growth in the capitation-financed secondary sector. This is being achieved in both general practice and community budget holder groupings through what might be called managed primary health care. The current health reform process has also created four regional health authorities (RHAs), responsible, within capped and capitated budgets, for the fully integrated purchasing of services from both primary and secondary providers. The success of these innovative arrangements, which could be of international significance, will depend upon the quality of the developing relationships between providers and their purchasing RHAs. PMID- 10137087 TI - Ambulatory care pavilion takes its place out front by solving multiple needs. AB - In sum, this structure exemplifies the fact that high-tech tertiary care medical centers can be user-friendly to the ambulatory health care consumer by serving their routine needs conveniently and efficiently. Says Gerald Miller, president of Crozer-Chester: "The ambulatory care pavilion has enabled Crozer to successfully and efficiently merge physicians' offices with institutional-based services and inpatient services. We are pleased with how the pavilion positions our medical center for the next century. PMID- 10137088 TI - Wages of war. A strong offense is the best defense when you're up against contract services. PMID- 10137089 TI - See me, hear me, heal me. How telecommunications will transform tomorrow's health facilities--regardless of reform. PMID- 10137090 TI - Out of sight, out of mind? Five-step plan manages the hidden risks of underground storage tanks. PMID- 10137091 TI - Too much, too often? Some institutions go overboard maintaining high-tech equipment. PMID- 10137092 TI - Sweet & sour news about salt. It offers short-term ice control--but with long term consequences. PMID- 10137093 TI - AHA's reaction to OSHA's air rule focuses on 3 critical areas. PMID- 10137094 TI - Need to reduce costs, redesign work will spur data base usage. First of two parts. PMID- 10137095 TI - Need to close a staff skills gap? Here's how one hospital did it. AB - Nearly one-third of unskilled workers, 29 percent of semiskilled workers , and 11 percent of managerial, professional and technical employees are functionally illiterate in the United States, according to a recent study titled Closing the Literacy Gap in American Business. Employers, including those in the ever-complex health care sector, are just now coming to grips with the problem, which robs the U.S. economy of an estimated $140 billion to $300 billion annually in lost work force productivity. Here's the story of how one health facility dealt with the problem. PMID- 10137096 TI - Occupational injuries: how do health workers rate? PMID- 10137097 TI - New remuneration arrangements for nurses and midwives. AB - Describes the results of a project carried out at Derby City General Hospital to introduce new pay and grading arrangements for nurses and midwives, consistent with their locally developed reward strategy. Identifies the factors critical to the success of the project, and also considers the project in the context of research carried out by the Hay Group in to the characteristics of high performing health-care organizations. PMID- 10137098 TI - GPs: principles and practice. AB - Defines the role of GPs and explores their possible involvement in practice management and planning, which authorities are trying to encourage. Suggests that there would be a conflict of interest between management and doctors' relationships with patients, and that they could risk becoming public scapegoats as they are in the most exposed position. Raises points to consider, such as should GPs contemplate becoming involved in practice planning. PMID- 10137099 TI - Healthy working and performance management. A discussion of the approach and a report on a survey of NHS organizations. AB - Achieving high performance in an organization is a complex business. Most approaches are too piecemeal, unidimensional or iatrogenic. Healthy working is an approach to managing performance that attempts to overcome these problems by aiming, in a holistic manner, to harmonize those factors which affect, either separately or jointly, individual physical, mental and emotional health and individual and organizational performance. The approach is based on a set of values and a series of steps. The first step has to be establishing an information base-line--the four key indicators. A survey was undertaken by PBS to establish the availability and usefulness of data in NHS organizations; summarizes some of the issues raised. Although a worryingly small number keep useful data or produce useful information, much can be done in making critical links if available data is fully used. PMID- 10137100 TI - Signposts, icons and change: inside the clockwork of an NHS trust with investors in people and BS 5750. AB - Discusses the need for cultural change in the NHS and the need to nurture a performing organization that uses outcome measures to improve service delivery. Considers Investors in People and BS 5750 as two iconographic signposts that could help to achieve successful change by introducing targets and incentives that involve staff and patients. PMID- 10137101 TI - Clinical psychology postgraduate training. Meeting the shortfall. AB - NHS targets for training clinical psychologists have not been met. Unless training resources are increased there will continue to be a shortfall in service provision. In order to ascertain those areas where training resources are most needed, a postal questionnaire survey of all British clinical psychology training courses was conducted. There was a 73 per cent response rate. Results showed that major areas of need are: (1) increased recruitment of course staff whose major responsibility is training, rather than an over reliance on clinical psychologists who have major NHS responsibilities; (2) greater representation of specialist areas; some priority services such as work with older adults or people with learning disabilities are under-represented; and (3) more equitable pay--not all university courses offer salaries on clinical scales. PMID- 10137102 TI - Outsourcing therapy services. A strategy for professional autonomy. AB - Explores the problems and opportunities for professions allied to medicine (PAMS) in the new NHS internal market. Uses a mechanism from IT, namely outsourcing, to provide a new organizational model for the effective delivery of care by this group of professionals who are marginalized by the new role of the doctor as manager. PMID- 10137103 TI - Seamless service: research and action. AB - Describes the process used by the Mater Infirmorum Hospital in Belfast in 1992 1994 to achieve high quality care (Seamless Service), and motivate staff to deliver and measure performance. Aims of the project include focusing the organization on the customer, improving teamwork and motivation at all levels. After comprehensive data collection from GPs, patients and staff forums developed a full TQM strategy to gain support and maintain momentum including innovative staff events (every staff member was given the opportunity to attend) where multilevel, multidisciplinary workshops enabled staff to design customer care standards, develop teams and lead customer-driven change. PMID- 10137104 TI - Investors in people: journey to continuous development. AB - Examines the experience of one NHS Unit in Wales as it carried through a strategic decision to meet the National Standard for Effective Investment in People (IiP). Argues that the IiP blueprint for improving personal and organizational performance has never been more important to an NHS undergoing radical change. Seeks to encourage more NHS organizations to be measured against the standard in the areas of commitment, regular review of training and development, continuous development of employee skills, knowledge and attitudes, and evaluating the effectiveness of the training investment in achieving business goals. PMID- 10137105 TI - Baxter blazes trail with three capitated supply contracts. PMID- 10137106 TI - Personal protective gear prices dip. PMID- 10137107 TI - Data drives migration toward capitated supply deals. PMID- 10137108 TI - Anesthesia department non-salary expenses. PMID- 10137109 TI - The roles of biomedical maintenance branch, automation management & informatics departments throughout a clinical information systems's life cycle. AB - The introduction of new technology, such as a Clinical Information System (CIS), requires hospitals to re-evaluate the roles of the Biomedical Maintenance Branch, Automation Management, and Informatics departments. This paper describes the process a 400-bed hospital underwent to resolve role ambiguity among the three activities. The institution's goal was to reach an optimal solution to using the resources offered by each activity through redrawing lines of responsibilities. This experience demonstrated that relationships among departments are dynamic and vary depending on the stage of the CIS life cycle. PMID- 10137110 TI - AIDS: a new frontier in epidemiology. AB - HIV infection has become a pandemic. As such, it is the most recent inclusion to epidemiology studies. A review of past epidemics allows a different perspective on the current status of scientific knowledge regarding AIDS. HIV is a retrovirus, one of three groups identified. The other two groups are commonly referred to as HTLV I and II and do not cause AIDS. Two forms of HIV (HIV-1 and HIV-2) make up the third group, HTLV-III. As with any research, various theories are formed, tested, and often rejected. Some theories receive excessive publicity before testing, resulting in incorrect public beliefs that become myths. The cumulative number of cases of AIDS in the United States is 361,509, as of December 31, 1993. Healthcare workers experience multiple opportunities for exposure to the infection in the course of their duties. Based on data from the 1993 BMET/CE survey, several biohazard issues, as well as preventive measures, are discussed. PMID- 10137111 TI - Ultrasound technology: the RADIUS (Routine Antenatal Diagnostic Imaging with Ultrasound) study & national policy. AB - The RADIUS study opened up controversial discussions of the applications of ultrasound technology in patient management, screening, and outcomes analysis. Advances in technology may ultimately resolve national policy issues. PMID- 10137112 TI - Focus on: Westchester County Medical Center Division of Biomedical Engineering. AB - The Division of Biomedical Engineering (DBME), a vital element in the structure of any medical center, provides complete biomedical equipment services at Westchester County Medical Center (WCMC), through a Biomedical Instrumentation Program. Under this program, the DBME assumes direct responsibility for all diagnostic imaging equipment in radiology, radiation medicine and nuclear medicine; and patient care, surgical life support (respiratory care) equipment in critical care units, operating rooms, G.I. (gastro-intestinal) suites, renal center, burn center, emergency rooms, as well as clinical laboratories. In addition, the DBME provides academic and internship programs, research, design, database support, technology planning, and device inspection or evaluation. The DBME is "looking into the future" for a gradual migration of state-of-the-art technology into healthcare. PMID- 10137113 TI - The five stages of managed care. Organizing for capitation and health reform. PMID- 10137114 TI - How many networks will there be when the dust settles?... Three to five, at most. PMID- 10137115 TI - Strategic executive briefing: the five stages of managed care. PMID- 10137116 TI - Private money and public health. Managing the risks. AB - Private capital can now be invested in the NHS. This new market freedom needs to be balanced against a backdrop of public accountability. Brian Salter and Glenn Douglas explain. PMID- 10137117 TI - Counselling in primary care. AB - A counselling scheme has been set up in general practices in Salisbury Health District by Wiltshire FHSA. Rose Wiles and colleagues give details of the findings of an audit of the scheme and Wiltshire FHSA's responses. PMID- 10137118 TI - Capital planning: investing in excellence. AB - Graham Slater and Kate Del Bravo describe the priorities considered and work undertaken by SETRHA to develop its capital investment strategy. Although the underlying concepts are straightforward, it represents a significant development beyond traditional NHS approaches to planning, embraces the NHS market reforms, and has reduced capital aspirations for the same service objectives by some 300m pounds. PMID- 10137119 TI - Sweeping changes for Welsh Health Authorities. AB - Despite the fact that Welsh Secretary John Redwood has stated he would like to see Welsh health authorities (HAs) administration cut by around 50% he has provided no indication as to whether or not his local government reforms will alter the HA's geographical or structural basis. This may mean that not only is there the possibility of moves towards 'commissioning authorities' and increases in the number of HAs and FHSAs merging, in addition Wales will have to contend with the unknown effect of local authority boundary changes. This is a concept which England and Scotland will also have to deal with. Russell Deacon and Tracey Deacon explore. PMID- 10137121 TI - Is public opinion really 'public'? PMID- 10137120 TI - Managing for change. AB - Since 1988, the Health Services Management Development Trust has given some 34,000 pounds in awards to people embarking on management projects in the health services. The Trust is funded by a partnership of the Institute of Health Services Management and a group of major suppliers to the health services: Boots, Four Square Division of Mars GB, Gardner Merchant, Hewlett Packard and IBM. They also offer mentoring and assist in publicising the project results. PMID- 10137122 TI - Management ... working day of a health services manager--East Cheshire NHS Trust. PMID- 10137123 TI - Consumer involvement in nonprescription medicine purchase decisions. AB - As self-medication with nonprescription drugs becomes increasingly popular and important in this era of escalating health care costs and growing consumer sophistication, the degree of consumer involvement in the purchase decision becomes an important factor. High involvement suggests active information-seeking behavior and, therefore, a greater likelihood of appropriate nonprescription drug use. The authors assess consumer involvement in nonprescription medicine purchase decisions and the use of expert sources of information. PMID- 10137124 TI - Referent opinion and health care satisfaction. AB - The author examines the influence that referent opinion--one's own opinion and the recommendations of relevant others--has on patient perceptions of the quality of care they receive at hospitals. A study of discharged hospital patients reveals that the demographic profile of a patient also has a mediating influence on this effect. Hospital administrators are urged to pay close attention to the relationship between types of referents patients use and how they form their evaluations. PMID- 10137125 TI - The great gap. Physicians' perceptions of patient service quality expectations fall short of reality. AB - The various players in a health care encounter all hold different perspectives on what constitutes service quality. Findings from this preliminary investigation show that doctors in a multispecialty clinic rated patient expectations of reliability, responsiveness, assurance, and empathy lower than did administrators, patient-contact personnel, and, most significantly, the patients themselves. Health care marketers need to educate doctors on the importance patients place on certain issues and how to address them. PMID- 10137126 TI - Health care case study. Wanted: 'a little marketing'. PMID- 10137127 TI - Re-engineering revenues. PMID- 10137128 TI - Tax-exempt status of hospitals and physician "control". PMID- 10137129 TI - New medicine for medical malpractice: the empirical truth about legislative initiatives for medical malpractice reform--Part I. PMID- 10137130 TI - New ways of financing and organizing health care in Sweden. AB - The health care system in Sweden has been undergoing radical change since 1991. The mainly public financed (90%) system with 26 autonomous counties spent 8.5% of its gross domestic product on health care in 1991. The main features of the 'paradigm shift' are: separation of production and financing; resource allocation to health districts in relation to the needs of the population; and introduction of public competition between health districts (purchasers) and hospitals (providers). The health district boards are responsible for the health care of the population in their district hospitals financed by their activities (e.g. through diagnosis-related groups (DRGs)) and quality aspects monitored by central authorities. A parliamentary committee (HSU 2000) is investigating how Sweden's health care system can be organized and financed in the future. Three models are analyzed: a reformed county council court model, a primary care-managed model, and a compulsory insurance model. Each model must be consistent with equity and public financing. From 1992 in the Stockholm county, five surgical specialties were paid for their activities according to DRGs for inpatient care and another system for outpatient care. The number of treated patients during 1992 increased by 8% in inpatient care, 50% in day surgery and by 15% in outpatient care. Taken together, the activities increased by 11%, which is slightly more than the expected 10% increase in productivity. (There was a 10% decrease in DRG prices from 1 January 1992.) The total costs decreased by 1% due to fewer personnel. Nothing has been reported concerning the quality of care, neither before nor after the model was introduced. From 1993, all somatic acute specialties are paid by DRGs and the equivalent outpatient classification systems. The results from 1993 will be presented in the autumn of 1994. PMID- 10137131 TI - Management challenges and markets. AB - The scarcity of resources in healthcare systems has general causes and country specific causes. Common to most healthcare systems is a strong emphasis on management and an increased attention to the role of the market. Management and market are concepts which need clarification: management applies not only to individual institutions but to systems of institutions. Market implies not only the pursuit of individual interests but also the assumption of responsibility. The design or redesign of healthcare systems must take into account the level of management skills which each system and its institutions can rely on. Cost patterns in a healthcare system develop around its institutional design. Different factors produce varying levels of costs in different healthcare systems. The same applies to the effort needed to reach a certain degree of effectiveness in output. An outline of strengths and weaknesses of options for the design of healthcare systems is presented in the final part of the article. These should always be considered together with the specific features of each country. PMID- 10137132 TI - The development of market approaches in Russia. AB - In the late 1980s, it became clear that poor outcomes of the Russian health system were caused not only by underfunding but also by inadequate management of health care. Some features of the system led to great inefficiency in medical care provision and an irrational structure of medical care. The recognition of this fact has intensified the search for new methods of finance and management. The underlying idea of health care reforms in Russia is to weaken providers' dominance, to make them more responsive to consumer preferences, and to change the structure of medical care. The main developments of the reform parallel the reforms in Western countries. These are primarily the separation of finance and provision of medical care, with the shift from an integrated to a contractual model of relationships between payers and providers. But the specific characteristics of the health care situation, primarily the great underfunding and the absolute dominance of state-owned medical facilities, make the reform in the Russian health sector more radical. This paper highlights the issues of the current and planned developments in the Russian health sector. After presenting the main characteristics of the current health systems, it addresses economic experiments which are underway in several regions of the new Russian Federation. They are designed to introduce elements of market relations into a highly bureaucratic system. The main features and the impact of the experiments are discussed. Then the new model of finance, which is based on a transition from tax financed to the health insurance system, is presented. PMID- 10137133 TI - What kind of healthcare 'internal market'? A cross-Europe view of the options. AB - Many governments are trying to invent new types of 'internal' healthcare market that will expose health services to competitive pressures to innovate, contain costs, raise service quality, and respond better to consumer demands; but not expose them to 'market failures' which prejudice universal access to 'basic' health services. Policy debates in this area are muddled and constricted by a failure to differentiate the variants of internal market that are available. This article outlines a taxonomy of the main types of internal market: primary doctor purchasing; managed competition; competitive bidding; social insurance; and compulsory private insurance. It notes their main structural characteristics and differences. Although internal market reforms have been intended to support the commercialization of healthcare, the idea of designing new types of economic structure to avoid market failure in healthcare has wider and more radical implications than most policy-makers intend. PMID- 10137134 TI - Planning and decision-making to develop performance contracts in Swiss public and private hospitals. AB - The Planning Department of the health authority for the Canton of Basel-Stadt has decided to develop a process of planning and decision-making to install performance contracts between them and the acute hospitals situated in the canton. In part I, a short description of the Swiss health system is given, followed by an analysis of the situation in the Canton of Basel-Stadt. The second and main part describes the process of planning and decision-making to achieve performance contracts for public and private hospitals. PMID- 10137135 TI - Japanese hospitals--culture and competition: a study of ten hospitals. AB - Japanese health care is characterized by a pluralistic system with a high degree of private producers. Central government regulates the prices and the financing system. All citizens are covered by a mandatory employment-based health insurance operating on a non-profit basis. The consumer has a free choice of physician and hospital. A comparison between Japan, Sweden and some other countries shows significant dissimilarities in the length of stay, number of treatments per hospital bed and year and the staffing of hospitals. About 80 per cent of the hospitals and 94 per cent of the clinics are privately owned. The typical private hospital owned by a physician has less than 100 beds. In this paper, data collected (1992/93) in an empirical study of Japanese hospitals and their leadership is presented. Also discussed are the hospitals' style of management, tools and strategies for competition and competences--personal and formal skills required of the leadership in the hospital. There follows a study of ten hospitals, among which hospital directors and chief physicians were interviewed. Interviews are also made with key persons in the Ministry of Health and Welfare and other organizations in the health care field. The result is also analysed from a cultural perspective--'what kind of impact does the Japanese culture have on the health care organization?' and/or 'what kind of sub-culture is developed in the Japanese hospitals'. Some comparisons are made with Sweden, USA, Canada and Germany. The different roles of the professions in the hospital are included in the study as well as the incentives for different kinds of strategies- specialization, growing in size, investments in new equipment, different kind of ownership and hospitals. Another issue discussed is the attempt to uncover whether there is an implicit distribution of specialties--silent agreements between hospitals, etc. PMID- 10137136 TI - The impact of maternal health improvement on perinatal survival: cost-effective alternatives. AB - Each year, an estimated half million women die from complications related to child birth either during pregnancy, delivery or within 42 days afterwards. When pregnant women have complications, their infants are at greater risk of becoming ill, permanently disabled or dying. For every maternal death, there are at least 20 infant deaths: stillbirths, neonatal or postneonatal deaths. Altogether, an estimated 7 million infants each year die perinatally (stillborn or deaths within the first week of life). Low cost, feasible, and effective intervention strategies include: a) improved family planning and abortion services; b) obstetric care at delivery; and, c) prenatal services. Two hypothetical populations of one million (a low mortality and a high mortality country) are used to illustrate maternal and perinatal program strategies and priorities. In countries with high fertility, major reductions in maternal and infant deaths result both from reductions in the number of pregnancies through family planning and from improved obstetric care. Where fertility is already low, reductions result almost entirely from improved obstetric and prenatal care. The investments required are relatively low, while the potential gains are great. The cost to avert each death in a high mortality population is estimated between $800 and $1,500 or as low as $0.50 per capita per year. The priorities for programs targeting maternal and perinatal health depend on demographic, ecologic and economic factors, and should include the promotion of good health, not merely the avoidance of death. More operational research is required on various aspects of maternal and perinatal health; in particular, on the cost-effectiveness of different service components. PMID- 10137137 TI - Health care cost-recovery simulations from parametric estimates: methodology and results for Ogun State, Nigeria. AB - Cost recovery in the health care sector in developing countries can be a powerful tool for achieving efficiency and equity goals, and for mobilizing financial resources for the improvement of quality. However, there is only fragmentary empirical evidence on the revenue, quality and cost effects of cost-recovery policies in the health care sector. Using parameter estimates from cost and demand functions that were derived from data from a facility and household interview survey in Ogun State. Nigeria, this article simulates various cost recovery scenarios for the public sector. The empirical results of the simulations show that, under certain realistic scenarios, cost recovery will generate additional revenue and improve quality. Equity would be enhanced by spending some of the additional net cost-recovery revenue on health care for the poor. PMID- 10137138 TI - Using hospital activity indicators to evaluate performance in Andhra Pradesh, India. AB - The performance of secondary level public hospitals in Andhra Pradesh. India was evaluated with the help of input-output ratios of hospital activity and service mix. Indicators for emergency, clinical, diagnostic and medico-legal services have been defined. Wide variability of global hospital activities was observed. Variability of turnover rate and bed occupancy was much more than length of stay. Combined utilization and productivity analysis showed that all outlying hospitals were either in the low turnover, low occupancy group or in the high turnover, high occupancy group. Low productivity or inadequate hospital capacity seem to be the major problems. All low turnover, low occupancy hospitals also had low levels of outpatient consultations, and high turnover, high occupancy hospitals had above-average outpatient activity. About 40 per cent of hospitals did not provide emergency services. About 10 per cent of hospitals were not performing any diagnostic tests. Strengthening emergency service delivery capacity, as well as diagnostic facilities, could improve productivity and capacity utilization. Extremes of turnover and occupancy were not associated with any particular case mix pattern. Thus, neither poor productivity and capacity utilization nor over crowding can be explained by case-mix differences. Problems of poor performance and inadequate capacity seem to be real. PMID- 10137139 TI - EMS along the Alaska pipeline. PMID- 10137140 TI - An entertaining brand of EMS. PMID- 10137141 TI - The wild side of EMS. PMID- 10137142 TI - Niche building in the new EMS. PMID- 10137143 TI - Want to work for one of the biggies? Here are the big four ambulance companies and where they operate. PMID- 10137144 TI - The successful EMS job campaign. PMID- 10137145 TI - The fine art of the resume. PMID- 10137146 TI - JEMS survey of college-based EMS providers. PMID- 10137147 TI - Surviving the ridealong. PMID- 10137148 TI - Expanded-scope paramedics. A nurse's perspective. PMID- 10137149 TI - Gays in EMS. Strengthening the EMS team. PMID- 10137150 TI - A new type of leadership in prehospital care. PMID- 10137151 TI - Decisions, decisions .... PMID- 10137152 TI - Let's get hyper! Interactive multimedia in EMS. AB - What's all this hoopla about interactive multimedia? You may have seen the headlines in the Wall Street Journal, Time, Newsweek or U.S. News and World Report. Their message: Brace yourself for the future--multimedia is going to change the world! And, while technology is ever-changing, here's an update on the EMS training products currently available, what they do and how they can be a part of your training program. PMID- 10137153 TI - Vested interest. Why you need body armor. PMID- 10137154 TI - Body armor. What it is and what it does. PMID- 10137155 TI - JEMS Buyers' Guide. PMID- 10137156 TI - Important functions debut in Mental Health Manual. PMID- 10137157 TI - Testing of cardiovascular, trauma indicators enhances hospital's CQI efforts. PMID- 10137159 TI - Medical staff plays key role in IOP standards. PMID- 10137158 TI - Beta testing taught valuable lessons--set clear path for IMSystem implementation. PMID- 10137160 TI - Residential treatment facility implements QI culture. PMID- 10137161 TI - Survival tactics for managing the hospital marketing effort. AB - Hospital marketing is an intricate and complex process. Especially difficult is the transition the hospital marketer must make from designing marketing strategies to implementing those strategies. This transition usually causes the marketer to call upon a different set of skills. These skills involve managing the personnel needed to implement the designed marketing strategy. Unfortunately, little in the way of formal training is provided the marketer for developing these management skills. Therefore, the authors have comprised a series of tactical procedures designed to assist the hospital marketer to survive this transition. Using these tactics for decision-making guidelines may help to improve the management of the hospital's marketing effort. PMID- 10137162 TI - Determining a hospital's trading area: an application of Reilly's law. AB - This paper reports the results of a study examining hospital trading areas. The research involved an application of the "Law of Retail Gravitation" (Reilly 1929) for three hospitals in an urban area of Ohio. First, the paper reviews Reilly's Law, then various refinements of the original concept are noted. The "Law" is tested by identifying the actual trading areas of the three hospitals and comparing each of these to the areas predicted by Reilly's Law. While this theory is very logical and offers considerable insight into economic location analysis, characteristics of the hospital marketplace confounded its ability to accurately and consistently predict hospital trading areas in the present study. PMID- 10137163 TI - The strategic marketing reaction of conventional nonprofit hospitals to the market entry of alternative care provider organizations. AB - A study was conducted examining the competitive reaction of incumbent firms to the market entry of new form competition in the health care services industry. Specifically, the study addressed the relative impact of both objective and perceptual characteristics of the threat potential posed by the entrance of alternative care facilities (ACF's) into markets previously dominated by nonprofit hospital organizations. The results showed that incumbent hospitals tend to rely most extensively on limited, low-risk market differentiation when responding to the threat posed by ACF entrants. Objective characteristics reflective of the structural complexity of the threat were found to be less important in influencing incumbent reaction than were administrators' perceptions of new entrant threat. PMID- 10137164 TI - An antidote for ailing TV ad testing measures and spiraling medical costs. PMID- 10137165 TI - Making hospital advertisements more readable and more effective. AB - Hospitals and other health care organizations make continuing use of newspaper and magazine advertising as part of their marketing programs. However, many institutions have questioned the effectiveness of advertising because they have not achieved the results they had hoped for. Part of the problem may lie in the fact that many hospital advertisements violate the principles of good copywriting. Well written advertisements will draw larger readership, and should subsequently prove more effective in helping the institution achieve its communications objectives. PMID- 10137166 TI - A buying center approach to understanding health care marketing. AB - Decision-making regarding health care treatment is often a complex process involving a number of constituents. For health care providers, defining these constituents and their influences is critical to successful marketing. This article describes the concept of a Decision Making Unit (DMU), and provides an illustration of how it applies to the marketing of a Physical Rehabilitation Facility. PMID- 10137167 TI - How have hospitals faced the pricing issues of the 1990's? AB - National health care expenditures are rising rapidly, bringing on a health care financing crisis. For this reason, it is useful to see how hospitals are facing the price issues of the 1990's. This study examines the price strategies hospitals follow and analyzes their observations on price sensitivity and payer mix. The results clearly show that hospitals have not given much attention to the pricing variable. The study suggests that marketing and finance will have to work closely together in developing future pricing strategies. PMID- 10137168 TI - Obstacles to real strategic marketing in health care: an experiential framework. AB - Accelerating technology, increasing competition, changing demographic trends, and fluctuating economic cycles are making it more difficult today to accurately assess a hospital's strategic opportunities and threats. To survive in a highly competitive marketplace, health care institutions must be able to identify and exploit major opportunities that complement their unique strengths, limitations, and clinical orientation. Without the ability to target key markets, satisfy VIP physicians and consumers, or integrate other business functions with its marketing programs, a health care institution could lose touch with its most important resource: its consumers. This article presents the what, why, and how of strategic marketing in health care by an analysis of the five most prevalent obstacles facing health care marketers and policy makers. Key concepts, suggestions, and strategies are offered to assist health care managers to overcome these obstacles and increase their institution's competitive edge. The JZMRS Model reflects the experiential base from which the article is derived. PMID- 10137169 TI - Is performance related to marketing research in the health care industry? AB - Marketing research has grown to become indispensable for superior performance in packaged goods industries. While health care institutions are spending large amounts on marketing research, few studies focus upon the relationship of marketing research to health care organizational performance. Utilizing a national sample of U.S. hospitals, this article points out that marketing research and superior performance are positively associated. PMID- 10137170 TI - The impact of an internal marketing program on accounts receivable. PMID- 10137171 TI - Marketing the mental health care hospital: identification of communication factors. AB - The current study provides guidance to hospital administrators in their effort to develop more effective marketing communication strategies. Two types of communication factors are revealed: primary and secondary. Marketers of psychiatric hospitals may use the primary factors as basic issues for their communication campaign, while secondary factors may be used for segmentation or positioning purposes. The primary factors are open wards, special treatment for adolescents, temporary absence, while patient, in-patient care, and visitation management. The secondary factors are temporary absence while a patient, voluntary consent to admit oneself, visitation management, health insurance, open staff, accreditation, physical plant, and credentials of psychiatrists. PMID- 10137172 TI - Why most hospital marketing programs still fail? PMID- 10137173 TI - Hospital patient loyalty: causes and correlates. AB - This study was designed to test whether factors associated with customer and employee loyalty are linked to hospital loyalty, and to measure the relative strength of the associations between traditional patient satisfaction factors and loyalty as compared to non-traditional factors. PMID- 10137174 TI - How consumers view hospital advertising. AB - This paper examines consumer attitudes toward hospital advertising. The results do not support recent findings in other professional fields that consumers are favorably disposed toward this marketing activity. From a demographic perspective, there were differences in attitudes based on gender, age, and education. Income levels had no significant relationship with attitudes. However, consistent results were found on the relative proportion of consumers who were able to recall hospital advertisements. Mostly, they recalled hospital ads seen on TV and newspapers. PMID- 10137175 TI - The impact of marketing on hospital performance. AB - This study examines the effect of traditional and innovative marketing factors on the overall financial, operations and market performance of 71 not-for-profit hospitals in a metropolitan area. Traditional marketing factors of location, services offered and pricing did influence the financial performance of system affiliated and non-system hospitals. They also influenced the operating performance of urban hospitals and the market performance of non-teaching institutions. In contrast, the innovative marketing factors of physician relations, community relations and specialized sales forces had no significant influence on performance differences among the hospitals in the entire sample and sub-samples based on geography, teaching involvement and system affiliation. PMID- 10137176 TI - Psychological burnout V (Part 1 continued). Performance and phases of burnout: a random pattern of associations? PMID- 10137177 TI - An OD comprehensive wellness strategy to identify, assess, and attenuate the causes and costs of employee stress. PMID- 10137178 TI - Pulling a volunteer out of your hat ... working with television and radio to recruit, recognize and retain volunteers. PMID- 10137179 TI - What are the motivational needs behind volunteer work? AB - Identification of an individual's motivational need and desired volunteer work enables volunteer administrators to capitalize on the motivation a person brings to the organization as well as to make effective use of the role by being cognizant of the levels of participation behind the differing volunteer assignments. The Motivation by Maslow Questionnaire was used to identify motivational needs of 35 helpline (crisis) volunteers, and three categories of volunteer work were used to classify their levels of participation. Implications for improving volunteer commitment to the formal voluntary organization and recruitment and retention strategies relative to volunteer motivational needs are discussed. PMID- 10137180 TI - Does your laboratory need a moonlighting policy? PMID- 10137181 TI - Paradigm changes in management: are we just spinning our wheels? PMID- 10137182 TI - How to be 'note'-worthy: tips for writing effective memos. PMID- 10137183 TI - Regionalization, Part 3. Lab networks: models of regional cooperation. PMID- 10137184 TI - Notifying clients of life-threatening results. PMID- 10137185 TI - Revamping the lab's staffing structure. PMID- 10137186 TI - Outreach to health professionals in a rural area. AB - An outreach project which juxtaposed technology (Grateful Med) and a human intermediary (a circuit librarian) to serve health professionals in a rural area of Illinois is described. The five goals of the project were: promote Grateful Med as a clinical tool; introduce circuit librarianship to Illinois; heighten the awareness of health professionals to the value of timely information services; increase the visibility of the resource library; and evaluate the impact of the two components, Grateful Med and circuit librarianship. While the project was well-received and enjoyed short-term success, sustaining the same level of information activity post-project has not been achieved. Insuring utilization of health information by remote health professionals may be characterized as a Sisyphean task. PMID- 10137187 TI - The basics of searching NLM's AIDS databases: Part one. PMID- 10137188 TI - Bibliographic instruction in the hospital library. AB - The nature of bibliographic instruction in this hospital library continues to evolve. As the library makes easy-to-master, menu-driven tools for online searching available to end users, the demand for this service and the accompanying training increases. The demand for formal sessions covering research techniques is also increasing. Upon request, the library offered an extended research orientation to the housestaff in Obstetrics and Gynecology in May of 1993. An introduction to the use of CD-ROM was included to highlight its usefulness for citation verification, author searches, and for periodic current awareness searches on a particular topic. The UMH Library staff strive to offer the most current and comprehensive facilities and services to their users. These include automated access to the library's book, journal, and audiovisual holdings using the Data Trek system; online bibliographic searching by library staff and end users using CD Plus MEDLINE on CD-ROM and Grateful MED software; participation in clinical rounds to provide research support for clinical care; and several types of bibliographic instruction. In addition to the informal teaching of library research techniques that the library staff offers on a daily basis, the Library at Union Memorial Hospital is pleased to be able to provide a formalized and evolving bibliographic instruction program. PMID- 10137189 TI - 75 years--a retrospective. PMID- 10137190 TI - A partnership that serves the underserved. HealthConnect. Bronson Methodist Hospital and Borgess Medical Center, Kalamazoo. PMID- 10137191 TI - Keeping U.P. seniors well-fed and independent. The Senior Meals Program. Keweenaw Health Resources, Portage View Hospital, Hancock. PMID- 10137192 TI - The well child program is healthy in Leelanau. Well Child Clinic. Leelanau Memorial Hospital. PMID- 10137194 TI - Employer mandates: are they the most logical solution? PMID- 10137193 TI - A broad range of services develop healthy students. Health Students 2000 Initiative. Genesys Health System, Flint. PMID- 10137195 TI - A healthy future for Tawas. PMID- 10137196 TI - MAHA and MHA: partners in service to Michigan hospitals. PMID- 10137197 TI - The permanence of values. PMID- 10137198 TI - Cigna drops workers' comp project. PMID- 10137199 TI - Columbia/HCA in deals for two not-for-profits. PMID- 10137201 TI - Methodist, St. Luke's ink letter of intent to merge; Mathis expected to exit. PMID- 10137200 TI - Calif. system, medical groups try integration--with a twist. PMID- 10137202 TI - Quorum signs on to aid Cape Coral. PMID- 10137203 TI - Debate to hinge on Medicare cuts. PMID- 10137204 TI - Not-for-profits in Philadelphia rush to avoid payments in lieu of taxes. PMID- 10137205 TI - HHS budget approved; Medicare changes eyed. PMID- 10137206 TI - Mass. Blues agree to fine to settle Medicare charges. PMID- 10137207 TI - Military may form advisory panel. PMID- 10137208 TI - Catholic group to end for-profit membership. PMID- 10137209 TI - NME explores options amid merger rumors. PMID- 10137210 TI - 22.8% of graduates week primary-care practices. PMID- 10137211 TI - Justice Dept., FTC offer more antitrust guidance. PMID- 10137212 TI - NME founder's suit to be resolved. PMID- 10137213 TI - Antitrust rules eased, but is there an issue? PMID- 10137214 TI - Firm gives up fight for Tenn. hospital. PMID- 10137215 TI - Chicago network-building shifting to new suburbs as big chains divvy up spoils. PMID- 10137216 TI - Deal would create large Michigan network. PMID- 10137217 TI - Holistic-care PPO tested in Chicago. PMID- 10137218 TI - Cardiac catheterizations to rise 6% in 1994--study. PMID- 10137219 TI - Optima exec receives governance award. PMID- 10137220 TI - Florida's big experiment starting to gather steam. PMID- 10137221 TI - Long-term-care firms add debt--S&P. PMID- 10137222 TI - Caremark moves to change relationships with doctors to comply with referral law. PMID- 10137223 TI - Federal probe ends; T2 to pay $500,000. PMID- 10137224 TI - JCAHO rushing to complete text of revised hospital rating system. PMID- 10137225 TI - Medicare affects docs' fees. PMID- 10137226 TI - We shouldn't allow death to be so slow, agonizing. PMID- 10137228 TI - AIDS. Better ways to care. PMID- 10137227 TI - Staying single. AB - Can single-specialty group practices survive in managed-care markets? Specialists are seeking strength in large practices, which are better positioned to shield themselves from abrupt shifts in managed-care provider lists and to resist exclusive deals with hospitals. PMID- 10137229 TI - Benchmarking study targets communications departments of systems. PMID- 10137230 TI - Partial hospitalization payments targeted. PMID- 10137231 TI - Modern Healthcare's Conventions '95. PMID- 10137232 TI - American Marketing Association launches new healthcare council. PMID- 10137233 TI - N.Y.'s rate-setting at issue. PMID- 10137234 TI - Coram settles T2 Medical suit. PMID- 10137235 TI - 3 Ga. hospitals consent to fines to settle patient-dumping charges. PMID- 10137236 TI - Antitrust battle continues over Iowa hospital link. PMID- 10137237 TI - NME, AMI to merge. AB - By agreeing to buy American Medical International in a $3.3 billion deal, National Medical Enterprises sets its sights on becoming an 84-hospital chain with $5.3 billion in annual revenues. But the deal also will bring $2.5 billion in debt and $150 million in fees. PMID- 10137238 TI - Calif. docs to form health plans. PMID- 10137240 TI - Antitrust probably not a problem in Calif. PMID- 10137239 TI - Facing mounting losses, CHC drops financial, administrative products. PMID- 10137241 TI - Physician/hospital relations must include cost concerns. PMID- 10137242 TI - The new CEOs. Healthcare's rapid-fire changes will provide a continuing education for this new class of leaders. PMID- 10137243 TI - Suppliers to face new pressures. PMID- 10137244 TI - Fla. to scrutinize merger's effects. Columbia/HCA Healthcare Corporation. PMID- 10137245 TI - Is jump in bond sales waiting in the wings? PMID- 10137246 TI - Groups, Joint Commission meet. PMID- 10137247 TI - Before adjourning, lawmakers aid VA, OK Medicare programs. PMID- 10137248 TI - HHS fraud alert targets labs. PMID- 10137249 TI - Nurses voice concern about managed care. PMID- 10137250 TI - Uwe Reinhardt to speak at OR managers' meeting. Interview by Pat Patterson. PMID- 10137252 TI - Battery of routine preoperative tests no longer recommended. PMID- 10137251 TI - 'Lite' hospitals to be part of ambulatory health campuses. PMID- 10137253 TI - Nurse liaison supports family during surgery. PMID- 10137254 TI - Solving the working capital crunch. AB - The healthcare landscape is changing rapidly. As a result, hospitals' working capital needs are becoming an increasingly critical issue and the need for bold and innovative thinking is growing. And if the healthcare reform proposals of the Clinton administration are enacted, there will be additional burdens placed on limited working capital. PMID- 10137255 TI - Smoking ban's juggling act. Con. PMID- 10137256 TI - Smoking ban's juggling act. Pro. PMID- 10137257 TI - The ethics of managed care. PMID- 10137258 TI - Driving quality. Total quality management in long term care. PMID- 10137259 TI - Subacute's success story. Making a difference in patient care. PMID- 10137260 TI - Wall Street flexes financing muscle. PMID- 10137261 TI - The eve of ergonomics. PMID- 10137262 TI - Retirement housing takes off. PMID- 10137263 TI - Subacute care. Case management collaboration. PMID- 10137264 TI - Residential living. A time for transition. PMID- 10137265 TI - AARC (American Association for Respiratory Care) clinical practice guideline. Neonatal time-triggered, pressure-limited, time-cycled mechanical ventilation. PMID- 10137266 TI - AARC (American Association for Respiratory Care). Application of continuous positive airway pressure to neonates via nasal prongs or nasopharyngeal tube. PMID- 10137267 TI - A unique approach to multi-state networking: BHSL (Basic Health Sciences Network). AB - Development of a reciprocal multi-state shared resources network is described. The Basic Health Sciences Library Network (BHSL) is one the largest interlibrary loan networks free of direct charges to participants and any direct federal or state funding. Established in June 1986, BHSL started with 132 member libraries from three northeastern states. Current membership is 460 libraries in 10 states. Interlibrary loan activity for 1992 resulted in a collective cost savings of $592,672. This model of resource sharing can be applied to any group of libraries that access a common locator tool. PMID- 10137268 TI - The new alternative: plasma sterilization. PMID- 10137269 TI - The little lobby that could. How small-business advocates whupped Clinton on the health care bill. PMID- 10137270 TI - The land of lost opportunity. PMID- 10137271 TI - Leader-follower exchange quality: the role of personal and interpersonal attributes. AB - A field study of 84 registered nurses and their supervisors revealed that leaders' perceptions of leader-follower attitudinal similarity and follower extraversion were positively related to the quality of leader-follower exchanges. Neither followers' locus of control nor growth need strength was found to be significantly correlated with the quality of the exchange between leaders and followers. PMID- 10137273 TI - Laundry continues to find ways to improve. PMID- 10137274 TI - Go with the flow (Part II). PMID- 10137272 TI - Injury prevention measures in households with children in the United States, 1990. PMID- 10137275 TI - Productivity skyrockets at renovated cooperative. PMID- 10137276 TI - The passion to lead: transforming accomplishment into achievement. PMID- 10137277 TI - Rationing healthcare. Is it a theory that can work? PMID- 10137278 TI - Is there truly a healthcare crisis? PMID- 10137279 TI - Breast care. Mastering the dynamics of change. PMID- 10137280 TI - Get a life. PMID- 10137282 TI - Will quality management paradigms of the 1990s survive into the next century? AB - This article offers four views of the future importance of quality management. First, a pathologist author describes current controversies surrounding the viability of established schools of practice. A vice president at the Joint Commission on Accreditation of Healthcare Organizations outlines the continued need for some form of total quality management and continuous quality improvement from the accreditation stance. A laboratory director from a university medical center discusses the economic changes that are fueling the continued emphasis on quality management. And, a laboratory manager from a community hospital focuses on the impact of quality management, pointing out what is required for quality management to be successful at the operational level in a laboratory. These four independent view-points reveal a clear consensus that the practice of quality management will continue to be important in our laboratories into the 21st century. PMID- 10137281 TI - Leadership in the clinical laboratory: strategies for change. AB - This article gives the reader insight into progressive approaches to effective leadership in the clinical laboratory. The report examines leadership styles conducive to the laboratory setting now and in the future. The laboratory requires a leadership style that creates a balance between management and leadership. This discussion includes hypothetical situations and responses to different circumstances and issues being confronted in this field. The laboratory is a vital link in the patient care process. This article emphasizes the importance of the human component of the system. Professional growth and productivity of employees are related to total organizational performance and success. Finally, this article focuses on progressive strategies for meeting the challenges of constant change in the health-care environment in general and in the laboratory in particular. The reader not only will enhance his/her effectiveness as a leader by applying these approaches and techniques, but also will gain significant insight through review of the referenced literature. PMID- 10137283 TI - Key indicators of laboratory performance. AB - Results of a CLMA survey designed to identify its members' need for tools to evaluate various aspects of laboratory performance are described. A review of the current and anticipated demand for this information is provided, as well as a description of a feasibility study currently being conducted by CLMA. PMID- 10137284 TI - Robotics: a way to link the "islands of automation". AB - This article looks at what the natural evolution of robots can do for the clinical testing industry, from performing simple functions to becoming the prime labor force of the clinical laboratory. Until now, robots have been applied to instrument processes as somewhat of an upgrade to accomplish a variety of laboratory tasks. Over the next 10 years, however, robotics development will respond to the internal and external influences expected to challenge the industry. A limited supply of human workers and the increased demands of testing volumes and cost-effectiveness will herald a new phase of robotics to link, as well as develop, technological capabilities. Since science fiction was invented, robots have teased the imagination-alternately as mindless automatons or as clones of their inventors endowed with minds of their own. The appeal in the first case was the seemingly infinite capacity for performing menial tasks too boring, complex, or dangerous for mankind. The appeal in the second was the fantasy of artificial intelligence. In both cases, the fictional concept has become reality--and, by the 21st century, should even be commonplace. Financial encouragement of robotics development might even be a mission for laboratories themselves, as they prepare for potential competition from even more complex technology. PMID- 10137285 TI - In pursuit of integration. Research-based lessons for physicians, hospitals, and health plans. PMID- 10137286 TI - Managed care and the hospital laboratory: survival of the fittest. AB - The authors review the reasons behind the currently evolving restructuring within the healthcare industry and its implications for hospital laboratories. They predict a continuing decline in the volume of inpatient care with a similar effect on the volume of hospital laboratory testing. They also foresee a shift to independent laboratories in the volume of outpatient testing--currently a key revenue source for many hospital laboratories. For those hospitals that redefine their mission, inpatient testing for higher-acuity patients is one role, as is managing point-of-care testing in nontraditional settings. PMID- 10137287 TI - Ethics and professionalism: the case of genetic testing. PMID- 10137288 TI - The laboratory information float, time-based competition, and point-of-care testing. AB - A new term, the laboratory information float, should be substituted for turnaround-time when evaluating the performance of the clinical laboratory because it includes the time necessary to make test results both available (ready to use) and accessible (easy to use) to clinicians ordering tests. The laboratory information float can be greatly reduced simply by telescoping the analytic phase of laboratory testing into the preanalytic phase. Significant costs are incurred by such a change, some of which can be reduced by developing a mobile clinical laboratory (sometimes referred to as a "lab-on-a-slab" or "rolling thunder") to transport the analytic devices directly to patient care units. The mobile clinical laboratory should be equipped with an integrated personal computer that can communicate continuously with the host laboratory information system and achieve some semblance of continuous flow processing despite test performance in point-of-care venues. Equipping clinicians with palmtop computers will allow the mobile clinician to access test results and order tests on the run. Such devices can be easily configured to operate in a passive mode, accessing relevant information automatically instead of forcing clinicians to query the laboratory information system periodically for the test results necessary to render care to their patients. The laboratory information float of the year 2,000 will surely be measured in minutes through the judicious deployment of relevant technology such as mobile clinical laboratories and palmtop computers. PMID- 10137289 TI - CLIA and future applications of new technology. A regulatory view. PMID- 10137290 TI - The total testing process and its implications for laboratory administration and education. AB - The Total Testing Process is a multistep process that begins and ends with the needs of the patient. Identifying the many steps in the Total Testing Process and planning and using an interdisciplinary team to begin a coordinated effort will improve the process and offer optimal patient care. Communication among departments and developing interdepartmental guidelines will improve the use, sampling, performance, and interpretation of health assessment procedures. A commitment to the continuous improvement of patient assessment will require the participation of numerous health professionals. It is time for every institution to bring individuals together, collectively identify solutions, implement an improvement plan, and evaluate the effectiveness of their efforts using outcome measures that both directly and indirectly relate to improved patient care. Doing it right the first time will benefit the patient and conserve our limited health care dollars. PMID- 10137291 TI - Rural health services in Warkworth--a blueprint for the future? PMID- 10137292 TI - Trauma systems--where to from here? PMID- 10137293 TI - Switching sheets brings unexpected benefits. PMID- 10137294 TI - Containing the paper war. PMID- 10137295 TI - Top-quality medical air for Middlemore Hospital. PMID- 10137296 TI - Private patient protocols. PMID- 10137297 TI - Using CQI to reduce patient falls: a fresh perspective on a chronic problem. PMID- 10137298 TI - Demonstrating quality to purchasers: responding to RFPs. PMID- 10137299 TI - Preventing employee-related violence. PMID- 10137300 TI - Preventing violence in the hospital: a nursing unit's quality improvement story. PMID- 10137301 TI - Information needs of risk managers. PMID- 10137302 TI - Formulating an in-house disability management program. PMID- 10137303 TI - A strategized approach toward AIDS in the workplace: experience at Sun Life. PMID- 10137304 TI - Revitalizing a hospital ethics committee. PMID- 10137305 TI - The use of metaphors in hospital ethics committees: a field study of a children's HEC and a Veterans Administration HEC. PMID- 10137306 TI - Nurses' participation in the institutional bioethical debate in The Netherlands. PMID- 10137307 TI - Should competent patients or their families be notified before HECs review the patients' cases? Yes. AB - In summary, it is, I believe, fairly uncontroversial that a patient always should be notified before a bioethics committee reviews the case. Respect for a patient"s confidentiality and autonomy also require that patients be asked prior to being interviewed or identifying the patient's name in a committee meeting. Permission is not required for an anonymous discussion of the case with a bioethics committee. PMID- 10137308 TI - Should competent patients or their families be notified before HECs review the patients' cases? Yes. PMID- 10137309 TI - Should competent patients or their families be notified before HECs review the patients' cases? No. PMID- 10137311 TI - Case series ... a patient's oral advance treatment directive. PMID- 10137310 TI - HEC consortium survey: current perspectives of physicians and nurses. AB - At the request of the Midwest Bioethics Center (MBC), we surveyed nurses' and physicians' attitudes and needs regarding Hospital Ethics Committees (HECs). The primary objective of this research project was to inform the practices and policies of the Ethics Committee Consortium of the Bioethics Center. Four thousand eight hundred and twenty-nine surveys were distributed to the medical and nursing staff of eight Kansas City metropolitan area hospitals. One thousand and fifty-five surveys were returned, representing a response rate of 21%. This survey examined five areas believed to be related to nurse and physician use of and participation on HECs: [1] Training in Biomedical Ethics; [2] Nature and Purpose of HECs; [3] HEC Functions-Case Consultation; [4] Ethical Decision-Making and Patient Care; and [5] Continuing Education. Important findings include lack of knowledge regarding whether case review is required or optional, and whether recommendations are binding or advisory; a perception that training in medical ethics was inadequate; and a strong indication that HECs should be accessible. These findings are consistent with and extend the findings of prior descriptive research in this area. PMID- 10137312 TI - Should HECs in secular institutions seek right-to-life advocates as members? Yes. PMID- 10137313 TI - Should HECs in secular institutions seek right-to-life advocates as members? No. PMID- 10137314 TI - Perspectives. Medicaid managed care in NY: a tidal wave of competition. PMID- 10137315 TI - Perspectives. Researchers call for renewed efforts in the war on cancer. PMID- 10137316 TI - Perspectives. The Los Angeles market: "managed competition" at work. PMID- 10137317 TI - Perspectives. AHCPR at five years: undertaking an inventory. PMID- 10137318 TI - Putting pieces together for the future. Interview by Bill Childs. PMID- 10137319 TI - New rules for the CPR (computer-based patient record): No more signing on the dotted line. PMID- 10137320 TI - Snap-shot of CHIME: physician order entry. PMID- 10137321 TI - HIS (hospital information systems) database delivers key answers. PMID- 10137322 TI - Reform report: states to by-pass ERISA? PMID- 10137323 TI - Building from the practice up: replacing the tower of paper. PMID- 10137324 TI - Survey: radiology information systems. PMID- 10137325 TI - Picture perfect savings--PACS productivity. PMID- 10137326 TI - Vendor collaboration? A new spirit in the HIS industry. PMID- 10137327 TI - Online medical records save time & energy. PMID- 10137328 TI - System saves costs, storage space & lives. ChartVision. PMID- 10137329 TI - Cutting time & costs with document imaging. PMID- 10137330 TI - Document imaging & the 21st century. PMID- 10137331 TI - The PC card: don't leave home without it. PMID- 10137332 TI - Practice management software: the state of the industry. PMID- 10137333 TI - North Carolina information & communication alliance formed. PMID- 10137334 TI - A few benchmarking dos & don'ts. PMID- 10137335 TI - Home health caregivers: information at their fingertips. PMID- 10137337 TI - Trends and imperatives for home healthcare IS (information systems). PMID- 10137336 TI - Enhancing practice efficiencies with a "bridge". PMID- 10137338 TI - Information network hits home. Case study. PMID- 10137339 TI - Enhancing performance with benchmarking. PMID- 10137340 TI - Short course: long-term automation. PMID- 10137342 TI - Pursuing a paper-free practice. PMID- 10137341 TI - Addressing EMR (electronic medical record) issues head-on. PMID- 10137344 TI - An innovative cost efficient solution to electromagnetic interference. PMID- 10137343 TI - Diagnostic imaging centres. PMID- 10137345 TI - Healthy energy savings. PMID- 10137346 TI - Energy efficiency in hospitals by good housekeeping. AB - In 1987 Somerset HA embarked upon a programme aimes at reducing its annual energy bill of 2.1 million pounds by 25% over a five year period whilst maintaining or improving on the standards of service and comfort required by the Department of Health. The target savings were to be achieved by the combination of good housekeeping measures and a parallel programme of capital investment in energy cost reduction projects. This Case Study briefly describes the good housekeeping elements of the programme. A later Case Study will cover energy savings arising from estate rationalisation. Initially, a policy statement set out the saving objectives and the methods to be used to achieve them. An Energy Management Group was set up for each of the three Units, consisting of members of the Unit Management team and chaired by the Unit General Manager. Energy "Monitors", appointed from existing staff in each department, were given the task of maintaining a watch on the day-to-day use of energy using equipment and identifying opportunities for savings. PMID- 10137347 TI - Rewards from Trusts energy policy. PMID- 10137349 TI - New visions for old age. PMID- 10137348 TI - Housing the elderly. PMID- 10137350 TI - New asbestos regulations require immediate action. PMID- 10137351 TI - OSHA's Voluntary Protection Program. PMID- 10137352 TI - Samaritan Hospital waves the VPP (Voluntary Protection Programs) merit flag. PMID- 10137353 TI - The uncertain future of healthcare: matrix management. PMID- 10137354 TI - Managed care and access into group practices. PMID- 10137355 TI - Healthcare reform: it's working in Oregon. AB - Oregon is beginning to operate a highly controversial program with explicit definitions of coverage. Oregon's Director of the Health Plan, Jean Thorne, has focused on the national and state political attention that Oregon is receiving and knows that "...there are many people who are waiting for us to fail." Thorne has requested that we keep our focus on making major changes to improve the chance that more people in poverty will receive coverage. We continue to believe that the Oregon Health Plan will improve overall healthcare in our state and serve as a blueprint for others to study and improve. PMID- 10137357 TI - Customer service, access and capacity: vital signs for developing a marketing plan. AB - Marketing plans that do not include an analysis of customer service, access and capacity issues are incomplete documents. Unresolved customer service, access and capacity issues can undermine an otherwise well-designed marketing plan. The medical and administrative leadership of the group practice or clinical department must work together to identify customer service, access and capacity issues which are affecting the practice's ability to respond to the needs of the marketplace. Someone with marketing expertise can provide valuable input to this process. The resulting solutions need to be developed which are realistic and in keeping with the general marketing direction of the practice. PMID- 10137358 TI - NAHAM's role in healthcare reform. PMID- 10137359 TI - On the road to change: healthcare access to nursing homes. PMID- 10137356 TI - Managing relationships with referring physicians: a systems approach. PMID- 10137360 TI - Influencing physician referrals through an advertising campaign aimed at consumers. PMID- 10137361 TI - Integrated service networks bring change to Minnesota healthcare. PMID- 10137362 TI - States stymied in health reform. PMID- 10137363 TI - Three state health reform initiatives fail. PMID- 10137364 TI - Health insurance purchasing alliances in Florida and California. PMID- 10137365 TI - California's single-payer initiative: Proposition 186. PMID- 10137366 TI - '94 state legislative survey. PMID- 10137367 TI - Providers and managed care: after the reform debate. PMID- 10137368 TI - Patient dumping regulations--are they helpful? PMID- 10137369 TI - The maturing of telemedicine technology. Part 1. AB - A part of the solution to scarce medical resources is telemedicine--a bundling of high- and low-tech equipment with distinct advantages for both rural and urban providers. Here is Part One of a two-part series on the state-of-the-art and its practical uses. PMID- 10137370 TI - What proposed DRG refinements mean for hospitals. Part III. PMID- 10137371 TI - Disease prevention means reduced spending. PMID- 10137372 TI - Valley Medical Center capitalizes on the times. PMID- 10137373 TI - Volunteer pilots move patients free. PMID- 10137374 TI - Trends in consolidation. AB - The big news of '94 was not the rise and fall of government-led health reform, it was hospital system integration, mergers and acquisitions. Here is the how, who and why of both the non-profit and investor-owned sectors and some educated guesses at what is yet to come. PMID- 10137375 TI - Merger mania: an analysis. PMID- 10137376 TI - Facing the "Stark II" realities. PMID- 10137377 TI - 1995 state legislatures face full plates. PMID- 10137378 TI - Can managed care do it all? AB - The thought of turning the public health system over to managed care companies worries many public health professionals. A look at the complexities involved in treating tuberculosis may explain why. PMID- 10137379 TI - Integrated health care networks: the challenges ahead. PMID- 10137380 TI - Scully to head Federation; Bromberg to assume vice chairmanship. PMID- 10137381 TI - The U.S. experience with smoke detectors: who has them? How well do they work? When don't they work? AB - From 1975 to 1984, the United States experienced remarkable growth in the use of home smoke detectors, making the home smoke detector the fire safety success story of the decade. As of 1993, only 1 home in 12 remained unprotected. PMID- 10137382 TI - Fire loss in the United States in 1993. PMID- 10137383 TI - Catastrophic fire deaths: the numbers are back up. AB - The number of catastrophic multiple-death fires in the United States rose in 1993 from the record low of 1992 to a level more consistent with that of recent years. Despite our efforts to highlight risk factors, we continue to see the same problems year after year. PMID- 10137384 TI - Hospital collections: steps that yield positive results. PMID- 10137385 TI - Coming together: building integrated delivery systems. PMID- 10137386 TI - The legacy of Hill-Burton. PMID- 10137387 TI - In search of the medical transcription supervisor. PMID- 10137388 TI - How to manage your organization's software resources. PMID- 10137389 TI - Crisis means danger and opportunity. PMID- 10137390 TI - Be all that you can be. PMID- 10137391 TI - Zero-base budgeting--a tool for conflict resolution: a case study. PMID- 10137392 TI - Physician cost variance analysis and economic credentialing. PMID- 10137393 TI - Indexing for inflation: a critical step in managed care calculations. PMID- 10137394 TI - Update on confidentiality legislation. PMID- 10137395 TI - Key healthcare reform bill contains changes for health information management. PMID- 10137396 TI - Big challenges on the last frontier. PMID- 10137397 TI - Steps for a successful paperless implementation. PMID- 10137398 TI - Clinical information systems: putting them in perspective. PMID- 10137399 TI - Eliminating the paper chase. PMID- 10137400 TI - Diagnostic imaging at Samaritan Hospital. PMID- 10137401 TI - Paper to paperless, and the paper in-between. PMID- 10137402 TI - Optical storage-based document imaging technology and the computer-based patient record. PMID- 10137403 TI - Procurement guidelines for electronic patient record systems. PMID- 10137404 TI - Building blocks for the CPR. PMID- 10137405 TI - Document imaging: not a transitional strategy. PMID- 10137406 TI - The role of document imaging in the CPR: a user's view. PMID- 10137407 TI - Document imaging: a basis for the CPR? PMID- 10137408 TI - Volunteers--AHIMA's backbone. PMID- 10137409 TI - 1994 Software Guide. American Health Information Management Association. PMID- 10137410 TI - Lobbying for AHIMA members in Washington. PMID- 10137411 TI - Home healthcare careers build on traditional HIM skills. PMID- 10137412 TI - Nontraditional career paths. PMID- 10137414 TI - Laying the foundation for a career in consulting. PMID- 10137413 TI - Self development: making the transition from practitioner to educator. PMID- 10137415 TI - HL7 update. PMID- 10137416 TI - Professional development: the HIM challenge of the '90s and the key to 21st century career opportunities. PMID- 10137417 TI - Library benefits from library automation system. PMID- 10137418 TI - Using continuous improvement methodology to reduce a hospital's procurement costs. AB - The National Naval Medical Center (NNMC) provides care and services to approximately 16,800 inpatients and 576,000 outpatients annually. In an era of healthcare reform, effective cost containment is crucial, and healthcare organizations can ill afford wasteful practices. To optimize its organizational effectiveness, NNMC adopted a philosophy of total quality management. This article chronicles the work of a team whose efforts resulted in improvements that resulted in a significant cost savings to the hospital that have been sustained over time. PMID- 10137419 TI - A systems approach to gathering and analyzing patient and family complaints and suggestions. AB - Most medical facilities' leaders are concerned with satisfying the patients who use their healthcare organization. Whereas many facilities have identified specific individuals whose job it is to hear patient complaints, the authors promote the view that all staff members play important roles in patient advocacy. Management's role is to determine how to collect and analyze the complaints and suggestions voiced by patients throughout their healthcare experience. This article presents one method. PMID- 10137420 TI - Improving a rural hospital's peer review process. AB - Quality monitoring in a small rural hospital is a challenge on many fronts. The case study presented here illustrates a quality monitoring failure and analyzes the contributing factors. Based on their experience, the authors suggest methods to improve small rural hospital quality monitoring. PMID- 10137421 TI - Restructuring a hospital's housekeeping department to improve performance. AB - The goal to decrease cost while improving efficiency and quality of service is a driving force in healthcare today. By redesigning and reassigning work, Poudre Valley Hospital was able to achieve this goal. This article describes the process of restructuring a central housekeeping department into patient care areas, the redistribution of work, and the outcomes that were achieved. PMID- 10137422 TI - Using quality service analysts to streamline record reviews. AB - By using registered nurse quality service analysts (RN-QSAs), the United States Air Force Medical Center in Wiesbaden, Germany, which closed in 1993, reduced physician reviews of medical records in 1991-1992 to only the records that did not meet the preestablished screening criteria. The authors relate how the screening of records by RN-QSAs increased the number of records reviewed, reduced the number of people reviewing records, established the quality services department as a repository of patient care information, and markedly improved the quantity, quality, and reproducibility of patient care reviews. PMID- 10137423 TI - Continuous quality improvement at work: the first team--Part I. AB - This first part of a two-part article describes the process of making the theory of continuous quality improvement a reality. The successes, the failures, and the struggles of the first team effort are outlined. The evolution of the team approach is captured from the perspectives of the quality directors, the facilitator, and the team leader. The team project discussed in this article focused on inpatient admissions and the assignment of patients to observation status. PMID- 10137424 TI - Legislative forum: 'Any willing provider' laws. PMID- 10137425 TI - Current topics in obstetrical risk management--Part II. AB - In this second part of a two-part article, the author describes more of the common loss exposures seen in the obstetrical areas of healthcare organizations. Topics discussed include vaginal birth after cesarean section, birth plans, and nursery security. The author addresses each subject from the risk management perspective and suggests industry methods for mitigating or preventing losses in obstetrical care. PMID- 10137426 TI - The flying doctors of east Africa. PMID- 10137427 TI - The 1995 Medicare fee schedule. Planned revisions to the geographic adjustment factors. PMID- 10137428 TI - Physicians mobilize to care for underserved Americans. PMID- 10137429 TI - Preparing for health care multimedia communications. PMID- 10137430 TI - Videoconferencing in patient care delivery and medical training. PMID- 10137431 TI - Advancing health care networks in Iowa. PMID- 10137432 TI - Case study: integrated voice and data services. PMID- 10137433 TI - Use of electronic mail as a clinical tool. PMID- 10137435 TI - Reengineering a telecommunications system: lessons learned. PMID- 10137434 TI - Creating an effective telecommunications request for proposal. PMID- 10137436 TI - Telemedicine still on the table. PMID- 10137437 TI - The future of telecommunications in rural health care. PMID- 10137438 TI - The hospital-at-home: an additional first-choice option. PMID- 10137439 TI - Willingness to pay for unfunded health services in a family practice clinic. AB - Data collected for this study of willingness to pay for unfunded health services in a family practice setting were collected through a cross-sectional survey of a sample of 250 patients. Willingness to pay was assessed by each patient responding on a five-point scale from "definitely not willing" to "definitely willing" to pay a fee of +10 for the service in question. Data analysis was performed using chi-square contingency tables. Findings indicated a strong willingness to pay for brief doctors' notes, an aversion against paying for telephone advice from a nurse and no consistent opinion for or against paying for prescription renewals received over the telephone. PMID- 10137440 TI - Health services in Israel: from Mishna to America?. Interview by Matthew D. Pavelich. PMID- 10137441 TI - Partnerships for health in Manitoba: the Mid Central Health Association. AB - In response to financial pressures, heightened consumer expectations and the need for a new focus on health and community-based care, the Manitoba government initiated a reform action plan in 1992. The plan stresses the restructuring of health services under the "partnership concept." This article presents a chronological account of the development of regional partnerships in rural Manitoba's Central Region. PMID- 10137443 TI - Surviving your next performance appraisal. PMID- 10137442 TI - Quick response programs: effective management of a population in crisis. AB - In our present health care system, emergency departments have become the gatekeepers of the acute care system for the elderly. These departments need other alternatives to in-hospital treatment for elderly patients. The Windsor Essex County Quick Response Program was developed as an innovative alternative to assist Hotel Dieu of St. Joseph Hospital's emergency department with this complex client population. This article describes the program, provides a rationale for this specialized service, offers suggestions for program success and reports on its accomplishments during the first year of operation. PMID- 10137444 TI - Brockville Psychiatric Hospital worms its way into waste management. PMID- 10137445 TI - Work-family initiatives in Canadian health care. AB - Society is no longer made up of workers from traditional families, and there is an ever-increasing degree of stress caused by family and work-life conflicts. The authors surveyed executive directors of provincial hospital/health associations to determine their estimate of the support being provided for health care workers in their province. PMID- 10137446 TI - Arizona's Carondelet nurse case managers save money and improve seniors' quality of-life. Case study. PMID- 10137447 TI - Overhauling technology decisionmaking to fit era of managed care. PMID- 10137448 TI - Virginia's Alexandria Hospital fattens on low-hanging fruit. Case study. PMID- 10137449 TI - Disproving the Peter Principle in healthcare management. PMID- 10137450 TI - Landmark benchmarking effort for networking children's hospitals. Columbus Children's Hospital, Ohio, joins with 11 others in successful search for best practices. Case study. PMID- 10137451 TI - Related settings: design--improving the quality of physical rehabilitation. PMID- 10137452 TI - Plenary session: A conversation with Dr. Leland R. Kaiser. Panel discussion. PMID- 10137453 TI - Related settings: design--producing extraordinary outcomes at the Meridian Medical Center. PMID- 10137454 TI - Related settings: a family-centered approach to neonatal & pediatric intensive care unit design. PMID- 10137455 TI - Design technology: light--medicine of the future. PMID- 10137456 TI - Design technology: the design of healing & prosthetic environments. PMID- 10137457 TI - Design quality: landscape design--improving the quality of healthcare. PMID- 10137458 TI - Design quality: designing for the human side of healthcare. PMID- 10137459 TI - Design quality: how bau-biologie principles can be applied to healthcare environments & how they can affect the human body. PMID- 10137460 TI - CEU course: Research--improving the quality of healthcare design. PMID- 10137461 TI - CEU course: Advanced healthcare facility lighting design. PMID- 10137462 TI - Plenary session: Design evaluation of six primary care facilities for the purpose of informing future design decisions. PMID- 10137463 TI - Design awards. PMID- 10137464 TI - Exemplary healthcare facilities. PMID- 10137465 TI - Acute care design: healing environment case study--North Hawaii Community Hospital. PMID- 10137466 TI - Keynote address: Transforming healthcare--designing for quality. PMID- 10137467 TI - Acute care design: healing environment case study--AMI Park Plaza Hospital. PMID- 10137468 TI - Acute care design: trendbusting for a new future in healthcare design. PMID- 10137469 TI - Long-term care design: research you can use in designing for older people. PMID- 10137470 TI - Long-term care design: current research on the use of color. PMID- 10137471 TI - Ambulatory care design: a patient-focused approach. PMID- 10137472 TI - Ambulatory care design: the changing nature of facilities. PMID- 10137473 TI - Ambulatory care design: interior design leadership--a case study of the space planning & design of a large medical office building. PMID- 10137474 TI - Special report. A comparison of 11 state purchasing cooperatives initiatives. PMID- 10137475 TI - Special Report. State "Any Willing Provider" (AWP) and Patient "Freedom of Choice" (FOC) laws. PMID- 10137476 TI - Express yourself: help customers understand materials goals and needs. PMID- 10137477 TI - Product committees try to be productive--and to prove it. PMID- 10137478 TI - Panel discussion: building bridges with surgeons. PMID- 10137479 TI - Waste reduction: ace-in-hand against incinerator regs. PMID- 10137480 TI - Are hospitals staying open past closing time? PMID- 10137481 TI - Searching for the best employee? Check out this action plan. PMID- 10137482 TI - Central station. The case of the missing instructions. PMID- 10137483 TI - Stats. Influence shifts among purchase decision makers. PMID- 10137484 TI - Madness in fine print. PMID- 10137485 TI - The critical role information systems play in reengineering efforts. PMID- 10137486 TI - Setting the stage for reengineering. PMID- 10137487 TI - Reengineering in healthcare. PMID- 10137488 TI - A checksheet for locating cost reduction opportunities. PMID- 10137489 TI - Integrating quality improvement and cost reduction. PMID- 10137490 TI - Working smarter: cutting costs using TQM. PMID- 10137491 TI - Better jobs, better care: building the home care work force. AB - This paper focuses on providing quality care in the paraprofessional home care industry. Despite government policies that have encouraged home-based care for 20 years, home health care still remains relegated to second-class status by the rest of the health care industry. Home care is unique because it relies primarily on paraprofessional care delivered by a home care aide working alone, essentially as a guest in the client's home. The resulting interpersonal dynamic between patient and caregiver--which develops far from the eyes of the primary physician, regulators, and third-party payers--is one unlike any other patient-caregiver relationship in the health care system. The quality of care received by the client is linked directly to the quality of the paraprofessional's job: "good jobs" are prerequisite for "good service." Good jobs, however, are not enough. They must be supported by paraprofessional agencies that add real value to the home care service. Part I We define quality home care as meeting the client's needs. Unfortunately, since home care is provided in dispersed, minimally supervised settings, measuring quality of service is very difficult. For this reason, we suggest that it is the front-line employee--the home care aide who is present for hours every visit--who can best determine if the client's needs are being met, and who is best positioned to respond accordingly. Part II To best meet client needs, paraprofessional home care must be built around the home care aide. This requires that home care aides (1) be carefully selected during the hiring process, (2) be well trained, and (3) be empowered with considerable responsibility and capacity to respond to the daily needs of the clients. This Model, one that emphasizes the front-line employee, is in full keeping with the "total quality management" innovations that are currently reorganizing America's service industries. Unfortunately this model is not typically reflected in current paraprofessional home health care practice. Part III Building the home care service around home care aide requires redesigning the paraprofessinal's job in 5 ways: 1. Make work pay, by providing a minimum of $7.50 per hour and a decent benefits package.(ABSTRACT TRUNCATED AT 400 WORDS) PMID- 10137492 TI - CAAMS (Commission on Accreditation of Air Medical Services): summary of progress and potential 1990-1994. PMID- 10137493 TI - Air medical transport systems as a health-care integrator. Association of Air Medical Services. AB - Air medical transport services are an essential, cost-effective component of health-care delivery in the United States. Air medical transport services provide rapid access to high-quality, sophisticated medical technologies over large geographic areas. They reduce the cost of duplicating resources by obviating the need to provide similar levels of access and service at multiple locals in the region. The sophistication and quality of care maintained during transport provides a level of services not available with traditional ground transport services, particularly in rural areas. Air medical transport services also facilitate linkages between primary, secondary and tertiary-care facilities, allowing integration of programs and services to create regionalized systems of healthcare. While numerous strategies are necessary to reduce health-care costs in the United States without reducing quality and access, air medical transport systems are uniquely positioned to support the efficient integration of regional healthcare services, while maintaining the highest standards of care for patients. PMID- 10137494 TI - Increasing our sphere of influence through collaboration. PMID- 10137495 TI - Analysis of intubations. Before and after establishment of a rapid sequence intubation protocol for air medical use. AB - INTRODUCTION: After finding the success rate of intubations in our air medical program to be less than optimal (with a success rate of only 73%), a protocol for increased doses of sedatives and neuromuscular blocking (NMB) agents was developed for field use by flight nurses and paramedics. METHODS: A retrospective chart review was performed for 100 intubations before and 100 intubations after establishment of this protocol. RESULTS: Success rate of intubation increased from 73% to 96%, which was statistically significant (p < 0.01). No difference existed between the two groups with regard to age, gender, Glasgow Coma Scale scores, nature of injury, route of intubation, number of attempts or percent intubated. Two patients (2%) became bradycardic using the new protocol. CONCLUSIONS: Our results suggest that protocols including sedatives and NMB agents can be used safely and effectively by an appropriately trained air medical team of nurses and paramedics and may improve patient care. PMID- 10137496 TI - Use of a pulse oximeter for determination of systolic blood pressure in a helicopter air ambulance. AB - INTRODUCTION: Traditional methods of determining blood pressure may be unreliable (auscultation or palpation) or unavailable (direct arterial cannulation) in the air medical environment. The authors investigated the combination of a pulse oximeter with a standard sphygmomanometer (blood pressure) cuff as an alternative method. METHOD: The pulse oximeter is applied to a finger on the same upper extremity on which a standard blood pressure cuff had been applied. A baseline blood pressure was obtained by palpation or an automated blood pressure device. One minute later, the systolic blood pressure (SBP) was determined by inflating the blood pressure cuff until the pulsatile display on the pulse oximeter was obliterated. This was taken as the systolic blood pressure. RESULTS: Complete data were obtained on 116 patients, with 223 data pairs. The SBP as obtained by the baseline method was strongly correlated with the SBP obtained by the pulse oximeter display obliteration method (r = 0.90, p < 0.001). CONCLUSION: The obliteration of the wave form display on a pulse oximeter is an accurate, convenient, inexpensive and readily available alternative method of determining SBP. PMID- 10137497 TI - 1994 communications survey. PMID- 10137498 TI - Hostile-environment sexual harassment. PMID- 10137499 TI - Managing in the new healthcare climate. PMID- 10137500 TI - The organization of heart services. Part three: Building a cardiac PHO. AB - This article has examined some of the legal requirements for establishing a PHO or a SPHO. These guidelines have been presented in a generalized format. Legal counsel should be retained prior to developing a PHO to ensure that applicable legal statutes at the state, local and national level are met. Various organizational models have been presented for developing the PHO. The PHO entity allows the physicians and the hospital a single entity, representative of both parties, to locate, negotiate and enter into contracts on their behalf. The PHO can allocate revenues among the parties based on the amount of risk and services provided. There are some questions as to the long-term viability of PHOs given the regulatory changes occurring in the healthcare arena. Regardless of the regulatory changes that may occur, PHOs provide a vehicle for enhancing the relationship between a hospital and its physicians. PHOs are often a step in the process of developing a fully integrated healthcare organization. The PHO provides a forum for developing and enhancing trust and collaboration among the physicians and between the physicians and the hospital. Trust and collaboration will be key ingredients in the future as physicians and hospitals work more closely together in providing high-quality, cost-effective care that meets the patient market needs and expectations. Part Four of this series will discuss the fully integrated healthcare organization. PMID- 10137501 TI - Improving catheterization laboratory throughput. PMID- 10137502 TI - Cost-effective cardiovascular product standardization: 10 steps to implementation. PMID- 10137503 TI - Couples team-up to fight heart disease. PMID- 10137504 TI - The 1994 American College of Cardiovascular Administrators' salary survey. PMID- 10137505 TI - Data watch. The cost of retirees' health care. PMID- 10137506 TI - Making HMOs compete. PMID- 10137507 TI - Medical savings accounts: are they a viable option? PMID- 10137508 TI - Setting standards for workers' comp. PMID- 10137509 TI - Workers' comp strategies. Simple answers to a complex problem. PMID- 10137510 TI - The managed care dilemma. PMID- 10137511 TI - Giving small employers more options. PMID- 10137512 TI - Vaccines: no longer kid stuff. PMID- 10137513 TI - Data watch. Mid-sized employer health plans. PMID- 10137514 TI - Hammering out a health reform plan. PMID- 10137515 TI - Expanding FEHBP (Federal Employees Health Benefits Program). PMID- 10137516 TI - Notes from the road. PMID- 10137517 TI - Moving toward 24-hour care. PMID- 10137518 TI - HMO ratings spur quality efforts. PMID- 10137519 TI - How living wills could save billions. PMID- 10137520 TI - Merging town & gown cultures. PMID- 10137521 TI - The battle for Cleveland. PMID- 10137522 TI - Big mergers in New England. PMID- 10137523 TI - Sound hiring practices gain value as hospitals emphasize productivity. PMID- 10137524 TI - HR and the budget knife. PMID- 10137525 TI - HR plays commanding role in restructuring at Mississippi med center. PMID- 10137526 TI - Documenting employee discipline is key in playing fair and helping staff members succeed. PMID- 10137527 TI - A future without paper: HR at Akron General launches full-throttle into cyberspace. PMID- 10137528 TI - Flexibility, cost savings drive acceleration in number of PTO (paid-time-off) banks. PMID- 10137529 TI - HR can help correct 'behavior mismatch'. PMID- 10137530 TI - The leading edge: trends in hospital HR information systems. PMID- 10137531 TI - Staff wants to hear what you want to say about labor issues. PMID- 10137532 TI - Secondments in health care quality assurance. AB - Describes different types of secondment in quality assurance. Addresses the social and occupational characteristics of the associated roles. Demonstrates that the benefits of secondment outweigh the limitations. Suggests that changes in the health care system are providing continuous scope for secondment and that this, therefore, should be taken advantage of. PMID- 10137533 TI - Quality improvement in general surgery: Hong Kong style. AB - A second article describing the significant move of United Christian Hospital towards "continuous quality improvement". Describes the general surgery CQI programme, its problems and successes. PMID- 10137534 TI - Quality costing. AB - Outlines the introduction of a "quality costing" perspective into quality improvement of priority services. Illustrates cash-releasing and non-cash releasing opportunities. PMID- 10137535 TI - Introducing anticipated recovery pathways: a teaching hospital experience. AB - Integrated Care Plans, or Anticipated Recovery Pathways, embrace quality and efficiency concepts. They allow multidisciplinary input on patient care planning. Pathways are now being developed hospital-wide. Discusses their development and implementation. PMID- 10137536 TI - Guidelines, protocols and outcomes. AB - Clinical guidelines are being widely advocated. Discusses the agenda for outcomes in a context of both purchasing and providing and from user and clinical perspectives. Debates the question of whether practitioners will change their behaviour and act on research evidence. PMID- 10137537 TI - Health visiting: a new model for a deprived area. AB - Discusses Nottingham's approach to developing a public health role explicitly alongside traditional health visiting. Argues that their approach makes significant improvements to the health status of a selected deprived area. PMID- 10137538 TI - What companies are learning from claims data. AB - Health care claims show how medical services are used by employees and dependents. Analysis of this type of information is essential for financial management, program planning, and benefits plan design. PMID- 10137539 TI - Point-of-service plans on the rise. AB - Point-of-service plans strike at the heart of the choice-of-provider debate. This is because they are managed care plans that allow employees to opt out of the network and choose their own providers. Employers would do well to examine the economic advantages of these plans. PMID- 10137540 TI - Does dental coverage fit into the health care reform? AB - Thirty-seven million Americans have little or no access to health care either because of cost, preexisting conditions, or other underwriting decisions. In addition, more than 128 million Americans have no dental coverage. PMID- 10137541 TI - Addressing AIDS in the workplace. AB - Chances that no one in an organization will ever be infected with HIV/AIDS are quite slim. Therefore, corporations must become compassionate about the spread of HIV/AIDS and their treatment of employees who are infected. PMID- 10137542 TI - Purchasers look at physician hospital organizations. AB - Business leaders are finally seizing the opportunity to shape the future of this country's health care delivery system. One such system could be new, community based alliances known as physician hospital organizations. PMID- 10137543 TI - Nursing's role in health care reform. PMID- 10137544 TI - What employers can do about pharmaceutical costs. AB - As costs for drugs continue to rise, employers are developing successful strategies to hold down this expense. Because these strategies involve controlling drug use, employers need to take measures to limit their liability for negligence. PMID- 10137545 TI - How employee surveys can improve health plans. PMID- 10137546 TI - Why Blue Cross is setting up new HMOs. PMID- 10137547 TI - Courts rule HMOs cannot be sued for negligence. PMID- 10137548 TI - Making the most of what doctors know. PMID- 10137549 TI - What to look for in a managed eye care plan. PMID- 10137550 TI - Lessons from Hawaii's health care system. AB - Hawaii has 20 years of experience with employer mandates and universal access. With the U.S. Congress considering the controversial issue of whether to require companies to provide health insurance for employees, Hawaii's approach to health care has some valuable lessons. PMID- 10137551 TI - Competing for patients: understanding consumer evaluation of primary care. AB - The introduction of a competitive market into primary care means that general practitioners must consider the way in which their patients evaluate the service which they receive. Reports the results of an exploratory study carried out in Scotland to investigate the evaluative strategies used by patients in assessing the service they receive. Identifies six particular dimensions of the care process which have implications for GPs protecting their existing patient lists and in understanding how to attract new patients. Suggests through its results that while communicating certain features of the service to potential patients is relatively straightforward, the experiential nature of primary care services leads to a reliance on word-of-mouth communication which depends on ensuring that existing patients are satisfied. PMID- 10137552 TI - Public health medicine and the district health authority. AB - The 1991 National Health service reforms have greatly changed the role of district health authorities. These bodies employ most public health physicians in England and thus the focus of public health departments has changed with the reforms. Presents the results of a series of semi-structured interviews with the board members of two health authorities about the role of public health. Board members outlined several roles for the specialty including defining key issues, interpreting technical issues, intelligence gathering, developing links with clinicians and legitimizing health authority decisions. There were some concerns about the corporacy of public health departments. There was a great deal of support for health promotion, but some reluctance to be drawn into political issues. Also explored were alternative sources of advice on health policy, such as the views of general practitioners. PMID- 10137553 TI - Out-patient case mix: a survey of user requirements. AB - Research and development of out-patient case mix systems, to plan and monitor resource use in the out-patient sector, has hitherto not been accorded priority in the NHS. As part of an investigation of their usefulness, a survey of NHS professionals' requirements for out-patient case mix was conducted. The results confirmed that there was support for developing out-patient case mix systems, although different users had different requirements. However, a common theme to emerge was the desirability of constructing holistic systems which cover in patient, day-case and out-patient care. Additionally, development of care packages was seen as a necessary first step in constructing systems for out patient care. Concludes that visit-based case mix systems are unlikely to fulfil users' requirements and recommends that case mix contracting projects by Healthcare Resource Groups should be extended to the out-patient sector, but must recognize that existing systems do not meet users' requirements. PMID- 10137554 TI - Beyond the business plan. AB - Acknowledges that business planning in the NHS frequently disappoints. Reasons for this are found in the tendency for managers to view the production of a plan as an end rather than a means. A further difficulty resides in the perception managers have of their world. Argues that marketing is the most appropriate paradigm for understanding and structuring this world at present. However, an adaptive cognitive style is necessary to allow constant reframing within the dominant paradigm or even reframing of the paradigm itself. In adopting these approaches, the probability of achieving competitive advantage is heightened. If they are ignored, however, it is likely that training and development techniques, however sophisticated, will have little lasting impact. PMID- 10137555 TI - Occupational health provision for NHS staff: users' opinions about its roles. AB - In 1990, 682 staff (61 per cent response without reminder) employed by 17 districts in the North Western Health Authority were surveyed to discover both their awareness of the existence of the Occupational Health Service and other relevant agencies, and their views about the principal roles of this service. There were replies from staff in six main occupational groups. The results showed clearly that most employees are aware of the existence of the service as a compulsorily provided general practice, while a small group of managers thought of it as a management tool to assist them in controlling their workforce. There was some significant occupational variation which pointed to the same direction- the strong curative image the service has among its clients. The most important conclusion derived from this research is the urgent need to expand NHS staff expectations towards more preventive activities the Occupational Health Service might and should provide. PMID- 10137556 TI - Prioritizing services: GPs' views, fundholders versus non-fundholders. AB - Aims to assess the level of agreement between priorities of service provision in 20 discrete clinical areas, as laid out in a district health authority (DHA) purchasing plan, and the views of GPs in the catchment area of that authority and to test for a statistically significant difference between the views of fundholding and non-fundholding GPs. A 74 per cent response rate was achieved, and analysis suggested that local GPs' views were broadly in line with their DHA strategy, and that a significant difference existed between the views of fundholders and non-fundholders in only one treatment area, namely that of lithotripsy. Concludes that the postal questionnaire is a cheap and easy method of assessing the views of GPs on prioritizing issues. As yet there is little difference between fundholding and non-fundholding GPs in this area of decision making. PMID- 10137557 TI - Hospital management in the 1990s: fundholding consultants? AB - Explores a model of clinical management which attempts to cope with the management-professional conflict and seeks to enable the hospital to run effectively and efficiently. Two key goals are identified for the hospital which are: to support consultant staff and provide physical and emotional support for patients. Notes that clinical services do not lend themselves to bureaucratic management and that there needs to be two distinct and parallel organizations within the hospital. Outlines the new structure for clinical service management. PMID- 10137558 TI - Contracting for services and limits to managed competition. AB - The introduction of market forces into the NHS has led to an operational divorce between health care providers and those who need health-care. Central to this change has been the widespread use of contracts. As a management problem, contract negotiation must incorporate consideration of full cost recovery to establish prices for hospital services sold and to ensure that available information is employed in assessing external services purchased. Ignoring the important issue of information availability in identifying relevant costs, it is the difficulty in specifying the cost of an episode of treatment, for example, that has led to contracts being negotiated in block form. Argues that this may be the only contract that can be effectively established. An important consequence of this is that the complexity of hospital services and requirements will work against a wider implementation of piecemeal managed competition and will form a natural barrier to market forces in the NHS. PMID- 10137559 TI - Business planning: can the health service move from strategy into action? AB - Advances the case for the use of one particular business planning technique within a National Health Service Trust. At the present time, NHS trusts are required to write strategic direction statements. Evidence suggests that these documents provide an accurate account of past performance and present position of the trust, but do not express the future position intended to be achieved. These documents also tend to be lengthy and lack strategic focus, which means that they are not helpful to managers who want clear organizational goals and objectives to which to work. Attempts to address the difficulties associated with determining how existing skills and resources can be used as the platform for future growth strategies by using the Ansoff Matrix and SWOT Analysis planning tools, given the external changes in the marketplace. Also attempts to shed light on some of the important links between busines strategy and management development by extending planning theory into practice. PMID- 10137560 TI - Fundholding in Northern Region: practice managers' views. AB - Describes the views of practice managers in 30 fundholding practices in the Northern Region concerning their role in the scheme. A self-completion questionnaire was mailed to practice managers and general practitioners containing questions designed to elicit their views about changes in relationships inside and outside the practice; their level of involvement in various aspects of fundholding; and the costs and benefits of the scheme. A total of 30 first-, second-, and third-wave fundholding practices in the Northern Region, June 1993 were involved. Replies were received from 22 practice managers (73 per cent) and 83 general practitioners (49 per cent). Concludes that although fundholding has increased the nature and volume of the workload of practice managers, these changes do not appear to be causing any tensions between managers and clinicians. At the moment fundholding extends the support role of practice managers and does not alter existing authority relations in practices. PMID- 10137561 TI - The market and health sector reform. AB - A new international orthodoxy has developed on health sector reform. The dominant theme of the orthodoxy is the alleged benefits of market style reforms for health development. This is shaping changes formulated, and being implemented, in the British NHS and other European health services (including Central and Eastern Europe), Latin America and a number of developing health systems in Africa and Asia. Sets out a ten-point description of the orthodoxy. Contends that the orthodoxy is showing distinct signs of restricting the analysis and development of health management and planning. This is a matter for considerable concern as the adoption of market-style reforms can generate unforeseen and, in some cases, negative consequences. There is clearly a need for strengthening management research and development as a basis for effective health sector reform. PMID- 10137562 TI - Specifying quality in health care. AB - Quality should be a central issue in the commissioning and provision of health care. This requires a systematic approach to defining and monitoring quality. Such an approach should address: quality characteristics such as efficiency, accessibility, effectiveness (which may conflict with each other); the several levels at which quality may be specified, from general (across all health care) to specific (particular conditions or patient groups); and the methods of quality monitoring which include documented policies, clinical audit, inspection visits/patient surveys, and routine information returns. Shows how a matrix for quality surveillance can be devised which provides a framework for purchasers and providers to work together in developing quality in health care. PMID- 10137563 TI - Towards better practice management: a national survey of Scottish general practice management. AB - Surveys a 50 per cent sample of Scottish practices (stratified by health board area), concerning whether they had a practice manager and who had responsibility for practice management tasks. The overall response rate was 73 per cent, with 63 per cent of responding practices employed a practice manager. Reports the findings from practices employing a manager, and reveals marked variations in levels of managers pay and responsibility. The development of practice management structures varied with only 85 per cent of practices holding regular practice management meetings. The results suggest that practices which previously coped without a manager have recognized the need for one as the complexity of practice administration increases and that the traditional career path of managers involving internal promotion is changing. PMID- 10137564 TI - Knowledge into practice: what's the problem? AB - It is now widely accepted that there is a problem in putting research findings into routine clinical practice. Approaches the topic by identifying the conditions which would have to be met for the "perfect" implementation of such findings, and by outlining some of the research findings concerning each of these. Concludes that research to date has concentrated on certain of these conditions at the expense of others. PMID- 10137565 TI - Revisiting an "old" solution to the high costs of maternity care. AB - This article examines the high costs of maternity care in the United States and proposes an old fashioned solution--the midwife. Particular attention is given to the costs associated with poor birth outcomes, such as prematurity and low birthweight infants. Literature is reviewed that demonstrates certified nurse midwives have achieved a reduction in these poor birth outcomes. Projections of cost savings resulting from these better outcomes are also presented. PMID- 10137566 TI - Considerations under capitated behavioral health care services. AB - A leading concern in the health care marketplace is the sharp cost increases associated with behavioral health care benefits over the past few years. Payers are desperately seeking alternative approaches for holding down managed behavioral health care costs and improving the quality of care. Many are focusing their attention on an integrated delivery system with capitated arrangements and direct contracting. The author discusses the requirements to succeed in this new delivery system. PMID- 10137567 TI - Managed Care College: a continuing education program for primary care clinicians. AB - This paper provides an overview of the Metro Medical Group Managed Care College- a new program of continuing medical education in primary care, created by the organization to improve the care it provides and demonstrate a new model that might serve as a prototype for other managed care organizations. PMID- 10137568 TI - A conversation with Debra Dullinger, PharmD. AB - Dr. Dullinger is the Vice President, Pharmacy Programs, Pharmacy Gold, Inc., a large pharmacy benefit management (PBM) company headquartered in St. Paul. An active player in the field of managed care pharmacy benefits and a keen observer of the recent spate of PBM-pharmaceutical company activity, the Journal sought her perspective on the current environment and the changing role of the PBM in the health reform environment. PMID- 10137569 TI - Redistribution of risk throughout the pharmaceutical industry. AB - When the pharmaceutical industry awoke to the reality of managed care, they found themselves spending millions of dollars on a customer they did not know or understand. Those companies did not realize that insurers and managed care organizations would be changing the entire face of the pharmaceutical industry. Nonaggressiveness by pharmaceutical manufacturers has meant loss of control by an industry that for many years existed in an unchallenged state. Partnerships are now tantamount to survival. PMID- 10137570 TI - Filling in the primary care gaps. AB - More than 50,000 nurse practitioners and physician assistants now provide care in all 50 states. Through advancements in training programs, physician and consumer acceptance, and governmental legislation, managed care organizations benefit from the continued growth of utilization of these "mid-level" providers. The author provides some background on the certification of these professionals and offers reasons for their increasing popularity across the country. PMID- 10137571 TI - Unleashing the potential of subacute care. AB - The emergence of subacute care as a legitimate setting for certain patients is attracting the attention of payers and providers in local delivery systems. The author suggests that incorporating subacute care within the continuum of services can have specific and immediate payoffs for payers and providers alike. The article explores alternative ways in which hospitals can provide subacute care and proposes an approach that involves the formation of a hospital subacute care organization with a long-term care provider. PMID- 10137572 TI - Feeling fit: preventing illness and improving quality. AB - Throughout the current American health care system, the use of modern medical technology and medications to treat illness are highlighted, with relatively little attention focused on health education. The Feeling Fit program at Independent Health is a step toward a managed care model that integrates treatment with teaching. The author discusses the principles of Feeling Fit and how they have been successfully adapted for off-site programs. PMID- 10137573 TI - Report card released for Greater Cleveland hospitals. PMID- 10137574 TI - The cost and prevalence of diabetes. PMID- 10137575 TI - Demographic changes in the labor force and subsidized health care costs. PMID- 10137576 TI - Who will become the system integrators as health care delivery systems reinvent themselves? AB - The author's main point is that the primary impetus for success is effective system integration, rather than the issue of size. Bigger is not necessarily better, even if his company, MetLife, has agreed to merge its health care operations with the Travelers', creating the nation's largest health insurance payer. PMID- 10137577 TI - The emerging managed care paradigm: health care in transition. AB - Defining business objectives is never easy. However, with market reform exceeding any realizable promise of governmental reform, the rapid evolution of health care may seem daunting. The Table presented by the author helps conceptualize where we are and where things seem to be moving. It incorporates issues of interest to the health care business manager, developer, provider, and informed consumer. PMID- 10137578 TI - What can physicians do to improve patient compliance? AB - The objective of this study was to determine the extent to which physicians are instructing patients about their medications. Using a telephone survey of approximately 2,000 adults, it was determined that whereas physicians are doing an excellent job in some areas of patient counseling on pharmaceuticals, they are lacking in other areas. PMID- 10137579 TI - Justifying the cost of pharmacy's clinical services. AB - Internally, when pharmacy managers have attempted to argue for the positive contribution of pharmacy on hospital and physician costs, they were generally unable to definitively prove the linkage between drug use and outcome. They were, however, able to demonstrate an ability to reduce the overall pharmacy program costs by applying a full array of cost-containment strategies to their internal executives as well as plan sponsor's benefit managers and consultants. PMID- 10137580 TI - Surviving the bite of health care reform: the future for dental benefits. AB - Dental benefits are not in the eye of the storm over cost and availability of health benefits. However, actions to reform health care on the state and federal level will affect the dental benefit market. Rather than having a direct effect, the potential is for health care reform to inadvertently devastate the dental benefits market and reduce the overall oral health of the nation. PMID- 10137581 TI - Court challenge to HCFA's authority to approve state health care reform initiatives. PMID- 10137582 TI - Changing systems of external monitoring of quality of health care in the United States. PMID- 10137583 TI - Qualitative methods for assessing health care. PMID- 10137584 TI - Total hip replacement. PMID- 10137585 TI - The purchaser role in provider quality: lessons from the United States. PMID- 10137586 TI - Knowing the knowledge. PMID- 10137587 TI - Views of survivors of stroke on benefits of physiotherapy. AB - OBJECTIVE: To describe the components of physiotherapy valued by survivors of a stroke. DESIGN: Qualitative study using in-depth interviews. SETTING: Two adjacent districts in North East Thames Regional Health Authority. PATIENTS: 82 survivors of stroke taken consecutively from a stroke register when they reached the tenth month after their stroke, 40 of whom agreed to be interviewed. MAIN MEASURES: Content analysis of interviews. RESULTS: Patients who agreed to the interview were significantly less likely to be disabled 12 months after stroke than those who did not. Twenty four patients had received physiotherapy, and these were more disabled than those who had not. Patients appreciated physiotherapy. It was believed to bring about functional improvement; the exercise component was valued because it was perceived to keep them active and busy and exercise programmes to follow at home were also valued for the structure they gave to each day; and therapists were considered a source of advice and information and a source of faith and hope. CONCLUSIONS: Many of the positive aspects of caring which patients described in the context of physiotherapy could be incorporated into the mainstream of rehabilitation care and training. However, health professionals need to be careful not to promote false expectations about recovery. IMPLICATIONS: The outcome of treatment is of critical importance to patients and should become a central dimension of patient satisfaction questionnaires. The impact of physiotherapy is not confined to reducing physical disability but may also affect wellbeing. The choice of outcome measures in rehabilitation research should reflect this situation. PMID- 10137588 TI - Lack of knowledge in health professionals: a barrier to providing information to patients? AB - OBJECTIVE: To assess obstetricians' and midwives' knowledge of routine prenatal screening tests for fetal abnormality and factors associated with such knowledge. DESIGN: Questionnaire assessment of antenatal clinic staff. SETTING: Six hospitals within the United Kingdom (four district general hospitals in London, one district general hospital in Wales, and one teaching hospital in Wales), offering routine prenatal screening tests. SUBJECTS: 29 obstetricians and 97 midwives were invited to participate, of whom 21 and 70 respectively responded to the questionnaire. MAIN MEASURES: Knowledge of prenatal tests, according to 19 item multiple choice questionnaire, reluctance to disclose uncertainty, and clinical experience. RESULTS: The overall response rate was 72% (91/126). In all, 43% of midwives and 14% of obstetricians obtained correct responses on fewer than half the items. Reluctance to disclose uncertainty to patients was associated in obstetricians with having less knowledge about prenatal testing (r = -0.50; p < 0.025, Pearson product moment correlation) and in midwives with more clinical experience (r = 0.43; p < 0.001). CONCLUSIONS: Lack of knowledge and greater clinical experience seem to be important barriers to providing patients with information about prenatal screening tests. PMID- 10137589 TI - Evaluation of patients' knowledge about anticoagulant treatment. AB - OBJECTIVE: To develop a questionnaire to evaluate patients' knowledge of anticoagulation. DESIGN: Anonymous self completed questionnaire study based on hospital anticoagulant guidelines. SETTING: Anticoagulant clinic in a 580 bed district general hospital in London. SUBJECTS: 70 consecutive patients newly referred to the anticoagulant clinic over six months. MAIN MEASURES: Information received by patients on six items of anticoagulation counselling (mode of action of warfarin, adverse effects of over or under anticoagulation, drugs to avoid, action if bleeding or bruising occurs, and alcohol consumption), the source of such information, and patients' knowledge about anticoagulation. RESULTS: Of the recruits, 36 (51%) were male; 38(54%) were aged below 46 years, 22(31%) 46-60, and 10(14%) over 75. 50 (71%) questionnaires were returned. In all, 40 respondents spoke English at home and six another language. Most patients reported being clearly advised on five of the six items, but knowledge about anticoagulation was poor. Few patients could correctly identify adverse conditions associated with poor control of anticoagulation: bleeding was identified by only 30(60%), bruising by 23(56%), and thrombosis by 18(36%). Only 26(52%) patients could identify an excessive level of alcohol consumption, and only seven (14%) could identify three or more self prescribed agents which may interfere with warfarin. CONCLUSION: The questionnaire provided a simple method of determining patients' knowledge of anticoagulation, and its results indicated that this requires improvement. IMPLICATIONS: Patients' responses suggested that advice was not always given by medical staff, and use of counselling checklists is recommended. Reinforcement of advice by non-medical counsellors and with educational guides such as posters or leaflets should be considered. Such initiatives are currently being evaluated in a repeat survey. PMID- 10137590 TI - Effect of guidelines on management of head injury on record keeping and decision making in accident and emergency departments. AB - OBJECTIVE: To compare record keeping and decision making in accident and emergency departments before and after distribution of guidelines on head injury management as indices of implementation. DESIGN: Before (1987) and after (1990) study of accident and emergency medical records. SETTING: Two accident and emergency departments in England. PATIENTS: 1144 adult patients with head injury in department 1 (533 in 1987, 613 in 1990) and 734 in department 2 (370, 364 respectively). MAIN MEASURES: Recording of relevant symptoms and signs as determined in the guidelines; presence of, indications for, and rates and appropriateness of skull x ray examination and admission. RESULTS: The median number of guidelines variables recorded for all study periods ranged from 7 to 9 out of a possible maximum of 27. For key decision making variables the presence or absence of penetrating injury was least likely to be recorded (< or = 1%) and that of loss of consciousness most likely (> or = 75%). Altogether, the proportion of patients receiving skull x ray examination or admitted varied from 25%-60% and 7%-23% respectively; overall, 69% (1280/1856) and 64% (1177/1851) of patients were managed appropriately. However, no consistent change occurred in the departments between the study periods. For instance, in department 1 the proportion of appropriate x ray examinations rose significantly after distribution of the guidelines (from 61% (202/330) to 73% (305/417)) and appropriate decisions on whether to x ray or not also rose (from 65% (340/522) to 72% (435/608)). There was no significant change in department 2, although the proportion of appropriate admissions fell (from 33% (55/166) to 15% (19/130)). CONCLUSIONS: Recording practice and decision making were variable and had not consistently improved after dissemination of the guidelines. Strategies are required to ensure effective implementation of guidelines. PMID- 10137591 TI - Regional organisational audit of district departments of public health. AB - Organisational audit of public health in the United Kingdom is rare. To provide a framework for a structured organisational audit in district public health departments in one region organisational factors contributing to efficient, high quality work were identified and compared between districts, enabling each department to identify its organisational strengths and weaknesses. A draft list of organisational factors, based on the King's Fund organisational audit programme, were rated by 52 public health physicians and trainees in 12 district public health departments in South East Thames region for their importance on a scale of 0 (not relevant) to 5 (vital). Factors with average ratings of > 4, judged to be "vital" and proxies for standards, were then used to compare each district's actual performance, as reported by its director of public health in a self reported questionnaire. In all, 37 responses were received to the rating questionnaire (response rate 71%) and 12 responses to the directors' questionnaire. Of the 54 factors identified as vital factors, 20(37%) were achieved in all 12 districts and 16(30%) in all but one district; 18 were not being achieved by two (33%) districts or more. Overall, vital factors were not being achieved in 9% of cases. The authors concluded that most departments are achieving most vital organisational factors most of the time, but improvement is still possible. The results have been used as a basis for planning the organisation of public health departments in several of the newly formed commissioning agencies. This was the first regional audit of public health of its kind performed in the region and it provided valuable experience for planning future regional audit activity. PMID- 10137592 TI - External monitoring of quality of health care in the United States. PMID- 10137593 TI - Raising awareness of quality in the NHS. PMID- 10137595 TI - Auditing for patients. PMID- 10137594 TI - Clinical Standards Advisory Group. PMID- 10137596 TI - Involving patients in clinical audit. PMID- 10137597 TI - Achievements with quality improvement in the NHS. PMID- 10137598 TI - Achievements of audit in the NHS. PMID- 10137599 TI - Quality: the Jurassic Park experience. PMID- 10137600 TI - Building quality into contracting and purchasing. PMID- 10137601 TI - Quality: link with effectiveness. AB - In summary, though the notion of "quality of care" has become fashionable, most of the focus has been on initiatives such as the patient's charter, waiting times, quality of the physical environment, patient centredness in outcomes measurement, etc. Nevertheless, at the heart of quality must be the effectiveness and cost effectiveness of interventions. Without ensuring that health technologies are effective and are delivered appropriately then many of the other dimensions of quality may simply be window dressing. Substantial variations in the rates of procedures, the way in which similar patients are treated, and the degree to which professionals often ignore the best scientific evidence have all been well documented. The NHS needs methods for ensuring that the effectiveness dimension of quality is brought to the fore and becomes a routine part of quality assessment and activity. Clinical autonomy can no longer be an excuse for inappropriate care. The challenge for the future is twofold: to increase the amount of health technology assessment carried out and to develop methods of ensuring that health care converges with this best practice--that is, the promotion of evidence based practice. By introducing evidence based clinical guidelines and associated utilisation review and persuading purchasers to "purchase protocols" rather than just procedures the effectiveness dimension may become more routine, but it will require a radical rethink of the type of data collected and the way in which the purchaser provider split is managed. PMID- 10137602 TI - Spreading the word: information for quality. PMID- 10137603 TI - Patient defined outcomes. PMID- 10137604 TI - Health care transformation and the case for a community-wide health information management environment. AB - The transformation of the health care delivery system in local, metropolitan, and regional markets is progressing rapidly. This transformation is fueled by competition, the shift of financial risk to the provider continuum, employer demands for cost containment, and the breadth and depth of state and federal government reform initiatives. However, information systems do not yet exist to support these transformations. We propose establishing a new community-level information management environment and new measures of health care system performance. PMID- 10137605 TI - Data collection strategies for patient-reported information. AB - The U.S. health care transition demands increased accountability for medical care. This has contributed to increased interest in documenting medical outcomes, including improvements in health-related quality of life and treatment satisfaction. These data can only be obtained by asking patients directly about their current health state, perception of well-being, and satisfaction with care. Systematic collection of patient-reported data is often poorly done because its demands are underestimated and inadequately supported. Rigorous quality assurance is critical in any clinical trial or treatment delivery evaluation program. PMID- 10137606 TI - The comprehensive health enhancement support system. AB - This article describes the process of using needs assessment data to develop an interactive information technology specifically designed to support patients in a health-related crisis. The Comprehensive Health Enhancement Support System (CHESS) is an interactive information, social support, and problem-solving system that was developed by a team at the University of Wisconsin. This article looks at the program developed for breast cancer patients and their families. PMID- 10137607 TI - Assessing organizational performance. AB - To achieve unprecedented levels of performance, health care organizations may have to redesign the process by which they generate performance-related information and redefine the content of the information itself. In this article, we suggest several principles for accomplishing these objectives. PMID- 10137608 TI - Information management and quality improvement: the Joint Commission's perspective. AB - Health care is an information-intensive endeavor. Its improvement is even more information intensive. The core processes of health care and their improvement are dependent on effective and efficient management of information in health care organizations and integrated health care networks. The authors describe a framework for effective information management in health care organizations and discuss the implications of a framework for improving performance on information management. PMID- 10137609 TI - The Malcolm Baldrige National Quality Award concept: could it help stimulate or accelerate health care quality improvement? AB - The United States has a major weapon in the battle to improve competitiveness: The Malcolm Baldrige National Quality Award Program. An increasingly asked question in industrial and health care sectors is whether there should be a Baldrige Award in health care. In the business community, the Baldrige Award has been a catalyst for cooperative development of quality criteria, assessment mechanisms, and continuous learning, greatly accelerating the pace of information sharing. PMID- 10137610 TI - Tutorial: planning for data collection. Part II: Designing the study. AB - Part II of this three-part tutorial focuses on the logistics of data collection. The author presents a checklist of things to consider when planning the details of a data collection effort; touches on the topics of bias and stratification; discusses examples of popular data collection methods; and points out some common pitfalls in data collection, offering practical tips on how to avoid them. PMID- 10137611 TI - Janet M. Corrigan, Ph.D.. Interview by Marie E. Sinioris. AB - The ability of health care purchasers and consumers to make objective evaluations and comparisons of health plan performance is a critical element in achieving competition based on quality and value. The Health Plan Employer Data and Information Set, commonly referred to as HEDIS 2.0, is a step toward making such evaluations and comparisons possible. To get an inside perspective on HEDIS and its implications for health care, QMHC interviewed Janet Corrigan, Ph.D., Vice President, Planning and Development, National Committee for Quality Assurance (NCQA). Dr. Corrigan is in charge of NCQA's efforts to implement and continually improve HEDIS. PMID- 10137612 TI - Health care: the 'con' that failed. PMID- 10137613 TI - Health care report cards. How good are the HMOs your company chooses? PMID- 10137614 TI - The effectiveness of health care cost management strategies: a review of the evidence. AB - This Issue Brief discusses the evolution of the health care delivery and financing systems and its effects on health care cost management and describes the changes in the health care delivery system as they pertain to managed care. It presents empirical evidence on the effectiveness of managed care and concludes with an analysis of the potential of future health care reform to influence the evolution of the health care delivery system and affect health care costs. Between 1987 and 1993, total enrollment in health maintenance organizations (HMOs) increased from 28.6 million to 39.8 million, representing an additional 11.2 million individuals, or 4 percent of the U.S. population. At the same time, new forms of managed care organizations emerged. Enrollment in preferred provider organizations increased from 12.2 million individuals in 1987 to 58 million in 1992, and enrollment in point-of-service plans increased from virtually none in 1987 to 2.3 million individuals in 1992. In addition, the percentage of traditional fee-for-service plans with some form of utilization review increased to 95 percent in 1990 from 41 percent in 1987. Measuring the effects of the changing delivery system on the costs and quality of health care services has been a difficult task, resulting in considerable disagreement as to whether or not costs have been affected. In a recent report, the Congressional Budget Office recognizes two new major findings. First, managed care can provide cost-effective health care at a level of quality comparable with the care typically provided by a fee-for-service plan. Second, independent practice associations can be as effective as group- or staff-model HMOs under certain conditions. In the future, we are likely to see a continued movement of Americans into managed care arrangements, an increase in the number of physicians forming networks, a reduction in the number of insurers, an increase in the number of employers joining coalitions to purchase health care services for their employees, and a health care system that is generally more concentrated and vertically integrated. PMID- 10137615 TI - Checklist helps C-R-E-A-T-E a successful CPR (computer-based patient record). PMID- 10137616 TI - Survey results indicate CPR (computer-based patient record) is making headway. PMID- 10137617 TI - CPR (computer-based patient record) development tunnel longer than expected. PMID- 10137618 TI - HotList. Outcomes effectiveness measurement. AB - October's HotList features Outcomes Effectiveness Measurement products. All data have been provided by individual vendors responding to survey questions. Health Management Technology has made every effort to contact all vendors within this market. Of 80 vendors contacted, 31 responded as offering outcomes effectiveness measurement products. A full contact list may be requested by calling HMT editorial at (303) 220-0600. See The 1994 Health Management Technology Market Directory for complete listings. PMID- 10137619 TI - Waste management in an urban medical center: the Mount Sinai program. PMID- 10137620 TI - Air pollution control for the year 2000 (the new dry scrubber cartridge collector control system). PMID- 10137621 TI - Energy efficiency survey of Colorado hospitals. PMID- 10137622 TI - United States Postal Service: mailability of sharps and other used medical devices. PMID- 10137623 TI - AHA's comments and recommendations to the U.S. EPA's draft medical waste incinerator regulations. AB - The following summarizes specific recommendations with respect to the requested regulatory changes discussed above: 1. Either defer publishing the proposed regulations or exclude the emission limits from the proposed regulations until they have been properly established based upon the specific requirements of Sections 111 and 129. 2. Establish the the emission limits on the basis of proper technical analyses, using all necessary data and information which are readily available, and after consulting with state APC agencies as required under Section 111(f)(3). 3. Establish emission limits and requirements for new facilities based upon actual "systems" and according to size classifications. 4. Establish emission limits and requirements for existing facilities using the full range of available data to establish MACT levels according to size classifications. Exclude LAER facilities in the MACT analysis as required under Section 129. 5. Properly account for technical achievability and applicability in setting limits for the various size categories. 6. Properly account for cost and risk implications in establishing emission limits as required under Sections 111 and 129. It is important to highlight that when specific emission values are identified from test data or elsewhere for the in establishing emission limits for new and existing MWIs, it is critical that a proper factor be applied to them as necessary to reflect standard deviations and statistical variables. A recommended methodology for this is included in the U.S. EPA document entitled, Combustion Emissions Technical Resource Document (CETRED), draft, EPA530-4-94 0114, May 1994, Chapter 5, "Determinations of Technically Achievable Emissions." Finally, it is recommended that the U.S. EPA reassess the technical feasibilities and cost implications of various other key issues which have been raised. Such reassessments could be done during the period that emission limits are reassessed and revised. PMID- 10137624 TI - Florida's study of state medical waste incinerator sitting requirements. PMID- 10137625 TI - Health care values or business values? PMID- 10137626 TI - Revealing rhetoric: an analysis of a health care executive's speech. PMID- 10137627 TI - Well-being: a philosophical basis for health services. AB - This paper develops and defends the claim that the promotion of human well-being is a philosophical basis or rationale for health services. It first sketches a case for this thesis, then defends it against various objections arising from the contrary position, here dubbed The Sceptical View. Later sections of the paper elaborate on the meaning of 'well-being', the nature of well-being, and the scope of appropriate health service concern with well-being. In particular, distinctions are made between 'thick' and 'thin' well-being, and between well being and its various measures. These discussions generate further defences of the philosophical centrality of human well-being to health services. PMID- 10137628 TI - Two paradoxes of caring: a response to Gorovitz. PMID- 10137629 TI - The management of illness--the need for health and social philosophy. PMID- 10137630 TI - Health care and chronic illness: a sociological view. PMID- 10137631 TI - International comparisons of health care systems: Part three. National surveys and organised international comparisons--the practical building blocks of national medical professions. PMID- 10137633 TI - To those seeking to follow in New Zealand's footsteps. PMID- 10137632 TI - Against manipulative campaigns by 'community based' AIDS organisations. PMID- 10137635 TI - Medicare home care coverage for the chronically ill and patients in need of home infusion therapy. PMID- 10137634 TI - Medicare home health care: the struggle for definition. PMID- 10137636 TI - Make art therapy a reality for the homebound. PMID- 10137638 TI - On the health care horizon. PMID- 10137637 TI - The mind-body-foundation connection. PMID- 10137639 TI - Medicare program; changes to the hospital inpatient prospective payment systems and fiscal year 1995 rates--HCFA. Final rule with comment period. AB - We are revising the Medicare hospital inpatient prospective payment systems for operating costs and capital-related costs to implement necessary changes arising from our continuing experience with the system. In addition, in the addendum to this final rule, we are describing changes in the amounts and factors necessary to determine prospective payment rates for Medicare hospital inpatient services for operating costs and capital-related costs. These changes are applicable to discharges occurring on or after October 1, 1994. We are also setting forth rate of-increase limits for hospitals and hospital units excluded from the prospective payment systems. Finally, we are revising the criteria used by the Medicare Geographic Classification Review Board (MGCRB) to decide on applications by hospitals for geographic reclassification for prospective payment purposes. PMID- 10137640 TI - Medicare program; criteria and standards for evaluating intermediary and carrier performance during FY 1994--HCFA. General notice. AB - In the September 30, 1993 issue of the Federal Register, we published a general notice with comment period describing the criteria and standards for evaluating intermediary and carrier performance in administering the Medicare program during FY 1994. This notice amends that document to require that contractors certify the accuracy and completeness of the information submitted to HCFA with respect to the evaluation process. PMID- 10137641 TI - Medicare program; criteria and standards for evaluating intermediary and carrier performance during FY 1995--HCFA. General notice with comment period. AB - This notice describes the criteria and standards to be used for evaluating the performance of fiscal intermediaries and carriers in the administration of the Medicare program beginning October 1, 1994. The results of these evaluations are considered whenever HCFA enters into, renews, or terminates an intermediary agreement or carrier contract or takes other contract actions (for example, assigning or reassigning providers of services to an intermediary or designating regional or national intermediaries). This notice is published in accordance with sections 1816(f) and 1842(b)(2) of the Social Security Act. We are publishing for public comment in the Federal Register those criteria and standards against which we evaluate intermediaries and carriers. PMID- 10137642 TI - Medicare and Medicaid programs; conditions of coverage for organ procurement organizations--HCFA. Interim final rule with comment. AB - This interim final rule with comment sets forth changes to the conditions of coverage for organ procurement organizations (OPOs). It redefines an OPO service area, revises the qualifications for the Board of Directors, specifies the assistance to be provided by an OPO to hospitals in establishing and implementing protocols governing organ procurement activity, requires an OPO to establish criteria for allocating organs, and requires an OPO to ensure that tests are performed on prospective organ donors to prevent the acquisition of organs that are infected with the etiologic agent for Acquired Immune Deficiency Syndrome. These changes are required by the Health Omnibus Programs Extension Act of 1988 (Public Law 100-607) and the Transplant Amendments Act of 1990 (Public Law 101 616). We also clarify the distinction between certification and designation and amend the criteria with respect to compliance with performance standards, change of ownership, and termination procedures. PMID- 10137643 TI - Medicare and state health care programs: fraud and abuse, civil money penalties and intermediate sanctions for certain violations by health maintenance organizations and competitive medical plans--HHS. Correction to final regulations. AB - This document corrects technical errors that appeared in 42 CFR part 1003 of the final rule published in the Federal Register on July 15, 1994 (59 FR 36072). Specifically, the final rule set forth the Secretary's authority to impose sanctions and civil money penalties on health maintenance organizations, competitive medical plans and other prepaid health plans contracting under Medicare and Medicaid. This correction notice sets forth the corrected text for sections 1003.100, 1003.103 and 1003.106, some of which was inadvertently omitted or amended. PMID- 10137644 TI - Medicaid program: outstation intake locations for certain low-income pregnant women, infants, and children under age 19--HCFA. Interim final rule with comment period. AB - This interim final rule interprets the statutory requirement that State Medicaid agencies must provide for receiving and initially processing Medicaid applications by certain low-income pregnant women, infants, and children under age 19 at locations other than those used for the receipt and processing of applications for Aid to Families with Dependent Children (AFDC). The statutory requirement also provides that the application form for these individuals must be different from the application form used for AFDC. The basis for the rule is section 1902(a)(55) of the Social Security Act, as added by section 4602(a)(3) of the Omnibus Budget Reconciliation Act of 1990. PMID- 10137645 TI - Medicaid program; drug use review program and electronic claims management system for outpatient drug claims--HCFA. Final rule. AB - This final rule revises some of the regulatory requirements for the drug use review (DUR) program for covered outpatient drugs furnished to recipients under the Medicaid program. The regulatory requirements became effective on January 2, 1993, as a result of an interim final rule with comment period that we published on November 2, 1992. Specifically, these revisions-- Clarify the definitions of overutilization, underutilization, consensus process, peer-reviewed literature, adverse medical result, adverse drug-drug interaction, appropriate and medically necessary, and individual medical history; Change the requirements for licensure of DUR board members, and telephone counseling arrangements for mail order pharmacies; Include non-prescription drugs in the consideration of alteration of therapeutic effect; Require hospitals to give assurances that they have met the requirements of the statute before claiming the hospital exemption from DUR; Specify the issues that State agencies must address when formulating counseling standards; Clarify the bases for DUR board recommendations; Clarify the distinction between DUR and surveillance and utilization review (SUR); and Make certain technical and editorial corrections. The November 1992 interim final rule with comment period incorporated and interpreted certain provisions of section 4401 of the Omnibus Budget Reconciliation Act of 1990. PMID- 10137646 TI - Collection from third party payers of reasonable costs of healthcare services- DoD. Final rule. AB - This final rule replaces the current method of per diem billings to one based on diagnostic related groups, expands the single outpatient billing category to as many as sixty, and expands the billing for outpatient services to include land ambulance service, air ambulance service and hyperbaric services. This final rule improves billing methods for both inpatient and outpatient care. This expansion creates a greater level of specificity which more accurately reflects the cost of the care provided. In addition, this final rule identifies additional outpatient services for which recovery of costs will be sought. PMID- 10137647 TI - Medicaid program; demonstration proposals pursuant to section 1115(a) of the Social Security Act; policies and procedures--HCFA and ACF. Public notice. AB - This public notice informs interested parties of (1) the principles the Department of Health and Human Services ordinarily will consider when deciding whether to exercise its discretion to approve or disapprove demonstration projects under the authority in Section 1115(a) of the Social Security Act, 42 U.S.C. section 1315(a); (2) the kinds of procedures the Department would expect States to employ in involving the public in the development of proposed demonstration projects under Section 1115; and (3) the procedures the Department ordinarily will follow in reviewing demonstration proposals. The principles and procedures described in this public notice are being provided for the information of interested parties, and are not legally binding on the Department of Health and Human Services. This notice does not create any right or benefit, substantive or procedural, enforceable at law or equity, by any person or entity, against the United States, its agencies or instrumentalities, the States, or any other person. PMID- 10137648 TI - Quality standards and certification requirements for mammography facilities--FDA. Interim rule; opportunity for public comment. AB - The Food and Drug Administration (FDA) is issuing regulations to implement the Mammography Quality Standards Act of 1992 (MQSA). The MQSA requires the establishment of a Federal certification and inspection program for mammography facilities; regulations and standards for accrediting bodies for mammography facilities; and standards for mammography equipment, personnel, and practices, including quality assurance. This regulation, which amends two previously published interim rules, modifies and adds to the definitions previously set forth. In addition, the interim rule provides a mechanism to request permission to meet alternative requirements, other than those previously set forth, if the proposed alternative requirement is at least as effective as the existing quality standards in achieving quality mammography services for women. PMID- 10137649 TI - Civilian Health and Medical Program of the Uniformed Services (CHAMPUS); continued health care benefit program--DoD. Final rule. AB - This final rule establishes a Continued Health Care Benefit Program (CHCBP) for certain DoD and other Uniformed Services health care beneficiaries who lose eligibility for health care in the Military Health Services System (MHSS). It also provides for use of the CHAMPUS benefit structure and CHAMPUS rules and outlines procedures for the CHCBP. PMID- 10137650 TI - Medicare program; Medicare coverage of screening mammography--HCFA. Final rule. AB - This final rule revises interim final regulations on Medicare coverage of screening mammography that were published in the Federal Register on December 31, 1990 (55 FR 53510). Those regulations implemented section 4163 of the Omnibus Budget Reconciliation Act of 1990, setting forth payment limitations and conditions for coverage of screening mammography. The conditions consist of quality standards to ensure the safety and accuracy of screening mammography services performed by qualified physicians and other suppliers of these services. As a result of the implementation of the Mammography Quality Standards Act of 1992 (MQSA) by the Food and Drug Administration (FDA), we are conforming the conditions for coverage to the applicable FDA certification requirements that all Medicare suppliers of services must meet effective October 1, 1994. The revisions in this final rule also respond to certain comments we received on the interim final rule published on December 31, 1990; they provide clarification of certain of its provisions; and they establish conditions for coverage of diagnostic mammography that are similar to those we have established for screening mammography. In addition, this final rule reflects changes resulting from the final rule on the fee schedule for physicians' services, which was published in the Federal Register on December 2, 1993 (58 FR 63626). PMID- 10137651 TI - Medicare program; qualified health maintenance organizations: technical amendments--HCFA. Final rule with comment period. AB - This rule clarifies and updates portions of the HCFA regulations that pertain to Federal qualification and continued regulation of health maintenance organizations (HMOs), inclusion of qualified HMOs in employee health benefits plans, and the administration of outstanding loans and loan guarantees that were awarded before October 1, 1986, under the Public Health Service Act (PHS Act). This rule is part of a special project to clarify and update all of 42 CFR part 417, which contains the regulations applicable to all entities that provide prepaid health care, that is, HMOs, CMPs (competitive medical plans) and HCPPs (health care prepayment plans). These are technical and editorial changes that do not affect the substance of the regulations. They are intended to make it easier to find particular provisions, to provide overviews of the different program aspects, and to better ensure uniform understanding of the rules. PMID- 10137652 TI - Federal employees health benefits program: debarment--OPM. Final rule. AB - The Office of Personnel Management (OPM) is issuing final regulations to incorporate into regulations the statutory requirement that carriers in the Federal Employees Health Benefits (FEHB) Program may not deny claims for services or supplies due to the debarment of the providers who supplied them if the claimants could not have known that the provider was debarred. The purpose of these regulations is to comply with the provision of law that requires OPM to prescribe regulations on this issue. PMID- 10137653 TI - Civilian Health and Medical Program of the Uniformed Services (CHAMPUS); FY95 DRG updates--DoD. Notice of DRG revised rates. AB - This notice provides the updated adjusted standardized amounts, DRG relative weights, outlier thresholds, and beneficiary cost-share per diem rates to be used for FY 1995 under the CHAMPUS DRG-based payment system. It also describes the non regulatory changes made to the CHAMPUS DRG-based payment system in order to conform to changes made to the Medicare Prospective Payment System (PPS). PMID- 10137654 TI - Guidelines for preventing the transmission of Mycobacterium tuberculosis in health-care facilities, 1994--CDC. Notice of final revisions to the "Guidelines for Preventing the Transmission of Mycobacterium Tuberculosis in health-care facilities, 1994". AB - The purpose of this notice is to print the final "Guidelines for Preventing the Transmission of Mycobacterium tuberculosis in Health-Care Facilities, 1994," and a summary of comments and responses to those comments. PMID- 10137655 TI - Health care's road show. PMID- 10137656 TI - A 50 per cent solution? PMID- 10137657 TI - Abortion: the tail wagging the dog. PMID- 10137658 TI - Not much wiggle room on abortion. PMID- 10137659 TI - The spoils of reform. AB - The nation's most prestigious medical schools and teaching hospitals like the idea of comprehensive health care reform. And little wonder: Thanks to aggressive lobbying and some powerful friends, they seem to have gotten just about everything on their wish list--and then some--in the leading reform plans now under consideration on Capitol Hill. PMID- 10137660 TI - Health reform losing the middle class. PMID- 10137661 TI - A voice, at last, for America's caregivers. PMID- 10137662 TI - Now it's time to play the blame game. PMID- 10137663 TI - The second wave. AB - The interest groups that helped defeat health care reform aren't uncorking the champagne yet. Some fear a new push for regulation and cost cutting in Washington and in state capitals. And some want to salvage pieces of the President's reform plan that would have benefited them. PMID- 10137664 TI - Doctors' lobby tries to heal itself. PMID- 10137665 TI - Signs of life in the wreckage. PMID- 10137666 TI - The RT: multi-skilled professional. Part III--Contract and self-employment. PMID- 10137667 TI - Structuring CQI processes within the laboratory: a case study from microbiology. PMID- 10137668 TI - The clinical laboratory of the future: re-engineering laboratory services. AB - Re-engineering of the process to deliver laboratory services to patients is essential to meet the pressures for patient-focussed care and cost control. Re engineering requires that laboratory staff abandon their current thinking and assumptions about organization, roles, procedures, skills and tools to focus on a totally new way of delivering value to the patient. The rewards are high for the organization. The risks must be managed by following a proven approach. The opportunities for personal development are exciting. PMID- 10137669 TI - Today's ARTs: facing challenges and seizing opportunities. Part I. PMID- 10137670 TI - Shared governance and imaging: "pyramid power" revisited. AB - Shared governance is a concept that is gaining wide acceptance in the United States; however, it is still in its infancy in Canada. This article introduces shared governance principles to diagnostic imaging administrators and staff and informs them of the rationale, benefits and challenges of this management philosophy. In addition, the implementation of an imaging department empowerment program will be explored, as will its relationship to a facility-wide shared governance program. PMID- 10137671 TI - The Canadian National Calibration Reference Centre for In-Vivo Monitoring: thyroid monitoring. Part V: Minimizing placement error in a thyroid monitoring system. AB - This article is the last of a five-part series covering various aspects of occupational thyroid monitoring. This part describes the techniques for minimizing errors due to improper placement of the detector. The impact of counting time and minimum detectable activity as a function of detector position are also discussed. The importance of minimum detectable activity is exemplified by showing how it can be used to ensure that the thyroid monitoring system can detect an amount of radioactivity below the derived investigation level. PMID- 10137672 TI - Competency-Based Certification Project. Phase II: Examination blueprint. AB - This is the second of three articles explaining the C.A.M.R.T.'s Competency-Based Certification Project--an effort to make the certification process more job relevant. The first article (August 1994 Journal) explained the job analysis process used to specify and validate the list of duties and tasks of entry-level medical radiation technologists, the imaging and treatment procedures they perform, and the equipment they use. This article discusses how the results of the project's job analysis will help determine the content of the certification process. It explains the work involved in reviewing the C.A.M.R.T.'s examinations and summaries of clinical experience in the context of competency-based evaluation and the job analysis validation in each discipline. The resulting "examination blueprint" will become a key document for persons involved in the C.A.M.R.T.'s certification process. This article briefly describes the examination blueprint's components and related concepts. The third and final article of this series will examine the development of assessment standards for certification examinations and summaries of clinical experience. PMID- 10137673 TI - Pilot testing of the Canadian Occupational Performance Measure: clinical and measurement issues. AB - The Canadian Occupational Performance Measure (COPM) is a measure of a client's self-perception of occupational performance in the areas of self-care, productivity and leisure. The COPM is administered using a semi-structured interview in which the client identifies significant issues in daily activities which are causing difficulty. Extensive pilot testing of the COPM has been completed with 268 clients in communities across Canada and in New Zealand, Greece and Britain. Results indicate the COPM has a median administration time of 30 minutes, is able to identify a wide range of occupational performance issues and appears to be responsive to changes in measurement issues centering around the interview, test construction, scoring, timing of the assessment, respondents, and the assessment process are discussed. PMID- 10137674 TI - Responding to workload measurement needs. AB - Workload measurement is a way of capturing and recording the time and/or activities of personnel in the performance of their health care duties. The traditional focus of workload systems in occupational therapy has been on resource allocation, activity tracking and long range planning. The systems are not organized to link with other institutional, financial and management tools to identify and cost client and programme resource use. The position taken in this paper is that occupational therapy workload measurement systems must be expanded to meet these new managerial responsibilities. Occupational therapists must be able to prospectively predict their workload to accommodate the move towards case costing and programme management. The paper also provides information from a national survey which indicates that there is support from the field for this position. PMID- 10137675 TI - Creating a good first impression. PMID- 10137676 TI - Live issues in healthcare reform. PMID- 10137678 TI - What kind of marketing pays off? PMID- 10137677 TI - Senate preparing PPS bill. PMID- 10137679 TI - Marketing nursing homes learn the rules to a whole new game. PMID- 10137680 TI - Dining with dignity. China and choices: the new face of foodservice. PMID- 10137681 TI - Cover me. Medicare Part B now pays for more wound care dressings. PMID- 10137682 TI - Chemical hazards in the nursing home. PMID- 10137683 TI - The seniors' club. PMID- 10137684 TI - Learning what lenders look for. PMID- 10137685 TI - Effective new manager socialization means ongoing development. AB - The move from a clinical position to a managerial one will make for a great change in the new manger's day-to-day work. Upper management can ease this transition by using definite educational strategies, thus smoothing the way for all staff and ensuring consistent, quality patient care. PMID- 10137686 TI - Home care comes full circle. AB - Health care practices in the US are changing as managed care, government regulations, and patient preferences alter care delivery. Home care will play a major role in these changes if the industry takes advantage of this trend toward a more flexible, independent patient model--returning health care to its origins as it completes the journey from home to institutions...and back again. PMID- 10137688 TI - Partnering for the paradigm shift. AB - With the goals of decreasing acute care length of stay and maintaining quality and patient satisfaction, an alliance took place between a physician's office, an acute care provider, and a home care provider. This model illustrates success in the shift from hospital to home care. PMID- 10137687 TI - Commitments to caring. AB - Home care agencies eager to embrace the future should not lose sight of what makes their agencies so effective: the dedicated staff who strive to fulfill the agency's mission. It is vitally important for agencies to clarify their missions and to create open and honest environments for employees. PMID- 10137689 TI - Foster family care--a nurturing alternative to institutionalization. AB - Foster family care is a compassionate alternative to institutional care. By placing clients with families who open their hearts and share their lives, one agency in Maui promotes the true spirit of ohana, the spirit of family. PMID- 10137690 TI - Opportunity knocks--shifting to home and community-based care. AB - Many senior citizens have few options when it comes to maintaining independence. One agency has developed a diverse delivery system to ensure that its elderly clients obtain the help they need and the independence they deserve. PMID- 10137693 TI - Accounts receivable funding: a tool for growth in the '90s. AB - Without enough capital, home care agencies will find it hard to expand to provide demanded services. If the traditional bank loan is difficult for an agency to obtain, there is another option. PMID- 10137691 TI - Life care at home: a model for the delivery & payment of long-term care. AB - This alternative to institutional long-term care is a new type of care plan. It guarantees life care to individuals without requiring them to move to retirement communities; home care is an integral part of the services provided. PMID- 10137692 TI - Assistance in living assures aging in place. AB - Life care and other large retirement centers transfer failing residents to assisted living units or nursing beds at various points. North Hill, a life care center, keeps many of its residents in their apartments years longer, with every department contributing to a creative, cost-effective Assistance-in-Living home care program. This program could inspire home care agencies to contract their services to other such communities. PMID- 10137694 TI - The paradigm shift--a team approach. AB - The expansion of managed care into the home care industry necessitates change to prepare for different systems of payment and cost containment. One home care provider learned from what hospitals were doing how it could improve its own day to-day workings and outcomes. PMID- 10137695 TI - Is the future of hospital-based home care in a freestanding structure? AB - Price, outcomes, and efficiency all play vital roles in the success of any Medicare-certified agency. In light of the paradigm shift to price-based care, will these factors be easier to control if hospital-based agencies become freestanding. PMID- 10137696 TI - Managing change--the challenge of the '90s. AB - Everyone knows that changes of all types are occurring in health care. Whatever those changes are, and whatever necessitates them, does not diminish the resistance that individuals may have to them. What can managers or administrators do to diminish the resistance and manage the changes they are making? PMID- 10137697 TI - A drug use evaluation of bedtime sedation in geriatric patients. AB - A pilot study was designed to assess the feasibility of a shared regional drug use evaluation (DUE) program involving patients. A retrospective DUE on the use of benzodiazepines, chloral hydrate and neuroleptics for bedtime sedation was performed on geriatric patient populations from two hospitals. Regional program staff coordinated the DUE, including development of the criteria and chart review. The participating Pharmacy departments performed the internal administrative and Pharmacy and Therapeutics committee communications. Forty patient charts from two sites were reviewed. The DUE results indicated different rates of drug use and discontinuation of therapy between the two geriatric patient populations. The overall rates of inappropriate drug use were similar. One undesirable clinical outcome occurred. Benzodiazepine use for more than 30 days was high in both groups. Identification of the justification for drug use, dosage reduction and drug discontinuation did not occur in the majority of patients. The pilot study identified areas where use of bedtime sedation could be improved, and allowed development of DUE criteria for future evaluation. PMID- 10137698 TI - Drug utilization & therapeutic intervention programs: pharmacy services that pay for themselves. AB - This mailed survey was a follow-up to a 1989 study to assess the status of pharmacy-directed, drug-related, patient care programs in response to the Pharmaceutical Inquiry of Ontario (Lowy Inquiry). A specific focus on Therapeutic Interventions and Drug Utilization Review/Evaluation Programs was adopted because the earlier study indicated a significant "financial return" for pharmacist time spent on these initiatives. A response rate of 62.2% (89 out of 143 hospitals) was achieved compared with an 80% response rate in 1989. Therapeutic interventions were performed by 97.7% of hospitals which identified an average of 184 therapeutic interventions per month and an 84.3% acceptance rate by prescriber. Based on data from 53 hospitals, an average of 29 minutes was taken on each intervention and financial data from 10 hospitals showed cost savings/avoidance of $49.34 per intervention. Drug Utilization program data was available from 45% of hospitals and specific financial data was provided by 29.2% of institutions. Cost savings/avoidance data demonstrated a return of $29.99 for every dollar invested in pharmacist time performing these activities. Collectively, both programs were recognized for their value in optimizing pharmacotherapy, improving patient outcomes as well as demonstrating a financial return to the institution. Despite the recessionary times, these programs are easily justified since they more than pay their own way. PMID- 10137699 TI - Documentation of pharmaceutical care. PMID- 10137700 TI - Pharmacy technician support of clinical drug trials and drug use evaluation. PMID- 10137701 TI - Discharge planning with battered women. PMID- 10137703 TI - Advocacy for victims of violent crime. PMID- 10137702 TI - The Child Witness to Violence Project. PMID- 10137704 TI - An emergency department protocol for domestic violence. PMID- 10137705 TI - Tuberculosis in AIDS patients: an ethical dilemma for discharge planning. AB - Discharge planning with AIDS patients has become more complex since the resurgence of tuberculosis in this group. Such psychosocial problems as drug use, homelessness, and poverty have also contributed to the difficulty in discharge planning because of issues of noncompliance with medical regimens and the subsequent development of drug-resistant strains of TB. Ethical conflicts, resulting from balancing respect for patient autonomy with the obligation to cause no harm to society, arise for the health care professional who coordinates the discharge plan. Every effort to decrease the incidence of rehospitalization, especially through the emergency department, should be taken to control the cost of inpatient care. These efforts should focus on arranging for directly observed therapy and placing the homeless in shelters that promote outpatient treatment. PMID- 10137706 TI - Community advisory boards: HIV-infected peer mentors and partners in planning care. PMID- 10137707 TI - HIV SWAT team: improving service delivery. PMID- 10137709 TI - Stressed? PMID- 10137708 TI - Community-based peer instructors teach risk prevention to homeless veterans. PMID- 10137710 TI - The ultimate betrayal. PMID- 10137711 TI - Protocols vs. guidelines. Choosing a medical-dispatch program. PMID- 10137712 TI - Showdown in Alabama: the sequel. PMID- 10137713 TI - Handle with care. PMID- 10137714 TI - 10 minutes with CHEMTREC. Interview by Paula Hess. PMID- 10137715 TI - Hand-to-hand combat. Some EMS providers still refuse to glove up. PMID- 10137716 TI - Endangered species: volunteers. AB - Volunteerism in America is changing. To continue to be an effective force in EMS, volunteers need to embrace rather than resist enhanced levels of care and other advances in providing service. Special care must be taken by medical directors to recognize the strengths and limitations of volunteer squads. In many suburban and rural areas, volunteers are strategically located to work with the EMS system and the medical director to bridge geographic or organizational service gaps. PMID- 10137717 TI - In the line of duty. PMID- 10137718 TI - Life in Nah Nah Land. PMID- 10137719 TI - Laundry operation returns in-house. PMID- 10137720 TI - Hospital linen handling and infection control. PMID- 10137721 TI - Upgrading laundry equipment doesn't mean lost time. PMID- 10137722 TI - Don't take performance appraisals for granted. PMID- 10137723 TI - A dime a dozen--makes no "cents". PMID- 10137724 TI - On the state of the public health. PMID- 10137725 TI - The Diabetes Control and Complications Trial (DCCT). AB - The Diabetes Control and Complications Trial (DCCT) provided much information towards settling the long-running controversy about the effectiveness of improving control of diabetes on the risk of its major complications. With the appearance or the advance of clinically significant retinopathy as its major outcome variable, DCCT randomised 1,441 insulin-dependent diabetic patients to conventional or intensified control groups. In both primary prevention and secondary intervention arms of the trial, intensified control reduced retinopathy risk by half or more, and also reduced nephropathy and neuropathy risks--however, risk of severe hypoglycaemic episodes was increased about three-fold. By contrast, there were no differences in quality of life, neurocognitive or emotional assessments between the two groups. The application of trial findings to 'real life' care is considered. PMID- 10137726 TI - Audit of the use of doctors' holding power under Section 5(2) of the Mental Health Act 1983. AB - The legal documentation and hospital case-notes of all patients detained during 1989 in Nottingham and Lincoln under Section 5(2) of the Mental Health Act 1983 (empowering the emergency detention of a voluntary inpatient who wishes to leave), were audited to establish if there were any predictors of conversion to longer-term restraint under that Act. Of the 146 Section 5(2) orders, 80 were converted to a Section 2 or 3; the conversion rate in people detained outside normal working hours and those detained within 12 hours of admission was significantly lower; and the conversion rate was significantly higher in people with a mental illness, compared with those with personality disorders, substance abuse and stress reactions. No differences existed in the overall conversion rates of people managed by senior or junior doctors, but junior doctors who did not seek the advice of a senior doctor had a significantly lower rate of conversion than those who did. These results indicate that Section 5(2) may have been inappropriately used in up to 45% of cases, and underline the need for appropriate consultation. PMID- 10137727 TI - The investigation and treatment of disorders of the knee: indications and a cost comparison of arthroscopy and magnetic resonance imaging. AB - Results of a year-long prospective audit of all arthroscopies of the knee in one NHS Trust hospital indicate that selective magnetic resonance imaging (MRI) would be cost-effective in up to 40% of patients. However, to achieve such savings, at least 14% of patients who would otherwise need diagnostic arthroscopy would need to be excluded from surgery, the cost of MRI must be low, and the success rate of interpreting the scans should be known. PMID- 10137728 TI - Survey finds more contractors getting into multi-department management. PMID- 10137729 TI - Fairview great deal for hospital. PMID- 10137730 TI - Every foodservice should have this problem. PMID- 10137732 TI - Prisms. Helen Devos Women & Children's Center, Butterworth Hospital, Grand Rapids, Michigan. PMID- 10137731 TI - Overcoming the age barrier at the Pennsylvania Hospital & the Institute for the Pennsylvania Hospital. PMID- 10137733 TI - Low-cost self-serve conversions. PMID- 10137734 TI - Food drives for the hungry. PMID- 10137735 TI - Getting connected & other plugs into the future. PMID- 10137736 TI - Preparing your board for fund raising. PMID- 10137737 TI - Non-profit software directory. PMID- 10137738 TI - Cost control: a personal balancing act. AB - Rid yourself of the word "spend." Substitute "invest." Spending never has been an acceptable component of effective cost control. Investing always has been and always will be. PMID- 10137739 TI - Alternatives to regular blood transfusions. PMID- 10137740 TI - Managing the health care market in developing countries: prospects and problems. AB - There is increasing interest in the prospects for managed market reforms in developing countries, stimulated by current reforms and policy debates in developed countries, and by perceptions of widespread public sector inefficiency in many countries. This review examines the prospects for such reforms in a developing country context, primarily by drawing on the arguments and evidence emerging from developed countries, with a specific focus on the provision of hospital services. The paper begins with a discussion of the current policy context of these reforms, and their main features. It argues that while current and proposed reforms vary in detail, most have in common the introduction of competition in the provision of health care, with the retention of a public monopoly of financing, and that this structure emerges from the dual goals of addressing current public sector inefficiencies while retaining the known equity and efficiency advantages of public health systems. The paper then explores the theoretical arguments and empirical evidence for and against these reforms, and examines their relevance for developing countries. Managed markets are argued to enhance both efficiency and equity. These arguments are analysed in terms of three distinct claims made by their proponents: that managed markets will promote increased provider competition, and hence, provider efficiency; that contractual relationships are more efficient than direct management; and that the benefits of managed markets will outweigh their costs. The analysis suggests that on all three issues, the theoretical arguments and empirical evidence remain ambiguous, and that this ambiguity is attributable in part to poor understanding of the behaviour of health sector agents within the market, and to the limited experience with these reforms. In the context of developing countries, the paper argues that most of the conditions required for successful implementation of these reforms are absent in all but a few, richer developing countries, and that the costs of these reforms, particularly in equity terms, are likely to pose substantial problems. Extensive managed market reforms are therefore unlikely to succeed, although limited introduction of particular elements of these reforms may be more successful. Developed country experience is useful in defining the conditions under which such limited reforms may succeed. There is an urgent need to evaluate the existing experience of different forms of contracting in developing countries, as well as to interpret emerging evidence from developed country reforms in the light of conditions in developing countries. PMID- 10137742 TI - The dangers of managerial perversion: quality assurance in primary health care. AB - The promotion of primary health care (PHC) at the Alma Ata conference has been followed by a variety of managerial initiatives in support of the development of PHC. One of the more promising vehicles has been the implementation of quality assurance mechanisms. This paper reviews recent examples of this genre and argues that the thrust of both primary health care and quality assurance are in danger of being distorted by a rather antiquated approach to management. PMID- 10137741 TI - Programming for safe motherhood: a guide to action. AB - The Safe Motherhood Initiative has successfully stimulated much interest in reducing maternal mortality. To accelerate programme implementation, this paper reviews lessons learned from the experience of industrial countries and from demonstration projects in developing countries, and proposes intervention strategies of policy dialogue, improved services and behavioural change. A typological approach with three hypothetical settings from resource poor to resource rich environments is used to address the variability in health behaviours and infrastructure encountered when programming for safe motherhood. PMID- 10137743 TI - Indigenous perceptions and quality of care of family planning services in Haiti. AB - This paper presents a method for evaluating and monitoring the quality of care of family planning services. The method was implemented in Haiti by International Planned Parenthood Federation Western Hemisphere Region (IPPF/WHR), the managerial agency for the Private Sector Family Planning Project (PSFPP), which is sponsored by the USAID Mission. The process consists of direct observations of family planning services and clinic conditions by trained Haitian housewives playing the role of 'mystery clients', who visit clinics on a random basis without prior notice. Observations conducted by mystery clients during one year, from April 1990 to April 1991, are presented and illustrate the use of the method. In addition, measurements for rating the acceptability of the services were developed, providing a quantitative assessment of the services based on mystery clients' terms. Statistical results demonstrate that simulated clients ranked some criteria of acceptability higher than others. These criteria are: the interaction provider/client, information adequacy, and competence of the promoter. Likewise, simulated clients' direct observations of the services permitted the identification of deficiencies regarding the quality of care such as the paternalistic attitudes of the medical staff; the lack of competence of promoters; and the lack of informed choice. Based on its reliability since its implementation in 1990 the method has proven to be a useful tool in programme design and monitoring. PMID- 10137744 TI - Micro-level planning using rapid assessment for primary health care services. AB - This paper describes the use of a rapid assessment technique in micro-level planning for primary health care services which has been developed in India. This methodology involves collecting household-level data through a quick sample survey to estimate client needs, coverage of services and unmet need, and using this data to formulate micro-level plans aimed at improving service coverage and quality for a primary health centre area. Analysis of the data helps to identify village level variations in unmet need and develop village profiles from which general interventions for overall improvement of service coverage and targeted interventions for selected villages are identified. A PHC area plan is developed based on such interventions. This system was tried out in 113 villages of three PHC centres of a district in Gujarat state of India. It demonstrated the feasibility and utility of this approach. However, it also revealed the barriers in the institutionalization of the system on a wider scale. The proposed micro level planning methodology using rapid assessment would improve client responsiveness of the health care system and provide a basis for increased decentralization. By focusing attention on under-served areas, it would promote equity in the use of health services. It would also help improve efficiency by making it possible to focus efforts on a small group of villages which account for most of the unmet need for services in an area. Thus the proposed methodology seems to be a feasible and an attractive alternative to the current top-down, target-based health planning in India. PMID- 10137746 TI - Spotlight on international organizations ... UNICEF. PMID- 10137745 TI - Health of the elderly in a community in transition: a survey in Thiruvananthapuram City, Kerala, India. AB - Results of a survey to assess the health and functional status of the elderly (defined as those who are 60 years or older) in Thiruvananthapuram city, the capital of Kerala state, India, are discussed. As the process of development results in longevity without concomitant economic success, traditional support systems break down. The differences in status of the elderly dependent on gender and socioeconomic class are highlighted. Women are poorer and generally suffer more morbidity than men in old age, even though their death rates are lower. The better-off among the elderly enjoy a quality of life much superior to their poor brethren. Thus, in transitional societies such as Kerala, socioeconomic status and gender play a significant role in determining the quality of life of the elderly, a finding which may have some policy implications. PMID- 10137747 TI - Preparing a for-profit war plan helps protect market share. PMID- 10137748 TI - GHAA (Group Health Association of America) offers valuable HMO data and research. PMID- 10137749 TI - Sutter begins all-or-nothing contracting. AB - Sutter Health has announced that it will soon require payers to contract with its entire network. While this strategy may work for Sutter, some have doubts that it will work for systems in other parts of the country. PMID- 10137750 TI - MSOs provide alternative to full integration. PMID- 10137751 TI - Rural hospital forms HMO for uninsured. PMID- 10137752 TI - Marketing must make integration transition. PMID- 10137753 TI - Health systems need objective criteria when selecting physicians for managed care. PMID- 10137754 TI - Making the move to the top. PMID- 10137755 TI - Computer-aided facilities management systems help planners allocate space, understand fixed costs. PMID- 10137756 TI - Most markets in initial stages of integration process. PMID- 10137757 TI - Calculated risk taking in the treatment of suicidal patients: ethical and legal problems. AB - The ethical rationale by which the law permits suicidal patients to be involuntarily confined to institutions, their suicides prevented, and treatment imposed has been much discussed. Economic factors have now made prolonged hospital care almost impossible in the United States. Psychiatrists feel great pressure to discharge suicidal patients from inpatient care. While discharge is therapeutically desirable for some suicidal patients, for others it is not. In the event of postdischarge suicide, the risk of a lawsuit is considerable. PMID- 10137758 TI - Hospitalization of the suicidal patient. AB - The safety needs of the suicidal patient are of the utmost importance. Decisions concerning the admission of such patients into the hospital are often difficult, and clinicians usually are anxious and ambivalent during this process. In this era of decreased resources, when clinicians are increasingly aware of suicidal danger and of safety requirements, it is even more critical that the inpatient psychiatric unit be used judiciously. There are risks and benefits involved in the use of a psychiatric inpatient program, and there are risks and benefits to not using such a facility. Development of safe treatment plans for suicidal patients is reviewed in the context of the psychodynamic formulation and therapeutic alliance. PMID- 10137759 TI - Managing suicidal inpatients. AB - Suicidality is the most common and vexing challenge presented by psychiatric inpatients. Although clinicians' ability to predict suicide is limited and suicide may inevitably occur, conscientious assessment of risk, effective distinction among various characteristics of the suicidal crisis, and thoughtful policies and procedures will help keep many patients from fatal outcomes. PMID- 10137760 TI - Essential clinical and legal issues when working with the suicidal patient. AB - The legal and clinical literatures on the standards of care for adult suicidal patients are reviewed. We discuss the components of an effective risk management approach that balances the need for high-quality care by a reasonable and prudent practitioner with the requirements of court-determined and statutory standards. Through a review of legal theories and an overview of the clinical literature, we detail the essential guidelines for sound assessment, intervention, and postvention procedures. PMID- 10137761 TI - Federal anti-referral status raises unanswered questions. Part I: Group practice issues. AB - Although legislation is pending that would require the federal government is issue advisory opinions to those seeking to comply with Stark II (see Press Release #26-A, Committee on Ways and Means, U.S. House of Representatives, July 1, 1994, at 26), such legislation would not entirely solve these interpretive problems, as questions encountered under Stark II are likely to be far too frequent and the response time too long to make it practical to obtain opinions each time. Thus, until such time as Stark II is amended, clarifying regulations are issued, or courts interpret it meaning, physicians who practice in groups that provide designated services must hope that federal enforcement agencies use common sense and understanding in applying an ambiguous statute to real life situations, affording leniency toward participants in arrangements that fit within reasonable interpretations of the statute's exceptions. PMID- 10137762 TI - Special report on health care delivery systems. Trends in the integrated delivery of health care and the corporate practice of medicine. AB - The prospects for federal legislation preempting state corporate practice restrictions are unclear. The health care reform bill originally introduced by President Clinton contained a provision that would have preempted "any state law related to the corporate practice of medicine" insofar as it applied to the arrangements between non-fee-for-service health plans and their participating providers. H.R. 3600/S. 1757, 103d Cong., 1st Sess. 1407(b) (1993). Whether and in what form a preemption provision may survive the legislative process and see a Presidential signature remains to be seen. The particular fate of the federal legislation notwithstanding, however, health care executives can nevertheless remain confident that the legal treatment of the "corporate practice" of medicine will continue to be of vital concern as the various forms of health care organizations evolve in the ongoing struggle to deliver quality medicine at affordable prices. PMID- 10137763 TI - No long-term solutions in current health care reform proposals. AB - As this article goes to press, it is nearly impossible to predict what sort of health reform plan will ultimately be passed, if any, and whether any form of long-term care coverage will be included. The need for such coverage will not, however, diminish with the close of the current congressional session and is likely to be a topic of debate for some time. The entire process of health reform legislation has been one of paring down initial hopes and expectations, and it may take many more years, until an even larger segment of our population is aged, before log-term care coverage becomes politically and fiscally desirable enough to withstand the political process. PMID- 10137764 TI - Futile treatment: the need for legislation and uniform policies. AB - As a matter of social policy, providers should place a top priority on educating colleagues and the public, including lawyers and the courts, so that there is genuine understanding that certain medical conditions, like anencephaly and brain death, cannot be ameliorated, changed, or improved through medical treatment even though the patient may continue to breathe with mechanical assistance for years. If health care professionals do not articulate and adhere to clear, universal standards of practice in this area, the courts will continue to define the duty of the medical profession, and, as Baby K illustrates, that is not acceptable. PMID- 10137765 TI - Physician-assisted suicide: the Washington federal court decision and related developments. PMID- 10137766 TI - Special report on medical staff relationships. Ninth Circuit buttresses peer review immunities. AB - Following on the heels of Austin, the Fobbs and Smith decisions may result in a significant reduction in the number of federal antitrust claims filed by aggrieved physicians in the context of peer review actions. However, by permitting claims of discrimination and conspiracy to go forward in the Fobbs case, the Ninth Circuit may have encouraged the filing of more suits against peer reviewers based on these types of claims, rather than on antitrust theories. In order to benefit from HCQIA's immunities, medical staffs are once again admonished to review, and revise when necessary their medical staff bylaws and peer review policies to provide for adequate notice and hearing, and to assure that peer review participants are well informed about and carefully comply with all of HCQIA's requirements. PMID- 10137767 TI - Federal anti-referral statute raises unanswered questions. Part II: Issues relating to exceptions. PMID- 10137768 TI - Georgia hospitals: coping with 'worst' floods and their aftermath. PMID- 10137769 TI - How hospital system restructured RM, security, safety, workers' comp. PMID- 10137770 TI - How CT hospitals dealt with patient prisoners following prison riot. PMID- 10137772 TI - Tarrant County's Operation H.E.A.L. (Health Employees Assisting Law Enforcement): a hospital crime watch program. PMID- 10137771 TI - Special report. Drug testing in the workplace: an update. AB - Workplace drug testing has become widespread in the U.S. and is a major component of the nation's "war on drugs." A recent annual survey by the American Management Association shows that the number of workplace drug-testing programs in surveyed companies grew almost 300% between 1987 and 1993. Nearly 85% of the 630 firms responding to the 1993 survey conduct some form of drug testing. Among activities sparking interest in drug testing are some highly publicized catastrophes in which drugs or alcohol played a major role--for example, the Exxon Valdez oil spill in Alaska which raised concern over threats to public safety. While the popularity of drug testing has increased, programs have been criticized at the same time for being inaccurate, costly, invasive of privacy, and even illegal in certain cases. As alternatives to urinalysis and other tests, companies have introduced impairment tests--also called performance tests and "fitness-for-duty" tests--which are computer-based and measure employees' eye-hand coordination or cognitive skills. Tests also have been introduced to detect drug residues on surfaces. In this report, we'll review some recent studies on drug testing and some of the programs currently being conducted. PMID- 10137773 TI - Does your organization have a learning disability? PMID- 10137774 TI - Pennies per portion and hundreds of dollars per day. PMID- 10137775 TI - Nutrition intervention documentation. PMID- 10137776 TI - When challenged, remember why established systems are in place. PMID- 10137777 TI - Health care system redesign: a strategic management framework. AB - The current health care environment can best be characterized as uncertain, unfamiliar, ambiguous, unexpected, untraveled, and amorphous. All administrators and managers are facing a tremendous challenge in managing available human, technological, materiel, and fiscal resources to accomplish their organization's mission. They must be able to assess organizational environments, identify strategies to align the organization and the environment, implement these strategies, and continuously evaluate the outcomes of those strategies. Therefore, health care administrators and managers must adopt a management perspective that is responsive, dynamic, comprehensive, systematic, and both process and outcome oriented. Such a perspective is strategic management. PMID- 10137778 TI - System redesign: planning in a multihospital setting. AB - This article explores the complexities of the proposed health care reform and the methodologies by which hospitals are coping with the impending changes. The article focuses on a large multihospital system in Alabama and the reorganization in process at that facility. Centralization as a key to more efficient management, as well as the partnering with smaller hospitals, is highlighted as an approach to dealing with health care reform. PMID- 10137779 TI - Efficient materiel handling and distribution: a design perspective. AB - This article offers a condensed examination of facility design and the interface between owners, hospital managers, and architects in planning for hospital materiel handling and storage needs. A brief history is given of the evolution of materiel management and progress today in efficient ordering, storing, distributing, and inventory and billing. The article closes with a discussion of work redesign and personnel vs. equipment concerns. Two case studies exemplify similar goals from different approaches. PMID- 10137780 TI - Putting supplies at the bedside via the Friesen concept. AB - Hospitals designed using the concepts of architect Gordon Friesen are especially conducive to reengineering for patient-focused care. The Nurserver, a closet-like space outside each patient's room, makes it very easy for hospitals to redesign their methods for delivering supplies so that caregivers seldom have to go more than a few feet to get what they need. In this article, staff of Monongalia General Hospital in Morgantown, West Virginia, describe how they have used the Friesen design to modify supply distribution processes. PMID- 10137781 TI - The new nurse manager: partner in managing costs and quality. AB - Today's nurse manager is a leader in the 1990s health care delivery system. Collaborating with managers throughout the organization, the nurse manager calls upon skills and advanced education to carry out functions in the areas of clinical systems management, human resource management, environmental management, and financial management. This article describes this health care management role and presents case studies where collaboration with other disciplines was successful. PMID- 10137782 TI - Specialty beds and wound care products: a new cost-saving role. AB - Recent technological advances in specialty beds and other products used in preventing and treating skin breakdown have left most health care professionals quite puzzled as to which surface or product to use for a given clinical situation. As a result, nurse consultants employed by the product vendors are often relied on as the primary source for "expert" advice on patient-specific product selection. Envisioning the potential for inappropriate utilization of these expensive products resulting from this reliance on the vendors, the Baptist Health System (BHS) chose to create their own internal "expert" for coordinating wound and skin care. Based on the BHS experience, the development of such a role is highly recommended for other multifacility health care systems dedicated to providing the highest-quality, most cost-effective patient care possible. PMID- 10137783 TI - Nursing case management: affecting quality and cost. AB - North Mississippi Health Services' nursing case management program has been deemed a success by all parties involved, especially the patients. High-risk patients with specific chronic health problems receive an enhanced level of care and experience significant reductions in cost, length of stay, and repeat hospitalizations. Quality of life for many of these patients is also improved. These outcomes are made possible by assigning a registered nurse to case manage or coordinate care for these patients. PMID- 10137784 TI - Implementation of an automated medication/supply distribution system. AB - In the summer of 1992, Carraway Methodist Medical Center implemented a computerized medication and supply distribution system from the pharmacy and central supply to the patient care units. Improved efficiency was achieved in the form of automatic billing, inventory control, decreased worked hours per patient day, and improved documentation. Regulatory requirements relating to narcotic distribution were simplified through technology eliminating manual counting, handwritten signatures, and manual record keeping. The impact from this change was cost effective, allowed more time at the bedside, provided easier access to pharmacy and central supply items, facilitated inventory control, and increased nursing productivity as well as increasing nursing satisfaction. PMID- 10137785 TI - Health reform planning models. The case of veterans hospitals. AB - As part of the national effort to reform healthcare, the Department of Veterans Affairs is undergoing a major reassessment of its healthcare mission. As Veterans Affairs prepares to meet the challenges of the twenty-first century, one underlying issue of critical importance is which planning assumptions will be selected and employed. Will historical patterns of veterans' use be interpreted as indicators of the market demand for Veterans Affairs healthcare services, or will estimates of disease prevalence among veterans be used as indicators of future healthcare need? If Veterans Affairs is to continue as a critical component of the nation's healthcare delivery system, its selection of a planning basis will have major implications for tomorrow's healthcare system. PMID- 10137786 TI - Ethical considerations of giving patients choices. AB - Customer service is becoming the watchword if companies are to remain competitive. This direction toward customer service has promoted the development of patient-centered services in the healthcare industry. However, creating these services is not easy. This article discusses the application of ethical principles in designing a patient-centered approach from the experience of a university hospital. It addresses some of the issues that a hospital must consider while working to become more user friendly for its "customers": its patients and their family members and visitors. PMID- 10137787 TI - Strategic options for hospitals based on ownership type. AB - Strategic planning for hospitals is difficult in this era of healthcare reform. This article offers strategy options based on an analysis of the strengths, weaknesses, opportunities, and threats of three types of hospitals. PMID- 10137788 TI - Education needs of hospital governing boards. AB - Hospital governing board members serve voluntarily, however they are integral to their hospitals' operations. This article investigates if there is a discrepancy between board members' knowledge of healthcare issues and how important they perceive these issues to be in their hospitals' operations and direction. In addition, it offers preliminary steps on how to ensure that board members are kept well-informed and up-to-date on issues for strategy planning in the healthcare marketplace. PMID- 10137789 TI - Changing nursing students' attitudes--an exploratory study. AB - Stereotypes, competition, and limited contact can contribute to nursing students from different programs developing negative attitudes about one another. This study applies an attitude change model to a small sample of nursing students in different programs to determine if this negative attitude can be changed. PMID- 10137790 TI - Clinton health reform: here come the health police. PMID- 10137791 TI - The end of the not-for-profit hospital? Institutional realities after reform. PMID- 10137792 TI - Prescription drug payment policy: past, present, and future. AB - The articles presented in this issue offer an array of policy-relevant studies in an area that has become increasingly important to both the public and third-party payers. Although it is believed that appropriate utilization of drugs can contribute to containing the growth of health care costs, the impact of appropriate prescribing, dispensing, and use of drugs associated with costs of hospitalizations and physician visits is generally unavailable. As new, ever-more expensive drugs come to market, comprehensive studies of utilization, expenditures, prices, quality, and cost effectiveness will enhance the policy process. PMID- 10137793 TI - Utilization effects of prescription drug benefits in an aging population. AB - In this article, the effects of prescription drug coverage on use are analyzed for beneficiaries of a large retiree health benefit fund in a quasi-experiment comparing new and established enrollees. Newer enrollees show an 18-percentage point greater increase in prescription drug expenditures per capita than established enrollees during the 3-year period following enrollment. This differential is interpreted as the insurance effect of prescription coverage. The impact was greater among high-cost drugs than among low-cost drugs, and also greater among low users of prescription drugs than among high users. No clear patterns were discerned across therapeutic categories. PMID- 10137794 TI - International pharmaceutical spending controls: France, Germany, Sweden, and the United Kingdom. AB - France, Germany, Sweden, and the United Kingdom each use different types of policies for controlling prescription drug spending. Until recent years, these policies have relied heavily on regulating prices charged by drug manufacturers, with different systems providing varying degrees of pricing freedom. While these policies appear to have brought some degree of price restraint, they have not prevented continued growth in prescription drug spending. As a result, each country is supplementing its policies with measures aimed at physicians and consumers and targeted at reducing a perceived over-utilization of pharmaceutical products. PMID- 10137795 TI - Pharmaceutical spending and German reunification: parity comes quickly to Berlin. AB - As the Berlin Wall fell and the population of the Federal Republic of Germany (FRG, West Germany) swelled by 25 percent with the addition of the former German Democratic Republic (GDR, East Germany), the health care system struggled to keep pace. This article examines drug outlays by the statutory sickness funds during the first 2 years of unified operations. It shows that providing equivalent coverage quickly led to equal rates of pharmaceutical consumption nationwide, while in Berlin the former East outdistanced the West by a considerable margin. PMID- 10137796 TI - State Medicaid pharmacy payments and their relation to estimated costs. AB - Although prescription drugs do not appear to be a primary source of recent surges in Medicaid spending, their share of Medicaid expenditures has risen despite efforts to control costs. As part of a general concern with prescription drug policy, Congress mandated a study of the adequacy of Medicaid payments to pharmacies. In this study, several data sources were used to develop 1991 estimates of average pharmacy ingredient and dispensing costs. A simulation was used to estimate the amounts States pay. Nationally, simulated payments averaged 96 percent of estimated costs overall but were lower for dispensing costs (79 percent) and higher for ingredient costs (102 percent). PMID- 10137797 TI - Medicaid policies for HIV-related prescription drugs. AB - As State Medicaid programs become increasingly important sources of payment for acquired immunodeficiency syndrome (AIDS)-related care, and drug regimens the major weapons available to fight human immunodeficiency virus (HIV)-related illnesses, Medicaid drug policies will have a substantial impact. State Medicaid programs were surveyed to identify policies on a range of prescription drug policies affecting these recipients. All Medicaid programs provide prescription drug benefits to all categorically needy recipients, and about three-fourths of the States provide these benefits to medically needy recipients. However, utilization limits, copayments, and off-label-use and prior-authorization policies in many States weaken the drug benefit available. PMID- 10137798 TI - Use of outpatient drugs as death approaches. AB - This article explores changes in outpatient prescription drug use up to 72 months prior to death and relates the findings to trends in Medicare-covered services during the same life stage. The study sample comprises 5,261 decedents who, prior to their deaths, had enrolled in the Pennsylvania Pharmaceutical Assistance Contract for the Elderly (PACE) program. Descriptive time-series show steady increases in both outpatient drug use and physician contacts in the final 36 months of life. However, multivariate analysis shows that impending death is associated with significant reductions in the probability of using outpatient drugs. Only in the final 12 months of life is this effect offset by rising numbers of drug claims by prescription users. PMID- 10137799 TI - A review of the first year of Medicare coverage of erythropoietin. AB - Recombinant human erythropoietin (rHuEPO) is a new drug for treating anemia associated with end stage renal disease (ESRD). In a study of rHuEPO diffusion, costs, and effectiveness, we analyze ESRD program data and all claims submitted to Medicare for reimbursement of rHuEPO administered to ESRD dialysis patients. Access to rHuEPO was rapid and extensive during the first year of Medicare coverage. Dosing of rHuEPO and achieved hematocrit were lower than expected based on the results of clinical trials. rHuEPO cost Medicare $144 million in its first year. The analysis of insurance claims data allowed effective monitoring of access, costs, and effectiveness of this new biotechnology. PMID- 10137800 TI - Who cares what it costs to dispense a Medicaid prescription? AB - Results of a 1992 Medicaid cost-of-dispensing study among North Carolina pharmacies are presented. The estimated statewide weighted average cost incurred by pharmacies to dispense a prescription was $5.37 in 1991. The variation in dispensing costs found among pharmacies of various sizes, organizational types, and locations is identified. Higher average dispensing costs were reported for large chain pharmacies and those pharmacies in urban areas. Considering the potential for expanded prescription drug benefits under a reformed health care system, the implications of the study's findings for pharmacy payment policy are discussed. PMID- 10137801 TI - Designing for health care in New York City. PMID- 10137802 TI - Health care comes to Phoenix House. PMID- 10137803 TI - Designing for health. PMID- 10137804 TI - Heart for Boise ... St. Luke's Regional Medical Center. PMID- 10137805 TI - Visiting health-care sites. PMID- 10137806 TI - Upbeat health center ... Center for Spine, Sports, and Occupational Rehabilitation, Chicago. PMID- 10137807 TI - Complementary design ... Atkins Center for Complementary Medicine, New York City. PMID- 10137808 TI - Fast-track rehab ... Hurley Rehabilitation Center, Flint, MI. PMID- 10137809 TI - Physicians and utilization management: stuck in a jam between quality and costs. PMID- 10137810 TI - Are computers on a collision course with confidentiality?. Interview by Diana Madden. PMID- 10137812 TI - Costs will reclaim center stage. PMID- 10137811 TI - Health system reform after the 103rd Congress: what does the future hold? PMID- 10137813 TI - The beatitudes of managed care. PMID- 10137814 TI - Can internists handle the driver's seat? PMID- 10137815 TI - How an integrated system thrives with physicians at the lead. PMID- 10137817 TI - Weighing the pros and cons of PHOs. PMID- 10137816 TI - 'David versus Goliath' merits help from government. PMID- 10137818 TI - More Texans gaining access to HMOs. PMID- 10137819 TI - Hospitals integrate delivery systems. Regulatory cooperation and legislative solutions required. PMID- 10137820 TI - Managed care in East Texas. A regional tour. PMID- 10137821 TI - Six Texas health plans accredited. PMID- 10137822 TI - Occupancy down, discounts up in second quarter. PMID- 10137823 TI - GP education. Bottom of the class? PMID- 10137824 TI - Mental health. No easy option. PMID- 10137826 TI - Corporate governance. Out of time. PMID- 10137825 TI - Hospital social work. Divided by change. PMID- 10137827 TI - Facilities management. Combined forces. PMID- 10137828 TI - Facilities management. Just the ticket. PMID- 10137830 TI - Facilities management. Taking the initiative. PMID- 10137829 TI - Facilities management. Survival course. PMID- 10137831 TI - Facilities management. Hospital highways. PMID- 10137832 TI - ECRs (extra-contractual referrals). Who goes where? PMID- 10137833 TI - Joint commissioning. Scoring doubles. PMID- 10137834 TI - Refugee health. Ways of saying. PMID- 10137835 TI - Health markets. Changing gear. PMID- 10137836 TI - Measuring outcomes. Two sides of the coin. PMID- 10137837 TI - Market testing. Eyes on the prize. PMID- 10137838 TI - Trusts. Things to come. PMID- 10137840 TI - Business cases. Back in business. PMID- 10137839 TI - Fundholding. Prima facie evidence. PMID- 10137841 TI - Purchasing. The gentle touch. PMID- 10137842 TI - Dial M for medicine advice. PMID- 10137843 TI - Purchasing. After the storm. PMID- 10137844 TI - Career development. Trading places. PMID- 10137845 TI - Health-promoting hospitals. Early warning systems. PMID- 10137846 TI - Data briefing. One point eight children. PMID- 10137847 TI - How to develop a proactive formulary system. AB - To develop a quality formulary system, a proactive approach is necessary. This approach incorporates a prospective product and concurrent product analyses. A prospective product analysis, in turn, involves a review of current formulary agents, those likely to enter the marketplace shortly, and the formation of an expert review panel. This panel's tasks are to examine therapeutic, economic, and humanistic aspects of therapy and to set initial parameters for appropriate and cost-effective use of accepted products. Keys to a successful formulary system are to continuously monitor drug use and compliance with criteria and to work collaboratively with all institutional professionals in the development, implementation, and monitoring of the system. PMID- 10137848 TI - Development and implementation of practice guidelines (Part 1). AB - Development and implementation of practice guidelines should be a team effort that includes pharmacists, the medical staff, and hospital administration. Described in this article are the steps involved in developing and successfully implementing practice guidelines. Also briefly presented are some practice guidelines developed by the staff at Cedars-Sinai Medical Center for the use of ondansetron in the post-op setting, colony stimulating factors, and sumatriptan for the treatment of migraine. Finally, discussion of a few practice guidelines that are in the implementation phase and future directions with regard to evolution of practice guidelines are presented. PMID- 10137849 TI - Replies to the question: should the practice of drug sampling be retained or eliminated? PMID- 10137850 TI - Investigational drug tracking: phases I-III and NDA submissions--Part II. AB - The author catalogs over 800 investigational drugs/biologicals currently in Phase I, II or III clinical trials or drugs/biologicals submitted to the FDA as new drug applications. Part I of this article appeared in the September issue of Hospital Pharmacy. The list assists in predicting when new drugs will be marketed. The entries include generic/chemical name, investigational drug number, synonyms, trade names, manufacturers, clinical trial status, predicted approval year, indications or drug class, whether the drug has been developed through biotechnology, and references. Entries were gleaned from medical journals, stock market analysis publications, and the Pharmaceutical Manufacturers Association's Medicines in Development Series. The list is alphabetized by the generic/chemical name or investigational drug number and cross-indexed by the trade name and synonyms. The list reflects those drugs which were not FDA approved as of April 15, 1994. Part I concludes with the remaining alphabetical listing by generic/chemical name or investigational drug number. PMID- 10137851 TI - Standardized dosing tables to reduce errors involving high-dose methylprednisolone for acute spinal cord injury. AB - High-dose methylprednisolone administered after spinal cord injury improves neurologic recovery. Repeated errors in the prescribing and administration of the recommended regimen occurred in a regional trauma center. Standardized dosage tables for high-dose methylprednisolone were developed for prescribers, nurses, and pharmacists. Verification of ordered doses by pharmacists is critical in assuring appropriate use of this regimen. All institutions are urged to develop standard procedures for ordering, preparing, and administering high-dose methylprednisolone for acute spinal cord injury. PMID- 10137852 TI - The rule of six: calculating intravenous infusions in a pediatric crisis situation. AB - The Rule of 6 is a mathematical equation which can be used in crisis situations to accurately speed the calculation process when preparing a medication infusion. The following article discusses the origin of the Rule of 6, applications for its use and several examples. Also included is a compatibility chart for drugs the Rule of 6 is commonly used with and common IV fluids. Institution specific compounding techniques are also included. PMID- 10137853 TI - Hospital financial trends that affect hospital pharmacies' future. PMID- 10137854 TI - Leadership's four cornerstones. PMID- 10137855 TI - Guiding the integrated delivery network. Seven models for cooperation. PMID- 10137856 TI - In the land of the giants, Part 1 of 2. Big. PMID- 10137857 TI - Merger meltdown. PMID- 10137859 TI - Paradigms in progress, Part 2. Virtuous circles. PMID- 10137858 TI - Healing the healers. PMID- 10137860 TI - Technology, medicine & health, Part 2. The dilemmas of diagnostic certainty. AB - In Part 1 of this series we discussed how it is that our new understandings of biology at the molecular level are revealing to us unexpected complexities in those processes labeled as diseases. Here in Part 2 we examine some remarkable ultra-sensitive tools with which it is becoming feasible to clarify these complexities with degrees of certainty heretofore regarded as impossible. PMID- 10137861 TI - Political and practical milestones in clinical quality improvement, Part 3 of 3. Living guidelines. PMID- 10137862 TI - The spirit of community. Interview by Joe Flower. PMID- 10137863 TI - A gift of trust. PMID- 10137864 TI - Protecting the confidentiality of computerized medical records, preparing for litigation. PMID- 10137865 TI - Developing a comprehensive medical records management and retention policy. PMID- 10137866 TI - Can total quality management help care for the poor? PMID- 10137867 TI - Overview: computerized medical records create new legal and business confidentiality problems. PMID- 10137868 TI - A national health care 'Infobahn': on what principles should its construction be based? PMID- 10137869 TI - Decade of the executive woman. Interview by Lisa Galvin. PMID- 10137870 TI - The 360 degree assessment. Healthcare executives receive letters from home about their leadership effectiveness. PMID- 10137871 TI - Protocols for healthcare executives. PMID- 10137872 TI - Making reform happen back home. PMID- 10137873 TI - American College of Healthcare Executives. Public policy statement. Community service ethic. PMID- 10137874 TI - Creating an organizational conscience. PMID- 10137875 TI - 1995 Executive search firm directory. PMID- 10137876 TI - Is hospital administration dead? PMID- 10137877 TI - HVAC requirements pose biggest challenge for small cardiac catheterization lab. PMID- 10137878 TI - Property management. Cover your assets. PMID- 10137879 TI - Capital planning: is tax exempt debt the best way to go under health care reform? PMID- 10137880 TI - Runaway renovation. PMID- 10137881 TI - Off the wall? Not at all! Vinyl wallcoverings: a versatile yet practical decorative option. PMID- 10137882 TI - Shopping smart at the Mart. PMID- 10137883 TI - Retrofit or replace? Shedding some light on fluorescent lighting upgrades. PMID- 10137884 TI - EPA's new rules on incinerators: more costs but no real benefits. PMID- 10137885 TI - Going green isn't so hard--and it may even really pay off. PMID- 10137886 TI - ES workers and reform: will you survive? Thrive? It's your choice. Part 2. PMID- 10137887 TI - Pneumatic tube systems still moving along. PMID- 10137888 TI - Former manufacturing plant once made fittings; now it makes people well. PMID- 10137889 TI - Built-in care. The future of patient-centered design is here at one hospital in Connecticut. PMID- 10137891 TI - Works of art--art at work. PMID- 10137890 TI - Deaconess Medical Center. A case study in rural patient-centered health facilities. PMID- 10137892 TI - Better safe than sorry. Four steps for effective security master planning. PMID- 10137893 TI - Trouble in the air. Electromagnetic interference can wreak havoc with medical devices. PMID- 10137894 TI - Positive or negative. How to test isolation rooms for negative air pressure. PMID- 10137895 TI - Will incinerator regs leave your facility holding the (red) bag? PMID- 10137896 TI - Installation: key but overlooked factor in picking carpet products. PMID- 10137897 TI - Will job security be a thing of the past for today's top-level staff? PMID- 10137898 TI - What affects plant operations/maintenance costs? PMID- 10137899 TI - Reassignment of HIV-positive surgical assistant ruled legal. Bradley v. University of Texas M.D. Anderson Cancer Center. PMID- 10137900 TI - Courts reject claims based on adverse credentialling decisions. PMID- 10137901 TI - Seamless service: maintaining momentum. AB - Describes the process used by the Mater Infirmorum Hospital in Belfast in 1992 1994 to achieve high quality care (Seamless Service), motivate staff to deliver and measure performance. Aims of the project include focusing the organization on the customer, improving teamwork and motivation at all levels. After comprehensive data collection from GPs, patients and staff management forums developed a full TQM strategy to gain support and maintain momentum including innovative staff events (every staff member was given the opportunity to attend) where multilevel, multidisciplinary workshops enabled staff to design customer care standards, develop teams and lead customer-driven change. PMID- 10137902 TI - Designing a "healthy" diploma in management studies. AB - Describes the range of issues considered in designing a programme of education and development for NHS managers. The programme took the form of a certificate and diploma in management studies with a very work-based approach using action learning sets and applied theory and techniques. Briefly discusses the recent history and debates in management education together with the tensions caused by academic focus on critical analysis and evaluation and the workplace focus of being effective and making improvements. This programme attempts to recognize and build on the strengths of both approaches and also to add some of the best practice from trainers' experience of designing personal development plans. Discusses the emphasis on reflective learning and the use of research-based assignments instead of conventional exams. Concludes with some indications of possible future developments from this model. PMID- 10137903 TI - The changing cultures of health and education. AB - Many public sector managers are facing fundamental organizational changes, as government macro reforms in health and education reach down to the managers' agenda. Cultural changes and a new set of values are demanding new management approaches and skills as managers seek to embrace an alternative organizational environment. Seeks to draw out some practical lessons and examples where successful managers in hospitals and colleges have embraced the positive aspects of change, while still preserving those aspects and values of the public sector which have provided for stability and integrity in organizations. Sets out a balance sheet for change, considering the detailed operational issues likely to arise in implementing such changes and suggests that a sensitive and pragmatic view, focusing on process and people, as well as outcome, is likely to remain a crucial skill for effective management. PMID- 10137904 TI - Trade union recognition. AB - An increasing number of organizations are addressing the issue of trade union recognition, particularly NHS trusts considering introducing local pay determination. Burnley NHS Trust developed a strategic approach to the issue, establishing pre-determined outcomes and measurable criteria to determine which organizations--if any--would have recognition extended for the purpose of local pay determination. The staff side case is examined in detail along with three other options: a staff association, recognition for some and recognition for none. Four organizations--representing 95 per cent of the unionized workforce- accepted recognition, with safeguards for 14 others. PMID- 10137905 TI - Continuity of care in maternity services--the implications for midwives. AB - Examines issues raised by Changing Childbirth. Summarizes an IMS/RCM report and is based on research in maternity units at different stages in the adoption of various approaches to developing continuity of care. It is concerned with the effect on midwives' working lives and explores issues of grading, responsibility, working hours, career progression and job satisfaction. PMID- 10137906 TI - Health-care continuum. AB - NHS managers must think of health care in a much wider sense than equating it solely with the National Health Service. Health care should rather be viewed as a continuum of businesses and services, including research and development, manufacturing, distribution and actual service delivery. Presents these and places them along a health-care continuum, which represents a systematic way by which the health care industry can be analysed through its discrete, yet integrated, segments. Manpower, along with finance and estate, are the key resource areas. Manpower resources must be managed effectively in order to maximize value for money, and ultimately ensure health gain for the patient. PMID- 10137907 TI - Work transformation in health care. AB - Examines the growing use of "work transformation" or process re-engineering techniques in health-care organizations. Identifies how pressures on funding and increased expectations are forcing health-care organizations to adopt radical solutions in their search for lower costs and improved quality of care. Also examines the experience of a number of organizations, and highlights some of the risks involved in taking these approaches. PMID- 10137908 TI - Physicians and business managers: a clash of cultures. PMID- 10137909 TI - Relying on physicians to control costs in a multispecialty group practice. PMID- 10137910 TI - Long-term change requires reengineering of hospital processes. PMID- 10137911 TI - A fresh approach to compensation can lead to a new tool for managing costs. PMID- 10137912 TI - Managing costs: where do we go from here? PMID- 10137913 TI - How do Germany and Canada provide more care for less money? The answer lies in compromises. PMID- 10137914 TI - Pureed diet: prevalence and reported reasons for use in a long-term care hospital. AB - Although pureed diets are thought to be widely used for patients in long-term care facilities, there is little specific information concerning prevalence and reasons for the actual use of this diet texture. At Saint-Vincent Hospital, a 516 bed, long-term care and rehabilitation facility, 25.9% of the chronic-care population (n = 424) were on a pureed diet. Those who received pureed diets tended to be older (83.5 years versus 75.4 years, P < 0.001) and were more likely to be female (82.7% versus 70.8% P < 0.006), than the total population of long term care patients. A greater percentage of patients receiving a pureed diet had dementia (43.0% versus 30.6%, P < 0.02), and fewer had cerebrovascular accident as a primary diagnosis (22.6% versus 33.9%, P < 0.05), than the total population of long-term care patients at this hospital. Following data collection, reasons for patients being on a pureed diet were grouped into five categories. The most popular categories were "Physiological/Mechanical" and "Cognitive" problems. PMID- 10137915 TI - Dietitians' human resource management skills enhanced by education and experience. AB - The purpose of this project was to examine the influence of education and experience on the development of human resource management skills in dietitians. The performance of 58 experienced dietitians, 67 entry-level subjects, and 63 undergraduate students was compared using a case study about a personnel problem with a dietitian. Performance was scored by comparing subjects' answers with selections of a panel of seven experienced dietetic managers. Experienced and entry-level groups had higher proficiency scores than students. Experienced and entry-level groups scored highest and students lowest in efficiency, defined as the proportion of total information containing sections chosen that contained helpful information. Experienced dietitians examined few inappropriate sections and students the most. Overall, experienced and entry-level groups performed better in this human resource management problem than students. We conclude that supervised practice is important in the development of human resource management skills. PMID- 10137916 TI - Position of The Canadian Dietetic Association and The American Dietetic Association: nutrition intervention in the care of persons with human immunodeficiency virus infection. AB - The goals of nutrition intervention in HIV disease include early assessment and treatment of nutrient deficiencies, the maintenance and restoration of lean body mass, and support for activities of daily living and quality of life. The maintenance and restoration of nutritional stores is closely interrelated and interdependent with each of the other recommended medical therapies. Therefore, it is vital to the health of persons with HIV/AIDS to have access to the services of a registered dietitian, who is the essential member of the health care team for providing nutrition care (48). The registered dietitian should take an active role in developing nutrition care protocols for HIV/AIDS in their practice setting. The dietetic professional must take responsibility for obtaining and maintaining current knowledge in this area and take the lead in translating current nutrition knowledge and research into practical and realistic nutrition guidelines for the individual with HIV/AIDS. Further research is needed in the area of HIV/AIDS and nutrition. Registered dietitians and other members of the health care team are encouraged to conduct nutrition research in the area of nutrition interventions and outcomes of nutrition therapy. Additionally, government health related agencies, national AIDS-related organizations, and private industry should be encouraged to provide funding sources and support to the issue of research in nutrition related problems and interventions in HIV/AIDS. PMID- 10137917 TI - I.V. solution prices remain stable. PMID- 10137918 TI - No relief in sight for beating high pacemaker prices. PMID- 10137919 TI - Analyzing non-salary expenses in radiology. PMID- 10137920 TI - Risk sharing helps ride out a "dysfunctional" purchasing system. PMID- 10137921 TI - Seattle HMO signs capitated supply pact with Owens. PMID- 10137922 TI - Diagnostic coronary catheter prices increase slightly. PMID- 10137923 TI - Like materials managers, HCMMS fights for survival. PMID- 10137924 TI - Value analysis builds teamwork, yields impressive savings. PMID- 10137925 TI - Controlling and managing operating room inventory. PMID- 10137926 TI - Suture prices take big jump. PMID- 10137927 TI - Supply capitation: a boom or a bust? PMID- 10137928 TI - Respiratory therapy expenses per treatment. PMID- 10137929 TI - CHA joins other organizations in electronic bulletin board system. PMID- 10137930 TI - ERISA may hinder states as they attempt healthcare reform. PMID- 10137931 TI - Communicating with the business community. A hospital launches two outreach efforts to educate community leaders. AB - Several years ago the management of Saint Francis Medical Center in Peoria, IL, decided that, with healthcare issues becoming increasingly complex, the hospital needed to find ways to share information with its community. Saint Francis's outreach effort began in 1991 with the launching of a Leadership Roundtable. Under its auspices, local leaders in business, finance, government, education, religion, and the media gather once a month to hear hospital staff members outline some aspect of healthcare or healthcare reform. A question-and-answer period follows. In 1993 James Moore, a Saint Francis administrator, began writing a monthly column on healthcare reform for a business publication that serves central Illinois. Moore's column explains to businesspeople how various healthcare reform proposals could affect them. With the column, as with the Leadership Roundtable, Saint Francis has strengthened its communication with the community. PMID- 10137932 TI - Community benefit reporting is worthwhile. A central Iowa healthcare provider annually distributes a report to its community. AB - To document our impact on the community's health, Mercy Health Center of Central Iowa has created a "Community Benefits Report"--a 14-page report listing all charitable projects among eight distinct subsidiaries of Mercy Health Center. The Mercy report lists all the charitable works provided to the community in the past year by Mercy Hospital Medical Center, the Mercy Clinic System, the Clark Street House of Mercy, the Bishop Drumm Care Center, and a few smaller affiliate hospitals in rural Iowa. Mercy's community benefits report serves not only as a summary, but as the blueprint for the work Mercy leaders are planning. This documentation helps in many ways, including identifying the needs of Des Moines and central Iowa and showing Mercy's role in meeting those needs. PMID- 10137933 TI - Hospital workers discuss Catholic values. Philosophy is the focus in a series of dialogue sessions. AB - Feedback from staff at Timken Mercy Medical Center in Canton, OH, suggested that they were taking the facility's Catholic identity for granted. Employees did not have a strong understanding of Catholic healthcare philosophy and how it made Timken Mercy different from non-Catholic hospitals. The hospital's administrators sought a solution to this problem. In fall 1992 the hospital began to hold a series of "dialogue sessions" for its staff members on Timken Mercy's philosophy. The first sessions, for managers, were so successful that meetings were added for other hospital workers early the following year. After an opening prayer, the participants in each session discussed points taken from Timken Mercy's statement of philosophy. After the sessions, participants suggested ways the hospital's philosophy might better be embodied in their work lives. Employee morale has improved as a result of the hospital-wide discussion of Catholic healthcare values. A new openness and willingness to grow has been noted in Timken Mercy's staff. PMID- 10137934 TI - The crisis plan. Nearly every hospital has one; not all are ready to follow it. AB - It is not enough that a healthcare facility have a "crisis plan" somewhere in its file cabinets. Indeed, unless the facility's executives have made thorough preparations for putting it into action, their plan could make a crisis even worse. Shortcomings commonly found in crisis plans include: Failing to make sure that the people designated to implement the plan are actually present when a crisis occurs Having a crisis team that is too large and unwieldy to be effective in a real crisis Forgetting that, while the crisis team acts, others must keep normal operations running Failing to designate a single, trained spokesperson to deal with the media Being unprepared for a long siege-the crisis that goes on for hours, days, or even weeks Forgetting during a crisis to inform, not only the general public, but also one's own staff, patients, and others Failing to have an understanding with staff and their unions that, in a crisis, some persons may be expected to perform duties other than their normal ones PMID- 10137935 TI - Celebrate the mission. A one-day workshop helps employees recommit to their facility's mission. AB - To ensure that the mission of their sponsoring religious institute--the Franciscan Missionaries of Our Lady--remains central to the facility' services, employees of Our Lady of the Lake Regional Medical Center, Baton Rouge, LA, commissioned the Mission Effectiveness Education Task Force to initiate a meaningful hospital-wide program that would bring Christian values into focus and put the spirit of the mission into daily practice. The goals of the one-day workshop---"Celebrate the Mission"--are: To articulate the central values of Our Lady of the Lake Regional Medical Center to all employees To promote the Franciscan Missionary of Our Lady's mission of a healthcare ministry To acknowledge and celebrate the creation of a vision by the sisters and the staff To allow a deep integration of the mission into daily work decisions To ensure that all of Our Lady of the Lake's 2,900 employees experience Celebrate the Mission, the program is offered twice a month but limited to groups no larger than 35 persons. Many employees, board members, and administrators facilitate Celebrate the Mission sessions. PMID- 10137936 TI - Denver physicians take flight to help their rural neighbors. PMID- 10137937 TI - Extending the mission to the work site. A Denver provider joins a local television station in sponsoring health fairs. AB - In 1991 KUSA Channel 9Health Fair Foundation asked Provenant Health Partners--a Catholic multi-institutional healthcare system in the Denver area--to become a sponsor of its annual fairs. Provenant viewed this invitation as an excellent opportunity to extend its mission and increase its focus on health and community service. Since January 1992, Provenant and 9Health Fair have conducted more than 45 fairs at 28 different work sites. At many sites, more than one employer participates, so approximately 90 companies have actually been served. Health fair volunteers and healthcare professionals check attendees' weight, blood pressure, lung function, body fat composition, foot conditions, vision, and hearing. Attendees may be screened for peripheral vascular disease, glaucoma, and a variety of cancers. In addition, a comprehensive blood chemistry test and a prostate-specific antigen blood test are offered for a small fee. For conditions requiring further evaluation, attendees are referred for medical follow-up. The fairs have been successful in identifying pathological conditions, enabling many people to seek early treatment. The early detection has resulted in significant healthcare cost savings. Health fairs have also promoted higher familiarity and favorability ratings of Provenant Health Partners and constituent institutions. Perhaps more important, the health fairs have enabled hundreds of Provenant employees and staff physicians to devote thousands of hours volunteering to promote better health in the community. PMID- 10137938 TI - The Rx to ease a community's burdens. A Detroit hospital helps low-income patients obtain prescription medication. AB - St. John Hospital and Medical Center found itself with an increasing volume of indigent and low-income patients who had few or no resources with which to purchase prescription medications. With funding cutbacks in various federal, state, and local programs, the hospital's pharmaceutical resources had diminished to the point at which it could only occasionally meet a patient's needs. The Indigent Pharmaceutical Fund was established in 1992. Once a staff member from the hospital's Social Work and Discharge Planning Department has exhausted all patient or community resources, he or she requests assistance for a patient. In the first year of operation, the fund assisted 278 patients at a cost of just under $5,000. PMID- 10137939 TI - A Kids' "Care-Van." Hospital's mobile health program provides screenings for neighborhood children. AB - Last year Franciscan Children's Hospital & Rehabilitation Center in Boston launched a "Kids' Care-Van" in an attempt to better serve the children of its community. That community, the city's Allston-Brighton neighborhood, is the home of many immigrants and minority group members, people likely to face economic, cultural, and linguistic barriers when seeking healthcare. A survey showed that neighborhood children especially needed better access to the Women, Infants and Children program (WIC), health education, and dental care. The Kids' Care-Van regularly tours Allston-Brighton, making stops at schools, Head Start programs, day care centers, a youth club, and the local YMCA. At those stops children are given medical and dental screenings; if needed, referrals are made to other healthcare sources. Parents, children, and adolescents are also given information about prevention and wellness. To date, 2,500 neighborhood children have been served. Approximately 70 percent have been found to be in urgent need of dental care, a serious problem because many Allston-Brighton parents cannot afford to pay for such care. Few Boston dentists accept Medicaid payment, and there are no other state or federal resources. The van program's manager is currently negotiating with area universities and lobbying local members of the State legislature in hopes of getting some assistance. PMID- 10137940 TI - The ethics of withholding information about mistakes. PMID- 10137941 TI - Communicating in a managed care environment. PMID- 10137942 TI - The extended family. PMID- 10137943 TI - States move ahead through incremental reforms. PMID- 10137944 TI - CHA's study helps in the search for new leaders. PMID- 10137945 TI - Integrated delivery networks. Research guides system's vision of redesigned care delivery. PMID- 10137946 TI - Payer contracts require close scrutiny. PMID- 10137947 TI - Socially responsible investing. Is it successful? AB - Socially responsible investing (SRI) has been defined as "the integration of social or ethical criteria into the investment decision-making process." Based on the values they hold, investors distinguish socially responsible investments from those which are not by implementing social screens: nonfinancial criteria applied in the decision-making process. Socially responsible investors typically follow one of three approaches to ethical investing: avoidance of businesses whose activities they do not support, a positive approach where they seek investments that will enhance the quality of life, and an activist approach where they attempt to influence the company's activities. In addition to individuals, many institutional investors are heavily involved with SRI. Activist investors can judge their investments' performance by the success of their shareholder activities. Investors might also look at the societal effects of their investments. If investors are seeking to change the corporation or society, SRI has proven to be successful. Empirical studies have shown mixed results with respect to the financial performance of SRI, but the findings tend to show that SRI has minimal impact, either positively or negatively, on investment returns. Nevertheless, many factors indicate that SRI may be here to stay. PMID- 10137948 TI - Health on wheels. AB - To adequately meet the needs of the poor and underserved, we must bring healthcare services to them. Saint Joseph's Hospital of Atlanta is doing just that through its Mercy Mobile Health Program. Even though Mercy Mobile has been available for a decade, the health status of Atlanta's homeless and working poor has deteriorated. The program has therefore increased its services to include primary care, disease prevention, health promotion, case management, and information and referral. With four vans and two mobile clinics, the program operates five days and three evenings a week, often in space donated by churches and other not-for-profit organizations. It provided more than 50,000 episodes of care last year. Developing strategies and resources to treat medically-at-risk, hard-to-reach clients with multiple diagnoses is a complex task, requiring the resources of more than one organization. One example of an effective collaborative effort is the "Street Home" program for HIV-infected homeless persons. This program, which provides early intervention and primary care to persons with HIV, is funded through the federal Ryan White "CARE" (Comprehensive AIDS Resources Emergency) Act. PMID- 10137949 TI - Delivering care to the streets. AB - St. Francis Hospital's management team has collaborated with other community organizations to respond to the very real needs of the homeless and indigent in Wilmington, DE. St. Francis Hospital has developed two innovative programs: St. Clare Medical Outreach and Tiny Steps. Recognizing that the poor and indigent find transportation, clinic schedules, and intimidating paperwork to be major barriers to healthcare, St. Francis Hospital and its partner in this collaborative ministry, Ministry of Caring, sought a creative approach that would bring healthcare to Wilmington's needy in a nonthreatening way, while also offering continuity of care. St. Clare Medical Outreach van staff began administering much-needed healthcare services on April 27, 1992. For years, St. Francis Hospital has supported a pediatric clinic at West End Neighborhood House, an organization offering a variety of family-related services to the indigent. In September 1992 the hospital collaborated with other community organizations to offer a more comprehensive, holistic healthcare service to those in need. This joint-venture of St. Francis Hospital and 11 other community organizations is designed to lower the infant mortality rate by identifying high-risk pregnancies early on and managing complications during pregnancy and after birth. PMID- 10137950 TI - Connecting values and program development. A Canadian hospital's experience with mission integration. AB - Catholic values distinguish Catholic healthcare facilities, their staff members like to say. But those values can remain merely rhetorical unless they are integrated into the facility's actual programs. The staff of St. Joseph's Hospital, Hamilton, Ontario, has been encouraged to express the facility's values in everyday language. More important, the staff has had an opportunity to employ those values--a belief in the sacredness of life and the dignity of the person; a special obligation to the poor and vulnerable; and a commitment to treat the "whole person"--in two new programs. One is for women who have miscarriages. The hospital's Obstetrics Department, realizing that society often fails to recognize the deep grief involved, developed a program for women experiencing early pregnancy loss (EPL). The EPL protocol stresses the uniqueness of each patient and the importance of support, continuity, appropriateness of care, and postdischarge follow-up for her. The hospital has also emphasized Catholic values in developing a set of guidelines for the examination of patients. St. Joseph's found that publicity about sexual abuse was making both patients and medical practitioners wary of physical examinations. The guidelines, called "Culture and Sensitivity," remind care givers that patients feel vulnerable and should be treated with respect and care, on one hand. On the other hand, the guidelines say, appropriate reassuring touch remains part of the healing process. PMID- 10137951 TI - Community benefit programs for young people. PMID- 10137952 TI - The motives behind collaboration. PMID- 10137953 TI - Holy Cross Health System. Guide helps integrate nursing services into strategic planning. PMID- 10137954 TI - Quality time for the dying. PMID- 10137955 TI - Profile of a BMET (biomedical equipment technician) in small hospitals. AB - A survey was done of biomedical engineering programs in hospitals of under 100 beds. A random sampling of 400 hospitals was selected from the American Hospital Association Guidebook. Questions were asked with regard to the size, educational background and experience of the biomedical engineering staff. The organizational location of the program was surveyed, and most programs were part of facility engineering. Programs are discussed as full-time, part-time and outside service contracts. An in-depth analysis of the educational and training background of BMETs has been done. This part of the study covered the type of training and what additional training they felt they required. PMID- 10137957 TI - Capitation strategies: eight physician-hospital models for capitation. PMID- 10137956 TI - Multi-level educational affiliations for a CE (clinical engineer) department. AB - Educational programs for clinical engineers and biomedical equipment technicians should provide students with an exposure to the clinical environment. Through alliances with educational institutions, hospitals can assist future engineers and technicians in obtaining a well-rounded education. These affiliations provide a hospital with engineering expertise for research projects, as well as a resource for the clinical engineering department. One hospital, Baystate Medical Center in Springfield, Massachusetts, has successfully developed internships for technician candidates in an Associate's degree program and for undergraduate and graduate engineering students through educational affiliations with three different academic institutions. The internships of the students intertwine, giving them a unique educational experience. PMID- 10137958 TI - Eight strategies for capitation. PMID- 10137959 TI - The sixth stage of managed care: 10 new models for the post-reform era. PMID- 10137960 TI - Hospitals should prepare for 0.8 beds per 1,000 patients. PMID- 10137961 TI - Overcoming resistance to technology change. PMID- 10137963 TI - New technology, old struggles plague vaccine developers. PMID- 10137962 TI - Information technology: the competitive advantage in a changing health care environment. PMID- 10137964 TI - Annual cardiac catheterizations exceed 2 million; total growing by more than 6%. PMID- 10137965 TI - Forces impacting technology growth. PMID- 10137966 TI - Health care report cards: what about consumers' perspectives? AB - Though the report card style is seen by many as a way to create better-informed consumers, very little is actually known about how consumers will respond to health care report cards. Report cards are only one of many factors that influence health care decision making. Much consumer-oriented effort and fine tuning will be required to make report cards effective. Using the approach called "social marketing" as a framework, specific examples are used to outline some ideas for more intensive pursuit of consumers' perspectives in the design and distribution of report cards. PMID- 10137967 TI - Performance reporting of health care delivery systems: will it make the grade? AB - Recently, federal governments, state governments, and private sector groups have begun initiatives that would report the performance of health plans in key areas. United HealthCare Corporation's experience in developing and publicly releasing "report cards" for 15 of its health plans may prove useful as other efforts go forward. There are both advantages and challenges to producing a report card in terms of resource investment, directing health plans toward performance improvement, and the ability for both purchasers and policy makers to understand and make use of results. These and other issues will be important to consider as other segments of the health care industry, particularly providers, focus on reporting performance measures. PMID- 10137968 TI - The central Iowa project. AB - This project developed and tested a population-based survey, the HS Form, to examine health and health care in the Central Iowa community. Data from this new collection of proven sets of items were used to compare competing health plans, doctor offices, hospitals, and to develop preliminary norms of the community's insured, in two areas: system performance and health burden. The results showed that the survey: (1) was both feasible and efficient in delivering a comprehensive and generic assessment of consumers and patients; (2) revealed consistent, noteworthy differences between plans and between providers across both sets of criteria; and (3) indicated that there is substantial room for improvement in Central Iowa's health care delivery system from the public's perspective. Recommendations for next steps include: (1) following through on the June 1993 community forum (held to discuss the project's methods and results with local decision makers); (2) broadening the evaluation design to increase sample representativeness; and (3) implementing a pre/post approach to measure changes in plan and provider performance. PMID- 10137969 TI - Commentary on the Central Iowa project. AB - The trend toward informed consumer decision making is a positive development in the evolution of the delivery of health care services. Measures currently under development are a reasonable first approximation of quality and efficiency measures within a continuous quality improvement context that will evolve over time. The Central Iowa project shows that comparisons among health plans and providers can be used by these entities as a valuable source of information on customer expectations and as part of an internal quality improvement process. PMID- 10137970 TI - Managing the quality of managed care delivery systems. AB - We have developed a quantitative "score card" for measuring the quality of 130 managed care organizations. This tool is currently being used in California as part of a large scale CQI process. When quality data are compared to cost data, we observe a negative correlation between cost and quality, consistent with the industrial model that better quality and lower cost can go hand in hand. PMID- 10137971 TI - The equity model. The Advisory Board. AB - This model is excerpted from The Grand Alliance, a study prepared for the 900 health system members of the Washington, DC-based Advisory Board. The Grand Alliance defends two positions for a stable system: a closer alignment of hospitals and physicians; and a rich primary care base. PMID- 10137972 TI - The equity model: three commentaries. AB - In the current ferment of health care reform, advocates of most proposals agree that one of the goals to be achieved is maintaining an environment in which physicians and other caregivers can be comfortable. One such proposal, the equity model, is evaluated here from the physician's viewpoint by three directors of established health care plans. While all express concern over potential loss of physicians' autonomy and control, they see the threat as coming from different sources. PMID- 10137973 TI - Developing an outpatient prospective payment system based on APGs for the Iowa Medicaid program. AB - This article describes the development of an outpatient prospective payment system (PPS) based on ambulatory patient groups (APGs) for the Iowa Medicaid Program. Currently, hospitals in Iowa are reimbursed for outpatient services on the basis of cost. Because of concern about escalating costs, the Iowa General Assembly mandated development of a hospital outpatient payment system to promote efficient use of resources and high quality care. The first use of APGs for payment across the full spectrum of services will be a testing ground that should have long term implications for outpatient prospective payment and quality improvement efforts. PMID- 10137974 TI - Health sector management capacity building in Central and Eastern Europe. PMID- 10137975 TI - The promotion of health markets in Central and Eastern Europe. PMID- 10137976 TI - Meeting the challenge: policymaking and management during economic transition. PMID- 10137977 TI - The economic transformation of Central and Eastern Europe: implications for managing health care resources. PMID- 10137978 TI - A region in transformation: the political realities of health care management. PMID- 10137979 TI - New health planning paradigms require new management outlooks. PMID- 10137980 TI - The crucible of health care reform in CEE (Central and Eastern Europe): managing change/managing implementation. PMID- 10137981 TI - Managing capital development for health care in Poland: Friends of Litewska Children's Hospital. PMID- 10137982 TI - Health services management development in the Republic of Albania. PMID- 10137983 TI - Quality assurance in Hungarian hospitals: a new focus for management development. PMID- 10137984 TI - Health services management education in Slovakia. PMID- 10137985 TI - Banking on confidentiality: should consumers be allowed access to the National Practitioner Data Bank? PMID- 10137986 TI - New medicine for medical malpractice: the empirical truth about legislative initiatives for medical malpractice reform--Part II. PMID- 10137987 TI - Hospital/physician contracting and the illegality defense. PMID- 10137988 TI - Setting goals and targets for performance standards within the Swedish health care system. AB - The development of any health care system towards setting goals and targets and intended outcomes--with national guidelines, a legislative framework, limited resources, consumer influence and competitive forces--makes great demands on the control mechanisms required. The Swedish health care system has no tradition of goal formulation of this type. Hence, the purpose of this article is to clarify the goal-setting process of performance standards, and to examine whether goal setting is a relevant method within the organization of a Swedish county council. Goal setting can be seen partly as a control method and partly as an administrative process. The approach used is a combination of qualitative and quantitative methods. Data have been collected from interviews, observations, notes taken in the field and available performance statistics. The analysis shows that working towards a goal is made easier through a common and simple concept. It 'stands and falls' with the management of the work and its manager. Good communications and information are important prerequisites if goal formulation, through dialogue, is to succeed. This process takes time and can be described as an iterative process, in which a common behaviour pattern develops a 'we-feeling' which spreads among the staff. It is important that the goal is relevant and directly related to the basic objects of the work. It is also crucial that the goal is realistic and reflects a priority. Goal formulation relating to performance standards can be a contributing factor to staff's experience of job satisfaction through increased engagement and motivation, and to the satisfaction of patients/relatives with the care given. It is difficult to formulate performance standards; there are many problems and obstacles. If goal formulation as a control method within the health care system in Sweden is to work, clearer manifestations of political will are necessary and also better measuring methods in order to guage achievement. PMID- 10137989 TI - Developing strategies to encourage appropriate care-seeking for children with acute respiratory infections: an example from Egypt. AB - Determinants of care-seeking and patterns of referral for acute respiratory infections (ARIs) in children were studied in two communities in Ismailia, Egypt. A video was used to assess mothers' recognition and interpretation of clinical signs of serious illness. Mothers were questioned about which of the locally available provider options they would choose for four different locally-defined ARI illnesses; they were also read brief descriptions of hypothetical cases, and asked how they would recommend treating children in those situations. These results were compared with reported care-seeking practices during past ARI episodes that occurred in their own children. The results indicate that mothers generally recognize rapid or difficult breathing, but do not use the recognition to take appropriate actions. The data suggest that a substantial proportion of children in the study area, who are perceived to have severe respiratory illnesses, may not be brought to the government health facilities for treatment. Implications of the findings for the training policies and strategies of the Egyptian national ARI program are considered. PMID- 10137991 TI - Beyond negligence. Is provider immunity good for EMS? PMID- 10137990 TI - Inter-organizational networks on the Dutch home health care market. AB - The demand for home care in the Netherlands is growing and changing. A decreasing rate of institutionalization, combined with an increasing number of elderly people with special age-related, often complex health problems, has led to new groups of patients, to be cared for in their home settings. This requires a strong coordination of services between suppliers from the primary and secondary health care sectors. In order to promote coordinated care, Dutch health care providers are building inter-organizational networks. The development of such arrangements was the target of 12 demonstration projects, selected by the Ministry of Health for the National Home Care Programme. This article presents some of the results of an evaluation study of the Programme, with special attention given to the question of the extent to which such inter-organizational networks contribute to the balance between quality and cost. PMID- 10137993 TI - Beauty in the beast. PMID- 10137992 TI - Helicopter emergency medical services. More than just a change in uniform. PMID- 10137994 TI - Calming the demon within. Chemical vs. physical restraint. PMID- 10137995 TI - Is your EMS system cutting edge? PMID- 10137996 TI - Florida and Texas expand expanded-scope programs. PMID- 10137997 TI - Changing organizational culture. PMID- 10137998 TI - Ways to promote successful training. AB - With today's financial cutbacks, long-term care facilities are looking for low cost ways to help nurses meet licensing requirements. In-house training can be one economical way, but getting employees involved is another challenge. PMID- 10137999 TI - Urinary incontinence: a program that works. AB - Using a simple and inexpensive intervention, improvement in dryness was apparent by the first week of the study. More importantly, results were achieved by changing staff behavior, rather than residents' behavior. PMID- 10138000 TI - Can injurious falls be prevented? AB - The resident population in facilities changes over time. In some facilities there may be a large turnover of residents; in other types of facilities some residents will remain, age in place and become more frail. In addition, some medical conditions and intrinsic factors cannot be changed. Since there is not a single set of factors that can guide nursing staff as to which residents are at high risk for serious injurious falls, taking some general protective actions is appropriate. Some examples are: Monitoring the use of psychotropic medications through the MDS. Assessing the environment to determine potential risks that can be minimized or abolished. Using hip protectors to reduce hip fractures among elderly residents who fall. PMID- 10138001 TI - Break down the language barrier. PMID- 10138002 TI - Blueberry picking is easy as pie. PMID- 10138003 TI - Keeping the community spirit alive. AB - The concept of community is often romanticized as emerging magically or naturally among residents within a facility. But, the feeling of community evolves through the philosophy, decisions and everyday communication practices of administrators. PMID- 10138004 TI - Bringing family members into the community. PMID- 10138005 TI - Go beyond "home," create a hometown. PMID- 10138006 TI - Women's mental health services. PMID- 10138007 TI - Women's mental health services: the need for women in mental health leadership. PMID- 10138008 TI - Gender differences in the use of outpatient mental health services. AB - Current economic constraints necessitate careful planning and evaluation of mental health services. Gender differences in need and use of outpatient mental health services are synthesized based on current epidemiological research. Although overall prevalence rates of mental disorder are similar, women use more outpatient mental health services than do men. This disparity exists largely within the primary care sector. The study of social roles and behavior may help explain these gender differences. Implications for planning and organizing outpatient mental health services are discussed. PMID- 10138009 TI - Women and outpatient mental health services: use by black, Hispanic, and white women in a national insured population. AB - Factors affecting ethnic differences in women's use of outpatient mental health services were analyzed to determine whether lower use by black and Hispanic women occurred when socioeconomic and other factors are controlled. Employing the Andersen and Newman model of health use, insurance claims of 1.2 million federal employees insured by Blue Cross/Blue Shield in 1983 were analyzed to identify significant predictors of use. Results revealed that black and Hispanic women had lower probabilities and amounts of use when compared to white women even after controlling for a number of variables. Further research is needed to examine cultural and gender-related factors that may underlie ethnic differences; attitudinal factors and service system barriers are also implicated. Such findings have policy implications in the current climate of health care reform for which efforts are needed to increase access to care for ethnic minority women and other underserved populations. PMID- 10138010 TI - Independent community living among women with severe mental illness: a comparison with outcomes among men. AB - This analysis addresses the question of whether or not women and men display differential ability to live in commercial housing following psychiatric rehabilitation. A multivariate model predicting the independent living status of 650 mental health consumers 6 months following psychiatric rehabilitation was tested. Results revealed that significant gender differences favoring women disappeared when controlling for level of functioning, program tenure, support continuity, parental status, and community participation. Implications of these results for service delivery are discussed. PMID- 10138011 TI - On being invisible in the mental health system. AB - The author provides a case study of her daughter's sexual abuse as a child and subsequent experiences as a chronically mentally ill client in the mental health system. Information from 17 years of mental health records and anecdotal accounts are used to illustrate the effects of the abuse, her attempts to reach out for help, and the system's failure to respond. There is evidence that a significant subset of psychiatric patients were severely sexually traumatized in childhood. Yet standard interview schedules consistently neglect to ask questions about such abuse, appropriate treatment is seldom available, and clients are often retraumatized by current practices. Psychiatry's historic resistance to addressing abuse as etiology is being challenged today by powerful economic, political, and professional forces leading to the emergence of a new trauma-based paradigm. PMID- 10138012 TI - Parents with severe mental illness and their children: the need for human services integration. AB - This article presents the findings and recommendations of a statewide interagency task force on parents with mental illness who have young children. Based on testimony from consumers, providers, and advocates, the task force concluded that this is a substantial and neglected public policy issue requiring an intergovernmental, services integration approach. Recommendations were made in the areas of services, policies and procedures, and service coordination. PMID- 10138013 TI - Modifications in service delivery and clinical treatment for women diagnosed with severe mental illness who are also the survivors of sexual abuse trauma. AB - Sexual abuse trauma and chronic revictimization are central to the experience of many women diagnosed with severe mental illness. The high reported prevalence rates of sexual abuse trauma among these women necessitate that program planners and clinicians be prepared to adapt their treatment interventions for use with trauma survivors. This article describes how current treatment approaches for women diagnosed with severe mental illness can be adapted to accommodate the special needs and vulnerabilities of sexual abuse trauma survivors. A history of trauma added to the clinical picture of longstanding and severe mental illness poses new diagnostic and treatment considerations, which are discussed. The full range of rehabilitation services--case management, residential placement and supervision, inpatient hospitalization, medication management, network intervention, and social skills training--must be grounded in an understanding of the trauma experience, informed by accurate assessment of the trauma, and accommodated to the woman's specific history of sexual abuse trauma. PMID- 10138014 TI - Great expectations: challenges for women as mental health administrators. AB - Although women have made many strides in the area of leadership, stereotypes still exist that limit their power. Traditional concepts of femininity have not typically been associated with strength and competence. This article describes an inpatient unit at San Francisco General Hospital, University of California, San Francisco, which is led by a group of women. The unit houses a women-focused treatment team specializing in treating women who have serious mental illness with histories of severe trauma, including poverty and violence. The article describes the challenges and rewards available to women leaders in this type of setting. Four areas of women's leadership are explored: the stereotypes women have about each other as leaders, the expectations and biases of staff and trainees, the projections of patients onto women leaders, and women's leadership in relation to department administration. Strategies for addressing biases in these areas and developing women's leadership conclude the article. PMID- 10138015 TI - Air ambulance services--integrated emergency care. AB - In the name of cost-conscious care, air ambulance program directors and service contractors are seeing the dawn of integrated networks as a boon to their business. As integrated networks form, facilities will become increasingly specialized in the types of services they provide. Patients will need to be moved around the system, resulting in more frequent patient transport and more points of transfer. Many programs are considering aircraft replacement and additions, rather than leasing. Financial benefits could come on depreciation and the high resale value of aircraft. Unless reimbursement levels increase, more program mergers and affiliations may take place to spread and reduce cost. Air ambulance services will increasingly become part of a facility's strategic plan. PMID- 10138016 TI - Devices for the prevention of TB transmission. Considerations for proper application. AB - Healthcare facilities throughout the country are confronted with the task of preventing the transmission of tuberculosis among their patients and staff. On October 12, 1993, The Centers for Disease Control and Prevention published the Draft Guidelines for Preventing the Transmission of Tuberculosis in Health Care Facilities, and this is scheduled for final publication before year's end. The pending CDC guidelines are comprehensive and include engineering recommendations which are applicable to all settings in which health care is provided. Facilities that do not intend to use conventional construction or renovation to accomplish TB guideline compliance may consider using some type of environmental control device. These devices typically utilize ultraviolet germicidal irradiation (UVGI) and/or high efficiency particulate air filtration (HEPA), each of which is recognized as a viable TB environmental control. TB environmental control measures for specific areas within a healthcare facility should be based on a careful assessment of the actual risk of TB transmission in that setting. PMID- 10138017 TI - Conducting physician surveys. AB - Physician/hospital cooperation is important to the success of health delivery systems. Surveying is one way to evaluate physician attitudes and needs. Personal interviews, telephone interviews and mailed questionnaires are the three principal ways survey data are generated. With physicians, a mailback survey yields the best response, because physicians can control when they respond. Survey methodologists strive to control for any systematic bias that may skew the data. For all surveys, it must be decided if those who responded are representative of all those who could have responded. High-quality surveys sent to doctors once a year with plenty of notification and encouragement to respond will yield the best results. Have a plan of action to deal with the results. Avoid writing questions that have yes/no responses and allow space for physicians to comment on each section. PMID- 10138018 TI - Carts, resuscitation. ECRI. PMID- 10138019 TI - Healthcare reform odyssey. PMID- 10138020 TI - Quality "in relationship". PMID- 10138021 TI - Team building. PMID- 10138022 TI - Contracts and supply assurance in the UK health care market. AB - We present a formal model of the relationship between a health care purchaser and a provider drawing on the recent experience of explicit contracting in the UK health sector. Specifically we model the contractual relationships emerging between District Health Authorities, who are presently the dominant health care purchasers, and the providers of hospital care. The comparative static analysis implies that the transaction cost of using non-local hospitals, the expected patient demand, the extent of excess capacity in local hospitals, and the proportion of that excess capacity expected to be lost to competitive purchasers, are all important determinants of the choice of contract. PMID- 10138023 TI - Do case-mix adjusted nursing home reimbursements actually reflect costs? Minnesota's experience. AB - Some states have adopted Medicaid reimbursement systems that pay nursing homes according to patient type. These case-mix adjusted reimbursements are intended in part to eliminate the incentive in prospective systems to exclude less profitable patients. This study estimates the marginal costs of different patient types under Minnesota's case-mix system and compares them to their corresponding reimbursements. We find that estimated costs do not match reimbursement rates, again making some patient types less profitable than others. Further, in confirmation of our estimates, we find that the percentage change in patient days between 1986 and 1990 is explained by our profitability estimates. PMID- 10138024 TI - Market work, wages, and men's health. AB - In this paper, we investigate the complex interrelations among work-time, wages, and health identified in the Grossman model of the demand for health. Hansen's generalized method of moments techniques are employed to estimate a 3-equation simultaneous model designed to capture the time dependent character of these interrelationships. We then estimate simpler models with more restrictive assumptions commonly found in the literature and find substantial differences between these estimates and those from our simultaneous model. For example, the positive relationship between work-time and health found in other studies disappears when the relevant simultaneities are taken into account. PMID- 10138025 TI - The effect of competitive pressure on charity: hospital responses to price shopping in California. AB - Since higher charges to private patients are a major source of financing for hospital care to the uninsured, increased price shopping by private payers may mean that hospitals are less able to provide such care. I study the effect of increased price shopping on California hospital markets over the 1984-1988 period. I find that there was a large fall in net private revenues and net income in the least concentrated hospital markets in the state after the advent of price shopping. Perhaps as a result, care to the uninsured fell dramatically in these markets as well, relative to more concentrated markets. PMID- 10138026 TI - The hazard of starting smoking: estimates from a split population duration model. AB - Understanding the determinants of the hazard of starting smoking is of great importance in developing policy to reduce the number of smokers. This paper develops a split population duration model of the decision to start smoking. Using data from the 1978 and 1979 Smoking Supplements to the National Health Interview Survey, we find some evidence that lifetime educational attainment, gender, and race are important determinants of both whether and when the smoking habit is initiated. The study finds no evidence that higher cigarette prices would have a significant impact on teenage decisions to pick up the smoking habit. PMID- 10138027 TI - Agency in health care with an endogenous budget constraint. AB - In this paper a doctor acts as a perfect agent for a group of patients in an environment where the health service is funded by a group of contributors. The contributor group donates resources to the health sector in accordance with its split preferences about the health care services which they would like for themselves and those which they would like for others. We show that the size of the health budget is endogenous and depends on the choices made by the doctor. The focus is on the division of the budget between health enhancing and non health enhancing health care. PMID- 10138028 TI - Another look at physician-assisted suicide. AB - Responds to a previously published article on the topic of physician-assisted suicide and argues against it from a bioethical standpoint. Suggests guidelines for pastoral caregivers in providing help to patients who may feel compelled to consider physician-assisted suicide. PMID- 10138029 TI - Conceptual learning in clinical pastoral education supervisory training: a focus group research project with recommendations. AB - Reports on focus group research designed to determine how conceptual skills are developed and integrated into the learning experience of supervisory training in Clinical Pastoral Education. Records actual participants' responses to five basic questions and identifies major underlying ideas gleaned via content analysis. Notes both limitations and strengths of the focus group method of qualitative research and offers recommendations designed to encourage and extend research focused on ways in which conceptual learning in Clinical Pastoral Education Supervisory Training may be achieved. PMID- 10138030 TI - Cancer nurses' perspectives on spiritual care: implications for pastoral care. AB - Explores nurses' perspectives regarding collaboration with chaplains and clergy in the provision of spiritual care to persons with cancer. Reports results of a survey via questionnaire of a random sample of Oncology Nursing Society members. Concludes that although a majority of the respondents report referring patients in spiritual need to clergy and chaplains, a significant minority did not do so. Notes that results secured from these respondents bring to surface several aspects of the collaborative relationship between nurses and chaplains and clergy. PMID- 10138031 TI - Strategic activity and financial performance of U.S. rural hospitals: a national study, 1983 to 1988. AB - This study examines the effect of 13 strategic management activities on the financial performance of a national sample of 797 U.S. rural hospitals during the period of 1983-1988. Controlled for environment-market, geographic-region, and hospital-related variables, the results show almost no measurable effect of strategic adoption on rural hospital profitability and liquidity. Where statistically significant relationships existed, they were more often negative than positive. These findings were not expected; it was hypothesized that positive effects across a broad range of strategies would emerge, other things being equal. Discussed are possible explanations for these findings as well as their implication for a rural health policy relying on individual rural hospital strategic adaptation to environmental change. PMID- 10138032 TI - Health and well-being of childbearing women in rural and urban contexts. AB - As part of the national focus on women's health issues, it is important to identify those health-related characteristics of rural women that distinguish them from women living in urban settings. The aim of this study was to compare rural and urban childbearing women on socioeconomic characteristics, perceived stress, health-related practices, illness symptoms, parenting confidence, and body weight. One hundred sixty-five midwestern women responded to a health survey sent to them six months after childbirth. Rural women were younger and less educationally and economically advantaged compared to urban women. Before adjusting for these differences, rural women were less self-actualized, more interpersonally isolated, and reported less healthy nutrition than urban women. These differences disappeared when socioeconomic differences were adjusted. Rural and urban mothers did not differ in most other areas, including perceived stress, parenting confidence, and body weight. Compared to national norms, the perceived stress levels of both rural and urban mothers were significantly higher than a probability sample of U.S. women. Findings support the role of socioeconomic factors as contributing to risk of poor health promotion among rural childbearing women. PMID- 10138033 TI - Rural primary care program survival: an analysis of financial variables. AB - This study examines the effect of financial characteristics of rural primary care programs on the probability of their continuing as federally funded entities. A randomly selected national cohort of rural primary care programs (n = 162) was used to compare financial measures of programs that were continuing and those that were noncontinuing. Financial data were obtained from 1978-1987 Bureau Common Reporting Requirements (BCRR) forms submitted to the Bureau of Health Care Delivery and Assistance of the Department of Health and Human Services as part of the requirement to receive federal grant support for the programs. The results emphasize the importance of both outside funding and increased level of self sufficiency in the continuation of rural primary care programs. Noncontinuing programs often suffer from both a lack of self-sufficiency and a lack of outside funding, mostly from federal sources. To a lesser extent, the number of patients also affects the program's chance of continuation. From a policy perspective, government intervention is both necessary and likely if rural primary care programs are to succeed and fulfill their mission of providing primary care for the medically underserved who are primarily poor, uninsured, and unable to pay. PMID- 10138034 TI - Studying the retention of rural physicians. AB - Rural communities and policy-makers struggle with efforts to enhance the retention of rural physicians. Research available to guide these efforts is often weak methodologically and thus may be pointing retention efforts in nonproductive directions. This article discusses a range of methodologic issues encountered in rural physician retention studies for the purpose of strengthening future studies. Ideal study approaches to answer causal questions, including questions about the "causes" of rural physician retention, must demonstrate good internal validity, for which chance, bias, and confounding are accounted. Retention studies that rely simply on asking physicians why they stay or leave rural areas can be useful at times, but are too prone to bias and their findings difficult to verify. Simply identifying what physicians find satisfying or dissatisfying about rural work also will not reliably reveal why they stay or leave, a related but still distinct question. Stronger approaches to studying retention include the traditional quantitative study--in which retention factors are identified when they are statistically related to physicians' retention, and the increasingly popular qualitative study--in which retention issues are revealed through prolonged, in-depth interactions with physicians. This article also discusses various definitions of retention, the use of survival curves to present retention findings, and the importance of studying retention in inception cohorts. The benefits and downside of studying retention with prospective and retrospective study designs are described. PMID- 10138035 TI - Geographic benefit from decentralized medical education: student and preceptor practice patterns. AB - The performance of area health education center (AHEC)-stimulated programs and decentralized education for medicine is not well understood. The Statewide Education Activities for Rural Colorado's Health (SEARCH)/AHEC project at the University of Colorado School of Medicine was examined to determine if the program had an effect on the practice location of its graduates. Practice location and specialty of graduates of the University of Colorado School of Medicine (UCSOM) classes 1980-1985 were compared for students who had participated in decentralized SEARCH/AHEC experiences versus students who had not. The majority of the graduates were practicing out of state in 1990. Non Colorado doctors were more often practicing in rural (non-metropolitan statistical area [MSA]) counties and in towns of fewer than 2,500, 5,000 and 10,000 residents, respectively. In addition, of the 251 active patient care physicians practicing in Colorado communities of fewer than 10,000 in non-MSA counties in 1986, those who precepted UCSOM students on SEARCH rotations were more likely to have remained in their same practice location in 1992 (77.8% versus 62.1% for those who had not precepted students). This analysis of both student and preceptor practice patterns documents the value of decentralized medical education in addressing the geographic and specialty maldistribution of physicians. These results have important policy implications for funding medical education programs. PMID- 10138036 TI - The development of a state-level health manpower database using an employer-based survey: a pilot project. AB - State health care reform may provide a better approach to meeting the health care needs of rural communities than does federal reform because the planning is closer to the needs of local communities. However, state health reform requires a health manpower database (along with other data) that includes all health occupations and such databases are often nonexistent. This study reports on one element of such a database--a survey of a wide range of rural health care employers covering the full range of health occupations in Alabama. Information on current and future employment of the most significant health occupations is reported here. It was found that the greatest numbers of new health personnel employees needed in the future were, in descending order, nursing assistants, registered nurses, licensed practical nurses, radiological technicians, specialist physicians, nurse practitioners, physical therapists, primary care physicians, and respiratory care therapists. While an employer survey has limitations and should be supplemented by data on community needs and health status indicators, it does provide useful information for planning educational programs to prepare health personnel. PMID- 10138037 TI - Impact of new information technologies on training and continuing education for rural health professionals. AB - Recently developed and emerging information and communications technologies offer the potential to move the clinical training of physicians and other health professionals away from the resource intensive urban academic health center, with its emphasis on tertiary care, and into rural settings that may be better able to place emphasis on the production of badly needed primary care providers. These same technologies also offer myriad opportunities to enhance the continuing education of health professionals in rural settings. This article explores the effect of new technologies for rural tele-education by briefly reviewing the effect of technology on health professionals' education, describing ongoing applications of tele-education, and discussing the likely effect of new technological developments on the future of tele-education. Tele-education has tremendous potential for improving the health care of rural Americans, and policy makers must direct resources to its priority development in rural communities. PMID- 10138038 TI - Why are hospital finances in the red? PMID- 10138039 TI - Hospital administration with medical information management--case study of a government-owned hospital under private management. PMID- 10138040 TI - Weathering the financial storm--survival strategies and observations. PMID- 10138041 TI - The Japanese health care system: planning the extinction of the private hospital? AB - The private hospital in Japan is like a patient with a very serious condition, but one that is reversible. Unless the treatment or appropriate support is given in a timely manner, the patient may have a cardiac arrest and either die or suffer permanent injury. In 1992 and 1993 there were record bankruptcies in private hospitals in Japan. These hospitals suffered permanent injuries, or ceased to exist because the proper support was not provided. More will suffer the same fate in the immediate future, because life saving measures continue to be withheld. This article attempts to provide some general and specific aspects of the Japanese health care system that have led private hospitals to the brink of extinction, and makes a plea for their survival. PMID- 10138042 TI - The effect of an introduction of a new consent form on settlement of the doctrine "informed consent". AB - Paternalism has been criticized lately in the japanese medical world, but it remained rather unfamiliar for a majority of the medical doctors to exercise the informed consent in the daily practice. It seemed that a consent form was one of the ways by which the medical and co-medical staffs became aware of importance of the informed consent. As it has been believed in Japan to be too formal to obtain a signature from the patient only for the evidence of the consent, it was worth while directing attentions of both the attending staffs and their patients to a renewed form, making them know that the doctrine of the informed consent had been introduced in the daily practice. Although it was an effective way, it turned out to be rather time-consuming process for a practical understanding of the informed consent. PMID- 10138043 TI - Changes in dietary and disease patterns in rural Japan. PMID- 10138044 TI - Outline of medical foods designated by the Ministry of Health and Welfare. PMID- 10138045 TI - Development of total medical material distribution management system. AB - Since September 1992, attempts have been made at Kagoshima University Hospital to develop the Medical Material Distribution Management System which helps to realize optimal hospital management as a subsystem of the Total Hospital Information System of Kagoshima University (THINK). As this system has been established, it has become possible for us to have an accurate grasp of the flow and stock of medical materials at our hospital. Furthermore, since September 1993, the Medical Material Distribution Management System has been improved and the Total Medical Material Distribution Management System has been smoothly introduced into the site of clinical practice. This system enables automatic demands for fees for treatment with specific instruments and materials covered by health insurance. It was difficult to predict the effect of this system, because no similar system had been developed in Japan. However, more satisfactory results than expected have been obtained since its introduction. PMID- 10138046 TI - A study of Japan's emergency medical care system--emergency transportation and medical care service areas for tuberculosis patients. AB - Since 1988, there has been a noted increase in the use of emergency transportation by tuberculosis patients in Japan. Therefore it is necessary to build a suitable emergency medical care system for these patients. We evaluated the present emergency medical care system available to them in Tokyo. We also studied emergency medical care service areas (MCSAs) to further aid in the revision of the emergency medical care system for tuberculosis. We used data from tuberculous patients who required the use of the emergency medical care system in Tokyo. The data was collected by the Tokyo Fire Department's emergency care information system from 1978 to 1990. We investigated and analyzed data regarding transportation and patient data. We also analized transportation data from the point of view of municipal districts (wards, cities, towns, villages), MCSAs and the Tokubetsuku region. We concluded that the number of emergency transports for tuberculosis patients has gradually been increasing and that the currently MCSA regions were not ideal for use in developing a transportation system for these patients. Using larger areas such as Tokubetsu-ku and Tokyotoka would be more practical emergency medical care system for tuberculosis patients in Tokyo, it will be necessary to take into account the Tokubetsu-ku area, the vagrant population within it, and the time required to transport the patients from this area to the Tokyotoka area. PMID- 10138047 TI - Hospitals labor desperately while associated industries flourish in prosperity. PMID- 10138048 TI - A study on hospital management by means of multivariate statistical analysis. Factors influencing the financial conditions of cooperative hospitals. PMID- 10138049 TI - Patient cost sharing for medical services: a review of the literature and implications for health care reform. PMID- 10138050 TI - Temporary firms in community hospitals: elements of a managerial theory of clinical efficiency. PMID- 10138051 TI - Measuring geographic access to health care in rural areas. PMID- 10138052 TI - Grabbing the bandwagon of change. PMID- 10138053 TI - Where CLIA isn't a four-letter word. PMID- 10138054 TI - PHOs are sprouting at children's hospitals. PMID- 10138055 TI - Medicine shortchanges women? Not at all. PMID- 10138056 TI - The malpractice dragon wasn't dead--just asleep. PMID- 10138057 TI - PHOs: castles in the sand? PMID- 10138058 TI - A doctor in Rwanda. "I hid in a corner, expecting to be murdered.". PMID- 10138059 TI - What the next decade will mean for managed care. PMID- 10138060 TI - Debt. When it's smart to borrow more. PMID- 10138061 TI - Practice agreements. The best ways to divide income now. PMID- 10138062 TI - Can a surgeon be happy as an FP? You bet! PMID- 10138063 TI - Why three out of four doctors participate in managed care. PMID- 10138064 TI - Look who's giving doctors clinical advice. PMID- 10138065 TI - Hospitals are hungrier for primary care. PMID- 10138066 TI - Health reform after the elections: what happens now? PMID- 10138067 TI - Do doctors kill 80,000 patients a year? PMID- 10138068 TI - Nothing about you will escape health plans' notice. PMID- 10138069 TI - Lower anxiety in today's high 'sue-ciety'. AB - Physician malpractice claims are part of the reason for the increased level of health care costs in the United States, according to authors Susan A. Chesteen, Ph.D., Fikry S. Gahin, Ph.D., and Joan M. Lally, Ph.D., of the University of Utah David Eccles School of Business. They present the results of a survey conducted on the residents of Utah on malpractice and discuss the implications for health care providers. PMID- 10138070 TI - The ethics of managed care. AB - The shift to managed care has placed administrators and physicians in the position of balancing the good of the organization with the good of the individual. This "dual moral agency," according to authors John Golenski, Ed.D, and Mark Cloutier, M.P.H., M.P.P., of the Bioethics Consultation Group, is a key challenge for administrators and physicians under managed care. PMID- 10138071 TI - Recent developments in 'any willing provider' legislation. AB - Because of recent state-level legislation, many health care networks may not be allowed to choose between qualified member providers. Gerald A. Neiderman, J.D., Jay D. Christiansen, J.D., and Kelly Phillips, J.D., of the health care practice group of Fagre & Benson, update the background, trends and potential impacts of any willing providers laws. PMID- 10138072 TI - The impact of managed care on specialty practices. AB - With the primary care physician being the focal point for managed care, the relative status that specialists have enjoyed may be at an end. Cynthia S. Rowe, FACMPE, administrator for the Oregon Eye Care, investigates how specialists are faring under managed care and writes that without major re-engineering, they will face a tough road. PMID- 10138073 TI - A medical group practice imperative. The practical use of RVUs for managing and contracting. PMID- 10138075 TI - Making effective use of a PHO. PMID- 10138074 TI - Managed care resource guide. PMID- 10138076 TI - Improving Medicare/senior hospital utilization. PMID- 10138077 TI - How provider productivity in a primary care walk-in clinic can be influenced. PMID- 10138079 TI - Collective bargaining in 1994. PMID- 10138078 TI - Specialty services capitation contracting by HMOs. AB - With health care moving toward prepaid services, HMOs are increasing their contracting activities. Author Linda Wong examines the results of research on the objectives, reasons, satisfaction levels and evaluation methods of 19 HMOs across the United States. PMID- 10138080 TI - Workers' compensation laws: significant changes in 1993. PMID- 10138082 TI - Employee benefits for union and nonunion workers. PMID- 10138081 TI - The labor market improves in 1993. PMID- 10138083 TI - The development and growth of employer-provided health insurance. PMID- 10138084 TI - Health care alternatives: employment and occupations in 2005. PMID- 10138085 TI - The impact of health care reform on the clinical lab. PMID- 10138086 TI - Monitoring the quality of testing performed by referral laboratories. PMID- 10138087 TI - Forms to help you document for CLIA. PMID- 10138088 TI - Why hiring a nontechnical marketing rep makes sense. PMID- 10138089 TI - Databased management of media. PMID- 10138090 TI - TQM, Part 1. Total quality management: in its prime or past its peak? PMID- 10138091 TI - TQM, Part 1. TQM: successes, failures, and wishful thinking. PMID- 10138092 TI - Is your hepatitis B vaccine really protecting you? PMID- 10138093 TI - Succession planning: a manager's guide. PMID- 10138094 TI - A rule-based system for cost savings in hematology. PMID- 10138095 TI - Putting patients first. AB - The average patient sees up to 60 hospital employees-everyone from doctors and nurses to orderlies and dietitians-during a hospital stay. But Booz-Allen has found that, through innovative hospital design and technology, this figure can be slashed to as few as 12-a dramatic decrease that can improve direct patient care by as much as 60 percent while cutting personnel costs by 30 percent. PMID- 10138096 TI - Lending a helping hand. PMID- 10138097 TI - Healing hearts. PMID- 10138098 TI - Get wise ... immunize. PMID- 10138099 TI - Structuring the health care reform debate: a guide to effective advocacy. PMID- 10138100 TI - A marriage of hospitals begats healthy babies. PMID- 10138101 TI - Collaboration--a new era begins. PMID- 10138102 TI - Michigan hospital medians. Center for Healthcare Industry Performance Studies. PMID- 10138103 TI - Missteps at opportunity's door. PMID- 10138104 TI - Healthy communities. Our focus for the future. AB - The autumn of 1994 has arrived. At this same time last year, most political pundits and policy wonks proclaimed that the Congress would surely take action to overhaul the American health care system before this year's November elections. But as 1994 draws to a close, it has become apparent that Washington is unlikely to produce comprehensive reform legislation at any time in the near future. However, while our political system has failed to act in any meaningful way, its inability to chart a course for change has not quelled the movement to reshape our nation's health care system. Despite Congressional inertia, substantial health care reform is taking place both in Michigan and throughout the nation. These reforms are characterized by a central theme: rapid movement away from our historic focus on illness, and toward a more rational focus on health. Our commitment to healthy communities stands as a firm testament to our mission of service and our role as the central core of the health care delivery system. This article will address the various components of that paradigm shift, and highlight some of the outstanding efforts of Michigan hospitals as they partner with their communities to reshape the delivery of health care services. PMID- 10138106 TI - County facility seeks merger with neighbor. PMID- 10138105 TI - Fired nursing home exec files lawsuit against IHS. PMID- 10138107 TI - Hospitals to get first look at controversial disclosures. PMID- 10138108 TI - Health PAC contributions jump. PMID- 10138109 TI - Mid-term elections expected to influence reform debate. PMID- 10138110 TI - Calif. providers fight initiatives. PMID- 10138111 TI - New rules for physician inducements. PMID- 10138112 TI - Cape Coral Hospital puts plans for merger on hold. PMID- 10138113 TI - Hospital's office building ignites dispute. PMID- 10138114 TI - More fraud cases seen. PMID- 10138115 TI - JCAHO indicators fail most test hospitals. PMID- 10138116 TI - IRS gives nod to PHO, but physicians say no. PMID- 10138117 TI - AIDS gets managed-care approach. PMID- 10138118 TI - Adventist/West reorganizes staff. PMID- 10138119 TI - ProPAC undecided on subacute payments. PMID- 10138120 TI - Two arrested in hospital rapes. PMID- 10138121 TI - Hospital interest in CHIN development growing. PMID- 10138122 TI - Despite complaints, docs using practice guidelines. PMID- 10138123 TI - Technology assessments need improvement--study. PMID- 10138124 TI - Clinton may choose budget as vehicle for 1995 reform efforts. PMID- 10138125 TI - OrNda, Charter sign market-building deal. PMID- 10138126 TI - Commissioner berates actuarial report. PMID- 10138127 TI - Another Medicare battle looms. PMID- 10138128 TI - Revising anti-kickback law may provide best guidance. PMID- 10138129 TI - Tracking risk in integration. AB - Healthcare systems rushing into integration may be leaving themselves vulnerable to lawsuits involving medical liability--risk that's often ignored. Winners in the fourth annual Excellence in Healthcare Risk Management Awards show how some providers are addressing that vulnerability. PMID- 10138131 TI - Okla. hospitals plan mergers. PMID- 10138130 TI - Champion settles shareholder dispute in AmeriHealth deal. PMID- 10138132 TI - Merger mania spawns multiple-CEO concept. PMID- 10138133 TI - Reorganizing nurses may reduce hospitals' mortality rates--study. PMID- 10138134 TI - Hospitals' profit margins jump as costs are adjusted. PMID- 10138135 TI - Falling share prices won't hinder merger. PMID- 10138136 TI - Lilly deal's timing drew FTC notice. PMID- 10138137 TI - Emory rejects Columbia/HCA. PMID- 10138138 TI - Memo lights a fire under opponents of Medicare spending restraints. PMID- 10138139 TI - Though study says patient dumping has slowed, it remains a problem. PMID- 10138140 TI - IRS finally has a target in exemption abuse probe. PMID- 10138141 TI - Columbia/HCA wins another big government contract in Fla. PMID- 10138142 TI - Tennessee alliance faults for-profits' charity load. PMID- 10138143 TI - IRS shows leniency in Hermann settlement. PMID- 10138144 TI - Ind. providers turn to capitation for Medicaid. PMID- 10138145 TI - 'Radical' new covenants would slash number of HUD project approvals. PMID- 10138146 TI - Lilly purchase of PCS awaits FTC clearance. PMID- 10138147 TI - Long-term-care allies adjust goals. PMID- 10138148 TI - 1994 awards applaud flexible architecture. PMID- 10138149 TI - Feds probe Continental. PMID- 10138150 TI - JCAHO details ratings steps. PMID- 10138151 TI - VA struggles to revamp government purchasing. PMID- 10138152 TI - Use fresh approach to win at outpatient psych care. PMID- 10138153 TI - Report charts integration levels. PMID- 10138154 TI - IRS auditing tax-deferred annuities. PMID- 10138155 TI - Caremark may sell home infusion arm. PMID- 10138156 TI - ProPAC suggests government repair reimbursement system. PMID- 10138157 TI - Community reports higher earnings. PMID- 10138158 TI - NME sells management division to exec. PMID- 10138159 TI - Oxford, ChoiceCare top N.Y. poll. PMID- 10138160 TI - Ramsay forms a managed-care spinoff. PMID- 10138162 TI - Philadelphia merger talks go slowly. PMID- 10138161 TI - Baxter unit to help hospitals plan for surge in elderly. PMID- 10138163 TI - AMA seeks to aid physician networks. PMID- 10138164 TI - States consider PHO cuts. PMID- 10138165 TI - Two hospitals win appeals; third faces more scrutiny. PMID- 10138166 TI - Cape Coral solicits bids after pending deal stalls. PMID- 10138167 TI - Those straddling poverty line most likely to be uninsured. PMID- 10138168 TI - With reform threat gone, healthcare firms are poised to gain from stock offerings. PMID- 10138169 TI - HMO receivables up 26%. PMID- 10138170 TI - Milestone year for minority applications. PMID- 10138171 TI - AMI shareholders file suit to block purchase by NME. PMID- 10138172 TI - Managed care at the top of health service sectors. PMID- 10138173 TI - Disproportionate-share payments drop. PMID- 10138174 TI - FTC analysis likely to go against Missouri merger. PMID- 10138175 TI - AMI ends battle over St. Jude. PMID- 10138176 TI - OrNda strengthens Phoenix network. PMID- 10138177 TI - Conn. docs see big profit in HMO sale. PMID- 10138178 TI - Some surprised IRS target isn't an active provider; firm tries to seal records. PMID- 10138179 TI - Columbia/HCA encounters hurdles in university partnership efforts. PMID- 10138180 TI - L.A. County health programs in peril--study. PMID- 10138181 TI - Harvard needs $5 million to fund research institute, seeks provider support. PMID- 10138182 TI - HCFA make take action in absence of reform. PMID- 10138183 TI - Generalists making gains. PMID- 10138184 TI - 'Road maps' more practical right now than 'report cards'. PMID- 10138185 TI - Columbia/HCA profits hit $153 million for quarter. PMID- 10138186 TI - Healthcare pioneers chosen for hall of fame. PMID- 10138187 TI - Providers get their due. AB - Providers are getting their due, but only after employing computer software programs to help sort through the complex managed-care contracts they've negotiated. More and more accounting departments are relying on contract management systems to ensure accurate billing. PMID- 10138188 TI - Feds spur local projects with grants. PMID- 10138189 TI - 'Snowbirds' want better U.S. coverage. PMID- 10138190 TI - Employer input aids HMO turnaround. PMID- 10138192 TI - N.Y.C. network picks Columbia-Presbyterian. PMID- 10138191 TI - Unrated isn't a bad sign for many investors. PMID- 10138193 TI - New rule to cut oxygen payments. PMID- 10138194 TI - Toledo hospitals choose profit sharing. PMID- 10138195 TI - HealthSouth-ReLife merger under further FTC scrutiny. PMID- 10138196 TI - Mental health managers discover disadvantages of government contracts. PMID- 10138197 TI - Finances healthy, Sutter says. PMID- 10138198 TI - Caremark acquires Atlanta group. PMID- 10138199 TI - Modest reform seen for 1995. PMID- 10138200 TI - 2 Catholic systems in Calif. considering $2.7 billion link. PMID- 10138201 TI - Ohio residents sue to get Quorum out of county hospital. PMID- 10138202 TI - New deals increase systems' reach. PMID- 10138203 TI - Battle over Prop. 187 moves to courts. PMID- 10138204 TI - HCFA's move to exclude managed-care plans from rate guarantee draws fire. PMID- 10138205 TI - Home remedy may have caused fumes. PMID- 10138206 TI - Opposition causes CDC to loosen TB guidelines. PMID- 10138207 TI - VA employee team to recommend change. PMID- 10138208 TI - VA, Defense hospitals slow to share resources. PMID- 10138209 TI - FTC says merger would constitute county monopoly. PMID- 10138211 TI - Docs await HCFA self-referral rules. PMID- 10138210 TI - Columbia/HCA, AMI at odds over noncompete clause. PMID- 10138212 TI - Lake criticizes reform strategy. PMID- 10138213 TI - Learning how to listen a truly valuable lesson. PMID- 10138214 TI - HCFA releases nursing home sanctions. PMID- 10138215 TI - Team suggests ERISA waiver limits. PMID- 10138216 TI - Getting hospital costs, quality in line. PMID- 10138217 TI - 'Top 100' hospitals set new success standards. AB - A survey rates the nation's top 100 hospitals by category and suggests using their successes as benchmarks. These facilities are finding ways to reduce death rates and complications while charging payers, less, maintaining good asset levels and operating at lower costs. PMID- 10138218 TI - System vendors looming larger. PMID- 10138219 TI - Hunting for data to limit risks of managed care. AB - As managed care ignites market after market, hospitals and health systems are turning to computer software to help collect the right payments and control the use of resources. Our Nov. 7 issue detailed how providers were using the classic number-crunching capability of computers to bill according to complex formulas in managed-care contracts. This article looks at how computer software is evolving to handle management of defined populations under predetermined reimbursement. PMID- 10138220 TI - Pa. effort examines health needs. PMID- 10138222 TI - Charter paying big insurance settlement. PMID- 10138221 TI - Texas hospitals rack up big profits. PMID- 10138223 TI - Catholic guides tackle local business deals. PMID- 10138224 TI - Growing Boston system creates parent company. PMID- 10138225 TI - New corporation to manage neighboring Atlanta hospitals. PMID- 10138226 TI - For-profit experiment in U.K. in receivership, on the market. PMID- 10138228 TI - Republicans outline action on healthcare. PMID- 10138227 TI - Columbia/HCA, UniHealth eye venture. PMID- 10138229 TI - Publishing firm to acquire Medstat. PMID- 10138231 TI - New SEC guidelines formalize disclosure rules for bond issuers. PMID- 10138230 TI - Vendor group wins Chicago CHIN. PMID- 10138232 TI - Calif. utility switches to managed care. PMID- 10138233 TI - Docs take different tacks with N.Y. initiatives. PMID- 10138235 TI - Columbia/HCA scores again. PMID- 10138234 TI - Merger costs contribute to Coram's $121 million loss. PMID- 10138236 TI - New snags in Philadelphia talks. PMID- 10138237 TI - Five hospitals win awards for vigilance on cost and quality. PMID- 10138238 TI - BJC to reorganize services. PMID- 10138239 TI - Long-awaited Chicago merger wins approvals. PMID- 10138240 TI - Details emerge on Houston system. PMID- 10138241 TI - Rivals turn partners in Charleston. PMID- 10138242 TI - Grants to aid spread of services. PMID- 10138243 TI - Merck, SmithKline deals probed. PMID- 10138244 TI - VA task force considers decentralizing hospitals. PMID- 10138245 TI - GOP targets healthcare spending. PMID- 10138246 TI - Hospitals' prosperity should be by design. PMID- 10138247 TI - Alaska--warning up to managed care. AB - Alaskan healthcare providers are beginning to feel the heat from healthcare costs. The result is a move toward managed care and increased integration and collaboration. But the state's fragmented healthcare system is slowing progress. PMID- 10138248 TI - Columbia/HCA, Kan. docs team up. PMID- 10138249 TI - Hearing set on Fla. hospital's future. PMID- 10138250 TI - Consumers put a premium on keeping physician choice. PMID- 10138251 TI - NLRB reviews definition of nurses as supervisors. PMID- 10138252 TI - HEDIS needs uniform provider data. PMID- 10138253 TI - Ga. hospital, Blue Cross form integrated network. PMID- 10138254 TI - Efficiencies help curb HMO rates. PMID- 10138255 TI - Houston HMO bucks for-profit trend. PMID- 10138256 TI - Retirement housing drawing interest. PMID- 10138257 TI - N.J. drafts Medicaid cuts. PMID- 10138258 TI - Accountability behind release of hospital-specific data in N.H. PMID- 10138259 TI - Expenses down, but operating margins also fall in Mass. PMID- 10138260 TI - Medco wins Iowa contract. PMID- 10138261 TI - R.I. system adds hospital. PMID- 10138262 TI - JCAHO still pulling in big profits. PMID- 10138263 TI - Unlikely allies support JCAHO. PMID- 10138264 TI - Changing of congressional guard to give GOP control of healthcare's key committees. PMID- 10138265 TI - FASB may alter financial rules. PMID- 10138266 TI - Will healthcare accept the 'virtual' doctor? Maybe, but telemedicine's cost effectiveness remains in question. AB - Although vast sums of money have been pumped into telemedicine demonstration projects, and studies project millions in savings, the promises are still unproven. Researchers are just starting to sort out when telemedicine makes sense and how much it will cost. PMID- 10138267 TI - Columbia/HCA-Healthtrust merger faces closer look from feds, state enforcers. PMID- 10138268 TI - No FTC action in Mich. merger. PMID- 10138269 TI - Docs say limits on fees would hurt patients. PMID- 10138270 TI - High-tech equipment purchases down. PMID- 10138271 TI - For-profits had record earnings in 3rd quarter. PMID- 10138272 TI - Diverting cash raises questions. PMID- 10138273 TI - Critics scrutinize Blues' for-profit move. PMID- 10138274 TI - NLRB takes on Mont. hospital for attempt to kill nurses union. PMID- 10138275 TI - Conn. may seek to dilute, overturn ruling on taxes to fund charity care. PMID- 10138276 TI - Facility's replacement discouraged. PMID- 10138277 TI - Managers' salaries, raises continue growth. PMID- 10138278 TI - ASC (ambulatory surgery center) managers see better raises, lower salaries. PMID- 10138279 TI - Managers stretched by downsizing, staffing pressures. PMID- 10138280 TI - Sacred cows still grazing in the OR, survey shows. PMID- 10138281 TI - Texas medical center giants Methodist, St Luke's to merge. PMID- 10138283 TI - ORs face pressure to change skill mix. PMID- 10138282 TI - Help for victims of "layoff survivor sickness". PMID- 10138284 TI - Survey: benchmarking data on operations. PMID- 10138285 TI - Interviews key in obtaining good managers. PMID- 10138286 TI - Improving patient satisfaction at all points in the revenue cycle. AB - A common expectation among consumers, whether in the market for a new automobile, a new home, or healthcare services, is that a certain level of customer service will be provided along with the product or service. And the level of customer service provided substantially influences a consumer's satisfaction with the purchase of a product or service. PMID- 10138287 TI - Using an expert system to ensure accurate third-party reimbursement. AB - Many hospitals experience difficulties with Medicare reimbursements tied to payments strictly related to a diagnosis related group (DRG) in which a patient's stay is grouped or assigned. Potentially compounding these difficulties, many large third-party payers have also adopted the DRG system. A lack of knowledge of the intricacies of the DRG system on the part of physicians, administrators, or medical records managers often can lead to hospitals receiving considerably less reimbursement than they are entitled. A computerized coding system that incorporates an expert system can substantially increase reimbursements by simplifying the coding process, identifying overlooked diagnoses, and identifying any missing procedures. PMID- 10138288 TI - What kind of information will be required if we are to reform health care? AB - The only logical way to avoid unnecessary future costs and improve quality is to analyze the past, providing input for the present. The informational management strategies are ready. There is continuous quality improvement, profiling with case-mix adjustment, and other techniques that will help us manage care and caring. But these strategies all rely on the customer being empowered to make truly informed decisions (the ethical principle of autonomy) and for us to advocate for patients (beneficence). Translating relevant data into information is the concentration of medical informatics. Virtually everyone in medical management can attest to the fact that, competitive forces notwithstanding, it is time for us to recognize not only that we are in the information business, but also that this information belongs to a larger community. Clearly, it is time to collaborate! PMID- 10138289 TI - The evolving role of the primary care physician. AB - In today's climate of health care reform, the title of this article might more appropriately be "Is the Role of the Primary Care Physician Evolving or Going the Way of the Dinosaur?" According to Koop, primary care is in trouble. Whereas only 29 percent of U.S. physicians are primary care physicians, in Great Britain, 72 percent of physicians are primary care physicians and in Europe and Canada the average is 50 percent. Many U.S. primary care physicians are in the later stages of their careers and nearing retirement age. Unless the supply increases, this number will dwindle further. However, in 1992, only 14 percent of U.S. medical school graduates were headed for primary care careers. Even if the supply of primary care graduates were increased to 50 percent of the graduating medical school class, it would be well into the next century before the ratio of primary care physicians to specialists would be equal. Primary care is at a critical juncture and the next few years will decide the fate of the primary care physician. Given the state of primary care today, I believe that a fundamental look at the assumptions regarding the role of primary care physicians is in order. The current health reform movement has placed a major responsibility on primary care to solve many of the problems in health care delivery today, such as cost, utilization, and prevention. Many health care organizations are planning strategies involving primary care providers, and physician executives can play a key role in these decisions. PMID- 10138290 TI - Formatting and presenting quality data to medical staffs and hospital boards. AB - A host of historical and practical precedents have made hospitals responsible for the quality of care rendered within their facilities. The medical staff and the board of trustees share in this responsibility. Increasing demands for demonstrative evidence of the quality of care in an institution have made the process data-based. There is no substitute for specific data on the performance of both the hospital and its providers in the delivery of care. The trick, however, is in presenting this information to the medical staff and the board in a fashion that will be understandable and that will still maintain confidentiality of provider and patient. The authors offer a presentation system that has met with success in their community hospital. PMID- 10138291 TI - Practice standards use with internal partners. AB - U.S. Department of Defense experience with internal partnership programs has indicated that a lack of close supervision by medical treatment facilities can result in cost increases. The use of medical practice guidelines or standards is the subject of active investigation. The global guidelines tend to be too rigid or too vague to affect the provision of care. Their general acceptance can often be low. The use of clinical guidelines, with supervision by a clinic peer, has been determined to be a provider-friendly method of delivering cost-effective, high-quality care. Comparisons were made between the supervised partners against the total expenditures for ENT outpatient CHAMPUS care. The results indicated not only a savings but a reduction in the rate of cost increases by more than 250 percent. It is our feeling that specialty provider, peer-directed medical standards can be applied in a cost-effective manner. Their adoption as an organization-wide standard for referral can be an important tool in maintaining quality while containing costs. PMID- 10138292 TI - Delivery and funding are provincial matters in Canada. AB - The following article is one of a series that deal with the provision of health care services around the world. Other countries in the series include Germany, Italy, Japan, Mexico, the Netherlands, and the United States. Countries scheduled for coverage in the series include Austria, France, Singapore, Spain, and the United Kingdom. The countries are described using a grid of characteristics so that comparisons may be made more easily. All of the analyses, along with further comparative data, will be gathered into a freestanding book to be published later in the year. Dr. Mendoza serves as editor for the project. PMID- 10138293 TI - The ethics of health care system reform. AB - The United States is now engaged in a momentous national debate about health care. How can we provide the best care possible while simultaneously containing cost (to promote the general economic integrity of society) and somehow maintain a semblance of a free health care marketplace. This is not just a political question; it is also a question of ethics. It is an ethical consideration because the current debate is not just about designing or promoting health care systems that can best address our concerns for costs, quality, and accessibility. It appears that at least some participants in the debate would not stop at arguing their beliefs as valid; they would make their beliefs law. Some urge the creation of the right to health care as a matter of law. There are significant differences between beliefs and rights, however, and they need to be considered carefully in the ongoing debate over the future of this country's health care delivery and financing system. PMID- 10138294 TI - Improving patient and community well-being. AB - There are great gaps in the well-being of patients and communities. But there are numerous practice and community tools and opportunities that can successfully close these gaps. The health care professional is an often overlooked and underutilized resource and leader to positively influence the health of the community and patient. Physicians and health care professionals are in the health care field to maintain and increase the well-being of their patients and communities through disease prevention and health promotion at the practice level. This article argues that combining a community-level public health approach with the traditional practice level approach is more likely to achieve well-being for both individual patients and the community. PMID- 10138295 TI - The impact of health care reform on group practice. AB - Just two years ago, it would have been very difficult to imagine that reform of the health care system would today be a national domestic priority and that Congress would be considering one of the most significant and far-reaching pieces of legislation in the past 50 years. The issue is still in doubt, but it seems clear that, in this session of Congress or the next, legislation of far-reaching consequences will likely be passed. In fact, change on a widespread scale has already begun. During 1993, every state legislature except those of Nevada and Wyoming considered measures that would alter the way medical care is financed and delivered. Of the states that acted, both last year and in recent legislative sessions, eight have passed laws with the ultimate objective of ensuring access to medical care for all citizens. Government, at both the state and federal level, is clearly taking on the health care issue. The impact of reform on physicians, and thus on group practices, will be substantial. This article outlines the current course of health care reform and addresses its specific implications for the management of group practices. PMID- 10138296 TI - Taking on Goliath. M.D. Health Plan, New Haven, CT. PMID- 10138297 TI - Tackling reform town-meeting style. Chesapeake General Hospital, VA. PMID- 10138298 TI - Reaching the medically needy. Saint Joseph Medical Center, Joliet, IL. PMID- 10138299 TI - Surviving a six-year siege. Ukiah Valley Medical Center, CA. PMID- 10138300 TI - Partnering with the press. Intermountain Health Center, Salt Lake City, UT. PMID- 10138301 TI - Caring for little people. Health Network for Children, Omaha, NB. PMID- 10138302 TI - Taking heart attacks seriously. Inland Valley Regional Medical Center, Wildomar, CA. PMID- 10138303 TI - Not quite what the doctor ordered. St. Mary's Medical Center, San Francisco, CA. PMID- 10138304 TI - Breast cancer screening. Interpreting new data for clinical practice. AB - While multiple trials support routine mammography for women aged 50 to 69 demonstrating a reduction in breast cancer deaths by about 30%, experts disagree on breast cancer screening recommendations for women 40 to 49 years old. A review of the data and its interpretation illustrate the areas of controversy: lack of statistical power, prolonged screening intervals, suboptimal mammographic technical quality, and difficulty applying the data to current mammographic screening practice. Clinical decision making for health care providers and women aged 40 to 49 is guided by understanding the risk of breast cancer and weighing the risk and benefits of screening mammography. Further research to resolve whether breast cancer screening is effective in decreasing breast cancer deaths in women aged 40 to 49 is needed. PMID- 10138305 TI - Computer-enhanced medical decision making. AB - Many clinicians balk at their first encounter with this intriguing technology, often fearful that information systems might usurp their autonomous role as a health care provider. Methods of implementation and application of this concept, and how it is beginning to find greater acceptance are discussed in this article. PMID- 10138306 TI - Prisms glitters. AB - In days past, employees ate almost anywhere but the cafeteria of the Butterworth Hospital in Grand Rapids, Mich. That's not true anymore. PMID- 10138307 TI - Our children's health. PMID- 10138308 TI - Make them fight for a place at the table: how to take on the insurance industry. Interview by David Dyssegaard Kallick. PMID- 10138309 TI - Beyond doctors: workers in health-care reform. PMID- 10138310 TI - If medicine doesn't affect health much, what does? PMID- 10138311 TI - Community health: beyond care for individuals. PMID- 10138312 TI - Women's health movements. PMID- 10138313 TI - Foster G. Mcgaw Award winner. Defining and solving community problems. Parkland Memorial Hospital, Dallas. PMID- 10138314 TI - Cultural diversity meets end-of-life decision making. PMID- 10138315 TI - Hospital/physician collaboration: how will it change governance? PMID- 10138316 TI - Future uncertain for tax exemption. PMID- 10138317 TI - Asking the right questions. Governance information systems will help provide the right answers. PMID- 10138318 TI - Governing board, know thyself: a technique for self-assessment. PMID- 10138319 TI - Self-reliance in a time of change. PMID- 10138320 TI - What will happen to Medicaid? PMID- 10138321 TI - New ways to keep people healthy. PMID- 10138322 TI - Pay attention: you will be graded. PMID- 10138323 TI - Are we facing the capacity crisis? PMID- 10138324 TI - Reform issue will return in 1995. PMID- 10138325 TI - Planning for technology acquisition. PMID- 10138326 TI - Adding value to compensation. PMID- 10138327 TI - Diversity the goal of new health institute. PMID- 10138328 TI - Are cities prepared for reform? PMID- 10138329 TI - Re-creating health care governance. PMID- 10138330 TI - Making your message count. Trustees offer practical advice on political advocacy. PMID- 10138331 TI - Face-to-face. Telemedicine provides valuable education and communication links for rural providers. PMID- 10138332 TI - Shutting the golden door. PMID- 10138333 TI - Poor diagnosis, bad prescription. PMID- 10138335 TI - 1994 HAVE (Hospital Awards for Volunteer Excellence) winners announced. PMID- 10138334 TI - 20 hot job tracks. PMID- 10138336 TI - Foster G. McGaw awards. Defining and solving community problems. PMID- 10138337 TI - Want to be taken for granted? PMID- 10138338 TI - Sharing the power. The AHA chairman-elect calls for providers to collaborate in controlling the health system. PMID- 10138339 TI - The power of boards in service providing agencies: three models. AB - Tensions in the relationship between boards and staff are a common feature of voluntary and nonprofit agencies which deliver services. Many of the difficulties reflect lack of clarity about the power of boards. The author describes three models of governance: traditional, membership, and entrepreneurial. Each model has different implications for the power of a board in relation to staff. Practitioners in nonprofit service delivering agencies in the UK have found the models to be a useful tool for explaining the practical difficulties they experience. PMID- 10138340 TI - Meeting the change challenge: managing growth in the nonprofit and public human services sectors. AB - The current economic climate has been particularly hard on non-profit and public human services organizations, frequently resulting in managing organizational decline. The authors believe that the dominant concern should be with fostering organizational growth. To this end, they suggest that nonprofit board members and executives, as well as public sector leaders, need to concern themselves with the concurrent management of two agendas: Running the Shop and Meeting the Change Challenge. This can be done effectively through the use of strategic issue management, which is a set of techniques that represents a blend of traditional strategic management and change management approaches. PMID- 10138341 TI - Packaging effective community service delivery: the utility of mandates and contracts in obtaining administrative cooperation. AB - Voluntary agreements, mandates, and contracts integrate networks of social service organizations, allowing them to function as coordinated wholes. The author reviews the history of contracting and mandating in the public sector. It is hypothesized that contracted relationships formalize agreements between local organizations dependent on others. Mandated relationships are perceived to be important by policy-makers at a state or federal level. The differential acceptance and rejection of these relationships in the community is explored. Data from social service agencies are used to compare administrators' assessments of the effectiveness of mandated and contracted relationships used to coordinate a group of agencies delivering services to children. When a mandated relationship has been formalized into a contract by a local administrator the perceived effectiveness of that relationship is higher than any other relationship in the community. If the mandated relationship has not been formalized by a contract this relationship is perceived to be the least effective. Important mandated inter-organizational ties without monetary incentives are less likely to work. Local administrators having developed the contracted ties see these ties as producing a higher level of performance. PMID- 10138342 TI - The effectiveness of services marketing: perceptions of executive directors of gerontological programs. AB - Interest in marketing services, as opposed to products, has gained considerable momentum in recent years. The author conducted a survey of human service executives in six metropolitan areas to gauge the current status and efficacy of marketing efforts in programs for the aged. Findings confirm that the majority of health and social service organizations now employ marketing strategies of some kind, although somewhat insensitive and inadequate. The most common indicator of marketing success has been increments in the number of clients served. Health organizations are significantly more likely to measure the effectiveness of marketing efforts than social service agencies. Agencies commonly employ multiple marketing strategies, with face-to-face approaches proving to be the most effective. Least effective are public service messages and commercials on television/radio. The author suggests recommendations for mounting more efficacious and sensitive marketing programs in the human services. PMID- 10138343 TI - Strategic planning in non-profits: profit from it. AB - Non-profit human service organizations, both public and private, face unique challenges and opportunities in the climate of the 1990s as human needs are increasing, funding is decreasing, and threats to organizational well-being are encountered. The purpose of this paper is to describe, advocate for, and illustrate a strategic planning model which facilitates a proactive, energizing, futuristic vision as services are being planned and delivered. Three case examples are used: a large state-run county social services department; a small, private, sectarian agency that provides group home services for the developmentally disabled; and a medium sized federal public health hospital. PMID- 10138344 TI - K-Bro Linen Systems seeks a new market. PMID- 10138345 TI - Can hospitals and vendors really be partners? Could supplier certification be a workable concept? PMID- 10138346 TI - Keeping records. PMID- 10138347 TI - C-space. Expanding physician services. PMID- 10138348 TI - Breast cancer doesn't happen in a social vacuum. PMID- 10138349 TI - Sell your service. Managing medical imaging in the 1990's. PMID- 10138350 TI - Image labeling. The need for a better look. AB - The important message in this editorial is for radiologists to critically examine how well images are labeled in their own department. If it is not satisfactory, then institute corrective measures. These can range from sophisticated computer programs for printing flashcards to merely sending the chief technologist all those films one comes across with unreadable labels. The quality of the image labeling should also be a consideration when purchasing CT, MRI, ultrasound, computed radiography and digital angiography equipment. The fact that you consider this important should be communicated to equipment manufacturers in the hope that they will pay more attention to it and offer more flexibility for each department to design its own labels. In any event, I feel consistently bad film labeling results in sloppy radiology with possible patient harm and unpleasant legal consequences for the radiologist. PMID- 10138351 TI - Ask me no questions, I'll tell you no lies. PMID- 10138352 TI - Customer business solutions. PMID- 10138353 TI - Radiosotopes. The next generation. PMID- 10138354 TI - The winds of change in healthcare. PMID- 10138355 TI - Pandemonium General Hospital (The Department of Redundancy Department). PMID- 10138356 TI - The substance of women's health. PMID- 10138357 TI - Breast care: a new way. PMID- 10138358 TI - Mammography education programs for business and community outreach. PMID- 10138359 TI - Women's healthcare: choices for radiographic services. PMID- 10138360 TI - Responsibility vs 'Let Mikey do it'. PMID- 10138361 TI - The correct usage of the new radiation oncology codes. 77395--3-dimensional simulation; 77419--conformal weekly radiation therapy treatment management; 77432 -stereotactic treatment management. AB - In summary, radiation oncology now has three new related codes describing the 3 dimensional simulation and treatment of relatively small tumor volumes. These codes, when properly used and completely documented, are reimbursable at rates higher than the conventional simulation and treatment delivery codes that they replace. The physician should be cautioned however, that the indiscriminate use of these codes without accurate documentation of the medical necessity could result in penalties and/or pay back in the event of an audit. As with all new codes, we may rest assured that the insurance carrier will be looking very carefully at the documentation of these new and expensive procedures. PMID- 10138362 TI - The dark side of technology. PMID- 10138363 TI - Health services in the New England region and their relevance to Aboriginal people. AB - Public hospitals provide the vast majority of available health services in rural areas of Australia. These services reflect their clinical European origins in terms of organisation and delivery. This is one reason why they remain largely foreign and irrelevant to Aboriginal people, who are reluctant users of the services and facilities available. In this article we examine what is being done in the New England region of New South Wales to improve the relevance of existing health services for Aboriginal people; this is an important first step in improving the third world health status which they presently endure. PMID- 10138364 TI - 'From little things, big things grow'--a history of the development of cooperation between Aboriginal health services and the South Western Sydney Area Health Service. AB - Aboriginal people suffer from the worst health of any identifiable group in Australia due to profound disadvantages experienced by them since European colonisation of Australia. The Aboriginal community of south-west Sydney represents almost 25 per cent of Sydney's Aboriginal population. Since 1990 the Tharawal Aboriginal Corporation, the South Western Sydney Area Health Service and staff of the Office of Aboriginal Health (NSW Department of Health) have been cooperating to improve the health of Aboriginal people in south-west Sydney. The Working Group on Aboriginal Health has produced a Strategic Plan for Aboriginal Health in South Western Sydney. This cooperation has come from the development of trust, the identification of local needs and the elaboration of local solutions. PMID- 10138365 TI - Medicare related payments to Australian medical practitioners. AB - This article analyses Medicare payments to doctors, both general practitioners and specialists. Although these payments represented approximately $4.5 billion in 1991-92, there has been little public analysis of the breakdown of these payments to different medical specialties and general practitioners. These payments are just one source of income for many doctors. Information on practice costs is also presented to give an indication of the size of doctors' net incomes. A comparison is also made between doctors' incomes and taxpayers in general. PMID- 10138366 TI - Achieving change and altering behaviour through direct doctor use of a hospital information system for order communications. AB - Direct use of hospital information systems, and particularly of order communications systems by doctors, is central to the anticipated benefits from hospital information systems in Australia and other countries. There is an expectation that doctors will accept this technology and that the benefits will flow from their use. Concord Repatriation General Hospital in Sydney is one of very few hospitals in the world where doctors directly use a hospital information system to access patient information, place orders for diagnostic services and retrieve results. This paper reports on research which explored the nature of the direct doctor use of the hospital information system at Concord Hospital, and the changing attitudes of the doctors there. PMID- 10138367 TI - Strategic management and organisational structure: transformational processes at work in hospitals. AB - There is a substantial amount of organisational restructuring presently occurring in Australian public hospitals. However, there has been a lack of systematic research conducted about this phenomenon. In Australia most literature about organisational restructuring has employed a case study approach. Although there has been a great deal of support for product line management organisational arrangements in recent literature from overseas, little investigation into the adoption of product line management has taken place in Australia. In this paper, a discussion about the relationship between strategic management and organisational structure is presented. Survey results of a sample of nine teaching hospitals in New South Wales are reported. Taken together with other more descriptive literature about organisational restructuring in Australian health care, the evidence from this survey suggests that there are vigorous transformational processes at work, perhaps especially in the larger hospitals. Despite support for it in the literature, product line management is not being adopted on a widespread scale. The shift toward restructuring occurring within Australian hospitals at the moment represents a bout of experimentation with new organisational designs which seems destined to continue. A number of management theorists conclude that there need to be strong linkages between strategic planning and the choice of organisational structure. However, the empirical evidence reported here did not identify such strong linkages. This phenomenon warrants further investigation. The view is put that where these linkages are weak there is a risk that whatever structure is chosen will not be robust or flexible enough to cope with mooted or predicted policy changes to the Australian health system. PMID- 10138368 TI - The effects on hospital use and costs of a domiciliary palliative care nursing service. AB - An economic evaluation of a domiciliary palliative care nursing service operating in NSW assessed the extent to which the program provided more cost-effective care at home, prevented admissions to hospitals and shortened lengths of stay for patients in the terminal stages of cancer. Hospital use (inpatient days) and cost during the patients' last 90 days of life were compared before and after the introduction of the program. There was no statistically significant difference in either and hence no savings to offset the operating costs of the program. However, future savings might be achieved if after-hours access to painkilling drugs is improved. PMID- 10138369 TI - Follow-up of recommendations for hostel care: some determinants of waiting times. AB - This study explores the impact of client characteristics on waiting times for hostel admission. A sample of 116 clients recommended for hostel care by Victorian aged care assessment teams (ACATs) between April and June 1991 were tracked until they entered a hostel, cancelled their applications, died, or until the end of the study in April 1992. Survival analysis was used to identify possible relationships between specific client characteristics and waiting times. High dependency clients consistently entered more quickly than low dependency clients (p < .05), while cognitive impairment did not appear to have an impact on waiting times for either group. Similarly, client living arrangement did not have a clear impact on waiting time. Possible explanations for the longer waiting times include client preference for a particular hostel and the incentives of the payment system. PMID- 10138370 TI - Why not a nurse as a general health service executive? Influences and constraints on the change to a generalist career by nurse managers. AB - Twenty-three generalist health managers in Australia who have made a career path change from management in the nursing division were surveyed about factors which they perceived as either promoting or constraining their changes in career path. The most significant influencing factors were determination to succeed, personal skills and abilities, the ability to work as part of a team and track record, with ten factors being rated overall as 'quite important'. The most constraining factors related to the shortage of management positions, turbulence in the health care industry, and political factors connected with the mechanisms for making executive appointments. PMID- 10138372 TI - Mortality surveillance Australia 1981-1992. PMID- 10138371 TI - Effects of participative decision making in central supply department: a case study. AB - This is an account of an effort to develop a culture of quality in a small service department of a major provincial hospital--in the belief that this could only be brought about by encouraging workers to take a larger degree of control over their work and the way in which it is carried out. The charge nurse, finding herself in a situation which amounted to a crisis in the work of the department and the lives of the staff, introduced a process which sought to establish that control. This account is derived from the journal of the charge nurse over the period of five months during which the changes occurred. PMID- 10138373 TI - Pharmacy labourforce in Australia. PMID- 10138374 TI - Australia's health 1994. PMID- 10138375 TI - Child abuse and neglect 1991-92. PMID- 10138376 TI - A history of medical professionalisation in NSW: 1788-1950. AB - This paper presents a brief history of medical professionalisation in the colony and State of New South Wales to the middle of the twentieth century. It is suggested initially that although 'western' medicine is a powerful international organisation with common structures and a shared scientific core, any worthwhile study of the medical profession in a particular setting must be founded on an analysis of the intersection of local conditions and international structures. Thus various overseas and interstate accounts of the social history of medicine are reviewed in terms of their relevance in helping to explain the process of medical professionalisation as it occurred in New South Wales. PMID- 10138377 TI - Alternative nurse rostering: an evaluation. AB - An evaluative research study was conducted to determine the principles underlying the implementation of alternative nurse rostering. The results of three research studies conducted in the Western Australian health care system over a period of three years were reviewed. It was clearly demonstrated that alternative rosters are a valid management tool that will improve nursing productivity and the quality of care. A subject's age and hospital category influenced the acceptance of alternative rostering systems. PMID- 10138378 TI - Practice-based training in nurse management development: a case study. AB - One hundred and twenty nurse managers within the Central Sydney Area Health Service completed a program designed to concurrently strengthen professional skills and management systems. The program was based on functional review of work practices. It required consultation with the unit staff and collaboration with other sections of the organisation in designing and implementing quality improvement projects. The success of the program supports the idea that adult learners benefit from the opportunity to reflect on their experience at work. The program demonstrated that nurse managers will make major contributions to improvements in an organisation when the review process is legitimised, when they can participate in developing a framework for the review, and when organisational support is provided. PMID- 10138379 TI - Strategic planning or muddling through? The relevance of the strategic planning process to the hospital sector. AB - We review some of the main themes in the literature about managerial strategy and strategic planning. Attention is paid to the limitations of strategic planning in the government sector generally and the public hospital system particularly. The alternative to strategic planning--to adapt a stance that is more pragmatic, incrementalist and iterative--is considered. A case study of a teaching hospital's approach to strategy over the last two years is used to provide an empirical complement to the literature analysis. We conclude that the rational planning approach has advantages over the adaptive, iterative approach through the information that it provides to hospital management about the strengths and weaknesses of the organisation. PMID- 10138380 TI - Caring nurses: the dilemma of balancing costs and quality. AB - This paper explores the tensions visible in the rhetoric and practice of today's health care system. This system is becoming dominated by the views of economic rationalists where decisions are based on principles more frequently associated with private enterprise. One could argue that health care should be managed as a business, however, the ethics which guide such a business must be examined closely to ensure the integrity of the caring which is implicit in much of the practice in health care. Individuals in today's society value humanistic functions more than ever before. The caring function of nursing is perhaps the most significant determinant of the quality of care received from a patient's perspective, and one to which there is little cost attached in dollar terms. While it is difficult to measure and cost the caring that nurses provide, it must be done to ensure that these qualities are maintained and enhanced. More importantly, strategies must be developed to provide cost-effective quality indicators of the caring function implicit in the nurse's role. (This is an abridged version of a paper delivered at the Nursing Economic$ International Symposium 1993 in Hobart, Tamsania.) PMID- 10138381 TI - Nurses and smoking: a comparative study of students of nursing and teaching. AB - This exploratory study compared three student groups (n = 221)--college student nurses, hospital student nurses and student teachers--in terms of their smoking behaviour, factors influencing smoking and their beliefs and values. More student nurses, both hospital and college students, smoked than student teachers while more hospital student nurses were smoking than college student nurses. The majority of students who smoked started smoking before they started their nursing and teaching courses. The influence of friends was the most important factor in starting smoking while enjoyment was the main reason for continuing to smoke. The risks in smoking were acknowledged by all groups. Student nurses were more likely to believe that smoking reduces stress levels. Hospital student nurses and student teachers were unconvinced about the health promotion role of nurses. PMID- 10138382 TI - A perspective on the Victorian health reforms. PMID- 10138383 TI - Predictors of perceived health status in elderly men and women. The Cardiovascular Health Study. AB - Baseline data on the perceived health status of participants (N = 5,201) in the Cardiovascular Health Study of the Elderly (CHS) are reported. The authors examined the predictive utility of health-related factors representing eight different domains, assessed gender differences in the prediction of perceived health, and tested a hypothesis regarding the role of known clinical conditions versus subclinical disease in predicting perceived health. Multivariate analyses showed that the majority of the explained variance in self-assessed health is accounted for by variables that fall into four general categories. Although gender differences were small, the analysis showed that the relative importance of several predictor variables did vary by gender. PMID- 10138384 TI - An investigation of nonresponse to self-assessment of health by older persons. Associations with mortality. AB - This study examined the association between mortality and nonresponse to questions about health status (both refusals and "don't know" responses) using a national sample of persons aged 70 and over. Data were drawn from the 1984-1990 Longitudinal Study of Aging. Three time points of vital status were used as the outcome indicators (1984-1986, 1984-1988, 1984-1990). Five self-assessment questions were examined; three of the five questions had bivariate odds ratios that indicated significant associations between a nonresponse and all three mortality indexes. Results of the study suggest that nonresponses by older persons can convey meaningful information. Research on self-assessments of health in later life should not routinely exclude nonresponses as missing data, even if they are an infrequent response. PMID- 10138385 TI - The impact of symptom interpretation on physician utilization. AB - This article explores physician consultation decisions among a sample of elderly people living in community settings. The analysis integrates the insights of research on illness behavior, particularly symptom interpretation and lay consultation, with previous specifications of the Health Behavior Model. Data were gathered through personal interviews and health diaries completed on a daily basis for 21 consecutive days by a probability sample of older people living in community settings. Results indicate that uncertainty regarding potential seriousness, level of pain or interference, and causal attributions were the most consistently significant predictors of physician contact. PMID- 10138386 TI - Comparing health-related indicators of very old hypertensives and nonhypertensives in an HMO. AB - The purpose of this study was to determine if very old hypertensives (85 years of age and over) were sicker and in poorer health than very old nonhypertensives. The authors compared the frequency of comorbidities, medical care and drug use, self-reported functional and health status, and health-related behaviors of very old hypertensive and nonhypertensive health maintenance organization (HMO) enrollees. Very old male hypertensives were less healthy than very old male nonhypertensives, female hypertensives, and nonhypertensives. In contrast, very old female hypertensives were healthy or healthier than very old female nonhypertensives. Hypertension may be a more serious condition among the very old males than very old females, or treatment may be more efficacious (or prevalent) for very old female hypertensives. These relationships require further study to determine if treatment guidelines should differ by sex among very old hypertensives. PMID- 10138387 TI - Can a survey influence quality of care in nursing homes? The impact of the New York Quality Assurance System on resident deterioration and adverse outcomes. AB - Data from a standardized administrative form, the Patient Review Instrument, were used to evaluate whether the New York Quality Assurance System (NYQAS) had an impact on deterioration in functional status or on the incidence of adverse outcomes among residents in New York's nursing homes. The NYQUAS approach evaluated nursing homes by using "triggers" suggestive of deficient quality of care. A random sample of nursing home facilities was selected from data encompassing 2 years before and 2 years after the implementation of NYQAS in 1988. Growth curve analysis and logistic regression were used to assess the influence of NYQAS on deterioration and on the probability of developing decubitus ulcers or contractures, or of being mechanically restrained. The functional status of most residents did not change significantly over time. After allowing statistically for differences in the resource needs of residents within the facilities, the implementation of NYQAS was associated with decreased deterioration in toileting and/or transferring, depending on the site of care. NYQAS was not associated with changes in incidence rates of decubitus, contractures, or the use of mechanical restraints. PMID- 10138388 TI - Turbo overdrive on the info superhighway: taking a RISC (reduced instruction set computing) without risking a ticket. PMID- 10138390 TI - Fish or fowl: deciding if a CIO is right or wrong. PMID- 10138389 TI - Serving clients at clinical workstations. PMID- 10138391 TI - When trends collide--telemedicine. PMID- 10138392 TI - Telemedicine: saving lives & costs in the Lone Star State. PMID- 10138393 TI - Teleradiology in an urban setting. PMID- 10138394 TI - Carriers of healthcare's load of information. AB - As the market for telemedicine products and services expands, many long distance telecommunications carriers and regional Bell operating companies developed strategies for meeting healthcare's needs. Some initiated projects to display their capabilities or to receive returns on investments in telecommunications infrastructures. Their capabilities and use of advanced technologies vary. The level of their healthcare commitment and involvement also varies. Regional Bell companies compete fiercely with each other and with national carriers for consulting and implementation contracts, unrestricted by service area boundaries. On the following pages, representatives from most of the major telecommunications carriers express their firms' healthcare strategies and offer synopses of their notable healthcare projects. For many, their resources are vast, their expertise undisputed. Access to high-quality healthcare services stands to benefit from their involvement. PMID- 10138395 TI - Scrutinizing the benefits of EDI. PMID- 10138396 TI - Global telemedicine & the future of medical science. PMID- 10138397 TI - Goals & roles: integrated delivery systems & the master patient index. PMID- 10138398 TI - Confronting the beast: integration products & services. PMID- 10138399 TI - America's best networked healthcare organizations. PMID- 10138400 TI - Partnering for survival: caregiver/vendor teamwork. PMID- 10138401 TI - Caregiver communications: we've gone wireless! PMID- 10138402 TI - Risk takers. Health care leaders face future skydiving at ground zero. PMID- 10138403 TI - Risk takers. Five strategies for managing change. PMID- 10138404 TI - Risk takers. Nurturing wisdom and confidence in the midst of change. PMID- 10138405 TI - Risk takers. Basic principles offer roadmap to reform. PMID- 10138406 TI - Where do the leading candidates for governor stand on health care? AB - Health care reform and the issues surrounding this sensitive and often contentious subject will play a significant role in the 1994 California governor's race. California Hospitals asked democratic candidate state Treasurer Kathleen Brown and republican candidate Gov. Pete Wilson to share their views on three of health care's most pressing issues: Proposition 186 on the November ballot; health care reform in California; and MICRA, the Medical Injury Compensation Reform Act of 1975. PMID- 10138407 TI - Energy conservation. Easy ways for hospitals to beat rising utility costs. PMID- 10138408 TI - Energy conservation. Green lights: a bright investment in the environment. PMID- 10138409 TI - Proposition 186: California's 'single-payer' nightmare. PMID- 10138410 TI - Violence in healthcare facilities. PMID- 10138411 TI - Cellular telephones and radio transmitters--interference with clinical equipment. PMID- 10138412 TI - Direct patient check-in: a compromise between centralized and decentralized registration. PMID- 10138413 TI - Reengineering: how to create radical organization-wide improvement. AB - Although reengineering may be considered by some as "the latest management fad," when applied broadly and boldly across the organization it can be a powerful driver to create sustainable and dramatic improvement throughout the organization. Thought-leading managers in healthcare should gain an understanding of the principles and concepts of reengineering and learn how to apply them to their individual situations when seeking improvements to quality, cost, timeliness, and customer satisfaction. Today's successful reengineers in healthcare, like Lori, will be tomorrow's leaders. PMID- 10138414 TI - Seventy years of sharing in community care yesterday--today--tomorrow. PMID- 10138415 TI - Physician-hospital integration. PMID- 10138416 TI - Rochester, New York hospitals: leasing acute-care beds. PMID- 10138417 TI - Innovative approaches to state health system reform. PMID- 10138418 TI - Utilization of information desks: the Alpha and Omega of the admitting process. PMID- 10138419 TI - Shared healthcare networks. PMID- 10138420 TI - RCH: one rural hospital's prescription for success. PMID- 10138421 TI - Will the status quo prevail without enactment of the Clinton administration's health care reform proposal? PMID- 10138422 TI - Single payer: do government-run programs meet America's needs? AB - The impact of a government-run program on our current health care system is not well understood by most Americans. Californians could be in for many unpleasant surprises should the single payer ballot initiative pass this November. The author examines how a single payer program attempts to meet the goals of health care reform and why it fails in many important aspects. PMID- 10138423 TI - Impact of prescription card service and mail-order drug programs on employers' prescription drug costs. AB - A study indicates that prescription card service and mail-order drug programs cost employers more money than a traditional indemnity offering because of the significant increase both in the number of claimants and in the paid charges per claimant. Focusing attention only on cost, however, may hamper the overall quality of care delivered under a health benefits program. PMID- 10138424 TI - Health and welfare benefit litigation under ERISA. AB - Denial of health benefits may result in devastating financial problems for the consumer. Given the complexities of the system, more and more employees turn to attorneys for help. Litigation and the resultant costs, in turn, further exacerbate the cost of providing benefits to employees and the burden to the employer. The law governing employer-paid health care and benefit plans is a blend of third party beneficiary contract law, trust law and administrative law. This article provides an overview of the federal litigation resulting from a third party payer's denial of coverage. PMID- 10138425 TI - Accounting for postretirement benefits: early adopters of SFAS 106. AB - A study of companies that adopted SFAS 106 early reveals the companies generally have not funded retiree health benefits. The timing of a firm's adoption of the accounting standard is affected by a number of variables specific to that firm. PMID- 10138426 TI - Vocational rehabilitation services in workers' compensation programs: evaluating research model effectiveness. AB - Vocational rehabilitation programs are a strategy used by many, employers to manage workers' compensation costs and the consequence of injuries for their workers. Soaring costs for employers and public entities associated with workers' compensation programs and vocational rehabilitation services indicate that additional research is needed--a need further demonstrated by the serious financial, social and psychological costs that workplace disability exacts from workers. PMID- 10138427 TI - Single payer: the California referendum. AB - The California Health Security Act is likely to appear on the November 1994 ballot. The bill would provide universal coverage to California residents and assign the state as the single payer for all medical care provided, financed with funding for programs already in place, employer payroll taxes, individual income taxes and taxes on tobacco products. PMID- 10138428 TI - Benefits communication: its impact on employee benefits satisfaction under flexible programs. AB - Using field data from a private organization in upstate New York, a large statistically significant portion of benefits satisfaction was explained by benefits communication, employee benefits choice and change patterns, and demographics. Users of the organization's benefits communication materials and employees reporting fewer unmet benefits needs are more satisfied. PMID- 10138429 TI - The impact of flexible benefits plans on job satisfaction, organizational commitment and turnover intentions. AB - This study assesses the dimensionality of employee attitudes toward flexible benefits plans and the impact of these plans on measures of job satisfaction, commitment and turnover intent. The study points to the need for more work on the measurement of employee attitudes toward flexible benefits and on the nomological framework of flexible benefits as a construct in compensation research. PMID- 10138431 TI - AAMT (American Association for Medical Transcription) position paper. Advertising educational programs. PMID- 10138430 TI - AAMT (American Association for Medical Transcription) position paper. Quality assurance guidelines. PMID- 10138432 TI - Press [2] to dictate. AB - Doesn't every MT know at least one physician who could use a primer on the fine art of dictating? One member seeking to educate physicians wrote this article for his local medical society's publication. PMID- 10138433 TI - I have a plan! PMID- 10138434 TI - The use of financial incentives in medical care: the case of commerce in transplantable organs. PMID- 10138435 TI - Racist health care: reforming an unjust health care system to meet the needs of African-Americans. PMID- 10138436 TI - Life style, health status, and distributive justice. PMID- 10138437 TI - Increasing the supply of cadaver organs for transplantation: recognizing that the real problem is psychological not legal. PMID- 10138438 TI - Promoting better health care: policy arguments for concurrent quality assurance and attorney-client hospital incident report privileges. PMID- 10138439 TI - Forcing rescue: the landscape of health care provider obligations to treat patients. PMID- 10138440 TI - Buyers, beware: short supply of plastic resin could create price explosion. PMID- 10138441 TI - Self-managed teams improve performance in central processing. PMID- 10138442 TI - Get ready for supply capitation. PMID- 10138443 TI - How much are you worth? Results from Hay's compensation survey. PMID- 10138444 TI - HEPA respirator use might simply mask the real issue. PMID- 10138445 TI - Reform. What went wrong, what went right. PMID- 10138446 TI - Checking out imaging needs before buying equipment. PMID- 10138447 TI - Specialty ICU beds: CQI team brings issues down to earth. PMID- 10138449 TI - Stats. Biomedical engineering offers more than in-house maintenance. PMID- 10138448 TI - Fun and games help ensure accurate record keeping. PMID- 10138450 TI - A no-touch therapy. Critics attach a mystical hand-motion treatment spreading through nursing homes and hospitals. PMID- 10138451 TI - The Palo Alto Medical Foundation. PMID- 10138452 TI - Capital acquisition planning in a managed-care environment. PMID- 10138453 TI - Double-merger veteran tells of survival...and success. PMID- 10138454 TI - Los Alamos rolls out technology transfer project for radiology. AB - Los Alamos National Laboratory in New Mexico has targeted the healthcare sector for defense technology conversion for peace-time use. As part of that transfer, a new teleradiology repository and network may soon give pulmonary specialists a powerful new information weapon to fight tuberculosis and other lung diseases. PMID- 10138455 TI - HotList. PACS and teleradiology products. PMID- 10138456 TI - Meeting the holiday needs. PMID- 10138457 TI - Promoting the cafeteria. PMID- 10138458 TI - Emerging pathogens. PMID- 10138459 TI - HACCP (Hazard Analysis Critical Control Point) in easy terms--the only true way for protection. PMID- 10138460 TI - Medicare and Medicaid programs; survey, certification and enforcement of skilled nursing facilities and nursing facilities--HCFA. Final rule. AB - This final rule implements certain provisions of the Omnibus Budget Reconciliation Act of 1987, as further amended by subsequent 1988, 1989, and 1990 legislation. These provisions make significant changes in the process of surveying skilled nursing facilities under Medicare and nursing facilities under Medicaid and in the process for certifying that these facilities meet the Federal requirements for participation in the Medicare and Medicaid programs. They also set forth a number of alternative remedies which may be imposed on facilities that do not comply with the Federal participation requirements (instead of or in addition to termination), and specify remedies for State survey agencies that do not meet surveying requirements. PMID- 10138461 TI - A cease-fire for doctors and hospitals. PMID- 10138462 TI - Conflict v. context in covering Clinton's health care proposal. PMID- 10138464 TI - Make it a C-CHIN instead: extending the utility of community health information networks. PMID- 10138463 TI - Posturing for the unknown: the future of HIS security standards. PMID- 10138465 TI - Verifying the future of electronic eligibility verification. AB - Many vendors and potential users of eligibility verification systems know the obstacles that deter the widespread acceptance and implementation of the technology. On the following pages, executives of firms representing the payor, provider and clearinghouse communities express their perceptions regarding the status and need for online eligibility verification and its cost advantages. PMID- 10138467 TI - America's most computer advanced preferred provider organizations. PMID- 10138466 TI - A CHIN by any other name? PMID- 10138468 TI - Legal issues for community health information networks. PMID- 10138469 TI - Striking the balance between cost and quality. PMID- 10138470 TI - Fine tuning the housekeeping department. PMID- 10138471 TI - Flexible work schedules and change management. PMID- 10138472 TI - Managing costs. Key to success for today's housekeeping managers. PMID- 10138473 TI - Staffing the environmental services department. Experience a paradigm shift. PMID- 10138474 TI - Health systems targeting important minority markets. PMID- 10138475 TI - Hospital re-engineers to improve patient care. PMID- 10138476 TI - Hospitals look to new breed of product line managers to lead them into future. PMID- 10138477 TI - Medical groups bit MCO providers; few in PHOs. PMID- 10138478 TI - Learning to estimate future market share. PMID- 10138479 TI - Health care of vulnerable populations. PMID- 10138480 TI - Stability of frailty in the social/health maintenance organization. AB - Although many long-term care (LTC) programs assume that the disabilities of their frail elderly participants are stable in nature, there has been suggestive evidence to the contrary. This study tests stability of disability among social/health maintenance organization (S/HMO) members who were judged eligible for admission into a nursing home. Identified persons were reassessed quarterly. By the end of 1 year, less than 50 percent were still considered to be nursing home eligible. Logit analysis revealed an increased likelihood of instability for persons who were newly identified as functionally disabled after hospitalization. Policy implications for capitated managed-care programs for the elderly are discussed. PMID- 10138481 TI - Activities of daily living and costs in nursing homes. AB - Functionality, as measured by activities of daily living (ADL), is the most important predictor of the cost of nursing home care. Data from a field-test version of the federally mandated Minimum Data Set (MDS) were examined using analysis of variance (ANOVA) and recursive partitioning methods to determine the relationships between ADL limitations and nursing cost (wage-weighted nursing time) among nursing home residents (n = 6,663). From this analysis, an index based on limitations in four ADLs was created. The developed ADL index is a readily determined measure of functional status useful in allocating nursing staff within nursing homes and in comparing the functional status of groups of residents, explaining 30 percent of variance in nursing costs among nursing home residents. PMID- 10138482 TI - Excess demand and cost relationships among Kentucky nursing homes. AB - This article examines the influence of excess demand on nursing home costs. Previous work indicates that excess demand, reflected in a pervasive shortage of nursing home beds, constrains market competition and patient care expenditures. According to this view, nursing homes located in underbedded markets can reduce costs and quality with impunity because there is no pressure to compete for residents. Predictions based on the excess demand argument were tested using 1989 data from a sample of 179 Kentucky nursing homes. Overall, the results provide partial support for the excess demand argument. Factors that may counteract the influence of excess demand are considered. Finally, the role of competition in nursing home markets and difficulties associated with making it operational are discussed. PMID- 10138483 TI - A profile of the Medicare Current Beneficiary Survey. AB - This article presents the logic, methods, and capabilities of a major new source of data on the Medicare population, the Medicare Current Beneficiary Survey (MCBS). The survey originated from the need to provide valid estimates of various kinds of health care spending, such as long-term care spending or expenditures by different age groups, to describe the effects of the Medicare program on its beneficiaries, and to model the effects of proposed program changes. Presented here is an account of the MCBS sampling and data collection design and the analytic strengths of the resulting data. Of special interest are the use of Computer-Assisted Personal Interviewing (CAPI); sampling from Medicare enrollment files; design for both cross-sectional and longitudinal analysis; surveying both community and facility residents; and merging survey and administrative data. PMID- 10138484 TI - The cost effectiveness of prenatal care. AB - This study uses hospital records for 7,000 births in McLennan County, Texas, during the period June 1987-July 1989 to examine the association between prenatal care and birth outcome and the implications for hospital costs of newborn infants. After controlling for a variety of maternal and birth factors, a significant relationship between prenatal care and birth outcome remained. Females who failed to receive prenatal care were almost three times as likely to have a low-birth-weight infant (weighing less than 2,500 grams) than females who did. Using an ordinary least squares (OLS) estimating equation (R2 = .24), the net expected hospital cost savings for females who received prenatal care was over $1,000. PMID- 10138485 TI - Medicaid policies for AIDS-related hospital care. AB - With hospital services comprising an important part of care related to acquired immunodeficiency syndrome (AIDS), and all Medicaid programs becoming major payers of these services, Medicaid policies affect the care that Medicaid recipients with AIDS receive. Many States pay hospitals on the basis of prospective payments that do not vary with patient diagnosis. In contrast, Medicaid programs using diagnosis-related group (DRG) payment methods adjust payments to reflect the greater cost of AIDS care. At least 12 Medicaid programs limited the number of paid inpatient hospital days during 1992; Medicaid recipients with AIDS could easily exceed such limits. PMID- 10138486 TI - Preventive health care in six countries: models for reform? AB - International systems are frequently offered as models for health care reform. This study, focusing on preventive services for children and pregnant women in six industrialized countries, finds that a broad range of preventive services can be provided through health care systems with divergent financing and cost containment, utilizing multiple entry points into the health care system, and employing targeted programs for high-risk patients. Despite variability in form and financing, health outcomes are not compromised, suggesting that health care reformers in this country need not be restricted to any single model to strengthen preventive health care for children and pregnant women. PMID- 10138487 TI - Swan-Ganz catheter use and mortality of myocardial infarction patients. AB - Using the 1989 Medicare provider analysis and review (MEDPAR) file, we calculated a 30-day indirectly standardized mortality ratio (SMR) for all "fresh" acute myocardial infarction (AMI) Medicare aged cases (i.e., fresh AMI patients are those who had not reported an AMI in the prior 8 weeks) at 2,900 hospitals, as well as an indirectly standardized procedure ratio (SPR) of Swan-Ganz catheter (SGC) use for these AMI cases at each hospital. Cases at hospitals with higher SGC SPRs also had higher SMRs. This positive association persisted when hospitals were further stratified by their annual volume of fresh AMI cases. We believe that our use of cases as the unit of observation, stratified by the SGC SPR of their hospital, avoids some case selection bias in observational studies directly comparing risk-adjusted mortality of cases with and without SGC. PMID- 10138488 TI - New intermediate sanctions are bad news for managed care. PMID- 10138489 TI - Proposed safe harbor regulations clarify a few issues, leave others unresolved. PMID- 10138490 TI - Perspectives offered on rapid spread of AIDS epidemic among African Americans. PMID- 10138491 TI - New anti-dumping regulations strengthen patient protections. PMID- 10138492 TI - Why can't we be friends? PMID- 10138493 TI - Measuring response times. PMID- 10138494 TI - Pneumatic antishock garments. Are the benefits overinflated? PMID- 10138495 TI - Award-winning tips for PR success. Getting your message across. AB - Remember your first attempt at taking a patient's blood pressure or the first time you held an IV catheter a few inches from your patient's arm? You now routinely perform those skills with confidence, and just as these procedures play an invaluable role in patient care, implementing a quality public information program can play a crucial role in community care. The public message of EMS providers should be, "We are the best at what we do and we are a vital link in the health care chain." Let's get that message out and fulfill the all-too-often forgotten role EMS plays in communities throughout the United States. PMID- 10138496 TI - On the ground at the U.S. Air Show. AB - Careful planning and organization at mass gatherings are essential if adequate medical care is to be ensured. The U.S. Air Show in Dayton, Ohio, attracts thousands of spectators annually and requires that dozens of EMS agencies and hundreds of first responders, EMTs, paramedics, nurses and physicians join forces to provide EMS coverage. PMID- 10138497 TI - What really is best for the patient? PMID- 10138498 TI - Country music funds EMS in Unionville, Iowa. PMID- 10138499 TI - Disposables vs. reusables. Throw and go vs. use and reuse. PMID- 10138500 TI - The mystery of the missing managers. PMID- 10138501 TI - Psycho-cybernetics: the proactive approach to stress management. PMID- 10138502 TI - Legal aspects of transfusion medicine. PMID- 10138503 TI - Inventory control and purchasing at reduced cost. PMID- 10138504 TI - Inventory control with a relational database. PMID- 10138505 TI - Consider all options when third-party benefits are paid in error. AB - For many healthcare providers, the greatest problem with third-party payers is getting them to pay the benefits they are contractually obligated to pay. However, another problem that arises consistently--thought less frequently--is what to do when a third-party payer provides benefits that it is not contractually bound to make and then demands the payment be refunded. One answer to this problem may be to just say "no." PMID- 10138506 TI - Application of physiotherapy outcome measures to the managed care model. AB - Managed Care (MC) is a multidisciplinary model for health care delivery that organizes and sequences the caregiving process. Its objectives include: 1) to reduce length of stay and resource consumption, and 2) to measure, maintain or improve patient outcomes related to care received. Our tertiary care facility is the first Canadian hospital to implement MC. Patient care is directed through the use of a Care Map. Each map is specific to a pathological state and its treatment, i.e. Total Knee Replacement (TKR), and consists of a Patient Problem List, with related patient-centred outcomes, and a Critical Path. The Critical Path outlines the temporal sequence of the provision of care. Most key events on a Care Map are determined anecdotally. The purpose of this project was to collect outcome information in patients assigned to the Total Knee Replacement Care Map in an attempt to validate the existing Care Map or make recommendations for revisions. Inter-rater and intra-rater reliability of knee range of motion-was calculated using the Intra Class Correlation Coefficient (ICC). ICC values ranged from .64-.97. Seventeen patients were assessed. All patients were measured on Day 6 and 8 of the Care Map. This process has resulted in validation of certain range estimates and recommendations for revision of others. PMID- 10138507 TI - Impact of physical therapy students on patient service delivery and professional staff time. AB - The purpose of this pilot study was to examine the productivity of physical therapy students during their clinical placements at the University of Alberta Hospitals and to assess the impact of supervision on professional staff time. Subjects were 29 professionals and 51 students. Data related to staff supervision time and to direct patient care time were obtained from the Workload Measurement System computer database. Average patient-related service time for staff while supervising a student was compared with average patient-related service time for the same staff while not supervising a student across nine service areas. Average hours per day of student direct care were compared with average hours per day of therapists' supervision time across the same nine service areas. Results indicated that average patient-related service time for staff supervising a student decreased significantly during periods of student supervision, and that physical therapy students' average amount of direct care was significantly greater than the average amount of therapists' supervision time. There was preliminary evidence of a positive net effect of clinical placements on service delivery. PMID- 10138508 TI - Hospices and home health agencies: data from the 1991 National Health Provider Inventory. PMID- 10138509 TI - The profession--1995 outlook. Construction's balancing act. PMID- 10138510 TI - Perspectives. Holes in the safety net: Medicare and vulnerable populations. PMID- 10138511 TI - Hospital PTAC (Professional and Technical Advisory Committee) refines 1995 standards; proposes revisions for 1996. PMID- 10138512 TI - ERNIE: Emory's record number integrity effort. AB - Learn how three large, affiliated healthcare facilities in Atlanta accepted the challenge of developing and implementing an electronic medical record system. The main obstacle--dealing with multiple patient identifiers--is outlined and practical and proven solutions are detailed. PMID- 10138513 TI - Text management in a healthcare information system. AB - Virtually there. Natural language or textual data in the patient record plays a critical role in medicine. Read about the innovative system LDS Hospital has implemented to integrate textual data into the computerized patient record. PMID- 10138514 TI - An integrated clinical computer system: implications for a medical information services department. AB - The hybrid record--both paper and electronic--is a cumbersome byproduct of the evolution to the computer-based patient record. Nancy Walker describes how William Beaumont Hospital managed its information services with this mixed media record. Her article provides practical solutions for health information managers including downtime procedures, report distribution plans, release of information steps, and audit procedures for maintaining confidentiality. PMID- 10138515 TI - How close are we to computer-based patient records? AB - The Computer-based Patient Record Institute recently initiated an exciting new program, the Davies Recognition Program, which will help facilities measure their progress toward the computer-based patient record. The program will also identify institutions with exemplary systems. Read on for more details on the program including important events associated with it. PMID- 10138516 TI - FORE moves to the front. Foundation of Research and Education. AB - What's in a name? A supercharged new mission in the case of FORE, now the Foundation of Research and Education. Find out how FORE's name change extends more service to the health information management field. PMID- 10138517 TI - Overview of the lobbying tax law and the impact on AHIMA members. PMID- 10138518 TI - Where do health information managers fit in the world of the computer-based patient record? PMID- 10138519 TI - 1994 year-end roundup. FORE Library. PMID- 10138520 TI - Update on federal trauma activities. PMID- 10138521 TI - Managing the cancer patient and family. PMID- 10138522 TI - Surgeons and mergers: making the right choice. PMID- 10138523 TI - Treating information and information technology as true resources. AB - Hospitals and other health care organizations historically have been slow to adopt new managerial techniques. The same holds true for the acceptance of information and information technology as true strategic resources. With so much emphasis being placed on lowering operating costs and increasing the quality of care combined with the information revolution in today's society, the current complacent attitude often displayed toward health information management poses glaring organizational dilemmas for today's health care organizations. As many health care organizations begin to grapple with technical tasks such as developing the electronic patient medical record, they realize that there are many organizational implications to be dealt with as well. Issues such as who has the proper authority and responsibility not only to manage the mainframe and networks but also to correlate the information that all the hardware and technology provide with the strategic goals of the organization present significant hurdles. If these hurdles are not successfully cleared, any attempts at improving organizational strategy and performance via improved management of information resources are inhibited. PMID- 10138524 TI - Data quality in hospital strategic information systems: a summary of survey findings. AB - Fundamental changes in health care financing and delivery have resulted in an unprecedented need for data and information. The application of computer technology to daily hospital operations has gone far toward aiding various kinds of organizational decision making. The quality of those decisions, however, is dependent upon the quality of the data delivered by the various information systems used in the course of health care delivery and management. What remains unknown is the extent to which poor data quality occurs and what actions are taken to measure and control data quality in information systems used for strategic decision making. This article summarizes the results of a survey that was conducted for the purpose of explaining what information systems are important to hospital administrators in their strategic decision making, the frequency with which strategic decision makers encounter data quality problems, and what, if any, actions are taken to prevent, control, or correct apparent data quality problems. PMID- 10138525 TI - The effect of information systems architecture on health care data quality. AB - A rapidly increasing number of health care provider institutions is dealing with data architecture design issues that directly affect the quality of data within their heterogeneous information systems. These problems result from a failure to recognize that they are actually managing a loosely distributed yet integrated database among their many information system platforms. Understanding the issues surrounding data integration, the application available interface standards, and the tools available for implementation is critical to operating a successful distributed health care information systems environment today. PMID- 10138526 TI - The process of managerial control in quality improvement initiatives. AB - The fundamental intent of strategic management is to position an organization with in its market to exploit organizational competencies and strengths to gain competitive advantage. Competitive advantage may be achieved through such strategies as low cost, high quality, or unique services or products. For health care organizations accredited by the Joint Commission on Accreditation of Healthcare Organizations, continually improving both processes and outcomes of organizational performance--quality improvement--in all operational areas of the organization is a mandated strategy. Defining and measuring quality and controlling the quality improvement strategy remain problematic. The article discusses the nature and processes of managerial control, some potential measures of quality, and related information needs. PMID- 10138527 TI - The effective use of patient satisfaction data. AB - Demonstrating the importance of patient satisfaction as a measure of health services quality, health care organizations are increasingly investing in information systems for the collection and manipulation of patient satisfaction data. Unfortunately, these information resources are often squandered as a variety of methodological, organizational, and psychological obstacles work to prohibit the productive use of patient satisfaction data. This article discusses the challenges that health care managers and clinicians face in effectively using patient satisfaction data and identifies statistical, operations management, and managerial-specific skills that these individuals should possess to use satisfaction data successfully. PMID- 10138528 TI - The emerging role of the health information management professional in data quality and analysis of an electronic medical record system. AB - The role of the health information management professional is changing with the advancement of the electronic medical record system (EMRS) and electronic financial database systems. The Medical ARchival System, a longitudinal EMRS developed at the University of Pittsburgh Medical Center, was used to describe the methodology that the health information management professional should use when performing data quality evaluations and data analysis of an EMRS. Specific examples of steps used to integrate databases to collect the data and generate appropriate reports and tables are also described and discussed. PMID- 10138529 TI - Health data collection and verification in a collaborative model: development of a position paper on cardiac catheterization laboratories by the Rocky Mountain Heart Consortium. AB - The framework of cooperation and collaboration enabled a unique voluntary organization of health care providers and consumers to develop and publish a position paper regarding the utilization of cardiac catheterization laboratories in the state of Colorado. The collection and analysis of valid, consistent, and comparable administrative health data provided the basis for recommendations regarding current utilization of cardiac catheterization laboratories, assessment of need by geographic area, and development of criteria for the establishment of additional laboratories. The article describes the methodology used to collect and analyze health data on a statewide basis, the issues of data reliability and validity that resulted, and the process of public release of such data. PMID- 10138530 TI - Data watch. 1994 B&H opinion poll results. PMID- 10138531 TI - Mental health: solving the quality problem. AB - After several years of focusing on the costs of mental health care, employers have shifted their attention to improving access and quality. PMID- 10138532 TI - Workers shoulder more health care costs. PMID- 10138533 TI - Get the most out of your PBM (pharmacy benefit manager) PMID- 10138534 TI - Data watch. The pharmaceutical market. PMID- 10138535 TI - Managing chronic disease. PMID- 10138536 TI - Doubts emerge about drug industry mergers. PMID- 10138537 TI - Reform: what direction in '95? PMID- 10138538 TI - Can coalitions extend their reach? PMID- 10138539 TI - Alcohol and employee education. PMID- 10138540 TI - Fear of latex. PMID- 10138541 TI - Handling family complaints. PMID- 10138542 TI - Private sector drives move toward subacute. PMID- 10138543 TI - Congress eyes incentives for home care. PMID- 10138544 TI - Are provider alliances in your future? PMID- 10138545 TI - Healthcare hookups. Providers who join forces come out ahead of the curve. AB - Nursing homes are racing to join other healthcare providers in alliances that offer cost-effective, coordinated services managed care is demanding. The ultimate goal: integrated delivery systems that offer one-stop shopping for healthcare consumers and payers. PMID- 10138546 TI - Attracting managed care. Eight tips for working with a managed care provider. AB - Managed care organizations won't work with a facility unless it offers what they need. These eight tips--and one case study--outline the key procedural changes and adjustments in attitude longterm care providers are making to accommodate managed care. PMID- 10138547 TI - Beating the bottle. Group programs combat the secret scourge of alcoholism. AB - Concerned about the prevalence of alcohol abuse among the elderly, a few nursing homes have developed programs employing sessions with peer counselors, group therapy, and other activities to assist patients with drinking problems. PMID- 10138548 TI - More than just fun and games. Recreation therapy plays a growing role in longterm care. PMID- 10138549 TI - Managed care moves into longterm care. PMID- 10138550 TI - Products and services directory. PMID- 10138551 TI - A study of home care quality management data-collection systems. AB - A recent study reveals that home care agencies have inconsistent standards for quality management and inefficient data-collection systems. Are currently available data-collection systems suited for home care needs, or should they be redesigned? PMID- 10138552 TI - Public health & home care: the changing health care delivery system. AB - Public health departments have long administered preventive programs. With the increasing emphasis on broad-based prevention, however, there is a chance for home care to step in again to provide services that started in this industry. Not for-profit agencies are already taking the lead. PMID- 10138553 TI - Examining roles: home care & public health in disease prevention & health promotion. AB - The New Mexico Association for Home Care is conducting a survey of home care and public health professionals to determine the current industry views on prevention and home care. The results will be important for the whole industry, possibly in setting guidelines for prevention activities. Agencies interested in presenting their views may contact the New Mexico Association for Home Care. PMID- 10138554 TI - Healthy People 2000: participation in prevention. AB - The US spends more on health care and has worse health outcomes than some nations that have nowhere near its resources. The federal government launched this program to address both costs of care and health status of Americans. PMID- 10138555 TI - Neighborhood wellness centers: collaboration between home care & nursing education. AB - There is growing evidence of the cost benefit of health promotion and disease prevention services for the older adult population. A nursing education program and a home care agency have come together to provide this valuable service to older adults in the community while educating the next generation of nursing professionals to do the same. PMID- 10138556 TI - Preventive nursing care: a keystone in health care for the well senior. AB - A program for prevention that visits seniors where they live takes a lot of coordination. One visiting nurse association developed a successful program highlighting thorough planning and community cooperation. This program provides an example for others to follow. PMID- 10138557 TI - Home care in the workplace. AB - For home care organizations to survive in an evolving marketplace, they must break away from the traditional Medicare model and be creative in designing programs that will make them financially stronger in the future. One way to do this is by offering quality preventive health services to local businesses. PMID- 10138558 TI - Medicare cost limits: exceptions to the rules. AB - As Medicare cost limits become tighter, home care agencies will increasingly have to file for exceptions to these limits. This is a slow and complicated process that requires some careful planning and thorough documentation. PMID- 10138559 TI - A strategy against elderly mistreatment. AB - Elderly mistreatment has become a hot topic--but what society is just now recognizing has been around for a long time. Home care professionals are in a prime position to recognize mistreatment and do something about it. Understanding why it occurs can help providers deal with this issue in a sensitive manner. PMID- 10138560 TI - In the best of families: crossing the line into neglect. AB - Home care professionals are in a good spot to identify abuse of their elderly patients; unfortunately, this is a delicate issue because so many of the caregivers are family members and the abuse arises out of unintentional neglect. What can nurses and social workers do when they identify such a situation? PMID- 10138561 TI - Developing an effective infection control program for home care. AB - Home care agencies can develop comprehensive, effective infection control and prevention programs by including six critical elements: surveillance for infections, infection control education, consultation, epidemiological investigation, quality improvement activities, and policy and procedure development. PMID- 10138562 TI - The immunization initiative. PMID- 10138563 TI - Preventing malnutrition in the home care client. PMID- 10138564 TI - Angeles Home Health Care: a model for nutrition services. AB - One in four older Americans is malnourished, and this figure is even higher for the homebound elderly. One home care agency built a successful nutrition services program into its existing pathways for care, decreasing the nutritional risk of its clients. PMID- 10138565 TI - Disaster recovery planning in the NHS. PMID- 10138566 TI - Risk management and patient-focused care. PMID- 10138567 TI - Requisite skills in managing a central fund. PMID- 10138568 TI - GPs and managers. What the doctors saw. AB - Low morale among many GPs was the trigger for a survey which examined the causes of communication breakdowns and misunderstandings. Mollie McBride and colleagues outline the results. PMID- 10138569 TI - Trust leadership. Following the leaders. PMID- 10138570 TI - New management. Screen test. PMID- 10138571 TI - Learning disabilities. New patterns of care. PMID- 10138572 TI - Ensuring safe home births. PMID- 10138573 TI - Pharmacist empowerment: taking practice guidelines to the next level (Part 2). AB - Empowering pharmacists to have direct control and responsibility for institutional drug-use protocols can assist in reducing costs and improving the quality of patient care. This article examines pharmacist involvement in two drug use protocols in place at St. Luke's Episcopal Hospital in Houston. The first is a pharmacist conversion order protocol in which pharmacists are given the responsibility of flagging and monitoring IV to oral dosage conversions of selected medications; the second is a pharmacist screening program for parenteral ketorolac dosing. PMID- 10138574 TI - Quality and productivity assessment of clinical pharmacy interventions. AB - The goal of our program was to implement an easily maintained system that could document, classify, and determine the economic significance of clinical pharmacy interventions on a medicine division of an 874-bed university teaching hospital. This clinical intervention documentation system, which emphasizing both quality of care issues and pharmacist productivity, can be easily implemented by other institutions. PMID- 10138575 TI - Should the practice of drug sampling be retained or eliminated? PMID- 10138576 TI - Effect of drug industry marketing practices on formularies questioned by federal agencies. PMID- 10138577 TI - Needleless emergency drug system needs better differentiation from regular prefilled syringes; what an improvement! PMID- 10138578 TI - Pharmacoeconomic principles and methods: including pharmacoeconomics into hospital pharmacy practice. PMID- 10138579 TI - Dispensing drug samples from the emergency room; drug use evaluation requirements. PMID- 10138580 TI - Orientation teaching tool to prevent medication error. AB - Patients can be harmed and even killed when a medication error occurs. The following questions are based on actual errors which have been reported through the Medication Error Reporting Program (MERP). This teaching tool is intended as a take home test to make newly hired pharmacists aware of common medication errors. An informed practitioner is another layer of safety in decreasing the possibility of a medication error occurring. PMID- 10138581 TI - Adjusting dosage intervals of intermittent intravenous ranitidine according to creatinine clearance: a cost-minimization analysis. AB - To provide effective ranitidine therapy at the lowest possible cost to institutions and patients, the main study objectives were to develop a dosage intervention strategy for intermittent intravenous ranitidine and to document the resultant cost savings through cost-minimization analysis. During a 6-week baseline phase, a pharmacy resident prospectively monitored all patients in the intensive care unit receiving intravenous ranitidine and evaluated appropriateness of dose according to creatinine clearance. Staff pharmacists collected identical data during the 6-week intervention phase but also made recommendations for dosage interval adjustment. In patients with creatinine clearance rates less than 50 mL per minute, the mean number of doses per patient treatment-day was reduced from 2.33 +/- 0.81 during baseline phase to 1.56 +/- 0.70 during intervention phase (P < 0.001). The hospital cost per patient treatment-day was decreased by 33%, from $5.29 +/- 1.83 to $3.54 +/- 1.59 (P < 0.001). Thus a program of prospective monitoring and verbal interventions by pharmacists effectively reduced the number of inappropriate ranitidine doses and hospital cost. PMID- 10138582 TI - Health system changes in the absence of national reform. PMID- 10138583 TI - HCFA's antidumping regulations contain new requirements. PMID- 10138584 TI - Integrated delivery networks. Sustaining community-based healthcare in central Nebraska. PMID- 10138585 TI - Assisted suicide ruling is flawed. A federal court decision has potentially grave implications for all healthcare workers. AB - Last May a federal judge struck down Washington State's law against assisted suicide on the grounds that it violated the U.S. Constitution. The judge ruled that just as a citizen has a right to refuse life-sustaining medical treatment, so does he or she have a right to request a physician's assistance in committing suicide. The court also concluded that because the decision to end one's life is as intimate and personal as a decision to have an abortion, assisted suicide must also be constitutionally protected. The court is mistaken. A "right" to assisted suicide is described nowhere in the text of the Constitution. Assisted suicide, furthermore, does not occupy a fundamental place in American history and traditions, and therefore cannot be deemed implicit in the constitutional guarantee of due process. Indeed, just the opposite is true: Our history and traditions actively discourage and prohibit assisted suicide. The asserted right to assisted suicide finds no support in cases involving either abortion or termination of medical treatment. Two terms ago, the Supreme Court relied heavily on stare decisis in upholding the abortion right, but there is no line of precedent for a right to assisted suicide. Not all "personal" decisions are constitutionally protected, so the personal nature of suicide does not dispose of the question of its constitutional status. Finally, in equating refusal of medical treatment with suicide, the federal court in Washington State ignores a long line of authority that recognizes a fundamental difference between the two.(ABSTRACT TRUNCATED AT 250 WORDS) PMID- 10138586 TI - Leadership in diversity. AB - As principal change agents, healthcare leaders are well positioned to integrate diversity into their institutions' organizational structure. Thus healthcare leaders must be competent in handling diversity issues. Diversity refers to any characteristic that helps shape a person's attitudes, behaviors, perspective, and interpretation of what is "normal." In the healthcare ministry, diversity encompasses the cultural differences that can be found across functions or among organizations when they merge or partner. Managers and supervisors will have to be familiar with the nuances of diversity if they are to be effective. Those managers who are not adept at incorporating diversity into human resource management may incorrectly evaluate subordinates' capabilities and provide inappropriate training or supervision. As a result, some employees may be underutilized. Others may resist needed direction, overlook instructions, or hide problems such as a language barrier. If executives, marketers, and strategic planners are to develop relevant healthcare services that take into account the needs of their constituencies, they will need to determine how different groups understand and access healthcare. Healthcare leaders who know how to uncover cultural dynamics and challenge cultural assumptions will go far in enabling their staff and managers to confront personal attitudes about community residents. Ultimately, quality of service delivery will be improved. PMID- 10138587 TI - Valuing our differences. How to manage a culturally diverse work force. AB - How can we become aware of cultural blind spots that keep us from understanding one another? To adequately prepare for the new work force, healthcare organizations must establish work force diversity goals. Of course, goals by themselves will not empower minority workers. And if goals are perceived as "window dressing," resentment builds. Most organizations claim their hiring practices are not biased. One way to ensure that your hiring practices are unbiased is to ask important questions: Does the ethnic makeup of our work force resemble that of the community? If not, what can be done to strengthen our affirmative action programs? In a multicultural work force, misunderstandings are bound to arise because human behavior is conditioned by cultural factors. One way for an organization to identify problems that are culturally based is for supervisors and subordinates to meet informally to ensure that the organization is maximizing the minority worker's talents. Climate surveys and exit interviews are two other frequently used methods. Cultural diversity training programs can also make a difference in an organization. Some training programs help participants learn how culture influences the way we communicate. Knowledge of the cultural basis of how we interact is one factor in building bridges of understanding. PMID- 10138588 TI - Blind prejudice. A black journalist's clash with racism illustrates the need for discussion about diversity. PMID- 10138589 TI - "Doing" diversity. Holy Cross Health System facilities honor differences in different ways. AB - Holy Cross Health System (HCHS), a South Bend, IN-based organization that stretches from coast to coast, has instituted a diversity initiative to take advantage of demographic changes in its facilities' work forces and the communities they are serving. Launched by Holy Cross's corporate headquarters, the program is carried out by the member facilities, each of which had added its own ideas. HCHS's diversity program has three major components: Consciousness raising among employees. Activities range from "transcultural rounds" for nursing students to fashion shows in which employees wear costumes from their places of national origin. Educating the larger community. HCHS facilities have been urged to increase awareness of diversity among physicians, patients, vendors, and local business and civic leaders. Strategic thinking. The leaders of HCHS facilities have been advised to integrate diversity into their strategic planning. Leaders are familiarizing themselves with the different cultural, ethnic, and religious groups in the community and preparing their facilities to take full advantage of those groups' contributions. PMID- 10138590 TI - Diversity among seniors. A Toledo, OH, hospital assesses the healthcare needs of elderly African Americans and Hispanics. AB - In 1992, leaders at Mercy Hospital, Toledo, OH, realized the facility's outreach programs were not reaching as many elderly African-American and Hispanic residents from the surrounding neighborhood as they would have liked. Mercy's leaders therefore decided that the hospital could offer cultural-specific programs that better meet the healthcare needs of these populations. To secure residents' perspective, an assessment process was launched. The data gathered from participants in face-to-face interviews revealed that some had problems with access to healthcare. A lack of money and other resources seemed to be the major barriers to care. The key concern of the elderly persons interviewed is securing personalized care or services that help them maintain their independence. A number of participants wanted free transportation (other than to and from the hospital). They need help getting to their physician's office, the pharmacy, the grocery store, and the bank. Public agencies may offer such transportation services. In addition, the Hispanic elderly interviewed would like to see Spanish speaking personnel in admissions and the emergency department. PMID- 10138591 TI - Congregation transfers its healthcare system. Franciscan Sisters of Little Falls list critical factors for a successful transfer of sponsorship. AB - In 1993 the Franciscan Sisters of Little Falls, MN, transferred ownership and sponsorship of their 12 healthcare facilities to Catholic Health Corporation of Omaha. The sisters had had two goals from the start of the process: To transfer the facilities to another Catholic system, and in such a way that both members of the religious institute and the facilities' personnel would "own" the decision To complete the transfer with minimal upheaval in facility operations The sisters accomplished both of these goals. They attribute their success to prayer and several critical factors. First, having pondered their healthcare ministry in light of their Franciscan tradition, the sisters decided that a larger system could better meet their facilities' needs. Second, they developed a set of criteria for the new sponsor, including the requirement that it be both Catholic and dedicated to rural healthcare. Third, the sisters became willing to take the risks a transfer involved for both their congregation and the 12 facilities. Fourth, the sisters clearly communicated their decision to everyone affected by it. Fifth, they sought the help of experts in making the transfer. Sixth, they worked hard to create trust, so that all involved--including those who would lose their jobs--took ownership of the transfer decision. After completion of the transfer, each of the facilities held a ritual celebrating the friendships and respect built over the long years the Franciscan Sisters were their sponsors. The sisters held their own ritual of commemoration. They continue their ministries in health, education, social services, and pastoral care. PMID- 10138592 TI - Creative ritual in a hospice. AB - St. Peter's Hospice, Albany, NY, is dedicated to meeting the emotional needs of patients, families, and staff. Creative ritual, hospice leaders have found, is a powerful tool that can: Provide an "arena" for healing, affirmation, reconciliation, and celebration Serve as a reminder of the sacred Evoke heartfelt emotion Effect renewal and inspiration Offer an opportunity to cleanse the soul of grief, anger, frustration, or guilt Provide tangible experiences of bonding and interdependence Prevent staff burnout St. Peter's staff show a good deal of imagination and variety in creating rituals. Possible themes include patients' birthdays or wedding anniversaries, religious celebrations, national holidays, and changes of seasons. A lighted candle, bouquet of flowers, or incense burner may be used to give the ritual a focus. Music is often played to help set the tone. Rituals involve a major shift in consciousness. They often allow participants to express feelings it would otherwise be difficult for them to put into words. At St. Peter's, participants may begin to communicate by sharing favorite prayers, poems, photos, or works of art. Or they may make music--the hospice provides the instruments--or pass around a Native American "talking stick." Such methods facilitate the bonding of patients and their families. Particularly important are those rituals which allow patients and estranged family members to reconcile. Others enable patients to acknowledge God-given gifts. Still other rituals are held for staff members, who thereby deal with the anger and sadness their work inevitably brings. For all at St. Peter's Hospice ritual is a source of healing, affirmation, renewal, inspiration, and grace. PMID- 10138593 TI - Medical school introduces teens to biotechnology careers. PMID- 10138594 TI - Considerations in managed care. PMID- 10138595 TI - Repositioning mission for the twenty-first century. PMID- 10138596 TI - Tax exempt status for hospitals and HMOs under the Health Security Act. PMID- 10138597 TI - Antitrust enforcement guidelines for providers in the wake of health care reform. PMID- 10138598 TI - To review or not to review: antitrust liabilities and peer review protections. PMID- 10138599 TI - Ninth Circuit clarifies immunity requirements and puts more teeth into the Health Care Quality Improvement Act. PMID- 10138600 TI - "Stockless" cost reduction in the operating room. AB - St. Paul-Ramsey Medical Center in St. Paul, MN became one of the first hospitals in the United States to initiate a "stockless" par level inventory system. Successes with stockless led the hospital to look at implementing it in the OR to achieve a reduction of expense to revenue. Materiel Management and Surgical Services discussed a number of issues relevant to implementing a stockless program, including product flow, accuracy and cost of case carts and preference cards, item pricing, committed usage of items brought into the system and establishment of a steering committee. Specific OR issues and practices required evaluation and adjustment, such as the routine use of emergency direct ordering. Information systems support was brought in and a products committee established to do education and oversee the program. Savings for 1993-94 were $185,146. PMID- 10138601 TI - Product standards committees today and tomorrow. AB - The results of a survey of product standards committees conducted by the JOURNAL OF HEALTHCARE MATERIEL MANAGEMENT show that most hospitals have such a committee, chaired by the materiel manager. Despite the fact that respondents named 49 different disciplines as possible members of the committees and 100% attendance is experienced less than a quarter of the time, most respondents said they had the right number of people on their committee and that the committee was effective or very effective. With more facility affiliations in the offing, purchasing decisions will be made at a corporate level. To be viable in the future, the products committee will have to transform itself into a utilization review and cost oversight committee, and drastically reduce its membership. PMID- 10138602 TI - Carts, anesthetist's. ECRI. PMID- 10138603 TI - Healthcare quality's journey. PMID- 10138604 TI - Steam sterilization. PMID- 10138605 TI - Accreditation Manual for Pathology and Clinical Laboratory Services. Joint Commission on Accreditation of Healthcare Organizations. AB - Scoring guidelines (specifically the intent statements) for selected laboratory standards have been revised. The changes become effective for surveys conducted after January 1, 1995. Additions are indicated below by underlining, and deletions are shown by strikeout. [These revised scoring guidelines are printed on perforated pages for easy removal and insertion in the Accreditation Manual for Pathology and Clinical Laboratory Services (LSM)] PMID- 10138606 TI - Public information interview policy. Effective date: January 1, 1995. Joint Commission on Accreditation of Healthcare Organizations. AB - The revised public information interview policy takes effect for January 1995 surveys of psychiatric hospitals, other mental health care organizations, nursing homes, home care providers, ambulatory care organizations, and health care networks. Application of the expanded policy to acute care general hospitals has been deferred pending evaluation of the initial experience with the policy in psychiatric hospitals. The public information interview procedure in general hospitals will continue to be governed by the policy published on page xxvii in the "General Administrative Policies and Procedures" section of the 1995 Accreditation Manual for Hospitals, until further notice. [This revised policy is printed on perforated pages for easy removal and insertion into the General Administrative Policies and Procedures section of your accreditation manual.] PMID- 10138607 TI - Joint Commission to release organization-specific performance information. PMID- 10138608 TI - Random unannounced survey topics for 1995. PMID- 10138609 TI - Laboratory survey process changes for 1995. PMID- 10138610 TI - Collaborative practice. AB - Linda DeAngelo, RNC, M.S.A., M.B.A., of the Carle Clinic, relates how mid-level providers and physicians collaborate to offer cost-effective, quality care while returning a high level of patient satisfaction. She highlights the history of mid level providers at Carle and describes the efficiencies and indirect benefits that their inclusion in the care team permits. PMID- 10138611 TI - New medical entities and delivery sites require specialized insurance coverage. AB - The addition of mid-level providers to the health care continuum and the development of off-site delivery has created new insurance coverage problems. Fran O'Connell, R.N., vice president of Shand Morahan & Company Inc., explains what to look for in coverage based on the level of care provided and the variety of care centers in use. PMID- 10138612 TI - The utilization of physician extenders. Mid-level providers in a large group practice within a tertiary health care setting. PMID- 10138613 TI - Adding a mid-level provider to a group practice. A step-by-step guide. AB - The demand for mid-level providers, especially physician's assistants, is on the rise, according to authors Robin W. Singleton and Norman Kilburn, P.A., of Tyler and Co. They offer tips on determining need, finding and screening candidates, interviewing and extending the offer. PMID- 10138614 TI - Techniques for evaluating cash flow. AB - Jean Sylvestre, Ph.D., and Frank Urbancic, D.B.A., CPA, of the University of South Alabama, write that because of the financial challenges for health care, cash flow problems can arise. They offer techniques for interpreting and evaluating cash flow information as a means to more effective decision making. PMID- 10138615 TI - Group universal and variable life programs. An alternative to group term for physicians and other health professionals. PMID- 10138616 TI - Integrated provider networks--a primer. AB - Integrated provider networks are burgeoning. With acronyms like MSO, IPA, PHO, IPN, etc., integration can be confusing to the uninitiated. Gerald A. Niederman, J.D., of Faegre & Benson, and Bruce A. Johnson, J.D., M.P.A., of the MGMA Management Consulting Services, offer a primer on integrated provider networks. PMID- 10138617 TI - Health care reform--a look to the future. PMID- 10138618 TI - Merger could cause more antitrust troubles in Tenn. PMID- 10138619 TI - Healthcare hardly an issue on the '94 campaign trail. PMID- 10138620 TI - Kaiser to study physicians' resource use. PMID- 10138621 TI - Pesch shelves controversial plan to create luxury hospital in Idaho. PMID- 10138622 TI - Columbia/HCA nabs Healthtrust. PMID- 10138623 TI - Chicago's quiet market growing turbulent--S&P. PMID- 10138624 TI - Calif. gets tougher on charity care. PMID- 10138625 TI - A Kansas war over 18-bed hospital. PMID- 10138626 TI - Lawmakers not likely to extend tax deduction for self-employed. PMID- 10138627 TI - Variety of factors affect exec pay--GAO. PMID- 10138628 TI - Debate turns to ERISA reform for states. PMID- 10138629 TI - Providers should follow lead of those trying alternative care. PMID- 10138630 TI - Ariz. hospitals to launch own HMO. PMID- 10138631 TI - Cedars-Sinai incentives questioned. PMID- 10138632 TI - Two N.C. managed-care firms to form. PMID- 10138633 TI - Workstations that work. AB - Computerization of patient information is no longer just a nice extra; for the healthcare system of the future, it's a necessity. Hospitals' experience shows that the right type of system can save big money. The trick is to have a system that clinicians really want to use. PMID- 10138634 TI - Latest target: workers' comp. PMID- 10138636 TI - Satellites assist hospital helicopters. PMID- 10138635 TI - System uses computer model to buck the urgent-care trend. PMID- 10138637 TI - Hospitals try to boost nonoperating revenues with better investments. PMID- 10138638 TI - California not-for-profits seek link. PMID- 10138639 TI - Hospitals to merge under one board. PMID- 10138640 TI - Three N.J. hospitals plan major merger. PMID- 10138641 TI - Hospitals establish Cincinnati area's largest network. PMID- 10138642 TI - Indiana, Ohio Blues plan merger. PMID- 10138643 TI - Universal buys Columbia/HCA hospital. PMID- 10138644 TI - Courts may see more fee disputes. PMID- 10138645 TI - Ill. approves public hospital replacement. PMID- 10138646 TI - Conn. office reports on reform options. PMID- 10138647 TI - N.Y.C. hospital jobs to decline--study. PMID- 10138648 TI - Concerned about NME deal, hospital ends talks with AMI. PMID- 10138649 TI - Court OK may be too late to save Florida merger. PMID- 10138650 TI - VHA Southwest reconsiders buying or developing HMO. PMID- 10138651 TI - New England hospitals team up. PMID- 10138652 TI - Doctors, hospitals using IRS' tax decision as bartering tool. PMID- 10138653 TI - Two hospitals pay fines to settle HHS charges. PMID- 10138654 TI - Plan targets hurdles to doc networks. PMID- 10138655 TI - Bay Area HMO enrollees satisfied overall--survey. PMID- 10138656 TI - Caremark, AIDS patient settle suit. PMID- 10138657 TI - Merger monopolies. AB - Research shows merged hospitals in small markets have become monopolies and may not be delivering all they promised employers. So businesses are joining forces to demand price reductions. Also, competition keeps the heat on a Wisconsin market, p. 42. PMID- 10138658 TI - Imagement management looks for a foothold. PMID- 10138659 TI - Government propels change with $70 million in grants. PMID- 10138660 TI - New game in casino town: managed care. PMID- 10138661 TI - FTC requests delay of Port Huron, Mich., link. PMID- 10138662 TI - GOP leaders drop overhaul strategy. PMID- 10138663 TI - Drug, DME firms expect to get benefits from GATT. PMID- 10138664 TI - Utah wants Columbia/HCA competition. PMID- 10138665 TI - Open communication pays off. Media briefings yield positive coverage of hospital's five percent reduction in work force. East Jefferson General Hospital, Metairie, LA. PMID- 10138666 TI - Not just child's play. HMO and Department of Education help teachers educate kids about wellness. M.D. Health Plan, North Haven, CT. PMID- 10138667 TI - Wellness for workers and children. Children's health advocates educate local businesses, spurring 14 workplace program inquiries. Center for Child Advocacy, Egleston's Children's Hospital, Atlanta, GA. PMID- 10138668 TI - When traditional strategies don't apply. Publicity campaign raises yearly census 36 percent. Hospice Care of Rhode Island, Pawtucket. PMID- 10138669 TI - Building donor ownership. Direct mail pulls more than eight percent response, increasing number of first-time givers. Good Samaritan Hospital Foundation, Corvallis, OR. PMID- 10138670 TI - Informed parents, pleased doctors. Coffee-table book distinguishes hospital's OB program and builds physician relations. Memorial Hospital of South Bend, IN. PMID- 10138671 TI - Reform, business style. Hospital positions CEO as managed care information source for businesses' decision-makers. Mount Carmel Health, Columbus, OH. PMID- 10138672 TI - Bandy mania. Stuffed bears, coloring books, and story books boost name recognition. Baystate Medical Center Children's Hospital, Springfield, MA. PMID- 10138673 TI - Speaking with symbols. Hospital designs and markets cards that facilitate patient communication. Mount Sinai Medical Center, New York, NY. PMID- 10138674 TI - Crime Act marshals reform. PMID- 10138675 TI - Caring for people with AIDS. Special care units offer tailored services. PMID- 10138676 TI - The shaping of an industry. Will the assisted living boom lead to new regulation? PMID- 10138677 TI - Wander monitoring/security systems guide. PMID- 10138678 TI - Public relations takes practice. PMID- 10138679 TI - Supreme Court backs providers. PMID- 10138680 TI - No place like home. PMID- 10138681 TI - Thanks to long-term care. PMID- 10138682 TI - Health services research--what it is, how to do it, and why it matters. AB - The term 'Health Services Research' (HSR) has achieved only recent currency in the UK. The purpose of this short article is to explain what it is, to say how it differs from clinical research even when using similar methods, and to argue that it is likely to become of rapidly increasing importance to health policy-makers and managers. PMID- 10138683 TI - Decentralisation of general management within the New Zealand health system. AB - The radical organisation changes implemented in the New Zealand health system in recent years are discussed and analysed in this study which is based upon a review of documents and interviews with general managers of area health boards. Service management, which involves the decentralisation of general management to programme or product groupings (medicine, child health etc) has been widely implemented in almost all boards completely replacing the traditional disciplinary hierarchies. It is also leading to a population-rather than an institutional-based system of management. General managers report positively on the achievements of service management including greater accountability and commitment of clinical staff, innovation and team building, improved performance and service quality, the integration of hospital and community-based care and a customer rather than an occupational orientation. There is an increasing trend towards the recognition of primary health care as a key service entity. PMID- 10138684 TI - The relationship between well-being and job satisfaction for staff working on long stay wards for the elderly confused. AB - The psychological well-being and job satisfaction of nursing staff working on long stay wards for the elderly confused were examined in one health district. Feelings of well-being were not related to job satisfaction. However, feelings of unhappiness were found to be related to job dissatisfaction, this relationship was found in the ward managers (predominantly males) and not other qualified or unqualified staff. The implications of this finding are discussed. PMID- 10138685 TI - Job stress, ill health and job satisfaction among health service employees. AB - The study examined the effects of occupational stressors, perceived locus of control, Type A behaviour pattern and use of coping strategies on well-being and job satisfaction of 1,176 health service employees. Several stressors were identified as having a negative impact on health and job satisfaction although these differed between the various occupational groups included in the study. The interactionist model of stress used in the study, and the diagnostic tool used (the Occupational Stress Indicator) proved to be useful in suggesting means of intervening to reduce ill health and increase job satisfaction among health service employees. PMID- 10138687 TI - The role of the middle manager in health care research: some problems and perspectives. AB - There is mounting pressure on health care professionals to undertake research. However, despite national and local directives, relatively little research is published within the paramedical professions. One reason for this may relate to the fact that changes in basic training have located the bulk of the research skills amongst the most newly qualified but potentially least influential staff. This pilot study examined the impact of developing research competencies in a group of middle managers, on the assumption that they might then influence and facilitate research productivity among junior staff. The study was largely unsuccessful as a result of numerous practical and attitudinal problems. Some suggestions are put forward for overcoming some of these difficulties and thus for increasing research output amongst the paramedical professions. PMID- 10138686 TI - The effect of primary nursing job design dimensions on caregiving technology and job performance in nursing homes. AB - Primary nursing job design, ie permanent assignment and increased job autonomy and communication, has been suggested as especially appropriate for long-term care. The present study examined its effects on nursing home assistants' (N = 248) job performance and technology perceptions. Job design was found to have a significant effect on caregiving technology, even after controlling for individual differences. In particular, increased autonomy was significantly related to increased task variability which suggests that nursing assistants who have more job autonomy provide more customized care. Unexpectedly, increased duration of assignment was significantly related to increased homogeneity of tasks. Suggestions for future job design research in long-term care are made. PMID- 10138688 TI - Making nonroutine decisions--what cost measure is appropriate? AB - It would be simple if there were just one correct measure of cost. Unfortunately, every time we use cost information, the most important thing we do is determine which costs are appropriate for answering the question that has been asked. The degree of accuracy in calculating those costs will have to depend on how valuable the information is. The more important it is to have very accurate information, the more effort should be made to get such information. However, we cannot even begin the process of cost measurement until we have defined which costs to measure. In routine management, we have taken the time to refine the definition of what cost information is appropriate for the efficient running of ongoing activities. In the area of nonroutine decisions, however, everything is new. It is therefore critical for managers to spend some time thinking about which things really will change as a result of the change. Only those factors should enter into the calculation. PMID- 10138689 TI - Accountability, program performance, and profitability. Part 1: How to assess fund-raising program performance. AB - Part 1 of this article examines ways to measure the performance of fund development programs. Part 2, which will appear in the AHP Fall journal, will provide additional tools for demonstrating the efficiency, effectiveness, and profitability of these same fund development programs. PMID- 10138690 TI - A philanthropic philosophy for the 21st century. PMID- 10138691 TI - There are many ways to skin a cat. The growth of multi-institution health care systems has created a pressing need to consider new organizational structures in philanthropy. PMID- 10138692 TI - Fluff or substance? A VIP guest relations program. PMID- 10138693 TI - Supporting health care reform through philanthropy. PMID- 10138694 TI - The role of philanthropy in a single-payer system. PMID- 10138695 TI - Philanthropy: the key to health care health. PMID- 10138696 TI - What's driving the health care system? PMID- 10138697 TI - Comprehensive reform dead for 1994: what went wrong? PMID- 10138698 TI - Regulating managed care into the 21st century. PMID- 10138699 TI - Problem knowledge couplers: can they extend our ability to use practice guidelines? AB - New information tools enable us to leave behind a world of medical practice in which providers of all sorts have been allowed to operate in the face of avoidable ignorance of relevant details from the medical literature as well as details about a given patient. Furthermore, the new tools can assist providers and patients alike in trying to process vast amounts of information in the course of everyday medical care. In the following article, the author discusses some of these new tools and how they can best be utilized. PMID- 10138700 TI - PPOs: moving from fee-for-service to accepting financial risk. AB - Introducing a new acronym for the health care delivery environment--the RPO. As PPOs prepare to accept risk in their relationships with payers and providers, new, more-integrated organizations will evolve to be better prepared to assume risk-bearing contracts. PMID- 10138701 TI - A decision analysis model in the evaluation of NSAIDs in a managed care setting: a case study. AB - The objective of this study is to utilize a clinical trial based on a decision analysis model to assess the economic benefit of a lower incidence of gastrointestinal lesions in elderly patients with osteoarthritis receiving nabumetone therapy compared with ibuprofen alone and in combination with misoprostol. An arthritic population of an HMO (> 60 yr of age) was applied to the decision analysis based on the HMO's nonsteroidal anti-inflammatory drug and antiulcer usage and acquisition costs. Results indicate the potential for a decrease in overall medical resource utilization through the use of nabumetone in elderly patients with rheumatoid and osteoarthritis. Based on this information, nabumetone has been added to the HMO formulary as a second-tier agent with a repeat of the analysis scheduled in one year to verify the economic benefits and modify prescribing guidelines accordingly. PMID- 10138702 TI - Health care reform and long-term care pharmacy. AB - "Waiting and preparing" describes the health care reform activity of most of the larger long-term care pharmacy providers. The complexity of this service sector, in combination with the potentially enormous cost and actuarial uncertainty, seems to have averted major federal action at this time. The frenzy caused by the reform debate, however, has precipitated several changes at the state level that may not be as prudent. PMID- 10138703 TI - Creating healthier communities: challenge for the 21st Century. AB - The challenge for the 21st century will be to create healthier communities. Health is the ultimate cost-reduction strategy and the defining outcome for future health care systems. The challenge for those managing care will be to influence the web of factors from which health arises. Across the country, communities are working to redesign underlying conditions, forge new partnerships, and create high-level health. They will do for themselves what Washington cannot. PMID- 10138704 TI - Case management: creativity in the ambulatory environment. AB - Case managers, serving as advocates for patients, can provide excellent cost benefit to medical groups and patients alike. The author describes some of the important aspects of case management initiatives and how medical groups, in particular, can approach their implementation. PMID- 10138705 TI - The risks and rewards of outcomes management systems. PMID- 10138706 TI - Clinical and economic benefits of a clinical pharmacokinetic service: 1987 versus 1992 data. PMID- 10138707 TI - Specialty services: capitation trends among physician groups. AB - Many health care providers, particularly those outside of California, Minnesota, and a handful of other states where managed care has become a dominant force, are hesitant to work under capitated contracts. Fear of capitation is basically fear of the unknown. If providers have the tools to track utilization patterns, gather information, and interpret it, then this fear is unjustified. PMID- 10138708 TI - Framework for a comprehensive health and safety program in the hospital environment. American Society for Hospital Engineering. PMID- 10138709 TI - Establishing full-service vending. PMID- 10138710 TI - Enhancing pureed foods at the Dayton VA Medical Center. PMID- 10138711 TI - Technomic: innovation & modest growth for 1995. PMID- 10138712 TI - 'The best is yet to be' ... at Morningside (CCRC), Fullerton, California. PMID- 10138713 TI - 'The best is yet to be' ... at Wesley Housing Corporation, Memphis, Tennessee. PMID- 10138714 TI - 'The best is yet to be' ... at Mystic Valley Elder Services, Malden, Massachusetts. PMID- 10138715 TI - Managing diversity in health services organizations. AB - The changing ethnic, racial, and gender workforce characteristics require innovations in management philosophy and practice. Valuing employees' differences is believed to be a competitive advantage in many modern corporations. This article offers recommendations to health care managers for rethinking and improving the management of their heterogeneous workforces. A conceptual framework and evaluative criteria are developed in an attempt to better understand the factors that influence effective diversity management. The experiences of health services institutions in the Southwest (already a multicultural region) are studied to illustrate various approaches to diversity management. Leader philosophy and support, organizational policies and programs, workforce composition, structural integration, and organizational type constitute the main elements in this study. As the nation debates restructuring the health industry, it should also take the opportunity to integrate a management philosophy that values diversity and its practice. PMID- 10138716 TI - Consequences of bad publicity: one example. AB - When Houston's leading newspaper investigated local for-profit psychiatric hospitals and ran a series of stories that ranged from unflattering to shocking, any hospital administrator might reasonably have expected dramatic effects on public perceptions of the specific hospitals named, and also perhaps on other psychiatric hospitals in the metropolitan area. In fact, a survey that tracks consumer awareness and impressions of all Houston-area hospitals found no such outcome. These results may be counterintuitive, but they are easily reconcilable with communications theory. PMID- 10138717 TI - Reengineering health care: management systems for survivors. AB - To survive in the coming era, health care organizations must support the powerful concepts of continuous quality improvement with better internal management systems that include: (1) new processes for making decisions from mission to clinical guidelines; (2) hoshin planning, which emphasizes strong financial management and innovation to meet customer needs; (3) new organizations that make cross-disciplinary teams as important as traditional clinical support services; and (4) expanded information covering several new dimensions, including enhanced analytic capability, and supporting both traditional organization and cross disciplinary teams. PMID- 10138718 TI - The hospital CEO: meeting the conflicting demands of the board and physicians. AB - This article examines the relationship between the hospital CEO and the governing board and physicians in Canada. Conflicts that result from the interaction of the three groups are identified. A CEO requires technical, human, and conceptual skills to manage conflict effectively but can be successful with minimal technical or human skills by relying on subordinates for these skills. This article argues that survival of health care organizations in the 1990s will depend on CEOs with strong conceptual skills. Although some believe conceptual skills are innate, it may be possible to learn such skills through coaching or mentoring. PMID- 10138719 TI - Perceptual measures of quality: a tool to improve nursing home systems. AB - Improvements in nursing home efficiency and quality typically have not addressed the needs of the entire customer base. The focus of most quality measures used in a health care setting is "technical," and perceptual or patient and family perspectives have been neglected. Data obtained from a survey of customers using services from a chain of nursing homes measured perceptual quality; the data are presented here in a variety of formats that may aid management in organizing and understanding better such information. The goal is to provide management with a tool to identify current strengths, as well as those areas needing attention. If nursing homes are operated without knowledge of perceptual quality data, their improvement efforts are unlikely to adequately address the needs of all their customers. PMID- 10138720 TI - Supervisors matter more than you think: components of a mission-centered organizational climate. AB - A study was conducted in a medical center among a diverse sample of employees to examine whether components of organizational climate related to workers' knowledge of the organization's mission and mission-centered values. Findings supported a mediated relationship between supervisor behaviors, mission knowledge, and customer service orientation (the organization's key mission value). Employee perceptions of coworker and organizational support and knowledge of their own performance expectations also related positively to customer service orientation. Results suggest that supervisors are in an ideal position to disseminate a mission-centered climate. Practical applications of these findings for management wishing to develop mission-centered climates in health care organizations are discussed. PMID- 10138721 TI - Adoption of costing systems by U.S. hospitals. AB - This article re-examines the use of costing information in hospitals. While previous research reports that hospitals are increasingly adopting costing methodologies, survey results indicate that costing systems and cost methodologies have not been widely implemented. A telephone survey of 94 hospital executives revealed only 26 percent routinely collect procedure-level costs and only 12 percent apply basic costing techniques described in prior health care management literature. It appears that despite cost accounting's benefits, immediate cost-control problems are answered with short-term, focused cost cutting solutions. While these short-term measures allow hospitals to survive in the current environment, health care reform and other pressures to control revenue growth will make sophisticated cost management a necessity for hospitals in the near future. PMID- 10138722 TI - Hospital plant and equipment replacement decisions: a survey of hospital financial managers. AB - Surveys of capital investment decisions have often neglected issues related to replacement of existing plant and equipment. As acute care hospitals experience declining inpatient utilization, appropriate hospital capital replacement becomes critical to efficiency and survival. Financial managers of 116 large, acute care hospitals were asked to rank factors that typically affect decisions to replace plant and equipment in their facilities. Factors influencing plant were expected to differ from those affecting equipment. The study found that replacements, particularly of equipment, are largely dictated by physicians, accreditors, and regulators. Rising operating costs and utilization were ranked as less important in replacement decisions. In light of impending health reform, these findings suggest that hospital executives need to reorder their replacement priorities to emphasize cost and efficiency. PMID- 10138723 TI - The role of national quality registers in the Swedish health service. AB - This article reports on a quality movement in Sweden that has gone largely unnoticed, namely the national quality control registers. These registers represent a potentially important primary data source for comparative studies and can play an important role in a national strategy for control and improvement of health care quality. First, we review the recent health care quality initiatives in Sweden and the background of national quality control registers. Secondly, we discuss our findings from a study on the purpose, content, value and problems associated with the registers. Our findings are based on (a) interviews with physician managers of the registers, (b) questionnaires to selected hospital departments participating in the registers and (c) questionnaires to elected officials and administrators representing the local health care providers. Finally, we discuss several crucial issues related to the registers. Although some have existed for several years, the registers are still defining their roles. Traditionally, this activity has been managed by the medical profession. However, interest in register information is increasing among health care policy makers and administrators at all levels in the system. Two key issues concern register ownership and finance, but the most sensitive issue concerns the right of policy makers and the public to access register information. The registers and the information they contain illustrate the ongoing conflict between openness and consumer sovereignty in health care on the one hand and professional autonomy on the other. PMID- 10138724 TI - Health care expenditures for the elderly and reforms in the health care system in Japan. AB - In recent times, significant reforms have been instituted in Japan's health care system, such as the introduction of hospital categorization and the clarification of hospital roles, together with the establishment of geriatric health care facilities, and the reform of the pharmaceutical distribution and pricing system. These reforms are expected to improve the efficiency and quality of the health care system in Japan and to provide better care for the aging society. The changes will also eventually affect health care costs and patterns of services. This paper describes Japan's health care system, including the recent reforms, and then examines the costs and patterns of health care services for the elderly in the light of the recent changes in the system. While more resource allocation is necessary for training of workers for nursing, rehabilitation and care-giving, drugs should be more cost-effective and fit for use at home and in non-medically oriented institutions. Health care providers, health care industries and the government need further to properly respond to the changes in demography, patterns of diseases and disabilities and patients' wishes for better quality of life. PMID- 10138725 TI - The economic consequences of malaria for households: a case-study in Nepal. AB - Increased attention has recently been paid to the impact of illness on the well being of households in developing countries. This has been a particular theme in the case of malaria, but relatively little evidence is available on how households react to malaria and on its impact on expenditure and time allocation patterns. This paper reports the results of a study designed to investigate the economic consequences of malaria for households in Nepal. A household survey of malaria cases in two districts provided information on use of various sources of treatment, their cost to households, time lost by the person with malaria, the extent to which others inside or outside the household provided assistance with the normal work of the malaria patient, the time spent caring for a child with malaria and any financial losses associated with the malaria episode. Out-of pocket expenditure on treatment differed greatly between the two districts, for reasons associated with the choice of public or private sources of treatment and the number of visits made per episode. The majority of households appeared to cope without great difficulty with the reduction in labour supply caused by a malaria episode, by drawing largely on the time of adult family members. Caution is advised in extrapolating the results to other situations, given the extent to which local factors are likely to influence the impact on households. Moreover, the findings relate to a situation where a malaria control programme is in place: a relatively greater impact per household would occur in the absence of control. However, it is argued that such surveys have value in informing health policy, particularly in relation to setting priorities and treatment policy. PMID- 10138726 TI - Disability development and the structure of care: some results from simulation of an area-based system of long-term care for elderly people. AB - In order to study the dynamic properties of an area-based system of long-term care for elderly people a simulation model was developed. The model describes the system of care in terms of the number of persons per level of care, age group, gender and degree of disability. Flows between levels of care and changes in degree of disability are regulated by Markovian transition matrices. The simulation proceeds by calculating for each year the changes in the system state depending on the inflow of new clients, the transfers of clients between levels of care, the changes in disability, mortality and the exit of clients from the care system. Data for the stimulation model have been collected during the period 1985-1991 through the application of the ASIM (Aldre SIMulering meaning 'Elderly Simulation') monitoring system in the municipalities of Solna and Sigtuna, Sweden. Using the observed relationship in Solna between disability development and level of care, it is estimated by the simulation that substituting the residential homes in Solna for sheltered housing would reduce the total care system work-load by about 5%. Approximately the same result is obtained when using the Sigtuna set of data. PMID- 10138727 TI - The Chinese medicines market: moving towards a market system? AB - This paper presents a review of the Chinese pharmaceutical policy in order to analyse the forms of effective market competition introduced or not in the system. Registration, pricing and trade are three areas showing the limits on competition. The government limits the duration of the registration procedure to three years, which leaves some opportunities for challengers to market similar products afterwards. The pricing system in place is a maximum price ceiling. The price structure reveals a net difference of treatment between foreign products and domestic products. With respect to trading policy, the government applies a selective licensing policy for exports and imposes variable custom taxes on a product-by-product basis on imports. At a micro level, the Chinese market has instant market conditions with fair trade where manufacturers, importers and distributors can meet. Different cost-sharing experiments between the state, the working units and the patients also introduce more sensitivity to prices from the consumer. Such a duality between the limits imposed on competition by public policy tools and the experiments or market conditions in place at the level of the organisations underlines the ambiguity of the move towards a market economy in the Chinese pharmaceutical market. PMID- 10138728 TI - Creative collaboration with the media. PMID- 10138729 TI - Health care marketing professionals: messengers and facilitators of change. PMID- 10138730 TI - A direct encounter with the 'Big Fear'. PMID- 10138731 TI - Leveraging the value of customer satisfaction information. PMID- 10138732 TI - Taking the direct route. AB - Direct marketing holds much potential for the health care industry, but little has been written about hospitals' use of DM techniques. The authors discuss the distinct characteristics of direct marketing, report findings from an exploratory study of how U.S. hospitals have incorporated DM into their communication programs, and construct a profile of high and low users. PMID- 10138733 TI - Uninformed choice. AB - The United Kingdom recently reformed its health service to promote consumer choice of a provider. The authors investigate the evaluative strategies patients use for their present primary care provider as a precursor to determining future choice criteria. However, this information has only limited value since health care providers still cannot market their services. The policy changes have introduced structural reforms but are not addressing some of the practical constraints to choice in this market. PMID- 10138734 TI - Service quality measurement. AB - Extending the research on service quality in health care, the authors examine the efficacy of four models for measuring service quality and conclude that SERVPERF methods are superior to SERVQUAL methods. Their study found that dental patients' assessments of overall service quality were strongly influenced by assessments of provider performance. Furthermore, an examination into the causal order between perceptions of overall service quality and patient satisfaction reveals such strong reciprocal influences that it's impossible to conclude that one empirically precedes the other. Finally, the authors found that purchase intentions are influenced by both patient satisfaction and patient assessments of overall service quality. PMID- 10138735 TI - Influencing physician referrals. AB - Primary care physicians have several external sources of information available when referring a patient to a specialist. The most-used sources were a fellow physician, followed by the specialist, the patient or the patient's family, and to a lesser extent, hospital-controlled sources including referral directories, call services, and sales representatives. The authors tested a cost-benefit model where source usage was predicted to increase as the costs of using the source decreased and benefits increased. PMID- 10138736 TI - Enhancing the provider/patient relationship: the case for patient advocacy programs. AB - Given the highly personalized and individualistic nature of the health care experience, care and attention must be directed to meeting the needs of the patient faithfully--through both competent medical care and the more abstract, but no less important, intangible service needs. The authors describe one process for providing an enhanced level of service: the adoption and implementation of a patient advocacy program. PMID- 10138737 TI - The budget monster. Taming health care costs won't be easy for the new Republican majority. PMID- 10138738 TI - Health insurance and cancer screening among women. PMID- 10138739 TI - Comparison of methods used for estimating pharmacist counseling behaviors. AB - OBJECTIVE: To compare the rates reported for provision of types of information conveyed by pharmacists among studies for which different methods of estimation were used and different dispensing situations were studied. DATA SOURCES: Empiric studies conducted in the US, reported from 1982 through 1992, were selected from International Pharmaceutical Abstracts, MEDLINE, and noncomputerized sources. STUDY SELECTION: Empiric studies were selected for review if they reported the provision of at least three types of counseling information. DATA EXTRACTION: Four components of methods used for estimating pharmacist counseling behaviors were extracted and summarized in a table: (1) sample type and area, (2) sampling unit, (3) sample size, and (4) data collection method. In addition, situations that were investigated in each study were compiled. DATA SYNTHESIS: Twelve studies met our inclusion criteria. Patients were interviewed via telephone in four studies and were surveyed via mail in two studies. Pharmacists were interviewed via telephone in one study and surveyed via mail in two studies. For three studies, researchers visited pharmacy sites for data collection using the shopper method or observation method. Studies with similar methods and situations provided similar results. CONCLUSIONS: Data collected by using patient surveys, pharmacist surveys, and observation methods can provide useful estimations of pharmacist counseling behaviors if researchers measure counseling for specific, well-defined dispensing situations. PMID- 10138740 TI - Perspectives. Antitrust enforcement: reshaping the health system. PMID- 10138741 TI - Perspectives. Do doctors make better network bosses? PMID- 10138742 TI - Waste incineration--the impact of legislation on hospital waste disposal. PMID- 10138743 TI - A system kitchen enables Bassetlaw Trust Hospital to meet new legislation without compromising future development plans. PMID- 10138744 TI - The design of the environmental services at Queens Building, De Montfort University. PMID- 10138745 TI - Bar code tracking system boosts performance of labour management system. PMID- 10138746 TI - How Lewisham District General Hospital has maximised space and increased patient focus at its new intensive care unit. PMID- 10138747 TI - Hospital put on probation for tests on pregnant women. PMID- 10138748 TI - Setting normative standards for the dying: work in progress. PMID- 10138749 TI - Ethics committees look to establish standards of performance. PMID- 10138750 TI - The patient-physician relationship and the allocation of scarce resources: a law and economics approach. AB - Patients with insufficient financial resources place physicians in a conflict of interest between the patients' needs and the financial interests of the physician, other patients, and society. Not only must physicians act ethically, but they must avoid liability for violating their legal duties to their patients. The traditional rules of contract and malpractice law that govern the patient physician relationship do not provide satisfactory guidelines. Better answers are found in the rules of fiduciary law, but only with regard to direct conflicts between patients and physicians and only at the risk of reducing patient access to care. Certain types of legislative action can resolve these conflicts by altering the traditional legal rules, but care must be taken to preserve patient physician trust, which the legal rules were designed to enhance. PMID- 10138751 TI - Allocation of resources at the bedside: the intersections of economics, law, and ethics. AB - In the preceding article, Mehlman and Massey examine possible legal responses to the issues that confront physicians faced with treating patients who have insufficient financial resources. This commentary explores the same issues from the perspective of ethics, including a comparison of the way law and ethics interpret the physician-patient relationship, the ethical obligations of physicians that are inherent in that relationship, and the propriety of Mehlman and Massey's legal and ethical proposals to ameliorate physicians' conflicting obligations in providing or withholding care on grounds of conservation of society's resources. PMID- 10138752 TI - Patients' rights in Japan: progress and resistance. AB - The discussion of patients' rights in Japan began in 1968 when a surgeon was accused of violating a potential organ donor's right to life by arbitrarily employing brain-based criteria in the determination of his death. A proliferation of documents that articulate and endorse patients' rights occurred in the 1980s and early 1990s. The doctrine of informed consent, which has been a central aspect of the movement toward patients' rights, is increasingly recognized in Japan, although importance rarely has been attached to the element of the patient's "appreciation" of the information disclosed by the physician, much less to the "voluntariness" of the patient's decision. Nevertheless, recent court decisions indicate progress both in the acceptance and the understanding of the doctrine in Japan. PMID- 10138753 TI - Religious perspectives on bioethics, Part 2. PMID- 10138754 TI - Psychosocial aspects of sickle cell disease: past, present, and future directions of research. PMID- 10138755 TI - Scholastic performance of children with sickle cell disease. AB - This article describes the scholastic performance of two groups of African American children with sickle cell disease: 17 with sickle cell anemia (SS), the most severe form, and 15 with sickle-C disease (SC), a less severe form. These two groups are compared to 34 healthy African American children with similar demographic characteristics. To determine scholastic performance, standardized reading and mathematics achievement test scores and school attendance were obtained. The conclusions drawn from these data reveal significant differences in reading, math, and school attendance of SCD children compared to healthy children. The healthy children's scores and attendance were better on both indicators. The most critical finding of the study shows that SC children, the ones with the less severe form of SCD, scored the poorest in reading and mathematics. As expected, the SS children had the most absences during a school year. The results of this descriptive study suggest that SCD children are at greater educational risk of school failure than their healthy peers. PMID- 10138756 TI - Adaptation and coping: a look at a sickle cell patient population over age 30--an integral phase of the life long developmental process. AB - Individuals with sickle cell disease experience a variety of psychosocial issues, some of which lead to maladjustments. To gather baseline data on coping and adjustment by a group of individuals over 30 years of age, a pilot study was conducted with 30 patients followed routinely at the Duke University Comprehensive Sickle Cell Center. The purpose of the study was to characterize such psychosocial parameters as coping behaviors, education, employment, group affiliation, health beliefs, marital status, parenting and perceptions regarding the disease. Using Erickson's stage of development as a point of reference, the middle adulthood stage was used as a theoretical framework for explaining and interpreting the results of this study. Study results reflect that, on the whole, the participants employed a wide variety of life skills to promote positive psychological and physical well being. These data suggest that this population of sickle cell disease patients have attained a reasonable level of psychosocial adjustment and many are leading productive lives. However, the minority of patients, who use the health care facilities more frequently, might lead one to speculate otherwise. PMID- 10138757 TI - Relationships in families of children and adolescents with sickle cell disease. AB - This study represents the findings from interviews and assessments of children and adolescents with sickle cell disease and their parents regarding the quality of family relations, the degree to which sickle cell disease has impacted on these relations, and the variables which contribute to these relations. With 70 families as respondents, the data reveal a wide variance in quality of relations, but a broad base of positive relations. Parent report tends to be more positive than child report, both in terms of quality of relations and the impact of sickle cell disease on relations. Social support and knowledge about the disease are significant contributors to positive relations, while socioeconomic status, family structure, and illness severity are not predictive of quality of relations. With age and gender as covariates, results indicate that the families of girls tended to have more positive relations. The data suggest approaches to family and community support in order to help families maintain and build relations in the face of the stresses which sickle cell disease imposes. PMID- 10138758 TI - The importance of grandparents in extended-kin caregiving to black children with sickle cell disease. AB - This study examined support and care the black extended-kin system provided to 34 chronically ill black children with sickle cell anemia. Findings show that grandparents played important roles in helping provide support to the sick children's primary caregivers and to the children themselves. Grandparents provided support that complemented that of fathers, and they remained in the system of care longer than any other relative in the family. The data indicate a need to design family interventions for sick children and their parent to include grandparents. PMID- 10138759 TI - The sickle cell mutual assistance movement. AB - The purpose of this paper is to describe the mutual help movement that is occurring in the sickle cell community. As sickle cell disease primarily affects African Americans in the United States, the research can show how mutual assistance groups are proliferating among this group of individuals. The study will provide the only qualitative analysis of mutual assistance groups known to exist that are primarily comprised of African Americans. In addition, demographic information on the leaders of these groups will be reported. This information can serve to educate individuals interested in forming mutual assistance groups for individuals affected by sickle cell disease. It is hoped that this information will broaden the perspective of mutual assistance groups and will illustrate that mutual assistance groups also serve diverse cultures in this country. PMID- 10138760 TI - Perceptions of ethnic and cultural factors in the delivery of services in the treatment of sickle cell disease. AB - Twenty-two parents or guardians of children with sickle cell disease seen at a university medical center were administered the Service Perception Test (SPT), a pilot designed for this study to assess how ethnocultural factors of age, race, and gender were perceived as influencing quality of health care received by patients. The medical staff at the sickle cell treatment clinic were also administered the SPT. Data were analyzed for family respondents, medical staff, and a comparison of the two groups. Results consistently show that whites were perceived as getting better service than blacks; young children as receiving better service than the elderly; and the elderly as getting better service than middle age adults. Females were perceived as receiving better service than males with an interaction of race and age. Conclusions and implications for delivering health care services to ethnically and culturally diverse patients with sickle cell disease are offered. PMID- 10138761 TI - Sickle cell mutual assistance groups and the health services delivery system. AB - One of the main reasons individuals with sickle cell disease (SCD) join self-help groups is to address the problems they perceive in the health care delivery system, such as long delays in hospital emergency departments, inadequate training of health care workers about SCD, and frequent accusations of drug seeking behavior. This formative evaluation study surveyed the leaders of 11 self help groups which are attempting to make changes in the health care system, representing 8% of the 134 known SCD self-help groups. The group leaders reported the problems their groups perceived in health care delivery, the obstacles they encountered in trying to make changes in the system, and the approaches they employed in addressing the perceived problems. This study shows that, in educating themselves and others about the experience of SCD, the members of the groups have taken a pro-active role in their own health care which gives them a sense of empowerment that they would not otherwise have. The activism of the SCD self-help groups is also helping to redefine the traditional relationship between patient and provider, and it signals an emerging new role for self-help groups in general. PMID- 10138762 TI - Depression and anxiety in patients with sickle cell disease: conceptual and methodological considerations. AB - The literature suggests that a significant number of patients with sickle cell disease experience social and psychiatric impairment. Recently, a few investigators have focused on the role of depression in sickle cell disease. A review of this literature indicates that patients with sickle cell disease have a higher incidence of depression when compared to physically healthy controls. This relationship appears to be true even when the investigator controls for illness related physical symptoms. This paper critically reviews the literature on the relationship between depression and sickle cell disease in African American patients, with particular emphasis on how depressive symptomatology affects treatment outcome (e.g., compliance, hospitalizations, etc.). The paper critically reviews this literature on both theoretical and methodological issues. Recommendations are also made with regards to both treatment and future research directions in this area. PMID- 10138763 TI - The role of social support in compliance and other health behaviors for African Americans with chronic illnesses. AB - Social support plays a positive role in compliance and other health behaviors. The purpose of this study was to investigate the role of social support in compliance and other health behaviors for patients with sickle cell disease and diabetes. Subjects consisted of 49 patients with sickle cell disease and 78 patients with diabetes attending outpatient clinics at an urban hospital. Subjects were given questionnaires which assessed their appointment-keeping behavior, adherence to health activities, and social support. The results indicated that social support was significantly associated with appointment keeping behavior and adherence to health activities in both the sickle cell and the diabetic sample. Implications of the study findings for improving compliance by increasing social support are discussed. PMID- 10138764 TI - Factors in the long term adjustment of children and adolescents with sickle cell disease: conceptualizations and review of the literature. AB - This paper focuses on the psychological and social factors that influence the adjustment process of children and adolescents with chronic conditions, primarily sickle cell disease. A review of the literature will reveal that psychological variables, such as anxiety and depression affecting adjustment, are the most studied. However, it will be pointed out that social variables such as family, school, and peers, also play a major role in this process. Furthermore, in keeping with the approach of this special collection, these psychological issues will be discussed within a developmental context. Clinical teams and practitioners are encouraged to take a longitudinal-biopsychosocial approach in addressing the needs of these children and their families. By doing so, they will be able to meet the present and long term psychological, social, educational, as well as medical needs of children and adolescents with sickle cell disease and other chronic conditions, and their families. This approach will also allow professionals to recognize and utilize the strengths of this population in the promotion of their overall well-being. PMID- 10138765 TI - Natural history of sickle cell disease and the effects on biopsychosocial development. PMID- 10138766 TI - Risk and resilience in adjustment to sickle cell disease: integrating focus groups, case reviews, and quantitative methods. AB - Case reviews and focus groups were used to develop clinical profiles of poorly adjusted and psychologically resilient children with sickle cell anemia. The convergence of these clinical profiles with quantitative data was examined by drawing upon objective information in the case records derived from physical and structured psychosocial assessments. Regression analyses were used to test the predictors of psychological, academic, and social adjustment identified in the clinical discourse. The results provide a basis for speculating about the process of adjustment to illness and the value of a family approach to psychosocial intervention. PMID- 10138767 TI - Continuing care team--a total approach to quality care. PMID- 10138768 TI - The SupportHealth/AmeriNet venture. PMID- 10138769 TI - One crisis after another. A summary of recent Medicaid funding woes. PMID- 10138770 TI - Reimbursement in the modern age. Capitation is coming, but other factors may still affect payment. PMID- 10138771 TI - America's social ills and our health care system: an interview with Dr. Leroy Schwartz. Interview by Carolyn Rogers. PMID- 10138772 TI - Statement of recommendations to ensure quality of surgical services in managed care environments. American College of Surgeons. PMID- 10138773 TI - The uniqueness of American surgical education and its preservation. PMID- 10138774 TI - Nonprofit organizations in the health sector. PMID- 10138775 TI - Assessing the impact of automated coding & grouping technology at St Vincent's Hospital, Sydney. AB - In 1992 the Hospital recognised that the existing casemix data reporting systems were too removed from individual patients to have any meaning for clinicians, analysis of the data was difficult and the processes involved in the DRG assignment were subject to considerable error. Consequently, the Hospital approved the purchase of technology that would facilitate the coding and grouping process. The impact of automated coding and grouping technology is assessed by three methods. Firstly, by looking at by-product information systems, secondly, through subjective responses by coders to a satisfaction questionnaire and, thirdly, by objectively measuring hospital activity and identified coding elements before and after implementation of the 3M technology. It was concluded that while the 3M Coding and Grouping software should not be viewed as a panacea to all coding and documentation ills, objective evidence and subjective comment from the coders indicated an improvement in data quality and more accurate DRG assignment. Development of an in-house casemix information system and a feedback mechanism between coder and clinician had been effected. The product had been used as a training tool for coders and had also proven to be a useful auditing tool. Finally, linkage with other systems and the generation of timely reports had been realised. PMID- 10138776 TI - The National Coding Centre--an overview. AB - Medical Record Administrators have been aware of the need for a National Coding Authority in Australia for many years. With the establishment of the National Reference Centre for Reference Centre for Classification in Health in 1991 and the subsequent call for tenders for the establishment of a Coding Authority the movement to develop much needed standards, improve data and coding quality began to take shape. This paper outlines the lead up to the call for tenders, the terms of reference and objectives of the Coding Centre, the proposed staff, and the work program for the first three years. PMID- 10138777 TI - Financial issues in health care--Part 3. Senator Richardson's reforms. PMID- 10138778 TI - Quality discussed in high places ... at last. PMID- 10138779 TI - Twin Cities hospitals tackle staff tensions head-on with unique turnover survey. PMID- 10138780 TI - Like it or not, the information freeway is driving new hires. PMID- 10138781 TI - 'V-time' (voluntary reduced work time) a practical way for hospitals to pare labor costs. PMID- 10138782 TI - Thorough research and the right expectations are critical in buying an information system. PMID- 10138783 TI - Health planning and resource allocation in a changing Vietnam. AB - Vietnam is rapidly changing from a centrally planned to a market economic system. Explores the existing constraints and the degree of flexibility for management in the Government health system. Analyses the potential influence of the recent changes in health sector resource allocation with budgets becoming less under the direct control of the local authority, and based on population rather than the current number of beds. These changes create new possibilities, and responsibilities, for managers actively to manage health services and preventive programmes. Health managers are ill-prepared for this challenge. PMID- 10138784 TI - Coping with change in public health medicine in the 1990s. AB - Investigates the effect of change, both structural and in process, in the NHS with regard to the capacity of public health doctors and dentists in the South Western Regional Health Authority to cope with the inherent stresses. Sixty-three public health doctors and dentists were asked to fill in a questionnaire. Satisfaction was expressed most with factors intrinsic to the job (41%) followed by the role in the organization (24%), relationships at work (21%), career development (8%), and organizational structure and climate (6%). Dissatisfaction was identified with factors related to organizational structure and climate (32%), factors intrinsic to the job (30%), the role in the organization (18%), career development (14%) and relationships at work (6%). Overall there was much more dissatisfaction than satisfaction with organizational structure and climate and career development than with the other factors. Improvements suggested included more support staff and improved training. Joint problem solving sessions with managers to identify what is required to co-ordinate the work of both, and the use of time management techniques might be helpful. PMID- 10138785 TI - Managing the AIDS crisis in Africa: in support of pluralism. AB - Although substantial evidence is now accumulating that some African peoples readily accept advice and help about health from both modern medical and traditional sources, this has not yet happened with--what is arguably the major health problem in many part of Africa--AIDS. We asked 175 of Malawi's undergraduates what sources they judged to be credible with regard to information on preventing and clinically managing AIDS. While traditional healers were seen on average to be less credible than modern health professionals (doctors and nurses), there was no correspondence between credibility of traditional healers and modern health professionals. Thus a strong belief in the credibility of modern health professionals was not associated with low credibility ratings for traditional healers. Our findings provide further support for "tropical tolerance", especially as regards a pluralistic (modern and traditional together) approach to the prevention of AIDS. Given the over-stretched health services in Malawi and many other African countries, a pluralistic approach to AIDS prevention could be a credible and economic use of indigenous human resources. PMID- 10138786 TI - Innovation in health care: developments in NHS trusts. AB - Essential parts of the R&D in virtually all UK biomedical innovations are executed within teaching hospitals, which are undergoing major organizational changes as part of the ongoing NHS reforms. Examines the impact of the changing structural and regulatory environment on the process of biomedical innovation management of two groups of technologically novel projects with the NHS. Finds that regulatory changes were tending to centralize and formalize innovation management, but that end users were playing an active role in directing the course of new treatment development. Problems of allocation of R&D resources within teaching hospitals were still unresolved, although some evidence from the London teaching hospitals suggested that hospital managers were able to deal with conflicting demands where they perceived that research excellence could be an asset rather than a cost. PMID- 10138787 TI - Who is the NHS for? AB - The immediate, common sense answer to the question, "Who is the NHS for?" would obviously be, "The patients who use it". This may well be the fundamental purpose of the NHS, yet it would appear that differing views of how this is to be achieved contribute to a misreading between stakeholders of each others' remit. The different positions taken by the two most important NHS stakeholders, the professional clinicians and the administrative managers, affect their definitions of, and therefore their attitudes to their own contribution to the purpose of the NHS. Suggests that before priorities in health care can be considered and discussed, let along be set, consensual agreement needs to be reached concerning the views of professional clinicians and managers of ways of achieving their vision of who the NHS is for. PMID- 10138788 TI - The impact of trust status on corporate culture. AB - Outlines the results of a study designed to examine the effects of trust status on perceived organizational culture and over time. Through the adoption of a prospective longitudinal design and incorporating both pre- and post-trust measures it has been possible to ascertain a number of issues including the move from a support-based to a power-based culture with greater autocracy and centralization of power and control. Further research is planned to examine the impact of these changes on the health and performance of individuals moving through the transitional stages of major organizational change. PMID- 10138789 TI - VIP interview: Stephen M. Shortell, Ph.D.. Interview by Maria R. Traska. PMID- 10138790 TI - Transforming a hospital facility company into an integrated medical care organization. AB - This article outlines the steps a major integrated health delivery system in Chicago has undertaken to transition from a primarily hospital-based fee-for service organization to an integrated medical care organization operating under full-risk capitation. The focus is on vision setting, building a foundation for change, structural building blocks, network building steps, and lessons learned to date. PMID- 10138791 TI - Integrated health care in California's managed care capital. AB - Sacramento, California's capital, represents the nation's most competitive managed care marketplace. The Sutter Health organization represents a significant force in this marketplace and surrounding regions of Northern California. Sutter has created an integrated regional health care network capable of delivering a full continuum of care through appropriate community-based facilities, a variety of physician relationships, and both owned and aligned managed care structures. The overall Sutter Health strategy that incorporates facilities, physician partnerships, and patient care financing is described. The article identifies six key lessons learned during this period of growth. PMID- 10138792 TI - Building a legacy for the future: creating an integrated health care system. AB - Local and national market forces of decreasing inpatient utilization and increasing costs paved the way for a major merger involving five hospitals and one home health agency in Portland, Oregon. The result: a health care delivery system that merged corporate cultures, eliminated duplicity, integrated medical and administrative staffs, realized cost containment savings, and effectively responded to market trends toward reform. PMID- 10138793 TI - Using claims data to select primary care physicians for a managed care network. AB - An insurance claims databased profiling system was developed to help select new primary care physicians (PCPs) for a managed care network. PCPs (family practitioners, internists, and pediatricians) were ranked based on how closely their actual use of outpatient services conformed to the predictions of a mathematical model that adjusted for differences in age, sex, and case mix. PMID- 10138794 TI - Case study in physician profiling. AB - In this article sustained and significant patient day reductions were accomplished over a short period of time with low capital investment. Using an education focus and concentrating on attempting to rationalize observed ranges of physician-resource use across peers, the hospital was able to reduce the length of stay by .5 days in a one-year period. This reduction was accomplished over a period where other local hospitals experienced minimal decreases in their lengths of stay. The success of this project suggests how the sharing of credible information with physicians within a constructive context can lead to significant and timely resource use reductions. PMID- 10138795 TI - The role of risk adjustment in the assessment of medical practices in managed care. AB - As reliance on managed care to control the cost of health care in the United States grows, clinicians and managers will come under increasing competitive and regulatory pressure to identify and adopt the strategies and interventions that are not only most economical but that also best improve the health of the populations served. Explicit criteria will be embodied in public performance reports. Clearly, in comparing the performance of firms and of individuals who provide health care, disparities in risk among the patient populations will have to be compensated. PMID- 10138796 TI - A length of stay study of the dually entitled Medicare and Medicaid population: challenges for managed competition. AB - Length of stay (LOS) differences were not observed between the dually entitled and other Medicare stroke patients when complexity of disease was considered. LOS for dually entitled heart failure patients was 33.2 percent longer than other Medicare heart failures and were equally likely to be in the extreme DRG subclass. Patients with extreme heart failure stayed 15.5 days longer than those with mild heart failure. LOS differences (+4.5 days) were observed between the dually entitled and other Medicare heart failures when complexity of disease was considered. Within these two DRGs, incremental health care needs for dually entitled equalled 10 percent of the hospital's total Medicare days associated with stroke and heart failure. PMID- 10138797 TI - Good politics, bad medicine. PMID- 10138798 TI - Let the states do it. PMID- 10138799 TI - Aid to Families with Dependent Children; extension of Medicaid when support collection results in termination of eligibility--HHS. Final rule. AB - These final rules interpret section 20 of the Child Support Enforcement Amendments of 1984, as amended by section 303(e) of the Family Support Act of 1988, and section 8003 of the Omnibus Budget Reconciliation Act of 1989. The 1984 law extended Medicaid coverage for a period of four months to certain dependent children and adult relatives who become ineligible for Aid to Families with Dependent Children (AFDC) as a result, wholly or partly, of the collection or increased collection of child or spousal support under title IV-D of the Social Security Act (the Act). The regulations are applicable to the AFDC and Medicaid programs in all jurisdictions. PMID- 10138800 TI - Health Care Financing Administration. Statement of organization, functions, and delegations of authority; Bureau of Policy Development. PMID- 10138801 TI - Medicare program; appeal rights and procedures for beneficiaries enrolled in prepaid health care plans--HCFA. Final rule. AB - This final rule modifies or establishes administrative review procedures for Medicare beneficiaries enrolled in health maintenance organizations (HMOs), competitive medical plans (CMPs), and health care prepayment plans (HCPPs). Specifically, it requires that an HMO or CMP complete a reconsideration, requested by a Medicare enrollee for denied services or claims, within 60 days from the date of receipt of the reconsideration request; extends to HMO and CMP enrollees the right to request immediate review by a Utilization and Quality Control Peer Review Organization of an HMO's, CMP's, or hospital's determination that an inpatient hospital stay is no longer necessary; and requires an HCPP to establish administrative review procedures for its Medicare enrollees who are dissatisfied with decisions on denied services or claims. PMID- 10138802 TI - National Practitioner Data Bank for Adverse Information on Physicians and Other Health Care Practitioners: amendments to data bank regulations to comply with court order and technical correction--HRSA. Final regulations. AB - This final rule amends the existing regulations governing the National Practitioner Data Bank for Adverse Information on Physicians and Other Health Care Practitioners (the Data Bank), codified at 45 CFR part 60, authorizing the reporting and release of information concerning: Payments made for the benefit of physicians, dentists, and other health care practitioners as a result of medical malpractice actions or claims; and certain adverse actions taken regarding the licenses and clinical privileges of physicians and dentists. This final rule revises sections 60.2 and 60.7 to require reporting only by entities which make medical malpractice payments, deleting the reference to reporting by persons (individuals). It also clarifies the reference to "professional society" in section 60.9. PMID- 10138803 TI - Medicare program; Part A premium for 1995 for the uninsured aged and for certain disabled individuals who have exhausted other entitlement--HCFA. Notice. AB - This notice announces the hospital insurance premium for calendar year 1995 under Medicare's hospital insurance program (Part A) for the uninsured aged and for certain disabled individuals who have exhausted other entitlement. The monthly Medicare Part A premium for the 12 months beginning January 1, 1995 for these individuals is $261. The reduced premium for certain other individuals as described in this notice is $183. Section 1818[d] of the Social Security Act specifies the method to be used to determine these amounts. PMID- 10138804 TI - Medicare program; inpatient hospital deductible and hospital and extended care services coinsurance amounts for 1995--HCFA. Notice. AB - This notice announces the inpatient hospital deductible and the hospital and extended care services coinsurance amounts for services furnished in calendar year 1995 under Medicare's hospital insurance program (Medicare Part A). The Medicare statute specifies the formulae to be used to determine these amounts. The inpatient hospital deductible will be $716. The daily coinsurance amounts will be: (a) $179 for the 61st through 90th days of hospitalization in a benefit period; (b) $358 for lifetime reserve days; and (c) $89.50 for the 21st through 100th days of extended care services in a skilled nursing facility in a benefit period. PMID- 10138805 TI - Where the workers are: a state-by-state guide to occupational employment. PMID- 10138806 TI - Women's earnings compared to men's in 16 occupations, 1991. PMID- 10138807 TI - Minimizing employee benefits litigation through effective claims administration procedures. AB - With the marked increase in employee benefits litigation, employers and benefit plan sponsors are searching for ways to avoid such lawsuits, minimize their exposure in such lawsuits, and maximize their ability of prevailing in such lawsuits. Benefit claim processing and administration have become fertile areas for lawsuits. Consequently, improving benefit claim processing and administration obviously becomes important, and an area where affirmative actions by the employer and plan sponsor will produce many litigation-related benefits. This article will discuss, in a very simple and straightforward manner, various actions an employer or plan sponsor can take which will decrease the number of lawsuits, minimize the potential exposure if a lawsuit is filed, and maximize the ability of prevailing if a lawsuit is filed. PMID- 10138808 TI - Impact of direct mail intervention on knowledge, attitudes, and behavioral intentions regarding use of emergency medical services for symptoms of acute myocardial infarction. AB - This study evaluated a direct mail intervention called the "Call Fast, Call 911" campaign designed to increase use of emergency medical services for symptoms of acute myocardial infarction. The campaign was targeted at individuals over the age of 50. Persons over 50 years of age (N = 130,000) in King County, Washington, were randomly assigned to intervention or control groups. Individuals in the intervention groups received six direct mail pieces over a 1-year period encouraging them to call 911 quickly in response to chest pain. A postintervention telephone survey of a random sample of households (N = 434) assessed the impact of the campaign on knowledge, attitudes, and behavioral intentions regarding use of emergency medical services for symptoms of acute myocardial infarction. The results showed no significant differences between intervention and control groups in terms of knowledge of AMI. However, there were significant differences in beliefs and behavioral intentions to call 911 in a cardiac emergency. PMID- 10138809 TI - Primary care and nonprimary care physicians' concerns in practice and perceptions of medical school curriculum. AB - The purpose of the present study is to address the issue of physicians' concerns in practice and their perception of a medical school's curriculum with an emphasis on comparisons between primary and nonprimary care physicians. The sample consisted of 663 physicians who graduated from Jefferson Medical College (JMC) between 1982 and 1986, and also responded to a mailed questionnaire. Comparisons were made between physicians in primary care (n=234) and in nonprimary care (n=429) specialties on their responses regarding concerns in medical practice and evaluation of the medical school curriculum. Primary care physicians were more concerned about the time for their professional development whereas nonprimary care physicians were more concerned about an oversupply of physicians in their specialties, prospective hospital payment, and malpractice litigation. Regardless of the specialties, the physicians overall seemed very concerned about their personal time. Interpersonal skills were regarded by all respondents as an important aspect of the medical school's curriculum. The importance of psychological, social, and cultural factors in the curriculum was strongly supported by these physicians' responses, particularly among primary care and women physicians. PMID- 10138810 TI - Methodological issues for health-related surveys of multicultural older women. AB - Given concerns about survey nonresponse bias as well as the need to plan resources for participant recruitment, this study tracked each step of the recruitment process (location, response, consent, and completion) of sociodemographically diverse older women for a survey concerning mammography experience. Younger, less educated poor women were likely to be lost due to inability to locate them, while older middle- and upper-economic-group women were more likely to be lost due to refusal to participate. Hispanic and Black women were significantly more likely to respond on successive attempts to recruit them than were White, non-Hispanic women. There was no significant difference in refusal rates by minority women over the successive contacts, as contrasted with White women, who refused at significantly higher rates with each attempt. PMID- 10138811 TI - Joint ventures offer benefits but don't replace mergers. PMID- 10138812 TI - Rural hospital develops integrated system. PMID- 10138813 TI - Hospitals select appropriate report cards. PMID- 10138814 TI - Planning process determines results. PMID- 10138815 TI - GOP Congress favors integrated health care. PMID- 10138816 TI - Improving community health depends on widespread involvement. PMID- 10138817 TI - University health plan reduces overall costs. PMID- 10138818 TI - Merger mania. PMID- 10138819 TI - Skill-mix. Pick'n' mix. PMID- 10138820 TI - Commissioning. Better by design. PMID- 10138821 TI - Community care. Safety networks. PMID- 10138822 TI - Risk management/law. Danger zones. PMID- 10138823 TI - Risk management/law. Poised for success. PMID- 10138824 TI - Risk management/law. Forms of consent. PMID- 10138825 TI - Risk management/law. Central concerns. PMID- 10138826 TI - Performance-related pay. The poverty of PRP. PMID- 10138827 TI - Service uptake. Clock wise. AB - The costs to certain social groups of time spent using healthcare services need to be addressed if true equity of access is to be achieved, argue David Torgerson and Cam Donaldson. PMID- 10138828 TI - Management teams. Measures of invention. PMID- 10138829 TI - Listening to patients. Homeward bound. PMID- 10138830 TI - Internal communications. Did you hear it on the grapevine? PMID- 10138831 TI - Is stress your occupation? PMID- 10138832 TI - ECRs (extra-contractual referrals). Heavy weight. PMID- 10138833 TI - Ethnic health. Breaking barriers. PMID- 10138834 TI - Educational strategies: Kaiser Permanente of Ohio shares its successful techniques. AB - What strategies are effective for educating your medical staff about medications and medication-related issues? Kaiser Permanente of Ohio has developed an educational program for its medical staff that involves four key components: a custom-designed formulary handbook, drug fairs, traditional letter/newsletter communication pieces and educational meetings, and collaborative projects between its pharmacy and medical staffs. These educational techniques--many of which have been successfully adapted from the pharmaceutical industry--can be adopted for use at your institution. PMID- 10138835 TI - Formalizing written communication by decentralized pharmacists with prescribers. AB - The development of a standardized drug information system is explained. The development of such a system provides increased communication, documentation, and quality assurance information. The pharmacist is now able to effectively and consistently communicate with the medical staff regarding pertinent patient information. This formalized drug information system also proves beneficial in containing drug costs for the patients and the hospital. PMID- 10138837 TI - Law and policy barriers hamper growth of telemedicine. PMID- 10138836 TI - Legend drugs for nurse's stock; accuracy checks on infusion pumps; number of patients required for accreditation. PMID- 10138838 TI - The corporate practice of medicine doctrine must go. PMID- 10138839 TI - Key factors in improving surgical resources. AB - The health care environment across the country is undergoing unprecedented uncertainty and change, so it is imperative that hospital leaders develop processes that enhance their organization's ability to adapt to new realities and directions. The key factors in maximizing the utilization of resources to meet community demand involve corporate changes and active support from medical, nursing, professional and support staff. This article describes the methods adopted by one community hospital to improve the utilization of surgical resources, with particular emphasis on the process developed for allocating Operating Room time to support corporate priorities. PMID- 10138840 TI - CONTINUUM: measuring and managing the patient care process. AB - The authors describe the CONTINUUM project which was initiated in a community hospital to manage the appropriateness, timeliness and acceptability of the patient care process on a concurrent or day-to-day basis. CONTINUUM is a quality and data-driven approach to continuous improvement of the patient care process. The St. Thomas-Elgin General Hospital researched "appropriateness of care" measurements and adapted their use for the CONTINUUM project. A concurrent care plan evaluation tool is applied to every care every day. This intensity of service (needs-based) strategy is called the ACTIVITY index. Patients are categorized ACTIV (appropriate) or non-ACTIV (perhaps inappropriate). Non-ACTIV patients are further subdivided into various "barriers to care," from which service, hospital or physician-related factors can be stratified. Practice patterns and hospital resource use are then rapidly identified. The operational dimensions of the project (bedside, organization and community) are described as well as the inhibitors and enablers of this change process. PMID- 10138841 TI - The changing status and environment for physicians. PMID- 10138842 TI - The change experience of a long-term care centre. AB - This article highlights the methodology and approaches chosen in preparing for a major change in orientation at La Pieta in Hull, Quebec, devising the content for change and facilitating the implementation of new directions. It is based on the observations of the change seen within the organization, research and interviews with management and the hired consultant involved in the change process. The first part of the article establishes the situation confronting the organization. It then describes the frame of reference that was to guide the centre through the change process. The conclusion sums up the La Pieta experience in the light of the guiding principles and elements that together formed the frame of reference for the change. PMID- 10138843 TI - Statute prohibiting physician-assisted suicide ruled unconstitutional. PMID- 10138844 TI - Reimbursement cuts keep IOL (intraocular lenses) prices low. PMID- 10138845 TI - IMS updates HMM med-surg price indexes. PMID- 10138846 TI - Statewide networks: providers organize megasystems to dominate state markets. PMID- 10138847 TI - Starting a statewide network: communication is more important than capital. PMID- 10138848 TI - Gearing up for state-level contracting: five models for statewide networks. PMID- 10138849 TI - The networking game: criteria for IDS partners. PMID- 10138850 TI - Unlocking the future. EMS must choose a path. PMID- 10138851 TI - Caring and curing. PMID- 10138852 TI - 1994 EMS salary survey. PMID- 10138853 TI - Woodstock '94. Peace, music and EMS. PMID- 10138854 TI - Measuring hospital efficiency with frontier cost functions. AB - This paper uses a stochastic frontier multiproduct cost function to derive hospital-specific measures of inefficiency. The cost function includes direct measures of illness severity, output quality, and patient outcomes to reduce the likelihood that the inefficiency estimates are capturing unmeasured differences in hospital outputs. Models are estimated using data from the AHA Annual Survey, Medicare Hospital Cost Reports, and MEDPAR. We explicitly test the assumption of output endogeneity and reject it in this application. We conclude that inefficiency accounts for 13.6 percent of total hospital costs. This estimate is robust with respect to model specification and approaches to pooling data across distinct groups of hospitals. PMID- 10138855 TI - Cost and efficiency in nursing homes: a stochastic frontier approach. AB - The average level of cost inefficiency in New York nursing homes is estimated at 29%, based on a two-year panel of 164 Skilled Nursing Facilities and 443 combination Skilled and Health Related Facilities. The stochastic frontier cost function is fit to the data utilizing the composed error model, wherein statistical noise and allocative and technical inefficiency are jointly estimated. There is no change in efficiency between 1987 and 1990, and it does not vary between for-profit and not-for-profit homes. Excessive managerial and supervisory personnel and diseconomies of size are linked to inefficient operation. Chronic excess demand is suggested as a cause of the high level of inefficiency. PMID- 10138856 TI - Nursing home care in The Netherlands: a nonparametric efficiency analysis. AB - This paper analyzes the technical efficiency of Dutch nursing homes with respect to the use of labor inputs by means of Data Envelopment Analysis (DEA). In addition, the determinants of the efficiency scores are investigated using censored regression analysis. Special attention is paid to checking the robustness of the results to using different versions of DEA and to the econometric specification of the censored regression models. Fifty percent of the nursing homes are fully efficient, according to the theoretically preferred frontier with constant or decreasing returns to scale. There is some evidence of a trade-off between labor input efficiency and the quality of care. PMID- 10138857 TI - Frontier estimation: how useful a tool for health economics? PMID- 10138858 TI - What do stochastic frontier cost functions tell us about inefficiency? AB - Recent studies using the stochastic frontier approach have suggested high levels of inefficiency in nursing home and hospital facilities. This paper makes two observations. First, one could falsely estimate high levels of inefficiency if a statistical assumption--zero skewness of the random component of the cost residual--is violated. Second, an inefficient industry may be difficult to distinguish either statistically or visually from an industry free of inefficiency. If available, panel data yields more robust estimates of cost differences among nursing homes or hospitals. PMID- 10138859 TI - Non-minimum cost functions and the stochastic frontier: on applications to health care providers. PMID- 10138860 TI - A re-examination of the meaning and importance of supplier-induced demand. AB - Despite twenty years of work on supplier-induced demand (SID) there has been little discussion or investigation of how inducement affects the health of patients. We develop a conceptual framework for SID which includes the clinical effectiveness of the health services utilized as well as the effectiveness of the agency relationship between the physician and the patient. The framework is used to identify several conceptually distinct types of utilization--each with its own policy implications--which have been intermingled in the SID literature. After examining each type of utilization, we conclude that a continued focus by health economists on the phenomenon of inducement (even within an extended conceptual framework) may be too limited for the development of policies regarding health service utilization. PMID- 10138861 TI - A re-examination of the meaning and importance of supplier-induced demand. PMID- 10138862 TI - Should your practice be a limited liability company? PMID- 10138863 TI - When patients steal, you could be sued. PMID- 10138864 TI - Managed care. Can doctor plans compete with the big boys? PMID- 10138865 TI - Is health care more of a cost burden for women? PMID- 10138866 TI - How high are new doctors setting their income sights? PMID- 10138867 TI - The only thing missing in American medicine. PMID- 10138868 TI - When it comes to malpractice, is there safety in numbers? PMID- 10138870 TI - How IPAs fail. PMID- 10138869 TI - Women in groups. Barriers keep falling, but frustrations persist. PMID- 10138871 TI - Why do patients think we're magicians? PMID- 10138872 TI - How your charts could jeopardize your license. PMID- 10138873 TI - Cape Coral cuts more staff to stem losses before sale. PMID- 10138874 TI - Court ruling underlines antitrust discrepancies. PMID- 10138875 TI - Conn. seeks nod for managed care. PMID- 10138876 TI - N.C. hospitals describe terms of proposed deal. PMID- 10138877 TI - JCAHO hit with reform edicts. PMID- 10138878 TI - Ariz. providers form statewide system. PMID- 10138879 TI - Philly hospitals save face, pay up. PMID- 10138880 TI - Mass. may stall employer mandate. PMID- 10138881 TI - '95 Medical physician fee update could be tempting for budget-cutters. PMID- 10138882 TI - Panel considers Medicare cuts to reduce entitlement spending. PMID- 10138883 TI - Proposal could aid long-term care. PMID- 10138884 TI - Layoffs rise as pace of cost-cutting accelerates. AB - According to the eighth annual hospital human resources survey, layoffs are on the rise. Results show nearly four out of every 10 hospitals are trimming their work forces to reduce operating costs and restructure themselves to better cope with competition and managed care. PMID- 10138885 TI - Study: most hospitals will try integration despite obstacles. PMID- 10138886 TI - Key strategies help providers hold winning hand in capitation game. PMID- 10138887 TI - Customer service. Award winners have same goal. PMID- 10138888 TI - Hospitals strengthen networks through new fitness facilities. PMID- 10138889 TI - Four Chicago Catholic hospitals to merge. PMID- 10138890 TI - HMO premiums to drop 1.2%. PMID- 10138891 TI - Hospitals clear one merger hurdle. PMID- 10138892 TI - Orange County debacle could hit hospitals. PMID- 10138893 TI - Columbia/HCA inks deal with Florida not-for-profit. PMID- 10138894 TI - Calif. Blue Cross' foundation draws support, opposition. PMID- 10138895 TI - HHS probes why spending on incontinence supplies rose as demand was falling. PMID- 10138896 TI - Health Images buys share in rival firm. PMID- 10138898 TI - Clinton against Medicare cuts. PMID- 10138897 TI - Pa. hospitals dispute bypass data. PMID- 10138899 TI - Federal takeover fears sparked attack on JCAHO. PMID- 10138900 TI - A jump in Medicaid managed care. PMID- 10138901 TI - PPRC debates differing changes in growing state waiver program. PMID- 10138902 TI - Federal agency examines guideline program. PMID- 10138903 TI - Largest Ind. system continues expansion. PMID- 10138904 TI - After hesitating, AMA releases data showing 7% rise in docs' pay. PMID- 10138905 TI - Hospitals' 1993 Medicare margins increase to -1.3%. PMID- 10138906 TI - 3rd-qtr. merger activity booms. PMID- 10138907 TI - Court invalidates VA benefit policy. PMID- 10138908 TI - AHA, AMA alter reform goals. PMID- 10138909 TI - Commission fails to agree on targets for entitlement cuts. PMID- 10138910 TI - Hospitals serve as pioneers in family-friendly programs. PMID- 10138911 TI - Last year's legacy for healthcare reform. PMID- 10138913 TI - Washington market sees rapid change. PMID- 10138912 TI - Let's make a deal. Healthcare mergers, acquisitions take place at dizzying pace. AB - More than 650 of the nation's hospitals were involved in mergers or acquisitions in 1994, eclipsing the numbers of hospital deals in recent years. The merger frenzy that enveloped the industry this year touched more than 10% of the nation's hospitals. PMID- 10138915 TI - Dubuque, Iowa, merger case draws attention of top guns from Justice Department. PMID- 10138914 TI - Center is key to administering anticoagulent safely and easily. PMID- 10138916 TI - New hospital chain ready to open for business south of the border. PMID- 10138917 TI - Take this test to see how much you missed in a year of change. PMID- 10138918 TI - Link to form largest lab operator. PMID- 10138919 TI - Management firm faces cash crunch. PMID- 10138920 TI - The case confessions of a pastoral visitor. AB - When a bungled catheterization following surgery causes a life-threatening hemorrhage, this Lutheran minister and hospital chaplain finds himself on the receiving end of professional pastoral care. Regretting the times in offered "Gospel platitudes and sugar-coated Bible verses" to suffering patients, the author finds that his experience has brought him closer to God's presence and made him a better minister. PMID- 10138921 TI - Commentary. The pastor as patient. AB - During his hospitalization for treatment of prostate cancer, this pastor-author found that the ill are often not put off by the shortcomings of those who would provide spiritual care. They are able to see beyond any shortcomings of their minister to the life and power of the liturgy itself and the pastor's "loving intentions." PMID- 10138922 TI - Commentary. Mid-life confessions. AB - Although he recalls times in his work as a hospital chaplain when he cared for people superficially, the author notes that patients themselves ministered to him, teaching him more compassionate ways to serve. PMID- 10138923 TI - Influencing prescribing practices and associated outcomes utilizing the drug use evaluation process. AB - Influencing prescribing practices and the implementation of pharmaceutical care utilizing the drug use evaluation (DUE) process at a 891-bed teaching hospital are described. The DUE program has been structured to provide for significant pharmacy involvement while maintaining medical staff responsibility as outlined by the Joint Commission on Accreditation of Healthcare Organizations. A multidisciplinary approach is used to identify problems and develop prescribing criteria and educational initiatives. Pharmacists provide drug therapy monitoring and engage in clinical interventions and documentation of outcomes on a daily basis. DUE program pharmacists help target possible interventions, assure monitoring and outcome documentation, and compile results of all initiatives for reporting purposes to the medical staff and quality assessment program. Specific performance compliance and problems are identified and incorporated into the credentialing process. Corrective measures are determined by the Pharmacy and Therapeutics (P&T) Subcommittee with subsequent actions carried out by peer physicians. The net result is a positive influence on prescribing practices that improves the appropriate and effective use of drugs and improves patient outcomes. PMID- 10138924 TI - Physician perceptions of clinical pharmacy encounters in a family practice clinic. AB - The purpose of this study was to classify pharmacist-physician encounters in a family medicine center into three progressive levels of service in order to determine the physician's perception of the relative value of each level. The three levels of service were drug information, pharmacy consultation individualized to the patient, and pharmaceutical care-consultation with follow up to monitor patient outcome. Physicians received a questionnaire with each encounter and were asked to rank questions regarding the quality of the information provided, the impact they perceived that the information had on patient care, and to assign a monetary value for each encounter. A total of 106 of 141 (75 percent) questionnaires suitable for analysis were stratified into drug information (25.5 percent), pharmacy consultation (49 percent), and pharmaceutical care (25.5 percent). Physicians' perceptions toward the quality, impact, and value of pharmacy services were favorable overall, but they perceived a significantly higher quality, impact, and value to pharmaceutical care encounters than for drug information and pharmacy consultation (p < 0.05). PMID- 10138925 TI - Automated order-entry mechanisms to influence prescribing. AB - On-line prescribing is available in many hospitals in the United States and has distinct advantages. On-line drug prescribing can be influenced by the use of automated prompts that guide and direct the prescriber to the preferred agent, dosage, or regimen. The authors have adapted screen prompts to facilitate appropriate prescribing as defined by pharmacy and therapeutic (P&T) committee decisions, restricted drug or target drug initiatives, drug-usage evaluation (DUE) actions, departmental guidelines and order-sets, and other institutional directives. Objective evidence for the effectiveness of on-line prompts is provided for H2-antagonists and antibiotics. As computer technology advances even further and is increasingly utilized in the health care setting, on-line interventions to facilitate appropriate prescribing may become increasingly useful. PMID- 10138926 TI - Nutritional support: pharmacists' influence on the prescribing process. AB - A commitment was made at a 1,025-bed county teaching facility to increase staff pharmacists' involvement in nutritional support and physician prescribing. The plan was to utilize the Nutritional Support Clinical Pharmacy Specialist (NSCPS) to train the staff pharmacists to provide direct patient care for patients receiving parenteral nutrition. The implementation included specialized training for staff pharmacists, staff pharmacists monitoring all parenteral nutrition patients, pharmacists' attendance at nutritional support rounds, documentation of all pharmacist interventions, and pharmacists' involvement in the drug-usage evaluation (DUE) process. The results of the increased influence of pharmacists on the prescribing process included more appropriate parenteral nutrition therapy, earlier transitioning from parenteral to enteral nutrition, recognition of staff pharmacists as resources by the physicians, and increased job satisfaction for pharmacists. PMID- 10138927 TI - Influencing prescribers. AB - Appropriate drug therapy is centered on the acts of selection and dosing of pharmaceuticals. Prescribing drugs has been the exclusive province of physicians until recently. Pharmacists and others who seek to encourage physicians to prescribe specific drugs or therapies or to use pharmaceuticals in a particular manner have addressed their concerns through influence. The article examines direct and indirect methods of influencing prescribers. The changing goals of providers, payers, pharmacists, and patients are discussed, and the effectiveness of various methods of influencing prescribers are reviewed, including financial incentives, drug use evaluation, persuasion, collaboration, and computer-aided information delivery. PMID- 10138928 TI - Patient information: community pharmacy needs and perspectives. AB - Providing complete and understandable information to patients about medicines is considered an integral component of high-quality medical and pharmaceutical care. With such information, not only can the level of general health increase, but costs associated with noncompliance, including polypharmacy and hospitalization, can decrease. Although patient information leaflets (PILs) have been available since the 1970s, their use is more relevant today because of the counseling requirements of the Omnibus Budget Reconciliation Act of 1990. A national survey of community pharmacists was conducted to determine their attitudes toward this patient education strategy. Results demonstrate that pharmacists believe PILs benefit patients, but that PILs need revision in terms of readability, understandability, and standardization. PMID- 10138929 TI - Pharmacy-based automated medication records: methods, application, and a survey of use. AB - A literature review of articles describing the development and implementation of automated medication administration records is summarized, and the results of a survey undertaken of all hospitals in Missouri to determine the extent of an automated medication administration record (MAR) are reported. For hospitals with an automated MAR, the survey compiled information about the demographics of responding facilities and production and distribution, design, implementation, and procedures for use of automated MARs. The most frequently reported advantages of an automated MAR were a more legible document, increased accuracy, savings in nursing personnel time, and fewer medication errors. The most frequently reported disadvantages were increases in pharmacy personnel time, different interpretation of orders by pharmacy and nursing, and multiple entries required for a medication order to appear correctly on the MAR. PMID- 10138930 TI - Right from the start. A strong orientation and continuous training for new board members can save them years of frustration and floundering. PMID- 10138931 TI - Slow but steady progress. New antitrust guidelines go further to aid integration efforts. PMID- 10138932 TI - Assessing community health. PMID- 10138933 TI - A pat on the back or stony silence? CEO performance evaluations can go either way. PMID- 10138934 TI - Saying goodbye to old friends. Are you prepared to sacrifice your board membership for the community's best interests? PMID- 10138935 TI - Burning out: handling stress crucial to health of caregiver and hospital. PMID- 10138936 TI - Reflections and predictions. PMID- 10138937 TI - Good neighbors make for good health. Community health workers educate their own. PMID- 10138938 TI - Dietary intake of vitamins, minerals, and fiber of persons ages 2 months and over in the United States: Third National Health and Nutrition Examination Survey, Phase 1, 1988-91. AB - Intervention strategies aimed at reducing the prevalence of nutrition-related diseases, including designing nutrition policies and nutrition education and assistance programs, require effective monitoring of what Americans are eating. Nutrient reference data from the third National Health and Nutrition Examination Survey provide essential information to achieve these goals. Mean and median iron intakes were adequate in males of all race-ethnic groups but were generally low in females and young children. Mean and median calcium intakes were also higher in males than in females and were lower than recommendations in adolescents and in women of all ages. Mean sodium intakes for all age, sex, and race-ethnic groups exceeded the minimum requirements of healthy persons and were higher in non-Hispanic black children and adolescents than in non-Hispanic white and Mexican American children and adolescents. Mean fiber intakes also did not meet recommendations in most subgroups and were higher in Mexican American adults followed by non-Hispanic white adults and non-Hispanic black adults. Further research is planned to compare the food sources of energy and nutrients consumed by different population groups in NHANES III to similar results from earlier nation surveys. NHANES III, Phase 2 (1991-94) recalls were collected using the same dietary method as those collected in Phase 1 (1988-91), and other analyses will compare findings from both phases of NHANES III. PMID- 10138939 TI - Identifying and comparing competencies for social work management: a practice driven approach. AB - The study explicates a competency-based model of contemporary social work management practice and compares this model with frameworks derived from earlier studies. Using a purposive sample of 184 social work managers throughout the country, an exploratory factor analysis yielded twelve sets of competencies required of today's social work manager. A comparison of the present model to earlier management frameworks reveals that substantive changes in the nature, scope, complexity, and priorities assigned to management competencies and skills have transformed the role of the social work manager over the last decade. Implications for social work manager education are reviewed and future research directions are proposed. PMID- 10138940 TI - Ownership differences in the provision of outpatient substance abuse services. AB - The authors examine the assumption of the 1980s that the provision and costs of substance abuse services, among others, could best be met by expanding programs in the private sector. The study presents a comparison of public and private substance abuse services, based on data drawn from a national sample of outpatient units, and develops a profile of treatment and financing within three auspice (ownership) categories--private nonprofit, private for-profit, and public. An input-throughput-output framework was used to assess the public private differences within a wide range of organizational characteristics. PMID- 10138942 TI - A painless switch to post sorting. PMID- 10138941 TI - Job satisfaction and retention of social workers in public agencies, non-profit agencies, and private practice: the impact of workplace conditions and motivators. AB - The authors examine a selected array of agency-influenced work and employment conditions and assess their impact upon social workers' job satisfaction, motivation, and intention to seek new employment. The study makes correlations with past empirical studies on job satisfaction and retention, with staff development concerns as stated in social work administration textbooks, and with conditions subject to administrators' influence. Some specified motivational issues included are salary, fringe benefits, job security, physical surroundings, and safety. The analysis demonstrates the contribution of certain contextual and motivational factors to a prediction of job satisfaction or of intent to leave the organization. PMID- 10138944 TI - Vendor relationships changing. PMID- 10138943 TI - Color Doppler energy imaging. PMID- 10138945 TI - Contract managers building networks to find new growth. PMID- 10138946 TI - Antibiotic therapy: strategies for the '90s. PMID- 10138948 TI - Paramedic educational programs. PMID- 10138947 TI - Wanted: slightly used hospitals. PMID- 10138949 TI - Strategic planning revisited. AB - The purpose of strategic planning is to create a favorable match between the organization's characteristics and its environment. Managers often focus exclusively on adapting the organization to circumstances in its environment. This approach overlooks opportunities for fostering environmental changes that will be favorable for the organization. Such changes often can be achieved through political action. Political action is an extension of the process of maximizing opportunities and averting threats. It requires the additional work of policy analysis and stakeholder assessment followed by developing and implementing a political strategy. The strategy must consider the possibilities for effective intervention at one or more of the five stages of the policy process. The choices also must take into account the positions of other stakeholders and the costs and benefits that the organization anticipates from each of the four strategic approaches: indirect action, collaboration, negotiation, and contest. PMID- 10138950 TI - Pathology and laboratory medicine as a service. AB - Quality is multidimensional. The relative importance of these dimensions to those using the service of the laboratory and a pathologist has not been previously defined as a conceptual model for measuring and investigating service quality. Ten major determinants of service quality are described: access, communication, competence, courtesy, credibility, reliability, responsiveness, security, technology, and understanding. These components must be integrated into any formula for a successful health-care outcome. PMID- 10138951 TI - Initiating a regional laboratory network. AB - Wherever we look--on television, in national and local newspapers, or within our own institutions and communities--the biggest issue facing health-care providers is integration. The Clinton plan virtually mandates integrated services, and many individual states are moving ahead rapidly with their own programs. Mandated purchasing alliances will require network services that are focused on cost savings and broad access to the medical system. The incentive to form collaborative medical networks defies our tradition of actively competing for patients and reimbursement dollars. Hospital and physician office laboratories, along with small independent laboratories, face both their greatest challenge and their best opportunity in the changing health-care environment. Those choosing to take up the gauntlet thrown down in the Clinton Administration's commitment to reform will be uniquely positioned to survive and thrive; those who dig their heels firmly into past paradigms will be swept away by the tide of economic change. Whether mandated by law or forged into being by the heat of economic pressure, the formation of integrated care networks positioned to vie for health care dollars seems inevitable. Some states, including Florida, Washington, and Minnesota, have already passed legislation that anticipates national reform by virtually mandating integrated health-care services. Others are contemplating similar action, and the economic impact is already apparent in a lower-than projected increase in health-care costs. How can community laboratories position themselves to participate in this rapidly changing environment? Most experts agree that laboratory services must roll themselves into total health-care programs and operate regionally to compete with the national, for-profit conglomerates.(ABSTRACT TRUNCATED AT 250 WORDS) PMID- 10138952 TI - Quality improvement in the cutaneous micrographic surgery laboratory. AB - A nationwide advocacy for improving health-care quality--including the dimensions of efficiency, productivity, and customer satisfaction--is rapidly growing. This initiative is evolving in an environment of total quality management (TQM) and continuous quality improvement (CQI). Quality assessment and improvement (QI) is a quality management program through which laboratories ensure the quality of their health-care services by continually monitoring, evaluating, and resolving opportunities for improvement. Using a systematic, FOCUS-PDCA approach, the Mohs histology laboratory implemented improvement of the quality management of frozen section slide production and turnaround time (TAT). The Mohs laboratory achieved improved technical process performance, faster TAT time, more efficacious patient care support, and increased customer satisfaction. Using a comprehensive quality assessment and improvement process can overwhelm quality management assets if it is not approached in a systematic, prioritized manner. However, when judiciously used, the process can become a key instrument for ensuring and improving high quality laboratory services in an efficient manner. PMID- 10138953 TI - Case studies in ethics. A case of overutilization. PMID- 10138954 TI - Together we are successful: a model affiliation. AB - This article describes a cooperative venture among several hospitals to create an educational consortium for training and preparing nonregistered histotechnicians to challenge the examination of the American Society of Clinical Pathologists (ASCP). This venture has resulted in increasing the available pool of employees for vacancies in the geographical area. PMID- 10138955 TI - Difco ESP Blood Culture System. PMID- 10138956 TI - Developing an educational program for perioperative nurses. PMID- 10138957 TI - Implementing TQM in the pharmacy. PMID- 10138958 TI - Managing the cost of care in the managed care market. PMID- 10138959 TI - Perspectives. 1994: a year of dashed hopes. PMID- 10138960 TI - CDC's long-awaited final TB guidelines are here. PMID- 10138961 TI - Worker safety problems spotlighted in health care industries. PMID- 10138962 TI - Stress management--holistic approach. AB - Trying to survive in the changing times of competition, productivity and quality issues, economic constraints, increasing healthcare costs and consumer satisfaction hospital administrator requires intellectual skills blended with emotional maturity. Challenge successfully dealt with is satisfying. Only when it cannot be met, when pressures become too great, does it become stressful. Coping with stress depends on holistic approach to health. Equally, Managers should ensure that their part of organisation provides an environment in which individuals can flourish to the benefit of the organisation and the individuals involved. The study explores the main causes of stress and various strategies to cope with it. PMID- 10138963 TI - Staffing needs of administrators in hospitals. PMID- 10138964 TI - Professional satisfaction of doctors working in a super speciality hospital in Bangalore. AB - The doctors' assessment of their jobs provides an insight into the facets of the Profession needing attention of the administration. This study assessed professional satisfaction of 80 doctors who responded to the 80--item multifaceted questionnaire. Although the doctors were generally satisfied with various facets of the jobs and career, variation in the level of satisfaction was noted. Personal background, revealed that 80% doctors had good academic and family background. The most satisfied group of doctors were the consultants with performance based pay scale. 30% of these consultants wanted to achieve professional excellence thus self actualizing. Overall satisfaction was moderately correlated to professional time and stress. Quality of life was moderately correlated to respect and income. Improvement of House keeping & Interpersonal relationship among doctors, nursing care and pay scale of junior doctors are areas which the administration should pay special attention to improve professional satisfaction of doctors. PMID- 10138965 TI - Utilisation pattern and managerial issues--a study of emergency medicine department at Nizam's Institute of Medical Sciences, Hyderabad. AB - The emergency medicine department (EMD) is one of the youngest department in the Nizam's Institute of Medical Sciences (NIMS). The study was conducted for a period of six months from it's inception, since November 01st 1992. The physical facilities, staffing, policies and procedures, work load and cost analysis were studied, and conclusions and suggestions were given. Total patients attended at EMD in the six months were 6,884, out of whom 3,484 were admitted into the hospital for further treatment. Cost analysis showed a net gain of Rs. 78.80 per patient. PMID- 10138966 TI - Cost analysis of central sterlisation services at a tertiary care medical institute. PMID- 10138967 TI - A study of four major areas in out patient department of NIMS with special reference to patient satisfaction. AB - A study of patient satisfaction was undertaken in four major Out-patient Departments of General Medicine, Cardiology, Orthopaedics and Neurology which accounts for nearly 70-80% of the Out-patient visits. The study was conducted through distribution of structured questionnaire for a period of six months with a total sample of 300 questions. Keeping in view the working hours, registration pattern, waiting time of various services, the work load and the patient's satisfaction for various services were studied. Some bottlenecks such as lack of flow concept and lack of adequate floor space were identified. Appropriate statistical tests (Chrisquare) were applied in assessing the patient's satisfaction and appropriate recommendations were made accordingly. PMID- 10138968 TI - Psychiatric knowledge & orientation of non-psychiatrist doctors. AB - 52 Non-psychiatrist doctors were evaluated in order to know their psychiatric orientation with the help of clinical case history along with questionnaire. Only one doctor subject could give all the diagnosis correctly on the basis of clinical stories; on the other hand all the doctors gave the diagnosis of epilepsy correctly. This reflects basic lack of understanding of psychiatry resulting from poor theoretical teaching and exposure at undergraduate level. Other characteristics of the sample and finding are discussed here. PMID- 10138969 TI - Hospital inventory management. PMID- 10138970 TI - Collaboration gets results in the Carolinas Best Practices Network. Case study. PMID- 10138971 TI - Rightsizing healthcare: what works, what doesn't, and why. AB - Recently a nationwide study of the methods and consequences of restructuring in healthcare was completed by E.C. Murphy, Ltd., in cooperation with the American Society for Work Redesign. The results have important implications for hospitals and systems involved in or considering restructuring. The following are excerpts of an interview with Emmett C. Murphy, PhD, president of the firm. PMID- 10138972 TI - Informal caregiving as state Medicaid expenditure: an only slightly immodest proposal. AB - States and Medicaid recipients would be better off if the federal Medicaid program allowed states to assign a dollar value to some unpaid care friends and family give to Medicaid recipients. The dollar value of this unpaid labor would then be counted as state spending in the calculation of federal match. The proposal, which would ease the pressure on tight state budgets, is entirely compatible with the recent federal-state compromise regarding provider taxes and donations and reinforces an important but overlooked Medicaid policy that cultivates and relies upon households to deliver care. PMID- 10138973 TI - Quality assurance in the voluntary sector. AB - Reports on a small-scale quality assurance analysis of rural mental health drop in centres. Within a cross-sectional research design, measures were taken of the centres' structure, process and outcome. The instruments used to take these measures were structured interviews, questionnaires and direct observation, which were applied to clients, staff and referrers. It was found that the centres achieved their objectives with considerable success, including high levels of client and referrer satisfaction. Concludes that the three centres provided a quality service which complements the formal options (i.e. NHS and Social Services). Draws implications for the extension of NHS staff roles in relation to the voluntary sector. PMID- 10138974 TI - The health care assistant: professional supporter or budget necessity? AB - The budgets of NHS Trust Hospitals are continually under scrutiny in an endeavour to reduce operating costs. Skill mix, the balance of professional staff to non professional staff, is a part of this process and the NHS has introduced a new level of staff called "health care assistants" (HCA). Examines the role and training of the HCA, and the reaction of professional nurses to their introduction into the area of patient care. Highlights areas of concern in relation to HCA training, selection techniques, and the absence of national guidelines which would ensure the quality level of HCAs produced. There is evidence of some managements leaning towards "cheaper:" staffing, i.e. using HCAs to replace professional nurses, and the conclusions give rise to some concern in quality of patient care and in the falling morale of professional nurses. PMID- 10138975 TI - Redefining NHS complaint handling--the real challenge. AB - More and more organizations find that a constructive and open dialogue with their customers can be an effective strategy for building long-term customer relations. In this context, it has been recognized that effective complaint-contact handling can make a significant contribution to organizations' attempts to maximize customer satisfaction and loyalty. Within the NHS, an intellectual awareness exists that effective complaint/contact handling can contribute to making services more efficient and cost-effective by developing customer-oriented improvement initiatives. Recent efforts have focused on redefining NHS complaint handling procedures to make them more user-friendly and effective for both NHS employees and customers. Discusses the challenges associated with opening up the NHS to customer feedback. Highlights potential weaknesses in the current approach and argues that the real challenge is for NHS managers to facilitate a culture change that moves the NHS away from a long-established defensive complaint handling practice. PMID- 10138976 TI - Completing the clinical audit cycle: discharge medication. AB - Describes the process of clinical audit following the introduction of a revised discharge policy. Identifies three key indicators of success regarding hospital supply of discharge medication: the extent to which ward staff and patients have to make personal visits to the pharmacy; the extent to which nursing staff telephone the pharmacy to chase individual prescriptions; and the rate of written complaints from patients. All three measures increased substantially during the four months following the introduction of the policy, compared with the previous four-month period. An action plan focused on changing relevant behaviour of consultants, junior doctors, ward and nursing personnel, patients and pharmacy staff by means of increased awareness of the consequences of their actions. A follow-up study demonstrated substantial reductions in all three measures during a third four-month period. PMID- 10138977 TI - Not just money: quality of working life as employment strategy. AB - Scarcities of qualified personnel are becoming a common phenomenon in The Netherlands. At the same time, increasing wages to secure an adequate workforce is not always possible or sufficiently effective, and other ways of retaining and recruiting personnel have to be found. Investigates the importance of various job characteristics for retaining and recruiting employees and presents the results from a survey among employees of a Dutch hospital experiencing a tight labour market. Job characteristics other than wages, such as labour relations and work content, were found to play a major role in individuals' choices to resign or stay. Discusses consequences for employment strategies in other organizations. PMID- 10138978 TI - Medicare and Medicaid programs; quarterly listing of program issuances and coverage decisions--second quarter 1994--HCFA. Notice. AB - This notice lists HCFA manual instructions, substantive and interpretive regulations and other Federal Register notices, and statements of policy that were published during April, May, and June of 1994 that relate to the Medicare and Medicaid programs. Section 1871(c) of the Social Security Act requires that we publish a list of Medicare issuances in the Federal Register at least every 3 months. Although we are not mandated to do so by statute, for the sake of completeness of the listing, we are including all Medicaid issuances and Medicare and Medicaid substantive and interpretive regulations (proposed and final) published during this timeframe. We are also providing the content of revisions to the Medicare Coverage Issues Manual published between April 1 and June 30, 1994. On August 21, 1989, we published the content of the Manual (54 FR 34555) and indicated that we will publish quarterly any updates. Adding to this listing the complete text of the changes to the Medicare Coverage Issues Manual allows us to fulfill this requirement in a manner that facilitates identification of coverage and other changes in our manuals. PMID- 10138979 TI - Omnibus Budget Reconciliation Act of 1993--VA. Final rule. AB - This document amends the Department of Veterans Affairs (VA) adjudication regulations to extend the date concerning limitation of pension benefits for veterans and surviving spouses receiving Medicaid-covered nursing home care. This amendment is necessary to conform the regulations to statutory provisions. PMID- 10138980 TI - Medicare, Medicaid and CLIA programs; extension of certain effective dates for clinical laboratory requirements and personnel requirements for cytologists- HCFA. Final rule with comment period. AB - This final rule extends certain effective dates for clinical laboratory requirements in regulations published on February 28, 1992, which implemented provisions of the Clinical Laboratory Improvement Amendments of 1988 (CLIA) and announces our approval of a certifying organization for qualifying cytotechnologists. This rule extends the date by which an individual must enroll in an HCFA-approved cytology proficiency testing (PT) program and the date by which an individual with a doctoral degree must possess board certification to qualify as a director of a laboratory that performs high complexity testing. In addition, we are extending the phase-in of the quality control requirements applicable to unmodified, moderate complexity tests cleared for commercial distribution by the Food and Drug Administration (FDA). We are extending the date to meet applicable CLIA QC requirements for laboratories using commercial, nonmodified tests to fulfill certain quality control (QC) requirements. These effective date extensions do not reduce the current requirements for quality test performance. The date extensions are necessary due to the limited number and scope of currently operating cytology PT programs, resource constraints that have prevented commencement of the substantial number of quality control reviews, and inability of many laboratory directors to complete certification requirements within the time period originally specified. PMID- 10138981 TI - Medicare program; changes to the hospital inpatient prospective payment systems and fiscal year 1995 rates; correction--HCFA. Final rule; correction. AB - In the September 1, 1994 issue of the Federal Register (59 FR 45330), we published a final rule with comment period revising the Medicare hospital inpatient prospective payment systems for operating costs and capital-related costs to implement necessary changes arising from our continuing experience with the system. In the addendum to that final rule with comment period, we announced the prospective payment rates for Medicare hospital inpatient services for operating costs and capital-related costs applicable to discharges occurring on or after October 1, 1994, and set forth update factors for the rate-of-increase limits for hospitals and hospital units excluded from the prospective payment systems. This notice corrects errors made in that document. PMID- 10138982 TI - Medical care reimbursement rates for FY 95--VA. Notice. AB - In accordance with provisions of OMB Circular A-11 section 12.5(a), revised reimbursement rates have been established by the Department of Veterans Affairs for inpatient and outpatient medical care furnished to beneficiaries of other Federal agencies during FY 1995. These rates will be charged for such medical care provided at health care facilities under the direct jurisdiction of the Secretary on and after December 1, 1994. PMID- 10138984 TI - Accessing Internet--tips for hospital librarians. PMID- 10138983 TI - Unmanaged care? AB - Changes in the health care marketplace have outpaced many of the laws and regulations that were intended to protect patients. Consumer advocates want new safeguards, but employers and the managed care industry warn that could raise the cost of coverage. PMID- 10138985 TI - JCAHO's IM chapter: their standards, our compliance. PMID- 10138986 TI - Hospital library customer survey: a needs assessment tool. PMID- 10138987 TI - Coping with electronic mail. PMID- 10138988 TI - 1994 Muriel Driver Memorial Lecture. Back to the future. AB - The profession is heading through some treacherous waters and to navigate them the author suggests a return to the sources of occupational therapy practice, and in particular, a shift in attitude towards greater simplicity; listening to clients more sensitively; encouraging their self discovery, values and direction; and a raised consciousness that the subjects of our discipline are human beings who must be considered individually. Dealing with the issue of professional ethics is another suggested shift in attitude as more occupational therapists are confronted with choices. The balance between what is do-able and what is desirable is not always clear, and it is suggested that by fully embracing the two fundamental values of competence and ethics, the profession will ensure that the public confidence necessary to do its work is deserved. The author debates the tension between the particular needs of the client, and the limited technological, financial and human resources that are available, and concludes by challenging us to change some attitudes and to become more open to creative and diverse opinions and experiences. PMID- 10138989 TI - Theory and practice in the occupational therapy guidelines for client-centred practice. AB - A model for occupational therapy has evolved and has come to be referred to as the "Guidelines" model or the Canadian Occupational Performance model. This paper attempts to reformulate information relating to the Guidelines model, to support its use as a conceptual model and a model of practice. Both the conceptual model and model of practice are described in terms of their domain of concern, underlying values and assumptions, concepts and principles. The conceptual model provides a means of understanding occupational performance, while the model of practice offers a way of understanding the relationship between occupational therapy interventions and occupational performance. Both models are evaluated relative to nine criteria derived from the literature. The conceptual model is found to be largely consistent, supportable, comprehensive and useful. The model of practice, however, proves more problematic, with technical, structural and conceptual variances. The paper is intended as a stimulus for discussion and study of this central model of Canadian occupational therapy. PMID- 10138990 TI - Male occupational therapists in Ontario: a survey of work-related issues. AB - Job satisfaction greatly influences an individual's decision to remain in his or her work situation. In many studies, one of the primary reasons for men leaving the profession of occupational therapy was due to job dissatisfaction. The purpose of this study was to further investigate the issue of job satisfaction in male occupational therapists. In March 1992, a survey was mailed to all (n = 82) male occupational therapists practicing in Ontario. A 67% (n = 55) response rate was obtained. This study addressed several factors pertaining to job satisfaction and other work-related issues. When using the median years of OT work experience (ie. seven) to divide the sample, two items were found to be significantly different when using one-way analyses of variance (ANOVA's): "satisfaction with the standing of the profession" and cumulative "satisfaction variable" items. In this study, less experienced male occupational therapists reported themselves to be less satisfied, more inclined to leave the profession or pursue another profession, but did not feel more isolated than their more experienced counterparts. The means of all items revealed a feeling of dissatisfaction on the Likert-scale used in this survey. Although no statistical significance could be achieved, a clear trend existed toward a lower level of satisfaction among the less experienced group. PMID- 10138991 TI - Congress passes Medicare fixes. PMID- 10138992 TI - Is there a future for the independent nursing home? PMID- 10138993 TI - M&A mania. Immersed in a sea of mergers and acquisitions, the industry is changing. Here's how. PMID- 10138994 TI - 1994 multi-facility operators survey. Settling into position. PMID- 10138995 TI - Care is the cure. Incontinence calls for individualized treatment. PMID- 10138996 TI - Reactivating appetite. PMID- 10138997 TI - The healing power of the mind. PMID- 10138998 TI - Home care A to Z. AB - My home care agency gives out little gold pins to employees to mark an anniversary. Now that I have one I feel confident in telling the real story about home care. I don't mean the dull paragraphs buried in the Policies and Procedures Manual or the dry information presented in our agency's mission. I am talking about the truth that every social worker, nurse, home care aide, or physical or occupational or speech therapist faces daily in visits to clients' homes. I dream of the day that this primer will be integrated into each new staff person's orientation. Here is the working bible of home care from A to Z. PMID- 10138999 TI - Laughter: a daily trip to your internal pharmacy. PMID- 10139000 TI - Developing a maternity home care program. AB - Maternity patients are being discharged from hospitals earlier than ever. This maternity care program provides new mothers with comprehensive home care that ensures healthier mothers and babies. PMID- 10139001 TI - Sudden infant death syndrome: back to sleep campaign. AB - Sudden infant death syndrome is the leading cause of death for infants between one month and one year of age. Studies outside the US have shown that a change in infant sleep position is connected to a significant decrease in the SIDS rate. This information has lead to an educational campaign in this country to promote back and side sleeping for healthy infants. PMID- 10139002 TI - Children with HIV: an update. AB - Standard practices of care for HIV-infected pregnant women and newborns are undergoing rapid changes. Definitive HIV diagnosis in early infancy and improved medical care make it possible for children with HIV infection to live much longer. Widespread underdiagnosis, however, remains a major obstacle to implementing these advances. PMID- 10139003 TI - Children with HIV/AIDS: caring at home. AB - The services the VNS of New York provides through its AIDS program are services that other agencies can implement. These services support caregivers--which helps them to keep their HIV-infected children healthy. PMID- 10139004 TI - Cincinnati Restoration, Inc.'s housing support and training program. AB - A Cincinnati mental health agency has developed a unique program using in-home training and support to help people with mental illness help themselves. Cincinnati Restoration, Inc.'s Housing Support and Training Services was designed to help these adults attain independence. PMID- 10139005 TI - Kitchen systems. The beginning of a dream. PMID- 10139006 TI - A call for consistency in cost accounting. PMID- 10139007 TI - Echo Awards. DMA (Direct Marketing Association) honors nine non-profit campaigns. AB - This year the Direct Marketing Association has chosen nine winners in the Non Profit Echo Awards competition--two gold, three silver and four bronze. Overall, the DMA bestowed 92 Echo Awards in its annual international competition. These creative campaigns are worth studying. In studying them, you may find your own creative idea. PMID- 10139008 TI - Safeguarding human tissue transplants. AB - Transplants of human tissues, such as cornea and bone, can be modern miracles. But they can also transmit disease such as HIV and hepatitis. FDA has tightened controls of transplanted human tissue to minimize risks, and is considering additional action. PMID- 10139009 TI - Survey: only two industries pay security directors less than health care. PMID- 10139010 TI - An interview with: Tryst M. Anderson on 'wayfinding' system for hospital parking structures. PMID- 10139011 TI - Theft of nitrous oxide. PMID- 10139012 TI - Special report. From alert to twisters: planning for and coping with tornadoes. AB - Hospitals in the South put their tornado disaster plans into effect in March when a series of twisters swept through Alabama, Georgia, Tennessee, North Carolina, and South Carolina--destroying homes, killing 43 persons, and injuring another 250. In Piedmont, AL, a town of 5,000, 20 people were killed when a tornado destroyed the Goshen United Methodist Church. In Guntersville, AL, the roof was blown off the Marshall Manor Nursing Home, sending a number of persons to area hospitals. In this report, we will review some of the measures taken by a number of hospitals that received patients and give details on how they prepare to deal with such disasters. PMID- 10139013 TI - Charlotte, NC hospitals: lessons learned from airliner crash. PMID- 10139014 TI - Staff training--sensitivity to the needs of elderly patients. PMID- 10139016 TI - Nutrient losses in quantity food preparation. PMID- 10139015 TI - Hospitals compare quality with IMSystem. PMID- 10139017 TI - Geriatric patients are customers too! PMID- 10139018 TI - On advocacy for the broader family. PMID- 10139019 TI - The real bottom line of health care. American Society of Internal Medicine. PMID- 10139020 TI - IT (information technology) update. PMID- 10139021 TI - Consumer audit. In the picture. PMID- 10139022 TI - Secure care. Taking a liberty. PMID- 10139023 TI - Total fundholding. Room at the top. PMID- 10139024 TI - Support costs. Single-minded solution. PMID- 10139025 TI - The AIDS vaccine: back to the basics? PMID- 10139026 TI - Utilization and costs of psychiatric services in the United States. PMID- 10139027 TI - Transforming data into action. PMID- 10139028 TI - Computerization of health care information: more automation, less privacy. PMID- 10139029 TI - The corporate practice of medicine prohibition: a dinosaur awaiting extinction. PMID- 10139030 TI - 1994 survey--healthcare materiel management and central service professions. AB - Our 1994 professional survey shows an industry in flux. Institutions seem to be getting smaller, job tenure is shrinking for CS managers and materiel managers are convinced there will be fewer of them around. Salaries seem to be flattening for materiel managers, female materiel managers are being financially discriminated against and CS managers, though making more money, are losing benefits. Job dissatisfaction appears to be on the rise for both professions. PMID- 10139031 TI - Directory of education. AB - One of the most important tools for career building and personal satisfaction is education, and there are a wide variety of ways for you to get it. Some are available through your professional associations; others through correspondence courses, on-site courses at local colleges and universities, seminar programs of associations, vendors and seminar groups; and still others in audiovisual formats. We've assembled a list of educational offerings that should be of interest to you and your colleagues. There may be others offered in your area, so contact your local institutions of higher learning to take advantage of what they have--or to develop a course with them! PMID- 10139033 TI - Directory of Federal Offices. PMID- 10139032 TI - Directory of resources. PMID- 10139034 TI - 1994 corporate profiles. PMID- 10139035 TI - The changing face of AIDS and the response of the religious community. PMID- 10139036 TI - The use of the computer as a tool for assessment and research in pastoral care. AB - Numerous articles have been written that are critical of the pastoral care and chaplaincy profession for its failure to utilize quantitative instruments for clinical care and research. This paper presents an instrument and methodology for collecting data using the computer as an assessment tool. It also presents initial research data indicating the constructive relationship between religious faith and healing. PMID- 10139037 TI - THE CHAPLAIN: how to survive the era of managed care. PMID- 10139038 TI - Praying with the terminally ill. PMID- 10139039 TI - The spirituality and religiosity of veterans. AB - This article reports on the author's clinical observations of certain religious and spiritual interests of one hundred and twenty-five veteran patients at a small VA hospital. Definitions of both spirituality and religiosity are presented to indicate that they are not the same phenomenon. A list of questions routinely used by the author in doing an assessment of a patient's religiosity and spirituality is provided. Impressions of the veteran patients' religious and/or spiritual needs and concerns are summarized. Suggestions for future research are outlined. PMID- 10139040 TI - Outpatient care: the modern chaplains' new impact in healthcare reform. PMID- 10139041 TI - Does managed care pay better than private practice? PMID- 10139042 TI - Bonus plans that go beyond productivity. PMID- 10139043 TI - HMO deals that give you more money for more risk. PMID- 10139044 TI - How mergers go wrong. PMID- 10139045 TI - Don't count soloists out. PMID- 10139047 TI - Santa Monica discussing merger with new partner. PMID- 10139046 TI - Records case closed for all but Magaziner. PMID- 10139048 TI - ProPAC, PPRC could be targets of congressional cuts. PMID- 10139049 TI - Ameritech wins Cleveland deal with its 'vendor-driven' CHIN (community health information network) PMID- 10139050 TI - In a tough climate, AIDS groups seek more funds. PMID- 10139051 TI - Ruling threatens any-willing-provider laws. PMID- 10139052 TI - Hospital profits level off--AHA. PMID- 10139053 TI - Marketing groups settle six-month legal squabble. PMID- 10139054 TI - Calif. groups ask for JCAHO change. PMID- 10139055 TI - Summit meeting will likely spell out new definition for JCAHO. PMID- 10139056 TI - Black community hospitals: setting the record straight. PMID- 10139057 TI - 4,600 hospitals are targeted in 2nd Medicare billing probe. PMID- 10139058 TI - Settlement curbs Mo. hospital's physician practice acquisitions. PMID- 10139059 TI - 1995 outlook. AB - Competition is transforming the healthcare marketplace, and providers are scrambling to emphasize their cost-effectiveness as well as their dedication to high quality. Modern Healthcare takes a look at what lies ahead in the varied sectors of the healthcare industry. PMID- 10139060 TI - Court lifts ban on Cape Coral merger. PMID- 10139061 TI - Vermont deal merges hospitals, docs. PMID- 10139062 TI - Health referral services' latest line: stay home. PMID- 10139063 TI - Software helps hospitals cut back on job, expense of patient-care 'rework'. PMID- 10139064 TI - Firm's purchase keeps small Fla. hospital open. PMID- 10139065 TI - Scott pitches cost savings. PMID- 10139066 TI - Salick founder sees ideal match in Zeneca. PMID- 10139067 TI - Final CDC rules on TB offer more flexibility. PMID- 10139068 TI - Slowing of cardiac procedures termed 'ominous'. PMID- 10139069 TI - Accreditation reports go public. PMID- 10139070 TI - Changes don't diminish importance of infection control. PMID- 10139071 TI - Stents may replace some angioplasties. PMID- 10139072 TI - New standards target what is actually achieved. PMID- 10139073 TI - Advice for OR managers in meeting the 1995 standards. PMID- 10139074 TI - Continuity of care: some experiences and thoughts. AB - Continuity of health care is a goal to be achieved. Most are for it. Many claim to provide it. But how do we know we have it? What are the key features of continuity? While dictionaries do not define the phrase "continuity of health care," we do find definitions of "continuity." The Oxford English Dictionary, Second Edition, includes in its definitions: "the state or quality of being uninterrupted in sequence or succession, or in essence or idea; connectedness, coherence, unbroken..." Stedman's Medical Dictionary includes: "absence of interruption, a succession of parts intimately united..." These definitions stress an uninterrupted succession and include the concept that there needs to be a connection to the parts. Without that connection, continuity, in health care delivery or elsewhere, does not exist. PMID- 10139075 TI - How practicing physicians are adjusting to managed care. AB - Managed care is here to stay. In fact, for the foreseeable future, health care will become increasingly more managed each year. The purpose of this article is to help physician leaders and executives understand how clinicians are reacting and adjusting to managed care. Those of us who are doing primarily management activities have our own set of problems and adjustments. Sometimes we can be insensitive to the problems that physicians who are primarily treating patients can have as a result of managed care. Health care executives who are managing physicians or attempting to influence their behavior must attempt to understand clinicians' feelings, reactions, and coping mechanisms. PMID- 10139076 TI - Legal implications of managed care arrangements. AB - Prior to the 1980s, managed care was virtually nonexistent as a force in health care. Presently, 64 percent of employees in America are covered by managed care plans, including health maintenance organizations (20 percent) and preferred provider organizations (44 percent). In contrast, only 29 percent of employees were enrolled in managed care plans in 1988 and only 47 percent in 1991. To date, the primary reason for this incredible growth in managed care has been economic market pressure to reduce health care costs. For the foreseeable future, political pressures are likely to fuel this growth, as managed care is at the center of President Clinton's national health care plan. Although there are numerous legal issues surrounding managed care, this article focuses primarily on antitrust implications when forming managed care entities. In addition, the corporate practice of medicine doctrine, certain tax issues, and the fraud and abuse laws are discussed. PMID- 10139077 TI - How should managed care physicians be paid? AB - When paying a physician for medical or surgical services, most patients expect the traditional bill or charge for that encounter or visit. While most people also pay health insurance premiums, few patients expect to prepay for their health care. But that is the foundation of most managed health care systems prepaid medicine. PPOs, IPAs, and HMOs are typically health care providers linked together to provide services to a set population for a specific prepaid fee or "capitation" payment. Other providers contract with these managed care insurers to receive a predetermined and often "discounted" professional fee for services. These managed care organizations have already gone through a number of stages in determining how physicians are to be compensated for their services, and further changes loom on the horizon. PMID- 10139078 TI - Benefits and barriers to consumer choice. AB - Any successful health care reform effort must increase the market power of individual consumers. If consumers act in the medical marketplace as they do in other segments of the economy they will make sensible decisions about the allocation of resources (rationing) without the intrusion of third parties and will select providers and medical interventions that meet their needs. This article asserts the importance of consumer influence, focuses on the barriers that prevent consumers from exerting the same muscle in health care that they manifest in other areas of the economy, and suggests ways to remove these barriers. PMID- 10139079 TI - Credentialing in managed care. AB - Through the use of managed care techniques in recent years, the insurance industry has tried to bring the runaway costs of medical care under control. The result of this control effort is system access limitations, compared to the full choice indemnity plans of the past. This limited system access has now clearly moved HMOs and other managed care organizations into the category of "potentially liable health care entities," based on patient steerage, economic disincentives, and limited choices of the plan's participating providers and facilities. Just as hospitals have had to exercise rigorous care in the credentialing of members of their medical staffs, managed care organizations will have to ensure that the providers they use meet acceptable standards of competence. PMID- 10139080 TI - The power of listening. AB - The list of physician dissatisfiers--complaining patients, disgruntled employees, the egos of other physicians, and more government regulations and control- continues to increase. There is a common thread among many of these dissatisfiers. They involve relationships with people and organizational cooperation, or the lack of it. Communication problems are targeted as the source of much of the organizational heartburn. In many cases, the real problem is that there is too much talking and too little listening. PMID- 10139081 TI - Economic credentialing is here to stay. AB - Health care organizations are being scrutinized by payers for the efficiency of their processes to render health care. Organizations must offer alternative avenues to satisfy health care needs that are less resource consuming and have a reasonable chance of success. This presents an enormous challenge to U.S. health care. In the past, while in training, physicians were conditioned to ignore costs in the provision of care. We cannot afford that behavior today. Physicians must be reeducated and their behavior reconditioned to alter the teachings at medical school and residency with respect to resource utilization. To be effective, this education and behavior modification must be done in a nonpunitive fashion. PMID- 10139082 TI - Management of medically fragile infants and children. AB - Medically fragile infants and children present a host of challenges. The neonatal intensive care unit (NICU) is initially the mainstay of care for these infants, but it does not meet the critical developmental interactive needs of the child and parents to ensure positive psychosocial bonding. The care of these infants is further complicated by high daily costs (ranging from $1,000 to $2,500 per neonatal intensive care bed day) and lengthy, expensive inpatient stays (typically ranging from one week to five months or more). FHP Utah, a managed care organization, met these challenges through an innovative case management oriented home care program called "Welcome Home." The program has produced a major impact on the quality and the cost of care for medically fragile infants. This article summarizes the first year's experience in implementing and operating the program. PMID- 10139083 TI - Proposed safe harbor "clarification" would ban sham transactions. PMID- 10139084 TI - An introduction to benchmarking in healthcare. AB - Benchmarking--the process of establishing a standard of excellence and comparing a business function or activity, a product, or an enterprise as a whole with that standard--will be used increasingly by healthcare institutions to reduce expenses and simultaneously improve product and service quality. As a component of total quality management, benchmarking is a continuous process by which an organization can measure and compare its own processes with those of organizations that are leaders in a particular area. Benchmarking should be viewed as a part of quality management programs, not as a replacement. There are four kinds of benchmarking: internal, competitive, functional and generic. With internal benchmarking, functions within an organization are compared with each other. Competitive benchmarking partners do business in the same market and provide a direct comparison of products or services. Functional and generic benchmarking are performed with organizations which may have a specific similar function, such as payroll or purchasing, but which otherwise are in a different business. Benchmarking must be a team process because the outcome will involve changing current practices, with effects felt throughout the organization. The team should include members who have subject knowledge; communications and computer proficiency; skills as facilitators and outside contacts; and sponsorship of senior management. Benchmarking requires quantitative measurement of the subject. The process or activity that you are attempting to benchmark will determine the types of measurements used. Benchmarking metrics usually can be classified in one of four categories: productivity, quality, time and cost-related. PMID- 10139085 TI - Excerpts from Managing CQI in Radiology and Diagnostic Imaging Services: A CQI Handbook. AB - Continuous quality improvement (CQI) is currently the most popular and influential quality management program used in healthcare organizations. It is an effective methodology for identifying and acting on opportunities to improve the efficiency, effectiveness and value of services provided to customers. CQI implementation can be broken down into four components: (1) achievement objectives and goal identification, (2) system process analysis, (3) action planning and implementation, and (4) performance measurement and follow-up. As the project team establishes goals, it should consider customer and staff needs, what constitutes "quality," existing guidelines and regulations, and how results will be measured. Many techniques can be used to analyze the procedure or function targeted for improvement, including charts and diagrams, formal monitoring, data collection and statistical analysis. After the project team has identified potential service improvements, they develop an action plan, which may include education, recruitment, reassignment or equipment acquisition. The team must consider the impact of proposed changes and the financial and logistical feasibility of various proposals. The dynamic challenges of radiology and diagnostic imaging cannot be addressed through single, isolated actions; efforts to improve quality should be continuous. Accordingly, the project team should measure and analyze results of the action plan, reappraise goals and look for opportunities to further improve service. PMID- 10139086 TI - The role of the radiology nurse. AB - The radiology nurse's role requires a high level of knowledge, expertise and independence because the department provides services to a wide variety of patients with diverse needs and about whom information may be limited. Radiology nurses routinely start or check peripheral i.v.s, assess infusaports, administer medications, monitor vital signs, suction patients, insert foleys and help patients with their personal needs. The nurse also informs the technologist or radiologist of any unusual patient needs and performs specialized nursing duties, such as administering i.v. sedation or analgesia during special procedures and closely monitoring patients with cardiac/pulse oximeters. Radiology departments call on nurses to care for patients transported from intensive care, patients in emergency situations and pediatric patients and others needing sedation. Teaching is another duty radiology nurses assume, instructing patients and their families, students, technologists, other nurses, radiologists and physicians about patient care. They also teach the radiology staff new nursing policies and national standards as such changes occur. Radiology nurses devote a lot of time to quality improvement and infection control programs: collecting data, keeping records and reporting results. Because radiology nursing is relatively new, the nurse may be called upon to help write patient care policies, design flowsheets or patient instruction sheets and develop protocols or care plans. Radiology nurses utilize skills employed in many other nursing specialties and incorporate them in the radiology setting. They must provide quality nursing care to a large, transient group of patients of all ages, be a spokesperson for patient care and a teacher to other radiology staff members on patient care issues. PMID- 10139087 TI - The orientation coach: an important player in competency-based orientation. AB - Competency-based orientation (CBO) is mandated by JCAHO's Agenda for Change and can improve quality patient care and employee retention. JCAHO redefined its requirements for staff orientation, training and education in 1993, emphasizing the use of competency assessment systems to foster continuous improvements in organizational quality. Proper training for staff members who conduct orientation for new employees--"orientation coaches"--is critical to the success of CBO programs. Our institution designed a training workshop to establish a common knowledge base for orientation coaches. The workshop clarifies the coaches' role and responsibilities, supplies practical information for the coaches' use and promotes a consistent approach to competency assessment. Coaches are familiarized with transitions or adjustment phases new employees typically experience and with adult learning principles, teaching behaviors and learning style differences. The orientation coaches' workshop has met organizational expectations by preparing qualified orientation leaders. New employees benefit from systematic, customized orientation plans facilitated by coaches who are comfortable with their roles and responsibilities, knowledgeable about adult education principles and competency assessment. PMID- 10139088 TI - AHRA survey. Job content and salary survey. Part III: Chief technologist. AB - In October, 1993, the AHRA surveyed its members on the scope of their jobs, as well as their salaries, benefits and raises. Data was collected on facility demographics, member characteristics, areas of responsibility, volume of procedures performed, number of full-time equivalent (FTE) personnel supervised, and operating budget. The relationship of these factors to salary was investigated. Part I (Radiology Management 16.2, spring, 1994) presented general demographic information and average salary for administrative directors of radiology in hospitals and nonhospitals. Part II (Radiology Management 16.3, summer, 1994) presented information about job content for administrative directors of radiology and compared the results to previous AHRA job content and salary surveys. Part III presents information about demographics, job content and average salary for chief technologists in hospitals and nonhospitals. One hundred and fourteen chief technologists working in hospitals and 16 working in nonhospital facilities responded to the survey. It is important to remember the small number of nonhospital respondents when reviewing the results. Fifty-eight percent of hospital and 56% of nonhospital chief technologists report no change in their benefits package in the past 12 months. Eighty-three percent of respondents from hospitals and 81% from nonhospitals received a salary increase in the past 12 months. The average salary increase was 5% in hospitals and 4% in nonhospitals. Average salary is reported as a function of several variables, which may be interdependent. In hospitals, the average chief technologist's salary is $45,838. In nonhospitals, the average salary is $42,562, 7% lower than for hospitals. PMID- 10139089 TI - Jobs '94. PMID- 10139090 TI - Heated debate over a law for the dying. Two Oregonians with AIDS take opposite sides. PMID- 10139091 TI - The grim message on entitlements. PMID- 10139092 TI - Scope of pharmacy. PMID- 10139094 TI - Perspectives. States eye reform in 1995: is the glass half-empty? PMID- 10139093 TI - Psychopharmacists' role in neuroleptic therapy. A pharmaceutical care approach. AB - OBJECTIVE: To describe the roles of the psychopharmacist in the use of neuroleptic therapy. SETTING: A geriatric psychiatry ambulatory care clinic in a 400-bed Department of Veterans Affairs Medical Center, San Diego, California. CONCLUSIONS: In the pharmaceutical care model, the pharmacist is involved in several important roles in the provision of neuroleptic therapy. In the ambulatory care program, psychopharmacists provide important drug-related information to patients and consultation regarding potential neuroleptic-induced adverse effects. In addition, psychopharmacists serve as consultants to other clinicians concerning the risks associated with the use of neuroleptics and participate in neuroleptic-discontinuation clinics. Morbidity associated with neuroleptic-induced tardive dyskinesia has exposed healthcare providers to legal repercussions; therefore, pharmacy intervention may aid in the reduction of legal liability. PMID- 10139095 TI - Managed care information systems: providing cost-effective care through better access to patient information. PMID- 10139096 TI - Is your organization ready for the information superhighway? PMID- 10139097 TI - Medical privacy in the computer age. PMID- 10139098 TI - New information network brings health care community closer. PMID- 10139099 TI - Hospitals can join the internet ... and network with the world. PMID- 10139101 TI - Saint Agnes Medical Center goes wireless. PMID- 10139100 TI - Protection from the latest con: document fraud. PMID- 10139102 TI - Stanford Hospital employs team effort to cut costs and enhance revenues. PMID- 10139103 TI - Retrofitting California hospitals for seismic safety. PMID- 10139104 TI - Proceed with caution along the information superhighway. PMID- 10139105 TI - Subject strengths and weaknesses of four current-awareness services on diskette. AB - This paper reports on a comparison of four current-awareness services on floppy disk: CURRENT CONTENTS ON DISKETTE--LIFE SCIENCES, CURRENT CONTENTS ON DISKETTE- CLINICAL MEDICINE, MEDICAL SCIENCE WEEKLY and REFERENCE UPDATE. The four differ considerably not so much in the number of journals as in the subject emphasis of journal titles covered. Like most bibliographic databases the area of particular interest to the individual or organization will dictate which of these services is the best choice. For many subspecialties the differences are too big to ignore; subject strengths and weaknesses are discussed in this article since many (end)users will depend on the advice of medical librarians. PMID- 10139106 TI - A comparison of the currency of secondary information sources in the biochemical literature. II. MEDLINE online and on CD-ROM. AB - The currency of selected versions of the MEDLINE database on CD-ROM and in online format was studied. The arrival of issues from 72 monthly journals and nine weekly titles during a 3-month period was monitored and their appearance in the various MEDLINE formats were recorded. Availability data for MEDLINE published by the National Library of Medicine were used as a baseline and subsequent distribution delays for the different MEDLINE formats were calculated. The study suggests a delay of approximately 2 weeks for indexing and mounting the MEDLINE file on to host computers for online access. A delay of 6-8 weeks was calculated for the MEDLINE data to be encoded on to compact disk, shipped and posted to the library customer. The currency of the MEDLINE database formats was compared with a weekly current-awareness service, CURRENT CONTENTS ON DISKETTE LIFE SCIENCES (CCOD). The majority of papers were indexed and distributed in CCOD within 10 weeks of publication date. Most papers appeared within 15 weeks in the online MEDLINE format and within 20 weeks in CD-ROM MEDLINE. The primary journal arrived at the library site within 5 weeks in most cases. PMID- 10139107 TI - Involving local people in commissioning health care: a role for consumer health information services. PMID- 10139108 TI - Hospital information systems applications and potential: a literature review revisited, 1982-1992. AB - Although this article has addressed the many advancements in administrative and clinical applications of hospital information systems, there are many other issues that have affected and will continue to affect the development and transition of hospital information systems that are beyond its scope. A few of the more critical of these issues are the emergence of local area networks and wide area networks, more widespread use of graphical user interfaces (such as Windows), the powerful technology afforded by workstations and personal computers built with the 486 microchip, legal issues, and the always present obligation of ensuring data confidentiality and system security. PMID- 10139109 TI - Achieving empowerment through information. AB - Despite the problems we encountered, which are not uncommon with the development and implementation of any data system, we are confident that our success in achieving our goals is due to the following: establishing a reliable information database connecting several related departments; interfacing with registration and billing systems to avoid duplication of data and chance for error; appointing a qualified Systems Manager devoted to the project; developing superusers to include intensive training in the operating system (UNIX), parameters of the information system, and the report writer. We achieved what we set out to accomplish: the development of a reliable database and reports on which to base a variety of hospital decisions; improved hospital utilization; reliable clinical data for reimbursement, quality management, and credentialing; enhanced communication and collaboration among departments; and an increased profile of the departments and staff. Data quality specialists, Utilization Management and Quality Management coordinators, and the Medical Staff Credentialing Supervisor and their managers are relied upon by physicians and administrators to provide timely information. The staff are recognized for their knowledge and expertise in their department-specific information. The most significant reward is the potential for innovation. Users are no longer restricted to narrow information corridors. UNIX programming encourages creativity without demanding a degree in computer science. The capability to reach and use diverse hospital database information is no longer a dream. PMID- 10139110 TI - A clinical case study: moving toward an automated patient record. AB - Automation of patient records is a concept that has slowly evolved into practical application during the last decade within the health care environment. Although limited progress has been made as far as standardizing automated record content and data exchange industrywide, we can be encouraged by individual hospital progress as illustrated by the Washington Hospital. This organization was successful in visualizing its goal, thoroughly planning its strategy, involving key players in the design, and following a methodical, purposely slow implementation plan to ensure system success. Benefits, both financial and intangible, have been achieved and recognized both within the organization and by those facilities that have been privy to its success first hand. Facilities contemplating automation of their patient record can be encouraged by Washington's example and the relentless pursuit of its vision for the automated patient record. PMID- 10139111 TI - Full-text document storage and retrieval in a clinical information system. AB - The overall design of the CIS at CPMC is heavily influenced by the decision support component. The type of automated decision support being implemented dictates the need for highly structured or coded data. The value of decision support systems has been well documented. The current reliance on free-text documents is natural and a rewarding first step to a more valuable mix of coded and free text. While the health care provider might find the textual comments of the various reports extremely useful, the capability of an automated system to vigilantly review every data element for trends and anomalies is becoming invaluable in today's ever more complex health care delivery environment. Other approaches such as optical imaging systems would facilitate human decision support, but do not supply data in a format that can be processed by automated decision support systems. The developers of the CIS at CPMC believe that data are most valuable when available for both human and automated decision support. PMID- 10139112 TI - A computer-based patient record: Emory's approach. AB - The replacement of the paper medical record at Emory will be gradual over the next several years. We foresee milestone events after which portions of the patient record are no longer retained in paper form. As these milestones are identified, the HIM professionals at the three institutions will begin the formidable task of managing the transition to a paperless system. Evaluation of business processes and the skill sets needed by staff members can be accomplished and a plan for each phase of transition developed. PMID- 10139113 TI - The new bedside manner: computer terminals--implementation issues. AB - Even with all the adventures Beaumont has gone through (and will yet encounter), there is no question in anyone's mind that having an integrated clinical information system is a much better way to treat patients than using the paper document. Data elements input by clinicians of different departments can be grouped together and presented in a format that becomes useful information for all the caregivers. Screens and reports can be designed and tailored for any one user, so that the same data elements can be presented differently for each user. William Beaumont Hospital is providing patient care more efficiently and quicker than ever before and is able to track and monitor information in ways that imaginative practitioners are only beginning to realize and appreciate. PMID- 10139114 TI - A primer on open systems. PMID- 10139115 TI - Using a hospital information system in the classroom environment. PMID- 10139116 TI - Diagnosis: work pain. Prescription: practical job redesign. PMID- 10139117 TI - Shedding light on flash sterilization. PMID- 10139118 TI - Could you cut OR costs by 25 percent? PMID- 10139120 TI - Big plan brings big savings on patient monitors. PMID- 10139119 TI - Targeting the top spot: materials managers may have a good shot. PMID- 10139121 TI - Benchmarking cardiac surgery: a regional initiative to improve outcomes. Interview by Reggi Veatch. AB - Many of the clinical benchmarking projects featured in the Lead Story are designed to produce quick results. The Northern New England Cardiovascular Disease Study Group (NNE), by contrast, is a long-term effort to improve patients' functional health status. Formed in 1987, NNE is a voluntary consortium comprising all providers of open heart surgery in Maine, New Hampshire, and Vermont--five facilities and 28 surgeons. Although NNE is just beginning to focus on best practices within the region, its early benchmarking efforts have produced a collaborative environment in which clinical information is now readily shared. Because of this, its accomplishments have been striking: the creation of a database that includes information on more than 18,000 patients; the development of a highly accurate mortality prediction tool for patients facing coronary bypass surgery; and a 24 percent decrease in regional operative mortality following coronary artery bypass graft (CABG) surgery. PMID- 10139122 TI - A directory of collaborative benchmarking resources. PMID- 10139123 TI - Applying benchmarking to the clinical arena. PMID- 10139124 TI - Medicare program; refinements to geographic adjustment factor values, revisions to payment policies, adjustments to the relative value units (RVUs) under the physician fee schedule for calendar year 1995, and the 5-year refinement of RVUs- HCFA. Final rule with comment period. AB - This final rule revises the geographic adjustment factor values and fee schedule payment areas, various payment policies for specific physician services, the relative value units (RVUs) for certain existing procedure codes, and establishes interim RVUs for new and revised procedure codes. It implements section 13518 of the Omnibus Budget Reconciliation Act of 1993 that requires payment for antigens under the physician fee schedule. This final rule also discusses the process for periodic review and adjustment of RVUs not less frequently than every 5 years as required by section 1848(c)(2)(B)(i) of the Social Security Act. PMID- 10139125 TI - Physician fee schedule update for calendar year 1995 and physician volume performance standard rates of increase for federal fiscal year 1995--HCFA. Final notice. AB - This final notice announces the calendar year (CY) 1995 updates to the Medicare physician fee schedule and the Federal fiscal year (FY) 1995 volume performance standard rates of increase for expenditures for physicians' services under the Medicare Supplementary Medical Insurance (Part B) program as required by sections 1848(d) and (f), respectively, of the Social Security Act. The fee schedule update for CY 1995 is 12.2 percent for surgical services, 7.9 percent for primary care services, and 5.2 percent for other nonsurgical services. While it does not affect payment, there was a 7.7 percent increase in the update for all physicians' services for 1995. The physician volume performance standard rates of increase for Federal FY 1995 are 9.2 percent for surgical services, 13.8 percent for primary care services, 4.4 percent for other nonsurgical services, and a weighted average of 7.5 percent for all physicians' services. In our December 2, 1993 notice announcing the CY 1994 update to the Medicare physician fee schedule and FY 1994 volume performance standard rates of increase, we invited public comment on the update indicators for surgical and nonsurgical procedures that were new or revised in 1994. There were no public comments on those indicators. We have decided not to establish a public comment period for the codes that are new and revised in 1995 since, although these codes are initially classified as surgical or nonsurgical based on the clinical judgment of our medical staff, that classification ultimately rests on charge data that we use when they become available to determine whether the codes classified as surgical meet the criteria specified in our December 1993 notice.(ABSTRACT TRUNCATED AT 250 WORDS) PMID- 10139126 TI - Payday! Trade associations are paying their top executives more than ever. PMID- 10139128 TI - NLM resources on the Internet. PMID- 10139127 TI - Not so fast. Doctors and hospitals are running head-on into federal antitrust laws. PMID- 10139129 TI - JCAHO's I.M. chapter: their standards, our compliance. PMID- 10139130 TI - Taking control of our future: President Roper's priorities include address concerns of hospital librarians. PMID- 10139131 TI - Managing interlibrary loan. PMID- 10139132 TI - Kaiser Permanente: green and growing. PMID- 10139133 TI - Controlling infection and costs at the touch of a button. PMID- 10139134 TI - The birth of an employee safety committee. PMID- 10139135 TI - Diversity management: key to future success. AB - Diversity has been a reality for American's health care field for years. Yet, a 1993 study conducted by the American College of Healthcare Executives and the National Association of Health Services Executives found that management opportunities for minorities are often limited; ethnic and racial minorities represent nearly 20 percent of all hospital employees, yet hold only 1 percent of top hospital management positions; and graduate school enrollments and graduation of minorities have declined. The article will set forth the major business implications of diversity management in health care in an increasingly competitive labor market. It will challenge assumptions and provide a blueprint for health care institutions to position themselves as future industry leaders. PMID- 10139136 TI - Diversity management: practical application in a health care organization. AB - Lee Gardenswartz and Anita Rowe extend our lead author's contributions to diversity management by suggesting a framework for organizational development that can create an "inclusive" environment for enhancing the productivity and service quality of its staff. The framework includes attention to (1) individual attitudes and beliefs, (2) organizational values and policies, and (3) management skills and practices. The common ground among these three aspects is change. Gardenswartz and Rowe posit that substantial change is necessary to realize maximum value from diversity, and therefore barriers to organizational, attitudinal and managerial behavioral change must be acknowledged and overcome. PMID- 10139137 TI - Managing diversity: the best for everyone. AB - Howard Greenwald argues that social diversity can be transformed from a "problem" to a solution if leaders can fashion ways of incorporating the commonalities across different groups in the population. Core values of "hard work, just rewards, and personal liberty" can form the foundation of shared understandings among persons of different nativity, culture, and gender. At the same time, Greenwald notes the importance of designing different strategies for different people. PMID- 10139138 TI - Bridging the gap between perception and reality: using diversity management as a tool. AB - Howard Jessamy writes from his own personal experience as a black man and health services professional. He remarks on the continuing disparities of perception and opportunity between persons of color and white persons in health care organizational leadership. The concentration of minority persons in certain kinds of positions and at lower points in the managerial ladder reflects the social forces and stereotypes that often determine hiring and promotional decisions within our larger culture. Jessamy points out that one way to break this kind of "gridlock" is to acknowledge those differences in background, perception, and approach and then ot use them constructively to advance the broader purposes of the health care organization. PMID- 10139139 TI - Supervising the health care professional. AB - Those employees called professionals are in some ways little different from any other employees but in a few ways can be anywhere from subtly to dramatically different. As others, professionals are motivated by a unique mix of needs that can be used to gain insight into the appropriate supervisory techniques to apply. Different approaches to supervision are sometimes called for in the face of professionals' advantages, specifically their generally greater education and their external mobility owing to the presence of specific expertise used in other organizations, and their resulting loyalty to an occupation that frequently outweighs loyalty to an organization. The professional in short supply enjoys unique advantages that provide additional challenges for supervision. The conclusion eventually reached concerning supervising professionals is that honest, people-centered management is the key to success. PMID- 10139140 TI - It's not what you do but how you do it: tips for the manager. AB - Effectively relating to others is critical at the managerial level. At this level it is not so much what you do that counts but how you do it. It is your manner of focusing on others and the effective feelings you evoke that will influence your ultimate success as a manager. PMID- 10139141 TI - Diagnosing the health of organizations. AB - The concept of a healthy organization is idealistic. Organizations are never fully stable, they never maximize their potential, and they never achieve complete harmony. It is a common myth that the leader determines an organization's health. It is how the psychodynamics of an organization are managed and the capacity of leaders and followers to repair broken relationships that influence an organization's health. PMID- 10139142 TI - Development of a comprehensive staff education plan for a rehabilitation center. AB - Staff education will be an important component of managing changes in health care. The development of a "learning organization" will necessitate developing management processes to encourage team building and participation. This article describes a management process created to develop a comprehensive staff development plan for a rehabilitation center. Four components of the management process are described: formation and articulation of a mission statement, establishment of an organizational structure, development of educational plan procedures, and description of the role of the management team in developing the plan. Strategies for plan implementation and evaluation are also discussed. PMID- 10139143 TI - An analysis of gainsharing in a health care setting. AB - This study examines the effect a gainsharing plan has had on the productivity of two hospitals. Previously, the hospitals had been using a set of ratios to determine changes in productivity. However, we use a nonparametric productivity measure because it simultaneously considers the relationship between the hospitals' inputs and outputs. Our results show that the gainsharing program had no significant effect on productivity in one hospital and a negative effect on productivity in the other hospital. These results raise questions as to whether gainsharing will help health care providers improve productivity. PMID- 10139144 TI - AIDS in the workplace: implementing an AIDS policy. AB - Much needless anxiety and misinformation about AIDS exists today. Many people are concerned that they can "catch" AIDS in the workplace through casual contact with co-workers. AIDS is hard to get. It is not spread by nonsexual, person-to-person contact among workers, clients, and consumers in offices, schools, factories, or other workplaces. Managers of corporations should institute AIDS policies, addressing discrimination, confidentiality, infection control, and education, before the first cases of the disease emerge in the organization. It is predicted that about 90 percent of HIV-positive individuals are presently in the labor force; every American employer will have to come in contact with HIV/AIDS infected employees in the near future. Any attempt to communicate positive messages--and reduce fear and confusion--leads to a more productive work environment, less discrimination, and more sensitivity regarding AIDS issues. PMID- 10139145 TI - Hospital resource allocation. AB - Good resource allocation is essential to effective hospital cost management. Yet current allocation methods are weak, and the damage done by bad allocations cannot be undone with utilization fine-tuning. The three traditional methods are resource-allocation-by-momentum (RAM); resource-allocation-by-physician (RAP); and resource-allocation-to-survive (RAS). As hospitals change, a new allocation method is needed: resource-allocation-in-response-to-need (RARN). To determine appropriate allocations, RARN analyzes each activity based upon community need, hospital response, and economics. RARN balances cost management emphasis of doing things right (utilization) with doing the right things (allocation). PMID- 10139146 TI - Running effective meetings, running effective groups. AB - Meetings are effective if they meet the objectives of each person involved in the least amount of time possible. Different strategies are needed for different types of meetings. Different leadership styles are necessary depending on the members' personality preferences and the stages of the group's development. Good leaders know how to adapt to these preferences and stages. PMID- 10139147 TI - Public health management. Outward bound. PMID- 10139148 TI - Eire health policy. Power with responsibility. PMID- 10139149 TI - Research. Gift or gain. PMID- 10139150 TI - Mental health. Acting on the evidence. PMID- 10139151 TI - Purchasing. Manchester united. PMID- 10139152 TI - NM cancer treatment center combines oncology services under one (brightly lit) roof. PMID- 10139153 TI - JCAHO's Ode Keil. What to expect from 1995 accreditation. Interview by Ellen Weisman. PMID- 10139154 TI - Salary increases no longer easy pickings. PMID- 10139155 TI - Taking control of controls. How to get the most out of building automation systems. PMID- 10139156 TI - What goes up ... must come down. PMID- 10139157 TI - OSHA's safety equipment rules: what is and isn't required? PMID- 10139158 TI - Survey: almost one out of two facilities process laundry in-house. PMID- 10139159 TI - Clinical engineering: it's more than maintenance. PMID- 10139160 TI - Installation of a network and custom made software connecting different HIV/AIDS centres. PMID- 10139161 TI - Decision making system. PMID- 10139162 TI - Six years of epidemiological monitoring with the Austrian computer based medical record abstract system for anonymous HIV-1 counseling and testing. PMID- 10139163 TI - The questions of the AIDS-epidemiology in health infomatics. PMID- 10139164 TI - Introduction to case management application software. PMID- 10139165 TI - Joint Commission on Accreditation of Healthcare Organizations. Supplemental standards from the 1995 Accreditation Manual for Mental Health, Chemical Dependency, and Mental Retardation/Developmental Disabilities Services (MHM) for Survey of Psychiatric Hospitals and Psychiatric Inpatient Units in General Hospitals. PMID- 10139166 TI - Survey of psychiatric hospitals and inpatient psychiatric units to include selected mental health standards. PMID- 10139167 TI - Joint Commission practices what it preaches. PMID- 10139168 TI - Measurement beat goes on. PMID- 10139170 TI - Joint Commission is NFPA "authority having jurisdiction". PMID- 10139169 TI - Six steps toward IMSystem implementation. PMID- 10139171 TI - A self-survey of the education standards in the AMH "Management of Human Resources" chapter. PMID- 10139172 TI - Rurality and tuberculosis incidence trends in North and South Carolina, 1980 to 1992. AB - U.S. tuberculosis incidence rates increased steadily from 1985 through the end of 1992. Many factors have been implicated as contributors to the reversal in the historic decline of tuberculosis: the HIV epidemic, poverty and homelessness, immigration from less developed countries, and a deteriorating public health infrastructure. The purposes of this study were to demonstrate the extent of geographic variation in tuberculosis incidence rate trends in North and South Carolina and to quantify the association between aggregate-level characteristics of state economic areas and incidence rate trends. Data were obtained from the U.S. 1980 and 1990 decennial census and from the North and South Carolina health departments. In North Carolina, tuberculosis trends declined rapidly in the early 1980s, but declined much less rapidly from 1986 to 1992. In South Carolina, tuberculosis trends were nearly static during the early 1980s, but declined rapidly from 1986 to 1992. Rural and high-poverty state economic areas in South Carolina experienced especially favorable changes in tuberculosis incidence trends. South Carolina has a unique tuberculosis control program that makes widespread use of enablers, incentives, and directly observed therapy. This study demonstrates the distinct tuberculosis incidence trends that existed in two contiguous states and suggests that approaches to tuberculosis control that improve access to care may be effective in improving tuberculosis incidence trends, particularly in poor and rural areas. Strengthening tuberculosis programs may be an important strategy for controlling the current resurgence of tuberculosis in the United States. PMID- 10139173 TI - Bypassing of local hospitals by rural Medicare beneficiaries. AB - Several previous studies of hospital utilization by nonelderly rural residents suggest that local rural hospitals have been increasingly bypassed, often for care in urban hospitals. This resulted in lost volume for rural hospitals, detracting from their financial viability. It is not clear to what extent elderly rural residents also bypass local hospitals and whether this reflects regionalization of treatment for some conditions or avoidance of local hospitals assumed to provide inadequate care. This study examines hospital use by aged rural Delaware Medicare beneficiaries living in a ZIP code area that has a local hospital during Fiscal Year (FY) 1987 (N = 670). Most of these Medicare beneficiaries were hospitalized locally. Those beneficiaries who bypassed local rural hospitals usually did so because cardiovascular surgical procedures were required and were often only performed in large urban teaching hospitals. Beneficiaries using nonlocal hospitals were similar to users of local hospitals with respect to age and sex and traveled an average of nearly 42 miles for treatment. "Bypassing" here appears to be due primarily to regional specialization of care rather than abandonment of local rural hospitals by rural residents. PMID- 10139174 TI - Decomposing area of residence differences in multiple regression studies: the relative contributions of independent variables and model coefficients. AB - When rural/urban differences are found in health status or health care use, it is often desirable to identify those factors (such as age, social structure, income, etc.) that influence such differences. To this end, researchers often test rural/urban differences in age, social structure, income, etc., for statistical significance. Also, researchers commonly perform multivariate analyses (such as multiple regressions) to examine rural-urban differences in the influence of various independent variables on the dependent variable of interest. Frequently, researchers discover: (1) statistically significant rural/urban differences in the independent variables (such as age, social structure, income, etc.) and (2) statistically significant rural/urban differences in the effects of these independent variables (i.e., statistically significant rural/urban differences in regression coefficients). The analysis typically stops here, without addressing the relative contributions of (1) and (2) to the rural/urban differences in the dependent variable. This paper argues that the relative contributions of (1) and (2) have important implications for the way policy-makers address rural health problems. This paper presents a method for assessing the relative contributions of differences in the independent variables and differences in regression coefficients to observed differences in the dependent variable, and illustrates the application of the method by analyzing rural/urban differences in the risk of institutionalization. PMID- 10139175 TI - To stay or not to stay: issues in rural primary care physician retention in eastern Kentucky. AB - An important aspect of primary care physician availability is the retention of physicians once they have located. While retention has been under-researched compared to recruitment, it is especially important in rural areas where physician shortages already exist. This study reports the results of a retention survey completed by 132 primary care physicians in rural eastern Kentucky. The survey sets up an objective, hypothetical retention scenario and asks physicians to respond to structured questions and to an open-ended question about factors not appearing in the survey. In response to the structured portion of the survey, physicians indicate that relief coverage is the most important factor in rural physician retention. A content analysis of 75 open-ended responses reveals that besides the other factors in the survey, "sociocultural integration" is the pre eminent retention issue for rural practitioners. This article concludes that the role of the local rural community may be more important in retention than in recruitment. Finally, it is suggested that additional in-depth qualitative research be conducted within the local contexts to enhance the understanding of rural physician retention processes. PMID- 10139176 TI - Former NME exec begins serving sentence for fraud conviction. PMID- 10139177 TI - Mo. hospital on selling block. PMID- 10139178 TI - HCFA asks nine states to pay for improper taxes, donations. PMID- 10139179 TI - Malpractice claims remain stable. PMID- 10139180 TI - Two giants take message to the masses. PMID- 10139182 TI - Health Systems weighs proposals for acquisition. PMID- 10139181 TI - Wis. antitrust judgement a shocker. PMID- 10139183 TI - Mullikin disputes reported problems. PMID- 10139184 TI - Hospitals rank high as health hazard for employees. PMID- 10139185 TI - Patient sues Health Net over unpaid claim. PMID- 10139186 TI - N.Y. hospital settles property-tax dispute over office building. PMID- 10139187 TI - 1995: the year of Medicare cuts. PMID- 10139188 TI - For-profit bed count rises while facilities tally drops. PMID- 10139190 TI - VA's health chief seeks change. PMID- 10139189 TI - Hospital chains' stock prices buck downward trend. PMID- 10139191 TI - Geographical software aids execs. PMID- 10139192 TI - N.Y. hospital's specialty lies at heart of facility's fiscal, operational health. PMID- 10139193 TI - JCAHO rethinks sponsors' control. PMID- 10139194 TI - Summit targets seven beefs. PMID- 10139196 TI - JCAHO given proposal to reduce follow-up surveys at small hospitals. PMID- 10139195 TI - Chicago-area consolidation continues on target for 1995. PMID- 10139197 TI - Columbia/HCA seeks Colo. partner. PMID- 10139198 TI - Not-for-profit keeps clout in N.D. deal. PMID- 10139199 TI - Columbia relentless in Healthtrust deal. PMID- 10139200 TI - Consortium to buy Scottish hospital. PMID- 10139201 TI - Caremark, feds meet in attempt to settle charges. PMID- 10139202 TI - Thinking locally--acting globally. PMID- 10139204 TI - Care in the recovery of expendable radioelement source costs. PMID- 10139203 TI - Violence in the healthcare industry. "The newest epidemic". PMID- 10139206 TI - The dis-ease in healthcare. PMID- 10139205 TI - Global protocol for healthcare administration. AB - Managers and administrators wanting to improve their leadership and influence should carefully analyze the factors which comprise their success. The first three factors described in this article are often learned easily through seminars and study. The final factor, developing a sense of the appropriate, though, is more difficult. It requires a willingness to recognize the importance of the unwritten rules of society which are placed upon leaders and then dictates that the leader continually engage in self-evaluation and correction of personal habits, characteristics and idiosyncrasies. Practicing appropriate protocols necessitates suppression of the personal ego and an openness to the suggestions of others. PMID- 10139207 TI - Breast imaging: why MQSA (Mammography Quality Standards Act). PMID- 10139209 TI - Time is money. Scheduling software reduces costs and increases efficiency. PMID- 10139208 TI - Medical physicists role under MQSA (Mammography Quality Standards Act). PMID- 10139211 TI - The use of APGs (ambulatory patient groups). Selected implications for radiology departments. PMID- 10139210 TI - Is going digital legal? A discussion of the legal issues concerning the implementation of PACS in place of conventional radiological film for patient diagnosis. PMID- 10139212 TI - Applied pharmacoeconomics for tomorrow's climate. A blueprint for the changing healthcare environment. PMID- 10139213 TI - Practice management strategies. New payment options. PMID- 10139214 TI - The image of inpatient imaging. PMID- 10139215 TI - Back to the future. RSNA vendors emphasize basics of imaging in high-tech ways. PMID- 10139216 TI - PAs and NPs in HMOs. AB - Recognition of NPP contributions to the delivery of care in HMOs has come slowly. Staffing continues to be a function of physician attitude instead of management rationale. Only a few enlightened HMOs seek management and staffing input from NPPs. Investigation of the role of NPPs in HMOs has seriously lagged behind that of physicians, nurses, pharmacists, and other health professionals. The status, reward systems, and job satisfaction of nonphysician clinicians, as well as efforts and problems in recruiting them, have been inadequately reported. Only a handful of HMOs have contributed to our understanding of NPP productivity and task delegation. If HMOs plan to continue using NPPs, much more information on optimizing their deployment must be shared. Member satisfaction surveys must be reported, prescribing practices must be compared, liability issues explored, and outcomes research pursued. We know little about the outcome of nonacute illness managed by NPPs. Do NPPs negate their cost-effectiveness by using more or different resources? Do differences between PAs and NPs exist with regard to each of these issues? Because so many study variables can be held constant by a large HMO which provides care in a given area under uniform market forces, HMOs can best explore how to maximize NPP effectiveness. PMID- 10139217 TI - How do non-physician providers function in HMOs? AB - Among the many issues that health care reform has brought to public attention is that health care in the future will be based on a primary care model, similar to the ones which have been the basis for our staff and group model HMO delivery systems for the past couple of decades. Policymakers have begun to realize that not only do our delivery systems depend upon a higher percentage of primary care physicians than the specialty-oriented, fee-for-service model, but that we also employ large numbers of nurse practitioners and physician assistants (NPs, PAs). Not surprisingly, major medical journals have recently carried several articles on non-physician providers, sometimes called mid-level or associate-level clinicians, their current roles and projected roles for the future. The sorts of issues that arise from these articles are not limited to determining the staffing patterns of the reformed health care system in the United States, but more specific and troublesome issues such as whether there is good evidence that use of mid-level clinicians is cost-effective. With a projected shortage of primary care physicians, many are interested in whether NPs can function effectively in an independent role. There is a meta-analysis of over 30 studies which indicates the effectiveness of non-physician providers, but interestingly almost all of the studies were done in managed care, such as our own, or university settings in which NPs work in collaborative teams with physicians. One critic has even questioned whether the original studies on the effectiveness of NPs are not too old to be useful.(ABSTRACT TRUNCATED AT 250 WORDS) PMID- 10139218 TI - Demonstration of the cost-effectiveness of a nurse practitioner/physician team in long-term care facilities. AB - To an HMO with a Medicare risk contract, providing high-quality medical care to a nursing home resident may generate considerable costs. To address this issue, Fallon initially assigned each primary care physician to just one nursing home. The program was successful in that coverage of all Fallon patients admitted to nursing homes was assured. In a pilot project 5 years ago, a geriatric nurse practitioner (GNP) was hired to provide primary and episodic visits to nursing home residents in three area nursing homes. Research was conducted to determine the effectiveness of a GNP-MD team. Based on positive outcomes, additional GNPs were recruited. In the current follow-up study, a review of the 1992 fiscal and utilization data for nursing home patients revealed significantly lower rates of emergency room transfers, hospital lengths of stay and specialty visits for patients covered by GNP-MD teams, as compared to patients covered by physician only. Nursing home drug costs, skilled nursing days and primary care visits were higher for patients covered by the teams, but the differences were not statistically significant. Overall costs were 42% lower for the aggregate pool (skilled nursing plus intermediate care) and 26% lower for those with long-term stays. PMID- 10139219 TI - Estimating the cost of using non-physician providers in primary care teams in an HMO: where would the savings begin? AB - The economic effects attributable to employing non-physician providers (NPPs) in primary care in a large HMO were estimated by calculating the per member per month (PMPM) cost for primary care provider compensation as a function of panel size for an MD/NPP provider team. After establishing an adjusted baseline of 1352 patients for an MD working alone, we hypothetically hired an NPP for each MD and increased the average panel size from 1400 to 2800 patients in increments of 200 while reducing the number of teams to keep total enrollment constant. For panel increases of less than 650 patients the addition of an NPP to a team represented a net economic loss in terms of professional service costs. By expanding the panel size for an MD/NPP team by more than 650 patients we were able to predict a linear increase in savings. The model projects that panels of 2400 patients would result in savings of $1.38 per member per month, approximately $1.65 million dollars per 100,000 enrollees per year. PMID- 10139220 TI - Exploring the use of NPs and PAs in primary care. AB - Although nurse practitioners (NPs) and physician assistants (PAs) can meet a majority of primary care needs, the implications for ambulatory health centers are not straightforward. One HMO health center undertook to determine its providers' and patients' views on the role of NPs and PAs in its Internal Medicine Department. The analysis suggests that 28% of visits required the attention of a physician, though physicians actually provided 66% of visits. We conclude that it may be possible to increase the use of NPs and PAs if we can educate members, particularly younger women, about the role of NPs and PAs so as to encourage their preferentially selecting these practitioners for their routine care. PMID- 10139221 TI - Beyond report cards: a health profile for HealthPartners Health Plan and the Business Health Care Action Group. AB - HealthPartners Health Plan and the "Business Health Care Action Group" (a buyer's coalition) operate in a market place increasingly concerned about accountability and quality improvement. Improving the population's health is a strategy that satisfies the mission and business purposes of employers and health care providers alike. Proposed quality measures and "report cards" have focused on clinical performance standards such as procedure rates or adherence to clinical practice guidelines. This paper describes a unique collaboration between an HMO and a purchasing coalition to assess member health status and health risks as a catalyst for increasing consumer involvement in health care. PMID- 10139222 TI - Improving the appointment scheduling process: a national, multi-HMO benchmarking initiative. PMID- 10139223 TI - Build a high-performance culture. PMID- 10139224 TI - A physician assistant laceration management program. PMID- 10139225 TI - Managing processes of care, not providers. Interview by Erica L. Drazen. PMID- 10139226 TI - Reform report: Washington state makes a big leap. PMID- 10139227 TI - Spanning the chasm with innovative information technology. PMID- 10139228 TI - 1994 pharmacy systems review. Incentives for pharmacy automation. PMID- 10139229 TI - RX for the pharmacy: new technology helps the medicine go down. PMID- 10139230 TI - Docs & pharmacists hang up on telephone tag. PMID- 10139231 TI - It's almost 1995: where is your long-range IS plan? PMID- 10139232 TI - Usage grows to meet & exceed all available capacity. PMID- 10139233 TI - Advanced costing of patient care. PMID- 10139234 TI - When medical records are altered or missing. PMID- 10139235 TI - The organization of heart services. Part Four: The future of heart services organizations. PMID- 10139236 TI - Outcomes analysis with case management. PMID- 10139237 TI - Doing business at the grass roots: the early cardiac care education program. PMID- 10139238 TI - Data watch. How patients rate health plans. PMID- 10139239 TI - Into the eye of the storm. PMID- 10139240 TI - Health reform: what to expect from the coming debate. Interview by Jeannie Mankelker, Dan Wise, and Steven Findlay. AB - Health care reform is in limbo as 1994 draws to a close. Last month's Republican sweep puts the issue in a starkly new political environment. The new Congressional leadership said last month it will put forth a reform plan in 1995. Also, the Clinton administration is working on a scaled-back proposal. To get an idea of what might happen next year, we invited 20 informed persons to give us their opinions and to tell us what action they'd prefer. Because of B&H's production schedule, the interviews took place before the election. We don't think that diminishes their insights and analyses. PMID- 10139241 TI - Case study: Pitney Bowes. Putting the stamp on managed care doctors. PMID- 10139242 TI - The prevention dilemma. PMID- 10139243 TI - States extend reform programs. PMID- 10139244 TI - Applying the Australian Quality Awards criteria to a clinical chemistry department. AB - National quality award schemes can provide a detailed self-assessment process enabling an organization to assess its current position and to highlight opportunities for further improvement along the road to implementing best practice. This article describes how the Australian Quality Awards were used to guide the intermediate stages of implementation and to integrate some advanced stages of implementation of total quality management within a clinical chemistry department. PMID- 10139245 TI - Reorganizing an academic medical center in a period of change. AB - On June 14, 1993, the University of Alberta Hospital was reorganized with the intention of making it more client focused. The decision to transform the organizational structure of the hospital was not taken lightly. The redesign decision was influenced by a host of factors in the external environment and the impact of changes within the organization from the implementation of a total quality management (TQM) philosophy. PMID- 10139246 TI - A customized quality management implementation strategy. AB - Austria's hospitals are not yet convinced total quality management (TQM) is a general cure for their problems. Neither competitive forces and cost consciousness nor regulations are pushing hospitals toward application of TQM methods. The Steiermarkische Krankenanstaltengesellschaft, a multihospital corporation, used a bottom-up approach to implementation of TQM as a way of dealing with the lack of a strong quality assurance tradition. PMID- 10139247 TI - Applying quality improvement to Canadian health care: can organizational skills address strategic challenges? AB - Most health care organizations in Canada employ quality improvement methods and tools to secure internal efficiencies rather than to achieve broader strategic aims or improve key clinical processes. If quality improvement efforts are to have much impact on the quality of Canadian health care, health care leaders must increase their advocacy of quality improvement methods and demonstrate that these can be used to achieve health care reform. PMID- 10139248 TI - Quality down under: if we knew then what we know now. AB - Australian health care's approach to performance improvement increasingly includes the use of total quality management (TQM) and its component principles and methods. Implementation experiences have confirmed TQM's relevance in the Australian health care environment, senior management's pivotal role, and the range of factors required for success. Ways of influencing executive behavioral change and streamlining implementation are discussed. PMID- 10139249 TI - Quality of care activities in Danish hospitals. AB - This article describes how hospitals in Denmark have tried to meet the quality challenge. How to improve health care has been a topic of debate in Denmark in the last decade, and various authorities and professional organizations have implemented quality improvement initiatives. A 1991 survey of Danish hospitals showed that methods of quality improvement and the responsibility for quality management were still issues in need of further clarification. This article illustrates the process of quality improvement using hospitals in the city of Copenhagen as examples. PMID- 10139250 TI - Using control charts to analyze serial patient-related data. AB - The authors collected data from the record of a patient who had recently undergone coronary bypass surgery and used these data to construct control charts. The control charts helped them to interpret the variation in several clinical parameters and to evaluate the clinical responses to this variation. PMID- 10139251 TI - Tutorial: planning for data collection. Part III--Sample size. AB - There is no simple answer to the question, "how large a sample should I take?" Sample size depends on various data collection design details and on how we intend to use the data in future decision making. But with careful thought and some basic statistical knowledge, even nonstatisticians can determine the appropriate sample size for achieving useful results from data collection efforts. PMID- 10139252 TI - Understanding JCAHO's new standards for managing hazardous materials and wastes. PMID- 10139253 TI - On-site waste treatment alternatives: the future of medical waste disposal. PMID- 10139254 TI - Compacting untreated medical waste. PMID- 10139255 TI - One perspective on the trade-offs of reduction and recycling options in medical waste packaging design. PMID- 10139256 TI - Will customers today be customers tomorrow? PMID- 10139257 TI - Conducting environmental service audits. PMID- 10139258 TI - Medicare program; Medicare coverage of home health services, Medicare conditions of participation, and home health aide supervision--HCFA. Final rule. AB - This regulation specifies home health aide supervision and duty requirements applicable to all home health agencies (HHAs) and hospices that furnish home health aide services under the Medicare program. It also specifies limitations and exclusions applicable to home health services covered under Medicare. The purpose of this regulation is to clarify Medicare home health policy and to promote consistent administration of the home health benefit. PMID- 10139259 TI - Who'll pick up the tab? Someone else. PMID- 10139260 TI - Now comes the real test of leadership. PMID- 10139261 TI - Brinksmanship. PMID- 10139262 TI - Coverage for all isn't catching on. PMID- 10139263 TI - Health care reform's price fight. PMID- 10139264 TI - Health care reform--a tsunami? PMID- 10139265 TI - The sounds of two senators waffling. PMID- 10139266 TI - Today's ARTs: facing challenges and seizing opportunities. Part II. PMID- 10139267 TI - Reorganization of laboratory services. Part 1: The context for change. PMID- 10139268 TI - The clinical laboratory of the future: re-aligning the human resources. AB - The first article in this series focussed on the laboratory process as a complete entity. Reengineering this process results in a totally new way of delivering value to the user of the laboratory services. Current thinking and assumptions about an organization, roles, procedures and skills are set aside and a new framework developed. The people are a key component in any change process and their involvement is essential for the project to succeed. Communication, understanding, participation, skill development and ultimately new roles are all part of an exciting personal development opportunity. PMID- 10139269 TI - The RT: multi-skilled professional. Part IV--The next steps. PMID- 10139270 TI - Diffusion of innovation I: Formulary acceptance rates of new drugs in teaching and non-teaching British Columbia hospitals--a hospital pharmacy perspective. AB - Lag times in the diffusion of new drugs in the hospital setting have both patient care and pharmaceutical industry implications. This two-part series uses diffusion theory to examine differences in the adoption rates of new drugs in British Columbia teaching and non-teaching hospitals. Formulary addition of a new drug by a hospital's Pharmacy and Therapeutics Committee was considered the adoption indicator. Time for adoption was defined as the difference between a drug's Canadian market approval date and the date of formulary addition. Surveys were mailed in September 1990 to 41 hospital pharmacies (response rate = 88%), asking respondents to provide formulary inclusion dates of 29 drugs marketed between July 1987 and March 1990. A significant difference (Mann-Whitney U Test, p < 0.0358) in median adoption time was observed between the six teaching and 25 non-teaching study hospitals, with the former adopting a new drug in 7.5 months versus the latter adopting a new drug in 12.1 months. PMID- 10139271 TI - A regional pharmacokinetic consultation service. AB - Clinical pharmacokinetics represents a way to ensure that a patient is receiving an optimal dose of a given drug for a specific indication. Pharmacokinetic consultation services have been implemented in many teaching hospitals and tertiary care facilities in the past. This project evaluated the feasibility of expanding the process to several community hospitals with one coordinator. Twenty seven hospitals, members of the Ottawa Valley Regional Drug Information Service, were approached. Fifty-two pharmacists from 21 sites agreed to participate. Four modules were taught: basic principles, theophylline, aminoglycosides, and digoxin. Regular follow-up meetings were arranged so pharmacists from different hospitals could share their administrative and patient-specific problems and solutions. After two years, 16 departments have implemented a clinical pharmacokinetic service and monitor 82% of targeted drug levels. The pharmacists trained in clinical pharmacokinetics through the project recommended changes in the regimen in 45% of all their consultations. Eight-one percent of these were accepted and implemented by physicians. These results indicate that pharmacists from small community hospitals can be trained by one individual to provide clinical pharmacokinetic services with minimal supervision. It also shows that these hospitals have a need for such services. PMID- 10139272 TI - The development and implementation of a hospital pharmacy electronic bulletin board system. PMID- 10139273 TI - The transition to pharmaceutical care on a geriatric unit in a community hospital. PMID- 10139274 TI - Crime in hospitals 1993--the latest IAHSS survey. AB - Increases in violent crimes, ranging from 3% to 26%, and decreases in burglary and theft, ranging from 1% to 26%, highlight the 1993 crime survey. The latest survey also sheds new light on state-by-state crime incident reporting. An increase in crime activity in rural-area hospitals was reported in 1993, the first time in eight years their rate equaled or surpassed the rate in urban/suburban locations. Some 35 Tables and Graphs are included. PMID- 10139275 TI - TB rears its ugly head. PMID- 10139276 TI - Fanning the flames of fire safety. AB - At a healthcare facility, evacuation cannot be the first response to a fire emergency, says the author. Institution-wide training is the answer. PMID- 10139277 TI - A healthcare canine security program: the first year. AB - This article provides a case history of a hospital's experience with a canine program. It gives details on how and why the program was chosen, training and costs involved, first-year results, and its value for hospital security. PMID- 10139278 TI - Simple survey saves the day. PMID- 10139279 TI - Continuous quality improvement--a method to involve staff in policy review and implementation. AB - How can a security department manual be completely revised and updated in a timely manner, with the full acceptance and endorsement of the security staff? The Continuous Quality Improvement (CQI) method provides the answer, says the author. The process can be a blueprint for quality management through a team effort. PMID- 10139280 TI - Encouraging growth and change by establishing trusting relationships between managers and employees. AB - The author discusses how trust between managers and employees must be established if managers expect employees to be committed to the organization. Trust is essential before changes can be implemented and growth can occur. PMID- 10139281 TI - The CHPA exam: one candidate's viewpoint. PMID- 10139282 TI - Cedars-Sinai security and the media--protecting celebrity patients. PMID- 10139283 TI - Chemical, gas explosions test disaster plans of suburban hospitals. PMID- 10139284 TI - Michael Reese first hospital to employ new ID/access control system. PMID- 10139285 TI - Special report. Integrated security systems in hospitals--an update. AB - Comprehensive security management systems which include voice, data, and video components are being employed in a number of hospital environments. Such systems may include a host computer for data gathering, remote panels for alarm monitoring, video cameras for surveillance, intercoms and phones for client communication, and access control devices for prevention and deterrence. In this report, we will present details of three such systems as installed and planned. PMID- 10139286 TI - Parking access cards replace old doctor 'phone-in, phone-out' system. PMID- 10139287 TI - Resource utilization in home health care: results of a prospective study. AB - Resource utilization in home health care has become an issue of concern due to rising costs and recent initiatives to develop prospective payment systems for home health care. A number of issues remain unresolved for the development of prospective reimbursement in this sector, including the types of variables to be included as payment variables and appropriate measures of resource use. This study supplements previous work on home health case-mix by analyzing the factors affecting one aspect of resource use for skilled nursing visits--visit length- and explores the usefulness of several specially collected variables which are not routinely available in administrative records. A data collection instrument was developed with a focus group of skilled nurses, identifying a range of variables hypothesized to affect visit length. Five categories of variables were studied using multiple regression analysis: provider-related; patient's socio economic status; patient's clinical status; patient's support services; and visit specific. The final regression model identifies 9 variables which significantly affect visit time. Five of the 9 are visit-specific variables, a significant finding since these are not routinely collected. Case-mix systems which include visit time as a measure of resource use will need to investigate visit-specific variables, as this study indicates they could have the largest influence on visit time. Two other types of resources used in home health care, supplies and security drivers, were also investigated in less detail. PMID- 10139288 TI - Growth and decline in the supply of providers of Medicare-covered home health services in the 80's: national and regional experience. AB - Using Health Care Financing Administration (HCFA) data, this study documents national and regional patterns of market entry and exit in the home health industry from 1980 to 1990. Nationally, agency origination rates accelerated during the early 1980's, then dropped abruptly in the second half of the decade. The for-profit sector exhibited the greatest volatility. Of the 3,620 proprietary agencies in existence during the decade, 3,284 (90.7%) were new entrants, and 1,551 exited the market by 1990. Regional differences in growth rates and the timing of market entry are also evident. Both growth and decline in the home health industry appear to be a response to the incentives of legislation implemented during this period. PMID- 10139289 TI - Human resources management practices and patient satisfaction in home health care. AB - Patient satisfaction is an important issue for home health providers. This study tested the influence of organizational factors, particularly human resource management practices, on quality of care, as measured by patient satisfaction. Six hundred ninety-six patients of thirteen home health agencies were surveyed to test the influence of organizational factors on five dimensions of patient satisfaction. Organizational variables included size of the agency, staffing characteristics, educational preparation of RNs, continuing education, and compensation. We found that full-time staffing, the number of BSN-prepared RNs, and percent of budget allocated to benefits all predicted high patient satisfaction scores. PMID- 10139290 TI - Denmark: changes in health and social services for the elderly and comparative observations. AB - In Denmark, legislation having the aim to help the elderly to be active as long as possible and prevent or delay institutionalization, is responsible for a number of innovative programs for this segment of the population. It is now the law that no more nursing homes will be constructed in Denmark. Free home nursing and permanent home help and night patrols for home nursing and help is a strategy to delay or prevent institutionalization. In the municipality of Skaevinge, a nursing home was converted to sheltered housing for the same patients and others from the community. Emphasis is on self care and autonomy in decision making. There are no fixed routines or schedules as found in the traditional nursing home. Examples of programs in facilities are given that have health professionals jointly planning and coordinating the delivery of their services that reduce fragmentation and duplication. PMID- 10139291 TI - Sweden: Some current observations on health services, housing and resource utilization for the elderly. PMID- 10139292 TI - THA announces proposed strategic plan. PMID- 10139293 TI - TMA (Texas Medical Association) study: Physicians banding together to adjust to managed care. PMID- 10139294 TI - Merger could create Texas giant. PMID- 10139295 TI - Health management guide. Managing mergers. AB - Structural change is everywhere in the health service. Driven by political imperatives, the logic of the market and the frenetic pace of development in medical technology, the impetus on both purchasers and providers is towards merger into fewer, more influential organisations. But as health authorities combine to increase their purchasing power, moving ever closer to family health services authorities, and as trusts rethink patterns of service provision to maintain a competitive edge, are they getting it right? This Health Management Guide surveys the changing health service landscape and puts forward a practical manifesto for successful mergers. PMID- 10139296 TI - Provider audit. On your marks. PMID- 10139297 TI - Local pay. Seize the day. PMID- 10139298 TI - Finance managers. Culture shock. PMID- 10139299 TI - The power of advocacy. PMID- 10139300 TI - Healthcare reform: the Pennsylvania experience. PMID- 10139301 TI - Collaboration in the Carolinas. An in-depth look at ACHE's Healthcare Leadership Demonstration Project. PMID- 10139302 TI - 1994 year in review. PMID- 10139303 TI - ACHE's 1995-1998 strategic plan. PMID- 10139304 TI - Employment outlook for military retirees. PMID- 10139305 TI - Opening lines of communication. PMID- 10139306 TI - Effective coalition building. PMID- 10139307 TI - Healthcare organizations' civic responsibilities. PMID- 10139308 TI - American College of Healthcare Executives. Ethical policy statement. Decisions near the end of life. PMID- 10139309 TI - Healthcare reform: what the future holds. PMID- 10139310 TI - Cooperative Care Center delivers on the promises of patient-centered care. PMID- 10139311 TI - Safe or sorry? New OSHA rules and more worker injuries keep safety managers' plates full--and spinning. PMID- 10139312 TI - Lost in space? How to make the most of limited storage areas. PMID- 10139313 TI - Health facility storage and transport systems: buy with today's and tomorrow's needs in mind. PMID- 10139314 TI - OSHA's final rule on asbestos cuts permissible exposure in half. PMID- 10139315 TI - Cleanliness vs. appearance key issue in making floor care plans. PMID- 10139316 TI - Really stressed out? Here's how to tell, with tips on how to cope. PMID- 10139317 TI - Energy management software: who buys what? PMID- 10139318 TI - CDC's final guidelines on TB go easy on health facilities with no TB cases. PMID- 10139319 TI - AIDS case emphasizes need for universal precautions. PMID- 10139320 TI - Food security: what the community wants. Learning through focus groups. AB - We used focus groups to learn the range of issues threatening food security of low income residents in our community. Five major themes emerged from the discussions: literacy, money, time, mental health and self-esteem, suggesting several approaches that could help ensure food security: 1) education, 2) sharing of resources, 3) coalition building, and 4) advocacy. Education programs have to be practical, allowing for demonstrations and hands-on learning while emphasizing skill building and problem solving. Incorporating a social aspect into learning may compensate for the social isolation and would capitalize on the impressive mutual support we witnessed. Strategies based on self-help and peer assistance may counteract low self-esteem and overcome suspicion of health professionals. A community-wide effort is needed to address the factors contributing to food insecurity. We envision the formation of a coalition of professionals, agencies, and low income people to develop a comprehensive strategy for achieving food security. PMID- 10139321 TI - Needle and syringe prices up 6.6%. PMID- 10139322 TI - Save money by scrutinizing linen usage. PMID- 10139323 TI - Materials manager's biggest complaint: product invoice inaccuracies, overcharges. PMID- 10139324 TI - Vendors develop concepts for providers to offer high-quality service at lowest cost. PMID- 10139325 TI - Republican-led Congress will take a new approach to healthcare reform. PMID- 10139326 TI - Can we still hear the call? What it means to be Catholic. AB - Despite the drastic changes occurring in the world today, certain elements of the Catholic tradition and communion can make the transition into a world colored by merger and shaped by governmental concerns for the general, not the particular. If Catholic particularism to many degrees and in many ways has been lost, the "loss" occurred before, apart from, alongside, and in many ways independent of merger and governmental contexts. "We gave it away." These are days for retrieval. The Catholic response to "the call" has been complicated by the following forces: bureaucratization of the world, acceptance of the terms of a liberal (i.e., "open") society, pluralism, and governmental involvement. These factors are formidable, and they do change contexts for response to the call. But they need not stifle the response. The following are some of the elements in "the call" that the Catholic "we" can hear and respond to, while they are also graspable and transmittable by non-Catholics in merged, governmentally related institutions and associations: Catholicholism, concern for the soul, a sacramental view, attention to human dignity, the quest for meaning, the value of ritual, human exemplarity, responsibility to community, the call to justice, and a special ethos. This sampling of elements could be debated within Catholic and in pluralistic contexts. But rather than debate, I would picture a value in conversation in each institution, system, association, or network. This conversation involves Catholics and non-Catholics alike. PMID- 10139327 TI - Are we ready for the challenge? Bringing Jesus' words and deeds alive in our healing ministry. PMID- 10139328 TI - The catholic moment. Providers must deepen their understanding of the Catholic tradition. PMID- 10139329 TI - Continuing the conversation. A pluralistic society has room for various religious traditions. PMID- 10139330 TI - Patient care versus market share: critical questions facing our healthcare system. PMID- 10139331 TI - A renaissance in healthcare? Catholic healthcare providers must adapt to a new world view. PMID- 10139332 TI - Physicians, payers, and power. The United States is witnessing a struggle for control of healthcare. AB - From its earliest days, healthcare in the United States has been controlled by providers, that is, by physicians and by hospitals (which, in turn, were also usually controlled by physicians). But this situation is changing. In the 1920s and 1930s, providers created health insurance companies like Blue Cross and Blue Shield to help patients pay for healthcare--to pay, in other words, for those services offered by providers. After World War II, the Hill-Burton program covered the nation with new hospitals. In the 1960s, Medicare and Medicaid eased the healthcare burden of older Americans--and also recapitalized hospitals. Thus providers called the shots in the creation of both the delivery and the payment systems. But in the 1970s, payers began to become more powerful. Now, in the 1990s, they have joined employers in acting to contain rapidly escalating healthcare costs. But even those long disturbed by the arrogance of some healthcare providers are now asking themselves: Is this really what we wanted? Payers are governed by the market; they may well seek, not the best, but the cheapest healthcare available. This is not in the interest of either patients or physicians. A middle ground--a new power alignment--will have to be worked out by patients, physicians, payers, and government. PMID- 10139333 TI - Character witness. Walking the talk on euthanasia. AB - Our response to the euthanasia movement brings us to the depths of moral character and spirituality. Character bears witness to the true significance of our Catholic convictions about the dignity of persons, the value of life, our dependence on God, and our interdependence on one another. To be credible players in public debates on euthanasia and assisted suicide, we have to bear convincing witness, personally and corporately, to the ways we care first for ourselves and for those who are not as fortunate as we--the sick, the elderly, the indigent, and the dying. Who we will be in the face of death will have a lot to do with what we have come to believe about life, with the values we have upheld, with the attitudes we have taken, and with the habits of thought and behavior we have formed. So we need not be victims of what dying has in store for us. Rather, we can engage our dying by developing those habits of the heart which will make a difference in the way we adapt to unwanted circumstances and endure what we cannot change. We cannot develop strength of character if we are not nurtured by a community of character. In addition to personal character, we also need to be a community that gives witness to those fundamental religious and moral convictions which shape our living and dying in ways that would make euthanasia unthinkable. PMID- 10139334 TI - The moral case against euthanasia. Catholics must articulate persuasive arguments to counter the cultural rush toward assisted suicide. AB - Catholics who adhere to a consistent ethic of life are going to face tougher opposition as they struggle to defend society's most vulnerable members. The major ethical contention will concern the ethics of dying. Unfortunately, there have not been well-articulated moral arguments to counter society's rush toward physician-assisted suicide and euthanasia. Catholics must articulate a persuasive ethical ideal for dying a truly good death. It is crucial to achieve a balance: between valuing individual autonomy and protecting the common good; between affirming the goodness of life and accepting death as a reality of the life cycle. Another challenging piece of the moral argument lies in convincing people that the means and processes used to achieve a goal are rarely neutral. Another serious problem with permitting the killing of self or others is that one cannot ever be certain of the agent's motivation. And when an individual's subjective determination of a need to choose death is given ultimate validity, there is no way to call a halt. If medical mercy killing becomes acceptable, social pressure can mount for an ill person to ask for death to relieve the family burdens. Maintaining an absolute prohibition against actively taking a human life--self or other, with or without consent, dying or not--is necessary to protect human communal bonds. PMID- 10139335 TI - After the shaking stops. Catholic healthcare workers should prepare for seismic changes. AB - In an attempt to cap spiraling costs and remain competitive, both providers and insurers are going through a frenzy of consolidation. Experts are predicting these changes: The integrated delivery system (IDS) will be the prevailing type of healthcare organization. There will be fewer acute care beds and fewer hospitals. Hospitals will be subsidiary to IDSs. Catholic and non-Catholic providers will join together to form IDSs. Regional IDSs will join statewide networks. The Catholic healthcare ministry can survive in such an era of consolidation if its leaders (1) collaborate with others on a basis of shared values, (2) have a well-defined mission, (3) provide holistic care, and (4) ensure that the organization remains true to its mission and demonstrates core values in its decisions and behaviors. Sponsors will need to find ways to share management of IDSs with non-Catholic organizations; to collaborate in the formation of regional and statewide IDSs; to urge other Church leaders to support social justice, human dignity, and community service; to be mindful of the stresses these changes will place on physicians and employees; to encourage dialogue about other changes in religious life; and to prepare laypersons to be their successors in the leadership of Catholic healthcare. PMID- 10139336 TI - The future is local. Interview by Judy Cassidy. PMID- 10139337 TI - Rejecting the myth of scarcity. Sponsors of rural healthcare ministries must learn to be pioneers again. PMID- 10139338 TI - Between two waves. Catholic healthcare providers must value their tradition and embrace the future. AB - By paying attention to our personal individuation process, our inner work, we can better deal with whatever the world presents. Much of the chaos healthcare is experiencing today is because we are currently trying to become more conscious both individually and organizationally. The future of Catholic healthcare is in recognizing the call, the challenge, the moral imperative to facilitate the creation of healthy communities. We must reflect on and understand health not as a commodity, but rather as both a process and a state of being that is at once personal and collective. In indigenous cultures there has always been an understanding of the deep connection between personal and community health and between spiritual, mental, and physical health. The current synchronistic shift from professional-directed, acute care to an awareness of how the individual psyche and society in general influence health and well-being is spurring Americans to focus on mind-body and healthy-community concepts. If we can "stay present" to the mission of healthcare-keep people well, prevent disease, deal with the causes and symptoms of illness, create healthy communities-we will have a future in healthcare delivery. We can do this by being healthy ourselves, recognizing our global responsibility for health, and providing direct services. PMID- 10139339 TI - Coopetition: the wave of the future. Catholic healthcare providers must work with others to remain viable. PMID- 10139340 TI - 1920-1995. What's past is prologue. 75 years of Health Progress: providing a foundation for the future. PMID- 10139341 TI - Hawaiian hospital communicates through outreach programs. PMID- 10139342 TI - Emergency care episodes: an economic profile. AB - A new "episode of care" definition of emergency care was developed, consisting of the emergency department encounter and all subsequent, related care delivered within 48 hrs from the initial contact. Data were analyzed by ICD-9-CM Major Diagnostic Category (MDC) and surgical intervention using 1.6 million episodes generated by 809,145 separate patients from a national claims database. Secondary/adjunct services were a major component of episode charges. For several MDCs, hospitalization and/or surgical procedures were also major determinants of overall episodic charges. Results support the premise that economic analysis and reimbursement of emergency care benefits from the use of episodic data. PMID- 10139343 TI - Cost-effectiveness: the case of home health care physician services in New Brunswick, Canada. AB - Home health care programs have direct and indirect effects within a health care system. A complete cost-benefit evaluation would include all such effects. A study of New Brunswick's Extra-Mural Hospital (EMH) home health care program used population-based administrative data on physician services utilization to examine whether home care services act indirectly as substitutes for physician services. Evidence suggests that the introduction and expansion of New Brunswick's EMH home health care program had unanticipated substitution effects, which reduced health system costs by reducing the rate of growth of per-capita utilization of physician services. PMID- 10139344 TI - Cost-effectiveness in ambulatory care: alternative approaches. AB - By relating health care resources and their use to health outcomes, through a coherent macro resource allocation framework, one can examine the health care system for allocative efficiencies. In this article, costs and outcomes are analyzed in such a framework, scenarios for optimizing the use of health care resources--while still maintaining existing health outcomes--are explored, and the implications for ambulatory care are discussed. The research clearly shows that much can be done to make health care systems more efficient without jeopardizing health outcomes. PMID- 10139345 TI - Consumer-sponsored health centers and health reforms in Canada. AB - The community health center movement, begun in Saskatchewan, is central to successsfully reforming the Canadian health care system. The arguments of 30 years ago are relevant today. Canadian Medicare is at the crossroads. The evidence shows that the provision of primary health care through community health centers is cost effective and that the quality of care is at least as high in these settings as in traditional fee-for-service settings. Each province must encourage the development of a network of community health centers capable of providing services to every resident who wishes to receive all of his or her primary care "under one roof." PMID- 10139346 TI - HMO outcomes research: lessons from the field. AB - This article examines the field of outcomes research from the perspective of a managed care organization, The Fallon Healthcare System, currently involved in many different types of studies. Outcome studies are characterized by the types of questions they examine. The cost and labor implications for each category are examined. Finally, a partnership among different participants in the outcome research field, including managed care organizations, academic institutions, and pharmaceutical companies, is proposed. PMID- 10139347 TI - Designing and using measures of quality based on physician office records. AB - This article presents our principles for developing performance measures to assess the quality of ambulatory care. The measures were developed as part of a project for developing and evaluating methods to promote ambulatory care quality (DEMPAQ). We describe our design for the performance measures, present examples of the DEMPAQ review criteria, and show the formats we used to feed back information to physicians. We conclude by presenting the results of our appraisal of the performance measures showing how evaluation can aid in the interpretation of measurement findings. PMID- 10139348 TI - Relationships of patient satisfaction with experience of system performance and health status. AB - This article investigates the relationship between three types of measures obtained from consumer surveys: satisfaction, health status, and report of systems performance. Analyses demonstrate that patient reports of the quality of processes of care or system performance (such as receiving results of tests or receiving conflicting information from staff members) are significantly related to satisfaction independently of perception of health status. Since dissatisfaction is known to be associated with disenrollment, patient reports of system performance are of great interest to health plans. PMID- 10139349 TI - Ambulatory care and the law: lien claims where none exist as of right. AB - The health care provider, whether an individual or an institution, needs to pay attention to appropriate mechanisms to ensure payment for services or repayment for benefits provided. While statutes provide some protection for large institutions, including health care providers, individual health care providers often are left to their own devices. The employment of a well drafted voluntary lien agreement can not only secure a right of recover against a patient, but where the patient pursues a personal injury claim through an attorney, can also give the health care provider recourse to patient's attorney. Knowing how to assert these liens, what funds are reachable by these lien, and what time factors must be adhered to in order to make the liens effective, are vital to a health care provider's financial well-being. PMID- 10139350 TI - Doctors rate the big HMOs. PMID- 10139351 TI - Doctors want to be behind the wheel of managed care. Illinois State Medical Society. PMID- 10139352 TI - Euthanasia promises Marcus Welby, but gives us Jack Kevorkian. PMID- 10139353 TI - What it takes to consummate a merger. PMID- 10139354 TI - How groups discipline problem doctors. PMID- 10139355 TI - I loved our new physician assistant--for 13 days. PMID- 10139356 TI - A surgeon goes to the U.S. Senate. Interview by Mark Crane. PMID- 10139357 TI - HCFA report card: where CLIA (Clinical Laboratory Improvement Amendments of 1988) stands. PMID- 10139358 TI - Stat testing, Part 1. Stats: Tolerable for some, a major headache for others. PMID- 10139359 TI - Stat testing, Part 2. Stat testing triumphs and disappointments. PMID- 10139360 TI - When drawing blood draws questions. PMID- 10139361 TI - A computerized approach to QA. PMID- 10139362 TI - Improving customer service by empowering staff. PMID- 10139363 TI - The instant M.B.A.: software to help manage staff. PMID- 10139364 TI - Is it harassment, or just 'horsing around'? PMID- 10139365 TI - Organizational structure and total quality management in the patient accounting environment. PMID- 10139366 TI - Elements and strategies of an effective provider integration strategy. AB - Regardless of the outcome of the debate in our nation's capitol, a health care revolution is sweeping the nation. In fact, if the debate lasts much longer, policy makers will be playing catch-up and responding to policies already in place in the trenches. Everywhere we turn as health care leaders, there is evidence of major change on the horizon. Reimbursement methodologies are undergoing radical alteration, traditionally stable institutions are being challenged, new organizational models are evolving, the types and roles of providers best suited to provide care are being questioned, and consumer expectations are being heightened. One of the basic strategies that is receiving attention throughout the country as a response to all this change relates to the development of integrated delivery organizations (IDO), integrated delivery systems (IDS), or integrated delivery networks (lDN). This article discusses these emerging systems in terms of health care reform, describes the rationale for their creation, and provides some strategies for their successful development. PMID- 10139367 TI - Hospitals' newest challenge: designing in quality. AB - The job of producing high-quality products is even more difficult for health care providers than it is for those in manufacturing, where the quality movement began. As a part of the service industry, health care providers are in the position of producing products and delivering services at the moment of sale. Our task is to improve the quality of all of these simultaneous and interrelated processes. Traditionally, health care providers have made efforts to improve their products and services without realizing the impact that could be made by also improving resources, processes, and outcomes. This article is an overview of the new direction we have been taking: Retrospective review. Critical pathways. Building quality into all areas (resources, processes, products and services, and outcomes). Focused study of outcomes). We foresee a further evolution that will lead to exciting new methods for understanding and delivering high-quality care. PMID- 10139368 TI - The new production theory for health care through clinical reengineering: a study of clinical guidelines--Part I. AB - Drucker writes that the emerging theory of manufacturing includes four principles and practices: statistical quality control, manufacturing accounting, modular organization, and systems approach. SQC is a rigorous, scientific method of identifying variation in the quality and productivity of a given production process, with an emphasis on improvement. The new manufacturing economics intends to integrate the production strategy with the business strategy in order to account for the biggest portions of costs that the old methods did not assess: time and automation. Production operations that are both standardized and flexible will allow the organization to keep up with changes in design, technology, and the market. The return on innovation in this environment is predicated on a modular arrangement of flexible steps in the process. Finally, the systems approach sees the entire process as being integrated in converting goods or services into economic satisfaction. There is now a major restructuring of the U.S. health care industry, and the incorporation of these four theories into health care reform would appear to be essential. This two-part article will address two problems: Will Drucker's theories relate to health care (Part I)? Will the "new manufacturing" in health care (practice guidelines) demonstrate cost, quality, and access changes that reform demands (Part II)? PMID- 10139369 TI - The business plan to manage high-damage liability lawsuits. AB - The material in this article is based on the concept of a business plan. Commonly used by business organizations, a business plan is a written document that provides the blueprint for development of a business concept, such as a product or a service. It includes a description of the business idea itself and an explanation of how the originators of the idea will develop the idea into a money making venture. The development aspect of the business plan is known as a strategy. As applied to managing lawsuits, a business plan may also be defined as a blueprint. What is described here demonstrates how the elements or components of a business plan may be adapted to gain advantages in active litigation, particularly in high-damage cases. In order for their working relationship to be most effective, both defense counsel and client should follow the methodology outlined in this article. PMID- 10139370 TI - Hospital and medical staff strategic planning: developing an integrated approach. AB - The physician as the principal customer of the hospital is a relatively new concept, indicative of the shift to a more complete market orientation in strategic planning. Although medical staff and medical community dynamics receive increasing attention in strategic planning, much more sophistication is now needed to involve physicians constructively in strategic planning for the hospital and medical staff. While full consonance of physician and hospital plans may be achievable only in a completely integrated delivery system, there is considerable room for improvement in current organizational models. PMID- 10139371 TI - Models for medical practice integration. AB - Decreased physician income, increased administrative burdens, and interference with the compassionate delivery of high-quality medical care are threatening the independent practice of medicine in solo and small group practices. Many established physicians, and the hospitals with which they relate, are searching for organizational models that, by integrating some or all aspects of their practices, will preserve incomes and reduce regulatory and administrative burdens. This article will describe several "practice integration models," pointing out advantages and disadvantages to physicians in established practices. (Many of the same arguments could be made for physicians new to practice, with different emphasis). The continuum of integration models is shown in figure 1, page 19. The group practice without walls and its two submodels, the independent group practice without walls (IGWW) and the affiliated medical practice corporation (AMPC) are more recent and more effective models and will be covered in depth in the article. PMID- 10139372 TI - Practice guidelines. Cookbook medicine. AB - A large measure of the confusion and doubt currently being sowed in the ongoing debate over the advisability and effectiveness of practice guidelines is a matter of terminology. In deference to the wishes and fears of physicians, the term "requirements" is not used. But requirements they are. Their quality and the degree to which they are useful will depend on their level of detail and the degree to which they are based on positive outcomes. Regardless, attorneys and others will always view and use them as requirements. PMID- 10139373 TI - The appointment-keeping habits of managed care patients. AB - Among the controversies surrounding the provision of health care in a managed care environment is the belief that patients, because they have no particular allegiance to a single physician, are more casual in regard to their keeping appointments. To test this proposition, the authors conducted a study at a California independent practice association, comparing the habits of managed care patients with those of other types of patients. The findings, although based on a limited sample, suggest that managed care patients do indeed have a greater tendency to be appointment no-shows. PMID- 10139374 TI - Constitutional rights versus malpractice insurance settlements. AB - The increasing costs and complexity of malpractice litigation have created an statutory right that allows malpractice insurance companies to settle malpractice claims regardless of the desires of the defendant physician. In the past, the consequences of settling a malpractice claim out of court were not as important as they are today. The Health Care Quality Improvement Act of 1986 mandates that any settlement in behalf of a physician be documented in the National Practitioner Data Bank (NPDB), which must be consulted every time the physician is credentialed. This NPDB requirement denies due process to health care providers and thus becomes a violation of the federal and many state constitutions. Physician executives and medical leaders must bring these issues to the table and negotiate solutions before damage to practicing physicians and the U.S. health care delivery system caused by this legal paradox become too severe. PMID- 10139375 TI - Reducing the error rate in Papanicolaou smears. One laboratory's experience with the PAPNET system. AB - False-negative Papanicolaou smears not only endanger the patient's life, but may also lead to legal problems for the clinician. The PAPNET interactive computerized system has been shown to reduce the false-negative rate in the author's laboratory, and disclosed the presence of atypical or cancerous cells in prior false-negative smears in a number of patients with invasive carcinoma. PMID- 10139376 TI - Reconciling rights with responsibility. PMID- 10139377 TI - Reducing waste and costs in the operating room. PMID- 10139378 TI - Secrets to effective cost management: reduce, recycle, reuse. PMID- 10139379 TI - Tandem plants fine tuned to reduce costs. PMID- 10139380 TI - Perspectives. "Fix it or forget it": the JCAHO in crisis. PMID- 10139381 TI - Breakthrough in cash collections for hospitals. PMID- 10139382 TI - Keeping the hospital secure. PMID- 10139383 TI - The new appeal of primary care. PMID- 10139384 TI - Where have the medical transcriptionists gone? PMID- 10139385 TI - Telecommuting in transcription. PMID- 10139386 TI - Saving time and paper: are we compromising confidentiality? PMID- 10139387 TI - Financial, legal, and operational perils of managed care contracting. PMID- 10139388 TI - Utilization management and healthcare reform. AB - The reform movement in healthcare is occurring in response to financial pressures on American business. The trend toward managed care with competition-based discounting and capitation contracts is likely to continue even if Congress does not enact healthcare reform legislation. Efficient management of resources with acceptable outcomes and customer satisfaction is becoming increasingly crucial. As cost-shifting options are reduced, accurate knowledge and management of resource consumption costs become critical to enable hospitals to assume the financial risks associated with competing in any future capitation area. Hospitals must consider altering their approach to utilization management and business as usual to survive these changes. PMID- 10139389 TI - Coordinating functional chapters of the Joint Commission and performance for departments and teams. AB - This article reviews the structural changes of the Joint Commission's accreditation manual and relates how organizations can provide documentation that illustrates departmental, team, or hospital-wide efforts to improve quality. The tools reviewed in this article capture systematic performance improvement across functions and departments and include team activity. The tools also can be used as reporting documents to the governing body. PMID- 10139390 TI - Developing a hospital report card to demonstrate value in healthcare. AB - The Sisters of Charity Health Care Systems, Inc., (SCHCS) developed methods to collect more than 290 data elements from its 15 hospitals to measure community benefit, illness prevention, patient satisfaction, severity of illness, appropriateness, traditional quality measures, outcome measures, maternal/child services, psychiatric services, efficiency, financial performance, and risk management. The data were compiled to produce a report card called the Hospital Quality Profile, which SCHCS hospitals now use for strategic quality planning, assessment, and monitoring. Collaboration between quality management, information systems, and financial department personnel is critical to the success of such a quality database. PMID- 10139391 TI - Continuous quality improvement at work: the first team--Part II. AB - This second part of a two-part article follows Cape Canaveral Hospital's first continuous quality improvement team through the processes of goal setting, system analysis, data gathering, and problem resolution in the area of patients' assignment to observation status. The team's primary goal was data-driven improvement. As detailed here, the team's solution to improve the use of observation status is both time-efficient and offers opportunities for financial gain. PMID- 10139392 TI - Using flowcharts in policy development: reporting abuse and neglect of patients. AB - Reports of abuse, both domestic and institutional, are increasingly common. A myriad of statutes and rules govern when and how incidents of abuse are reported. It is incumbent upon medical centers to establish policies that clearly outline the responsibility of all staff members to identify and report suspected abuse and neglect. This article presents a summary of a comprehensive hospital policy on identifying and responding to all types of suspected or witnessed abuse and neglect of patients. It also illustrates how multidisciplinary teams and flowcharts can be useful in developing and implementing policy in complicated areas that involve many players, rules, and regulations. PMID- 10139393 TI - Special report. A new comparison of nine public and private purchasing alliance initiatives. PMID- 10139394 TI - Improving care in group practices and group-model HMOs. PMID- 10139395 TI - Driving the quality transformation: what's missing? AB - Around the country, healthcare providers are using the tools of continuous improvement to redesign patient care, match customer needs with available resources, and make management decisions based on data-driven analyses of key processes. Initiatives such as these are producing positive changes within healthcare organizations, but two serious barriers all but preclude improvement at the system level: a compensation process that punishes innovation and the emergence of integrated care systems that lack a common vision. Unless these barriers can be removed, insists the author, healthcare providers ultimately will be unsuccessful in their effort to improve value for their customers. PMID- 10139396 TI - Population-based health improvement: Group Health Cooperative's eight-step process. PMID- 10139397 TI - Managed care and labor issues: Part I--Termination issues. AB - The intent to expand, shrink, reorganize, or redistribute will have vastly different effects on an organization's workforce. In this article, the author discusses employment law issues in general as they apply to managed care organizations that have both unionized and nonunionized employees. PMID- 10139398 TI - Lessons learned: health reform in the Czech Republic. PMID- 10139399 TI - Health care "down under". PMID- 10139400 TI - Variations in state health care costs. PMID- 10139401 TI - Merging the medical and pharmacy databases: barriers and implications. PMID- 10139402 TI - The trend towards capitation: the basis for the movement. AB - With the trend towards integrated health delivery systems gaining momentum, more health plans and joint ventures are considering capitation as the payment method of choice to physicians, specialty contractors, and other suppliers of health care services. This first article of a two-part series examines the basis for the capitation movement. PMID- 10139403 TI - Implications of disease management in the future of managed care. AB - Disease management holds the promise of profound improvement in the care presently delivered to sufferers of specific diseases and provides the potential for a marked reduction in both short- and long-term health care costs. It has created an excitement that has formed new partnerships, caused managed care organizations to alter their focus, and encouraged the pharmaceutical industry to spend its wealth of resources on the total well-being of the patient. The authors address the somewhat ambiguous definition of disease management and examine the essential elements required to successfully implement programs of this nature. PMID- 10139404 TI - A conversation with Michael Freeman, MD. AB - The Institute for Behavioral Healthcare, a nonprofit organization that serves as an informational resource on issues surrounding the delivery of Behavioral Health Care Services, has been directed by Dr. Michael Freeman since its inception in 1988. In this crucial, unstable period in health care, membership in the Institute and attendance at its sponsored meetings has increased dramatically. Recently, Medical Interface talked with Dr. Freeman about topics of interest to the behavioral health care industry, ranging from any willing provider laws to the benefit itself. PMID- 10139405 TI - Managed care transforming workers' compensation market. PMID- 10139406 TI - User-friendly CQI for the mental health care team. AB - Past efforts in continuous quality improvement (CQI) have focused on the rigor of CQI indicators and the reliability of data collection, with little consideration about organizational characteristics of the team required to carry out the CQI plan. It is crucial that evaluators who set up CQI procedures for inpatient mental health care consider characteristics of the treatment team responsible for carrying out CQI recommendations. In this article, the authors discuss a paradigm for user-friendly CQI based on program development efforts made in Illinois State Hospitals. PMID- 10139407 TI - Appraising clinical guidelines: towards a "which" guide for purchasers. PMID- 10139408 TI - Clinical complaints: a means of improving quality of care. AB - OBJECTIVES: To establish the reasons for clinical complaints, complainants' feelings about the original incident, and their motivation in complaining. DESIGN: Postal questionnaire survey. SETTING: 24 hospitals in North West Thames region. SUBJECTS: 1007 complainants who had written to 20 hospitals between 1 January 1992 and 30 June 1993 about a complaint involving a clinical incident. MAIN MEASURES: Personal details, the nature of the complaint, the complainant's reaction to the original incident, the quality of the explanation at the time of the incident, the reasons for making a complaint, and what would have prevented the incident. RESULTS: 491 completed questionnaires were received (response rate 49%). Complaints arose from serious incidents, generally a clinical problem combined with staff insensitivity and poor communication. Clinical complaints were seldom about a clinical incident alone (54; 11%); most (353; 72%) included a clinical component and dissatisfaction with personal treatment of the patient or care. In all, 242(49%) complainants reported a need for additional medical treatment, 206(42%) reported that the patient's condition had worsened as a result of treatment, and 175(36%) that side effects had been experienced. In 26(5%) cases the patient had died. Complainants' primary motive was to prevent recurrence of a similar incident. Lack of detailed information and staff attitude were identified as important criticisms. CONCLUSIONS: The emphasis must be on obtaining a better response to complaints at the clinical level by the staff involved in the original incident, not simply on adjusting the complaints procedure. Staff training in responding to distressed and dissatisfied patients is essential, and monitoring complaints must form part of a more general risk management programme. PMID- 10139409 TI - Community asthma clinics: 1993 survey of primary care by the National Asthma Task Force. AB - OBJECTIVES: To establish a baseline of work done in primary care asthma clinics in the United Kingdom and to assess the degree of clinical delegation to nurses and the appropriateness of their training. DESIGN: Prospective questionnaire survey of asthma care in general practices and a subsidiary survey of all family health services authorities (FHSAs) of the number of asthma clinics in their area. SETTING: All 14,251 general practices in the United Kingdom and 117 FHSAs or health boards (Scotland and Northern Ireland). RESULTS: Questionnaires were returned by 4327 (30.4%) general practices, 54% being completed by practice nurses and 22% by general practitioners; in 24% profession was not stated. In all, 77.2% (3339/4327) of respondents ran an asthma clinic. 60 FHSAs state the number of asthma clinics at the time of the general practice survey (total 3653 clinics); within responding FHSAs 1702 (46.6%) practices running an asthma clinic replied to the general practice survey. Clinics exclusive for patients with asthma mostly occurred in practices with five or more general practitioners (70.2%), compared with single-handed practices (31.7%). The average number of asthma clinics run per practice was five a month; the average duration was 2 hours and 20 minutes. 1131 (48.8%) nurses ran clinics by themselves, 1180 (47.9%) with the doctor, and 39 (1.7%) had no medical input. Comprehensive questioning occurred other than for nasal (872, 26.1%) or oesophageal (335, 10.0%) symptoms and use of aspirin and non-steroidal drugs (1161, 33.4%). Growth in children was measured by only a third of respondents. Of the 1131 nurses who ran clinics alone, 251 (22.2%) did so without formal training entailing assessment. CONCLUSION: Asthma clinics are now common in general practice and much of their work is done by nurses, a significant minority of whom may not have had sufficient training. IMPLICATIONS: As this survey is probably biased toward the more asthma aware practices, greater deficiencies in training and standards may exist in other practices. Further evaluation of the effectiveness of asthma clinics is needed. PMID- 10139410 TI - Assessing discomfort after anaesthesia: should you ask the patient or read the record? AB - OBJECTIVE: To assess the quality of anaesthesia care from the patients' viewpoint compared with the hospital record. DESIGN: Prospective study during 1988-9. SETTING: Four teaching hospitals (A-D) in Canada. PATIENTS: 15,960 inpatients receiving anaesthetic requiring at least an overnight stay, for whom an interview and review of hospital records within 72 hours of surgery were complete. MAIN MEASURES: Rates of postoperative symptoms of discomfort (nausea or vomiting, headache, back pain, sore throat, eye symptoms, and tingling) according to the hospital record versus interview and the relation between symptoms and patients' satisfaction with the anaesthetic experience. RESULTS: The preparation of completed interviews ranged from 31.0% to 72.7%, owing mainly to patients discharge (hospitals A and B) and severity of illness (C and D). Interviewed patients were similar to all inpatients in the hospitals but were younger and healthier and more had had effective operations and were general surgical than cardiovascular or neurosurgical patients. In all, 26% to 46% of patients at the four hospitals reported at least one symptom of discomfort. Agreement between interviews and hospital records was low, symptoms being more commonly reported by interview than in the record (for example, headache was reported for 5.8%-17% of patients compared with 0.3%-3.0% in hospital records). After controlling for case mix patients who reported at least one symptom were 2.91 times (95% confidence interval 1.89 to 4.50) more likely to be dissatisfied with their anaesthetic care than patients who did not. CONCLUSIONS: Anaesthesia services are typically neglected in studies of hospital quality, yet patients express considerable anxiety about anaesthetic care. Monitoring and recording patients' discomfort clearly need to be improved if the quality of anaesthesia is to be properly evaluated. PMID- 10139411 TI - Sending parents outpatient letters about their children: parents' and general practitioners' views. AB - Parents' cooperation is essential to ensuring implementation of effective healthcare management of children, and complete openness should exist between paediatricians and parents. One method of achieving this is to send parents a copy of the outpatient letter to the general practitioner (GP) after the child's outpatient consultation. To determine the views of parents and GPs a pilot survey was conducted in two general children's outpatient clinics in hospitals in Newcastle upon Tyne. In March and April 1991 a postal questionnaire was sent to 57 parents of children attending the clinics, and a similar questionnaire to their GPs to elicit, respectively, parents' understanding of the letter and perception of its helpfulness, and GPs' views on the value of sending the letters to parents. Completed questionnaires were received from 34(60%) parents and 47(82%) GPs; 26(45%) respondents were matched pairs. 27(79%) parents said they understood all of the letter, 19(56%) that it helped their understanding, 32(94%) felt it was a good idea, and 31(91%) made positive comments. In all, 29(61%) GPs favoured the idea and six (13%) did not. Eleven (23%) said they would be concerned if this became routine practice, and 20(74%) of the 27 providing comments were doubtful or negative; several considered that they should communicate information to parents. The views in the matched pairs were dissimilar: parents were universally in favour whereas many GPs had reservations. The authors concluded that sending the letters improved parents' satisfaction with communication, and they recommend that paediatricians consider adopting this practice. PMID- 10139412 TI - Quality improvement by peer review in primary care: a practical guide. PMID- 10139413 TI - Improving quality of health care: the role of pharmacists. PMID- 10139414 TI - Quality of life of long wait orthopaedic patients before and after admission: a consumer audit. PMID- 10139415 TI - Multidisciplinary audit in primary healthcare teams: facilitation by audit support staff. PMID- 10139416 TI - Cardiac rehabilitation services: the need to develop guidelines. PMID- 10139417 TI - Streamlining environmental safety in the operating room: a common bond between surgeons and hospital engineers. AB - The operating room presents environmental safety concerns unlike any problems in other parts of a health care facility. Special disciplines must be utilized to ensure that risk is minimized during surgery. This document addresses the needs of both the surgeon and the plant engineer in order for both groups to learn more about the other's concerns and problems. PMID- 10139418 TI - AIDS, science and the totem. PMID- 10139419 TI - Scientific surveillance and the control of AIDS: a call for open debate. AB - This paper reviews some of the history of AIDS in order to put into perspective the claim that AIDS is or will be the pandemic plague of the twentieth century. It is concluded that AIDS shows a relatively stable and predictable pattern in the developed world, and that open and unbiased debate about AIDS is long overdue. PMID- 10139420 TI - AIDS policy response in New Zealand: consensus in crisis. AB - Typically, Western governments have aimed to construct consensus over HIV/AIDS policy. The history of policy formation in New Zealand is examined, and is found to reflect the general pattern. There was a deliberate strategy designed to establish the broadest possible consensus. However, partly because of this breadth, the consensus was nevertheless fraught with contradiction and tension. PMID- 10139421 TI - Cost-effectiveness analysis of health care services, and concepts of distributive justice. AB - Two answers to the question 'how can we allocate health care resources fairly?' are introduced and discussed. Both utilitarian and egalitarian approaches are found relevant, but both exhibit considerable theoretical and practical difficulties. Neither seems capable of solving the problem on its own. It is suggested that, for practical purposes, a version of Rawls' famous thought experiment might provide at least some enlightenment about which theoretical approach should be used to address the question. PMID- 10139422 TI - Analysing ethics. Ethical praxis. PMID- 10139423 TI - Critique. The silence of philosophy. PMID- 10139424 TI - A blue-print for complaining in the NHS. PMID- 10139425 TI - Casemix information, health care funding and nursing. PMID- 10139426 TI - Decision-making in intensive care--a reply to Sundstrom. PMID- 10139427 TI - The artificial and elusive demarcation between health and disease. PMID- 10139428 TI - International comparisons of health care systems: Part four. The necessity of articulating the political dimensions of medical systems. The case for contemporary national systems comparison. PMID- 10139429 TI - Alternative models of the AIDS epidemic. PMID- 10139430 TI - Eleven years of house calls: a description of a family practice residency program's experience from 1981-1992 with an urban home visit program for the elderly. PMID- 10139431 TI - A proposed academic program for pediatric home health. PMID- 10139432 TI - Japan's current experiment in care of the elderly. PMID- 10139433 TI - Medical devices; substantial equivalence; 510(K) summaries and 510(K) statements; class III summaries; confidentiality of information--FDA. Final rule. AB - The Food and Drug Administration (FDA) is issuing this final rule to implement the provisions of the Safe Medical Devices Act of 1990 (the SMDA) that require all persons who submit a premarket notification (510(k)) to provide to FDA, as part of the submission, an adequate summary (510(k) summary) of any information respecting safety and effectiveness or a statement (510(k) statement) that such information will be made available upon request by any person. This rule also implements the requirement of the SMDA that 510(k) submitters claiming substantial equivalence to a class III preamendments device for which FDA has not yet called for premarket approval submit a class III summary and certify that they have conducted a search of safety and effectiveness data. In addition, this rule amends the device regulations governing the confidentiality of certain premarket notification submissions to conform to the SMDA. This rule also provides that persons who submit a premarket notification must certify that, to the best of their knowledge, all information is truthful and accurate and that no material fact has been omitted. PMID- 10139434 TI - Child support enforcement program: paternity establishment and revision of child support enforcement program and audit regulations--Office of Child Support Enforcement. Final rule. AB - This final rule contains provisions regarding both paternity establishment and the audit. The paternity establishment provisions implement the requirements of section 13721 of the Omnibus Budget Reconciliation Act of 1993 (OBRA '93) signed by the President on August 10, 1993, which amends title IV-D of the Social Security Act (the Act). These provisions require States to adopt procedures for a simple civil process for the voluntary acknowledgement of paternity, including early paternity establishment programs in hospitals. For paternity cases that remain contested, the statutory provisions require States to adopt a variety of procedures designed to streamline the paternity establishment process. These include the use of default orders, a presumption of paternity based on genetic test results, conditions for admission of genetic test results as evidence, and expedited decision-making processes for paternity cases in which title IV-D services are being provided. In addition, this final regulation amends the Child Support Enforcement program regulations governing the audit of State Child Support Enforcement (IV-D) programs and the imposition of financial penalties for failure to substantially comply with the requirements of title IV-D of the Act. This regulation specifies how audits will evaluate State compliance with the requirements set forth in title IV-D of the Act and Federal regulations, including requirements resulting from the Family Support Act of 1988 and section 13721 of OBRA '93. This final regulation also redefines substantial compliance to place greater focus on performance and streamlines Part 305 by removing unnecessary sections. PMID- 10139435 TI - Implementation of Pro-Children Act of 1994--HHS. Notice to prohibit smoking in certain facilities. AB - The Department of Health and Human Services announces the implementation of the Pro-Children Act of 1994, which prohibits smoking in certain facilities in which education, library, day care, health care and early childhood development (including WIC and Head Start) services are provided to children. In accordance with section 1043(d) of the Act, the Secretary of Health and Human Services is publishing the prohibitions which restrict smoking in certain indoor facilities. PMID- 10139436 TI - Medicare program; refinements to geographic adjustment factor values, revisions to payment policies, adjustments to the relative value units (RVUs) under the physician fee schedule for calendar year 1995, and the 5-year refinement of RVUs- HCFA. Correction of final rule with comment period. AB - This document corrects technical errors that appeared in the final rule with comment period published in the Federal Register on December 8, 1994 (59 FR 63410) entitled "Medicare Program; Refinements to Geographic Adjustment Factor Values, Revisions to Payment Policies, Adjustments to the Relative Value Units (RVUs) Under the Physician Fee Schedule for Calendar Year 1995, and the 5-Year Refinement of RVUs." PMID- 10139438 TI - Harry, Louise and doublespeak. PMID- 10139437 TI - They make House (and Senate) calls. PMID- 10139439 TI - Long-term problem. PMID- 10139440 TI - Lost cause. AB - Cost containment was supposed to be a major goal of health care reform. Now, it's been all but forgotten--thanks in large measure to aggressive lobbying by health care industry interests. PMID- 10139441 TI - Looking for explanations. PMID- 10139442 TI - New enforcement rules clarify OBRA. PMID- 10139443 TI - New Congress likely to target Medicaid. PMID- 10139444 TI - Making 1995 the year of enhancement. PMID- 10139445 TI - What healthcare issues should Congress address? PMID- 10139446 TI - A dream of one's own. Residents get what they wish for in this activities program. PMID- 10139447 TI - The states of the union. PMID- 10139448 TI - Battling bacteria. PMID- 10139449 TI - HCFA's new take on substandard care. PMID- 10139450 TI - Loans: a thousand and one options. PMID- 10139451 TI - Catholic healthcare leadership program. PMID- 10139452 TI - Reflections on World Day of the Sick. PMID- 10139453 TI - Continuous quality improvement: a cooperative project. PMID- 10139454 TI - Innovative approach to health and wellness. PMID- 10139455 TI - Spiritlinking: a key to the future. PMID- 10139457 TI - State and province survey. PMID- 10139456 TI - Emergency Medical Services. 1995 gold book/buyer's guide. PMID- 10139458 TI - Organizations. PMID- 10139459 TI - Music, mud & medicine. Woodstock '94: a maniacal, musical mass-casualty incident. PMID- 10139460 TI - Deputy Chief Bob Derr. A South Carolina fire chief/paramedic launches ambulances for Bosnia. PMID- 10139461 TI - Bosniabound. A Pittsburgh trauma surgeon risks her life to help save others. PMID- 10139462 TI - War without glory. PMID- 10139463 TI - Man vs. tree. PMID- 10139464 TI - A penetrating dilemma. PMID- 10139465 TI - Burn free. Are you prepared for the "fire of the future"? PMID- 10139466 TI - Triage of a holocaust. PMID- 10139467 TI - Hermann Hospital campaign: employees set the pace. PMID- 10139468 TI - Charting a course for success. PMID- 10139469 TI - Reforming the health sector in developing countries: the central role of policy analysis. AB - Policy analysis is an established discipline in the industrialized world, yet its application to developing countries has been limited. The health sector in particular appears to have been neglected. This is surprising because there is a well recognized crisis in health systems, and prescriptions abound of what health policy reforms countries should introduce. However, little attention has been paid to how countries should carry out reforms, much less who is likely to favour or resist such policies. This paper argues that much health policy wrongly focuses attention on the content of reform, and neglects the actors involved in policy reform (at the international, national sub-national levels), the processes contingent on developing and implementing change and the context within which policy is developed. Focus on policy content diverts attention from understanding the processes which explain why desired policy outcomes fail to emerge. The paper is organized in 4 sections. The first sets the scene, demonstrating how the shift from consensus to conflict in health policy established the need for a greater emphasis on policy analysis. The second section explores what is meant by policy analysis. The third investigates what other disciplines have written that help to develop a framework of analysis. And the final section suggests how policy analysis can be used not only to analyze the policy process, but also to plan. PMID- 10139470 TI - Donor funding for health reform in Africa: is non-project assistance the right prescription? AB - During the past 10 years, donors have recognized the need for major reforms to achieve sustainable development. Using non-project assistance they have attempted to leverage reforms by offering financing conditioned on the enactment of reform. The experience of USAID's health reform programmes in Niger and Nigeria suggest these programmes have proved more difficult to implement than expected. When a country has in place a high level of fiscal accountability and high institutional capacity, programmes of conditioned non-project assistance may be more effective in achieving reforms than traditional project assistance. However, when these elements are lacking, as they were in Niger, non-project assistance offers nothing inherently superior than traditional project assistance. Non-project assistance may be most effective for assisting the implementation of policy reforms adopted by the host government. PMID- 10139471 TI - Controlling schistosomiasis: the cost-effectiveness of alternative delivery strategies. AB - Sustainable schistosomiasis control cannot be based on large-scale vertical treatment strategies in most endemic countries, yet little is known about the costs and effectiveness of more affordable options. This paper presents calculations of the cost-effectiveness of two forms of chemotherapy targeted at school-children and compares them with chemotherapy integrated into the routine activities of the primary health care system. The focus is on Schistosoma haematobium. Economic and epidemiological data are taken from the Kilombero District of Tanzania. The paper also develops a framework for possible use by programme managers to evaluate similar options in different epidemiological settings. The results suggest that all three options are more affordable and sustainable than the vertical strategies for which cost data are available in the literature. Passive testing and treatment through primary health facilities proved the most effective and cost-effective option given the screening and compliance rates observed in the Kilombero District. PMID- 10139472 TI - Developing countries' health expenditure information: what exists and what is needed? AB - In the past decade, the scarcity of financial resources for the health sector has increasingly led countries to take stock of national health resources used, review allocation patterns, assess the efficiency of existing resource use, and study health financing options. The primary difficulties in undertaking these analyses have been 1) the lack of information on health expenditures and 2) not using existing information to improve the planning and management of health sector resources. The principle sources of available health expenditure information are reported by organizations such as the World Bank, WHO, UNICEF and OECD. Special studies and non-routine information are a second major source of information. This existing data has a number of difficulties, including being sporadic, inconsistency, inclusion of only national level public expenditure, high opportunity and maintenance costs, quantitative and qualitative differences across countries, and validity and interpretability problems. Reliable health expenditure data would be useful not only for in-country, national purposes, but also for cross-national comparisons and for development agencies. Country uses of health expenditure data include policy formulation and planning and management, while international uses would facilitate examination of cross-national comparisons, reviews of existing programmes and identification of funding priorities. Collaborative efforts between countries and international development agencies, as well as between agencies, are needed to establish guidelines for health expenditure data sets. This development must ensure that the resulting information is of direct benefit to countries, as well as to agencies. Results of such collaborative efforts may include a set of standardized methodologies and tools; standardized national health accounts for developing countries; and training to enhance national capabilities to actively use the information. The opportunities for such collaboration are unique with the issuance of the World Development Report 1993, to build on this work in clearly identifying what is needed and proposing a standardized data set and the tools necessary to regularly and economically gather such data. PMID- 10139473 TI - Employer's willingness to pay: the case for compulsory health insurance in Tanzania. AB - This article documents employers' expenditure on the arrangements for the health care of their employees in one of the least developed countries; Tanzania. The case for compulsory health insurance is considered in the light of the fact that only 3% of the population is employed in the formal sector and could be covered at first. It is shown from a survey of larger employers, outside government, that they were spending on average 11% of payroll on health care for their employees. This demonstrated their lack of satisfaction with the government health services. Nevertheless, those who could readily be covered by insurance were making considerable use of the more expensive government hospital services. It is argued that a compulsory health insurance scheme could be introduced for the formal sector of employment which would cover a wider range of health services at lower cost. The scheme would also have the desirable economic effect of lowering employers' labour costs while making it possible to improve the standards of the government health services. PMID- 10139474 TI - Gender, work and illness: the influence of a research unit on an agricultural community in The Gambia. AB - Changes in employment opportunities and medical services are exploited by men and women in different ways. This paper examines gender-based variation in the selective use of employment and health opportunities in a Gambian village which has been the subject of medical and nutritional research by the Medical Research Council (MRC) for 43 years. The seasonal workloads of 105 men and women in Keneba were compared during one calendar year. Women carried a heavier burden of agricultural labour, while men had a higher rate of waged employment. The impact of the MRC field station on the local economy was assessed and evidence of associated male dependence on MRC employment found. Illness reporting patterns and the treatment choices of men and women were examined. Women made greater use of the MRC medical service, while men resorted more frequently to local remedies and healers. Female dependence on the MRC medical services is suggested by the data, and may be linked to the greater attention paid to them by researchers and medical practitioners. PMID- 10139475 TI - Assessing and planning home-based care for persons with AIDS. AB - The HIV/AIDS pandemic continues to gather momentum in many developing countries, increasing the already heavy burden on health care facilities. As a result, donors, implementing partners and communities are beginning to create home-based care programmes to provide care for persons with HIV/AIDS. This paper recommends reorienting this home care provision as a service founded in, and coming from, the community rather than the health system. A methodology, in the form of an assessment matrix, is provided to facilitate the assessment of a community's capacity to provide care for people with AIDS. The focus is on rapid assessment methods using, where possible, readily available information to clearly and systematically define current circumstances. The matrix created for a specific community is then used in the development of an action plan with interventions prioritized and tailored to local needs. A case study from a hypothetical developing country, where HIV/AIDS is a significant problem, is used to illustrate the process. PMID- 10139476 TI - An operational evaluation of the Community Oral Rehydration Units in Peru. AB - Since 1984, in Latin America donor agencies and national governments have extensively supported the implementation of the Community Oral Rehydration Units (CORUs) in an attempt to increase the access to oral rehydration therapy and improve the case management of diarrhoea at the community level. This study surveyed 40 CORUs in two regions of Peru to assess their operation, the number of patients with diarrhoea attended, and the knowledge of volunteers in charge. The results show that CORUs were mainly implemented close to existing health centres; the median of case load was 2.0 patients in the preceding month; and the volunteers' knowledge of case management was principally deficient in the diagnosis of hydration status, dietary management and in preventive measures. This lack of knowledge was replicated by professionals at the supervising health centres. Despite the fact that CORUs have been functioning for around four years, they exhibit numerous deficiencies which prevent them from fulfilling their objectives. A global review of the whole CORU strategy is called for. PMID- 10139477 TI - UNDP (United Nations Development Programme)--healthy development? The case of HIV. PMID- 10139478 TI - Shadow capitation schemes help protect against losses. PMID- 10139479 TI - Group practice organization promotes quality. PMID- 10139480 TI - Preparing for the strategic planning process helps ensure implementation success. AB - Strategic planning in many organizations has been less satisfying and useful than these organizations had hoped. We believe these outcomes may be due to a limited view of planning and the implications of the planning process for the organization. Our belief is that these organizations were not genuinely "ready" to engage in the kind of thinking and work required for strategic planning. Therefore, we propose a model of planning readiness consisting of seven components. Each component offers the organization leader an opportunity to achieve improved levels of planning readiness within the organization. PMID- 10139481 TI - PHO success in an evolving managed care environment requires matching your market. PMID- 10139482 TI - New Year's brings new roles and resolutions ... role of hospital strategic planners in the new environment. PMID- 10139483 TI - Joint Commission completes transition to functional standards. AB - The Joint Commission's new emphasis on performance-based standards led it to identify functions it believed were likely to have the most significant impact on patient outcomes. Carrying out these functions requires an interdisciplinary team approach to patient care. Thus, the old strategy of handing out one manual chapter to each department head and asking him or her to implement the standards in that chapter will not work in 1995. Rather, providers will have to allocate already stretched human and financial resources to redesign their methods of assessing and improving patient outcomes in order to comply with yet another major revision of the Accreditation Manual for Hospitals. To ensure an adequate understanding of and compliance with Joint Commission standards, organizations should make the entire CAMH "required reading" for its leadership and make it available in strategic areas of the hospital for review by all employees. While the Joint Commission recognizes that its new functional approach will take some time to implement, all providers that want to ensure that they remain accredited should begin now to orient their leadership, staff, and employees to the new functional standards in the CAMH and the ways in which those standards affect patient outcomes. PMID- 10139484 TI - Special report on corporate/finance. Effectively negotiating integrated information system contracts: common issues and practical approaches (Part II). PMID- 10139486 TI - Neurosurgical ICU for Mount Sinai Medical Center, New York City. PMID- 10139485 TI - An integrated delivery systems review: common problems to be addressed. AB - The most critical element in developing a successful IDS is identifying the needs and goals of the parties within the context of the realities of their local health care market. It is therefore unwise to select the structure of a proposed IDS until this process has been completed. An honest goals assessment might result in the immediate formation of a PHO, MSO, medical foundation or other formal IDS, or might alternatively point in the direction of something much less structured, such as a joint marketing contractual arrangement (sometimes called a "PHA"), which can be relatively inexpensive to implement and can provide a fairly immediate response to quickly changing market conditions. Some organizations might even decide to utilize a number of different IDS vehicles in order to offer physicians a menu of affiliation options. The legal issues that arise when forming an IDS can almost always be dealt with in a reasonable manner. The real key to success is entering into integration discussions with an open mind, rather than a preconceived commitment to a particular integration. PMID- 10139487 TI - Health care technology as a policy issue. AB - Health care technology has become an increasingly visible issue in many countries, primarily because of the rising costs of health care. In addition, many questions concerning quality of care are being raised. Health care technology assessment has been seen as an aid in addressing questions concerning technology, including benefits and costs. A number of industrialized countries have developed active programs of health care technology assessment during the past two decades. Eight countries at similar levels of socio-economic and health development--Australia, Canada, France, Germany, the Netherlands, Sweden, the United Kingdom and the United States--have been examined to gain insights into how they manage health care technology and what place technology assessment has in such management. In addition to seeking general information, specific cases- treatment for coronary artery disease, medical imaging, laparoscopic surgery, treatment of end-stage renal disease, neonatal intensive care, and breast cancer screening--were examined in each country. PMID- 10139488 TI - Special issue: Health care technology and its assessment in eight countries: Australia, Canada, France, Germany, Netherlands, Sweden, United Kingdom, United States. PMID- 10139489 TI - Health care technology in France. AB - The French health care system combines freedom of medical practice with nation wide social security. The system is centrally regulated with specific attention to technology. Prices and budgets are also regulated. Despite these controls, concerns about quality of care began to appear in France in the 1970s. At the same time, increasing costs became an issue. Health care technology assessment has been under discussion as part of the solution to these problems since the early 1980s, but little was done until 1989, when a national agency was established to develop and coordinate health care technology assessment in France. In 1991, a new law on hospitalization strengthened the role of the government in health care and required extensive evaluation activities. The law has made legal requirements for the health care system and the government at all levels, as well as establishing specific institutions and public grants to support evaluation and related activities. While further evolution of the health care system is inevitable, it seems clear that technology assessment is becoming one of the key tools for addressing problems of quality of care and rising costs. PMID- 10139490 TI - Health care technology in the Federal Republic of Germany. AB - The basic goal of the German health care system is equal access to all medical services for all citizens. The federal government sets the legal framework for the system, but most health policy decisions are made through bargaining between large organizations within a legal framework. The federal government took little active role in health care until the early 1990s, when it became increasingly apparent that budgeting and other cost containment measures seemed to be insufficient to successfully reduce the growth of mandatory sickness funds expenditures. A 1993 law has attempted to address some of the most obvious deficiencies in the system, while encouraging a market-oriented approach to health care. Health care technology assessment has almost no role in the German health care system. Attempts by professionals and politicians to introduce technology assessment into the health care arena have been largely unsuccessful. PMID- 10139491 TI - Health care technology in The Netherlands. AB - The Dutch health care system has been described as a 'patchwork quilt'. It is a complicated system that has evolved from a constant adding and changing of institutions, regulations and responsibilities. Every citizen of the Netherlands has an entitlement to health care. The government authorities in the Netherlands have focused on creating favourable conditions in which the already existing private sector could expand or improve services. Although health care is provided largely through private institutions and practitioners, the system is considered to have a high degree of regulation. Until the 1980s, the Dutch health care authorities had no clearly defined philosophy of controlling the development and use of health care technology. Since the mid-1980s, however, a number of initiatives have been taken, policy instruments for controlling technology have been used in a more coordinated manner, and health care technology assessment had developed rapidly. The immediate future will see increasingly explicit use of the benefit package to control introduction of new technologies, as well as a growing influence of technology assessment itself. PMID- 10139492 TI - Health care technology in Australia. AB - The health care system in Australia is pluralistic, complex, and only loosely organized. The Commonwealth government is primarily concerned with funding programs and the development of broad policies. The introduction and diffusion of health care technologies in Australia is determined by a complex interaction of market forces, public funding, and regulation. Australia became involved in health care technology assessment in 1982. In 1990, activities were reorganized and the Australian Health Technology Advisory Committee (AHTAC) was formed at the national level. Despite limited funding, Australia has had some significant successes in informing policy through appropriately targeted, well-timed assessment. PMID- 10139493 TI - Health care technology in Sweden. AB - Health care in Sweden is a public sector responsibility and equity in access to care is quite important. The Swedish system is organized into several levels, with the Federation of County Councils at the top, and with regional, county, and local levels. In theory, the four hospital tiers developed by these different levels provide a clear hierarchy for acquisition of sophisticated new technologies. In practice, certain problems have emerged, especially rigidity of the system. Reforms are underway. Sweden was one of the first countries to become involved in the assessment of health care technology. From the beginning, technologies were assessed to determine if they were 'consistent with proven scientific knowledge and good experience'. Sweden has a national program in health care technology assessment (TA), and TA is increasingly visible to policy makers and physicians. Health care TA has been effectively institutionalized in Sweden and has a bright future. The greatest problem in the Swedish context is the large number of unassessed technologies. Because of this, international cooperation is essential. PMID- 10139494 TI - Health care technology in the United Kingdom. AB - The UK National Health Service (NHS) is based on the principle that everyone is entitled to any kind of medical treatment for any condition, free of charge. The NHS is funded primarily from general tax revenues. The health service is presently in the middle of a profound change in philosophy and practice. Health authorities have been given specific responsibility for identifying their population's health needs and for using public money to buy services under a specific contract so as to meet those needs. Health care technology assessment (TA) has also developed very rapidly in the UK recently. While the limited budgets of the NHS have controlled expenditures for health care, there has not been a coherent policy for technology development until very recently. During the past decade, awareness of the concepts of appropriateness, effectiveness, and cost-benefit analysis have moved to center stage on the agenda of policy makers. A new R&D strategy in the NHS is emphasizing technology assessment as an aid to choice and management of technology. The increased necessity for making choices, and the increasing availability of results from health care TA, seem to indicate that such research will have an increasing impact on health care and its management. PMID- 10139495 TI - Health care technology in the United States. AB - The US health care system reflects the free market of the US economy--there is no fixed budget and no limit on expenditures in the loosely structured matrix of largely private-sector health industry components. Mainly because of the inaccessibility of adequate health care for a large segment of the population, and because of the enormous cost of care threatens financial ruin for many more people, the first major reform of the system was debated in Congress for most of 1994, though, in the end, no leglislation was passed. One focus of the debate on spending has been the problem of excessive use of expensive medical technology and the need for some control, which, by and large, is lacking in the existing system. Health care technology assessment itself is a thriving industry in the United States, used by government, insurers, medical societies, hospitals, and other groups for their own purposes. At the national policy level, few opportunities for technology assessment to affect the health care industry exist, so most effort is directed at trying to affect medical practice at the level of the individual hospital and practitioner. The discernible effect of technology assessment has been minimal. PMID- 10139496 TI - Lessons from the eight countries. AB - While the eight countries presented in this issue differ considerably from each other, they have important similarities. All have faced the problem of increasing health care expenditures, and all are coming to recognize problems with health care technology such as inappropriate use and poor quality of care. Health reforms appear to be accelerating in the countries examined. In addition, all countries now have stated policy goals of assessing the benefits of health care technologies and most have established formal programs for health care technology assessment. Technology assessments impact varies, but it is becoming an important factor in technology acquisition. These trends point to a future for technology assessment and perhaps to better management of health care technology. International cooperation is important if this goal is to be realized. PMID- 10139497 TI - Health care technology in Canada (with special reference to Quebec). AB - In Canada, all citizens are insured for health services. Health care is a provincial responsibility. The federal role is limited to health care financing, health protection including regulation of pharmaceuticals, and environmental health. The health care system represents a balance among government direction, consumer choice, and provider autonomy. Canada has largely controlled the costs of health care by funding and management mechanisms, the most important of which is the global budget formula used to fund hospitals. This paper discusses the Canadian health care system, with particular emphasis on the province of Quebec. In 1988, the provincial government of Quebec established the first Canadian body dedicated to technology assessment. Since then, a national coordinating office and several other provincial bodies have developed. The work of these and other evaluation efforts has had a growing influence on technology management decisions, particularly those dealing with procurement of capital-intensive technologies. Expanding this influence into the realm of technology use, especially for low-cost, high-volume technologies, remains a challenge. PMID- 10139498 TI - Comments relating to medical screening examination required by EMTALA (Emergency Medical Treatment and Labor Act). PMID- 10139499 TI - A tale of two doctors. PMID- 10139500 TI - Health care 1995: top 10 trends for the era of capitation. PMID- 10139501 TI - Review of 1994 predictions: another ".900" batting average. PMID- 10139502 TI - Three years into patient self-determination, 'inertia reigns'. PMID- 10139503 TI - Data systems. PMID- 10139504 TI - Defensive medicine and medical malpractice. PMID- 10139505 TI - Behavior change: best hope for stopping the spread of AIDS. PMID- 10139506 TI - Can end-stage renal disease be delayed? PMID- 10139507 TI - More than money stands in the way of full immunization. PMID- 10139508 TI - Subacute care: an overview for acute care hospitals and systems. AB - Defined in different ways by different organizations, subacute care offers providers the opportunity to manage high-resource patients more efficiently and effectively. Among subacute care providers, there is strong consensus that this modality represents a viable and necessary level of care. Within managed care circles, subacute care has engendered strong interest and support. Overall, subacute care will continue to grow and change the face of inpatient care as we know it. Subacute care will continue to be an important modality of care regardless of changes in applicable payment and certification mechanisms. Therefore, development of subacute care within a hospital or health system may be viewed as a strategy for moving the organization into the future as well as offering a prudent financial strategy today. PMID- 10139509 TI - Technology management: case study of an integrated health system. AB - Technology management has assumed a role of vital importance in today's health care environment. Capital reserves and operating income have been stretched by pervasive and expensive technologies, while overall reimbursement has been reduced. It is imperative for hospitals to develop and consistently use technology management processes that begin prior to a technology's introduction in the hospital and continue throughout its life cycle. At Samaritan Health System (SHS), an integrated health care delivery system based in Phoenix, technology management provides tools to improve decision making and assist in the system's integration strategy as well as control expenses. SHS uses a systemwide technology-specific plan to guide acquisition and/or funding decisions. This plan describes how particular technologies can help achieve SHS' organizational goals such as promoting system integration and/or improving patient outcomes while providing good economic value. After technologies are targeted in this systemwide plan they are prioritized using a two-stage capital prioritization process. The first stage of the capital prioritization process considers the quantitative and qualitative factors critical for equitable capital distribution across the system. The second stage develops a sense of ownership among the parties that affect and are affected by the allocation at a facility level. This process promotes an efficient, effective, equitable, and defensible approach to resource allocation and technology decision making. Minimizing equipment maintenance expenditures is also an integral part of technology management at SHS. The keys to reducing maintenance expenditures are having a process in place that supports a routine fiscal evaluation of maintenance coverage options and ensuring that manufacturers are obligated to provide critical maintenance resources at the time of equipment purchase. Maintenance service options under consideration in this report include full-service contracts with the manufacturer, insurance coverage, time and materials, and independent service vendors/in-house support. Careful consideration of all the ramifications of each option is warranted because there are substantial cost differences among these methods. At SHS, technology management efforts resulted in equipment purchases and maintenance negotiations representing savings of more than $1.5 million in a single year. SHS undertakes an intensive review of purchases and maintenance expenditures, using the techniques described in this report, with the objective of reducing expenses by 10% per year. This report describes the technology management methods that SHS uses to achieve these results. PMID- 10139510 TI - The effect of economic changes on health care and health in Chile. AB - The existence of possible associations between the economy and health in Chile, 1974-1992, is documented. The gross domestic product fell in 1975-1976 and again in 1982-1983; at both times, the public expenditure on health care followed those falls. In addition, the sources of financing public expenditure and the patterns of health expenditure changed during the decades under study. Several indicators of health care activity, and of health and nutrition status consistently suggest an impact which results from the economic difficulties. Staffing levels and pay factors apparently played a role as intervening variables. The differences between the two crises are discussed, and reveal that the organization and programmes of the public health system seem to have been seriously affected. At the same time, they may still have played an important role in protecting the people--particularly, mothers and small children--from further damage. PMID- 10139511 TI - Voices from the inside: managing district health services in Nepal. AB - Apparent inconsistencies and irrational decisions can be found in all organizations and they often point to underlying attitudes and assumptions among staff, about the organization and the way it works. Concepts such as 'negotiated order' and 'values in use' have been suggested in recent literature on organization theory to describe the important role of individual, and social, needs and expectations upon the functioning of organizations. This article presents the apparently common assumptions made about government service, as encountered during research into the management of district public health services in Nepal. It argues that, when taken together, these form a wide and coherent system of 'values in use', or an 'implicit theory' which appears to guide many of the bureaucracy's actions. The way in which staff are selected and promoted, common attitudes towards work, the shortcomings of the reporting systems, all appear to be part of an 'implicit' theory which is based on the fundamental belief that it is the main purpose of the district public health service to provide incomes for its staff. Thus, most posts do not have job descriptions and staff are recruited to them on the basis of factors other than the skills or knowledge required. Training and supervision are seen commonly as means of earning extra allowances, and service quality is not seen as a priority. This contrasts with the 'official' theory which is that the organization exists to provide health services to the community and that it is the purpose of the staff to provide those services. Such an implicit 'theory', recognized and accepted by staff but never acknowledged, and based on very different values and expectations to those assumed in a 'rational', task-oriented bureaucracy, obviously has implications for the success of development programmes. It explains why training so rarely results in improved performance and why the bureaucracy is so resistant to change which does not satisfy the implicit theory. While the implicit theory described here is specific to Nepal, the phenomenon may be widespread. The failure to take account of such 'theories in use', guiding the actions of staff and hence organizations, could explain the failure of many attempts to improve government health services. PMID- 10139512 TI - Implementing health management information systems: measuring success in Korea's health centers. AB - This article analyses the effects that the introduction and adoption of a health management information system (HMIS) can have on both the productivity of health center staff as well as on user-satisfaction. The focus is upon the service provided by the Kwonsun Health Center located in Suwon City, Korea. Two surveys were conducted to measure the changes in productivity and adoption (knowledge, persuasion, decision, implementation and confirmation) of health center staff over time. In addition, a third survey was conducted to measure the effects of HMIS on the level of satisfaction perceived by the visitors, by comparing the satisfaction level between the study health center and a similar health center identified as a control. The results suggest that HMIS increased the productivity and satisfaction of the staff but did not increase their persuasion and decision levels; and, that is also succeeded in increasing the levels of visitors' satisfaction with the services provided. PMID- 10139514 TI - 1995 almanac. State EMS directors. PMID- 10139513 TI - Contraceptive pricing and prevalence: family planning self-sufficiency in Indonesia. AB - Imposing or increasing user fees can move family planning programs toward self sufficiency. But, economic theory predicts that quantities demanded decrease following price increases; and, that the size of the response depends, all else constant, upon the share of income accounted for by spending on the good or service. This article uses survey data collected in conjunction with an Indonesian self-sufficiency program to assess the differential magnitudes of contraceptive usage responses to price differentials between sample-wide and relatively poor households, and for both subsidized and full private-sector prices. We find a much more substantial response among poor households. As prices move up toward full cost-recovery, the effect is magnified. PMID- 10139515 TI - 1995 almanac. Information resources. PMID- 10139516 TI - Redesigning our future: a forum. Focusing the expanded scope. PMID- 10139517 TI - Refusing emergency medical care. How far do a patient's rights go? PMID- 10139518 TI - So you want to be a "most excellent" medic. PMID- 10139519 TI - Partners. Part I: The good, the bad and the perfect. Roundtable discussion. PMID- 10139520 TI - Crime scene preservation. It's everybody's concern. PMID- 10139521 TI - A one-on-one interview with Ricardo Martinez, NHTSA's new administrator. Interview by Jack Sheehan. AB - From car crashes to pedestrians struck to bicyclists run down, vehicle accidents are among the most common EMS emergencies. The new man in charge of overseeing the safety of the nation's highways and motor vehicles is Ricardo Martinez, MD. PMID- 10139522 TI - 1995 almanac. EMS in the United States. 1995 survey of providers in the 200 most populous cities. AB - In summary, the continued acquisition of technology capable of providing managers with comprehensive analysis of system operations will enable managers to develop EMS configuration models capable of predicting operational and financial performance. Increased involvement of MCOs in the design and funding of EMS, in addition to recent HCFA decisions to reimburse for treatment--not provider training--will result in a move away from funding mechanisms that reward consumption of services to mechanisms that reward conservation (e.g., capitation). Ultimately, we (the authors) predict that the realignment of funding mechanisms, with assurances that quality patient care will not deteriorate, will result in some significant changes in the 200 most populous cities. PMID- 10139523 TI - 1995 almanac. EMS providers in America's 200 most populous cities. PMID- 10139524 TI - Residents talk about end-of-life issues. PMID- 10139525 TI - Managing behaviors of chronically confused residents. PMID- 10139526 TI - Oldest and newest promise is responding to community needs. PMID- 10139527 TI - How ethical dilemmas are resolved. AB - The prevalence of ethics committees in long-term care facilities has been on the rise since 1970. This study explores the nature of these committees and how ethical dilemmas are resolved where there is no committee. PMID- 10139528 TI - Ways to chart your facility's future. PMID- 10139529 TI - How staff used decision and process analysis techniques to reduce restraint use. PMID- 10139530 TI - Short-term rehab maximizes patient potential. PMID- 10139531 TI - Laying a foundation for a successful short-term unit. PMID- 10139532 TI - The impact of organizational and managerial factors on the quality of care in health care organizations. PMID- 10139533 TI - Rx-to-OTC switch movement. PMID- 10139534 TI - Total quality management in health care: a view of current and potential research. PMID- 10139535 TI - Just what does case management mean these days? PMID- 10139536 TI - The legal issues of integrated delivery systems. PMID- 10139537 TI - The state of integration: today and tomorrow. PMID- 10139538 TI - Information systems for an integrated health care network. PMID- 10139539 TI - Technology and rural needs heighten interest in telemedicine. PMID- 10139540 TI - Plan strategically for your group now. PMID- 10139541 TI - Utilization management for medical groups. Using information to achieve collaboration. PMID- 10139542 TI - Budgeting for the future. Where dreams meet reality. PMID- 10139543 TI - Financing alternatives for medical group practices. PMID- 10139544 TI - Maintaining records on manhour consumption. PMID- 10139545 TI - CAP (College of American Pathologists) cedes little to obtain deemed status under CLIA. PMID- 10139546 TI - CD-ROM: an on-ramp to the information superhighway. PMID- 10139547 TI - When disaster strikes, is your lab prepared? PMID- 10139548 TI - Immunoassay automation: saving time, labor, and money. PMID- 10139549 TI - Training verification for lab personnel: a new guide. PMID- 10139550 TI - Implementing work teams in the clinical laboratory. PMID- 10139551 TI - Designing and implementing lab CE programs. PMID- 10139552 TI - Reengineering the clinical laboratory. PMID- 10139553 TI - Complaints cause Florida to freeze prepaid Medicaid. PMID- 10139554 TI - Foundation, FHP International retract bids for Health Systems. PMID- 10139555 TI - Alexis gets probation, but forfeits assets in NME case. PMID- 10139556 TI - Calif. insurers hit with big suit. PMID- 10139557 TI - Medical price news may stall reform. PMID- 10139558 TI - JCAHO prepares for board scrutiny. PMID- 10139560 TI - State's legal threat quashes merger in northeastern Pa. PMID- 10139559 TI - Ind. awards bids for Medicaid plan. PMID- 10139561 TI - Hospitals warming to use of physician data bank in hiring. PMID- 10139562 TI - Advice for easing the pain of layoffs. PMID- 10139563 TI - Tenn. vote adds to JCAHO's woes. PMID- 10139564 TI - New Hawaiian program suffers growing pains. PMID- 10139565 TI - Mammogram law comes at a price. PMID- 10139566 TI - Healthcare bond sales drop 54% in '94. PMID- 10139567 TI - Congress at loggerheads over balanced-budget amendment. PMID- 10139568 TI - Republicans reverse accounting plan. PMID- 10139569 TI - Coincidence? Tenn. drops probe; Columbia/HCA moves to Nashville. PMID- 10139570 TI - Cedars may form data subsidiary, HMO. PMID- 10139571 TI - Conn. probes billing complaints. PMID- 10139573 TI - Mich. Blues pays claims. PMID- 10139572 TI - HSI directors face lawsuits. PMID- 10139574 TI - Va. hospitals report strong earnings gains. PMID- 10139575 TI - Tremor-torn hospitals rebuild, despite critics. PMID- 10139576 TI - Survey finds no uniformity in packaged-price services. PMID- 10139577 TI - ProPAC recommends 2.1% boost in '96 PPS payments. PMID- 10139578 TI - Budget amendment advances in Senate. PMID- 10139579 TI - Caremark probe widens; infusion unit sale near. PMID- 10139580 TI - Catholic hospitals ready to battle all competitors. PMID- 10139581 TI - Tenn. hospitals band against Columbia/HCA. PMID- 10139582 TI - Docs hops for office lab exemptions. PMID- 10139583 TI - A silent majority backs JCAHO's change agenda. PMID- 10139584 TI - JCAHO goal: satisfied customers. PMID- 10139586 TI - Hospitals could save foundering industry of recovery care. PMID- 10139585 TI - For real reform, watch the states. AB - The Medicaid reimbursement system has long been the domain of state actuaries and payment specialists. But it's fast becoming a battering ram for managed care as states gain federal approval to put their billion-dollar programs into the hands of risk-taking HMOs. PMID- 10139587 TI - Systems test performance measures. PMID- 10139588 TI - Proposals for new bond rules offer pros, cons for providers. PMID- 10139589 TI - Calif. HMOs deficient--watchdog. PMID- 10139590 TI - Plan would slash N.Y. providers' rates. PMID- 10139591 TI - Columbia/HCA adds Denver hospital. PMID- 10139592 TI - New Orleans-area hospitals agree to discuss merger. PMID- 10139594 TI - SunHealth Alliance to OK supply-buying incentives. PMID- 10139593 TI - St. Louis system requests resignation from hospital CEO. PMID- 10139595 TI - Top hospitals providing higher quality at lower cost. PMID- 10139596 TI - Nurses assess impact of reform, new technology. PMID- 10139597 TI - Helping staff members help themselves. PMID- 10139598 TI - OR of the future to be less complicated, more efficient. PMID- 10139599 TI - Optical disk storage saves time and money. AB - Hospitals run on paper, or sometimes so it seems. The patient accounts department at Cabell Huntington Hospital was having an increasingly difficult time handling the hospital's growing patient accounts load, which was creating a forest of paperwork to be processed, filed, retrieved, updated, and refiled. PMID- 10139600 TI - Reinhardt on reform. Interview by Donna Vavala. AB - Almost since the federal government took its giant step into health care delivery and financing in 1965 with Medicare and Medicaid, the emphasis in Washington has been on reducing the costs of health care. Almost all federal health law subsequent to those two programs has been aimed at cost control, even when the titles of the bills promised a more noble purpose. The most notable exception is the law establishing end-stage renal disease coverage, but it has become a prime exacerbator of rising costs. Not even the designers of the federal programs envisioned how quickly health care costs would rise and how substantial the increases would be. The federal tab in 1993 was $280.6 billion. In 1960, it was $3 billion and in 1970 it was $17.8 billion. And overall health care costs have followed a similar curve, growing from 5.3 percent of the U.S. GDP in 1960 and 7.4 percent in 1970 to 13.8 percent in 1993. The end is not in sight. Economists are predicting growth to 18 percent of GDP by the next century. Uwe E. Reinhardt, PhD, James Madison Professor of Political Economics in the Woodrow Wilson School at Princeton University, does not believe that the "bite" will become that large, but he does expect increases to continue into the near future. In the interview recorded in this article, Professor Reinhardt assesses both the current and his predicted financial scenario for the health care field. PMID- 10139601 TI - What happened, what next? AB - Many physicians and other health care professionals breathed a collective sigh of relief when the 103rd Congress adjourned without passing the Clinton Health Security Act or any other health care reform legilsation. The ambition of this brief paper is to describe why health care reform did not pass in 1994, the issues that need to be resolved if we are to pass legislation, the political forces that will need to be addressed before legislation is passed, and the type of struggles we can expect to see in the coming session of Congress. PMID- 10139602 TI - DOJ/FTC provide new guidance for providers. AB - Antitrust guidelines released September 27 by the Department of Justice (DOJ) and the Federal Trade Commission (FTC) have produced new guidance for providers in three areas and refined six areas that were the subject of last year's statement. Although the agencies have characterized the 1994 Statement as a "landmark," it is more evolutionary than revolutionary in nature--providing clarifications, adjustments, and additions to the 1993 Statement, including an expansion of the safety zone for certain physician joint ventures and a significant discussion of the agencies' framework of review of multi-provider networks. The 1994 Statement is also significant because it appears that it will be the agencies' last formal statement on this issue for some time. Since its release, both DOJ and FTC have stated that no clarifications or expansions to the 1994 Statement are currently planned. This article provides highlights of the new statement. "Health Law" is a regular feature of Physician Executive from the Washington, D.C., law firm Epstein Becker & Green, P.C. Mark Lutes of that law firm serves as editor for the column. PMID- 10139603 TI - The new production theory for health care through clinical reengineering: a study of clinical guidelines--Part II. AB - In Part I of this two-part article, in the December 1994 issue of the journal, the author discussed the manufacturing theories of Peter Drucker in terms of their applicability for the health care field. He concluded that Drucker's four principles and practices of manufacturing--statistical quality control, manufacturing accounting, modular organization, and systems approach--do have application to the health care system. Clinical guidelines, a variation on the Drucker theory, are a specific example of the manufacturing process in health. The performance to date of some guidelines and their implications for the health care reform debate are discussed in Part II of the article. PMID- 10139604 TI - Specialist versus primary care: not an easy question. AB - The central focus in the debate to reform our nation's health care system is on cost, quality, and access. There is general agreement that there are too many specialists in the wrong places, which is said to contribute to the rising cost of health care. Physician profiling has supported the concept that some specialists are more costly than primary care physicians, although the severity of illness in patients treated by specialists may often be greater. Increasing the number of primary care providers may be a solution to reduce costs and will clearly improve access. The study reported in this article was carried out to examine the efficiency of primary care physicians and endocrinologists, a specialty that has been cited as one in which resource utilization is high, in caring for hospital inpatients with diabetic ketoacidosis. PMID- 10139605 TI - The politics of family leave. AB - There are many who would insist that the best laws from Washington, D.C., are those that aren't passed. A singular problem with many of the laws that are placed on the books is that their intended achievements are frequently largely overcome by unintended results. Such may be the case with the Family and Medical Leave Act of 1993. For all the good this law has done for those who need to take leaves of absence, it has added greatly to the woes of those who remain behind, the author says. Managers, she insists, will have to work diligently with the reactions of those who must accept additional workloads to accommodate the leaves of their colleagues. PMID- 10139606 TI - Health care's power brokers in the 21st Century. Interview by Donna Vavala. AB - Health care has undergone turbulent change in the 20th Century. In addition to dramatic pharmaceutical and technological advances, the entire health care delivery system has been significantly improved. Through all the turmoil, hospitals have been at the center of the health care universe. But, as the 21st Century approaches, that may change, too. What will become of hospitals, which for most of this century have played a commanding role? Will managed care organizations and group practices come out on top? And, once the new power broker takes over, what will be the impact on providers, insurers, and the government, and how will their relationships to each other change? Jeff Goldsmith, PhD, President of Health Futures, Inc., Bannockburn, Ill., and health care futurist, examines tomorrow's health care delivery system and makes some eye-opening predictions. PMID- 10139607 TI - Health reform hibernates. PMID- 10139608 TI - Managers for the 21st century. PMID- 10139609 TI - A practical approach to TB prevention. PMID- 10139610 TI - Curing empty-bed syndrome. PMID- 10139611 TI - Wandering and liability revisited. AB - Providers are challenged to keep wandering residents safe. Liability considerations for injuries incurred by wanderers go beyond the question of whether or not to restrain. PMID- 10139612 TI - Subacute equipment: lease or buy? PMID- 10139613 TI - Starting out on the right foot. PMID- 10139614 TI - Hospitalizations for injury and poisoning in the United States, 1991. PMID- 10139615 TI - Five years of total quality management: Campbelltown Hospital. AB - There are many articles in the health literature outlining either a framework for total quality management (TQM) or a success story. There is a dearth of literature reflecting the shortcomings of total quality management during implementation. Yet many of the world's most successful companies learn by reflecting about their past, for example, British Petroleum, IBM, Boeing, Xerox. This paper describes, from a general manager's perspective, the practical application of total quality management to a hospital setting over five years. The paper outlines the important ingredients to success and the shortcomings encountered along the way. Supporting literature is cited where appropriate. Strategies that were implemented contrary to common total quality management thinking are highlighted. The paper concludes with an outline of the four key lessons learnt over the five-year period. PMID- 10139616 TI - Hospital and departmental management in the era of accountability: addressing the new management challenges. PMID- 10139617 TI - Best practice and workplace reform. PMID- 10139618 TI - A model of organisational change. PMID- 10139619 TI - Best practice and enterprise bargaining. AB - Most of us have heard of 'best practice' but what does the term really mean and how is it being applied in the health sector? Is there a relationship between best practice and enterprise bargaining? What are the key issues which this industry must address to ensure best practice approaches can be successfully applied? PMID- 10139620 TI - Total quality management in health care. AB - Studying 'the best way of doing things' does expedite performance improvement. Using cost as the only measure of health care has provided a one dimensional view of 'the best'. Now there is an urgency to improve the value of clinical outcomes, the real product of health care. For this to be achieved by any method, more effective and comparable measures of quality are needed to focus improvement efforts. This paper comments on the application of the best practice principles, developed for other Australian industries, to health care. PMID- 10139621 TI - Patient care model project: St Vincent's Hospital, Melbourne. PMID- 10139622 TI - The challenge of best practice. PMID- 10139623 TI - Best practice communication strategy: Princess Alexandra Hospital. PMID- 10139624 TI - A customer focus to paediatric health care: John Hunter Hospital. AB - The Department of Paediatrics at John Hunter Hospital, Newcastle, was invited to represent paediatric services in the New South Wales Department of Health's customer focus initiative. Six health care organisations were selected to be pathfinder centres in customer focus under this initiative. The aim of these pathfinder centres was to trial customer-oriented projects that would be applicable to other health care organisations. This article will discuss the process through which three customer-focused projects were identified and implemented, and discuss some of the outcomes of these projects. PMID- 10139625 TI - Hospital in the Home project: Royal Prince Alfred Hospital. AB - The Central Sydney Area Health Service has developed and piloted a Hospital in the Home program as an alternative to inpatient admission. Hospital in the Home offers the opportunity for increased productivity of existing hospital services, and advantages for patients in terms of satisfaction and improved or comparable clinical outcomes. Having developed treatment protocols and established a core Hospital in the Home team, a wider demonstration project across three hospitals within the Central Sydney Area Health Service is proposed. PMID- 10139626 TI - Perspectives. Cleveland's private sector does its own reforming. PMID- 10139628 TI - The 104th Congress and AHIMA. PMID- 10139627 TI - American Health Information Management Association. Position statement. Issue: Educational clinical affiliations. AB - In the realm of health information management, the clinical affiliation refers to the course(s) in which the student reports to a healthcare facility and experiences planned activities in the environment of the actual workplace. The provision for technical and managerial experiences is an integral component of the curricula. The importance of the clinical affiliation to health information management education is immeasurable. Through the application of didactic learning, the theories of health information management are reinforced, the dynamics of the workplace are observed, and the realistic dimension of the profession is added. No amount of classroom simulation can replace it. Objectives of an affiliation should include but are not limited to: 1) development of the student as a person responsible for actions and outcomes, 2) acquisition of the knowledge and skills needed for entry level competency, 3) recognition of the needs of patients and clients, and 4) adherence to the mission, policies, and procedures of an organization. PMID- 10139629 TI - The road to educational reform in health information management. PMID- 10139630 TI - Computer literacy among students entering the health information management programs. PMID- 10139631 TI - The use of AHIMA domains, tasks, and subtasks for graduate follow-up. PMID- 10139632 TI - Systems analysis and design of an integrated dental hygiene clinic system. PMID- 10139633 TI - The effect of education on career advancement patterns of health information professionals. PMID- 10139634 TI - Thinking outside the box: new opportunities for HIM professionals. PMID- 10139635 TI - Database management: an emerging HIM role. PMID- 10139636 TI - Using HIM skills in systems analysis. PMID- 10139637 TI - Managing health databases for California. PMID- 10139638 TI - Occupational health consulting: an open field for HIM professionals. PMID- 10139640 TI - HIM-related bibliographic databases: online and CD-ROM. PMID- 10139639 TI - Making the computer-based patient record usable and user friendly. PMID- 10139641 TI - Clinical audit. Star quality. PMID- 10139642 TI - Purchasing. A time to share. PMID- 10139643 TI - Terms of reference. PMID- 10139644 TI - Cancer data. Off the record. PMID- 10139645 TI - When a group's survival depends on a hospital. PMID- 10139646 TI - Are HMOs really a doctor's best friend?. Interview by Michael Pretzer. PMID- 10139647 TI - Medicare payment updates: some you'll like, some you won't. PMID- 10139648 TI - How to discipline your staff without getting sued. PMID- 10139649 TI - Can the world's largest integrated health system learn to feel small ... Kaiser Permanente. PMID- 10139650 TI - AHA to stay on sidelines as state groups explore JCAHO alternatives. PMID- 10139651 TI - Joint Commission board ends ties with Margaret O'Leary. PMID- 10139652 TI - $1 billion Horizon-Hillhaven merger proposed. PMID- 10139653 TI - AHA selling lucrative liability insurance subsidiary to MMI. PMID- 10139654 TI - Plan to drop congress spurs trustee protest. PMID- 10139655 TI - Clinton urges baby steps. PMID- 10139657 TI - New hospital raises stakes in Louisiana healthcare war. PMID- 10139656 TI - Ore. academic medical center breaks state tie. PMID- 10139658 TI - Solutions sought to close physician-fee gap. PMID- 10139659 TI - A new way to navigate future of healthcare. PMID- 10139660 TI - Health Management wins Cape Coral. PMID- 10139661 TI - JCAHO outlines action to improve performance. PMID- 10139662 TI - Challenges entering the ER. Survey outlines top issues facing hospital executives. PMID- 10139663 TI - Are docs board certified? Does it make a difference? PMID- 10139664 TI - Calif. utility switches to managed-care plans. PMID- 10139665 TI - Illinois system takes unique path to national award. PMID- 10139666 TI - Specialty services maintain big share of healthcare IPOs (independent public offerings). PMID- 10139667 TI - Healthtrust set to cast off 'stones'. PMID- 10139668 TI - Underwriters flock to NME offering. PMID- 10139669 TI - AMA advertises plea to Congress to adopt changes. PMID- 10139670 TI - Columbia/HCA requests tax breaks from Tenn. for new HQ. PMID- 10139671 TI - Budget law menaces federal health programs. PMID- 10139672 TI - Wellcome nixes Glaxo bid. PMID- 10139673 TI - Audit of health services--the crucial role of information. AB - A healthcare delivery agency evaluates its effectiveness and efficiency by the use of audit techniques. The audit can either be an ad hoc occurrence or part of a scheduled programme of examination and can be initiated by a specific concern, review of good practice or a process of change. Information plays a crucial role in defining the actual situation and informing the discussion from the earliest pre-audit stage to the decision-making process which follows the assessment of the audit outcomes. Measurement of any changes that have actually occurred as a result of actions undertaken is very important. It is necessary to quantify the movement from a baseline since the last scrutiny, rather than rely on anecdotal evidence or perceptions. The information to underpin the consideration of the topic of the healthcare audit must be consistent, contemporary, complete and correct information. This paper makes observations based on a number of studies carried out in the UK for both public and private healthcare organizations, and stresses the need for the availability of good information to determine the benefits of actions taken and changes made. PMID- 10139674 TI - An operational view of the role of health librarians in informatics. AB - The National Library of Medicine is currently funding the Pilot Connections project to promote and support use of the INTERNET in community health care settings. With previous networking applications of this kind largely confined to academic and research environments, the health librarian has emerged as the agent with the unique knowledge and skills to participate in and manage organizational change. An experiment in applied informatics, the Pilot Connections project shows how health librarians should be aware of the expanding opportunities that exist for them to help their organizations cope more effectively with the external trends and forces currently affecting the role and value of information. PMID- 10139675 TI - The evolution of undergraduate medical informatics programmes. AB - This article summarizes developments in the teaching of medical informatics to undergraduate health care professionals. Whilst clinical schools are adopting quite different approaches to informatics education and training, there seem to be a number of common factors shaping educational policies and the resultant programmes. Different professional schools face similar problems in relation to resources and staff development. At the same time, examination of different syllabuses suggests the existence of divergent models as to what medical informatics should encompass, as well as different views as to what elements of the domain should be included in preliminary or undergraduate courses. The relevance of these trends to health libraries is briefly considered. PMID- 10139676 TI - What are the Read Codes? AB - The Read Codes were initially developed by a general practitioner, Dr James Read from Loughborough, in the early 1980s and rapidly gained acceptance by general practitioners as a popular and useful mechanism for storing structured information about patients in individual, patient-based records, which were beginning to become popular in a few general practices at the time. This short article aims to explain the past and future development of the coding system in the National Health Service as a whole. PMID- 10139677 TI - The information handling techniques of research (laboratory and clinical) scientists: preliminary indications of current practice. AB - This paper arises from a longitudinal study concerning the impact of information technology developments on the information handling techniques of research (laboratory and clinical) scientists from the perspective of perceived value or benefit based on subjective evaluation by users. The project's main method of data collection is the semi-structured interview utilizing samples from various categories of Imperial Cancer Research Fund (ICRF) staff plus a composite external comparison group. This method is complemented by analyses of Library and Information Services Department's (LIS's) records (particularly statistics of database usage and requests relating to document supply) and, where possible, indications of other software usage (to provide further background to the degree of electronic activity of users). This paper focuses on the ICRF staff sample only and reports selected results obtained from interviews during the first phase of the project, October 1992-September 1993, which give preliminary indications of the information handling techniques of research scientists at that time. PMID- 10139678 TI - Getting better with information. PMID- 10139679 TI - The 1994 Unified Medical Language System knowledge sources. PMID- 10139680 TI - Networking MEDLINE in a district general hospital: a case study at Ealing Hospital NHS Trust. PMID- 10139681 TI - ASSIST--Association for Information Management and Technology Staff for the NHS. PMID- 10139682 TI - HMOs: an industry snapshot. PMID- 10139683 TI - Choosing the best HMO. AB - Contrary to recent studies, the form of a health plan--whether it's a group-model or IPA-model HMO--is less important than quality, performance, and administrative efficiency. PMID- 10139684 TI - Health care reform in the states. Washington: the struggle to fulfill a vision. PMID- 10139685 TI - Big savings for small companies. PMID- 10139686 TI - Entitlement reform: the time has come. PMID- 10139687 TI - Detroit sponsors group buying effort. PMID- 10139688 TI - Let's keep pushing for reform. PMID- 10139689 TI - For one out of every three doctors, capitation is a headache. PMID- 10139690 TI - Practice guidelines: a safe legal lifeline? AB - To what degree should compliance with clinical practice guidelines protect you from a malpractice charge? And will physicians who are offered such protection practice less defensively, and thus less expensively? As guidelines proliferate, answers are emerging. PMID- 10139691 TI - 'Any Willing Provider' laws: the pros and cons for doctors. AB - Seven states now have laws requiring managed care plans to sign contracts with any primary care physician willing to meet contract terms. How do these laws affect patient care? Here's background on the issue, followed by the views of two physicians: one in favor of such laws and one opposed. PMID- 10139692 TI - Answers to vexing data bank questions. Interview by Ron Schaumburg. PMID- 10139693 TI - Where to go to become a managed care expert. AB - When it comes to finding your way through the thicket of managed care options and opportunities that are springing up across the country, knowledge is power. Here's a handy reference that lists places you can turn to increase your knowledge of managed care. PMID- 10139694 TI - These Oxford docs have some lessons for you. PMID- 10139695 TI - Patients can get data on doctors just by picking up the phone. PMID- 10139696 TI - There's more than one way to merge a practice. PMID- 10139697 TI - For HMOs, diversification is the order of the day. PMID- 10139698 TI - Preparing for leadership in the 21st century. PMID- 10139699 TI - To Russia with love ... from N.E.H.A. (National Executive Housekeepers Association). PMID- 10139700 TI - After the merger. Quality assurance for combined services. AB - The Patient Support Services Supervisory/Lead Staff have adapted well to using the MQAI format. We had always used a Quality control of Inspection sheet internally to evaluated performance levels, correct problems and generate work orders. Interviewing patients directly on a random basis was first approached with some fear and reticence. However, the positive comments, especially about the friendliness of our staff, made the task more enjoyable. The input of the nurse or area manager has been more difficult to obtain because of busy work schedules. We receive mostly favorable marks about our staff's service, quality and attitude. The most consistent feedback reflects the desire of area managers to have a dedicated support service person for their unit. This is not based on job performance, but personality, a support person who "fits in" with the other unit staff. This is probably a result of a clear shift to a patient centered care of "team" concept. From the MQAI form, we still generate many work orders for the engineering department and seek to correct housekeeping deficiencies. The problem area that seems to stand out is carpet spotting and odor. We have come to the conclusion that due to rising patient acuity levels, carpeting simply does not belong in a patient room. A program to replace carpeted patient rooms, one at a time if necessary, has been initiated. By constant repetition, our staff knows the hospital codes, safety procedures and universal precautions. We are proud to say, the most "appropriate action" based on our Quality Assessment and Improvement Plan has been to congratulate our staff for a job well done. PMID- 10139701 TI - Implementing HACCP (Hazard Analysis of Critical Control Points) standards. PMID- 10139702 TI - Rethermalization carts. PMID- 10139703 TI - Challenge: how to reduce kitchen accidents. PMID- 10139704 TI - New roles, new identities. PMID- 10139705 TI - New year, new rules. PMID- 10139706 TI - Equipment can sabotage your budget. PMID- 10139707 TI - Avoiding legal disputes. PMID- 10139708 TI - Partnership in education: central service prepares students for materiel management duties. AB - Partnership in education looks at one technical college's approach to meeting the demand for trained workers in central service and materiel management. This article examines the partnership formed between a college, area health care facilities, and industry to design, develop, and implement a central service materiel management program. PMID- 10139709 TI - A step-by-step approach to identifying a partner--and making the partnership work. AB - In an effort to prepare one's facility for certain change, management is looking to "partner" with vendors/manufacturers in an effort to reduce the total cost of supplies. Several opportunities exist, as long as goals and expected outcomes can be identified and realized by both parties. Much thought and work are involved before making such a commitment; however, the payback is certainly worth the investment. PMID- 10139710 TI - Purchasing: a necessary partnership. AB - According to a recent survey published in Hospital Purchasing News, a Mcknight Medical Communications publication, the average hospital in the United States spent $16.7 million, not including equipment purchases, in 1994. This represents an increase of 41.6 percent over the amount spent in 1990, $11.8 million. The hospital's objective of having year-end revenues exceed expenses largely depends on the ability to purchase materiel at the best price, not necessarily the lowest cost. This goal can be achieved by partnering with suppliers and customers (hospital administrative and surgical staff, as well as patients) through open communication and trust. Reducing costs by a percent on the dollar could return $167,000 to the average hospital. Partnering can assist in achieving these savings! PMID- 10139711 TI - A case history: forging a "reusable" alliance. AB - This article presents the focus of partnerships in the future of health care providers. It discusses the necessity for partnerships as well as the mutual benefits that must be a vital part of the relationship. The article also shows specific information about and outlines the value of a specific partnership between the Medical Center of Central Georgia and Medline Industries. The future of health care delivery and reform will depend on different types of partnerships and that all the providers of services and products, as well as health care delivery, must be willing to aggressively align with partners. PMID- 10139712 TI - Survival depends on effective partnerships with suppliers, management, and physicians. AB - Partnering in health care materiel management circles is a concept that has been discussed for years. We, as materiel managers, have never accomplished effective partnering; but I propose that if we are to have a professional future, we should learn to establish effective partnership arrangements with our various customers- externally and internally. PMID- 10139713 TI - The hospital-supplier partnership: take care of the relationship first, and individual rewards will follow. AB - Partnerships and consolidation will continue to occur with increasing frequency within the supplier and health care provider communities as the health care industry strives to lower costs without diminishing quality and service. This article examines what constitutes the ideal hospital-supplier relationship. It asks the question: What does each partner need to do to make the relationship work effectively? It outlines the keys to a win-win proposition and ways to prevent the relationship from breaking down. PMID- 10139714 TI - Partnering as a key strategy of managing to outcomes. AB - More than ever, administrators need "great" materiel managers to produce board room-worthy results. What are those? Administrators are less interested in the details of what we do and more interested in what have we done for them--today. This means performance output with less time and support for the why and how we get the job done. Are we delivering on the desired outcomes? In many instances we have become victims of the details of the profession, forgetting that the details, while important to sustain a process, are not in themselves the process or the solution needed for our troubled industry. PMID- 10139715 TI - Effective alliance--hospital partnering: beyond price. AB - By looking beyond alliances and groups as simply a "vendor" of group purchasing contracts, a hospital can realize significant additional value beyond acquisition price. Doing so takes an attitude conducive to partnership on both sides. When this occurs, the value delivered from these services can often exceed the savings from the group contracts themselves. PMID- 10139716 TI - Partnering: a closer look at one group's programs. AB - The word "partner" brings to mind myriad thoughts and ideas: an association, a sharing relationship, joint interests, marriage. "Partnering" is arguably the most overused term in health care purchasing so far in the 1990s; nonetheless, it represents a change in how business is being conducted and an effective way to lower costs. The following is a representation of how one of the nation's leading group purchasing organizations (GPOs) uses partnerships with a variety of associates to provide opportunities for health care providers to lower costs. PMID- 10139717 TI - The role of materiel management in effective equipment planning. AB - Capital equipment acquisition commonly occurs in hospitals as part of the routine annual budgeting process, one with which materiels executives are familiar. However, when faced with a major construction or renovation project, there are special issues related to capital equipment acquisition that materiels executives must consider. The major phases in project management include: predesign, schematic design, design development, construction document preparation, bidding, construction, occupancy, and postoccupancy phases. As such projects don't occur as frequently, the details of these processes and the role of the materiels executive is described here. This includes a discussion of project-related equipment planning and project-related capital acquisition. PMID- 10139718 TI - From chaos to order: health care quality in context. AB - Quality underlies diverse efforts to repair the troubled health care system, yet the many abstract definitions offered are not particularly useful. A better approach is to evaluate quality in an applied or situational context. This article offers six propositions that establish such a context and explain why the current health care environment is so volatile. Some parallels between health care and the emerging field of science called chaos theory are drawn as a possible future basis for recognizing order in the health care system. PMID- 10139719 TI - Physicians' perspectives of HMOs and marketing: implications and recommendations. AB - The authors compare physicians in HMOs and those not in HMOs in order to determine how HMOs have affected their practices. Physicians in HMOs see more patients per day, but receive less income per patient than physicians not in HMOs; however, both groups of physicians agree that HMOs have not changed marketing practices. In fact, both groups report uncertainty as to the best way to market their practice, and in their understanding of marketing. The physicians do agree that patient referrals are the most important means of patient acquisition; however, both groups report a surprisingly low use of patient questionnaires. Implications and recommendations for HMOs, physicians, and health care marketing researchers are discussed. PMID- 10139720 TI - A descriptive study of personal, institutional, and media sources of preventive health care information. AB - Wellness can be defined as a set of attitudes and behaviors indicating a person's perception of their ability to have some control over their physical well-being. One such behavior associated with wellness is the search and use of preventive health care information. Preventive health care information is the oral and written knowledge available to consumers concerning preventive health care issues. This study examines various demographic characteristics and their association with the propensities to be knowledgeable, seek, and to experience lifestyle changes resulting from preventive health care information. It also examines the relative importance to respondents of three broad sources of preventive health care information. PMID- 10139721 TI - Attributes to consider in the marketing of hospice services. PMID- 10139722 TI - The utilization of employee wellness programs by government, business and industry: a strategic evaluation. AB - This study ascertains the extent of use of employee wellness programs by a cross section of organizations in the United States. Nearly one-thousand organizational personnel professionals responded to a mail survey asking if their organization provided specific wellness services within five areas: (1) incentive programs, (2) exercise and fitness programs, (3) health screening and prevention, (4) nutritional aid, and (5) educational programs. Organizations were then categorized using Standard Industrial Classification (SIC) codes. The results are strategically valuable to both users and providers of wellness products, providing bench-mark data which: (1) allows comparisons of wellness offerings among similar organizations and across organizational types, and (2) provides product development and segmentation guidance to hospitals and other providers of wellness products. PMID- 10139723 TI - The practice of marketing by dentists. AB - The attitudes and practices of dentists regarding the implementation of all the strategic variables in the marketing mix is examined. Factor analysis is used to reduce the data to five factors which are used to describe the attitudes and practices of dentists. The importance of using other marketing variables besides promotion is pointed out along with the implications for influencing dentists to take a broader strategic perspective in the development of their practice. PMID- 10139724 TI - Using wild cards for facilities, program and trend forecasting. PMID- 10139725 TI - Ethical attitudes of pharmacists: balancing practices and beliefs. AB - This study represents the responses of 377 pharmacists to a mail survey examining their beliefs concerning various business situations involving ethical issues. Several short vignettes involving ethical issues are presented and respondents were asked whether they agreed or not with the actions described in each. Conclusions and implications are outlined as are future research needs. PMID- 10139726 TI - Who would approve new drugs if there were no FDA? PMID- 10139727 TI - Experience with an automated point-of-use unit-dose drug distribution system. AB - Two years' experience with an automated, point-of-use unit-dose system at the University of California, San Diego Medical Center (UCSDMC) is described. Growing concerns about the efficiency and cost-effectiveness of the traditional unit-dose drug distribution system at UCSDMC, and the corresponding diversion of professional staff time from pharmaceutical care responsibilities, led us to investigate alternative systems. Criteria for a new system were developed and used in evaluating alternatives. Consideration was given to three possibilities: 1) improving the existing system, 2) automating the unit-dose cassette fill process, or 3) automating the final step in medication delivery at the nursing station. Based on the realization that our traditional unit-dose system was largely inefficient in today's hospital environment, it was concluded that the drug distribution system needed to be re-engineered in a way that simplified delivery and reduced waiting time. The Medstation Rx system marketed by the Pyxis Corporation (San Diego, CA) seemed to meet the need. During a 2-year period a Medstation Rx system was implemented in most of the hospital (in all but three specialty units) and evaluated. This system has resulted in several benefits, including a net savings in labor costs, a significant reduction in waiting time for first doses, and a reduction in dispensing errors. In the process, it was possible to minimize the disruption of pharmacists engaged in the direct provision of pharmaceutical care, thereby increasing their efficiency. PMID- 10139728 TI - Minimizing aminoglycoside toxicity by prescriber notification of prolonged therapy. AB - The development of aminoglycoside toxicity has been reported related to duration of exposure. To potentially reduce the duration of exposure to aminoglycosides, pharmacists documented, via a permanent note in the patient health record, the exposure and potential associated risks of any patient who received greater than 10 consecutive days or 20 days total within 3 months of aminoglycoside therapy at this institution. The impact of the notification on further aminoglycoside exposure was evaluated over two 6-month periods. Notification was successful in ending further aminoglycoside exposure in 25 of 57 patients. Continued aminoglycoside therapy primarily involved treatment of febrile neutropenia and endocarditis. Prevention of toxicity was suggested in the second evaluation period in which none of the patients, having therapy altered by the notification, developed toxicity versus 13 of the 40 other patients who developed a rise in serum creatinine concentration or a reduction in hearing acuity. The methodology that produced these positive results should be easily transferable to other institutions. PMID- 10139729 TI - Bristol-Myers Squibb drug information department services. AB - The pharmaceutical industry has become a leading source of information on pharmaceutical products. Recent data from Bristol-Myers Squibb Primary Care Division indicate that pharmacists are leading users of drug information services. This article was written with the intent to augment the journal's annual feature of the Pharmaceutical Manufacturer's Directory. PMID- 10139730 TI - Managed care organizations: an introduction--Part I of II. AB - Today, managed care organizations operate along a wide spectrum of healthcare delivery models. From staff model HMOs to EPOs, the common element remains the delivery of cost-effective healthcare services to the patient. Implicit in such a system is pharmaceutical care and its related services provided by a pharmacist. Just as the definition or specific delivery model for medical services in managed care has changed since the mid-1950s, pharmacy and pharmaceutical service is different today from our predecessors' practice. Contemporary pharmacist roles and responsibilities continue to change and expand beyond those which existed as little as 1 year ago. As has been accomplished in hospitals, MCO pharmacists are increasingly involved in determining and selecting the best course of rational drug therapy for selected patients' conditions in all managed care settings. This is manifested by drug formularies, drug review programs, clinical practice guidelines, coordinated care committee work, and direct patient counseling. In the next part, the different organizational and professional roles of a pharmacist will be explored. PMID- 10139731 TI - How to prepare for a 1995 JCAHO survey. PMID- 10139732 TI - Planning for a culturally diverse environment. PMID- 10139733 TI - Survival through community services: from sick care to health care. PMID- 10139734 TI - Lessons from 1994 point the way to future reform. PMID- 10139735 TI - Strategy for survival: change and stability in the management of health-care institutions. PMID- 10139736 TI - An older America: strategic challenges for the acute-care hospital. PMID- 10139737 TI - Directory of CE & biomedical organizations. PMID- 10139738 TI - Device-related litigation & clinical engineering. AB - The investigation of patient-related incidents often must include consideration of the role of the associated medical devices. In addition to being good practice from quality review perspectives, federally mandated MDR requirements generally need to include clinical engineering input. Medical devices also play a significant role in patient litigation aimed at medical providers, hospitals and device manufacturers. Clinical engineering has an important role to play in supporting and tracking litigation as it relates to medical equipment. This role requires an understanding of the litigation process and active participation as a claim progresses. It also should include careful evaluation of the assertions and defenses raised by the various parties both during and at the conclusion of litigation. PMID- 10139739 TI - Hepatitis: protecting BMETs & CEs. AB - Hepatitis is the primary occupational hazard for healthcare workers. Not until the 1970s were hepatitis viruses isolated and identified as types A and B. In the late 1970s, hepatitis D was discovered as a major cause of fulminant hepatitis. Soon, it was evident that another type was also at work. Because testing was only available for types A and B, the new category was referred to as non-A, non-B. In the 1980s, scientists identified two more viruses from this non-A, non-B group, namely hepatitis E and hepatitis C. These five types of hepatitis have different modes of transmission. The fecal-to-oral route is the mode of transmission for hepatitis types A and E. But, types B and D are bloodborne pathogens. With the advent of a safe vaccine for hepatitis B, this category is declining. To date, hepatitis C appears to have multiple routes of transmission, with half the cases being posttransfusion. In the United States, 85,000 people per year develop chronic hepatitis C, which ultimately leads to severe liver damage. This paper addresses each of the five viruses that have been grouped by routes of transmission, prevention techniques for BMETs and CEs, and statistics of reported cases to the Centers for Disease Control and Prevention (CDCP) over the last 20 years. PMID- 10139740 TI - Survey of automated noninvasive blood pressure monitors. AB - Automated noninvasive blood pressure (NIBP) monitors, or automated sphygmomanometers, have been increasingly used both inside and outside clinical environments. An extensive survey of such monitors was carried out over the past five years. This survey covers a broad spectrum of monitors including ambulatory monitors, bedside and transport monitors, stress-test monitors, and monitors that are intended for self-measurement. It includes more than 400 models from suppliers in the United States and many other countries. A review of NIBP measurement methods that have been used in automated NIBP monitors is presented in this paper, along with statistical distributions of their use in the surveyed monitors and a list of the suppliers and monitors. PMID- 10139741 TI - Electrical conductivity as a test for the integrity of latex gloves. AB - Electrical and ionic penetration of latex gloves, both intact and with holes, was investigated using salt solutions. Also, simultaneous measurements were made of electrical conduction and bacteriophage penetration, and the effect of latex stretching on effective hole size. The presence of holes was apparent, although the onset of current passage was often delayed because they did not wet immediately. The current through intact gloves increased markedly with time. There was little correlation between current and the number of bacteriophage that passed through a hole. The effective size of holes increased faster than would be predicted by the elongation of the latex. PMID- 10139742 TI - Color technology in video endoscopy. AB - The psychophysical aspects of the color experience and the clinical significance of color during video endoscopy are introduced in this paper. This introduction includes a description of how colors are rendered in video endoscope systems along with basic colorimetry, the science of color. Together these provide the clinical engineer with an understanding of color and a method of effectively communicating color information. The ability to standardize color rendition in video endoscopy systems is not yet available. Nonetheless, an argument is presented in favor of the clinical engineer normalizing color rendition in video endoscope systems in the hospital and educating the clinicians on managing endoscopic system color performance in the clinical setting. PMID- 10139743 TI - R&I '95 industry forecast. Industry surges ahead. PMID- 10139744 TI - R&I '95 industry forecast. Regional outlook: the West will rise again. PMID- 10139745 TI - R&I '95 industry forecast. Experts voice opinions. PMID- 10139746 TI - R&I '95 industry forecast. Associations press for strategic alliances. PMID- 10139747 TI - Incident tracking systems for long-term care facilities: a practical approach. PMID- 10139748 TI - The cooperative cardiovascular program. PMID- 10139749 TI - The ins and outs of operations improvement at OSUMC (Ohio State University Medical Center). PMID- 10139750 TI - Perspectives. Drug formularies pose legal threat to providers. PMID- 10139751 TI - Perspectives. The FY96 Clinton budget: setting the stage for a battle. PMID- 10139752 TI - A glossary of federal budget "terms of art". PMID- 10139753 TI - Pharmaceutical pricing. Health care purchasing at risk. PMID- 10139754 TI - Pharmaceutical pricing. Let the market decide who gets discounts. PMID- 10139755 TI - Maturing of telemedicine technology. Part II. PMID- 10139756 TI - "Give me your tired, your poor ..." so long as they're legal! PMID- 10139757 TI - States still interested in health reform, but Medicaid is where the action is. PMID- 10139758 TI - Great value in gainsharing. PMID- 10139759 TI - The national health system of Great Britain. Part I. AB - The U.S. can learn much from close observation of off-shore single-payer health systems in decline. This is the first of a two-part series that deals with the ills of a well meaning effort. Part two will present a close examination of incremental repair efforts. PMID- 10139760 TI - The multi-hospital system survey. Part II. PMID- 10139761 TI - A new era: House Republicans in the driver's seat. Interview by Thomas A. Scully. PMID- 10139762 TI - The need for standardization of ICD-9-CM E code groupings by cause and intent. PMID- 10139763 TI - Preparing for Joint Commission surveys in 1995. PMID- 10139764 TI - New Mexico. PMID- 10139765 TI - Reengineering healthcare: the future awaits us all. Interview by Laurie Palmer. PMID- 10139766 TI - Reengineering your department: a focus on human resources. PMID- 10139767 TI - Reengineering: a step beyond CPR. PMID- 10139768 TI - From business process engineering to business process innovation. PMID- 10139769 TI - In practice. PMID- 10139770 TI - The logic of severity: outcomes measurement at Minnesota's HealthSpan hospitals. PMID- 10139771 TI - AHIMA's education strategy advances through coordinated efforts. PMID- 10139772 TI - The 1995 Medicare fee schedule. PMID- 10139773 TI - Statement on managed care and the trauma system. American College of Surgeons. PMID- 10139774 TI - Our own worst health enemies. PMID- 10139775 TI - Quality improvement--boon or boondoggle? AB - Is quality improvement (QI) reducing healthcare costs while improving patient care? Researchers find that QI has improved employee satisfaction and morale, but it was designed to do more. One solution is to use problem-solving techniques to help teams identify the level at which they want to address a problem, whether that be the subinstitutional, institutional, or system level. If QI is to fulfill its promise, skilled managers must create effective teams capable of defining and solving complex problems. PMID- 10139776 TI - The algebra of managed care. Creating physician and hospital partnerships. AB - As healthcare faces an economic reengineering, hospitals and physicians are faced with new challenges. It is the first time that they have had joint economic interests, and survival for both is dependent on designing new economic models. This article describes the economic interrelationship between hospitals and physicians and provides insight into opportunities to encourage new levels of collaboration between them. PMID- 10139777 TI - Home care. An emerging solution to the healthcare crisis. AB - As the nation's policy makers and healthcare professionals have wrestled with changing the fundamental way that medical care is delivered in this country, they have considered many options. Home care is one option that should be considered seriously. It is one of the fastest growing segments of the U.S. healthcare system because it's cost-effective, improves patients' quality of life, and can efficiently treat patients with a broad range of medical conditions. PMID- 10139778 TI - Career wellness plans. Change and the healthcare worker. AB - Technological advances, rising costs, and government reforms are revolutionizing delivery of medical services, eliminating thousands of hospital jobs. Without immediate "career wellness therapy," many healthcare workers will find themselves with flatliner careers instead of valuable new skills. PMID- 10139779 TI - Alternative dispute resolution in health services: now more than ever. PMID- 10139780 TI - After the dust settles. Work at the close of the century. PMID- 10139781 TI - States look to press on with health system reform. PMID- 10139782 TI - The reformation of the health care system. PMID- 10139783 TI - Look to the private sector for the future of managed care. PMID- 10139784 TI - Getting HCFA's attention: how ASIM delivers the internist's message. PMID- 10139785 TI - Payment for care plan oversight: an ASIM win for patients and physicians. PMID- 10139786 TI - Clinical research: a neglected issue in health system reform. PMID- 10139787 TI - Reducing the Medicare budget--will it limit your access to care? American Society of Internal Medicine. PMID- 10139788 TI - Health system reform: what's the agenda on Capitol Hill? PMID- 10139789 TI - Health system reform: where will 1995 take us? PMID- 10139790 TI - NHS secures 1.3 billion pound increase. PMID- 10139791 TI - A mixed blessing. PMID- 10139792 TI - It's not always fair weather. PMID- 10139793 TI - Getting and spending. PMID- 10139794 TI - Quality. All together now. PMID- 10139795 TI - Siberian health reform. Health in a cold climate. PMID- 10139796 TI - Drug costs. Compound interests. PMID- 10139797 TI - Hospital officials shift gears when it comes to financing, building parking structure. PMID- 10139798 TI - What price progress? Technology assessment teams field requests--and politics. PMID- 10139799 TI - Technology acquisition: how to plan more strategically for the future. PMID- 10139800 TI - Blanket security, security blanket. PMID- 10139801 TI - Sign of the times. Unique research asks: Which health care symbols are best understood--and by whom? PMID- 10139802 TI - Insider viewpoints on hot conference issues. A project manager's view; an architect's view. PMID- 10139803 TI - Breaking backs vs. breaking the bank. Ergonomic considerations are critical when buying health facility furniture. PMID- 10139804 TI - Constructive change. Two process elements--project vision and flexible tools--are essential for cost effective change management during health care building projects. PMID- 10139805 TI - Famous last words. Will you utter them (or something else) after your next health care building project? PMID- 10139806 TI - TB respirators: do they mask real issues of worker safety? PMID- 10139807 TI - Incinerator rule ignites interest in alternative waste methods. PMID- 10139808 TI - Staff diversity: difference not always creates division at work. PMID- 10139809 TI - New AHA institute helps minorities to climb health care management's career ladder. PMID- 10139810 TI - What factors affect laundry equipment purchases? PMID- 10139811 TI - Choosing a group where you'll be happy. PMID- 10139812 TI - Visit Vegas! Get your boards while you're there. PMID- 10139813 TI - Ten ways to show health plans how good you are. PMID- 10139814 TI - A group dedicated to ethnic health care. PMID- 10139815 TI - Why we dropped most inpatient visits. PMID- 10139816 TI - Pataki's Medicaid-cut plan hit by N.Y. hospital groups, unions. PMID- 10139817 TI - Three vendor groups in hunt for CHIN (community health information network) deal. PMID- 10139818 TI - Calif. oncology network goes national. PMID- 10139819 TI - Joplin, Mo., merger back on track. PMID- 10139820 TI - Merged Fla. hospital changes plans. PMID- 10139821 TI - Buffalo hospitals seek to merge. PMID- 10139822 TI - Catholic, public systems in Charlotte, N.C., turn partnership into merger. PMID- 10139824 TI - GOP floats ideas for health reform. PMID- 10139823 TI - Columbia/HCA to pay in Medical Care suit. PMID- 10139825 TI - Sale to Coram infuses Caremark. PMID- 10139826 TI - Cancer network's goal: draw business. PMID- 10139827 TI - Cleveland system faces layoffs. PMID- 10139828 TI - Kaiser makes loan to bail out Orange County Medicaid effort. PMID- 10139829 TI - Agency takes steps to improve guidelines. PMID- 10139830 TI - N.Y. hospital stops clinical trials. PMID- 10139831 TI - Pa. proposes regulations to license risk-bearing PHOs. PMID- 10139833 TI - Area businesses fight Mich. hospital projects. PMID- 10139832 TI - Mo. clinic ruled tax-exempt. PMID- 10139834 TI - Self-referral law rife with gray areas. PMID- 10139835 TI - Hospitals putting profit margins ahead of high-quality nursing care. PMID- 10139836 TI - Amicable divorces. Academic medical centers refocus on their teaching mission by shedding hospitals. AB - The nation's 120 academic medical centers have long been viewed as the elite of U.S. healthcare providers. But in today's environment, their costly missions of research, education and specialized care may be a liability as they strive to compete with community hospitals. PMID- 10139837 TI - Clinical integration increases profitability, efficiency--study. PMID- 10139839 TI - AHA's political donations grow. PMID- 10139838 TI - AHA board persists with plan to replace trustee congress. PMID- 10139840 TI - Management firms hope to lasso more docs with IPAs. PMID- 10139841 TI - Equality a prominent issue in Columbia/HCA San Antonio deal. PMID- 10139842 TI - Chicago hospital's workers authorize strike. PMID- 10139843 TI - Downgrades outpace upgrades. PMID- 10139844 TI - Hospital layoffs, restructurings cut average business-office pay. PMID- 10139845 TI - Md. Blues for-profit arm denied. PMID- 10139846 TI - Physician groups back top doc pick. PMID- 10139848 TI - Hospitals may offer to help fix Des Moines' budget woes. PMID- 10139847 TI - Colo. hospital asked for bad-debt records. PMID- 10139849 TI - Michigan hospitals approach settlement in antitrust case. PMID- 10139850 TI - Complaints against Medicare HMOs show large variances nationwide. PMID- 10139851 TI - Incinerator emissions rules cause dispute over methodology and risk. PMID- 10139852 TI - Feds probing links between providers in St. Joseph, Mo. PMID- 10139853 TI - Catholics may run Texas hospital. PMID- 10139854 TI - Healthcare industry snaps up image transfer, storage systems. PMID- 10139855 TI - Chicago CHIN (community health information network) planning, hiring. PMID- 10139856 TI - Hospitals show interest in Cleveland CHIN (community health information network) PMID- 10139857 TI - Clinton's budget boosts VA funding. PMID- 10139858 TI - Clinton passes budget ax to Congress. PMID- 10139859 TI - Charter's turnaround of former NME hospitals off to shaky start. PMID- 10139860 TI - Emergency firm links with hospitals. PMID- 10139861 TI - HealthSouth keeps on buying. PMID- 10139862 TI - ANA report stokes restructuring debate. PMID- 10139864 TI - JCAHO reorganizes senior ranks. PMID- 10139863 TI - Hospital wins battle, keeps accreditation. PMID- 10139865 TI - Community voices concern over hospital's Catholic affiliation. PMID- 10139866 TI - Study shows dramatic rise in use of bonuses to lure doctors. PMID- 10139867 TI - Hospitals dodge fallout from D.C. fiscal crisis. PMID- 10139868 TI - Medicare managed care weighed as federal budget-cutting tool. PMID- 10139869 TI - St. Luke's talking with other suitors. PMID- 10139870 TI - Snags in four states have slowed Columbia/HCA's rapid expansion. PMID- 10139871 TI - GOP talks tough, but will act slowly. PMID- 10139872 TI - Info systems refocus priorities. AB - Healthcare executives say improving their computer systems' managed-care capabilities is their No. 1 information technology priority. Resolving thorny cost and control issues involving community health information networks also rated high among the executives. PMID- 10139873 TI - Control, cost top issues facing CHINs. PMID- 10139874 TI - Hillhaven offer could spur other bids. PMID- 10139875 TI - Business-provider organizations reap cost and health dividends. PMID- 10139876 TI - Providers have to tailor ads to consumer needs. PMID- 10139877 TI - Hospitals report revenue, profit gains. PMID- 10139878 TI - Medical groups draw financiers' interest. PMID- 10139879 TI - Enforcing OBRA's reforms. PMID- 10139880 TI - Forecast for 1995. PMID- 10139881 TI - Vent patients: breathing easier. PMID- 10139882 TI - Drug therapy in long term care: new drug options spur a focus on outcomes. PMID- 10139883 TI - Provider rates the top multifacilities. PMID- 10139884 TI - Stock markets spur LTC growth. PMID- 10139885 TI - Watching the waiver process. PMID- 10139886 TI - Getting a good night's sleep. PMID- 10139887 TI - Subacute offers a second chance. PMID- 10139888 TI - Getting the itch under control. When trustees and CEOs don't communicate, minor irritations can become blistering sores. PMID- 10139889 TI - Team teaching pays off. PMID- 10139890 TI - Mixing politics and public hospitals is a recipe for failure. PMID- 10139891 TI - Financial options for integration. PMID- 10139892 TI - Retaining good leaders before and after mergers. PMID- 10139894 TI - The right to know. PMID- 10139893 TI - Are patients happy? Managed care plans want to know. PMID- 10139895 TI - Conflict of interest. PMID- 10139896 TI - Preparing trustees for the future. PMID- 10139897 TI - Failed courtships, broken engagements. Why mergers and affiliations fall apart. PMID- 10139898 TI - Is there life after death? A look at the prospects for health reform in the new Republican Congress. PMID- 10139900 TI - New ways to stay healthy. PMID- 10139899 TI - Fiscal state of the states. PMID- 10139901 TI - Measure your gift shop's performance, then set goals and go for it! PMID- 10139902 TI - Why we need community boards. PMID- 10139903 TI - The way it was. PMID- 10139904 TI - Cultural diversity meets end-of-life decision making. PMID- 10139905 TI - Want to be taken for granted? How to apply for--and win--grant money for your hospital's volunteer projects. PMID- 10139906 TI - Volunteers are 'healing presences'. PMID- 10139907 TI - Managing conflict resolution models. AB - Do you always agree with your boss, peers, and employees? If not, then you have conflict. This article presents five conflict management styles and examples of situations in which each is appropriate for resolving a conflict. With the aid of step-by-step models, you will learn how to use the Collaborating conflict management style to: 1) initiate a conflict resolution with others; 2) respond to a conflict resolution brought to you by someone; and 3) mediate a conflict resolution between your employees. This article should help you to improve your ability to resolve conflicts without negative effects on human relations. PMID- 10139908 TI - Professional managers examine their listening ability. AB - This article describes the results of a study of perceived listening abilities among members of a professional organization much like the Clinical Laboratory Management Association (CLMA). Those members completed a listening types inventory, and the results were analyzed. About 75% of the members were classified as passive or detached listeners, the least effective types; only about 2% were active listeners, the most effective type. The results also showed that females perceived themselves to be better listeners than did males, and there were no significant differences based on age. Those who had taken more than one listening training seminar or course had significantly higher scores on the inventory than did those who had no training or just one seminar or course. The implications of these findings for professional managers are discussed at the conclusion of the article. PMID- 10139909 TI - Transition in quality: from quality assurance to strategic quality management. AB - The 1990s and beyond present formidable challenges to health-care providers, including clinical laboratories and pathology departments. However, numerous opportunities lie within these challenges. Discovering these opportunities and exploiting them will be critical success factors for future survival. Quality assurance, continuous quality improvement, and strategic and financial planning are all activities used to a varying extent by clinical laboratories. The cumulative potential benefits to an organization in which these activities are integrated can far exceed their sum as individual components. Coordinating these interdependent processes is the basis for managing strategically. The experience of one organization's efforts to plan and develop such a strategy is presented and discussed. PMID- 10139910 TI - Is the customer always right? PMID- 10139911 TI - Reengineering our laboratories. PMID- 10139912 TI - Six steps to improve discussions of employee performance. AB - Formal performance appraisal interviews are often ineffective because they strain working relationships between managers and employees and provide inadequate feedback to both parties. This article provides supervisors with specific guidance to improve appraisal interviews by addressing three topics: 1) why appraisal interviews are held; 2) what information is exchanged; and 3) how the interviews are planned and conducted. The author advises supervisors to discuss administrative decisions with the employee in an annual meeting and to stress employee development and performance improvement in separate interviews held as often as necessary. The article emphasizes that interviews are more effective when the topics discussed are observable employee performance and results rather than more subjective assessments of personal qualities, skills, and knowledge, which lead to employee defensiveness. Specific guidelines are given to help supervisors draw out the employee's assessments of his or her own performance and plans for improvement. This two-way communication approach contributes to a positive discussion between supervisors and employees and is also appropriate when team members assess the performance of their peers. PMID- 10139913 TI - Managed approach to modernising services. PMID- 10139914 TI - 'Proposed changes will improve nursing quality and professional accountability.'. PMID- 10139915 TI - Cook chill--innovation par excellence! PMID- 10139916 TI - How users are finding ORA*CARE. PMID- 10139917 TI - Needs and services in North Health region. AB - North Health has made an extensive survey of the needs and services required in its region and has drawn up a locality plan for each of its five areas- Northland, North Shore and Rodney, Auckland City and Gulf Islands, West Auckland, and South Auckland. Following is an account of needs and services that will be receiving special attention over 1994-95. PMID- 10139918 TI - Perspectives. GOP sets its sights on Food and Drug Administration. PMID- 10139919 TI - Healthcare IT (information technology) compared to the rest of federal spending. PMID- 10139920 TI - Resolutions & goals for healthcare IT (information technology) halfway through the nineties. PMID- 10139921 TI - For the busy healthcare executive: information tools. PMID- 10139922 TI - Implementing an EIS (executive information system), one step at a time. Case study. PMID- 10139923 TI - Merger mania: surviving the on-going shake-outs. PMID- 10139924 TI - Getting more money for your I.S. (information systems) budget. PMID- 10139925 TI - Healthcare informatics around the world. PMID- 10139926 TI - Distributing databases: a model for global, shared care. PMID- 10139927 TI - Mobilizing physicians for wireless technology. PMID- 10139928 TI - Focusing care: away from the patient & toward the population. PMID- 10139929 TI - Getting to the point of information systems: a tale of two client sites. PMID- 10139930 TI - The new mindset: a tool for improving patients' health. PMID- 10139931 TI - The new 1995 JCAHO "Environment of Care" and other related standards. PMID- 10139932 TI - EPA's Green Lights Program. PMID- 10139933 TI - Using SUPPORT (Study to Understand Prognoses and Preferences for Outcomes and Risks of Treatment) to GUIDe (Guidelines for Use of Intensive Care in Denver) our fix on futility. AB - Futility is finally getting systematic and detailed attention. The subject is being redefined and dissected into its component parts, factored and analyzed into predictable models, set into professional and organizational policies, and crafted into community guidelines, as the following articles describe. PMID- 10139934 TI - Opinions surface on ethical dimensions of health education. PMID- 10139935 TI - PA ethics consortium program becomes a model for education. PMID- 10139937 TI - Limits placed on embryo research. PMID- 10139936 TI - State passes physician-aided suicide; now asks, 'What have we done'? AB - It's hard to tell whether we're hearing a collective sigh of relief or the catching of one's breath as Oregon's Death with Dignity Act was passed but put on hold. Regardless, the show's not over, although the devil in the details is starting to emerge. Many are calling the vote a "wake-up call," although it appears that opposing messages are being heard. Moreover, the distinction between physician-aided suicide and euthanasia are becoming ever more blurred. PMID- 10139938 TI - Breakeven analysis for capitated arrangements. PMID- 10139939 TI - Capitated hospital contracts: the empty beds versus filled beds controversy. PMID- 10139940 TI - Montclair Baptist and AtlantiCare break new ground with care paths for psych patients. PMID- 10139941 TI - Finding your way through the hospital cost-reduction maze. PMID- 10139942 TI - Medication errors in an acute care setting. PMID- 10139943 TI - Committed volume contracts: their growth could change your job. PMID- 10139944 TI - The ABCs of cost-effectiveness. PMID- 10139945 TI - Considering automated supply tellers? Crunch a few numbers first. PMID- 10139946 TI - The delicate balance. IV supplies and infection control. PMID- 10139947 TI - Why we stopped using EtO. PMID- 10139948 TI - Check please! Materials managers pay the bills at Middlesex. PMID- 10139949 TI - Capital equipment group brings materials management into the loop. PMID- 10139950 TI - Here's one way to foil those phone pilferers. PMID- 10139951 TI - Stats. News from the laundry front. PMID- 10139952 TI - Capitation strategies. PMID- 10139953 TI - The effect of mergers and acquisitions on behavioral health care. AB - The consolidation of America's managed health care industry rivals any corporate raider scenario. Unlike previous merger booms, however, health care unions in the 1990s have been strategically planned. Particular attention is paid to merger activity in the behavioral health care field. Ultimately, the author writes, mergers will bring greater efficiency and lower costs to health care but also less choice for patients. Unless providers and payers pay close attention to the human side of mergers and acquisitions, new alliances are likely to fall short of their goals. PMID- 10139954 TI - Consultant pharmacists improve patient care in HIV/AIDS group home. PMID- 10139955 TI - Customer complaints: a managed care firm's best weapon in CQI. AB - Encouraging customer feedback and developing an automated customer complaint system are two essential steps a health plan must take if it wishes to develop a balanced relationship with the customer. The author explores how the right attitude and appropriate action can ensure that both customers and the company reap the benefits of a comprehensive customer complaint system. PMID- 10139956 TI - Medicare and managed care: working together for the future. PMID- 10139957 TI - The trend towards capitation: pros and cons. AB - In certain basic ways, capitation seems to be a win-win situation for everyone. A health plan pays providers in carefully structured networks a fixed fee for each enrollee. Providers are prepaid these fees for a certain number of patients in one or more plans in which they participate. Costs are reasonable and predictable for both plans and employers. Although providers assume most of the risk, they have a guaranteed, predictable revenue stream and a ready-made patient base in exchange for this risk. PMID- 10139958 TI - Pharmacy access to electronic patient records. AB - Electronic medical record keeping may prove to be a boon to the managed care industry, enabling efficient administration of health delivery and better access to a particular patient's long-term medical history. It is hoped that better quality care will result. The availability of electronic medical records to pharmacists has tremendous implications on pharmacy's ability to deliver on the promise of pharmaceutical care. PMID- 10139959 TI - Managed care and labor issues: Part II--Bargaining unit clarification. AB - The intent to expand, shrink, reorganize, or redistribute will have vastly different effects on the workforce. This article discusses employment law issues in general as they apply to MCOs that have both unionized and nonunionized employees. PMID- 10139960 TI - Health plans and providers: how new partnerships are evolving in a volatile environment. AB - As the fee-for-service health system dwindles, organized provider structures and mutually beneficial relationships are forming between providers and payers. Providers and payers--united by shared goals of efficiency and effectiveness of care--are beginning to work together to identify and achieve their financial and quality objectives. In this article, the author discusses the evolution of these relationships in health care delivery, addresses the challenges of integration, and reveals the winners in this new delivery system. PMID- 10139961 TI - The CFC challenge: chillers to replace, retrofit or ? AB - Health care facilities are planning for changes in regulations regarding chlorofluorocarbon-based refrigerants. These changes are imminent, leaving little time to figure out what to do with equipment using these refrigerants. This article looks at the background of the CFC phaseout program and reviews options available to engineers in assessing their equipment. PMID- 10139962 TI - Sexual harassment: preventive steps for the healthcare practitioner. AB - Like other employers, healthcare providers can be held liable for sexual harassment in the workplace. However, by implementing an effective sexual harassment policy, healthcare providers can avoid corporate liability for sexual harassment and create a more productive working environment as well. PMID- 10139963 TI - Rationing health care in Canada. AB - Canada has been able to develop a fairly successful system of healthcare rationing by balancing the conflicting concerns of equal access and cost efficiency, federal funding and provincial control, and public sector management and private sector provision. Financial constraints limit the kinds of services included within the notion of equal access, however, forcing healthcare providers to make difficult choices about who will receive a particular healthcare service. PMID- 10139964 TI - The construction of health care and the ideology of the private in Canadian constitutional law. AB - Healthcare benefits are provided universally to all Canadians through a national healthcare system with provincial differences. A history of the manner in which healthcare issues have been understood in different historical and constitutional periods reveals the ever present inequalities in many aspects of healthcare delivery. PMID- 10139965 TI - The right to health care in the United States. PMID- 10139966 TI - The allocation of healthcare resources in the National Health Service in England: professional and legal issues. AB - Although Britain's National Health Service has implemented a number of reforms designed to improve the quality of care in a cost-effective manner, healthcare litigation in the United Kingdom continues to increase. Resource shortages have prompted many patients to bring legal actions against the National Health Service in an attempt to compel a resource allocation, while other patients have sued their physician for negligence in providing a healthcare service. PMID- 10139967 TI - Psychotherapists' sexual relationships with their patients. AB - Sexual contact between psychotherapists and their patients is currently one of the leading causes of malpractice claims against psychotherapists. Some courts have recognized the devastating emotional harm that patients suffer as a result of psychotherapist-patient sex and have expanded the remedies available to these patients; a few state legislatures have enacted statutes that impose civil or criminal penalties on psychotherapists who engage in sexual activity with their patients. PMID- 10139968 TI - Employee participation programs after electromation: they're worth the risk! AB - Employee participation programs (?EPP?s) can be an invaluable means of utilizing employee input, particularly in the healthcare industry. However, the National Labor Relation Board's (?NLRB?) recent decision in Electromation, Inc. affects the structure and use of EPPs. There are still ways in which EPPs can be structured to meet the NLRB's requirements. PMID- 10139969 TI - Criminal investigation and enforcement of the antitrust laws in the health care field. PMID- 10139970 TI - Recent developments for tax-exempt healthcare organizations. AB - Significant developments in the law of tax-exempt healthcare organizations occurred during the early 1990s. The span of developments includes a seminal Seventh Circuit case, Living Faith v. Commissioner, as well as an Internal Revenue Service determination letter recognizing the charitable tax status of integrated delivery systems, showing the recent activitism of the IRS in the healthcare arena. In addition, the federal and state courts have struggled to define and apply concepts of community benefit and charity to modern healthcare organizations. PMID- 10139971 TI - Rationing of health care--who determines who gets the cure, when, where, and why? AB - Healthcare rationing means the equitable distribution of limited healthcare resources. The means of distribution and the manner in which these choices are made varies depending on each person's perspective. Rationing already occurs in the United States in areas such as organ transplantation. PMID- 10139972 TI - Antitrust enforcement encourages health care providers to cooperate procompetitively. AB - A review of significant administrative and judicial rulings in antitrust law during 1993 shows that the antitrust laws should not impede innovative, cost cutting cooperative arrangements among providers, so long as their actual or potential procompetitive benefits are not outweighed by their anticompetitive effects. PMID- 10139973 TI - Medical malpractice and physician accountability: trends in the courts and legislative responses. PMID- 10139974 TI - Efficacious or precarious? Comments on the processing and resolution of medical malpractice claims in the United States. PMID- 10139975 TI - Malpractice and the presuppositions of medical practice. PMID- 10139976 TI - Exponential change: today is already tomorrow. PMID- 10139977 TI - The efficacy of the medical malpractice system: a Canadian perspective. PMID- 10139978 TI - Overview of medical malpractice law in Canada. PMID- 10139979 TI - Economic aspects of medical negligence in the context of the National Health Service in Britain. PMID- 10139980 TI - Medical malpractice: an overview of the English position. PMID- 10139981 TI - An evaluation of the Danish no-fault system for compensating medical injuries. PMID- 10139982 TI - Medicare and Medicaid false claims: prohibitions and sanctions. AB - Both state and federal agencies are cracking down on health care professionals who file false Medicare claims, but physicians who make good faith attempts to comply with the law are fairly secure from prosecution, since both criminal and civil penalties must be based on willful or knowing breaches of the law. PMID- 10139983 TI - Judicial review of Medicaid hospital and nursing home reimbursement methodologies under the Boren Amendment. AB - Congress passed the Boren Amendment to allow states to develop and implement alternative reimbursement methodologies that promote the efficient and economical delivery of hospital and nursing facility services. However, courts have interpreted Boren in ways that limit state discretion and impede their ability to meet budgetary constraints. PMID- 10139984 TI - Paying for health care reform. PMID- 10139985 TI - The demise of the diagnosis-related group/all payer system in New Jersey: the aftershock. PMID- 10139986 TI - Adverse occurrences during hospitalization on a general medicine service. AB - OBJECTIVE: To investigate the sensitivity and efficiency of medical record review for detecting adverse occurrences. DESIGN: A prospective observational study. Adverse occurrences were defined broadly as events that caused or had potential to cause adverse patient outcomes. Between August 1, 1990 and March 1, 1991 a research nurse reviewed written medical records and attended nursing morning report. SETTING: A university hospital. PATIENTS: Inpatients on two general medical wards and the medical and cardiovascular intensive care units. RESULTS: There were 317 occurrences identified (0.2 per patient day): 56% were medication related, 20% were new medical conditions, 11% were procedure complications, 5% were patient dissatisfaction related, 4% were equipment related, and 3% were accidents. Review of physician progress notes was the most sensitive means of detecting new conditions (sensitivity 73%), procedure complications (sensitivity 100%), equipment-related occurrences (sensitivity 71%), and adverse drug reactions (sensitivity 89%). Review of nursing notes was the most sensitive means of detecting patient dissatisfaction (sensitivity 69%) and accident-related occurrences (sensitivity 100%). Passive reporting through incident reports identified only 9% of all adverse occurrences. Surveillance was time-consuming: concurrent review of all written sources in a 250-bed hospital would require 5.5 technicians. CONCLUSIONS: Surveillance for adverse occurrences is expensive. If selected adverse occurrences were identified as being important for quality improvement, surveillance could be focused efficiently on limited sources. The number of adverse occurrences discovered by surveillance will be heavily dependent on the choice of data source (physician progress notes, nursing notes, etc.). Comparisons among hospitals can be made only when systems for detection have similar validity. PMID- 10139987 TI - Case study. Quality health care--what does it mean and how will we know it? The Sentara Health System. PMID- 10139988 TI - Developing risk-adjusted monitoring systems: illustration of an approach. PMID- 10139989 TI - Hospital quality improvement programs: meeting the challenges of public expectations, professional responsibility, and survival in a reformed health care system. PMID- 10139990 TI - The Clinton administration's proposed Health Security Act. PMID- 10139991 TI - Quality of care and quality assessment in Spanish hospitals. PMID- 10139992 TI - Medicare program; special payment limits for home blood glucose monitors--HCFA. Final notice. AB - This notice establishes special payment limits for standard home blood glucose monitors, identified as code E0607 of the HCFA Common Procedure Coding System (HCPCS). This final notice is intended to prevent excessive payment for these items. Currently, payment under the Medicare program for home blood glucose monitors and other items of durable medical equipment (DME) is equal to 80 percent of the lesser of the actual charge for the item or the fee schedule amount for the item. This notice requires that payment for standard home blood glucose monitors be equal to 80 percent of the lesser of the actual charge or a special payment limit. PMID- 10139993 TI - Statement of organization, functions, and delegations of authority--HCFA. PMID- 10139994 TI - Preparation, transfer for commercial distribution, and use of byproduct material for medical use--NRC. Final rule; clarification. AB - The Nuclear Regulatory Commission (NRC) is amending regulatory text and the response to a public comment contained in a final rule published in the Federal Register on Friday, December 2, 1994, entitled "Preparation, Transfer for Commercial Distribution, and Use of Byproduct Material for Medical Use." This action is necessary following reconsideration by the NRC regarding the requirements for the information to be included on labels for radioactive drugs to be transferred for commercial distribution. The effect of this action is to reduce regulatory burden and uncertainty for licensees that manufacture and distribute radiopharmaceuticals that contain byproduct material for medical use. PMID- 10139995 TI - Medicare program; providers and suppliers of specialized services: technical amendments--HCFA. Final rule with comment period. AB - This rule reorganizes Medicare regulations that pertain to providers and suppliers of specialized services, in order to facilitate the incorporation of future rules in logical order. The rule also makes minor technical and editorial changes to clarify the rules and eliminate duplication without substantive change. PMID- 10139996 TI - Medicaid program; limitations on aggregate payments to disproportionate share hospitals: FFY 1995--HCFA. Notice. AB - This notice announces the preliminary Federal fiscal year (FFY) 1995 national target and individual State allotments for Medicaid payment adjustments made to hospitals that serve a disproportionate number of Medicaid recipients and low income patients with special needs. We are publishing this notice in accordance with the provisions of section 1923(f)(1)(C) of the Social Security Act (the Act) and implementing regulations at 42 CFR 447.297 through 447.299. The preliminary FFY 1995 State DSH allotments published in this notice will be superseded by final FFY 1995 DSH allotments to be published in the Federal Register by April 1, 1995. PMID- 10139997 TI - The '95 plan? Forget bells and whistles. PMID- 10139998 TI - Here's how much new physicians expect to earn. PMID- 10139999 TI - The coming boom in primary care. PMID- 10140000 TI - Contracting with an MCO? Ask these 20 questions. PMID- 10140001 TI - Know your needs, not just your desires. PMID- 10140002 TI - Publishing a guideline is just the first step. PMID- 10140003 TI - Integration groundswell keeps growing among groups. PMID- 10140004 TI - In primary care physician incomes, there's still a gender gap. PMID- 10140005 TI - The sleeper in managed care. What the mental health dispute means for your practice. PMID- 10140006 TI - The sleeper in managed care. 10 charges leveled against managed mental health care. PMID- 10140007 TI - Medical education takes on a managed care flavor. PMID- 10140008 TI - These doctors built a managed care plan from scratch. PMID- 10140009 TI - What's behind the fight for female patients? PMID- 10140010 TI - What are the rules for providing 'marginal' treatment? PMID- 10140011 TI - Six more pointers to help you prepare for effective negotiations. PMID- 10140012 TI - Here's why critical pathways make sense for your practice. PMID- 10140013 TI - Two types of videos help educate patients about treatment options. PMID- 10140014 TI - As plans trim hospital days, expect to see more patients. PMID- 10140015 TI - How do your staff salaries compare to these averages? PMID- 10140016 TI - How regulated will you be? PMID- 10140017 TI - Coping with E/M changes in the '94 CPT manual. PMID- 10140018 TI - How the urge to merge affects you. PMID- 10140019 TI - Are your employees in the dark about health care reform? PMID- 10140020 TI - Clarifying the alphabet soup of managed care. PMID- 10140021 TI - New psoriasis guidelines for primary care physicians and dermatologists. PMID- 10140022 TI - Computer program assists physicians in selecting antibiotics. PMID- 10140023 TI - Don't get burned by the boilerplate in your managed care contract. PMID- 10140024 TI - Under Health Security Act, alliances would dominate coverage. PMID- 10140025 TI - HMOs remain a riskier proposition than PPOs. PMID- 10140026 TI - Physician bonuses: tarnished awards? AB - Physician bonuses tied to meeting a managed care plan's profit or utilization targets reward doctors for stinting on care. Bonuses tied to patient satisfaction surveys measure service levels, not quality. Still, these deeply flawed payment systems are becoming more widespread. PMID- 10140027 TI - Joining a pediatric group gave these internists an edge. PMID- 10140028 TI - The right way to fire an employee. PMID- 10140029 TI - Finally, computers catch up with doctors. PMID- 10140030 TI - Two more snares to beware in contract boilerplate. PMID- 10140031 TI - AHCPR asks primary care physicians to assume management of early HIV. PMID- 10140032 TI - Health spending passes $1 trillion, with no letup in sight. PMID- 10140033 TI - Adjustments to billed charges keep climbing. PMID- 10140034 TI - "Should I join this alliance?" and other questions for your lawyer. PMID- 10140035 TI - At the controls: physician-owned plans are back. PMID- 10140036 TI - What the contract doesn't say. AB - Even when a PPO contract looks acceptable at first glance, hidden snags can await the unwary. A family physician who is an experienced negotiator points out possible "sleepers"--unstated conditions that aren't in your best interests. PMID- 10140037 TI - A system for boosting your collections. PMID- 10140038 TI - Blueprint for one perfect day. AB - Managed care will force you to be more efficient in hundreds of ways in your office day. Here's a proven system for meeting that challenge--a system that will pay dividends in office morale and patient satisfaction. PMID- 10140039 TI - Cleveland project rates performance of 30 hospitals. PMID- 10140040 TI - When an inflation rate of 8% is good, we must be talking about health care. PMID- 10140041 TI - Primary care incomes keep rising as those of specialists stall. PMID- 10140042 TI - How will care be rationed? AB - No bill before Congress fully answers the explosive question of who gets how much care--and who ultimately makes the hard choices. But experts say health care rationing of some kind is inevitable. Here's how to decipher the debate, and what it means for your practice. PMID- 10140043 TI - Health plans want to know: are you certified? AB - Physicians without board certification are finding themselves cut out of managed care. But do their board-certified colleagues have better outcomes, or just better credentials? PMID- 10140044 TI - Fee-for-service lives--in this managed care firm. AB - A medical group management firm in California is turning conventional managed care wisdom on its ear. It pays primary care physicians on a fee-for-service basis, while putting specialists on salary. PMID- 10140045 TI - Timing your move to computerized charts. PMID- 10140046 TI - Orlando area hospitals use software to cut costs and improve quality. PMID- 10140047 TI - Your compensation formula may soon violate the law. PMID- 10140048 TI - How much information are you getting from your health plans? PMID- 10140049 TI - Physicians benefit from income gains thanks to modest inflation rate. PMID- 10140050 TI - Will managed care limit your scope of practice? PMID- 10140051 TI - Are PHOs just a passing fad? PMID- 10140052 TI - How I spur payers to reverse bad decisions. PMID- 10140053 TI - How one clinic handles a dominant HMO. PMID- 10140054 TI - How cardiologists view managed care. PMID- 10140055 TI - Mayo, Deere go beyond guidelines to wider management of diseases. PMID- 10140056 TI - More practice structure ideas for the age of managed care. PMID- 10140057 TI - Fruits of automation: more data on line for doctors, less time in line for patients. PMID- 10140059 TI - Are your expenses in line with these norms? PMID- 10140058 TI - Five tips for improving your negotiating skills. PMID- 10140060 TI - Protecting the value of your practice. AB - If your planned retirement nest egg rests substantially on the value of your practice, look again. For many solo practices and small groups, managed care is pushing values down and making willing buyers harder to find. PMID- 10140061 TI - Tips for effective telephone triage. AB - With the tight schedules imposed by managed care, physicians find themselves providing more initial care over the phone. These pointers will help your office staff take over the chore of determining which patients need to see you and which don't. PMID- 10140062 TI - How three doctors coped with the battle for Atlanta. PMID- 10140063 TI - Thinking merger? Employ this safeguard. PMID- 10140064 TI - 7 questions to answer before negotiations begin. AB - Whether you have a solo practice or work with a large, sophisticated multi specialty group, asking basic questions can reduce your chances of signing unfavorable contracts. Here are some of the most important factors to keep in mind. PMID- 10140065 TI - When it's hard to be sure of the patient's own goals. AB - As the new world of managed care transforms your professional life, it also poses new ethical problems. This month, Managed Care welcomes to its pages columnist John La Puma, M.D., who will address the ethical concerns introduced by capitation and similar features of a fast-changing environment. PMID- 10140066 TI - New mental health screening tool is said to improve quality of care. PMID- 10140067 TI - Aetna opens its guidelines to review by outside internists. PMID- 10140068 TI - How do managed care ties affect a doctor's decision to advertise? PMID- 10140069 TI - If you work with PPOs, odds are they're using fee schedules to pay you. PMID- 10140070 TI - How well can you read your market? PMID- 10140071 TI - How capitation changes your staffing needs. PMID- 10140072 TI - Should physicians refer patients to chiropractors? PMID- 10140073 TI - Making the case for chiropractic referrals. AB - Are chiropractic physicians a cost-effective choice for the treatment of back pain in the age of managed care? Two chiropractors and an internist join to answer that question with an emphatic "yes." PMID- 10140074 TI - These letters can help you open up 'closed' panels. AB - The bad dream is starting to come true in many metropolitan areas. Physicians who resisted joining managed care panels are losing patients. Worse, they are now being told it's too late to join. Is there anything you can do to get on a panel once it's closed? Of course! PMID- 10140075 TI - New low back pain guidelines will keep patients out of bed. PMID- 10140076 TI - What to expect from your hospital's ethics program. PMID- 10140077 TI - How to divide income fairly--and steer clear of Stark violations. PMID- 10140078 TI - Plans move to closed formularies, with incentives to get you to use them. PMID- 10140079 TI - NN/LM hospital libraries connect to the Internet. PMID- 10140080 TI - One-person health science librarians: extinction, evolution, or exhaustion? PMID- 10140081 TI - JCAHO's I.M. Chapter: their standard, our compliance. PMID- 10140082 TI - Library automation profile. Richmond Memorial Hospital & Nursing Libraries. PMID- 10140083 TI - Technical services. PMID- 10140084 TI - Special report. Successful strategies for building an integrated hospital/physician healthcare system. PMID- 10140085 TI - Five challenges of building an integrated delivery system. PMID- 10140086 TI - Building a culture of participation in a vertically integrated, regional health system. PMID- 10140087 TI - How fee-for-service groups are making the transition to capitation. PMID- 10140088 TI - From doorkeeper to building manager: the changing role of the primary care physician. PMID- 10140089 TI - Success factors for the delivery of prepaid healthcare. PMID- 10140090 TI - Visionary systems design quality into their integrated care networks. PMID- 10140091 TI - Developing quality- and customer-focused credentialing criteria for physicians in integrated healthcare systems. PMID- 10140092 TI - Glossary of terms relating to managed care and capitation. PMID- 10140093 TI - Assessing models for integration: a strategic analysis. PMID- 10140094 TI - Generations of managed care. PMID- 10140095 TI - Lutheran General HealthSystem, Chicago. Case study. PMID- 10140096 TI - Why are we building integrated systems? PMID- 10140097 TI - Why are we building integrated systems? PMID- 10140099 TI - Self-assessment of integrated system boards. PMID- 10140098 TI - Understanding capitation and at-risk contracting. AB - New payment methods are driving the formation of integrated systems, but how do these payment plans really work? HSL researched capitation and other forms of at risk contracting with primary care practices, specialty groups, and hospitals in both second and third generation managed care. Our story clarifies the complexities underlying capitation so leaders can identify the implications for their systems. PMID- 10140101 TI - Tax exemption no slam dunk for integrated systems. PMID- 10140100 TI - Case study. Memorial Healthcare System, Houston. PMID- 10140102 TI - Managed cooperation: an approach to healthcare reform in rural areas. PMID- 10140103 TI - The primary care group: the catalyst for network integration. PMID- 10140104 TI - Antitrust implications of hospital mergers. PMID- 10140105 TI - Case study. Allina Health System, Minneapolis-St. Paul. PMID- 10140106 TI - Reflections on the merger that never happened. Interview by Meg Matheny. PMID- 10140107 TI - Depression in primary care: toward cost-effective management. PMID- 10140108 TI - Hospital mergers and affiliations. PMID- 10140109 TI - A board checklist for mergers and affiliations. PMID- 10140110 TI - Case study. Bassett Healthcare--lessons from a rural regional network. PMID- 10140111 TI - Evaluating and choosing an affiliation partner. PMID- 10140112 TI - A merger is forever: focus on mission and values. Interview by Meg Matheny. PMID- 10140113 TI - Hospital mergers and affiliations--Part II. PMID- 10140114 TI - Case study. HealthCare Partners Medical Group. PMID- 10140115 TI - The future of integrated delivery systems. Interview by Meg Matheny. PMID- 10140116 TI - What happens when a payer owns or controls a hospital? PMID- 10140117 TI - Utilization management checklist. PMID- 10140118 TI - Case study. The Hitchcock Clinic and Dartmouth Hitchcock Medical Center: linking community and academic medicine. PMID- 10140119 TI - Strategic performance measurement in an integrated healthcare system. PMID- 10140121 TI - A glossary of information system terms. PMID- 10140120 TI - Can PHOs work? Success strategies and lessons from three generations. PMID- 10140122 TI - The future of healthcare information systems. Interview by Barry S. Bader. PMID- 10140123 TI - Case study. Rush Prudential Health Plans, Chicago. PMID- 10140124 TI - Appropriate selection of antimicrobials in the treatment of ambulatory patients. PMID- 10140125 TI - Information systems for managed care. PMID- 10140126 TI - Case study. Orlando Health Care Group and PruCare of Orlando. PMID- 10140128 TI - Governance of community-based integrated healthcare delivery systems. PMID- 10140127 TI - Kaiser Permanente in the Mid-Atlantic region: an interview with Alan J. Silverstone. PMID- 10140129 TI - Survey process gets a total makeover. PMID- 10140130 TI - Retirement. Branching out into the community. PMID- 10140131 TI - How is computerization affecting nursing staff training? PMID- 10140132 TI - Longterm care goes on-line. AB - With the growing computerization of longterm care, streamlined administration and electronic bridges between healthcare providers is on the horizon. Many facilities already use computers for financial and administrative tasks, while an increasing number use them to track and document patient care. Once patient data has been input, it's an easy step to electronically outputting the MDS. PMID- 10140133 TI - 1995 Software Buyers' Guide. PMID- 10140134 TI - A sense of community. Special programs build bridges to neighbors. PMID- 10140135 TI - Minimum data set, maximum aggravation. PMID- 10140136 TI - International models. Home care in Canada. AB - Canada's exemplary health care system provides a great deal of medical coverage for its citizens, yet there are still some inconsistencies in delivery that need to be ironed out. This article takes a look at how home care is evolving in Canada and what the future holds for this growing industry. PMID- 10140137 TI - International models. Home care in Belgium. AB - The Belgian health care system blends national health insurance with private service providers. This small nation's home care system is clearly and simply organized, providing an example that other countries may wish to follow. PMID- 10140138 TI - International models. Home care of the elderly in Eastern Mediterranean countries. AB - The graying of nations is a worldwide concern. In Mediterranean countries, several programs are in place to address an increasingly elderly population. These programs all tap into the family or community as a resource. What factors will enable home care to be a solution? PMID- 10140139 TI - International models. Saudi Arabia: the Kingdom, its health care programs, and the beginning of home health care. AB - Home care in Saudi Arabia is in its infancy. Most programs that do exist are based in hospitals. What sets home care in this country apart is the multitude of unique cultural and religious considerations that nurses--most of whom come from western countries--face on each visit. PMID- 10140140 TI - 1994 Home care award winners. PMID- 10140141 TI - International models. Health care of the elderly in Africa: focus on Ghana. AB - The African perspective on health is to a great extent linked to the family, which provides most of the care for its sick and elderly population. Few African countries, however, have any formal systems of care for the elderly. Health problems of the elderly in Ghana hinge on ongoing social and economic problems that require government action that begins with a focus early in life. PMID- 10140142 TI - Supervisory status of charge nurses: Supreme Court ends controversy. AB - A recent Supreme Court decision has refuted the National Labor Relations Board's position that supervisory field RNs are not technically supervisors. This decision makes it easier for providers to supervise staff and aligns these nurses more closely with management. PMID- 10140143 TI - First in a series. Preventing back injury in home care. AB - Home care organizations focus on patients and families. But caring for care providers--their employees--is another paramount responsibility. In this and the following two issues, CARING magazine will highlight and suggest strategies for preventing a major problem facing employees, employers, and patients: back injuries. This article will give an overview of the problem and focus on organizational needs and responses. The subsequent issues will cover ergonomic and personal approaches to preventing back injury. PMID- 10140144 TI - Your doctors' estates: How much do they have? How much can they give? PMID- 10140145 TI - Dispute escalates over security shortcomings at NYC municipal hospitals. PMID- 10140146 TI - Infant kidnapping: hospitals push education, seek monitoring systems. PMID- 10140147 TI - Hospitals report on usage of system for covert video surveillance. PMID- 10140148 TI - Hospital's garage houses security command center, emergency backup. PMID- 10140149 TI - Special report. Training for a hostage situation; dealing with the real thing: two case histories. AB - While fire and disaster drills are held regularly at most hospitals, conducting a hostage-taking drill is not. Yet, one hospital has come up with a detailed scenario for such a drill, which is described in this report. And the key ingredients of the drill seem to have been verified by a real-life hostage taking that took place at another hospital at the same time. PMID- 10140150 TI - Contemplating home health PPS: current patterns of Medicare service use. AB - Implementing a per-episode prospective payment system (PPS) for home health services is one option for Medicare policy makers facing rapid increases in service use and expenditures. Analysis of data on recent episodes of Medicare home health care identified systematic differences in service patterns across provider types; these indicate potential differences in the capacity of agencies of different types to adjust to PPS. The second phase of a national demonstration, which is about to be implemented, will provide information on the extent to which the agency practices that generate much of the observed variation (such as the number of visits provided per episode) are susceptible to management decisions; and whether managers can and do respond to the incentives of per episode prospective payment. PMID- 10140151 TI - Post-hospital home health care for Medicare patients. AB - Medicare patients in five diagnosis-related groups (DRGs) associated with heavy use of post-hospital care discharged from 52 hospitals in 3 cities were followed up at 6 weeks, 6 months, and 1 year to determine the factors associated with their being discharged home with or without home health care and the correlates of improvement in their functional status. Models correctly predicted those discharged home from those going to institutions in a range from 54 to 82 percent of cases. The amount of the variance in the change in function for those who went home (with or without home health care) explained by the models tested ranged from 19 percent to 73 percent. Total Medicare costs for the patients who went home were considerably less in the year subsequent to the hospitalization compared with those discharged to institutional care. PMID- 10140152 TI - Home health and skilled nursing facility use: 1982-90. AB - In this article, analyses are made of home health and skilled nursing facility (SNF) use for the period 1982-90 using Medicare records linked to data on community and institutional residents from the National Long-Term Care Surveys (NLTCSs) of 1982, 1984, and 1989. The combined survey and administrative data analyses are performed to ascertain how the chronic health and functional characteristics of community and institutional residents using Medicare reimbursed services changed during the period. During this period, changes had been made in the Medicare system that affected the use of services for persons with specific health and functional problems. PMID- 10140153 TI - A profile of home health users in 1992. AB - Recently, the use of home health services by Medicare beneficiaries has been growing. From 1987 to 1992, the percentage of all enrollees receiving home health rose from 4.8 to 7.2 percent, while the average number of visits among users increased from 23 to 54. This article uses the 1992 Medicare Current Beneficiary Survey (MCBS) to profile home health users. In addition to providing descriptive information about who uses Medicare home health, Tobit models are estimated to determine the factors that predict home health utilization and reimbursement. Various policy options for redesigning the home health benefit are also discussed. PMID- 10140154 TI - Home health care outcomes under capitated and fee-for-service payment. AB - In this article, case-mix-adjusted outcomes of home health care are found to be superior for Medicare fee-for-service (FFS) patients relative to Medicare health maintenance organization (HMO) patients. The superior outcomes for FFS patients were accompanied by higher utilization and cost of home health services, suggesting a volume-outcome (or dose-response) relationship that was further substantiated by within-HMO and within-FFS analyses. The findings suggest that greater attention should be paid to both outcome-based quality assurance and managed care practices that may be overly restrictive in terms of the use of home health services. PMID- 10140155 TI - Political perspectives on uncertified home care agencies. AB - This article examines the political agendas of public sector and organized private sector interests concerned with policies affecting uncertified home care agencies in three metropolitan areas. Using a telephone survey, the study found substantial differences across these groups in both the frequency with which they work on given issues and in some key attitudes. Overall, respondents were most likely to work on policies related to home care quality, and had particularly diverse--and at times conflicting--concerns in this area. Policymakers need to actively solicit the diverse attitudes of key interest groups towards controversial issues in order to understand less dominant perspectives, keep in mind the interconnection of policy issues, and arrive at politically viable solutions to home care policy problems. PMID- 10140156 TI - National health expenditures, 1993. AB - This article presents data on health care spending for the United States, covering expenditures for various types of medical services and products and their sources of funding from 1960 to 1993. Although these statistics show a slowing in the growth of health care expenditures over the past few years, spending continues to increase faster than the overall economy. The share of the Nation's health care bill funded by the Federal Government through the Medicaid and Medicare programs steadily increased from 1991 to 1993. This significant change in the share of health expenditures funded by the public sector has caused Federal health expenditures as a share of all Federal spending to increase dramatically. PMID- 10140157 TI - Measuring and assuring the quality of home health care. AB - The growth in home health care in the United States since 1970, and the exponential increase in the provision of Medicare-covered home health services over the past 5 years, underscores the critical need to assess the effectiveness of home health care in our society. This article presents conceptual and applied topics and approaches involved in assessing effectiveness through measuring the outcomes of home health care. Definitions are provided for a number of terms that relate to quality of care, outcome measures, risk adjustment, and quality assurance (QA) in home health care. The goal is to provide an overview of a potential systemwide approach to outcome-based QA that has its basis in a partnership between the home health industry and payers or regulators. PMID- 10140158 TI - Perspectives on home care quality. AB - Home care quality assurance (QA) must consider features inherent in home care, including: multiple goals, limited provider control, and unique family roles. Successive panels of stakeholders were asked to rate the importance of selected home care outcomes. Most highly rated outcomes were freedom from exploitation, satisfaction with care, physical safety, affordability, and physical functioning. Panelists preferred outcome indicators to process and structure, and all groups emphasized "enabling" criteria. Themes highlighted included: interpersonal components of care; normalizing life for clientele; balancing quality of life with safety; developing flexible, negotiated care plans; mechanisms for accountability and case management. These themes were formulated differently according to the stakeholders' role. Providers preferred intermediate outcomes, akin to process. PMID- 10140159 TI - The Medicare home health initiative. AB - This article describes the Medicare home health benefit and summarizes growth and change in the use of the benefit and in the industry providing home health care. The article also details the organization and goals of the Home Health Initiative, describes its four key components--quality assurance (QA), administration, policy, and research-and concludes with a discussion of the status of the Initiative. PMID- 10140160 TI - Do preset per visit payment rates affect home health agency behavior? AB - This article reports on preliminary impacts during the first year of a demonstration in which home health agencies (HHAs) were paid a prospectively set rate for each Medicare home health visit rendered, rather than being reimbursed for costs. Forty-seven agencies in five States participated. The evaluation compared the experiences of randomly assigned treatment agencies and their patients with those of control agencies and their patients and found no compelling evidence of any demonstration impact on agency cost per visit, the volume of home health services, agency revenue and profit, patient selection and retention, quality of care, or use and cost of Medicare services. PMID- 10140161 TI - Texas health care in the year 2000: what does the future hold? PMID- 10140162 TI - National study reveals possible keys to success for PHOs. PMID- 10140163 TI - Small-business health care program goes statewide. PMID- 10140164 TI - Technology acquisition in Canadian hospitals: how is it done, and where is the information coming from? AB - A 1990 nation-wide survey on technology acquisition in Canadian hospitals, based on 509 Anglophone and 55 Francophone hospital questionnaires and 193 hospital equipment request forms, revealed that 53% of capital funds were used to replace existing equipment, with the remainder spent on new purchases. However, very little regional planning was taking place. Most of the institutional acquisition decisions were made by committees, 17% of which were classified as medical staff, 25.1% as administrative, 32.4% as board committees and 22.5% as mixed. Although administration was heavily represented, medical staff were frequently present and nursing was just as likely to have at least minimal representation. However, technical experts usually played a minimal role. This omission, combined with the limited information asked for on equipment request forms and the limited availability and use of technology assessment information, suggests that acquisition decisions in many Canadian hospitals are likely to be based on inadequate information. PMID- 10140165 TI - Program management and health care informatics: defining relationships. AB - The program management (PM) structure is a relatively well-known organizational model for hospitals. A variation of the matrix structure, it allows for an interdisciplinary team of health care providers to facilitate patient care delivery. However, providing such focused care results in a complex, highly information-dependent operational environment. To meet the information needs of such an environment, careful planning in selecting and implementing technology is required. Along with supporting patient care, the technology will also help in managing costs, human resources, quality and utilization, as well as in monitoring performance and outcomes measurement. Focusing specifically on the information technology environment, this article addresses health care informatics (the diverse categories of information and systems) needed to support clinical program managers, executives and others in a PM organization. Examples from both a university-affiliated and a community-based program managed hospital illustrate their approach to PM and information technology. PMID- 10140166 TI - Careers in health care management, Part 2: Experiences, attitudes and definitions of success. PMID- 10140167 TI - Business process reengineering: a remedy for health care. AB - Health care organizations are facing significant economic constraints that threaten to dismantle core services. The perceived need for reform is great. Business process reengineering may be the strong medicine required to achieve dramatic productivity improvement without jeopardizing the quality and scope of core health care services. Reengineering challenges health care organizations to eliminate functions that do not contribute to a flattened organization structure in which fewer care providers deliver a wider range of health care services. Information technology is used to displace manual checks and controls. Reengineering may facilitate the implementation of contemporary management models, such as patient-focused care, case management and product or program management. The product of reengineering can be enhanced over time by Continuous Quality Improvement. PMID- 10140169 TI - Forecasting the demand for maternity services. AB - Faced with demands on maternity services exceeding design capacity, one British Columbia hospital commissioned forecasting studies to determine trends in demand and if accurate forecasts could be obtained. In addition to describing the forecasting method employed, the data used and the results, the authors look at what literature is available on obstetrics forecasting. PMID- 10140168 TI - The chaplain's role in bioethical decision-making. AB - With advances in medical technology, difficult questions of "What should be done?" and "Who should decide?" are a daily occurrence in hospitals. This paper reports the results of a survey of Canadian chaplains with respect to their involvement in bioethical decision-making. The survey suggests that chaplains make a significant contribution to discussion and resolution of bioethical dilemmas. Using a case study, the paper elaborates on the chaplain's role in bioethical decision-making, and indicates how such participation can influence both cost containment and risk management. PMID- 10140170 TI - Working with Jehovah's Witnesses on treatment issues. PMID- 10140171 TI - Generic drug prices fall overall in '94. PMID- 10140172 TI - Premier, SunHealth commit to partnering with vendors. PMID- 10140173 TI - Critical care unit costs differ between teaching, non-teaching facilities. PMID- 10140174 TI - Take dieters' approach to reducing costs. PMID- 10140175 TI - New York City hospital combines storage for two facilities off-site, saves $3 million a year. PMID- 10140176 TI - Is there a private cause of action under COBRA for misdiagnosis? PMID- 10140177 TI - The False Claims Act: potential liability for health care providers for fraud and abuse and beyond. PMID- 10140179 TI - State implementation of increases in Medicaid copayment requirements. PMID- 10140178 TI - Theoretical and generic considerations for hospital life-sustaining treatment policies. AB - Paralleling the expansion of the complexity of our society, medical decision making has become intensely intricate. Given this technological explosion that geometrically multiplied the possibilities and nuances of end-of-life decisions, the processes for making fully informed decisions became overwhelmed. The interest in end-of-life, medical decisions encompasses the patient, his or her physicians and family, health care administrators, and all parties engaged in protecting the public welfare. At one narrow window in time all parties must have a clear, personal understanding of: 1) the importance and meaning of informed consent; 2) the content of and process for advance directives; 3) the legal status of patient surrogates; 4) the economic issues involved in medical care; 5) the circumstances surrounding medical futility; 6) the spectrum of euthanasia; and 7) the perception of panic at the moment of acute emergency. For the patient and those who care, it is only when these concepts gel that the toughest decisions one will ever have to make can become conceivable. PMID- 10140180 TI - Board certified health law attorney: a new specialist. PMID- 10140181 TI - Optimizing health care in developing countries. PMID- 10140182 TI - Consumer health education--caught in the crossfire of health care reform. PMID- 10140183 TI - Perceived prestige and health careers recruitment. AB - Perceived occupational prestige is an important factor in career choice. The purpose of this study was to obtain prestige ratings of 13 allied health occupations and 13 general occupations for high school students, community college students (nonhealth majors), and community college health occupations students. The obtained ratings were compared with ratings of a combined group of health care providers. There was little agreement among the groups as to level of prestige. The high school rankings were the most disparate. Career exploration and outreach programs as part of recruitment efforts by health care institutions are suggested. PMID- 10140184 TI - Advocacy: the time for involvement is now. AB - The American Hospital Association has targeted 1994 for its national advocacy campaign, which is called "Health Care '94: Shaping Tomorrow Today." Health care educators have an important opportunity to participate in the AHA advocacy efforts and to play a role on the local level, perhaps by assisting their institutional campaigns. In order to be effective, they must be (1) informed about national issues and reform efforts, and (2) committed to participating. This article summarizes actions taken in the first half of 1994 and offers options for educators to consider in expanding their own roles in the advocacy effort. PMID- 10140185 TI - Strategies for designing culturally relevant client education materials. AB - This article addresses strategies for designing and implementing a culturally significant and appropriate client education tool for use with non-English speaking clients or for any client in a culture different from the mainstream. These strategies include: (1) understanding the relationship between culture and behavior, (2) developing a strategic plan, (3) gathering demographic data about the setting, (4) evaluating the characteristics of the learner, and (5) developing culturally specific, unique education learning materials. PMID- 10140186 TI - IBM chosen to build Ohio data network. PMID- 10140187 TI - Managed care steers info systems. PMID- 10140189 TI - NME, Columbia/HCA battle in Fla. near courtroom finish. PMID- 10140188 TI - Employers' switch to managed care cut '94 healthcare costs. PMID- 10140190 TI - Giuliani seeks big Medicaid cuts. PMID- 10140191 TI - Horizon dismisses watchdog group's report. PMID- 10140192 TI - HIV case causes hospital confusion. PMID- 10140193 TI - Antitrust probe prompts Utah hospital divestiture. PMID- 10140194 TI - VHA, SunHealth team up in battle against for-profits. PMID- 10140195 TI - Daughters lease Texas hospital. PMID- 10140196 TI - Judge dismisses Calif. immigrant-care case. PMID- 10140197 TI - Texas hospital bids for closed meetings. PMID- 10140198 TI - States attack not-for-profit tax breaks. PMID- 10140199 TI - Columbia/HCA beats out AMI. PMID- 10140200 TI - Hospital giant gains Oklahoma ground with network deal. PMID- 10140201 TI - Fla. not-for-profits form PPO network. PMID- 10140202 TI - Governors lobby to end Medicaid law. PMID- 10140203 TI - Longtime Louisville observer bids farewell to Rick Scott. PMID- 10140204 TI - Hospitals try to devise solutions in device debate. AB - A federal probe into hospitals' billing for investigational medical devices is raising more questions in the debate among providers, payers and equipment manufacturers over research and testing of new technologies and who should pick up the tab. PMID- 10140205 TI - Home-care payment freeze set. PMID- 10140206 TI - Providers fear GOP governors' Medicaid plans. PMID- 10140207 TI - Simple asthma-management study produces hard evidence. PMID- 10140208 TI - Hospital deal may indicate reversal of ESOPs' foibles. PMID- 10140209 TI - Iowa merger off as boards disagree. PMID- 10140210 TI - Merger called off in two-hospital town. PMID- 10140211 TI - Consensus on reform remains remote. PMID- 10140212 TI - Military hospitals may face closure. PMID- 10140213 TI - Surfing Stark II: prohibition against self-referrals. AB - In 1989, the Chairman of the House Ways and Means Subcommittee on Health, Fortney (Pete) Stark (D.-Calif.), turned the health care industry on its ear by introducing the "Ethics in Patient Referrals Act" to Congress. The bill, commonly known as "Stark I," prohibited physician referrals to entities in which they held a financial interest. As Stark's bill made its way through Congress, its substance was dramatically reduced by the legislative process. Ultimately, the law was incorporated as part of the Omnibus Budget Reconciliation Act of 1990. Stark I's main thrust is that it bars physicians from referring Medicare patients to clinical laboratories with which they have a financial relationship. Furthermore, laboratories providing those services must report information concerning any ownership arrangements between the referring physician and the laboratory. Now, to complicate the picture, providers must contend with amendments to the original law that extend the reach of its prohibitions. Called "Stark II," these amendments took effect on January 1, 1995. In this article, guidelines for dealing successfully with the requirements of the law are outlined. PMID- 10140214 TI - The physician-patient privilege: friend or foe? AB - The physician-patient privilege that has been enacted in most states has usually been seen as having the benign, even salutary, effect of protecting confidences that patients have entrusted to their physicians in the course of obtaining medical care and treatment. However, case decisions in one state have turned the privilege into a sword that plaintiffs can use to interfere with physicians' and hospitals' defense of cases against them by denying their counsel access to key defense witnesses. This development could occur in many other states that have taken a similar general approach in analyzing the privilege. PMID- 10140215 TI - If patients are now "customers," what does that make physicians? AB - As patients become "members" and "customers," as physicians become "practitioners" and "providers," the practice of medicine becomes more complex and more demanding. The changes that have affected the daily lives of physicians across America will continue and will likely become even more dramatic in the future. There is much to mourn in the passing of the medical practice of the recent past, but there is every reason to celebrate the ongoing triumphs of medicine and its successes in improving the human condition. The job of being a physician is not becoming any less important. The job has just gotten tougher. Successful physicians will cope with the multitude of changes in which the health care field is engaged and make themselves effective agents of change within their organizations. PMID- 10140216 TI - Leading an organization through change. Interview by Barbara J. Linney. AB - Robert Jamplis, MD, FACPE, has been President and CEO of the Palo Alto Medical Foundation for the past 30 years. During those years, he has led his group through many of the changes that are just occurring in other medical group practices--movement away from long hospital stays and toward large integrated health care systems. In an interview conducted late in 1994, the author asked Dr. Jamplis to describe the major changes that have taken place in his organization during his tenure and the leadership skills he used to make them happen. His comments are summarized in the following report. PMID- 10140217 TI - MSOs: key to PHOs and community-based health care systems. AB - In the '50s and '60s, as you drove through the United States, you could not help but notice the large number of mom and pop businesses--gas stations, groceries, restaurants. The same ride in the '70s and '80s is remembered because of the large number of these businesses that had closed their doors. In the '90s, this could very well begin to happen to doctor's offices and small clinics as medicine comes to look more and more like a business. This decade has already seen a shift in medicine from fee-for-service to more managed types of insurance and payment programs and the beginning of larger physician groups. Proposed health reform initiatives can only serve to accelerate these trends. Those in medicine prepared for changes will survive and perhaps even thrive. The others will wither on the vine. One of the key strategies that will enhance survival is cooperation and organization among the different players--hospitals, insurance companies, and providers. An extremely valuable tool for survival, along with the independent practice arrangement, the integrated delivery system, etc., will be the management service organization. PMID- 10140218 TI - Medicine and management. Bridging the cultural gaps. AB - Cost-effective health care requires the informed and intensive collaboration of medicine and management. Unfortunately, the two cultures tend to view the health care enterprise very differently. To physicians, the essence is individual physician-patient encounters, patient hospital days, nurse-patient contact hours, diagnoses, and procedures. To managers, the $1 trillion-plus colossus called health care is a challenge to corporate practices of finance, accounting, organization, planning, and personnel. The efforts of these two cultures to face medicine's dilemmas can result in conflict and confrontation--or in collaboration and synthesis. PMID- 10140219 TI - Effect of regulations and guidelines on gastroenterology programs. AB - This paper reviews the standards of practice, regulations, and guidelines that govern gastrointestinal endoscopy and their effect on space and equipment, staff and physician quality of care, and educational programs. It also examines how all these considerations have affected the growth of an endoscopy center and describes the processes that have been instituted to ensure compliance with all relevant standards, regulations, and guidelines. PMID- 10140220 TI - Maintaining competitiveness in a changing industry. AB - The health care industry is undergoing a period of intense change. Mergers and acquisitions are common. Indemnity companies develop managed care divisions. HMOs develop PPO products. Hospitals form partnerships with medical groups. Unless government takes decisive action, (which appears unlikely), only the marketplace will eventually distinguish winners from losers. Meanwhile, these changes create anxiety for those of us trying to adapt to these changes. Change entails transition from the old to the new. Planning a smooth transition entails many decisions. Does it seem your management is always doing the wrong thing? Have you ever wondered if your own organization's actions are being sabotaged? Maybe they are. Maybe the following document is fiction, or maybe the author really did find it, crumpled and torn, behind the paper shredder. Because of the sensitive nature of the account, the author has asked for anonymity in return for supplying the story. PMID- 10140221 TI - A hospital protocol to resolve complaints against staff physicians. AB - Complaints of discrimination or harassment in the workplace have become almost commonplace in recent years, increasing in both frequency and variety. In the hospital setting, this trend is manifested in allegations against members of the medical staff by hospital employees as well as by patients or their families. Whether real or fancied, such allegations are reflective of a potentially disruptive undercurrent of organizational tensions. Left unresolved, they can erode the essential partnership between staff physicians and other members of the health care delivery team. Unsatisfactory patient experiences may also damage the reputation of the institution and thereby undermine its viability. With either group of complainants, allegations of malfeasance that are not resolved at the source in a timely manner are far more likely to result in expensive, time consuming, and potentially damaging litigation. PMID- 10140222 TI - Health care reform. Pan American Uni-Care Health Insurance Plan. AB - Something is definitely wrong with the American health care system. Too many citizens are denied health care, and health care costs continue to rise at an uncomfortable and intolerable rate. Ensuring care for all is a paramount goal. There is no way to simultaneously cover everyone; leave the reimbursement of physicians unrestrained; ensure instantaneous access to every imaginable high technology service; subsidize the world's costliest and least efficient health bureaucracy; and contain costs. Widespread dissatisfaction in all quarters- physicians, hospitals, third-party payers, regulators and consumers--has led to an avalanche of reform proposals. Rapidly changing social, political, and economic environments; rising fiscal pressure; and an evolving understanding of the major determinants of health have also created pressure for changes. There are some new and hopeful signs that America is facing up to the need for changes in the health care delivery system. The Pan American Uni-Care Health Plan that is described in this article may serve as a reasonable balance among these competing priorities. PMID- 10140223 TI - The war on cancer. Can PAs offer something different? PMID- 10140224 TI - Using a laptop computer to improve clinical performance. AB - Computer-generated notes (CGNs) created on a laptop computer can both improve your clinical skills in the examining room and enhance patient care. Myriad gains can be realized from the use of CGNs, from the elimination of illegible and ambiguous handwritten records to improved follow-up and patient management. This article guides the reader through the hardware and software requirements for setting up CGNs, as well as basic instructions for creating your own CGN files. PMID- 10140225 TI - Who's your no. 1 doctor? With more doctors competing for the role of primary-care provider, the answer is tricky. PMID- 10140226 TI - Can't reach your doctor? Try E-mail. PMID- 10140227 TI - The effect of services coordination teams on outcomes for children in state custody. AB - The author describes the results of a quasi-experimental study of the effects of interorganizational services coordination teams on the quality and outcomes of services to children in state custody. The findings suggest that services coordination teams improve access to services and enhance service outcomes. Children served by services coordination teams were more likely to be placed in less restrictive residential settings, more like to be placed in settings appropriate to their levels of psycho-social functioning, and more likely to receive needed services from the state's mental health system. Moreover, those children with the most serious externalizing problem (i.e., aggressive, antisocial) behavior made more progress when served by services coordination teams. PMID- 10140228 TI - Perspectives. Medicaid at 30 years: on the brink of revolution. PMID- 10140229 TI - Role of district health authorities: a strategic future. PMID- 10140230 TI - The trouble with brain injury. PMID- 10140231 TI - SF 36 health survey questionnaire: I. Reliability in two patient based studies. AB - OBJECTIVE: To assess the reliability of the SF 36 health survey questionnaire in two patient populations. DESIGN: Postal questionnaire followed up, if necessary, by two reminders at two week intervals. Retest questionnaires were administered postally at two weeks in the first study and at one week in the second study. SETTING: Outpatient clinics and four training general practices in Grampian region in the north east of Scotland (study 1); a gastroenterology outpatient clinic in Aberdeen Royal Hospitals Trust (study 2). PATIENTS: 1787 patients presenting with one of four conditions: low back pain, menorrhagia, suspected peptic ulcer, and varicose veins and identified between March and June 1991 (study 1) and 573 patients attending a gastroenterology clinic in April 1993. MAIN MEASURES: Assessment of internal consistency reliability with Cronbach's alpha coefficient and of test-retest reliability with the Pearson correlation coefficient and confidence interval analysis. RESULTS: In study 1, 1317 of 1746 (75.4%) correctly identified patients entered the study and in study 2, 549 of 573 (95.8%). Both methods of assessing reliability produced similar results for most of the SF 36 scales. The most conservative estimates of reliability gave 95% confidence intervals for an individual patient's score difference ranging from 19 to 19 for the scales measuring physical functioning and general health perceptions, to -65.7 to 65.7 for the scale measuring role limitations attributable to emotional problems. In a controlled clinical trial with sample sizes of 65 patients in each group, statistically significant differences of 20 points can be detected on all eight SF 36 scales. CONCLUSIONS: All eight scales of the SF 36 questionnaire show high reliability when used to monitor health in groups of patients, and at least four scales possess adequate reliability for use in managing individual patients. Further studies are required to test the feasibility of implementing the SF 36 and other outcome measures in routine clinical practice within the health service. PMID- 10140232 TI - SF 36 health survey questionnaire: II. Responsiveness to changes in health status in four common clinical conditions. AB - OBJECTIVE: To assess the responsiveness of the SF 36 health survey questionnaire to changes in health status over time for four common clinical conditions. DESIGN: Postal questionnaires at baseline and after one year's follow up, with two reminders at two week intervals if necessary. SETTING: Clinics and four training general practices in Grampian region in the north east of Scotland. PATIENTS: More than 1,700 patients aged 16 to 86 years with one of four conditions: low back pain, menorrhagia, suspected peptic ulcer, and varicose veins; and a random sample of 900 members of the local general population for comparison. MAIN MEASURES: A transition question measuring change in health and the eight scales of the SF 36 health survey questionnaire; standardised response means (mean change in score for a scale divided by the standard deviation of the change in scores) used to quantify the instrument's responsiveness to changes in perceived health status, and comparison of patient scores at baseline and follow up with those of the general population. RESULTS: The response rate exceeded 75% in a patient population. Changes across the SF 36 questionnaire were associated with self reported changes in health, as measured by the transition question. The questionnaire showed significant improvements in health status for all four clinical conditions, whether in referred or non-referred patients. For patients with suspected peptic ulcer and varicose veins the SF 36 profiles at one year approximate to the general population. CONCLUSIONS: These results provide the first evidence of the responsiveness of the SF 36 questionnaire to changes in perceived health status in a patient population in the United Kingdom. PMID- 10140233 TI - Effectiveness of training health professionals to provide smoking cessation interventions: systematic review of randomised controlled trials. AB - OBJECTIVE: To assess the effectiveness of interventions that train healthcare professionals in methods for improving the quality of care delivered to patients who smoke. DESIGN: Systematic literature review. SETTING: Primary care medical and dental practices in the United States and Canada. Patients were recruited opportunistically. SUBJECTS: 878 healthcare professionals and 11,228 patients who smoked and were identified in eight randomised controlled trials. In each of these trials healthcare professionals received formal training in smoking cessation, and their performance was compared with that of a control group. MAIN MEASURES: Point prevalence rates of abstinence from smoking at six or 12 months in patients who were smokers at baseline. Rates of performance of tasks of smoking cessation by healthcare professionals, including offering counselling, setting dates to stop smoking, giving follow up appointments, distributing self help materials, and recommending nicotine gum. METHODS: Trials were identified by multiple methods. Data were abstracted according to predetermined criteria by two observers. When possible, meta-analysis was performed using a fixed effects model and the results were subjected to sensitivity analysis. RESULTS: Healthcare professionals who had received training were significantly more likely to perform tasks of smoking cessation than untrained controls. There was a modest increase in the odds of stopping smoking for smokers attending health professionals who had received training compared with patients attending control practitioners (odds ratio 1.35 (95% confidence interval 1.09 to 1.68)). This result was not robust to sensitivity analysis. The effects of training were increased if prompts and reminders were used. There was no definite benefit found for more intensive forms of counselling compared with minimal contact strategies. CONCLUSIONS: Training health professionals to provide smoking cessation interventions had a measurable impact on professional performance. A modest, but non-robust, effect on patient outcome was also found, suggesting that training alone is unlikely to be an effective strategy for improving quality of care, unless organisational and other factors are also considered. PMID- 10140234 TI - Involving consumers in assessing service quality: benefits of using a qualitative approach. AB - Although important to users, practice standards rarely incorporate users' views of care provided. These views are a valuable source of information, even though there are limits to their value. To improve the standards of care in a 20 bed hospital elderly care unit caring for acute medical conditions a qualitative approach was used. Patients' and carers' perceptions of care and problems with the process of care in the unit were elicited with a specially designed semistructured interview schedule in 83 separate tape recorded interviews with a research nurse in patients' homes. In all, 50 patients and 35 carers were interviewed between 6 June 1991 and 28 May 1992. Of the 50 patients, 33 were female; seven patients were aged less than 80 years, 16, 80-85; 21, 86-90; and six over 90. A total of 16 patients lived with spouses or other carers, two with non-carers, and 32 lived alone, 18 of whom received informal care. Content analysis of the interviews disclosed patients' and carers' general satisfaction with individualised professional care and planning of follow up services on discharge but dissatisfaction in the lack of information about and involvement in treatment and care and about specific staff notes. These findings have prompted remedial changes in clinical practice in the unit; they have also formed the structure of a criterion based survey of practice. The authors conclude that the qualitative approach suited elderly users and also provided the basis for the findings to be incorporated into a continuous audit cycle through a process of feedback and standard setting. PMID- 10140235 TI - Role of users of health care in achieving a quality service. PMID- 10140237 TI - The game of head injury hop-scotch, UK style. PMID- 10140236 TI - Effectiveness of care for older people: a review. PMID- 10140238 TI - Is audit running out of steam? PMID- 10140239 TI - Patients' knowledge of warfarin treatment. PMID- 10140240 TI - Intensive care on a budget. PMID- 10140241 TI - Assessing the value of a medical practice. PMID- 10140242 TI - The Lahey Clinic: adapting to a managed care environment. Case study. PMID- 10140243 TI - "PHO-Itis": a disease affecting the American healthcare scene. PMID- 10140244 TI - Organizing and sizing an integrated delivery system: building a common strategic vision for hospitals and physicians. PMID- 10140245 TI - The Consolidated Medical Management Team at Scripps Clinic & Research Foundation. PMID- 10140246 TI - Primary care development strategies. PMID- 10140247 TI - Acting against hunger. An update on associations' efforts to wipe out hunger. PMID- 10140248 TI - 'Same day' menu collection. PMID- 10140249 TI - Challenge: how to provide care for AIDS patients. PMID- 10140250 TI - Challenge: how to improve nutrition services to homebound elderly. PMID- 10140251 TI - Performance assessment for health administration education: applications of the Baldrige criteria. PMID- 10140252 TI - A federal affair in quality management: case study. PMID- 10140253 TI - Total quality management: needed research on the structural and cultural dimensions of quality improvement in health care organizations. PMID- 10140254 TI - Total quality management at Motorola: a successful blueprint for manufacturing and service organizations. PMID- 10140255 TI - The costs of quality. PMID- 10140256 TI - Continuous quality improvement in Latin American health systems. PMID- 10140257 TI - Summative comments on the Task Force on Quality Improvement. PMID- 10140258 TI - Integrating total quality management core concepts into health management education. PMID- 10140259 TI - Total quality: gains in the business sector. PMID- 10140260 TI - Quality improvement in health management education. PMID- 10140261 TI - Transformation: the new knowledge needed for health care administrators. PMID- 10140262 TI - The managed care perspective. PMID- 10140263 TI - A conceptual framework for learning continual improvement in health administration education programs. PMID- 10140264 TI - Incorporating quality improvement in the health administration curriculum. PMID- 10140265 TI - Trade groups discuss deal. PMID- 10140266 TI - Pilot NCQA report card rates managed-care plans. PMID- 10140267 TI - Private Healthcare Systems reorganizes. PMID- 10140268 TI - U.S. keeps roster open to new health plans. PMID- 10140269 TI - New York mayor planning to sell three hospitals. PMID- 10140270 TI - Coronary-bypass rate program may go national. PMID- 10140271 TI - SmithKline data sought in dialysis probe. PMID- 10140273 TI - 1995 Health Care Hall of Fame. Past inductees. PMID- 10140272 TI - 1995 Health Care Hall of Fame. This year's inductees dreamed, persevered. PMID- 10140274 TI - Best provider discounts are sought for Medicare. PMID- 10140275 TI - Medicare reimbursements closing gap. PMID- 10140276 TI - JCAHO reorganizes staff, resources to improve accreditation. PMID- 10140277 TI - Dose of history accompanies care at nation's first hospital. PMID- 10140278 TI - Joint Commission inaugurates subacute-care accreditation by adapting nursing home regs. PMID- 10140279 TI - Arizona hospital shooting raises security questions. PMID- 10140280 TI - Sensible downsizing can lower costs, improve quality--study. PMID- 10140281 TI - Municipal hospitals becoming converts. PMID- 10140282 TI - FTC reconsiders case against Missouri deal. PMID- 10140283 TI - Caremark sells another unit; more in works? PMID- 10140284 TI - It's time to mend ties with suppliers. PMID- 10140285 TI - Medical savings accounts make waves. AB - MSAs: the theory. Medical savings account legislation would allow consumers to set aside pre-tax dollars to pay for day-to-day healthcare costs. The accounts are to be backed up by a catastropic policy with a deductible roughly equal to the maximum amount allowed in the MSA. The aim is to reduce healthcare cost inflation by making consumers more aware of the costs of healthcare than they are under comprehensive policies and enabling them to shop for the lowest-cost, highest-quality care. PMID- 10140286 TI - Price bundling packs pitfalls. AB - Hospitals thought bundling of healthcare services under one all-inclusive price would have great appeal to payers, bringing in more business. But instead, the concept has brought disappointment as the expected boost in patient volume has failed to materialize. PMID- 10140287 TI - Maine hospitals hope to avert FTC suit. PMID- 10140288 TI - 'Model' joint venture in Florida collapses with Columbia buyout. PMID- 10140289 TI - You know about DRGs, but what about APGs? PMID- 10140290 TI - New network will aid information sharing on drug management. PMID- 10140291 TI - Rising interest rates blamed for falling returns at REITs. PMID- 10140292 TI - Radiologist wins big jury award. PMID- 10140293 TI - How to protect confidentiality during the contracting process. PMID- 10140294 TI - Research project probes risk managers' roles. PMID- 10140295 TI - Promoting health information networks while protecting patient confidentiality. PMID- 10140296 TI - Physician-hospital organizations: prospects and pitfalls. PMID- 10140297 TI - Physician liability: new areas of concern under managed care. PMID- 10140298 TI - Statement on laser surgery. American College of Surgeons. PMID- 10140299 TI - Documentation guidelines for evaluation and management services. PMID- 10140300 TI - Issuing the challenge: creating leadership for health information management. AB - Fundamental and profound changes are occurring within the health care industry that directly affect and change the roles and functions of health information managers. To meet and survive these changes, the health information management profession must exercise leadership and transform itself. A model of leadership consisting of systems thinking, personal mastery, mental models, shared vision, and team learning to accomplish this transformation is described. PMID- 10140301 TI - The information imperative of outcomes management. AB - Health care providers are being asked to collect, analyze, and evaluate the results of medical processes or procedures to improve the outcome of health care services. The linkage of process to outcome is not a new science, but it has assumed greater importance in today's health care economic climate. Medical effectiveness and outcomes management studies, once within the purview of health services investigators, are moving to the individual provider setting. This evolution has tremendous impact on health information management professionals. As the guardians of the data that are indispensable for medical effectiveness and outcomes management investigations, health information management professionals play a key role in caregivers' attempts to correlate process and outcome performance measures. The article discusses the historical origins of outcomes management, the prominence of outcomes management in health care reform activities, and the responsibilities of health information management professionals in these strategic initiatives. PMID- 10140302 TI - Overcoming historical and organizational legacies: AHIMA poises to lead. AB - Considering leadership as both an individual and an aggregate characteristic, the article examines the leadership potential for members of the American Health Information Management Association (AHIMA) and for AHIMA as a professional organization within the field of health information management. AHIMA and its members are uniquely suited for leadership within this occupational field. The long association with paper records and a hospital maintenance function, however, plus the predominance of women within the field result in organizational features and political factors that could block leadership development. PMID- 10140303 TI - The emerging need for transformational leadership in health information management. AB - The prospect of national healthcare reform, new clinical and information technologies, and the need to cut the cost of health care delivery are contributing factors in the restructuring of the health care system. In light of these rapid changes and great uncertainties, health information management (HIM) leadership must radically change its style. The appropriate new styles will move the HIM practitioner from the specialized medical records department to a larger, more professional role. The successful transformational leader will help HIM emerge as a central function in the new health care industries. PMID- 10140304 TI - The leadership role of the health information management professional in research. AB - Research and its role in the health information management (HIM) field are discussed in the context of the priorities and research needs of the Health Security Act of 1993 and Healthy People 2000. Research needs from Healthy People 2000 specific to the HIM field are outlined. Questions to ask when the research proposal, study designs, methodologies, and examples specific to HIM are formulated are explained and discussed so that HIM professionals can become leaders in the field of HIM research. PMID- 10140305 TI - Hospital middle management experience and peer interpersonal conflict. AB - Each manager brings a unique decision style to the problem-solving process. This decision style may be quite different from the decision style of other managers and a potential source of interpersonal conflict. A study was undertaken to determine which decision styles were potential sources of interpersonal conflict for hospital middle managers and to determine whether years of management experience had any bearing on the sources of conflict. Study results reported interpersonal conflict with decision styles that were impersonal, logical, and factual. Results were consistent regardless of years of management experience. PMID- 10140306 TI - Research review: a computer-based diagnostic model for individual case review. AB - A previous study found that Iliad, a diagnostic expert system, detects diagnostic errors missed by peer review organization (PRO) review. That study used volunteer physicians from an institution as gold standard reviewers, however. The article discusses a second experiment employing Utah PRO (UPRO) review physicians as gold standards. Iliad was compared with the Unified Clinical Data Set used by the UPRO and was found to detect otherwise unsuspected diagnostic errors. The confirmation rate of Iliad flags was much higher in the earlier study, however. No agreement was found between institution and UPRO physicians, but there was agreement between a unique physician (who was both an institution and UPRO physician) and each of the two groups. Because Iliad screens for potential diagnostic errors to be confirmed or denied by gold standard physician review, the different types of physicians in the two experiments might have been the cause. PMID- 10140307 TI - Hospital administrator perceptions of health information managers as future leaders in health care reform. AB - The article examines hospital administrators' perceptions of health information professionals moving into leadership positions within health care organizations. Data for this study were collected from a national random sample of hospital administrators (N = 62). Findings from the study suggest that, although health information managers are viewed as integral to the success of the health care organization, health information managers are perceived as lacking appropriate educational training to move into administrative or leadership positions. For the health information professional to move into a leadership position, educational training (at the master's level) must focus on quality management, statistical process control, and performance evaluation. PMID- 10140308 TI - Networking within the network. PMID- 10140309 TI - No pat answers: solving your own protective wear puzzle. PMID- 10140310 TI - Mergers' missing link: equipment management. PMID- 10140311 TI - Check the pulse of supply prices. PMID- 10140312 TI - Two studies of event-related sterility. Adding up the costs. PMID- 10140313 TI - Two studies of event-related sterility. Patient safety. PMID- 10140314 TI - Will new incineration rules burn up your waste disposal budget? PMID- 10140315 TI - Sexual harassment: health care's costly little secret. PMID- 10140316 TI - Patient systems often redo manual process. PMID- 10140317 TI - Networked labs build continuity of care. PMID- 10140319 TI - HotList. Document imaging products and devices. PMID- 10140318 TI - Perfect knowledge: the physician's role. PMID- 10140320 TI - Managed-care negotiation assisted by benchmarking. PMID- 10140321 TI - Ganging up on the FDA. PMID- 10140322 TI - Preserving teaching and research in an era of managed care. Interview by Meg Matheny. PMID- 10140323 TI - Case study. Opposites attract: the Group Health Cooperative-Virginia Mason Alliance. PMID- 10140324 TI - Minnesota 1994: year of consolidation. PMID- 10140325 TI - Academic and community medical centers form new alliances. PMID- 10140326 TI - File update: challenges in computerization across the behavioral healthcare industry. PMID- 10140327 TI - Use of electronic networking for the enhancement of mental health services. AB - In the Behavioral Informatics Tomorrow column of our November/December, 1994, issue, we presented an introduction to the basic concepts and techniques of electronic communication via the Internet, as well some resources for behavioral healthcare professionals who already utilize electronic bulletin board services (BBS). Now we offer this more detailed article for those interested in utilizing archies, gophers, browsers and chats to gain access to the rapidly growing body of behavioral healthcare informational resources residing in Cyberspace. The authors present dozens of mental health BBs, conferences and networks--with instructions on how to get there. PMID- 10140328 TI - Confidentiality on the information highway: balancing the needs of individual patients and society. AB - State and federal agencies, professional associations and business coalitions are actively promoting the development of regional or statewide health database organizations (HDOs). One of the key missions of HDOs is the public release of aggregated healthcare data and analyses to facilitate improved patient care. In 1992 and 1993 a committee appointed by the National Academy of Sciences' Institute of Medicine studied the implications of HDO formation in a landmark report. The committee's recommendations on how to assure accuracy and completeness of data, minimize potential harm from released data and guarantee appropriate protections for individually identifiable data are summarized and interpreted in the following article. PMID- 10140329 TI - The use of automated assessment with seriously mentally ill clients. AB - Despite the skepticism of many behavioral healthcare practitioners that their clients are "much too ill" to interact positively with a computer-based assessment system, this article describes a successful program that integrates computerized interactions for seriously mentally ill adults into its overall information management. At the core of this information system is a 30- to 45 minute assessment using eight basic scales plus clinical data. According to a satisfaction survey, clients generally are quite open to interacting with the computer--when it is presented as an adjunct to the work of clinicians. PMID- 10140330 TI - Managed care systems require sophisticated data interactions. PMID- 10140331 TI - Standardized data interchange offers administrative cost savings. PMID- 10140332 TI - Clinicians need standardized procedures and credentialing. PMID- 10140333 TI - The quest for a computerized group practice information system to manage capitation. PMID- 10140334 TI - Linking outcomes analysis to critical clinical pathways. AB - Expert decision-support soft-ware systems, when integrated with outcomes analyses, provide the opportunity to develop behavioral healthcare delivery systems in which providers are equipped to act decisively in a socially responsible manner. Key benefits of such systems include: enhancing the consistency and quality of clinical decision making across providers with varying professional backgrounds; providing a mechanism to ensure the rapid dissemination and implementation of new clinical research findings; performing severity adjusted profiling of providers and programs based on the outcomes their services produce; and linking the prospective focus of clinical pathways with the retrospective rigor of outcomes analysis to accelerate advances in behavioral health. Integrating expert systems with outcomes analyses has the potential to rectify the historical failure by the behavioral healthcare professions to systematically link patient assessment data and their analysis to actual clinical decision making. Such systems will help make behavioral healthcare practice more accountable, thereby strengthening the argument for psychiatric patients to gain parity in healthcare benefits. PMID- 10140335 TI - Fair health information practices. PMID- 10140336 TI - Congressional Republicans plan incremental health reforms. PMID- 10140337 TI - Where are we headed? Visioning the computer-based patient record. PMID- 10140338 TI - Secretary of State's POPUMET Inspectorate: the first six years. AB - The first six years work of the Secretary of State for Health's Inspectorate for regulation 4 of the Ionising Radiation (Protection of Persons Undergoing Medical Examination or Treatment) Regulations 1988 is described. The regulations are colloquially known by the acronym POPUMET, and implement European Directive 84/466 EURATOM in Great Britain. This laid down basic measures for the protection of persons undergoing medical examination or treatment involving ionising radiation. The POPUMET regulations are applicable to all health care settings, public or private sector, but exclude research. Regulation 4 is intended to prevent unnecessary or excessive medical exposure to radiation. Of 68 reported incidents, 54 (79%) were relevant to regulation 4, comprising 20 (37%) incidents in radiotherapy, 21 (39%) in radiology, 11 (20%) in nuclear medicine and 2 (4%) in dental radiology. Allowing for the denominator number of NHS departments in England, the greatest frequency of incidents were reported from radiotherapy departments, followed by nuclear medicine and then radiology departments. Of the 54 incidents investigated, 42 (78%) required a site visit; 39 (72%) resulted in advice from the Inspectorate; 13 (24%) required no action following investigation and 2 (4%) were still under investigation as at 31 May 1994. No enforcement notices were issued and there were no prosecutions. PMID- 10140339 TI - Medical and dental staffing prospects in the NHS in England and Wales 1993. AB - This article provides a brief update on current national policies affecting medical education and training, and information on the present medical and dental workforce. Although of general interest, senior medical students and doctors in the training grades may find it particularly helpful when considering choices of future career. As there may be marked local variations in career prospects for any one specialty, further information and advice is available from Regional Postgraduate Medical and Dental Deans, specialty advisors (through Royal College and specialty associations) and clinical tutors. The information in this article relates to the present situation only and a review of previous articles in this series may be useful to observe certain trends. PMID- 10140340 TI - Trends in arterial reconstruction, angioplasty and amputation. AB - Data from operating theatre and X-ray department ledgers, and other sources, for two periods (1983-87 and 1988-91) were compared retrospectively to determine the trend in leg amputation in the defined population of a District Health Authority, following an increase in arterial reconstruction and percutaneous transluminal angioplasty for peripheral arterial disease. There was an eleven-fold increase in arterial reconstructions, and a thirteen-fold increase in angioplasty, in 1988 1991 compared with 1983-1987. A significant reduction occurred in the age- and sex-adjusted mean annual rate for major leg amputation, from 47.5 (95% confidence intervals 41.5-53.6) in 1983-87 to 32 (95% confidence intervals 26.5-37.6) in 1988-91 (Wilcoxon rank sum test, p < 0.05). There was no increase in the ratio of above-knee to below-knee amputations. The introduction of peripheral arterial reconstruction and percutaneous transluminal angioplasty was associated with a reduction in major amputations for peripheral arterial disease of 3.8 per 100,000 population per year. PMID- 10140341 TI - Addressing social and economic responsibilities through governance. PMID- 10140342 TI - Governance in integrated delivery systems: serving the public's interest. PMID- 10140343 TI - Mission-based governance. PMID- 10140344 TI - Disease management stealing patients from health systems. PMID- 10140345 TI - Benchmarking sets standards for clinical improvements. PMID- 10140346 TI - Columbia/HCA must win communities' trust. PMID- 10140347 TI - Integrated system survivors adopt revolutionary structures. PMID- 10140348 TI - HMO cuts premature baby rate in half. PMID- 10140349 TI - Automation in pharmacy: two institutions' experiences with novel distribution systems. AB - A computerized medication system, implemented at Rochester (MN) Methodist Hospital in 1987, has been adopted by the hospitals at the Mayo Medical Center, Rochester, MN. A key component of the medication system, which uses individualized patient medication envelopes, is the delivery of doses of medications to nursing units just before their administration time. The system has been shown to provide greater nursing support, increase patient safety by reducing medication errors, and decrease both full-time equivalent costs and operating costs. The immediate impact of the system has been to shift dose scheduling from a nursing to a pharmacy responsibility. At Duke University, an automated pharmacy system (APS) has been in operation since October 1993 and is used to dispense the majority of unit dose drugs. The APS provides up-to-the minute information about the drugs that patients are receiving, which is used to fill each patient's unit dose drawer. It has not dispensed an incorrect drug since its installation and has allowed centralization of the unit dose cart system. Other benefits include decreased billing labor and increased drug usage reporting. PMID- 10140350 TI - How a CQI program improved aminoglycoside use in a community hospital. AB - The P & T Committee of our institution, a 285-bed, non-tertiary care regional medical center, undertook a study to evaluate the use of the aminoglycoside amikacin sulfate (Amikin). Results of an initial DUE, a follow-up to an educational effort, and the estimated annual cost savings that could be achieved with appropriate prescribing of aminoglycosides are presented. PMID- 10140351 TI - Health issues on hold, but lurking behind GOP's Contract with America. PMID- 10140352 TI - Antibiotic therapeutic interchange program: six years of experience. AB - To assess the long-term impact of a therapeutic interchange program on the use of target antimicrobial drugs, we conducted a retrospective study of target drug utilization at our institution--a 1,000-bed Canadian tertiary care teaching hospital. Data were assessed to determine target drug utilization, incidence of therapeutic interchanges, and patient-target drug exposures. Results showed that the incidence of therapeutic interchanges per patient-target drug exposure decreased from a mean of 23% to 2%, resulting in a total net savings for the target drugs of approximately $1.07 million (Canadian) over 6 years. Prescriber acceptance and low manpower requirements combine to make this a useful method of altering prescribing patterns and reducing drug and drug delivery costs. PMID- 10140353 TI - Key industry facts. American College of Healthcare Executives. PMID- 10140354 TI - Caught between two paradigms ... ensuring that quality of care is not affected by managed care. PMID- 10140355 TI - European healthcare changes parallel U.S. PMID- 10140356 TI - American College of Healthcare Executives. Professional policy statement. Responsibility for mentoring. PMID- 10140357 TI - Defining career success. PMID- 10140358 TI - Trends in managed care. PMID- 10140359 TI - Managing the medical workforce: time for improvements? AB - There has been a regular cycle of Government committees in Britain that have forecast 'shortages' and 'surpluses' in medical manpower. It is remarkable how little change there has been in the methods used in these forecasts despite criticism of their methods and the move towards competitive markets in the delivery of health care. The practice of medical manpower planning was criticised in the 1960s because of the failure to explore the implications of alternative skill mixes and incentives. Whilst these criticisms were ignored, the forecasters now pay more regard to budget constraints and produce more regular estimates. The 1992 forecast could be improved by sensitivity analysis (e.g. for GP/population ratios). However, unless the issue of scope (forecasting for all health care staff, not just for doctors alone) and the implications of skill mix and incentives identified in the 1960s are addressed effectively, the current recommendations may produce doctor 'surpluses' in the early twenty-first century. The Government's analysis should be challenged at the level of principle and practice, and this implies that the research activity proposed in the 1960s is carried out in the 1990s to facilitate efficiency in the twenty-first century. Furthermore, the issue of policy priorities and their ranking needs to be spelt out explicitly: does the Government want a competitive NHS internal market, and if it does, what is the role of central manpower planning? One implication of current policy choice and the maintenance of manpower planning is that cost containment is of more importance to policy makers than the internal market. PMID- 10140360 TI - Handling complaints in hospitals. AB - GOAL: To find out about complaints procedures in hospitals in North-Holland and to determine to what extent they function independently. METHOD: All 21 hospitals were visited between the spring of 1992 and the autumn of 1993. Before the visit took place the hospital management had to complete and return a questionnaire relating to the complaints procedure in that hospital. RESULTS: All except two hospitals had rules for dealing with complaints. In 18 hospitals there was a complaints committee; in 12 of these the management was not--or was no longer- involved. The element of independence was expressed in a great variety of ways. In a quarter of the hospitals complaints were often not dealt with within two months. DISCUSSION: The situation with regard to complaints procedures in hospitals in North-Holland is definitely improving. Some hospitals, however, are much more successful than others in meeting the criteria for an adequate complaints procedure. There is room for improvement in two particular areas; complaints should be handled more promptly and independently. PMID- 10140361 TI - Health for all in the Republic of Korea: one country's experience with implementing universal health care. AB - Health care reforms in many countries face the twin challenges of providing universal coverage while controlling spiraling costs. Sixteen years ago the Republic of Korea had no national plan for health insurance, and only 8.8% of the population was covered. In 1975, health care accounted for 2.8% of GDP with government providing 12% of the finances. In 1977, Korea adopted a policy designed to achieve universal coverage while maintaining fee-for-service reimbursement. Korea incrementally established an employer based health care scheme by first mandating coverage for businesses, then government employees and teachers. Coverage was later extended to the poor, the self-employed, and residents of rural areas. Independent insurance societies manage each scheme, set premiums and co-payments, and are responsible for maintaining financial viability. By 1991, 30% of Korea's health care expenditures were from public funds, and health care costs had risen to 7.1% of GDP. Health care reform in Korea has been successful in achieving universal coverage, providing for a full range of services, and eliminating adverse selection. The system is financially solvent, costs are equitably distributed with the government providing subsidies when necessary, and small businesses have not been unduly burdened economically. Attempts to limit costs, however, have been unsuccessful. Patient demand for health care has remained surprisingly resistant to increasing co-payments. Providers have responded to lower physician and hospital fees by providing shorter, more frequent patient visits, relabeling services, and increasing hospital admissions. Competition between insurance societies has not materialized in a meaningful way to control costs. PMID- 10140362 TI - The place of magnetic resonance imaging in health care. AB - Magnetic resonance imaging has been an important advance in diagnostic imaging technology and is now widely established in many countries. However, evidence of proven benefit in patient management and outcome remains limited. Health policy makers, professional groups and administrators are faced with a range of questions on the technical capabilities, costs and comparative advantage over other diagnostic methods. The challenge remains to use this expensive technology in an effective manner, with critical review of its cost effectiveness and its suitability for individual health care programs. PMID- 10140363 TI - The introduction of deductibles for prescription drugs in a national health insurance: compulsory or voluntary? AB - We consider a situation of full insurance coverage for prescription drugs where, at a certain point in time, people are given the opportunity to take a deductible in exchange for a lower premium. Four determinants of this premium reduction can be considered: expected out-of-pocket payments, adverse selection effects, moral hazard effects, and administration costs. The purpose of this study is to analyse the first two determinants. Survey data of 17,242 insureds in the Netherlands have been used for this research. Results show that the expected out-of-pocket expenditures in case of a certain deductible amount depend strongly on age and gender. People in poor health could be given a larger premium discount if they would take a deductible than those in good health. This implies that a uniform premium discount would induce adverse selection. The effects of such selection have been simulated by using a survey question about the preference to take a general deductible. If the premium reductions for policies with a deductible are adjusted for age and gender, the selection effect will halve but will still be substantial. We conclude that, in the situation considered here, it is largely immaterial whether deductibles are compulsory or voluntary, provided premium reductions are allowed to depend on relevant risk factors. PMID- 10140364 TI - American Hospital Association calls for greater attention to Joint Commission operations issues. PMID- 10140365 TI - Restraint and seclusion scoring guideline correction in 1995 AMH--"Care of Patients" standard TX.7.1. PMID- 10140367 TI - An action plan to satisfy Joint Commission IOUs. PMID- 10140366 TI - Designing an integrated, initial patient assessment. PMID- 10140368 TI - Small and Rural Hospital Work Group proposes experimental model. PMID- 10140370 TI - Mayo Scottsdale plans new facility near rival. PMID- 10140369 TI - Credentialing and privileging are separate, but related, steps to good patient care. PMID- 10140371 TI - Industry leaders weigh implications of Microsoft's healthcare invasion. PMID- 10140372 TI - Cargill provides Qualis Care $150 million in financing. PMID- 10140373 TI - Harvard stint offers CFO valuable lessons. PMID- 10140374 TI - Physicians Health board gives OK to 'poison pill'. PMID- 10140375 TI - REIT's acquisition strategy scrutinized by Standard & Poor's. PMID- 10140376 TI - Abbey, Homedco agree to merge. PMID- 10140377 TI - NIH report aims to legitimize non-mainstream treatments. PMID- 10140378 TI - Horizon files suit against Hillhaven. PMID- 10140379 TI - Antitrust concerns pit Texas hospital against staff docs in legal fight. PMID- 10140380 TI - Cape Coral's ex-CFO to plead guilty in embezzlement case. PMID- 10140381 TI - Columbia keeps on growing. PMID- 10140382 TI - Home-care firm facing ouster from Medicare. PMID- 10140383 TI - Bondholder group petitions for CompCare's bankruptcy. PMID- 10140385 TI - Ameritech plans to fight on for role in Chicago-area CHIN. PMID- 10140384 TI - Former Hallmark chairman launches mental health firm. PMID- 10140386 TI - California imaging company sues subsidiary executives over $4.8 million in charges. PMID- 10140387 TI - GOP funding plan draws states' concern. PMID- 10140388 TI - Ill. budget proposal angers hospitals. PMID- 10140389 TI - Missouri hospitals complete merger. PMID- 10140390 TI - FTC may call Columbia's hand in Va. PMID- 10140391 TI - Mont. hospitals asking state for immunity. PMID- 10140392 TI - 90% of surveyed women don't want health services restricted. PMID- 10140393 TI - Archer tries to ease welfare woes. PMID- 10140394 TI - GOP vows to continue fight for balanced-budget measure. PMID- 10140396 TI - Market forces hospital to lose Catholic status. PMID- 10140395 TI - Columbia loses out on lease as hospital is sold in Oklahoma. PMID- 10140397 TI - Health facilities targeted for closing. PMID- 10140398 TI - Fla. system aids small Keys hospital. PMID- 10140399 TI - BJC Health System expands its reach. PMID- 10140400 TI - N.Y. Jewish, Catholic hospitals teaming up. PMID- 10140401 TI - Providers, suppliers report double-digit earnings growth. PMID- 10140402 TI - FTC decides on two consolidations. PMID- 10140403 TI - More managed-care plans are embracing Medicare's formula for setting doc fees. PMID- 10140404 TI - Bill requiring disclosure of cost shifting defeated by New Mexico House. PMID- 10140405 TI - Florida HMO sues to block release of negative report. PMID- 10140406 TI - Wisconsin's Gov. Thompson proposes reorganization of university hospital system. PMID- 10140407 TI - Orange County bailout plans may be costly for hospitals. PMID- 10140408 TI - JCAHO puzzles observers with call for competition. PMID- 10140410 TI - L.A. hospital sees trauma deaths fall. PMID- 10140409 TI - Risk awards expected to draw diverse group. PMID- 10140412 TI - GOP wields budget ax on healthcare. PMID- 10140411 TI - NME's new day dawns. AB - With a new partnership and a new name, the former NME (now Tenet Healthcare Corp.) is starting over. After two years of turmoil, Chairman and Chief Executive Officer Jeffrey Barbakow says, ?No more excuses.? Plus, AMI executives reap millions and NME plays the name game. PMID- 10140413 TI - Providers to push malpractice reform. PMID- 10140414 TI - HASC weighs lack of industry consensus on quality measures. PMID- 10140415 TI - Kansas PHO receives tax-exempt status in landmark IRS ruling. PMID- 10140416 TI - Explain reasons, goals for restructuring. PMID- 10140417 TI - Nurses need role in staffing changes. PMID- 10140418 TI - Dissatisfaction with JCAHO widespread. PMID- 10140419 TI - CFOs take new tack. AB - To financing integrated delivery systems, healthcare executives are getting creative. Working in many cases without precedent, they're supplementing traditional financing techniques with new ideas and taking risks. A motto: ?Let's look at all the options,? says an adviser. PMID- 10140420 TI - Children's facilities court managed care. PMID- 10140421 TI - Electrotherapy usage trends in private physiotherapy practice in Alberta. AB - Electrotherapy is a common treatment intervention administered by physiotherapists. Owing to a lack of scientific reporting of modality usage, particularly within Canada, it was the purpose of this study to survey all private practitioners registered within the Province of Alberta. A total of 208 clinicians representing 41% of the population sample, responded to the survey. Results indicated hot packs followed by ultrasound, ice, transcutaneous electrical nerve stimulation (TENS) and interferential were the most frequently used modalities. With the exception of ultrasound, these findings differed considerably from previous reports of modality usage. Statistical comparisons, using Fisher's exact test of independence, revealed frequent use of TENS was greater amongst older clinicians and clinic owners (p < 0.05) while male therapists used biofeedback more often than female colleagues (p < 0.05). No significant differences were found between therapists trained at the University of Alberta and those educated elsewhere. Peer influence within the geographically and politically defined sample population may explain the relatively few between group differences. Future research should target additional population samples plus continue to monitor trends within previously studied groups. PMID- 10140422 TI - Physiotherapy, charity, and social responsibility. PMID- 10140423 TI - A win-win venture. Montefiore Medical Center and Local 1199 benefit from a partnership designed to upgrade employee skills. PMID- 10140424 TI - Opportunities for pharmaceutical care with critical pathways. AB - Critical pathways are multidisciplinary tools designed to improve patient care and efficiency. Almost every path requires some type of pharmacotherapeutic intervention, from selection of surgical prophylaxis to management of anticoagulation. Pharmacists should become involved with the critical pathway process because it offers an excellent opportunity to incorporate pharmaceutical care and to meet Joint Commission on Accreditation of Healthcare Organization compliance criteria. PMID- 10140425 TI - The transition to medication system performance indicators. AB - Economic and competitive pressures in the health care market are causing hospitals and other health care providers to seek more effective ways to improve the quality of care and to decrease costs. Integrating total quality management and continuous quality improvement techniques into traditional drug use evaluation methodology allows for the development of critical performance indicators. These indicators integrate the selection, use, delivery methods, and outcomes of drug therapy with other operational therapeutic modalities. The article describes the development of medication system performance indicators using heparin dosing as a model. PMID- 10140426 TI - Development of a continuous quality improvement/total quality management program for medication use monitoring. AB - The design of institutional medication use programs that are effective and meet regulatory and accreditation standards is becoming increasingly dependent upon a thorough understanding of the principles and applications of continuous quality improvement (CQI) and total quality management (TQM). Both the Joint Commission on Accreditation of Healthcare Organizations and the federal government have recently begun to make significant attempts to transform our existing quality assurance programs into indicator-based quality improvement management systems that are based on the principles of CQI and TQM. The article outlines and illustrates an effective approach for developing and implementing a comprehensive CQI/TQM program for medication use monitoring. PMID- 10140427 TI - Communication strategies to improve drug use evaluation. AB - Successful examples of teams and drug use evaluations explore communication strategies to enhance quality improvement of medication use. Topics highlighted include establishing contacts within key departments, creating committee connections, fostering physician and nurse participation, and increasing visibility and maintaining awareness. Multidisciplinary collaboration and linkage between the hospital and the managed care pharmacy are also reviewed. Medication use can be improved by integrating these communication tactics. PMID- 10140428 TI - Use of critical pathways and indicators in pharmacy practice. AB - The development of critical pathways along with continuous quality improvement and patient-focused care represents one of the key initiatives in health care in the 1990s. The critical pathway defines the components of care, including treatments, diagnostic measures, and activities to be performed each day, to achieve the desired outcome for a patient with a given diagnosis. Indicators can then be used to define opportunities for improving the pathway. Participation in the critical pathway development process provides pharmacists with an opportunity to utilize their expertise in the medication use process to ensure optimal medication management. PMID- 10140429 TI - Use of total quality management techniques to improve compliance with a medication use indicator. AB - Total quality management techniques were used to lay the groundwork for and to implement procedural changes designed to improve compliance with the Joint Commission on Accreditation of Healthcare Organizations' medication use indicator for ordering and administering presurgical antibiotics. The effect of these procedural changes on patient outcomes (i.e., postsurgical infection rates and length of hospitalization) is described. In a study to assess compliance, 57 (30 percent) of 40 control patients received a presurgical antibiotic within 1 hour of incision compared with 65 (52 percent) of 126 study group patients, and 83 (44 percent) of the control group received a presurgical antibiotic within 2 hours of incision compared with 88 (70 percent) of 126 study group patients. Postsurgical infection rates and length of hospitalization were not significantly different (p = .407 and p = .885, respectively). PMID- 10140430 TI - Technical considerations in the preparation and dispensing of chemotherapy. AB - The safe handling of cytotoxic agents is intimately related to the technical aspects of drug preparation, dispensing, and administration. The appropriate equipment, supplies, protective clothing, and waste disposal systems must be available to the health care worker who is called upon to prepare cytotoxic agents. In addition, the health care worker must be adequately trained in and familiar with the safe use of these products and equipment and the preparation techniques or manipulations necessary during cytotoxic drug compounding. The article describes in detail and reviews the technical considerations, such as aseptic technique, proper use of the biological safety cabinet, gowning and gloving, labeling, and waste disposal, that are essential to the safe preparation and dispensing of chemotherapy. PMID- 10140431 TI - Pharmacotherapy quality improvement in the managed care setting. AB - Physician partnering, value-added relationships, and integrated delivery systems with risk/incentive arrangements are emerging in managed care. These arrangements require time-sensitive program information that can be used in continuous quality improvement programs. Components of any clinical intervention program designed to improve the quality of pharmacotherapy are on a continuum, from those that are primarily individual patient focused to those that are disease or system/process focused. Components include case management, patient profile review, brand to generic drug conversion, targeted therapeutic evaluations, provider profiling, and pharmacoeconomic analysis. All health care professionals involved in pharmacotherapy need to be involved in implementation of these quality improvement programs. PMID- 10140432 TI - Going overboard on health coverage. Congress's change of heart could cost seniors. PMID- 10140433 TI - Perspectives. The Ryan White CARE (Comprehensive AIDS Resources Emergency) Act: facing its first crossroad. PMID- 10140434 TI - Perspectives. Nurse layoffs and hospitals: changing the course of care. PMID- 10140435 TI - National health care reform: choice opportunities. PMID- 10140436 TI - A healthy America: a health care reform challenge. PMID- 10140437 TI - The Oregon Health Plan and public health. AB - The Oregon Health Plan would provide all Oregonians with health insurance through a combination of Medicaid expansion, employer mandates and high-risk coverage, with services delivered largely through managed care. The role of public health in a managed care environment is an important national issue, and one which has received much attention in Oregon. "Cultural" differences between Medicaid and public health have arisen over issues such as whether eligibility assures access, whether the private medical model will provide integrated care, the potential for exploitation of vulnerable populations in a capitated system, and the loss of cost-based Medicaid reimbursement to public clinics. In 1991, legislation required that Oregon's Medicaid managed care plans enter agreements with local health departments to assure their continued participation in providing certain public health services; these agreements are now being implemented. Oregon's experience suggests that any national health system will require a continuum of community and individual health services, with an important role for public health departments. PMID- 10140438 TI - National health care reform: prognosis for success. PMID- 10140439 TI - Health care reform: public views of problems and solutions. AB - Public opinion surveys have found growing discontent with the health care system. In response, major reform legislation has been introduced in Washington and in many statehouses as well. Nonetheless, very few, if any, state-level public opinion surveys examining health care have been conducted in the South. During November of 1991, a statewide survey of 1,250 Alabamians was conducted to collect information on a wide range of health care issues. The survey is perhaps the largest and most complete survey on health care issues ever conducted in a southern state. Major findings of the survey are as follows: (1) Two-thirds of Alabamians believe the health care system needs fundamental change or needs to be completely rebuilt; however, there is little consensus on the shape of this new health care system. (2) Over 50 percent of Alabamians believe that rising health care costs are the most important issue facing the country. Yet, only about one third support managed-care mechanisms as a means of controlling personal health care costs. (3) Four of ten Alabamians believe access to care is a critical health care issue. Nonetheless, only 16 percent are willing to pay more than $100 in additional annual taxes to guarantee health care for everyone. This survey yields a set of conflicting conclusions. Policy makers and elected officials should be aware of these issues as they attempt to forge health care reform legislation. PMID- 10140440 TI - Clinical preventive medicine in business and industry: the economic impact. AB - Profits and earnings are the most important objectives for companies. Clinical preventive medicine programs reduce an employee's risk factors for illness, reduce absenteeism, and increase productivity. These programs can produce significant physiologic benefits for the employee, regardless of involvement level by the company. Cost-benefit analysis reveals benefit from smoking cessation, fitness, and some educational programs. The employer benefits from a happier and healthier work force which impacts on the public image. PMID- 10140441 TI - An analysis of market shares of Maryland hospitals in their service areas. AB - The study analyzes market shares (or competitiveness) of Maryland hospitals based on a service area definition of hospitals used for acute care planning in Maryland. The study uses this service area definition to analyze market shares of Maryland hospitals, to test them under alternative hypotheses and, finally, to examine the impact of several key variables. The study finds that proximity of other hospitals, and hospital's occupied bed size, have statistically significant impacts on market shares of hospitals irrespective of hospital location in a metropolitan or rural area. PMID- 10140442 TI - Workers' compensation in Pennsylvania: the effects of delayed contested cases. AB - This study examines the effects of delayed workers' compensation cases in the Pennsylvania system. Forty-five claimants of a workers' compensation support group responded to interviews. Delay periods averaged two years with a 68.4% drop in income. Results indicate that claimants endured financial and emotional stress, exhausted personal assets, relied on assistance from relatives, and received public assistance. Implications for social work practice include educating workers about benefits, counseling claimants with delayed claims, and advocating for administrative reforms. PMID- 10140443 TI - NFPA Journal Buyers' Guide 1995. Professional Services/Consultants Directory. PMID- 10140444 TI - NFPA Journal Buyers' Guide 1995. Trade Name Directory. PMID- 10140445 TI - NFPA Journal Buyers' Guide 1995. Fire Protection & Fire Service Reference Directory. PMID- 10140446 TI - Length of stay cost reduction fallacies. PMID- 10140447 TI - What affects nonprofit survival? AB - This article describes mortality patterns for nonprofit organizations in a major U.S. metropolitan area between 1980 and 1988. Twenty percent of the nonprofits in a panel ceased operations during this period. Mortality rates were found to vary widely. In some instances, high mortality was found in parts of the sector that were growing rapidly. Overall, nonprofits that ceased to operate were younger and smaller, used fewer strategies to attract funders, and had less diversified income streams than survivors. These patterns also varied substantially. The results point to the drawbacks of using limited or commonsense information and the necessity of theory-based research. PMID- 10140448 TI - Nonprofit boards and perceptions of funding. AB - The study presented in this article examines the extent to which board characteristics and activities are associated with the executive director's level of certainty about future funding, using a sample of 127 human service agencies. The executive directors of agencies with low levels of funding adequacy expressed more certainty about future funding when their boards were more expert, influential, and involved in planning and fundraising activities. For agencies with more adequate funding, board expertise and activities were associated with lower levels of perceived funding certainty. This articles argues that, rather than improving agency performance, boards serve a homeostatic function, acting in crisis situations to return their organizations to stable equilibria. PMID- 10140449 TI - The liability of nonprofits to donors. AB - The success of the third sector depends on public confidence, and that confidence rests, in part, on holding managers, directors, and officers of nonprofits responsible for their conduct. This accountability can be accomplished by clearly defining the roles of these individuals and the stands that they are to uphold, and by providing channels for all interested to challenge uncontrolled activities. Though interest in this goal is unanimous, a debate exists over how to ensure oversight and accountability. PMID- 10140450 TI - The third rail of U.S. politics. PMID- 10140451 TI - Real solutions for integrated delivery systems. PMID- 10140452 TI - Demand management may help stem costs. AB - Technology may soon reduce consumers' need for and use of the most expensive healthcare services, thereby controlling costs and even improving overall health status. It's called the science of 'demand management'. PMID- 10140453 TI - Health Management Technology goes one on one with Bill Gates. PMID- 10140454 TI - Computer-based records. Still searching for the 'Holy Grail'. AB - The developers of three new databases propose to evaluate computer-based patient record systems in great detail. They promise to rigorously benchmark how CPR systems perform on a suite of tests in what they are calling a 'CPR certification laboratory.' PMID- 10140455 TI - EDI plays major role in coordinating care. PMID- 10140456 TI - Need for information drives PHO formation. PMID- 10140457 TI - Survey forecasts future I/T expenditures. PMID- 10140458 TI - Computer-based patient record assessment standards. PMID- 10140459 TI - HotList. Data warehousing products and services. PMID- 10140460 TI - Employee violence in health care: guidelines for health care organizations. AB - Workplace violence is increasing, and health care environments are not immune to this escalating public health problem. In order to prevent or diminish the risk of a violent episode in the health care setting committed by employees, former employees, or family/significant others, health care managers need to be cognizant of certain factors associated with violence in the workplace. These variables include employee characteristics and behavior patterns, coworker indicators, organizational policies and procedures, mentally impaired employees, and so forth. Prevention strategies, use of employee assistance programs, managerial responses in escalating situations, impact of the Americans with Disabilities Act, and postviolence interventions must also be considered as part of progressive health care system administration, relative to the phenomenon of workplace violence. PMID- 10140461 TI - Managing diversity in the health care industry: a conceptual model and an empirical investigation. AB - Between 1985 and 2000, 8 out of every 10 new entrants to the work force will be minorities, immigrants, or women. If the U.S. health care industry has to retain a competitive edge, it will have to effectively attract and manage the diverse talent that will characterize its new work force. This article analyzes the authors' cultural awareness survey results and suggests a strategic model for managing diversity in the health care industry. PMID- 10140462 TI - "That's not my fault!". AB - Employees may use denial as a way to cope with underperformance. When denial is used in the health care environment by employees, it often presents the supervisor with a situation requiring intervention. This article describes the dynamics of denial and strategies for the supervisor for responding to denial in the workplace. PMID- 10140463 TI - Workplace loyalty in the 1990s. AB - The loyalty paradigm is evolving as part of our cultural modifications. We must enunciate our own standards and temper them with realism. Employers can seldom promise permanent jobs, and employees are reluctant to hitch their stars to one organization. In health care institutions, ethical considerations may result in divergent allegiances. The new loyalty paradigm is affected by the movements toward participative management and team building. A number of suggestions are offered for enhancing a pragmatic form of loyalty. PMID- 10140464 TI - Reflections on recruitment and retention at the unit level. AB - This article describes factors that 451 nurses reported influenced decisions to stay or leave their positions as well as factors they believed would recruit nurses to their units. Similar categories for both recruitment and retention were salary/hours/benefits, personal growth/challenge, work environment/staff relationships, satisfaction/fulfillment, and patient contact. Stress, lack of respect or acknowledgement, and role change related to turnover. The factors are consistent with other surveys across the decade. Implications of these factors for nurse-manager recruitment and retention strategies are discussed. PMID- 10140465 TI - The role of location in medical technologist job satisfaction. AB - The purpose of this study was to determine if a difference in job satisfaction existed between medical technologists working in an urban hospital and those working in a suburban hospital. The four areas of investigation were (1) satisfaction with pay, (2) professional status, (3) medical technologist physician relationship, and (4) job task requirements. Sixty medical technologists, from two different hospital locations, were surveyed using a work satisfaction questionnaire. A response rate of 60 percent from the suburban and 58 percent from the urban hospital was achieved. Analysis using the Mann-Whitney U test indicated that urban laboratorians were more satisfied with all areas of interest than were their suburban counterparts. The surveyed medical technologists were most satisfied with professional status, medical technologist physician relationship, pay, and job task requirements. All scores were, in general, low, suggesting a need to attend to improved job satisfaction among medical technologists. PMID- 10140466 TI - Delegate with confidence. AB - Supervisors need to be able to delegate work. They may not delegate due to lack of trust in subordinates, the feeling that they can do tasks better, new/old employees not being fully trained, a need to dominate, and/or fear that their bosses will think they are lazy. Employees may engage in one or more games to avoid delegated work: whine, miss deadlines, do incomplete or sloppy work, be unavailable, and/or appear busy. To delegate properly, supervisors should ensure that all employees are properly trained; ignore whining; establish deadlines; schedule follow-up meetings; communicate fully; and, possibly, use discipline. PMID- 10140467 TI - Information systems analysis approach in hospitals: a national survey. AB - A survey of 216 hospitals reveals that some hospitals do not conduct cost-benefit analyses or analyze possible adverse effects in feasibility studies. In determining and analyzing system requirements, external factors that initiate the transaction are not examined, and computer-aided software engineering (CASE) tools are seldom used. Some hospitals do not investigate the advantages and disadvantages of using in-house-developed software versus purchased software packages in the evaluation of alternatives. The survey finds that, overall, most hospitals follow the traditional systems development life cycle (SDLC) approach in analyzing information systems. PMID- 10140468 TI - The seven S's for successful management. AB - Becoming a successful manager in a health care agency is, for most new managers, an awesome goal. Successful management is more than knowledge of leadership roles and management functions that can be learned in school or educational workshops. Successful management involves effective use of both the manager's affective and cognitive domains. Mentoring and apprenticeship with a successful nurse leader is for many novice managers a highly valuable way to learn management skills since this allows for techniques with a successful nurse manager to be visualized and then modeled. "Seven S's" that provide a framework for managerial success are discussed. PMID- 10140469 TI - Total quality and the shifting management paradigm. AB - The concepts at the heart of total quality management (TQM) have existed for several decades, resurfacing every few years with variations, each time under a new name. Most efforts at incorporating these concepts into the operation of a business organization have failed, but each time the concepts come back, they meet with incrementally greater success than the previous time. This increasing rate of success is due largely to the shifting management paradigm. What we think and believe about management is making the gradual transition from strict authoritarianism, far more of an influence than we readily recognize, toward a practiced belief in true participative management. The closer the shifting management paradigm moves to open participation, the more success will accrue to total quality implementations. PMID- 10140471 TI - Frequent violations of the professional code of ethics. PMID- 10140470 TI - Improving continuity of care. PMID- 10140472 TI - Training for change. PMID- 10140473 TI - Measuring patient satisfaction. PMID- 10140474 TI - Strategy. Tomorrow's world. PMID- 10140475 TI - HIV/AIDS. A lost clause. PMID- 10140476 TI - Needs assessment. All out of perspective. PMID- 10140477 TI - Junior doctors. New deal? Big deal. PMID- 10140478 TI - Mind that child. PMID- 10140479 TI - A world apart ... South Africa. PMID- 10140480 TI - Rationing is a desperate measure. PMID- 10140481 TI - Inpatient experiences. What do patients really think? PMID- 10140482 TI - Mental health. Crisis? What crisis? PMID- 10140483 TI - Civil liberties. Under surveillance. PMID- 10140484 TI - Identifying risk in clinical care. PMID- 10140485 TI - The effects of Tomlinson on risk management. PMID- 10140486 TI - Managing risk. The legal implications of clinical protocols. PMID- 10140487 TI - State of emergency. PMID- 10140488 TI - How far can you go? PMID- 10140490 TI - The ballad of Peckham Health Centre. PMID- 10140489 TI - Stranglehold on health. PMID- 10140491 TI - Market testing--does it bring home the bacon? PMID- 10140492 TI - Listening to patients. What the patients said. PMID- 10140493 TI - Local pay. Only connect. PMID- 10140494 TI - Health promotion. Oxford blues. PMID- 10140495 TI - Assessing health impact. Plane truths. PMID- 10140496 TI - Safecode: a health and safety management tool. PMID- 10140497 TI - IT update. No longer counting beans. PMID- 10140498 TI - IT update/community systems. Community battles. PMID- 10140499 TI - IT mandate/ownership. Behind the mirror. PMID- 10140500 TI - IT update/electronic records. No stars in their eyes. PMID- 10140501 TI - And so to beds ... PMID- 10140502 TI - Centres of gravity. PMID- 10140503 TI - Restructuring. 1. Setting the framework--restructuring the organisation. AB - The NHS has undergone several major overhauls since it was set up in 1948. This series of five articles examines some of the current fashions in organisational restructuring--from process re-engineering and patient-focused care to GP fundholding--and analyses some of their longer-term consequences from the perspective of professional training and development. Finally, we consider what the shape of the NHS might look like in the late 1990s. PMID- 10140504 TI - Just help yourself. PMID- 10140505 TI - Race and ethnicity. True colors. PMID- 10140506 TI - Recruitment. Put to the test. PMID- 10140507 TI - Training. Women only. PMID- 10140508 TI - Training. Business letters. PMID- 10140509 TI - Training. Access ability. PMID- 10140510 TI - Training. Stand at ease. PMID- 10140511 TI - A vision beyond winners and losers. PMID- 10140512 TI - Training. Going live. PMID- 10140513 TI - On the road to recovery. PMID- 10140514 TI - The big push. PMID- 10140515 TI - Another false dawn. PMID- 10140516 TI - Primary Care. Mapping the course. PMID- 10140517 TI - Patient records. Open secret. PMID- 10140518 TI - Restructuring. 2. Bureaucracy in context--restructuring the hospital. PMID- 10140519 TI - Getting out, getting on. PMID- 10140520 TI - Women in management. Is macho management back? PMID- 10140521 TI - Marketing. Hard sell. PMID- 10140522 TI - Restructuring. 5. Cultural consequences--process re-engineering. PMID- 10140523 TI - HIV/AIDS. Do they have to know? PMID- 10140524 TI - Changes in effectiveness of psychotherapeutic drug level monitoring program after lessening pharmacy involvement. AB - The psychotherapeutic drug monitoring policy established by the medical, laboratory, and psychopharmacy departments at Austin State Hospital allowed for psychopharmacists to schedule, interpret, and monitor antidepressant and antipsychotic plasma concentrations. A recent policy change eliminated the psychopharmacists' role in scheduling blood draws for plasma drug concentration determinations. A comparison of the use of psychotropic plasma drug concentrations before and after implementation of the policy change, with regards to appropriate disease states, indication, scheduling, and choice of drug was conducted. Despite a fourfold increase in the number of plasma drug concentrations obtained after the policy change, the physicians appeared to be aware of the steady state requirements and situations in which monitoring plasma drug concentrations was justified. The number of plasma drug concentrations that were obtained to verify a suspected drug interaction, or adverse effect, increased after the new policy was implemented. This seemingly indicates physician uncertainty in determining the clinical implication of potential drug drug interactions and recognizing which adverse effects may be dose related. PMID- 10140525 TI - A pharmacy intervention program: recognizing pharmacy's contribution to improving patient care. AB - An on-line pharmacy intervention program developed to document and evaluate pharmacist's contribution to patient care is described. Over a 1-year period, the number and types of interventions and their impact on patient care were collated and reviewed by a clinical coordinator. Two thousand four hundred ninety-nine interventions were recorded. The most common types of interventions were order clarification/change (18%), pharmacokinetic consult (16%), chart review (13%), restricted drug follow-up (8%), discharge medication screen (7%), initiate drug therapy (6%), drug information (5%), discontinued drug (4%), and therapeutic alternative (4%). There were 3459 impact codes assigned to these interventions. Forty-one percent decreased toxicity, 35% increased efficacy, 17% decreased cost, 16% avoided allergy or drug interaction, 8% improved compliance, and 22% were classified as other. Our analysis found that pharmacy interventions elevated the standard of care and prevented major organ damage and potentially life threatening events. This program shows that pharmacists play a significant role in improving patient outcomes. PMID- 10140526 TI - Antibiotic utilization and cost analysis in hospitalized patients with community acquired pneumonia. AB - All cases of presumptive community-acquired pneumonia (CAP) in adult patients admitted to a community/teaching hospital during the first 6 months of 1993 were reviewed. A total of 67 patients ranging in age from 20-90 years (73% > 60 years) had CAP. Fifteen (22%) patients were receiving antibiotics before admission. A typical respiratory pathogen was identified in only 18 (27%) patients. Empiric parenteral antibiotics were initiated in all but 2 patients. These agents usually included cefuroxime (42%), ampicillin/sulbactam (28%), or ceftriaxone (14%). Concomitant erythromycin (25%) or clarithromycin (17%) was used empirically in 42% of patients. Parenteral antibiotics were given for a mean of 5.2 days (median, 4 days). The mean therapy cost of these common parenteral agents ranged from $69.50 (cefuroxime, 750 mg every 8 hours) to $271 (ceftriaxone, 1 gram every 12 hours). Hospitalization ranged from 2-37 days (mean, 8.3 days; median, 6 days). A total of 50 patients were switched to oral antibiotics. Prescriptions for outpatient therapy ranged from 5-21 days (mean, 8.6 days; median, 7 days). The most common oral antibiotics included cefuroxime (33%), clarithromycin (20%), and amoxicillin/clavulanate (20%). The mean therapy cost for these drugs ranged from $85.19 (cefuroxime, 500 mg every 12 hours) to $39.24 (clarithromycin, 500 mg every 12 hours). This study found that empiric therapy with low-dose parenteral cefuroxime, with or without erythromycin, followed by outpatient clarithromycin was less costly than other common regimens used to treat CAP. PMID- 10140527 TI - The future of U.S. hospitals is tied to an integrated health system. PMID- 10140528 TI - Evaluating the quality of published pharmacoeconomic evaluations. PMID- 10140530 TI - Annual Pharmaceutical Manufacturers Directory--1995. PMID- 10140529 TI - Competence assessment; requirements of a drug recall system; dealing with ethical issues. PMID- 10140531 TI - Returns to R&D on new drug introductions in the 1980s. AB - This study finds that the mean IRR for 1980-84 U.S. new drug introductions is 11.1%, and the mean NPV is 22 million (1990 dollars). The distribution of returns is highly skewed. The results are robust to plausible changes in the baseline assumptions. Our work is also compared with a 1993 study by the OTA. Despite some important differences in assumptions, both studies imply that returns for the average NCE are within one percentage point of the industry's cost of capital. This is much less than what is typically observed in analyses based on accounting data. PMID- 10140532 TI - A new test for supplier-inducement and application to the Canadian market for dental care. AB - The hypothesis that dentists do not induce demand for their services is tested using reduced form estimates of the price elasticity of demand. If demand is autonomous, shifts in supply for whatever reason should generate equivalent estimates provided access costs change proportionately with shifts in supply. If demand inducement is present demand can appear to be very elastic, or very inelastic, depending on what is causing the shift in supply. Each of three applications of this test, conducted in the context of jointly estimated fee and quantity equations using annual Canadian data for 1956-1989, rejects the no inducement hypothesis. PMID- 10140533 TI - Physician labor supply: do income effects matter? AB - This paper estimates a model of physician labor supply, focusing on the impacts of wage and non-wage income. We find evidence of significant income effects. For male physicians, the income effect of a wage change on labor supply is negative, with an elasticity of -0.26. The pure substitution effect of a wage change increases labor supply: a 1% increase in wages leads to a 0.49% increase in labor supply, controlling for income effects. The results also suggest that the labor supply decisions of females are more responsive to variations in their earnings than are those of males. PMID- 10140534 TI - Health inputs and child mortality: Malaysia. AB - This paper is concerned with the relationship between child mortality and the use of health care. We develop a simultaneous model of fetal and postnatal mortality risks and input demand equations for prenatal medical care and institutional delivery. This model is applied to retrospective data from Peninsular Malaysia covering 1950-1988. The results show that prenatal medical care and institutional delivery have strong beneficial effects on child survival probabilities, and that these effects are substantially underestimated when adverse self-selection among users of health care is ignored. The effectiveness of prenatal health care in Malaysia improved until 1980, and then deteriorated. We find that the risk of infant and child mortality is not independent of fetal survival, but show that ignoring selective fetal survival introduces only mild biases in infant and child mortality estimation. Higher infant and child mortality rates among young mothers are partly explained by their lower likelihood of purchasing health care. PMID- 10140535 TI - Response to Pauly on a re-examination of the meaning and importance of supplier induced demand. PMID- 10140536 TI - Personnel licensure: making slow inroads. PMID- 10140537 TI - How to keep the lab lit during power failures. PMID- 10140538 TI - Cost analysis for instrument selection. PMID- 10140539 TI - Laboratory teambuilding: Rx for success. PMID- 10140540 TI - How labs contribute to rising health care costs. PMID- 10140541 TI - Reorganizing the laboratory to better serve patients. PMID- 10140542 TI - Missouri OKs controversial CON. PMID- 10140543 TI - Budget woes may halt some HCFA certifications. PMID- 10140544 TI - Clinton criticizes GOP's planned cuts. PMID- 10140545 TI - House approves malpractice limits. PMID- 10140546 TI - Cincinnati CHIN picks IBM but has vendors in reserve. PMID- 10140547 TI - ACHE move signals fate of AHA convention. PMID- 10140548 TI - Okla. HMO wraps up Columbia deal. PMID- 10140549 TI - Study: 83% of HMO enrollees satisfied. PMID- 10140550 TI - Conn. hospital receives nod for scaled-back replacement. PMID- 10140551 TI - Former Humana executive gets probation, jail time for bribing Kentucky lawmaker. PMID- 10140552 TI - Ohio's first provider networks take shape. PMID- 10140553 TI - Docs pay for cutting Medicare visits. PMID- 10140554 TI - High court grants HHS power to alter provider payments. PMID- 10140555 TI - Physician recruitment tactics top IRS list. PMID- 10140556 TI - A delicate balancing act. AB - This week, Modern Healthcare begins a two-part series examining the growing number of sales of not-for-profit hospitals to for-profit chains and the consequences of those sales for the communities involved. The stories in this installment explore whether a community benefits more from having an investor owned hospital that pays taxes or a tax-exempt hospital that provides more charity care. They also review how this issue played out in Oklahoma City 10 years after a sale. Next week: a look at whether charitable foundations created with the proceeds of sales of not-for-profits deliver on their promises. Also, an analysis of Columbia/HCA Healthcare Corp.'s strategy of acquiring not-for-profits through partnership arrangements. PMID- 10140557 TI - Calif. HMOs discussing merger. PMID- 10140559 TI - Duplication hard to limit despite hospital mergers. PMID- 10140558 TI - JCAHO backs off on requiring use of its indicator system. PMID- 10140560 TI - Providers ponder impact of Medicare squeeze. PMID- 10140561 TI - Academic medical center seeks link with Indiana not-for-profit. PMID- 10140562 TI - N.Y. Medicaid cuts threaten jobs. PMID- 10140563 TI - Horizon raises takeover offer, wins Hillhaven's consideration. PMID- 10140564 TI - Surveyed hospitals cut '94 expenditures in response to changing marketplace. PMID- 10140565 TI - Some implications of managed care for physician assistants. AB - The American health industry is now focusing on managed care, capitated payment, and the formation of regional networks. As a result, additional cost constraints in the delivery of our nation's health services should be expected. Such proposals are also anticipated to have a major impact on PAs: (a) there will be an increased demand for qualified PAs to provide primary care services; (b) PAs will be better positioned for advancement than other health professionals despite industry-wide cost-containment efforts; and (c) most PAs can expect to practice in less "user-friendly" environments, irrespective of the implementation of the procompetitive concept of managed care or more regulatory global budgetary targets. PMID- 10140566 TI - NOVA Awards. Building healthier communities. AB - The following profiles of this year's winners of the second annual NOVA Awards, sponsored by the American Hospital Association and Hospitals & Health Networks magazine, exemplify humanity, which is what health care is all about. The winners all set out to boost the health and well-being of their communities. That frequently means expanding the traditional hospital mission to ensure that disadvantaged and underserved people not only get good health care, but also safer streets, nutritious food, a decent place to live, and a future for their children. They're all part of a community's ecology. None of these projects is finished. But you have to start somewhere to get somewhere else. PMID- 10140567 TI - PHOs: what are they? And how do you form one at your hospital? PMID- 10140568 TI - Finding a way: one trustee talks about forming a PHO. Interview by Therese Hudson. PMID- 10140569 TI - When a for-profit comes knocking. PMID- 10140570 TI - How to succeed in business without laying off employees. PMID- 10140571 TI - Rethinking term limits. PMID- 10140572 TI - Diversity on the board. PMID- 10140574 TI - Talking heads: lessons on capitation. PMID- 10140573 TI - Merger mania: what can you expect? PMID- 10140575 TI - A trustee goes to Congress. Interview by Renee Blankenau. AB - Of the 99 new faces on Capitol Hill, 85 are Republicans and only 14 are Democrats; all 11 Senate freshmen are Republicans. One of the new Republican representatives, Mark Foley, a real estate agent from West Palm Beach, is a hospital trustee. American Hospital Publishing senior editor Renee Blankenau talked with Foley recently about the new focus on local responsibility, what it means for health care, and how health care leaders can be part of local solutions. PMID- 10140576 TI - Portrait of outstanding leaders. PMID- 10140577 TI - New surgery for health care. PMID- 10140578 TI - Contraceptive use in the United States: 1982-90. PMID- 10140579 TI - Surgical workforce: the case for change. PMID- 10140580 TI - Food service trends in NSW hospitals, 1986-1993. AB - In 1993 a survey of the food service departments in 159 hospitals in New South Wales was carried out using a mailed questionnaire, and the results were compared with those of a similar survey in 1986. The results reveal that over the past seven years there has been a significant increase in the proportion of hospitals using cook-chill systems, from 5 per cent in 1986 to 18 per cent in 1993. Hospitals with cook-chill systems do not appear to be operating more efficiently than those with conventional catering systems: in cook-chill hospitals the mean food service staffing ratio was 7.1 beds/full-time equivalent (FTE) compared to 7.8 beds/FTE in hospitals with cook-serve systems. Most hospitals in New South Wales still use traditional hot food delivery to the wards, and more of these are now using effective heat maintenance systems for patient meals. The proportion of special diet meals has increased over the past seven years to 17.1 per cent in public hospitals. The percentage of food service departments with an unqualified person in charge fell from 47 per cent in 1986 to 22 per cent in 1993. Meal times remain largely unchanged, with more than 90 per cent of hospitals still serving the evening meal before 5.30pm. PMID- 10140581 TI - A review of rural health restructuring in the New South Wales. AB - In 1993 the delivery of rural health services in New South Wales was restructured by the establishment of 23 district health services with the aims of diverting resources from administration to clinical services and enhancing decision-making at the local level. Implementation of the restructuring in its infancy was examined by structured interviews conducted with five general managers and 15 of their second-tier appointees. The organisational structure of the districts, the managerial attributes required of senior staff and approaches to change were emphasised. Political constraints on organisational decision-making such as organisational design were acknowledged and the importance accorded to demonstrable achievement in managing change and incorporating consultative techniques was recognised. PMID- 10140582 TI - The impact of strategic conflict on the management of information technology in a hospital. AB - This case study examines the management of information technology in a public teaching hospital. The technology is divided into two major classes: central, mainly administrative systems; and local clinical systems. This split is an outcome of the strategic conflict between the goals of efficiency and effectiveness as pursued by administrators and clinicians respectively. Without resolving this conflict it would be very difficult to develop an integrated information system for this hospital. PMID- 10140583 TI - Dedicated MRI extremity scanners. PMID- 10140585 TI - Balance of care. PMID- 10140584 TI - Stereotactic image-guided surgery. PMID- 10140586 TI - Conviction is not a dirty word. PMID- 10140587 TI - Victorian casemix--the first year. PMID- 10140588 TI - Why did it happen? What did it mean? PMID- 10140589 TI - A third way: beyond incremental reform of the Australian health economy. PMID- 10140590 TI - Ownership issues obscure outcomes. PMID- 10140591 TI - A long way to come, a long way to go. PMID- 10140592 TI - Public hospital pathology--at what cost? AB - Public hospital laboratories have in the past fended off financial scrutiny and accountability on the grounds of their complexity and lack of compelling need. However, the cost of providing diagnostic laboratory services has now come under intense scrutiny because of budget reductions and options for private sector competition. Costing of pathology services is not difficult, but their organisation and outputs do have unique features that need to be understood and defined to ensure that the costing model used provides robust data that accurately reflects how resources are consumed. The cost data generated for diagnostic services can then be compared to the various benchmarks widely used for activity-based funding, such as the Commonwealth Medical Benefits Schedule and the pathology component of the AN-DRG Service Weights System, while the requirement and funding for other activities can be rationally determined. PMID- 10140593 TI - Change of government and health services policy in Victoria, 1992-93 [see comment]. AB - Although constrained by Federal financial dominance, State governments can, nevertheless, significantly shape a number of aspects of health policy within their own jurisdiction. New governments often seek to implement both substantive and symbolic policy changes. This is often also accompanied by alterations to organisational structures and personnel with a view to making implementation more effective. This article chronicles the continuities and changes in health services policy in the first year of the Liberal-National Coalition State Government in Victoria. These include institutional changes, key ministerial and bureaucratic appointments, health workforce issues, health services funding decisions, public and community health, and relations with the Federal Government. The decision-making style of the new government is also discussed. The authors regard the economic imperatives of Victoria's severe deficit as the dominant influence in all areas of public policy, including health services policy, although certain ideological predilections have also been evident. They further argue that the new government has primarily sought legitimacy by appealing to what it regards as its mandate to rectify Victoria's 'economic crisis' by reducing public expenditure and reforming managerial practices in the public sector. PMID- 10140594 TI - Influences on the use of capital by public hospitals. AB - This paper examines key influences on the volume of capital employed by public hospitals. Empirical models are constructed and analysed separately for total capital employed and for plant and equipment only, using data from 68 Victorian hospitals. Such data provide an empirical base to guide government decisions on funding capital expenditure in hospitals. The analysis finds that the proportion of hospital expenditure devoted to outpatients and teaching, and the proportion of funding derived from government all influence the level of capital utilised per inpatient. The model provided a reasonable fit for plant and equipment, but much improved data coverage and consistent valuation of land and buildings are required to adequately explain influences on total capital. PMID- 10140595 TI - HMO survival: determination of optimal size. AB - The concept of prepaid health care as embodied by health maintenance organizations (HMOs) provides variety in the provision and coverage of health care benefits. This is important in the development of a diverse and appropriate health care system for the US. HMOs were developed to provide a cost-effective, alternative form of health care delivery and financing to ensure access and continuity. HMOs can achieve this only by sustaining organizational viability. A survivor analysis modelling technique is employed to analyze the optimal size of HMOs by region model type and profit status over the period from 1977 through 1986. A determination of an optimal size category establishes a survival criterion for HMOs. A minimum enrollment of at least 25,000 members should be achieved as quickly as possible. This minimum standard can be used as a guide for initial success, however a higher enrollment in the 40,000 to 60,000 member range appears necessary for longer-term survival. PMID- 10140596 TI - Structure, environment and strategic outcome: a study of Pennsylvania nursing homes. AB - This study applies Porter's model of competitive advantage to the nursing home industry. Discriminant analysis is used to identify organizational and environmental characteristics associated with nursing homes which have demonstrated valued strategic outcomes, and to distinguish the more successful nursing homes from their rivals. The results of the discriminant analysis suggest that nursing homes with superior payer mix outcomes are distinguishable from their less successful rivals in areas associated with a focused generic strategy. The study suggests that nursing homes which are better staffed, of smaller size and lower price are more likely to achieve high levels of self-pay utilization. Independent living units, continuing care retirement communities in particular, are likely to act synergistically with nursing home organizational characteristics to enhance competitive advantage by linking the value chain of the nursing home to that of retirement housing. Nursing homes with higher proportions of Medicare were found to provide a unique product when compared to their rivals. Profit status does not discriminate better self-pay strategic utilization, but for-profit facilities are more likely to pursue a Medicare strategy. Concern was raised that, as nursing homes become more strategically oriented, Medicaid access may become more problematic. PMID- 10140597 TI - Taylorism in a post-modern age? AB - F.W. Taylor made an early and important contribution to the organisation of work in an industrial society. His ideas, or versions of his ideas, are once again receiving attention. Some commentators even describe a new or neo Taylorism (Pollitt, 1990). This paper argues that the only theoretical justification for the re-introduction of Taylorist strategies in the workplace is found in the notion of the post-modern world; where rationality is replaced by a ritual of signs and work becomes part of that ritual; where form replaces rationale, and strategies for work are governed by processes of survival in the remnants of modernity. PMID- 10140598 TI - Recruitment and retention: what can the NHS learn from other employers? PMID- 10140599 TI - Objectives, information and incentives in the NHS internal market. AB - In order to achieve and monitor success in the NHS internal market, it is important that information related to health care objectives is developed and used. The paper argues that these objectives are not always easy to specify but that four groups can be identified: efficiency, equity, quality and accountability/responsiveness. Although information management specialists have emphasised the construction and use of appropriate frameworks for planning information flows, whether appropriate information is used depends on the existence of incentives for its supply. Using concepts from game theory, the paper offers a non-technical examination of the incentives that the contracting environment imposes on the development of new information. The article concludes by suggesting that, for a variety of reasons, the incentives to produce information which would help monitor medical outcomes and related objectives, as distinct from inputs or activities, are often weak and sometimes perverse. PMID- 10140600 TI - Workload in trauma and orthopaedic surgery: use of linked statistics to profile a specialty. AB - We have used linked hospital morbidity statistics to construct a basic profile of the demographic and epidemiological features of trauma and orthopaedic surgery in a defined population. This paper reports on this profile and illustrates trends in the specialty between 1976-86. During this period episode-based inpatient admission rates rose by about 20%. Multiple admissions per person varied with age but did not increase over time. Thus the increase in admission rates in this specialty represented an increase in numbers of people who received treatment. Average length of stay per episode of inpatient care and the total time spent in hospital per person declined over time. New outpatient attendance rates increased by 19% in the 11-year period. The ratio of follow-up outpatient appointments to new appointments fell from 2.68:1 to 2.24:1; the number of inpatient beds fell by about 13% and bed occupancy remained stable at about 80%. We describe some of the major components of clinical workload in the specialty, with emphasis on conditions for which admission rates changed over time, relating the data to numbers of people treated as well as to episodes of care. PMID- 10140601 TI - Determinants of rural hospital utilization of multiskilled health practitioners. PMID- 10140602 TI - Understanding the relationship between community health groups and RHA. PMID- 10140603 TI - Who should get treatment first? What the public thinks. PMID- 10140604 TI - Importance of cervical screening to health of Maori women emphasised at hui. PMID- 10140605 TI - Perspectives. Clinical practice guidelines: winning a dubious audience. PMID- 10140606 TI - Promoting the HIM profession--Montana style. PMID- 10140607 TI - Making the CPR vision a reality: where should you start? PMID- 10140608 TI - Seizing the opportunity for a paperless record. PMID- 10140610 TI - Resources for HIM. PMID- 10140609 TI - On the line: professional practice solutions ... critical paths. PMID- 10140611 TI - The electronic patient record maze: where is the beginning--and is there an end? PMID- 10140612 TI - Common pitfalls in scanning electronic patient records and how you can avoid them. PMID- 10140613 TI - Where's the data? Hierarchical storage management systems. AB - Management of the vast volume of documents and data that must be maintained in an EPRS requires well designed architecture that can manage the complexities involved in allowing secure, long-term storage of the information combined with speed of access necessary to please users. This calls for a tightly integrated platform of hardware and software components that are optimized to work in the health information environment. PMID- 10140614 TI - Administrative and security challenges with electronic patient record systems. AB - EPRS security is clearly an area of concern to all health information management professionals. With the advent of enterprise-wide linkages, as well as community health information networks (CHINs) and other remote linkages, security is a critical issue that must be addressed in detail during system selection and implementation. Strict enforcement of security policies and procedures is mandatory. Technology has given health information management professionals the tools to secure the patient record. Use of these tools is required to meet the challenges presented by the transition to the electronic realm. PMID- 10140615 TI - The graphical user interface. AB - The systems are getting better, but they are not perfect yet. With physicians, health information managers, nurses, and software engineers working together to more accurately define what these systems can do, should do, and will do, better and even more elegant GUIs will be developed. PMID- 10140617 TI - Create your own computer curriculum. PMID- 10140616 TI - Digital data capture for electronic patient record systems. AB - The importance of digital data capture in optimizing the benefit and cost savings provided by an EPRS has been shown. Data will come from several sources including ADT systems, laboratory computer systems, and transcription computers, and the data will need to be stored in the electronic patient record. The HL7 standard provides a common language for new systems to exchange data. For older systems, an interface engine or toolkit may be necessary to transfer the data from another hospital system to the EPRS. In any case, capturing and storing digital data will greatly enhance the usability of an EPRS. PMID- 10140618 TI - The Anesthesiology Consultant Report (ACR): a document for effective dissemination of critical information. PMID- 10140619 TI - The open road. PMID- 10140620 TI - Volunteer surgery program in the Amazon. PMID- 10140621 TI - Is there a role for the surgeon in today's cancer management? PMID- 10140622 TI - Should the surgeon manage perioperative pain? PMID- 10140623 TI - The federal budget process. PMID- 10140624 TI - Case study. Quality strategies on the for-profit front reflect corporate philosophies ... Columbia/HCA and Community Health Systems. PMID- 10140625 TI - Critical pathways in total joint procedures ... Morristown Memorial Hospital. PMID- 10140626 TI - Marketing for health-care organizations: an introduction to network management. AB - The introduction of regulated competition in health care in several Western countries confronts health care providing organizations with changing relationships, with their environment and a need for knowledge and skills to analyse and improve their market position. Marketing receives more and more attention, as recent developments in this field of study provide a specific perspective on the relationships between an organization and external and internal parties. In doing so, a basis is offered for network management. A problem is that the existing marketing literature is not entirely appropriate for the specific characteristics of health care. After a description of the developments in marketing and its most recent key concepts, the applicability of these concepts in health-care organizations is discussed. States that for the health-care sector, dominated by complex networks of interorganizational relationships, the strategic marketing vision on relationships can be very useful. At the same time however, the operationalization of these concepts requires special attention and a distinct role of the management of health-care organizations, because of the characteristics of such organizations and the specific type of their service delivery. PMID- 10140627 TI - Formal and informal authority of hospital directors. AB - Describes and contrasts the perceptions of formal and informal authority of hospital directors of two different kinds of organizations: hospitals that are part of public multi-hospital organizations (PMOs) and independent hospitals. Indicates that all the directors perceive their formal authority to be greater than their formal authority. However, there is a gap in the perception of formal and informal authority by directors of the two types of hospital. Directors of independent hospitals perceive themselves to have more formal and informal authority than do their colleagues at hospitals that are part of PMOs. Both structural and personal explanations for these findings are given. In addition, discusses the implications for policy making of the source of authority, informal, and formal authority in the transition to autonomous semi-independent hospitals in a changing environment. PMID- 10140628 TI - Assessing strategic behaviour within the acute sector of the National Health Service. AB - The creation of the internal market has merely been the latest progression in the change processes confronting the NHS over recent years as the UK Government searches for new ways of expanding patient output while concurrently restricting provision of additional financial resources. To assist in the implementation of change, acute sector providers have introduced managerial concepts from the private sector such as strategic planning. It is not clear, however, whether these techniques are appropriate or effective in the management of health-care services. A survey was undertaken to gain the perspectives of middle managers in acute units on the degree to which senior management involves them in determining performance goals and strategic plans. Results indicate that in most units, the orientation of senior management is to retain control over key issues associated with strategic planning and to minimize the degree to which the workforce is involved in any decision-making processes. Reviewing these results relative to the service-sector management theories concerning the options of industrializing or employee empowerment strategies indicates that senior management in the acute sector is operating a production-line service output philosophy. Although this orientation may meet the immediate needs of the UK Government, a review of how this strategic philosophy has severely weakened Western firms' position in world markets provides a basis for examining whether greater economic advantages might accrue to Britain by redirecting the management of change in the NHS towards a strategic philosophy based on employee empowerment. PMID- 10140629 TI - Which "internal market"? AB - There are two potential types of "internal markets". In Type I, the patient is treated only by "contracted" providers while in Type II, he/she is free to choose a provider. The rhetoric of Working for Patients is Type II while the practice is Type I. Type I market with its contracting concept is a pernicious version of the line relationship that existed in the past between health authorities and provider units. The ethos of the NHS is best suited to the Type II market which is similar to the market that operates in higher education, another public service. PMID- 10140630 TI - A demographic view of Medicaid populations in the United States. PMID- 10140631 TI - Restructuring Canada's hospitals--looking for financial vital signs. AB - Hospitals across Canada are busy restructuring their facilities and services, trying to head off a crisis precipitated by increasing patient demand and static or declining provincial government funding. The challenge is compounded by a looming age wave of elderly. In Ontario, and Toronto in particular, the country's hospital heartland, an unusual interdisciplinary committee has reached out far beyond obvious health care sources, to the public that uses these facilities and services. PMID- 10140632 TI - Creating a managed care service network. AB - As health care services in general and pharmacy services specifically become more important, health care administrators may wish to consider focus strategies that include service differentiation in specific or narrow target markets. The type of strategy, whether cost, differentiation, or focus, will provide the mission and establish the organizational goals for health care providers. PMID- 10140633 TI - From cost control to quality management. PMID- 10140634 TI - A successful field-based pharmacy program. AB - Once physicians are aware of the trends and of how pharmacy utilization methods such as therapeutic interchange and formulary management can control costs, they are better able and more willing to provide patients with effective, lower-cost treatment. As the majority of pharmacy benefit managers (PBMs) today stress quality in addition to greater cost efficiencies, quantitative results defining quality and highlighting improved compliance and increased patient knowledge should also be initiated by PBMs. The author describes a pilot field-based pharmacy program, which indicates that active intervention and cooperation between the medical group and pharmacy benefit manager works. PMID- 10140635 TI - Network participation by employees of managed care organizations: good business judgement or a prohibited transaction under ERISA? Part I. PMID- 10140636 TI - Computerized patient records: backbone to an emerging information infrastructure. AB - The potential reform of our health care system has initiated market changes that include mergers, acquisitions, and consolidations. This shift in the market has created demand for immediate access to clinical information. The author predicts that the computer-based patient record system will become the clinical information source of the future, providing staff with the ability to capture, store, and communicate medical information instantaneously. PMID- 10140637 TI - Electronic records: better service for customers & payors. PMID- 10140638 TI - What is the best way to conduct provider credentialing in a managed care environment? PMID- 10140639 TI - Choosing the right direction: survival in the managed care wilderness. PMID- 10140640 TI - Shifting to a new medical care paradigm. PMID- 10140641 TI - Components of a managed care IS. PMID- 10140642 TI - Tuberculosis in home care. Complying with OSHA. AB - Tuberculosis has found its way back into the mainstream after decades of slow decline. The Centers for Disease Control and Prevention and the Occupational Safety and Health Administration have implemented standards for all health care providers in an effort to prevent and control this disease before it reaches epidemic levels. PMID- 10140643 TI - Critical pathway. An effective way to manage care of the insulin-dependent diabetic. AB - Critical pathways are recommendations for delivery of care. They can encompass all facets of treatment, from clinical care to patient education. In light of the growing prevalence of managed care, clinical pathways and outcomes measurement increasingly will interest both providers and payors as they strive for cost effective yet top-quality patient care. PMID- 10140644 TI - Home administration of nutritional & medical therapies for persons with AIDS. AB - With the increasing numbers of AIDS patients in home care settings, professional caregivers will be required to provide home infusion and to help informal caregivers in enteral and total parenteral nutrition. The first thing all caregivers--both professional and informal--need to understand is how the infusion devices work and what pointers will help keep the patients healthy. PMID- 10140645 TI - Outcome-based quality improvement in home care. AB - A system of outcome measures of service quality was developed and tested. The findings of this project will provide a framework for moving forward with outcome based quality improvement in home care. Using outcome measures will permit agencies to analyze their performance in terms of effectiveness of care. PMID- 10140646 TI - Treat It Right--a systematic wound care program. AB - Most home care agencies have a good number of wound care patients whose care necessitates many visits and a great deal of time. How can providers ensure that this use of major resources results in the most effective patient outcomes? A systematic wound care program may be the key to cost containment and quality outcomes. PMID- 10140647 TI - Cost savings through computerized staff scheduling. AB - In their quest to control and minimize labor expenses, health care organizations have spent large amounts of time and effort fine-tuning existing management practices. With staff scheduling software, however, they can improve this poorly understood and often-overlooked management practice and save time and money in the process. PMID- 10140648 TI - Leadership: the engine of development. PMID- 10140649 TI - The ABC's of charitable gift annuities. PMID- 10140650 TI - Nurses' attitudes toward patient education--yesterday and today. AB - This study examines nurses' attitudes toward patient education. The original study completed in 1986 established a data base and concluded that nurses were generally positive about their patient education role, but were not always clear on certain aspects of the role. Since 1986, there have been replication studies. This present investigation reviews the results of these replication studies and discusses a general consensus of findings. PMID- 10140651 TI - Budgeting for hospital in-service education--a missing standard. PMID- 10140652 TI - How do health care education and training professionals learn about the environment? AB - Preparing for the health care system of the future includes the ability to abstract information from relevant sectors of the environment. This study looked at the way health care educators scan the environment and the relationship of scanning behavior to management style. Results indicate that education and training professionals focus on the regulatory and customer sectors of the environment more than the technological and sociopolitical sectors. PMID- 10140653 TI - The place of private accrediting among the instruments of government. PMID- 10140654 TI - Private accreditation in the regulatory state. PMID- 10140655 TI - Recent developments concerning accrediting agencies in postsecondary education. PMID- 10140656 TI - Medicare and the Joint Commission on Accreditation of Healthcare Organizations: a healthy relationship? PMID- 10140657 TI - Regulations under the Higher Education Amendments of 1992: a case study in negotiated rulemaking. PMID- 10140658 TI - Confidentiality and disclosure in accreditation. PMID- 10140659 TI - Tort liability to those injured by negligent accreditation decisions. PMID- 10140660 TI - Accrediting and the Sherman Act. PMID- 10140661 TI - Color as a trademark under the Lanham Act: confusion in the circuits and the need for uniformity. PMID- 10140662 TI - Private accreditation as a substitute for direct government regulation in public health insurance programs: when is it appropriate? PMID- 10140663 TI - Health care reform and the constitutional limits on private accreditation as an alternative to direct government regulation. PMID- 10140665 TI - Don't shut family physicians out of the hospital. PMID- 10140664 TI - The unfolding tendency in the federal relationship to private accreditation in higher education. PMID- 10140666 TI - From ally to enemy. The ugly split between 175 doctors and Prudential. PMID- 10140667 TI - Are you expected to see too many patients? PMID- 10140668 TI - Hospitals' little secret: they make lots of money. PMID- 10140669 TI - Equifax eyes healthcare market. PMID- 10140670 TI - Most students pursue generalist training. PMID- 10140671 TI - Troubled Fla. hospital under probe. PMID- 10140672 TI - FTC approves two-way merger in Maine. PMID- 10140673 TI - Antitrust issues on state agendas. PMID- 10140674 TI - House votes to restore VA funds. PMID- 10140675 TI - Congress busy planning health spending cuts. PMID- 10140676 TI - Columbia involved in ownership dispute. PMID- 10140677 TI - N.J. hospital group sues state to stop payment cuts. PMID- 10140678 TI - Connecticut wants to retain 17% tax on hospital revenues. PMID- 10140679 TI - Freeze on certification threatens clinic boom. PMID- 10140680 TI - IRS issues proposed revenue ruling on physician-recruitment tactics. PMID- 10140681 TI - La. physician group considers partners. PMID- 10140682 TI - Ohio hospital, system discuss merger. PMID- 10140683 TI - Verdict in Bio-Medical case demonstrates high cost of breaking management pact. PMID- 10140684 TI - Group urges study of merger effects. PMID- 10140685 TI - Executive quits as school considers selling hospital. PMID- 10140686 TI - Keane bids to revive CHC product. PMID- 10140687 TI - Columbia adds Ky., Texas hospitals. PMID- 10140689 TI - Idaho hospitals try court, politics in Medicaid feud. PMID- 10140688 TI - Nursing home group wants quality rules added to moratorium. PMID- 10140690 TI - Managed care's impact on military studied. PMID- 10140691 TI - Hospital groups must refocus to maintain pace of members. PMID- 10140692 TI - Are foundations bearing fruit? AB - This is the second installment of a series on the impact of the growing number of sales of not-for-profit hospitals to investor-owned chains. Our March 13 issue reviewed whether communities benefit more from having inventor-owned hospitals that pay taxes or tax-exempt hospitals that provide more charity care. This week: Do tax-exempt foundations deliver on their promises? Also, an analysis of Columbia/HCA Healthcare Corp.'s strategy of acquiring not-for-profits through partnership agreements. PMID- 10140693 TI - Enrollment, access woes cited at some Medicare risk HMOs. PMID- 10140694 TI - NCQA (National Committee for Quality Assurance) pilot project aims to make measures comparable, accurate. PMID- 10140695 TI - PHO infrastructures may be unsound. PMID- 10140696 TI - Reserves needed to cushion capitation. PMID- 10140697 TI - Making health insurance affordable. PMID- 10140698 TI - Health care REITs (real estate investment trusts): a fine performance. PMID- 10140699 TI - Subacute care. Teaming up with hospitals. PMID- 10140700 TI - Residential living. Options for seniors of modest means. PMID- 10140701 TI - Computer power: LTC on the information superhighway. PMID- 10140702 TI - 5th Annual Provider Software Buyer's Guide. AB - To help long term care providers find new ways to improve quality of care and efficiency, PROVIDER presents the fifth annual listing of software firms marketing computer programs for all areas of long term care operations. On the following five pages, more than 70 software firms display their wares, with programs such as minimum data set and care planning, dietary, accounting and financials, case mix, and medication administration records. The guide also charts compatible hardware, integration ability, telephone numbers, company contacts, and easy-to-use reader service numbers. PMID- 10140703 TI - Dealing with due process concerns. PMID- 10140704 TI - Avoiding computers doesn't compute. PMID- 10140705 TI - Developing a community-focused mission. PMID- 10140706 TI - Rationing: the specter of necessity. PMID- 10140707 TI - Opening doors for your patients. PMID- 10140708 TI - A trip to our health care future. PMID- 10140709 TI - Ask the experts ... hospital should be involved in a community health assessment. PMID- 10140710 TI - Ask the experts ... suburban hospital board. PMID- 10140711 TI - Not-so-random acts of kindness. PMID- 10140712 TI - Wanted: a few good trustees. PMID- 10140713 TI - Following the leaders. Helping communities take ownership of their health. PMID- 10140714 TI - Reducing inappropriate prescribing of sublingual nifedipine. AB - OBJECTIVE: To report a program to reduce the practice of prescribing sublingual nifedipine. MONITORING AND EDUCATIONAL PROGRAM: Pharmacy records were used to identify orders for sublingual nifedipine at Georgetown University Medical Center. Initial review showed 30-40 orders/month, or approximately 11% of all nifedipine orders. A newsletter was published outlining Pharmacy and Therapeutics Committee guidelines for the use of nifedipine when rapid onset of action is desired. Further educational efforts involved correspondence with each attending physician responsible for the sublingual nifedipine orders. A reduction in orders for sublingual nifedipine to approximately 10 orders/month (3.9% of total nifedipine orders) was observed after using this educational approach. The reduction in orders has been maintained by frequent contact with the attending physicians. CONCLUSIONS: Repeated educational measures have resulted in a reduction in the inappropriate prescribing of sublingual nifedipine. PMID- 10140715 TI - Semiannual regulatory agenda. PMID- 10140716 TI - A Vermont hospital turns its garbage into gold. PMID- 10140717 TI - What should hospitals do about vacated OSHA PELs (permissible exposure limits)? PMID- 10140718 TI - Structure and adequacy of human service facilities: challenges for nonprofit managers. AB - Findings from a statewide survey of nonprofit human service organizations in Illinois show great diversity in access to and use of facilities. Large proportions have facility-related problems that will require substantial investments beyond the financial capacity of the organizations themselves. The findings also point to major shortcomings in attention to or knowledge about facility-related problems among managers of these organizations. The findings have important policy implications for nonprofit managers, as well as for public and private funders and policy makers. PMID- 10140719 TI - Human service organizations and self-help groups: can they collaborate? PMID- 10140720 TI - Board members' influence on the government-nonprofit relationship. AB - This study examines whether, how, and under what conditions nonprofit boards of directors influence the government and voluntary sector relationship. The survey responses of executive directors and board presidents in a randomly selected sample of 400 nonprofit organizations indicate that boards are not bystanders in the contracting relationship with government. Rather, many boards play multiple roles, simultaneously enhancing interdependence and maintaining the boundary between state government and nonprofits. PMID- 10140721 TI - Cough up that cash. PMID- 10140722 TI - What killed health care reform? PMID- 10140723 TI - Data watch. PPOs gain strength. PMID- 10140724 TI - Private matters ... workers' confidential medical files. PMID- 10140725 TI - A B&H survey. Direct contracting. PMID- 10140726 TI - Will ERISA's wall come tumbling down? PMID- 10140727 TI - Health care reform in the states. A state of flux--Minnesota. PMID- 10140728 TI - A whole new ball game ... guide to Congress's major health-policy players. PMID- 10140729 TI - Employer group proves knowledge is power. PMID- 10140730 TI - Forging local solutions. PMID- 10140731 TI - What about the health of ancillary staff? A management audit. AB - Health at Work in the NHS was launched at the same time as Health of the Nations, in July 1992. There is good national and local evidence identifying ancillary staff as a priority for health promotion. Despite the evidence, and a regional drive to make work with ancillary staff a priority, a recent audit made clear that very little has happened. Market testing seems to have excluded ancillary staff health from senior management responsibility. discusses possible reasons and the implications. PMID- 10140732 TI - Management training for doctors: an in-house approach. AB - Having recognized the importance and inevitability of doctors becoming involved in the management of National Health Service (NHS) Trusts, the Leicester Royal Infirmary NHS Trust initiated its own in-house management development programme for senior medical staff. Describes the programme and identifies some of the benefits already realized and its role in facilitating s shift in the management agenda from managers to doctors. PMID- 10140733 TI - Commissioning and public health. AB - Improving the nation's health is a major challenge. It has a long history within the specialty of public health medicine, with is commitment to knowledge and actions. But achieving a balance between these activities has been a source of considerable tension within the specialty. The commissioning function, with its related dimensions of purchasing and contracting, provides the best chance for decades of aligning public health knowledge with the action that can produce health improvement. The concept of public health management seeks to bridge knowledge and action, drawing on a range of skills. But there is a long way to go before the necessary skills and capacities are demonstrated in practice. The organizational and personal development agenda remains very large. Yet, what is occurring in the NHS has not been achieved anywhere in the world. Describes one practical approach to strategic health development and commissioning. But it will require sustained commitment if it is to succeed. PMID- 10140734 TI - Getting research into practice: facing the issues. AB - The translation of research into practice is currently a high-profile issue in the NHS. A number of regions have undertaken work in this area. Reports on a project that is part of the Anglia and Oxford Regions's "getting Research into Practice" (GRiP) initiative. The work focuses on the use of steroids in pre-term delivery, a procedure that medical evidence suggests can reduce neo-natal mortality and morbidity. Presents a number of findings which suggest that getting research into practice does not merely rest on the availability of well researched evidence. PMID- 10140735 TI - The pre-registration year. It's time for job reprofiling. AB - The pre-registration house officers' year has a dual purpose. On the one hand, there is the basic service requirement for long hours of routine assistance to senior medical staff. On the other hand, there is the educational component of the job as seen in the GMC and post-graduate deans' objectives. Reports on a study which shows there is considerable tension between these two objectives. Examines the extent and nature of this divergence. Suggests that there are two problems to be addressed: how best to generate a sense of ownership and affinity to the trust hospital, and even more fundamental, requires a strategic audit and reappraisal of the purpose of the pre-registration year and strongly suggests the desirability of reprofiling it in order to provide a rich working experience and learning environment. PMID- 10140736 TI - An integrated communication strategy for health service managers. AB - Highlights the importance of communication as a management activity. In particular, examines ways in which internal and external communication strategies can be integrated. To this end, proposes a communication strategy sequence which provides a robust methodology for gathering data and informing decision making regarding communication needs. Details the four key steps in the sequence and provides examples from work done in Northern Ireland. Discusses the principles and practices of data collection and emphasizes the importance of securing the commitment of senior managers. Examines the costs and benefits of introducing comprehensive communication programmes and points out organizational advantages. PMID- 10140737 TI - Sources of health insurance and characteristics of the uninsured: analysis of the March 1994 Current Population Survey. AB - This Issue Brief provides summary data on the insured and uninsured populations in the nation and in each state and is based on EBRI analysis of the March 1994 supplement to the Current Population Survey (CPS). It discusses the way health protection has changed for the insured, how the states rank in health insurance protection, and the characteristics most closely related to whether or not an individual is likely to have health insurance protection. The March 1994 CPS represents 1993 data--the most recent data available. Forty-three percent of nonelderly respondents indicating they were noncitizens were uninsured in 1993, compared with 16.4 percent of citizens. Among all nonelderly uninsured, 15.1 percent were noncitizens. In six states a higher proportion of the total uninsured were noncitizens than in the nation as a whole. These states include California (37.8 percent), New York (26.6 percent), Florida (21.7 percent), New Jersey (20.8 percent), Illinois (19.9 percent), and Texas (17.8 percent). The CPS contained data regarding citizenship for the first time in its March 1994 survey and does not allow for the determination of legal status of noncitizens. Eighty two percent of nonelderly Americans and 99 percent of elderly Americans (aged 65 and over)--or 215.7 million individuals--were covered by either public or private health insurance in 1993. In 1993, 18.1 percent of the nonelderly population--or 40.9 million people--were not covered by health insurance, up from 17.8 percent and 39.8 million in 1992. However, the margin of error in 1993 at the 95 percent confidence level is 0.4 percent and 765 thousand. Thus, the percentage of uninsured in 1993 ranged from 17.7 percent to 18.5 percent, and the number of uninsured ranged from 40.1 million to 41.7 million. Children accounted for the largest proportion of the increase in the number of uninsured between 1992 and 1993. Sixteen percent of all children--or 11.1 million children--were not covered by private health insurance and were either ineligible or did not receive publicly financed medical assistance in 1993, up from 15.1 percent and 10.2 million in 1992. PMID- 10140738 TI - 1995 Market Directory. Health Level Seven vendor and consultant organizational members. PMID- 10140739 TI - 1995 Market Directory. Alphabetical listings/application breakouts. PMID- 10140740 TI - 1995 Market Directory. Industry associations/agencies. PMID- 10140741 TI - Establishing fair profiling systems in a managed care environment. PMID- 10140742 TI - Statistical mapping systems: network access analysis. PMID- 10140743 TI - Managing vendors & care in a changing environment. PMID- 10140744 TI - Building on a key ideal. Linking CHINS to create a national healthcare information infrastructure. PMID- 10140745 TI - Which CHIN ownership model holds the promise for long-term success? PMID- 10140746 TI - Overcoming physician challenges in a changing market. PMID- 10140747 TI - High speed document imaging supports: HMO's rush of new members. AB - Today, Physicians Health Services Inc. (PHS), headquartered in Trumbull, Conn., is one of the nation's largest, publicly-held IPA model HMOs. But in 1977, when it became operational, only four percent of Americans were covered under HMOs, and file cabinets and manual processes were the status quo in healthcare operations. Fortunately for us, PHS has forward thinking directors and executives who saw the value of introducing an image-based operations management system into our organization. PMID- 10140748 TI - Targeting an integrated delivery system at a defined population: a case study. PMID- 10140749 TI - Double vision: uniting the provider/payor communities. PMID- 10140750 TI - Which port in the storm? Can a contract management system alone meet all your managed care requirements? AB - For the past decade, contract management was synonymous with managed care for hospitals. Today, managed care is taking on new meaning, especially as hospital administrators and clinicians begin to think "outside the four walls." To address the increasing demands managed care is placing on hospitals, the vendors of contract management software are adding HMO-like functionality to their systems. The vendors claim their products can confirm eligibility, track referrals, process claims and even calculate capitation, in addition to managing contract administration. How do these enhanced contract management systems differ from managed care information systems used by managed care organizations to perform essentially the same functions? PMID- 10140751 TI - Anticipating & supporting the evolution of an IDS. PMID- 10140753 TI - Kaboom! A comet collides with Jupiter. Could an asteroid wipe out the earth? PMID- 10140752 TI - Confidentiality safeguards for quality assurance systems. PMID- 10140754 TI - Call weighting. Dispatchers can tip you off to potentially violent calls. PMID- 10140755 TI - Adolescent suicide. PMID- 10140756 TI - Suicidal callers: the dispatcher's dilemmas. PMID- 10140757 TI - The Feds do it again. The EMS community grows wary--and weary--of FDA intervention. PMID- 10140758 TI - The straight buzz. Should rescuers take killer bees seriously? PMID- 10140759 TI - New 'security network' ties private security, police via computer. PMID- 10140760 TI - Jack Bologna on fraud auditing and the law. PMID- 10140761 TI - Special report. Violence in hospitals: new facts and approaches to a growing threat. AB - Evidence of increasing violence in hospitals across the United States is both anecdotal and statistical. In this report, we'll review some recent surveys and attempt to pinpoint the nature of such violence, where in the hospital it is most likely to occur, and who commits or is victimized by it. We'll also report on some actual cases of violence and give some advice from hospital security directors on what can be done about it. PMID- 10140762 TI - Tips on reducing parking security risks. PMID- 10140763 TI - Nutrition support pharmacist board certification process. AB - Specialization is the logical outcome of the maturation of the profession of pharmacy, although its acceptance has been controversial. Specialization also meets a need created by the increasing complexity of the medical management of disease. Although the skills of the generalist pharmacist are still much in demand, the specialist pharmacist has the skills and knowledge to meet more in depth, or more focused, patient care needs. The current specialties within pharmacy that are recognized by the Board of Pharmaceutical Specialties (BPS) are nuclear pharmacy, pharmacotherapy, and nutrition support pharmacy practice. Psychiatric pharmacy practice has also been approved by BPS as a specialty, however, the process for attaining certification has not yet been established. This article will describe the process by which pharmacists, whose practice is concentrated in nutrition support, may become recognized as Board Certified Nutrition Support Pharmacists (BCNSPs). PMID- 10140764 TI - Factors associated with noncompliance of patients taking antihypertensive medications. AB - Poor adherence to drug therapy decreases the effectiveness of antihypertensive treatment. Patients must take more than 80% of their antihypertensive drugs to maintain adequate blood pressure control. To understand the incidence of noncompliance and contributing factors, a pilot study was conducted in which a questionnaire was devised and administered to a random sample of 243 hypertensive patients of the adult ambulatory care clinic at Methodist Hospital of Indiana. Ninety-eight patients completed the telephone survey. Demographic data were obtained through chart reviews. The results indicated that 30-46% of the patients were noncompliant with their antihypertensive drug regimens. Factors found to be associated with noncompliance were; employment (P = .0077), use of home remedies (P = .0043), age (P = .0165), experience of side effects (P = .0051), level of concern with missed doses (P = .0043), and cost (P = .014). The incidence of noncompliance in this pilot sample is lower than the estimated 50% noncompliance rate of published data. More research is needed to understand the determinants of noncompliance in order to design interventions to improve compliance. PMID- 10140765 TI - Euthanasia and the healthcare professional. AB - Euthanasia, often called mercy killing, is the act of inducing death often on terminally ill individuals for reasons assumed to be merciful. Euthanasia can be active or passive, and voluntary or involuntary. Voluntary euthanasia indicates the patient's full consent to terminate life, whereas involuntary euthanasia indicates the lack of patient's consent. Active euthanasia means the termination of life using an agent such as a drug, whereas passive euthanasia refers to the withholding a potentially life-prolonging treatment. Euthanatizing agents terminate life through various mechanisms, causing physical damage, direct or indirect tissue hypoxia, depression of the nervous system. Euthanasia is an issue filled with moral and ethical, as well as legal dilemmas that cannot be avoided. As members of the health care team, pharmacists may be asked to provide advice involving some form of euthanasia. PMID- 10140766 TI - Medicaid moving to managed care. PMID- 10140767 TI - Top 10 reasons for not reporting adverse drug reactions. PMID- 10140768 TI - Deathcare: exploring the troubled frontier between medical technology and human mortality. PMID- 10140769 TI - New beginnings in hospice. AB - Healthcare decisionmakers in acute settings might well benefit from lessons learned over two decades of hospice experience providing community-based, cost effective care. Now the hospice concepts of interdisciplinary symptom management and transition counseling are being made available to patients and families long before they reach the traditional six-month prognosis entry point. PMID- 10140770 TI - Reinventing the newborn ICU. PMID- 10140771 TI - Through the patient's eyes. The Planetree experience at Griffin Hospital. PMID- 10140772 TI - Healing environments. PMID- 10140773 TI - Running with the herd: building a business strategy. PMID- 10140774 TI - Rick Scott: icon of greed or leader of true health reform?. Interview by Joe Flower. PMID- 10140775 TI - A sense of loss. Why do people make irrational demands for care and incomprehensible refusals of care? PMID- 10140776 TI - Four-part team: better cleaning, less training and supervision. First of two parts. PMID- 10140777 TI - Hold 'em or fold 'em: negotiation requires more than persuasion. PMID- 10140778 TI - CFC phaseouts: an update on the fate of the earth. PMID- 10140779 TI - Joint maneuvers. PMID- 10140780 TI - What's in a name? PMID- 10140781 TI - Up-front planning helps ensure back-end success for multifacility project. Meridia Hillcrest Hospital Medical Center, OH. PMID- 10140782 TI - New age public won't settle for old-fashioned facilities. PMID- 10140783 TI - Check, please. PMID- 10140784 TI - Fine lines. PMID- 10140785 TI - Well built. PMID- 10140786 TI - Better buildings mean building better. 10 questions for construction managers. PMID- 10140787 TI - Vista Award winners. 94/95. AB - Winners. New construction project totaling more than $3: Valley Medical Center, Community Outpatient Center, Renton, WA. Renovation project totaling more than $3 million: Beth Israel Hospital and Children's Hospital (joint project), Medical Care Center, Lexington, MA. Renovation project totaling less than $3 million: The Birthing Center/Lincoln Institute for Women's Health, John C. Lincoln Hospital & Health Center, Phoenix. Honorable mention. Children's Hospital Medical Center Clinical Facility, Cincinnati. Kaiser Permanente Regional Reference Laboratory, Los Angeles. Takopid Indian Health Center, Tacoma, WA. St. Elizabeth Hospital Replacement Facility, Elizabeth, NJ. PMID- 10140788 TI - Groups question JCAHO's value; look for options to accreditation. PMID- 10140789 TI - Does today's JCAHO wear too many hats? State officials respond. PMID- 10140790 TI - Most surgical packs increase by 0.8%. PMID- 10140791 TI - New EPA emission standards may prove costly to hospitals. PMID- 10140792 TI - Hospitals looking at bottom line and quality care. PMID- 10140793 TI - Limit waste management costs by cutting waste generation. PMID- 10140794 TI - Entering the future of capitation-based provider-supplier partnership. PMID- 10140795 TI - Hospitals in the new world of managed care. PMID- 10140796 TI - Understanding culture: key messages for leadership. AB - It is crucial, in an era of healthcare mergers and acquisitions, that leaders understand organizational culture and the role it plays in major transitions. Research indicates that organizational factors can lead to either the success or failure of a major change. Too many failed mergers testify to the fact that cultures sometimes collide, rather than coalesce. Culture is the human dimension of an organization. Anytime an organization makes a major change, some of its employees will experience the change as chaos. But chaos is not necessarily a bad thing. It can free people from the constraints of the past, enabling them to create new structures. But, for this to happen, leaders must help employees separate essential from peripheral matters and specify their common values and beliefs. Good leaders are vital for change as significant as an acquisition or a merger. They may want to begin with assessments of their respective cultures. They will certainly give employees an opportunity to express their sense of loss. As early in the process as possible, they should create communications mechanisms that involve employees in the change process and share vision and values. And leaders should share themselves, both their strength and vulnerability, so that employees can see change as something all are experiencing together. PMID- 10140797 TI - Culture, chaos, and refounding. How leaders can refound the Catholic health ministry. AB - Culture provides us with what we so desperately need in human life--a set of felt meanings in an orderly pattern. A group creates a culture as a way to cope with life's challenges and teach members the correct way to feel, think, and behave. No group is ever without a culture. If culture has a built-in tendency to resist change, how does change take place at all? The process of change involves separation, chaos, and reentry--the letting go of the old and familiar and the embracing of the uncertain new. The way to use chaos constructively is for people to return to the sacred time of their founding in order to identify, relive, and reown the heart of their creation mythology, liberated from the accidental and historical accretions that hold back creativity. For healthcare workers today, this means reidentifying with Christ's actions such as healing the sick or giving sight to the blind. Through this reidentification, healthcare givers can be fired up to form a new cultural integration adapted to changing needs. The chaos that our healthcare ministry is experiencing today offers us unparalleled opportunities for refounding. By acknowledging the chaos of the healthcare system, we thus lock in on the healing and reconciliatory power of God, and from this comes the energy to journey through the refounding process--the process whereby we struggle to enter collaboratively into the paschal mystery with Christ for his mission of healing; thus energized, we work to challenge systems and to create responses to the most urgent needs confronting the health of the people we serve. PMID- 10140798 TI - Communication eases pains of acquisition. Suburban hospital becomes part of Mercy Healthcare Sacramento. AB - In 1991 American River Hospital, a facility in the suburbs of Sacramento, CA, was bought by Mercy Healthcare Sacramento. At the time, MHS owned three hospitals and a number of outpatient delivery sites. The acquisition fit MHS's strategic plan, which was to develop an integrated delivery system covering the metropolitan area. After completing the purchase, MHS began consolidating the operations of the new Mercy American River Hospital with those of nearby Mercy San Juan Hospital. Consolidation was eased by the fact that the two facilities shared a primary service area, with many physicians serving on the staffs of both hospitals. Though they had been competitors, the hospitals had collaborated on a number of activities. And they shared a common vision of managed care. An employee climate survey conducted in 1993 showed that some American River employees had, before the acquisition, feared being "inappropriately influenced by the Catholic Church." Others saw American River and Mercy San Juan as differing in their patient care and worried that the two styles might not be compatible. Still other American River employees were afraid they would lose their jobs. But the survey revealed that American River employees had seen no major cultural barriers to the acquisition. They had perceived MHS as a values driven organization whose focus was the healing ministry. During the consolidation, a joint MHS-American River communications team held meetings and published newsletters to help employees understand the process. American River employees participated in a formal blessing of the transfer of their hospital's ownership to MHS. PMID- 10140799 TI - Transformation toward teamwork: a methodical approach to change. Three disparate cultures come together. AB - In January 1995, following a 19-month planning process, Fanny Allen Hospital, Medical Center Hospital of Vermont, and the University Health Center formed Fletcher Allen Health Care, a single operating entity. The University of Vermont is linked by contract to the new organization. From the beginning, the organizations' leaders approached the planning process with the human dimension in mind. Although the process was led by top leaders of the four entities, they relied on input from physicians and multidisciplinary teams of professionals. To gain employees' acceptance of the transition by making them feel secure, in December 1993, the organizations announced that no one would involuntarily lose his or her job for the next year. And managers have gained acceptance of the transition planning process by gaining input from employees and making it clear that the plans are not cast in stone. Nevertheless, both leaders and employees face anxiety and discomfort with change. In addition to fears about job security, they fear loss of control, quality, and a feeling of mission fulfillment. Communication has been fundamental to easing the transition. Leaders have delivered the same message to everyone, using a newsletter, employee meetings, management meetings, and a telephone hotline. Leadership education, development, and selection are other critical issues in helping employees adjust to change. PMID- 10140800 TI - Guiding principles for cultural transformation. Eight tips for leaders of change. PMID- 10140801 TI - Self-tests to assess your culture's capacity for transformation. PMID- 10140802 TI - Persistence and pain. Women and healing in the Gospel offer insights to Catholic healthcare providers. AB - Scripture can enlighten us on the difficult times Catholic healthcare providers face today. Two stories from Mark's Gospel offer helpful insights to persons engaged in the institutional context of healing. These stories are of the woman with the "flow of blood" (Mk 5:25-34) and of the Syro-Phoenician woman (Mk 7:24 30). The women were determined to receive the healing they needed. They went for it, and got it, despite considerable obstacles. I suggest five insights we might draw from these two narratives of healing. These women were persistent. Sometimes it takes a great deal of persistence to find God in all the ordinariness, the numbing everydayness we encounter in our daily work. Like these women, the healing you seek for those you care for takes place in a hostile world. Catholic healthcare institutions themselves face some hostility from other institutions. The stories remind us that we must feel our own pain and that of others. The capacity to hurt and to feel the hurt of others helps us persevere in the face of this hostile world. Both women did what others could--and should--have done for them. Each of these women found in herself a place of strength she could draw on. This place of strength is the presence of God. I hope that Catholic healthcare providers are aware of God's presence in them and in those to whom they minister. I hope they work against the "quick-fix" mentality of much of modern healthcare and modern consumerism. Catholic healthcare recognizes the sacramentality of life on earth, struggling always to find the God who is revealed where we least expect her. PMID- 10140803 TI - Organizations collaborate to provide wellness programs to area businesses. PMID- 10140804 TI - Nursing: a human connection. PMID- 10140805 TI - Difficult decisions: weighing treatment costs and benefits. PMID- 10140806 TI - Information technology and the management process. PMID- 10140807 TI - Taking charge of health: an educational intervention for patients and staff. AB - Attitudes about attributing health effects to oneself (internal locus of control on health issues), as opposed to fate, chance, or powerful others, have resulted in improved health behavior and treatment outcome. Although this construct has been researched among patients and self-efficacy has been studied for patients and nurses, changes in internal health control beliefs among staff following specific empowering interactions have not been studied. Psychiatric nursing students at Middlesex Community College took part in one of three types of practicum experiences: a psychoeducation practicum with psychiatric patients utilizing "empowering" learning principles, a traditional psychiatric placement, or a medical-surgical placement. The Achterberg and Lawlis Health Attribution Test was administered to all groups, before and after the clinical placement. The psychoeducation group evidenced a significant rise in internality following the placement; other groups did not experience this change. Specifically, after being involved in an empowering educational experience, the nurses themselves attributed more power to the patient for maintaining good health rather than to doctors and other health staff, or to fate. These nurses saw the patient as more powerful and empowered. Scales that measured attribution of causality to "powerful others" (such as doctors, etc.) or to just "chance" (such as "it was my fate--these things happen"), were stable across administrations of the test. Implications for educational and medical communities were discussed. PMID- 10140808 TI - Preparing a university hospital to meet JCAHO education standards. PMID- 10140809 TI - Occupational and demographic characteristics of the health care educator: a 20 year perspective. AB - This study describes the demographic and occupational patterns of the health care educator in the 1990s. A sample of ASHET members formed the study frame. The data obtained were compared with previous demographic and occupational pattern studies. Trend lines over the past 20 years seem to indicate relative stability in the health care educator's characteristics. Although better educated than in the past, the health care educator tends to be female, middle-aged, working in an acute care urban setting, occupying an administrative rather than instructional role, residing in a department of hospitalwide education and training, and reporting to a vice presidential level. This study also forecasts future patterns for the 21st Century. PMID- 10140810 TI - Managed care 1995. Do any-willing-provider laws really help doctors? PMID- 10140811 TI - Who says house calls are passe? PMID- 10140812 TI - Groups crowd the on ramp for the information superhighway. PMID- 10140813 TI - The managed-care tide keeps rising among groups. PMID- 10140814 TI - Managed care 1995. Managed care: there's no stopping it now. PMID- 10140815 TI - Managed care 1995. The four market stages, and where you fit in. PMID- 10140816 TI - Managed care 1995. Turn capitation into a moneymaker. PMID- 10140818 TI - Managed care 1995. It doesn't pay to shortchange managed-care patients. PMID- 10140817 TI - Managed care 1995. Boost the value of your contracts. PMID- 10140819 TI - Risk-sharing deals aimed at lowering costs of supplies. PMID- 10140820 TI - Managers take reins to cut costs by up to 25%. PMID- 10140821 TI - Managers tell how they made the top 100 hospitals list. PMID- 10140822 TI - New isolation guidelines written to ease confusion. PMID- 10140823 TI - Monitoring and improving receivables with TQM. AB - Total Quality Management (TQM) processes have been effectively implemented in manufacturing, revolutionizing the automotive, electronic, and semiconductor industries. The application of TQM processes in healthcare providers' patient financial services departments can help these departments to improve collections, decrease bad debt write-offs, achieve cost savings, and increase overall efficiency. PMID- 10140824 TI - The Contract's impact on LTC ... balanced budget amendment. PMID- 10140825 TI - The right stuff for subacute ... highest quality pysicians. PMID- 10140826 TI - HUD toasts assisted living ... Section 232 Mortgage Insurance program. PMID- 10140827 TI - Cultivating new business niches. The growth of ancillary services. AB - Shopping for long term care? From pharmacy to hospice to adult day care to medical supplies, our facility can serve all your health care needs. While you're here, don't forget to check out our X-ray department, located next door to psychological services and down the hall from our full-service laboratory. PMID- 10140828 TI - Whole new ballgame--providers prepare for enforcement. PMID- 10140829 TI - Breaking the bottleneck ... HCFA's streamlined RCL exception review process. PMID- 10140830 TI - NLRB charts aggressive course ... supervisory status of charge nurses. PMID- 10140831 TI - Any willing provider: the great debate. Con. PMID- 10140832 TI - Any willing provider: the great debate. Pro. PMID- 10140833 TI - Keeping records (Part II). PMID- 10140835 TI - Senior living, long-term-care loans increase. PMID- 10140834 TI - Setting standards was key ingredient to Lohmar's turnaround. PMID- 10140836 TI - Banks plug into expansion through EDI. PMID- 10140837 TI - Las Vegas: bright lights, big profits. AB - The Las Vegas area is one of the fastest-growing regions in the country, a trend that's helping to keep the market's healthcare providers in the chips. Both the area's for-profit and not-for-profit hospitals are busy developing projects to meet the needs of the surging population. PMID- 10140838 TI - Justice Department settles eight-hospital case in N.Y. PMID- 10140839 TI - HTM 2022 medical gas pipeline systems. AB - The new edition of HTM 2022 was published in April 1994 and supersedes HTM 22 which was last published in 1978. The new HTM was prepared following extensive consultation within the NHS and with contractors, manufacturers and other health care professionals. This article summarises the significant changes and developments which have been incorporated into the new HTM 2022. These developments are operational and technical and have considerable implications for Estates Managers. There are many significant changes in HTM 2022 for example Validation and Verification. It is strongly recommended that all staff who are in any way responsible for the operation of a medical gas pipeline system should attend an appropriate training or updating course. PMID- 10140840 TI - Voltage transients, their effects, and the solution. PMID- 10140841 TI - Scottish Trusts pioneer environmentally-friendly clinical waste disposal system. PMID- 10140842 TI - Remote diagnostics--reality or rhetoric? PMID- 10140843 TI - Reproductive and developmental hazards in the healthcare workplace. PMID- 10140844 TI - Engineers, sprinklers, and the authority having jurisdiction: working together to benefit fire fighters and the public. PMID- 10140845 TI - Motivational theory in the work environment. PMID- 10140846 TI - Effective use of a common problem-solving process as an integral part of TQM. AB - Many organizations implement TQM programmes, but it is estimated that only 25 per cent of them can be classified as successful in terms of delivering the benefits that should be expected from them. Failure to create the conditions through systems and procedures which highlight problems in the organization and provide common approaches to solving them (such as an "in-company" problem-solving process) is often a main reason for such a low success rate. The benefits of successfully implementing the extensive use of a common problem-solving process and adopting a management style at all levels that supports, allows and encourages employees to use it are enormous. The problem-solving process should be an integral part of the TQM initiative and supported by ongoing training and facilitation, and used by management at all levels. PMID- 10140847 TI - Clinical protocols are key to quality health care delivery. AB - The use of clinical protocols allows health care providers to offer appropriate diagnostic treatment and care services to patients, variance reports to purchasers and quality training to clinical staff. Such protocols provide a locally agreed standard to which clinicians and the organization can work and against which they can be audited. By embedding protocols into patients' records and reporting by exception, the use of protocols may help to tackle a raft of other issues successfully such as the reduction in junior doctors' hours, and the facilitation of shared care. It may also bolster the medico-legal robustness of the health care delivered. If the protocols are sufficiently detailed, costing, coding and other resource usage information can flow directly from the clinical records. Such benefits may be maximized by using protocols within the framework of an electronic patient record system. PMID- 10140848 TI - Quality management initiatives in health care: diagnostic imaging and quality management case study. AB - A comparative study of the quality management procedures adopted in six general hospitals in the UK, to examine different approaches to quality management, the extent of involvement of diagnostic imaging departments and the level of multi disciplinary working. PMID- 10140849 TI - Patient satisfaction studies: methodology, management and consumer evaluation. AB - Discusses how consumer evaluation studies of health-care services might be undertaken to provide valid assessments of consumer opinions and priorities, amenable to subsequent, effective management action. To do so, provides an account of the history of patient satisfaction surveys, presents a detailed examination of key examples, and discusses the well-documented strengths and weaknesses of this approach. Draws attention to recent critiques of survey methods and growing interest in qualitative research focusing on the rationale that the latter provides more useful data for managers. Argues that the search for a "best" consumer evaluation method is misplaced since appropriate methods should be determined by research objectives which themselves may vary. Points to existing analyses of relevant research which offer sound methodological guidelines and concludes by offering explicit suggestions for the future conduct of consumer evaluation research. PMID- 10140850 TI - What makes for successful TQM in the NHS? AB - A three-year evaluation of total quality management (TQM) at NHS demonstration sites shows there are clear factors which predict successful implementation of TQM. The intention is to raise awareness at both TQM and non-TQM sites of the need to have a structured, pre-planned approach to TQM, based on a thorough understanding of alternative approaches. PMID- 10140851 TI - Recipe for reform? PMID- 10140852 TI - Lessons learned: a survey of integrated delivery network formation. PMID- 10140853 TI - Integration from the viewpoint of improvement. PMID- 10140854 TI - Ten predictions for integrated system development in 1995. PMID- 10140855 TI - Baptist Hospital of Miami: a head-on collision with payers on the road to integration. Case study. PMID- 10140856 TI - Foundations of integration. Definition: what is an integrated healthcare system? PMID- 10140857 TI - Hospital networks: system building blocks or mirages? PMID- 10140858 TI - The interpersonal relationship in clinical practice. The Barrett-Lennard Relationship Inventory as an assessment instrument. AB - The biomedical model that has long been central to medical practice is gradually being expanded to a broader biopsychosocial model. Relationship-building skills commensurate with the new paradigm need to be understood by educators and taught to medical practitioners. The person-centered, or humanistic, model of psychologist Carl Rogers provides a theoretical approach for the development of effective biopsychosocial relationships. The Barrett-Lennard Relationship Inventory (BLRI) was developed in 1962 as an assessment instrument for the person centered model. In this article, the person-centered model and the use of the BLRI as an assessment instrument of this model are discussed. Current and potential uses of the BLRI are explored. PMID- 10140859 TI - Using a new program evaluation model to chart the outcomes of an educational intervention in residency training. AB - The purpose of this article is to introduce a new outcome-oriented, utilization focused, and practical approach to program evaluation: Charting the Outcomes of Educational and Clinical Approaches (COECA) model. It provides a framework that encourages stakeholders to consider academic dissemination, product development, and implementation as three primary outcomes when evaluating educational and clinical approaches. The model then identifies measurements of the impact of each of these primary outcomes. Finally, it outlines three secondary outcomes that focus on education, clinical service, and administration. As an example, this article discusses the application of the model to an educational intervention in residency training. This intervention has been implemented at two sites. Secondary outcomes include increased competency of residents and a change in responsibilities among health care team members. The COECA model provides an easy to-apply and efficient method for documenting actual progress and determining potential for further development. PMID- 10140860 TI - The precision of practice analysis results in the professions. AB - A practice analysis, in which an appropriate sample of professionals is asked to describe what they do in their practices, is considered an essential part of the content-related validity evidence for licensure and certification tests. This article examines the precision of estimates of the mean frequencies for categories of activities in an activity inventory administered on two occasions about 6 weeks apart. In particular, it explores the variability in estimates of the mean frequencies for categories due to the sampling of respondents, activity statements, and occasions. The results suggest that samples of 200 respondents, about 10 to 20 activity statements per category, and one occasion are adequate for estimating the mean frequency for each category. PMID- 10140861 TI - Using a set-aside to encourage the evaluation of public health service programs. AB - For over 20 years, the secretary of the Department of Health and Human Services (HHS) has had the authority to use up to 1% of the annual Public Health Service (PHS) appropriations for the evaluation of federal health programs. However, recent changes to the Public Health Service Act put not only a ceiling (1%) but also a floor (0.2%) on the funds that the secretary can set aside for evaluation. The changes to the legislation are intended to encourage HHS to dedicate more funds to evaluation, focus the funds set aside for evaluation on studies of PHS program implementation and effectiveness, and regularly report the findings of the evaluations to Congress. These changes respond to concerns raised by the U.S. General Accounting Office in a study of the PHS evaluation set-aside conducted for Congress. PMID- 10140862 TI - A comparison of multiple indicators--observations, supervisor report, and self report as measures of workers' hearing protection use. AB - The purpose of this study was to compare multiple indicators of behavior and identify the most viable measure of blue-collar workers' use of hearing protection. Three measures of use were employed: observations, supervisor report, and self-report. Supervisor report was highly discrepant from both self-report and observed use; self-report and observations were highly correlated, and discrepancies between the two were slight. These results suggest that, for this type of measurement, self-report is an appropriate measure and may be the best choice when time and monetary resources restrict measurement to one indicator. PMID- 10140863 TI - Screening clients for an augmentative and alternative communication clinic: a multitrait-multimethod approach. AB - The aim of Augmentative and Alternative Communication (AAC) services is to support, enhance, or provide alternative methods of communication for individuals who are not independent verbal communicators. However, relatively little evaluative research has been conducted with adult AAC users. The establishment of Freeport Hospital's AAC Clinic for adults included the development of questionnaires to gather information for the selection and provision of services for its clients. The present study addresses the issue reliability and validity of three novel measures contained within the AAC Clinic's Background Information Questionnaire using a multitrait-multimethod (MTMM) design. Results from this evaluation are discussed in terms of clinical application and policy development. PMID- 10140864 TI - The use of cognitive taxonomies in licensure and certification test development: reasonable or customary? AB - This research addressed the functioning of a cognitive taxonomy within the test specifications of a health sciences certification examination. The research investigated whether test items written purposefully to assess the higher order cognitive processes provided evidence of assessing differing levels of cognitive processing. Overall, the results yielded no support for the continuing use of a hierarchical cognitive classification dimension for the test specifications. Implications of the research for test specifications development, test construction, item writing, and score reporting are presented. Limitations and suggestions for future research are provided. PMID- 10140865 TI - Physicians' intention to stay in or leave primary care specialties and variables associated with such intention. AB - A national mail survey of primary care physicians was conducted in 1993 to examine the differences between those who planned to leave and those who planned to stay in primary care disciplines. The physicians who planned to stay in primary care were those who, at the time of choosing primary care specialties, were more influenced by factors such as personal social values, religion, and the presence of a role model prior to medical school. Physicians' race, sex, workload, debt, place where they grew up, family income as a child, and timing when they made the decision to enter primary care disciplines are not associated with their plans to stay in or leave primary care disciplines. Findings indicated that personal social values, religious beliefs, and the presence of a role model prior to medical school not only influenced physicians' choice of primary care, but had a lasting effect on their commitment to such choice. PMID- 10140866 TI - Texas Medical Foundation broadens scope. PMID- 10140867 TI - Enhanced patient data system available to Texas hospitals. PMID- 10140868 TI - Work ethics and CQI. AB - CQI is a management paradigm adopted by many health care organizations. This paradigm can be helpful as health care organizations respond to the ethical demands created by the workplace, particularly respect for empowerment of the worker, shared levels of power, subsidiarity, collegiality, and the production of goods and services that meet the needs of the community served. An analysis of the workplace reveals other ethical questions that require the attention of managers, owners, and trustees. Some of these are not addressed by the CQI paradigm. PMID- 10140869 TI - Employee participation programs in the health care industry: are they unlawful under recent labor rulings? AB - Two recent National Labor Relations Board decisions, Electromation and DuPont, may very well be used to declare many health care organizations' employee empowerment and participation programs (including TQM and CQI groups) in violation of U.S. labor laws. This article provides a detailed explanation of the NLRB's two-part inquiry that will now be used to determine whether a health care institution's employee participation programs are under the NLRB's jurisdiction as a labor organization, and if so, whether the institution is engaged in unlawful employer domination. This article will also provide guidance from the NLRB as to what form of employee participation may be permitted under the National Labor Relations Act. PMID- 10140870 TI - The impact of CQI on human resources management. AB - If CQI is to become a mind-set and not simply a management fad, adjustments need to be made in all aspects of management, especially human resources management. This article will consider the impact of CQI on human resources philosophy and practice in health services organizations. The effects will be illustrated by the experiences of a group of human resources managers and the organizations in which they work. PMID- 10140871 TI - Quality improvement: beyond the institution. AB - This article considers the potential of community-based quality improvement initiatives. Challenges facing managers as they function beyond the institution are presented along with action steps to assure the potential success of quality improvement within the larger community. PMID- 10140872 TI - The patient as the pivot point for quality in health care delivery. AB - Health care enterprises make comprehensive and durable changes in people. This human-centered purpose defines the fundamental nature of quality in health care settings. Traditional perspectives of quality and familiar views of customer satisfaction are inadequate to manage the complex relationships between the health care delivery firm and its patients. Patients play four roles in health care systems that must be reflected when defining and measuring quality in these settings: patient as supplier, patient as product, patient as participant, and patient as recipient. This article presents a conceptual model of quality that incorporates these diverse patient roles. The strategic and managerial implications of the model are also discussed. PMID- 10140873 TI - Assessing the evidence on CQI: is the glass half empty or half full? AB - Review of the literature on CQI/TQM in both health care and non-health care settings reveals some evidence of a positive impact for selected dimensions of CQI/TQM. There is little research, however, that examines CQI/TQM as a holistic integrated approach to quality improvement, nor are there many studies that go beyond single or small sample case studies. Using a conceptual framework involving cultural, technical, strategic, and structural dimensions, a number of barriers to CQI implementation are identified along with suggestions for high priority areas of research. PMID- 10140874 TI - Patients, physicians, and professional knowledge: implications for CQI. AB - As we consider how to improve health care, we must understand the transformation that focuses on the physician's role in health care. A multidisciplinary team is critical for improvement activities-hospital administrators, nurses, and other colleagues. All need to learn new knowledge and leadership skills, but there is a special need to understand underlying issues that will require a transformation in many physicians. This will not be easy--nor should it be. Physicians must continue to achieve the benefits for patients that come from traditional professional knowledge. However, there is an even greater need to understand how physicians can move from the dominance approach of the medical model to a partnership approach inherent in CQI. This article describes lessons learned from our CQI work with physician colleagues over the last several years. First the relationship of professional knowledge to knowledge for improvement is described, and then the individual patient-doctor relationship is reexamined. Next, the implications of knowledge for improvement for the roles of physicians in organized health care systems are considered. PMID- 10140875 TI - Techniques for managing quality. AB - The science of quality management is an eclectic collection of concepts and methods primarily borrowed from other fields. Techniques roughly fall into three categories involving quality improvement, planning, and measurement. Improvement techniques include models to guide team-based efforts, tools for process description, and tools for data analysis. These methods are the most visible artifacts of CQI efforts in health care organizations today. Less widely known, but equally powerful, are the techniques of quality planning. There are models to guide both process design and strategic planning, methods for identifying customer needs, and tools to support these efforts. Finally, while measurement is a traditionally well-developed area in health care, industrial quality management science broadens our outlook about what is important to measure. It also provides the technique of benchmarking, which suggests that we look beyond our own organization when we measure performance. PMID- 10140876 TI - Improving hospital performance: issues in assessing the impact of TQM activities. AB - Despite numerous published reports of the need for TQM activities in health care organizations and their widespread diffusion within the health care industry, whether they make a difference remains an unresolved issue. In this article, we discuss the major reasons why the impacts of TQM should be assessed, what needs to be measured during assessment activities, and significant methodological issues that can confound the evaluation of TQM effects. An audit framework is described that can be used to depict the types of effects that TQM may have on the performance of health care organizations. Assessment guidelines are offered that will hopefully benefit the future efforts of institutional managers and health services researchers in their attempts to determine whether TQM activities do in fact make a significant difference. PMID- 10140877 TI - Continually improving governance. AB - What can governance do to ensure the continual improvement of organizational performance? This article explores this question, with particular emphasis on two central considerations. First, what constitutes good governance? Second, what are the sources of and opportunities for leveraging performance available to governance? We argue that focusing on strategy, evaluating performance, and developing the means to learn are the key venues available to governance for leveraging its own and organizational performance. PMID- 10140878 TI - The role of technology in rising healthcare costs. AB - Historically, science and technology have been considered a means to improve the quality of life and to foster economic growth. Technology applied to healthcare has unquestionably improved the quality of life; however, the economic implications of the use of technology in medicine have created considerable controversy. How much technology is responsible for the total cost of healthcare is not clear because its role in rising costs follows the biases of who is doing the analysis. Only addressing the appropriate use of technology in medicine will result in improved health outcomes and long-term healthcare savings. PMID- 10140879 TI - Automated analog-to-digital conversion of graphical cardiotocographic records. AB - The system described, VISC, has as its aim the acquisition and subsequent digitization of monodimensional cardiotocographic signals. These signals can originate in any type of hospital cardiotocographic register, as well as in a book of uterine activity (UA) or fetal heart rate (FHR) signals. VISC consists of a set of algorithms to identify the fetal heart rate signal, although it can be used with minor corrections to work on any continuous curve. Some of the problems that may arise, such as signal loss and presence of noise, are discussed to illustrate the proposed method. The program is integrated into a wider environment, whose main nucleus is the NST-EXPERT expert system, for the diagnosis of fetal well-being, the recommendation of therapeutical plans and the prognosis of immediate neonatal states. PMID- 10140880 TI - An international strategy in medical equipment maintenance. AB - In many developing countries, the growth in maintenance services has lagged far behind the rate of increase in medical equipment use. Urgent attention to maintenance services is required by district health facilities supporting primary healthcare. To date, most international assistance has been devoted to training technicians who are usually associated with major hospitals. A change of strategy is necessary to place priority on training technicians and on strengthening capabilities to maintain basic, essential medical equipment in district health facilities. Not only would such an approach meet urgent current needs, it would take less time to benefit a larger sector of the population, and it can also facilitate the development of higher maintenance capabilities. The advantages are illustrated by examining an empirical model. This strategy is in full support of the global goal to achieve "Health for All by The Year 2000." PMID- 10140881 TI - Health Services Technology Assessment Research (HSTAR): an introduction. AB - The National Information Center on Health Services Research and Health Care Technology (NICHSR), located at the National Library of Medicine (NLM), mounted a database called Health Services Technology Assessment Research (HSTAR). HSTAR pulls together a number of online resources which cover topics such as clinical practice guidelines, technology assessments, and clinical trials. This article gives a brief overview of the database and some hints for effective searching. PMID- 10140882 TI - Enhancing reference services with the support of your colleagues. AB - The expertise of colleagues and experience gained through professional organizations is an overlooked resource for adding value to reference service. Collegial networks must be nurtured. They deserve the support and investment of the institution. PMID- 10140883 TI - New models for outpatient surgery centers. PMID- 10140884 TI - Benchmarking. Measuring your performance against the leaders. PMID- 10140885 TI - Programs to help prevent TB transmission in the OR. PMID- 10140886 TI - Outpatient services grow; hospitals integrate. PMID- 10140887 TI - Consolidation in Canada forces out managers. PMID- 10140888 TI - Reorganization: 'Looking differently at how we do things.'. PMID- 10140889 TI - The role of the coordinator of care. AB - Regardless of the specific outcome of the current health reform debate in Washington, it is likely that major changes to the health care system are in the offering. These changes, many of which are already in place or imminent in some locations, will have a major impact on the evolving relationships between physicians and hospitals. Most expect that these changes will accelerate the development of integrated health care delivery systems that will compete in the marketplace for a mixture of public and private health insurance dollars. In this system of "managed competition," health care dollars will flow to those systems that can ensure the best clinical outcomes while using the least economic resources. In this scenario, competing collaborative health networks that can manage the continuum of care will be central to the health care delivery system. The economic and political ties between physicians and hospitals will become more closely linked as government and private payers of health care services foster the development of these integrated, value-based health care delivery systems. PMID- 10140890 TI - How can I motivate you to do it my way? AB - Want to motivate others? Establish meaningfulness and value to them of what they are supposed to do for you, and provide the tools they need to do it. Until they see the value to them, and that value outweighs their perceived risks or costs of doing it, you may get motion but you won't get motivated behaviors. Without motivated behaviors, you'll waste a lot of time trying to goad them on toward your goal, which they don't share. What we want is bilateral motivation toward a common goal. If we're smart, we don't want to be the only ones who are motivated, and others just move. PMID- 10140891 TI - Strategically integrating hospital/home care services for improved profitability. AB - Because hospitals and home health agencies have been predominantly separate organizations, coordination of their efforts has not been optimized. However, with the recent proliferation of hospital-based home health agencies, opportunities to integrate these health care service delivery systems have increased. Bethesda Memorial Hospital, Boynton Beach, Fla., is a 362-bed not-for profit community hospital with a Medicare-certified home health agency organized as a department of the hospital. Until recently, the home health agency was generally perceived as a separate entity whose services were distinct from hospital services. Progress toward integration of hospital and home care services was given impetus through collaboration of the home health agency administrator and a newly appointed director of medical affairs who was given the responsibility as medical director of the home health agency. A prime responsibility of the director of medical affairs was to reduce length of stay and hospital costs through appropriate resource management. PMID- 10140892 TI - Strategic alliances. Partnerships with a purpose. AB - During the past few years, health care providers, managed care companies, and insurers around the country have formed a variety of strategic alliances aimed at stemming runaway costs, broadening referral bases, and generally preparing for the formal arrival of health care reform and the mandates it may carry. The list of such ventures is long and creative, and it grows as major changes in the health care delivery and financing system become more imminent. In interviews with physician executives and others whose organizations have undertaken integration efforts, the author explores some of the arrangements that are already in place or under development. PMID- 10140893 TI - Housestaff coverage in a nonteaching community hospital. AB - In August 1992, a project team of senior medical and administrative personnel was formed (Housestaff Coverage Project Team) at the Park Ridge Health System, Rochester, N.Y.. The team was given a mandate to address housestaff coverage, primarily from an economic standpoint. Through total quality management (TQM), the project team sought to develop a house coverage plan that was sustainable, efficient, and effective. A plan was developed that includes three layers of service. A minimum "standard hospital coverage" would be available to all physicians and their patients and cover the basic needs of admission, crisis intervention, and issues of length of stay. A complete level of service would be available under the title of "case management" and would consist of total patient management, under the direction of the attending physician, from admission through discharge. The third level of service available to both "standard" and "case managed" patients would be a "consultative service." The latter would function as a traditional in-house medical service and would bill for its services. Park Ridge Hospital believes it has developed a system of housestaff coverage that is sustainable, efficient, and effective. An evaluation mechanism, primarily addressed at length of stay, will tell if we are correct in this assumption. PMID- 10140894 TI - The single-staff model for bone marrow transplantation. AB - This paper will demonstrate the advantages of pursuing an integrated model of care that utilizes one staff of caregivers in one facility for all phases of patient care from the time of patient evaluation through the time the patient returns to the care of his or her primary physician. We took the opportunity afforded by the development of a new program at the University of Alabama at Birmingham, the Bone Marrow Transplantation (BMT) Program, to reconsider as many variables as possible in an attempt to develop a model of care that would represent the best of all worlds, i.e., high levels of quality of care, quality of life, staff job enrichment, patient convenience, operational efficiency, and cost reduction. PMID- 10140895 TI - A cost containment program targeting home infusion drug therapy. AB - A program was instituted to determine if retrospective, concurrent, and prospective analysis of home infusion therapy cases by a multidisciplinary team comprising clinicians and financial analysts would lead to cost reductions and cost-effective behavioral changes by providers. Actual invoices and prospective price quotes for infusion therapy were reviewed and compared to a database of "usual and customary" prices. The results were presented to providers with the intent of obtaining a reduction in prices for the services rendered or about to be rendered. As a result, $3,265,248 in short-term cost reductions were achieved, and $15,146,789 in long-term cost reductions are projected. Analysis resulted in average cost reductions of $2,247 and $10,424 respectively. Very significant cost reductions can be achieved through the use of a multidisciplinary team and a comprehensive pricing database for home infusion therapy. PMID- 10140896 TI - Managing the new technical employee. AB - We live in an age of information. Almost every element of society is dominated by information and the need for information. No person can expect to thrive in the future unless he or she knows and understands information processing, particularly computerized information processing. The growth of medical informatics in the health care field is a further indication of the pervasiveness of the information age. With this technology, however, comes a new and very different cadre of employees. Physician executives who desire to succeed in this new and changing world will have to understand how these employees are different and how management must change to accommodate them. Marilyn Kennedy begins the understanding process in this column. PMID- 10140897 TI - The importance of data warehouses for physician executives. AB - Soon, most physicians will begin to learn about data warehouses and clinical and financial data about their patients stored in them. What is a data warehouse? Why are we seeing their emergence in health care only now? How does a hospital, or group practice, or health plan acquire or create a data warehouse? Who should be responsible for it, and what sort of training is needed by those in charge of using it for the edification of the sponsoring organization? I'll try to answer these questions in this article. PMID- 10140898 TI - Physician financial relationships in the new regulatory environment. AB - In recent months, physicians have been under scrutiny by the federal government with respect to their financial relationships with both drug manufacturers and home care companies. This heightened scrutiny can be attributed, in part, to the attention that has been placed on health care fraud and abuse in this country as a major cause of rising health care costs. Federal investigators currently are examining physician financial relationships in light of the Medicare/Medicaid antikickback statute to determine whether certain payments made to physicians are intended as inducements to refer patients or to prescribe certain products. "Health Law" is a regular feature of Physician Executive contributed by Epstein Becker & Green. Mark Lutes of the law firm's Washington, D.C., offices serves as column editor. PMID- 10140899 TI - Getting the most benefit from information systems consultants. AB - Consultants are usually well-meaning people who enjoy the variety of organizations and problems they face in their work. Most do not like to get bogged down in fruitless and wasteful consulting engagement any more than managers of health care organizations like to supervise them, but at least the consultants are paid for their time. The health care organization that defines a project poorly, does not know what it wants from consultants, or does not direct consultants will pay the price in increasingly scarce resources squandered. The tips in the following article for managing an information systems consulting engagement apply to most consulting engagements and to the use of other expensive advisers, such as attorneys and engineers. But information systems is a field particularly foreign, and often threatening, to most administrators and physician executives, so the risk of wasting money on unsuccessful consulting engagements is high. PMID- 10140900 TI - Personal trainer, personal coach. AB - The increasing number of fresh faces in the management ranks, many of them with highly polished credentials but little in the way of practical experience in the work-a-day management world, has increased the need for a new consulting professional--the personal coach. There simply aren't enough volunteer mentors to accommodate the growing medical management profession. Whatever the conditions under which this new professional's services are sought, both the individual to be coached and the organization for which the individual works should approach the arrangement with care and planning. The author offers some guidance for making the arrangement pay off. PMID- 10140901 TI - Health care reform. Four variables and a theory: an equation for health care. AB - Writings about health care reform currently appearing in all manner of publications often can confuse, rather than clarify, both problems and solutions. One of the strengths of the study of economics is the ability to summarize complex situations in graphic form, and one of the benefits of management theory is to visualize approaches to problems in a broad and well-organized manner. Three recent articles, when combined, suggest a fresh analysis of the problems demanding health care reform in this nation. They are reviewed here and synthesized into a philosophical view that encourages a more positive approach to solutions for the problems. The first article considers an economic theory with striking applications to health care. The second article suggests one management approach for the future for both for-profit and not-for-profit organizations. The third article takes a fresh approach to competition in health care. This review will discuss the economic theory and then apply the management principles to the problem of health care reform confronting the profession and the nation today. PMID- 10140902 TI - Antitrust limits on acquisitions of physician practices--new threshold suggested. PMID- 10140903 TI - Utilization management in Alberta's new funding environment. AB - Although physicians have the greatest influence on the resource utilization of hospital patients, Canadian hospitals have not been too successful in bringing physicians into the resource planning and decision-making processes. This is because most hospitals have been unable to provide the information needed by physicians to participate in resource management in a meaningful way. With the introduction of a new system in the Canadian Province of Alberta that fundamentally changes the way hospitals are funded, it has become even more important to involve medical staffs in the utilization management process. This article describes the new funding system and highlights some of the ways in which Wetaskiwin Health Care Centre has leveraged information technology to support the utilization management process in this new environment. PMID- 10140904 TI - Getting the most for your consulting dollars. AB - Major changes in the health care financing and delivery system have usually been accompanied by an increase in demand within the health care field for consulting services. The passage of Medicare/Medicaid in 1965 is one example. The passage of the DRG-based prospective pricing system in 1983 is another. Both spawned a substantial amount of work, and income, for consulting firms. Now the health care field is engaged in nearly total transformation as the forces of health care reform at the national level are met with myriad adjustments at the local and regional levels. Managed care, already a byword, is being strengthened by a multitude of so-called integrated system initiatives. It is not easy to survive, and the call is out to consultants to save the day, or at least stave off disaster. In the following four articles, Marilyn Kennedy, a member of the ACPE faculty and a consultant herself, gives some advice on how to make the consulting arrangement successful; three physician executives provide a glimpse at consults that have worked, and some that did not work. PMID- 10140905 TI - Involving vendors in continuous quality improvement efforts. AB - In the hospital environment, vendors supply a wide range of items, from surgical sutures to the latest in high-cost technological equipment. Also, many clinical and support services, such as respiratory therapy, transcription, and computer databanks are now outsourced to commercial vendors. Interaction with such vendors is often less than satisfactory, with prolonged timelines and disruption of an important process that is being computerized. Although hospitals deal with very few vendors in long-term relationships, such as those seen in manufacturing, this should not preclude the formation of a supplier-customer relationship that goes beyond management's interaction with the sales representative in response to a request for proposal. This is especially true when a process improvement team has studied an internal process and defined a key quality characteristic. PMID- 10140906 TI - Merging medical groups. AB - One of the trends of the past 10 years that has marked the way physicians practice medicine is growth in the size and complexity of group practice. The reasons for these changes (better patient coverage, within-the-group referral, a larger financial base, a collegial environment, shared overhead, professional management, and packaged negotiation) are clear and are certainly valid. This trend shows few signs of slowing and may be accelerating. Indeed, most of the proposals for national health care reform seem likely to put larger groups at a competitive advantage. We have developed a highly effective procedure that helps improve the efficiency and the success of the merger process. PMID- 10140907 TI - A positive experience with a consultant. AB - Consulting services would not be the multimillion industry they are if the results were not of value to those using them. Obviously, consulting pays off in some large percentage of cases. But it does not happen automatically, and the consultant used is less important in the process than the advance work that is done by the client in establishing the conditions under which the consultation will take place. In the following example, preplanning led to a result that was immensely satisfying to all involved. PMID- 10140908 TI - In pursuit of physician/organization linkage. AB - A friend of mine once said that medical staff/administrative relationships are the Bermuda Triangle of health care management. The Bermuda Triangle, as I recall it, is an area of the Atlantic Ocean into which ships and planes disappear without a trace, for no apparent reason. Sometimes, especially late at night on reruns of "Twilight Zone," these planes reappear years later, crew intact and youthful. Sometimes, salt and sharks get the ships, planes, and voyagers. In a like manner, problems in medical staff/administrative relations draw consultants into a vortex. Sometimes, the consultants and their reports float to the surface a long afterward. Sometimes, they are digested by the organization and become a part of its mythology. Sometimes, they vanish forever. This is the story of three consultations. All were intended to make recommendations concerning the structural relationship of management to the physicians and their groups in our HMO: How to link the physician organization to the corporate structure. Like any narrative, this story is constructed to provide a context for reflection and is not intended to question the value of the contribution of specific individuals or companies. PMID- 10140909 TI - Don't ask the question if you don't want to know the answer. AB - Consultants can and do play many different roles for the client that hires them. In many cases, it is not as simple as it may appear in terms of laying out the problem and then letting the consultant you have contracted with either solve it for you or present you with options from which to pick the best solution. The retaining of outside expertise is usually done for one or more of the following reasons (by no means inclusive): Lack of "in-house" manpower or time to deliver a product. The need for an external expert to bring credibility to the project;. Getting someone outside your organization to deliver unpopular or bad news. Genuine interest in the independent findings and recommendations of the consultant. Whatever the motivation for seeking the advise of outside counsel, be sure you are prepared for the answer they may give to the question you have asked. PMID- 10140910 TI - Technology alert: a new look at instrument sterilization. PMID- 10140911 TI - Quality improvement in the operating room. The University of Chicago Hospitals' experience. PMID- 10140912 TI - A dramatic approach to healthcare ethics committee education. PMID- 10140913 TI - [Ethics Consultants' Recommendations for Life-prolonging Treatment of Patients in a Persistent Vegetative State. Fox E, Stocking C. JAMA 1993; 270(21):2578-2582]. PMID- 10140914 TI - Case series. Case #2: What to do when the patient's goals are non-medical. Response of the Bioethics Committee, St. John's Hospital and Health Center, Santa Monica, California. PMID- 10140915 TI - Case series. Case #2: What to do when the patient's goals are non-medical? Clinical ethics consultants' response. PMID- 10140916 TI - CPR alert: Ten steps to end the great paper chase. PMID- 10140917 TI - Explosive growth in CPRs: evaluation criteria needed. PMID- 10140918 TI - Case study. Networking to face the challenges of a managed care environment ... St. Luke's-Roosevelt Hospital Center. PMID- 10140919 TI - Hardware vendors discuss plans for the year ahead. PMID- 10140920 TI - The CIO of the integrated care delivery system. PMID- 10140921 TI - From beta site to hospitalwide clinical pathways. PMID- 10140922 TI - Data repositories: turning the tides of change. PMID- 10140923 TI - A clinical look at critical pathways. PMID- 10140924 TI - Taking the materials management challenge. PMID- 10140926 TI - Reengineering information systems with the customer in mind. PMID- 10140925 TI - America's most computer advanced healthcare facilities. AB - Healthcare Informatics polled industry experts for nominations for this listing of "America's Most Computer Advanced Healthcare Organizations." Survey responses from organizations nominated were reviewed by Ronald L. Johnson, founder and president of R.L. Johnson & Associates, Danville, Calif. The results of his evaluations follow. PMID- 10140927 TI - The big picture: scheduling for a competitive advantage. PMID- 10140928 TI - Enterprisewide scheduling: technology for the waning millennia. PMID- 10140929 TI - Building the electronic information warehouse. Interview by Bill Childs. PMID- 10140930 TI - CIOs in healthcare: evolving roles & goals. PMID- 10140931 TI - How to: implement a winning system. PMID- 10140932 TI - They're coming to America. PMID- 10140933 TI - An alternative to "quick-fix" systems integration solutions. PMID- 10140934 TI - Automated time & attendance: keeping pace with growth. PMID- 10140935 TI - Preparing for the future of patient cards. PMID- 10140936 TI - Using artificial intelligence to predict myocardial infarction. PMID- 10140937 TI - Artificial intelligence--the solution for scanned patient records. PMID- 10140938 TI - '95 LIS Review: 9th Annual State-of-the-Lab. PMID- 10140940 TI - Making your laboratory information system work. PMID- 10140939 TI - Positioning the lab for managed care. PMID- 10140941 TI - CIO forum: convincing the docs to use IT. PMID- 10140942 TI - Technology watch: wireless LANs. PMID- 10140943 TI - Barcode is better, bar none. PMID- 10140944 TI - Implementing one HIS: meeting the requirements of four hospitals. PMID- 10140945 TI - Health manpower management--rural India. PMID- 10140946 TI - A comprehensive review of medicolegal procedures in service hospitals. AB - Medicologal service is one of the vital component of hospital services which helps in providing justice to the victim and strengthen the public relations. Any shortcomings in the form of disrespect, negligence and inadvertant delay on the part of hospital staff towards the patient masks the image of the hospital. Some events such as expert evidence, methods of proff, assesment of disability, the work of the medical examiner, Blood groupings, organ transplantation and effectiveness of other tests have great practical importance in providing justice. Steps to deal with medicologal cases effectively and minimising legal complications are enumerated. PMID- 10140947 TI - The role of counselling in hospital administration. PMID- 10140948 TI - Planning and organisation of AIDS unit in hospital. PMID- 10140949 TI - Quality circles--a revolution in the health sector. PMID- 10140950 TI - Resource mobilisation in hospitals--a view point. PMID- 10140951 TI - Medical informatics--an overview. PMID- 10140952 TI - Reaching out. Hospitals and their employees go the extra mile to help those in need. PMID- 10140953 TI - Filling the gaps. Mid-level practitioners try to find a niche. PMID- 10140954 TI - Working MTs count! PMID- 10140955 TI - MTs make magic happen. PMID- 10140956 TI - IMPACT CARE: a quality assessment tool that works. AB - IMPACT CARE is the Morton Plant Mease Health Care's internally developed quality measurement tool designed to implement an integrated quality assessment/quality improvement system. IMPACT CARE enables work groups to measure all aspects of performance from a total quality management (TQM) perspective and at the same time meet Joint Commission requirements. The IMPACT CARE format works equally well for the medical staff and for clinical and nonclinical departments throughout the health system. This article relates process improvements that have been made at Morton Plant Mease Health Care since 1992 as a result of using IMPACT CARE. PMID- 10140957 TI - Creative discharge planning using the electronic medical record. AB - A multidisciplinary continuous quality improvement (CQI) team at the authors' facility was commissioned and empowered to study and improve communication among the disciplines involved in discharge planning. CQI methods and tools were applied to analyze the process and determine the improvement. The authors of this article describe the use of a customized electronic medical record system to deliver accurate, rapid technology (DART) at their facility. DART was programmed to improve communication among the disciplines by assisting with the referral process. In addition, users are systematically prompted throughout the discharge process to ensure that all aspects are considered and documented. PMID- 10140958 TI - The quality professional's expanding role as internal consultant: practical tips and survival strategies--Part I. AB - Expertise in quality and process improvement is becoming widely recognized as a valuable resource. The more objective viewpoint and experience of consulting firms or outside professionals in quality and change management often is critical to the success of organization-wide quality or change implementation. Outside consultants, however, are not inexpensive. It is predictable that there will be an increasing tendency for healthcare systems to look internally for organizational and quality expertise. Part one of this article discusses the approach and skills needed to gain a clearly defined and agreed-upon direction for the consulting mission. The importance of mental preparation and flexibility is discussed. Ethical dilemmas are a core challenge, and a number of real-life scenarios and associated strategies are presented. PMID- 10140959 TI - Oregon's "death with dignity" law in limbo. PMID- 10140960 TI - Identifying nursing outcome indicators. AB - Patient outcomes...indicators..measurement. What do these concepts mean to you? More importantly, what do they mean to our customers, the patients? The department of nursing at the University of Maryland Medical System (UMMS) embarked on a 6-month initiative to begin to identify the major outcome indicators of nursing practice. This article will discuss the outcome indicator project from its inception to the identification of the actual outcome indicators. The rationale for undertaking this project and the process of selecting the indicators also will be addressed. PMID- 10140961 TI - Re-engineering to meet client needs. PMID- 10140962 TI - Home-use medical devices: a need for consumer education. AB - The trend toward home care, the increase in personal health consciousness, and the availability of over-the-counter medical devices--all have prompted a need for consumer education about the safe and appropriate use of medical devices. Citing three specific studies supporting the need for such education, the author offers a challenging opportunity to health organizations that might undertake to publish educational booklets imparting essential knowledge about home-use medical devices to consumers. PMID- 10140963 TI - A capital planning model for health care organizations. AB - Limited capital funds in health care organizations have lead to aggressive capital acquisition campaigns. This article presents a model for a systematic, comprehensive capital planning process. The model, based on a review of the literature on capital budgeting, includes detailed recommendations on how to structure an effective capital planning process. PMID- 10140964 TI - Motivating your staff. PMID- 10140965 TI - Sustainable health care for Canada. AB - Sustainable Health Care For Canada is a synthesis of the research findings of the Cost-Effectiveness of the Canadian Health Care System Project initiated by the Economic Council of Canada. Upon the council's closing, the team moved to become part of the Queen's-University of Ottawa Economic Projects to complete the research. During the project, 18 working papers were produced, in addition to the research report and the synthesis report. In this article, the authors provide an overview of this large-scale research program and highlight some of its key findings. PMID- 10140966 TI - Economists can help control health costs. PMID- 10140967 TI - The class of '95: three students share their hopes and fears on entering a precarious job market. Interview by Matthew D. Pavelich. PMID- 10140968 TI - Drug utilization: a regional approach. AB - A two-year Hospital Incentive Fund grant facilitated activities to improve drug utilization through a regional drug utilization evaluation involving 21 Ontario hospitals. While reporting on the development of a regional drug evaluation process, the authors identify areas where drug use, patient outcome and cost efficiency could be improved, and discuss the issues to be considered when developing such a process. PMID- 10140969 TI - The information corridor: electronic charting in health care. PMID- 10140970 TI - A network for children's health. AB - This article explains how a new network of children's health services is evolving in Edmonton within existing hospital facilities. When plans for a free-standing children's hospital for northern Alberta did not prove economically feasible, an alternative was needed that would allow child health needs to be met more effectively within the existing system. The Children's Health Centre of Northern Alberta is the result. Its multidisciplinary, multisite, program-based nature has guided planning and operations from the beginning and has led to its unique strategic organization structure. PMID- 10140971 TI - Special report. A comparison of eight HHS-approved state Medicaid managed care 1115 waivers. PMID- 10140972 TI - Air medical response for illness revisited. AB - INTRODUCTION: A previous study (1988-1990) suggested that the majority of air medical scene transports for illness in the Columbus, Ohio, service area were inappropriate. The current study followed an aggressive prehospital educational program (1991-1993) that continued during the study. The question asked: Did this educational program make a difference? METHODS: A descriptive, retrospective review of all patients transported from the scene of illness to tertiary care by air. SETTING: A single air medical transport service with a rural service area encompassing most of central and southeastern Ohio. RESULTS: In the 27 months ending September 1993, there were 3,669 completed missions and 1,039 scene missions. Twenty-seven patients transported for illness included 11 males and 16 females, with an average age of 22.3 years. Significant differences between 1988 90 and 1991-93 included: Number--10% vs. 2.6% (2,414 vs. 3,669), diagnosis arrest -29.4% vs. 3.7%, diagnosis seizure--14.7% vs. 48.1%, tertiary care needed--20.6% vs. 70.4%, helicopter needed--0.0% vs. 29.6%. Total mission volume increased (2,414 vs. 3,669) while the percent scene total volume remained constant (28.3%). CONCLUSION: An aggressive educational program led to a significant decrease in inappropriate helicopter use in the service area studied. PMID- 10140973 TI - Determining the National Flight Nurses Association's research priorities. AB - INTRODUCTION: Increased federal attention to nursing research has prompted professional nursing organizations to develop research programs identifying areas of scientific knowledge most needed for professional and clinical practice. The study purpose was to identify the National Flight Nurses Association's (NFNA's) research priorities. METHODS: A two-round Delphi technique was used, with systematic surveys in Round I mailed to 500 NFNA members. Responses from 127 members were coded to form the Round II survey that was completed by members at the NFNA meeting in St. Louis in October 1993. RESULTS: According to frequency scores, issues of highest priority relate to specialty and nonspecialty team, crew configurations, clinical indications for transport, airway management, educational preparation and continuing education. CONCLUSION: Identified priorities support development of research studies and programs that lead to increased knowledge, facilitate collaborative studies and also provide a basis for research funding. PMID- 10140974 TI - Influence of the helicopter environment on patient care capabilities: flight crew perceptions. AB - INTRODUCTION: Flight crew perceptions of the effect of the rotary-wing environment on patient-care capabilities have not been subject to statistical analysis. We hypothesized that flight crew members perceived significant difficulties in performing patient-care tasks during air medical transport. METHODS: A survey was distributed to a convenience sample of flight crew members from 20 flight programs. Respondents were asked to compare the difficulty of performing patient-care tasks in rotary-wing and standard (emergency department or intensive care unit) settings. Demographic data collected on respondents included years of flight experience, flights per month, crew duty position and primary aircraft in which the respondent worked. Statistical analysis was performed as appropriate using Student's t-test, type III sum of squares, and analysis of variance. Alpha was defined as p < 0.05. RESULTS: Fifty-five percent of programs (90 individuals) responded. All tasks were significantly rated more difficult in the rotary-wing environment. Ratings were not significantly correlated with flight experience, duty position, flights per month or aircraft used. CONCLUSIONS: We conclude that the performance of patient-care tasks are perceived by air medical flight crew to be significantly more difficult during rotary-wing air medical transport than in hospital settings. PMID- 10140975 TI - Use of composite material to reduce equipment weight during neonatal transport. PMID- 10140976 TI - Flight crew physical fitness: a baseline analysis. AB - INTRODUCTION: The purpose of this pilot study was to determine whether flight crew personnel are physically fit in comparison to published standards for the average American adult. SETTING: The study group consisted of pilots, paramedics and nurses in two similarly configured and geographically located rotor-wing air medical transport programs. METHODS: A physical fitness assessment of flight crew members was conducted. The results were compared with published standards for average adult males and females (AVG). Percentage of fat in body composition (FM%), aerobic fitness (VO2MAX), muscular endurance (ME), muscular strength (MS) and flexibility (FL) measurements were obtained using accepted testing methods. RESULTS: The study population consisted of 29 male and 21 female individuals. The following were their mean scores. Males averaged: pFAT = 19% (AVG = 20.0%); VO2MAX = 41.0 (AVG = 42.5); ME = 37.0 (AVG = 28.5); MS = 125.0 (AVG = 86.5); FL = 5.2 (AVG = 1.4); Females averaged: pFAT = 28.0% (AVG = 26.5%); VO2MAX (AVG = 34.0); ME = 27.0 (AVG = 21.0); MS = 83.0 (AVG = 76.5); FL = 4.5 (AVG = 3.4). CONCLUSION: These baseline data suggest the study population of air medical flight crew was physically fit compared to the average American adult. PMID- 10140977 TI - Basics of research (Part I): Why conduct clinical research and how to get started? PMID- 10140978 TI - Fostering staff ownership of cardiovascular program improvement. Part one: Standardizing care. AB - This is the first of a two-part series discussing the role that hospital staff play in improving a heart program's ability to compete in the changing heart services market. It examines the need to provide staff with information about larger, external changes so that there is a basis for understanding why change must occur within the program. Specifically, this first part addresses the role that staff can play in a key competitive strategy: standardization of care. Part Two will outline the importance of providing staff with information and feedback on the impact of their efforts to manage costs and quality. PMID- 10140979 TI - A valuable cost-saving initiative in the catheterization laboratory. PMID- 10140980 TI - The development of case management in cardiac services: creating change for future survival. PMID- 10140981 TI - Evaluating digital archive system performance: looking beyond the jargon. PMID- 10140982 TI - ACC (American College of Cardiology) president discusses healthcare reform. Interview by Ronald M. Schwartz. PMID- 10140983 TI - Creating an integrated health care system as a basis for managed care excellence: a health plan's perspective. AB - Environmental factors and sentiments of leaders within health care organizations are stimulating the rapid evolution toward integrated health care systems. This article outlines the strategic considerations that led to the development of an organization spanning health care delivery, financing, and administration. The perspective is that of Medica, a successful health maintenance organization (HMO) operating in the mature and very competitive Minneapolis/St. Paul marketplace. Traditional approaches to managing care as a third-party intermediary were deemed unlikely to support future success and the next level of performance in meeting community needs. Key considerations, critical success factors, and a variety of unanswered questions are discussed. PMID- 10140984 TI - Identifying and strengthening core values. AB - An organization that identifies and behaves in alignment with a set of core values that are widely shaped by its employees and derived from its history can build a deep sense of community. Consequences of deep community are greater levels of trust and organizational commitment that can, in turn, be harnessed to help the organization more successfully adapt to and cope with future challenges. However, to be successful, an organization needs to go beyond mere espousal of core values and make a sustained and systematic effort to take practical steps to strengthen both the core values and the behaviors that generally flow from them. PMID- 10140985 TI - Health status of populations as a measure of health system performance. AB - This article describes the assessment of self-reported health status as one indicator of the performance of health care delivery systems. This work took place in the context of a larger effort to measure performance in health care. The Consortium Research on Indicators of System Performance (CRISP) project is developing measures of the performance of integrated health care systems, rather than plans or providers. The system focus leads to measurement of the health status of defined populations and an analysis of health care episodes and processes extending beyond the physician's office or hospital that relate directly to patient outcomes and satisfaction. This focus provides opportunities for application of performance measures to quality improvement efforts, since outcomes can be logically linked to identifiable and measurable processes. After a discussion of the purpose and the history of CRISP and how populations were defined within the systems, some preliminary data on the health status of populations are presented. PMID- 10140986 TI - Managed care and the provision of hospice care. PMID- 10140987 TI - Home care can lead the way in health cost control. PMID- 10140988 TI - Open-ended options in Medicare risk contracts with HMOs. AB - The open-ended option has achieved broad acceptance in the health maintenance organization (HMO) industry. Permitting HMOs that enter into risk contracts with Medicare to offer open-ended products would expand the number of managed care options available to Medicare beneficiaries. The attractiveness of this option to HMOs depends in part on how issues are addressed relating to tracking and managing of out-of-plan use, education of Medicare beneficiaries, interface with peer review organizations (PROs), payment of nonnetwork providers, and use of medical screening. Perhaps most importantly, changes in the Medicare supplementary insurance market probably would be necessary before an open-ended product would be offered by HMOs under Medicare risk contracts. PMID- 10140989 TI - Contracting for outpatient surgical services. AB - This article provides a review of factors that influence a managed care entity's choice of a provider of outpatient surgical services. In reviewing issues, this article also provides practical guidance to the outpatient surgery center with respect to the pricing and marketing of its services. Finally, the article provides an overview of both business and legal issues relating to managed care contracting choices. PMID- 10140990 TI - An analysis of outpatient psychotherapy: quality improvement indicators. AB - Two studies investigated relationships among quality improvement indicators in a large outpatient mental health delivery system. Results showed patient satisfaction with treatment, good agreement between treatment outcome ratings by patients and therapists, modest agreement between patient satisfaction and problem resolution ratings, and a significant relationship between peer reviewer ratings of therapists and client satisfaction ratings. Although reflecting significant improvement, GAF ratings were not related to clients' or therapists' ratings of problem resolution. Overall, the studies support the use of these ratings in quality improvement programs and suggest directions for further research. PMID- 10140991 TI - Purchasing coalitions and managed care. AB - This article analyzes the role of managed care plans in purchasing coalitions. It examines the California Public Employees Retirement System (CalPERS) and three employer coalitions in Central Florida, Colorado, and Memphis. These organizations appear to successfully demonstrate the advantages of many features of managed competition and managed care. They report significant cost savings, reductions in the use of unnecessary services, and improvements in quality. This article describes the types of managed care plans used by these coalitions and their arrangements with Medicare managed care. PMID- 10140992 TI - Out of the line of fire. PMID- 10140993 TI - Measuring the quality of health care. AB - This Issue Brief examines some of the issues involved in defining and measuring the quality of health care and in implementing quality measures. It discusses the importance of measures of health care quality in the evolving health care delivery system, examines some of the conceptual issues involved in defining quality of care, and discusses some of the measures of health care quality and how these measures have been implemented in the health care delivery system. The major impetus for quality assurance programs is cost management: it is an attempt to allocate scarce health care resources efficiently. This requires making choices among alternatives, which may mean that maximizing quality of care for whole populations may not maximize the quality of care for individuals. Quality, in terms of any single good or service, has a number of dimensions. Health care is a complex bundle of services, and each component service within an episode of care affects the other components and the patients differently. Moreover, patients differ in numerous ways, which means that similar symptoms may require different services if care is to be effective. Measuring quality of health care services requires accounting for all of these factors. In attempting to manage health care costs, employers and other private health plans have begun to employ process measures of quality, i.e., evaluating caregivers' activities, the decisions made at each step in an episode of illness, and the appropriateness of the care provided. Process is an important component of quality measures because it focuses directly on the uncertainty in the efficacy of treatment. Given this uncertainty, the logic of medical decision making is an important determinant of quality and cost effectiveness. Examining the process of care involves assembling a panel of physicians who review medical records to determine the appropriateness of the care received. Providers have increasingly found that their medical decision making and practice styles are being monitored by purchasers as new health care delivery systems are being formed. The American Medical Association found that 39 percent of surveyed physicians were subject to clinical profiling. PMID- 10140994 TI - The great philosophy of science war. PMID- 10140995 TI - Rich, relevant, and rigorous: do qualitative methods measure up? PMID- 10140996 TI - Pursuing knowledge through qualitative research. PMID- 10140997 TI - The strategy of grounded theory: possibilities and problems. PMID- 10140998 TI - Less marketing and more scholarship. PMID- 10140999 TI - Policy research and the voices of women. PMID- 10141000 TI - Applications of qualitative research: let the work begin. PMID- 10141001 TI - Mediation and moderation in social work research. PMID- 10141002 TI - When an irresistible epistemology meets an immovable ontology. PMID- 10141003 TI - GHS (Graduate Health System) links regional network of care. AB - Philadelphia-based Graduate Health System is implementing technology that will ultimately change the way physicians practice medicine, according to Harold Cramer, chairman and chief executive officer of GHS. The new technology centers around an electronic medical record, consensus protocols, outcomes measurement and electronic medical library resources. PMID- 10141004 TI - HCI shows I/T commitment from the ground up. AB - Physicians now have extraordinary access to patient information at HCI's Medical Centre in Clydebank, Scotland. The boundaries for such access are international in intent and design. Opened last June, the center's commitment to electronic medical records is now paying off. PMID- 10141005 TI - National Health Service's I/S network takes shape. PMID- 10141006 TI - Telecommunications role evolves beyond mere utility. AB - A more regionalized healthcare delivery system has expanded the role of the telecommunications department. Applications such as teleradiology and telemedicine are making increasingly sophisticated demands on communications systems and their managers. PMID- 10141007 TI - HotList. Enterprise integration products and services. PMID- 10141008 TI - Ring in the changes and manage the transitions. PMID- 10141009 TI - The National Health Data Dictionary. PMID- 10141010 TI - America's health care reforms. AB - President Bill Clinton is currently proposing the most sweeping changes to American social policy since the New Deal by Roosevelt in the 1930s. Major concerns about escalating health care costs, a mushrooming health care bureaucracy and a growing proportion of the American population who can no longer afford adequate health care insurance coverage have motivated Clinton's plan for health care reform. Ideas about telemedicine, the electronic medical record and more comprehensive and advanced information systems are already being canvassed during the course of the debate. Australian clinicians and policy makers are following the American debate closely. So too, should health information managers. America watching should prove interesting, stimulating and professionally rewarding. PMID- 10141011 TI - A study using working DRGs to examine variations in length of stay. AB - The results of a working DRG utilisation review study conducted at St Vincent's Hospital, Sydney in 1992 are described. The project aimed to allocate a working DRG to Cardiology and Orthopaedic patients. Working DRGs are defined as DRGs allocated on admission based on the presenting problem or provisional diagnosis. Patients were then concurrently reviewed until discharge. Actual length of stay (LOS) of patients was compared to the LOS predicted by the working DRG. Results indicated that a utilisation review program using a working DRG can predict a LOS reasonably well for large groups of patients but not for individual patients and that St Vincent's is a comparatively efficient provider of Cardiology and Orthopaedic Services. The paper describes the study design, methods and results. Medical Record Managers played an integral role in the preparation phase, design of the study, day to day coordination and analysis of results. Medical Record Managers' participation in the study is highlighted in this paper. PMID- 10141012 TI - Health workforce planning: an analysis of employer demand pertaining to the Victorian medical record administration & diagnostic coding workforces. AB - In 1990, LaTrobe University introduced the world's first Post-Graduate Diploma in Nosology, in response to unmet demand for diagnostic coders in Victoria. After the first graduates entered employment, a two-part study was undertaken. The composition, employment levels and projected institutional demand for the coding workforce (comprising medical record administrator coders, Nosologists and "unqualified" coders) were ascertained. In parallel, the current employment levels and projected demand for the institutional medical record administrator workforce also were investigated. The institutional variables of major health care role, annual inpatient discharges and operating sector were found to impact upon employment levels and demand for both workforces by current, prospective and non-employers. The study identified a minimal projected demand for nosologists, the reasons for which are postulated, and negligible projected demand for nonqualified coding personnel. The results highlight a health current and projected employer demand for both medical record administrators and medical record administrator coders. PMID- 10141013 TI - The Uniform Data Set for Medical Rehabilitation: the role of the health information manager. AB - The Uniform Data Set for Medical Rehabilitation (UDS) can be used to measure the effectiveness of rehabilitation programs. This article outlines potential applications of the UDS and the role of the health information manager (HIM) in managing data collection. HIMs can assist in the design of data collection systems which will provide data which are of high quality. The HIM can also assist in the production and interpretation of reports. PMID- 10141014 TI - The Establishment Committee of the National Coding Centre. PMID- 10141015 TI - Coding of medical records on the day after discharge. PMID- 10141016 TI - Plugging a big drain on Medicaid. PMID- 10141017 TI - Culture shock and synergy. Academic/managed care/corporate alliances in outcomes management. AB - The Behavioral Health Outcomes Study is a partnership in conducting outcomes measurement involving a corporate healthcare purchaser, five managed behavioral healthcare organizations and academic researchers. The goals of this study are to: evaluate the feasibility of incorporating patient self-reported data in outcomes research; identify factors that may be predictors of outcome; and evaluate the effectiveness of an employee-sponsored aftercare program. The differing perspectives and needs of the three partners have created a number of challenges in the areas of goals, confidentiality, proprietary vs. open access issues and methodology. However, after the study's first year, it is clear not only that outcomes research can be conducted under such a partnership, but that the partnership generates a kind of synergy in problem-solving. PMID- 10141018 TI - Outcomes, clinical models and the redesign of behavioral healthcare. AB - Outcomes measurement and data-triggered improvements in treatment delivery are formidable challenges, in part because of their inherent interdependence. Outcomes systems need to provide reliable, valid and comparable data that can also guide transitions in care delivery. While there is much empirical support for the efficacy of psychiatric and behavioral healthcare interventions, it is incumbent upon those who know both the literature and clinical practice to participate in setting the future course of behavioral healthcare by stirring together the seemingly immiscible aims of good business and good care. This paper briefly reviews the importance of outcomes measurement systems and their use in redesigning treatment delivery in behavioral healthcare. It then describes a clinical care model now being implemented at Park Nicollet Medical Center, incorporating clinical and operational considerations, clinical outcomes measures and algorithms or decision trees into a framework for redesigning treatment and improving the delivery of appropriate clinical care. PMID- 10141019 TI - The "psychology" of technology. PMID- 10141020 TI - Dialogue: treatment guidelines: what are the risks? Risks are outweighed by the benefits. PMID- 10141021 TI - Dialogue: treatment guidelines: what are the risks? Finding a balance between quality and marketplace realities. PMID- 10141022 TI - Dialogue: treatment guidelines: what are the risks? Provider involvement is critical. PMID- 10141023 TI - Shifting to a new paradigm to measure clinical outcomes. AB - Most clinical outcomes monitoring systems have relied on paper- and pencil-driven forms and/or interviews to collect information. The following article outlines some methodological and logistical problems inherent in these approaches, as well as describing the implementation of a ground-breaking new effort in how outcomes data are collected and analyzed. This computer-assisted interview approach can be less costly, provide more accurate information, allow for a broader range of questions to be addressed and even lead to a new paradigm for outcomes management programs--one that is practical in real-world settings and offers clinicians instant norms. Decision-makers in behavioral healthcare organizations can use the principles described here to develop systems tailored to their organizations' specific needs. PMID- 10141024 TI - Legal implications of practice guidelines and outcomes management. PMID- 10141025 TI - Why focus on outcomes data? PMID- 10141026 TI - Data collection and practice parameters: crucial reform components. PMID- 10141027 TI - Outcomes: healthcare reform implications. PMID- 10141028 TI - Movement on reform: implications for outcomes/guidelines. PMID- 10141029 TI - The future of outcomes research in mental health. PMID- 10141030 TI - Integrating outcomes, quality and utilization data for profiling behavioral health providers. AB - Profiling the performance of mental health providers can be done on the basis of performance indicators derived from outcomes research, quality assurance and utilization review. By focusing on collaboration and data-driven accountability, the authors have attempted to use provider profiling to rebalance the relationship between payor, provider and managed care organization, while avoiding the perception of a punitive grading system. Outcomes data thus are directly tied into provider profiling, in addition to their more customary uses in assessing and improving the quality of treatment results. PMID- 10141031 TI - Quality indicators for partial hospitalization. AB - Partial hospitalization and other services along the continuum of ambulatory mental healthcare are rapidly gaining acceptance as attractive alternatives to inpatient treatment. To assure continued development of high caliber programs, leaders of the partial hospital field have been working to develop quality indicators and outcomes measures specifically tailored to the unique aspects of ambulatory care. The quality domains and indicators outlined below are based upon the principles of effectiveness, efficiency, satisfaction and viability that provide foundations for this treatment modality. PMID- 10141032 TI - Direct contracting between employers and behavioral healthcare providers. AB - With the healthcare reform process stalled, direct contracting between employers or business coalitions and regional behavioral healthcare providers remains an effective way for employers to offer enriched managed behavioral healthcare services. This article examines the successful contractual relationship between the Procter & Gamble Company of Cincinnati, OH, and Bethesda Behavioral Health Services, a division of Bethesda Hospital, Inc., a multiservice regional healthcare provider also based in Cincinnati. Although Procter & Gamble has been committed to employee assistance program (EAP) services for more than 15 years, it determined in 1989 that a comprehensive managed care/EAP gateway plan best fit its employee relations philosophy and its need to improve the quality and reduce the cost of behavioral healthcare without reducing benefits. This article describes how that idea evolved into today's successful direct contractual relationship between Procter & Gamble and Bethesda. PMID- 10141033 TI - Dialogue: integrated or carved out: the future of behavioral health programs. Key to clinical quality and cost control: integrated care. PMID- 10141034 TI - Dialogue: integrated or carved out: the future of behavioral health programs. Network collaboration can produce integrated care. PMID- 10141035 TI - Dialogue: integrated or carved out: the future of behavioral health programs. A marriage unconsummated. PMID- 10141036 TI - The evolution of a shared relationship: the capitation contract over time. AB - How can behavioral healthcare providers retain their contracts with payors in a volatile marketplace? One way is to establish and strengthen ties with the payor that give each party a stake in the other's long-term success. This article outlines some of the areas in which such bonds can be forged. PMID- 10141037 TI - How to tailor outcomes management programs for public sector mental health. PMID- 10141038 TI - Accessing the Internet. Guidelines for beginners and mental health resources for experts. I. Just for beginners. The information highway's on-ramp. AB - People have very different levels of comfort and experience in traveling the information superhighway. In the following column, Part I will provide an overview for beginners from two experts with the Boston Computer Society, the oldest and largest computer user organization in the world. Part II provides information to those with previous Internet experience who want to access specialized mental health information resources. It is written by an expert in this area who has served as a member of the Information System Committee of the American Psychiatric Association. PMID- 10141039 TI - Accessing the Internet. Guidelines for beginners and mental health resources for experts. II. The next step. How to access mental health resources on the Internet and on BBS. AB - People have very different levels of comfort and experience in traveling the information superhighway. In the following column, Part I will provide an overview for beginners from two experts with the Boston Computer Society, the oldest and largest computer user organization in the world. Part II provides information to those with previous Internet experience who want to access specialized mental health information resources. It is written by an expert in this area who has served as a member of the Information System Committee of the American Psychiatric Association. PMID- 10141040 TI - Accreditation and regulation of utilization review organizations. PMID- 10141041 TI - Hawaii moves to implement HealthQUEST mental health "carve-out". PMID- 10141043 TI - New Congressional approaches to health reform expected in 1995. PMID- 10141042 TI - The legacy of public policy debates: healthcare report cards. PMID- 10141044 TI - Behavioral healthcare mega-trends (or the end of managed care as we know it). PMID- 10141045 TI - Another crusade for Koop. Interview by Howard J. Anderson. PMID- 10141046 TI - How the outpatient shift is prompting automation. PMID- 10141047 TI - Science goes to battle to save lives. PMID- 10141048 TI - The thorny issue of attachments. PMID- 10141049 TI - The standards movement builds momentum. AB - The success of efforts to build health information networks and to implement computerized patient records will hinge on the development of standards for the electronic format and content of financial and clinical transactions. Without standards, sharing data among disparate systems will be extremely cumbersome, and drawing conclusions based on research will prove difficult. For years, several volunteer groups have been toiling to develop these standards. These efforts are beginning to pay off. This special report summarizes the latest trends in standards development. This series of stories includes an update on efforts to develop standard data sets for financial and administrative transactions; a guide to the jargon of health care electronic data interchange, an overview of efforts to speed the development of standards for computerized records; and a case study of a hospital implementing one set of clinical standards. PMID- 10141050 TI - Ending the paper trail ... Memorial Sloan-Kettering Cancer Center. PMID- 10141051 TI - Health information networks. Where are we headed? AB - Proponents of community health information networks have high hopes for improving care and cutting costs by sharing information among providers, payers and others. But significant issues must be resolved before networks can deliver on those high expectations. PMID- 10141052 TI - The new frontier for pharmacy automation. AB - The retail pharmacy industry, long a leader in applying EDI, is preparing to use automation in several new areas. For example, pharmacists will be able to interact electronically with physicians' offices and access clinical information. PMID- 10141053 TI - Smaller clearinghouses face an uphill climb. AB - With industry consolidation in full swing and competition intensifying, smaller claims clearinghouses are weighing survival strategies. Market pressures are forcing more clearinghouses to offer a broader range of services designed with managed care in mind. PMID- 10141055 TI - Which works better: a freestanding assisted living facility or one on a nursing home campus? PMID- 10141054 TI - Assisted living faces new challenges. PMID- 10141056 TI - Exercise by design. PMID- 10141057 TI - Private acts, public places. PMID- 10141058 TI - Where's the beef? Extra protein helps the elderly heal and stay healthy. PMID- 10141059 TI - Getting ready for MDS--again. PMID- 10141060 TI - Outcomes measures are a necessity. PMID- 10141061 TI - Ciprofloxacin use under a reserved drug and stepdown promotion program. AB - This study retrospectively evaluated the use of parenteral ciprofloxacin (PC) under the influence of a reserved antimicrobial drug program and an intravenous oral stepdown program. During the first three months following its formulary introduction, 92 PC treatment courses were initiated. Fifty of these treatment courses in 49 adults were randomly selected for study. The hematology service accounted for 50% of the courses reviewed. The balance were initiated in the intensive care unit (16%), and six other services (34%). PC was used for the treatment of febrile neutropenia (50%), respiratory tract infections (20%), gram negative sepsis (10%), and five other indications. Initial use of the intravenous formulation was considered appropriate in 92% of courses. Stepdown therapy occurred in 17 (34%) of treatment courses. Of the 26 patients considered candidates for oral therapy, seven patients (27%) were eligible for earlier stepdown and nine patients (35%) did not receive oral drug. According to our criteria, unnecessary use of the intravenous route occurred in 20% of PC treatment days. Mean total cost (acquisition plus delivery) of therapy per course was $668. This cost was higher in the hematology service (mean $990) than any other service (p = 0.0015). When stepdown therapy was employed the mean daily cost of therapy was $43.63 vs. $55.61 when the oral dosage form was not used (p = 0.04). Parenteral drug costs totalling $6245 were avoided by subsequent use of the oral dosage form. If full compliance with stepdown criteria had occurred, an estimated total savings of $10,769 could have been realized. PMID- 10141062 TI - Leucovorin taste challenge. PMID- 10141063 TI - Diffusion of innovation II: Formulary acceptance rates of new drugs in teaching and non-teaching British Columbia hospitals--a drug development perspective. AB - Diffusion theory was used to examine differences in adoption rates of new drugs by British Columbia teaching and non-teaching hospitals. Surveys were mailed in September 1990 to 41 hospital pharmacies (response rate = 88%), requesting hospital pharmacy directors to provide formulary inclusion dates of 29 study drugs marketed between July 1987 and March 1990. Of the 36 initial responses, 31 were suitable for further analysis and these were surveyed again in April 1993 (response rate = 100%) as to the formulary status of drugs not initially approved. The second survey ensured that all study drugs would have at least 36 months on the Canadian market when determining formulary acceptance times. Of the 29 study drugs, six were not approved for use in any of the 31 study hospitals. The six teaching hospitals had a median formulary approval time of 8.0 months compared to 12.8 months in the 25 non-teaching hospitals for the 23 study drugs. Although 21 of 23 study drugs were approved for use earlier in teaching hospitals than non-teaching hospitals, only alfentanil was found to be adopted significantly earlier (U = 11, n1 = 5, n2 = 19, alpha = 0.05). Variations in formulary approval times for new drugs have a bearing on patient care, Pharmacy and Therapeutics Committees, hospital budgets, and pharmaceutical firm revenues. PMID- 10141064 TI - International benefits policy: a U.S. multinationals perspective. AB - An international benefits policy requires considerable planning both at the corporate level and in relation to the local environment. The creation of such a policy also calls for careful research into the company's basic benefits philosophy. PMID- 10141065 TI - Same-sex spousal benefits: a Canadian perspective. AB - Employers considering same-sex spousal benefits for employees based in Canada must deal with a number of unanswered questions. Some plan sponsors may make benefits coverage decisions based on personal or corporate beliefs or in response to employee demands. PMID- 10141066 TI - ERISA estoppel: say what you mean and mean what you say. AB - Estoppel is rapidly becoming part of ERISA litigation. However, as employers, TPAs and other entities associated with ERISA plans learn to take precautions against erroneous representations, estoppel litigation may subside. PMID- 10141067 TI - Strategies in controlling health care costs for public employees. PMID- 10141068 TI - Developing & applying effective personnel policies. PMID- 10141069 TI - Mergers and acquisitions: director and consultant liability exposure. AB - Corporate directors and their consultants must make decisions in an uncertain and changing health care environment. The losses each may face as a result of an incomplete analysis of the true value of the entities involved in mergers or acquisitions may extend beyond the failure of the transaction to the creation of personal liability as well. Accordingly, objective, careful, detailed, and fair decision-making based upon adequate information is more critical than ever for directors if they are to be able to take advantage of the business judgment rule, and also for consultants to avoid their own liability when transactions fail to deliver the values they have estimated. PMID- 10141070 TI - Special report on patient care. The new federal patient-dumping regulations: some commonly asked questions and answers. AB - Until both providers and government surveyors become more familiar with the new EMTALA regulations, there will be an uncomfortable period of adjustment, and perhaps some turmoil as well, particularly regarding the new requirement that facilities who receive suspicious transfers report those transfers to HCFA. Providers should carefully examine their internal policies on discharge and transfer of emergency patients to assure that those policies are consistent with the new regulations. Particular attention should be given to inservice training for medical and support personnel in the emergency department, because they must precisely comply with the law and their errors can subject the hospital to costly investigations and potential fines of $50,000 for each violation. PMID- 10141071 TI - The Hermann Hospital closing agreement. Is informal guidance better than no guidance at all? AB - Creating barriers to communications between the IRS and the tax-exempt health care community is particularly troubling in this time of fundamental change. As exempt hospitals around the country gear up to provide service in a managed care environment, they are becoming involved in new forms of integrated delivery systems for which there is an utter lack of guidance. If the IRS is to formulate effective policy on questions involving the creation of these new health care entities, it needs to be aware of the dynamics and economic incentives at work in a managed care environment and how these incentives and dynamics differ from those in a fee-for-service context. The Hermann Hospital experience seems altogether contrary to these objectives. PMID- 10141072 TI - The joint venture alternative to mergers. AB - However, while a joint venture may be "safe" from antitrust challenge, it is not without some practical difficulties, especially with respect to consolidating services at one location or jointly offering services provided at multiple facilities. These practical concerns include: 1. Who will exercise operational management of the joint venture? 2. How will the joint venture deal with different pricing for services that will be provided at multiple locations? 3. What criteria will be used to decide the location at which consolidated tertiary services will be offered? 4. In what circumstances can the joint venture be unwound, either in its entirety or as to discrete functions? When clinical services have been consolidated at one location, there is an appropriate concern by the other hospital that it will be unable to provide or re-enter the market for those services if the joint venture dissolves. These operational concerns, of course, are not addressed in the Consent Decree. Thus, even if a joint venture relationship survives antitrust scrutiny, the parties must still negotiate and resolve these operational issues in order for the joint venture to be viable. PMID- 10141073 TI - The brave new world of Medicare and Medicaid fraud and abuse enforcement: whistle blowers, pre-filing agreements, and voluntary disclosure. AB - Providers participating in the recent wave of mergers, acquisitions, and affiliations may have unwittingly expanded their false claims exposure because many false claim-type situations are difficult, if not impossible, to identify in pre-closing due diligence. In addition, the possibility of retrospective characterization of ordinary billing mistakes as "false claims" increasingly introduces significant uncertainty to the average provider's financial future. To date, the single most effective approach to this problem is an independent compliance review to identify and resolve any existing exposure, including voluntary disclosure if appropriate, and an ongoing compliance program to communicate to all employees not only the content of applicable rules but also the genuine commitment of management to ensure continuing compliance above other concerns. PMID- 10141074 TI - Special report on labor and employment. The Department of Labor issues final regulations for the federal Family and Medical Leave Act. AB - The FMLA is a complicated and comprehensive regulatory scheme, and it is impossible to review any but the most basic provisions in this article. The final regulations provide very detailed guidance on such issues as benefits continuation, reinstatement rights, notice requirements, and enforcement measures. Personnel policies and practices must be revised to be consistent with these final regulations, and care must be taken that leave policies do not restrict rights under the FMLA or unintentionally create expanded leave rights. In complying with the FMLA, employers must also keep in mind that there are complex interplays between the federal FMLA, state laws that provide family and medical leave, the Americans with Disabilities Act, and state workers' compensation laws, that can require expert advice depending on the particular circumstances. PMID- 10141075 TI - Recent state legislative approaches to regulating utilization review reflect URAC national standards. AB - As state legislatures begin to regulate utilization review activities, some appear to be utilizing the URAC standards for guidance. Still others (e.g., Iowa, Nebraska, and New Hampshire) require URAC accreditation as a prerequisite for utilization review organizations to operate in their states, while others (e.g., Alabama, Arizona, Connecticut, Indiana, North Dakota, Tennessee, and Rhode Island) accept URAC accreditation in lieu of state certification. "States Look to Accreditation for Managed Care Seal of Approval," Medical Utilization Review, Vol. 22, No. 20, Oct. 27, 1994, at 7-8. The remarkable consistency between the 1994 URAC standards and the new California law are a hopeful sign that managed care decision-making will in the future be undertaken on a more uniform and objective basis. Only through this type of consensus building will the historical chasm between providers and payors be made smaller. PMID- 10141076 TI - Incapacity and autonomy: striking a balance. AB - We want to take this opportunity to offer our perspective on some of the issues to which the Substitute Decisions Act, 1992, and the Consent to Treatment Act, 1992, represent a response. To a lesser extent, the provisions of the Advocacy Act, 1992, which governs the provision and role of advocates, will be considered. First, we hope to explain, perhaps a little more than can be done in Committee, or in the Legislature, the thinking that underlies some of the protective measures this legislation makes available to persons who are thought to be mentally incapable. Second, we provide some discussion of the problem of the criterion of mental capacity, and argue that where there is no strict criterion, it is important to ensure that individuals who are subjects of assessments of their mental capacity are protected by a balance of power in which they hold a prominent position. Third, we suggest that the lack of a strict criterion of capacity argues for a broad criterion for assessors. PMID- 10141077 TI - The learned intermediary doctrine and prescription wheelchairs. PMID- 10141078 TI - Medical malpractice and surgical generalism in the 1990s. PMID- 10141079 TI - Towards quality organizations. AB - Quality improvement and patient-centered care hold great promise for effective health care delivery. The corporate group must show the way, by demonstrating visionary, strategic planning and enabling skills. The development of direct care and infrastructure quality teams require trust and nurturing. Criticism of management is to be expected. The corporate group must walk a fine line by creating a vision and establishing the necessary strategic processes. Operational aspects must be delegated to quality teams, which must acquire skills of problem identification and the analytical processes for their resolution. PMID- 10141080 TI - An investigation of causes of patient satisfaction/dissatisfaction with physician services. AB - To provide the highest level of satisfaction, health care providers must control patients' expectations and perception of treatment quality. This study is designed to gain insight into the perception and attitudes of consumers toward physician services. It attempts to examine the satisfaction/dissatisfaction of patients in association with the cost and quality of medical care; interpersonal skills, competence and professional recognition of physicians; information provided and attention given by physicians; waiting time, physical facilities, and receptionists and nurses in the physicians office. Data was gathered using telephone interviews from a sample of 245 respondents. Factor analysis techniques in the SPSSX software package were used in data analysis. Findings indicated that there are generally favorable attitudes toward the quality of medical services, and that medical cost has secondary importance. PMID- 10141081 TI - Level of knowledge and misconceptions about cholesterol: gender and race differences. AB - This study highlights the differences in knowledge and misconceptions about cholesterol according to gender and race in the United States. Data were obtained from a randomly selected national sample of 1,068 adults. Respondents were asked a series of true-false questions covering such topics as recommended cholesterol levels, how cholesterol is reduced, the effect of diet, smoking habits, and exercise on cholesterol levels, etc. The results indicated that the knowledge level differed according to gender and race. PMID- 10141082 TI - Physician choice criteria: factors influencing patient selection of generalists versus specialists. AB - This paper presents the results of an exploratory study designed to (1) ascertain the primary sources of information patients use when selecting physicians and (2) identify differences in patient selection factor importance by type of physician under consideration (specialists versus generalists). The results support previous research which finds word-of-mouth and physician referrals the primary sources of information. Selection factors considered important when selecting a generalist were significantly different from factors considered important when selecting a specialist. Implications of the study's findings for effective physician marketing and future research are discussed. PMID- 10141083 TI - The impact of office characteristics on satisfaction with medical care: a "before and after" analysis. AB - A great deal of research has examined the impact that tangible cues can play in influencing patients' satisfaction with their physician. Because most people are not able to assess the technical expertise of their doctor, they often rely on tangible "surrogates" as standards of assessment for what is essentially an intangible product. While the research to date has helped us better understand the nature of this problem, it has often been characterized by some important design flaws. This paper reports on the results of a recent study that assessed patient satisfaction with a physician through the tangible cue of physical (office) surroundings. We sampled two sets of patients: one set prior to the doctor's move to newer facilities and the other after the relocation. Our findings offer mixed support for the hypothesis that physical cues influence attitudes toward and satisfaction with the medical care we receive. PMID- 10141084 TI - Initiating change through alliance and network-building: Part one. PMID- 10141085 TI - Warnings for health care products: a communication perspective. PMID- 10141086 TI - Changing the public perception of physiotherapeutic treatment. AB - Market research was undertaken to establish the public perception of physiotherapy. Using this market research strategic recommendations for the future marketing of physiotherapy are made within the professional context. Marketing will be used to contribute to changing the public perception of physiotherapy. The market research involved a qualitative study of five focus groups of the general public and one focus group of physiotherapists. The responses from the focus groups were used to construct an appropriate questionnaire for the qualitative study. A random sample of 510 members of the general public were then surveyed. The market research results yielded the following key features: The best known conditions treated by physiotherapists are musculoskeletal. The least known are women and children. Client-centered care is sought. The importance of location gives potential for physiotherapists to capitalise on tailoring to clients in their area. Doctors are important for referral and communication about physiotherapy. Marketing should be used to inform doctors of what physiotherapy has to offer. A marketing orientation has begun within physiotherapy; however, it must 'fit' the culture initially to be successful. A marketing strategy should be developed on national, state and individual levels based on a strategic intent. At the state level, strategies must be responsive to area or regional needs. Marketing needs to target identified market segments such as workers compensation organisations. Individual physiotherapists must promote themselves within their region, particularly to doctors and clients with the use of relationship marketing. Informal presentations to community groups and school students about physiotherapy will increase their profile. PMID- 10141087 TI - Working together for health: NSDA's (Nova Scotia Dietetic Association) submission to the Blueprint Committee on Health System Reform. AB - The Nova Scotia Dietetic Association (NSDA) submitted seven position papers in response to a call for submissions for the Nova Scotia Government's Blueprint Committee on health system reform. The purpose of the submission was to delineate the preferred roles of dietitians/nutritionists in the reformed provincial health system. The position papers addressed the following health issues: primary health care, public health, long-term care, institutional/tertiary care, home care/home based services, health human resources, and healthy public policy. Each position paper included sections on the proposed nutrition planning structure, existing and proposed nutrition delivery structures, and expected outcomes of the proposed nutrition delivery structure. A number of actions associated with NSDA's position papers on health system reform are presented. Meanwhile, members of NSDA are continuing to work for health system reform in a proactive manner. PMID- 10141088 TI - Survey of food-related waste management practises in New Brunswick health establishments. AB - A survey was conducted jointly by Universite de Moncton and the New Brunswick (N.B.) Department of Health and Community Services to generate information on waste management practises within health care institutions. The objectives of the survey were: 1) to identify the type of waste management methods in place in N.B. health establishments; 2) to identify the major difficulties associated with recycling food-related waste; 3) to study the attitudes and beliefs of food service managers toward waste management. Data were collected through a questionnaire mailed to food service managers. Results indicated that 86% of establishments were involved in waste reduction. There were no statistically significant differences in reduction practices between hospitals and nursing homes or between the size of these establishments (P = 0.11). The same applied for reutilization (P = 0.09) where 93% of the establishments were involved. Recycling was carried out in 64.8% of the establishments. Major obstacles to recycling included the lack of pickup services, the lack of storage space, and the absence of buyers for recyclable materials. The results of this survey will help in the formulation of policies, strategies, and recommendations for better protection of the environment. PMID- 10141089 TI - Get a grip. PMID- 10141090 TI - Access to early defibrillation. The latest stats. PMID- 10141091 TI - Why wait? Early defibrillation must be a top priority. PMID- 10141092 TI - Treating AICD (automatic implantable cardioverter defibrillator) patients. Are you in for a shock? PMID- 10141093 TI - Partners. Part II: The real world, EMS style. Roundtable discussion. PMID- 10141094 TI - It's as easy as 1-2-3. Managing school bus incidents. PMID- 10141095 TI - Banished to the boonies. PMID- 10141096 TI - Selecting the right collection professional. PMID- 10141097 TI - It's going to cost how much? PMID- 10141098 TI - Continuing education: who is responsible? PMID- 10141099 TI - Expanding roles for radiology administrators. AB - In a fast-moving trend, radiology administrators are being asked to assume responsibility for other hospital departments. Pressure to reduce costs is the primary force behind restructuring that results in expanded roles for managers. The changes mean fewer management positions and increased responsibilities for those who retain their jobs. To maximize their opportunities for success, radiology administrators should actively seek expanded duties; cultivate the support of medical leadership; use mentors, professional literature and organizations such as the AHRA to gear up for new responsibilities; and recognize negotiation and presentation skills as extremely valuable assets. PMID- 10141100 TI - Benchmarking in healthcare: selecting and working with partners. AB - The process of selecting a benchmarking partner begins with gathering information to establish industry standards, identifying potential partners and supplying data on the subject to be benchmarked. Suggested sources of information are business and trade publications; investment industry analysts; journalists; trade associations and professional organizations; government research reports; disclosure documents; current and former employees; and product and service providers. Potential partners should be approached only after careful preparation of a project plan that includes information about the benchmarking team's organization and purpose, description of the subject and a statement of benefits for the prospective partner. After obtaining a commitment from the benchmarking partner, relevant comparative data is gathered and analyzed, using some of the following methods: library research, questionnaires, telephone surveys, site visits and consultants. Because benchmarking often involves sharing information with competitors, a code of ethical conduct has been developed by the International Benchmarking Clearinghouse. PMID- 10141101 TI - AHRA (American Healthcare Radiology Administrators) patient satisfaction survey. AB - Healthcare's focus has shifted from the institutional to the personal, requiring hospitals to carefully evaluate patient satisfaction. A carefully written survey can supply invaluable feedback from patients about their experiences in the department. The AHRA has developed and provides in this article a survey designed to measure the aspects of care that contribute most to patient satisfaction, such as length of wait, explanation of procedures and privacy, etc. When conducting the survey, use procedures that ensure a representative sample and adequate response rate. Computerized, on-site data collection is the most timely and accurate method when available. Results of the survey must receive action to correct problems and analyze perceptions of quality. CQI should be used to ensure continual improvement. PMID- 10141102 TI - A contemporary perspective on capitated reimbursement for imaging services. AB - Capitation ensures predictability of healthcare costs, requires acceptance of a premium in return for providing all required medical services and defines the actual dollar amount paid to a physician or hospital on a per member per month basis for a service or group of services. Capitation is expected to dramatically affect the marketplace in the near future, as private enterprise demands lower, more stable healthcare costs. Capitation requires detailed quantitative and financial data, including: eligibility and benefits determination, encounter processing, referral management, claims processing, case management, physician compensation, insurance management functions, outcomes reporting, performance management and cost accounting. It is important to understand actuarial risk and capitation marketing when considering a capitation contract. Also, capitated payment methodologies may vary to include modified fee-for-service, incentive pay, risk pool redistributions, merit, or a combination. Risk is directly related to the ability to predict utilization and unit cost of imaging services provided to a specific insured population. In capitated environments, radiologists will have even less control over referrals than they have today and will serve many more "covered lives"; long-term relationships with referring physicians will continue to evaporate; and services will be provided under exclusive, multi-year contracts. In addition to intensified use of technology for image transfer, telecommunications and sophisticated data processing and tracking systems, imaging departments must continue to provide the greatest amount of appropriate diagnostic information in a timely fashion at the lowest feasible cost and risk to the patient. PMID- 10141103 TI - Cookbooks, guidelines and double-edged swords. PMID- 10141104 TI - The economics of capitation. PMID- 10141105 TI - 1994 Buyers Guide Index. PMID- 10141106 TI - The controversy of mammography screening. PMID- 10141107 TI - Change...today's choices. Commitment...tomorrow's challenges. PMID- 10141108 TI - Archives for diagnostic imaging. Building information networks. PMID- 10141109 TI - Darwinian theory evident on RSNA (Radiological Society of North America) exhibit floor. PMID- 10141110 TI - Understanding vertically integrated healthcare delivery systems. PMID- 10141111 TI - Mandates, transmittals & other myths. PMID- 10141112 TI - Ultrasonography. A new approach in the diagnosis of renovascular disease. PMID- 10141113 TI - Perspectives. Health care fraud & abuse: changing to fit the times. PMID- 10141114 TI - Perspectives. MN business group fosters new wave of competition. PMID- 10141115 TI - Perspectives. PPRC issues '95 report; Wilensky takes the helm. PMID- 10141116 TI - Perspectives. Battle heats up over product liability reform. PMID- 10141117 TI - Reforming Medicare: a White Paper. PMID- 10141118 TI - 873 change jobs at Brookwood Medical Center. PMID- 10141119 TI - Restructuring the health care delivery system. AB - Enormous changes continue to occur in how Americans receive their health care. Hospitals are redesigning their institutions to accommodate their changing delivery patterns. The result: costs are down, inpatient stays are shorter, patients are satisfied, staffs are very, very nervous. PMID- 10141120 TI - Methodist Hospital. Interview by John Herrmann. PMID- 10141121 TI - Physician retraining in primary care. AB - Part of the health care provider restructuring consists of physician specialists retraining in primary care. The need is there, with additional pressures for qualified "gatekeepers" coming from the increase in managed care contracting. PMID- 10141122 TI - Health care in the 21st century. Part II. AB - One year ago, this author offered a practical list of survival tactics for hospitals attempting to cope with an uncertain shape of reform. Now he comes back with an update. It is practical management advice as we travel toward a new century. PMID- 10141123 TI - "Debugging" the information system contracting process. PMID- 10141124 TI - Medicaid managed care continues to interest states. PMID- 10141125 TI - The best care pays off, not cheapest. AB - The plan is simple for this managed care insurer: you put quality of care first, no matter what, and it pays off. That system flies in the face of the usual press HMOs receive. The charges are heard over and over again: HMOs drive the hardest negotiations to find the least expensive providers. Consumers and others have the notion that managed care means reduced choice and financial hardships for hospitals and physicians under contract with them. At least one major insurer has a different story to tell. PMID- 10141126 TI - Finding savings through resource consumption management. PMID- 10141127 TI - Can we successfully restructure Medicare and Medicaid? PMID- 10141128 TI - Environmental equity: dilemmas and challenges for public health policy and social work for the 1990s. PMID- 10141129 TI - American health care: myths and realities. PMID- 10141130 TI - Clinical preventive medicine in business and industry: a rational foundation. AB - The individual educational and intervention emphasis of clinical preventive medicine programs is successful in reducing an employee's risk for disease and injury. Although some studies note that decreased risk is found predominantly in those with low initial risk, a critical mass of healthful lifestyles may spread to non-participants in the organization, the halo effect. Thus, the more employees there are modeling a health lifestyle, the greater likelihood others will follow. Preventive medicine programs offer intangible advantages to the employer. Such programs demonstrate an attitude of caring for the employee which has an influence on the public. Happier employees tend to increase their level of socialization within a company. The ultimate effect is decreased employee risk, improved productivity, reduced absenteeism, and improved health at reduced cost. PMID- 10141131 TI - Health care professionals' characterizations of the system of care for long-term ventilator-dependent patients: a preliminary study. AB - The purpose of this study was to characterize, from multiple professional perspectives, current management approaches and systems of care for long-term ventilator-dependent patients. This study was preliminary in nature and served to generate questions to be explored with subsequent research. A focus group methodology was used. Three focus sessions were held, with participants representing nursing, social services, and respiratory therapy. Field notes were recorded by two independent observers. The primary themes arising from the narrative data were: (i) caregiver impact, (ii) system barriers to appropriate care, (iii) communication difficulties among professionals and between patients and professionals, (iv) ethical concerns, and (v) patient characteristics that influence medical management and patient outcomes. Implications include the need for systematic research regarding caregiver impact, ethical practice of health care professionals, and the epidemiology of ventilator dependency, as well as evaluative studies of different system approaches to caring for these patients. PMID- 10141132 TI - Caregiver burden: who the caregivers are, how they give care, and what bothers them. AB - The present research describes the association between objective and subjective caregiver burden experienced by families and friends of individuals with chronic mental illness. Although there has been a significant quantity of research conducted about burden and mental illness, the findings have been equivocal because of varying definitions of burden and varying sampling procedures. The present research utilizes a standardized interview instrument for caregivers. Caregivers were named by a stratified random sample of clients who have been certified as severely mentally disabled and have received publicly-funded community mental health services in the state of Ohio during the 1990 fiscal year. Data were collected by the first author and a research assistant during telephone interviews between August 1991 and May 1992. One hundred and eighty nine caregivers were interviewed. Findings showed that the majority of caregivers are female, white, and aged 50 years or more. Parents comprise the largest group of caregivers and slightly more than one third of clients live with the caregiver. The relationship between caregiver and client is generally described as positive; however, the interviews were conducted during a period when the clients' symptomatology was more under control than previously in the relationship. Caregivers state that the clients need help much more often than they ask for it in all categories of possible help. Considering caregiver burden in relation to caregiver behaviors, time management is a somewhat frequent problem that is very troublesome to the caregiver. Considering client behaviors in relation to caregiver burden, embarrassing behaviors are most troublesome and occur with moderate frequency. The surprise element of these behaviors seems to be the most problematic. PMID- 10141133 TI - Opioids for chronic pain of non-malignant origin--coercion or consent? PMID- 10141134 TI - Psychology, health promotion and aesthemiology. Paper one: Social cognition models as a framework for health promotion: necessary, but not sufficient. AB - Much of health promotion is premised on the notion that health-related behaviours are under individual control, and strongly influenced by intra-psychic factors, including knowledge and attitudes. The emphasis placed on such factors has led to a neglect of the social and material context in which the individual is situated. This paper describes a number of psychological theories which have influenced health promotion, and suggests ways in which a wider set of psychological theories and methods, which take into account social and material factors, may more usefully inform health promotion initiatives. PMID- 10141135 TI - Psychology, health promotion and aesthemiology. Paper two: what you do is determined by what you do. PMID- 10141136 TI - The bioethics tabloids: how professional ethicists have fallen for the myth of tertiary transmitted heterosexual AIDS. AB - The hysteria and misconceptions about AIDS which are fostered and held by the popular press have been accepted uncritically by many bioethicists, who have not bothered to explore popular empirical claims in sufficient depth. As a result, and because ethicists attempt to sell moral problems in a manner not much different from the way the popular press attempt to sell newspapers, artificial dilemmas have been produced in professional journals. We concentrate on just one popular misconception about AIDS--that the heterosexual incidence of the syndrome is widespread--and show how bioethicists' unreflective acceptance of this myth has led them to make conceptual and practical errors. PMID- 10141137 TI - Dworkin, Rawls and reality. PMID- 10141138 TI - An American perspective on nursing liability. PMID- 10141139 TI - Issues in Australian nursing law. PMID- 10141140 TI - Opioids for chronic pain of non-malignant origin--caring or crippling. AB - Pain management has improved in the past few decades. Opioid analgesics have become the mainstay in the treatment of cancer pain whilst inter-disciplinary pain management programmes are the generally accepted approach to chronic pain of non-malignant origin. Recently some pain specialists have advocated the use of opioids in the long-term management of non-cancer pain. This has raised some fundamental questions about the purpose of pain management. Is it best to opt for maximum pain relief and comfort, or should one emphasise function and activity as higher priorities? Will the use of opioids create more autonomy for pain sufferers or will this add handicaps to lives which are already limited? Until more clinical outcome data are available we advocate caution in the use of opioid analgesia. Such caution can, and does, raise questions about the rights of the patient and the rights of the prescriber in a context where the facts do not point to a clear course of action. PMID- 10141141 TI - Professional accountability in nursing in the UK. PMID- 10141142 TI - Anarchists for health: Spanish Anarchism and health reform in the 1930s. Part I: Anarchism, neo-malthusianism, eugenics and concepts of health. PMID- 10141143 TI - To anyone morally perplexed about the politics of US health care. PMID- 10141144 TI - Teaching analysis. PMID- 10141145 TI - Power and influence: the changing world of medical professionals. PMID- 10141146 TI - Marketing: a professional issue. PMID- 10141147 TI - Selecting a core clinical computerised information system. PMID- 10141148 TI - Guidelines for Medical Record Committees. NSWMRA Casemix and Quality Assurance Subcommittee. PMID- 10141150 TI - Customer focus, outcomes, indicators, best practice: putting quality on the agenda! ... Or is it? PMID- 10141149 TI - Total quality management in the public sector--issues for implementation. AB - The Quality Matters Article is reprinted from the Australian Association for Quality in Health Care (AAGQHC) Newsletter (Vol 4, No 2). Researched and written by Sharyn White (Senior Planner, Southern Health Advancement Planning Unit, with the South Australian Health Commission) it is an excerpt from a qualifying dissertation for for a Masters in Policy and Administration at Flinders University. Written when the author was the Quality Co-ordinator, Noarlunga Health Services, SA, the article examines the literature related to some of the differences between the public and private health sectors, and explores the use of Total Quality Management systems in public health care facilities in light of the literature. Many of the issues around the use of Total Quality Management in health care remain unresolved. Will it achieve better results than other quality approaches? Can an industrial model achieve improvements in patient care? Is it more appropriate in teh public or private sectors? Is TQM appropriate in health care? Is it just a jargonistic name change? What's the difference, when all is said and done, between TQM and other ways of addressing quality? Does the cost of implementing TQM justify the results? Sharyn White's research addresses some of these issues from a refreshing perspective. My thanks to the author, and to the editors of the AAQHC Newsletter for their permission to reprint the article in Health Information Management Journal. PMID- 10141151 TI - Adapting DRGs: the British, Canadian and Australian experiences. AB - The DRG classification was developed in the United States, and has been widely used there for analytical and resource allocation purposes. Its utility has been recognised in other countries. Some have adopted US versions without change, and others have chosen to develop their own adaptations. This paper discusses the processes and outcomes of adaptation in Canada, Britain and Australia. An attempt is made to generalise the trends. It is concluded that there is a high degree of similarity of intent, although different solutions have been adopted in some cases. Where major differences remain, they are mostly a consequence of the lack of resources to pursue all opportunities for refinement at the same time. All three countries have correctly focused on involvement of their own clinician groups. However, they have tended to restrict their view to US experiences when looking overseas. It is argued that greater attention should be paid to sharing their ideas with countries with which they have a greater degree of similarity. PMID- 10141152 TI - A profile of ICD-9-CM coding staff in NSW and ACT hospitals. AB - The ICD-9-CM coder workforce is on the brink of major changes given impetus by increasing commitments to casemix-based funding and management strategies within the public and private hospital sectors. A study of the ICD-9-CM coding process in NSW and ACT hospitals was undertaken by the School of Health Information Management, Faculty of Health Sciences, The University of Sydney during 1991. This article profiles the composition of the ICD-9-CM coder workforce in NSW and the ACT based on the findings of this study. Recent developments pertaining to national coder workforce issues are also discussed. PMID- 10141153 TI - Annual update of the HHS poverty guidelines--HHS. Notice. PMID- 10141154 TI - CLIA program; approval of the College of American Pathologists--HCFA. Notice. AB - This notice announces the approval of the College of American Pathologists (CAP) as an accrediting organization for clinical laboratories under the Clinical Laboratory Improvement Amendments of 1988 (CLIA) program. We have found that the accreditation process of this organization provides reasonable assurance that the laboratories accredited by it meet the conditions required by Federal law and regulations. Consequently, laboratories that voluntarily become accredited by CAP in lieu of receiving direct Federal oversight and continue to meet CAP requirements would meet the CLIA condition level requirements for laboratories and therefore are not subject to routine inspection by State survey agencies to determine their compliance with Federal requirements. They are, however, subject to validation and complaint investigation surveys. PMID- 10141155 TI - Medicare program; Medicare coverage of prescription drugs used in immunosuppressive therapy--HCFA. Final rule. AB - This final rule amends the regulations to provide Medicare coverage for prescription drugs used in immunosuppressive therapy furnished to an individual who receives an organ transplant for which Medicare payment is made. This rule reflects the enactment of section 1861(s)(2)(J) of the Social Security Act that provides Medicare coverage for prescription drugs used in immunosuppressive therapy for a period of up to 1 year from the date of discharge from an inpatient hospital stay during which the Medicare-covered organ or tissue transplant was performed. This final rule also implements section 13565 of the Omnibus Budget Reconciliation Act of 1993 (Public Law 103-66) and section 160 of the Social Security Act Amendments of 1994 (Public Law 103-432) that, beginning January 1, 1995, expand Medicare coverage for prescription drugs used in immunosuppressive therapy from 1 year to a phased-in period of 3 years from the date of discharge from a hospital stay during which the Medicare-covered organ or tissue transplant was performed. PMID- 10141156 TI - VA homeless providers grant and per diem program--VA. Final rule. AB - We are, with changes, adopting as a final rule the provisions of an interim final rule promulgated pursuant to The Homeless Veterans Comprehensive Service Programs Act of 1992. The Act authorizes the Department of Veterans Affairs to assist public or nonprofit private entities in establishing new programs to furnish supportive services and supportive housing for homeless veterans through grants. The Act also authorizes VA to provide per diem payments, or in-kind assistance in lieu of per diem payments, to eligible entities that established programs after November 10, 1992 that provide supportive services or supportive housing for homeless veterans, or service centers providing supportive services. This rule contains criteria and requirements relating to the awarding of grants and relating to per diem payments. Accordingly, this rule is necessary so that grants can be awarded and per diem payments can be made. PMID- 10141157 TI - Notice of attestations filed by facilities using nonimmigrant aliens as registered nurses--Employment and Training Administration, DOL. Notice. AB - The Department of Labor (DOL) is publishing, for public information, a list of the following health care facilities that have submitted attestations (Form ETA 9029 and explanatory statements) to one of four Regional Offices of DOL (Boston, Chicago, Dallas and Seattle) for the purpose of employing nonimmigrant alien nurses. A decision has been made on these organizations' attestations and they are on file with DOL. PMID- 10141158 TI - National Practitioner Data Bank: change in user fee. PMID- 10141159 TI - Civilian Health and Medical Program of the Uniformed Services (CHAMPUS); mental health services--DoD. Final rule. AB - This final rule is to reform CHAMPUS quality of care standards and reimbursement methods for inpatient mental health services. The rule updates existing standards for residential treatment centers (RTCs) and establishes new standards for approval as CHAMPUS-authorized providers for substance use disorder rehabilitation facilities (SUDRFs) and partial hospitalization programs (PHPs); implements recommendations of the Comptroller General of the United States that DoD establish cost-based reimbursement methods for psychiatric hospitals and residential treatment facilities; adopts another Comptroller General recommendation that DoD remove the current incentive for the use of inpatient mental health care; and eliminates payments to residential treatment centers for days in which the patient is on a leave of absence. PMID- 10141160 TI - Columbia/HCA's physician equity strategy. AB - How and why did 450 South Florida physicians invest $30 million to acquire a 20 percent interest in their own health system? HSL explains Columbia's syndication strategy and why some critics fear it could lead to "cream skimming." PMID- 10141161 TI - Does equity enhance physician performance? Yes. PMID- 10141162 TI - Does equity enhance physician performance? No. PMID- 10141163 TI - St. Vincent Community Health Network: operationalizing a vision of collaboration. AB - Can two successful health systems, one Catholic and one community-owned, integrate without merging assets? HSL visits Indianapolis to find out how this unusual collaboration is bucking the odds. PMID- 10141164 TI - Success factors for integrated systems. PMID- 10141165 TI - Creating physician-driven integrated delivery systems. AB - Put doctors in control of key strategic and clinical decisions? Make them part owners or give them financial performance incentives? Yes, say many experts, that's the road to success for integrated systems. Read how they're doing it and evaluate your physician integration initiatives on HSL's 10-question self assessment. PMID- 10141166 TI - Quality & access in the managed behavioral healthcare industry. AB - Building on a study of the costs of behavioral healthcare under managed care first released in the March/April, 1994 issue of this journal, the American Managed Behavioral Healthcare Association has now turned its attention to two other fundamental issues in healthcare reform: access and quality. The following study presents data indicating how managed behavioral healthcare plans assure quality and access in such areas as response time, accreditation, provider credentialing, patient satisfaction and outcomes measurement. PMID- 10141167 TI - How much will coverage for universal access to comprehensive behavioral healthcare really cost? AB - The following article summarizes and reviews four recent research reports attempting to quantify how much a universally available, nondiscriminatory behavioral healthcare benefit would actually cost--per person per year. The author suggests that the cost differences between these reports primarily reflect different assumptions related to the expected behavioral healthcare delivery system and designs for behavioral healthcare benefits. Comprehensive behavioral healthcare delivered through well-managed benefit plans is likely to cost a little more than $200 per person per year, which would be much more affordable for our country than unmanaged comprehensive behavioral healthcare, which easily could cost in excess of $300 per person per year. PMID- 10141168 TI - Building strategic partnerships between employers and managed care firms to enhance quality of care. AB - The challenges of integrating behavioral healthcare delivery and the demand for better management of behavioral healthcare benefits require corporate risk managers to focus on issues of quality and outcomes. A strategic partnership between the employer and a managed care organization is one tool for reducing risk and improving the quality of services for beneficiaries, using the techniques of total quality management. The following article describes a six step process for launching such a strategic partnership, along with some potential pitfalls. PMID- 10141169 TI - Dialogue: how can we assure behavioral health security for all Americans? Creating security within appropriate boundaries. PMID- 10141170 TI - Dialogue: how can we assure behavioral health security for all Americans? Requirements for achieving a practical vision. PMID- 10141171 TI - Dialogue: how can we assure behavioral health security for all Americans? Security in the context of universal coverage. PMID- 10141172 TI - Characteristics of psychotherapy under managed behavioral healthcare. PMID- 10141173 TI - National outcomes management survey: summary report. AB - Spurred by national trends towards accountability and outcomes management, behavioral healthcare organizations are increasingly focused on efforts to develop and implement outcomes research strategies. CentraLink, in cooperation with the Institute for Behavioral Healthcare, developed a survey designed to reflect and summarize current outcomes efforts in early 1994. This column provides a brief summary of several salient features reported by organizations responding to that survey. PMID- 10141174 TI - Behavioral healthcare provisions of California's single payor initiative. PMID- 10141176 TI - Re-engineering the behavioral healthcare industry with information technology. PMID- 10141175 TI - Key state legislative provisions on purchasing alliances. AB - In order to function effectively in post-reform healthcare markets, behavioral healthcare professionals must understand and interact with health purchasing alliances. Healthcare reform initiatives based upon the principles of managed competition envision an important role for cooperative health purchasing organizations, or "health alliances," that collect premiums and contract with health plans for the provision of comprehensive health services delivered within the framework of a standardized benefit package. Health purchasing alliances have already been implemented in eight states, and this trend is expected to grow. The following article illustrates the structure and authority of the health alliances that are already in operation, and is presented here to give Behavioral Healthcare Tomorrow journal readers an up-to-date overview of reforming healthcare markets. This matrix arrays recent state laws which we identify as clearly including components of managed competition or purchasing alliances. Other states undoubtedly have elements of reform that include some aspects of these concepts. For example, under legislation, a Vermont health care authority was established and, among other things, charged with developing two comprehensive reform proposals, one of which will involve multipayors and the other a single-payor system. Options will likely embody many of the activities of alliances. Vermont is not included in this matrix because these provisions are still in the developmental stage. PMID- 10141177 TI - Structural alternatives for providers to increase managed care business and service integration. PMID- 10141178 TI - Mental health services in the 21st century: challenges and vision. PMID- 10141179 TI - Setting the tone for HMO automation. Interview by Howard J. Anderson. AB - William W. McGuire, M.D., who heads United HealthCare Corp., sees information technology as an essential tool for improving the health care system. The managed care executive boils down the nation's health care reform challenge to this: "We need to achieve desired clinical outcomes at appropriate costs." To achieve this goal, United is using automation on several fronts. For example, it has developed its own electronic data interchange network to serve hospitals and clinics. And it's putting the finishing touches on a sophisticated new medical management information system to track cost, quality and patient satisfaction. PMID- 10141180 TI - Managed care's EDI challenge. AB - Because managed care plans have to compare themselves with others in price and quality, they are struggling with the issue of how to capture relevant data. Health maintenance organizations and others are attempting to build a consensus on ways to define, standardize and collect information on patient encounters before the federal government imposes mandates. "There's a revolution in managed care data collection," one HMO executive says. PMID- 10141181 TI - The payers' automation challenge. AB - Despite some success stories, most of the nation's 300 commercial insurers and hundreds of managed care plans are in the earliest stages of using electronic data interchange for health care transactions. However, there are some encouraging signs of progress in the effort to shift to EDI, as more payers offer providers incentives to automate. Payers blame the relatively slow progress on cost, the absence of universally accepted standard electronic formats and uncertainties over the political debate on health reform. But providers say many commercial payers are moving too slowly to automate and are expecting providers to bear too much of the financial burden. PMID- 10141182 TI - Moving down the path to electronic records. AB - The national debate over health care reform is drawing attention to how electronic records could improve the quality of care. After more than 20 years of sometimes frustrating effort, the pioneers in the movement to automate health care records are being joined by legions of others who are seeing the potential benefits of automation. In this special report, learn the latest developments in the computerized patient record movement. PMID- 10141183 TI - Demonstrating the value of electronic records. PMID- 10141185 TI - Sorting out the players in the standards movement. PMID- 10141184 TI - Volunteer standards groups ask Congress for a financial infusion. PMID- 10141186 TI - How EDI will redefine materials management. AB - Supply expenses and the related administrative costs are a big-ticket item for America's hospitals. As a result, more materials managers are investigating the use of EDI to cut overhead costs and minimize the need to keep huge stockpiles of supplies. In fact, some envision a day when the routine ordering of supplies will no longer be necessary. But getting there won't be easy. First, hospitals must make small, incremental steps toward automation. And these steps may be the hardest because they involve creating a new way of doing business. PMID- 10141187 TI - Homeless projects show value of electronic records. AB - Across the country, clinicians who have established health care outreach programs for the homeless are using computerized patient records to improve the quality of care delivered. Automated records are enabling providers to offer consistent case management to homeless patients who see many different doctors at many sites, including shelters and mobile clinics. The experience of those involved in these charitable efforts could provide valuable lessons for those attempting to phase in electronic records for the general population. PMID- 10141188 TI - Getting rid of paper pushing. AB - A hospital in Tacoma, Wash., is taking several steps toward streamlining its business office functions. For example, the hospital is transmitting 90% of its claims electronically and has automated the posting of remittance advice and the billing of Medicare secondary payers. "Eventually we'll have a paperless system; we won't push paper back and forth," the hospital's patient accounts manager says. PMID- 10141189 TI - Disaster plan gets real-life test. Interview by Karen Sandrick. PMID- 10141190 TI - Sorting out the Baby Bells' strategies. AB - After months of uncertainty, the seven regional Bell operating companies have divided into two camps: those that provide only the infrastructure for health care networks, and those that offer infrastructure along with other networking features, such as systems integration and central data repositories. In their quest for health care market share, the Bells face a number of obstacles. For example, they can't provide long-distance service, and they face restrictive rate regulations. In addition, increased interest in cable TV and wireless communication ventures has led some of the Bells to downsize their health care ambitions. PMID- 10141191 TI - Automation a vital component of new Minnesota networks. AB - Faced with state legislation aimed at controlling health care cost increases, providers and payers in Minnesota are joining forces to form capitated managed care networks. Mandated universal claim forms, standards development and data reporting requirements will virtually require that the newly emerging networks make extensive use of electronic data interchange. The health care industry is watching closely to see whether the state's experience can serve as a model. PMID- 10141192 TI - Sizing up the role POS (point-of-sale) devices will play. AB - As more providers attempt to automate such health care transactions as eligibility verification and claims filing, many are taking a look at point-of sale terminals. POS devices provide low-cost, user-friendly access to a variety of on-line information. But critics say personal computers and practice management software are better suited to complex claims processing. Still, some say there may be a place for both, with POS terminals in physicians' and dentists' front offices and PCs for claims processing in the back offices. PMID- 10141193 TI - EDI clears a path for simplifying workers' comp. AB - In an effort to cut costs in the paperchoked workers' compensation insurance system, states, insurers, employers and third-party administrators are testing new electronic data interchange applications. Proponents say EDI will not only reduce administrative costs, but also will speed the flow of information so that workers can receive proper care sooner and return to work faster. Two groups are developing standard electronic formats for workers' compensation transactions to simplify the conversion to EDI. PMID- 10141194 TI - Giving home care nurses a hand. AB - Parkview Episcopal Medical Center in Pueblo, Colo., joined forces with Patient Care Technologies of Atlanta to automate the hospital's home care department- traditionally one of the least automated areas of health care. Home care nurses using hand-held computers now make more home visits in the time previously devoted to paperwork. These extra visits generate $876,000 in additional annual revenues. What's more, automation has improved the quality of the home care division's record-keeping and patient care. PMID- 10141195 TI - The new star of cable TV: smart cards. AB - Cable television viewers in New York are tuning in to an unusual new ad campaign for health care smart cards. Berdy Medical Systems Inc. of Rochelle Park, N.J., is running the ads in the hopes that card-carrying consumers will press their physicians and hospitals to jump on the automation bandwagon and buy electronic records software. PMID- 10141196 TI - Automation keeps inner-city practice afloat. PMID- 10141197 TI - Health Data Management innovators 1994. AB - Throughout the country, innovative organizations are devising groundbreaking technology applications to cut administrative costs and improve the quality of care. For example, they are using EDI to eliminate paperwork and creating computerized patient records as the building blocks for health information networks. Health Data Management has singled out five organizations that are at the forefront in the application of automation. These include two provider groups, two payers and a research institute. PMID- 10141198 TI - Building a network on a legacy of teamwork. AB - The nine hospitals that belong to the Hospital Consortium of Greater Rochester have a long history of working together to control health care costs in this upstate New York community. Now they're focusing on creating an electronic health information network. The project has the support of major local employers, which want to keep unnecessary care to a minimum to reduce costs. Electronic networking also will support longstanding efforts in Rochester to ensure that hospitals don't needlessly duplicate services. And the network will allow providers to more easily draw on a treasure trove of information already stored in clinical data bases. PMID- 10141199 TI - How automation is breaking the cash flow logjam. AB - As financially strapped hospitals look for ways to improve their cash flow, they are turning to automation to streamline claims processing and shorten the payment cycle. By using the latest automation tools, hospital business offices are making the most of their limited staff resources. PMID- 10141200 TI - Drawing two conclusions on pen computers. AB - In a modern version of David and Goliath, backers of hand-held pen computers hope to make serious inroads against well-established computer workstations. A start up company, Practice Technology Inc., wants to build information networks based on pen computing. But it's going up against well-established network vendors that are relying on PC-based systems. Meanwhile, two pen computer manufacturers have stopped producing those devices, citing lack of demand. PMID- 10141201 TI - Making the most of a translator. AB - Anaheim Memorial Hospital in California is a trailblazer. It's one of the first hospitals in the nation to use translation software for both supply procurement and claims-related transactions. Initially, it acquired the software to streamline the ordering of supplies by shifting to standard electronic formats. Today, the hospital is using the software to receive electronic remittance advice, and it has plans for other labor-saving applications. PMID- 10141202 TI - Telemedicine is poised to revolutionize the practice of medicine. AB - Telemedicine--the application of audiovisual technology to patient care and medical education--has tremendous potential benefits, especially in linking doctors in remote rural locations to specialists in urban areas. The technology permits remote examinations and diagnoses of patients and continuing education for rural doctors. And there's potential for long-term savings by eliminating some hospital stays and reducing transportation costs. Telemedicine projects are multiplying as they become more economically feasible, thanks to new technology. PMID- 10141204 TI - GTE's growing stake in health care. PMID- 10141203 TI - Group Health's $100 million automation initiative. AB - Group Health Cooperative of Puget Sound, a large regional health maintenance organization in the Pacific Northwest, is so convinced that automation holds the key to improved patient care that it plans to spend $100 million on new information systems in the next five years. A shift to computerized patient records will place clinical practice guidelines at doctors' fingertips. And a wide variety of other functions will be automated, including claims processing. PMID- 10141205 TI - JCAHO surveys in 1995--collaboration for real. PMID- 10141206 TI - Outpatient case management: phase two of a three-part model. PMID- 10141207 TI - Heartlight: reaching out to grieving children--in two languages. PMID- 10141208 TI - Hospice--an option for patients with advanced AIDS. PMID- 10141210 TI - The honeymoon is over for many PHOs now coping with unresolved financial issues. PMID- 10141209 TI - Provider-owned HMOs target unsaturated markets. PMID- 10141211 TI - Leaner management structures prepare hospitals for change. PMID- 10141212 TI - Physician resource planning must keep pace with evolving markets. PMID- 10141213 TI - Board education borrows from adult learning: the board's role and CQI. PMID- 10141214 TI - PPO option will attract Medicare beneficiaries to integrated systems. PMID- 10141215 TI - Hospital's units combine CCTV, alarms to protect grounds, parking areas. PMID- 10141216 TI - Cause of Legionnaire's Disease outbreak at hospital traced. AB - The cause of an outbreak of Legionnaire's Disease at St. Vincent's Medical Center, Bridgeport, CT, has been traced to the hospital's hot water system after months of testing and decontamination efforts. A total of 28 patients were diagnosed with the disease between January and October 1994, with most of the cases occurring in June and July. Legionnaire's Disease is a kind of pneumonia caused by bacteria that thrive in warm water and can become airborne on tiny water droplets that, if inhaled, spread the disease. PMID- 10141217 TI - Security/safety updated at two children's hospitals--large and small. PMID- 10141218 TI - Growing use of keypad access systems for pharmacies reported by VA. PMID- 10141219 TI - Medicare--earned necessity or government dole? PMID- 10141220 TI - Internists and the future of Medicare. PMID- 10141221 TI - When patients have a legal right to die. Interview by C. Burns Roehrig. PMID- 10141223 TI - Ways of managing your health care. American Society of Internal Medicine. PMID- 10141222 TI - Cutting Federal programs and red tape: seeking the right balance. PMID- 10141225 TI - Primary suspect. PMID- 10141224 TI - What cannot go on forever must stop: Medicare and the federal budget. PMID- 10141226 TI - Health Management Awards. Energy and innovation were high on the list in this year's Journal awards for managerial excellence. PMID- 10141227 TI - Emergency admissions. In the fast lane. PMID- 10141228 TI - Maternity services. Baby boon. PMID- 10141229 TI - Guidelines. The good guide to guides. PMID- 10141230 TI - Primary care. Open for business. PMID- 10141231 TI - Clinicians in contracting. Seeking medical advice. PMID- 10141232 TI - Mental health. Another time, another place. PMID- 10141233 TI - Exercise. Partners in action. PMID- 10141234 TI - Ethnic minority health. Unsound barrier. PMID- 10141235 TI - Restructuring. 3. Decentralisation--purchasing. PMID- 10141237 TI - Day surgery. A change of setting. PMID- 10141236 TI - Data briefing. Waiting for fairness. PMID- 10141238 TI - How the tables have turned. PMID- 10141239 TI - Purchasing. Pull the other one. PMID- 10141240 TI - Outsourcing. Inside out, upside down. PMID- 10141241 TI - Patient records. Record achievement. PMID- 10141242 TI - Restructuring. 4. A catalyst for change--fundholding. PMID- 10141243 TI - Community care. Coming apart at the seams. PMID- 10141244 TI - Acute beds. Bedtime stories. PMID- 10141245 TI - Hospital discharge. On the panel. PMID- 10141246 TI - Armenia. Moving heaven and earth. PMID- 10141247 TI - Law. No win, no fee. PMID- 10141248 TI - The changing relationship between health care professionals and the pharmaceutical industry. AB - Although UCLA had established policies and procedures for visiting pharmaceutical representatives, changes in both the pharmaceutical business environment and in UCLA's physical environment mandated an update. To deal with the changes, a multidisciplinary team comprised of various departmental staff members met to develop a new vendor representative visitation policy that included the practice of drug sample distribution. More stringent registration requirements and shared responsibility for policy enforcement are the key elements of the new policy. PMID- 10141250 TI - The drive to reform the FDA gains momentum. PMID- 10141249 TI - Who should conduct outcomes research? PMID- 10141251 TI - The use of economic evaluation in health care: Australian decision makers' perceptions. AB - Decision making about the alternative uses of health care resources is an issue of critical concern for governments and administrators in all health care systems. While many factors need to be taken into consideration when making these decisions, economic evaluation can help to determine the relative efficiency of different choices. Research in various countries suggests that economic evaluation is not being used by health care decision makers to the extent that health economists think that it should be. Interest in the use of economic evaluation is increasing in Australia but, to date, there has been no Australian research which looks at its use from the point of view of its potential users- the decision makers. This study fills that gap. It was found that there was a high level of awareness of economic evaluation among the group of decision makers interviewed and that some had used it in their decision making. However decisions often have to be made quickly and take into account factors other than efficiency, hence limiting the use of economics. Other problems limiting its use were availability of data and lack of expertise. Those interviewed suggested a number of ways in which the problems they identified could be overcome. In particular, they recommended that researchers doing economic evaluations should be more responsive to the needs of the decision makers using them. PMID- 10141252 TI - A critical review of health-related economic evaluations in Australia: implications for health policy. AB - In Australia, as in many other countries, economic evaluation is increasingly seen by health care policy makers as a useful aid to priority setting and resource allocation. In Australia, economic evaluation is now a requirement for new drugs to be listed on the Pharmaceutical Benefits Scheme which provides a government subsidy on the price of listed drugs for purchasers. Yet, despite recognition of the importance of economic evaluation by policy makers, there is a paucity of published evaluations in Australia. We reviewed all of the 33 health related economic evaluations conducted in Australia and subsequently published since 1978. This study assesses how well informed decision makers might be if they used the results and conclusions of published economic evaluations as an aid to resource allocation. The review highlights several issues: (i) it is difficult to interpret the conclusions or assess the generalisability of individual papers without information on the context of the original study; (ii) the choice of comparator(s) was often unexplained and most papers did not employ marginal analysis; (iii) in the absence of marginal analysis, the comparability of cost effectiveness ratios in league tables must be questioned as well as the completeness (were all the relevant alternatives included?) of studies; and (iv) the quality of effectiveness evidence varies enormously, with some authors content to use the best available evidence (even if it is of poor quality). The development of standards for economic evaluation methods might ensure a more consistent and scientific approach to evaluative work, but they cannot guarantee it. A more concerted effort to disseminate the principles and methods of economic evaluation to policy makers and non-economist evaluators might be a more important precursor to improving the credibility and usefulness of economic evaluations in priority setting. PMID- 10141253 TI - AIDS scenarios for The Netherlands; the economic impact on hospitals. AB - OBJECTIVE: To assess the economic impact of HIV/AIDS on the health care system in The Netherlands. DATA AND METHODS: Two types of data are used: (i) routine surveillance data on AIDS incidence and (ii) information on hospital resource utilisation and corresponding monetary costs. Progression of disease is modelled using a multi-stage model, with stages corresponding to clinical classifications and to different phases of health care need. Economic impact is analysed for all stages in three scenarios: the reference and two alternative scenarios. RESULTS: In the year 2000 hospital bed need would reach 220 beds if yearly new HIV infections in the 1990s remain at the level estimated for the end of the 1980s, and if the intensity of hospital care remains constant. A minimum need of 125 beds is projected if no new HIV infections occur in the 1990s. Hospital costs in 1993 are estimated to amount to 33.8 million ECUs. Scenarios indicate a range of 26.7-50.7 million ECUs for the year 2000 (price level: 1993). The proportion of the costs of hospital inpatient care and cure in total hospital costs increases, whereas the proportion for outpatient services decreases. CONCLUSIONS: Projected hospital bed need of 125-220 for HIV/AIDS in the year 2000 is limited compared to the projections for coronary heart disease and stroke, but approaches that for lung cancer, pneumonia and diabetes. We estimate hospital costs to have been 85% of total health care costs for HIV/AIDS in 1993. In 1993, the estimated proportions in hospital costs are 41% for inpatient care, 20% for inpatient cure and 39% for outpatient facilities. Our scenarios indicate a decreasing share of outpatient costs--possibly to 30% of total hospital costs for HIV/AIDS in 2000- illustrating the growing relative importance of the AIDS stage for the hospital costs. We project hospital costs for HIV/AIDS in 2000 to reach up to 0.53% of projected hospital costs for all diseases. A present value of 38 million ECUs (23%) of hospital costs projected in the reference scenario might be avoidable, during the period 1994-2000. However, with unchanged treatment patterns a present value of 127 million ECUs for hospital costs during the same period is projected to represent unavoidable costs (discount rate: 5%). In The Netherlands, data needs in the field of economic impact assessment of HIV/AIDS especially refer to registrations of non-hospital outpatient resource utilisation and costs. PMID- 10141254 TI - Negotiating fees for medical specialists in The Netherlands. AB - This article presents an analysis of the negotiations on fees for medical specialists in the Netherlands since the introduction of the Law on Health Care Charges (WTG) in 1982. The peculiar position of the medical specialists and the institutional setting of the negotiations have produced a complex decision making process. Negotiations between the government and the health insurers on the one hand and the association of medical specialists on the other hand have been dominated by deep conflicts which were sometimes settled by temporary "peace contracts'. Attention is paid to the policy network, to the participants in the network and their principal goals, to the strategic use of the WTG by each participant and to the political effectiveness of the WTG. The article ends with a short overview of some recent developments and a sketch of three alternative scenarios on the future of the payment for specialist care. PMID- 10141255 TI - WI system moves fast to build prototype outpatient center in a growing area ... Aurora Health Center, Kenosha, WI. PMID- 10141256 TI - Northwestern Memorial's redevelopment project: swimming against the tide or sailing into the future?. Interview by Ellen Weisman. PMID- 10141257 TI - Future schlock. Will willy-nilly investments in ambulatory care facilities today result in even more problems tomorrow? Two case studies provide telling insights. PMID- 10141258 TI - Location, location, location! Where to locate ambulatory care facilities? Five different models offer varying advantages and disadvantages. PMID- 10141259 TI - The meaning of greening ... roundtable discussion. PMID- 10141260 TI - Beyond compliance: environmental issues critical for providing high-quality health care. PMID- 10141261 TI - Code compliance complicates (but need not cancel) exit sign update. PMID- 10141262 TI - Team cleaning and indoor air quality: where the twain meet. Second of two parts. PMID- 10141264 TI - Staff training helps minimize fire's danger to life and property. PMID- 10141263 TI - Vacuuming. The single most important component of any carpet maintenance program. PMID- 10141265 TI - Study shows who makes the decisions on software. PMID- 10141266 TI - Hospital averts UST (underground storage tank) liability by creating an AST (aboveground storage tank) tank farm. PMID- 10141267 TI - Service coordination in mental health systems for children, youth, and families: progress, problems, prospects. AB - The present article focuses on critical issues in the provision of service coordination to children and youth with serious emotional disabilities (SED) and their families, particularly those concerns most relevant to program organization and administration. Perspectives and issues gleaned from a review of evaluative data, focus group discussions with service coordinators and their supervisors, and clinical and administrative experience within a statewide SED initiative are considered in three areas: (1) roles, responsibilities, and relationships; (2) organizational context; and (3) training and supervision. Recommendations for enhancement of child, youth, and family mental health service coordination are provided. PMID- 10141268 TI - Holding on to success: a case study in mental health care reform. AB - This article analyzes the changes experienced by a mental health care organization in response to environmental threats and fluctuating expectations. On a general, more theoretical level, the article demonstrates how processes of environmental selection as well as organizational adaptation shape organizational forms. On a concrete, applied level, those administrative practices are articulated that can help ensure that reform efforts are successful. Administrators also must be aware of the inertial forces operating upon stable organizational forms and work to ensure that the organization remains vital and open to change. PMID- 10141269 TI - Description of a geriatric medical/psychiatry unit in a small community general hospital. AB - This article describes a geriatric medical/psychiatry inpatient unit (GMPU) in a small community general hospital. A program description and data from the second year of the unit's operation are presented. The GMPU provides comprehensive geriatric assessment and interdisciplinary treatment for frail, medically ill elderly patients with neuropsychiatric disorders. Many of the patients have dementia or other neurobehavioral disorders, and most reside in nursing homes. The GMPU provides a valuable clinical link in the continuum of care for the elderly. Moreover, it has proven to be an economically viable financial asset for the hospital. PMID- 10141270 TI - Assertive outreach for frequent users of psychiatric hospitals: a meta-analysis. AB - A meta-analysis was conducted on nine studies of an assertive outreach model for frequent users of psychiatric hospitals. Four studies used experimental or quasi experimental designs and five used pre-post designs. Findings at one-year follow up were examined for retention in community mental health services, psychiatric inpatient days, quality of life, and client level of functioning. Eighty-four percent of assertive outreach clients were still receiving mental health services after one year, compared to 54% of controls. In two thirds of the programs, the mean annual rate of inpatient days declined by 50% or more. The overall experimental effect size for quality of life was negligible, although changes over time for assertive outreach clients were more encouraging. Similarly, improvement in level of functioning was found for assertive outreach clients. The study examining experimental differences in level of functioning obtained a nonsignificant moderate effect. PMID- 10141271 TI - Evaluating program design in the state hospital setting. AB - This study used a benchmarking and goal attainment approach to identify the extent to which two state hospital-based programs were doing what they were intended to do. The 1989 version of the Moos Ward Atmosphere Scale (WAS) was used to collect information from staff and patients in resocialization and admissions programs. Analysis of variance revealed differences between and within programs, and t tests revealed differences between the study sample and the WAS norms. Program descriptions, information from the literature, and features of the measurement scale were used to interpret the findings and develop recommendations for improvements. PMID- 10141272 TI - Implementing psychosocial rehabilitation in long-term inpatient psychiatric facilities. AB - Using the focus group methodology, data were gathered from the initial experiences of Missouri's four long-term psychiatric facilities with psychosocial rehabilitation (PSR). Significant implementation factors include the establishment of a firm PSR philosophical base; extensive staff training in PSR values, technologies, and the skills necessary to implement the technologies; support for staff as their roles change with the adoption of PSR; adaptation of PSR for use with forensic clients; use of community resources while clients are still inpatients; maintenance of PSR values and skills learned after clients are released into the community; and the establishment of a program evaluation system that assesses both outcome and process. Clients residing in long-term, public psychiatric facilities also can receive substantial benefits from this approach to service delivery. PMID- 10141273 TI - Regional variation in service system performance: comparing the perceptions of key stakeholders. AB - Area variation studies rarely focus on perceptions of service system performance in their comparative analyses. Using an instrument designed specifically for assessing key stakeholders' perceptions of the performance of mental health service delivery systems, this study compared three areas in Massachusetts that differ significantly with regard to service system structure and resource allocation. Despite these differences, key stakeholders' perceptions of service adequacy, availability, quality, and coordination did not vary substantially, although the findings suggest that to some extent organizational structure may have more effect than resource availability and allocation on perceptions of key stakeholders within the three systems. These differences were also of far less magnitude than differences in hospitalization rates and other more traditional measures of service system performance. The authors argue that stakeholders' perceptions should be considered, along with other standard performance measures, in evaluating service system performance. PMID- 10141274 TI - Health care reform: implications for academic psychiatric institutions. AB - Health care reform provides an opportunity to redefine all aspects of our health care delivery system. This article focuses on mental health services and on the implications of health care reform for academic psychiatric institutions. Questions are raised regarding the challenges that academic psychiatric centers will face in pursuing the traditional responsibilities of research, education, and clinical care. The authors propose that intersystems dialogue will create solutions to the questions. The challenge to academic psychiatric institutions rests in creating the dialogue that will inform and guide new decisions regarding research, education, and clinical priorities with the ultimate aim of ensuring that quality is preserved through reform. PMID- 10141275 TI - Medical and health care needs of families providing in-home care for relatives with developmental disabilities. AB - The purpose of this investigation was to attempt to describe the health care needs of families providing in-home care to members with developmental disabilities as well as the characteristics and demographics of families providing in-home care. The survey included 761 families who participated in a federal demonstration project in rural southern Georgia. The results indicated that impoverished families need increased assistance to provide adequate medical and health care when providing in-home care to relatives experiencing developmental disabilities. Implications for administration of programs and development of policies are discussed. PMID- 10141276 TI - Legislative and policy strategies for supporting rural health network development: lessons from the 103rd Congress. AB - There was considerable support in most major health reform bills considered by the 103rd Congress for the development of rural integrated service networks. The demise of comprehensive health reform, together with the pace of current market driven changes in the health care system, suggests the need to assess the impact of specific policy strategies considered in the last Congress on rural integrated service network development. Toward this end, this article evaluates the rural health policy strategies of the major bills in relation to three essential preconditions for the development of rural integrated service networks: (1) the need for a more stable financial base for rural providers; (2) the need for administrative, service and clinical capacity to mount a successful network; and finally, (3) the need for appropriate market areas to ensure fair competition among networks and plans. Key policy strategies for supporting rural network development include reform of insurance and payment policies, expansion of targeted support and technical assistance to the underserved, limited-capacity rural areas, and policies governing purchasing groups or alliances that will ensure appropriate treatment of rural providers and networks. PMID- 10141277 TI - Lessons from the Essential Access Community Hospital Program for rural health network development. AB - The Essential Access Community Hospital (EACH) Program is testing a concept for limited-service hospitals established under Medicare called the Rural Primary Care Hospital (RPCH). The program uses cost-based reimbursement and relaxed regulatory requirements to help low-volume rural hospitals shift emphasis from acute care to primary care and emergency services. RPCHs must form "horizontal" networks with larger hospitals and may form "vertical" arrangements with ambulatory service providers and practitioners. A small number of rural hospitals have converted to the RPCH status since the program entered the implementation stage in late 1993. It is unclear how many other hospitals will convert given uncertainty regarding the financial impact of RPCH conversion and concerns with certain requirements. The program illustrates how payment policies can provide incentives for network development and reflects the importance of physician involvement and technical assistance in developing limited-service hospitals. In addition, it appears that EACH/RPCH networks that form under the program may serve as building blocks for broader networks, as the seven states involved in the program look to develop rural health networks that go beyond the EACH/RPCH model. PMID- 10141278 TI - Rural health networks in Florida. AB - This article describes the development of rural health networks in Florida, which has adopted formal policies to support these networks. First, the history and content of the relevant legislation are described. The current networks are identified and their development to date summarized. Finally, a detailed case study is employed to outline the steps taken to establish one network. PMID- 10141279 TI - A 10-point strategic checklist for rural health care systems. AB - A checklist format is used to provide a framework for rural hospital executives and community members for gauging the health and stability of rural hospitals and rural hospital systems. Benchmarks are provided for financial and operational performance and emphasis is placed on medical staff size and physician recruitment. Physician/hospital organizations and regional partnerships are used as examples of strategies available to rural providers. The importance of market knowledge and regional strategic alliances also is stressed. In an era of dwindling resources and tight reimbursement, rural providers are encouraged to consider cooperative clinical programming and technology consolidation. PMID- 10141280 TI - Two decades of experience in the University of Washington Family Medicine Residency Network: practice differences between graduates in rural and urban locations. AB - This study describes how graduates of the University of Washington Family Medicine Residency Network who practice in rural locations differ from their urban counterparts in demographic characteristics, practice organization, practice content and scope of services, and satisfaction. Five hundred and three civilian medical graduates who completed their residencies between 1973 and 1990 responded to a 27-item questionnaire sent in 1992 (84% response rate). Graduates practicing outside the United States in a specialty other than family medicine or for fewer than 20 hours per week in direct patient care were excluded from the main study, leaving 116 rural and 278 urban graduates in the study. Thirty percent of graduates reported practicing in rural counties at the time of the survey. Rural graduates were more likely to be in private and solo practices than urban graduates. Rural graduates spent more time in patient care and on call, performed a broader range of procedures, and were more likely to practice obstetrics than urban graduates. Fewer graduates in rural practice were women. A greater proportion of rural graduates had been defendants in medical malpractice suits. The more independent and isolated private and solo practice settings of rural graduates require more practice management skills and support. Rural graduates' broader scope of practice requires training in a full range of procedures and inpatient care, as well as ambulatory care. Rural communities and hospitals also need to develop more flexible practice opportunities, including salaried and part-time positions, to facilitate recruitment and retention of physicians, especially women. PMID- 10141281 TI - Measuring and evaluating the performance of vertically integrated rural health networks. AB - The growing interest in health care networks is extraordinary given the lack of a common understanding of what networks are and what they can accomplish. The purpose of this article is to develop a conceptual approach to the study of vertically integrated rural health networks. This article provides a network typology, a framework for assessing network performance, and examples of measurable performance indicators. It concludes with a description of the salient research questions that need to be addressed concerning the relationships between the environment, structure, and performance of vertically integrated rural health networks. PMID- 10141282 TI - A study of attitudes and perceptions of volunteers in nonprofit organizations. PMID- 10141283 TI - Elder abuse peer support partners: a family violence prevention strategy utilizing volunteers. AB - The Elder Abuse Resource Centre, a program of the Winnipeg, Manitoba-based Age & Opportunity Inc., provides counselling, information/referral, community education and research and data collection services related to family violence issues that affect older adults (60+). Volunteers have been involved in every aspect of the Centre's operations since its inception in 1990 and are key to the Centre's existence. This article will describe the Elder Abuse Resource Centre's Peer Support Volunteer Program, beginning with the rationale for establishing this vital volunteer position. The primary role that training has played in maintaining a quality volunteer program will also be addressed. PMID- 10141284 TI - Thomas urges shifts in residency financing. PMID- 10141285 TI - House passes welfare reforms; Medicaid trims total $8.5 billion. PMID- 10141286 TI - N.Y. provider protests take on new urgency. PMID- 10141287 TI - VA: regrouping facilities would cut costs, staff. PMID- 10141288 TI - Blues plans expand reach in Midwest. PMID- 10141289 TI - In changing Ind. market, hospital seeks affiliation. PMID- 10141290 TI - Calif. PPO grows with acquisitions. PMID- 10141291 TI - HEDIS is updated to ease data collection. PMID- 10141293 TI - Hawaiian lure could be a lei and a stethoscope. PMID- 10141292 TI - HHS plans further study of subacute-care sector. PMID- 10141294 TI - Hospitals shouldn't sacrifice patient needs to lower costs. PMID- 10141295 TI - Healthcare by design. Construction survey finds providers concentrating on the future. AB - Spending on design and the development of master plans helped build up the healthcare construction market last year, according to Modern Healthcare's Construction & Design Survey. Executives are looking for facility design to contribute to overall cost-effectiveness. PMID- 10141296 TI - House GOP: cuts needed to keep Medicare program afloat. PMID- 10141297 TI - Republicans want Wilensky to head merged PPRC, ProPAC. PMID- 10141298 TI - Proposed outpatient PPS outlined. PMID- 10141299 TI - FBI seeks power to make health fraud more costly. PMID- 10141300 TI - Ga. hospital may face grand jury probe. PMID- 10141301 TI - Accounting rule changes to be more than marginal. PMID- 10141302 TI - Catholic system merger approved. PMID- 10141303 TI - Cleveland Clinic takes on partner. PMID- 10141304 TI - HCFA seeks managed-care measure. PMID- 10141305 TI - Federation aims to broaden base. PMID- 10141306 TI - Hillhaven Corp. seeks new suitors. PMID- 10141307 TI - Calif. rejects full risk for providers. PMID- 10141308 TI - HMOs reduce service use--study. PMID- 10141309 TI - Psych companies take steps to boost appeal to investors. PMID- 10141310 TI - Report weighs fitness-center issues. PMID- 10141311 TI - Cancer center's bonds unaffected by uproar. PMID- 10141312 TI - Senate malpractice bill lacks provision passed by House. PMID- 10141313 TI - Teaching hospitals warn shift to primary care may hurt specialist programs. PMID- 10141314 TI - Sharp HealthCare cancels AHA membership. PMID- 10141315 TI - Two large Calif. HMOs close to mega-merger. PMID- 10141316 TI - Integrated Health's growth keeps company in spotlight. PMID- 10141317 TI - Texas, Louisiana in scramble to overhaul Medicaid systems. PMID- 10141318 TI - TennCare hit on cuts in payments. PMID- 10141319 TI - AMA, MGMA to team up. PMID- 10141320 TI - Study links bigger size, bigger probability of profit. PMID- 10141321 TI - Children's hospital struggles to recoup TennCare treatment costs. PMID- 10141322 TI - Ind. hospitals question allegations. PMID- 10141323 TI - Group Health nurses allege lockout. PMID- 10141324 TI - AHA board approves convention changes. PMID- 10141325 TI - Judge rejects request to block Columbia-Healthtrust merger. PMID- 10141326 TI - Hospital strikes fewer but nastier. PMID- 10141327 TI - Hospitals play key role in slowing TB spread. PMID- 10141328 TI - N.J. hospitals adopt a strategy of the more networks the merrier. PMID- 10141329 TI - Hospitals' advertising spending up 11.4%. PMID- 10141330 TI - Canadians experience pain of healthcare cuts. PMID- 10141331 TI - Hillhaven reports earnings. PMID- 10141333 TI - Town fights loss of hospital services. PMID- 10141332 TI - Wis. clinic disputes antitrust ruling. PMID- 10141334 TI - Effects of proposed cuts vary per state, GOP finds. PMID- 10141335 TI - Teaching hospitals fear Medicare voucher plan. PMID- 10141336 TI - Reform still within reach. PMID- 10141338 TI - Capitation to shift boards' priorities. PMID- 10141337 TI - Medicare: the final frontier for HMOs. AB - Medicare is one of the final frontiers for HMOs. And with Congress indicating a willingness to consider changes in Medicare risk contracting, the senior-citizen population is drawing the interest of managed-care plans nationwide. PMID- 10141339 TI - Survey gives nod to system boards. PMID- 10141340 TI - Clinical errors humble hospitals. PMID- 10141341 TI - Equifax, Microsoft: same mission, different focus. PMID- 10141342 TI - Hospices play bigger role in care continuum. PMID- 10141343 TI - ORex may wash away waste disposal problem. PMID- 10141344 TI - The disease busters. PMID- 10141345 TI - Nurse telephone screening of new Medicare HMO members: a pilot program. AB - Members newly enrolled in an HMO and covered under a Medicare risk contract were screened over the telephone by a registered nurse within their first month of membership to assess whether screening could lead to early intervention and later reduce utilization of health care services. This pilot study screened 36 patients (mean age = 71 years) constituting 25.2% of the new Medicare members during the period of study. Health care encounters were tracked for the first 6 months of membership. A historical comparison group included 32 patients (mean age = 72.6 years) who had enrolled 1 year earlier. A retrospective chart review determined the number of health care encounters during the comparison group's first 6 months of membership. Episodes of health care service utilization were fewer among the screening group than among the comparison group in all areas studied. This pilot study suggests the potential benefit of screening and early intervention by health care providers. PMID- 10141346 TI - Improving management of hyperemesis gravidarum. PMID- 10141347 TI - Technology assessment at the Institute for Clinical Systems Integration and HealthPartners. AB - The Technology Assessment Committee of the Institute for Clinical Systems Integration (ICSI) draws upon the resources of many different groups and in turn, keeps the groups informed about new medical treatments, devices, and procedures. This new Minneapolis-based technology assessment committee uses a collaborative effort to serve the information needs of many employer groups, patients, providers, and health care organizations in the area. This committee serves as the principal mechanism by which new medical and surgical procedures, devices, and treatments, as well as new applications of old but unproved or doubtful applications of existing technologies are reviewed for medical appropriateness at ICSI (a nonprofit quality improvement organization) and at HealthPartners (a combined staff and group model HMO in Minnesota). PMID- 10141348 TI - Chiropractic services in HMOs. PMID- 10141349 TI - The benefits of a home parenteral nutrition team. PMID- 10141350 TI - An integrated continuum of care. PMID- 10141351 TI - Management of patients with diabetes by nurses with support of subspecialists. AB - A program was developed for managing diabetic patients within an HMO system. The system uses physician-supervised diabetes nurse specialists and a computer system to enhance compliance and management of patients. The focus of the program is on preventing hospitalizations as well as preventing the development of the complications of diabetes, with early detection (and treatment) of any complications that do occur. The program was associated with a significant fall in glycated hemoglobin levels (12.5% to 9.5%, p < 0.005) and led to likely cost savings by avoiding acute hospitalizations for diabetes in an estimated 244 patients over a 4-year period. PMID- 10141352 TI - Integrated physician networks. PMID- 10141353 TI - Who cares about that black box anyway? The access manager's role in selecting a computer system. PMID- 10141354 TI - Outcomes: buzzword or practical tool? PMID- 10141355 TI - Strategies for rehabilitation services in today's environment. PMID- 10141356 TI - Confronting the challenge of change brought about by managed care and market driven reforms. PMID- 10141357 TI - Capitation is in your future. PMID- 10141358 TI - Impact of specialty consults on length of stay and cost-per-case. AB - The authors hypothesize that consultation of medical specialists in two departments results in a decrease in length of stay and a corresponding decrease in cost-per-case. The two departments where this investigation took place were the departments of Gastroenterology and Infectious Disease at the Cleveland Clinic Foundation. The Decision Support System, Transition Systems, Inc., was used in analyzing the information. PMID- 10141359 TI - US coding professional visits the Land Down Under. PMID- 10141360 TI - Proposed 1996 standards for long term care; update on other accreditation programs. PMID- 10141362 TI - Beyond e-mail. PMID- 10141361 TI - A star is born in Virginia. PMID- 10141363 TI - Core system selection process: HIM involvement. PMID- 10141364 TI - Assessing allied health data needs. PMID- 10141365 TI - The establishment of clinical data management. PMID- 10141366 TI - The integrated client encounter system: a strategic approach to documentation of public health services. PMID- 10141367 TI - Fulfilling the curricular intent. PMID- 10141368 TI - Are TQM and reengineering really different? PMID- 10141369 TI - Dividends from a total quality initiative at a rehabilitation health care system. PMID- 10141370 TI - Using the Baldrige criteria as a self-assessment tool: a case study from the University of Michigan Medical Center. PMID- 10141371 TI - Ten commandments of TQM. PMID- 10141372 TI - How a regional health provider uses information technology to meet its strategic objectives. PMID- 10141373 TI - The use of computerized risk adjustment tools in clinical process improvement. PMID- 10141374 TI - Relationships among quality assurance, quality improvement, and reengineering. PMID- 10141375 TI - Experiences in implementing an electronic meeting room. PMID- 10141376 TI - Preparing a successful satisfaction survey. PMID- 10141377 TI - Automating total quality management. PMID- 10141378 TI - Selecting quality improvement projects: the dimensions of impact scale. PMID- 10141379 TI - The disturbing case of the cure that killed the patient. PMID- 10141380 TI - Doctors and patients: breaking down the walls. PMID- 10141381 TI - Helping the terminally ill face death with dignity. PMID- 10141382 TI - Making patients part of their healthcare team. PMID- 10141383 TI - Network participation by employees of managed care organizations: good business judgement or a prohibited transaction under ERISA? Part II. AB - Merely steering hospital employees into a network in which a hospital participates may violate the prohibited transaction rules and require a close examination of the structure of the network. PMID- 10141384 TI - Medical office staff: the forgotten members of the provider network. AB - Medical office management personnel provide a critical link between non-staff model managed care organizations and physician groups or small practices. These front-line professionals serve not only as the conduit between the health plan and the provider, but they are usually the first contact a patient has with a particular health plan. PMID- 10141386 TI - Is confidentiality of the computerized patient record something that cannot be achieved, and does it really matter? PMID- 10141385 TI - Alternative approaches to hysterectomy: clinical and economic implications for managed care. AB - Hysterectomy is one of the most frequently performed surgical procedures in the United States. Through advances in pharmacological and surgical technologies, opportunities now exist for converting selected hysterectomies from the traditional abdominal approach to vaginal or laparoscopically-assisted vaginal procedures. Such conversions may lead to diminished operative morbidity, fewer hospital days, a decreased period of convalescence, and the opportunity for cost savings. This paper reviews current clinical thought on the subject and considers the economic effect for providers of care. PMID- 10141387 TI - The growth of prescription drug costs and national health expenditures. PMID- 10141388 TI - A conversation with David Nash, MD. PMID- 10141389 TI - Establishing a statewide primary care network: the PrimaryOne experience. AB - To insure that patients receive the highest quality, cost-effective health care in the future, primary care physicians must become the leaders in the reform. The future of medicine belongs in physicians' hands. Physicians have the opportunity to bring about the greatest reform to the largest industry in the world, and do it in such a fashion that patient care is not compromised. The following article describes the purpose, objectives, organizational structure, accomplishments, philosophy, goals, results, and future of PrimaryOne and its HMO, PrimeONE. PMID- 10141390 TI - DUR applications in managed care. AB - Dr. Navarro suggests that although our efforts to automate systems can enhance the velocity and volume of DUR and DUE projects, the soul of DUR lies not with technology, but rather with the robustness of the database, the program methodology and assumptions, and the clinical skills of the pharmacists. PMID- 10141391 TI - Drug utilization review in the managed care environment. AB - Traditional drug use evaluation (DUE) and Medicaid drug utilization review (DUR) prototypes do not meet the needs of managed care organizations. yet, creating entirely new systems for measuring quality drug use in managed care, such as HEDIS, needlessly discards the good clinical foundations already built in the other health care settings. A better solution would be for managed care to apply its hallmark traits, namely state-of-the-art electronic data management systems, integrated health care system interchange, and strong customer communication, to make the DUR process better. A strong union between clinical criteria and sophisticated health care management can revolutionize the DUR/DUE process. PMID- 10141392 TI - Toward the behavioral health report card. AB - In this article, the authors review current organized efforts, strategies, and partnerships involved in attempts to design a behavioral health care report card that offers a comprehensive approach to obtaining performance measurements in the fields of psychiatry and chemical dependence treatment. PMID- 10141393 TI - Two feet of mistakes. Medicine: How to police serious errors by doctors? PMID- 10141394 TI - Factors associated with nonprescription of evolving modes of therapy--a model for drug use evaluation in hospitalized medical patients. AB - OBJECTIVE: To measure the rate of inappropriate underuse of drug therapy among hospitalized patients and to identify factors associated with nonprescription of two effective modes of therapy. DESIGN: A survey was conducted by retrospective chart extraction to measure the rates of nonprescription of two therapeutic modalities--aspirin and angiotensin converting enzyme inhibitors. Stepwise logistic regression was used to determine which factors were significantly associated with nonprescription of either drug. SETTING: Two internal medicine departments in a major community and referral hospital in Israel. PATIENTS: Those who were hospitalized through 1990 with a diagnosis on their discharge sheet of angina pectoris or congestive heart failure. A random sample selection was made to define the study population. RESULTS: The rates of nonprescription among patients in whom there are no drug contraindications were 54% (95% CI 47-62) for aspirin and 34% (95% CI 27-41) for angiotensin converting enzyme inhibitors. Three variables correlated independently with nonprescription of both drugs: hospitalization in ward B, nonuse of the drug prior to hospitalization, and secondary priority of the diagnosis angina pectoris or congestive heart failure on discharge sheet. CONCLUSIONS: Nonprescription of essential drugs is a common phenomenon that varies significantly among physicians. Inconsistency in application of knowledge to clinical practice, as well as a diversity of approaches toward interpretations of clinical study results, significantly influences the prescription rates of evolving modes of therapy. PMID- 10141395 TI - Review: feedback about practice patterns for measurable improvements in quality of care--a challenge for PROs under the Health Care Quality Improvement Program. AB - The Health Care Quality Improvement Program (HCQIP), administered by the Health Care Financing Administration and implemented through Utilization and Quality Control Peer Review Organizations (PROs), is a new approach to monitoring the health care received by Medicare beneficiaries. The HCQIP shifts the focus of the PRO program from regulatory quality management to quality improvement principles. Through a series of cooperative projects, each focusing on a specific medical condition or procedure, PROs will conduct pattern analysis and share information about these analyses with health care organizations for the purpose of stimulating internal quality improvement efforts. As a fundamental shift in the way PROs have conducted quality-related activities, the HCQIP presents PROs with numerous challenges. This paper provides insight into one of their most significant challenges, the development of a model for constructive, nonevaluative feedback. Successful HCQIP feedback efforts may serve as models for quality management programs that will accompany national health care reform. PMID- 10141396 TI - Multiple sclerosis as a comorbidity: a study of resource utilization and outcomes of care. AB - The purpose of this paper is to compare the resource utilization and outcomes of care of elderly hospitalized patients with multiple sclerosis (MS) as a comorbidity to a comparison group without multiple sclerosis, matched by age, gender, and diagnosis related group (DRG) using the 1989 Quality Care (QC) MEDPAR file. The results of this paper demonstrate some differences in resource use. MS discharges incur lower average charges ($8698 for MS discharges, $8977 for controls), although the results are not statistically significant. Proportionately fewer MS discharges use intensive or coronary care services (14.7% versus 18.5%, P < .05). MS patients had a lower, but not statistically significant, 30-day mortality rate than the comparison group matched by age, sex, and DRG (7.6% versus 8.8%), a lower rate of readmission (13.9% versus 16.7%, P < .05), and a lower rate of complications (2.6% versus 4.7%, P < .05), although the results are not consistent across DRGs. Charges, length of stay, and intensive/coronary care utilization were lower, as expected, for a subset of less comorbid MS discharges and controls with, at most, four diagnoses. In this subset, MS discharges and controls were not statistically different, with the exception of overall complication rates (1.0% for MS versus 4.1% for controls, P < .05) and surgical complication rates (2.1% for MS versus 10.0% for controls, P < .05). It is unclear whether these results are due to differences in disease severity, case-mix within DRG, surgical risk, patient surveillance, or quality of care. PMID- 10141397 TI - Measuring health system performance from a community service perspective: the case of pediatric preventive services in Mason City. AB - The effectiveness of the local medical system may be evaluated using hospital discharge rates. The method is illustrated using the case of preventable pediatric admissions. Results of the analysis support the validity of admission rates for bronchitis and asthma, pneumonia, gastroenteritis, and otitis media as indicators of the primary care delivery system. The results also suggest that the study community, Mason City, Iowa, is performing well on these indicators. PMID- 10141398 TI - Public health departments and the quality movement: a natural partnership? AB - This case study presents an example of a local health department's quality initiative process with regard to evaluating the key position of community health deputy administrator. The process of evaluation, as well as basic public health and quality movement tenets, are described. Conflicting and consonant philosophies among public health, health services, and the quality movement are also examined. The authors provide specific benchmark and programmatic examples of how the community health program is functioning. In addition, specific recommendations resulting from the quality evaluation process are provided. The authors conclude that this particular department has gone beyond the traditional public health department and successfully incorporated central concepts of the quality movement. PMID- 10141399 TI - From Red Adair to Smokey Bear: the renaissance of common sense in health care. PMID- 10141400 TI - Evaluation of drug underuse: the burden of proof. PMID- 10141401 TI - Medicare program; criteria for Medicare coverage of lung transplants--HCFA. Notice with comment period. AB - This notice announces a Medicare national coverage decision for lung and heart lung transplantations. Lung transplantation refers to the transplantation of one or both lungs from a single cadaver donor. Heart-lung transplantation refers to the transplantation of one or both lungs and the heart from a single cadaver donor. We have determined that, under certain circumstances, lung transplants and heart-lung transplants are a medically reasonable and necessary service when furnished to patients with progressive end-stage pulmonary or cardiopulmonary disease and when furnished by Medicare participating facilities that meet specific criteria, including patient selection criteria. DATES: This notice is effective February 2, 1995. For information on how this notice effects Medicare payment for lung and heart-lung transplants, see sections E and F of this notice. PMID- 10141402 TI - Administration of grants and agreements with institutions of higher education, hospitals, and other non-profit organizations; direct grant programs--DoE. Final regulations. AB - The Secretary amends 34 CFR parts 74 and 75 to add the Office of Management and Budget (OMB) control numbers to certain sections of the regulations. Those sections contain information collection requirements approved by OMB. The Secretary takes this action to inform the public that these requirements have been approved. PMID- 10141403 TI - Compensation for certain undiagnosed illnesses--VA. Final rule. AB - This document amends the Department of Veterans Affairs (VA) adjudication regulations to authorize compensation for disabilities resulting from the undiagnosed illnesses of Persian Gulf veterans. This amendment provides the necessary regulatory framework to allow the Secretary to pay compensation under the authority granted by the Persian Gulf War. PMID- 10141404 TI - Medicare program; schedule of limits on home health agency costs per visit--HCFA. Notice with comment period. AB - This notice with comment period sets forth a revised schedule of limits on home health agency costs that may be paid under the Medicare program for cost reporting periods beginning on or after July 1, 1993. These limits replace the per-visit limits that were set forth in our July 8, 1993 notice with comment period (58 FR 36748). This notice also provides, in accordance with the provisions of the Omnibus Budget Reconciliation Act of 1993 (OBRA '93), that there will be no changes in the home health agency (HHA) cost limits for cost reporting periods beginning on or after July 1, 1994, and before July 1, 1996. In addition, this notice responds to public comments on the July 8, 1993 notice with comment period, which originally set forth the HHA cost limits for cost reporting periods beginning on or after July 1, 1993, and on the January 6, 1994 notice with comment period (59 FR 760), which announced the elimination of the hospital based add-on effective for cost reporting periods beginning on or after October 1, 1993. PMID- 10141405 TI - The big fix. AB - Republicans are talking about making at least $100 billion in cuts or reductions in the growth of medicare--the highly popular, though increasingly unaffordable, health program for older Americans. But is taking on medicare a political poison pill? PMID- 10141406 TI - When should managed care firms terminate private benefits for chronically mentally ill patients? AB - Corporate America's healthcare cost crisis and the country's budget deficit are forcing limits on the resources used to finance healthcare, including mental healthcare. At the same time, the 1990 Americans with Disabilities Act bars discrimination against patients with chronic illnesses, including chronic mental illness. Therefore, corporate benefits managers need guidance on how to ethically and rationally allocate scarce clinical resources to those high-morbidity insureds who utilize disproportionate amounts of these resources. In particular, how should we define the public/private interface: When do patients who repeatedly fail to respond to treatment fall out of the private sector's responsibility? The author, medical director for a leading behavioral healthcare utilization management company, offers the following guidelines recommending reasonable and practical limitations on trials of treatment for seven common categories of difficult psychiatric patients. PMID- 10141407 TI - Workplace 2001 for psychotherapists. PMID- 10141408 TI - Dialogue: can managed behavioral healthcare plans serve the severely mentally ill? Patients' families say no! PMID- 10141409 TI - Dialogue: can managed behavioral healthcare plans serve the severely mentally ill? For a public-private system partnership. PMID- 10141410 TI - Dialogue: can managed behavioral healthcare plans serve the severely mentally ill? Dual diagnoses raise special challenges. PMID- 10141411 TI - A framework for the continual improvement of behavioral healthcare. Part II- Policy for leadership. AB - In the first part of this article, published in the November/December 1993 issue of Behavioral Healthcare Tomorrow, the authors presented a framework for understanding the process of continuous quality improvement in the behavioral healthcare setting. Four elements of continual improvement were identified: underlying knowledge, policy for leadership, tools and methods, and daily work applications. They showed how traditional professional knowledge of one's subject, discipline and values must be augmented by improvement knowledge--which quality improvement guru W. Edwards Deming calls "the system of profound knowledge." In Part II, they focus on the second element of continual improvement, the importance of organizational leadership. PMID- 10141413 TI - One step at a time ... Rush-Presbyterian-St. Luke's Medical center. PMID- 10141412 TI - Reengineering managed behavioral healthcare. AB - Reengineering is an industrial method for rethinking and redesigning basic business processes in order to improve performance and lower cost. Just as many of the corporate clients of managed behavioral healthcare companies go through reengineering initiatives, behavioral healthcare needs to streamline its production processes, in order to deliver services that are high quality but affordable. Traditional, cumbersome, bureaucratic and labor-intensive work processes must be reexamined. This article reviews basic principles of reengineering in the context of the evolving managed behavioral healthcare industry, defines ten core processes for managed behavioral healthcare companies and then illustrates how reengineering methods can be applied to two intermediate processes: "manage access" and "manage network." PMID- 10141414 TI - Hospitals play the role of test pilots. AB - Computerized patient record developers are turning to providers for real-world tests of their new products. The experiences of these pioneers offer valuable lessons. PMID- 10141415 TI - PPOs are beginning to plug into age of automation. AB - As relative latecomers to the computer age, most preferred provider organizations are just beginning to see the value of automation in gaining a competitive advantage. In addition to using electronic data interchange to automate claims processing, some forward-thinking PPOs are using automation to provide quick confirmation of patient eligibility for coverage or to streamline utilization review. PMID- 10141416 TI - More states turn to EDI as a way to cut expenses. PMID- 10141417 TI - Hospitals seek strength in numbers. AB - Six Iowa hospitals that don't have a common owner are banding together to form a health information network using a software system that they couldn't have afforded individually. The network will provide easy access to electronic records throughout a broad, rural area. PMID- 10141418 TI - Will on-line adjudication fit the need? AB - On-line claims adjudication would provide the virtually immediate, paperless determination of who owes what to whom for the delivery of health care services. Proponents point to the potential cost savings from the elimination of paperwork and increasing efficiency. But skeptics question whether physicians will use the service. They say that the growth of capitated managed care plans could eliminate the market for on-line claims. PMID- 10141419 TI - Automated coding creates accurate information to support clinical and financial goals. AB - Specialized coding software is becoming more crucial for providers as they seek to maximize reimbursement and gather data to analyze the care they deliver. Providers are acquiring coding software and preparing for a wave of coding changes. In addition, some computerized patient records pioneers are incorporating coding. PMID- 10141420 TI - Measuring the movement to electronic claims. AB - Congressional inaction on health care reform during 1994 spelled a temporary halt to efforts to enact government mandates for the use of automated transactions. But even without the added pressure of government mandates, the steady shift to automated health care transactions continued during the year. Now that more of the nation's 1,500 health care payers and 700,000 providers are linked to regional and national electronic data interchange networks, more than one-third of all health care claims are transmitted electronically. PMID- 10141421 TI - Meeting managed care's needs. PMID- 10141422 TI - Transition to new global standards on hold. AB - The nation's major standard-setting body for health care financial transactions has delayed a decision on migrating to new, international standards. An immediate move to EDIFACT standards would have been a setback for efforts to encourage the use of standards-based EDI. PMID- 10141423 TI - Health care reform is alive & well in 1995. AB - While Congress continues to postpone any action on health care reform, the Clinton Administration has found a way to allow states to expand Medicaid coverage to previously ineligible and uninsured Americans. The Social Security Act allows for waivers on certain Medicaid requirements so that states can conduct research and demonstration projects--these projects may become the wave of the future for health care reform. PMID- 10141424 TI - HCFA's home health initiative: the first comprehensive reassessment of the Medicare home health benefit. AB - Last year the Health Care Financing Administration announced an exciting program: the HCFA Home Health Initiative, which provided the home care industry an opportunity to contribute to changes in the way Medicare operates. For a year the Initiative pushed forward with goals and meetings. The newly elected members of Congress, however, have revealed many plans for cutting back on spending as well as government regulation. What does that mean for the Initiative and the Medicare home health benefit? PMID- 10141425 TI - Prospective payment for home care. AB - Prospective pay models propose to make one payment to cover an entire episode of care, rather than making one payment per visit. What elements must be considered in developing such a system? Is the new Congress likely to enact such a plan--and if so, what does that mean for the home care industry? PMID- 10141426 TI - Data sets for home care organizations. AB - Those who predict the future see managed care as a major element in reformed health care delivery. And one tool that managed care uses increasingly is outcomes measurement. Home care has just begun to develop its role in outcomes measurement by completing a uniform minimum data set to gather and compare data. The data set as yet does not include outcomes; it is the first step toward that goal. PMID- 10141427 TI - Home care in the 104th Congress. PMID- 10141428 TI - Insurance approaches for addressing home care liability. PMID- 10141429 TI - Liability of directors and officers in home care. PMID- 10141431 TI - Managing infectious waste: guidance for home care. AB - Infectious waste handling is a major concern for all health care professionals, yet most literature on the subject focuses on the acute care setting. Home care agencies must develop infectious waste protocols that keep in mind federal, state, and local regulations. PMID- 10141430 TI - Workers' compensation issues in home care. AB - Workers' compensation expenses can add up quickly for home care agencies, where employees are in and out of patients' homes all day, often with no supervision or with no help in transferring patients or heavy equipment. Simple precautions and proper training and followup can greatly reduce this financial burden. PMID- 10141432 TI - Humor-care for the caregiver. AB - Humor is exclusively human. No other species is proven to introduce humor into any situation. Humans, however, find it beneficial in many ways. Advanced nurse practitioners will find humor a valuable aide in self-help, enabling them to continue helping others. PMID- 10141434 TI - Symposium: National health care reform on trial. PMID- 10141433 TI - Home care enjoys bipartisan support. PMID- 10141435 TI - The sleeper issue in health care reform: the threat to workers' compensation. PMID- 10141436 TI - Blending reform of tort liability and health insurance: a necessary mix. AB - The thesis of this Article is that making more health insurance benefits available to more people, far from lessening injury victims' proclivity to sue in tort (as conventional wisdom argues), will increase such suits. Thus, it is necessary to accompany any increases in health care coverage with the type of tort reform proposed herein. This reform would allow parties to opt out of the cumbersome and expensive tort claim process with its compensation of noneconomic losses by substituting quicker and surer compensation of any unmet economic losses. PMID- 10141437 TI - A national health care program: what its effect would be on American tort law and malpractice law. PMID- 10141438 TI - Universal health care and the continued reliance on custom in determining medical malpractice. PMID- 10141439 TI - The Health Security Act: coercion and distrust for the market. PMID- 10141440 TI - Health care reform: perspectives from the economic theory of regulation and the economic theory of statutory interpretation. PMID- 10141441 TI - Health care reform and competing visions of medical care: antitrust and state provider cooperation legislation. PMID- 10141442 TI - Managed competition, integrated delivery systems and antitrust. PMID- 10141443 TI - Health insurance purchasing alliances: monopsony threat or procompetitive Rx for health sector ills? PMID- 10141444 TI - Pay attention to "small touches". PMID- 10141445 TI - Exporting philanthropy: democracy, voluntarism and community organization in post communist society. PMID- 10141446 TI - Calming fears, easing pain. Children's anesthesia tricky. AB - To a child, pain and fear are inseparable. How to safely relieve both is a subject of growing debate and research. Only recently has a narcotic drug been approved specifically for children, and its use is controversial. PMID- 10141447 TI - Mental health. The incentives war. PMID- 10141448 TI - Infection data. HAI spy. PMID- 10141449 TI - Health and safety. Safety first. PMID- 10141450 TI - IT update/patient-administration system. 21st century PAS? PMID- 10141452 TI - IT update/electronic mail. Live wires. PMID- 10141451 TI - IT update/strategy. Come in, CBS (common basic specification). PMID- 10141453 TI - Involving consumers. Coming in from the cold. PMID- 10141454 TI - Mental health audit. Telling it like it is. PMID- 10141455 TI - Contract data. Set piece. PMID- 10141456 TI - Management concepts. Buried treasure. PMID- 10141457 TI - Helping community health centers adapt to changing environments: one foundation's response. AB - The history of community health centers (CHCs) reflects attitudes toward health care delivery in general. Developed as part of the war on poverty, they later survived the more conservative attitudes of the early 1970s to flourish in the late 1970s. In the 1980s, we again witnessed a reduction in the funding available to CHCs. In response to this, The Robert Wood Johnson Foundation (RWJF) established The Program to Strengthen Primary Care Health Centers. The program was designed to help centers to adapt to this environment by becoming more businesslike in their operations and decreasing their dependence on public dollars. PMID- 10141458 TI - Strengthening the financial position of community health centers. PMID- 10141459 TI - The financial impact of management innovations by health centers. AB - The primary goal of The Program to Strengthen Primary Care Health Centers was to identify innovations that could improve the financial viability of health centers. This article describes the impact of program-related innovations on financial indicators. During the study period, all of the participant centers continued in existence, whereas one of the comparison centers went bankrupt. Total revenue and net income both improved significantly for the study centers relative to the comparison group. Centers that received audits of their operational systems prior to program commencement fared less well than those that did not. PMID- 10141460 TI - The community health center: an enduring model for the past and future. AB - This article provides insights into the history of community health centers (CHCs) and the role that they play in providing care to the poor. The mission of the CHC has always been to provide comprehensive primary care services to community residents regardless of their ability to pay. Health centers served an estimated 7 million people in 1993. In the near future, centers will be faced with new challenges. For example, the nationwide momentum toward managed care is defining new areas of growth for health centers, including new forms of practice management and contractual arrangements with other providers. PMID- 10141461 TI - Implementation of management innovation at primary care health centers: qualitative assessments. AB - This article describes the implementation of innovations at health centers participating in The Robert Wood Johnson Foundation Program to Strengthen Primary Care Health Centers. Relatively successful approaches to management innovation are described and common obstacles to innovation are considered. Key issues include poor physician retention, inadequate or inappropriate space, the complexities of automation, difficulty in the recruitment of staff and consultants (particularly in rural areas), and disruptions caused by internal promotions. PMID- 10141462 TI - Management techniques at primary care health centers: the impact of management innovation. AB - Long-term financial viability was a goal of The Program to Strengthen Primary Care Health Centers. To accomplish this, it was expected that participant centers would increase their management capabilities. We evaluated 32 management techniques in five principal areas: budgeting, strategic planning, general financial management, collections, and general health services management. Eight of the techniques showed change over the course of the demonstration (six increases and two decreases). It appears that there was somewhat more improvement among study centers than in a comparison group. Management sophistication has been expanding among health centers in general; Program participation appears to have accelerated this growth. PMID- 10141463 TI - Case studies of management innovation at primary care health centers. AB - This article discusses the experiences of four individual health centers that participated in The Program to Strengthen Primary Care Health Centers. These centers were attempting "typical" initiatives, were considered highly likely to succeed, and were located in geographically diverse areas. Given these characteristics, it is likely that other centers could replicate their endeavors and could gain valuable knowledge from their implementation experiences. This article presents each center's characteristics, history, and mission; describes the environment in which the center operates; and discusses the barriers to implementation of selected innovations. PMID- 10141464 TI - One center's perspective on participation in The Program to Strengthen Primary Care Health Centers: a slow harvest. AB - This article presents an account of one center's experience participating in The Program to Strengthen Primary Care Health Centers. The center developed a multifaceted strategy that aimed to increase and diversify revenue, both earned and nonearned. The first year got off to an uneven start, although the project eventually progressed according to plan but on a slower time line than anticipated. By the end of the three-year project period, most of the initiatives had become fully integrated into center operations. The center was able to increase financial reserves. However, their financial stability remained tenuous. PMID- 10141465 TI - Innovations by primary care health centers: lessons for managers and policy makers. AB - This article highlights results from the evaluation of The Program to Strengthen Primary Care Health Centers, and suggests some directions for public policy. Program participants reported substantial improvements in financial viability, given the relatively small monetary investment. Technical assistance in the development of innovations, however, appears to dampen creativity and ultimately hinder financial gains. Recommendations address improved physician retention, the development of professional expertise, the importance of attention to long-range objectives, the related problems of excess capacity and surplus patient demand, and the integration of primary care health centers into managed care systems and health networks. PMID- 10141466 TI - Reflections from The Robert Wood Johnson Foundation on The Program to Strengthen Primary Care Health Centers. AB - Given the modest amount of resources provided by the Foundation through The Program to Strengthen Primary Care Health Centers, the grantees undertook a high level of activity. Perhaps centers were aided by the momentum and focus of the Program in addition to financial resources. Such grants seem to move longer-range projects onto the daily agendas of managers. It might be worthwhile to convert some portion of federal community health center funding to support financial and managerial innovations. Generally, positive evaluation findings should encourage centers to explore some of the demonstrated initiatives. Evolution and innovation are considered key to the survival of primary care health centers. PMID- 10141467 TI - Addressing the service versus education conflicts created by residency training in ambulatory care settings. AB - Much of the tension and conflict that result from the competing demands of work and learning during residency training--the service versus education conflict- can be addressed by mutual adherence to fundamental guidelines of fairness and personal responsibility by residents and their employers, mentors, and teachers. Residents should be recognized by their employers as professionals and by their teachers as colleagues. Because residency is postgraduate professional education for medical school graduates, the content of resident education must be primarily determined by the educational needs of maturing physicians. The greatest value of residents' services for their employing institutions remains in the inpatient setting where they work as inexpensive professional labor, working long and unattractive patient care shifts providing acute care. In the ambulatory setting, they are less efficient, work ordinary hours, and require real-time on-site supervision. Nevertheless, it is clear that the opportunities for medical education are rapidly shifting from the inpatient setting to ambulatory settings- locations in which there is less experience in proven techniques in medical education. PMID- 10141468 TI - Overview of the Program to Strengthen Primary Care Health Centers: a profile of the grant-making process, the recipients, and their activities. AB - The Program to Strengthen Primary Care Health Centers supported improvements in operating systems and the development of good business practices at participant centers. This article provides an overview of the Program. Participant centers were small, community-based organizations that served high-need populations and offered a sliding fee scale for uninsured patients. Grants supported activities to increase patient revenues, serve more patients, promote general stability of center operations, expand the kinds of services provided, and enhance nonpatient revenues. Successful organizations needed to take a step back and analyze their options and also to have a good management team. PMID- 10141469 TI - Scope of employer, sex and transference: when is an employer liable for therapist sexual relations? PMID- 10141470 TI - Unions, nurses, and the health care industry: recent administrative and judicial developments. PMID- 10141471 TI - Regulation of advanced practice nursing in health care reform. PMID- 10141472 TI - Advance directives revisited: a proposal to amend advance directive laws. PMID- 10141473 TI - Quarantining the noncompliant TB patient: catching the "Red Snapper". PMID- 10141474 TI - Would an MSO make your life easier? PMID- 10141475 TI - The many pluses of investing in your own MSO. PMID- 10141477 TI - Difficult patients are easy if you know these techniques. PMID- 10141476 TI - MRIs: do investors see only negatives? PMID- 10141478 TI - New strategies for clamping down on referrals. PMID- 10141479 TI - Hate those Medicare denials? Try moving. PMID- 10141480 TI - Creating a workable specimen rejection policy. PMID- 10141481 TI - An update on lab safety regulations. PMID- 10141482 TI - The individual versus group approach to decision making. PMID- 10141483 TI - Computer assistance for infection control. PMID- 10141484 TI - PPOs seek bigger piece of Medicare business. PMID- 10141485 TI - QualMed chosen for CHAMPUS contract. PMID- 10141487 TI - HealthSouth's plan to acquire NovaCare under FTC probe. PMID- 10141486 TI - Merger to give SDI-WellPoint muscle for national expansion. PMID- 10141488 TI - Imperiled Medicare fund fuels debate on reform. PMID- 10141489 TI - Calif. management firm fuels growth through acquisition. PMID- 10141490 TI - Tenet posts 31% increase in income for latest quarter. PMID- 10141491 TI - Charter buys Mass. system, links with Columbia model for future. PMID- 10141492 TI - Detroit system files bankruptcy petition. PMID- 10141493 TI - Nursing homes in six states will be part of reimbursement test. PMID- 10141494 TI - Columbia-Healthtrust merger stirs things up across nation. PMID- 10141495 TI - Horizon's about-face leaves many questioning its strategy. PMID- 10141496 TI - New N.J. group targets funding. PMID- 10141497 TI - Pataki proposes steps to trim red tape. PMID- 10141499 TI - Merger talks cease in Ohio. PMID- 10141498 TI - $1 million awards less common than suggested. PMID- 10141500 TI - Catholic providers find support in papal document on life issues. PMID- 10141501 TI - FHA worried about looming N.Y. cuts. PMID- 10141502 TI - 21 Fla. Medicaid HMOs cited for violating state regulations. PMID- 10141503 TI - Nurses nationwide air gripes against hospitals. PMID- 10141504 TI - Firms file IPOs to raise total of $100 million. PMID- 10141505 TI - Healthcare stock prices up 10%. PMID- 10141506 TI - Necessary size of military health force in question. PMID- 10141507 TI - Industry rivals must unify for the real war. PMID- 10141508 TI - Military, VA coordinate healthcare. AB - In this era of a downsized military, sharing agreements between the Defense and Veterans Affairs departments makes sense. Stephen C. Joseph, M.D., assistant secretary of defense for health affairs, views large-scale joint ventures as the future. PMID- 10141509 TI - Hanlester ruling a victory for HHS, providers. PMID- 10141510 TI - Debate doesn't end with practice guidelines. PMID- 10141511 TI - HMOs adapt to Medicaid market. PMID- 10141512 TI - New health systems hungry for capital. PMID- 10141513 TI - Medicus acquires software products of MMC Healthcare. PMID- 10141514 TI - Georgia Blues to go for-profit. PMID- 10141515 TI - More docs disciplined in '94. PMID- 10141516 TI - Aetna challenges Pentagon's managed-care contract award. PMID- 10141517 TI - Mass. providers work together to help hospital pay debts and retool for a changing market. PMID- 10141518 TI - Union tries PR campaign to force a new contract. PMID- 10141519 TI - Committee seeks to allow for-profit chains into N.Y. PMID- 10141520 TI - Hospital reimbursed in TennCare dispute. PMID- 10141521 TI - HMOs selected for St. Louis Medicaid program. PMID- 10141522 TI - Moody's downgrades Kaiser debt, cites lack of growth, competition. PMID- 10141523 TI - HCIA to buy firm, gain access to 1,000 hospitals, 13 groups. PMID- 10141524 TI - HMO enrollment up 12% nationally. PMID- 10141526 TI - GOP outlines its plan for Medicare options. PMID- 10141525 TI - Block grants may mean cuts in indigent care, providers say. PMID- 10141527 TI - Calif. Blue Cross tries again with bigger foundation plan. PMID- 10141528 TI - Lawmakers send warnings to managed-care executives. PMID- 10141529 TI - Calif. group's capitated AIDS-care plan launched ... Positive Healthcare. PMID- 10141530 TI - Cost of blood rises across nation as Red Cross tries to trim losses. PMID- 10141531 TI - UMHS grows network through merger with community hospital. PMID- 10141532 TI - IRS' proposed ruling gets mixed reviews ... not-for-profit hospitals' physician recruitment tactics. PMID- 10141533 TI - How close is too close in hospital partnership? AB - How close is too close in hospital partnerships? Not-for-profits are testing the limits as they team up in creative but often controversial relationships and draw the attention of antitrust authorities. Plus, alliances are a challenge for competing hospitals. PMID- 10141534 TI - Hospitals responding to cost-cutting call. PMID- 10141536 TI - Calif. specialists worry as cuts grow. PMID- 10141535 TI - Troubled Fla. hospital may lose JCAHO accreditation. PMID- 10141537 TI - Bond sales shift into lower gear. PMID- 10141538 TI - Fla. system continues quest to block merger. PMID- 10141539 TI - W.R. Grace division under FDA fire--again. PMID- 10141540 TI - Hospital mergers, acquisitions go against the industry grain. PMID- 10141541 TI - Judge blocks Columbia stake in Fla. hospital. PMID- 10141542 TI - Providers' ads push malpractice limits. PMID- 10141543 TI - 'Common thread' sought in rash of errors. PMID- 10141544 TI - Tampa hospital gets dose of good news. PMID- 10141546 TI - Catholic systems eye $4 billion merger. PMID- 10141545 TI - North Carolina hospital's accounting discrepancies raise oversight concerns. PMID- 10141547 TI - Hospitals race to treat 400 bomb victims. PMID- 10141548 TI - Columbia's multi-year deal with GE has industry talking. PMID- 10141549 TI - Denver hospital ends inpatient services. PMID- 10141550 TI - Technology assessment gaining ground, government study shows. PMID- 10141551 TI - Calif. physicians start managed-care venture. PMID- 10141552 TI - Shareholders sue to stop WellPoint deal. PMID- 10141553 TI - Managed-care contracts up, but capitation hits just 40% of California providers- study. PMID- 10141554 TI - Managed care eats at hospital cost shifts--study. PMID- 10141555 TI - Calif. system sees results from radical restructuring. PMID- 10141556 TI - New national cooperative teams up buyers, sellers. PMID- 10141557 TI - Ore. company secures credit line. PMID- 10141558 TI - VHA, SunHealth aim to set record straight. PMID- 10141559 TI - Columbia agrees to divestitures; merger cleared. PMID- 10141560 TI - State lets hospital limit charity care. PMID- 10141561 TI - Pa. system masses forces for managed-care battle. PMID- 10141562 TI - Once upon a time, in the year 2002 .... PMID- 10141563 TI - Coram-Lincare merger to form largest alternate-site provider. PMID- 10141564 TI - Miami hospitals merging to form integrated system. PMID- 10141565 TI - Docs try to own managed care. AB - Fed up with big for-profit HMOs, physicians across the nation are forming plans, sometimes with the help of state associations, as they try to own managed care. However, the sale of an HMO that services as a model for other doctors fuels industry doubt. PMID- 10141566 TI - Tennessee for-profits lag in care for poor. PMID- 10141567 TI - Communication key in life-or-death decisions. PMID- 10141568 TI - Researchers test safety of medical device reuse. PMID- 10141569 TI - 14.3% of CEO posts turned over in 1994. PMID- 10141570 TI - Chest pain centers on rise in U.S. hospitals. PMID- 10141571 TI - Patient's benevolence helps Texas system to expand its unusual outpatient program. PMID- 10141572 TI - Standardizing supplies in 17-hospital system. PMID- 10141573 TI - Clinical ladders, other benefits fading away. PMID- 10141574 TI - Postanesthesia unit does double duty: admissions in am; postop care in pm. PMID- 10141575 TI - Pediatric hospitals identify best practices. PMID- 10141576 TI - OR technology decisions shift to outcomes. PMID- 10141577 TI - RN reductions endangering patient care, ANA says. PMID- 10141578 TI - Cellular phones may interfere with some medical equipment. PMID- 10141579 TI - Work redesign based on data successful. PMID- 10141580 TI - Hospitals that made top 100 hospitals list--and why. AB - What does it take to make the list of the nation's top 100 hospitals for the second year in a row? We interviewed some OR managers to find out. Second of two parts. PMID- 10141581 TI - Shared governance works in facilities committed to ideals. PMID- 10141582 TI - At its birthplace, shared governance holding its own. PMID- 10141583 TI - Characteristics of elderly men and women discharged from home health care services: United States, 1991-92. PMID- 10141584 TI - Assessing outcome measurements fairly. PMID- 10141585 TI - New concept in cath lab configuration. PMID- 10141586 TI - The Consortium Ethics Program: an approach to establishing a permanent regional ethics network. AB - This paper describes the first three-year experience of the Consortium Ethics Program (CEP-1) of the University of Pittsburgh Center for Medical Ethics, and also outlines plans for the second three-year phase (CEP-2) of this experiment in continuing ethics education. In existence since 1990, the CEP has the primary goal of creating a cost-effective, permanent ethics resource network, by utilizing the educational resources of a university bioethics center and the practical expertise of a regional hospital council. The CEP's conception and specific components stem from recognition of the need to make each hospital a major focus of educational efforts, and to provide academic support for the in house activities of the representatives from each institution. PMID- 10141587 TI - From anonymity to respect: lessons in the establishment of a bioethics forum. PMID- 10141588 TI - The development of the Bioethics Program of the National Institutes of Health Warren G. Magnuson Clinical Center. PMID- 10141589 TI - Should competent patients or their families be able to refuse to allow an HEC case review? Yes. PMID- 10141591 TI - Selected bibliography on HECs, 1993-1994. PMID- 10141590 TI - Should competent patients or their families be able to refuse to allow an HEC case review? No. PMID- 10141592 TI - Perspectives. Idealistic hospice industry confronts managed care era. PMID- 10141593 TI - Perspectives. Big payers, HMOs unite around quality measurement system. PMID- 10141594 TI - Fostering staff ownership of cardiovascular program improvement. Part two: Monitoring variance and outcomes. AB - The clinical guideline is a living document meant to be updated as clinical knowledge is expanded and program-specific data are generated. This final installment focuses on how programs should measure, manage and report the outcomes of clinical guidelines utilization to remain competitive. PMID- 10141595 TI - Quality of life and outcomes in healthcare management. PMID- 10141596 TI - Managed care's role in catastrophic illness cases increasing. PMID- 10141597 TI - Stopping costly equipment theft. PMID- 10141598 TI - Legal and policy aspects of home care coverage. AB - Home health care is a compassionate, cost-effective, and practical alternative for some individuals who require long-term or constant care. However, the coverage of home health care costs is far from comprehensive under the Medicare, Medicaid, and private pay systems. A uniform and comprehensive coverage system is necessary. PMID- 10141599 TI - Using Good Samaritan Acts to provide access to health care for the poor: a modest proposal. AB - Some states are providing immunity to those willing to voluntarily provide health care for the poor. The proposal is a modest and questionable step toward solving the health care access dilemma. PMID- 10141600 TI - Patching the patchwork quilt: "reforming" the Medicaid program--the Medicaid Voluntary Contribution and Provider-Specific Tax Amendments of 1991. AB - Congress modified the Medicaid program by restricting states' sources of funding, capping payments to certain hospitals, and altering the relationship between the states and the federal government. While the legislation puts to rest an ongoing dispute between the state and federal governments, it does not improve access to or quality of care nor address fundamental problems with the Medicaid program; it is simply another patch to the patch-work quilt called Medicaid. PMID- 10141601 TI - Application of the Medicare and Medicaid anti-kickback statute to business arrangements between hospitals and hospital-based physicians. AB - Hospitals and hospital-based physicians enter into a variety of agreements. Given the recent advisory memorandum from the Inspector General of Health and Human Services and a recent administrative decision, these arrangements may violate the Medicare Anti-Kickback statute. PMID- 10141602 TI - Internal Revenue Service General Counsel's Memorandum threatens tax exemption for charitable hospitals. AB - A recent memorandum from the General Counsel of the Internal Revenue Service changes the standard against which tax exempt entities will be measured, which change can adversely affect charitable hospitals' tax exempt status. In addition, the memorandum makes clear that a violation of the Anti-Kickback statute, discussed in Mr. Aaron's article, is inconsistent with tax exempt status. PMID- 10141603 TI - Antitrust in the early 1990's: challenges to new competitive strategies. AB - The early 1990's brought a number of cases that raise challenges to new competitive strategies. As health care providers seek to gain a competitive advantage, courts are being asked to review practices under antitrust laws. PMID- 10141604 TI - Physician credentialing in managed care. AB - The managed care industry is increasingly using physician credentialing when seeking health care providers. The credentialing process must be conducted in a manner that meets the goals of the managed care program. PMID- 10141606 TI - The political projection: how do case management and long-term home health care "fit" into national plans for new health care models? PMID- 10141605 TI - Family values: who will take care of Murphy Brown when she's 90? PMID- 10141607 TI - Mental health needs of the homebound elderly. PMID- 10141608 TI - Remaining competitive won't be easy in the 90s. PMID- 10141609 TI - Re-designing dietary departments a necessity. PMID- 10141610 TI - Crest Haven: feeding the elderly. PMID- 10141611 TI - Energy distribution systems ... from concept to reality. PMID- 10141612 TI - Is your kitchen operating as efficiently as it should? PMID- 10141613 TI - Waste management. Solving the world's biggest problem. Is a pulper the answer? PMID- 10141614 TI - Going for the Gold. AB - J. Patrick Rooney, the chairman of Golden Rule Insurance Co., has an idea that he says will curb health care spending--and make money for his company. Newt Gingrich and other congressional Republicans appear sold on it. PMID- 10141615 TI - Teaming up on Medicare. PMID- 10141616 TI - Hospitals still rebuilding from quake. PMID- 10141617 TI - Coping with resistance to change. PMID- 10141618 TI - Achieving homogeneity at Willow Valley Lifecare Community. PMID- 10141619 TI - Challenge: how to capture visitor & outpatient business. PMID- 10141620 TI - Stroke: the global burden. AB - Stroke is a major global health problem. It is a major cause of mortality, morbidity and disability in developed and increasingly in less developed countries. Worldwide, it is the leading cause of healthy years lost in late adulthood, and evidence indicates that the burden of stroke, particularly in terms of morbidity and disability, will almost certainly increase in the foreseeable future. This review aims to generate a better understanding of the present and projected future global burden of stroke, with particular emphasis on the non-established market economy countries (NEMEC). The first part summarizes and interprets the currently available evidence on stroke mortality, incidence, case-fatality and related disability rates from both established and non established market economy countries. The second part reviews the main risk factors for stroke. For the modifiable factors, it examines current prevalence rates in NEMEC with a view towards identifying patterns that are relevant for predicting future rates of the disease. Reversing the consequences of stroke is difficult, thus primary prevention is of utmost importance. The potential for prevention is illustrated by the experience of Japan, which in the last two decades has seen substantial declines in stroke mortality--mostly due to reductions in dietary salt intake. The last section discusses potential strategies and approaches to effective stroke prevention and highlights other areas that need to be addressed if stroke management in the coming decades is to be effective. PMID- 10141621 TI - The state of health planning in the '90s. AB - The art of health planning is relatively new in many developing countries and its record is not brilliant. However, for policy makers committed to sustainable health improvements and the principle of equity, it is an essential process, and in need of improvement rather than minimalization. The article argues that the possibility of planning playing a proper role in health care allocative decisions is increasingly being endangered by a number of developments. These include the increasing use of projects, inappropriate decentralization policies, and the increasing attention being given to NGOs. More serious is the rise of New Right thinking which is undermining the role of the State altogether in health care provision. The article discusses these developments and makes suggestions as to possible action needed to counteract them. PMID- 10141622 TI - Resource allocation for public hospitals in Andhra Pradesh, India. AB - The composition of the hospital sector has important implications for cost effectiveness accessibility and coverage. The classification of acute general hospitals is reviewed here with particular reference to India and Andhra Pradesh. Approaches to arrive at a norm for allocation of hospital expenditure among secondary and tertiary hospitals are discussed. The actual allocation of public sector hospital expenditures is analyzed with data from Andhra Pradesh. The shift in allocative emphasis away from hospitals and in favour of primary health care during the 1980s was found to have been equally shared by secondary and tertiary hospitals. The shares of recurrent (non-plan) expenditure to secondary and tertiary hospitals were 51% and 49% respectively. This can be compared to a derived norm of 66% and 33%. The opportunity that new investment funds (plan schemes) could have provided to rectify the expenditure bias against secondary level hospitals was missed as two-thirds of plan expenditure were also spent on tertiary level hospitals. The share of secondary hospital bed capacity was 45.5% against India's Planning Commission norm of 70%. Public spending strategies should explicitly consider what mix of hospital services is being financed as well as the balance between hospital and primary health care expenditures. PMID- 10141623 TI - Acute childhood diarrhoea and maternal time allocation in the northern central Sierra of Peru. AB - Interventions to improve child health depend, at least implicitly, on changing maternal knowledge and behaviour and a reallocation of maternal time. There have been few studies, however, of the time cost involved in the adoption of new health technologies and even fewer that examine changes in maternal activities in response to child illness. The present study examines maternal daytime activities and investigates changes that occur when children are ill. We examine the impact of acute childhood diarrhoea episodes on the activity patterns of the mother/caretaker in this setting. The results show that mothers alter their usual activity patterns only slightly in response to acute diarrhoea episodes in their children. They continue to perform the same variety of activities as when the children are healthy, although they are more likely to perform them with the child 'carried' on their back. There is some indication that diarrhoea perceived to be more severe did result in the mother acting as caretaker more frequently. These findings have important implications for health interventions that depend on changing the amount of maternal or caretaker time spent for child health technologies, but the implications may vary depending on the reasons for the observed lack of changes in caretaker activities. PMID- 10141624 TI - Reducing maternal mortality in Kigoma, Tanzania. AB - An intervention programme aiming at a reduction of maternal deaths in the Regional Hospital, Kigoma, Tanzania, is analyzed. A retrospective study was carried out from 1984-86 to constitute a background for an intervention programme in 1987-91. The retrospective study revealed gross under-registration of data and clarified a number of potentially useful issues regarding avoidable maternal mortality. An intervention programme comprising 22 items was launched and the maternal mortality ratio was carefully followed in 1987-91. The intervention programme paid attention to professional responsibilities with regular audit oriented meeting, utilization of local material resources, schedules for regular maintenance of equipment, maintenance of working skills by regular on-the-job training of staff, norms for patient management, provision of blood, norms for referral of severely ill patients, use of antibiotics, regular staff evaluation, public complaints about patient management, travel distance of all essential staff to the hospital, supply of essential drugs, the need of a small infusion production unit, the creation of culture facilities for improved quality of microbiology findings, and to efforts to stimulate local fund-raising. The results indicate that the maternal mortality ratio fell from 933 to 186 per 100,000 live births over the period 1984-91. Thus it is underscored that the problem of maternal mortality can be successfully approached by a low-cost intervention programme aiming at identifying issues of avoidability and focusing upon locally available problem solutions. PMID- 10141625 TI - Methods used to study household coping strategies in rural South West Uganda. AB - This paper describes the data collection methods used in a longitudinal study of the coping strategies of 27 households in three villages in the study area of the MRC/ODA Research Programme on AIDS in Uganda. After pre-testing and piloting, 9 local interviewers made regular visits to the 27 study households over a period of just over one year. The households were purposively selected to represent different household types and socioeconomic status categories. Data were obtained through participant observation using a checklist to ensure systematic collection of data on household activities. Debriefing sessions with the interviewers after the visits provided opportunities for the discussion of the findings and exploration of themes for further study. On the basis of the study findings, and data from the Programme's general study population survey rounds, broad indicators of household 'vulnerability' were identified. A participatory appraisal technique, 'well-being ranking', was used at the end of the study in order to test the viability of the chosen indicators. It is proposed that the example of the research method, which relied on local people not only as interviewers but also as co-investigators in the research, be used to guide future research approaches. The participation of the study community at every stage of research and design, as well as monitoring and evaluation of supportive interventions, is strongly encouraged. PMID- 10141626 TI - Pediatric discharge against medical advice in Bouake Cote d'Ivoire, 1980-1992. AB - Discharge information was obtained from pediatric ward logbooks of the Centre Hospitalier Regional de Bouake from 1982 to 1992. While number of children admitted per month and discharge diagnosis remained relatively stable throughout the period, the proportion of children who left the hospital against medical advice increased by nearly 5 times during the 11-year period to over 12% of all pediatric admissions. The proportion of discharges against medical advice decreased to 10% of all pediatric admissions after institution of a programme to provide essential drugs at cost to patients (previously only available from private pharmacies). Most children who were taken from the hospital left within the first two days of hospitalization. The admission diagnoses of these children suggest that most had serious, life-threatening illness and that they left the hospital prior to having received adequate treatment. The increase in pediatric ward discharge against medical advice occurred simultaneously with serious budgetary shortfalls in the hospital resulting in inadequacy of medicines and basic equipment. Hospital staff suspected that most of the discharges against medical advice were caused by families being unable to afford the purchase of medicines and supplies necessary for inpatient treatment. It is suggested that widespread policies of decreasing funding for basic curative services in public hospitals may be associated with a substantial increase in preventable child mortality. PMID- 10141627 TI - Willingness and ability to pay for health care: a selection of methods and issues. PMID- 10141628 TI - Cost containment in emergency departments. AB - Traditionally, cost effectiveness has been overlooked in emergency departments because of a mandate to provide emergency care in every community regardless of expense. However, in the current era of managed care, reduced reimbursement, and cost controls, emergency departments are being examined more carefully to determine whether their costs can be contained or even whether they can become profit centers. Detailed billing, cost accounting, enhanced communication among emergency departments within a community, and linking of suburban and inner-city emergency departments are several means by which emergency departments can control costs and raise revenues. PMID- 10141629 TI - Considerations before you sign that contract. PMID- 10141630 TI - Managed care puts some hospitals in a credit squeeze. PMID- 10141631 TI - Ten success factors in healthcare affiliations. PMID- 10141632 TI - Introducing the revised directives. What do they mean for Catholic healthcare? PMID- 10141633 TI - The principle of cooperation. Theologians explain material and formal cooperation. PMID- 10141634 TI - Serving our communities better. Guidelines for planning and developing integrated delivery networks. AB - In 1994 the Daughters of Charity National Health System-East Central (DCNHS-East Central) adopted 11 guidelines to help corporate staff and local leaders plan and develop integrated networks. Guideline 1 emphasizes needs-based strategic planning. Guideline 2 focuses on the community-based network planning process, recommending a team approach and ongoing communication with the local ordinary. In guidelines 3 through 5, the DCNHS-East Central Board of Directors spells out key issues that must be covered in proposals ultimately presented for governance action. Guideline 6 presents three core elements that should characterize all CBNs in which DCNHS-East Central institutions participate. Guideline 7 emphasizes that all CBN proposals and agreements must be clear with respect to the Catholic identity of DCNHS-East Central institutions. Guidelines 8 and 9 require that proposed changes to traditional policies and management practices be explicit in CBN proposals. The tenth guideline requires that all CBN proposals indicate an explicit evaluation function. The final guideline underscores that regardless of the strategic fit or how well a CBN is designed, it is unlikely to succeed unless both internal and external relationships are based on a solid foundation of honesty, mutual respect, and trust. PMID- 10141635 TI - Getting it all together. Systems should link their strategic and financial planning. AB - Foreseeing dramatic changes in healthcare delivery, the leaders of the Franciscan Health System (FHS) decided in the early 1990s to more closely link their strategic and financial planning. Though this cooperation was tentative at first, by 1993 both our planners and our chief financial officers shared certain assumptions about the future--above all, that the coming delivery model was managed care provided by integrated delivery systems (IDSs). Having agreed on our assumptions, we translated them into a vision statement, from which we derived four strategic goals: Advance the healing mission of our sponsors; Create a culture of continuous improvement in leadership, quality, innovation, cost effectiveness, and measurable customer value; Create an environment that values and empowers those with whom we work; Develop, through partnering, an IDS that provides affordable care to our communities; Our goals established, we charted what we call a "crosswalk" between the strategic and financial aspects of our budgeting. We found that we had to think in a new way about capital. For example, we began investing as heavily in "soft" items like research, partnerships, and new services as in the traditional "bricks and mortar." This process is new for us, and developing it has not always been comfortable. But we believe it has helped us to more wisely allocate FHS's resources and thus give our system greater stability. PMID- 10141636 TI - Delivering the message. Communications is a vital link in the strategic chain. AB - Healthcare providers often treat communications as an afterthought when it comes to strategic planning. But that is a mistake in the 1990s. As providers adapt to the new managed care environment, marketing will be more important than ever. In recent years, providers have tended to devote much of their marketing budgets to advertising. The need to advertise will continue, but hospitals are increasingly using communications skills to educate consumers about changes in the healthcare system, the services available, and ways to get access to them. Hospitals are also marketing their staffs of associated physicians. They are launching community outreach efforts, both in city neighborhoods and in affluent suburbs. Realizing that women make most family healthcare decisions, hospitals are putting healthcare information booths in local shopping malls. Providers also need to keep in mind the changing nature of their "customers." Frequently, customers are not individuals but employers, insurers, and health maintenance organizations. To remain competitive, providers must demonstrate their cost-effectiveness to such payers through skillful communications. PMID- 10141637 TI - The race of the care giver: should managers honor patients' requests? PMID- 10141638 TI - Outreach efforts expand hospital's community service. PMID- 10141639 TI - Schumpert Medical Center. Building community trust. PMID- 10141640 TI - Bobby Bo has gone to God. PMID- 10141641 TI - Effect of constraints and limitations on decision making. PMID- 10141642 TI - Chaplaincy in Europe. PMID- 10141643 TI - Using INSPIRIT to conduct spiritual assessments. AB - Notes that pastoral caregivers are increasingly interested in spiritual assessment of patients. Reports results when the Index of Core Spiritual Experiences (INSPIRIT) is used for assessment with medical and surgical outpatients as well as patient family members (N = 371). Reports subscales within the instrument, mean scores, and notes that 80% of all respondents reported at least one experience which they regarded as spiritual. PMID- 10141644 TI - Patient rights issues and their implications for pastoral caregivers. AB - Reports on actual results of operationalizing the "spiritual concerns" dimension of the Patient Self-Determination Act in one hospital setting. Opines a variety of implications for hospital chaplains and for Clinical Pastoral Education. PMID- 10141645 TI - A twist on Tarasoff: is there a duty to warn one's client? AB - Describes a famous legal case in which the court's decision obligates a therapist to protect potential victims from harm that may be done to them by the therapist's client and relates it to the issue of confidentiality as frequently understood by pastoral counseling specialists. PMID- 10141646 TI - Republican senators delay budget debate. PMID- 10141647 TI - Senate begins deliberating changes in malpractice law. PMID- 10141649 TI - Study shows hospital bills being paid faster. PMID- 10141648 TI - Justice Department seeks IRS referral link. PMID- 10141650 TI - Academic practices see rise in clinical revenues. PMID- 10141651 TI - Bills would repeal employer mandate, expand low-income coverage in Wash. PMID- 10141652 TI - Hawaii legislators consider move to integrate delivery. PMID- 10141653 TI - High court backs some patient rate surcharges. PMID- 10141654 TI - PPRC seeks single doc fee update. PMID- 10141655 TI - Mass. gets federal waiver for Medicaid expansion. PMID- 10141656 TI - Providers laud, HHS fights latest Hanlester case ruling over definition of kickbacks. PMID- 10141657 TI - IHA to accept for-profit members. PMID- 10141659 TI - Groups fear ruling may hinder rural care--Marshfield Clinic. PMID- 10141658 TI - West Coast hospital groups team up in tri-state alliance. PMID- 10141660 TI - Mo. hospital, docs settle anti-competitive charges. PMID- 10141661 TI - Va. physician group settles FTC charges of price fixing. PMID- 10141662 TI - Keane closes InfoStat deal when rival bid falls through. PMID- 10141663 TI - Vencor, Hillhaven make challenging match. PMID- 10141664 TI - Proposed billion-dollar Catholic merger may lack critical mass in major markets. PMID- 10141665 TI - Former Cape Coral executive sentenced for embezzlement. PMID- 10141666 TI - States targeting CON laws, but few changes expected. PMID- 10141667 TI - Defense's contract commotion continues. PMID- 10141668 TI - Congress urges VA eligibility reform. PMID- 10141669 TI - It's time for nursing to drop 'poor me' attitude and take leadership role in healthcare. PMID- 10141670 TI - Fla. system switches alliances in search of 'better cultural fit'. PMID- 10141671 TI - PPOs diversify, accept some risk to ensure survival. AB - A Modern Healthcare survey of provider-owned managed-care organizations finds PPOs outpacing HMOs. PPOs are proving experts who predicted their decline wrong. They're diversifying, accepting risk, and lobbying for inclusion in government programs. PMID- 10141672 TI - New software helps docs explore diagnosis, treatment alternatives. PMID- 10141673 TI - Insurer to team up with providers in planning, capitalizing new HMOs. PMID- 10141674 TI - Indicators point up for hospitals. PMID- 10141676 TI - Columbia to manage Va. facility. PMID- 10141675 TI - Columbia merger has big impact in Florida, Texas. PMID- 10141677 TI - Columbia's tactics hit. PMID- 10141678 TI - How to manage the Medicare appeals process. PMID- 10141679 TI - Weaning from mechanical ventilation: physician-directed vs a respiratory therapist-directed protocol. AB - To speed weaning and free physicians for other duties, we changed from a physician-directed to a respiratory therapist (RT)-directed protocol for weaning cardiac surgery patients from mechanical ventilation. METHODS: Eligible patients were identified by physicians after which RTs initiated and directed an intermittent mandatory ventilation weaning in accordance with a written weaning protocol. Eligibility criteria for entry into the weaning protocol (Phase 1) were expanded at the end of 4 months to include more complicated and unstable patients to be weaned by the RT-directed protocol (Phase 2). Total ventilation time and the duration of weaning were recorded for all patients during both phases and during the 2-months prior to implementing RT-directed weaning (control period). All patients were physician weaned during the control period. RESULTS: No complications were associated with the introduction of RT-directed weaning. The percentage of all cardiac surgery patients weaned by the RTs increased progressively from 41 to 90% over the 7-month study period. When compared to a similar group of physician-weaned patients in the control period, the RT-weaned patients in Phase 1 and Phase 2 of the study had a significantly shorter median total ventilation time (18.6 vs 16.8 hours [p = 0.02, chi 2.95,1] for Phase 1 and 19.7 vs 17.8 hours [p = 0.04] for Phase 2). CONCLUSIONS: We have demonstrated that respiratory therapists can safely and efficiently wean cardiac surgery patients from mechanical ventilation. PMID- 10141680 TI - Psychological factors in weaning from mechanical ventilatory support. PMID- 10141681 TI - A seat at the table. Community advisory boards help consumers direct their own health care. PMID- 10141682 TI - Creating the building blocks for health. PMID- 10141683 TI - A healthy community is just good business. PMID- 10141684 TI - CEO survey spotlights community health. PMID- 10141685 TI - The healing power of art. PMID- 10141686 TI - Can we manage Medicare reform? PMID- 10141687 TI - This itch won't go away. PMID- 10141688 TI - Violence in the streets. What can communities do? PMID- 10141689 TI - Energy and macronutrient intakes of persons ages 2 months and over in the United States: Third National Health and Nutrition Examination Survey, Phase 1, 1988-91. PMID- 10141690 TI - Cost savings through the use of digital angiography. PMID- 10141691 TI - Cardiovascular care. The unprecedented evolution continues. PMID- 10141692 TI - A comprehensive center for the diagnosis and treatment of breast cancer. PMID- 10141693 TI - To manage or to be managed. This is a question? AB - Change is reality and the strategic decisions which are made by hospital leadership will largely determine the ultimate success or demise of an institution into this new world of managed care and capitation. There is no magic formula or right answer as to what an institution needs to do to survive and succeed. However, certain strategies can increase the likelihood of success in the inevitable future of riddled with so many unknowns. As a healthcare and hospital leader you can either manage your own destiny or be managed by the market forces which will inevitably be thrust upon you and your organization. PMID- 10141694 TI - Employee satisfaction: an integral component of total quality. AB - As part of the Total Quality Management process, the leadership of Rush Medical Laboratories, with a staff of 400, made an initial commitment to focus on their own employees as the most important customers. Only after the employees' development, their help, their support, and their empowerment could Rush Medical Laboratories make the improvements in customer relationships and obtain the operations improvement, cost savings, and productivity necessary to maintain a competitive edge. This article outlines the numerous employee initiatives that have resulted from this commitment. All of these initiatives were successful at some point during the 5 or more years since the incorporation of TQM within Rush Medical Laboratories. In the spirit of continuous improvement, some have been modified or discontinued and replaced by others. This article provides an overview of the many improvements that are possible when employees are provided a forum in which to voice their needs, and it challenges the management and employees of all laboratories to focus on this vital component of total quality. PMID- 10141695 TI - Cost-effective purchasing and the responsible manager. PMID- 10141696 TI - Managing stress through prevention. AB - This article presents a practical approach to stress management in the clinical laboratory setting. While advocating a proactive approach to stress management, the underlying principle of this paper is that several well-documented human resource techniques should be more widely interpreted and implemented to serve as stress management techniques. Major sources of stress in the clinical laboratory setting are identified, and specific strategies to address these sources are discussed. PMID- 10141697 TI - Medical Automation Systems' RALS (Remote Automated Laboratory System). PMID- 10141698 TI - Laboratory integration. AB - As managed care moves from a concept to the forefront of health care, providers are seeking more efficient ways to service their customers. Clinical laboratories are currently in the midst of this new challenge, and many are integrating their services into health-care system alliances. In this issue, we asked some of our members who are currently blazing the integration trail: What role did your laboratory play in integrating your institution into a health-care system alliance? PMID- 10141699 TI - Development opportunities for hospital clinical laboratory joint ventures. AB - Regional health-care providers are being given the opportunity to collaborate in specialty health-care services. Collaboration to achieve superior economies of scale is very effective in the clinical laboratory industry. National laboratory chains are consolidating and enhancing their control of the industry to ensure their historic profitability. National companies have closed many laboratory facilities and have laid off substantial numbers of laboratory personnel. Health care providers can regain control of their locally generated laboratory health care dollars by joining forces with clinical laboratory joint ventures. Laboratorians can assist the healthcare providers in bringing laboratory services and employment back to the local community. New capital for operational development and laboratory information systems will help bring the laboratory to the point of care. The independent regional laboratory is focused on supporting the medical needs of the community. The profit generated from a laboratory joint venture is shared among local health-care providers, supporting their economic viability. The laboratories' ability to contribute to the development of profit making ventures will provide capital for new laboratory development. All of the above will ensure the clinical laboratories' role in providing quality health care to our communities and employment opportunities for laboratory personnel. PMID- 10141700 TI - Perspectives. Practice guidelines: more than attitudes will have to change. PMID- 10141701 TI - Building an integrated health care delivery system. PMID- 10141702 TI - How are state and federal laws impacting integrated delivery systems in California? PMID- 10141703 TI - Risk management remedies under integrated managed care. PMID- 10141704 TI - The more things change ... the more they stay the same. PMID- 10141705 TI - The ethics of managed care: profit vs. patient welfare. PMID- 10141706 TI - Intensive care: heroic efforts or futile care? PMID- 10141707 TI - Re-engineering: myth or miracle? PMID- 10141708 TI - Legal issues raised by workplace re-engineering. PMID- 10141709 TI - Leading the way to a successful re-engineering effort. PMID- 10141710 TI - The NHS R&D Information Systems Strategy (ISS). AB - Following a strategy study which reported in August 1992 the NHS R&D Information Systems Strategy (ISS), a strategic framework for information systems, has been developed to support research and development in the NHS. This paper summarizes its main features, illustrates the benefits which specific information systems will bring, and outlines how the products of the programme are disseminated and accessed. PMID- 10141711 TI - The Cochrane Collaboration: the role of the UK Cochrane Centre in identifying the evidence. AB - This paper attempts to explain why systematic reviews of randomized controlled trials, based on as high a proportion as possible of the relevant studies, are so important in generating reliable information for evidence-based decision making within health care. The preparation, maintenance and dissemination of such reviews is the challenge which has been taken up by the Cochrane Collaboration. The first phase of data collection is the identification of relevant studies. Currently, bibliographic databases are inadequate for this task. MEDLINE searches identify on average only about half of the relevant studies, and until 1994 there were no suitable indexing terms in EMBASE to identify randomized controlled trials. Co-operation between the Cochrane Collaboration and both the National Library of Medicine and Elsevier, however, is already transforming this situation. From January 1994 a new indexing term has been added to EMBASE to help identify randomized controlled trials. From January 1995 a new indexing term will be added to MEDLINE to help identify controlled trials where the method of allocation to treatment or control cannot be described with certainty as being randomized. Also from January 1995 an additional 20,000 reports will be identifiable as randomized controlled trials in MEDLINE. Progress during the first 2 years of the Cochrane Collaboration has been encouraging, but much remains to be done if users of health services are to benefit from the evidence based health care which they deserve. PMID- 10141712 TI - Evidence-based practice: the role of the NHS Centre for Reviews and Dissemination. AB - The increasing need to adopt evidence-based practice places large information demands on health professionals. This paper draws on the experience of the information team of the NHS Centre for Reviews and Dissemination to examine opportunities for information workers to assist researchers and health professionals in the move to more evidence-based care. The importance of research reviews for the development of evidence-based practice and the process of conducting overviews are discussed. The Centre for Reviews and Dissemination is disseminating the results of reviews and developing information services for information professionals, health practitioners and health service managers. The services include databases of structured abstracts of quality reviews and economic evaluations and an enquiry service. PMID- 10141713 TI - The demand for and use of outcomes information. AB - As the focus of UK health care moves towards the achievement of health gain, information on health outcomes is required by health care commissioners and providers in order to bring about improved patient outcomes. The information required includes health care activity and population data, and textual and bibliographic information to identify published outcomes studies and current health outcomes activities. A survey of enquiries received by the UK Clearing House on Health Outcomes was undertaken to ascertain the nature and level of enquiries, and their geographical and organizational origins in the UK. The study cannot claim to be a comprehensive review of the demand for and use of health outcomes information. What it does illustrate is the still developmental stage of health outcomes activity in the UK. Providers are the major group of users of outcomes information. The potential impact of health outcomes information on health care commissioning has yet to be realized. PMID- 10141714 TI - Assembling the evidence: patient-focused outcomes research. AB - Wide variations in medical practice point to the need for better information about the effectiveness of medical interventions derived from well-conducted outcomes studies. The best outcomes research is patient-focused. The example of hysterectomy is used to illustrate the type of information patients need if they are to be active participants in decisions about their care. These decisions are complex, involving the weighing up of a number of potential risks, benefits and uncertainties. Patients as well as doctors need reliable summaries of the evidence to promote shared decision-making and to increase the chance of beneficial health outcomes. PMID- 10141715 TI - A GRiPPing yarn--getting research into practice: a case study. AB - This article describes the GRiPP initiative in the (old) Oxford Region which set out to explore the potential role of purchasers or commissioners of health care in putting the findings of research into the practice of healthcare. A short account of the background to GRiPP is followed by a more detailed description of the GRiPP project carried out in Buckinghamshire and some of the lessons which may be useful to other health authorities. The final section of the article considers the role of the healthcare librarian in the context of 'Getting Research into Practice and Purchasing'. PMID- 10141716 TI - Sharing outcomes information with consumers: a new course for health librarians. PMID- 10141717 TI - Shading the truth in seeking informed consent for research purposes. AB - I want to argue for two propositions. First, I suggest that what some researchers may take to be a simple trade-off between minor violations of the truth for the sake of access to far greater truths represents a profound miscalculation with far-reaching and cumulative reverberations. Second, I submit that today's research environment, as demanding, competitive, and sometimes bewildering as it is, offers genuine scope for what Murdoch calls truth-seeking, for imaging and questioning, and for relating to facts through both truth and truthfulness; but that, in so doing, it presents hard choices with respect to methods, and, in turn, to personal integrity--not only in particular research projects but also with respect to that fragile research environment in its own right. PMID- 10141718 TI - When OPRR (Office for Protection from Research Risks) comes calling: enforcing Federal research regulations. PMID- 10141719 TI - Cloning without prior approval: a response to recent disclosures of noncompliance. AB - In September 1994, the Kennedy Institute of Ethics Journal published a special issue on the ethics of embryo splitting or "cloning," which included papers originally prepared for a workshop on embryo splitting sponsored by the National Advisory Board on Ethics in Reproduction (NABER) and NABER's report, Human Cloning through Embryo Splitting. The impetus for the project was embryo splitting research conducted by Drs. Jerry L. Hall, Robert J. Stillman, and others, at George Washington University and presented in October 1993 at a joint meeting of the American Fertility Society and the Canadian Fertility and Andrology Society. Media coverage at the time reported that the research had been approved by the university's formal review committees. However, it came to light in December 1994 that the researchers had not obtained approval from the university's institutional review board prior to conducting the research. Following a university investigation, the researchers were disciplined and instructed to destroy their data. The university also voluntarily forwarded the records of the incident to the Office for Protection from Research Risks at the National Institutes of Health. Dr. Hall resigned from George Washington University in September 1994. In the following postscript to her article on the ethics of embryo splitting (KIEJ, September 1994), Ruth Macklin discusses these events. The letters and memoranda that she cites were obtained from NIH through the Freedom of Information Act. PMID- 10141720 TI - Gender issues in health care. PMID- 10141721 TI - Is law submerging ethics in health care? PMID- 10141722 TI - Reprofiling human resources: transferring care from hospital to community. AB - It is generally accepted that there must be a shift from expensive acute care services, which often only serve a limited population, to a method of community based care that is supported by an appropriate mix of primary care providers and specialists. This article identifies constraints to the successful implementation of models of primary care and community-based approaches to the delivery of health services. The importance of health human resource planning and policies is emphasized and suggestions are made on approaches that tend to match human resource development with community-based delivery. PMID- 10141723 TI - Stress: your work and your life. PMID- 10141724 TI - Maximizing service delivery: one OR's experience. AB - Hospitals are being forced to make strategic downsizing decisions at a rapid rate. Surgical services are frequently targeted as much of the related activity is deemed to be controllable. However, strategies that only focus on bed and operating room reductions do not always achieve desired results. This article describes the experience of one community hospital in controlling surgical costs over a five-year period. The keys to its success include evaluating and monitoring the outcome of strategic decisions, identifying and integrating the systems that comprise the surgical process, and ensuring the involvement of users in developing and implementing change. PMID- 10141725 TI - Transitional care: filling the gap for older patients. AB - Frequently, when the acute phase of a frail older person's illness resolves, the patient is too weak to function independently and cannot be discharged from hospital. Acute care staff often lack the ability and resources to deal adequately with these situations. A program of transitional (or subacute) care at Ontario's Mississauga Hospital has been shown to fill this gap in the continuum of care by improving the functional level of frail elders and ensuring better bed utilization. PMID- 10141726 TI - Preventing hospital-acquired infection: an underexploited opportunity to reduce cost and increase quality of care. PMID- 10141727 TI - New Brunswick hospital system reorganization: a formula for success. AB - Propelled by a staggering burden of national and provincial debt, Canada has been overtaken by reform of its health system. New Brunswick's regionalization of hospital services has been a fascinating experience in health care reform, and many of its characteristics have now been emulated by other provinces. The approach has been bold, challenging and exciting. PMID- 10141728 TI - If this is Tuesday, it must be the district council meeting. Interview by Matthew D. Pavelich. PMID- 10141729 TI - The use of decision support systems in health facility allocation problems. AB - Employing Kitchener's Freeport Hospital as a case study, the author introduces decision support systems as possible aids for allocating public health care facilities. The study found that the Dynamic Interactive Network Analysis System (DINAS) was useful in determining Kitchener as the most suitable location for Freeport, based upon a comparison of need throughout Ontario. PMID- 10141730 TI - Victoria Hospital listens to the community. PMID- 10141731 TI - CHA comments on the Fraser Institute's latest waiting lists survey. PMID- 10141732 TI - Client-centred standards: risk implications for boards and management. AB - The author argues that the Canadian Council on Health Services Accreditation standards have acquired the status of law and that, therefore, there may be an increased risk of legal liability inherent in the use of the council's new client centred standards. As survey teams focus less on structure and more on the individual client, the potential for instances of substandard care to be uncovered and documented as part of the survey process escalates. PMID- 10141733 TI - Chairing productive meetings. AB - In today's tight economic climate, it is essential to make every meeting productive. The responsibility for this belongs largely to the person conducting the meeting. If members do not actively contribute, the chair may need to deal with this behaviour, either at the time of the meeting or afterward, depending on the situation. PMID- 10141734 TI - Laboratory service sharing for cost containment. AB - A pilot project implemented by two Montreal hospitals measured the impact on costs of sharing laboratory services for a limited number of biochemical tests while maintaining quality of care. The incremental costs of shared services were compared to the costs of the hospitals performing tests independently and to those of referring tests to another hospital laboratory. The costs of the tests were based on the average price asked by three major Montreal facilities. PMID- 10141735 TI - Hospital-based schizophrenia program evaluates its supported housing project. AB - The Hamilton Psychiatric Hospital schizophrenia psychosocial rehabilitation program developed a supported housing project to meet the goals of patients severely disabled with schizophrenia. An evaluation was conducted to assess whether the project had been implemented according to the original proposal. The assessment allowed adjustments to be made to the project, provided lessons for future undertakings, and demonstrated the value of clearly specifying the elements underlying any pilot project. PMID- 10141736 TI - From rhetoric to reality: moving hospitals into health promotion. AB - Health promotion has received a lot of attention over the past several decades as an important means of improving the health of Canadians and reducing the costs of health service delivery. How do hospitals reorient themselves to a greater role in health promotion? Is hospital-based community health promotion viable? This article describes the process undertaken by Seven Oaks General Hospital as it moved aggressively into this field. PMID- 10141737 TI - Heartfelt determination to increase organ and tissue donations. Interview by Matthew D. Pavelich. PMID- 10141738 TI - Client, care or cost? The focus of health care reform. PMID- 10141739 TI - A timeless tale: converting from date-related to event-related resterilization of supplies. PMID- 10141740 TI - Hospital care in a tent: Canada's health service peacekeepers on display. PMID- 10141741 TI - Voluntary boards must play leadership role in health reform. PMID- 10141742 TI - Privacy and security of health information in the emerging health care system. PMID- 10141743 TI - Health care reform and the patient-physician relationship. PMID- 10141744 TI - Integrated delivery systems: reforming the conflicts among federal referral, tax exemption, and antitrust laws. PMID- 10141745 TI - Policy issues in health alliances: of efficiency, monopsony, and equity. PMID- 10141746 TI - Protecting consumers and providers under health reform: an overview of the major administrative law issues. PMID- 10141747 TI - Genesys Health System in Flint, Michigan, pays more than lip service to a continuum of care. PMID- 10141748 TI - Obstacles to designing and implementing integrated care delivery in the medical center. PMID- 10141749 TI - Case study update. Arizona's UMC model of patient-center care thrives after four years. Three new features of redesign at University Medical Center, Tucson. AB - In January 1992, this publication introduced a promising one-year-old program of patient-centered care at 312-bed University Medical Center (UMC), Arizona Health Sciences Center, in Tucson. Since then, the groundbreaking program (dubbed the "Arizona Model" by admiring colleagues in other states) has continued to grow, even as the small teaching institution saw its environment evolve into "a war zone" of managed care competition. In the last year, three important enhancements have been implemented. PMID- 10141750 TI - At Albert Einstein, alignment of staff and MD performance with values is business strategy. PMID- 10141751 TI - Move it! Solving patient transportation problems. PMID- 10141752 TI - Recruits from other industries. What can they teach you?. Interview by John McCormack. AB - When Michael Jordan traded in his high-tops for cleats, people had their doubts. What skills could this high-flying king of the court bring to the baseball diamond? Ask the players for the Birmingham Barons, the minor league team that he joined last year. Jordan didn't bring sophisticated baseball skills to the organization, but he was able to teach his new peers--all lifelong baseball players--about physical conditioning, competitiveness, mental preparation, and the ups and downs of fame. When materials managers from other industries sign on to a hospital team, there may be doubts about whether their skills are transferable. But, like Jordan, they bring to the team unique experiences and perspectives that can enhance the game. Hospitals that hire managers from other disciplines often find that these people bring bold new ideas to the organization. Their special skills could even help improve the performance of longtime players in the health care arena. We recently spoke with four hospital managers who immigrated to health care from other industries. Read their stories and you, too, might see your job in a whole new way. PMID- 10141753 TI - The right touch. Support surfaces can pamper skin--and your budget. PMID- 10141754 TI - Closing a warehouse opens new opportunities. One department's redesign. PMID- 10141755 TI - Bar coding in the OR: it's more than just inventory control. PMID- 10141756 TI - Attacking the basket 'monster': one SPD shows you how. PMID- 10141757 TI - Can academic medical centers survive? PMID- 10141758 TI - Managed care stats. PMID- 10141759 TI - Specialists lose ground & generalists & group physicians gain. PMID- 10141760 TI - Rectification of the primary data obtained by a patients' satisfaction survey. AB - Examines an attempt at implementation of a total quality management programme in a university hospital in the Czech Republic where patient satisfaction was found to be very high. Tentatively ascribes the "generosity error" to the historic experience of the population. Demonstrates that this factor may be compensated for by a mathematical process ("rectification"), which is derived from the assessment of every respondent's general scale. PMID- 10141761 TI - Quality assurance and the myth of rationality. AB - Examines the extent to which quality assurance can be conceived as a rational endeavour, particularly in ethical terms. Examines the Weberian distinction between rationality as values as an "end in themselves" and values conceived in terms of a "means-ends" distinction. While the emergence and existence of quality assurance can be viewed from either of these two perspectives, both entail a number of problems. Suggests that quality assurance, while appearing rational, fails at a crucial point for two reasons. First, while rationality is a relational concept, quality within the health service does not appear to function in such a manner; and second that quality assurance often neglects to evaluate its own activities. Claims that in both instances quality assurance acts more in terms of its functional role than in terms of its rationality. PMID- 10141762 TI - Continuous improvement and TQM in health care: an emerging operational paradigm becomes a strategic imperative. AB - Argues that US health care is in a state of crisis. Escalating costs account for 13 per cent of GNP, making health care the third largest industry in the USA, and spending is expected to increase. Claims health-care providers need to control rising costs, improve productivity and flexibility, adopt appropriate technologies, and maintain competitive levels of quality and value. States that TQM may provide an environment that will focus on quality of patient care and continuous quality improvement at all levels of the organization including the governing body, the administrative, managerial, and clinical areas. Any new national or state health-care plan will force providers to be more efficient while maintaining quality standards. Concludes that it will be strategically imperative that health-care providers ranging from family physicians to major medical centres and suppliers ranging from laboratories to pharmaceutical firms establish methods for making rapid continuous improvement and total quality management the cornerstone of the strategic planning process. PMID- 10141763 TI - Implementation and evaluation of a quality assurance programme. AB - Describes the three stages of implementation of a quality assurance programme (preparatory, development of quality assurance structure and process, appearance of quality assurance outcomes). Observes that it is advantageous to implement the programme by providing external support to internal quality assurance efforts. Mentions the way of conducting a formative and a summative evaluation of a programme as well as the factors that influence the effectiveness of a programme. PMID- 10141764 TI - Using adverse events in health-care quality improvement: results from a British acute hospital. AB - Adverse event monitoring is a problem-oriented approach to clinical audit and health-care quality improvement, which was developed and has been widely used in the USA. Briefly explores the technique itself and its evolution. Presents experience gained from the widespread use of the approach in a British acute hospital, and results from one specialty--ophthalmology. Suggests that the study of adverse events in patient care can produce significant improvements in patients' care, that it is particularly suited to some specialties, and that it should be used alongside other techniques in hospital clinical audit programmes. Concludes that, as the demand for quality-monitoring information from purchasers and within providers grows, adverse event monitoring may become one of the key techniques for quality assessment and improvement. PMID- 10141766 TI - The pharmacy benefit and transaction-based reimbursement. PMID- 10141765 TI - Economic costs of obsessive-compulsive disorder. AB - Obsessive-compulsive disorder (OCD), classified as a severe mental illness by the National Advisory Mental Health Council, affects 2.1% of the population annually, as shown by the Epidemiological Catchment Area surveys. This study, using the human capital approach, estimated the direct and indirect costs of OCD. The total costs of OCD were estimated to be $8.4 billion in 1990, 5.7% of the estimated $147.8 billion cost of all mental illness, and 18.0% of the costs of all anxiety disorders, estimated to be $46.6 billion. The indirect costs of OCD, reflecting lost productivity of individuals suffering from or dying from the disorder, were estimated at $6.2 billion. PMID- 10141767 TI - Implementation issues in disease management programs: a pharmaceutical company perspective. AB - Eli Lilly, a pharmaceutical manufacturer, recently established a disease management subsidiary. The author, one of the key forces behind the new venture, provides a how-to based on the company's experiences in developing Integrated Disease Management, Inc. His views, from the pharmaceutical company perspective, may also be applicable to any organization seeking to climb into the red-hot arena of disease management. PMID- 10141768 TI - Information: what do consumers want to know? AB - National statistics indicate the potential demand for health care information will become an increasingly important area of attention in the years ahead. Consumers currently focus on such factors as reputation, accessibility, and cost when making health care decisions. Future consumers will be concerned with the interests, experience, satisfaction, and outcomes of health professionals, facilities, and plans. Current public dissemination efforts will create additional demand for more and better health care information. PMID- 10141769 TI - Using PERT/CPM (Program Evaluation and Review Technique/Critical Path Method) to design and improve clinical processes. AB - Recent changes in health care have focused attention on new tools for planning and managing clinical processes. The use of one tool in particular, clinical pathways, has increased dramatically. Pathways employ a concept long used in other industries: the explicit design and documentation of a process. However, the most common tools used in other industries to perform process design, the Program Evaluation and Review Technique (PERT) and the Critical Path Method (CPM), have not migrated to health care. This article presents a methodology for incorporating PERT/CPM into the design and management of clinical processes. PMID- 10141770 TI - Extending the application of critical path methods. AB - Most health care organizations are using critical pathways in an attempt to reduce the variation in patient care, improve quality, enhance communication, and reduce costs. Virtually all of the critical path efforts to date have developed tables of treatments, medications, and so forth by day and have displayed them in a format known as a Gantt chart. This article presents a methodology for identifying the true "time-limiting" critical path, describes three additional methods for presenting the information--the network, precedent, and resource formats--and shows how these can significantly enhance current critical path efforts. PMID- 10141771 TI - Managing critical pathway variances. AB - As the use of critical pathways expands at an increasing rate, we are faced with the issue of how to manage variances from the pathway. Variance management is not clearly defined in the literature, and many institutions search for the best approach. We have implemented a number of different techniques for variance management at Fletcher Allen Health Care. Our success benefits both patients and providers. PMID- 10141772 TI - The COPD critical pathway: a case study in progress. AB - Patients with chronic obstructive pulmonary disease (COPD) consume many health care resources and require complex coordination of care among multiple caregivers. In this report, we share our experiences at Fletcher Allen Health Care, Burlington, Vermont, in developing and implementing a critical pathway for these patients. The COPD pathway has resulted in measurable improvements in the quality of care and has provided us with lessons that will enhance our use of critical pathway methods. PMID- 10141773 TI - Critical paths at Alliant Health System. AB - Alliant Health System (Alliant) was an enthusiastic, early user of critical paths in a hospital setting. In spite of its apparent early successes with the approach, Alliant eventually dropped critical paths as an overall corporate strategy and redesigned its approach to those critical paths still in use. This article summarizes the lessons learned and offers suggestions on the use of critical paths. PMID- 10141774 TI - Malpractice claims, patient communication, and critical paths: a lawyer's perspective. AB - Patient confusion and anger resulting from poor provider-patient communication are major factors giving rise to malpractice claims. This article uses the true story of Patient X to explore how communication issues contribute to claims. It also studies the motives of malpractice plaintiffs within the context of the scholarly literature. The article concludes that critical paths can play a positive role in ensuring timeliness, consistency, thoroughness, and patient comprehension of key communication. If used correctly, critical paths can address some of the root causes of malpractice suits. PMID- 10141775 TI - Achieving cost and quality benefits in critical pathway implementation. PMID- 10141776 TI - Interpreting quality improvement data with time-series analyses. AB - In quality improvement efforts, the data are frequently a series of measurements taken over time. A collection of statistical methods, commonly referred to as time-series analysis, provides a simple and understandable method for interpreting this longitudinal data. In this article, we present a time-series analysis of data on the quality of prenatal care at a mid-sized public hospital. We will demonstrate some simple tests that alert us to the potential value of using more sophisticated tests of association such as regression. Using regression, we show how to confirm a visual impression of an improvement. The analytical approach we present here is useful with many types of process or outcome data from health care quality improvement efforts. PMID- 10141777 TI - Networking guru cherishes 'the links'. Interview by Damon Braly. AB - "The links" takes on several meanings to avid sportsfan and networking guru Mark Caron, director of networking and personal computing for Healthsource, Inc., Hookset, N.H. Caron is attempting to lead the way among integrated healthcare delivery networks by setting up a client/server architecture, videoconferencing and Internet connections between Healthsource sites. PMID- 10141778 TI - A marriage of necessity: automated and manual systems. PMID- 10141779 TI - HotList. Managed-care products and services. PMID- 10141780 TI - Medical devices; Mammography Quality Standards Act of 1992; inspection fees--FDA. Notice. AB - The Food and Drug Administration (FDA) is announcing the fees it will assess for inspections of mammography facilities during fiscal year 1995 (FY 95). The Mammography Quality Standards Act of 1992 (MQSA) requires FDA to assess and collect fees from mammography facilities to cover the costs of annual inspections required by the MQSA. This notice explains which facilities are subject to payment of inspection fees, provides information on the costs included in developing inspection fees, and provides information on the inspection, billing, and collection processes. PMID- 10141781 TI - Civil money penalties for referrals to entities and for prohibited arrangements and schemes--HHS. Final rule with comment period. AB - This final rule implements the civil money penalty (CMP) provisions established through sections 1877(g)(3) and 1877(g)(4) of the Social Security Act. Specifically, in accordance with section 1877(g)(3), these regulations set forth CMPs, assessments and an exclusion against any person who presents, or causes to be presented, a bill or claim the person knows or should know is for a service unlawfully referred under section 1877(a)(1)(A) of the Act, or has not refunded amounts inappropriately collected for a prohibited referral. In addition, in accordance with section 1877(g)(4), these regulations set forth CMPs, assessments and an exclusion in cases where a physician or entity enters into an arrangement or scheme in which the physician or entity knows, or should have known, that the principal purpose is to assure referrals by the physician which, if made directly to a particular entity, would violate the prohibition on referrals described in section 1877(a) of the Act. PMID- 10141782 TI - Medical facility construction and modernization; requirements for provision of services to persons unable to pay--PHS. Final rule. AB - This document revises the rules currently governing how certain health care facilities, assisted under Titles VI and XVI of the Public Health Service Act, fulfill the assurance, given in their applications for assistance, that they would provide a reasonable volume of services to persons unable to pay. Public comment on the current rules and operational experience with them indicated the need to revise the current requirements with respect to nursing homes, many of which are unable under current requirements to meet their obligation to provide such services. The rules below should permit qualified facilities to satisfy their uncompensated services assurance. PMID- 10141783 TI - Centers for Disease Control and Prevention; statement of organization, functions, and delegations of authority--PHS. PMID- 10141785 TI - Managed care serves to boost incomes of family physicians. PMID- 10141784 TI - Managed Medicare. PMID- 10141786 TI - Piecing together your profile. What plans know about you, and how they use it. AB - Managed care plans are amassing vast amounts of information about physicians. Here's what you could expect to find in your profile--if you could get your hands on it--and what plans do with the information. PMID- 10141787 TI - The law's 3 standards of informed consent. PMID- 10141788 TI - Can a hospital compel physicians to sell? AB - Officially, physicians in Springfield, Mo., were free to take or leave a local hospital's purchase offer. But to some doctors, the hospital's proposal--and its urgent decision deadline--left them little choice. PMID- 10141789 TI - 12 ways to tell if this merger is right for you. PMID- 10141790 TI - The safe, effective way to check out a plan. PMID- 10141791 TI - Restructuring guidelines to reflect how physicians really work. PMID- 10141792 TI - Managed 'menage a trois': doctor, patient and payer. PMID- 10141793 TI - Some Stark facts about rules governing referrals within groups. PMID- 10141794 TI - What kinds of health care coverage are mid-size employers buying. PMID- 10141795 TI - 'Mid-level providers' can ease your capitation crunch. PMID- 10141796 TI - How to prime the pump for patient referrals. PMID- 10141797 TI - Coping with HMO burnout. PMID- 10141798 TI - Treating the patient who won't stay away. PMID- 10141799 TI - To get medical students to choose primary care, raise their incomes. PMID- 10141800 TI - Medicaid and managed care: opportunities for innovative service delivery to vulnerable populations. AB - The crisis in state "safety-net" funding for high-need, high-risk, high-cost vulnerable populations has led to the development of creative strategies and financing mechanisms by the states for delivering essential community-based services. This is also an opportunity for private-sector providers who can recognize the special needs of these populations, form links with other key constituencies and apply managed care concepts to long-term health and human service delivery. PMID- 10141801 TI - Administrative and management issues in public-private collaboration. AB - With the growing emphasis on developing public/private-sector collaborations for the provision of behavioral healthcare services to Medicaid recipients, one of the key issues will be clarifying the distinction between provider networks and systems of care. The latter provide a comprehensive spectrum of vertically and horizontally integrated services to targeted populations. Public/private collaborations will also require new and modified outcomes measurement systems and quality management programs, building on what already exists in each sector. PMID- 10141802 TI - Managing the financial challenges of public-private collaboration. AB - With the growing emphasis on Medicaid managed care waivers as a method for states to constrain healthcare cost overruns (see also State Policy Review on page 63), new and creative pricing techniques for carve-out and carve-in programs will be a key to their success. The author builds on his experience in developing a Medicaid behavioral healthcare carve-out in Massachusetts to illustrate some basic principles in the pricing and management of such public-private collaborations. These collaborative systems should be based on specific actuarial models, plans for enhanced access to services and the need to change incrementally in the context of the political process. PMID- 10141803 TI - Legal and regulatory challenges in public-private managed behavioral healthcare program procurement: moving beyond the conflicts. AB - In the past year a number of states have initiated managed behavioral healthcare proposals to reform the delivery of public mental health services. Those in Florida, Iowa and Pennsylvania have been met with administrative and legal challenges. Given the potential controversies surrounding this procurement process, the authors suggest some guidelines on how to improve the process and thereby enhance public/private collaborations--to the benefit of states, behavioral healthcare providers and clients. PMID- 10141804 TI - Dialogue: how will litigation impact on the integration of public and private behavioral healthcare services? Is believing you have a case a good enough reason to sue? PMID- 10141805 TI - Dialogue: how will litigation impact on the integration of public and private behavioral healthcare services? Casualties of litigation: trust, credibility, political equilibrium, cost-effectiveness. PMID- 10141806 TI - Dialogue: how will litigation impact on the integration of public and private behavioral healthcare services? Causes and effects of litigation in Medicaid managed behavioral healthcare ventures. PMID- 10141807 TI - New clinical challenges: managed behavioral healthcare and the chronic psychiatric patient. PMID- 10141808 TI - Developing a customized outcomes program. PMID- 10141809 TI - Can private-sector behavioral healthcare benefit from public-sector information technology experience? PMID- 10141810 TI - States use HCFA waivers to transform Medicaid mental health. PMID- 10141811 TI - Who will assure that the need for mental health and substance abuse services is met? PMID- 10141812 TI - Public-private behavioral healthcare integration trends: a vision for the '90s and beyond. PMID- 10141813 TI - Institutional influences on physicians in an academic Department of Veterans Affairs Medical Center: a conjoint model of physician behavior. PMID- 10141814 TI - Professions, norms, and the phase model: physicians as a special case? PMID- 10141815 TI - Rural hospitals closings: a case study of the effects in Texas on infant mortality and accidental deaths. PMID- 10141816 TI - Improving quality and resource utilization through the clinical technologist. AB - This paper reports on the significant benefits realized during the implementation of a Clinical Technologist position in two wards of a major teaching hospital. In addition to efficient and effective handling of specimens and test results, the program results in significant savings and in enhanced patient care. PMID- 10141818 TI - Sexual harassment in health care: implications for medical radiation technology training programs. AB - In May 1993, the Council on Education--Radiation Therapy of the Canadian Association of Medical Radiation Technologists (CAMRT) decided to include two new items in its curriculum guide: components of sexual abuse prevention; and legal requirements of consent to treatment and specific procedures (especially those related to gender-sensitive procedures). In order to design a lecture or workshop that would cover these subjects, the committee undertook a review of current literature on sexual harassment and abuse. A two-hour workshop was then given to the 12 students in the Radiation Therapy Program at the Cross Cancer Institute in Edmonton, Alberta. This article attempts to give an overview of the literature as well as the author's recommendations on the format and content for presenting this subject to students. A summary of the students' comments is also included. PMID- 10141817 TI - Competency-Based Certification Project. Phase III: content validity, standard setting and criterion-related validity. AB - This is the final article in a three-part series explaining the CAMRT's Competency-Based Certification Project--an effort to make the Association's certification process more job-relevant. The first article (Journal, August 1994) explained the job analysis process used to specify and validate the list of duties and tasks required of entry-level medical radiation technologists, the imaging and treatment procedures they perform, and the equipment they use. The second article (Journal, October 1994) explained the process for developing an examination blueprint by reviewing the CAMRT's examinations and summaries of clinical experience in the context of competency-based evaluation and the job analysis validation in each discipline. This article examines the development of assessment standards for certification examinations and summaries of clinical experience. It provides an overview of the steps necessary to develop a valid and defensible licensure/certification process after development of the examination content is complete. PMID- 10141819 TI - On becoming a caregiver. Default or election--& does it matter? AB - Family caregivers provide an enormous amount of care--often without being prepared for it. However, research has brought to light that family members may have been groomed from childhood to accept the role of caregiver. Insight into how family members become caregivers could help professionals work with and support these invaluable team members. PMID- 10141820 TI - Navigating the seas of caregiving. Allies & ideas for success. AB - Formal and informal caregivers share an awesome responsibility in caregiving. If they are going to be effective, caregivers must take care of themselves, communicate with each other, and understand the elements of caring. Home care professionals who recognize the interdependence among formal and informal caregivers and their patients can create a supportive caregiving team. PMID- 10141821 TI - Establishing partnerships with family caregivers. Local and cosmopolitan knowledge. AB - Families now provide most of the care received by older people in the United States. Proposed changes in the health care system will mean that families must take an even greater role in delivering health care. It is crucial that nurses practicing in a variety of settings be prepared to establish partnerships with family caregivers in order to attend to the long-term care needs of older people. PMID- 10141822 TI - Supporting family caregivers. It makes good business sense, too. PMID- 10141823 TI - Confidence, relief, & support: family caregivers look to professionals. AB - Professional caregivers often take on two patients for every one client: the patient requiring home care and that patient's informal caregiver. These caregivers need as much guidance and support as the home care professional can provide to ensure calm and effective patient care. PMID- 10141824 TI - "How much can I give?" The other side of caregiving. AB - Informal caregivers--usually family members--take on a lot when they care for a patient. Professionals need to be aware of potential stress and recognize caregiver burnout. There are several ways agencies can help these caregivers. PMID- 10141825 TI - Coping with caregiving: supporting the informal caregiver. AB - Community health nurses often work side by side with informal caregivers. Professional caregivers can reduce their own stress and that of their patients by helping to reduce the stress of the informal caregivers, who provide a great deal of support and medical care to their loved ones. PMID- 10141826 TI - Creating care partnerships with long-distance caregivers. AB - Primary family caregivers cannot always physically be there to care for aging relatives; they may live in another state or even another country. By developing a care partnership, however, with a provider and the older relative, long distance caregivers can be assured that relatives get the care they need from qualified and effective providers. PMID- 10141827 TI - Thro' the night: family care when the patient is dying. AB - Working with dying patients can have an overwhelming effect on both formal and informal caregivers. What strategies will help professionals work with families to ease this difficult time--and what can professionals do to help themselves? PMID- 10141828 TI - Caring through activities. AB - Home care patients require help with health-related activities, but they also want to engage in activities that they like to do, such as reminiscing or listening to music. Home care professionals can improve the lives of their patients by integrating some special activities into daily caregiving activities and teaching these activities to informal caregivers. PMID- 10141829 TI - Stressors, needs, and resources: what AIDS home caregivers have to say. AB - Caregivers of persons with AIDS often face psychological, physical, economic, and social barriers to effective care. Community resources and support are inadequate. How can home care professionals help caregivers deal with the implications of caring for a friend or loved one who has this socially stigmatized disease? PMID- 10141830 TI - The personal assistant--a new option for home care. AB - One agency has tapped middle-aged women as resources for home care aides- specifically as personal assistants. This approach has fine results and may prove a good model for addressing the normally high-turnover rate this position accrues. PMID- 10141831 TI - Focus on the family. PMID- 10141832 TI - Family caregivers. AB - The home care industry relies on family caregivers to provide a great deal of the care for patients, and the industry acknowledges that. But do professionals know just who these family members are, and what they think and feel? The National Family Caregivers Association answers these questions and provides guidance on how professionals can help informal caregivers. PMID- 10141833 TI - Home Care Aide Association of America white paper. Guiding principles governing the delivery of long-term care. PMID- 10141834 TI - The agency's role in hiring private help. PMID- 10141835 TI - Children Adjusting to New Situations (CANS)--a grief support group. AB - Children and adult children who are grieving for a parent often feel confused, angry, and alone. One hospice started a support program to address the needs of these children, helping them to deal with their feelings and to realize that they are not alone. This program won the 1993 National Hospice Organization's President's Award of Excellence. PMID- 10141836 TI - Home care aides: the heart of the industry. PMID- 10141837 TI - Pushing the boundaries to reduce biomedical waste. PMID- 10141838 TI - Partnering in healthcare with a one-source supplier. PMID- 10141839 TI - Warding off HIV wasting syndrome. PMID- 10141840 TI - Progress in blood supply safety. PMID- 10141841 TI - Health systems begin clinical integration with oncology. PMID- 10141842 TI - Joint venture service realignment: new opportunities, but only a partial solution. PMID- 10141843 TI - First national report card on managed care quality is ready with NCQA standardization. PMID- 10141844 TI - Organizational links, communications vital when hospitals integrate home care. PMID- 10141845 TI - Soliciting employee ideas. PMID- 10141846 TI - Mildred Cody, PhD, RD. PMID- 10141848 TI - Road map to 1995 standards. PMID- 10141847 TI - Increasing cafeteria and vending profits. PMID- 10141849 TI - Does just-in-time (JIT) purchasing really work? PMID- 10141850 TI - Overcoming the barriers. Tips for improving communication with nurses. PMID- 10141851 TI - The search for outcome indicators. PMID- 10141852 TI - Selling nutrition to case managers. PMID- 10141853 TI - What's new in labor-saving equipment? PMID- 10141854 TI - Lowell Pediatric Unit. PMID- 10141855 TI - Nice little earner. PMID- 10141856 TI - General practice. Core values. PMID- 10141857 TI - Restructuring. Building blocks. PMID- 10141858 TI - Corporate governance. Spice of life. PMID- 10141859 TI - Rehabilitation. Pecan choose. PMID- 10141860 TI - Accreditation. Measuring up. PMID- 10141861 TI - Leadership. Scots opine. PMID- 10141862 TI - Privatisation. Get real. PMID- 10141863 TI - Mental health. On the team. PMID- 10141864 TI - Staff safety. The driving force. PMID- 10141865 TI - Career profile. Finance--on the up. PMID- 10141866 TI - A team approach to adverse drug reaction surveillance: success at a tertiary care hospital. AB - A retrospective adverse drug reaction (ADR) reporting system has been in place at Cedars-Sinai Medical Center for 7 years. Initially, the system identified 300 to 400 ADRs per year. After adding a checklist, that number increased to 750 to 850 per year, an ADR rate of about 2% of total patient admissions. To increase the ADR reporting rate, we initiated a concurrent surveillance program in conjunction with the retrospective system. In the first year of the program, the combined systems identified 1,174 ADRs. In addition, the ADR rate per 100 patient days increased to between 0.5 and 0.7, and the ADR per admission rate increased to 4%. As a result of the more effective ADR surveillance program, the P & T Committee has additional data from which to develop guidelines and educational programs to increase ADR awareness and prevention, and thus, to improve patient outcomes. PMID- 10141867 TI - Safety, efficacy, and lipid profile of doxazosin at a VA medical center. AB - The Veterans Administration Lakeside Medical Center (VALMC) is a 500-bed hospital located in downtown Chicago providing a broad scope of inpatient and outpatient medical services for more than 12,000 veterans. The VALMC Pharmacy and Therapeutics Committee requested a study to evaluate doxazosin mesylate (Cardura) to determine if this agent would be an acceptable alternative to other formulary agents. It appears that doxazosin provides several therapeutic advantages, including once-daily dosing, when compared with other more costly antihypertensive agents. PMID- 10141868 TI - Pharmaceutical industry wins "round one" in protections against product liability claims. PMID- 10141869 TI - Formulary streamlining through therapeutic class review. AB - The authors describe their methods for streamlining the formulary at a small teaching hospital. The therapeutic drug review process comparatively examined pharmacology, pharmacokinetics, indications, side-effects, interactions, usage patterns, and costs within classes of medications. The information was presented in a table format which aided in the dissemination of large volumes of material and served as an educational tool for the medical and pharmacy staff. The goals of this program were avoidance of therapeutic duplication, assurance of efficacy, and cost containment without compromised patient outcome. The authors discuss methods for assuring intra-pharmacy and hospital wide cohesion in achieving the goals of formulary streamlining. PMID- 10141870 TI - Pharmaceutical care provides positive outcomes for postpartum patients. AB - This study examined a method for incorporating the philosophy of pharmaceutical care into the care of postpartum women to promote patient independence and satisfaction with hospital care. Patients became active participants in their own care through a bedside medication, self-administration program. Results of a patient survey indicated that 146 of 167 patients responded positively to the benefits of the bedside medication program. A self administered medication program for postpartum women allowed for patient controlled analgesic and laxative use. The availability of medications before symptom onset, and the provision of pertinent information on use of medications, allowed patients the independence to make appropriate decisions for their own care. PMID- 10141871 TI - Drug information resources in the Veterans Affairs healthcare system. AB - Results of a survey characterizing drug information services and resources from a defined practice area are presented. At the end of 1992, a questionnaire was mailed to 167 Veterans Affairs Medical Centers and Outpatient Clinics. One hundred fifty-one of the surveys (> 90%) were completed and analyzed. The knowledge obtained from this survey may provide a basis for future development of an essential clinical service within the Veterans Affairs health care system. PMID- 10141872 TI - Pharmacist paradigm shift--drug review to management. PMID- 10141873 TI - Managed care influences physician/hospital organization growth. PMID- 10141874 TI - JCAHO's pharmaceutical care plan requirements. PMID- 10141875 TI - The infrastructure of integrated delivery systems. Do you have the management foundation to support radical change? PMID- 10141876 TI - Competing in an integrated healthcare market: four strategies for success. PMID- 10141877 TI - Pick your partners wisely. PMID- 10141878 TI - Physician resource planning. PMID- 10141879 TI - Why integration makes sense. PMID- 10141881 TI - Glove prices continue to slide 1.4%. PMID- 10141880 TI - Integrated delivery systems: fact or fiction. PMID- 10141882 TI - Saving radiology dollars with portable imaging. PMID- 10141883 TI - Medical-surgical supply non-salary expenses per patient day averaged $25.48 in 1994. PMID- 10141884 TI - Focus on: Washington Hospital Center, Biomedical Engineering Department. AB - The Biomedical Engineering Department of the Washington Hospital Center provides clinical engineering services to an urban 907-bed, tertiary care teaching hospital and a variety of associated healthcare facilities. With an annual budget of over $3,000,000, the 24-person department provides cradle-to-grave support for a host of sophisticated medical devices and imaging systems such as lasers, CT scanners, and linear accelerators as well as traditional patient care instrumentation. Hallmarks of the department include its commitment to customer service and patient care, close collaboration with clinicians and quality assurance teams throughout the hospital system, proactive involvement in all phases of the technology management process, and shared leadership in safety standards with the hospital's risk management group. Through this interactive process, the department has assisted the Center not only in the acquisition of 11,000 active devices with a value of more than $64 million, but also in becoming one of the leading providers of high technology healthcare in the Washington, DC metropolitan area. PMID- 10141885 TI - Technical note: observations of intermittent electromagnetic interference on impedance respiration monitors. AB - The sensitivity of three different types of impedance-respiration recorders (impedance pneumographs) to electromagnetic interference was demonstrated using a dummy subject (loop antenna) and human subjects with transchest electrodes. It was found that the impedance recorders detected electromagnetic energy emitted by sparking thermostat contacts, a soldering gun, a hot-air gun, an electric hair clipper and a fluorescent lamp, all of which were turned on and off to generate the electromagnetic energy. PMID- 10141886 TI - Integrated delivery systems create new challenges in health care computing. PMID- 10141887 TI - New hope from AIDS research and long-term HIV-infected survivors. PMID- 10141888 TI - TB prevalence and prevention. PMID- 10141889 TI - Planning progressive change: a guide to anticipatory responsiveness. PMID- 10141890 TI - Poetry in motion. Transfer of care from the field to the ED. PMID- 10141891 TI - What'd he say? How to effectively communicate via radio reporting. PMID- 10141892 TI - EMS gets an incomplete on its report card. PMID- 10141893 TI - The evil test. PMID- 10141894 TI - Medical innovation at the crossroads. PMID- 10141895 TI - Coping successfully with death to help staff, families and residents. PMID- 10141896 TI - Mapping out the road to quality. AB - Through the experiences of 12 long-term care organizations, we learn how to successfully create total quality management programs. Commitment, leadership, time, money and ongoing education and training are major components of TQM efforts. PMID- 10141897 TI - Experimenting with alternative work schedules. PMID- 10141898 TI - Developing principles of care for non-acute long-stay patients. PMID- 10141899 TI - Dutch health-care system restructures to curb costs. PMID- 10141900 TI - Residents who make decisions reveal healthier, happier attitudes. AB - Resident participation implies that all parties see themselves as contributing to decision making and think that their participation will make a difference. A nursing home where residents participate with care providers is a community of openness, information sharing and mutual respect. Having residents participate in their care as well as in care-giving policies and procedures improves quality of care, increases residents' sense of involvement and creates an environment that is more satisfactory for all involved. Health promotion programs are a good method for increasing participation. PMID- 10141901 TI - Death and dying fears overcome by progressive strategies. PMID- 10141902 TI - Long-term care for the long haul... The Boston Home. AB - The Boston Home's mission, to preserve the dignity and autonomy of its residents, was achieved through thoughtful design. The updated facility is a "true success story" and serves as an example of what can be achieved when residents and staff work together. PMID- 10141903 TI - Doctors hold down their expenses. PMID- 10141905 TI - "IPA" also stands for "increased physician acceptance". PMID- 10141904 TI - Who's the key to hospitals' success? You are. PMID- 10141906 TI - My sweet hospital deal left me bankrupt. PMID- 10141907 TI - Let my people go. PMID- 10141908 TI - New tax traps in buy-sell agreement. PMID- 10141909 TI - Are your pockets $15 million deep? PMID- 10141910 TI - Why we love capitation. PMID- 10141911 TI - Can specialists become primary-care doctors? PMID- 10141912 TI - Community health: one doctor can make a difference. PMID- 10141913 TI - The rapidly changing world of clinics without walls. PMID- 10141914 TI - When an HMO sends you Medicare patients. PMID- 10141915 TI - Groups get serious about judging their doctors. PMID- 10141916 TI - "The doctors are our employees now. We make the decisions". PMID- 10141917 TI - Designing a lab that meets evolving needs. PMID- 10141918 TI - Future challenges for the clinical immunology laboratory. PMID- 10141919 TI - A guide to developing clinical pathways. PMID- 10141920 TI - Entering pathology cases by voice. PMID- 10141921 TI - Making telephone references work for you. PMID- 10141922 TI - Outpatient requisition problem solved. PMID- 10141923 TI - Applied health services research: responding to the changing health care environment. AB - Health care in America is changing rapidly. The forces that are reforming our health care system are both numerous and compelling. Americans are requesting access to more affordable health care. At the same time, many Americans want to build upon what is considered the best and most technologically advanced health care system in the world. Especially during economically troubled times, innovative and well-formulated solutions to respond to these fundamental challenges are needed to improve the quality and accessibility of health care. It is essential that policy markers base their health care decisions on sound medical research that specifically examines which aspects of medical care improve patient outcomes. PMID- 10141924 TI - Utilization management, case management, and you. AB - Historically, most monitoring functions have been carried out by insurance companies. Monitoring costs was considered their fiduciary obligation to their customers. The exercise of this fiduciary obligation kept premiums low, while increasing or maintaining the benefit levels. Risk (the assumption of losses generated by services costing more than the income received from premiums) was assumed by the insurance company and eventually passed to the customer or the payer. Today, risk is being transferred more and more to the provider. This transfer was started by the creation of DRGs, the main purpose of which was to transfer risk from payers (insurance companies, employers, state and federal government, etc.) to provider health care organizations (physician groups, individual practitioners, hospitals, clinics, etc.). PMID- 10141925 TI - Fighting fire with fire: physicians blazing new paths to autonomy. AB - Thousands of physicians around the country have stopped complaining about being burned by the system and have started reengineering their destinies. They're building super IPAs, forming and operating HMOs, and joining unions to represent their rights in a growing grassroots physician effort to regain control. These physicians have thumbed their noses at managed care companies they say have drastically cut reimbursements, arbitrarily dropped them from panels, dictated utilization, and cost them patients. They're tired of working harder and earning less and frustrated by sacrificing quality in the name of cost reduction. And they have learned that there are ways to prevail. PMID- 10141926 TI - The relationship between hospital charges and a modified Parsonnet risk score. AB - Health care now consumes approximately 14 percent of the U.S. Gross National Product (GNP). The amount of money spent on health care in America per capita and as a percentage of GNP far exceeds that of any other industrialized country. Currently, the financial burden of health care is being shouldered by government and business. The expenditure of billions of dollars of corporate profits on health care progressively undermines the global competitiveness of American business. These economic realities have emerged as the dominant driving force in health care reform. Cost control efforts to date have focused on strategies to limit inpatient hospital expenditures. The DRG prospective payment system is designed to reimburse a fixed sum based on the diagnostic category of the patient. The DRG payment is essentially independent of underlying patient characteristics that can potentially drive up expenditures. The work reported in this article was done to develop a descriptive formula that could be used to predict resource consumption in the care of patients. The financial viability of a hospital depends on its ability to predict expenditures, allocate resources, and choose its service areas correctly. Errors in financial forecasting in the era of prospective payment will result in financial failures of entire institutions. PMID- 10141927 TI - On being digital. PMID- 10141928 TI - Are you obsessed with interaction? AB - Too many organizations and managers, the author says, are using "interaction" among employees as a means to encourage them to buy-in, to stimulate teamwork, or to build morale. In too many cases, the forced interaction only serves to annoy or embarrass employees--or raise suspicions about management motives. Wise employees fear they will be burned if they open up and interact. There are better ways to run meetings, the author says, and she provides a few. PMID- 10141929 TI - Market share vs. preference. Clinic's marketing campaign for information line increases calls, referrals, and patient volume. Cleveland Clinic Foundation, OH. PMID- 10141930 TI - Taking a stand. March on Washington, direct mailers, and newspaper ads spread hospital's message of violence prevention. St. Joseph's Children's Hospital, Tampa, FL. PMID- 10141931 TI - Employees speak out. Testimonials help hospital recruit in- and out-of-state, boost staff morale and patient satisfaction. McLeod Regional Medical Center, Florence, SC. PMID- 10141932 TI - Monument Valley Hospital. Networking with government, community, and church keeps doors open. PMID- 10141933 TI - Middletown Psychiatric Center. Teamwork revitalizes state hospital, provides better community service. PMID- 10141934 TI - Happy kids, happy parents. Hospital expands day care program, establishing kindergarten which has 88 percent enrollment in its second year. St. Peter's Hospital/Mercycare Corporation, Albany, NY. PMID- 10141935 TI - Building a new foundation. Billboard, print, radio, and TV ads about new facility convey hospital's message of renewed commitment. Bristol Regional Medical Center, TN. PMID- 10141936 TI - Moving in on newcomers. Revamped direct mail program yields 13 percent response. Sherman Health Systems, Elgin, IL. PMID- 10141937 TI - Reaching an untapped market. Partnership with American Cancer Society enables hospital to screen 72 men and increase its database by 14 percent. Thomas Hospital, Fairhope, AL. PMID- 10141938 TI - Looking for fraud in Medicare. PMID- 10141939 TI - Subacute care. Overcoming culture conflict. PMID- 10141940 TI - Residential living. Preparing your ALF for disaster. PMID- 10141941 TI - Bridging the salary gap in long term care. PMID- 10141942 TI - LTC nurses go high tech. Bedside care takes on new meaning. PMID- 10141943 TI - Management. Easing the pain of separation. PMID- 10141944 TI - Putting pressure sores to bed in LTC. PMID- 10141945 TI - Breaking through LTC's glass ceiling. PMID- 10141946 TI - The Patient Self-Determination Act. A matter of life and death. AB - The Patient Self-Determination Act (PSDA) is a federal law, and compliance is mandatory. It is the purpose of this act to ensure that a patient's right to self determination in health care decisions be communicated and protected. Through advance directives--the living will and the durable power of attorney--the right to accept or reject medical or surgical treatment is available to adults while competent, so that in the event that such adults become incompetent to make decisions, they would more easily continue to control decisions affecting their health care. Without advance directives and the proper adherence to such directives, former President Richard Nixon and former First Lady Jacqueline Kennedy Onassis might still be alive today, in persistent vegetative states. This article examines the history of the act, its importance to each individual, the clinical, ethical and legal issues, and the role of health care professionals in effectively implementing and ensuring compliance of the PSDA. PMID- 10141947 TI - Hepatitis update. PMID- 10141948 TI - Caring for each other. PMID- 10141949 TI - Team teaching pays off. PMID- 10141950 TI - Love Letters Inc. supports sick kids. PMID- 10141951 TI - Revisiting our ideas about health. PMID- 10141952 TI - Ready or (probably) not: the elderly are coming. PMID- 10141953 TI - Spirited team. Interview by Jill L. Sherer. AB - J. Harry Kreuger put an old calling to a new use. Kreuger, an ordained minister and pastoral care director at Adventist Healthcare Mid-Atlantic, Rockville, MD, is a self-proclaimed visionary. In his words, "I see things that could be and ask 'why not?'" Instead of turning to divine inspiration alone for a better way to create wellness in the Adventist system's service community, Kreuger asked his colleagues in neighboring churches for help. He spoke with staff editor Jill L. Sherer about how they responded to his initiative--and on how the 5-month-old Damascus (MD) Community Wellness Center became a reality. PMID- 10141954 TI - Good neighbors make for good health. Community health workers educate their own. PMID- 10141955 TI - Healthier times at Ridgemont High. PMID- 10141956 TI - Office visits for glaucoma: United States, 1991-92. PMID- 10141957 TI - Casemix: the building blocks. AB - This paper distinguishes three separate ways in which casemix measurement serves as a foundation for hospital and health system reform. At the hospital level, diagnosis related groups provide a means of describing kinds of acute inpatient care which in turn facilitates utilisation review activities essential to modern clinical and financial management. At the system level, casemix adjusters such as diagnosis related groups provide the basis for comparisons of productive efficiency across institutions, and reduce the risk of adverse funder reactions to higher per case costs which are attributable to differences in casemix. States are increasingly using casemix as the basis for funding hospitals in order to reduce non-casemix related differences. Finally, health reform experiments in using market-like mechanisms (such as managed competition, purchaser-provider split) require at a minimum that the product purchased be precisely specified, and that clinical risks of cost overruns be equalised amongst insurers or providers. PMID- 10141958 TI - Medicare: where to now? AB - Although it is now more than ten years since Medicare was introduced, Medicare is still a relevant response to ensuring access to health care. However, marginal improvements to Medicare are needed in three areas. First, in terms of bureaucratic issues, rational development of health policy suffers from problems associated with the contemporary division of Commonwealth and State responsibilities. Secondly, more sophisticated methods for priority-setting, which take account of both the technical and allocative efficiency issues, are needed. Finally, Medicare needs to be enhanced by improving its ability to meet the diverse and varying needs of patients with long-term illnesses: improvement in 'coordinated care' is necessary. Approaches to meeting these needs are canvassed. PMID- 10141959 TI - An overview of aboriginal and Torres Strait Islander health: present status and future trends. PMID- 10141960 TI - Health inequalities persist into older age. PMID- 10141961 TI - Medicare: radical reform or incrementalism? PMID- 10141962 TI - The United Kingdom National Health Service reforms: where are we now? AB - In April 1991 the reforms of the United Kingdom National Health Service (NHS) established an internal market, separating the roles of purchaser and provider, established new provider organisations (NHS trusts) and initiated the general practice fundholding scheme, where practices of a given minimum size could opt to manage their own budget. This paper reviews the experience so far and outlines recent developments. It concludes that it is difficult to assess whether, overall, the benefits of the reforms outweigh the costs. This is primarily because of a failure to undertake formal evaluation, either before the reforms were implemented, or since they have been implemented. Also, there have been a number of other changes over the same period, including an increase in funding of the NHS. However, two impacts can be identified. Firstly, there has been a shift in the balance of power from secondary to primary care. Secondly, there has been a growing realisation that very little is known about the costs and effectiveness of health care interventions, whether provided within a market-based system or not. PMID- 10141963 TI - The purchaser-provider split in New Zealand: the story so far. AB - In July 1993 some major structural changes were introduced into the New Zealand health system. The main feature was a separation of the purchasing and providing functions that had previously been performed by area health boards. This paper describes the reasons for and nature of the original (1991) proposals, together with changes that have been made subsequently. It discusses the nature of the contracting environment between purchasers and providers, including the integration of primary and secondary funding, the flexibility of contractual arrangements, and the degree of competition. Some information is provided on progress to date, including the impact on quality of services and accountability of providers, as well as some more tangible measures such as changes in throughput, waiting lists, and expenditure since the restructuring took place. The paper concludes that the success or failure of the purchaser-provider split in New Zealand appears to hang crucially on the contractual arrangements which are struck between purchasers and providers. In the longer term, purchasers are likely to encourage the vertical integration of primary and secondary care providers into managed care organisations styled along the lines of health maintenance organisations. Hence the purchaser-provider split may best be viewed as a temporary structure which provides a pathway towards the desired end, that is, more managed and coordinated patient care provided by vertically integrated organisations which were unlikely to emerge under the previous arrangements. PMID- 10141964 TI - Health care financing reform in the United States: the community equity model. AB - The paper discusses the practical structural aspects required for implementing 'managed competition' reform policy which are often overlooked by policy designers of change. Namely, without fundamentally new organisational structures to mediate among the parties of interest, the policies for change will not be sufficient to meet the future. The paper discusses in some detail an organisational mediating structure called the Community Equity Model which organises care at the local neighbourhood or community level using the community as actual fundsholder. This puts the critical stakeholders in a practical mutual ownership relationship by making allocation, services and resource accountability a local act. The paper briefly discusses the organisational and information technology for this type of health care system redesign. PMID- 10141965 TI - Managed competition: issues for Australia. AB - Rising costs and slower economic growth are resulting in progressive stress on the current structure of health care finance in Australia. As in other developed countries, managed competition offers a potential solution, by increasing system efficiency. The case for restructuring current financing arrangements is even stronger than in other countries because of inefficiencies arising from inconsistencies and overlaps between Commonwealth, State and private sector functions. This paper outlines an illustrative model for managed competition in Australia. In addition, it discusses in more detail two specific issues which have received some attention in the literature: whether to have multiple payers, in the form of competing public and private budget holders; and whether 'catastrophic risks' such as long-term institutional care should be incorporated in a managed competition program. PMID- 10141966 TI - Managed competition in The Netherlands: lessons from five years of health care reform. AB - In many European countries health care reforms are taking place. The guiding principle of the reforms is 'more market, less government'. In 1988 the Dutch Government launched proposals for the most radical market-oriented reform in Western Europe. The proposed system can be described as a national health insurance based on regulated competition among both insurers and providers of health care. It can be seen as an ingenious attempt to combine the 'efficiency' of competitive arrangements in the markets for health care and health insurance with the 'equity' of finance through predominantly income-related premiums (National Economic Research Associates 1993). Similar reforms have been proposed and discussed in other countries. In this paper we will concentrate on lessons that other countries may learn from the Dutch experience. What progress has been made since the proclamation of the reforms six years ago? What new issues and problems have arisen and how can we solve these new problems? PMID- 10141967 TI - Use of lithium, carbamazepine, and valproic acid in a state-operated psychiatric hospital. AB - OBJECTIVE: To examine the prescribing of mood stabilizers (lithium, carbamazepine, and valproic acid) in a 500-bed state-operated psychiatric hospital in New York. METHODS: All 129 inpatients receiving mood stabilizers were identified and their medical records reviewed using a standardized drug use evaluation form. Diagnosis, other indications, and prior experience with mood stabilizers were examined, as well as outcome and adverse effects. RESULTS: Approximately one-quarter of the inpatient population received a mood stabilizer. The frequency of carbamazepine use exceeded the use of lithium, with 72 patients receiving carbamazepine and only 62 receiving lithium. Twenty-eight patients received valproic acid. Indications found most frequently for carbamazepine use included assaultive or aggressive behavior (70% for those receiving carbamazepine as the only mood stabilizer). Of those patients with bipolar or schizoaffective disorder and receiving either lithium, carbamazepine, or valproic acid, 36% were prescribed carbamazepine (10% as a first-line agent) and 50% lithium (26% as a first-line agent). None of these indications for carbamazepine has been approved by the Food and Drug Administration. In general, positive outcomes were documented but without supporting objective measures. Significant adverse effects were documented in the medical record in one-quarter of the patients. CONCLUSIONS: There was widespread use of the three mood stabilizers examined, singly and in combination, for a variety of indications. Lithium and valproic acid remain more frequently prescribed for the treatment of bipolar and schizoaffective disorders. Monotherapy with carbamazepine or valproic acid results in statistically significantly fewer adverse effects than lithium or combination therapy (p values between p = 0.00038 and p = 0.006). Current clinical practice has endorsed the use of carbamazepine for aggressive or assaultive behavior, although there does not appear to be sufficient proof of effectiveness in the literature. Formal studies of carbamazepine's antiagressive effects should be conducted. PMID- 10141968 TI - The pharmacy technologist: versatile element in the provision of healthcare services. PMID- 10141969 TI - APhA (American Pharmaceutical Association) approves new code of ethics for pharmacists. PMID- 10141970 TI - Pursuing the paperless office with EDI (electronic data interchange). PMID- 10141971 TI - EDI (electronic data interchange) gives Central Plains competitive edge. PMID- 10141972 TI - Slice and dice accounting time and costs. PMID- 10141973 TI - Integrating a CIS (clinical information systems) across the continuum of patient care. PMID- 10141974 TI - Achieving the CPR while keeping an ancient oath. PMID- 10141975 TI - A growing "family" staves off storage space shortage. PMID- 10141976 TI - Automating nursing from assessment to evaluation. PMID- 10141977 TI - Outsourcing: new reasons why. PMID- 10141978 TI - Document imaging: long-term solution or stop-gap measure? AB - Just what exactly does a "paperless office" mean? To some healthcare professionals, it means just that-no use of paper documents whatsoever. But to others, "paperless" more or less means using paper documents to reach a higher level of electronic recording, in other words-document imaging. We asked four industry insiders to discuss their views and opinions on the use of document imaging in healthcare. Their comments follow. PMID- 10141979 TI - Document imaging: a vision for the future. PMID- 10141980 TI - Document imaging vendors and their systems. AB - As hospital administrators confront the towers of paper generated daily throughout their organizations, document imaging technology promises short-term and possibly long-term relief. Sales of document imaging systems remain strong, probably due to their easy cost justification. The following pages offer an overview, a market sample of document image-vendors who target healthcare. PMID- 10141981 TI - Dispensing with DIP (document image processing) myths. PMID- 10141982 TI - Document imaging: preparing for reform. PMID- 10141983 TI - Technology watch: looking for the best EIS (executive information system). PMID- 10141985 TI - Does fire resisting construction really provide effective compartmentation? PMID- 10141984 TI - CIO forum: imaging to provide information access. PMID- 10141986 TI - Where there's smoke there's fire? PMID- 10141987 TI - Hospital fire safety. PMID- 10141988 TI - Hospital fire doors under scrutiny. PMID- 10141989 TI - Fire risk assessments of hospitals. PMID- 10141990 TI - Integrated communications and security system at Alder Hey Children's Hospital in Liverpool. PMID- 10141991 TI - Healthcare fire safety: FIRECODE. PMID- 10141992 TI - Report on OSHA's 1994 activities in the healthcare arena. PMID- 10141993 TI - The computer ate my MSDS (material safety data sheet)! PMID- 10141994 TI - Understanding managed care risk sharing arrangements. AB - A risk sharing agreement between a managed care organization and an employer can be used by employers to either guarantee a managed care plan's short-term success or mitigate its failure. Under such arrangements, the managed care organization financially shares the employer's risk of unfavorable claims experience. PMID- 10141995 TI - Benchmarking health and disability benefits in the energy and communications industries. AB - A survey of the 140 largest energy and communication companies in the United States marks the first attempt to identify best practices and trends relating to health care and disability activities in these industries. The results provide insights into the vital connection between the costs of disability and the costs of health care. PMID- 10141996 TI - Qualified medical child support orders--commentary. PMID- 10141998 TI - Know your customers. PMID- 10141997 TI - Making waivers: federal approval brings reforms to Medicaid. PMID- 10141999 TI - Using costing to provide incentives for efficiency. PMID- 10142000 TI - Process-based cost accounting for nursing homes. PMID- 10142001 TI - Eternal/mystery or essential/mastery: evaluation and management coding for physician services. PMID- 10142003 TI - Cleaning up the master patient index. PMID- 10142002 TI - Developing an information management plan. PMID- 10142004 TI - Database query languages. PMID- 10142005 TI - A case of coding controversy. PMID- 10142006 TI - The codes keep coming. PMID- 10142007 TI - Regulatory data requirements with a view toward HCFA changes. PMID- 10142008 TI - Legal aspects of medical records confidentiality. PMID- 10142009 TI - HIM roles in investigations of significant risk devices. PMID- 10142010 TI - Can clerks using coding systems code as accurately as trained medical record specialists? PMID- 10142011 TI - The doctor's crystal ball. PMID- 10142012 TI - Improving health service quality from within: the case of United Leeds Teaching Hospitals NHS Trust. AB - Illustrates how the implementation of the internal customer concept has assisted United Leeds Teaching Hospitals NHS Trust to establish a culture for quality. Explains the conceptual framework on which the notion of the internal customer is derived. Describes how, from 1992 to date, the Trust's quality management approach was designed to apply these management principles in a large teaching hospital setting. Outlines how this quality management approach has been successful in enabling departmental managers to recognize, develop and improve internal customer/supplier relationships. Concludes by explaining that business process re-engineering is now being applied as a prime quality tool to help deliver a major culture change throughout the organization. PMID- 10142013 TI - Making total quality a clinical priority. AB - Outlines the introduction of total quality systems into all clinical services within a community-based NHS Trust in the West Midlands. Provides practical details of each aspect of the quality-planning process. Shows the commitment of clinicians to "managing quality improvement". PMID- 10142014 TI - Total quality management. PMID- 10142015 TI - Measuring service quality at a university health clinic. AB - Describes research undertaken to assess the quality of service provided by a public university health clinic. The SERVQUAL instrument was administered to patients of the University of Houston Health Center in order to evaluate customer perceptions of service quality. The results of this study are currently being incorporated into the clinic's strategic planning process, specifically with respect to future resource allocation towards quality improvement projects. PMID- 10142016 TI - Involving patients in the provision of community care: a change in philosophy. AB - The National Health Service (NHS) has many different kinds of professionals and managers working underneath its large umbrella: non-clinical managers administer the work of health-care professionals, who in turn are concerned with the management of patients' treatments. Delivery of health-care services involves the managers and professionals working together to achieve a service that is good for, and acceptable to, patients. A change in the philosophy of the NHS is indicated by the growing acceptance, by both managers and professionals, of the necessity to elicit the views of patients (i.e. the expectations and perceptions of service users) and to incorporate these views into the planning and implementation of services. Discusses one such attempt to elicit the perceptions of service users, and reports on the preliminary findings of a patient-centred audit which has been undertaken in Southend Community Care Services NHS Trust. Discusses the effects that the audit has had on the chiropody services in Southend, for both non-clinical managers and health-care professionals, in order to highlight the usefulness of the approach. PMID- 10142017 TI - Value from resources in Southampton University Hospitals NHS Trust. AB - Outlines the use of the "value from resources" approach to build bridges between clinicians and managers. The simple but powerful use of graphical interactive presentations has resulted in increased staff awareness of how quality improvement and resource utilization are inextricably linked. PMID- 10142018 TI - Redesigning a national healthcare system: the Israeli experience. AB - In 1988 the Government of Israel appointed a Commission of Inquiry (of which the authors were members) to examine the state of its health-care services. Although relating to Israel, some of the problems contributing to the crisis in the health services are shared by other industrialized nations. In 1991 the findings and recommendations of the Commission were adopted by the Government. They related to the major problem areas analysed by the Commission: poor standard of service to the public; health ministry structure and performance; funding and budgeting; poor labour relations in the public health sector; surplus of physicians; mix of public and private health care; shortage of qualified health-care managers. The main recommendations adopted were: legislation for compulsory health insurance (due to be effective on 1 January 1995), establishing a National Health Authority, running of hospitals by autonomous corporations and reform in salary structure. PMID- 10142019 TI - Cooperation and consensus in the outcomes movement. AB - The "outcomes movement" is based on the confluence of two streams of influence: the translation of clinical outcomes research to applied settings and managed care's interest in competition and accountability. Leadership of the movement is diffuse, yet outcomes practitioners recognize the need for greater collaboration and information exchange. Two recent efforts to establish an ongoing forum for outcomes cooperation led to four consensus-based goals for collaboration: to disseminate information, to standardize measurement methods, to inform public opinion and public policy, and to use outcomes information to improve the quality of care. Obstacles to further progress on these four goals include lack of resources, lack of organization, and lack of leadership. Options for addressing these obstacles are presented. PMID- 10142020 TI - Integrating outcomes measurement into clinical practice improvement across the continuum of care: a disease-specific episode of care model. AB - This article describes a model for incorporating outcomes measurement into a comprehensive, continuum-wide clinical practice improvement program developed at Lovelace Health Systems (Albuquerque, N.M.). Created in 1993, the Lovelace Episode of Care Program currently includes nine disease-specific multidisciplinary teams that are working to improve care by addressing such issues as severity, appropriateness, efficiency, continuous quality improvement indicators, practice guidelines, care maps, and outcomes. Key features and advantages of the model are discussed, as well as implementation issues, successes, lessons learned, program restructuring and improvement, and applicability of the framework across diseases and health organizations. PMID- 10142021 TI - The utility of outcomes information at the point of service. AB - A systemwide outcomes management plan is in the process of implementation at Dean Medical Center. Plans for data collection include a core data set of patient satisfaction, basic health, and functional and risk status along with specific clinical and clinically related functional status reported by patients and providers. PMID- 10142022 TI - Improving customer satisfaction: emerging lessons about strategy and implementation. AB - A six-phase strategy has been developed and tested to strategically improve customer satisfaction across an entire managed care system. This article summarizes the theoretical underpinnings of the approach and highlights the first two phases of the overall strategy. Emerging lessons about strategy and implementation are described. A follow-up article will include a description of the last four phases of the strategy and a summary of initial results associated with the implementation of this approach. PMID- 10142023 TI - Cost reduction using patient-focused care concepts. AB - The latest wave of hospital reengineering has been based on the concepts of patient-focused care (PFC). PFC concepts include decentralizing low-scale activities to the point-of-care, cross-training employees to minimize hand-offs, simplifying processes to eliminate unnecessary complexity, redesigning the organization structure to focus on the care continuum, and adopting empowerment and teamwork to change individual behavior. Three innovative health systems have begun to reap the benefits of their PFC implementation efforts. Based on these three case study organizations, PFC is not only cost-justified, but also drives increases in quality and service levels. Each of the three case study organizations chose significantly different routes to implement these concepts due to various internal and external factors. Size of cost savings was the result of three main factors: level of change implemented, size of investment required to effect change, and time frame for implementation. Article includes results of economic analysis. PMID- 10142024 TI - Achieving breakthrough performance in an integrated delivery system. AB - The challenges facing Blue Cross and Blue Shield of Massachusetts were considerable. Its products were largely indemnity-oriented. Its cost structure was high compared to the newer managed care industry. Its service culture was more internally directed than the competition. Its financing and payment systems were not well integrated into the delivery system. The ultimate challenge in the face of an increasingly competitive environment was to reengineer the company. PMID- 10142025 TI - Why outcomes measurement must be the basis for the development of clinical guidelines. AB - Three approaches to clinical quality improvement, health care standards, clinical guidelines, and quality improvement research, are differentiated by the quality of the available medical evidence linking health care processes to health care outcomes. The key determinant of Permanente Medical Group physician acceptance and use of a clinical guideline is the belief that solid data links the guideline's advice to improved patient outcomes. Purchasers, government agencies, regulatory organizations, and health plans must understand the difference between health care standards and clinical guidelines. Strict adherence to clinical guidelines should never be the basis for accountability for physicians, medical groups, or organized systems of care. PMID- 10142026 TI - Bringing clinical accuracy to provider profiling systems. AB - Traditional provider profiling systems have difficulty accounting for the wide ranging differences between patients, their conditions, and the physicians' practices. However, new technologies and methodologies that can extract the needed information from existing data sources offer a means of accurately and efficiently comparing the performance of providers, specialties, networks, and other elements of managed care organizations. Profiling can strengthen the bonds of trust between the providers and the managed care organization, making them partners in delivering quality care. PMID- 10142027 TI - Preparing for health reform: a blueprint for improving health care access, cost, and quality in metropolitan areas. AB - This article analyzes the preparedness of 16 cities for health care reform. Readiness for reform is defined as when cities' health care systems are aligned with three goals of health care reform: increased access, reduced cost, and improved quality. The study confirms that health care is distinctly different among metropolitan areas and that each city has strengths on which to build and challenges to overcome. The study concludes that steps toward health care reform are within the reach of many cities, with health care purchasers, providers payers, and patients playing significant roles. PMID- 10142028 TI - Restructuring: a tale of four cities. AB - As the United States struggles to redefine the cost and delivery of health services, health care executives struggle to identify the most appropriate strategic agenda. With the model for the market evolution of health care becoming an accepted industry paradigm, it serves as an excellent medium for discussing the potential challenges an institution may face as its market progresses toward managed competition. Four cities, each at a different stage of evolution, are discussed in an effort to help health care executives in craft strategies for sustaining their institution's viability. PMID- 10142029 TI - League tables: Use for patients. PMID- 10142030 TI - Comparison of short term outcomes of open and laparoscopic cholecystectomy. AB - OBJECTIVE: To compare the three month outcome of open and laparoscopic cholecystectomy. DESIGN: Prospective assessment of outcome for a series of patients encompassing the introduction of the laparoscopic technique. SETTING: One teaching hospital. PATIENTS: 269 patients admitted for open cholecystectomy between January 1989 and March 1992 and 122 admitted for laparoscopic cholecystectomy between January 1991 and March 1992. MAIN MEASURES: Patients' reported symptoms and self assessed scores with the Nottingham health profile before operation and at three month follow up. Incidence of complications and adverse events after discharge. RESULTS: Similar improvements in symptom rates and health scores were seen regardless of surgical technique. A lower rate of postoperative complications was seen in the patients given laparoscopic surgery (6/95(6%) v 45/235(19%)), and their mean length of stay was lower (4.5 v 9.8 days). Similar results were obtained when the analysis was restricted to a subset of fairly uncomplicated cases (patients aged 60 or less without other illnesses on admission who were not undergoing emergency or urgent surgery), which constituted a larger proportion of the group given laparoscopy (35/95(37%) v 40/235(17%)). Between these two groups no significant difference was seen in the frequency of relevant readmissions to hospital or visits to general practitioners or accident and emergency departments. CONCLUSION: Ideally, a new surgical technique would be evaluated in a randomised trial. In the absence of such a trial, this observational study provides some evidence that the switch from open to laparoscopic cholecystectomy has brought benefits, particularly in terms of reduced length of stay in hospital. A range of clinical and patient derived indicators suggests that these gains have not been associated with a reduction in the quality of the outcome at three months. PMID- 10142031 TI - Comparison of patients' needs for information on prostate surgery with printed materials provided by surgeons. AB - OBJECTIVES: To identify strengths, weaknesses, and omissions in existing leaflets and factsheets on prostatectomy given by surgeons to patients. DESIGN: Comparison of content of leaflets and factsheets with patients' needs and discontents in a questionnaire survey as part of the national prostatectomy audit. SETTING: All NHS and independent hospitals performing prostatectomy in four health regions. SUBJECTS: 87 surgeons, 53 of whom used printed material to inform patients about their operations; a total of 25 different factsheets being used. 5361 men undergoing prostatectomy were sent a closed response questionnaire about their treatment; 4226 men returned it completed. A random sample of 2000 patients was asked for further comments, of whom 807 supplied pertinent comments. MAIN MEASURES: Content of the 25 factsheets compared with patients' needs identified in the questionnaires. RESULTS: Much of the information distributed had considerable shortcomings: it lacked uniformity in form and content, topics of relevance to patients were omitted, terminology was often poor, and patients' experience was at variance with what their surgeons said. For example, only one factsheet discussed the potential consequences of malignancy. Patients wanted more information on prostate cancer (1250(29%)) and some thought that the explanation of biopsy results was inadequate (29(4%)). Only six factsheets discussed the possible changes in sexual sensation after transurethral resection of the prostate, stating that patients would feel no change. However, 1490(35%) patients reported a change and 500(12%) were worried about it. CONCLUSION: Current standards of printed information do not meet the needs and requirements of patients undergoing prostatectomy. PMID- 10142032 TI - National audit of acute severe asthma in adults admitted to hospital. Standards of Care Committee, British Thoracic Society. AB - OBJECTIVE: To ascertain the standard of care for hospital management of acute severe asthma in adults. DESIGN: Questionnaire based retrospective multicentre survey of case records. SETTING: 36 hospitals (12 teaching and 24 district general hospitals) across England, Wales, and Scotland. PATIENTS: All patients admitted with acute severe asthma between 1 August and 30 September 1990 immediately before publication of national guidelines for asthma management. MAIN MEASURES: Main recommendations of guidelines for hospital management of acute severe asthma as performed by respiratory and non-respiratory physicians. RESULTS: 766 patients (median age 41 (range 16-94) years) were studied; 465 (63%) were female and 448 (61%) had had previous admissions for asthma. Deficiencies were evident for each aspect of care studied, and respiratory physicians performed better than non-respiratory physicians. 429 (56%) patients had had their treatment increased in the two weeks preceding the admission but only 237 (31%) were prescribed oral steroids. Initially 661/766 (86%) patients had peak expiratory flow measured and recorded but only 534 (70%) ever had arterial blood gas tensions assessed. 65 (8%) patients received no steroid treatment in the first 24 hours after admission. Variability of peak expiratory flow was measured before discharge in 597/759 (78%) patients, of whom 334 (56%) achieved good control (variability < 25%). 47 (6%) patients were discharged without oral or inhaled steroids; 182/743 (24%) had no planned outpatient follow up and 114 failed to attend, leaving 447 (60%) seen in clinic within two months. Only 57/629 (8%) patients were recorded as having a written management plan. CONCLUSIONS: The hospital management of a significant minority of patients deviates from recommended national standards and some deviations are potentially serious. Overall, respiratory physicians provide significantly better care than non respiratory physicians. PMID- 10142033 TI - Impact of a national audit project on gynaecologists in Scotland. AB - The objectives of the study were (a) to determine consultant gynaecologists' awareness of and views on a national audit project (the gynaecology audit project in Scotland) and (b) to measure changes in their reported practice in relation to 12 specific elements of care related to three audit topics (induced abortion, endometriosis, and vulvar carcinoma) for which recommendations for change had been made within the project. The study comprised a postal questionnaire survey of all 128 consultant gynaecologists in NHS practice in Scotland. The response rate was 90%. Of the respondents, 96% (109/113) recalled receiving feedback material from the audit project team and around 75% (range 66/89 to 84/105) had retained feedback reports for future reference. For the two more common clinical topics (induced abortion and endometriosis), over two thirds of the respondents indicated that they had been prompted to reconsider or change aspects of practice. Significant changes in reported practice, in line with project recommendations, were found for seven of the 12 specific elements of care examined. Thus, gynaecologists in Scotland showed a high level of awareness of and positive views towards a national audit project. Significant changes in reported practice, in accordance with circulated recommendations, were measurable in relation to several elements of clinical care. PMID- 10142034 TI - Using marketing principles for healthcare development. PMID- 10142035 TI - Implementing findings of medical research: the Cochrane Collaboration on Effective Professional Practice. PMID- 10142036 TI - Effective Health Care bulletins: are they efficient? PMID- 10142037 TI - Mortality league tables: do they inform or mislead? AB - OBJECTIVE: To examine certain methodological issues related to the publication of mortality league tables, with particular reference to severity adjustment and sample size. DESIGN: Retrospective analysis of inpatient hospital records. SETTING: 22 hospitals in North West Thames health region for the fiscal year 1992 3. SUBJECTS: All admissions with a principal diagnosis of aortic aneurysm, carcinoma of the colon, cervical cancer, cholecystectomy, fractured neck of femur, head injury, ischaemic heart disease, and peptic ulcer. MAIN MEASURES: In hospital mortality rates adjusted by disease severity and calculated on the basis of both admissions and episodes. RESULTS: The numbers of deaths from specific conditions were often small and the corresponding confidence intervals wide. Rankings of hospitals by death rate are sensitive to adjustment for severity of disease. There are some differences that cannot be explained using routine data. CONCLUSIONS: Comparison of crude death rates may be misleading. Some adjustment for differences in severity is possible, but current systems are unsatisfactory. Differences in death rates should be studied, but because of the scope for manipulating data, this should be undertaken in a collaborative rather than a confrontational way. Any decision to publish league tables of death rates will be on political rather than scientific grounds. PMID- 10142038 TI - The ideal: enemy of the useful? PMID- 10142040 TI - 'I think about it all the time'. PMID- 10142041 TI - Compensation for disability resulting from hospitalization, treatment, examination, or vocational rehabilitation--VA. Interim final rule with request for comments. AB - This document amends Department of Veterans Affairs (VA) adjudication regulations concerning compensation for disability or death resulting from VA hospitalization, medical or surgical treatment, or examination. Previously, the regulations required that VA be at fault or that an accident occur to establish entitlement to compensation for adverse results of medical or surgical treatment. This rule deletes the fault-or-accident requirement and instead provides that compensation is not payable for the necessary consequences of proper treatment to which the veteran consented. This amendment is necessary to conform the regulations to a recent United States Supreme Court decision. PMID- 10142042 TI - Medicare program; Medicare coverage of screening mammography; correction--HCFA. Correcting amendment. AB - This document corrects a technical error that appeared in the final regulations published in the Federal Register on September 30, 1994 (59 FR 49826). Those regulations, in part, established conditions for coverage of diagnostic mammography that are similar to those we had established for screening mammography. This correcting amendment restates the applicability of diagnostic mammography to men as well as to women. PMID- 10142039 TI - Developing and implementing clinical practice guidelines. PMID- 10142043 TI - Medicaid program; rescission of the guidelines for documenting Medicaid recipient access to immunizations under the Vaccines for Children (VFC) Program--HCFA. Notice. AB - This notice rescinds the guidelines that we published in the Federal Register on October 3, 1994, that required States to document equal access to immunizations for Medicaid children if States elected to use lower vaccine administration fees than the maximum charges that were published and applicable under the Vaccines for Children program. These guidelines are rescinded in response to public comments on the October 3, 1994 notice. States indicated that there were numerous problems regarding the collection of useable data. PMID- 10142044 TI - He'll be taking the House's temperature. PMID- 10142046 TI - HEDIS (Health Plan Employer Data and Information Set): managed care's emerging gold standard. PMID- 10142045 TI - For paying primary care physicians, big cities lead in reliance on capitation. PMID- 10142048 TI - How to evaluate a physician recruiter. PMID- 10142047 TI - Three mistakes to avoid in marketing your practice. AB - If you don't view your practice as a business, and don't have a written mission statement and business plan, you may not be taking full advantage of opportunities in your market. A practice consultant explains how these mistakes can hurt you and how to avoid them. PMID- 10142049 TI - A physician's success story in 'the new public health'. PMID- 10142050 TI - Hospitals receive financial awards for preventing adverse outcomes. PMID- 10142051 TI - Is managed care another name for outpatient clinical ethics? PMID- 10142052 TI - An old idea made new again: two twists on 'productivity' pay. PMID- 10142053 TI - HMO premiums take a new direction: downward ... but the trend isn't universal. PMID- 10142054 TI - FPs looking for high starting salaries are singing 'Down on the Bayou'. PMID- 10142055 TI - The squeeze on your pay goes far beyond RBRVS. PMID- 10142056 TI - Putting a premium on patient satisfaction. PMID- 10142057 TI - The surprising durability of 'point-of-service' plans. PMID- 10142058 TI - Could hospital perks ensnare you? PMID- 10142059 TI - Drug plans need an ethics infusion, STAT (subsidies, titles, access, theory). PMID- 10142060 TI - Income division for the 1990s: advanced ideas on productivity and salary. PMID- 10142061 TI - Use of guidelines continues to find favor among HMOs. PMID- 10142062 TI - Look for market share to shift toward HMOs. PMID- 10142063 TI - Internists vs. family physicians: who's paid more? PMID- 10142064 TI - Avoid these traps in creating a primary care compensation system. PMID- 10142066 TI - Does your practice need a newsletter? PMID- 10142065 TI - What's so new about 'demand management'? PMID- 10142067 TI - A small state's big plans for a physician network. PMID- 10142068 TI - How software tools can improve patient education. PMID- 10142069 TI - Understanding medical ethics can reduce your liability risk. PMID- 10142070 TI - Using point systems to figure compensation. PMID- 10142071 TI - Managed care is helping to slow growth in health care spending, but health care's share of the economy keeps on growing anyway. PMID- 10142072 TI - Planning communications step-by-step. PMID- 10142073 TI - The fungible facility: constructing an ideal setting for restructuring. AB - In summary, the ideal facility for a restructured hospital is highly flexible and adaptive. It is fungible. The more fungible, the more it will promote optimal performance in the long-term. Let's face it. Whether you are constructing a new or even launching a major renovation of an existing floor plan, a chance like this doesn't come along every day. For the sake of your restructuring initiative, and your hospital, make the most of it. Don't stop at what the facility should look like--allowing it to be merely the cosmetic by-product of other restructuring action steps. Go for what the facility should be like--giving it an important action step of its own. The Fungible Facility. With this, you'll make the most of that chance! PMID- 10142074 TI - Establishing economic savings targets right out of the gate. AB - Although very important, establishing savings targets at the outset of a restructuring program is by no means an exact science. This article outlines three options for setting targets that vary according to the basis for the target and the level of effort required to arrive at the target. Under Option 1, financial realities dictate the target. Restructuring is simply pursued as a means to achieve the required cost reductions. Under Option 2, a hospital does not pre-suppose a target, but adopts directly the achievements of other institutions as their own economic goals. Lastly, under Option 3 hospitals compare themselves to other successful restructured hospitals across specific organizational and operational characteristics. With these comparisons as guides, the hospital establishes a comfort level within each area and sets targets accordingly. Regardless of the method you choose, our experience & research has taught us one universal truth about savings through restructuring. The hospitals that save money are the hospitals that try. PMID- 10142075 TI - Restructured care team design. Managing the trade-off between cost and performance. AB - The trade-off between team performance and cost-effectiveness is pivotal to identifying care teams that have the best odds for success in a newly restructured environment. Use the framework to picture how those teams might operate. Think about how they may share work or work side-by-side. Use the team performance characteristics as a guide, but don't be afraid to overrule them. By clearly communicating to the organization how each dimension of performance and cost-effectiveness can be used to identify the best teams, you can allay some of the fears and concerns staff may be feeling. Similarly, if administration, using the same criteria, recognizes that every effort has been made to maximize care and minimize expense, their concerns will be met. Both groups can then complete the job of creating effective care team designs. PMID- 10142076 TI - The state of innovation. A year of successes and stumbles. PMID- 10142077 TI - Boundaries and bogies. The keys to faster, more successful restructuring. PMID- 10142078 TI - Layered learning. Improved learning through phased education. AB - If you do have the time and money to put on a "train everyone all at once in every new skill they need" educational program, then by all means, "Go for it!" However, for the rest of us, this traditional approach to education just may make initial implementation of our restructuring designs impractical. For us, Layered Learning comes to the rescue. That's the up-side of Layered Learning. Sooner. Faster. Timelier. Safer. Healthier. Cheaper. A better approach to restructuring education. The challenge of Layered Learning is that it raises restructuring education from just another "to do" on a project plan to a strategic weapon to be carefully structured and put in place. By definition, we will have to make some tough decisions in terms of defining layers and interim designs. Still, more and more hospitals around the country are discovering that Layered Learning can be a powerful ally in their restructuring initiatives. You just can't turn your back on it. PMID- 10142079 TI - Demystifying service redeployment. Picking the "right" delivery approach for service. AB - Service redeployment will always be an emotionally and intellectually challenging process marked by two sides fighting desperately for what they believe is "best." While many view ancillary personnel as impediments to restructuring, their technical concerns are usually the result of a misunderstanding of the redeployment process. These concerns can be answered by thoroughly discussing the process used to identify "What" services should be considered, "Where" services would be best utilized, "By whom" services could be safely delivered, and "How" processes will be redesigned to increase responsiveness. Once a common understanding of the process has been shared and agreed to, the facts will usually overcome any fears or apprehension that linger. PMID- 10142080 TI - Pharmacists transporting patients? Don't worry, it's free. PMID- 10142081 TI - Leadership spotlight. Breakthroughs in designing patient access services. Part 1. PMID- 10142082 TI - Occupational therapists as case managers: responding to current approaches to community mental health service delivery. AB - Case management has been identified as an effective approach to service delivery which can assist persons with severe psychiatric disabilities to live in the community. The conceptualization and development of case management services have been the focus of much discussion. Occupational therapists are attempting to define their role in relation to case management. The purpose of this paper is to explore the relationship between occupational therapy and the case management approach to service delivery. The case management approach will be described including its objectives, models, functions and training requirements for case managers. A discussion of some of the philosophical, educational and professional issues facing occupational therapists in the role of case manager will be examined. PMID- 10142083 TI - The impact of care coordination on children with special health care needs. AB - Families of children with special health care needs face challenges in securing comprehensive health, educational, and social services. As a result, care may be fragmented, duplicative, confusing, and unnecessarily costly. Case management or care coordination is a method of overcoming some of the obstacles experienced by these children and their families. This article describes the Automated Case Management System/Community Based Care Coordination Project for California Children Services Children and Their Families in Los Angeles County (grant number MCJ 065020), a grant project funded by the Maternal Child Health Bureau from October 1987 to December 1990 in which family-centered, community-based care coordination services were provided to a select group of clients and the effectiveness of the interventions was evaluated. Care coordination was readily accepted by families and resulted in increased services, but the evaluation proved to be challenging. PMID- 10142084 TI - Impact of home-based respite care on families of children with chronic illnesses. AB - The recent dramatic medical and technological advances have meant that many children, who would have died previously of their chronic illnesses, now survive and live longer with their families. The purpose of this undertaking was to evaluate whether the implementation of home-based pediatric respite care reduced stress and improved the quality of life for families caring for children with chronic illnesses. Utilization of respite services was associated with a statistically significant (p < .05) reduction in somatic complaints by primary caregivers. There was also a trend in the data suggestive of an association between respite utilization and a subsequent decrease in the number of hospitalization days required by children (p < .07). Public health policy implications of the intervention are discussed. PMID- 10142085 TI - Information needs of the siblings of critically ill children. AB - This study explored parental and sibling perceptions and feelings about sibling information needs during a pediatric admission to an intensive care unit (ICU). Using a qualitative research design, parents (n = 14) and school-age siblings (n = 12) of children who were patients in ICU were interviewed using open-ended questions. Themes of information that the parents report having given to the siblings were similar to the themes that siblings report having heard. However, parents reported that the siblings had numerous questions about the reasons for hospitalization and expectations for the future of the family. The findings indicate that parents may neither be aware of the effects of the ICU experience on the siblings nor have the knowledge and skill to assist them. Parents may need counseling to increase their awareness of the siblings' need for information and teaching to increase skill in providing the information. PMID- 10142086 TI - Children's distress during magnetic resonance imaging procedures. AB - We investigated the epidemiology of pediatric anxiety and distress associated with magnetic resonance imaging procedures (MRIPs). Scores on the State-Trait Anxiety Inventory (Spielberger, Gorsuch, Lushene, Vagg, & Jacobs, 1983) and the State-Trait Anxiety Inventory for Children (Spielberger, Edwards, Lushene, Montuori, & Platzek, 1973), and subjective ratings of distress associated with MRIP were obtained from 55 pediatric oncology patients and their parents. Approximately 30% of children and their parents reported that MRIP produced significant distress. However, parents' ratings of their child's distress were significantly higher than children's self-ratings, and agreement between child and parent pairs was poor. Insertion of an intravenous line was identified as the most aversive component of MRIP by both parents (55%) and children (38%). The selective application of cognitive-behavioral interventions for noninvasive diagnostic procedures is suggested. PMID- 10142087 TI - Physician noncompete agreements must be carefully tailored. AB - When covenants not to compete are used, care must also be taken that they are not viewed as a violation of the Medicare anti-kickback statute, 42 U.S.C. Section 1320a-7b(b). Some government officials have asserted that, when physicians selling their practices continue to be affiliated with the buyers of those practices, payments to physicians for intangibles (including covenants not to compete) could be disguised payments for future referrals. See Dec. 22, 1992 letter from D. McCarty Thornton, General Counsel to the Office of Inspector General, to T. J. Sullivan at the Internal Revenue Service. Although the anti kickback statute is beyond the scope of this article, it must be considered in this context, and care should be taken in any event to assure that purchase prices for physician practices in no event exceed fair market value. PMID- 10142088 TI - Special report on reimbursement. HCFA enacts new enforcement remedies covering nursing facilities. AB - While the regulations are revolutionary in their use of "substantial compliance," the interpretation and application of HCFA's new remedial scheme are still uncertain, as states are given broad discretion in defining important terms and in applying and interpreting the criteria to select remedies. Further complicating the issue is the fact that some states, including California, intend to seek waivers from HCFA to substitute their own state enforcement systems for most, if not all, of the new federal system. Based upon these uncertainties, the enforcement of nursing facility standards will likely be in a state of flux for some time to come. PMID- 10142089 TI - As outcomes measurement and management become widespread, providers should beware of legal pitfalls. AB - Until new statutes and court decisions clarify the law applicable to outcomes research, providers will continue to face new questions. In the meantime, paying careful attention to satisfying the requirements of existing laws protecting peer review information will put providers in the best position to minimize their exposure. Providers should review their current outcomes measurement and management systems to ensure that (1) they are structured to take full advantage of the confidentiality protections available under state law, and (2) appropriate access to outcomes data for those who need it is clearly provided for in the relevant documentation. PMID- 10142090 TI - The Department of Health and Human Services issues proposed regulations on physician incentive payments by hospitals. AB - Hospitals tempted to operate their own physician incentive plans are reminded that, under OBRA 1986, they are precluded from paying physician incentives of any kind to reduce or limit Medicare or Medicaid covered services. In light of the proposed regulations and the guidance of the preamble, hospitals should review their incentive plans to determine whether physicians providing direct patient care are receiving prohibited payments. Further, supervising physicians who are receiving incentives for certain hospital departments may not influence direct care over patients served by those departments, even through other physicians. Some risk may also exist if incentives are based on a formula that considers patients of the supervising physician's medical group. Finally, it may be useful to develop a utilization and quality of care review program specifically designed to assure that patient undertreatment does not occur as a result of any supervising physician incentive program. PMID- 10142091 TI - Thomas Jefferson University wins first annual Jeanne Clery Award. PMID- 10142092 TI - New technologies greatly enhance capabilities of electronic tour systems. PMID- 10142093 TI - University acts to combat patron fears of crime at its hospital garage. PMID- 10142094 TI - Special report. Conducting pre-employment background checks: where to get help. AB - In the December 1994 issue, we warned of the need to conduct adequate background checks of physicians, nurses, administrators, and other types of employees. A number of examples were presented in which hospitals put themselves at risk by hiring: an administrator with a phony doctorate and master's degrees; a nurse who had been found guilty of stealing drugs when she worked at a nursing home; a male nurse who had been arrested for raping patients under anesthesia (he had previously had his teaching license revoked for sexual misconduct with a student); a nursing aide arrested for fondling a 73-year-old woman in her bed who had been convicted of a similar attack at a nearby medical center three years earlier; and a doctor who had served jail time for attempted murder, who was hired by a leading hospital as a psychiatric resident. As was pointed out in the December article, conducting adequate background checks is not always an easy matter, even if your hospital has such a policy. However, a number of firms have emerged to provide improved services in this area. In this report, we will bring you up to date on a firm that specializes in background checks for health care industry job applicants, another firm that maintains a database of work histories of thousands of officers, and a firm that claims its integrity test can spot potential thieves. PMID- 10142095 TI - Different hospitals may have similar security problems. PMID- 10142096 TI - Level-headed about empowerment. AB - Empowerment: born as quality circles, declined, and reincarnated beneath a broader heading. Parents empower children, yet organizational efforts lack the same basic skills. Is self-direction for everyone? Seven levels of empowerment are examined plus tips for conducting a feasibility study to determine your opportunities for success. PMID- 10142097 TI - Accelerating momentum for change! AB - As we develop strategies to compete globally, we are challenged with integrating our resources to execute these strategies effectively. Many companies are in the midst of dramatic shifts in corporate cultures, giving more responsibility to employees while raising expectations for their performance. The extent of these changes is far reaching and brings significant challenges to both employees and corporations. This article is a continuation of the evolution (over five years) of a corrective action/continuous improvement process implemented at Exide Electronics. It discusses organizational structures, including steering committees, corrective action teams, task teams, and work cells. Specific expectations, goals, and results of the teams are presented, along with ground rules for functioning within the organization. After structuring the organization and coordinating the resources effectively, the next challenge is accelerating momentum for change. The presentation also discusses the evolutionary process required to make a culture focused on change, including ongoing communication and feedback, constant evaluation and direction of the process, and measuring and paying for performance. PMID- 10142098 TI - The winners know how to change--do you? AB - Major change is always costly, but when maintaining the status quo is even more expensive, a strategic imperative for change has been created. The process of managing change is not focused on what to change, but how change decisions can be implemented successfully. Successful organizations achieve their change objectives (human and technical) on time and within budget. Unsuccessful organizations either never accomplish what they plan or do so only after consuming a great deal more time and money than they anticipated. This article introduces an abbreviated review of the ten best practices associated with change management. The reader will recognize the multitude of variables that can be relevant to any change effort and begin to assess the matrix relationship between these interdependent variables. PMID- 10142099 TI - Empowered to do what? Why? AB - This article reviews an approach to leverage business process reengineering and employee empowerment for not only cycle time and cost reduction opportunities, but also a more exciting and expanded role for the employee. It promotes the reduction of simple, routine tasks, and refocusing the improved skill level of today's employees on higher value adding activities. PMID- 10142100 TI - Creating a culture of change. AB - The objective of this presentation is to assist companies in creating a culture of change. In the 1970s our manufacturing companies pursued planning as the answer to competitive strength. Throughout the 1980s, we networked with suppliers and customers and smoothed the product flow. Now, in the 1990s, we are focused on the end customer to drive our programs to simplify the process to gain a competitive edge! Each of these answers was correct for its time. Stepping back from it all, however, we can see that the only lasting advantage is the underlying ability to adapt and change; to reinvent our companies again and again amid a rapidly changing, increasingly competitive environment. PMID- 10142101 TI - Developing people: a strategy for competitive advantage. AB - This article will provide vital insights, acquired in a recent study with eight manufacturing companies, to guide the development of a human resource development strategy. This study was a pilot for a larger study, planned for the fall of 1995 with 50 manufacturing companies randomly chosen from the Directory of Massachusetts High Technology Companies. PMID- 10142102 TI - Closing the loop on employee training. AB - World class enterprises have placed a premium on employee training but often have difficulty in confirming the success of that training. An employee's improved performance is the ultimate measure of success, but frequently it is desirable to have feedback on the training session before the employee begins work with his or her new skills. Assessment instruments that accurately reflect the training activities and their learning objectives can be useful to both the trainee and the trainer. Types of instruments that might be useful for measuring success are discussed, processes for developing appropriate assessment instruments are described, and some of the hazards associated with testing in the workplace are provided. PMID- 10142103 TI - Interpersonal team leadership skills. AB - To say that a team leader's job is a tough one is certainly not saying enough. It is up to the team leader to manage a group of people to be individuals but yet work as a team. The team leader must keep the peace and yet create a revolution with this group all at the same time. The good leader will require a lot of education, training, and tons of practical application to be a success. The good news, however, is that the team leader's job is a rewarding one, one that they'll always feel good about if they do it right. How many of us get the opportunity to take a group of wonderful, thinking individual minds and pull from them ideas that a whole team can take to success? Yes, the job is indeed tough, but the paybacks are many. PMID- 10142104 TI - The facilitator: as teams battle to be effective. AB - In this article, you will learn the role facilitators play in team operations, including several power and authority models that can be used. Various group dynamics that facilitators must deal with in team situations will be identified. A suggested facilitator training curriculum is also included. PMID- 10142105 TI - Assessing and developing team effectiveness. AB - Introduction of new decision-oriented information technology, a powerful means of improving competitive performance, can be viewed as one of six elements of culture change. By creating more knowledgeable employees, old hierarchical norms become counterproductive. This demands upgrading job descriptions, collaborative skills, cross-functional networking, pay and progression systems, and leadership styles. PMID- 10142106 TI - Teams in the workplace: the way to power them to productivity. AB - Teams! Teams! Teams! It seems you can't pick up a trade magazine or periodical without seeing something about team building. Once you get by the buzzwords and the acronyms, you have to wonder who's really doing it right. This article explains a proven process to build productive work teams. Teams that get bottom line results in the first 90 to 120 days. The author presents the five keys to assure successful work teams the very first time! In addition, you will learn five issues management must address, five skills every team member must master, five ways to help team members learn faster, and five tips to ensure a powered start to productivity. PMID- 10142107 TI - Change: still an enigma to be faced. AB - Industries may have closed, but the real problem to be faced today is the attitude of the worker, employed and unemployed. They caused all their own problems. It has been more than 10 years since the manufacturing base began to erode. Can anyone still fear change? Where do the dislocated worker and the downsizing firm stand in relationship to the future? PMID- 10142108 TI - Plan to win your career battle. AB - It is ironic that the central focus of our profession is predicated on our ability to plan; however, when the subject of career planning is discussed, we often leave it to change. Our career should be a series of planned events. The notion of doing a good job is no longer the key to a career. We must be proactive and develop a personal marketing strategy. PMID- 10142109 TI - The next step. PMID- 10142110 TI - Biomedicine, meet ethnomedicine. PMID- 10142111 TI - Dismantling sociocultural barriers to care. PMID- 10142112 TI - Future search: power tool for building healthier communities. Interview by Joe Flower. PMID- 10142113 TI - Creating healthier communities: 25 pioneering models. AB - The Healthcare Forum Journal has compiled this compendium to serve as a resource in creating healthier communities. Our aim is to help healthcare organizations, policymakers, and others (payers, providers, patients, physicians, and citizens) rethink the system of healthcare delivery by opening up a dialogue--the ideas presented in Lappe and Du Bois' overview, "The Quiet Revolution," provide the groundwork for understanding how grassroots efforts are having a remarkable impact in creating healthier communities and enhancing quality of life, and 25 pioneering models of communities that are making a difference illustrate the kinds of innovative programs and initiatives that are going on in the U.S. and abroad. If you know of additional resources, please let us know. We'll report your ideas in upcoming issues of the Journal. Our special thanks to Marion Merrell Dow Inc. for co-sponsoring this import project. PMID- 10142114 TI - Eldercare: out of the institution and into the community. PMID- 10142115 TI - Technology, medicine & health, Part 5. The metamorphosis of the modern physician. PMID- 10142116 TI - A visionary executive. Interview by Russell C. Coile, Jr.. PMID- 10142117 TI - Redefining work in the integrated delivery system. PMID- 10142118 TI - 1995 Healthier Communities Fellows. PMID- 10142119 TI - If you really mean it. PMID- 10142120 TI - Incentives and provider payment methods. AB - The mode of payment creates powerful incentives affecting provider behavior and the efficiency, equity and quality outcomes of health finance reforms. This article examines provider incentives as well as administrative costs, and institutional conditions for successful implementation associated with provider payment alternatives. The alternatives considered are budget reforms, capitation, fee-for-service, and case-based reimbursement. We conclude that competition, whether through a regulated private sector or within a public system, has the potential to improve the performance of any payment method. All methods generate both adverse and beneficial incentives. Systems with mixed forms of provider payment can provide tradeoffs to offset the disadvantages of individual modes. Low-income countries should avoid complex payment systems requiring higher levels of institutional development. PMID- 10142121 TI - Planning for health: the significance of life style. AB - The health of a population is related to more than the volume and quality of health services available. Ischaemic heart diseases and cancers are the main causes of death for adults in most developed countries. Partly, these diseases are related to diet and other life style variables. The purpose of this article is to discuss some prevention possibilities related to health practices. Empirical data were collected by means of a questionnaire on health status and 'life style' among long-standing members of a Swedish popular movement for physical culture. The principal question was what could be learned for health planning and management. Genetic factors have lately come more in focus as an explanation of untimely death and disease while, for example, life style has been de-emphasized. There is a risk, thereby, that a purchaser-provider approach, where short-sighted returns are in focus, will give too low a priority to health promotion. PMID- 10142122 TI - The Israeli health care reform: a study of an evolutionary major change. AB - Like other advanced market economies, Israel has been engaged in a reform of its health care system, more intensely so since 1994. The first two sections describe the key features of the Israeli health care system before the reform, and their strengths and weakness. A State Commission of Inquiry, established by the government in 1988, proposed in its 1990 report two different reform strategies, respectively developed by the majority and the minority in it. The Commission diagnoses, recommendations and strategies are assessed and explained in the next sections. Legislators and policy makers opted for the incremental, evolutionary reform strategy, proposed by the minority in the Commission. The essence of the reform strategy being implemented as from 1995 is presented and examined in the penultimate section. In the concluding part, the Israeli experience with the formulation and implementation of a health care reform is discussed. PMID- 10142123 TI - Hospital or health centre? A comparison of the costs and quality of urban outpatient services in Maseru, Lesotho. AB - Urban hospital outpatient clinics in developing countries are said to be overburdened and some policy experts are proposing a new intermediate tier of advanced health centres between hospitals and health centres to solve this problem (termed 'reference centres' by the World Health Organization). In Maseru, Lesotho, hospital congestion led the Ministry of Health to decide to build reference centres. To delineate precisely how these centres should operate, research was carried out on the existing system comparing utilization, quality and cost between health centre and hospital outpatient care. The study showed that throughout per clinician at the hospital and the city health centres was similar; that the hospital service saw a greater proportion of adults and more men; that the technical care quality was similar; and, that health centre staff took longer with patients and had higher interpersonal consultation scores. Average costs at the hospital were 39 per cent greater, but, the calculated net costs to the provider at the hospital and at government centres were very similar once user fees had been taken into account. The results questioned the assumptions underlying the decision to build reference centres in Maseru, and also the relevance of a new tier to solve health service delivery problems in the city. The study highlights the need for national and municipal planners to examine carefully existing health services with respect to utilization, quality and cost before adopting urban reference centres as a standard solution to congested hospitals. PMID- 10142124 TI - Characteristics of mental health case management: results of a national survey. AB - In the last several years, state mental health authorities throughout the United States have assigned a high priority to the funding, development, and operation of case management programs. Although the concept of case management has been in existence for over a decade, there is still confusion regarding the definition of case management and the identification of alternative case management approaches. Recognizing this confusion, the Center for Psychiatric Rehabilitation undertook a comprehensive study to determine the state of case management practice today. This article reports on the results of a national survey of case management programs and describes the characteristics of the programs themselves, the case managers, the clients they serve, and the systems within which they operate. Implications of these findings for a definition of case management are discussed. PMID- 10142125 TI - Critical ingredients of assertive community treatment: judgments of the experts. AB - Twenty experts on assertive community treatment (ACT) rated the importance of 73 program elements, also indicating ideal model specifications (e.g., minimum time commitment for psychiatrist) when appropriate. Interexpert agreement on ratings of importance was high (intraclass r = .94), although there was less agreement for some areas--for example, team structure (intraclass r = .70). Survey responses suggested several areas of increasing emphasis (e.g., vocational and addictions specialists) and of decreasing emphasis (e.g., the avoidance of office visits). Two subgroups of experts were identified--those who advocated large multidisciplinary teams (100 or more clients) and day and evening shifts, and those who advocated smaller, often generalist, teams (approximately 50 clients). Experts also reported ideal staffing for an ACT team. The most frequently identified disciplines were psychiatrist, nurse, and social worker. Implications for mental health policy--for example, quality assurance and program standards- are discussed. PMID- 10142126 TI - The working alliance and consumer case management. AB - The Working Alliance Inventory was used to measure the strength of the therapeutic relationship between seriously mentally disabled case management clients and their case managers in a randomized trial of consumer-provided case management services. It was found that while there was no difference in the strength of the alliance between the consumer and nonconsumer teams of case managers, there were positive relationships between alliance and some outcomes, including quality of life, symptomatology, attitudes toward medication compliance, and satisfaction with mental health treatment. PMID- 10142127 TI - The efficacy of a consumer case management team: 2-year outcomes of a randomized trial. AB - This article reports the results of a randomized trial of a team of case managers who are mental health consumers compared to a team of nonconsumer. Using a repeated measures MANOVA design, consumer case managers were found to be as effective as a team of nonconsumer case managers in maintaining the stability of severely mentally disabled clients served over a 2-year period. Implications for the employment of consumers in mental health services and the vocational capacity of persons with mental illness are discussed. PMID- 10142128 TI - Unclaimed Children revisited: the status of state children's mental health service systems. AB - In 1982, Jane Knitzer's Unclaimed Children described continued nationwide failure to provide services for children and adolescents with serious emotional disturbances. Since 1982, there has been considerable change in the philosophy, administration, and operation of services for this population. The current study compared state child and adolescent (C/A) mental health systems to those described in Unclaimed Children. Present findings are based on surveys of State Mental Health Representatives for Children and Youth in 1988/89 and 1993. Results indicated a marked increase in the number of state administrative offices and staff for C/A mental health. Much pertinent legislation had been passed. States developed a target population definition and largely officially embraced the Child and Adolescent Services System Program (CASSP) principles of an ideal system of care. Out-of-state placements were high, and placements on adult wards still existed. Counts of these placements were often unavailable to mental health officials. PMID- 10142129 TI - The relationship between supply and hospitalization rates for mental illness and substance use disorders. AB - This study investigated the extent to which mental illness and substance use hospitalization rates were related to the supply of psychiatric treatment services. Supply variables, notably the per capita rate of psychiatrists, primary care physicians, and specialty units, were strongly related to mental illness and substance use hospitalization rates to acute care hospitals across 114 small geographic areas in Iowa. The supply of outpatient services was not related to hospitalization rates. The need to study the reliability of patient assessment processes, refine guidelines and admissions criteria, and understand the contributions of supply variables to hospitalization rates are indicated by these results. A conceptual model is offered within which the dynamic cycle from patient functioning to service delivery may be framed. PMID- 10142130 TI - System impact and methodological issues in the development of an empirical typology of psychiatric hospital residents. AB - The identification and categorization of similar objects or individuals into groups is a universal theme that permeates science and provides a conceptual framework to facilitate comprehension. For mental health administrators, a sound methodology to group individuals in a meaningful way would prove useful in the areas of general system understanding, as well as staffing, program planning and evaluation, and service system research, to name a few. Cluster analysis is a set of techniques that approach this grouping process empirically. Within the context of a large psychiatric hospital system, both the methodological processes involved in the application of cluster analysis and the resulting utility of such an analysis are discussed. Issues fundamental to the understanding of such a system are addressed. Special emphasis is placed on methodological issues regarding the application of cluster analytic techniques, which have left such techniques open for criticism. The value of such analyses, when used appropriately, is illustrated by the development of a stable, five-group typology of psychiatric hospital residents whose group characteristics are particularly germane to service system understanding. The implications of such a model for administration, planning, and research in a psychiatric hospital system are also addressed. PMID- 10142131 TI - Mental health leadership training: a survey of state directors. AB - There is periodic support in the mental health literature for increased training opportunities in the area of management and leadership. The purpose of this study was to verify the need for such training as perceived by state directors of mental health and mental retardation/developmental disabilities programs and to explore related issues. The results confirmed a perception of need and provided insights into ways that such training might be successfully provided to states. PMID- 10142132 TI - Opinions of hospital advertising: advertising managers' perspectives. PMID- 10142133 TI - The dual impact of "appeal" and "researcher credibility" on mail survey response rate in the context of preventive health care. AB - Health and fitness centers are becoming increasingly aware of their importance in the realm of preventive health care. Many hospitals have begun to open and run fitness centers, a trend that seems very likely to continue. In a competitive environment, every center would desire to obtain maximum valid customer information at minimum cost, and this paper addresses this issue. The authors investigate the confluence of both appeal and researcher credibility on mail questionnaire response rates from a metropolitan membership of a large fitness center. Personal appeal with high researcher credibility was found to generate significantly higher response rate followed by the hybrid appeal with low researcher credibility. PMID- 10142134 TI - The changing face of consumption: the aging of the baby boomers. AB - Many marketers have called the baby-boom generation, i.e., those individuals born between 1946 and 1964, one of the most over-studied and over-defined groups of individuals that has ever hit the marketplace. While it sometimes seems as if the attitudes, lifestyles, and problems of this large generation should be known to all, accurate generalizations about the baby boom are difficult to make. It is a diverse collection of individuals whose needs continue to shape American society. The key challenge to marketers will be to recognize these differences among the generations and take advantage of the opportunities presented to them. PMID- 10142135 TI - A political economy perspective: why pharmacists may be reluctant to dispense generic medications. AB - As pressures mount for the government to intercede in the pricing structure of pharmaceutical products, some pharmacists remain reluctant to dispense generic counterparts for branded drugs. This paper attempts to explain this reticence by identifying the sources of conflict present in the pharmaceutical distribution channel. A political economy framework is applied to the pharmaceutical distribution channel to yield a basis for developing relationship management. This approach extends the pharmacist's substitution decision process from a traditional emphasis on product attributes to the complexity of the health care channel relationship itself. Relationship management offers several insights regarding how to reduce the conflict that inherently accompanies the generic substitution decision. PMID- 10142136 TI - Should/can the health care system expand its marketing and services to include AIDS and aging issues. PMID- 10142137 TI - Factors related to hospital use of strategic marketing activities. PMID- 10142138 TI - Making the most of conspicuous production in hospital marketing. AB - In today's marketplace, having an effective marketing strategy is key to changing a hospital's image as well as the nature of the product/service. To make the strategy effective, the focus of hospital administrators should be on getting the most out of the hospital's budget, and making a socially responsible decision that can maximize the contribution margin of all marketing expenditures. This article presents a model which attempts to maximize the contribution of various inputs toward a better image and conspicuousness of a hospital. PMID- 10142139 TI - Service quality in hospitals: an integrated approach. PMID- 10142140 TI - Reengineering hospital marketing. Why has hospital marketing declined in value? PMID- 10142141 TI - Impressions of service quality potential based on nurse image. PMID- 10142142 TI - Marketing to rural seniors: opportunities for the service sector. AB - A recent study of rural Midwestern elderly consumers revealed a need for and interest in purchasing services designed for this sizeable and rapidly growing market. The study investigated the levels of need for 54 proposed services which could be provided through non-governmental institutions (businesses and non profit organizations), along with the elderly consumer's ability and willingness to pay a "reasonable price" for the services. Based on the research findings, those service categories possessing market potential are presented and recommendations for marketing to rural elderly consumers are discussed. PMID- 10142143 TI - Legal concerns of rural hospitals. PMID- 10142144 TI - Hospital staffing patterns in urban and nonurban areas. PMID- 10142145 TI - Home-sweet-home health care. PMID- 10142146 TI - The effects of health insurance on consumer spending. PMID- 10142147 TI - Health benefits coverage among male workers. PMID- 10142148 TI - Alliances, standardization, cost cutting changing OR purchasing. PMID- 10142149 TI - Prepare to be measured as the outcomes effort gathers steam. PMID- 10142150 TI - OR has a role in controlling 'superbugs'. PMID- 10142151 TI - Patients feel at home in short-stay unit. PMID- 10142152 TI - Education the best prevention for fires in the operating room. PMID- 10142153 TI - An era of change. Professional and individual responsibilities. Panel discussion. PMID- 10142155 TI - American Laundry Digest distributors directory. PMID- 10142154 TI - America's new budget math. PMID- 10142156 TI - Hospitals & healthcare aren't what they used to be. PMID- 10142157 TI - Innovative automation: the competitive/collaborative human factor. AB - In summary, a dual-group in-hospital Radiology practice by two competing groups is not only feasible, it is indeed a very viable and practical option, capable of producing numerous benefits to patients, practitioners, staffers and facilities. For the model to succeed, there has to be full cooperation on the part of the hospital administrative staff coupled with their firm mandate to facilitate such a progressive practice. Once the process is clearly and carefully explained to the support staff, with well-defined instructions and ground rules, implementation of the model becomes a matter of following a carefully detailed plan of operation. Our experience with this unique alignment produced challenges for all involved. Our Radiologists were tasked to evolve their practice techniques. As well, all our staff and administration were called to redesign, adapt and utilized at St. Elizabeth's Hospital. In our own way, we see our process of assessment, adaptation and implementation of the dual-group model as a schematic for the wellness of Radiology and perhaps even all of Medicine. Our unified focus to achieve a common goal for the good of all, most particularly our patients, has led us through the fog of fear and trepidation into the clarity of reward. Vision becomes reality through individual effort; and all who come through the doors of St. Elizabeth's, now reap its numerable rewards. And most particularly for our healthcare recipients, the one year experience of two competing groups of radiologists working side by side within the Radiology Department of a single hospital, without an exclusive contract, indicates that the model is successful and has no negative impact on patientcare. PMID- 10142158 TI - Mammography malpractice litigation and the impact of MQSA (Mammography Quality Standards Act). PMID- 10142160 TI - Why is cost a keystone to managed care contracting? PMID- 10142159 TI - An accountable healthcare delivery system. Accountable to whom? PMID- 10142161 TI - Ultrasound emerging as winner in imaging sweepstakes. Market demand grows through steady technology development, new clinical applications. PMID- 10142162 TI - Perspectives. Republicans inherit quest for answers on health costs. PMID- 10142163 TI - The peer review process: the art of judgment. AB - Peer review is an essential mechanism for evaluating the judgment and performance of clinical providers. Reasons for conducting physician peer review range from identified quality-of-care concerns to general education. There are a variety of challenges to conducting an effective peer review, including the personal concerns of the peers conducting the reviews. This article reviews the potential uses of physician peer review, its basic methodologies, and challenges to and suggestions for obtaining effective peer review. PMID- 10142164 TI - Implementing an integrated program of resource management. AB - The physicians at Methodist Hospitals of Memphis have designed a program of resource management that has resulted in significant patient care cost savings while maintaining an excellent quality of care. The program combines methods of increasing physician awareness of cost issues, sharing physician utilization and quality data with them, and coordinating patient care through the use of multidisciplinary clinical pathways and case management. Our physicians, patients, nursing staff, and quality management personnel are enthusiastic about the program's positive effect on costs and improved quality patient care. PMID- 10142165 TI - Achieving excellence in thrombolytic therapy. AB - Hospitals today are challenged to provide high-quality, high-technology, cost effective care while maintaining a humanistic approach toward patients and their families. Thrombolytic therapy for patients with acute myocardial infarction (AMI) can present challenges to emergency department and critical care nursing staff members. The areas of concomitant medications, screening checklists, associated laboratory studies, and overall time to treatment presented opportunities for improvement at a Florida hospital. The clinical process and the existing quality improvement activities were reviewed by a multidisciplinary continuous quality improvement (CQI) team. The outcomes of the CQI process were extremely favorable; 100% compliance was achieved in all aspects of care for patients with AMI. PMID- 10142166 TI - Effective systems documentation: essential for safety management. AB - The rapid pace of change in healthcare has caused critical engineering systems in hospitals and other healthcare facilities systems to be altered and upgraded on a virtually continuous basis. Changes to these systems, which include heating, ventilating, and air conditioning (HVAC), medical gases, normal and emergency electrical systems, plumbing, and fire protection systems, often are not properly documented. As a result, healthcare facilities may, over time, be exposed to increased risk. Such a situation compromises an organization's high level of patient and staff safety; it also may cause problems during a Joint Commission on Accreditation of Healthcare Organizations review of environment of care. This article outlines seven specific questions safety officers should review to determine if their facility needs a thorough systems assessment. PMID- 10142167 TI - The quality professional's expanding role as internal consultant: practical tips and survival strategies--Part 2. AB - Part 1 of this two-part article addressed the approach and skills needed to gain a clearly defined and agreed-upon direction for the consulting mission. The importance of mental preparation and flexibility was emphasized and a number of ethical dilemmas were reviewed, including confidentiality issues. Part 2 addresses strategies for handling difficult psychological issues that often come up in the process of internal consulting. Transference, resistance, regressions, and counterproductive group dynamics are reviewed. These psychological issues may be the predominant source of stress in an internal consulting experience. Case examples are presented along with some empowering strategies. It is hoped that through this review, the quality professional will be better prepared to meet the exciting and rewarding challenges of internal consulting. PMID- 10142169 TI - Legislative forum: customer satisfaction becomes real to the Joint Commission. PMID- 10142168 TI - Pediatric clinical path program development: project selection and "rollout". AB - Criteria-based project prioritization is key to the rational development of a clinical path program. Implementation education that emphasizes a philosophy of cost-quality balance fosters multidisciplinary participation and program "rollout," or expansion. This article explains the selection of case types based on volume, cost, physician interest, resource use variability, market opportunity, and clinical homogeneity. Also described is how implementation is facilitated by educating physicians, nurses, and other clinicians about the relationship between clinical paths, collaboration, and quality improvement. PMID- 10142170 TI - Symposium on Justice and Child Health: National and International Perspectives. PMID- 10142171 TI - The crisis for families and children in Africa: change in shared social support for children. PMID- 10142172 TI - Agenda for change in the U.S. child health care system. PMID- 10142173 TI - Children in heavy traffic: health status, health policy, and prospects for reform. PMID- 10142174 TI - More tales from institutional review boards. PMID- 10142175 TI - Is mandatory HIV testing of professional athletes really the solution? PMID- 10142176 TI - Using politics to improve the health of children. PMID- 10142178 TI - The impact of medical progress on child health. PMID- 10142177 TI - Child health: equity in the non-industrialized countries. PMID- 10142179 TI - Child health and theories of right allocation. PMID- 10142180 TI - Saving children's lives in Sweden through accident prevention. PMID- 10142181 TI - To have (medical devices) or have not: what's better for patients? PMID- 10142182 TI - Let's take the 'oops' out of sterile processing. PMID- 10142183 TI - Get to the bottom of it: streamlining preference lists. PMID- 10142184 TI - Tubing or not tubing? That's the question in pediatric ICUs. PMID- 10142185 TI - Nursing the product purchase process back to health. PMID- 10142186 TI - Instrument repairs reengineered. PMID- 10142187 TI - "Show & tell' for the JCAHO features needle-free product success story. PMID- 10142188 TI - Waste away: how does your disposal method compare? PMID- 10142189 TI - Funding cash reserves with capitation payments. PMID- 10142190 TI - Must insurance payments made in error be returned? AB - Healthcare organizations sometimes receive payments made in error from insurance companies. Such payments may occur when insurance companies do not determine that a person receiving care was not covered until after the care has been provided and the bill has been paid. A review of pertinent cases in this area suggests that a legal precedent exists for viewing a healthcare organization as an innocent third-party creditor, thus absolving it of the responsibility to return the mistaken payment. PMID- 10142191 TI - Securitizing receivables offers low-cost financing option. AB - Securitization began in the 1980s with mortgage payments, auto loans, and credit card debt being pooled and used as collateral for securities offerings. More recently, healthcare providers have securitized accounts receivables to obtain low-cost, off-balance-sheet financing. As the need to both raise capital and contain costs grows in health care, providers likely will make increased use of this financing method. PMID- 10142192 TI - Using case management to improve claims payment. AB - Payers increasingly are subjecting claims to intensive review in an attempt to control amounts paid for healthcare services. An internal case management program, however, can help providers better understand and respond to the review techniques employed by payers as well as streamline overall claims processing. PMID- 10142193 TI - CFO compensation increasingly linked to performance. AB - Organization size and individual seniority are key factors affecting compensation of hospital senior executives. However, a recent survey suggests that an organization's financial performance also influences executive compensation, especially of chief financial officers (CFOs). CFOs can benefit from being at the forefront of this trend in compensation practices. PMID- 10142194 TI - Managing financial risk with options on futures. AB - With the rise of managed care and capitation, more providers will be sharing in the financial risk of providing care. To help protect their organizations from the risk of unexpectedly high utilization under such a fixed-payment system, healthcare financial managers soon will be able to use options on futures contracts. These contracts provide wide profit potential but limited loss potential. Before investing in options on futures, however, healthcare financial managers should consider issues such as basis risk and trading costs. PMID- 10142195 TI - SFAS No. 116 changes accounting procedures for contributions. AB - SFAS No. 116 will significantly change the accounting procedure for contributions received by healthcare organizations. It requires that contributions be recognized as revenue, at fair value, in the period received. In addition, a major change in SFAS No. 116 is that an unconditional pledge must be recognized in the year it is received, even if the actual contribution will be received in installments over future accounting periods. PMID- 10142196 TI - Reviewing consolidation guidelines for not-for-profit providers. AB - For many years, some not-for-profit providers of healthcare services have struggled with a decision whether to consolidate. Various accounting-related organizations have issued statements outlining their views on major issues related to consolidation policy. This article explains some of those statements, reviews their implications, and outlines the latest statements issued regarding consolidation guidelines and standards. PMID- 10142197 TI - CHINs (community health information networks): the Iowa experience. PMID- 10142198 TI - Documenting financial risk. PMID- 10142199 TI - Competency models help identify promising candidates. PMID- 10142200 TI - Data trends. May 1995. PMID- 10142201 TI - How do Canadian hospitals do it? A comparison of utilization and costs in the United States and Canada. AB - In 1990 Canadian hospitals provided more services at less cost than did acute care facilities in the United States. Canadians spent $2,720 less per discharge for 48 percent longer stays. If U.S. acute care facilities had achieved an average discharge cost comparable to that in Canada, the annual savings among hospitals in the United States would have totalled $84.3 billion. In a comparative study of volumes and costs in medium-size and teaching hospitals, it was found that U.S. hospitals had greater costs for delivering services than Canadian acute care facilities did in almost every department. PMID- 10142202 TI - Decentralized lab testing. A collaborative approach to point of care testing. AB - What is involved in setting up and managing a decentralized laboratory testing program at a hospital? What elements are involved in making such a program a success? Multidepartmental and multidisciplinary cooperation and communication are the keys to implementing a cost-effective, user-friendly system that assures quality patient care and operator competence. PMID- 10142203 TI - Access to healthcare and the long-stay patient. A case study. AB - The delivery and financing of healthcare services continue to be two of this nation's most debated issues. This case study found that long-stay patients could spend up to 37 percent of their hospital stay waiting for discharge to postacute care services. Because acute care costs more than postacute care, increasing access to postacute care facilities for long-stay patients could substantially decrease overall medical costs for the United States. PMID- 10142204 TI - Improving patient care, cutting hospital costs. A process improvement system. AB - Today's healthcare managers all find themselves confronted with the dilemma of finding ways to reduce costs while simultaneously improving the quality of patient care. Working with management consultants, cross-functional teams at Good Samaritan Hospital carried out a four-step process to reduce the average length of stay for knee and hip replacement surgery from twelve to seven days. The improvements are saving the hospital an estimated $800,000 a year. PMID- 10142205 TI - Flexible benefits plans. Perceptions of their effectiveness. AB - Flexible benefits plans have been used in businesses since the 1970s to control healthcare costs and meet the needs of an increasingly diverse work force. More recently, healthcare organizations have begun to implement the flexible benefits concept. This study collected data from human resources executives at hospitals with and without flex plans to investigate how they perceive the effectiveness of and the problems associated with such plans. PMID- 10142206 TI - Heart attack: a personal encounter with the healthcare system. PMID- 10142207 TI - A guide through the maze of managed care. PMID- 10142208 TI - The changing face of public health. PMID- 10142210 TI - The high cost of defensive medicine. American Society of Internal Medicine. PMID- 10142209 TI - Fair compensation for internists' services: ASIM's continuing mission. PMID- 10142211 TI - Managed care: winning (and losing) in the West. PMID- 10142212 TI - Practicing medicine under capitation: one group's experience. PMID- 10142213 TI - Harassment: recognizing and responding to a costly problem. PMID- 10142214 TI - Who buys groundskeeping/landscaping products? PMID- 10142215 TI - Critical care unit uses nature to foster a healing environment. Legacy Good Samaritan Hospital, Portland, OR. PMID- 10142216 TI - Lights out. New regulations may treat lighting ballasts as hazardous materials. PMID- 10142217 TI - The big brush-off. How to select paint for renovation projects. PMID- 10142218 TI - Up on the roof. Simple checklist uncovers problems. PMID- 10142219 TI - JCAHO and other accreditors work to end overlap and disruptions. PMID- 10142220 TI - Disinfectants: do they still do that voodoo that they claim to do? PMID- 10142221 TI - A healthcare reform postmortem. PMID- 10142222 TI - Arranged marriages, unlikely partners. How will their offspring look? AB - In the new era of managed care, many religious healthcare providers are making "arranged marriages"--permanent partnerships with secular organizations. As they do so, the religious partners naturally ponder how best to ensure that their values permeate the new entity and thus prevail in later organizational "offspring." The organizations most likely to perpetuate their values are those with ethical corporate cultures and climates. These include religiously based healthcare providers, but such providers seem to lack confidence today in their ability to maintain culture and climate in newly formed partnerships. That may be fortunate because it prevents them from trying to impose their values on secular partners. Nevertheless, such values are often attractive to a prospective partner. A religious healthcare provider will need market leverage, as well as attractive values, to make a good "marriage." Even so, religious providers and secular investor-owned organizations are unlikely partners, because their motives and incentives differ radically. But religious providers can form solid relationships with secular, not-for-profit healthcare organizations if they take care to negotiate a binding commitment to maintain an ethical culture and climate. However, Catholic providers are at a disadvantage in such negotiations because Catholic religious congregations are unlikely to continue as owner sponsors much beyond another decade. It is crucial that a stable source of influence develop to ensure a religious presence in the offspring of new partnerships. PMID- 10142223 TI - Making culture a forethought. What to do when strategy meets organizational culture. AB - Organizational culture is a key ingredient in successfully managing monumental strategic change initiatives. Those who are successful in managing change are actively integrating organizational culture into their total planning process. Organizational cultures should be a forethought in the management of the change process. Managers should give the same care and thoroughness to culture that they allot to the other major aspects of a plan. The culture of any organization in the midst of rapid change will not tolerate an information vacuum. People affected by change want to be able to ask questions and be heard. Communication should be interactive. Create opportunities that allow people at all levels of the organization to close the past. Without closure, some of the best people may feel that the organization has betrayed them. Creating a process that allows people to work through the change and motivating people to reinvent their approach and role in the new ways of doing things is what healthcare leadership in the 1990s is all about. It is part of the critical skill set that is necessary to lead Catholic-sponsored health services into the future. PMID- 10142224 TI - Trading places. Two hospitals adjust to a sponsorship swap. AB - On December 31, 1993, the Carondelet Health System transferred sponsorship of St. Joseph Hospital, Kirkwood, MO, to SSM Health Care System in exchange for SSMHCS's St. Mary's Hospital in Blue Springs, MO. Even though both systems and hospitals involved in the deal were Catholic, the hospitals' staffs had to adjust to cultural changes. After the letter of intent was signed at St. Joseph, the lines of communication were kept open throughout the transition. Assurances and explanations of the benefit program alleviated major tension and removed fears. Information on benefits became the essence of an employee newsletter that the hospital put out every few weeks. St. Mary's Hospital chief executive officer also placed a high value on communications. At St. Mary's, in answering employees' questions, administrators found uncertainty gave way to relief when they learned the hospital would remain Catholic and not-for-profit. Still, employees experienced a period of anxiety. Employees at both hospitals were more concerned about losing their jobs than they were about the transfer of sponsorship. Despite this uncertainty, employees at both hospitals feel the recent trade to another system has strengthened their position. PMID- 10142225 TI - Companions on the journey. Working together, two congregations preserve the Catholic healing mission. PMID- 10142226 TI - Culture audits: a tool for change. AB - The culture audit, which has five phases--needs awareness, diagnosis, planning, action, and evaluation--is a critical tool for easing cultural transformation in healthcare organizations. The objective of the audit--usually conducted by outsiders--is to help leaders better understand the current culture and adapt the culture to enhance organizational performance. Most leaders contract with an outsider to facilitate the needs exploration process, often with the guidelines of an advisory team of managers and staff. During the diagnosis phase, the audit team chooses the data-gathering methods, collects and analyzes the data, and develops a model of the culture. The third phase of the culture audit involves planning interventions. Once leaders have a clear picture of their organization's culture, they must ascertain whether the culture will enhance or impede the changes demanded by healthcare reform and an increasingly competitive environment. During the action phase, the culture begins to move toward its desired future. This transition generally requires change in all the organization's systems, including technology, structure, rewards, decision making, budgeting, and managing. Finally, the organization assesses the impact of its culture on its performance. Using the original diagnosis as a baseline and the organization performance goals, the evaluation process maps the changing culture against the benchmark beginning and the goals. PMID- 10142227 TI - Leadership development plan. A CQI approach to management performance appraisals. AB - In 1993 managers at St. Mary's Hospital Medical Center established the attributes necessary to be a successful leader in St. Mary's continuous quality improvement culture. These leadership attributes formed the basis of a new performance appraisal system for managers. The medical center adopted its new performance appraisal system at the beginning of fiscal year 1994-1995. The objective of the plan is to develop St. Mary's managers' leadership skills. St. Mary's Leadership Development Plan is an ongoing cycle, with three phases. First, managers and administrative representatives jointly agree on objectives to discuss throughout the fiscal year. The objectives reflect the hospital planning and financial goals and objectives, department goals and objectives, and leadership growth opportunities. Each manager is then responsible for gathering feedback from subordinates on how well he or she is meeting the set objectives. Finally, each manager and administrative representative highlight accomplishments achieved during the fiscal year. St. Mary's decided to discontinue pay-for-performance salary increases beginning with the 1994-1995 fiscal year, coinciding with the initiation of the Leadership Development Plan. Manager's compensation is now a flat percentage increase granted to all managers. PMID- 10142228 TI - Teamwork rewarded. Performance management reflects system values. PMID- 10142229 TI - Healthcare and social responsibility. The revised directives clarify the Catholic position. AB - The Catholic Church participates in the U.S. healthcare system by reason of its contribution to the common good of society. To facilitate this, the Ethical and Religious Directives for Catholic Health Care Services set forth certain normative principles. Catholic healthcare is dedicated to promoting human dignity and the sacredness of life; it has an "option for the poor"; it seeks the common good, cooperating with other providers toward that end; it prohibits abortion, in vitro fertilization, contraceptive sterilization, and assisted suicide procedures in free-standing Catholic healthcare institutions. This article focuses on the directives in Parts 1 and 6 of the ERD. Directive 2 calls for mutual respect among care givers. Directive 3 discusses ways to care for people "at the margins of society." Directive 4 describes the medical research permitted in Catholic facilities, and Directives 5 and 9 suggest how such facilities can best perpetuate their Catholic identity. Directive 7 mandates that Catholic facilities treat employees justly. Directive 8 says that such facilities must observe canon law in transferring sponsorship or in founding, closing, or selling an institution. Directive 68 suggests that the bishop be involved in a proposed partnership that may infringe upon Catholic identity. Directive 70 urges Catholic facilities to avoid scandal, and Directive 69 warns that some forms of cooperation are unethical even when scandal is not present. PMID- 10142230 TI - Legislative affairs: a powerful tool for healthcare providers. PMID- 10142231 TI - Please hold my hand. PMID- 10142232 TI - Firm seeks buyer for pain unit. PMID- 10142233 TI - Hospitals plan campaign to defend staff changes. PMID- 10142234 TI - Calif. firm sees founder leave, profits decline. PMID- 10142236 TI - Income drop halts acquisition bid. PMID- 10142235 TI - Employers say the Colorado Hospital Association killed data commission. PMID- 10142237 TI - Hospitals strive for shares in $6 million grant program. PMID- 10142238 TI - Hospitals won't restart program that won OK in antitrust battle. PMID- 10142239 TI - Clinton rebuffs GOP on Medicare. PMID- 10142240 TI - Grace exec makes surprise bid for NMC. PMID- 10142242 TI - Biggest Iowa system pushes ahead with expansion plans. PMID- 10142241 TI - FTC plans more lenient approach for examining potential hospital deals. PMID- 10142243 TI - Hospitals awaiting merger OK draw others' interest. PMID- 10142244 TI - Calif. system, hospital sign pact. PMID- 10142245 TI - Merger's off in New England, but not managed-care deals. PMID- 10142246 TI - Study casts doubt on need to test healthcare workers for HIV. PMID- 10142247 TI - For-profits, not-for-profits reignite battle. PMID- 10142248 TI - Senate strips down product-liability reform bill. PMID- 10142249 TI - Tax-paying hospitals' Medicare rates may grow. PMID- 10142250 TI - Fla. physician group to join growing Caremark empire. PMID- 10142251 TI - N.M. nursing home chain buys respiratory therapy company. PMID- 10142252 TI - Calif. hospital settles federal charges of 'patient dumping'. PMID- 10142253 TI - Kentucky hospital agrees to pay $2.3 million fine in false-claims settlement. PMID- 10142254 TI - Fla. bill gives public facilities leeway to rival private sector. PMID- 10142255 TI - Profits up at two dialysis chains. PMID- 10142256 TI - Hospitals fear impact of Ohio's Medicaid reform. PMID- 10142257 TI - Charter to repay insurers. PMID- 10142258 TI - Drug firms set deal. PMID- 10142259 TI - Provider groups aiding effort to save peer review. PMID- 10142260 TI - Providers fear cost-benefit analyses' regulatory effects. PMID- 10142261 TI - Interface engines rev up. AB - Interface engines are helping diverse networks connect a hodgepodge of information systems so they can communicate and share resources. Plus, the costs of starting the engine (p. 54) and finding an integration hub that fits (p. 58). PMID- 10142262 TI - GranCare, Evergreen agree to $155 million merger deal. PMID- 10142263 TI - Reports involving Columbia, Florida hospital spark probe. PMID- 10142264 TI - Psych hospitals fight for survival. PMID- 10142265 TI - Health professionals explore ways to reduce drug-dispensing errors. PMID- 10142266 TI - Hospitals tout data with report cards. PMID- 10142267 TI - Companies build Pap smear safety nets. PMID- 10142268 TI - Assisted living captures profitable market niche. AB - The $15 billion assisted-living industry has captured a profitable market niche and created a star on Wall Street. Sunrise Retirement Home of Falls Church (Va.), right, is a facility of the nation's largest assisted-living provider. PMID- 10142270 TI - Pennsylvania hospitals see overall profitability erode. PMID- 10142269 TI - Five-state project takes aim at Medicare, Medicaid fraud. PMID- 10142271 TI - Senate budget proposal would force closures--VA. PMID- 10142272 TI - Ind. hospital faces protests from jilted physician group. PMID- 10142273 TI - Troubled transplant program on hold. PMID- 10142274 TI - Deluge in New Orleans hits providers hard. PMID- 10142275 TI - Medicare reductions disappoint providers. PMID- 10142276 TI - Columbia study opens fire on Orlando not-for-profits. PMID- 10142277 TI - Grace's sale of NMC imminent; buyer, price remain uncertain. PMID- 10142278 TI - Groups step up efforts to change device policy. PMID- 10142279 TI - Boston partnership gives voice to community centers. PMID- 10142280 TI - Mass. center wins renovation loan. PMID- 10142281 TI - Malpractice reform hopes still flicker. PMID- 10142282 TI - Ill. hospitals threaten suit over Medicaid tax. PMID- 10142283 TI - Therapy providers criticize HCFA guidelines. PMID- 10142284 TI - Teaching hospitals not immune to merger trend. PMID- 10142285 TI - 'Frontier' hospitals fight for survival. AB - Remote facilities are being tested by a host of problems, but they're fighting for survival with the help of their communities. Administrator Rose Contreras Taylor, left, and Financing Officer Christina Campos provide the leadership at Guadalupe County Hospital, a 16-bed facility in Santa Rosa, N.M. PMID- 10142286 TI - HMO contests hospital control of docs. PMID- 10142287 TI - More for-profit chains court public hospitals. PMID- 10142288 TI - Columbia hopes to unshutter Fla. hospital. PMID- 10142289 TI - Scott not Columbia's top dog in terms of pay. PMID- 10142290 TI - Columbia, HealthOne agree on merger. PMID- 10142291 TI - Montana PHO targeted in fed probe. PMID- 10142292 TI - Montana law could provide antitrust shield for merger. PMID- 10142293 TI - Big firms launch health buying group. PMID- 10142294 TI - Ethics in KU case under criticism. PMID- 10142295 TI - Report questions logic of N.Y. plan. PMID- 10142296 TI - Pharmacy management firm sues Wash. Blues plan for deception. PMID- 10142297 TI - Columbia's first big Catholic deal faces scrutiny. PMID- 10142298 TI - St. Louis network's hospitals will merge with large system. PMID- 10142299 TI - Baptist in Nashville agrees to buy two nearby for-profits. PMID- 10142300 TI - Philadelphia systems' merger gets nod from rating agency. PMID- 10142302 TI - Bill puts VA cuts at $50 million for 1995. PMID- 10142301 TI - High court upholds HMO suit dismissal. PMID- 10142303 TI - Donations up 12.9% in 1994, report finds. PMID- 10142304 TI - Bon Secours prefers Catholic partners. PMID- 10142305 TI - Tenet inks deals worth $400 million. PMID- 10142306 TI - CIS Technologies agrees to buy managed-care software vendor. PMID- 10142307 TI - HBO & Co.'s growing client list to top 2,000 with latest deal. PMID- 10142308 TI - K.C. Blues drops two area hospitals from major plans. PMID- 10142309 TI - Plans for Kansas City network in final stages. PMID- 10142310 TI - Panel lines up Medicare targets. PMID- 10142311 TI - Senate at work as House passes GOP budget plan. PMID- 10142312 TI - Multi-unit Providers Survey 1995. Hospital chains: a down year at not-for profits; for-profits soar. PMID- 10142313 TI - Medicare growth may still mean cuts. PMID- 10142314 TI - Troubled Pa. charity files Chapter 11. PMID- 10142315 TI - Multi-unit Providers Survey 1995. Psychiatric hospitals: psych chains had another tough year. PMID- 10142316 TI - Multi-unit Providers Survey 1995. Rehabilitation hospitals: for-profits boost results in rehab. PMID- 10142317 TI - Multi-unit Providers Survey 1995. Long-term care: nursing home chains expanding services. PMID- 10142318 TI - Multi-unit Providers Survey 1995. Retirement centers: CCRC industry growth steady. PMID- 10142319 TI - Columbia loses license for Fla. hospital. PMID- 10142320 TI - CON adds to Omaha confusion. PMID- 10142321 TI - Fla. hospital exec resigns amid flap. PMID- 10142322 TI - Multi-unit Providers Survey 1995. Ambulatory care: outpatient chains keep on growing. PMID- 10142324 TI - Multi-unit Providers Survey 1995. Respondents. PMID- 10142323 TI - Multi-unit Providers Survey 1995. Home care: more consolidation on the home front. PMID- 10142325 TI - Switching to fitted sheets saved time and money. PMID- 10142326 TI - The world's first digital hospital. PMID- 10142327 TI - Patient management and information technology: hand in hand. PMID- 10142328 TI - Strategic planning for quality. PMID- 10142329 TI - Cleveland communities collaborate in effort to evaluate hospital efficiency and quality. PMID- 10142330 TI - Using quality standards to improve outcomes. PMID- 10142331 TI - Evaluating quality of care in fee-for-service and managed care delivery systems: recommendations for quality leaders. PMID- 10142332 TI - Should physician specialists be capitated? Yes. PMID- 10142333 TI - Should physician specialists be capitated? No. PMID- 10142334 TI - Should physician specialists be capitated? Maybe. PMID- 10142335 TI - California providers navigate across the cost-quality battlefield. PMID- 10142336 TI - NCQA (National Committee for Quality Assurance) accreditation: ensuring quality in managed care. PMID- 10142337 TI - Schedule for rating disabilities; gynecological conditions and disorders of the breast--VA. Final regulation. AB - This document amends the section of the Department of Veterans Affairs (VA) Schedule for Rating Disabilities on Gynecological Conditions and Disorders of the Breast. This amendment is based on a General Accounting Office (GAO) study noting that there has been no comprehensive review of the rating schedule since 1945, and recommending that such a review be conducted. The intended effect of this action is to update the gynecological and breast disorders section of the rating schedule to ensure that it uses current medical terminology, unambiguous criteria, and that it reflects medical advances which have occurred since the last review. PMID- 10142338 TI - Medicaid program; required coverage of nurse practitioner services--HCFA. Final rule. AB - This final rule stipulates the requirements for coverage of and payment for pediatric and family nurse practitioner services under the Medicaid program. The coverage of these additional services under the Medicaid program increases the availability and accessibility of medical care for specified Medicaid recipients. This final rule adds to the Medicaid regulations provisions of sections 1902(a)(10)(A) and 1905(a)(21) of the Social Security Act, as amended by section 6405 of the Omnibus Budget Reconciliation Act of 1989. PMID- 10142339 TI - Navigating the World Wide Web. PMID- 10142340 TI - Volunteers and hospital auxiliaries. PMID- 10142341 TI - Medical Library Association position paper: The Copyright Law and Fair Use. November 1994. PMID- 10142342 TI - Fluid strategy in action. A look at Bellin Hospital's restructured outpatient services. PMID- 10142343 TI - Leadership spotlight. Interview by William J. Leander. PMID- 10142344 TI - How will restructuring work in your hospital? The helps and hinderances of a large academic environment. AB - In summary, academic medical centers face the same issues as their less complex brethren. Sure there are some "downs." The high expectations that the staff bring to their jobs can decrease flexibility in role design, and the increased need to keep professionals together can make the organizational matrix more complex. But there are also some "ups." In many ways their size and specialty focus can help with the difficult decisions in the areas of patient grouping and service delivery approach. Taking advantage of the positives and working to minimize the effect of the negatives can allow even the most complex organization to restructure successfully. Academic medical centers may not be "just right" for restructuring, but they are definitely not "too big." PMID- 10142345 TI - From fixed to fluid. A strategic shift in restructuring outpatient services. PMID- 10142346 TI - The Medicare reimbursement puzzle for home drug infusion therapy. PMID- 10142347 TI - Vascular access device choices for home care patients. AB - The clinician has a variety of available vascular access devices. Home care professionals need to consider several factors before choosing the most appropriate access device for each patient. PMID- 10142348 TI - Patient selection criteria for home i.v. therapies: from A to Z. AB - Home intravenous therapy is a fast-growing industry, but it may not be for everyone: several medical and safety criteria must be met to ensure effective patient care. Home care agencies should examine each patient situation closely before deciding to implement a home i.v. program. PMID- 10142349 TI - Patient education in high-tech home care. AB - High-tech home care requires that nurses have intricate knowledge and skills to care for patients with complicated treatments and equipment. Yet the need for teaching skills is often overlooked. Home care professionals can teach patients to help in their own care if the professionals assess that patients are ready to learn and incorporate principles of adult teaching and learning. PMID- 10142350 TI - The risks of using complex technology in home care. AB - New medical devices make it possible to care at home for patients who are dependent on ventilators, have cardiac problems, or need respiratory monitors, dialysis, or high-risk pregnancy monitoring. Yet this technology has also increased risks for this growing industry. Can these risks be addressed and lessened? PMID- 10142351 TI - High-tech, high-touch perinatal home care. AB - Perinatal home care for women experiencing a high-risk pregnancy often requires the use of technologies for safe home management. Home care professionals need to integrate high technology with high touch to ensure the best results. PMID- 10142353 TI - Transtracheal oxygen--setting up a home care program. AB - Available care for patients with transtracheal oxygen is becoming more diverse. This program uses strict standards that include staff training to ensure quality care for a specific population of patients, setting an example for other high tech programs in home care. PMID- 10142352 TI - Infusion techniques for perinatal home care. AB - Perinatal home infusion therapy is one service component of a comprehensive maternity care program. Physicians can prescribe perinatal home infusion therapies for various conditions, as an alternative to treatment in acute care settings. Maternal and fetal assessment is an integral part of the management of these therapies. PMID- 10142354 TI - Telemedicine--a new idea for home care. AB - Telemedicine could prove to be an important tool in the delivery of home care. Early experience indicates that it keeps patients home, reducing emergency room visits, rehospitalization, and institutionalization. How does it work? PMID- 10142356 TI - Future trends affecting the home infusion therapy industry. PMID- 10142355 TI - The home infusion formula: high tech + high touch = high-quality home care. AB - Case studies show that home infusion benefits a variety of patients, from ambulatory to pediatric patients. The first year of a home infusion program can offer many lessons for providers interested in starting their own programs. PMID- 10142357 TI - Home care challenges for those affected by AIDS. AB - AIDS is affecting more and more people, yet our health care system has been slow to respond to this growing population. Public interest has focused on AIDS as an acute illness while ignoring the chronically ill, homebound majority of persons with AIDS. PMID- 10142358 TI - High-tech home care. AB - The past 20-25 years have seen innovations in equipment and drugs that have allowed infusion services to move from institutions to the home. The home care industry moved into the HDIT field, considering this a natural direction in which to develop. High-tech home care is now a substantial aspect of the industry. PMID- 10142359 TI - MediCaring: comprehensive support services as a Medicare option. AB - MediCaring is a feasibility project that aims to develop an alternative benefit for comprehensive, supportive, home-based care to individuals who are enrolled in Medicare. Will Medicare-eligible consumers be willing to relinquish acute care benefits to finance supportive, home-based care? PMID- 10142360 TI - Keeping medical devices safe from electromagnetic interference. PMID- 10142361 TI - Public affairs specialists. FDA's walking encyclopedias. PMID- 10142362 TI - Application of the strict liability doctrine to hospitals and other health care providers. AB - The legislation and cases discussed above reflect the fact that if hospitals and other health care providers were not excluded from application of the doctrine of strict liability in connection with the equipment and supplies they furnished to physicians and patients, they would be forced to perform what is in essence an insurance function for patients and physicians. This would ultimately serve to increase health care delivery costs and potentially discourage the use of innovative drugs and equipment that carry with them inherent, but tolerable risks. PMID- 10142363 TI - Special report on taxation. New IRS revenue procedure clarifies tax classification of limited liability companies. AB - Although its rules are complex, the publication of Revenue Procedure 95-10 will substantially facilitate the use of LLCs in those states with statutes that permit significant flexibility in the structuring of LLCs. Previously, the only way to assure that LLCs in those states would be classified as partnerships for income tax purposes was to obtain a private letter ruling from the IRS, often resulting in lengthy delays. The new revenue procedure should provide sufficient guidance in the vast majority of cases to allow tax counsel to determine the appropriate treatment for tax purposes without having to seek an IRS private letter ruling. PMID- 10142364 TI - IRS focuses on employment status of hospital-based physicians. AB - In view of these serious consequences and the IRS' renewed interest in hospital based physicians, it is imperative that all hospitals examine their contractual relationships with physicians under the foregoing standards to ascertain whether any physicians are improperly being characterized as independent contractors. Of particular concern are arrangements with aspects similar to those in TAM 9443002. Hospitals operating in states that still prohibit the employment of physicians are not necessarily protected, as the IRS does not accept the corporate practice of medicine doctrine as a defense to characterization of physicians as employees for tax purposes. In those states, it is probably best to handle problematic situations through the use of professional corporations, as discussed above. PMID- 10142365 TI - Immunity from criminal prosecution for parents who withhold medically necessary treatment from children on religious grounds. AB - Because child endangerment laws and their judicial interpretation are different in each state, healthcare providers should familiarize themselves with the law in their particular jurisdiction. In situations in which parents refuse on religious grounds to consent to medical treatment for their children, health care providers should consult local counsel as to the legal options available. PMID- 10142366 TI - New directions for Medicare payment systems. AB - This overview discusses articles published in this issue of the Health Care Financing Review, entitled "Medicare Payment Systems: Moving Toward the Future." These articles focus on the ongoing development of Medicare payment methodologies, their adoption by non-Medicare payers, and issues to be addressed in the development of all-payer systems based on these methodologies. PMID- 10142367 TI - Creating a MEDPAR (Medicare provider analysis and review) analog to the RUG-III (Resource Utilization Groups, Version III) classification system. AB - As Medicare payments for post-acute institutional care continue to rise sharply, policy interest in the clinical characteristics of beneficiaries admitted to nursing homes and their variation across facilities has stimulated research into case mix. Measures of Medicare skilled nursing facility (SNF) case mix are important in relating payments to the care requirements of residents. The Resource Utilization Groups, Version III (RUG-III) classification system uses a new minimum data set that is not currently available nationally. In preparation for a multi-State demonstration, we needed to simulate at least the first-level splits at the national, State, and facility level. Therefore, we developed proxy measures using comparable data available on the National Claims History files. The analog is an easily programmed measure of the acuity/severity of beneficiaries' conditions across a Medicare Part A SNF stay in 75 percent of the SNF providers. This can be a method for estimating changes in case mix over the years, and differences across provider types and States. PMID- 10142368 TI - Use of diagnosis-related groups by non-Medicare payers. AB - Medicare's prospective payment system (PPS) for hospital cases is based on diagnosis-related groups (DRGs). A wide variety of other third-party payers for hospital care have adapted elements of this system for their own use. The extent of DRG use varies considerably both by type of payer and by geographical area. Users include: 21 State Medicaid programs, 3 workers' compensation systems, the Civilian Health and Medical Program of the Uniformed Services (CHAMPUS), more than one-half of the Blue Cross and Blue Shield Association (BCBSA) member plans, several self-insured employers, and a few employer coalitions. We describe how each of these payers use DRGs. No single approach is dominant. Some payers negotiate specific prices for so many combinations of DRG and hospital that the paradigm that payment equals rate times weight does not apply. What has emerged appears to be a very flexible payment system in which the only constant is the use of DRGs as a measure of output. PMID- 10142370 TI - Diffusion of Medicare's RBRVS and related physician payment policies. AB - In 1992, Medicare reformed its physician payment method by implementing the Medicare fee schedule (MFS), of which the resource-based relative value scale (RBRVS) is a major component. Using a recent survey and case studies, we examine the diffusion of Medicare's RBRVS to non-Medicare payers and how those payers use and perceive the RBRVS and MFS policies. We find that approximately one-third of payers that participated in the survey have adopted RBRVS-based payment systems in varying degrees while another 40 percent were seriously considering its adoption. Prospects for expanded use of Medicare's RBRVS appear favorable. PMID- 10142369 TI - Hospital wage and price controls: lessons from the Economic Stabilization Program. AB - The Clinton Administration has implied that short-run failures to control health care costs may cause a reexamination of wage and price controls as elements of comprehensive health care reform. The most recent imposition of mandatory wage and price controls was the Economic Stabilization Program (ESP) of the early 1970s. We analyze trends in hospitals' economic behavior and utilization before, during, and after ESP. We also review the relevant literature to estimate ESP's impact, considering other factors that influence hospital behavior. Noting important changes in the hospital industry since the 1970s, we conclude that ESP had limited effect and that similar controls would have little effect today. PMID- 10142372 TI - Medicare Transaction System: platform for change. AB - This article provides an overview of the Medicare Transaction System (MTS), a Health Care Financing Administration (HCFA)-wide initiative to be implemented starting in 1997 which will develop a national, standard, integrated, government owned, contractor-operated Medicare claims processing system that will meet the challenges confronting Medicare over the next 2 decades. The authors discuss MTS goals and objectives, major features, how it will work, standardization efforts being undertaken in support of the initiative, contracting efforts involved, and project status. PMID- 10142371 TI - Should insurers pay the same fees under an all-payer system? AB - Medicare's use of diagnosis-related groups (DRGs) and the resource-based relative value scale (RBRVS) has led to interest in developing a national all-payer system in which insurers use the same payment methods and payment rates. Using data for 81 high-volume DRGs from 457 California hospitals, we conclude that a single set of rates for hospital care would not be appropriate. On average, Medicare patients were 11.7 percent more expensive than commercially insured patients, but less expensive in many DRGs. Further research is needed to determine if Medicare patients require more physician resources compared with non-Medicare patients, particularly for surgical procedures. PMID- 10142373 TI - Health care indicators ... community hospital statistics; private sector employment, hours, earning; prices; national economic indicators. PMID- 10142374 TI - Refinement of the Medicare diagnosis-related groups to incorporate a measure of severity. AB - This article presents a system under consideration by the Health Care Financing Administration (HCFA) for incorporating a measure of severity of illness into the Medicare diagnosis-related groups (DRGs). DRG assignment is one of the main factors in determining the payment made for hospital inpatient services furnished to Medicare beneficiaries. Specifically, the formula used to calculate payment for a single Medicare hospital inpatient case takes an average payment rate for a typical case and multiplies it by the relative weight of the DRG to which it is assigned. Thus, it is easy to see that the DRG relative weights have a large impact on the payment a hospital receives. In this article, we describe the Medicare DRG prospective payment system (PPS), evaluate the various classification elements available for assessing severity of illness, describe the analyses used in formulating this proposal, and present the proposed DRG severity system. PMID- 10142375 TI - RUG-II (Resource Utilization Group, Version II) impacts on long-term care facilities in New York. AB - This article observes changes during the first 5 years of Resource Utilization Group, Version II (RUG-II) system utilization by the New York State Department of Health (NYDOH) for Medicaid program reimbursement. Findings include a dramatic increase in the number of residents scoring in the highest intensity resident care categories, a substantial increase in staffing and expenditures for rehabilitation therapies, and a possible negative impact on the financial performance of New York long-term care (LTC) facilities. RUG-II appears to have been successful in improving access to nursing homes for individuals with heavy care needs and in encouraging the appropriate utilization of institutionalized skilled nursing care. PMID- 10142376 TI - Pharmaceutical care role model in psychiatry--pharmacist prescribing. AB - Pharmacist's expanded roles in a mental health clinic are described. A needs assessment identified problems which could be solved by expanding the pharmacist's scope of practice. Pharmacy, psychiatry, and medical center administration approved the pharmacist's psychiatric prescribing privileges and the authority to order appropriate laboratory tests, which provides the mechanism of solving the problems identified. Psychiatry's acceptance of pharmacists in this new role is demonstrated by the continued expansion of this program. By the end of a 4-year period, pharmacists were seeing 46% of all psychiatric medication visits. A description of the privileges, roles, and process is provided. PMID- 10142377 TI - Developing a comprehensive medication reaction reporting system. AB - A step-by-step method for developing a comprehensive medication reaction reporting system is reported. The program was developed from information obtained by literature review, from the existing programs of other hospitals, and the authors' ideas. The following steps were developed and implemented after approval by the Pharmacy and Therapeutics Committee. The name of the program was changed from the Adverse Drug Reporting Program to the Medication Reaction Reporting Program. A voice mail system was installed, the medication reaction reporting form was revised, a suspected medication reaction sticker was developed, the peer review mechanism was revised, and a system for positive feedback to reporters was developed. After implementation of the revised program, the number of reported medication reactions increased by 144%, from an average of 12.7 reports per month to 31 reports per month. The revised program has increased medication reaction reporting from 1.2% to 2.7% of discharged patients. Program revision has also increased the quality of the reports, increased the number of cases for peer review, and has aided the medical center in identifying medication related problems which has resulted in closer monitoring to reduce future problems. PMID- 10142378 TI - Conducting pharmacoeconomic evaluations in a hospital setting. PMID- 10142379 TI - Healthscapes: the importance of place. PMID- 10142380 TI - The consumer will reign supreme in health care reform. PMID- 10142381 TI - Six challenges facing Catholic health care marketing. PMID- 10142382 TI - Decreasing anxiety. PMID- 10142383 TI - Gaining insurance coverage for alternative therapies. PMID- 10142384 TI - Predicting appointment breaking. AB - The goal of physician referral services is to schedule appointments, but if too many patients fail to show up, the value of the service will be compromised. The authors found that appointment breaking can be predicted by the number of days to the scheduled appointment, the doctor's specialty, and the patient's age and gender. They also offer specific suggestions for modifying the marketing mix to reduce the incidence of no-shows. PMID- 10142385 TI - Direct-to-consumer advertising of prescription drugs. AB - Starting consumers off on the "path to purchase" by encouraging them to seek more information is a major goal of direct-to-consumer (DTC) advertising for prescription medications. But the authors found that a consumer's attitude toward DTC advertising can determine which of several paths he or she is likely to take. The attitudes of older adults are especially significant for pharmaceutical marketers because these consumers are heavy users of the drugs being advertised. PMID- 10142386 TI - Explaining blood donation: the trust factor. AB - Appealing to people's altruism may not be the best way to reach those who never donate blood. Rather, the authors found that several variables influence the decision, including whether or not people trust blood banks. Decreasing the perception that there are health risks associated with donating blood can also go a long way toward increasing the declining pool of blood donors. PMID- 10142387 TI - AIDS patients' perceptions of nursing care quality. AB - The authors propose a model, adapted from literature on quality in health care and services marketing, that identifies dimensions of quality in nursing care for persons with AIDS. In focus groups, respondents expressed concern about structural factors such as formal hospital practices, and process factors, which include nurses' knowledge of AIDS treatment and issues, their use of universal precautions, discrimination issues, expressions of empathy, and provision of health status information to the patient. PMID- 10142388 TI - Patient satisfaction or acquiescence? Comparing mail and telephone survey results. AB - Debates about whether to use telephone or mail to survey discharged patients are waged in many hospitals. Findings from a methodological test indicate the two methods result in significant differences in evaluations--differences that health care marketers would be wise to heed. Mail-back questionnaires generate a wider range of responses and minimize the "acquiescence bias" telephone interviews tend to elicit, especially in health care surveys. PMID- 10142389 TI - The Human Genome Project--promise and problems. PMID- 10142390 TI - Medical savings accounts. PMID- 10142391 TI - Rethinking the national organ transplant program: when push comes to shove. PMID- 10142392 TI - Genetic determinism or genetic discrimination? PMID- 10142393 TI - Health and the aesthetics of health--an historical case study. PMID- 10142394 TI - LTC providers may get correction period. PMID- 10142395 TI - Mandating nonforfeiture benefits. Con. PMID- 10142396 TI - Mandating nonforfeiture benefits. Pro. PMID- 10142397 TI - Failed amendment haunts Capitol Hill. PMID- 10142398 TI - Finding new niches in LTC. PMID- 10142399 TI - Subacute care. Accreditation: a necessary next step. PMID- 10142400 TI - Designing affordable senior housing. PMID- 10142401 TI - The Medicaid hand-off: who will end up running the program? AB - The Medicaid program may get an overhaul this year, as Congress pursues the deep spending cuts needed to balance the budget, and governors seek greater control of the program. Supporters of dramatic Medicaid reform say it is essential to curbing runaway entitlement growth, and giving states the flexibility they need to achieve greater efficiencies in the delivery and financing of care. Skeptics contend that deep cuts will jeopardize health care coverage for millions of poor children and families, and slash already parsimonious payments to providers. PMID- 10142402 TI - Recasting profits and losses. PMID- 10142403 TI - Reading the antitrust road map. PMID- 10142404 TI - 1995 corporate profiles. AB - As the long term care industry seeks out new products, new solutions, and new ways of providing quality care, it is important for long term care providers to know more about the companies they do business with. The following Corporate Profiles showcase information about leading companies in the long term health care industry. Some of the areas highlighted include: Mission of Company History Product Lines Support Services. We hope you will find this information useful when making purchasing decisions, and we're confident you'll keep this issue of Provider as a handy reference guide. PMID- 10142405 TI - Resuscitation in Acute Care Hospitals, Part I. Based on a conference held October 21-23, 1994, in Cancun, Mexico. PMID- 10142406 TI - The development of AHA (American Heart Association) guidelines for emergency cardiac care. AB - In summary, the value of the ECC training programs is improving the outcome for patients in cardiac arrest. It is believed that, by giving clinicians overall guidelines to use for this emergency situation, better decisions will be made. The Guidelines are in a dynamic state of re-evaluation, and the development process for guidelines is imperfect. However, every effort has been made to look at all sides of any controversy and make decisions based on scientific evidence. In addition, recommendations are now based on the relative strength of the scientific data. The process will continue even in the absence of National Consensus meetings. Finally, the importance of transmitting the Guidelines to participants in an educationally sound program has received a great deal of emphasis. The ACLS course is now interactive and based on clinical scenarios. The emphasis is on improving the knowledge and skills of the participants who take the course rather than on certification or evaluation. The effect of these changes will be evaluated over the next several years. PMID- 10142407 TI - Clinical practice guidelines for resuscitation in acute care hospitals. AB - The development of the AHA Guidelines for CPR and ECC and the AARC RACH Clinical Practice Guideline should both be instrumental in improving the performance of RCPs on in-hospital resuscitation teams. The AARC and AHA are assuming important leadership roles in this movement by publishing CPGs for CPR and ECC. RCPs with ACLS training are in a prime position to assume more responsibility on resuscitation teams within acute care facilities. They should be prominent members of the resuscitation team--committed to the entire team's performance- and be actively involved in ACLS training. The first step in that process is to study the current levels of RCP competence in ACLS. Further, RCPs and health-care providers should define the goals of resuscitation in terms of long-term survival, quality of life, and years of useful life after CPR. The cost of inadequate attention to which patients should have DNR orders is a drain on the entire health-care system. Research on the impact of disease categories on CPR outcome should be used to educate physicians, nurses, and RCPs so they can help patients better understand their chances of regaining their pre-CPR quality of life. Successful CPR outcome should be carefully defined using the patient's disease category. Each patient should be individually evaluated for DNR orders. As suggested by Schwenzer, "Patients' perception of their quality of life before and after CPR should guide their and our decisions." However, we must all accept the responsibility for defining the limitations of medical technology and try to determine when CPR is futile. PMID- 10142408 TI - Pacemakers and electrical therapy during advanced cardiac life support. PMID- 10142410 TI - ACLS systems and training programs--do they make a difference? PMID- 10142409 TI - Practice guidelines for airway care during resuscitation. AB - Existing guidelines for equipment and personnel have been described. In addition, the ASA guidelines on management of the difficult airway have been presented as an example of the type of algorithm that might be used for management of the difficult airway. Whereas guidelines are not standards, it is important to recognize that as guidelines are adopted by more and more practitioners, they become "standards of care" to which we are all held accountable. PMID- 10142412 TI - A hospital company and how it grew. PMID- 10142411 TI - Analyzing the surgical hand scrub using CQI. PMID- 10142413 TI - Medicare's fine fix. PMID- 10142414 TI - Case management in today's health care environment. PMID- 10142415 TI - Nurses develop indicators to measure the safety and quality of health care. PMID- 10142416 TI - JCAHO issues report cards on accreditation findings. PMID- 10142417 TI - Perspective. MSAs (medical savings accounts): practical, political tests await free-market paradigm. PMID- 10142418 TI - Perspectives. Assessing cost and quality in behavioral managed care. PMID- 10142419 TI - HIMSS/HP (Health Information and Management Systems Society/Hewlett-Packard Company) Survey results. Information systems professionals cite trends in healthcare computing. PMID- 10142420 TI - Care coordination begins with integration. PMID- 10142421 TI - Mapping care: one step at a time. PMID- 10142423 TI - Texas clinic goes wireless and paperless. PMID- 10142422 TI - Centered care: focusing on the patient. PMID- 10142424 TI - Wireless communications: taking healthcare by storm. PMID- 10142425 TI - Case study. Midwest hospital selects point-of-care workstations. PMID- 10142426 TI - Point of care: an essential technology for the CPR. PMID- 10142427 TI - CIO forum: pushing to reengineer. PMID- 10142428 TI - Technology watch: finding the right pathway. PMID- 10142429 TI - Clinical data repositories: the need for contextual cues. PMID- 10142430 TI - Legionella disinfection--an alternative approach. PMID- 10142431 TI - Protecting computers from lightning. PMID- 10142432 TI - Wallbeds in hospitals. PMID- 10142433 TI - Reflections on Latham. PMID- 10142434 TI - Are you paying too much for maintenance? PMID- 10142435 TI - NHS X-ray departments need modernising to cope with expanding demand. Audit Commission. PMID- 10142437 TI - UHCDA (Uniform Health Care Decisions Act) seen as an aid for proper surrogate decision making. PMID- 10142436 TI - When does big become too big for optimal patient care? AB - Current efforts at health care reform seem focused on two interrelated areas--an emphasis on cost containment through the shift to managed care and the expansion of managed care organizations through mergers and acquisitions. At some point, one could question whether interorganizational competition, or organizational size and the resulting complexity and fragmentation of the work force, might not lead to difficulties in providing high-quality care, as well as the avoidance of certain clients and patient populations deemed too small to provide the scales of economy required to maintain these large organizations. The following articles examine some of these questions. PMID- 10142438 TI - Reproductive medicine. New procedures fool Mother Nature and evade ethical debate. AB - Fetal tissue transplants that rely on abortions, and techniques used in prenatal diagnosis and artificial reproduction, have raised fervent and intractable opposition from the Roman Catholic Church and pro-life groups. Recent medical reports of advances in these areas have acknowledged the arguments offered by these organizations and, in turn, are offering some new ways for resolving the differences, as the following articles show. PMID- 10142439 TI - New encyclical condemns 'culture of death'. PMID- 10142440 TI - Courts continue to curtail aid-in-dying laws. PMID- 10142441 TI - To treat or not to treat: a closer look at unilateral decisions. PMID- 10142442 TI - Fulfilling the transcriptionist's responsibility for information security. PMID- 10142444 TI - State Medicaid managed care plans: TennCare and beyond. PMID- 10142443 TI - Preparing for the computerized patient. Record and managing its security. PMID- 10142445 TI - Medical professional liability: background and college views. American College of Surgeons. PMID- 10142446 TI - Statement on the surgeon and hepatitis B infection. American College of Surgeons. AB - In summary, immunization against HBV appears to be the most effective method of preventing transmission of HBV from patients to members of the surgical team. Such immunization is also the most effective way to reduce the risk of transmission of HBV from surgeons to patients. Eventually, by virtue of voluntary or required immunization, essentially all surgeons will be immunized. Until that time, HBV is likely to remain a threat to surgeons. The College and its appropriate committees will continue to monitor the data and update these recommendations accordingly. PMID- 10142447 TI - Evaluation and management of the injured child. American College of Surgeons Committee on Trauma. PMID- 10142448 TI - Life-threatening injuries in children: what have we learned and what are the challenges? PMID- 10142449 TI - A simple tool for designing a database: bridging the communication gaps among health care providers, researchers, and programmers. AB - As databases are used by a greater variety of people, highly technical methods of designing them are giving way to more human, user-centered approaches. The article describes a human approach to designing a complex, multiuse database with limited resources. The article introduces a simple data modeling tool, the entity relationship (E-R) diagram, that crosses professional boundaries and enables providers, researchers, and programmers to communicate more easily. Constructing an E-R diagram provides a human description of the social health maintenance organization (S/HMO) multisite demonstration project. This project, now in its tenth year, provides integrated acute and community-based in-home services to allow frail elderly HMO members to stay in their homes. After briefly reviewing the three types of databases and three rules of thumb for designing a relational database, the article shows how a simple E-R diagram can clarify the management and research issues of the S/HMO health care model. The article concludes with a brief discussion of the benefits and limits of housing research-related health data in a relational database. PMID- 10142450 TI - Grouping systems enhance outcomes analysis. AB - The production of outcomes data has often resulted in the collection of hundreds of additional data elements or review of massive numbers of charts. Tenet Healthcare Corporation (formerly National Medical Enterprises) developed an outcomes database using existing clinical-financial data elements with the help of two grouping systems provided by 3M Health Information Systems: all patient refined-diagnosis-related groups and ambulatory patient groups. These systems allow comparisons of outcomes within and across facilities, as is shown in specific examples in the article. PMID- 10142451 TI - The Maryland Quality Indicator Project: searching for opportunities for improvement. AB - High-quality care is a goal of all health care providers; defining and measuring quality care, however, can be challenging. The Maryland Quality Indicator Project, which began in 1985, helps hospitals in measuring quality within their own institutions. Fifteen in patient and outpatient monitors based on the data provided by participating hospitals are compared. Institutions can then compare their own activity both internally and externally. Definitions for the 15 indicators are provided, as are several examples for applications of these data. PMID- 10142452 TI - Impact of enterprisewide data. AB - The article provides an overview of initiatives relating to enterprisewide data collection. It discusses the meaning behind the term enterprisewide data and describes how health care entities are working to make the goal of enterprisewide data a reality by evaluating and employing such technologies as electronic data interchange, automated medical payment systems, and computerized patient records. It concludes with a discussion of data standardization in the health care industry and some issues that must be addressed by a health care entity as it strives to create an enterprisewide data system. PMID- 10142453 TI - Meeting the Joint Commission's information management planning standard: a primer and example. AB - The 1994 edition of the Accreditation Manual for Hospitals contains the first release of the Joint Commission on Accreditation of Healthcare Organizations' new standards for information management. These standards reflect the Joint Commission's vision of how hospitals should be managing one of their key corporate assets: information. The article focuses on the information management planning section of the standards. A sample information management plan is provided along with practical advice and experience in conducting a strategic planning project. PMID- 10142454 TI - Evolution of SACRED (staff authority credentialing): an automated credentialing system. AB - Over a period of 5 years, the medical record department (MRD) at the Warren G. Magnuson Clinical Center of the National Institutes of Health developed and refined a customized medical staff credentialing system. The result is SACRED, an automated credentialing system that supports the changing requirements of the credentialing process and continues to meet the needs of its customers. Using a reiterative approach to development and application of the concept of controlled manageable growth, the system can be maintained by the MRD and is adaptable to change without requiring reinvention or replacement of its basic structure, process, or equipment. PMID- 10142456 TI - Education review: diversity and opportunity in health management systems and health information management. AB - Innovative methods for managing health care information are critical to solving the problems posed by our nation's health care system. The Department of Health Information Sciences at the John G. Rangos, Sr. School of Health Sciences at Duquesne University in Pittsburgh has created baccalaureate and master's degree programs in health management systems that respond to a need for the redesign and management of the cultural and technologic infrastructure necessary to create more efficient, highly effective, and better informed health care organizations. PMID- 10142455 TI - Research review: the effect of barriers to communication on job satisfaction and perceived work productivity. AB - The article describes a study that examined the effects of communication barriers on job satisfaction and perceived work productivity. Data for this study were collected from a stratified random sample of health information management professionals (n = 237). In general, supervisors and employees had similar responses on all three measures. Both supervisors and employees focused on defensiveness and personality conflicts as important barriers to communication, personal satisfaction with work and job pride as the most satisfying elements of their work, and control over the work environment as the least satisfying work condition. Also in general, personality conflicts among workers and lack of organizational skills had the strongest effects on job satisfaction and perceived work productivity. PMID- 10142457 TI - Smoke rings and war signals: EPA's recent action on incineration. PMID- 10142458 TI - Five strategies for drafting doctors to your cost-cutting team. PMID- 10142459 TI - Passages. Work redesign doesn't have to hurt CS quality. PMID- 10142460 TI - Nurses and central service managers share job and quality concerns over work redesign. PMID- 10142461 TI - A comprehensive system for i.v. device management. PMID- 10142462 TI - The little heart program that could. A small hospital revives its cardiac surgery engine. PMID- 10142464 TI - Watching the watchdog. Hospitals take on the JCAHO. PMID- 10142465 TI - Taming the 7-headed beast: how to lead difficult personalities. PMID- 10142463 TI - Teams fit 7.5 million worth of requests into a 3 million budget. PMID- 10142466 TI - Between the sheets and the towels: linen awareness days cut costs. PMID- 10142467 TI - AHA stats verify network expansion. PMID- 10142468 TI - Once a hero. PMID- 10142469 TI - The race to consolidate. PMID- 10142470 TI - Specialist survival strategies. PMID- 10142471 TI - The practice management companies. PMID- 10142472 TI - The "Battle for Cleveland." Report from the front. PMID- 10142473 TI - New medical record system in Queen Elizabeth Hospital, Hong Kong. AB - During the 1980's, the medical record problems had been identified and it was not until 1991 that Queen Elizabeth Hospital was chosen to be the pilot hospital for the development of a new medical record management system for the Hospital Authority hospitals. The new medical records system was implemented in Queen Elizabeth Hospital in December, 1993. Six month after implementation, a pre implementation and post-implementation review of the medical record services were conducted to compare the results of the new and old system. The results showed that there were significant improvements in the record retrieval and record integrity in the new system. New medical record services such as the delivery of readmission records to the ward, filing of medical records forms in pre-defined order and filing of loose sheets in the relevant hospital notes are able to facilitate the efficient, effective and complete access to patient information. The support and cooperation of the hospital staff are crucial to the success of the new system. Continuous review and improvement of the new system is essential in order to obtain the best results. PMID- 10142474 TI - Data quality--monitoring the accuracy of clinical information. PMID- 10142475 TI - A new graduate MRA's experience in a new Hong Kong private hospital. PMID- 10142476 TI - The development of medical record services in Hong Kong public hospitals. AB - Medical record service in Hong Kong public hospitals have been developing at different levels. Since 1992, various improvements in medical record services have been carried out in public hospitals, e.g. professional management, record storage, organized medical records, computerization, completion of discharge summaries, and the introduction of a more precise coding system. The aim of the reform is to provide timely, accurate, organized and meaningful clinical information for end-users. Evolving from this reform, work has been started on developing Patient Related Groups and Specialty Clinical Information Systems. PMID- 10142477 TI - Medical Record Abstracting System/Information Delivery System (MRAS/IDS). PMID- 10142478 TI - Quality matters ... presentation and analysis of data. PMID- 10142479 TI - Civilian Health and Medical Program of the Uniformed Services (CHAMPUS); establishment of national differentials for children's hospitals--DoD. Notice. AB - The Office of the Civilian Health and Medical Program of the Uniformed Services (OCHAMPUS) is announcing the national differential rates for children's hospitals which go into effect April 1, 1995. This notice is issued as required in 32 CFR 199.14 in which OCHAMPUS announced that a notice would be published setting forth the national differential and eliminating the hospital-specific differentials. PMID- 10142480 TI - Medicare program; revisions to criteria and standards for evaluating intermediaries and carriers--HCFA. CFR correction. PMID- 10142481 TI - Who's really Medicare's best friend? PMID- 10142482 TI - How HEDIS (Health Employer Data and Information Set) is impacting IS (information systems) & managed care. PMID- 10142483 TI - CHINs (community health information networks): protecting the right to privacy. PMID- 10142484 TI - What information technology do you employ to manage and control risk at the HMO level? PMID- 10142485 TI - Provider profiling keeps care up and costs down. PMID- 10142486 TI - Turning data into knowledge. A selection of America's most computer advanced health maintenance organizations. PMID- 10142487 TI - Wisconsin cities win with WHIN (Wisconsin Health Information Network). PMID- 10142489 TI - Climbing out of the basement: IT (information technology) organizational requirements. PMID- 10142488 TI - IDS (integrated delivery system) vs. CHIN (community health information network): the great debate? PMID- 10142490 TI - HL7: not just for hospitals. PMID- 10142491 TI - The new informatics of national healthcare reform. AB - The President's Health Security Act has succeeded in attracting America's attention. Several of its initiatives have been well-publicized and hotly debated in Congress. The act also includes a number of implications for healthcare informatics, and devotes an entire chapter to this subject, although this area has not received as much publicity. Every behavioral healthcare provider's information system would be significantly affected by enactment of the Health Security Act. Selected forms and data elements for the management and delivery of behavioral healthcare services would need to be standardized. Organizations of behavioral healthcare providers, managed care companies and purchasers would increasingly share selected patient and subscriber information in aggregated form, for a variety of purposes. As a result, tougher laws to protect patient data privacy will likely be forthcoming. The following article gives an overview of the informatics needs of the soon-to-be reformed American healthcare system, into which behavioral healthcare will be integrated. As part of the larger system, behavioral healthcare services and information systems will need to comply with the same guidelines and requirements, outlined below, as other healthcare providers. Preparation to meet the information demands of the evolving healthcare system will require adaptation of existing computerized information systems, utilization of new technology, consultation with the system's major shareholders and attention to continuous quality improvement processes. PMID- 10142492 TI - Open, networked, integrated, multimedia, client/server behavioral healthcare. AB - Drawing upon the results of research from over 4,500 businesses that are now re inventing themselves through the application of current information technology, the author envisions the informational characteristics of the behavioral healthcare enterprise of the future. The new technology will be open for all stakeholders in the healthcare system to interoperate, integrated between providers and facilities nationwide, decentralized, immediately accessible and continuously updating clinically useful information. Although the new information system architecture may not be fully implemented for another 10 to 15 years, the transformation is already well underway. New computer technology makes such a reinvention of the behavioral healthcare enterprise both possible and inevitable. PMID- 10142493 TI - Today's or tomorrow's computer systems? AB - The computer technology of behavioral healthcare information systems must meet at least twelve requirements to effectively support clinical and management operations. Existing, antiquated "legacy" computer systems often fail to meet these requirements, due to high cost, slow turnaround, inconsistent data definitions, duplication, inflexibility and the lack of data integrity. There are five major transitions that an organization's information system undergoes to realize the full potential of new technology: from monolithic to parallel architectures; from procedural to object-oriented programming; from structural to relational databases; from legacy to "leap-frog" systems; and from fragmented systems to multimedia. PMID- 10142494 TI - Dialogue: will the increased integration of information systems necessitate lowering standards for patient confidentiality and data privacy? Protecting data privacy under federal healthcare reform. PMID- 10142495 TI - Dialogue: will the increased integration of information systems necessitate lowering standards for patient confidentiality and data privacy? Provider recommendations for safeguarding patient confidentiality. PMID- 10142496 TI - Dialogue: will the increased integration of information systems necessitate lowering standards for patient confidentiality and data privacy? Balancing individual and societal needs: micro- vs. macro-ethics. PMID- 10142497 TI - Clinical management information systems. PMID- 10142498 TI - Psychiatric decision making in the 90's: the coming era of decision support. AB - Guidelines for how mental health care is allocated form a pivotal point on the fulcrum balancing preservation of quality care and containment of costs. Advances in information system technology are creating new opportunities for research based decision support tools in this area. Such tools can systematically and reliably scale the domains of evidence used in psychiatric assessment in order to more precisely describe the severity of impairment and point to appropriateness of care decisions. The first psychiatric decision support tools were introduced in the 1960s in response to changes in the mental health community, but research in this area tended to have limited inter-rater reliability or validity. More recently, several computerized decision support tools have been developed, with a stronger research base and consequently a wider application. These tools are reviewed, and one such tool is described in greater depth to illustrate the possibilities of computer technology and the direction in which decision support software is headed. PMID- 10142499 TI - Overview of major healthcare reform legislation. PMID- 10142500 TI - Behavioral healthcare computer systems and the law: the problem of privacy. PMID- 10142501 TI - Vision: 2001--behavioral informatics. PMID- 10142502 TI - Patient-focused care from a materials manager perspective. AB - In one year, Cedars-Sinai Medical Center (Los Angeles, CA) implemented patient focused care on 32 nursing units. Through utilizing a continuous quality improvement (CQI) model of which patient-focused care was one operative, successful implementation was completed. The key concept was teamwork, and Materials Management Services proved to be a valuable member at all levels in the process whether at the oversight, design, or specialty task force level. Materials Management Services provided a consistent, efficient, streamlined service while following the guiding principles of patient-focused care: managed demand, redesigned work, and empowered employees. PMID- 10142503 TI - Patient-focused care from the ground up. AB - When it opens in April 1997, Genesys Health Park (Grand Blanc Township, MI) will be one of the first US hospitals to offer patient-focused care from the ground up. Located on a 480-acre wooded site, south of Flint and northwest of Detroit, this new hospital will take a holistic, personal approach to treating patients while attempting to keep area residents healthy during their life span. The personal touch afforded by Genesys is evident from a patient's first contact. During a typical 4-day hospital stay, most patients see up to 60 caregivers. At Genesys, through hospital design, technological innovation, and cross-trained employees, a patient will see only 12 caregivers, improving patient care by 60% while cutting personnel costs 30%. This is just one facet of putting the patient first that will be used at this hospital of the future. PMID- 10142504 TI - Electronic documents benefit integrated healthcare networks. AB - As healthcare entities begin to establish direct links with each other and with sources such as physicians and HMOs, electronic document management plays a key role in facilitating each party's simultaneous access to accurate, real-time data about patients, test results, insurance claims, and many other information levels. Though it may be some time before the majority of healthcare entities are aligned in fully functioning community healthcare integrated networks (CHINs), there is no reason for individual hospitals and healthcare providers to postpone electronic document management. They can realize significant benefits by integrating electronic document management into an organization's information management plan now, and that will help them move into a future CHIN. PMID- 10142505 TI - Planning: technology re-engineering. PMID- 10142506 TI - Proposed GME reductions threaten hospital purchasing. PMID- 10142507 TI - Ethical implications of re-engineering. PMID- 10142508 TI - In closing ... occupational safety advocate. PMID- 10142509 TI - Spiritual sickness afflicts the modern world. PMID- 10142510 TI - Being at the bedside of dying patients. PMID- 10142511 TI - Care-in-dying: a call to action. PMID- 10142512 TI - Caring with technology: relationship as the key to promoting dignity. PMID- 10142513 TI - The marketplace and health care reform: the unfinished agenda of the '90s. AB - A long-term approach to health care reform demands an agenda that involves purchasers, payers and providers, as well as users. The overall goal of such an effort must be integrating ongoing cost reductions with continuous improvements in quality of care. PMID- 10142514 TI - The role of employee communication in a changing health care environment. AB - Employee communication and medical management are two vital components of an effective health care delivery system. They must work together to support appropriate, cost-effective care and the efficient consumption of resources. PMID- 10142515 TI - Unraveling the ramifications of recent pharmaceutical industry acquisitions by looking at the past, present and future of PBMs (pharmacy benefit management firms). PMID- 10142516 TI - Using diagnostic clusters to evaluate patterns of treatment and develop capitation rates. AB - Payers and providers of medical services need to understand what is effective in medical care and what determines patient outcomes. The diagnostic cluster methodology offers a way to analyze physicians' overall practice patterns in treating a specific medical condition and provides a good foundation for performing medical outcomes studies. PMID- 10142517 TI - Medicare--where is its future? AB - Canadian health care policy is in a period of transition. Continuing reform is necessary to ensure quality; to evaluate health outcomes; and to promote efficiency, effectiveness and appropriateness of care. PMID- 10142518 TI - Health care purchasing alliances--a Michigan multiemployer trust funds' approach. AB - A group of multiemployer trust funds in Michigan has formed a coalition that eventually will offer its members an integrated managed health care program. As the first step toward this goal, the coalition recently implemented a managed pharmaceutical program. PMID- 10142519 TI - Personal health management--a better way to wellness. AB - A risk management approach to disease prevention and health care utilization allows identification of the high-risk portion of an employee population. Benefits administrators can then implement strategies to manage costs for this small employee group. PMID- 10142520 TI - Strategies for health care cost containment. PMID- 10142521 TI - Delivery systems for vision care benefits. AB - The best way to provide a vision care benefit is with a managed care plan. With this type of design, there is cost containment without cost shifting, and quality assurance and member satisfaction are readily attainable at relatively inexpensive rates. PMID- 10142522 TI - When Johnny and Jane come marching home: retirement and welfare benefits enhanced for returning veterans. PMID- 10142523 TI - Saving the heroes. PMID- 10142524 TI - Cowboy care. PMID- 10142525 TI - Rude awakenings. AB - A new nurse recently complained in a national nursing publication that her manager, a 22-year veteran, refers to her staff as"dodos," "dipsticks" and "resident idiots." The vexed grad wanted to know whether she had to put up with this verbal abuse. It's amazing that she even had to ask. The Los Angeles Times reports that rudeness is epidemic in America, as "embedded in the workplace culture as time cards, fluorescent lighting and computers." EMTs and paramedics are prime targets. You endure it from patients, their families, bystanders, coworkers, managers, ED staffers and cops. You no doubt take a deep breath, hold your tongue and prepare to move on to the next call. But what if you're mad as hell and don't want to take it anymore? On the following pages, experts share their experiences and offer communication strategies. So, hurry up! Turn the page! (Oops. We apologize for being rude...) PMID- 10142526 TI - Ambulance manufacturers look toward the future. Interview by Marie Nordberg. PMID- 10142527 TI - The influence of ethics on leadership. AB - Value driven ethical leadership is needed today. The housekeeping field employs a diverse work force, and managers must develop and empower workers to attain organization goals. As managers, we must understand and develop our personal value structures that affect our decision making. This paper reviews Lawrence Kohlberg's study of moral behavior and how those stages are relevant to ethical management practices. It also addresses ways to overcome some obstacles in understanding and dealing with personal values that may threaten moral and ethical practices. Mature ethical principles and good communication are the foundation for and foster strong leadership for the future. PMID- 10142528 TI - If it is to be, it is up to me. PMID- 10142529 TI - Ethics in the workplace: staying clean while keeping clean. PMID- 10142530 TI - Chemical emergencies and the Health Advisory Group on Chemical Contamination Incidents (HAGCCI). AB - The Health Advisory Group on Chemical Contamination Incidents (HAGCCI) (pronounced 'Hag-C'), is an independent advisory group which was established to advise Directors of Public Health throughout the United Kingdom (UK) and the Chief Medical Officers of the UK Health Departments on the medical aspects of major chemical contamination incidents involving air, soil or water. Separate arrangements exist for the provision of advice on chemical contamination of food. HAGCCI comprises a core group of three individuals, supported by a multidisciplinary panel of experts, and a secretariat provided by the Department of Health. We describe the role of HAGCCI within the overall framework of preparedness for the public health aspects of chemical emergencies. PMID- 10142531 TI - The European Directives: safeguarding the patient and staff. PMID- 10142532 TI - Trends in the management of fractured mandibles 1983-93. AB - The aetiology, presentation and management of fractured mandibles were investigated in a major accident and emergency department in 1983 and 1993. Demographic features of patients in both years were similar: most injuries were in males (89%), most were a result of an assault ( > 75%), and 50% of the patients presented for treatment between the hours of 10pm and 5am. There were striking reductions in the numbers of patients who waited more than 24-hours for an operation (60% in 1983; 34% in 1993), and out-of-hours operating (60% in 1983; 41% in 1993). There was an increase in the number of patients for whom consultants were the principal operator (13% in 1983; 32% in 1993). Changes in the methods of treatment included a decrease in the use of postoperative intermaxillary fixation (98% in 1983; 56% in 1993) and an increase in internal fixation using bone plates (2% in 1983; 53% in 1993). Total inpatient stay was the same in both study years (mean = 3 days), and there was no difference in duration of stay between treatment modalities (internal versus intermaxillary fixation). PMID- 10142533 TI - Incidence of decompression illness in amateur scuba divers. AB - This paper reports changes in the incidence and manifestations of decompression illness in amateur scuba divers in the United Kingdom (UK) between 1981 and 1993, a period during which the popularity of the sport increased. Since 1981, there has been a trend to increased annual incidence of decompression illness, but the large yearly fluctuations reflect a considerable annual variation in the numbers of dives. The need for recompression facilities to treat decompression illness in amateur scuba divers in the UK should take account of this greater public participation in the sport, and should also allow for large annual fluctuations related to meteorological and financial factors. PMID- 10142534 TI - Health trends in the past 75 years. PMID- 10142535 TI - Developing a code of ethics. PMID- 10142536 TI - Wellness in the works at Community Hospital of Roanoke Valley, Roanoke, Virginia. PMID- 10142537 TI - Integrating major gifts and planned giving. PMID- 10142538 TI - Continuous quality improvement as an ideal in hospital practice. AB - Continuous quality improvement (CQI) is an important part of successfully managing change in health care. This article describes a CQI plan and process created to develop a comprehensive plan for a rapidly evolving organization. Four key components of the planning process are described: initial initiatives, customer service orientation, teamwork approach, and physician involvement. A case study is also included to illustrate how one CQI plan and process was implemented and evaluated. PMID- 10142539 TI - Job satisfaction of nursing assistants in long-term care. AB - A study of job satisfaction of nursing assistants (NAs) was conducted in two nursing homes (one in a relatively poor urban neighborhood, the other in an affluent suburban neighborhood). When it comes to job content, NAs were more satisfied than dissatisfied. However, they are less satisfied with working conditions. The NAs of the suburban facility were less satisfied than those of the urban facility. Managers need to focus more on the work environment than on job content to develop a more satisfied work force. PMID- 10142540 TI - Taking the dread out of annual performance evaluations. AB - Many employees and managers alike dread annual performance evaluations. However, there is a way to get past the "dread" factor. Annual performance evaluations can be a positive experience and even motivational. They can be a time for affirming good work of the past year and planning together what will be accomplished in the year to follow. By keeping employees informed of the larger picture, helping them to see how they fit in, involving them in setting performance objectives, dealing with performance problems as they arise, and noticing when they have achieved their objectives can make evaluation a positive experience. PMID- 10142541 TI - How learning style and personality type can affect performance. AB - Many factors can influence the performance of allied health professionals in the academic arena and working environment. This study looked at how learning style and personality type influenced the performance of medical transcription students in both routine and creative tasks. Since the sample was small, there were no statistically significant findings, but an interesting pattern did emerge. Further study is warranted to determine how to fit health care professionals to the jobs for which they are best suited. PMID- 10142542 TI - Management of violent patients: a training approach. AB - With the increased occurrence of violence in hospitals, this article provides information on how to resolve violence in the hospital and how to help heal the emotional scars of health care practitioners involved in job-related violent acts. Techniques of conflict management include preventive methods such as observing various cues of possible violence, safety procedures when approaching a violent incident, and various appeals when attempting to persuade the violent person to follow a safer course of action. The process of dealing with the aftermath of a violent act includes establishing a Crisis Aftermath Plan (CAP). PMID- 10142543 TI - Nonlicensed employee turnover in a long-term care facility. AB - The purpose of this study was to analyze nonlicensed employee turnover in a long term care facility using Maslow's hierarchy of needs as a framework. During exit interviews, a convenience sample of 34 employees completed an attitudes and beliefs survey regarding their work environment. Findings were mixed; 39.6 percent of the employees stated positive personal relationships were a strength of the organization, although 24.3 percent resigned because of personal/staff conflicts. Financial concerns were not a major factor in their resignations. The study suggests that decreasing nonlicensed employee stress and increasing their personal satisfaction with patient care may decrease employee turnover. PMID- 10142544 TI - The nursing human resource budget: design for success. AB - As vital as the nursing human resource budget is to the successful achievement of institutional goals, it is very important to present a well-developed budget. Using current automated spreadsheet technology, the nursing human resource budget can be laid out in a format that is easy to understand and easy to present. Using the methods discussed in this article, the nurse executive will be able to perform infinite iterations of the proposed budget with a few simple key strokes, thus allowing for things like zero-based budgeting or addition of programs during the budgeting process or at a later date. Implications for nurse executives are discussed. PMID- 10142545 TI - Total quality management: lessons learned from the medical practice environment. AB - Experience in dealing with the application of total quality management (TQM) to the medical practice environment suggests some generic lessons that can be helpful in applying TQM in other health care settings. These lessons focus on the need to address the motivation for TQM and its potential value; understanding the barriers created by the organizational and industry culture; identifying the structural barriers within the organization; clearly stating the guiding principles of the TQM effort; implementing the correct management tools for implementation; and allowing users of TQM to create new ideas for the application of TQM in their organizations. PMID- 10142546 TI - Coping with default management. AB - Management by default occurs when a manager fails to act on a given situation, ignores a problem, or simply "lets things happen." It can be unconsciously following the path of least resistance; it can be consciously deciding not to decide. It is owing largely to displaced priorities. Whatever its form, it causes staff to lose time and it leads them into risky situations when they attempt to compensate for default. However, the risks and frustrations caused for staff by default management can be minimized by an assertive communications posture in dealing with one's manager. While almost always representing an undesirable working circumstance, default management can nevertheless be approached by the subordinate as a potential source of challenge and satisfaction. PMID- 10142547 TI - Nurses resist change, need CEO's attention. PMID- 10142548 TI - Competition in specialized managed care contracting produces bundled treatments. PMID- 10142549 TI - IRS may allow physician recruitment latitude if hospitals prove community need. PMID- 10142550 TI - ProPAC calls for Medicare reform: change hospital outpatient payment. PMID- 10142551 TI - Disease management brings major challenges. PMID- 10142552 TI - Vertically integrated services for the elderly: fact or fiction? PMID- 10142553 TI - Data trends. June 1995. PMID- 10142554 TI - Provider integration: PO (physician organization) versus PHO (physician hospital organization). AB - The PO model, in which a PO and hospitals "peacefully coexist" without some level of integration, may not be sustainable in the long term, as managed care and healthcare reform initiatives pressure providers to integrate delivery and align their economic incentives (either on a fee-for-service or capitated basis). Therefore, while integrating physicians and hospitals within a PHO may not be attractive to physicians initially, opting for an approach that does not integrate physician and hospital services and align their economic incentives can eventually invite a significant level of competition between the two. PMID- 10142555 TI - A practical approach to medical practice acquisition. PMID- 10142556 TI - Healthcare financial manager's role will change drastically. PMID- 10142557 TI - Nationwide EDI system can trim administrative costs. AB - Administrative costs related to the healthcare industry can be reduced dramatically through implementation of a nationwide electronic data interchange (EDI) system. Estimates suggest that such a system could trim $73 billion from the $220 billion spent annually in the United States on healthcare administrative costs by automating 11 transactions traditionally performed manually. The greatest potential for cost savings lies in the electronic conversion of enrollments, submissions, and payments. PMID- 10142558 TI - Applying TQM/CQI principles to information system selection. AB - Faced with the challenge of selecting a new information system, senior management at North Valley Hospital in Whitefish, Montana, decided to employ principles of total quality management and continuous quality improvement to help ensure an efficient process that involved and empowered those who would use the new system. Senior managers set a vision for the process, then assigned responsibility for system selection to a task force representing departments and disciplines that would be most affected by the system. The task force established a systematic process for identifying information system needs, evaluating existing products, and selecting among those products. PMID- 10142559 TI - CHINs: making the important decisions. AB - Community health information networks (CHINs) are an evolving concept. In their most basic form, CHINs provide a structure for sharing financial and clinical information among a defined group of entities. However, several key decisions affect how a CHIN will function. Among those decisions are what "community" will be included, what technical infrastructure to use, what organization or group of organizations will lead the CHIN development effort, what types of information will be shared, and how to safe-guard confidentiality. PMID- 10142560 TI - Reducing ICU costs with computerized tools. AB - A significant opportunity for cost savings in health care lies in managing ICU utilization. Computerized tools that collect data about patient severity of illness, monitor ICU utilization, and track patient outcomes have the potential to help hospitals lower costs by changing practice patterns and treating patients in appropriate, less-expensive settings. PMID- 10142561 TI - Navigating the waters of Medicaid managed care contracting. AB - Managed care organizations (MCOs) are responding enthusiastically to Medicaid waiver contracting opportunities. However, these opportunities involve financial risks as well as complex requirements regarding services to be offered and enrollment procedures to be followed. MCOs that understand these complex programmatic and operational requirements can take best advantage of Medicaid contracting opportunities. PMID- 10142562 TI - SFAS No. 117 brings uniformity to financial statement formats. AB - Statement of Financial Accounting Standards (SFAS) No. 117 was issued to establish consistency in financial reporting among not-for-profit organizations, which are subject to various American Institute of Certified Public Accountants (AICPA) audit guides. In addition, SFAS No. 117 was designed to close the gap between the statements of not-for-profit and for-profit organizations. The provisions of SFAS No. 117 are intended to override AICPA audit guides and statements of position when the two conflict. PMID- 10142563 TI - Juggling paper and electronic claims. PMID- 10142564 TI - The accounting profession under attack. PMID- 10142565 TI - Case study. When outsourcing goes awry ... seven experts discuss how the outsourcing crisis could have been avoided. AB - Grant Newman, chief executive officer of Regional Medical Center, expected the worst from the meeting that was scheduled to begin in less than an hour. The anesthesiologists were at the end of their rope, and the hospital's surgeons and obstetricians were pretty riled up, too. Eighteen months earlier, Newman had made the decision to outsource RMC's anesthesia services, and he had signed a contract with Physicians Development Services, a contract management company. As is typical in these arrangements, the anesthesiologists would be independent contractors with PDS while PDS would be under contract with RMC. Legally, therefore, there would be no agreement of any sort between the anesthesiologists and the hospital where they worked. At the time, PDS seemed a good fit. It had a reputation for providing high-quality physicians both on a permanent basis and for temporary assignments. Unfortunately, however, PDS was undercapitalized and chronically mismanaged. PDS's paychecks to the anesthesiologists began arriving late and then bounced several times over a three-month period. In addition, the contract between the anesthesiologists and PDS had expired three months earlier, and the anesthesiologists were providing services without a contract. Newman knew that he had no legal right to interfere with the contract between PDS and the anesthesia group unless PDS breached the contract with RMC. But Newman felt that the future viability of the hospital would be seriously compromised if he allowed an exodus to occur even for a single day. What can Newman do to resolve this conflict? Seven experts consider how the hospital's outsourcing crisis could have been avoided. PMID- 10142566 TI - Nutrition trends in home health care. PMID- 10142567 TI - Home care: a new paradigm for nutrition services. PMID- 10142569 TI - Model for assessing quality data. PMID- 10142568 TI - Medicare/Medicaid reimbursement for home care services. PMID- 10142570 TI - Medicare and Medicaid statistical supplement. PMID- 10142571 TI - Medicaid expenditures and state responses. AB - This overview summarizes issues addressed in this issue of the Health Care Financing Review, entitled "Medicaid and State Health Reform." Articles cover the following topics: growth in the level of expenditures for Medicaid and creative financing strategies by States to manage these increases; section 1115 demonstration waivers; States' experiences with implementing approved section 1115 demonstrations; how section 1115 demonstration waivers fit into larger State health reform efforts; and other reform efforts in two States. PMID- 10142572 TI - Medicaid and state health care reform: process, programs, and policy options. AB - Health care reform is a continuously evolving process. The States and the Federal Government have struggled with policy issues to combat escalating Medicaid expenditures while ensuring access and quality of care to an ever-expanding population. In the absence of national health care reform, States are increasingly relying on Federal waivers to develop innovative approaches to address a myriad of issues associated with the present health care delivery system. This article provides a summary of State health care reform efforts that have been initiated under Federal waiver authority. PMID- 10142573 TI - State perspectives on health care reform: Oregon, Hawaii, Tennessee, and Rhode Island. AB - The general consensus among States which have had their section 1115 demonstration projects approved is that there is no one best way to implement State health care reform. The Health Care Financing Administration (HCFA), however, wished to discern how States were accomplishing the task of implementing the demonstrations, and solicited responses from State representatives whose section 1115 demonstration waivers had been approved. The resulting article gives an overview of this implementation process from four State perspectives. Written by representatives from Oregon, Hawaii, Tennessee, and Rhode Island, the ideas presented here are indicative of the complex undertaking of State health care reform. PMID- 10142574 TI - State health reform and the role of 1115 waivers. AB - This article summarizes the status of State health reform and includes a table of major initiatives undertaken by each State. The Health Care Financing Administration's (HCFA's) role in reviewing State waiver proposals is analyzed, and the author examines why States are likely to continue to seek section 1115 waivers, absent Federal health care reform. The often conflicting roles and responsibilities of Federal and State policy-makers in health reform are explored. PMID- 10142575 TI - Rate regulation as a policy tool: lessons from New York State. AB - For over a decade, New York State has used hospital rate regulation (the New York Prospective Hospital Reimbursement Methodology [NYPHRM]) as a policy tool to achieve three objectives: containing costs, supporting financially stressed hospitals, and financing access to care for the uninsured. This case study of NYPHRM suggests that the regulatory approach, if pursued with vigor, can achieve any one of these goals. On the other hand, the New York experience also shows that these are competing goals, and that achieving all of them over a period of time can prove to be difficult. PMID- 10142576 TI - Washington State Health Services Act: implementing comprehensive health care reform. AB - In 1993, Washington State enacted the Health Services Act of 1993 (HSA) to guarantee universal access to health care through an employer mandate, with caps on premiums as the primary cost-control mechanism. The HSA represents the Nation's first formal experiment with managed competition. This article reports the results of a case study of the HSA's implementation. The study concludes that the Washington State initiative can be replicated in other States, but that implementation is complex, requires sustained public education, and requires cooperation from the Federal Government through program waivers. A major implementation challenge is to facilitate competition and minimize regulation. PMID- 10142577 TI - Practice expenses in the MFS (Medicare fee schedule): the service-class approach. AB - The practice expense component of the Medicare fee schedule (MFS), which is currently based on historical charges and rewards physician procedures at the expense of cognitive services, is due to be changed by January 1, 1998. The Physician Payment Review Commission (PPRC) and others have proposed microcosting direct costs and allocating all indirect costs on a common basis, such as physician time or work plus direct costs. Without altering the treatment of direct costs, the service-class approach disaggregates indirect costs into six practice function costs. The practice function costs are then allocated to classes of services using cost-accounting and statistical methods. This approach would make the practice expense component more resource-based than other proposed alternatives. PMID- 10142578 TI - Health care indicators ... community hospital statistics; private sector employment, hours, earnings; prices; national economic indicators. PMID- 10142579 TI - Provider Reimbursement Review Board annual report: fiscal year 1994. AB - The Provider Reimbursement Review Board (PRRB) is the first step in the administrative/judicial appeals process for Medicare payment disputes of $10,000 ($50,000 for group appeals) or more. This annual report provides information about the PRRB, its performance during the past fiscal year (FY), an assessment of current issues, and comments regarding the future. Tables and figures accompanying this report illustrate trends reported herein. PMID- 10142580 TI - Medicaid disproportionate share and other special financing programs. AB - Medicaid disproportionate share hospital (DSH) and related programs, such as provider-specific taxes or intergovernmental transfers (IGTs), help support uncompensated care and effectively reduce State Medicaid expenditures by increasing Federal matching funds. We analyze the uses of these funds, based on a survey completed by 39 States and case studies of 6 States. We find that only a small share of these funds were available to cover the costs of uncompensated care. One method to ensure that funds are used for health care would be to reprogram funds into health insurance subsidies. An alternative to improve equity of funding across the Nation would be to create a substitute Federal grant program to directly support uncompensated care. PMID- 10142581 TI - Equity in the Medicaid program: changes in the latter 1980s. AB - The possibility of health care reform has helped focus attention on equity in the receipt of health care. This is a particular issue for the Medicaid program, as State variations in eligibility and payment policies have historically created inequity. This study examines equity for Medicaid beneficiaries and State taxpayers during the latter 1980s. Findings indicate that federally mandated expansions significantly increased equity in the coverage of the poor, but inequality in real resources per enrollee remained significant. Although equity improved from 1984 through 1991, the increased use of provider-specific tax and voluntary donation (T&D) programs by traditionally high-spending States played an important role in the 1992 figures. PMID- 10142582 TI - Equity of the Medicaid program to the poor versus taxpayers. AB - The last 15 years have witnessed explosive growth in State Medicaid programs. This article demonstrates the equalizing impacts of greater spending and recent Federal mandates on the health care coverage of the poor. Large inequalities in generosity still remain, however. Inequalities in taxpayer burdens are also documented, and simulations of alternative Federal sharing algorithms show significant changes that would be required to achieve a more equitable distribution of the program's financial burden. PMID- 10142583 TI - The ABIM perspective: past, present, and future. Board certification in the 1990s. PMID- 10142584 TI - The ABIM perspective: past, present, and future. Why board certification came into being. PMID- 10142585 TI - As the practice of medicine changes, so do academic health centers. Interview by C. Burns Roehrig. PMID- 10142586 TI - Should Medicare be reinvented? PMID- 10142587 TI - It's time to end federal regulation of office labs. American Society of Internal Medicine. PMID- 10142588 TI - Are physicians becoming too much of a good thing? PMID- 10142589 TI - Access to health care should be a right--not a luxury. PMID- 10142590 TI - Regulatory relief: a boon to health care. American Society of Internal Medicine. PMID- 10142591 TI - Joining managed care plans--is board certification a necessity? PMID- 10142592 TI - Assessing a physician's true worth. PMID- 10142593 TI - Self-scrutiny. A prerequisite to collaborative planning. PMID- 10142594 TI - Provider competition. Wheel and deal. PMID- 10142595 TI - Corporate governance. Gender gap. PMID- 10142596 TI - Market regulation. Contriving competition. PMID- 10142597 TI - Accident prevention. Watch that child. PMID- 10142598 TI - Primary care. Reviving the sleeping beauty. PMID- 10142599 TI - Medical education. Shaking up the class system. PMID- 10142600 TI - Community care. The tasks in hand. PMID- 10142601 TI - Evaluating the reforms. Balancing act. PMID- 10142602 TI - Health promotion. Heart attack. PMID- 10142603 TI - Data briefing. Clinical negligence: who pays? PMID- 10142604 TI - Facilities management. Food, food, glorious food. PMID- 10142605 TI - Facilities management. Powers that be. PMID- 10142606 TI - Facilities management. First impressions. PMID- 10142607 TI - Facilities management. From belly dancing to beef wellington. PMID- 10142608 TI - Contract disputes. Whose problem? PMID- 10142609 TI - Community dentistry. Something to smile about. PMID- 10142610 TI - Managing risk. A priority in the Health Service. PMID- 10142612 TI - User involvement. Self-service. PMID- 10142611 TI - Managed care. The perfect package. PMID- 10142613 TI - Health insurance in Russia--the Kuzbass experience. AB - The leading pilot region for health finance reform in the Russian Federation has been adapting systems to changing economic circumstances since 1986. In 1992 a 'regulated competition' model was introduced and compulsory contributions are now routed to insurers via a central compensation fund. Hospitals are paid at standard rates (using 'clinical statistical groups') per case by diagnosis and procedure, and by outcome. Primary care is moving from fundholder polyclinics to general practitioners operating under incentives to efficient gatekeeping and provision of quality out-patient care. Private insurance co-exists for about five percent of the population, but the compulsory component is regulated through the central fund and only supplements are voluntary. The region has strong natural resources, but against a background of economic and environmental problems, a one third increase on funding available to health over the pilot period is satisfactory, with costs of health insurance administration limited to three percent. PMID- 10142614 TI - Primary care and health care reform: the need to reflect before reforming. AB - The system of primary care in the UK National Health Service appears to have become popular amongst policy makers worldwide. This is surprising given the poor knowledge base regarding the care provided and its cost effectiveness. It is necessary for policy makers to identify which health care interventions are effective and cost effective, and develop knowledge about how behaviour can be changed and cost effective interventions adopted in routine medical practice. Trials of pharmaceuticals in primary care therapeutic areas reveal a poor knowledge base about clinical effectiveness and often fail to include economic aspects. Initiatives such as the UK general practice fundholding scheme, the general practitioner contract and the Health of the Nation targets were not based on empirical evidence and have not been subject to adequate evaluation. If health care reforms elsewhere are to include emphasis on primary care, policy goals must be clearly articulated and the knowledge base informing efficient delivery of primary care must be improved. PMID- 10142615 TI - Evaluating the effects of GP remuneration: problems and prospects. AB - General practice reform is occurring in a number of countries. Little is known, however, of the effects of remunerating general practitioners on the costs and outcomes of care. Valuable lessons can be learned for the scope and design of future research, however, from the existing literature on the effects of general practioner (GP) remuneration. The objectives of this paper are to highlight some of the problems and pitfalls that should be avoided in any further research on the effects of GP remuneration and to identify the main issues for future research. Eighteen studies of the effects of GP remuneration have been reviewed, with a focus on the methods used. Eight studies addressed the effect of changes in the level of remuneration, three evaluated the effect of special payments and bonuses and seven assessed the effects of different remuneration systems. Although there are often practical constraints on the choice of study design, crude 'before and after' analyses and the use of aggregate data should be avoided in favour of prospective evaluations using consultation-based data. The studies reviewed did not evaluate the effects of remuneration on patient welfare and were characterised by the omission of major confounding variables and an inability to generalise to other settings. These issues present a considerable challenge to researchers, GPs and policy makers. PMID- 10142616 TI - Ethical dilemmas in care for HIV infection among French general practitioners. AB - A survey was carried out in May-June 1992, in the city of Marseille (South Eastern France), to analyze attitudes towards ethical issues associated with the care of HIV-infected patients in a random sample of general practitioners (GPs) (telephone interviews; answer rate = 78.6%; n = 313). A total of 70.6% were consulted by HIV carriers and 48.9% regularly took care of these patients over the past year. Multi-dimensional analysis showed that support for HIV mandatory screening was related to lack of knowledge and experience with HIV infection, high perception of risks associated with HIV care, and the individual characteristics of GPs, such as religious beliefs and intolerance to uncertain situations. GPs with experience of regular care of HIV carriers had the same opinions than the rest of the sample about 'creation of specialized hospitals for AIDS patients' and similar attitudes toward HIV testing 'without patients' consent' or breaching of confidentiality of HIV diagnosis. Debates on ethical issues among GPs cannot be reduced to a simplistic division of a 'liberal group' highly involved in prevention and HIV care and a 'conservative' majority more or less inclined to stigmatize HIV-infected patients. Ambiguous messages on these issues from health authorities and professional ethical bodies may have very negative impacts on the attitudes of primary care physicians regarding the acceptability of HIV-infected patients. PMID- 10142617 TI - The changing availability of residential aged care in Australia. AB - Australian aged care services have undergone a series of substantial reforms in recent years under the rubric of the Aged Care Reform Strategy. Overall, there has been a progressive refinement of the targeting of available services on those most in need, defined in terms of both disability levels and financial resources. A key component of this process has been a deliberate reduction in the relative emphasis accorded to nursing home care within the aged care system. This has been accompanied by increases in the resources directed toward less intensive forms of residential care (hostels) and community based services. This paper explores the actual consequences of these intentional policy changes in terms of the availability of nursing home and hostel care, and the changing characteristics of nursing home residents. The results suggest that a more substantial reduction has occurred in the availability of nursing home care than has hitherto been suggested, with consequent decreases in the proportion of aged persons in nursing homes. The effect has been particularly marked amongst women and the very old. These findings raise policy questions about the appropriateness of current and planned future levels of provision. PMID- 10142618 TI - On the estimation of cost-effectiveness ratios. AB - In a recent paper Birch and Gafni criticised the use of cost-effectiveness ratios in decisions about the allocation of health care resources. To support their claim that the use of cost-effectiveness ratios will not lead to the maximization of health effects for a given budget they used an example. In this paper it is pointed out that the example used contains two basic errors. The first error is the failure to exclude dominated programmes in the estimation of incremental cost effectiveness ratios. The second error is the failure to distinguish between independent and mutually exclusive programmes. It is concluded that to get a more sober discussion about the use and interpretation of cost-effectiveness analysis it is important that the technique is used correctly. PMID- 10142619 TI - Cost-effectiveness league tables: think of the fans. AB - In a recent issue of Health Policy, Birch and Gafni argued against the use of cost-effectiveness league tables in health care decision making. They argued that league tables should be returned to where they are best used and understood--the sports pages. Recently the debate about the presentation and interpretation of cost-effectiveness data has been given an additional impetus in the UK through the publication, by the Department of Health, of the Register of Cost Effectiveness Studies (RCES). During the production of the RCES, it became apparent that there were similarities between the decision makers' thirst for economic data and the sports fans' thirst for information about their team. In this paper we review the pros and cons of using published cost-effectiveness data in decision making, compared with the local team approach suggested by Birch and Gafni. We conclude that there are advantages from using published data, providing these are produced according to standardized methods and interpreted intelligently. Most importantly, cost-effectiveness data, whether published or generated locally, are unlikely to give decision makers a technical solution to the resource allocation problem. Rather, they should be viewed as a stimulus for local discussion and debate. PMID- 10142620 TI - Development, testing and implementation of an emergency services methodology in Alberta. AB - Alberta was the first province in Canada to mandate reporting of hospital-based emergency services. This reporting is based on a workload measurement system that groups emergency visits into five discreet workload levels/classes driven by ICD 9-CM diagnoses. Other related workload measurement variables are incorporated, including admissions, transfers, maintenance monitoring, nursing and non-nursing patient support activities, trips, staff replacement, and personal fatigue and delay. The methodology used to design the reporting system has been subjected to extensive testing, auditing and refinement. The results of one year of province wide data collection yielded approximately 1.5 million emergency visits. These data reveal consistent patterns/trends of workload that vary by hospital size and type. Although this information can assist in utilization management efforts to predict and compare workload and staffing levels, the impetus for establishing this system derived from its potential for funding hospital-based emergency services. This would be the first time that such services would be funded on a systemic, system-wide basis whereby hospitals would be reimbursed in relation to workload. This proposed funding system would distribute available funding in a consistent, fair and equitable manner across all hospitals providing a similar set of services, thus achieving one of the key goals of the Alberta Acute Care Funding Plan. Ultimately, this proposed funding methodology would be integrated into a broader Ambulatory Care Funding system currently being developed in Alberta. PMID- 10142621 TI - Evaluation of a hospital-based utilization management program. AB - The objective of this study was to evaluate the impact of a utilization management (UM) program designed to decrease inappropriate use of acute care hospital beds while maintaining quality of care. The measure used to define appropriateness was the ISD-A, a diagnosis-independent measurement tool which relies on severity of illness and intensity of service criteria. The outcome measures for the study included appropriate admission to hospital and continued days of stay in hospital, 30-day readmission rates and physician perceptions of the impact of the intervention on quality of care, access to services and patient discharge patterns. The sample frame for the study included two control and two intervention community hospitals, involving 1,800 patient charts. Readmission rates were determined by analyzing all separations from medical services (N = 42,014) in the two experimental and two control hospitals. All physicians with admitting privileges (N = 312) at the intervention hospitals were surveyed; obstetricians, pediatricians, and psychiatrists were excluded from the survey. The results of the study demonstrated that the proportion of inappropriate admissions did not decrease significantly in any of the hospitals, but there were significant decreases in inappropriate continued stay in the intervention hospitals (p < 0.05). Both intervention and one of the control hospitals had lower 30-day readmission rates in the "after" period than in the "before" period (p < 0.05). Eighty-six percent believed that there had been no adverse impact on access to care and, although 25% thought the program may have led to premature discharge, this was not supported by the readmission data. PMID- 10142622 TI - The impact of relocating vasectomies from hospital outpatient departments to non hospital sites. AB - The objective of this study was to estimate the net dollar value of hospital resources that would be released if vasectomies currently performed in outpatient departments were performed in non-hospital sites. This article provides a descriptive analysis using administrative data for all non-hospital sites and all acute care institutions in Ontario performing vasectomies. It is based on 23,741 records of patients for whom a vasectomy was billed to the Ontario Health Insurance Plan (OHIP) in 1991-92. No substantial differences in the age distribution of patients were seen in non-hospital sites and those in hospital settings. About 75% of hospital outpatients received a local anesthetic that could have been administered in a non-hospital setting. Approximately $4.4 million in hospital resources would be released if 75% of all outpatient vasectomies were performed in non-hospital settings while OHIP billings would increase only by about $140,000. The demands on hospital funds available for patient activity could have been decreased by about $6.2 million, if this shift had occurred in 1991-92. Although opportunities exist in Ontario to release hospital resources by shifting vasectomies to non-hospital sites, current hospital and physician funding policies may represent a disincentive to shift activity away from institutional-based care. PMID- 10142623 TI - A stakeholder's communication approach for balancing hospital information systems investment priorities. AB - The Stakeholders Communication Approach is aimed at supporting the decision process in the choice of information systems (IS) applications at the start of a hospital IS planning cycle. It promotes discussion among senior management, key stakeholders, IS Department management, end users and the Accounting Department using specific tools and a negotiation process. The IS applications portfolio profile allows visualizing the hospital's strategic position and directions for development of IS. End users' responses to a questionnaire give a measure of "user functional value added" (UFVA) to inform management about the effectiveness and usefulness of the systems implemented. Stakeholders' evaluation of recently completed IS applications uses UFVA and cost, both separately and combined, along with assessment of strategic changes, to edify the priority-balancing process for deciding on investments in further IS applications. PMID- 10142624 TI - Locating community health care centres in rural Saskatchewan: the case of the Living Sky Health District. AB - Using the Living Sky Health District in rural Saskatchewan as a sample case, this paper illustrates and discusses the use of location theory modelling tools as an aid to achieving high levels of efficiency coupled with administrator-determined levels of access. The paper begins by examining access issues as they affect location decisions. One of the empirical pillars of the paper is the well documented idea that people will travel great distances in situations of acute circumstances, but are unwilling to travel far for important preventive care and monitoring of some chronic conditions. The study continues by presenting a non technical overview of location theory which demonstrates the applicability of location modelling to the present problem; several possible location scenarios for Living Sky Health District are calculated, the most appropriate of which will depend on the goals and priorities of the district board. Finally, the study's results and more general conclusions are presented and discussed. PMID- 10142625 TI - System uses quality principles to plan and build medical center. PMID- 10142626 TI - Mergers' missing link. PMID- 10142627 TI - Sitting smarter. PMID- 10142628 TI - Pest patrol. A guide to in-house integrated pest management. PMID- 10142629 TI - The comfort of courtyards. An outdoor spot for patient is a real breath of fresh air. PMID- 10142630 TI - To have (medical devices) or not: what's safer for patients? PMID- 10142631 TI - Linen awareness days educate staff, help cut costs. PMID- 10142632 TI - Who makes purchasing decisions for pipe/drains/sewer products and water treatment programs? PMID- 10142633 TI - Recycling jobs go to people society tends to push aside. PMID- 10142634 TI - Hospital capital equipment purchasing remains flat. PMID- 10142635 TI - Robots and tubes provide cheap labor for New Jersey hospital. PMID- 10142636 TI - Food floor stock costs can be tracked and controlled. PMID- 10142637 TI - Hospitals slash spending for capital projects, equipment. PMID- 10142638 TI - Incremental steps to reform. PMID- 10142639 TI - The influence model of sponsorship. A Catholic hospital is now part of the "Mayo Clinic". AB - Saint Marys Hospital was founded in Rochester, MN, in 1889. Constructed by the Sisters of St. Francis, it was staffed by physician members of the local Mayo family. The Mayo practice grew into an association of many physicians and medical residents who later began to staff Rochester Methodist Hospital also; the three healthcare institutions became collectively known as the "Mayo Clinic." By the mid-1980s, billing was so complex for the three still-independent facilities that their leaders decided to integrate more formally. This was done in three phases and resulted in the creation of a single institution known as the Mayo Medical Center. From Saint Marys' standpoint, the facilitating document in this process was a "Sponsorship Agreement" whose purpose was to maintain the sponsor's interests and obligations in the integrated structure. A Sponsorship Board was created to continue the hospital's Catholic tradition, including maintaining its chaplaincy, chapels, religious symbols, and special funds. The Sponsorship Board views the new environment as a special challenge. Its members know that Catholic sponsorship: Comforts patients, who realize they are in the hands of people motivated by the Christian ethic Creates an atmosphere in which patients and their families can seek the spiritual support that often aids healing Strengthens a sense of community among physicians, hospital staff, and administrators The Sponsorship Board hopes the sponsor's influence may come to affect the whole Mayo Medical Center, bringing patients, family members, and staff an "added dimension" of care. PMID- 10142640 TI - An educational response to assisted suicide. Catholic systems reach out to advance compassionate care of the dying. AB - The future of "The Oregon Death with Dignity Act" is uncertain since a preliminary injunction blocking the law's enactment has been granted. Still, three Catholic healthcare systems in the Pacific Northwest are quite clear about their commitment to providing optimal care to persons at the end of life. Bellevue, WA-based PeaceHealth; Seattle-based Sisters of Providence Health System; and Aston, PA-based Franciscan Health System have formed the Committee on Care of the Dying of the Franciscan, PeaceHealth, and Providence Health Systems. The three organizations have collaborated to develop and offer comprehensive educational outreach on compassionate care of the dying throughout Oregon. Twenty system representatives met in Portland, OR, in January 1995 and developed a vision statement, "Care at the End of Life." In addition, a steering committee of 12 representatives has identified the goals of the Committee on Care of the Dying. The steering committee has also identified seven "Organizational Commitments and Common Elements" to ensure quality and excellence in compassionate care of the dying. Recently, the Daughters of Charity National Health System, the Carondelet Health System, and the Catholic Health Association all based in St. Louis-have joined this collaborative effort to educate healthcare providers and the public. PMID- 10142641 TI - Inventing the future. Three leaders call on new skills for their growing strategic role. Interview by Judy Cassidy. PMID- 10142642 TI - Our essential journey. A Denver system decides to "grow" its own leadership. AB - Last year Provenant Health Partners (PHP), a Denver healthcare system, decided it would begin to "grow" new lay leaders. The idea was to allow PHP personnel to self-select themselves as potential leaders and to guide their development so their daily work would come to reflect the system's heritage and values. PHP is part of Sisters of Charity Health Care Systems (SCHCS), based in Cincinnati. As a foundation for its project, PHP had its senior and middle managers participate in SCHCS's Values in Leadership program, which increases leaders' awareness of their role as stewards of Jesus' healing ministry and encourages them to develop effective skills based on their sponsor's core values. PHP then formed an 11 person leadership development planning team representing its three hospitals and various system departments. The team drafted a plan which encourages PHP leaders and potential leaders to develop leadership skills with the aid of feedback from their colleagues. PHP is currently fine-tuning the plan in a pilot project. In addition to using the plan to develop leaders, the system is considering adapting it for use in employment screening, intraorganizational promotion, and the allocation of educational funds. PMID- 10142643 TI - A new vision of leadership. Deep spirituality moves leaders to effectively serve community. PMID- 10142644 TI - Collaborative focus. A system and its affiliates create their vision for healthy communities. AB - To help the system respond to changes in healthcare, managers of Hobart, IN-based Ancilla Systems, sponsored by the Poor Handmaids of Jesus Christ, formed the System Integration Team in 1993. Using the seven steps of the Quality Improvement Story, the team agreed on the reason for improvement: "Ancilla Systems is currently not positioned to provide the healthier communities that we envision in the twenty-first century." The team also noted, "Roles, responsibilities, and authority levels are not being effected in a coordinated manner." In August 1993, the team asked that each of its six affiliates develop its own vision statement by year's end. In a September meeting the System Integration Team defined the impediments to achieving a shared vision. The team designed countermeasures to address these impediments: (1) Communicate throughout all levels of the system to clarify roles, responsibilities, and authority levels; (2) Continue educating trustees and managers on healthcare trends, costs, and quality and on Ancilla's response to the changing environment; (3) Refrain from reviewing any governance structural changes until a system vision is finalized. In February 1994 the System Integration Team recommended a vision statement to the Ancilla Systems board of directors. The system vision, as well as affiliate visions, will serve as a basis for structure and role changes that are-and continue to be-necessary. PMID- 10142646 TI - Culturally diverse management teams. Mercy International sponsors project on Guam. AB - In 1989 Mercy International Health Services (MIHS) sent a team of advisers to help upgrade the skills of the managers of Guam Memorial Hospital. Their experience offers lessons for U.S. healthcare organizations as they become culturally diverse. The hospital had a number of problems, including high management turnover, troubles with financial resources, political interference, and a building that did not meet codes. The advisers also planned to prepare the hospital for an accreditation survey by the Joint Commission on Accreditation of Healthcare Organizations (JCAHO). MIHS, which has a growing presence in the Pacific, does not take charge of healthcare organizations. Instead, it trains local persons to assume leadership roles. At Guam Memorial Hospital, the MIHS advisers spent their first year assessing the organization and the various cultures represented on its staff. Then the advisers devoted three years to coaching and mentoring their Guamanian counterparts. The advisers learned that the hospital had basically been run by one person. It had no management team, either formal or informal. The advisers began their coaching by forming a management team in the dietary department. When the rest of the hospital staff saw that team perform successfully, they became willing to join similar teams themselves. Guam Memorial Hospital had changed by the time the MIHS advisers left the island in 1993. It has not yet been accredited, but it does have management teams working to meet JCAHO standards. The hospital also has in place a continuous quality improvement system, with more than three years of documentation. And the hospital building now conforms to codes. PMID- 10142645 TI - Safeguarding patients' dignity. The revised directives discuss spiritual and professional considerations. AB - The Catholic health ministry recognizes that caring for the spiritual nature of a person is a high priority. The rights of patients and residents in their relationship with care givers are also important. These topics are treated in Parts 2 and 3, respectively, of the Ethical and Religious Directives for Catholic Health Services. This article focuses on those directives. Directive 10 says pastoral care should be available to all persons in a Catholic healthcare facility, no matter their religious affiliation. Directives 12 to 20 are concerned with the reception of the sacraments of baptism, penance, anointing, and communion by Catholics. Directive 21 discusses the appointment of priests and deacons to the pastoral care staff. Directive 23 reminds care givers that respect for human dignity must inform all Catholic healthcare. Directives 24 and 25 discuss norms for responding to advance directives and the responsibilities of surrogates. Directives 26 to 28 are concerned with free and informed consent on the part of patients and surrogates. Directives 29 to 30 say care givers have a moral obligation to preserve a patient's anatomical and functional integrity. Directive 31 discusses the ethical limits on medical research, and Directive 33 discusses therapeutic procedures likely to harm the patient. Directive 34 says care givers must protect patients' privacy. Directive 36 discusses the care of women who have been raped, including treatment that would prevent ovulation as a result of the rape. Directive 37 says ethical consultation should be available to all Catholic facilities, usually through an ethics committee. PMID- 10142647 TI - Hospital challenges employees to choose health. PMID- 10142648 TI - What makes "Catholic" managed care Catholic? PMID- 10142649 TI - Gifts of healing. PMID- 10142650 TI - Trusts: dreams or nightmares? PMID- 10142651 TI - The role of marketing for GDPs (general dentist practitioners). AB - Dentists, while recognising the need to be more marketing orientated, still have some way to go to improve the perception of themselves and their services in the eyes of the public. Nigel Coates and John Willans suggest some ways to address the barriers to visiting dentists. PMID- 10142652 TI - Ah, c'mon ref! PMID- 10142653 TI - Managing for health gain. PMID- 10142654 TI - Designing for patients. AB - In February 1992, Health Services Management (HSM) readers were invited to submit details of a proposed project that needed a designer. HSM teamed up with design consultants, the PDI Group, which offered 10,000 pounds-worth of design and project management to the reader submitting the most challenging design problem. Such was the quality of the entrants that two prizes were awarded, divided equally between The Eric Burden Community Unit at Littlemore Hospital, Oxford, and the Perth Royal Infirmary Community Unit project. PMID- 10142655 TI - Management ... the working day of a health services manager. South West Regional Outpost. AB - With responsibility for 43 trusts and a national role in liaison and communication between the outposts and the NHSME, Roger Hoyle, Chief Executive of the South West Regional Outpost, can clock up 25,000 miles on the road in a year. The way outposts work with a light touch and empowering others is a model for the rest of the NSHS. PMID- 10142656 TI - Waiting lists. PMID- 10142657 TI - Participatory workplace literacy training in a hospital setting. AB - This qualitative case study of a workplace literacy program in a hospital setting provides a description and analysis of a continuum of educational services. The specific purposes of the study were to identify the benefits of working through an advisory committee, to explain the program planning processes that create a context for participatory learning, and to give examples of the support needed by an advisory committee. Special attention was paid to the participation of employees as students in the program. Implications for developing a participatory approach are discussed. PMID- 10142658 TI - Quality performance development for education: implementation of a plan. AB - Measuring or evaluating the impact of educational interventions has presented a challenge for the educator. Implementing a quality performance improvement (QPI) plan addressing education processes and outcomes provides an expansion and extension of QPI, as well as validates the pivotal and evolving role of the educator in measuring patient care outcome. This article describes an education based QPI plan using the 10-step process identified by the Joint Commission on Accreditation of Healthcare Organizations (JCAHO). A QPI study will clarify application of each step. PMID- 10142659 TI - Learning to 'live the values'. PMID- 10142660 TI - Ways to resolve conflicts within group practices. PMID- 10142661 TI - Doctor-friendly health reform. Interview by Stephen Murata. PMID- 10142662 TI - A surefire way to destroy your malpractice defense. PMID- 10142663 TI - Will PHOs have to answer to HMOs as well as state laws? PMID- 10142664 TI - Incentives that will energize your staff. PMID- 10142665 TI - How capitation is transforming hospitals--and their staffs. PMID- 10142666 TI - Tailoring your job to fit your lifestyle. PMID- 10142667 TI - Salaried or private practice? Some doctors have both. PMID- 10142668 TI - Class action suit attacks pathology billing. PMID- 10142669 TI - Jobs plentiful, but incentives and salary increases scarce. Part 1: Salary survey. PMID- 10142670 TI - Laboratorians speak out on benefits, managed care, and the bottom line. Part 2: Salary survey. PMID- 10142671 TI - Reengineering the laboratory. AB - Don't wait like a lamb for slaughter for reengineering consultants to arrive at your door. Take the bull by the horns and look for ways to increase your lab's productivity. PMID- 10142672 TI - Launching a DNA lab. Molecular pathology, Part 1. PMID- 10142673 TI - Bar coding in the microbiology lab. PMID- 10142674 TI - Promoting an awareness of retractions: the Louisiana State University Medical Center in Shreveport experience. AB - The current mission statement of the Medical Library Association states that it is "dedicated to improving health through professional excellence and leadership of its members in the ... provision of information services and educational programs ..." With this goal in mind, retractions offer medical librarians a professional challenge to become involved in the scientific process. Through results of a survey conducted among the consortium of South Central Academic Medical Libraries (SCAMeL), this paper reveals opinions on the importance of retraction awareness and who is responsible for disseminating this knowledge. The paper also reports what the Louisiana State University Medical Center at Shreveport Library and other SCAMeL member libraries are doing to promote awareness. PMID- 10142675 TI - Reconciling rising serials costs, the serials budget, and reference needs in a medical library serials retrenchment program: a methodology. AB - Devising a coherent serials retrenchment plan while maintaining quality reference service is a dilemma faced by increasing numbers of medical librarians. In 1991, the staff of the Shiffman Medical Library, Wayne State University, began to address increasing serials budget reductions that by 1994 amounted to a projected 20% maximum cut. The resulting retrenchment plan combined an ongoing serials use study, faculty and librarian reviews of cancellation lists, and systematic refinements in interlibrary cooperation and document delivery service. The Shiffman plan provides a constructive framework that can be adapted to other medical libraries facing immediate, major serials retrenchment. PMID- 10142676 TI - The basics of searching NLM's AIDS databases: Part two. PMID- 10142677 TI - The virtual library, information visions and WHCLIS (White House Conference on Library and Information Services). AB - Why should librarians, including those in hospitals and corporations, build virtual libraries and create information visions? This question is explored in relation to the three themes of the 1991 White House Conference on Library and Information Services-Democracy, Productivity, and Literacy. PMID- 10142679 TI - Exemption law repeal sparks filing flurry. PMID- 10142678 TI - Expanding rural primary care training by employing information technologies: the need for participation by medical reference librarians. AB - The use of rural sites to train badly needed primary care providers requires access to sophisticated medical information not traditionally available outside of academic health centers. Medical reference librarians can play a key role in the development of primary care training sites in rural settings. Electronic information technologies, with proactive support from medical reference librarians, can provide current and detailed information without concern for distance from the health science center library. This paper discusses recent developments in technology, describes current challenges to the application of this technology in rural settings, and provides policy recommendations for medical reference librarians to enhance rural primary care training. PMID- 10142680 TI - Charitable giving climbs again in '94. PMID- 10142681 TI - Hospital chain, university get IRS approval for deal. PMID- 10142682 TI - Hospitals sue malpractice insurer. PMID- 10142683 TI - Deaths prompt HCFA probe at Denver hospital. PMID- 10142684 TI - Newborns should stay put--docs. PMID- 10142685 TI - Western Catholic systems merge into 24-hospital, 8,000-physician network. PMID- 10142686 TI - GAO: expansion could add to Medi-Cal's woes. PMID- 10142687 TI - Failed talks with key hospital jeopardize firms' merger plans. PMID- 10142688 TI - Kaiser vies for market share with new products. PMID- 10142689 TI - International deals take opposite routes. PMID- 10142690 TI - Senate defeats attempts to pare health cutbacks. PMID- 10142691 TI - Catholic system drops local board members. PMID- 10142692 TI - Nellcor gains strength via Puritan-Bennett deal. PMID- 10142693 TI - Medicaid cuts fuel state conflicts. PMID- 10142694 TI - Workers strike back. AB - Frustrated by layoffs and new rules, healthcare workers are striking back. Nurses, such as those rallying in Seattle, are leading the charge. Interest in unions is rising. Specifically, unions have made inroads in efforts to organize nursing home workers, p. 28. PMID- 10142695 TI - Provider companies lead profit growth during first quarter. PMID- 10142696 TI - System hospitals earn high JCAHO marks. PMID- 10142697 TI - Dealmaking lands some execs hefty bonuses. PMID- 10142698 TI - Pa. task force urges five-county network. PMID- 10142699 TI - Columbia makes deal to buy Va. hospital. PMID- 10142700 TI - Fla. hospital close to choosing offer. PMID- 10142701 TI - HMA reaches further into rural markets. PMID- 10142702 TI - Pentagon urged to expand managed-care program. PMID- 10142703 TI - VA revamp emphasizes move to outpatient care. PMID- 10142704 TI - AHA announces plans to revamp field operations. PMID- 10142705 TI - AHA begins survey on performance of Joint Commission. PMID- 10142706 TI - Fla. hospital finds way to team with Columbia. PMID- 10142707 TI - Charlotte, N.C., merger to take place this week. PMID- 10142708 TI - Mich. merger plan includes price freeze. PMID- 10142709 TI - Would-be joint-venture partners just can't agree. PMID- 10142710 TI - Missouri hospitals join forces. PMID- 10142711 TI - CHA membership to vote on requiring not-for-profit status. PMID- 10142712 TI - AHA to drop controversial closure report. PMID- 10142713 TI - GOP counterattacks AHA Medicare ads. PMID- 10142714 TI - California mulls bill to regulate conversions to for-profit status. PMID- 10142715 TI - Delayed breast cancer diagnoses leading cause of lawsuits--study. PMID- 10142716 TI - Physicians are providing more charity care, but 32% do none, AMA survey finds. PMID- 10142717 TI - Graduates look beyond hospital administration. PMID- 10142718 TI - Phone inquiries less revealing than mail-back surveys--study. PMID- 10142719 TI - Colo. data will add to debate on number of heart programs. PMID- 10142720 TI - Medicaid plan could trim Medicare. PMID- 10142721 TI - Strengths of VA grow with system changes. PMID- 10142722 TI - HCFA proposes 20% rise in capital rates. PMID- 10142723 TI - Feds come knocking in search of home-care fraud. AB - Home care has become a target for federal investigators looking for ways to reduce the amount of money Medicare doles out to fraudulent providers. Companies and executives in the multibillion-dollar industry are facing charges ranging from filing bogus claims to money laundering. PMID- 10142724 TI - AIDS/HIV care proving costly for hospitals. PMID- 10142725 TI - Data reveal that healthcare inflation still rages. PMID- 10142726 TI - Managed care cuts costs, mortality--study. PMID- 10142727 TI - Drug inflation exaggerated--GAO. PMID- 10142728 TI - GOP plan would bundle hospital, post-acute care. PMID- 10142729 TI - Docs ask for equalized Medicare fees. PMID- 10142730 TI - Study: strict rules driving device industry abroad. PMID- 10142731 TI - Chicago CHIN, vendors sign pact. PMID- 10142732 TI - Most Missouri hospitals likely to participate in voluntary disclosure plan. PMID- 10142734 TI - Columbia to consolidate four hospitals' services. PMID- 10142733 TI - Catholic network, university medical center to study link. Mission Health and University of Michigan Hospitals. PMID- 10142735 TI - Clinton's first veto blocks $50 million in VA reductions. PMID- 10142736 TI - N.C. lawmakers may offer rescue for hospital deal. PMID- 10142737 TI - State legislatures enter debate on mom, newborn hospital stays. PMID- 10142738 TI - Ind. establishes tax-exemption test. PMID- 10142739 TI - Cuts may fuel Medicaid MSAs (medical savings accounts) PMID- 10142740 TI - AHA finds middle ground narrowing. PMID- 10142741 TI - Mantle's transplant raises questions. PMID- 10142742 TI - Conn. PHO faces antitrust investigation. PMID- 10142743 TI - Disease management faces obstacles. AB - Health plans and providers are encountering many obstacles in their attempts to manage disease. Among them are patients' refusal to follow doctors' instructions, and the costliness and complexity of information systems that could help resolve treatment questions. PMID- 10142744 TI - Distributors, suppliers strive for efficiency with partnerships. PMID- 10142745 TI - Rural referral centers fighting to retain special reimbursement. PMID- 10142746 TI - Grace receives another offer for National Medical. PMID- 10142747 TI - HMOs, providers at odds over Texas bill. PMID- 10142748 TI - Louisiana needs new plan to bail out Medicaid program. PMID- 10142750 TI - The Medicare fight and the budget war. PMID- 10142749 TI - RCPs (respiratory care practitioners) and health-care reform: demonstrating value, creating opportunity. AB - We should embrace respiratory care protocols. We have had a system in our hospital for more than two years; it has been very successful. We have approximately 60-70% of all of our therapy now ordered by a true protocol process. Some people have been dragged kicking and screaming through this process, including a number of respiratory care practitioners. It is more work. It is harder. Yes, it takes more time and more work to be a professional, but a professional is what you want to be. Anybody can go around and stick those nebulizers in people's mouths, but not everyone has the skill to determine which patients do not need that nebulizer or which may need a different drug or a different therapy. We must demonstrate through projects our ability to have an impact on the delivery of unnecessary and inappropriate care, and we must have physician support for what we are doing. These elements are essential to our survival. When we embrace appropriate and effective technology, we demonstrate value. If we show--through improved weaning technology--that we can decrease length of stay by decreasing the time that people are on ventilators, we demonstrate value. If we function as effective bronchoscopy assistants who help to treat people and get them out of the hospital or avoid hospitalization entirely, we demonstrate value. So, we must embrace technology. We need to function across the entire continuum of care to demonstrate value. We need to start managing health instead of managing illness.(ABSTRACT TRUNCATED AT 250 WORDS) PMID- 10142751 TI - The professional relationship: ethics. PMID- 10142752 TI - Invasive procedures on newly deceased examined with an ethical eye. AB - Death is a hot topic. Books on death are making the best-seller lists and their authors are on speaker circuits, TV talk shows, and at book-signing parties. No longer a taboo topic in polite conversation, our society has become voyeuristic and hell-bent on unmasking death. At the Brooklyn Academy, for example, a dance/theater troupe is performing choreographer Bill T. Jones's "Still/Here," which incorporates videotaped segments of real people who are terminally ill and talk about it. Given the nation's preoccupation with death and dying, it should come as no surprise that the issue of how the newly deceased are treated within health care institutions has become a current topic in the literature, as the following articles show. PMID- 10142753 TI - One hospital's attempt to create an institutional code of ethics. AB - Chaplain Linda Smith-Criddle, chair of the ethics committee at Riverside Hospital, Toledo, OH, was kind enough to share with the readers of Hospital Ethics the committee's final (sixth!) draft of a code of ethics [that it would hope will be adopted in toto] by the Hospital Medical Staff and Board of Trustees. With the committee's permission, the entire document is reprinted here, and we invite readers to review and critique the policy and to send any comments or suggestions to either Hospital Ethics or directly to Chaplain Smith-Criddle at Riverside Hospital, 1600 North Superior Street, Toledo, OH 43604. PMID- 10142754 TI - Health care executives examine moral responsibilities underlying public trust. PMID- 10142755 TI - Insulating ethical policymaking from politics: three views. AB - Above politics and beyond the law. That is what those in the field of health care ethics expect of their field, at least in the United States. We differentiate between what the law allows and what ethics expects, and we go to great lengths to champion the protection of ethical decision making from political influence and to preserve individual autonomy, personal integrity, and self-determination in the face of social pressure. We like the "supreme court" model as a structure to ensure autonomous decision making when it comes to ethical situations and deliberations. This view is consistent across organizational levels--from individual membership groups, to national commissions, to international bodies, but it is not easy to achieve, as the following articles show. PMID- 10142756 TI - How managed care forces change the patient-physician relationship. PMID- 10142757 TI - Measuring the economic value of HMOs. AB - The economic efficiency of HMOs varies dramatically, affected by such factors as market share, provider contracting agreements and utilization management techniques. Employers that establish HMO strategies without conducting quantitative assessments may incur unnecessary costs. A combination of both quantitative and qualitative analyses can lead employers to a best practice system of health care. PMID- 10142758 TI - Pitney Bowes: using comprehensive cost information to build provider networks. AB - Wishing to develop a work partnership with a managed care organization, Pitney Bowes decided to select its own network providers. The company reached out to the medical community for input and participation in crafting both a clinical and a business partnership that would set new standards for health care delivery in the country. A methodology--described here--was developed for comparing medical plans and selecting providers. PMID- 10142759 TI - Managed care operations and plan design. AB - Plan design has come a long way from the days when all one had to do was figure out the right deductible, coinsurance and out-of-pocket amounts and consider some questions about competitive practice and employee perception. Today one must also consider systems capabilities, strategic fit, provider requirements and consistency of the logic supporting each payment decision. PMID- 10142760 TI - Assessing health plan quality. AB - Health plan accreditation and report cards represent the beginning of a rapidly evolving information flow that impacts all stakeholders within the health care system. By understanding what information is available--and its limitations- stakeholders can work together to promote improved health plan quality. PMID- 10142761 TI - Access to services: what are the real needs? AB - Adequate accessibility to managed care services is typically a key determining factor when an employer decides to implement a managed care plan. And although it can be difficult for an employer to determine what constitutes adequate accessibility, it is necessary in order for managed care utilization and associated cost savings to be maximized. PMID- 10142762 TI - The customer satisfaction factor: the value of conducting employee evaluations of managed care networks. AB - Gathering customer satisfaction information is an idea whose time has come. Employers conducting employee evaluations of their managed care networks find the data valuable from both a strategic and a tactical standpoint. The thoughtful, intelligent use of such data can lead to more effective health care management. PMID- 10142763 TI - Integrated health care management through comprehensive information systems. AB - The true impact of a company's benefit strategy can be known only when relevant indicators can be adequately tracked, evaluated and brought together. An unparalleled opportunity exists to creatively apply computer technologies to address decision makers' needs for integrated health care information. PMID- 10142764 TI - Developing a health care strategy: a results-based approach. AB - In today's corporate environment, health care managers will be evaluated on performance--and forward-thinking companies are already quantifying their health care success. How this performance is defined and measured will differ from company to company, but shaping the definition and aligning it with the overall business strategy ensures success. PMID- 10142765 TI - Measuring the savings from managed care: experience at Citibank. AB - In a leap of faith, Citibank in 1989 designed a point-of-service plan aimed at containing health care costs in the long term without sacrificing quality of care. In 1994 a study was undertaken to empirically evaluate whether these goals had been achieved. The study supported Citibank's overall managed care strategy, providing objective, quantifiable data that can lead to greater efficiencies. PMID- 10142766 TI - Rolling budgets and variance reports. PMID- 10142767 TI - Allocating the cost of fringe benefits. PMID- 10142768 TI - How long is the long run? PMID- 10142769 TI - Principles and power in the health care arena: reflections on the Canadian experience. PMID- 10142770 TI - Legal issues arising out of medical provision for ethnic groups. PMID- 10142771 TI - Distributing health care: rationing and the role of the physician in the United Kingdom National Health Service. PMID- 10142772 TI - A right to health care?: A comparative perspective. PMID- 10142773 TI - Women's health at a crossroad: global responses to HIV/AIDS. PMID- 10142774 TI - Economic credentialing: your money or your life! AB - The economic overhaul of health care in America is restructuring the business of medicine, and with it the relationship between physician and patient. Previously accustomed to thinking primarily about the best interests of each patient, the physician now finds this traditional loyalty in conflict with competing concerns, including those of government, business, and insurers who watch with alarm the relentless rise in their health care expenditures. And there are competing interests of hospitals, health maintenance organizations, and other provider institutions who find their survival threatened by high-powered competition and increasingly stringent resource limits, and interests of other physicians and their patients whose health needs compete for limited health care dollars. PMID- 10142775 TI - Using management information systems to enhance health care quality assurance. AB - Examines how computers and quality assurance are being used to improve the quality of health care delivery. Traditional quality assurance methods have been limited in their ability to effectively manage the high volume of data generated by the health care process. Computers on the other hand are able to handle large volumes of data as well as monitor patient care activities in both the acute care and ambulatory care settings. Discusses the use of computers to collect and analyse patient data so that changes and problems can be identified. In addition, computer models for reminding physicians to order appropriate preventive health measures for their patients are presented. Concludes that the use of computers to augment quality improvement is essential if the quality of patient care and health promotion are to be improved. PMID- 10142776 TI - Commissioning community health care: missing the point. AB - Discusses commissioning community health care and the fact that present mechanisms do not enable commissioning to meet the needs of patients requiring community care relevant to their needs. The focus on efficiency, money and simple activity does not take into account the complex nature of community care and the need to take a variety of factors into account if commissioning is to be effective. PMID- 10142777 TI - From purchasing to commissioning: fact or fantasy? PMID- 10142778 TI - Information management and technology in England's large acute NHS hospitals. National strategy versus local reality. AB - Discusses the NHS Executive's information management and technology (IM&T) strategy and its relationship to the 1991 reforms. Examines the recommendation for large acute hospitals to adopt integrated hospital information support systems (HISS). Reports that a recent census of these hospitals, undertaken by the authors, suggests that the implementation of the strategy's recommendations has been slow at the local level. Attempts to diagnose the factors that are impeding implementation, using the evidence provided by the census. Identifies four main problem areas: the lack of success of past IM&T initiatives undermines confidence in the current strategy; the strategy is poorly aligned with other policy initiatives; the legacy of discrete, proprietary information systems within hospitals makes the creation of an integrative information environment difficult to accomplish without massive investment in new systems; and there are implicit contradictions between the following: the absence of a comprehensive post-implementation evaluation of the economic, technological and cultural feasibility of HISS at any of the three HISS pilot sites; the strategy's advocacy of HISS as the way forward for large acute hospitals; the requirement for a comprehensive business case to support any substantial investment in IM&T. Concludes that a massive rethink of policy is required, with a much greater emphasis on research, development and independent evaluation. PMID- 10142779 TI - We all need a good wife to support us. AB - A survey of 890 appointment committee members undertaken in South Thames (West) Regional Health Authority showed that women doctors are less likely to apply for posts in hospital medicine, although if they do apply they stand a better chance of getting appointed. Male respondents perceived role conflict in combining professional and family demands, child-care arrangements and career breaks to be the main barriers facing female hospital doctors. In contrast female doctors considered organizational culture, career structure and working practices to be the main barriers. Candidates, particularly female candidates, are still being asked questions about their plans to have a family and ability to combine family and professional demands. There is a need to ensure the culture, attitudes and organizational practices within the medical profession are changed if there is to be equity of opportunity and effective use of resources in the future. PMID- 10142780 TI - The organization, delivery and audit of a specialist immunization clinic. AB - Immunization is a key primary prevention activity which has assisted in the reduction of childhood morbidity and premature mortality. Uptake rates for two year-old children are now in excess of 90 per cent throughout the UK and for the vast majority of infants immunization is a routine procedure with a high benefit to-risk ratio. Concerns about particular children, either because of their previous medical history or an adverse vaccine event, have been responded to in various ways. The experiences of a specialist immunization facility established in 1987, which since inception has seen just over 3,000 children are described. The clinic operates four sessions a week, with two held in the District General Hospital and two in community clinics; the resource requirements for the clinic are identified. A parent satisfaction survey for the first 1,700 attenders was undertaken in 1992 and the results are reported; their comments led to changes in the method of service delivery. A study of GPs' views was also undertaken at the same time; their satisfaction with the service is reflected in the continuing level of referrals, It is believed that all provider units should consider developing a similar facility for five reasons. First, it provides a source of expert advice for both professionals and parents; second, it facilitates the immunization of children with problem histories; third, it enables the investigation of serious post-vaccination adverse events; and fourth, the clinic provides a means of co-ordinating and delivering neonatal immunizations (including BCG, HBV, Varicella zoster and the vaccination of pre-term infants). And finally the clinic offers training for health care staff involved in primary immunization programmes and travel vaccination services. PMID- 10142781 TI - Service quality in NHS hospitals. AB - Discusses the utilization of an instrument--SERVQUAL--as a means of assessing patient satisfaction with service quality. Patients treated (174) for a variety of health problems in a number of departments completed the SERVQUAL questionnaire. There is a dearth of knowledge in this important field and the authors note that the results indicate the need for improvement in service quality as identified by the study population. PMID- 10142782 TI - The effect of financial incentives on physicians' behaviour in health maintenance organizations. AB - Examines the relationship between the presence of financial incentives and their effect on physician behavior in health maintenance organizations (HMOs). By reviewing the scope and dimensions of both HMOs and financial incentives, a foundation is laid for the review of the current empirical evidence. Further analysis and conceptual development is given to this topic by stating the limitations of existing research--in the confounding variables, in the complexity of incentives, and in the unanswered questions of quality of care--and by proposing innovative ways of studying the ?other aspects of physician behavior' not previously considered. Questions and implications are raised for future research and practice. PMID- 10142783 TI - Using quality for daily work in ambulatory care settings. AB - How do we improve the delivery of quality health care? How do we continue to motivate and recognize employees who see layoffs, downsizing, reengineering, and cutbacks? Do we continue to work with obsolete systems in the same top-down management staffs used for the last 100 years? The answer is no. The answer is total quality management, continuous quality improvement, and process improvement, but with a new twist--activity-based resourcing. PMID- 10142784 TI - Providers and reviewers teach informed managed care. AB - Two utilization review case studies are summarized, with discussion of both the provider's and the reviewer's perspective. This interface between managed care organizations and behavioral health care professionals offers some instructive guidelines on how to best approach the utilization review process. PMID- 10142785 TI - Health economics in drug therapy management. PMID- 10142786 TI - The military health services system model for pharmacoeconomic decision making. AB - Pharmaceutical expenditures have been increasing over the last few decades, both in the private sector and the Department of Defense (DoD). The Pharmacoeconomic Center (PEC), staffed with personnel from the Army, Navy, and Air Force, was established in 1993 to develop the means to control these pharmaceutical expenditures and to develop the DoD TriService Formulary (TSF). The TSF serves as the basis for a consistent and equitable pharmacy benefit for DoD patients. The initial TSF contains medications that are well accepted as standard therapy and are currently available at most military facilities. Revisions to the initial TSF are based on pharmacoeconomic analyses of ambulatory disease states accounting for the majority of pharmaceutical expenditures. The PEC also develops treatment guidelines, preferred drug lists, and drug use evaluation criteria based on the results of each disease state analysis. PMID- 10142787 TI - The electronic patient record system: the journey begins now. AB - The movement toward an electronic patient record parallels our efforts to increase the efficiency and the effectiveness of our health care delivery system. In the final article in our continuing series on the computerized, patient-based medical record, the author explains the evolutionary time line toward reaching this goal. PMID- 10142788 TI - Strategic and financial considerations for integrated health care delivery. AB - The author predicts that most providers will realize that the benefits of integrated health care delivery, which include lower overhead costs, increased marketshare, and secure income, are well worth the change toward market principles. He outlines some of the strategic and financial factors that should be considered when setting up an integrated health care delivery system. PMID- 10142789 TI - Updated analysis of unnecessary inpatient procedures. PMID- 10142790 TI - The cost of care and the quality of care in the management of hypertension. PMID- 10142791 TI - Including alternative providers in managed care--managing the malpractice risk: Part 1. PMID- 10142792 TI - Disease management: linking clinical and pharmacy data. PMID- 10142793 TI - PeaceHealth's Marsha George drives down costs. Interview by Damon Braly. PMID- 10142794 TI - The network is the solution. AB - Although the U.S. healthcare system has at its disposal some of the best technology in the world, information systems from the 1970s are still used in many cases. Pacific Bell's William Halverson analyzes the slow adoption of information technology in the healthcare industry. PMID- 10142795 TI - Client/server: where are we really? PMID- 10142797 TI - EDI companies to watch. PMID- 10142796 TI - Client/server hotlist. PMID- 10142798 TI - HotList. Electronic claims/EDI products and services. PMID- 10142799 TI - HR departments lose cost-center status. PMID- 10142800 TI - Severity adjustment reimbursement. PMID- 10142801 TI - Association of Health Care Information and Medical Records Officers. Disclosure of information. Guidelines No. 2. PMID- 10142802 TI - ICD-10: making the changeover from ICD-9, in April 1995. PMID- 10142803 TI - "National ID systems demand proper safeguards". Data Protection Registrar advocates debate. PMID- 10142804 TI - Federally Supported Health Centers Assistance Act of 1992--PHS. Final rule. AB - The Secretary of Health and Human Services (the "Secretary"), in consultation with the Attorney General, issues the following rules under the "Federally Supported Health Centers Assistance Act of 1992." The Act provides for liability protection for certain health care professionals and entities. This rules sets forth information whereby an entity or a person can determine when, and the extent to which, it is likely to be protected under the Act. PMID- 10142805 TI - Medicare program; clarification of resumption of entitlement rules for Medicare patients with end-stage renal disease (ESRD)--HCFA. Final rule. AB - In this final rule, we clarify the terms of Medicare entitlement when an individual resumes a regular course of renal dialysis treatment or receives a kidney transplant after a previous course of treatment has been terminated (with or without a transplant) and add the same considerations for those who have a second transplant or begin dialysis after a previous transplant. We also respond to comments on a proposal to revise the definition of ESRD for the purpose of qualifying for Medicare. These revisions are necessary so that beneficiaries, providers, suppliers, and other insurers can determine with certainty when Medicare coverage begins and ends. Beneficiaries rely on this information to make informed decisions whether or not to enroll or re-enroll in the Medicare Supplementary Medical Insurance Program (part B). PMID- 10142806 TI - Arbitration gains favor as a way to cut legal costs. PMID- 10142807 TI - When measuring quality doesn't make sense. PMID- 10142808 TI - Searching for the elusive quality measuring stick. PMID- 10142809 TI - Coming to a state near you: report card battles. PMID- 10142810 TI - Blues no longer health care's back seat driver. PMID- 10142811 TI - Alliances may open door to cheaper long term care. PMID- 10142812 TI - Unleashing the health care border guards. AB - A fervent anti-immigrant sentiment is picking up momentum, and it is reflected in state and federal legislative proposals, including those addressing health reform. If these bills become law, including a California initiative, doctors and nurses could be turned into border patrol guards, and as many as one million legal immigrants could be denied non-emergency medical care. PMID- 10142813 TI - Dead on or dead wrong. AB - Public agencies, lobbying groups, and the press are relying on hospital mortality data to rank who's the best and who's the worst. Do these report cards mislead, or are they providing helpful information? PMID- 10142814 TI - First, do no harm. Second, turn a profit. AB - In the past, a good bedside manner and nimble fingers were characteristics of a good doc. But in these cost cutting, profit-motivated days, hospital and health plans are now looking for physicians who can boost the bottom line. It's called "economic credentialing." Medical groups don't like it, and they're suing. PMID- 10142815 TI - Improving the state of reform. AB - If health reform is going to work, lawmakers need to recognize that states will play a central role in reforming the health system. In doing so, reformers must address the varying health systems and stop viewing complex solutions as a poor choice. To ignore these facts is to dim the future prospects for reforming the nation's health care system. PMID- 10142816 TI - Will antitrust cops bust billion-dollar drug deals? PMID- 10142817 TI - Redirecting, not reinventing, Medicaid. PMID- 10142818 TI - Chronically ill clash with managed care's cost controls. PMID- 10142819 TI - No strings attached! AB - Many governors want to convert medicaid to a block grant and do away with the myriad federal rules that have vastly expanded the program's reach in recent years. Congress may oblige them. But groups that fought for the rules aren't going to sit still. PMID- 10142820 TI - Case study. Group Health Association: can Humana resuscitate the moribund HMO? AB - HMO pioneer Group Health Association of Washington, DC, was hemorrhaging members and dollars when Humana bought it in 1994. Its turnaround strategies run the gamut from outsourcing and devising administrative efficiencies to creating a new physician group and network to replace a feisty, unionized medical staff. PMID- 10142821 TI - Thinking of boards as families. AB - As hospitals forge new strategic partnerships, the question of "what to do about the board" is always prominent. But before hospital boards can look at governance roles, composition, and structure in integrated mechanisms, many need to take a hard look at themselves, writes long-time board observer John Witt. In this perspective, he argues that many boards act like dysfunctional families: They appear normal and even successful until a crisis occurs to reveal underlying malfunctions. Both families and boards can help themselves by working on who they function as a group, he says. PMID- 10142822 TI - Key strategic measures for system leaders. AB - How do integrated leaders know if they're on the right track? By forsaking old measures such as hospital occupancy and market share and refocusing on covered lives, PMPM costs, and other measures that reflect the system's vision and strategy. We offer some examples. PMID- 10142823 TI - Educating physicians in managed care. AB - Mullikin Medical Centers, Fallon Clinic, Henry Ford Health System, and other advanced integrated systems have added a new dimension to continuing medical education. They're training physicians in capitation, referral management, practice guidelines, and other basic skills of a managed care practice. Learn why they do it--and how. PMID- 10142824 TI - What is resource management? AB - Healthcare is changing rapidly. One of the most significant changes is the way that modern society views healthcare. In response to public demand for high quality care at low cost, providers have to take a broader, more encompassing view of the total cost of patient care. Resource management is emerging as the discipline to integrate the healthcare delivery process. Resources comprise time, money, people, facilities, equipment, information, pharmaceuticals, and fixed assets. The central question for every healthcare provider is: "How can I optimize resources to maximize patient wellness?" PMID- 10142825 TI - Regionalization: Canadian-style integrated networks. A case study. AB - Developing a successful integrated network requires senior management to scrutinize and apportion available resources--technologies, beds, personnel and so forth--on a regional basis. Regionalization--the Canadian version of integrated networks--increasingly came to be seen as the answer that would work, and in New Brunswick the broadest efforts have been made. Fifty-one hospital and health center boards across the province were dissolved, and health services in the province were apportioned into seven regional hospital corporations, with an eighth encompassing the entire province. At Region 3 Hospital Corporation, a strategic planning exercise helped management identify resources. New information systems were put in place to provide resource utilization information for designating facilities for the level of care they would provide, as well as to provide feedback to physicians and develop critical pathways. Support services were consolidated. Budget reductions caused the curtailment of new service plans, but also increased cooperation among clinicians and non-clinical managers. Layoffs created worker bumping throughout the system to accommodate union seniority rules. Nearly three years into regionalization, most people in New Brunswick say they are satisfied with the healthcare they receive. PMID- 10142826 TI - Information systems' key role in healthcare change. AB - Crisis in the US healthcare system, resulting from escalating costs and a large number of uninsured citizens, has caused industry-wide change. Joint ventures and alliances are being forged, and Integrated Healthcare Delivery Systems (IHDS) and Community Health Information Networks (CHINs) are forming. The evolving healthcare delivery system requires shifts in information systems, technology, and resources. New demands on information systems and networking infrastructures to support data exchange between multiple entities will be critical for survival and success. PMID- 10142827 TI - Planning: technology re-engineering. PMID- 10142828 TI - Healthcare reform becomes healthcare revision. PMID- 10142829 TI - Integrated information systems: tools for affiliation. AB - The development of healthcare information systems as tools to facilitate business success traditionally has focused on a single profit center. The cataclysmic changes that are reshaping American healthcare have accelerated the affiliation of provider entities to form systems that have broader geographic coverage, deliver a larger portion of the provider continuum of care, and are more attractive partners for purchasers of healthcare services. Integrated and/or standardized information system technologies can provide great benefit in containing costs and optimizing quality among partners resulting from healthcare mergers and acquisitions as the new entity positions itself to increase market share and enhance its bottom line. Graduate Health System (GHS) in the Philadelphia area has demonstrated the efficacy of its investment to build a system-wide information network that delivers multiple standardized, integrated systems for both the financial and operational advantage of all component institutions. Building on its patient information system as the centerpiece of its information strategy, GHS has deployed a variety of tools across its network infrastructure that have brought new capabilities and savings to its member hospitals. In light of some of GHS's successes, other hospitals and healthcare systems may be able to re-create similar savings and efficiencies by applying like strategies in cooperation with their affiliated partners. PMID- 10142830 TI - Networking services to reach rural outpatients. AB - The outreach program Marquette General Hospital (Marquette, MI) set up provides rural residents with healthcare services close to home. To create the comprehensive network of healthcare services required establishing outlying clinics with facilities and equipment for visiting specialists and sophisticated, yet cost-effective, laboratory testing instruments. The administrators at Marquette General decided an in-house lab at Marquette Medical Clinic would be convenient for patients as well as physicians. In the future, this lab will be linked to a communications system that encompasses the hospital and all Marquette clinic labs. PMID- 10142831 TI - Hand-held computers. AB - Changes in healthcare delivery, such as patient-focused, point-of-service care, demand that data be entered and accessed at the site where the patient is located (bedside, ER, home, ambulance). But this is not possible without some type of portable information system. The first step to bring information to the patient's side was through the use of bedside computers, but this delivery method has received limited acceptance. At present, some hospitals have begun to use hand held computers that follow the healthcare clinician, not the patient. Why? Fewer terminals are needed. Handhelds have become easier to use with intuitive graphical user interfaces. As the size of computers has decreased, so has the cost. Personal-sized assistants come in many formats, using proprietary or off the shelf software, or bar code attachments, and with various ports for card or cable access. Most people are becoming computer literate, adapting to downloading, recharging, inserting, and pen/keystroking. PMID- 10142832 TI - Consolidating technology: keep, move, surplus, or buy. PMID- 10142833 TI - Evading the third rail: Congress and the federal budget. PMID- 10142834 TI - Providers muscle in on rehab. PMID- 10142835 TI - Clearing the air. Many facilities are voluntarily adopting policies that snuff out secondhand smoke. AB - Faced with the need to prevent fires and protect nonsmokers from secondhand smoke -and, in some cases, to obey state or local anti-smoking laws--a growing number of administrators are restricting the use of cigarettes in their facilities. The trickiest part? Honoring the rights of residents who smoke. PMID- 10142836 TI - Battle-weary generals fight on. Our annual DON survey tracks trends in salaries and satisfaction. AB - There may be a revolution raging in long term care, but directors of nursing are doing all they can just to hold their ground. Contemporary Long Term Care's annual DON salary survey finds directors of nursing soldiering on despite a shortage of money, time, and motivated staff--and despite salaries that are, on the average, slightly lower than last year's. PMID- 10142837 TI - Do we need minimum nurse staffing levels? PMID- 10142838 TI - The challenge of end-of-life decisions. PMID- 10142839 TI - Are old-school administrators extinct? PMID- 10142840 TI - Incorporation of pharmaceutical care into a hospital residency rotation. PMID- 10142841 TI - Evaluation of a patient education program for solid organ transplant patients. AB - Medication counselling of transplant patients plays a major role in the outcome of the transplant. The medication counselling program at Vancouver Hospital and Health Sciences Centre for Solid Organ Transplant (SOT) patients consists of verbal counselling by a pharmacist, provision of medication teaching sheets, and patient participation in the self-medication program. The objectives of this study were to evaluate the effectiveness of the medication counselling program for SOT patients and to develop a series of tests to serve as a teaching tool. Solid organ transplant patients who were English speaking and tolerated oral medications were enrolled in the study. A prospective evaluation of the medication counselling program was done through a series of identical tests. Percent scores were calculated for each test, and pre-test scores (scores prior to counselling) were compared to post-test scores (scores after counselling). Twenty-eight SOT patients participated in the study. Patients scored an average of 25% on the pre-test prior to the counselling session and 66% on the post-test at the time of discharge. When scores on specific questions were compared, patients did well on drug identification, dosage and indications, but poorly on questions regarding side effects. Patient counselling improves medication knowledge in SOT patients as indicated by an increase in test scores. The combination of repeated counselling sessions and the participation in the self medication program reinforces medication knowledge and maximizes retention of knowledge. PMID- 10142842 TI - Development of a comprehensive clinical pharmacy workload documentation system. AB - The purpose of this project was to develop a workload documentation system which captures the clinical activities of the pharmacist, as well as the pharmacist's impact on the patient's drug therapy outcomes and costs. The documentation system consists of three sections: clinical activities, clinical effectiveness indicators, and cost-effectiveness indicators. In addition to those established by the National Hospital Productivity Improvement Program-Pharmacy Workload Measurement System, other indicators are incorporated to more accurately reflect the pharmacists' daily clinical activities. Clinical effectiveness indicators of patient outcomes include the number and type of drug-related problems identified and resolved and the number of therapeutic interventions made and accepted. Cost effectiveness is measured by pharmacists' interventions on 14 focused areas of drug therapy. Compliance with daily documentation is facilitated by use of pocket sized cards for data collection and retrieval. This documentation system has been implemented since December 1990. Quarterly reports submitted to the Director identify changes and trends in workload. Information is used for staff justification, impact assessment of clinical service provided, identification of needs for staff development and planning future clinical directions. In order to enhance the efficiency of documentation and data analysis, future plans include computerization and evaluation of the frequency of data collection. PMID- 10142843 TI - G-CSF (Granulocyte Colony-Stimulating Factor): follow-up and use in a French University hospital. AB - Granulocyte Colony-Stimulating Factor or G-CSF (NEUPOGEN) was approved for use in France in November 1991 for prevention of chemotherapy-induced neutropenia. This retrospective study was conducted at Saint-Louis Hospital, Paris, France, from November 1991 to March 1993 with a more detailed analysis of patient profiles for courses ordered between November 1991 and December 1992. Data were collected on standardized G-CSF-treatment summary forms. The purpose of the study was to define, in clinical terms, the patients treated by G-CSF to determine the average cost per course of therapy and its impact on the hospital pharmacy budget. From November 1991 to December 1992 data from 307 patient profiles were collected and analyzed. The subcutaneous route was the preferred route and only 16.6% of courses were administered intravenously. 45.6% of patients received a single course, 24.3% received two courses, and 30.1% received more than two courses. Each patient completed an average of 2.3 courses at an average cost per course of $2,000.00 (Canadian dollars). During March 1993, 50% of vials dispensed were administered to outpatients. During the 14-month period, an average of 613.8 vials were dispensed per month corresponding to an average monthly expenditure of $104,000.00 (Canadian dollars). In the first 12 months following the commercial availability of G-CSF, G-CSF expenditures accounted for 8% of the pharmacy budget. PMID- 10142844 TI - An evaluation of verbal and written methods in counselling cancer patients. PMID- 10142845 TI - Centro Medico de la Mujer Hospital Los Angeles, Torreon, Coahuila. Mixing elegance, local craft, and high-tech know-how, HDR delivers its first hospital for women in Mexico. PMID- 10142846 TI - Nationwide study of PHOs reveals need to mature operations. PMID- 10142847 TI - Toward a safer label. AB - Pharmacy literature has reminded hospital pharmacists that our computer generated intravenous and medication labels often fall short in the area of legibility and usability. A new computer system and Zebra Stripe S-500 printers (Zebra Technologies Corporation, Vernon Hills, IL) allowed Methodist Medical Center to reexamine our labels and to join with nursing to develop a safer, more user friendly set of labels. These new labels have been well received by our nursing staff. PMID- 10142848 TI - Formulary conversion from glipizide to glyburide: a cost-minimization analysis. AB - Economic pressure prompted us to search for and implement cost-saving strategies at Bronx Municipal Hospital. This paper describes a cost-minimization analysis of the impact of formulary substitution of glyburide for glipizide on glycemic control, safety, and costs. In 76 patients with computerized prescription records, switching from a mean daily glipizide dose of 19 mg to a mean daily glyburide dose of 10.2 mg did not affect glycemic control. A subset of 33 elderly patients experienced only three drug-related adverse events during the 2-year observation period. The conversion program yielded a 51% reduction in overall expenditures for oral hypoglycemic agents between 1991 and 1993. These findings indicate that our conversion program was successful, which has led to its becoming a model for other New York City municipal outpatient pharmacies. PMID- 10142850 TI - Indicators for medication use; home infusion therapy and the IMSystem. PMID- 10142849 TI - Innovative programs for integrated delivery systems. AB - These programs are most effective under a MCO setting, but will succeed only if there are individuals within the organization to champion these programs. Many pharmacists have taken the lead and are working closely with manufacturers to identify the best use of these programs. These individuals ensure that the programs are implemented and that the appropriate pathways are followed. The pharmacist can assist in identifying those who are not using products appropriately. Using the manufacturer's resources (sales force) to supply the provider with educational material can help the provider follow the pathways and focus on appropriate use. The pharmacist can monitor the data and offer suggestions on program modifications. Therefore, the pharmacist plays a key role in meeting the challenges presented by outcomes performance programs and in creating an opportunity for the patient care organization to achieve its financial goals. With the MCO and manufacturer as partners, these programs will be successful and can increase the quality of care to MCO members who receive care in an institutional or community managed care setting. PMID- 10142851 TI - The Canadian Dietetic Association Biotechnology Committee opinion paper on biotechnology and food. AB - Biotechnology allows scientists to improve foods, create new food products and provide better tools to ensure food safety. It can assist in achieving the goal of an abundant, safe and nutritious food supply for a growing population. These technologies can lead to a greater variety of food with improved taste, nutrition and cooking quality. There are valid concerns about the widespread use of biotechnology which remain to be addressed by health, scientific and consumer constituencies. Dietitians need to be informed about biotechnology in food production and processing. They need to be aware of potential benefits and risks. Dietitians are uniquely positioned to inform the public about food safety and food products of biotechnology. Dietitians can discuss this information in understandable language and with sensitivity to public values. Dietitians should participate in the development of food-related policies at local, provincial and federal levels. PMID- 10142852 TI - Inhibiting organizational entropy. PMID- 10142853 TI - Ten important things we now know from cancer research. PMID- 10142854 TI - Steady increase in AIDS among U.S. women. PMID- 10142855 TI - Study finds HMO members satisfied. PMID- 10142856 TI - Continuous restandardization. PMID- 10142857 TI - EMS workers come in from the dark. PMID- 10142858 TI - DWI awareness. Austin EMS drives it home. PMID- 10142859 TI - After the smoke clears. PMID- 10142860 TI - IMSystem will be an option. Performance measurement strategy evolves, offers flexibility. PMID- 10142861 TI - 1995 survey process update. Review of closed medical records in hospitals has been improved. PMID- 10142862 TI - Tips for a better survey. "Canned" presentations by hospital staff can get in the way. PMID- 10142863 TI - Joint Commission now accredits ambulatory care infusion centers. PMID- 10142864 TI - President's column ... Joint Commission's testimony to Health Subcommittee of the House Ways and Means Committee, Spring 1995. PMID- 10142865 TI - Health care reform prospects in the 104th Congress. PMID- 10142866 TI - An "any willing provider" law didn't help me. PMID- 10142867 TI - Medicare under the knife: radical or cosmetic surgery? PMID- 10142868 TI - Is the Hippocratic oath still relevant? PMID- 10142869 TI - Keep your fees from being squeezed. PMID- 10142870 TI - You can fight frivolous suits--and win. PMID- 10142871 TI - A new approach to patient care is coming your way. PMID- 10142872 TI - Why you should care how your group is run. PMID- 10142873 TI - Bombing pulls Oklahoma City hospitals together. PMID- 10142874 TI - Allergy issues complicate buying decisions for gloves. PMID- 10142876 TI - Health maintenance organizations gain popularity, increase capitation. PMID- 10142875 TI - ORs return to one room for pre, postop care. PMID- 10142877 TI - The changing roles of PFS (patient financial service) managers. PMID- 10142878 TI - Outcome measures or measuring outcome. PMID- 10142879 TI - Keynote address: 1994 Joint CPA/APTA Congress. A whole new world. PMID- 10142880 TI - How and why do you measure a rainbow? Enid Graham Memorial Lecture, 1994. PMID- 10142881 TI - Implementing CQI: measuring levels of service quality at physiotherapy clinics. AB - The purpose of this study was to provide a profile of patient perceptions of the service quality delivered by a back pain rehabilitation clinic. Data were gathered and analyzed at the clinic level in twelve different locations across Canada. Measurement techniques were based on validated survey methods and developed from a growing stream of social science research. Results provided clinic managers with a profile of perceived service quality in terms of three key aspects: administrative support, quality of therapy received, and satisfaction with the results. The results also provided each clinic with benchmarks so that on-going service quality measurements can be incorporated into a system of continuous quality improvement. This process can assist rehabilitation clinics (and other health care providers) in improving service as well as ultimately reducing the costs of providing treatments involving physiotherapy. PMID- 10142882 TI - Critical review of disability measures: conceptual developments. AB - The development of outcome measures of disability is an important focus in physical therapy research. This paper reviews the content of functional status/disability measures developed between 1950 to 1989 to ascertain trends in disability measurement. Content analysis reveals that measures have followed three predominant patterns: a self care to a functional focus, a physical to a psychosocial focus, and a clinician to a client focus. These patterns related issues are discussed. The development of physical therapy measures requires the consideration of various perspectives, including the consumer perspective. Physical therapy measures must reflect a perspective which integrates physical capacity, physical function and environmental concerns. PMID- 10142883 TI - Inappropriate patient sexual behaviour in physiotherapy practice: a qualitative analysis of questionnaire comments. AB - It has been reported that over 80% of physiotherapists and physiotherapy students have experienced inappropriate patient sexual behaviour (IPSB). This paper reports the results of a qualitative analysis of written comments respondents made to four open-ended questions that were part of a survey on IPSB. Quantitative analyses of the responses to the remainder of the questions have been reported previously. The objectives of this study were to determine the content required for educational programs and to explore the strategies and suggestions respondents have made relevant to IPSB. A questionnaire was sent to 118 physiotherapists and 87 physiotherapy students. Completed questionnaires were returned by over 70% in each group. The questions asking for comments on how respondents have learned to deal with IPSB and what information about IPSB is important for in-service and undergraduate education were coded into themes to characterize the responses. Respondents described their experiences with IPSB, identified the knowledge areas that they consider to be important, emphasized the importance of prevention, getting and giving support, the specific ways that they have learned to cope, and the skills to handle IPSB. This emphasized the importance of a comprehensive educational strategy to respond to IPSB. PMID- 10142884 TI - Development of a safety module to satisfy the requirements of regulatory agencies for hospital staff safety education. AB - We developed a self-administered safety module (SM) to instruct respiratory care (RC) employees in their responsibilities during emergency situations. The SM has five phases--a pretest (PRE), statement of module objectives, presentation of information in outline form, a posttest (POST), and review of the POST. This training meets the specific requirements outlined by the Occupational Safety and Health Administration and the Joint Commission on Accreditation of Healthcare Organizations. METHODS: To evaluate the effectiveness of the SM, we compared test scores among three groups of employees: those with no previous exposure to safety education in the hospital setting (G1), those with exposure at other institutions (G2), and those with exposure at this institution (G3). Our goal was to equalize the POST scores among the three groups. Using a 1-way analysis of variance, we tested to find whether the PRE scores were different from one another and repeated the test for the POST scores. We tested for within-group differences, PRE vs POST, using paired t tests. RESULTS: Previous exposure to hospital safety management was associated with significantly higher PRE scores (p < 0.001). No previous exposure was associated with the greatest improvement (POST vs PRE), although all groups experienced significant improvement (p < 0.05). The POST scores for G1 were significantly lower than those of either G2 or G3 (p < 0.001). However, they were still adequate to pass (> or = 80%). CONCLUSION: This self administered SM is an effective and efficient method of educating RC personnel, regardless of entry-level knowledge, in safety issues and, although the POST scores were not statistically equalized, these scores were all sufficient to pass. Further evaluation of this process will include assessment of knowledge retention among employees. PMID- 10142886 TI - Resuscitation in Acute Care Hospitals, Part II, a special issue based on a conference held October 21-23, 1994, in Cancun, Mexico. PMID- 10142885 TI - Asthma self-management programs can reduce the need for hospital-based asthma care. AB - Mortality from asthma and its complications is increasing as is the expense associated with treating this disease. We hypothesized that an asthma-education program, already in place, had reduced hospitalizations (HOS) and emergency department (ED) visits for asthmatic patients who participated. METHODS: We compared asthmatic patients' ED visits and HOS for the 12-month periods immediately before and after treatment in our center. METHODS: All patients received physician-directed medical management based upon the National Asthma Education Panel recommendations. One group (PART, n = 13) received instruction in self-management using the peak-flow meter (PFM) and an action plan (AP) to adjust medication dosages in response to changing post-bronchodilator peak-flow meter readings. Average cost for this intervention was $820 (2 visits, each with 60-90 minutes of instruction). The other group (FULL, n = 13), in addition to receiving a PFM and AP, completed a multidisciplinary education program stressing trigger identification and avoidance, environmental control, proactive adjustment of anti inflammatory agents, and stress management. Average cost for this intervention was $1,700 (multidisciplinary evaluations and 12 hours of instruction). Those who did not enter the education program did so by choice or circumstance (ie, transportation problems, inability to commit the required time for the program, insurance denial). RESULTS: Of the 13 PART-group subjects, 8 experienced all 31 ED and/or HOS in the year prior to our program. Four of 13 accounted for the 15 ED and/or HOS after discharge from the program (50% improvement, p < 0.05). Of the 14 patients in the FULL group, 7 accounted for 25 ED and/or HOS prior to the program. There were no ED and/or HOS after the program (100% improvement, p < 0.05). CONCLUSION: Based on this sample, it is evident that both PART and FULL programs can significantly impact the frequency with which hospital-based asthma care is required and thus reduce the overall cost of caring for patients with asthma. PMID- 10142887 TI - Resuscitation: when is enough, enough? AB - Almost half of patients respond acutely to resuscitation but most die within the first several days after arrest. The incidence of survival to discharge from the hospital after cardiopulmonary arrest is about 15%; one third of those surviving have evidence of neurologic deficits. Although some prognostic variables are useful in determining which patients are most likely to die prior to discharge from the hospital, each patient needs to be evaluated on an individual basis and the various risk factors weighed carefully. As additional data accumulate, we may well be more effective at deciding which patients are more likely to benefit from CPR so that we can more judiciously apply this therapeutic modality. A number of studies have identified factors that contribute to poor outcome. Patients over 70 years of age usually fare poorly after CPR, but this is more a reflection of the number of coexisting diagnoses rather than years. Although initial survival may not be different from younger patients, fewer elderly patients live to discharge and more are likely to have neurologic sequelae. Concurrent diagnoses such as sepsis, AIDS, gastrointestinal bleeding, renal failure, cancer, and central nervous system disease have a universally poor response to CPR. If defibrillation occurs more than 6 minutes after arrest or on the general ward or if the resuscitative attempt lasts longer than 15 minutes, mortality is greater than 95%. If CPR continues for more than 30 minutes, there are no survivors. A low exhaled CO2 concentration (< 2%) during cardiac massage, asystole or EMD as the first identified rhythm, and recurrent arrest also carry a poor prognosis. On the other hand, at the time of arrest or during the immediate postarrest period, poor neurologic status is a less helpful predictor. The absence of spontaneous respiration is the only variable at the time of admission after out-of-hospital arrest that is particularly ominous. There is no evidence to suggest that the absence of spontaneous respiration implies any better prognosis for patients arresting in the hospital. Coma, hypoxic myoclonus, and absent reflexes, while not useful immediately following arrest, are of greater prognostic significance 48 hours later. Only 5% of patients who are unconscious 48 hours after arrest will have a full neurologic recovery. The Glasgow Coma Scale has also been used for prognostication.(ABSTRACT TRUNCATED AT 400 WORDS) PMID- 10142888 TI - Do-not-resuscitate orders: a critical review of the literature. AB - Formal DNR policies have improved the process by which decisions to withhold CPR are made. Slow and sham codes are now rare. Communication between physicians and patients and between physicians and providers of in-hospital CPR clearly exceeds that in other developed countries. Results of early studies that examined the care received by those with and without advance directives have been unable to document differences. A more realistic appraisal of the potential role for advance directives coupled with an emphasis on education and rational treatment guidelines should promote continued improvement in the compassionate use of cardiopulmonary resuscitation. PMID- 10142889 TI - Research on ACLS training--which methods improve skill & knowledge retention? PMID- 10142890 TI - Strategies for maintaining ACLS skills in hospitals. PMID- 10142891 TI - The first ACLS course--resuscitation training for students. PMID- 10142892 TI - Neonatal Resuscitation Program and Pediatric Advanced Life Support. AB - The need for delivery resuscitation of the newborn cannot be predicted in most cases; therefore it is judicious to train all providers who may be involved in the delivery of newborns to follow guidelines developed to improve outcome, especially in the presence of transitional asphyxia. The Neonatal Resuscitation Program emphasizes basic steps of warming, drying, suctioning, and adequately ventilating the newborn. It also addresses current theories regarding resuscitation of the low birthweight newborns, infants with meconium aspiration, and medication use. The NRP applies to all acute-care hospitals that provide delivery services and those at which a respiratory therapist is likely to be present in the high-risk delivery or unanticipated delivery-room resuscitation. Outcomes have not been well documented and more clinical research is needed to identify which therapeutic strategies promote the best survival in this population. A topic that should be included in the NRP of the future is exogenous surfactant delivery. Respiratory distress syndrome has been a significant cause of death and morbidity in prematurely born neonates. Exogenous surfactant therapy has had a dramatic effect on the death rate of premature infants and on the incidence of respiratory distress syndrome. Current methods of surfactant administration demand that personnel proficient in management of the low birthweight newborn be present. As hospitals with all levels of nurseries continue to receive the prematurely delivered newborn and better methods to administer surfactant are discovered, the NRP could add information and a skills laboratory on surfactant administration. A trained cadre of health professionals who are proficient in the specific resuscitation skills required in pediatric patients can make a difference. The infant and child have different anatomy, physiology, and disease etiology that need to be emphasized and understood by the pediatric caregiver. The Pediatric Advanced Life Support course focuses on early recognition and treatment of respiratory failure and shock. The possibility of improving outcome with properly trained prehospital providers is a topic of interest. Intubation in the field can be successful and may contribute to a reduction in mortality, although complications of field intubation need to be reduced. PMID- 10142893 TI - An inside look at IFMA's (International Foodservice Manufacturers Association) Silver Plate winners. PMID- 10142894 TI - The pain of workers' compensation. PMID- 10142895 TI - Trustee workbook. Assessing and improving your community's health. PMID- 10142896 TI - Letting go for a healthier community. PMID- 10142897 TI - News flash: the media have heart. Reporters want to tell your story. You just have to cultivate a good relationship with them. PMID- 10142898 TI - Case studies. Baton Rouge puts community first. PMID- 10142899 TI - Taking the initiative on suicide. PMID- 10142900 TI - Good people won't go in there. PMID- 10142901 TI - The implications of death with dignity. PMID- 10142902 TI - Massachusetts initiates information partnership. PMID- 10142903 TI - Clinical pathways and risk. PMID- 10142904 TI - JCAHO launches project to support quality improvement efforts in central Pennsylvania. PMID- 10142905 TI - Perspectives. Medicare struggles to size up risks in capitated plans. PMID- 10142906 TI - Bomb threats self-assessment questionnaire. PMID- 10142907 TI - New, more reasonable OSHA policy on article and consumer products exceptions to HAZCOM. PMID- 10142908 TI - Sen. Jack Biddle and Rep. Steve Flowers. PMID- 10142909 TI - Multiskilling: cross-training helps fill hospital needs. PMID- 10142910 TI - Building bridges to meet clinical information challenges for ambulatory care providers in nonhospital settings. PMID- 10142911 TI - Close at hand: hand-held electronics point toward a health information revolution. PMID- 10142912 TI - Managing the change process. PMID- 10142914 TI - Facing change--preparing for the future. AB - This case study demonstrates that team development takes time. It involves interpersonal skill development for staff members, management training, and specific team building sessions after the teams form. It is crucial that the specific content of training for managers, staff members, team leaders, and team members evolves from an assessment of organizational needs coupled with involvement of all levels of the department. You may ask if this entire process has made a difference. Yes, it has. Staff members are beginning to be more open and honest with one another regarding issues detrimental to the group process. Above all, team leaders and staff are assuming responsibility together for the workload and process improvement. Implementing the team process without proper training and assessment is sure to fail. Yet we must continue to work and shape the team process toward the final level of self-direction. PMID- 10142913 TI - Change ... taking giant steps. PMID- 10142915 TI - Should patient focused care include decentralized coding? PMID- 10142916 TI - Electronic signature thrives in different environments. AB - Implementing electronic signature has been a positive experience for both our organizations. The benefits we sought were there, and unforeseen benefits surfaced. Five activities that facilitated the success of electronic signature at our two facilities were (1) flowcharting the electronic signature process prior to purchase and installation; (2) becoming familiar with legal requirements for electronic signature, and assuring that products under consideration meet these requirements; (3) gaining the support of medical staff leadership; (4) using a written agreement of password confidentiality and document responsibility with physicians; and (5) thoroughly training medical records staff, then establishing a positive one-on-one training procedure for physicians with a high degree of staff attention. PMID- 10142917 TI - Doctors should lead, not follow. PMID- 10142919 TI - Cancer conferences in Illinois: compliance with COC (Commission on Cancer) guidelines. PMID- 10142918 TI - How DTEMs (Division of Trauma and Emergency Medical Systems) is working toward optimal trauma care. Interview by Cynthia A. Brown. PMID- 10142920 TI - Surgical heroes: an anesthesiologist's perspective. PMID- 10142921 TI - Ethics and the transplant surgeon. PMID- 10142922 TI - Is small really beautiful? Some thoughts on the 1995 federal budget. AB - The 1995 federal budget meets the financial markets' expectations by proposing deep funding cuts and defining a smaller federal presence in several sectors of Canadian society. The most significant aspect of the budget for health care is the creation of the Canada Health and Social Transfer, which merges federal funding for health, post-secondary education and social assistance into one block grant. Provinces will be free to shift funds among these programs. PMID- 10142923 TI - Self-reliance key to successful career management. PMID- 10142924 TI - Living in interesting times: applying creative strategic planning. AB - Rapidly changing expectations and environments have put health care facilities under increasing pressure. Using traditional strategic planning to deal with these challenges has often produced disappointing results. This article outlines a different approach, based on Robert Fritz's model of the creative process, and discusses its application in Kiwanis Lodge in West Vancouver, an intermediate care facility. PMID- 10142925 TI - A CHA call to arms. Grass-roots action needed to renew the federal commitment to health. PMID- 10142926 TI - Health care sector volunteer community faces a disturbing trend. PMID- 10142927 TI - Rethinking social work service delivery. AB - Providence Centre is a 577-bed, multilevel, geriatric health facility located in Scarborough, Ontario. This article outlines the transition from a traditional model of social work service delivery to a specialized case referral system. It describes the review process, creation of the alternative service model, implementation strategies, evaluation measures and outcomes of the undertaking. Through these efforts, the centre succeeded in creatively redefining and restructuring its social work service delivery and resource utilization in today's tough economic climate. PMID- 10142928 TI - Health professionals: take control of the system before it's too late. Interview by Matthew D. Pavelich. PMID- 10142929 TI - Equipment maintenance: moving beyond insurance to self-managed programs. AB - Equipment maintenance insurance is a recent development that has achieved some cost savings for hospitals. However, greater cost savings can be achieved by a centrally managed self-insurance program that crosses departmental lines. The benefits of such programs are further enhanced when they are run by a technical rather than a financial person. PMID- 10142930 TI - Is a trust agreement necessary? PMID- 10142931 TI - 1995 Standards for Acute Care Organizations not responsive to customer voices. PMID- 10142933 TI - Disease management broadens focus of care from episodic to long-range. PMID- 10142934 TI - Case study. Rightsizing: two competitors become one health system. PMID- 10142932 TI - The client-centred approach to accreditation: an exciting new direction. PMID- 10142935 TI - Allying with suppliers to improve quality and reduce costs. AB - The Quality Letter invited Eastman Kodak Company to sponsor this issue because of the company's interest in changing customer-supplier relationships from price based purchasing agreements to true partnerships. This article describes how hospitals view their changing relationship with Kodak and other suppliers and how these newly emerging customer-supplier partnerships are working. PMID- 10142936 TI - A checklist for certifying suppliers. PMID- 10142937 TI - Adding value through improved provider-supplier relationships. PMID- 10142939 TI - A directory of decision support tools. PMID- 10142938 TI - Six strategies for gaining physician buy-in for computerized information systems- an interview with three physician leaders. Interview by Reggi Veatch. PMID- 10142940 TI - Using information at the cost-quality interface. PMID- 10142941 TI - Medicare, managed care, and vision services to the elderly. AB - Proportionately, fewer Medicare patients are enrolled in HMOs than in fee-for service programs. Despite the advantages of selecting the HMO option, only 2.9 million beneficiaries are enrolled. Integrating Medicare into health care reform will be a major challenge to this administration. There is general recognition that it will be difficult to control health costs if people at least 65 years of age remain outside the system. With renewed marketing programs directed toward the elderly, we can expect further increases in Medicare HMO enrollment. PMID- 10142942 TI - Including alternative providers in managed care--managing the malpractice risk: Part 2. PMID- 10142943 TI - The transition from pharmacy transaction reimbursement to transaction-service reimbursement. PMID- 10142944 TI - Patient-centered care: a revolution in medicine. AB - Systems management has the potential to become the catalyst for a private sector revolution that could replace public sector attempts at health care reform. This article will attempt to illustrate the concepts behind systematic, totally integrated, individualized, patient-centered health care--what the authors have coined "systems management of medicine." PMID- 10142945 TI - Founders hold the future of integrated provider organizations. AB - Success of an integrated delivery system will be based on a common understanding of the new business of integrated care delivery and the creation of a stable and organized provider structure. Physicians' income will be based on the efficiency and success of integrated provider organizations--how well they manage patients and how well providers work with their peers to promote high-quality care while managing the cost of care and its utilization. PMID- 10142946 TI - Changing the marketing message. PMID- 10142947 TI - The future of employment-based health benefits. PMID- 10142948 TI - Medicaid matching formula, federal subsidies, and Medicaid payments. AB - The federal government uses the Medicaid matching formula to distribute federal funds to states to finance various social welfare programs involving billions of dollars. How does the formula affect the distribution of federal money? How would that distribution change if a revised formula were used? This article presents the results of a regression analysis on Medicaid payments in the states and the federal subsidies for states to finance Medicaid. The findings indicate that under the current Medicaid matching formula, fewer federal subsidy dollars per poor person go to states with lower per capita incomes and to states with a higher percentage of African Americans than to states with the opposite characteristics. Even under the revised formula, states with lower per capita incomes would receive the same amount of federal matching dollars per poor person as would states with higher per capita incomes. The implications for policy are discussed. PMID- 10142949 TI - Models of case management in long term home health care. PMID- 10142950 TI - Models of case management in long term home health care. The not-for-profit model. PMID- 10142951 TI - Models of case management in long term home health care. The evolution of for profit geriatric care management. AB - Professional geriatric care management has the potential to provide an emotionally satisfying, lucrative career for the social worker or nurse who is self-educated or who has formal continuing professional education in assessment, care options, and care coordination. Yet GCM as an organized profession, or as a career choice for the individual, requires institutional supports to grow and flourish. The GCM profession requires recognition by the states (including certification and credentialing). A network must be developed so that young persons can receive a first professional degree, or at least a concentration within nursing or social work, in the legal and financial implications of elder care as well as the biology of aging and the techniques of hands-on physical care of the elderly. Structures must be created for continuing professional education of the GCM practitioner. The various Medicaid programs that offer home care to the elderly and disabled rely heavily on assessment and case management; so does the entire Medicare system. However, the federal statutes and regulations do not explicitly authorize GCM participation in care planning. More to the point, they do not clearly authorize reimbursement of GCMs as independent professionals or as Medicare/Medicaid service providers. As private long-term care insurance evolves, GCM services should be recognized as proper components of the planning process (and therefore as services that can be reimbursed by the policy). Once this is done, the challenge for GCM professionals is to retain their focus on the needs of the elder and family, rather than to perceive themselves as gatekeepers who function to cut the cost of services instead of optimizing their variety and quality.(ABSTRACT TRUNCATED AT 250 WORDS) PMID- 10142952 TI - Models of case management in long term home health care. The government-run model of case management. PMID- 10142953 TI - Determining the need for case management: family and patient. PMID- 10142954 TI - Is case management of any value? What is the evidence? PMID- 10142955 TI - Determining requirements for case management in long-term health care. PMID- 10142956 TI - History of case management: what is it anyway? PMID- 10142957 TI - Robot joins Michigan hospital's foodservice department. PMID- 10142958 TI - Increase efficiency/reduce costs with cook/chill. PMID- 10142959 TI - Sinai Hospital utilizes foodservice in staff recruitment and benefit plan. PMID- 10142960 TI - Association of Health Care Information and Medical Records Officers. Access to health records--Guideline No. 3. Administration relating to the implementation of the Access to Health Records Act 1990. PMID- 10142961 TI - The Clinical Messages Project. AB - Following a series of national and local initiatives which demonstrated the feasibility of and enthusiasm for utilising structured electronic messages for the transfer of clinical information, increasing requests are being made to the NHS Executive to make available national standard messages. PMID- 10142962 TI - The medical records manager. How successfully does he manage? PMID- 10142963 TI - Guideline No. 4. Security of data held in computer systems. Institute of Health Record Information and Management. PMID- 10142964 TI - Standardization of paperless health records. PMID- 10142965 TI - Medical records development in Malaysia. PMID- 10142967 TI - Common Administrative Data Set. PMID- 10142966 TI - Certificates of Technical Competence. PMID- 10142968 TI - District hospitals and strengthening referral systems in developing countries. AB - An important strategy to make a better use of the scarce resources available to the health sector in developing countries should focus on strengthening the referral system. Hospitals overcrowded with patients who could be more cheaply treated in smaller facilities is a common feature of poorly functioning referral systems. After defining what is meant by referral system, the paper discusses the main problems affecting its implementation within a primary health care strategy in developing countries. The essential prerequisites for an effective referral system are then discussed, emphasizing the need for a clear division of tasks between the different levels of the health delivery system. The paper concludes that efficiency gains and improvement of access are the most likely outcomes of a well-functioning referral system. PMID- 10142969 TI - International experience and health sector reform: the challenge for developing health systems. AB - Health sector reform is a priority issue in many countries and there is great scope for an international exchange of experiences. We should not be amiss, however, to the problems and dangers of such international exchange. Focusing on the situation of developing countries, three critical problems are identified: tendencies to the universalism of a market approach, a one-way transmission of ideas, and the lack of policy analysis. In order to contribute to a more constructive process of international exchange, four recommendations are proposed in the areas of training and the approach to management, management research, strengthening health policy analysis, and developing new exchanges between countries. PMID- 10142970 TI - A systems approach to the design and planning of hospitals in the Arab world. AB - The aim of this paper is to propose a 'planning framework' which offers a contemporary methodology for the accomplishment of reasonable and virtually fail safe goals for the design and construction of Arab hospitals. The methodology can serve where economic conditions vary, from the very wealthy Gulf States to the presently very poor economy of the Sudan. Hospital programmes, which reflect so closely the essential features of their respective culture, will have to be carefully adopted to the conditions prevailing in each country. The hospital design team must recognize the importance of the influence of its country's cultural heritage on the evolution of hospitals in the future. Two central topics have been discussed: the 'healthcare building' and the 'building process', both of which can be affected by how information is assembled and how it is presented. The presentation of information for clarity is an essential part of logically translating thought into constructive action. The process is enhanced by a 'systems approach', an integration of an orderly presentation of facts with an orderly presentation of design components, using an orderly time-sensitive methodology. PMID- 10142971 TI - Technology assessment and transfer in district health systems. AB - Initially reviewing the concepts of a district health system and technologies, the article develops into a discussion on health technologies and the process of their transnational diffusion, as well as their impact on district health systems in developing countries. Finally, the paper points to the need for assessment and quality assurance in a managed transfer of technologies. PMID- 10142972 TI - The role of the supervisor and training. AB - The supervision of health personnel has always been important in the health sector. The introduction of decentralization and quality assurance, however, has made it even more relevant. This paper looks at the various roles of the supervisor and indicates key criteria for understanding the possible burden of supervision. An important factor here is the training of supervision, and this is discussed in terms of the content and means of training. Finally, it is suggested that improvements in supervision can be developed through action research. PMID- 10142973 TI - Sustaining the Bamako Initiative in the Gambia--some management implications. AB - There is increasing pressure in developing countries to improve the social, political and economic status of their people. For former colonies such as the Gambia, pre-independence promises of equity in health, education, water supply and sanitation were vaguely presented in political manifestos. Some of these promises were not translated into concrete plans because of the economic difficulties that the countries experienced. The Alma Ata Declaration on Primary Health Care in 1978 was seen as a strategy to improve the deteriorating health status in developing countries. The economic crisis however, which these countries were facing forced them into implementing Structural Adjustment Programmes (SAP). This resulted in a search for alternative methods of financing health care including that of the Bamako Initiative in 1987 to strengthen the implementation of PHC. The Gambia adopted The Bamako Initiative in 1993 to help in strengthening its already well-developed PHC infrastructure. The Bamako Initiative, like any other form of financing health services, is however not without shortcomings. This paper assesses the structural bottlenecks likely to affect the sustainability of the programme in the Gambia. It examines the political and operational management issues such as political stability, donor commitment and support, effective community management, health sector support and the availability of financial resources. PMID- 10142974 TI - The district health information system and its potential in the management of district and rural hospitals. AB - A study to assess the role that the HIS plays in the management of district and rural hospitals in Zvimba district (Zimbabwe) was carried out by the authors between August and October 1993. It revealed that there is an elaborate and well developed set of tools which mainly collect data on morbidity, mortality, births, coverage and health activities. Cost and financial data as well as community based data are not entering the HIS at the peripheral level. Very little analysis and interpretation of data takes place at the rural and district hospitals, therefore limiting the indicators that could be derived. Staff use the raw data they collect mostly for patient care. In terms of processed data, there is little use made of it. PMID- 10142975 TI - The inevitable partnership between healthcare practice and healthcare buildings. AB - In this paper, the author points out the tightly-woven relationship between the healthcare provider and the facilities in which the care takes place. This relationship has evolved from the earliest days of organized medicine. Further, he asserts that in these days of reform and of heightened consumer expectations, the facilities controlled by the provider are among his most important assets. Examples cited cover intensive care settings, ambulatory care, and patient focused care concepts. The author concludes by speculating on the form that the healthcare facilities of the future might take and on some strategies that the provider might follow. PMID- 10142976 TI - A puzzle for our times: using healthcare resources wisely and justly. AB - In the past fifty years health care has become one of the most challenging, expensive and dynamic of all sectors of human activity. The author's purpose in this short paper is to suggest that the key issues in the management of this sector are about individual and collective choices, that these choices are becoming harder and more constrained and that we have to become better at making them. With less certainty, he will suggest some of the ways in which we might tackle this dilemma, including some discussion of rationing. PMID- 10142977 TI - Professional autonomy and accountability. A critique of current health reforms and an alternative proposal. AB - Many countries have become increasingly concerned about the cost of health services, and the issue is considered to be a crisis in the United States. There are many factors that influence the performance of health service professionals, and they all need to be taken into account in reforming the industry. Accountability is important, but it must be compatible with the underlying character of health service delivery. A long-term programme needs to be developed to provide the environment in which professionals can work most effectively. This requires a greater emphasis on professionally-based processes that promote performance and provide accountability. PMID- 10142978 TI - Federal Employees Health Benefits Program: limitation on physician charges and FEHB program payments--OPM. Interim regulation with request for comments. AB - The Office of Personnel Management (OPM) is issuing an interim regulation that amends current Federal Employee Health Benefits (FEHB) Program regulations to require that the charges and FEHB fee-for-service plans' benefit payments for certain physician services furnished to retired enrolled individuals do not exceed the limits on charges and payments established under the Medicare fee schedule for physician services. The regulation authorizes the FEHB plans, under the oversight of OPM, to notify the Secretary of Health and Human Services (HHS) of a Medicare participating hospital, physician or supplier who knowingly and willfully fails to accept, on a repeated basis, the Medicare rate as payment in full from an FEHB plan. The regulation also authorizes the FEHB plans, under the oversight of OPM, to notify the Secretary of HHS of a Medicare nonparticipating physician or supplier who knowingly and willfully charges, on a repeated basis, more than the Medicare limiting charge amount (115 percent of the Medicare Nonparticipating Physician Fee Schedule amount). PMID- 10142979 TI - Waiver of the two-year home country physical presence requirement for certain foreign medical graduates--INS. Interim rule with request for comments. AB - This rule amends the Immigration and Naturalization Service (Service) regulations by allowing certain foreign medical graduates who entered the United States in J 1 status, or who acquired J-1 status after arrival in the United States, to obtain a waiver of the 2-year home country residence and physical presence requirement under section 212(e)(iii) of the Immigration and Nationality Act (Act) pursuant to a request by a State Department of Public Health, or its equivalent. The waiver is intended to permit these foreign medical graduates to work at a health care facility in an area designated by the Secretary, Health and Human Services (HHS), as having a shortage of health care professionals ("HHS designated shortage area"). This interim rule also contains provisions which will permit these foreign medical graduates to change their nonimmigrant status in the United States from J-1 exchange visitor to H-1B specialty occupation worker. PMID- 10142980 TI - In this debate, allies become brawlers. PMID- 10142981 TI - Whose services does an HMO value most? PMID- 10142982 TI - Are 'silent PPOs' sinking your practice? AB - So-called "silent PPOs" area costing physicians millions of dollars each year by extending discounts to patients who aren't entitled to them. Here's how they work -and what you can do about them. PMID- 10142983 TI - Working for the patient: has it become passe? PMID- 10142984 TI - Payment promises? Get them in writing. AB - When patients have trouble paying their bills in full, consider using a confirming letter of payment. It will increase your chances of getting paid, and it also offers some legal backing if you end up in small claims court. PMID- 10142985 TI - How (and why) to shop the stop-loss insurance market. AB - Stop-loss insurance is capitation's "escape clause," which permits you to assume risk without risking ruin. But which stop-loss coverage is right for you? Here are 11 questions to ask before you decide. PMID- 10142986 TI - Integrating patients' views into the guideline movement. PMID- 10142987 TI - Why ethics defines quality--and goals define ethics. PMID- 10142988 TI - Avoiding fraud and abuse: five rules for success. PMID- 10142989 TI - How HMO members rate the quality of their doctors ... and how all consumers rate HMOs. PMID- 10142990 TI - Another view of Medicare HMOs: not always what the doctor ordered. Interview by Meg Matheny. AB - Sally Hart Wilson is one of several lawyers who, on behalf of the Center for Medicare Advocacy, have filed a class-action suit seeking better protections for Medicare beneficiaries in HMOs. The experience of the lead plaintiff (one of 15) in Grijalva v. Shalala illustrates the down side of Medicare HMOs, says Ms. Wilson. Grigoria Grijalva, 71, an enrollee with diabetes, hypertension, congestive heart failure, anemia, and a uremic bladder, complained to her physician about pain in her foot. But the physician's treatment was inadequate, the complaint alleges, and as a result her right leg was amputated. In subsequent years, the lawsuit says, the HMO denied necessary skilled nursing home days and skilled home health services and never sent a notice of denial or a description of her appeal rights, as Medicare requires. PMID- 10142991 TI - Case study. Meadville Medical Center: a small town's integration strategy meets reality. PMID- 10142992 TI - "Enhanced competition model" proposed in Twin Cities would bypass HMOs and link employers directly with integrated systems. PMID- 10142993 TI - Primary care in integrated networks. PMID- 10142994 TI - Medicare managed care resources. PMID- 10142995 TI - Prevention drives care management strategies for Medicare HMOs. PMID- 10142996 TI - Quality systems for the clinical laboratory. Canadian Society of Laboratory Technologists Working Group. AB - This paper has outlined some of the factors which have given rise to the interest in TQM which is evidenced by changing accreditation requirements and widespread implementation in health care facilities. Implementation of TQM in the clinical laboratory is dependent upon: 1. A clear focus on the most important aspects of the service we provide, where if quality fails patient care would be most seriously effected (high volume procedures, high risk and/or problem prone). 2. A focus on the customers of our services: ensuring that process improvements address their requirements. 3. A new leadership philosophy: tapping into the expertise of each member of the team to achieve service improvements. 4. Recognition of the importance of interdisciplinary and/or multidisciplinary collaboration: closing the gaps in our existing QA programs and ensuring that quality is defined in terms of the broad experience of patients receiving health care. 5. Taking advantage of staff development in the use of team tools to provide teams the opportunities to be successful in collaborative projects. 6. Demonstrating perseverance and commitment to quality improvement. Giving the process time to demonstrate success. The methods and tools used to accomplish the transformation from quality assurance to TQM are various. The important point for laboratory professionals is to ensure that our plans are consistent with the total quality picture for patient care. To do this will require collaboration, coordination and communication between the various care givers with whom we interact. It will also require recognition that no one health care process stands alone: quality patient care requires an intersection of processes that ensures our ultimate customer, the patient, of service that will meet expectations and will produce a successful outcome. PMID- 10142997 TI - Today's ARTs: facing challenges and seizing opportunities. Part III. PMID- 10142998 TI - Call-back--the hidden issues. PMID- 10142999 TI - Reorganization of laboratory services. Part II: Complementing regional planning through internal restructuring. PMID- 10143000 TI - A global agenda for bioethics: Declaration of Ixtapa. Council for International Organizations of Medical Sciences. PMID- 10143001 TI - Moderating effects of family functioning on the social adjustment of children with liver disease. AB - In this study, we examined the moderating effects of family functioning on parent and child-reported indices of social functioning in 30 children with liver disease. Consistent with previous research, children with liver disease exhibited significantly lower levels of social functioning compared to normative data. Hierarchical multiple-regression analyses were conducted to examine the relative influence of cognitive functioning, disease severity, and family functioning (i.e., family cohesion and adaptability, parenting stress, and parenting esteem) on children's social functioning. Family functioning accounted for an additional 23% of the variance in parent-reported social functioning and only 4% of the variance in child-reported social competence after controlling for cognitive functioning and disease severity. These preliminary results underscore the importance of considering family factors in designing interventions to enhance the social functioning of children with liver disease. PMID- 10143002 TI - Interpersonal distance and coping in children with HIV and cancer. AB - We compared interpersonal distance and coping among two groups of pre-school pediatric patients diagnosed with either HIV or cancer and a third group of healthy children. In comparison to the children with cancer, children with HIV indicated greater mother-child interpersonal distance--a finding that correlated with mothers' reports of social withdrawal. Other notable findings included increased father-child distance in the HIV population and mother-child discrepancies of perceived interpersonal distance. In addition, seven of the children with HIV indicated that the adults turn away--a finding that correlated with the children's knowledge of their illness. We also explored the possible role of protective communication in the pediatric HIV population. PMID- 10143003 TI - Common obstacles to the daily functioning of pediatric traumatically brain injured patients: perceptions of caregivers and psychologists. AB - Common difficulties encountered by patients with pediatric traumatic brain injuries (referred to hereafter as pediatric TBI patients) were identified, and the congruence between caregiver and professional perceptions of these problems was examined. Forty-seven caregivers identified 118 obstacles experienced in the care of their pediatric TBI patients. Another sample of 46 caregivers cross validated these problems by rating each for its frequency and difficulty. Items were tank ordered by their composite score, a derived measure obtained for each item by cross-multiplying the frequency and difficulty ratings. Twenty psychologists who work with pediatric TBI patients also rated each of the 118 problem situations. A modest correlation (tau = .28, p < .001) between the two groups' rank orders of the problem situations, although significant, suggests that there are discrepancies between caregiver and professional perceptions of problem situations. Items perceived as most common and difficult by caregivers often received far lower ratings by psychologists and vice versa. The results suggest that carefully evaluating individual patient concerns may contribute to more efficient use of professional resources and improved patient education and follow-up care. PMID- 10143004 TI - A survey of psychosocial adaptation in long-term survivors of pediatric liver transplants. AB - We assessed 41 children and adolescents who had received liver transplants at least 4 years ago, for social, behavioral, and emotional adaptation; physical function; and family stress. We compared their level of adaptive functioning to published data from chronically ill and medically well children. On many measures, transplant recipients had equivalent levels of function to the comparison groups. However, 6- to 11-year-old patients showed mild social and scholastic deficits. Patients' parents report less negative impact of the illness on the family than do parents of other chronically ill children. A listing of medication side effects and the degree to which they are problematic was obtained. PMID- 10143005 TI - Beyond psychobabble: careers in psychotherapy. PMID- 10143006 TI - What is a technician? PMID- 10143007 TI - The contingent workforce. PMID- 10143008 TI - FDA regulation of liquid chemical germicides and medical device cleaners. PMID- 10143009 TI - No-fault medical liability in Virginia and Florida. A preliminary evaluation. AB - State governments are experimenting with a variety of innovative approaches to the current tort system for medical malpractice liability. One such approach is to apply the concept of no-fault liability to medical practice. States such as Virginia and Florida have already adopted a limited version of such a concept. This article examines the problems of the current tort system, different types of no-fault medical insurance alternatives and their advantages, and the experiences of the states of Virginia and Florida with their limited no-fault malpractice insurance systems. The author concludes that the concept of no-fault compensation for medical malpractice is a promising remedy. However, it is a medicine that will require more testing before it can be pronounced a cure for the disease that plagues the current system. PMID- 10143010 TI - Rethinking how to measure organizational culture in the hospital setting. The Hospital Culture Scale. AB - Like all organizations, health care delivery systems must be concerned with understanding the implicit beliefs, values, and assumptions extant within the organization that ubiquitously motivate and shape the behavior of participating members. The Hospital Culture Scale (HCS) was designed as a way to assess the unique culture of hospital organizations. The HCS demonstrated high discriminant validity and reliability when applied to all members (patients, nurses, and physicians) of this particular organization. Data provided from different hospital organizations indicated that the HCS could differentiate between a variety of hospitals. Physicians, nurses, and patients were also compared. Although there was agreement between nurses and patients on how scale items are used, there were disagreements when these organizational members were compared to physicians. Differences between hospital members on the overall perception of hospital culture were found. The implications and utility of the HCS are discussed. PMID- 10143011 TI - Estimating cancer screening indicators in the primary care setting. AB - The software "Profile: A Cancer Risk Profile of Your Patient Practice" was used to estimate cancer screening activities in a primary care practice. "Profile" is a public health tool that does not track the screening histories of individual patients, but rather, using a sampling strategy, provides estimates for the entire practice of the age and sex specific number of screening eligible patients, the number screened, and the number that should have been screened, based on National Cancer Institute/American Cancer Society (NCI/A CS) guidelines. This report describes "Profile," and the results it generated from a sample of medical records. Primary care providers who seek to integrate primary and secondary cancer prevention activities into their routine practices will find it useful to have an objective estimate of their current level of such activities. PMID- 10143012 TI - Graduate education in health services administration. Integrating business with clinical perspectives. AB - Health services administration continues to evolve in response to environmental changes in reimbursement, technology, demographics, and health care reform. These changes encourage further integration of business skills in health services, an emphasis which often conflicts with the perspectives of clinicians. The balance between business and clinical perspectives must be developed such that administrators and clinicians foster the survival and growth of their organizations while assuring comprehensive and quality health services to patients and the community. This paper describes education in health services administration, and uses a survey of one program's graduates to assess the usefulness of the current educational model in balancing business and clinical perspectives. PMID- 10143013 TI - Community health initiatives are widespread, challenging our sense of civic obligation. PMID- 10143014 TI - Building healthy communities. PMID- 10143015 TI - The market and regulation: where community forces fit. PMID- 10143016 TI - Back to the future: partnerships and coordination for community health. AB - In the current tumultuous health care scene, competitive health plans and capitated delivery systems are becoming the driving forces in the health care marketplace. Although these plans may be successful in containing costs, their competitive nature prevents them from providing leadership in comprehensive, coordinated initiatives to benefit the entire community. In contrast, executives and trustees at the frontiers of health services management are reaching beyond the current scene toward a vision of community care networks. They are taking incremental steps to coordinate care of patients, enrolled populations, and communities--both within and among independent organizations in the public, for profit, and not-for-profit sectors. As they bring increasing competence in coordination to bear on complex problems of long standing, a health care system that actually delivers more for less to all is a real possibility. My historical perspective, dating back to the studies of the Committee on the Costs of Medical Care (1928-1932), convinces me that community coordination is the missing element in moving from our current fragmented health system to an ever more effective system. This article suggests that the CCMC was on the right track in recommending that every community have an agency to exercise coordination functions, relying on the power of knowledge and persuasion rather than control. Presented here are details of how to organize and manage such an entity as well as a discussion of the nature of the leadership and the incentives required to overcome obstacles to this essential approach. PMID- 10143017 TI - Disease management: they all "say" they're doing it. PMID- 10143018 TI - The joint operating company: an innovative approach to collaboration. AB - Hospitals interested in horizontal integration often run into difficulties. In spite of otherwise sound business logic for two organizations to merge, there may be political, legal or financial reasons why a merger option cannot be pursued. Increasingly, enterprises are turning to a joint operating company structure as the solution to their needs. Scott A. Mason and Donald W. Seymour, partners with consulting firm National Health Advisors, explore situations where a JOC model of collaboration may be appropriate. PMID- 10143019 TI - SMG Marketing Group offers database and profiles on integrated health care networks. PMID- 10143020 TI - Need for interpreter/translation services critical in hospitals and other clinical settings. PMID- 10143021 TI - HMOs and providers will avoid real price wars. PMID- 10143022 TI - "How many beds are needed?": evaluating bed need in managed care setting. AB - After downsizing, re-engineering, consolidating and merging, health care administrators are still asking the eternal question, "How many beds are needed in my hospital?" The significant capital and operating cost required to support a staffed bed warrants a thorough and in-depth examination of the factors leading to bed need, writes Steven D. Sauer, consultant with Hamilton/KSA. PMID- 10143023 TI - Hospital, school system offer anti-crime 'shock mentor' program. PMID- 10143024 TI - Renovated facilities add high-tech, low-tech security improvements. PMID- 10143025 TI - Special report. Complying with the 1995 JCAHO security and safety standards: Part II. AB - With the recent publication and enforcement of its Environment of Care (EC) standards, the Joint Commission on Accreditation of Healthcare Organizations (JCAHO) has completed a 10-year transition from having no security standards, to promulgating vague standards buried under plant management, to (in 1995) specific standards enforced by specific survey guidelines that apply to all hospitals- large and small. This transition, while applauded in principle by hospital security management leaders, has led to charges by some that complying with the standards--and, more importantly, preparing for the surveys--is overtaxing their departments. Concern is also being voiced about the limited know-how of some surveyors in what constitutes good and/or meaningful security. JCAHO officials, however, remain positive about the new standards, as do a number of others in security management who feel that the current difficulties will work themselves out. In Part II of this report, we'll present the views of JCAHO officials and members of the Commission's advisory faculty, as well as the views and experiences of security directors at major hospitals--including a number of IAHSS officials. PMID- 10143026 TI - Bolstering employee morale. PMID- 10143027 TI - Physician referrals for nutrition services. PMID- 10143028 TI - Monitoring productivity of the clinical staff. PMID- 10143029 TI - Making effective dietary recommendations. PMID- 10143030 TI - The changing management of public agencies. PMID- 10143031 TI - Business strategy and financial structure: an empirical analysis of acute care hospitals. AB - This study investigated the relationship between business strategy and financial structure in the U.S. hospital industry. We studied two dimensions of financial structure--liquidity and leverage. Liquidity was assessed by the acid ratio, and leverage was assessed using the equity funding ratio. Drawing from managerial, finance, and resource dependence perspectives, we developed and tested hypotheses about the relationship between Miles and Snow strategy types and financial structure. Relevant contextual financial and organizational variables were controlled for statistically through the Multivariate Analysis of Covariance technique. The relationship between business strategy and financial structure was found to be significant. Among the Miles and Snow strategy types, defenders were found to have relatively high liquidity and low leverage. Prospectors typically had low liquidity and high leverage. Implications for financial planning, competitive assessment, and reimbursement policy are discussed. PMID- 10143032 TI - Admission severity of illness and resource utilization: comparing Medicaid and privately insured patients. AB - This study compares Medicaid patients and privately insured patients. Regression analyses examine the effect of Medicaid status on hospital admission severity, length of stay, and ancillary charges for 14,557 patients in ten medical DRGs and ten surgical procedures. The results show that Medicaid patients were significantly sicker on admission, especially the medical patients. After adjustments for patient age and sex, admission severity of illness, case mix, and hospital, Medicaid patients still had significantly longer lengths of stay and higher ancillary charges, although the effect was not as strong for ancillary charges. We suggest that this association between Medicaid status and length of stay and ancillary charges may be due to greater difficulty in discharge planning for Medicaid patients, health status differences not captured adequately in severity classification, and utilization review practices. The implications of these findings for hospital management, health care policy, and future research are discussed. PMID- 10143033 TI - Access implications of rural hospital closures and conversions. AB - This article examines the effects of rural hospital closures and conversions on various structural dimensions of access. Based on a data set of rural hospitals in Texas during the period 1985-1990, the results indicate that closure or conversion typically had relatively little detrimental effect on hospital services and distance to alternative sources of care, but hospital bed and physician availability may have been adversely affected in certain cases. Rural hospital conversions to alternative types of health care facilities, such as ambulatory care clinics, do appear to have maintained the availability of a restricted set of medical services in some rural areas. PMID- 10143034 TI - Rural hospital closures and access to services. AB - This article examines the implications resulting from the closure of 25 rural hospitals during 1990. The implications are evaluated by estimating travel distance and time to the nearest open hospitals. In addition, the types of services offered in the hospitals studied were measured to provide a view of potential change in access to services. The average travel distance and time to the nearest hospital after closure was 25.7 miles and 30.2 minutes, respectively. In most cases, the remaining hospitals offered a broader scope of services than did the hospitals that closed. A possible interpretation is that the hospital closures resulted in a tradeoff between breadth of services and rapid access for emergency conditions. PMID- 10143035 TI - Gender differences in factors affecting health care administration career development. AB - At first glance, a woman's prospects for a career in health administration seem encouraging. More than half of the recent graduates of health administration master's programs are female, and initially post-master's salaries are comparable with those of male graduates. Unfortunately, opportunities for promotion and financial benefits seem to decrease for women and expand for men as their respective careers progress. This study found that, with the same educational background, men earned an average of $51,491 annually, compared to $50,839 for women, in health care administration. We examined gender differences in organizational and individual factors that have been modeled as influences on career development. These factors include financial and nonfinancial benefits, access to training programs, success factors, demographics, and motivating factors underlying education, employment, and career choices. Some evidence of gender differences in the organizational and individual factors affecting career development is provided. Academic and professional strategies addressing these differences are suggested for consideration by both professional and university administrators. PMID- 10143036 TI - Evaluating nurse turnover: comparing attitude surveys and exit interviews. AB - High turnover rates among hospital nurses demand rigorous and valid processes of research to determine the reasons motivating such attrition. In most hospitals, the exit interview often provides the only relevant data. The case study reported here examines the relative effectiveness of exit interviews and an employee attitude survey in generating data that are useful in managing nurse retention. The conclusion reached is that the attitude survey generates more data and higher quality data. Further, the study shows that the use of open-ended questions can provide useful information and probably should be the starting point in developing or supplementing an attitude survey for nurses. Recommendations for improving the usefulness and validity of nurse attitude surveys and exit interviews in managing nurse retention are provided. PMID- 10143037 TI - Management education for nurses: hospital executives' opinions and hiring practices. AB - Because registered nurses are assuming expanded roles in hospital management, the appropriate educational preparation for these roles has become a widely debated issue. A national survey of hospital CEOs and CNOs was conducted to assess their personal preferences for management education for nurses and to gather information about their hospitals' policies and practices in hiring nurses for management positions at various levels within the hospital (from unit-level management to executive level). Both CEOs and CNOs preferred the joint MSN/MBA degree option as the best model for graduate management education for nurses, and they perceived greater demand in the future for hospital nurses with graduate management degrees. However, hospital policies and practices with regard to degree requirements and preferences for nurses hired in management positions at all levels varied widely. PMID- 10143038 TI - 9 lessons of value-driven leadership. How to position your organization for success while maintaining your values. PMID- 10143039 TI - Campaigning for your community. PMID- 10143040 TI - Institute for Diversity: a progress report. PMID- 10143042 TI - Serving and competing ethically. PMID- 10143041 TI - Healthier communities and the business of creating health. PMID- 10143043 TI - 1995 directory of management consulting firms. PMID- 10143044 TI - Taking the pulse of the community. AB - In recent years, the technology and methodology have been developed to help you identify, collect, analyze, and apply health status information about the community you serve. Called a population-based community health status assessment, this tool is not intended to help you identify "needs"--you probably already know what many of them are in your community. Rather, it allows you to develop precise indicators of the health status of the community in general as well as of specific subgroups with particular health problems and risk factors. The assessment is useful both for the data and insights it provides and for organizing, implementing, and evaluating community health improvement interventions. Seven steps for the successful design and implementation of a population-based community health status assessment follow. PMID- 10143045 TI - Managing change: an emerging new consensus. AB - The management of change has been a continuing concern for NHS managers. Suggests that many of the change processes over the last 25 years have been subject to fundamental flaws, preventing the successful management of change. Outlines a new approach for the management of change and examines the implications for management practice, the role of top management, and of external and internal consultancy/advisory resources. PMID- 10143046 TI - Evaluating National Vocational Qualifications: a European view of the experience of Mount Vernon Hospital. AB - Evaluates an in-house National Vocational Qualification Scheme at Mount Vernon Hospital. Examines the main issues of differing management and trainee perspectives, time and resource constraints and the non-transferability of the qualifications at present within a European context. PMID- 10143047 TI - Managing temporary nursing staff: nurse banks in Scotland. AB - Nurse banks are locally organized in-house sources of temporary nursing staff. Reports on a study of policy and practice in the management of nurse banks in the National Health Service in Scotland. The study was based on a census survey of all 55 NHS units in Scotland (100 per cent response rate). Examines management rationales in establishing a nurse bank, explores costs and benefits of managing a bank, and provides recommendations on good practice in maintaining continuity of care. PMID- 10143048 TI - The death (and rebirth?) of organization development. AB - Reviews the origins and development of organization development (OD) in health care. Examines how a set of original OD assumptions and values has changed through time, and suggests some foundations for a "born-again" OD. PMID- 10143049 TI - When the talking is over: using action learning. AB - Outlines the workings of action learning sets, team-building and cultural change, and explores the use of action learning methodology in the development of health care managers. Outlines the spin-off benefits of the implementation of action learning at Ashworth Hospital, such as self-discipline, commitment, improved morale, empowerment, etc. Concludes that it could be a powerful tool for future health-care management. PMID- 10143050 TI - Whose job is it anyway? The doctor/nurse debate. AB - The reduction in junior doctors' hours is a key objective for the NHS. Reports on the activities of junior doctors during randomly selected shifts over a four month period, in general medicine and obstetrics and gynaecology in a district general hospital. Raises issues of job design, stress management, work organization and general issues of staff training and professional restrictions. Points to the need for management action with regard to the training of all staff, the way the service production is organized and the introduction of multidisciplinary team working. PMID- 10143051 TI - Evaluating self-managed learning--Part 2: Accelerating management development in an NHS region. AB - Evaluates the use of self-managed learning (SML) in management development processes in health-care settings. Focuses on the application of SML to region wide management development initiatives in the South West Thames Region of the UK National Health Service (NHS) from the late 1980s onwards. PMID- 10143052 TI - Personal protective gear prices mixed. PMID- 10143053 TI - Baylor, Baxter and Bergen form one-stop supply chain. PMID- 10143054 TI - Integrated systems will exercise tight rein on purchasing. PMID- 10143055 TI - Operating room strategies: shining light into the surgical black hole. PMID- 10143056 TI - Litigation in medical education: retrospect and prospect. PMID- 10143057 TI - Patient-therapist sex: criminalization and its discontents. PMID- 10143058 TI - Did you think about buying her a cat? Some reflections on the concept of autonomy. PMID- 10143059 TI - Rethinking aspects of AIDS policy. PMID- 10143060 TI - Autonomy and rights: dignity and right. PMID- 10143061 TI - Who will hear? An examination of the regulation of hearing aids. PMID- 10143062 TI - Ethics. A code for the laboratory. PMID- 10143063 TI - Key trends in cost containment. Roundtable discussion. PMID- 10143064 TI - MDMS (medical decision making systems): practical issues, specific approaches. Part 2. PMID- 10143065 TI - Healthcare providers must abide by their ethical responsibilities. PMID- 10143066 TI - CFOs are passing too many bucks. AB - Although finance executives at not-for-profit hospitals and healthcare systems don't have a great record when it comes to fixed-asset returns, more CFOs are getting creative in pursuit of new methods to make their facilities' assets work harder. PMID- 10143068 TI - HHS to monitor new nursing home quality rules. PMID- 10143067 TI - Progressive Portland. The market has mastered managed care. Now attention is turning toward physician groups. PMID- 10143069 TI - Thomas opposes 'bundling' plan. PMID- 10143070 TI - Critics: Columbia tax argument doesn't add up. PMID- 10143071 TI - Employers, insurers center attention on primary care. PMID- 10143072 TI - Automatic patient record in spotlight. Sales of traditional products are expected to decline, leaving vendors to fight over emerging market niches. PMID- 10143073 TI - Walking seniors through first HMO takes a personal touch. PMID- 10143074 TI - Watch out for the danger signs as HMO enrollment increases. PMID- 10143075 TI - Conn. heart program has holistic approach. PMID- 10143076 TI - Hungry system eating up N.C. market. PMID- 10143077 TI - Mass. systems halt merger plans. PMID- 10143078 TI - Hospitals aren't rushing to adopt new drug test. PMID- 10143080 TI - Health systems neglecting real estate issues--survey. PMID- 10143079 TI - Investment firms banking less on healthcare. PMID- 10143081 TI - Conn., N.Y. hospitals feel pinch from budget cutting. PMID- 10143082 TI - U. of Missouri to seek offers. PMID- 10143083 TI - Study: Pa. heart bypass surgery growing safer, costs stabilizing. PMID- 10143084 TI - Indiana examines ramifications of proposed merger. PMID- 10143085 TI - Amarillo hospitals consider merger. PMID- 10143086 TI - Columbia suit adds fuel to fire of Omaha battle. PMID- 10143087 TI - New England will have uniform managed-care coverage by Blues. PMID- 10143088 TI - Managed care's positive impact. PMID- 10143089 TI - AMA proposals aim to bolster doc standing. PMID- 10143090 TI - AMA reports '94 losses, equity declines. PMID- 10143091 TI - Clinton seeks reduced health cuts. PMID- 10143092 TI - Deals have New Orleans market cookin'. PMID- 10143093 TI - HHS releases guidelines for providers' participation in fraud amnesty program. PMID- 10143094 TI - Mo. merger ruling may provide ammunition for not-for-profits. PMID- 10143095 TI - Grace division seen as more merger-friendly after spinoff. PMID- 10143096 TI - Managed-care groups may merge to create unified industry voice. PMID- 10143097 TI - Senators, not-for-profits set for duel. PMID- 10143098 TI - FTC clears two Va. hospital sales, but pushes settlement of Mich. deal without merger. PMID- 10143099 TI - Suit over Florida hospital on hold. PMID- 10143100 TI - Citizens challenge hospital's closure. PMID- 10143101 TI - 10,000 apply to osteopathic schools. PMID- 10143102 TI - Hospitals lack severance plans. PMID- 10143103 TI - Caremark to plead guilty in fraud case. PMID- 10143104 TI - Feds end Hill-Rom antitrust probe. PMID- 10143105 TI - HCFA warns Fla. hospital over ER woes. PMID- 10143106 TI - Mich. group envisions expansive data network. PMID- 10143107 TI - Iowa hospital groups team up. PMID- 10143108 TI - Its feeding frenzy over, HBO & Co. must deliver. PMID- 10143109 TI - Los Angeles County faces lost Medi-Cal revenues in computer system debacle. PMID- 10143110 TI - Growth in information system expenditures will continue, study projects. PMID- 10143111 TI - Colo. hospitals post high profits and lower costs. PMID- 10143112 TI - Group advances method to weigh value of new medical technology. PMID- 10143113 TI - Columbia leaps into Mass. market. PMID- 10143114 TI - Survey shows steady growth in hospitals' drug expenses. PMID- 10143115 TI - State probe shows Dana-Farber failed to follow basic protocols. PMID- 10143116 TI - Malpractice claims, premiums continue to indicate stability. PMID- 10143117 TI - University of Kansas to study troubled transplant program. PMID- 10143118 TI - Counties would get Medicaid funds under Texas' managed-care plan. PMID- 10143119 TI - Insurers, AHA-IRI (AHA Insurance Resource Inc.) to develop products. PMID- 10143120 TI - More workers uninsured--study. PMID- 10143121 TI - Hospital studies life-support withdrawal. PMID- 10143122 TI - Maine hospitals in taxing dilemma. PMID- 10143123 TI - Few listening to warnings over Medicaid. PMID- 10143124 TI - Marketing fitness centers. Riverside Health System, Newport News, VA. PMID- 10143125 TI - Getting to the heart of the matter. St. Francis Hospital of Evanston, IL. PMID- 10143126 TI - The survival of Samaritan Medical Center ... Watertown, NY. PMID- 10143127 TI - Lutheran General repositions itself. Lutheran General Health System, Park Ridge, IL. PMID- 10143128 TI - Franklin Square enhances residency recruitment package. Franklin Square Hospital Center, Baltimore, MD. PMID- 10143129 TI - Caring for kids. NorthShore Regional Medical Center, Slidell, LA. PMID- 10143130 TI - Highlands Regional goes for growth. Highlands Regional Medical Center, Prestonsburg, KY. PMID- 10143131 TI - Riverside licenses successful hospital-based fitness centers. Riverside Health System, Newport News, VA. PMID- 10143132 TI - When tempers flare. PMID- 10143133 TI - Healthcare reform: what happened? PMID- 10143134 TI - Quality function development. PMID- 10143135 TI - Scheduling: if your RIS cannot, perhaps your HIS can. AB - As the services radiology departments provide have proliferated--new modalities, additional procedures--the scheduling process has become more complex. Radiology departments have been criticized by referring physicians and their staff for difficulties they encounter when scheduling patients for procedures. In light of managed care and increased competition for outpatient services, scheduling systems should be designed with the referring physician's office as the prime customer. Vanderbilt University Medical Center (VUMC) has devised a collaborative, hospital-wide system for scheduling. The same system is used by The Vanderbilt Clinics, which refer a significant number of outpatient procedures to VUMC. The radiology department has tailored the system to its technical requirements, and clinic staff members can access the system directly to schedule patient appointments. Minor adjustments were made during implementation of the process. Now, appointments are made efficiently by the clinic staff, and other systems, such as the film library, are benefiting from better information and organization. VUMC has changed the scheduling process of the radiology department to reach the customers who actually promote the radiology practice. Communication between the department and the clinics has improved and a spirit of teamwork is growing. PMID- 10143136 TI - CQI: using the Hoshin planning system to design an orientation process. AB - The Hoshin planning system, developed in Japan after World War II, includes management tools intended specifically for planning new processes. There are seven tools, which can be used individually or in any combination: affinity diagrams, interrelationship digraphs, systematic diagrams, matrix diagrams, process decision program charts, arrow diagrams and prioritization matrices. The radiology department at Carson-Tahoe Hospital formed a CQI team to improve the training of front office clerks. The team quickly discovered that a new orientation program was needed and decided to use Hoshin tools to create one. Using the tools, the team identified and prioritized all relevant factors, described specific tasks needed to complete the planning process and how long each would take, anticipated problems, and assigned areas of responsibility to members of the team. Each time the team grew weary or discouraged, the clarity and organization afforded by the tools helped them feel productive and in control of the process. The team was amazed at the creative ideas they generated through this 3-month-long process. Not only did they develop and implement a new orientation program, they also cultivated a stronger sense of pride and confidence in their work and each other. PMID- 10143137 TI - The impact of work rewards on radiographers' organizational commitment. AB - Organizational commitment is an affective work outcome that has been used to predict work-related behaviors such as turnover, absenteeism and intent-to-leave. There has been little research in organizational commitment for the allied health professions and no empirical studies in the radiologic sciences. The purpose of this study was to examine the predictive value of selected intrinsic and extrinsic work reward variables--involvement, significance, autonomy, general working conditions, supervision and salary--on staff radiographers' organizational commitment. In this study of 600 full-time staff radiographers in North and South Carolina, supervision (for ages 20-37 years) and involvement (for ages 38-66 years) were significant predictors of organizational commitment. The results of the study indicate that healthcare organizations should provide potential supervisors with managerial training, especially for radiographers who move to supervisory positions based on clinical skills and years of experience. In the long run, such programs are much less expensive than costs associated with replacing employees who leave the organization because of low organizational commitment. Also, management strategies and programs to redesign and enhance job tasks may help maintain or increase organizational commitment. PMID- 10143138 TI - AHRA (American Healthcare Radiology Administrators) survey. Trends in radiology 1994: Part I. AB - Departments of medical imaging and therapy must balance the need to improve delivery and efficiency with the need to lower costs by finding better ways to deliver their services. As each department struggles to find its way, new trends will develop. In October, 1994, the AHRA surveyed its membership to determine those trends in hospital and nonhospital facilities. This article presents data and analysis for equipment acquisition and maintenance; operations; staffing and professional coverage; education programs; competition; marketing and new programs. Demographic information and comparisons with AHRA Trends Surveys conducted in 1985, 1987, 1989 and 1991 are included. Editor's Note: Part II of this article will review trends in exam volume, charges and volume from referral sources. Also, data from hospital departments will be analyzed by bed size groupings. Part II will be published in the summer, 1995, issue of Radiology Management, 17(3). PMID- 10143139 TI - Time to switch to an HMO? Managed-care plans offer Medicare enrollees a way to save money. PMID- 10143140 TI - The role of animation as a program development strategy. AB - As an approach to community organization, animation involves the activation of people to take responsibility for their own affairs, with the aim of achieving their own, self-defined ends. The authors analyze the use of animation as a strategy of social program development undertaken by a nonprofit organization to initiate a clubhouse serving people with serious mental illness. Six animation strategies and their impact on the local community, sponsoring organization, and subsequent clubhouse program development are examined. The authors recognize the intensive resource requirements of animation, but they conclude that successful animation results in a program that enjoys high levels of community support, understanding, and legitimacy. PMID- 10143141 TI - The effect of characteristics of human service workers on subsequent morale and turnover. AB - The authors examine the relationship of sociopsychological characteristics of human services workers to their subsequent morale and continuance on the job. Eighty-two intensive case managers (half of them social workers) who had caseloads of clients with severe mental disorders were invited to participate in a four-wave panel study. Explored are the relationships between 16 predictors (general background, prior work experience and training, and social psychological variables) and worker outcomes (beliefs, attitudes, perceptions, and turnover). The major finding was that better personal well-being at the time of hiring was the most consistent and significant predictor of lower burnout, higher job satisfaction, and generally higher worker morale at later points in time. Those from higher social class backgrounds and those with lower starting salaries were more likely to leave the job. Those workers with more experience had a tendency to perceive greater client improvement. PMID- 10143143 TI - Security vs. personal growth. PMID- 10143142 TI - Doing a difficult task "right": firing employees. PMID- 10143144 TI - Inverting the pyramid--healthcare management for the year 2000. PMID- 10143145 TI - The decline of a 15-year incline. The impact of financial trends on medical imaging. PMID- 10143146 TI - Meeting the challenge of marketing your breast center. PMID- 10143147 TI - Medicare HMOs: how your practice can reduce the federal deficit. PMID- 10143148 TI - Day-case laparoscopy revisited: have post-operative morbidity and patient acceptance improved? AB - Previous studies of day-case laparoscopy have indicated considerable post operative morbidity, with high incidences of nausea, vomiting and pain, often resulting in overnight admission. These studies also indicate that 30% of patients would have preferred an overnight stay. Changes in day surgery anaesthetic practice since then have included the wider use of non-steroidal analgesics and the specific use of propofol, a new short acting anaesthetic drug, with improved recovery and anti-emetic properties. We audited 74 patients who had day-case laparoscopy for diagnosis or sterilisation, and found that the incidence of nausea and vomiting was lower than any previously recorded, and mean pain scores were minimal. No patient was admitted for recovery problems, despite the inclusion of afternoon procedures; two patients only were admitted for surgical complications. Despite considerable morbidity after their return home, only 8% of patients said they would have preferred an overnight stay. Changes in anaesthetic practice would seem to make day-case laparoscopy a more acceptable procedure than previously reported. PMID- 10143149 TI - Patients, health care workers, and latex allergy. PMID- 10143150 TI - Behavioral medicine: taking its place in the mainstream of primary care. PMID- 10143151 TI - Behavioral disorders: an unrecognized epidemic with implications for providers. AB - It is reported that behavioral and mood-related problems are associated with more than 25% of medical visits. Many patients seeking help are misdiagnosed or not effectively treated by their physicians. We believe that medical education has not prepared primary care providers to evaluate and treat behavioral problems. The traditional medical or biological model needs to be replaced by a more integrated and comprehensive biopsychosocial approach. HMO delivery systems should take the lead in developing this new framework for care. PMID- 10143152 TI - Pain management program. PMID- 10143153 TI - Personal health improvement program. PMID- 10143154 TI - Arthritis self-help course. PMID- 10143155 TI - How to help patients stop smoking. PMID- 10143156 TI - Behavioral medicine pain program. PMID- 10143157 TI - Behavioral medicine and the primary care provider: a view from the trenches. PMID- 10143158 TI - The role of medical staff in a changing marketplace. PMID- 10143159 TI - Abortion counseling and physician conscience. PMID- 10143160 TI - United Health Plan bridges gap between HMOs and community health centers. PMID- 10143161 TI - A psychiatric day hospital program in an HMO. AB - A model Psychiatric Day Hospital program developed in an HMO is described. The HMO and the Day Hospital program's function within the spectrum of adult psychiatric services of the organization are discussed. This program has enhanced the quality of the clinical care provided. Three measurements demonstrate the success of the program. Such a program is ideally suited to the needs of an HMO. PMID- 10143162 TI - Manage the difficult patient to reduce malpractice risk. AB - Managed care is becoming the predominant model of health care delivery in the United States, and cost containment pressures are being felt by physicians and patients alike. As a result, the doctor-patient relationship is being subjected to greater pressures and conflicts. These conflicts can result in patients being viewed as "difficult." Difficult patients represent a clinical challenge which many providers feel unprepared to address. When difficult patients become dissatisfied and angry with care, a professional liability claim can result. This article presents difficult patient cases and management recommendations, along with evaluation results of three seminars based on the difficult patient concept. PMID- 10143163 TI - Use of self-care manual shifts utilization pattern. PMID- 10143164 TI - Effects of managed care on the laboratory. The Rochester, New York experience. AB - This analysis was performed in an attempt to understand how managed care affects laboratory utilization and costs, specifically on a nonpatient basis, as well as overall health-care expenditures. Rochester, New York, was chosen as an initial case study because it is a well-documented, studied, and mature managed care market. PMID- 10143165 TI - Developing key laboratory performance indicators: a feasibility study. Potential roles for CLMA. AB - The challenges (and opportunities) for laboratory management posed by cost control, managed care, information networks, and health system integration call for both short- and long-term responses. In rapidly evolving markets, new measures are needed to assess how effectively laboratories manage the information process. The objective of the research described in this report was to determine the feasibility of a system that would collect, analyze, and report nationally standardized indicators of laboratory performance and that would meet the needs of health system executives, managed care plans, and external agencies, as well as laboratory service providers. The feasibility study involved extensive interviews with a broad cross-section of the health-care industry, as well as a literature search of journals, newspapers, marketing brochures, and other documents addressing comparative performance assessment in the health-care industry. The study investigated the current status of comparative performance assessment in the health-care industry. We found that there are several important lessons laboratorians can learn from the experiences of others involved in key indicator development and performance assessment: Key indicators must measure those aspects of performance that are important and meaningful to laboratory customers. Indicators developed for laboratory management performance should be compatible with performance criteria established in other health-care sectors, particularly those that represent managed care and other customers of laboratory services. The identification of participants in the process of consensus development should be as inclusive as possible if the indicators are to gain wide acceptance. Standardized definitions and data collection rules are essential for data comparability. Credibility is key. It is necessary that the chosen measures be not only reliable, valid, and easy to implement, they must also be demonstrably related to patient care outcomes. In order to make meaningful interlaboratory comparisons, an effective system for peer groupings is also required. Currently available systems for collecting and reporting laboratory performance data were also reviewed.(ABSTRACT TRUNCATED AT 400 WORDS) PMID- 10143166 TI - Successful negotiations. Develop your personal strategy for negotiating. AB - Successful managers are successful negotiators. This article addresses how to develop a negotiation strategy that fits an individual manager's personality and objectives. The authors provide 12 rules aimed at developing that personal strategy and also define the elements of power, skill, and timing, and their relevance to the negotiating process. PMID- 10143167 TI - The quintessence of quality in the clinical laboratory. AB - Providing quality service is the goal of laboratory managers. The quintessence of clinical laboratory quality is the provision of an appropriate service--either medical information or some other service--that can be shown to measurably satisfy a patient's medical need and can be tied to patient outcome. Traditional quality measures, such as laboratory inspections and proficiency testing surveys as used by CLIA'88, are not the optimal yardsticks to apply. More effective programs are needed, such as the CAP's Q-Probes, that link laboratory operations with documented desired patient outcome. Only when a laboratory can define quality in a way that allows it to be quantitatively assessed in terms of patient care can it really know if it is providing optimal service. PMID- 10143168 TI - "Maxim"izing time. AB - "You have to live on this 24 hours of daily time. Out of it you have to spin wealth, pleasure, money, content, respect, and the evolution of your immortal soul. Its right use, its most effective use, is a matter of the highest urgency...all depends on that."--Arnold Bennett The items presented here are not meant to contain all the answers to your time management challenges. However, these thoughts should spark your thinking process. Take these ideas, turn them over in your mind, play with them, develop your own thoughts on the subject, and force yourself to become more effective, more efficient, and more systematic. Acquiring this discipline now will ensure the most efficient path to your life's dreams. PMID- 10143169 TI - Whither outcomes? PMID- 10143170 TI - Live "free" or die? Will New Hampshire and other Medicaid high fliers be big losers in Medicaid reform? PMID- 10143171 TI - MediCrunch. A federal Medicaid cap will only shift the pain to the local level. PMID- 10143172 TI - Winners and losers. States could suffer as Congress divides the Medicaid pie. PMID- 10143173 TI - Medicaid: a policy menu. Congress has more options for Medicaid than some suspect. PMID- 10143174 TI - TennCare: reforming Medicaid with markets. Tennessee's year-old Medicaid reform is working. PMID- 10143175 TI - Sound concept, unhealthy in practice ... but at great expense to providers and patients. AB - Those states considering implementation of a TennCare-type program should learn from Tennessee's mistakes. Enough lead time should be allowed for the development of the program and for patients and providers to learn about the new program. It should be actuarially should and have strong oversight with provider input. Finally, it should be done in an open forum to allow public accountability. PMID- 10143176 TI - Giving Medicaid back to the states. Medicaid block grants will send unwanted ripples through the health system. AB - If Medicaid is given back to the states in a form that caps federal funds, many states with growing poor populations will be severely damaged... Services will be cut back, access will be compromised, maintenance and replacement of buildings and equipment will be delayed and new technology will not be acquired. Eventually services will be terminated; institutions will close or will relocate to areas where they can survive. PMID- 10143177 TI - Arizona AHCCCS--back from the dead. What had seemed like bitter failure is now touted by independent studies as a model for reform. PMID- 10143178 TI - The Medicare Transaction System Initiative. AB - Here is a progress report on the Medicare Transaction System Initiative originally reported in these pages about two years ago. In addition, the author describes some of the interim steps HCFA is taking in preparation for the move to MTS. PMID- 10143179 TI - Adding, defining and measuring value. AB - Suppliers to the health care industry are changing relationships with their customers by forging partnerships that blur the boundaries between them. Here, representatives from several suppliers discuss what programs and services the market has driven them to offer. PMID- 10143180 TI - Quality improvement, OrNda style. PMID- 10143181 TI - A memo from the central office: the "Ethical and Religious Directives for Catholic Health Care Services". AB - In 1994, the National Conference of Catholic Bishops revised the "Ethical and Religious Directives for Catholic Health Care Services." A goal of the Directives is to maintain the moral integrity of Catholic health care institutions and to address controversies in bioethics and health care. The Directives represent a shift to an exclusively principle-based approach to moral reason. This shift threatens to undermine the very tradition that the bishops seek to protect. PMID- 10143182 TI - The goodness of fragility: on the prospect of genetic technologies aimed at the enhancement of human capacities. AB - Beginning with the assumptions that genetic technology will make possible the enhancement of some significant human capacities and that our society will have self-evident reasons to pursue such enhancements, this essay suggests less evident reasons to proceed with extreme caution. The essay asks: Will we, in our attempts to enhance humans by reducing their subjection to chance and change, inadvertently impoverish them? It explores how technologies aimed at enhancement might affect the good that is our experience of some forms of the beautiful and the excellent, the good that is relationships of care, and the good that is diversity across the life span. In the end, it speculates about the fundamental philosophical difference that underlies the disagreement between those who would tend to embrace a project to enhance human capacities and those who would tend to criticize such a project. PMID- 10143183 TI - Scope Note 28. Eugenics. PMID- 10143184 TI - Negotiating the moral order: paradoxes of ethics consultation. AB - Ethics consultation at the bedside has been hailed as a better way than courts and ethics committees to empower patients and make explicit the value components of treatment decisions. But close examination of the practice of ethics consultation reveals that it in fact risks subverting those ends by interpolating a third (expert) party into the doctor-patient encounter. In addition, the practice of bioethics through consultation does the broader cultural work of fashioning a shared moral order in the face of manifestly plural individual commitments. In doing so, however, bioethics furthers medicine's position as a privileged domain of public moral discourse in contemporary American society. PMID- 10143185 TI - "Any willing provider". AB - Before the managed care revolution, we had a costly, fragmented, disjointed, uncoordinated system of healthcare that at one time in our recent history caused the President and his wife to propose massive political reforms. While those reforms were being endlessly debated, the market reformed itself. The electorate reinforced their displeasure over big government by electing a Republican majority in Congress. But, as someone once said, those who forget history are bound to repeat it. At least some of the electorate are forgetting how they originally felt when the Clinton-style big government reforms were rejected. By all accounts, HMOs, integrated health systems, physicians and the general public have a lot to loose, if anti-managed care legislation prevails. The sad fact is that, in states where the issues have been brought to a head, emotions have clearly outpaced facts. Once it hits the "tabloids" it appears that there's no going back. Fears rule actions and the many studies being produced about HMO quality don't seem to make a difference. Perhaps those with the most to lose are the physicians, hospitals and insurers who have gone down that long, difficult and costly road to creating integrated health systems that can actually deliver superior care. The investment in time and talent has been enormous. The existing regulatory hurdles have been steep. Now they face another layer of bureaucracy and complexity in certain states. Given the stakes, it might just be time to fashion "swords into plow shares" as they've done in Colorado. It may beat the alternatives. PMID- 10143186 TI - Gearing up for changes. Interview by Damon Braly. PMID- 10143187 TI - Telecom use grows for regional data access. PMID- 10143188 TI - Tying outcomes to cost and quality. PMID- 10143189 TI - Decision-support systems aiding new care delivery. PMID- 10143190 TI - HotList. Financial decision-support tools. PMID- 10143191 TI - I/T can save $159 billion per year. PMID- 10143192 TI - Physician recruitment after Hermann Hospital. AB - The state of physician recruitment changed after the Internal Revenue Service required Hermann Hospital to publish its closing agreement with the IRS. The closing agreement released the long-awaited IRS "Hospital Physician Recruitment Guidelines." The IRS' recently proposed revenue ruling provides additional insight on acceptable physician recruitment practices as well. PMID- 10143193 TI - The False Claims Act: an old weapon with new firepower is aimed at health care fraud. PMID- 10143194 TI - Nursing, employment, and resource allocation in a reorganized National Health Service. PMID- 10143195 TI - Nursing legal issues in Australia: the nurse practitioner. PMID- 10143196 TI - Preferred provider organization structures and agreements. PMID- 10143197 TI - Potential anticompetitive effects of most favored nation contract clauses in managed care and health insurance contracts. PMID- 10143198 TI - The aftermath of HMO insolvency: considerations for providers. PMID- 10143199 TI - Removal of standard setting requirements for medical and nonmedical facilities where SSI recipients reside--HHS. Final rule. AB - This notice removes from the Code of Federal Regulations the provisions on standard setting requirements for medical and non-medical facilities where Supplemental Security Income recipients reside. These standard setting requirements implement the requirements of the Keys Amendment, Section 1616(e) of the Social Security Act, as amended. This action is necessary because, as of March 31, 1995, Federal responsibility for the Keys Amendment will be assumed by the independent Social Security Administration as required by statute. PMID- 10143200 TI - Who's minding the data: information system requirements for participating in at risk contracts. AB - Managed behavioral healthcare organizations that receive capitated payments to provide behavioral healthcare services for a defined population need sophisticated management information systems that allow for two-way data exchange with payors. Such systems must be able to generate data on cost per service and utilization of services by beneficiary population, while incorporating a number of subsystem capabilities. In this article the author reviews the requirements for such an information system, the various potential financial loss points that have made such capabilities essential and the specific features that are demanded -as well as offering suggestions on how to select an information system vendor. PMID- 10143201 TI - Behavioral health at-risk contracting--a rate development and financial reporting guide. AB - The process of developing rates for behavioral capitation contracts can seem mysterious and intimidating. The following article explains several key features of the method used to develop capitation rates. These include: (1) a basic understanding of the mechanics of rate calculation; (2) awareness of the variables to be considered and assumptions to be made; (3) a source of information to use as a basis for these assumptions; and (4) a system to collect detailed actual experience data. PMID- 10143202 TI - Dialogue: ethical hazards of capitation contracting. Antidotes to the incentive for under-treatment. PMID- 10143203 TI - Dialogue: ethical hazards of capitation contracting. Legal and ethical concerns. AB - In summary, the challenge to managed care is whether it ultimately will fulfill its potential to create comprehensive, coordinated systems of care which have the potential to ease rather than exacerbate the legal and ethical dilemmas noted in this discussion. PMID- 10143204 TI - Dialogue: ethical hazards of capitation contracting. The dangers of at-risk contracting. PMID- 10143205 TI - At-risk contracting: preparing to deliver what purchasers want. AB - Behavioral healthcare organizations wishing to enter the "brave new world" of capitated and at-risk contracting must understand the various categories of healthcare purchasers and risk contracts, as well as the perspectives and goals of those purchasers. The following article also identifies some critical elements in successful at-risk contracting and next steps for providers in such areas as quality improvement, outcomes management and accessibility. PMID- 10143206 TI - How to develop collaborative outcomes management programs with managed care vendors. PMID- 10143207 TI - Computer-based patient records: challenges to implementation. AB - In summary, behavioral healthcare organizations are faced with an environment which is demanding that cost and quality decisions be made based upon the information gleaned from patient records. The challenge before the industry is how best to collect, store, retrieve and disseminate this information to key decision makers. The CPR has been identified as one means of addressing this challenge. Hopefully, the results of this study will help behavioral healthcare organizations in developing a CPR system to meet this challenge. PMID- 10143208 TI - What we already know about healthcare reform. PMID- 10143209 TI - Committees get down to business. PMID- 10143210 TI - The role of capitation in quality behavioral healthcare systems of the future. AB - Capitation is more than just a challenge for the behavioral healthcare industry. It also presents an opportunity to develop comprehensive systems of care--driven by the appropriate use of technology and of quality methods--that will meet the needs of designated populations. PMID- 10143211 TI - Teamwork at the Detroit Medical Center. Bridging the gap. AB - In 1992, Harper Hospital, a part of the Detroit Medical Center, initiated a Quality Enhancement and Clinical Resource Management (QE/CRM) program. The program was designed to be physician-driven and multidisciplinary. Its goal is to "look closely and critically at the appropriate use of clinical resources to affect the most desired outcomes." Through the use of teams for different clinical services, led by physicians and comprised mainly of physicians, quality of care and cost issues are identified and investigated. Changes to practice have occurred that have not only improved outcomes and saved the medical center money, but prepared it to go to managed care. PMID- 10143212 TI - Technology management in an information age. AB - Healthcare spending in this country is approaching 15% of the gross national product (GNP) while 1.4 million more Americans have become uninsured in the past 12 months. Although we spend nearly twice what some industrialized nations spend, an increasing number of people do not have access to our healthcare system. To complicate matters, healthcare reform legislation has stalled, leaving hospitals without a clear sense of direction. Yet, even without federal mandates, hospitals need to be more cost effective. Reform will occur regardless of whether it is driven by legislation, private payers, or marketplace competition. Successful hospitals in the post reform era will maintain or raise their quality standards while reducing operating expenses. The key question is: How can one do more with less? The answer, of course, is better resource management. To achieve real gains, however, it will be important to think of these resources in new ways. Typically hospitals have focused on managing human and capital resources, and many have undertaken initiatives to improve productivity and preserve financial reserves. But to be successful in the new era, you must define resources in non traditional ways, then develop new strategies to manage them. This article suggests that technology is a resource that can be managed. A straightforward method for identifying a manageable, representative set of core technologies will be described. Once this informational baseline is established, the costs associated with a hospital's technology infrastructure can be estimated and summarized. Then, "if you can measure it, you can manage it." A template for a four-phase technology management program is proposed. PMID- 10143213 TI - Risk managers: an underused strategic resource. PMID- 10143215 TI - The benevolent autocrat: is it the right fit for you? PMID- 10143214 TI - Federal Acquisition and Streamlining Act threatens health purchasing for private sector. PMID- 10143216 TI - The leap to automating clinical pathways. AB - Managing care is one of the most pressing concerns in today's healthcare environment. There are a mind-boggling number of approaches an organization can take to realize cost and quality goals. These range from case management and paper clinical pathway systems to work redesign and computerization. Often an organization's first step toward better care management is to implement some form of clinical pathway system. For most, this is a struggle that results in little success, but this is not always the case as demonstrated by Overland Park Regional Medical Center, a Columbia/HCA facility (Overland Park, KS). There the next step in success is to streamline care delivery through computerized clinical pathways. PMID- 10143217 TI - Will shared rooms in LTC facilities become a thing of the past? PMID- 10143218 TI - Intimate strangers. When roommates clash, caregivers can ease the tension--or make it worse. PMID- 10143219 TI - 1995 retirement housing survey. Retirement housing: the top providers. PMID- 10143220 TI - Senior housing comes of age. Cautious but steady growth characterizes the industry. AB - This is the fourth year that Contemporary Long Term Care, in conjunction with Senior Housing Investment Advisors, Inc., has prepared a report on the state of the senior housing industry. This year's report is based on the comments of 22 industry experts. Vast changes in our nation's political landscape, in conjunction with an improved awareness of the senior housing market, are shaping the growth of this business into the 21st century. The answers to the following questions offer perspective on some of the factors impeding and enabling that growth. PMID- 10143221 TI - Healing more than wounds. Interview by Yvonne Parsons. PMID- 10143222 TI - Providers win rulings on crossover claims. PMID- 10143223 TI - Medical savings accounts--an idea whose time has come? PMID- 10143224 TI - When parents kill. How do you deal with the unthinkable? PMID- 10143225 TI - Leadership paves way to good service. PMID- 10143226 TI - Simply the best. PMID- 10143227 TI - What happens to corpses? Death doesn't have to be a mysterious subject. PMID- 10143228 TI - Tales from the crypt. PMID- 10143229 TI - Shall we play a game? Has experience changed your view on death? PMID- 10143230 TI - Cruisin' the information superhighway. Learn how to enter the world of cyberEMS on the Internet, online services and BBS systems. PMID- 10143231 TI - In a bind. A lawsuit forces L.A. medics and police to reexamine their policy on applying restraints. PMID- 10143232 TI - The sick and the dead. The door to the spirit of EMS is coming off its hinges. PMID- 10143233 TI - Keep your cool. Feelings ... nothing more than feelings. PMID- 10143234 TI - Benchmarking. Remove the blindfold and hit the target. PMID- 10143235 TI - Environment of care. Organize to find your way through the maze. AB - The Environment of Care and the Orientation, Training, and Education sections of the JCAHO manual will be important parts of the 1995 survey process. All departments must be able to describe their role in both programs, as well as demonstrate compliance with them. Staff knowledge of the two programs is also critical since 40-50% of the survey process will be devoted to asking staff members questions concerning their role in each of the two programs. Organizing the manual as described will force you to examine each section closely. As each section is completed, you will accomplish two goals. First, you have complied with the requirements because you have developed departmental programs geared towards EOC. Second, by developing these sections, you have created a basic training outline for your staff. If you organize and gather the data described in this article, the development of your training programs will be much easier. Most of you have all of the tools required to comply with both programs, but by organizing them in an efficient and orderly fashion, you will assure yourself a much easier time complying with the new EOC standards. PMID- 10143236 TI - Challenge: how to enhance socialization & generate revenue in a continuing care retirement community. PMID- 10143237 TI - Healthcare foodservice report 1995. Designing menus for survival. PMID- 10143238 TI - Healthcare foodservice report 1995. Designing menus for survival. Factoring in flavor. Interview by Donna Boss. PMID- 10143239 TI - Healthcare foodservice report 1995. Designing menus for survival. Replacing the printed menu. Interview by Karolyn Schuster. PMID- 10143240 TI - Healthcare foodservice report 1995. Designing menus for survival. Making selectivity efficient. Interview by Paul King. PMID- 10143241 TI - Healthcare foodservice report 1995. Designing menus for survival. Going nonselect systemwide. Interview by Paul King. PMID- 10143242 TI - Healthcare foodservice report 1995. Designing menus for survival. Branding for profitability. Interview by Carol Carangelo. PMID- 10143243 TI - Garbage wars '95. A mid-decade report. AB - Noncommercial foodservice operators continue to participate in solid waste recycling & source reduction programs in high numbers. While the global results are uncertain, many operators report local success. Their efforts have reduced landfill waste & saved their institutions money. PMID- 10143244 TI - An FDA guide to choosing medical treatments. PMID- 10143247 TI - FBI agent: hospitals should seek training in proper infant footprinting. PMID- 10143248 TI - Special report. Complying with the 1995 JCAHO security and safety standards: Part I. AB - Leading consultants agree that complying with 1995 inspections by the Joint Commission on Accreditation of Healthcare Organizations will amount to the difference between an oral and a written exam: inspectors are expected to place more emphasis on quizzing all kinds of hospital employees about safety and security issues, and less on reviewing security paperwork and documents. The consensus is that hospitals that have been in compliance shouldn't have any worries about meeting the new standards, although there is some disagreement about the extent to which they will have to adapt. Initiated to set standards for patient care, JCAHO has been placing increasing emphasis lately on safety and security. The latest refinements are reflected in its 1995 Comprehensive Accreditation Manual. Terminology has been changed, security and safety standards added, and the responsibility for security has been spread throughout the organization rather than placed just on the shoulders of the security and safety departments. In Part I of this report, we'll present the viewpoints of consultants who have been heavily involved in assisting hospitals to successfully comply with the latest standards, as well as the experiences of one security director. Next month, in Part II, we'll present the latest viewpoints of JCAHO, plus the experiences of other security directors from around the country in meeting the current JCAHO challenge. PMID- 10143254 TI - Medicare and the federal budget: the truth behind the rhetoric. PMID- 10143253 TI - How can you change the system without knowing what to change?. Interview by C. Burns Roehrig. PMID- 10143246 TI - Massive upgrade of fire-damaged wing continues at Tampa hospital. PMID- 10143249 TI - How hospital tightened security following two kidnapping incidents. PMID- 10143245 TI - Safety programs credited with sharp drop in accidents, comp claims. PMID- 10143250 TI - Physicians in transition: retraining in primary care. PMID- 10143251 TI - Graduate medical education: what does the future hold?. Interview by Laurie Hall. PMID- 10143252 TI - IM match continues upward trend in 1995. PMID- 10143255 TI - Internist or family practitioner--who is the logical choice? PMID- 10143256 TI - Do our children need to die of AIDS for politics? PMID- 10143257 TI - Medical savings accounts. American Society of Internal Medicine. PMID- 10143258 TI - Does internal medicine training make you an internist? PMID- 10143261 TI - Strategic aspects of the purchasing process in the Finnish hearing instruments business. AB - Discusses the Finnish hearing instrument market which, in the past decade, has been characterized by both closed and shared markets. Indicates there has been some formal competition, but real price competition has not influenced the resharing of market shares. Finds that the current recession has forced hospitals to re-evaluate their purchasing criteria. Investigates the process with the help of industrial marketing theories to determine the strategic means which can be used to create competitive advantages. The new automatic data-processing (ADP) based high technology in the hearing-instrument business provides opportunities for identifying these advantages. Surveys the abilities of hearing-centre personnel in university hospitals to take advantage of ADP-based tools. Shows that hearing-centre personnel have a low level of ADP knowledge and, thus, a great need for ADP training. Discusses the ADP-based strategy chosen to be AP Medical Hearing Ltd's main strategy and emphasizes the importance of ADP-based training in high technology. PMID- 10143259 TI - Learning theory and the design of training in a health authority. AB - Gives an explanation of the salient factors which affected the design of a training intervention aimed at clinicians in West Birmingham Health Authority. Discusses the theoretical considerations relevant to learning in an organization, using a case study to illustrate. PMID- 10143260 TI - The effects of advanced information technology on organizational design. AB - Illustrates several issues associated with the effects of advanced information technology on the organizational design function. Explores the relationship between technology and organizational design. Cites some early empirical studies and identifies with some contemporary challenges. Also mentions implications for new organizational forms within the context of a realigned health-care industry perspective. Concludes that organizational theorists and information systems scholars must integrate their efforts in order to appreciate the changes within this field of management theory, thought and practice. PMID- 10143262 TI - Managing nurse absence. AB - Examines in detail the issue of absence among nurses in the National Health Service (NHS) in the UK. Three main objectives are to: investigate levels and reasons for absence among nurses; assess the abilities of NHS management to monitor and control nurse absence effectively; and examine the impact of nurse absence on organizational costs and care delivery. Draws on data generated from four linked studies: a survey of back-injured nurses, conducted in 1992; a survey of 4,000 qualified nurse members of the Royal College of Nursing, conducted in March/April 1993; a postal survey of 119 NHS employing units, conducted in May/June 1993; and detailed case studies, conducted with management in ten NHS hospital sites in May/June 1993. PMID- 10143263 TI - The evolution of biomedical equipment technology. AB - This feature article presents an overview of how the biomedical equipment technology field developed. It begins with some of the early medical equipment breakthroughs, such as the discovery of X rays. The article then traces the key role of the military in electronic technology design, leading to the concept of specially trained individuals to maintain medical equipment. The Technical Education Research Center is discussed, along with the evolution of BMET schools. Formal BMET education had a strong advocate in Ralph Nader, whose concerns about electrical safety in hospitals supported the need for trained technicians to test medical equipment. BMET certification, BMET careers, and Clinical Engineering are discussed. The article concludes with some speculation on healthcare reform and its possible effect on the biomedical equipment profession. PMID- 10143267 TI - Training with cadavers. A class act. PMID- 10143264 TI - Before the call comes in. EMS and injury prevention. PMID- 10143266 TI - The tying game. How effective are body-to-board strapping techniques? PMID- 10143265 TI - After the bomb. Oklahoma City rescuers talk about their experiences. AB - Rather than trying to write a second-hand description of the response to the April 19 bombing of the Federal Building in Oklahoma City, we thought we'd let some of the people who were there caring for patients and searching for victims share their experiences in their own words. Marion Angell Garza, JEMS editorial/news coordinator, spoke at length with six responders, including paramedics, the triage and treatment officer, a firefighter/EMT-1 and an emergency physician. The following excerpts are from those interviews. PMID- 10143268 TI - HIV and AIDS. An EMS perspective. PMID- 10143269 TI - GIS (geographic information systems) in Raleigh County. Small towns with a big database. PMID- 10143270 TI - Infection control for our patients and ourselves. PMID- 10143271 TI - A logit analysis of the likelihood of leaving rural settings for registered nurses. AB - This study examined the net effects of individual and community factors on the likelihood of registered nurses leaving current jobs using a logit analysis. Based on data from a survey of 2,509 rural nurses, four separate models were estimated and compared: one for nurses in rural settings as a whole and the other three for nurses in hospitals, skilled nursing facilities, and community/public health agencies. Results of the general model indicated that nurses' marital status, age, position, income, job satisfaction, and satisfaction with the community were significant determinants of the likelihood of leaving current jobs. Job satisfaction was the most significant factor, followed by satisfaction with the community. Findings from the models for three different employment settings were similar to those of the general model. However, the significance of factors and their strength of effect on nurses' decisions to leave or stay in their current jobs differed across the three types of facilities. Based on these findings rural nursing administrators and policy-makers should give priority to retention strategies that focus on improving the job environment. The development of different strategies for different groups of nurses (i.e., by age or marital status) and different types of facilities should increase the benefit/cost ratio. In addition, programs that involve rural health care agencies in community and economic development should be further explored as an avenue to increased nurse retention in rural areas. PMID- 10143272 TI - The process and outcomes of care for major depression in rural family practice settings. AB - Although primary care physicians provide the majority of care for rural residents with major depression, little is known about the quality of the care they provide. The aim of this study was to characterize the process and outcomes of care for rural patients with major depression, and to examine the relationship between the process and outcomes of care in this population. Six hundred and thirty-one patients in 21 primary care practices in small towns were screened; 47 patients (7.4% of patients screened) meeting DSM-III-R criteria for current major depression were recruited into the study, and 38 (81.0% of patients recruited) were followed an average of five months later using the Depression Outcomes Module (Rost, Smith, Burnam, & Burns, 1992). While 24 (63.1%) of the 38 depressed subjects received a prescription for one or more antidepressants between the index visit and follow-up, only 11 (28.9%) received pharmacologic treatment in concordance with the new Agency for Health Care Policy and Research (AHCPR) guidelines; 26 (68.4%) of 38 depressed patients continued to meet criteria for major depression at five months. Those who received pharmacologic treatment concordant with AHCPR guidelines showed more improvement at follow-up. The findings suggest that outcomes for major depression may be worse in rural family practice settings than in urban settings. The study also demonstrates that AHCPR guidelines define effective treatment for major depression in the study sample. The Depression Outcomes Module appears to be a reliable and valid instrument for monitoring the outcomes of care for major depression in family practice settings. PMID- 10143273 TI - Access to health care: urban-rural comparisons from a midwestern agricultural state. AB - Lack of access to quality health care for a large number of Americans, particularly those living in rural areas, is a major health care problem. Differences in access between rural and urban areas are caused by obstacles to providing adequate care, such as hospital closures and physician shortages, and low income and/or employment that does not provide health insurance as an employee benefit. This study, based on a random sample of 6,000 households in Nebraska, finds that access to health care is better for residents of rural than urban areas. The relationship holds with controls for health status and health insurance. The pattern in Nebraska reflects an absence of differences in income, health insurance, and health status that produce differences in access between rural and urban areas nationwide. The findings suggest that any serious proposal to reform health care delivery should involve the states and use established patterns of seeking care among state residents. PMID- 10143274 TI - Health insurance coverage and use of services among low-income elders: does residence influence the relationship? AB - This research uses a nationally representative sample of 1,425 low-income elders from the 1987 National Medical Expenditure Survey (NMES) to assess the independent and interaction effects of health insurance coverage and residence on the use of seven health care services: doctor visits, visits to other personnel, telephone contact, emergency room visits, overnight hospital stays, outpatient visits, and prescription medicines. It is hypothesized that (a) elders without insurance to supplement Medicare; (b) those who lived in nonmetropolitan areas use fewer health services; and (c) insurance status and residence interact to influence use of health services, with nonmetropolitan elders using fewer services than those living in metropolitan areas, regardless of insurance type. Using multivariate statistical analyses with both main effects and interaction term models, the data indicate that the type of insurance that low-income elders have is associated with their use of health services, and that residence has only modest effect. Individuals who have Medicaid, and to a lesser extent private supplements, use services more frequently than do those without supplements. Finally, despite the hypothesis, residence does not interact with insurance status in influencing use of services; the relationship between insurance and use of services does not vary across area of residence. The data suggest that the ability to pay, rather than supply constraints associated with nonmetropolitan areas, are of primary importance in determining health care use among low-income elders. PMID- 10143276 TI - Washington works on Medicaid. PMID- 10143275 TI - The relationship of farm residency status to demographic and service characteristics of agricultural injury victims in central Wisconsin. AB - This study performed a surveillance of a defined population in central Wisconsin during a two-year period that included six months of follow-up. The study included those who worked and lived on farms and those who only worked on farms. The injury rate for farm residents was 3.15 injuries per 100 persons per year. However, 195 of the 510 injuries (38.2%) involved persons who were not farm residents. For nonfarm residents, 88.7 percent of the victims were male, whereas for farm residents 79 percent of the victims were male. More than one half of the farm residents who were injured were the owners and an additional 21 percent were juvenile children. Of those aged 18 to 29 years, 51.3 percent were nonfarm resident victims and 15.2 percent were farm resident victims. Of nonfarm residents, 41.1 percent were married; of farm residents, 65.3 percent were married. More than one half of all injured nonfarm residents were seen within two hours of injury while one quarter of the injured farm residents were seen more than 24 hours after the injury. Only 4 percent of the injured farm residents were self-insured, but 15 percent of the nonfarm residents were self-insured. However, the time of injury, actual injuries, diagnoses rendered, and services received were similar for injured farm residents and injured nonfarm residents. Effective attempts to intervene on agricultural injuries will need to consider different risk factors for injuries for nonfarm residents as compared to farm residents. PMID- 10143277 TI - Subacute care. Managing a head injury program. PMID- 10143278 TI - Is this the hour of managed care? Lawmakers seem to think so. PMID- 10143279 TI - When the surveyor calls. PMID- 10143280 TI - Is the empowered employee for you? PMID- 10143281 TI - Nursing staff can give dental exams. PMID- 10143282 TI - Through the eyes of a nurse assistant. PMID- 10143283 TI - The military's real time answer for PACS. PMID- 10143284 TI - MR equipment acquisition parameters. AB - Arguably, MR is the most costly and sophisticated diagnostic imaging equipment in wide use today. Since its inception in the mid 1980s, much has been written regarding the purchase criteria for this million-dollar-plus capital investment- most of it pitting one technological advantage against another. Expectedly, the lion's share of this information was directed at radiologists. Today, it is universally accepted that, as far as the MR purchase decision is concerned, the "buck stops" at increasingly higher administrative levels in the healthcare organization. However, it has been our experience that the most satisfactory MRI acquisitions are not made strictly in the executive conference room. They encompass teams of buying influences from the various areas of the hospital that will be impacted by the MRI system. Knowing that institutions have utilization differences, different patient demographics, varying reimbursement agreements and other pertinent areas of definition, this article does not offer a cookie cutter checklist for an MRI purchase. Instead, it profiles the true-life decision-making processes undertaken by four MRI customers. The article's objective is to provide the reader with an understanding of various approaches to the same process from which the reader can glean ideas relevant to his or her own situation. PMID- 10143285 TI - New standards and the practice of radiology. Where the art of medicine is lost. PMID- 10143286 TI - Teleradiology: reaching rural America. PMID- 10143288 TI - Lessons from a high-volume credentialing environment. PMID- 10143287 TI - Risk factors related to the use of latex gloves. PMID- 10143289 TI - Value of pharmacy-related bulletin board services as a drug information resource. AB - OBJECTIVE: To orient pharmacists to bulletin board services (BBSs) as a source of drug information, and to provide information concerning equipment, services, and resources, as well as examples of systems that are used frequently. DISCUSSION: Pharmacy-related BBSs allow pharmacists who have no experience with a new formulation or therapeutic use for a medication to obtain information from those who have such experience. CONCLUSIONS: As computers become increasingly common in both hospital and community pharmacies and because many BBSs provide free access to newsletters and databases for drug information, pharmacy-related BBSs represent an easy, inexpensive method to share ideas and obtain information on medication use. PMID- 10143290 TI - Information services: when management loses control. PMID- 10143291 TI - Information technology: a tool for helping children. PMID- 10143292 TI - Integrating care by meeting expectations. PMID- 10143293 TI - Technology watch: point of care moves away from the bedside. PMID- 10143294 TI - Bringing technology closer to the patient. PMID- 10143295 TI - 1995 & beyond--sputtering at best. PMID- 10143296 TI - Network integration: the impact of integrated delivery systems. Roundtable discussion. AB - One of the hottest, most competitive segments of the healthcare IS industry encompasses integration tools and systems for linking divergent, best-of-breed systems. As firms such as Healthcare Communications, HUBLink, Oacis, Software Technologies Corp., Century Analysis and Eagle Innovations vie for new contracts, CIOs and IS directors wonder about the strategic advantages of single-vendor solutions vs. the best-of-breed approach. This dynamic has driven system acquisitions for several years. More recently, 33 percent of respondents to the 1995 HIMSS/HP Survey cited integration across separate facilities as their No. 1 priority for the next two years. Clearly the emergence of integrated delivery systems and providers of continuums of care--where the cost to replace the information technologies of acquired or partnered entities remains prohibitive- will cause the market for interface engines and other integration tools to continue expanding. Following are the perceptions of a few experts on the topic. They were asked to answer two questions: 1) What are the toughest challenges faced when integrating an integrated delivery system? and 2) What are the current best practices to solving this challenge? PMID- 10143297 TI - Systems review. Interoperability: data interchange systems. PMID- 10143298 TI - On the front lines of patient care. PMID- 10143299 TI - Expert system helps hospital get its due. PMID- 10143300 TI - Case study. Red or black: positively impacting claims management. PMID- 10143301 TI - Transforming the HR department. PMID- 10143302 TI - Client/server HR system provides unity. PMID- 10143303 TI - Going global. Putting theory into practice. PMID- 10143305 TI - Hospitals turn to nature for help in healing. PMID- 10143304 TI - 1995 & beyond: stepping around the pitfalls. The fourth annual Healthcare Informatics Top 100 listing. PMID- 10143306 TI - The art of healing. Interview by Vivian Carmichael. PMID- 10143307 TI - Using creative imagery to help heal the body. PMID- 10143308 TI - Aligning incentives: the key to risk sharing. PMID- 10143309 TI - CAHHS-UMGA joint statement on full- and partial-risk sharing. California Association of Hospitals and Health Systems and the Unified Medical Group Association. PMID- 10143310 TI - Risk-sharing issues in physician/hospital arrangements. PMID- 10143311 TI - The state of the Joint Commission. PMID- 10143312 TI - Management compensation survey reflects results of reorganizations. PMID- 10143313 TI - Maximizing health through lifestyle changes and community partnerships. PMID- 10143314 TI - Glutaraldehyde sterilants: FDA vs. APIC soaking times. PMID- 10143315 TI - CHEM challenges claims of low demand for environmental health specialist. PMID- 10143316 TI - Semiannual regulatory agenda... Federal Register. PMID- 10143317 TI - Small businesses: the health insurance bind. AB - This paper discusses the structural and regulatory barriers that stymie small businesses' efforts to provide health insurance for employees. Specifically, small businesses face lower revenues and higher health insurance costs than large businesses. Furthermore, small businesses cannot gain the administrative, as well as cost, advantages of self-insurance. The two options for pooled insurance-Taft Hartley groups and Multiple Employer Wellness Arrangements-are increasingly difficult to pursue. Even state-developed "basic insurance" packages have not proven a genuine solution for small businesses. However much we as a nation want to tie health insurance to employers, the small business sector cannot easily fill that function for its employees. PMID- 10143318 TI - Coming of age in hard times. AB - Young people are facing very serious problems of unemployment and underemployment in the current job market. Disadvantaged youth are enduring the most difficult struggle. One plausible reason is that youth are undereducated and insufficiently skilled to meet job requirements. This article explores forty in-depth interviews with young people from three high-unemployment neighborhoods to closely examine experiences in high school and in the post-high school work entry phase. The purpose was to determine whether the youths were receiving the skill set components advanced by Comprehensive Collaborative Models. Policy implications are drawn from the lack of fit between model prescriptions and actual experiences. PMID- 10143319 TI - Body-image syndromes in sexology: phenomenology and classification. PMID- 10143320 TI - The development of the Hill-Burton legislation: interests, issues and compromises. AB - The Hill-Burton Hospital Survey and Construction Act has its roots in the social health and welfare programs of the New Deal. This paper traces its development and the positions of three groups-the hospital industry, the U.S. Public Health Service, and the Senate Subcommittee on Wartime Health and Education-on four issues: the nature of federal funding to states, the use of public funds by private hospitals, the oversight powers of a Federal Hospital Council, and health services for the poor. The analysis involves two lines of thought: the political strategy of incrementalism and the roles of the three interest groups in reaching compromises to quickly pass an "unsponsored" bill. Relevance to the current effort to pass a single payer national health insurance is explored. PMID- 10143321 TI - Cost-effectiveness analysis in health care. PMID- 10143322 TI - Making choices: for patients and physicians. PMID- 10143323 TI - Capitation strategies for your surgical practice. PMID- 10143324 TI - Assessing your CHIN (community health information network) readiness. AB - Whether your health care organization is considering developing a CHIN, an enterprise network, or an integrated delivery system, the CHIN readiness assessment process is a valuable one. Bringing together the information technology staff, managed care and strategic planners, clinical staff, and executive management in a forum for open exchange of ideas and plans is, in itself, a critical activity. A formal assessment will provide your health care organization with a baseline measure of where you are today, and where you need to focus your efforts over the next months and years to achieve your organization's goals. PMID- 10143325 TI - Building the CHIN (community health information network) organization. AB - This article presents a template for establishing a community health information network (CHIN) and focuses primarily on the most popular organizational model for a CHIN, the community coalition model. Additionally, practical solutions to the challenges facing these organizations are presented, based on experiences with CHIN initiatives across the country. PMID- 10143326 TI - Technological considerations in the CHIN (community health information network) design process. PMID- 10143327 TI - Health care, CHIN (community health information network) technology, and privacy. PMID- 10143329 TI - CHINs (community health information networks): fad or destiny? PMID- 10143328 TI - Selected legal issues in the use of community health information networks. PMID- 10143330 TI - Fitting the CHIN (community health information network) to the customer: three case studies. AB - Each of the case studies described above is typical of many health care organizations in the northeastern United States. The reasons each of these three organizations seeks to form or participate in a CHIN varies-from establishing the loyalty of practicing physicians in a community hospital's struggle to survive, through sharing of real-time patient care data in a successful community-wide effort to avoid expensive duplication of services, to driving the transition from a multihospital integrated delivery system to a full-risk accountable health plan. While the need to reduce costs, by taking advantage of economies of scale and prospectively monitoring utilization, is common to all three organizations, selecting the type of CHIN that best fits each scenario, with particular emphasis on aspects of control, is the key success factor. PMID- 10143331 TI - Charting the evolution of community health information networks. PMID- 10143332 TI - The next wave(s) of care delivery re-engineering. PMID- 10143333 TI - Preparing the staff environment for change. PMID- 10143334 TI - Process design and discipline are critical to cost-reduction success. Three case studies. PMID- 10143335 TI - Uplifting news for patients, worker safety and financial returns. PMID- 10143336 TI - Do your gloves really protect you from glutaraldehyde? PMID- 10143337 TI - Calling all nurses: enhanced paging system improves responsiveness. PMID- 10143338 TI - Stats. Is quickness all it's cracked up to be? Productivity and warehouse equipment. PMID- 10143339 TI - Respirator proposal loses breath when applied to health care. AB - The debate continues. As Materials Management in Health Care went to press, the Occupational Safety and Health Administration was getting an earful about proposed revisions to its respiratory protection standard. The standard sets requirements for respirator use in the workplace and will be a basis for part of OSHA's proposed tuberculosis standard, which should be released later this year. Here are the American Hospital Association's comments on the proposed revisions. PMID- 10143340 TI - The learning tree: panel mulls new contract definitions. Panel discussion. PMID- 10143341 TI - Bumpy junction may lie between supplies and nursing models. PMID- 10143342 TI - Be a maverick: post-sort your laundry and improve safety. PMID- 10143343 TI - Ensuring a high-quality standardization process. PMID- 10143344 TI - Capital decisions: what is your boss thinking?. Interview by Frank Cerne. PMID- 10143345 TI - Purchasing trends erode clinician clout. PMID- 10143346 TI - Unlock the door to the executive suite. PMID- 10143347 TI - The debate that wasn't. The public and the Clinton health care plan. PMID- 10143348 TI - Medicare: what to do? PMID- 10143349 TI - Marketing cardiovascular services: the new paradigms. AB - In this first of three articles dealing with how to market cardiovascular services in today's healthcare environment, the groundwork is laid for understanding what those changes are, what effects they can have on how those services should be marketed, and the market strategy planning process. PMID- 10143350 TI - The EHAC (early heart attack care) strategy: Citizens Chart the Course for Healthy People in the Year 2000. AB - Within the last four years, more than 500 chest pain centers have developed in response to new paradigms for early heart attack care. These shifting paradigms now focus on acute prevention, in terms of both early thrombolytic therapy and cardioprotection of patients with prodromal symptoms of a heart attack. PMID- 10143351 TI - Cooperative efforts between tertiary-care centers and outlying hospitals boost imaging services and transfer technologies. AB - Information maintained in the medical record is becoming computerized and is thus accessible to real-time retrieval and correlation. The potential for digital images lies not only in greater diagnostic power, but in the ability to telecommunicate and share the images with all physicians managing the patient, regardless of geographic location. PMID- 10143352 TI - Simon says, join us! PMID- 10143353 TI - Deliver, then depart. PMID- 10143354 TI - Global government consensus: is this the future of health care? Health services into the future. PMID- 10143355 TI - The Wall Paper re-examined. PMID- 10143356 TI - Compulsory AIDS testing--a recent judgement by the Italian Constitutional Court. PMID- 10143357 TI - Testing health care workers for AIDS in England. PMID- 10143358 TI - Homophobia is a health issue. True stories. PMID- 10143359 TI - Homophobia and health: unjust, anti-social, harmful and endemic. PMID- 10143360 TI - Anarchists for health: Spanish Anarchism and health reform in the 1930s. Part II: 'Our Speech as Vibrant as a Dance of Swords'. PMID- 10143361 TI - To health care professionals and researchers: take courage and unite! PMID- 10143362 TI - Making choices: the ethical problems in determining criteria for health care rationing. PMID- 10143363 TI - There's logic, and then there's what we do around here. PMID- 10143364 TI - Health care need and contracts for health services. AB - Assessments of health care needs are embedded in contracts for health services. Such contracts are the formal link between the identification of health care needs and the purchasing of services to satisfy those needs. They are a central part of the procedural relationship between the British health service (NHS) and the satisfaction of human needs. To evaluate contracts it is necessary to investigate this relationship. A number of headings under which it may be possible to begin to evaluate contracts are described, and the potential of a 'universalist' approach to interrogate contract-based decision-making is briefly discussed. PMID- 10143365 TI - The pros and cons of immunisation. PMID- 10143366 TI - State's first integrated system. Blue Cross/Blue Shield, Columbus Regional create risk-assumptive partnership. PMID- 10143367 TI - Dept. of Justice construes recently released "antitrust safety zones". PMID- 10143368 TI - Movement toward managed care leads to shifts in organizational cultures. PMID- 10143369 TI - One expert's view of hospital restructuring. PMID- 10143370 TI - Additional antitrust guidance announced. PMID- 10143371 TI - Cross-training reduces hospital costs, alleviates job uncertainties. PMID- 10143372 TI - Free Georgia! Vote yes on Amendment Three. PMID- 10143374 TI - Education--the human side of organizational change. PMID- 10143373 TI - Adapting to change: 10 roles of the new hospital educator. PMID- 10143375 TI - OIG issues special fraud alert addressing suspect clinical laboratory arrangements. PMID- 10143376 TI - The 11th Circuit issues guidance on HCQIA (Health Care Quality Improvement Act) immunity. PMID- 10143377 TI - Practice acquisition and integration: Alliances for survival. PMID- 10143378 TI - A look inside the Georgia Partnership for Health. PMID- 10143379 TI - "Qui tam" provision encourages self-policing. PMID- 10143380 TI - Six participants share insights on the Georgia Partnership for Health. PMID- 10143381 TI - Healthcare Partners of Southeast Georgia: Savannah partnership spurs local health reform. PMID- 10143382 TI - Georgia Partnership for Caring: statewide private initiative aims to fill system gaps. PMID- 10143383 TI - Integrated delivery system earns high marks after first year. PMID- 10143384 TI - Health reform in Georgia: Ledbetter outlines plan for Georgia Coalition for Health. PMID- 10143385 TI - ERISA preemption doctrine impacts state health reform efforts. PMID- 10143386 TI - Georgia Hospital Association strategic plan. Part two: The people behind the plan. PMID- 10143387 TI - Internal Revenue Service to issue physician recruitment guidance. PMID- 10143388 TI - Under the Gold Dome: State Assembly makes progress on insurance access, managed care. 1995 legislative summary. PMID- 10143389 TI - Grants for the establishment of Departments of Family Medicine--HRSA. Final rule. AB - This final regulation amends the existing regulations governing the program for Grants for the Establishment of Departments of Family Medicine authorized by section 747(b) of the Public Health Service Act (the Act), to bring the regulations into conformity with technical amendments made by the Health Professions Extension Amendments of 1992 and to include other changes for consistency with current grant program policies. PMID- 10143390 TI - Health Care Financing Administration. Statement of organization, functions, and delegations of authority. PMID- 10143391 TI - Health Resources and Services Administration. Statement of organization, functions and delegations of authority. PMID- 10143392 TI - Disease subject to presumptive service connection (radiation risk activity)--VA. Final rule. AB - This document amends Department of Veterans Affairs (VA) adjudication regulations concerning diseases presumed to be the result of exposure to ionizing radiation. This amendment is necessary to implement Public Law 103-446, the Veterans' Benefits Improvements Act, which provides that the term "radiation risk activity" includes the onsite participation in a test involving the atmospheric detonation of a nuclear device by the United States and by other governments. The intended effect of this amendment is to extend the presumption of service connection for radiogenic disabilities to those veterans exposed to radiation during active military service due to onsite participation in atmospheric nuclear tests conducted by nations other than the United States. PMID- 10143393 TI - Uniform administrative requirements for grants and agreements with institutions of higher education, hospitals and other non-profit organizations--OMB Circular A 110 (revised)--HUD. Final rule. AB - Office of Management and Budget (OMB) Circular A-110 provides standards for obtaining consistency and uniformity among Federal agencies in the administration of grants and agreements with institutions of higher education, hospitals, and other non-profit organizations. On September 13, 1994, the Department published a final rule which adopted the revised circular as it pertains to HUD. However, the September 13, 1994 rule contained, in subpart E, special provisions relating to the use of lump sum grants. Therefore, subpart E was treated as an interim rule, and the public was invited to submit comments on subpart E. This final rule addresses the public comments received on subpart E and makes final the provisions of subpart E. PMID- 10143394 TI - Medicare program; uniform electronic cost reporting system for hospitals--HCFA. Final rule. AB - This final rule responds to comments on the May 25, 1994, final rule with comment period that implemented a standardized electronic cost reporting system for all hospitals under the Medicare program. In that rule, we solicited comments on the requirement that cost reporting software be able to detect changes made to the electronic file after the provider has submitted it to the fiscal intermediary. This final rule responds to comments on that requirement and clarifies that although changes to the "as-filed" electronic cost report are prohibited, an intermediary makes a working copy of the as-filed electronic cost report for use in the settlement process. PMID- 10143395 TI - Medicare program; clarification of Medicare's accrual basis of accounting policy- HCFA. Final rule. AB - This final rule revises the Medicare regulations to clarify the concept of "accrual basis of accounting" to indicate that expenses must be incurred by a provider of health care services before Medicare will pay its share of those expenses. This rule does not signify a change in policy but, rather, incorporates into the regulations Medicare's longstanding policy regarding the circumstances under which we recognize, for the purposes of program payment, a provider's claim for costs for which it has not actually expended funds during the current cost reporting period. PMID- 10143396 TI - Medicare program; date for filing Medicare cost reports--HCFA. Final rule. AB - This final rule extends the time frame providers have to file cost reports from no later than 3 months after the close of the period covered by the report to no later than 5 months after the close of that period. This change is necessary to ensure that providers have an adequate amount of time to file complete and accurate cost reports. We are also defining what HCFA considers to be an "acceptable" cost report submission. PMID- 10143397 TI - Medicare and Medicaid programs; advance directives--HCFA. Final rule. AB - This final rule responds to public comments on the March 6, 1992 interim final rule with comment period that amended the Medicare and Medicaid regulations governing provider agreements and contracts to establish requirements for States, hospitals, nursing facilities, skilled nursing facilities, providers of home health care or personal care services, hospice programs and managed care plans concerning advance directives. An advance directive is a written instruction, such as a living will or durable power of attorney for health care, recognized under State law, relating to the provision of health care when an individual's condition makes him or her unable to express his or her wishes. The intent of the advance directives provisions is to enhance an adult individual's control over medical treatment decisions. This rule confirms the interim final rule with several minor changes based on our review and consideration of public comments. PMID- 10143398 TI - CDC recommendations for civilian communities near chemical weapons depots: guidelines for medical preparedness--CDC. Publication of final recommendations. AB - On July 27, 1994, CDC published in the Federal Register, 59 FR 38191, "CDC Recommendations for Civilian Communities Near Chemical Weapons Depots: Guidelines for Medical Preparedness" and requested public comment. Seven people sent comments; many were responding on behalf of governments or other institutions in affected communities. These comments are available upon request. These recommendations incorporate changes made in response to the comments received and constitutes CDC's final recommendations for minimum standards for prehospital and hospital emergency medical services' readiness in communities near the eight locations where the U.S. stockpile of lethal chemical weapons is stored. The eight locations are: Umatilla Army Depot Activity, Oregon; Tooele Army Depot, Utah; Pueblo Army Depot Activity, Colorado; Pine Bluff Arsenal, Arkansas; Newport Army Ammunition Plant, Indiana; Anniston Army Depot, Alabama; Lexington Bluegrass Depot Activity, Kentucky; and Edgewood Area, Aberdeen Proving Ground, Maryland. These recommendations were prepared to assist emergency planners in determining emergency medical services' readiness in communities near the 8 locations where the U.S. stockpile of lethal chemical weapons is stored. These guidelines should not be used for any purpose other than planning for the Chemical Stockpile Emergency Preparedness Program. PMID- 10143399 TI - U.S. House Ways and Means Committee. PMID- 10143400 TI - U.S. Senate Labor and Human Resources Committee. PMID- 10143401 TI - Scalpels out for Medicare, Medicaid. PMID- 10143402 TI - Primary care physicians' pay on the upswing compared with other doctors in managed care. PMID- 10143403 TI - It's time to tell patients the facts about managed care. PMID- 10143404 TI - When your plan tells you what not to say. PMID- 10143405 TI - Does managed care require a new way of talking to patients? No. PMID- 10143406 TI - Does managed care require a new way of talking to patients? Yes. PMID- 10143407 TI - Don't make these common coding errors. PMID- 10143408 TI - Diary of a fast-growing primary care network. Part I. AB - Don't despair, says this family physician. Even in mature managed care markets, doctors can protect their independence and the value of of their practices by forming a primary care network. California's BayCare, for example, has grown from 13 doctors to 220 in a little over a year--and it's still expanding. PMID- 10143409 TI - Needed: clear standards for defining futile care. PMID- 10143411 TI - Post-stroke guidelines give patients a second chance. PMID- 10143410 TI - A haven from the storm--or a cage for the unwary? PMID- 10143412 TI - Data describe the changing HMO industry: bigger enrollments, more hybrid plans. PMID- 10143413 TI - Best practices for implementing outcomes management. More science, more art, worldwide. AB - Based on his own and other large-scale studies, the author explains that the current push to measure treatment outcomes and develop outcomes management programs is a worldwide phenomenon in behavioral healthcare. He presents a model showing outcomes measurement as the cornerstone of good clinical practice, from intake through diagnosis and treatment to outcomes management and clinical information systems. PMID- 10143414 TI - Practice guidelines and empirically validated psychosocial treatments: ships passing in the night? AB - As outcomes research and clinical practice guidelines are more widely disseminated throughout the healthcare industry, what will happen to scientifically validated but less widely recognized psychosocial interventions? The authors critically review the issues involved in guideline development, primarily in terms of the criteria used for this development and the research available to determine which interventions should be included or excluded. Evidence is presented for the cost effectiveness of psychosocial treatments in areas ranging from schizophrenia, bulimia, borderline personality and panic disorder to the psychological aspects of such physical disorders as myocardial infarction and breast cancer. PMID- 10143415 TI - Outcomes measurement and management with a large Medicaid population: a public/private collaboration. AB - Recipients, consumer advocates and purchasers expect managed care companies, in partnership with their provider networks, to measure and to continuously improve quality of care. This task is especially challenging when the beneficiaries of that care are covered by a publicly funded program. Yet this will be an increasingly common occurrence as more states contract with managed care companies for the care management of their Medicaid populations. In this article, the authors describe the outcomes measurement and management program of the first statewide managed Medicaid behavioral health carve-out program. Much of the foundation of that program has been built through collaborative efforts between the Massachusetts Division of Medical Assistance as purchaser, MHMA as managed care vendor, recipients, providers and other stakeholders. The authors report on the FMH/MHMA experience and what they learned. The principles derived from this outcomes program may be helpful to other states and to managed care companies undertaking similar public/private partnerships. PMID- 10143416 TI - Practice-relevant research findings: APA's Psychiatric Research Network. PMID- 10143417 TI - Dialogue. The rush to measure outcomes: help or hazard? Can health services research have a role in managed care? PMID- 10143418 TI - Dialogue. The rush to measure outcomes: help or hazard? The shift from efficacy to effectiveness research to demonstrate value. PMID- 10143419 TI - Dialogue. The rush to measure outcomes: help or hazard? Struggling to reach common ground. PMID- 10143420 TI - Behavioral healthcare report card indicators: AMBHA (American Managed Behavioral Healthcare Association) begins to define standards for accountability. AB - AMBHA--The American Managed Behavioral Healthcare Association--was formed by a number of the country's leading national behavioral health managed care firms in order to influence the national reform debate and document the cost effectiveness of managed care techniques in this setting. Recently, AMBHA undertook the challenge of setting standardized quality assessment measures and methods and related benchmarks. The author describes the association's beginning efforts to develop a behavioral healthcare "report card" addressing basic elements of access, client satisfaction, quality and outcomes. PMID- 10143421 TI - Parity surfaces as states pare back comprehensive reform. PMID- 10143422 TI - Parity, equity and discrimination. PMID- 10143423 TI - The ecology of assessment: a "patient-centric" perspective. PMID- 10143424 TI - Sharing clinical data for provider profiling: protection of privacy versus the public's need to know. PMID- 10143425 TI - Can outcomes measurement make a difference? PMID- 10143426 TI - Internet. Cutting through the red tape. PMID- 10143427 TI - A crusader for cutting paperwork. Interview by Howard J. Anderson. PMID- 10143428 TI - Provider automation. Making the most of what you've got. PMID- 10143429 TI - Innovators 1995. Layered solution helps network evolve. Methodist Health Group, Indianapolis. PMID- 10143430 TI - Innovators 1995. Preparing for a managed care shift. Jacobi Medical Center, New York City. PMID- 10143431 TI - Innovators 1995. Hospitals move together toward EDI. Ancilla Health Systems, Hobart, IN. PMID- 10143432 TI - Innovators 1995. Blues plan jumps ahead. Blue Cross and Blue Shield of Massachusetts, Boston. PMID- 10143433 TI - Telemedicine: managed care could create a technology boom. PMID- 10143434 TI - Network support critical in choosing a lab system. AB - When providers acquire laboratory information systems, they're looking beyond improving their lab operations to determine how the software will provide data to build computerized patient records throughout an integrated delivery system. Vendors are beginning to differentiate themselves based on how effectively their systems support the formation of enterprisewide information networks. PMID- 10143435 TI - Where to get help. PMID- 10143436 TI - Chiropractic treatment. An "alternative medicine" becomes mainstream health. PMID- 10143437 TI - Chiropractic must be accountable to "win" at managed care. PMID- 10143438 TI - Chiropractic's future: competition, consolidation, and capitation. PMID- 10143439 TI - "Partners": chiropractic may merge with rehabilitation. PMID- 10143440 TI - Integrating the concepts of health promotion and community into occupational therapy practice. AB - Health reform activities in Canada have encouraged health care professionals to examine new and innovative ways to share their skills, not only with other professionals, but with the public. Historically, occupational therapists have been encouraged by leaders in the profession to expand their practice and to share their skills through active participation with their communities. Health promotion has been identified as a process through which this expansion can be pursued. In order for occupational therapists to contribute to their communities in a meaningful way, the concepts of health promotion and community require definition, development and reflection within their model of practice. Through a discussion of these concepts, this paper encourages occupational therapists to develop, expand and integrate new practice roles within the community by integrating health promotion into their practice. PMID- 10143441 TI - An occupational therapy course on community practice. AB - This article outlines a course on occupational therapy community practice offered at the University of Ottawa and discusses its assets and limitations in terms of preparing students for the shift to community-based health services. The shift to community services in the health care systems of Ontario and Quebec is described. Then the curricular components needed to prepare students for community practice are summarized. Finally, the community practice course at the University of Ottawa including its goal, objectives, class topics and evaluations is outlined. The strength of the community practice course described is that it includes many of the curricular components needed for community practice. On the other hand, limitations include the lack of skill training in some areas, its place in the last year of the programme, and its optional nature. Changes planned for the course and other recommendations for curricula are also discussed. PMID- 10143442 TI - Evaluation of the cost effectiveness of therapist computerized entry of occupational therapy workload measurement data. AB - A study was conducted to examine the cost effectiveness of two methods of managing occupational therapy workload measurement data. The computer entry of statistical data by a clerk in a central location was compared to multi-site direct input of data by therapists. Cost effectiveness, efficiency and accuracy of each method were the primary outcomes. Ease of coordination and level of computer comfort were secondary outcomes. It was clear that clerk entry of data was more cost effective, efficient and accurate than therapist entry of data. The monitoring of monthly data entry was best facilitated by clerk entry. Therapists had a positive attitude towards direct entry but were unable to approximate the speed and accuracy of the data entry clerk. Therapists' comfort with computers increased slightly during the study. Since the prime purpose of the study was to examine cost effectiveness, it was concluded that clerk entry of workload data is the best use of resources. PMID- 10143443 TI - General hospital services for attempted suicide patients: a survey in one region. AB - A survey of the general hospital services for attempted suicide patients in one Region indicated that most hospitals fell short of many of the standards contained in the Department of Health 1984 guidelines and the recently established Royal College of Psychiatrists guidelines, particularly with regard to active planning and monitoring of the service, involvement of non-medical clinical staff, availability of the service and the training of staff. PMID- 10143444 TI - Variations in clinical experience of pre-registration house officers: the effect of London. AB - A postal questionnaire was used to examine possible differences in clinical experience of pre-registration house officers (PHROs) in eight former English regions, and, within the Thames regions, between teaching hospitals, and non teaching hospitals in Inner London, Outer London and outside London. The main measurements were the numbers of patients clerked in an average week as emergency, routine or day admissions or as outpatients; the number of patients under the respondents' care at time of reply; the experience of specific clinical conditions gained; the overall adequacy of clinical experience; and the suitability of posts for preparing respondents to work as casualty officers, senior house officers, or general practitioners. The results indicate that less clinical experience was acquired by PRHOs training in the Thames regions. They had fewer admissions per week, fewer patients, and exposure to fewer surgical conditions. Within the Thames regions, there was a gradient of improving educational quality (in all areas of this study) from the teaching hospitals, through the non-teaching hospitals in inner and in outer London, and then to the hospitals outside London. No differences were found between Thames region posts outside London and non-Thames regions. PMID- 10143445 TI - Job satisfaction and health of house officers in the West Midlands. AB - A postal questionnaire survey was conducted in 1993 to determine the job satisfaction and current state of health of British-trained pre-registration house officers (PRHOs) working in the West Midlands Regional Health Authority. The questionnaire included parts of the Occupational Stress Indicator looking at job satisfaction, and mental and physical ill-health (as manifestations of stress). Out of 234 eligible PRHOs 182 (78%) returned questionnaires: female PRHOs had significantly higher scores for physical and mental ill-health than male PRHOs; 14.2% of PRHOs had scores for mental ill-health, and 17.6% scores for physical ill-health that were higher than the average reported for patients with psycho-neurotic disorders. The PRHOs had significantly lower scores for all individual aspects of job satisfaction and total job satisfaction, and significantly higher scores for mental and physical ill-health than a comparative group of junior hospital doctors (all grades), and a large group of non-health care white-collar workers. These results indicate that there is a need to raise awareness of stress and stress-related problems faced by junior doctors, and to provide adequate support. PMID- 10143446 TI - Use of Office of Population Censuses and Surveys records in medical research and clinical audit. AB - Clinicians and epidemiologists have become increasingly interested in access to patient records for clinical audit and medical research. This article describes the historical background of the Office of Population Censuses and Surveys (OPCS), and the ways in which its records can be used to support such research. It also discusses how confidentiality is safeguarded, whilst at the same time access for those with approved studies has been improved. PMID- 10143447 TI - The demand for primary dental care at a dental teaching hospital, 1989 and 1993. AB - The demand for, and provision of, primary dental care was investigated in a teaching hospital setting in 1989 and 1993 - a period which saw the introduction of the new dental contract and the publication of the Poswillo report on general anaesthesia and sedation. Five hundred patients who attended the primary care department for the first time at the University of Wales Dental Hospital were interviewed in May/June 1989, and a further 520 patients were interviewed in May/June 1993. Self-referrals increased from 260 patients (52%) in 1989 to 352 patients (68%) in 1993. The proportion of patients who did not have a general dental practitioner (GDP) increased from 32% (160) in 1989 to 39% (202) in 1993. More patients registered with a dentist self-referred in 1993 compared to those in 1989, reportedly because of inability to obtain an appointment with their own GDP (88), rather than because of cost (17). Over the four-year period there was an increase in demand for treatment of early stage (pulpitic) dental infection from 32% to 40%, and a decrease in relation to end-stage infection (dentoalveolar abscess) from 11% to 6%. This 'safety net' role of dental hospitals needs to be taken into account when contracting for services. PMID- 10143448 TI - Making it easier to read prescriptions. PMID- 10143449 TI - The urban environment, poverty and health in developing countries. AB - The process of urbanization could be described as one of the major global environmental changes directly affecting human health today. Populations particularly affected are in developing countries where rapid urban growth has been accompanied by massive urban poverty. Urban environmental health impacts, particularly the impact on adults of an environment of poverty, are still poorly understood. Definitions of the urban environment tend to be physical, excluding the complex ramifications of a social setting of disadvantage. This paper provides a brief overview of existing knowledge on the links between environment, poverty and health in urban areas of developing countries, with an emphasis on the policy implications implied by research on health differential between groups within cities. The paper argues that urban poverty and inequalities in conditions between groups within cities present a central crisis confronting urban policy in terms of human health and quality of life. The paper suggests that definitions of the urban environment tend to consider only the physical, and not the social complexity of the urban setting. The review concludes that the scale and the complexity of the urban crisis in developing countries demands a real commitment to re-thinking the management of cities to address multiple deprivation. The paper suggests that this challenges urban professionals who continue to act with a bias towards unintegrated single sector solutions despite claims to the contrary. PMID- 10143450 TI - Whose policy is it anyway? International and national influences on health policy development in Uganda. AB - As national resources for health decline, so dependence on international resources to finance the capital and recurrent costs is increasing. This dependence, combined with an increasing emphasis on policy-based, as opposed to project-based, lending and grant-making has been accompanied by greater involvement of international actors in the formation of national health policy. This paper explores the process of health policy development in Uganda and examines how major donors are influencing and conflicting with national policy making bodies. Focusing on two examples of user fees and drugs policies, it argues that while the content of international prescriptions to strengthen the health system may not be bad in itself, the process by which they are applied potentially threatens national sovereignty and weakens mechanisms for ensuring accountability. It concludes by proposing that in order to increase the sustainability of policy reforms, much greater emphasis should be placed on strengthening national capacity for policy analysis and research, building up policy networks and enhancing the quality of information available to the public concerning key policy changes. PMID- 10143451 TI - Mental health care in the primary health care setting: a collaborative study in six countries of Central America. AB - The results of a naturalistic epidemiological study conducted in 6 Central American countries in collaboration with the WHO/PAHO Regional Office are reported, aimed at describing the patients with mental distress presenting to the primary health care setting, the interventions enacted and the evolution of the patients over the 6 months following recruitment. A total of 812 patients were recruited by the personnel of 11 primary health care centres. A high degree of heterogeneity was observed with respect to the patients' characteristics and the patterns of care provided. The factors potentially contributing to the heterogeneity, identified through multivariate analyses, are discussed in detail against the specific background differences between countries and between areas within each country. Interestingly albeit expectedly, besides the differences in health care provision and availability, social needs appear to influence both interventions and outcomes. PMID- 10143452 TI - Improving primary health care through systematic supervision: a controlled field trial. AB - Most primary health care services in developing countries are delivered by staff working in peripheral facilities where supervision is problematic. This study examined whether systematic supervision using an objective set of indicators could improve health worker performance. A checklist was developed by the Philippine Department of Health which assigned a score from 0 to 3 on each of 20 indicators which were clearly defined. The checklist was implemented in 4 remote provinces with 6 provinces from the same regions serving as a control area. In all 10 provinces, health facilities were randomly selected and surveyed before implementation of the checklist and again 6 months later. Performance, as measured by the combined scores on the 20 indicators, improved 42% (95% Cl = 29% to 55%) in the experimental group compared to 18% (95% Cl = 9% to 27%) in the control group. In the experimental, but not in the control facilities, there was a correlation between frequency of supervision and improvements in scores. The initial cost of implementing the checklist was US $ 19.92 per health facility and the annual recurrent costs were estimated at $ 1.85. Systematic supervision using clearly defined and quantifiable indicators can improve service delivery considerably, at modest cost. PMID- 10143453 TI - Introducing health insurance in Vietnam. AB - Like many other countries Vietnam is trying to reform its health care system through the introduction of social insurance. The small size of the formal sector means that the scope for compulsory payroll insurance is limited and provinces are beginning to experiment with ways of encouraging people to buy voluntary insurance. Methods of contracting between hospitals and insurance centres are being devised. These vary in complexity and there is a danger that those based on fee for service will encourage excessive treatment for those insured. It is important that the national and provincial government continue to maintain firm control over funding while also ensuring that a substantial and targeted general budget subsidy is provided for those unable to make contributions. PMID- 10143454 TI - User charges in government health facilities in Kenya: effect on attendance and revenue. AB - In this paper we study demand effects of user charges in a district health care system using cross-sectional data from household and facility surveys. The effects are examined in public as well as in private health facilities. We also look briefly at the impact of fees on revenue and service quality in government facilities. During the period of cost-sharing in public clinics, attendance dropped by about 50%. This drop prompted the government to suspend the fees for approximately 20 months. Over the 7 months after suspension of fees, attendance at government health centres increased by 41%. The suspension further caused a notable movement of patients from the private sector to government health facilities. The revenue generated by user fees covered 2.4% of the recurrent health budget. Some 40% of the facilities did not spend the fee revenue they collected, mainly due to cumbersome procedures of expenditure approvals. The paper concludes with lessons from Kenya's experience with user charges. PMID- 10143456 TI - Quality of primary outpatient services in Dar-es-Salaam: a comparison of government and voluntary providers. AB - This study aimed to test whether voluntary agencies provide care of better quality than that provided by government with respect to primary curative outpatient services in Dar-es-Salaam. All non-government primary services were included, and government primary facilities were randomly sampled within the three districts of the city. Details of consultations were recorded and assessed by a panel who classed consultations as adequate, inadequate but serious consequences unlikely, and consultations where deficiencies in the care could have serious consequences. Interpersonal conduct was assessed and exit interviews were conducted. The study found that government registers of non-government 'voluntary' providers actually contained a high proportion of for-profit private providers. Comparisons between facilities showed that care was better overall at voluntary providers, but that there was a high level of inadequate care at both government and non-government providers. PMID- 10143455 TI - Village-based AIDS prevention in a rural district in Uganda. AB - OBJECTIVE: To design, implement and evaluate a village-based AIDS prevention programme in a rural district in north-western Uganda. A baseline KAP survey of the general population was carried out to design a district-wide information campaign and condom promotion programme. Eighteen months later the impact achieved was measured through a second KAP survey, using the same methodology. METHODS: Anonymous structured interviews were conducted in March 1991 and October 1992 with 1486 and 1744 randomly selected individuals age 15-49, respectively. RESULTS: At 18 months, 60% of respondents had participated in an information session in the past year (47% women, 71% men) and 42% had received a pamphlet about AIDS (26% women, 58% men). Knowledge about AIDS, high initially (94%), reached 98%. More respondents knew that the incubation period is longer than one year (from 29% to 40%), and were willing to take care of a PWA (from 60% to 77%). Knowledge about condoms increased from 26 to 63% in women and 57 to 91% in men. Ever use of condoms among persons having engaged in casual sex in the past year increased from 6 to 33% in women, and 27 to 48% in men. Fifty per cent of condom users criticized lack of regular access to condoms. CONCLUSIONS: This is the first documented example of the impact a village-based AIDS prevention programme can achieve in a rural African community. Critical areas to be improved were identified, such as: women must be given better access to information, more attention must be paid to explain the asymptomatic state of HIV infection in appropriate terms, and condom social marketing must be developed. PMID- 10143457 TI - Health services research in the English-speaking Caribbean 1984-93: a quantitative review. AB - Evaluating the effectiveness and efficiency of health services is important for all countries, especially those with limited resources. This study aimed to evaluate the volume and quality of health services research (HSR) conducted in one developing region, the English-speaking Caribbean. Data were abstracted from all 770 abstracts describing presentations at the annual scientific meetings of the Commonwealth Caribbean Medical Research Council for the decade 1984 to 1993. Of these, 341 abstracts were judged to report health services research and were from the English-speaking Caribbean. Hospital services were evaluated in 240 (70%) reports while primary health services were evaluated in only 90 (26%). Most hospital-based studies evaluated the use and outcome of medical and surgical services through the collection of case series and cohorts of cases, with a median sample size of 104 (interquartile range 38 to 320). Evaluations at primary level were more likely to evaluate need or demand for services, were more likely to report cross sectional surveys or randomized trials and included larger numbers of subjects (median 343, interquartile range 121 to 661). Patient-based measures of health status and measures of resource use were not often reported at either primary or secondary level. Estimation and hypothesis testing were infrequently employed in data analysis. A large proportion of the research presented could be classified as HSR but measures are needed to increase the motivation for research into primary care and to improve skills in HSR study design, conduct and analysis among those presently conducting research. PMID- 10143458 TI - Using capture-recapture in promoting public health. PMID- 10143459 TI - Proposed regulations to govern private business use of tax-exempt bond financed facilities. AB - For the most part, owners of tax-exempt hospitals and other health care facilities should welcome the issuance of the proposed regulations because they generally clarify and liberalize former law. As pointed out, however, in certain instances the proposed regulations do impose additional requirements not found in current law. Accordingly, in those instances in which exempt facility owners may elect to apply the proposed regulations prior to their finalization, a careful analysis needs to be made of whether the old or new regime would be most beneficial. PMID- 10143460 TI - Special report on antitrust. Antitrust implications of physician practice affiliations and acquisitions: a question of market power, Part I. PMID- 10143461 TI - The ethical, medical, and legal implications of the forcible treatment provisions of the Criminal Code. PMID- 10143462 TI - Charter implications of compelling dentists to reveal their HIV status. PMID- 10143463 TI - Mining for new markets. PMID- 10143464 TI - Keeping the pace. PMID- 10143465 TI - Integrated patient assessment. PMID- 10143466 TI - Data collection methods. PMID- 10143467 TI - Who should serve patient meals? PMID- 10143468 TI - The use and image of mature adults in health care advertising (1954-1989). AB - Health care professionals who treat older (over 65) patients are influenced by the journals they read. Advertising directed at health care professionals during the period 1954 to 1989 was subjected to a content analysis. Advertising in health care journals was expected to reflect the demographic changes in American society with increasing numbers of older models and to present positive images of older people. Contrary to content analyses of magazine cartoons (Smith 1979) and general readership magazines (Bramlett-Solomon and Wilson 1989; Gantz, Gartenberg, and Rainbow 1980; Ursic, Ursic, and Ursic 1986), this study did find a significant use of older people in health care advertising and positive role portrayal. PMID- 10143469 TI - Gray marketing. PMID- 10143470 TI - The impact of risk adjustment in valuing a medical practice. PMID- 10143471 TI - The impact of affective responses on physician evaluations: an exploratory study. PMID- 10143472 TI - Initiating change through alliance and network-building: Part two. PMID- 10143473 TI - Newspaper advertising versus direct mail marketing in a family practice: a hands on approach. AB - This study compares newspaper advertising and direct mail marketing to attract private patients. Newsletter advertising was distributed to 92,251 homes throughout 1991 at a cost of $20,827.13. Newspaper advertising was conducted from August 28 to October 9, 1991 at a cost of $2,261.94. The newsletter attracted 101 new patients at a cost of $206.21 per patient and a mean response rate of 0.11%. No new patients were attracted through newspaper advertising. PMID- 10143474 TI - Physicians contracting with managed care. AB - It has been observed that enrollees in managed care systems such as HMOs and PPOs have lower expenditures and utilization rates than those in conventional insurance plans. Few studies have investigated this issue by examining providers. This paper studies whether physicians with low costs are more likely to sign contracts with HMOs and PPOs in order to help explain the observation of lower expenditures and utilization rates by HMO and PPO enrollees. A logistic regression is applied to the data from the 1984-1985 Physician Practice Costs and Income Survey. The results do not show strong evidence that a physician's likelihood of contracting with HMOs and PPOs is related to the physician's practice costs and utilization pattern. Instead, major factors that significantly affect a physician's decision of contracting with managed care systems are the physician's socio-demographics, the physician's practice region, and the market conditions. PMID- 10143475 TI - Polling patients with self-administered surveys. AB - After this paper describes how various forms of the self-administered survey can affect response to patient surveys, it compares survey response to two patient surveys-one conducted in a waiting room and the other conducted by mail. The waiting room survey produced a higher rate and speed of response, and resulted in more respondents with favorable attitudes toward the medical facility and the survey. PMID- 10143476 TI - Are you ready for the computer-based patient record? AB - Moving to a computer-based patient record (CPR) involves much more than simply putting computers in clinical offices. To achieve success, a health care organization must rethink and revise traditional workflows and organizational structures. Diverse constituencies within an organization must be targeted to gain buy-in to the process. Other considerations include cost justification and implementation strategies. Current market dynamics suggest that organizations should be contemplating the move to a CPR in order to gain competitive advantage or even to maintain the status quo. PMID- 10143477 TI - Remote real-time ultrasound interactive telediagnosis: putting it into practice. AB - Teleradiology, the practice of radiology over a distance via electronic transmission of radiologic images, has the potential to fundamentally alter the practice of radiology in the years to come. Different models for the practice of teleradiology include on-call reading, consultation and overreading, primary reading teleradiology, and integration with picture archiving and communication system (PACS) and miniPACS. Remote real-time ultrasound telediagnosis represents a specialized subset of primary-reading teleradiology, specifically designed to involve the radiologist directly with sonographer in the performance of the ultrasound examination. This type of practice involves rapid transmission of patient demographics and captured still images and live transmission of the real time video output of the ultrasound machine. When utilized properly real-time telediagnosis extends the high standards of tertiary center sonographic diagnosis out to community and rural sites. PMID- 10143478 TI - CHESS (Comprehensive Health Enhancement Support System): an interactive computer system for women with breast cancer piloted with an underserved population. AB - The Comprehensive Health Enhancement Support System (CHESS) is an interactive computer system containing information, social support, and problem-solving tools. It was developed with intensive input from potential users through needs assessment surveys and field testing. CHESS had previously been used by women in the middle and upper socioeconomic classes with high school and college education. This article reports on the results of a pilot study involving eight African-American women with breast cancer from impoverished neighborhoods in Chicago. CHESS was very well received; was extensively used; and produced feelings of acceptance, motivation, understanding, and relief. PMID- 10143479 TI - Small-area variations in the treatment of prevalent medical conditions: a comparison of three cities in the Northeast. AB - This article presents a small-area variation study that examines utilization differences for primary care physicians (PCPs) in treating a homogeneous set of prevalent medical conditions. The study used secondary data collected over a 24 month period from a large, Northeastern region independent practice association. The diagnostic cluster methodology was used to examine geographic differences for PCPs in treating prevalent medical conditions. This methodology groups International Classification of Diseases, 9th revision (ICD-9), codes into diagnostic clusters based on clinical homogeneity with respect to generating a similar clinical response from the physician. For each diagnostic cluster, diagnostic episode clusters (DECs) were formulated. Each DEC links all services incurred in treating a patient's medical condition within a specific period of time. Differences in use rates across small areas were tested using t tests. The data showed little variation in the physician office visit rate across small areas. However, services generated from these office visits exhibited large rate variations. The most significant small-area differences were for hospital inpatient days and surgical procedures. Pattern-of-treatment differences exist across small areas for the homogeneous set of prevalent medical conditions treated by PCPs. PMID- 10143480 TI - The "revolution" in outpatient care. AB - Although the concept of outpatient care is not a new one, the growth in ambulatory facilities has revolutionized medical care in the United States. The growth in ambulatory surgery centers, imaging centers, and cancer centers in Florida is explored in detail. With the many changes forthcoming in health care, ambulatory care will play an increasing role in delivering good health care at a reasonable cost. PMID- 10143481 TI - The case for a code of ethics in an ambulatory care setting. AB - The health care industry leads others in the development and use of professional codes of ethics. However, ambulatory care facilities continue to operate without coherent ethical guidelines addressing the workplace itself. New diagnostic and treatment capabilities, coupled with economic pressures, have intensified the ethical dilemmas facing the ambulatory care practice. This article argues that office codes of ethics decrease the risk of liability exposure, clarify the expectations of patients and staff, and foster responsible ethical reflection in the workplace. Material for this article was gathered from relevant literature in the areas of business ethics, bioethics, and health care management. PMID- 10143482 TI - Performance of community health centers under managed care. AB - The Bureau of Primary Health Care, a division of the Health Resources and Services Administration of the Department of Health and Human Services, Public Health Service, commissioned a study to evaluate the performance of community health centers (CHCs) under managed care. This article reports on the findings of the bureau's study, which examined the managed performance of seven CHCs that contract with health maintenance organizations (HMOs). The experience of these centers can provide valuable insights for other CHCs and the HMOs with which they partner. Policy makers contemplating the role of CHCs in managed care will also benefit from these findings. PMID- 10143483 TI - Physician use of information technology in ambulatory medicine: an overview. AB - Physicians practicing ambulatory medicine have never had more opportunities to use information technology to help them in their everyday practice. In parallel, evolving health care industry dynamics are increasing the need for clinical computer applications, which help improve the quality, efficiency, and the cost effectiveness of patient care. This article examines: (1) the information needs of practicing physicians, (2) current and emerging technologies that can improve clinical decision making at the point of care, and (3) the impact of these technologies on clinical quality, medical costs, and physician practice efficiency. The article uses patient case scenarios to illustrate the emerging role of information technology in patient care. PMID- 10143484 TI - The myth of the HYE (healthy year equivalent) PMID- 10143485 TI - A note on entry by small hospitals. PMID- 10143486 TI - HMOs, market competition, and premium cost. PMID- 10143487 TI - QALYs and HYEs (healthy year equivalents): under what conditions are they equivalent? AB - The paper examines what restrictions have to be imposed on the individual's preference structure for QALYs and HYEs to yield identical results. It is shown that using QALYs involves imposing three additional restrictions. Empirical evidence suggests that these restrictions cannot be expected to hold in all applications. The main problem in using HYEs appears to be practical. An alternative index is proposed, that may help to bridge the gap between QALYs and HYEs by combining to some extent the advantages of the two measures. PMID- 10143488 TI - QALYs versus HYEs (healthy year equivalents): a reply to Gafni, Birch and Mehrez. PMID- 10143489 TI - Worker demand for health insurance in the non-group market. AB - This paper examines decisions to purchase individual insurance by workers who do not have employment-based insurance. Using data from the Current Population Survey and the Survey of Income and Program Participation, coupled with prices for a standard insurance product in different market areas, we estimate a price elasticity of -0.3 to -0.4 and an income elasticity of 0.15. Our estimate of the price response raises doubts that even substantial subsidies to the working uninsured would induce many of them to purchase coverage voluntarily. PMID- 10143490 TI - Wealth from optimal health. AB - Recently, much research has been devoted to the question of how the conventional net national product measure should be augmented so as to cover changes in the stocks of natural resources. This paper investigates the treatment of health (capital) and the risk of 'doomsday' caused by pollution in such welfare measures. Our problem is not a standard optimal control problem because the survival probability depends on state variables. We show how to handle this complication. The resulting welfare measure is contrasted with the conventional net national product measure. Finally, we address the matter of how to design a subsidy on health investment such that a market economy provides the optimal level of health. PMID- 10143491 TI - The effect of market structure on HMO premiums. AB - We examine the effects of HMO market structure on HMO premiums from 1988 to 1991. More competition, measured by the number of HMOs in the market area, reduces HMO premiums. Although this effect does not appear for IPAs before the highest level of competition is reached, it appears throughout the competitive range for Group HMOs. More market penetration, measured by the percent of the market area population enrolled in HMOs, reduces premiums for IPAs. Since the goal of managed competition is to reduce health care costs by creating competition among managed health care plans, our results offer encouragement for managed competition advocates. PMID- 10143492 TI - Quality-adjusted life-years versus healthy-years equivalents. PMID- 10143493 TI - The role of hospitals in an evolving delivery system: living in two worlds: capitation and fee-for-service. PMID- 10143494 TI - Living in two worlds now. A single-hospital community. PMID- 10143495 TI - Living in two worlds now. A multihospital community. PMID- 10143496 TI - living in two worlds now. A regional system. PMID- 10143497 TI - Living in two worlds now. A multiregional system. PMID- 10143498 TI - Potential hospital roles in a capitated delivery system. The hospital as initiator. PMID- 10143499 TI - Potential hospital roles in a capitated delivery system. The hospital as partner. PMID- 10143500 TI - Potential hospital roles in a capitated delivery system. The hospital as participant in several CDSs. Doubling the effort, squaring the error. PMID- 10143501 TI - Potential hospital roles in a capitated delivery system. The hospital as niche player. PMID- 10143502 TI - Different hospital perspectives of the evolving system. The single-hospital community. PMID- 10143503 TI - Different hospital perspectives of the evolving system. The multihospital community. PMID- 10143504 TI - Different hospital perspectives of the evolving system. The inner-city hospital. PMID- 10143505 TI - Different hospital perspectives of the evolving system. The academic medical center. PMID- 10143506 TI - EDI becomes an essential cost-management tool. PMID- 10143507 TI - Bench evaluation: three face-shield CPR barrier devices. AB - Due to the fear of disease transmission, the practice of mouth-to-mouth (M-M) rescue breathing is rarely performed; to address this concern, many types of CPR barrier devices have been developed. These include bag-valve-mask devices, mouth to-mask devices, and face shields (FS). The purpose of this study was to measure the volumes delivered during mouth-to-face shield (M-FS) breathing, to measure the back pressure and calculate the resistance to flow through their 1-way valves, and to test for backward leak of gas through the valves. METHODS: Three FS brands were evaluated: Kiss of Life (KOL), MicroSHIELD (Micro) and Res-Cue Key (RCK). Volume delivered during M-M and M-FS breathing was evaluated by 10 rescuers who used the devices while performing rescue breathing on a CPR mannequin. Back pressure was measured and resistance calculated by directing airflow through the 1-way valves. Backward leak was evaluated by measuring the O2 concentration at the rescuer side of the valve while 100% O2 was directed toward the patient side of the valve. Differences among the brands were evaluated using analysis of variance. RESULTS: The mean (SD) values for volumes in L were: M-M 1.00 (0.25), Micro 0.77 (0.20), RCK 0.64 (0.10), and KOL 0.24 (0.11). Mean values for back pressure in cm H2O at 50 L/min were Micro 16.7 (1.29), KOL 7.22 (0.13), and RCK 2.15 (0.16). Significant backward leak only occurred with RCK. CONCLUSION: Not one of the FSs tested met all of the requirements suggested by the American Heart Association and by the International Standards Organization. PMID- 10143508 TI - Circadian patterns of emergency asthma presentations: implications for staffing and treatment. AB - Are there circadian patterns for time of presentation and clinical status in asthmatic patients admitted to an emergency department for acute exacerbations? DESIGN: Prospective observational study. SETTING: Urban community teaching hospital emergency department. PARTICIPANTS: 279 consecutive patients who presented a total of 310 times with asthma exacerbations between October 19 and December 31, 1993. We grouped patients aged 16 years and above as adults and patients younger than 16 years of age as children. INFORMATION COLLECTED: Time of emergency department presentation, time attack began (for adult patients), peak expiratory flowrate prior to emergency department treatment (for adult patients), need for hospital admission, ventilatory failure during an acute attack, and death during an acute attack. RESULTS: Circadian patterns were demonstrated for time of presentation. For the total study group, the peak time of presentation was 8:00 PM to 11:59 PM (p < 0.05) and the trough time of presentation was 4:00 AM to 7:59 AM (p < 0.01). There were differences in peak time of presentation for patients grouped by age. For adult patients only, the peak time of presentation was 8:00 AM to 11:59 AM (p < 0.01), whereas for children only, the peak time of presentation was 8:00 PM to 11:59 PM (p < 0.001). No statistically significant patterns in time of attack onset, hospital admission rates, or peak flow measurements were observed. CONCLUSIONS: There are circadian patterns for the time at which patients with acute asthmatic exacerbations present to our emergency department. Adult patients have a peak time of presentation between 8:00 AM and 11:59 AM, whereas children have an apparent peak time of presentation between 8:00 PM and 11:59 PM. For all age groups, there is a trough in presentation between 4:00 AM and 7:59 AM. PMID- 10143509 TI - Evaluation of the Ciba Corning 840 blood gas analyzer. AB - BACKGROUND: Because our laboratory had used the Ciba Corning 200 series blood-gas analyzers for a number of years, we were asked to participate in the evaluation of a premarket unit of the Model 840 analyzer (C840). DESCRIPTION OF DEVICE: The C840 is a bench-top instrument that combines a menu-driven user interface with an automated sampler and integrates software for data management and system diagnostics. EVALUATION METHODS: We compared the performance of the C840 to a laboratory-based Ciba Corning 278 (C278), analyzing a total of 325 blood samples. We also evaluated the software for routine laboratory applications. EVALUATION RESULTS: The bias and imprecision (+/- 2 SD) between the C840 and C278 was calculated for pH (+0.004 +/- 0.014 pH units), PCO2 (+1.8 +/- 3.3 torr), and PO2 (+0.01 +/- 9.0 torr for all PO2 ranges; -0.17 +/- 4.8 torr for PO2 < 150 torr). CONCLUSIONS: We conclude that the analytical performance of the C840 is comparable to the C278, and its data storage and interface capabilities should help laboratories meet CLIA-88 requirements. PMID- 10143511 TI - A new kind of volunteer board. PMID- 10143510 TI - Emergency room, save thyself. PMID- 10143512 TI - Partnerships are key to renovating health care. PMID- 10143513 TI - Harlem hospital helps foster a renaissance for children. PMID- 10143514 TI - The healing power of art. PMID- 10143515 TI - Caring for patients of all cultures. PMID- 10143516 TI - Fewer urban patients speak English. Interpreters bridge language gap. PMID- 10143517 TI - Helping communities create health. PMID- 10143518 TI - Perspectives. Perestroika at Hopkins: new environment in microcosm. PMID- 10143519 TI - Overview of existing engineering set up, operations and problems in Fiji hospitals. PMID- 10143520 TI - Sterilizers, medical gas pipeline systems and medical equipment. PMID- 10143521 TI - Planning appropriate hospitals for developing countries. AB - Since the most prevalent characteristic of developing countries is the lack of human and financial resources, and that social custom and practice play a more important role in developing countries than in others, the paper discusses how those characteristics influence the planning of hospitals, focusing on the issues that differentiate hospitals in developing countries from those in other parts of the world. Against that background the paper proposes an approach to planning hospitals for incremental development and for subsequent growth and change to ensure that they will remain appropriate to evolving patterns of healthcare and changing circumstances in developing countries. PMID- 10143522 TI - Developing the case for combined heat and power. PMID- 10143523 TI - Update on healthcare reform. PMID- 10143524 TI - Tips in preparing for the 1995 CCS exam. PMID- 10143525 TI - The future is what you make it. PMID- 10143526 TI - Developing service-specific forms for computer-based patient records. PMID- 10143527 TI - Statistical inference in health information management. PMID- 10143528 TI - Coding against an uncertain future. PMID- 10143529 TI - FORE Library turns 30! PMID- 10143530 TI - Should AHIMA consider distance learning? PMID- 10143531 TI - The new world of management or is it coaching, facilitating, or mentoring? PMID- 10143532 TI - A model to implement and sustain change. PMID- 10143533 TI - Meeting employer needs: innovations in training coders. PMID- 10143534 TI - Challenges of distance learning for the allied health educator. PMID- 10143535 TI - Learning at a distance: people, technology, and learning experiments. PMID- 10143536 TI - Communicating quality improvement through a hospital newsletter. AB - Healthcare organizations across the United States are embracing the tenets of continuous quality improvement. The challenge is to disseminate information about this quality activity throughout the organization. A monthly newsletter serves two vital purposes: to share the improvements and to generate more enthusiasm and participation by staff members. This article gives practical suggestions for promoting a monthly newsletter. Preparation of an informative newsletter requires a significant investment of time and effort. However, the positive results of providing facilitywide communications can make it worth the effort. The current availability of relatively inexpensive desktop publishing computer software programs has made the process much easier. PMID- 10143537 TI - Quality at the hub of HMO Blue. AB - Since the mid-1980s, quality management has infused the healthcare industry with a newborn commitment to improving the quality and efficiency of its service delivery processes. Increasing industry competition has served to sharpen the focus on quality. For health services companies such as Blue Cross and Blue Shield of Massachusetts, a relative latecomer to the managed care marketplace, the challenges of getting quickly up to speed were significant. This article describes the simultaneous efforts of the company to develop a substantial new presence in the managed care marketplace, while also applying the basic principles of quality assurance and continuous quality improvement to its organizational transformation. PMID- 10143538 TI - A structure for organizing a facility's annual performance review. AB - A facility's annual appraisal or report historically has evaluated the traditional quality assurance (QA) role of morbidity and mortality, infection control, tissue review, and medical record data. With the evolution of QA to performance improvement (PI), the traditional annual appraisal has had to expand to address multiple organizational programs, projects, and indicators, as well as the structure and outcome of teams. This article discusses a structure for evaluating various programs and reviewing how well the organization has met its goals. PMID- 10143539 TI - The Contract with America--implications for healthcare reform. PMID- 10143540 TI - Perspective: healthcare on a diet. AB - Both state healthcare reform and the market are shrinking the healthcare infrastructure and changing the needs of the workforce. Managed care, in its various forms, generally uses fewer doctors and makes more efficient use of hospitals. This will have a profound effect on medical schools, existing specialties, and underutilized hospitals. After many false starts, Adam Smith's "invisible hand" is having its impact. This article explores some of the consequences. PMID- 10143541 TI - Combining utilization management and discharge planning. AB - Utilization management and discharge planning are two essential functions for all healthcare facilities. In many hospitals, these two jobs are performed by personnel from two separate departments. This article describes the methodology and benefits of a project that combined the functions of utilization management and discharge planning. PMID- 10143542 TI - Teaching hospitals in crisis. PMID- 10143543 TI - Basics of research (Part 2): Reviewing the literature. PMID- 10143544 TI - Intubation quality assurance thresholds. AB - INTRODUCTION: Quality assurance (QA) and continuous quality improvement (CQI) are valued activities within health-care organizations. Quality assurance indicators as guidelines for quality practice usually are established intuitively. The purpose of this study was to determine an appropriate threshold for successful intubation in patients transported by air and to examine factors impacting this success rate. SETTING: Fifteen rotor-wing programs from across the United States participated. METHOD: The study was a prospective descriptive design. A total of 369 flight crew members agreed to participate, and intubations were attempted on 862 patients during the 12-month study. RESULTS: Intubations were attempted on 862 patients and were successful in 788 (91.4%) of the patients. Of the patients not successfully intubated, 14 received supplemental oxygen only, 25 were supported with bag-valve-mask, 26 received a surgical cricothyroidotomy and for nine patients it was unknown what form of airway support was provided. CONCLUSION: Factors impacting successful intubation include cardiac arrest, use of neuromuscular blockade, use of sedatives and facial trauma. Data from the study support a threshold for successful intubation of between 90% and 95%. PMID- 10143545 TI - Trauma and nontrauma cardiopulmonary arrest: a national survey. AB - INTRODUCTION: This survey attempts to identify the current standard of care for the air medical transport of the patient in cardiopulmonary arrest. METHOD: An Association of Air Medical Services/National Flight Nurses Association-approved survey by a single mailing with an anonymous response. SETTING: All rotor-craft programs with current memberships in AAMS. RESULTS: Fifty-three of the 178 questionnaires mailed were returned. Program demographics, crew composition and transport volumes were typical of other reported national experiences. The majority of programs (84%) had standing operational protocols for trauma and non trauma cardiopulmonary arrests. The indications for not initiating or discontinuing CPR, the transport of the patient in cardiopulmonary arrest, triage and financial considerations varied widely between air medical programs. CONCLUSIONS: This study provides some insight on the current air medical management of the patient in cardiopulmonary arrest. National practice guidelines should be developed and tested prospectively in future studies. PMID- 10143546 TI - Improved transport incubator temperature control with insulating thermal cover. AB - INTRODUCTION: Cold stress, secondary to heat loss, can compromise infants in transport incubators during interfacility transfer. With current incubator designs, considerable radiant heat loss occurs. The use of additional external thermal insulation to reduce heat loss has been recommended for infant transports in cold environments. METHOD: A laboratory experiment was done to compare the rate of heat loss from a transport incubator with and without a commercially available, thermal insulating cover in place. The environment was a commercial freezer simulating subzero environmental temperatures. Measurements included air temperatures. inside the incubator and freezer, patterns of heater action and duration of battery power output. The significance of the different rates of cooling was compared using Pearson's r. Suboptimal battery performance was excluded by repeating one arm of the study with an external battery in place of the internal unit. RESULTS: The rate of heat loss from the incubator was: 1) significantly slower when the covered and uncovered incubators were compared (r2 = 0.52), and 2) essentially identical for the uncovered incubator with either the internal or the external battery (r2 = 0.96). CONCLUSION: In the laboratory setting, external thermal insulation slows transport incubator radiant heat loss. Clinically, this effect likely would benefit infants at risk of cold stress during interfacility transports. PMID- 10143547 TI - Red cabin lights impair air medical crew performance of color-dependent tasks. AB - INTRODUCTION: Red cabin lighting is often used for nighttime patient transports in helicopters. This study was conducted to determine if red lighting results in impairment of color-dependent tasks. METHODS: An emergency medical services pilot adjusted red lighting in a BO-105 cabin to maximum acceptable intensity. Thirteen emergency room residents were shown positive and negative CO2 detectors and skin colored and cyan-tinted rubber masks; percentages of correctly identified masks and detectors were noted. Subjects also read drug name and amount from 12 medication labels. Wilcoxon analysis (p = 0.05) was used to compare label reading accuracy between two groups: control (black/white lettering/background) and red (red lettering or background). RESULTS: Percentages of accurately identified masks and detectors in the red light setting were as follows: normal mask 61.5%, cyanotic mask 30.8%, negative and positive CO2 detectors 46.2%. Ability to correctly read medication labeling was significantly (p = 0.003) greater in control (76.9 +/- 10.9%) as compared to red groups (16.3 +/- 13.4%). CONCLUSION: Red cabin lighting appears to impair performance of certain critical tasks requiring color discernment. Consideration of this by medical crews working under red light conditions could reduce risk for patient-care errors. PMID- 10143548 TI - Adverse effects of rotating schedules on the circadian rhythms of air medical crews. PMID- 10143549 TI - Altitude physiology and the stresses of flight. PMID- 10143550 TI - Will reengineering save us all? AB - If you've gotten the message that reengineering is an exercise designed to create profound change, you've gotten the message. If you know from experience that buying a medical group and tacking it onto a hospital or insurance company doesn't create the results you want, you may be starting to understand the importance of reengineering. It isn't easy, but we can't see an alternative. Traditional components of our industry are all on the endangered species list. To us this means making changes in our business processes that are fundamental, radical, dramatic, and process-focused. It means that reengineering must become a way of life. PMID- 10143551 TI - Patient evaluation of care within a multidisciplinary breast care center. AB - To understand patient perceptions of multidisciplinary medical care, a survey instrument was developed to poll 1,023 consecutive visitors to the University of Michigan Breast Care Center (BCC). Factors influencing patient satisfaction included staff concern for patients, one-stop shopping, medical thoroughness, and length of waiting in the reception area (negative correlation). These factors are well addressed by a multidisciplinary approach to medical care. Similar models of multidisciplinary care can probably be implemented at other institutions and in other clinical settings. PMID- 10143552 TI - Introducing a clinical improvement process in a multispecialty group practice setting. AB - In response to initial concerns about utilization of services by procedural specialists, the Sunnyvale Clinic encouraged a team of physicians and support staff to overcome differences and create a clinical guideline for sinusitis treatment. Using CQI tools, the team implemented process improvements intended to reduce variation and cost of care. The success of this pilot project, albeit slow in coming, led to further clinical guideline development and a complete restructuring of the quality management programs. PMID- 10143553 TI - Acuity systems and control charting. AB - The strengths of control charting and other statistical process control (SPC) tools have not previously been applied to acuity systems. Intermountain Health Care, Salt Lake City, Utah, developed a new acuity system that relies heavily upon control charting for an array of purposes, including immediate feedback to caregivers regarding decisions, ongoing feedback to managers regarding decision patterns, and longer-term feedback regarding trends and budget-relevant information. The use of control charts has eliminated the need for auditing acuity-based staffing and has maintained the reliability of classifications at levels above 95 percent. Implications for other novel applications are offered. PMID- 10143554 TI - Evolving an empowering approach to continuous quality improvement in home care. AB - Theory suggests that in an "empowering" organization all individuals assume genuine decision-making roles and control over their work. Unfortunately, many organizations actually stifle empowerment through creating new bureaucratic barriers as they implement structures to deploy quality management principles. The Oxford County Home Care Program describes how it redesigned its organizational structure to facilitate empowerment. PMID- 10143555 TI - C.I. Lewis and Deming's theory of knowledge. AB - W. Edwards Deming's theory of management has had significant impact on the way managers have understood their role in recent times. An important influence on his philosophy was the work of C.I. Lewis in an area of philosophy known as epistemology, or theory of knowledge. This article examines Lewis's influence on Deming, connects it to a larger intellectual context, and draws out the implications for the work of management. PMID- 10143556 TI - Patient satisfaction and experience with health services and quality of care. AB - This article discusses the use of patient satisfaction and personal health care experiences as a measure of health care quality. It also presents a field-proven patient experience and satisfaction assessment methodology known as the Patient Experience Survey (PES) that has been employed throughout the country for the last decade. Finally, it offers recommendations and comments on the use of patient satisfaction data in quality assessment and improvement. PMID- 10143557 TI - The evaluation of hospital stays for total hip replacement. AB - The purpose of this study is to present four care experiments developed in the Netherlands and New York State that aim to reduce mean hospital stays for total hip replacement and thus increase efficiency of hospital utilization without adversely influencing quality of care. The major components of the programs and their impact on lengths of stay are described. PMID- 10143558 TI - Benchmarking in health care--paradigms, culture, and change. PMID- 10143559 TI - Summary report from the Cleveland Health Quality Choice Program. PMID- 10143560 TI - Community hospital expands role in patient care. PMID- 10143561 TI - Blending the old with the new. Interview by Damon Braly. PMID- 10143562 TI - In the world of IDS (integrated delivery systems), timing is everything. PMID- 10143563 TI - Information systems and integrated healthcare: an essential partnership. PMID- 10143564 TI - HCFA's evolving role. PMID- 10143565 TI - Telemedicine and interconnection services reduce costs at several facilities. Prison and health system partner with Ameritech. PMID- 10143566 TI - CPR definition becoming clearer. PMID- 10143567 TI - HotList. Computerized patient-record applications. PMID- 10143568 TI - 1995 Health Management Technology market directory supplement. PMID- 10143569 TI - If you bill it, they will pay. PMID- 10143570 TI - Strategic plan provides link between action and need. PMID- 10143571 TI - Physician networks prompt antitrust enforcement. PMID- 10143572 TI - Savings for seniors? PMID- 10143573 TI - Quality of care and patient satisfaction: a review of measuring instruments. AB - Surveying the literature on the assessment of quality of care from the patient's perspective, the concept has often been operationalized as patient satisfaction. Patient satisfaction has been a widely investigated subject in health care research, and dozens of measuring instruments were developed during the past decade. Quality of care from the patient's perspective, however, has been investigated only very recently, and only a few measuring instruments have explicitly been developed for the assessment of quality of care from the patient's perspective. The authors consider patient satisfaction as an indicator of quality of care from the patient's perspective. This review is concerned with the question of whether any reliable and valid instruments have been developed to measure quality of care from the patient's perspective. PMID- 10143574 TI - Research on hospital administrators' ethics: an agenda. AB - This discussion argues that whereas ethically questionable practices have been identified in many industries, the moral consequences of many hospital management decisions make this industry particularly worthy of ethics studies. Because health care, the hospital's product, typically represents more immediate, intimate, and possibly irreversible benefit or harm to its customer, the patient, than does the typical product of general industry, hospital executives should be held to higher ethical standards in their decision making. Yet little is known about the ethical thinking of hospital managers. Kohlberg's moral reasoning development theory and Rest's Defining Issues Test offer the theoretical base and the means to compare the ethical reasoning of hospital executives to that of their nonhospital counterparts in general industry. This research agenda can offer important clues regarding the need to emphasize ethics in health care industry educational programs. PMID- 10143575 TI - Incentive effects of workers' compensation benefits: a literature synthesis. AB - Increasingly, the health care community and public policymakers are recognizing the role of economic and psychosocial factors in disability in addition to their traditional attention to environmental, physical, and somatic influences on health and illness. In particular, current discussions of health reform include serious consideration of the integration of workers' compensation and health plan benefits. This article synthesizes what is known regarding one important aspect of health policy: the effects on disability behavior of changes in workers' compensation benefits. The best available literature reveals that an increase of 10 percent in workers' compensation benefits is related to a 1 to 11 percent increase in the frequency of workers' compensation claims and a 2 to 11 percent increase in duration per claim. The article examines the sensitivity of these parameter estimates to differences in research design and proposes an idealized study methodology that, the authors hope, would improve the precision of estimates of the incentive effects of workers' compensation payments. PMID- 10143576 TI - The health services establishment is becoming an independent variable: a life of its own. AB - Until recently, the health services establishment was assumed to be a product of the social, economic, and scientific medical developments since the turn of the century. It consumed a modest and relatively constant percentage of the gross national product (GNP). It was a dependent variable. Since the 1950s, sparked by labor-management negotiations for health insurance coverage and Medicare and Medicaid, plus the dazzling high medical technology such as organ transplants, the health services establishment took off. It grew faster than the GNP and the Consumer Price Index. It competes with other priorities for goods and services. It became an independent variable having an impact on society. This essay attempts to demonstrate conceptually and empirically how and why this transformation took place. PMID- 10143577 TI - Conceptual and methodological sources of variation in the measurement of nursing facility quality: an evaluation of 24 models and an empirical study. AB - Whereas many researchers have developed sophisticated instruments to assess quality of care in nursing facilities (NFs), the concept of quality, its measurement, and its relationship to organizational characteristics remain important issues that are characterized by inconsistent findings across studies. The conceptualization and methodologies used in twenty-four NF quality studies are compared. The review identifies four main sources of variation hypothesized to be important bases of inconsistency in the NF quality literature: (1) differences in conceptualization and operationalization, (2) differences in the unit of analysis (resident vs. facility), (3) differences in sampling method and sample constitution, and (4) differences in the main method of analysis. As an empirical test of three of these sources of variation, the authors investigated relationships between primary organizational characteristics and various measures of quality using a sample of 104 Wisconsin NFs. From both the comparative and Wisconsin analyses, implications for research are drawn. PMID- 10143579 TI - Starting from scratch. Interview by Sharon Watson. PMID- 10143578 TI - Primary care, avoidable hospitalization, and outcomes of care: a literature review and methodological approach. AB - The purpose of this article is to review the literature on the relationships between primary care, potentially avoidable hospitalizations, and outcomes of care and to develop a methodology to study these relationships. The methodological approach includes developing criteria to select medical conditions, aggregating patient claims files of both ambulatory and acute care records, and delineating episodes of care. A taxonomy of physician visits is proposed that classifies visits on the basis of type of care, type of illness, and linkage to hospital episodes. A structural model of use and outcomes is specified that includes hazard rate models to estimate the likelihood of a potentially avoidable hospitalization, primary care and ad hoc physician visits, and mortality; the latter suggests a modification of the Health Care Financing Administration methodology that includes physician visit variables. PMID- 10143580 TI - Building an electronic highway for rural America. AB - A telemedicine network in Montana is giving isolated hospitals access to specialist consultations through interactive video links. These connections are saving patients hundreds of miles of travel, improving care delivery and saving money. PMID- 10143581 TI - Mergers create a challenging puzzle. AB - Market forces are pushing more health care organizations into mergers. This urge to merge has brought pressure to bear on information departments, which face the huge task of tying together disparate information systems, and doing it quickly while holding the line on expenses. PMID- 10143582 TI - Using new criteria to assess electronic records. PMID- 10143583 TI - Will CHINs be able to mesh with enterprise networks? AB - The current proliferation of enterprisewide information networks developed by integrated delivery systems wasn't foreseen when the community health information network concept was spawned. Now, many are wondering how enterprise networks will mesh with CHINs and whether there will be needless and expensive duplication of services. PMID- 10143585 TI - Yet another group prepares to work on claims standards. National Uniform Claim Committee. PMID- 10143584 TI - Start your engines. A variety of market forces are revving up the demand for a new technology known as interface engines. PMID- 10143586 TI - Launching a high-profile automation mission. Interview by Brian Deming. PMID- 10143587 TI - Designing a place for automation. AB - Re-engineering is a hot topic in health care as market forces increase pressure to cut costs. Providers and payers that are redesigning their business processes are counting on information systems to help achieve simplification and make large gains in efficiency. But these same organizations say they're reluctant to make large upfront investments in information systems until they know exactly what role technology will play in the re-engineered entity. PMID- 10143588 TI - Good news for the business office. AB - For the past decade, St. Alphonsus Regional Medical Center in Boise, Idaho, has been seeking ways to use automation to make its business office more efficient. Today, the hospital is a leader in the movement toward electronic remittance advice and payments. PMID- 10143589 TI - Mixed signals on translation software's future. AB - Health care providers have been slow to acquire and implement translation software to streamline electronic data interchange with payers, suppliers and other trading partners. Proponents argue that after the movement to standard electronic transactions picks up speed, the market for the software will explode. But skeptics argue that the benefits of the software are limited and predict that demand will remain modest. PMID- 10143590 TI - Outsourcing gets providers back to the basics. AB - Information technology is advancing so quickly that many organizations can't keep up. That's why demand for the outsourcing of data processing functions is growing as providers and payers attempt to implement the latest technology while holding costs down. Those investigating outsourcing must carefully scrutinize whether an arrangement actually will cut costs, experts advise. And clients should review contract terms to ensure all expectations are spelled out. PMID- 10143591 TI - Team-centered discharge management: on a fast track to performance improvement. PMID- 10143592 TI - A volunteer guardianship program: balancing benefits against the loss of self determination. PMID- 10143593 TI - Care planning in integrated delivery systems: pitfalls for the unwary. PMID- 10143594 TI - Strategic planning for residency training programs. AB - Residency training is practice-based learning that is reflective of the practice environment. As practice changes, changes in residency training are needed. Strategic planning is a process that considers internal and external factors that will impact the future. The planning process includes gathering input, focusing on important issues, developing a consensus, and writing clearly defined goals. The strategic planning process was applied to residency training at Hamot Medical Center. A retreat was held, consensus was developed, and a plan was written. The planning process prepared us to make changes in the types of residency programs we offered. This article describes strategic planning for our residency and progress on our goals. PMID- 10143595 TI - Pharmacy residency training programs: a resident's perspective. AB - As changes are being made in the health care system, the roles and responsibilities of the pharmacist are evolving in direct patient care. The knowledge and skills necessary to succeed in these clinical positions are obtained through postgraduate training through pharmacy practice and specialty residencies and fellowships. Residency candidates are faced with important decisions in choosing which training programs to select and planning the course of the training. This article approaches the questions and decision-making process in residency selection from pharmacy residents' points of view. PMID- 10143596 TI - Integrating postgraduate pharmacy training programs into colleges of pharmacy. AB - An important issue facing colleges of pharmacy is the integration of postgraduate clinical training programs into the mainstream of pharmacy education. Colleges of pharmacy have a major role to play in postgraduate clinical training programs to the benefit of the college, resident, and institution. Students must be provided with information about residencies during their first year, and this information must be continually reinforced throughout their academic career. Residency and fellowship programs contribute significantly to the education of pharmacy students. Colleges must take an active role, working in partnership with institutions to enhance postgraduate pharmacy training programs. PMID- 10143597 TI - The evolution of pharmacy residency training programs and corresponding standards of accreditation. AB - Practice-based pharmacy training has a long history, particularly in institutional pharmacy practice. Formal pharmacy residency training programs and accreditation standards were first developed in the early 1960s. Practitioners now practice in a much different environment. Residency programs and accreditation standards have changed dramatically to meet the needs of practitioners, patients, and employers. The authors trace the evolution of programs from general internships through clinical practice and specialty residencies and fellowships and the development of standards and competency-based training. PMID- 10143598 TI - Residency training--the profession's forge for leadership development. AB - The concept of leadership may be the most widely studied and least understood topic in the domain of social services. Leadership has been described as a major force in the profession's transition to pharmaceutical care and effective program development. Pharmacy practice residency programs are a major means of developing and sustaining leadership for the growth of the profession. Three concepts that are explored include: (1) some insight into noncognitive elements of residency training that are critical to the development of professional practice, (2) analysis of leadership perceived to be critical for pharmacists, and (3) a definition of how residency training can develop professional leaders to meet the challenges for pharmacy. PMID- 10143599 TI - Promotion of the appropriate use of outpatient drug therapy in the Texas Medicaid Program through retrospective drug use review. PMID- 10143600 TI - Restructuring postgraduate training programs for survival. PMID- 10143601 TI - Realities of conducting pharmacoeconomic evaluations as part of clinical trials. PMID- 10143602 TI - Decision making in pharmacy practice: a case study. PMID- 10143603 TI - Community needs assessment: provider networks plan for health. PMID- 10143604 TI - Managed care outlook, 1995-2000: top 10 trends for the HMO insurance industry. PMID- 10143605 TI - Age wave: organizing integrated care networks for an aging society. PMID- 10143606 TI - Nursing trends 1995-2000: advanced practice nurses, case management, and patient centered care. PMID- 10143607 TI - Different sector, same mission. Interview by Therese M. Droste. PMID- 10143608 TI - Full speed ahead for Banc One. PMID- 10143609 TI - Lining up vital political support for EDI. PMID- 10143610 TI - Provider automation. Paper cuts. PMID- 10143611 TI - Plugging in national networks. AB - National claims processing networks, now in their infancy, will dominate the market as the industry consolidates. Processors are attempting to plug in their larger networks in anticipation of an explosion in automated claims and payment activity. PMID- 10143612 TI - Putting together the Blues puzzle. PMID- 10143613 TI - Moving from blueprint to action. PMID- 10143614 TI - The professor of claims automation. Interview by Diane Dannenfeldt. PMID- 10143615 TI - Linking claims to automated medical records. PMID- 10143616 TI - Standards. The difficult road ahead. PMID- 10143617 TI - New capital fuels new services ... Health Management Systems Inc. PMID- 10143618 TI - Who owns the data? PMID- 10143619 TI - The standard bearer. Interview by Joseph Goedert. PMID- 10143620 TI - Arming TPAs to join the automation revolution. PMID- 10143621 TI - Surgeons take a scalpel to claims costs. PMID- 10143622 TI - The corporate threat in the EDI seas. PMID- 10143623 TI - Multi-hospital systems guide their members into the automation age. PMID- 10143624 TI - Patient ID cards: passports to care. PMID- 10143625 TI - Pilot projects demonstrate the need for diplomacy. PMID- 10143626 TI - Long-term automation leader. Interview by Craig Wyatt. PMID- 10143627 TI - Bank networks. Exchange banks on medical market for growth. PMID- 10143628 TI - Where automating claims is like pulling teeth. PMID- 10143629 TI - Speeding the managed care traffic flow. PMID- 10143630 TI - How EDI erodes the mountain of worker's comp paperwork. PMID- 10143631 TI - The key to a clean claim: get it right the first time. PMID- 10143632 TI - Experiments offer access to credit without a card. PMID- 10143633 TI - Sizing up the potential market for processing. PMID- 10143634 TI - Is there a satellite in your future? PMID- 10143635 TI - Nursing homes get an automation incentive. PMID- 10143636 TI - Guarding against liability for lost claims. PMID- 10143637 TI - A catalyst for federal automation. Interview by Marybeth Burke. PMID- 10143638 TI - Pentagon dollars trigger corporate treaties. PMID- 10143639 TI - Provider automation. Growth without expansion. PMID- 10143640 TI - Managing data in a new era. AB - Detroit's Henry Ford Health System prepares for life after health care reform by automating managed care transactions, computerizing the medical record and using EDI to eliminate paper claims. PMID- 10143641 TI - Clearinghouses are here to stay. PMID- 10143642 TI - The market is fading away. PMID- 10143644 TI - A real-world test for Hartford's network theory. PMID- 10143645 TI - Top payer dances with plenty of partners. PMID- 10143643 TI - Canada warms up to health care EDI. PMID- 10143646 TI - How FFMC (First Financial Management Corp.) bought into health care market. PMID- 10143647 TI - Clinton places paperwork at top of his hit list. PMID- 10143648 TI - An EDI pioneer's winding road to health care. Interview by Mark Brohan. PMID- 10143649 TI - Surgery chain uses EDI to sharpen its edge. PMID- 10143650 TI - Data security: how much is enough? PMID- 10143651 TI - Smart shopping: how to select a vendor. PMID- 10143653 TI - Hospitals racing to make smooth transition to UB-92. PMID- 10143652 TI - WEDI's (Workshop for Electronic Data Interchange) tests demonstrate the value of automation. PMID- 10143654 TI - Claim form laws are a mixed bag. PMID- 10143655 TI - Medicare cost limits ... is there any relief? AB - Medicare cost limits stem from 20-year-old legislation that determines "reasonable" rates for reimbursement. Although those rates have periodically been adjusted, they often do not represent a reasonable limitation on a provider's reimbursement. How can agencies challenge limits and appeal unfavorable rulings? What are the most successful means of appeal? PMID- 10143656 TI - Cost allocations to meet the challenges of today & tomorrow. AB - Home care agencies need to plan their position in the industry carefully and consider all available options for organizing their operations and allocating costs. This article outlines some of the many options for cost allocations. PMID- 10143657 TI - Capitation. AB - As managed care increases its presence in the home care industry, providers need to take a good look at capitation, the reimbursement method that some managed care users. This article explores the issues involved in this new payment method. PMID- 10143658 TI - Home care's integration into managed care. AB - As hospitals and managed care organizations strive to reduce costs and maintain quality, home care agencies will need to intervene and care for an increasing number of patients. Therefore, agencies will need to be knowledgeable about and competitive under the same reimbursement mechanisms and risks to which hospitals and physicians are forced to respond. PMID- 10143659 TI - The importance of management information systems in a managed care environment. AB - Keys to successful information systems for home care providers are planning and control. With managed care's emphasis on data, agencies need to have information systems that can handle the demands managed care puts on agencies today--planning before hurrying to install a system will ensure control as the managed care contracts add up. PMID- 10143660 TI - Have you seen your budget lately? AB - Managers talk about budgets, about being over or under budget, but are they really using budgets as management and planning tools? With several types of budgeting, one or two types will certainly help agencies remain stable in the evolving home care market. PMID- 10143661 TI - Opening a branch office: a successful approach. AB - Branch offices offer advantages for both agencies and clients. From increased visibility in the community and thus more business to increased contact with community resources and thus better client service, establishing a branch office where the potential home care population warrants it is a good idea. PMID- 10143662 TI - Limiting exposure to liability: simple but crucial steps when hiring. AB - Home care agencies serve a frail and often elderly population that requires competent and trustworthy caregivers. Solid personnel policies that establish thorough and clear hiring and training practices can ensure top-notch employees and reduce an agency's risk of exposure to liability. PMID- 10143663 TI - Medicare: current audit & reimbursement issues. AB - Home care agencies have been under the Medicare microscope lately for issues of fraud; the Health Care Financing Administration (HCFA) is retooling its audit process in light of this focus. HCFA is also reconsidering its policies on deductible costs of lobbying. What do agencies need to know about this and other issues to stay financially healthy? PMID- 10143664 TI - Drug testing from a patient's perspective. PMID- 10143665 TI - What team leaders need to know. PMID- 10143666 TI - Data trends. July 1995. PMID- 10143667 TI - Integrated healthcare systems. Understanding the "physician-equity model". PMID- 10143668 TI - Managed care. The case for case-based pricing. PMID- 10143669 TI - Medicaid and managed care can work together. Interview by Wendy Herr. PMID- 10143670 TI - Paying specialists and subspecialists on a capitated basis. AB - Primary care physicians are the focal point of any capitated system. They are the gatekeepers to specialty and subspecialty physicians and to ancillary providers. However, many experts now believe that to truly align the incentives of all providers and to bring costs to the lowest level possible, specialty and subspecialty physicians also should be paid on a capitated basis. PMID- 10143671 TI - Capitation: implications for provider cost structures. AB - Healthcare operating managers understand that capitation has inverted the financial incentives that existed in the fee-for-service environment. However, cost-structure implications of the managed care environment also must be understood if organizations are to prosper as markets evolve into capitation. PMID- 10143672 TI - Positioning for capitation by redesigning internal processes. AB - Now that healthcare reform is no longer at the forefront of President Clinton's agenda, competition among providers, practitioners, and health systems will become more common as they ready themselves for capitation. In addition, mergers, consolidations, acquisitions, alliances, and partnerships will continue to reshape the healthcare industry. In order for the parties to be successful in a capitated environment, providers, practitioners, and healthcare systems must manage and adapt to consolidation, capitation, communication, control, cost, customer, capital, and culture. PMID- 10143673 TI - CPRI and the future of computer-based patient records. Interview by Robert Fromberg. PMID- 10143674 TI - Justifying the cost of a computer-based patient record. AB - Computer-based patient records (CPRs) that integrate financial and clinical information are important tools for improving the quality and lowering the cost of care. However, purchasing, implementing, and maintaining a CPR requires a significant investment that must be justified. At The University of Texas M. D. Anderson Cancer Center, a cost-benefit analysis of a CPR involved identifying the goals of a CPR, determining its quantifiable and nonquantifiable benefits, estimating its initial costs, projecting its costs and benefits over 10 years, calculating its net present value, and monitoring its results. PMID- 10143675 TI - Using the CPR to benefit a business office. AB - Computer-based patient records can help a healthcare organization's business office achieve higher-quality service at lower cost by providing improved access to necessary financial as well as clinical information. The systemwide utility of a computer-based patient record that serves both clinical and financial needs helps justify its cost. PMID- 10143676 TI - The need to integrate clinical and financial information. AB - To succeed under managed care, healthcare organizations must integrate clinical and financial information. This integration can help minimize financial risk by improving the ratio of costs to clinical outcomes. This clinical-financial integration will require healthcare organizations to improve outcomes measurement and cost accounting systems and use tools such as computer-based patient records to identify more clearly the interventions that produce excellent outcomes at minimal cost. PMID- 10143677 TI - Who rates the rating agencies? PMID- 10143678 TI - The demand for high-tech and "high-touch" skills. PMID- 10143679 TI - Health management guide. Ethics and probity. AB - Changing structures, roles and relationships have thrown many of the old certainties of health service management into question. But whereas clinicians have professional codes to guide them, managers have had to make difficult choices and decisions in the absence of a written and clearly understood ethical framework. More recently, codes of practice for NHS boards and for individuals have started to address this issue. This Health Management Guide aims to provide a practical introduction to the ethics of health service management. PMID- 10143680 TI - Emergency admissions: what is driving the increase? PMID- 10143681 TI - The battle for Hastings. PMID- 10143682 TI - Community care. PASS (practice agreements with social services) notes. PMID- 10143683 TI - Law. Rising pressure. How can health service employers avoid being sued for stress-related illnesses? PMID- 10143684 TI - Law. Unchartered territory. Can failure to meet national and local Patient's Charter standards be challenged in the courts? PMID- 10143685 TI - Law. Feeling the heat ... potential liability of non-executive directors of NHS trusts. PMID- 10143686 TI - Law. A load off their minds. Trusts would face fewer compensation claims for back injuries if they made more use of hoists and relied less on manual handling. PMID- 10143687 TI - Law. Where there's a will. How should health professionals regard 'living wills'? PMID- 10143688 TI - Integrated purchasing. The alliance of scions. PMID- 10143689 TI - Corporate governance. Knowing me, knowing you. PMID- 10143690 TI - Organisational change. Death in service. PMID- 10143691 TI - Finance. PAYE day. PMID- 10143692 TI - The death of management. PMID- 10143693 TI - Leadership without easy answers. Interview by Joe Flower. PMID- 10143694 TI - Learning to lead. PMID- 10143695 TI - 1995 Emerging Leaders in Healthcare. The new leaders: Gita Budd, Colene Daniel, Elizabeth Gallup, Scott Wordelman. AB - Fierce pressures for cost containment. Demands for quality improvements. The drive toward patient-centered care. The push for community involvement. Insistent voices of payers, patients, consumers, physicians. Accumulated tensions amid the chaos of change. Balancing all of these demands while inspiring and encouraging the professionals and other workers within the healthcare organization requires a high level of leadership ability. One that insists on the best from everyone involved in a healthcare system--from physicians to staff, nurses to social workers. And then strives for more. The four young executives who are this year's Emerging Leaders in Healthcare have all pushed their systems beyond traditional boundaries into new territory, helping their patients, their employees, their physicians, and their communities rise to new levels of achievement. At the same time, these leaders emphasize teamwork and consensus-style management, so that their co-workers feel like they're participating in the changes, not being victimized by them. Gita Budd, Colene Daniel, Elizabeth Gallup, and Scott Wordelman are winners of the 1995 award from The Healthcare Forum and Korn/Ferry International that honors ?dynamic, decisive young leaders (under 40) with the proven ability to nurture the growth of the industry.? Korn/Ferry International and The Healthcare Forum are proud to present 1995's Emerging Leaders. PMID- 10143696 TI - Technology, medicine & health, Part 6. Exploding the myths of medicine. PMID- 10143697 TI - 1995 Healthier Communities award winners. Communities healing themselves: Growing into Life Task Force, Aiken SC; Bethel New Life Inc., Chicago IL; Norris Green Community Health Forum, Liverpool, England. PMID- 10143698 TI - Health and its determining factors in the Tokyo megacity. AB - This study was designed to (i) analyze community health in post-industrial, densely populated Tokyo, and (ii) find a statistical-based prediction model for the health level of the communities from the environment. For this purpose, we compiled health-level indicators for each city-ward, and indicators for demography, infrastructure, land-use, amenities, education, working conditions, economics, and medical and welfare services. The health factors and the environmental factors were obtained by using weighted principal factor analysis; their relation was examined by weighted correlation analysis and weighted linear regression analysis. One to six environmental factors correlating significantly to health were found for each health-level indicator or factor. The prediction model explained up to 0.98 of the variance of the health-level factors and indicators. This analysis elicited health-determinant factors in various fields. The community health level was well reproduced by the present method; the model will be conducive to decision making pertaining to health policies. PMID- 10143699 TI - Issues in the evaluation of picture archiving and communication systems. AB - Picture archiving and communication systems (PACS) are an example of the application of computer technology in the medical field. PACS automates image handling in a hospital and has the potential to transform the way radiology is currently performed. This paper focuses on the evaluation of the PACS technology, and considers the claims that have been made for PACS, how these claims might be turned into questions to be addressed by evaluation and the appropriate methods for the evaluation of PACS. A distinction is drawn between evaluation questions for which the hospital is the appropriate focus and those for which the patient is the appropriate focus. The preferred research design is different for hospital focused PACS evaluation and patient-focused evaluation of small scale PACS systems. A contemporaneous experimental comparison within hospitals is the preferred design for the patient-focused evaluation of small scale PACS systems. The patient-focused evaluation of large scale systems and the hospital-focused evaluation of all PACS systems could feasibly be conducted as contemporaneous experimental comparisons between hospitals but the large research costs implied by such a design almost certainly mean that non-contemporaneous, non-experimental comparisons within hospitals are more realistic. The current situation for the PACS technology is that it has potential, but as yet unproven, benefits and a large capital cost. Thus, the primary purpose of funding additional PACS implementations must be to add to the currently small body of evaluation evidence. PMID- 10143700 TI - A note on the depreciation of the societal perspective in economic evaluation of health care. AB - It is common in cost-effectiveness analyses of health care to only include health care costs, with the argument that some fictive 'health care budget' should be used to maximize the health effects. This paper provides a criticism of the 'health care budget' approach to cost-effectiveness analysis of health care. It is argued that the approach is ad hoc and lacks theoretical foundation. The approach is also inconsistent with using a fixed budget as the decision rule for cost-effectiveness analysis. That is the case unless only costs that fall into a single annual actual budget are included in the analysis, which would mean that any cost paid by the patients should be excluded as well as any future cost changes and all costs that fall on other budgets. Furthermore the prices facing the budget holder should be used, rather than opportunity costs. It is concluded that the 'health care budget' perspective should be abandoned and the societal perspective reinstated in economic evaluation of health care. PMID- 10143701 TI - Renovation may herald the ambulatory hospital of the future. Lahey Clinic North, Peabody, Ma. PMID- 10143703 TI - Finding a parking space. PMID- 10143702 TI - Make wash day worker friendly: try post-sorting. PMID- 10143704 TI - Safety first. A construction firm may get the job done on time and on budget. But what about its safety record? PMID- 10143705 TI - Spare space. As the health care system shrinks, unused units and empty buildings are ballooning. PMID- 10143706 TI - AHA responds to proposals on medical waste incineration. AB - Roger Olson, chairman of facilities operations for the Mayo Clinic, Rochester, MN, testified on behalf of the American Hospital Association before the U.S. Environmental Protection Agency's Office of Air Quality Planning and Standards on the EPA's proposed rules on medical waste incinerators. Here's what he had to say. PMID- 10143707 TI - Space planning: 'clean team' should be in on design decisions. PMID- 10143708 TI - Risky business. Why EMS needs risk management. PMID- 10143709 TI - The 10 questions you should always ask. Avoid insurance emergencies: a guide for savvy shoppers. PMID- 10143710 TI - Detox drunks in a different light. PMID- 10143711 TI - Theme park EMS. It's no Mickey Mouse operation. AB - In a single shift, they can rescue someone trapped in a time warp, perform CPR while menacing monsters look over their shoulders or calmly watch as a motorboat chase ends in a huge ball of fire. It's just another routine day for EMS providers in America's theme parks, where getting ready for unusual calls is the norm. JEMS went behind the scenes with theme park responders to explore the unique challenges of their service environment. What we found was a group of super-dedicated professionals who place genuine hospitality right alongside quality patient care. PMID- 10143712 TI - It's Morphin time! PMID- 10143713 TI - HMOs and EMS. Is it too late to SOS? PMID- 10143714 TI - Motivation. PMID- 10143715 TI - Until violence is unacceptable. PMID- 10143716 TI - Columbia, Catholic link has new foe. PMID- 10143717 TI - HMOs seek stricter PHO oversight. PMID- 10143718 TI - AMA members target managed care. PMID- 10143719 TI - AMA names first black president. PMID- 10143720 TI - K.C. hospitals' attempt to affiliate a struggle. PMID- 10143722 TI - Stymied on shareholder gamble, Conn. IPA backs HMO's strategic plan. PMID- 10143721 TI - Public system in Florida to lease Columbia hospital. PMID- 10143723 TI - AMA proposes fixes for Medicare flaws. PMID- 10143724 TI - FTC softens some merger policies. PMID- 10143725 TI - Florida public hospital, HMO, university form partnership. PMID- 10143726 TI - HBO, First Data deal complete; some products to be dropped. PMID- 10143727 TI - Baltimore hospital alliance will contract with employers. PMID- 10143728 TI - Fla. system will choose partner in hospital deal. PMID- 10143729 TI - Managed care could save U.S. billions--study. PMID- 10143730 TI - Neutron-therapy facility loses sponsor, may close. PMID- 10143731 TI - AARP defends its not-for-profit status. PMID- 10143732 TI - Settlement drafted in billing probe. PMID- 10143733 TI - Feds investigate Medaphis offices. PMID- 10143734 TI - Pyxis expands role by buying firm. PMID- 10143735 TI - Study: number of networks up 69% in 1995. PMID- 10143736 TI - New York lawmakers join backlash against 'drive-through deliveries'. PMID- 10143737 TI - Ill. hospitals can't employ docs--judge. PMID- 10143738 TI - Northwest Ohio hospitals plan partnership. PMID- 10143739 TI - Law gives hospitals OK to employ docs in Tenn. PMID- 10143740 TI - Group seeks OK to share fee info. PMID- 10143741 TI - Hospital fined in dumping case. PMID- 10143742 TI - House, Senate negotiators reach budget compromise. PMID- 10143743 TI - United HealthCare eyes MetraHealth. PMID- 10143744 TI - Boren Medicaid law may be axed. PMID- 10143745 TI - Hospitals should buy into bundling. PMID- 10143746 TI - Effort to privatize drug reviews grows. PMID- 10143747 TI - Consumer group helps county design managed-care plan. PMID- 10143748 TI - Medical savings accounts accrue interest. PMID- 10143749 TI - Budget cuts could doom County-USC. PMID- 10143751 TI - Doubts on Foster's candor doomed bid. PMID- 10143750 TI - Sloan-Kettering latest to admit botched care. PMID- 10143752 TI - FTC decision may aid Medicaid managed care. PMID- 10143754 TI - Merged home-care firm leads respiratory arena. PMID- 10143755 TI - Execs fired in whistleblower case. PMID- 10143753 TI - Cut out the middleman. Coalition seeks big savings by taking the direct approach. AB - A large Minnesota business coalition is planning to contract directly for healthcare services with groups of providers. The effort, headed by Fred Hamacher and Steve Wetzell, aims to save money by eliminating the middleman--a move viewed with alarm by managed-care plans in the Minneapolis/St. Paul market. PMID- 10143756 TI - Minn. groups plan merger. PMID- 10143757 TI - N.J. legislators OK Blues' plan to turn for-profit. PMID- 10143758 TI - Virginia Blues takes first step toward for-profit conversion. PMID- 10143759 TI - Clinton Medicaid plan gains support. PMID- 10143760 TI - Indiana physicians suing state over Medicaid payment logjam. PMID- 10143761 TI - La. hospitals hit with Medicaid cuts. PMID- 10143762 TI - Administration to test its brand of Medicare reform. PMID- 10143763 TI - Medicaid managed care receives nod in Vermont. PMID- 10143764 TI - HMO stocks fall with news of Fla. Medicaid rate cut. PMID- 10143765 TI - Fla. hospital sold to Bon Secours. PMID- 10143766 TI - IRS hikes cost of buying tax-exempts. PMID- 10143767 TI - Miami psychiatric hospital to close. PMID- 10143768 TI - N.J. medical center wins McGaw Prize. PMID- 10143769 TI - Three hospitals settle patient-dumping charges. PMID- 10143770 TI - Under fire, PHO alters contract. PMID- 10143771 TI - Olsten buys Wis. home-care firm. PMID- 10143772 TI - Conn. orders hospitals to clean up patient bills. PMID- 10143773 TI - Base commission spares military-VA collaboration. PMID- 10143774 TI - Economics at heart of Marshfield Clinic case. PMID- 10143775 TI - Vendors see new business in CHINs. PMID- 10143776 TI - Healthcare learns what's in a name. PMID- 10143777 TI - Mergers complicate fund raising. PMID- 10143778 TI - Hospital profits stable despite market changes. PMID- 10143779 TI - Hospital mergers slip in first quarter. PMID- 10143780 TI - JCAHO streamlining survey process; 45 management jobs cut. PMID- 10143781 TI - Groups, feds duel over 'deal'. PMID- 10143782 TI - House, Senate OK budget compromise. PMID- 10143783 TI - AMA plan puts squeeze on hospitals. PMID- 10143784 TI - GHAA wants more choice for Medicare. PMID- 10143785 TI - VA hospitals can bid on Tricare. PMID- 10143786 TI - United HealthCare now a Goliath. PMID- 10143787 TI - FHP drops staff-model operations. PMID- 10143788 TI - Survey to stress quality assurance. PMID- 10143790 TI - Entering the managed care arena. PMID- 10143789 TI - Subacute care. Facilities, hospitals, working together. PMID- 10143791 TI - Agency pushes for ergonomics rule. PMID- 10143792 TI - Breaking through incontinence. PMID- 10143793 TI - Is it time to take that gamble? PMID- 10143794 TI - Starting up a quality improvement program. PMID- 10143795 TI - Provider-assisted suicide: a survey of PA attitudes. Results of the 1994 Michigan survey conducted by the Michigan Academy of Physician Assistants Public Policy Committee. AB - Assisted suicide continues to be a topic of debate among health care providers, including PAs. The Public Policy Committee of the Michigan Academy of Physician Assistants surveyed all licensed PAs in Michigan regarding assisted suicide in an effort to determine whether a public policy statement should be developed, and whether that could be extrapolated into a resolution to be taken to the House of Delegates (HOD) of the American Academy of Physician Assistants in 1994. Based on the divergent results of the survey, the Michigan delegation did not submit a resolution to the HOD. PMID- 10143796 TI - New patient management system for Canterbury Health. PMID- 10143797 TI - New system for Mental Health Act in operation at Ngawhatu. PMID- 10143798 TI - Consumer survey of health system. PMID- 10143799 TI - Auckland Healthcare launches new 'Clinical Genetics Service'. PMID- 10143801 TI - More lifestyle choices for mental health clients. PMID- 10143800 TI - Mobile lithotripsy service starts. PMID- 10143802 TI - Hutt Valley Health limits some services. PMID- 10143803 TI - Perspectives. Freedom and responsibility hard to balance in Medicaid. PMID- 10143804 TI - Perspectives. Medicaid oversight failures cloud block grant scenario. PMID- 10143805 TI - Perspectives. House subcommittee vote signals AHCPR reprieve. PMID- 10143806 TI - New MRI unit for Tawam Hospital, at Al Ain, UAE. PMID- 10143807 TI - NHS X-ray departments need modernising to cope with expanding demand. Audit Commission. PMID- 10143808 TI - The registration of authorised persons (sterilizers). PMID- 10143809 TI - Strategic planning of healthcare facilities. PMID- 10143810 TI - Water saving techniques with a porous load sterilizer. PMID- 10143811 TI - Fire resistant cables. PMID- 10143812 TI - Benchmarking survey: monitoring transcription productivity. PMID- 10143813 TI - AAMT (American Association for Medical Transcription) speaks out on confidentiality, privacy, and patient care documentation. AB - Increased use of technology within the healthcare system has raised concerns about the confidentiality, privacy, and security of patient care documentation. These guidelines acknowledge the responsibility and assume the commitment to protect confidentiality, privacy, and security of patient care documentation by all individuals associated with the medical dictation and transcription process. These guidelines suggest means by which such responsibility and commitment should be demonstrated. PMID- 10143814 TI - Putting managers in control of hospital operations. PMID- 10143815 TI - Critical indicators for hospital managers. PMID- 10143816 TI - IMS America drops Common Category Database project. PMID- 10143817 TI - The hidden cost calculator: a new way to look at custom packs. PMID- 10143818 TI - The hard facts about software. PMID- 10143819 TI - Cash poor? Leasing may be the best option--but do your homework. PMID- 10143820 TI - Mix it up: cycle counting for inventory accuracy. PMID- 10143821 TI - The changing face of materials management. PMID- 10143822 TI - Re-check the pulse of supply prices. PMID- 10143823 TI - The "25 percent challenge". Forging a new supply chain. PMID- 10143824 TI - Coping with hard times: find the hero inside. PMID- 10143825 TI - CPI (clinical practice improvement): improving quality and decreasing cost in managed care. AB - The focus on quality has never been greater. As a result, a new concept, clinical practice improvement (CPI), is emerging. Clinical practice improvement is the application of the scientific method to the day-to-day practice of medicine and can be employed in all health care settings: inpatient or ambulatory, large or small. According to the author, CPI has proved to be effective in reducing costs and improving outcomes because it requires the committed support of clinicians who are involved directly in the process of designing studies, analyzing data, and developing more efficient forms of treatment in their own organizations. PMID- 10143826 TI - The need for integrated risk management in capitated provider groups. AB - Financial risk is not just ensuring that there is enough capitation revenue to cover claims for services. The changing world of health care is devolving risk and exposures to provider groups that were previously covered by insurance companies, HMOs, and other payers. Capitated providers must first understand the risk they face and then manage it. There is more to be gained in terms of independence than to be feared in additional administrative work. PMID- 10143827 TI - Exportation of U.S. pharmacy benefit management companies to Canada. PMID- 10143828 TI - Creating consent through effective public relations. AB - Public relations activities within the health care field are often taken for granted. Well-directed public relations efforts can not only greatly assist an organization's community- and investment-oriented goals, but help the media to properly report on events involving the health care firm. In this article, the author describes the steps to success in strategic public relations. PMID- 10143829 TI - National Practitioner Data Bank for Adverse Information on Physicians and Other Health Care Practitioners; payment of fees--HRSA. Final rule. AB - This final rule amends the existing regulations governing the National Practitioner Data Bank for Adverse Information on Physicians and Other Health Care Practitioners (the Data Bank) authorizing the reporting and release of information concerning: Payments made for the benefit of physicians, dentists, and other health care practitioners as a result of medical malpractice actions or claims; and certain adverse actions taken regarding the licenses and clinical privileges of physicians and dentists. This final rule removes restrictions on allowed methods of payment for Data Bank fees. PMID- 10143830 TI - National Practitioner Data Bank; change in methods of fee payment--HRSA. PMID- 10143831 TI - Health care programs: fraud and abuse; technical revision to the scope and effect of the OIG exclusion regulations--HHS. Final rule. AB - This document sets forth a technical revision to OIG regulations on program integrity for Medicare and State Health Care programs, concerning the scope and effect of the OIG's program exclusion regulations. Prior to this revision, the regulations provided that a program exclusion imposed under title XI of the Social Security Act was to affect future participation in all Federal non procurement programs. This revision specifically amends the language in the existing regulations to clarify that the scope of an exclusion is now applicable to all Executive Branch procurement and non-procurement programs and activities. This rule is consistent with the Federal Acquisition Streamlining Act, and the Department's Common Rule on debarment and suspension which is also being amended and published elsewhere in this issue of the Federal Register. PMID- 10143832 TI - Who's in charge here? AB - In previous Congresses, the chairman of the House Ways and Means Subcommittee on Health would have been free to write the medicare restructuring bill of his dreams. But William M. Thomas, like other chairmen, will have to accommodate his vision to that of the Republican leadership. PMID- 10143833 TI - Medicare and hindsight. PMID- 10143834 TI - Where does benchmarking fit? Crafting a role for sharing best practices. AB - Benchmarking strategy alone may get you started, but the development of a sustainable program becomes the key to success. That development involves characteristics such as educating and nurturing appropriate benchmarking behaviors, building a best practice network to share learning and developing a continuous updating mechanism. With clear direction and these supporting systems in place, benchmarking can be a powerful tool to help you innovate today and stay on the right track for tomorrow. A thorough understanding of the benchmarking can avoid the "Benchmarks are great," "More benchmarks are always better," and "Why do I have so much trouble innovating?" cycle that has plagued many who embraced this idea without first seeing its risks to culture and improvement. With the proper program, benchmarks can add the critical shared learning and best practice role that successful change initiatives need. PMID- 10143835 TI - Highly-effective Steering Teams. Tips for setting them up and keeping them on track. AB - Not every Steering Team is effective is its role to guide and facilitate the organization through the rigors and towards the rewards of restructuring. To be effective, the first step is to establish a solid platform of appropriate membership, unwavering commitment and clear expectations. The second step is to put in place a process to promote cultural transition and sound decision-making. This process entails role modeling desirable behaviors, spreading a vision of the future, defining performance improvement priorities, establishing an advantageous roll-out plan and--perhaps most importantly--supporting the "owners" of change through boundaries and bogies. Are you setting up a new Steering Team? Is a Steering Team already in place but you want to identify any areas for enhanced effectiveness? Either way, pursuing this platform and process may not avoid or solve all of your problems...but it can go a long way to helping your Steering Team help the rest of the organization through the uncertainties and anxieties of change. PMID- 10143836 TI - Compensation in a patient focused environment. The past, present and future of reward systems. AB - What have you done with compensation? It's the question asked of every healthcare organization in the midst of restructuring and work redesign. The prescription at the outset of these dramatic change programs was often for a heavy dose of compensation overhaul. But the reality has often been far less dramatic. A group of PFCA Executive Members, led by executives Mike Speer and Roger Gerard from United Health Group of Appleton, Wisconsin, were not content that the best thinking had been applied to culling out successful compensation improvements and with finding breakthrough redesign options. The group has completed the first of its brainstorming sessions in search of new approaches and offers these initial thoughts to the PFCA REVIEW readership. PMID- 10143837 TI - Bringing medicine down to earth. Interview by Bill Siwicki. PMID- 10143838 TI - Provider automation. The secret to better cash flow. AB - Morton Plant Hospital has a remarkable track record in applying automation in its business office. The provider cut its receivables in half while reducing patient complaints about billing. PMID- 10143839 TI - Clinical protocols: the next automation frontier. Computerized records will play a key role in the implementation of clinical guidelines. AB - Interest in creating clinical protocols has surged in recent years, and experts say computer-based patient records represent the most practical way to put these guidelines to use. Economic forces, particularly the growth of managed care, will push clinicians to identify the most cost-effective ways to deliver care. Electronic records will serve as a useful source of information on which to base and refine guidelines. PMID- 10143840 TI - Hardware issues in the movement to computer-based patient records. AB - The health care field is making significant progress in shifting to computer based patient records. Providers are faced with some difficult decisions about what hardware options are most appropriate. Key issues include the choice of clinical workstations vs. portable computers, the use of new client-server architecture or traditional mainframe-based systems and the role of personal computers. This special report offers an indepth assessment of important hardware trends in the records automation movement. The first story offers an analysis of the hardware implications of client-server architecture and an assessment of the long-term role of mainframe computers. The second story sizes up the potential role for mobile computing, including hand-held devices and wireless technology. PMID- 10143841 TI - As networks multiply, privacy concerns grow. AB - Ensuring the confidentiality of health care data is a critical issue as consumers become increasingly worried about the prospects of having sensitive medical information shared over health information networks. System designers are taking many steps to safeguard medical information. PMID- 10143842 TI - The marriage of financial and clinical software. AB - As physicians feel increased pressure from managed care to operate more efficiently, they're expecting more from their practice management software than the streamlining of administrative tasks. Vendors are responding by adding clinical functions to their products. PMID- 10143843 TI - A surfer's guide to hospitals. PMID- 10143844 TI - Career path takes an unusual turn. Interview by Bill Siwicki. PMID- 10143845 TI - The allure of the Internet. AB - Health care providers are just beginning to devise uses for the emerging information superhighway. The Internet, a vast network of computer networks, provides inexpensive ways to gain easy access to a wealth of health information. The Internet's growing popularity, including the e-mail boom, boosts the likelihood that the broader health care networking movement will pick up speed. PMID- 10143846 TI - Demonstrating how automation can improve outcomes. AB - Automation is playing a key role in the study of the outcomes of medical treatment to determine what delivery methods are most effective. Several organizations that are using technology to facilitate outcomes research are gaining tangible results. PMID- 10143847 TI - CHINs (community health information networks) go head-to-head for big city markets. AB - Competition between community health information networks already is brewing in several cities. Some say that competition could speed network development and keep costs in check. But others worry that competition could dilute anticipated CHIN benefits. PMID- 10143848 TI - EFT (electronic fund transfer) is low on automation priority lists. AB - Electronic funds transfers are taking a back seat to other automated health care transactions. Providers, payers and bankers say the health care industry is focusing on automating claims, eligibility verification and other transactions that logically precede electronic payments. PMID- 10143849 TI - Provider automation. Focusing on the big picture. AB - St. Vincent's Hospital in Birmingham, Ala., is preparing for a new world of health care by creating an enterprisewide information systems strategy rather than developing automation solutions for departmental "islands." PMID- 10143850 TI - Not-for-profits can preserve their mission. PMID- 10143852 TI - Show some respect. Nursing assistants are a vital part of the caregiving team. PMID- 10143851 TI - Should more requirements be added for the certification of CNAs (certified nursing assistants)? PMID- 10143853 TI - Death wish. Suicide rates for the elderly are rising. Here's what providers should know. PMID- 10143854 TI - Health care REIT may be the key to capital. PMID- 10143855 TI - According to whose standards of care? PMID- 10143857 TI - Should regulations governing LTC be revised or streamlined? PMID- 10143856 TI - Western Europe turns to group housing. PMID- 10143858 TI - Nonprofits build fund-raising muscle. PMID- 10143859 TI - Camouflaging care. For assisted living providers, the challenge is delivering care discreetly. PMID- 10143860 TI - Breaking free from restraints. PMID- 10143861 TI - Gaining an edge with tax-exempt bonds. PMID- 10143862 TI - Why are we using antipsychotics? PMID- 10143863 TI - Union FAQs (frequently asked questions). PMID- 10143864 TI - Working with foreign languages. PMID- 10143865 TI - Working with older people. PMID- 10143867 TI - The Silver Book. The ultimate EMS fact guide. PMID- 10143866 TI - High earning workers who don't have a bachelor's degree. PMID- 10143868 TI - What's up, DOT (Department of Transportation)? Federal budget-trimming will affect EMS' future. PMID- 10143869 TI - Going for the gold. EMS Gold Standard Service Award. Margate Fire Rescue, FL. PMID- 10143870 TI - Deadly delays. The National Heart Attack Alert Program is working to reduce deaths and disabilities. PMID- 10143871 TI - MI myths. Is gender bias killing female patients with myocardial infarctions? PMID- 10143872 TI - The enemy within. Acts of domestic terrorism are bound to occur again. PMID- 10143873 TI - Futile care. What is the endpoint of unsuccessful field resuscitation? PMID- 10143874 TI - Hospital laundry bloodborne pathogens alert. PMID- 10143875 TI - Patient focused care--a bittersweet pill. PMID- 10143876 TI - Employee manuals--by and for management and staff. PMID- 10143877 TI - The information wars: what you don't know will hurt you. PMID- 10143878 TI - After years of neglect, a golden age dawns for small business. PMID- 10143879 TI - How to find it on the Internet. PMID- 10143880 TI - America's healthiest companies. PMID- 10143881 TI - Female security heads: straight talk about women in hospital security. PMID- 10143882 TI - State upgrades security at mental hospitals after escaped patients kill. PMID- 10143883 TI - Hospital violence: officials act to keep guns out of ER and other areas. PMID- 10143884 TI - Special report. Mobile, Alabama, and New York City hospitals: meeting the new challenges of recurring disasters. AB - Unexpected disasters, natural and manmade, continue to occur and pose challenging situations for hospitals called on to treat casualties. Hospitals in Mobile, AL, which were tested by the Amtrak crash two years ago, faced another disaster in March when a fog caused numerous multi-vehicle collisions. Downtown New York City hospitals, which handled the over a thousand persons injured in the World Trade Center bombing in February 1993, faced another bombing emergency in December 1994 when a bomb exploded in a crowded subway train. How hospitals reacted to the new emergencies and the lessons they learned from the prior incidents are the subject of this report. PMID- 10143885 TI - Health care in the 21st century: marketing's role in vertically integrated delivery systems. AB - Health care delivery has become one of the most significant economic and political issues of the 1990s. Historical efforts to reform the system to reduce costs while providing quality care to an ever-expanding population have not proven to be satisfactory. With attempts to restructure the industry for the 21st century come important implications for the marketing of health services. This article reviews the economics of the issues, historical efforts to control costs, and activities in the 1990s to restructure the industry. From this, implications for marketing's role in an evolving health care delivery system are described. PMID- 10143886 TI - Occupational and longitudinal differences in health-care and non-health-care worker attitudes concerning AIDS exposure and work: evidence of professional dedication. AB - To assess changes in occupational preferences of health-care workers in response to the AIDS epidemic, attitudes for nine issues concerning AIDS in the workplace were gathered in 1990 and 1992. AIDS-aversive patterns strengthened for both health-care and non-health-care workers over time as AIDS incidence rose. Compared to non-health-care workers, significantly more health-care workers showed greater concern over job related AIDS exposure, and over time they also reported more approval of testing and status disclosure for AIDS. Despite these concerns, significantly more health-care workers than non-health-care workers were willing to work with an AIDS-infected coworker or boss, and significantly fewer health-care workers than non-health-care workers believed they had a right to refuse work with an AIDS-infected coworker. Training had little effect on AIDS aversive preferences among health-care workers. But significantly more non-health care workers with AIDS-related "protective" training reported a self-protective rejection of AIDS-infected coworkers. Implications for health-care management are explored. PMID- 10143887 TI - Improving the effectiveness of condom advertising: a research note. AB - A limited number of studies have examined ways that health promotion messages about condoms can be improved, leading to increased purchase and use. This study tests alternative message structures as a potential avenue to improving condom advertising. As hypothesized, two-sided messages (positive and negative information about the product category) result in more positive attitudes toward the advertisement and the brand than do one-sided messages (positive information only about the product category). The study's implications for health care marketers interested in developing more effective advertising for condoms and other health care products are discussed. PMID- 10143888 TI - A segmentation analysis of consumer uses of health information. AB - Public and private health data organizations are receiving increased pressure to produce consumer-level health information. In addition, the proposed health care reforms imply that health care networks will have to market their health plans. However, little attention has been given to what format the information should have and what the consumers' information needs are. This article discusses the health services marketing literature published to date on the subject, compares it to general marketing literature, and suggests some general guidelines for the effective publication and distribution of health information. PMID- 10143889 TI - The marketing of physicians' services: should doctors advertise? PMID- 10143890 TI - Managed care: the danger of replacing the doctor-patient relationship with contractual obligations. PMID- 10143891 TI - Containing health care costs: the effects of an infant wellness program. PMID- 10143892 TI - Variations in mature market consumer behavior within a health care product: implications for marketing strategy. AB - America is undergoing a profound age shift in its demographic make-up with people 55 and over comprising an increasing proportion of the population. Marketers may need to increase their response rate to this shift, especially in refining the application of marketing theory and practice to older age consumers. To this end, a survey of older couple buying behavior for health insurance coverage is reported here. Results clarify evaluative criteria and the viability of multiple market segmentation for health care coverage among older consumers as couples. Commentary on the efficacy of present health coverage marketing programs is provided. PMID- 10143893 TI - New drug adoption models: a review and assessment of future needs. AB - New drug products today are the key to survival in the pharmaceutical industry. However, the new product development process in the pharmaceutical industry also happens to be one of the riskiest and most expensive undertakings because of the huge research and development costs involved. Consequently market forecasting of new pharmaceutical products takes on added importance if the formidable investments are to be recovered. New drug adoption models provide the marketer with a means to assess new product potential. Although several adoption models are available in the marketing literature for assessing potential of common consumer goods, the unique characteristics of the prescription drug market makes it necessary to examine the current state of pharmaceutical innovations. The purpose of this study, therefore, is to: (1) review new drug adoption models in the pharmaceutical literature, (2) evaluate the existing models of new drug adoption using the ten criteria for a good model as prescribed by Zaltman and Wallendorf (1983), and (3) provide an overall assessment and a ?prescription? for better forecasting of new drug products. PMID- 10143894 TI - New options in long-term care for the elderly: evaluation results of demonstration projects in The Netherlands. PMID- 10143895 TI - The process of innovation in health care for the elderly: a preliminary analysis from six experiments. PMID- 10143896 TI - Interorganizational networks for the care of the elderly in The Netherlands: possibilities and limitations. PMID- 10143897 TI - Innovation in health care for the elderly in The Netherlands. PMID- 10143898 TI - Effects of preventive outpatient geriatric assessment: short-term results of a randomized controlled study. PMID- 10143899 TI - Independently living disabled elderly: first results from an innovative home care project in Haarlem, The Netherlands. PMID- 10143900 TI - Absenteeism. Absence makes the bills grow longer. PMID- 10143901 TI - Complementary therapies. With complements. PMID- 10143902 TI - Locality commissioning. A little local difficulty. PMID- 10143903 TI - Service uptake. A weighty problem. PMID- 10143904 TI - Federal False Claims Act "model" settlement agreement completed. PMID- 10143905 TI - Physician recruitment guidelines: a change in direction. PMID- 10143906 TI - Shared risk deal prompts Owens-to-Baxter supplier switch. PMID- 10143907 TI - IV solution prices continue their slide. PMID- 10143908 TI - Operating room strategies: shining light into the surgical black hole. PMID- 10143909 TI - Joint Commission On Accreditation of Healthcare Organizations. Revisions to the Intent Statement and Scoring Guideline for Standard TX.7.1 Regarding Restraint or Seclusion in the 1995 and 1996 "Accreditation Manual for Hospitals". PMID- 10143910 TI - Orion Project launched in Pennsylvania. PMID- 10143911 TI - Hospitals get revised accreditation decision rules. PMID- 10143912 TI - New introduction clarifies when anesthesia standards apply. PMID- 10143913 TI - Interim changes made in hospital restraint and seclusion scoring guideline. PMID- 10143914 TI - Performance measurement expectation revised. PMID- 10143915 TI - Age-specific competency added to scoring of AMH standard. PMID- 10143916 TI - Guidelines for construction: a reference, not a requirement. PMID- 10143917 TI - President's column ... testimony delivered to Health Subcommittee of the House Ways and Means Committee. PMID- 10143918 TI - Board establishes Council on Performance Measurement. PMID- 10143919 TI - Project aims to make manuals more reader-friendly. PMID- 10143920 TI - Why your staff needs a manual for handling phone calls. PMID- 10143921 TI - Does the GOP have "Medicare madness"?. Interview by Michael Pretzer. PMID- 10143922 TI - Why defensible malpractice cases have to be settled. PMID- 10143923 TI - How doctors cope in the land of 10,000 mergers. PMID- 10143924 TI - Save big on health insurance for your employees. PMID- 10143925 TI - Accepting a hospital offer? Beware the IRS. PMID- 10143926 TI - How much will Congress relax the self-referral law? PMID- 10143927 TI - Has managed care rediscovered fee-for-service? PMID- 10143928 TI - Collective bargaining in state and local government, 1994. PMID- 10143929 TI - Collective bargaining in private industry, 1994. AB - In sum, for the last 3 years, bargainers have negotiated wage and compensation increases that have been lower, on average, than those agreed to the last time the same parties met, despite an improving national economy. While negotiators may have been taking their cue from economic conditions specific to their company or industry, rather than from overall economic conditions, the modest changes in compensation under 1994 settlements were similar to the moderate changes in compensation prevailing the economy. PMID- 10143930 TI - Consumer prices in 1994. PMID- 10143931 TI - Who really has access to employer-provided health benefits? PMID- 10143932 TI - The nature of occupational employment growth: 1983-93. PMID- 10143933 TI - CLR 1995-1996 clinical laboratory reference. Directory of professional organizations. PMID- 10143934 TI - CLR 1995-1996 LIS vendors. PMID- 10143935 TI - HCFA team to create outcomes measures. PMID- 10143936 TI - Latest budget battle: military med school. PMID- 10143937 TI - Tufts makes move into N.H. PMID- 10143938 TI - Methodist of Indiana adds to its network. PMID- 10143939 TI - Suit may prove costly--Mo. official. PMID- 10143940 TI - Troubled teaching hospital restructures for the future. PMID- 10143941 TI - New antitrust rules applied in Mich. PMID- 10143942 TI - How healthy is community. More hospitals want to know. PMID- 10143943 TI - N.Y. experiments again on capitation. PMID- 10143944 TI - Too many beds, docs in Baltimore--study. PMID- 10143945 TI - Calif. Blue Cross starts unique contracting plan. PMID- 10143946 TI - HCFA answers queries on hourly payment rules. PMID- 10143947 TI - Bills back payment for experimental devices. PMID- 10143948 TI - Mixed messages on managed care. PMID- 10143949 TI - AHA study: GOP cuts son't save Medicare. PMID- 10143950 TI - Modern Healthcare's 1995 physician compensation report. AB - As more healthcare organizations employ physicians, the issue of how much they're paid draws more attention. They may typically make less money than self-employed or independent-contractor physicians, but doctors who punch the clock are gaining ground on the salary front. PMID- 10143951 TI - Alliances have a new strategy. Instead of joint ventures with insurers, they're helping hospitals build managed-care networks. PMID- 10143952 TI - New techniques deployed against infertility. PMID- 10143953 TI - Control becomes issue in 50-50 deal. PMID- 10143954 TI - Peace Corps seeks managed-care bids. PMID- 10143955 TI - FPA expands into Texas. PMID- 10143956 TI - Specialty firms go public. PMID- 10143957 TI - Nation's first freestanding surgery center still strong. PMID- 10143958 TI - What should be in your manager's tool kit? PMID- 10143959 TI - Computer system helps recover lost charges. PMID- 10143960 TI - Cleveland Clinic researches device reuse. PMID- 10143961 TI - Nurse executives' salaries on par with senior hospital executives. PMID- 10143962 TI - Vanderbilt model creates patient care centers. PMID- 10143963 TI - Outpatient center designed from patient perspective. PMID- 10143964 TI - Improve customer relations with a patient-friendly billing statement. PMID- 10143965 TI - Legal issues in accepting capitation. AB - The effort to reduce the cost of medical, hospital, and ancillary services increasingly focuses on shifting the financial risk for the cost of these services to those who provide them. Shifting arrangements include capitation for physicians classified as "primary care" physicians; capitation arrangements that include primary and specialty services; risk shifting to medical groups, IPAs, and other physician organizations; as well as the packaging of physician and hospital services on a "full risk," "per case," or other basis. Accepting financial risk for the cost of medical and other health care services, as well as the responsibility for managing the provision of services, may very well be the only remaining opportunity for providers to maximize reimbursement and maintain administrative and clinical self-direction. However, physicians must work with managed care organizations (MCOs) through negotiation of contracts and throughout the relationship to make sure: Unnecessary financial and legal risks to the MCO and physicians are eliminated. Risks that cannot be eliminated are apportioned between the MCO and physicians. All risks are managed in a coordinated fashion between the MCO and physicians. PMID- 10143966 TI - Capitation and informatics. AB - When physicians, hospitals, and allied health professionals bill for services they render, their information processing requirements are relatively simple, at least compared to those of capitated organizations. When payers (insurers or employers) accept financial risk for the health care services of beneficiaries, they have usually invested in claims processing, membership tracking, and, under managed care, utilization review and provider profiling systems. But payers, for the most part, have not invested in electronic collection of clinical information about beneficiaries, nor have they tended to keep all claims they have processed in electronic form for study after accounts are settled and payments disbursed. In this article, we will explore why informatics is so important to capitated organizations and why payers that have traditionally taken financial risk for insuring the health care costs of populations are also learning about the importance of informatics. PMID- 10143967 TI - Cutting out the middlemen: physicians as providers, direct contractors, and payers. Interview by Donna Vavala. AB - While many physicians and physician groups are forging alliances with other groups, with hospitals, and with other elements of the health care delivery system, an Ohio group decided that the loss of autonomy involved in these approaches was not acceptable. Instead, the group became the core of a new entity aimed at restoring physician control over the provision of and payment for health care services. In an interview with the principal of the new organization, Physician Executive learned the basis for the venture. PMID- 10143968 TI - Interdisciplinary, functional approach to quality review. AB - Dramatic changes in the standards of the Joint Commission on Accreditation of Healthcare Organizations, as part of its "Agenda for Change," pose new challenges for health care managers. The goal of the "Agenda for Change" is to focus accreditation on the actual performance of important functions while continuously stimulating improvement in the organization's performance and outcomes of care. In 1994, seven important functions--improvement of performance, leadership, management of information, assessment of patients, education of patients and families, operative and other procedures, and treatment of patients--were identified by JCAHO. Performance, as defined by JCAHO, can be measured through observing specific dimensions, such as, availability, safety, timeliness, effectiveness, continuity, efficiency, and respect and caring. These are considered important elements in the determination of quality, value, cost, and patient outcome. In 1995, JCAHO identified 11 important functions--patient rights and organizational ethics, assessment of patients, care of patients, education, continuum of care, improving organizational performance, leadership, management of the environment of care, management of human resources, management of information, and prevention and control of infection. In addition each institution has the opportunity to decide by prioritization where it wants to devote resources. This article reports on one hospital's response to the new JCAHO initiatives. PMID- 10143969 TI - Constitutional guarantees to health care in Spain. AB - This analysis of the Spanish health care system is one in a series of such studies undertaken by the author, following a grid of factors that influence the delivery and financing of health care. The purpose of the national analyses is to facilitate a comparison of the United States' and other health care systems in terms of anticipated reform of the U.S. system. Analyses of the U.S. and nine other national systems are included in a book that has just been published by the College. Spain and nine additional countries will be studied in a book due for publication later this year. A final book with ten additional national analyses will appear in 1996. PMID- 10143970 TI - Organ transplantation criteria represent insurer dilemma. AB - In its simplest form, technology assessment, as used for coverage decision making, involves an analysis of published data regarding the safety and effectiveness of a technology, either on its own merits or in comparison with a competing technology. However, while the medical literature, and thus technology assessments, typically focus on a well-defined population, a positive coverage policy almost immediately creates pressure for broadening patient selection criteria. A variant on this phenomenon is the patient selection criteria for organ transplantation. These criteria are based not only on the scientific merits of the procedure but also on frequently ill-defined notions of the most appropriate allocation of a scarce resource, which in turn is determined by supply and demand at individual transplant centers. In these cases, the payer may defer to the patient selection criteria of the individual transplant center. However, the situation arises when a patient, rejected at one transplant center, "shops" and finds another center that has more favorable selection criteria. How, then, can the payer resolve these discrepancies and establish consistent policy guidelines? Should allocation of scarce donor organs be part of a technology assessment and coverage decision? The case of liver transplantation will be used here to illustrate the insurer's dilemma. PMID- 10143971 TI - A physician's perspective on capitation. AB - Change is not on the horizon; it is already here. Capitation is only the latest form of competition with which we physicians have dealt through high school, college, medical school, postgraduate training, and even entry into practice. Capitation is a reality. It is here to stay. It will not disappear. It is a concept that must be understood, embraced, and managed to ensure financial survival. Physicians face issues of life and death on a daily basis. It is not too much for them to handle capitation. PMID- 10143972 TI - IRS proposed "physician recruitment" revenue ruling offers few kernels in search for. AB - Not to sound corny, but things have really been popping since the Internal Revenue Service (IRS) recently released a proposed revenue ruling regarding the scope of recruitment incentives that may be offered to nonemployee physician members of tax-exempt hospital medical staffs. Commentators have criticized the proposed revenue ruling, however, because it offers little in the way of guidance in all but the most obvious cases of recruitment violations. Nonetheless, the proposed ruling may provide insight that may assist hospitals to prepare permissible recruitment incentives for physicians. The IRS provided a public comment period within which individuals and groups could submit proposals to improve or revise the proposed ruling. However, with or without such comments, clarification of the ruling is called for. "Health Law" is a regular feature of Physician Executive from the Washington, D.C., law firm Epstein Becker & Green. Mark Lutes of the law firm serves as editor of the column. PMID- 10143973 TI - The marriage of risk management and the processes of patient care. AB - So, your organization is considering taking on a capitation contract. Or you have already done so. Sooner or later, most physician executives with whom I have worked have asked the question: "How the hell are we going to manage this thing so we don't go broke?" Good question. Here, in brief, is the answer: Accepting capitated contracts without having the resources to manage both insurance-like risk and the process of caring for capitated patients is roughly equivalent to flying through mountains shrouded by clouds: Sooner or later, a mountainside is likely to appear in your windshield, close up and closing rapidly, at a point where it is too late to do anything about it! PMID- 10143974 TI - 1995 best hospitals. Matthew's miracle. PMID- 10143975 TI - 1995 best hospitals. Tragedy at Dana-Farber. PMID- 10143976 TI - 1995 best hospitals. Managing managed care. PMID- 10143977 TI - 1995 best hospitals. The hospital rankings. PMID- 10143978 TI - Recruiting for success--the potential for using occupational personality questionnaires for the assessment of doctors. AB - OBJECTIVES: to evaluate the Saville and Holdsworth Occupational Personality Questionnaire (OPQ) to assess its potential and validity as a tool in the recruitment of doctors. To determine the range of personality characteristics in a group of general practitioners. DESIGN: an administered commercially available questionnaire. SETTING: general practitioners in North and Mid. Stafftordshire. SUBJECTS: 133 general practitioners or trainees. RESULTS: 44% of general practitioners agreed to participate. The majority found it useful and recognised its potential to increase self-awareness, highlight weaknesses that might be improved and for future recruitment of others to their teams. Doctors' personality traits were similar to those of managerial/professional norms. The validity of the OPQ was supported by (a) significant associations with subjects' previously reported mental health problems and (b) 83% of respondents confirming that their reports correctly described their personalities at work. CONCLUSIONS: OPQs have a place in the recruitment of doctors by identifying appropriate people to strengthen the team. PMID- 10143979 TI - Decentralisation, integration and accountability: perceptions of New Zealand's top health service managers. AB - This paper reports on the findings of a representative survey of senior managers within New Zealand's health system. Respondents report most favourably upon the implementation of a new organisational structure, service management, which appears to have largely replaced the traditional division of health services into hospitals and community services. Service management, which is the decentralisation of decision making to integrated patient groupings, i.e. medicine, surgery, mental health, women's health, primary health care etc., appears to have been remarkably successful, in the view of the respondents, in achieving greater efficiencies, better quality care, better decision making about priorities and greater accountability of doctors. A majority of respondents consider that services have replaced hospitals as organisational entities. Significant progress is reported in the integration of hospital and community services, primary and secondary care, preventive and treatment services and of public, private and voluntary services through service management. The findings point to a new paradigm which may be of fundamental significance in the future organisation of health services. PMID- 10143980 TI - Munificent environments, management control, and the cost of rural hospital care. AB - Rural hospitals have been threatened by declining revenues. Control over costs will be necessary to help these hospitals survive. Investigation of the determinants of hospital costs in Iowa reveals that costs are primarily caused by environmental factors, rather than variables over which managers have control. Furthermore, efforts by policy makers to improve hospital efficiency by stimulating competition among hospitals may have been ineffective, since the level of competition was not found to be associated with hospital production costs. PMID- 10143981 TI - Efficiency analysis of federally funded hospitals: comparison of DoD and VA hospitals using data envelopment analysis. AB - This article applies the technique known as Data Envelopment Analysis (DEA) to assess differences in performance efficiency among two branches of the federal hospital system, The Department of Defense (DoD) and The Department of Veterans' Affairs (VA). The analysis is based on two measures of performance output (inpatient days and outpatient visit, and six measures of resource input (capital investment in operational beds, service mix intensity, and supplies and three components of labor--providers, nurses and support). This study finds that based on these input and output measures, DoD hospitals are, on average, significantly more efficient than their VA counterparts. Within DoD, however, there are no significant differences in efficiency among the service components (US Air Force, Army or Navy), although Army hospitals appear more efficient in using service mix and provider labor. PMID- 10143982 TI - The role and impact of formal strategic planning in public hospitals. AB - In recent years, formal strategic planning methods originally developed for private business have been increasingly adopted by health care institutions, including publicly funded hospitals. Yet, as a technocratic management process, formal planning may seem at first sight to run counter to the natural mode of strategy formation in these organizations where negotiation and mutual adjustment between powerful groups of professionals, managers and government agencies traditionally control decision-making. This article describes an exploratory study aimed at understanding how formal strategic planning has become integrated and adapted into the management practices of a group of 23 Canadian hospitals. The context, processes and impact of planning are first examined over the entire sample of hospitals (descriptive analysis), and an attempt is then made to explain different planning outcomes in terms of a variety of contextual and process design characteristics (comparative analysis). The descriptive analysis shows that in practice formal strategic planning is easily absorbed into the political process: political and symbolic motives often drive the initiation of planning, the processes themselves are highly participative and the resulting plans often reflect the difficulties of obtaining consensus on goals in these complex organizations. The comparative analysis suggests that in general, contextual factors (eg, stimuli behind planning) appear to be more significant than process design factors (eg, extent of participation) in determining outcomes. In conclusion, it is noted that the confrontation between technocratic rationality and professional bureaucracy gives rise to a number of paradoxes that make both the use and the subsequent evaluation of formal strategic planning a difficult task in these organizations. PMID- 10143983 TI - Managed care, our nation's healthcare dilemma and challenge, and the Providence Health System. PMID- 10143984 TI - Internal auditors and healthcare access managers: are our responsibilities mutually exclusive? AB - Internal auditing should not be looked upon as a threat. It is a management tool that can assist patient access professionals by minimizing risk of loss, improving the reliability of data, enhancing productivity, and crossing "political" lines. Access professionals should feel comfortable in asking their internal auditors for assistance, particularly when they are concerned that there are barriers preventing optimal performance in their areas of responsibility. In general, in organizations with internal audit functions, admitting and registration personnel should expect to see more of them. PMID- 10143985 TI - Mergers and acquisitions in the changing healthcare environment. PMID- 10143986 TI - Advance directives--current trends and developments. PMID- 10143987 TI - Healthcare in the year 2000: a look to the future. PMID- 10143988 TI - Overview of a JCAHO visit. PMID- 10143989 TI - How prepared are you? Reviewing your disaster plan may save your life. PMID- 10143990 TI - Healthcare's newest affiliation: forging relationships between the community and the hospital through emergency medicine. PMID- 10143991 TI - Simulated patients: an example of a professional shopping program in the healthcare setting. PMID- 10143992 TI - U.S. fireworks injuries remain high. PMID- 10143993 TI - Links between clinical audit and contracting systems. AB - In 1989, a programme of clinical audit was introduced throughout the UK National Health Service (NHS), in an attempt to improve care through the application of quality methodology to clinical issues. However, the role of clinical audit in the new NHS "internal market" is unclear. Reviews evidence on the development of audit and concludes that it has operated largely in isolation, under professional control. Central policy is now advocating greater purchaser and provider management involvement in audit, enabling feedback from and to service provision and management decisions. Where there are constructive local relationships the opening up of audit should be beneficial, but these do not always exist. Discusses a range of models for the interaction of clinical audit with wider NHS management systems. Recommends a split system of professionally controlled background audit and collaborative shared audits to balance conflicting goals. PMID- 10143994 TI - Service quality in hospital care: the development of an in-patient questionnaire. AB - Describes the development of a multi-item scale for assessing in-patient perceptions of service quality in an NHS or NHS Trust hospital. Presents evidence of the high reliability of the scale and its factor structure. Five intangible factors emerge: empathy, relationship of mutual respect, dignity, understanding of illness and religious needs, along with two tangible factors: food and physical environment. Results in a trial hospital indicate that patients' perceptions meet or exceed expectations in respect of four of the seven factors and 22 of the 49 individual variables. Of concern, however, while possibly not generalizable, must be the unfulfilled expectations in respect of the factors "relationship of mutual respect" and "understanding of illness" and the individual variables relating to the various communications between doctors and patients. Not unexpectedly, dissatisfaction is also expressed with the physical environment. Argues that the situation can only be remedied, usually, by a large injection of cash--an unlikely scenario. PMID- 10143995 TI - A needs-led approach to hospital resettlement. AB - Reports on an inter-agency initiative in Wakefield that used a needs-led case management approach for the resettlement of 32 former users of long-term hospital mental health services. Reviews the programme using headings provided by the values which underpinned local mental health services, namely, that services should endeavour to be appropriate, acceptable, accessible, effective/efficient and equitable for service users. The main objective of the programme was achieved -32 former users of hospital mental health services were resettled. Issues were, however, raised concerning the extent to which the programme could be described as needs-led. Concludes that there is still much to learn about the application of case management within the British health context. PMID- 10143996 TI - Setting standards. AB - A method of involving users and providers in residential care for older people was used to develop standards of care and outcome indicators. The standards were prioritized using the paired comparison technique. Describes the method and the outcomes of the processes. These include 28 standards relating to the quality of care developed by providers and service users. PMID- 10143997 TI - Integrated communications perspectives and the practice of total quality management. AB - Communication is becoming increasingly identified as a significant factor influencing the ability of the NHS to achieve high-quality outcomes. Typically, organizations have tended to conceptualize communication as a process dealing with external relationships. Emphasizes the importance of both internal and external communications, and argues that the NHS now needs to integrate both these dimensions of the communication function. Proposes a strategic framework which suggests how this can be accomplished. Proposes and discusses a communications-centred model of the management process in the light of this approach. This model integrates perspectives which have hitherto dichotomized management as either a science or an art. It also locates communication at the heart of effective management. Finally, suggests the NHS is uniquely well placed to provide data on the impact and costs of total communication programmes. PMID- 10143998 TI - The prescription that kills. Can hospitals reduce their mistakes? PMID- 10143999 TI - Medicaid program; third party liability (TPL) cost-effectiveness waivers--HCFA. Final rule. AB - This final rule revises regulations concerning Medicaid agencies' actions where third party liability (TPL) may exist for expenditures for medical assistance covered under the State plan. It allows the Medicaid agencies to request waivers from certain procedures in our regulations that are not expressly required by the Social Security Act. We will consider waiving nonstatutorily required procedures relating to identifying possible TPL where the agency finds that following a given required procedure is not cost-effective and is duplicative of another State activity. A nonstatutorily required activity is eligible for a waiver if the cost of the required activity exceeds the TPL recoupment and the required activity accomplishes, at the same or at a higher cost, the same objective as another activity that is being performed by the States. This change gives States greater flexibility in managing their Medicaid programs. PMID- 10144000 TI - Case study. Several systems revisited. AB - HSL takes a second look at four systems we profiled in 1994. In the fierce Chicago market, Lutheran General Health System expanded geographically by merging with a long-time ally. Similarly, New England's Hitchcock and Lahey clinics joined to become a regional powerhouse. Finally, Houston's Memorial Health System forged an alliance with the Sisters of Charity to build a network throughout southeast Texas. Read what each has accomplished and learned. PMID- 10144001 TI - Capital financing is emerging as a critical success factor for integrated systems. AB - The bubble may burst soon, but right now capital financing is readily available to help physician-driven, integrated entities acquire practices, build infrastructure, and take on risk contracts. However, given the inflated prices some investors are paying, some of these deals will fail. HSL talks to capital financing experts to find out what the future may hold. PMID- 10144002 TI - Specialty care in integrated networks. AB - Properly sizing a panel of physician subspecialists is integral to the cost effectiveness and efficiency of an integrated system. This installment in our series "Building an Integrated Healthcare System" explains how to select, compensate, and organize your subspecialty component. PMID- 10144003 TI - Physician management companies: are they a good choice for doctors? AB - To many of the physicians who've signed with them, physician management companies (PMCs) seem like the answer to a prayer. The practice gets needed capital for growth, professional management, and managed care contracting expertise from a partner that has the doctors' best interests at heart--or does it? HSL looks at four leading PMCs to identify the pros and cons of partnering with them. PMID- 10144004 TI - Product and equipment strategies for surgical services. AB - One of the most difficult challenges a materiel manager can face is designing different programs to support materiel management services for specific clinical and ancillary areas of the hospital. While basic service standards for purchasing and logistic services should exist for all areas, a large part of how effective a materiel management department is depends on customized program development. In other words, fine tuning services to major customers, such as the Operating Room, can mean the difference between simply filling supply orders and aggressive cost control. This article reviews how Baystate Medical Center (Springfield, MA) maintains consistency in standardizing materiel services while adapting to the requirements of individual departments, such as Surgical Services. PMID- 10144005 TI - Sterile processing reorganization leads to product line standardization. AB - Product line standardization is not a new idea. Periodically hospitals must take a look at the way they do things and ask, "Are we doing the work relevant to today's and tomorrow's needs?" Pressures from managed care cost containment initiatives, advances in technology, and regulations have changed the way hospitals deliver services to meet the new needs and expectations. This article reviews St. Agnes Hospital's reorganization of Sterile Processing Services based on product line standardization. PMID- 10144006 TI - Design standards. Cutting the costs you don't see. AB - In an era of hospital cost cutting and reengineering at all levels, it is still important to implement interior design standards in planning, selecting, and arranging the products that affect hospital image and function. Design standards manuals include manufacturer and model of furniture, fixtures, and equipment from desks, chairs, and computer stands to window treatments. This article reviews how to save on interior design costs while keeping a professional healthcare image. PMID- 10144007 TI - Information technology planning: act, don't react. PMID- 10144008 TI - Generics battle brand names over mortality of drug patents. PMID- 10144009 TI - Dos & don'ts for scramble systems. PMID- 10144011 TI - 'Modern yet restful' at Poudre Valley Hospital, Ft. Collins, Colorado. PMID- 10144010 TI - Challenge: how to make foodservice more productive. PMID- 10144012 TI - The struggle to create an organization for the 21st century. AB - The horizontal company is hot--but getting there is difficult. You have to define core processes, transfer power, and redesign work. Here's how four organizations are coping. PMID- 10144013 TI - Making change stick. PMID- 10144014 TI - America's 100 fastest-growing companies. PMID- 10144015 TI - The Fortune 500--1955-1995. Winning ideas in technology. When laws of physics meet law of the jungle. PMID- 10144016 TI - The Fortune 500--1955-1995. Winning ideas in finance. Today's hot concept, tomorrow's forest fire. PMID- 10144017 TI - The Fortune 500--1955-1995. Winning ideas in marketing. To avoid a trampling, get ahead of the mass. PMID- 10144018 TI - The Fortune 500--1955-1995. Winning ideas in management. Distilled wisdom: Buddy, can you paradigm? PMID- 10144019 TI - The Fortune 500 largest U.S. corporations. PMID- 10144020 TI - Domestic extremists: dealing with demonstrators. AB - The security department of any healthcare facility faces delicate security problems. In addition to guarding staff and the facility, security professionals must protect the patients. This duty becomes even more difficult, says the author, when hospitals become political and moral battlegrounds for demonstrators. PMID- 10144021 TI - Hospital fire training heats up. AB - The author describes the fire safety training program at Robert Wood Johnson University Hospital, and discusses its benefits. He concludes that the security department's enhanced image because of this program has made other security objectives easier to accomplish. PMID- 10144022 TI - Meeting the training requirements of a state law regarding security officers. AB - A security director relates his experience in trying to comply with the training requirements of the New York State Security Guard Act of 1992. He discusses why he chose in-house training and how this was accomplished. PMID- 10144023 TI - Dangerous words: forewarning of workplace violence. PMID- 10144024 TI - Hospital violence. AB - The author discusses the problem of healthcare violence, including factors that contribute to it, how to identify high-risk individuals, the socioeconomic impact of assault injuries, violence associated with prisoners as patients, and psychiatric ward violence. He also provides an outline of emergency department security survey procedures, as well as guidelines for improving hospital security. PMID- 10144025 TI - Managing violent patients. AB - There are many steps a health care facility can take in dealing with violent patients. This can be accomplished through a recognition of the causes of violent behavior. Unfortunately, each situation is different. While we can learn from previous experience, it is difficult to predict violent patient behavior. The steps that a hospital can take to deal with violence include intervention, restraint and seclusion, and proper training. This will increase quality of care and reduce liability. According to Steve Wilder, director of risk management at St. Mary's Hospital in Kankakee, IL, "The issue is not to fight, but to control and modify aggressive behavior and defuse the situation" (Hospital Risk Management, 1993). PMID- 10144026 TI - Riding with The Queen's Medical Center's security bike patrol. PMID- 10144027 TI - Proprietary vs. contract security in the healthcare setting. PMID- 10144028 TI - Healthcare security and sexual harassment: management issues and answers. PMID- 10144029 TI - Violence in the workplace--assessment, prevention, liability. PMID- 10144030 TI - CQI strategies to reduce patient details. AB - The author presents a case study in which multidisciplinary teamwork, data collection, and carefully planned interventions decreased the number and expense of violent or security-related incidents in a hospital. The study was prepared in collaboration with Claude Barnes, security officer, who did much of the research and statistical analysis. PMID- 10144031 TI - Using IRS--identify ... respond ... support--to solve security problems. PMID- 10144032 TI - Effectively changing the management methodology for tornado evacuation procedures. AB - This article discusses how action research was used to identify, diagnose, and involve focus group members in resolving problems associated with the safe evacuation of patients and employees during imminent tornado weather. Collaboration and joint action planning among group members, says the author, resulted in new evacuation procedures that increased dependable communications among staff, ensured the continuation of good patient care, and assured the expedient and safe evacuation of patients and employees. PMID- 10144033 TI - Bryan Memorial Hospital. PMID- 10144035 TI - Sutter may shutter Sacramento hospital. PMID- 10144034 TI - HSI to buy units from Graduate as firms link. PMID- 10144036 TI - Another Caremark exec faces charges. PMID- 10144037 TI - AvMed snubs Columbia for Fla. network. PMID- 10144038 TI - Iowa system seeks Ill. deal. PMID- 10144039 TI - N.Y. Presbyterian talks partnership. PMID- 10144040 TI - Companies forced to amend deals. PMID- 10144041 TI - HCFA joins move to cut regulations by dropping form. PMID- 10144042 TI - White House weighs Medicaid proposal. PMID- 10144043 TI - Kohlberg Kravis agrees to buy Medco, but may not just squeeze costs. PMID- 10144044 TI - JCAHO panel to evaluate performance measures. PMID- 10144045 TI - NCQA drafts Medicaid performance measures. PMID- 10144046 TI - Per-enrollee cuts hit Fla.'s HMO effort. PMID- 10144047 TI - Calif. activist wants new moms in hospital longer. PMID- 10144048 TI - GOP spending bills would scrap plans for 2 VA hospitals. PMID- 10144049 TI - AGPA urges choices for Medicare patients. PMID- 10144050 TI - AMA seeks patient, physician freedom. PMID- 10144051 TI - Kaiser retools to fight for lost ground. AB - In the face of mounting competition, the country's oldest not-for-profit HMO is retooling to fight for lost ground. Kaiser, headed by David Lawrence, M.D., is focusing on regaining robust growth in profits and enrollment by improving its roll as an industry leader. PMID- 10144052 TI - Oklahoma billing firm may face federal suit. PMID- 10144053 TI - Groups experiment to find best formula for doc compensation. PMID- 10144054 TI - Reproductive clinics reach out to HMOs. PMID- 10144055 TI - Bond sales slump 39% in first half. PMID- 10144056 TI - Three states added to fed billing probe list. PMID- 10144057 TI - Louisiana PHO latest to attract antitrust scrutiny. PMID- 10144058 TI - VA to consolidate nursing home contracts. PMID- 10144059 TI - Crisis communications moves to front burner. AB - Crisis communications, or crisis management, moved to the front burner on a national basis following the Tylenol poisonings in the early '80s. It's a fact of life (or death) that day after day, incident after incident, hospital after hospital has to deal with internal problems that become external issues. Balancing disclosure and the media's relentless quest for every available detail with the legal implications involved can test the public relations skills of even the most experienced practitioner. So how do you learn how to handle a crisis situation? There are books available on the topic, there are experts in the field and then there are those who have "been there, done that" and have agreed to share the experiences. Enter Greg McGarry, public relations director at Albany Medical Center in Albany, N.Y. If any hospital PR director has had to deal with a more challenging series of tragic and unusual circumstances in a brutally short timeframe, we have yet to hear about it. As a result of his forthrightness and candidness, backed by a supportive and understanding senior management team, news articles were fair, balanced and included the hospital's position. Even critical editorials included words of praise. PMID- 10144060 TI - Saint Joseph Health Center builds a better way. Medical Mall designed for and dedicated to customer service. AB - Saint Joseph Health Center's new outpatient facility in Kansas City looks like a mall, sounds like a mall, smells like a mall. But it's also a state-of-the-art medical facility designed with the patient uppermost in the planning. Take the escalator to your next appointment. PMID- 10144061 TI - Greater Hollywood health partnership "heals L.A.". AB - Queen of Angels-Hollywood Presbyterian Medical Center is strategically situated in culturally diverse Hollywood, Calif. The facility has formed coalitions with 25 churches to deliver healthcare and education throughout the community. PMID- 10144062 TI - Saint Joseph's Hospital of Atlanta is taking healthcare to the streets. AB - Mercy Mobile Health Care is, literally, taking healthcare to Atlanta's streets. Although it has a 10-year success record, few associated it with Saint Joseph's Hospital, the sponsoring organization. Now that's changing. PMID- 10144063 TI - Relationship building with referring physician groups. AB - To strengthen its ties and build on relationships with partnership physicians, the University of Chicago Medical Center launched a campaign, "Joining Expert Hands." It built loyalty and strengthened referrals. PMID- 10144064 TI - Two hospitals join forces to sponsor "A Woman's Comfort Day". AB - Two Baton Rouge, La., hospitals--usually strong competitors--decided to join forces and collaborate on a special event for the women of the community. "A Woman's Comfort Day," now in its third year, was the successful result. If they're feeling good about themselves, can the Super Bowl be far behind? PMID- 10144065 TI - Do you know me? At Washington Hospital Center they do, since embarking on an employee ID campaign to focus on a common problem. AB - It's a common problem for many hospitals around the country: employees who become lax about wearing ID badges. Washington Hospital Center, in Washington, D.C., launched an internal campaign to address the problem. Now employees wear them as if their paychecks depended on them! PMID- 10144066 TI - Garfield Medical Center's multicultural marketing mission. PMID- 10144067 TI - Accuracy of laminated disposable pulse-oximeter sensors. AB - BACKGROUND: In our hospital, widespread utilization and clinical importance of arterial oxyhemoglobin saturation monitoring by pulse oximetry (SpO2) generated a growing cost-center in a time of fiscal restraint. We hypothesized that lamination of a pulse-oximeter sensor and insertion into a disposable, protective shield allowing reusability would not alter sensor response time or relative accuracy. MATERIALS AND METHODS: Six healthy adult men volunteered to be studied during hypoxemia (induced by spontaneous ventilation of a 8-10% oxygen concentration in helium by face mask) to an SpO2 less than or equal to 70%. The SpO2 was monitored by 2 Nellcor N-200 pulse oximeters with D25II sensors and an Ohmeda 3700 pulse oximeter with the OxyTip sensors. Single desaturations, repeated twice in 5 subjects, and 2 desaturations, repeated 5 times in 1 subject, were evaluated. After the initial desaturation and recovery, 1 D25II sensor was laminated, inserted into a protective sheath, reattached and followed by repeat desaturation. SpO2 readings from each oximeter, during both desaturations sets were compared. Clinical importance was subjectively determined by comparison to published SpO2 bias data. RESULTS: 907 data sets were collected. In 447 SpO2 comparisons in 5 individuals (range 62-100%), 1 laminated sensor was 0.8 percentage points lower and one sensor was 1.3 percentage points higher (P less than 0.05) than controls compared with prelamination differences. No difference was clinically important. In individual repeated desaturations (range, 52-100%) following lamination, one sensor was 2.9 percentage points and one sensor was 2.6 percentage points higher. During repeat desaturations, differences between the OxyTip and the D25II control sensor were 1.3 percentage points lower and 1.8 percentage points higher than the initial desaturation (all p less than 0.001). Response times were not altered. CONCLUSIONS: Lamination and protective shield applied to disposable sensors did not alter SpO2 measurements or response times to incremental reductions in SpO2 in a clinically important manner. PMID- 10144068 TI - AARC (American Association for Respiratory Care) clinical practice guideline. Defibrillation during resuscitation. PMID- 10144069 TI - AARC (American Association for Respiratory Care) clinical practice guideline. Management of airway emergencies. PMID- 10144070 TI - AARC (American Association for Respiratory Care) clinical practice guideline. Infant/toddler pulmonary function tests. PMID- 10144071 TI - Giving back. Retirees contribute to healthy communities. PMID- 10144072 TI - If you want to play, you've got to pay. Community outreach is the name of the game, but how do hospitals pay for it? PMID- 10144073 TI - Community health networks: in living color. PMID- 10144074 TI - Reshaping governance: the Hay Group's study. PMID- 10144075 TI - It's time to tackle social ills. PMID- 10144076 TI - Is Medicaid's mission in jeopardy? PMID- 10144077 TI - Family matters. Parent support programs don't just promote health; they also change people's lives. PMID- 10144078 TI - "Now entering OZ". PMID- 10144079 TI - The accreditation process: an update on the Joint Commission on the Accreditation of Healthcare Organizations. PMID- 10144080 TI - Cost implications of using inhaled nitric oxide compared with epoprostenol for pulmonary hypertension. AB - OBJECTIVE: To compare the cost of using intravenous epoprostenol with that of inhaled nitric oxide (NO) for treating episodes of pulmonary hypertension in children with congenital heart disease. DESIGN: An analysis of the cost of epoprostenol and NO use over the previous 18 months was performed. Three 6-month periods were identified, two in which epoprostenol was used and the third in which inhaled NO was introduced for the treatment of pulmonary hypertension. SETTING: A 10-bed pediatric cardiac intensive care unit, Royal Liverpool Children's Hospital, Alder Hey, Liverpool, England. SUBJECTS: Children with congenital heart disease and persistently elevated pulmonary artery pressure following cardiac surgery. MAIN OUTCOME MEASURES: The total duration of use of epoprostenol and inhaled NO was documented. The costs per hour for epoprostenol and inhaled NO were calculated and the annual cost of each agent was estimated. RESULTS: In the two 6-month periods prior to the introduction of inhaled NO, epoprostenol was used on 14 occasions (5 in the first period, 3 in the second). In the last 6-month period, nine children required pulmonary vasodilator therapy on 14 occasions. All nine children were treated successfully with inhaled NO; none were given or needed epoprostenol, as NO always was effective in providing pulmonary vasodilatation. For resistant pulmonary hypertension, increasing the concentration of NO would have been the next therapeutic option. The cost for the two 6-month periods using epoprostenol was $19,483.48 for the drug and $283.25 for equipment costs (total cost $19,766.73). There was no expenditure on epoprostenol in the final 6-month period. The cost of NO was $465. However, the total expenditure, including the delivery and monitoring system, was $4,722.85. CONCLUSIONS: Using inhaled NO in our pediatric cardiac intensive care unit abolished the use of epoprostenol during the reported monitoring period. The cost savings were significant, amounting to 12% of the annual drug budget for the unit. The cost of setting up the inhaled NO delivery system is recouped rapidly. The ease of delivery and measurement of inhaled NO also may have contributed to its increased clinical use. PMID- 10144081 TI - Perspectives. Kassebaum tackles alliances, ERISA, and individual market. PMID- 10144082 TI - Perspectives. History lesson: "privatization" nothing new for Medicare. PMID- 10144083 TI - Perspectives. Public health and managed care find common ground. PMID- 10144084 TI - Perspectives. Managed care agnostics question savings claims. PMID- 10144085 TI - Building an information bridge for integrated delivery systems. PMID- 10144086 TI - Developing an enterprise wide strategy for managing healthcare information. PMID- 10144087 TI - Barcoding facilitates patient-focused care. PMID- 10144088 TI - Perioperative clinical information systems: the hunt is on for hidden treasure. PMID- 10144089 TI - Clinical data repository: a survey of providers. PMID- 10144090 TI - Physicians in search of the great IS (information system). PMID- 10144091 TI - The importance of the arts in hospital development. PMID- 10144092 TI - Review of fire safety. AB - This paper describes work to develop a comprehensive suite of guidance documents for the fire safety of healthcare premises. Some of the key issues are discussed and future developments are identified. PMID- 10144093 TI - HEPA respirators bite the dust! So do dust masks. PMID- 10144094 TI - HAZWOPER (hazardous waste operations and emergency response standard)--training an in-house response team. PMID- 10144095 TI - Uninformed consent. New tests raise questions over right not to know test results. PMID- 10144096 TI - Aid in dying. Murders? Yes. Punishment? No. PMID- 10144097 TI - Care of the dying. Deciding who decides. PMID- 10144098 TI - Can ethics committees adapt to double duty in managed care? PMID- 10144099 TI - Catholic Health Association bars for-profit membership. PMID- 10144100 TI - Organ transplantation. Speed and deliberation raise questions of trust. AB - A double whammy of organ transplant stories hit the media within days of one another, giving the public plenty to mull over. Overall, the media's treatment seemed well-balanced. It sifted through the details of Mickey Mantle's speedy transplant of a new liver and declared the former slugger's shot for a new liver to be fair. On the other hand, the media called foul the latest report by the AMA Council on Ethical and Judicial Affairs (CEJA), which recommends the use of anencephalic neonates as organ donors. These stories served as a convenient and appropriate backdrop to a June 9-10 Chicago conference on ethical, legal, and policy issues of organ and tissue donation sponsored by the Department of Medical Humanities at Southern Illinois University School of Medicine and the Live and Learn Organ Donation and Awareness Program of the Illinois Secretary of State. The following articles summarize the Mantle episode, the CEJA policy, and various presentations at the conference that emphasized the development of new frameworks to consider for increasing the nation's organ supply. PMID- 10144101 TI - Proprietary ethics. Patent pursuits evoke calls for limits on commercial ventures. AB - Despite America's claim as the champion of capitalism, there does seem to be some ingrained sense of boundaries beyond which making money is viewed as not fair or proper. The following stories look at two very different cases in which the patent process came under attack for very different ethical reasons. PMID- 10144102 TI - CACs (Carrier Advisory Committees), offer chapters a voice. PMID- 10144103 TI - The Medicare fair hearing process. PMID- 10144104 TI - Case study. Prompted by insurers, Intermountain Health Care fast-tracks alignment between MDs, hospitals & health plans. PMID- 10144105 TI - Re-engineering outpatient services at Arkansas Children's Hospital, Little Rock. PMID- 10144107 TI - Becoming a customer-driven organization. PMID- 10144106 TI - Medicare: selling a painful cure. PMID- 10144108 TI - Calculating the return on quality. PMID- 10144109 TI - From service to product. Banks must change and become customer-oriented. PMID- 10144110 TI - Can a company be both low cost- and service-oriented? How to deliver service at a profit. PMID- 10144111 TI - Keeping the customer satisfied. PMID- 10144112 TI - Passenger focus keeps railway on track. Core values training and defining customer needs can lead to increased market share. PMID- 10144113 TI - Service you can bank on. Different levels of service and better communication are the key to improvement. PMID- 10144115 TI - Capturing the customer's voice. PMID- 10144114 TI - In-flight philosophy. A competitive approach has led to strength and steady growth. PMID- 10144116 TI - No news is bad news. Complaints are a valuable form of feedback and should be treated as such. PMID- 10144117 TI - Quality planning and the communication plan. PMID- 10144118 TI - Four steps to improving service quality. PMID- 10144119 TI - Focusing on customers. PMID- 10144120 TI - Focus on customers, focus on growth and focus on profit. PMID- 10144121 TI - ISO and total quality. PMID- 10144122 TI - Total quality can work. PMID- 10144123 TI - Delivering community benefits. The TQM approach can work in the wider community. PMID- 10144124 TI - Managing customer loyalty. PMID- 10144125 TI - Enhancing quality in service industries. The benefits of IT introduction are efficiency and customer satisfaction. PMID- 10144126 TI - Making EIS (executive information systems) work. PMID- 10144127 TI - Leading the knowledge workers of the 1990s. The information age requires a new style of manager. PMID- 10144128 TI - VIP interview: Patrick G. Hays. Interview by Maria R. Traska. PMID- 10144129 TI - Public accountability for health: new standards for health system performance. AB - This article reviews the failure of contemporary quality oversight organizations to respond to the changing health care environment and suggests an overhaul of quality measurement and assurance functions. The authors examine the factors that have limited public accountability for health care, emphasizing the limited agreement that exists on the purpose of American health care, standards for evaluating care, or the appropriate locus of responsibility for quality of care. A five-part quality oversight system is proposed including development of quality measures, promulgation of national standards, validation and accreditation, use of data for purchasing and provider selection, and use of data for quality improvement. PMID- 10144130 TI - Commentaries on public accountability. PMID- 10144131 TI - Improving customer satisfaction: emerging lessons about strategy and implementation, Part 2. AB - This article describes a six-phase strategy designed to systematically improve customer satisfaction across an entire managed care system. Part 1 (Spring 1995) of this two-part series summarized the theoretical underpinnings of the approach and highlighted the first two phases of the improvement strategy. Those phases involve systematically listening to the organization's customers and using customer information to strategically target key areas for improvement. This article describes the specifics of the last four phases of the strategy; these phases involve achieving and sustaining unprecedented levels of improvement in targeted areas. Initial results and emerging lessons associated with the implementation of this strategy are summarized. PMID- 10144132 TI - Commentary on improving customer satisfaction. PMID- 10144133 TI - Framework for performance measurement of health care networks and health plans. AB - Emerging health networks are poised to play an important role in the future American health care delivery system. The trend toward vertical integration, coupled with growing purchaser and consumer demands for information about value, has created an increasingly chaotic measurement environment. This article describes a successful collaborative effort among providers, users, and purchasers of health services and developers of performance measurement tools and databases to develop principles and a framework for measuring the performance of health care networks. Eleven principles and five measurement categories were identified; seven clinical conditions were targeted for performance measurement. PMID- 10144134 TI - Commentary on framework for performance measurement of health care networks and health plans. PMID- 10144135 TI - Leadership issues: health care in the year 2004. AB - The intent of this article is to develop a plausible scenario for health care in the year 2004. We hope to engage the reader in a process that will help discern the exogenous forces that are currently impacting the way that health care organizations do business. By identifying these forces, we can track their development and learn to adapt and change proactively as may be necessary. We also discuss the current and projected trends that are shaping health care delivery. Our theme is that the future of health care is continually being reinvented and that the potential for dealing effectively with the dramatic change that the future is bringing already exists in most health care organizations. The future is only waiting to be reinvented. PMID- 10144136 TI - The political correctness of a physician hospital organization may precipitate its demise in a community hospital. AB - Health maintenance organizations are placing an increased pressure on physicians and hospitals to assume the risk of providing health care services under capitated agreements. They believe that if the providers' profits are based upon their cost-efficient provision of medical services, they will control their use of medical resources and reduce health care spending. Managing the risks of a capitated contract necessitates the integration of the hospital's and the physician's incentives. However, is the most appropriate legal structure that will enable physicians and hospitals to form risk-sharing contracts with managed care entities and manage these contracts profitably a physician-hospital organization? It is estimated that over 50 percent of the physician-hospital organizations that are created each year fail within the first two years of their operation because of political and financial reasons. A multispecialty group composed of select physicians, who are willing to integrate their practices and who have a low length of stay in the hospital, may be in a better position to manage the risks imposed by capitated contracts. PMID- 10144137 TI - Benchmarking risk-adjusted complications and mortality: a case study on outcomes assessment. AB - This article illustrates a process by which hospitals can assess their outcomes performance on rate-related complications and mortality using readily available administrative data. This approach allows hospitals to demonstrate the value of their clinical services to managed care organizations and further investigate services that may be experiencing adverse outcomes. The analysis compares outcome performance to national norms and benchmarks, as well as to local competitors. PMID- 10144138 TI - Access to health care for HMO enrollees in California. AB - Using predefined guidelines, the California HMO Quality Management Coalition monitored access by HMO members to six different types of health services across provider groups. Results highlight regional differences and point to some significantly poorer scores in the urgent visits and specialty referrals. Design considerations are discussed and suggestions are made for follow-up quality improvement. PMID- 10144139 TI - Using Medicaid fee-for-service data to develop community health center policy. AB - This article presents an analysis of fee-for-service Medicaid data for King County, Washington. This analysis was conducted using Department of Social and Health Services billing records for patients of the community health centers of Seattle-King County (14 primary care sites), the Seattle-King County Department of Public Health (9 primary care sites), and Harborview Medical Center (a large tertiary facility with a primary care outpatient clinic associated with the University of Washington) from January through June, 1992. The complete billing records of all patients who utilized any one of the 24 sites were made available. These records were used to review utilization patterns and patient costs. The implications for community health centers regarding Medicaid managed care, health care reform, and population-based management are discussed. PMID- 10144140 TI - Use of Queensland Hospital services by interstate and overseas visitors. AB - In response to concerns about the number of interstate and overseas visitors using Queensland hospital services, the present study examined a sample of 1,295 hospital records to determine the proportion of patients who were incorrectly identified as Queensland residents. Across six hospitals the overall detection rate was 4.6%. Rates varied between hospitals, with the highest detection recorded for Goondiwindi near the Queensland/New South Wales border; and the lowest for Prince Charles in Brisbane. There were also important variations across hospitals based on specific holiday periods. In particular, Goondiwindi and the Gold Coast had substantially higher detection rates for the Christmas holiday period (December-January) than for the mid-year period (June-August). These findings are discussed in terms of their implications for hospital services, especially lost revenue and increased patient load. Health information managers are identified as a key group for addressing some of the current problems in this area. PMID- 10144141 TI - Student feedback on professional experience placements. AB - As part of the Professional Experience Programme in the School of Health Information Management (HIM), at the Faculty of Health Sciences, University of Sydney, students undertake a block of professional experience in the intersemester recess. Students were invited to provide feedback to the School on their experience via a post-placement tutorial discussion with the Professional Experience Coordinator. In addition, written feedback was obtained from HIM II and HIM III students via a questionnaire. The aim of the questionnaire was to obtain student perceptions of the value of the placements as a learning experience, the role of the supervisor, the best aspects of the placement, and ways in which the placement could have been better. The results indicate that over 78% of respondents felt that the placement was an excellent or useful learning experience. No student felt the experience to be fair or poor. Student feedback provides the School with valuable information which can be used for planning and organising future placements. By aiming to continually improve the quality of professional experience we aim to improve the quality of our graduates as beginning practitioners. PMID- 10144142 TI - Patience, patients. PMID- 10144143 TI - National Coder Workforce Issues Project--update on coder accreditation. PMID- 10144144 TI - Through a dark glass more clearly? Health information managers and strategic planning in the 1990s. AB - This article considers the application of a formal strategic planning approach to the health information management profession. After a brief discussion of the two main strategic planning models, the process adopted by the Health Information Management Association of Australia at its recent strategic planning workshop is described and the planning outcomes are outlined. The merits of explicitly expressing strategic intent through the creation of a vision of the future and the establishment of strategies and an action plan to realise the vision are discussed. PMID- 10144145 TI - Full reporting by health maintenance organizations (HMOs) and competitive medical plans (CMPs) paid on a cost basis--HCFA. Final rule. AB - This rule affects HMOs and CMPs that contract with HCFA to furnish services to Medicare beneficiaries and be paid on a cost basis. It requires a cost HMO or CMP to include in its cost report the costs of hospital and skilled nursing facility (SNF) services even if it has elected (under section 417.532(c) of the HCFA regulations) to have HCFA's intermediary process those claims and pay the hospital or SNF directly. This change is necessary so that HCFA can determine and compare the cost of all services furnished by HMOs and CMPs with the cost of equivalent services paid for under the fee-for-service system. This rule also adds a definition and makes technical changes to clarify and update certain related provisions of subparts O and U of part 417 of the HCFA rules. PMID- 10144146 TI - Medicare program; refinements to geographic adjustment factor values, revisions to payment policies, adjustments to the relative value units (RVUs) under the physician fee schedule for calendar year 1995, and the 5-year refinement of RVUs; correction--HCFA. Correction of final rule with comment period. AB - This document is a second correction to technical errors that appeared in the final rule with comment period entitled "Medicare Program; Refinements to Geographic Adjustment Factor Values, Revisions to Payment Policies, Adjustments to the Relative Value Units (RVUs) Under the Physician Fee Schedule for Calendar Year 1995, and the 5-Year Refinement of RVUs" published in the Federal Register on December 8, 1994. The first correction notice was published in the Federal Register on January 3, 1995 (60 FR 46). PMID- 10144147 TI - Setting the stage for an epic drama. PMID- 10144148 TI - The future of Catholic health care: nine models for integration and consolidation. PMID- 10144149 TI - Transformational leadership in healthcare reform. PMID- 10144150 TI - Touching moments. Performance Citation Awards: Fred Barth; Point de rencontre, Baie-Comeau, Quebec. PMID- 10144151 TI - Building communities from the inside out. PMID- 10144152 TI - In-home psychiatric nursing. The At-Home Mental Health Program. AB - In-home psychiatric nursing can bridge the gap between inpatient and outpatient treatment of mental illness. This article outlines a home care program that provides a more comfortable, less costly alternative to traditional mental health treatment models. PMID- 10144153 TI - Creative alternatives in mental health. AB - With budgets being cut universally, all types of patients face new challenges in obtaining care. When states began to release patients from state hospitals, those patients often had nowhere to turn for the basics. One demonstration program, however, strives to take them beyond the basics so they can be fully integrated members of the community. PMID- 10144154 TI - Management of depression in patients with HIV infection. AB - AIDS is no longer an obscure, mystifying disease. However, it still carries with it many of the social stigmas that it did when the world was just learning about it. And along with those stigmas providers naturally see signs of depression. Depression in persons with AIDS can be treated either with psychotherapy or with medication. First, however, providers must recognize the signs of depression and focus on improving the quality of the patient's life. PMID- 10144155 TI - Geropsychiatric nursing knowledge--a need in home care. AB - Few nursing schools include in their curriculum home care work; fewer still include coursework in geropsychiatric issues. Yet this is a vital area of knowledge, particularly for home care nurses. What might such courses cover, and how important are they? PMID- 10144156 TI - Firearm safety. Prevention put into practice. AB - As guns seem to become more a part of Americans' lives, home care agencies need to be aware of any potential for danger when making home visits. One agency's mental health staff has created a program that reduces risk of firearm casualties for patients and staff by taking a preventive approach. PMID- 10144157 TI - In-home behavioral health services. Establishing a program. AB - As requirements for staying in the hospital or going into the hospital become more stringent, home care is becoming more recognized and preferred. One service that is just coming into its own is in-home behavioral health services. Here an agency discusses strategies for developing such a service line and the success of its first year of providing this service. PMID- 10144158 TI - Leading the fit life: jobs in health clubs. PMID- 10144159 TI - The twenty largest occupations in America. PMID- 10144160 TI - Can not-for-profits learn from for-profits? AB - Marketing management will help you maintain service quality, keep donors satisfied and generate a dependable source of income. For-profits survive on these activities. PMID- 10144161 TI - The Associate Life Legacy Program: the ultimate gift from employees. AB - St. Vincent Hospital Foundation introduced a program whereby employees can leave a legacy without cost to them. To date the program has generated nearly $26 million in pledges. PMID- 10144162 TI - Cardiac integration means facing heart-hitting realities. PMID- 10144163 TI - Economic dislocation's trickle-down impact for health providers. PMID- 10144164 TI - Hospital drug errors tracked, results provide large medication incident database. PMID- 10144165 TI - InterStudy provides "competitive edge" managed care databases. PMID- 10144166 TI - Patient satisfaction rates are too high. PMID- 10144167 TI - The joint operating company: operational and legal considerations. PMID- 10144168 TI - Value Health, Johnson & Johnson collaborate to develop disease management products. PMID- 10144169 TI - Planning along the continuum of care. PMID- 10144170 TI - Negotiating successful managed care contracts. AB - The goal in managed care contracting is to create a coherent framework for treatment and payment decisions that is as unintrusive, flexible, and cooperative as possible for both payers and providers. That goal rarely is achieved with a generic contract that ignores the circumstances and interests unique to a particular payer and provider. This article highlights a number of key issues that arise in managed care contracting in general and offers several practical suggestions for resolving those issues. PMID- 10144171 TI - Structuring managed care joint ventures. AB - Providers that undertake joint ventures to secure managed care contracts must understand the important governance, operational, legal, and political issues involved. Careful planning in all these areas can help ensure that the joint venture will meet its goals and avoid problems such as inappropriately negotiated contracts and legal violations. PMID- 10144172 TI - Reasons providers form PHOs. AB - According to a recent survey, providers form physician-hospital organizations (PHOs) to improve their contracting positions with managed care organizations, to facilitate collaborative efforts with physicians, and to enhance their abilities to accept and manage capitation. The survey also revealed that PHOs are still in their infancy and operate amid regulatory uncertainty as they develop the expertise and infrastructure necessary to successfully compete in a managed care environment. PMID- 10144173 TI - Renaissance CFO emerges in response to market pressures. AB - A 1995 survey of chief financial officers (CFOs) in healthcare organizations finds that as the healthcare industry reshapes itself through mergers, acquisitions, and downsizing, the CFOs of the mid-1990s also are reshaping themselves into "Renaissance CFOs." They are acquiring new skills and expertise beyond the traditional area of finance. About one-third of the CFOs who took part in the February 1995 survey, which updates similar surveys in 1992 and 1990, said they are working to enhance their knowledge of managed care because they expect to assume responsibility for managed care as part of their expanding CFO responsibilities. Other new areas survey respondents said they expect to oversee before the decade's end are financial costing and pricing and physician relations. The 1995 CFO survey was commissioned by HFMA and Executive Risk Management Associates, Inc., and was conducted by Elrick & Lavidge, Inc. Previous CFO profile surveys have included analysis of CFO compensation data. This year, however, a separate, more indepth survey of CFO compensation was commissioned by HFMA; the findings of this survey will be presented in the October issue of HFM. PMID- 10144174 TI - Assessing healthcare market trends and capital needs: 1996-2000. AB - An analysis of recent data suggests several significant trends for the next five years, including a continuation of market-based reform, increases in managed care penetration, growth of Medicare and Medicaid health maintenance organizations, and erosion of hospital profits. A common response to these trends is to create integrated delivery systems, which can require significant capital investment. The wisest capital investment strategy may be to avoid asset-based integration in favor of "virtual integration," which emphasizes coordination through patient management agreements, provider incentives, and information systems, rather than investment in large number of facilities. PMID- 10144175 TI - Avoiding physician compensation problems. AB - Hospitals and other healthcare organizations traditionally have been free to structure compensation arrangements with physician employees without governmental interference. However, recent changes in how the statute prohibiting kickbacks has been interpreted and new self-referral legislation indicate that the days of unfettered discretion have come to an end. These changes create new pitfalls for healthcare organizations that seek to employ physicians to provide care as part of integrated delivery systems. PMID- 10144176 TI - AICPA (American Institute of Certified Public Accountants) seeks comments on proposed accounting changes. AB - The American Institute of Certified Public Accountants has exposed for public comment a revised version of its accounting and auditing guide--Audits of Providers of Health Care Services. The guide covers accounting, auditing, and financial reporting in healthcare organizations and is being revised primarily to address the changing healthcare environment and changes mandated by the Financial Accounting Standards Board. This article provides an overview of some of the more significant proposed changes. The comment period ends August 14, 1995. PMID- 10144177 TI - Telemedicine and EDI. PMID- 10144178 TI - The evolving role of the treasury manager. PMID- 10144179 TI - Data trends. August 1995. PMID- 10144180 TI - Materiel executives and the managed cost continuum in a capitated environment. AB - Strategies that involve supplier partnerships and pose high risk for both hospitals and suppliers are an increasing trend. The materiel management professional who is proactive and able to assess risks in a managed care contractual environment will be the winner as materiel management becomes a network function rather than individual hospital function. PMID- 10144181 TI - Business process reengineering: a pathway for performance improvement. AB - Health care materiel management executives are coping with a revolutionary environment. Demands and constraints are being placed on hospitals that necessitate both long-term solutions and rapid responses. Materiel management executives can play a vital role in transforming their areas from a passive service center to an active command center. It is essential that the materiel management executive play an active role in the change process. PMID- 10144182 TI - For the times they are a-changin'. AB - Today, as we deal with managed care, vertical integration, mergers, new technologies, diagnosis related groups, stockless or just-in-time distribution, capitated contracts, consignment, health maintenance organizations, preferred provider organizations, total quality management/continuous quality improvement, reengineering, federal regulations, care mapping, patient focused care, and so forth, it is obvious that the only thing that is constant is change. "For the times they are a changin." PMID- 10144183 TI - Developing self-managed logistic service teams. PMID- 10144184 TI - Reengineering hospital materiel management. AB - Reengineering involves significant change and dramatic rethinking of the business process. The expected result of these changed processes is dramatic improvement. Hospital cost pressures and technological change necessitate review or reengineering the process to enhance customer service at a lower cost. Three areas that yield significant results include reducing the cost of purchasing, implementing new technologies, and empowering teams to accomplish customer driven goals. PMID- 10144185 TI - Reducing computer hardware service costs. AB - This article reviews the process of designing and launching a group-purchasing effort to significantly reduce the single most expensive line item in the computer operating budgets for 16 Massachusetts hospitals. PMID- 10144186 TI - Reengineering materiel management for strategic placement. AB - The future of a hospital's materiel management function will depend on how well aligned it is with the institution's strategic direction. A sleek, customer directed, information-rich supply process will provide the competitive edge. A reengineering mindset is needed to meet the challenge. PMID- 10144187 TI - Capitation: developing partnerships for health care. AB - As medical-surgical supply distributors begin to establish partnerships with hospitals, thus sharing financial risk, materiel executives must understand all potential contractual ramifications. This article will discuss the types and features of supply capitated contracts and the subsequent need to correctly assess new categories of contractual risk. PMID- 10144188 TI - Tomorrow's materiel management executive today. AB - As materiel management executives in today's market, the challenges of not only operating effectively but with fewer resources is a reality that has no end in sight. The role of the materiel executive in hospitals is moving from supply manager to resource consultant. This may be quite appealing to many of us; however, not all are prepared to assume these responsibilities. As a result, we find ourselves overwhelmed with information and examples of case studies from different facilities describing how they are resolving their individual issues. Reactions to these changes are met in different ways, ranging from marveling at others' imaginations to fear from not understanding how to commit to these radical new processes. Is there a proper way or a mold to use? I suggest not. PMID- 10144189 TI - Reengineering materiel management using computer technology. AB - The Materiel Management Department in today's hospital is in a uniquely advantageous position. It can better support the hospital's mission by applying current techniques in material management systems automation together with current computing technology as part of a broad-based reengineering process. Materiel management executives, suppliers, software developers, and hardware manufacturers now have all the necessary tools to create and implement a flexible, cost-effective, complete, paperless system. The model system offers tremendous advantages in terms of increased productivity and reduced total cost. This article discusses the process and the tools and techniques that should be considered. PMID- 10144190 TI - Opportunity costs associated with long decision making. AB - In certain cases, prompt utilization of an already negotiated group purchasing agreement will save a hospital more money than bidding out the same products. This occurs because there are large opportunity costs associated with not taking savings immediately. Savings can be further enhanced by redeploying staff to contract for items not covered by group agreements. PMID- 10144191 TI - A total expense reduction plan. AB - The article depicts strategies for reducing both salary and nonsalary expenses. The importance of productivity monitoring and flexible staffing are key points. Nonsalary reduction techniques include signature controls, review of existing policies and procedures, and cost awareness education. PMID- 10144192 TI - Medicare and ASIM--and me. PMID- 10144193 TI - Working together for medicine. Interview by C. Burns Roehrig. PMID- 10144194 TI - What will a balanced budget really mean for internists? PMID- 10144195 TI - Reinventing Medicare: let's keep the cart behind the horse. American Society of Internal Medicine. PMID- 10144196 TI - Choosing Medicare's future. PMID- 10144197 TI - Can Medicare be saved with a market approach? PMID- 10144198 TI - NHS entrants. Great expectations. AB - The plethora of tabloid newspaper stories slating penny-pinching managers and the glut of television soaps featuring over-worked nurses and exhausted junior doctors portray life in the NHS as far from glamorous. But it seems that once you have been bitten by the NHS bug nothing can put you off. The lure of large salaries, expense accounts and company cars apparently counts for nought when offered the prospect of a 72-hour working week and a significantly reduced income. The opportunity to 'do some good' and 'make a difference' is very obviously a strong motivating factor for many people considering a career in the NHS and there is no shortage of those who are keen to play their part. These are the stories of just some of those people. PMID- 10144199 TI - Career planning. Fast and loose. PMID- 10144200 TI - Job sharing. Two dimensional. PMID- 10144201 TI - Contracting. A big deal. PMID- 10144202 TI - Data briefing. Screening. PMID- 10144203 TI - Corporate governance. The effective non-executive. PMID- 10144204 TI - Management consultancy. A whole new ball-game. PMID- 10144205 TI - Management consultancy. Outside in. PMID- 10144206 TI - Management consultancy. Critical relationships. PMID- 10144207 TI - Management consultancy. Open to advice. PMID- 10144208 TI - Mental health. Beyond the asylum. PMID- 10144209 TI - Mental health. Home and away. PMID- 10144210 TI - Ambulance services. Road to recovery. PMID- 10144211 TI - Practice information. A sensitive subject. PMID- 10144212 TI - Implementation of pharmaceutical care in acute medical cardiovascular patients. AB - All inpatients who were admitted to one designated cardiologist at a private community hospital were followed by a pharmacist. The pharmacist prospectively evaluated the patients' medications in order to identify, resolve, and prevent any medication related problems. Recommendations concerning these medication related problems were made to the physician involved. In addition, the pharmacist documented medication information questions, medication dosing consultations, and patient medication counseling consults. Ninety-seven percent of the recommendations were accepted by the prescriber. The most common categories of recommendations were for drugs belonging to cardiovascular (40.3%) and anti infective (18.4%) classes. Improper medication selection (19.6%), untreated indication (17.4%), overdosage (16.3%), and medication given without an indication (13%) were the most common medication related problems and accounted for over two-thirds of the total accepted recommendations. Sixty-six percent of the recommendations were considered significant and 4% were considered extremely significant. Based on the pharmacist's interventions, an annual patient medication charge savings of $17,576.00 was estimated. PMID- 10144213 TI - Patient satisfaction as an outcome indicator of pain management during labor and delivery. AB - Increased emphasis is being placed on using various indicators to assess the quality of health care services. The purpose of this study was to assess the use of patient satisfaction in evaluating the pain management of patients admitted for childbirth. Three hundred eighty-nine patients who were admitted to the labor and delivery unit were asked to evaluate the technical and interpersonal aspects of the pain management process. One hundred seventy-seven patients (45.5%) responded to the questionnaire. The results showed that the aspects that received the lowest level of satisfaction were: 1) the patient's role in the decision of preferred type of pain medication; and 2) the use of a different medication after informing the health care professional that the original medication was not relieving their pain. No relationship was found between satisfaction and pain. This indicated that satisfaction was based on the patient's reaction to aspects of the service experience, and was not dependent on the type or intensity of pain experienced. PMID- 10144214 TI - Disease management: opportunity for pharmaceutical care? AB - Most of the efforts to control health care costs in the U.S. have been based upon control of the more expensive components of health care. These efforts have typically failed or fallen short, and some studies even indicate that certain efforts to reduce costs of drugs have significantly increased other medical costs, resulting in overall increases in cost of care. A dramatic new concept called disease management advocates a much broader approach to appropriate treatment of the entire disease process. This often involves shifting care and necessary dollars away from expensive inpatient and acute care to areas such as preventive medicine, patient counseling and education, and outpatient care. This concept has great potential impact regarding drugs and drug therapy because of the implications of appropriate versus inappropriate therapy on the overall cost and clinical outcome of a particular disease. Managed care organizations, prescription benefit management companies, and pharmaceutical manufacturers all are very interested in this promising new paradigm for patient care. Likewise the concept possibly has great implications for pharmacists' successful implementation of pharmaceutical care. In this regard, disease management may have the potential to prove both clinical and economic value of appropriate drug therapy and related pharmaceutical care far beyond the cost of the drug. Some suggestions for pharmacists interested in pursuing the concept of disease management are included at the end of this article. PMID- 10144215 TI - The do's and don'ts of patient education. PMID- 10144216 TI - Hospital pharmacy services turnover is among highest of all health professions. PMID- 10144217 TI - Alberta's acute care funding plan: update to December 1994. AB - From 1990 until 1994 Alberta Health adjusted the acute care portion of hospital budgets based on a case mix index, initially called the Hospital Performance Index (HPI). The HPI formula method was a temporary measure; in November 1993, Alberta Health announced that, commencing in 1994, hospitals would be funded on a prospective basis, although they would still use the core of the HPI in the setting of funding rates. The creation of 17 health regions in June 1994 created the need for a new system of funding which would supplant the modified prospective system. In this paper we review the evolution of the HPI plan and its individual components-patient data, patient classification, funding weights, inpatient costs and adjustment factors. PMID- 10144218 TI - Technology acquisition in Canadian hospitals: how are we doing? AB - We surveyed attitudes of decision makers involved in making decisions about technology acquisition in hospitals, receiving replies from 989 (72%) anglophone respondents and 201 (68%) from francophone respondents. Respondents split on whether to try unverified procedures, strongly agreed that medical technology should be evaluated, and expressed a desire for technology assessment data. The quality of health care, need, and compatibility with the institution's role and mission were seen as the most important factors affecting acquisitions. Our study suggests that half the battle has been won; decision makers appear convinced that technologies must be evaluated. Organizational mechanisms, however, may still be required to ensure implementation. PMID- 10144219 TI - New management structures at Sunnybrook Health Science Centre: identifying patient groupings. AB - An important step in re-engineering to achieve patient focused care is to define operational units of patients with like needs. This paper describes one process oriented approach for this task. The approach allowed early and significant involvement of the staff in the re-engineering project. PMID- 10144220 TI - Multiskilling--re-engineering work process. AB - Many North American companies have recognized the need to re-engineer their core processes to achieve breakthrough improvements in cost, service and efficiency. In fact, it is estimated that U.S. companies alone will spend millions on business re-engineering projects this year. But change experts say that most re engineering is in name only, cautiously tackling only one process or department at a time. Even fewer hospitals have attempted this magnitude of change. Toronto's Sunnybrook Health Science Centre is the first institution of its size in Canada to embark on a multifaceted re-engineering strategy toward a model of patient focused care. The following is an overview of Sunnybrook's experience with the first of these strategies: multiskilling service workers. The concept of multiskilling provides for a focus on redesigning job classifications to broaden the scope of responsibility. For Sunnybrook, this entailed the amalgamation of six service positions--unit aide, health care aide, dietary aide, orderly, porter, housekeeper and attendant into one service assistant position. PMID- 10144221 TI - A paradigm shift in providing care for the HIV/AIDS patient. AB - The authors report on a detailed cost study of HIV-infected patients receiving treatment at the McGill medical facilities. The results indicated that a home care setting is a cost-efficient site in which to care for an AIDS patient, with care provided in other settings when required. As the number of people with AIDS increases, efforts are needed to develop alternative care services for those infected with the virus. What is required would seem to be a service delivery system which would ensure cost-effective continuity of care across a continuum of services geared to varying levels of independence and illness severity. PMID- 10144222 TI - Hemodialysis unit at Renfrew Victoria Hospital. AB - In June 1994, the Renfrew Victoria Hospital was selected as the first-ever recipient of the Health Care Quality Team Award in the "Small and Rural Provider" category. This award, offered by the Canadian College of Health Service Executives and 3M Health Care, was established to recognize health care organizations that have sustained measurable improvements in their network of services, and have done so through the use of a team. Renfrew Victoria Hospital's entry focused on the establishment of a hemodialysis unit for the residents of Renfrew County. This article summarizes the parameters of this award, as presented in our submission. PMID- 10144223 TI - Unprecedented cuts seen for Medicare, Medicaid. PMID- 10144224 TI - Revitalizing our vision. PMID- 10144225 TI - Evolving sponsorship and corporate structures. Canon law considerations for changing organizations. PMID- 10144226 TI - Making mission possible. A response to Rev. Richard A. McCormick's article on the preservation of Catholic hospitals. AB - In "The Catholic Hospital Today: Mission Impossible?" (Origins, March 16, 1995, pp. 648-653), Rev. Richard A. McCormick, SJ, STD, questions whether Catholic hospitals can continue their missions in a society with so many factors and influences that seem to oppose efforts to perpetuate the healing ministry of Christ. As Fr. McCormick states, the matrix of good medicine is centered on the good of the individual. But too often, the patient has been considered an individual isolated from others. The rights of families, people who belong to the same insurance program, and the society funding much of healthcare must also be considered. Fr. McCormick points out that an obstacle to the healing mission arises because healthcare is often treated as a business instead of a service. If not-for-profit healthcare facilities come to exist for the well-being of the shareholders, as do for-profit healthcare facilities, then a perversion of values results. This should lead us to renounce for-profit healthcare and the behavior that some Catholic health organizations have borrowed from the for-profit sector. In addition, Fr. McCormick calls attention to our society's denial of death and tendency to call on medicine to cure personal, social, or economic problems. This denial-of-death phenomenon helps us realize the need for the mission of Catholic hospitals. Continuing the mission of Catholic hospitals will require the attention of all involved in them-physicians, trustees, nurses, administrators, and ancillary personnel. These healthcare providers must not be distracted from the mission by joint ventures and economic issues. PMID- 10144227 TI - Healthy vision. Baton Rouge, LA, healthcare organizations collaborate to complete a needs assessment. AB - Baton Rouge, LA, has in recent years seen rocketing rates of syphilis, alcohol abuse, and other health problems. In response, 10 local healthcare organizations met in 1993 to form the Baton Rouge Health Forum. The forum began its work by conducting a community needs assessment. The forum organized three task forces. One compiled existing data on area demographics, public health, economics, and education. A second task force employed personal interviews and focus groups to gather residents' opinions on the area's top 10 healthcare needs. The third task force kept local media and community leaders informed about the assessment's findings. As in other U.S. communities, Baton Rouge residents' top 10 needs centered around social issues with health implications. The number one perceived need, for example, was a central clearing-house to provide information about healthcare to those who lack it. PMID- 10144228 TI - Model for the integrated network? Rehabilitation makes a good candidate. AB - Rehabilitation is a good model for an integrated delivery network (IDN). Because it is an integral part of the treatment plans of a diverse group of medical specialties, rehab often plays a pivotal role in patients' recovery. Since its focus is on functional outcomes, rehab is compatible with a capitated payment system. In addition, rehab entered the managed care arena before other "product lines," so rehab providers have experience with diverse reimbursement conditions. And although rehab encompasses all levels of care, it is not too large to function as a model for a full-scale IDN. There are four key stages in the development of a rehab IDN: A strong leader with a clear vision organizes a working committee composed of the key leaders of each entity involved in rehab: hospitals, nursing homes, home health, and others. The committee begins to design the proposed network. Though the committee may study other IDNs, its focus is on its own organization's needs and objectives. A master plan addressing systems gaps and opportunities throughout the IDN is drawn up. Integral to the plan is a schedule according to which each of the network's components will be integrated. The master plan is implemented. The working committee determines the IDN's final structure and names the members of the management team. PMID- 10144229 TI - Providers paying heed to non-English-speaking communities. PMID- 10144230 TI - Principles of health infrastructure planning in less developed countries. AB - This article proposes a number of key principles for health infrastructure planning, based on a literature review on the one hand, and on a process of internal deduction on the other. The principles discussed are the following: an integrated health system; a thrifty planning of tiers within that health system; a specificity of tiers; a homogeneity of the tiers' structures; a minimum package of activities; a territorial responsibility and/or an explicit and discrete responsibility for a well-defined population; a necessary and sufficient population basis; a partial separation of administrative and public health planning bases; and, finally, rules for a geographical division and integration of non-governmental organizations. The definition of two strategies, primary health care and district health systems, is also revisited. PMID- 10144231 TI - Culturally acceptable health care services for Saudi's elderly population: the decision-maker's perception. AB - This article reports on a study carried out in 1993 to elicit the opinions of decision makers (medical and non-medical) as to the types of facilities, locations and culturally acceptable levels of health care appropriate for the elderly in Saudi Arabia. In addition, the study sought to find out the procedures and likely constraints in the development of future health care services for the elderly. An opinion survey was carried out on a randomly selected sample of decision makers, drawn from: hospitals of 100-bed capacity or more; and, from directorates of education, agriculture, police, municipalities, commerce, transport and media, in each of the regions of Saudi Arabia. A predesigned Arabic questionnaire was completed by the respondents during February-April, 1993. Of the 244 respondents, the most important categories of elderly to be cared for were considered to be those with handicaps, the chronically ill, and those without family support. The non-medical decision makers gave higher scores to these alternatives than did the medical decision makers (P < 0.05). Use of the family home for elderly health care was rated as the most appropriate, followed by medical rehabilitation centres, and only then by hospitals. Non-medical respondents gave more emphasis on rehabilitation centres (P < 0.02). Medical respondents thought that primary care doctors (87.2%), physiotherapists (87.2%) and general nurses (78.2%) can adequately fulfil the needs of most elderly patients. In contrast, non-medical respondents demanded the presence of specialist doctors (72.3%), specialist nurses (78.9%), laboratory and X-ray facilities to run such services (P < 0.05).(ABSTRACT TRUNCATED AT 250 WORDS) PMID- 10144232 TI - Hospitals: to the next millennium. AB - Hospitals are changing. Throughout the OECD the hospital, that enduring and pervasive organization which has delivered the vast majority of acute care services for decades, is being reconceptualized. We briefly analyse trends which clearly indicate that the existing concept of the hospital is rapidly coming to an end. The emerging model consists of a core facility comprising only the most acute services, intensive care, operating theatres and an accident and emergency unit, with all other services and units linked by information technology to each other and to the core facility. We explore some of the management challenges confronting those who will be responsible for taking their organization through the transition to the boundaryless hospital arrangement, discuss a number of the existing problems with today's hospitals which the new model has the propensity to resolve, and deal with some of the emerging issues which it brings with it. PMID- 10144234 TI - Cure those post-merger blues. PMID- 10144233 TI - The uninsured in the United States: a strategic critical management review. AB - The purpose of this article is to provide a critical review on studies of access and utilization of the uninsured, and some related proposals regarding the health care reform debate. Also, an attempt is made to determine if conclusions or trends can be identified to develop the groundwork for effective policy initiatives to assure access to the 37 million uninsured persons in the United States. PMID- 10144235 TI - Will doctor unions finally take hold? PMID- 10144236 TI - Employers to doctors: it's time for real savings. PMID- 10144237 TI - When downsizing hits the medical staff. PMID- 10144238 TI - Is capitation worth the risk? PMID- 10144239 TI - Growing pains--responding to change. PMID- 10144240 TI - Knowing what we mean by wanting autonomy. AB - Central to decisions regarding merging your medical group into another organization is the concern for loss of autonomy. Merging the vehicle from which the physician's livelihood is derived demands careful consideration and clear understanding of what will be gained and what will be lost. In the marriage of any two parties, whether individuals or businesses, some autonomy must be forfeited or the marriage won't work. Understanding what autonomy means to the individuals or businesses is essential before the forfeiture of any autonomy can be assessed. The author suggests autonomy can be defined in three levels, each building on the one before and each carrying different levels of importance to those considering a marriage or merger with another. Understanding these levels, and what importance one places on each, will make the decision process easier to address by both parties in the merger. PMID- 10144241 TI - Integrated delivery systems/networks in the uncertain future. Strategic stakeholder management, Round One continued. AB - This article presents an analysis of Round One data with a focus on integrated delivery systems/networks (IDS/Ns). These complex, multifaceted organizations are growing in importance in the turbulent health care industry. The emergence of these multi-organizational forms requires that all health care industry organizations--medical groups, hospitals, payer organizations, suppliers--adapt to the ever-increasing demands placed on them as the industry experiences revolutionary changes. The findings presented in this article were compiled from the responses of 580 health care industry experts about the uncertain future facing health care executives. These respondents represented virtually every health care organizational form, including medical groups, physicians, hospitals, payer organizations, academic researchers, pharmaceutical firms and other health care industry suppliers. Each of these health care respondent panels answered hundreds of questions pertaining to both the present (1994) and the future (1999). These analyses seek to describe the different relationships between medical groups, their stakeholders and IDS/Ns, and how they will change over the years of 1994 to 1999. We also present experts' perceptions and predictions about five other key stakeholders of medical groups--managed care organizations, governments, employers, system hospitals and patients. PMID- 10144242 TI - Health Card: a new reform plan. AB - Health Card is a new reform plan. Every household, regardless of employment of health status, would receive a government-issued health credit card to use at the doctor's office or hospital like MasterCard. Later, it would be billed a percentage of the provider's charge--a percentage scaled to its last income tax return; its annual burden would never exceed a designated percentage of its income. Health Card would simply and directly achieve universal coverage and equitable patient cost-sharing. Like MasterCard, government would pay bills, not regulate providers. Each household would choose its medical provider (fee-for service or HMO), bearing a percentage of the charge. Provider competition for cost-sharing consumers would help contain health care costs. PMID- 10144243 TI - Subcapitation: sharing risks and rewards with community physicians. AB - The continuing growth of managed care and payers' growing preference for working with integrated systems require medical groups of all sizes to examine their options. A Cincinnati multispecialty group developed a network--in partnership with community physicians--that may serve as a model for other evolving managed care markets. To provide geographic coverage and cost effectiveness, the group created a network of more than 350 primary care and specialty physicians to serve as the delivery system for three capitated payers. The system is based on subcapitation and aligned incentives. These enable the multispecialty group to deliver a wide array of specialty services cost effectively and allows subspecialty and primary care groups to benefit from this tie to a multispecialty provider. The groups approached to participate in the subcapitated network were selected carefully and chosen according to objective criteria. The system provides incentives for physicians to increase their efficiency and to work cooperatively to improve patient care processes. The subcapitated network physicians are represented on many of the system's quality improvement committees and have generally found the arrangement to be favorable. PMID- 10144244 TI - Planning for physician succession: no longer a luxury. AB - Many physicians are opting for early retirement rather than contend with the increasing loss of control within the changing health care environment. Unfortunately, these retirements are often abrupt--the physician is unaware until it's too late that quick transitions to new successors can yield disastrous financial results. Physicians sometimes overestimate the intrinsic value of their practices. Sometimes they are emotionally unprepared for the change, and bail out at the last minute. In either case, unplanned successions often result in a serious loss of practice value for the physician and a loss of market share for affiliated hospitals and groups. Physicians and administrators must work together to prepare a succession plan allowing adequate time to phase in the new successor. This helps maintain practice value, ensuring there are no unpleasant surprises when the physician retires. In this article, the author also provides a checklist containing succession plan guidelines. PMID- 10144245 TI - Budgeting for a more likely future. AB - "The future isn't what it used to be!" Medical group managers must take this humorous truth as gospel. Managed care and capitation are rapidly changing everything about medical group planning and budgeting. Profit centers will cease to exist and instead, all departments will become cost centers. Specialists and primary care physicians will find themselves in very different--and much less comfortable--roles. Administrators must strive to keep the whole team working together even in the face of unprecedented stress. Incentives may change, but quality of care and patient satisfaction will need to stay high and even improve to ensure survival. The budgeting process can be an important tool for helping to prepare for the evolution of medical groups, but first the implications of medical marketplace reform must be understood and accepted. This task will be emotionally and intellectually challenging. Accepting the shape of our future is painful but necessary. The choice is clear: rapidly evolve or disappear. PMID- 10144246 TI - From crisis to success. Turning around a family practice residency program. AB - On Match Day in 1991, Broadlawns Medical Center in Des Moines, Iowa, learned that no residents had matched for the family practice residency program. In the 1992 match, the medical center filled all its residency positions, and repeated the success in the 1993 and 1994 matches. Broadlawns affected this impressively rapid turnaround through a strong commitment to bring its program to a level competitive with leading family practice residency programs, substantive changes to the structure and curriculum of the program, and significant expenditures of time, resources and personal energy. The Broadlawns' case illustrates the need for family practice residency programs to position themselves as strong competitors in the residency market. PMID- 10144247 TI - Reducing legal fees in medical group practices. The role of health care alternative dispute resolution. AB - Conflict is a growth industry, particularly in an increasingly complex health care system. Litigation is the most common, and most costly, method of settling health care disputes. Highly adversarial, the process of litigation often generates as much, if not more, hostility than the original dispute. In addition, satisfaction with the outcome is very low. The challenge that has arisen is to manage the conflicts so that the underlying needs and interests of all the parties can best be met. Often the techniques and processes of alternative dispute resolution (ADR) can be successfully used in resolving these sorts of conflicts quickly, cheaply and with greater satisfaction for all parties. Various applications of ADR are currently being used or tested in a variety of health care disputes in the United States and Canada. Tremendous success has been achieved in mediating medical malpractice claims, medical staff disputes, economic credentialing conflicts, insurer relations issues and denial of coverage disputes. Professional relations and departmental staff disputes, partnership and employee conflicts, and organizational disputes within clinics, HMOs and large group practices have all been found particularly amenable to ADR. These are all situations in which everyone benefits from quick, non-hostile resolutions and on going relationships can continue. PMID- 10144248 TI - Patient satisfaction: examine your practice through their eyes. AB - In an environment of constant change, effective management decisions are harder to make. Physicians and clinic managers often miss valuable information from one key group--the patients. Their input builds a framework for sound solutions. The most efficient, unbiased collection method is a patient satisfaction study. With guidance from some one who is experienced in survey design and handling, physicians and managers will find these studies are easy to administer, are tools for learning and help build patient loyalty. Effectively designed studies give proportion to issues raised by patients. This information helps physicians and managers make good decisions on practice style, operations and service delivery. In the two case studies of primary care practices included in this article, the physician partners had very different issues of concern than the patients did. Without the studies, the physicians might have made poor decisions on the future of their clinics. Insurance providers recommend regular satisfaction studies to measure quality improvements, a clinic's strengths and weaknesses, and the patients' expectations. Patients are your lifetime partners and have valuable information for the survival of a practice. They help define where a practice is and where it should be. PMID- 10144249 TI - Federal labor panel declares MTs "professionals". PMID- 10144250 TI - Improving chemistry TAT with intradepartmental TQM. PMID- 10144251 TI - New technology, Part 1. Introducing new technology into the clinical laboratory. PMID- 10144252 TI - Molecular pathology, Part 3. Is a career in molecular pathology for you? PMID- 10144253 TI - Do's and don'ts for winning the job interview. PMID- 10144254 TI - Automating laboratory send-out tasks. PMID- 10144255 TI - Bills seek to boost vets' access to outpatient care. PMID- 10144256 TI - L.A. County-USC saved; smaller hospitals at risk. PMID- 10144257 TI - N.J. hospitals continue to battle cuts. PMID- 10144258 TI - STates team up to protect Medicaid. PMID- 10144259 TI - Medicare PPOs subject of Senate panel hearing. PMID- 10144260 TI - Florida systems seek accelerated savings. PMID- 10144261 TI - Competing Pa. systems receive merger approval. PMID- 10144262 TI - House panel crops VA spending. PMID- 10144263 TI - Children's hospital joins Methodist in Memphis. PMID- 10144264 TI - Costs outweigh savings of 24-hour system--study. PMID- 10144265 TI - Virginia not-for-profits charge less, offer more charity care--alliances. PMID- 10144266 TI - FTC nixes proposed Nevada network. PMID- 10144267 TI - Judge rules IES misused Picker materials. PMID- 10144268 TI - Fla. to investigate fee paid to official for sale of plan. PMID- 10144269 TI - FTC drops complaint against Lee Memorial. PMID- 10144270 TI - Heat wave scorches emergency services. PMID- 10144271 TI - House GOP unveils Medicare plans. PMID- 10144272 TI - Chicago Catholic network nears start. PMID- 10144273 TI - 2 Fla. hospitals link. PMID- 10144274 TI - Cerner stock split coincides with hike in revenues, income. PMID- 10144275 TI - HBO & Co.'s deal adds CliniCom. PMID- 10144276 TI - Defense firms find hostile market. PMID- 10144277 TI - Tenet makes outsourcing pact. PMID- 10144278 TI - St. Louis indigent hospital may cut 90 jobs. PMID- 10144279 TI - 10 N.C. hospitals push to form PHO. PMID- 10144281 TI - New Jersey Blues cuts payments for C-sections. PMID- 10144280 TI - Fla. plan fights loss of state contract. PMID- 10144282 TI - Officials track cause of Legionnaires' disease outbreak at Pa. hospital. PMID- 10144283 TI - K.C. plan weighs managed-care IPO. PMID- 10144284 TI - Cardiac hospital planned in Little Rock. PMID- 10144285 TI - Ex-hospital CEO uses radio to push for price competition. PMID- 10144286 TI - Ownership sectors fight for Va. hospital project. PMID- 10144287 TI - Schools of thought differ on fixed-payment Medicare. PMID- 10144288 TI - Pitfalls may come with HMO success. PMID- 10144289 TI - Columbia plans to build opposite Houston facility. PMID- 10144290 TI - CIOs use outsourcing to revamp systems. AB - Faced with the challenge of keeping pace with computer technology, many chief information officers are farming out projects to experts. Outsourcing firms are circling the healthcare industry, ready to pounce on market opportunities that exceeded $1 billion in 1994. PMID- 10144291 TI - Minnesota's reform pullback a harbinger for nation. PMID- 10144292 TI - Study shows big picture on adverse drug effects. PMID- 10144293 TI - Depending on the study, enrollees love or hate managed-care plans. PMID- 10144294 TI - GHAA forms own physician group. PMID- 10144295 TI - Bill auditors save hospitals millions. PMID- 10144296 TI - HMOs put satisfaction data to work. PMID- 10144297 TI - Wall Street welcomes health services IPOs. PMID- 10144298 TI - Managed-care firms using credit ratings as selling point. PMID- 10144299 TI - Acquisition of Santa Monica hospital to boost UCLA managed-care firepower. PMID- 10144300 TI - L.A. County bailout plan targets outpatient clinics. PMID- 10144302 TI - Merger creates University of Pa. unit. PMID- 10144301 TI - Columbia to bid for S.C. deal, agrees to novel Fla. venture. PMID- 10144303 TI - Coram, Lincare call off merger. PMID- 10144304 TI - Despite attempts at peace, AMA-ANA turf war rages on. PMID- 10144305 TI - GNYHA, insurers to develop CHIN. PMID- 10144306 TI - Miss. hospitals to help politicos get on the air. PMID- 10144307 TI - New NCQA survey seeks standardization. PMID- 10144308 TI - Mass. hospitals agree to merge. PMID- 10144309 TI - Cincinnati system wins Healthcare Forum award. PMID- 10144310 TI - Laidlaw-CareLine deal creates ambulance giant. PMID- 10144311 TI - Cleveland Clinic, Tenet team up in South Florida. PMID- 10144312 TI - Tenet faults managed care for earnings disappointment. PMID- 10144314 TI - Training programs next on Congress' consolidation list. PMID- 10144313 TI - Pa. bill links pay limit with tax exemption. PMID- 10144315 TI - This lemming won't join healthcare's rush to sea. PMID- 10144316 TI - Parties trade barbs as Medicare turns 30. PMID- 10144317 TI - Senator: AMA inflates red-tape burden. PMID- 10144318 TI - Solving the cost-quality equation. PMID- 10144319 TI - Execs in merger have purposeful party. PMID- 10144320 TI - Old financing concept gains new ground. PMID- 10144321 TI - Provider-sponsored plans seek direct Medicare contracts. PMID- 10144322 TI - Quorum-AmHS pact valued at $1 billion. PMID- 10144323 TI - 17 Iowa hospitals dump VHA for AmHS, cutting longtime ties. PMID- 10144324 TI - Medicaid HMO pioneer finds services in demand. PMID- 10144325 TI - State wants more info from Calif. Blue Cross. PMID- 10144326 TI - HCFA tells HealthOne hospital to shape up. PMID- 10144327 TI - L.A.'s King-Drew under investigation. PMID- 10144328 TI - The next generation: beyond health care. The Barbara C. White Lecture Award. PMID- 10144329 TI - Bias in assessment of nonverbal pain in compensation patients: does it exist? AB - This study examined whether providing information to rehabilitation professionals, on the compensation status of patients, would influence their rating of nonverbal expressions of pain. In an experimental design two groups of physiotherapists and occupational therapists were asked to view videotapes of 10 patients with shoulder pain undergoing a total of 88 pain induction tests. They were asked to rate the amount of pain the patients were experiencing based solely on the facial expression of pain. Bias was instilled in one group (n = 18) by informing them that the patients originated from a workers' compensation facility. Sixteen therapists served as a control group. Results indicate that the therapists rated the nonverbal expression of pain similarly regardless of their perceived compensation status. These findings suggest that the mistrust that is commonly experienced by patients on workers' compensation does not come from rehabilitation professionals but from other sources within the system. Alternative explanations for the findings and directions for future research are explored. PMID- 10144330 TI - The assessment of clinical competency: an overview and preliminary report of Canadian physiotherapy programs. AB - This pilot project was designed to collect information on the student assessment formats used by Canadian Physiotherapy programs. A mail questionnaire was used to gather the information. Practical exams generally consist of one to two cases with one examiner present. Little examiner training takes place. The Objective Structured Clinical Examination is being used at five universities. Stations are generally five to ten minutes long, with five to fifteen stations per exam. Patient and examiner training is sporadic. Multiple Choice Question Exams are used regularly with 40-150 questions being included. The respondents were generally satisfied with their clinical placement assessments. None of the respondents showed an understanding of standard setting. Various responses and methods of using the assessment procedures are not in accordance with research findings on the use of these methods. This may indicate a need for faculty development in the area of measurement and evaluation. PMID- 10144331 TI - 400 foodservice giants. PMID- 10144332 TI - R & I 400: health care. Health care still in pain. PMID- 10144333 TI - R & I 400: overview. 400 companies lighten up. PMID- 10144334 TI - R & I 400: segments. The 400 by segment. PMID- 10144335 TI - Saving for hospital care costs in Singapore: are there lessons for Australia? [corrected]. AB - Australian political leaders and policy analysts have increasingly sought to learn from Singapore, a nation which, despite its small size and lack of natural resources, has enjoyed rapid economic growth. Of particular interest to Australian policymakers has been Singapore's compulsory superannuation system, which has provided high levels of domestic savings and high levels of home ownership; it has also incorporated a scheme to enable Singaporeans to save for the costs of health care. In this article, Singapore's Medisave policy is described within its broader socioeconomic context. Saving for health care costs has been a largely neglected option in recent policy debate about reforming funding arrangements for hospital care in Australia. The potential for a formalised scheme for medical savings in Australia, subsidised by taxation concessions, is explored in terms of its socioeconomic policy implications, its congruence with Australian values, and the logistical ramifications of such a scheme. PMID- 10144336 TI - New South Wales group pathology services--the Southpath model. AB - There has been significant rationalisation of public pathology service provision in New South Wales through the formation of group pathology services. These services are a fundamental change in the method of service organisation and delivery and little has been reported detailing their organisational and financial structures. Southpath, the group pathology service of the Southern Sydney Area Health Service, has improved service delivery, improved productivity by 18.2 per cent and reduced pathology expenditure per admission by 19.2 per cent. This paper describes the organisation of Southpath as knowledge of the organisational structures and performance of the group pathology service is necessary for the evaluation of this change in the method of service delivery and is essential to the current debate on the value of public pathology services. PMID- 10144337 TI - Obstetric early discharge versus traditional hospital stay. AB - Recent research and media reports have suggested that obstetric early discharge is not cost-effective for postnatal care in the Australian health care system, based on the work of the Centre for Health Economic Research and Evaluation. This is probably an erroneous conclusion because the centre excludes the important cost category of medical costs, and its conclusions depend on survey estimates of 'community costs' which are empirically of poor quality and theoretically of doubtful relevance to health care system decision-making. This study finds that obstetric early discharge is more cost-effective than a traditional hospital stay even when community costs are included; and highly cost-effective when considering health system costs alone. Further cost advantages are simulated by increasing obstetric early discharge program activity and reducing length of stay for both programs. Our results suggest that safe, cost-effective options for low risk obstetric care deserve further investigation in Australia. PMID- 10144339 TI - Predictors of length of stay in a geriatric assessment and rehabilitation unit. AB - This study aimed to determine predictors of length of stay within a geriatric assessment and rehabilitation unit at Bundoora Extended Care Centre. We conducted a retrospective examination of demographic and medical characteristics of the patients, and the characteristics of admission care programs (assessment, rehabilitation, booked and emergency respite care, and interim care), and determinants and predictors of length of stay. The mean length of stay was 28 days, varying from 12 to 50 days between care programs. Diagnostic category, stream of care and activities of daily living score were the major predictors of length of stay, together accounting for 20 per cent of the variance (R2 = 0.20). PMID- 10144338 TI - The continuum of care for older people. AB - The introduction of casemix in hospitals has increased concerns about cost shifting to community services. There has been little evidence with which to test claims about shifting balances in the continuum of care, in particular for major user groups like older people. These matters have come into greater prominence with the Council of Australian Governments Communique which agreed in April to radical reforms of health and community services. We used an existing longitudinal study of people aged 60 years and over in the community of Dubbo, New South Wales, to study hospital and aged care service use over 50 months. Fifty-five per cent of those studied were hospitalised but only 1.7 per cent were admitted to nursing homes over the period. In the 12 weeks after hospital discharge, 24 per cent received Home and Community Care services, while 78 per cent visited a general practitioner. All post-acute community services over 12 weeks after discharge cost an average of $150. In the light of this new evidence, current proposals for structural reform are critically discussed. PMID- 10144340 TI - Patient reports of health education activities in a public hospital. AB - Hospitals have been greatly underutilised as settings for health promotion activities in Australia. Most research on this subject has been derived from hospital administrators or clinicians. An exit survey of inpatients (n = 460) of a large regional public hospital in Queensland was conducted to examine reported levels of health education in relation to cancer prevention and control. Patients indicated considerable receptivity to a range of secondary prevention activities in the hospital setting, indicating the potential for an increased contribution to the national health agenda by many hospitals. PMID- 10144341 TI - Selecting qualified candidates through effective interviewing. AB - Some managers may not feel confident conducting job interviews. A major reason is that most have not been trained to interview, and managers in departments with few employees and/or low turnover rates usually do not interview frequently enough to develop the skill on their own. Hiring the wrong employee results in wasted time, effort, and money, and possibly a law suit. A list of what you can and cannot legally ask during the selection process is presented in Table 1. The best way to avoid problem employees is not to hire them in the first place. PMID- 10144342 TI - Courageous leaders. The integral force behind organizational excellence. AB - For more than a decade, Total Quality Management (TQM) has been used as a powerful instrument in shaping the competitive strategies of businesses, and producing quality products and services has become the credo of firms trying to defend or expand their markets. During this time, we have come to realize that without effective leadership no quality program can succeed. That is why the quality guru, W. Edwards Deming, refused to work in any organization unless he could begin with the CEO. That is why the first criterion examined for the Malcolm Baldridge National Quality Award is leadership. Focusing on quality will not guarantee success in today's rapidly changing markets. Increasingly discriminating consumers have come to expect quality in the products and services they buy, and businesses that fail to deliver it will not survive. In a very real sense, quality performance is the price you must pay simply to play the game. But consumers want more, and satisfying their expectations will determine tomorrow's winners and losers. Building organizations capable of producing superior results that consistently meet the needs of customers is the responsibility of leaders. For this reason, leaders are more important today than they have ever been before. Leaders in successful businesses must show the way for their employees by nurturing "cultures" that encourage and reward superior performance and by exhibiting personal characteristics that inspire excellence. Great leaders possess three crucial characteristics--vision, strong values and beliefs, and the courage to do the job despite seemingly insurmountable obstacles. These characteristics make the difference between excellence and "business as usual." PMID- 10144343 TI - Paradigm shift: phlebotomy belongs to nursing. AB - Defining, analyzing, and changing macro- and micro-processes has become almost a routine part of the TQM efforts of many laboratories as they strive to improve service and reduce costs. Scrutinizing each part of a process can reveal unnecessary steps that, if eliminated, would generate improvements with desired outcomes. This laboratory reviewed the processes associated with phlebotomy, especially for STAT tests, at the same time its administration was planning to establish 11 patient care centers where there previously had been three traditionally operated hospitals. Through process analysis, this laboratory transferred the entire function of in-patient phlebotomy from the laboratory to nursing. The results of an 8-month follow-up study show a significant favorable effect on laboratory turnaround time and related costs but not without some problems. PMID- 10144344 TI - Resumes and cover letters: a guide. AB - Many beginning managers have poorly constructed resumes. The content of resumes is fairly standard. The style should be clear and concise. Common pitfalls include irrelevant material, distracting detail, and repetition. The cover letter is a more flexible document that introduces the resume. Like the resume, the cover letter should cover some essential details clearly and concisely. Additionally, the cover letter should detail important qualifications and can elaborate on specific aspects of your resume. The cover letter should be tailored to fit the opening. PMID- 10144345 TI - Measurement of platelet force: the Hemodyne hemostasis analyzer. PMID- 10144346 TI - Clinical pathways: Part I. Panel discussion. PMID- 10144347 TI - System strategies. Building the perfect IS plan. PMID- 10144348 TI - CPR drives company changes ... Nursing Care and Communications Management System, Citation. PMID- 10144349 TI - Healthcare heats up with COLD (computer output to laser disk) systems. PMID- 10144350 TI - Making the most of limited time. PMID- 10144351 TI - Paying the price and liking it: justifying IT expenditures. PMID- 10144352 TI - Case study. Supporting executive decision-making with EIS (executive information systems). PMID- 10144353 TI - Excellence of care in rural America: the LIS contribution. PMID- 10144354 TI - Streamlining lab services: point-of-care technology. PMID- 10144356 TI - America's 10 most computer advanced laboratories. PMID- 10144355 TI - Serving clients in the lab. PMID- 10144357 TI - Health care purchasing goes national. AB - Health providers have long assumed that they serve buyers only in their local markets, but the demands of multi-state employers are making nationwide health care purchasing more than just a distant possibility. PMID- 10144358 TI - Demythologizing Hanlester. AB - The conventional wisdom about the Hanlester kickback case may be wrong. Not only is the long-term impact of the decision unclear, but the government is out to challenge it. PMID- 10144359 TI - Any willing provider meets the formulary. AB - Like doctors who would legislate less restrictive provider panels at HMOs, some drug makers are trying to muscle their products onto managed care formularies. PMID- 10144360 TI - "No margin, no mission". PMID- 10144361 TI - "They believe that we can be had". PMID- 10144362 TI - Fine-tuning psychiatric health care. AB - As they emerge from turbulent times, behavioral health providers are finding their place in the managed care world. The key, argues the new executive director of the National Association of Psychiatric Health Systems, is managing the whole spectrum of services and matching patients to just the right level of care. PMID- 10144363 TI - Medicare reform: the inner game. AB - On the surface, providers and the GOP Congress are in synch on Medicare reform. But serious controversy lies just beneath, especially over who could be on the receiving end of a proposed voucher system. PMID- 10144364 TI - The outcome for AHCPR. Interview by Laura Lynn Brown. AB - In late July, a House Appropriations Subcommittee voted to cut the Agency for Health Care Policy and Research (AHCPR) budget by 21 percent in fiscal year 1996. The six-year-old, $162 million agency has produced clinical practice guidelines for 10 of the 15 costliest conditions for which people are hospitalized. Their application has saved the health system far more than AHCPR costs, many experts believe. The agency's supporters say its work is a critical underpinning of the movement in value-based purchasing and quality assurance, while many Congressional Republicans believe the private sector could do AHCPR's work just as well. Health Systems REVIEW recently spoke with AHCPR administrator Clifton R. Gaus about the agency's mission and its strategy for survival. PMID- 10144365 TI - Rehabilitation's quiet surge. AB - Post-acute rehabilitation care is growing by the day. A few large companies, born in the 1980s, are bringing a once obscure niche of care into its financial and clinical maturity. Here is what's happening and an analysis of why. PMID- 10144366 TI - Hospitals maintain control with subacute rehabilitation units. PMID- 10144368 TI - Developing systems to control the cost and outcomes of new projects. PMID- 10144367 TI - Choosing a partner: should hospitals align or compete? PMID- 10144369 TI - Information resource management strategic business planning. AB - The business process and information management, rather than technology and systems, must be considered in today's health care environment. The article discusses the contents of an information resource management (IRM) strategic business plan and a five-step process used to construct the plan. Examples of strategic goals and objectives from an actual case study are provided. The resulting IRM strategic plan is designed to be used as a management tool that provides the flexibility and cohesiveness required to manage information in the current dynamic and resource-constrained environment. PMID- 10144370 TI - An Internet health care information resources server as a component of a statewide medical information network. AB - A health care information server utilizing Internet resource discovery technology is presented as a component of a statewide medical information network. The development of an information server, including the development process and its design and operation, is presented. Menu design and implementation, which involved providing access to information resources in support of the tasks that make up the health care delivery process, are described. The potential impact of this technology on the health care delivery process is explored, and ways in which access to information can be facilitated and matched with the information needs of the various health care delivery tasks are identified. Issues associated with the use of public domain information resources are discussed, including control over Internet resources, access to information resources, network operational delays, client connection and software availability, information quality, and menu navigation. This project has demonstrated that Internet information resources exist that match the information needs of the tasks that make up the health care delivery process. Positive response has been received from physicians after initial utilization of the server in a stand-alone context. In the future, more applications will integrate the vast information resources on the Internet with traditional computing systems. PMID- 10144371 TI - Information technology in the foxhole. AB - The importance of digital data capture at the point of health care service within the military environment is highlighted. Current paper-based data capture does not allow for efficient data reuse throughout the medical support information domain. A simple, high-level process and data flow model is used to demonstrate the importance of data capture at point of service. The Department of Defense is developing a personal digital assistant, called MEDTAG, that accomplishes point of service data capture in the field using a prototype smart card as a data store in austere environments. PMID- 10144372 TI - The use of work teams: a help or hindrance to performance? AB - The use of work teams is a popular topic in business literature. Although there is a growing literature on this topic, the team concept is not new to organizations. The article examines historical developments in the use of teams for performance of work. The use of work teams is discussed in the context of the movement away from hierarchical, bureaucratic management structures and toward participative decision making. The benefits of and problems with self-directed teams, in particular, are explored. PMID- 10144373 TI - Operations improvement and reengineering at Ohio State University Medical Center. AB - Rising costs and increasing competition have forced hospitals to respond to the needs of their customers. At Ohio State University Medical Center, operations improvement and reengineering are being used to redesign processes and to position the medical center competitively in today's changing environment. An operations improvement team identified business processes with the greatest opportunity for positive impact based on the goals of the medical center. Next, these areas were prioritized and teams appointed to begin the reengineering process. Reengineering methods focused on specific outcomes, including improved patient satisfaction, reduced cost, and improved clinical and service quality. Throughout the process, the goals and successes of reengineering were communicated to the organization and community. PMID- 10144374 TI - Research review: a comparison of two theories of resistance to innovation in baccalaureate level health information management programs. AB - Health information management (HIM) practitioners and educators must keep abreast of changing technologies in the health care environment as well as in education. The study reported compared two explanations of resistance to innovation to determine which one best explains the variance in receptivity and proposed innovations among faculty members in HIM programs. The psychological explanation holds that organization members' receptivity to change is a function of their personalities. The sociological explanation holds that members respond to specific innovations and that they do so in terms of whether the innovation would increase or reduce their present status. The 138 faculty members of all HIM baccalaureate degree programs in the United States were queried to measure their receptivity to computer-assisted instruction and televised courses. The data were collected using four semantic differential scales. The findings revealed that status variables accounted for the greatest variance in receptivity for each innovation. Significant relationships between selected status variables and receptivity to each innovation were found. The data indicated that the respondents were moderately receptive to the innovations of computer-assisted instruction and televised courses. The study also concluded that faculty were inclined to have a positive attitude toward change. PMID- 10144375 TI - Education review: realizing opportunity--health information management curricular approaches and activities. AB - Health information management program faculties have a responsibility to reengineer their curricula to prepare graduates with a competitive advantage in the long-term perspective. In the process, they can realize some rewarding academic opportunities themselves. PMID- 10144376 TI - Local healthcare planning in rural southwestern Ontario. AB - In rural areas, local health and social services are often planned and developed by members of the community, the hospital and community agencies acting together. This system is a web of informal ties that, relying heavily on volunteer commitment, provides programs that aptly fit the local situation. In this article, the authors show how this functions in the Ontario community surrounding Palmerston and District Hospital, and offer a suggestion for the improved support of this system. PMID- 10144377 TI - Enhancing professional relationships. PMID- 10144378 TI - Communication system facilitates integrated patient-centred care. AB - At the Wellesley Hospital in Toronto, a unit designed to house patients awaiting placement developed a communication system to facilitate integrated patient centred care. The system included a patient and family orientation brochure, an interdisciplinary kardex and an interdisciplinary patient goal sheet. Patient care improved under the new system, as staff was easily able to access current assessment data and establish and document integrated patient goals. Other outcomes included improved communication among team members, enhanced team member accountability, cohesiveness and satisfaction, and increased patient and family satisfaction. PMID- 10144379 TI - Participative management and shared leadership: implementing a model. AB - The author identifies the development, implementation and outcomes of a task subgroup model of management that provides a mechanism for shared leadership, planning, decision making, implementation and evaluation by staff, patients and families on a program level. The conceptual model and its operationalization are outlined within the context of the rehabilitation program at the Providence Centre in Scarborough, Ontario. PMID- 10144380 TI - Someone to watch over you. Interview by Matthew D. Pavelich. PMID- 10144381 TI - Patient representative brings human touch to quality management. PMID- 10144382 TI - Aggression: one hospital responds. AB - Aggression in the healthcare system is a reality that can no longer be forgotten or ignored. The problem extends beyond what to do when someone is aggressive. What is needed is a comprehensive program that addresses prevention, intervention and evaluation. In this article, the authors describe the process that Lions Gate Hospital experienced while addressing the complex issue of aggressive behaviour. PMID- 10144383 TI - Ontario's new law of consent to treatment: potential for liability. AB - Do the immunity provisions in the Consent to Treatment Act that came into force in April in Ontario protect healthcare providers and facilities from litigation? This article, a presentation made at the Canadian Institute of Law and Medicine's 1995 spring conference, discusses the potential for liability notwithstanding the new act's immunity provisions. This article is for general information only and is not intended as legal advice. Readers with legal problems are advised to contact counsel. PMID- 10144384 TI - Ethical dilemmas: right vs. right. A guide for public administrators who must make tough ethical decisions on the job. PMID- 10144386 TI - Need a new drug? PMID- 10144385 TI - Should the poor share in their medical costs? PMID- 10144387 TI - A real job for managers in the health service. AB - Suggests that current conditions in and around the NHS are creating stressed and difficult work for NHS managers--this obscures the fact that, in common with all managers in the West, they have been given the wrong work to do. Proposes that Western management is built on command and control assumptions which are entirely dysfunctional for today's work. Outlines a challenge to the principle of command and control and describes, with the help of W. Edwards Deming's views, what an alternative picture of work could achieve. PMID- 10144388 TI - Complaints management--in-depth review. AB - Introduces the Complaints Manager program from Health-TEC to address the problems involved in complaints management and control in the health service. Shows the main screens available for data input. Demonstrates the wide range of reports which can be generated. Suggests that the Complaints Manager program provides an efficient and low-cost means of keeping complaints under control. PMID- 10144389 TI - Planning and management tools to help with provision of effective health care. AB - Introduces the Planman system of techniques and diagrams. Describes each tool and how it should be used. Suggests that this system could meet many of the planning and management needs of the health-care profession. PMID- 10144390 TI - Improving the peri-operative experience: a multidisciplinary team approach. AB - Describes the clinical audit forum of anaesthetists in North Tees NHS Trust with particular reference to patients' peri-operative experience. Shows that a designated waiting room in theatre has improved the effectiveness and efficiency of the service provided. PMID- 10144391 TI - Economic evaluation of quality assurance programmes. AB - Substantial investments are now being made in quality assurance programmes throughout the developed world. Proposes that economic evaluation is one approach to justifying these in terms of value for money. Three key elements are: comparison with some alternative course of action; measurement of costs; and measurement of consequences. Illustrates the difficulties of addressing these by a case-study--an audit programme aiming to increase the use of intravenous thrombolysis for acute myocardial infarction. Discusses the production of accurate costings; the wide confidence limits associated with regression analysis; and the numerous assumptions required in the modelling of effectiveness. Economic evaluation of quality assurance programmes may be useful in future, if the required data can be collected. PMID- 10144392 TI - Long-term care and the private insurance market. AB - Increased life expectancy and the aging of the baby boom generation will bring rapid growth in the number of people at risk of needing long-term care (LTC). This Issue Brief provides an overview of the current LTC financing and delivery system in the United States, focusing on private-sector initiatives to meet the United States' LTC needs. It discusses private-sector plan design--particularly employment-based plan design--providing an in-depth look at the dramatic changes taking place in the private-sector LTC market since its inception in the early and mid 1980s. Aside from informal care provided in the community, the current system of financing LTC depends largely on the Medicaid program and individual financing. Issues confronting this system include spiraling costs associated with LTC services that may threaten beneficiaries' access to care. Other issues include the potential depletion of personal assets and a bias toward institutionalization (which may not always provide the most cost-effective or desired type of care available). Many leaders regard private long-term care insurance (LTCI) as a way to increase access to financing and as a potential alternative to Medicaid and out-of-pocket financing. By the end of 1993, a total of 3.4 million private-sector LTCI policies had been sold, up from approximately 815,000 in 1987. While the majority of these plans were sold to individuals or through group associations, employment-based plans accounted for a significant proportion of this growth. Premiums for LTCI vary substantially based on age and plan design. Insurers generally attempt to set premiums such that they will remain level over the insured's lifetime. However, because little LTC claims insurance experience yet exists, the actuarial basis for developing premiums and statutory reserves is limited. Several bills over the last three Congresses have been introduced to address the issue of LTC. However, due to cost implications and lack of consensus regarding the optimum overall structure required to finance and deliver care, broad legislation to expand coverage--particularly public coverage--is not likely in the near term. PMID- 10144394 TI - Agency for Health Care Policy and Research; general reorganization; statement of organization, functions, and delegations of authority--HHS. PMID- 10144393 TI - Medicare program; optional payment system for low Medicare volume skilled nursing facilities--HCFA. Final rule. AB - This final rule allows skilled nursing facilities (SNFs) that provide fewer than 1,500 days of care to Medicare beneficiaries in a cost reporting period to have the option of receiving prospectively determined payment rates in the following cost reporting period. The prospectively determined payment rates are based on components of SNF costs such as routine operating costs, capital-related costs, and a return on equity for proprietary facilities for routine services furnished before October 1, 1993. This rule also specifies that the return on equity provision for proprietary SNFs is eliminated for services furnished on or after October 1, 1993. PMID- 10144395 TI - Publication of OIG Special Fraud Alerts: home health fraud, and fraud and abuse in the provision of medical supplies to nursing facilities--HHS. Notice. AB - This Federal Register notice sets forth two recently issued OIG Special Fraud Alerts concerning fraud and abuse practices in the home health industry and in the provision of medical supplies to nursing facilities. For the most part, the OIG Special Fraud Alerts address national trends in health care fraud, including potential violations of the Medicare anti-kickback statute. These two Special Fraud Alerts, issued directly to the health care provider community and now being reprinted in this issue of the Federal Register, specifically address fraud and abuse in the provision of (1) home health services and (2) medical supplies to nursing facilities, including the submission of false claims and anti-kickback violations. PMID- 10144396 TI - Medicrunch. AB - The managed care revolution and crackdowns on government health care spending have put many of the nation's hospitals in a fiscal bind. Things could get worse if Congress makes big cuts in medicare and medicaid. PMID- 10144397 TI - Business isn't buying Medicare plan. PMID- 10144398 TI - Countdown to a political explosion. PMID- 10144400 TI - Medicare is House GOP's supreme test. PMID- 10144399 TI - Turning up the heat. AB - As Congress gets closer to a showdown over medicare, groups for and against overhauling the program are getting ready to take their cases to the public and to target potentially vulnerable members of Congress. PMID- 10144401 TI - Unlocking the information vault. AB - With a multitude of departmental information systems, executives find it difficult to make well-informed decisions affecting cost or to change physician behavior. A well-conceived EIS is alleviating such difficulties at many organizations. PMID- 10144402 TI - Managing information: today's integrated healthcare enterprises. AB - Managed care forces healthcare providers to focus simultaneously on costs and outcomes. To support the new priorities, providers are creating new business models, moving rapidly to merge, and forming alliances. The industry is witnessing the rise of integrated healthcare delivery systems that encompass hospitals, physician groups, ambulatory clinics, HMO and PPO plans, and other provider facilities. PMID- 10144403 TI - The consumer revolution arrives. Using smart customer service to attract, educate & retain satisfied members & lower costs. AB - Across the country, managed care organizations pursue ways to enhance customer service and maintain member satisfaction, without breaking the bank by authorizing unnecessary services. One method gaining popularity is reducing customer demand for inappropriate services through education. Approaches include welcome-to-the-plan calls, member education, automated and in-person answer lines, and 24-hour telephone coverage. Several firms have recognized the need for such services, and offer them to HMOs on an outsourcing basis, with generally positive results. PMID- 10144404 TI - Using provider practice profiles as preventative care for medical costs. PMID- 10144406 TI - Will hospital rounds go the way of the house call? PMID- 10144405 TI - Medicare and managed care: the stats. PMID- 10144407 TI - If you want computer records, but don't want to type them. PMID- 10144408 TI - Disease state management: why not hypertension? PMID- 10144409 TI - How BayCare prospers by betting on primary care. PMID- 10144410 TI - Pharmacists and physicians: perils, potential and parallels. PMID- 10144411 TI - A formal compliance program could help protect your practice. PMID- 10144412 TI - How do plans choose physicians? PMID- 10144413 TI - Earthquake-induced MIs? PMID- 10144414 TI - 911 system tracks cellular calls. PMID- 10144415 TI - Dispatch disasters. PMID- 10144416 TI - When your patient can't hear. PMID- 10144417 TI - The big one. PMID- 10144418 TI - 3 ways to improve your infection control. PMID- 10144419 TI - Focus on a plan for competency, orientation, training, and education. PMID- 10144420 TI - Material safety data sheets--the key to hazard communication. PMID- 10144421 TI - New ways to create lifetime bonds with your customers. PMID- 10144422 TI - Home health agencies: targets of anti-fraud and abuse investigations. AB - Increased health care fraud and abuse investigations could result in home health agencies, and other targets, becoming politically acceptable casualties of war in the battle to balance the federal budget. To protect themselves, home health agencies would be well advised to conduct internal fraud and abuse audits on an annual basis and to develop corporate compliance plans (see Newsletter, Vol. 9, No. 7, July 1994, at 16, and next month's issue, which will discuss corporate compliance programs as well as the OIG's new voluntary disclosure program). In addition, purchasers of home health agencies should be especially vigilant of fraud and abuse problems during the due diligence phase of the acquisition and, if problems are discovered, should consider whether voluntary disclosure to the OIG and settlement of any resulting claims is an appropriate condition of closing. PMID- 10144423 TI - Legal issues raised by restructuring to achieve multi-skilling and patient focused care. PMID- 10144424 TI - Telemedicine--the diagnostic tool of the future. AB - The most immediate concern in the development of telemedicine programs, technology, and equipment is the continuation of federal funding. As Congress continues its efforts to balance this year's federal budget, funds for research generally and particularly for the pilot programs discussed above could be cut or eliminated. Federal funding is surprisingly important to the rapid maturation of telemedicine. Without these pilot projects, HCFA believes that it would be unable to assess the effect of Medicare reimbursement for telemedicine consultations. Without such assessment, HCFA may be unwilling to relax the current restrictions on reimbursement for telemedicine outside of pilot programs. HMOs and third-party payors would then be less likely to support telemedicine programs and reimburse providers who participate in them. Similarly, without the promise of federal or private reimbursement, the telecommunications industry will find it harder to justify continuing research and development in new technologies. Nonetheless, even a complete elimination of all federal research monies is likely only to slow the growth of telemedicine, not stop it. PMID- 10144425 TI - Special report on health care reform. ERISA preemption, Traveler's and health care reform. AB - Although S. 308 reportedly has some bipartisan support, its passage is by no means certain. ERISA has for years provided employers with the freedom to design their own benefit plans without state interference, as well as the ability to operate such plans in a uniform manner throughout the country. large employers are thus not likely to cede the advantages of ERISA preemption without a battle. When strong business interests are pitted against the states' equally strong interests in enacting health care reforms, the outcome cannot be predicted. PMID- 10144426 TI - Gang members on your security staff? Check it out. PMID- 10144427 TI - Difficult problems slow security upgrading at mental hospitals. PMID- 10144428 TI - Barbarians at the gates? Combating some new threats to hospital security professionals. AB - As more and more hospitals seek to change their services and operations to conform to the requirements of managed care, pressures to cut costs in all departments including security are increasing in many areas. Cost-cutting on a large scale is nothing new in health care; witness the DRG "revolution" of the 1980s. And hospitals calling in security consultants for advice or entertaining proposals from contract security firms has always been part of the way things are done. But the current situation has spawned some new players in the game. These include facilities planning and space programming consultants with "simplistic" square-footage formulas that have already cost some security directors their jobs, according to IAHSS. Also reportedly getting into the security act are hospital housekeeping contractors whose absence of security know-how or experience has not deterred some administrators from taking their "low ball" bids seriously. In this report, we'll alert you to the nature of the new threats to your hospital's and your own security. We'll spell out how security directors and experts are answering simplistic security formulas with meaningful measurements. And we'll present some ideas and approaches for cost-cutting from past special reports that will help enable you, if called on, to cut costs in a way that will continue to give your facility or organization the most security per dollar spent. PMID- 10144429 TI - Financial benchmarking in food service. PMID- 10144430 TI - Should RDs become health care managers? PMID- 10144431 TI - Defining a "meal": moving toward standardization and increased accountability. PMID- 10144432 TI - Using data analysis methods to monitor improvement. PMID- 10144433 TI - Senior living. Sandhill Cove, Stuart, Florida. PMID- 10144434 TI - Senior center. Vintage Center for Health and Longevity, Pittsburgh, Pennsylvania. PMID- 10144435 TI - Clearing the fog on the Tyne: programme budgeting in Newcastle and North Tyneside Health Authority. AB - When the internal market was introduced, the National Health Service Management Executive envisaged purchasing as a process by which contracts would be developed from information concerning current services, modified in the light of strategic purchasing objectives, epidemiological needs assessment and indicators of comparative performance and efficiency. Our concern in this paper is with the promotion of efficiency. We distinguish between three levels and, in particular, discuss how the programme budgeting and marginal analysis framework can be used in the promotion of efficiency at 'top-level' decision making. PB/MA can be used to give a focus to needs assessment and forge explicit links between individual contracts within a well defined health strategy. The objectives of the current research and development ongoing within Newcastle and North Tyneside Health Authority are outlined. The intention is to achieve programme budgeting which is more responsive to decision makers' needs and is consistent with the contracting cycle. However, a number of constraints are expected to impede development. They include transferability of national and international information; absence of local information on epidemiology, effectiveness and cost-effectiveness; limitations on the accuracy and precision of programme budgets; and whether purchasers make strategic decisions based on macro budgets. The contribution of each of these constraints is explored. PMID- 10144436 TI - A survivor's guide to programme budgeting. AB - In this paper a descriptive account is given of programme budgeting in the Hastings and Rother localities of East Sussex Health Authority. The primary purpose of the exercise was to track past resource consumption in a comprehensive and overlapping matrix of programmes, with a view to simplifying past annual expenditure into a single matrix, informing the health authority of the overall pattern of resource consumption, planning future expenditure, co-ordinating the strategic plans and purchasing intentions of all those involved in commissioning health care, and communicating the health authority's view of past and future spending. Many of the findings gave new insights and led either to changes in resource allocation or to plans for future study. They have proved to be a useful tool for communication and education, especially with providers of health care and public representative bodies. The process will now feed into long-term strategic planning and short-term purchasing intentions. Marginal analysis is now being undertaken in a number of clinical specialties and disease areas. The cumulative effect of a series of planned investment and disinvestment decisions can be tested against agreed priorities for programmes before final decisions are taken. Thus, programme budgeting can be a powerful tool in the commissioning process and should be within the capabilities of even the smallest health authorities. PMID- 10144437 TI - Messages from Mid Glamorgan: a multi-programme experiment with marginal analysis. AB - This paper discusses the issues and problems arising from the first attempt to apply marginal analysis across a full range of health care activities within a UK Health District. Following a brief description of the two stage process undertaken in Mid Glamorgan, the paper focuses on the importance of a conducive environment to a successful application of the approach and to three key issues of group composition, group dynamics and openness/explicitness. The paper also addresses two parts of the Mid Glamorgan process which might be of questionable importance; the need for programme budgets prior to the exercise and the relevance of stage II which attempted to interfere with the expressed priorities identified by the expert groups in stage I. The main message is that marginal analysis works in practice as well as being attractive in theory and that much can be achieved even when only crude data on marginal costs and benefits are available. It is more important that priority setting be addressed within an appropriate framework than with accurate data. Marginal analysis provides such a framework. PMID- 10144438 TI - PBMA (programme budgeting marginal analysis)--its role in the future purchasing arrangements for health care services. AB - The movement of the purchasing process in health care from a central to local level has to be accompanied by an accountability process which makes local purchasers accountable within an agreed national and area framework for their decisions and implementation of change. This paper focuses on PBMA and its applicability to health boards and general practitioner fundholders in future purchasing arrangements. It is argued that it is a useful tool which may provide a basis for more rational discussion about use of resources, both at a micro and macro level, than the current arrangements. PMID- 10144439 TI - Public health and economics in tandem: programme budgeting, marginal analysis and priority setting in practice. AB - In the wake of the reforms of the UK National Health Service there has been increased interest in 'getting it right' with respect to priority setting in health care. This article examines the way in which programme budgeting and marginal analysis (PBMA) were introduced into North Mersey. It provides a very practical introduction to the topic and indicates the actual processes that were gone through. It is suggested that, in terms of getting participants in the PBMA exercise to think through what programmes comprise, what they cost, what they are trying to achieve and to focus on relevant possible changes, there was considerable merit in the approach. However there are problems, particularly at the level of determining the costs of different programmes. PMID- 10144440 TI - Economics, public health and health care purchasing: reinventing the wheel? AB - In this paper, a framework for using economics in health care priority setting is outlined. This framework is known as programme budgeting and marginal analysis (PBMA). Programme budgeting involves an assessment of how health care resources are currently distributed amongst programmes and within programmes. Such data can be used along with other information on local needs to decide on the main areas of change in service delivery. As resources are fixed, areas of change requiring more resources will be funded from service reductions within the same programme or within another programme. Candidates for more resources should be compared with each other and with candidates for service reduction to determine whether and what changes should go ahead. This involves 'marginal analysis' of costs and benefits of the candidates. In the paper, the problems with implementing this approach are outlined and the contribution of the other papers in the volume described. PMID- 10144441 TI - Programme budgeting and marginal analysis: application within programmes to assist purchasing in Greater Glasgow Health Board. AB - Recent NHS policy statements advocate the use of 'knowledge-based' purchasing. This paper describes an attempt to use an economic method to inform the purchasing process. The approach of programme budgeting and marginal analysis (PBMA) offers information on current service provision and provides a framework in which changes in a service can be evaluated and agreed within the context of a fixed budget. This has been applied to gynaecology services in Greater Glasgow Health Board and, following positive reaction to the results of this exercise, is now being extended into other areas. The process of carrying out the exercise is described. Additionally, limitations of the approach and the advantages of using PBMA in achieving knowledge-based purchasing are discussed. PMID- 10144442 TI - Community pitches in to create a kinder, gentler emergency department. PMID- 10144443 TI - Air care. Indoor air quality: much ado about nothing? PMID- 10144444 TI - Managing mergers. Here's how to take charge of assessing ancillary real estate before--and after--a merger. AB - Hospital and network mergers, acquisitions and affiliations dramatically affect a health care facility at many levels. Corporate cultures are evaluated and merged. Programs and services are evaluated, combined and sometimes relocated. Trustees, doctors and administrators are evaluated and merged. So are facilities management, construction and real estate departments. PMID- 10144445 TI - Partnerships are key to renovating the health care system. PMID- 10144446 TI - The day the earth moved. AB - Diane Lowder wasn't sure how ready her hospital was for a catastrophe. But a unique disaster plan helped keep Northridge Hospital open after the '94 Los Angeles earthquake. Here's what Lowder saw at the epicenter. PMID- 10144447 TI - Clearing the air on EPA study of MWI dioxin emissions. PMID- 10144448 TI - Managing restroom supply costs: it's more than price. PMID- 10144449 TI - Compare plant operations and maintenance costs. PMID- 10144450 TI - Health care managers wage battle against burnout. PMID- 10144451 TI - Foley catheter prices on the way down. PMID- 10144452 TI - ASHMM survey: job security top materials manager concern. PMID- 10144453 TI - Cath lab non-salary expense reduction: cost control is vital. PMID- 10144454 TI - California hospital saves by standardizing orthopedic supplies. PMID- 10144455 TI - 1995 survey of salaries & responsibilities for hospital biomedical/clinical engineering & technology personnel. AB - The Journal of Clinical Engineering conducted its tenth annual survey of the salaries paid to biomedical/clinical engineering and technology personnel in U.S. hospitals. This paper reports the salary and work responsibility data obtained from 1,091 professionals in relationship to: Certification; Region of the U.S.; Teaching versus Nonteaching Facilities; Years of Experience; Education; Union Membership; and Gender. Data are included on Wage Increases and Job Responsibilities. Data are as of 12/31/94 and are compared to 12/31/93. The average BMET I has 3.2 years of experience and earns $25,460 +/- $6,600 (std. dev.). The average BMET II has 7.4 years of experience and earns $31,745 +/- $8,500. The average BMET III has 13.3 years of experience and earns $39,383 +/- $7,600. The average BMET Specialist has 13.3 years of experience and earns $43,090 /+- $1,700. The average BMET Supervisor has 14.7 years of experience and earns $42,930 /+- $7,600. The average Clinical Engineer has 10 years of experience and earns $43,169 /+- $11,100. CE Supervisors have an average 13.1 years of experience and an average salary of $47,776 /+- $11,300. The overall group or department Director or Manager has 15.5 years of experience and earns $51,982 /+- $14,000 on average. PMID- 10144456 TI - Role of the Biomedical Engineering Department in William Beaumont Hospital's technology assessment process. AB - Biomedical/Clinical Engineering Departments with expertise in engineering and technology management have a vital role to play in determining the potential for implementation and cost effectiveness of new medical technologies through technology assessment. Technology assessment offers the essential bridge between basic research and development and the prudent practical applications of medical technology. Because of the recent explosion of healthcare technologies, it is almost impossible for any single individual to stay abreast of these new technologies, much less provide an adequate assessment. To meet this need for comprehensive technology assessment, a multidisciplinary team approach is desirable. This paper deals with the assessment of medical technologies in a hospital environment and explores the possible roles biomedical engineering departments can play in the technology assessment process. It shares the experiences of the Biomedical Engineering Department of William Beaumont Hospital, a major, tertiary-care teaching institution currently involved in the technology assessment process utilizing a multidisciplinary team approach. PMID- 10144457 TI - A systems engineering approach to technology assessment. AB - This paper presents a technology assessment process based on systems engineering methodologies used in the aerospace and defense industries. Systems engineering, defined in the U.S. military manual for engineering management, is a logical sequence of activities and decisions transforming an operational need into a description of system performance parameters and a preferred system configuration. Like systems engineering, technology assessment is driven by a single, clear need. The objective of systems engineering is to design a new system configuration; technology assessment assesses existing technologies to address this need. A six-step technology assessment model based on systems engineering principles is presented, including: (1) needs assessment; (2) clinical feasibility analysis; (3) systems assessment; (4) approval; (5) implementation; and (6) follow-up/CQI. PMID- 10144458 TI - Pragmatics of tracking mental health outcomes in a managed care setting. AB - Accountability, cost effectiveness, and continuous quality improvement are essential features of all managed health care systems. However, application of these principles to mental health treatments has lagged behind other health care services. In this article, administrative, practice, and technical issues are addressed through a joint effort between academically based researchers and administrators from two large managed health care organizations. Principles related to the measurement of outcome, instrument selection, and obstacles to the implementation of an ongoing program to assess mental health treatment outcomes are identified. Finally, principles for successfully changing mental health provider behavior toward outcome assessment and the implications of such for mental health delivery systems are discussed. PMID- 10144459 TI - Maintaining the confidentiality of computerized mental health outcome data. AB - The emergence of managed behavioral health care has increased the value of data describing outcomes of mental health treatment. At the same time, increased development of the national information infrastructure and other computer linkage systems has facilitated the flow of information among a wide network of data systems. These two developments create a dynamic tension between the need to share information and the need to protect the privacy of mental health clients and the confidentiality of their computerized records. This problem is exacerbated by the cost associated with potential solutions. Unfortunately, policy development in this area has lagged behind rapid developments in technology. The mental health administrator must balance the three components of this conflict (the increasing need for information transfer, the protection of confidentiality, and cost) without a great deal of guidance. This article offers recommendations that may help the mental health administrator manage this conflict. PMID- 10144460 TI - Measuring treatment outcome and client satisfaction among children and families. AB - As the delivery and reimbursement methods for mental health services change rapidly, measuring treatment outcome and client satisfaction has become critical. This article describes a case example of a treatment outcome and client satisfaction assessment program at the Children's Health Council, a private nonprofit agency affiliated with Stanford University that provides comprehensive mental health services to children and families in Palo Alto, California. Approximately 300 families receive mental health treatment per year at the agency. The simple and inexpensive program presented herein can be used and modified by other mental health professionals and agencies struggling to develop satisfactory treatment outcome and client satisfaction evaluation programs. PMID- 10144461 TI - The impact of preadmission approval and continued stay review on hospital stay and outcome among children and adolescents. AB - Managed care has emerged as the centerpiece of the health care industry's efforts to control costs and ensure appropriate use of hospital services. This study assesses the impact of managed care by preadmission approval and/or continued stay review on length of psychiatric hospitalization and clinical outcome of children and adolescents. The sample included 277 cases hospitalized in nine psychiatric specialty hospitals in 1990. Demographic and clinical characteristics, hospital ownership type, and preadmission approval or continued stay review were used as independent variables in a multiple regression model to predict length of stay and clinical outcome. Results indicate that the model accounted for 27% of the variance in length of stay. Previous psychiatric hospitalization and for-profit hospital status predicted longer hospitalization. Clinical outcome was not significantly predicted by the model. Managed care did not predict either length of stay or clinical outcome. Implications for health care reform are discussed. PMID- 10144462 TI - Application of total quality management to mental health: a benchmark case study. AB - The search for models or "benchmarks" that reflect the successful application of total quality management (TQM) to the mental health field is one that goes largely unrewarded. This article describes a case study of one comprehensive mental health center that has made a serious commitment to the philosophy and principles of TQM and that is reaping significant benefits from that effort. PMID- 10144463 TI - The failure of the diversion process: the impact of transferring of patients to state hospitals. AB - The diversion of people with severe mental illness into the private sector is examined. The purpose of the diversion system is to reduce the number of admissions to the state hospitals by diverting patients into the private hospitals, which may offer more diverse treatment to these patients. Insurance is highlighted as an important factor in diverting patients from state hospitals. When the diversion system fails and the patient is transferred from the private sector to the state hospitals, continuity of care is disrupted. The failure of the diversion is more costly not only to the patient but to the federal and state governments as well. Policy issues such as cost to the mental health system and continuity of care are discussed. PMID- 10144464 TI - Alaska Youth Initiative: the dream, the reality. AB - Many states have been interested in revising their systems of care for young people. The Alaska Youth Initiative (AYI) attempted to improve the system of care by providing community-based, individualized services to youths who would otherwise be institutionalized outside the state. Major policy changes included emphasis on local service provision, individualized services, unconditional care, and coordination of services. The AYI's performance on its original goals is mixed. Complications in implementation arose from lack of provider training, conflict over coordination at the state level, and difficulty in individualizing programs. Although significant successes have occurred, administrators could improve the implementation of similar types of programs by making specific plans to address concerns of various stakeholders, providing fiscal incentives for cooperation for state workers, and providing ongoing training in both clinical and administrative areas. PMID- 10144465 TI - State mental health agency spending, 1985-1990. AB - Major differences exist among states in the level of spending on mental health care, in the magnitude and direction of changes in those levels, and in the share of resources devoted to state hospital and community-based services. Using data collected by the National Association of State Mental Health Program Directors (NASMHPD) Research Institute, this article describes those differences and examines their relation to a set of state-level fiscal determinants of mental health spending. Levels of spending in 1990 and rates of change in those levels between 1985 and 1990 show virtually no correlation. Changes in spending between 1985 and 1990 are decomposed into several components. States with high growth tend to have high growth in tax capacity and high growth in mental health spending as a share of health and welfare spending. PMID- 10144466 TI - CHA leaders hit HCFA's capital payment policy. PMID- 10144467 TI - ProPAC: outpatient PPS needs rework. PMID- 10144468 TI - Columbia's Florida PPO loses major hospitals. PMID- 10144469 TI - Blues forms national network for managed-care Medicare. PMID- 10144470 TI - FTC scrutinizing proposed Columbia-HealthOne deal. PMID- 10144471 TI - AmHS, Premier to merge. PMID- 10144472 TI - Eight Florida hospitals create for-profit laboratory network. PMID- 10144473 TI - AHA's Warden urges caution on Medicaid. PMID- 10144474 TI - Caremark reports net loss. PMID- 10144475 TI - GAO, citing conflict, seeks to pull big contract from QualMed. PMID- 10144476 TI - Chicago merger completed. PMID- 10144477 TI - FTC approves Lilly's PCS purchase. PMID- 10144478 TI - MGMA joins Marshfield's appeal. PMID- 10144479 TI - Pa. duels with hospitals over capitation formula. PMID- 10144480 TI - Minn. group says fewer providers hurt cost, quality. PMID- 10144481 TI - Fla. hospital affiliates with two Ala. facilities. PMID- 10144482 TI - Medicare ambulatory-care pay up. PMID- 10144483 TI - Rural Iowa hospital buy sign of times. PMID- 10144484 TI - Brim, Paracelsus announce plans to merge operations. PMID- 10144485 TI - Managed-care 'windfall' in free-fall. PMID- 10144487 TI - Let doctors, not legislators, decide how long infants stay. PMID- 10144486 TI - Discharging moms, babies early is harmful to health. PMID- 10144488 TI - End of the line approaches for AHA convention. PMID- 10144490 TI - S&P: hospital debt picture brightens. PMID- 10144489 TI - L.A. hospitals try to save axed outpatient clinics. PMID- 10144491 TI - 'Dispro' changes could pinch rurals. PMID- 10144492 TI - Senate panel backs modest reform bill. PMID- 10144493 TI - Foe of Columbia in Neb. buys into for-profit hospital. PMID- 10144494 TI - S.C. university hospital weighs competing bids. PMID- 10144495 TI - Big health PACs bet heavily against reform. PMID- 10144496 TI - Foundations must answer community health needs. PMID- 10144497 TI - Hospital execs decide if the AHA makes the grade. AB - Some 242 hospital executives responded to Modern Healthcare's American Hospital Association ?report card,? which queried their views of the AHA after four years under the direction of President Richard Davidson. Included are the survey's findings as well as an interview with Davidson. PMID- 10144498 TI - AHA's advocacy efforts maturing. PMID- 10144499 TI - Mile-high spending in Denver. PMID- 10144500 TI - Cost-conscious providers take to holistic medicine. PMID- 10144501 TI - Emerging data show programs are effective. PMID- 10144502 TI - Hospital stands behind promise of fast service. PMID- 10144503 TI - Building networks to stay competitive. PMID- 10144504 TI - A shot in the arm for Medicare risk HMOs. PMID- 10144505 TI - No surprises in final rules implementing 'Stark I' law. PMID- 10144506 TI - Treat providers like insurers-NAIC (National Association of Insurance Commissioners) PMID- 10144507 TI - Don't lose sight of our common goals. PMID- 10144508 TI - Hospitals helping docs with retirement. PMID- 10144509 TI - Dems, GOP launch air attacks over Medicare. PMID- 10144510 TI - MedPartners, Mullikin to form largest doc management firm. PMID- 10144511 TI - Catholic systems weigh expanding link. PMID- 10144512 TI - Did hospitals kill N.C. data commission? PMID- 10144513 TI - Inpatient stay lengths drop sharply. PMID- 10144514 TI - Tenet gets federal OK to buy El Paso hospital. PMID- 10144515 TI - AHA brief supports merging Mo. hospitals. PMID- 10144516 TI - For-profits unlikely to receive higher capital payments. PMID- 10144518 TI - N.C. hospitals seek exemption. PMID- 10144517 TI - Big second-quarter loss hammers Coram stock. PMID- 10144519 TI - Congressman learns firsthand: Medicare reform a tough sell. PMID- 10144520 TI - Coastal blames loss on Florida clinics. PMID- 10144521 TI - Rival files antitrust suit against Hill-Rom. PMID- 10144522 TI - Whistleblower suit alleges patient records doctored. PMID- 10144523 TI - Senators fight proposed cuts in AHCPR funding. PMID- 10144524 TI - Fast-growing Texas HMO may seek for-profit status. PMID- 10144525 TI - Hawaii workers' comp plan edges into managed care. PMID- 10144526 TI - Pa. urban hospitals unite to battle state. PMID- 10144527 TI - Group revises capital-solvency test. PMID- 10144528 TI - Increasing competition forces HIP of New York to reduce staff. PMID- 10144529 TI - Physicians Health Services gets nod to consider recapitalization. PMID- 10144530 TI - Lawsuit sought to halt 'silent PPOs'. PMID- 10144531 TI - Disclosure of AHA salaries delayed. PMID- 10144533 TI - Home-care, rehab firms dampen growth figures. PMID- 10144532 TI - Nurse execs see growth in responsibilities, pay. PMID- 10144534 TI - Structure of vendor deal stalls Cleveland's CHIN. PMID- 10144535 TI - Top EDI company plugs into Medicare/Medicaid business. PMID- 10144536 TI - Medicus earnings remain disappointing. PMID- 10144537 TI - Doc diversity is goal of Mass. HMO. PMID- 10144538 TI - L.A. County cuts to shift mentally ill to private sector. PMID- 10144539 TI - N.Y. panel urges shutdown of HHC. PMID- 10144540 TI - Doc offers cure for healthcare's 'disease'. PMID- 10144541 TI - Jackson & Coker aims for comeback. PMID- 10144542 TI - Maker of healthcare financial risk software nets $4.5 million in IPO. PMID- 10144543 TI - Legal fears force some changes in recruiting tactics. PMID- 10144544 TI - Cigna of New York seeking docs to enable expansion. PMID- 10144545 TI - North Carolina hospitals' credit ratings show stability. PMID- 10144546 TI - Clinical guidelines: a defense in medical malpractice suits. AB - Clinical pathways, or practice guidelines, have been gaining wider acceptance from physicians and hospitals seeking to constrain increasing operating costs for inpatient care. The authors believe that properly developed and agreed upon guidelines can also be used in certain cases as appropriate standards of care in determining if medical malpractice has occurred. Adherence to the guidelines could then be asserted by defendants as an affirmative defense in a medical malpractice suit. PMID- 10144547 TI - Health promotion/disease prevention guideline development: process and results. AB - As part of its strategic plan, Physician Plus Insurance Corp. (PPIC), an 80,000 enrollee, provider-owned, network-model, prepaid insurance plan has targeted improvement in enrollee and community health. Health promotion/disease prevention (HP/DP) guidelines were developed as one tool to promote health screening and to close identified gaps between desired and actual rates of health screening. Additional efforts within the health plan have focused on identifying barriers to health screening and on identifying and implementing solutions to overcome these barriers. Opportunities in health screening are identified from in-house data: mammography, Pap smear, cholesterol screening, immunization rates, and the like. Note that these screening topics are among those that the Health Plan Employer Data and Information Set (HEDIS) has selected. This article will describe the processes to develop HP/DP guidelines, obtain provider participation, obtain buy in from providers, and educate enrollees and employers. It will also show the results that have been obtained in the form of HP/DP Guidelines and outcomes measures. PMID- 10144548 TI - The theory of S-curve discontinuity in the medical care field. AB - Confusion reigns supreme in the health are field today. In a previous paper, I described my thoughts about the reasons for this chaos. This article reviews the gradual escalation of health care costs and many of the unsuccessful methods to control them, reiterates the theory of S-Curve discontinuity in health care and develops a "tool" that will enable physician executives to determine whether or not a product or process in health care will succeed in the near and distant future. This new tool can be of value to all health care providers, investors, health planners, politicians involved in evolving health care legislation, and any others who have an investment in the future of health care. PMID- 10144549 TI - New governance for a new era: issues and challenges for integrating systems. AB - In this first part of a two-part column, Dr. Ruffin introduces seven key factors that will govern the operations of integrated systems. It is important to understand, he says, that, in the movement from a fee-for-service payment mechanism, in which the various elements of the health care field bill for their services independently and according to rules designed for their benefit, to an intregrated system, in which such independence can only lead to confusion in information systems, very substantial changes will be required in the governance of our health care institutions and organizations. In the second part of the column, Dr. Ruffin will elaborate on the seven factors that must be considered in the transition. PMID- 10144550 TI - Herding stats: the quality measurement dilemma. AB - All over the country, millions of research dollars are being spent to devise an effective way of measuring quality that could be standardized in health care, and hospitals and managed care companies are experimenting with a variety of quality tools, trying to document what they now can only perceive as improvement. Experts are divided on what works best, but all applaud and embrace the efforts. In this special report, several of them discuss their views on what works, and what doesn't work, in the exploding field of health care quality measurement. PMID- 10144551 TI - Nutrition, immunity, and HIV disease. AB - Nutritional counseling and support has emerged as a crucial factor in the prognosis for HIV-infected individuals. A thorough nutritional history and assessment for obstacles to adequate nutritional intake is essential, as well as close monitoring of nutritional status. PAs should be knowledgeable about the beneficial effects of high-dose nutritional supplementation on the immune system and interactions between nutrients and therapeutic and prophylactic drugs used in HIV infection. PMID- 10144553 TI - Servers' wages fall under U.S. median. PMID- 10144552 TI - Increasing PAs' awareness and understanding of self-help groups. An educational model. AB - A model for inclusion of information about self-help groups into a PA training program is provided based on the results of a study of 26 PA students enrolled in a patient-counseling class. Interactions with self-help groups yield more positive beliefs and greater intentions to collaborate with self-help groups than training programs that do not address self-help groups. The experiential component is also useful for increasing understanding of appropriate roles for professionals interacting with self-help groups. PMID- 10144554 TI - Trustee workbook 3. Strategic planning by the board. PMID- 10144555 TI - Healing communities. Churches make the connection between body and spirit. PMID- 10144556 TI - Taking care of their own. In western Pennsylvania, hospital leaders are taking a local approach to health care reform. PMID- 10144557 TI - Legislated vs. voluntary community benefit standards: what works best? PMID- 10144558 TI - Case studies. Seeing is believing at rural system. PMID- 10144559 TI - Things go better with COKE. PMID- 10144560 TI - What is the board's job? Info needed on managed care. PMID- 10144561 TI - Whose job is it anyhow? School-based clinics give kids a chance to learn. PMID- 10144562 TI - Enriching the final days. PMID- 10144563 TI - HLS (Hospital Laundry Service) opens off-site sterile pack plant. PMID- 10144564 TI - AlaHA (Alabama Hospital Association) chairman Bob Smith. PMID- 10144565 TI - Making due and managing care: the future of Medicare. PMID- 10144566 TI - ER innovations. PMID- 10144567 TI - Satisfy surgeons by improving instrument turnaround time. PMID- 10144568 TI - Big fish, little fish learn to swim (and buy) together in the same pond. PMID- 10144569 TI - Aerosol safety in the OR: help staff breathe easier. PMID- 10144570 TI - Bring frontline workers to the forefront of product design. PMID- 10144571 TI - Food for thought: are prime vendors the answer to dietary dilemmas? PMID- 10144572 TI - Your own special week is coming soon ... share it with others. PMID- 10144573 TI - Help injured workers get back on their feet quickly. PMID- 10144574 TI - Procurement cards help take charge of supply chain costs. PMID- 10144575 TI - In the picture: convenience, efficiency and high-quality images. PMID- 10144576 TI - Materials management minisurvey: surgical packs. PMID- 10144577 TI - Are the Twin Cities a Stage V marketplace? AB - The Twin Cities continues to be an outstanding laboratory for discovering what could be the future in many other markets. Over the last year or two it has been the site of massive consolidation among hospitals, physicians and health plans. Even as the entire infrastructure for healthcare financing and delivery has changed, the state has turned in a good performance in comparison with national cost averages. It is hard to beat premium levels that are 25%-35% lower than national benchmarks. And, these have been achieved by the marketplace, not by government. Nevertheless, employers aren't completely satisfied and the sources of discontent are very instructive. The natural course of market change throughout the country is consolidation from many fragmented competing groups down to a handful of large integrated systems. From an employer/consumer perspective, this natural evolution will reduce competition, concentrate power, eliminate choice, weaken the employer's negotiating leverage, discourage innovation, and reduce the responsiveness and sensitivity to customer service needs. Strategies have to be devised by those engaged in integrated health systems development to counter the perception that consolidation is only an attempt to grab market share. True integration should produce demonstrable improvements in the quality, coordination and delivery of care. But, the trick is understanding the employer and consumer perspective on "improvements". The financing and delivery of healthcare has literally been hidden inside a "black box" for as far back as anyone can remember.(ABSTRACT TRUNCATED AT 250 WORDS) PMID- 10144578 TI - Legislating medical care. PMID- 10144580 TI - Scheduling/T&A products. PMID- 10144579 TI - Shaking up the foundation ... Good Samaritan Health System. PMID- 10144581 TI - PACS pulls rabbit from healthcare reform's hat. PMID- 10144583 TI - HotList. New laboratory software. PMID- 10144582 TI - Flexibility, access give RDBMS (relational database management systems) the edge. PMID- 10144584 TI - Crossing the privacy minefield. PMID- 10144585 TI - Liability for improper maintenance of life support: balancing patient and physicians autonomy. PMID- 10144586 TI - Nursing home reform: objective regulation or subjective decisions? PMID- 10144587 TI - The emerging trend of corporate liability: courts' uneven treatment of hospital standards leaves hospitals uncertain and exposed. PMID- 10144588 TI - Peer review potpourri: new developments in credentialing and privileging. Panel discussion. PMID- 10144589 TI - Physician-patient sexual contact: the battle between the state and the medical profession. PMID- 10144590 TI - Medical expert systems and publisher liability: a cross-contextual analysis. PMID- 10144591 TI - Health standards and quality bureau: statement of organization, functions, and delegations of authority--HCFA. PMID- 10144592 TI - Case study. Challenges and opportunities for integrated health systems in rural communities. AB - You might not think of Holland, Michigan (pop. 35,000), as an HMO hotbed. But it has an HMO that was started by the local hospital and that now is part of the Butterworth Regional Health Network in Grand Rapids. Holland is one of five communities profiled in this first of a series on how managed care and integration are coming to rural America. PMID- 10144593 TI - Chicago project provides insights into improving managed care. AB - Managed care enrollees are generally more satisfied with their HMO, PPO, and POS plans than their employers expected they'd be. But both consumers and employers think health plans can improve on member services and efficient delivery of care. These results come from a Chicago Business Group on Health project involving 14 employers, 7 health plans, and 22,000 surveyed employees. The study's multi dimensional design and emphasis on improving health plan performance make it a model from which others may learn. PMID- 10144594 TI - Hospitals in integrated delivery systems. AB - With inpatient use plummeting and HMOs demanding deep discounts, hospitals are restructuring themselves to run more efficiently and promote health as part of integrated delivery systems. This installment of HSL's continuing series discusses major strategies hospital directors can establish to support their institutions. PMID- 10144595 TI - Medicaid managed care. AB - Managed care plans that successfully deliver services to low-income populations say the first challenge can be the toughest: gaining potential enrollees' trust. Without it, they won't seek timely care or follow treatment instructions. That done, several care management strategies, including prevention and provider incentives, hold the key to keeping costs down and enrollment up, agree leaders at seven established Medicaid plans interviewed by HSL. PMID- 10144596 TI - Transfer pricing--better decisions for greater savings. AB - The potential economic benefits of many restructuring initiatives are lost to the uninformed decisions which result from a mismatch between operational and financial systems. Transfer pricing helps eliminate this mismatch. Through it, a restructured center "pays" for all services provided by centralized departments for its patients. In this way, it can be an invaluable tool during and after your restructuring initiative. It helps you create a more cost-effective and beneficial vision of a fully restructured future. It makes setting economic targets for the right-sizing of centralized departments a relatively easy matter. And it will be an essential tool for leaders as they overcome the challenges of tomorrow's marketplace. In short, the higher the priority on economics, the more ongoing value transfer pricing adds to your restructuring initiative. PMID- 10144597 TI - Process strategy teams--the transition from planning to detailed design. AB - Process Strategy Teams expedite the transition from planing to implementation by providing timely, consistent hospital-wide recommendations to the Implementation Teams. These Process Strategy Teams create a common direction. They facilitate the implementation process by eliminating rework, educating more people, creating more internal resources, and building restructuring leadership throughout the organization. While these Process Strategy Teams won't eliminate the tough decision-making required to move forward, they certainly can ease the burden of the Implementation Teams trying to operationalize a strategic restructuring plan. PMID- 10144598 TI - Horizontal versus vertical--two restructuring approaches to the same vision. AB - In summary, horizontal and vertical restructuring represent two different paths to the same vision. Both require a rock-solid foundation for success. In deciding the best approach for your organization, consider the trade-offs between the cultural ("we versus them") and operational ("to leap or not to leap") challenges associated with each approach. Furthermore, consider the differences in savings streams from these two paths. Then customize a restructuring initiative that best fits your organizational goals and priorities. PMID- 10144599 TI - The value in "value added"--a tool for understanding your operations. AB - There are two roles a value added profile can play--as a communication tool and as a target for restructuring. As a communication tool, the profile very clearly shows the inefficiencies of the system and the resulting underutilization of employees. These messages establish for everyone the need for and urgency of change. If your organization is convinced of the need for change, the restructuring process is made easier. The other benefit of the profile is not as a benchmarking tool between institutions or even between bedside care areas of the same hospital. Rather, its real benefit is as a rule to measure progress towards a goal, and to identify when adjustments to the design need to be made. PMID- 10144600 TI - Naming practice: the case for the term client-driven. PMID- 10144601 TI - Professional expertise of occupational therapists in community practice: results of an Ontario survey. AB - This paper presents findings of a study, The Community Practice Project, that examined the situation of occupational therapists practising in community based settings in the province of Ontario, Canada in 1992. In addition to providing a profile of the typical community based therapist, the study considered issues relating to: the principal roles in places of employment; specific job skills and areas of professional expertise utilized in the community; and how well occupational therapists; formal training prepared them for their community oriented roles and tasks. Results indicate that great opportunities exist and job satisfaction is high in community settings. Nonetheless, therapists feel inadequately prepared for the new role of consultant and its concomitant skills in a field that has re-oriented itself toward the client and is increasingly focused on health promotion and disability prevention. PMID- 10144602 TI - Clinical education in Saskatchewan: a needs assessment. AB - Clinical education or fieldwork requires a collaborative relationship and coordinated effort between the university and the clinic. Although the literature notes the increased recognition and responsibility given to clinicians as a teaching resource, minimal attention has been given to describing the clinical educator's perspective or in preparing clinicians for the role of educator. The purpose of this study was to explore the support and educational needs of Saskatchewan occupational therapists as they related to providing clinical education. Focus group interviews were conducted with 70% participation of the practicing registered occupational therapists in Saskatchewan. Emerging themes related to the participants (needs and responsibilities of the student, the clinical educator, the facility and the university), the process (positive and negative elements of communication, placement coordination and student evaluation), and the environment (clinical education models, length and number of placements). Recommendations were made for enhancing the clinical education experience in Saskatchewan. PMID- 10144603 TI - Culture and its influence on occupational therapy evaluation. AB - In the increasingly multicultural society of north America, occupational therapists have a responsibility to develop awareness and knowledge concerning different cultural groups. By accepting and understanding clients' customs, values and beliefs, clinicians have a better chance of assessing and producing more effective outcomes. Since occupational therapy has incorporated western middle-class values into its theory and practice, many evaluation tools used are based on norms developed for a white middle-class population. Using these evaluations with minority groups brings the danger of improper interpretation of test results. Consequently, increasing emphasis is being placed on the importance of culture fairness and the development of culture-fair evaluation tools for usage across different cultural groups. This paper will present a discussion concerning the importance, advantages and disadvantages of both culture-fair and culture-specific tests and evaluation tools. PMID- 10144604 TI - Don't forget the life safety survey. PMID- 10144605 TI - How much of a role should family members play? PMID- 10144606 TI - Little wars. Unions fight management for control of employment issues in nursing homes. PMID- 10144607 TI - Safe and unsound. By focusing on threats to physical safety, providers may be overlooking the things that make the elderly feel truly secure. PMID- 10144608 TI - An ounce of prevention. Screening can improve both quantity and quality of life. PMID- 10144609 TI - Contemporary Long Term Care's 1995 software showcase. PMID- 10144610 TI - Retirement communities need a financial checkup. PMID- 10144611 TI - Surviving the survey. Teamwork is key to zero-deficiency game plan. PMID- 10144612 TI - Food on the move--tales from two cities. AB - As consolidation & downsizing become more & more common in all segments of noncommercial foodservice, so does centralized food production & with it, the satelliting of food. In these case studies, two foodservice directors share their experiences in planning, implementing & managing successful satellite foodservice programs. PMID- 10144613 TI - Antitrust implications of health care reform. AB - Antitrust issues affect the insurance industry, hospital industry, and physicians. The authors explore the history of antitrust issues in the health care field and implications for future developments. Interest in antitrust has increased due to current merger and acquisition activities in the industry. With the failure of the Health Security Act, health care reform will be left to private industry. Will there be increasing or decreasing antitrust activity by the Department of Justice and Federal Trade Commission? PMID- 10144614 TI - When you think a subordinate is after your job. AB - Many managers find themselves in a position where they think a subordinate is after their job. Guidelines are presented for the manager's response when it appears a subordinate is after the manager's job. Deciding on a plan of action, discussing the matter with the supervisor and subordinate, confronting the subordinate with lack of support, maintaining a positive self-image, avoiding actions that can be criticized, and setting limits on the employee's behavior can all be acceptable approaches for the manager to use. PMID- 10144615 TI - Organizational moles: information control and the acquisition of power and status. AB - All organizations have moles or informants who seek to acquire informal power and status within the organization by keeping supervisors and the chief executive officer informed about employees and their activities. If the leaders of an organization are insecure and distrustful, they value the information about the organization that moles provide. Moles survive organizational change because they are loyal first to themselves. Moles often are hardworking, productive people, but their net effect on the organization's moral is negative because they foster distrust and defensiveness among employees. Guidelines are offered to help identify possible moles so they can be avoided lest one become a victim to moles' methods. PMID- 10144616 TI - Health care supervisors and employee relations success: three C's a day keep the union away. AB - The health care industry is experiencing rapid change and uncertainty. Given the tremendous amount of instability in the industry, many observers are not surprised at the high level of militancy currently being displayed by many health care workers. However, it should not automatically follow that turbulent times will lead to uneasy management-labor relations. Maintaining nonunion status depends largely on the employee relations skills and capabilities of first-line supervisors. The article reviews and discusses three key attributes (communication, consideration, and commitment) that supervisors must display in order to promote employee satisfaction and remain union-free. Practical guidelines and suggestions are provided. PMID- 10144617 TI - Rational people and why they do irrational things: the theory of psychological reversals. AB - The theory of psychological reversals developed by Michael Apter, a British psychologist, is used to explain behavior and motivation in employees. The article explains that such behaviors are neither haphazard nor necessarily undesirable. Reversal theory provides a structured way of analyzing employee behaviors through the use of four pairs of exclusive, opposite states. An employee may reverse back and forth between these states. PMID- 10144618 TI - The demand for graduate education in health services administration: a case study. AB - This article documents research into the demand for graduate education in health services administration/management with a case study model. Research included background information on the profession, the history of graduate education in health services administration, health care administrator demographics and their perceptions of the demand for graduate-prepared professionals and their own educational needs, most appropriate degree to offer, and curriculum content. The findings support the trend toward a balance between specific and general health care business skills in graduate education. Other schools may benefit from the student profile, program delivery, appropriate degree information, and curriculum content findings as well as the research instrument design and methodology when assessing and planning graduate programs in health services administration/management. PMID- 10144619 TI - Delegation versus empowerment: what, how, and is there a difference? AB - Delegation--or empowerment--represents the essence of the supervisory task: getting things done through people. The terms are no different from each other; empowerment is simply delegation done properly. The process still fails for the same old reasons, and failure still causes the same kinds of problems. Delegation or empowerment involves authority; it is authority that is delegated, not responsibility, as commonly claimed. Under either name it is an imperfect process requiring subjective judgments and chronic risk. Although either label is acceptable--the few differences between delegation and empowerment are semantic only--the significant constant that must be present is a sense of task ownership on the part of the empowered employee. PMID- 10144620 TI - A supervisor's checklist: overtime. PMID- 10144621 TI - Antibiotic therapy intervention at a community hospital. Opportunities for cost and quality improvements. AB - In a one-year study, thirty-two physicians' antibiotic costs decreased significantly and were lower than those in a comparison group. The quality of patient care was not adversely affected, and the hospital's overall rate of nosocomial infection decreased. The success of the program led to its being adopted throughout the hospital. The dynamics of pharmacies' implementing cost reduction strategies with voluntary medical staffs are discussed throughout the article. PMID- 10144622 TI - Health promotion in France. Toward a new way of giving medical care. AB - Health promotion is not a concept often encountered in France, especially in university teaching hospitals. In fact, the spontaneous orientation of healthcare services tends to emphasize high-technology care, rather than preventive care. This article describes the main characteristics of the French healthcare system, some new elements of its health policy, and a specific experiment of health promotion in a new geriatric hospital. PMID- 10144623 TI - Development of a local integrated health network. AB - Integrated health networks are viewed as one possible organizational response to healthcare reform. This article discusses the variables that are critical to the development and success of a local integrated network. The case of a network currently under development is used to illustrate the underlying theory. Virtual integration is envisioned as the method by which the network comes together. PMID- 10144624 TI - The Turkish healthcare system. Can the United States learn from the Ottoman legacy? AB - Can the United States, in its continuing search for means to improve patient care while decreasing costs, learn from Turkey's healthcare system? There is a strong emphasis on preventive healthcare in Turkey that makes the system there worth examining. PMID- 10144625 TI - Technical support for biomedical equipment decision making. AB - Biomedical equipment in a hospital is diagnostic, therapeutic, monitoring, communication, and recordkeeping equipment that is directly or indirectly connected to the patient. This equipment continues to proliferate as developments in microcircuitry allow it to be smaller, more flexible, and thus more adaptable. One result of the equipment's increased flexibility is the ability to integrate individual equipment, clinician-users, patients, and hospital facilities into complex systems that enable the hospital to enhance patient care. Therefore, decision making regarding the acquisition and use of new equipment in the hospital must take into account the potential impact of the equipment on all the other elements of the system, including clinical and support staffs. PMID- 10144626 TI - Myths in the health services field. PMID- 10144628 TI - Out of hours. Hard day's night. PMID- 10144627 TI - Silent PPOs: signs of the times--portents for the future. PMID- 10144629 TI - Clinical effectiveness. Given in evidence. PMID- 10144630 TI - Guernsey. A tax by any other name. PMID- 10144631 TI - Community care. Strained relations. PMID- 10144632 TI - Labour policy. Change is as good as a rest. PMID- 10144633 TI - Fundholding. Creative tensions. PMID- 10144634 TI - GP referrals. Primary teachers. PMID- 10144635 TI - IT update. Never never land. PMID- 10144636 TI - IT update. Cheap and cheerful. PMID- 10144637 TI - IT update. Worth its wait in gold. PMID- 10144638 TI - IT update. Older and wiser. PMID- 10144639 TI - Working hours. Is the 56-hour week good for you, your family, or the NHS? PMID- 10144640 TI - Staff roles. All of the people most of the time. PMID- 10144641 TI - Flexible working. Good timing. PMID- 10144642 TI - Information services. An inside job. PMID- 10144643 TI - RAWP: weighting for a change. PMID- 10144644 TI - Leading 1994 dollar volume pharmaceuticals. PMID- 10144646 TI - A 5-year retrospective analysis of alpha-interferon usage. AB - Alpha interferon is an immune modulator used in the treatment of hematologic malignancies and immunosuppressive diseases. While many of the clinical indications for interferon have been well described and are FDA-approved, a large number of clinical uses of interferon are being developed. This study evaluated the appropriateness, efficacy, and safety of interferon therapy at our institution from 1987 to 1991. Data were collected by chart review. Response rates of patients in this hospital were compared to those published in the literature. Twenty-six patients were prescribed alpha interferon. Ten patients (38%) demonstrated a partial response, the highest responses seen in Hairy cell leukemia (67%) and chronic myelogenous leukemia (57%). Response rates for each disease compared favorably to those predicted from the literature. Twelve patients (46%) demonstrated intolerance. Overall five patients (19%) remain on therapy. While interferon appears to be moderately effective in certain diseases, intolerance to interferon seems to be the major limiting factor to its clinical application. PMID- 10144645 TI - Implementation of a once-daily aminoglycoside program in a large community teaching hospital. AB - Recently, there has been an emergence of interest in the use of once-daily aminoglycoside dosing. In an attempt to take advantage of the pharmacodynamic properties of these agents and to reduce the potential for toxicity, a once-daily aminoglycoside program was developed at this institution. This program uses a fixed intravenous dose of 7 mg/kg with dosing interval adjustments based on estimates of creatinine clearance or a single random serum aminoglycoside concentration. Because this automatic conversion program was initiated hospital wide, more than 2,400 patients received the regimen with no apparent alteration in clinical success and the incidence of toxicity was lower than that previously observed. The purpose of this report was to describe the implementation process and unique features of this hospital-wide once-daily aminoglycoside program in a 850-bed community-teaching hospital. PMID- 10144647 TI - Bureaucrats show restraint. PMID- 10144648 TI - A portfolio approach to management development: the Ashworth model. AB - Looks at management development at Ashworth Hospital as part of a continuing programme of professional development. This programme is innovative and revolutionary. It puts control of learning in the hands of the participants who are responsible for driving the programme and share the responsibility for supporting and motivating colleagues. PMID- 10144649 TI - Critical success in management development. AB - Details the results of an attempt to identify the impact of a comprehensive management development programme on organizational effectiveness within the health service public sector. Concludes that management development programmes must have a prespecified set of strategically linked outcomes, identifying the benefits to the organization, and a set of critical success factor measures to determine their achievement or otherwise. Programmes which do not result in managers feeling empowered will be criticized in not impacting positively on the organization. PMID- 10144650 TI - Not just money: quality of working life as employment strategy. AB - Scarcities of qualified personnel are becoming a common phenomenon in The Netherlands. At the same time, increasing wages to secure an adequate workforce is not always possible or sufficiently effective, and other ways of retaining and recruiting personnel have to be found. Investigates the importance of various job characteristics for retaining and recruiting employees and presents the results from a survey among employees of a Dutch hospital experiencing a tight labour market. Job characteristics other than wages, such as labour relations and work content, were found to play a major role in individuals' choices to resign or stay. Discusses consequences for employment strategies in other organizations. PMID- 10144651 TI - Nurse practitioners in the USA--their past, present and future: some implications for the health care management delivery system. AB - Chronicles the role of nurse practitioners from their early beginnings to the present. Not only examines this group's history but also explores their present role in health care delivery. Discusses interprofessional relationships along with consumer perceptions of their function. Concludes with an analysis of the issues facing nurse practitioners and future implications for their viability. PMID- 10144652 TI - Change management in the public sector. AB - Summarizes the management of change in a high profile public service with more than its fair share of political influences. Demonstrates the scale of change possible, given a clear strategy and a strong managerial commitment. Argues that this leads to high productivity, quality and value for money, with a strong element of organizational loyalty and ownership of the end product. PMID- 10144653 TI - Management training for consultants: a personal experience. PMID- 10144654 TI - Longitudinal electronic records for diabetic patients. Part I: Clinical aspects. PMID- 10144655 TI - Longitudinal electronic records for diabetic patients. Part II: Clinical aspects. PMID- 10144656 TI - Sounds of the silent epidemic. PMID- 10144657 TI - Proposed FDA "unsafe" lead wire ban could affect many medical devices. PMID- 10144658 TI - Measuring quality: an imperative for ambulatory care. PMID- 10144659 TI - Health-based profitability. PMID- 10144660 TI - Laboratory financial management: a tool for analyzing productivity, cost effectiveness, and utilization. PMID- 10144661 TI - Case study: reducing costs and remaining technologically competitive with asset management. PMID- 10144662 TI - Demarketing inappropriate health care consumption. Canada's prized health care system suffers from chronic overuse. PMID- 10144663 TI - Touchy subjects. Marketing a controversial product such as fetal tissue research requires sensitivity and finesse. PMID- 10144664 TI - Competitive dynamics in pharmaceuticals. PMID- 10144666 TI - Complaint intensity and health care services. AB - The author extends his Complaint Intensity Outcome Framework by including a customer-need component and applying the model to a sample of elderly health care consumers. The results indicate that immediate action should be taken to improve complaint mechanisms and performance related to the quality of physicians. Other attributes require less dramatic action, and some require none at all. PMID- 10144665 TI - Following the drill: the search for a dentist. AB - The authors identify strategically useful distinctions between the activities of potential patients in search of specialized vs. routine dental services. Survey findings question the advisability of assuming (1) that what occurs in the search process for routine dental care will automatically be mirrored in the process for more specialized services and (2) that potential patients use the same specific sources of information--both between (e.g., physicians vs. dentists) and within (e.g., specialized dental care vs. routine dental care) existing health care typologies. PMID- 10144667 TI - Time to choose. Consumers who make a snap decision about long-term care use different criteria from those who can afford to deliberate. AB - When consumers face an immediate vs. future need for a long-term health care facility, their decision process is rushed. The authors investigate the possible effects of time on the use of and emphasis on specific evaluative criteria consumers employ in making their choice. Findings suggest that marketers of long term care facilities should adopt a temporal-based approach to market segmentation. PMID- 10144668 TI - Demographic change is faster than you think. PMID- 10144669 TI - Senior Health Day. PMID- 10144671 TI - Joint Commission on Accreditation of Healthcare Organizations. Standards for the use of restraint. 1995 Accreditation Manual for Home Care. PMID- 10144670 TI - Advertising health care services. PMID- 10144672 TI - Joint Commission on Accreditation of Healthcare Organizations. Additional standards for surveying freestanding laboratories. 1994 Accreditation Manual for Pathology and Clinical Laboratory Services. PMID- 10144673 TI - Surveyors to use laptop computers on site. PMID- 10144674 TI - Quality oversight in a changing environment. PMID- 10144675 TI - New standard sets out to prevent transmission of infections. PMID- 10144677 TI - Statement of Conditions: steps during the survey process. PMID- 10144676 TI - Subacute programs follow credentialing, privileging standards. PMID- 10144678 TI - On the matter of value. PMID- 10144679 TI - Division of Accreditation Operations reorganized. PMID- 10144680 TI - Collaborative project studies hospital performance measures. PMID- 10144681 TI - Don't let referrals go sour. PMID- 10144682 TI - The new low-back guideline: the best you'll get? PMID- 10144683 TI - When a doctor accuses colleagues of health fraud. PMID- 10144684 TI - Medicine's second-class citizen: the patient. PMID- 10144685 TI - Are health plans asking too much of primary-care doctors? PMID- 10144686 TI - A malpractice strategy that backfired. PMID- 10144687 TI - Dropping a bad HMO patient? Do it very carefully. PMID- 10144688 TI - Columbia ends rivalry in Fla. market. PMID- 10144689 TI - Merger forces Pa. university to spin off health operations. PMID- 10144690 TI - Mass. hospitals back doc-run network. PMID- 10144691 TI - Ind. public hospital to stay alone. PMID- 10144692 TI - Marshfield case has appeal for bigwig antitrust attorneys. PMID- 10144693 TI - Calif. starts transitional-care program. PMID- 10144695 TI - GHAA-AMCRA merger in the offing. PMID- 10144694 TI - Calif. court ruling retains Kaiser's malpractice arbitration program. PMID- 10144696 TI - Study backs longer hospital stays for moms, infants after C-sections. PMID- 10144698 TI - More alliance consolidation expected. PMID- 10144697 TI - FHP, Nippon make exclusive deal. PMID- 10144699 TI - Docs to take leading role in Mo. network. PMID- 10144700 TI - GOP, Democrats take Medicare battle on road. PMID- 10144701 TI - Groups call for merger rejection. PMID- 10144702 TI - Deficit-plagued hospital in D.C. lays off more staff. PMID- 10144703 TI - Residents need teaching docs' supervision--HCFA. PMID- 10144704 TI - CHAMPUS managed care may be slowed by Senate. PMID- 10144705 TI - HHS details 'significant' hike in fraud prosecutions. PMID- 10144706 TI - Democrats seek to return favor to GOP on reforms. PMID- 10144707 TI - Doc practice management set to explode. AB - An industry that barely existed give years ago is emerging as a prime mechanism to organize doctors. Independent physician management companies are uniquely situated to do the job as HMOs rethink the strategy of employing physicians and as hospitals find doctors reluctant to come under their control. PMID- 10144708 TI - Columbia Visa card gives communities some credit. PMID- 10144709 TI - Groups weigh forming direct-contracting coalition. PMID- 10144710 TI - A new product solves old problems. PMID- 10144711 TI - Nurses a phone call away with clinic info line. PMID- 10144712 TI - Former Pa. competitors negotiate cash-flow link. PMID- 10144714 TI - Columbia reports 32% operating income gain. PMID- 10144713 TI - Six years later, Stark law regulations issued. PMID- 10144715 TI - Forced to sell Utah hospitals, Columbia now begins to build. PMID- 10144716 TI - N.Y.'s Interfaith settles patient 'dumping' case. PMID- 10144717 TI - Unionized nurses rally in Calif. PMID- 10144718 TI - Charter closing hospital. PMID- 10144719 TI - Tennessee Blues agree to merge. PMID- 10144720 TI - Columbia seeks OK to build in Florida. PMID- 10144721 TI - Tenet relocating headquarters. PMID- 10144723 TI - Roper: jump to SunHealth wasn't tied to bid help. PMID- 10144722 TI - Columbia, Georgia Baptist put different spins on demise of joint-venture agreement. PMID- 10144724 TI - Intermountain settles 1 antitrust suit. PMID- 10144725 TI - JCAHO staff proposes 3% rise in survey fees. PMID- 10144726 TI - N.Y. HMOs must offer point-of-service option. PMID- 10144728 TI - N.Y. docs file antitrust suit against Aetna. PMID- 10144727 TI - Probe sought of docs' big Medicare bills. PMID- 10144729 TI - Mich. system, hospital sign joint operating agreement. PMID- 10144730 TI - Value Health sells Lewin unit to avoid contract loss. PMID- 10144731 TI - Postman rings again in billing probe. PMID- 10144733 TI - CBO projects 7% increase in 1995 healthcare costs. PMID- 10144732 TI - Providers fear rules will hinder Medicare direct-contracting. PMID- 10144734 TI - IRS fines Cape Coral $10 million. PMID- 10144735 TI - Self-insured plans get no special break--N.Y. court. PMID- 10144736 TI - Government ill-suited to hospital business. PMID- 10144737 TI - New York's academic medicine world goes ape. The city's teaching facilities struggle to survive amid upheaval. AB - The Big Apple's world of academic medicine is in upheaval. Managed care is eating away at academic medical centers' revenue base and generating excess capacity. Each institution, to one degree or another, is ?re-engineering? to reduce costs, improve efficiency and brace for painful cuts in government support. PMID- 10144738 TI - Ga. home-care firm indicted for fraud. PMID- 10144740 TI - Kemp backs AHA in call for independent Medicare panel. PMID- 10144739 TI - Hospital groups give thumbs down to HCFA's reclassification changes. PMID- 10144742 TI - 1995 LTC Buyer's Guide. PMID- 10144741 TI - Rethinking revenue collection at military MTFs (medical treatment facilities). AB - Military medical treatment facilities (MTFs) throughout the nation have felt the impact of the dramatic transition from traditional fee-for-service health insurance coverage to managed care programs. Some facilities have had to struggle to survive. Yet one facility, the Naval Medical Center-San Diego, San Diego, California, nearly doubled its revenue collections in spite of a reduction in billable claims, reduced staff, and a substantial increase in non-billable policies. PMID- 10144743 TI - Pulmonary disease in AIDS: implications for respiratory care practitioners. PMID- 10144744 TI - Interpretations of stress in institutions: the cultural production of ambiguity and burnout. AB - This ethnographic study of interpretations of stress among hospital social workers reveals concrete ways in which institutional systems take form in the mundane actions and interpretations of individuals embedded in these systems. It also reveals how organizational cultures reflect and reinforce institutional conditions that have been negotiated in the interactions of individuals. Here, the institutional systems of medicine and social work come together in the everyday work of the social workers and result in two patterns of cultural dominance. Within these distinct types of culture emerge two forms of stress experience, including a dominant form, consistent with medical ideology, and a marginalized form, consistent with social work ideology. Some surprising patterns of interpretation emerge, including interpretations of ambiguity and burnout as normal, social, and desirable when the social work ideology is dominant. This institutional analysis of stress has theoretical, practical, and epistemological implications. PMID- 10144745 TI - Reaching 52% of the earth's surface. PMID- 10144746 TI - The paper connection. PMID- 10144747 TI - Waste: another meeting to discuss it? PMID- 10144748 TI - A tale of two practices. PMID- 10144749 TI - Linking collaboration and prevention with margin and mission. PMID- 10144750 TI - Baldrige Award health care pilot introduces criteria for quality in health care organizations. PMID- 10144751 TI - Sharpening the customer focus. PMID- 10144752 TI - Developing an interdisciplinary approach to enhanced clinical resource utilization. PMID- 10144753 TI - Using quality improvement as a system-building strategy. AB - When leaders at Henry Ford Health System (HFHS) in Detroit decided to integrate the various components of their system eight years ago, they not only had to overcome numerous barriers, such as lack of strategic alignment among HFHS's 11 business units, but also had to change the system culture and develop a new approach to managing care. Key strategies used in making the shift included revamping the governance process, implementing quality management, and linking financial performance to compensation. In this article, HFHS executives discuss their sometimes-tumultuous journey and give tips for other organizations considering integration. PMID- 10144754 TI - Best practices in quality leadership. AB - In today's competitive healthcare market, leaders face increasing pressure to ensure rapid and lasting improvements at their facilities. Typically, such improvements happen only when senior management provides leadership in two areas- structure and culture. Often this means completely revamping inadequate information systems and developing a better understanding of improvement technology. By employing a number of strategies, such as benchmarking, implementing practice guidelines, and other tactics to make optimal use of existing information, and establishing formal learning plans, healthcare leaders can effect significant and continuing quality improvements within their facilities. PMID- 10144755 TI - TQM: helping to build integrated delivery systems. PMID- 10144756 TI - Applying TQM to community health improvement: nine works in progress. AB - Traditionally, quality improvement principles have been used in business and healthcare settings. Nine North American cities, however, have demonstrated how these same QI principles can be applied to improving community health. Guided by a conceptual framework based on a three-question model and employing a Plan-Do Check-Act cycle, the communities were able to develop interventions that are bringing about change in targeted populations, ranging from reducing the number of suspensions from school due to violence among youths to improving post neonatal mortality rates. PMID- 10144757 TI - Best practices for chronic obstructive pulmonary disease (COPD). Kaiser Permanente Orange County. PMID- 10144758 TI - Clinical redesign of acute chest pain management: conceptual approach and implementation. Lutheran General Hospital, Park Ridge, Illinois. PMID- 10144759 TI - Improving fiscal outcomes in behavioral health. Northwest Covenant Medical Center, New Jersey. PMID- 10144760 TI - Creating clinical process improvement teams. Morton Plant Hospital, Florida. PMID- 10144761 TI - Surgical services operational planning: from vision to reality. Salt Lake City, Utah. PMID- 10144762 TI - Citizens' views on health care. AB - Considers the importance and relevance of taking into account the views of the public in the provision of health care. Identifies the salient questions and explores some of the broader issues. Aims to describe how far countries have been concerned to take into account citizens' views, the mechanisms and channels through which these views are represented and their effectiveness for influencing decision making. PMID- 10144763 TI - A generalizable framework for information systems for physician recruitment/referral. AB - Hospital information systems have evolved from data processing systems for patient billing and payroll to decision-support systems which support decision making at the middle and upper management levels. With the advancements in the areas of database management, expert systems and networks, important hospital functions such as physician recruitment and referral which historically were performed using traditional procedures, are now performed using these computer based technologies. Develops a generalizable framework for information systems for physician recruitment and referral using technologies of database management, expert systems and networks. This GIS-PRR system may be used by hospitals and other health-care providers to improve the efficiency and effectiveness of the physician recruitment/referral process. PMID- 10144764 TI - Developing an information system to support the pursuit of decentralization. The perspective of Ceara State in Brazil. AB - Discusses the national health information system in Brazil which, until very recently, consisted of two main structures of health services with a dichotomy between curative and preventive health care acting in a vertical manner. The autonomy of health authorities and specialized structures created numerous independent health information systems with different methods of data collection. Although the issues of decentralization and a unified health system had been agreed on in 1963, they had not been implemented until the new health policy reform was lunched in 1988. The reform was based on the strengthening of primary health care at national level and accelerating decentralization of health systems. However, in spite of strong political will the new health managers at local level are lacking essential information, data and instruments that only a decentralized health management information system can provide. Based on a study conducted in the Ceara State of the north east of Brazil, explores how the present health information system can support the process of decentralization. PMID- 10144765 TI - Can the hospices survive the market? A financial analysis of palliative care provision in Scotland. AB - Hospices are undergoing changes in the way they are funded by health boards as a result of the change to a contract-setting regime in the NHS. This may have implications for the overall funding position of the hospices; particularly there is a concern as to whether charitable giving to these bodies will decrease as a result. Analyses the accounts of Scottish voluntary sector hospices over the transition period as a means of identifying any such changes. Finds no immediate threat to the continued functioning of the hospices, on a financial basis. PMID- 10144766 TI - Accessibility of sexual health services for young people: survey of clinics in a region. AB - Describes the approach and results of a regional survey to assess the accessibility of sexual health services for young people in the south-east Thames region. Outlines the practicalities of performing such a survey and what can be achieved through this approach. PMID- 10144767 TI - Care frames: interactive units of health-care delivery. AB - Describes a way of characterizing the progress of a patient into and out of acute care. Presents a model of the process which resulted from a study of the interface between tertiary care and resettlement in the home community in a single health district. After discussion of the problems relating to patient discharge as described in the literature, briefly describes the origins of and setting for the study. The method of data collection (through documentary analysis, individual and group interview and case study) involved over 100 staff and patients on both sides of the interface. Does not present the substantive findings in detail, as these remain confidential to the organizations involved. However, outlines the process whereby the data gave rise to a model of patient progress and discusses in detail the essential feature of that model--the care frame--both as a theoretical entity and as a basis for practical action. Concludes with a demonstration of how the care-frame model can be used to manage the interface between successive phases in the provision of care and, especially, how it helps to define and manage the interface between acute care and care in the home community. PMID- 10144768 TI - Managing underwriting risk in capitated provider groups. AB - Physicians working under capitated arrangements must provide quality care and make money, i.e., manage the underwriting risk. Sometimes those ends can seem to be contradictory. To use capitation as a tool to provide cost-effective and quality health care, it behooves the physician to know what forces are at work that influence the results of this capitated environment. Several of those areas are under control of the physician directly and others are not. The physician must know what he or she can control and what cannot be controlled. PMID- 10144769 TI - Antidepressant utilization in managed care: an evaluation of SSRI use in two HMO settings. AB - Antidepressant costs and utilization are growing rapidly as newer selective serotonin reuptake inhibitors (SSRIs) comprise an ever-increasing share of the market. A number of factors and related costs must be considered when evaluating antidepressant products. An antidepressant drug utilization review study performed in two different HMO models revealed important variations among available SSRI therapies in terms of dosage escalation and discontinuation, as well as concomitant medication costs associated with treating side effects. New antidepressants may alleviate some of these problems. PMID- 10144770 TI - New association formed for outcomes research. PMID- 10144771 TI - Controversy over hysterectomy. PMID- 10144772 TI - A conversation with James Prochaska. PMID- 10144773 TI - Implementing physician buy-in to practice guidelines. AB - A major obstacle in the quest for health care quality improvement is physician acceptance of clinical practice guidelines. Typically objective and autonomous, physicians do not readily "buy-in" to standards that challenge their judgement. In this article, the authors identify the necessary conditions for physician acceptance if not active participation in the development and promulgation of these living documents. PMID- 10144774 TI - Relational triangles in managed care. AB - Relational triangles provide a conceptual framework for understanding interpersonal relationships and utilization review disputes in managed care programs. Relational triangles exist in the every day practice of medicine. The most striking example of relational triangles in practice is found in managed care systems' concurrent utilization management programs. The author provides some rules of relational triangles and vignettes to illustrate how they work in the managed care setting. PMID- 10144775 TI - Analysis of inpatient treatment of HIV-associated pneumonia in Medicare patients. PMID- 10144776 TI - Achieving provider support of pharmacy benefit design. PMID- 10144777 TI - Involving physicians in efforts to control pharmaceutical expenditures. AB - Managed care methods of influencing physician prescribing behavior work as well in hospital settings as they do in the ambulatory environment. The authors studied the effect of pharmacist interventions in certain diagnostic areas and found that these efforts do result in significant cost savings. PMID- 10144778 TI - Federal tax concerns in structuring integrated delivery systems. Part I: Background, tax rules, and exempt systems. AB - As health care providers develop integrated delivery systems, they need to be aware of the Internal Revenue Service's careful scrutiny of these systems. In the first installment of this two-part article, the author reviews the current tax rules for exempt health care providers. PMID- 10144779 TI - Why outcomes management doesn't (always) work: an organizational perspective. AB - Insufficient attention to organizational issues has prevented outcomes management from achieving its full potential. This article examines the impact of structural, cultural, and cognitive factors on outcomes management. Organic structures differ from mechanistic ones in regard to the organization and implementation of the outcomes management function. Organizational cultures determine the degree of acquisition, sharing, and use of outcomes information by organization members. Cognitive factors affect the level of member compliance with outcomes management initiatives. This article also discusses managerial implications and develops research propositions. PMID- 10144780 TI - Medical organization structures that promote quality and efficiency: past research and future considerations. AB - This article reviews studies of the effects of medical organization structure on quality and cost conducted over the past three decades. Topics of inquiry have proceeded from the organizational to the individual provider level and from the inpatient to the ambulatory level. The article presents the findings of these studies as clues regarding the likely impact of integrated delivery systems. It also considers future areas for study in medical organization. PMID- 10144781 TI - An integrative model for organization-wide quality improvement: lessons from the field. AB - This article describes a model of CQI that is designed to characterize the elements necessary for successfully improving quality at an organization-wide level; describe and understand the organizational dynamics in implementing an organization-wide effort; and aid in diagnosing and solving common implementation challenges. Three cases illustrate the model and how it can be used. PMID- 10144783 TI - The organization of the medical practice and implications for delivering quality care. AB - The attention devoted to quality in health care has focused primarily on hospitals. With the shift in care from hospitals to outpatient clinics and physicians' offices, there has emerged a need to consider how quality should be approached in these settings. This article explores the structural barriers in the typical medical practice that must be removed in order to improve the many dimensions of quality. The typical practice must concentrate on enhancing clinical outcomes, patient satisfaction, and practice productivity. One effective strategy is to form teams of physicians and other staff to work on relevant issues. Another is to focus on how the practice can be defined to better meet the needs of patients. PMID- 10144782 TI - Organizing for nursing home quality. AB - This article explores the relationship between job, work group, and organizational design and the quality of nursing home care. Contingency theorists contend that effective organizations develop structures that support the nature of their production processes and complement their environment. Within the same facility, units with differing care requirements should be structured differently to achieve quality outcomes. Efforts to improve quality can be integrated through the practice of total quality management and facilitated by using the Health Care Financing Administration Minimum Data Set. PMID- 10144784 TI - Structural impediments to TQM in Australian health care. AB - The culture of quality called for by total quality management (TQM) has much to recommend it. Australian experience, however, suggests that it is not something that can easily be added to the profession-based structures and cultures prevailing in most Australian hospitals. Implementing TQM is not just a matter of advocating it. The institutional transformation implied by TQM requires additional action on multiple fronts, both internal and external to the hospital. PMID- 10144785 TI - Developing a corporate-level performance assessment system. AB - Monmouth Medical Center (Long Branch, New Jersey) developed a corporate-level performance assessment system to provide information to external customers and to use as an internal management tool. In this article, we recount the process used to develop the measurement system and describe some of the indicators included in it. PMID- 10144786 TI - Tutorial: chaos theory--a primer for health care. AB - Chaos theory, also called nonlinear systems theory, provides new insights into processes previously thought to be unpredictable and random. It also provides a new set of tools that can be used to analyze common administrative and clinical data. This tutorial provides an introduction to chaos theory. Subsequent articles will address applications of those principles to the administrative activities of health care organizations, implications of those principles for clinical data, and application of chaos theory concepts to our understanding of organizational dynamics. PMID- 10144787 TI - Medicare program; allowing certifications and recertification by nurse practitioners and clinical nurse specialists for certain services--HCFA. Final rule with comment period. AB - This final rule with comment period authorizes nurse practitioners and clinical nurse specialists, working in collaboration with a physician, to certify and recertify that extended care services are needed or continue to be needed. In addition, it sets forth the qualification requirements that a nurse practitioner or clinical nurse specialist must meet in order to sign certification or recertification statements. This final rule is necessary to implement section 6028 of the Omnibus Budget Reconciliation Act of 1989. PMID- 10144788 TI - Parental perceptions of procedure-related distress and family adaptation in childhood leukemia. AB - Child and parental distress related to lumbar punctures and bone marrow aspirates and general family adaptation are evaluated in a cross-sectional study of children currently in treatment with leukemia in first remission (N = 70). A parental self-report measure developed for this study--the Perception of Procedures Questionnaire (PPQ)--yielded three factors: (a) parental satisfaction, (b) parental distress or involvement, and (c) child distress. Data from the PPQ showed high levels of both satisfaction and distress in the context of invasive procedures. Data from standardized measures of family adaptation demonstrated a range of functioning. Analyses by length of time since diagnosis indicated that parental distress remains stable over the course of treatment. The data are discussed with respect to the newly developed measure of parental procedures (the PPQ) and the need for research in this field that provides an integration of procedural distress with parent and family perceptions and adjustment. PMID- 10144789 TI - Maternal presence during children's routine immunizations: the effect of mother as observer in reducing child distress. AB - This study replicates and extends previous research examining the effect of mother presence versus absence on child distress in response to medical procedures. The effect of degree of maternal involvement during a routine immunization at a 5-year well-child visit to the pediatrician was examined. Behavioral observations of child distress and self-reported ratings of child affect were obtained in a repeated measures (pre, during, and post) design. Mother-child dyads (N=36) participated in one of four experimental conditions: (a) mother present as usual (routine), (b) mother absent (absent), (c) mother present as observer (watch), and (d) mother present as coping coach, using distraction (coach). Results support the efficacy of instructed, limited maternal involvement compared to routine procedures: Children in the watch condition showed less behavioral distress and their postinjection affect was more positive than children in the noninstructed, high maternal involvement, routine condition. PMID- 10144790 TI - A customer view of CHINs. PMID- 10144791 TI - Evolving community health information networks. AB - A community health information network (CHIN) provides technology-based information services to help maintain optimal health for all the residents of a community. Defining features of a CHIN are that its services are available to all stakeholders and that competitors collaborate to share information. The initial impetus for a CHIN is usually to facilitate paying for health care or to share clinical records. Complex legal, organizational, funding, and control issues confront CHIN initiators, and reliable models do not exist today. During development, issues of program focus and technology selection arise, followed by concerns about information privacy and the CHIN's role in quality of care. Once basic capabilities are implemented, a mature CHIN can offer extensive cost recovering health-related services to providers, related agencies, and consumers. Developments are underway that eventually will allow a CHIN to support a fully integrated longitudinal health record. A national network of mature CHINs would offer health care professionals further collaborative possibilities that could change the shape of future health care. PMID- 10144792 TI - Laying the foundation for community health information network development. PMID- 10144793 TI - Creating community information networks for healthy communities. PMID- 10144794 TI - Stroke management--the evolving role of paramedics. Symposium presented at EMS Today Conference & Exposition, March 12, 1995 in Baltimore, MD. PMID- 10144795 TI - Pulling the plug. PMID- 10144796 TI - Hyper rigs. AB - What's red and white and huge all over? Monster ambulances built by Braun Northwest of Chehalis, Wash., for a Russian mining company. PMID- 10144797 TI - Are we getting the help we need. AB - The Oklahoma City bombing was a made-for-TV catastrophe. The images thrust on the EMS community after the devastation of the Alfred P. Murrah Federal Building last April are imprinted on our minds with awful clarity. And to see images of other disasters often causes memories of other awful scenes to arise unbidden: Sioux City's airline disaster, the New York City World Trade Center bombing, hurricanes, earthquakes and other devastation. Each takes its toll on emergency care providers. PMID- 10144798 TI - Down syndrome. Implications for emergency care. PMID- 10144799 TI - When jobs are scarce. AB - "Sorry, we're not hiring." This is becoming a common refrain for those of you searching in today's EMS job market. JEMS has received numerous letters from people frustrated by their inability to find employment following training. A spot-check of organizations and employers around the country suggests that, indeed, EMS positions are scarce. The waiting time for employment in many large urban services can be from six months to two years or more, and one director from a busy midwestern ALS service said he was receiving approximately 75 to 100 applications for every paramedic opening. PMID- 10144800 TI - Wisdom from a dinosaur. PMID- 10144801 TI - Staying on top--9 rules for surviving and excelling on the streets. AB - When EMS providers at both the BLS and ALS levels leave their training programs, they are armed with newfound knowledge, but they usually lack the appropriate life experiences to excel and survive on the streets. As these new providers enter the real world of EMS, they face the challenge of making life-and-death decisions in uncontrolled environments. This includes making the appropriate decisions while functioning effectively--even in potentially dangerous settings. The high job stress this creates often leads to burnout and, in many systems, high turnover rates. This need not be the situation, however, as field providers can learn to survive and excel in the streets by using the following nine rules. PMID- 10144802 TI - Starting over again. PMID- 10144804 TI - Information resources. AB - Looking for a job? Want to find out how to become a flight paramedic? Want to join a search and rescue team? The organizations and agencies listed here can help point you in the right direction, give you information to make your job search easier and help you achieve a satisfying career in emergency services. PMID- 10144803 TI - Critical care transport: an evolving role in EMS. AB - Critical care transport (CCT). It is defined as the movement of critically ill patients from facilities where the patients' needs exceed available resources to places that meet their needs, while maintaining a specialized level of care. And it is a specialty that is becoming increasingly common in today's managed care environment--an environment that emphasizes putting people in network hospitals. It is also becoming a viable career move for paramedics wishing to upgrade their skills and education. PMID- 10144805 TI - Medicaid managed care keys to success. PMID- 10144806 TI - Are provider integrated delivery systems the final step to integration? AB - Provider integrated delivery systems are not the final step to full-fledged integration, states author R. Daniel King, president of Medi-Call of St. Louis Inc. While a PIDS is on the way, true interdependent integration takes place when the community joins with the integrated system to represent all phases of the health care continuum and assumes some of the responsibility for planning. These community integrated delivery systems (CIDS) should be the aim of integration. PMID- 10144807 TI - Break-it thinking--the key to quality management for health care institutions. AB - Thinking outside the mold is the key to creating a truly high quality health care delivery system, states author Andrew J. Kasarda, Ph.D., of Quantum Technologies International. He takes a look at Deming's 14 points of total quality management and offers his own version of how to deal with change. PMID- 10144808 TI - Academic internal medicine and managed care--early responses from eight Southeastern departments. Southeastern Study Group. AB - Eight Southeastern U.S. academic medicine departments have begun collecting data on how managed care is affecting their practice of medicine. Writing for the Southeastern Study Group, James E. Lewis, Ph.D., of the University of Alabama at Birmingham, presents information that the group has gathered as a means of attempting to bridge the information gap on managed care's effects on academic practice. PMID- 10144809 TI - Medicaid, a new frontier for managed care ... but it's a very tough sell. AB - June Stollman of Healthscope/United writes about the marketing of an HMO to Medicaid recipients in New York City. Getting the patients to use the HMO rather than their local hospital emergency room was only one of the challenges they faced. PMID- 10144810 TI - Medicare risk contracting. Early identification and follow-up of high risk enrollees are essential first steps to success. AB - Seniors' involvement in HMOs goes against conventional wisdom, writes Peter Yedidia, president of Geriatric Health Systems, and yet enrollment in Medicare HMOs is way up and now tops 2 million. Identifying and following up on high-risk enrollees is one key to meeting financial goals. PMID- 10144811 TI - CQI longitudinally applied to integrated service outcomes. AB - Citing data collected between 1987 and 1994 at the St. Paul-Ramsey Medical Center, Ramsey Clinic and Ramsey Foundation, Paul A. Sommers, Ph.D., executive vice president and chief administrative officer of Ramsey, Michael G. Luxenberg, president of Professional Data Analysts, and Eric. P. Sommers of the River Falls Clinic, write how CQI has been introduced. The key is the application of inferential evaluation. PMID- 10144812 TI - Why is medical group management now so contentious? PMID- 10144813 TI - Proposals threaten Boren Amendment. PMID- 10144814 TI - Market stays active as prices rise. PMID- 10144815 TI - Outcomes assessment in subacute programs. PMID- 10144816 TI - Finding and keeping good direct care staff. PMID- 10144817 TI - The future of long term care. Finding the road to success in a new era. PMID- 10144818 TI - Medicare reform. Will the train stay on track ... or even leave the station? PMID- 10144819 TI - Charge nurses: promoting from within. PMID- 10144820 TI - Reducing the risk of injury liability. PMID- 10144821 TI - Good nutrition key to resident health. PMID- 10144822 TI - Candid report from concerned consumer. PMID- 10144823 TI - Bye-bye film, hello workstation. PMID- 10144824 TI - Buy the premise and you buy the bit. PMID- 10144825 TI - Federal agencies issue new antitrust guidelines. PMID- 10144826 TI - Ten steps to improve your chances for success with PACS. PMID- 10144827 TI - Writing a PACS program statement. AB - Medical telecommunications is becoming a necessity for maintaining the quality of care and delivering services on a timely basis in the current environment of cutting services and specialists to reduce costs. (Vanden Brink 1994). Picture archiving and communications systems (PACS) and teleradiology are increasingly viable because there is easier connectivity among modalities and manufacturers. Agreement on the DICOM Standard is one step toward greater connectivity. Two thirds of the 350 radiology administrators, radiologists, hospital administrators and MIS directors interviewed for the 1994 IMACS/PACS Tracking Study believe that the use of image telecommunication technology is growing. In 1993, Vanderbilt University Medical Center (VUMC) formed a committee to evaluate the need for PACS and to compile a program statement. The principal purpose of the program statement is to provide fundamental information that can be understood easily by individuals outside the radiology department. It outlines the benefits of PACS and includes a financial analysis of the purchase and installation of a system. Key elements of the program statement include a description and analysis of the existing film library system, advantages of PACS, implementation plan, financial proforma and integration with the hospital information system. These and other topics are covered in detail in the following article. PMID- 10144828 TI - Gradual PACS adoption. AB - For more than a decade, radiology professionals have hoped that picture archiving and communications systems (PACS) would improve efficiency and reduce costs. However, pioneer PACS systems were extremely expensive, and they didn't always meet their users' needs. Recent changes mean that PACS are more accessible. Advances in technology have resulted in decreased costs and increased computer power, and many radiologists recognize that they must consider new tools, such as teleradiology, to compete. There are roughly five classes of digital image systems used by radiologists: modality clusters, on-call review and teleradiology, remote primary diagnosis, mini-PACS and PACS. Even though hospitals seem to view PACS as inevitable, the challenge is to manage PACS implementation economically. One answer is to install PACS incrementally. Once teleradiology and mini-PACS are in place, they can be used as the building blocks of full-fledged PACS. Because PACS have a broad impact on healthcare facilities, careful planning is needed. Design your system to support future, as well as current, applications. Another important planning step is to set goals for improved efficiency and cost reduction. PMID- 10144829 TI - A new look at OEM (original equipment manufacturer) service agreements. AB - Next to personnel services, equipment maintenance is the second largest budgetary expense in large radiology departments. Because they are under constant pressure to contain costs, radiology administrators spend considerable time negotiating the best service at the lowest cost. Today, administrators have several options for imaging equipment maintenance: equipment maintenance insurance, in-house engineering, and various arrangements with original equipment manufacturers (OEMs) and independent service organizations (ISOs). In response to increased competition, OEMs have become more price-competitive with ISOs and have expanded their service menu and equipment maintenance insurance programs. OEM service menu options include: full service, tiered pricing, labor only, planned maintenance, full service with deductible, shared maintenance and extended warranty. Any type of service arrangement can be customized according to equipment age and sophistication, redundancy, income-producing potential, criticality of downtime and the strength and depth of the service organization. Even when vendor maintenance contracts are more expensive than purchasing service on a time-and materials basis, they allow customers to budget accurately for the service of covered equipment. The authors' institution gets the best results for the best price from a judicious mix of maintenance options. Wise customers will explore many options before choosing a service agreement. PMID- 10144830 TI - Assuring a trained workforce for allied health: the administrator's role. AB - In many areas healthcare education has failed to keep pace with changing needs for new skills and characteristics. The Project on the Future of Allied Health solicited a number of white papers detailing characteristics, competencies and attitudes that will be required of allied health workers in 2005. Two concepts from those white papers pertain especially to radiology: (1) the knowledge burden of today's health professional is quickly approaching overload and (2) manufacturers of healthcare equipment and technology must bear some responsibility for the problems and solutions. Some large employers have determined that allied health education is not providing appropriate training and have initiated their own programs. New models of allied health education and practice already exist around the country. It is no longer "if" but "how" we can make progress toward change. The impetus and funding for new programs probably will not come from the government; leaders in the industry must implement changes in education and staff development. Radiology administrators and professional associations must play a role in redesigning programs for allied health training. PMID- 10144831 TI - Competency assessment for radiology. AB - Two important changes in the past year have addressed the need for ongoing assessment and training of radiologic technologists. Those changes are mandatory continuing education for ARRT-registered technologists and the JCAHO's requirement to assure staff competency. To prepare for a JCAHO inspection, supervisors at Pennsylvania Hospital developed competency checklists for orientation and annual performance appraisals. The checklists included job specific skills in two areas: equipment and protocols. Sample checklists are reprinted in this article. They cover representative jobs in different areas of radiology: support staff, diagnostic radiology, radiation oncology, computed tomography and nuclear medicine. PMID- 10144832 TI - Art therapy with a hospitalized child. AB - Art therapy can help pediatric patients communicate their feelings about being in the hospital and cope with their illness or injury. This case study of Alan, who was admitted to a pediatric unit with orthopedic injuries, shows how the art therapy process helped him cope with his injury and subsequent 14-day hospitalization. Once Alan overcame his initial resistance to the art materials, he was able to use artwork as a communicative channel to express his feelings about being in the hospital and away from his family, suffering from a painful injury. The anarchic, freeing quality of the art media lowered Alan's inhibitions and served as an outlet for his feelings. Termination was also discussed. PMID- 10144833 TI - Lighting on the bleeding edge. PMID- 10144834 TI - Medical center given comfort lighting. Menorah Medical Park, Overland Park, Kansas. PMID- 10144835 TI - The best way to fix Medicare. PMID- 10144836 TI - Questions and answers on health insurance benefit issues. AB - This Issue Brief addresses eight topics in the areas of health insurance and health care costs. Using a question and answer format, the discussion draws largely on EBRI research and the EBRI Databook on Employee Benefits, third edition. In 1993, U.S. expenditures on health care were $884.2 billion, and they are projected to reach $2,173.7 billion by 2005, increasing at a projected average annual rate of 7.8 percent. Health care spending accounted for 13.9 percent of Gross Domestic Product (GDP) in 1993 and is projected to reach 17.9 percent of GDP by 2005. Among the factors contributing to the increase in health care costs are the growth in the number of individuals with traditional reimbursement health insurance coverage, the rapid expansion of technology and treatment options, and demographic factors such as the aging of the population. In 1993, employers, both public and private, spent $235.6 billion on group health insurance, accounting for 6.2 percent of total compensation. Group health insurance is the fastest growing component of total compensation, increasing at an average annual rate of 13.7 percent from 1960 to 1993. An increasing number of employees are required to make a cash contribution to their health insurance plan premium. In 1993, 61 percent of full-time employees in medium and large private establishments who participated in an employee only health insurance plan were required to make a contribution to the premium, up from 27 percent in 1979. In 1993, 185.3 million persons under age 65 had health insurance coverage, while 40.9 million people--or about 18.1 percent of the nonelderly population--received neither private health insurance nor publicly financed health coverage. Of those individuals who had health insurance coverage, 60.8 percent, or 137.4 million persons, received their health insurance through an employment-based plan. In 1993, 15.2 percent of the nonelderly population without health insurance coverage were noncitizens. In six states noncitizens represented a higher proportion of the total uninsured population than individuals in the nation as a whole. An increasing number of employers are self-funding their health insurance plans. In 1994, 74 percent of employers with 500 or more employees self-funded their health insurance plans, up from 63 percent in 1993. An estimated 22 million full-time employees in private industry and state and local governments participated in a self-funded employment-based health insurance plan.(ABSTRACT TRUNCATED AT 400 WORDS) PMID- 10144837 TI - Effectiveness of a psychoeducational and task-centered group intervention for family members of people with AIDS. PMID- 10144838 TI - Reducing HIV infection among African Americans by targeting the African American family. PMID- 10144839 TI - Injection drug users, crack smokers, and the use of human services. PMID- 10144840 TI - Prediction accuracy of the Washington and Illinois risk assessment instruments: an application of receiver operating characteristic curve analysis. PMID- 10144841 TI - Confirmatory factor analysis of the Maslach Burnout Inventory. PMID- 10144842 TI - Medicare program; physician financial relationships with, and referrals to, health care entities that furnish clinical laboratory services and financial relationship reporting requirements--HCFA. Final rule with comment period. AB - This final rule with comment period provides that, if a physician or a member of a physician's immediate family has a financial relationship with an entity, the physician may not make referrals to the entity for the furnishing of clinical laboratory services under the Medicare program, except under specified circumstances. It contains revisions to our proposal of March 11, 1992, based on comments submitted by the public. Further, it incorporates the new expansions and exceptions created by the Omnibus Budget Reconciliation Act of 1993 and the amendments in the Social Security Act Amendments of 1994 (SSA '94), that are related to referrals for clinical laboratory services and have a retroactive effective date of January 1, 1992. In addition, we are responding to comments received on the interim final rule with comment period (published on December 3, 1991) that set forth Medicare reporting requirements for the submission by certain health care entities of information about their relationships with physicians. That document implemented the reporting requirements of section 1877(f) of the Social Security Act. This rule revises those requirements to incorporate the amendments to section 1877(f) made by SSA '94, to apply to any further reporting we may require. PMID- 10144843 TI - Statement of organization, functions, and delegations of authority; substructure for the Bureau of Program Operations--HHS. PMID- 10144844 TI - Disagreeing on the diagnosis. PMID- 10144845 TI - The characteristics of highly effective therapists in managed behavioral provider networks. AB - As managed behavioral healthcare plans experience increasing requirements to measure outcomes, create report cards and adopt other quantifiable approaches to quality management, rating the effectiveness of behavioral healthcare providers is essential. The authors describe one aspect of their company's quality management program, which uses standardized assessments of client satisfaction, problem resolution and appropriateness of care to identify highly effective therapists. This process has yielded useful results that indicate some of the characteristics of highly effective therapists in such areas as experience, gender and personality type. PMID- 10144846 TI - A business plan for starting a behavioral group practice. AB - The era of the solo behavioral healthcare practitioner is ending, as market forces spur the formation and the merging of group practices. But what are the financial realities of forming a behavioral group practice? In this article the author reviews the likely market entry strategy, organizational structure, expense line items and cash flow projections involved in the formation of a hypothetical, four-member behavioral group practice corporation. PMID- 10144847 TI - The new competitive enterprise: the behavioral healthcare PHO. AB - The physician-hospital organization (PHO), whether in a general medical context or in the specialty of behavioral healthcare, represents an intermediate step or model in the process of integration required by current market forces in healthcare. This article describes both general medical and behavioral healthcare PHOs and analyzes the model's competitive advantages in the behavioral healthcare arena. The ways in which behavioral PHOs interface with other practice delivery models is described, along with their advantages and the factors leading to their success. PMID- 10144848 TI - Dialogue: should any willing provider laws become a mandate for behavioral healthcare? Making any willing provider work for health plans, consumers and providers. PMID- 10144849 TI - Dialogue: should any willing provider laws become a mandate for behavioral healthcare? Any willing provider? To be or not to be? PMID- 10144850 TI - Dialogue: should any willing provider laws become a mandate for behavioral healthcare? Consumer and payors require customization and choice of network products. AB - To reiterate, if managed behavioral health plans or delivery systems wish to offer products that include AWP, they should be able to do so. This is typical of indemnity and POS products. Conversely, if they wish to offer products with selective networks, they should be able to exercise this option also. If the principle of market choice in selection of a product can be allowed to operate, it will tell us what products are valued. The available evidence so far indicates that consumers (patients) are as satisfied or more satisfied with their treatment when it is delivered in a selective network (e.g., HMO) as when they are in an AWP network (e.g., fee for service). There is a great deal of change (and opportunity) for providers in managed behavioral healthcare today, not unlike transitions in other professions which have undergone significant changes (e.g., manufacturing, crafts, farming). The stresses that are creating greater efficiency, accountability and innovation in mental health and substance abuse service delivery are also causing provider anxiety and altered practice styles and lifestyles. While managed behavioral health plans and delivery systems need to be sensitive to these stresses within the provider community, it is not the responsibility of any organization to assure a group of workers that they will always be paid for doing what they did in the past, in the way they did it in the past. Given the pace of our growing knowledge about behavioral healthcare, that would be an irresponsible objective.(ABSTRACT TRUNCATED AT 250 WORDS) PMID- 10144851 TI - Business coalition initiatives related to behavioral healthcare purchasing and quality improvement. AB - Across America there are over 90 employer health coalitions, and their ranks are growing. Their members can be businesses located in a city, a region or a state, while a few encompass employers located in multistate regions. Coalitions may include only private-sector employers, or private- and public-sector employers; some are coalitions between employer purchasers and providers. Following a brief historical overview, this article summarizes the behavioral healthcare initiatives that are currently under way in six business coalitions. PMID- 10144852 TI - Medicaid cuts raise threat of cost shifting and undertreatment. PMID- 10144853 TI - Quality indicators measured by behavioral group practices. PMID- 10144854 TI - A guide to public constituencies. PMID- 10144855 TI - Judging, trusting, and utilizing outcomes data: a survey of behavioral healthcare payors. PMID- 10144856 TI - Computer applications for the selection of optimal psychosocial therapeutic interventions. PMID- 10144857 TI - The role of provider credentialing in quality-of-care improvement and clinical risk reduction. PMID- 10144858 TI - Leadership for change in behavioral healthcare. PMID- 10144859 TI - Materials management--a department of one. AB - This article is the result of long and serious thought about the future direction of healthcare and, more specifically, of materials management. As a number of trends emerge, particularly those that already exist in other industries, potential applications of these trends may also apply to materials management. While not all of these concepts and ideas are currently in practice in healthcare settings, the purpose of this article is to initiate thought, conversation, and evaluation of these models and applications. PMID- 10144860 TI - Planning equipment acquisitions. AB - As the mire of healthcare reform continues to grow, many providers are developing an insatiable appetite for alternatives to the way they currently do business. For some, solutions come in the form of repackaging the same old stuff. Others have jumped recklessly into every managed, capitated, or reformed idea that has come along. Old-school thinkers are still awaiting government direction. Providers of quality healthcare face increasing demands on their shrinking capital funds. An aging population, indigent care, AIDS patients, medical waste disposal, nursing shortages, declining reimbursement, increasing labor costs, and the federal healthcare reform threat have negatively affected cash flow. Though previous cost-plus reimbursement encouraged wasteful spending, the threat of healthcare reform has already caused providers and suppliers alike to work together to cut costs even without government mandates. The impact has been the closure of over 600 facilities nationwide in the past ten years. More than 70,000 acute care hospital beds have been lost from the US healthcare system. Many healthcare facilities have merged into managed care systems, integrated delivery networks, and regional alliances whose costs can be consolidated and controlled. At the same time, new services and profit centers are also being created to increase revenue. A healthcare moves into alternative care environments--home care, ambulatory care, diagnostic testing--these providers need more capital equipment to serve an increased patient load. Coupled with an aging installed base of technology in the acute care environment, healthcare managers face an ever-growing need for capital equipment and creative financing programs to meet longer payment options.(ABSTRACT TRUNCATED AT 250 WORDS) PMID- 10144861 TI - Wise purchasing under healthcare reform. AB - Group Health Cooperative of Puget Sound (Seattle, WA) believes that wise purchasing practices contribute both to cost efficiency and high quality healthcare delivery. At Group Health Cooperative, we came by this belief through a variety of forces all pushing for healthcare reform--legislative-, market-, and consumer-driven forces. At nearly fifty years of age, Group Health Cooperative of Puget Sound is the oldest health maintenance organizations (HMO) in the country. As in the beginning, Group Health is still a consumer-governed cooperative that has grown to over 400,000 enrollees, 44,000 of whom are seniors. The Co-op has a mixed staff/group/network physician model. Its 1994 budget was over $1 billion, with Medicare revenue accounting for about 30% of the budget. For nearly its first four decades, Group Health was just about the only show in town. If you wanted prepaid healthcare or independent consumer oversight for quality of care, you joined Group Health. But by the mid-1980s, there were over twenty other managed care competitors. Some were local health plans with a sideline managed care business, but, increasingly, competitors included huge, national, for-profit corporations. In addition, two other streams of change pressured healthcare in the Seattle area and elsewhere--legislative and market reform. In Washington, legislative reform started in 1989 with the Basic Health Plan, a program to aid the working poor by subsidizing their healthcare insurance premiums based on financial need.(ABSTRACT TRUNCATED AT 250 WORDS) PMID- 10144862 TI - Vendor partnering: VHA and Source, Inc. PMID- 10144863 TI - Service options under managed care: how to reap savings. PMID- 10144864 TI - Federal prime vendor project ready to ride. PMID- 10144865 TI - Ethics--wants, needs, and costs. PMID- 10144866 TI - In closing ... threat to the vitality of our nation's academic medical centers. PMID- 10144867 TI - Behind the curve: a critical assessment of how little is known about arrangements between managed care plans and physicians. AB - Extraordinary growth in managed care arrangements over the past decade has been both widely praised and criticized. Proponents and critics agree that the nature of medical practice is being profoundly altered by this growth, even if they cannot articulate the direction and consequences of this change. We explore the roots of this uncertainty by examining the available evidence on critical features of the arrangements managed care plans currently have with affiliated physicians. Our approach is to review and synthesize the literature in several key substantive areas from a broad range of sources. We found that existing knowledge is dated, derived form a limited subset of plans, inattentive to important structural differences between plans, and responsive to a very narrow set of issues poorly reflecting the range of medical practice and change introduced by managed care. We highlight key questions of interest and the knowledge gaps critical to address so that policy and management decisions can both reflect and be informed on these issues that define the arrangements managed care plans make with physicians and ultimately influence medical practice. PMID- 10144868 TI - Indications for hysterectomy: variation within and across hospitals. AB - This study investigates the factors associated with the probability of finding specific clinical indicators (benign or malignant tumor, cancer in situ, fibroid, abscess/empyema, or positive culture of salpinx, fallopian tube, fetus, or uterus) that validate necessity for hysterectomy. Data for the 4,660 cases in the study come from 42 Pennsylvania hospitals. The probability that validating indicators were present varied significantly at the hospital level but not at the level of individual surgeons within hospital, suggesting that physicians in different hospitals adopted different practice styles. The results at the hospital level indicate that higher hysterectomy volume increased the probability of validating findings, whereas presence of an OB/GYN program was associated with lower probability of validating findings. The policy and management implications of these results are discussed. PMID- 10144869 TI - Subacute care, Medicare benefits, and nursing home behavior. AB - Two policy changes in 1988, one administrative and one legislative, allowed greater Medicare coverage of subacute care in skilled nursing facilities (SNFs). The Medicare Catastrophic Coverage Act (MCCA) of 1988, in conjunction with an administrative directive, or transmittal, from the Health Care Financing Administration (HCFA), changed the Medicare SNF benefit structure substantially. In this study, we specified a simultaneous equation system to explain the effects of the benefit changes on Medicare use. The results suggest that the two policy changes increased Medicare use in Pennsylvania SNFs substantially; however, the increase was associated with facility and case mix characteristics, which suggest that the increase was largely attributable to reclassification of current patients from other payer categories, Medicaid and self-pay, rather than new admissions. The effects of the MCCA and the HCFA transmittal on increased Medicare use were unanticipated and have important implications for the way in which subacute care is defined and financed in future benefit discussions. PMID- 10144870 TI - Who belongs to HMOs: a comparison of fee-for-service versus HMO enrollees. AB - As employers have turned to managed care to curtail the rising cost of health care benefits, the number of HMO enrollees has proliferated. Between 1984 and 1994, HMO enrollment increased from approximately 15 million to over 49 million individuals. Although research has indicated that HMOs have been effective in limiting medical costs, there is mixed evidence in the literature on how they achieve these savings. This article uses data from the 1987 National Medical Expenditure Survey to examine one hypothesis for these patterns: that HMOs enroll a healthier population than fee-for-service plans. To test this hypothesis we examine HMO and fee-for-service enrollees with respect to socioeconomic variables such as age, race, sex, income, education, health status, and location. Our results indicate that HMOs tend to enroll a younger but not much healthier population than traditional fee-for-service plans, suggesting that self-selection is not a major contributor to HMO cost savings. PMID- 10144871 TI - Design and feasibility of a national Medicaid Access Survey with state-specific estimates. AB - This article presents the results of a study to design and assess the feasibility of conducting a national Medicaid Access Survey to generate timely, state specific estimates of access to care for Medicaid enrollees. State-specific data on Medicaid access is especially relevant because state programs and environments vary considerably and are changing rapidly in ways that could influence access. We analyze (1) basic survey design parameters and instrument content, (2) alternative sampling approaches and their feasibility, (3) pilot test results, (4) the feasibility of using existing national surveys to generate comparison estimates for state-based surveys, and (5) estimates of the required sample size and costs for such a national Medicaid Access Survey. We conclude that a survey generating timely, state-specific estimates of Medicaid access is both feasible and affordable if attention is paid to key design challenges while keeping objectives and design simple. PMID- 10144872 TI - Designing a disease management program: how to get started. AB - To successfully design and implement disease management programs, clinicians must understand the disease's natural course and cost drivers, base the diagnosis and treatment on the disease process and not the reimbursement schedules, educate and reinforce compliance to improve treatment outcomes, and focus on commonly occurring and costly chronic diseases. This article describes a 7-step process for developing a disease management program based on those concepts. The changing role and functions of the P & T Committee in disease management programs are also presented. PMID- 10144873 TI - Criteria-based antimicrobial i.v. to oral conversion program. AB - Collaborative efforts among several departments and the P & T Committee resulted in an IV to oral conversion program for select antimicrobials in our 580-bed county teaching hospital. This criteria-based program was designed to monitor and educate physicians on the appropriateness of parenteral antimicrobial prescribing, ensure rapid transition from IV to oral therapy, and contain costs. In the first 2 months of the program, 78 patients were converted from IV to oral administration with an estimated savings of $12,935. Of the ordering physicians, 66 (84.6%) accepted the interventions. All patients who switched administration routes were successfully treated with an oral agent. This program also has had a positive effect on patient outcomes and physician prescribing habits. PMID- 10144874 TI - Dosing guidelines for foscarnet and trimetrexate. AB - The P & T Committee at Trinity Lutheran Hospital, a 320-bed, community/teaching hospital in Kansas City, MO, has developed dosing and monitoring guidelines for foscarnet sodium (Foscavir) and trimetrexate glucuronate (Neutrexin)--two drugs used to treat patients with opportunistic infections associated with the human immunodeficiency virus (HIV). Presented in this Experience Brief is a short discussion of these drugs, the rationale for guideline development, and the actual dosing and monitoring protocols devised. PMID- 10144875 TI - Do UK charities have a lot to learn? AB - This article discusses the key findings of some recent research carried out into the application of market segmentation in the UK charity sector. 410 of the top performing charities (as ranked by income from voluntary donations) were surveyed to profile their major donor groups. Respondents were also asked to indicate how this data was used for fund-raising purposes both in terms of new donor recruitment and existing donor development. The findings show that with the exception of a very few large organizations, the UK charity sector still has much room for improving the sophistication of its fund-raising techniques. PMID- 10144876 TI - Development policies: protect your image. PMID- 10144877 TI - Special events: are they worth the trouble? PMID- 10144878 TI - Special events: where is institutional integrity? PMID- 10144879 TI - Turning lemons into lemonade. PMID- 10144880 TI - Video: bringing the message home. PMID- 10144881 TI - Resident director or on-demand consultant? You decide. PMID- 10144882 TI - Charitable giving on the rise. PMID- 10144883 TI - Disease state management: it's gotta be different for kids. PMID- 10144884 TI - Mercy's "rags to riches" comeback centered on health system's vertical integration. PMID- 10144885 TI - Sachs Group data helps health care organizations plan, market and manage. PMID- 10144886 TI - Providers can slow HMOs' Medicare growth. PMID- 10144887 TI - Strategic planning futurists need to be capitation-specific and epidemiological. AB - Strategic planning has always been a proposition of envisioning an organization's future state, then working backward, quarter by quarter, year by year, to plot a course of action. The surer the vision, the surer the course. In our burgeoning capitated environment, the successful provider will clarify a singular vision: to manage health care for a defined population. The key will be to understand the changing needs of covered lives and to prepare the organization to serve those needs. Gone are the days when mere responsiveness to market needs and preferences could secure a hospital's competitive advantage. Nimble, surefooted, practically clairvoyant--the emerging health care leader will listen to reliable epidemiologic information and custom-design its future. Timing is everything. Depending only your market's readiness for capitation, epidemiologic research and planning techniques may not prove critical to your organization for five to seven years. Good thing, too, because a few years may be just the head start many hospitals and health care systems need. Now is the time to lay the groundwork, to cultivate new planning techniques that will work under capitation, and to jettison any outdated modes of strategic thinking. Assemble all the talent and knowledge you need, then give your best minds ample room to do their work. PMID- 10144888 TI - Inspector General issues home health fraud alert. PMID- 10144889 TI - Department of Justice challenging big insurers' "Most Favored Nation" clauses. AB - The DOJ's latest actions suggest that MFNs in managed care contracts should be evaluated on a case-by-case basis, focusing on the actual or potential impact that the MFNs have on price competition among providers and payors in the relevant marketplace. For health care providers desiring to avoid MFNs, however, the DOJ's heightened activity in this area might furnish an appropriate reason to resist such clauses. To date, the DOJ's focus has been on the market power of payors with MFN status. However, the DOJ's reasoning applies equally to providers that wield buying power in contracting with others. Although the DOJ has yet to take up this latter issue, MFNs imposed by increasingly powerful provider organizations can expect to receive similar scrutiny from the DOJ, especially as their market influence grows. PMID- 10144890 TI - Litigation by patients as third party beneficiaries of payor-provider contracts. AB - "No third party beneficiaries" clauses, if drafted with care, can offer some measure of protection to providers. Although courts may give minimal weight to "boilerplate" clauses in determining contractual intent, a more detailed and substantive clause may be more persuasive. In drafting such clauses, however, care should be taken to clearly state the specific intentions of the parties, including the scope and purposes of the contract, the identity of the intended beneficiaries, and the classes of persons that are to be excluded as beneficiaries (e.g., HMO enrollees). PMID- 10144891 TI - Issues raised by respiratory therapy arrangements. AB - In large part due to the foregoing issues, Medicare program officials have focused on respiratory therapy as an area with great potential for abuse, and may well introduce significant reforms in the near future. Accordingly, any contractual arrangements for respiratory therapy programs of the type discussed above should be carefully reviewed for compliance with Medicare requirements and for a realistic assessment of the parties' potential exposure to liability under the anti-kickback statute. At a minimum, these agreements should provide for short "without cause" termination provisions, or include a so-called "jeopardy" provision that permits the parties to renegotiate or terminate their contract if significant changes occur in, or if the current arrangement is found or threatened to be found to violate, applicable law. PMID- 10144892 TI - Corporate compliance and voluntary disclosure. AB - In any event, the decision to institute a corporate compliance program is a relatively simple one. In view of the ambiguity surrounding certain fraud and abuse provisions, and the corporate "death sentence" that may result from program exclusion, a compliance program is always sound corporate policy. To be sure, if the compliance program is administered improperly, it can actually increase the likelihood of whistleblower actions and create a body of potentially hurtful documentation. But these dangers can be minimized by structuring the program to protect the self-evaluative process through relevant privileges. The risks also pale in comparison to the exposure to criminal or exclusionary sanctions when improper conduct goes undetected by an organization. PMID- 10144893 TI - Really governing: what type of work should boards be doing? AB - Effectiveness is generally defined as "doing the right things." To be effective, boards of health systems and hospitals must have a clear, precise, and shared image of the type of work they should be doing to really govern their organizations. This article forwards a paradigm of board work--the five ultimate responsibilities and three core roles of governance. The paradigm is then employed to discuss the division of responsibilities and roles among boards and their standing committees, and superordinate and subordinate boards in tiered governance situations typical of many multifacility and integrated health care delivery systems. PMID- 10144894 TI - The adoption of corporate restructuring by hospitals. AB - This study investigates factors associated with the adoption of corporate restructuring by hospitals in Massachusetts, where restructuring occurred much more rapidly than it did nationally. Drawing on studies of management innovation in hospitals, this article hypothesizes that early adopters will differ from those that adopt later on the basis of individual and organizational factors, and that institutional forces will explain later adoption. The findings show no differences between early and later adopters but do show that after an intense period of restructuring, hospitals became less likely to adopt the innovation. The article concludes with a discussion of the impact of reimbursement laws on the adoption pattern and the implications for the diffusion of management innovation, particularly under health care reform. PMID- 10144895 TI - Medical staff consolidation issues and concerns. AB - In the past decade there have been increases in health care consolidations. While the literature on hospital mergers is abundant, there is little on mergers of medical staffs. In this study, we interviewed senior administrators in 22 midwestern medical institutions that had consolidated between 1987 and 1990. Our study is an exploration of topics of concern that administrators have encountered during processes of medical staff consolidation. Administrators stated that the medical staff was most concerned about relationships with nursing and support staff, "turf" issues, and a sense of loss. They recommended that increased attention be paid to specific local issues and that there be active involvement and communication between medical staff and administrators at all phases of the consolidation process. PMID- 10144896 TI - A model of voluntary turnover among hospital CEOs. AB - This study examines factors contributing to hospital CEOs' voluntary decisions to leave their positions in 1990. Using a longitudinal design, we contrast 49 leavers with 1,362 stayers. We view turnover as influenced by both "push" factors that promote leaving (dissatisfaction with the position) and "hump" factors that need to be overcome (the cost of job change). Push factors giving rise to dissatisfaction include lower compensation, the predecessor's termination, and value incongruity between the CEO and the hospital. Testing the impact of key variables from Fiedler's contingency theory of leadership, we show that task oriented leaders are relatively less satisfied when compared with relationship oriented leaders. CEOs also express less satisfaction in low-situational control settings, a measure heavily influenced by perceived inadequate support from medical staff and subordinates. "Hump" factors that deterred leaving included family-related obstacles such as spouse's work or children's school, features mentioned most often by younger CEOs. The study suggests that boards should structure competitively paid positions with opportunities to generate support from the medical staff and subordinates. Recruiters for CEO positions are apprised of the importance of nonwork features in CEOs' willingness to consider new positions. PMID- 10144897 TI - A decision support system for hospital bed assignment. AB - This article presents the use of a computer-based decision support system for hospital bed assignment. The specific computer application discussed involves the development of an expert system, which mimics the decision-making process typically used by experts in a field. Expert systems are useful as consultants for problems that are best approached from the perspective of an expert. The prototype expert system presented in this article can be used to efficiently assign hospital beds to specific patients at the time of hospital admission or during the hospital stay. This assignment is based on a matching process by the expert system of patient needs and hospital bed characteristics. Data needed for this assignment are routinely collected at admission and updated during the patient's stay in the hospital. Use of this computer-based decision support system in conjunction with existing hospital information systems will result in more effective management of physical and human resources. As may be expected, any improvement in efficiency of use of resources will have an associated reduction in cost. Implications of using expert systems for future practice are also discussed. PMID- 10144898 TI - The role of knowledge utilization in adopting innovations from academic medical centers. AB - A literature review and an exploratory survey were conducted to find out about knowledge utilization activities in academic medical centers. Structured interviews were conducted with one respondent in each of ten selected programs in one center and were followed by qualitative data analysis concerning types of knowledge utilization activities and their effectiveness, and barriers and incentives to the success of knowledge utilization. Suggestions are provided for ways administrators in both academic and community medical centers may increase their effectiveness in using knowledge utilization strategies to promote the adoption of innovations. PMID- 10144899 TI - Physician practice acquisitions: valuation issues and concerns. PMID- 10144900 TI - Implementation strategies of patient-focused care. PMID- 10144901 TI - Something in common. PMID- 10144902 TI - Managed care comes of age. PMID- 10144903 TI - A lively learning agenda. AB - It started with little, but telling, incidents. Like the time a utility company employee phoned the hospital to inquire about its cardiac package. Someone in the admitting office told him: "I'm not aware of any such plan, sir. By the way, what is a PPO anyway?" Then, about three years ago, an internal survey on managed care education confirmed an organization-wide knowledge gap in this area: Only 4 percent of directors and 7 percent of executives claimed to have a clear understanding of managed care. These were among the wake-up calls that became the impetus for a comprehensive education program at Borgess Medical Center, a 426 bed regional referral center in Kalamazoo, Michigan. PMID- 10144904 TI - Building a case for team learning. AB - The materials are heaped on the ground: pieces of plywood, ropes, PVC pipes, tarps, a saw. Twelve people--physicians and administrative leaders from Presbyterian Healthcare Services in Albuquerque--appraise the pile. Their assignment: Build a structure into which all 12 people will fit; one that will be wind-proof, rain-proof, and sun-proof; and that will house their traveling library (about $500 worth of books). By the time they are finished, this group will have begun to experience the pleasures and problems of team learning. And over the next six months, they will have occasion to reflect back on their common experience as it reverberates through the life of their organization in ways they cannot now foresee. PMID- 10144905 TI - Creating learning environments. AB - The Healthcare Forum Journal has compiled this compendium to serve as a resource in building learning organizations. Our aim is to help healthcare organizations, policymakers, and others (payers, providers, patients, physicians, and citizens) rethink the system of healthcare delivery by opening up a dialogue--the ideas presented in Sandra Seagal's interview, ?The Pillars of Learning?, provide the groundwork for understanding how human dynamics impact learning, and the further resources section offers readers an annotated bibliography on the subject, as well as a listing of organizations that focus on systems thinking and how to create organizations that continually learn. PMID- 10144906 TI - Welcome to virtual learning. PMID- 10144907 TI - Built to last. Interview by Joe Flower. PMID- 10144908 TI - Altared states. PMID- 10144909 TI - A marriage saved. PMID- 10144910 TI - Technology, medicine & health, Part 7. The age of holistic molecular medicine. PMID- 10144911 TI - Modern imaging suite began as a cafeteria. PMID- 10144912 TI - Team players. Patient-centered care creates new roles for support staff. PMID- 10144913 TI - The walls don't have to come tumblin' down. Sometimes renovation is the best answer to your needs and budget. PMID- 10144914 TI - Twice around. Savings in the used telecom market. PMID- 10144915 TI - Northern and southern exposure. PMID- 10144916 TI - A plan for proposals. The role of facilities planning in winning research grants. PMID- 10144917 TI - Capital decisions. What is your boss thinking? Discussion. PMID- 10144918 TI - ASHE (American Society for Healthcare Engineering), JCAHO team up to settle 15 controversial issues of care. PMID- 10144919 TI - Environmental rules and regs: time and money well spent? PMID- 10144920 TI - Help injured workers get back on their feet quickly. PMID- 10144921 TI - Waste away: how does your disposal method compare? PMID- 10144922 TI - Foundation of the American College of Health Care Administrators. Shaping your future workbook. PMID- 10144923 TI - Hospital usage of marketing research over a ten year period. AB - The acceptance and use of marketing techniques and concepts in the health care area is a phenomenon well known to most marketers. Prior to 1979, marketing in the health care field was relatively unknown. Since that time, however, the growth of health care marketing has not been accompanied by commensurate growth in marketing research efforts. PMID- 10144924 TI - Envisioning excellence: an architectural approach to healthcare facility planning and design. PMID- 10144925 TI - Strategically positioning tomorrow's hospital today: current indications for strategic marketing. PMID- 10144926 TI - The marketing implications of a hospital scheduling system. PMID- 10144927 TI - Health care in the future may be as close as your neighborhood retail store: the case of Mount Sinai Hospital, Chicago. AB - The hospital industry nationwide has undergone tremendous changes over the past several years. As a result, hospitals have had to develop new marketing strategies for survival, diversifying their services and seeking new non-hospital sources of revenue. This case study focuses on the successful development of the Family Health Corners, a pair of primary care medical practices sponsored by Mount Sinai Medical Center (Chicago) and located inside Zayre Department Stores. PMID- 10144928 TI - The aging of America and health care marketing: making use of generalized knowledge. PMID- 10144929 TI - Hospitals contracting with managed care. AB - It has been observed that enrollees in managed care systems such as health maintenance organizations (HMOs) and preferred provider organizations (PPOs) have lower utilization rates and lower expenditures than those in conventional fee-for service health insurance programs. To date, no study has investigated this issue by examining providers. This paper studies whether lower cost hospitals are more likely to sign contracts with HMOs and PPOs and thus explain the observed lower utilization rates and lower expenditures by HMO and PPO enrollees. A logistic regression is applied to the data from the 1988 AHA Annual Survey of Hospitals. The results show that private hospitals, teaching hospitals, hospitals accredited by JCAHO, hospitals with high case mix index, and hospitals located in MSAs are more likely to contract with HMOs and PPOs than their counterparts. If hospitals with these characteristics have higher costs, then the results do not suggest that hospital costs can explain the lower utilizations and lower expenditures by HMO and PPO enrollees. PMID- 10144930 TI - Perceptions of responsiveness in service delivery. AB - The delivery of service quality has become a topic of increasing interest especially in the context of health care services marketing. The research investigated the responsiveness component of quality service. Both issues, the customers' perception of time as well as their expectations for responsiveness in quality service delivery were addressed. Specifically, an attempt was made to determine if the patients' perception of bell response time differed from the actual response time. In addition, this paper tried to determine if the difference between patient's perception of bell response time and actual response time had an effect on their perception of the responsiveness of the nurse. PMID- 10144931 TI - The need for implementing TQM in the health care industry: an empirical investigation. AB - The U.S. health care industry is facing an era of increased competition, declining profits, decreed hospital utilization, and consolidation. By reviewing existing literature on the application of total quality management in the health care industry, and by surveying a hospital in which this technique has been recently applied, this paper shows that service providing organization can indeed use the same methods used by manufacturing organizations to increase quality. PMID- 10144932 TI - Revenue enhancement through total quality management/continuous quality improvement (TQM/CQI) in outpatient coding and billing. AB - To survive and thrive, rural hospitals are seeking enhanced revenues. This study focuses on outpatient laboratory and radiology coding and billing accuracy in a nonrandom sample of seven rural hospitals in a Western state. Information was gathered on (1) procedures incorrectly coded, (2) potential revenue increases from correct coding and billing, (3) barriers to implementing changes, and (4) perceived audit value. The identified major source of potential revenue enhancement was increased fees from private payers. Correct coding and billing to Medicare and Medicaid offered the potential of additional revenue. Participating administrators appreciated the validation of coding and billing practices and identification of potential enhanced revenues. Five of seven hospitals (71.4%) selectively implemented recommended changes. Complete compliance with recommended changes was limited by barriers of tradition, competition, and reimbursement, which must be overcome to realize successful implementation. Joint Commission on Accreditation of Healthcare Organization's (JCAHO) new Total Quality Management/Continuous Quality Improvement (TQM/CQI) emphasis provides an opportunity for revenue enhancement through coding/billing assessments and interdepartmental focus and coordination. PMID- 10144933 TI - Changing consumer perceptions in healthcare marketing. AB - This paper serves as a survey of how hospitals are looking for new and innovative ways to market their hospital (E.R.) to the consumer. Traditionally, the Emergency Department in a hospital was the area that consistently lost money. Today more than ever, MBA's and other business professionals are being hired by hospitals in order to reverse this spiraling trend. This paper deals with hospitals across the U.S. who have employed many new and exciting ways of marketing a service to the consumer in a way that has never been done before. PMID- 10144934 TI - FDA a main culprit in delayed access to technology. PMID- 10144935 TI - "A picture is worth ...". PMID- 10144936 TI - How to thrive--not just survive--with managed care. PMID- 10144937 TI - The practicalities of moving a hospital lab. PMID- 10144938 TI - Training CLIA inspectors using TQM strategies. PMID- 10144939 TI - Medicare cuts threatening hospitals, nursing. PMID- 10144940 TI - Study identifies 'better performers' in the OR. PMID- 10144941 TI - What does it take to be a best performer? PMID- 10144942 TI - New glutaraldehyde labeling controversial. PMID- 10144943 TI - OR staff files suit over sexual harassment. PMID- 10144944 TI - Medical imaging equipment matrix. A resource guide for purchasing medical imaging equipment. AHRA Western Region, American Healthcare Radiology Administrators. PMID- 10144945 TI - Enhancing library services: an exploration in meeting customer needs through total quality management. AB - Total Quality Management (TQM) is a process which focuses on understanding customer needs and improving customer service and satisfaction. A TQM committee was created at the Devereux Foundation's Professional Library to assess user satisfaction and make recommendations for improving library services to better meet consumer needs. The committee distributed a satisfaction survey to 156 of the most likely library users and 84 (54%) were returned. Overall, survey results indicate that most consumers are satisfied with the materials and services provided by the Professional Library. Recommendations for improving library services and strategies for implementing these recommendations are discussed. PMID- 10144946 TI - Putting off the surgery on Medicare. PMID- 10144947 TI - Informed consent process streamlined by telephony and imaging solution. PMID- 10144948 TI - New communications system for hospital staff. PMID- 10144949 TI - Are the health reforms working? PMID- 10144950 TI - MidCentral gets to grips with its information. PMID- 10144951 TI - Developing a comprehensive program to implement the Safe Medical Devices Act. PMID- 10144952 TI - New roles for outcomes data in physician practices. AB - In the new environment of providing health care for a population and competing for contracts with other providers, information is the key to success. Hospital providers are using comparative data for internal improvement efforts and to market their efficiency and effectiveness to plans and employers. Health plans are using comparative data to monitor performance and to evaluate providers. Physician groups need to manage their own clinical information--or they may end up being managed by it. PMID- 10144953 TI - Joint Commission appoints Council on Performance Measurement. PMID- 10144954 TI - Perspectives. More heat than light in Medicare anti-fraud debate. PMID- 10144955 TI - Perspectives. Health plans, teaching centers seek strategic alliances. PMID- 10144956 TI - Perspectives. Mapping boundaries between specialist and primary care. PMID- 10144957 TI - Perspectives. HHS, Republicans both defer to managed care industry. PMID- 10144958 TI - Occupational exposure to hazardous drugs. PMID- 10144959 TI - Toward a virtue-based normative ethics for the health professions. AB - Virtue is the most perdurable concept in the history of ethics, which is understandable given the ineradicability of the moral agent in the events of the moral life. Historically, virtue enjoyed normative force as long as the philosophical anthropology and the metaphysics of the good that grounded virtue were viable. That grounding has eroded in both general and medical ethics. If virtue is to be restored to a normative status, its philosophical underpinnings must be reconstructed. Such reconstruction seems unlikely in general ethics, where the possibility of agreement on the good for humans is remote. However, it is a realistic possibility in the professional ethics fo the health professions where agreement on the telos of the healing relationship is more likely to arise. Nevertheless, virtue-based ethics must be related conceptually and normatively to other ethical theories in a comprehensive moral philosophy of the health professions. If he really does think there is no distinction between virtue and vice, why, sir, when he leaves our house, let us count our spoons. Samuel Johnson PMID- 10144961 TI - Creating a communications plan for fund-raising success. Getting your message across to donors. PMID- 10144960 TI - Catastrophic fires of 1994. PMID- 10144962 TI - How to start a planned giving program. The right place, right time, and right method for planned gifts. PMID- 10144963 TI - Nailing down planned gifts when you're also the electrician and the plumber. Planned giving in a small shop. PMID- 10144964 TI - Endowed named funds--the ultimate relationship builders. PMID- 10144965 TI - Lessons from the turkey. A humorous look at special events that have flopped. PMID- 10144966 TI - Health care fund raising: new rules, new issues, new actions. PMID- 10144967 TI - Health care philanthropy: the CEO perspective. How this key leadership group defines institutional advancement. PMID- 10144968 TI - Not-for-profit and for-profit health care institutions. Making a clear and convincing case for support for voluntary, not-for-profit health care institutions. PMID- 10144969 TI - What does it take to be in control? PMID- 10144970 TI - 1995 AHIMA software guide. PMID- 10144971 TI - Approaches to statewide data consistency in Maryland for hospital-based rehabilitation. PMID- 10144972 TI - Medicare Conditions of Participation outline additional standards for healthcare providers. PMID- 10144973 TI - Getting started on the Internet. PMID- 10144974 TI - Sharpening your negotiation skills. PMID- 10144975 TI - Automation--do it right! PMID- 10144976 TI - How two small hospitals moved from analog to digital transcription. PMID- 10144977 TI - A guide to buying computer systems. PMID- 10144978 TI - Homeward bound: growth in home care industry opens door for HIM professionals. PMID- 10144979 TI - Rural cooperative coding project. AB - Data quality is the cornerstone on which other quality activities are built. The importance of accurately coded data cannot be overlooked. The Rural Cooperative Coding Project sought to collaborate with rural hospitals in Utah to improve the quality of that data through an individualized educational program allowing open and active discussions. We hope that this project has assisted rural facilities in building and enhancing their own ongoing coding and data quality improvement activities. PMID- 10144980 TI - Taking the bull by the horns: effectively planning for National HIM Week. PMID- 10144981 TI - Quality improvement in hospitals: how much does it reduce healthcare costs? AB - The philosophy of W.E. Deming suggests that continuous quality improvement efforts, when properly applied, ultimately will lead to financial dividends and will help ensure business longevity. Reducing hospital charges can be exciting for the participants and can provide an impetus for expanding quality improvement efforts. Americans, however, tend to demand almost instant gratification and have limited patience for longer-term results. This factor, coupled with minimal knowledge of actual operational costs and inaccurate charge accounting systems, may lead hospital managers to misinterpret the potential net long-term effects of their quality improvement efforts. In the approaching environment of capitated reimbursement, such mistakes may have serious consequences. PMID- 10144982 TI - Lessons learned while implementing service quality improvement. AB - The successful implementation of quality improvement (QI) in an organization requires the organization's executives to visibly and consistently demonstrate an understanding of and commitment to QI principles. One means of developing this understanding is to give executives firsthand experience with QI tools and skills. This article details the lessons learned by personnel at a large medical center during the implementation of QI initiatives and highlights some aspects of the role hospital executives must play in achieving QI. Whatever approach an organization chooses for the implementation of QI, the exercise of discipline to do what is right inevitably will lead to the improvement of quality. PMID- 10144983 TI - A rural hospital's use of software to determine accurate Medicare reimbursement levels. AB - This article details how a software program has helped a hospital collect more Medicare payments for which it was eligible than it previously had collected. The software simplifies the process of selecting complications by reminding the user when no complications have yet been entered, by determining whether each item entered qualifies as a complication, and by suggesting other possibilities. In many instances, these complications are possibilities that a person performing manual coding might not consider. PMID- 10144984 TI - An integrated approach to hospital strategic planning, quality assurance, and continuous quality improvement. AB - Like many other healthcare organizations today, the authors' facility, a 306-bed acute care community hospital in Michigan, strives to visualize and make a transition from traditional quality assurance to continuous quality improvement. The Juran Trilogy provided the insight that strategic planning, measurement, and continuous improvement must exist side by side. At the authors' facility, this realization resulted in the hospital quality plan, which treats each of these components as part of the foundation for quality. The authors explain this model and the reporting and communication mechanisms that support it. PMID- 10144985 TI - Reengineering the quality management process. PMID- 10144986 TI - Legislative forum: Maryland HEDIS report card project. PMID- 10144987 TI - Utilization management advancement system: a career ladder for nonclinical nursing. AB - This article describes a utilization management advancement system at the authors' facility that recognizes the staff members' levels of utilization management expertise and links them with the annual performance appraisal. After 2 years of brainstorming, analysis, discussion, and research, the utilization management nurses were able to define their practice in terms of functional domains that reflect levels of experience and competencies. The process of developing these levels and the performance appraisal standards is addressed. PMID- 10144988 TI - The origins and consequences of organ transplantation. Excelsior Surgical Society/Edward D. Churchill Lecture. PMID- 10144989 TI - Fellows identify key issues affecting surgery. AB - All changes in our health care delivery system during the past three years have had an effect on reimbursement rates, net income, and practice satisfaction among surgeons. Implementation of the Medicare fee schedule and increasing penetration of the health care market by managed care firms have clearly had the most profound influence. Sixty percent of practicing surgeons have experienced a decrease in net practice income since 1992. Of referrals from required gatekeeper physicians, 15 percent of such episodes are viewed by surgeons to result in decreased quality of care. Finally, there was a surprisingly high (40%) enthusiasm for implementation of a federalized single-payor health care system. PMID- 10144990 TI - The Maine demonstration project: using practice parameters as an affirmative defense. PMID- 10144991 TI - Accreditation of the office-based surgical facility. PMID- 10144992 TI - Case study. Middle managers at Connecticut's Middlesex Hospital resolutely scissor $14 out of every $100 in expenses. PMID- 10144993 TI - Employers recognize the need for better management of asthma. PMID- 10144994 TI - Setting the standards for asthma care. PMID- 10144995 TI - Data watch. The case for managing asthma care. PMID- 10144997 TI - MedPartners & Mullikin to merge. PMID- 10144996 TI - The cost of asthma. PMID- 10144998 TI - Humana buys EMPHESYS. PMID- 10145000 TI - Interface engines. PMID- 10144999 TI - National Jewish Center launching disease-management message. PMID- 10145001 TI - Clinicians, execs team up in system selection. PMID- 10145002 TI - User survey proves value of I/S strategy. PMID- 10145003 TI - Avoid shaky ground with a leap to new systems. PMID- 10145004 TI - Block grants--the inevitable fix? PMID- 10145005 TI - Big issues, big money, big stakes. PMID- 10145006 TI - Expert systems for third-party reimbursement: planting seeds for accuracy. AB - Predictably, the genesis of most business expert systems development is not related to one particular issue, but to a series of business issues that converge to form the basis for system design as either enhancements or overhauls. Rarely, if ever, is there a conclusion to the system's enhancement process, but rather, an ongoing evolution of the system as dictated by a multitude of both internal and external forces. The focal point of these processes must be to benefit our customers and the markets we serve. PMID- 10145007 TI - What is the difference between IS needs for fee-for-service & managed care organizations? PMID- 10145008 TI - America's most computer advanced PPOs--1995. PMID- 10145009 TI - The electronic data interchange: avoiding potholes to add value & power for payors & providers. PMID- 10145010 TI - Close encounters: tracking patient satisfaction. PMID- 10145011 TI - Family physicians vs. internists: who benefits more from managed care? PMID- 10145012 TI - To sell or not to sell: a tale of two practices. PMID- 10145013 TI - Why managed care should provide supportive therapies for cancer patients. PMID- 10145014 TI - The minefield after Marshfield: how to avoid antitrust violations. PMID- 10145015 TI - The Mick and the liver: is organ allocation fair? PMID- 10145016 TI - Cities where HMOs are strongest. PMID- 10145017 TI - Tips for your JCAHO survey. PMID- 10145018 TI - JCAHO & information management: complying with the standards, realizing the vision. PMID- 10145020 TI - Fundraising and hospital auxiliaries. PMID- 10145019 TI - The urgency of innovation. PMID- 10145022 TI - MHA: an active partner in community service. PMID- 10145021 TI - State-wide health care reform a challenge we cannot back away from. PMID- 10145023 TI - Kaleidoscope: changing phases. PMID- 10145024 TI - Aligning change with progress. PMID- 10145025 TI - Where now, health care reform? PMID- 10145026 TI - MHA, Mid-Michigan Hospitals, and Crossroads: a study in community involvement. PMID- 10145027 TI - Caring goes both ways at Lakeshore Community Hospital. PMID- 10145029 TI - Job re-engineering and cross-training: is Michigan ready? PMID- 10145028 TI - Glad you asked. What do you predict will be the best and/or worst thing to happen to health care in 1995? PMID- 10145030 TI - New directions for the Association and health care. Interview by Patrick Foley. PMID- 10145031 TI - Michigan's health care recruitment receives a boost from MOM (Medical Opportunities in Michigan). PMID- 10145032 TI - The Community Health Profiles Project. PMID- 10145033 TI - Safety first in Lansing. PMID- 10145035 TI - Can we make a difference? PMID- 10145034 TI - Working together to close the primary care gap. PMID- 10145036 TI - Benchmarking in human resources. PMID- 10145037 TI - Michigan hospital medians. Radiology--diagnostic. PMID- 10145039 TI - MHA--delivering on change. PMID- 10145038 TI - Working together for a healthy Michigan. PMID- 10145040 TI - Trends in health care delivery. PMID- 10145041 TI - Hutzel Hospital's road to success is paved with more than just good intentions. PMID- 10145042 TI - Getting a community health assessment and improvement initiative off the ground- lessons learned. AB - For the past eighteen months, the Michigan Health Care Institute has been administering the Rural Health Project--a W.K. Kellogg Foundation funded project to assist Michigan's rural communities with assessing and improving their health status and health care systems. During that time, MHCI staff have observed community health assessment initiatives all over the country. We have talked to the experts, the veterans, and the consultants; worked closely with the Michigan Department of Public Health to launch a state-wide community health assessment and improvement initiative; and been closely involved with Michigan's rural sites. The following is our best advice to those communities just beginning a health assessment and improvement initiative. It is the first in a two-part series about the process of improving community health. PMID- 10145043 TI - Glad you asked ... community-based health status assessment. PMID- 10145044 TI - Cover me, I'm going to the copy machine: violence in the workplace. PMID- 10145045 TI - Extra! Extra! Read all about it! PMID- 10145046 TI - What's next for auxilians? PMID- 10145047 TI - Physicians and hospitals: shared challenges for the future. PMID- 10145048 TI - Community partnership 'AIMs' to improve child health. Alliance for Immunization in Michigan. PMID- 10145049 TI - 'An apple a day' gets new meaning. PMID- 10145050 TI - Staying atop the waves of change. PMID- 10145051 TI - Meeting the challenge of health education. PMID- 10145052 TI - Squeezing the cantaloupe: the case for pre-employment testing. PMID- 10145053 TI - Primary care: new demands for a new era. PMID- 10145054 TI - Getting a community health assessment and improvement initiative off the ground- Part II: Easing your way into priorities and action plans. AB - The Michigan Health Care Institute administers the Rural Health Project--a W. K. Kellogg Foundation funded project to assist Michigan's rural communities with assessing and improving their health status and health care systems. We have talked to the experts, the veterans, and the consultants: worked closely with the Michigan Department of Public health to launch a state-wide community health assessment and improvement initiative: and been closely involved with Michigan's rural sites. The following is our best advice to those communities just beginning a health assessment and improvement initiative. It is the last in a two-part series about the process of improving community health. PMID- 10145055 TI - Healthy Michigan 2000: public health supports healthy communities. PMID- 10145056 TI - Glad you asked ... health care employment. AB - With mergers, managed care, mounting pressure to hold the line on costs, and the expansion of services outside of the hospital setting, health care employment patterns and practices are changing drastically. Employment security is no longer a given in the health care field. Based on these conditions, what changes do you currently see taking place in health care employment? PMID- 10145057 TI - Into the arms of safety. McLaren Regional Medical Center, Child Evaluation Clinic. PMID- 10145058 TI - Physician Partnership Project: social work case managers in primary care. PMID- 10145059 TI - Fitting subacute care into the continuum. PMID- 10145060 TI - SSI (Supplemental Security Income) for premature infants. PMID- 10145061 TI - Final rule on advance directives. PMID- 10145062 TI - Transplanting the physician partnership model. PMID- 10145063 TI - The supply chain vs. the food chain. Strategies for group purchasing organizations, suppliers, and customers in the managed care era. PMID- 10145064 TI - CSLT standards of practice. Canadian Society of Laboratory Technologists. Approved June 1995. PMID- 10145065 TI - Workplace violence. AB - Whether you work in the acute care, continuing care or outpatient setting, you cannot afford to ignore the effects of workplace violence. The costs are significant when you consider that they affect morale, productivity, service delivery, turnover and ultimately your financial success. Remember, a violent incident doesn't end when the incident is over. People must cope with the consequence of verbal or physical abuse and continual feelings of anger, guilt and fear. We must recognize workplace violence as a major occupational health and safety hazard. Most importantly, a program that reduces or eliminates violence requires an organizational and personal acknowledgment that violence towards employees is unacceptable. PMID- 10145066 TI - Competency-based objectives for clinical training. PMID- 10145067 TI - Student performance appraisal: an approach to evaluation of attitudes in medical laboratory technology students. AB - This paper describes the development and implementation of a new evaluation format for assessing professional attitudes in medical laboratory technology students--the performance appraisal. This tool measures attitudes considered desirable in the ?ideal technologist?, and links the presence or absence of these attitudes to behaviors which can be observed in the student. The performance appraisal functions not only as an evaluation instrument for instructors, but as a learning tool for students, who can identify behavioral objectives, assess their own progress, and set goals and strategies for development of professional attitudes. Details regarding the administration of the evaluation instrument, such as rating scales, remedial planning, and responsibilities of faculty, clinical coordinators, and students are presented. In addition, controversies regarding the evaluation of professional attitudes are discussed, including: optimizing instructor objectivity; timing and grading of evaluations; forwarding of evaluations from one instructor to another; identification of mandatory and desirable attitudes; and criterion referencing of objectives. Plans for future development of the system are included. PMID- 10145068 TI - The challenges and opportunities of multiskilling in health care. Canadian Association of Medical Radiation Technologists. AB - The pursuit of lower costs and greater efficiency in Canada's health care sector has led some governments and health care institutions to consider multiskilled workers as an option in health care reform and organizational restructuring. Multiskilled practitioners perform more than one main function, often in more than one discipline. This article explores various aspects of multiskilling and how it could affect, or already is affecting, medical radiation technologists and other allied health professionals. It discusses key issues and implications of multiskilling for governments, employers, educational institutions, professional associations, health care professionals, and patients. The article is based on a report released to members for discussion at the 53rd CAMRT Annual General Meeting. Copies of the full report are available on request from: CAMRT, Suite 601, 294 Albert St., Ottawa, ON K1P 6E6. Or, fax your request to: (613) 234-1097. PMID- 10145069 TI - A framework to develop a sexual abuse prevention program. AB - In 1993, the Province of Ontario proclaimed the Regulated Health Professions Act (RHPA) and 21 health profession acts, including the Medical Radiation Technology Act. Under the RHPA, 21 health care regulatory colleges were created to ensure that Ontario patients receive safe, competent and quality care. Programs administered by the colleges ensure that all patients are treated with dignity and respect, and include measures for preventing or dealing with the sexual abuse of patients. This article sets out a framework and discusses issues related to the development and implementation of a sexual abuse prevention program. Key components include: establishing a patient-relations committee, preparing a statement of philosophy, defining sexual abuse, setting guidelines for professional behaviour, and educating members, staff and the public. Other aspects of such programs include procedures for complaints and discipline, mandatory reporting and penalties, and funding for therapy and counselling for patients who have been sexually abused by members. PMID- 10145070 TI - Pharmacoeconomics of propofol versus thiopental for induction of anaesthesia in short procedures. AB - This study compared the costs and benefits of using propofol/fentanyl versus thiopental/fentanyl for induction of anaesthesia in short procedures. A prospective, cohort trial was conducted in conjunction with a patient survey. The study population included a consecutive sample of American Society of Anaesthesiologists. Class I or II patients who underwent short operative procedures and who were given one of the studied anaesthetic regimens. Insoflurane/N2O was used for maintenance of anaesthesia in all cases. Propofol patients showed a significantly shorter time to eye opening (p = 0.0025); orientation to date of birth, place, and day of week (p = 0.0002); time to consciousness (p = 0.0019); and time in recovery room (p = 0.013); but not time to tolerating 50 mL of oral fluid (p = 0.06). Nausea and vomiting occurred in 41% of thiopental patients and 19% of propofol patients (difference 22%; 95% C.I., 1% to 44%). Based on survey results, propofol patients subjectively reported fewer side effects upon returning home and were able to resume daily activities earlier than thiopental patients. With the current staffing and patient load at our institution, an estimated 4.8 hours of nursing time per day would be made available if propofol were used in place of thiopental for induction of anaesthesia in these procedures. If propofol were used for all daycare surgery patients in our institution, the annual acquisition cost is projected to be $60,331.28 versus $8,079.68 for thiopental.(ABSTRACT TRUNCATED AT 250 WORDS) PMID- 10145071 TI - Analysis of problems in a medication distribution system. PMID- 10145072 TI - A review of recent developments affecting COBRA rights. AB - Due to the high cost of health care claims and COBRA's status as remedial legislation, COBRA has generated a significant amount of litigation in recent years. While the early COBRA decisions tended to broaden the law in order to provide a remedy to an otherwise uninsured qualified beneficiary, the recent trend in the case law has been to limit the expansion of COBRA rights based on a narrower construction of the statute. Even so, COBRA still represents a legal minefield for employers. As a result, a careful employer will minimize its exposure by monitoring changes in the law and its interpretation and making appropriate modifications to its COBRA documentation and administration. This article discusses some of the more significant recent changes in the law affecting qualified beneficiaries' COBRA rights--and therefore, employers' exposure. PMID- 10145073 TI - Safe passage. Should basic EMTs be allowed to intubate? PMID- 10145074 TI - Campus chaos. See Johnny kill. PMID- 10145075 TI - Street smarts. The dangerous '90s call for greater vigilance and preplanning. PMID- 10145076 TI - Meeting the training challenge of cross-cultural differences. AB - So if your training and education needs are complicated with a workforce that more and more reflects national origins other than the United States, the following strategies may help: Use a "hands-on" approach. People learn and remember what they do. Use pictures to reinforce and clarify. Be consistent, patient, and respectful. Check regularly for understanding. Promote safety with consistency, careful listening, and a variety of oral, written, and pictorial media. Look for products that are easy to use and that reduce procedural steps. Simplify processes. Use color coding to decrease confusion. The changing demographics of the workforce create both challenges and opportunities. Successfully overcoming challenges such as establishing appropriate systems, training a diverse group of associates, and encouraging safe work habits can increase productivity, reduce costs, and generate a creative work environment. Suppliers and product manufacturers can often be valuable partners in this process. PMID- 10145077 TI - The growth of meta-analytic literature from 1980 to 1993. AB - A search of the literature was undertaken to estimate the number of meta-analytic studies that have been published in the social and health sciences to date. Altogether, 1,874 published quantitative reviews were located by the end of 1994: 892 in the health sciences, 982 in the social sciences. Trends from 1980 to 1993 indicate that, while the social sciences embraced the technique earlier, health researchers are now publishing almost twice as many meta-analyses as their social science colleagues. PMID- 10145078 TI - Meta-analytic methods for health services research--an example from geriatrics. AB - The authors recently published a meta-analysis of controlled trials of comprehensive geriatric assessment (CGA). The results supported the view that efficacy of CGA is strongly related to the patients, objectives, and basic design of CGA programs, and that particular program models and design features are associated with important health outcome improvements (e.g., survival, living at home, and functional improvement at follow-up). Present objectives include the outline of methods and how they were developed given the condition of the trial database and scientific context. Aspects of the approach, such as (a) survey of primary trialists to recover unpublished information and standardize data, (b) development of a program typology to guide the principal analysis, and (c) incorporation of program design features as covariates where statistical heterogeneity was detected, proved extremely useful, and have implications for other systematic reviews of similarly complex primary trials of new health care technologies, health services, and organizational interventions. PMID- 10145079 TI - Exploratory research synthesis--methodological considerations for addressing limitations in data quality. AB - Exploratory meta-analysis or research synthesis has been advocated as a way of developing important hypotheses for further study. An exploratory research synthesis was conducted on the carotid endarterectomy (CE) literature to illustrate this method. The CE scientific literature is similar to that of many other new medical interventions because it contains numerous limitations to data quality. Exploratory research synthesis of such literature necessitates a number of methodological and statistical considerations to address these limitations, including the problems of missing data, appropriate unit of analysis, nonnormal distribution of outcomes, and lack of controlled studies. Strengths and limitations of the exploratory research synthesis approach are discussed within the context of public policy decisions for assessing medical technologies. PMID- 10145080 TI - Misunderstanding meta-analysis. AB - Although it is increasingly common, meta-analysis is still a relatively new addition to the toolbox of research strategies. Partially because of its newness and partially because its early enthusiasts may have overstated its presumed contributions, a number of common misunderstandings have developed about the meta analytic approach. These misunderstandings have to do with the way that meta analysis is conducted and interpreted and its relation to primary research and narrative review. This article aims to highlight these misunderstandings and offer an alternative view of meta-analysis. It is hoped that meta-analytic research of the future will be a partnership with primary research and that meta analysis will be valued not so much for its definitiveness as for the creative speculations it allows about patterns that appear across studies. PMID- 10145081 TI - Understanding and using meta-analysis. AB - Meta-analysis represents a technique with almost limitless potential to improve the practice of persons in the health professions. However, the technique is not without limitations that deserve careful consideration when going over any meta analytic finding. The essay provides some perspectives on the possible uses of meta-analyses and standards that permit the evaluation of the worth of any particular meta-analysis. As with primary research, the meta-analytic reviewer must make a decision, and the consumer (reader) must evaluate those choices. This article offers an exploration of those choices and some of the potential consequences of those choices. PMID- 10145082 TI - Realizing the meta-analytic potential--a survey of experts. AB - A survey of 99 authors of meta-analyses conducted between 1988 and 1993 was undertaken to identify policies and products that might be helpful in the realization of the procedure's ultimate potential. Although a number of differences were found between medical and social/nonmedically related health scientists, the greatest degree of overall enthusiasm for both groups was observed for the need to educate journal editors and primary researchers regarding information that needs to be reported in an empirical study. The respondents were also in general agreement that a consensus should be developed and disseminated on minimum standards for published meta-analyses. A number of the other proposals were less popular, although an argument is made that some of these have actually come to fruition since the original survey was conducted. PMID- 10145083 TI - Opportunities were never better for fund raisers--but are they qualified? PMID- 10145084 TI - Development in the 90's. PMID- 10145085 TI - Grantwriting emergency preparedness. PMID- 10145086 TI - Enough is enough ... or is it? PMID- 10145087 TI - The rise of antibiotic-resistant infections. PMID- 10145088 TI - FDA examining computer diagnosis. PMID- 10145089 TI - Where the jobs are. PMID- 10145090 TI - Executive women confront midlife crisis. PMID- 10145091 TI - Developing a super PHO. PMID- 10145092 TI - Effective income distribution for employed physicians. PMID- 10145093 TI - Improving materials management through re-engineering. AB - Activities related to the purchase, distribution, and management of supplies account for about one-third of the operating costs of healthcare facilities. Under a free-for-service reimbursement system, the use of supplies generates revenue; there is little motivation to control supply costs, and the goal in most facilities is to ensure abundant availability of supplies to both patient care staff and patients. As the reimbursement picture changes, however, and supplies become expenses instead of revenue generators, facilities are being forced to scrutinize all activities, including materials management, that influence operating costs and to identify and seize cost-reduction opportunities. One approach to improving materials management to reduce the cost of supplies is re engineering. A successful re-engineering effort involves six basic steps: 1) recognizing the need for change, 2) establishing guidelines, 3) forming a team, 4) analyzing current processes and costs, 5) redesigning processes, and 6) implementing and managing the changes. In this article, a case study illustrates the possible benefits of re-engineering materials management processes. PMID- 10145094 TI - Clinical engineering helps reduce equipment costs. AB - Clinical engineering involves, among other activities, managing equipment repair and maintenance activities, assessing technology needs and potential equipment acquisitions, training users, negotiating service contracts, and optimizing patient-care equipment utilization. Effective clinical engineering programs can help healthcare organizations reduce the high cost of acquiring and maintaining patient care equipment. PMID- 10145095 TI - Survey provides data on practice acquisition activity. AB - In an effort to assess trends in the number and type of physician practices being acquired by healthcare organizations throughout the country and to gather information on related costs, HEALTHCARE FINANCIAL MANAGEMENT and Physician Services of America, Louisville, Kentucky, cosponsored the first national survey on trends in practice acquisition and integration. More than 5,300 senior financial executives in healthcare organizations and systems were surveyed. Thirty-six percent of respondents said that their healthcare organization had acquired practices in the past five years. Most practice acquisitions were in primary care; family practice physicians and groups were in high demand, with the Midwest the most active region in the country regarding family practice acquisitions. In addition, the survey gathered information about the considerations involved in acquisitions. Respondents cited strategic planning, communicating with medial staff, negotiating compensation packages, and managing productivity as reasons to pursue acquisition opportunities. PMID- 10145096 TI - Converting accounts receivable into cash. AB - In recent years, increasing numbers of healthcare providers have converted their accounts receivable into cash through a process called securitization. This practice has gained popularity because it provides a means to raise capital necessary to healthcare organizations. Although securitization transactions can be complex, they may provide increased financial flexibility to providers as they prepare for continuing change in the healthcare industry. PMID- 10145097 TI - Communication: an essential element in internal control. AB - In a healthcare organization, an internal control system segregates duties by function within the organization's financial operations. But segregating duties by function can result in poor internal communication that, in turn, can undermine an organization's internal processes and procedures. Effective communication can serve as an essential link between internal controls and operational effectiveness. PMID- 10145098 TI - FASB considers consolidation rules change. AB - The Financial Accounting Standards Board (FASB) is considering a change in rules concerning the circumstances when an organization must present consolidated financial reports with its related organizations. This change could affect healthcare providers that have related foundations or have profit-making affiliates such as a property management company, laundry company, or collection bureau. PMID- 10145099 TI - To centralize or decentralize? PMID- 10145100 TI - Understanding the job is the first step to quality. PMID- 10145101 TI - Management success: viewing mistakes as opportunities. PMID- 10145102 TI - Meeting the challenges of restructuring. Tips on surviving staff reductions. PMID- 10145103 TI - Developing an effective nutrition screening system. PMID- 10145104 TI - Que esperan los Hispanos de los servicios de salud? (What do Hispanics expect from health care?). PMID- 10145105 TI - New IRS physician recruitment ruling: a welcome relief. PMID- 10145106 TI - Funding. For richer, for poorer. PMID- 10145107 TI - Mental health. A promise of better things to come. PMID- 10145108 TI - General practice. MAAGic (medical audit advisory group) powers. PMID- 10145109 TI - Does working overseas damage your career? PMID- 10145110 TI - Pay. Savings grace. PMID- 10145111 TI - Community care. What price care? PMID- 10145112 TI - Primary care. All for one and one for all. PMID- 10145113 TI - 25 ideas for maximizing board effectiveness. AB - The ability to bring new board members up to speed quickly has always been a key determinant of board effectiveness. In today's marketplace, the challenge is even greater. You must prepare your entire board to navigate the rapidly changing healthcare landscape and to get out in front on challenges such as capitation, mergers and acquisitions, and integrated delivery systems. How can you make board education a successful, ongoing process, effectively delivering useful, current information in a scant amount of time? Healthcare Executive posed this question to a panel of practitioners and consultants, who offered the following 25 ways to maximize board effectiveness. PMID- 10145114 TI - Interview with the ACHE's new chairman. Interview by Ann C. Bartling. PMID- 10145115 TI - Physician compensation planning. PMID- 10145116 TI - What entitlement program cuts could mean. PMID- 10145117 TI - Ethics and the business of healthcare. PMID- 10145118 TI - Governance 1995: new hurdles to clear. PMID- 10145119 TI - Donor card registration system in Japan: an obstacle to procuring kidneys for transplantation. AB - Donor cards are a simple and effective way to give a consent to organ donation in cases of unexpected death. In Japan the prevalence of donor cards is low (0.4%) compared to the United States (24.6%), although about 50% of Japanese people are reported to be willing to donate their organs after death, a figure equivalent to the United States. We hypothesized that the donor card registration system can explain the low prevalence, and an introduction of a free delivery system will increase the prevalence. From April 1992 to April 1993, 402 high school students and 3391 workers in the Tokyo metropolitan area were requested to answer questionnaires; all the questionnaires were returned. Few respondents (15.5%) knew the way in which to be registered as a donor card holder. If donor cards were delivered freely and registration to carry a donor card was not required, 48.8% replied that they would be willing to carry donor cards. The most commonly cited reason for not carrying a donor card was 'I had no opportunity to get a donor card'. This study indicates that the introduction of free delivery of donor cards will increase the prevalence dramatically if a sufficient number of opportunities are offered. We recommend that a free delivery system should be introduced in order to increase the prevalence and secure the will of the deceased rather than the will of the family. PMID- 10145120 TI - Economic evaluation of health care and policymaking. AB - The interest in economic evaluation of health care programmes is steadily increasing, but the impact of economic evaluations on decisions concerning the allocation of resources to health care programmes is unclear. In this paper we examine different decision and policy situations where economic evaluation of health care programmes could potentially be used. Economic evaluation as an aid to: the development of treatment guidelines, decisions within health care organizations, introduction of new medical technologies, reimbursement decisions, and pricing decisions are examined. It is concluded that economic evaluation seems to be most useful in the development of treatment guidelines and as an aid to reimbursement decisions. The importance of the incentives to use economic evaluation embodied in the health care system is also stressed. It is argued that it is too early to introduce regulations that require the use of economic evaluation in for instance reimbursement decisions. A more cautious approach may be preferred with economic evaluation used more selectively until the methods and the field have developed further. PMID- 10145121 TI - The pursuit of equity: a health sector case study from Vietnam. AB - The health care system in Vietnam has long been cited as an example of primary health care that has worked well. The achievements of the system during the past decades have indeed been impressive, but the changing economic situation in Vietnam has consequences for all public sector activities, including health care. Liberalization of economic policies has encouraged private medical practice and free trade in medicines and drugs, while financial support for the state health system is decreasing. Equity has always been an important goal for the vietnamese health system, but it becomes harder and harder to realize under the new conditions of financing. The restrictions in centralized planning and funding brought about by recent changes also reveal weak points in the system, from planning to training to management at the different levels. This situation is discussed and issues concerning policy, legislation and human resources are highlighted in terms of their effect on equity. PMID- 10145122 TI - The European health potential: what can we learn from each other? AB - In this paper global differences in health between the 12 countries of the European Union are compared and related to variations in so-called determinants of health, especially socio-economic and life style factors and characteristics of the health care system in each country. This leads to two main conclusions. The first conclusion is that the health differences that exist within the European Union can only be partially explained by variations in determinants of health. Still, the comparison offers intriguing clues for improving health, containing cost and further research in the European Union. The second conclusion is that considerable data on health and determinants of health are collected in each country, but that international comparability is still limited. The ongoing activities in the standardization of European data collection need our full support. PMID- 10145123 TI - Assessment of health producing measures across different sectors. AB - To date, economic evaluation of health producing measures has concentrated on health care treatments and technologies. However, it is increasingly being recognized that many health promoting measures are in other sectors, such as education, safety programmes, income maintenance and improvements to the physical environment. This paper examines the principles of assessing health promoting measures across different sectors and reviews current practice. Such assessments pose methodological challenges not often encountered in health care evaluations, in framing the evaluation, in identifying, measuring and valuing costs and benefits, and in interpreting results. It is concluded that intersectoral economic evaluation is unlikely to provide a complete technical solution to the problem of allocating resources within and between sectors of the economy, but that the application of an economic way of thinking could yield benefits. Five proposals are made for taking matters forward. These include undertaking more pilot studies, insisting on a minimum data set to justify spending plans and increasing the incentives for intersectoral collaboration. PMID- 10145124 TI - Suture price ships pass in the night. PMID- 10145125 TI - Premier/AmHS merger could alter purchasing landscape. PMID- 10145126 TI - Food service cost per patient day increases slightly. PMID- 10145127 TI - Early postpartum discharge: a public policy issue? PMID- 10145128 TI - A new social contract. Catholic healthcare leaders rethink their relationship with employees. AB - The sea changes that have occurred recently in economics, technology, and social order have profoundly disturbed the relationships between organizations and their workers. The promise of lifelong employment--once the foundation of the "social contract" between employer and employee--has evaporated. The dissolution of this social contract has led managers of Catholic healthcare organizations to ask, if we can no longer guarantee lifelong employment, then what is our relationship with employees? Participants in two think tanks sponsored by the Catholic Health Association's Center for Leadership Excellence addressed this question. Participants in the first think tank (i.e., one senior executive and several human resources professionals from Catholic healthcare systems) agreed that a new social contract with employees was needed, one of mutual responsibility to replace the paternalistic relationships of the past. To begin constructing such a contract, the group articulated a set of values held by Catholic healthcare regarding employees. Based on the values they identified, participants in the first think tank drafted the "Social Contract for Turbulent Times." Participants in the follow-up think tank expanded this draft contract in the "Elements of a New Relationship Agreement with Employees." PMID- 10145129 TI - Commitment to diversity. A system's diversity program prepares it for the future. AB - Three years ago the president/chief executive officer of Franciscan Health System of Cincinnati, Inc., developed a vision in which diversity would be the key to a major cultural shift of the organization. In April 1993 the system formed a Diversity Steering Committee to establish an infrastructure for a healthy, multicultural environment. The committee outlined two key objectives: to develop consensus around a vision of diversity for the organization, and to conduct research to determine the organizational culture with regard to diversity issues. By 1994 diversity had become one of the system's 10 strategic initiatives, and a Diversity Department had been added to the corporate structure. The Diversity Steering Committee developed a three-year management action plan that includes seven major goals: Demonstrate the corporate commitment to diversity Educate, train, build, and support a diverse organization Communicate the importance of diversity Create a diverse work force Track diversity progress Establish accountability for diversity implementation Build loyalty with diverse external customers. PMID- 10145130 TI - Hospital layoffs. One facility's experience with a work force reduction. AB - In 1994 the conversion of Tennessee's Medicaid program to managed care sharply reduced the census of all Memphis hospitals, including St. Joseph Hospital and Health Care Centers. St. Joseph's Operations Leadership group (OLG) decided that expenditures must be cut by $8 million-$6 million of it coming from wages and salaries--so the hospital could enter fiscal year 1995 with a balanced budget. With the help of a consulting firm, the OLG determined that the wage and salary cuts could be realized by laying off a certain number of employees. All workers were told, in a series of round-the-clock meetings, that 162 jobs (22 managers and 140 hourly workers) would be eliminated in nine days. The hospital's labor relations attorney approved the criteria according to which workers would be dismissed. On the designated days (one for managers, another for rank-and-file workers), the layoffs were completed in an organized manner. The OLG had arranged with a private firm to set up a career placement center for the dismissed employees. Of the 162, 105 took advantage of the center's services. Thirty-five of those (21 percent) had new jobs within 45 days of the layoffs. The OLG was straightforward with the local media about the layoffs. Hospital leaders calmed remaining St. Joseph workers' anxieties with a series of follow-up meetings. These sessions also provided the OLG with useful feedback on the way it had conducted the layoffs. PMID- 10145131 TI - Guidance for a failing system. Catholic social teachings provide the needed principles. AB - Catholic healthcare has traditionally relied on four major ethical principles- nonmaleficence, beneficence, autonomy, and justice--to address conflicts between various goods. However, all healthcare now finds itself facing great changes. "Principleism" is too limited to guide the Church's health ministry through the current crisis. But the Church possesses a body of social justice teachings that may provide healthcare with the necessary guidance. Eight inseparable but distinct themes are found in the social teachings: human dignity, human solidarity, the option for the poor, the common good, human rights, social justice, stewardship, and liberation. The eight themes are here applied to five critical healthcare issues: the patient-physician relationship, the right to choose, healthcare as a communal good, rationing and limits, and work and its implications. The Church's social teachings may provide us with a basis for a structural reexamination of healthcare--including Catholic healthcare. In that analysis, we may find that Catholic healthcare has developed practices and standards that are at odds with its own teachings. Such an analysis will be painful, but it must be done. PMID- 10145132 TI - Care for the beginning of life. The revised Ethical and Religious Directives discuss abortion, contraception, and assisted reproduction. AB - Part 4 of the Ethical and Religious Directives for Catholic Health Care Services- which discusses such controversial issues as abortion, contraception, and assisted reproduction--is informed by a profound respect for human life and the institution of marriage. The controversies are familiar. But many in Catholic healthcare may be less familiar with the principles underlying Church teaching on these issues. Appropriate interpretation and application of these directives require that all concerned be educated in both the theological-ethical and the clinical dimensions of care giving. Directives 38 through 43 deal with reproductive technologies such as in vitro fertilization and surrogacy. Directives 52 and 53 express the Church's consistent teaching on contraceptive interventions. Directives 45 to 48, 50 to 51, and 54 reiterate the Church's firm stance on the inviolability of human life, including nascent human life. However, the directives also say that not all medical interventions resulting in fetal death are prohibited abortions. However, appropriate regard for human life, marriage, and the family require more than mere adherence to the directives' prescriptions and proscriptions. Ethics committees in Catholic healthcare should study clinical data as well as theological materials. PMID- 10145133 TI - 1995 Achievement Citation winners and nominees. Archbishop's Commission on Community Health, St. Louis, MO; Domestic Violence Task Force, Spokane, WA; Project MotherCare, New Haven, CT. PMID- 10145134 TI - Promoting self-care. PMID- 10145135 TI - Soft skills: who needs them? PMID- 10145137 TI - Uncertain demand, the structure of hospital costs, and the cost of empty hospital beds. AB - In this paper we reformulate the theory of cost and production to take account of uncertain demand facing a firm. In the reformulated theory the duality between cost and production no longer obtains, and demand distribution parameters enter the cost function as well as the traditional outputs and input prices. We then estimate a short run cost function for a hospital facing uncertain demand using data from a national sample of over 5000 hospitals for the years 1983-1987. The traditional cost model is strongly rejected in favor of the reformulated model. This model is used to calculate the cost of empty hospital beds, controlling for the effect of uncertain demand on the structure of hospital costs. The cost of an empty hospital bed is calculated as $36,443 in 1987 dollars. We estimate that a one percent decrease in the number of hospital beds would decrease hospital costs by slightly over one-third of one percent. Increasing the occupancy rate from the average 1992 level (65 percent) back to the average 1980 level (76 percent) is estimated to save the average hospital over $2 million, or 9.5 percent of costs. PMID- 10145136 TI - Physician ownership of ancillary services: indirect demand inducement or quality assurance? AB - This paper analyzes two competing explanations for the ownership of ancillary facilities by referring physicians: indirect demand inducement and quality assurance. Consistent with the demand-inducement explanation we find physician owned clinics treat patients for 50 percent more visits than do independent clinics and the differential is directly related to factors facilitating demand inducement. We find no difference in quality of care across ownership structures, however. In further support of the demand-inducement hypothesis we find that physical therapists are less likely to work in physician-owned clinics in states where therapists are allowed to practice independently. PMID- 10145138 TI - Is moderate alcohol use related to wages? Evidence from four worksites. AB - Moderate alcohol users (approximately two drinks per day on average) have recently been shown to have a lower risk of coronary heart disease relative to abstainers and heavy drinkers. Conversely, a few studies have found that alcoholism is associated with greater unemployment and lower earnings. But, little research has examined the differential effects of drinking levels on job compensation. We utilize a newly created database on employees at four worksites to test for a nonlinear relationship between alcohol use and wages. We also examine whether alcohol use affects wages indirectly through educational achievement, marital status, and poor health. Our findings suggest an inverse U shaped relationship between alcohol consumption and wages with a peak at approximately 1.5 to 2.5 drinks per day on average. Thus, controlling for other variables and conditional on working, moderate alcohol users have higher wages than abstainers and heavy drinkers at these worksites. We also find evidence that alcohol use is related to wages through human capital variables. PMID- 10145139 TI - Priority setting in health care: an axiomatic bargaining approach. AB - This paper examines how axiomatic bargaining theory can be used to analyze different rules for dividing the health care budget between two patients. This approach allows an explicit statement of the assumptions underlying the division rules and also provides a general characterization of the consequences of using these rules when the opportunity set (or number of patients) changes. PMID- 10145140 TI - Estimating treatment cost functions for progressive diseases: a multiproduct approach with an application to breast cancer. AB - Using the theory of multiproduct cost functions, a treatment cost function is derived for diseases which progress through a number of stages. The output classes are conceived as the stages at detection of the disease, with the unit of output within each class being the treated case. The derivation clarifies the assumptions underlying various specific functional forms for the treatment cost function. An empirical application to the treatment of breast cancer is provided, producing evidence on an important issue in the economics of screening programs, viz. whether detection of breast cancer at an earlier stage results in treatment cost savings. PMID- 10145141 TI - The welfare loss of disease and the theory of taxation. PMID- 10145142 TI - Economics, health and health economics: HYEs versus QALYs--a response. PMID- 10145143 TI - The Daily Point of Light Awards: an analysis of recipients and effects. AB - During his presidential administration, George Bush used the phrase "points of light" to connote and promote voluntary service. His program to honor those with exemplary service with a Daily Point of Light (DPOL) Award attracted great publicity--but no systematic analysis. Accordingly, this article presents the first comprehensive examination of the DPOL recipients, and the possible effects the Award had for strengthening and publicizing their voluntary activities. The analysis is based on a review of the press releases describing each recipient of the Award and a mail survey of this group administered by the authors. PMID- 10145144 TI - Volunteer and paid long term care ombudsmen: differences in complaint resolution. AB - Data are reported from a pilot study of the ombudsman reporting system in one southeastern state. The focus of this article is the relationship between types of complaints investigated and resolved by both paid and volunteer long-term care ombudsmen operating under various auspices. Statistically significant differences exist between the resolution of complaints by volunteer and paid ombudsmen. Data are discussed in terms of the implications of these differences for the implementation of a federal mandate to increase citizen participation in long term care facilities. PMID- 10145145 TI - Training volunteers to deliver a breast health programme. PMID- 10145146 TI - The power of special friends: addressing the risk of child abuse through mentoring. AB - Since 1989 two Saint Paul, Minnesota agencies have carried on a collaborative effort called the Befriender Volunteer Project. This project is designed to address the risk factors associated with child abuse which are often inherent in families headed by an adolescent. Between November of 1993 and October of 1994 a self-study of this project was conducted. An important objective of this study was to determine how the positive elements of a successful relationship affected the risk factors in these young families. Consistent with what we know about the effects of successful helping relationships, most significant improvements in young mothers were found in the areas of hopefulness, self-esteem, and parenting skills. Of significant note was the observation of the various ways the Befriender/young mother relationship enhanced the young mothers' potential for breaking the generational cycle of risk for child abuse and neglect. PMID- 10145147 TI - Medicare faces identity crisis as program turns 30 years old. PMID- 10145148 TI - Managed care, Part 1. The managed care era strikes the lab. PMID- 10145149 TI - Laboratory automation, Part 2. Total lab automation: system design. PMID- 10145150 TI - Turn problems into gold with the team approach. PMID- 10145151 TI - Hospital groups seek united front. PMID- 10145152 TI - Accord near in dispute over earthquake claims. PMID- 10145154 TI - Columbia U., Cornell deny rumors of pending merger. PMID- 10145153 TI - AHA suffers building sale snafu. AB - By relocating its Chicago headquarters to a new building before selling its old two-building office complex, the American Hospital Association has been stuck with two leases to pay. According to AHA records, the snafu may be costing the association nearly $3 million annually in unnecessary expenses. PMID- 10145155 TI - Suit aims to block L.A. County closures. PMID- 10145156 TI - Kaiser in N.C. to start mixed-model plan. PMID- 10145157 TI - Insurer surveys distress hospitals. PMID- 10145158 TI - Sutter, CHS join to battle Kaiser in Calif. PMID- 10145159 TI - 3 bishops urge Ohio system to shun Columbia. PMID- 10145160 TI - Columbia deal in Va. to require hospital sale. PMID- 10145162 TI - Home-care product revenues on rise. PMID- 10145161 TI - VA officials convening to outline system revamp. PMID- 10145163 TI - Not-for-profit system aims to rival Columbia in Florida. PMID- 10145164 TI - Fla. not-for-profits dispute Columbia report. PMID- 10145165 TI - Financial services firm goes public. PMID- 10145166 TI - HCFA drops capital-payment hike. PMID- 10145168 TI - Columbia planning more closures. PMID- 10145167 TI - IRS watching for deal inducements. PMID- 10145169 TI - AMA expands, renames its medical staff section. PMID- 10145170 TI - 'Hospital RTC' proposed to protect N.Y. facilities. PMID- 10145171 TI - Medicaid woes threaten states' credit ratings. PMID- 10145172 TI - Hospitals relying more on outpatient income to boost profits--index. PMID- 10145173 TI - Healthcare costs are still near top of executives' worry list. PMID- 10145175 TI - Hawaii governor woos Mayo Clinic. PMID- 10145174 TI - OccuSystems, Henry Ford join to treat work injuries in Mich. PMID- 10145176 TI - W.Va. seeks fix for Medicaid program. PMID- 10145177 TI - Catholic merger OK'd in Wichita, Kan. PMID- 10145178 TI - Major K.C. hospital systems may be considering merger. PMID- 10145179 TI - Military recommends healthcare overhaul. PMID- 10145180 TI - Plan would redistribute Medicare GME funds. PMID- 10145181 TI - Marshfield antitrust ruling ignored full market analysis. PMID- 10145182 TI - Outsiders on the inside track. AB - Modern Healthcare's annual Contract Management Survey reveals that hospitals are casting an ever-more-critical eye on their basic services to see what they can and cannot do well. Those that can be done cheaper and better by outsiders are likely to be handed over to the mushrooming contract management system. PMID- 10145184 TI - Oregon plan covering Medicaid patients is off to rough start. PMID- 10145183 TI - Siegel resigns post at N.Y. HHC, denies harassment charges. PMID- 10145185 TI - Medicaid HMOs change ways in response to state rules. PMID- 10145186 TI - Nursing home probe's findings misleading, industry sources say. PMID- 10145187 TI - Lucrative market at heart of three-way battle in Texas. PMID- 10145188 TI - The Medicaid debate: beyond the numbers. PMID- 10145189 TI - Subacute care. Critical pathways link services to outcomes. PMID- 10145190 TI - Negotiating risk using resident agreements. PMID- 10145191 TI - Quality of Life Award. Northwood Healthcare Center. PMID- 10145192 TI - Quality of Life Award. Sombrillo Nursing and Rehabilitation Center. PMID- 10145193 TI - Quality of Life Award. Arbors Care Center. PMID- 10145194 TI - Turning their backs on geriatrics. PMID- 10145195 TI - Training for quality across the facility. PMID- 10145196 TI - Agency clarifies discharge rules. PMID- 10145197 TI - Hospice care allows death with dignity. PMID- 10145198 TI - How facilities can avoid the flu season. PMID- 10145199 TI - Medicaid growth cap unfair to states. PMID- 10145200 TI - Off the record, computers, and more on new ideas. PMID- 10145201 TI - A small OPL (on-premise laundry) that generates big savings. PMID- 10145202 TI - A note on HYE (healthy years equivalent) AB - This note presents a simplified description of the Healthy Years Equivalent (HYE) health outcome measure. I examine the claims made for the HYE and discuss their theoretical validity. The HYE is shown to be conceptually flawed because of confusions between the measures of value and the things being valued. Under close inspection the unnecessarily complicated multiple stage valuation used to determine the HYE is seen to be no more than an indirect way of asking the Time Trade-Off. For this reason the claimed superiority of the method over the Quality Adjusted Life Year (QALY) is rejected. PMID- 10145204 TI - The need to manage emergency department revenues. PMID- 10145203 TI - Procuring organs from a non-heart-beating cadaver: commentary on a case report. AB - Procurement of organs from non-heart-beating cadaver donors raises concerns. Standards for optimal patient care during withdrawal of life-sustaining therapy are evolving and continue to be debated and studied. Consensus on specific procedures and methods has not been attained, however, and protocols for the procurement of organs from patients following the withdrawal of life-sustaining therapies may compromise the evolving standards and harm the patient and the attendant family. In addition, there is little evidence to suggest that such protocols will significantly increase the number of organs procured. "Non-heart beating cadaver" protocols that do not give comprehensive attention to optimal patient/family care at the time of withdrawal of life-sustaining therapy ought not to be endorsed. PMID- 10145205 TI - Cures or 'quackery'? How Senator Harkin shaped federal research on alternative medicine. PMID- 10145206 TI - Respiratory care in the era of preventive medicine. PMID- 10145207 TI - Using fax machines can lower receivable days. PMID- 10145208 TI - Strategies for boosting outpatient care profitability. AB - With outpatient charges approaching one-fourth of hospital revenues nationwide, healthcare providers are pressed to handle this care more efficiently and profitably. Five steps toward healthier profit margins for outpatient services involve finding ways to expand volume and market share; setting and meeting strict quality standards; studying operational efficiency; working with physicians to improve productivity; and monitoring price-cost relationships. PMID- 10145209 TI - Assessing the feasibility, performance of geriatric clinics. AB - Geriatric outpatient clinics offer a way for healthcare providers to add Medicare patients and better manage their care. Opening a new clinic, however, requires a substantial commitment from hospital executives and a sizable investment, sometimes including an operating subsidy until clinic volume can cover initial expenses and continuing operations. Hospitals considering such a move should weigh the strategic effects on medical staff members; assess competitors; conduct a detailed marketing analysis; and forecast expenses and revenues. PMID- 10145210 TI - How to improve allocation of support service costs. AB - Better accounting for support service costs at outpatient facilities involves distinguishing between fixed and variable expenses, then creating separate budgets for them. To simplify this step, financial managers can create a surrogate, such as the number of patient visits, to represent service activity. Once this is completed, separated costs are allocated by using criteria that recognize short-term and long-term service use. PMID- 10145211 TI - How proposed financial statement rules would affect hospitals. AB - The Financial Accounting Standards Board (FASB) is soliciting comments on proposed standards for financial statements for tax-exempt organizations. Most of the recommendations that would affect healthcare organizations concern cash flow statements. Once comments are received on this initial step in formulating new reporting guidelines, FASB will issue an exposure draft of the proposals prior to their adoption. PMID- 10145212 TI - Medicare GME regulations: a challenge for teaching hospitals. AB - As a result of new regulations, teaching hospitals face reduced payments from Medicare for graduate medical education costs. In light of the new rules, teaching hospitals must consider reallocation of overhead costs among their existing programs. And many will be forced to reexamine the economics of their education programs and seek out new sources of funds. PMID- 10145213 TI - Cash budgeting leads to better cash management. PMID- 10145214 TI - Portfolio insurance offers protection against risk. PMID- 10145215 TI - Poor risk assessment can doom new ventures. PMID- 10145216 TI - Hospital's programs talk for patients who can't. PMID- 10145217 TI - Patient hotline offers money-back guarantee on service. PMID- 10145218 TI - EDI holds potential for cutting receivables processing costs. PMID- 10145219 TI - How investors evaluate the creditworthiness of hospitals. AB - Responding to health care's turbulent economy of the 1980s, investors in hospital bonds have revised the way they conduct a hospital credit analysis. This new thinking is reflected in a 10-step method that examines the hospital's operating margin and cash from operations; its Medicare and Medicaid receivables; occupancy and admission levels; security provisions of the bond; and other important factors. Healthcare financial managers can use the analysis as a guide to self assessment. PMID- 10145220 TI - Capital management balances charitable, financial goals. AB - Effective capital management allows not-for-profit healthcare organizations to make investment decisions that fulfill their missions and meet financial goals. The process involves identifying components of the hospital's value and creating policies aimed at maximizing it; determining the hospital's ability to produce financial capital; and developing a process for allocating this financial capability among the components of value. Once this is completed, hospitals should determine criteria that balance charitable and financial goals, enabling them to pursue sound investments. PMID- 10145221 TI - Profitability: comparing hospital results with other industries. AB - Changes in healthcare economics now permit more meaningful financial comparisons between hospitals and other industries. A study focusing on return on equity and other financial ratios highlighted critical changes needed to improve the fiscal health of hospitals. These suggestions include increasing net prices on existing product lines, entering new markets, using short-term debt to relieve long-term debt burdens, and expanding uses of operating leases. PMID- 10145222 TI - Empowerment managers promote employee growth. AB - Organizations that encourage individual abilities and hold employees accountable for achieving goals are more likely to succeed. Groups that take an empowerment approach to management prefer action in place of further study; decisions made by subordinates rather than managers; personal responsibility instead of strict rules; and specific rewards for achievement, not broad gestures of thanks. PMID- 10145223 TI - Tips on how and when to use written communication. PMID- 10145224 TI - How do you motivate staff members? PMID- 10145225 TI - Outwitting, controlling stress for a healthier lifestyle. AB - When managed effectively, stress can lead to more productive, creative, and successful lives at home and in the workplace. Through exercise, relaxation, and a network of social support, stress can be managed and channeled. Other attributes of a healthy, stress-managed lifestyle include good nutrition, a sense of humor, and strong communication and time management skills. PMID- 10145226 TI - Despite victory in Vermont, tax exemption battle continues. PMID- 10145227 TI - Using probability to evaluate managed care contracts. PMID- 10145228 TI - Mutual funds offer investment benefits. PMID- 10145229 TI - Five steps toward stronger organizations. PMID- 10145230 TI - Gaining control of the uncontrollable in preadmissions. PMID- 10145231 TI - PRRB chairman discusses board's role, case load. Interview by Ronald R. Kovener. PMID- 10145232 TI - Strategic plans provide lasting solutions to rural crisis. AB - Strapped for money and time, many rural hospitals could be tempted by temporary fixes to their financial struggles. Strategic planning helps develop a broader, long-range blueprint for survival. Its steps include making financial evaluations of services; undertaking market and patient origin studies; assessing competitors; involving community leaders; and defining possibilities for joint projects and facility mergers. PMID- 10145233 TI - Swing beds: a strategy in rural hospitals' fight to survive. AB - More rural hospitals now have the opportunity to offer long-term care services under the expanded Federal swing-bed program. The ability to use inpatient beds for acute care or skilled nursing care can, in many cases, help rural hospitals improve their occupancy levels and increase revenues. However, hospitals must be aware of the need to closely monitor costs. PMID- 10145234 TI - Military contracts present growth opportunities. AB - Healthcare organizations interested in new markets should consider military contracting opportunities now available in many areas of the United States. To ensure a competitive bid, however, knowledge of military procurement procedures and bidding demands is needed. Like any other venture, doing business with the Federal government depends on the capabilities of the organization and the nature of the services to be provided. PMID- 10145235 TI - Applying Japanese management tips to patient accounts. AB - "Just in time," a Japanese management philosophy that has been applied successfully in manufacturing operations, also can be used to improve management of patient accounts departments. Under its principles, healthcare organizations would develop standardized procedures; involve workers in decision making; set up training and education programs aimed at creating a multi-skilled pool of workers; establish smooth production schedules; and foster cooperation and commitment to the philosophy throughout the organization. PMID- 10145236 TI - Nurse extenders offer a way to trim staff expenses. AB - Troubles confronting hospital nursing--from a national shortage of nurses to low morale, high turnover, and rising costs of replacing and retaining staff members- require creative approaches and a rethinking of traditional primary care nursing. Nurse extender programs place non-nursing tasks in the hands of technicians trained to deliver meals, transport patients, take vital signs, and perform other patient care tasks. PMID- 10145237 TI - Washington takes steps to help rural hospitals. PMID- 10145239 TI - How U.S. Treasury, agency debt comes to market. PMID- 10145238 TI - Daily index offers snapshot of financial health. PMID- 10145240 TI - Team approach ensures better strategic plans. PMID- 10145241 TI - Cooperative care units reduce patient care costs. PMID- 10145242 TI - New board offers potential relief for some hospitals--Medicare Geographical Classification Review Board. PMID- 10145243 TI - The ventilator of the 1990s. PMID- 10145244 TI - Mechanical ventilation and respiratory care in the home in the 1990s: some personal observations. PMID- 10145245 TI - How to tighten the reins on workers' compensation costs. PMID- 10145246 TI - A global view essential when making investments. PMID- 10145247 TI - Nurses, administrators exchange jobs for a day. PMID- 10145248 TI - Three documents help control the uncontrollable. PMID- 10145249 TI - Strategic plan creates a blueprint for budgeting. AB - Effective healthcare organizations develop budgets that reflect and support a strategic plan. Senior managers set a framework that expresses the hospital's future strategic objectives. The budget enables executives to determine which specific service lines are profitable or unprofitable. Administrators and clinicians at all levels are involved in the budgeting process. PMID- 10145250 TI - Financial plan charts a hospital's course for success. AB - A strategic financial plan is a healthcare organization's corner-stone for carrying out goals set by executives, board members, and the medical staff. If properly developed, the plan ensures that operational decisions support established financial goals. A typical plan follows a hospital's traditional statement of revenues and expenses, setting priorities and objectives for each component. PMID- 10145251 TI - Six myths that can cloud strategic vision. AB - Strategic planners must guard against relying on false assumptions that interfere with organizational growth. Six myths that can sidetrack innovative strategy are: Higher occupancy means improved financial performance; the growing elderly population will fill empty hospital beds; physical assets define hospital capacity; "enhance payer mix" is a truly strategic objective; information is power; and capital is a limiting resource. PMID- 10145252 TI - Turning around financially distressed hospitals. AB - Just as a hospital's financial distress seldom results from a single mistake or catastrophe, its recovery involves a complex interplay between leadership, resources, and strategic action. To create a turnaround plan aimed at restoring a hospital to fiscal health, management must appoint a steering committee to oversee the effort; complete a thorough assessment of damage caused by financial problems; reduce operating expenses such as staffing and supply costs; and take steps to improve cash flow. PMID- 10145253 TI - Providers forecast 5-year construction spending. AB - Results from a national survey of hospitals and long-term care facilities project construction plans for the first half of the 1990s. The survey was conducted by the author for the Merit Shop Foundation of the Associated Builders and Contractors. Using a constant measure of average anticipated spending per bed, the findings are compared by facility sizes, building ages, bed utilization, facility ownership, and occupancy rates. PMID- 10145254 TI - Survey: more CFOs see financing as a challenge. PMID- 10145255 TI - Appropriate rewards are key to motivation. PMID- 10145256 TI - Healthcare executives as symbolic leaders. PMID- 10145257 TI - Commitment, time critical to patient accounting. PMID- 10145258 TI - A method for determining capital investment strategies. PMID- 10145259 TI - Relaxed mail standards could slow receivables. PMID- 10145260 TI - Creating a culture of success. PMID- 10145261 TI - Charity options allow donors to keep property interests. PMID- 10145262 TI - Hospital's nurse registry fills in staff gaps. PMID- 10145263 TI - Chairman calls for advanced standards. PMID- 10145264 TI - Wilensky seeks dialogue with providers. Interview by Richard L. Clarke. PMID- 10145265 TI - How to improve information system installations. AB - The complex and often bumpy path toward installing a new information system can be smoothed out by following practical advice on managing the project and working with system vendors. Tips include using a project management system, involving all levels of a hospital's management, testing and retesting applications, screening prospective installers, declining to be a system's first user, resisting efforts to rush an installation, and making sure a vendor completes its share of the workload. PMID- 10145266 TI - Making the most of information system consultants. AB - Choosing an information system consultant can be as critical as finding the right hardware and software. To increase efficiency and reduce wasted time, hospitals should evaluate the chain of events consultants traditionally follow in helping their clients select information systems. Hospitals should be aware of ways to streamline the process and should consider potential conflicts of interest that can arise if consulting firms have ties to vendors or system installers. PMID- 10145267 TI - Justifying costs of computer software purchases. AB - To help complete the often cumbersome task of justifying costs of software purchases, health-care financial managers should follow a multi-step process. This involves determining an organization's information system needs, evaluating vendor offerings and system benefits, assessing the value of system benefits, and determining returns on investments in new systems. PMID- 10145268 TI - Payment changes require integrating records. AB - The greatest challenges for healthcare organizations facing radical changes in their payment and reporting structures lie in finding ways to integrate various forms of patient information. An analysis of how three New York City hospitals dealt with their state's switch to an all-payer diagnosis related group-based payment system reveals strengths and weaknesses in their existing information systems and in steps taken to adapt to the change. PMID- 10145269 TI - Electronic claims can be a remedy for cash flow troubles. AB - Electronic claims processing systems and their related applications have the potential to speed payments from insurers and other payers to healthcare providers. Various services are available, including direct data entry terminals, software created by hospital information system vendors, and electronic claims processing clearinghouses. A clearinghouse allows providers to interface with insurer databases. PMID- 10145270 TI - Database marketing targets existing patients. AB - Clinical database marketing systems are designed to give hospitals a way to expand in existing markets by approaching regular patients for clinically valid follow-up services. Hospitals use knowledge of disease progression and treatment side effects to contact patients for additional services. Special care should be taken to protect patient confidentiality and to ensure that ethical and legal issues are properly addressed. PMID- 10145271 TI - Task force backs ambulatory payment adjustments for hospitals. PMID- 10145273 TI - Is charity care revenue? PMID- 10145272 TI - As the twig is bent. AB - The trauma of having no home imposes unique health problems on families, especially children. Homeless children are more subject to infectious diseases, are more in need of immunizations, and have more growth and developmental problems than children growing up in nurturing environments. A study of the homeless in St. Louis found that increasingly they are families headed by single women who had to leave their homes mainly because of overcrowding. A study of data obtained from healthcare clinics set up at shelters showed that the mean age of homeless children was 4.9 years; the mean number of months they had lacked a permanent residence was more than four. Healthcare screenings showed that chronic health problems, such as asthma and anemia and deficits in growth and development, were among the top 10 diagnoses. Less serious problems like colds and lice were more prevalent, however. Intelligence tests administered to homeless children showed that they had three times the cognitive and developmental problems that would be expected among children in general. PMID- 10145274 TI - Uniform accounting standards enable accurate comparisons. PMID- 10145275 TI - After the fall: reasons behind 1989 hospital closings. PMID- 10145276 TI - Leasing can add flexibility to asset management. AB - Better management of high-technology assets begins with an understanding of a healthcare organization's goals and the equipment it needs to meet them. Under the right conditions, leasing can shift economic and technological risks of equipment obsolescence from healthcare organizations to leasing companies. Steps involved in a leasing decision include reviewing a hospital's equipment acquisition plans; conducting cost-benefit analyses, determining useful and product lives of desired equipment; and watching the market for potential technology changes. PMID- 10145277 TI - Watch for pitfalls when analyzing lease options. AB - Seemingly minor provisions included in leases of major equipment can substantially increase a healthcare organization's expenses. When reviewing lease bids, financial managers should beware of commitment fees, progress payment interest, residual value, and other variables in the agreement. On the whole, the costs of leasing options should be viewed for their effects on a hospital's cash flow at various points during the rental period. PMID- 10145278 TI - Analysis weighs issues in divestiture decisions. AB - Financial managers faced with the task of recommending whether diversified services should be dissolved or continued need a logical means of analysis. Their evaluations should consider not only the venture's financial results but concerns specific to the hospital and its market, as well as related social and legal issues. Failure analysis, a function of business portfolio management, helps put these variables in perspective and provides a framework for decision making. PMID- 10145279 TI - What AICPA audit guide revisions mean for providers. AB - Long-awaited revisions to the American Institute of Certified Public Accountants' (AICPA's) auditing and accounting guide bring major changes to the ways some healthcare organizations account for charity care and bad debts, report cash flows and patient service revenue, handle risk contracting, and perform other functions. Providers not before covered by AICPA guidance and those facing accounting changes should work with their auditors to develop policies consistent with the new guidelines. PMID- 10145280 TI - How to measure investment performance consistently. PMID- 10145281 TI - Annuity fund options hold special benefits for healthcare workers. PMID- 10145282 TI - Improving departmental performance. PMID- 10145283 TI - Day care center helps manage pediatric AIDS cases. PMID- 10145284 TI - Reforms to Medicare appeals process needed. PMID- 10145285 TI - Rejecting criminal liability for life-shortening palliative care. AB - Is it possible that a physician who administers life-shortening palliative care, even to a terminally ill patient with the patient's consent, commits murder? The Law Reform Commission of Canada, as part of its proposals on recodifying criminal law, has recommended that criminal liability not attach to the administration of life-shortening palliative care "appropriate in the circumstances." The author submits that while the aim of the Commission's recommendation is good, the phrase "appropriate in the circumstances" should be replaced with more specific criteria for determining when life-shortening palliative care may be administered. Failure to do so would leave physicians in almost as uncertain a situation as is presently the case, preventing them from administering such care without fear of criminal liability. PMID- 10145287 TI - Patient complaints require proper handling. PMID- 10145286 TI - Physician payment reform: are you watching? PMID- 10145288 TI - Group practices tie hospital, physician objectives. AB - Group practice arrangements can underlie a hospital's strategy to recruit physicians and ensure steady patient volumes. Because physicians largely control where their patients are treated, many hospitals are considering ways to more closely align practitioners with their programs and services. Models for developing group practices range from asking young physicians to join an established practice to helping merge the practices of a retiring physician and an established practitioner. PMID- 10145289 TI - Affiliated practices can boost patient referrals. AB - A hospital wanting to strengthen its care delivery system chose to acquire existing practices of physicians nearing retirement. Its affiliated group practice is directed and owned by an established lead physician who teaches and practices with younger physicians. The hospital supplies capital for purchasing existing practices and provides support services for the affiliated group. PMID- 10145290 TI - How to start a physician relations program. AB - An effective physician relations program focuses on providing good customer service rather than raising hospital admissions and revenue. If good service is provided, increased admissions can follow. The principles behind a strong physician relations program include adequate staffing, proper training of physician representatives, and an ability to address varying needs of medical practices. PMID- 10145291 TI - Master plan lays foundation for facility investments. AB - Because construction and renovation projects can involve substantial risk, a healthcare organization should closely assess the economic implications before work begins. A facility master plan--a phased program of facility investment--can forecast the economic value of various options. It also helps ensure that projects comply with a hospital's long-term objectives. PMID- 10145292 TI - Why business office consolidations can fail. AB - Because of a maze of organizational and resource issues, healthcare systems planning to consolidate the business operations of member facilities should proceed carefully. A central business office can lead to increased cash flow but also can exaggerate problems existing at individual hospitals. Before moving ahead, hospital systems should consider their objectives, evaluate existing support systems, set up accountability procedures, and take other steps. PMID- 10145293 TI - The troubled history of Medicare capital payments. PMID- 10145294 TI - New arbitage rules can mean higher investment yields. PMID- 10145295 TI - Credit options carry differing costs, benefits. PMID- 10145296 TI - Reducing turnover can bring bottom line results. PMID- 10145297 TI - Computer network links hospital to its physicians. PMID- 10145298 TI - Healthcare Financial Management Association. Constitution and Bylaws. PMID- 10145299 TI - Solutions that work for finding and keeping top staff. AB - "It is important for providers to celebrate their quality employees and give them actual data as to what makes them good employees. Not subjective opinions, but actual, real-world information about why they are good and why they have been chosen to be part of this celebration." PMID- 10145300 TI - The story of ProCare. A strategic relationship builds tools for the industry. PMID- 10145301 TI - Resource management for noninvasive monitoring. AB - Today we are faced with an ever-expanding array of technologies that allow monitoring to be accomplished more accurately and more easily than before. Each institution's needs differ--yet, the methods for determining appropriate utilization are similar. A rational method of utilization includes a criteria based process for deciding who will be monitored and when. An accurate estimation of the number of units required, their purchase and operating cost, the complexity of operation, and the potential impact on both patients and staff must be calculated. An ongoing educational program for respiratory care practitioners, nurses, and physicians should be implemented to communicate the values and limitations of each device. These technologies can be valuable adjuncts to our process of caring for patients. Used appropriately, noninvasive monitors can fulfill their promise of improving health care. However, they do carry the risk of increasing the overall cost of health care and of distracting us from personally assessing our patients. The existence of an expensive device is not reason enough to employ it. If it were, I would have a difficult time responding to my wife's frequent question of, "If they can send one man to the moon, why can't they send them all?" PMID- 10145302 TI - While employees work, hospital watches children. PMID- 10145303 TI - Hospitals can limit Medicare bad debt liability. PMID- 10145304 TI - Agreeing on information and how to present it. PMID- 10145305 TI - High-tech health care and society's ability to pay. AB - The nation's failure to admit that it cannot afford everything medical science has invented has led to its failure to contain healthcare cost. To avert a collapse of the system, citizens and policy makers must come to grips with the fact that they cannot do everything for everyone. In fact, more lives may be saved by ensuring less expensive preventive health care for all Americans. PMID- 10145306 TI - Uncovering the mysteries of MRI maintenance. PMID- 10145307 TI - Curing the system: what ails health care? AB - Spiraling costs of high-technology medicine and gaps in insurance are creating a gulf in the nation's healthcare system. Solving problems in the U.S. healthcare system may seem an overwhelming task, but leaders in academics, bioethics, medical technology, and within HFMA discuss guidelines and specific aspects of the system warranting concern. Their analysis of the issues clarifies the questions to ask, but the decisions ultimately must come from the public. PMID- 10145308 TI - Transfer center can control, manage admissions. AB - Despite Federal laws restricting inter-hospital transfers, some hospitals continue to transfer patients for purely financial reasons. To combat the financial strain of receiving inappropriate transfers, some large hospitals have established a centralized office to coordinate transfers. A well-run transfer center can aid in the overall treatment of appropriately transferred patients as well as reduce hospital costs. PMID- 10145309 TI - Analysis of emergency physician data can pay off. AB - A hospital's emergency physician billing procedures and fee schedules may not have kept pace with changes in the make-up of emergency room personnel. Revisions require thorough analysis of coding procedures, payer and patient data, Medicare rates, and breakdowns of collections. A successful analysis may yield improved collections, increased physician compensation, and separate billing by emergency physicians. PMID- 10145310 TI - How OBRA admission rules affect nursing facilities. AB - Because of disclosure requirements contained in the Omnibus Budget Reconciliation Act of 1987, nursing facilities should review their admission agreement documents. The new rules become effective on Oct. 1 and cover resident rights, rules of conduct, and other expectations during a nursing home stay. Information contained in admission agreements, along with any changes, must be given to residents orally and in writing. PMID- 10145311 TI - High capital costs could trigger losses. Interview by Richard L. Clarke. PMID- 10145313 TI - Foreign exposure requires risk management. PMID- 10145312 TI - Bond update: slowing but continued deterioration. PMID- 10145314 TI - Improving departmental quality. PMID- 10145315 TI - Putting them in the picture. PMID- 10145316 TI - Meeting the challenge of mandatory AIDS education for health care workers. AB - AIDS is the number one health problem in our country today. To date, education is the only vaccine. In March 1988, the Washington State Legislature passed into law the Omnibus AIDS Bill, viewed nationwide as model AIDS legislation. This law mandated AIDS education in 1989 for approximately 110,000 Washington state licensed health care workers. In this article we describe the implementation of this requirement for 800 affected employees in a Seattle area community hospital. We describe audience response to the education requirement as well as to the AIDS education program developed at our hospital. Based on this experience, we have recommendations for other state legislative bodies considering similar legislation as well as for educators and other professionals who may be involved in the implementation of similar legislation. PMID- 10145317 TI - An evaluation of volumes delivered by selected adult disposable resuscitators: the effects of hand size, number of hands used, and use of disposable medical gloves. AB - Due to increasing concern over potential cross-infection during cardiopulmonary resuscitation (CPR), a number of disposable resuscitators have become commercially available. The wearing of disposable medical gloves by persons performing CPR has also become commonplace. In this study, we evaluated the effects of hand size, use of disposable medical gloves, and number of hands used (one versus two) on the volumes delivered by five adult disposable resuscitators. METHOD: Persons familiar with bag-valve ventilation were recruited to participate in the study--eight with small hands, eight with medium hands, and eight with large hands. Ventilation was delivered to one side of a Vent-Aid training test lung (TTL), and volumes were measured with a BEAR VM-90. In random order, each participant ventilated the TTL with all combinations of one hand/two hands, gloves/no gloves, and each of the following resuscitators: Code Blue, Hospitak, Pulmanex, Mercury, and Ambu SPUR. The participants were instructed to ventilate the TTL as they would ventilate a patient. RESULTS: The mean =/- SD volumes (in liters) were small hands = 0.68 +/- 0.15, medium hands = 0.71 +/- 0.18, large hands = 0.81 +/- 0.19 (p=0.006); gloves = 0.73 +/- 0.19, no gloves = 0.73 +/- 0.18 (p=0.80); one hand = 0.62 +/- 0.12, two hands = 0.84 +/- 0.17 (p less than 0.0001); Code Blue = 0.79 +/- 0.14, Hospitak = 0.56 +/- 0.11, Pulmanex = 0.71 +/- 0.15, Mercury = 0.77 +/- 0.18, SPUR = 0.83 +/- 0.2 (p less than 0.0001). CONCLUSIONS: The use of gloves did not significantly affect volume delivery. Delivered volumes did increase significantly as hand size increased and as number of hands used to squeeze the bag increased, and observed differences in volume delivery between brands of resuscitators may be clinically important in some cases. This study emphasizes the importance of squeezing the resuscitator with two hands during bag-valve ventilation. PMID- 10145318 TI - Extended use of prefilled humidifier reservoirs and the likelihood of contamination. AB - We sought to determine the potential for disposable prefilled humidifiers to become contaminated during extended patient use. METHODS & MATERIALS: We sampled the water in 55 humidifier reservoirs, which were being used by patients or which had been used by patients and then been placed on 'standby,' and had the samples cultured by a commercial clinical laboratory. RESULTS: None of the humidifiers showed contamination after 72 hours of continuous patient use, and 33 of the 55 were used by patients for an additional 3-9 days with no contamination. Fifteen humidifiers that had been in use on patients were put in a standby mode for 30-32 days, with 5 continuing for 60-62 days, with no contamination seen. CONCLUSIONS: An automatic 72-hour change-out for prefilled humidifiers used with low-flow oxygen (less than or equal to 4 L/min) is wasteful. Our study demonstrates that the use-time of humidifiers can be safely extended to as long as 6-12 days. PMID- 10145319 TI - System encourages patients to pay physician bills on the spot. PMID- 10145320 TI - In Virginia Medicaid decision, high court opens a door. PMID- 10145321 TI - Automation of medical records can boost cash flow. AB - Hospitals operating with manual medical records systems may find themselves unable to meet the increased need for documentation brought on by healthcare administration developments of the 1980s. Automation can improve efficiency of coding, abstracting, chart tracking, chart deficiency analysis, and correspondence. Whether a hospital chooses a stand-alone system for medical records or opts for a hospital-wide information system, automation can yield financial benefits. PMID- 10145322 TI - Auditing medical records helps reduce liability. AB - An internal audit of a hospital's medical records department compares the department to standards developed by the hospital and to benchmarks set by accrediting organizations. An auditor can review the department's economy and effectiveness through employee surveys, direct observation, and interviews. By uncovering deficiencies and making recommendations for their correction, an internal audit can help limit a hospital's liability exposure. PMID- 10145323 TI - Medevac programs must face financial scrutiny. AB - Hospital-based air medical (medevac) programs underwent rapid expansion during the past decade, but the financial incentives for operating the programs may no longer exist. Today, as some medevac programs are being consolidated or are ceasing operations altogether, a successful program requires careful attention to charge structures, lease negotiations, and efficiency studies. PMID- 10145324 TI - Pension funds warrant a financial manager's review. AB - A hospital's pension funds may be managed by its finance department, another internal department, or an outside investment adviser. Whatever the arrangement, healthcare financial managers should be involved in the decision between internal and external management of pension funds. A financial manager also can play a prominent role in developing a pension fund policy that balances a hospital's commitment to legal requirements, pension plan goals, and communication with investment advisers. PMID- 10145325 TI - New rules affect bad debt, charity care reporting. AB - Many healthcare organizations must change the way they report patient service revenue, following provisions in the American Institute of Certified Public Accountants' recently revised healthcare audit guide. The guide directs that bad debts should be reported as expenses and that charity care should be excluded from revenue and accounts receivable. As a result, hospital executives must ensure that criteria for differentiating charity care from bad debts are in place, understood, and properly carried out. PMID- 10145326 TI - Statement no. 12: Accounting for resource transfers among affiliated entities. Healthcare Financial Management Association, Principles and Practices Board. PMID- 10145327 TI - Using charge protocols to document clinical activities. PMID- 10145329 TI - New services offset interest rate risk. PMID- 10145328 TI - How to arrange an internal audit of clinical operations. PMID- 10145330 TI - Promoting team playing. PMID- 10145331 TI - Videodiscs are starring in faculty training programs. PMID- 10145332 TI - Technology update: computer-assisted video instruction in hospitals. AB - Interactive videodisks are state-of-the-art technology, and their potential is rapidly beginning to be recognized in the health care industry. A recent survey of 169 health institutions found that 79% planned the purchase of videodisks within the next year, and 72% planned to develop a videodisk program. As the role of the medical records practitioner increasingly includes acting as a hospitalwide information manager, CAVI provides the medical records professional a unique opportunity to both provide effective training within the department and hospital and be the leader in bringing the advantages of CAVI to the institution. PMID- 10145333 TI - Laboratory and clinical evaluation of the MAX transport ventilator. AB - Transport of critically ill, mechanically ventilated patients from intensive care units for diagnostic and therapeutic procedures has become common in the last decade. Maintenance of adequate oxygenation and ventilation during transport is mandatory. We evaluated the Hamilton MAX transport ventilator in the laboratory and in the clinical arena to determine its usefulness during in-hospital transport. METHODS: In the laboratory, we determined the MAX's ability to assure tidal volume (VT) delivery in the face of decreasing compliance of a test lung, and we tested the alarm system. Using a two-compartment lung model modified to simulate spontaneous breathing, we also evaluated the responsiveness of the demand valve. The clinical evaluation was accomplished by comparing arterial blood gases and ventilator settings in the intensive care unit to those during transport. RESULTS: As lung compliance was reduced from 0.1 to 0.02 L/cm H2O [1.0 to 0.20 L/kPa], delivered VT fell significantly at each set VT. The alarm systems performed according to manufacturer's specifications. The demand valve triggered appropriately without positive end-expiratory pressure (PEEP), but as PEEP was increased, triggering became more difficult. The demand valve is referenced to ambient pressure and cannot compensate for elevated end-expiratory pressures. During patient transport, arterial blood gases were comparable to those achieved in the ICU. Because an inspired oxygen concentration of 1.0 was used during transport, arterial oxygenation (PaO2) was significantly greater (123 +/- 75 vs 402 +/- 85 torr [16.4 +/- 10 vs 53.6 +/- 11 kPa]). A higher ventilator rate was required during transport to prevent tachypnea (7 +/- 3 vs 12 +/- 6 breaths/min), and peak inspiratory pressure (PIP) was higher during transport (40 +/- 8 vs 52 +/- 11 cm H2O [3.9 +/- 0.8 vs 5.1 +/- 1.1 kPa]). CONCLUSIONS: The MAX is a reliable transport ventilator, capable of maintaining adequate ventilation and oxygenation in a majority of mechanically ventilated patients. Care should be taken to assure adequate VT delivery at high PIP, and ventilator rate may require adjustment to prevent tachypnea associated with triggering the non-PEEP compensated demand valve when PEEP greater than 8 cm H2O [0.8 kPa] is used. PMID- 10145334 TI - Evaluation of ten disposable manual resuscitators. AB - We evaluated the performance and safety of 10 disposable resuscitators -- six adult units: SPUR, Code Blue, 1st Response, Hospitak MPR, CPR Bag, and Pulmanex; and four pediatric units: CPR Bag, 1st Response, Hospitak MPR, and LSP Bag Mask. METHOD: We tested the devices against the American Society for Testing and Materials (ASTM) Standard F-920. We tested each resuscitator by using a lung model, the Bio-Tek VT-1 Ventilator Tester. RESULTS: All resuscitators met the ventilation requirements for VT and f (adult: 600 mL x 12/min; child: 300 mL x 20/min and 70 mL x 30/min) and I:E less than 1:1. Standard F-920 specifies a fractional delivered O2 concentration (FDO2) greater than or equal to 0.85 with attachments and greater than or equal to 0.40 without attachments, at oxygen flow of 15 L/min, and VE of 7.2 L (600 mL x 12/min) for adult units and VE of 6 L (300 mL x 20/min) for pediatric units. All 10 resuscitators met standard F-920 for FDO2 with attachments. Nine resuscitators met the FDO2 standard without attachments. The 10 resuscitators passed the test for valve function after contamination with simulated vomitus, at an oxygen flow of 30 L/min, and for backward leakage. Three pediatric resuscitators (1st Response, Hospitak MPR, and LSP Bag Mask) did not pass the pressure-limit requirement of 40 +/- 10 cm H2O. Four resuscitators, Hospitak MPR (adult and pediatric) and CPR Bag (adult and pediatric), were unable to pass the test for mechanical shock (a fall from a height of at least 1 meter). CONCLUSION: We conclude that only Code Blue, 1st response, Pulmanex (with tube-type reservoir), and SPUR meet ASTM Standard F-920 and are acceptable replacements for permanent resuscitators. PMID- 10145335 TI - Complications of mechanical ventilation in a children's hospital multidisciplinary intensive care unit. AB - During a 12-week period, 204 consecutive patients admitted to the multidisciplinary intensive-care unit of a children's hospital were prospectively studied for complications of mechanical ventilation. METHOD: A respiratory therapist completed a standardized data form at the end of each shift for each ventilated patient. Patient age, sex, length of ventilation, diagnosis, and complications were noted. Complications were classified as relating to the endotracheal tube (ETT), the ventilator, or the patient's medical management, and were analyzed according to incidence (number per 100 patients or per 100 ventilator days) and to associated mortality. RESULTS: Patients ranged in age from newborn to 24 years. Sixty-three percent were male. Twenty-one percent of patients were managed by the medical staff, 11% by the general surgical staff, and 68% by the cardiac surgical staff. Average length of ventilation was 5.2 days. Overall survival rate was 91.7%. ETT complications reported as number per 100 patients were: pre-necrosis (13.0 [4/57 orally intubated patients and 23/147 nasally intubated patients]), ETT retaping complications (6.0), ETT plugging (1.0), and self-extubation (3.0). Ventilator complications reported as number per 100 ventilator days were: alarm failures (6.5), ventilator failures (0.7), and circuit problems (7.0). Medical complications reported as number per 100 patients were: massive gastric distension (8.8), right-upper-lobe collapse (4.4), pneumothorax (4.4), subcutaneous air (1.5), and pneumoperitoneum (1.0). ETT and ventilator complications showed no association with mortality. The large number of cardiac infants less than 24 months of age (n = 101) led us to further analyze this group for survival rate. We found that the survival rate was 93% for those requiring less than 7 days mechanical ventilation and 89.3% for those requiring greater than or equal to 7 days. As the study progressed, the respiratory therapists independently noted that their attentiveness to both patient and machine increased as did their awareness of complications. The incidence of alarm failure, circuit problems, and pre-necrosis was higher among the first 103 patients compared to the 101 patients entered into the study subsequently. PMID- 10145336 TI - Patterns of practice in neonatal and pediatric respiratory care. AB - Because little information has been available regarding common respiratory care practices in neonatology and pediatrics, it has been difficult to develop departmental standards of care. We therefore conducted a national survey of current practices, hoping to establish whether any de facto standards exist in the U.S. METHODS: A 47-item multiple-choice survey instrument was mailed in 1988 to 689 U.S. hospitals that included all neonatal and perinatal high-risk centers. RESULTS: Response was received from 323 hospitals, for a 47% response rate. Some de facto standards do seem to exist, notably (1) q 2 h ventilator checks, (2) continuous measurement of oxygen concentration in oxygen hoods and ventilator circuits, (3) staffing ratio of four ventilator patients to one respiratory care practitioner, and (4) changing of ventilator circuits q 48 h. CONCLUSION: While we do not claim that such de facto standards have a scientific basis, we suggest that respiratory care services whose practices vary from the de facto standards should investigate why their own practices differ and whether they can be justified. PMID- 10145337 TI - Patient accounts managers must be data managers too. PMID- 10145338 TI - Four principles that lead to greater productivity. AB - A healthcare organization's productivity review should cut across department lines, similar to the way a patient moves through a hospital. A periodic system wide analysis includes defining activities performed, determining the mix of skills involved, identifying duplicated efforts, and analyzing why and how certain activities are triggered. To help ensure success, productivity should be treated as a management philosophy and as part of strategic planning. PMID- 10145339 TI - Hospitals reap productivity benefits. PMID- 10145340 TI - Scrutiny of resource use can increase efficiency. AB - In their attempts to control costs and increase net revenue, hospitals may overlook a key strategy: improved efficiency in delivering care. An analysis of each department's clinical and financial data, however, may provide only a rough framework for decreasing a hospital's expenses. focusing on areas of high resource consumption can yield the greatest benefit. Ultimately, communication between a hospital's administrators and its medical staff is the vital link in improving efficiency. PMID- 10145341 TI - Examine revenue cycle to smooth patient accounting. AB - Because it is a hospital's prime generator of cash flow, accounts receivable must be closely and creatively managed. Patient accounts troubleshooting, however, involves looking at more than the goings-on in the billing department. An effective approach includes an examination of all departments' effects on the revenue cycle. PMID- 10145342 TI - Breakdown approach helps managers select projects. AB - In an era of increased financial strain, effective capital budgeting is critical to a hospital's continued viability. Without accurate estimates of a project's costs and benefits, however, even the most sophisticated selection method is subject to a capital manager's prediction errors. Rather than use typical performance reports to evaluate particular projects or the managers proposing them, administrators should scrutinize the assumptions behind managers' predictions. A decomposition or divide-and-conquer approach can assist in this analysis. PMID- 10145343 TI - Occupational health programs can generate new revenue. AB - A hospital may find an untapped source of revenue by setting up occupational health services. Starting with treatment of workers' compensation cases, an occupational health program may open the door to additional revenue through family practice or group health plans. A preliminary feasibility study of market conditions, operational needs, and potential obstacles is essential to successful program management. PMID- 10145344 TI - Risk factor helps determine debt maturity mix. PMID- 10145345 TI - Organizational values guide all employees. PMID- 10145346 TI - Negotiate end-of-lease options up front. PMID- 10145347 TI - Information card speeds admitting process. PMID- 10145348 TI - Expect a growing job market for the surgical technologists. PMID- 10145349 TI - Preparing surgical techs in an uneven job market. PMID- 10145350 TI - Becoming a CEO or COO requires planning. PMID- 10145351 TI - Joining forces to make managed health care work. AB - Despite the failure of managed care to infuse cost effectiveness into the nation's healthcare system, structured health plans can be made to work. The rules must be rewritten so that risk-sharing and gain-sharing are more equitably spread among providers, payers, and consumers, according to a recently published book, Making Managed Healthcare Work: A Practical Guide to Strategies and Solutions. This excerpt from the book reflects on basic underpinnings of managed care, its successes and failures, the perspectives of key players, and how trends in managed care will affect the healthcare industry overall. PMID- 10145352 TI - How to evaluate managed care contracts. AB - In the early days of managed care, some hospitals hastily agreed to health plan contracts without proper deliberations. An analysis model can be used to examine the results of current managed care contracts and to estimate a proposed contract's potential bottom line contribution or opportunity loss. With this information, healthcare organizations can identify new contract proposals worth pursuing with health maintenance organizations, preferred provider organizations, employer groups, and other health plans. PMID- 10145353 TI - Care model benefits HIV patients, hospitals. AB - In the battle against acquired immune deficiency syndrome (AIDS), focusing treatment on early intervention of its underlying condition, human immunodeficiency virus (HIV) infection, may help reduce the disability associated with AIDS. A comprehensive care hospital unit featuring physicians with expertise in HIV treatment, clinical research activities, and home health services may offer the most effective care for HIV patients. The preventive nature of comprehensive care also can reduce costs through decreased hospitalization, integrated hospital revenue centers, patients' minimized lost work time, and reduction of medical disability. PMID- 10145354 TI - Partners cite need for consistency in reporting--discussion. PMID- 10145355 TI - Cash discounts can minimize operating costs. PMID- 10145356 TI - Choosing an investment management consultant. PMID- 10145357 TI - Health care's recovery requires trust and partnership. PMID- 10145358 TI - Fund raising offsets hospital's indigent care costs. PMID- 10145359 TI - The expanding role of the respiratory care practitioner. PMID- 10145360 TI - Respiratory care devices and techniques through the years. PMID- 10145361 TI - Developmental, learning, and emotional problems. Health of our nation's children, United States, 1988. AB - The data presented in this report show that developmental, learning, and behavioral disorders are among the most prevalent chronic conditions of childhood and adolescence. Overall, nearly 20 percent of young people ages 3-17 years were found to have had one or more of these conditions. By the time they reached ages 12-17 years, 1 in 4 adolescents, and nearly 3 in 10 male adolescents, had experienced one of these disorders. When very young children with developmental delays were included, the total number of U.S. children affected came to about 10.7 million. As high as these figures may seem, it is altogether possible that they are underestimates of the true prevalence of the conditions. The only childhood disorders counted in NHIS-CH were those that had been recognized by parents or identified by physicians, psychologists, or teachers and communicated to parents with sufficient clarity that the parents were able to report them to survey interviewers. There is reason to believe that some developmental, learning, and emotional disorders of children are not recognized as such, or the assessment of teachers or health professionals are not understood or not accepted by parents. Confusion over changing diagnostic terminology and simple forgetting of problems that occurred in the past probably work to reduce the reporting of these conditions as well. Despite the limitations of parental reporting, it is useful to have data on the prevalence of psychological disorders in young people based on standard survey questions put to the parents of a large and nationally representative sample of children. Estimates derived from NHIS-CH provide national benchmarks on the overall frequency of recognized psychological disorders in children and on the relative frequency of such problems in different population groups. The findings with regard to overall prevalence were that 4.0 percent of all children 17 years of age and under had delays in growth or development, 6.5 percent of children ages 3-17 years had learning disabilities, and 13.4 percent had significant emotional or behavioral problems. The proportions of all children ages 3-17 years who had ever received treatment or counseling for the conditions were about 2 percent for developmental delays, just over 5 percent for learning disabilities, and more than 10 percent for emotional or behavioral problems. These proportions fall within the range of prevalence estimates that have appeared in the literature.(ABSTRACT TRUNCATED AT 400 WORDS) PMID- 10145362 TI - Investment policy statement clarifies objectives. PMID- 10145363 TI - How to read signs of organizational change. PMID- 10145364 TI - Recycling program reduces hospital's disposal costs. PMID- 10145365 TI - Career boost requires personal strategic plan. PMID- 10145366 TI - Pressure growing in the fight to stay tax exempt. AB - With legislative and regulatory scrutiny trained on not-for-profit hospitals, administrators should brace themselves for potential challenges to their tax exempt status. Industry leaders recommend reviewing documents that outline a hospital's charitable purpose, setting a clear policy on providing care to persons unable to pay for it, placing a value on community services, and taking other steps. Whether changes in laws governing tax exemption come from national, state, or local efforts, hospitals should be ready to show proof of their charitable activities. PMID- 10145367 TI - Tax-exempt challenges warrant hospitals' attention. AB - The tax-exempt status of not-for-profit healthcare organizations is being questioned and sometimes challenged on Federal, state, and local fronts. While the Internal Revenue Service (IRS) has created a special program for randomly auditing not-for-profit organizations, Congress is expected to consider legislation that would mandate the amount of charity care and community benefits a tax-exempt hospital must provide in relation to its tax-exemption value. Familiarity with IRS and Congressional activity, as well as with cases in which a hospital's tax-exempt status has been challenged in court, may provide guidelines for hospitals to assess their vulnerability. PMID- 10145368 TI - Materials management crucial to overall efficiency. AB - Because supplies are important to many departments, improved materials management may be an integral part of a hospital's productivity assessment. A successful program should encompass technical as well as managerial aspects of materials management. While looking at national performance statistics may provide a basis, each hospital should set its own standards in line with its strategic plan. PMID- 10145369 TI - Two ways to handle a pension plan surplus. AB - A healthcare organization wanting to tap into its pension plan surplus may be reluctant to do so for fear of Medicare recapture. By following a recent court decision and a reasonable interpretation of Medicare regulations, however, a facility may terminate an existing pension plan, purchase a group annuity contract, and reduce Medicare recapture. Two methods for treating termination of a plan are in line with Medicare rules. A facility considering termination should analyze the effects of both and use the method likely to produce a better financial result. PMID- 10145370 TI - IRS toughens its guidelines on tax exemption for HMOs. PMID- 10145371 TI - Credit balances can trip up a provider's accounting. PMID- 10145372 TI - Revised Form 990 signals greater IRS scrutiny. PMID- 10145373 TI - Round one in Medicaid funding bout: defining "donation". PMID- 10145374 TI - Removing barriers in hospice pain management--a family matter. AB - Pain control in the terminal cancer patient can be complicated by beliefs and experiences that patients and families have regarding narcotics and their use. Anticipation and recognition of these beliefs by hospice team members is the first step in removing the barriers to adequate pain control. PMID- 10145375 TI - Who gets radiotherapy? AB - This study investigated the use of radiotherapy for patients perceived to be unsuitable for curative therapy. Patients were grouped according to whether their cancer was considered curable or incurable and whether they received radical or palliative schedules of radiotherapy. The latter group was further evaluated to clarify current practice, to examine the problems in establishing guidelines for treatment and as a basis for prospective audit. Results confirmed that therapy guidelines within the unit were in line with national practice. Changes in standard therapy were proposed in view of resource limitations and recent results from other surveys. A second audit in 1989, together with a formal costing exercise, showed a reduction in the median number of fractions per course in both patient groups. This study suggests that palliative radiotherapy was used selectively for patients likely to receive significant benefit, and that consensus management was practised, and influenced, by informal internal audit. Results highlighted decision-making problems in the management of advanced non metastasised cancer; confirmed doubts about the advisability of establishing rigid guidelines in palliative therapy; and clarified some of the difficulties in conducting meaningful cost-benefit analyses in this area. PMID- 10145376 TI - Program offers help for capital expenditures. PMID- 10145377 TI - A quality fad? PMID- 10145378 TI - Quality enhancement means total organizational involvement. PMID- 10145379 TI - Quality mind-set overcomes barriers to success. AB - To remove hindrances to fiscal strength, a healthcare facility needs a long-term, organization-wide strategy. Total quality management (TQM) can offer such a solution, but it requires a revised management philosophy. Under TQM, a hospital must adopt a workable definition of quality; develop a customer orientation; form organizational teams to study and revise work processes; involve all employees in quality efforts; and strive for continuous improvements. PMID- 10145380 TI - Given time, quality investments pay off. PMID- 10145381 TI - Satisfied patients can spell financial well-being. AB - As a healthcare performance indicator, patient satisfaction may be overlooked by providers that regard patients' perceptions as evidence of service quality rather than quality of care. Because a patient's trust in caregivers and overall attitude toward care received may affect outcome, however, healthcare providers are paying more attention to interpersonal issues of care delivery. Meanwhile, changes in the industry, such as increased competition, consumerism, and demand for accountability, mean patient satisfaction can contribute to a healthcare organization's bottom line. PMID- 10145382 TI - Performance management challenges patient accounting. AB - Although performance management has applications in many areas of healthcare facility operations, one hospital used the approach in its patient accounts department, with days in accounts receivable decreasing nearly 32 percent in less than a year's time. Through the process, employees are involved in determining specific performance goals, which are monitored department-wide and individually. Appropriate reinforcements, both tangible and verbal, are given as encouragement toward achieving identified, benchmarks. PMID- 10145383 TI - Marketing, financial goals play into CCRC refund plan. AB - An entry fee refund is the marketing tool for continuing care retirement communities (CCRCs) with the most easily assessed financial effects. The financial results of refund schedules can be measured in terms of a CCRC's ability to generate pools of cash and withdraw cash from these pools to fund operations. A CCRC's choice of refund schedule also will affect net present value of an investment in retirement housing. PMID- 10145384 TI - Consistency endangered by FASB-GASB (Financial Accounting Standards Board, Government Accounting Standards Board ) dispute. AB - The Financial Accounting Foundation's (FAF's) November 1989 decision to uphold the 1984 jurisdictional arrangement between the Financial Accounting Standards Board (FASB) and the Government Accounting Standards Board (GASB) leaves little doubt that the healthcare industry will now be subject to two sets of accounting standards. The FAF's decision created a distinction between the accounting practices of government-owned hospitals and non-hospital governmental entities and their adherence to standards set by FASB, GASB, and the American Institute of Certified Public Accountants. A governmental healthcare organization should carefully determine which accounting rules it follows and remain attentive to further GASB developments. PMID- 10145385 TI - Survey: hospitals looking for new ways to fund capital projects. PMID- 10145386 TI - Settlement method may be an Rx for malpractice costs. PMID- 10145387 TI - Setting EDI standards slow but progressing. PMID- 10145388 TI - Know how lease types affect financial statements. PMID- 10145390 TI - Taking the stress out of resume writing. PMID- 10145389 TI - Company car may mean higher tax liability. PMID- 10145391 TI - Considering charity care policy and procedure. PMID- 10145392 TI - Tax-exempt bond financing may benefit not-for-profits. PMID- 10145393 TI - Elder program promotes patient loyalty. PMID- 10145394 TI - Winning resume packages have style--and substance. PMID- 10145395 TI - Committing to quality. PMID- 10145396 TI - Standards opening a door to electronic payments. AB - Electronic data interchange (EDI)--computerized transmission of business documents over telephone lines--holds promise for improving the flow of claims information between healthcare payers and providers. Draft format standards now under development and scheduled for release later this year are turning the EDI focus to electronic payments to healthcare providers. Along with potential cash flow improvements, EDI remittance applications may help healthcare facilities achieve cost savings by eliminating cash processing steps and assigning some business office staff members to other duties. PMID- 10145397 TI - Charge reviews can beef up bottom lines. AB - Traditionally, healthcare organizations have been reluctant to pursue charge reviews until pressed to do so by third-party challenges to their charges. But a hospital pursuing either a concurrent or retrospective review may realize significant revenue enhancement--and not only from correcting undercharges on charge-based accounts. Charge reviews can lead to smoothed patient documentation, better cost accounting, more appropriate Medicare payment, and, ultimately, an improved bottom line. PMID- 10145398 TI - Charge system improvements may forestall third-party audits, legislation. PMID- 10145399 TI - Know the effects of not-for-profit conversions. AB - Because Congress and the business community currently are challenging established traditions regarding hospitals' tax status, healthcare administrators considering converting a public hospital to a not-for-profit structure must understand the tax consequences of such a move. A public hospital's conversion to not-for-profit status can affect its reporting requirements, unrelated business income tax, access to tax-exempt financing, ability to attract charitable contributions, required charter and bylaw amendments, compensation flexibility, public disclosure, and the ability to reconsider a conversion decision. PMID- 10145400 TI - Cost control should extend to legal services. AB - While a healthcare organization may consider legal services to be outside its management scope, control of legal spending is within a hospital's grasp. Whether an organization is large or active enough to merit an internal legal staff, an administrative position should be established to centralize management of legal services. A hospital may choose to undertake a cost reduction audit, which can determine the feasibility of an internal legal staff and coordinate competitive proposals from outside law firms handling litigation. PMID- 10145401 TI - Reporting method can meet new AICPA (American Institute of Certified Public Accountants) guidelines. AB - Guidelines contained in the American Institute of Certified Public Accountant's (AICPA's) new healthcare audit guide require some hospitals to revise systems for compiling financial statements on accounts receivable and revenue. An accounting method can be devised to identify financial responsibility as soon as possible after discharge, record amounts to be written off, and, through an analysis of closed accounts, estimate the collection process on accounts for which insufficient information is available. PMID- 10145402 TI - Anti-dumping law flashes a yellow light on emergency cases. PMID- 10145403 TI - Enhancement program can uncover unrealized revenue. PMID- 10145404 TI - Clinical evaluation of ColdSpor, a glutaraldehyde-phenolic disinfectant. AB - Disinfecting solutions may vary in concentration and bactericidal activity with use, may have subjectively unpleasant characteristics, and may affect the appearance and physical condition of the equipment processed. We evaluated the high-level disinfectant ColdSpor (0.5% glutaraldehyde, 0.025% ortho-phenylphenol, and 0.005% para-tertiary amylphenol) by using it as the disinfecting agent in the processing of equipment for a large respiratory care service. MATERIALS & METHOD: The type and quantity of equipment disinfected and the physical condition of the equipment were observed and recorded. Samples of the disinfectant solution were analyzed each week, and the antimicrobial activity of the solution was tested against clinical isolates and test cultures of Pseudomonas aeruginosa. The odor of the solution and ease of use were subjectively evaluated by two equipment processing technicians. RESULTS: More than 2,400 pieces of respiratory equipment were passed through the disinfectant solution during the 30-day study period. No changes in the appearance of the equipment were noted. Analysis revealed that 71% or more of the antimicrobial chemicals remained in the solution. Clinical isolates and test cultures of P aeruginosa showed no growth when cultured with samples of the solution in use up to 30 days. The two technicians subjectively judged the solution to have no noticeable odor and to produce no burning of the eyes. CONCLUSION: The concentration of components of the glutaraldehyde-phenolic solution maintained bactericidal activity for as long as 30 days. The solution produced no apparent physical change in equipment and was subjectively acceptable to those processing equipment. PMID- 10145405 TI - Is it time for universal health care in America? PMID- 10145406 TI - NICU infants born at developmental risk and the Individualized Family Service Plan/Process (IFSP). AB - In summary, newborn intensive care is a rapidly changing field serving a heterogeneous population of infants and families. A family-centered/developmental perspective needs to be incorporated as a part of basic nursery care. Some infants and families have developmental needs beyond this baseline. The ability to respond to these needs is supported by PL 99-457. A way to sort out which infants and families might benefit from entering the IFSP process has been described. The IFSP process and plan have been presented and a framework for integrating this continuum of care into the NICU has been proposed. Implementing the IFSP process in the hospital setting needs to be approached gradually and with caution, recognizing the lack of correspondence between early risk factors and ultimate outcome. PMID- 10145407 TI - Plan for IRS scrutiny when using independent contractors. PMID- 10145408 TI - Managing change at the front line. PMID- 10145409 TI - Short selling as a risk management tool. PMID- 10145410 TI - Ten steps to better employee interviewing. PMID- 10145411 TI - A note of sanity in debate over Medicare bad debts. PMID- 10145412 TI - Effects of war trickles down to hospital business offices. PMID- 10145413 TI - Altman sees industry unwilling to control costs. Interview by Richard L. Clarke. PMID- 10145414 TI - Taking a deep breath over capital payments. AB - As the Congressional deadline nears for incorporating Medicare payment for capital investments into the prospective payment system, a number of healthcare groups are renewing their opposition to the initiative. They insist that a payment method cannot be constructed to equitably account for geographic influences, different capital cycles among healthcare facilities, and other factors. Opponents of the initiative say this failure will impose further stress on hospitals already burdened by less than adequate Medicare payments for operating expenses. PMID- 10145415 TI - Watch for pitfalls of discounted cash flow techniques. AB - Discounted cash flow (DCF) techniques can enhance the effectiveness of a healthcare organization's capital budgeting decisions. But a financial manager unaware of common misapplications of DCF techniques may make capital decisions with a hidden bias against long-term projects, an inaccurate evaluation of options, or inappropriate estimations of expected inflation and risk. Social and psychological factors also can impede effective decisions on projects already introduced. PMID- 10145416 TI - Bedside terminals can improve nursing efficiency. AB - Today's emphasis on cost containment and quality of care is leading hospitals to widen their automation focus from assisting financial departments to improving operations. Because acute nursing care accounts for a substantial portion of a hospital's personnel and services, developing an information system that places computer terminals at patient bedsides may lead to greater efficiency, among other benefits. Bedside access to information systems can mean that data is more accurately recorded and that nurses' time is more effectively spent on clinical care rather than clerical duties. PMID- 10145417 TI - Patient account managers' role comes into focus. AB - As hospitals begin to see their accounts receivable as a sleeping giant, the role of patient accounts managers may increase in importance. A 1991 survey of patient accounts managers reveals a 25 percent average salary increase over the 1988 figure. The responsibilities of patient accounts managers have remained much the same, with increased emphasis on the basics: receivables management, billing, and collection. A majority of patient accounts managers aspire to higher positions within healthcare finance and management. Most aspirants are well qualified in terms of education but may require professional certification before advancing. PMID- 10145418 TI - Determining an allowance for bad debt. PMID- 10145419 TI - Trustee orientation: AHA videos. PMID- 10145420 TI - Evaluation of ten manual resuscitators across an operational temperature range of -18 degrees C to 50 degrees C. AB - Because of the temperature extremes encountered during emergency resuscitation and transport in the field, we sought to evaluate the performance and safety of 10 adult resuscitators (5 permanent units: Hope 4, Laerdal, Lifesaver, Mark 3, and PMR; and 5 disposable units: BagEasy, Code Blue, CPR Bag, DMR, and SPUR) across an operational temperature range of -18 degrees C to 50 degrees C. METHOD: We tested the devices against the American Society for Testing and Materials (ASTM) Standard F-920 and the International Organization for Standardization (ISO) Standard 8382. We tested each resuscitator by using a lung model, the Bio Tek VT-1 Ventilator Tester. RESULTS: All of the resuscitators met the ventilation requirements for VT and F (600 mL X 20) and I:E less than 1:1 except the SPUR at 18 degrees C. Standards ASTM F-920 and ISO 8382 specify a fractional delivered oxygen concentration (FDO2) of greater than or equal to 0.85 with attachments and greater than or equal to 0.40 without attachments at oxygen flow of 15 L/min and VE of 7.2 L/min (600 mL X 12). Nine resuscitators met Standards ASTM F-920 and ISO 8382 for FDO2 with attachments at 21 degrees C and 50 degrees C, but only 3 units (Code Blue, DMR, and PMR) passed at -18 degrees C. At 21 degrees C, the Hope 4 had an FDO2 of 0.77 +/- 0.03, which was significantly lower (p less than 0.001) than that of the other 9 resuscitators, all of which were greater than or equal to 0.93. Nine resuscitators met the FDO2 standard without attachments. All 10 resuscitators passed the tests for valve function after contamination with simulated vomitus (at an oxygen flow of 30 L/min) and for backward leakage. At the ventilation pattern recommended by the American Heart Association (AHA) (800 mL X 12) the PMR's mean FDO2 dropped to 0.86 +/- 0.03 because of air leaking into the bag where it attaches to the patient-valve assembly. All 10 resuscitators passed the test for mechanical shock at 21 degrees C and 50 degrees C, but 3 units failed at -18 degrees C. CONCLUSION: We conclude that only the Code Blue and DMR meet the ASTM and ISO standards for operator-powered adult resuscitators across the operational temperature range of -18 degrees C to 50 degrees C. PMID- 10145421 TI - Oxygen-conservers, home oxygen prescriptions, and the role of the respiratory care practitioner. PMID- 10145422 TI - Placement alternatives for ventilator-dependent patients outside the intensive care unit. PMID- 10145423 TI - Long-term mechanical ventilation: patient selection and discharge planning. PMID- 10145424 TI - Panel sees high demand for diverse CFO skills. AB - A more sophisticated healthcare industry, challenged by competition and payer demands, also looks for sophistication when filling its senior financial positions. Individuals with experience in managed care contract negotiations, knowledge of hospital-physician ventures, and superior planning and treasury management skills are increasingly sought by hospitals. Some organizations also may single out chief financial officers able to assume broader administrative duties, including chief executive officer positions. These are among the observations of a panel convened by HFMA to discuss recent trends in healthcare executive recruiting. Highlights of the session, moderated by HFMA President Richard L. Clarke, FHFMA, follow. PMID- 10145425 TI - Model helps to determine bad debt allowance. PMID- 10145427 TI - Written policy can ensure socially conscious investing. PMID- 10145426 TI - FASB proposes consistent treatment for contributions. PMID- 10145428 TI - Nursing home fights fiscal strain with staff retraining program. PMID- 10145429 TI - Guarding tax-exempt status amid legislative scrutiny. PMID- 10145430 TI - At risk: a look at managing Medicare losses. AB - On top of declining Medicare payment rates, hospitals face the prospects of increasing numbers of Medicare patients and costs associated with caring for them. Geriatric care management programs can help prevent financial losses by focusing on high-risk patients and costly diagnosis related groups. Under one approach, a geriatric care manager works to improve the efficiency of care, reduce lengths of stay, smooth transitions to alternate care settings, and involve patients and their families in decision making. PMID- 10145431 TI - California HMOs may provide national forecast. AB - With more than one quarter of the nation's health maintenance organization (HMO) insured patients, California may provide an example of what other states can expect in terms of the financial viability of HMOs. A recent study of the enrollment patterns, premium trends, and net profit margins of 47 full-service California HMO plans over a four-year period showed that larger HMOs tend to be in better financial health than smaller HMOs. Meanwhile, the state has revised its code of regulations to include stricter requirements for the operation of full-service HMO plans. PMID- 10145432 TI - Direct purchase contracts carry risks, benefits. AB - To better control their purchasing of healthcare services, some employers are seeking direct managed care contracts with healthcare facilities. Along with evaluating potential markets introduced by a proposed contract, a provider should develop a pricing strategy, a monitoring system, and a process for internal audit before entering into a direct purchase contract. With the proper checks in place, direct purchase contracts can be mutually beneficial to providers and purchasers. PMID- 10145433 TI - Repricing plan yields realistic revenue enhancement. AB - Actual reimbursement plays a key role in hospital rate restructuring. Moving away from a policy of rate setting "across-the-board" and toward modifying charges that positively affect a hospital's bottom line can more effectively generate net operating revenue, increase cash flow, and reduce increases in contractual allowances. A participatory approach between senior executives, managers, and physicians is working at several hospitals. PMID- 10145434 TI - A decade of change: the emerging role of the CFO. AB - The average senior financial executive today in a hospital or corporate healthcare setting is a 42-year-old male who has a master's degree or at least some postgraduate education and who has been in his position for six years, according to a 1991 national survey of healthcare chief financial officers (CFOs). The individual has the title of CFO, earns $82,100, and last year received incentive compensation amounting to 12.3 percent of base salary. He aspires to a higher position, although not necessarily the job of chief executive officer. PMID- 10145435 TI - Prepare now to move up the career ladder. PMID- 10145436 TI - Enhanced capabilities of current ICU ventilators: do they really benefit patients? AB - The current-generation mechanical ventilators are certainly enhanced in performance, style, and cost. Many of these enhancements appear to benefit both the patient (eg, reduced work of breathing, wider range of operation) and the hospital (eg, reduced maintenance costs). Although vast areas for refinements remain, my plea is that efforts be made to learn about and take advantage of the current technology, before embarking upon new technology. As we have learned, you have to have the right tool for the right job. Unfortunately, it's not the right tool, if you don't know how to use it. PMID- 10145437 TI - How should bronchodilators be administered to patients on ventilators? PMID- 10145438 TI - Withholding and withdrawing life support from the critically ill: how does it work in clinical practice? AB - Withholding and withdrawing life support from the critically ill commonly occurs in clinical practice. Sedatives and analgesics are frequently given during this process to patients who are not so deeply comatose that they cannot benefit from them. The withholding and withdrawal of life support is compatible with several judicial decisions, including the recent Cruzan decision of the U.S. Supreme Court. Recent studies are providing insights into how, why, and under what circumstances the withholding and withdrawal of life support take place, and how drugs are administered during these processes. Additional studies are needed to further elucidate these processes and to contribute to the shaping of realistic and humane standards of terminal care. PMID- 10145440 TI - Cash management check-up can yield savings. PMID- 10145439 TI - Portable airway-suction systems: a comparison of performance. AB - A number of portable suction systems (powered either manually, pneumatically, or electrically) are available. We compared the performance of three electric systems (Laerdal Medical LSU, Laerdal Medical CSU, and Matrx Medical) and two manual systems (Vitalograph Emergency Aspirator and California Medical V-VAC) to wall suction set at maximum pressure of 300 torr [39.9 kPa]. METHODS: We determined the maximum pressure each system was capable of generating, and we measured the volume of imitation maple syrup each system at maximum pressure could suction within 5 seconds and the time required by each system at maximum pressure to suction 150 mL of syrup. In addition, we evaluated the life of each electric system's internal battery. RESULTS: All the electric systems were capable of generating suction pressure greater than 300 torr [39.9 kPa]. The amount of time required by the electric systems to suction 150 mL of syrup was not significantly different from that required by wall suction. In 5 seconds, wall suction suctioned a significantly greater volume of syrup than did the Matrx Medical system (p less than 0.05, ANOVA), but a significantly smaller volume of syrup than did the Laerdal Medical CSU system (p less than 0.05, ANOVA). The manual Vitalograph Emergency Aspirator was capable of generating 300 torr [39.9 kPa] pressure, but the California Medical V-VAC was not. Wall suction significantly outperformed both of the manual systems when volume of syrup suctioned in 5 seconds and time required to suction 150 mL of syrup were compared (P less than 0.05 ANOVA). All electric systems were capable of maintaining maximum suction greater than 15 minutes.(ABSTRACT TRUNCATED AT 250 WORDS) PMID- 10145441 TI - Credit reviews necessary for sound investment policy. PMID- 10145442 TI - Bundling requirements create operational problems. PMID- 10145443 TI - Playing around with guest relations. PMID- 10145444 TI - Practice underlies good public speaking skills. PMID- 10145445 TI - Interactive leadership gaining sway in the 1990s. PMID- 10145446 TI - Gaining a competitive edge through HIS technology. AB - Streamlined procedures, fewer errors, improved consultation on patient care, and lowered costs are among the advantages cited by healthcare facilities that are using information technology in efforts to outpace their competitors. Technology ranging from executive information systems to medical record imaging can provide improved access to data and aid strategic decision making. Even so, the perceived benefits of a particular form of technology should not outweigh sound business planning. PMID- 10145447 TI - Paper chase: how to manage computer reports. AB - Although healthcare information systems are increasingly sophisticated, they are capable of burying some users beneath flurries of unneeded reports while failing to provide sorely needed data for others. Environmental issues and patient privacy concerns add to the need to conduct periodic audits that explore how computer reports are distributed, used, retained, and discarded in health-care organizations. The process begins by reviewing and updating a report distribution list, a master document that shows why and how reports are created and circulated. PMID- 10145448 TI - Include information needs in corporate planning. AB - Constraints placed on the healthcare industry throughout the 1980s make long-term planning for information systems needs difficult and, at the same time, vital to an organization's survival. One hospital's model for information systems planning balances strong executive leadership with participation from groups inside and outside the hospital and incorporates an analysis of the information systems environment into the facility's annual planning cycle. The hospital's experience highlights several issues to be considered in an information systems plan. PMID- 10145449 TI - Team mix can smooth information system acquisitions. AB - Through effective planning and preparation, a healthcare organization can avoid bad experience in acquiring an information system. While outside consultants may be helpful in considering a proposed computer system, resources needed for successful system acquisition may be found among an organization's staff members. An acquisition team of employees with expertise in financial management, information systems management, clinical matters, operations, and legal issues can help a team leader acquire a system that balances the needs of each department. PMID- 10145450 TI - Patient data critical to hospital-wide quality. AB - Health care's interest in quality management has followed the lead of the manufacturing industry, originally focusing on retrospective review of products and outcomes and eventually undertaking concurrent reviews focused on processes. Critical to such reviews is a healthcare organization's use of an information system that incorporates departmental data into a hospital-wide framework, includes objective criteria for evaluating procedures and outcomes, and tracks modifications to an organization's processes for care delivery. The goal of an integrated, patient-centered information system is to establish a continuous cycle for improving clinical and administrative quality within an organization. PMID- 10145451 TI - Joint-venture, capitation model can strengthen market share. AB - As health maintenance organizations (HMOs) and preferred provider organizations (PPOs) control an increasingly larger percentage of the healthcare market, many hospitals are entering capitation contracts to capture and preserve market share. A joint-venture and capitation model may provide an additional mechanism for large referral centers and community hospitals to jointly maintain or increase market share through improved service delivery. While the model includes many benefits, hospitals should thoroughly consider ramifications. Only through substantial institutional commitment, careful planning, and ongoing management will the model prove successful. PMID- 10145452 TI - CCRCs should prepare now to follow AICPA guidance. PMID- 10145453 TI - Early classification may ease bad debt burden. PMID- 10145455 TI - Prepare personally and professionally for an interview. PMID- 10145454 TI - Hospital develops private label credit card. PMID- 10145456 TI - A union election never held cannot be lost. PMID- 10145457 TI - Set state health spending caps. PMID- 10145458 TI - Strategies can enhance rural hospital viability. AB - Although some rural hospitals struggle to remain financially viable, the Internal Revenue Service (IRS) often shows greater flexibility in interpreting regulations for tax-exempt hospitals in rural areas. To take advantage of this flexibility, rural facilities should understand issues affecting Federal tax-exempt status, such as private benefit, private inurement, and unrelated business income. A not for-profit, rural healthcare facility well versed in tax-exempt regulations and their interpretations by the IRS can structure recruitment and retention programs, joint ventures, unrelated businesses, and even cooperative coalitions to enhance its financial well-being without endangering its tax exemption. PMID- 10145459 TI - Consider rural clinic to enhance care, revenue. AB - To make health care in underserved rural areas more accessible, Congress established rural health clinics (RHCs) in 1977. Although most RHCs operate independently, a provider-based RHC can help a hospital attract physicians, boost market share through increased referrals, enhance third-party payment, and provide an opportunity for reallocating overhead costs. Proper planning for a provider-based RHC includes carefully considering qualification requirements, staffing strategies, and clinic location. PMID- 10145460 TI - Factors driving costs must figure into reform. AB - Employers and employees seeing their health plan premium costs rise faster than physician and hospital costs is one indication that the U.S. healthcare system is in a state of crisis. Examining factors behind providers' and health plans' costs -demographics, increased hospital expenses, insurance overhead, fragmentation among managed care plans, and failure of some cost-containment initiatives- indicates the shape healthcare reform must take if it is to succeed. Reform proposals in the 1990s likely will entail simplification and consolidation, such as providing universal access, consolidating managed care, and establishing a single-payer system. PMID- 10145461 TI - Selecting the best disbursement account. PMID- 10145462 TI - Court rejects HCFA's unnecessary borrowing decision. PMID- 10145463 TI - One last chance to get it right. PMID- 10145464 TI - Palliative radiotherapy--counting the costs of changing practice. AB - "Working for Patients', the government's review of the National Health Service (NHS) advocates reforms which have led inevitably to pressure for medical specialities to review both the outcomes of their services and the resources used in achieving these outcomes. This paper considers these issues in the context of provision of palliative radiotherapy for patients with incurable cancers and presents the results of a study which evaluated the costs of radiotherapy. In addition to producing some of the first detailed cost estimates for the delivery of radiotherapy, this exercise highlighted the methodological and practical difficulties of undertaking such studies. As increasing pressure to evaluate cancer therapy is a prominent feature of a 'post-NHS Review' world, lessons learnt from this study may also be applicable to the audit of other cancer therapies. Efficient audit practices will, of course, have to evaluate the benefits (in terms of enhancements to length and quality of life) as well as the costs of cancer therapies. PMID- 10145465 TI - Montana's 'angels of mercy'. Morphine for the dying. PMID- 10145466 TI - Guidelines: physicians in the lead. PMID- 10145467 TI - Employees experience effects of aging--and learn. PMID- 10145468 TI - Understanding issues can thwart union efforts. PMID- 10145469 TI - "First, do no harm" will guide reform. Interview by Richard L. Clarke. PMID- 10145470 TI - Strong medicine: rethinking the PFS (patient financial services) director's role. AB - Burdened by accounts receivable problems and the growing complexity of patient accounting, hospitals soon may require an enhanced resume for individuals responsible for patient financial services (PFS) departments. Advanced skills in management, productivity, budgeting, analysis, and other areas increasingly must be put to work. Outdated perceptions also must change, giving PFS directors the influence needed to make change happen. A hospital's options include supporting course work toward an advanced degree, organizing rotation training in other hospital departments, or filling a PFS director position by searching for parallel skills in other service industries. PMID- 10145471 TI - Factory approach can streamline patient accounting. AB - Although they may seem fundamentally different, similarities exist between operations of factories and healthcare organizations' business offices. As a result, a patient accounting approach based on manufacturing firms' management techniques may help smooth healthcare business processes. Receivables performance management incorporates the Japanese techniques of "just-in-time" and total quality management to reduce unbilled accounts and information backlog and accelerate payment. A preliminary diagnostic assessment of a patient accounting process helps identify bottlenecks and set priorities for work flow. PMID- 10145472 TI - Better MSP (Medicare secondary payer) process may boost payments. AB - Because the Federal government estimates large overpayments by Medicare, changes in the Medicare Secondary Payer (MSP) program may play a significant role in future Medicare budget cuts. A major contributor to MSP problems is providers' failure to adequately collect coverage information from Medicare beneficiaries. Along with data sharing between Federal agencies to help identify responsibility for Medicare claims, providers likely will face more pressure to properly collect Medicare beneficiary information. Because of MSP program payment structure, improving billing offices' procedures for collecting Medicare beneficiary information ultimately may increase providers' overall payments. PMID- 10145473 TI - Revamped, joint ventures make a comeback. AB - After a period of declining popularity, joint ventures are beginning to re-emerge as viable solution to challenges facing health care. Future joint ventures likely will be different, however, in response to problems and resulting legislation. Healthcare providers interested in starting a joint venture should consider five basic formats and some guidelines for developing them. Joint ventures ultimately may become a focal point for renewed efforts at regional healthcare planning. PMID- 10145474 TI - Geographic reclassification can increase payment--for now. PMID- 10145475 TI - Study: Hospice care can yield savings to HMOs, patients. PMID- 10145476 TI - EDI (electronic data interchange) use coming sooner rather than later. PMID- 10145477 TI - How to reduce family relocation stress. PMID- 10145478 TI - Lockboxes can improve processing, cash flow. PMID- 10145479 TI - Role conflict and role ambiguity among respiratory care managers. AB - The health occupations and management literature does not specifically address role stress among technical directors of respiratory care departments. We undertook an analysis of role conflict, role ambiguity, and job satisfaction among technical directors of respiratory care departments in Texas. METHODS & MATERIALS: We distributed a questionnaire designed to measure role conflict and ambiguity and a questionnaire to elicit demographic and organization data to 283 technical directors in all Texas hospitals with more than 75 beds. Organization characteristics and demographic factors were studied as moderators. RESULTS: Analysis of the 199 responses received revealed that both role conflict (mean [SD] 3.86 [0.97] on 7.0 scale) and role ambiguity (2.64 [0.93] on 7.0 scale) scores were low compared to the neutral point of measure. Role overload, a component of role conflict, was found to be above the neutral point (4.64 [1.85]). One-way analysis of variance revealed no significant differences between the role conflict or the role ambiguity measures based on age, race, gender, number of employees supervised, size of institution, and position to which the respondent reported. Role conflict and role overload were each found to have significant negative correlations with job satisfaction (p less than 0.01). CONCLUSION: We are encouraged by the low role-conflict and ambiguity scores observed but concerned about the elevated role-overload scores. We believe that an in-depth study of role overload among respiratory care managers is warranted. PMID- 10145480 TI - Testing airway management skills: interactive video courseware vs ACLS instructor. AB - Lectures and demonstrations have been the teaching and testing strategies most often employed by the American Heart Association in Advanced Cardiac Life Support (ACLS) training. I compared the abilities of interactive videodisc (IVD) courseware and ACLS instructors to evaluate airway management skills. METHODS & MATERIALS: Twenty-two subjects were simultaneously tested during 30 attempts at endotracheal (ET) intubation and 34 attempts at esophageal obturator airway or esophageal gastric tube airway (EOA/EGTA) insertion. The instructors were blind to the visual and auditory messages produced. RESULTS: The IVD program and the ACLS instructors showed high agreement in their evaluation of student performance for time of intubation (95.5% ET; 100% EOA/EGTA), proper tube placement (91% ET; 93% EOA/EGTA), appropriate tube assessment (95.5% ET; 100% EOA/EGTA), and correct EOA/EGTA cuff inflation (100%). Lower levels of agreement were noted with ET and EOA/EGTA appropriate head positioning, and the evaluation of tooth pressure with ET intubation (60.5%, 76.5%, and 66.0%, respectively). The IVD system was unable to detect certain procedural errors associated with appropriate intubation procedure--syringe attachment, syringe removal after cuff inflation, and control of tube after intubation. The low agreement for tooth pressure suggests that the sensor-equipped manikin may better evaluate tooth pressure than does the observer. CONCLUSIONS: Although the IVD system shows promise as an adjunct method for instruction and testing, it cannot be considered suitable for 'stand-alone' instruction. Further research is needed to explore costs, skills retention, and possible impact of the medium for training hospital and prehospital-care personnel. PMID- 10145481 TI - State licensing boards and your legal rights. PMID- 10145482 TI - How a malpractice defense attorney earns his keep. PMID- 10145483 TI - IRS challenges Medicare cost deductions for UBIT (unrelated business income tax). PMID- 10145484 TI - Know the rules to benefit from Social Security. PMID- 10145485 TI - By any name, patient accounts manager ripe for re-evaluation. PMID- 10145486 TI - Time-saving 'employees' work non-stop. PMID- 10145487 TI - Three methods figure into cash concentration schedule. PMID- 10145488 TI - If unsatisfactory, a job offer can be negotiated. PMID- 10145489 TI - Ten criteria for effective team building. PMID- 10145490 TI - Empowerment, not numbers, will end nursing shortage. AB - Record-breaking nursing school enrollments cannot solve the nation's nursing shortage, but management strategies that give nurses greater say in patient care and nursing routines may offer solutions to the problem. Recognition of nursing as a key hospital service also requires appropriate compensation for nursing staff members and opportunities for career advancement. Because nurses work on a facility's clinical front lines, empowering them to make day-to-day decisions also can help achieve quality improvement goals. PMID- 10145491 TI - Demand for nurses requires quick action from hospitals. PMID- 10145492 TI - Putting teeth into pay-for-performance programs. AB - Although performance-based evaluation and salary systems are common among healthcare organizations, most facilities have not adopted rank-and-file variable compensation plans. One option, gain sharing, may draw increasing attention in health care because it is designed to reward employees based on financial performance, productivity, and quality measures--addressing some prominent concerns in the industry. PMID- 10145493 TI - Study shows ways to win, avoid union elections. AB - Because of an April Supreme Court ruling authorizing the National Labor Relations Board to establish eight collective bargaining units in hospitals, administrators should be concerned with consequences of unionization within their hospitals. A three-year study of union activity at hospitals across the nation indicated a typical pattern of union organization and isolated approaches a hospital should avoid to lessen the likelihood of employee dissatisfaction. Most important, administrators should establish a two-way communication system in which employees feel free to air grievances. PMID- 10145494 TI - RBRVS: how new physician fee schedules will work. AB - The Health Care Financing Administration's (HCFA's) new Medicare fee schedule for physicians will break physician services into three components: physician work, practice expenses, and malpractice expenses. HCFA intends the new fee schedule to reduce and more equitably distribute Medicare expenditures for physician services. For healthcare organizations, the new fee schedule may mean changes in revenue collections, revisions to coding and billing systems, and greater competition between physicians and outpatient hospital services. PMID- 10145495 TI - Larger urban hospitals increasingly on closed list. PMID- 10145496 TI - Founders' vision: foresight and action launch 45 years of HFMA (Healthcare Financial Management Association). PMID- 10145497 TI - Adapting with members, HFM maintains founders' goals. PMID- 10145498 TI - ECMO: where have we been? Where are we going? PMID- 10145499 TI - Respiratory care in the transport of critically ill and injured infants and children. PMID- 10145500 TI - Using product line management to meet strategic objectives. PMID- 10145501 TI - Patient accounts managers play a role in advocacy. PMID- 10145502 TI - Courts side with hospitals on advance refunding losses. PMID- 10145503 TI - Every facility needs a cash management procedures manual. PMID- 10145504 TI - Nebraska hospital brings services closer to patients. PMID- 10145505 TI - Psychological testing enters the job market. PMID- 10145506 TI - Final safe harbors narrow and rarely navigable. PMID- 10145508 TI - How strategic planning can go wrong. PMID- 10145507 TI - Creating a market strategy for 'brand loyalty'. AB - A healthcare organization's financial well-being stems from sound strategic planning, which increasingly requires the merger of marketing intelligence and financial management expertise. As a participant in strategic planning, a hospital's chief financial officer (CFO) ensures that plans achieve organizational goals for growth and return on investment. CFOs can apply their analytical and measurement skills to help determine areas of strength and potential growth, then match those services to market segments. PMID- 10145509 TI - Planning effectiveness may grow on fault trees. AB - The first step of a strategic planning process--identifying and analyzing threats and opportunities--requires subjective judgments. By using an analytical tool known as a fault tree, healthcare administrators can reduce the unreliability of subjective decision making by creating a logical structure for problem solving and decision making. A case study of 11 healthcare administrators showed that an analysis technique called prospective hindsight can add to a fault tree's ability to improve a strategic planning process. PMID- 10145510 TI - Crisis management can leave residual effects. AB - A healthcare organization that once suffered from poor financial performance may fail to correct recovery methods that can cause lingering legal and accounting problems. A crisis management style is prone to creating problems with an organization's debt structure, Medicare and Medicaid payment, tax issues, labor relations, licensing and accreditation, compliance with fraud and abuse rules, and accounting for charity care. After stabilizing a worrisome financial situation, a healthcare organization should conduct an internal audit to ensure that its legal and accounting practices remain above board. PMID- 10145511 TI - Giving receivables an 'outside' chance. AB - Because of a greater number of patient visits and transactions, outpatient care typically involves more clerical and administrative work for less revenue than inpatient accounts. One hospital turned to outsourcing its outpatient receivables contracting with an outside company to handle outpatient receivables. An outside company first can help an organization tackle an outpatient billing backlog and increase cash flow from outpatient accounts. Eventually, outsourcing can help an organization replace an outdated computer system and stem the tide of billing office employee attrition. PMID- 10145512 TI - Financing maneuvers. Two opportunities to boost a hospital's working capital. AB - Two receivables financing approaches, factoring and asset-backed securitization, offer an initial cash flow boost and a predictable source for continual cash flow. In a typical receivables factoring program, a healthcare organization receives advance funding from its receivables and reduces collection and follow up efforts required of its staff. In exchange, the organization: Sells receivables at a discount between 5 percent and 10 percent off face value; and Pays a factoring fee of up to 20 percent of sold receivables. In a typical asset backed securitization: Proceeds generated from the sale of A1-rated commercial paper are used to purchase receivables from a hospital; Accounts receivable eligible for sale are advance-funded at a level between 80 and 90 percent, with the unfunded portion remaining an asset of the hospital; The hospital is responsible for collection and follow-up activities; and An asset manager maintains cash collections to retire commercial paper notes and pay administrative costs. A healthcare organization interested in receivables financing should review each option's structure and benefits to assess advance funding provided, costs, a seller's level of control, and program eligibility requirements. PMID- 10145513 TI - Financial reserve. Hospitals leery of credit lines, factoring receivables. AB - Opening lines of credit and factoring (selling) accounts receivable are two ways to generate operating cash that non-healthcare industries have long used successfully. A recent survey of hospital officials across the nation, however, showed these techniques are used infrequently in health care. Among the 281 hospitals responding: Only 45 percent use lines of credit; Less than 5 percent pursue accounts receivable factoring; and Only 12 percent plan to begin factoring receivables in the future. As hospitals look for ways to offset depleted cash reserves, these percentages may increase. PMID- 10145514 TI - Where there's a will. How to finance Medicare receivables--legally. AB - Although factoring transactions involving Medicare (and, in some states, Medicaid) receivables are prohibited by Medicare regulations, a healthcare organization can allow a lender to finance its Medicare receivables and still retain "ownership" of accounts until they are paid. An organization can convert Medicare receivables into cash if: A lender finances between 65 percent and 80 percent of certain "eligible" accounts receivable and takes a security interest in all (or some) of the organization's receivables; Payments on eligible accounts are sent to a designated lockbox account; An amount equal to the amount deposited in the lockbox account is regularly swept into another account (the collateral account); and Legal agreements are drawn up among the healthcare organization, the lender, and any other depository involved. An organization pursuing this financing method should understand the risks involved and prepare legal documents to offset these problems. PMID- 10145515 TI - Amid change, management undergoes a redefinition. PMID- 10145516 TI - Support in a time of need. The team approach at Mercy Medical Hospice addresses medical, emotional, and spiritual needs. AB - Mercy Medical Hospice, Daphne, AL, uses an interdisciplinary team approach, which includes medical, nursing, social work, pastoral care, pharmacy, therapies, volunteer, and bereavement services. Mercy Medical has two home care offices and offers inpatient respite care for short periods, which is helpful for those who have an inadequate care giver system or need time to work out a better alternative to care in the home. An assessment of medical and nursing care needs, mental and emotional state, and psychological and spiritual needs is the first step after patients enter hospice. The entire team develops a care plan for the patient and family. Among the issues they address are education about the disease process, medication for pain control and symptom management, and how the patient and family cope with the patient's imminent death. Working with the dying and their families can be stressful for staff members, and they offer each other a lot of support. Working in hospice requires good stress management techniques, but staff feel that it is a calling that enriches their lives. PMID- 10145517 TI - A video-based information system for patients. AB - This paper describes a video-based information system (VISP) for general practice waiting areas, and considers its potential for broadening the range of information which might be made available to patients. PMID- 10145518 TI - Thumbs up for governance video. PMID- 10145519 TI - A path through the mine field. PMID- 10145520 TI - Scrutiny of analysis statements may uncover savings. PMID- 10145521 TI - Living will center, videotapes help hospitals meet regulation. PMID- 10145522 TI - Coding accuracy ultimately affects the bottom line. PMID- 10145523 TI - Making the best of a bad career move. PMID- 10145524 TI - Doing more with less. PMID- 10145525 TI - Roles people play: managing group dynamics. PMID- 10145526 TI - Inventory to go: can stockless deliver efficiency? AB - Influenced by the Japanese management concept of "just-in-time," healthcare organizations are looking to their departmental inventories for possible cost reductions. Some organizations have developed a materials management technique known as stockless inventory, in which much of the management of an organization's supplies is switched to an outside vendor. By eliminating its storeroom and many of the staffing needs that go along with it, a hospital with a stockless inventory program can realize significant cost savings. Whether these savings offset potentially large service fees is a question each hospital must decide on its own. PMID- 10145527 TI - Purchasing coming into its own. PMID- 10145528 TI - Fixing the quick fixes to physician relations. AB - Traditional methods for cooperation among hospitals and physicians have not been successful at warding off problems that prompt hospitals and physicians to work together in the first place. Management service organizations and income guarantees have left hospitals open to third-party payer contracting problems, legal risks, and poor spending decisions. A solution perhaps begins with hospitals and physicians' groups finding a way to align their strategic planning processes. PMID- 10145529 TI - Physician recruiting: do you know where your dollars go? AB - Time and resources spent on physician recruitment are investments that hospitals often overlook. While they may allocate resources for recruitment, many hospitals fail to analyze the value of recruitment dollars spent. By developing a physician search plan, however, a hospital can evaluate market demand for physicians, review ways to reduce physician turnover, and calculate a hospital's return on recruitment investments. PMID- 10145530 TI - Complexity, caution mark start of PPS for capital. AB - The Health Care Financing Administration's revised and highly complex method of paying for inpatient capital costs includes broadened provisions for old capital, a series of payment "floors" for especially vulnerable facilities, and other changes meant to address industry criticism. But a villain known as budget neutrality inevitably led to reductions in some areas. During the system's 10 year transition, one prominent concern will center on how the Federal rate will be set and adjusted. PMID- 10145531 TI - Capital PPS: trekking through the labyrinth. AB - The Health Care Financing Administration's (HCFA's) new method of paying for Medicare inpatient capital costs will pay a hospital under either a fully prospective system or a hold harmless method. The new system includes a payment floor on total capital, a revised outlier payment system, and an exceptions process by which some hospitals can receive additional capital payments. HCFA plans to phase in the new system over a 10-year period. PMID- 10145532 TI - Activity-based costing may reduce costs, aid planning. PMID- 10145533 TI - Investment strategy II: looking at options. PMID- 10145534 TI - Balancing the scales. AB - A regional register of early childhood impairments can monitor the long-term health of low birth weight babies. Ann Johnson describes the planning benefits in the Oxford region. PMID- 10145535 TI - Aerosol exhaust: escape of aerosolized medication into the patient and caregiver's environment. PMID- 10145536 TI - Control of tuberculosis during aerosol therapy administration. AB - In summary, despite the major benefits conferred by aerosol therapy, the risk of transmission of M tuberculosis remains a concern. The most effective approach to preventing nosocomial transmission of respiratory infections such as tuberculosis is to prevent disease in patients at risk, particularly those receiving aerosol therapy. Tuberculin skin tests should be applied to all HIV-infected persons and chemoprophylaxis administered to those with greater than or equal to 5mm reaction. Early detection and treatment of tuberculosis are essential to prevent transmission both inside and outside of health-care settings. Cough-reduction measures should be taken when giving pentamidine aerosol, and patients who do cough should cover their mouths. Proper ventilation of treatment areas with negative air pressure and at least 10 air changes per hour, and more if feasible, is essential. HEPA filters should be installed to cleanse exhaust air from treatment rooms, and air should not be recirculated. The use of UV light to disinfect air is recommended only for special situations. Finally, personal protective devices should be worn by health-care workers who are exposed to patients receiving aerosol therapy when other measures do not offer adequate protection. PMID- 10145537 TI - Propellant gases in metered dose inhalers: their impact on the global environment. PMID- 10145538 TI - Aerosol consensus statement--1991. American Association for Respiratory Care. PMID- 10145540 TI - PFS managers are participants in quality improvement. PMID- 10145539 TI - Aerosol generators and delivery systems. PMID- 10145541 TI - Prepare now for changes in banking environment. PMID- 10145542 TI - Summer festival offers capital raising tradition. PMID- 10145543 TI - Determining indicators of patient financial services performance. PMID- 10145544 TI - The wrapping is an essential part of the package. PMID- 10145545 TI - Management is a key to financial performance. PMID- 10145546 TI - Integrated delivery can ally physician and hospital plans. AB - Hospitals trying for successful business cooperation with physicians have become frustrated with risky joint ventures, quick-fix recruiting plans, and management service organizations. An integrated delivery system (IDS), however, may succeed where other approaches have failed. An IDS can align physician and hospital strategic planning, command more favorable contract terms from payers, and meet community needs in recruiting physicians and allocating capital. With the healthcare payment system likely to remain chaotic, however, the value of IDS improvements to healthcare delivery remains to be seen. PMID- 10145547 TI - Financial analysis critical to physician alliances. AB - Although physician support programs have gained in popularity in recent years, organizations must be careful to select the most effective mix of physician relations programs. A healthcare financial manager can help create a productive physician alliance program by analyzing physicians as strategic business units, providing financial and analytical support for program assessment, screening programs for legal risks, and assessing an alliance program's risks in terms of antifraud and abuse legislation, tax laws, and private inurement issues. PMID- 10145548 TI - Integrated information systems can seal physician alliances. PMID- 10145549 TI - Budget model can aid group practice planning. AB - A medical practice can enhance its planning by developing a budgetary model to test effects of planning assumptions on its profitability and cash requirements. A model focusing on patient visits, payment mix, patient mix, and fee and payment schedules can help assess effects of proposed decisions. A planning model is not a substitute for planning but should complement a plan that includes mission, goals, values, strategic issues, and different outcomes. PMID- 10145550 TI - Market forces can boost quality, lower costs. AB - Competitive market forces may do more to ensure healthcare quality than government regulatory attempts. Independent research can show that healthcare quality drives profits and increases market shares. Greater market shares increase volumes, and increased volumes can lead to lower costs per case. These improvements may better position providers for payer contract negotiations, especially as payers are encouraging providers to assume more risk. Ultimately, however, a public more informed about costs and outcomes may be necessary for market forces to reduce national average costs per case. PMID- 10145551 TI - Clinical pharmacists can ensure quality at acceptable costs. PMID- 10145552 TI - Statement No. 13: Timing differences pertaining to third-party payments. Healthcare Financial Management Association, Principles and Practices Board. AB - As this statement describes, institutional healthcare providers have recorded timing differences and continue to be confronted with circumstances warranting their recording. Medicare arrangements for paying for capital related cost are the most frequent basis of recording or changing previously recorded timing differences but other bases for recording or changing previously recorded timing differences are described in this statement. As this statement was being prepared for publication, another significant change in Medicare arrangements for paying for capital-related cost was under consideration. This statement is intended to describe the issue of timing differences generally and not to focus only on changes called for by a single legislative or regulatory action. Furthermore, the disposition of the currently proposed change is uncertain. Accordingly, the examples included in the appendices of this statement are the same as were included in the exposure draft of this statement released in 1990. HFMA has indicated its intent to prepare examples of the recording of changes in timing differences called for by legislation or regulations when the terms are sufficiently certain to warrant action. Those examples will be based on the conclusions included in this statement. PMID- 10145553 TI - Claims processing advances likely in 1992. PMID- 10145554 TI - Professional networks require maintenance. PMID- 10145555 TI - New program aims to increase awareness of organ donation. PMID- 10145556 TI - A better way to evaluate hospital capital expenditures. PMID- 10145557 TI - Medicare geographic reclassifications a missed opportunity. PMID- 10145558 TI - Healthcare reform stews in Congressional pressure cooker. AB - The United States Congress responded to Americans' healthcare worries with more than 30 healthcare reform proposals in 1991. Each bill falls into one of three camps: incremental approaches that favor improvements in the current system, employer-based programs, and single-payer programs, which would funnel all funds through a public administrator. Although major reform is unlikely to pass through Congress in the next year, knowing the details of proposals from Congress and other groups helps provide a framework for discussion of healthcare reform. PMID- 10145559 TI - Health care uber alles: how it works in Germany. AB - The German healthcare financing system combines regulated, employment-based "sickness funds" for most workers and private insurance available to those above an income threshold. Costs are paid on a fee-for-service basis to private physicians and at an all-inclusive per diem rate to hospitals. Workers and their employers contribute to sickness funds at a percentage of their earnings. The German government sets regulations by which services are provided but does not actively administer either services or payment. PMID- 10145560 TI - How hospitals can avoid antitrust exposures. AB - Healthcare institutions' growing diversity of business activities increasingly exposes them to antitrust liability. Greater exposure threatens assets not only of institutions, but of their officers and directors as well. Chief financial officers should be aware of emerging exposures and consider transferring risks through the use of directors' and officers' and entity liability insurance. PMID- 10145561 TI - Lessons from the hospital merger wars. PMID- 10145562 TI - Capital PPS transition period affects timing differences. AB - The Health Care Financing Administration's new capital payment system means hospitals face timing differences in their financial statements. A hospital's 10 year transition into the new system could involve a switch from the hold-harmless payment method to the fully prospective method. To maximize the recoverability of deferred assets and liabilities, hospitals should understand the details of both methods and how changes in third-party payment programs can affect timing differences. PMID- 10145563 TI - The right way to hire a cash management consultant. PMID- 10145564 TI - Effect of PEEP-valve placement on function of a home-care ventilator. AB - BACKGROUND: The addition of a PEEP valve to the circuit of a home-care ventilator like the Aequitron LP-6 can be viewed as a consumer modification of the system. We sought to determine the effect that such a modification would have on ventilator function. METHODS & MATERIALS: Part 1. We tested the effect of PEEP level and PEEP-valve position on volume delivered at the ventilator Y-adapter, over a range of tidal volumes. Part 2. We held tidal volume, frequency, and inspiratory time constant, and varied PEEP level and PEEP-valve position to test the effect of PEEP-valve position on pressures measured at the ventilator outlet, patient-Y, and within the exhalation-valve pressurization line. RESULTS: Conventional placement of the PEEP value (distal to, or 'after,' the exhalation valve) in the LP-6 ventilator circuit resulted in statistically significant and potentially clinically important decreases in the volumes delivered to the patient at some ventilator settings. Proximal placement of the PEEP valve (proximal to, or 'before,' the exhalation valve) resulted in consistent volumes delivered to the patient at all levels tested, without changing the ventilatory performance characteristics of the ventilator as reflected by pressure waveforms. CONCLUSION: We recommend that appropriate observations and measurements be made to verify system function before a home-care ventilator modified to provide PEEP is applied to the patient. PMID- 10145565 TI - Cost impact of metered dose inhalers vs small volume nebulizers in hospitalized patients: the Cleveland Clinic experience. AB - To assess the cost impact of using metered dose inhalers (MDIs) versus small volume nebulizers (SVNs) for hospitalized adult patients not being managed in ICUs, we analyzed the labor, equipment, and medication costs associated with using MDIs at The Cleveland Clinic Foundation. Over the study interval (January 1988-December 1989), a policy was implemented to enhance MDI use, resulting in increased use of MDIs (18% of all bronchodilator treatments in 1989 vs 5% in 1988). Based on a volume of approximately 70,000 bronchodilator treatments/year in our hospital, increased MDI use with this policy reduced direct costs by $26,510, with associated savings in respiratory-therapist time. To extend this analysis of costs to other institutional settings, we present an analysis of projected changes in institutional costs when the volume of bronchodilator therapies and the percentage administered by MDI varies. PMID- 10145566 TI - Comparison of tidal volumes, minute ventilation, and respiratory frequencies delivered by paramedic and respiratory care students with pocket mask versus demand valve. AB - BACKGROUND: The importance of establishing the airway and providing ventilation during resuscitation is well recognized; however, the effectiveness of demand valve ventilation has not been fully addressed. METHODS & MATERIALS: We examined the differences in respiratory frequency (f), tidal volume (VT), and minute ventilation (VE) achieved by 15 emergency medical technicians (EMT) in a paramedic training course (EMT-4) and 16 second-year respiratory care students (RC) when ventilating a mannequin by three different methods: Laerdal pocket mask, a mask designed for mouth-to-mask ventilation (Method I), demand valve with one hand (Method II), and demand valve with two hands (Method III). RESULTS: The RC f was much higher for all three methods compared to the EMT-4. The EMT-4 demonstrated larger VT for each method compared to the RC. The RC only achieved acceptable VT with Method III. The EMT-4 and RC demonstrated statistically significant differences in VE between each method. However, the clinical importance of these differences for EMT-4 is negligible. Although the mean values indicated achievement of minimum VTS by the EMT-4 with the pocket mask, 40% were unable to do so at 1 minute and 60% at 5 minutes. A great difference was seen in VE produced by RC with Method I at both 1 and 5 minutes vs Methods II and III. CONCLUSIONS: EMT-4 appear to have superior ventilation skills compared to RC. Superior performance skills may be related to (1) different instructional methodologies, (2) effects of various amounts of experience in ventilating actual victims, and (3) greater familiarity of EMTs with the demand valve. As a consequence of this study, we are re-evaluating the instructional methodology used in our programs; we encourage other programs to do the same. We recommend that EMS providers and hospitals consider changing to an acceptable alternate mask in light of these and previous data. PMID- 10145567 TI - Compression volume in adult ventilator circuits: a comparison of five disposable circuits and a nondisposable circuit. AB - Although the concept of ventilator circuit compression is well known, it is not fully appreciated clinically. We compared the compression volume of five adult disposable ventilator circuits and a nondisposable circuit. METHODS: Five brands of disposable circuits (Inspiron, Intertech, Marquest, Seamless, and U-Mid) and one nondisposable brand (Bennett) were used. The circuits were attached to the outlet of a Bennett MA-1 ventilator in the standard manner, and the filter and humidifier were bypassed to eliminate their contribution to compression volume. The ventilator delivered 1 L of gas to a Michigan Instruments Test Training Lung at a flow of 60 L/min and a rate of 12/min. A valve system was placed between the Y-connector and the TTL to partition circuit compression volume from the volume delivered to the test lung. The compression factor was calculated by dividing the compression volume by the ventilating pressure. Five compliance settings were used on the TTL (0.1, 0.05, 0.03, 0.02, and 0.015 L/cm) to simulate different ventilating pressures. Pressure at the Y-connector, compressible volume, and volume delivered to the TTL were measured using a calibrated Timeter RT200 volume pressure analyzer. Five measurements were made with each brand. A new circuit was used for each run with a disposable circuit, and a different circuit from the respiratory care department stock was used for each run with a nondisposable circuit. RESULTS: There were significant differences between the compression factors at different TTL compliance settings (p less than 0.001), and brands of circuits evaluated (p less than 0.001). There was a significant interaction effect for compression factors between TTL compliance setting and circuit brands (p less than 0.001). The compression factors for all disposable circuits were greater than the compression factors for the nondisposable circuits (p less than 0.05). CONCLUSIONS: There were differences in circuit compression factors as a function of the ventilating pressure and the brand of circuit. Although these differences are too small to be clinically important in many cases, they may be important during ventilation with low tidal volumes and high pressures. PMID- 10145568 TI - A comparison of the Puritan-Bennett 7200a ventilator's flow-by mode to the T piece mode prior to extubation in postsurgical patients. AB - We compared flow-by ventilation (FB) via the Puritan-Bennett 7200a ventilator with T-piece ventilation (TP) during weaning from mechanical ventilation (MV). METHODS: We placed 22 consecutive postsurgical patients being weaned from MV on FB at base flows of 10 L/min and 20 L/min and then on TP. Blood pressure, pulse rate, respiratory rate, blood gases, tidal volume, and peak inspiratory flow were measured after at least 20 min in each mode. Statistical analysis of clinical status used a three-level, one-way analysis of variance with technique as a within-subjects factor. Setup costs of the three ventilatory modes were evaluated using relative value units for labor plus actual costs of added equipment and supplies. RESULTS: Although there was a statistically significant difference in PaCO2 among the ventilatory modes, this was not clinically important. No other differences were found. Each FB mode cost $2.55 to set up, whereas TP cost $11.90. CONCLUSIONS: FB and TP were clinically equivalent. However, the alarm and monitoring capabilities during FB are useful and may be worth the one-time cost ($1,000) of adding the optional flow-by software to the 7200a ventilator. PMID- 10145569 TI - Manual ventilation during magnetic resonance imaging. AB - Mechanical ventilation during magnetic resonance imaging (MRI) requires a specially constructed ventilator that contains no ferromagnetic components; however, the expense of acquiring such a ventilator may not be warranted if projected use is infrequent. We adapted a Laerdal manual resuscitator to allow its use during MRI, and report the simulation and monitoring procedure that we developed and the successful ventilation of three pediatric patients with the device. PMID- 10145570 TI - Tax-exempt yardstick: defining the measurements. AB - Congress, the Internal Revenue Service (IRS), and state and local governments still are trying to determine requirements a hospital must meet to warrant tax exemption. Revisions to a bill introduced by Rep. Brian Donnelly (D-Mass.) likely will focus Congressional debate on whether charity care or the broader concept of community benefits is the most appropriate measure for not-for-profit hospitals to meet; the IRS may develop intermediate sanctions it could impose on errant not for-profit facilities in lieu of a total revocation of tax-exempt status; and perhaps the most stringent clamp-down on healthcare facilities' tax-exempt status will come from state and local governments that develop boundaries for tax-exempt hospitals to maintain. Not-for-profit facilities can respond to increased scrutiny by viewing government challenges as opportunities to "tell their stories" about charity care and community benefits. PMID- 10145571 TI - Model refines quantification of community service. AB - Challenges to their tax-exempt status prod hospitals to answer the question: Are we doing enough to respond to our communities' needs? One consultant has devised a tool for identifying quantifiable hospital charitable services. The model allows hospitals to decide how well they are addressing community needs on the basis of the full range of activities defining their relationships with their communities. PMID- 10145572 TI - Variance analysis refines overhead cost control. AB - Many healthcare organizations may not fully realize the benefits of standard cost accounting techniques because they fail to routinely report volume variances in their internal reports. If overhead allocation is routinely reported on internal reports, managers can determine whether billing remains current or lost charges occur. Healthcare organizations' use of standard costing techniques can lead to more realistic performance measurements and information system improvements that alert management to losses from unrecovered overhead in time for corrective action. PMID- 10145573 TI - Documenting investment policy boosts safety, returns. AB - The process and responsibility for a healthcare organization's investment decisions should be clearly documented in an investment policy. Any investment policy should contain at least seven elements: how investments relate to the organization's mission; responsibilities of involved parties; long- and short term objectives; desired balance between return and risk; proportions of a portfolio held in stocks, bonds, and other investments; disposition of donated assets; desired investment reports; and the process for keeping the policy current. PMID- 10145574 TI - How to manage banker relations. PMID- 10145575 TI - Plan now for processing changes. PMID- 10145576 TI - New notes bring fixed rates at lower prices. PMID- 10145577 TI - Benefits program covers adoption costs. PMID- 10145578 TI - Identify sources to help manage stress. PMID- 10145579 TI - Laboratory and clinical evaluation of the impact Uni-Vent 750 portable ventilator. AB - BACKGROUND: Transportation of critically ill, mechanically ventilated patients from intensive care units for diagnostic and therapeutic procedures has become common in the last decade. Maintenance of adequate oxygenation and ventilation during transport is essential. We evaluated the Impact Uni-Vent 750 portable ventilator in the laboratory and in the clinical arena to determine its usefulness during inhospital transport. MATERIALS & METHODS: In the laboratory, we determined the Uni-Vent 750's ability to assure tidal volume (VT) delivery in the face of decreasing compliance of a test lung and tested the alarm systems. Using a two-compartment lung model modified to simulate spontaneous breathing, we also evaluated the responsiveness of the demand valve. The clinical evaluation was accomplished by comparing arterial blood gas values and ventilator settings in the intensive care unit before transport to those during transport. RESULTS: As lung compliance was reduced from 0.1 to 0.02 mL/cm H2O [1.0 to 0.20 L/kPa], a slight, statistically insignificant decrease in delivered tidal volume was observed. All alarm systems operated according to manufacturer's specifications. The demand valve triggered appropriately with PEEP from 0 to 20 cm H2O [0 to 1.96 kPa]. Sensitivity settings less than -6 cm H2O [-0.59 kPa] sometimes resulted in inability to trigger the demand valve. During patient transport, arterial blood gas values and ventilator settings were comparable to those observed in the ICU. Because an FIO2 of 1.0 was used during transport, mean (SD) PaO2 was significantly greater 89 (26) vs 341 (78) [11.8 (3.5) vs 45.3 (10.4) kPa]. CONCLUSIONS: The Uni-Vent 750 is a reliable transport ventilator, capable of maintaining adequate oxygenation and ventilation in a majority of mechanically ventilated patients. The Uni-Vent 750's ability to (1) provide CMV, AMV, and SIMV; (2) provide low and high pressure alarms; and (3) provide PEEP compensation is unique among portable ventilators. PMID- 10145580 TI - Evaluation of a double-enclosure double-vacuum unit scavenging system for ribavirin administration. AB - BACKGROUND: Because of our concern for the safety of bedside caregivers who care for infants receiving ribavirin for long periods of time each day for many days, we evaluated the effectiveness of a double-tent enclosure with vacuum scavengers during simulated and actual patient administration. MATERIALS & METHODS: Part 1- We sought to determine whether two or three scavenging pumps were necessary, by 3 8-h trials with 2 pumps and 3 8-h trials with 3 pumps. Entry into and replacement of mannequin occurred according to protocol. Continuous samples were obtained from three locations in the room. Part 2--The double-tent, double-pump scavenger system was evaluated with patient simulation for a 16-h period. Part 3--The double-tent, double-pump system was evaluated during actual patient use. Air samples were also collected during ribavirin administration via mechanical ventilator circuit with filters in the expiratory limb. Coded environmental samples were analyzed by liquid chromatography. RESULTS: Environmental levels were effectively decreased below published maximal acceptable levels. CONCLUSIONS: Use of a double-enclosure, double-pump scavenging system and implementation of entry protocols ensure reduction of environmental ribavirin levels below recommended maximum levels during administration to spontaneously breathing patients. Use of expiratory filters adequately controls environmental ribavirin levels during mechanical ventilation. PMID- 10145581 TI - Analysis of job satisfaction, burnout, and intent of respiratory care practitioners to leave the field or the job. AB - BACKGROUND: Increased stress, burnout, and lack of job satisfaction may contribute to a decline in work performance, absenteeism, and intent to leave one's job or field. We undertook to determine organizational, job-specific, and personal predictors of level of burnout among respiratory care practitioners (RCPs). We also examined the relationships among burnout, job satisfaction (JS), absenteeism, and RCPs' intent to leave their job or the field. METHODS: A pilot tested assessment instrument was mailed to all active NBRC-credentialed RCPs in Georgia (n = 788). There were 458 usable returns (58% response rate). A random sample of 10% of the nonrespondents (n = 33) was then surveyed by telephone, and the results were compared to those of the mail respondents. Variables were compared to burnout and JS scores by correlational analysis, which was followed by stepwise multiple regression analyses to determine the ability of the independent variables to predict burnout and JS scores when used in combination. RESULTS: There were no significant differences between respondents and sampled nonrespondents in burnout scores (p = 0.56) or JS (p = 0.24). Prediction of burnout: The coefficient of multiple correlation, R2, indicated that in combination the independent variables accounted for 61% of the variance in burnout scores. The strongest predictor of burnout was job stress. Other job related predictors of burnout were size of department, satisfaction with work, satisfaction with co-workers and co-worker support, job independence and job control, recognition by nursing, and role clarity. Personal-variable predictors were age, number of previous jobs held, social support, and intent to leave the field of respiratory care. Prediction of job satisfaction: R2 indicated that, in combination, the independent variables accounted for 63% of the variance observed in satisfaction with work, 36% of the variance observed in satisfaction with pay, 36% of the variance in satisfaction with promotions, 62% of the variance in satisfaction with supervision, and 48% of the variance in satisfaction with co workers. Predictors of work-satisfaction level were recognition by physicians and nursing, age, burn-out level, absenteeism, and intent to leave the field. Predictors of level of satisfaction with pay were actual salary, job independence, organizational climate, ease of obtaining time off, job stress, absenteeism, intent to leave the field, and number of dependent children. Predictors of level of satisfaction with promotions were recognition by nursing, participation in decision making, job stress, intent to leave the field, past turnover rates, and absenteeism. Predictors of level of satisfaction with supervision included supervisor support, role clarity, independence, and ease of obtaining time off. The strongest predictor of level of satisfaction with co workers was co-worker support. As overall level of JS increased, level of burnout decreased significantly (r = -0.59, p less than 0.001). As burnout level increased, increases occurred in absenteeism (r = 0.22, p less than 0.001), intent to leave the job (r = 0.48, p less than 0.001), and intent to leave the field (r = 0.51, p less than 0.001). CONCLUSIONS: Reduced job stress, increased job independence and job control, improved role clarity, and higher levels of JS were all associated with lower levels of burnout. Managerial attention to these factors may improve patient care and reduce absenteeism and turnover among RCPs. PMID- 10145582 TI - Bronchodilating efficacy of an open-spacer device compared to three other spacers. AB - BACKGROUND: Spacers devices are commonly used in aerosol therapy; however, they are bulky and require regular cleaning. A compact open spacer (OS, Synchroner, Fisons, UK) has been developed to overcome this problem. We compared bronchodilator efficacy associated with its use to efficacy of same dose via three other spacers: Volumatic (Glaxo Laboratories), Nebuhaler (Astra Laboratories), Inspirease (Key Pharmaceuticals). MATERIALS & METHODS: Sixteen asthmatics (greater than 20% reversibility of FEV1) took part in the study. In random order, they used a different device on each of the 4 study days to inhale 2 puffs of a combination aerosol (1 mg reproterol and 2 mg sodium cromoglycate, Aarane). We recorded results of spirometry before and 5, 30, and 60 minutes after bronchodilator inhalation. RESULTS: At each time, we found no significant difference in bronchodilation. CONCLUSION: OS is as efficient as other commonly used spacers to produce bronchodilation resulting from a conventional dose of reproterol. PMID- 10145583 TI - The future educational needs of respiratory care practitioners: a Delphi study. PMID- 10145584 TI - Produce award-winning training videos. AB - To be a winner, video training has to achieve its net result--effectively training employees. By understanding the basics of production, a video program can be your best training tool. PMID- 10145585 TI - Spiritual care of the dying. PMID- 10145586 TI - Perspectives. New guidelines prescribe relief from pain. PMID- 10145587 TI - Comparability of pulmonary function results from 13 laboratories in a metropolitan area. AB - We have observed that the results of pulmonary function tests obtained at one site, in general, may not be considered 'acceptable' at another site--in part because of known or suspected variability in equipment and techniques. We sought to document the presence or absence of such variability in our metropolitan area. METHODS & MATERIALS: We compared the test results from 5 trained healthy subjects (3 men and 2 women) studied in 13 Denver-area pulmonary function laboratories in a randomized order and at approximately the same time of day. RESULTS: We performed analysis of variance on commonly reported parameters and found no significant difference for FVC (p = 0.11), FEV1 (p = 0.075), FEF25-75% (p = 0.41), and FRC by helium dilution (p = 0.22). However, marked differences between certain sites could be clinically important. In addition, we found a statistically significant difference for DLCO (p less than 0.001) and TLC (p = 0.024). Six different brands of pulmonary function equipment were used by the 13 hospitals, and differences in the number of trials performed, sequence of testing (eg, FRC determinations were sometimes done first, sometimes last), and calculation of the DLCO breath-hold time. CONCLUSION: We conclude that although the FVC, FEV1, FEF25-75%, and FRC measured by helium dilution were not statistically different in healthy trained subjects in the 13 hospitals studied, clinically important differences may exist. The DLCO and TLC were statistically different. To minimize variability and improve comparability, hospitals in a given area should give consideration to adopting standardized techniques, using comparable equipment, and adopting common reference equations. PMID- 10145588 TI - The AARC (American Association for Respiratory Care) clinical practice guidelines. PMID- 10145589 TI - AARC (American Association for Respiratory Care) clinical practice guideline. Incentive spirometry. PMID- 10145590 TI - AARC (American Association for Respiratory Care) clinical practice guideline. Pulse oximetry. PMID- 10145591 TI - AARC (American Association for Respiratory Care) clinical practice guideline. Oxygen therapy in the acute care hospital. PMID- 10145592 TI - AARC (American Association for Respiratory Care) clinical practice guideline. Spirometry. PMID- 10145593 TI - AARC (American Association for Respiratory Care) clinical practice guideline. Postural drainage therapy. PMID- 10145594 TI - Risk factors for developmental delay among infants and toddlers. AB - Definitions of risk, types of risk factors used in longitudinal studies of the development of infants and toddlers (0-3 years), and the predictive power of risk models in assessing developmental delays are reviewed. Biologic factors in combination with environmental risk factors give the best prediction of long-term outcome. When biological or environmental risk factors are examined independently, they are not powerful predictors. Recommendations are made for repeated screening for developmental risk factors during the first 3 years, and a model for provision of services is presented that assumes a differential risk algorithm. PMID- 10145595 TI - Strategic planning is essential to career success. PMID- 10145596 TI - TQM: the questionable movement? PMID- 10145597 TI - Taming the remittance beast electronically. AB - The next step in coralling the back-office-beast is automating remittance processing. Before taking any steps in that direction, healthcare providers need to establish new procedures for cash management and patient accounting. Opportunities exist for related uses of electronic data interchange (EDI), which will provide additional benefits but will also trigger fundamental changes in the way healthcare providers do business. PMID- 10145598 TI - Integrated business office can boost cash flow. AB - Management of patient accounts traditionally has treated billing and collections as separate functions, with staff members working accounts alphabetically by patient. In an integrated business office, however, staff members are trained in both billing and collections and are specialized according to payers. The advantages of a payer-specific design include more efficient contact with major payer groups and a better trained, more flexible staff. PMID- 10145599 TI - Quality of care emerges as a determinant of creditworthiness. AB - Sophisticated profiles of the quality of care provided in hospitals are prompting investors and bond rating agencies to ask questions about debt capitalization: What elements of the quality of care--measured by illness outcome, length of stay, morbidity, and mortality--will improve as a result of a proposed capital financing? Can the hospital demonstrate that cost benefits will result from a proposed financing by correlating costs with measurable improvements in patient outcomes? Can the hospital show, through financial feasibility analyses that reflect quality assessments, that its market share will remain stable? Hospitals' ability to gain access to credit markets will be influenced materially by their answers to these questions. PMID- 10145600 TI - The case for comparability in financial reporting. AB - Government-owned organizations are accountable to citizens and their elected representatives. These organizations must provide financial information that will help in determining whether they are effectively pursuing their primary goal, which is to promote the general welfare. Regardless of the kind of service provided by a government-owned organization, the information needs of citizens and their elected representatives must be considered when developing accounting rules. If these needs are ignored or compromised in favor of the needs of other users, such as investors or creditors (the primary users of business financial reports), then financial reporting by government-owned organizations will not meet its objectives. PMID- 10145601 TI - Ensuring high-quality banking services. PMID- 10145602 TI - Closing the GAAP (generally accepted accounting principles) with special reports. PMID- 10145603 TI - Automated payroll systems a must for outmoded hospitals. PMID- 10145604 TI - Patient accounting not immune to quality bug. PMID- 10145605 TI - Balancing investment liquidity and maturity to increase yield. PMID- 10145606 TI - Capital PPS 10-year transition up and running. AB - Hospital financial officers must prepare themselves for the long stretch, as the 10-year transition to Medicare's new capital prospective payment system (PPS) gets underway. Documentation related to capital assets and their financing must be assembled and preserved throughout the transition period; audit procedures must be understood; crucial deadlines must be met; and calculations by Medicare fiscal intermediaries (FIs) must be verified by reference to a hospital's records. Most important, lines of communication with FIs must be established and maintained because rates set this year will determine a substantial portion of Medicare payment for the next decade. PMID- 10145607 TI - Accuracy of investment risk models varies. AB - Financial analysis of proposed capital investments must include an assessment of risk as well as return. Four assessment techniques can be used to provide insight into the risk inherent in any capital investment project: breakeven analysis, sensitivity analysis, scenario analysis, and Monte Carlo simulation. The most complete picture of a project's stand-alone risk is provided by a Monte Carlo simulation, which generates a profitability probability distribution. The primary concern of most hospital decision makers, however, is the amount of risk the capital investment adds to the riskiness of the hospital in the aggregate. PMID- 10145608 TI - Profile of internal auditors in health care. AB - The internal auditor is an important management resource for maintaining control over operations. As the importance of healthcare cost management grows, so does the potential contribution of the internal auditor. A recent study examines what internal auditors do, what backgrounds they have, what salaries they receive, and what their career attitudes are. PMID- 10145609 TI - The burden of uncompensated care grows. AB - It is not surprising that costs for uncompensated care are rising dramatically for most hospitals. What generally has not been understood is that uncompensated care costs are rising faster than overall hospital costs, and government subsidies are failing to keep pace. In addition, the unpaid care problem no longer is being shouldered by one specific group. The facilities seeing the greatest increases in expenditures are those not traditionally associated with uncompensated care--small, non-teaching, non-disproportionate care, and suburban hospitals. Finally, a hospital's commitment to care for the uninsured cannot be predicted by any common classification. This information emerged from an analysis conducted by the Prospective Payment Assessment Commission in an effort to develop a basis for devising options to address the uncompensated care problem. PMID- 10145610 TI - Bottom-line budgeting based on estimated cash flow needs. PMID- 10145611 TI - Equity in rehab hospital payment changes needed. PMID- 10145612 TI - Voice processing systems have great potential. PMID- 10145613 TI - Patient accounts faces public relations challenge. PMID- 10145614 TI - Outplacement is vital to human resources planning. PMID- 10145615 TI - Patient education: a potential marketing tool for the private physician. AB - To keep pace with increasing competition, the private physician is encouraged to consider a patient education program as a marketing tool. Meeting the educational needs of patients is presented as an opportunity to create a trusting environment in the practice, enhance the doctor-patient relationship, and increase the active role of the patient in the health care process. A management model is proposed for successfully planning, organizing, staffing, leading, and controlling the patient education program. PMID- 10145616 TI - A cart to provide high frequency jet ventilation during transport of neonates. AB - We report the evaluation of a cart we created to provide high frequency jet ventilation (HFJV) to neonates during intrahospital or interhospital transport. DESCRIPTION: The cart carries a conventional ventilator, jet ventilator (JV), incubator, gas blender, 3 E cylinders of oxygen and 2 of air, uninterruptible electric power supply (UPS), 2 syringe infusion pumps, cardiac monitor, and oximeter. EVALUATION METHODS: To determine the available operating time of the ventilators, we ran tests with 60% and 100% oxygen, high and low ventilator settings, 2.5-mm and 3.5-mm endotracheal tubes, and lung simulator set for low and high time constants. With five different combinations of these variables, the system was run to exhaustion of its gas supply. To determine the operating time limit of the UPS, we used it to operate the JV until the low-battery alarm sounded. RESULTS: The UPS always provided electrical power for at least 2 hours. In no case did a single cylinder of oxygen fail to power the system for less than 20 min. Because the cart carries 3 cylinders of oxygen and 2 of air, under the conditions tested a minimum of 60 min of continuous operation, using 100% oxygen, should be available during those portions of transports when the system is away from hospital and ambulance bulk power sources and is dependent on its own UPS and E cylinders of gas. EXPERIENCE: We have used the cart on two occasions to transport a 30-week gestational age, 1-kg, HFJV-dependent infant, first from ICU to surgery, then to another hospital for cardiac catheterization. Total transport time was 3 hours; there were no problems. The cart has also been used to transport three patients between hospitals during ECMO, without HFJV. CONCLUSIONS: Our HFJV transport system is adequate to transport an HFJV-dependent infant during the 30 to 60 minutes that may elapse when the cart is away from ambulance or hospital sources of electricity and gas. Available operating time with an HFJV transport system should be estimated conservatively; when an infant is dependent on HFJV, it would be well to have aircraft backup in case of ambulance breakdown or other contingencies. PMID- 10145617 TI - Application form items as predictors of performance and longevity among respiratory therapists: a multiple regression analysis. AB - Errors in employee selection and consequent high turnover rates are expensive and can result in poor staff morale and possible harm to patients and personnel. METHOD: We investigated the predictive validity of commonly used application blank items as measures of future performance, absenteeism, tardiness, and tenure (the criterion variables) among 100 hospital-employed respiratory therapists and looked at the relationships among the criterion variables. RESULTS: Regression analysis showed the most significant predictive variables to be grade point average in respiratory therapy school, college education in addition to respiratory therapy training (particularly an associate degree in health sciences or a baccalaureate degree), and, surprisingly, the neatness of the application form itself. No important differences were found among the types of respiratory therapy program attended or the length of previous respiratory therapy experience. CONCLUSION: The data offer cautious evidence for the validity of some application items to predict some employee behaviors. The relatively low correlations among the criterion variables (absenteeism, tardiness, tenure, and performance) suggest that these items may be assessing substantially different aspects of employee behavior. PMID- 10145618 TI - Computers in the ICU: panacea or plague? AB - The introduction of the intensive care unit (ICU) in the 1960s with its demands for management of large volumes of patient data drove the initial introduction of computers into the ICU. Since the mid-1960s computer systems for the ICU have evolved into the highly sophisticated bedside workstations commercially available today. Despite all of the technologic advances in computers, their application in ICUs in the United States continues to spread very slowly. One of the largest problems is justifying the cost of systems primarily designed to automate data charting and generation of care plans. Although the existing commercial systems do an excellent job, few conclusive studies prove that these systems have a favorable cost-to-benefit ratio. Research systems have demonstrated that if one extends these systems to incorporate a fully integrated database, decision support tools, automation of data acquisition, and more sophisticated display and user-interface technology, then these ICU computer systems can have a significant impact on improving the quality and reducing the costs of patient care. For computers to be embraced in the ICU environment, commercial systems of the future must move beyond merely gathering and displaying information. They must help the clinician at the bedside assimilate the vast array of ICU data and help him to make more effective decisions. PMID- 10145619 TI - Theological reflections on the ethics of pain control among the terminally ill. AB - Explores the reality of pain thru explications of the theological notions of "justification by pain," "justification by death," and "justification by faith." Notes particularly the facilitating role of the hospital chaplain in the understanding of pain and its possible Christian meanings. PMID- 10145620 TI - Information systems: financial class vs. insurance plan. PMID- 10145621 TI - Fee schedules help gauge cost, competitiveness. PMID- 10145622 TI - Medicare home office cost reporting rules are flexible. PMID- 10145623 TI - Whether hiring or looking, understand executive recruiting. PMID- 10145624 TI - Direct deposit circumvents check fraud. PMID- 10145625 TI - Does hospital financial performance measure up? AB - Comparisons are continuously being made between the financial performance, products and services, of the healthcare industry and those of non-healthcare industries. Several useful measures of financial performance--profitability, liquidity, financial risk, asset management and replacement, and debt capacity, are used by the authors to compare the financial performance of the hospital industry with that of the industrial, transportation and utility sectors. Hospitals exhibit weaknesses in several areas. Goals are suggested for each measure to bring hospitals closer to competitive levels. PMID- 10145626 TI - System approach to effective direct contracting. AB - Many of the nation's employers now see direct contracting as a way to regain control over their costs for employees' healthcare benefits. As a result, provider competition for direct contracting arrangements with employers is likely to increase. For a healthcare system, the key to winning employers' contracts may lie in establishing system-wide pricing based on cost determinations. Once prices are set, a healthcare system should select the optimal revenue distribution method for maximizing returns and winning the cooperation of clinical staff. PMID- 10145627 TI - Medicare outpatient bundling: a precursor to full Medicare PPS. PMID- 10145628 TI - The effect of respiratory care department management of a blood gas analyzer on the appropriateness of arterial blood gas utilization. AB - We investigated the effects of establishing a blood gas analysis service controlled by respiratory care practitioners (RCPs) on the appropriateness of arterial blood gas (ABG) sampling. An ABG analyzer was placed outside the surgical intensive care unit (SICU) and only RCPs were permitted to process samples on it. In 1-month and 1-year follow-up audits of appropriateness of ABG analysis, the nursing staff improved from 42% appropriate to 73% appropriate in both follow-up periods. RCPs maintained a high degree of appropriateness in all periods (90%, 87%, and 91%), although the percentage of the total ABGs performed by RCPs increased. Additional benefits included a better mutual understanding of each caregiver's role and work load, more collaboration among caregiver groups, and caregiver's perception of improved patient care. PMID- 10145629 TI - Variations in tidal volume with portable transport ventilators. AB - BACKGROUND: As intra- and interhospital transportation of ventilator-dependent patients has become more commonplace, the number of portable transport ventilators has increased. Transport ventilators should be capable of delivering consistent tidal volume (VT) from breath to breath following changes in lung thorax compliance and airways resistance. We sought to determine the effect of changes in compliance (C) and resistance (R) on the VT delivered by eight commercially available, time-cycled transport ventilators. METHODS & MATERIALS: Each ventilator (PneuPAC Model 2, Autovent 3000, MAX, Bird Transport Mini-TXP, IC 2A, P7, E100i, and Logic 07a) was connected to a calibrated pneumotachograph and a test lung set for normal adult C (C = 100 mL/cm H2O [1.02 L/kPa]) and R (R = 2 cm H2O.s.L-1 [0.2 kPa.s.L-1]), with VT at 1,000 mL. RESULTS: As C and R were manipulated, VT varied widely. Tidal volume decreased least with the P7 and most with the Bird transport ventilator. CONCLUSION: Decreases in VT with a transport ventilator predispose patients to hypoventilation, hypercapnia, and acidemia. Tidal volume often is not monitored continuously during transport, yet large decreases in VT must not be allowed when pulmonary mechanics are unstable. Internal pressure-limiting valves, venturi flow-generating devices, and compression volume in the breathing circuit are at least three factors that affect VT with transport ventilators. PMID- 10145630 TI - Respiratory care practitioner: Carpe Diem! PMID- 10145631 TI - A debate on the ultimate self-determination. AB - An act to be voted on this November in California could set the precedent for the rest of the country: will terminally ill, competent adults legally be able to ask their doctors to help them die? This initiative would allow patients and physicians to take a more active role in deciding the time and place of death. PMID- 10145632 TI - An evaluation of the resistance to flow through the patient valves of twelve adult manual resuscitators. AB - What is the inspiratory and expiratory resistance to flow through the patient valves of adult manual resuscitators? MATERIALS & METHODS: We evaluated the resistance to flow through the patient valves of 12 adult resuscitators (Ambu, Code Blue, DMR, Hope 4, Hospitak, Hudson, Intertech, Laerdal, Mercury, Respironics, SPUR, Vitalograph). Expiratory resistance was evaluated by directing a flow of oxygen through the valve in the direction that the patient expires. Inspiratory resistance was evaluated by directing oxygen through the valve in the direction of flow when the bag is squeezed. Flow was controlled by a Timeter 0-75 flowmeter, and measured using a calibrated Timeter RT-200. Flows of 10, 20, 30, 40, 50, 60, 70, 80, and 90 L/min were used. Resistive back pressure of the resuscitator valves was measured using a calibrated Timeter RT-200. Resistance was calculated by dividing back pressure by flow. Five measurements were made at each flow setting for each resuscitator. RESULTS: Significant differences in back pressures and resistances existed between the resuscitators for both expiratory and inspiratory flows (p less than 0.001 in each case). Significant interaction effects also existed between resuscitator brands and flows (p less than 0.001 in each case). At an expiratory flow of 50 L/min, all resuscitators except the Hospitak and Vitalograph produced a back pressure less than 5 cm H2O (the International Standards Organization standard). At an inspiratory flow of 50 L/min, all resuscitators but the Hospitak, Mercury, and Vitalograph produced a back pressure less than 5 cm H2O. CONCLUSIONS: Significant differences existed in the back pressures produced due to the flow resistance through the patient valves of these resuscitators, and these might be considered excessive in some cases. Because this was a bench study, further work is needed to determine the clinical importance of these findings. PMID- 10145633 TI - The volume of gas emitted from five metered dose inhalers at three levels of fullness. AB - We conducted this study to determine the volume of gas emitted from five commonly used metered dose inhalers (MDIs). MATERIALS & METHODS: We used the following MDIs: Alupent (Boehringer Ingelheim), Atrovent (Boehringer Ingelheim), Beclovent (Allen & Hanburys), Intal (Fisons), and Ventolin (Allen & Hanburys). The test system consisted of plastic bag, MDI adapter, 4-way stopcock, and 60-mL calibrated syringe. This system was glued together, and absence of leaks was confirmed by underwater testing. Each evaluation consisted of 10 puffs from the MDI into the bag, after which the volume in the bag was determined using the syringe, and the volume/puff was calculated by dividing by 10. Each MDI was evaluated at 3 levels of fullness: nearly full, partially empty, and nearly empty. Five measurements were made with each MDI brand, using a new MDI for each set of measurements. RESULTS: Although there was a significant difference in the volumes emitted between MDI (p less than 0.001) and the levels of fullness (p = 0.001), the volume of gas emitted from these MDIs was small (approximately 15-20 mL). A significant interaction existed between MDI brand and level of fullness (p = 0.001). CONCLUSIONS: Based on prior studies of propellant toxicity coupled with our findings on the volumes of gas emitted from MDIs, we conclude that the volumes of gas emitted are too small to be clinically important in the care of adult patients. The volume of gas emitted from an MDI is only potentially important if MDIs are used with very small tidal volumes in a closed system (eg. infants). PMID- 10145634 TI - Patient-focused hospitals: an opportunity for respiratory care practitioners. PMID- 10145636 TI - Three ideas to save money. PMID- 10145635 TI - GOOD campaign generates ideas. PMID- 10145637 TI - Reform means growth, says new HFMA Chairman. PMID- 10145638 TI - PRRB dispute resolution on fast track. Interview by Wendy Herr. AB - Administrative changes are trimming the Provider Reimbursement Review Board's (PRRB's) considerable case backlog, and procedures are being devised to resolve cases before they get to the hearing stage, relates Jack Martin, chairman of the PRRB, Baltimore, Md. Appointed by the Secretary of the Department of Health and Human Services (HHS) in May 1991, Martin has a unique perspective on the workings of the five-member board that serves as a quasi-judicial panel for appeals of Medicare payment disputes. Congress created the PRRB in 1972 to provide an administrative appeals forum for Medicare payment disputes, a forum where providers who are dissatisfied with the reimbursement determination made by their intermediary may request and be afforded a hearing to adjudicate the issues involved. As late as 1975, the board was seeing only 107 appeals a year. But subsequently, volume mushroomed. In fiscal year 1991, the PRRB received 3,062 appeals, the highest number ever. This year, for the first time, however, the board is forecasting a decrease in its appeals (See Exhibit). Nevertheless, implementation of new laws promises more volume growth down the road. In an interview with Wendy Herr, HFMA vice president for policy and government relations, Martin discussed changes, procedural equity, and the potential for an increase in appeals submitted to the board. PMID- 10145639 TI - Long-range planning for information systems. AB - While it can appear to be an overwhelming task, developing a long-range plan for information systems (IS) in a community hospital can be a simple exercise. The plan should focus on long-range strategic objectives that best support the hospital's business strategy. The hospital executive management team must work with information systems staff to create a road map for securing the necessary IS technology, applications, and support. PMID- 10145640 TI - Selecting an information system without an RFP. AB - Rapid advances in computer hardware and software have not been accompanied by improvements in the process of acquiring these systems. Reginald P. Gibson, Steven Berger, and Vincent G. Ciotti explain how the traditional request for proposal approach increases administrative costs. A simpler request for price quotation approach enables hospitals to conserve time and money, while involving user departments when acquiring a new installation. PMID- 10145641 TI - Physician recruitment: the role of the hospital information system. AB - Hospital information systems can support physician recruitment activities by helping identify the type of physician the institution needs, describe the type of medical practice a physician can expect, support the institution's strategic plan for the future, and demonstrate the institution's ability to assist a physician with his or her office billing and other administrative functions. PMID- 10145642 TI - Systems must be compatible with quality efforts. AB - As hospitals begin to pursue total quality management or continuous quality improvement strategies, they are finding that the data collected from various departments to assess quality often are incomplete and inconsistent and that the decision support systems used by hospital departments frequently are incompatible. A common MIS environment produced by establishing a common database manager can eliminate these problems. PMID- 10145643 TI - Claims submission leads electronic advances. AB - To increase and accelerate reimbursement, providers are increasingly establishing electronic linkages with payers at all points in the patient accounting process where labor costs can be reduced and accuracy of information can be improved. The greatest advances are being seen in claim submission, as manual data entry of claims information is being replaced by electronic data interchange. Cleaner claims, faster payment, and reduced staff are just some of the results. PMID- 10145644 TI - Don't let fear of the unknown affect leasing decision. PMID- 10145645 TI - Predictive autodialers enhance self-pay collections. PMID- 10145646 TI - Tools for advance directives. American Health Information Management Association. AB - This issue of the Journal of AHIMA contains a Position Statement on advance directives. Here we have included several "tools" or helpful documents to support your organization's ongoing education regarding advance directives. First, we offer a "Sample Policy and Procedure" addressing the administrative process of advance directives. This sample policy was adapted from a policy shared by Jean Clark, RRA, operations director with Roper Hospital in Charleston, SC, and a director on the AHIMA Board of Directors. Do not automatically accept this policy and procedure for your organization. Instead, the health information management professional could use this sample to write your organization's own, specific policy and procedures that are consistent with your state's law and legal counsel's advice. The second article, "Advance Directives and the New Joint Commission Requirements," compares 1992 Joint Commission standards for Patient Rights and The Patient Self-Determination Act requirements. Selected sections from the Joint Commission chapter on Patient Rights are highlighted and comments added that contrast it with the act. "Common Questions and Answers Related to Advance Directives" is the third tool we offer. These questions and answers may be used for a patient education brochure or staff inservice education program outline. Again, information specific to your own state needs to be added. The fourth tool we offer is miniature "Sample Slides" or overhead transparency copy that can be enlarged and used for a presentation on the basics of advance directives for a community group for staff education. We thank Dee McLane, RRA, director, Medical Information Services at Self Memorial Hospital in Greenwood, SC, who developed these slides for presentations conducted at her hospital. We also thank Jeri Whitworth, RRA, who produced the graphics on these slides. Whitworth is a first year director on the AHIMA Board of Directors this year. Again you can use as is or consider these a model as you develop your own presentation geared for your specific audience. Last, but not least, we include samples of a "Living Will Declaration" and a "Durable Power of Attorney for Health Care" forms reprinted with permission from the American Association of Retired Persons (AARP). We include them here so you can examine the language of each type of advance directive. Copies for your organization should be requested from AARP at 1909 K Street NW, Washington, DC 20049, (202) 662-4895. Forms specific to each state are available from The Society for the Right to Die/Concern for Dying at 250 W. 57th Street, New York, NY 10107, (212) 246-6973. The requirement under The Patient Self-Determination Act became effective December 1, 1991, but the educational requirements of the act are meant to be ongoing. These "tools" are to help you continue to be a regular contributor to the educational process in your organization. PMID- 10145647 TI - Meditation and palliative care. AB - Embert Van Tilburg, a specialist in palliative care, shares his insights about the total care of those who are terminally ill due to cancer or AIDS, or of the many elderly who are "dying in the slow lane" in so many of our chronic care institutions. PMID- 10145648 TI - Study aids for retraining and updating technologists. PMID- 10145649 TI - Health insurers cannot avoid risk. Interview by Richard L. Clarke. AB - The private health insurance system is not working well, but it can be changed so that insurance companies will insure risk rather than avoid risk, says Rep. Bill Gradison (R-Ohio). The ranking member of the Health Subcommittee of the House Ways and Means Committee, Gradison served as vice chairman of the Bipartisan Commission on Comprehensive Health Care (the Pepper Commission). At HFMA's National Convention in June, he received the Board of Directors' Award, an award established to honor persons or organizations who have contributed materially to the healthcare financial management field. Recently, Gradison spoke with HFMA President Richard L. Clarke, FHFMA, about rising healthcare costs, the structure of the U.S. healthcare system, and proposals for reform. Following are highlights from the interview. PMID- 10145650 TI - Shifting no solution to problem of increasing costs. AB - Rising healthcare costs are being allocated unevenly because some stakeholders are better than others at insulating themselves from paying their share of the burden. Those with significant or group purchasing power are paying less than actual cost, forcing providers to shift a disproportionate share of the costs to small businesses and non-group purchasers. The magnitude of this cost shifting is large and growing. Its primary impact is a destabilization of insurance markets. Stability can only be restored with well thought-out proposals that deal with causes of the cost increases. PMID- 10145651 TI - Guidelines help managers deal with ethical issues. AB - While a great effort has been devoted to improving financial management techniques in the healthcare field, little attention has been paid to addressing the ethical issues facing financial managers. In the years ahead, the ability to evaluate the ethical aspects of alternative courses of action may be as important as technical and managerial skills. Because of the importance of this issue, this article is being reprinted, with some modification, from the July 1989 issue of Healthcare Financial Management. PMID- 10145652 TI - Executives in healthcare administration: where do women stand? AB - The disparity in management responsibility and earning potential of men and women seen in business at large is mirrored in healthcare administration. While a variety of factors may influence this difference, a preliminary study of the career advancement of recent graduates of a healthcare administration graduate program suggests that recruitment and promotion policies may be largely responsible for gender disparities. PMID- 10145653 TI - Use direct deposit to reduce payroll costs. PMID- 10145654 TI - Bonus incentives can work in the business office. PMID- 10145655 TI - Supreme Court may consider retroactive corrective adjustments. PMID- 10145656 TI - Oregon's successful reform. PMID- 10145657 TI - Palliative home care program for terminally ill children. AB - A study conducted for the Dr. Charles A. Janeway Child Health Centre, St. John's, Newfoundland, determined that pediatric oncology patients and their families had needs that were not being met by the existing program of care. The article describes those needs, and then outlines the multidisciplinary palliative home care program that was established by the health centre to address them. The program's procedures of operation and follow-up, and the evaluation process are discussed. PMID- 10145658 TI - Graduate nursing students in Texas learn by 'remote'. PMID- 10145659 TI - ACLS (advanced cardiac life support) skills for the respiratory therapist: time for a mandate. PMID- 10145660 TI - The role of the respiratory therapist in emergency care. PMID- 10145661 TI - Interpreting HCFA mortality data for the public. AB - The Health Care Financing Administration (HCFA) has released mortality data for hospitals to the public. Administrators of hospitals designated by HCFA as mortality outliers have to respond to negative press, the concerns of their medical staffs, and inquiries from employers and third-party payers. D. Michael Waggoner, MD, explains the numbers and suggests how hospitals can respond. PMID- 10145662 TI - Financial, operational issues entangle Medicaid managed care. AB - Federal and state governments may soon require provision of managed care to the Medicaid eligible segment of the community. HMO financial managers must develop financial and operational plans prior to entering into negotiations for the development of a contract with a state. Key financial and operational issues related to Medicaid aid categories, contracting with providers, general administration, and product design must be addressed to minimize financial risk. PMID- 10145663 TI - Managed care strategies for the '90s. AB - With the proportion of patient care activity controlled by managed care organizations skyrocketing, providers need to study managed care trends, understand their strategic implications, and devise a response to them. Tremendous opportunities exist for hospitals that offer their own managed care programs, as long as they can avoid making costly mistakes. A critical tool is an overall strategy that includes collaboration with physicians, internal organization to manage risk, and direct contracting. PMID- 10145664 TI - IRS memorandum limits joint ventures. AB - Based on a new memorandum, the Internal Revenue Service (IRS) will be looking at joint hospital/physician activities with greater attention to the nuances of public versus private benefit. As a result, hospitals face greater risk of losing their tax-exempt status in the maze of joint ventures, physician recruitment, and practice acquisition. To be successful, ventures will have to be backed by sound reasoning and thorough documentation. PMID- 10145666 TI - Treasury update can boost bottom line. PMID- 10145665 TI - Guidelines for billing audits set new standards. PMID- 10145667 TI - Trends in cash management services. PMID- 10145668 TI - Periodic review of qualifications can help executives. PMID- 10145669 TI - Teamwork moves Louisiana hospital to the top--LSU Hospital. PMID- 10145670 TI - Emergency ventilation techniques and related equipment. AB - Emergency ventilation techniques used during CPR have been refined over the last 40 years. The methods and equipment for emergency ventilation all have their advantages and disadvantages (Table 5), and the appropriate technique varies with the training and experience of the rescuer. Problems encountered during CPR with victims who have unsecured airways remain unresolved at this time and more work needs to be done. Respiratory care practitioners because of their special training and experience with resuscitation are in an excellent position to make contributions to our knowledge by implementing and publishing relevant clinical studies. PMID- 10145671 TI - Hyperbaric treatment of respiratory emergencies. PMID- 10145672 TI - Monitoring during resuscitation. AB - Use of many different types of monitors during resuscitation has been described in the literature. These monitors differ in their usefulness, technical feasibility, initial costs, and long-term costs (Table 4). There have been many published reports of CPR success rates in the hospital and in the pre-hospital setting. In spite of considerable advances in technology over the past 30 years, survival from CPR has changed little over that time. Although numerous types of monitoring during resuscitation are possible, and sometimes useful, the impact of expensive technology on ultimate outcome (survival) must be critically evaluated. PMID- 10145673 TI - Intrahospital transport of critically ill, mechanically ventilated patients. PMID- 10145675 TI - A managed care survival guide for hospitals. PMID- 10145674 TI - Air medical transport in 1991. PMID- 10145676 TI - Automating patient accounting improves billing. PMID- 10145677 TI - How to choose a treasury workstation. PMID- 10145678 TI - TQM champion. Interview by Joanne M. Judge. PMID- 10145679 TI - Accounting for the costs of quality. AB - Total quality management (TQM) represents a paradigm shift in the organizational values that shape every aspect of a healthcare provider's activities. The TQM approach to quality management subscribes to the theory that it is not the work of employees of an organization that leads to poor quality; rather, it is the poor design of systems and procedures. In a book recently published by HFMA, Management Accounting for Healthcare Organizations, third edition, authors Suver, Neumann and Boles point out that the changes in behavioral focus and organizational climate brought about by TQM will have a major impact on management accounting function in healthcare organizations. TQM will require new methods of accounting that will enable the effects of declining quality to be recognized and evaluated. It also will require new types of management accounting reports that will identify opportunities for quality improvement and will monitor the effectiveness of quality management endeavors. The following article has been adapted from the book cited above. PMID- 10145680 TI - Is there a link between hospital profit and quality? AB - In industrial firms, high perceived quality in products or services leads to high return on investment. The link between high quality and high profit is more difficult to document for healthcare products and services. An even more important question for healthcare managers is whether there is a link between poor-quality services and low profitability. A study of a small sample of HCFA high-mortality hospitals shows that poor quality hospitals are less profitable. Although the demand for the products and services of poor-quality hospitals is relatively strong, such hospitals are underinvested in assets and understaffed, the study shows. PMID- 10145681 TI - Adjudicated pricing--when rates are challenged in court. AB - When the courts become involved in taking hospitals to task for their prices, hospital financial officers should prepare themselves for the unpleasant, potentially costly, and time-consuming legal dance that awaits them. The authors examine the pitfalls of judicial regulation of hospital charges and offer suggestions on how hospitals can avoid legal challenges or best prepare to meet them. PMID- 10145682 TI - Nursing process approach improves receivables management. AB - The "nursing process" is a systematic decision-making approach to problem solving based on open-system theory. This theory assumes that there is an on-going interchange between all system components. Components cannot be viewed in isolation, because decisions regarding one component will affect other components. Receivables management is similar to the nursing process, in that it involves constant diagnosis, assessment, and intervention in the work in process during all phases of the receivables cycle. In experiments that applied the nursing process concept to the management of accounts receivable in several hospitals, gross days in accounts receivable were reduced and cash flow was increased. PMID- 10145683 TI - HFMA healthcare reform framework. Healthcare Financial Management Association. AB - This spring, an HFMA Chairman's Task Force on Healthcare Reform identified nine elements that ideally would be included in any healthcare reform plan that ultimately becomes law. The purpose of the panel was not to add yet another proposal to the many in existence, but rather to provide policymakers and members with a structure for analysis of reform proposals being introduced. The Association's Board of Directors adopted the nine elements which together comprise a healthcare reform framework. The following task force report provides additional explanation of the framework's elements. PMID- 10145684 TI - Revolving loan pools: rewards in the deep waters of tax law. PMID- 10145685 TI - 1992-93--change and partnerships in patient financial services. PMID- 10145686 TI - Valuing a long-term care facility. AB - The business valuation industry generally uses at least one of three basic approaches to value a long-term care facility: the cost approach, sales comparison approach, or income approach. The approach that is chosen and the resulting weight that is applied to it depend largely on the circumstances involved. Because a long-term care facility is a business enterprise, more weight usually is given to the income approach which factors into the estimate of value both the tangible and intangible assets of the facility. PMID- 10145687 TI - The impact of fraud and abuse regulations. AB - Increased forays by hospitals and physicians into joint ventures make both parties subject to a complex network of laws and regulations and to scrutiny by many Federal agencies. In this article, the law of fraud and abuse under the Federal Medicare and Medicaid statutes is discussed. PMID- 10145688 TI - Limits on Medicaid program fund transfers. AB - Recent Federal legislation has curtailed many of the so-called creative ways states previously used to fund their Medicaid programs. Specifically, the Medicaid Voluntary Contributions and Provider-Specific Tax Amendments of 1991 prevent states from using voluntary donations and taxes on healthcare providers to obtain increased Federal matching funds. In the future, therefore, many state governments may be forced to make a difficult choice between either increasing taxes significantly to finance health care for the poor or drastically reducing Medicaid rates and coverage. PMID- 10145689 TI - Understanding HCFA-2552-92 cost reporting forms. AB - The new cost reporting requirements necessitated by the new Medicare capital regulations may require up to 160 hours of additional data collection. Authors Powell and Pierce detail the anticipated changes to the Medicare cost reporting worksheets used to collect the data. PMID- 10145690 TI - Marketing management enhances customer relations. AB - The implementation of automated marketing management systems in hospitals across the United States can change dramatically the way in which a hospital builds business by managing relationships with prospective customers. PMID- 10145691 TI - Statement No. 14. Patient service revenue and related issues. Healthcare Financial Management Association, Principles and Practices Board. PMID- 10145692 TI - ERISA and tax-deferred retirement plans. PMID- 10145693 TI - Is it time to combine utilization review and admitting? PMID- 10145694 TI - At Providence Hospital, it pays to be well. PMID- 10145695 TI - The American healthcare dilemma: is there a solution? PMID- 10145696 TI - Reducing the risk of check fraud. PMID- 10145697 TI - Consensus statement on the essentials of mechanical ventilators--1992. American Association for Respiratory Care. PMID- 10145698 TI - Classification of mechanical ventilators. PMID- 10145699 TI - Essential gas delivery features of mechanical ventilators. PMID- 10145700 TI - Mechanical ventilator design and function: the trigger variable. AB - Because of the design characteristics, flow-triggering appears to offer measurable advantages over pressure-triggering, particularly during spontaneous breathing. During the trigger phase, flow-triggering provides a relatively shorter time delay than pressure-triggering. A trigger sensitivity that does not cause autocycling can be set while a short time delay is maintained. It remains to be determined whether flow-triggering has less effect on the pressure-time product than pressure-triggering. During the post-trigger phase, the relatively optimal flow delivery with flow-by results in the maintenance of airway pressure at or above the end-expiratory airway pressure level. This accounts for the lower level of inspiratory muscle work observed with flow-by over that observed with demand-flow. Whether inspiratory muscle work on a demand-flow system with optimal flow delivery will be similar to that on flow-by is not known. With a flow-by or demand-flow system, the circuit pressure-sensing site influences the flow pressure control algorithm in the post-trigger phase only. In microprocessor based ventilators, the shortcomings seen with pressure-triggering during the post trigger phase can unquestionably be overcome with a better ventilator algorithm design or the application of a small amount of pressure support. However, during the trigger phase, the impact of this effort is less clear. PMID- 10145701 TI - Inspired gas conditioning. PMID- 10145702 TI - Monitoring of pressure, flow, and volume during mechanical ventilation. PMID- 10145703 TI - What derived variables should be monitored during mechanical ventilation? AB - Without a careful definition, it is very difficult to propose a list of essential derived variables that should be monitored during mechanical ventilation. The list of essentials will vary not only with disease type and severity but also with the expertise of the operator in interpreting the data, and willingness to incorporate it into his/her surveillance and treatment plan. It can be cogently argued that the only variables of crucial significance to the vast majority of patients are the primary ones--airway pressure, flow, tidal volume, and minute ventilation. My own view is that end-inspiratory (PD, Ps, and Pz), end-expiratory (total PEEP), and mean airway pressures must be checked at frequent intervals, especially in ARDS. Partitioning of the total pressure into its flow-driving and elastance-counterbalancing components is always wise, whether or not resistance and compliance or elastance are formally calculated. Incremental changes in the pressure-volume relationship should be monitored whenever adjustments in PEEP or VT are made. Ventilatory demand, strength, and power-reserve assessment are often instrumental in the care of the ventilator-dependent patient who presents as a weaning problem. The most valuable indicators of these include the VE, the maximum voluntary inspiratory pressure, and the frequency-to-tidal-volume ratio. Measurements of the work of breathing, P0.1, and Pes should be reserved for unusually difficult clinical questions. Finally, the variability of the Paw tracing yields valuable data regarding the synchrony of patient-ventilator interactions. PMID- 10145704 TI - Essentials for ventilator-alarm systems. PMID- 10145705 TI - Digital electronic communication between ICU ventilators and computers and printers. AB - Although many modern ICU ventilators offer the option of electronic communication, most of these systems are not used because there is a huge communication gap between the ventilator and the computer it might be connected to. When such systems are now used, a large part of what is communicated is artifactual and misleading. We need to overcome both legal and knowledge barriers in the effort to provide seamless communication between ventilators and computers. With regard to the specific issues raised in this paper, here are our answers. Issue #1: Is it essential to have a digital electronic communication port on an ICU ventilator? ANSWER: No, it is not essential. The purpose of the mechanical ventilator is to support pulmonary ventilation by supplying gas and pressure. There is no vital role for digital communication in the gas-delivery function of the ventilator; however, in the future it will be essential to have effective electronic communication in order to guarantee accurate and timely charting. Issue #2: What impact does electronic communication between a ventilator and a computer have on patient outcome? ANSWER: Our preliminary data show that electronic communication can reduce the number of charting errors and can improve the timeliness of data entry. However, there is little evidence, other than anecdotal, that this has any impact on patient outcome. Automated charting has been shown to reduce the time spent on charting. This time-savings could be used to increase time spent in direct patient care, but there is no conclusive evidence that this occurs. In fact, one report on computerized charting systems indicates that the result is less time spent in direct patient care. Issue #3: If electronic communication is to be effective in the future, how should these interfaces be configured for mechanical ventilation? ANSWER: We recommend an optimal algorithm for automated respiratory care charting that has been suggested. Sampling frequency: Sample data from the ventilator every 10 seconds. Ventilator-setting changes: Report every new setting if change lasts more than 3 minutes. Measured respiratory care data: Filter raw MIB-collected data with a 3-minute moving-median filter. Report one filtered value every hour for each variable. In addition, use a threshold table (Table 3) to define significant events. Report changes that remain above threshold more than 3 minutes. Report all measured respiratory-care data 1 minute following any ventilator-mode changes. PMID- 10145706 TI - What constitutes an order for mechanical ventilation, and who should give the order? PMID- 10145707 TI - Consensus Conference on the Essentials of Mechanical Ventilators, held February 27-29, 1992, in Cancun, Mexico. American Association for Respiratory Care. PMID- 10145708 TI - Palliative care and the art of dying. Interview by Matthew D. Pavelich. PMID- 10145709 TI - Customer focus: the cornerstone of quality management. PMID- 10145710 TI - Merger boosts quality and service. AB - Three hospitals in a predominantly rural, grain-producing county in North Central Ohio merged in the mid-1980s to fortify their financial stability and serve their communities in a more effective and cost-efficient manner. As part of the merger, the finance departments of the three institutions reorganized into one centralized department. PMID- 10145711 TI - Restructuring improves hospital competitiveness. AB - The operational evolution of hospitals, driven by advances in technology and clinical research and an increased emphasis on clinical specialization, has resulted in complex and fragmented operational service structures. Hospitals willing to critically evaluate and change their operating structures not only can increase productivity and decrease operating costs, but also can significantly improve the quality of patient care. PMID- 10145712 TI - Perceptions of new AICPA (American Institute of Certified Public Accountants) audit guide. AB - A survey was conducted by authors Bitter and Cassidy to assess hospital providers' and auditors' perceptions of the reporting requirements of the new Audits of Providers of Health Care Services guide published by the American Institute of Certified Public Accountants. Responses indicated that there is still much dissent in the healthcare community as to what is useful information and what the effects of the new guide will be on hospital providers, auditors, and users. PMID- 10145713 TI - Practitioner-provider joint ventures, the OIG, and the IRS. AB - Increased forays by hospitals and physicians into joint ventures make both parties subject to a complex network of laws and regulations and to scrutiny by many Federal agencies. Institutional healthcare providers should be aware of the legal pitfalls and exercise extreme caution when creating such arrangements. This is the second of a two-part examination of issues relative to taxes and Medicare and Medicaid fraud and abuse regulations. (Part I was published in the October 1992 issue of HFM.) PMID- 10145714 TI - EIS (executive information systems): a better way to view hospital trends. AB - Executive information systems (EIS) are changing the way managers and executives view information. EIS is a work-station based information system that integrates information from the important parts of a healthcare organization to give executives a high-level perspective on key performance indicators and trends affecting their institutions. Such systems employ graphics and color to display real-time data in a format that is easily interpreted by executives and that helps them make better decisions. EIS technology is particularly appropriate for disseminating and highlighting financial information. However, for such systems to work effectively and for executives to obtain the greatest benefits from them, financial managers must help establish and promote EIS. PMID- 10145715 TI - Revenue recovery firms may be helpful. PMID- 10145716 TI - Hospitals, chapters weather Hurricane Andrew. PMID- 10145717 TI - Useful bank information sources. PMID- 10145718 TI - When unemployed, taking charge of life is vital. PMID- 10145719 TI - Improving work processes improves productivity, quality. PMID- 10145720 TI - Medical office buildings--the challenges and the rewards. AB - Hospitals considering the development of on-campus medical office complexes may find the process challenging and costly. But when developed and leased appropriately, medical office complexes can provide significant benefits to hospitals. Leasing on-campus medical office space to physicians serves to improve relationships with the physician community, and thereby can increase hospital utilization and revenue. The expanded facilities also allow the hospital to offer a greater scope of medical services to the local community. Authors Sands and Rendina examine the advantages of participation in medical office building development. PMID- 10145721 TI - Creative leasing strategies for medical office buildings. AB - The financing and ownership of medical office buildings have changed along with their design and function. Once merely a convenience for the medical staff, medical office buildings are becoming an increasingly important part of a hospital's marketing and financial strategies. Understanding the economic evolution of these buildings will help hospital financial managers approach their development in a manner that will meet the needs of the future. PMID- 10145722 TI - A look inside the actuarial black box. AB - Hospital executives often rely on actuaries (and their "black boxes") to determine self-insurance program liabilities and funding contributions. Typically, the hospital supplies the actuary with a myriad of statistics, and eventually the hospital receives a liability estimate and recommended funding level. The mysterious actuarial calculations that occur in between data reporting and receipt of the actuary's report are akin to a black box--a complicated device whose internal mechanism is hidden from or mysterious to the user. PMID- 10145723 TI - Changes in Medicare capital PPS rates and rules. AB - Author Grimaldi discusses recent changes in Medicare's capital prospective payment system (PPS) regulations, published in the Federal Register, September 1992, as well as major changes in operating cost guidelines that affect capital payments. Policy interpretations that the Health Care Financing Administration (HCFA) has issued in the past year are reviewed, and changes made to the Medicare cost report in order to accommodate capital PPS are summarized schedule by schedule. PMID- 10145725 TI - Mexico no vacation for chapter volunteer. PMID- 10145724 TI - Practice enhancement strengthens hospital-physician ties. AB - In the increasingly competitive U.S. healthcare environment, hospitals must be concerned with maintaining and increasing the number of patients admitted. A key strategy for hospitals is to fortify relationships with physicians who admit and refer patients. Practice enhancement services designed to improve the strategic, financial, and administrative operation of physicians' practices can contribute significantly to the development of positive hospital-physician relationships. PMID- 10145726 TI - Banks aggressively marketing cash management services. PMID- 10145727 TI - IRS sharpening focus on hospital-physician business relations. PMID- 10145728 TI - Tough choices. PMID- 10145729 TI - Euthanasia and other medical decisions concerning the end of life. An investigation performed upon request of the Commission of Inquiry into the Medical Practice concerning Euthanasia. PMID- 10145730 TI - Purpose of admission and resource use during cancer hospitalizations. AB - This study examined the role of purpose of admission (POA) in hospitalizations for lung, colon, and breast cancers, using the 1985 20-percent Medicare provider analysis and review file. Six POA categories were created from discharge abstract data. Average hospitalization charges, per diem charges, length of stay, and rates of death varied significantly by POA (p < .001). Rural and small hospitals were more likely to admit patients for palliation, while urban and large hospitals admitted relatively more patients for active interventions (p < .0001). POA and indicators of case complexity added only modestly to the ability of diagnosis-related groups to predict hospitalization charges. PMID- 10145732 TI - Managing by fact. PMID- 10145731 TI - Less pain, more gain. PMID- 10145733 TI - AHA president Dick Davidson and the 'new future'. Interview by Richard Clarke. PMID- 10145734 TI - Improving charge capture to increase net revenue. AB - Although a decreasing percentage of hospital revenue continues to be based on total charges, providers can still significantly increase net revenue through a process of evaluating and improving current charge structures, charge capture procedures, and service delivery methods. After reviewing various reasons why hospitals fail to capture charges adequately, the authors present a systematic methodology for reviewing all revenue producing departments to identify opportunities for successfully addressing charge capture problems. This methodology, known as the clinical pricing approach, can improve the accuracy of internal cost accounting and have a positive net revenue impact of from one percent to three percent of gross revenue. PMID- 10145735 TI - Latest Medicare benefit: FQHC (Federally Qualified Health Center) services. AB - The Federally Qualified Health Center (FQHC) service benefit has been effective since Oct. 1, 1991, but the governing "interim final" regulations were not issued until June 12, 1992. Paul Grimaldi, PhD, details the requirements that must be met in order for a clinic or center to qualify for FQHC reimbursement. PMID- 10145736 TI - EDI (electronic data interchange): simple, but not easy. PMID- 10145737 TI - Improving the claims process with EDI. AB - Electronic data interchange (EDI) is redefining the healthcare claims process. The traditional managerial approach to claims processing emphasizes information flow within the patient accounting department and between patient accounting and other departments. EDI enlarges the scope of the claims process to include information exchange between providers and payers. Using EDI to improve both external and internal information exchange makes the claims process more efficient and less expensive. This article is excerpted from "The Healthcare Financial Manager's Guide to Healthcare EDI," by James J. Moynihan, published by the Healthcare Financial Management Association. PMID- 10145738 TI - Adapting to the ANSI 835 transaction set. AB - Adapting to the American National Standards Institute (ANSI) 835 Health Care Claims Payment/Advice format--the first nationwide, all-payer electronic standard for healthcare claims--requires an approach tailored to the individual provider's system. Providers have four options for receiving ANSI 835 claims payments. They include: direct transmission from payers, value added network services (VANs), banks with electronic data interchange capabilities, and paper reports. Providers' claims processing systems vary enormously in the formats they use and in their capacities to transmit and receive claims payments electronically. Author Romo reviews factors that providers need to consider when refining internal capabilities and selecting external processors to accept the 835 format. PMID- 10145739 TI - EDI experts realistic and optimistic. AB - Recently, Healthcare Financial Management contacted five EDI experts to discuss a variety of issues related to EDI and the healthcare industry. Their answers to our questions, presented below, are both optimistic and realistic. Our experts feel that EDI can transform the healthcare industry into a model of efficiency, but their enthusiasm is tempered by the realization that politics, bureaucracy, budgets, and resistance to change can take a toll on even the most ardent of EDI supporters. Nevertheless, they believe that EDI can and will work. In the pages that follow, they discuss why, how, and when. PMID- 10145740 TI - U.S. banking system's future is positive. PMID- 10145741 TI - Opportunities under capital PPS. PMID- 10145742 TI - New York hospital discovers joy of optical imaging. PMID- 10145743 TI - UB-92, HCFA 1500: the genesis of EDI? PMID- 10145744 TI - Crucial calculations: preparing for retirement. PMID- 10145746 TI - Evaluation of a closed-system, directional-tip suction catheter. AB - INTRODUCTION: It is difficult to successfully suction the left bronchial tree. We evaluated the success rate of left bronchial cannulation with a new closed suction directional-tip catheter (Trach Care directional-tip catheter, TCDT, Ballard Medical Products, Midvale UT). Success rates were compared in patients with endotracheal and tracheostomy tubes. We also studied the effects on success rate of (1) the distance of the endotracheal tube from the carina, (2) the tube's bevel orientation, and (3) the tube's position in the patient's mouth. METHOD: At the time of the routine daily chest radiograph, 75 attempts at left bronchial cannulation were made in 45 patients. With the head maintained in a midline position, the TCDT catheter was advanced with the radiopaque blue line in the 1 o'clock position. The radiograph was evaluated for correct placement of the TCDT catheter. RESULTS: Due to lung pathology and x-ray technique, catheter placement could not be interpreted in 17% of the radiographs. In the remainder, overall success rate was 71% (79% with tracheostomy tubes and 67% with endotracheal tubes, not significantly different, with p > 0.3). Tube distance from the carina and bevel orientation did not significantly affect success rates. Success rates for tubes located in the left and central positions of the patient's mouth were significantly better (p < 0.002 and p < 0.03, respectively) than for tubes located on the right side of the patient's mouth. With the endotracheal tube on the left side of the patient's mouth, the success rate was 89%. CONCLUSION: We conclude that the TCDT catheter successfully combines the features of a closed suction system with those of a directional-tip catheter that allows selective bronchial cannulation, a large percentage of the time. PMID- 10145745 TI - Bronchoscope damage and repair costs: results of a regional postal survey. AB - Flexible fiberoptic bronchoscopy is a commonly performed procedure for which the indications, technical aspects, and potential patient complications have been well described. However, limited information is available regarding damage to the instrument itself. In order to better describe the types and causes of bronchoscope damage, repair costs, and time out of service, we performed a postal survey of hospital bronchoscopy laboratories in Alabama, Mississippi, and Louisiana. We received 43 completed surveys from laboratories that perform an average of 233 bronchoscopies per year. The respondents reported 103 episodes of bronchoscope damage, the majority of which consisted of damage to the bronchoscope cover, broken fiber bundles, malfunction of the bending apparatus, and suction channel damage. The respondents attributed 62% of all the damage to one of the three following categories: unknown, improper handling, and damage caused by biopsy forceps, brushes, or needles. Of the 103 episodes of bronchoscope damage, 66 (64%) were judged to be preventable, 13.6% not preventable, and 17.5% to be indeterminant. The average time out of service (mean, SD) for each damaged bronchoscope was 3.5 (3.9) weeks, and the average repair cost per episode of bronchoscope damage was $2,726.13 ($1,391.21). At least 19 episodes of bronchoscope damage occurred during cleaning and disinfecting procedures. We conclude that the majority of bronchoscope damage and repair costs should be potentially preventable and suggest that a program to familiarize all personnel handling bronchoscopes with proper maintenance and handling procedures should decrease the risk of bronchoscope damage. PMID- 10145747 TI - Clinical comparison of Gentle-Haler Actuator and Aerochamber Spacer for Metered Dose Inhaler (MDI) use by asthmatics. AB - Spacing devices such as the Aerochamber have been shown to improve delivery of medication from MDIs in patients who could not use proper technique with an MDI alone, but the Aerochamber may be inconvenient to carry & use because of its bulkiness. We therefore compared clinical responses of asthmatics using a new, smaller MDI actuator (Gentle-Haler) with no spacer to their responses using a standard MDI actuator & spacer (Aerochamber). METHODS: We treated 30 asthmatic patients in 2 sessions with the beta-agonist albuterol using the above-mentioned devices. Both devices were utilized in each treatment session, with one delivering albuterol & the other generating a placebo. During the second session on a different day, the albuterol & placebo were reversed with respect to the two devices. On each study day, physiologic measurements of FEV1, FVC, FEF25-75, blood pressure, & pulse were obtained at pretreatment (baseline) & after treatment at 15 & 30 minutes & 1, 2, 3, 4, 5 & 6 hours. Analysis of variance & Student's t test were used to compare the ratio of physiologic responses to albuterol delivered with the two devices. RESULTS: Both devices were equally effective in eliciting desirable increases in FEV1, FEF25-75, & FVC. No statistically significant differences (5% significance level) in effectiveness of the albuterol were associated with the use of either device. A very small (< 7%) but statistically significant reduction in diastolic blood pressure (3 of 8 time points) & systolic pressure (1 of 8 time points) was associated with the use of the Gentle-Haler.(ABSTRACT TRUNCATED AT 250 WORDS) PMID- 10145748 TI - Defining quality is difficult, but necessary. PMID- 10145749 TI - Integrating technology assessment into the capital budgeting process. AB - Technology assessment can help hospitals rank the importance of capital requests by providing crucial information both about existing equipment and about new equipment that has been requested. Integrating technology assessment into the capital budgeting process is the best way for hospitals to determine what equipment should be purchased each year. PMID- 10145750 TI - Capital update factor: a new era approaches. AB - The Health Care Financing Administration (HCFA) has constructed a preliminary model of a new capital update method which is consistent with the framework being developed to refine the update method for PPS operating costs. HCFA's eventual goal is to develop a single update framework for operating and capital costs. Initial results suggest that adopting the new capital update method would reduce capital payments substantially, which might intensify creditor's concerns about extending loans to hospitals. PMID- 10145751 TI - Optimizing Medicare reimbursement in skilled nursing facilities. AB - Effective utilization review (UR) and clear, complete clinical documentation are essential if a skilled nursing facility (SNF) is to capture charges efficiently and bill appropriately to ensure optimal Medicare reimbursement. Authors Micheletti, Shlala, and Greenfield detail how financial managers can assess UR activities and clinical documentation practices to help improve an SNF's profitability. PMID- 10145752 TI - RBRVS as a financial assessment tool. AB - The relative value service units that underlie the Health Care Financing Administration's resource-based relative value scale (RBRVS) fee schedule can provide an alternative basis for evaluating many financial aspects of a physician practice. PMID- 10145753 TI - Healthcare Financial Management Association, Principles and Practices Board. Statement no. 15: Valuation and financial statement presentation of charity service and bad debts by institutional healthcare providers. AB - Principles and Practices Board (P&P Board) Statement No. 2, issued in 1978, provided a basis for differentiating between charity service and bad debts. The statement acknowledged that, while the differentiation was helpful, the financial accounting and reporting of charity service and bad debts were the same. In 1990, the American Institute of Certified Public Accountants (AICPA) published (after review and approval by the Financial Accounting Standards Board and the Governmental Accounting Standards Board) an extensive revision of the guide titled "Audits of Providers of Health Care Services." The revised guide substantially changed the reporting of bad debts and eliminated charity service from revenue. Disclosure of the entity's policy for providing charity service and the level of charity service provided is required by the revised guide. The P&P Board decided that a substantive revision of its Statement No. 2 was required to bring it into conformity with the revised guide and to provide direction on implementation of the revised guide's requirements. This statement supersedes Statement No. 2 and deals with the same issues, including bad debts. PMID- 10145754 TI - Data comparison helps medical center improve service, cut costs. PMID- 10145755 TI - Preparing for a treasury management merger. PMID- 10145756 TI - Tax deductions for personal casualty or theft losses. PMID- 10145757 TI - Beating the capital budgeting blues: developing capital request evaluation criteria. PMID- 10145759 TI - Computerized management of respiratory care. AB - Respiratory care as an organized discipline is only about 45 years old, and the management of this dynamic allied health profession has usually been characterized by a demand-for-service mentality. As pressure continues to control costs, those departments that maximize quality patient care cost-effectively with thoroughly documented outcomes are in a better position to compete for future resources. The practice of respiratory care is changing as is the practice of medical care in general. Accountability for resource consumption and the quality of the product delivered are essential elements in the delivery of respiratory modalities. We have developed and implemented a comprehensive patient-data-based approach to the management of respiratory care. The essential elements of this approach are (1) relative-value-unit procedure base; (2) individual, shift, and department productivity that is attached to the annual performance review process; (3) management reporting on a 24-hour basis, with biweekly review at the management level; (4) development and implementation of a comprehensive patient data-documentation system that permits automatic patient billing and 100% data review for quality-assurance documentation; (5) the development of a medical alerting system that alerts the Medical Director and Respiratory Care staff to potentially harmful events that, if untreated, may result in increased morbidity or mortality; and (6) the development of concurrent and retrospective tools for patient-outcomes research. These functions are supported by an active Medical Informatics Department that is nationally recognized in medical computing and logic application. PMID- 10145758 TI - Pain management. Theological and ethical principles governing the use of pain relief for dying patients. Task Force on Pain Management, Catholic Health Association. AB - Pain management is a societal problem because of concerns about the use of drugs, the belief that patients are not good judges of the severity of their pain, and an alarming level of ignorance about pain and its treatment among physicians, nurses, and other healthcare providers. The result is that patients suffer pain unnecessarily, even up to the point of their death. Pain management is also a clinical-practice problem. Courses in pain and symptom management are not readily available to medical and nursing students. And in clinical practice, good pain assessment is not easy to accomplish because pain is so subjective. Fortunately, with education, doctors and nurses can vastly improve their ability to assess and manage patients' pain. Additional problems in pain management relate to the manner in which healthcare is provided today: an acute disease-oriented model of hospital care, frequent transfers, fragmented care, inadequate reimbursement, market forces that drive up costs, and maldistribution of clinical services. In improving their ability to manage pain, professionals must understand the difference between pain and suffering, acute and chronic pain, and the sensory and emotional aspects of pain. Guiding principles include Church teaching and ethical principles, such as patient self-determination, holistic care, the principle of beneficence, distributive justice, and the common good. Pain management strategies that will be instrumental in formulating effective responses to these problems include expanding professional and community education, affording pain funding priority, establishing institutional policies and protocols, forming clinical teams, encouraging hospice and home care, and requiring accreditation in pain and symptom management. PMID- 10145760 TI - Using belief networks to interpret qualitative data in the ICU. PMID- 10145761 TI - Microprocessor-based mechanical ventilation. PMID- 10145762 TI - Making safety pay. Incentive campaign reduces accidents and workers' compensation costs. Chalmette Medical Centers. PMID- 10145763 TI - Planning palliative care services. AB - An audit was conducted to assess the use of, and satisfaction with, local services for the care of the dying, which have developed over the past seven years in South Glamorgan. These services include hospice inpatient, outpatient and day care facilities, home care specialist nursing, volunteer services and domiciliary medical consultations. All general practitioners in the district were surveyed about the services by postal questionnaire; respondents represented most of the practices in the district. The results show a variable level of uptake of services for those well established (excluding paediatric oncology), including a high level of satisfaction with the available services. The results identify a lack of provision for patients dying from a non-malignant disease. PMID- 10145765 TI - Managed competition is the future of healthcare reform. Interview by Bill Siwicki. PMID- 10145764 TI - HIV, AIDS, and the respiratory care practitioner. PMID- 10145766 TI - Healthcare reform: models and implications. PMID- 10145767 TI - Ethical misconduct in healthcare financial management. AB - Serious violations of ethical conduct by healthcare financial managers have made headlines over the past few years. Leaders in both the healthcare financial industry and the academic community believe these violations reflect the influence of the ambiguous ethical atmosphere of the 1980s, a breakdown in external and internal controls, and a failure of personal character on the part of a few individuals. PMID- 10145768 TI - Practical applications of healthcare marketing ethics. AB - All businesses--healthcare businesses in particular--have an absolute duty to treat their customers ethically; anything less is unacceptable. Author Goldman discusses four ethical principles that can be applied to help ensure that marketing decisions conform to the highest ethical standards. PMID- 10145769 TI - Fraud and abuse compliance programs: their time has come. AB - Two recent developments in Federal law enforcement should prompt healthcare providers to establish or augment programs to detect and prevent Medicare and Medicaid fraud and abuse. New and controversial Federal sentencing guidelines require judges to impose multi-million dollar fines on companies convicted of certain Federal crimes, and substantial civil monetary penalties may be imposed for violation of the Medicare and Medicaid fraud and abuse laws. One of the ways to avoid these penalties is to establish an effective compliance program designed to prevent criminal conduct before it happens. PMID- 10145770 TI - Examining the effect of PPS on cost accounting systems. AB - The cost of treating patients varies widely, but the prospective payment system (PPS) pays hospitals the same amount for every patient at a standard diagnosis related group (DRG) rate. When PPS was implemented in October 1984, many predicted that implementation of PPS would cause hospitals to make significant changes to their traditional cost-accounting systems. This article examines the accuracy of those predictions. PMID- 10145771 TI - The value of relationships with venture capitalists. PMID- 10145772 TI - The analysis stage of a merger. PMID- 10145773 TI - Joint effort to establish payment schedule disappoints CFO. PMID- 10145774 TI - Responding to family violence. AB - Family violence affects not only the lives of home care clients, but those of the home care aides who serve them. One organization has developed a program to prepare home care aides for coping with situations of domestic violence. PMID- 10145775 TI - Misallocation of respiratory care services: time for a change. AB - In summary, with increasing scrutiny given to the effectiveness and costs of health care, innovative programs that allocate respiratory care ordering to practitioners based on rigorous, specified appropriateness criteria and/or branching-logic algorithms are a promising solution to respiratory care misallocation. Widespread acceptance and implementation will require staunch medical directors' input and advocacy, therapists' support for new programs and for leaving the comforts of 'traditional' practice, and confirmation of the benefits of Respiratory Therapy Consult Services by more extensive, 'hard-nosed' evaluation. PMID- 10145776 TI - Lung transplantation: an update. PMID- 10145777 TI - An evaluation of MDI (metered dose inhaler) spacers and adapters: their effect on the respirable volume of medication. AB - The use of a metered dose inhaler (MDI) with an adapter or spacer designed to deliver medication to ventilated patients has been found to produce effects similar to those achieved with small volume nebulizers. For 9 commonly used MDI adapters or spacers, we measured and compared their production of available respirable volume (ARV) of medication. A simulated ventilator circuit was configured to determine ARV as measured by a laser particle-size counter. The adapters or spacers were grouped in three categories: chamber, in-line, and elbow styles. The devices were actuated into the circuit, and ARV was measured 36 separate times with various combinations of medication and medication canister. We found significant differences in ARV between devices, device categories, and medications as compared by ANOVA testing. In this study, chamber-style MDI devices produced greater respirable volume than the in-line- or the elbow-style devices. Of the chamber-style devices, the cone-shaped chamber device provided more respirable volume than did the other two chamber devices. We also found differences among the medications, although we did not anticipate such differences. The possible factors to explain medication differences were not investigated in this study. Because ARV differs according to the design of the individual device used, the choice of device may alter the respirable volume of the medication delivered and, therefore, the effectiveness of the prescribed medication. We conclude that to achieve the desired effects of the medication, practitioners may need to customize the number of MDI actuations according to the device in use. PMID- 10145778 TI - AARC clinical practice guideline. Patient-ventilator system checks. American Association for Respiratory Care. PMID- 10145779 TI - AARC clinical practice guideline. Humidification during mechanical ventilation. American Association for Respiratory Care. PMID- 10145780 TI - AARC clinical practice guideline. Selection of aerosol delivery device. American Association for Respiratory Care. PMID- 10145781 TI - AARC clinical practice guideline. Nasotracheal suctioning. American Association for Respiratory Care. PMID- 10145782 TI - AARC clinical practice guideline. Bronchial provocation. American Association for Respiratory Care. PMID- 10145783 TI - AARC clinical practice guideline. Exercise testing for evaluation of hypoxemia and/or desaturation. American Association for Respiratory Care. PMID- 10145784 TI - AARC clinical practice guideline. Sampling for arterial blood gas analysis. American Association for Respiratory Care. PMID- 10145785 TI - AARC clinical practice guideline. Oxygen therapy in the home or extended care facility. American Association for Respiratory Care. PMID- 10145787 TI - Tame the healthcare paperwork monster. PMID- 10145786 TI - CFOs have accepted the challenge. PMID- 10145788 TI - Healthcare reform adds complexities for today's CFO. AB - The profile of the typical senior financial executive in a hospital or corporate healthcare setting has changed little over the past two years. A November 1992 survey of CFOs by HFMA and Zimmerman & Associates, Inc., which updates a similar survey conducted in 1990, showed that the typical healthcare CFO is an extremely busy 41-year-old male with a postgraduate education who has held the position of CFO for six years. Survey findings also reveal that the CFO title is the predominant title for senior financial executives in healthcare facilities. For those receiving incentive compensation, the average compensation in 1992 was 11.7 percent of base salary. Within the context of career advancement, the CFO is most interested in learning more about healthcare reform; declining operating margins was seen as the CFO's most significant career challenge. PMID- 10145789 TI - Business continuity planning: the hospital's insurance policy. AB - A comprehensive business continuity plan can prepare an organization for unforeseen circumstances that would otherwise totally disrupt the delivery of healthcare services. Properly planning for such an event can build confidence in the organization and safeguard the assets of the institution. In this article, the authors present a step-by-step plan for creating a business continuity plan. PMID- 10145790 TI - FASB (Financial Accounting Standards Board) proposes changes in not-for-profit reporting. AB - The Financial Accounting Standards Board (FASB) will soon issue two statements that will have a major impact on not-for-profit financial reporting. The first, entitled Financial Statements of Not-For-Profit Organizations, deals with the form and content of not-for-profit financial statements. The second, entitled Accounting for Contributions Received and Contributions Made, establishes standards of financial accounting and reporting for contributions. PMID- 10145791 TI - Strategic capital planning scenarios for the future. AB - Hospitals have traditionally looked to income from operations, depreciation, debt, and philanthropy as their major source of revenue. This viewpoint, however, is changing as hospitals move from being the hub of the healthcare provider network to being spokes in an integrated delivery network (IDN), and the traditional tools of debt financing and revenue optimizing become less effective. PMID- 10145792 TI - Managing the stages of hospital cost accounting. AB - Since the institution of diagnosis-related group-based reimbursement by the Medicare program and the rise of managed care, hospitals have had to examine the costs incurred by patients and patient groups, analyze the cost behavior of individual departments, and implement strategies to contain costs. Hospitals have been hampered in these efforts by inadequate cost-accounting systems. To meet the challenges of the 1990s, hospitals need to follow a four-stage approach to cost accounting: Stage 1, improve overall cost-accounting systems; Stage 2, separate variable and fixed costs; Stage 3, identify factors that drive costs, the ways these factors can be controlled, and redefine departments as profit or cost responsibility centers; and Stage 4, reconfigure administrative systems that cut across traditional organizational lines. PMID- 10145793 TI - More efficient hospitals are closing. AB - An examination of factors related to hospital closures reveals a disconcerting trend. Hospitals that closed in 1991 appear to have been more efficient than hospitals that closed in 1990, and hospitals that closed in 1990 appear to have been more efficient than hospitals that closed in 1989. This trend suggests that future hospital closures may pull relatively efficient hospitals out of the healthcare system. The end result may be increases, not decreases, in total healthcare costs. PMID- 10145795 TI - Patient accounts and MIS (management information systems): facing the future together. PMID- 10145794 TI - Courts uphold HCFA geographic reclassification standards. PMID- 10145796 TI - Hospital, clinic merger proves advantageous, perhaps prophetic. PMID- 10145797 TI - Benchmarking makes its way to treasury management. PMID- 10145798 TI - A critical technico-ethical dilemma of current medicine. PMID- 10145799 TI - Care of the dying: a Catholic perspective. Part III: Clinical context--good palliative care eases the dying process. Catholic Health Association. AB - In the midst of a push for legalized euthanasia and assisted suicide in the United States, the Catholic healing tradition should provide good palliative care and support for dying patients. Catholic healthcare institutions can have a counterinfluence on the euthanasia movement if they strive to relieve all forms of pain-physical, psychological, social, and spiritual. Care givers must adapt their pain management methods to diverse groups of patients and their needs. Comprehensive pain management includes not only specialized clinical programs to control physical pain, but also counseling and human support to minimize psychological pain, community support groups to counter social pain, and pastoral care resources to address spiritual pain. Truthful communication lies at the heart of the therapeutic relationship. Healthcare institutions can likewise organize themselves internally to offer optimal support programs for those who are dying, their families, and their care givers. Necessary ingredients for a comprehensive approach include integrated treatment plans, hospitable environments, policies on advance directives and collaborative decision making, ethics committees that are well versed in end-of-life issues, education programs, and a hospice philosophy of care. PMID- 10145800 TI - Policy succession: the case for federal health planning in the 1990's. AB - Direct federal involvement in local health planning ended in 1986 with the repeal of the Health Planning and Resources Development Act of 1974. This article argues that planning has remained an important element in state and local public health activities, and that it will re-emerge as a national effort. Theories of policy succession are used to derive conditions for policy renewal that are satisfied by the current policy environment for health planning. The need for planning is obvious when issues related to health care delivery in rural areas are considered, and there are strong advocates of the need for planning. PMID- 10145801 TI - Accounting practice diversity in the healthcare industry. AB - A recent study examining accounting practices currently being used to prepare annual hospital financial statements indicates relatively little diversity, regardless of organizational type or size. The study's findings should interest those concerned with healthcare accounting and financial reporting issues, especially healthcare administrators and members of standards setting boards who participate in accounting policy deliberations. PMID- 10145802 TI - Independent contractors or employees? Reducing reclassification risks. AB - With the aggressive stance taken by the IRS regarding worker classification, many organizations may be risking significant retroactive assessments with respect to the use of independent contractors. Employers should be aware of the 20 primary factors considered by the IRS when examining independent contractor relationships and prepare in advance for IRS classification review or audit. PMID- 10145803 TI - Healthcare Financial Management Association, Principles and Practices Board. Statement No. 16. Classifying, valuing, and analyzing accounts receivable related to patient services. AB - This Principles and Practices Board project was undertaken in response to the frequent requests from HFMA members for a standard calculation of "days of revenue in receivables." The board's work on this project indicated that every element of the calculation required standards, which is what this statement provides. Since there have been few standards for accounts receivable related to patient services, the industry follows a variety of practices, which often differ from each other. This statement is intended to provide a framework for enhanced external comparison of accounts receivable related to patient services, and thereby improve management information related to this very important asset. Thus, the standards described in this statement represent long-term goals for gradual transition of recordkeeping practices and not a sudden or revolutionary change. The standards described in this statement will provide the necessary framework for the most meaningful external comparisons. Furthermore, management's understanding of deviations from these standards will immediately assist in analysis of differences in data between providers. PMID- 10145804 TI - Managed competition: is there a future for PFS (patient financial services) managers? PMID- 10145805 TI - Bank pricing study provides useful yardstick. PMID- 10145806 TI - AMA's Todd pushes for reform--cautiously. Interview by Richard L. Clark. AB - James S. Todd, MD, executive vice president, American Medical Association (AMA), believes there are only two ways to make sure all Americans are covered by health insurance--raise taxes or decrease benefits. In an interview with Richard L. Clarke, FHFMA, president, Healthcare Financial Management Association, Todd discusses the AMA's national healthcare reform plan and the AMA's outlook on global budgets, managed competition, and physician-hospital relationships. PMID- 10145807 TI - Selling accounts receivable to fund working capital. AB - The sale of accounts receivable by hospitals and other healthcare providers--and the securing of those receivables--has been the subject of considerable recent discussion. New developments and revised analyses of the financial and legal aspects of the sale of receivables make a continuing review of this financial management tool advisable. PMID- 10145808 TI - Measuring accounts receivable performance: a comprehensive method. AB - Nonperforming assets, such as accounts receivable, are frequently cited as sources of financial difficulty for hospitals. Yet, many hospitals, relying on the traditional measure of accounts receivable--days revenue outstanding--may not have a true grasp of the real cost of their accounts receivable. The author discusses the costs imposed on a hospital by accounts receivable and describes three cost components that must be calculated if the true cost of accounts receivable is to be determined and controlled. PMID- 10145809 TI - Patient accounts managers prepare for change. AB - Automated data processing and electronic data interchange have become necessary and increasingly vital aspects of the processes of admission, registration, billing, and collection. A recent survey of patient accounts managers found they feel they may need to improve their technical skills to meet future challenges. PMID- 10145810 TI - Three choices for death. AB - Ethicists and lobbyists for euthanasia have added qualifiers like "direct" and "indirect" to the word. Nonetheless, they still mean killing. E. Catherine Moroney, SSA, is a doctor of public health and a trustee of Greater Victoria Hospital Society in Victoria, British Columbia, and chairperson of its Patient Health Care Committee. PMID- 10145812 TI - Managing SFAS 106 as a provider. PMID- 10145811 TI - Palliative care for children. International Work Group on Death, Dying, and Bereavement. AB - The International Work Group on Death, Dying, and Bereavement recognizes the wide variation of attitudes, beliefs, and behaviours pertaining to childhood death, dying, and bereavement. The purpose of this statement is, therefore, to identify a set of assumptions which can serve as guidelines, across cultures, in the care of children with terminal illness and their families. PMID- 10145813 TI - Need for 'quality data' sets new frontiers for PFS (patient financial services) staff. PMID- 10145814 TI - Evaluating a job opportunity. PMID- 10145815 TI - Managing bank relationships effectively. PMID- 10145816 TI - Communication, mission make Methodist one of '100 best'. PMID- 10145817 TI - Creating an atmosphere of complete employee involvement in TQM. PMID- 10145818 TI - Contribution margin analysis: a case study. PMID- 10145819 TI - Databases, physicians, and accountants of the 21st Century. PMID- 10145820 TI - Healthcare EDI (electronic data interchange)--the transatlantic experience. PMID- 10145821 TI - The quest for uniformity in billing goes on. PMID- 10145822 TI - 'Educate, advocate, and participate,' says Weinheimer. PMID- 10145823 TI - HIS (healthcare information systems) consultants: when are they necessary, and why? AB - The rapid escalation of consulting fees for the installation of healthcare information systems and the potential abuses associated with consulting relationships has prompted some to question the need to hire consultants for systems installation. Consulting arrangements were considered cost effective when information systems were first being automated, but the rising cost of consulting services along with the increasing sophistication of hospital personnel regarding computerization suggest that the use of consultants receive close scrutiny. Following some simple guidelines may limit potential abuses and allow hospitals to obtain maximum service for their investment. PMID- 10145824 TI - Using PCs for effective case-mix based budgeting. AB - Precise statistical budgeting remains an underused cost-control technique in healthcare organizations, despite the increasing need for such techniques resulting from national movement toward prospective pricing and managed care. As revenues are capped, the use of precise case-mix based statistical budgeting to reduce unit costs has become one of the few strategies available to financial managers to assure profitability. The use of personal computers with database and spreadsheet software can facilitate effective case-mix based budgeting. PMID- 10145825 TI - Reaping the benefits of electronic medical record systems. AB - An electronic medical record system can provide benefits beyond the obvious functions of efficient and less labor-intensive scanning, archiving, retrieving, and printing of patient care information. The less tangible benefit of providing record access to several users simultaneously is difficult to quantify, but can enhance operations and improve the quality of patient care throughout a healthcare facility. PMID- 10145826 TI - Cost justifying the electronic billing decision. AB - Many patient accounts professionals have a "gut" feeling that electronic billing systems save hospitals time and money. But they need more than a gut feeling to convince hospital management to invest in such systems. The key is to make some objective financial estimates of the potential impact that electronic billing can have on hospitals. PMID- 10145827 TI - Improving the bottom line with imaging technology. AB - Imaging technology creates efficiencies in medical record processing that can positively affect a hospital's bottom line by improving productivity, reducing labor costs, and generating income through accelerated accounts receivable operations and billable copying and correspondence functions. PMID- 10145828 TI - Smart financial management of medical office space. AB - In a healthcare environment of strained resources and scarce profits, hospital administrators must seek revenue from all available sources. Some potential revenue sources are capital intensive, however, requiring large initial investments for new construction and modern equipment. Other potential revenue sources may require starting new programs and recruiting additional staff. Few potentially income-producing alternatives can be funded from existing assets, require little additional investment, and yield significant revenue. But hospitals that own and lease medical office buildings, will find that with proper management these existing assets can become sources of additional revenue. PMID- 10145829 TI - Hospital control and decision making: a financial perspective. AB - A study was conducted to test the hypothesis that there are no significant differences in financial decision making among hospitals in different control categories. Significant differences were found in financial decision making in for-profit hospitals, voluntary hospitals with religious affiliations, and secular voluntary hospitals. Managers of for-profit hospitals base their financial decisions more on the need to achieve operating efficiency and profitability than do managers of voluntary hospitals. Managers of voluntary hospitals with religious affiliations and secular voluntary hospitals give about the same emphasis to efficiency. Surprisingly, however, managers of voluntary hospitals with religious affiliations emphasize profitability and financial leverage more than managers of secular voluntary hospitals do. PMID- 10145830 TI - Early SFAS 106 adopters provide revealing healthcare data. AB - Healthcare executives should have a strong interest in the recently released Statement of Financial Accounting Standards No. 106, Employers' Accounting for Postretirement Benefits other than Pensions (SFAS 106). The requirements of SFAS 106 focus heavily on estimating the healthcare benefits of retirees and forces corporations to project the magnitude of expected increases in healthcare costs. Estimates for recording these retiree healthcare benefits for all U.S. companies range from $200 billion to $400 billion, imposing significant financial statement implications for all firms that provide healthcare benefits to retirees. The requirements of SFAS 106 will also have an impact on the way corporations design and implement healthcare cost controls, which may directly affect many healthcare entities. Understanding SFAS 106, and the reactions of firms to this standard, will allow healthcare executives to better manage their organizations to take advantage of new opportunities and meet new challenges that may arise. PMID- 10145831 TI - Palliative care. AB - Palliative care may not seem the highest of priorities; it is sometimes thought of as a 'luxury' to be paid for privately while the NHS picks up the 'public' cost of acute medicine. But anyone who has witnessed or experienced the work of palliative care teams would be dissuaded from these views. PMID- 10145832 TI - Analysis of an endotracheal intubation service provided by respiratory care practitioners. AB - Our Respiratory Care Services Department provides an endotracheal intubation service that responds to all intubation requests. Intubation is performed by registered respiratory therapists who complete an 8-hour training program, advanced cardiac life support (ACLS) training and certification, and clinical performance of intubation with supervision. The goals of this service are (1) to provide competent persons for performing this service, (2) to assure a rapid response time, and (3) to be cost-effective. EVALUATION METHODS: A retrospective analysis of our service was conducted over a 1-year period (7/90 to 6/91), and calculations were made of the intubation success rate and complication rate. RESULTS: Of the 833 total intubations, 791 were successfully performed by respiratory care practitioners; 730 of those successful intubations (92.3%) were accomplished in fewer than 3 attempts. Recognized complications occurred in 96 intubations (12.1%) and included oral bleeding, vomiting, and short periods of oxygen desaturation. In the 5.1% (42) of the patients not intubated by our service, 22 required heavy sedation, and an anesthesiologist was consulted; 17 patients were intubated by other physicians; and 3 tracheotomies were performed. Multiple intubation attempts were a result of secretions, induced bradycardia, blade-light malfunction, damaged cuff, and esophageal intubations. CONCLUSION: Respiratory Care Services can provide an effective intubation service. Cost savings were realized by centralizing equipment. PMID- 10145833 TI - AARC clinical practice guideline. Directed cough. American Association for Respiratory Care. PMID- 10145834 TI - AARC clinical practice guideline. Endotracheal suctioning of mechanically ventilated adults and children with artificial airways. American Association for Respiratory Care. PMID- 10145835 TI - AARC clinical practice guideline. Single-breath carbon monoxide diffusing capacity. American Association for Respiratory Care. PMID- 10145836 TI - AARC clinical practice guideline. Use of positive airway pressure adjuncts to bronchial hygiene therapy. American Association for Respiratory Care. PMID- 10145837 TI - Finding savings in laundry operations. AB - A 450-bed hospital, operating at 75 percent occupancy, which has a cash outlay of $10.00 per patient day for linen service, will spend $1,231,875 on linen service per year. If the cash outlay for linen service can be reduced to $7.00 per patient day, the hospital will save $369,562 per year. This article details the factors that affect linen service operations expenses, suggests ways such operations may be improved, and provides a method of measuring the potential savings. PMID- 10145838 TI - The need for consistency in healthcare reporting. AB - Different authoritative accounting and reporting guidelines apply within the healthcare industry. The issue at hand is whether or not the current accounting and reporting framework adequately addresses the needs of those with interests in healthcare financial information. PMID- 10145839 TI - Promoting cost-effective physician behavior. AB - The current demand for cost containment, improved quality of care, and increased efficiency requires the cooperation of hospital administrators and physicians. Too often, however, administrators are frustrated in their attempts to gain the cooperation of physicians in working toward improving a hospital's financial position. In many instances administration efforts are perceived by physicians as promoting economic efficiency at the expense of quality of care. This article offers specific suggestions, from the physician's perspective, regarding how hospitals can develop a successful program to promote cost-effective physician behavior. PMID- 10145840 TI - Subacute care as a new source of revenue. AB - Subacute rehabilitation is a segment of subacute care that offers potential financial rewards for providers while offering needed care to rehabilitation patients who would qualify for subacute care. It is also a logical level of care for acute care providers and/or rehabilitation providers to implement. While a subacute rehabilitation unit definitely can be a more financially attractive opportunity than a traditional skilled nursing unit, success in such a venture requires an in-depth understanding of the structure of such units and of reimbursement for skilled nursing care. PMID- 10145841 TI - Check truncation and ACH (automated clearing house) trends. PMID- 10145842 TI - Some thoughts on change. PMID- 10145843 TI - Waverly Municipal Hospital on a special mission. PMID- 10145844 TI - Graduate medical education reaudit regulation challenged. PMID- 10145845 TI - EDI for the human resource department. PMID- 10145846 TI - Enhancing hospital cash reserves management. PMID- 10145847 TI - The nuts and bolts of increasing arterial oxygenation: devices and techniques. AB - PaO2 can be increased by oxygen supplementation or by application of EEP and by manipulation of P(aw) during mechanical ventilation. Techniques and devices for accomplishing these maneuvers are many and varied. Clinicians should be aware of the appropriate application, complications, and limitations of each. PMID- 10145848 TI - Early intervention services in selected Florida counties: the provider perspective. AB - Early intervention providers in five Florida counties were interviewed to obtain their perspective on the current service system in preparation for the implementation of programs under Public Law 99-457. Recommendations from the providers' perspective that have implications for policy development include (a) increase public awareness of disability, handicap, and at risk conditions as well as awareness of services; (b) increase funding for early intervention services with particular attention to the needs of families for support and other services; (c) drastically improve the transportation system; and (d) focus on helping parents and the public to learn how to negotiate the system as it exists. PMID- 10145849 TI - What makes a financial manager successful? PMID- 10145850 TI - Preventive systems in a CQI/TQM environment. PMID- 10145851 TI - An integrated approach to managed care contracting. AB - Managed care plans make up an increasing share of today's hospital payer mix. As a result, it is important for hospitals to negotiate the best possible managed care contract terms in order to minimize risk and maximize opportunity. This article presents a six-step "closed loop" approach to managed care contracting, showing how hospitals can integrate--through their information systems--the strategic, financial, and patient care processes that are part of the managed care cycle. PMID- 10145852 TI - Ramifications of the Family and Medical Leave Act of 1993. AB - Six months ago, the Family and Medical Leave Act of 1993 was signed into law, and key provisions of the act became effective on August 5, 1993. This article examines the main provisions of the act, explains how employee leaves will be granted in compliance with the act, outlines the consequences of noncompliance with the act, analyzes the operational ramifications of the act, quantifies the financial implications of the act, and discusses the role of the healthcare financial manager in assisting with the formulation of a hospital policy to comply with the act. PMID- 10145853 TI - Avoiding antitrust compliance difficulties in mergers and acquisitions. AB - Highly publicized court cases may lead hospital executives to believe that almost any merger or joint venture will provoke costly antitrust litigation. Executives need to realize that many types of workable and useful transactions may be accomplished without incurring legal action by antitrust law enforcement agencies. PMID- 10145854 TI - Capital investment analysis: three methods. AB - Three cash flow/discount rate methods can be used when conducting capital budgeting financial analyses: the net operating cash flow method, the net cash flow to investors method, and the net cash flow to equity holders method. The three methods differ in how the financing mix and the benefits of debt financing are incorporated. This article explains the three methods, demonstrates that they are essentially equivalent, and recommends which method to use under specific circumstances. PMID- 10145855 TI - Contracting for helicopter emergency transport services. AB - A hospital considering the lease of a helicopter for use in a medical emergency evacuation program will need to consider many issues, from the type and availability of the aircraft needed to the experience and qualifications required of the pilot and mechanic. Also to be considered are the liability of the hospital for negligence or misconduct of the helicopter service, and the particulars of reimbursement for helicopter service under Medicare as a capital related cost. PMID- 10145856 TI - Improving outpatient registration with TQM. AB - Quality improvement techniques have long been used in clinical departments to improve the quality of patient care. More recently, however, continuous quality improvement and total quality management techniques have been applied in nonclinical hospital departments with the goal of increasing efficiency, productivity, and cost effectiveness. In this article, the author describes how quality improvements in outpatient registration can lead to improved customer satisfaction, enhanced hospital-physician relationships, and increased revenue from outpatient services. PMID- 10145857 TI - Preparing checks with laser printers. PMID- 10145858 TI - New ways to get paid electronically. PMID- 10145859 TI - Government request sends HFMA members to Albania. PMID- 10145860 TI - Cost-benefit considerations in managing oxygenation failure. AB - The evaluation of new therapy poses a formidable challenge in intensive care medicine. When therapy evaluation cannot be double-blinded, as in the evaluation of extracorporeal support, the problem becomes more difficult. The result of the extracorporeal clinical trial, like that of the ECMO trial in the 1970s, is a potent reminder of the importance of concurrent controls in such evaluations. We should view with caution ethical objections to controlled trials of therapies that are not supported by credible data. A stronger ethical argument may frequently be mounted in favor of a randomized, controlled clinical trial. This is particularly pertinent in the high-technology ICU environment in which information overload is intense. The establishment of ICU human laboratories should enable the medical community to make much needed progress and help us identify the useful elements in our therapeutic armamentarium. PMID- 10145861 TI - Physician-assisted suicide: putting the cart before the horse. PMID- 10145862 TI - The re-emergence of tuberculosis: a previously forgotten disease becomes a problem for caregivers. PMID- 10145863 TI - Control of tuberculosis in the United States. Joint Statement of the American Thoracic Society, the Centers for Disease Control, and the Infectious Disease Society of America. PMID- 10145864 TI - Continuous quality improvement as an organizational strategy. PMID- 10145865 TI - Achieving excellence in the management of accounts receivable. AB - Recent changes in healthcare reimbursement rules and practices have made the task of accounts receivable management a particularly demanding one for most financial managers. One multihospital system, after pursuing numerous strategies to reduce its accounts receivable with only marginal levels of success, launched a systemwide initiative to share both the positive and the negative accounts receivable management experiences of each department at each hospital in the system with all patient accounting staff. The objective of the initiative was to use the lessons learned from those experiences to attain excellence in accounts receivable management throughout the system. The ultimate success of the initiative is detailed in the following article. PMID- 10145866 TI - Healthcare financial managers and CQI. AB - The continuous quality improvement (CQI) process can be a mechanism for balancing a healthcare organization's quests for quality and for profitability. This article explores the role healthcare financial managers can play in the CQI process, discusses how healthcare financial managers can champion a hospital's drive for quality, and presents some basic tools used in the CQI process. PMID- 10145867 TI - Improving clinical practices can boost the bottom line. AB - An investment in improving quality has the potential to yield a higher rate of return than any other investment a healthcare organization can make. Payers and employers in the future will contract with those healthcare organizations that not only charge appropriate amounts for delivering care but also can demonstrate the quality--i.e., value--of the care they are providing. Improving the quality of care can improve both a hospital's fiscal performance and its market share. PMID- 10145868 TI - Achieving superior performance through process improvement. AB - The regular and continuous use of process improvement practices leads to superior performance, according to an international study of management practices. Process improvements enable hospitals to translate total quality management (TQM) and continuous quality improvement (CQI) initiatives into action. This article presents a step-by-step approach to process improvement in the hospital environment. PMID- 10145869 TI - Patient supply charges: still a revenue source? AB - Patient supply charges, billed to patients for the consumption of medical/surgical supplies, have been in use since the first medical insurance programs were established. But, as healthcare costs have escalated, so have supply charges. In turn, initiatives to limit supply charges have been promulgated, and healthcare financial managers should be sensitive to the fact that the cost of a patient supply charge program can exceed the real contribution generated by such a program. PMID- 10145870 TI - Prebilling DRG training can increase hospital reimbursement. AB - Over the past decade, appropriate reimbursement has become increasingly dependent on accurate coding and correct DRG assignment. In this article, a study outlining the cost of inaccurate coding is presented, and a program for prebilling coder training is described. The authors show that a well-designed prebilling coding program can improve the accuracy of DRG assignment and thereby increase reimbursement by 10 percent or more. PMID- 10145871 TI - Trends in banking relationships. PMID- 10145872 TI - Integrated system moves hospitals out of 'Jurassic Park'. PMID- 10145873 TI - Linking physicians to hospitals. AB - Hospitals and physicians appear to be reexamining how they do business together, including improving operating efficiencies both to cut costs and to improve quality. The electronic exchange of information is a vital tool in this effort regardless of the specific approach taken to build a community healthcare network for the 1990s and beyond. PMID- 10145874 TI - The TQM critic: a rational revolutionary? PMID- 10145875 TI - The five toughest interview questions. PMID- 10145876 TI - A strategy for reducing costs associated with pulse oximetry in noncritical care areas. PMID- 10145877 TI - Occupational asthma in the respiratory care worker. PMID- 10145878 TI - Geriatric care management reduces Medicare losses. AB - Healthcare costs for the elderly are rising rapidly in the United States. One way for a hospital to control these rising costs is to implement a geriatric care management system. The goal of a such a system is to change the way the hospital treats medically complex Medicare patients and, thus, reduce unnecessary hospital costs. Such a system requires a process for identifying elderly patients in need of geriatric care management services, treating them efficiently, and assessing the system itself. An effective process usually results in significant cost savings for the hospital as well as improved patient care and satisfaction. PMID- 10145879 TI - Nutritional intervention influences the bottom line. AB - Clinical nutrition professionals can influence hospital operating margins by the way they respond to patients who are at risk for protein-calorie malnutrition. Early nutritional intervention can reduce costs associated with at-risk patients, while appropriate documentation and billing can increase revenue from government and private payers. PMID- 10145880 TI - Manufacturers, hospitals cooperate on imaging equipment acquisition. AB - In the past, some diagnostic imaging equipment manufacturers offered "boiler plate" financing strategies to healthcare organizations. Today, however, many employ representatives with backgrounds in finance and train them to work with hospitals to develop financing strategies appropriate for the organization. This consultive relationship allows equipment manufacturers to create customized financing plans to fit a hospital's individual needs. For example, radiologists and financial managers can now work with manufacturers' representatives to determine which imaging equipment would be the most appropriate and cost effective for a particular hospital. Manufacturers' representatives also may consult with the hospitals' strategic planners to determine the most appropriate piece of equipment to buy and to arrange financing. PMID- 10145881 TI - Costs and benefits of shell space construction. AB - "Shell space" is space constructed to meet future needs; it is space enclosed by an exterior building shell, but otherwise unfinished inside. The construction of shell space at the same time another facility is constructed, while adding to overall immediate construction costs, often can lower total expenditures over the long term. This article presents a model for evaluating the financial feasibility of constructing shell space during a capital construction project. PMID- 10145882 TI - Deferred compensation for tax-exempt entities. AB - Many executives in tax-exempt organizations, including healthcare executives, find their tax-advantaged savings opportunities dramatically reduced today compared to previous years. The benefit of employer-sponsored, "qualified" retirement and savings programs has been severely limited by ever-increasing tax restrictions on such plans when they are offered by tax-exempt organizations. And the opportunity for tax-sheltered personal investments has virtually disappeared. One of the last remaining opportunities for tax-advantaged savings in tax-exempt organizations is an employer-sponsored, non-qualified, deferred compensation plan, an option that appears increasingly attractive in light of the recently enacted increased personal tax rates. PMID- 10145883 TI - Retroactive reimbursement under HCFA's PPS for capital. AB - Most hospitals participating in a diagnosis related group-based prospective payment system (PPS) make the transition to HCFA's PPS for capital reimbursement much as they did to PPS for operating cost reimbursement. However, unlike the transition to a Federal rate of reimbursement for a hospital's operating cost, the initial years of the transition to a Federal rate for Medicare capital cost reimbursement may offer significant opportunities for retroactive reimbursement. PMID- 10145884 TI - FAS 116 and 117: the implementation process. AB - The Financial Accounting Standards Board finalized and issued two new statements in June 1993: "Financial Statements of Not-for-Profit Organizations" (FAS 117) and "Accounting for Contributions Received and Contributions Made" (FAS 116). The statements will become effective for fiscal years beginning after December 15, 1994. Until a revised audit guide is issued, however, several factors will need to be carefully considered when implementing the two standards. PMID- 10145885 TI - Update on direct deposit of payroll. PMID- 10145886 TI - Cash spurs hospital staff to stay fit. PMID- 10145887 TI - Court sides with providers on advance refunding. Guernsey Memorial Hospital v. Secretary of Health and Human Services. AB - One of the most controversial Medicare issues has been the timing of reimbursement for losses incurred on advance refundings of bond indebtedness. The U.S. Court of Appeals for the Sixth Circuit has handed down a decision on this issue. In Guernsey Memorial Hospital v. Secretary of Health and Human Services, the court ruled in favor of providers. PMID- 10145888 TI - Healthcare EDI needs leadership. PMID- 10145889 TI - Personal marketing during a job hunt. AB - Understanding and facing new employment realities can help individuals recognize the changing needs of employers and match their skills with available opportunities. Individuals should exploit the healthcare industry's new realities by refining their personal product package and promoting it effectively. PMID- 10145890 TI - Adventures in recycling: the reuse of "disposable" pulse oximeter probes. PMID- 10145891 TI - MEDWATCH: the new FDA medical products reporting program. PMID- 10145892 TI - Preliminary evaluation of high-frequency chest compression for secretion clearance in mechanically ventilated patients. AB - BACKGROUND: A high-frequency chest compression (HFCC) device called the ThAIRapy System has been developed to provide secretion clearance therapy. We evaluated the safety, efficacy, and utility of the device in long-term mechanically ventilated patients. DESCRIPTION OF DEVICE: The primary components of the device are an air-pulse generator and an inflatable vest. Small gas volumes are alternately injected into and withdrawn from the vest by the air-pulse generator at a fast rate, creating an oscillatory or vibratory motion. The pulses cause the vest to inflate and deflate against the thorax of the patient. EVALUATION METHODS: We evaluated HFCC by comparing it to percussion and postural drainage therapy (P&PD); sputum production, patient comfort (PC), pulse-oximetry saturation (SpO2), heart rate (HR), and blood pressure (BP) data were collected and compared between the 2 methods. We monitored the reliability of the device and distributed a survey questionnaire to the entire respiratory therapy staff to assess utility. EVALUATION RESULTS: Nine patients completed the safety and efficacy portion of our evaluation. No significant difference was found between P&PD and HFCC in the wet weight of collected sputum, the mean change-in-percent of SpO2 or the mean percent change from baseline in HR, BP, or PC. All therapists believed that the ThAIRapy System was easy to learn, and 70% considered it an acceptable alternative to P&PD. Of the staff members surveyed, 80% believed that use of the HFCC device resulted in time savings in all or most cases. There were no equipment malfunctions in 225 hours of use. CONCLUSIONS: Compared to P&PD, HFCC via the ThAIRapy System may be equally efficacious in promoting secretion clearance in long-term mechanically ventilated patients. HFCC is neither more nor less safe for patients than is P&PD using SpO2, HR, BP, and PC as outcome variables. Most of our respiratory therapists perceived HFCC as an acceptable alternative to P&PD. PMID- 10145893 TI - Multipatient use of prefilled disposable oxygen humidifiers for up to 30 days: patient safety and cost analysis. AB - BACKGROUND: Prefilled disposable oxygen humidification units have been shown to decrease the likelihood of contamination when compared to reusable oxygen humidification units. However, prefilled disposable humidifiers are expensive when used for single patients, especially in areas of high turnover, and it is not known whether these units need to be routinely changed before they are empty. The number of patients safely using a prefilled disposable humidifier has not been documented in previously reported work. Are patients at risk of nosocomial infections due to cross-contamination when prefilled disposable oxygen humidifiers are applied to multi-patient use? What are the cost benefits of multiple patient use of prefilled disposable oxygen humidifiers? When local practice or physician preference dictates the use of humidification for low-flow oxygen, these questions need to be answered. METHODS & MATERIALS: Data were collected over two time periods to address changes due to seasonal variations and include area of use, number of patients, and quantitative cultures for aerobic microorganisms (including Legionella). Each disposable humidifier was monitored for a period of 1 month or until only 1 inch of water remained. Costs of using reusable humidifiers and prefilled humidifiers and therapist/nurse time to initiate therapy with both units were compared. During this period, 60 reusable humidifiers were also cultured for aerobic microorganisms and Legionella. RESULTS: We report results on 1,311 of the 1,315 disposable prefilled oxygen humidifiers used. We saw no significant growth in any of the prefilled disposable humidifiers for periods of up to 30 days, with > 100 humidifiers having been used by > 20 patients. CONCLUSIONS: Our results show that prefilled disposable oxygen humidifiers can be used without cross-contamination, on multiple patients, for a period of 1 month. The use of prefilled humidifiers in this way represents a substantial cost saving when compared to reusable humidifiers. PMID- 10145894 TI - Weathering the storm. Making the most of available sight can liberate the visually-impaired. PMID- 10145895 TI - Voluntary euthanasia in Canada. PMID- 10145896 TI - Breaking crayons aids creativity. PMID- 10145897 TI - Blue Cross Blue Shield CEO Tresnowski calls for insurance reform. Interview by Richard L. Clarke. AB - The Blue Cross Blue Shield Association is the coordinating organization for the 70 independent Blue Cross Blue Shield plans across the United States. In an interview with Richard L. Clarke, FHFMA, president, Healthcare Financial Management Association, Bernard R. Tresnowski, Blue Cross Blue Shield's president and chief executive officer, addresses the issue of healthcare reform, some of which he believes may be implemented as early as next summer. In addition, Tresnowski discusses the need for insurance reform, offers reasons why some Blue Cross plans have failed, reinforces his belief in the benefits of administrative simplification, and emphasizes the strengths of linking financing and delivery. PMID- 10145898 TI - New service lines for hospital emergency departments. AB - One way for a hospital to increase revenue, improve the delivery of health care, and boost patient satisfaction is to develop new services as an adjunct to its emergency department. New service lines that treat emergency department patients quickly and efficiently and eliminate negative experiences patients often associate with emergency department visits can offer significant benefits to a hospital as well as its patients. PMID- 10145899 TI - Medicare physician payment reform: a view from the field. AB - On Jan. 1, 1992, a major revision process was initiated to change the method by which the Medicare program pays for physician and other professional services. The changes, to be phased in over a five-year period, included payment on the basis of a resource-based relative value scale (RBRVS) and prospective global budgeting for all physician and other professional service payments. Before and shortly after the reform process began, many predicted that far-reaching changes in physician practice would occur as a result. The findings of a survey of physicians in California on the effects that Medicare physician payment reforms had on their practices during 1992 indicate that these predictions may have been exaggerated. PMID- 10145900 TI - Interest rate swaps: financial tool of the '90s. AB - The implementation of prospective payment for capital costs makes it more necessary than ever for healthcare financial managers to be able to creatively balance capital costs with risk. A new financial management tool--the interest rate swap (a contractual agreement in which one party with a fixed interest rate payment liability and another party with a variable interest payment liability agree to trade those obligations)--is proving to be a solution for a growing number of hospital managers. This article describes the uses of interest rate swaps and discusses the variables to be considered when evaluating whether the benefits of an interest rate swap offset the additional risk. PMID- 10145901 TI - Key financial ratios can foretell hospital closures. AB - An analysis of various financial ratios sampled from open and closed hospitals shows that certain leverage, liquidity, capital efficiency, and resource availability ratios can predict hospital closure up to two years in advance of the closure with an accuracy of nearly 75 percent. PMID- 10145902 TI - Registry-supplied nurses reduce tax headache for hospitals. AB - The use of registry-supplied nurses sometimes raises questions about the hospital's potential liability for Federal employment taxes. As this article shows, if a hospital's relationships with the registry and with the nurse are carefully structured, the hospital should be able to avoid liability for such taxes. PMID- 10145903 TI - The hidden costs of accounts receivable. AB - To maintain and expand their missions, hospitals must make the best use of their assets. Knowing the true cost of accounts receivable is important for efficient operations. Knowing how to reduce this cost is critical for liquidity. This article offers a guide to ensuring these assets are used most productively. PMID- 10145904 TI - Reengineering is here to stay. PMID- 10145905 TI - Pioneering child care center provides parents peace of mind. PMID- 10145906 TI - EDI and electronic mail. PMID- 10145907 TI - Healthcare financial managers should strive to be invaluable. PMID- 10145908 TI - Keeping 'the basics' in sight during times of change. PMID- 10145909 TI - Symptom relief in palliative care. AB - Palliative medicine in hospice is emerging as a growing discipline, committed to holistic and compassionate, comforting care for seriously ill patients. It is essential to include aggressive medical therapy for pain relief; even more important to the issue is that the patient be the central figure in decisions of care. PMID- 10145910 TI - Automated training for system users. PMID- 10145911 TI - Institutional perspective strong suit of new PRRB. Interview by Wendy Herr. AB - The Provider Reimbursement Review Board (PRRB) is the body appointed by the Secretary of Health and Human Services (HHS) to provide an appeal mechanism for healthcare providers to whom Medicare fiscal intermediaries deny reimbursement for services under Medicare. HFMA Colorado Chapter member Michael D. Richards, CPA, formerly director of finance at St. Mary's Hospital and Medical Center, Grand Junction, Colo., was appointed to the PRRB by HHS Secretary Donna Shalala for a three-year term that began in July 1993. HFMA policy services group executive Wendy Herr, FHFMA, CMPA, interviewed Richards in September for Healthcare Financial Management. PMID- 10145912 TI - Practice acquisition: buy or build? AB - While the advantage to a hospital of having a stake in a physician's practice is clear, the manner by which it should gain that stake is not. Should a hospital acquire an existing practice through outright purchase or assist a physician in building a new one? This article discusses the financial components that influence this decision and presents a pro forma analysis model. PMID- 10145913 TI - Economic credentialing survey of university teaching hospitals. AB - Economic credentialing, the process of applying economic criteria to the determination of initial appointments or reappointments of physicians to hospital medical staffs, has become a major issue in hospital medical staff relations. Nearly all major academic health center hospitals have the ability to perform economic analyses of faculty/physician clinical practices, and more than one third of their CEOs see nothing wrong with terminating or denying hospital privileges for excessive use of hospital resources. Sixty-eight percent of surveyed academic health center respondents currently develop and review physician practice profiles, but only 35 percent of these respondents include economic data. PMID- 10145914 TI - Estimating the value of group medical practices: a primer. AB - Estimating the value of a group medical practice can be a difficult task for a healthcare financial manager. There are three generally accepted approaches to estimating value, however, that a financial manager can take: the income approach, the cost approach, and the market approach. Whichever approach or combination of approaches is chosen, a financial manager must thoroughly understand the subjective nature of value and how it relates to the objective task of performing such an estimation. PMID- 10145915 TI - Beyond value: legal aspects of medical group acquisitions by tax-exempt organizations. PMID- 10145916 TI - Update on hospital-physician relationships under Stark II. AB - Among the Federal laws affecting business and payment practices in the healthcare field is the limitation on certain physician self-referrals known as the "Stark law." This article includes an expanded analysis of the Stark law, with particular attention paid to Congressional amendments under the Omnibus Budget Reconciliation Act of 1993. PMID- 10145917 TI - Practical applications of Stark II to hospital operations. AB - With the passage of the Omnibus Reconciliation Act of 1993, the Social Security Act was amended to substantially expand the Medicare self-referral prohibitions. The amended statute, commonly referred to as "Stark II," now covers Medicare and Medicaid referrals and substantially expands the list of services covered, effective January 1, 1995. This article illustrates how Stark II may apply to some of the most common financial relationships between hospitals and referring physicians. PMID- 10145918 TI - 'Reform' plan pushes business office staff past days in AR goal. PMID- 10145919 TI - EDI standards--a year-end review. PMID- 10145920 TI - In defense of total quality management. PMID- 10145921 TI - Purchasing cash management services with RFIs and RFPs. PMID- 10145922 TI - Physician-ordered respiratory care vs physician-ordered use of a respiratory therapy consult service: early experience at The Cleveland Clinic Foundation. AB - BACKGROUND: Accumulative evidence suggests that respiratory care is frequently misallocated. We report the results of a pilot study of a delivery system aimed at correcting such misallocation. METHODS: The delivery system (Respiratory Therapy Consult Service, or RTCS) allows respiratory therapists (when requested by the case-managing physician) to determine respiratory care, with decisions guided by algorithm (ie, Consult patients). In the pilot study, Therapist Evaluators responded to requests for Consults on two study wards. All staff therapists participated in implementing Evaluator-determined treatment. STUDY DESIGN: We evaluated 38 patients (20 of whom were Consult patients) randomly selected from a total of 82 patients undergoing abdominal surgery during the study period. RESULTS: Consult patients were significantly older than non-Consult patients, more likely to be heavy smokers (67 vs 43%), and sicker as suggested by a higher Triage Score. Consult patients received more types and more total respiratory care services, demonstrated a trend toward longer stay, and had significantly higher respiratory therapy charges. CONCLUSION: Our experience shows that a consult program can be successfully implemented in a large, tertiary care institution with widespread physician and nursing support. Whether the RTCS fulfills its goal of ameliorating misallocation of respiratory care has yet to be proven and awaits the completion of other studies currently under way. PMID- 10145923 TI - Residual bacterial contamination on reusable pulse oximetry sensors. AB - BACKGROUND: An early study demonstrated that standard cleaning techniques did not adequately disinfect reusable pulse oximetry sensors that had been intentionally contaminated with high titers of pathogenic microorganisms. This current study evaluated patient-ready sensors being used in hospitals, by testing them for bacterial contamination. METHODS: Reusable pulse oximetry sensors from 15 hospitals throughout the United States were tested. Each sensor was deemed by the hospital to be ready for patient use, and it had been prepared for use according to hospital procedures. Patient-contact areas of each sensor were swabbed, and the swabs were analyzed for bacterial contamination using standard testing procedures. This study had two stages, and different sensors were tested in each stage. In the "bacterial-growth stage," swabs were evaluated for bacterial contamination but organisms were not identified; in the "identification stage," bacterial species were identified. RESULTS: Forty-four sensors were evaluated, 16 in the bacterial-growth stage and 28 in the identification stage. Bacteria were cultured from 29 of the 44 sensors (66%), including 20 that had been cleaned with alcohol or an antibacterial/antiviral agent. Among the isolated organisms were Staphylococcus aureus, Staphylococcus haemolyticus, Enterococcus faecalis, and Klebsiella oxytoca. Bacterial contamination was found on sensors from 12 of the 15 participating hospitals. CONCLUSIONS: These data demonstrate the need to define effective cleaning methods for reusable sensors, and we are currently conducting such studies. The data also suggest that disposable patient-dedicated sensors may be the most appropriate choice when infection control is of particular concern. PMID- 10145924 TI - AARC clinical practice guideline. Transport of the mechanically ventilated patient. American Association for Respiratory Care. PMID- 10145925 TI - AARC clinical practice guideline. Fiberoptic bronchoscopy assisting. American Association for Respiratory Care. PMID- 10145926 TI - AARC clinical practice guideline. Resuscitation in acute care hospitals. American Association for Respiratory Care. PMID- 10145927 TI - AARC clinical practice guideline. Intermittent positive pressure breathing. American Association for Respiratory Care. PMID- 10145928 TI - AARC clinical practice guideline. Bland aerosol administration. American Association for Respiratory Care. PMID- 10145930 TI - State variation cornerstone of reform says HCFA's Vladeck. Interview by Wendy Herr. PMID- 10145929 TI - Responding to the challenge. A status report on shared decision-making programs. AB - Interactive video programs have been developed to provide patients with tailored information about treatment choices for their medical conditions. The article provides a status report on the use and production of these programs. Evaluation results are presented in terms of patient satisfaction, patient preference shifts and impacts on clinical practice. The future of shared medical decision-making is discussed. PMID- 10145931 TI - Provider alliances: key to healthcare reform. AB - No matter what form healthcare reform takes, managed care is the future of health care, and the future is now. Hospitals and physicians will have to work together as partners and align incentives. It will be necessary to develop more primary care capability to adequately compete in the managed care arena. There will need to be increased coordination of managed care contracting between hospitals and physicians. PMID- 10145932 TI - Alternatives to Federal regulatory realignment of health care. AB - In this article, author Christopher J. Kalkhof puts forth the view that the U.S. healthcare system could be made more cost effective and cost efficient without the implementation of government-directed managed competition strategies. Noting that current private sector initiatives already are forming more cost-sensitive integrated delivery and financing mechanisms, Kalkhof asserts that corresponding realignment initiatives for publicly financed healthcare benefit programs would provide additional incentive and momentum for these private sector efforts without requiring reconfiguration of the healthcare system by the government. PMID- 10145933 TI - A review of 'The Health Security Act of 1993'. AB - The Health Security Act of 1993, which is now before Congress, holds the potential to effect major changes in the way health care is delivered in this country and in how that delivery is financed. This article reviews the principal provisions proposed to be contained in the act (as presented in the preliminary summary released in September 1993) and offers suggestions regarding the issues that hospital financial managers should begin addressing now. PMID- 10145934 TI - CHIN (community healthcare information network) provides vital healthcare linkages. AB - When the term "electronic data interchange" (EDI) was first introduced, it referred to purchase orders, electronic claims, and electronic remittance processing. Those EDI applications are becoming commonplace now, however, and new applications for EDI technology are being developed. Healthcare financial managers should expect that the electronic data highways used for claims traffic eventually will transport both financial and clinical information. These electronic exchanges will not only be between payers and providers but also between hospitals, laboratories, physicians, and allied health professionals. The name commonly given to this view of an electronically linked healthcare world is the community healthcare information network (CHIN). PMID- 10145935 TI - Health care and privacy law in electronic commerce. AB - As electronic data interchange (EDI) continues to gain acceptance and use, questions regarding protection of the confidentiality of private healthcare information have arisen. This article explains how a computer-based information system equipped with appropriate safeguards can be far better at ensuring privacy than a paper-based system. PMID- 10145936 TI - EDI (electronic data interchange) for human resources saves money and time. AB - Healthcare financial managers seeking immediate cost savings through the use of electronic data interchange (EDI) may find that the automation of repetitive transactions can reduce staffing levels in hospital human resource departments and lower the cost of employee benefits. New procedures and EDI also can tighten controls on hospital employee health benefit eligibility and reduce the per employee cost of benefits. PMID- 10145937 TI - Using EDI (electronic data interchange) to improve the accounts payable department. AB - Additional paperwork, escalating costs, and an outdated accounts payable system at St. Joseph Health System forced management staff to alter the way the accounts payable department operates. This article describes the process the health system used to automate one of its accounts payable departments by using electronic data interchange/electronic funds transfer (EDI/EFT) technology. PMID- 10145938 TI - EDI (electronic data interchange) provides strategy for laboratory results reporting. AB - Historically, results of laboratory tests have been transmitted from hospitals to physicians' offices by mail and telephone. Two problems inherent in this system are the difficulty in notifying the physician and in the timeliness of delivery of results. Telephone messages may fail to reach the physician. Hard copies of reports may be misfiled, lost, or delayed in the mail. Today, test results can be transmitted between physicians' offices and hospitals via facsimile machines and electronic data interchange (EDI). This article examines the cost effectiveness, confidentiality, and opportunity for growth these alternative methods of transmission offer. PMID- 10145939 TI - Lockbox service can be beneficial. PMID- 10145940 TI - Healthcare reform and emerging employment trends. PMID- 10145941 TI - Hospital prepares for twenty-first century with innovative vision ... Hackley Hospital, Muskegon, Mich. PMID- 10145942 TI - EDI (electronic data interchange): when to start, where to begin. PMID- 10145943 TI - Making the most of your hematology proficiency surveys. PMID- 10145944 TI - Symbolic processes in the implementation of technological change: a symbolic interactionist study of work computerization. AB - This study examined the symbolic processes involved in the computerization of work in a health maintenance organization. Guided by symbolic interaction as a methodological framework, this inductive study used the methods of participant observation and in-depth interviewing for gathering data. It documents the multiple symbols associated with computerization in the organization and discusses local interpretations of those symbolic realities. It also explores the influence of this symbolism on the computerization process. PMID- 10145945 TI - The Australian National Non-Acute Inpatient Project. AB - The Australian National Non-Acute Inpatient Project has produced a casemix classification system for non-acute inpatients (NAIP). The daily classification has 19 final classes which bring together descriptions of a patient's clinical type (from admission diagnosis) and functional ability (from automated nursing care plans). Data on salary cost relating to care of 786 patients were collected at three large metropolitan teaching hospitals for six months during 1991, yielding a total sample of 15,013 non-acute bed-days. The NAIP classification was built from first principles, combining clinician input and statistical testing using an analysis of variance model (PC Grouper). Overall variance reduction on the full set of 15,013 records was 26.15 per cent. PMID- 10145947 TI - The CFO in a changing healthcare world. PMID- 10145946 TI - Community education on mental health in later life: findings from an evaluation of a series of three model programs. AB - This article describes a series of three community educational programs--The Second Story, The Final Course, and Winter Comforts--designed to increase knowledge about and skills for responding to three common mental health concerns in later life: loss and grief, depression and suicide, and alcohol abuse. It also presents findings from an evaluation of the impact of these educational programs on a total of 389 workshop participants, including 203 who also received training on how to present the educational workshops. The findings are relevant to anyone who wants to conduct a workshop that will lead to increased recognition and precrisis treatment of mental health problems affecting older adults. PMID- 10145948 TI - The Health Security Act--good news, bad news. PMID- 10145949 TI - Universal coverage, cost control, and substantial benefits not negotiable elements of reform, says Shalala. Interview by Richard L. Clarke. PMID- 10145950 TI - Do-it-yourself strategic planning provides map to the future. AB - An alternative to spending a six-figure sum for a consultant-produced strategic plan may be for the staff of a healthcare organization to develop a strategic plan as a "do-it-yourself" project. In addition to being less expensive to acquire, such a plan offers staff the opportunity to control the plan's content tightly and thus make it easier to implement. PMID- 10145951 TI - Understanding the referral services safe harbor. AB - In today's competitive healthcare environment, healthcare facilities and individual providers must form new relationships to safeguard their market positions and compete efficiently. But while such relationships are necessary and serve legitimate goals, those entering into such arrangements must be concerned that in so doing they do not run afoul of the Medicare and Medicaid fraud and abuse statute. This article examines the potential dangers of remuneration for referrals, and explains how one of the many so-called "safe harbor" provisions of the fraud and abuse statute applies to this practice. PMID- 10145952 TI - Reclassifying physicians as employees for Federal tax purposes. AB - The Internal Revenue Service is attempting to reclassify many physicians as hospital employees rather than as independent contractors. Reclassifying physicians as employees could leave thousands of physicians and hospitals facing costly employment tax audits and owing millions of dollars in back taxes and penalties. In addition, some hospital pension and benefits plans that have misclassified physicians could be invalidated, and substantial penalties could be imposed on hospitals. PMID- 10145953 TI - Implications of new accounting rules for income taxes. AB - The provisions of the Financial Accounting Standards Board (FASB) Statement No. 109, Accounting for Income Taxes, require all organizations that issue financial statements to shift the focus of their accounting for income taxes from the income statement to the balance sheet. This change can alter significantly a healthcare organization's financial position. The change also may affect the way in which investors, lenders, regulators, and other users of financial statements evaluate corporations in the healthcare industry. Hospitals and other healthcare organizations, particularly for-profit organizations, therefore, should review carefully their methods of accounting for such items as deferred tax assets and loss and expense reserves. PMID- 10145954 TI - Trends in the hospital financial picture. AB - In 1992 (the most recent year for which complete financial data are available), the overall financial condition of U.S. hospitals was better than it had been in a decade. However, low-performing hospitals were falling further behind their high-performing counterparts. Moreover, the continuing drop in prices for services, which requires hospitals to achieve greater productivity and cost control, may pose a threat to the ability of some to maintain high-quality care in the future. PMID- 10145955 TI - The advantages of controlled disbursement. PMID- 10145956 TI - Medical staff development plan a valuable resource. PMID- 10145957 TI - Electronic data interchange. A question of eligibility. PMID- 10145958 TI - Data trends. February 1994. PMID- 10145959 TI - Advanced cancer: aiming for the best in care. PMID- 10145960 TI - "The song of death: the lyrics of euthanasia". PMID- 10145961 TI - Inhaled bronchodilators during mechanical ventilation: delivery techniques, evaluation of response, and cost-effectiveness. AB - Inhaled beta 2 agonists can be administered by SVN or MDI during mechanical ventilation. MDI is an effective administration technique, it avoids the problems related to SVN, and it may be less expensive than SVN. A variety of techniques can be used to evaluate bronchodilator response during mechanical ventilation. Low-tech methods are also low cost, but may lack sensitivity. High-tech approaches to evaluate bronchodilator responsiveness may be more sensitive but are also more expensive. More work is needed to determine the most appropriate and cost-effective methods to evaluate bronchodilator response in mechanically ventilated patients. PMID- 10145962 TI - Monitoring gas exchange: clinical effectiveness and cost considerations. PMID- 10145963 TI - Flow-triggering systems. PMID- 10145964 TI - Special report on licensure, accreditation and CON. Certificate of need laws: still alive and costing. PMID- 10145965 TI - Patient accounts management in a changing world. PMID- 10145966 TI - Costs and benefits of integrated healthcare systems. AB - Although forming an integrated healthcare system can be extremely expensive, many hospitals and physician groups are discovering that by doing so, they can reap significant benefits, including increased market share, more secure physician income, and better physician "quality of life," a financially stronger organization, and an enhanced ability to adapt to the changing healthcare environment. In most cases, the return on the investment required to reorganize the physician, hospital, and healthcare plan relationship is likely to be substantial. PMID- 10145967 TI - Strategic considerations for capital formation and development. AB - It is the role of healthcare financial managers to maximize their organizations' return on equity, not only for the short term, but also with an eye to the future. This article explores the financial and managerial factors financial managers should consider when planning the strategic sources of capital funds and asset acquisitions for an organization, then examines the factors comprising return on equity-margin, leverage, and turnover-in light of current and projected industry trends. PMID- 10145968 TI - A return-based alternative to IRR (internal rates of return) evaluations. AB - A dilemma often faced by healthcare financial managers is whether to describe a potential investment project to organizational decision-makers in terms of the projects' internal rates of return (IRR) or to use the net present value (NPV) method. The IRR represents an intuitively appealing method of measuring investment value, but a number of conceptual and methodological problems associated with IRR measurement would seem to argue the use of the NPV method. Unfortunately, while the NPV measure is theoretically valid, it lacks the intuitive appeal of the IRR in communicating the value of investment alternatives. This article details an alternative method of measuring return that incorporates all the intuitive appeal of the conventional IRR, but few of the shortcoming associated with that measure. PMID- 10145969 TI - Methods for optimizing revenue in rural hospitals. AB - Rural hospitals have been failing over the last two decades, and one of the biggest reasons has been lack of attention paid to detail and accuracy in the coding and pricing of services rendered. Most research that has explored the problems of coding accuracy and its impact on reimbursement has focused on coding by medical record professionals, but many coding procedures are performed by "front line" lower-level employees working in a hospital's laboratory, radiology department, pharmacy, or other ancillary service departments. This article explains how rural hospitals can optimize their reimbursement and adhere to Medicare/Medicaid and other third-party payer regulations by training coders properly and by reviewing their pricing policies to make sure that prices charged accurately reflect the true cost of services. PMID- 10145970 TI - Periodic reviews improve pension fund management. AB - An independent review and audit of pension fund management can help a plan sponsor improve the fund's financial performance. Reviewing a pension fund's management periodically is important to determine if, among other things, the fund's investment policy is reasonable; the fees charged by investment managers, pension consultants, and trustees are acceptable; and certain revenue-generating ideas (i.e., securities lending and soft dollar usage) are being properly implemented/employed. PMID- 10145971 TI - Postretirement healthcare benefit rules require careful study. AB - Several alternatives exist for employers to use to fund postretirement healthcare benefits within the context of the Employee Retirement Income Security Act (ERISA) and the Financial Accounting Standards Board's Statement of Financial Accounting Standards No. 106: Employers' Accounting for Postretirement Benefits Other Than Pensions. The liability potential of employer-promised postretirement healthcare benefits, however, requires careful study. PMID- 10145972 TI - Minimizing projected liability under FAS No. 106. AB - Although the Statement of Financial Accounting Standards No. 106: Employers' Accounting for Postretirement Benefits Other Than Pensions requires that the anticipated cost of providing medical services to an employee following his or her retirement be accrued while the individual is employed, hospitals that provide their retirees with medical services are in a position to minimize their projected liability. The values of actual expenditures to be incurred for providing medical services should be valued in a manner consistent with the recording of other expenditures. PMID- 10145973 TI - Protecting your organization as the banking environment changes. PMID- 10145974 TI - When providers become payers under managed care. PMID- 10145975 TI - Negotiating job offers. PMID- 10145976 TI - Payment systems: moving from the present to the future. PMID- 10145977 TI - Integrated healthcare systems. The goodwill dilemma. PMID- 10145978 TI - JCAHO's O'Leary: 'We are an interpreter of public expectations'. Interview by Richard L. Clarke. PMID- 10145979 TI - Third-party capital equipment management cuts costs. AB - In an effort to reduce maintenance, repair, and reorder costs associated with the wide range of capital equipment necessary for the operation of most healthcare facilities, some healthcare organizations are turning to third-party capital equipment management companies. These companies can help reduce costs by providing the high-level technical expertise many facilities lack, reducing response time when equipment servicing is necessary, and developing effective preventive maintenance programs. PMID- 10145980 TI - Cost accounting supports clinical evaluations. AB - This article describes how a hospital cost accounting system was used to evaluate the financial impact of the use of a new and expensive drug at a 700-bed academic medical center. PMID- 10145981 TI - Involving physicians in cost reduction strategies. AB - One of the major complaints often voiced by healthcare organization administrators is that physicians do not seem to cooperate when it comes to reducing costs. This article presents several techniques designed to involve medical staff more actively in the financial management of a healthcare facility. PMID- 10145982 TI - Determining optimal risk retention in the healthcare industry. AB - Several methodologies may be used for determining the level of risk that a healthcare organization should retain as part of its overall insurance and risk management program. Approaches used in the past, however, may not be appropriate to use in the 1990s. This article proposes a more comprehensive methodology of risk determination. PMID- 10145983 TI - Courts reverse HCFA on bad-debt issue. PMID- 10145984 TI - Cutting costs in patient accounting departments. PMID- 10145985 TI - Getting the most out of banking relationships. PMID- 10145986 TI - Tax deductions for nursing home expenses. PMID- 10145987 TI - Californians thwart problematic legislation ... again. PMID- 10145988 TI - A comparison of the CPAP performance characteristics of the Puritan-Bennett 7200a and a prototype continuous pressure-regulating ventilator. AB - BACKGROUND: A prototype demand-flow medical ventilator for intensive care unit (ICU) applications has been developed with the ability to maintain continuous pressure regulation of proximal airway pressure during both inspiratory and expiratory respiratory phases. The performance of this system was investigated in laboratory tests of continuous positive airway pressure (CPAP) mode, a ventilatory mode in which airway pressure regulation is strongly challenged. MATERIALS & METHODS: Comparative tests of the pressure-regulating ventilator (PRV) prototype and a Puritan-Bennett 7200a (PB7200a) ventilator were made in three performance categories: pressure-volume product error, peak pressure error during inspiration, and peak pressure error during expiration. Testing was performed on a Bio-Tek VT-2 test lung modified to simulate spontaneous breathing, at CPAP levels of 0, 10, and 20 cm H2O. Results were obtained at a lung compliance of 50 mL/cm H2O and at three parabolic airway resistance levels (Rp10, Rp20, and Rp50 cm H2O.L-2.s2 per ANSI Z79.7-1976). RESULTS: The PRV prototype achieved reductions in pressure-volume product error of more than 0.111 joules (43%) for all test conditions, relative to the PB7200a. Peak pressure errors were reduced by at least 4.0 cm H2O (55%) during inspiration and 4.9 cm H2O (38%) during expiration. CONCLUSIONS: An ICU ventilator utilizing continuous regulation of proximal airway pressure has been shown to provide statistically significant improvements in CPAP performance relative to the PB7200a in laboratory tests. Further testing will be required to quantify the clinical significance of these results. PMID- 10145989 TI - Evaluation of an educational program for asthmatic children ages 4-8 and their parents. AB - BACKGROUND: Evaluation of a number of asthma education programs for children 8-13 has shown improved self-management behaviors and decreased use of healthcare services. However, nearly 80% of children with asthma develop symptoms by age 5. MATERIALS & METHODS: We evaluated a program (Huff and Puff: The Children's Asthma Program) that addresses the developmental learning needs of children ages 4-8. This multicenter study employed a pre- and post-test design to evaluate the impact of the Program on cognitive, behavioral, and affective learning and medical care utilization. We report here data on 128 of the 130 children who completed the program and on the 125 households on which we have nonduplicated data. RESULTS: Statistically significant changes were observed in all categories of learning in those who completed the Program. Medical care utilization (including hospitalizations, days of hospitalization, emergency room visits and sick visits to the physician for "out-of-control" asthma) demonstrated statistically significant decreases. CONCLUSION: The Program was shown to be an effective educational intervention for children 4-8 years of age and their parents in this cohort (nonrandomized, noncontrolled study of volunteers). Future research should also explore ways to utilize and adapt the program for specific populations such as inner-city children and parents and non-English speaking groups. PMID- 10145990 TI - Managing the patient-ventilator system: system checks and circuit changes. AB - Checking and maintaining mechanical ventilators traditionally have been the responsibility of the respiratory care practitioner and among the many reasons that the need for the profession of respiratory care persists. The increasing complexity of the mechanical ventilator itself and the appropriate application and monitoring of the various modes available in a single device are such reasons. In addition, we must continually strive to be knowledgeable and skilled in the assessment and appropriate treatment of patients with respiratory diseases. The practice of respiratory care focuses on patient care, education and research. The perception of an institution's need for trained respiratory care specialists is affected by both the quality and quantity of service that each individual RCP offers to the care of patients. Our skills and performance should be patient-centered not device-centered so that our assessment and monitoring of patients includes more than just "writing down the numbers." Finally, respiratory care research must continue to subject the old dogma to rigorous scrutiny while searching for new and innovative ways to care for our patients. PMID- 10145991 TI - Travel for the technology-dependent individual. AB - In summary, recreational travel for the technology-dependent individual is common and includes travel via ground, water, and air, with oxygen and with mechanical ventilators. However, successful travel requires substantial advance preparation that involves fact-finding and communication with physicians, carriers, and vendors of equipment and oxygen. An increasing number of resource documents, both in the trade and in the scholarly literature are available for relevant information and assistance. PMID- 10145992 TI - Investor response to health care cost containment legislation: is American health policy designed to fail? AB - Two failed congressional attempts to control escalating health costs are examined. The data show that investors apparently anticipated their failure. With the implementation of a policy encouraging market competition, however, investors expected larger firms to benefit and firms with previously high profit growth rates to lose. From the viewpoint of the politics of structural choice, it appears that identifiable structural flaws were deliberately designed into both laws in ways that would promote failure and protect key interest groups. PMID- 10145993 TI - Who should perform endotracheal intubation? A summary of issues. PMID- 10145994 TI - Respiratory care practitioners as secondary providers of endotracheal intubation: one hospital's experience. AB - The management staff of the Respiratory Care Department at the suggestion of the Department of Anesthesiology determined that there was a need for respiratory care practitioners (RCPs) to be trained to perform endotracheal intubation. This need was demonstrated by the frequency with which anesthesia personnel were called away from the operating room (OR) to perform endotracheal intubations in other hospital areas. METHODS: The training program included didactic instruction followed by written examination, simulations, and intubation experience in the OR under the direct supervision of a staff anesthesiologist. RESULTS: Initially 15 therapists, from all shifts were trained. Currently, there are 20 fully-trained RCPs on staff. These therapists have successfully intubated 160 patients in 178 attempts over a 49 month period. All attempts followed failed attempts by other professionals. No major complications were observed in the patients intubated by RCPs. DISCUSSION: This training program has successfully provided support for endotracheal intubation procedures, sparing the anesthesiology staff and expanding the role of RCPs in our hospital. PMID- 10145995 TI - Statistical process control and direct care staff performance. AB - A state-operated residential facility has for the past five years been using performance feedback as the primary method for improving direct care staff interactions with clients. The major problem with this approach is determining when staff performance is significantly above or below average. Statistical process control charts are being used to determine whether variations in staff performance are the result of common or special causes. Analysis of staff performance for one year suggests that variation in staff performance may be due to special causes, such as the characteristics of the clients served and the type of service that is provided to these clients. Services were adapted to the characteristics of these clients, which improved staff performance and reduced variation. PMID- 10145996 TI - Washington hospitals struggle amid serious urban problems. PMID- 10145997 TI - Recognizing the symptoms of employee fraud. AB - Unlike crimes that leave easily detectable physical evidence, employee fraud may be difficult to detect because often only symptoms of such crimes are readily apparent, and the symptoms may or may not signal actual fraud. This article discusses six categories of symptoms that indicate fraud may have been committed by an employee, and presents a case study example to illustrate symptoms auditors and financial managers should investigate. PMID- 10145998 TI - Are emergency room physicians always employees? AB - The Internal Revenue Service (IRS) has recently increased its scrutiny of the worker classifications used by hospitals in arrangements with physicians for the provision of services (see "Reclassifying physicians as employees for Federal tax purposes," HEALTHCARE FINANCIAL MANAGEMENT, February 1994, pp. 38-44). In particular, emergency room physicians have been singled out by the IRS as a category of physicians who are often treated as independent contractors by hospitals but should, in the view of the IRS, be characterized as employees. PMID- 10145999 TI - New developments in 'any willing provider' laws. AB - As the debate over healthcare reform continues, the controversy concerning "any willing provider" laws also continues. "Any willing provider" laws require a healthcare insurer (or managed care organization) to establish criteria that a provider must meet in order to participate as a network provider. Such laws prohibit an insurer from denying any provider willing to meet those criteria from participating as a network provider. Proponents of any willing provider laws cite the recent decision by the U.S. Supreme Court not to review a lower court ruling finding in favor of a hospital as validation of such laws. PMID- 10146000 TI - Calculating the economic impact of healthcare facilities on communities. AB - A methodology has been developed to calculate the direct, indirect, and induced spending effects of a healthcare facility on the community it serves. This methodology may be used by financial managers to produce data that demonstrate the effect of facilities on local economies. The data may be used by administrators to increase awareness of the pivotal economic role healthcare facilities play in communities among business and government leaders, economic development organizations, medical staff members, facility employees, trustees, and patients. PMID- 10146001 TI - Sales: evaluating the return on investment. AB - In this article, a case study is presented to illustrate the ways in which sales programs have evolved in healthcare organizations over the last few years. The importance of developing a system of tracking sales so revenues can be tied to sales efforts is emphasized. PMID- 10146002 TI - Benefits of distinct part psychiatric or rehabilitation units. AB - Distinct part psychiatric or rehabilitation units may help produce a positive financial margin for a hospital by transforming unused capacity into a revenue generating enterprise and securing cost-based reimbursement from Medicare. PMID- 10146003 TI - Healthcare Financial Management Association. Principles and Practices Board. Statement No. 17. Assessments and arrangements similar to taxes on tax-exempt institutional healthcare providers. PMID- 10146004 TI - It's time to change buying and investment strategies. PMID- 10146005 TI - More payers should convert to EDI (electronic data interchange). PMID- 10146006 TI - Recruiters can help financial managers find jobs, employees. PMID- 10146007 TI - Is there a place for good death? PMID- 10146008 TI - Transition from the intensive care unit to home: patient selection and discharge planning. PMID- 10146009 TI - Noninvasive positive pressure ventilation at home. PMID- 10146010 TI - Indications and criteria for decannulation and transition from invasive to noninvasive long-term ventilatory support. PMID- 10146011 TI - Use of negative pressure ventilation, rocking beds, and pneumobelts. PMID- 10146012 TI - Home mechanical ventilatory assistance for infants. PMID- 10146013 TI - Collaborative self-management strategies for patients with respiratory disease. AB - The effectiveness of collaborative self-management of respiratory disorders has been most clearly demonstrated in asthma. In both adults and children with severe asthma requiring emergency care and hospitalizations, collaborative self management can decrease not only the need for emergency care and hospitalization but also time lost from work and school, thereby increasing the patients' ability to be full and active participants in the community. Collaborative self management is best provided in a comprehensive program that includes ready access to healthcare professionals, education, behavioral therapy, and peak-flow monitoring. The relative value of each of these components and the value of single components applied simultaneously is unclear. In some studies, asthma symptoms and medication adherence have also improved following implementation of collaborative self-management. The available data indicate that collaborative self-management should be considered as a potential therapeutic adjunct in the management of every patient with asthma and should be routinely employed with patients who have severe disease as defined by emergency room use and hospitalizations. Additional investigations should be conducted in patients with other respiratory diseases to define the role of collaborative self-management. Nonetheless, state-of-the-art medical care and the nature of the patient physician relationship in the 1990s dictates that collaborative self-management be routinely employed in the optimal outpatient management of any individual who is interested in participating in his or her own healthcare. However, individualization of the practitioner-patient relationship is necessary. Not all patients desire to play an active role in their illness and its management. The personality, attitudes, and desires of individuals in assisting in their own management must be assessed. Theory would suggest that patients who do not appear to have an interest in self-management may have low self-efficacy that may be increased by educational efforts. Improved self-efficacy and active participation in disease management may result in beneficial outcomes. It is clear that the physician-patient relationship has changed over the past decade. As patients have been empowered to act in their own best interests, the physician's role as an educator and facilitator has become more prominent than ever. Even if medical investigations had not demonstrated any beneficial effects of collaborative self management, patients have the right to participate in decisions affecting their healthcare and are increasingly exercising that right. Respiratory care practitioners are in a unique position to enhance collaborative self-management. In the home environment, RCPs can foster smoking cessation and serve as a liaison between patients and physicians.(ABSTRACT TRUNCATED AT 400 WORDS) PMID- 10146014 TI - Parent-professional agreement on diagnosis and recommendations for children with developmental disorders. AB - Twenty-eight children with developmental disorders underwent an interdisciplinary assessment for diagnosis and recommendations about management. Following this assessment, the degree of agreement on diagnosis and recommendations between parents and the team was determined. There was substantial agreement for diagnosis of clearly identifiable conditions such as genetic disorders, autism, and mental retardation but less agreement for milder disorders such as learning disabilities, attention deficit disorder, and emotional disorders. Agreement on management varied, being higher for speech therapy and psychosocial interventions but lower for use of stimulant medication and diet. The parents identified additional diagnostic labels in their child and mentioned more recommendations than the clinicians prescribed. The results suggest the need for careful attention to parent perceptions following interdisciplinary assessment. PMID- 10146015 TI - No pain, no gain? The Agency for Health Care Policy & Research's attempt to change inefficient health care practice of withholding medication from patients in pain. PMID- 10146016 TI - Evaluation of a prototype expiratory-phase aerosol controller during simulated pediatric volume-controlled ventilation. AB - BACKGROUND: Some methods of administering aerosolized medications during volume controlled ventilation require adjustment of ventilator settings to avoid inadvertent increases in tidal volume (VT). Our bench evaluation of an expiratory phase aerosol controller (EXPAC) sought to determine the differences (1) in aerosol delivery between continuous and EXPAC nebulization in pediatric and neonatal ventilator circuits and (2) in delivered VT with a 30-cm vs a 213-cm nebulizer supply line. DESCRIPTION OF DEVICE: An electrically powered EXPAC linked to the VIP Bird ventilator by a fiberoptic cable and driven by flow from an integral blender was developed to our performance specifications. EVALUATION METHODS: In Phase 1, VT was measured at the patient connection under 3 conditions: (1) no nebulizer in-line, (2) a dry in-line nebulizer driven by EXPAC with a 30-cm supply line, and (3) Condition 2 with a 213-cm supply line. In Phase 2, we measured the aerosol delivered to a filter placed between the patient connector and the test lung. Aerosol delivery = filter wet weight-filter dry weight. RESULTS: (1) When EXPAC was operated according to manufacturer's recommendations, no significant differences were found between VTS measured with EXPAC plus the 30-cm line and with no nebulizer in-line. VT increased significantly (p = 0.0001, 1-way ANOVA) in both circuits with the 213-cm supply line. (2) Mean (SD) aerosol delivery at the patient connection of the pediatric circuit was 1.5 (0.002)% with EXPAC and 1.7 (0.003)% with continuous nebulization (p = 0.23, t test) and of the neonatal circuit 1.6 (0.002)% with EXPAC and 1.5 (0.002)% with continuous nebulization (p = 0.45, t test). CONCLUSIONS: EXPAC eliminated need for adjustment of ventilator settings and according to our data was as effective as continuous nebulization for delivering aerosol to the patient connection. PMID- 10146017 TI - Can a PHO threaten hospital's tax-exempt status? PMID- 10146018 TI - Does your patient accounting process pass the systems test? AB - There have been many changes to the patient accounting management process in recent years, the introduction of electronic data interchange (EDI) among them. The future, however, holds considerably more opportunities--and some potential threats. This article examines the issues and provides a series of practical suggestions for meeting the future challenges of the patient accounting process. PMID- 10146019 TI - Effective reassignment of accounts can decrease bad debt. AB - Sometimes patient account balances remain unpaid, even following placement with a third party for collection (primary placement). Reassignment of the account for collection to another third party (secondary placement) offers the patient accounts manager another opportunity to gain the balance due, but there are several factors to consider when making the decision for secondary placement. PMID- 10146020 TI - Using control charts to help manage accounts receivable. AB - The relative performance of a healthcare organization's accounts receivable (AR) department is a critical factor affecting an organization's financial well-being. Park Nicollet Medical Center (PNMC), Minneapolis, Minnesota, changed the way it measured its AR department's performance, switching from the rolling averages method of performance measurement to the percentage collected method of performance measurement, and was able to improve its patient accounts management effort. PMID- 10146021 TI - Financial advantages of operating a skilled nursing unit. AB - Hospitals may accrue specific financial advantages from the operations of a skilled nursing unit (SNU), such as the ability to allocate some fixed costs to a hospital-based unit that receives cost-based reimbursement from Medicare. The level of reimbursement SNUs receive from Medicare, however, can be optimized by obtaining an exemption or an exception to routine cost limits. PMID- 10146022 TI - What makes tax-exempt hospitals special? AB - As local, state, and federal policy makers seek additional sources of revenue to help finance health care and other services, the distinction between for-profit and not-for-profit healthcare organizations is receiving increased scrutiny. Healthcare financial managers and consultants should prepare to defend their organizations against those seeking to demonstrate that, at the very least, there is no substantive difference between not-for-profit and for-profit providers. PMID- 10146023 TI - Effective methods for cash flow analysis. AB - This article discusses techniques that healthcare financial managers can use to interpret and evaluate information from the statement of cash flows for more effective financial decision-making. The use of these techniques as a basis for systematically planning and controlling cash flows has the potential to benefit all healthcare organizations. PMID- 10146024 TI - Using EDI for utilization management. PMID- 10146025 TI - Pension funding and management affects healthcare organizations. PMID- 10146026 TI - Data trends--July 1994. MECON Associates. PMID- 10146027 TI - Baquero strives to increase awareness of Hispanic healthcare issues. PMID- 10146028 TI - Data trends--June 1994. MECON Associates. PMID- 10146029 TI - Do 38 million Americans truly lack healthcare coverage? PMID- 10146030 TI - Integrating primary care practices into provider networks. PMID- 10146031 TI - It's a jungle out there: strategies for controlling information systems costs. AB - This article discusses four major areas where healthcare financial managers can reconcile the conflicting goals their healthcare organizations face: keeping up with the latest in technology while at the same time constantly striving to reduce healthcare information systems costs. PMID- 10146032 TI - Will sophisticated MIS lead to increased legislation of medicine? AB - If the healthcare industry automates clinical practices and links them along critical care pathways, will it be providing Federal regulators with data they may use to legislate how hospital care should be delivered? This article examines the implications of expanded use of increasingly sophisticated information systems in health care. PMID- 10146033 TI - Functional requirements of a computer-based patient record system. AB - The installation of a computer-based patient record system represents a substantial capital investment, but the system can help provide higher quality health care at significantly lower cost. This article examines the functional requirements of such a system, as well as the steps required for implementation. PMID- 10146034 TI - Experts debate the future of healthcare computing--discussion. AB - Healthcare Financial Management engaged four healthcare information systems experts in a discussion about the future of computing and technology in the healthcare industry. The four experts agree that as the healthcare industry consolidates, managed care advances, and healthcare reform legislation continues to be debated, demands for increased connectivity and new applications will be met by new healthcare information systems products based on new technology. PMID- 10146035 TI - Strategies for enhancing computer system availability. AB - Lack of access to a healthcare facility's computer system can contribute to several problems: low employee productivity, reduced revenues, increased expenses, cash flow difficulties, and poor quality patient care. Three potential strategies that can improve system access are disk shadowing, clustered processors, and protection from environmental factors. PMID- 10146036 TI - Career path to CFO: selection, training, and placement. AB - Not long ago, chief financial officers (CFOs) in hospitals could focus almost exclusively on financial accounting. Today, however, financial managers must tend diverse tasks of coordination, education, and professional specialization. The authors suggest that those who desire the position of CFO would do well to couple accounting expertise with a capacity to understand ethics and mores, economics, descriptive and predictive statistics, people from diverse socioeconomic and cultural backgrounds, as well as features of disease, its prevention, and course of treatment. PMID- 10146037 TI - EDI can help speed up workers' compensation claims. PMID- 10146038 TI - When is it time to review treasury management options? PMID- 10146039 TI - The growth of managed care. PMID- 10146040 TI - Assessing organizational readiness for capitation and risk sharing. PMID- 10146041 TI - Direct contracting: the future of managed care. AB - Direct contracting is an agreement whereby healthcare providers directly contract with employers or health plan purchasing cooperatives to provide healthcare services to their employees or enrollees. While this type of arrangement requires a high degree of integration and cooperation between the delivery and financing of care, the flexibility it offers makes it a necessity in the new world of integrated healthcare financing and delivery systems. This article demonstrates the importance of strong vertical and horizontal links with both other providers and various components of the financing system. It also shows how those organizations with the capacity to finance and assume risk for employers will be most successful and play a major role in the healthcare system of the future. PMID- 10146042 TI - Is your organization ready to share financial risk with HMOs? AB - Of growing importance in healthcare delivery is the issue of how the risk of providing services to healthcare maintenance organizations (HMOs) enrollees should be shared by the provider and the HMO. Understanding and monitoring risk sharing arrangements and how they are developing is critical. This article reviews the trends in managed care and risk sharing and examines regulation of capitation and risk sharing as it varies form state to state. PMID- 10146043 TI - Hospitals become cost centers in managed care scenario. AB - In a risk-bearing managed care enterprise, acute-care facilities will change from being profit centers to being cost centers, and this transformation will require a focus on controlling costs rather than increasing admissions. This article details the elements of change that healthcare financial managers should consider, from the increased difficulty of matching revenue to expense, to the expanded role of clinical engineers. PMID- 10146044 TI - Determining a healthcare organization's value. AB - As the consolidation activity among healthcare providers increases, it becomes more important than ever for healthcare financial managers to understand how to determine a healthcare organization's fair market value. There are many methods of determining an organization's value, but three general methods are the foundation of all others: the market comparable method, the underlying assets method, and the income, or cash flow, method. PMID- 10146045 TI - Responsibility for retirement planning shifts to employees. AB - In recent years, organizations have shifted away from offering their employees defined benefit plans that promise specified income streams to employees when they retire. Instead, they are offering employees defined contribution plans, which rely on investment performance, as directed by plan participants, to generate sufficient retirement income. Healthcare financial managers who work in organizations that offer retirement plans for their employees find themselves increasingly prevailed upon to play the role of instructor to plan participants. While some financial managers may not relish the role, the more successful financial managers are at helping plan participants achieve their retirement income goals, the better the chance of healthcare organizations avoiding future liability problems. PMID- 10146046 TI - Healthcare Financial Management Association. Principles and Practices Board. Statement No. 18: Public disclosure of financial and operating information by healthcare providers. PMID- 10146047 TI - Hospitals prevail on Medicare 'disproportionate share' computation. PMID- 10146048 TI - Paying for doughnuts. PMID- 10146049 TI - Using the RFI/RFP process to negotiate banking prices and services. PMID- 10146051 TI - Benefits communication embraces multimedia in a push to involve employees. PMID- 10146050 TI - Data trends--August 1994. MECON Associates. PMID- 10146052 TI - Benefits associated with a respiratory care assessment-treatment program: results of a pilot study. AB - BACKGROUND: During the months of July, August, and September 1993, we implemented a respiratory care assessment-treatment pilot study on the orthopedic surgery floor in our hospital. The purpose of the study was to determine feasibility and establish cost-effective treatment plans with quality patient outcomes, while maintaining appropriate communications with physicians and nursing staff. STUDY DEVELOPMENT & IMPLEMENTATION: The study's Task Force developed protocols for oxygen therapy, aerosolized medication therapy, volume expansion therapy, and bronchial hygiene therapy using the American Association for Respiratory Care's Clinical Practice Guidelines as supporting documents. Meetings were held with the orthopedic surgeons and nursing staff to inform them of the key components of the pilot program. Ten patient evaluators were trained to assess patients and implement treatment plans. EVALUATION METHODS: A reference book was established that contained the protocols and support material. Patient outcomes were evaluated using previously established quality assurance plans. The length of stay, procedural volume, and cost data were collected. EVALUATION RESULTS: More than 50% of the orders received during the pilot program were for "Respiratory Care Protocol." This allowed the patient care evaluator the flexibility to initiate one of the approved protocols if indicated. No changes in patient outcomes were noted and average length of stay remained unchanged during the pilot study compared to the base period. Treatment volumes decreased, resulting in identified cost savings of $5,318 during the study. Nurses and physicians supported protocol implementation, and increased communication among caregivers was documented. We believe that professionalism of the RCPs was enhanced without compromising the ultimate decision-making responsibilities of the physician. CONCLUSIONS: The use of respiratory care protocols is an acceptable method of developing clinically effective and fiscally responsible care plans. RCPs at our hospital were able to implement care plans that resulted in cost savings without a measured change in patient outcomes. Approval has been extended from the Executive Committee of the medical staff to expand hospital-wide. PMID- 10146053 TI - Simulated pediatric cardiopulmonary resuscitation: initial events and response times of a hospital arrest team. AB - BACKGROUND: Cardiopulmonary resuscitation (CPR) training programs exist to enhance knowledge and skills retention. However, they do not ensure that effective CPR will be performed by trainees or resuscitation teams. One aspect of CPR effectiveness is the ability of the team to respond to an emergency call in a timely manner. METHODS: We prospectively evaluated the time required for team members to respond to an emergency call and to initiate definitive treatment in our pediatric facility. The medical staff who responded had no prior knowledge of the simulated cardiac arrest (SCA) events. All events were recorded on audio cassette tape to determine the sequence of events and response time of arrest team members. SCA scenarios represented examples of cardiac, hematologic, renal, respiratory, and pharmacologic pathophysiology. All participants were instructed to respond as though the SCA were an actual emergency. RESULTS: From December 1991 to January 1993, 37 SCAs were evaluated. Documentation began after a concise arrest scenario had been presented to a designated nursing representative who was to be the first rescuer on the scene. The rescuer first assessed the patient's condition, activated the cardiac arrest system (median elapsed time, MET, 0.50 minutes), and then initiated single-person CPR (MET 0.58 minutes). Administration of oxygen occurred at an MET of 2.25 minutes. The first member of the arrest team to respond was the pediatric resident (MET 3.17 minutes) followed by the respiratory therapist (MET 3.20 minutes), an ICU nurse (MET 3.58 minutes), a pharmacist (MET 3.42 minutes), and anesthesiology personnel (MET 4.70 minutes). DISCUSSION: The use of SCAs (termed "Mega Code") serves as an extension of Basic Life Support and Advanced Cardiac Life Support education and provides a valuable learning experience and quality assurance tool. Limitations that might influence patient outcome during an actual in-hospital arrest have led to refinements in our cardiac arrest procedures. Of particular note was the delay in oxygen administration, which may be linked to its omission from the 1986 and 1992 American Heart Association Basic Life Support Guidelines. CONCLUSION: We believe that BLS education for hospital employees should include and emphasize oxygen delivery for resuscitation. PMID- 10146054 TI - One respiratory care department's contribution to the 'bottom line'. AB - BACKGROUND: Although many hospital departments that were revenue producers have become cost centers and revenues above expenditures have shrunk, some departments continue to contribute. METHODS: I analyzed the financial statements of our 240 bed, not-for-profit hospital to determine the Respiratory Care Department's actual contribution to the hospital's 'bottom line' (ie, revenue above expenditures). The Respiratory Care Department's financial statement, the Hospital's profit and loss statement, and the financial statements for all 54 hospital departments were reviewed. RESULTS: Analysis revealed that the Respiratory Care Department's revenue dollar contributed $0.095 to the hospital bottom line for each revenue dollar generated. Analysis also demonstrated that the break-even contribution margin for revenue departments was 76.77%. Departments with contribution margins greater than 76.77% were revenue contributors and those departments with less than 76.77% were cost centers. CONCLUSIONS: The Respiratory Care Department was the hospital's largest revenue contributor, generating 42.8% of the hospital's revenue above expenditures. In today's health-care environment, it is sound fiscal reasoning to control cost and to strengthen those departments and services that are responsible for the financial viability of the institution. The results of this study show that our Respiratory Care Department has assumed the leadership role in the economic viability of our hospital and is its most cost-efficient contributor to health care. PMID- 10146055 TI - State health alliances implement EDI. PMID- 10146056 TI - The genesis of treasury management products. PMID- 10146057 TI - Writing a winning resume. PMID- 10146058 TI - Data trends. September 1994. PMID- 10146059 TI - Executive role vital during succession and transition planning. PMID- 10146060 TI - New compensation strategies support quality initiatives. AB - Three significant trends will dramatically affect human resources management within the healthcare industry in the next decade: changing workforce demographics, declining reimbursement revenues, and increasing demands for high quality services. These trends will require healthcare organizations to develop compensation programs that tie the effectiveness of their human resources to productivity measurements, total quality management initiatives, and individual employee empowerment. PMID- 10146061 TI - Measuring the impact of quality improvement efforts. AB - Healthcare organizations are looking to quality programs as a key to survival, but many financial managers are unaware of the measurement methods they can use to quantify the results of quality management efforts. These methods can tell what impact quality initiatives have had on corporate culture, systems operations, and the bottom line. PMID- 10146062 TI - Patient-focused care units improve service and financial outcomes. AB - Patient-focused care units have reduced labor costs for a 211-bed for-profit acute care hospital and improved patient and physician satisfaction by reducing the number of hospital staff members who interact with patients. They also have enhanced efficient resource use by relocating to the patient care site 75 percent of the labor, supply, and technology resources needed by patients. PMID- 10146063 TI - Rightsizing: living with the new reality. AB - After a rightsizing, employees often succumb to survivor sickness, which is characterized by anger, resentment, fatigue, and skepticism. Careful implementation of the rightsizing process as well as direct intervention with survivors can reduce the severity of this sickness. PMID- 10146064 TI - Benchmarking in healthcare organizations: an introduction. AB - Business survival is increasingly difficult in the contemporary world. In order to survive, organizations need a commitment to excellence and a means of measuring that commitment and its results. Benchmarking provides one method for doing this. As the author describes, benchmarking is a performance improvement method that has been used for centuries. Recently, it has begun to be used in the healthcare industry where it has the potential to improve significantly the efficiency, cost-effectiveness, and quality of healthcare services. PMID- 10146065 TI - Benchmarking can add up for healthcare accounting. AB - In 1993, a healthcare accounting and finance benchmarking survey of hospital and nonhospital organizations gathered statistics about key common performance areas. A low response did not allow for statistically significant findings, but the survey identified performance measures that can be used in healthcare financial management settings. This article explains the benchmarking process and examines some of the 1993 study's findings. PMID- 10146066 TI - Enhancing customer service in the admitting process. AB - As a result of participating with 28 other healthcare organizations in a study on benchmarking the hospital admitting process, St. Marys Hospital Medical Center, Madison, Wisconsin, was able to speed-up its admitting process and improve its telephone system to serve patients better. St. Marys switched from an admitting system to a preadmitting system, coordinated its admitting system information, and improved its ability to identify triage patients. PMID- 10146067 TI - Improving cash flow through benchmarking. AB - Healthcare organizations can use two benchmarking techniques to improve their accounts receivable departments' performance: 1) studying the accounts receivable statistics of model healthcare organizations, and 2) visiting these model organizations in order to get a first-hand look at how they do business. Employing these two benchmarking techniques can help healthcare organizations reduce gross days revenue outstanding, bad debt, the length of time between the date a patient is discharged and the date a bill is mailed, the total percentage of receivables more than 90 days old, and general business office expenses related to collection. PMID- 10146068 TI - Collaborative benchmarking in a healthcare system. AB - Leading organizations outside of the healthcare industry have benefitted from benchmarking for more than a decade. In the last few years, healthcare organizations also have begun to use benchmarking to achieve breakthrough improvements in their performances. Most of these organizations have conducted their benchmarking studies independently, working one-on-one with outside benchmarking partners. More recently, some organizations have chosen to benchmark processes in conjunction with other healthcare organizations. This article discusses the application of a collaborative benchmarking project conducted by selected facilities within the Catholic Health Corporation (CHC). It reviews the rationale for implementing collaborative benchmarking efforts and the benefits such efforts bring to the organizations involved. Presentation of a work in process--a case study on workers' compensation--provides insights into collaborative benchmarking. The article focuses on the initial phases of the benchmarking process--selecting the project and establishing the benchmarking collaborative. PMID- 10146069 TI - Experts discuss how benchmarking improves the healthcare industry. Roundtable discussion. AB - Healthcare Financial Management engaged four benchmarking experts in a discussion about benchmarking and its role in the healthcare industry. The experts agree that benchmarking by itself does not create change unless it is part of a larger continuous quality improvement program; that benchmarking works best when senior management supports it enthusiastically and when the "appropriate" people are involved; and that benchmarking, when implemented correctly, is one of the best tools available to help healthcare organizations improve their internal processes. PMID- 10146070 TI - How families of children with severe disabilities choose to allocate a cash subsidy. AB - This study examines how families raising children with severe developmental disabilities use a cash subsidy. Eighty-one families were interviewed prior to receiving the $225 monthly subsidy and again 1 year later. Families reported no change in the number of services they used, nor did they significantly increase the amount spent on services. Although families did not spend significantly more on purchases in the month prior to each interview, there was a significant increase in the amount spent on major purchases made in the year after receipt of the subsidy. The pattern and amount of expenditures are described. Lower income families reported the subsidy as significantly more helpful than higher income families. The implications of the findings for social policy are discussed and recommendations are made. PMID- 10146071 TI - Navigating change. PMID- 10146073 TI - Administrative simplification eases the billing and payment process. PMID- 10146072 TI - 1994-1995 HFMA Buyer's Guide. PMID- 10146074 TI - Beyond cost management. PMID- 10146075 TI - Integrated healthcare systems. State laws can frustrate IHS development. PMID- 10146076 TI - Risk versus uncertainty in managed care contracting. PMID- 10146077 TI - Wise management of investments: the CFO's role. AB - Asset pools of investable funds are major sources of revenue for healthcare organizations. A prudent investment program can assure that these funds will be controlled adequately and managed efficiently. This type of program clearly defines the goals of investment, the characteristics of appropriate investment instruments, the means of monitoring and reporting fund activities, and the responsibilities and qualifications of the institutional investor. PMID- 10146078 TI - FASB (Financial Accounting Standards Board) issues new accounting rules for debt and equity securities. AB - The Financial Accounting Standards Board (FASB) recently issued a new statement that requires all companies to change their methods of accounting for debt and equity securities. Rather than allowing organizations to use a historical cost approach in accounting for such financial instruments, FASB Statement No. 115 requires organizations to adopt a market value approach. The provisions of this statement will affect significantly organizations in the healthcare industry that have large investment portfolios. PMID- 10146079 TI - An indexing and price movement model for managing pension funds. AB - A model for the investment of pension funds has been created that combines passive and active portfolio management strategies. The model uses a passive index fund to reduce the amount spent in transaction costs. It applies a percentage band that identifies the portion of the portfolio that should be committed to equity investments at various stages of the market movement cycle. Finally, it uses price movement trigger points to dictate when pension funds should be moved into and withdrawn from stock market investments. PMID- 10146080 TI - Coping with reduced cost limits for home health agencies. AB - The Omnibus Budget Reconciliation Act of 1993, together with cost-limit reductions and wage-index changes published in the Federal Register, have resulted in a substantial reduction in Medicare cost limits, particularly as they apply to hospital-based home health agencies. This article examines specific changes in home health agency cost limits, reviews strategies to identify the bottom-line impact of the Medicare cost-limit reductions, and discusses methods that may be applied to minimize the negative impact of the reduced cost limits. PMID- 10146081 TI - Defending against challenges to reasonable and customary charges. AB - A consulting auditing firm that reviews hospital charges incurred by members of a union covering several Midwestern states argued in court that a patient should not be required to pay the full amount of charges for services provided by a hospital in a multihospital system. The basis of the firm's argument was that the charges set by the hospital system were unreasonable because charges made by all hospitals are unreasonable. Mistakes made by the hospital during the court action caused it to lose the suit. However, the system won a second, similar suit through better preparation and documentation. This article examines both court cases and suggests methods other hospitals can use to prevail in such cases. PMID- 10146082 TI - New healthcare price indexes aid financial analysis. AB - Two new price indexes are available for measuring healthcare inflation. One price index focuses on hospital care; the other focuses on physician services. Healthcare financial managers may find the new price indexes helpful when preparing and evaluating budgets, premiums, and capitation rates. Healthcare reform analysts may use the new price indexes to calculate premium caps, payment rates, and global expenditure limits. PMID- 10146083 TI - Collection agencies use EDI with trading partners. PMID- 10146085 TI - Data trends. October 1994. PMID- 10146084 TI - 'Sweeping' an organization's bank balances. PMID- 10146086 TI - AARC (American Association for Respiratory Care) clinical practice guideline. Ventilator circuit changes. PMID- 10146087 TI - AARC (American Association for Respiratory Care) clinical practice guideline. Delivery of aerosols to the upper airway. PMID- 10146088 TI - AARC (American Association for Respiratory Care) clinical practice guideline. Surfactant replacement therapy. PMID- 10146089 TI - AARC (American Association for Respiratory Care) clinical practice guideline. Static lung volumes. PMID- 10146090 TI - Bioethics commissions abroad. PMID- 10146091 TI - An overview of IBNR (incurred but not recorded). PMID- 10146092 TI - Reforming health care from Jackson Hole. Interview by Richard L. Clarke. PMID- 10146093 TI - Using patient classification systems to identify ambulatory care costs. AB - Ambulatory care continues to increase as a percentage of total hospital revenue. Until recently, reimbursement for ambulatory care was provided on a cost basis. However, payers are attempting to exert more control over reimbursement for ambulatory care. The Health Care Financing Administration, for example, is expanding the use of prospective payment to cover more forms of outpatient care. Thus, in order to ensure the financial viability of their organizations, healthcare financial managers will need cost-accounting tools, such as patient classification systems, to ascertain the direct and indirect costs of emergency or outpatient visits and thereby to refine pricing, contracting, staffing, productivity, and profitability analyses for ambulatory care. PMID- 10146094 TI - Benefits and operational concerns of rural health clinics. AB - In 1977, Congress enacted the Rural Health Clinic Act in an effort to make healthcare more accessible in underserved rural areas. Changes in the regulations affecting these clinics, such as offering incentives to start and staff the facilities, have been enacted in a series of Omnibus Budget Reconciliation Acts beginning in 1987. As a result, the last few years have seen the number of clinics double. In this article, authors Lawrence A. Fogel and Cindy MacQuarrie examine the advantages offered by rural health clinics and review the operational issues involved in setting up and running them. PMID- 10146095 TI - Avoiding unnecessary critical care costs. AB - Critical care services are major contributors to rising healthcare costs, with intensive care units (ICUs) consuming nearly 20 percent of the country's healthcare expenditures. This article examines ways of controlling and avoiding unnecessary ICU costs. A case study shows how a thorough examination of admission, discharge, and transfer practices and provision of the appropriate number and mix of ICU and step-down beds can significantly reduce the use of critical care resources. PMID- 10146096 TI - Following new tax rules on charitable deductions. AB - The Omnibus Budget Reconciliation Act of 1993 established new rules governing individuals who make donations to charitable organizations and organizations that provide goods and services in return for charitable donations. Healthcare financial managers and fund-raising personnel need to become familiar with these rules so they can assure that donors of charitable contributions to their organizations will receive appropriate tax deductions and that the organizations themselves will not incur penalties for failing to make proper disclosures. PMID- 10146097 TI - Internal compliance systems are the best defense against fraud. AB - Healthcare reform a key issue for the Clinton administration, extends far beyond healthcare coverage concerns. With healthcare fraud estimated by Congress to total as much as $80 billion to $100 billion per year, uncovering fraud has become one of the administration's top priorities. With FBI and other investigators assigned to the problem, all areas of the healthcare industry will face increasing levels of scrutiny. This anti-fraud campaign will affect every type of provider, from large hospitals to small equipment vendors. An internal compliance program can help healthcare managers identify problems and avoid criminal prosecution. PMID- 10146098 TI - Unravelling the confusion caused by GASB, FASB accounting rules. AB - Separate GASB and FASB accounting and financial reporting rules for governmental healthcare providers are producing confusion. Among other problems, they reduce the usefulness of aggregated data about the healthcare industry. This article addresses the inconsistencies of the various reporting standards and identified problems they can cause. PMID- 10146099 TI - Does your organization need a HUG (healthcare user group)? PMID- 10146100 TI - Preventing banking and check fraud. AB - Most banking fraud involves disbursement activity which, by its nature, necessitates access to an organization's bank account. Banking fraud can be prevented by employing several internal controls and by using various banking products. PMID- 10146101 TI - Data trends--November 1994. PMID- 10146102 TI - Predicting managed-care growth. PMID- 10146103 TI - Planning physician deployment in integrated healthcare networks. PMID- 10146104 TI - Structuring medical practice acquisitions. AB - A successful medical practice acquisition requires both the buyer and the seller to understand the complex legal and business issues that arise throughout the negotiation of the transaction. This article surveys the key issues involved in setting the purchase price, determining how that price will be paid, deciding whether to acquire assets or stock, establishing a physician employment agreement, and addressing the concerns of nonphysician staff. PMID- 10146105 TI - Nonqualified benefit programs help recruit and retain physicians. AB - Healthcare reform, mergers, and managed care are leading many physician employees to reconsider their association with hospitals and other healthcare facilities. Healthcare organizations can no longer rely on traditional retirement benefit packages and qualified plans to attract or keep these physicians. Changes in tax legislation have made nonqualified retirement plans an important factor in recruiting and retaining physicians. This article examines nonqualified retirement plans and how they can be used by healthcare organizations to supplement qualified plans benefits. While the article focuses on physicians, nonqualified plans also can be used to supplement benefits and secure the financial future of other high-salaried healthcare professionals. PMID- 10146106 TI - Recruiting physicians for rural America. AB - Rural America desperately needs primary care physicians. Rural residents need the healthcare services that primary care physicians provide, while rural healthcare organizations need the revenue generated by referrals for specialty and acute care services. However, as managed care grows in urban areas, so does the demand for primary care physicians. As a result, large urban healthcare systems routinely offer primary care physicians alluring incentives, making rural recruitment more challenging than ever. Although Federal and state initiatives eventually may encourage more physicians to practice in rural areas, managers of rural healthcare organizations must undertake their own well-planned recruitment campaigns to fulfill current and future physician needs. Effective physician recruitment in rural areas requires commitment from hospital and community leaders, a plan for identifying candidates who are likely to put down roots in a rural area, adequate financial and other professional incentives, and community support after a new physician arrives. PMID- 10146107 TI - Navigating the legal waters of physician referral. AB - Beginning in 1995, new Federal laws will expand prohibitions against physician referrals of patients to ancillary services in which the referring physician has a financial interest. In addition, proposed changes to the "safe harbor" regulations will allow referrals within group practices and referrals to specialists when the referring physician receives no remuneration. The new regulation also will allow physicians to make certain financial investments in healthcare organizations. PMID- 10146108 TI - Avoiding litigation after a reduction in workforce. AB - Healthcare organizations can avoid litigation after a reduction in workforce by observing Federal and state laws that protect employees, by documenting why and how the reduction will be carried out, and by training healthcare managers to terminate employment properly. Careful planning and scrupulous execution of a reduction-in-workforce plan can prevent costly lawsuits. PMID- 10146109 TI - Offsetting unexpected healthcare costs with futures contracts. AB - Group health insurance futures contracts will be traded at the Chicago Board of Trade in the near future. These contracts may be useful devices for capitated systems, such as health maintenance organizations (HMOs), to hedge unanticipated increases in the costs of providing health care. This article discusses how futures contracts may be used by an HMO to prevent financial losses that arise from unexpected increases in inpatient utilization. PMID- 10146110 TI - Outside management firm may help drive up parking revenues. AB - Larger healthcare organizations may be able to realize additional net revenues by using an outside firm to manage their paid-parking programs. As the author of this article explains, experienced outside management firms work to reduce operational expenditures and improve collections. They use program-specific revenue control methods and monitor parking activity on a daily, weekly, and monthly basis. Arrangements with outside parking management firms span a variety of lease and contract arrangements. PMID- 10146111 TI - Should claims submission vendors be accredited? PMID- 10146112 TI - Supreme Court decides reimbursement cases. PMID- 10146113 TI - Benchmarking's role in treasury management. PMID- 10146114 TI - Pulmonary artery catheterization in exacerbations of COPD requiring mechanical ventilation: a cost-effectiveness analysis. AB - The cost-effectiveness of pulmonary artery catheterization (PAC) has been questioned in many clinical situations. We sought to assess the cost effectiveness of PAC in patients with an acute exacerbation of chronic obstructive pulmonary disease (COPD) requiring mechanical ventilation. METHODS: We constructed a decision analysis model and calculated the incremental cost/quality-adjusted life-year (QALY) saved for hypothetical patients, comparing a PAC strategy to one of no PAC. Sensitivity analyses were performed to test the stability of conclusions over wide ranges of values. RESULTS: The incremental cost/QALY saved in the cost-effectiveness analysis using baseline data is $77,407 when catheterization-driven therapeutic changes result in a 5% improvement in survival. Cost-effectiveness is sensitive to variations in post-hospital life expectancy, quality of life, and the probability of favorable therapeutic changes resulting from the use of catheterization data. CONCLUSIONS: Pulmonary artery catheterization in COPD exacerbation requiring mechanical ventilation is expensive compared to accepted medical interventions for other conditions, unless changes in therapy prompted by catheterization increase hospital survival to a level 8.7% above baseline. Randomized, controlled trials are needed to investigate the economic impact of PAC and its effect on morbidity and mortality of critically ill patients. PMID- 10146115 TI - Interruption of oxygen therapy during intrahospital transport of non-ICU patients: elimination of a common problem through caregiver education. AB - Hospital inpatients frequently leave their rooms for diagnostic procedures and for other reasons. For some, interruption of oxygen therapy during transport could lead to serious complications. In our institution, non-ICU patient transport is done mainly by nonclinical personnel from an independent transport service. MATERIALS & METHODS: We reviewed respiratory care department and transport service records for 5 arbitrarily selected days to determine the number of non-ICU patients receiving O2 therapy, the number of times these patients were transported, and the number of occasions on which O2 was used during the transport. We then interviewed the primary nurse for each patient transported without O2 and reviewed the charts of those patients to determine whether this practice was consistent with the therapy as it had been ordered. After our initial investigation showed a high rate of transport without prescribed O2, we sent memoranda to all nursing units describing proper procedures for transport of patients for whom O2 had been ordered. We then repeated the audit. Because the second audit showed the need, we conducted education sessions with all nursing personnel on the affected units and posted guidelines for O2 use during transport. A third audit was then conducted. In addition, we performed a telephone survey of respiratory care department managers to learn the patient transport practices in all hospitals in our state with more than 200 beds, using a structured questionnaire. RESULTS: During the initial 125 patient-days of O2 therapy, O2 accompanied patients on only 30 of 55 transports (55%). After distribution of memoranda, O2 use increased to 28 of 35 transports (80%) during 82 patient-days. The second educational effort resulted in O2 use with all 35 transports (100%) performed during 99 patient-days. Survey results from 24 hospitals with 225-680 beds showed that 11 (46%) had separate transport services and that decisions on O2 use during patient transport were generally made by nursing staff. Although respiratory care departments supplied the O2 equipment, their personnel were involved in non-ICU transports in only 5/24 hospitals. CONCLUSIONS: Patients receiving O2 therapy on acute-care wards are often transported to other areas of the hospital without O2. This potentially dangerous practice can be corrected by respiratory care practitioners through educational efforts targeted toward those responsible for administering O2 therapy in non-ICU hospital areas. PMID- 10146116 TI - A new respiratory monitor that enables accurate measurement of work of breathing: a validation study. AB - BACKGROUND: Computerized, yet portable, bedside pulmonary monitors that can measure work of breathing (WOB) are now commercially available; however, none accurately measures WOB. The purpose of this study was to evaluate new software designed to measure WOB by means of the Campbell diagram and to test the agreement between a monitor (Model CP-100, Bicore, Irvine CA) programmed with the new software and the conventional method of measuring WOB. MATERIALS & METHODS: Using a lung model of our own devising, we compared WOB measurements between the monitor and conventional laboratory equipment. Inspiratory flow-rate, tidal volume (VT), and resistance of the model were adjusted to produce WOB ranging from 0.80 to 3.25 J/L. Regression analysis and calculation of bias and precision were performed for these data. RESULTS: For total, elastic, and resistive WOB, the two methods of measurement correlated strongly and positively. For all values of WOB, the correlation coefficients (r) and coefficients of determination (r2) were close to 0.99 (p < 0.0001); bias was minimal (-0.05 J/L) and precision acceptable (0.06 J/L). CONCLUSION: Data from a lung model reveal that a respiratory monitor programmed with appropriate software can accurately measure total, elastic, and resistive WOB. The monitor may eventually prove useful for clinically assessing WOB, which then can be used to adjust the ventilator to optimize respiratory muscle loads. PMID- 10146117 TI - Behavioral assessment of sickle cell disease pain. PMID- 10146118 TI - Children's hospice: completing the circle of caring. AB - Often an ignored area of hospice care, children's hospice programs are growing as more and more children contract cancer and AIDS. Children's hospice care differs from adult programs in its approach and requires the cooperation of families and professionals to care for the dying child. PMID- 10146119 TI - Qualitative reasoning for AIDS treatment. AB - We present a qualitative model of the interaction between HIV-1 virus and human cell, based on qualitative process theory. This model can be regarded as a first step for setting up a comprehensive model of the HIV 1 infection treatment in which the possible points where a drug can attack the virus are evidentiated. The first simulation trials indicate that the model reproduces the major features of the real behavior of the virus inside and outside the human cell. PMID- 10146120 TI - Making the transition to healthcare business advisor. PMID- 10146121 TI - Data trends. January 1995. PMID- 10146122 TI - Defining primary care. PMID- 10146123 TI - Integrated healthcare systems. Stark II complicates system planning. PMID- 10146124 TI - The future of integrated systems. Interview by Paul Manus. PMID- 10146125 TI - Building consensus for integration. AB - Nearly one out of every three system integration efforts among healthcare organizations fails, and as many as nine of every ten fall short of expectations. Integration initiatives often prove unsatisfactory due to lack of attention to building consensus among all internal and external constituencies regarding the reasons for and objectives of an integration strategy. This article presents an organized plan for pursuing partnerships that pays careful attention to planning and consensus building. The plan is particularly applicable to most non-profit healthcare organizations. PMID- 10146126 TI - Addressing integrated systems' tax-exemption problems. AB - Integrating for-profit providers with charitable providers raises many questions about tax exemption. The traditional criteria for determining tax-exempt status that apply to hospitals do not necessarily apply to integrated delivery systems because of their hybrid nature. The appropriate Internal Revenue Service (IRS) rulings and issues must be understood and adhered to before an integration can be structured in the most tax-efficient way. Reasonable as such a course of action seems, it is somewhat difficult because both the integrated delivery system concept and the IRS rulings that apply are evolving. In a time of flux, this article serves as a timely if temporary guide. PMID- 10146127 TI - Second-generation legal issues in integrated delivery systems. AB - The formation and operation of integrated healthcare delivery systems raise significant legal issues. Some of these issues, such as antitrust, tax-exempt status, and fraud and abuse, have been discussed extensively. However, other legal issues, such as those involving management of business risk, use of systemwide information management, and securing of tax-exempt financing, have not received much attention. PMID- 10146128 TI - The importance of primary care providers in integrated systems. AB - Primary care physicians are essential to the success of an integrated healthcare delivery system. Because the current supply of primary care physicians does not meet the demand, healthcare systems are competing aggressively to offer primary care physicians attractive incentives to join their systems. Adequate financial incentives are essential, but equally important are incentives related to the types of affiliation established between a system and a physician. This article explains the role of primary care physicians in an integrated healthcare system, presents two examples of how healthcare systems have recruited and deployed primary care physicians, and describes key factors in achieving productive, long term primary care affiliations. PMID- 10146129 TI - Hermann agreement updates IRS guidelines for incentives. AB - The October 1994 agreement between the Internal Revenue Service (IRS) and Hermann Hospital of Houston, Texas, elucidates current IRS policy on physician recruitment incentives. The IRS distinguishes between the recruiting and the retention of physicians and perimts incentives beyond reasonable compensation in the former but not the latter circumstance. This new agreement, while not legally precedential, nevertheless provides guidance for healthcare organizations seeking safe harbor protection. PMID- 10146130 TI - Using information networks for competitive advantage. AB - Although the healthcare "information superhighway" has received considerable attention, the use of information technology to create a sustainable competitive advantage is not new to other industries. Economic survival in the new world of managed care may depend on a healthcare delivery system's ability to use network based communications technologies to differentiate itself in the market, especially through cost savings and demonstration of desirable outcomes. The adaptability of these technologies can help position healthcare organizations to break the paradigms of the past and thrive in a market environment that stresses coordination, efficiency, and quality in various settings. PMID- 10146131 TI - Implementing the Medicare electronic remittance advice. AB - Some hospitals have delayed converting to the electronic remittance advice recently implemented by the Health Care Financing Administration because the process is unfamiliar and because the electronic data interchange (EDI) translation software is expensive. However, the University of Pittsburgh Medical Center (UPMC) found that it could begin to reap the benefits of EDI technology by using existing software and hardware along with a common-sense approach to implementation. As a result, UPMC has begun an organizationwide EDI initiative designed to reduce costs and improve cash flow. PMID- 10146132 TI - The need to manage and reconcile capitation payments. AB - As capitation becomes a more common method of paying providers, healthcare financial managers must determine if these payments are being made correctly. The reconciliation process under capitation contracts is new for most financial managers. Standard industry conventions for payers and providers are needed to reduce the associated administrative costs for this type of payment. Recent efforts to create an American National Standards Institute (ANSI) X12 capitation payment standard have focused on provider information needs under capitated payment agreements. A solution is at hand if providers and payers can agree on a standard for reconciling capitation payments. PMID- 10146133 TI - Organizing for EDI. AB - In many ways, nontechnical issues of an electronic data interchange (EDI) initiative--such as organizational issues--can be more daunting and expensive than the technical issues of EDI implementation. Estimates are that the "human" costs associated with education, training, and implementation management constitute 90 percent of EDI implementation costs. In order to successfully implement EDI, a strategy is needed for managing the nontechnical, organizational issues involved in the process. PMID- 10146134 TI - Financial system risks to watch for in 1995. PMID- 10146135 TI - Healthcare opportunities on the Internet. PMID- 10146136 TI - Guideline for prevention of nosocomial pneumonia and ventilator circuits: time for change? PMID- 10146137 TI - AARC clinical practice guideline. Metabolic measurement using indirect calorimetry during mechanical ventilation. American Association for Respiratory Care. PMID- 10146138 TI - AARC clinical practice guideline. Transcutaneous blood gas monitoring for neonatal and pediatric patients. American Association for Respiratory Care. PMID- 10146139 TI - AARC clinical practice guideline. Capillary blood gas sampling for neonatal and pediatric patients. American Association for Respiratory Care. PMID- 10146140 TI - AARC clinical practice guideline. Body plethysmography. American Association for Respiratory Care. PMID- 10146141 TI - Guideline for prevention of nosocomial pneumonia. Centers for Disease Control and Prevention. AB - Pneumonia is the second most common nosocomial infection in the United States and is associated with substantial morbidity and mortality. Most patients with nosocomial pneumonia are those with extremes of age, severe underlying disease, immunosuppression, depressed sensorium, and cardiopulmonary disease, and those who have had thoracoabdominal surgery. Although patients with mechanically assisted ventilation do not comprise a major proportion of patients with nosocomial pneumonia, they have the highest risk of developing the infection. Most bacterial nosocomial pneumonias occur by aspiration of bacteria colonizing the oropharynx or upper gastrointestinal tract of the patient. Intubation and mechanical ventilation greatly increase the risk of nosocomial bacterial pneumonia because they alter first-line patient defenses. Pneumonias due to Legionella spp., Aspergillus spp., and influenza virus are often caused by inhalation of contaminated aerosols. Respiratory syncytial virus (RSV) infection usually follows viral inoculation of the conjunctivae or nasal mucosa by contaminated hands. Traditional preventive measures for nosocomial pneumonia include decreasing aspiration by the patient, preventing cross-contamination or colonization via hands of personnel, appropriate disinfection or sterilization or respiratory therapy devices, use of available vaccines to protect against particular infections, and education of hospital staff and patients. New measures under investigation involve reducing oropharyngeal and gastric colonization by pathogenic microorganisms. PMID- 10146142 TI - Watchful waiting encouraged for benign prostatic hyperplasia. PMID- 10146143 TI - The new risk management. PMID- 10146144 TI - How to determine financial reserves for capitated contracts. PMID- 10146145 TI - Working capital and the importance of capital planning. PMID- 10146146 TI - Avoiding pitfalls in medical practice valuation. PMID- 10146147 TI - Making INROADS into cultural diversity. Interview by Richard L. Clarke. PMID- 10146148 TI - Ensuring adequate return on investment for primary care networks. AB - Developing and managing a successful primary care network requires a vision of what that network must accomplish, realistic performance objectives, well designed management and support systems, and methods to reverse adverse performance trends if they occur. This article offers suggestions for fulfilling each of these requirements to help a healthcare organization achieve its long term financial goal in a healthcare environment dominated by managed care. PMID- 10146149 TI - Charitable remainder trusts provide a creative source of capital. AB - Operating margins for hospitals continue to shrink, making it increasingly difficult for hospitals to realize returns high enough to replace capital. Thus, accumulating capital through hospital earnings will continue to be difficult. Credit ratings will continue to drop as not-for-profit hospital operations remain marginal, making access to capital through debt markets more expensive. As a result, not-for-profit hospitals will need to develop creative ways of accessing capital through gifting programs. One such creative way is through the use of charitable remainder trusts--planned gifts that can take three to seven years to mature but can provide long-term-thinking hospital executives with an innovative source of capital. PMID- 10146150 TI - Overcoming financing challenges with bond insurance. AB - As the revenues of healthcare organizations continue to decline, finding ways to raise low-cost capital has become increasingly important. By incorporating municipal bond insurance into a finance plan, healthcare organizations can achieve sizable debt-service savings for both new-money projects and refunding transactions. Bonds insured by one of the major municipal bond issuers are enhanced and carry AAA ratings from Moody's Investors Service, Standard & Poor's Corp., and, in some cases, Fitch Investors Service. Thus enhanced, they can attract a broader range of investors than uninsured issuers and can make it easier for healthcare organizations to raise long-term capital in a cost effective manner. PMID- 10146151 TI - A bank's role in EDI implementation. AB - By improving accuracy and speed of accounting operations, financial electronic data interchange (EDI) can enhance a healthcare organization's cash flow. Banks play a key role in implementing EDI for accounts receivable. This article describes how a healthcare organization's bank can assist in EDI by translating incoming electronic payments into the healthcare organization's general ledger format, thus allowing the organization to take advantage of EDI without investing in expensive translation software. PMID- 10146152 TI - Successful physician affiliations through fair compensation. AB - Appropriate physician compensation is essential if affiliations between physicians and healthcare organizations are to be successful. A physician's compensation should be based on market-specific data about compensation for his or her specialty, as well as on data about each physician's productivity. Healthcare organizations also must have a process for adjusting compensation based on performance and market changes and a process for ensuring equity between newly hired physicians and currently employed physicians. A systematic, data driven approach to establishing physician compensation can help build a foundation for successful physician recruiting and relations. PMID- 10146153 TI - Choosing medical practice acquisition models. AB - Various models have been used to carry out medical practice acquisitions. Each model results in a different degree of integration between physicians and purchasing organizations, and all involve potentially detrimental legal and business issues to be resolved. This article describes six models of medical practice acquisition and the most common legal and business problems associated with valuing medical practices. PMID- 10146154 TI - EDI helps improve payer, provider, and supplier relationships. PMID- 10146156 TI - Healthcare organizations should consider custodial arrangements. PMID- 10146155 TI - Medicaid public notice regulation generates litigation. PMID- 10146157 TI - Plan to recruit the right director of managed care. PMID- 10146158 TI - Data trends. March 1995. PMID- 10146159 TI - From increasing revenues to controlling costs: benchmark data for strategic planning. Healthcare Financial Management Association. PMID- 10146160 TI - Ritual's role in profound change. AB - In today's healthcare environment, characterized by downsizing, restructuring, mergers, and acquisitions, organizational cultures and employees are experiencing rapid--and often tense--changes. Ritual can facilitate change by acknowledging it and allowing the grieving process to take its course. The success of an organizational culture change can depend on whether the organization and its members have been given an opportunity to grieve. Until they grieve their losses, people cannot embrace the new. Organizational leaders who have survived downsizing must come to grips with their own survivor status first and then lead others in the organization through the current painful but irrevocable shift in their relationship to the organization. The use of ritual helps organizational survivors see the connection between the grieving process and their survivor symptoms of denial, anger, depression, guilt, fear, insecurity, anxiety, and uncertainty. A good ritual should allow those present to rise above barriers that separate, worries that overburden, and blindness that limits and to gather as one with God. As a rule, a good ritual is participative and recognizes the audience's diversity. The ritual should not just address those present but invite them to act, pray, or sing. Ritual is an important way to provide a structure that allows people to express their emotions. For leaders, it can be a visible way to acknowledge grief and show support for organizational members. For ritual to have any meaning, key leaders need to be present and perhaps have a role in the creation and enactment of the ritual. PMID- 10146161 TI - Emerging technology: multimedia in healthcare. PMID- 10146162 TI - How far does the IRS's 20 percent rule reach? PMID- 10146163 TI - Using strategic planning to address managed care growth. PMID- 10146164 TI - Capitalizing strategic planning costs to recognize future value. AB - As healthcare organizations devote more resources to strategic planning, financial managers should consider capitalizing, rather than expensing, planning costs. Traditionally, healthcare organizations have absorbed these costs in the year a plan is developed. However, a strategic plan may be viewed as an intangible asset that provides the organization with future benefits. Therefore, its costs can be amortized over the plan's life. PMID- 10146165 TI - Containing costs through effective facilities planning. AB - Effective facilities planning can help healthcare organizations contain costs by ensuring that new building projects will bring a return on investment and reflect efficient operating practices. To fulfill this role in cost-containment, facilities planning must take into account important trends in healthcare delivery. These trends include declining inpatient utilization, declining ancillary utilization, integration of providers and services, development of new technologies for patient care and service, development of automated information systems, and use of contracted services. PMID- 10146166 TI - Preventing fraud and abuse fallout. AB - With government and public scrutiny of healthcare costs becoming more intense, the healthcare industry can learn from the defense industry's response to charges of fraud, waste, and abuse. Ethics-awareness programs, compliance programs, and related training can reduce the risks of such violations and their financial and public relations consequences. PMID- 10146167 TI - Helping financial analysts communicate variance analysis. AB - Healthcare organizations often use variance analysis to explain variation between planned and actual costs and charges. This type of analysis is becoming even more common as healthcare executives work to improve efficiency, to set priorities for organizational improvement as part of strategic planning, and to explain costs and charges to interested groups such as purchasers and payers. Variance analysis produces data that must be presented in a format useful to senior executives. An effective format would express the data in a visual summary that is simple enough to be readily understood and detailed enough to provide valuable information. PMID- 10146168 TI - Moving beyond generic integration models. AB - Rigid adherence to generic models of integration often fails because healthcare executives and physicians have not laid a proper foundation for integration. A series of building blocks must be in place before an integrated delivery system can be properly implemented. These building blocks are essential for management of integrated systems so physicians, executives, and managers can respond effectively to the needs of purchasers and patients. PMID- 10146169 TI - Case management can reduce costs and protect revenues. AB - In order to reduce costs, improve quality, and protect revenues, an integrated healthcare system should depend heavily on a case management program that provides continuity of care across all clinical settings for an entire episode of illness or injury. In addition, such a program should move homogeneous, uncomplicated groups of patients quickly and cost effectively through the healthcare delivery system and determine why other patients are not able to move through the system as quickly and effectively. PMID- 10146171 TI - Goodbye electronic connection, hello EDI. PMID- 10146170 TI - Long-term service contracts may not be advantageous. AB - Equipment maintenance costs in healthcare organizations often are the second highest operating costs in departments such as radiology. Savvy financial managers are beginning to understand that much of their organizations' equipment may be under long-term service contracts that are hard to break and that can prevent an organization from saving money. Financial managers should carefully consider their organizations' long-term maintenance goals before entering into such service contracts. PMID- 10146172 TI - A simple cash forecasting procedure. PMID- 10146173 TI - Carefully consider the benefits of credentials. PMID- 10146174 TI - Data trends. April 1995. PMID- 10146175 TI - Analyzing cost variance in capitated contracts. PMID- 10146176 TI - Healthcare benefits in Minnesota. Interview by Robert Fromberg. PMID- 10146177 TI - Integrating financial modeling and patient care reengineering. AB - Healthcare organizations face significant pressure to decrease costs and increase quality. In response, many organizations are attempting to reengineer patient care processes through standardization, using critical paths and processes such as total quality management. Many of the organizational initiatives to analyze patient care, explore alternative processes, and establish standardized patient care have been managed primarily by clinical personnel who have not adequately incorporated financial analyses. A thorough understanding and documentation of the costs of providing standardized patient care have become essential parts of hospital management, particularly with regard to managed care contracting and financial planning under healthcare reform. This article presents a practical methodology to integrate financial analysis with the development of standardized clinical practices. PMID- 10146178 TI - Applying activity-based costing to healthcare settings. AB - Activity-based costing (ABC) focuses on processes that drive cost. By tracing healthcare activities back to events that generate cost, a more accurate measurement of financial performance is possible. This article uses ABC principles and techniques to determine costs associated with the x-ray process in a midsized outpatient clinic. The article also provides several tips for initiating an ABC cost system for an entire healthcare organization. PMID- 10146179 TI - Restructuring wages and benefits to gain a competitive edge. AB - Healthcare organizations that are able to develop a cost advantage in their wage and-benefit programs will have a competitive edge as managed care continues to become more pervasive. Organizations can gain an edge by developing pay systems that reward quality, productivity, and cost containment, and by developing benefit systems that provide cost-containment incentives while meeting organizational recruitment and retention objectives. PMID- 10146180 TI - Managing the transition to capitation. AB - Although most experts believe that capitation and financial risk-sharing among providers will become key components of the U.S. healthcare system, providers may not feel the full effect of this shift for several years. In the interim, providers must operate under an activity-based payment system that rewards them for the volume of patients seen, while preparing for the transition to a fixed, per-capita payment system that will reward them for the efficiency with which services are provided. Preparation for the move to capitation will involve implementation of the systems necessary to negotiate managed care contracts, enhance quality and efficiency, and take responsibility for the health of a defined population. PMID- 10146181 TI - Legal issues in medical practice acquisitions. AB - As the changing healthcare delivery environment places increased emphasis on primary care, many healthcare organizations are striving to broaden their base of primary care physicians. One method that organizations are using to accomplish this goal is acquisition of medical practices. Practice acquisitions require careful planning to address the complex legal issues involved, including possible violations of antikickback, self-referral, and antitrust laws. This article offers an overview of the acquisition process and a checklist of relevant legal issues. PMID- 10146182 TI - Achieving critical mass. PMID- 10146183 TI - Protecting organizations from electronic-transaction fraud. PMID- 10146184 TI - Prepare now for tomorrow's managed care environment. PMID- 10146185 TI - Data trends. February 1995. PMID- 10146186 TI - Making a good impression: how modern technology can help you get your point across. AB - Three-quarters of the participants in a personal computer (PC) workshop at the CLMA 1994 National Meeting had had no experience with software available to prepare high-quality presentations. Although 96% felt they would be more effective in their positions if they knew more about computers, and two-thirds had PCs on their desks, 70% indicated that lack of support and education had inhibited their progress in this area. The field of presentation software and hardware is more complex than simple word processing and spread sheet applications, because peripheral issues such as film recorders, graphic file formats, and the human factor are involved. This article attempts to demystify the technology and to educate laboratory managers so that they will be able to take advantage of the numerous tools and enhance their ability to communicate effectively in a variety of circumstances. PMID- 10146187 TI - Innovative communication in a biomedical engineering department. AB - Effective communication is one of the most important and often overlooked components of the functioning of a biomedical engineering department. The Biomedical Engineering Department (Biomed) at the VA Medical Center, Boston, Massachusetts uses innovative methods and resources to improve communication between Biomed and the Medical Center staff. While some changes have dealt directly with the information content communicated by Biomed, many improvements have also been made to the format in which information and ideas are presented. The latter changes serve the purpose of improving communication by ensuring that the presented information is both understood and retained. Improvements have been made in the areas of operator training, alerting users to actual and potential hazards and recalls, and staff education concerning Biomed's role in the Medical Center and the availability of Biomed to assist in technology issues. PMID- 10146188 TI - Perspectives. Grassroots state initiatives wage war on cancer pain. PMID- 10146189 TI - Euthanasia and assisted suicide. PMID- 10146190 TI - Implementation of a pharmaceutical care practice model for palliative care. PMID- 10146191 TI - Rhodamine-123 as a new chemosensitizing versus toxic agent on human squamous carcinoma cells and fibroblast cultures. AB - Rhodamine-123 is a specific dye with an absorption maxima at 511 nm which was tested as a potential chemosensitizing agent for laser treatment of tumor cells. Because Rhodamine, at high doses, has direct cytotoxic effects on human cells in the absence of laser exposure, we tested the human squamous P 3 carcinoma cell line and two normal fibroblast cell lines for sensitivity to various levels of this dye. These cells were exposed to Rhodamine-123 at concentrations of 1, 3, 6, and 10 mug/ml for 1, 8, and 24 hours. The results indicate that Rhodamine-123 is nontoxic to human P 3 carcinoma cells and normal fibroblast cultures at concentrations equal or lower than 1 mug/ml. However, at concentrations equal or higher than 3 mug/ml, a significant immediate and/or delayed inhibition of cell duplication was demonstrated. The results show that Rhodamine-123 at 1 mug/ml can be used to sensitize tumor cells for targeting by monochromatic 514.5 nm Argon lasers. PMID- 10146192 TI - Laser bonding of secondary bronchi with solvent--detergent-treated cryoprecipitate. AB - Management of bronchopleural fistula is a challenging clinical problem. Laser assisted cryoprecipitate bonding techniques offer a means to fix precisely tissue glues into the fistulae through a bronchoscopic approach. Analogous studies exist using fibrin glue with thrombin. Using a canine model, secondary bronchi were sealed with cryoprecipitate made from solvent/detergent-treated plasma (treated to inactivate membrane-enveloped virus) mixed with indocyanine green (absorption 805 nm). Diode laser energy (emission 808 nm, 7.3 W/cm 2) was applied to the solder until dessication was observed. Leakage pressures (n = 7) ranged between 18 and 86 mmHg with a mean of 46 +/- 24 mmHg. Laser-assisted solder techniques provide a reliably strong seal over leaking bronchial stumps and use of dye enhancement prevents undesired collateral thermal injury to surrounding bronchial tissue. Solvent/detergent plasma, prepared by methods shown to inactivate large quantities of HIV, HBV, and HCV, is an effective source of cryoprecipitate and should allow widespread use of pooled human material in a clinical setting. PMID- 10146193 TI - Experimental surgery on dog's stomach and liver using CO 2 laser plastic hollow fibers: technical method. AB - Plastic hollow fibers for the transmission of CO 2 laser energy in curved paths were produced by plating the inner surface of plastic tubes with a metal film and dielectric film upon it. These fibers can transmit high power up to 40 W at the outlet, with high transmission yield even through several bendings. A three dimensional simulator was built to simulate paths in the dog's body and the outlet power was measured. From the achieved data the expected transmitted power during real surgery was appreciated. The fibers were checked for their influence on live tissues of dogs. Incisions were made in the liver and ulcers in the dogs' stomachs were treated. The fibers were inserted into the stomach through the dogs' esophagus. Complete healing was observed after four weeks. PMID- 10146194 TI - Removal of benign tumors using the CO 2 laser. AB - The CO 2 laser is most widely used for treatment of lesions affecting the oral mucosa. This paper concerns the use of CO 2 laser surgery in benign tumors. Thirty-seven cases of benign tumors were treated and two of them, a papilloma and a reactional fibroma, are described in detail. PMID- 10146195 TI - The CO 2 laser in omphalitis. AB - Over a period of 18 months, from January 1988 to June 1989, 8 patients with chronic omphalitis were treated in a Multi-Specialty Military Clinic, using a CO 2 laser. A significant decrease in periumbilical pain, elimination of the disturbing chronic discharge, and vaporization of the reactive granulation tissue were achieved, suggesting this technique as an attractive option in the treatment of chronic recidivant omphalitis. PMID- 10146196 TI - Experimental and clinical studies on laser hyperthermia for gastric cancer. PMID- 10146197 TI - Advanced fiberoptic catheters for coronary laser angioplasty. PMID- 10146198 TI - Brain tumor biology and therapy. AB - There is renewed interest in boron neutron capture therapy of gliomas, while enthusiasm for immunotherapeutic modalities, such as interferon, has begun to wane. Basic research into glioma biology is shedding light on the proliferative pathways which may be amenable to future therapeutic manipulation. Recent evidence has confirmed the benefit of surgical excision in patients with solitary brain metastases. Great technical advances are occurring in radical skull base surgery; however, the indications for such surgery remain poorly defined, particularly for patients with malignant lesions. PMID- 10146199 TI - Neuroimaging in infections and demyelinating disease. AB - Computerized tomography and magnetic resonance imaging continue to illuminate the changes that occur in the central nervous system in infections and demyelinating disease. Imaging in the acquired immune deficiency syndrome helps to better understand neurological complications. Magnetic resonance imaging also helps to be specific about the diagnosis of cryptococcal meningitis and toxoplasmosis. Major contributions have been made to the understanding of the diagnosis and the living pathology of multiple sclerosis. Experimental studies have identified the mechanism of blood-brain barrier disruption in inflammatory disease. PMID- 10146200 TI - Neuroradiology. AB - Posterior fossa cysts have been reclassified, migrational defects have been matched with histology, and new abnormalities have been described in neurofibromatosis, tuberous sclerosis and ceroid lipofuscinosis. Normal myelination, progressive hydrocephalus, infantile neoplasms, cryptic angiomas and irreversible anoxic brain damage are reviewed. The distribution of grey matter changes in subacute necrotizing encephalomyelitis is discussed and the superiority of magnetic resonance imaging in partial epilepsy and neurological acquired immune deficiency syndrome is confirmed. PMID- 10146201 TI - Pediatric neurosurgery. AB - Many aspects of pediatric neuro-oncology including epidemiology, diagnosis and treatment are covered by this review. Important advances in the treatment of hydrocephalus and craniosynostosis are also reviewed. A number of congenital conditions involving the cranium and spinal cord are analyzed with respect to optimal treatment and new experimental data are highlighted. Advances in the treatment of pediatric intracranial and extracranial vascular anomalies are reviewed and advances in the understanding of head trauma are emphasized. Finally, a couple of the technical advances in pediatric neurosurgery are highlighted. PMID- 10146202 TI - Imaging of the spinal cord and cauda equina. AB - Magnetic resonance imaging continues to dominate the literature on spinal imaging and further advances have occurred during the last year. It is now the investigation of choice for most problems. Intraoperative sonography also may have a place, but other modalities are being superseded. Plain films retain a value in trauma. PMID- 10146203 TI - Neuroimaging. PMID- 10146204 TI - Imaging in neuro-ophthalmology. AB - As in other fields, the major radiological advances in neuro-ophthalmology have been in the application of magnetic resonance imaging (MRI) to parenchymal disease not necessarily characterized by gross structural change. This is particularly true in diseases of the optic nerve and chiasm, and in systemic diseases of the nervous system in which the visual apparatus is also affected. PMID- 10146205 TI - Cerebrovascular disease. AB - The recent literature addresses the early detection of cerebrovascular disease using imaging techniques, metabolic assessment using spectroscopy, developments in quantitative analysis of brain blood flow, and new interventional techniques for aneurysm obliteration and carotid angioplasty. PMID- 10146206 TI - White matter disorders. AB - Magnetic resonance imaging (MRI) has a leading role in the diagnosis of white matter disorders because of its superior sensitivity. It also allows a detailed analysis of white matter disorders, improving the specificity of the diagnoses. There is an increasing knowledge about MRI patterns, in particular in hereditary metabolic disorders. Although these patterns are not always pathognomonic, they often serve as a guide for further diagnostic steps. In the non-hereditary white matter disorders, MRI has an increasing role in the diagnoses, follow-up, and monitoring of clinical trials. In inflammatory disorders, gadolinium diethylenetriamine-penta-acetic acid (Gd-DTPA) appears to be helpful in analyzing the 'natural' course of the disease. Magnetic resonance spectroscopy (MRS) is gradually also finding a niche in the diagnosis of white matter disorders, both as a marker of neuronal loss and as an indicator of the age and activity of a lesion. New magnetic resonance techniques, such as diffusion and magnetic transfer imaging, will probably provide more information about the involvement of myelin sheaths. PMID- 10146207 TI - The spinal cord. AB - Magnetic resonance imaging (MRI) has become the imaging modality of choice in spinal cord diseases. Computerized tomography (CT) myelography remains a valuable alternative and may be performed even on patients with a known sensitivity to iodine contrast media. Ultrasonography provides excellent intraoperative evaluation of spinal cord injury. MRI, however, offers new knowledge about spinal cord disease, especially in trauma, ischemia and degenerative lesions; using this technique direct visualization of ischemic spinal cord lesions is presently possible. Rare infections or degenerative spinal cord lesions are imaged albeit in a non-specific manner. Cervical and thoracic disk disease may cause severe myelopathy, yet close correlation between images and symptomatology remains mandatory. PMID- 10146208 TI - Neuroimaging and pediatrics. AB - The emphasis in understanding significant categories of pediatric brain and spinal cord lesions, such as brain neoplasms, white matter diseases, fetal abnormalities and lesions of the pituitary gland, is changing towards a clinical perspective with respect to modern imaging techniques. The initial experience with magnetic resonance imaging (MRI), Doppler sonography, computerized tomography (CT), and high-resolution ultrasound (US) is now being consolidated, compared and contrasted with each other and with the increasing clinical experience, particularly in diseases that are peculiar to childhood. PMID- 10146209 TI - Head injury. AB - Obliteration of mesencephalic cisterns, midline shift, subdural and epidural hematomas, shearing injuries involving the brainstem and/or interpeduncular cistern, fractures of the sphenoid body and/or clivus, as well as perfusion defects larger than the intracerebral hematoma have been identified in the recent literature as findings indicative of poor outcome in patients with head injury. PMID- 10146210 TI - Measuring and marketing network accessibility. PMID- 10146211 TI - Low-vision aids in age-related macular degeneration. AB - In spite of the many patients with low vision due to age-related macular degeneration, the year's publications on their rehabilitation are few. The most common complaint of these patients is their inability to read. For this purpose, simple optical devices, eg, overcorrection in reading glasses, hand-held or stand magnifiers, are usually best. With closed-circuit television systems, reading speed may be faster and reading time may be longer but these systems are still too expensive for most users. Results on bifocal intraocular lenses used as a Galilean telescopic system are still unconfirmed. New ideas for many technical devices suitable also for elderly patients have been presented. PMID- 10146212 TI - Color Doppler ultrasonography of the eye and orbit. AB - Color Doppler imaging is the recent development in ultrasonography that allows simultaneous two-dimensional structural imaging in Doppler evaluation of blood flow. With this technique, it is possible for the first time to indirectly display the fine orbital vessels such as the ophthalmic artery and its branches, the central retinal artery, the posterior ciliary artery, and the lacrimal artery. Also, the display of venous structures such as the superior ophthalmic vein, the vortex vein, and the central retinal vein is possible. In addition to the qualitative display of those vessels, the hemodynamics in those vessels can be quantitatively assessed by looking at the Doppler spectrum and determining flow velocities during various periods of the cardiac cycle. This technique is now being used in ophthalmology to evaluate orbital tumors and vascular lesions, intraocular tumors, carotid-cavernous-sinus-fistulas, and hemodynamic changes in patients with retinal vascular disease such as central retinal artery occlusion, central retinal vein occlusion, and diabetic retinopathy. PMID- 10146213 TI - Laser treatment for retinopathy of prematurity. AB - Threshold retinopathy of prematurity is a level of disease at which 50% of affected infants are predicted to go blind without treatment. The Cryotherapy for Retinopathy of Prematurity Study has shown that this number can be halved with treatment. Cryotherapy, however, is stressful on the infant, leaves large scars, and is more difficult for the surgeon to administer. Laser photocoagulation with the indirect ophthalmoscope has been shown in pilot studies to be as effective as cryotherapy, less stressful on the infant, and easier for the surgeon to administer. This form of therapy may become the preferred method for treating threshold retinopathy of prematurity. PMID- 10146214 TI - Meet the matrix: information technology for clinical laboratory scientists. PMID- 10146215 TI - Bone marrow sampling and processing. PMID- 10146216 TI - Guide to safety in the workplace. Part II: occupational exposure to bloodborne pathogens. PMID- 10146217 TI - Flow cytometry instrumentation in research and clinical laboratories. AB - OBJECTIVE: To describe the basic components of a flow cytometer and the features unique to research and clinical instruments. DATA SOURCES: Recent review articles and textbooks on cytometry or laboratory diagnosis. STUDY SELECTION: Not applicable. DATA EXTRACTION: Performed by the authors. DATA SYNTHESIS: A cytometer is used for counting and measuring the physical and chemical characteristics of cells and other biological particles. A flow cytometer is different from other cytometers in that a single-cell suspension is passed through it in a fluid stream. A flow cytometer is a complex combination of optics, fluidics, and electronics. A labeled cell is forced through the system, causing the cell to scatter light and emit fluorescence. This output is sensed by photodetectors and then amplified and converted to digital signals for storage in computers. This stored data can be displayed or used for further analysis. CONCLUSION: Some instruments can separate cells that meet certain preselected criteria. Therefore, the flow cytometer is widely used in research as well as in clinical immunology and hematology to perform rapid immunophenotyping, cell sorting, and DNA analysis. PMID- 10146218 TI - Clinical applications of flow cytometry. AB - OBJECTIVE: To describe the basics of three clinical applications of the flow cytometer. DATA SOURCES: Recent articles and books on flow cytometry and laboratory diagnosis. STUDY SELECTION: Not applicable. DATA EXTRACTION: Performed by the author. DATA SYNTHESIS: Immunophenotyping is the classification of cells based on antigens present on their surfaces. These antigens can be detected and quantified by a flow cytometer using monoclonal antibodies conjugated to fluorescent dyes. Reticulocytes are immature red blood cells that contain varying amounts of RNA and DNA. They can be stained with a fluorescent dye and enumerated by a flow cytometer. DNA ploidy analysis of solid tumors involves staining the nuclei of cells with a fluorescent dye. The amount of DNA in each cell is determined, and the percentage of cells in the S phase is calculated. CONCLUSION: Flow cytometry is a relatively new technology in the clinical laboratory. There are many clinically useful applications for which it is suited. As the technology continues to grow, so will the use of the flow cytometer. PMID- 10146219 TI - Impact of DRGs on the medical profession. AB - OBJECTIVE: To present an overview of the history of diagnosis-related group (DRG) reimbursement and its impact on physicians and hospitals. DATA SOURCES: Recent research articles on reimbursement and medical ethics. STUDY SELECTION: Not applicable. DATA EXTRACTION: Performed by the author. DATA SYNTHESIS: The DRG system is part of a system developed at Yale University to provide hospitals with incentives to control costs. Hospital Medicare inpatients are classified into groups that are clinically coherent and homogenous with respect to resource use. The classification is also dependent on principal and secondary diagnoses and procedures, age, gender, and discharge status of the patient. Reimbursement is determined by the classification. Hospitals can create excess revenues by treating the patient more efficiently and economically, or they can absorb monetary losses by doing otherwise. It is argued that hospitals will become more frugal and that physicians will adjust their methods of practice as well. Hospitals that fail to adapt will close, reducing overall Medicare expenditures and deterring inefficiency by example. CONCLUSION: DRGs provided a way to prevent the collapse of the Medicare program but have also required stricter criteria for hospital admissions. DRGs remain in evolution and under evaluation for expansion into other health care settings. PMID- 10146220 TI - Assessing the real cost of analyzer ownership. PMID- 10146221 TI - Principles and applications of the polymerase chain reaction. AB - The invention of the polymerase chain reaction (PCR) technique for nucleic acid amplification has had a major impact on many diverse areas of both basic and clinical research. Since its inception in 1985, reports on a wide variety of applications for PCR have received much attention in scientific and medical literature. This technology has been shown to have wide applicability to the diagnosis of human disease, including such diverse areas as infectious diseases, genetic disorders, and cancer. This article presents a broad overview of the principles of PCR including generic concerns that must be addressed when using or designing PCR-based assays. The application of PCR-based assays for the diagnosis of genetic disorders and for infectious disease testing is also discussed. PMID- 10146222 TI - Interlaboratory evaluation of methods for the assay of Protein C in purified concentrates. AB - Determination of the quantity and activity of the Protein C molecule is of the utmost importance in highly purified concentrates prepared for replacement therapy. A multicenter study was undertaken to evaluate the comparability and accuracy of Protein C assays from commercial sources. Significant between-assay and interlaboratory differences were found for both functional and immunological assays. The interlaboratory variability is explained in part by the use of different control plasmas. The results also indicate the importance of the diluent used. This study emphasizes the need for standardized methods for determining the characteristics of Protein C concentrates. PMID- 10146223 TI - The use of magnetic resonance imaging in monitoring interferon therapy of multiple sclerosis. AB - Magnetic resonance imaging (MRI) was used to evaluate the efficacy of systemic lymphoblastoid interferon therapy in chronic progressive multiple sclerosis. The clinical outcome of this trial has been reported previously. Thirty-six patients with chronic progressive multiple sclerosis were treated with interferon daily for 6 months and 27 received placebo. Patients had MRI at the outset of the study and after 6 and 24 months. Lesion activity and changes in lesion load were determined. As the study progressed, both the interferon- and the placebo treated group developed more active lesions. There was no difference in lesion activity between the two groups. Comparison of lesion load, however, showed a trend toward improvement after 6 months for the interferon-treated group. This difference between the two groups had disappeared by the end of the study. We conclude that lymphoblastoid interferon was not effective in decreasing active MRI-detected lesions or in decreasing MRI lesion load in patients with chronic progressive multiple sclerosis. PMID- 10146224 TI - Magnetic source images reveal brain plasticity. PMID- 10146225 TI - Wrist MRI challenges triple-phase arthrogram. PMID- 10146226 TI - TB's resurgence makes early detection critical. PMID- 10146227 TI - Colon cancer screening: where radiology fits in. PMID- 10146228 TI - Ultrasound, MR back up prostate cancer diagnosis. PMID- 10146229 TI - Why and how to use office spirometry. PMID- 10146230 TI - Breast cancer screening and prevention. PMID- 10146231 TI - A comprehensive review of vascular ultrasound for intensivists. AB - Ultrasound has an increasingly important role in evaluation of the vascular system. Ultrasound is especially useful for intensive care patients because of the frequency of vascular complications developing in the ICU setting, as well as the ability of ultrasound to be performed at the patient's bedside. Ultrasound is the method of choice for evaluation of deep vein thromboembolic disease of the lower extremity in all patients; it demonstrates excellent sensitivity and specificity for this condition. It should also be the initial method of evaluation of upper extremity deep vein thrombosis. However, ultrasound may be limited in this assessment due to lack of reliably demonstrating the central subclavian and innominate veins, and therefore may be inadequate for evaluation of malfunctioning central venous catheters. Ultrasound can reliably identify and potentially be used to treat arterial complications of arterial catheterization, such as pseudoaneurysms. Similarly, ultrasound is accurate in the diagnosis of the presence of abdominal aortic aneurysm, and ultrasound can be used to assess carotid and lower extremity arteries noninvasively. Finally, ultrasound is useful for evaluation of hemodialysis fistulas and vascular complications of transplants. PMID- 10146232 TI - Biliary lithotripsy--FDA limbo forever? PMID- 10146233 TI - Extracorporeal shock wave lithotripsy treatment of lower caliceal stones: an update on the use of a cobra catheter for direct irrigation. AB - As the general experience with extracorporeal shock wave lithotripsy (ESWL) for renal calculi broadens, it is increasingly evident that the clearance of stone fragments in lower pole calices needs to be improved. The stone-free rate posttreatment for lower caliceal stones is consistently less than that for other upper tract locations. Utilization of a cystoscopically placed cobra catheter for directed irrigation during ESWL with a Dornier HM4 lithotripter resulted in an increase of our lower caliceal stone-free rate to 64% (29/45) at 1 month follow up and 73% (33/45) at 3 months follow-up compared to 36% (15/42) of randomly selected controls at 1 month (p less than 0.007) and 54% (23/42) at 3 months (p < 0.070). Patients were included in the study if they had a solitary calculus, less than 2 cm in size, located in a normal lower pole calix and had no indwelling stent placed by the referring physician. The cobra catheter was positioned in the appropriate calix with fluoroscopic guidance under intravenous sedation. Statistical analysis was performed using Pearson's Chi-square test. We conclude that the pre-ESWL treatment placement of a cobra catheter into the lower pole calix and intermittent irrigation during the procedure is a useful adjunct in the successful treatment of lower caliceal calculi. PMID- 10146234 TI - Role of magnetic resonance imaging (MRI) in detecting liver changes after gallstone extracorporeal shock wave lithotripsy (ESWL). AB - Recently published literature on biliary extracorporeal shock wave lithotripsy (ESWL) has shown that high-energy ESWL utilizing high kV is more effective than the low-energy ESWL and low kV used previously. Prior studies have not reported injury to the gallbladder or adjacent liver following ESWL. Our study evaluated 29 patients that were treated with high kV ESWL. Magnetic resonance imaging (MRI) was used to study the gallbladder and adjacent liver for possible injury resulting from the high-energy treatment. The patients, selected using the Dornier MPL-9000 United States protocol, underwent ESWL using 18-24 kV (average 21 kV). MRI was done both pre and post-ESWL in all 29 patients. Ten patients had a second treatment to reduce fragment size and, subsequently, had an additional MRI examination. Spin echo MRI images were obtained at the level of the gallbladder fossa using a 0.5-Tesla ESATOM RM 5000 (ESAOTE Biomedica, Genva, Italy.) superconductive unit. Both T1- and T2-weighted images were obtained. In 26 patients the hepatic parenchyma was normal post-ESWL. Two patients had a hyperintense region on T1-weighted images post-ESWL that was felt to be related to pericholecystic fat. A third patient had an abnormality detected on T2 weighted images that was thought to be due to hepatic edema or microhemorrhage. No significant changes were shown by laboratory or concurrent ultrasound examinations. Repeat MRI examinations in these three patients were normal. High energy ESWL appears as safe as low-energy ESWL in the treatment of patients with symptomatic gallstones. PMID- 10146235 TI - The effect of single shock waves on the vascular system of artificially perfused rabbit kidneys. AB - Extracorporeally-perfused rabbit kidneys were exposed to five shock waves at 14 kV on the XL1 Dornier experimental lithotripter (Dornier Medical Systems, Inc., Germering, Germany). While the perfusion flow rate was kept constant, the arterial perfusion pressure was recorded to assess changes in vascular resistance. Immediately after shock wave application, perfusion pressure decreased by 20%-30%, followed by a short, relative pressure rise that did not reach pretreatment values. Fifteen-twenty minutes later, arterial perfusion pressure reattained pretreatment values. Subsequent to treatment, urine flow decreased by greater than 50%. The observed pressure rise was also induced in nontreated kidneys by perfusion with the effluent of treated kidneys indicating that this is based on a humoral mechanism. On the other hand, shock wave application to formalin fixed kidneys only caused a marked decrease in arterial perfusion pressure, suggesting that this effect is due to a pure mechanical interaction of the shock wave also found with denaturated kidneys. The observed decrease of urine flow is probably caused by a decreased filtration rate. Since this was not the case in nontreated kidneys being perfused with the effluent of treated kidneys, the reduction of urine flow after extracorporeal shock wave lithotripsy does not appear to be mediated by a humoral factor, but is more likely a result of the mechanically-induced vasodilation with consecutive decline of the glomerular filtration rate. PMID- 10146236 TI - Edge targeting reduces the number of shock waves required for biliary ESWL in vitro. AB - In vitro experiments were conducted to determine if differences in targeting would effect stone fragmentation. Ten pairs of twin gallstones were used. The stones in each pair were identical in volume, diameter, radiolucency, and gross shape. One stone from each pair was subjected to shock waves focused at the center of the stone; the other was treated with shock waves targeted at the edge. Lithotripsy was terminated when all fragments were less than 5mm in diameter. The total number of shock waves used for each stone was recorded. In 7 of 10 pairs, fewer shock waves were required to fragment the edge targeted stone than the center targeted stone. In two of the remaining three pairs, equal numbers of shock waves were required for complete fragmentation. The difference between edge targeting and center targeting was shown to be statistically significant using the nonparametric Wilcoxin Signed Rank Test. (1 tailed = p less than 0.02, 2 tailed = p less than 0.04). These findings suggest that the outcome of biliary lithotripsy may be improved by targeting the edge of the stone. PMID- 10146237 TI - Biliary extracorporeal shock wave lithotripsy: the efficacy and safety of concomitant catheter cholecystostomy during biliary lithotripsy. AB - The major limitations of biliary extracorporeal shock wave lithotripsy (ESWL) relate to adequate stone fragmentation and clearance of the stone fragments. We hypothesized the removal of small fragments with concomitant catheter cholecystostomy during ESWL would improve its efficacy. ESWL with aspiration or flushing through three different cholecystostomy catheters was performed on pigs with surgically implanted gallstones. Twenty-two percent and 46% of the pre-ESWL stone weight were aspirated through the 10 and 12 French catheters respectively. The clearance, size, and visualization of fragments was not significantly different between any of the groups. No significant post-mortem tissue or catheter damage was found. Catheter aspiration is a safe and effective method of removing gallstone fragments during biliary ESWL, but it does not improve stone fragmentation, stone clearance, or visualization of other fragments. PMID- 10146238 TI - Design of synthetic polymeric structures for cell transplantation and tissue engineering. AB - Two approaches for cell transplantation and new tissue constructions are discussed. In one case, a novel synthetic polyphosphazene has been synthesized that can be gelled by simply adding ions to it at room temperature under aqueous conditions. This polymer has been shown to be compatible for several different cell types. Microcapsular membranes based on the complex of this polymer with poly (L-lysine) allow the inward diffusion of nutrients to nourish the encapsulated cells, but are impermeable to antibodies. In a second approach, biodegradable polyesters have been designed as scaffolds for liver cells and cartilage cells to aid in organ regeneration. Design of the polymer scaffold including the characterization of the surface chemistries for cell attachment, as well as in-vitro and in-vivo data on cell behavior are presented. PMID- 10146239 TI - Poly(HEMA)-collagen composite as a biomaterial for hard tissue replacement. AB - This article briefly reviews the possibilities for hard tissue replacement with a new biomaterial. The basic differences found experimentally for polymer (HEMA) and collagen composite at the biological environment are stressed. The influence of the collagen distribution and matrix porosity of composite material on biodegradation is also discussed. PMID- 10146240 TI - In-vivo and clinical evaluations of poly(L-lactide) plates and screws for use in maxillofacial traumatology. AB - The possible application of biodegradable osteosynthesis material presents many advantages over conventional metallic devices. This study was concerned with the in-vivo evaluation of poly(L-lactide) with different molecular weights, in particular in regard to their mechanical strength, changes of molecular weight and their tissue response. It was found that poly(L-lactide) has acceptable mechanical strength for use in maxillofacial traumatology. In another trial, mandibular fractures of 12 dogs were successfully stabilized with resorbable plates and screws made of this polymer. Finally, the results of a pilot study of its clinical application in the treatment of zygomatic fractures have been presented. PMID- 10146241 TI - Ultra-high strength, self-reinforced absorbable polymeric composites for applications in different disciplines of surgery. AB - Biodegradable (or absorbable), self-reinforced polymeric composites have potential applications as temporary fixation materials in the treatment of damaged or operated tissues. These materials have high strength and appropriate stiffness and strength retention which can be tailored according to the healing rate of recovering tissues. Macroscopical, absorbable, ultra-high strength, self reinforced, polymeric composites can be manufactured by creating the polymeric microstructure, where oriented reinforcing elements and matrix material, which have the same chemical element composition, are combined with each other. Self reinforced materials can be processed into the form of rods, screws, tacks, cerclages, clamps, plates, spirals, etc. Such implants have attractive application possibilities in different disciplines of surgery, such as orthopaedics and traumatology, in maxillofacial, oral and dental surgery and in internal organ surgery. PMID- 10146242 TI - Tetrahydrofuran (co)polymers as potential materials for vascular prostheses. AB - Polyethers were studied as potential materials for vascular prostheses. By crosslinking poly(tetramethylene oxide)(PTMO) with poly(ethylene oxide)(PEO), hydrophilic networks were obtained containing PTMO as well as PEO. Attempts were made to reduce the crystallinity and melting point of PTMO because of the required elastomeric behaviour at body temperature. Compared to non-crosslinked PTMO, crosslinking in the melt resulted in a decrease in the melting point from 43.7 to 38.4 degrees C and a decrease of the crystallinity from 46 to 28%. By copolymerizing tetrahydrofuran with oxetane or dimethyloxetane, melting points below 38 degrees C were obtained, together with crystallinities lower than 20%. PMID- 10146243 TI - An improved method of endothelial seeding on small caliber prosthetic vascular grafts coated with natural extracellular matrix. AB - The feature that clearly distinguishes natural blood vessels from their artificial counterparts is the presence of the endothelial cell lining that, besides being non-thrombogenic, is capable of repair and renewal. This study describes a method of coating vascular grafts with a uniform naturally produced subendothelial extracellular matrix (ECM) prior to implantation. Bovine aortic endothelial cells were seeded at a low density on untreated GORE-TEX, GORE-TEX that was precoated with ECM, or GORE-TEX that was first coated with fibronectin and then with ECM. The cells were maintained in the absence of fibroblast growth factor (FGF) and the cell number determined after 7 days in culture. Poor growth was observed on untreated GORE-TEX (6030 +/- 1030 cells/well), a 10-fold improved growth was observed on ECM coated GORE-TEX (59900 +/- 1560 cells/well) and best results were obtained on fibronectin-ECM precoated GORE-TEX (131000 +/- 21000 cells/well). The thrombogenicity of the ECM was reduced by a mild glutaraldehyde treatment, performed prior to seeding the cells, accompanied by a 40-50% reduced endothelial cell growth. These results indicate that ECM provides a suitable biolayer for endothelial cell adhesion, growth and differentiation. It contains both adhesion glycoproteins (fibronectin, laminin, collagen) and endothelial cell growth factors (basic fibroblast growth factor) that support adhesion and normal growth of suboptimal concentrations of endothelial cells. We suggest that the presence in ECM of both adhesive macromolecules and potent endothelial cell growth promoting factors will make the ECM a promising substrate for vascular grafts. PMID- 10146244 TI - Analysis of biomedical polymer surfaces: polyurethanes and plasma-deposited thin films. AB - The surface characterization of biomaterials is important for understanding the biological reactivity of surfaces and for monitoring surface reproducibility and contamination. Electron spectroscopy for chemical analysis (ESCA), secondary ion mass spectrometry (SIMS), contact-angle methods, vibrational spectroscopic methods, and scanning probe microscopies are briefly reviewed. Examples are presented using these methods to characterize RF plasma-deposited surfaces based upon acetone and oxygen for cell culture and Biomer? surfaces. PMID- 10146245 TI - Safety and intracardiac function of a silicone-polyurethane elastomer designed for vascular use. AB - No ideal prosthetic heart valve exists. While polyurethane copolymers possess excellent physical properties, thrombosis and embolism remain a problem and compounds designed to be less thrombogenic have been prone to biodegradation and failure ('cracking'). We tested a new material which has an elastomeric silicone applied to the polymer surface. A hydrophilic film of protamine and gelatin is covalently bonded to the silicone--this obviates the need for preclotting and should permit endothelial growth. The material was tested by implantation during cardiopulmonary bypass as patches in the mitral valve of six weanling sheep (weanling sheep provide a standard model of accelerated calcification for bioprosthetic heart valves). Prosthetic valves constructed from the material were implanted in an additional four animals, but all of these died within 30 days with heavily calcified valves. Four of the six animals with patches survived and were sacrificed 180 days after surgery when the patches were found to be well healed to native tissue, with collagenous ingrowth and partial endothelial covering. Scanning electron microscopy confirmed good healing, tissue ingrowth and good surface endothelium. The material functioned well as a patch in the mitral valve, allowing tissue ingrowth and endothelial growth on the surface of the patch. The material is not able to resist the strains experienced by a mitral valve prosthesis. Prospects for improved polymers for intravascular applications are good. PMID- 10146246 TI - A morphine-triggered delivery system useful in the treatment of heroin addiction. AB - The ultimate objective of this work is to develop a device that can be triggered by morphine to release naltrexone. Two device configurations are described. In one configuration, naltrexone is dispersed in cellulose acetate phthalate microspheres which are then spray-coated with trilaurin. In the other configuration, naltrexone is dispersed in an n-octyl half ester of methyl vinyl ether and maleic anhydride copolymer and the mixture fabricated into a disk which is then coated with trilaurin. The microspheres are designed to release naltrexone abruptly while the disks are designed to release naltrexone at a constant rate over a two week period. The microspheres, or the disk along with a reversibly inactivated lipase are placed inside a semipermeable membrane that allows free passage of morphine and naltrexone but excludes the higher molecular weight components of the device. Reversible inactivation of lipase is achieved by covalent attachment of morphine and complexing with morphine antibody. Activation of the device occurs by diffusion of morphine into the device and displacing the lipase-morphine conjugate from the antibody. The activated lipase then removes the trilaurin protective coating, thus triggering naltrexone release. PMID- 10146247 TI - Glucose-sensitive polymeric matrices for controlled drug delivery. AB - Hydrogel matrices were prepared by chemical polymerization of solutions containing 2-hydroxyethyl methacrylate, N,N-dimethyl-aminoethyl methacrylate, tetraethylene glycol dimethacrylate, ethylene glycol and water solutions containing glucose oxidase, bacitracin or insulin. The hydrogels displayed faster and higher swelling and release rates at lower pH or at higher glucose concentrations. Swelling and release kinetics were also responsive to step changes in glucose concentration in the physiological range. The kinetics of the soluble and immobilized enzyme followed Michaelis Menten's kinetics. In the soluble state the enzyme was more active than the immobilized one due to mass transfer limitations, which may be overcome by preparation of microbead configuration. PMID- 10146248 TI - The efficacy of controlled antibiotic release for prevention of polyethyleneterephthalate- (Dacron-) related infection in cardiovascular surgery. AB - Infection of prostheses containing polyethyleneterephthalate (Dacron) remains a dreaded complication in cardiovascular surgery despite perioperative antibiotic (AB) prophylaxis. Dacron, which is widely applied as a fabric for manufacturing vascular prostheses and also the sewing rings of artificial heart valves, remains a source for infection once implanted in the body. In order to increase the AB concentration in Dacron, an experimental study including topical application of the gentamicin derivative EMD 46/217 and fibrin sealant (F) as AB carrier was initiated. In-vitro pretreatment of Dacron with the gentamicin derivative and F was followed by constant AB release for three weeks. In a subsequent animal study, four Dacron rings with different pretreatments were implanted in the descending aorta of ten pigs after direct contamination with 10 8 Staph. aureus solution. One ring was pretreated with the AB/F compound, a second ring with the AB alone. Ring 3 (no pretreatment) and ring 4 (F alone) served as controls. After one week, the Dacron rings and their corresponding implantation sites were asserved for measurement of AB content and for culture. The AB content of AB/F rings was 24.99 +/- 7.16 mug/g wet weight, while Dacron rings pretreated with the AB alone contained no measurable drug amounts, with the exception of one specimen (0.5 mug/g)(AB/F versus AB rings: P less than 0.0005).(ABSTRACT TRUNCATED AT 250 WORDS) PMID- 10146249 TI - Ultrasound for controlled delivery of therapeutics. AB - Release of substances from polymeric drug delivery systems can be repeatedly modulated at will through ultrasound. Nondegradable-diffusion controlled and degradable-erosion controlled polymeric delivery systems have both been shown to have enhanced kinetics of release when exposed to ultrasonic energy. The effect of ultrasound was also evaluated on skin and synthetic membranes permeability. The main factors contributing to this effect included mixing, temperature, cavitation, acoustic streaming and polymer morphological changes. These phenomena have appealing therapeutic and commercial possibilities, as many drugs may benefit from subtle delivery pattern under temporal control to obtain optimal therapeutic effects. PMID- 10146250 TI - Large loop excision of the transformation zone (LLETZ) as an alternative to both local ablative and cone biopsy treatment: a series of 1000 patients. AB - One thousand patients, referred to the Oxford Colposcopy Clinic, were treated with either large loop excision of the transformation zone (LLETZ, 891 cases) or LLETZ cone (109 cases). Forty-five LLETZ cones were performed empirically, 64 under microcolposcopic guidance. Over 98% of patients were managed as outpatients under local anaesthesia, and 87% of new patients treated with LLETZ had treatment at their first visit. Ninety percent of patients had at least cervical intraepithelial neoplasia grade one (CIN I) and 73% had CIN II or worse. Seventeen cases of invasive or possibly invasive disease were detected, 6 of them unsuspected. The overall rate of complete excision of CIN or worse was 72%. Follow-up was cytologic with or without colposcopy depending on lesion severity. Ninety-one percent of 967 treated patients were free of dyskaryosis at a mean follow-up of 23 months, with complete excision of CIN or worse at LLETZ a significant predictive factor. No cases of invasive carcinoma have developed following treatment. Major morbidity was uncommon, with 3.8% severe hemorrhage. Stenosis was noted in 3.8% cases, mostly after LLETZ cone. One patient (0.1%) has reduced fertility possibly attributable to LLETZ. Questionnaire assessment revealed a very high degree of acceptability of the treatment to patients. LLETZ and LLETZ cone have proved highly acceptable and effective outpatient diagnostic and treatment alternatives to both local ablation and cone biopsy in the Oxford Colposcopy Clinic. PMID- 10146251 TI - Vaginal hysterectomy for myomatous polyp. AB - Vaginal hysterectomy was performed in 28 perimenopausal women with large myomatous polyps protruding from the cervix. The vaginal route was selected for hysterectomy instead of the usual abdominal approach, based on assessment made after examination under anesthesia following polypectomy. All patients made an uneventful recovery. In women who need hysterectomy, we recommend that removal of myomatous polyps vaginally should be followed by a thorough assessment for deciding the route of hysterectomy. In most cases, the choice would be vaginal hysterectomy, sparing the women the trauma of an abdominal operation. PMID- 10146252 TI - Proposed criteria for the selection of patients for ambulatory therapy of acute gonococcal salpingitis. AB - No firm criteria have existed that delineate which patients with acute gonococcal salpingitis can be managed successfully on an outpatient basis and which patients would be best handled by hospitalization. This article describes one individual's rationale for selecting candidates for ambulatory therapy of acute salpingitis. PMID- 10146253 TI - Advisory Council on Health Promotion of the life and health insurance industry: a short history, a large legacy. PMID- 10146254 TI - A comprehensive smoking cessation program for the San Francisco Bay Area Latino community: Programa Latino Para Dejar de Fumar. AB - Background. Prevalence of cigarette smoking among Latinos compared to whites is higher among men (30.9% versus 27.9%), but lower among women (16.3% versus 23.5%). More acculturated Latina women, however, smoke more. Compared to other smokers, Latinos report consuming about half the average number of cigarettes per day. Up to a quarter of Latino smokers of less than 10 cigarettes per day may be underreporting consumption. The association between smoking and depression has also been found in Latinos. Program Goals. The Programa Latino Para Dejar de Fumar (Programa) goals are: 1) to evaluate attitudinal, behavioral, and cultural differences between Latino and white smokers; 2) to integrate these findings into a comprehensive, culturally-appropriate smoking cessation intervention; and 3) to implement the intervention in a defined community in order to decrease cigarette smoking prevalence, increase behaviors that may lead smokers to quit, and promote a nonsmoking environment. Program Components. Heightened concern about health effects of smoking, the importance of social smoking, and the influence of the family on behavior are integrated in the Programa components: 1) the promotion of a full-color, Spanish-language, self-help, smoking cessation guide (Guia), distributed at no charge; 2) an anti-smoking, Spanish-language, electronic media campaign; 3) community involvement; 4) quit smoking contests; 5) smoking cessation, individual, telephone consultations (consultas); and 6) collaboration with health care personnel. Results. Effectiveness of the Programa is being evaluated by annual, cross-sectional, random digit dialing telephone surveys compared to two baseline surveys. After 19 months of intervention, the proportion who had heard of the Programa increased from 18.5% to 44.0%, and over one third of less acculturated smokers had the Guia. Future directions will emphasize smoking prevention among youth, prevention of relapse among quitters, and depression prevention. PMID- 10146255 TI - An analysis of comprehensive health promotion programs' consistency with the systems model of health. AB - Purpose. The purpose of this article is to report a review and analysis of the concordance between current comprehensive corporate health promotion programs as described in the published literature and the systems model of health and to explore emerging trends in the field of health promotion. Search Methods. MEDLINE, BIOSIS, and PsycINFO searches were conducted from 1985 to 1991, and the bibliographies of articles thus obtained were back searched for additional descriptions of corporate health promotion programs. Inclusive criteria included "comprehensive" corporate programs, published in peer-reviewed journals or books, and descriptions adequate enough to permit coding in the majority of analysis matrix categories. Out of 63 identified programs, 16 met the inclusion criteria; 47 were excluded. A common reason for rejection was the limitation imposed by inadequate program descriptions in the published literature. Major Findings. On average, the comprehensive corporate programs reviewed were initiated between 1984 and 1987 and set in the context of a manufacturing firm with over 10,000 employees. A minority of programs (12.5%) consistently satisfied systems model criteria. The most common category of programs were those which were inconsistent (44%), meeting some of the criteria of a systems model of health promotion, but not all. The mechanistic medical and public health models predominated strongly (63%) with the preeminent goal being individual risk factor modification. Conclusions. The limitations of the published literature do not permit strong conclusions about the number or degree to which current corporate comprehensive programs are concordant with the systems model of health. Although mechanistic models of health predominated, there is evidence that a number of comprehensive programs were inconsistent with the mechanistic model, meeting some of the criteria, but also meeting some systems model criteria. To continue the advancement of health promotion with clarity and focus, further research is needed to clarify outcomes across different "world view" models of health promotion. Health promotion specialists need to carefully scrutinize programs emanating from different "world view" models as they design, develop, implement, and evaluate corporate programs. PMID- 10146256 TI - 1992 National Survey of Worksite Health Promotion Activities: summary. US Department of Health and Human Services Public Health Service. PMID- 10146257 TI - The increasing role of transesophageal echocardiography in unexplained cerebral ischemia. AB - Cerebrovascular disease is a leading cause of morbidity and mortality in the United States. A significant number of cerebral infarctions are due to a cardiac source of embolus. Transesophageal echocardiography (TEE) is being used with increasing frequency to study patients with potential cardiac causes of cerebral ischemia. TEE has a higher sensitivity for detecting left atrial and left atrial appendage thrombi and for visualizing abnormalities of the atrial septum such as patent foramen ovale and aneurysm. Abnormalities of the aorta and native and prosthetic valves can now be clearly identified by TEE. Preliminary data suggest that TEE may influence clinical management in patients with unexplained stroke. PMID- 10146258 TI - Neurologists' perspective in the evaluation of ischemic stroke. AB - The evaluation of victims of ischemic stroke has evolved over the last few years, primarily as a result of the introduction of innovative, sensitive, and informative diagnostic procedures. The role of the neurologist appears to have been redefined as one in which the identification of the presumptive cause and mechanism of the stroke is one of the primary responsibilities. The trend towards classification of patients into stroke subtypes, based upon etiology and pathogenesis, has led to a shift in care to a more etiology-specific approach. The inclusion of results of ancillary tests in the criteria utilized for stroke subtype classification has expanded the neurologists' ability to ascertain the presumptive etiology of many strokes that in the past were considered of unknown etiology. This has also resulted in an apparent increase in the proportion of ischemic strokes presumably due to cardiogenic embolism. The impact of transesophageal echocardiography upon changes in the presumptive etiology of ischemic stroke is illustrated, underscoring the future collaboration of neurologists and cardiologists in the evaluation of victims of presumed cardiogenic ischemic stroke. PMID- 10146259 TI - Echocardiography in the evaluation of cardiac sources of emboli: the role of transthoracic echocardiography. AB - Cardioembolism is responsible for a significant number of systemic emboli including approximately 15% of all ischemic strokes. Transthoracic echocardiography has contributed to the understanding of cardioembolism and has been used to detect specific and potential cardiac sources of systemic emboli and risk stratify patients with specific clinical findings for subsequent cardiovascular events. Findings from transthoracic echocardiography indicate that stasis is an important prerequisite for intracardiac thrombosis while reversal of stasis and thrombolysis appear operative in embolism of existing thrombus. Transthoracic echocardiography allows a sensitive and specific noninvasive means to detect left ventricular thrombus, valvular vegetation, and intracardiac tumor, lesions that are directly responsible for cardioembolism. Transthoracic echocardiography can also detect lesions that could potentially contribute to cardioembolism but are not specific causes. Examples of these potential lesions include mitral valve prolapse, patent foramen ovale, and interatrial septal aneurysm. Finally, population-based studies and prospective clinical trials have indicated that the results of transthoracic echocardiography have predictive value for subsequent cardiovascular events and hence provide a means for stratification of patients at risk for cardioembolism. The latter is most notable for the group of patients with nonvalvular atrial fibrillation where left ventricular dysfunction and increased left atrial size are independent predictors for subsequent stroke. PMID- 10146260 TI - Transthoracic echocardiography versus transesophageal echocardiography in detecting cardiac sources of embolism. AB - Although the yield of potential cardiac sources of embolism by echocardiography in patients with stroke and arterial embolism has been low, with the advent of transesophageal echocardiography, a renewed enthusiasm for echocardiography in these patients has developed. This article reviews the six major studies comparing transthoracic to transesophageal echocardiography in the search for potential cardiac sources of embolism. The overall yield of transesophageal echocardiography in these studies for potential cardiac sources of embolism is 43% compared to 14% by transthoracic echocardiography in a total of 367 patients. In patients without clinical cardiac disease, the yield is lower but still substantially higher by transesophageal echocardiography (24% compared to 7% by transthoracic echocardiography). For left atrial thrombus, left atrial spontaneous contrast, patent foreman ovale, and atrial septal aneurysm (ASA), transesophageal echocardiography is clearly superior than transthoracic echocardiography. Data on the detection of mitral valve prolapse and left ventricular thrombus are conflicting and neither method is clearly superior. In addition, transesophageal echocardiography identifies certain abnormalities including debris in the aorta and prosthetic strands that transthoracic echocardiography is incapable of identifying. Although transthoracic echocardiography should continue to be the initial screening modality for stroke patients, transesophageal echocardiography should be performed when surface findings are negative or equivocal in patients with likely cardioembolic stroke. PMID- 10146261 TI - The role of transesophageal echocardiography in the detection of left atrial thrombi. AB - Sensitivity of transthoracic echocardiography in the detection of left atrial thrombi, in particular thrombi confined to the left atrial appendage, is surprisingly low (33%-72%). Concerning the detection of left atrial thrombi, transthoracic echocardiography appears as an inadequate technique in patients with suspected cardiogenic embolism with a success rate of only 0.8% in earlier, and about 3% in recent studies. Imaging from the esophagus substantially increases the detection rate for left atrial thrombi, and is the only clinically relevant semiinvasive technique to diagnose thrombi confined to the left atrial appendage. Transesophageal echocardiography has markedly increased the diagnostic power of cardiovascular ultrasound in patients with suspected cardiogenic embolism and/or atrial fibrillation. Meta-analysis of pooled studies using the transesophageal approach in these patients revealed thrombi within the left atrial cavity in about 7% and within the atrial appendage in about 12% of cases. PMID- 10146262 TI - Protruding atheromas in the thoracic aorta: a newly recognized source of cerebral and systemic embolization. AB - Up to 40% of stroke patients do not have an obvious etiology for their illness. Because transthoracic echocardiography is often negative in these patients, there has been increasing enthusiasm for transesophageal echocardiography (TEE) as a newer tool for evaluating patients with embolic disease. In a study of patients referred because of unexplained stroke or transient ischemic attacks, the most common finding was protruding atheroma in the aortic arch. In a case control study, protruding aortic atheromas were found in 33 of the 122 patients with emboli (27%). Mobile components to the atheromas were found in 11 case patients, and there were no mobile components found in any control patients. It is also possible that protruding aortic atheromas may play a role in patients with other sources of emboli (e.g., carotid disease). Atheromas may also cause emboli during catheterization, balloon pump placement, and cardiopulmonary bypass. The pathological composition of the lesions seen on TEE has been atheroma with superimposed thrombus. The correct treatment for patients with embolization due to protruding aortic atheromas has not yet been determined, although anticoagulation may play a role, since the mobile components to these lesions appear to be thrombus. We have recommended surgery for several patients. However, the operation is a major one with major potential complications, including aortic dissection. TEE should be done in patients with unexplained emboli, and it may also play a role in patients with other sources of embolization. TEE should be considered in elderly patients or those with extensive vascular disease before cardiac catheterization or heart surgery. In addition, cannulation techniques during bypass can be modified to avoid atheromas. The ideal medical and/or surgical approaches to patients with protruding atheromas remain to be clarified. PMID- 10146263 TI - The role of echocardiography in the evaluation of cardiac source of embolism: left atrial spontaneous echo contrast. AB - Left atrial (LA) spontaneous echo contrast, also known as "smoke," is a frequent transesophageal echocardiographic finding characterized by swirling, smokelike echoes in the LA cavity or appendage. LA smoke is associated with conditions favoring stasis of LA blood, including atrial fibrillation, mitral stenosis, the absence of mitral regurgitation, and LA enlargement. LA spontaneous echo contrast is a marker of previous embolic events in patients with atrial fibrillation, mitral stenosis, or mitral valve replacement. Most LA thrombi are accompanied by smoke. Recent studies show that LA spontaneous echo contrast is also associated with increased fibrinogen, hematocrit, and blood viscosity, indicating a relatively hypercoagulable state in addition to stasis. These findings suggest that LA spontaneous echo contrast is a manifestation of erythrocyte aggregation, and that hematologic factors may contribute to the association between spontaneous echo contrast and thromboembolism. PMID- 10146264 TI - Cholesterol screening and cholesterol-lowering regimens examined. PMID- 10146265 TI - Cord dorsum potentials suppressed by low power laser irradiation on a peripheral nerve in the cat. AB - The effects of low-power helium-neon laser irradiation on the cord dorsum potentials (CDP) evoked by electrical nerve stimulation of a distal portion of exposed sural nerve were observed in unanesthetized decerebrate cats. These evoked CDP were significantly suppressed (25.6 +/- 2.5%, p less than 0.01) during low-power laser irradiation. It is suggested that the analgesic effects of low power laser irradiation is based on the decrease of ascending signals from the spinal cord to the higher central nervous system. The suppressive effect of low power laser irradiation upon the impulse transmission of nerve fibers is discussed. PMID- 10146266 TI - Comparison of three lasers on dental pulp chamber temperature change. AB - Previous studies have reported dental pulp chamber temperature changes using only one beam size per laser. This study was designed to evaluate the effects of beam size, wattage, and energy density on pulp chamber temperature changes of extracted human teeth for three lasers (CO 2, Argon, Nd:YAG). During laser irradiation of the outer enamel surface, a thermocouple was placed in the pulp chamber which measured and recorded the temperature changes. This was done for each combination of lasing dosimetry parameters. In all cases the recorded temperatures increased with the increase in beam size for a given energy density (J/cm 2) and wattage. Also, the recorded temperatures increased with increased energy density for a given wattage and beam size. PMID- 10146267 TI - Laser-assisted fibrinogen bonding of umbilical vein grafts. AB - Despite success with autologous tissue welding, laser welding of synthetic vascular prostheses has not been possible. The graft material appears inert and fails to allow the collagen breakdown and electrostatic bonding that results in tissue welding. To develop a laser welding system for graft material, we repaired glutaraldehyde-tanned human umbilical cord vein graft incisions using laser-assisted fibrinogen bonding (LAFB) technology. Modified umbilical vein graft was incised transversely (1.2 cm). Incisions were repaired using sutures, laser energy alone, or LAFB. For LAFB, indocyanine green dye was mixed with human fibrinogen and the compound applied with forceps onto the weld site prior to exposure to 808 nm diode laser energy (power density 4.8 W/cm 2). Bursting pressures for sutured repairs (126.6 +/- 23.4 mm Hg) were similar to LAFB anastomoses (111.6 +/- 55.0 mm Hg). No evidence of collateral thermal injury to the graft material was noted. In vivo evaluation of umbilical graft bonding with canine arteries demonstrates that LAFB can reliably reinforce sutured anastomoses. The described system for bonding graft material with laser exposed fibrinogen may allow creation or reinforcement of vascular anastomoses in procedures where use of autologous tissue is not feasible. PMID- 10146268 TI - A preliminary report on the Stone-Kaplan instrumentation for CO 2 laser periodontics. Phase I: periodontal pocket opening surgical procedure. AB - A preliminary report on the Stone-Kaplan instrumentation for CO 2 laser periodontics is presented describing the instrumentation and introducing the first phase of its clinical usage. The design enables the introduction of a hollow fiber delivered CO 2 laser beam into the depth of a periodontal pocket enabling invasive surgical procedures to be carried out with exacting control of the laser beam as afforded by the design of the instrumentation. This design enables the performance of pocket-opening surgical procedures with ease of performance for the operator enhanced by the "instrument-in-hand" tactile feedback and blind-visualization phenomena afforded by this unique design. The basic performance for a periodontal pocket opening procedure is presented here. PMID- 10146269 TI - Subglottic plasmacytoma: the use of jet ventilation and contact Nd:YAG laser for tissue diagnosis. AB - Extramedullary plasmacytomas (EMP) constitute only 1% of all head and neck malignancies, with the vast majority occurring in the upper respiratory tract. The diagnosis of laryngeal EMP can be difficult since the symptoms are non specific and the tumor usually mucosally covered. This paper discusses the successful combination of jet Venturi ventilation technique with suspension microlaryngoscopy and contact Nd:YAG laser for tissue diagnosis in a patient presenting with a large subglottic mass. Previous attempts using standard endotracheal intubation and forceps technique for biopsy failed to reach the diagnosis and resulted in significant bleeding from the biopsy site. A review of the disease and technique is presented. PMID- 10146270 TI - Laparolithic cholecystectomy: laboratory data and first clinical case. AB - A method of laparoscopic cholecystectomy is described. After control of the cystic duct and artery, gallstones are emulsified with a laparoscopic lithotriptor and the debris aspirated from the gallbladder. The free wall of the gallbladder is excised and the remaining gallbladder mucosa ablated with holmium:yttrium-aluminum-garnet (Ho:YAG) laser. This technique eliminates the need for dissection of the gallbladder from the liver, thereby reducing the possibility of hemorrhage from the gallbladder fossa. At the same time stones and bile are aspirated so that the excised portion of gallbladder can be easily removed through an access port without spillage of contaminated bilious debris into the abdominal cavity or puncture wound that could cause infection. Acute and chronic animal studies confirm the feasibility of this technique. A clinical case is described. PMID- 10146271 TI - Q-switched ruby laser used to remove pigmented lesions. PMID- 10146272 TI - Photodynamic therapy using new photosensitizer shows promise for skin tumor treatment and possibility for psoriasis treatment. PMID- 10146273 TI - Photodynamic therapy curbs ovarian cancer. PMID- 10146274 TI - Use of Nd:YAG laser in the excision of Morton's neuroma. PMID- 10146275 TI - The krypton laser: new yellow-green laser shows promise for dermatology. PMID- 10146276 TI - A microspray nozzle for local administration of liquids or suspensions to lung airways via bronchoscopy. AB - A microspray nozzle has been developed for the localized administration of solutions or suspensions to discrete pulmonary airway regions via bronchoscopy. Toxicants or tracer particles can be administered to single or multiple, specific lung airway segments. This permits studies of local-airway, whole-lung, and systemic responses to inhaled materials. The nozzle is fabricated by ultra precision machining, has an overall length of 1 mm, and a diameter small enough to fit in the end of a 1.1-mm inner diameter, 1.2-mm outer diameter catheter. In vitro studies demonstrated the delivery efficiency for 99mTc solutions (98 +/- 1% SD) and for suspensions of 99mTc sulfur colloid or 3-mum 85Sr-labeled microspheres (55 +/- 15%). Photographic and gamma camera images of material deposited in the airways of Beagle dogs demonstrated in vivo that the deposition patterns are compact and uniform. The technique may also have therapeutic medical applications. PMID- 10146277 TI - The relationship between powder inhaler resistance and peak inspiratory conditions in healthy volunteers--implications for in vitro testing. AB - Despite the fact that powder inhaler devices have been available for over 3 decades there is still very little fundamental information as to how powder inhaler design interacts with the airway dynamics of patients. This paper documents the results of human volunteer investigations designed to elucidate this interaction. These data indicates that if 'maximum' inhalation effort is employed the flow rate attained through an inhaler is controlled by the maximum pressure drop developed by the chest muscles. If a moderate or 'comfortable' effort is used, however, the relationship is more complex. An equation for defining the 'respirable fraction' of an inhalation aerosol cloud as a function of inhalation flow rate is also proposed. PMID- 10146278 TI - Long-term infusion. PMID- 10146279 TI - The technique of small-catheter pleural aspiration. A new, less invasive method for draining pneumothoraces. AB - Small-catheter aspiration may be preferable to chest tube drainage in many patients with primary spontaneous or iatrogenic pneumothoraces, as well as in some patients with pneumothoraces resulting from minor trauma. It is also less invasive than chest tube drainage, allows greater control over the rate of air removal, and produces less patient discomfort. Following administration of a local anesthetic, the catheter can be inserted into the pleural space using either a trocar or modified Seldinger technique. Addition of a Heimlich valve (with or without a suction device) permits continued air removal. Complications are infrequent and generally minor. PMID- 10146280 TI - An in vitro comparison of surface strain patterns in cementless femoral arthroplasty. AB - A hypothesis associated with applications of contemporary cementless pressfit femoral stem designs is that stems which uniformly fit the proximal medullary canal of the femur will result in load transmission patterns which approximate those of a normal femur. The objective of this study was to examine biomechanical variables such as implant/bone fit and the associated load transmission patterns of the proximal femur before and after cementless femoral arthroplasty utilizing the technique of reflection photoelasticity. Harris Galante (Zimmer), S-ROM (Joint Medical Products), and INFINITY prostheses were implanted in cadaveric femora and subjected to conditions simulating single-limb stance loading. The bone/implant constructs were later transversely sectioned and fit was analyzed. Insertion and subsequent loading of both prothesis types resulted in a large decrease in strain in the medial calcar of each intact control. Visual examination of the Harris-Galante prosthesis under polarized light revealed patchy, localized areas of high strain along the proximal region. In contrast, the modular prostheses displayed more uniform and diffuse strain profiles with minimal regions of localized strain. In all cases, the surface strain patterns produced by cementless femoral arthroplasty correlated with the pattern and degree of implant/bone fit. PMID- 10146281 TI - Optimum acetabular component fixation. AB - Acetabular pressfit fixation depends on rigid initial fixation, subchondral bone preservation, and close apposition to allow biologic interface incorporation. A hemispherical cup with a 1 to 2 mm pressfit offers optimal fixation and adjunct fixation with screws or pegs appears to be limited. Pressfit continues to be the ideal fixation choice for most patients. PMID- 10146282 TI - Rationale and clinical application of hydroxyapatite coatings in pressfit total hip arthroplasty. AB - Although the long-term clinical results of cemented total hip arthroplasty are quite good, there is a significant problem with failure after approximately 10 years, especially with younger patients. Uncemented total hip arthroplasty has been developed in response to prosthesis loosening due to cement fragmentation and osteolysis. Porous-coated hip stems have been used, with generally promising results. However, clinical studies of porous-coated prostheses have revealed findings of concern such as thigh pain, subsidence of the femoral prosthesis, and radiographic lucencies at the bone-prosthesis interface. Hydroxyapatite coatings were developed to improve the fixation of uncemented prostheses. This article discusses the chemical, mechanical, and biological properties of hydroxyapatite coatings, and reviews the biologic behavior of experimental hydroxyapatite-coated implants. The clinical and radiographic results of a 4-year prospective trial are presented. The authors conclude that the reported experimental evidence, as well as the early clinical experience of this series and others, support the continued clinical evaluation of hydroxyapatite-coated titanium for total hip arthroplasty in younger, active patients. PMID- 10146283 TI - Optimum pressfit and proximal stress transfer with an improved modular design in total hip arthroplasty. AB - Femoral stem pressfit fixation depends on optimal proximal fit and stress transfer for long-term function. Newer modular designs offer improvements that enhance proximal-distal sizing, anatomical canal fill in the proximal metaphysis, and better stress transfer resulting from more intimate cortical contact. The Infinity modular femoral stem has the unique advantage of very proximal loading and gains fixation with a flexible stem that allows matching the variables of anteversion and proximal metaphyseal bow. PMID- 10146284 TI - Hospitals minimize risks with cautious buying. PMID- 10146285 TI - Specialists compete in feeding tube placement. PMID- 10146286 TI - PET challenges biopsy in fight to justify cost. PMID- 10146287 TI - MR, CT enhance diagnosis of pulmonary emboli. PMID- 10146288 TI - Venous access devices: low-cost convenience. PMID- 10146289 TI - Ultrasound unit features reduction of speckle. PMID- 10146290 TI - Finally: the recognition of PPOs as viable managed care programs. PMID- 10146291 TI - Automated credentialing: a practical approach to quality measurement. PMID- 10146292 TI - Approaching hidden psychiatric illness in PPOs: the "Medical Offset" effect. PMID- 10146293 TI - Staying competitive in the 1990s: value-added services. PMID- 10146294 TI - Analyzing network accessibility. PMID- 10146295 TI - CO 2 laser-resistant endotracheal tube shows no clear advantage. PMID- 10146296 TI - Prolonged ECMO in two children with severe ARDS. PMID- 10146297 TI - Current recommendations on breast cancer treatment. PMID- 10146298 TI - Selecting the best stress test for each patient. PMID- 10146299 TI - An assessment of the need for the voiding cystourethrogram for urologic screening prior to renal transplantation. AB - A retrospective review of the records of 450 patients who were evaluated for renal transplantation was undertaken to determine whether a voiding cystourethrogram (VCUG) influenced the surgical care of the recipient. Three hundred and forty eight of these patients proceeded to transplantation, with 333 of them receiving a VCUG as part of their evaluation. A urologic abnormality was identified by VCUG in 51 individuals, 19 of whom had a known urologic abnormality as the etiology of their renal disease. None of the other 32 patients with abnormalities discovered by VCUG required surgical correction. In the remaining 282 patients the VCUG was normal. The VCUG is not essential for the preparation of potential recipients for renal transplantation and should be utilized selectively in individuals with a history of urologic disease or when urinary tract abnormalities are identified by physical examination or an abnormal urine analysis. PMID- 10146300 TI - Relief of hepatic vein stenosis by balloon angioplasty after living-related donor liver transplantation. AB - We have experienced 5 hepatic vein stenoses in 3 children (8 to 23 months old) after living-related liver transplantation (total 48 liver transplants for 48 children between June 1990 and November 1992). The initial symptoms of hepatic vein stenosis were ascites and/or edema. The blood flow of hepatic vessels was monitored by duplex sonography. The mean velocity of the hepatic vein and the portal vein was decreased and flow wave pattern of the stenotic hepatic vein was flat. The patients were treated by percutaneous transhepatic balloon angioplasty. After a successful angioplasty, the mean velocity of the hepatic vein and portal vein increased and pulsatile waves returned to the hepatic vein. Arterial ketone body ratio (acetoacetate/3-hydroxybutylate) increased, promptly followed by recovery of other liver function tests. In 1 patient, this complication occurred three times with intervals of 7 months and 3 months between episodes of hepatic vein stenosis. In conclusion, hepatic vein flow should be monitored routinely with duplex sonography after living-related donor liver transplantation. Percutaneous transhepatic balloon angioplasty is a primary treatment for the stenosis. PMID- 10146301 TI - Development of an index to predict posttransplant diabetes mellitus. AB - The objectives of this study were to (1) identify risk factors and develop a prediction index for posttransplant diabetes mellitus (PTDM), (2) validate the risk factors and assess the index's predictive ability, and (3) modify the index to enhance its predictive accuracy. Preoperative variables included gender, race, age at transplantation, donor source, number of previous transplants, percentage of ideal body weight, family history of diabetes, and HLA type. Postoperative variables were glucose intolerance on postoperative days 0-3 and 4-7. Age, family history, glucose intolerance during postoperative d 4-7, and specific HLA types were significant independent risk factors for PTDM. No independent effects of race, gender, or donor source were detected. The four independent risk factors produced an equation that accurately predicted PTDM in 77% of the patients. Specificity and negative predictive values reached 75% and 97%, respectively, for the population of men. PMID- 10146302 TI - ExacTech blood glucose meter clinical trial. AB - INTRODUCTION: Current prehospital protocols for the management of patients with altered mental status include the empiric administration of hypertonic glucose, naloxone, and thiamine. The injudicious use of 50% dextrose (D50W) may result in hyperosmolarity, a worsening of hypokalemia, and unwarranted additional health care costs for the patient. The administration of D50W also may worsen the neurological outcome of patients with local or generalized ischemia. OBJECTIVE: To evaluate the ExacTech blood glucose meter's ability to estimate blood glucose levels accurately and rapidly. METHODS: Emergency medical technicians (EMTs) from selected advanced life support (ALS) units in the Portland, Ore., metropolitan area participated in a prospective clinical trial of the ExacTech blood glucose meter. A convenience sample was drawn from emergency medical services (EMS) patients with suspected diabetic emergencies, altered mental status, and other neurological deficits. Venous blood samples were drawn from these populations at the same time as the ExacTech readings were obtained. The venous blood was submitted to the receiving hospitals for laboratory analysis of blood glucose levels, and a comparison was made between the results of the two methods. RESULTS: A total of 80 matched sets of data were obtained from 1 April 1990 through 6 May 1991. The hospital blood glucose values ranged from 8 to 1233 mg/dl. Sixteen (20%) of the patients were hypoglycemic (&.lt.60 mg/dl) and 23 (28.8%) were hyperglycemic ( greater than 180 mg/dl). The ExacTech device sensitivity and specificity for hypoglycemia using venous samples were 94.6% and 89.2%, respectively. For hyperglycemia, these same parameters were 87.5% and 97.1%. Pearson's r over the range of the instrument (40-450 mg/dl) was 0.8656 (p less than .001). If the prehospital "definition" of hypoglycemia (for threshold to-treat) is raised to 65 mg/dl, the device has 100% sensitivity in the sample population. CONCLUSION: The device functioned accurately and consistently in the prehospital environment over a wide range of temperatures, and in the hands of many different individuals. PMID- 10146303 TI - Emergent intubation and CT scan pathology of blunt trauma patients with Glasgow Coma Scale scores of 3-13. AB - INTRODUCTION: Widely accepted guidelines for use of pharmacologic agents for prehospital intubation have not been fully developed. Toward the goal of formulating specific guidelines, this study sought to determine how well the Glasgow Coma Scale (GCS) score stratifies the need for emergent intubation (within 30 minutes of emergency department arrival or in the prehospital setting). METHODS: A one-year, retrospective review of the charts of blunt trauma patients with presumed head injury who presented to the emergency department of a Level 1 trauma center with a GCS score of less than or equal to 13 was performed. A total of 120 patients met the inclusion and exclusion criteria. RESULTS: A significant number of patients presenting with a GCS score of less than or equal to 9 required emergent intubation. A significant minority of patients presenting with a GCS score of 10-13 required emergent intubation (20%) or had intracranial pathology on head CT scan (23%), and the majority of patients from this subgroup did not require subsequent intubation. Alcohol or substance intoxication and communication barriers such as deafness and language difficulties limited the clinical examination. CONCLUSIONS: Patients with a presenting GCS score of less than or equal to 9 represent candidates for the use of pharmacologic agents to facilitate aggressive airway control by well-trained and supervised emergency medical technicians (EMTs). Emergent intubation of patients with a GCS score of 10-13 is problematic. Patients with a presenting GCS score of 10-13 must be evaluated individually and closely monitored.(ABSTRACT TRUNCATED AT 250 WORDS) PMID- 10146304 TI - Accuracy of the Prehospital Index in identifying major hemorrhage in trauma victims. AB - PURPOSE: To determine the sensitivity of the Prehospital Index (PHI) in identifying patients with severe blood loss, a one-year review was conducted at a regional trauma facility. METHODS: The study population consisted of 217 consecutive trauma admissions (ages 3 to 88 years). Patients were managed using standard resuscitation techniques; blood transfusions were ordered at the discretion of attending physicians and did not follow any preplanned protocol. Medical records were examined to determine total blood requirements for each patient during the first 12 hours of hospitalization, the emergency department (ED) disposition, and final outcome of treatment. The following clinical variables were analyzed (unpaired t-test) to determine their value as predictors of blood loss: age, gender, mechanism of injury, initial vital signs, revised trauma score, PHI, and injury severity score. RESULTS: Forty-two percent (92 patients) received transfusions during the first 12 hours of hospitalization. The best predictor of blood loss was the Prehospital Index. Of the total group, 45% had a PHI greater than 3; 77% (75/98) of these patients required transfusion and received an average of 7.1 units of packed cells. Fifty-five percent (119/217) had a PHI less than or equal to 3; 86% (102/119) of these patients did not require transfusion. CONCLUSION: The data suggest that patients with PHI scores greater than 3 require close hemodynamic monitoring to rule out significant blood loss and may warrant immediate cross-matching on arrival to the ED. PMID- 10146305 TI - Clinical guidelines for delayed or prolonged transport: IV wounds. Rural Affairs Committee, National Association of Emergency Medical Services Physicians. PMID- 10146306 TI - Effects of ions in aqueous media on hydroxyapatite induction by silica gel and its relevance to bioactivity of bioactive glasses and glass-ceramics. AB - Hydroxyapatite induction by a synthesized pure silica hydrogel was examined in various simulated body fluids (SBFs) having different magnesium, calcium, and phosphate ion concentrations as well as pH values. The silica hydrogel generated biologically active apatite on its surface by taking up calcium and phosphorous ionic groups from a surrounding SBF that was prepared to emulate the human plasma in inorganic composition. The induction period for apatite nucleation on the surface of the silica was largely decreased with the addition of a small amount of the calcium or phosphate ions to the SBF and with an increase in pH, but increased with the addition of magnesium ion. Bioactivity of bioactive materials like Bioglass and glass-ceramic A-W was well interpreted in terms of the rate of apatite formation reflected in these results. Moreover, the results provide the basic knowledge for designing new bioactive materials. PMID- 10146307 TI - Influence of surgeon's tying technique on knot security. AB - The purpose of this study was to determine the influence of the surgeon's tying technique on knot security using 0 and 2-0 monofilament and multifilament nylon sutures. Using an Instron Tensile Tester and a portable tensiometer, knot security was achieved with these sutures using four-throw square knots (1 = 1 = 1 = 1). After didactic and psychomotor skill training, medical students were taught to construct the four-throw square knot using either a two-hand tie or an instrument tie. Using the portable tensiometer, their knot tying techniques were judged to be superior to those used by surgeons. The surgeon's faulty technique can easily be corrected by didactic information and psychomotor skill training. PMID- 10146308 TI - Corneal endothelium cell adhesion on intraocular lenses in vitro. AB - An in vitro evaluation was conducted of the adhesion capabilities of rabbit corneal endothelial cells on intraocular lenses (IOLs) made of heparin-coated polymethylmethacrylate (HSM-PMMA). The concave endothelial surfaces of albino rabbit corneas were placed in contact in vitro with the convex surfaces of the optical side of HSM-PMMA IOLs in 4-day cultures. PMMA IOLs served as controls. After an incubation period, the preparations were examined via phase-contrast microscopy and via inverted microscopy after staining with vital dye (neutral red), both with and without the cornea in place. After fixation and staining with Giemsa, the cells adherent on the lens were counted on five different microscopic fields. It was observed that the corneal endothelial cells adhered equally to heparin-coated and untreated PMMA IOLs. PMID- 10146309 TI - Poly(2-hydroxyethyl methacrylate) particles for preoperative endovascular occlusion of extensive angiodysplasias. AB - The application of superselective endovascular occlusion in vascular radiology has broadened the scope of possible radical surgery of giant angiodysplasias by reducing considerably the risk of severe haemorrhage during the surgery. Occlusion was performed on 229 patients using spherical and cylindrical particles of porous poly(2-hydroxyethyl methacrylate). The treatment of a patient suffering from angiodysplasia of the pelvis is described as an example. The first day following endovascular occlusion a hypercoagulation reaction developed, with a decrease of both the level of fibrinolysis and of anticoagulant factors. This was mainly due to a decrease of the level of antithrombin III and activation of the factor XIII indicating a strong tendency of intravascular thrombosis. During the third day, the hypercoagulation reaction increased. However, on the fifteenth day, parameters of the haemostasis system were close to normal values. Only the activity of the factor XIII remained high suggesting the stabilization and the organization of fibrin clot in the embolized blood vessel territory. PMID- 10146310 TI - Characterization of a synthetic foam as a model for human cancellous bone. PMID- 10146311 TI - Clinical reviews: particulate debris and failure of total hip replacements. PMID- 10146312 TI - I have some further comment concerning "Biocompatibility Tests on a Novel Glass- Ceramic System". PMID- 10146313 TI - Hospital use behaviors and associated costs in a health insurance organization, Japan. AB - Physicians are known to play an important role in the rise of health care costs. But patients--the other side of the chain of health care systems--have been given little attention. The present study utilized the outpatient claims (in the belief that the outpatient hospital visits are mainly decided by the patients) from a health insurance organization in Japan (the Fukuoka Prefecture public service mutual aid association for government employees who serve in small cities, towns, and villages) to analyze the employee behaviors in the use of hospital care and the costs associated with these behaviors. Number of diseases diagnosed for an employee, number of claims an employee submitted for one disease, number of hospitals an employee visited, number of claims an employee had from one hospital, and the total number of claims an employee submitted were used to describe the hospital use behaviors. Results showed that some employees exhibited unusual behaviors, characterized by having an extremely large number of diseases diagnosed, visiting a large number of different hospitals, having a large number of claims, etc. Higher medical expenditures were associated with such behaviors. The findings of this study suggest that the patients' role in the rise of health care costs cannot be ignored, and cost-containment strategies targeting modification of patient behaviors in the use of hospital care may prove to be very useful. PMID- 10146314 TI - Tumor markers: issues from an insurance perspective. PMID- 10146315 TI - Reduction in colorectal cancer mortality related to annual fecal occult blood screening--13 year follow-up of 46,000 subjects. PMID- 10146316 TI - Symptomatic and incipient congestive heart failure--the SOLVD experience. PMID- 10146317 TI - The esophageal-tracheal Combitube. PMID- 10146318 TI - Prototype development and comparative evaluation of wheelchair pressure mapping system. AB - Wheelchair pressure mapping devices used in the prescription of seat cushions and postural supports have been limited in durability, data presentation, and/or clinical efficiency. This project sought to establish the ideal specifications for clinically useful pressure mapping systems, and to use these specifications to influence the design of an innovative wheelchair pressure mapping system (Tekscan "Seat"). Technology, previously developed for measurement of forces of dental occlusion and of the foot during gait, was applied to wheelchair seat mapping. Tests were designed to compare the performance of three pressure mapping systems: the Tekscan system, the FSA system, and the Talley TPM3. Bench tests were done to measure reproducibility, hysteresis, and creep of each of the pressure mapping systems. A contoured loader gauge was developed to test for the influence of hammocking. Tests were also performed using spinal cord-injured subjects to demonstrate the relative performance of the pressure mapping systems in a clinical setting. A focus group session was conducted with seating specialists to review the strengths and weakness of the systems for routine clinical use. The TPM3 was found to be the most accurate, stable, and reproducible but limited in ease of use, speed, and data presentation. FSA was rated well in clinical application and data management but demonstrated a pronounced hysteresis (+/-19%) and creep (4%). The Tekscan system also showed substantial hysteresis (+/-20%) and creep (19%) but was preferred by clinicians for its real-time display capabilities, resolution, and display options. Some trends in system performance on varied support surfaces were identified and can be a valuable guide to interpretation of measurements and prescription decision making in the clinic. Problems identified with the accuracy and stability of the Tekscan and FSA systems may be amenable to resolution with software correction and changes in fabrication. With these improvements all three systems show the potential to be useful clinical tools. PMID- 10146319 TI - Seat cushion comparison for nursing home wheelchair users. AB - Finding solutions to the seating problems of nursing home wheelchair users is challenging due to the lack of data regarding the pressure-relieving and comfort performance of wheelchair cushions for this population. This study's goal was to determine whether commercially available seat cushions provide better pressure relief and comfort than do traditionally provided or "makeshift" cushions or pads. Using a repeated measures design, 21 nursing home wheelchair users were enlisted to help evaluate two traditionally provided or "makeshift" cushions or pads and two selected commercially available seat cushions. The peak sitting pressures for 20 subjects were recorded using an Oxford pressure monitor. Twenty one subjects were asked to score the test cushions' comfort. Due to the somewhat surprising results for the traditionally provided eggcrate cushion, the results fell short of supporting our initial hypothesis. Nevertheless, the study did identify three cushions, the eggcrate, the gel/foam, and the foam, which provided significantly lower peak sitting pressure averages than those recorded for the mix of cushions and pads used by 50 residents in a previous survey. Select commercially available seat cushions can offer nursing home residents lower sitting pressures and increased comfort. Further investigation is required to assess the long-term performance of these and other seat cushions and to explore the predictive benefits of the statistically significant relationship identified between peak sitting pressure and comfort. PMID- 10146320 TI - Design of a device to exercise hip extensor muscles in children with cerebral palsy. AB - Children with cerebral palsy (CP) often have weak hip extensor muscles and gait related difficulties. Current therapeutic techniques do not provide sufficient exercise for this muscle group. In addition to calisthenics, therapists use a traditional tricycle to strengthen leg muscles, yet the mechanics of traditional tricycles are not effective in exercising hip extensor muscles. A new therapeutic tricycle was designed specifically to exercise the hip extensor muscles, and tests compared the traditional tricycle to the new hip extensor tricycle in effectiveness of promoting hip extensor activity in two subjects without CP. The tests demonstrated that the hip extensor tricycle was more effective in promoting hip extensor activity. Tests are underway to investigate the effect of the hip extensor tricycle in improving hip extensor strength and gait in patients with cerebral palsy. This paper describes the design of the hip extensor tricycle and a preliminary investigation of its effectiveness. PMID- 10146321 TI - Exercise echocardiography in combined mild mitral valve stenosis and regurgitation. AB - Dynamic mitral regurgitation (MR) is typically associated with either severe systolic left ventricular dysfunction or episodes of acute myocardial ischemia. We report three patients with mild combined mitral stenosis and regurgitation and normal global left ventricular systolic function who presented with severe exertional dyspnea. Upright bicycle exercise echocardiography revealed development of severe dynamic MR in all three cases with Doppler evidence of severe pulmonary hypertension. There was no echocardiographic or electrocardiographic evidence of ischemia. Exercise echocardiography is an established tool for assessing dynamic changes in transvalvar pressure gradients. These results suggest that exercise echocardiography may also be useful for evaluating changes in severity of MR and for the assessment of dynamic changes in pulmonary artery systolic pressures. PMID- 10146322 TI - Pericardiocentesis guided by two-dimensional contrast echocardiography. AB - The clinical application of two-dimensional contrast echocardiography to pericardiocentesis was investigated in 20 patients with pericardial effusion. Multiple views were obtained to determine the ideal needle entry route. During pericardiocentesis, after 5 to 10 mL of pericardial fluid was withdrawn, 3 to 5 mL of agitated saline solution was injected through the exploring needle into the pericardium and a cloud of echoes indicated the needle's position. Contrast echoes were observed in all 20 patients. The procedure was performed smoothly in all patients except two (10%): the exploring needle was inserted into the right atrium in one patient and into the right ventricle in the other patient. The former promptly underwent a surgical drainage procedure, and the latter a second pericardiocentesis successfully guided by contrast echocardiography. The pericardial fluid was simply, safely, and successfully aspirated in the other 18 patients. We conclude that two-dimensional contrast echocardiography is valuable for locating needle position, thus facilitating successful pericardiocentesis in clinical practice. PMID- 10146323 TI - Myocardial contrast echocardiography: relation between on-line and off-line assessment of myocardial perfusion. AB - BACKGROUND: Quantitative assessment of myocardial perfusion by myocardial contrast echocardiography has been made possible by the use of custom-made off line video-intensity programs. A standardized program that could be used by all investigators would improve the reproducibility of results and enhance its clinical utility. METHODS AND RESULTS: The purpose of this study was to determine if the assessment of myocardial perfusion by contrast echocardiography using a new commercially available, quantitative on-line software program correlates with an off-line custom-made video-intensity program previously validated by our laboratory and with radiolabeled microspheres, under various experimental myocardial perfusion conditions. Two of the measured myocardial contrast echocardiographic parameters (peak intensity, area under the time-intensity curve {area}) correlated well among on-line and off-line methods and radiolabeled microspheres, especially when the data were "normalized" by comparing percent change from baseline or a ratio of ischemic to nonischemic myocardium. The third myocardial contrast echocardiographic parameter examined, half-time of the peak intensity on the washout limb of the curve (t 1/2), correlated only when the percent change from baseline was compared between the two methods or when the off line method was compared with radiolabeled microspheres. CONCLUSION: The results of this investigation add further support to the potential use of myocardial contrast echocardiography to evaluate serial changes in myocardial perfusion.(ABSTRACT TRUNCATED AT 250 WORDS) PMID- 10146324 TI - Discrete subaortic valvular stenosis: the clinical utility and limitations of transesophageal echocardiography. AB - Transesophageal echocardiography (TEE) is a useful technique in the diagnosis and intraoperative assessment of discrete subaortic stenosis (DSS). It allows clear visualization of the subaortic membrane, which may be missed by transthoracic echocardiography, differentiates DSS from other causes of left ventricular outflow tract obstruction, and accurately detects the presence of associated aortic regurgitation and bacterial endocarditis. Limitations in its use include inadequate visualization of the left ventricular outflow tract by TEE in the presence of a prosthetic mitral valve or mitral annular calcification, and improper alignment of the Doppler cursor across the outflow tract. PMID- 10146325 TI - Current trends in prosthetics. PMID- 10146326 TI - The differentiation between restrictive cardiomyopathy and constrictive pericarditis: the impact of the imaging techniques. AB - The differentiation between constrictive pericarditis and restrictive cardiomyopathy remains a difficult problem for clinical cardiologists. Recent advances in imaging techniques and the understanding of diastolic function have created a new diagnostic approach to this problem. In this article we will summarize the recent advances in the understanding of the pathophysiology of both disorders and how this is reflected mainly in the use of flow imaging techniques, such as Doppler echocardiography and radionuclide angiography. Combined with the advances in the radiological imaging of the pericardium by means of computed tomography and magnetic resonance imaging, an integrated approach to the differential diagnostic problem is proposed and an algorithm for clinical use has been designed. PMID- 10146327 TI - Echocardiography in the adult with congenital heart disease. PMID- 10146328 TI - Doppler echocardiographic evaluation of ventricular septal defects in adults. AB - Ventricular septal defects account for 10% to 15% of all congenital heart defects observed in adults. The type of defects observed tend to fall at the extreme ends of the spectrum: small restrictive defects with minimal shunts, and large nonrestrictive defects associated with severe occlusive pulmonary vascular disease. Doppler echocardiography has evolved into a powerful diagnostic modality that comprehensively evaluates the anatomical and pathophysiological consequences of a ventricular septal defect. The spectrum of findings caused by ventricular septal defects is the subject of this review. PMID- 10146329 TI - Echocardiographic evaluation of isolated pulmonary valve disease in adolescents and adults. AB - Congenital pulmonary valve disease is often not discovered until adolescence or adulthood. Transthoracic two-dimensional echocardiography can provide detailed information regarding right ventricular outflow anatomy, although images are often less satisfactory than those obtained in infants and children. The more recent addition of biplanar transesophageal echocardiography has enhanced our ability to image the right ventricular outflow tract, pulmonary valve, and pulmonary artery noninvasively. Pulsed and continuous-wave Doppler estimates of subvalvular and transvalvular gradients have proved to be accurate. Doppler color flow mapping has proved useful in determining the location and direction of stenotic and regurgitant flow. With no accepted standard for comparison, quantification of regurgitation remains problematic. In many cases, echocardiography has replaced catheterization and angiography in the evaluation and long-term follow-up of congenital pulmonary valve disease before and after intervention. PMID- 10146330 TI - Echocardiographic assessment of atrial septal defects. AB - Echocardiography has become the method of choice for the assessment of patients with a known or suspected atrial septal defect. The majority of patients with defects can be identified by this method. In patients with inconclusive transthoracic studies, transesophageal echocardiography is useful for identification or exclusion of a defect. Echocardiography is useful for quantification of left-to-right shunting, identification of associated anomalies, and estimation of pulmonary pressure. Cardiac catheterization can be reserved for patients who require measurement of pulmonary vascular resistance, those who have a significant risk of coronary artery disease, and those with complex congenital heart disease. PMID- 10146331 TI - Coarctation of the aorta in the adolescent and adult: echocardiographic evaluation prior to and following surgical repair. AB - The combination of two-dimensional and continuous-wave (CW) Doppler echocardiographic imaging forms the cornerstone of diagnostic imaging in pre- or postoperative coarctation of the aorta. Because of the frequent association of other congenital heart defects, e.g., bicuspid aortic valve, a segmental imaging approach with multiple image planes should be used. CW Doppler examination from the suprasternal notch should be utilized to assess the degree of obstruction at the coarctation site in all patients. This enhances diagnostic sensitivity. CW Doppler examination can also be applied throughout exercise. Such application allows detection of relative degrees of aortic obstruction following surgical repair of coarctation that may only manifest at elevated levels of cardiac output, e.g., exercise. It aids in the identification of individuals with exercise related systolic hypertension following "successful" coarctectomy and provides a rationale for treatment with beta blockade. The methodology for applying this relatively new technique is discussed. PMID- 10146332 TI - Clinical trial registries. PMID- 10146333 TI - International collaborative group on clinical trial registries. Position paper and consensus recommendations on clinical trial registries. Ad Hoc Working Party of the International Collaborative Group on Clinical Trials Registries. PMID- 10146334 TI - Perspectives for apheresis in hypercholesterolaemia. PMID- 10146335 TI - Plasma exchange for homozygous familial hypercholesterolaemia: the Cape Town experience. AB - Homozygous familial hypercholesterolaemia (FH) is a rare disorder having a greater frequency in populations with founder effects for the mutations in low density lipoprotein (LDL) receptors. It is characterized by early signs of cholesterol infiltrates with premature coronary artery disease and does not respond to conventional lipid-lowering therapy. Plasma exchange is an established mode of treatment which improves the biochemical abnormality and may allow reversal of the physical manifestations as well as favourably influencing the clinical course of the disease. The efficacy, safety and tolerability of this procedure is confirmed by our experience over the 15 years following the previous report. In a subset of these patients who have residual LDL receptor activity, further lowering of the plasma cholesterol concentration was achieved by adding simvastatin, an hydroxy-methylglutaryl coenzyme A reductase inhibitor. It is concluded that this combined approach may be of benefit in selected cases of homozygous FH undergoing regular plasmapheresis. PMID- 10146336 TI - LDL-apheresis: clinical experience and indications in the treatment of severe hypercholesterolemia. AB - LDL-cholesterol is the leading risk factor which influences the clinical outcome of patients with preexisting coronary heart disease. Clinical trials show that plasma LDL-cholesterol below 100 mg/dL decrease the rate of recurrent myocardial infarction and can induce regression in patients with coronary heart disease. However, in most cases of severe hypercholesterolemia with plasma LDL-cholesterol concentrations above 220 mg/dL LDL cannot be sufficiently decreased by maximal dietary and pharmacological therapy alone. Today this group of high risk CHD patients can be treated in addition with an extracorporeal procedure to eliminate LDL from the plasma circulation, the H.E.L.P.--LDL-apheresis. This method for selective removal of LDL, lipoprotein(a) and fibrinogen from plasma has been shown to be a clinically safe and very efficient method for the treatment of patients with homozygous familial hypercholesterolemia or CHD patients with severe hypercholesterolemia. Treatments with 1 week H.E.L.P. intervals revealed a mean reduction of minus 51% for LDL, of minus 45% for Lp(a) and of minus 46% for apo B, while HDL was increased by +12%. Fibrinogen was decreased by minus 46%. Besides the marked reduction of LDL and fibrinogen plasma concentrations the H.E.L.P. treatment significantly improves hemorheological parameters and increases the oxygen tension in the tissue. We have also investigated the efficiency of a combined therapy, using HMG-CoA reductase inhibitors together with the H.E.L.P.--apheresis. Under this combined treatment, a reduction of the interval LDL-cholesterol levels of 70-80% has been achieved, while Lp(a) and fibrinogen were not further affected. We now report about our long-term clinical experience with the H.E.L.P. system in treating patients with different lipoprotein disorders: (1) Homozygous form of familial hypercholesterolemia; (2) CHD patients with familial and non-familial hypercholesterolemia; (3) CHD patients with very high concentrations of lipoprotein(a); and (4) Hypercholesterolemic patients after heart transplantation. Based on present experience guidelines for secondary prevention of coronary heart disease indications for the H.E.L.P.--LDL-apheresis treatment are discussed. PMID- 10146337 TI - Immunoadsorption and dextran sulfate cellulose LDL-apheresis for severe hypercholesterolemia: the Rogosin Institute experience 1982-1992. PMID- 10146338 TI - Role of LDL apheresis in the management of hypercholesterolaemia. PMID- 10146339 TI - 1991 registry of the French Society of Hemapheresis (SFH): preliminary results for the first year of the on-line computer access file. The Registry Study Group. AB - From 1985 to 1990, the French Society of Hemapheresis (SFH) managed a National Registry of Plasma Exchange (PE) which included a data collection service, computer data input and statistical analysis of the total operation. The management of this registry did, however, encounter some problems. In 1991, an on-line computer access file was created, permitting French centers to input their data in Minitel Registry System. As a result, analysis on a national scale has proven more time-effective and data collection errors have been noticeably reduced. In January 1991, 43 centers were connected to the Minitel System. Only 17 centers, representing 4706 PEs, entered their data directly to the Minitel System during 1991 and, during the first term of 1992, a further 11 centers, representing 3258 PEs, communicated their data on paper in batch mode. The final total for 1990 was: 26 centers representing 860 patients and 7991 PEs. It is likely that some small imperfections have already developed during processing of the 1991 data, but these will be corrected as they are entered into the system. With the implementation of the Minitel System the French PE Registry represents a more accurate picture of plasmapheresis activity in France. PMID- 10146340 TI - The problem of under utilization of therapeutic hemapheresis. PMID- 10146341 TI - Current trends: evolving concepts in transfusion medicine. The need for standardization of cryoprecipitate-derived fibrin adhesive. PMID- 10146342 TI - In utero fetal liver cell transplantation in the treatment of immunodeficient or thalassemic human fetuses. AB - Following 18 years' experience in postnatal fetal liver transplantation (FLT), we have developed a new therapeutic method, namely the in utero transplantation of stem cells from the human fetal liver. This early transplant takes advantage of the immunological tolerance that exists in young fetal recipients. The four fetuses that we treated were 28, 26, 17 and 12 weeks of gestation. The first two patients had immunodeficiencies, the two others had thalassemia major. Donor cells were obtained from 7- to 12-week-old fetuses, with conditions approved by the National Committee for Bioethics. Donors and recipients were not matched. The fetal cells were infused through the umbilical vein of three patients and injected intraperitoneally into the other one, under ultrasonic visualization. The first patient, born in 1988, has evidence of engraftment and reconstitution of cell-mediated immunity: initially 10% then 26% of lymphocytes of donor origin (with distinct phenotype), T-cell responses to tetanus toxoid, CMV and candida antigens. This child, who had bare lymphocyte syndrome, has no clinical manifestation of the disease and lives normally at home. The second child was born in 1989; donor cell engraftment has been proven (Y-chromosome in this female patient) and immunological reconstitution is in progress, allowing a normal life at home. The third patient also has evidence of donor cell take (Y-chromosome in a female patient) and a partial effect on thalassemia has been documented (donor hemoglobin present in peripheral blood). In all three cases, no side-effect of any kind developed in the mother nor in the fetus.(ABSTRACT TRUNCATED AT 250 WORDS) PMID- 10146343 TI - Costing complexities in mixed apheresis. AB - For mixed apheresis procedures {plasma (PMA) and platelets (PLTs) as products}, six cost-accounting methods are described for apportioning the unit procedure cost ($156.02; representative example) to the two products. The methods are derived from clinical/scientific apheresis principles, but provide a wide range of unit PLT costs ($14.10, 19.71, 34.37, 42.06, 43.82 and 52.00) which relate inversely to the corresponding unit PMA costs ($73.84, 63.01, 34.36, 19.37, 15.94 and 0.00). Two of the methods appear particularly appropriate, depending upon whether the procedure is driven by PLTs predominantly or by PMA+PLTs equally. The paper encourages apheresis physicians and scientists to debate the relative attributes of the methods, develop refinements of the same, and determine through dialogue that mixed apheresis costing models properly account for the clinical science of the service provided. PMID- 10146344 TI - Lots of practical uses for PACS technology. PMID- 10146345 TI - Wanted: new model for teleradiology. PMID- 10146346 TI - Military takes lead in PACS development. PMID- 10146347 TI - Desktop computers offer individualized learning. PMID- 10146348 TI - Reexamine screening of women under age 50. PMID- 10146349 TI - No consensus on contrast for MRI of male pelvis. PMID- 10146350 TI - PCs compare favorably to dedicated systems. PMID- 10146351 TI - C-arm film changers add diagnostic flexibility. PMID- 10146352 TI - Immunologic monitoring during OKT3 therapy. AB - The monoclonal antibody OKT3 is a potent immunosuppressant inducing both T-cell depletion and antigenic modulation of the CD3/T-cell receptor complex. CD3 + lymphocytes are cleared from the circulation within 1 hour of intravenous administration of OKT3. Periodic monitoring of remaining or reappearing CD3 + lymphocytes gauges the adequacy of OKT3 dosing and OKT3 consumption by anti-OKT3 antibodies. The maximum acceptable concentration of CD3 + lymphocytes for maintaining the effectiveness of OKT3 therapy remains controversial due to variable sensitivity of the methods used. Intravenously administered OKT3 has a half-life of approximately 18 hours and results in trough serum levels ranging from 500 to 1000 ng/ml in 3 to 4 days. The antibody response to OKT3 is oligoclonal, and both IgM and IgG antibodies to OKT3 may develop, showing restricted specificity; anti-isotypic and/or anti-idiotypic antibodies can be detected. The IgG anti-idiotypic antibodies are the ones that neutralize the therapeutic activity of OKT3, and their specific detection involves the use of an immunofluorescence method that tests their ability to block the binding of OKT3 to normal T cells. The production of OKT3 antibodies has been shown to be affected by concomitantly administered immunosuppressive agents. Studies have demonstrated that OKT3 can be successfully reused in allograft recipients who do not present anti-idiotypic blocking antibodies. The acute clinical syndrome regularly observed upon the first OKT3 injection is related to massive, although transient, release of several cytokines, which may be easily monitored with currently available radioimmunologic or immunoenzymatic tests. PMID- 10146353 TI - Genetic discrimination by insurers: the public perception. PMID- 10146354 TI - Reintroduction to classical genetics. PMID- 10146355 TI - Molecular biology and the "new genetics.". PMID- 10146356 TI - The genetics of coronary artery disease. PMID- 10146357 TI - General session: cost-effectiveness of screening for genetic predisposition to diseases of adult onset. PMID- 10146358 TI - The genetics of cancer. PMID- 10146359 TI - Screening tests: problems with DNA-based insurance testing. PMID- 10146360 TI - Will new therapy for genetic disease alter underwriting practices? PMID- 10146361 TI - Panel on ethical issues in genetic testing. PMID- 10146362 TI - Panel on legal issues in genetic testing. PMID- 10146363 TI - Confidentiality and genetic test results. PMID- 10146364 TI - Choosing equipment for your new baby. PMID- 10146365 TI - Blood conservation techniques for cardiac surgery: a survey of French centres. AB - A survey resulting from a partnership between CECEC (Centre d'Etudes en Circulation Extra-Corporelle) and Laboratoires Hoechst, France was carried out amongst all French adult cardiac surgery centres. The aim of this study was to investigate the various strategies used to decrease blood loss during open-heart surgery. Due to an exceptionally high response rate, we are able to report the current practice of French cardiac centres which account for 75% of open-heart adult surgery. The three most interesting strategies for blood conservation appear to be haemodilution, blood salvage from the extracorporeal circuit and previously deposited autologous blood transfusion, yet the three methods which are predominantly used are haemodilution (92.7%), aprotinin therapy (87.8%) and blood salvage from the extracorporeal circuit (82.9%). PMID- 10146366 TI - The proposed use of a 'screening test' to assess oxygenator performance. AB - This study aimed to assess whether the use of the physiological shunt equation could (within the first five minutes of initiating CPB) serve as a 'screen' to differentiate normal and dysfunctional oxygenator performance. If dysfunction severe enough to require replacement was necessary, the normothermic patient could be weaned from CPB and replacement would be carried out under safe, controlled conditions. This technique would require postponing the induction of hypothermia (if used), aortic cross-clamping, and arresting the heart until after this screen was completed. This study demonstrates that a strong negative correlation exists between the degree of blood shunting and the membrane's 0 2 transfer performance (r = -0.874). This relation enables us to predict 0 2 transfer performance when only the shunt fraction is known. Of the 41 oxygenators used in this study, 40 demonstrated normal, or below-normal, shunt fractions. Oxygen transfer performance at or above predicted levels would be anticipated for these oxygenators. One of the 41 oxygenators had mildly elevated shunt fractions, which we predicted would be associated with mild 0 2 transfer dysfunction. Based on the performance screen worksheet we created, replacement was not necessary since the oxygenator maintained high levels of 0 2 transfer in reserve despite its marginal performance dysfunction. Assessment of oxygenator performance dysfunction in this earliest phase of CPB would greatly reduce the incidence of emergency oxygenator replacement secondary to actual or perceived oxygenator failure later in the course of the procedure. PMID- 10146367 TI - Magnetic resonance imaging and P300 (event-related auditory evoked potentials) in the assessment of postoperative cerebral injury following coronary artery bypass graft surgery. AB - Cerebral injury following coronary artery bypass grafting (CABG) surgery was investigated with magnetic resonance imaging (MRI) and P300, a long-latency endogenous evoked potential associated with psychological processing of stimulus information. Twelve patients were studied before and after surgery. Prior to surgery, MRI abnormalities were found in all but one patient. After surgery, five patients had new abnormalities, mainly deep white-matter lesions (DWML). Postoperative P300 latency was significantly increased in six patients. P300 topographical distribution showed a shift from predominantly posterior cerebral regions to frontal regions in most patients. Postoperative P300 and MRI deficits were found in three of the five patients. One of the patients with marked MRI change (DWML in caudate nucleus) did not show P300 deficit. PMID- 10146368 TI - Filtration of shed mediastinal blood. AB - Re-infusion of shed blood carries the risk of re-infusing cellular debris. All re-infusion devices have some sort of integral filtration which is variably supplemented with a second intravenous filter. Using electron microscopy we have observed what debris is collected by secondary filtration. In 12 patients studied, nine out of 12 filters had significant amounts of cellular debris present, but not clearly related to increased rates of postoperative bleeding. Noncellular debris, silicon and strands of cellulose were also observed. Although we have not detected any clinically significant embolic phenomena from re infusion of shed mediastinal blood, it seems prudent to include a second filter prior to re-infusion. PMID- 10146369 TI - Imaging of myocardial viability: a head-to-head comparison among nuclear, echocardiographic, and angiographic techniques. AB - The relationship between radioisotopic, echocardiographic, and angiographic markers of myocardial viability is still to be defined. To this purpose, 14 patients with previous myocardial infarction were studied using a multiparametric approach. Each patient underwent, on separate days, rest thallium 201 and technetium 99m Sestamibi planar scintigraphy, dobutamine/dipyridamole stress echocardiography, and coronary angiography; 11 of these patients underwent also dipyridamole echocardiographic testing. Thallium 201 and Sestamibi uptakes at rest were expressed as percentage of maximal activity in each projection using a 13 segment model. Dobutamine and dipyridamole stress echocardiography were analyzed using a score index ranging from 1 (normokinesis) to 4 (dyskinesis) and a similar segmentation. Coronary angiography was analyzed by quantitative approach. In all patients, follow-up echocardiography was performed following coronary revascularization. Before revascularization, 75 segments showed regional dyssynergies. Thallium 201 showed the highest sensitivity and specificity in the preoperative identification of viability, whereas Sestamibi was affected by a significant number of false-negative studies. Among echocardiographic techniques, dobutamine was slightly superior to dipyridamole in the detection of viable segments. The degree of coronary stenosis failed to predict the recovery of function following by-pass graft or angioplasty in almost all segments; however, in case of occlusion, most viable segments were perfused by adequately collateralized coronary arteries. PMID- 10146370 TI - Symposium: three-dimensional cardiac imaging. Editorial: introduction and overview. PMID- 10146371 TI - Medical image rendering. AB - Three-dimensional (3-D) visualization has recently become an established discipline in medicine. Although numerous visualization methods are currently available, a unified framework to describe and study them has been lacking. Often, the functionally independent operations in a method are integrated among themselves or with the method itself for computational efficiency. The two main aims of this article are (1) to review the methods in a unified way in a general setting so that it becomes possible to appreciate the interrelationship and interdependence of methods, and (2) to show how a variety of new methods emerge with potentially improved renditions in this unified treatment. To this end, we introduce an operator notation to describe concisely the basic 3-D imaging transforms commonly used in visualization and identify a comprehensive set of basic transforms. We describe several new basic transforms for filtering and interpolating structures and scenes, and for rendering surfaces and volumes. We show the power of the principle of treating 3-D imaging methodologies as comprising an appropriate combination of the basic operators. We show how such a treatment leads to a great variety of new rendering methods and how many such methods can lead to improved portrayal. We develop separate transform sequences to optimally render robust and frail structures (ie, structures represented in scenes with well-defined and ill-defined boundaries, respectively). PMID- 10146372 TI - Tool box-based cardiac volumes: visualization and quantitation by computed tomography. AB - Volumetric image display and analysis techniques have been under development to support x-ray computed tomographic (CT) imaging of the heart and lungs since the mid 1970s when investigators began to understand the image analysis requirements for the Dynamic Spatial Reconstructor. With the spread of Imatron's C-100 scanners (Imatron, South San Francisco, CA) around the world along with the development of slower helical scanners that generate volumetric information, there is an increased interest in the use of volume visualization and analysis tools to study the cardiopulmonary system. An historic overview of the development of such volume visualization for x-ray CT scanning is given along with a discussion of techniques for data acquisition, volumetric display, and image quantitation. We further show throughout the discussion how the integration of tools into a comprehensive image display and analysis software package (the tool box) enhances the utility of the individual tools. An example of such a tool box is given in a discussion of an X Windows-based package dubbed VIDA. PMID- 10146373 TI - Three-dimensional display of cardiac single photon emission computed tomography. AB - Similar to other cardiac imaging modalities, the quest for a three-dimensional display that can be used for visualizing cardiac single photon emission, computed tomography studies has resulted in several techniques: surface shading, surface modeling, and volume rendering. Each of these techniques has its own advantages and disadvantages. Surface shading yields displays that can be used to enhance a patient's or referring clinician's understanding of a diagnosis, but they are rarely used for diagnostic purposes. Surface modeling yields images that can easily be used for diagnostic purposes, but at present have only been applied to cardiac imaging because of the difficulty of modeling other organs. Volume rendering, in some forms, is beginning to be used diagnostically for some hot spot imaging procedures, but these are basically refined planar procedures and do not yet have application in quantitative tomography. Because of each technique's unique advantages, each will likely appear in some form in clinical cardiovascular nuclear medicine in the future. PMID- 10146374 TI - Three-dimensional coronary angiography. AB - For at least two decades coronary cine-angiograms have been reviewed on film projectors. The cardiologist most often reviews the multiple two-dimensional projections of the coronary arterial tree on a screen, and then mentally create a three-dimensional (3-D) model of the patient's arteries. The ability to synthesize this data and grasp the three-dimensionality of a patient's specific anatomy is quite difficult and requires extensive training and experience to perfect. Fortunately, with advances in computer hardware and software, cardiologists, with all levels of experience, will have assistance with this difficult task. It is now possible, with the use of computers, to reconstruct and display a patient's coronary angiogram in 3-D, allowing the cardiologist to review this data in ways not previously available. In the near future, enhancements in the technique will allow this technology to be placed on-line, directly in the cardiac catheterization laboratory, greatly facilitating the ability to diagnose abnormalities and more appropriately plan treatment strategies. PMID- 10146375 TI - Three-dimensional cardiac magnetic resonance imaging. AB - Evaluation of time-varying cardiac structure and function is challenging because of the three-dimensional (3-D) anatomy and time-varying (4-D) behavior of the heart. Historically, contrast angiography has served as the cornerstone of cardiac diagnosis because of its excellent spatial and temporal resolution. However, magnetic resonance (MR) imaging is now increasingly applied because of the wide variety of available MR imaging and data acquisition techniques, including spin-echo, gradient-echo, wall motion techniques, 1H 31P spectroscopy, and, most recently, echo-planar imaging. Planar 2-D MR imaging is used to characterize many aspects of cardiac structure and function, including anatomic relationships, valvular heart disease, ischemic heart disease, and congenital abnormalities, among others. The development of imaging display and data postprocessing analysis techniques have paralleled the growth of these image and data acquisition schemes and, increasingly, an emphasis has been placed on defining structure and function in 3-D, or even 4-D. Three-dimensional reconstructions of the heart have commonly relied on conventional planar MR image acquisition techniques; a 3-D volume of data is then created from stacked 2-D images. Surface reconstruction and graphical rendering techniques are used to generate representations of the heart that depict 3-D and 4-D cardiac structure and function. These techniques have been used both clinically and experimentally in a variety of settings, including ischemic heart disease, MR coronary angiography, and congenital heart disease. PMID- 10146376 TI - Three-dimensional echocardiography. AB - Lack of spatial registration of imaging transducers is a major technical limitation of two-dimensional (2-D) echocardiography. Volume scanning of the heart, or three-dimensional (3-D) echocardiography, is achieved by using a 3-D spatial registration device with a conventional 2-D scanner, or by using a high speed, phased-array real-time scanner. Three-dimensional spatial coordinate systems may be external or internal systems with respect to the scanning transducer. With external systems data acquired from several cardiac windows may be integrated and reconstructed. An external coordinate system allows creation of a "line of intersection" display to guide image positioning in the nonvisualized dimension orthogonal to the real-time image. Use of this display has shown a significant, threefold improvement in the accuracy of image positioning and the reproducibility of chamber measurements. Three-dimensional echocardiography using polyhedral surface reconstruction also yields more accurate measurement of ventricular volume and new measurements of total endocardial surface area and infarct surface area. Computer modeling and 3-D computergraphic displays hold promise of valuable new methods of communication, data analysis, and surgical planning. PMID- 10146377 TI - Methods of assessing coronary blood flow and flow reserve. PMID- 10146378 TI - Magnetic resonance angiography and blood flow quantification. AB - A variety of magnetic resonance (MR) techniques are available for flow imaging and quantification, each exploiting a different property of flowing blood to achieve contrast with stationary tissue, and each with its own strengths and limitations dependent on the flow conditions. These same techniques have been used to perform MR angiography of peripheral as well as the coronary arteries. This article provides an overview of MR angiographic and blood flow quantification techniques and their clinical application. Future technical advances in MR in concert with continuing developments in computer software and hardware are likely to make MR a major vascular technique in the coming decade. PMID- 10146379 TI - Coronary artery visualization using ultrafast computed tomography. AB - The advantages and limitations of ultrafast computed tomography in the imaging of normal and pathologic conditions of the coronary artery are discussed. The scanner's speed, resolution, and lack of significant motion artifact enhance the visualization of coronary arteries. Coronary artery calcification also is well visualized, and coronary artery fistuli, coronary bypass graft patency, and Kawasaki disease can be assessed accurately using contrast-enhanced flow studies. The inability to image stenoses and the lack of longitudinal images detract from its usefulness. Future scanner upgrades to provide increased resolution and thinner slices should improve the scanner's ability to evaluate the coronary artery. PMID- 10146380 TI - Cardiovascular ultrafast computed tomographic angiography. AB - Ultrafast computed tomography can substitute for angiography and provide answers to clinical and therapeutic questions. Because of superior definition of vessels and myocardium, current applications include imaging the aorta, carotids, vena cava, and other venous structures, congenital and acquired pulmonary artery abnormalities, coronary arteries, coronary artery saphenous, and internal mammary artery bypass grafts, right and left ventricles, cardiac tumors and thrombi, cardiomyopathies (ischemic, dilated, hypertrophic, and restrictive), congenital heart disease, and a variety of other acquired abnormalities. Parallel contiguous tomographic levels provide excellent structural definition including inner vessel wall and endocardium. PMID- 10146381 TI - A clinician's overview of laser systems for cardiovascular applications. AB - This paper discusses the current lasers used in cardiovascular applications and presents an overview on function, characteristics, and tissue interactions of the principal lasers used in this field. The discussion includes the lasers and delivery systems currently in use, or with potential future application, for laser angioplasty and laser recanalization. Included are low-intensity laser as well as high-power laser applications. PMID- 10146382 TI - Laser advances in urology. AB - This paper reviews the current use of lasers in urology--CO 2, Nd:YAG, KTP/532, Diode, pulsed dye--and describes the most common procedures performed with them. It discusses surgical techniques of lasers that are expected to be useful to urologists in the future and concludes that lasers are important tools for this specialty. PMID- 10146383 TI - Use of laser in aesthetics. AB - In aesthetic surgery different laser systems may be considered as an alternative, or as an adjunct to conventional treatments. Well established, and today a must, is the treatment of port wine stains (PWS) with argon, argon dye, pumped dye, or copper vapor lasers. In many other indications such as the treatment of scars and keloids the laser gives results superior to conventional surgery and other physical modalities. In other aesthetic procedures at the moment the laser should be regarded as an alternative, though not necessarily superior tool, for those already familiar with lasers. In this paper we discuss the workings of several lasers and some cases that our group has performed with the lasers. We have learned that certain lasers are more appropriate for some dermatologic applications than for others. PMID- 10146384 TI - Percutaneous laser disc decompression (PLDD) update: focus on device and procedure advances. AB - This discussion is an update on the U.S. advances in percutaneous laser disc decompression (PLDD). This report summarizes the knowledge that has been gained about the procedure, advances in technique, and increased information about the three lasers currently in use for PLDD: KTP, Nd:YAG, and holmium. A new surgical approach to the L5-S1 disc is described. It is concluded that PLDD has become an established procedure that will be more widely used because it is simple, effective, and reasonably safe. PMID- 10146385 TI - Effect of low-power He-Ne laser on deformability of stored human erythrocytes. AB - This study was designed to investigate the effect of the He-Ne laser (continuous wave, lambda = 632.8 nm, 8.5 mW in power) irradiation on human erythrocyte deformability. Blood samples were obtained from hematologically normal adult donors by venipuncture. Red cells were washed and adjusted to 30% Ht with 0.9% NaCl solution (pH 7.00). Red cell solution samples were assigned to three groups. Each sample was divided into seven 3-ml working aliquots. The aliquots in Group I were irradiated for 0 (control), 1, 3, 5, 10, 15, and 30 min within 2 hr after sampling. The aliquots in Group 2 and Group 3 were stored at 5 degrees C for 24 and 36 hr, respectively, and received similar irradiations after 12 hr (in both groups), 24 hr (in Group 2), and 36 hr (in Group 3) from sampling. Red cell deformability was measured by the Nuclepore filter filtration and presented as the filter filtration rate (FFR). The deformability shown as FFR was unchanged in Group 1 (fresh cell group) from the control value, but improved significantly in Groups 2 and 3 (damaged cell groups) after the irradiation. These results suggested that the irradiation of low-powered He-Ne lasers improved cytoskeletal protein activities in damaged erythrocytes. PMID- 10146386 TI - Do low-power lasers change phase transition temperature of dipalmitoyl phosphatidylcholine (DPPC) membrane? AB - This study was designed to investigate the effects of the He-Ne laser (632.8 nm of wavelength, 8.5 mW in power, Senko Med. Co. Ltd., Tokyo, Japan) on the phase transition temperature of dipalmitoyl phosphatidylcholine (DPPC) membranes. Liposomal bilayers of DPPC (12.5 mM) were obtained with ultrasonification for 45 min at 40 degrees C and refrigerated for 2-3 days at 5 degrees C. The bilayers vesicle solution was divided into 3-ml working aliquots, which were assigned to three groups. The aliquots in Group 1 were used as controls without irradiation and the aliquots in Groups 2 and 3 were irradiated in 37 degrees C baths for 15 to 30 min, respectively. To determine phase transition temperature, optical density (%T; percent of permittance) of each aliquot was measured spectrophotomechanically at a wavelength of 440 nm while increasing its temperature at a rate of 0.5 degrees C every minute. Main phase transition temperatures in Groups 1, 2, and 3 were 41.54 +/- 0.23 degrees C (n = 10), 41.50 +/- 0.27 degrees C (n = 10), and 41.30 +/- 0.36 degrees C (n = 10), respectively. No significant difference between the nonirradiation and irradiation groups was established. These results suggest that irradiations of low-power He-Ne lasers up to 30 min do not change important physical characteristics of artificial DPPC membranes. PMID- 10146387 TI - CO 2 laser subcapsular orchidectomy in the treatment of prostate cancer. AB - Hormonal manipulation remains the main method of treatment in metastatic carcinoma of the prostate. Traditional techniques of surgical castration may result in complications due to bleeding within the scrotum. Because of its cutting and hemostatic properties the carbon dioxide laser has been used in performing subcapsular orchidectomy in an attempt to reduce such complications. Postoperative hormonal assays have demonstrated a response identical to orchidectomy, and no treatment complications were encountered in our series. Subcapsular orchidectomy using the carbon dioxide laser may offer an advantage over traditional methods of surgical castration by reducing the frequency of postoperative hematoma. PMID- 10146388 TI - Dermatologist develops laser diagnostic and therapeutic device for burn surgery. PMID- 10146389 TI - What role today for hemodynamic monitoring? When is this procedure indicated? How much training is required? AB - Hemodynamic monitoring is an important adjunct to clinical evaluation. Nevertheless, it should not be performed unless the derived data are needed to establish a diagnosis or guide treatment. Successful use of the flotation catheter requires technical skill in insertion and maintenance, knowledge of cardiopulmonary physiology, an understanding of potential complications (and their avoidance), and the ability to correctly interpret and apply results. To maintain competence, physicians should perform at least 50 procedures a year. It is unlikely that a large clinical trial of the general efficacy of hemodynamic monitoring could ever be conducted; however, more limited studies could help define the role of this procedure in certain settings. PMID- 10146390 TI - Deciding when hemodynamic monitoring is appropriate. How will the data affect your diagnostic or therapeutic approach? AB - Hemodynamic data can be used to differentiate a variety of cardiopulmonary disorders, including right ventricular dysfunction, massive pulmonary embolism, and precapillary pulmonary hypertension. In patients with acute pulmonary edema, low-output states, or shock, hemodynamic measurements can help guide therapy; they also provide a precise estimate of a patient's response to vasoactive or inotropic drugs. Consider a flotation catheter for patients with complicated MIs, critically ill patients with multiorgan or major organ dysfunction, and high risk cardiac patients undergoing surgery. PMID- 10146391 TI - Blood lead proficiency testing: overview of the federally sponsored program in the U.S. AB - External proficiency testing is a proven method for improving the quality of laboratory measurements, including lead in blood. Several proficiency testing programs exist to fill this need. This article describes the U.S. federally sponsored Blood Lead Proficiency Testing Program. Three specimens, composed of blood from dosed cows, are distributed to participants each month. Target values are determined by a group of 10 referee laboratories. Participant performance has shown steady improvement over time. PMID- 10146392 TI - A guide to IFCC recommendations on reference values. AB - Six recommendations on the theory, production, and use of reference values have been prepared by the IFCC's Expert Panel on Theory of Reference Values. This review serves as a guide to the documents and presents the main topics. PMID- 10146393 TI - Commutability of reference materials in clinical chemistry. AB - The term commutability applied to reference materials denotes the ability of the material to show interassay changes comparable to those observed in the measurement of the same analyte in human serum. In this study commutability was studied by first establishing the relationship between the results obtained on patient serum samples with two independent methods for a given analyte. Then, the calibration or control material was assayed with the same pair of methods, and its interassay bias was statistically compared with that shown by patient sera. The results obtained in 27 experiments showed that the frequencies of noncommutability in the measurement of some nonenzymic organic components, enzymes, and inorganic ions were, respectively, 25/83, 44/99, and 32/61. The impact of noncommutability of the materials on the results of external quality assessment schemes (EQAS), matrix interferences, and the behavior of particular components are considered. The conclusion drawn is that each material should be tested for commutability before it is used as a reference material. PMID- 10146394 TI - Vision care retrospective: the upbringing of a billion dollar stepchild. PMID- 10146395 TI - Helpful hints in the selection of a utilization review company. PMID- 10146396 TI - The pharmacist's role in smoking cessation programs. PMID- 10146397 TI - Smoking cessation: a closer look. PMID- 10146398 TI - Utilization management: the heart of managed care. PMID- 10146399 TI - Designing for the future. AB - Manufacturers of medical equipment are faced with an environment of intense competition and continual technological change. The self-testing and home diagnostic equipment markets, for example, are growing and in these areas the end user is also the purchaser and a sophisticated consumer, living in a very design conscious environment. This factor makes new demands on manufacturers, who must take into account consumer preferences as well as the ability of their products to function effectively. This article outlines some of the problems that manufacturers now face and offers suggestions on how companies can succeed in the future. PMID- 10146400 TI - Emerging clinical roles for ambulatory blood pressure monitoring. AB - Ambulatory blood pressure monitoring is becoming increasingly popular in the diagnosis and treatment of patients with hypertensive disorders. Widespread clinical use, however, has been limited by a lack of normative data and prospective, controlled clinical studies of its impact on subsequent cardiovascular morbidity and mortality. Particular applications of this technology include the investigation of white coat hypertension and correlation of the components of diurnal blood pressure variation with hypertension associated target organ damage. Recently, interest has extended to the role of different physiologic states such as pregnancy and aging, as well as racial and other genetic differences, in the development of hypertension and susceptibility to target organ damage, and the study of hypertension associated with diabetes mellitus, renal disease, and organ transplantation. This review summarizes recent studies in these areas in addition to discussing the current clinical indications, limitations, and future research directions of ambulatory blood pressure monitoring. PMID- 10146401 TI - Pulmonary thromboendarterectomy for pulmonary hypertension. AB - Chronic thromboembolic pulmonary hypertension is a term that has been proposed by Dr. Kenneth Moser to describe a progressively debilitating process that occasionally follows venous thrombosis and pulmonary embolism. In the past, the disease was dramatically underdiagnosed for several reasons: 1) the initial event--deep vein thrombosis or pulmonary embolism--is usually clinically silent; 2) there is a subsequent asymptomatic "honeymoon period" in most patients; 3) there is no clinical description of chronic thromboembolic pulmonary hypertension in most textbooks of medicine and surgery; and 4) until recently, surgical therapy could be performed by only a few surgeons, and with a prohibitive operative mortality. Intensive efforts by physicians at the University of California, San Diego have led to increased recognition of the disease, a better understanding of its pathophysiology, and development of a curative procedure with an acceptable operative mortality. Chronic thromboembolic pulmonary hypertension is truly the "aortic stenosis" of the pulmonary circulation, and the clinical improvement after pulmonary thromboendarterectomy is even more dramatic than that seen after aortic valve replacement. PMID- 10146402 TI - Questioning the use of body fat analysis as a stand-alone screening device. PMID- 10146403 TI - Factors influencing participation in worksite smoking cessation and weight loss programs: the Healthy Worker Project. AB - Worksite intervention for health behavior change has attracted much recent interest as a potentially cost-effective way to promote healthier behaviors in the general population. In evaluating the impact of health promotion activities, it is essential to consider the entire work force rather than just self-selected participants. Overall, recruitment results reported to date have varied widely. There are a large number of factors pertaining to both employee and worksite characteristics that could contribute to variability in how well worksite health promotion programs attract employees. A critical issue that has received little research attention is the dynamics of participation in employee health promotion programs as they are offered repeatedly over time. The present study examined participation rates and contributing factors in worksite health promotion programs for weight loss and smoking cessation in the Healthy Worker Project, a randomized trial of worksite intervention conducted among 16 intervention and 16 control worksites in the Minneapolis/St. Paul metropolitan area between 1987 and 1990. Data analyses focused on characterizing individuals enrolling in worksite health promotion programs in comparison to those in the worksite population as a whole who would be considered in need of such programs. PMID- 10146404 TI - Comparison of the effects of walking and weight training programs on body image in middle-aged women: an experimental study. AB - Purpose. This study was conducted to determine the effect of a resistive training intervention on body image in middle-aged women compared to an exercise walking program. Another purpose was to develop two multivariate models to explain improvement in body image among the lifters and walkers. Design. A pretest-posttest experimental design with random assignment of subjects to two exercise groups was employed. Setting. Subjects trained in their own homes and were tested at the university. Subjects. Participants were 60 women recruited from the local community with an average age of 42.5 +/- 4.2 years. Intervention. Subjects were randomly assigned to a resistive training or exercise walking program, both of which were three days per week and 12 weeks in duration. Measures. Body cathexis was assessed using the Body Cathexis Scale; cardiovascular endurance was measured using the one-mile walk test, and muscular strength was assessed using standard weight training procedures. Results. After completion of the exercise interventions, lifters showed greater muscular strength than walkers, and walkers displayed greater cardiorespiratory endurance than lifters, as expected. Lifters also improved significantly more in body image than the walkers. Conclusions. Participation in a three-day-per-week resistive training program seems to improve body image in middle-aged women more than participation in a three-day per week walking program. Further, it appears that hard work and fitness improvements contribute significantly toward positive changes in body image. PMID- 10146405 TI - The impact of organizational characteristics on smoking policy restrictions in midwestern hospitals. AB - Purpose. The relationship between hospitals' organizational characteristics and adoption of restrictive smoking policies was examined. Design. Self-administered questionnaires and telephone interviews were conducted prior to and following the target date for policy implementation. Setting. The Director of Regional Medical Services of a community network of hospitals requested in the summer of 1989 that the 57 member hospitals voluntarily implement a policy prohibiting all smoking in hospital buildings as of January 1, 1990. Subjects. Subjects were the 49 hospital CEOs (86%) who provided data at both time points. Intervention. The Director of Regional Medical Services made a personal request of the CEO during a routine visit at each hospital. Measures. Measures included structural aspects of the hospitals (e.g., number of employees, number of beds, presence of chemical dependency and psychiatric units); orientation toward employee health; support for smoking restrictions among various groups; and extent of CEO authority to set smoking policy. Results. Fifty-one percent of hospitals increased the restrictiveness of their smoking policy; 35% adopted a complete indoor smoking ban. Stepwise multiple regression analysis demonstrated that adoption of additional smoking restrictions was related to CEOs' and perceived board of directors' support of smoking restrictions, absence of a chemical dependency unit, and experience of financial difficulties in the previous two years. Conclusions. It is important to educate top decision makers as to the necessity of restrictive smoking policies. Barriers to smoking restrictions in organizations with chemical dependency units deserve particular attention from health promotion practitioners and researchers. PMID- 10146406 TI - A review and analysis of the health and cost-effective outcome studies of comprehensive health promotion and disease prevention programs at the worksite: 1991-1993 update. PMID- 10146407 TI - An accurate assay for platelet factor 3. PMID- 10146408 TI - Laser light scattering in biomedical diagnostics and therapy. AB - The description of special features of laser light interaction with biotissues, such as the skin, eye and dental tissues etc., with respect to laser diagnostics and therapy methods development is done. Optical models of transparent and turbid biotissues are analyzed. The role of static and dynamic light scattering in the light dosimetry, tissue heating, and receiving information of biotissue optical parameters, its structure, movements, and vibrations is considered. PMID- 10146409 TI - Some military conversion projects for biomedical applications. PMID- 10146410 TI - Diagnosis of hepatic allograft rejection: role of liver biopsy. AB - The role of the liver biopsy for establishing a diagnosis of liver allograft rejection was investigated by examining under code 151 liver biopsies from 32 recipients and correlating the results with the clinical diagnosis determined by chart review. One-hundred-and-four biopsies were obtained to evaluate the cause of liver dysfunction and 47 were performed on a weekly protocol basis independent of the clinical status. A diagnosis of "definite histologic rejection" was made if a biopsy contained portal triaditis, bile duct injury, and endothelialitis, while biopsies were said to be suspicious for rejection if portal triaditis and bile duct injury were evident. A diagnosis of rejection using clinical and biochemical findings and response to therapy was made in association with 37 biopsies, of which 16 had definite histologic rejection and 13 were suspicious for rejection. Of the 114 biopsies performed in patients without clinical rejection, 71 had histology suspicious for rejection. Thus, biopsy was sensitive for the detection of rejection (78%), but was not very specific (33%). The positive predictive value was low (28%), while the negative predictive value was high (83%). These results indicate that liver biopsy is useful to evaluate graft dysfunction, to exclude rejection, to confirm clinically suspected rejection, and to diagnose other problems that can affect allograft function. Protocol biopsies appear to have little value. PMID- 10146411 TI - Transvaginal sonography in the postoperative evaluation of colposuspension. AB - Thirty-two patients with cystocele and rectocele with complaints of genuine urinary stress incontinence were subjected to complete urodynamic study, including intravaginal endosonography, before the operation and 6 weeks and 1 year after the operation. Intravaginal endosonography demonstrated the anatomic correlation of the bladder base, neck, and proximal urethra in relation to the inferior border of the symphysis pubis. In 28 patients, satisfactory correction of the bladder anatomy was achieved with operative treatment of genuine stress incontinence (GSI). Four patients presented persistent and recurrent GSI (2 in each group) after several weeks postoperatively. In addition, 2 patients had frequency-urgency syndrome, and 3 had voiding difficulties after the operation, but with no symptomatology of GSI. The patients with the symptoms described had various anatomic configurations after colposuspension. Vaginal endosonography is a simple technique with many advantages and satisfactory results in preoperative postoperative study, without radiation exposure and with minimal inconvenience to the patient. PMID- 10146412 TI - Magnetic resonance imaging in intracranial paracoccidioidomycosis. AB - Paracoccidioidomycosis is a systemic mycosis, endemic in South and Central America, that affects the central nervous system (CNS) in almost 10% of patients. Neurological involvement includes two different clinical forms: meningeal and granulomatous, also known as the pseudotumor form. Five patients with biopsy proved systemic paracoccidioidomycosis and neurological complaints were studied by magnetic resonance imaging. CNS involvement was detected in all patients in the form of multiple round or lobulated lesions, predominantly hypointense on T2 weighted images and ring or nodular enhancement on post-gadolinium T1-weighted images. The lesions were distributed diffusely, with a slight predominance in the supratentorial compartment, although infratentorial lesions were also observed, mainly in the cerebellum. Hypointense lesions on T2-weighted images persisted in all 3 patients reexamined after treatment, whereas enhancing lesions on post-gadolinium T1-weighted images turned isointense in 2 patients. Magnetic resonance imaging is a sensitive method in documenting CNS paracoccidioidomycosis, most frequently as supratentorial and infratentorial multiple, round or lobulated hypointense lesions on T2-weighted images. PMID- 10146413 TI - Advantages of color Doppler imaging for the evaluation of vertebral arteries. AB - Assessment of the vertebral arteries is often difficult with conventional duplex ultrasonography. This study of 60 patients aimed to determine the potential advantages of color Doppler imaging over conventional duplex ultrasonography in the evaluation of vertebral arteries, specifically three extracranial segments of these vessels. Both methods allowed visualization of the vertebral artery in the midcervical course (V2 and distal V1 segments) in all subjects. Color Doppler imaging appeared more effective for visualization of the V0 and the proximal V1 segments (on the right side in 88% of patients and on the left side in 73%). Conventional duplex ultrasonography imaged the ostium on the right side in 80% of patients and on the left side in 65%, but was difficult and time-consuming. Visualization at the atlas loop (V3 segment) was rarely successful with duplex sonography, whereas color Doppler imaging visualized the vertebral artery on the right side in 87% of patients and on the left side in 85%. Color Doppler imaging allows better visualization of the proximal and distal segments of the vertebral arteries, compared to conventional duplex ultrasonography. PMID- 10146414 TI - Multiple wavelength offers new approach to intraoral surgery. PMID- 10146415 TI - Back pain sufferers see quick recovery with laser disc surgery. PMID- 10146416 TI - Equipment acquisition: who calls the shots? PMID- 10146417 TI - Leasing yields income while minimizing risk. PMID- 10146418 TI - Team approach wins in acquisition process. PMID- 10146419 TI - Larger hospitals turn to refurbished equipment. PMID- 10146420 TI - MRI helps target causes of sports-related elbow pain. PMID- 10146421 TI - Octreotide agent shows peptide imaging potential. PMID- 10146422 TI - GRASE imaging provides image quality and speed. PMID- 10146423 TI - Functional MR imaging leaps into clinical realm. PMID- 10146424 TI - Treatment of ureteral calculi with an 8.3F disposable shaft rigid ureteroscope. AB - Seventy-one adult patients underwent ureteroscopy for treatment of ureteral calculi using the disposable shaft semirigid mini-ureteroscope. The ureteroscope has an 8.3F outer diameter with a fiber optic core that allows some flexibility of the shaft. It has a 4.0F working channel that allows simultaneous use of 3F instruments and irrigation. Twenty-three patients had upper ureteral calculi and 48 patients had lower ureteral calculi. Thirty-six patients did not require ureteral dilation and the remainder had minimal dilation to 10-12F. Fifty-one patients underwent laser lithotripsy, 14 patients underwent basket extraction, and six patients had both. Five patients required use of a second flexible ureteroscope. Seventy-seven percent of the patients went home the day of the procedure, 16% stayed one night in the hospital, and the remaining 7% had longer hospital stays. No major complications or infections were noted. Only 11% of the patients required IV or IM narcotics for pain management post-operatively. The stone-free results at 1 month were 96% for lower ureteral calculi and 91% for upper ureteral calculi. We have found this ureteroscope to be similar to other rigid mini-ureteroscopes with some additional advantages. A larger working channel, increased flexibility/steerability, and improved optics make it useful for treating ureteral calculi in the lower ureter in men and the entire ureter in women. PMID- 10146425 TI - Improved results of extracorporeal shock wave lithotripsy with the Dornier MPL 9000 for single gallstones. AB - Our aim was to compare the results of extracorporeal shock wave lithotripsy with the Dornier MPL 9000 for patients with single radiolucent gallstones less than or equal to 20-mm diameter using higher power (kV) and more shock waves during lithotripsy with our results during the Dornier National Biliary Lithotripsy Study using lower power and fewer shock waves. Nineteen patients were treated at higher power (mean +/- SE, 21.0 +/- 0.4 kV) vs 11 patients at lower power (18.8 +/- 0.5 kV). In the higher power group, the actuarial rate for complete clearance of gallstone fragments was 39 +/- 9%, 63 +/- 9% and 78 +/- 9% after 6 weeks, 3- and 6-months follow-up, respectively, versus only 19 +/- 12% after 6 months in the lower power group. We conclude that the use of higher power and more shock waves during extracorporeal shock wave lithotripsy with the MPL 9000 results in fragment clearance rates over 6 months for patients with single gallstones that are significantly higher than those previously achieved in the Dornier National Biliary Lithotripsy Study. PMID- 10146426 TI - Inhibitory effect of high energy shock waves and radiotherapy in vitro. AB - Exposure of mice fibroblasts cell strain 3T3 to high energy shock waves and megavoltage radiotherapy resulted in a reduction in cell viability as determined by trypan-blue exclusion and H3-Thymidine incorporation assays. Electromagnetic shock waves have a higher cytotoxic effect on cell viability than megavoltage radiotherapy, at low and medium levels of energy. Megavoltage radiotherapy has a higher cytotoxic effect on cell viability at high levels of energy, as nucleoside incorporation reveals. The combination of electromagnetic shock waves and megavoltage radiotherapy delivered on cell cultures at medium levels of energy, did not enhance their cytotoxicity when it was compared with their high levels of energy individually. PMID- 10146427 TI - The influence of electrode shape on the performance of electrohydraulic lithotripters. AB - This study was performed to determine the advantages and disadvantages of the two shapes of electrodes (flat and conical) commonly used in electrohydraulic extracorporeal shock wave lithotripters. Hundreds of measurements made on profiles obtained from a piezoelectric pressure gauge in an underwater shock wave research device showed that conical electrodes are more convenient than flat electrodes, since they produce shock waves with larger compressional amplitudes, less misfires and a better reproducibility, having similar widths and rise times. In an attempt to improve the effectiveness and duration of the electrode tips, a new shape was designed that proved to be more reliable and suitable for lithotripsy than the conventional flat or conical electrodes. Experiments with calculi models placed in the focal region of the shock wave generator seem to confirm the results obtained from pressure measurements. PMID- 10146428 TI - Evaluation of patient controlled sedation and analgesia for ESWL. AB - This study was designed to evaluate the quality of sedation/analgesia and patient cooperation provided by Patient Controlled Sedation & Analgesia (PCSA) using propofol and fentanyl (Group II) when compared with anesthetist administered propofol/fentanyl (Group I) in 32 ASA I & II patients undergoing ESWL of renal or ureteric stones. Demographics of the patients and the duration of ESWL were similar in both groups. Dose of propofol/fentanyl used during the procedure was significantly higher in Group I patients as compared to group II (p less than 0.05). Interpatient variability in propofol requirement was reflected in both groups in the lack of significant correlation between propofol dose and procedure duration. PCSA provided a marginally higher degree of patient and surgeon satisfaction scores as compared to anesthetist administered propofol/fentanyl. Quick recovery was more consistent in the PCSA group as compared to group I patients. PMID- 10146430 TI - Are race, age, gender, and insurance status determinants in interhospital helicopter transport time and frequency? AB - OBJECTIVE: To examine the effects of age, race, gender, and insurance status on utilization and times-to-transport (TTT) for interhospital air medical transfers from rural hospitals to tertiary care centers. DESIGN: A retrospective review of interhospital transport records. The TTT was examined as a function of age, gender, race, and insurance status using the Student's t-test for unpaired samples. The Exact Binomial Test (alpha error at 0.05) was used to compare the observed versus expected transport rates for non-whites. SETTING/PARTITIPANTS: A total of 268 patient transfers from hospitals within a two-county region in central Pennsylvania to tertiary care centers was analyzed. All records with sufficient demographic, TTT, or insurance data were included. Absence of data was the only exclusion. RESULTS: The TTT (mean +/-SD) was longer (2666 +/-3940 minutes (min.) versus 619 +/-909 min., respectively) for adult than pediatric patients (p less than .01), and (2588 +/-4041 min. versus 640 +/-1301 min., respectively) for insured versus uninsured patients (p less than .01). The observed proportion of non-whites transported was less than expected (.41% versus 2.1%) based on the proportion of non-whites in the region (p less than .05). CONCLUSION: The TTT was longer for adults than for children and for the insured than the uninsured. Non-whites were transported less frequently than predicted. PMID- 10146431 TI - Prehospital pediatric endotracheal intubation: a survey of the United States. AB - INTRODUCTION: The standard of practice and teaching for prehospital pediatric endotracheal intubation (PETI) in the United States currently is unknown. The accepted practice of prehospital PETI is of interest because it has contradictory support in the medical literature. HYPOTHESIS: PETI is an accepted method of prehospital airway control in the United States. METHODS: Nationwide mail survey (June 1991 to March 1992) of each state emergency medical service (EMS) agency and all known paramedic training sites. RESULTS: The use of PETI is supported by 100% of state EMS agencies and the American Virgin Islands. Ninety-seven percent (339 of 349) of the responding (349 of 523) paramedic training sites reported that PETI was taught in their programs. The results of the survey did not identify a predominate method for instructing paramedics in PETI. Lectures, mannequins, operating room demonstration, animal models, and cadavers were used in various ways for teaching the skill. CONCLUSION: Endotracheal intubation is an accepted standard in prehospital pediatric care. This standard exists with marginal support in published literature and study of prehospital PETI is needed to define the benefits, risks, and optimal instruction methods for the procedure. PMID- 10146432 TI - Tumor marker committee observations on PSA. PMID- 10146433 TI - Prostate cancer and prostate-specific antigen: facts, figures and commentary. PMID- 10146434 TI - Chronic pancreatitis and the risk of pancreatic cancer: 20 year multicenter follow-up study of 1500 patients. PMID- 10146435 TI - Two not-quite-Jurassic classics, and some mathematica prostatica. PMID- 10146436 TI - A statistical-based quality control/quality assurance system for immunoassay analysis. PMID- 10146437 TI - Cholesterol readings: biological variation and analytical accuracy. PMID- 10146438 TI - Holmium thermal sclerostomy: successful approach to glaucoma. PMID- 10146439 TI - Pulsed dye laser gives hope to scar patients. PMID- 10146440 TI - Evaluation of wear in an all-polymer total knee replacement. Part 1: laboratory testing of polyethylene on polyacetal bearing surfaces. AB - The friction and wear characteristics of a prototype, all-polymer hip prosthesis were evaluated using a multi-station hip-joint simulator. The components consisted of 41 mm diameter polyacetal copolymer balls in combination with acetabular cups of UHMW polyethylene, and were compared to the conventional combination of cobalt-chromium alloy balls against UHMW polyethylene cups. The all-polymer combination exhibited about 20% lower friction and 39% lower wear of the polyethylene cups. The total volume of polymer wear from the all-polymer combination (i.e. including the wear of the polyacetal ball) was 23% less than the volume of polyethylene wear from the metal-polymer components. The appearance of the worn surfaces of the polyethylene cups in the scanning electron microscope were similar for the two combinations of materials, and the surfaces of the polyacetal balls showed only mild wear. Formaldehyde, a product of the degradation of polyacetal, was present in traces in some samples of lubricant from the test chambers with polyacetal balls. In this laboratory model, the friction and wear properties of a polyacetal copolymer ball in combination with an UHMW polyethylene demonstrated good potential for clinical application. PMID- 10146441 TI - Evaluation of wear in an all-polymer total knee replacement. Part 2: clinical evaluation of wear in a polyethylene on polyacetal total knee. AB - In an effort to improve the long-term result of total joint replacement arthroplasty, we have investigated the use of a polymer-on-polymer articular replacement arthroplasty. Because of their known biocompatibility and previous use in orthopedic surgery, polyethylene and polyacetal (copolymer, Hoechst) were selected. Polyethylene served in its usual role as the concave member of the articulation; polyacetal formed the convex number. Formal wear testing using a multi-channel hip simulator demonstrated superior wear characteristics of the polymer-on-polymer configuration compared to a conventional chrome-cobalt versus polymer (polyethylene) configuration. A clinical series of relatively high activity patients having a minimum five-year follow-up (N = 26) showed no specific unfavorable reaction to this material combination in a total knee replacement. Given certain potential advantages of polymeric materials, as well as some theoretical disadvantages of metallic materials, a polymer-on-polymer design for a large joint replacement may have some merit. PMID- 10146442 TI - A comparison of the dimensional accuracy of microwave and conventionally polymerized denture base materials. AB - This study compares the dimensional changes of microwave and conventionally polymerized denture bases and also establishes the degree of monomer conversion using gas-liquid chromatography. Dimensional changes of three denture base materials were assessed using an optical comparator and the results showed no significant differences between the materials employed or the curing method used. Efficient monomer conversion was demonstrated with levels of residual monomer of less than 1% for all materials. PMID- 10146443 TI - The repair of inguinal hernias using carbon fibre patches--a five-year follow-up. AB - One hundred and eight inguinal hernias were treated following a standard surgical technique, using 3-mm thick loosely woven carbon-fibre patches. The average follow-up was five and a half years. There was one recurrence. Otherwise, excellent clinical results without pain were found in all but one patient and only a further three experienced a slight discomfort in the area of the implant, without any restriction on function. The technique is simple and permeation of the carbon-fibre patch by fibrous tissue showed a lasting repair. PMID- 10146444 TI - Bioactive glasses and glass-ceramics. AB - Bioactive materials are designed to induce a specific biological activity; in most cases the desired biological activity is one that will give strong bonding to bone. A range of materials has been assessed as being capable of bonding to bone, but this paper is solely concerned with bioactive glasses and glass ceramics. Firstly, the structure and processing of glasses and glass-ceramics are described, as a basic knowledge is essential for the understanding of the development and properties of the bioactive materials. The effect of composition and structure on the bioactivity is then discussed, and it will be shown that bioactivity is associated with the formation of an apatite layer on the surface of the implant. A survey of mechanical performance demonstrates that the structure and mechanical properties of glass-ceramics depend upon whether the processing involves casting or sintering and that the strength and toughness of glass-ceramics are superior to those of glasses. Attempts to further improve the mechanical performance by the use of non-monolithic components, i.e. bioactive coatings on metal substrates and glass and glass-ceramic matrix composites, are also reviewed and are shown to have varying degrees of success. Finally, some miscellaneous applications, namely bioactive bone cements and bone fillers, are briefly covered. PMID- 10146445 TI - Mechanical properties of a Ti-6A1-4V dental implant produced by electro-discharge compaction. AB - Cylindrical, porous-surfaced implants were fabricated from Ti-6A1-4V atomized powders by an electro-discharge compaction technique (EDC). Input energy (1-2.5 kJ/g powder) was used to produce implant compacts having a solid core surrounded by a porous layer. The solid core size, neck size between core and particle, neck size between particles, and pore size in the porous layer varied as input energy was changed. Compression tests were carried out to evaluate the mechanical properties of the EDC compacts. The yield strength ranged from 270 to 530 MPa and the ultimate compressive strengths ranged from 390 to 600 MPa. The yield strengths for solid core, core-particle and particle-particle interfaces remained constant at 755 MPa regardless of input energy. The endurance limits estimated from these results were 190-310 MPa, which were higher than the reported values for sintered titanium implants. Microhardness testing revealed that hardness was independent of input energy and the position where the testing indentation was applied. The average hardness of the compacts was 3430 MPa. PMID- 10146446 TI - A new biodegradable matrix as part of a cell seeded skin substitute for the treatment of deep skin defects: a physico-chemical characterisation. AB - A bilayered matrix, as an integral part of a cell seeded skin substitute for deep dermal skin injury, is described. The skin substitute has been given a dense top layer, to function as a substrate for keratinocyte culture, and a porous under layer for wound adhesion and to serve as a template for dermal regeneration. This porous under layer may be seeded with dermal fibroblasts for improvement of neodermis formation. The elastomeric hydrogel Polyactive?, a biodegradable polyether/polyester block copolymer, has been selected as the top layer component and Polyactive or Poly-L-lactide (PLLA) as the constituents of the under layer; this to ensure that the matrix is degradable and fulfils certain mechanical requirements. Polyactive top layers were found to be highly permeable to water vapour (+/-30 g/m -2 h -1 kPa) -1 and to molecules up to 150 kD (human IgG). Tensile properties of the bilayered matrices were to a considerable extent dependent on top layer and under layer composition and thickness. Elasticity moduli were in the range of those previously reported for human skin. Varying the weight ratios of the soft/hard segments of the Polyactives and/or substituting PLLA for Polyactive as the under layer component, allows the modulation of the matrix to specific application site dependent demands. PMID- 10146447 TI - Ionogran--an ionomeric micro implant in bone tumour reconstruction. A clinical evaluation. AB - A new implant material, Ionogran (Ionos, Medizinische Produkte GmbH & Co. K.G., Germany), is evaluated in a series of 60 cases requiring augmented bone grafting for major bone defects. The material, an ionomeric porous micro implant (IMI), is stable, non-degradable, osteoconductive and biocompatible. It promotes the formation of osteoid and displays a dynamic surface activity which stimulates the process of repair. In the compromised situation of a large cavity following curettage and cryotherapy, Ionogran when mixed with a mulch of autogenous cancellous bone is a valuable filler, providing a direct osteoid bond with host bone, and a permanent scaffold which maintains shape, length and form of the affected part. It replaces allogenic bone grafts and the problems associated with that technique. PMID- 10146448 TI - Echocardiographic guidance during placement of the buttoned double-disk device for atrial septal defect closure. AB - The usefulness of two-dimensional and Doppler echocardiography during buttoned double-disk device closure of an atrial septal defect was evaluated in 20 consecutive patients at the time of interventional catheterization. Transesophageal echocardiography was used in 11 patients (ages 5 to 62 years, weights 20 to 91 kg). Because of the size of the available transesophageal echo probe, transthoracic echocardiography was used in the remaining 9 patients (ages 4 to 5.5 years, weights 14 to 21 kg). In the transesophageal echo group, 1 patient was found to have no atrial septal defect despite a previous diagnosis by transthoracic echocardiography, 3 patients had atrial septal defects too large for closure despite attempts in 2, and 7 patients had transesophageal echo guided device placement. All of these 7 patients had small residual shunts by color Doppler, 2 had unusual arm positions, and 2 had surgical removal of the device due to embolization to the pulmonary artery in 1 and failure to obtain close approximation of the occluder and counteroccluder in 1. In the transthoracic echo group, 2 patients had atrial septal defects too large for closure, 1 patient had no femoral venous access, and 6 patients had transthoracic echo guided device placement. All of these 6 patients had small residual shunts by color Doppler and 3 of the 6 had unusual arm positions. For atrial septal defect sizing, transesophageal echo measurements correlated with catheter balloon size more closely than did transthoracic echo measurements (r 2 = 0.97 vs 0.86).(ABSTRACT TRUNCATED AT 250 WORDS) PMID- 10146449 TI - Reliability of Doppler color flow mapping in the identification and localization of multiple ventricular septal defects. AB - The purpose of this study was to compare Doppler color flow mapping with angiography and surgical observation for detection of multiple ventricular septal defects (VSDs). Only patients with elevated pulmonary ventricular pressure were included. Among 137 patients with VSDs, 38 multiple defects were identified in 25 patients echocardiographically, 34 multiple defects in 24 patients angiographically, and 21 multiple defects in 17 patients surgically. Using surgical observation as the reference standard, the sensitivity of echocardiography for identifying patients with multiple VSDs was 17 of 17 (100%) and for angiography 15 of 17 (88%). The sensitivity of echocardiography for identifying all multiple VSDs seen at operation was 19 of 21 (90%) and of angiography was also 19 of 21 (90%). In many patients, use of both techniques may no longer be necessary. PMID- 10146450 TI - Routine use of transesophageal echocardiography and color flow imaging in the evaluation and treatment of children with congenital heart disease. AB - We reviewed our experience with transesophageal echocardiography (TEE) and color flow imaging in 157 consecutive patients with known or suspected heart disease to ascertain the impact of this technology on patient care. TEE was performed for diagnostic purposes (22/157), during interventional cardiac catheterizations (13/157), and during operative procedures (122/157). Diagnostic studies were performed after transthoracic echocardiography (TTE) in 21 of 22 patients. TEE was performed because TTE was inconclusive (15/21) or failed to provide sufficient detail of an abnormality (6/21). TEE detected an abnormality in 6 of 15 inconclusive TTEs. TEE was helpful during interventional cardiac catheterizations, particularly during umbrella closure of septal defects and in patients with complex venous and atrial anatomy undergoing transseptal puncture. TEE studies performed before cardiac operations significantly changed the diagnosis in only 5 of 122 (4%) patients, but the information changed the surgical approach in 4 of 5 of these patients. Postoperative TEE assessment more frequently changed care and resulted in further surgical management in 9 of 122 (7%) or a change in medical management in 6 of 122 (5%) patients. TEE was discontinued because of complications before studies were completed in only 4 of 157 (3%) patients. TEE and color flow imaging is a useful adjunct to care of children with known or suspected congenital heart disease. PMID- 10146451 TI - Intraoperative transesophageal echocardiography using high resolution imaging in infants and children with congenital heart disease. AB - A transesophageal probe recently has been developed for use in pediatric patients, which incorporates 48 rather than 26 elements, and permits continuous wave Doppler, and pulsed and color Doppler flow modalities. This probe potentially offers significantly enhanced image quality. To evaluate its capabilities, we tested the probe intraoperatively in 53 infants and children undergoing surgical repair of congenital heart disease, and found that clear echocardiographic images with good detail were provided, including the ability to image coronary arteries in patients weighing as little as 2.7 kg. Imaging detail transesophageally is commensurate with the performance of this system from a transthoracic route. This probe also has the capacity for accurate estimates of high velocity jets using continuous-wave Doppler, which is a relatively new development. PMID- 10146452 TI - Transesophageal echocardiographic imaging in infants and children: the elements of the plane truth. PMID- 10146453 TI - Two-dimensional Doppler color flow imaging in adults with L-transposition of the great arteries. AB - Abnormalities of the left atrioventricular (AV) (tricuspid) valve and pulmonic stenosis are part of the spectrum of manifestations in patients with corrected transposition of the great arteries (L-TGA). However, the utility of Doppler color flow imaging combined with two-dimensional echocardiography in L-TGA has not been established. Thus, we evaluated 14 adults (mean age 33 +/- 8 {SD} years) with L-TGA. Two-dimensional echocardiography demonstrated Ebstein's anomaly in five patients. Color flow imaging detected left AV valve regurgitation in 13 (moderate to severe in six); the other patient had a prosthetic valve. Right AV valve regurgitation was detected in two (mild in both). Aortic regurgitation was present in five (moderate in three). Pulmonic regurgitation was present in nine (moderate to severe in three). Pulmonic stenosis was detected in three (subvalvular in two, valvular in one) and two patients had pulmonary atresia. One patient had a bicuspid aortic valve with mild stenosis. Mean right ventricular ejection fraction (apical, area-length) was 44%; only 1 of 9 patients had a value greater than 55%. Thus, two-dimensional Doppler echocardiography with color flow imaging detects a high incidence of systemic AV valvular regurgitation and reduced right (systemic) ventricular systolic function in adults with L-TGA. PMID- 10146454 TI - Endotracheal intubation. PMID- 10146455 TI - Bronchoalveolar lavage in the diagnosis of nosocomial pneumonia. PMID- 10146456 TI - A tool to measure the change in health status of selected adult patients before and after intensive care. AB - If the effect of intensive care on the patient is to be fully assessed then the health status of patients before and after admission to ICU must be measured. The validity of a simplified system which can also use relatives, where necessary, as informants on the patients' pre-morbid health status has been evaluated. In a District General Hospital Intensive Care Unit a questionnaire based survey of 85 patients admitted over a period of eight months used a new specially-designed instrument and compared this with the Functional Limitations Profile (FLP) and the Perceived Quality of Life instrument (PQL). Relatives completed the health status questionnaire as soon as possible after the patient's admission and patients completed a suitably modified version at discharge from ICU. Patients were sent the FLP, PQL and modified health status questionnaire six months and one year after discharge. Questionnaires were completed by 59 paired relatives and patients. Questions were answered in the same way by relatives and patients; 42 of the 59 pairs of results were in agreement within two points of better or worse health. The closest responses were provided by wives in daily contact with their partner. At six months post ICU discharge, 49 patients completed the follow-up questionnaires, 12 patients had died and three were too confused to co-operate. Twenty-one patients (25%) were lost to follow up. At one year post ICU discharge, 43 patients completed the follow-up questionnaires, one other patient had died and three still remained confused.(ABSTRACT TRUNCATED AT 250 WORDS) PMID- 10146457 TI - Liver function tests in the critically ill patient. AB - The liver has a wide range of functions that may be disturbed in different ways by the many diseases which affect it and, in consequence, there are a large number of tests which look at different aspects of its function. Specific diagnoses are made using a range of clinical, biochemical, histological and radiological methods. Measurement of the plasma concentration of alanine aminotransferase (ALT, SGPT), gamma-glutamyl transpeptidase (gammaGT) and albumin are particularly valuable as these substances are specifically affected by liver disease. Their elevation can reveal increases in the membrane permeability of hepatocytes (ALT), cholestasis and toxic damage (gammaGT), or an impairment of liver protein synthesis and secretion (albumin), respectively. If their activities remain within the normal range the likelihood of significant liver disease is less than 2%. A series of quantitative liver function tests are described which each examine one aspect of hepatic function. Table 1 lists several situations where the assessment of hepatic function is necessary. Liver function tests are classified in Table 2. PMID- 10146458 TI - How to sharpen your skills as a medical consumer. PMID- 10146459 TI - New products for pediatrics: 1993. PMID- 10146460 TI - PPO franchising: a trend for the future? PMID- 10146461 TI - Continuous quality improvement of the modalities of care through physician behavior modification: focus on billing behavior modification. PMID- 10146462 TI - PPO credentialing policies: legal concerns and practical guidance. PMID- 10146463 TI - Pharmaceutical research: cost savings through innovation. PMID- 10146464 TI - Excimer angioplasty: multicenter trials showing excellent results. PMID- 10146465 TI - Q-switched ruby laser provides effective treatment for tattoos. PMID- 10146466 TI - A historical overview and update on pulse oximetry. AB - Pulse oximetry has revolutionized the way in which blood oxygenation is measured. It provides an accurate and relatively reliable noninvasive means for the continuous measurement of peripheral oxygen saturation in a variety of patients. The pulse oximeter has detected many clinical situations in which arterial hypoxemia (SaO 2 less than 90%) was not previously known to occur. The accuracy of this instrument depends on many factors, particularly the clinical scenario and the machine itself. The pulse oximeter is accurate under the following conditions: SaO 2 is greater than 22% in hemodynamically stable patients and greater than 35% in hemodynamically unstable patients; core body temperature is greater than 32 degrees C; cardiac index is greater than 1.5 L/min per m 2; pulse pressure is > 20 mm Hg; hematocrit is greater than 10%; hyperbilirubinemia is corrected for carboxyhemoglobin; fetal hemoglobin is at any level. Pulse oximeter readings have limited accuracy in the presence of methemoglobin, carboxyhemoglobin, nail polish, fluorescent light, and motion. This article presents a historical overview of pulse oximetry and an update on its current uses. PMID- 10146467 TI - A comparison of the incidence of nausea after laparoscopic cholecystectomy and diagnostic laparoscopy. AB - Thirty-four patients undergoing gynecologic diagnostic laparoscopy and 30 patients undergoing laparoscopic cholecystectomies were followed prospectively for nausea and vomiting 24 hours postoperatively. Diagnostic laparoscopy patients had a significantly higher incidence of nausea and vomiting than laparoscopic cholecystectomy patients with similar anesthetic techniques, duration of surgery, and population parameters. All patients had their stomach contents suctioned after induction. While both procedures involve bowel manipulation, patient position and organ manipulation differ: diagnostic laparoscopy involves the Trendelenburg position and laparoscopic cholecystectomy involves the reverse Trendelenburg; diagnostic laparoscopy involves the uterus, ovaries, and fallopian tubes while laparoscopic cholecystectomy involves mainly the gall-bladder and its appendages. These factors may contribute to the differences found in this study. PMID- 10146468 TI - The Anesthesia Simulator Consultant: simulation plus expert system. AB - The Anesthesia Simulator Consultant was designed to provide anesthesiologists the opportunity to practice the management of anesthesia-critical incidents. The program simulates the operating room environment in a graphic display on the screen of a personal computer. Physiologic models predict the patient responses and an automated record-keeping system produces a detailed summary of the case. An expert system provides interpretations of patient information, differential diagnosis, and treatment for abnormal patient conditions. The coupling of the simulator, recorder, and expert system creates a unique self-study and evaluation environment. PMID- 10146469 TI - Should transesophageal echocardiography routinely be used during coronary artery bypass surgery? PMID- 10146470 TI - The technique of inserting a Swan-Ganz catheter. Selecting the equipment; positioning the catheter properly. AB - Before hemodynamic monitoring, carefully select and test the appropriate equipment and calibrate all monitors. To insert the catheter, use strict aseptic technique and, whenever possible, fluoroscopic guidance. The internal jugular vein is generally preferred for cannulation, but cutdown of an antecubital vein may be better for patients receiving anticoagulants or thrombolytics. The balloon remains deflated until the catheter tip is in the right atrium. Characteristic pressure wave forms signal the catheter's passage through each heart chamber. In most patients, advancement from the right atrium to wedge position is completed within 20 to 30 seconds. PMID- 10146471 TI - Porous coating in total hip arthroplasty. PMID- 10146472 TI - Biomechanics of total hip arthroplasty. PMID- 10146473 TI - Community coalitions for prevention and health promotion. PMID- 10146474 TI - The evolution, operation and future of Minnesota SAFPLAN: a coalition for family planning. AB - Health coalitions are a key means by which health educators can pursue policy objectives. However, little research to date has focused on the formation, operation and maintenance of health coalitions. This paper examines the development and operation of Minnesota SAFPLAN (Statewide Association for Family Planning), a coalition of organizations and individuals that came together in 1990 to address the problem of inadequate state-subsidized family planning funds. Data were collected through 31 structured interviews with coalition member representatives and lobbyists, review of documentary data, and participant observation in coalition activities and meetings. The paper focuses on SAFPLAN's recruitment of members and division of labor. Recruitment of member organizations of SAFPLAN relied heavily on existing interpersonal and interorganizational networks. While this allowed rapid mobilization of a coalition that was an effective force in the state legislature, it left important gaps in SAFPLAN's membership and lingering questions about whom the coalition was designed to represent. A division of labor that reflected variation in members' commitment, skill, knowledge and discretionary time was developed. The SAFPLAN model merits careful consideration by health educators and others interested in affecting public policy through health coalitions. PMID- 10146475 TI - Correlates of coalition effectiveness: the Smoke Free Class of 2000 Program. AB - Fifty state and local coalitions that carry out the Smoke Free Class of 2000 program of the American Cancer Society, American Heart Association and American Lung Association were surveyed in 1990. Almost all (95%) rated themselves moderately or very active and a total of 88 900 second grade teachers were estimated to have received the materials. The availability of funds, competing priorities, lack of coordination, differences in agency service areas and personnel availability were most frequently cited as areas of concern to the coalitions. Personnel barriers and formality of coalition structure were independently related to perceived coalition effectiveness and, with the number of elementary schools, to perceived coalition activity. General recommendations, that were accepted upon completion of the assessment, included (1) formalization of agreements, mission statements, and goals and objectives, (2) attention to group formation and identification, and (3) clarification of national coalition expectations. PMID- 10146476 TI - Sustaining collaborative problem solving: strategies from a study in six Asian countries. AB - This paper presents findings from seven case studies of collaborative problem solving. The cases represent models of large-scale collaborative effort to improve the social, economic or health status of residents in poor communities. In these examples a variety of organizations worked together: government, business, voluntary agencies, community groups and people's organizations. A range of strategies was evident as these entities tried to sustain their collaboration. Strategies identified included those deployed collectively, those used by an individual organization to maintain its ability to participate and those used to persuade or pressure needed collaborators to become involved or stay the course. Specific strategies employed and descriptions of their use are presented and comprise a compelling profile of how collaborative problem solving functions. PMID- 10146477 TI - A methodology for monitoring and evaluating community health coalitions. AB - Community coalitions are prominent mechanisms for building local capacities to address health and social concerns. Although there are case studies and descriptive reports on coalitions, there is little empirical information about coalition process and outcome. This paper describes a case study using a methodology for monitoring and evaluating community health coalitions. Data are fed back to coalition leaders and members, funding agents, and other relevant audiences as part of the development process. The monitoring system provides data on eight key measures of coalition process and outcome: the number of members, planning products, financial resources generated, dollars obtained, volunteers recruited, services provided, community actions and community changes. Illustrative data are presented for two different community health coalitions. Finally, challenges and opportunities in evaluating community coalitions are discussed. PMID- 10146478 TI - Identifying training and technical assistance needs in community coalitions: a developmental approach. PMID- 10146479 TI - Developing and maintaining state-wide adolescent pregnancy prevention coalitions: a preliminary investigation. AB - This paper presents the results of a study of state-wide adolescent pregnancy prevention coalitions. Key informants in five states throughout the southern United States were given semi-structured interviews regarding the adolescent pregnancy prevention coalitions in their states. From these interviews and other documents, conclusions were drawn regarding the nature and importance of the environments within which these coalitions operate, the universe of activities in which coalitions engage, and the stages of development of these coalitions. Katz and Kahn's model of social organizations served as the basis for understanding coalitions in terms of these three considerations. Future research should consider the utility of organizational models that can explain more fully the organization--committee hybrid structure that tends to characterize these coalitions. PMID- 10146480 TI - Angiography among top applications for spiral CT. PMID- 10146481 TI - Spiral methods create some practical problems. PMID- 10146482 TI - Finding thoracic lesions in breath-hold intervals. PMID- 10146483 TI - Improving detection of abdominal disease. PMID- 10146484 TI - Monitoring success of interventional therapy. PMID- 10146485 TI - Oculoplastic and orbital surgery. PMID- 10146486 TI - Enucleation, evisceration, and exenteration. AB - This review outlines many of the recent advancements in the understanding and management of the anophthalmic patient. A population-based study demonstrated that the annual incidence of enucleations for all causes was about 3 to 5 per 100,000. Application of expandable orbital implants appears to be promising in the management of microphthalmia or anophthalmia in infants to maximize orbital growth. Some reports on the use of hydroxyapatite enucleation implants are encouraging, with no major complications observed in one large series. Yet other reports of hydroxyapatite implant exposures, at a very concerning frequency, are also beginning to emerge. Few of the exposures heal spontaneously; however, infections or extrusions are very rare, and they are attributable to the porous composition of the implant. Conjunctival flaps alone are suboptimal in the management of exposures. Adjunctive autologous fascial grafts seem preferable to heterologous sclera in the management of these exposures. Magnetic resonance imaging of the hydroxyapatite implant appears to be superior to bone scan in the noninvasive assessment of vascularization of these implants. Further advancements are necessary to achieve a more optimal enucleation implant. PMID- 10146487 TI - Orbital imaging. AB - Appropriate axial or coronal computed x-ray tomography is the most inexpensive method to reliably supply detail in orbital disease. Magnetic resonance imaging can provide additional information and may be characteristic in some conditions. Magnetic resonance imaging is imperative for detailed imaging of disease at the orbital apex, optic canal, or chiasm. Color-coded Doppler ultrasonography allows examination of physiological blood flow within orbital vasculature and recent reports have reported the changes of flow in various orbital diseases. Limited results with computed tomographic or video-radiographic investigation of lacrimal outflow obstruction have been presented in several articles, although it remains doubtful whether these techniques are superior to the cheaper, more readily available, conventional macrodacryocystography. Endoscopy of the lacrimal drainage system is proving to be an interesting research tool, but is of uncertain applicability in the treatment of disease. PMID- 10146488 TI - Lacrimal disease and surgery. AB - The lacrimal drainage system includes the nasolacrimal duct, lacrimal sac, and canaliculi. Stenosis or obstruction at any portion of the lacrimal drainage system or an impaired lacrimal pump may cause bothersome epiphora. Tear stasis may also be associated with ocular or adnexal infections. This article reviews the recent literature pertaining to anatomy and physiology, pathology, and clinical evaluation and treatment, as well as complications of lacrimal drainage system disorders. PMID- 10146489 TI - Blepharoplasty. AB - Cosmetic blepharoplasty is performed in various subspecialties, therefore articles appear in the ophthalmic, plastic surgical, otolaryngologic, and dermatologic literature. We review the past year's articles regarding evaluation, technique, adjunctive procedures, and complications. As the various techniques of upper-eyelid and lower-eyelid blepharoplasty have taken their place in the armamentarium of the aesthetic surgeon, attention has turned toward adjunctive procedures to enhance the surgical result. PMID- 10146490 TI - Surgical techniques of strabismus. AB - Improvements in the management of strabismus are largely dependent on making the specific diagnosis and differentiating patterns of strabismus. This finding is especially true in the management of superior oblique paresis because there are various types. Recent observation suggests that superior oblique paresis may be associated with a lax superior oblique tendon and that the cause of the paresis is not always neurogenic. Some authorities have suggested using the traction test of the superior oblique to determine whether the superior oblique tendon is lax. If it is lax, the treatment of choice would be a tightening procedure of the superior oblique such as the superior oblique tuck. Adjustable-suture strabismus surgery has reduced the incidence of repeat operations; however, adapting the procedure to the fornix incision has been difficult. The use of a scleral traction suture that retracts the conjunctiva to expose the muscle suture area has been useful for fornix surgery. The rectus muscles supply circulation to the anterior segment via the anterior ciliary vessels, which are routinely interrupted during strabismus surgery. Various procedures have recently been described to preserve the anterior ciliary vessels, and these procedures will be useful in patients who are predisposed to anterior segment ischemia. In the 1950s, inferior oblique weakening procedures were deemed dangerous and unpredictable. Recent advances in the understanding of inferior oblique physiology and fascial relationships have inspired the development of a new inferior oblique weakening strategy--the anteriorization procedure.(ABSTRACT TRUNCATED AT 250 WORDS) PMID- 10146491 TI - Unilateral frame distraction: proximal tibial valgus osteotomy for medial gonarthritis. AB - An undertreated group has emerged in modern orthopaedic surgery--patients with degenerative disease of the medial compartment of the knee who are young and active, who may have undergone multiple arthroscopic procedures, and who have been advised to "take it easy and wait for a total knee replacement." If the knee is in varus, unilateral frame distraction with upper tibial corticotomy is advocated to achieve valgus alignment. The procedure is straightforward, with few complications in our first 100 cases, with almost universal success. Even if it is believed that all tibial osteotomies will eventually fail and require a total knee replacement, this method, by which bone stock is actually enhanced, length is maintained, and the ligamentous structures about the knee are undamaged, is superior to methods previously described. PMID- 10146492 TI - How outcomes analysis impacts medical imaging. PMID- 10146493 TI - High-resolution EEG enters imaging arena. PMID- 10146494 TI - Remote diagnosis raises efficiency of radiology. PMID- 10146495 TI - Enhanced MR clarifies cause of failed back surgery. PMID- 10146496 TI - MRA of coronary arteries overcomes early limitations. PMID- 10146497 TI - Image-guided biopsy plays key role in patient care. PMID- 10146498 TI - New methods advance intervention in stroke. PMID- 10146499 TI - Multimedia demands integrated databases. PMID- 10146500 TI - Private MRI centers spring up in Canada. PMID- 10146501 TI - The economics of advanced biomaterials. AB - A patient who has previously lost an eye through trauma develops a cataract in his remaining eye. Two types of intraocular lens are available for his treatment, one of modest cost, which is effective in all but a few high-risk patients, the other much more expensive, which gives marginally better results on average, but better performance in those with diabetes or glaucoma. Should the higher-cost lens be used even if there is no direct evidence that it will do better in this patient who does not have these conditions, or is it ethically justified to use the lower-cost lens even though failure would result in the total loss of sight? This case is used as the basis of a discussion on the use of high-cost materials and medical devices. PMID- 10146502 TI - Design and properties of maxillofacial prosthetic materials. AB - Maxillofacial reconstruction by prosthetic means is a valuable contribution that medicine offers to the public. Materials design and properties are the main problems faced by scientists in this field. Materials used for intraoral prostheses are not ideal, but they have been perfected to the point of practical use. Denture resins, gold, chromium-cobalt alloys, and porcelain are widely used and produce acceptable results in the oral cavity. In this review, the properties and performance of some polymeric materials used in maxillofacial prosthetics are discussed, and new trends in research and development are also reported. PMID- 10146503 TI - Clinical investigations: taking a global approach, part I. AB - Clinical investigations are a vital part of the development process of a medical device. A number of advantages can be gained by initiating a global approach to clinical investigation and implementing a well-designed, multinational, multicentred programme. It can mean that market approval can be accelerated and that the marketing effort is supported in specific countries, which can lead to greater market share. This article, which will be published in two parts, outlines the strategy that is required to set up and implement an effective global clinical investigation. Part I considers the elements that are involved and defines the advantages of adopting this approach. PMID- 10146504 TI - Investing in medical device companies. AB - For companies seeking investors, money is available, but it is not as easy to obtain as it has been in recent years. Although the medical device industry remains an attractive proposition, several factors have contributed to the downturn in public-offering investment. This article outlines these factors and discusses the types of medical technologies that are likely to attract investment in the immediate future. PMID- 10146505 TI - Long-term implications of CABG. PMID- 10146506 TI - Two useful tools for exploring the middle ear. PMID- 10146507 TI - Out to pasture: a case for the retirement of Canadian mental health legislation. AB - The emergence of new adult guardianship and related legislation and systems in British Columbia, Ontario, and other jurisdictions has generated questions about the utility of separate mental health legislation. Mental health statutes are the descendents of legislation that once created and regulated separate institutions and systems for the insane (later known as the mentally diseased and, more recently, the mentally ill). Such legislation is no longer consistent with the dominant community care and treatment strategies in the mental health field and the growing trend to recognize and respect consumer involvement in care and treatment decision making. Emerging legislation in the guardianship field makes provision for a range of options and mechanisms that can replace separate mental health statutes (e.g., general consent to health care legislation, and provision for enduring powers of attorney of the person and Ulysses agreements) and produce a new and more effective legal framework for the provision of mental health care and treatment. PMID- 10146508 TI - Compulsory community treatment? I. Ontario stakeholders' responses to "helping those who won't help themselves.". AB - This paper explores the highly controversial issue of compulsory treatment of allegedly mentally disordered persons within the community. In light of American literature on the subject, we examine and contrast the positions and arguments of a variety of Ontario stakeholders. This is done through content analysis of 224 submissions to the Ontario Ministry of Health in response to its "Discussion Paper Towards Community Mental Health Services Legislation of January 1990" which addresses the specific question: "Should the legislation include provisions for out-patient commitment/compulsory community treatment?" Our purpose in this paper is not to determine the desirability or undesirability of compulsory community treatment (CCT) as such, but to examine Ontario positions as a first and necessary step in the process of acquiring perspective on the issue. PMID- 10146509 TI - Compulsory community treatment? II. The collision of views and complexities involved: is it "the best possible alternative"? AB - This paper pursues our exploration of the highly controversial issue concerning the compulsory treatment of allegedly mentally disordered persons within the community. We contrast, in their most basic arguments, the discourses which proponents and opponents of CCT characteristically construct for the specific purposes of convincing policy makers of the rightfulness of their respective positions and of ultimately influencing the legislative choices to be made. We identify key practical questions which have to be addressed in order to further our thinking on the issue and suggest that what today's mental health system unequivocally requires is real commitment on the part of government to make a greater political, organizational, and financial commitment to effective partnership models and to a balanced mental health system. PMID- 10146510 TI - An evaluation of a self-help clearinghouse: awareness, knowledge, and utilization. AB - This paper reports on an evaluation of the Self-Help Clearinghouse of Metropolitan Toronto. The purpose of the Clearinghouse is to facilitate the growth and development of self-help/mutual aid groups, and to inform and educate both the Metropolitan Toronto professional helping community and the larger community of the nature and availability of self-help. This study included: (a) a pre- and post-test assessment of awareness, knowledge, and utilization of the Clearinghouse's services and (b) a descriptive assessment of the perceived value of the Clearinghouse from the perspective of a range of informants. Study information was collected from: (a) a selection of representatives of Metro Toronto self-help groups (pre-test N = 70 and post-test N = 52) and (b) a selection of representatives of Metro Toronto health and social services agencies (pre-test N = 70 and post-test N = 55). The findings demonstrated that the awareness, knowledge, and utilization of the Clearinghouse's services by members of the self-help community and human service professionals increased over a 2 1/2 year period. Statistically significant differences were noted among both groups in terms of increased awareness and utilization of the Clearinghouse. As well, professionals' increased knowledge of information and referral services and the directory and the self-help groups' perception of a need for a unique organization dealing with self-help were statistically significant. Both groups perceived a need for a distinct clearinghouse for self-help groups and were very satisfied with the services of the Self-Help Clearinghouse in Metropolitan Toronto. PMID- 10146511 TI - {The perception of mental health professionals of barriers to the delivery of mental health services for the aged in New Brunswick}. AB - The present survey examines the barriers associated with the delivery of mental health services to the elderly as perceived by mental health professionals. The sample consisted of 139 professionals of the New Brunswick Mental Health Commission. The results reveal that the mean percentage of elderly clients in the practice of mental health professionals is low. The percentage of elderly clients in the practice of mental health professionals was positively correlated with training in gerontology. The attitudes of the respondents toward the elderly were either positive or neutral rather than negative. In addition, the results show that the barriers perceived by the professionals to explain the low utilization rates differ in order of importance from those acknowledged by the elderly. The lack of human resources was identified as the major barrier to the development of specific consultation services to the elderly. Finally, the implications of these results for the development of mental health consultation services for the elderly are examined. PMID- 10146512 TI - {A pro-active approach to community intervention in the rural setting}. AB - This paper reports an evaluation study of a pilot project held in a "CLSC" (Local Community Health Centre) located in a rural community. The intervention design is based on multidisciplinary teams created to meet specific local community needs. Mental health intervention is part of a community-based approach open to all kinds of requests for support. Practitioners in the field give support not only to the individual with a mental health problem, but also to existing self help networks in the community. The intervention is also designed to change the relationship between a professional, seen as the one who provides services, and a client, defined as a consumer. The term "client" gains a wider meaning, and collaborative work with informal self-help networks induces a closer relationship between the community and the practitioner. The practitioner is more open to local community values and adjusts his or her practice to match variable contexts. The evaluation study has expanded knowledge of this type of intervention design, on its impact upon service demand, intervention modalities, and service management and organization. This project was coupled with a similar project in an urban environment and was financed by the Health and Social Services Ministry in Quebec. PMID- 10146513 TI - Radiological considerations: percutaneous laser disc decompression. AB - Diagnostic radiology is an integral part of percutaneous laser disc decompression (PLDD). All physicians involved in PLDD patient selection and treatment must be familiar with the imaging techniques unique to this procedure to ensure a successful outcome. The following review is based on the cumulative experience gained in performing over 150 PLDD procedures. It discusses the function of diagnostic radiology in all facets of PLDD including patient selection, intraoperative imaging, postoperative evaluation, and analysis of complications. Fundamental radiologic concepts that apply to PLDD are explained and protocols suggested to optimize results and avoid complications. PMID- 10146514 TI - Second generation photodynamic agents: a review. AB - Over the last decade, laser treatment of neoplastic diseases has become routine. The ability of these light-induced therapies to effect positive results is increased with the utilization of photosensitizing dyes. The approval of Photofrin in Canada as a first generation photodynamic therapeutic agent for the treatment of some forms of bladder cancer is being followed by the development of other agents with improved properties. At this time a number of second generation photosensitizing dyes are under study in phase I/II clinical trials. A review of the status of these trials along with mechanistic aspects is reviewed in this article. In addition, a review of the status of lasers to be utilized for photodynamic therapy gives some indication of which instruments could be considered for this therapy in the future. PMID- 10146515 TI - A neodymium:YAG fiber delivery system for interstitial photothermal therapy. AB - We describe here a highly durable 600-mu optical fiber with a 20-mm frosted distal tip protected by a smooth transparent cover that is capable of remaining in contact with tissue for prolonged periods. When used with a neodymium:YAG (Nd:YAG) laser, the active fiber surface diffuses optical radiation in a radial pattern, delivering up to 40 W power, and thus providing consistent and uniform interstitial photothermal therapy. Preliminary animal studies have demonstrated the feasibility of using these fibers to treat a variety of soft-tissue tumors, including benign prostatic hyperplasia. PMID- 10146516 TI - Green light photodynamic therapy in the human bladder. AB - We conducted this pilot clinical study to investigate the safety, primarily acute toxicity, of green light (514.5 nm) whole bladder photodynamic therapy (PDT) in human bladders with transitional cell carcinoma. We enrolled five patients who were scheduled to undergo radical cystectomy and urinary diversion for locally muscle invasive bladder cancer. Four patients received intravenous injection of Photofrin at 1 mg/kg, while one patient received no drug, 48 hr before undergoing green light whole bladder photoactivation with light doses of 20-60 J/cm 2. Each patient underwent radical cystectomy on day 7 following light treatment. Post PDT evaluation included daily monitoring of voiding symptoms, cystometric measurements of bladder capacity, and gross and histopathologic examination of the excised bladders. Our results show that the intensity of acute bladder irritation and acute post-PDT loss in bladder volume depended on the light dose and extent of bladder tumor with the associated inflammation. There was no transmural bladder injury and no treatment related morbidity. These data on acute toxicity suggest that green light whole bladder PDT treatment with 1 mg/kg of Photofrin and 20-40 J/cm 2 of laser power is safe. PMID- 10146517 TI - Evaluation of a new laser-resistant operating room drape, eye shield, and anesthesia circuit protector. AB - To determine whether Dermacare's laser eye shield, anesthesia circuit protector, and barrier drape were laser resistant, the three products were tested with CO 2 and Nd:YAG lasers set to 70 to 60 W, respectively. Five separate areas on each product were unaffected by 1 min of continuous laser fire with each type of laser. It is concluded that the Dermacare draping products offer good laser safety under the conditions of this experiment. PMID- 10146518 TI - The need for coronary surgery in 1993. AB - Coronary surgery remains an important therapeutic option for coronary revascularization, particularly in the elderly with coronary disease, in whom recent studies have demonstrated improvement of quality of life and long-term survival compared with medical treatment. Morbidity and mortality in the elderly may be predicted by stratification of preoperative risk factors into scoring systems. Interim results from multicenter trials comparing coronary surgery and coronary angioplasty for the treatment of multivessel coronary disease suggest that coronary surgery may be better for symptom relief in angina, with fewer hospital admissions and therapeutic interventions. Surgery for single- or double vessel disease is appropriate when initial attempts at revascularization by coronary angioplasty have failed. Coronary surgery may be a therapeutic option in the treatment of cardiogenic shock, particularly in the presence of three vessel disease or the presence of complex lesions not amenable to angioplasty. Long-term survival after myocardial infarction may be improved by revascularization of the infarct-related artery. Recent studies of myocardial viability have examined the use of positron-emission tomography scanning to determine which patients may benefit most from myocardial revascularization. PMID- 10146519 TI - Current expectations for survival and complications in coronary artery bypass grafting. AB - The outcome of coronary artery bypass surgery is best assessed in terms of two independent components: the operative mortality and complications on the one hand, and the late survival and relief of symptoms on the other. The expected operative mortality rate in a particular patient can be calculated with reasonable accuracy from preoperative risk factors. This calculation also enables results from different units to be compared by correcting for the preoperative risk factors in the patient population. Despite improvements in cardiopulmonary bypass, there is still a low but appreciable incidence of subtle neuropsychological changes induced by coronary artery bypass grafting. The expected long-term results of the procedure must be determined from the results of surgery in the past. However, allowance must be made for two new influences. One is the expected improvement in the long-term results of current surgery, due to the improved longevity of currently used graft conduits such as the internal mammary artery. The other is the worsening of late results of present-day coronary artery bypass grafting caused by the greater number of preoperative risk factors in patients currently accepted for surgery, such as old age, impaired left ventricular function, and reoperation. PMID- 10146520 TI - Coronary artery surgical technique. AB - The increased use of arterial conduits in coronary artery bypass grafting is reflected in numerous publications addressing indications, choice of conduits, and possible side-effects. Besides the internal thoracic artery, the right gastroepiploic artery is becoming established, and the inferior epigastric artery is being subjected to clinical trials. The latter conduit provides good patency and can be combined with the internal thoracic arteries, but harvesting must be done carefully to prevent local complications. Arterial conduits can lead to hypoperfusion, and additional saphenous vein grafting may become necessary; careful vasodilatation of the conduit before implantation is necessary. Xenografts and allogenic implants demonstrate poor late patency and should be used only as a last resort. Aprotinin reduces blood loss during surgery and seems to be particularly useful in reoperations; but it prolongs the activated clotting time and underheparinization can occur. Retrograde cardioplegia seems to be particularly indicated in reoperations, whereas topical cooling can be omitted. Coronary revascularization can be safely combined with carotid endarterectomy; the exact indication for this simultaneous procedure is still being explored. PMID- 10146521 TI - Assessment of myocardial viability and the role of surgery. AB - The importance of accurately predicting functional recovery of the myocardium has become clear with the advent of interventional techniques for coronary revascularization. Detection of hibernating myocardium (reversibly dysfunctional myocardial segments subtended by stenosed arteries) has been approached by techniques that assess different characteristics of this condition, such as contractile reserve, membrane integrity, and metabolic activity. The standard for detecting viable myocardium is considered to be metabolic imaging with positron-emission tomography using the glucose analogue 18F-fluorodeoxyglucose, which makes it possible to quantitate regional glucose utilization in myocardium. However, recently, a new approach has been proposed based on the use of 15O labeled water, which does not require metabolic imaging and appears to offer advantages in terms of scanning time and quantitation of viable tissue. PMID- 10146522 TI - Postoperative arrhythmias and the role for implantable cardioverter defibrillators. AB - Arrhythmias are seen frequently in the early postoperative phase of coronary artery surgery. Ventricular ectopic beats and atrial fibrillation are the most common rhythm disturbances and they offer the greatest management challenges. Yet despite the lack of good clinical trial data, few new studies have been initiated and reported in recent years. Recent reviews have given a better picture of the epidemiology of atrial fibrillation, but as yet there is little of practical use for the clinician. Magnesium, which looks so promising in the treatment of patients with acute myocardial infarction, offers no preventative action against postoperative atrial fibrillation. Implantable cardioverter defibrillators have brought a new "surgical" procedure to arrhythmia management, but with the development of transvenous systems, implantation of these devices may revert from the surgeon to the cardiologist. Implantable cardioverter defibrillators have dramatically reduced interest in map-directed antiarrhythmic surgery, yet recent work suggests that abandoning such techniques would be inappropriate. Implantable cardioverter-defibrillators and map-guided surgery must evolve together; neither can replace the other. PMID- 10146523 TI - Angioplasty, stenting, atherectomy, and laser treatment after coronary artery bypass grafting. AB - Saphenous vein grafts remain an essential part of coronary artery bypass surgery. However, their inferior long-term patency due to graft attrition often means recurrent ischemia or infarction. Repeat surgical revascularization carries a significantly higher morbidity and mortality and is frequently associated with less symptomatic improvement as compared with the initial surgery. Thus, nonsurgical alternatives are preferred in such a situation, particularly when the lesions are technically approachable and amenable to these transcatheter procedures. Traditionally, percutaneous transluminal coronary angioplasty has been the standard approach. However, there are certain shortcomings of this technique, principally its inadequacy in treating certain adverse lesion morphologies. Problems include an appreciable risk of coronary debris embolization and acute complications in old vein grafts, and the prohibitively high restenosis rate for stenoses situated at the ostium or the proximal and middle segments of grafts. Newer, second-generation intravascular techniques such as stents, atherectomy, and laser procedures have been introduced in an effort to overcome these problems. This review presents an update of the results of these new tools together with some suggestions on their clinical utility in a vein graft setting. PMID- 10146524 TI - The impact of health care reform on cardiac imaging. PMID- 10146525 TI - Stress echocardiography. AB - Stress echocardiography has become an accepted noninvasive method for the diagnosis of coronary artery disease. Stress echocardiography is more sensitive than exercise electrocardiography and as sensitive and specific as radionuclide perfusion studies for detecting coronary artery disease. Pharmacologic stress echocardiography using dobutamine also has excellent diagnostic accuracy for patients who are unable to exercise. Dobutamine stress echocardiography can provide prognostic data to determine perioperative cardiac risks in patients who are undergoing vascular surgery. PMID- 10146526 TI - Imaging in the catheterization laboratory. AB - Recent work confirms that visual assessment of the effect of widely employed coronary interventions is highly inaccurate. Rapid and reliable on-line angiographic quantitation is a useful advance, but problems in the application of the technique are encountered in a substantial number of cases. New algorithms have been devised to provide a comprehensive assessment of the geometry and likely functional significance of lesions as well as an objective evaluation of lesion morphology, and recent work has provided the framework for the quantitation of diffuse disease. Studies with intravascular ultrasound confirm the inadequate sensitivity of angiography in demonstrating mild to moderate atheromatous disease in the presence of vascular remodelling. The complex wall and lumen changes after percutaneous transluminal coronary angioplasty have been extensively studied; features often inadequately identified by angiography- including mural calcification and dissection--appear to affect short- and long term outcome. The precise clinical utility of intravascular ultrasound is a critically important question that is being addressed by a number of multicenter studies. Current evidence suggests it will become part of a more comprehensive system of coronary assessment, both as the imaging modality of choice in selected indications (such as cardiac allograft arteriopathy) and as an important adjunct to angiography in certain coronary interventions. PMID- 10146527 TI - Update in nuclear cardiology. AB - Imaging techniques for the noninvasive detection and evaluation of coronary artery disease continue to develop. New techniques for the quantification of myocardial blood flow by positron-emission tomography, new approaches to metabolic imaging, and new gamma camera technology have the potential to expand the scope of cardiac nuclear medicine in many facilities. Determination of the best and most cost-effective method of assessing myocardial viability in patients with advanced coronary artery disease remains of key interest with research directed at alternative 201Tl imaging protocols, fatty acid metabolism, and viability assessment with the new 99mTc-based myocardial perfusion radiopharmaceuticals. The assessment of endothelial function and determination of coronary flow reserve with 13N-ammonia positron-emission tomography may aid in the identification of preclinical atherosclerosis, and in monitoring disease progression and response to therapy. New information in radionuclide perfusion imaging in young and elderly patients and in those with interventricular conduction disturbances may allow for more accurate identification of coronary artery disease. The role of radionuclide imaging in patients with dilated cardiomyopathy continues to evolve with the development of radiolabeled chemicals of the adrenergic nervous system and their analogues, which will be helpful in the stratification of disease severity. These new imaging techniques promise to increase the accuracy of nuclear cardiology for detection of disease, assessment of function, and prognosis. PMID- 10146528 TI - Comparative imaging techniques and models. AB - In vitro modeling remains an effective method of assessing the effect of hemodynamic variables and instrumentation settings on the display characteristics of imaging modalities. Most emphasis has been placed on the quantitative estimation of mitral regurgitation using the zone of flow convergence proximal to the regurgitant orifice on color Doppler flow mapping. Comparative studies of cardiac ultrasound imaging and flow-related magnetic resonance imaging have led to an improved understanding of the appearance of flow voids on cine magnetic resonance imaging and the shape of flow velocity fields on color Doppler flow mapping. We review recent advances in the above areas and introduce some of the more innovative recent research in the area of cardiac imaging. The results of evaluating imaging techniques using in vitro and animal models provide useful insights into the basic display characteristics of these often quite different modalities and supply a valuable basis for the interpretation of these images in the clinical setting. Comparative clinical observations of a variety of cardiac imaging techniques such as transesophageal and transthoracic echocardiography, magnetic resonance imaging, and computed tomography scanning can often highlight and explain differences in their individual characteristics and clinical utility. PMID- 10146529 TI - New implant designs for bioresorbable devices in orthopaedic surgery. AB - From today's point of view it is not possible to transfer the designs of metal implants in orthopaedic surgery to biodegradable polymers. The attempt of a simple mimicry of metal implants for those made of polymers was condemned to fail from the very beginning. In this paper some fundamental limitations of implants made from biodegradable polymers (PGA and PLA) are experimentally demonstrated. Fixing devices adapted to the characteristic properties of polymers and adjusted to the specific therapeutic problems have to be developed. The creation of new implant devices made of biodegradable polymers depends on the influence of manufacturing processes, composite materials, fibre reinforcement, coating, specific erosion processes and the development of new implant designs. The basis for a new implant philosophy is discussed. PMID- 10146530 TI - The characteristics and performance of dentine bonding agents. AB - Several attempts have been made to synthesise dentine bonding systems, but low bonding strength, increased variance, toxicity and poor hydrolytic stability were some of the disadvantages excluding them from being widely approved. However, many dentine bonding systems are considered to be biocompatible and have become commercially available. These adhesives are thought to have one or two bifunctional agents where one part of the molecule is intended to bond to the inorganic part of the dentine (calcium ions of the apatite), or to the organic part of the dentine (amino and hydroxy groups of the collagen), and the methacrylate part of the molecule is intended to copolymerise with the restorative resin. This review demonstrates that further work is needed to achieve the synthesis of novel dentine bonding agents which bond chemically to dentine by strong covalent bonds, and which are hydrolytically durable and non toxic to the oral environment. PMID- 10146531 TI - Clinical studies used in medical device approvals: can they be improved? PMID- 10146532 TI - Vascular graft sealants. AB - Although the use of vascular graft sealants is primarily intended to decrease the porosity of grafts upon implantation, sealants also may serve to passivate polymeric surfaces or act as a temporary scaffold for cell attachment and subsequent graft healing. The safety and efficacy of vascular grafts sealed with albumin, collagen, and gelatin have been established through many preclinical and clinical studies. Such products have been used in clinical practice since the mid-1980s. Any differences in the long-term human healing response to these sealants and the clinical relevance of such differences can be assessed only as the time of implantation increases and the data are evaluated. PMID- 10146533 TI - Assessment of olefin-based IUD tail strings. AB - The "tail string" that extends from a contraceptive intrauterine device (IUD) into the vagina is an illustrative case in materials engineering design. The strings must satisfy certain criteria for strength and other properties in order to fulfill the function of providing a means of insuring that the IUD has not been ejected, and eventually of helping remove the IUD. This must be done without contributing to an additional risk of unwanted medical side effects beyond those that may be inherent in any such device. Oriented monofilament olefins appear to satisfy these criteria, and have been used successfully in several IUD designs. This article describes a study of two such monofilaments taken from new IUDs, showing how the material's processing, structure, and properties lead to effective performance as tail strings. Several types of used IUDs were also studied, to insure that nothing occurred during use that would alter the conclusions drawn from the study of new strings. PMID- 10146534 TI - Porous polyurethane tubes as vascular graft. AB - A vascular graft with the inner diameter of about 3 mm was prepared from segmented poly (ether urethane) with an extrusion technique. To make the wall of the vascular grafts porous, NaCl salts were added to the polyurethane solution to be extruded and removed with water extraction after evaporating the solvent in the extruded tube. The wall was reinforced with elastic fiber to prevent dilation. The compliance of the vascular graft measured with the method of Hayashi et al. ranged from 0.2 to 0.3% mmHg -1. The initial Young's modulus was close to that of canine carotic artery, to which the porous polyurethane graft 4 cm long was anastomosed. Vascular grafts were occluded within 2 weeks after implantation, when their pore size was 0, 1.7, or 4.4 mum, whereas those with the pore size of 5.5, 7.4, and 30 mum were patent for longer than 4 weeks. When the vascular graft with the pore size of 30 mum was implanted for 6 months, the luminal surface was covered with neointima, but the endothelium-like cells appearing in the middle of the intima of the vascular graft were immature and sometimes had a very big nucleus. In addition, spindle-shaped, modified smooth muscle cells were noticed in the deep layer of the neointima, especially in the tissue where anastomotic intimal hyperplasia occurred. PMID- 10146535 TI - A one-handed needle-protection device for venipuncture. PMID- 10146536 TI - Implementing cross-department use of a point-of-care system. PMID- 10146537 TI - Clinical laboratory instrument interfacing: basic considerations and functional types of interface applications, part 1. PMID- 10146538 TI - Trials confirm utility of renovascular stents. PMID- 10146539 TI - Power Doppler expands standard color capability. PMID- 10146540 TI - The application of new composite materials for total joint arthroplasty. AB - The material and design issues for the composite hip stem development are examined. The development of the "isoelastic" hip is based on the hypothesis that the matching of the material modulus to that of cortical bone will result in an optimal stress transfer to the bone, resulting in a minimal bone loss. The biomechanical data showed no statistical difference in strain transfer in the bone before or after implantation of low modulus stems. The clinical reports of a number of earlier "isoelastic" devices showed evidence of loosening and lack of stability. The current interest has been in the development of femoral components made from carbon fiber reinforced polyaryletherketone, polysulfone, and carbon/carbon composites. As these materials are optimized, it is important to look into matching the rigidity of bone. Moreover, the unsupported neck area needs to be as strong as metal, like Ti6-Al4-V, to prevent failure, whereas the femoral component inside the bone needs to have lower rigidity. Therefore, monolithic composite material from neck area to the distal stem will not withstand the loading needs and a material optimization scheme is required to come up with a long-lasting composite device. Lastly, the price vs. patient benefits for these composite material stems need to be established. PMID- 10146541 TI - Analysis of performance of root-form endosseous implants placed in the maxillary sinus. AB - To evaluate the long-term effect on metal-bone interface of the perforation of the maxillary antral floor by root-form titanium implants, a study was undertaken in five mature Macaca fascicularis monkeys. One root-form titanium implant was placed bilaterally in the maxillary sinus perforating the sinus 5 mm and a second implant was placed completely in bone tissue. The protruding implant in the right antrum was grafted with autogenous cancellous bone and porous bone mineral (Bio-Oss) and the contralateral antral implant protruding in the antrum was left without grafting. The bilateral implants were used to support "free-standing" fixed prostheses, which were in full function for 14 months, during which time there was excellent clinical function and no mobility of the implants. Histomorphometric analysis of specimens revealed that there was no difference in the trabecular pattern or the amount of calcified matrix vs. marrow vascular spaces along the titanium implant interface. New reparative bone partially restored the osseous surface along the implant on the ungrafted side. Implants in the grafted antrum demonstrated bone regeneration over the implant surface ranging from 2 cm to complete regeneration. Histomorphometric analysis revealed the peri-implant bone to contain some particles of the Bio-Oss, although most of the implant bone interface exhibited only vital bone and marrow vascular spaces. The study indicates that the protrusion of implants maximally into the sinus floor does not necessarily require a bone graft to produce functional abutments for fixed prostheses and that implants can function well with 5 mm of protrusion into the antrum with excellent bone-metal interface. PMID- 10146542 TI - A-way express: a way to empowerment through competitive employment. AB - As traditional vocational rehabilitation programs for the psychiatrically disabled have failed to improve participation of this most marginalized group in the labour force, alternatives are needed to deal with extremely high unemployment of psychiatric survivors. The following article describes a grassroots initiative that has considerably changed life and employment prospects of 50 consumers-survivors in Toronto. PMID- 10146543 TI - The employment connection: the application of an individual supported employment program for persons with chronic mental health problems. AB - An individual supported employment program for people with psychiatric disabilities is described. Specific program components are outlined as well as issues related to implementation of job placement and job training processes. Preliminary outcome data indicated a 50% competitive employment rate following the first year of the program. The importance of collaboration between mental health and vocational rehabilitation specialists was highlighted. Emphasis on maintaining a client-centred approach was also discussed along with the need for a comprehensive employer education program. PMID- 10146544 TI - Social support for the elderly and their caregivers. PMID- 10146545 TI - {Critical review of studies on social support and its relation to the well-being of people suffering from dementia}. AB - Many people suffering from dementia live at home, in spite of the demands that such a situation puts on those who care for them. The role of helper is usually assumed by a particular family member who is therefore more likely to feel the impact of the caregiving responsibility. Researchers are concerned with the relationship between the well-being of these helpers and their informal social support. This article presents a critical review of 21 studies of that relationship. The various dimensions of social support considered in the studies are analyzed, as are the methodological limits. A discussion of findings about the relationships between social support and well-being completes the analysis. It appears that researchers have a limited conception of social support and assess only a few of its many dimensions in a variety of ways. Very few authors explicitly specify underlying assumptions or a theory relevant to their conceptualization of social support. The weakness and the diversity of this conceptualization are reflected in the measurement tools which consist of a few ad hoc questions on social support in nearly 50% of the studies. Few studies consider the support availability, duration, conflict, and reciprocity. The buffering effect model of support is examined in one study. Inadequate sample size, unrepresentative samples, and lack of control in regard to confounding variables are among the methodological problems identified. When researchers use an evaluative approach to measure social support, the relationships between support and well-being are more often significant than when a descriptive approach is used. In future studies, researchers should be careful to better articulate the theoretical notions proposed in studies on caring for a family member with dementia at home with those coming from studies on social support in general. It is important for researchers to strengthen their study design and to carry out longitudinal studies; they must also try to understand how the influence of society works. From this perspective, one avenue for the future might involve studying the sequence of relationships between stress, support, coping strategies, and well-being. This is all the more important because at the present time certain studies on the caring of persons with dementia are based on a conceptual framework of stress. Such a framework considers support as a mediating factor. PMID- 10146546 TI - {State of health and social support networks of natural female caregivers of mentally ill persons}. AB - Studies of the health and family situation of natural caregivers of the mentally ill do not indicate the gender of the principal caregiver. Consequently, they do not provide details about the health or the social support networks of women, who, in general, are the ones who assume the caregiving role. The purpose of this study of 61 female natural caregivers living with mentally ill patients was to describe the state of health of these natural caregivers as well as their social support from both neighbours and professionals. Another purpose was to verify the existence of relationships among these variables. Four health variables are studied: emotional distress, well-being, perception of general health, and number of health problems. Support from both neighbours and professionals is examined from the point of view of the caregivers' needs and the satisfaction felt by the caregivers, and according to several functions of social support. Descriptive analyses show that at least half of the natural caregivers suffer from emotional distress, diminished well-being, and various health problems. When support from neighbours is considered, the caregivers express numerous needs; two thirds of the caregivers declare themselves satisfied except in regard to their need to socialize. Regarding professional support, caregivers express fewer needs and seem less satisfied by the support received. Regression analyses demonstrate that two of the four predictors of neighbour support contribute significantly, though modestly, to the variations of emotional distress; one of those predictors also contributes to variations in the perception of general health. No significant relation was found for professional support. Recommendations are made for future research and for preventive interventions with women who are natural caregivers. PMID- 10146547 TI - Stakeholders as partners: the challenges of partnership in Quebec mental health policy. AB - The notion of partnership has swept our society's image makers' imagination and invaded our policy designers' conception of the desirable, the rational, and the marketable. This is particularly true in the field of mental health which is now earnestly investing in its operationalization. This paper presents the case of Quebec, a province which has legislated partnership within its recent mental health policy. The author examines the many responses this concept has provoked among the key stakeholders involved. Such an analysis provides us with a unique and direct insight into the many challenges government-legislated partnership is to meet in the human services, if it is ever to be viable. PMID- 10146548 TI - {Staff perceptions of the community approach in psychiatry}. AB - Since the 1960s, psychiatric practice in North America and in many Western countries has been increasingly oriented toward implementing community services for the care of the chronically mentally ill. This study is part of a larger research project whose main goal was to assess the impact of a community-based program on the quality of life and social reintegration of psychiatric patients living in a remote area. The project took place in the northwestern region of Quebec where the community approach is clearly recognized as a basic principle in the delivery of mental-health services. The first part of this research, reported here, measured to what extent staff attitudes correspond with the community orientation. PMID- 10146549 TI - The prevalence and mental health sequels of child sexual abuse in a community sample of women aged 18 to 27. AB - A community mental health survey of 750 women aged 18 to 27 in a large urban centre established mental health profiles using a variety of measures, including investigations of any history of child abuse (including sexual abuse, defined as the unwanted fondling of the child's genital area, or attempted or achieved penetration of the child's body before the age of 17). Overall, 32% of respondents recalled abuse of this type. Of the 750 women, 6.8% had experienced sexual abuse which went on for more than one week. This long-term category included virtually all of those who experienced abuse by a trusted, authority figure. The Trauma Symptom Checklist (TSC) was found to be the most useful instrument among the several used in identifying sexual abuse histories. Scores of 30 or more on the TSC identified 72% of victims of long-term abuse, while 23% of those with scores of 30+ had experienced short-term sexual abuse. Seven percent of individuals with 30+ scores had never experienced (or did not recall) sexual abuse. No particular sub-scale of the TSC had better utility in identifying former victims than did the scale total. PMID- 10146550 TI - {Psychosocial portrait of students presenting with suicidal tendancies}. AB - The present article reports the results of a study of 550 Shawinigan Cegep students enrolled in their first year of college. The study attempts to establish the prevalence of suicidal behaviours and to describe predisposing factors identified by the authors such as family problems, lack of social support, depression, stressful events having a negative impact, and attitudes toward life and death. The information was gathered using a questionnaire combining several elements: (a) a questionnaire similar to the one used by Lamontagne (1986) and Tousignant, Bastien, Hamel, and Hanigan (1986) to identify family problems; (b) the Sarason, Levine, Basham, and Sarason (1983) Social Support Questionnaire, translated and adapted by De Man (1986), which evaluates social support; (c) the Aneshensel, Clark, and Fredrichs test (1983) which indicates the presence or absence of depression; (d) the Sarason, Johnson, and Siegel (1978) Life Experience Survey, measuring the quantity of stressful events experienced, and their impact on personal life; and (e) Beck's (1979) Scale of Suicide Ideation which measures attitudes toward life and death. Two questions were added for the present study: Did you ever attempt suicide? If yes, how many times? Three hundred and fifty-five students answered the questionnaire, making the level of participation 71% (355/550). Participants were divided into four groups: those having made a suicidal attempt (n = 28) or planned suicide (n = 16), those having a score of 30 or more on the test relating to suicidal ideation (n = 18), and those regarded as "normal" (n = 278). The cut-off point of 30 on the scale of of suicidal ideation was determined by averaging the scores of those who made a suicide attempt and confirmed by a discriminant analysis. The students who had attempted suicide had major family problems, lacked social support, presented depressive tendencies, and had experienced stressful events having a negative impact on their lives. Furthermore, they manifested problems in their attitudes toward life and death. However, the study did not determine the contribution of each variable. The participants who had planned suicide, at first sight, did not seem to present more problems than those designated "normal," which seems astonishing. This was explained by the fact that the planned suicide was not recent or was a cry for help which found a response.(ABSTRACT TRUNCATED AT 400 WORDS) PMID- 10146551 TI - Developing services for lesbian and gay adolescents. AB - The needs of lesbian and gay adolescents for service provision are discussed in this paper. These needs are identified through research investigating milestones in the coming-out process. In addition, the way in which the research results influenced community development initiatives is described. The social context in which the research was conducted is also described. PMID- 10146552 TI - Resecting upper-tract urothelial Ca by ureteroscopy. PMID- 10146553 TI - Living-related liver transplantation for biliary atresia. AB - We reviewed our initial experience of 29 living-related liver transplantations (LRLT) for children with biliary atresia in terms of postoperative complications and management to analyze the factors that may influence the outcome. All patients underwent an initial portoenterostomy at 17-134 days of age. The age distribution at the time of LRLT ranged from 6 months to 12 years, following revised portoenterostomy 0 to 3 times, and with (n=5) or without enteric stoma (n=24). Living-related donors provided the partial liver grafts weighing 170 to 630 g according to recipient size. Twenty-six of the 29 recipients are alive and well with follow-up between 1 and 27 (mean=14) months. Three patients died of extrahepatic complications including aspiration asphyxia, Candida infection and lymphoproliferative disorder. Four of 5 children with enteric stoma had 9 incidences of postoperative complication, while only 4 incidences occurred in 4 out of 24 children without stoma (p=0.007). Children hospitalized at the time of transplantation seemed to have early postoperative complications more frequently than home-bound children (p=0.06). The present results indicated that LRLT could offer satisfactory outcome for children in whom repeated Kasai's operation could not attain adequate biliary diversion and for those who developed cirrhosis despite good initial bile drainage.(ABSTRACT TRUNCATED AT 250 WORDS) PMID- 10146554 TI - Clinical applications of hematopoietic growth factors. AB - OBJECTIVE: To explore the history and current clinical uses of hematopoietic growth factors. DATA SOURCES: Recent professional literature and texts dealing with recombinant DNA technology, the development of hematopoietic growth factors, and their use in various disease states. STUDY SELECTION: Not specified. DATA EXTRACTION: Not specified. DATA SYNTHESIS: Hematopoietic growth factors are glycoproteins that regulate the differentiation and proliferation of hematopoietic precursor cells, and, in some cases, the function of mature blood cells. Several have been molecularly characterized and produced in quantity via recombinant DNA technology. Medically, hematopoietic growth factors can be used to replenish hematopoietic lineages by raising cell counts to normal levels; to augment host defenses against infection; to stimulate the immune system against malignancy; and to increase production of effector cells with cytotoxic activities. CONCLUSION: In the past eight years, the hematopoietic growth factors have been used in a variety of clinical settings. They have proven to be effective in stimulating marrow proliferation, increasing circulating blood cell counts, and stimulating various host defense mechanisms. Others are in earlier stages of clinical studies, and their full therapeutic potential remains to be evaluated. New therapies are expected to emerge at a rapid pace. PMID- 10146555 TI - B- and T-cell gene rearrangement test: an overview of application and methodology. AB - OBJECTIVE: To examine the use of the B- and T-cell rearrangement test in the diagnosis of lymphoid neoplasms. DATA SOURCES: Recent texts, professional journals, and authors' experiences. STUDY SELECTION: Not specified. DATA EXTRACTION: Not specified. DATA SYNTHESIS: The B- and T-cell rearrangement test can detect a monoclonal population of B- and T-cells, strongly indicative of neoplasia. This is accomplished through the use of DNA probes. The presence of a unique band on the Southern blot signifies a monoclonal gene rearrangement, which can make or confirm a diagnosis of a lymphoproliferative disorder and classify the lineage as B- or T-cell. T-cell neoplasms generally behave more aggressively than B-cell neoplasms, which can have important implications for prognosis and therapy. The unique gene rearrangement "signature" can be followed during and after therapy to document remission or recurrence. The most commonly examined samples are from the blood, bone marrow, and lymph nodes, but any tissue or fluid suspected of harboring a lymphoid neoplasm can be examined. CONCLUSION: The test is an important diagnostic indicator in the evaluation and follow-up of patients with lymphoma or lymphoid leukemia. It is most helpful when it can be correlated to the clinical condition of the patient and other ancillary studies. PMID- 10146556 TI - Comparison of three prothrombin time and activated partial thromboplastin time reagent systems on the MLA 700 coagulation analyzer. AB - OBJECTIVE: To determine the difference in prothrombin time (PT) and activated partial thromboplastin time (aPTT) results among three reagent systems using a single analyzer instrument. DESIGN: Convenience sample of 100 patient specimens tested in duplicate with three reagent systems: Baxter-Dade, Pacific Hemostasis, and Organon Teknika. SETTING: A tertiary hospital that services other institutions within a three-state area. PATIENTS: Patients were divided into four groups: (1) normal preoperative patients who received no anticoagulants, (2) patients who received warfarin for at least the week immediately before the study, (3) patients who received heparin on the day of the testing, and (4) patients with severe liver disease accompanied by abnormal liver function tests. MAIN OUTCOME MEASURE: Coefficients of correlation of Baxter-Dade results versus the other two systems. RESULTS: PT values were significantly different in normal samples and in warfarin-treated patients. aPTT values were significantly different for normal patients and, for the Organon system only, for heparin treated patients. When expressed as international normalized ratio (INR) values, taking reagent sensitivity into consideration, the results correlated well. Problems with precipitation when using Organon's system limited its practical utility. CONCLUSION: Compatibility between a reagent system and analyzer instrument should be verified by the manufacturer of the instrument. Use of the INR format produced more accurate and comparable results, allowing safer and more effective dosage adjustments. Laboratories should convert PT and aPTT results to the INR format routinely. PMID- 10146557 TI - Identifying program preferences through conjoint analysis: illustrative results from a parent sample. AB - PURPOSE: The purpose of this article is to illustrate the application of conjoint analysis, a consumer research technique, using data from a survey of parents' preferences for prevention programs. DESIGN: This study utilized a one-time, cross-sectional telephone survey. SETTING: Data were collected from subjects living in economically disadvantaged rural midwestern counties. SUBJECTS: Subjects were 202 randomly selected parents with preadolescents who indicated interest in family-focused prevention programs. MEASURES: Conjoint analysis software was employed in computer-assisted telephone interviews to evaluate relative preferences for 39 individual features of family-focused prevention programs falling under 11 categories (e.g., program meeting time, facilitator background). The software also guided computer simulations of parent choices among four types of programs. RESULTS: Findings indicated that meeting time was the most important category of program features. Strongly preferred individual features included meetings scheduled on weekday evenings, instruction by child development specialists, and programs based on extensive research. Two multiple session programs evaluated via computer simulations incorporated several preferred features and received higher ratings than did single-session programs. Estimated variance z-tests indicated limited differences in perceived importance of program feature categories across sociodemographic subgroups. CONCLUSIONS: Findings highlight a) differences in the relative value parents place on various features of prevention programs in the surveyed population and b) the importance of practical aspects of program delivery. PMID- 10146558 TI - Toward a health promotion research agenda: compilation of database reports and introduction to "state of the science" reviews. PMID- 10146559 TI - The importance of horizontal programmes in health education. PMID- 10146560 TI - The determinants of four cancer-related risk behaviours. AB - This paper reports research into the determinants of four cancer-related risk behaviours: smoking, excessive alcohol consumption, high fat consumption and exposure to artificial sunlight. The results indicate that the four types of risk behaviour are determined by several factors: the perceived behaviour of the social environment, individual's attitudes towards the risk behaviour and self efficacy perceptions on changing the risk behaviour. High fat consumption differs from the other risk behaviours in that people tend not to be aware of their high fat consumption. No significant relationships were found among the risk behaviours apart from small correlations between smoking and heavy alcohol consumption, and between high fat consumption and heavy alcohol consumption. The implications of these results for the development of behaviour change programs are discussed. PMID- 10146561 TI - A re-assessment of health education on HIV/AIDS for young heterosexuals. AB - Despite a fairly high level of public knowledge about HIV there has, apparently, been little behavioural response to the disease by heterosexuals. Condoms are still used by young people primarily for contraceptive purposes. There are serious cultural and structural factors that impede the practice of safer sex, and for most young people HIV has little salience. They associate the disease with socially distant, stigmatized groups and do not feel personally vulnerable. Increase evidence suggests that the risk of HIV infection in Britain to non injecting heterosexuals in most geographical areas is currently very low, which undermines appeals to individuals' perceived vulnerability. An alternative approach to HIV/AIDS education would be to promote safer sex practices indirectly, by addressing other preexisting sexual concerns of young people, in particular the prevention of unwanted pregnancy. This might be achieved through a comprehensive sex education programme involving small group work to actively learn communication and negotiation skills and to empower young women. However, such an approach would need to be carefully evaluated. PMID- 10146562 TI - Factors affecting the efficacy of a community-based quit smoking program. AB - Community-based Fresh Start courses have been running at local community centres throughout Victoria since February 1983. This paper describes the key features of this program and identifies the factors which relate to smoking cessation. Data were collected from 3298 participants who attended a program between February 1983 and June 1988. All participants were asked to complete three short questionnaires: on arrival at the course, at the conclusion of the course and a year after finishing the course. Although most participants had made previous unsuccessful quit attempts and perceived quitting to be difficult, attendance at the course had a major impact on their reported smoking. At the conclusion of the course at least 51% of participants had quit smoking and the remaining participants had reduced their smoking by an average of 50%. At the 1 year follow-up, at least 23% of participants were non-smokers and the remaining participants had reduced their smoking by an average of 21%. Successful quitting at the end of the course and at the 12 month follow-up was positively related to the number of sessions attended and the perceived likelihood of quitting, and negatively related to initial cigarette consumption. PMID- 10146563 TI - The worksite component of variance: design effects and the Healthy Worker Project. AB - Variance estimates in worksite health promotion studies depend partly on the intraclass correlation coefficient (ICC). ICC quantifies homogeneity of a variable within worksites. ICC would be zero for randomly formed worksites, but is generally positive because employees tend to share personal characteristics. The ratio comparing the variance estimated from worksite means with that estimated from individuals under simple random sampling is the design effect (DEFF). A DEFF of 1.0 indicates no excess variance due to worksite. The Healthy Worker Project (HWP) was a 32 worksite cross-sectional and longitudinal study of a weight and smoking intervention program. ICCs in cross-sectional surveys for health-related outcome variables ranged from 0.006 to 0.009, DEFFs from 2.0 to 2.6 ICCs/DEFF's in longitudinal analysis were smaller; ICCs ranged from -0.002 to 0.003, DEFFs from 0.7 to 1.5. Positive ICCs substantially increased variance estimates at a single measurement, yet variance of longitudinal analysis was less subject to worksite dependence. It is concluded the worksite component of variance is real and should not be ignored, although the worksite component of variance is small in these longitudinal analyses. This observation should be replicated before it is used in other worksite health promotion research. PMID- 10146564 TI - A breast cancer screening educational intervention targeting medical office staff. AB - There is persistent evidence that breast cancer screening techniques remain under utilized. While physicians cite lack of time as a barrier to the provision of preventive services, nurses and other medical office staff are in an ideal position to educate women and motivate adherence to screening recommendations. This paper describes the design, implementation and process evaluation of a breast cancer screening educational program targeting primary care medical office staff. This intervention was conducted in two Washington State counties as part of a larger community organization study. The PRECEDE model, educational outreach principles and focus groups were used to guide the program development. Consistent with 'academic detailing' concepts, the sessions were delivered at health care facilities. The program included a review of breast cancer-related data and screening methods, an overview of the nurse's role as a 'change agent' and breast self-examination instructor, and a discussion of women's barriers to mammography. Community-level penetration was relatively high, with sessions being completed by approximately 50% of the eligible staff. Overall, participants were positive about the value of the program. Medical office-based educational sessions have the potential of reaching a large proportion of primary health care workers and increasing disease prevention in communities. PMID- 10146565 TI - The Human Genome Project and health behavior and health education research. AB - The Human Genome Project (HGP) is a multinational initiative to map and sequence the human genome. This major biological research effort, estimated to take 15 years and cost $3 billion, should have significant implications for public health generally, and for health behavior and health education research in particular. It is anticipated that the HGP research will lead to expanded (1) newborn genetic disease screening, (2) prenatal diagnoses and (3) trait carrier screening. The HGP also is likely to lead to presymptomatic screening of people with late onset genetic diseases, as well as screening for genetic-based susceptibility for common disease morbidity and mortality mediated by either or both life style and environmental factors. These potential developments have raised ethical, legal and social questions, and have highlighted the fact that research is needed on individual, organizational, population and governmental use of and response to these developments. Central to the expanding role of genetics in public health will be health behavior and education research. Such research could contribute to an effective and humane applied human genetics. PMID- 10146566 TI - Clinical investigations: taking a global approach, part II. PMID- 10146567 TI - (De)-constructing continuity of care: the deinstitutionalization of support services for people with mental health problems. AB - The objective of this paper is to raise questions about appropriateness of the concept of continuity of care for guiding the development of helping strategies for people with mental health problems in the era of noninstitutionalization. Research on continuity of care is reviewed to show the strong legacy of institutional thinking. A leading problem addressed in this literature is that of client drop-out from programs designed to ensure continuity. The research results clearly suggest that this "problem" lies with the agency of clients: the fact that, in the natural milieu, they make decisions according to their own definitions of the situation and in a social context of their own. This perspective, however, seemingly cannot be incorporated into the continuity of care paradigm, which remains firmly grounded in the world of service providers. We argue, therefore, that the era of the noninstitutionalization calls for a recasting of the meaning of "continuity" for people with mental health problems, a reorientation of the type of research conducted in this domaine, and ultimately, a reformulation of the nature and role of support services in the community. PMID- 10146568 TI - What makes a house a home? An evaluation of a supported housing project for individuals with long-term psychiatric backgrounds. AB - Supported housing (as distinct from supportive housing) emphasizes the values of consumer choice; independence; participation; permanence; normalcy; and flexible, ongoing supports. As a model, it has only recently become popular in the literature and therefore little is known of its effectiveness in serving people with long-term psychiatric backgrounds. In 1989, Homeward Projects, a community mental health agency located in Metropolitan Toronto, established a supported housing project. Homeward included an evaluative component in its program from the outset. In order to give equal weight to the tenants' opinions, both quantitative and qualitative methodologies were employed. In the quantitative component, residential milieu, social support, and service delivery were examined. The qualitative component involved an ethnographic study which allowed the tenants to voice their experiences of living in such a setting. Results provided a rich understanding of the model. Overall, the tenants eventually came to describe their house as a home. PMID- 10146569 TI - The socio-cultural context of health behaviour among Esan communities, Edo State, Nigeria. AB - This paper reports on health beliefs and their influence on treatment decisions and behaviour among the Esan people of mid-west Nigeria. The sources for the study are my own experience of growing up in Esan society, anthropological field work, and focus groups. The research revealed a transitional society where both traditional and modern medicine are employed and where the choice between them is determined by belief systems which are themselves in the process of change, as well as by distance and costs. The traditional health-belief system was one which placed most responsibility and blame upon women, and a system of social control over the adult female population. Changing health beliefs are less the result of the introduction of a new health philosophy than of the retreat, under the impact of Christianity, of traditional religion which embodied the older health philosophy. PMID- 10146570 TI - Intra-household differentials in women's status: household function and focus as determinants of children's illness management and care in rural Mali. AB - In West Africa, health-seeking behaviour can be better understood by assessing how women differ from each other, rather than how they differ from men, in terms of their socioeconomic and political power within the domestic environment. Anthropological and demographic data were collected among rural Malian Fulani and Dogon populations who possess similar health beliefs and who live in the same ecological area. However, real differences between the two ethnic groups were reflected in variations in maternal status defined according to women's support and/or autonomy in their households. When a child becomes sick, status obligations result in limited degrees of co-operation between marital female relatives. By contrast, on a day-to-day basis such assistance is rarely forthcoming and women rely on their own unmarried daughters or on external kin networks for surrogate child care. It is concluded that variations in health behaviour and mortality outcomes within these populations reflect not simply 'ethnic' differences in beliefs or culture, but rather real differences in mothers' social positions within their family environments and in their access to household resources for children's treatment and care. PMID- 10146571 TI - Women's education, child welfare and child survival: a review of the evidence. AB - This paper reviews recent evidence concerning the relative importance of women's education for child health, especially child survival in the Third World. Important regional patterns are uncovered, and particular attention is paid to discussion of the weaker associations observed in sub-Saharan Africa. PMID- 10146572 TI - Maternal education, female labour force participation and child mortality: evidence from the Indian census. AB - The objective of this paper is to examine how child mortality changes with different levels of maternal education and to quantify the impact of material education and female labour force participation. Child mortality gradients, according to years of education, are rather steep at the primary education level for both male and female children. In post-primary stages of education incremental gains in mortality reduction are almost non-existent. Child mortality is inversely related to both maternal education and female labour force participation but disaggregated analysis showed that female labour force participation has no impact on child mortality among females with fewer than seven years of education. The relative impact of maternal education on child mortality is three times stronger than that of female labour force participation. Excess female child mortality prevailing in certain parts of India also has an inverse relationship with the length of mothers' education, and female labour force participation. Female labour force participation has a stronger influence on excess female child mortality than on absolute child mortality. The evidence in the paper lends support to Bardhan's hypothesis on excess female child mortality. PMID- 10146573 TI - Forum: On the limited utility of KAP-style survey data in the practical epidemiology of AIDS. PMID- 10146574 TI - Digital indocyanine-green videoangiography of intraocular tumors. PMID- 10146575 TI - Achieving optimal nutritional status in COPD. PMID- 10146576 TI - Active compression decompression: a novel CPR technique. PMID- 10146577 TI - Minimally invasive angioplasty. PMID- 10146578 TI - A randomized controlled trial of the efficacy, safety and cost of a single-use myocardial bioptome. AB - A randomized single-blind study was performed comparing a reusable 8 French bioptome with a single-use 7 French bioptome in a consecutive series of 63 myocardial biopsy procedures performed during follow-up of cardiac transplant patients. Safety, efficacy and cost were compared between 30 procedures performed with the single-use bioptome (Group I) and 33 procedures performed with the reusable bioptome (Group II). The two instruments were found equally efficient in obtaining adequate biopsy samples (69% of attempts for both instruments). The average specimen weight was not significantly different (Group I 2.5+/-1.3 mg, Group II 2.7+/-1.1 mg) despite different nominal jaw sizes. There was no significant difference in the incidence of incompletely cut specimens (Group I 13%, Group II 7%) and there were no complications in either group. The cost of the two instruments was, as expected, markedly different with an estimated average per-use cost of $250.00 for the single-use bioptome and $35.89 for the reusable instrument. In this small study, a single-use 7 French myocardial bioptome was found to be an acceptable substitute for the larger, reusable instrument with no decrement in specimen size. The substantial cost differential is noteworthy, although the maintenance required by the reusable instrument can present a formidable challenge. PMID- 10146579 TI - The evolution of a clinical database to evaluate the treatment of coronary artery disease. AB - BACKGROUND: The field of invasive cardiology has evolved rapidly since the initial use of catheters for treatment of coronary artery disease in the late 1970's. The pace of this change coupled with the complexity of the clinical setting and proliferation of devices and drugs used for therapy have made it extremely difficult to construct and maintain a viable clinical database. METHODS: Using a standard hardware and software system with the direct clinical input from a multidisciplinary team of physicians, nurses and biostatisticians, a clinical database was developed that is capable of tracking complex in-hospital and longterm follow-up data in patients undergoing treatment of coronary artery disease. RESULTS: The database has provided the basis for in-depth analysis of angioplasty results in patients with vessels and lesions of varying morphology, showing greater than 90% success in most complex lesion morphology using contemporary balloon technology and/or new devices. Longterm analysis (14 years) of patients after angioplasty has demonstrated that 76% survived without major cardiac events. Other analyses of various clinical and morphologic subsets have shown favorable results with angioplasty. The databases for angioplasty and coronary bypass surgery have been combined, showing comparable survival and freedom from cardiac events in multivessel disease patients treated with these procedures. CONCLUSIONS: The development of a dynamic and clinically relevant database that has evolved has contributed valuable information to the understanding and effective management of patients with coronary artery disease.(ABSTRACT TRUNCATED AT 250 WORDS) PMID- 10146580 TI - Determining patient utility following coronary revascularization. AB - The observation of the primary endpoints of a clinical trial is only one part of what goes into determining the flow of benefits an individual receives from the treatments under consideration. An optimal comparison of CABG and PTCA requires a consideration of the varying time paths of patient "utility" associated with each procedure because these procedures differ in that CABG will have a higher initial morbidity and mortality while PTCA involves more frequent recurrent angina pectoris resulting in more repeat procedures or crossovers. This paper introduces a survey which can be used to estimate the patient's utility associated with two alternative forms of therapy, CABG and PTCA, for the treatment of multivessel coronary artery disease. Once these estimates of utility are determined, they can be combined with expected years of survival to create Quality Adjusted Life Years (QALYs). PMID- 10146581 TI - Late outcome of multivessel coronary artery disease after angioplasty or bypass surgery. AB - Background. Results from randomized trials to determine optimal treatment for patients with multivessel coronary disease are not yet available. Thus, the early and late outcomes of 191 PTCA and 221 CABG patients done in 1985-86 were evaluated. Methods and Results. CABG patients selected had more coronary risk factors and more severe coronary artery disease compared to PTCA patients. Comparison of the initial outcome showed that clinical success without major cardiovascular events was similar (93.7% for PTCA vs. 90.0% for CABG; p=n.s.). Five year followup was obtained in 99.0% of PTCA patients and 94.4% of CABG patients. In the PTCA group, 89.8% were alive, 4.8% had sustained an MI, and repeat revascularization was required in 46.8%. In the CABG group, 87.1% were alive, 3.2% had had a MI, and 3.5% required repeat revascularization. Statistical comparison demonstrated no difference between the groups in survival or late cardiac events, but rate of repeat revascularization was significantly higher for PTCA patients (p less than 0.0001). Incompleteness of revascularization (p<0.01) was independently associated with an increased need for repeat revascularization in the PTCA group. In the CABG group, depressed left ventricular function (p less than 0.001) and female sex (p<0.01) were associated with lower survival rates. An analysis of cost per patient showed that the strategies were comparable. Conclusions. PTCA and CABG in multivessel disease patients have similar early results and comparable rates of survival and late cardiac events. Significantly more repeat revascularization is required in PTCA patients to maintain these results.(ABSTRACT TRUNCATED AT 250 WORDS) PMID- 10146582 TI - Balloon mitral valvuloplasty: where are we now? PMID- 10146583 TI - Minimally invasive angioplasty: acute and long term results of low pressure dilatation with a non-compliant balloon during percutaneous transluminal coronary angioplasty. AB - Despite technological advances in angioplasty equipment and increased operator experience, the incidence of dissection and abrupt closure remains unchanged. To test the hypothesis that a different balloon inflation strategy may influence the degree of arterial trauma, and therefore reduce the incidence of major complications, the success rate, acute complications and incidence of restenosis were analyzed in 110 consecutive patients using a non-compliant dilatation catheter. The term "minimally invasive angioplasty" has been coined to describe a strategy of minimizing arterial trauma by using the lowest possible inflation pressures during percutaneous transluminal coronary angioplasty (PTCA). Lesion analysis using a modified American College of Cardiology/American Heart Association Classification showed that 37% of lesions were Type A, 40% were Type B, and 23% were Type C. Overall, PTCA success was achieved in 98% of lesions. Major dissection and abrupt closure occurred in 1%. No patient required emergency coronary bypass surgery and there were no deaths. The mean coronary stenosis was reduced from 85% to 18.4%. In 75% of lesions, inflation pressures of 5 atmospheres (atm) or less were used. Angiographic follow-up was available in 80 (73%) of the patients and restenosis occurred in 19 (24%). Thus, minimally invasive angioplasty, a technique which may reduce arterial trauma, results in a high primary success rate; low residual stenosis; and very low incidence of abrupt closure, major dissection and perhaps lower restenosis. These data suggest the need for further study of PTCA techniques designed to minimize arterial trauma. PMID- 10146584 TI - The results of treatment of posttraumatic avascular necrosis of the femoral head in young adults: report of 31 patients. AB - A series of 31 adult patients less than 42 years of age who were treated for avascular necrosis (AVN) following a healed femoral neck fracture were followed for an average of 14.6 years, and the results of their treatment were analyzed. The average age at fracture was 26.3 years (range: 12.2 to 41.4 years). The mechanism of injury was a motor vehicle accident in 18 and a fall in 13. Sixteen patients had multiple injuries. The average time from fracture to diagnosis of AVN was 19.1 months. The management of AVN included one or a combination of the following: non-weightbearing ambulation, decompression and bone grafting, electrical stimulation, femoral osteotomy, cup arthroplasty, resurface arthroplasty, arthrodesis, hemiarthroplasty, and total hip arthroplasty (THA). The average number of hip operations after initial fracture treatment was 2.9 per patient (range: 0-7). Current follow-up was possible in 97% (30 out of 31) of the patients. THA was performed either primarily or following other treatment in 23 patients at an average age of 31.9 years (range: 16.9-55.3 years). The survivorship of these THAs was 89% at five years and 49% at ten years. Revisions have been done for aseptic loosening of cemented components with the exception of two infections and one loose metal-on-metal press-fit THA. The results of this study indicate that total hip arthroplasty has a high long-term failure rate in this population, and alternate treatment should be considered in order to improve the long-term results. PMID- 10146585 TI - Evaluation of malignant skeletal tumors: the role of CT with multiplanar imaging. PMID- 10146586 TI - Advances in the prevention of venous thromboembolic disease in orthopaedics: the introduction of LMWH. PMID- 10146587 TI - Extracorporeal support with a cadaver liver as a bridge to transplantation. AB - Extracorporeal liver perfusion (ECLP) has been used for detoxifying blood in patients in class IV hepatic encephalopathy. Palliation of the moribund patient utilizing extracorporeal devices with cross-circulation of a cadaver liver has been documented for over three decades. Common problems associated with this procedure which appear in the literature include cadaver liver distention, increased resistance to blood flow, and limited time of extracorporeal support due to cadaver liver failure. This report summarizes the experiences of the perfusion team in utilizing an extracorporeal circuit with an otherwise nontransplantable cadaveric liver, to support the decompensating hepatic patient as a bridge to transplantation. Between January and July 1992, three patients were supported for hepatic failure with ECLP. Two patients were placed on ECLP with a modified circuit containing two positive displacement pumps and one centrifugal pump. The third patient was placed on ECLP with a circuit that contained two centrifugal pumps and one positive displacement pump. Patient age ranged from 6 to 38 years and length of support ranged from 24 to 72 hours. In all three patients, a centrifugal pump was placed in the suprahepatic inferior vena cava line to facilitate cadaver liver drainage and decompression. Intensive monitoring of both patient and cadaver liver hemodynamics, hepatic function, and hematological status was performed. All three patients were successfully weaned from ECLP. Two patients received successful orthotopic liver transplantation. The third died of complications unrelated to ECLP after support was discontinued.(ABSTRACT TRUNCATED AT 250 WORDS) PMID- 10146588 TI - An in vitro protocol for evaluation and comparison of membrane oxygenators. AB - With the trend in open heart surgery toward normothermic bypass and warm blood cardioplegia, greater demand is being placed on the perfusionist to select an oxygenator that will perform safely and efficiently under a variety of conditions. While manufacturers report performance parameters for their products, the data is often not comparable due to widely differing conditions. Recent in vitro evaluation techniques employed to characterize membrane oxygenators do not simulate the actual oxygenator conditions observed during cardiopulmonary bypass. Biocompatibility and drug delivery are reported but comparisons of different oxygenator performance parameters are not completely addressed. We have designed a test circuit and an evaluation protocol to simultaneously characterize the performance of multiple oxygenators under identical conditions. The test circuit is designed to simulate clinical conditions and to evaluate gas exchange, blood path pressures, gas path pressures, and hemolysis. Previously reported studies have relied on a comparison of a single membrane oxygenator and a single bubble oxygenator. Our protocol will compare multiple membrane oxygenators, in vitro, under similar clinically relevant conditions. Such testing would be done prior to animal or clinical trials. Furthermore in vitro tests should be more reproducible and more discriminating than are ex vivo tests. PMID- 10146589 TI - HFV: applied technology, saving both lives and costs. PMID- 10146590 TI - Synchronous and patient-triggered ventilation in newborns. PMID- 10146591 TI - PPO franchising: look before you leap. PMID- 10146592 TI - Twenty-four hour coverage: a consideration of the issues. PMID- 10146593 TI - Integrating eye and vision care. PMID- 10146594 TI - Congress expands limitations on physician self-referral: uncertain impact on managed care. PMID- 10146595 TI - Basic components of pharmaceutical utilization management. PMID- 10146596 TI - Restenosis after coronary angioplasty: pathophysiology and therapeutic implications (part 2 of two parts). PMID- 10146597 TI - Percutaneous transluminal coronary angioplasty for chronic dialysis patients. AB - Accelerated forms of atherosclerosis continue to be responsible for considerable morbidity and mortality among patients on chronic hemodialysis, and coronary artery disease is responsible for approximately 20-30% of the deaths of such patients. The suitability of such patients for percutaneous transluminal coronary angioplasty (PTCA), however, remains unknown. Accordingly, the purpose of this study was to evaluate the feasibility of PTCA in a group of chronic dialysis patients. PTCA was performed on a total of 15 dialysis patients with medically refractory angina pectoris. Angiographic success was obtained in 16 of 21 (76%) stenoses attempted after the first PTCA. Restenosis was observed in 6 of 16 (38%) lesions, which was significantly related to longer dialysis history (p less than 0.01), and low maximal inflation pressure (p < 0.05). Five of the 6 patients with restenosis underwent a second PTCA, however, all 4 patients with successful second PTCA developed recurrence of angina. Three of 4 patients with a second episode of restenosis underwent a third PTCA, and angina recurred in 2. Thus, PTCA is a reasonable initial strategy for patients with chronic hemodialysis, especially when dialysis history is short. For restenotic lesions and when there is a long dialysis history, restenosis rates are high and coronary bypass surgery should be considered. PMID- 10146598 TI - Successful placement and re-expansion of a new balloon expandable stent to maintain patency of the ductus arteriosus in a newborn animal model. AB - OBJECTIVE: We performed this study in order to evaluate the usefulness of a new balloon expandable stent for maintaining ductal patency in a neonatal piglet model and to evaluate the ability to re-expand the stent weeks following initial implantation. BACKGROUND: Maintaining patency of the ductus arteriosus without administration of Prostaglandin E has been reported previously using balloon dilation and stent implantation techniques. However, the experience is limited and the currently available stents are not modified for neonates. METHODS: 14 newborn piglets all at age 12 days and median weight 3.6 Kg (range 2.7-4.3 Kg), underwent initial balloon dilation of the ductus arteriosus. Angiography after dilation demonstrated no significant left to right shunt. All piglets underwent successful stent (3.5 mm x 17 mm) placement in the ductus arteriosus. RESULTS: Percutaneous ductal stent implantation via the arterial route was successful in all piglets with angiographic demonstration of a significant left to right shunt. Follow-up studies at weekly intervals with color flow Doppler were used to confirm patency of the stents. In 3 piglets the stent was not patent at initial follow-up and autopsy revealed sub-optimal stent placement. In two animals the stent was later re-expanded to 4 mm at 22 days, in one to 4 mm at 30 days and in one to 6 mm at 15 days, maintaining flow for an additional period of 15 to 34 days.(ABSTRACT TRUNCATED AT 250 WORDS) PMID- 10146599 TI - Recent review article on percutaneous balloon mitral valvuloplasty. PMID- 10146606 TI - Coronary angiographic determination of myocardial perfusion and flow reserve. PMID- 10146607 TI - Comparison of delivered volumes and airway pressures when ventilating through an endotracheal tube with bag-valve versus demand-valve. AB - INTRODUCTION: Use of an oxygen-powered demand-valve to ventilate through an endotracheal tube is considered inappropriate due to concern regarding excessive airway pressures. HYPOTHESIS: It was hypothesized that ventilation through an endotracheal tube using bag-valve (BV) device and the recently modified demand valve (DV) would produce similar tidal volumes (Vt), minute ventilation (MV), and peak airway pressures (PAP). METHODS: This is a prospective, randomized in vitro experimental model. Subjects were blinded to volume and pressure gauges. Thirty nine EMTs (mean age 27 years with mean experience five years) volunteered to ventilate a mechanical test lung through an endotracheal tube for 10 minutes. Each subject was randomized to BV or DV and to either normal (0.1 L/cm H 2O) or poor (0.04 L/cm H 2O) lung compliance. This DV delivers set flow of 40 L/min at maximum 50+/-5 cm H 2O. Subjects were instructed to use their "usual" technique for an average size adult in respiratory arrest with normal heart rate and blood pressure. The Vt and PAP were recorded for each breath; the MV and maximum PAP (PAP-max) for each minute was noted. Data were analyzed using repeated measures ANOVA and Tukey multiple comparisons with alpha set at 0.05. RESULTS: Overall average tidal volumes and minute ventilations were acceptable with both ventilatory devices at both normal and poor compliance for the first, fifth, and 10th minute of continuous ventilation.(ABSTRACT TRUNCATED AT 250 WORDS) PMID- 10146608 TI - Intravenous maintenance with a saline lock intermittent infusion device in the prehospital environment. AB - INTRODUCTION: A study was done with EMS personnel to determine the ease of use and acceptance of a saline lock (SL), intermittent infusion device in place of traditional intravenous tubing and fluid bags for prehospital intravenous (IV) maintenance. STUDY HYPOTHESES: Saline lock, intermittent infusion device use in specific clinical scenarios is easier, less expensive, and as effective as traditional IV tubing and fluid bags. The emergency medical technician-paramedic (EMT-P) would accept the implementation of saline locks in the emergency medical services (EMS) system. METHODS: This was a prospective, non-blinded study with the EMS providers under the medical command of a suburban community hospital's emergency department. Patients were included if prophylactic IV access or medication administration was required by clinical protocols. Excluded from the study were those patients requiring IV access for fluid infusion, constant drug infusion, cardiac arrests, or transport to another hospital's emergency department (ED). Intravenous access was achieved with the usual catheter over needle cannulation techniques. The device (Interlink Injection Site SL) was attached to the hub of the IV cannula and flushed with 2 cc of 0.9% saline from prefilled carpujects. RESULTS: There were completed questionnaires for 79 successful SL initiated in 98 attempts of IV access on 80 patients over a four month period. When compared to traditional IV fluid bags, SL were judged by the paramedics to be less time-consuming to initiate and maintain (55 of 79 or 70%), easier to use (51 of 79 or 65%) and facilitated patient transportation (73 of 79 or 92%).(ABSTRACT TRUNCATED AT 250 WORDS) PMID- 10146609 TI - Use of Nd:YAG for excision of breast lesions promising. PMID- 10146610 TI - Structural analysis of a collagen--polyester composite vascular prosthesis. AB - The Omniflow Vascular Prosthesis is a collagen--polyester composite which has been used successfully for peripheral vascular replacement. In this study, we have examined the distribution of the various connective tissue components and the ultrastructural organisation of these in order to understand and allow improvement of its functional properties. Using immunohistology with specific monoclonal antibodies, types I and III collagens were found to be the major components throughout the prosthesis. Type VI collagen was also present but was mainly associated with cells, particularly around the polyester mesh and silicone interfaces. While elastin was absent, two elastic tissue microfibrillar proteins were present uniformly throughout the structure. Ultrastructurally, clear differences existed between the local environments of the inner surface, which had formed around the silicone mandrel, the polyester mesh within the prosthesis, and the outer collagenous tissue which formed the central wall. At the inner surface, the amount of collagen was less and the orientation of these fibres was not well defined. The collagen fibrils in the polyester region were smaller than those of the main wall, which were well ordered and orientated along the axis of the device. PMID- 10146612 TI - Color Doppler imaging of the ocular and orbital blood vessels. AB - Color Doppler imaging (CDI) is a technique that provides color-encoded blood flow information on a gray-scale two-dimensional background. Although first reported in the investigation of orbital disease in 1979, it is only in the past 1 to 2 years that CDI has become established as a tool in the assessment of vascular disease of the eye and orbit. Discussed are clinical syndromes in which CDI has been shown to demonstrate abnormalities and also assist in diagnosis and determination of etiology. PMID- 10146611 TI - Complement activation and cytokine production as consequences of immunological bioincompatibility of extracorporeal circuits. AB - The use of devices which result in exposure of blood to artificial surface has gained increasing importance in routine medical and surgical practice. In the field of biocompatibility, attention has long been directed at the mechanisms of thrombus formation of surfaces. In recent years however, a special interest has emerged for the study of the immunological consequences of blood-artificial surface interactions, thus broadening the concept of hemocompatibility. The contact of blood with artificial devices results in the activation of a number of humoral and cellular processes involved in natural and in specific immunological recognition of foreign surfaces by the host, and in the secondary occurrence of acute and chronic adverse reactions in patients undergoing extracorporeal circulation. The purpose of this review is to discuss the mechanisms involved in immunological bioincompatibility of extracorporeal circuits, with particular emphasis on the molecular basis of the activation of the complement system, the role of endotoxins, and the induction of cytokine production by activated monocytes. PMID- 10146613 TI - Recent developments in oculomotor neurophysiology. AB - Articles relevant to the topic of supranuclear eye-movement control including anatomy, physiology, pathology, and clinicoimaging correlates are emphasized in this review. Significant contributions in human oculomotor physiopathology were published during this review period and are discussed specifically in the sections on saccades, pursuit eye movement, and optokinetic nystagmus. A very important section is devoted to eye-to-hand coordination. Advances in the understanding of congenital nystagmus also are reviewed. PMID- 10146614 TI - Comparison of dynamic compression plating and reamed intramedullary nailing in the treatment of aseptic tibial shaft nonunions. AB - Among 105 tibial shaft aseptic nonunions followed for a mean of 32 months, 30 were treated with dynamic compression plating and 75 were treated with either Kuntscher or Grosse-Kempf interlocking intramedullary nailing. With the plating technique, the union rate was 90.0% (27/30), the period of time to union was 5.2 +/- 1.7 months, the complication rate was 16.7% (5/30), the infection rate was 13.3% (4/30), and the surgical time was 110 +/- 30 minutes. With the intramedullary nailing technique, the union rate was 93.3% (70/75), the period of time to union was 5.0 +/- 1.6 months, the complication rate was 17.3% (13/75), the infection rate was 13.3% (10/75), and the surgical time was 70 +/- 30 minutes. Thus, while the union rate was high with both techniques, the complication rate also was high, especially deep infection. However, the technique for nailing was simpler and required less surgical time than plating (p less than 0.001). With open reamed intramedullary nailing, a higher infection rate was noted in the cases initially treated with an external fixator than for cases in which other forms of treatment initially were used (p less than 0.05). PMID- 10146623 TI - Engineering the future. PMID- 10146624 TI - Forecasting the future. Part one. PMID- 10146625 TI - Ethics, outcomes, and reimbursement. PMID- 10146626 TI - Managing change: a practical approach to preparing for managed care. PMID- 10146627 TI - Strength in numbers. PMID- 10146628 TI - Health reform's opening act. PMID- 10146629 TI - Dual-head SPECT lifts nuclear medicine market. PMID- 10146630 TI - Core biopsy or FNA? A matter of preference. PMID- 10146631 TI - Washington roars ahead with health-care reform. PMID- 10146632 TI - Optical imaging reborn with technical advances. PMID- 10146633 TI - A prospective review of 303 cementless universal cups with emphasis on wear as the cause of failure. AB - Three hundred thirteen primary uncemented total hip arthroplasties were performed in a 20-month period using Universal cups and Taperloc stems with titanium heads. The follow-up period was 2 to 5 years and 303 cups were measured radiographically for polyethylene wear, demarcation, osteolysis, and migration. Analysis was performed clinically, radiographically, and via inspection at revision. Twenty-three cups (7.5%) had greater than 0.5 mm polyethylene wear. Eleven of these loosened radiographically (4%) and eight (3%) required revision. All cup failures showed evidence of polyethylene wear as a contributory cause of failure. The average rate of wear was 0.5 mm/yr. Thin polyethylene liners (less than 6 mm) and titanium heads were used in all failed implants both of which have been abandoned. PMID- 10146634 TI - Biomaterial and design concepts to minimize wear in total joint arthroplasties. AB - The evolution of high technology-based total joint arthroplasty (TJA) materials and designs has resulted in systems that provide significant advantages related to surgical procedures, functional mechanics, and short-term and long-term rehabilitation. The research and development community has been addressing key issues associated with attachment-to-tissues for force transfer and wear and debris from articulating surfaces. To minimize wear, multiple material and design technologies have been applied, with recent emphasis on surface and bulk modifications of alloys and polymers plus the reconsideration of ceramic and metallic articulations. This article provides an overview of the biomaterial considerations for articulating surfaces of existing TJA systems, efforts to control wear phenomena, and implications on the clinical aspects of long-term function. PMID- 10146635 TI - Comparison of laboratory testing methods for prostate-specific antigen. PMID- 10146636 TI - Newer therapies for urethritis. PMID- 10146637 TI - New treatments for alcoholic liver disease. PMID- 10146638 TI - Exercise for pulmonary rehabilitation. PMID- 10146639 TI - Outcome of removal of intrauterine devices with flexible hysteroscopy in early pregnancy. AB - Removal of intrauterine devices (IUDs) in early pregnancy, when the IUDs threads are not visible at the cervical canal and the patient wishes to continue her pregnancy, remains a problem. Thirty-three patients using IUDs with nonvisible filaments on examination underwent flexible hysteroscopy for retrieval of the devices and follow-up until delivery. In all cases, hysteroscopies were performed without cervical dilatation and anesthesia. In 30 patients, the devices were found within the uterine cavity, and 28 IUDs were removed. In the remaining 3 patients, no IUD was observed. Twenty-four healthy children have been born. Six other patients requested a dilatation and curettage (D & C) about 1-2 weeks later after successful IUD removal. In 2 women, examinations were done at 22 and 29 weeks antepartum, and these 2 patients were lost to follow up. Operative fiberoptic hysteroscopy is proposed as a useful and effective method of retrieval of IUDs in early pregnancy when the filaments of the IUD are absent. PMID- 10146640 TI - Massive blood transfusion: the blood bank perspective. AB - The pathophysiology and support of the massively transfused patient from the vantage of a blood banker is reviewed. Hypothermia, acidosis and shock must be reversed if blood component therapy is to be effective. Algorithms which employ ratios of various blood components have not proved themselves, nor are screening coagulation tests of value until they are remarkably abnormal. Thrombocytopenia, thrombocytopathy, and hypofibrinogenemia appear to be the parameters which predispose to continued bleeding and microvascular hemorrhage in these patients. A large part of the impaired hemostasis is due to a consumption coagulopathy rather than the anecdotal assumption that dilution of the hemostatic elements is to blame. Hypocalcemia, hypomagnesemia and hyperkalemia are rarely observed nor do they pose a problem for this group of individuals. The logistics of blood supply to the clinical areas are addressed by describing one system that has proved itself. PMID- 10146641 TI - Transfusion support in liver transplantation. PMID- 10146642 TI - Standardization of plateletpheresis products. PMID- 10146643 TI - The growing practice of "splitting" double-dose apheresis platelet products. PMID- 10146644 TI - Clinical application of functional assays for assessing the red cell antibody activity. AB - Functional assays (the monocyte monolayer assay, the chemiluminescence test, and the antibody dependent cellular cytotoxicity assay) aim to reflect an interaction between sensitized red calls and Fc-gamma receptor bearing mononuclear cells, which plays the main role in immune destruction of erythrocytes in vivo. These assays have been used for predicting the clinical significance of antibodies in hemolytic disease of the newborn, in patients with alloantibodies requiring transfusion and patients suspected of autoimmune hemolytic anemia. This review presents a brief summary of the literature on this subject. In many cases (especially in hemolytic disease of the newborn, RhD) the results of bioassays can assess the functional activity of antibodies in vivo, but further investigation is needed to establish their real value for clinical practice. PMID- 10146645 TI - Successful treatment of HIV-related vasculitis with peripheral neuropathy with short-term steroids followed by the association of zidovudine and plasmapheresis. AB - OBJECTIVE: treatment of HIV-related vasculitis, avoiding prolonged immunosuppressive therapy. DESIGN: prospective pilot study of HIV-related neurological vasculitis. PATIENTS: two HIV-infected patients with histologically proven vasculitis. INTERVENTION: short-term corticosteroid followed by zidovudine combined with plasmapheresis. MAIN OUTCOME MEASURES: clinical, biological, immunological and electromyographic evaluation. RESULTS: complete neurological recovery. CONCLUSION: excellent tolerance and efficacy of combined zidovudine and plasmapheresis therapy in peripheral neurological HIV-related vasculitis. PMID- 10146646 TI - Viability of platelets collected by apheresis versus the platelet-rich plasma technique: a direct comparison. AB - Different platelet preparation techniques have not previously been compared directly and simultaneously with respect to in vivo platelet viability. Using a dual-label technique with 111-In and 114m-In, platelet apheresis was compared with the platelet-rich plasma (PRP) procedure with respect to platelet recovery and survival (n=4). Furthermore, a continuous flow cell separator (Cobe 2997) and an intermittent apheresis system (Haemonetics V50) were compared with each other (n=4). No differences in platelet viability were found between the PRP platelets and the apheresis-platelets. Also no differences were found between the two apheresis systems. Although different platelet preparation methods result in a varying degree of platelet activation, no difference in platelet viability has been observed. PMID- 10146647 TI - Separation of buffy coat using the top and bottom drainage system: reduction of red blood cell loss. AB - We studied the effect of automated separation of the buffy coat in a top and bottom "drainage system" using a standard and a modified backplate. The use of the modified method results in reduction of the volume (36 +/-3 mL vs 49 +/-2 mL, P less than 0.001) and the red blood cell content (8 +/- 1% vs 15 +/- 2%, P less than 0.001) of the buffy coat, but also increases the leukocyte content (27 +/- 11% vs 17 +/- 11%, P less than 0.001) of the red cell concentrate. The leukocyte content of the red cell concentrate obtained with the modified method compares well with the reported results of manual buffy coat removal. Therefore the same advantages can be expected. PMID- 10146648 TI - Treatment of homozygous familial hypercholesterolemia by plasma exchange and LDL apheresis. AB - Two girls with familial hypercholesterolemia were treated for 7 years by plasma exchanges (PE) or LDL-apheresis (LA). We compared different methods of treatment; PE with or without reuse of the plasma separator, LA of varying frequency, and LA with or without oral administration of simvastatin. We assessed the long-term results by measuring the blood levels of the biochemical parameters before sessions, and determined the effectiveness of each session by the percentage of decrease in the blood levels between the beginning and the end of the sessions. LA led to a more selective treatment (lowering of LDL cholesterol and maintenance of HDL cholesterol), but the blood levels of total cholesterol before sessions were the same as those obtained by PE. IgG and haemoglobin levels decreased little with LA. The rhythm of one session a week gave better results in LA. Although reuse of the plasma separator represents a financial saving it produced poorer results. The oral administration of simvastatin improved the results of LA. PMID- 10146649 TI - Which patients are candidates for lung transplantation? Indications for unilateral, bilateral, and heart-lung procedures. AB - Single-lung transplantation, long successful in resolving interstitial lung disease, can now be used in COPD patients and shows promise in managing pulmonary hypertension. The bilateral procedure, which often avoids cardiopulmonary bypass, is preferred when chronic airway infection is present. Heart-lung transplants, now rare, are used when pulmonary hypertension is complicated by congestive cardiomyopathy or irreparable cardiac defects. Mechanical ventilation, prior cardiothoracic surgery, and corticosteroid use no longer constitute absolute contraindications to lung transplantation. The growing scarcity of donor organs is increasing waiting times; thus, earlier recognition of potential recipients is necessary. PMID- 10146650 TI - The promises of excisional therapy of burn wounds: have they been achieved? PMID- 10146651 TI - Management of burn wounds with prompt excision and immediate closure. AB - The past 30 years have been witness to significant improvements in the overall care and prognosis of those suffering burn trauma. At the heart of this success is an aggressive approach to burn wounds. This approach, which is detailed in this review, involves early operative removal of devitalized tissue and biological coverage of resultant wounds, with particular attention to wounds in specialized areas. PMID- 10146652 TI - Radiologists must define cost/quality assessments. PMID- 10146653 TI - Biologic approach refines tumor imaging in kids. PMID- 10146654 TI - Fat suppression proves essential in neuro MRI. PMID- 10146655 TI - Digital radiology display must fit variety of needs. PMID- 10146656 TI - Digital mammo delivers quick, reliable images. PMID- 10146658 TI - Assessment of the accuracy of color Doppler flow mapping by digital image analysis. AB - An in vitro steady flow experiment was performed in order to test the accuracy of velocity measurements obtained through color Doppler flow mapping (CDFM). Using the American Society of Echocardiography (ASE) flow phantom, low (maximum velocity = 60 cm/sec), medium (maximum velocity = 300 cm/sec) and high (maximum velocity = 600 cm/sec) speed accelerating flow fields, in which multiple aliases were visible, were imaged. A fully automatic computer algorithm was used to unwrap the aliases and to convert the CDFM to digital velocity. Packet size and wall filter frequency on the ultrasound machine were varied and the measured velocity compared to the true velocity. The results show that the velocity obtained in this way from the CDFM is very accurate at the low and medium velocities, but for the high velocity the turbulence is too intense to obtain an accurate result. There was no marked difference between the data for different packet sizes or wall filter settings. PMID- 10146659 TI - Diagnosis of accessory mitral valve tissue by transesophageal echocardiography. AB - Accessory mitral valve tissue is a rare cause of intracardiac mass and subvalvular left ventricular outflow tract obstruction. The preoperative diagnosis of this congenital anomaly has been facilitated by transthoracic two dimensional and Doppler echocardiography. However, transthoracic two-dimensional echocardiography cannot identify or correctly diagnose all cases of accessory mitral valve tissue. We report a patient in whom an intracardiac mass detected by transthoracic echocardiography was definitively diagnosed as accessory mitral valve tissue by transesophageal echocardiography. PMID- 10146660 TI - Transesophageal echocardiography and concurrent coronary angiography for the rapid assessment of papillary muscle rupture. AB - Echocardiography with color flow imaging is valuable for identifying mechanical complications of myocardial infarction. Transesophageal echocardiography is useful for critically ill patients in whom transthoracic imaging is often insufficient. A case of papillary muscle rupture is presented in which transesophageal echocardiography was performed concurrently with coronary angiography. The detailed information obtained from two-dimensional and color flow imaging eliminated the need for diagnostic right heart catheterization and left ventriculography. Transesophageal echocardiography used in this manner can facilitate expeditious surgical management. PMID- 10146661 TI - Intravascular ultrasound for angiographically indeterminant left main coronary artery disease. AB - The precise diagnosis of the presence of significant left main coronary artery disease has profound prognostic and therapeutic implications. Coronary cineangiography has shown to be imprecise and inaccurate to determine the percent stenosis of the left main coronary artery. We report a case with significant left main coronary artery disease in whom coronary cineangiography was in discordance with the clinical data and intravascular ultrasonography. Based on the intravascular ultrasound findings, the patient underwent coronary artery bypass graft surgery. Therefore, the intravascular ultrasonography may be the procedure of choice for assessing indeterminant left main coronary artery lesions by coronary angiography. PMID- 10146662 TI - Utility of in vivo, intracardiac two-dimensional echocardiography in the assessment of myocardial risk area and myocardial dyssynergy during coronary occlusion and reperfusion. AB - We have previously reported the potential use of intracardiac echocardiography (ICE) in a variety of clinical settings, including detection of pericardial effusion, intracardiac masses, congenital cardiac defects, and during simulated balloon valvuloplasty. The utility of intracardiac ultrasound imaging of the left ventricle (LV) in patients with coronary disease needs to be further explored. We performed this study with the purpose of evaluating risk area and regional wall-motion abnormalities produced by ischemia using ICE. Ten episodes of ischemia were produced by transiently occluding the left anterior descending coronary artery in five dogs. ICE was performed with a modified 5-MHz transesophageal echocardiographic probe placed in the right atrium. Continuous short-axis images of the LV were obtained before, during, and after coronary occlusion. Risk area was defined using myocardial contrast echocardiography. In all cases, ICE provided high resolution images of the LV. Risk area and regional wall-motion abnormalities were readily detected. There was good correlation between the risk area (x) and extent of dyssynergy (y), defined by the equation y = 0.76x + 6.38 (r = 0.80, P less than 0.01). We conclude that ICE provides potentially useful information concerning regional LV dysfunction, and, when combined with myocardial contrast echocardiography, area at risk. This technique may be useful during interventional procedures once a catheter-based ultrasound transducer with adequate depth of field to provide images of the entire LV can be developed. PMID- 10146663 TI - The interface identified as the right side of the interventricular septum. PMID- 10146664 TI - Percutaneous tracheostomy. AB - Percutaneous dilational tracheostomy (PDT) originated in the USA and now an increasing number of UK centres are adopting the technique. It compares favourably with traditional surgical tracheostomy; PDT can be performed more satisfactorily at the bedside, avoiding the transport of critically ill patients to the operating theatre. It is a more rapid and convenient technique and evidence increasingly suggests that it is associated with significantly fewer and less severe complications. If early reports are confirmed by larger, carefully controlled trials, it is likely that PDT will largely replace conventional surgical techniques for the provision of tracheostomy in the critically ill. An improved risk-benefit ratio of PDT may favour earlier conversion of translaryngeal intubation to tracheostomy. PMID- 10146665 TI - Echocardiographic diagnosis of mechanical complications in acute myocardial infarction. AB - Myocardial infarction occurs with an incidence of approximately 1.5 million cases annually in the United States. Mortality remains at about 12% despite recent advances in medical and interventional therapies. A significant proportion of deaths is due to mechanical complications following infarction. These complications include rupture of the ventricular free wall, septum and papillary muscles. Collectively, they are potentially treatable. However, they require prompt diagnosis and urgent surgical intervention. Traditional measures in the evaluation of these patients include invasive tests such as right heart catheterisation, coronary angiography and contrast left ventriculography, which may be time-consuming and are not without untoward effects. The purpose of this review is to examine the role of echocardiography as an adjunct in the diagnosis of mechanical complications in acute myocardial infarction. Echocardiography is particularly well suited for this purpose as it is safe, performed rapidly and is capable of providing reliable information regarding the presence and location of transmural rupture, interventricular shunts and the evaluation of mitral regurgitation. In addition, echocardiography is capable of assessing overall left ventricular function and regional wall motion abnormalities. PMID- 10146666 TI - Use and effectiveness of buddy support in a self-help smoking cessation program. AB - Purpose. This study assesses buddy support in a community-based, minimal-contact smoking cessation program. Design. Telephone interviews with participants (n=641, response=74%) before and after (end-of-program, n=1,023, response=83%; three months n=757, response=74%; six months, n=859, response=84%; and 12 months, n=713, response=70%) intervention provided the data to be analyzed. Setting. The Chicago metropolitan area was the setting. Subjects. Subjects were a random sample of registrants for the intervention program. Intervention. A self-help smoking cessation program was used, which included a manual and complementary televised segments. Engaging a buddy was optional. Measures. Background and psychosocial characteristics of participants, characteristics of buddies, program compliance, and smoking behavior were the measures used. Results. Almost one third (30.3%) engaged a buddy. Those most likely to engage a buddy were female (33.4%), younger than 30 (37.2%), educated beyond high school (33.4%), highly determined to quit (41.8%), and more likely to need help from others (39.8%). More than half of the buddies were from outside the participant's household (55.1%), and more than half were nonsmokers (60.9%). Having a buddy was associated positively with manual use (gamma=.38), viewing televised segments (gamma=.23), recalling manual segments (gamma=.33), and recalling televised segments (gamma=.26). Among those who read the manual least, having a buddy was associated with viewing televised segments (gamma=.26, p less than .05) and with end-of-program quitting (16.8% vs. 9.8%, p less than .05). Having a buddy also was associated with higher abstinence through 12 months (5.8% vs. 2.7%, p=.013). Among those with lower determination, the end-of-program quit rate was more than three times greater (p=.013) for those with a buddy (16.1%) than without a buddy (5.2%). Participants whose buddy was their spouse or partner were more likely to quit at end-of-program (29.1% vs. 18.4%, p=.031). Conclusions. Buddy support should be promoted as an adjunct to minimal-contact smoking cessation programs. Impact of buddy support might be improved by guiding participants in choosing a buddy. PMID- 10146667 TI - Randomized controlled trial of cost reductions from a health education program: the California Public Employees' Retirement System (PERS) study. AB - Purpose. This study evaluated the cost trend reduction from a health promotion program. Design. A randomized 12-month trial comparing claims data was conducted. Additional studies, utilizing quasi-experimental designs, analyzed changes in health habits and changes in costs estimated by self-report. Subjects. All active California Public Employees' Retirement System (PERS) employees (21,170), non-Medicare eligible retirees (8,316), and retirees with Medical Supplement coverage (25,416) administered by Blue Shield of California were included. Intervention. The program consisted of mailed health risk assessments at six- or 12-month intervals, with individualized reports and recommendation letters sent to participants emphasizing and encouraging change, self-management materials emphasizing self-care when appropriate, and quarterly newsletters. Passive participants received printed materials only. Measures. Health risks were based upon self-report; summary scores were computed by modified Framingham algorithms. Self-report cost data were estimated from reported doctor visits, hospital days, and days sick or confined to home. Claims data were those paid by Blue Shield of California. Results. The program was associated with: 1) reduction in health risk scores at 12 months, (p less than .001), 2) reduction of subject reported medical utilization from baseline (p less than .05), and 3) decrease in claims cost growth relative to controls (p=.03). Annual claims costs were approximately $3.2 to $8.0 million less than expected had costs for the experimental participants increased at the same rate as the control group. Discussion. Results suggest that appropriately designed health promotion programs can reduce health risks and at the same time reduce the medical care claims cost trend. PMID- 10146668 TI - Directional coronary atherectomy in acute myocardial infarction. AB - To date, application of directional coronary atherectomy (DCA) in acute myocardial infarction (AMI) has had limited reports. In eleven patients with AMI, DCA was applied. In three of these patients, DCA was used as a stand-alone procedure without use of thrombolytic agents. In each case a guidewire was placed across the stenosis, and in eight patients balloon angioplasty was utilized as a predilating modality prior to DCA. The thrombolytic agent urokinase was utilized in five of these eight patients, either before, during, or after angioplasty and/or DCA. DCA success (defined as ability to cross the lesion, reduction of less than or equal to 20% in stenosis and thrombolysis--when a thrombus is present) was achieved in 10 of 11 patients. One patient had persistent abrupt reclosure of an LAD lesion, accompanied by hemodynamic compromise, necessitating intra-aortic balloon pump insertion and subsequent emergent coronary artery bypass graft surgery. Final angiograms revealed residual stenoses less than or equal to 20%, and adequate thrombolysis. Significant cardiac events were limited to one emergent CABG, Q wave MI in four patients, and non-Q wave MI in two patients. Clinically all eleven patients improved, survived the AMI/CABG, and were discharged. This clinical experience demonstrates the feasibility and safety of DCA application in selected patients who experience acute myocardial infarction. PMID- 10146669 TI - Two years experience with the Palmaz-Schatz coronary stent in a heterogeneous patient population. AB - Between January 1991 and December 1992, 136 Palmaz-Schatz coronary stents were implanted in 113 native coronary arteries in 106 patients. Forty-seven patients presented with stable angina, 50 with unstable angina, 7 with congestive cardiac failure and unstable angina and 2 were asymptomatic. Stenting was carried out in 15 patients for restenosis after coronary angioplasty (PTCA), 32 for significant dissection during PTCA (with 19 acute and 13 threatened closure), 10 for suboptimal PTCA results and 56 for de novo lesions, 52 (92.9%) of which were either ACC/AHA type B or C. Successful delivery was achieved in 97.2% (103/106) of patients or 97.3% (110/113) of vessels. Percent diameter stenosis was reduced from 78 +/- 13% to 4 +/- 11%. There were two subacute stent thromboses (1.9%), resulting in Q-Wave myocardial infarction. Three deaths (2.9%) occurred, all from the group with congestive cardiac failure and unstable angina. Major bleeding/vascular complications occurred in 4 patients (3.9%). All patients were followed up for a mean of 18 months (6 months to 30 months). Eighty-five patients were asymptomatic. Three patients were angina-free but continued to have, albeit improved, congestive cardiac failure. Ten patients had recurrence of angina, all within 6 months of the stenting procedure. Four were treated medically and 4 had PTCA of whom one eventually had coronary bypass surgery. Two patients had new lesions, successfully treated by PTCA or stenting. In conclusion, a high rate of successful delivery of the Palmaz-Schatz coronary stent can be achieved in a wide spectrum of patients with few complications which are mostly related to anticoagulation. It offers very effective bailout for acute closure during PTCA. Despite the presence of unfavorable pre-procedure patient and lesion characteristics, the acute and long term clinical results are encouraging. PMID- 10146670 TI - Technology transfer in the diagnostics industry. AB - Initiatives are underway to increase links between researchers and inventors working in the diagnostics sector and companies ready to commercialize the new technologies. This article describes the formation and aims of two groups working in this area, and reports on a review that has been made of the market requirements and opportunities for advanced sensors in the health care sector. The medical sensors market is predicted to expand during the next few years and the best opportunities for their development are outlined. PMID- 10146671 TI - Implementing a quality system, part I. AB - This article, which will be published in two parts, presents the basic principles of quality assurance and describes how they can be applied in a medical manufacturing environment. Although quality assurance standards in manufacturing will be harmonized one day, they will remain open to nationalistic interpretation. Thus, it is instructive to understand the differences between, as well as the similarities of, all perspectives. This article reflects an American approach to compliance, but by discussing the important elements and interrelations of a quality system, it will be useful to those operating in Europe and the US. PMID- 10146672 TI - The promise of PDT for urologic cancer. PMID- 10146673 TI - Unmasking essential hematuria by endoscopy. PMID- 10146674 TI - Flexible endoscopes advance to the upper tract. PMID- 10146675 TI - Behavioral therapy: practical approach to urinary incontinence. AB - Behavioral treatments for incontinence improve bladder control by altering the patient's actions or environment. In most of these procedures, the patient learns new skills and strategies to prevent the accidental loss of urine. Pelvic muscle training and exercise, biofeedback, bladder training, behavioral strategies for coping with urgency, and prompted voiding are the most common of these treatments. This article describes how to apply them. PMID- 10146676 TI - A guide to sample size and interim analysis in clinical trials. PMID- 10146677 TI - Taking action when simple renal cysts cause symptoms. PMID- 10146678 TI - Chondral defects of the knee. AB - The surgical treatment of a young adult with a localized defect in the articular cartilage of the knee most commonly employs arthroscopic shaving and/or subchondral drilling. Fresh osteochondral allografting is an alternative that is being performed with increasing frequency. As of June 1993, fresh osteochondral allografts have been used in 90 knees in our institution. Thirty-eight of these knees have been evaluated two or more years postoperatively, and a successful result was obtained in 76%. If the lesion was confined to the medial condyle, the success rate was 86%, but when both reciprocal surfaces were replaced (bipolar) the success rate was 56%. PMID- 10146679 TI - Bicondylar tibial plateau fractures: principles of treatment. AB - The management of intraarticular fractures such as tibial plateau fractures in weightbearing joints is inherently complex. Bicondylar tibial plateau fractures resulting from high energy trauma are particularly difficult to treat successfully. The objectives in managing these fractures are to obtain adequate reduction and appropriate stabilization while allowing early range of motion and limiting potential morbidity. The incidence of complications and long-term sequelae is relatively high in cases treated with traditional open reduction and internal fixation. From 1986 through 1993, 32 bicondylar tibial plateau fractures were treated at our institution. Of these, 26 were treated operatively using various methods of open reduction and internal fixation, and, more recently, indirect reduction techniques with percutaneous screw and/or external fixation. These newer techniques include arthroscopically-assisted reduction with percutaneous screw fixation or applications of a hybrid circular external fixator with or without limited internal fixation. These techniques provide adequate reduction and fixation while limiting the complications associated with traditional open methods. This retrospective study was conducted to compare these newer techniques with more traditional methods of open reduction and internal fixation (ORIF). PMID- 10146680 TI - Symposium: current concepts in the management of osteomyelitis. PMID- 10146681 TI - Functional Aqualaser sinuscopy for nasal polyposis. PMID- 10146682 TI - How important are the prostate-specific antigen assays? PMID- 10146683 TI - Enzyme reference materials: their place in diagnostic enzymology. AB - The method-dependency of measurements of enzyme activity presents problems of interpretation and comparison. Enzyme calibration materials may provide results in agreed-upon units of catalytic concentration while allowing a choice of routine methods. However, this requires the calibrating and calibrated methods to be equally specific, close agreement in intermethod ratio to exist between the calibrator and target enzyme in serum, and absence of significant sample dependent variation in the intermethod ratio. PMID- 10146684 TI - Clinical chemistry questions and answers. PMID- 10146685 TI - Ultrasound upgrades reveal hidden detail. PMID- 10146686 TI - Ultrasound characterizes equivocal breast lesions. PMID- 10146687 TI - Imaging studies reveal ECMO-induced changes. PMID- 10146688 TI - Routine fetal ultrasound: a billion dollar baby? PMID- 10146689 TI - How to set up a rural teleradiology network. PMID- 10146690 TI - Assessing medical technology. PMID- 10146691 TI - Value added. PMID- 10146692 TI - Dialing-in the future. PMID- 10146693 TI - Clinical electrophysiology in CTD. PMID- 10146695 TI - Radiologists explore new therapeutic roles. PMID- 10146694 TI - Treatment options widen in peripheral vasculature. PMID- 10146696 TI - Patient care requires shift in perspective. PMID- 10146697 TI - Evaluation of absorbable poly(ortho esters) for use in surgical implants. AB - Recent reports describe an unfavorable noninfective inflammatory response to acidic degradation products in clinical applications of bone fixation devices fabricated from bulk hydrolyzing polyglycolides and polylactides (PGA and PLA). The work described here suggests that poly(ortho esters) (POEs) offer an alternative. By comparison, hydrophobic POEs degrade predominately via surface hydrolysis, yielding first a combination of nonacidic degradation products, followed by alcoholic and acidic products gradually over time. POE specimens proved acutely nontoxic in United States Pharmacopeia tests of cellular, intracutaneous, systemic, and intramuscular implant toxicity. Hot-molded specimens degraded slowly in saline, retaining 92% initial stiffness (1.6 GPa flexion) and retaining 80% initial strength (66 MPa flexion) in 12 weeks. Degradation was almost unaffected by decreasing saline pH from 7.4 to 5.0. This demonstrated the relative hydrophobicity of POEs, since incorporation of small amounts of acid within the polymer markedly increases the degradation rate. Degradation rates were increased substantially by dynamic mechanical loading in saline. This may be true for other degradable polymers also, but no data could be found in the literature. Presumably, tensile loading opens microcracks, allowing water to enter. Solvent cast POE films were strong in tension (30 + MPa tensile yield) and reasonably tough (12-15% elongation to yield). Higher molecular weight films (41-67 kDa) showed no degradation in mechanical properties after 31 days in physiological buffer at body temperature. A 27-kDa film offered similar initial strength and stiffness but began showing mechanical degradation at 31 days. The films showed a decrease in weight with exposure time but no change in either molecular weight or water absorption at 31 days, further supporting the observation that POE degrades by surface hydrolysis rather than by bulk hydrolysis. PMID- 10146698 TI - Phosphonated polyurethanes that resist calcification. AB - Cardiovascular implant mineralization involving bioprosthetic materials, such as glutaraldehyde cross linked porcine aortic valves or synthetic materials such as polyurethanes, is an important problem that frequently leads to clinical failure of bioprosthetic heart valves, and complicates long-term experimental artificial heart device implants. Novel, proprietary, calcification resistant polyetherurethanes (PEU) as an alternative to bioprosthetic materials were the subject of these investigations. A series of PEU was derivatized through a proprietary reaction mechanism to achieve covalent binding of 100 to 500 nM/mg of bisphosphonate (2-hydroxyethane bisphosphonic acid, HEBP). The stability of HEBP (physically dispersed or covalently bound) verified by studying the release kinetics in physiological buffer (pH 7.4) at 37 degrees C, demonstrated the covalent binding reaction to be stable, efficient, and permanent. Surface (FTIR ATR, ESCA, SEM/EDX) and bulk (solubility, GPC) properties demonstrated that the covalent binding of HEBP occurs in the soft segment of the PEU, reduces surface degradation, and does not affect the original material properties of the PEU (prior to derivatization). In vitro calcium diffusion of the derivatized PEU showed a decrease in calcium permeation as the concentration of HEBP covalent binding was increased. In vivo properties of underivatized and derivatized PEU (containing 100 nM of covalently bound HEBP) were studied with rat subdermal implants for 60 days. Explants demonstrated calcification resistance due to the covalently bound HEBP without any side effects. It is concluded that a PEU containing HEBP might serve as a calcification resistant candidate material for the fabrication of a heart valve prosthesis and other implantable devices. PMID- 10146699 TI - Noninvasive prediction of restenosis after coronary angioplasty: a head to head comparison among exercise ECG, dipyridamole and exercise thallium scintigraphy. AB - Restenosis remains the main limitation of percutaneous transluminal coronary angioplasty (PTCA). Since it seems likely that restenosis not severe enough to induce ischemia may be better detected with pharmacological testing than with exercise, we investigated whether dipyridamole thallium scintigraphy is better than exercise-electrocardiogram and exercise-thallium in predicting restenosis after PTCA. Noninvasive tests and re-angiography were performed in 61 consecutive patients, 5-6 months after successful single vessel PTCA. Detection of vessel stenosis greater than or equal to 50% was used as angiographic criteria for restenosis. Exercise-induced angina, ST segment depression greater than or equal to 1 mm at exercise-electrocardiogram and reversible perfusion defects in the area supplied by the dilated vessel, during either dipyridamole and exercise thallium, were considered noninvasive abnormal responses. The overall restenosis rate was 41% (25/61). Angina was the most specific (97%) of all criteria for restenosis, but also one of the least sensitive (40%), slightly better than exercise-ECG (24%). Exercise-thallium had lower sensitivity (72% vs 88%, p less than 0.05) and negative predictive value (82% vs 91%, p less than 0.05) than dipyridamole-thallium. In patients positive at both exercise-thallium and dipyridamole-thallium testing, mean stenosis at follow-up was more severe (73 +/- 23%) than in patients with positive dipyridamole-thallium and negative exercise thallium (55 +/- 26%) results, but the difference did not reach statistically significant levels. For these reasons, dipyridamole-thallium seems to be an acceptable alternative to exercise thallium to follow patients after initially successful PTCA. PMID- 10146700 TI - Reproducibility and comparison of cardiac output measurement by transthoracic bioimpedance and thermodilution methods in critically ill patients. AB - The short-term reproducibility in cardiac output (CO) and stroke volume (SV) measurements by transthoracic electrical bioimpedance (TEB) and thermodilution (TH) and their agreement were studied in 31 consecutive patients in the Intensive Care Unit (ICU). For comparison of changes in CO and SV, six patients were studied separately. TEB data were not obtainable in four patients due to interference with impedance signals or heart rate detection. Both methods were reproducible. For TEB, the mean difference of duplicate measurements was 0.03 (SD 0.3) l/min for CO and 0.3 (SD 3.2) ml for SV. For TH, it was -0.04 (SD 0.5) l/min for CO and 0.6 (SD 6.6) ml for SV. The coefficient of reproducibility for CO was thus 0.6 l/min for TEB and 1.0 l/min for TH and that for SV was 6.4 ml for TEB and 13.2 ml for TH. There was no agreement in absolute CO or SV between the methods; TEB giving lower absolute readings. The mean difference (TH-TEB) was 1.4 (SD 1.4) l/min for CO and 14 (SD 13.4) ml for SV. There was, however, good correlation between the two methods. For CO, the regression equation was TEB=0.623+0.739 (TH); (p less than 0.0005, r=0.87). For SV, the regression equation was TEB=-0.23+0.823 (TH); (p less than 0.0005, r=0.86). When only changes were considered, the mean difference (TH-TEB) was -0.5 (SD 0.9) l/min for CO and -4 (SD 8) ml for SV. There was significant correlation in the changes detected by each method.(ABSTRACT TRUNCATED AT 250 WORDS) PMID- 10146701 TI - The application of molecular biology techniques to the diagnosis of hyperlipidaemia and other risk factors for cardiovascular disease. Committee on Molecular Biology Techniques in Clinical Chemistry of the International Federation of Clinical Chemistry (IFCC). PMID- 10146702 TI - Genes in the diagnosis of malignant disease. IFCC Scientific Division Committee on Molecular Biology Techniques. PMID- 10146703 TI - Implications of healthcare reform for cardiologists. PMID- 10146704 TI - Mechanical interventions for restenosis. PMID- 10146705 TI - Creating a rational system for reviewing clinical decision-making: the time critical review. PMID- 10146706 TI - High frequency ventilator therapy for newborns. AB - High-frequency ventilation is a general term that refers to a family of ventilator techniques that utilize respirator rates greater than 60 breaths/minute and tidal volumes that are usually less than or equal to the anatomical dead space of the airways. These techniques include high frequency positive-pressure ventilation, high frequency jet ventilation, high frequency flow interruption, high frequency oscillatory ventilation, and high frequency chest wall oscillation. I review the proposed mechanisms of gas transport during high-frequency ventilation and the different ventilators capable of delivering this mode of ventilation. In addition, clinical studies involving infants treated with this new technology are reviewed, along with long-term patient follow-up and reported complications. PMID- 10146707 TI - The effectiveness of a mobile worksite health promotion program in lowering employee health risk. PMID- 10146708 TI - An evaluation of a theory-based demonstration worksite nutrition promotion program. PMID- 10146709 TI - Breast cancer screening in older African-American women: qualitative research findings. AB - PURPOSE: The purpose of this study was to gain a better understanding of the cultural meanings that shape the breast cancer screening behavior of older African-American women. DESIGN: Qualitative research methods elicited social and cultural themes related to breast cancer screening. SETTING: Focus group interviews were conducted in the natural settings (churches, etc.) of older African-American women. SUBJECTS: Interviews were conducted with 132 members from 14 social networks of older African-American women. MEASURES: A focus group guide asked about 1) perceived risk of breast cancer, 2) behavioral intentions about breast cancer screening, 3) health seeking behavior, and 4) social support. RESULTS: For older African-American women: other health concerns are of more concern than breast cancer; age is generally not recognized as a risk factor for breast cancer; fear of finding breast cancer and its social consequences are salient barriers to mammography; they tend to rely on breast self-exam rather than mammography to detect a breast problem; cost may be more an issue of competing priorities than cost per se; the tradition is to go to doctors for a problem, not prevention; and women in their own social networks are important sources of social support for health concerns. CONCLUSIONS: These data offer explanations for mammography screening in older African-American women and emphasize the strength of naturally existing sources of social support for designing interventions to increase breast cancer screening. PMID- 10146710 TI - Clinical evaluation of dental hard tissue applications of carbon dioxide lasers. AB - This clinical study examined the pulpal safety of selected CO2 laser hard tissue applications. A total of 187 hard tissue procedures were performed on 54 patients. The mean period of follow-up following laser treatment was 13.5 months (range 2-24 months). The procedures included etching (n = 96), desensitizing (n = 56), laser-enhanced fluoride (n = 28), treatment of external resorption (n = 4), and pulp capping or pulpotomy (n = 3). Only the latter two procedure types were performed with anesthesia. The total irradiation received during these procedures ranged from 2 to 12 J. No patients complained of sensation or discomfort during any procedure. Pulp vitality was maintained in all teeth, and no instances of postlasing thermal sensitivity or pulpitis were reported. These results indicate that pulp vitality can be maintained provided that conditions of irradiance are controlled carefully to minimize thermal effects. PMID- 10146711 TI - Power density and external temperature of laser-treated root canals. AB - The purpose of this study was to determine the power and time parameters for an argon laser that would result in the removal of pulpal tissue without excessively elevating the external temperature of the root. External temperatures were measured by attaching thermistors to the surfaces of the teeth at the cemento enamel junction (CEJ) areas and at the root apices. Results indicate that a 1-W power setting with a pulse duration of 0.1 sec and a 1 sec interval between pulses produced a mean temperature rise of 0.89 +/- 0.27 degrees C at the cemento enamel junction area and a mean temperature increase of 2.04 +/- 0.47 degrees C at the apex. A 2-W power setting with a 0.1 sec pulse duration and a 1 sec interval between pulses resulted in a mean temperature increase of 1.58 +/- 0.45 degrees C at the CEJ and a mean temperature rise of 2.59 +/- 0.20 degrees C at the apex. Based upon the results of this study, it was concluded that an argon laser operating at 1 or 2 W of power with a 0.1 sec pulse duration could be used to remove pulpal tissue without creating an excessive increase in the external temperature of the tooth. PMID- 10146712 TI - Pulpal effects of a high rep rate Nd:YAG laser. AB - Molar teeth in male rats were used in this study to assess the effects of enamel surface treatments of pulp survivability. The occlusal surfaces of the first and third molars in each quadrant were treated with an Nd:YAG laser (Pulsemaster, Incisive Technologies, Inc.) using a 300-mum contact tip fiber, in a figure-8 motion, for a 30 sec ablation time. The second molars were not treated. Energy parameters/animal were as follows: (1) 0.6 W, 30 mJ energy, and 20 Hz, (2) 1.2 W, 30 mJ energy, and 40 Hz, (3) 1.8 W, 30 mJ energy, and 60 Hz, (4) 2.4 W, 30 mJ energy, and 80 Hz, (5) 0.6 W, 60 mJ energy, and 10 Hz, (6) 1.2 W, 60 mJ energy, and 20 Hz, (7) 1.8 W, 60 mJ energy, and 30 Hz, (8) 1.0 W, 100 mJ energy, and 10 Hz, and (9) 2.0 W, 100 mJ energy, and 20 Hz. Animals were sacrificed at two time periods (1 and 6 weeks, postoperatively). SEM analysis of enamel was performed at 2000x magnification to observe the parameter difference in surface quality. Microscopic examination of the histological samples was accomplished at 250x magnification. Surface analyses of tooth structure revealed a wide dispersion of enamel roughness, ranging from slightly etched to moderately cavitated. Power levels above 2.4 W exhibited significantly more roughness than lower energy parameters. Efforts were made to correlate the pulp biology effect with enamel surface condition to determine a safe threshold for survivability of the pulp tissue.(ABSTRACT TRUNCATED AT 250 WORDS) PMID- 10146713 TI - Novel laser imaging techniques. PMID- 10146715 TI - Quantification of left ventricular dimensions on line with biplane transesophageal echocardiography and lateral gain compensation. AB - To determine the feasibility and accuracy of biplane transesophageal echocardiography (TEE) with automatic boundary detection (ABD) for the estimation of left ventricular areas, we examined 19 consecutive patients with the use of this technique. In addition, we evaluated the utility of lateral gain compensation (LGC) to improve the online tracking of the ABD algorithm on the lateral endocardial-blood boundary of the echocardiographic image. The transverse plane short-axis TEE view and the longitudinal plane two chamber TEE view were used for the analysis. A semiquantitative estimate (in degrees) of the endocardial circumference, in which the boundary was correctly identified and tracked on line, improved from a mean of 198 degrees to 360 degrees with LGC (P less than 0.001). Results of comparisons of offline and online biplane TEE cavity areas revealed excellent correlations of values for the 16 patients (84%) in whom adequate transverse plane short-axis images were obtained (r values greater than 0.9 at systole and diastole). The correlation was also excellent (r values greater than 0.9) in the nine patients in whom longitudinal plane two chamber views adequate for ABD analysis were obtained at systole and diastole. LGC significantly improved the accuracy of endocardial detection and tracking, which otherwise would be limited due to the anisotropic properties of the myocardium. Thus, ABD during biplane TEE may be feasible in a significant number of patients and accurately reflects left ventricular areas when compared with offline methods. PMID- 10146716 TI - Physiological assessment of coronary artery disease and myocardial viability in ischemic syndromes using adenosine echocardiography. AB - We hypothesized that it would be feasible and safe to use adenosine echocardiography to assess the physiological significance of coronary stenoses, detect ischemic myocardium, and assess myocardial viability in a high risk group of patients with coronary artery disease (CAD). Therefore, in 40 patients with either unstable angina, non-Q myocardial infarction, or myocardial infarction treated with thrombolytic therapy, we performed adenosine echocardiography (140 mug/kg per min for 5 mins with a 16 segment model for analysis) and compared the findings with quantitative planar thallium-201 scintigraphy, and (in 26 patients) coronary angiography. The technique was safe, and there were no serious complications. Adenosine resulted in a significant increase in heart rate and decrease in blood pressure. The sensitivity of adenosine echocardiography and thallium scintigraphy were 96% and 88%, respectively, for detecting greater than 75% stenosis. The change in echo score from baseline during adenosine infusion was significantly higher with more severe coronary disease (single vessel right coronary artery {RCA} or left circumflex {LCX} disease = 0.125 +/- 0.15, proximal left anterior descending coronary artery {LAD} disease = 0.23 +/- 0.15, RCA and LCX disease = 0.30 +/- 0.14, LAD and RCA and/or LCX disease = 0.62 +/- 0.13). Likewise, the echo score during adenosine infusion was significantly higher in patients with high risk thallium scans (low risk = 1.29 +/- 0.26, medium risk = 1.74 +/- 0.22, and high risk = 2.21 +/- 0.37). In 13 patients receiving thrombolytic therapy, adenosine echocardiography identified 12 with viable myocardium as defined by quantitative thallium criteria. Furthermore, the wall motion response of the viable segment was indicative of the degree of stenosis of the artery subtending the segment. Regional function deteriorated in patients with high grade (95 +/- 2%) stenoses and improved in those with nonflow limiting stenoses (66 +/- 25%, P = 0.03). Therefore, we conclude that adenosine echocardiography can detect significant coronary stenoses, has a high degree of concordance with thallium in detecting cardiac perfusion abnormalities, and can assess myocardial viability following thrombolytic therapy. PMID- 10146717 TI - Dynamic three-dimensional echocardiographic imaging of congenital heart defects in infants and children by computer-controlled tomographic parallel slicing using a single integrated ultrasound instrument. AB - Three-dimensional cardiac reconstruction generated from transesophageal interrogation can be performed using an integrated unit that captures, processes, and postprocesses tomographic parallel slices of the heart. This probe was used for infants and young children in the transthoracic position to evaluate the feasibility of producing three-dimensional cardiac images with capability for real-time dynamic display. Twenty-two infants and children (range 1 day-3.5 years) underwent image acquisition using a 16 mm 5 MHz 64 element probe placed over the precordium. Two infants were also imaged from the subcostal position. Data was obtained and stored over a single cardiac cycle after acceptable cardiac and respiratory gating intervals were met. The transducer was advanced in 0.5-1 mm increments over the cardiac structures using identical acquisition criteria. The images were reconstructed from the stored digital cubic format and could be oriented in any desired plane. In 9 of the 22 infants the images obtained were of optimal quality. The images obtained displayed normal cardiac structures emphasizing depth relationships as well as visualization of planes not generally demonstrated by two-dimensional imaging. Several lesions were also depicted in a unique fashion using this technique. Though the method employed was limited by movement artifact and reconstruction time, the quality of the three-dimensional display was excellent and enhanced by real-time demonstration. The transthoracic approach was successful in capturing sufficient data to create three-dimensional images, which may have further application in more accurate diagnosis of complex cardiac abnormalities and generation of planes of view which could duplicate surgical visualization of a lesion. Further assessment of the technique in infants with congenital heart disease is warranted. PMID- 10146718 TI - Initial clinical experience with a miniature biplane transesophageal echocardiographic probe in adults. AB - Transesophageal echocardiography (TEE) is now routinely used in cardiovascular medicine. With improved technology the size of TEE probes has increased. Recently there has been interest in using smaller probes for adult TEE. We used a miniature 32-element, phased array biplane probe in 20 consecutive adults who underwent clinically indicated TEE evaluation. The miniature biplane probe was easily inserted without complication in all patients including one with thrombocytopenia and one with an esophageal stricture. Subjectively the probe was easier to insert and better tolerated by patients than standard adult TEE probes. High quality images of near-, mid-, and far-field structures were obtained in a majority of patients. Color Doppler identified mitral regurgitation in 12 (60%) patients, tricuspid regurgitation in ten (50%) patients, and aortic insufficiency in five (25%) patients. The miniature biplane TEE probe used in this study enhanced patient comfort without significant loss of image quality. PMID- 10146719 TI - Color flow Doppler in the diagnosis of double-chambered right ventricle: a demographic and echocardiographic study. AB - The purpose of this study was to evaluate the demographic and echocardiographic data of patients diagnosed with double-chambered right ventricle and attempt to explain a perceived rise in the incidence. DEFINITION: Double-chambered right ventricle (DCRV) is a division of the right ventricle into two chambers by a hypertrophied muscle bundle. METHODS: The medical records of patients diagnosed with DCRV were reviewed, and demographic, echocardiographic, and catheterization data were tabulated. Annual incidence of DCRV, based on year of birth, was compared to yearly detection rate, based on year of DCRV diagnosis. To evaluate the influence of color flow Doppler on the frequency of diagnosis of DCRV, demographics of patients born prior to September 1986 (when utilization of color Doppler began in our institution) were compared to those born after that date. RESULTS: Despite an unchanged annual incidence of DCRV, yearly detection rate of this lesion rose significantly following the introduction of color flow Doppler to our institution (September 1986). DCRV was diagnosed earlier and was accompanied by earlier catheterization, which also showed lower right ventricular body gradients after September 1986. Associated anomalies, both cardiac and noncardiac, in our population differed from those reported in previous series. CONCLUSION: This study infers that the advent of color flow Doppler significantly enhanced the diagnosis of DCRV in our pediatric patients and led to a perceived rise in incidence. PMID- 10146720 TI - Analysis of right ventricular kinesis by means of transesophageal echocardiography: present problems and perspectives. AB - The evaluation of right ventricular (RV) kinesis by two-dimensional echocardiography represents a difficult task. Transthoracic echocardiography can visualize the RV in several projections, but the image quality and the variability of imaging views usually do not allow quantitative analysis. We investigated the potential of transesophageal echocardiography (TEE) for evaluating RV global function and regional kinesis, in 32 controls and in 16 patients with inferior myocardial infarction (MI) and asynergy involving the inferior wall of both ventricles. Good-quality images of at least one horizontal section of the RV were obtained in 73% of subjects by conventional, 90 degrees sector and in 100% of subjects by wide-angle, "panoramic" sector. Images of the RV in short-axis view at medium level were acquired and evaluated in 93% of cases, but at basal and apical levels only in 67% and 39%, respectively. The low percentage of successful detection and evaluation of the RV at apical level can be explained by prominent motion and trabeculation of the apex. Global systolic area changes (SAC) in controls attained similar values at apical and medium levels (60% and 59%, respectively), but were significantly lower (48%, P less than 0.05) at basal level. In patients with previous inferior MI and inferoposterior asynergy, global SAC were significantly (P less than 0.01) lower at medium and basal levels (32% and 27%, respectively) compared with controls. Regional kinesis of RV was assessed as segmental SAC in 12 different segments, by fixed and float system of center of cavity.(ABSTRACT TRUNCATED AT 250 WORDS) PMID- 10146721 TI - Diagnosis of main-stem pulmonary thromboemboli by transesophageal echocardiography. AB - The aim of this report is to describe the usefulness of transesophageal echocardiography in the diagnosis of pulmonary emboli. A biplane transesophageal probe was used to examine the pulmonary artery in multiple views in three patients with suspected pulmonary emboli. The diagnosis of pulmonary emboli was made by transesophageal echocardiography in each of three patients when an echodense, circular or linear mass was seen in more than one view of the main or right pulmonary artery. In conclusion, our findings, coupled with previous case reports, suggest that transesophageal echocardiography should be considered in all critically ill patients with suspected pulmonary emboli. PMID- 10146722 TI - Managed care credentialing: a consumer protection. PMID- 10146723 TI - Behavioral health risk rating: health care cost management that works. PMID- 10146724 TI - Dental PPOs come of age. PMID- 10146725 TI - Quality outcomes measurements relevant to behavioral health services. PMID- 10146726 TI - Oxygen extraction in patients with sepsis and heart failure: another look at clinical studies. AB - We collected all complete sets of measurements of cardiac index and oxygen derived variables available in the recent literature (1975-1991; computerised Medline search) on critically ill patients with sepsis (n=21 studies), septic shock (n=20 studies) or severe heart failure (n=13 studies). For each study, the mean value for cardiac index, oxygen delivery (DO 2), oxygen uptake (VO 2), oxygen extraction ratio (O 2ER) and lactate concentration (when available) were analysed together with mortality rates. There was a significant relationship between VO 2 and DO 2 for the studies on patients with severe heart failure (r=0.79, p less than 0.001) or septic shock (r=0.55, p less than 0.01), but not in patients with sepsis (r=0.3, p=NS). As expected, O 2ER was higher in the studies in heart failure (31 to 50%) than in septic shock (25 to 45%) or sepsis (19 to 40%). When compared to the studies on patients with sepsis, the studies in septic shock included patients with lower DO 2 (481+/-89 vs 539+/-79 ml/min.M 2, p=0.032) and higher O 2ER (32.5+/-5.2 vs 27.8+/-5.0%, p less than 0.01) but similar VO 2 (143+/-29 vs 143+/-19 ml/min.M 2, p=NS). In a cardiac index/O 2ER diagram where a line of reference represents proportional changes in cardiac index and O 2ER from normal values at rest, all studies in heart failure fell below the line of reference. The majority of studies in sepsis (18/21) fell above the line of reference. Interestingly, only nine of the 20 studies in septic shock fell above this line. The review of the 14 studies in septic shock, in which O 2ER and blood lactate were reported, showed a direct relationship between these two variables (r=0.68, p less than 0.01), but no relationship between cardiac index and blood lactate (r=0.37, p=NS). This analysis suggests that patients with septic shock tend to have a lower cardiac index and higher O 2ER than septic patients who are haemodynamically stable. Furthermore, the positive relationship between O 2ER and lactate suggests that, despite the alterations in oxygen extraction capabilities in severe sepsis, mean O 2ER may be higher in the most severe cases of septic shock. This could reflect an attempt to maintain VO 2 when DO 2 is insufficient. The prevailing opinion that 0 2ER is a meaningless variable in septic shock needs to be reassessed. PMID- 10146727 TI - The use of pulmonary artery catheters in intensive care: time for reappraisal? AB - The precise role of the pulmonary artery catheter (PAC) in reducing the morbidity and mortality of intensive care patients remains uncertain. Future studies of the different patient groups who possibly benefit from their use may well require multicentre trials in order to include sufficient numbers and produce significant conclusions. This would suggest a need for a consensus opinion on how PACs are actually used to obtain the different physiological variables which can influence patient management. A questionnaire was designed to assess the degree of conformity of PAC use in intensive care; the questions were derived from a Medline search and considered by the authors to represent a cross-section of the different aspects and potential errors of PAC use. A postal questionnaire was sent from a District General Hospital to 42 adult Intensive Care Units (ICUs) requesting information on the use of PACs in each ICU. The reply rate was 93%, with all but one of the respondents using PACs. The questionnaire obtained information in different areas of PAC use: 1. General usage of PACs. 2. Measurement of patient height and weight. 3. Confirmation of position of PAC tip. 4. Measurement of pulmonary artery wedge pressure (PAWP). 5. Measurement of cardiac output (CO). 6. Derived values. 7. Monitoring for PAC-related sepsis. The results of the questionnaire demonstrated a considerable lack of standardisation in the use of PACs in the United Kingdom.(ABSTRACT TRUNCATED AT 250 WORDS) PMID- 10146728 TI - Infusion therapy options. PMID- 10146729 TI - Health care technology: how can we tell if we can afford it? A Canadian viewpoint. AB - Major changes are reshaping the economic, political, and social climate in which Canada's health care systems operate. Cost containment has become an essential element of that climate. The perception is that health care technology is a major contributor to health care costs, and this has served as the impetus for a call for assessment and evaluation of all health care technology. While the need for health technology assessment is valid, such assessments must be much broader than simple economic assessments. A complete cost-benefit analysis of the clinical use of a given technology, including consideration of possible alternatives and the implications of rejection of that technology in certain circumstances, is complex. If we are to utilize the results of these analyses to effect important changes in health care delivery, studies must include the science behind the technology, the technology itself, the devices resulting from the technology, the medical outcome, and the societal impact in addition to pure cost considerations. Only then will we be able to properly assess the effectiveness and efficiency of health care technology in society and decide whether we can afford it. PMID- 10146730 TI - Long-term stability of intraocular lenses: literature review, assessment, and testing protocol. AB - A critical review of the literature confirms the generally excellent, very long term clinical stability and performance of polymethylmethacrylate (PMMA) in intraocular lenses. In contrast, only short-term, largely nonsystematic data are available on the performance of other, newer materials, such as soft silicones based on polydimethylsiloxane and copolymers of dimethyl- and diphenylsiloxane, hydrogels based on poly(2-hydroxyethylmethacrylate), and various "temporary" and "permanent" hydrophilic coatings. Some conflicting reports have been published on the long-term stability of isotactic polypropylene loop materials. However, the medical consensus seems to be that these are essentially stable to ultraviolet light energy reaching intraocular lenses during the expected service life in excess of 20 years. Uncertainty still surrounds the use of various ultraviolet-absorbing chromophores in the optics and/or haptics of intraocular lenses. Published reports indicate varying transmittance and effectiveness of ultraviolet-absorbing intraocular lenses. Furthermore, there is concern about the fate of the ultraviolet-absorbing chromophores during clinical conditions, especially with regard to degradation and leaching. Although a number of papers has been published on the effect of ultraviolet light energy on intraocular lenses, the experimental approaches differed substantively, so that intercomparative deductions must be made guardedly. A few papers have been published on the long-term biostability (hydrolytic, oxidative, and enzymatic) of intraocular lens materials. However, much of what has appeared in the literature is often illustrative of simplistic assumptions that largely ignore the environment of the eye. Clearly, the eventual success of newer materials must be based on performance characteristics that exceed those of the time-tested polymethylmethacrylate and the refined manufacturing technology designed to transform this polymer into intraocular lenses. The unquestioned clinical success of intraocular lenses rests on long historical data with PMMA that are unavailable with proposed newer materials. Thus, the entry of such new materials into the commercial market, meriting the acceptance of clinicians (and patients), must follow rather than precede thorough in vitro accelerated testing procedures under conditions that permit intercomparative conclusions and recommendations. PMID- 10146731 TI - Community coalitions for health promotion: summary and further reflections. PMID- 10146732 TI - Program evaluation strategies for community-based health promotion programs: perspectives from the cardiovascular disease community research and demonstration studies. AB - Community-based programs are being widely adopted in the struggle to prevent chronic disease. Program evaluation of community-based programs involves a particular set of problems stemming from the variety of activities being undertaken simultaneously, the multiple intermediate goals of the programs and the rapidity with which the programs evolve. An analysis of the experience of four large community-based cardiovascular disease research and demonstration studies (Stanford Five-City Project, Minnesota Heart Health Program, Pawtucket Heart Health Program and the German Cardiovascular Prevention Project) provides valuable models, methodologies and strategies for planning and conducting evaluations of public health programs or community studies. By comparing and combining their experiences, the four programs have identified eight categories of evaluation for community studies, including formative evaluation, quality assurance, assessment of delivered dose, assessment of received dose, component program impact, intermediate outcomes, community impact and cost analysis. This paper presents information on the strategies by which each of the four programs addressed these evaluation categories. PMID- 10146733 TI - Condom use negotiation among sex workers in Singapore: findings from qualitative research. AB - Following an earlier study of 806 sex workers in Singapore in which they were found to succeed only half the time in getting clients to use condoms, a qualitative investigation was conducted on 40 sex workers to explore their perceived barriers and approaches in negotiating condom use with clients. Five different patterns of condom use were identified: successful, unsuccessful, misinformed, passive and uninterested. The successful negotiators used several practical approaches to secure clients' compliance. Unsuccessful negotiators experienced problems such as inability to resist clients' pressure or respond to their queries. The misinformed group believed that regular clients were safe. The passive group did not negotiate condom use due to their perceptions of lack of support from peers and brothel keepers, and the uninterested group was apathetic with fatalistic perceptions of AIDS. The in-depth interviews with successful negotiators provided relevant, specific and practical information which could be disseminated to their peers to develop their negotiation skills. This qualitative study also provided useful insights on condom use negotiation and highlighted the need for comprehensive interventions which should not only aim at developing sex workers' negotiation skills but also at gathering support from brothel keepers to facilitate behaviour change, and public education directed at clients to increase condom use. PMID- 10146734 TI - Does tailoring matter? The impact of a tailored guide on ratings and short-term smoking-related outcomes for older smokers. AB - There is new evidence that smokers of all ages benefit from cessation of smoking. Although most older smokers, like younger smokers, prefer to quit on their own, at the time this project was started, there were no materials or programs targeted to older smokers. Using the literature, focus groups with older smokers and a national survey of older smokers, we created Clear Horizons, a self-help guide for older smokers, and a telephone counseling protocol tailored to the needs of older smokers (age 50-74). Smokers were recruited from around the United States and assigned randomly to a control guide, Clearing the Air, Clear Horizons alone or Clear Horizons and two counselor calls. Follow-up of nearly 2000 smokers was conducted by telephone 3, 6, 12 and 24 months after delivery of the self-help guides. This report focuses primarily on results at 3 months because that was the measurement for reactions to the interventions. At the 3 month interview, those in the tailored interventions rated their guides more highly than did those in the control group. They also read more of their guides and were more likely to reread them. Quit rates were significantly higher among smokers who received a combination of the tailored guide and telephone counseling. At 3 months, the combination of the guide and telephone counseling was most effective in helping smokers to quit. By 12 months, both the tailored guide alone and the tailored guide and calls groups had higher quit rates than the control guide but were not statistically different from one another. PMID- 10146735 TI - Reaching low-income women at risk of AIDS: a case history of a drop-in center for women in the South Bronx, New York City. AB - The Women's Drop-In Center, sponsored by a church with an active social ministry, offered education and support to African-American and Latina women at risk of HIV infection in a low-income community in New York City. Peer educators were trained to provide information, counseling and referrals on substance abuse, sexuality, HIV infection and related issues. The drop-in center offered a safe space for participants to discuss common concerns, learn about community resources and support each others' efforts to protect their health. Based on an evaluation that included quantitative and qualitative measures of changes in participating individuals and organizations, it is suggested that grass-roots community organizations can play an important role in AIDS prevention but they may need additional resources to sustain the intensive interventions that are likely to lead to lasting changes in neighborhoods with other significant social problems. PMID- 10146736 TI - Epidemiology and screening of open-angle glaucoma. AB - Two major prevalence surveys for chronic open-angle glaucoma have been published in the last year. These are discussed in relation to the comprehensive Baltimore Eye Survey of 2 years ago, which also studied the blindness arising from the disease and comparative figures for white and black individuals. The newer tests for identification of loss of visual function prior to visual field loss as demonstrated by conventional automated perimetry are considered. The three main screening tests for chronic open-angle glaucoma--ophthalmoscopy, tonometry, and perimetry--are evaluated in the light of case finding experience in the United Kingdom. The maximum detection of asymptomatic early chronic open-angle glaucoma in the community is likely to be best achieved by a combination of public awareness of glaucoma aided by patient-based associations and the promotion of improved glaucoma testing and case finding by the army of professionals who are already in place in most developed countries and who carry out primary eye examinations. PMID- 10146737 TI - The role of temporal threshold criteria in psychophysical testing in glaucoma. AB - The magnicellular system seems to be affected early and specifically by glaucomatous damage. It shows high temporal resolution and good motion perception. Psychophysical tests investigating the temporal transfer characteristics of the afferent visual system thus are of special interest for the detection of early glaucomatous damage. Flicker perimetry is largely independent from disturbances of the ocular media and provides a means to identify eyes with pressure-produced functional loss. Defects in temporal modulation perimetry may precede the onset or progression of defects in conventional light-sense perimetry. Motion sensitivity seems to be affected early by glaucomatous damage. The problem of noisefield campimetry is the lack of quantification and reliability control of the patients' responses. Large-field or Ganzfeld stimulators can separate glaucomatous from normal eyes with high sensitivity and specificity; their value for the identification of eyes at risk to develop progression of functional loss still must be demonstrated. PMID- 10146738 TI - The diagnosis of normal-tension glaucoma. AB - The diagnosis of normal-tension glaucoma includes optic nerve head and retinal nerve-fiber layer assessment, standard static computerized visual field testing, gonioscopy, and a diurnal (24-hour) intraocular pressure curve. In addition to a careful history to exclude previous phases of increased intraocular pressure, an internal medicine checkup including 24-hour ambulatory blood pressure measurements and neurological assessment are required. Additionally, carotid artery Doppler sonography, nailfold capillary microscopy, and a computed tomography scan of the brain may be performed. PMID- 10146739 TI - The value of different screening techniques for glaucoma. AB - The role of tonometry has been relegated from case finding to risk stratification, because intraocular pressure poorly differentiates between health and glaucomatous eyes. Led by the evidence that optic disc and retinal nerve fiber layer change may precede glaucomatous visual field loss by several years, enormous efforts have been made to accurately measure these parameters for case definition; however, the wide variability in optic nerve head topography among the normal eyes, and the marginal quality of a substantial proportion of fundus photographs limit the usefulness of biomorphometry as a screening tool. Scanning laser ophthalmoscopy may potentially overcome the limitations of conventional photographic techniques for accurate biomorphometry, but this technology remains expensive. In light of the limitations of tonometry and biomorphometry in a general screening setting, the value of psychophysical testing has assumed an increasing importance. The low prevalence of glaucoma in an unselected adult population, combined with the lack of a valid screening technique, argues for a shift in focus from widespread population-based screening with a single test to case finding targeted at high-risk individuals. PMID- 10146740 TI - The diagnosis of visual field progression in glaucoma. AB - The detection of true visual field deterioration in glaucoma is of fundamental importance but is limited by inherent variability of the measurements. New techniques have been developed that use powerful statistical regression analysis methods to objectively quantify progression of visual field defects. These have been combined with new methods of graphical presentation to reveal the spatial distribution in the visual field of deterioration. New measurement techniques utilizing blue-on-yellow, flicker, and motion stimuli provide further advantages and may be combined with regression analysis to improve the early detection of real progression of visual field loss. PMID- 10146741 TI - Cataract surgery and lens implantation. PMID- 10146742 TI - Techniques and instruments for cataract surgery. AB - New techniques for cataract surgery have evolved around access to the cataract, a renewed interest in nuclear expression extracapsular techniques, and a near completion of the developmental cycle of phacoemulsification back to the original "divide and conquer" strategies. Options to improve access to the cataract include surgical pupil revision, self-retaining iris retractors, and surgical techniques for operating through a small pupil. Nucleus expression through a capsulorhexis is facilitated by global hydrodissection and hydrostatic tilting of the nucleus before removal. New phacoemulsification strategies revolve around the Phaco-Chop method that emphasizes nuclear rim fracturing. PMID- 10146743 TI - Intraocular lenses. AB - Cataract remains a major source of blindness in many countries throughout the world. Although modern medicine and technology have combined to provide an almost ideal solution, availability of modern cataract and lens implant surgery is restricted, even in developed nations. The health care "cake" is not always divided fairly in favor of ophthalmology in general and lens implant surgery in particular. The transition to small-incision surgery continues, whereas intraocular lens technology attempts to catch up so that incision size for cataract extraction and lens implantation is compatible with both aspects of the process. Complications continue, although their degree may differ from former times. The world ophthalmic literature continues to record the enthusiasm and contribution of individual investigators who pioneered lens implantation as well as multicenter and university-based groups. American, Japanese, and European contributions dominate the literature from 1992 to 1993. PMID- 10146744 TI - Laser therapy in cataract surgery. AB - Since the development of ultrasound phacoemulsification more than 25 years ago, cataract surgery has changed dramatically. One of the major changes in cataract surgery has been the research into the use of laser for the removal of cataracts. To date, both ultraviolet and infrared wavelengths have been studied, with the infrared showing more promise. The ultraviolet end of the spectrum has shown promise, but concerns with safety have hindered its progress. An infrared laser device developed by Dodick has been used successfully for the removal of cataracts under an Investigational Device Exemption from the Food and Drug Administration and a second infrared laser developed by Colvard should be approved soon. These developments have brought us a step closer to realizing the dream of laser cataract surgery. PMID- 10146745 TI - New light on ear thermometer readings. PMID- 10146746 TI - Where is radiotherapy for stage C prostate cancer headed? PMID- 10146747 TI - An important goal of prostatectomy: minimizing incontinence. PMID- 10146748 TI - Supravesical urinary diversion: variety means versatility. PMID- 10146749 TI - Screening for prostate cancer: is it worthwhile? PMID- 10146750 TI - Laser treatment of diabetic macular edema. PMID- 10146751 TI - Laser treatment of choroidal neovascularization. PMID- 10146752 TI - Laser treatment of macular edema resulting from branch vein occlusion. PMID- 10146753 TI - The development of a women's health center in an academic health center. AB - Women's health needs have been a special focus of health care for more than a century. In the early 1970s, a segment of the women's market began seeking changes in the health care system. Since then, the emergence of women's health centers has been a nationally growing trend. This professional paper will address the various elements in designing a women's health center in an academic health setting, beginning with the development of a concept and needs assessment and ending with the influence a women's health center has on health care for others. PMID- 10146758 TI - Is bigger really better? AB - As administrators, we continually strive to compare our group's performance to accepted standards of cost and production. In making comparisons to national norms, it is important to understand the statistical sample of groups from which these norms are drawn. Therefore, differentiations in the size of a group alone may have predisposed a group to either favorable or unfavorable comparisons to national standards. This professional paper was written in order to investigate the relationship between group size and measures of performance. PMID- 10146760 TI - Ethics for medical group managers: patient-centered or bottom-line? AB - Many physicians hire financial directors and accountants to manage their bottom line. While most of us had courses in financial and operations management, ethics was not a major part of the curriculum. This professional paper will define several ethical theories. After applying these to three moral issues- marketing, fee setting and rationing--it will outline a values clarification plan and finally will conclude by providing a framework for making moral decisions, realizing, of course, that the study of ethics offers no right or wrong responses. PMID- 10146764 TI - The laryngeal mask airway for neonatal resuscitation. PMID- 10146762 TI - Recruiting physicians for rural states: a comparative, socio-economical model. AB - Recruitment of physicians to rural states is complicated by several barriers precipitated by non-metropolitan locations. These constraints need to be addressed and put into proper perspective in order to attract the interest of potential candidates. This case study addresses our efforts to educate the candidate regarding the potential foregone, social and economical practice opportunity benefits associated with our rural location. PMID- 10146765 TI - New technologies assist neonatal care providers. Hospitals across US reap benefits of point-of-care testing. PMID- 10146766 TI - Measurement of adrenal corticosteroids by high-performance liquid chromatography. AB - OBJECTIVE: To develop a high-performance liquid chromatography (HPLC) method for simultaneous measurement of adrenal corticosteroids important for the diagnosis of congenital adrenal hyperplasia. DESIGN: Blind comparison using convenience samples. SETTING: Research laboratory at the Department of Medical Technology, Bowling Green State University. PATIENTS: Referred samples for cortisol, 11 deoxycortisol (S), and 17-hydroxyprogesterone (OHP). Stimulation condition unknown. INTERVENTION: Venous blood collected, processed to serum, and frozen. Adrenal steroids measured by radioimmunoassay (RIA) and by HPLC. MAIN OUTCOME MEASURES: Linearity, analytic sensitivity, accuracy, and precision were evaluated using recovery, coefficient of variation (c.v.), correlation coefficient (r), Student's t test, F test, and linear regression. RESULTS: Calibration curves were linear to at least 50 mumol/L, and the low-end sensitivity was 10 nmol/L. Analytic recovery ranged from 89.8% to 103.9%. The CV was below 7.5% (n = 10) for all three steroids. Comparison to RIA yielded r values of 0.909 (n = 25), 0.932 (n = 10), and 0.983 (n = 10) for cortisol, S, and OHP, respectively. Student's t-test results were 1.13 (p = 0.27), 0.10 (p = 0.93), and 0.48 (p = 0.64) for cortisol, S, and OHP, respectively. F-test results were 1.14 (p = 0.75), 1.37 (p = 0.66), 2.39 (p = 0.21) for cortisol, S, and OHP, respectively. Results for cortisol showed a negative bias of 97.0 nmol/L (3 mug/dL). Linear regression analysis revealed proportional errors of -15.0% -7.0%, and +9.0%, for cortisol, S, and OHP, respectively. CONCLUSION: (ABSTRACT TRUNCATED AT 250 WORDS) PMID- 10146767 TI - Nd:YAG improves outlook for endobronchial radiation therapy. PMID- 10146768 TI - LAUP found successful for sleep apnea, snoring. PMID- 10146769 TI - Setting the course for critical pathways. PMID- 10146770 TI - New future for colorectal screening? PMID- 10146771 TI - Critical values: when they're reported, how they're used. PMID- 10146772 TI - In the eyes of the JCAHO. PMID- 10146773 TI - Labs step in to help map care. PMID- 10146774 TI - The economics of CK-MB testing {see comments}. PMID- 10146775 TI - Coagulation cascade continues. PMID- 10146776 TI - Role of formalin-preserved allograft in fresh fractures with comminution. AB - The use of bone grafting in polytrauma patients is associated with significant problems. Additional surgical time is required for the use of cancellous autografts, and there may be a significant incidence of donor site morbidity. Various types of allografts used in western countries are expensive to obtain and store, and the technical know-how required for their use may not be available in Third World countries. A series is reported in which formalin-preserved allograft (FPA) was used for the management of comminuted fractures in 22 polytrauma cases. This type of allograft is inexpensive, easy to prepare and store, and has been shown in experimental and clinical studies to be nonantigenic and sterile. The complication rate and time to union were comparable with a control series of autografted cases and previously reported series in the literature. Based on the results in this series of patients, the use of FPA is recommended for the grafting of multiple fractures, especially when other forms of allograft are not available because of technical or financial limitations. PMID- 10146777 TI - Management of sacral pressure sores with a myocutaneous flap. AB - Sacral ulcers usually are caused by pressure leading to pathologic changes in the layers of tissue extending from the skin to the bone. This type of ulcer occurs most commonly in paraplegic or unconscious patients. In a series of 25 patients with sacral pressure sores studied during a one year period of time, the initial management consisted of conservative treatment with excision of the ulcer and daily dressing changes. The results with this method of treatment were satisfactory in ten cases and unsatisfactory in 15 cases. The 15 cases in which the results were unsatisfactory then underwent treatment with operative methods including excision of the ulcer and primary closure, myocutaneous flaps, skin grafting, and transcutaneous skin flaps. In six of ten cases in which a myocutaneous flap was used, the wounds healed satisfactorily. In four cases an infection occurred; in three of these cases the wound healed after infection control, while skin grafting was required for the fourth patient. Overall, the postoperative results with the use of a myocutaneous flap were satisfactory, and the results also were good at follow-up. PMID- 10146778 TI - The laryngeal mask airway in emergency and intensive care medicine. PMID- 10146779 TI - Advances in monitoring in intensive care: continuous mixed venous oxygen saturation and right ventricular ejection fraction. AB - Direct cardiorespiratory measurements and the use of optimum values to guide therapy have been associated with improved survival in a number of conditions causing critical illness. Increasingly sophisticated monitoring that provides more accurate and reproducible assessment of the cardiorespiratory system at the bedside is pivotal to this better outcome. The inclusion of fibreoptic filaments and fast response thermistors in pulmonary artery catheters makes possible the continuous monitoring of mixed venous oxygen saturation and the measurement of right ventricular ejection fraction. Although the place of measurement and manipulation of these variables in critically ill patients has yet to be fully defined, clinical studies are promising. We discuss some practical aspects of the use of these measurements and some potential clinical applications. Additionally, some of the studies in which the use of these measurements is increasing our knowledge of the pathophysiology of critical illness and contributing to improved management of critically ill patients, are highlighted. PMID- 10146780 TI - Best of teleradiology: how it's being done. PMID- 10146781 TI - MR: premier approach to imaging bone neoplasms. PMID- 10146782 TI - Quality issues reemerge in unstable MR market. PMID- 10146783 TI - Consumer trends in the 1990s: implications for health promotion. PMID- 10146785 TI - How effective are health fairs? Quantitative evaluation of a community health fair. PMID- 10146784 TI - Powerlessness, empowerment, and health: implications for health promotion programs. AB - PURPOSE AND SCOPE. This article reviews the health and social science research relevant to both the role of powerlessness as a risk factor for disease, and the role of empowerment as a health-enhancing strategy. The research literature surveyed includes studies that address these key concepts from the fields of social epidemiology, occupational health, stress research, social psychology, community psychology, social support and networks, community competence and community organizing. Definitions are provided to operationalize these sometimes loosely-applied terms. IMPORTANT FINDINGS. Powerlessness, or lack of control over destiny, emerges as a broad-based risk factor for disease. Empowerment, though more difficult to evaluate, can also be demonstrated as an important promoter of health. MAJOR CONCLUSIONS. Given the importance and currency of these concepts of powerlessness and empowerment, a model of empowerment education is proposed for health-promotion practitioners. Measurement of empowerment raises issues for researchers on how to test the multiple personal and community changes that may result from an empowering education intervention. PMID- 10146786 TI - Psychosocial characteristics of stress management class attendees. PMID- 10146787 TI - Reporting evaluation results. AB - The major purpose of program evaluation is to provide information that can be used in decision-making by program administrators and other interested parties. How to communicate that information clearly and persuasively is the subject of this article. Sensitivity to the cognitive styles of the intended audience(s) and awareness of one's own areas of uncertainty are first recommended. In addition, guidelines are offered to help achieve a clear and persuasive report, ways to effectively present results to various audiences are reviewed, and advice is provided on how to minimize the likelihood of hostile political responses to major findings. Finally, evaluation researchers are urged to share their results with others interested in the evaluation of health promotion programs through publication or presentation at professional meetings to create an influential body of cumulative research findings. PMID- 10146788 TI - Health care reform: challenge and opportunity to put prevention first. PMID- 10146789 TI - A comparison of seven methods of recruiting older adults into an exercise study. PMID- 10146791 TI - Interactive, touchscreen nutrition education system. PMID- 10146790 TI - Effects of weight training on the emotional well-being and body image of females: predictors of greatest benefit. AB - BACKGROUND: This study was conducted to determine the extent to which participation in a weight training intervention was associated with changes in the emotional well-being and body image of females compared to non-weight trainers. An ancillary objective was to study the extent to which psychological, physical, and demographic factors accounted for changes in emotional well-being and body image. METHODS: The experimental group consisted of 60 females, and a comparison group was comprised of 92 females. Experimental subjects participated in a 15-week, two-day-per-week weight training intervention, while subjects in the comparison group did not participate in any weight training activities. Subjects were pre- and posttested on the General Well-Being Schedule and the Body Cathexis Scale. Experimental subjects were also tested in muscular strength and three skinfold measurements. RESULTS: With pretest scores controlled, the weight trainers had significantly higher General Well-Being and Body Cathexis posttest scores than the comparison group. Weight trainers also showed significant increases in muscular strength, and significant decreases in skinfold thickness. Four variables predicted 38.8% of the variance of those who improved most in General Well-Being: lower pretest General Well-Being, lower parental income, greater loss of body weight, and lower posttest skinfold. Five variables predicted 61.5% of the variance of those women who improved most in Body Cathexis: lower pretest Body Cathexis, greater body weight at the outset, shorter in height, less involvement in non-weight training exercise, and lower posttest skinfold. DISCUSSION: (ABSTRACT TRUNCATED AT 250 WORDS) PMID- 10146792 TI - Computerized mental health risk appraisal for college students: user acceptability and correlation with standard pencil-and-paper questionnaires. AB - Due to an interaction of age, birth cohort, genetics, and the lifestyle factors inherent in the "college experience," some college students are at increased risk for mental health problems such as alcohol, tobacco, and other drug abuse; depression; stress and anxiety; and eating disorders. A program to promote self monitoring of students' health behaviors could prove beneficial to their future well-being and potentially reduce overall medical costs for this group. Computerized mental health risk appraisals, if valid, reliable, and acceptable to students and administrators, could facilitate implementation and minimize the costs of such a program. This pilot study was designed to determine whether a confidential computer-based risk appraisal is a valid and acceptable measure of current mental health status in a university student sample. Two basic questions were addressed. First, do computerized questionnaires yield results similar to their pencil-and-paper counterparts? Second, how do students rate and compare the two formats? PMID- 10146793 TI - A pilot study of the effect of cholesterol measurement on the eating patterns of adolescents. AB - Epidemiologic research demonstrates that a diet high in total fat, saturated fat, and cholesterol is linked to elevated cholesterol levels and increased risk for heart disease in adults. It is thought that this relationship also holds true for children and adolescents. The literature shows strong support for combining instruction strategies with cardiovascular risk factor screening within the educational setting. Reasons cited include: enhancing the effectiveness of classroom curriculum in achieving health behavior modification; presenting a motivational component; providing important physiological feedback; and offering norm-creating potential. Teaching the adolescent the importance of controlling blood cholesterol through a low-fat diet can be difficult, but producing a change in behavior can be even more challenging. The purpose of this project was to determine whether or not incorporating a cholesterol measurement into instructional strategies would enhance learning. Project objectives included: 1) increasing students' knowledge of the health effects of a high blood cholesterol; and 2) promoting a change in dietary behaviors related to low-fat dietary choices. PMID- 10146794 TI - Empowerment, not outreach: serving the health promotion needs of the inner city. PMID- 10146795 TI - Analysis of commercial health newsletters by worksite decision makers. AB - Health newsletters are an important component of worksite wellness, and human resource program managers believe these publications motivate employees and promote health services. Research has identified employee segments more likely to read health newsletters as well as how these publications may contribute to better medical self-care decision making. Even so, virtually no data exist on the factors contributing to newsletter selection and purchase except proprietary, anecdotal information collected by commercial vendors. Therefore, the purpose of this research was to investigate how newsletter features are rated by decision makers and determine factors predicting intent to purchase a health newsletter. PMID- 10146796 TI - Building a corporate wellness consortium: the Los Angeles Downtown Wellness Consortium. PMID- 10146797 TI - The relationship of internally directed behavior to self-reinforcement, self esteem, and expectancy values for exercise. AB - PURPOSE: This study investigated two opposing orientations toward exercise and wellness behavior as related to selected personal characteristics. A "self trusting" orientation focuses on process measures, and exercise and wellness behavior is internally directed. A "self-controlling" orientation focuses on outcome measures, and exercise and wellness behavior is externally directed. DESIGN: Relationships among variables were assessed using Pearson correlation and step-wise multiple regression. SETTING: One questionnaire was administered to all subjects under quiet classroom conditions. SUBJECTS: Subjects were enrolled in university physical education activity classes (N = 154), a health promotion and fitness undergraduate class (N = 52), and a commercial aerobic dance program (N = 68). MEASURES: The questionnaire, containing 157 items, assessed exercise orientation, wellness orientation, general self-esteem, physical self-esteem, self-reinforcement, expectancy values for exercise, and level of physical activity. RESULTS: Individuals who reported exercising to improve physical appearance and/or physical performance had higher control scores on the exercise scale; exercising for pleasure or social reasons served as suppressor variables. High control scores on wellness and exercise orientation were indicative of individuals less likely to positively self-reinforce their behavior. A high control score on the wellness scale was significantly related to lower general and physical self-esteem scores. Finally, higher physical self-esteem was significantly related to exercising for pleasure and athletic reasons; exercising to improve physical appearance served as a suppressor variable. CONCLUSIONS: These data strengthen the recommendation that health promotion professionals consider alternative approaches to promoting exercise and enhancing wellness.(ABSTRACT TRUNCATED AT 250 WORDS) PMID- 10146798 TI - Personal crisis: growth or pathology? AB - PURPOSE: The aim of this article is to present an emerging theoretical framework for viewing certain types of personal crises as developmentally healthy rather than as psychopathological. These types of crises are referred to as "spiritual emergence" and "spiritual emergency." SEARCH METHODS USED: Selected literature from psychology, psychiatry, and philosophy is used to describe the new paradigm, which views the development of human consciousness across the life span as going beyond the well-adjusted and productive adult ego. The intent is to introduce this paradigm and some of its implications for further critical consideration by health promotion professionals. It is not the authors' purpose to critically evaluate the relevant theoretical literature in this article. SUMMARY OF IMPORTANT FINDINGS: The new paradigm represents an expanded theory of human development that explicitly recognizes a spiritual dimension in personal growth and health. Within this paradigm, spiritual emergence and spiritual emergency are viewed as signs of transitional, personal growth rather than as symptoms of psychopathology. Accordingly, signs of growth need to be differentiated from symptoms of pathology. The first step in doing this is to contextualize human experience in a larger developmental framework. MAJOR CONCLUSIONS: Health promotion professionals may benefit personally and professionally by being aware of the new developmental paradigm which differentiates spiritual growth from pathological symptoms. Further theoretical clarification and research will be needed before detailed recommendations for practice can be made. PMID- 10146799 TI - Issues related to participation in worksite health promotion: a preliminary study. AB - PURPOSE: The purpose of this study was to identify characteristics associated with participation in worksite-based health promotion activities. DESIGN: Follow up interviews were used to identify demographic, attitudinal, and behavioral differences among three employee groups. Reasons employees chose not to participate in health promotion activities were also explored. SETTING: All respondents were employed at a large midwestern university and were eligible to participate in free onsite health fairs and health promotion programs. SUBJECTS: A stratified random sample of 89 nonparticipants, health fair participants, and behavior change program participants was interviewed. MEASURES: The interview was comprised of questions related to demographic information, personal health habits, physical activity, perceived health status, perceived self-efficacy, worksite norms, health promoting lifestyle factors, and knowledge about health promotion activities. RESULTS: ANOVA and chi-squared comparisons revealed few group differences. Graduate students and employees with advanced degrees were most likely to take part in health fairs. Behavior change program participants were older, clerical-technical staff members, and women. Faculty members were least likely to participate. A lack of time was the most often cited reason for nonparticipation. CONCLUSIONS: The study was retrospective and the analyses limited due to low statistical power. The results suggest that different groups of employees are attracted to different types of health promotion activities. PMID- 10146800 TI - Is it possible to simultaneously reduce risk factors and excess health care costs? PMID- 10146801 TI - The health promotion research agenda revisited. PMID- 10146802 TI - Response to "health risk changes with a low-cost individualized health promotion program: effects at up to 30 months" by Fries et al. PMID- 10146803 TI - Using the stages of change model to increase the adoption of physical activity among community participants. AB - PURPOSE: This study examined the use of the stages of change model to design an exercise intervention for community volunteers. DESIGN: The "Imagine Action" campaign was a community-wide event incorporating the involvement of local worksites and community agencies. Community members registering for the campaign were enrolled in a six-week intervention program designed to encourage participation in physical activity. SUBJECTS: Six hundred and ten adults aged 18 to 82 years old enrolled in the program. Seventy-seven percent of the participants were female and the average age was 41.8 years (SD = 13.8). SETTING: The campaign was conducted in a city with a population of approximately 72,000 and was promoted throughout community worksites, area schools, organizations, and local media channels. MEASURES: One question designed to assess current stage of exercise adoption was included on the campaign registration form as were questions about subject name, address, telephone number, birthdate, and gender. INTERVENTION: The intervention included written materials designed to encourage participants to initiate or increase physical activity, a resource manual describing activity options in the community, and weekly "fun walks" and "activity nights." RESULTS: A Stuart-Maxwell test for correlated proportions revealed that subjects were significantly more active after the six-week intervention. Sixty-two percent of participants in Contemplation became more active while 61% in Preparation became more active. CONCLUSIONS: Most participants increased their stage of exercise adoption during the six-week intervention. This study provides preliminary support for use of the stages of change model in designing exercise interventions. PMID- 10146804 TI - The impact of a cholesterol screening and intervention program among unskilled and semiskilled workers. PMID- 10146805 TI - Factors associated with participation in a worksite cholesterol screening and nutrition education program. PMID- 10146807 TI - Religion and disease prevention: beyond the metaphor. PMID- 10146806 TI - Putting stress into words: the impact of writing on physiological, absentee, and self-reported emotional well-being measures. AB - BACKGROUND AND PURPOSE: Inhibiting or holding back one's thoughts, feelings, or behaviors is associated with long-term stress and disease. Actively confronting upsetting experiences can reduce the negative effects of inhibition. The present study describes a unique approach to aid individuals in dealing with psychological and emotional issues that they must often face. METHODS: Forty-one of the 81 university employees who were participating in a wellness program agreed to participate in the present study. Subjects were randomly assigned to write about either personal traumatic experiences (n = 23) or non-traumatic topics (n = 18) for 20 minutes once a week for four consecutive weeks. RESULTS: Results indicate that individuals who wrote about upsetting personal experiences evidenced significant drops in selected blood measures compared to those who wrote about non-traumatic topics (e.g., for SGOT: 4.0% drop among traumatic topic group versus 13.1% increase among non-traumatic topic group, ANOVA p = .029; for SGPT: 24.5% drop versus 7.7% increase, p = .001). During the month of writing, traumatic topic group subjects evidenced a 28.6% reduction in absentee rates from work relative to the eight months before the experiment compared with a 48.5% increase in absentee rates among non-traumatic topic subjects (p = .04). Subjects low in emotional inhibition evidenced the greatest reductions in absentee rates following personal disclosure compared to those high in emotional inhibition (p = .011). DISCUSSION: The proposed writing strategy offers a unique tool for health promotion practitioners.(ABSTRACT TRUNCATED AT 250 WORDS) PMID- 10146808 TI - Challenging employees to health: an incentive contest approach. PMID- 10146809 TI - The effects of a comprehensive health risk appraisal, basic screening, and interpretation session on employee health practices: differences between participants and nonparticipants. PMID- 10146810 TI - Breaking the cycle of broken promises: the role of supportive cultural environments in successful health promotion. PMID- 10146811 TI - A guided self-help smoking cessation intervention with white-collar and blue collar employees. PMID- 10146812 TI - The impact of small sample size on estimating the relationship between lifestyle practices and employee medical care costs. PMID- 10146813 TI - Creating the health care system we want for the early twenty-first century. PMID- 10146814 TI - Preliminary comparison of medical care costs between fitness center members and nonmembers. PMID- 10146815 TI - Perception of the Apple Computer Fitness Center as a recruiting tool. PMID- 10146816 TI - Impact of a 12-week aerobic exercise and weight program for law enforcement trainees. PMID- 10146817 TI - Worksite health promotion and health care reform. PMID- 10146818 TI - Office ergonomics education: a health promotion program at Stanford University. PMID- 10146819 TI - Effects of intensity of staff training on program participation in religious organizations and worksites. PMID- 10146820 TI - The potential impact of health promotion on health care utilization: an introduction to demand management. PMID- 10146821 TI - Examining the use of a fully-automated interactive voice response tobacco cessation support line. PMID- 10146822 TI - The use of focus groups in the design of cholesterol education intervention programs. PMID- 10146823 TI - An empirical evaluation of the effectiveness of tangible incentives in increasing participation and behavior change in a worksite health promotion program. PMID- 10146824 TI - Housestaff knowledge of prevention guidelines. PMID- 10146825 TI - Preliminary report of a home-based education program for dietary treatment of hypercholesterolemia in children. PMID- 10146826 TI - Health habits and risk factors among truck drivers visiting a health booth during a trucker trade show. AB - PURPOSE: The purpose of this report is to provide general information on the personal characteristics, health status, and health interests reported by long haul truck drivers. DESIGN: A cross-sectional survey was conducted based on a convenience sample. Statistical independence between comparison groups for driver type, age, and gender were tested with the Pearson chi-square test. SETTING: The study population consisted of truck drivers who stopped at one of 65 truck stops participating in a trucker trade show. SUBJECTS: Subjects were 2,945 male self identified truck drivers and 353 female self-identified truck drivers who visited health booths at the trade show. It was estimated that two thirds of visitors to the health booth participated. MEASURES: A self-administered, close-ended questionnaire recorded the participant's personal characteristics, health status, and health interests. Blood pressure was measured by trained volunteers. RESULTS: A large percentage of male truck drivers smoked cigarettes (54% vs. 30% of U.S. white males), did not exercise regularly (92%), were overweight (50% vs. 25% of U.S. white males), and/or were not aware they had high blood pressure (66% vs. 46% of U.S. population). Also, 23% of surveyed truck drivers tested positive on one measure of alcoholism. CONCLUSIONS: Although a scientific sample frame was not used, the health status and lifestyle observed in this study suggest truck drivers would clearly benefit from a health education and promotion program. The truck stops should be evaluated as a possible setting for such a program. PMID- 10146827 TI - Physical activity and alcohol consumption trends among physically active college students. PMID- 10146828 TI - Participation and psychological changes among retirees in a corporate fitness program. PMID- 10146829 TI - Continuous in-line respiratory monitoring in the critically ill preterm infant. PMID- 10146830 TI - The new Vital Signs meconium suction device. PMID- 10146831 TI - Detection of hyperoxemia in neonates by a new pulse oximeter. AB - OBJECTIVE: We studied the ability of a new pulse oximeter to detect hyperoxemia in neonates. METHODS: One hundred arterial blood samples were obtained from umbilical artery catheters of 41 acutely ill neonates (birth weight 560-4100 grams) while SpO2 was simultaneously measured at a postductal site. The relationship between PaO2 and SpO2 was examined and expressed on a matrix. Hyperoxemia was defined as PaO2 greater than 90 mm Hg and upper alarm limit for pulse oximetry was set at 95%. The incidence of true hyperoxemia (PaO2 greater than 90 mm Hg, SpO2 greater than 95%) was determined and sensitivity and specificity for detection of hyperoxemia by the SpaceLabs device was calculated. RESULTS: Hyperoxemia was detected in eighteen samples with sixteen having SpO2 greater than 95% (89% sensitivity). In 82 samples having a PaO2 value less than or equal to 90 mm Hg, 53 were associated with SpO2 less than or equal to 95% (65% specificity). Among 55 samples with SpO2 less than or equal to 95% hyperoxemia occurred in only 2 (3.6%). Sensitivity of 95% would have been achieved with upper alarm limit set at 94%. CONCLUSION: The new pulse oximeter evaluated detected 89% of episodes of hyperoxemia with upper alarm limits set at 95% and 95% of episodes if upper limit was set at 94%. As previously reported, both individual device algorithms and upper alarm limits chosen determine ability of pulse oximeters to detect hyperoxemia. PMID- 10146832 TI - Coronary health disease risk factors and health related fitness in long-term exercising versus sedentary corporate executives. PMID- 10146833 TI - Adherence factors in a worksite fitness program. PMID- 10146834 TI - Comparison of the effectiveness of three forms of advertising on the purchasing of clinic-based health promotion programs and services. PMID- 10146835 TI - Self-efficacy and exercise participation in sedentary adult females. AB - BACKGROUND: This study examined the importance of selected psychosocial and biometric variables in the prediction of exercise behavior in sedentary adult females. Specifically, the relationships among exercise behavior and instructor influence, self-efficacy cognitions, self-motivation, and body composition and their ability to predict exercise participation were evaluated. METHODS: Fifty eight females volunteered to participate in an eight-week aerobic exercise program. Biometric and psychosocial variables were assessed prior to and following the program. Attendance data and activity logs provided participation data. Subjects were also contacted three months after program termination to assess their activity patterns at that time. RESULTS: Multivariate analyses of variance indicated that subjects categorized as high or low in either program or overall exercise participation differed significantly on body weight, efficacy cognitions, and post-program perceptions. Multiple regression analyses indicated that instructor influence (R2 = .116) and self-efficacy cognitions (R2 = .093) contributed to the variance in subjects' program attendance. However, only self efficacy was a significant predictor of overall exercise levels (R2 = .125). Correlational analyses revealed a modest but significant difference between self efficacy and regularity of exercise (r = .28) and duration of activity (r = .32) at follow-up. DISCUSSION: The findings are discussed in relation to the role that efficacy might play in exercise behavior. PMID- 10146836 TI - Correlates of anger symptoms in women in middle adulthood. AB - BACKGROUND: Anger is of great interest to health professionals due to its relationship with disease outcomes. However, male samples have been used in most studies examining linkages between anger and health indicators. In this exploratory study, anger symptoms and their cognitive and environmental correlates were examined in a sample of 87 women in middle adulthood. METHODS: This descriptive-correlational study involved secondary analyses of data obtained in the third phase of a longitudinal study of health in middle adulthood. Data were collected with a battery of well-established self-report instruments. Descriptive statistics, t tests, and correlational and regression analysis were used. RESULTS: Significant correlates of anger symptoms included lower optimism, external health locus of control, higher frequency and severity of daily hassles, lower functional social support, and loss of important relationship(s) during the past year. Greater body mass index, inadequate sleep, lack of exercise, drinking, and use of over-the-counter drugs were also associated with anger symptomatology. DISCUSSION: Findings regarding the relationship of daily stress and anger were consistent with the Framingham Study. Contrary to expectations, women who reported more anger symptoms were not suppressors of their anger but directed it outward. PMID- 10146837 TI - Exploring spirituality and consciousness with an expanded science: beyond the ego with empiricism, phenomenology, and contemplation. AB - Spirituality has been recognized as pivotal in health education and health promotion. Although spirituality is often discussed as a dimension of health, there is little evidence of integrating it into educational settings and health promotion programs. The difficulty in addressing the concept of spirituality is related to both its association with denominational religion and our cultural emphasis on the material realm. However, some scholars are now associating spirituality with the development of human consciousness beyond the ego level. It has been suggested that the scientific investigation of this development beyond the ego may be possible with empirical and phenomenological, as well as with traditional contemplative methods. Thus, investigation in the realms of consciousness beyond the ego can be addressed within theories of knowledge that are grounded in experience. An examination of the spirituality/consciousness relationship may be crucial for any profession that purports to address the health issues of the whole person. It may then be possible to more easily integrate spirituality into educational settings and health enhancement programs. If spirituality is part of human experience, then willingness to make forays into this dimension is fundamental to health. PMID- 10146838 TI - Partners in prevention: a mobilization plan for implementing Healthy People 2000. PMID- 10146839 TI - Response to a telephone smoking information line. PMID- 10146840 TI - Results of a long-term community smoking cessation contest. AB - BACKGROUND: Successive quit smoking contests undertaken as part of the Minnesota Heart Health Program had generated diminishing impact. The 1988 contest attempted to rejuvenate community interest and participation through a substantially extended enrollment period. METHOD: Smokers were eligible for monthly prize drawings and a grand prize drawing by entering the contest at any point between June 1988 and January 1989 and remaining abstinent for at least one month. The contest was promoted through newspaper advertisements, contest flyers, schools, and a community-wide direct mail campaign. RESULTS: A total of 1,328 smokers returned initial interest cards and 918 (69.1%) of these smokers returned quit pledges. Self-reported abstinence for pledgers and nonpledgers was 16.7% and 9.2%, respectively. Survival analysis indicated significantly longer periods of abstinence for pledgers (p = .0001). DISCUSSION: The extended contest was successful in recruiting smokers (almost 7% of the entire Bloomington smoking population vs. 1% for a previous one-month contest), especially those with less than a high school education. The current contest required substantial expenditures. However, these costs could be dramatically reduced through innovative use of donated resources. PMID- 10146841 TI - Demographic and predictive correlates of smokeless tobacco use in elementary school children. AB - BACKGROUND: To assess the basic demographics and predictive correlates of smokeless tobacco use in school-age children, a stratified random sample of 559 rural and urban first, third, fifth, and seventh graders in western North Carolina was surveyed regarding experimentation with smokeless tobacco. METHODS: Two versions of a survey were developed: a shorter version administered orally to first graders and a longer version provided to others. Reported percentages across demographic variables were broken down in a 4 x 2 x 2 analysis of variance; correlations were used to assess the relationships among potentially predictive variables. RESULTS: Results indicated that 36 percent of male rural first graders had tried smokeless tobacco, increasing to 70 percent by the seventh grade. Overall, rural males were more likely to have tried or be regularly using smokeless tobacco than were urban males or females. Other questions correlating with smokeless tobacco use indicated that it is predicted by three general concerns: a) perceived flavor, b) self-concept and presentation to peers, and c) family influence. DISCUSSION: Educational interventions must begin at the kindergarten or first grade levels. Programs for adolescents must provide for alternative ways of receiving perceived social image benefits of smokeless tobacco use. Familial support must be considered in all programming. PMID- 10146842 TI - A large-scale, short-term, media-based weight loss program. AB - BACKGROUND: This article describes the evaluation of a media-based weight loss and nutrition program. METHODS: Fifteen broadcasts were aired on a Chicago television news program over a three-week period in November of 1986. Some participants (n = 37) received the television program and an accompanying manual, and some (n = 37) received, in addition to the television and media interventions, encouragement to attend self-help groups dealing with obesity. RESULTS: Repeated measures analysis of variance tests were performed, and planned comparisons were conducted only if main effects were significant. At posttesting, those participants attending the self-help groups lost an average of more than nine pounds, whereas those provided only the television program and manual had decreased by less than a pound. Those attending the groups had significantly decreased their percent of dietary fat intake, significantly increased aerobic exercise, and had significantly more hopefulness, motivation, and stimulus control. DISCUSSION: The findings suggest that short-term mass media programs by themselves were probably not very effective, but when supplemented by a self-help manual and support groups may be able to produce significant short term weight loss. PMID- 10146843 TI - Qualitative methods in program evaluation. AB - The choice of evaluation methodology is as important as any part of the assessment process. In the past, most selections have been made from among various quantitative strategies and techniques. Recently, program evaluation researchers have begun to discuss some of the limitations of quantitative techniques for addressing some evaluation questions. In response to these limitations--most of which characterize the evaluation of health promotion programs--some have turned to a set of techniques which can complement or, at times, replace quantitative evaluation methods. These methods are collectively called "qualitative" evaluation methods. In this article, we highlight some of the differences between quantitative and qualitative approaches and suggest ways in which both may be used in a given evaluation effort. PMID- 10146844 TI - The Burma-Shave safety signs: history and lessons for health education. PMID- 10146845 TI - Employee health promotion at a university medical center: a pilot project. PMID- 10146846 TI - A participative culture-based intervention for promoting mental health among Quebec youth: "clip et vous.". PMID- 10146847 TI - Empowerment of children and youth for consumer self-care. PMID- 10146848 TI - Is homophobia hazardous to lesbian and gay health? PMID- 10146849 TI - Comparison of total cholesterol and full lipid panel values in identifying at risk individuals in a community screening program. PMID- 10146850 TI - The impact of incentives and competitions on participation and quit rates in worksite smoking cessation programs. AB - PURPOSE: The purpose of this review is to determine whether incentive-based programs conducted at worksites increase participation and long-term smoking cessation rates. METHODS: Published studies of workplace smoking cessation programs involving incentives and competition were identified through all available years up to winter of 1992 in MEDLINE (1966-1992), Psychlit (1967 1992), Smoking and Health (1960-1992), and Combined Health Information (1973 1992) computer databases and article reference lists. Programs were considered incentive programs when they involved either cash or other prizes paid to the participant for quitting smoking. Incentive competition programs typically involve groups contesting for prizes by having the greatest smoking cessation rates. Thirty studies were found, out of which 15 quasi-experimental and experimental studies are reviewed. The 15 studies that did not have comparison groups were excluded from this report. RESULTS: Only eight studies had a comparison group in which the effects of incentives and competition were separated from the effects of other interventions. Only one study separated the effects of competition from incentives. Five of these studies evaluated smoking rates after six months, and three after 12 months from the program start. Three of these studies showed that incentives increased participation rates, and five enhanced smoking reduction. No study showed, however, that incentives and/or competition enhanced smoking cessation past six months. CONCLUSIONS: It appears that incentives/competition may be useful for increasing participation and smoking reduction. Further research needs to be conducted to determine whether incentives and/or competition enhance long-term quit rates, and what are the most effective types of incentive procedures. PMID- 10146851 TI - Researching and preventing alcohol problems at work: toward an integrative model. AB - PURPOSE OF PROPOSAL. A consolidated framework is proposed to highlight modifiable factors in work organizations that may contribute to alcohol-related problems. This research model serves to organize existing knowledge, highlight pathways for new research initiatives, and offer insights into the design of primary and secondary preventive strategies. CONTRIBUTING INFLUENCES. Current research on problem drinking in the workplace either locates problems in individual drinkers or looks to the social environment to understand how drinking problems unfold. There is a clear need for a more complete theoretical model which incorporates social, cultural, organizational, and personal factors. PROPOSAL SUMMARY. This article elaborates on a model for examining problem drinking at work which integrates policy, normative, and psychosocial influences. It emphasizes the structures within which health-related decisions and actions are contained and constrained. The focus here on the connections between alcohol use and work builds on the premise that health is socially produced. PMID- 10146852 TI - A case for no-fault health insurance: from the "worried well" to the "guilty ill.". PMID- 10146853 TI - Use of focus groups to enhance family services in a hospital-based fitness facility. PMID- 10146854 TI - A statewide intervention to increase safety belt use: adding to the impact of a belt use law. PMID- 10146855 TI - European news and perspectives {news}. PMID- 10146856 TI - Reducing environmental tobacco smoke (ETS) exposure for infants: a cessation intervention for mothers of newborns. PMID- 10146857 TI - Facility access and self-reward as methods to promote physical activity among healthy sedentary adults. PMID- 10146858 TI - European news and perspectives {news}. PMID- 10146859 TI - Size and shape of biomaterial wear debris. AB - A literature review of wear debris is presented. Included are debris retrieved at revision of total joint replacement and at autopsy, as well as debris produced in vitro in wear testers and joint simulators or otherwise fabricated for biological experiments. Observations of wear debris in vivo and in vitro are classified in tabular form according to material type, origin, size, shape and color. Polymer particles, most commonly ultra-high molecular weight polyethylene (UHMWPE), exhibit the largest size range and appear as granules, splinters or flakes, while ceramic particles possess the smallest size range and have a granular structure. Metal particles seen in vivo and in vitro, whether from cobalt-chromium alloys or, less frequently, other alloys, form granular or needle like shapes and generally are smaller than polymer particles but larger than ceramic particles. Particles generated in joint simulators resemble the size and shape of in vivo wear particles from total joint replacement (TJR) retrieved at revision or autopsy. However, particles prepared in vitro, whether in simulators or by other means, do not consistently resemble wear debris particles from TJR. PMID- 10146861 TI - Dispensing by physicians and pharmacists: a UK perspective. PMID- 10146860 TI - Benefits, risks and costs of calcium supplementation in postmenopausal women. PMID- 10146862 TI - Dispensing physicians and prescribing pharmacists: economic considerations for the UK. AB - Recent years have seen an increase in the number of dispensing physicians in the UK. There have also been suggestions that legislation restricting certain drugs to prescription-only availability should be relaxed and that pharmacists should take a more active role in the provision of drugs. General medical practitioners and pharmacists have common ancestry in the medieval spicers, who dispensed medicines and offered medical advice. Rural practitioners have been allowed to dispense drugs since 1911. Physician dispensing can benefit patients via savings in time and the monetary cost of visiting a pharmacist, but it restricts drug choice, can compromise safety, and encourages overprescribing except for physicians with drugs budgets. The effects of physician dispensing on government costs are not yet clear. Over-the-counter (OTC) purchase can save patients the cost of a physician visit and reduce drug costs to some patients, but it can also provide an incentive to pharmacists to profit twice from a drug, at government expense. Switching drugs from prescription-only to OTC reduces the government drug bill, but provides an incentive to pharmacists to overprescribe, and may not be as safe for patients. Liberalising prescribing by doctors would discourage community pharmacies which provide an advisory service to patients. Liberalising OTC switches would reduce opportunistic assessment of patients by doctors and could compromise patient safety. Separation of physician and pharmacist functions is probably safer for patients. It is concluded that the current situation in the UK, whereby most dispensing is done by pharmacists, is the preferred option other than for those patients who do not live within easy access of a pharmacy. A reassessment of the legal status of drugs and subsequent OTC switch of drugs used to treat minor self-limiting illnesses is also favoured. PMID- 10146863 TI - Low-dosage epoetin in maintenance haemodialysis: costs and quality-of-life improvement. AB - Decisions about epoetin (recombinant human erythropoetin) dosage and target haematocrit in dialysis patients have been determined largely by the high acquisition cost of epoetin, but are made with incomplete knowledge about which target haematocrit gives the optimum clinical benefit. Haematopoietic response to epoetin may be determined by pharmacodynamic factors such as rate and frequency of administration, as well as by individual patient characteristics such as ethnicity. Resistance to epoetin may be due to iron or vitamin deficiency, natural or exogenous inhibitors of erythropoiesis and bone marrow fibrosis. The high acquisition cost of epoetin must be considered along with a number of other factors that can influence the true cost of epoetin treatment. Hidden costs of epoetin treatment include administration costs, changes in other treatments, extra laboratory tests and adverse events. Administration costs and extra laboratory surveillance add little to overall cost. Depletion of iron stores, hypertension, increased blood coagulability and reduced dialyser efficiency resulting from epoetin treatment may all add a small additional component to the true cost. Severe complications with significant cost implications are rare. Amongst the various components of true cost, only the acquisition cost can definitely be reduced by low dosage treatment. Balanced against the true and potential costs of epoetin are a number of benefits which can result in potential savings. The need for blood transfusion is all but abolished, avoiding the cost of transfusion and its complications. Sensitisation against histocompatibility antigens is reduced by avoiding transfusion, and so the waiting time for cadaveric transplantation may be reduced. Rates of hospitalisation for all causes, especially those associated with anaemia, may be reduced by epoetin treatment. By improving well-being, epoetin may allow patients to be transferred to minimal-care units or home where dialysis can be performed much more cheaply. Amongst the various potential benefits of epoetin, the one with the greatest potential to save money for society is improved productivity. To date, productivity improvements with epoetin have been demonstrated only in small studies. If the acquisition costs of epoetin are reduced by low dosage therapy, these potential benefits can cover a large proportion of the total cost of epoetin. Epoetin undoubtedly improves quality of life and activity, but it is not clear which level of haematocrit gives optimum improvement.(ABSTRACT TRUNCATED AT 400 WORDS) PMID- 10146864 TI - The formulary decision-making process in a health maintenance organisation setting. AB - The goal of a health maintenance organisation (HMO) is to provide high quality, cost-effective healthcare services and products which meet the needs of the membership. Providing and managing pharmaceutical products and services within the HMO is a major aspect of accomplishing this goal. Several decisions must be made in developing, implementing and maintaining a formulary system. The numbers of people seeking their healthcare from HMOs in the US has increased 4-fold in 10 years, and several model types of HMOs have developed, including network HMOs, group HMOs, independent practitioner associations and staff models. HMOs utilising formulary systems provided cover to 76% of enrollees in 1992. Formulary system management and decision making entails the use of open vs closed formularies and the role of the pharmacy and therapeutics (P & T) committee. Product selection takes into account efficacy, safety, costs, patient acceptance, ease of use, dosage forms, preparation requirements, stability and storage requirements and the reputation of the manufacturer and the service it provides. We list and describe various policy decisions which HMO pharmaceutical decision makers must address if the formulary system is to become an efficient tool for the HMO. PMID- 10146865 TI - Net economic benefit of a manufactured dinoprostone gel for pre-induction cervical ripening. AB - The purpose of this study was to estimate the net economic cost or benefit of pretreating women who have a medical indication for induction of labour, and an unprepared (unripe) cervix, with a manufactured dinoprostone (prostaglandin E 2) gel. Findings of a meta-analysis of the results of 3 large, randomised clinical trials were employed in the construction of a decision tree used in the economic analysis. For the intended target population, the primary clinical and economic outcomes of gel pretreatment were shortening of the treatment-to-delivery interval, an increase in the percentage of patients achieving labour and a decrease in the percentage of patients requiring delivery by caesarean section. Application of cost factors associated with these and other variables led to a finding of net savings associated with use of the dinoprostone gel pretreatment, compared with no gel pretreatment, of $US159 to $US214 (1993 prices) per treated patient, corresponding to the maximum and minimum duration of the pre-induction treatment period, respectively. PMID- 10146866 TI - Prophylaxis for venous thromboembolism in hip fracture surgery: total costs and cost effectiveness in The Netherlands. AB - Fracture of the hip is one of most significant risk factors for development of deep vein thrombosis (DVT) and its complications. A number of pharmacological prophylactic methods are currently available which can reduce the incidence of postoperative thromboembolism in patients undergoing surgery for fracture of the hip. A retrospective analysis of controlled clinical studies was performed to examine in this patient group the total cost of prevention and treatment, and the cost effectiveness in terms of lives saved, of 5 prophylactic regimens--oral anticoagulants, dextran, low dose heparin, low molecular weight (LMW)-heparin and danaparoid sodium--compared with clinical diagnosis and conventional treatment of DVT only. Our results show that the total cost, including the savings in treatment of the complications of DVT, of each prophylactic regimen is less than the total cost of no prophylaxis. Thus, prophylaxis may not only save lives but may also lead to lower costs of care (including prophylaxis costs). The total cost of the new antithrombotic danaparoid sodium is less than that of the other forms of prophylaxis considered and danaparoid sodium appears to be the most cost effective modality. We conclude that general use of danaparoid sodium in surgery for hip fracture is the most efficient approach to decreasing the incidence of postoperative morbidity and mortality and reducing healthcare expenses for the complications of DVT. PMID- 10146868 TI - Episode-free days as end-points in economic evaluations of asthma therapy. PMID- 10146867 TI - Recombinant granulocyte-macrophage colony-stimulating factor (rGM-CSF): an appraisal of its pharmacoeconomic status in neutropenia associated with chemotherapy and autologous bone marrow transplant. AB - Recombinant granulocyte-macrophage colony-stimulating factor (rGM-CSF) expedites neutrophil recovery in cancer patients receiving chemotherapy with or without autologous bone marrow transplant (ABMT). The limited cost analyses available in patients undergoing ABMT support a cost reduction of about 25 to 35% with rGM-CSF therapy, relative to placebo, generated primarily by decreases of 20 to 30% in hospitalisation costs reflecting reductions in length of hospitalisation. Results of 1 trial show equivalent cost savings of 40% versus placebo with either rGM-CSF or recombinant granulocyte colony-stimulating factor (rG-CSF) in patients with chemotherapy-induced febrile neutropenia. Whether reduced infection rates seen with rGM-CSF may lessen costs of antimicrobial therapy is undetermined; however, a 16% decrease in this cost factor was reported in 1 evaluation of high dose chemotherapy with ABMT. No analyses have assessed the cost effectiveness of rGM-CSF as prophylaxis in patients receiving chemotherapy. Survival rates have increased in patients treated with rGM-CSF after bone marrow graft failure. In contrast, with the exception of one small trial, improvements in mortality or relapse rates have not occurred with rGM-CSF used prophylactically with chemotherapy, despite favourable effects on neutrophil recovery and facilitation of dose-intensified chemotherapy regimens. Similarly, survival has not increased in patients undergoing ABMT. The long term economic impact of rGM-CSF in these indications is thus unknown. Other factors predicted to produce modest cost savings include possible reductions in expenditure related to treating mucositis, and lowered transfusion requirements in some patients. Whether rGM-CSF may provide benefits in other areas that can be expressed in economic terms, such as quality of life, also remains to be established. On the whole, rGM-CSF has a good tolerability profile, obviating the need for costly monitoring procedures. Like other expensive biotechnology products, its cost effectiveness will be aided by implementation of appropriate prescribing techniques and protocols to minimise wastage. Thus, at present rGM-CSF therapy appears to offer a means of reducing hospitalisation costs, and therefore a substantial component of treatment expenditure, in patients undergoing ABMT or with chemotherapy-induced febrile neutropenia. PMID- 10146869 TI - Is clozapine worth its cost? PMID- 10146870 TI - Strategic use of pharmacoeconomic research in early drug development and global pricing. PMID- 10146871 TI - The role of insurance claims databases in drug therapy outcomes research. AB - The use of insurance claims databases in drug therapy outcomes research holds great promise as a cost-effective alternative to post-marketing clinical trials. Claims databases uniquely capture information about episodes of care across healthcare services and settings. They also facilitate the examination of drug therapy effects on cohorts of patients and specific patient subpopulations. However, there are limitations to the use of insurance claims databases including incomplete diagnostic and provider identification data. The characteristics of the population included in the insurance plan, the plan benefit design, and the variables of the database itself can influence the research results. Given the current concerns regarding the completeness of insurance claims databases, and the validity of their data, outcomes research usually requires original data to validate claims data or to obtain additional information. Improvements to claims databases such as standardisation of claims information reporting, addition of pertinent clinical and economic variables, and inclusion of information relative to patient severity of illness, quality of life, and satisfaction with provided care will enhance the benefit of such databases for outcomes research. PMID- 10146872 TI - Economic implications of smoking cessation therapies: a review of economic appraisals. AB - There is a paucity of studies on the economics of smoking cessation. Those undertaken have investigated only a narrow range of available interventions, using variable methodologies which make interstudy comparisons problematical. There is a need for more economic appraisal in this area and for greater consistency in the methodologies employed. Growing evidence on the effectiveness of pharmacotherapies has not been matched by evidence of their cost effectiveness, and studies in this area, particularly on transdermal nicotine, are urgently required. Cost-benefit analyses (CBAs) have focused on programmes targeted at pregnant women and indicate that resource savings, mainly from reductions in the number of low birthweight neonates, can exceed the costs of the measures. Efforts to persuade pregnant women to quit thus appear to be highly cost beneficial, but further evidence on the efficiency of measures targeted at other groups or to the general population of smokers is required. Cost effectiveness analyses (CEAs) suggest that measures targeted at specific groups are more cost effective than those targeted at the general population of smokers, and that the cost effectiveness of such programmes is further improved by providing educational materials that are specific to the targeted groups. Advice on how to maintain abstinence appears to improve the cost effectiveness of help with quitting, and routine advice from physicians to their smoking patients is a cost-effective way of reducing smoking prevalence. PMID- 10146873 TI - The episode-free day as a composite measure of effectiveness: an illustrative economic evaluation of formoterol versus salbutamol in asthma therapy. AB - The construction of a composite effectiveness measure was explored using clinical data collected routinely in trials of drug therapies for asthma. The measure is the episode-free day (EFD), where an 'episode' is either an asthma attack, the need for rescue medication, sleep disturbance caused by asthma, or an adverse event. The EFD measure was used in a retrospective cost-effectiveness analysis of a previous Phase III controlled clinical trial of formoterol versus salbutamol, in which 145 patients with bronchial asthma were randomised to receive maintenance therapy with either inhaled formoterol or inhaled salbutamol over a 12-week period. Average and incremental cost-effectiveness ratios were assessed for the 2 drugs in terms of the total expected cost of drug plus rescue therapy, and EFD rates. The analysis suggests that, with relatively little addition to clinical data collection, economically and clinically meaningful composite measures can be constructed to assist in making cost-effectiveness comparisons between alternative asthma therapies. PMID- 10146874 TI - The validity and reproducibility of a work productivity and activity impairment instrument. AB - The construct validity of a quantitative work productivity and activity impairment (WPAI) measure of health outcomes was tested for use in clinical trials, along with its reproducibility when administered by 2 different methods. 106 employed individuals affected by a health problem were randomised to receive either 2 self-administered questionnaires (self administration) or one self administered questionnaire followed by a telephone interview (interviewer administration). Construct validity of the WPAI measures of time missed from work, impairment of work and regular activities due to overall health and symptoms, were assessed relative to measures of general health perceptions, role (physical), role (emotional), pain, symptom severity and global measures of work and interference with regular activity. Multivariate linear regression models were used to explain the variance in work productivity and regular activity by validation measures. Data generated by interviewer-administration of the WPAI had higher construct validity and fewer omissions than that obtained by self administration of the instrument. All measures of work productivity and activity impairment were positively correlated with measures which had proven construct validity. These validation measures explained 54 to 64% of variance (p less than 0.0001) in productivity and activity impairment variables of the WPAI. Overall work productivity (health and symptom) was significantly related to general health perceptions and the global measures of interference with regular activity. The self-administered questionnaire had adequate reproducibility but less construct validity than interviewer administration. Both administration methods of the WPAI warrant further evaluation as a measure of morbidity. PMID- 10146876 TI - Roxithromycin vs cefaclor. PMID- 10146877 TI - Economic aspects of pharmacokinetic services. PMID- 10146875 TI - Cyclosporin: a pharmacoeconomic evaluation of its use in renal transplantation. AB - Cyclosporin is a powerful immunosuppressive agent which has markedly improved the outcome of renal transplantation, a technique now well established as the treatment of choice for patients with end-stage renal disease (ESRD). Comparison of cyclosporin-based regimens with a regimen of azathioprine and a glucocorticoid (conventional immunosuppression) indicates an improved clinical course and increased long term graft survival rate with cyclosporin which is most apparent in the recipients of a kidney from a living related donor (human leucocyte antigen mismatched) or cadaver donor source. Cyclosporin has also improved the clinical outcome in patient subgroups previously associated with a higher risk of graft failure with conventional immunosuppression, namely older patients and those with diabetes mellitus. Cost-of-treatment studies conducted over the first post-transplant year in the US have found that higher pharmacy charges with cyclosporin-based regimens are associated with lower hospitalisation charges and total billed charges compared with conventional immunosuppression. Lower hospitalisation charges reflect an improved post-transplant clinical course with cyclosporin and this has been associated with an improved quality of life in the recipients of a cadaver donor kidney. Longer term, the direct cost to society of using cyclosporin-based dual therapy (in combination with a glucocorticoid) may be higher than that with conventional immunosuppression, although the difference is likely to be small compared with the ongoing cost of dialysis. Clinical research continues to focus on modified regimens which maximise the clinical benefits of cyclosporin while minimising the associated adverse events, in particular the potential for nephrotoxicity. Sequential drug therapy (induction with globulin, azathioprine and a glucocorticoid followed by delayed administration of cyclosporin) has been associated with an improved clinical course compared with dual therapy, as well as cost containment to a level comparable to that for conventional immunosuppression. Compared with sequential therapy, triple drug therapy (cyclosporin, azathioprine plus a glucocorticoid) has been associated with a similar clinical course and lower acquisition cost during the first post-transplant year, although its overall impact on the longer term cost of transplantation has yet to be assessed. Elimination of cyclosporin from the immunosuppressive protocol of carefully selected patients can be safely achieved during the first post-transplant year. However, it remains to be established whether savings in the long term acquisition cost of immunosuppression are more than offset by the cost of treating a potentially less favourable clinical course.(ABSTRACT TRUNCATED AT 400 WORDS) PMID- 10146878 TI - Novel monoclonal antiendotoxin antibody therapy: efficacy at any price? PMID- 10146879 TI - Economic and quality-of-life aspects of treating small cell lung cancer. PMID- 10146880 TI - Decision analysis in formulary decision making. AB - Although decision making about what drugs to include in an institutional formulary appears to lend itself readily to quantitative techniques such as decision analysis and cost-benefit analysis, a review of the literature reveals that very little has been published in this area. Several of the published decision analyses use non-standard techniques that are, at best, of unproved validity, and may seriously distort the underlying issues through covert under counting or double-counting of various drug attributes. Well executed decision analyses have contributed to establishing that drug acquisition costs are not an adequate measure of the total economic impact of formulary decisions and that costs of labour and materials associated with drug administration must be calculated on an institution-specific basis to reflect unique staffing patterns, bulk purchasing practices, and the availability of surplus capacity within the institution which might be mobilised at little marginal cost. Clinical studies of newly introduced drugs frequently fail to answer the questions that weigh most heavily on the structuring of a formal assessment of a proposed formulary acquisition. Studies comparing a full spectrum of therapeutically equivalent drugs are rarely done, and individual studies of particular pairs of drugs can rarely be used together because of differences in methodology or patient populations studied. Gathering of institution-specific economic and clinical data is a daunting, labour-intensive task. In many institutions, incentive and reward structures discourage behaviour that takes the broad institutional perspective that is intrinsic to a good decision analysis.(ABSTRACT TRUNCATED AT 250 WORDS) PMID- 10146881 TI - The economics of smoking: an overview of the international and New Zealand literature. AB - The majority of work to date on the costs of smoking has focused on the enumeration of direct medical care costs. Published estimates of excess medical care expenditure attributable to smoking range from $US54 to $US1058 per smoker per year (1990 prices). Most of these studies used a cross-sectional approach to costing, however consensus increasingly favours the 'life cycle' approach to estimating the costs of cigarette smoking. The life cycle approach to costing consists of tracking all expenditures associated with smoking over the individual's lifetime. The purpose of taking this approach is to separate out the opposite impacts on medical care expenditures of higher utilisation and higher mortality. Thus, in a cross-sectional costing approach, smokers always appear to incur higher medical care costs. Using the 'life cycle' methodology, however, some of the higher medical care costs of smokers are offset by their shorter life expectancy. The policy question is whether smoking is associated with higher healthcare expenditures over the lifetime. The conclusion from studies that have adopted the 'life cycle' approach have been inconsistent. One of the earliest studies, based on Swiss data, concluded that the lifetime medical care costs for a cohort of nonsmokers was equivalent to the costs of providing care for a society of smokers. This conclusion was based on the finding that nonsmokers lived longer than smokers and used medical services more heavily during the last years of their lives.(ABSTRACT TRUNCATED AT 250 WORDS) PMID- 10146882 TI - Ondansetron: costs and resource utilisation in a US teaching hospital setting. AB - A retrospective pharmacoeconomic analysis was conducted to compare lengths of hospital stay for, and usage of hospital resources by, patients (850 admissions) who received either ondansetron or standard antiemetic therapy during hospital admissions for cancer chemotherapy. Average hospital costs for patients admitted to a 720 bed academic medical centre for maintenance chemotherapy between October 1990 and September 1991 were analysed using the hospital's online computerised clinical financial management system. A separate prospective time-and-motion study was used to evaluate specific costs of nursing care associated with episodes of severe nausea and vomiting. In addition, patient perception of quality of life and satisfaction with therapy were evaluated for 27 chemotherapy patients using quality-of-life measurements on the Functional Living Index-Cancer (FLIC) scale. The results of these studies showed that the average length of hospital stay was shorter for patients who received ondansetron rather than standard antiemetic therapy, but that average hospital costs were not significantly different. The reduced hospitalisation costs offset the higher acquisition cost of ondansetron. Mean quality-of-life scores decreased significantly after chemotherapy for patients receiving either ondansetron or standard therapy, but the changes in scores were not strongly associated with the antiemetic agents used or with any of the clinical or demographic variables measured in this study. PMID- 10146883 TI - Omeprazole: a pharmacoeconomic evaluation of its use in duodenal ulcer and reflux oesophagitis. AB - Omeprazole regulates gastric acid secretion and is an effective treatment of acute duodenal ulcer and reflux oesophagitis, achieving more rapid healing and symptomatic relief than histamine H 2-receptor antagonists. When administered as maintenance therapy, omeprazole reduces the incidence of relapse. The drug is also highly effective in patients poorly responsive to histamine H 2-receptor antagonists. The daily acquisition cost of omeprazole is higher than that of histamine H 2-receptor antagonists in many countries, and thus it is important to evaluate the pharmacoeconomic impact of omeprazole in the short and long term treatment of duodenal ulcer and reflux oesophagitis. Pharmacoeconomic analyses have been performed in several clinical settings using pooled data from clinical trials or simulated models of clinical practice. In a single analysis using Finnish cost data, omeprazole was more cost effective than ranitidine in the treatment of duodenal ulcer disease over a 6-month period. The cost effectiveness of omeprazole was comparable to that of sucralfate-containing regimens, with patients receiving omeprazole being healed more quickly and experiencing a greater number of healthy days. Using a computer-model simulation and Swedish cost data, omeprazole was more cost effective than ranitidine when administered as intermittent treatment of duodenal ulcer over 5 years. Preliminary reports indicate that regimens which eradicate Helicobacter pylori are more cost effective than those which do not. As short term treatment of reflux oesophagitis, omeprazole 20 to 40 mg/day was the dominating treatment strategy, being less costly and more effective than ranitidine 300 to 1200 mg/day. Omeprazole 20 mg/day produced symptom-free days more cost effectively than either cimetidine 1.6 g/day or ranitidine 300 mg/day. More importantly, as long term (maintenance or intermittent) treatment of reflux oesophagitis, omeprazole 20 mg/day was more cost effective than both ranitidine 150 mg twice daily and 'phase 1' therapy (diet and antacids) over 6 and 12 months. Thus, based on analyses evaluated, omeprazole appears to be more cost effective than ranitidine in the short term treatment of duodenal ulcer. Results for long term treatment are less clear cut, but full details from some studies are not yet available. For the short term treatment of reflux oesophagitis omeprazole is more cost effective than ranitidine or cimetidine and for long term treatment omeprazole is more cost effective than ranitidine. As treatment for reflux oesophagitis, omeprazole is considered to be the dominating treatment strategy. PMID- 10146884 TI - Sequential antimicrobial therapy: a realistic approach to cost containment? PMID- 10146885 TI - The reliability of cost-utility estimates in cost-per-QALY league tables . PMID- 10146886 TI - Guidelines for economic analysis of pharmaceutical products: a draft document for Ontario and Canada. AB - In Canada, provincial formulary review committees consider the effectiveness, safety, and cost of products when they derive advice for each Minister of Health. This article offers a draft set of guidelines for pharmaceutical manufacturers making submissions which include economic information, moving beyond a simple presentation of the unit price of the pharmaceutical product (e.g. price per day or course of therapy) and comparison to similar prices for alternative products. A full economic analysis compares all relevant costs and clinical outcomes of the new product with alternate therapeutic strategies for treating patients with a particular condition. The perspective of the decision maker must be clearly identified. The quality of the evidence supporting estimates of the variables incorporated in the analysis should be evaluated. Sensitivity analyses are used to assess the robustness of the qualitative conclusions. Reviewers will examine the answers to a set of 19 questions. Manufacturers can use these questions as a worksheet for preparation of an economic analysis to be incorporated in a submission. These guidelines are intended to be a starting point for further refinement, and discussion with health economists in industry and academia. Considerable flexibility will be used in reviewing documentation supporting economic analysis. Those preparing submissions should be encouraged to experiment with various approaches as part of the general development of this field and to engage provincial review committees in ongoing discussions. PMID- 10146887 TI - Cost effectiveness of surfactant replacement in preterm babies. AB - Surfactant replacement in preterm babies has been shown in recent years in randomised controlled trials to be an effective treatment for respiratory distress syndrome (RDS). It is expensive and, because it increases survival, it has implications for the costs of neonatal services. We used evidence about resource use obtained from trials of surfactant and other studies on the economics of surfactant to assess the cost effectiveness of different policies for its use. For the smallest babies, surfactant is likely to increase overall costs of neonatal care, but also to reduce the ratio of costs to survival, whether surfactant is given prophylactically or as a treatment for established RDS. It is less clear what the optimal policy should be for babies of more than around 31 weeks' gestation. Comparison of the relative cost effectiveness of policies of early prophylactic surfactant and surfactant for later treatment of RDS, and of different dosage policies, is currently being conducted in the context of 2 large multicentre trials. No policy for surfactant use should be considered in isolation from the availability of effective obstetric interventions which have been shown to reduce the risk of RDS in preterm babies and which will therefore reduce the need for surfactant. PMID- 10146888 TI - Time preference for health gains versus health losses. AB - The purpose of this research was to determine whether people devalue further health gains differently from future health losses. 108 subjects in various states of health were randomised to groups that rated their preference for a hypothetical health gain or loss of variable duration and delay, in the condition of arthritis. Direction and duration of the hypothetical future health change had an interactive effect on time preference (p less than 0.001). For the health gain, devaluation due to delay was consistent across durations. For the health loss, devaluation depended on duration; the long-duration loss was devalued with delay while the fleeting loss was inflated. These findings cast doubt on the assumptions of positive time preference and constant rate discounting that underlie the classical model of discounting. They provide support for a theory of intertemporal choice which posits that vivid, fleeting, future events engender 'anticipation utility' which attenuates positive time preference. Our findings suggest that standard practices for discounting future health outcomes in economic evaluations of arthritis and possibly other conditions may need to be re examined. PMID- 10146889 TI - Effects of ACE inhibitors on heart failure in The Netherlands: a pharmacoeconomic model. AB - A modelling approach is used to analyse the cost effectiveness of prescribing angiotensin converting enzyme (ACE) inhibitors, compared with standard practice, as first-line therapeutic agents in the treatment of heart failure in The Netherlands. Data concerning costs, incidence, prevalence and survival are used to construct an age-dependent semi-Markov-chain model. Two scenarios are compared. The first reflects the continuation of common practice. The second, containing assumptions made on the basis of results from randomised clinical trials, reflects the situation in which ACE inhibitors are given as first-line pharmacotherapy. Conditional on the estimates and assumptions made, it is shown that prescribing ACE inhibitors as first-line pharmacotherapy will improve survival by about 4% over the first 10 years, and will save about 17% in costs over the first 10 years. Sensitivity analysis shows the robustness of the conclusions to all major parameters. PMID- 10146891 TI - QALY league tables revisited. PMID- 10146890 TI - Oral ciprofloxacin: a pharmacoeconomic evaluation of its use in the treatment of serious infections. AB - The broad spectrum of antibacterial activity and favourable pharmacokinetic profile of ciprofloxacin permit oral treatment of many serious infections which have traditionally necessitated parenteral antibacterial therapy. This has been demonstrated in comparative studies, in which ciprofloxacin was as effective and well tolerated as standard parenteral therapies (usually aminoglycoside/beta lactam combinations or broad spectrum cephalosporins) in small numbers of patients with infections of the lower respiratory tract, urinary tract, skin and soft tissue, and bones and joints. Oral ciprofloxacin is considerably less expensive than most parenteral therapies, does not necessitate therapeutic drug monitoring and can be administered on an outpatient basis. In addition, administration by the oral route is more comfortable and convenient for the patient. Pharmacoeconomic studies have confirmed that substitution of oral ciprofloxacin for parenteral therapy in the treatment of serious infections can achieve considerable savings in drug acquisition costs, and labour and supplies associated with parenteral drug administration, and may allow early discharge from hospital, resulting in even greater savings. Mean reductions of 43 to 83% were achieved in antibacterial costs in 3 randomised prospective studies, when patients received oral ciprofloxacin instead of various parenteral agents, from the beginning of treatment, or after 3 days' parenteral therapy. It can be concluded that oral ciprofloxacin offers considerable scope for cost avoidance when appropriately substituted for parenteral therapy in the treatment of serious infections. PMID- 10146892 TI - Economic costs of theophylline toxicity. PMID- 10146893 TI - Costing and funding of healthcare in Australia: pharmaceuticals in context. PMID- 10146894 TI - Clinical and economic factors in the selection of low-osmolality contrast media. AB - Both high- and low-osmolality contrast media are available for most radiographic procedures requiring iodinated contrast material. Newer low-osmolality contrast media cost much more than conventional high-osmolality formulations but cause fewer adverse reactions. However, most of these reactions are mild and easily treated, and do not affect the outcome of the procedure. Whether these additional clinical benefits justify the added cost is a crucial question which has not been answered. This review introduces some of the economic and clinical issues on which the choice of contrast media should be based. Low-osmolality contrast agents are not cost effective considering current pricing strategies and current inability to select patients at increased risk of an adverse event. Therefore, a better understanding of these adverse events and their mechanism takes on added importance. PMID- 10146895 TI - Systemic therapy in breast cancer: efficacy and cost utility. AB - Cancer treatment accounts for a large proportion of healthcare costs. Often, new treatment modalities provide benefits, but at high costs. The impression that cancer treatment is expensive is enhanced by publicity surrounding treatments like bone marrow transplantation. There is a need to evaluate costs of different treatment approaches and to address the cost utility of cancer treatment in general compared with therapies for other conditions. Breast cancer can serve as a good model for economic evaluation of cancer treatment because of the broad range of treatment options and objectives it encompasses, and also because well defined benefits can be achieved. The cost utility of contemporary adjuvant therapy strategies, specifically chemotherapy in premenopausal women and hormonal treatment in estrogen-receptor (ER) positive pre- as well as postmenopausal women, seems favourable. Cost-utility ratios {cost per quality-adjusted life year (QALY) gained} range from $US4000 to $US10 000. However, hormonal treatment in ER-negative women may be associated with cost-per-QALY ratios of $US50 000 to $US200 000. So far there are no published cost-utility analyses of neo-adjuvant therapy or adjuvant bone marrow transplantation as the long term effects of these treatment options are undefined. Few data exist on cost utilities of systemic drug treatment in advanced breast cancer, although drugs may account for only a moderate part of the total treatment and caring costs. Bone marrow transplantation in patients with metastatic breast cancer costs about $US100 000 per QALY, which is expensive. PMID- 10146896 TI - Formulary management of antiulcer drugs: clinical considerations. AB - Peptic ulcer disease (PUD) is thought to result from an imbalance between aggressive (excessive) {especially gastric acid and pepsin} and protective (diminished) factors (gastric mucus and bicarbonate, prostaglandins and others) in the stomach. Recent attention has focused on the role of Helicobacter pylori as a cause of chronic active gastritis and a pathogenic factor in PUD. Antiulcer medications with proven efficacy in the treatment of acute PUD include histamine 2 (H 2)-receptor antagonists, H +/K +-ATPase (proton pump) inhibitors, antacids, sucralfate and prostaglandin analogues. The advent of proton pump inhibitors in particular has resulted in effective therapy for ulcers that previously would have been considered refractory. H 2-receptor antagonists and sucralfate are also useful for maintenance therapy of PUD. Recent interest has focused on strategies aimed at eradicating H. pylori and the ensuing change in the natural history of PUD, specifically a marked decrease in ulcer recurrence. In contrast, with standard treatment regimens there is a high rate of ulcer relapse (50 to 90%) after acute ulcer healing. Eradication of H. pylori has until now required a triple drug regimen of bismuth and 2 antibiotics, and is too cumbersome for routine use. It is likely, however, that treatment aimed at eradicating H. pylori will be routine in the near future and will represent a cost-effective alternative to standard long term maintenance therapy. PMID- 10146897 TI - Cost and cost-effectiveness analysis of ondansetron versus metoclopramide regimens: a hospital perspective from Italy. AB - In a large double-blind study of antiemetic therapy conducted in Italy, 289 patients underwent 3 consecutive cycles of cisplatin chemotherapy. Antiemetic treatment with ondansetron plus dexamethasone was more efficacious and better tolerated, but also more expensive, than treatment with metoclopramide plus both dexamethasone and diphenhydramine. To evaluate the different costs of the 2 antiemetic regimens, we conducted a retrospective cost-effectiveness analysis from a hospital perspective. Direct costs of antiemetic therapy (acquisition cost of drugs, materials and time spent by nurses to prepare and administer therapies), cleanup after emesis, rescue medication and adverse events were evaluated. Antiemetic drug acquisition costs per patient were 5.23-fold higher for the ondansetron regimen than for the metoclopramide regimen. However, when the costs of materials and nursing time required to prepare and administer the antiemetic regimens were included, this ratio was 3.77. Furthermore, including the cost of emesis, rescue antiemetic treatments and medication used to treat adverse events, hospital costs per patient were 3.21-fold higher with the ondansetron regimen during the first cycle, 3.08-fold higher during second cycle and 2.89-fold higher during third cycle of chemotherapy. Complete protection from vomiting and from both vomiting and nausea with ondansetron occurred, respectively, in 78.7 and 69.1% of patients in the first cycle, 73.8 and 57.3% in the second cycle, and 74.2 and 58.1% in third cycle of chemotherapy. Corresponding figures for the metoclopramide regimen were 59.5 and 50.4%, 53.6 and 37.1%, and 46.8 and 27.3%, respectively. Thus, the cost per successfully treated (completely protected) patient was 2.43- and 2.34-fold higher, respectively, for ondansetron at the first cycle, 2.23- and 1.99-fold higher, respectively, at second cycle, and 1.82- and 1.36-fold higher, respectively, at third cycle. In conclusion, the study demonstrates that, while ondansetron has a greater acquisition cost than metoclopramide, the ondansetron regimen costs per successfully-treated patient substantially decrease when all direct hospital costs are taken into account. PMID- 10146898 TI - A new method of estimating cost effectiveness of cholesterol reduction therapy for prevention of heart disease. AB - The purpose of this study was to demonstrate a new method of estimating the cost effectiveness of interventions that lower blood cholesterol levels in the prevention of coronary heart disease (CHD) at the community level. The participants in the study were 67 651 men aged 35 to 64 years in the Lower Hunter region of New South Wales, Australia. Census data, risk factor profiles and CHD event rates from community surveillance, plus costs in 1988-1989 Australian dollars, were used as inputs to a computer program that used a logistic equation. The output estimated the CHD events avoided and the cost effectiveness of an intervention that identified and treated men with cholesterol levels greater than 6.5 mmol/L with dietary modification and cholestyramine. The cost of implementation of the intervention was $A50.1 million to prevent 104 CHD events. The cost-effectiveness ratio was $A482 224 per CHD event avoided (SD = $A24 761) and the direct medical costs avoided were approximately $A500 000 over a 5-year period ($A4535.07 per CHD event avoided). Drug acquisition costs contributed substantially (88%) to the total costs of interventions that rely on screening to identify individuals with high cholesterol for intensive treatment. PMID- 10146899 TI - Cost utility of maintenance treatment of recurrent depression with sertraline versus episodic treatment with dothiepin. AB - The objective of this study was to model, for patients at risk of recurrent depression, the cost-utility of maintenance therapy with sertraline compared with treatment of acute episodes with dothiepin ('episodic treatment'). Using clinical decision analysis techniques, a Markov state-transition model was constructed to estimate the lifetime costs and quality-adjusted life-years (QALYs) of the 2 therapeutic strategies. The model follows 2 cohorts of 35-year old women at high risk for recurrent depression over their lifetimes. Model construction and relevant data (probabilities) for performing the analysis were based on existing clinical knowledge. Two physician panels were used to obtain estimates of recurrence probabilities not available in the literature, health utilities, and resource consumption. Costs were obtained from published sources. The baseline analysis showed that it costs 2172 British pounds sterling ($US3692, 1991 currency) to save an additional QALY with sertraline maintenance treatment. Sensitivity analysis showed that the incremental cost-utility ratio ranged from 557 British pounds sterling to 5260 British pounds sterling per QALY. Overall, the resulting ratios are considered to be well within the range of cost-utility ratios that support the adoption and appropriate utilisation of a technology. Based on the study assumptions, long term maintenance treatment with sertraline appears to be clinically and economically justified choice for patients at high risk of recurrent depression. PMID- 10146900 TI - Cost effectiveness of hepatitis B immunisation strategies. PMID- 10146901 TI - Benefits versus profits: has the orphan drug act gone too far? PMID- 10146902 TI - Is there a need for an independent centre for pharmacoeconomics in the UK? PMID- 10146903 TI - Quality of life of patients receiving home parenteral or enteral nutrition support. AB - Limited data are available on the impact of enterally or parenterally supplied home nutritional support on quality of life. Data from national registries have been useful in identifying the outcome of different patient groups in terms of their functional capacity and rehabilitation status. Results in patients with inflammatory bowel disease are used as the 'gold standard' for this type of therapy. The annual cost of home parenteral nutrition can range from $US100 000 to $US150 000 per patient, depending on the frequency of feeding. Only one cost utility analysis has been reported in the literature, based on a Canadian home parenteral nutrition programme which suggested that the estimated quality adjusted survival of patients receiving this treatment is 4 times greater than if they had not been treated. There are many controversial areas associated with the use of home parenteral and enteral nutrition, including the treatment of patients with terminal malignant disease or severe dementia, and those infected with human immunodeficiency virus. To date, the clinical benefit of providing this type of nutritional support for these patient groups has not been clearly demonstrated. Prospective randomised controlled trials are necessary to evaluate the costs and benefits of this expensive high technology treatment. PMID- 10146905 TI - Economic assessment of drugs in Spain. AB - In order to assess the characteristics and influence on healthcare decision making of the economic assessment of drugs in Spain, pharmacoeconomic studies carried out between 1982 and 1992 were examined. We identified and analysed 16 pharmacoeconomic studies. The commonnest type of economic assessment was cost effectiveness analysis. Only one study included measures of health-related quality of life. Only one study was carried out in conjunction with a controlled clinical trial. Evidence of influence on decision making was found in 6 studies. Two studies implemented hepatitis vaccination programmes, one set up a telephone follow-up of antituberculosis chemoprophylaxis, one developed the official procedures for using epoetin (recombinant human erythropoietin), one initiated clinical discussion meetings about the cost effectiveness of cholesterol-lowering therapy, and one strengthened the decision to register nebacumab (HA-1A, Centoxin), the monoclonal antibody against endotoxin. The quality of the studies was acceptable according to generally agreed checklists, although somewhat lower than those in other countries with longer traditions in this field. Improvement of the scientific quality of the studies and an increased use of the results for decision making need to be promoted. At present the number of studies of economic assessment of drugs in Spain is low, as is the influence of these studies on healthcare decision making. The movement of the Spanish healthcare authorities towards a selective drugs funding policy is likely to increase the number of studies and their impact on healthcare decision making. PMID- 10146904 TI - Health and healthcare costs and benefits of exercise. AB - To assess the value of promoting health through exercise, we review what is known about the medical and medical care resource costs and benefits of exercise. Literature searches were undertaken to derive estimates of the relative risk, in individuals who exercise regularly compared with those who do not, of each of the major disease groups for which there is good evidence that the disease can be ameliorated by exercise (coronary heart disease, stroke, diabetes, hip fracture, and mental illness). These relative risks were used to estimate the incidence of hospital admissions and mortality, and associated healthcare costs, which could be prevented if the whole population exercised. Literature on the incidence and costs of exercise-related morbidity and mortality was also reviewed to derive estimates of both the costs to health and also the healthcare resource implications of exercise in total population. Indirect costs and benefits, and also quality-of-life effects associated with exercise were not included in this assessment. The results show that in younger adults (ages 15 to 44 years) the average annual medical care costs per person that might be incurred as a result of full participation in sport and exercise (approximately 30 pounds British sterling) exceed the costs that might be avoided by the disease-prevention effects of exercise ( less than 5 pounds British sterling per person). However, in older adults ( greater than or equal to 45) the estimated costs avoided ( greater than 30 pounds British sterling per person) greatly outweigh the costs that would be incurred ( less than 10 pounds British sterling). There was little evidence that exercise leads to deferred health or health service resource benefits. We conclude that with regard to health and medical care costs, there are strong economic arguments in favour of exercise in adults aged greater than or equal to 45 but not in younger adults. Estimates derived from the international scientific literature and routine UK data sources may have limited direct application in the healthcare systems of other countries. Nevertheless, the result that exercise costs exceed the benefits in younger adults but vice versa in older people is likely to be generally true. Indeed, a similar result has been found in a study of a Dutch population. PMID- 10146906 TI - Medical cost savings from pentoxifylline therapy in chronic occlusive arterial disease. AB - This article assesses the direct medical cost savings associated with therapeutic dosages of pentoxifylline therapy compared with lower dosages in treating chronic occlusive arterial disease (COAD). The savings accrue from elimination of invasive diagnostic measures or a number of surgical procedures received by patients with COAD during hospital admissions. Findings are based on a secondary analysis of results presented in a previously published report of a population based historical cohort study. Patients in this study were severely enough afflicted by the disease that most were under the care of vascular specialists and many underwent surgery to restore normal blood flow. Costs are based on charges from Medicare expenditures in 4 US states in 1989. A case-mix adjustment procedure was applied and a sensitivity analysis was conducted on key assumptions and variables in the cost savings model. Pentoxifylline therapy reduced average hospital costs per patient by $US1173 per year (1989 dollars). After further adjustment for the costs of outpatient visits, other related drugs and the drug acquisition cost, an overall saving of $US965 would still be realised with a patient who received the full therapeutic dose of pentoxifylline. Sensitivity analysis suggests total annual direct medical cost savings between $US69 and $US3090 per patient. Hence, under the most plausible assumptions regarding choice of procedures, study design and patient population, and considering the possibility that diagnostic and surgical costs are delayed but not prevented, pentoxifylline therapy substantially reduces direct medical costs. PMID- 10146907 TI - Hepatitis B vaccine: a pharmacoeconomic evaluation of its use in the prevention of hepatitis B virus infection. AB - Worldwide, hepatitis B virus (HBV) infection is a major cause of acute and chronic hepatitis, cirrhosis and hepatocellular cancer. Infants and children are at the greatest risk of becoming chronically infected with HBV, and therefore at the greatest risk of developing long term sequelae. Immunisation against HBV represents an important means of controlling the disease. Hepatitis B vaccines are effective in preventing HBV infection and are well tolerated. In addition, they are suitable for integration into mass neonatal vaccination programmes. While there are considerable economic data concerning hepatitis B vaccination, differing methodologies and end-points present a challenge in reviewing these studies for consistent findings. Immunisation strategies should be implemented in accordance with local area disease incidence and patterns of HBV transmission, and will be influenced by regional budgetary constraints. In conclusion, universal neonatal vaccination is both cost effective and appropriate for control of HBV infection in regions of medium or high endemicity. In low endemicity areas, selective vaccination of high-risk groups is cost effective, but its impact on the incidence of HBV infection will depend on the ability to reach these groups. Expanded vaccination strategies may be appropriate where local conditions prohibit efficient access to high-risk groups. PMID- 10146908 TI - High technology drugs for cancer: the decision process for adding to a formulary. PMID- 10146909 TI - The cost effectiveness of drug utilisation review in an outpatient setting. AB - Drug utilisation review (DUR) has been adopted as a mechanism for balancing cost containment and quality in prescription drug programmes. In this article we review published DUR reports in order to examine the cost effectiveness of DUR in an outpatient setting. DUR reports are defined either as DUR studies, which examine patterns of drug use, or as DUR programmes, which examine patterns of drug use and subsequent efforts to alter drug use. An adequate cost effectiveness analysis (CEA) is defined as one that used multiple methods to measure and evaluate patterns of drug use, and/or efforts to alter drug use, and that also performed an analysis of the costs of the review or intervention methods employed, with a focus on efficiency. DUR studies and programmes that satisfied all the criteria and thus fit the framework for conducting CEA were included; others that satisfied only some of the criteria were examined for the insights that they could contribute to a study of costs relative to outcomes. We identified 14 reports that could be categorised as DUR studies. Only 3 of these examined more than 1 method of measuring and evaluating drug use, thereby potentially fitting the CEA framework, but none included a cost analysis. Of the other DUR studies, only 1 contained estimates of costs for the DUR method employed, but since it examined only 1 DUR method it did not satisfy the criteria for an adequate CEA. Although such studies provide information about different methods of identifying drug use patterns (a somewhat intermediate outcome), they do not provide insight into the cost effectiveness of methods designed to influence drug use. We identified 34 reports of DUR programmes. Only 5 of these reports fit the CEA framework; they examined multiple efforts to change drug use patterns (after identifying drug use patterns). None of them satisfied the criteria for an adequate CEA; in 3 of the reports no costs were provided, and the other 2 provided only partial input costs or costs for only some of the interventions designed to change drug use. DUR programmes were grouped by drug or drug use issue in an attempt to gain insights by comparing reports on similar drugs. The drugs or drug classes and number of reports reviewed were: cephalosporins (3); chloramphenicol (3); antiulcer drugs (2); dextropropoxyphene (2); tranquillisers (benzodiazepines) {3}; anti-infective agents (5); 'all drugs' (7); and other drugs/miscellaneous (9).(ABSTRACT TRUNCATED AT 400 WORDS) PMID- 10146910 TI - Drug utilisation in preterm and term neonates. AB - Drug utilisation in term and preterm neonates (i.e. less than 28 days of age) has been investigated prospectively in 4 clinical studies during the past 10 years. 3880 neonates with a mean gestational age of 34.5 weeks (corresponding birthweight 2280g) were enrolled in these studies. An overview indicates a high prevalence of antibiotic treatment throughout the studies, ranging from 69% to virtually 100%. The highest prevalence was observed in studies enrolling only preterm neonates (gestational age less than 30 weeks) with need for mechanical ventilation. A further high prevalence of parenteral nutrition (84 to 100%), transfusion of blood products (91 to 100%) and vitamin use (16 to 78%) was described. Higher degrees of immaturity and rates of complications were associated with an increased drug usage up to a mean of 17 different drugs in very preterm (i.e. less than or equal to 30 weeks gestation) neonates with severe respiratory disorders and related complications. The high prevalence of antibiotic usage may be explained by the fact that clinical symptoms of neonatal bacterial infections are usually variable, and laboratory tests initially are not highly specific. Respiratory disorders in neonates are often associated with or caused by infections. Nosocomial infections in neonatal intensive care units further prompt administration of antimicrobial agents. Six prospective controlled clinical trials during the past 10 years have investigated treatment with dexamethasone of bronchopulmonary dysplasia, a chronic lung disease secondary to mechanical ventilation of surfactant-deficient lungs in very preterm neonates.(ABSTRACT TRUNCATED AT 250 WORDS) PMID- 10146911 TI - Indirect costs in economic studies: confronting the confusion. AB - Indirect costs of disease often constitute a substantial part of estimated costs or savings in economic evaluations of healthcare programmes. The human capital approach is almost unanimously used for estimating indirect costs, defined as production loss due to disease, although a growing number of authors question its validity. This article discusses the relevance of indirect cost estimates for health policy and reviews the current empirical and methodological literature on this issue. It describes several important issues and controversies regarding indirect costs, such as the consequences of short term absence from work for productivity, reduced productivity without absence from work, the influence of unemployment on production loss, the relation between health effects and indirect costs, and the possible medium term macroeconomic consequences of absence from work and disability. It concludes that indirect costs are relevant for health policy, provided that the estimates of indirect costs reflect the real changes in production due to disease, including the production of unpaid labour. Future research should focus on attaining these estimates. Indirect costs in economic evaluations should preferably be presented separately from direct costs, health effects and other study outcomes. PMID- 10146912 TI - Identifying drug usage patterns in the intensive care unit. PMID- 10146913 TI - Developing the QALY concept: exploring the problems of data acquisition. PMID- 10146914 TI - Methodological aspects of international drug price comparisons. AB - Drug prices have become an important issue in the last few years as concerns about constrained healthcare resources have increased. Healthcare authorities in all industrialised countries are questioning whether their country is carrying a heavier burden than others in paying for drugs. In view of this discussion, several price comparison studies have been conducted. However, there is no generally accepted methodology on how to conduct price comparisons, and many methodological issues remain unresolved. The results of most published studies are affected by moderately serious methodological flaws, which are never properly addressed. The purpose of this study is to discuss the methodological issue of international drug price comparison, in terms of 6 points that appear to this author to be necessary to conduct a methodologically sound study. A previous review of a large number of drug price comparisons revealed that they all fail to take into account some or all of these 6 basic methodological points. Studies that fulfil the methodological criteria outlined in this paper are therefore urgently needed before drug pricing studies can be fully utilised as a basis for important policy decisions in the healthcare arena. PMID- 10146915 TI - Cost effectiveness of inhaled corticosteroid plus bronchodilator therapy versus bronchodilator monotherapy in children with asthma. AB - In an incremental cost-effectiveness analysis, combined inhaled beta 2-receptor agonist plus inhaled corticosteroid therapy (BA + CS) was compared with inhaled beta 2-agonist plus placebo (BA + PL) in 116 asthmatic children aged 7 to 16 years. Clinical data have been reported previously. To account for the selective withdrawal rate due to pulmonary problems that occurred in the group receiving BA + PL, costs were calculated using 2 approaches: (1) the cumulative cost approach and (2) the patient-year approach. Besides improvements in forced expiratory volume in 1 second (FEV 1) and airway responsiveness expressed as the provocative dose of histamine required to give a 20% fall in FEV 1 (PD 20), the frequency of asthma symptoms and school absenteeism were significantly reduced in the BA + CS group. Annual drug acquisition costs for the group receiving BA + CS were NLG480 higher than for the BA + PL group ($US1 = NLG2.12, 1989 prices). Based on conservative calculations using the cumulative cost approach, annual savings due to reduced healthcare utilisation, excluding the cost of study drugs, by the group receiving BA + CS compared with BA + PL were estimated to be about NLG273 per patient. The incremental cost effectiveness of BA + CS was estimated to be about NLG175 per 10% increase in FEV 1, or somewhat less than NLG10 per symptom-free day gained. The patient-year approach estimated savings due to corticosteroids of about 43% of the costs of BA + PL (95% confidence intervals, 21 to 58%). Savings were larger when the indirect costs that a family incurred during school absenteeism were considered. Addition of an inhaled corticosteroid to an inhaled beta 2-receptor agonist is a cost-effective treatment option that could even result in net healthcare savings. PMID- 10146916 TI - Survey of wastage from intravenous admixture in US hospitals. AB - The purpose of this study was to assess current wastage from intravenous systems designed for intermittent use in US hospitals. Questionnaires were mailed to pharmacy directors at 1393 randomly selected hospitals. Respondents were asked to indicate their overall percentage intravenous wastage rate, intravenous admixture policies and procedures, and wastage rates for currently used intermittent intravenous drug delivery systems. If actual data were not available, respondents were asked to provide estimates based on their perceptions of waste. A total of 237 (17.0%) usable responses were returned. The mean intravenous wastage was 2.85% (+/- 3.40) for respondents who provided actual values and 4.28% (+/- 3.83) for respondents who provided estimated values. Lower mean wastage rates were found for hospitals which: (a) received written notification of discontinued intravenous systems; (b) had an elapsed time of less than or equal to 1 hour from discontinuation of the intravenous system to notification in the pharmacy; (c) actively retrieved discontinued intravenous systems from the nursing unit; and (d) had a daily return of discontinued intravenous systems to the pharmacy. Based on actual values provided by respondents, for 9 intravenous systems the mean wastage rates were lowest for commercially prepared intermittent systems such as frozen piggyback systems {1.5% (+/- 1.4)} and piggyback systems stored at room temperature {3.2% (+/- 5.2)}, and 4.4% (+/- 16.0) for nursing-activated ADD-Vantage systems. We expected that pharmacy managers would monitor waste regularly and be able to provide actual values for wastage rates. However, only 124 (53.3%) of the respondents provided actual data.(ABSTRACT TRUNCATED AT 250 WORDS) PMID- 10146917 TI - Cost effectiveness of beractant in the prevention of respiratory distress syndrome. AB - Beractant, a modified natural bovine surfactant extract, has been used successfully in the prevention of respiratory distress syndrome (RDS) in premature neonates. This analysis investigates the cost effectiveness of prophylactic surfactant therapy. Resource utilisation data were analysed retrospectively from 210 patients who had participated previously in a double blind, placebo-controlled clinical trial. No baseline differences were apparent between the beractant and sham-air control groups. There was a significant difference in survival favouring the beractant-treated neonates. When the acquisition cost of the study drug was excluded, there was an incremental, daily cost-savings benefit for the beractant-treated group compared with the sham-air treated group. Costs per case per day were significantly lower for neonates treated with beractant ($US1442 beractant vs $US1544 sham-air; 1991 dollars p = 0.01). Costs for radiological and diagnostic procedures, respiratory care and drugs (excluding beractant) were all significantly lower. When the acquisition cost of beractant was included, the cost to produce a 28-day survivor was $US3319 less with beractant ($US41 020) than with sham-air ($US44 339). Thus, when viewed in terms of costs per year of life saved, beractant compares very favourably with other recently evaluated health technologies. PMID- 10146918 TI - Idarubicin: a pharmacoeconomic evaluation of its use in adult patients with acute myeloid leukaemia. AB - Idarubicin is an effective agent in the treatment of acute myeloid leukaemia (AML), inducing complete remission in 39 to 80% of newly diagnosed patients. Although it also demonstrates efficacy as monotherapy, and is of use in relapsed or refractory disease, most comparative clinical trials have administered idarubicin intravenously in combination with cytarabine in newly diagnosed patients. These trials indicate that improved survival and response rates, and rapid achievement of remission, are more likely with idarubicin than with daunorubicin, when both agents are given in combination with cytarabine. In elderly patients, however, response rates are lower than in younger patients, and there is less disparity in efficacy between idarubicin and daunorubicin induction therapy. Although AML is an expensive disease to treat, the majority of costs are associated with the length of hospitalisation, with the acquisition cost of the chemotherapy agents contributing less than 10% to overall expenditure. Idarubicin combined with cytarabine therapy achieved higher response rates with the first cycle of therapy than daunorubicin, thereby reducing the requirements for a second cycle of therapy and further hospitalisation. Compared with daunorubicin plus cytarabine induction treatment, idarubicin plus cytarabine reduced the costs of achieving a complete response by between 22 and 39% in patients with a median age less than 60 years. In patients with a median age of 62 years, who are more representative of the AML population, costs of achieving a complete response were reduced by 3 to 6%. Thus, idarubicin is more cost effective than daunorubicin as induction therapy in combination with cytarabine, in adult patients with AML. The pharmacoeconomic position of idarubicin in postinduction therapy remains to be established. PMID- 10146919 TI - Determinants of hospital drug expenditures in Western Europe. PMID- 10146920 TI - Drug utilisation review and pharmacoeconomics: interaction after parallel development? PMID- 10146921 TI - Economic evaluation of pharmaceuticals: a European perspective. AB - In recent years there has been a large increase in the number of economic evaluations of pharmaceuticals. Many of these studies have been commissioned by individual pharmaceutical companies, in support of new or existing products. In 2 countries, Australia and Canada (in the province of Ontario), draft guidelines issued by the government have outlined the requirements for economic evaluations to be submitted in support of requests for reimbursement (government subsidy) of particular products. One consequence of the guidelines is that they clarify what is required, and in specifying the procedure for submission of dossiers, identify a clear audience for the economic evaluation. In contrast, the situation in Europe is diverse. A wide range of healthcare systems exist, including national health services and more liberal systems, involving a wide range of insurers and providers. European countries also differ widely in their approach to the pricing and reimbursement of pharmaceuticals. Because of this diversity, the nature, conduct and impact of economic evaluation in Europe is not clear. It is therefore difficult for pharmaceutical companies to develop appropriate strategies for economic evaluation and for analysts to decide on appropriate study methodology. This article reviews the nature of any official guidance or requirements for economic evaluation, the potential for use of economic evaluation, the range of studies carried out and the identifiable impacts. There is currently no official guidance in any country, although some countries are considering issuing guidelines. In some countries there is official encouragement to pharmaceutical companies to undertake studies, and where economic data have been presented they have been considered by the relevant committees. The potential uses of economic evaluation vary widely from country to country. These can be classified in terms of a potential role in undertaking national price negotiations, deciding on reimbursement status or copayment level, deciding on inclusion in local formularies or in treatment guidelines, or in improving prescribing decisions. Approximately 80 economic evaluations of pharmaceutical products have been conducted to date in Europe, covering a wide range of clinical areas. There are relatively few examples of identifiable effects of such studies. In part this is because it is often difficult to assess the part played by various items of data. Nevertheless, the overriding conclusion is that economic evaluation of medicines is likely to be more relevant in Europe in the future. The problem for the pharmaceutical industry is in determining when and how. PMID- 10146922 TI - Economic impact of cost-containment strategies in third party programmes in the US. Part II. AB - This is the second article in a 2-part series that examines the economic impact of several different strategies used to control costs in third party programmes. This article investigates 5 different methods: (a) formularies; (b) capitation; (c) drug utilisation review; (d) prior approval; and (e) drug product selection. The published literature indicates that use of formularies decreases drug expenditures, but these savings may be offset by expenditures in other areas of healthcare programmes. Capitation, though less well studied than other strategies, may show some effectiveness in reducing costs by increasing generic dispensing and promoting switching from prescription drug to over-the-counter. Drug utilisation review, as a systematic programme of claims data review, has been shown to yield positive economic return in a variety of areas, including both impersonal and face-to-face educational interventions with healthcare practitioners. Prior approval and drug product selection both result in savings when examined in isolation from other aspects of healthcare. Cost-shifting, administrative costs and costs incurred because of possible decreased access to care have yet to be fully accounted for. PMID- 10146923 TI - Cost analysis of imipenem-cilastatin versus clindamycin with tobramycin in the treatment of acute intra-abdominal infection. AB - Clinical effectiveness of imipenem/cilastatin (I/C) versus tobramycin with clindamycin (T + C) in treatment of patients presenting with suspected acute intra-abdominal infection was assessed in a multicentre randomised clinical trial conducted during 1985 to 1986. The principal finding was a lower incidence of treatment failure among patients in the I/C arm (p = 0.043). We now report results of retrospective analysis of hospital treatment costs during an episode of infection incurred by patients enrolled in the trial. Treatment costs (in 1989 US dollars) were calculated from a hospital perspective, using an intention to-treat analysis. Among 161 patients with low illness severity (APACHE II less than or equal to 14) the mean cost for the episode of care was $US7038 in the I/C arm versus $US8404 for the T + C regimen; the difference was not statistically significant (p = 0.40). For 93 more severely ill patients (APACHE II score greater than 14) the mean cost for the I/C arm was $US19 985 versus $US16 582 for the T + C regimen; the difference was not statistically significant (p = 0.36). Multiple regression analysis, controlling for patient demographics and study site, showed that the cost of the episode was positively associated with the severity of illness (p less than 0.01) and presence of malnutrition (p < 0.01), but that the total cost of the episode of infection was not statistically different for the 2 drug regimens (p = 0.45). PMID- 10146924 TI - Drug expenditure and new drug introductions: the Swedish experience. AB - This article measures the impact of the switch to new and more expensive drugs on the aggregate drug expenditure (both prescription and nonprescription) in Sweden during the period 1974 to 1991, and also on the disaggregated expenditure for 3 medical areas: asthma, hypertension and peptic ulcer disease. During the period studied, nominal drug expenditure increased 6-fold. The retail price index of drugs and the number of prescribed drugs accounted for 51.6 and 5.8% of this increase, respectively. The remaining residual amount accounted for 42.6%. Since the price index of drugs increased more slowly than the overall net price index of goods and services, the relative price of drugs decreased dramatically by about 30%. This means that increases in prices of drugs cannot explain the increase in real inflation-adjusted drug expenditure. We also show that the residual increase can be partly explained by the introduction of new and more expensive drugs. It is therefore argued that economic evaluations which compare the extra costs induced by new drugs with the extra benefits should be undertaken to guide decisions about the prescription of new and more expensive drugs. PMID- 10146925 TI - Price regulation, industry structure and innovation: an international comparison of pharmaceutical industries. AB - The home competitive environment has a powerful effect on companies -- shaping skills, strategies, and performance outside the home environment. Government industrial policies, such as pharmaceutical pricing regulations, affect companies primarily through shaping the nature of the home environment. Successful competitive environments (such as the UK) exhibit higher average drug prices and an internal structure of prices that favour significant innovators, discourage minor products, and provide a shield against foreign competitors. Poor competitive environments (such as France) exhibit low average prices and an internal price structure that favours weak local companies producing imitative or minor products. PMID- 10146926 TI - Rising research and development costs for new drugs in a cost containment environment. AB - The concurrence in recent years of mounting pressures to contain pharmaceutical expenditures in the United States and Europe, and rising research and development costs for new drugs, raises concerns about the future of new drug development. A recent study has shown that the research and development expenditures required to get new drugs to the marketplace are high and have been increasing rapidly. A random sample of 93 new chemical entities (NCEs) first tested in humans in 1970 to 1982 yielded an estimate for the cost per approved NCE of US$231 million in 1987 dollars. This estimate is more than double, in constant dollars, that of a previous study that used a similar methodology and covered a period roughly one decade earlier. The 2 studies were analysed to determine the components of the cost increase, and some of the more fruitful areas for future research on research and development costs are discussed. PMID- 10146927 TI - The reimbursement factor in pharmaceutical regulation: rebates, cost effectiveness, and practice guidelines. AB - The delivery of health care services in the United States is increasingly influenced by the coverage determinations of third-party payers. This paper reviews 3 specific initiatives recently undertaken by the federal government that relate directly or indirectly to reimbursement for pharmaceuticals. The 3 initiatives, involving new conditions of coverage and incorporating language and policies that signal broader changes for the future, are the Medicaid Prudent Pharmaceutical Purchasing Program enacted as part of the Omnibus Budget Reconciliation Act of 1990, the national coverage criteria proposed by the Health Care Financing Administration, and the Agency For Health Care Policy and Research with its mandate to oversee the development of clinical practice guidelines. PMID- 10146928 TI - US Medicaid drug formularies: do they work? AB - Does the use of a restricted drug formulary achieve cost savings within state Medicaid programmes? Restricted formularies are often justified by putting forth the attributes of a perfectly operating and implicitly costless policy. Analysis suggests, however, that the operation of 'actual' restricted formularies produce realised effects that are substantially at odds with the desired effects. Although the implementation of a restricted formulary can reduce a state's drug expenditures, service substitution causes expenditures to increase elsewhere in the system. Furthermore, direct savings in the drug budget are completely offset by these spillover effects. PMID- 10146929 TI - The effect of Medicaid formularies on the availability of new drugs. AB - This study expands our previous work on the availability of new drug introductions to poor patients in states in the USA with restrictive Medicaid formularies. In particular, it focuses on the experience of 9 states over the period 1979 to 1985. In these states, a typical new drug took 20 months after FDA approval to gain acceptance onto the Medicaid formulary. New drug introductions were available to Medicaid patients less than 40% of the time during their first 4 years of market life. Restrictions on availability also extended to drugs ranked high in terms of both therapeutic and commercial importance. There was substantial variation observed across states and therapeutic categories. While formularies are prohibited under legislation recently enacted by the US Congress, state governments may attempt to continue to restrict access to expensive new medicines through prior approval systems. This is an issue that warrants future attention and study. PMID- 10146930 TI - Clinical aspects of therapeutic substitution. AB - A variety of problems are associated with the operation, quality, costs, and benefits of therapeutic substitution programmes. Adequate communication of procedures, events, and failures are essential features of a safe therapeutic substitution policy. However, case reports of suboptimal therapy and differences in pharmacological profiles of related agents indicate the potential for clinical nonequivalence even between similar drugs of a class. Suboptimal or failed therapy associated with such nonequivalence may offset savings in drug costs resulting from therapeutic substitution. Thus, consultation on behalf of each patient is necessary for optimal therapy and maximum cost savings. Currently, there are no data on the interchangeability of specific agents of a class and the effects of therapeutic substitution on overall treatment costs. Thus, the health and economic outcomes of therapeutic substitution policies are unknown. PMID- 10146931 TI - Improving the quality and cost-effectiveness of prescribing. AB - The 1980s witnessed the evolution of a number of programmes designed to improve the quality and economy of medication use. In the approach known as 'academic detailing', the effective communications techniques of the pharmaceutical industry are employed in the service of programmes designed to promote rational medication use, rather than to maximise sales of a particular product. Using this method, a balanced, concise presentation of the best available current research and cost literature is put into an engaging, readable format, and presented to the physician in a one-on-one interactive educational session by a pharmacist. In randomised controlled trials in 5 states, this approach has been shown to be effective in reducing inappropriate prescribing; benefit-cost analyses have shown that it generates savings that exceed programme costs. On the other hand, the 1980s also saw the implementation of several alternative approaches to changing prescribing practice, often through crude bureaucratic measures uninformed by the realities of clinical practice. Many such policies have proven to be either ineffective or counterproductive clinically and/or economically. As the issue of drug utilisation review receives increasing attention in the 1990s, it will be important to assimilate the lessons of the last 10 years to design programmes in both the public and private sectors that will enhance the quality of drug therapy while containing its costs. PMID- 10146932 TI - Comparative potency and dissolution performance of internationally available piroxicam products. AB - Generic drug products are marketed throughout the world and are generally regarded as being equivalent to the name brand product. Piroxicam is a widely prescribed nonsteroidal anti-inflammatory drug and is marketed under the Pfizer tradename Feldene or Felden . In countries with no patent laws or where the Feldene patent has expired, the drug is available under various trademarks by many different producers. Differences in formulations produced by different manufacturers can be assessed by measuring dissolution rate and potency. In this study, the United States Pharmacopeia (USP) dissolution and potency tests were applied to 85 generic piroxicam products obtained from 21 countries in an attempt to evaluate if the available formulations met standard quality assurance tests. The results show that of the 85 piroxicam products tested, 17 products met the USP dissolution standards and 68 products failed. Of the 85 products tested for potency as a percentage of label claim, 50 products failed the USP criteria. Overall, 91% of the generic piroxicam products evaluated failed to meet the routine in vitro USP quality assurance criteria for potency and/or dissolution. The substantial differences observed in this study regarding performance of piroxicam dosage forms available worldwide have possible implications in terms of product equivalency and standards at an international level. While these results cannot be used to draw clinical conclusions without bioavailability data, they should nonetheless be kept in mind by healthcare practitioners.(ABSTRACT TRUNCATED AT 250 WORDS) PMID- 10146933 TI - Challenging official health cost estimates: an alternative view that incorporates the behavioural and economic effects of policy changes. AB - Cost estimates of health care policy changes are extremely important. Historically, however, the US government has done a poor job in projecting the actual cost of new health care programmes. These projections have been inaccurate primarily because government forecasters use 'static' methods that fail to incorporate the change in people's behaviour as a direct result of a new policy. In contrast, 'dynamic' forecasts incorporate the behavioural effects of policy changes on individuals and the economy. Static and dynamic estimates can lead to different results for 4 areas of US health policy: (a) the Medicare Catastrophic Coverage Act; (b) mandated health benefits; (c) health insurance tax subsidies; and (d) national health insurance. Improving health care policy requires the adoption of dynamic estimation practices, periodic appraisals evaluating the accuracy of official estimates in relation to actual experience, and clear presentation of proposed policy changes and estimates to policymakers and the general public. PMID- 10146935 TI - Standardisation of quality of life trials: an industry perspective. PMID- 10146934 TI - Australian guidelines for cost-effectiveness studies of pharmaceuticals: the thin end of the boomerang? AB - In the summer of 1990, the Australian Government took a major step by requiring evidence of cost-effectiveness of new medicines prior to reimbursement by the public health care system. This paper assesses whether the methodological principles behind the guidelines are sound and whether they raise important new logistical and policy implications. It is concluded that, while the guidelines may represent the 'thin end of the wedge' for the pharmaceutical industry, in that other countries may follow the Australian lead, they also may represent the 'thin end of the boomerang' for government. Namely, the development of explicit guidelines for public funding decisions concerning new health technologies places as many demands on funders (the government) as it does on the suppliers (the industry). PMID- 10146936 TI - Health-related quality of life in pharmaceutical evaluation: forging progress and avoiding pitfalls. PMID- 10146937 TI - Health services needs and related costs for HIV care. PMID- 10146938 TI - Quality of life instruments in the evaluation of new drugs. AB - The importance of measuring changes in a patient's quality of life when evaluating the efficacy of new drugs is increasingly recognised. In this paper, we review the steps associated with this process--recognising the opportunity and the need to include quality of life instruments during the investigation, choosing the most suitable instrument(s) and interpreting the results. To be useful in clinical trials, quality of life measures must be both responsive (able to detect all important differences) and valid. Generic instruments are applicable to a wide variety of populations but may lack responsiveness. Disease specific instruments are more likely to be responsive and are directly relevant to patients and clinicians. The approach to measurement in a specific clinical trial should be dictated by the goals of the investigators. PMID- 10146939 TI - Quality of life evaluation of antihypertensive drugs. AB - Eleven studies (10 randomised controlled trials and 1 large open study) that evaluated quality of life (QOL) are reviewed. The areas of QOL measured by the studies are compared and a consensus is reported that health-related QOL measures in patients with hypertension should include: symptomatic and psychological well being, activity (work, leisure, sleep, sexual activity and social participation), cognitive function and life satisfaction. Recommended methods for measuring these aspects of QOL are noted. Seven studies included atenolol as 1 of the treatments and the effects of this drug on QOL are reviewed. The drug appears to maintain QOL as well as the angiotensin converting enzyme (ACE) inhibitors captopril, enalapril and cilazapril. One trial also suggests that verapamil maintains QOL as well as atenolol, although this was not suggested by the nonrandomised study. Nifedipine slow release (SR) and propranolol both fared worse than atenolol in 2 separate trials, but 1 trial suggested that nifedipine gastrointestinal therapeutic system (GITS) was preferred to atenolol in terms of QOL. In the latter study, however, only patients completing the prescribed therapy revealed a preference for nifedipine GITS; this was absent in an intention-to-treat analysis. The rate of discontinuation of nifedipine therapy was high, underlining the necessity for an intention-to-treat analysis in trials assessing QOL. PMID- 10146940 TI - Pharmacoeconomics of intravenous drug administration. AB - Direct administration of a drug into a vein guarantees bioavailability, i.e. the total amount of drug is fully available to the bloodstream for transport to all areas of the body. What is not ensured is the safety, need and 'value for money' of this route. Few workers would disagree that there is increased morbidity associated with this method of administration. Adverse events range from the painful irritation of veins to life-threatening infection introduced by needle puncture. It is proposed that in many situations the disadvantages of the intravenous (IV) route outweigh the advantages. There are many hidden costs of IV therapy ranging from the adverse events associated with IV administration to the need for specialised equipment, consumables and additional personnel time. Recent studies have shown that the oral route can be substituted in many patients receiving IV therapy without loss of efficacy. The reduction in costs intrinsic to IV therapy is an additional bonus. There is a need to increase the use of alternative routes of administration on the basis of safety, quality of life and cost. PMID- 10146942 TI - Regulation of pharmaceutical prices: a managed care perspective. PMID- 10146941 TI - Simvastatin: a pharmacoeconomic evaluation of its cost-effectiveness in hypercholesterolaemia and prevention of coronary heart disease. AB - Epidemiological and intervention study results support reduction of coronary heart disease (CHD) risk, and hence direct and indirect costs, by lowering plasma lipids. Cost-effectiveness of a lipid-lowering strategy thus depends significantly on the extent of plasma lipid decrease achieved. The 3-hydroxy-3 methylglutaryl-coenzyme A (HMG-CoA) reductase inhibitor simvastatin is a well tolerated and highly effective antihyperlipidaemic agent. Despite a current lack of direct evidence that simvastatin reduces CHD incidence, the cost-effectiveness of the drug {in terms of years of life saved (YOLS)} has been studied, based on findings of epidemiological trials. Simvastatin 20 mg/day is more cost-effective than cholestyramine 4g 3 times daily, particularly in men and in those with a higher pretreatment cholesterol level ( greater than 8 mmol/L) and other risk factors. Cost-effectiveness is also enhanced if treatment is started at a younger age (35 to 45 years) and maintained for a defined period rather than lifelong. Thus, while additional direct comparative studies are needed to confirm this finding, present evidence suggests simvastatin is a cost-effective intervention in appropriately selected patients. PMID- 10146943 TI - Routine childhood immunisation: is it worth it? PMID- 10146944 TI - The cost of asthma: can it be reduced? AB - Asthma is a major public health problem in developed countries, where it consumes a large and increasing share of scarce health resources. Ideally, medical management should be both optimal in terms of improving the patient's quality of life, and cost-effective for society. At present, there is very little information relating to costs and economic efficiency of current asthma management. Although the true total cost of asthma is unknown, current estimates suggest it is high. The main value of recent total cost estimates is that they identify the most expensive areas of asthma costs, and ideally, formal cost effectiveness analyses should be concentrated on these areas. Asthma is still under- or inappropriately diagnosed, and undertreated. Several national and international consensus plans for the optimal management of asthma in children and adults have been published. If these inadequacies in asthma management were corrected, using current treatment recommendations, the overall cost of asthma from both the community and patient perspective should fall. The situation requires increased use of preventative medications {sodium cromoglycate (cromolyn sodium) or inhaled corticosteroids}, more widespread use of written crisis plans, more proactive medical consultations (rather than reactive or urgent consultations), further expansion of asthma education programmes, and further education of medical practitioners about the optimum management of both long term asthma and the acute exacerbation of asthma in the patient's home, the doctor's office, the hospital emergency room and the hospital inpatient setting. The increased costs associated with these measures would be more than offset by reduced expenditure on bronchodilator drugs, less widespread use of nebulisers at home and in hospitals, reduced antibiotic usage, reduced need for expensive emergency medical care and particularly reduced utilisation of hospital resources. To ensure that resources are being directed into the most cost effective areas of asthma care, clinical trials of asthma should include utilisation of healthcare resources as an outcome measure, and estimates of the costs of the treatment under study. In addition, since the intangible cost (quality of life) is one of the most important effects of treatment from the patient's perspective, this should be more widely used as an outcome measure in clinical trials. Ultimately, prevention of asthma is the long term goal. If the hypothesis that sensitisation to house dust mite in early infancy is a major contributor to the subsequent development of asthma, then prevention may require drastic and expensive changes to current housing. PMID- 10146945 TI - Economics of home intravenous services. AB - Home care has become a more attractive option as economic constraints are placed on the total healthcare system. Over the past 25 years, home intravenous service programmes have developed simultaneously with the development of more reliable means of providing intravenous therapy in the home. Reports have been published on a variety of home intravenous programmes including antibiotic therapy, parenteral nutrition support, chemotherapy, blood product administration and pain control. This review examines the economics of home intravenous programmes, including such direct cost items as drugs, medical supplies and equipment, personnel, hospital room, inventory control, and carrying inventory. Indirect costs, assessed as loss of wages, are also analysed. Cost savings have been reported ranging from 18 to 75% for intravenous antibiotic programmes and 60 to 76% for parenteral nutrition programmes. Earlier reports concentrated on analysis of savings derived from comparison of direct costs only, but recent studies have explored a more comprehensive fiscal analysis. PMID- 10146947 TI - A cost-effectiveness analysis of epoetin usage for patients with AIDS. AB - Epoetin (recombinant human erythropoietin) therapy for patients with AIDS may reduce the need for blood transfusion; however, it is expensive. We conducted a cost-effectiveness analysis of the use of epoetin for AIDS patients from a healthcare system perspective. We constructed a decision analysis model using probability, outcome and cost data from the literature and hospital sources. The incremental cost-effectiveness ratio was measured in dollars per unit of blood saved. In AIDS patients undergoing transfusion with serum epoetin concentrations less than or equal to 500 U/L treatment with epoetin cost $US1007 per unit of blood saved compared with treatment without epoetin. One-way sensitivity analysis revealed that the incremental cost-effectiveness ratio was sensitive to the efficacy and unit price of epoetin, but less sensitive to the current price cap determined by the distributor. PMID- 10146946 TI - Methods of minimising the cost of aminoglycoside therapy to hospitals. AB - Aminoglycoside agents are used for a wide variety of systemic infections and can profoundly affect hospital expenditures depending upon the amounts used, acquisition costs, and costs incurred during therapy. Significant cost advantages can be gained through selection and proper use of the appropriate aminoglycoside. Institutions can improve the selections by using inservice training and other educational methods, drug-use audits, and therapeutic substitution. Institutions may also restrict or delete certain aminoglycosides from the drug formularies to help minimise costs. Therapeutic drug monitoring can reduce the incidence of aminoglycoside adverse effects. However, some methods of monitoring, such as certain clinical pharmacokinetic services, can be time consuming and require additional manpower. These measures can be shown to be cost effective if they can decrease the length of therapy, minimise toxicity, decrease the length of hospitalisation, or affect mortality. Experimental data and preliminary clinical evidence suggest that once-daily regimens of aminoglycoside agents have some possible advantages over the standard regimens. If this regimen can be widely used, cost savings secondary to decreased use of aminoglycosides can be realised in the future. Potent, broad spectrum beta lactam monotherapy has threatened to replace conventional combination therapies that include aminoglycosides in some infectious processes and a few studies have found certain single-drug therapies to be cost effective. PMID- 10146948 TI - Regulations controlling costs of drugs: a perspective from the US. PMID- 10146949 TI - Interpreting economic evaluations of medicines: a new role for the pharmacist? . PMID- 10146950 TI - The influence of pharmacoeconomic factors on prescribing patterns in Ireland. PMID- 10146951 TI - Interpreting pharmacoeconomic and quality-of-life clinical trial data for use in therapeutics. AB - Interpretation of quality-of-life (QOL) and pharmacoeconomic data for therapeutic decision making and therapeutic policy planning requires a basic understanding of the methods, assumptions and limitations of the data and associated methods of analysis. Measures of the effectiveness of different pharmaceutical agents can be modified by including functions which involve assessment of the treated individual's quality of life. These quality-adjusted effectiveness measures will alter conclusions concerning clinical decisions as well as the cost-effectiveness of the comparative agents under consideration. To provide a conceptual and analytical framework for understanding the relationship between QOL assessment and pharmacoeconomic modelling, interpretations of the quality-adjusted analyses are reviewed, conceptual and analytical models are proposed, and recommendations for using QOL data in pharmacoeconomic models are outlined. Techniques for incorporating QOL measures in pharmacoeconomic models are examined using a hypothetical model involving therapeutic assessments of antiviral treatments for individuals with HIV disease. Adjustments of effectiveness measures based upon QOL-related functions are then globally addressed using stochastic compartmental models. Three specific methods for adjustment used in therapeutic trials are reviewed. Applications of these techniques to 3 studies involving the treatment of HIV disease and hypertension are critically reviewed. Issues relevant to choosing or estimating measures of quality of life for use in pharmacoeconomic models are summarised, and research guidelines are proposed. PMID- 10146953 TI - The UK indicative prescribing scheme: background and operation. AB - The cost of drugs in the UK has increased at a rate of 4% above inflation over the last ten years. Prescribing in general practice accounts for 80% of the total drugs bill. Within general practice, there is considerable variation in individual prescribing frequency and costs, reflecting demographic, morbidity and professional influences. Recognition that much prescribing is unnecessary and wasteful of resources which may be better used elsewhere in the NHS is a major force behind recent radical changes to the organisation of British general practice. This paper describes the background, implementation and first year of the Indicative Prescribing Scheme (IPS). The IPS is an initiative of the Department of Health in the United Kingdom that aims to introduce greater accountability for, and control over, the costs of prescribing in general practice. Previous attempts to control the costs of drugs to the NHS included efforts to control price, demand, availability; encouraging generic prescribing; and educational initiatives. The IPS was introduced to place downward pressure on expenditure on drugs by improving the quality of prescribing and by eliminating wasteful prescribing. The scheme hinges around the setting of 'indicative prescribing amounts' for each general practice. Practitioners are expected to operate within these guidelines and are provided with regular financial summaries to help them gauge their progress. Additionally, Family Health Service Authorities (the new administrative and managerial body with responsibility for the day-to-day running of primary care services) have engaged medical and pharmaceutical advisers to provide support and information to assist general practitioners with their prescribing. The first year of the scheme has been one of establishment and consolidation. It is too early to judge whether it will be a success. After initial resistance, many doctors are adopting the principles of the scheme and are critically reviewing their prescribing. Greater awareness of the content and influences on prescribing in primary care and of the resource implications for the rest of the NHS of rational prescribing has encouraged dialogue between hospital clinicians, managers and general practitioners. PMID- 10146952 TI - Selegiline: an appraisal of the basis of its pharmacoeconomic and quality-of-life benefits in Parkinson's disease. AB - Selegiline (deprenyl) is a selective, irreversible cerebral monoamine oxidase type B inhibitor (MAO-B) that is used in the treatment of Parkinson's disease. It has a relatively mild adverse effect profile without risk of the tyramine ('cheese') reaction at normal therapeutic doses. In about half to two-thirds of patients with mild levodopa response fluctuations, selegiline improves overall disability and 'end-of-dose' fluctuations, with a levodopa-sparing effect. Selegiline thus may improve patient quality of life, although formal cost-utility analyses are required to establish the costs of these benefits. Cost effectiveness studies may help characterise the relative pharmacoeconomic benefits of selegiline and the dopamine agonists, agents which can also be administered as adjuvant therapy at this stage of the disease. There is also evidence to suggest that selegiline may delay the need for levodopa therapy by up to 11 months in patients with early Parkinson's disease, although the relative contribution of neuroprotective and symptomatic effects of selegiline in these patients has yet to be clarified. From a societal perspective, a theoretical analysis indicates that the economic benefits of selegiline therapy are likely to be substantial. An agent which slowed progression of disability by around 10% would realise savings, through reduction in both direct and indirect costs, in the order of $US330 million per annum in the United States. Available data suggest that selegiline slows progression of symptoms well in excess of 10%. Further, if a simple and inexpensive method is developed to identify preclinical Parkinson's disease before nigrostriatal damage is advanced, selegiline may be useful in a broader patient population with possible financial benefits to society through reduction of the considerable indirect costs of Parkinson's disease. PMID- 10146954 TI - Discounting of health benefits in the pharmacoeconomic analysis of drug therapies: an issue for debate? AB - In most economic evaluations, future monetary costs and benefits and future health benefits are discounted at the same rate. The purpose of this article is to question such current practice. The primary reason behind discounting costs and benefits is to allow for individuals' preferences over the timing of such events, i.e. to represent social time preference. We argue that the social time preference rate for health benefits is unlikely to be the same as that for monetary costs and benefits. The results of a sensitivity analysis of pharmacoeconomic analyses of drug treatments for hypertension illustrate how the choice of discount rate can affect the conclusions. As no definite conclusions can be drawn regarding the magnitude of the discount rate for health benefits, we recommend that analysts conduct sensitivity analyses employing differential discount rates for health benefits as well as monetary costs and benefits. PMID- 10146955 TI - Costing wound infection in a Scottish hospital. AB - Data from a trial of preoperative whole body disinfection in postoperative wound infection prophylaxis involving 3733 patients were used to analyse the cost of a postoperative wound infection. The overall wound infection rate was 14.73% (513/3482), 61% of which were diagnosed after hospital discharge (312 outpatient infections versus 201 inpatient infections). This highlights the prevalence of the transfer of the cost of wound infection to the community. The inpatient and outpatient costs were calculated separately for those with and without a wound infection. Operative procedures were placed into 38 different categories. 12 of these 38 categories accounted for over 90% of the total number of operations performed. Overall, infected patients cost society more than noninfected patients. The hospitalisation costs for inpatients for all categories of patients, whether infected or not, comprised over 99% of the total cost. The excess cost for the infected patients in the study was calculated as 312 915 British pounds sterling (1990 British pounds sterling) or 610 British pounds sterling per infected patient, equivalent to 1926 hospital days overall. For some operations (e.g. stripping varicose veins) an excess of 52 hospital days were associated with wound infection diagnosed after discharge from hospital. Wound infections in some operative categories were consistently more expensive to manage (e.g. excess cost/infected vascular patient = 1085 British pounds sterling) while other operative categories had less costly wound infections (e.g. excess cost/infected thyroid patient = 110 British pounds sterling).(ABSTRACT TRUNCATED AT 250 WORDS) PMID- 10146956 TI - Economic evaluation of oral ofloxacin versus standard parenteral therapy in the treatment of pneumonia. AB - The purpose of this study was to examine how inpatient use of oral ofloxacin, a fluoroquinolone antibiotic, affects utilisation of healthcare resources in the treatment of pneumonia. We collected data via chart review from a recent multicentre trial that randomised hospitalised adult patients with pneumonia to oral ofloxacin or standard parenteral therapy of the investigators' choice. We followed a total of 126 patients from randomisation until rule-out of pneumonia, death, loss to follow-up, or 30 days following cure, whichever occurred first. For each patient, we collected data on all inpatient antibiotic usage, duration of stay in hospital, and the utilisation of selected healthcare services following discharge from hospital. While length of stay did not differ between ofloxacin and standard-therapy patients (9.2 vs 11.1 days, respectively; p = 0.28), the cost of inhospital antibiotic therapy for those who received ofloxacin was one-fifth that of patients who were randomised to parenteral therapy ($US47 vs $US268). Costs of outpatient antibiotic therapy were slightly higher for the group receiving ofloxacin ($US26 vs $US3). No difference was noted in the rate of hospital readmission during follow-up. Our study therefore suggests that the use of oral ofloxacin among inpatients with pneumonia reduces the costs of antibiotic treatment compared to standard parenteral therapy. PMID- 10146957 TI - Managing childhood chickenpox: cost implications. PMID- 10146958 TI - Clinical and economic factors in the selection of drugs for gastroesophageal reflux disease. PMID- 10146959 TI - Health economics in primary care in the UK: containment of drug costs. PMID- 10146960 TI - Pharmacoeconomics of nonsteroidal anti-inflammatory drugs (NSAIDs). AB - Nonsteroidal anti-inflammatory drugs (NSAIDs) are widely used for the relief of the symptoms of osteoarthritis (OA), rheumatoid arthritis (RA), sprains and strains, sports injuries and menstrual disorders, and have a small role in the management of patent ductus arteriosus in the neonate. In patients with RA, symptom relief through use of NSAIDs is firmly established, although it remains unclear whether they influence the course and outcome of the disease. For the average patient with RA taking NSAIDs, the attributable risk of hospitalisation with gastrointestinal problems related to NSAIDs is 1.3 to 1.6% annually and risk of death is 0.15%. Associations of therapy with risk are greatest with age, corticosteroid use and previous NSAID-related gastrointestinal adverse effects, and less marked with disability and high NSAID dose. These are important data in attempting to balance risk of therapy with clinical efficacy in an individual patient, and assessing the cost-effectiveness of prophylaxis. Although half of all NSAID consumption is for control of pain associated with degenerative conditions, their superiority over simple analgesics in osteoarthritis is poorly documented. This finding supports the use of the simple analgesic paracetamol (acetaminophen) as the preferred therapy of osteoarthritis, especially when its lower cost and low incidence of adverse effects are taken into consideration. Consistent differences in clinical effectiveness of individual NSAIDs have not been demonstrated, although unpredictable interpatient variation in response to individual agents is of considerable clinical importance, and a more expensive NSAID may prove cost effective for some patients. Cost effectiveness can be improved by a self-adjusted dosage regime which also leads to lower overall drug consumption. The adverse gastrointestinal effects of these drugs account for about 30% of the overall cost of arthritis treatment, and although studies to date have been too limited to assess the relative risk of gastrointestinal toxicity of the different NSAIDs reliably, ibuprofen appears to be one of the least hazardous, and azapropazone one of the most hazardous. Although the effectiveness of prophylaxis with H 2-antagonists and with prostaglandin E 1 analogues (prostaglandin-E 1 analogues) has been established, estimates of cost benefit ratios are widely divergent. To establish the most cost-effective therapy with NSAIDs, more data are required to establish multivariable risk profiles for identification of patients at particular risk, the optimal drug, and its optimal dosage and duration of treatment.(ABSTRACT TRUNCATED AT 400 WORDS) PMID- 10146961 TI - Cost-effectiveness study of a lipid-lowering therapy in hyperlipoproteinaemia type IIb and type IV (Frederickson). AB - We performed a cost-effectiveness simulation of acipimox, bezafibrate, fenofibrate and gemfibrozil in patients with hyperlipoproteinaemia type IIb and IV (Frederickson). A distinction was made between patients with HLP type IIb and IV and HLP associated with diabetes mellitus type II (NIDDM). Direct costs were assessed as those incurred by social security for the treatment, and indirect costs were not taken into account. In appropriate dosages, all 4 substances can be considered equally efficacious in lowering lipid levels, although gallstones occur 3 times more frequently in patients treated with fibrates than in those treated with acipimox. Acquisition costs of the 4 drugs under consideration are comparable. Thus, when hospitalisation costs for treatment of gallstones are taken into account, therapy with acipimox is more cost effective than fibrate therapy. PMID- 10146963 TI - Proactive review of biotechnological and other high-cost pharmaceuticals: a US approach. PMID- 10146962 TI - Misoprostol: pharmacoeconomics of its use as prophylaxis against gastroduodenal damage induced by nonsteroidal anti-inflammatory drugs. AB - Misoprostol effectively prevents nonsteroidal anti-inflammatory drugs (NSAID) induced gastric ulcer and is the only agent currently indicated for this purpose. In addition, misoprostol is effective as prophylaxis against NSAID-induced duodenal ulcer. Because of the widespread use of NSAIDs, the cost of routine misoprostol prophylaxis would be high, and thus its pharmacoeconomic evaluation is an important factor in assessing the most appropriate role of misoprostol in this group of patients. Current cost-benefit analyses undertaken in major European centres and the US have generally indicated that, depending on initial assumptions, misoprostol prophylaxis over a 3-month period is cost-saving in patients with osteoarthritis taking NSAIDs. The net savings (costs) realised were dependent on several variables, including the acquisition cost of misoprostol, silent ulcer rate and patients' compliance. Importantly, misoprostol prophylaxis was consistently more cost-beneficial in elderly patients aged greater than 60 to 65 years than in their younger counterparts. In contrast, in one study misoprostol was found to reduce patients' quality of life and, although misoprostol therapy is potentially cost-saving to society, patients generally preferred no therapy. A single study assessing the cost-effectiveness of misoprostol prophylaxis in preventing ulcerative complications concluded that primary treatment was not an economically viable option for all NSAID users. Misoprostol was most cost-effective in the prevention of recurrent or secondary gastric ulcer complications in 'high-risk' patients, for example patients aged over 60 years and patients with rheumatoid arthritis. Thus, although there are areas of interest awaiting further pharmacoeconomic investigation, misoprostol prophylaxis appears to be cost-effective in elderly and high risk patients receiving NSAIDs. Additionally, misoprostol prophylaxis is cost-saving in elderly patients with osteoarthritis requiring NSAID therapy. PMID- 10146964 TI - Direct costs of intravenous delivery systems. PMID- 10146965 TI - The economic costs of asthma: a review and conceptual model. AB - There is a growing international concern about increasing asthma morbidity. While much is known about asthma morbidity, there are few available data on the economic burden of this condition, particularly in underdeveloped countries. In the absence of data on social costs, it is not possible to develop rational approaches to policies regarding resource allocation to reduce morbidity. The purpose of this article is to provide a review of the available literature on the social costs of illness for asthma. In light of this literature, we propose a conceptual model that links asthma morbidity to the social opportunity costs of the disease. We then delineate a framework, based on the proposed model, that can be used to conceptualise and evaluate the relative impact of alternative asthma intervention strategies. Based upon proposed analyses using this model, we believe that it would be possible to compare how various intervention strategies are likely to affect asthma costs and morbidity, thus providing a means for a more rational approach to healthcare policies regarding societal resource allocation for asthma. PMID- 10146966 TI - Test of an instrument to measure function-related quality of life in patients with ulcerative colitis. AB - An instrument for measuring function-related quality of life (QOL) in patients with ulcerative colitis was tested for validity, reliability, and responsiveness, using concepts and statistical methods easily understandable for pharmaceutical researchers. For this 8-week study, 374 patients were randomised and received placebo or oral mesalazine (mesalamine) at 1g, 2g, or 4g daily. A 10cm visual analogue scale and patient diaries were used to measure the 12 QOL parameters at baseline and study termination. Physician's Global Assessment was measured at end point and used to assess change in the disease state of each patient. Analysis of covariance was used to test the construct validity, reliability and responsiveness of the instrument. Construct validity (p less than or equal to 0.0001), reliability (p greater than 0.05), and responsiveness (p less than or equal to 0.0001) were established for all 12 parameters of the instrument. We conclude that the instrument demonstrated precision in measuring function-related QOL in patients with active ulcerative colitis. Furthermore, content validity was maximised by combining disease-specific and general questions in the instrument. PMID- 10146968 TI - Pharmacoeconomic evaluation to assist prescription drug pricing: a US perspective on an international issue. PMID- 10146967 TI - Tamoxifen: a review of pharmacoeconomic and quality-of-life considerations for its use as adjuvant therapy in women with breast cancer. AB - Extensive clinical experience, summarised in the recent overview of the Early Breast Cancer Trialists' Collaborative Group (EBCTCG), have confirmed that tamoxifen reduces the rate of both disease recurrence and mortality when administered as adjuvant therapy in women with early breast cancer. Tamoxifen is now established as the preferred adjuvant agent in postmenopausal women; in particular, patients with node-positive, estrogen receptor-positive breast cancer have the most to gain from tamoxifen therapy. Data from a decision-analysis model indicated that tamoxifen monotherapy had a cost-utility ration {$US6000 per additional quality-adjusted life-year (QALY), in 1989 dollars} 5 to 6 times lower than that cited as the cost-acceptability cut-off point in the US. While tamoxifen monotherapy is effective in postmenopausal women, the EBCTCG overview findings indicate that a combined regimen of tamoxifen and antineoplastic chemotherapy has superior efficacy in the same patient group. An issue of current interest is whether the added benefit offered by such a regimen can be justified in terms of added toxicity and cost. Data from a decision-analysis model indicate that combined therapy has a high incremental cost-utility ratio ($US58 000 per additional QALY, in 1989 dollars) compared with no therapy in postmenopausal women. However, the quality-of-life measures TWiST (Time Without Symptoms and Toxicity) and Q-TWiST (quality-adjusted TWiST) indicate that the early toxicity associated with a combined regimen appears to be justified given the superior long term benefits. Patient preference data from 1 study further indicate that the degree of benefit offered by a combined regimen would be acceptable to the majority (73%) of patients. Other areas where pharmacoeconomic analyses may help define more closely the optimal use of adjuvant tamoxifen is in patients at low risk of developing metastatic disease and in determining the optimal duration of therapy. Both areas require further clinical data. In conclusion, tamoxifen adjuvant monotherapy has a low cost-utility ratio in postmenopausal women with node-positive, estrogen receptor-positive breast cancer. Combined therapy in the same patient group has a high cost-utility ratio compared with no therapy but quality-of-life and patient preference data suggest that the costs may be justified. Firm conclusions relating to the use of the drug in other patient subgroups and the optimal duration of therapy await further research. PMID- 10146969 TI - Physician education and prescribing costs. PMID- 10146970 TI - Quality-of-life evaluation in diabetes. PMID- 10146971 TI - Economic impact of cost-containment strategies in third party programmes in the US (part I). AB - The rising cost of healthcare has strained the resources of governments, private third parties and individuals with responsibility to pay for it. Various strategies have been used in an attempt to control costs. This article examines the economic impact of 4 such strategies: (a) cost sharing; (b) prescription limits; (c) rebates; and (d) cost limits. Cost sharing has been successful at reducing utilisation of prescription drugs, although the effects have not been uniform across therapeutic categories. However, the long term effect on cost and utilisation of other medical services, and the impact on overall health status, remain largely unknown. Some evidence suggests that utilisation of other services may increase. The available data regarding drug rebate programmes have been descriptive in nature. However, the designs employed in this research do not establish a direct causal relationship between rebate programmes and changes in Medicaid drug expenditure. Furthermore, still unknown is the degree of cost shifting and the effect of the rebate programme on other large public and private drug purchasers. The Maximum Allowable Cost programme led to direct savings in drug costs, but the size of these savings was variable and uncertain because of administrative costs of the programme. The Estimated Acquisition Cost programme has not resulted in significant savings. PMID- 10146972 TI - Roxithromycin versus cefaclor in lower respiratory tract infection: a general practice pharmacoeconomic study. AB - An economic evaluation comparing roxithromycin 150mg twice daily and cefaclor 250mg thrice daily in the treatment of lower respiratory tract infections (LRTI) was undertaken as part of a randomised clinical trial in New Zealand general practice. The observed statistically significant difference in adverse events, withdrawal rates and extra treatment courses in favour of roxithromycin in the clinical study was translated into medical cost savings. Treatment failures, withdrawals or adverse events resulted in additional costs for 11 of 120 (9%) patients receiving roxithromycin and 19 of 118 (16%) patients receiving cefaclor. In these cases (treatment failures, withdrawals, adverse effects) additional antibiotics and general practitioner visits were required 3 times more often and the cost of additional medication for treating failure or adverse effects was 3 times higher for patients treated with cefaclor than for patients receiving roxithromycin. The total direct medical cost per patient treated with roxithromycin was $NZ9.37 lower (on an incremental basis) than for patients treated with cefaclor, despite a higher drug acquisition cost. An estimate of $NZ656 000 per year in total savings in direct medical costs could be made in New Zealand if roxithromycin were to replace all cefaclor prescriptions in the treatment of LRTI. PMID- 10146974 TI - Cost-of-illness studies: a major headache? PMID- 10146975 TI - The cost of migraine: more than just a headache? PMID- 10146973 TI - Clozapine: an appraisal of its pharmacoeconomic benefits in the treatment of schizophrenia. AB - Clozapine, an antipsychotic agent with relatively weak central antidopaminergic activity, displays atypical pharmacological and clinical properties vis-a-vis the classic antipsychotics. Thus, clozapine is effective against both the positive and negative symptoms of schizophrenia and has a low propensity to cause extrapyramidal effects. Furthermore, clozapine is effective in a substantial proportion (up to 60%) of patients who are refractory to or intolerant of standard antipsychotic therapy. Despite its promising therapeutic potential, the relatively high incidence of clozapine-induced agranulocytosis (approximately 1% of patients) and the associated need for regular haematological monitoring currently restricts the drug's use to the treatment of chronic and severe schizophrenia refractory to standard antipsychotic therapy, and to those patients unable to tolerate such therapy. In the US, the current wholesale price of clozapine (exclusive of monitoring) is $US2.85 per 100mg tablet, amounting to $US4160 annually (1992 dollars) at the most commonly prescribed dose of 400 mg/day ($US2.40 per tablet and $US3510 annually to state programmes through Medicaid reimbursement legislation). In the UK, the annual cost of clozapine (at the average dose of 300 mg/day), inclusive of blood monitoring, is 1806 British pounds sterling (1992 pounds). Although the acquisition cost of clozapine is high in comparison with that of standard antipsychotics, preliminary cost effectiveness estimates in patients with treatment-resistant schizophrenia suggest that the clinical benefits of the drug (viz. improved psychopathology, social functioning and quality of life) may confer medium to long term economic benefits, primarily by reducing the need for psychiatric hospital services. This effect is most likely to be seen on long term ( greater than or equal to 2 years) maintenance therapy with clozapine. Savings in hospital costs are, however, likely to be offset, at least initially, by increased reliance on outpatient services, and clozapine may therefore confer additional economic costs during the first year or so of treatment. In the longer term, however, the initial cost investment may be recouped in the form of savings to psychiatric institutions and insurers. PMID- 10146978 TI - Quality-of-life assessment in respiratory disease: an examination of the content and validity of four questionnaires. AB - Four recent questionnaires for measuring the quality of life of patients with respiratory disease (Chronic Respiratory Disease Questionnaire, St George's Respiratory Questionnaire, Living with Asthma Questionnaire, and Asthma Quality of Life Questionnaire) differ in the content and style of the items used. Differences in content arise over the use or emphasis on symptom items, functional limitation (activity) items, and emotion items. These differences stem in part from the different methods used for item selection and refinement, which include selecting the most 'important' items, qualitative analysis for clarity, ratings of distress, and psychometric analysis. Despite these differences, there is considerable evidence for content validity of all four questionnaires. Because quality of life is so poorly developed as a theoretical construct, the demonstrable statement that all 4 questionnaires have construct validity provides little information about the questionnaires. PMID- 10146977 TI - Cost-effectiveness of drug therapy for hypercholesterolaemia: a review of the literature. AB - In this article we review published studies of the cost-effectiveness of drug therapy for hypercholesterolaemia to take stock of the principal findings that have been reported to date. We identified 9 studies that met all criteria for inclusion in our review, including 3 of bile-acid sequestrants (cholestyramine, colestipol), 2 of HMG-CoA reductase inhibitor (lovastatin), and 4 that considered both an HMG-CoA reductase inhibitor (simvastatin) and a bile-acid sequestrant (cholestyramine). While these studies were largely consistent in methodological approach, some differences were noted in the costs attributed to drug therapy. The cost-effectiveness of therapy with bile-acid sequestrants was found to range from $100 000 to $209 000 per year of life saved (1991 $US) for middle-aged men (42 to 55 years of age) with moderately high cholesterol levels (280 to 290 mg/dl) and otherwise average coronary risk characteristics. Corresponding cost effectiveness ratios that have been reported for lovastatin range from $64 000 to $82 000, while those for simvastatin range from $45 000 to $65 000. Studies to date therefore suggest that therapy with HMG-CoA reductase inhibitors (i.e. lovastatin and simvastatin) is substantially more cost-effective than treatment with bile-acid sequestrants. PMID- 10146979 TI - Assessing the responsiveness of a quality-of-life instrument and the measurement of symptom severity in essential hypertension. AB - A pilot study was conducted to compare symptoms elicited with an open-ended question versus a checklist and to measure the responsiveness of quality-of-life measures to symptom severity. The pilot study was part of a multicentre, randomised, double-blind, placebo-controlled study of clentiazem, a calcium channel blocker, in the treatment of essential hypertension. Symptom and quality of-life data were obtained from 88 patients at baseline and after 10 weeks of therapy by a trained telephone interviewer. Comparison of the symptom checklist and open-ended question method suggests that both methods are necessary to capture severe symptomatology. The 24-item checklist failed to elicit approximately 50% of the severe symptoms reported on the open question list. On the other hand, only 18% of the most severe symptoms subsequently reported on the checklist were first reported by the open question method. The responsiveness of quality-of-life measures to symptom severity was tested using a 20% change in symptom severity obtained from the checklist as the minimal clinically significant difference. Using Guyatt's formula, a minimum sample size of approximately 428 (alpha = 0.05, beta = 0.10) patients per treatment group is required to detect differences in measures of general health perception, anxiety, depression and limitations in social activities. A larger sample is required to show differences in leisure activities. Differences in limitations of the capability to perform house or yard work might be demonstrable with as few as 17 patients per group. This pilot study demonstrated that the severity of symptoms associated with hypertension, and the side effects of its treatment with drugs, are adequately captured by a symptom checklist preceded by an open-ended method of questioning. Responsiveness testing estimated the sample size required to show a statistically significant difference, assuming a 20% change in symptom severity. PMID- 10146976 TI - Pharmacoeconomic consequences of measurement and modification of hospital drug use. AB - Patterns of drug usage affect hospital-based delivery of healthcare in a variety of ways. Adverse reactions to drugs (ADR) precipitate some 5% of admissions and prejudice the care of some 20% of patients who are in hospital, while inadequate drug therapy prejudices outcomes and prolongs hospital stay. Conversely, appropriate application of drugs can promote recovery and increase the quality of care. Well documented examples include prevention of deep vein thrombosis and postoperative wound infections. Accordingly, optimisation of drug use represents a major quality assurance issue in addition to determining cost-efficiency of healthcare delivery. Drug utilisation review (DUR) requires all elements of the quality assurance process. In practice, therapeutically meaningful and cost efficient exercises can only be mounted if there is knowledge of the linkage between patterns of drug use and clinical outcomes. These processes of measurement are currently rate-limiting in quality assurance. There are various ways that hospital drug usage can be measured. These range from readily available and relatively cheap quantitative methods to methods requiring the availability of expert staff. There is a sequence of methods involving increasing costs and increasing resource demands yielding increasing detail of information obtained. This sequence commences with pharmacy purchases, followed by pharmacy issues to particular clinical areas, prescription or treatment sheet survey, clinical record review, and finally the reports of trained investigators working in the clinical area. The simpler methods can provide useful information and an efficient basis for choosing and planning definitive studies. Once a category of drug use is appropriately targeted for intervention, drug use can be modified by planned intervention with improvement in clinical outcomes and reduced economic costs in many instances. The intervention strategies to modify drug usage may be classed as re-educative, persuasive, facilitative and power strategies. Other models for implementing behavioural change have been considered, including the impact of trained investigators and the use of online computer prescribing with interactive software with appropriate guidelines. The challenge is to achieve sustained change when interventions are implemented. Cost-efficient quality assurance of drug use is possible with modest resources if outcome-orientated activities are prioritised. PMID- 10146980 TI - Healthcare resource and lost labour costs of migraine headache in the US. AB - Migraine headache is responsible for significantly more healthcare resource and lost labour costs than previously reported. Costs associated with migraine were assessed via a survey conducted in 940 patients, 70% of whom responded. All met the International Headache Society's diagnostic criteria for migraine and had participated in one of two multicentre, single-dose, parallel-group, randomised, placebo-controlled clinical trials designed to assess the efficacy of an anti migraine compound. Migraine frequency and costs, in terms of healthcare resource utilisation and lost labour (decreased productivity and missed workdays), were assessed. Over 90% of respondents visited a clinic and nearly 50% presented to an emergency room for treatment of migraine-related symptoms at least once in the year prior to the survey. These 648 respondents used an estimated $US529 199 per year in healthcare services. 89% of employed respondents reported that job performance was adversely affected by migraine and over 50% of them missed at least two days of work per month. Depending on the estimates used for migraine prevalence and using 1986 estimates of median earnings for the US work force, the extrapolated costs to employers ranged from $US5.6 billion to $US17.2 billion dollars annually due to decreased productivity and missed work days. The cost of migraine is not fully appreciated by the medical community or by society. PMID- 10146981 TI - Comparison of prescribing habits of general practitioners in The Netherlands versus England and Wales. AB - The alleged prescribing habits of 44 randomly chosen Dutch family doctors were compared with those of 59 family doctors from England and Wales by inference from their prescribing responses to 10 hypothetical patients presented in a mail survey. The response options were: (a) neither prescribing nor advising over-the counter (OTC) medication; (b) advising OTC medication; or (c) prescribing medication. Although sample numbers were small, the sample appeared to be broadly representative of GPs in each country. There were significant differences in stated treatment habits between doctors of the 2 countries, especially with regard to treatment of sore throat, temporal arteritis, epigastric pain, travellers' diarrhoea and polyarthralgia. The results suggest substantial differences in management of common general practice problems exist between England/Wales and The Netherlands, despite their similar healthcare systems. These differences point to the need for rationalisation of management through improved education and audit. PMID- 10146982 TI - Cost-effectiveness analysis: obstacles to standardisation and its use in regulating pharmaceuticals. PMID- 10146983 TI - General practice fundholding in the United Kingdom: is it working? PMID- 10146984 TI - Impact of drug usage review on drug utilisation. AB - Drug use review (DUR) programmes have been a component of efforts to improve prescribing practices in both the institutional and ambulatory care settings in various areas of the world. DUR provides the mechanism for developing standards, assessing current therapy, and implementing a specific intervention followed by reassessment of drug utilisation. A number of interventions aimed at improving drug prescribing practices have been included as components of the DUR process. At this time, face-to-face interaction with the prescriber has been shown to be the most effective intervention. However, DUR interventions have rarely been subjected to quality pharmacoeconomic evaluation. There is a need for future research to evaluate the effects of DUR programmes on overall healthcare outcomes. PMID- 10146985 TI - The formulary decision-making process in a US academic medical centre. AB - This article reviews and describes the formulary decision-making process in an academic medical centre. The pharmacy and therapeutics (P & T) committee is the organisational nucleus of the drug use control process in the institutional environment. Thomas Jefferson University Hospital (TJUH), a 720-bed academic medical centre in an urban locality in the US, is used as a model representative of how most of these committees function. Survey responses collected from 29 peer academic medical centres are presented to compare and contrast the structure and function of the P & T committee at TJUH with corresponding procedures in other university hospitals in the US. TJUH is typical of the institutions which comprise the University Hospital Consortium (UHC). The P & T committee of TJUH is composed of 29 members, meets once per month for 10 months of the year, and has a network of 13 subcommittees. TJUH has an intermediately controlled (mixed) formulary, and uses both restricted drugs and treatment guidelines. Of the 29 UHC member institutions responding to the survey, the average P & T membership is 18, the average meeting frequency is 11 times per year, and 83% of these committees have a network of subcommittees. None describe their formulary system as open, 86% have a closed formulary and 14% have a mixed formulary system. There is a restricted drug programme in 76% of the institutions, 79% utilise treatment guidelines, 76% practice therapeutic interchange and all employ generic substitution. Specific areas addressed in this review include the history of the formulary system, the structure and function of the P & T committee, types of formularies, cost containment and the formulary decision-making process, the impact of organisational culture on physician decision making, the role of the pharmacy department, the role of pharmaceutical sales representatives and their impact on prescribing habits, the impact of the Joint Commission on Accreditation of Healthcare Organisations (JCAHO) Agenda for Change on the formulary process, and future challenges. PMID- 10146986 TI - Cost-effectiveness of antihypertensive treatment: metoprolol versus thiazide diuretics. AB - The aim of the present analysis was to calculate the cost-effectiveness of metoprolol versus thiazide diuretics in middle-aged men with mild to moderate uncomplicated hypertension. The analysis was based on the Metoprolol Atherosclerosis Prevention in Hypertensives (MAPHY) study, a randomised trial which showed a significantly lower risk for coronary events in patients taking metoprolol than in patients on thiazide diuretics. The main analysis was based on Swedish costs, but the costs were also varied in a special sensitivity analysis. Metoprolol was shown to be cost-saving compared with thiazide diuretics when both direct and indirect costs of morbidity were included. When only direct costs were included, the cost per life-year gained was $US2400. The result of the present analysis suggests that metoprolol is to be preferred to thiazide diuretics from a cost-effectiveness standpoint in the treatment of mild to moderate hypertension in middle-aged men. These findings regarding cost effectiveness should, however, not be extrapolated to patient groups not included in the MAPHY trial. PMID- 10146988 TI - Therapeutic substitution: an option for cost-effective prescribing? PMID- 10146987 TI - Epoetin: a pharmacoeconomic review of its use in chronic renal failure and its effects on quality of life. AB - Epoetin (recombinant human erythropoietin) is an effective treatment for the anaemia of patients with chronic renal failure. It is well tolerated, and the risk of adverse effects that are caused by too rapid a correction of anaemia, for example hypertension, can be reduced in most cases by lower starting dosage regimens. Epoetin improves the quality of life of anaemic patients with end stage renal disease (ESRD), and significant improvements in most parameters of the Kidney Disease Questionnaire, the Sickness Impact Profile and the Nottingham Health Profile have been reported by patients. However, acquisition costs of epoetin are high, thereby adding a considerable cost to ESRD therapy despite a reduction in blood transfusion requirements. Notwithstanding, although cost effectiveness studies have indicated that epoetin is associated with higher costs of therapy, cost-benefit analysis indicates that these costs can be reduced markedly with low-dose regimens and may be completely recovered if patients regain employment. PMID- 10146989 TI - Economic considerations in pain management. PMID- 10146990 TI - Drug treatment of pneumonia in the elderly: efficacy and costs. PMID- 10146991 TI - Discounting in cost-effectiveness analysis of healthcare programmes. AB - Discounting is a technique commonly used in cost-effectiveness analysis to 'make fair' comparisons of programmes whose costs and outcomes occur at different times. It is not a correction for inflation. While there is general agreement among health economists regarding the need to discount, there is less consensus on the procedure for discounting costs or benefits. We describe the method of constant-rate discounting, which uses the same rate to discount costs and benefits, and examine its impact on the cost effectiveness of selected health interventions. This methodology has significant limitations, however. Constant rate discounting may not accurately represent the values of a society. Furthermore, discounting does not reflect the longitudinal time preferences of individuals (or groups). The philosophical rationale for constant-rate discounting is the concept of longitudinal equity, i.e. that society should make allocation decisions in such a way that present and future cohorts are treated equally, regardless of when they come into existence. In general, discounting affects the cost effectiveness of preventive interventions more than acute interventions, and it affects programmes with immediate cost more that those with ongoing cost. The reader of such analyses should be aware of these effects, and should use caution in comparing the cost effectiveness of interventions with vastly different timing of cost and benefit. PMID- 10146992 TI - Pharmacoeconomics of immunisation: a review. AB - The effects of immunisation programmes that have existed for several decades in developed countries are demonstrated by the decrease and even eradication of smallpox, poliomyelitis, measles, mumps and hepatitis B. Cost, health policy and spontaneous evolution in the incidence of communicable diseases have a decisive influence on the use of a vaccine. Investment in vaccination policy has to be encouraged to maintain this progress made in the control of infectious diseases and to meet new challenges. Studies re-evaluating ongoing immunisation programmes are scarce. Nevertheless, it can be concluded that for vaccination against hepatitis B in professionally exposed at-risk populations, arguments for positive returns are consistent. The same holds for vaccination against S. pneumoniae and for influenza virus in the elderly. The results of the economic evaluation of revaccination against measles, when insufficient coverage exists, are inconclusive. Universal vaccination of children against Haemophilus influenzae type b (Hib) and of children of hepatitis B-positive mothers against hepatitis may require costs to be paid in order to gain extra health benefits. PMID- 10146994 TI - Pitfalls in the interpretation of pharmacoeconomic studies. PMID- 10146993 TI - Zidovudine: a review of pharmacoeconomic and quality-of-life considerations for its use in patients with human immunodeficiency virus. AB - In patients with human immunodeficiency virus (HIV) infections or the acquired immunodeficiency syndrome (AIDS), zidovudine is a first-line therapy that reduces morbidity and may reduce mortality. By delaying progression to AIDS, the drug reduces the duration and incidence of hospitalisations in a given time period, resulting in overall decreases in the cost of medical treatment per unit of survival time. In current therapeutic dosages zidovudine is generally well tolerated. Most pharmacoeconomic and quality-of-life studies of this agent were conducted using data relating to higher dosages and higher drug acquisition costs than those currently applicable, but nevertheless generally support the cost effectiveness of zidovudine in patients with HIV disease. Studies examining the use of the drug in higher dosages demonstrate neither clear positive nor negative effects of the drug on quality of life. The cost effectiveness of the drug as prophylaxis against seroconversion after occupational exposure to HIV is dependent primarily on the establishment of clinical effectiveness in this condition. Further pharmacoeconomic studies should examine changes to dosage and cost factors, along with direct nonmedical treatment costs, indirect medical treatment costs and the effects of the drug on quality of life. An evaluation of existing studies suggests that if these factors were accounted for, zidovudine might be shown to be more clearly cost effective, and indeed its use in the treatment of patients with HIV disease might be found to result in cost savings. PMID- 10146995 TI - Evaluation of pharmaceutical innovation: challenges and opportunities arising from the reforms to the national health service in the United Kingdom. PMID- 10146997 TI - Economic evaluation of drug therapy: a review of the contingent valuation method. AB - The aim of this paper is to review the use of the contingent valuation (CV) method in economic evaluation of drug therapy. With the CV method, willingness to pay for a project 'treatment' is measured with survey methods, which makes it possible to carry out traditional cost-benefit analysis. The CV method has been developed in environmental economics and is now the most commonly used method of measuring environmental benefits. Due to the limitations of existing methods, empirical applications are starting to appear in the health field as well. From the empirical applications with respect to drug treatment it is evident that it is possible to achieve acceptable response rates. The methodological problems encountered when measuring willingness to pay with survey methods are similar to the problems encountered when measuring utility and quality of life in cost utility analysis. It is concluded that further studies with the CV method are necessary to further explore questions concerning the reliability and validity of the method in this field. PMID- 10146996 TI - Economic costs of functional dyspepsia. AB - Dyspepsia is defined as chronic or recurrent symptoms believed to originate in the upper gastrointestinal tract. When routine investigation results in no identifiable explanation for those symptoms patients are labelled as having functional dyspepsia. In community-based surveys, approximately 30% of the otherwise apparently healthy population report dyspeptic symptoms and the majority are believed to have functional dyspepsia. Although only 1 in 4 or 5 patients make use of healthcare resources, this patient category is one of the largest in ambulatory care (1.6 to 5% of all consultations in general practice). The annual frequency of consultations for functional dyspepsia in Sweden has been estimated at 47 per 1000 population. In consequence of its high prevalence and associated absenteeism, the total costs of functional dyspepsia are considerable. In Sweden in 1981, the costs were estimated at $US55 000 per 1000 population ($US113 630 in 1991 dollars). The most cost-effective management strategy remains to be defined. Evidence is accumulating that the traditional 'wait-and-see' policy with initial empirical therapeutic trials without investigation may not be the most cost conserving strategy. PMID- 10146998 TI - Preference based outcome measures for economic evaluation of drug interventions: quality adjusted life years (QALYs) versus healthy years equivalents (HYEs). AB - Decisions about medical treatment and health programmes involve both technical and value judgements. For the purpose of performing an economic appraisal of different health interventions (including drug interventions), a single global score is essential as the measure of outcome. This measure should enable us to compare different interventions that affect both duration and quality of life at different levels of effect. This article provides a short but critical overview of the most commonly used measure of outcome in such cases--the quality adjusted life years (QALY). We describe the measure and discuss its limitations. More specifically we discuss problems stemming from the fact that QALYs do not fully reflect individual preferences and the fact that different (not necessarily comparable) methods of measurement can be used to generate the weights. We also discuss the issue of the equity implications of the methods used to aggregate the QALY values of individuals to arrive at a community health outcome measure. Our conclusion is that the use of QALY does not coincide with achieving the stated goal of economic evaluations (i.e. efficient allocation of resources to enable maximisation of the health of the community for any given level of resources). An alternative measure of outcome--the healthy years equivalent (HYE), which does not suffer from many of the major limitations associated with the QALY measure- is described and discussed. PMID- 10146999 TI - A comparison of the costs and benefits of recombinant human erythropoietin (epoetin) in the treatment of chronic renal failure in 5 European countries. AB - The purpose of this study was to estimate the costs and benefits of the use of recombinant human erythropoietin (epoetin) in the treatment of anaemia arising from chronic renal failure. A 5-nation study, using an identical research protocol, was carried out by groups in France, Germany, Italy, Spain and the UK to identify the costs of the use of epoetin, the resource savings generated by such treatment and the effects of this treatment on the quality of life of patients. The latter was measured using the Rosser matrix of disability-distress states. The results show that the use of epoetin can produce a competitive cost per quality-adjusted life-year (QALY) only in patients with serious incapacity. Use of epoetin in patients who are not transfusion dependent would be an expensive way of gaining health benefits, which would be achieved at considerable opportunity cost. PMID- 10147001 TI - Clinical economics: a method for prospective health resource data collection. AB - Information about the economic benefit of new drugs is becoming increasingly important for formulary considerations, reimbursement policies and related considerations. Although economic benefits of drugs have been analysed and reported, the economic benefits of drugs have rarely been examined in the course of randomised therapeutic trials. We designed a modular survey instrument, the Resource Utilisation Survey (RUS), to collect economic outcomes in prospective trials. A pilot test of the RUS was conducted using clinical trial methods in a study of nizatidine versus placebo in preventing ulcers induced by nonsteroidal anti-inflammatory drugs. The purpose of the pilot study was to evaluate the RUS instrument and corresponding study design issues in clinical trials for either acute or chronic diseases. With the lessons learned from the pilot study, the RUS has been used successfully in other ongoing clinical trials. PMID- 10147000 TI - Comparison of the cost-effectiveness of various therapies for common prostatic disorders. AB - Diseases of the prostate currently represent a major health problem worldwide. As the age of the male population increases in the future, so will the number of patients suffering from these disorders and the cost for treatment increase. Currently, benign prostatic hyperplasia (BPH) and prostate cancer are common in men over 50 years of age. In men after puberty, prostatic infections (prostatitis) are common. Each condition carries with it controversy regarding the most cost-effective treatment. Treatment for these disorders can include surgical intervention, drug therapy, or no treatment at all. In the United States, surgery is the usual treatment of BPH in men over 65 years of age, but most patients with BPH are asymptomatic and require no intervention. Aside from acute urinary retention or backpressure that compromises renal function, the indications to perform surgery are questionable. While some alpha-adrenergic antagonists are used to temporarily relieve symptoms, many patients with BPH will eventually require surgery. Transurethral resection of the prostate is the surgical treatment of choice in selected patients with BPH, accounting for over 90% of surgery performed in this area. The risk-to-benefit ratio for this procedure is favourable and cost-saving steps can be taken by the physician. Open prostatectomy, both suprapubic and retropubic, is performed to treat large prostates. However, both hospital stay and overall morbidity is higher for open prostatectomy than for transurethral prostatic resection. Radical prostatectomy and radiotherapy are commonly performed to treat patients with cancer of the prostate. For patients with the early stages of the disease, administering no treatment is also acceptable. Each therapeutic method has its advocates, and overall survival rates are similar for all treatments. Radiotherapy, however, is less expensive. We review the magnitude of these diseases, therapies available and relevant cost-effectiveness studies. When this sort of scientific information is not taken into account, the physician's decision of which therapy to choose is sometimes blinded by the prejudices and fears of the patient. PMID- 10147002 TI - Drug cost containment at a large teaching hospital. AB - Faced with a reduction in the 1990-91 pharmaceutical budget despite escalating prices, decisive cost-saving measures had to be implemented in our 1500-bed state funded teaching hospital. 15 drug categories were reviewed by the Medicines Control Committee in conjunction with specialist work groups based on a detailed audit of the previous year's pharmaceutical expenditure. The usage of medicines was rationalised by paying particular attention to expensive agents, substitution of less expensive alternatives, deletion of nonessential drugs from the formulary, restriction of certain medicines and by imposing fixed budgets. 65 items were deleted from the hospital formulary. The previous trend of an increase in annual expenditure was reversed during the 1990 to 1991 financial year; for the first time, it was less than the allocated budget. The 20 pharmaceuticals making the greatest contribution to the drug bill comprised 31% of total expenditure in the 1989 to 1990 financial year and 26% in 1990-91 and declined from R7.4 million to R5.7 million during this period, a decrease of 23%. A decrease in expenditure was realised in 14 of the 15 categories reviewed. Overall a 20% saving, or R3.3 million, was achieved for these categories. PMID- 10147003 TI - Regulation of the pharmaceutical industry and now pharmacoeconomic research? PMID- 10147004 TI - The economics of screening for measles. PMID- 10147005 TI - Dementia: a costly problem. PMID- 10147006 TI - Pharmacoeconomic considerations in antiarrhythmic therapy. AB - Recently, the Cardiac Arrhythmia Suppression Trial (CAST) has focused attention on the morbidity and mortality that may be associated with pharmacological antiarrhythmic therapies. While the severity and frequency of adverse effects vary among the available agents, it is uncertain whether initial therapy with one agent is preferable to that with another when efficacy, incidence of adverse effects and costs of treating these adverse effects are examined. Moreover, it is uncertain whether pharmacotherapy is more cost-effective than other strategies. PMID- 10147007 TI - Cost-effectiveness analysis of treatment with liposomal amphotericin B versus conventional amphotericin B in organ or bone marrow transplant recipients with systemic mycoses. AB - Economic appraisal of pharmaceuticals is becoming increasingly important. In a retrospective study of patient records from 58 organ or bone marrow-transplanted patients with systemic mycoses, the cost-effectiveness of treatment with a liposomal amphotericin B formulation was compared with that of conventional amphotericin B. Treatment with liposomal amphotericin B results in fewer adverse reactions, increased life expectancy and higher costs than treatment with conventional amphotericin B. Pricing liposomal amphotericin B at about SKE6000 per patient treatment day will result in an additional cost per life-year gained of about SEK150 000 relative to that using conventional amphotericin B for patients receiving kidney, kidney and pancreas, or pancreas transplants. For liver and bone marrow transplant (BMT) recipients the marginal cost-effectiveness ratio was about SEK195 000 and SEK150 000 per life-year gained. Compared with alternative use of resources in society and health care, use of liposomal amphotericin B rather than conventional amphotericin treatment can be considered cost-effective at the price assumed. PMID- 10147008 TI - Quality-of-life assessment in small cell lung cancer. PMID- 10147009 TI - Economic constraints and prescribing patterns in New Zealand. PMID- 10147010 TI - Review of cost-benefit analyses of influenza vaccine. AB - Vaccination is an underutilised, low cost and effective method of preventing illness. Cost-effectiveness analysis discloses a beneficial role of influenza vaccination in preventing illness especially in patients over 65 years of age and in high risk patients. In one large study, when 150 million doses of influenza vaccine were given between 1971 and 1977 in the US, over 13 million more years of life were gained at a cost of only $US63 per year of life gained (1978 dollars). The vaccination programmes also resulted in productivity gains of approximately 5 million days which was valued at $US250 million. Other studies from Canada, Finland and the US found similar benefits. The findings of these studies are reviewed. In order to increase the use of influenza immunisation substantially, there has to be a greater acceptance of the value of immunisation by healthcare providers and the public. PMID- 10147011 TI - Economic evaluation of treatments for respiratory disease. AB - Considerable quantities of health service resources are being devoted to tackling the problems posed by respiratory diseases and this can be expected to continue as the prevalence of such diseases increases. This paper provides an assessment of the most efficient use of these healthcare resources by reviewing the literature on economic evaluation relating to interventions in the field of respiratory medicine. Currently, this literature largely comprises cost minimisation studies of both management and educational interventions. Asthma educational interventions, whether targeted at adults or children, appear to be effective in improving patient self-management and adherence to medications, and appear to be associated with a lower overall use of healthcare resources. In terms of management interventions the overall picture is rather less clear although there is some support for the greater efficiency of patient administration of beta-adrenergic agonists by metered dose inhalers over therapist-administered up-draft nebulisation. Two features of respiratory disease make evaluation in this field somewhat unusual: there are alternative methods of delivering therapy to patients, which makes patient compliance an important issue, and since most respiratory diseases are chronic conditions the long-term effectiveness of interventions must be assessed. The scarcity of cost effectiveness and cost-utility studies in this field may, in part, reflect the difficulties of measuring outcomes in respiratory disease. PMID- 10147012 TI - Prescription cost sharing: economic and health impacts, and implications for health policy. AB - Cost sharing for prescription pharmaceuticals--in the form of copayments, coinsurance, or deductibles--is now common in healthcare systems throughout the world. Although there are no studies that directly or convincingly measure the effects of prescription cost sharing on health status or treatment outcomes, cost sharing does appear to reduce utilisation of pharmaceuticals; however, more information is required concerning the relationship between cost sharing and prescription-filling behaviour. Additionally, outcomes studies are needed to define appropriate and inappropriate cost-sharing levels for particular groups of patients, based on income, disease, employment status, and other factors. Cost sharing for pharmaceuticals and other medical services is likely to increase in the near future. As a result, consumers will have a greater role in treatment decisions and will also become more interested in knowing the value of the medicines they are asked to purchase. They are therefore likely to demand pharmaceutical products that are more cost-effective and products that improve quality of life. The increased implementation of cost-sharing programmes necessitates the adoption of appropriate cost-sharing policies, which incorporate the following general principles: 1. Consumers must be provided with the information required to make informed decisions, including the value of the medication, its importance in the treatment plan, and the consequences of not having the prescription filled. 2. Aggressive or abusive cost-sharing features that deny access to optimal pharmaceutical therapy must be avoided. 3. Inappropriate cost sharing, either fixed level or percentage of the prescription cost, may affect disease control and ultimately health or functional status. 4. Cost sharing restricted to pharmaceuticals may encourage replacement of drug therapy with more expensive forms of treatment; therefore, cost sharing should apply to the full range of medical services to prevent service substitution. PMID- 10147013 TI - Consumption of antibiotics in Sweden, 1975 to 1992: pharmacoeconomic and clinical aspects. AB - Using official statistics for the consumption of antibiotics in Sweden during the period 1975 to 1991, the pharmacoeconomic consequences were analysed. An increase of more than 25% in Swedish consumption of antibiotics during the study period was found. There is no obvious clinical explanation; indeed, improved hospital hygiene as well as decreased frequencies of some common bacterial infections should have resulted in a decrease in total consumption. Overconsumption was most marked for oral antibiotics. In 1991 the most often used antibiotic, phenoxymethylpenicillin, was given in about 20 million defined daily doses (DDD), corresponding to 2.4 DDDs per member of the population per year. From a pharmacoeconomic viewpoint, this overconsumption is acceptable because the drug has a low price and causes a minimum of severe adverse reactions. More serious is the marked misuse of tetracyclines (12 million DDDs in 1991) and macrolides (5.3 million DDDs in 1991), with which adverse reactions are more common, and where the high consumption has led to increasing frequencies of resistance among common bacterial pathogens. This emergent resistance often leads to a need to use newer more expensive antibiotics, in addition to the costs resulting from therapeutic failures of the initial treatment. Of the parenteral antibiotics, the cephalosporins, particularly cefuroxime, dominate in Sweden. The introduction of 'diagnosis-related groups' (DRGs) for reimbursement of hospitals for in-patient care is likely to result in the development of antibiotic use in 'intensive home care' as has occurred in the US.(ABSTRACT TRUNCATED AT 250 WORDS) PMID- 10147014 TI - Defining quality of life. PMID- 10147015 TI - Recombinant granulocyte colony-stimulating factor (rG-CSF): pharmacoeconomic considerations in chemotherapy-induced neutropenia. AB - Recombinant granulocyte colony-stimulating factor (rG-CSF) therapy is associated with a dose-proportional reduction in the frequency, duration and severity of neutropenia associated with cytotoxic chemotherapy. This is associated with a decrease in the incidence of infection, with subsequent reductions in the number of hospitalisations, days of hospitalisation and antibiotic requirements. These effects produce marked reductions in costs, and could contribute substantially towards offsetting the costs of rG-CSF, although the magnitude of the savings will vary between institutions and with the chemotherapy regimen used. Other benefits include a reduction in the frequency and severity of mucositis, and an improved patient quality of life. However, further research is required to evaluate other potentially important considerations including the targeting of specific patient populations (e.g. those receiving regimens with a curative intent), and additional improvements in patient quality of life and, perhaps, mortality. Thus, although specific pharmacoeconomic analyses are limited, preliminary evidence indicates that rG-CSF, administered prior to the onset of neutropenia in patients receiving cytotoxic chemotherapy, can provide cost reductions both from an institutional and a payor perspective, with even greater potential savings from a societal viewpoint. PMID- 10147016 TI - A review of cost-effectiveness analyses of hypertension treatment. AB - In this paper cost-effectiveness analyses of hypertension treatment are reviewed. Nine studies using life-years gained or quality-adjusted life-years gained as outcome measure are identified, summarised, and their results analysed. It is noted that there is a lack of methodological conformity between the studies, which makes comparisons difficult. The only consistent finding among the studies is that the cost-effectiveness increased with higher pretreatment blood pressure. The studies also indicated that treatment of hypertension is more cost-effective in younger men than in younger women, and that cost-effectiveness increases with age for both men and women. It is impossible at present to draw any policy conclusions from the cost-effectiveness analyses comparing different drugs, owing to poor methodology and insufficient data. For the future it is important to upgrade the quality of the cost-effectiveness analyses in this area by improving both the data and the methodology used. There is also a need to complement cost effectiveness analysis with other approaches, for example willingness to pay. PMID- 10147017 TI - Institutional formularies: the relevance of pharmacoeconomic analysis to formulary decisions. AB - Formularies, in one form or another, have been in existence for nearly 100 years. Beginning simply as a list of available agents, the formulary has evolved into a complex system which acts as a guide to prescribing practices. As the importance of the formulary has increased, so has the need for formulary managers to make an appropriate decision about each drug's formulary status. Several systematic approaches to drug evaluations have been developed to aid in the decision process. However, while some reviews of drug utilisation contain fairly rigorous analyses of their clinical efficacy, very few include an economic evaluation that goes beyond the cost of drug acquisition, preparation, distribution and administration. This is surprising, since formulary managers rank economic data second only to clinical data when making formulary decisions. In the past this apparent oversight has been due, in part, to the absence of a sophisticated model which can both approximate a drug's true economic impact and express cost and quality in similar terms. The explosion of new and very expensive biotechnology drugs into the market has the potential to improve patient care significantly. Such drugs also have the potential to increase institutional pharmacy budgets significantly; with some analysts predicting a spending of $US60 million yearly for these drugs by the year 2000, critical evaluation will be mandatory. Fortunately, advances in the relatively new science of pharmacoeconomics have made it possible to conduct appropriate estimates of the true economic impact of new drug therapies. Pharmacoeconomic studies can be very useful in evaluating drugs for formulary inclusion and in assessing the effects of formulary changes on institutional budgets. Cost-effectiveness and cost-benefit analyses, utilising decision analysis models and/or data gathered from clinical studies, are used most frequently. Relatively simple models can be used to evaluate drugs within the same class if sufficient published data on their clinical efficacy and safety are available. More complex analyses are necessary when comparing dissimilar agents or when comparing agents with non-drug therapy. Pharmacoeconomic studies have frequently been used to demonstrate that very substantial direct costs of drug therapy are often offset by equal or greater reductions in other institutional direct and indirect patient care costs. Pharmacoeconomic studies have also been used to calculate the relative cost effectiveness of drug therapies for different disease states, although such evaluations are more useful to governmental and regulatory agencies than to individual institutions.(ABSTRACT TRUNCATED AT 400 WORDS) PMID- 10147018 TI - Meta-analysis and quality of evidence in the economic evaluation of drug trials. AB - Meta-analysis is an important part of assessing cost-effectiveness in that it may help determine which treatments are indeed effective and estimate the level of effectiveness of each. Meta-analysis uses the data from all the relevant trials and is a powerful tool for detecting effects too small to be picked up by individual trials. The assessment of quality of studies in a meta-analysis is critical, with priority needing to be given to high quality randomised studies. A written protocol, literature retrieval system, evaluation and selection criteria, choice of endpoints and ways to evaluate bias must all be pre-defined. Nevertheless, problems can arise when meta-analysis is used for cost effectiveness analysis, due to variation in study medication protocols, duration of follow-up, and difficulties in interpreting patient subgroups and compliance. Despite being subject to the design flaws of both the trials analysed and the methods used in the analysis itself, meta-analysis provides a more objective and thorough means of evaluating effectiveness and hence the cost-effectiveness of treatments. Based on the meta-analysis evidence, we recommend that the current QALY league tables be split into an implementation table for clearly effective therapies, and a research priority table where the evidence of treatment effectiveness is less clear and more research is needed. PMID- 10147019 TI - Potential cost savings of oral versus intravenous etoposide in the treatment of small cell lung cancer. AB - An economic analysis was conducted on a randomised multicentre study comparing the use of intravenous (IV) etoposide versus oral etoposide treatment regimens in patients with small cell lung cancer. 41 patients received cisplatin 100 mg/m 2 intravenously (IV) on study day 1 and etoposide 120 mg/m 2 IV on study days 1, 2, and 3 (IV regimen); and 42 patients received cisplatin 100 mg/m 2 IV and etoposide 120 mg/m 2 IV on study day 1 and 240 mg/m 2 orally (equivalent to 120 mg/m 2 IV) on study days 2 and 3 (oral regimen). The results of the study from which these data were extracted showed equal efficacy between groups. Based on a retrospective review of resource use in the clinical trial, patient healthcare costs were examined in the following areas: antineoplastic drugs, IV fluids, supplies used for chemotherapy administration, and chemotherapy administration procedure fees. The total cost per course of therapy was $US2002 for the IV regimen and $US1653 for the oral regimen. This represented a 17% savings for patients receiving the oral regimen. PMID- 10147020 TI - Cost-effective prescribing in elderly people. PMID- 10147021 TI - Health-related quality of life assessment and the pharmaceutical industry. AB - Concerns about cost containment in healthcare and interest in the impact of medical treatment on patient health status and well-being have increased the emphasis on health-related quality of life (HRQOL) research. HRQOL assessment as part of the development and evaluation of pharmaceuticals is a reality and is likely to increase over time. HRQOL studies may assist industry in the regulatory approval process, for marketing purposes, and to assist physicians and healthcare managers in making decisions about alternative drug therapies. HRQOL studies provide physicians with complete information about the benefits and risks of drug treatments in terms of patient physical, psychological, and social functioning and well-being. HRQOL measures, especially health utility assessments, can contribute to defining health outcomes in cost-effectiveness analyses. HRQOL studies need to be planned early in the drug development process and careful attention must be made to selecting comparative medical treatments, instrumentation, data collection protocols, length of follow-up, and sample size for these studies. It is important to address issues of investigator and other sources of bias. There is evidence that the pharmaceutical industry is increasing the use of HRQOL outcomes in clinical studies. Healthcare decision makers, physicians and patients are demanding that industry demonstrate the impact of a new drug on patient HRQOL in addition to safety and efficacy. Clearly, HRQOL represents an important indicator of the benefit of pharmaceuticals. PMID- 10147023 TI - Cost-utility analysis of early thrombolytic therapy. AB - 167 patients suffering from acute myocardial infarction (AMI) were recruited from 12 cardiology centres and given thrombolytic treatment. Cost-utility analyses were performed and a cost-utility ratio was computed according to time of initiation of thrombolysis after the AMI and the location of the infarct. Early thrombolysis ( less than 3 hours) proved to cost about the same per QALY ($US3734 vs $US3577) as late thrombolysis ( greater than 3 hours), although posterior infarcts cost slightly more per QALY ($3433 vs $2996) than anterior infarcts. Quality of life coefficients for all patients after the AMI were judged to be about 40% less than before the AMI. Thus, in terms of resources consumed and patient well-being, time of treatment initiation or location of the infarct were less significant than the fact of having an AMI. In terms of quality of life, the best strategy is that which seeks to prevent AMI occurring. PMID- 10147025 TI - Should indirect costs and benefits be included? PMID- 10147024 TI - Imipenem/cilastatin: a pharmacoeconomic appraisal of its use in intra-abdominal infections. AB - Imipenem/cilastatin possesses a very broad spectrum of antibacterial activity that encompasses the range of Gram-negative and Gram-positive aerobes and anaerobes usually associated with intra-abdominal and other polymicrobial infections. Its therapeutic efficacy is comparable to that of aminoglycoside/antianaerobe combination regimens, and the most commonly reported adverse effects are similar to those of other beta-lactam antibacterials and are generally of a non-serious nature. The acquisition cost of imipenem/cilastatin is generally greater than that of aminoglycoside/antianaerobe combination regimens, but treatment with the latter incurs the additional costs of multiple intravenous administration, aminoglycoside pharmacokinetic and other monitoring, and possible nephrotoxicity and ototoxicity. The available pharmacoeconomic studies show a trend towards lower total treatment costs with imipenem/cilastatin compared with gentamicin plus clindamycin. Results from other sources suggest that imipenem/cilastatin may achieve further cost savings through reduced duration of hospitalisation. Although further study is required to confirm these trends, it appears that the total treatment cost of imipenem/cilastatin does not exceed that of usual combination therapy and the risk of aminoglycoside-induced toxicity is avoided. PMID- 10147022 TI - Pharmacoeconomics of antibacterial treatment. AB - Antibacterial drugs account for between 3 and 25% of all prescriptions, between 6 and 21% of the total market value of drugs in a single country, and up to 50% of the drug budget in hospitals. Bacterial infection is widely perceived as disease caused by harmful outside agents which can be isolated and tested to select the best drug for treatment. In fact, the need for any treatment and the pros and cons of different drugs are just as debatable as in any other therapeutic area. Moreover, the bacteria which make up the normal flora of the body fulfil important roles, so that the ecological implications of treatment for the individual and for society should be considered in assessing the costs and consequences of antibacterial treatment. In this review we outline the most important issues relating to the treatment of bacterial infection in the community and in the hospital, contrasting information from developed and developing countries where appropriate. We review the existing literature on economic evaluation, but in general most of the literature deals with containing the costs of antibacterial drugs in hospitals, and there are many gaps in the literature on cost-effectiveness of treatment. Consequently there are still extreme variations in medical practice which present a challenge for future evaluation. As the outcomes of antibacterial treatment are apparent in a few weeks or months, this is an ideal field for testing pharmacoeconomic methodology. The desire to overcome medical practice variation through consensus statements should be avoided. Instead we recommend wider application of decision analysis to acknowledge that choices exist for the diagnosis and treatment of bacterial infection and to gather information about the implications of these choices. Much of the existing literature would be improved by a more explicit definition of costs. Direct costs to the health services should be distinguished from non medical costs. Moreover, the analysis should consider whether savings from one budget result in costs to another health service budget, or to the patient (transfer costs). These deficiencies in cost analysis will be relatively easy to correct. Of more concern is the fact that the efficacy of much antibacterial treatment is either totally debatable, or variable, depending on factors such as the type of patient treated or the quality of delivery of treatment.(ABSTRACT TRUNCATED AT 400 WORDS) PMID- 10147026 TI - Indices of therapeutic outcome in pharmacoeconomic evaluation of drug therapy. PMID- 10147027 TI - The pharmacoeconomics of HIV disease. AB - Human immunodeficiency virus (HIV) infection is a major public health problem in all parts of the world. For the United States, federal spending on HIV disease for 1982 to 1989 was $US5.5 billion. Projections indicate that AIDS spending may reach 1.6% of total health expenditures in 1992, while the indirect costs of HIV infection may be 5 times as great as the direct costs. In the developing world, the cost per person with HIV infection may be 0.8- to 9-fold greater than the per capita gross national product (GNP). Pharmacoeconomic analysis has been used to assess 2 important therapeutic options in caring for HIV patients: zidovudine therapy for asymptomatic illness, and prophylaxis for Pneumocystis carinii pneumonia (PCP). The cost-effectiveness ratio for zidovudine therapy, $US6553 to $US70 526 per year of life saved, compares favourably with ratios for other medical therapies. Prophylaxis against Pneumocystis carinii pneumonia has been shown to be most efficient using oral dapsone or cotrimoxazole (trimethoprim sulfamethoxazole). Pharmacological therapy for HIV is costly, however, and may limit the access to new therapies for patients in the developing world. Concurrent economic assessment of therapies during phase III trials may serve as an essential part of the research that will advance international efforts to combat this disease. PMID- 10147028 TI - Selection of items and avoidance of bias in quality of life scales. AB - The total score of a quality of life (QOL) questionnaire reflects the items that make up the questionnaire. Although different questionnaires have strikingly similar items, the balance between types of items can affect research outcomes. Four general quality of life (QOL) scales and one specific scale may be compared to show how the balance of items can bias the results to: (a) increase or decrease the chance of obtaining a significant result in a clinical trial; (b) make one treatment appear better or worse compared with that of a competitor; (c) make the QOL of one disease category appear better or worse than that of another disease category. Healthcare decision-making should be based on relatively unaggregated measures of health. PMID- 10147030 TI - Utilisation of psychotropic drugs in patients of the long stay ward. AB - A survey of the prescribing of psychotropic drugs was carried out at the Psychiatric Hospital of Bahrain. This retrospective study on 60 inpatients of the Long Stay Ward revealed a man:woman ratio of 2.7. 91% of the men and 88% of the women were over 40 years old. 44 of the 60 patients had a diagnosis of schizophrenia, the rest had dementia, depression, schizoaffective disorders, drug induced psychosis, general paralysis or Huntington's chorea. 95% of patients received antipsychotic drugs. Thioridazine was the most common drug followed by chlorpromazine. The mean number of drugs/patient was 1.7, with 41.7% of patients receiving only 1 drug. Tardive dyskinesia was observed in 11 patients and 9 experienced varying degrees of tremor. The findings confirm that psychiatric illness treated by psychiatrists need not lead to polypharmacy. As a consequence, its treatment may be less likely to result in adverse reactions than when patients are treated by general practitioners. PMID- 10147029 TI - A review of limited lists and formularies: are they cost-effective? AB - The 'limited list' or 'formulary' concept has been used to promote rational use of drugs and to set standards for drug use. Recently the concept has been aimed more toward containment of drug costs. Effective hospital formulary systems assist in purchasing and inventory management. Application of the formulary concept has resulted in savings within specific classes of drugs and in total hospital drug costs. Key features which promote effectiveness are development of policies by prescriber consensus and continued education along with feedback on drug usage. The formulary concept also provides a foundation for appropriate use of drugs in hospitals. In the community setting, limited lists can achieve cost savings and can assist in the rational use of drugs. National limited lists have been less successful in controlling overall drug costs, probably because they have focused on economic effects, rather than education, feedback or user participation. Properly organised drug rationalisation policies embracing the limited list concept can improve health outcomes by promoting rational drug use. They can also contain or reduce drug costs. PMID- 10147031 TI - The economics of an intensive education programme for asthmatic patients: a prospective controlled trial. AB - The costs and benefits of a planned patient education programme for patients with asthma were evaluated in a controlled trial. The patient education group received a planned patient education programme, performed by a physician, a pharmacist and a nurse over a 6-month period. Changes in the use of resources, productive output and in health status were measured for the patient education group and the control group. The total cost for planning, implementation and evaluation of the programme was 14074 British pounds sterling. The patient education group increased its contacts to general practitioners and the extra costs totalled 252 British pounds sterling. The increased costs of drugs used by the patient education group in the 6-month period was 2313 British pounds sterling compared with costs in the control group. The number of days lost through sickness decreased in the patient education group, corresponding to a 4528 British pounds sterling saving of otherwise lost earnings. The quality of life increased in the patient education group by 3.2 points on the Psychosomatic Discomfort Scale (2.9%). Health status increased by 38.9%. The study shows that the patient education programme has a positive clinical effect on the patient's quality of life and health status. The economic consequences of the implementation programme depend on the specific setup of the local healthcare system, where the programme is applied. PMID- 10147032 TI - Cost-effectiveness of simvastatin versus cholestyramine: results for Sweden. AB - Cost-effectiveness ratios were estimated for each of 2 plasma cholesterol lowering drug therapies, the HMG-CoA reductase inhibitor simvastatin and the well established cholestyramine, in comparison with a nonpreventive drug treatment alternative. The study was confined to Swedish men (aged 37 to 64 years at start of therapy) with total serum cholesterol levels above 6.2 mmol/L who were free of coronary artery disease (CAD). Costs included expected direct costs of plasma cholesterol-lowering treatment less expected savings resulting from preventing CAD. Effects were defined as changes in life expectancy. A discount rate of 5% and Swedish kronor (SEK) 1988 prices were used. The impact on CAD risks was calculated using multivariate logistic risk estimates from the Framingham Heart Study; Swedish estimates were used to calculate intervention costs and changes in healthcare costs. Over the range of cholesterol levels examined (6.2 to 9.8 mmol/L), simvastatin was consistently more cost-effective than cholestyramine. PMID- 10147033 TI - Why a journal of pharmacoeconomics? PMID- 10147034 TI - The changing healthcare environment: socioeconomic evaluation of drug therapy. PMID- 10147035 TI - Economic evaluation of pharmaceuticals: science or marketing? PMID- 10147036 TI - Economic evaluation of drugs: a UK pharmaceutical industry perspective. PMID- 10147037 TI - Principles of pharmacoeconomic analysis of drug therapy. AB - Economic analyses have become increasingly important in healthcare in general and with respect to pharmaceuticals in particular. If economic analyses are to play an important and useful role in the allocation of scarce healthcare resources, then such analyses must be performed properly and with care. This article outlines some of the basic principles of pharmacoeconomic analysis. Every analysis should have an explicitly stated perspective, which, unless otherwise justified, should be a societal perspective. Cost minimisation, cost effectiveness, cost-utility and cost-benefit analyses are a family of techniques used in economic analyses. Cost minimisation analysis is appropriate when alternative therapies have identical outcomes, but differ in costs. Cost effectiveness analysis is appropriate when alternative therapies differ in clinical effectiveness but can be examined from the same dimension of health outcome. Cost-utility analysis can be used when alternative therapies may be examined using multiple dimensions of health outcome, such as morbidity and mortality. Cost-benefit analysis requires the benefits of therapy to be described in monetary units and is not usually the technique of choice. The technique used in an analysis should be described and explicitly defended according to the problem being examined. For each technique, the method of determining costs is the same; direct, indirect, and intangible costs can be considered. The specific costs to be used depend on the analytical perspective; a societal perspective implies the use of both direct and indirect economic costs. A modelling framework such as a decision tree, influence diagram, Markov chain, or network simulation must be used to structure the analysis explicitly. Regardless of the choice of framework, all modelling assumptions should be described. The mechanism of data collection for model inputs must be detailed and defended. Models must undergo careful verification and validation procedures. Following baseline analysis of the model, further analyses should examine the role of uncertainty in model assumptions and data. PMID- 10147038 TI - Pharmacoeconomic evaluation of risk factors for cardiovascular disease: an epidemiological perspective. AB - Over the past 30 years the identification of high blood pressure and hypercholesterolaemia as major predictors of cardiovascular disease has led to an increasing expenditure on healthcare costs in pharmacological treatment of these risk factors. Most of the cost has been due to antihypertensive treatment, but evidence from randomised trials of the benefits of cholesterol-lowering drugs, along with the introduction of therapies with fewer side effects, suggests that expenditure on cholesterol treatment will rise dramatically. Cost-effectiveness analyses can aid decision making in the use of these treatments. For both hypertension and hypercholesterolaemia, the most favourable cost-effectiveness ratios were found in late middle age, in men compared to women, at the highest level of the risk factor, and in subjects with multiple risk factors. The most cost-effective treatments appear to be those which were the cheapest and which also produced the largest reductions in the risk factor. However, certain findings were based on assumptions which may be invalid. The most important of these in hypertension, and to a lesser extent in hypercholesterolaemia, is that different treatments have similar effects on morbidity and mortality for a given level of risk reduction. Experimental evidence that might confirm or refute this is not available for most treatments of hypertension. Moreover there are no trials in women or in the elderly of cholesterol-lowering treatments. The burden of disease due to these risk factors has been underestimated, and further research is required to establish the benefits of treatment on prevention of conditions such as heart failure, peripheral vascular disease, and vascular dementia. PMID- 10147039 TI - Economic analysis as an aid to subsidisation decisions: the development of Australian guidelines for pharmaceuticals. AB - Factors governing the entry of new drugs into clinical practice are changing, with increasing emphasis on economic issues. In future, organisations that subsidise the use of pharmaceuticals are likely to require sponsors to provide evidence of the cost-effectiveness of their products. The first national government to signal such an intention is the Commonwealth Government of Australia, which from January 1993 will require economic analyses in support of applications for listing of new pharmaceutical products on its schedule of pharmaceutical benefits. This move is underpinned by legislation that requires the country's Pharmaceutical Benefits Advisory Committee (PBAC) to consider costs and effectiveness when recommending listing of new drugs. The approach that has been recommended to the Committee is based on advice from a group of consultants, health economists and clinicians. The PBAC will use economic analyses as an aid to decision-making that will remain within a clinical framework; the viewpoint will be societal, and analyses will include costs that fall outside the pharmaceutical benefits scheme. The preferred approach is comparative cost effectiveness analysis with a particular emphasis on the marginal costs of obtaining additional health benefits with new drugs, compared with existing therapies. The use of analyses that are restricted to potential cost savings with new drugs is discouraged, as is the inclusion of indirect costs and benefits. To facilitate the conduct of economic analyses, it is planned to hold meetings with specialist clinicians to obtain consensus on a range of intermediate clinical outcome indicators, and to publish lists of 'standard' Australian costs that will be updated regularly. The approach being followed in Australia has implications for both the government and the pharmaceutical industry. The responsibility for monitoring the effects of this new policy lie with the government. The success, or otherwise, of the policy should not be gauged simply by the effects on the price of new drugs which, historically, have been relatively low in Australia. A full evaluation will require that more effort be put into clinical outcomes research and the development of population databases, an area in which Australia lags behind other countries. PMID- 10147040 TI - Injustices in the healthcare system: are the wealthier healthier? PMID- 10147041 TI - Pharmaceutical formulation and healthcare expenditures. PMID- 10147042 TI - Economic evaluation of pharmaceuticals: a critical appraisal of seven studies on cholesterol-lowering agents. PMID- 10147043 TI - Principles of quality of life assessment in cancer chemotherapy. PMID- 10147044 TI - Ondansetron: a pharmacoeconomic and quality-of-life evaluation of its antiemetic activity in patients receiving cancer chemotherapy. AB - Ondansetron is more effective than high-dose metoclopramide in the prevention of acute nausea and vomiting due to highly emetogenic chemotherapy, and, unlike metoclopramide, is rarely associated with extrapyramidal effects. Pharmacoeconomic analyses have demonstrated that, in specified clinical settings, ondansetron (8mg 4-hourly for 3 doses or 8mg followed by 1 mg/h for 24 hours) is equally cost-effective as high-dose metoclopramide (3 mg/kg followed by 0.5 mg/kg/h for 8 hours) in the prophylaxis of emesis in patients receiving highly emetogenic chemotherapy, at an acquisition cost 4- or 5-fold higher than that of the metoclopramide regimen. Furthermore, the combination of dexamethasone plus ondansetron has been shown to be more effective than ondansetron monotherapy in controlling emesis. In patients receiving high-dose ( greater than 50 mg/m2) cisplatin-based chemotherapy, antiemetic therapy with ondansetron (8mg intravenously as a single dose) plus dexamethasone (16mg total intravenous dose) was shown to be more cost-effective than the combination of high-dose metoclopramide (11 mg/kg total intravenous dose), dexamethasone (8mg intravenously as a single dose) plus lorazepam (1 to 1.5mg intravenously as a single dose). In a limited number of studies, quality-of-life scores, as assessed using the Rotterdam Symptom Checklist or the Functional Living Index- Emesis instrument, were significantly higher with ondansetron than with other antiemetic agents, including metoclopramide. Together, these results suggest that ondansetron, as an alternative to antiemetic regimens including high-dose metoclopramide, is appropriate cost-effective therapy for the prevention of acute nausea and vomiting in patients receiving highly emetogenic chemotherapy. Ondansetron is effective in controlling acute emesis associated with moderately emetogenic chemotherapy, and its use in this clinical setting may best be reserved for patients who have not responded well to previous antiemetic therapy with more traditional agents. However, poorly controlled emesis can lead to anticipatory nausea and vomiting in subsequent courses of chemotherapy, thus, consideration should also be given to the use of ondansetron in patients receiving moderately emetogenic chemotherapy, although further pharmacoeconomic investigations are required to clarify its use in this clinical setting. PMID- 10147045 TI - Economic factors in the initiation of antihypertensive therapy. AB - Optimal management of hypertension involves finding a balance among its benefits, risks and costs. Cost-effectiveness analysis helps to clarify not only the trade offs between the costs and benefits of treatment, but also the trade-offs between the risks and benefits, and the costs and quality of therapy. Existing analyses of hypertension treatment suggest a consistent set of strategies by which cost effectiveness may be improved. These include strategies to increase the effectiveness of therapy, such as excluding false-positive diagnoses of hypertension, and according higher priority to treating patients with sustained elevations of diastolic blood pressure above 100mm Hg. A complementary set of strategies involve reducing the costs of therapy by prescribing lower-cost first step regimens, making use of the minimum effective dose for particular medicines and attempting step-down therapy for suitable patients. Consideration of economic factors in initiating hypertension treatment is consistent with sound clinical practice. PMID- 10147046 TI - Impact of consumer fees on drug utilisation. AB - A review of research on consumer fees for drugs and drug utilisation suggests that the demand for drugs tends to be quite insensitive to consumer fees. Although higher consumer fees are associated with slightly reduced rates of drug utilisation, use of most other medical services is not meaningfully affected and health status has not been shown to be adversely affected. The larger impact of consumer fees demonstrated in the published literature is to shift drug costs from third parties to consumers. Since much of the literature is limited to insurance programmes with quite small consumer fees, the generalisability of results may be limited. Ability-to-pay and health needs may also be important considerations in the relationship between use and fees for particular drugs. PMID- 10147047 TI - The costs of medical injury. PMID- 10147048 TI - The Australian Guidelines for subsidisation of pharmaceuticals: the road to cost effective drug prescribing? PMID- 10147049 TI - Medicaid drug utilisation review under OBRA 1990: current issues and future directions. PMID- 10147051 TI - The costs and benefits of switching a drug from prescription-only to over-the counter status: a review of methodological issues and current evidence. AB - In recent years various governments, pharmacy associations, consumer groups and the pharmaceutical industry have suggested that more drugs should be switched from prescription-only (Rx) to over-the-counter (OTC) status. Many rationales have been offered, including lowering healthcare costs, taking advantage of pharmacists' training and knowledge, promoting the concept of prevention and self care, and increasing sales of pharmaceuticals. The purpose of this article is to examine the current state of knowledge on assessing the effects of such a change. First, the paper discusses the methodology and data necessary for conducting an assessment of the costs and benefits of switching a drug from Rx to OTC status. Basically two methods, the economic theory of consumers' surplus and the epidemiological approach, are available; the choice of method depends on the drug examined and the data available. Secondly, the article discusses existing evidence pertaining to the costs and benefits of these switches. Based on our review of the literature, we conclude that the benefits, to individual consumers and to society as a whole, resulting from a change in prescription status outweigh the costs. The extent of the benefits depends on the type of drug and the size of the market. PMID- 10147050 TI - Optimising the economic efficiency of drug studies. AB - The cost of the development of a new drug product, from concept and synthesis of a new chemical entity to safety and efficacy testing, to the approval process and postmarketing surveillance, has more than quadrupled in the last 20 years. To amortise these costs, the pharmaceutical industry has taken on international dimensions. These efforts will not be enough. This review outlines many cost saving and cost-containment suggestions that have been instituted or that need to be instituted in order to bring cost-effective drug therapy to individual patients. As the cost of illness continues to increase worldwide, it is imperative that new and cost-effective medications be developed and brought to worldwide markets. This article considers components of the drug discovery and development processes which are likely to be inefficient and correctable. It further reviews current knowledge about the conduct of different parts of the processes, including different types of clinical trials and proposals that have been made to address these in an efficient manner. Documented and proposed cost containment measures are presented, using several large scale trials as examples. Particular emphasis is placed on statistical methods and their contribution to either efficiencies or inefficiencies. No facet of the drug/product development should be overlooked in the attempt to reduce costs, from reducing the time it takes to bring a product to market to simple but too-frequently occurring errors, such as failing to have trial material at hand at the optimum time. PMID- 10147052 TI - Clinical and economic evaluation of benzodiazepines: a value analysis. AB - Benzodiazepines are one of the most frequently prescribed classes of medications in the world. Thought to relieve the symptoms of anxiety, insomnia, epilepsy, and some less common conditions, these medications are supported by a body of clinical trials demonstrating efficacy. However, there is also literature that suggests problems of abuse and dependence, along with some serious adverse effects. The present article utilises a value-analysis strategy to outline the clinical efficacy and economic efficiency of benzodiazepines from a variety of perspectives including those of the patient, physician and manufacturer. Results of this analysis suggest that these medications are effective when used appropriately, but that implementation of appropriate use is difficult. Remedies to this situation are discussed. PMID- 10147053 TI - The economic impact of HA-1A (Centoxin) against endotoxin. AB - Monoclonal antibodies have been shown to reduce morbidity and mortality in selected subsets of patients with Gram-negative sepsis and/or septic shock. However, the acquisition costs of the antibody products are expected to be in the range of $US3500 to $US4000 per course of therapy and precise identification of patients who will benefit may be difficult. Therefore, the economic impact of these antibodies will be significant. We have performed a model cost effectiveness and cost-benefit analysis specific to our institution based on previously reported mortality figures. Our data suggest that the cost effectiveness of HA-1A (Centoxin) will be comparable with that of a variety of commonly used medical interventions, but will produce an incremental increase in costs of at least $US7000 per patient because of the acquisition cost of the drug, as well as an increase in numbers of survivors whose hospitalisation will be prolonged. PMID- 10147054 TI - Effect of biological and analytical variation in cholesterol measurement on the cost-effectiveness of cholesterol-lowering therapy. AB - A number of recently published studies on the cost-effectiveness of cholesterol lowering therapy use data from the Framingham Study to model the effect of cholesterol lowering on coronary heart disease risk. However, the risk estimates from the Framingham Study underestimate the association between coronary heart disease risk and serum cholesterol level because they do not account for intraindividual biological variation and analytical variation in cholesterol measurement. Cost-effectiveness studies that use these risk estimates are therefore likely to overestimate the cost per year of life saved of cholesterol lowering interventions. We have developed an algorithm that can be used to improve current estimates of the cost-effectiveness of cholesterol-lowering therapy. Our results show that adjusting for intraindividual biological variation and analytical variation lowers the cost per year of life saved by 17 to 29%, depending on sex, pretreatment cholesterol level, and age at initiation of therapy. PMID- 10147055 TI - The Australian Guidelines for subsidisation of pharmaceuticals. PMID- 10147056 TI - Recent advances in aerosol therapy. PMID- 10147057 TI - Drug delivery to the respiratory tract and drug dosimetry. PMID- 10147058 TI - Drug delivery via the respiratory tract. AB - Inhalation offers an enormous absorptive surface area for rapid drug absorption and substantial absorption of polypeptides. Due to slow clearance from the lower lung, even compounds with very small absorption rates can be absorbed in significant quantities over 10-12h periods. Aerosol dosimetry problems can also be minimized when lung-normal patients are considered. In the near future, optimal formulations will be combined with modified aerosol delivery devices to achieve reproducible dosing. These will be used as alternatives to parenteral delivery for drug doses of the order of milligrams or less. Research on the molecular structural dependence of lung disposition is in its infancy. Absorption kinetics for small molecules are known to depend on lipophilicity and molecular size. For macromolecules however, electronic charge and site of deposition may be additional determinants of bioavailability. Carrier-mediated absorption processes may also be important. The pulmonary absorption of a number of molecules is reviewed with special emphasis on new and promising products of biotechnology like human insulin and human growth hormone. Delivery improvements in the future should ensure, ideally, that nondenatured, monomeric pure compounds are delivered reproducibly and predominantly to the lung itself, so that these compounds may elicit reproducible systemic effects following absorption. PMID- 10147060 TI - Generation of aerosolized drugs. AB - The expanding use of inhalation therapy has placed demands on current aerosol generation systems that are difficult to meet with current inhalers. The desire to deliver novel drug entities such as proteins and peptides, as well as complex formulations including liposomes and microspheres, requires delivery systems of improved efficiency that will target the lung in a reproducible manner. These efforts have also been spurred by the phase out of chlorofluorocarbons (CFCs) and this has included a directed search for alternative propellants. Consequently, a variety of new aerosol devices and methods of generating aerosols are being studied. This includes the use of freon replacement propellants, dry powder generation systems, aqueous unit spray systems and microprocessor controlled technologies. Each approach has advantages and disadvantages depending upon each principle of action and set of design variables. In addition, specific drugs may be better suited for one type of inhaler device vs. another. The extent to which aerosol generation systems achieve their goals is discussed together with a summary of selected papers presented at the recent International Congress of Aerosols in Medicine. PMID- 10147059 TI - Aerosols as diagnostic tools. PMID- 10147061 TI - The insurance industry--a leader in the fight against AIDS. PMID- 10147062 TI - AIDS-related insurance claim experience. PMID- 10147063 TI - HIV antibody testing methods: 1985-1988. PMID- 10147064 TI - Beta-2 microglobulin as a marker for HIV infection. AB - Beta-2 microglobulin is a sensitive surrogate test for HIV infection for use in jurisdictions where HIV antibody tests are not allowed to be performed on life insurance applicants by law/regulation. The advantage of beta-2 microglobulin over T cell testing, which is a surrogate test also used by the life insurance industry for detecting HIV infection, is the stability of B 2M in serum over long periods of time. PMID- 10147065 TI - Statistical analysis of HIV seropositive results from 1988-1993 performed on life insurance applicants. AB - This review of statistical data, derived from HIV antibody testing performed on life insurance applicants over a period of five and one-half years, reflects the evolving nature of the HIV epidemic in the United States and demonstrates how the findings in the life insurance low risk population mirror the trends and changes that are occurring in the general population. PMID- 10147066 TI - The AIDS epidemic: update on laboratory statistics. PMID- 10147067 TI - The peace dividend. Part I. AB - As companies traditionally involved in manufacturing for the aerospace and defence sectors come to terms with shrinking markets, their need to diversify into new markets is apparent. The potential for crossover from the aerospace to medical sectors is striking, if not ironic, and the technology that helped produce weapons of destruction is now being put to good use improving the quality of life. This potential will be examined in two articles, the first concentrating on the use of titanium. PMID- 10147068 TI - The use of bar coding technology. AB - This is a brief overview of the use of bar code technology in the medical device industry drawn from information collected in the recent Medical Device Technology Packaging Survey. PMID- 10147069 TI - Sterilizers and the medical device directive. AB - There are a number of important issues currently facing the European Commission on the interpretation and implementation of the Medical Device Directive (MDD). One of these concerns medical device sterilizers used in hospitals, physicians' or dentists' offices, or other medical settings, and whether they should be regulated under the MDD. Any decision made on this issue could have important implications on future decisions of whether or not to include a product under the European medical device regulatory scheme. For this reason, the medical device industry in general, not only manufacturers of sterilizers, should be aware of this issue. The industry should also understand the implications of the resulting policies that may be developed. This article will point out some of the factors that could influence the European decision-making process. It will also provide information on the regulatory approach that the US Food and Drug Administration (FDA) has taken towards sterilizers. PMID- 10147070 TI - Cobalt-60: the heart of gamma-radiation sterilization. AB - Currently, more than three million cubic metres of single-use medical devices are sterilized by gamma radiation each year. The wide use of this method of sterilization is a result of the lethal effects of ionizing radiation on microbial populations and the penetrative powers of cobalt-60. This article describes how cobalt-60 is produced and used in gamma-radiation sterilization, and how it is disposed of once it has reached the end of its useful life. Cobalt 60 sources typically have a life of 20 years, at which point they are returned to the suppliers for re-encapsulation, reprocessing, recycling, or disposal. PMID- 10147071 TI - The use of clean-room technology in medical device manufacturing: a tool in the service of quality. Part II. AB - Part 1 of this two-part article outlined the contamination-control requirements for medical device manufacturing, and the basic technical concepts for effectively and economically achieving them. Part II provides four case studies that illustrate how the basic principles of clean-room technology can be translated into industrial practice. It features examples of controlled clean air manufacturing environments used in the production of injection cannulae, orthopaedic endoprostheses, heart pacemakers, and porcine aortic bioprostheses. PMID- 10147072 TI - Wound dressings in the 1990s. AB - Technology in the field of wound management is constantly progressing as researchers search for the ideal wound dressing. The regulatory situation for wound-care products can be confusing because in some cases they are considered to be pharmaceuticals and in others they are deemed to be medical devices. In addition, the situation has not been assisted by the system of risk classification in the Medical Device Directive. This article highlights the issues and provides an update on the latest position. PMID- 10147073 TI - An update on pulse oximetry. Part II: limitations and future applications. AB - The pulse oximeter can be used in all clinical situations in which the patient is at risk for hypoxemia. Now standard in the operating room, pulse oximetry is beginning to be used in prehospital transport, emergency department, postanesthesia recovery room, intensive care unit, endoscopy and catheterization suites, and delivery room, as well as for ambulatory monitoring and preoperative screening. The pulse oximeter is an invaluable monitor for the anesthesiologist and may allow better health care delivery to the patient, especially when combined with capnography and mixed venous oximetry. This article presents an update on its limitations and future applications. PMID- 10147074 TI - Pharmaceutical formulations--suspensions and solutions. AB - Solutions and suspensions of drugs are used widely in the pharmaceutical industry for production of dosage forms for different routes of administration; for example, oral, parenteral and inhalation. Pharmaceutical solutions and suspensions might appear to be simple formulations but they can present many technical problems both for the manufacturing industry and for the individual pharmacist. Substances can be chemically unstable, insoluble in water, distasteful etc. Suspensions are often used as a dosage form when the drug is insoluble in water and when use of solubilizing agents is not possible. Based on method of preparation, suspensions can be divided into two categories, flocculated and deflocculated systems. PMID- 10147075 TI - Basic nebulizer function. AB - The main function of a jet nebulizer is to aerosolize the contained liquid. The primary generation point is the orifice where the compressed air expands and increases in velocity. At this point the expanding air induces an underpressure and liquid is sucked up to the air orifice where it meets the rapidly expanding air. Droplets from the liquid surface are carried away with the airstream towards the baffle system. After cut-off by impaction on the baffle surface, secondary generation occurs on the baffle as droplets are produced due to high air velocity. Several different designs of nebulizer are available. The differences cause variation in the output characteristics; for example, in the liquid output and droplet size distribution. There is also disparity between individual nebulizers of the same brand. This is due to manufacturing errors. Repeated use of a single nebulizer over time causes ageing. This, in turn, causes the critical points of droplet generation to change. The most significant changes are the small increases in the diameter of the air orifice. This may be due to mechanical wear from the compressed air source or to extensive cleaning procedures. The effect of the increasing diameter, as seen by the user, is decreased driving pressure at a constant rate of air flow. There is also an effect on the output characteristic of the nebulizer. With decreasing driving pressure the air velocity decreases. This in turn, increases the droplet size generated at the air orifice.(ABSTRACT TRUNCATED AT 250 WORDS) PMID- 10147076 TI - Behavior of nebulizing solutions and suspensions. AB - A compressed air source is needed to run a jet nebulizer; its operating pressure affects the aerosol flow through the nebulizer, the quantity of drug and/or solution leaving the nebulizer, and the droplet size. With increasing pressure, the output (gravimetric change during nebulization) will increase and the droplet size decrease. The temperature of the nebulizing solution will decrease by as much as 10 degrees C due to energy loss from evaporation of droplets. Other important considerations in nebulizer therapy are taste, pH and viscosity of the solution. For those drugs which cannot be dissolved, the nebulizing behavior is different. In nebulizing suspensions, the drug particles must be micronized to a mass median diameter of 1-2mum to give optimal output conditions from jet nebulizers with a droplet size of 3mum mass median diameter. The solid drug particles leave the nebulizer through the medium of the droplets, and when a solid drug particle is larger than the droplet it will become trapped in the nebulizer. This has been illustrated in a separate experiment in which 0.5mg/ml budesonide was nebulized from eight different nebulizers. The droplet size as well as the output--calculated from the quantity of drug remaining in the nebulizer after 10 min nebulization--varied with type of nebulizer. A preferable way of determining drug delivery to a patient is to collect the aerosol on a filter during normal breathing and then analyse the drug content on the filter.(ABSTRACT TRUNCATED AT 250 WORDS) PMID- 10147077 TI - Drug delivery systems. AB - Nebulizers, both jet and ultrasonic, were originally designed to convert a liquid solution into an aerosol. During recent years suspensions for nebulization have been developed and nebulized with the available devices. In-vitro comparisons of drug output from jet and ultrasonic nebulizers have shown significant differences between solutions and suspensions. Ex-vivo comparisons have confirmed the in vitro results. In an ex-vivo trial with 10 adult healthy volunteers, budesonide suspension was compared with terbutaline solution in terms of inhaled mass of drug, when using either jet or ultrasonic dosimetric nebulizers (Spira). The inhaled mass of drug was defined as the dose of drug on a filter inserted between the nebulizer and the patient. The nebulizers were run to a fixed gravimetrically determined suspension output of 75% of the initial weight. The inhaled mass of drug as a percentage of the nominal dose was close to 50% for the terbutaline solution in both nebulizer systems, while the inhaled mass of drug as a percentage of the nominal dose for the budesonide suspension was about 30% for the jet nebulizer and about 10% for the ultrasonic nebulizer. However, the inhaled mass of drug measured in adults cannot be directly extrapolated to infants and children. In order to study the range of the inhaled mass of budesonide suspension in children an ex-vivo trial in 322 patients with bronchial asthma in the age range 0.6-15.7 years was performed.(ABSTRACT TRUNCATED AT 250 WORDS) PMID- 10147078 TI - Deposition patterns of nebulized drugs: is the pattern important? AB - It is logical to assume that the efficacy of an aerosolized drug should be related to the local airway dose. To test this assumption, it is necessary to have some index of the distribution of deposited drug within the airway and a measure of efficacy. However, most studies, in which the regional distribution of a deposited radiolabeled aerosol throughout the lung has been carefully measured, have not been directly related to the efficacy of any drug. For example, the deposition pattern is critical in terms of interpreting studies of mucociliary clearance but, in those cases, the radiolabel is usually not tied to a therapeutic agonist. Most classical studies measuring the efficacy of an aerosolized drug involve bronchodilators. While bronchodilation itself has been shown to affect subsequent regional ventilation and particle deposition, targeting specific airways has never been shown to be critical for bronchodilator efficacy. This situation may be different for agents which have a more delayed effect; for example, aerosolized steroids and antibiotics. Little data are available that directly address this question. We have developed techniques for measuring total and regional lung deposition for purposes of addressing the issue of airway site versus drug efficacy. Presently, we have information on methacholine, which is useful for measurement of airway reactivity, gentamicin, pentamidine and cyclosporin. While many factors affect total and regional deposition, we have found that the underlying disease process in the lung is a major determinant of the final deposition pattern.(ABSTRACT TRUNCATED AT 250 WORDS) PMID- 10147079 TI - Clinical efficacy of nebulized drugs. AB - There is a mandatory need for effortless drug administration to young children since the prevalence among them of recurrent wheezing is a 15-20%. It is becoming increasingly evident that many of these children respond dramatically well to beta2-agonists and topical steroids; accordingly this sub-group of children should be treated as asthmatics. The dose of topical steroids is critical as opposed to that of beta2-agonists which are often administered in doses well above the minimal effective dose. Budesonide suspension has proven its efficacy in adults in a study of 21 patients with asthma treated with budesonide suspension delivered from a nebulizer activated during inspiration versus metered dose inhalation (MDI) via a large-volume spacer. Nebulized in this manner the suspension exhibited a dose-dependent effect, apparently equipotent to the MDI administration as evaluated from daily peak expiratory flow measurements and symptom scoring. Continuous nebulization of budesonide in 18 schoolchildren with bronchial asthma similarly showed a dose-dependent improvement of lung function and symptom score, though in a 1:2 potency ratio as compared to MDI administration, probably due to loss of nebulized aerosol during expiration. In a subsequent study of 23 young children unresponsive to beta2 agonist therapy, nebulized budesonide was without demonstrable effect. Recently, a study of 31 young children with steroid-dependent asthma demonstrated a significant improvement from continuous nebulization of budesonide 1mg twice daily. In conclusion, the efficacy of nebulized budesonide has been convincingly demonstrated in patients with reversible symptoms of asthma.(ABSTRACT TRUNCATED AT 250 WORDS) PMID- 10147080 TI - Turbuhaler, an inspiratory flow driven inhaler: chairman's introduction. Part 2. PMID- 10147081 TI - Deposition patterns with Turbuhaler. AB - The degree of lung deposition is an important factor in the evaluation of different inhalation flow driven dry powder inhalers. A number of studies using radioactive and non-radioactive methods have been performed with Turbuhaler to assess lung deposition under different conditions. Mean total lung deposition of terbutaline sulfate or budesonide via Turbuhaler in healthy volunteers ranged from 21-32% of the dose when a normal inhalation flow (60L/min) was used. At a low flow (30L/min) a mean 15% of the dose was deposited in the lungs, a similar value as for a well-performed inhalation via a pressurized metered dose inhaler. Regional deposition of inhaled drug can be expressed as the ratio between the amount of drug deposited in the more peripheral parts of the lung relative to the more central parts. In a comparative study, budesonide and terbutaline sulfate were given by inhalation via Turbuhaler to healthy volunteers. The ratio of peripheral to central deposition was 2.03 for terbutaline and 1.72 for budesonide. Thus, both the water-soluble terbutaline sulfate and the non-water soluble budesonide seemed to behave in the same way when inhaled via Turbuhaler. In conclusion, Turbuhaler delivers over 20% of a metered dose to the lungs when inhaled at a normal inhalation flow rate. The regional deposition pattern in the lungs was the same for terbutaline sulfate and budesonide, in spite of differences in water solubility. PMID- 10147082 TI - Clinical efficacy and safety of budesonide Turbuhaler in adults. AB - In two studies comparing budesonide delivered by Turbuhaler with budesonide delivered by pressurized metered dose inhaler (pMDI), a significantly higher morning peak expiratory flow (PEF), and a patient preference in favor of budesonide by Turbuhaler was found. Less cough was also noted. In a third study no difference was found between the two formulations. However, a meta-analysis of the three studies demonstrated a significant difference in favor of budesonide by Turbuhaler for forced expiratory volume in one second (FEV1) and morning PEF. These findings are supported by data on lung deposition showing the Turbuhaler to be twice as efficient as a pMDI. At the same time, the availability of budesonide from the gastrointestinal tract is reduced. Thus, a more beneficial ratio arises between local lung delivery and systemic availability. Inhaled glucocorticosteroids are now recommended for mild asthma. Thus once daily treatment with 400mug budesonide by Turbuhaler has been studied in two trials; a comparison with 200mug twice daily was also made. In both studies morning/evening PEF increased significantly over placebo and no difference was demonstrated between once- and twice-daily treatments. A study to determine the effect of placebo and 200mug twice daily and 400mug once daily of budesonide by Turbuhaler on 24-h plasma and urinary cortisol demonstrated no difference between the treatment regimens. Budesonide by Turbuhaler is at least as effective as budesonide by pMDI. When patients are switched to budesonide by Turbuhaler an attempt should be made to reduce the dose.(ABSTRACT TRUNCATED AT 250 WORDS) PMID- 10147083 TI - Clinical efficacy and safety of budesonide Turbuhaler as compared to MDIs in children. AB - Pharmacokinetic studies in children indicate that budesonide by Turbuhaler results in higher intrabronchial deposition of drug but a higher systemic activity than the same dose of budesonide inhaled from a Nebuhaler. Furthermore, around 85% of the total systemic activity is caused by drug absorbed from the lungs. Therefore, subsequent studies have been performed to compare the clinical and/or systemic effect of these two inhalers. The findings in all these studies were in agreement with the findings of the pharmacokinetic studies: (1) In a double-blind crossover study, urinary cortisol excretion was reduced during Turbuhaler but not during Nebuhaler treatment. At the same time the Turbuhaler seemed clinically more effective than the Nebuhaler. (2) A double-blind parallel group study on 126 children showed no deterioration in asthma control when the dose of budesonide was reduced by 50% when the children used the Turbuhaler. When the Nebuhaler was used a dose reduction resulted in deterioration of asthma control. (3) When the dose of budesonide delivered to the patient was measured by analysing the amount of drug deposited on a filter inserted between the patient's lips during inhalation, it was found that twice as much budesonide was deposited after Turbuhaler as after Nebuhaler treatment. (4) When the dose of budesonide required by 224 children followed in our outpatient clinic was recorded, we found that the mean daily dose in children using the Turbuhaler was 50% lower than the dose required by children using the Nebuhaler.(ABSTRACT TRUNCATED AT 250 WORDS) PMID- 10147084 TI - Spiral CT withstands fury over health reform. PMID- 10147085 TI - Piecing together parts of managed-care puzzle. PMID- 10147086 TI - Strategies for adapting to the new health care. PMID- 10147087 TI - Sonologists take steps to control their destiny. PMID- 10147088 TI - Catheters, embolic agents spark neurointervention. PMID- 10147089 TI - Stereotactic radiosurgery treats intracranial lesions. PMID- 10147090 TI - Traversing K space with fast MR scans. PMID- 10147091 TI - Vaginal hysterectomy with the Autosuture stapler. AB - Our objective was to assess the applicability of hysterectomy by the vaginal route completely performed with Autosuture staples. Between January 1992 and September 1993, 5 vaginal hysterectomies using Autosuture staplers were performed by the authors. Five vaginal hysterectomies matched for age, parity, and uterine size performed by the same surgeons using reabsorbable sutures during the same period were used as case controls. No febrile morbidity, cuff infections, thrombophlebitis, bladder injury, or hemorrhage complications were observed in the 10 women who entered the study. In summary, vaginal hysterectomy can be performed with Autosutures easily, probably faster with experience, and with less oozing from the operative field, thus providing a safe procedure. PMID- 10147092 TI - Pulsed dye laser: effective for plantar verrucae. PMID- 10147093 TI - Health care reform: how it may re-form clinical laboratories. PMID- 10147094 TI - Amniotic fluid tests for fetal lung maturation--the good, the bad, and the promising. AB - OBJECTIVE: To assess promising laboratory tests for fetal lung maturity (FLM). DATA SOURCES: Professional literature. DATA EXTRACTION: Survey of literature. DATA SYNTHESIS: Traditional biochemical tests for FLM such as the LSR are reliable if performed properly but are difficult to perform, costly, and not widely available; most are not good predictors of respiratory distress syndrome. Many of the newer biochemical and biophysical FLM assays are more reliable, faster, require less personnel time, and are readily available. CONCLUSION: The development of laboratory tests to measure the presence or effects of pulmonary surfactant in amniotic fluid has contributed greatly to the management of premature deliveries; newer tests show promise but require more extensive evaluation. PMID- 10147095 TI - How to identify the best candidates for kidney transplantation: protocols for making the best use of scarce donor organs. AB - Potential kidney transplant recipients must be thoroughly evaluated to ensure that scarce donor organs are used appropriately. Begin by determining the cause of renal failure (some diseases can recur in transplanted organs; others are associated with increased post-transplant morbidity and mortality). Cancer, active infection, some forms of thrombosis and atherosclerosis, and patient noncompliance usually contraindicate kidney transplantation. A careful patient assessment can identify other factors that may increase the risks of significant postoperative complications; however, most of these factors can be modified before proceeding with transplantation. PMID- 10147096 TI - The path leading to reform. PMID- 10147097 TI - Trauma radiology: part I. Computerized tomographic imaging of abdominal trauma. AB - The value of computerized tomography (CT) scanning for identification of injuries sustained primarily from blunt trauma to the abdomen and pelvis is well established. During the 1980s, numerous articles appeared comparing the value of CT versus diagnostic peritoneal lavage (DPL) as a screening test for intraperitoneal injury. A consensus emerged recognizing the complimentary and different kinds of information provided by each study. CT is indicated in hemodynamically stable patients; to assess the retroperitoneum; after indeterminant DPL results; potentially in patients with positive DPL results by cell count; whenever DPL is contraindicated; in patients with persistent abdominal pain despite a negative DPL; for penetrating flank trauma; for mild abdominal tenderness in alert patients; and arguably for patients with unreliable physical examination. The accuracy of CT is dependent on speed and quality of the scanner, attention to technique to provide optimal oral and intravenous contrast enhancement, and experience of the image interpreter. In general, the accuracy of the CT for detection of solid visceral injuries (including in the liver, the spleen, and the kidneys) and for evaluation of the retroperitoneum is well established. Recent studies indicate that CT also offers important information regarding pancreatic and hollow viscous injuries. Fast scanning with a power-injected intravenous contrast bolus can provide localization of active bleeding sites, with important implications for management by surgery or interventional angiography. We review the CT imaging findings typically observed with a variety of abdominal/pelvic injuries. PMID- 10147098 TI - Updated AIDS statistics for insurance applicants. PMID- 10147099 TI - The AIDS testing experience of a major company. PMID- 10147100 TI - Mental retardation: severity and survival. PMID- 10147101 TI - Mycosis fungoides--an underwriting prospective with emphasis on staging and risk selection. AB - Mycosis Fungoides is a T-cell lymphoma having a broad clinical spectrum ranging from localized cutaneous to rapidly fatal systemic disease. Early clinical presentation is non specific, delaying correct diagnosis. Compared to clinical, the insurable spectrum is narrow. Staging for skin, lymph node and other organ manifestations is presented. Factors which influence mortality within each stage are elucidated. The survival curves of stages and stage groupings are illustrated and discussed to facilitate risk classification. Cutaneous (T) and lymph node (LN) stages are the most important prognosticators. Substages T1/T2, LN1/LN2 without associated palpable adenopathy, eosinophilia, visceral and blood positive findings are insurable. It would be most appropriate to place them in a tumor class of mild/moderate risk after the initial excessive mortality period ends. Higher T and LN substages, adenopathy and visceral disease have highly adverse mortality. These ultimately reveal a flattening of survival curves at 8 10 years. Although numerous treatment modalities have been used, none appear to consistently prolong life expectancy except in the earliest stage skin disease. PMID- 10147102 TI - Intermittent intraventricular conduction defects. PMID- 10147103 TI - Idarubicin more cost-effective than daunorubicin? PMID- 10147104 TI - Economic cost of asthma substantial in NSW. PMID- 10147105 TI - Total costs of HIV disease higher with zidovudine? PMID- 10147106 TI - Efficacy and cost-effectiveness of oral ciprofloxacin. PMID- 10147107 TI - Ethics in health economics. PMID- 10147108 TI - Monitoring tricyclic antidepressant therapy. PMID- 10147109 TI - Payment restrictions for prescription drugs under Medicaid. PMID- 10147110 TI - Opportunities to improve the cost-effectiveness of treatment for hypertension. PMID- 10147111 TI - Duodenal ulcer disease: to treat H. pylori infection or not? PMID- 10147112 TI - Cost-effectiveness of cost-effectiveness studies. PMID- 10147113 TI - Acceptable usage of the term 'cost-effective'. PMID- 10147114 TI - Importance of side effects in treating impetigo. PMID- 10147115 TI - Oral ciprofloxacin versus intravenous antibiotics. PMID- 10147116 TI - Spreadsheet software program to analyse costs beyond drug acquisition price. PMID- 10147117 TI - Cost of pharmaceutical services. PMID- 10147118 TI - HA-1A in gram-negative sepsis. PMID- 10147119 TI - Costs of asthma. PMID- 10147120 TI - QOL measurement in lung cancer. PMID- 10147121 TI - Outpatient management of febrile infants. PMID- 10147122 TI - Do patients with prostatic cancer require treatment? PMID- 10147123 TI - Quality of life with antihypertensives. PMID- 10147124 TI - NSAIDS and gastropathy. PMID- 10147125 TI - Is HA-1A cost-effective? PMID- 10147126 TI - Impact of triplicate prescribing programme on psychotropic prescribing. PMID- 10147127 TI - COPD education reduces consumption of healthcare services. PMID- 10147128 TI - Evaluating IV drug delivery systems. PMID- 10147129 TI - Cost-effectiveness of gentamicin vs tobramycin. PMID- 10147130 TI - Evaluating evaluations of new health technologies. PMID- 10147131 TI - Breast cancer: clinical decision making. PMID- 10147132 TI - Clinical decision making vs programme evaluation perspectives. PMID- 10147133 TI - Quality-of-life assessment in cancer. PMID- 10147134 TI - The cost of breast cancer recurrences. PMID- 10147135 TI - Disposable adult breathing circuits for use with critical care ventilators. AB - In this issue, we evaluate seven models of disposable breathing circuits from seven manufacturers; the evaluated circuits are intended to be used for adult patients on critical care ventilators. This study is a follow-up to our earlier Evaluation of disposable breathing circuits for use with portable ventilators, published in Health Devices 22(7), July 1993. We based our ratings on the breathing circuits' ability to function properly with minimal intervention from the healthcare provider. We rated only one of the evaluated units Acceptable; this circuit was not likely to interrupt ventilation during normal use (provided that its operation was verified before use). Three of the evaluated breathing circuits were rated Unacceptable because they had disadvantages that were likely to interrupt ventilation during normal use (e.g., a component could accidentally disconnect, the tubing could become kinked or crushed). When such a disadvantage could be compensated for by the healthcare provider, we rated the circuit Conditionally Acceptable: one circuit was rated Conditionally Acceptable; two circuits that had other significant disadvantages were rated Conditionally Acceptable--Not Recommended. We caution readers not to base purchasing decisions on our ratings alone, but on a thorough understanding of the issues surrounding our conclusions, which can be gained by reading this study in its entirety. We offer additional guidance and discuss important selection factors and usage issues in the Selection and Use Guide for Disposable Breathing Circuits included at the end of the Evaluation. Also see "Pre-use Verification of Breathing Circuits" in this issue for step-by-step guidelines to help healthcare providers and caregivers verify proper performance and identify the defective circuits that inevitably reach the clinical setting. PMID- 10147140 TI - New technique to correct strabismus and diplopia. PMID- 10147141 TI - An evaluation of three methods for determining colloid osmotic pressure. AB - Plasma colloid osmotic pressure (COP) is an important determinant in edema formation. Three methods for assessing the COP were evaluated. Direct measurement of COP using the 4420 Wescor Colloid Osmometer was compared to the estimation of COP from both serum total protein and total serum solids (TSS) determinations. Blood samples from twenty adult patients (mean age = 64 years) undergoing cardiopulmonary bypass surgery were collected for COP assessment. Sample collection was performed prior to heparinization/hemodilution, during hypothermic bypass and at the conclusion of bypass following protamine administration. The results obtained from each method were analyzed by a two-way analysis of variance. The Bonferroni technique was used for comparison of sample means when the difference was significant (p less than 0.05). Correlations were reported by linear regression analysis. A statistically significant difference (p less than 0.01) was found between the three methods. A regression equation for the estimation of COP from total serum solids is offered: COP = (3.02 * TSS) + 0.65. Prospective clinical testing between the direct COP measurement and the estimation of COP from TSS using the equation (n = 38) revealed a significant correlation (R2 = .932) and no significant difference between the two (p greater than 0.05). PMID- 10147142 TI - Outcome assessment following limited wrist fusion: objective wrist scoring versus patient satisfaction. AB - Eighteen nonrheumatoid patients were reviewed an average of 4.4 years following limited wrist fusion to evaluate whether patient satisfaction or objective wrist scoring more closely correlated with functional outcome. Range of motion, grip strength, pain relief, radiographs, and patient satisfaction were assessed by examination and interview, and each wrist was scored based on a clinical scoring system described by Cooney. Twelve patients (67%) were very satisfied with their results, and six (33%) were dissatisfied. Thirteen (72%) experienced good pain relief, 12 of whom denied functional restrictions. Six patients (33%) reported suboptimal wrist function, and four indicated they had inadequate pain relief. Despite high levels of satisfaction in 12 patients, the objective wrist scores were only fair and poor. These low wrist scores unreliably reflected functional outcome. Patient self-assessment of wrist performance, however, was uniformly predictive. Pain relief was more critical to patient satisfaction than residual range of motion. Therefore, compared to objective wrist scoring, consideration of patient satisfaction may allow more accurate prediction and assessment of functional outcome following limited wrist fusion. Satisfactory postoperative function appears to be more dependent on pain relief than residual motion. PMID- 10147143 TI - The versatility of the contoured AO plate as a mode of fixation for proximal femoral fractures. AB - Proximal femoral fractures, especially in young adults, usually are high-energy injuries associated with severe comminution. Presently available fixation devices such as the blade plate and DHS are difficult to apply in comminuted cases, their application requires the use of an image intensifier, and their versatility is limited. This report describes the use of the AO plate molded according to the proximal femoral anatomy in 21 cases (seven subtrochanteric and 14 trochanteric fractures) in which high-energy injuries were sustained. Eleven cases were primarily bone grafted. Postoperative mobilization was started by an average of 5.4 weeks. All cases united by an average of 3.2 months. There were six excellent, ten good, three fair, and one poor result (one patient died). This method was found to be superior to conventional devices as it offers more versatility in placement of screws and plate contouring. The inventory of implants is also reduced, and there is no need for specialized instruments, a significant factor in Third World countries. PMID- 10147144 TI - A brief history of orthopaedics in Germany and an overview of the current status. PMID- 10147145 TI - Fibrinolytic agents: a new approach to the treatment of adult respiratory distress syndrome. AB - Nineteen patients suffering from adult respiratory distress syndrome (ARDS) secondary to trauma or sepsis, or both, failed to respond to treatment with mechanical ventilation with oxygen and positive end-expiratory pressure. On the premise that ARDS may be caused by the microclots of disseminated intravascular coagulation obstructing the pulmonary microcirculation, the patients were treated with either streptokinase or urokinase. Eighteen patients responded with significant improvement in PaO 2 value. No bleeding occurred and clotting parameters remained normal. PMID- 10147146 TI - Compliance with therapy for ulcer disease: clinical experience and review of the literature. AB - As a factor favoring relapses, noncompliance is particularly crucial to the treatment of peptic ulcer disease, and greater efforts should be made to eliminate or reduce it. To investigate the reasons for noncompliance, we performed two clinical trials involving a total of 592 patients with duodenal ulcer treated with various H 2 antagonists for 12 months. In the first study, 40.3% of patients with uncomplicated duodenal ulcer were noncompliant, compared with only 4.6% who had had previous bleeding episodes. Compliance in the second study averaged 68%. Major reasons for noncompliance among these patients were an absence of symptoms and an inconvenient dosage schedule. On the basis of our clinical experience and a review of the literature, compliance appears to be higher in patients with previous complications of their disease and when the effectiveness of prescribed drugs does not depend on ingestion with the evening meal. PMID- 10147147 TI - Choosing a bronchodilator for asthma therapy: the role of rapid onset of action. AB - National guidelines for the treatment of asthma recommend anti-inflammatory corticosteroids or cromolyn in patients with mild to moderate disease. A comparison of different bronchodilators demonstrates that beta-adrenergic receptor agonists, specifically those selective for beta 2 receptors in the airways, are the safest and most effective agents for "rescue" during acute attacks. Because rapid onset of action is a clear advantage for the reversal of bronchoconstriction, a fast-acting agent such as albuterol is preferable to a slow-acting agent such as fenoterol or salmeterol. PMID- 10147148 TI - Reexamining interstitial radiotherapy for PCa. PMID- 10147149 TI - Ureterosigmoidostomy: urinary diversion with minimal disability. PMID- 10147150 TI - For incontinence after prostatectomy, tap a diversity of treatments. PMID- 10147151 TI - Sex-specific noninvasive cardiac testing. PMID- 10147152 TI - Management options for cystic fibrosis in adults. PMID- 10147153 TI - Hemodynamics and oxygen transport: using your computer to manage data. A user friendly tool for data calculation, storage, and retrieval. AB - Efficient calculation, storage, and retrieval of hemodynamic and oxygen transport data can be a problem in the clinical setting. A free computer program is now available to calculate commonly used hemodynamic and oxygen transport variables and to provide results in a chart-ready format or in a side-by-side comparison when serial measurements are performed. The program was developed to be easy to use, menu-driven, and usable at various institutions. The program automatically conducts error checking during the simple data entry process as well as during data calculation and retrieval. PMID- 10147154 TI - Utilizing ileal and colonic segments for supravesical diversion. PMID- 10147155 TI - The outlook for preserving continence and potency during radical prostatectomy. PMID- 10147156 TI - Ultrasonography in the care of the infertile man. PMID- 10147157 TI - Trends in diagnosing lower gastrointestinal disorders. PMID- 10147158 TI - Video colonoscope systems. PMID- 10147159 TI - Ankle arthroscopy using the Ho:YAG laser wins praise. PMID- 10147160 TI - A functional analytical technique for monitoring nutrient status and repletion. Part 3: clinical experience. AB - This paper, third in a series describing a testing procedure for nutrient analysis, will focus on clinical experiences after targeted repletion of deficient nutrients. Part one described the Essential Metabolics Analysis (EMA) procedure (SpectraCell Laboratories, Houston, TX), which determines functional status of 19 nutrients by measuring lymphocyte growth responses to variations of a patented, chemically defined serum-free medium. Part two described validation studies of lymphocytes as markers for whole body nutrient status and metabolic functions. EMA provides a sensitive, specific, and accurate method of determining nutrient needs, requirements, or deficiencies for each individual. PMID- 10147161 TI - Workflow analysis, a tool for laboratorians. Case study: a drug-testing laboratory. PMID- 10147162 TI - Maternal schooling and child health: preliminary analysis of the intervening mechanisms in rural Nepal. AB - This article provides evidence from a community-level study in rural Nepal of the mechanisms by which schooling affects maternal behaviour and infant and child health. Two hypotheses concerning the mechanisms are identified and tested. It was found that schooling equips women with specific skills and dispositions or identity which significantly predict two principal domains of health-care behaviour: use of medical services; and changes in household health behaviour. It was also found that women with schooling had healthier children using height for-age as an indicator of health. PMID- 10147163 TI - Childhood immunization and pregnancy-related services in Guatemala. AB - In this paper we examine the experience of one poor country, Guatemala, that provided childhood immunization partly through a major national campaign, and provided pregnancy-related services through government health facilities, during the 1980s. Specifically, we compare the breadth of coverage of these two types of services using national sample survey data collected in 1987. We then draw upon results of previous qualitative studies to explore the social, cultural, and organizational factors that may account for differences between the use of immunization and the use of pregnancy-related health services. PMID- 10147164 TI - The focus group as a tool for health research: issues in design and analysis. AB - The focus group is a technique for eliciting information from specific population subgroups. Issues addressed may be little known or relatively well known to the researcher. The method is most effectively used when the objective of the investigation is to elicit points of view of client or consumer groups which may differ from those of providers. Despite the frequency with which focus groups are used, few published materials describe the practical application of the method. This paper presents a detailed methodology for the conduct of focus groups and analysis of focus-group data with the intention of improving its use among researchers and health-care professionals. Data from two studies, immunization compliance in West Africa, and barriers to use of prenatal-care services in Bolivia, are used as illustrative examples. PMID- 10147165 TI - Triple vessel revascularization: coronary angioplasty versus coronary artery bypass surgery: initial results and five-year follow-up. Comparative costs and loss of working days and wages. AB - OBJECTIVES: The purpose of this study was to compare early and late outcomes in patients undergoing PTCA or CABG for triple vessel disease. BACKGROUND: Although early results of PTCA/CABG randomized trials have recently become available, at present little data exists on long-term medical and socioeconomic effects of these treatment modalities in patients with triple vessel revascularization. METHODS: During 1986-87, 76 patients undergoing triple vessel PTCA and 85 patients having triple vessel CABG were selected from a consecutive series of patients having multivessel revascularization. Initial results and 5 year outcome, hospital stay and charges and out-of-work time were assessed from prospectively collected data. RESULTS: Clinical and morphological factors were similar in the PTCA and CABG groups. Hospital success and complications were also similar, except for higher mortality in the CABG cohort (0 vs. 3.5%). Five year follow-up showed no differences in survival, nonfatal infarction and angina free status; however, there was a difference in need for repeat revascularization (PTCA 55.4% vs. CABG 6.3%, p less than 0.001). Repeat PTCA accounted for 49% of the revascularization in the PTCA cohort. Crossovers were similar (PTCA[CABG 6.8%; CABG[PTCA 6.3%, pNS). Predictors of late death in the entire population were female gender (p less than 0.0001), diabetes (p<0.05) and depressed LVEF (p less than 0.05). The choice of revascularization procedure (PTCA vs. CABG) was not an independent predictor of late death or MI. Analysis of initial hospital charges showed a 2:1 advantage in favor of PTCA but this advantage was lost in late followup due to the need for repeat revascularization in the PTCA group. However, the PTCA cohort lost fewer working days than CABG patients (3017 vs 5874 days) and therefore, lost less wages ($7,022 vs. $14,685). CONCLUSIONS: The study shows that for selected triple vessel disease patients, PTCA and CABG results are comparable after 5 years, though repeat revascularization (mainly due to restenosis) was necessary in the PTCA group to maintain these favorable results. After 5 years, hospital charges are similar in the 2 groups, though out-of-work time and lost wages were 2:1 in favor of PTCA. PMID- 10147166 TI - Improved hemodynamic, angiographic and functional results after renal artery stenting. AB - Eighteen patients with severe renal artery atherosclerosis underwent conventional percutaneous transluminal renal angioplasty (PTRA) followed immediately by implantation of an endovascular stent. Hemodynamic measurements showed a baseline trans-stenotic pressure gradient of 78.3 mmHg that was reduced to 14.8 mmHg after PTRA. The post PTRA trans-stenotic pressure gradient was further reduced to 0.86 mmHg after stent placement. The average baseline diameter stenosis of 81.3% was reduced to 43.7% after PTRA and 6.1% after stent placement. Six month angiographic follow-up revealed restenosis in 6/16 patients. In patients treated for chronic renal insufficiency without restenosis the 6 month creatinine was 1.46 mg/dl compared to a pre-procedure creatinine of 2.4 mg/dl. Therefore those patients with renal insufficiency and renal artery stenosis who had long term patency after successful stent implantation showed significant improvement in renal function at six months. Stent implantation also significantly improved acute hemodynamic results and acute angiographic results compared to conventional renal artery angioplasty. PMID- 10147167 TI - Contemporary clinical trials of restenosis. PMID- 10147168 TI - Percutaneous balloon mitral commissurotomy: an update. PMID- 10147169 TI - Optimization of thickness, pore size and mechanical properties of a biomaterial designed for deep burn coverage. AB - A collagen and chondroitins 4-, 6-sulphate biomaterial designed for the coverage of severe burns was optimized in terms of mechanical strength by addition of 20% (wt/vol) of chitosan to the starting material. Chitosan should create ionic bonds with collagen and thus increase the tensile strength and Young's modulus of the sponge. On the other hand, sterilization by h-irradiation of the biomaterial induced a decrease in its mechanical properties that could be avoided by sterilization using beta-irradiation. The thickness, pore size and morphology of the biomaterial were optimized before freeze-drying by freezing the mixture at 60 degrees C at a weight/volume concentration of 1.25% and a volume of 270 mul/cm2. The biomaterial obtained under these conditions may further the vascularization and cellular colonization of the porous structure by the host cells of the wound bed and therefore may accelerate the regeneration of a new dermis. PMID- 10147170 TI - Synthetic calcium phosphates: models for biological crystals? AB - Characterization of the mineral phases of calcified tissues or ectopic calcifications has demonstrated the complexity of biological calcium phosphate salts. Chemists and numerous biologists involved in calcified tissue research have generally described bone and teeth crystallites as hydroxyapatite rather than biological apatites. All biological calcium phosphates have a non stoichiometric formula, and numerous and variable substitutions. Moreover, in vivo transformations/maturations occur. There is no particular representative synthetic calcium phosphate crystal either for the normal mineral phases of calcified tissues or for the pathological phases. However, they constitute efficient models for the understanding of biological mineralization, and are good approaches to in vitro studies of biomaterials. PMID- 10147171 TI - A dermal substrate made of collagen--GAG--chitosan for deep burn coverage: first clinical uses. AB - In cases of severe burns, it seems necessary to excise burnt tissues as soon as possible and to cover the excised area immediately with a skin substitute, when few autografts are available. We report here the first clinical uses of a dermal substrate made of collagen--GAG--chitosan grafted immediately after early excision, then epidermalized either with autologous meshed autograft or with autologous cultured epidermis. The dermal substrate replaces the excised dermis by adhering to the underlying tissue, promoting fibrovascular ingrowth. Then after 15 days it can be epidermalized. The quality of the underlying dermis obtained permitted 100% take after epidermalization with large-meshed autograft, and tended to avoid the usual typical diamond aspect of the meshed skin. After epidermalization with autologous cultured autograft, the quality of the underlying dermis permits a good take. The best aspect is obtained by combining dermal substrate and autologous cultured epidermis. Even if it still does not replace the high quality of a homograft, this dermal substrate is a promising solution for replacement of dermis. It is always available, can be stored and is exempt from micro-organism transmission. PMID- 10147172 TI - Improvement of vascular grafts compliance by modifying their thermal treatment. AB - To produce properly matching vascular grafts and replace arteries, samples of Czech weft- and warp-knitted vascular grafts (MF and RA respectively) were tested. Their deformation response was measured on a special experimental device. Samples of these grafts, prepared under different thermal conditions, were then produced and tested. Strong dependence of graft compliance on graft temperature treatment was found. The most compliant structure was achieved when this temperature was set at 160 degrees C and applied for 10 min, which was sufficient to fix the crimps properly. Nevertheless, the grafts produced under these optimum conditions are still more rigid than the replaced arteries. PMID- 10147173 TI - Polyurethanes grafted by pendent groups with different sizes and functionality. AB - Polyurethanes grafted by pendent alkyl chains along the backbone have been prepared and characterized by their mechanical properties and by in vitro adsorption of albumin and fibrinogen. The grafting of butyl, octyl, decyl, hexadecyl and tetratriacontyl chains on to the urethane nitrogen weakens the stress-strain properties, whereas these properties remain high when these alkyl groups are grafted on the 1,3-propanediol used as chain extender. The hexadecyl chain gives the highest values of albumin adsorption from in vitro tests. Polyurethanes prepared from a commercial diol bearing a polyoxyethylene polyoxypropylene propylsulphonate side chain adsorb albumin and fibrinogen, the respective amounts depending on the substitution yield of the sulphonate group. PMID- 10147174 TI - In vitro study of the hemocompatibility of superparamagnetic contrast agent for magnetic resonance imaging. AB - Five different nanoparticles, potentially useful in magnetic resonance imaging (MRI) after venous administration, were studied for their hemocompatibility. The in vitro methodology evaluated these materials by several parameters: cytotoxicity towards cells cultured in vitro, aggregation ability of platelets, hemolysis inducibility, intrinsic and extrinsic coagulation pathway activation, and complement activation. With the proposed clinical dose, regardless of the cell type used (murine cell line or human endothelial cells) no toxicity was observed. The presence of the particles in blood did not produce any considerable damage: either hemolysis or platelet aggregation or blood coagulation were recorded. However, a slight decrease in aggregation ability of platelets was noticed as well as an increase in partial thromboplastin time. Because of the quick removal of the particles from the bloodstream, these phenomena must be short-lived, thus avoiding significant adverse clinical effects. PMID- 10147175 TI - Six bioabsorbable polymers: in vitro acute toxicity of accumulated degradation products. AB - Bioabsorbable polymer implants may provide a viable alternative to metal implants for internal fracture fixation. One of the potential difficulties with absorbable implants is the possible toxicity of the polymeric degradation products especially if they accumulate and become concentrated. Accordingly, material evaluation must involve dose-response toxicity data as well as mechanical properties and degradation rates. In this study the toxicity and rates of degradation for six polymers were determined, along with the toxicity of their degradation product components. The polymers studied were poly(glycolic acid) (PGA), two samples of poly(L-lactic acid) (PLA) having different molecular weights, poly(ortho ester) (POE), poly(epsilon-caprolactone) (PCL), and poly(hydroxy butyrate valerate) (5% valerate) (PHBV). Polymeric specimens were incubated at 37 degrees C in 0.05 M Tris buffer (pH 7.4 at 37 degrees C) and sterile deionized water. The solutions were not changed during the incubation intervals, providing a worst-case model of the effects of accumulation of degradation products. The pH and acute toxicity of the incubation solutions and the mass loss and logarithmic viscosity number of the polymer samples were measured at 10 days, 4, 8, 12, and 16 weeks. Toxicity was measured using a bioluminescent bacteria, acute toxicity assay system. The acute toxicity of pure PGA, PLA, POE, and PCL degradation product components was also determined. Degradation products for PHBV were not tested. PGA incubation solutions were toxic at 10 days and at all following intervals. The lower molecular weight PLA incubation solutions were not toxic in buffer but were toxic by 4 weeks in water.(ABSTRACT TRUNCATED AT 250 WORDS) PMID- 10147176 TI - Characterization of a polyepoxy compound fixed porcine heart valve bioprosthesis. AB - Concerns with the currently available bioprostheses are calcification, long-term durability, and suboptimal hemodynamic performance. It is well known that these concerns are all more or less related to the cross-linking reagent, glutaraldehyde or formaldehyde, used in fixing bioprostheses. To address these concerns, we undertook the development of a porcine bioprosthesis fixed with a polyepoxy compound. In the development of this polyepoxy compound valve, it was found that the porcine leaflets fixed with polyepoxy compound were softer and more pliable than those fixed with glutaraldehyde. In this study, a special microtoming technique was developed to section the biological tissue so that the fixation uniformity in distinct layers of porcine aortic wall could be characterized. The fixation index and the denaturation temperature measurements in distinct layers of aortic walls showed that the cross-linking density was uniform throughout the entire aortic wall for the polyepoxy compound fixed porcine valve. It was also noted that the fixation index of the polyepoxy compound fixed aortic wall (91.5 +/- 0.5, n = 3) was not significantly different from that of its valvular leaflet (90.6 +/- 0.8, n = 3). Similarly, the denaturation temperature of the polyepoxy compound fixed aortic wall (80.4 +/- 0.9 degrees C, n = 5) was statistically comparable to that of its valvular leaflet (79.0 +/- 0.5 degrees C, n = 5). The results of this study indicated that polyepoxy compound can adequately fix the entire porcine aortic wall as well as its valvular leaflets.(ABSTRACT TRUNCATED AT 250 WORDS) PMID- 10147177 TI - Surface modification of polymeric biomaterials by albumin grafting using h irradiation. AB - Polymeric biomaterial surfaces were modified by albumin grafting to improve their blood compatibility. Albumin molecules were functionalized by introducing double bonds using glycidyl acrylate. The functionalized albumin was covalently attached to various biomaterial surfaces such as polypropylene, polycarbonate, and poly(vinyl chloride) by h-irradiation. Surface-induced platelet adhesion and thrombus formation on the albumin-grafted surfaces was examined using computer enhanced video microscopy and scanning electron microscopy. The amount of the grafted albumin was dependent on the h-irradiation dose and the concentration of albumin used for adsorption. The grafted albumin molecules remained on the surface even after exposure to blood for prolonged time periods. This approach was used to graft albumin to polymeric materials of an oxygenator. The albumin grafting resulted in a substantial improvement in blood compatibility as compared to control oxygenators. The covalent grafting of functionalized albumin by h irradiation obviates the need for premodification of chemically inert polymer surfaces. It is useful for albumin grafting to various biomaterial surfaces. PMID- 10147178 TI - Biomaterials lubricated for minimum frictional resistance. AB - To improve the frictional characteristics of a biomaterial, the mechanical performance of a lubricated surface was studied. In vitro friction tests showed that the coefficient of dynamic friction of the lubricated surface was about 0.01 against rabbit bladder and the coefficient of static friction increased with the preload period. The efficacy of a lubricated cystoscope was evaluated by an in vivo test simulating cystoscope operation. The maximal and the total resistance force on the cystoscope model were found to decrease with the surface lubrication. Histological study revealed that urethral damage caused by rubbing with the cystoscope model was reduced by this lubrication technique. Presumably, prolonged retention of water on the lubricated surface region prevented tissue adhesion to the foreign material. PMID- 10147179 TI - External quality assessment for trace element assays. PMID- 10147180 TI - Coagulation testing. PMID- 10147181 TI - How should prostate specific antigen (PSA) be used clinically, as a screening test alone or as a test to detect recurrence or residual disease after radical surgery? PMID- 10147182 TI - Micromechanics and nanotechnology: implications and applications in the clinical laboratory. PMID- 10147183 TI - Superiority of Nd:YAG laser to cryosurgery in the treatment of rectal carcinoma. AB - Laser coagulation (LC) by Nd:YAG laser and cryodestruction (CD) by insulated cryoprobe were done in 52 patients with carcinoma of the rectum (LC = 27, CD = 25). The patients were divided into four groups: group I, inoperable rectal carcinoma because of advanced stage of malignancy, severe concomitant disease, old age (LC = 14, CD = 12); group II, patient refused permanent colostomy (LC = 4, CD = 3); group III, polypoid lesion fulfilled the criteria of local excision (LC = 3, CD = 2); group IV, local recurrence after anterior resection (LC = 6, DC = 8). The mean hospital stay was 8.11 +/- 5.6 days for LC and 12.8 +/- 8.7 days for CD (p less than 0.05). For LC minimal or no sedation was needed, but for CD general anesthesia (n = 3) was occasionally necessary. Significant improvement was achieved in 85.18% (n = 23) of cases with LC and 56% (n = 14) of cases with CD (p less than 0.05). Complications after LC were mild (n = 7) to moderate (n = 3) and after CD they were moderate (n = 11) to severe (n = 2). Almost every patient with CD complained of moderate to severe discharge of malodorous necrotic tissue for a period of 2 weeks or more. In groups I, II, and IV patients with LC enjoyed a longer (81.08 +/- 47.48 days) trouble-free period than those with CD (43.3 +/- 13.45 days) (p less than 0.001).(ABSTRACT TRUNCATED AT 250 WORDS) PMID- 10147184 TI - Craniofacial hyperhidrosis treated with video endoscopic sympathectomy. AB - Craniofacial hyperhidrosis as well as palmar hyperhidrosis is an abnormal state of local excessive sweating of unclear etiology. The hyperhidrosis may be isolated in the craniofacial region or associated with palmar hyperhidrosis. The patient's face is so wet with sweat that their daily activities are often seriously disturbed. To the best of our knowledge, there has been no satisfactory medical therapy, nor any effective surgical treatment reported in the literature. In 1991, we started to treat a patient with such distress using endoscopic ablation of the sympathetic T2 segment, because we mastered the technique after treating a large series of palmar hyperhidrosis patients. Furthermore, we were impressed by concomitant reduction of craniofacial sweating after T2-3 sympathectomy resulting from the relatively different domination of sympathetic supply between the eye and face. It appears possible to relieve excessive sweating of the head and face, without producing ptosis or miosis by ablation of the T2 segment. During the past 2 years, 7 patients with severe craniofacial hyperhidrosis have been successfully treated with the method and all obtained a satisfactory result. No complete Horner's syndrome has been produced except in one patient, who showed a mild and transient left eye ptosis, in whom coagulation of the sympathetic trunk higher than the T2 segment was performed. Intraoperative monitoring of forehead skin perfusion and observation of the change of pupillary size is emphasized during the lesion making. The longest postoperative follow-up was 2 years, with a mean follow-up of 12.4 months.(ABSTRACT TRUNCATED AT 250 WORDS) PMID- 10147185 TI - Endoscopic laser surgery for subglottic and tracheal stenosis. AB - Seventeen patients with subglottic and tracheal stenosis were treated with laser surgery. Six patients had airway stenosis caused by malignant tumors. Out of 16 patients who required emergency endolaryngeal laser surgery, satisfactory results were achieved in 12, obtaining a sufficient lumen for ventilation. Five cases with airway tumors underwent laser surgery to increase the airway lumen, however, only one patient showed excellent results, with a sufficient airway lumen not being obtained in the others. Airway obstructions due to tumor can be treated satisfactorily by laser surgery, though long-term postoperative follow-up confirmed recurrence of tumor in some cases, which is a problem that must be overcome in the future. PMID- 10147186 TI - Clinical applications of the Nd:YAG laser in oral soft tissue surgery and periodontology. AB - Different clinical applications of the Nd:YAG laser in periodontology are discussed in this study. Several clinical cases are presented showing the application spectrum of the Nd:YAG laser in oral soft tissue surgery. Literature reports are discussed to present to the clinical practitioner the advantages and disadvantages of laser surgery. Lasers have a useful place in the periodontal and oral surgical techniques, if manufacturer's guidelines are strictly followed. PMID- 10147187 TI - The 578-nm copper vapor laser in the treatment of cavernous hemangiomas in the oral cavity. AB - A variety of operative and nonoperative treatment methods have been proposed to deal with cavernous hemangiomas. In an otorhinolaryngological unit where experience has been gained from managing superficial vascular lesions in Chinese skin with the 578-nm copper vapor laser, three patients with symptomatic large mucosal hemangiomas in the oral cavity were treated. All lesions have shown significant shrinkage after a single treatment utilizing an energy level of 20 J/cm 2. No further treatment, surgical or laser, has been necessary after follow up of at least 12 months. The unique biological and tissue interaction of the copper vapor laser light is believed to be responsible for this remarkable response. PMID- 10147188 TI - Getting your money's worth: the strategic planning program of the Stanford Corporate Health Program. PMID- 10147189 TI - Job stress, predisposition to steal, and employee theft. PMID- 10147190 TI - Perspectives beyond health promotion. PMID- 10147191 TI - European news and perspectives {news}. PMID- 10147192 TI - Health promotion and world peace: a developmental perspective. AB - To facilitate the inclusion of world peace as a health promotion issue, a theoretical framework is presented that describes a possible relationship between continued personal growth and development and world peace. In this framework, personal health and growth are related to the evolution of human consciousness beyond the adult ego. This personal growth is then viewed as a contribution to the multiple conditions necessary for world peace. Consequently, world peace can be viewed as a personal health issue as well as a social and political issue. So viewed, peace becomes a personal and professional concern in health promotion. PMID- 10147193 TI - Formative and effectiveness evaluation of a worksite program promoting healthy alcohol consumption. AB - PURPOSE: This project involved the formative and effectiveness evaluation of a program aiming to enable working, nondependent drinkers to consume alcohol in a healthy and socially responsible fashion. DESIGN: A baseline survey (n=387) of employee needs and interests was followed by a formative evaluation testing accessibility, interest/resistance, and potential effectiveness. The formative evaluation used successive iterations of focus groups. The subsequent effectiveness evaluation (n=268) used a randomized pre-post design with three conditions: alcohol program, placebo (nutrition) program, or no program. SETTINGS AND SUBJECTS: The program was implemented in a multi-branch, blue-collar, shiftworking organization (n=813) in four Quebec cities with many mobile workers. INTERVENTION: The worksite alcohol program consisted of two, half-hour sessions delivered one week apart by a health professional during paid time. The program provided information on the social and personal costs of alcohol, on strategies for promoting socially responsible drinking, and for the prevention of negative consequences of intoxication for oneself and one's family and friends. MEASURES: Constructs measured using self-administered questionnaires were: alcohol knowledge, socially responsible attitudes, perceived self-efficacy for drinking management, and self-reported drinking behavior. RESULTS: Despite the lack of interest in the topic (as found in the needs and interests survey), the program was effective in promoting socially responsible attitudes and reducing self reported weekly consumption among participants. Some placebo effects were also present. Participants were not completely representative of all employees. CONCLUSION: Worksite alcohol health promotion programs can be effective especially when promoting socially responsible attitudes. PMID- 10147194 TI - Dietary, alcohol, and tobacco intake among Mexican-American women of childbearing age: results from HANES data. AB - PURPOSE: Dietary intake and substance abuse are important predictors of pregnancy outcome yet little is known about these behaviors in Mexican Americans. Dietary, tobacco, and alcohol intake of Mexican-American and non-Hispanic white women were compared across the reproductive cycle. DESIGN: Four cross-sectional groups- interconceptional, pregnant, lactating, and postpartum non-lactating--were compared within and between ethnic groups. SUBJECTS: A stratified sample of 682 women, 16 to 44 years old, of Mexican birth or origin from the Hispanic HANES was contrasted with a similarly stratified sample of 1,396 white non-Hispanic women from the NHANES: MEASURES: Demographic, behavioral and health characteristics, food practices, and fluid intake were examined. Data on food servings were combined into five major food groups. RESULTS: Compared with white non-Hispanics, Mexican-American women had lower socioeconomic status and worse perceived health. However, Mexican Americans reported lower consumption of tobacco, alcohol, diet soda, and caffeine, particularly during pregnancy and lactation. Although portion sizes for the foods consumed were not assessed, frequency of consumption of fruits and vegetables and milk was lower and meat higher among Mexican Americans. CONCLUSIONS: Despite socioeconomic disadvantages, Mexican-American women have better health habits than white non-Hispanic women. From these data it is unclear how diet affects pregnancy outcomes in Mexican Americans. PMID- 10147195 TI - Risk management in transfusion medicine. PMID- 10147196 TI - Risk management in transfusion medicine: a hospital transfusion service perspective. AB - The hospital transfusion service has always been at the heart of the blood component therapy chain. It has had the multiple roles of not only maintaining an inventory of a wide range of blood components, monitoring their storage conditions and ensuring compatibility when appropriate, but also being the source of expertise in transfusion medicine, and attempting to follow up any adverse consequences of transfusion. Hospital transfusion medicine has been seen essentially as a scientific and technical specialty with a minimal component of medical input. This is now changing and transfusion medicine is becoming an all embracing specialty where the hospital transfusion service still remains at the heart of transfusion medicine, but a much higher level of understanding is necessary at the clinical and consumer level. PMID- 10147197 TI - The clinician's approach to the management of risk. AB - Although risk has always been accepted as an integral part of any medical or surgical therapy, it is only in recent years that quantitation of this risk in transfusion medicine is being assessed in a detailed and practical manner. Balancing of the risk/benefit equation in relation to blood component therapy has only become a day-to-day issue in clinical medicine since the recognition that HIV could be transmitted by blood transfusion. Blood transfusion has never been as safe a procedure as most patients and clinicians have thought, with numerous potential complications and new ones being recognized. As medical teaching in blood component therapy has not had a high profile in most undergraduate and postgraduate medical curricula, there has been an inappropriately low level of awareness for the indications for the risks and benefits of blood component therapy. Since the appearance of transfusion-transmitted HIV, clinicians and patients alike have rapidly become aware of the potential risks associated with transfusion medicine. This paper addresses the issues of how the clinician can minimize the risks of blood component therapy and to effectively present the risks and benefits to clinical users and potential recipients of blood component therapy. Paradoxically, in developed countries, transfusion therapy is probably safer than it has ever been in the past, but the perception of the community is the opposite. Why is this so?, and what can be done to improve that patient's perception and associated fear? The ultimate answer rests with improving assessment of risks versus benefits, effective education and communication with the patient (and relatives) in order to achieve meaningful informed consent. PMID- 10147198 TI - An overview of laboratory and clinical aspects of leucocyte-depleted blood components. PMID- 10147199 TI - Risk management in transfusion: an historical overview. PMID- 10147200 TI - Current trends: evolving concepts in transfusion medicine: potential alternatives to platelet transfusion. PMID- 10147201 TI - Evaluation of the Fresenius cell separator AS 104 for harvesting peripheral blood stem cells in pediatric patients. AB - In a single institution trial we carried out 35 peripheral blood stem cell harvesting procedures in 12 children with advanced malignancies to evaluate the procedure's safety and the collection efficiency of the Fresenius blood cell separator AS 104 in a pediatric population. Despite a significant mean decrease of 21% (+/-8%) in systolic blood pressure after starting the procedure, all children tolerated leukapheresis without any adverse reaction. After termination of leukapheresis there was a significant decrease of all determined hematological parameters, as compared with pre-harvest values. The mean mononuclear cell recovery was 64% (+/-26%), and in 25/35 (71%) harvesting procedures the minimum progenitor number required for safe autografting could be obtained by one single leukapheresis. We conclude that the Fresenius AS 104 blood cell separator provides a high cell yield and is a safe device for leukapheresis in pediatric patients. PMID- 10147202 TI - The "Hillary effect" is actually effective managed care. PMID- 10147203 TI - A brief primer on health care reform. PMID- 10147204 TI - Integrated delivery systems: considerations for organizations and providers. PMID- 10147205 TI - Tips on monitoring quality and outcomes in rehabilitation services. PMID- 10147206 TI - Design goals for augmentative communication. PMID- 10147207 TI - Human factors considerations in the design of language interfaces in AAC. AB - The design and development of new augmentative and alternative communication (AAC) systems and techniques must often include a focus on the presentation, selection, and processing of language items. We define this as the language interface and argue that researchers must take into account the broad base of knowledge available from the fields of human factors and human-computer interaction in the design process. This article will present an overview of these fields and discuss design principles that are relevant to AAC language interfaces. These principles will be discussed with respect to a number of currently available techniques. In addition, design case studies will be presented on some techniques currently under investigation. Finally, issues related to evaluation will be discussed. PMID- 10147208 TI - Mastering alternative computer access: the role of understanding, trust, and automaticity. AB - Many individuals use computer-based assistive devices as alternatives for the fluent, automatic skills of speech, writing, and touch-typing. This paper proposes that controlling an alternative access technique should become as automatic as touch-typing or speech. The process of acquiring a cognitive-motor skill is discussed. Prerequisites to skill acquisition and impediments to motor automaticity are outlined. Factors that promote or impede skilled control of alternative computer access systems at each stage of the design, assessment, prescription, training, and evaluation process are reviewed. Several case examples are used to illustrate relevant issues. PMID- 10147209 TI - Learning and performance of able-bodied individuals using scanning systems with and without word prediction. AB - This study examines how the cognitive and perceptual loads introduced by a word prediction feature impact learning and performance. Two groups of able-bodied subjects transcribed text using two row-column scanning systems for 10 consecutive trials each. The two systems differed only in that one system had a word prediction feature. Subject groups differed in their order of system use. The results show that, under the conditions of this study, the word prediction system was not substantially more difficult to learn, but it did not yield a statistically significant improvement in text generation rate. This suggests that the cost of using this word prediction system balanced the benefit of the keystroke savings achieved by these subjects. The relationship between keystroke savings, cost in item selection rate, and improvement in text generation rate is explored in order to provide insight into this outcome. PMID- 10147210 TI - Successful antidote of multiple lethal infections using sustained delivery of difluoromethylornithine by means of ceramic drug delivery devices. AB - The objectives of this study were (1) to cure multiple infections of trypanosomiasis in rats by the sustained release of DFMO from biodegradable tricalcium phosphate (TCP) and aluminum-calcium-phosphorous oxide (ALCAP) delivery systems, and (2) to determine if the side effects associated with oral administration of DFMO can be avoided by using TCP and ALCAP capsules. Sixty eight SD male albino rats (235-270 g) were divided randomly into five groups. Each rat in group I (n = 16) was implanted subcutaneously (s.c.) with four TCP capsules (two large TCP (L-TCP), one PLA-impregnated large TCP (IL-TCP) and one thin TCP capsule (TN-TCP)). Rats in group II (n = 16) were implanted s.c. with four ALCAP ceramics (two large ALCAP (L-ALCAP), one PLA-impregnated large ALCAP (IL-ALCAP) and one thin ALCAP capsule (TN-ALCAP)). Rats in groups III (n = 16), IV (n = 4) and V (n = 16) were left without implants. Rats in group III (n = 16) were given 4% (w/v) DFMO (pH 7) in drinking water at the day of inoculation and continued up to 7 days postinoculation. Rats in group IV (n = 4) served as a nontreated group. Rats in group V (n = 16) served as normal controls. The results showed that all rats implanted with with TCP or ALCAP implants had no intoxications symptoms or side effects such as diarrhea during the treatment period. In contrast, rats given DFMO in drinking water exhibited foul-smelling diarrhea during the treatment period. Microscopic evaluation of blood smears collected from rats receiving DFMO chemotherapy showed an occasional or limited number of stumpy shape (SS) trypanosomes. This study suggests that (1) ceramic drug delivery systems are capable of delivering DFMO in a sustained manner for two months, and were able to cure repeated infections of trypanosomiasis; (2) the use of ceramic implants avoided widely fluctuating, irregular levels of DFMO in the body by keeping sustained levels above minimal effective concentrations; (3) ceramic drug delivery systems provide a pharmacological potentiality for drugs such as DFMO which have been withheld from the market because of severe side effects when administered using conventional methods of drug administration; and (4) DFMO-filled ceramic devices can be implanted subcutaneously in animals that face a threat of lethal protozoal infections in highly infested areas of the world. PMID- 10147211 TI - The impact of the AIDS epidemic on the paramedical industry. PMID- 10147212 TI - Reducing endoscopic contamination levels: are liquid disinfecting and sterilizing reprocessors the solution? PMID- 10147213 TI - Liquid disinfecting and sterilizing reprocessors used for flexible endoscopes. AB - In this issue, we evaluate three liquid disinfecting flexible endoscope reprocessors that can be used with a user-supplied liquid chemical germicide (LCG), primarily for high-level disinfection (HLD). Applying most of the same criteria and test methods, we also evaluated a fourth unit, presented separately, that is marketed as a liquid sterilizing reprocessor and must be used with manufacturer-supplied, single-use containers of LCG. Although the sterilizing unit can be used for rigid endoscopes, surgical instruments, and endoscopic accessories, we evaluated its application to the reprocessing of only flexible endoscopes. Our ratings are based on the following: (1) basic performance, such as compatibility with several different types of endoscopes and LCGs, inclusion of all essential reprocessing phases, and exposure of all endoscope surfaces to the LCG and rinse water; (2) safety, such as ensuring that essential reprocessing phases cannot be skipped or omitted, that personnel exposure to LCG vapors is minimized, and that the reprocessor is unlikely to contaminate the endoscope during reprocessing; and (3) human factors design, such as ease of use and installation. We did not perform microbiological testing to confirm HLD or sterilization by any of the evaluated reprocessors because, with a suitably clean endoscope that is in good condition, no evidence indicates that the LCGs used would not be effective on the surfaces that they contact; also, the results would be unique to the two flexible endoscopes that we used for our testing. We rated all four reprocessors Conditionally Acceptable. The units are Acceptable on the condition that users understand that they cannot be used to process the elevator cable channel of side-viewing duodenoscopes; additional conditions apply only to the liquid disinfecting units. However, if the conditions are met, all four units reduce the likelihood of using a contaminated endoscope on a patient and reduce personnel exposure to the LCG. Selection of a unit will be based on the needs and preferences of the individual healthcare facility. Our ratings also assume that these units will be used according to the manufacturers' instructions and the endoscope's operator's manual. Note that, although the evaluated liquid disinfecting units provide detergent-flushing, post-detergent water-rinse, and post-detergent water-rinse-removal phases, manual cleaning of endoscopes before automatic reprocessing is essential, regardless of which reprocessor is used.(ABSTRACT TRUNCATED AT 400 WORDS) PMID- 10147214 TI - Guidance section: selecting, purchasing, and using reprocessors for flexible endoscopic applications. AB - In this section, we summarize and expand on the significant findings from our Evaluation of liquid disinfecting and sterilizing flexible endoscope reprocessors. Below, we present factors that will help users decide whether their facility should purchase a reprocessor and which unit is the best selection for their needs. We also provide guidance intended to improve the overall safety and effectiveness of flexible endoscope reprocessing. Readers are advised to review the entire study in conjunction with this guidance material to establish a firm foundation for any selection, purchasing, or use decisions regarding flexible endoscope reprocessors in general, as well as those that we evaluated. Decisions on selecting and purchasing one of the evaluated reprocessors should not be based on our criteria, test methods, test results, or ratings alone, but on a thorough understanding of the clinical and technical issues associated with these devices, which can be gained by reading this issue in its entirety. PMID- 10147216 TI - Health care reform and rationing: process lessons from the states. PMID- 10147217 TI - Simple, rapid method for assessment of serum vitamin A concentration. PMID- 10147218 TI - Hemoglobin F and measurement of oxygen saturation and fractional oxyhemoglobin. PMID- 10147219 TI - Implementing quality assurance in the physician office laboratory. PMID- 10147220 TI - Patella infera following arthroscopic anterior cruciate ligament reconstruction. AB - Fifty patients who had an arthroscopic anterior cruciate ligament reconstruction for chronic insufficiency were reviewed at an average of 13.6 months following surgery. Among these patients, 32% complained of anterior knee pain that interfered with daily activities. Radiographic patella infera was present in 12% of patients using the Insall-Salvati ratio and in 16% using the Blackburne-Peel ratio. Radiographic patella infera did not correlate with the clinical problem of postoperative anterior knee pain. However, loss of knee extension of greater than 5 degrees correlated highly with pain (p=0.002). PMID- 10147221 TI - Wound closure using a skin stretching device. AB - The recent development of an indexed tissue advancement system makes it possible to take advantage of the viscoelastic properties of skin to close large wound deficits in one procedure. A case is presented in which serial excision of a previous split-thickness skin graft and tissue expansion to achieve wound coverage were performed in one sitting to close an 8cm defect on the lateral side of the patient's leg without subsequent wound separation or dehiscence. PMID- 10147222 TI - Long-arm Charnley splint. AB - Fractures of the distal forearm--the eponymic Colles' or Smith's fractures--are among the most common injuries treated by the orthopaedist. Most of these fractures are amenable to closed reduction and immobilization. A new modification of the Charnley splint is presented for use in the acutely injured patient. The major advantages of this new splint are decreased weight and ease of application. PMID- 10147223 TI - The painful total knee replacement and the influence of component design. PMID- 10147224 TI - Front-end automation: the last hurdle. PMID- 10147225 TI - Shared pools: a boost for laboratory quality control. PMID- 10147226 TI - Pharmacoeconomics of selective decontamination of the digestive tract in intensive care patients: a US perspective. PMID- 10147227 TI - The economics of screening for microalbuminuria in patients with insulin dependent diabetes mellitus. PMID- 10147228 TI - Expanding the role of pharmacists in pharmacoeconomics: why and how? PMID- 10147229 TI - Quality of life measures in cancer chemotherapy: methodology and implications. AB - Quality of life has been an implied outcome of medical care since ancient times, yet only recently have tools become available to measure quality of life in a systematic fashion. Cancer is one of the chronic diseases where quality of life outcomes have been particularly salient. Currently, there are a wide variety of generic and cancer-specific instruments that are being used to evaluate the impact of cancer chemotherapy on the patient's quality of life. Most of these instruments rely on patient self-report rather than expert evaluation. The addition of quality-of-life (QOL) assessment to pharmacological investigations of cancer chemotherapy may enhance evaluation of clinical outcomes, as well as identify unsuspected drug toxicities. Clinicians, researchers and pharmaceutical companies are more frequently incorporating these measures into the design of cancer treatment protocols. Data on the performance of these tools should become more widely available in the near future, leading to refinements in the selection and use of specific instruments for different purposes. PMID- 10147230 TI - Statistical versus quantitative significance in the socioeconomic evaluation of medicines. AB - This article examines the twin concepts of the statistical significance and quantitative importance of observed differences in studies comparing medicines in terms of economic parameters such as cost-effectiveness and measures of health related quality of life (HRQOL). Central to the design and interpretation of any comparative study, such as a randomised controlled trial, is some prior judgement about the order of magnitude of a difference that would make one switch from one therapy to another. Starting with current definitions of clinically important differences we argue by analogy that the importance of differences in HRQOL require a shift of focus from the physician to the patient for preferences and judgements concerning what is important to them. Whether an intervention offers sufficient value for money (cost effectiveness or cost utility) to warrant resources being reallocated to it is a collective decision requiring the input of public preferences about the relative importance of alternative therapies and health benefits. Ultimately, the importance of the health benefits offered by a new drug is revealed by societal willingness-to-pay. This may be stated implicitly through committees using cost-effectiveness 'league tables' for decision making, or explicitly by consumer surveys of willingness-to-pay in the context of cost-benefit analysis and stemming from the theoretical foundation of welfare economics. PMID- 10147231 TI - An evaluation of antihypertensive prescribing practices. AB - We evaluated the management of patients with hypertension (including drug prescribing) by US physicians, compared their prescribing to National Institutes of Health (NIH) guidelines, and compared the pharmacoeconomics of the prescribed antihypertensive drugs. A 1991 national US database, using physician-patient encounter forms, was our data source. Results showed that physicians generally met the NIH guidelines regarding diagnostic/screening services, patient counselling/education, antihypertensive drug prescribing and follow-up. Two areas should be the foci of continuing medical education for US physicians. Firstly, physicians need to be reminded that centrally acting alpha 2-agonists are optimally used as supplemental antihypertensive drugs rather than as initial agents, which is how some physicians utilised them. Secondly, if once-daily administration is used to promote patient compliance, physicians should be aware that, of the frequently prescribed first-line antihypertensive drugs, hydrochlorothiazide, chlorthalidone and atenolol presently have substantially less expensive once-daily dosage forms than other diuretics or beta-blockers, calcium antagonists or ACE inhibitors. PMID- 10147232 TI - Treatment perspectives in rheumatoid arthritis: a descriptive study in a Swedish healthcare district. AB - This study analyses patterns of treatment offered to individuals with a clinical diagnosis of rheumatoid arthritis (RA). A cross-sectional investigation was carried out in 321 patients (aged greater than 16 years) fulfilling the 1958 American Rheumatism Association (ARA) criteria for RA. Medical records were scrutinised retrospectively for information about medical, surgical and other treatments during a 5-year period (1982 to 1986). All patients had received medical treatment, but a large number had discontinued drug therapy because of adverse effects or lack of efficacy. 45.9% of the individuals were receiving 1 drug at the time of the survey, 33.8% were on 2 drugs, 11.7% were on 3 or 4 drugs, and 8.6% were not receiving any medication. Nearly 50% of the patients had had various kinds of surgical procedures performed. The clinical manifestation of the disease, as measured by the number of ARA criteria fulfilled, showed a linear correlation to nearly all medical and surgical treatments. A primary healthcare physician was the basic contact person for 90% of the patients, but in addition 70% of the participants had been examined at sometime by a rheumatological specialist. The study confirms our expectations that patients with RA receive numerous pharmaceutical and other treatments. Even patients with mild and/or early disease (probable RA) had received a considerable amount of treatment. Qualified specialised care was also provided despite the distance to a university referral centre.(ABSTRACT TRUNCATED AT 250 WORDS) PMID- 10147233 TI - Hormone replacement therapy: I. A pharmacoeconomic appraisal of its therapeutic use in menopausal symptoms and urogenital estrogen deficiency. AB - Menopause and the accompanying reduction in estrogen production may cause a number of symptoms in women which include hot flushes, sweating, mood and sleep disturbances, fatigue and urogenital dysfunction. The effectiveness of estrogen based hormone replacement therapy (HRT) in ameliorating these symptoms, and in preventing long term sequelae such as osteoporosis, is well established. Comparative trials indicate that oral conjugated estrogens 0.625mg, oral ethinyl estradiol 0.02mg and transdermal estradiol 0.05mg have equivalent efficacy in relief of mild to moderate menopausal symptoms and prevention of bone mineral loss. Concomitant progestogen therapy is usually prescribed for women with intact uteri to protect against endometrial hyperplasia and carcinoma. The addition of progestogen maintains and may even enhance the bone-conserving effects of estrogen, and continuous regimens appear to reduce the incidence of irregular menses. Adverse reactions are predominantly local skin irritation with transdermal preparations (14% of patients) and systemic effects common to most forms of HRT including breast tenderness, flushing, headache and irregular bleeding, occurring in less than or equal to 2% of patients. Data concerning the effect of HRT on quality of life are limited, but most analyses have assigned utility values of 0.99 for mild and 0.95 for severe menopausal symptoms. However, recent clinical data suggest that these utility values may underestimate the impact of menopausal symptoms on quality of life. The cost benefit and cost effectiveness of HRT in the treatment of menopausal symptoms have not been fully researched, although preliminary results suggest that conjugated estrogens and transdermal estradiol compare well with alternative therapies such as veralipride and Chinese medicines. A Swedish study using a prevalence-based approach estimated that estriol treatment in all women with urinary incontinence aged greater than or equal to 65 years resulted in monetary savings compared with treating 20% of women. Cost-utility data indicated that the change in quality adjusted life years (QALYs) with HRT was always positive, but the degree of change was determined by the baseline assumptions. Estimated changes in QALYs with HRT ranged from 0.006 for 5 years of treatment with unopposed estrogen in women with intact uteri, to 0.5 for 10 years of the same treatment in women with severe menopausal symptoms following hysterectomy. Compliance with HRT is suboptimal as 5 to 50% of women withdraw from therapy, thereby increasing costs per year of life saved.(ABSTRACT TRUNCATED AT 400 WORDS) PMID- 10147234 TI - Costs of epoetin in patients with AIDS. PMID- 10147235 TI - Political, economic and ethical aspects of use of medical abortifacients. PMID- 10147236 TI - Pharmacoeconomic studies on antibiotics: current controversies. PMID- 10147237 TI - Pharmaceutical price review in Canada. PMID- 10147238 TI - Assessment of quality of life in rheumatoid arthritis: methods and implications. AB - During the last decade, self-report of health status and quality of life has gained increasing credibility and acceptance in studies of individuals with rheumatoid arthritis (RA). According to a number of reports, the new self assessment instruments offer an excellent complement to the more traditional clinical outcome measurements. In the absence of a cure for RA and the use of potentially toxic drugs, quality-of-life assessment seems to have an important place in clinical drug trials. The most commonly used quality of life or health status instruments in studies of RA seem to perform well and give reliable and valid information. A common concern, however, with these instruments is that there appears to be a lack of questionnaires which allow satisfaction with various aspects of quality of life to be expressed. Many instruments focus on negative aspects of quality of life, although quality of life for most individuals is related to something positive. There is no perfect instrument applicable for all situations, but the selection of an instrument depends on the specific purpose of a particular study. Psychological interventions are more likely to affect people's emotions and well-being, whereas a drug intervention might more dramatically affect physical function. It appears, however, reasonable to assume that effects of drug intervention on quality of life should be measured with a longer perspective, such as after at least 6 months' observation. The field is still in a phase of methodological and theoretical development which is also reflected in the few numbers of published studies concerning the effect of drug interventions on quality of life of patients with RA. PMID- 10147239 TI - Drug utilisation studies as tools in health economics. AB - Drug utilisation and many pharmacoeconomic studies use pharmacoepidemiological methods characterised by the study of drugs from a socioeconomic perspective. Drug utilisation studies may be defined as studies of the marketing, distribution, prescription and use of drugs in a society, with special emphasis on the resulting medical, social and economic consequences. Pharmacoeconomic studies are used to measure drug efficiency, through comparison of the costs and effects of alternative therapies. Drug utilisation studies can provide highly valuable information, at a reasonable price, on the costs and effects (harmful and beneficial) of drugs. Such studies make available much useful information including indirect data on morbidity, the pharmaceutical component of the treatment cost of an illness, therapeutic compliance, the incidence of adverse reactions, the effectiveness of drug consumption and the choice of comparators. This information can be of great use in the subsequent elaboration of pharmacoeconomic studies, or in the selection of problematic areas in which these studies may be applied. Pharmacoeconomic studies, in turn, can be used to discover the economic repercussions of inappropriate prescribing and to quantify the cost effectiveness of various therapeutic interventions. The use of drug utilisation studies in conjunction with pharmacoeconomic analysis can result in more cost effective utilisation of medicines and a better utilisation of pharmacoeconomic methods, both of which contribute to a more rational use of drugs. PMID- 10147240 TI - Formulary management of antiulcer drugs: economic considerations. AB - Peptic ulcer disease (PUD) is a common medical problem costing billions of dollars annually around the world. Since the availability of the first histamine H2-receptor antagonist, cimetidine, many economic analyses have been conducted to compare the impact of this drug class on resource consumption. H2-Antagonists have been shown to reduce mortality, hospitalisations, ambulatory care visits and endoscopy use caused by PUD. Because of changing risk factors and variations in diagnosis, it remains controversial whether these drugs have had a long term impact on PUD incidence and prevalence. Three studies conducted after the introduction of cimetidine showed it to reduce total direct medical healthcare expenditures, despite increases in drug costs. Studies investigating the short term treatment of PUD show mixed results because of diverse study designs and different comparator drugs. No specific therapy appears consistently superior economically because of variations in population studies, ulcer relapse rates and drug acquisition costs. However, maintenance therapy for PUD has been shown to be cost-effective. When compared with surgery--an extremely efficacious option- maintenance therapy (both daily and intermittent) is cost-effective over at least a 10-year period. Within the maintenance therapy options, daily ranitidine has been shown to be more cost-effective than intermittent therapy for up to 2 years. Omeprazole is the least costly and most efficacious treatment for gastroesophageal reflux disease (GORD or GERD) compared with ranitidine and/or lifestyle modification alone. It has also been shown that the costs for empirical treatment of GORD are offset by the costs of additional investigation of those who do not have the disease. Thus the decision of whether to treat empirically should be based on physician and patient preferences, and not on costs. The use of misoprostol for ulcers caused by nonsteroidal anti inflammatory drugs is somewhat controversial. Three studies examining the short term (3-month) costs of misoprostol generally show it to be cost saving or cost neutral. Misoprostol is consistently more cost beneficial in elderly or other high risk patients. Results are highly sensitive, however, to several parameters, such as patient type, ulcer severity and rate, drug costs and patient compliance. One study examining prophylaxis using misoprostol over 1 year showed it to be a generally expensive therapy for primary prevention, but was more cost effective for those with a proven GI bleed in the previous year.(ABSTRACT TRUNCATED AT 400 WORDS) PMID- 10147241 TI - Drug prices and third party payment: do they influence medication selection? AB - The growing burden of prescription drug costs has focused attention on factors which influence physicians' prescribing decisions. We hypothesised that third party coverage of prescription costs would elicit selection of expensive drugs, but that this tendency could be moderated by price reminders. In a mailed survey, primary care physicians throughout Ontario (n = 1072) were provided with the clinical scenario of a patient with an infectious exacerbation of chronic obstructive pulmonary disease, and asked to select diagnostic tests as well as 1 of 6 antibiotics. Two antibiotics were expensive (ciprofloxacin and cefaclor; average price $Can52.23), and 4 inexpensive {amoxicillin, cotrimoxazole (trimethoprim/sulfamethoxazole), erythromycin and tetracycline; average price $Can2.80}. Neither expensive drug is considered first line therapy for the condition described. Questionnaires differed in the presence or absence of drug benefit coverage and price information. The response rate was 71%. With third party cost coverage and prices shown, 18% of respondents selected an expensive antibiotic. This increased to 38% when the prices were omitted {odds ratio 2.72; 95% confidence interval (CI) 1.61, 4.60; p less than 0.001}, and decreased to 8% when the patient was said to have no drug benefits coverage (odds ratio 0.40; 95% CI 0.19, 0.84; p less than 0.01).(ABSTRACT TRUNCATED AT 250 WORDS) PMID- 10147242 TI - The cost per treatment success. PMID- 10147243 TI - Worldwide epidemiology of obesity. AB - Average body mass index values and prevalence data for overweight show complex patterns varying with sex, age, socioeconomic circumstances, race, geography, and over time. Differences in the predominant lifestyles and developmental status of nations and regions also influence weight patterns. Estimates of the prevalence of obesity in developed countries vary depending on the definitions used. For example, one recent survey has reported that the prevalence of obesity in the US is 15%, while another survey has found it to be 26%. It appears that overweight and obesity are becoming more prevalent worldwide, not only in developed nations, but also in the populations of developing countries, possibly as a result of urbanisation, migration, new eating habits and recent affluence. Since modernisation appears to be an inevitable process throughout the world, there is every reason to expect that the epidemic of overweight and obesity will extend globally in the future. PMID- 10147244 TI - Causes, diagnosis and risks of obesity. AB - This paper reviews definitions of obesity and evidence concerning risk factors for becoming obese. Modifiable aetiological factors, including diet and physical activity, are described, and possible interactions with genetic predisposition are addressed. The impact of obesity on health and quality of life is then considered. Although epidemiological studies have not observed linear associations between increasing weight-for-height and decreasing longevity, there is a consensus that excess mortality occurs at extremely high body mass index values. Compromised quality of life is also observed at this end of the obesity distribution, and is manifested as decreased psychological well-being, less social integration, and stigmatisation. PMID- 10147246 TI - Introduction: the medical cost of obesity. PMID- 10147245 TI - Options for the management of obesity. AB - The need to treat obesity successfully can be measured by the medical penalty paid by the obese individual and the financial price paid by society in general. The management of obesity has 2 objectives: first, to produce significant weight reduction (10% of pretreatment bodyweight) and, second, to maintain this weight reduction. For the purpose of this paper, we have defined successful treatment as that maintaining significant weight loss for at least 5 years. A review of the literature confirms that there is no single outstanding treatment for obesity, and that clinicians must consider an individual's needs before selecting a particular method of weight reduction. The main determinants of suitability of any specific treatment are degree of obesity, concomitant medical disorders, urgency of treatment, and the individual's willingness to undergo the programme prescribed. PMID- 10147247 TI - The cost of obesity: the US perspective. AB - Obesity is associated with an increased risk of many major chronic diseases. We estimated the economic costs of obesity-associated non-insulin-dependent diabetes mellitus, cardiovascular disease, gallbladder disease, cancer, and musculoskeletal disorders in 1990 US dollars, using a prevalence-based approach to cost-of-illness. In addition to direct costs, indirect costs were also estimated. The indirect cost of morbidity was estimated by calculating the costs associated with work days lost, and mortality costs were estimated on the basis of lifetime earnings lost. In 1990, the direct cost of obesity-associated disease in the US was $US45.8 billion, and the indirect cost of obesity was estimated to be $US23.0 billion. Therefore the total economic cost of obesity was estimated to be $US68.8 billion in 1990. PMID- 10147248 TI - Obesity in Europe: prevalence and consequences for use of medical care. AB - Obesity {defined herein as a body mass index (BMI) greater than 30 kg/m2} is common in middle-aged Europeans, particularly in women from Mediterranean and Eastern European countries. Epidemiological comparison shows no relationship between obesity and coronary heart disease mortality in men, but a weak association in women, which became stronger after adjustment for smoking. Within individual countries, however, increased BMI is associated with increased cardiovascular risk factors in populations across Europe. In The Netherlands, the direct annual healthcare costs associated with overweight and obesity (BMI greater than 25 kg/m2) have been calculated to be approximately 1 billion Dutch guilders, which corresponds to about 4% of total healthcare costs. PMID- 10147249 TI - The cost of obesity: the Australian perspective. AB - Obesity is a known risk factor for a number of diseases with serious mortality and morbidity implications. Thus, obesity is an economic burden to communities, since it reduces quality of life and leads to premature mortality; in addition, healthcare resources are used to manage obesity-related disease. It was estimated that in 1989, management of disease due to obesity (defined as body mass index greater than 30) cost A$395 million. This estimate covers the healthcare costs for the management of obesity, non-insulin-dependent diabetes mellitus (NIDDM), gallstones, hypertension, coronary heart disease (CHD), breast cancer (among postmenopausal women), and colon cancer. As this estimate excludes the costs of some disease attributable to obesity, it is an underestimate of the true costs. Nonetheless, the estimated cost of the management of obesity-related conditions represents 86% of the healthcare costs used for the management of alcohol-related diseases in Australia. Healthcare costs attributable to obesity have not yet been estimated for countries elsewhere in Asia and the Pacific. However, it is acknowledged that obesity is a major problem in the Pacific, with exceptionally high prevalence rates and concomitant high rates of diseases for which obesity is a major risk factor, particularly NIDDM and CHD. It would, therefore, be useful to explore the cost of disease attributable to obesity in healthcare systems in these communities, and the potential for preventive programmes to reduce these costs. PMID- 10147250 TI - Introduction: the indirect socioeconomic costs of obesity. PMID- 10147251 TI - Socioeconomic consequences of obesity: the effect of obesity on the individual. AB - Obese persons, particularly women, are socially stigmatised, which adversely affects their educational, socioeconomic and marital status. Obese individuals are excluded from certain occupations, and are discriminated against in others. Various surveys have found lower educational and socioeconomic achievement in obese and overweight populations. The inverse relationship between obesity and social class is more evident in women. Obese women were found to complete fewer years of school, be less likely to marry, and have lower household incomes compared with women of normal weight. They were also less likely to improve their social status on marriage. Although differences in socioeconomic status between obese and nonobese persons might be accounted for to some extent by differences in social, economic and educational background, obesity is frequently associated with health problems or reduced physical performance, which can restrict socioeconomic achievement. Furthermore, society's poor perception of obese persons, particularly women, is a major handicap to socioeconomic progress. PMID- 10147252 TI - The indirect costs of obesity to society. AB - Losses in productivity due to illnesses associated with obesity are considerable. In addition, significant social costs resulting from underachievement in education, reduced social activity and job discrimination can be incurred. While social class appears to influence the prevalence of obesity, obesity has, in turn, an influence on social class, probably through employment discrimination; obese men and women have lower status jobs, a situation that is perpetuated through lower status marriages. A comprehensive review of both the direct and indirect consequences of this condition is necessary to identify the most appropriate measures to be taken, e.g. mass education to heighten social awareness and sensitivity. These issues should be considered in the formulation of policies and activities aimed at preventing obesity. PMID- 10147253 TI - The economics of treating obesity. AB - Obesity has become a major contemporary public health concern. The excess burden of disease associated with obesity (e.g. cardiovascular disease, diabetes mellitus, gallbladder disease) results in considerable costs to society, while the indirect costs of obesity include decreased labour input and lower educational achievement. Obese individuals have decreased quality of life and life expectancy. Furthermore, society's stigmatisation of the obese results in decreased opportunities in education, housing and employment. Obesity may be treated by behavioural modification (dieting, exercise), or by interventionist means (pharmacotherapy, jaw-wiring, surgery). The method of weight reduction should be chosen to suit the individual patient; interventionist approaches may be required for patients with severe obesity. Studies to examine the cost and quality of life implications of the various treatment modalities are needed. PMID- 10147254 TI - Continuous invasive cardiac output monitoring--the Baxter/Edwards Critical-Care Swan Ganz IntelliCath and Viligance system. AB - We evaluated the Baxter/Edwards Critical-Care Swan Ganz IntelliCath continuous cardiac output catheter and Vigilance continuous cardiac output monitor in critically ill adult intensive care patients, and compared cardiac output measurements obtained from this new system with those from a standard bolus thermodilution technique using cold normal saline. Nine Swan Ganz IntelliCath catheters were inserted into patients selected at random, following the decision that pulmonary artery catheter monitoring was required. A total of 100 comparisons were made in nine patients. We found the Swan Ganz IntelliCath catheter to be both easy to insert and position, and simple to use. There were no complications or technical difficulties. The mean cardiac output measured by the continuous system was 8.00 l/min (SD 1.66/min) compared to 8.02 1/min (SD 1.74 l/min) using bolus techniques. Continuous cardiac output values correlated well with bolus measurements (r = 0.87), there was excellent accuracy (bias of 0.02 l/min) and precision was acceptable (limits of agreement of -1.71 to 1.75 l/min). These larger than anticipated limits of agreement may not reflect any inaccuracy in the continuous measurement system, rather they may highlight the extent of well recognised potential errors inherent in the intermittent bolus technique. The availability of a system to measure cardiac output continuously provides a major improvement in intensive care monitoring. This system will permit the rapid and accurate assessment of the response of patients to therapy while providing increased diagnostic facilities and a new research tool. PMID- 10147255 TI - A re-evaluation of the ventilator score as an indicator of prognosis in the adult respiratory distress syndrome. AB - OBJECTIVE: To determine whether the ventilator score of Smith and Gordon (1986) can accurately predict outcome in patients with severe Adult Respiratory Distress Syndrome (ARDS). DESIGN: Retrospective study of data from case records and flow sheets. SETTING: University Hospital Intensive Care Unit. SUBJECTS: Fifty-five patients with severe Adult Respiratory Distress Syndrome. MEASUREMENTS AND MAIN RESULTS: The ventilator score of Smith and Gordon (1986), based on a compound score of the patient's age, alveolar to arterial oxygen tension difference and mean peak airway pressure, was calculated daily for for each patient. In contrast to the original report, a high ventilator score ( greater than 80) had a predictive value for death of only 59%, and a specificity of only 29%. The use of a higher ventilator score ( greater than 100) resulted in a predictive value of only 70% with a specificity of 75%. The use of inverse ratio ventilation was associated with a significant improvement in survival in those patients with ventilator scores greater than 100. This finding has not been reported previously. CONCLUSIONS: The ventilator score does not provide a satisfactory predictor of outcome in ARDS and cannot be used as a prognostic tool. It may have some use as an indicator of the severity of respiratory failure. A ventilator score greater than 100 may be an indication for the institution of inverse ratio ventilation. PMID- 10147256 TI - Usefulness of (Tc 99m) HM-PAO scan in supporting clinical brain death in children: uncoupling flow and function. AB - OBJECTIVE: To determine the usefulness of (Tc 99m) HM-PAO scan in supporting the clinical diagnosis of brain death. DESIGN: Retrospective review. SETTING: Paediatric Intensive Care Unit. SUBJECTS: A total of 39 paediatric patients had HM-PAO scans conducted to confirm the presence of brain death or to assess the degree of brain injury. INTERVENTIONS: All patients had (Tc 99m) HM-PAO injected before the scan was conducted. MEASUREMENTS AND MAIN RESULTS: Fifty-four scans were done in 39 patients. The majority of cerebral injury was as a result of closed head injury or asphyxia/anoxia. There were 20 scans which demonstrated no cerebral blood flow (CBF); however, in 26 situations patients were clinically brain dead. All of the patients who continued to have CBF in the presence of clinical brain death sustained asphyxial/anoxic injuries. CONCLUSIONS: The HM-PAO scan is a useful non-invasive portable tool for supporting the diagnosis of brain death when there is absent CBF. However, continued flow may be present in asphyxial/anoxic injuries in the presence of clinical brain death. PMID- 10147257 TI - Reasons for the epidemic of obesity in the US? PMID- 10147258 TI - Characteristics and predictors of participation and success in a televised smoking cessation activity. PMID- 10147259 TI - Adopting a self-care curriculum for Pacific Asian elderly in Hawaii. PMID- 10147260 TI - Comparison of forces in high- and low-impact aerobic dance at various tempos. PMID- 10147261 TI - Alglucerase for Gaucher's disease: dose, costs and benefits. PMID- 10147262 TI - Chronic fatigue syndrome: does it need more healthcare resources? PMID- 10147263 TI - Australian pharmaceutical pricing guidelines: preliminary practical experience. PMID- 10147264 TI - Cost-per-QALY league tables: their role in pharmacoeconomic analysis. AB - It has become common for analysts to present the findings of cost-utility analyses in cost per quality-adjusted life-year (QALY) league tables or rankings. These purport to show the relative value-for-money of different healthcare technologies. Concomitantly, there is an increasing market for cost effectiveness data worldwide. However, the practice of constructing league tables has drawn criticism. Claims of inappropriate comparisons, and poor and flawed methodology have been made. How should decision-makers view cost/QALY league tables? In future, published league tables will need to be more informative and thus, by necessity, complex. The principal obstacle to informing health policy-makers with economic analysis is the lack of appropriate outcome data. From this follows uncertainty as to what represents acceptable value-for money in healthcare purchasing. Thus, the long term objective must be to obtain valid assessments of the value of current and new health service activities. It is in this context that league tables may eventually be most helpful. More immediately, a strategy is required to help decision-makers to prioritise resources rationally with incomplete information. PMID- 10147265 TI - Cost-effectiveness comparison of cefepime and ceftazidime using decision analysis. AB - A retrospective cost-effectiveness analysis, from the institutional perspective, was performed on the 1637 clinically evaluable patients who participated in randomised studies of cefepime versus ceftazidime. The clinical success rate was 88% for patients in both the cefepime and ceftazidime groups. Adverse events occurred in 16.5% of cefepime and 19.0% of ceftazidime patients (p greater than 0.05). In most cases cefepime was administered every 12 hours while ceftazidime was administered every 8 hours. The amount of drug administered per patient (mean+/-SEM) was 17.6+/-0.4g of cefepime and 29.1+/-0.8g of ceftazidime (p less than 0.01). The median number of days of antibiotic treatment was 8 for each group. Decision and sensitivity analyses of drug price and hospital bed cost demonstrated that cefepime was consistently more cost effective than ceftazidime. The probability of clinical success varied between 60 and 97% and revealed that ceftazidime would have to be 31% more effective than cefepime to change the economic decision. If the acquisition prices per gram of drug are similar, cefepime will be cost effective compared with ceftazidime. PMID- 10147267 TI - Fetal monitoring during pregnancy: clinical opinion. PMID- 10147266 TI - Hormone replacement therapy: II. A pharmacoeconomic appraisal of its role in the prevention of postmenopausal osteoporosis and ischaemic heart disease. AB - The reduction in estrogen production that occurs at menopause is associated with several long term sequelae. There is an accelerated decrease in bone mineral density leading to an increased risk of osteoporotic fracture. Furthermore, changes in plasma lipid profiles and other cardiovascular parameters increase the risk of cardiovascular and cerebrovascular pathology. These effects are additional to the menopausal symptoms experienced by many women. The effectiveness of estrogen-based hormone replacement therapy (HRT) is well established in preventing bone mineral loss and also in ameliorating menopausal symptoms, with the addition of progestogen maintaining or possibly enhancing the bone-conserving effects. However, prolonged therapy appears to be necessary to conserve bone mineral density and prevent osteoporotic fracture, particularly in women aged greater than or equal to 75 years, and compliance with long term therapy is likely to be poor. Estrogen favourably alters plasma lipid profiles, improves coronary blood flow and inhibits the central distribution of body fat. Effects on haemostatic mechanisms and coronary vasomotor response to acetylcholine have also been suggested as mechanisms for the beneficial effects of estrogen on ischaemic heart disease. The effects of concomitant progestogens on plasma lipids are variable, and may depend on the type, dosage regimen and duration of therapy. Pharmacoeconomic analyses of HRT have used a variety of risk assumptions. Relative risk rates of osteoporotic fracture and mortality from myocardial infarction are assumed to reduce to 0.5 after greater than 5 years' therapy. Long term HRT is associated with a relative risk of approximately 1.3 for breast cancer, whereas the relative risk of endometrial cancer is 4.0 to 8.0 in women with intact uteri receiving prolonged unopposed estrogen therapy. HRT that includes progestogens is assumed to incur no added risk of endometrial cancer, and this treatment is generally recommended for women with intact uteri. Data concerning the effect of HRT on quality of life are limited and utility values for hip fracture of 0.95 to 0.36 have been assigned, depending on assumptions of disability. Cost-benefit, cost-effectiveness and cost-utility studies evaluating HRT in the prevention of osteoporotic fracture have differed widely in methodology, making comparison of results difficult. HRT appears to be most economically useful in the prevention of fracture if used in women who have undergone hysterectomy, in women with high risk of osteoporotic fracture or ischaemic heart disease, and/or in women with menopausal symptoms.(ABSTRACT TRUNCATED AT 400 WORDS) PMID- 10147268 TI - Fit to nurse: a worksite health promotion program for nurses. PMID- 10147269 TI - College students' awareness, knowledge, and compliance with food guide pyramid recommendations. PMID- 10147271 TI - Perspectives beyond health promotion. PMID- 10147270 TI - Short-term and long-term abstinence rates associated with a hospital-based behavioral approach to smoking cessation. PMID- 10147272 TI - European news and perspectives {news}. PMID- 10147273 TI - The impact of two corporate lactation programs on the incidence and duration of breast-feeding by employed mothers. AB - PURPOSE: The goal of this study was to examine the impact of two corporate lactation programs on breast-feeding behavior among employed women. DESIGN: Breast-feeding behavior was measured for up to one year among women who had given birth during 1989, 1990, 1991, and 1992 and compared with national norms. SETTING: The study was conducted at two corporations: a utilities company with 11,000 employees of which 22% were female with approximately 100 births each year and a space corporation with 3,900 employees of which 31% were female with approximately 30 births per year. SUBJECTS: Participants were 187 employees returning to work following maternity leave for a medically uncomplicated birth. INTERVENTION: Participants collected and stored breast milk using the worksite breast pump room at scheduled times during the workshift and were counseled by a lactation professional throughout the study. MEASURES: A questionnaire was used to establish breast-feeding behavior. Duration was reported by the lactation professional. RESULTS: Since program inception, 75% of the participants who returned to work while breast-feeding continued until their child was six months old. This represented 139 of the 187 mothers at the two companies. Average duration of breast-feeding overall was 8.1 months. DISCUSSION: Participants were able to maintain a breast-feeding regimen for at least six months at rates equivalent to the statistical norms for women who are not employed outside the home. This was not an experimental study. Participants were self-selected and there was no control group. On a year-to-year basis, the numbers of participants were relatively small.(ABSTRACT TRUNCATED AT 250 WORDS) PMID- 10147274 TI - Can life expectancies be used to determine if health promotion works? AB - PURPOSE: The goal of this study was to develop a method to measure the impact and cost-effectiveness of health promotion. DESIGN: Age- and sex-specific changes in life expectancy in Canada between 1970 to 1972 and 1985 to 1987, after the introduction of national health insurance (1970) and health promotion (1975), are used to assess the impact due to biological hardiness, improvements in the health care field, and the effects of health promotion. SUBJECTS: The subjects were the total male and female population of Canada between the years 1970 to 1972 and 1985 to 1987. MEASURES: Life expectancy by years of age by sex was the measurement used. RESULTS: A method is presented that allows the calculation of the differential effects of health promotion, health care, and biological hardiness on changes in life expectancy based on sequential subtraction of life expectancies for one-year age cohorts over a 15-year period. Results were obtained for each year of age for men and women, showing gender and age differences in the relative impact of the three factors. In this illustrative example using Canadian data, health promotion was found to have less impact on longevity than health care or biological hardiness. However, of the three, health promotion was the most cost-effective. CONCLUSION: This method can be used to quantify changes in life span due to health promotion, health care, and biological hardiness for men and women at each year of age and to relate this to health expenditures for the whole population. The method is limited in that it cannot determine the relative impact of other factors that can affect life expectancy such as environmental changes or social trends. PMID- 10147275 TI - Toward a health promotion research agenda: "state of the science" reviews. PMID- 10147276 TI - Impact on behavior therapy on weight loss. PMID- 10147277 TI - Regulatory aspects of modifications to innovator bronchodilator metered dose inhalers and development of generic substitutes. AB - Regulatory requirements for modifications to an approved innovator metered dose inhaler (pressurized MDI; USP nomenclature: inhalation aerosol) and for development of a new generic product are discussed. Although many of the requirements apply generally to MDI's, they are discussed with specific reference to albuterol. Changes to the container and closure system may impact on the dosimetry of the redesigned product, as well as upon toxicologic and chemistry, manufacturing and controls (CMC) concerns. Changes to the formulation, including the use of alternate propellants, may raise issues requiring both clinical and in vivo performance evaluation. In view of the level of interest of a number of firms in approval requirements for generic Albuterol Inhalation Aerosol products, the article discusses in considerable detail the CMC and bioequivalence requirements for a generic product. Similarities in the CMC requirements for innovator and generic products are evident. Three comparative in vivo bioequivalence tests, particle size distribution, spray pattern and plume geometry, and unit spray content, established by the Division of Bioequivalence are discussed. Similarities and differences in the in vivo requirements for innovator and generic products are evident. Differences are the result of U.S. statute, which requires safety and efficacy testing for a product approved under a new drug application (NDA), but documentation of bioequivalence for a product approved under an abbreviated new drug application (ANDA). The advantages and disadvantages of three pharmacodynamic study designs which have potential usefulness for documentation of in vivo bioequivalence are discussed. PMID- 10147278 TI - Feasibility of drug delivery to the respiratory tract by a mechanical micro spray pump. AB - A hand actuated, propellant free spray device is being developed which may be suitable for medical inhalation therapy. The purpose was to evaluate the feasibility of the mechanical micro spray pump to produce a fine spray whose droplets were suitable for inhalation. The physical and technical requirements have been achieved using an air blast nozzle which has been improved by changing the geometry and therefore the dynamic properties within the spray nozzle. The generation of particles above 50 mum in diameter was suppressed and the injection time of the spray increased. These features resulted in a finer and more uniform spray. In-vivo experiments were conducted, where 15 mul per stroke of a 99mTc labeled saline solution was delivered to test persons. The activity was measured by gamma-scintigraphy. It was observed that without and with a spacer, a respective thoracic deposition of 8 %vol and 13 %vol was achieved on average. PMID- 10147279 TI - Potential use of microencapsulation for sustained drug delivery to the respiratory tract. AB - Microencapsulation has long been regarded as a means of achieving sustained drug delivery. In these studies, a spray drying technique was used to produce salbutamol-loaded albumin microparticles with a view to formulating a controlled release system to be used in respiratory drug delivery. Encapsulation efficiencies (40-60 % w/w) obtained using this technique compared very favourably with those obtained using emulsification procedures (1-2 % w/w). PMID- 10147280 TI - A mechanical micro spray pump: an alternative to propellant driven devices? AB - An account is given on the development of a purely mechanical Micro Spray Pump (MSP) which is capable of delivering aqueous drug solutions to the respiratory tract. In-vitro, deposition characteristics of two solutions, food dye and salbutamol sulphate, at different dosage levels and various flow rates were determined. A theoretical flow model was employed to understand deposition pattern in the Twin Impinger. In-vivo experiments where a 99mTc marked isotonic saline solution which nebulized by the MSP showed bronchial deposits on average of 8% and in a single experiment with spacer even up to 25%. The MSP prototype proves to be a feasible alternative non-propellant driven device to deliver drugs to the respiratory tract. PMID- 10147281 TI - The characterisation of inhalation devices by an inhalation simulator: The Electronic Lung. AB - The Electronic Lung is an inhalation simulator designed for the characterisation of breath-actuated inhalation devices. It enables the in-vitro evaluation of devices under conditions that have been produced in-vivo. Data generated on the Serevent Diskhaler inhaler have highlighted the reproducibility of particle size distribution of drug delivered from the device over a range of inhalation parameters. PMID- 10147282 TI - Feasibility of a low dosage dynamic powder dispenser for drug delivery to the lungs. AB - Inhalation of drugs offers the opportunity to treat diseases of the respiratory tract. A manually operated prototype, called Dynamic Powder Dispenser (DPD), for dispensing a predetermined amount of powdered drug has been developed. This device actively disperses powder from a chamber through a mouthpiece ready for inhalation. The DPD is a multi-single dose device which delivers drugs actively and does not require breath actuation. This DPD which insufflates dry powder into the respiratory tract can be considered as a counterpart to an MDI. The respirable fraction was found in-vitro in the range of 10% and 25% for salbutamol and terbutaline, respectively. PMID- 10147283 TI - Epidemiology and pharmacoeconomic issues relating to acute respiratory tract infections and acute uncomplicated infections of the urinary tract. AB - Respiratory and urinary tract bacterial infections are among the most frequently encountered conditions in clinical medicine. Driven by the increasing incidence of antimicrobial resistance and treatment failures in these conditions, newer, and unfortunately more costly, alternatives are constantly being sought. As expenditures on healthcare are currently under greater levels of scrutiny than ever before, the economic aspects of drug therapy have become an important area of inquiry. Cost-effective drug therapy depends on several factors, of which initial drug cost is only one. Clearly, drug efficacy, duration of therapy and dose regimen, diagnostic strategies, route of drug administration, microbial drug resistance and patient compliance all directly impact on cost-effectiveness evaluations. However, to avoid merely shifting costs, true evaluation of cost benefit must take indirect economic factors such as loss of patient (and parental) income, loss of productivity, opportunity costs, and patient discomfort/suffering into account. In this article, these issues are discussed and illustrated using common respiratory and urinary tract bacterial infections as a model. PMID- 10147284 TI - Defining criteria for the pharmacoeconomic evaluation of new oral cephalosporins. AB - Economic analysis is founded on the assumption that resources are limited and that they should be used in a way that maximises the benefits gained. It should be clear that economic analysis must be based on a consideration of choices for resource utilisation. Pharmacoeconomics extends these assumptions to drug treatment. Therefore, a full pharmacoeconomic analysis must consider two or more alternative treatments and should be founded on measurement of incremental cost, incremental efficacy, and the value of successful outcome. Most doctors would agree that it is easy to choose between two treatments if the least expensive drug is also the most effective. Economic analysis is required whenever the more expensive of two options is also the more effective. In this instance, the decision maker must believe that the value of one additional successful outcome is greater than the investment made in the more effective treatment. This approach would be a suitable model for comparing new oral third generation cephalosporins with cheaper oral drugs such as amoxicillin. Another decision requiring economic analysis is the choice between a new, oral third generation cephalosporin and an older intravenous formulation of a third generation cephalosporin. In this case, the new treatment is cheaper than the old treatment and the decision maker must be convinced that the oral treatment is as effective as the intravenous treatment. Statistically, it is only possible to exclude a difference of a given magnitude.(ABSTRACT TRUNCATED AT 250 WORDS) PMID- 10147285 TI - Cost-effectiveness and value of an IV switch. AB - A few antibiotics (i.e. metronidazole, clindamycin and ciprofloxacin) are available in both parenteral and oral formulations, and have good bioavailability, ensuring equivalent systemic drug concentrations. During a 4 year period subsequent to the initiation of a parenteral to oral (IV-PO) stepdown programme for metronidazole and clindamycin, Vancouver General Hospital saved approximately $C85 000. However, many parenteral antibacterials lack an oral formulation, requiring oral stepdown to a different antibacterial with a similar spectrum of activity. Alternatively, the oral formulation of a parenteral antibacterial may have poor bioavailability (i.e. cefuroxime axetil, ampicillin, cloxacillin, erythromycin, and tetracycline) and it is not possible to maintain equivalent systemic drug concentrations. While rigid criteria are not applicable to all clinical scenarios, the general criteria for oral stepdown include the following: the patient 1) continues to need an antibiotic; 2) is clinically stable; 3) is capable of tolerating the oral dosage form; and 4) has no factors present (e.g. gastrointestinal abnormalities or drug interactions) that would adversely affect oral bioavailability. A review of subsequent IV-PO stepdown programmes at Vancouver General Hospital revealed that 1) not all patients receiving parenteral therapy are candidates for oral stepdown; 2) oral stepdown is delayed in a large proportion of treatment courses; 3) oral stepdown is not occurring in many patients for whom it is deemed appropriate; and 4) in a very few treatment courses stepdown may occur prematurely and may contribute to clinical deterioration.(ABSTRACT TRUNCATED AT 250 WORDS) PMID- 10147286 TI - Third generation cephalosporins in the parenteral to oral switch. AB - In the present economic climate, it is increasingly necessary to ensure the cost effectiveness of all aspects of healthcare. The expenditure on medications in a hospital is largely determined by the workload and throughput, but efforts to rationalise the use of medications will result in benefits both in patient care and overall costs. The purpose of this report is to discuss the advantages of switching from parenteral to oral cephalosporin therapy after the initial stage of infection treatment, the potential of presently available oral cephalosporins for use in a parenteral-to-oral switch regimen, and the outcome of a parenteral to-oral switch programme, which used parenteral cefotaxime and oral cefixime, implemented at Hillingdon Hospital. PMID- 10147287 TI - Choosing between the new cephalosporin antibiotics: a pharmacodynamic approach. AB - The use of pharmacodynamic properties when formulating antibacterial administration guidelines can maximise the potential for efficacy while minimising the risk of toxicity. Aminoglycosides and quinolones demonstrate concentration-dependent bactericidal killing, which is maximised when their concentrations appreciably exceed their minimum inhibitory concentration (MIC) for an organism. beta-Lactams demonstrate time-dependent or concentration independent bactericidal killing, which is maximised when the time that concentrations exceed the MIC is prolonged, regardless of the absolute levels attained. Methods of prolonging the time beta-lactam concentrations exceed the MIC include the following: interfering with excretion (e.g. probenecid); decreasing the dosage interval; increasing the dose; infusing continuously rather than by bolus; and choosing an agent with a prolonged elimination half-life. The optimal duration for exceeding the MIC varies with the infecting organism, site of infection, inoculum effect, and the immunocompetence of the host. Integration of the microbiological activity and pharmacokinetic properties enables estimation of the time that serum concentrations of various cephalosporins will exceed the MIC of a given organism, consequently allowing estimation of the relative potential for clinical success. Cefixime, a third generation oral cephalosporin with a long plasma elimination half-life, allowing once-daily administration, achieves serum concentrations that exceed the MIC of Haemophilus influenzae, Moraxella catarrhalis, Escherichia coli, and Group A streptococci for greater than 90% of the dosage interval, and the MIC of Streptococcus pneumoniae for 50 to 90% of the dosage interval. PMID- 10147288 TI - Cost-effectiveness opportunities for new antibiotics. AB - Antibacterial drugs account for between 6 and 21% of the drug market in various countries, or between 3 and 25% of the total prescriptions. Given the high usage of these agents, they are appropriate candidates for economic appraisal in the near future. It is probable that the marketplace and healthcare reform will give managed care the dominant position in the US healthcare system. Cost effectiveness analyses of managed care organisations are based on both hospital and outpatient costs, and they are increasingly being aimed at formulary decisions regarding pharmaceuticals. Appropriate outcome parameters, long term follow-up, and phase IV trials to determine costs and outcomes relating to actual clinical use are needed to assess cost-effectiveness. Unbiased pharmacoeconomic research is needed to accurately answer questions on the economic viability of new products, and to avoid scepticism on the part of the purchasers of healthcare. The ultimate challenge for research and development of new antibiotics will be to reconcile the needs of the patient with the economic needs of society, within the cost-effectiveness paradigm. PMID- 10147289 TI - Conventional x-ray still tops in vascular imaging. PMID- 10147290 TI - Managed care transforms how rads think and work. PMID- 10147291 TI - Who will pay the bill for outcomes research? PMID- 10147292 TI - Images identify pathology causing spine pain in kids. PMID- 10147293 TI - Neuroradiologists tussle over practice guidelines. PMID- 10147294 TI - Value and cost criteria determine MRI pricing. PMID- 10147295 TI - Applications of computerized videokeratography in the management of cataract surgical patients. PMID- 10147296 TI - The use of computerized videokeratography in keratorefractive surgery. PMID- 10147297 TI - Use of the excimer laser in refractive surgery. PMID- 10147298 TI - Excimer photorefractive keratectomy in very high myopia. PMID- 10147299 TI - Holmium YAG laser thermokeratoplasty: synopsis of clinical experience. PMID- 10147300 TI - Lamellar refractive surgery. PMID- 10147301 TI - Onlay lamellar refractive keratoplasty. PMID- 10147302 TI - Molecular techniques for the laboratory identification of Chlamydia trachomatis. AB - Chlamydia trachomatis detection has been substantially advanced by molecular amplification methods. As diagnostic or screening tests, the methods have shown performance characteristics equivalent to culture, but are more rapid and have no special requirements for specimen transport. The challenge for this generation of diagnostic tests is to prevent laboratory and specimen cross contamination. PMID- 10147303 TI - Molecular biology techniques in the diagnosis of monogenic diseases. AB - Monogenic diseases are defined by their patterns of inheritance: autosomal dominant, autosomal recessive, or X-linked. This article examines the molecular biology techniques available for their study and detection. These techniques comprise direct detection of mutations (including trinucleotide repeats) and linkage analysis. The usefulness of these techniques is compared to conventional biochemical tests for the diagnosis of various inherited diseases. The authors stress the need for caution in the interpretation of test results and the importance of genetic counseling. PMID- 10147304 TI - Application of IUPAC-IFCC recommendations on quantities and units to WHO biological reference materials for diagnostic use: recommendations 1994. AB - This document deals with the nature of WHO biological reference materials, their development for the control of the therapeutic substances, and recommendations to improve their application in diagnosis. The nature of international units specified by WHO biological reference materials is contrasted with that of SI units, and the method for assigning values in international units to such reference materials is described. The document recommends the use of SI units (mole) with existing and proposed WHO biological reference materials whenever the elementary entity of the stated component can be recognized. It also recommends that the description of quantities having no recognized kind-of-quantity with a definable dimension should be clearly distinguished by the term "arbitrary" and include a reference to the procedure and calibrator used. The WHO is urged to involve appropriate nongovernmental organizations in advising on the need for, and the suitability of, international reference materials. PMID- 10147305 TI - The role and uses of telemetry arrhythmia monitoring. PMID- 10147306 TI - Ambulatory telemetry arrhythmia monitoring systems. PMID- 10147307 TI - Guidance section: implementation and effective use of telemetry arrhythmia monitoring systems. PMID- 10147309 TI - Adolescent motherhood: an application of the stress and coping model to child rearing attitudes and practices. AB - In the past two decades there has been a significant increase in adolescent pregnancy and childbearing across North America. Research has shown that both mother and child remain at high risk for physical, psychological, social, and economic consequences of premature parenthood and its accelerated role transition. Although considerable research has examined adolescent parenthood, the literature lacks theoretical integration. The stress and coping model is proposed as a theoretical context to explain developmental outcomes of adolescent motherhood. This model suggests that diminished psychological and social coping resources of adolescent mothers influence negative parent-child interactions and result in ineffective parenting behaviours concomitant with parenting stress, thus increasing the likelihood of high risk outcomes for both parents and children. PMID- 10147310 TI - {Evaluation after three years of early intervention for parental support}. AB - This article reports the findings of a quasi-experimental evaluation of a newsletter for new parents which was adapted to the age of their children. Satisfaction with and the effectiveness of the intervention after three years of distribution were assessed. As in a previous evaluation undertaken after one year, the newsletter enjoyed widespread readership in the experimental families and among their friends and relatives. Compared to this previous evaluation, similar but stronger effects on aspects of the parental role were found, although these were confined to mothers. Mothers in the experimental group displayed greater knowledge of family support resources and had more favourable attitudes toward them than mothers in the comparison group. They also tended to display greater knowledge of child development. The discussion centres on the study's implications for research and the advisability of broadening this form of intervention. PMID- 10147311 TI - Ethnocultural parent education in Canada: current status and directions. AB - The delivery of parent education services to families from ethnocultural communities in Canada is considered. Despite the increased recognition of the importance of matching programs to the needs of participants, an extensive review of the literature revealed only five published studies evaluating parent education programs within ethnocultural communities. Because it was hypothesized that ethnocultural parent education programs exist in Canada despite the paucity of published data, community and tertiary care organizations were surveyed regarding their efforts in this area. The majority of service providers that responded to the survey indicated they do employ special provisions for parents from ethnocultural communities. The most frequently endorsed provisions included: addressing cultural issues within the program curriculum, utilizing ethnocultural facilitators, and offering the program in the first language of the participants. Future directions that follow from the findings are discussed. In particular, the need for empirical evaluation regarding the utility and acceptability of these cultural provisions is stressed. PMID- 10147312 TI - {Importance and realization of expectations of the experience of childbirth in primaparas}. AB - The discrepancy between childbirth as planned and childbirth as actually experienced raises concerns about the consideration accorded to women's demands. This descriptive study examines the importance and fulfillment of primiparas' child-birth expectations. The sample was formed of 125 pregnant women recruited from groups attending prenatal classes in community health care centres. Participants completed structured prenatal and postnatal questionnaires about six variables related to childbirth experience: control, partner's support, nurse's support, pharmacological pain relief, obstetrical interventions, and first contact with the baby. Childbirth expectations are numerous and their importance varies from one woman to another. Also, their fulfillment varies depending on their nature and is rarely associated with the importance given to them by the woman. Overall, three variables, control, partner's support, and nurse's support were ranked equally as the most important by participants. Nurses should make more efforts to fulfill women's expectations and individualize their approach. They are instrumental in having this short but intensely meaningful event in a woman's life contribute to the development of a healthy identity as a mother. PMID- 10147313 TI - {Social support and the help offered by mothers to their psychologically troubled sons or daughters}. AB - We describe in this paper the everyday support mothers give to their adult sons or daughters suffering from psychotic disorders. We also describe the support these women receive from their social network regarding specific needs related to their children's disorders. Ninety-nine women, representing all socioeconomic groups, were interviewed. They were recruited through hospitals and self-help groups. The results of this study highlight the fact that participants give a substantial amount of support to their children, that they have considerable concern for their children's well-being, and that members of their family are their main source of emotional and practical support, and of advice. Mental health professionals give primarily informational support to respondents, in part through community-based agencies. The respondents who belong to self-help groups have significantly more needs related to their children's disorders and have more concern for their children's well-being than do the other respondents. PMID- 10147314 TI - The experience of mental health consumers as researchers. AB - The purpose of this study was to examine the experiences of six mental health consumers who were involved in paid employment as researchers in the mental health field. Semi-structured interviews were conducted with these individuals in order to identify any benefits experienced as a result of their employment and to identify special needs that should be considered when employing consumers. Although consumers felt they had benefitted from their employment, several unmet needs were identified. The study findings support both the benefits experienced by mental health consumers who are employed as researchers and the necessity of providing meaningful opportunities for them to give feedback on their experience. PMID- 10147315 TI - Control or treatment? Experiences of people who have been psychiatrically hospitalized in New Brunswick. AB - Retrospective personal accounts of 48 people concerning their admission to, treatment in, and discharge from a psychiatric unit were examined. Analysis reveals that the research participants were poorly informed about their legal rights. One in eight participants did not know whether they were voluntarily or involuntarily admitted. Few participants were ever consulted about their treatment programs or discharge plans. In general, the research participants reported being powerless and having little control over their lives during psychiatric hospitalization. PMID- 10147316 TI - The value of focus-group research in targeting communication strategies: an immunization case study. PMID- 10147317 TI - Using focus-group discussions to explore the role of women's groups (tontines) in family-planning information dissemination in Yaounde, Cameroon. PMID- 10147318 TI - Focus-group research for family planning: lessons learned in sub-Saharan Africa. PMID- 10147319 TI - Conducting comparative focus-group research: cautionary comments from a coordinator. PMID- 10147320 TI - The role of echocardiography in assessing the morphological response of left ventricular thrombus to anticoagulation. AB - We present a patient with idiopathic dilated cardiomyopathy and a large left ventricular apical thrombus in which serial echocardiography over a 1-month period documented progressive enlargement of this mural thrombus. This case illustrates the dramatic progression of left ventricular thrombus size despite aggressive anticoagulation. In addition, the critical role of echocardiography in the diagnosis and follow-up of patients with left ventricular thrombus is emphasized. PMID- 10147321 TI - Noninvasive estimation of left ventricular Max(dP/dt) from aortic flow acceleration and pulse wave velocity. AB - The Doppler method of obtaining left ventricular Max(dP/dt) proposed recently was based on the measurement of mitral regurgitation velocity. Since Max(dP/dt) is an isovolumic phase index, its use in cases of mitral regurgitation may be open to argument. However, we had proposed a noninvasive method of estimating left ventricular Max(dP/dt) based on different principles. In our method, Max(dP/dt) had been given by Max(dP/dt) = (rho)cMax (du/dt), where rho is the blood density, c is the pulse wave velocity, and u is the flow velocity in the aorta. We had derived the above equation theoretically, and confirmed its validity by animal experiments. In our previous study, we also applied our method in the clinical setting. The aortic flow velocity was measured by Doppler echocardiography, and the pulse wave velocity by mechanocardiography or Doppler echocardiography. (Rho)cMax(du/dt) obtained noninvasively was compared with Max(dP/dt) measured with a catheter-tip micromanometer. We found an excellent correlation between (rho)cMax(du/dt) and Max(dp/dt), and concluded that (rho)Max(du/dt) is useful in assessing noninvasively the contractile state of the left ventricle. Here, we summarize our method, review previous results, and report new results of the clinical application of our method. PMID- 10147322 TI - Quantification of images obtained during myocardial contrast echocardiography. AB - This article describes currently used quantitative methods for analysis of data obtained during myocardial contrast echocardiography. The specific issues addressed are: obtaining time-intensity curves from the myocardium in order to derive transit rates of microbubbles through the myocardium; defining spatial distribution of flow within a myocardial segment; and color-coding algorithms used to define the extent and magnitude of hypoperfusion within a cross-section of the heart. These methods are being adopted by several companies dealing with acquisition and analysis of echocardiographic data and should become available soon for clinical use. PMID- 10147324 TI - FEDL could end frustration of treating unexplained vulvar pain. PMID- 10147325 TI - Laser surgeons reach previously inoperable tumors via computer. PMID- 10147326 TI - Bending stiffness of two aesthetic orthodontic archwires: an in vitro comparative study. AB - The aims of the study were to quantify the transverse stiffness of two aesthetic orthodontic archwires (0018 inch Teflon-coated stainless steel and 0017 inch Optiflex) in a simulated clinical setting and to assess the influence of deflection direction on the bending stiffness. The aesthetic archwires were randomly divided into three equal groups: group 1, lingual deflection; group 2, labial deflection; and group 3, occlusal deflection. Each group consisted of six archwires of the same type. The control group consisting of eighteen 0014 inch stainless steel archwires were also subjected to the same grouping. A total of 54 archwires were tested in the study. The deflection of the archwires was measured with a travelling microscope and the load measured with a calibrated strain gauge ring transducer. The mean stiffnesses of the archwires in the lingual, labial and occlusal deflection groups were found to be 29, 08 and 25 mN/mm respectively for 0017 inch Optiflex (r = 09, P less than 0001), 132, 105 and 245 mN/mm respectively for 0018 inch Teflon-coated stainless steel (r = 09, P less than 0001) and 266, 164 and 323 mN/mm respectively for the control (r = 09, P less than 0001). Springback was found to be poor for Optiflex and the archwire remained bent upon deactivation. ANOVA showed that the influence of arch curvature on the bending stiffness was significantly different for Optiflex (P less than 005), Teflon-coated stainless steel (P less than 0005) and the control group (P <0005).(ABSTRACT TRUNCATED AT 250 WORDS) PMID- 10147327 TI - Mechanical characterization of endoscopic surgical staples during an experimental hernia repair. AB - Recent developments in laparoscopic hernia repair techniques have led to the design of titanium staples. In a laparoscopic hernia repair, a polypropylene mesh is stapled over the direct and indirect hernia sites in the inguinal region. The effectiveness of these staples in holding the prosthetic mesh, and therefore providing adequate strength to the abdominal wall, has not been yet investigated. We have characterized the bursting strength (BS) of an experimental hernia mesh repair fixed with Prolene suture, which is used extensively for this procedure, and the BS of repairs fixed with two currently available staplers, the Endopath EMS endoscopic multifeed stapler and the Endo Hernia stapler. We first simulated abdominal wall hernias in 16 piglets by creating incisions on both sides of the abdomen of each animal. Each defect was then covered with a polypropylene mesh, which was fixed on one side with Prolene sutures and on the other side using either the Endopath EMS (Group 1) or the Endo Hernia stapler (Group 2). The abdominal tissue with the mesh covering the defect was then excised and the BS evaluated using an Instron machine. Since many mechanical characteristics contribute to the BS of a repair, we investigated these characteristics in vitro, including tensile properties of the staples and the prosthetic mesh as well as the suture-tearing resistance of the mesh. Polypropylene mesh exhibits the same elongation in the three directions, i.e. 0 degrees , 45 degrees and 90 degrees . This elongation was estimated at 136% (SD = 130).(ABSTRACT TRUNCATED AT 250 WORDS) PMID- 10147328 TI - Validation and optimization of a polymer system for potential use as a controlled drug-delivery system. AB - A room temperature polymerizing system consisting of polyethylmethacrylate (PEM) and tetrahydrofurfuryl methacrylate (THFMA) monomer was validated for use as a drug-delivery system. The effect of gelling PEM/THFMA copolymers with a more hydrophilic monomer, hydroxyethyl methacrylate (HEMA), was also investigated. The release of growth hormone (GH) and bovine serum albumin (BSA) protein from this polymer has been studied. The polymer has the advantage of high water absorption and low shrinkage properties. Changes in release profiles have been studied by introducing structural differences in the polymer by changing the mixing technique. The stability and bioactivity of the GH incorporated have been examined at various temperatures. To optimize release profiles further, the possibility of attaining a more sustained and controllable release by varying the ratios of polymer used has also been investigated. PMID- 10147329 TI - Mechanical properties of cellulose in orthopaedic devices and related environments. AB - The authors have undertaken a series of mechanical tests in order to assess the performance of regenerated cellulose under either static or dynamic conditions, and to evaluate its long-term behaviour under mechanical stress. In this respect, bending stiffness, resistance to compression, creep under compressive stress, in vitro and in vivo ageing and fatigue resistance were studied. It appears that this material demonstrates mechanical properties which depend upon its density, which is itself related to its water content. Moreover, this material is very stable under dynamic stress. This could be an interesting property for use in orthopaedic devices. PMID- 10147330 TI - Corneal and external disorders and refractive surgery. PMID- 10147331 TI - Contact lenses and collagen shields. AB - Contact lenses may change the topography of the eye of asymptomatic patients. Complications continue to occur requiring extreme attention to be paid to fitting techniques, care instructions, and follow-up. All physicians must be alert to complications. Early diagnosis and treatment are essential. The pediatric aphakic patient and the presbyopic contact lens wearer present a challenge. The contact lens fitter must understand the way these lenses function to fit patients more successfully. Collagen shields may be of some benefit in cataract surgery and symblepharon, but may exacerbate the effects of alkali burns on the eye. PMID- 10147332 TI - Corneal topography. AB - Computer-assisted videokeratography systems are becoming the prevailing method for analysis of the corneal surface. A realistic insight into the limitations of these topography systems is critical for proper interpretation of the data. Methods based on reflections have limited accuracy when measuring aspherical surfaces. The error may become quite extensive when abrupt changes of curvature exist, eg, at the edge of a photorefractive keratectomy. In this case, raster stereographic methods have a theoretical advantage because they determine a true corneal topography, but additional means to visualize the corneal surface must be used and enough sensitivity is more difficult to achieve. Improved calculations have provided a better approximation of the ideal contour a cornea should have to provide optimal visual performance. New methods are proposed to evaluate the optical aberration induced by a given cornea and to discern focusing errors that are correctable with eyeglasses from irregular astigmatism that is not. PMID- 10147333 TI - Corneal storage and complications related to grafting. AB - This review covers the literature during the past year and follows up results published on corneal storage techniques and complications related to corneal grafting. It considers the recent progress and suggests new perspectives on the reconstituted or renovated human donor cornea. It might be possible to revive postmortem donor corneas with new cells, eg, epithelial, endothelial, or keratocytes, drawn from the future recipient or eventually with transgenetic multidonor cells. The future holds promise for the development of a new concept in corneal banking, where we leave the period of conservation and enter the era of donor cornea production. PMID- 10147334 TI - Indications, results, and complications of refractive corneal surgery with lasers. AB - The applications of the current laser technology in refractive surgery have developed during the past year. Several techniques to correct ametropia with various laser sources have been proposed and investigated. To date, using the myopic photorefractive keratectomy excimer laser is the most common technique; it has already been performed on more than 100,000 eyes worldwide. Refractive results on large series of patients with long-term follow-up indicate that the technique is safe, effective, and highly predictable in the correction of low to moderate myopia. Concerns about the treatment of high myopia still arise, especially regarding regression toward myopia and stability of achieved refraction; multizone treatments have been proposed to reach better results. The correction of compound myopic astigmatism with the excimer laser seems to be promising, although long-term results on large series are still pending. Among the patients treated, very few complications occurred. We believe that laser technology will play the most important role in refractive surgery in the future. PMID- 10147335 TI - Corneal complications of cataract surgery. AB - Developments in cataract surgery have stimulated a greater interest in minimizing unwanted effects of cataract surgery on the cornea. The two main areas of concern are protection of the corneal endothelium and minimizing distortion of the anterior corneal surface. Endothelial cell loss is of particular importance where there is a preexisting significantly low cell count due to ocular trauma, surgery, or dystrophy, and in situations where cataract extraction is combined with other procedures that may be prolonged or require extensive manipulation. Recent availability of heavier molecular-weight viscoelastic substances are expected to help in minimizing endothelial cell trauma in these situations. In terms of postoperative corneal astigmatism the emphasis has changed for those who are regularly performing phacoemulsification from minimizing surgically induced astigmatism to planning the procedure so that it incorporates a correction of preexisting astigmatism. This emphasis may be more significant in cases of previous anterior segment surgery or trauma. PMID- 10147336 TI - Laser tyndallometry in anterior segment diseases. AB - Laser tyndallometry refers to in vivo quantification of aqueous flare by measuring the scatter of a laser beam that is scanned into the anterior chamber. The laser flare-cell meter was introduced in 1988 and allows noninvasive, reproducible tyndallometry. Because biochemical studies have shown that the amount of laser light scattering correlates with aqueous protein concentration, laser tyndallometry allows noninvasive analysis of the integrity of the blood aqueous barrier. Laser tyndallometry has been mainly applied to uveitis and to postoperative anterior segment changes with many of studies focusing on the anti inflammatory effects of postoperative medications. In addition, the method was shown to give valuable information on the integrity of the blood-aqueous barrier in ocular and systemic diseases including diabetic retinopathy and pseudoexfoliation syndrome, in eyes with graft rejection after penetrating keratoplasty, and in various disease processes that mainly affect the posterior segment including retinitis pigmentosa, retinal vein occlusion, and uveal melanoma. PMID- 10147337 TI - Meet your new customer: how managed care organizations contract for laboratory work. PMID- 10147338 TI - PCR: more pathogens than dreamed of. PMID- 10147339 TI - Tracking your lab's finances: using test frequency is simpler than using workload units. PMID- 10147340 TI - Continuous-read blood culture systems. PMID- 10147341 TI - Anxiety mounts over drug resistance. PMID- 10147342 TI - The trade-off and the tragedy. PMID- 10147343 TI - Molecular methods track clusters of resistant organisms. PMID- 10147344 TI - Proximal femoral replacement prostheses. PMID- 10147345 TI - Extremity reconstruction via allograft transplantation. PMID- 10147346 TI - Segmental prostheses for reconstruction of defects about the knee. PMID- 10147347 TI - Resection arthrodesis of the knee for tumor: large intercalary allograft and long intramedullary nail technique. AB - Twenty-five patients had a procedure consisting of resection of the distal femur or proximal tibia for aggressive or malignant neoplasms. The resulting bony gap was bridged by allografts averaging 18 cm in length. Fixation was achieved using a long fluted intramedullary nail. The average follow-up time and time to union were 3 years (range, 0.25 to 9 years) and 13 months (range, 6 to 28 months), respectively. Eleven patients had nononcologic complications related to the index surgical procedure, including two patients with allograft nonunion. There were no infections. Three patients had amputations for local recurrence of their tumor. Twenty patients (80%) had no evidence of tumor at the time of follow-up. According to the Evaluation System of the Musculoskeletal Tumor Society, 80% of patients had a satisfactory result. No patient had a nononcologic complication resulting in total failure or amputation. The procedure of resection-arthrodesis of the knee using a large allograft with a long intramedullary nail provides patients with a stable, durable biological reconstruction that allows early weight-bearing, and the procedure carries a low incidence of infection. PMID- 10147348 TI - Allograft prosthetic composite reconstruction for limb salvage and severe deficiency of bone at the knee or hip. AB - We reviewed the clinical, radiographic, and where applicable, oncologic results of 112 consecutive allograft prosthetic composite reconstructions performed at Rush Presbyterian St Luke's Medical Center. The source of the bone defects included resection of a tumor, failure of a prior arthroplasty, and periprosthetic fracture. The patients having reconstruction after tumor resection achieved an average Enneking functional score of 28.3. Satisfactory clinical and radiographic results were obtained in 70% to 93%, depending on the group. Based on our experience, we have established a set of principles that should maximize functional results and minimize problems with allograft prosthetic composite arthroplasty. PMID- 10147349 TI - Cost implications of wastage of drugs: focus on insulin. PMID- 10147350 TI - The New Zealand preferred medicines concept: a national scheme for audit and quality assurance of prescribing. PMID- 10147351 TI - Fluoroquinolones: use of clinical data to aid formulary choice by the system of objective judgement analysis (SOJA) method. AB - Fluoroquinolones are used in many hospitals for the treatment of complicated urinary tract infections, gastrointestinal infections, hospital acquired pneumonia and osteomyelitis. A review of the fluoroquinolones by the System of Objective Judgement Analysis (SOJA) method is presented. The following selection criteria were involved in the study: the number of registered indications, the number of dosage forms, the ratio between the area under the plasma concentration time curve (AUC) and the minimum inhibitory concentration for 90% of strains (MIC 90), variability of the oral bioavailability, drug interactions, dosage frequency, equal dosage for oral and parenteral use, development of resistance, clinical efficacy, adverse events, cost and documentation. Both the oral and the parenteral formulation were included in the study. Ofloxacin shows the highest score, mostly because of the lower incidence of drug interactions, dosage frequency, cost and (relative to ciprofloxacin) a similar dosage for oral and parenteral use. Ciprofloxacin is the best documented drug. Pefloxacin shows the lowest SOJA score. Users of this method are free to determine the relative weight of the various selection criteria that they consider to be correct, although some of the criteria are internationally valid. PMID- 10147352 TI - Quality-of-life assessment in patients with headache. AB - Although headache is the most common pain complaint seen by primary care physicians, the measurement of quality of life in patients with headache is in its earliest stages. Most of the research has been published within the past 2 years, much of it only in abstract form. Quality-of-life data derived from the Medical Outcomes Study instrument (SF-20) demonstrate that chronic headache disorders are associated with significant limitations in all 6 health categories of patient well-being and functioning. The outcomes profile for each of the common benign headache disorders appear to be unique for the specific headache diagnosis. Migraine is primarily associated with an impairment in role (work) functioning. Chronic tension-type headache is associated with a marked impairment in mental health and a generalised impairment in functioning. Cluster headache is associated with the greatest amount of pain, but with little impairment in physical functioning. The economic toll of recurrent headache is considerable. Lost productivity in the US due to migraine is estimated at $US6.5 to 17.2 billion per year. Chronic headache disorders cause significantly more morbidity, impairment of function, and economic loss than has previously been recognised. PMID- 10147353 TI - Multivariate analysis of health status scores: chronic airway disorders and the MOS SF-36. AB - Multivariate analysis of variance (MANOVA) with follow-up canonical discriminant analysis may be used to interpret differences in health-related quality of life measured by the Medical Outcome Study Short Form 36 (MOS SF-36). Due to the moderate correlations between the 8 health dimensions of the SF-36, MANOVA is theoretically a more appropriate method than traditional univariate approaches for detecting group differences on the SF-36. Additionally, canonical discriminant analysis presents a novel approach to understanding the relationship between health dimensions of the SF-36 and model-independent variables. Results from the MANOVA and canonical discriminant analysis provide evidence of the sensitivity of the SF-36 in cross-sectional, self-reported data. Significant differences in health status (alpha less than or equal to 0.05) were found for the variables of age, and primary physician visits, and between levels of disease severity, type of breathing problem, whether patients had seen a specialist or not, use of emergency room, the comorbid states of depression and arthritis, and income. No significant differences in health status were reported between males and females or racial groups. PMID- 10147355 TI - Warning on low dose mifepristone use. PMID- 10147357 TI - Platelet storage in a liquid environment. PMID- 10147354 TI - Ranitidine: a pharmacoeconomic evaluation of its use in acid-related disorders. AB - Ranitidine is a histamine H 2-receptor antagonist which, on the basis of its well established tolerability and efficacy profile, has been widely prescribed for the treatment of ulcer disease and mild to moderate reflux oesophagitis. However, the advent of more powerful gastric acid inhibitors (e.g. acid pump inhibitors) and the realisation of the role of Helicobactor pylori infection in duodenal ulcer disease could have considerable clinical and economic implications for the use of ranitidine (and other H 2-receptor antagonists). Simulation modelling studies based on current pricing policies in Europe predict that ranitidine-based treatment will be less cost effective than omeprazole in the short term healing of duodenal ulcer and reflux oesophagitis disease. During longer term treatment, omeprazole is expected to be the dominating strategy over ranitidine-based therapy in Europe and the US. However, the inherent limitations of modelling studies reinforce the need for randomised prospective trials, preferably conducted in a general practice setting and including a quality-of-life analysis. Of the currently accepted approaches for the long term management of recurrent duodenal ulcer disease, daily maintenance therapy with ranitidine has been shown to be more cost effective than intermittent treatment for up to 2 years in the US. The annual cost of providing continuous maintenance therapy with ranitidine 150 mg/day is higher than with cimetidine 400 mg/day, although the extra benefits include a reduced risk of pain and discomfort from an expected lower rate of ulcer recurrence with ranitidine. Simultaneous ulcer healing and eradication of H. pylori markedly reduces relapse rates and is likely to become the management strategy of choice in H. pylori-positive patients, particularly with the advent of more convenient, well tolerated and effective regimens. Moreover, widespread clinical acceptance of H. pylori eradication may yield substantial cost savings to society by reducing the overall need for long term antisecretory therapy. Nonetheless, maintenance therapy with histamine H 2-receptor antagonists remains indicated for patients at high risk of ulcer recurrence who are poorly responsive to or cannot tolerate H. pylori eradication regimens. In summary, the proven efficacy and tolerability of ranitidine will ensure its continued use in the treatment of many patients with duodenal ulcer and mild to moderate reflux oesophagitis. However, there is increasing clinical and economic data favouring the selection of omeprazole in patients with more severe symptoms of these diseases.(ABSTRACT TRUNCATED AT 400 WORDS) PMID- 10147356 TI - Extending the storage of red cells at 4 degrees C. PMID- 10147358 TI - Prestorage leukocyte reduction of cellular blood components. AB - With the increasing demand for leukoreduced cellular blood components, many blood centers in Europe, North America, and Asia have begun to prepare leukocyte depleted cellular blood components prior to storage. Increased understanding of transfusion complications resulting from recipient exposure to residual donor leukocytes has focused attention on donor leukocytes during blood storage. This review examines production options for prestorage leukocyte removal, considers approaches to quality control, discusses proposed laboratory and clinical advantages of leukoreduction prior to storage compared with after storage, and suggests a strategy for cost-effective implementation of widespread prestorage leukocyte removal. PMID- 10147359 TI - Storage of saline-adenine-glucose-mannitol suspended red cells in diethylhexyl phtalate and butyryl-n-trihexyl-citrate plasticized polyvinyl chloride containers. An in vitro comparative study. AB - Units of whole blood collected into butyryl-n-trihexyl-citrate (BTHC) and diethylhexyl phtalate (DEHP) plasticized polyvinylchloride (PVC) blood storage containers and processed by means of an 'Optipress', which allows automated removal of the buffy coat, were compared. Units collected into standard PVC containers processed by the traditional method (no buffy coat removal) were used as a control group. The red cell concentrates were suspended in saline-adenine glucose-mannitol (SAGM) and stored 42 days at 2-6 degrees C. Comparison of the buffy coat depleted red cell concentrates showed that red cell energy and oxygen delivery capacity, as evidenced by ATP and 2,3-DPG values, were slightly better preserved in the BTHC plasticized container, compared to the DEHP container. The red cell membrane, however, was slightly less well preserved, (the hemolysis at day 42 with BTHC ww 0.39%; with DEHP, 0.20%) in this container. The higher ATP levels might lead to a better in vivo recovery of stored red cells. In vivo studies comparing both plastic containers, therefore are indicated in order to determine if these differences have practical significance. A longer holding time of the whole blood at room temperature before processing reduced the hemolysis (42 days stored RCC as 0.26%). Slightly more fibrinopeptide A (FPA) generation and marginally lower pH and 2,3-DPG values were observed in this situation. This finding suggests an effect of higher plasticizer levels on the red cell membrane. PMID- 10147360 TI - Effect of filtration, storage and platelet suspension media on platelet indices. AB - We describe a new approach for assessing filtration-induced changes in cellular indices of platelet concentrates at the beginning and the end of storage, using pairs of identical packs. The results revealed that post-filtered products did not store as well as their counterparts. Filtration did not induce any significant changes on aggregation as determined by spontaneous aggregation nor was there a disparity between leucocyte peroxidase/basophil count. We recommend filtration on day 2 which causes minimal loss of platelets and less change in the mean platelet volume. PMID- 10147361 TI - Computers as clinical consultants. PMID- 10147362 TI - Pain relief for children: new concepts, new methods. PMID- 10147365 TI - Economics of CK-MB. PMID- 10147366 TI - Changes in quality assurance for diagnostic allergy labs. PMID- 10147367 TI - Software links labs to physician office clients. PMID- 10147368 TI - Classifying segmented and band neutrophils. PMID- 10147369 TI - Comparison of gaseous microemboli counts in arterial, simultaneous and venous heat exchange with a hollow fiber membrane oxygenator. AB - Potential sources of gaseous microemboli during cardiopulmonary bypass are varied. However, it is known that membrane oxygenators generate fewer gaseous microemboli than bubble oxygenators and that bubblers cannot utilize arterial heat exchange without generating significant gaseous microemboli during rewarming. A membrane oxygenator utilizing simultaneous gas and heat exchange raises the concern that concurrent gas and heat exchange would result in a higher production of gaseous microemboli compared to conventional venous heat exchange devices. This in vitro study compared venous, simultaneous, arterial and control (venous) heat exchanger gaseous microemboli counts during rewarming. No significant difference was found between the four heat exchangers when comparing inlet and outlet gaseous microemboli counts. This in vitro study suggests that there is no difference in gaseous microemboli generation when varying the position of the heat exchanger in the extracorporeal circuit incorporating a microporous membrane oxygenator. PMID- 10147370 TI - Alpha-stat capnography for the Sorin Monolyth oxygenator. AB - Monitoring the carbon dioxide exhaust of an oxygenator is an inexpensive method to accurately predict and control the arterial carbon dioxide tension during cardiopulmonary bypass (CPB). The partial pressure of carbon dioxide in the exhaust ventilating gas (p exCO 2) was continuously monitored from the capnograph port of the Sorin Monolyth oxygenator during CPB. At the time of routine arterial blood gas sampling, the arterial blood temperature (ABT) was recorded along with the p exCO 2 from the capnograph monitor. The arterial carbon dioxide tension (paCO 2) from the arterial blood sample analysis was then statistically analyzed and related to the p exCO 2 and ABT. The statistical relationship of p exCO 2 and ABT while employing alpha stat ventilation resulted in an exponential regression with a correlation coefficient of 0.98. The exponential regression is unique to each manufacturer's oxygenator; we have titled this the "regression signature." This regression signature can be easily learned and employed by the perfusionist during CPB as an aid in controlling oxygenator ventilation. The mean paCO 2 value obtained during the study period was 39.0 +/-2.5 mmHg. There was no statistical difference between the paCO 2 values when separated into four different blood temperature groups, ( less than 28, 28-32, 32-37, and greater than 37 degrees C). PMID- 10147371 TI - Comparison of four stainless steel heat exchangers for neonatal ECMO applications. AB - Conventional neonatal extracorporeal membrane oxygenation (ECMO) circuits utilize a heat exchanger distal to the oxygenator to replace ambient heat loss and maintain patient normothermia. A secondary function of the ECMO heat exchanger is to act as an arterial line bubble trap to protect the patient against accidental air embolism. Using an asanguinous recirculating test circuit, we measured and compared heat transfer properties, pressure drop, air trapping capabilities, and priming characteristics of four commercially available stainless steel heat exchangers currently being used in neonatal ECMO circuits: Avecor ECMOtherm, Gish HE-3, Gish HE-4, and Electromedics D1079. Manufacturers' product specifications were also compared. The pressure drop across all four heat exchangers was less than 10 mmHg with flow rates up to 500 ml/min. The Gish HE-3 and HE-4 were the easiest to prime and de-air, while the Electromedics D1079 was the most difficult. The heat exchangers with integral bubble traps (D1079 and HE-4) have superior air trapping capabilities. The ECMOtherm provided moderate air trapping capabilities ( greater than 7.3 ml +/- 1.5 ml) at flow rates under 300 ml/min. The low prime HE-3 was the poorest at trapping air; less than 1 ml at a 400 ml/min pump flow rate. Thermal analysis indicated that the D1079 had the highest performance factor, though all four heat exchangers had similar heat transfer rates and were capable of warming perfusate from 34 degrees to 37 degrees C on a single pass at pump flow rates of 500 ml/min.(ABSTRACT TRUNCATED AT 250 WORDS) PMID- 10147372 TI - Low flow veno-venous ECMO: an experimental study. AB - Clinical use of extracorporeal membrane oxygenation (ECMO) and carbon dioxide removal (ECCO 2R) have become well established techniques for the treatment of severe respiratory failure; however they require full cardiopulmonary bypass, representing major procedures with high morbidity. We theorized the possibility of an efficient low flow veno-venous extracorporeal membrane gas exchange method. Four mongrel 12 kg dogs were submitted to veno-venous extracorporeal membrane gas exchange via a jugular dialysis catheter using a low flow (10 ml/min) roller pump and a membrane oxygenator for a period of four hours. Respiratory rate was set at 4 breaths/min with a FiO 2 of 21% and ventilatory dead space was increased. Adequate gas exchange was obtained (pO 2139, pCO 224, Sat 99.4%), without major hemodynamic changes or hematuria. Our results demonstrate the feasibility of a low flow, less aggressive system. Further research should be considered. PMID- 10147373 TI - Considerations for inter-hospital extracorporeal cardiopulmonary support resuscitation and transport. AB - The availability of commercial, pre-packaged extracorporeal cardiopulmonary support (ECPS) circuits, which are simplified for rapid set-up and priming, has made the intra-hospital resuscitation of moribund patients routine. The successful utilization of this technology in the emergent setting requires planning and the coordination of personnel familiar with the technology. Many issues must be addressed when a patient requiring life-sustaining support utilizing this technology at an outlying hospital, must be transported while on ECPS. After reducing the size and weight of the ECPS cart and obtaining Federal Aviation Administration approval for use during aeromedical transport, the Emanuel Hospital Mobile Surgical Transport Team (MSTT) was able to extend the use of emergency cardiopulmonary bypass to outlying medical facilities. The patients selected for transport, using ECPS, are a group of patients with a potentially survivable pathology unlikely to survive inter-hospital transport without such measures. This report describes our experience with inter-hospital transport of patients on ECPS with special emphasis on transport considerations. PMID- 10147374 TI - Proximal femoral diaphysectomy in cerebral palsy. AB - A study was conducted to evaluate the outcome of massive proximal femoral shortening in the cerebral palsy patient with severe spastic quadriplegia and hip instability. A retrospective review of 13 children (age range: three to 19 years of age) representing 18 hips treated with massive shortening of the proximal femur was conducted. Bilateral procedures were performed in five patients. All procedures were performed between February 1986 and March 1990. Radiographs were evaluated for preoperative and postoperative migration percentage (MP) and femoral neck-shaft angle (NSA). Charts were reviewed for complications and clinical results. All femoral osteotomies healed without difficulty. Clinical follow-up averaged 27.6 months. Satisfactory results occurred in all but one hip. Radiographs taken an average of 19.5 months postoperatively showed improved MP in all but one hip. The average preoperative MP was 70% and postoperative MP was 18%. Femoral NSA also was improved. Heterotopic bone formed in 13 hips but caused no significant problems. Other complications included postoperative seizure, urinary tract infection, cast sores, transient arm weakness, weight loss, pin protrusion through skin, and femur fracture after cast removal. Based on the good results and minimal complications in this series, massive femoral shortening appears to be a superior alternative to proximal femoral resection in these difficult patients. PMID- 10147375 TI - The use of power-driven staples in fracture surgery. PMID- 10147376 TI - A liquid thromboplastin reagent for the determination of PT. PMID- 10147377 TI - A functional analytical technique for monitoring nutrient status and repletion- part 2: validation. PMID- 10147378 TI - Oral anticoagulants and the INR: confusion, controversy, fiction, and fact. PMID- 10147379 TI - Anticipating the clinical laboratory of the future from a dry chemistry perspective. PMID- 10147380 TI - A small hospital's experience with an expandable LIS. PMID- 10147381 TI - An automated mycobacterium identification system. PMID- 10147382 TI - An improved approach to blood gas quality control. PMID- 10147383 TI - A discrete random access benchtop clinical chemistry analyzer. PMID- 10147384 TI - A method for testing APC resistance in thrombophilic patients. PMID- 10147385 TI - Nanotechnology today: the Oak Ridge Conference explores nanotechnology. PMID- 10147386 TI - A workstation-based quick furnace method for the determination of lead in whole blood. PMID- 10147387 TI - Clinical laboratory instrument interfacing: planning for interfaces, potential problems, and summary, part 3. PMID- 10147388 TI - Advances in cell culture detection of chlamydiae and viruses. PMID- 10147389 TI - Optimizing laboratory quality processes through integrated information technology. PMID- 10147390 TI - In vitro evaluation of dental materials. AB - Biocompatibility has been described as the ability of a material to perform with an appropriate host response in a specific application. Appropriate host response means no (or a tolerable) adverse reaction of a living system to the presence of such a material. An adverse reaction may be due to the toxicity of a dental material. Therefore toxicity may be regarded as one reason for nonbiocompatibility of a dental material. The toxicity of a dental material can be evaluated by in vitro tests, animal experiments and clinical trials. There exists a variety of different in vitro test methods. The most widely used biological systems for toxicity screening of dental materials are cell cultures. Cell cultures for toxicity screening of dental materials are valuable tools for understanding their biological behavior, if the limitations of the methods are taken into consideration, especially concerning the interpretation of the results. Further research should concentrate on better simulations of the in vivo situation in cell cultures. In this review the applications of various cell culture methods to evaluate the cytotoxicity of a wide range of dental materials, e.g. metals, alloys, polymers and cements, are described. PMID- 10147391 TI - Lasers provide cosmetic and functional improvements. PMID- 10147392 TI - Medical management of COPD. PMID- 10147393 TI - Cardiovascular monitoring: clinical applications of technologic advancements. AB - Increasing senescence is leading to increased incidence of cardiovascular disease in the surgical population. Because of advances in technology, extensive cardiovascular monitoring is increasingly available, and guidelines for monitoring are being developed. An understanding of the cardiac risk of the patient allows proper choice of monitors. Several advances have been made in the monitoring of blood pressure, myocardial ischemia, infarction, arrhythmias, and various systemic parameters. The large-scale studies necessary to elucidate the impact of monitoring on clinical outcome have yet to be conducted. PMID- 10147394 TI - From start to finish, how accurate are lab tests? PMID- 10147395 TI - Advancing hematology quality control practices. PMID- 10147396 TI - Quality control and reproductive technology. PMID- 10147397 TI - Transthoracic and transesophageal echocardiographic study of pulmonary autograft valve in aortic position. AB - Eleven patients who underwent pulmonary valve autograft to aortic position with placement of bovine pericardial prosthesis in pulmonary position were studied with echocardiography. The etiology of aortic valvuloplasty as determined by anatomopathological examination was rheumatic in five, degenerative in four, and congenital in two. Important mitral stenosis coexisted in two patients, and during the same operation as the Ross surgery, a mitral valvuloplasty with Carpentier ring was practiced on one and an open mitral commissurotomy on the other. Transthoracic echocardiography, which helped to confirm the viability of the surgery by determining the diameters of the semilunar valve rings and quantifying the severity of the aortic valve lesions, was performed on all patients before surgery and repeated 3 months later. Transesophageal echocardiograms were practiced on nine patients during the surgical procedure and repeated after 6 months on seven. The latter technique aided in immediate postoperative evaluation, and repetition at 6 months served to explore the ventricular infundibuli and evaluate pulmonary valve performance in aortic position. In conclusion, transthoracic and transesophageal echocardiography provide a practical and valuable means of investigating the pre-, trans-, and postoperative conditions of patients undergoing Ross surgery. PMID- 10147398 TI - Quantification in cardiac ultrasound {editorial}. PMID- 10147400 TI - New method for quantitatively determining aortic regurgitant volume using Doppler color flow imaging: experimental validation study. AB - We have developed a method to provide the two-dimensional distribution of blood flow velocity and the blood flow volume rate in the ascending aorta from the cross-sectional Doppler color flow image. Regional blood flow velocities were determined by converting color intensities of the cross-sectional Doppler color flow image into the corresponding flow velocities with the correction with the spatial ultrasound beam incident angle. The spatial ultrasound beam incident angle was estimated from the geometric characteristics of the color flow image contour. The method was validated in a steady flow model circuit comparing the calculated flow volume rates by the method with those simultaneously measured by an electromagnetic flowmeter. We performed an open chest dog experiment and calculated the blood flow volume rate at the ascending aorta before and after the aortic regurgitation was made. The calculated ejection flow volume rate and regurgitant volume were validated by the comparison with those simultaneously measured by an electromagnetic flowmeter. Based on these data, we can conclude that the current method provides accurate measurements of regurgitant volume as well as ejection flow volume rate in the ascending aorta. PMID- 10147401 TI - Quantitative assessment of lumen area stenosis by Doppler echocardiography and application of continuity equation. AB - Assessment of luminal stenosis plays a central role in the clinical decision makings for patients with heart diseases. To examine the role of Doppler echocardiography in the measurement of stenotic areas, we attempted to determine the mitral valve area and coronary artery stenosis by Doppler technique with a continuity equation. Mitral valve area was determined as a product of aortic or pulmonic annular cross-sectional area and the ratio of time velocity integral of aortic or pulmonic flow to that of the mitral stenotic jet. Mitral valve area determined at catheterization by Gorlin's formula was used as a gold standard. In the determination of coronary artery stenosis, flow velocity at the site prior to the stenotic lesion and that of stenosis was measured by catheter-tipped Doppler flowmeter (3-Fr, 20 MHz). The severity of the stenosis was calculated from the ratio of time-velocity integrals from prestenotic and stenotic segments. In 41 patients with mitral valve stenosis, valve area determined by continuity equation method correlated well with catheterization measurements irrespective the presence of aortic regurgitation (r = 0.91, y = 0.84x + 0.15, P less than 0.01). Of 20 patients with coronary artery disease, flow velocity both at the stenosis and prior to the stenosis could be determined in 13 patients examined. Under these conditions, coronary artery stenosis determined by continuity equation varied from 21%-76%. When these values were compared with those determined by biplane cineangiography, there was good correlation between them (r = 0.83, y = 0.92x - 0.45, P less than 0.01). These results demonstrate that Doppler-derived luminal area stenosis is applicable to assess the severity of the stenotic lesions, providing further information which cannot be obtained by the conventional methods, although several limitations should further be resolved. PMID- 10147403 TI - The MSO: the physicians' IDS alternative. PMID- 10147404 TI - Provider and client mental health care outcome expectations: results of a survey and commentary on reducing the dissonance through training for managed care. PMID- 10147405 TI - Mental health care reform--can everyone win? PMID- 10147406 TI - Subacute care. PMID- 10147407 TI - Maximizing therapeutic outcomes through cost-effective formulary decisions. PMID- 10147408 TI - Multi-hospital deals realize mixed blessings. PMID- 10147409 TI - Radiology networks cast for capitated contracts. PMID- 10147410 TI - MRI of the knee also reveals bone injuries. PMID- 10147411 TI - Staying afloat in the MRI services ocean. PMID- 10147412 TI - Can ultrasonography advance the diagnosis of varicocele? PMID- 10147413 TI - Gene therapy: progress and prospects. PMID- 10147415 TI - Effectiveness of interactive videodisc instruction for the continuing education of paramedics. AB - OBJECTIVES: To evaluate the effectiveness of interactive videodisc (IVD) instruction of paramedics through the use of computer analysis of trip sheets. DESIGN/SETTING: Prospective, controlled, in an urban 9-1-1, paramedic, emergency medical services (EMS) system with total call volume of 62,000/year; 15,000 advanced life support (ALS). INTERVENTIONS: All 150 paramedics in the system received eight hours of IVD instruction covering five subject areas: 1) airway; 2) head/cervical trauma; 3) chest; 4) shock; and 5) cardiac arrest. Trip sheets from 9,943 runs in the pre-IVD period were subjected to computer analysis, and a compliance score was generated using previously developed algorithms that assigned a weight to each omission and commission. After a nine-month IVD training period, 4,303 cases were collected and analyzed in the post-IVD period. Statistical analyses were made using "Student's" t-test and Chi-square with alpha set at 0.05. EXCLUSIONS: Only those records of adult patients who fit one of the five protocols were eligible for computer analysis. Of the 9,943 cases in the pre-IVD group, 480 (4.8%) were excluded, all due to inadequate data recording by the paramedics. A statistically similar portion, 233 (5.4%) of the 4,303 post IVD instruction cases were excluded (p = .15). RESULTS: Overall the mean compliance score of the pre-IVD group was 0.65 +/-0.19 (+/-SD). The post-IVD group score was 0.65 +/-0.19 (p = 0.99). Analysis of scores for each algorithm also showed no significant differences. This study had an observed power of .94 to detect a difference in compliance as small as 0.030. CONCLUSION: (ABSTRACT TRUNCATED AT 250 WORDS) PMID- 10147417 TI - Percutaneous abscess drainage: current applications for critically ill patients. AB - Radiologically guided percutaneous abscess drainage (PAD) was first reported in 1977. Since this time, technological advances in imaging, improved catheter technology, and increased experience with the procedure have resulted in a tremendous expansion of the indications for PAD. This procedure currently has applications in nearly every organ system of the body. These changes have also contributed to improved success rates, with concurrent minimization of procedure related complications. The advantages of PAD include simple, rapid performance; feasibility of bedside intensive care unit (ICU) performance; safety; avoidance of general anesthesia; and well-documented efficacy. This procedure has now become well entrenched in clinical medicine and probably ranks with the development of effective antibiotics as the most significant improvement in the treatment of abscesses in the past century. PAD is ideally suited for the treatment of critically ill ICU patients. We discuss technical developments over the past 15 years; general principles of patient preparation and catheters are also reviewed. Current applications of PAD in each organ system are discussed. PMID- 10147418 TI - Dobutamine stress echocardiography: what role in today's ICU? AB - Changes in left ventricular systolic wall motion and thickness (systolic function) may develop in response to dobutamine infusions; such changes can be detected echocardiographically--a technique called dobutamine stress echocardiography (DSE). By mapping the changes to graded doses of dobutamine, DSE permits us to detect myocardial ischemia and to assess whether myocardial damage is reversible. As a result, this test can help predict which patients are likely to benefit from revascularization. DSE also allows us to determine a specific point at which evidence of ischemia begins. The test is highly accurate, safe, and comparatively inexpensive. PMID- 10147419 TI - The technique of dobutamine stress echocardiography. AB - Dobutamine stress echocardiography (DSE) can be performed safely at the bedside and offers more immediate results and lower cost than other pharmacologic imaging methods. Applications in the intensive care unit include detection of coronary artery disease and assessment of myocardial viability. DSE is also a useful adjunctive study for examining valvular function or revealing obstructive cardiomyopathy. Dobutamine infusion is started at 5 mug/kg/min and peaks at 40 or 50 mug/kg/min. Four standard echocardiographic views are used to show left ventricular wall segment responses; both the extent of thickening and type of motion are assessed. PMID- 10147420 TI - The CO 2 laser in mastectomy: a ten-year follow-up. AB - We compared the healing process, postoperative course, and follow-up of patients who underwent modified radical mastectomy in the conventional way with those who underwent a laser procedure. Sixty women, aged 33 to 77 years, who suffered from carcinoma of the breast were randomly divided into two groups: Group 1: surgery was performed using scalpel and electrosurgery; Group 2: surgery was performed with a CO 2 Sharplan laser, skin-to-skin including the axilla dissection; maximal power, 40-60 W. The postoperative course was uneventful in both groups. Wound healing was normal. Sutures were removed on the tenth day. Patients were followed at the Outpatient Clinic for 10 years. The circumference of the arm and forearm was measured at fixed points before surgery and at follow-up. Mammography and liver and bone scans were performed every year. Four Group 1 patients developed swelling and edema of 2 to 3 cm at 6 to 8 months after surgery. Also two patients from subgroup A developed local recurrence. No edema or swelling or local recurrence could be detected in patients operated by laser. Surgery with laser is preferable to the conventional approach. PMID- 10147421 TI - Jet-assisted laser tools for tooth preparation. AB - Previous oral calcified-tissue laser ablations have yielded inadequate results because of the difficulty in producing a desired effect on a surface without concomitant pulp or osseous damage. The purpose of this study was to characterize a new modality of ablating teeth using argon and diode lasers (488.5 nm, 805 nm) in combination with the repetitive placement of specific photoabsorptive dyes. In this design, energy from laser light, that would otherwise be reflected, is coupled to the tooth-dye interface. Thirty-two specimens of recently extracted human enamel were sectioned and prepared into 3 x 2 x 2 rectangular blocks and smoothed with a polishing point. Two-microliter droplets of dye were placed on the external enamel surface and subsequently air dried. Specimens were then ablated with the laser-dye combinations, producing craters approximately 100-200 mum in depth and devoid of visual carbonization. Similar irradiations were performed on enamel specimens without dye application, and displayed no cavitation or surface carbonization. SEM studies showed evidence of crater formation within the enamel surface. Optimization of laser parameters integrated with specific dispensing of dye is necessary before this technique can be studied further. PMID- 10147422 TI - Vasoreactivity and structure of human coronary arteries irradiated by excimer laser. AB - In this study the effects of excimer laser (308 nm) angioplasty on arteries have been studied. We report histology and vasoreactivity properties of human atherosclerotic and normal coronary arteries and bovine coronary arteries after exposure to pulsed excimer laser irradiation. Segments of isolated and pharmacologically active human coronary arteries were obtained within 5-8 hr postmortem. Segments of bovine arteries were obtained from fresh hearts. Side branches were ligated and vessels perfused with Krebs-Ringer's-bicarbonate solution in a perfusion apparatus to maintain their viability. Excimer laser irradiation was performed using a fused silica fiber advanced through the artery within a polyethylene cannula to assist with steerability and to protect against perforation. The fiber delivered a total of 40-60 J at its tip at 100 mJ/pulse at 15 pulses/sec. A total of 5 human atherosclerotic, 2 human normal, and 8 bovine arteries were used. Ablation of plaque was accomplished with remarkable ease and little resistance. Histologic studies showed clear-cut wedges inscribed by the catheter along the arterial wall without charring or thermal effects of coagulation necrosis. Vasoreactivity was assessed by measuring flow changes during perfusion before and after excimer angioplasty using a transient challenge with the vasoconstrictor serotonin. All excimer-irradiated arteries showed no increase in vasoreactivity during the challenge and showed preservation of relaxation properties following the challenge. In conclusion, coronary artery angioplasty by excimer laser appears to allow for effective plaque ablation with simultaneous preservation of structure and pharmacological properties of arteries. PMID- 10147423 TI - Investigation of a new light imaging technique to detect incipient caries in teeth. AB - At the present time dental X-rays are the best method to locate carious lesions, however, small lesions can be detected only with difficulty. Even though investigations in the past have shown that light imaging systems are more sensitive to small lesions than X-rays it is difficult to determine the characteristics of these lesions with any of these systems. We developed a new light imaging technique that makes it much easier to determine the size and depth of these lesions on most areas of the teeth even though modifications on the present setup will still be necessary to detect them as easily on occlusal surfaces. This technique is based on raster scans of the teeth with narrow collimated light beams. The results of this investigation show that the areas ( greater than 0.1 mm 2) of small incipient lesions can be measured and their depths estimated. PMID- 10147424 TI - Silent night: lasers provide breakthrough in treatment of snoring. PMID- 10147425 TI - New Nd:YAG laser opens vistas for arthroscopic repair. PMID- 10147426 TI - Laser procedure for hair transplants developed. PMID- 10147427 TI - Percutaneous laser disc decompression (PLDD) moves to the clinic. PMID- 10147428 TI - Quality control program for point-of-care glucose testing. PMID- 10147429 TI - Routine diagnostic testing for apoA-I, apo-B, Lp(a), and LDL cholesterol in clinical laboratories. PMID- 10147430 TI - Current status of HIV testing in neonates. PMID- 10147431 TI - Current transfusion therapy: indications for basic components. AB - OBJECTIVE: To review basic blood components and currently acceptable transfusion practices. DATA SOURCES: Professional journals, current texts, and the author's experience. STUDY SELECTION: Not applicable. DATA EXTRACTION: Not applicable. DATA SYNTHESIS: Red blood cells, platelets, cryoprecipitate, and fresh-frozen plasma are the basic blood components ordered daily in hospitals and transfusion services all over the world. To notify the laboratory medical director of inappropriate orders for components, the clinical laboratory scientist must be aware of currently acceptable transfusion practices. This article reviews these four components and indicates acceptable processing methods and appropriate use. CONCLUSION: Considering the known risk factors of blood and blood component transfusions, it is essential that components be used only when necessary. Criteria for appropriate transfusion have changed over the years; old transfusion triggers are no longer acceptable. To provide the best medical care to the patient, the clinical laboratory scientist must stay abreast of currently acceptable transfusion practices. PMID- 10147432 TI - Advances in transfusion therapy. AB - OBJECTIVE: To review several recent advances in blood transfusion therapy. DATA SOURCES: Professional journals and current American Association of Blood Banks (AABB) recommendations. STUDY SELECTION: Not applicable. DATA EXTRACTION: Not applicable. DATA SYNTHESIS: Improvements in leukocyte reduction of blood components have been effective in preventing alloimmunization to white cell antigens and the transmission of cytomegalovirus. Leukocyte reduction has not proved effective, however, in preventing febrile reactions after platelet transfusions in alloimmunized patients. To reduce the risk of transfusion associated graft-versus-host disease, new recommendations for the irradiation of blood components have been made. They include the irradiation of donor units from all blood relatives of the recipient and an increase in the recommended dose of irradiation to 2,500 cGy. Current investigations of both hemoglobin-based and fluorocarbon-based blood substitutes may improve the safety and efficacy of transfusion therapy in the future. CONCLUSION: Advances in transfusion therapy include the prevention of alloimmunization to leukocyte antigens, the prevention of CMV transmission by using leukocyte-reduced blood products, the reduction of the risk of transfusion-associated graft-versus-host disease, and the investigation of potential blood substitutes. PMID- 10147433 TI - Evaluation of a new, rapid latex test for the detection of heterophil antibody. AB - OBJECTIVE: To compare the performance of the MONO-LEX system to that of the MONO TEST in detecting infectious mononucleosis (IM) heterophil antibodies. SETTING: Baptist Regional Laboratories, Memphis, Tennessee. PRACTICE DESCRIPTION: Not applicable. PRODUCT COMPARISON: The MONO-LEX system, manufactured by Trinity Laboratories, Raleigh, North Carolina, distributed by Gull Laboratories, Salt Lake City, Utah, and the MONO-TEST kit, manufactured by Wampole Laboratories, Cranbury, New Jersey, are agglutination assays that show visible agglutination when reagents are mixed with serum or plasma containing IM heterophil antibodies. MAIN OUTCOME MEASUREMENTS: Accuracy in detecting heterophil antibodies in the study specimens, ease of interpreting test results, and cost-effectiveness. RESULTS: Of the 139 specimens tested, 132 produced the same results using both products and seven produced discrepant results. The possibility that the MONO TEST produced a "prozone effect" was eliminated. Titration of sera that tested positive for heterophil antibody by both methods revealed titers as high as 1:152 by the MONO-LEX compared with 1:128 by the MONO-TEST. A total of 31 specimens that tested positive for IgM antibodies to Epstein-Barr virus nuclear antigen by enzyme immunoassay were assayed using the two methods; MONO-LEX detected heterophil antibodies in eight sera while the MONO-TEST detected antibody in only four samples. CONCLUSION: The MONO-LEX surpassed the MONO-TEST in sensitivity, cost-effectiveness, and ease of interpretation. PMID- 10147434 TI - Use of the Technicon H *1 to identify abnormal lymphocytes in peripheral blood. PMID- 10147435 TI - Prescribing and dispensing of pharmaceuticals in Japan {editorial}. PMID- 10147436 TI - Effect of isotretinoin on the quality of life of patients with acne. AB - Acne is the commonest skin disease, and affects 85% of teenage boys and 80% of teenage girls. More than half of teenagers with acne will obtain advice on treatment from family, friends and pharmacists. However, in 1992 there were approximately 3.5 million consultations for acne with primary care physicians in the UK. Of these, approximately 51 000 were referred for specialist advice. It is clear that rationalisation of acne treatment based on cost-effective analysis will have potential benefit in terms of usage of resources. This article reviews the current epidemiological data on acne, and demonstrates that acne now affects members of a population who are no longer at school, but are in work or tertiary education. This article argues that, due to this shift, the social and economic consequences of acne are quite different from those that occurred 10 years ago. Finally, the article discusses the cost effectiveness of competing therapies for acne, and examines isotretinoin in terms of cost per disease-free years and the utility of the treatment in cost per quality-adjusted life years (QALYs). PMID- 10147437 TI - Cost-effective use of autologous bone marrow transplantation: few answers, many questions, and suggestions for future assessments. AB - High dose chemotherapy with the support of autologous bone marrow transplantation (ABMT) or peripheral blood progenitor cells (PBPC) has been increasingly used in a variety of haematological and epithelial cancers over the last decade. The rationale of this approach is to overcome the chemotherapy resistance of tumour cells by increasing the dose of cytotoxic drugs. However, the clinical benefit of dose-intensification has been difficult to prove. Almost all studies of ABMT have been done without randomised comparisons with the standard form of therapy for a specific condition. From an economic perspective, the cost of ABMT has been steadily decreasing with improvements in supportive care primarily. Still, current ABMT cost estimates range from $US70 000 to $US150 000 for each uncomplicated procedure. Despite the lack of compelling evidence in support of dose-intensification, ABMT has become a default standard of care after relapse for many patients with lymphoma or leukaemia. We used a decision analysis model to estimate the cost effectiveness of the timing of ABMT in relapsed Hodgkin's disease. The model illustrates the difficulty of using available clinical trial data when follow-up of promising early reports is not available. The model showed that in most situations the optimal strategy is ABMT in second relapse despite growing consensus that immediate ABMT is the treatment of choice. ABMT for women with high-risk or early metastatic breast cancer is one of the most controversial areas in clinical oncology. In the US, several ongoing major randomised trials are addressing the role of ABMT in breast cancer. Using a Markov process we found that ABMT is the preferred strategy under almost all assumptions. The size of the benefit and cost effectiveness of ABMT varied markedly depending on the assumptions made. The model does not supplant the need for randomised trials that concurrently measure efficacy, quality of life, and resource utilisation. However, such analyses point out the critical areas where costs could be cut substantially without effecting efficacy. Drawing conclusions about the cost effectiveness of ABMT for all conditions is hampered by the lack of randomised comparisons of efficacy. Concurrent economic appraisals of selected phase III comparative trials should be considered since the supportive care costs associated with ABMT appear to be stabilising. However, the most important point is that randomised trials are the only mechanism for estimating the therapeutic effect of high dose chemotherapy. PMID- 10147439 TI - The cost of treatment for post-herpetic neuralgia in the UK. AB - Post-herpetic neuralgia (PHN) following acute shingles caused by the herpes simplex virus is a painful and often disabling condition. Treatment of the condition can involve a range of drug therapies. In addition, patients with continuing pain may make several visits to general practitioners and hospital outpatient departments. The costs of treatment for these patients may be substantial. The main objective of this study was to estimate the costs and consequences to the UK National Health Service (NHS) of the treatment of PHN following shingles, and the effect of the condition on patients' lives in terms of pain and time off usual activities such as work. The lifetime direct treatment costs of a cohort of people from onset of PHN to resolution of the disease or death were calculated. These costs were estimated from data on the type and quantity of health resources used, and the unit costs or prices of those resources. This study has shown that PHN can be a costly consequence of acute shingles. For patients attending a tertiary referral centre the lifetime cost was 770 British pounds sterling. For a 1-year incidence cohort of people with shingles in the UK, the lifetime costs of treating PHN are between 4.8 million British pounds sterling (incidence of 21 000 people) and 17.9 million British pounds sterling (incidence of 78 200 people). Efforts are needed to reduce the incidence or severity of PHN.(ABSTRACT TRUNCATED AT 250 WORDS) PMID- 10147438 TI - Clinical and economic considerations in the treatment of prostate cancer. AB - Prostate cancer is a growing health problem with considerable economic consequences. Despite progress in the management of this disease, few areas in medicine generate greater disagreement. The larger part of healthcare resources are allocated to 'halfway technologies' aimed at palliative intervention to prolong life, while a relatively small part goes to measures aimed at preventing or curing the disease. The aetiology of this cancer is multifactorial and no practical measures for primary prevention are known. The number of patients diagnosed with prostate cancer is increasing steadily. The age-adjusted mortality, however, has increased only slightly. In its early stages, prostate cancer is often asymptomatic and is usually not diagnosed until it has advanced. Programmes for the early detection of prostate cancer (screening) claimed to reduce morbidity and mortality are a matter of controversy. Furthermore, there has been much debate regarding optimal treatment in the early stages of the disease. Economic considerations have not as yet been integrated into studies concerning localised prostate cancer. The routine first-line treatment of advanced prostate cancer usually involves some type of endocrine treatment. The most straightforward technique is surgical castration. Oral estrogens are as effective as castration, but have significant cardiovascular adverse effects. These may possibly be prevented if estrogens are given parenterally. A third principal endocrine treatment is the administration of antiandrogens. Medical castration can be attained by the administration of recently developed synthetic peptides, gonadotrophin-releasing hormone {luteinising hormone-releasing hormone (LHRH)} (GnRH) analogue agonists which are given parenterally. The advantage of this type of medical castration is that the trauma of surgical castration and the adverse effects of oral estrogens are avoided. In an attempt to improve the results obtained with endocrine treatment, the concept of combining surgical or medical castration with antiandrogens was introduced. This combination could offer improved response rates and survival in a significant number of patients. However, this advantage must be weighed against the tolerability profiles and the high costs of antiandrogens and GnRH analogues. When using expensive drugs, the duration of treatment is a crucial factor in the total cost. As the length of treatment varies greatly between patients it is difficult to decide the most cost effective alternative for a single individual. The patient's preference is an important factor when selecting treatment. When there is little or no difference in the effect of different regimens the total lifetime cost is important.(ABSTRACT TRUNCATED AT 400 WORDS) PMID- 10147440 TI - Critical leg ischaemia in New Zealand: economic cost of amputation versus intravenous iloprost. AB - The purpose of this study was to establish the incidence of surgical amputation for critical leg ischaemia in New Zealand, and estimate the hospital, prostheses and indirect costs of this intervention. The cost of amputations was then compared with the cost of treating such patients with iloprost. The study was retrospective. Individual patient records relating to 1991 for both public and private hospitals were analysed. Unit costs relevant to 1991 were applied to the volume data of patients and procedures to derive total costs. Costs were estimated on an incremental basis taking a societal perspective. Conservative estimates were obtained for hospital costs, prostheses and for production loss (loss of output or productivity). Total cost was $NZ15.9 million (hospital and prosthesis cost $NZ13.1 million, production loss $NZ2.8 million). The total quantified cost per amputation was $NZ23 038 (hospital and prosthesis cost $NZ19 020, production loss $NZ4017). 32% of patients requiring amputations were in the working age group. The theoretical avoidance of amputation by treatment with iloprost resulted in net savings of hospital and prosthetic costs of between $NZ6660 and $NZ8720 per patient. Amputation for critical leg ischaemia is costly and has a high mortality, but for iloprost treatment to be cost effective in a New Zealand hospital setting, patients must be targeted and a success rate of at least 55% achieved in avoidance of amputation and reduction of pain while at rest. PMID- 10147442 TI - The costs of urinary incontinence. PMID- 10147441 TI - Enalapril: a review of quality-of-life and pharmacoeconomic aspects of its use in heart failure and mild to moderate hypertension. AB - Enalapril is an angiotensin converting enzyme (ACE) inhibitor with an established clinical profile. In patients with symptomatic heart failure, enalapril reduces overall mortality, death from progressive heart failure and hospitalisation rates. In those with asymptomatic left ventricular dysfunction, enalapril decreases the combined risk of death and development of heart failure, and the risk of death and hospitalisation. The effects of enalapril in reducing hospitalisation rates in symptomatic patients translate into net savings in healthcare costs in heart failure. Enalapril also produces modest benefits in quality-of-life (QOL) parameters in patients with symptomatic heart failure as shown in well controlled studies. Its effects appear similar to those of hydralazine plus isosorbide dinitrate. The influence of enalapril on quality of life in patients with asymptomatic disease is minimal but not deleterious. Enalapril generally either maintains or slightly improves quality of life from baseline in patients with mild to moderate hypertension. The drug appears to have a QOL profile that is more favourable than that of propranolol and similar to those of most other comparator drugs, as assessed by subjective measures of quality of life. Clarification is required of its QOL profile relative to that of captopril, in view of conflicting results in the literature. The effects of enalapril on cognitive and psychomotor function appear to resemble those of comparator agents. Thus, enalapril has modest beneficial effects on the quality of life of patients with symptomatic heart failure, while generally maintaining quality of life in patients with asymptomatic left ventricular dysfunction or mild to moderate hypertension. Enalapril is a cost-effective treatment in heart failure that would be expected to yield considerable cost savings in this therapeutic area. PMID- 10147443 TI - Polyethylene wear debris and tissue reactions in knee as compared to hip replacement prostheses. AB - Differences in bearing surface conformity and wear mechanisms suggest that the polyethylene (PE) wear debris generated by total knee replacement (TKR) prostheses should be different than that in total hip replacement prostheses (THR). To address this issue, PE wear debris and the cellular response in periprosthetic tissues from 19 failed TKRs was compared to that from 24 failed THRs using polarized light microscopy and a semiquantitative grading system. The foreign-body inflammatory reaction in the THR case was characterized by plump macrophages with a diffuse cytoplasmic birefringence when examined under polarized light, indicating the presence of multiple submicron particles of PE. The majority of PE particles were less than 1 mum in size and only a small fraction of the total were greater than 10 mum. The foreign-body inflammatory reaction in the TKR cases was characterized by giant cells with fewer macrophages. In the TKR specimens, the size range of PE particles was broader than in the hips. PE particles between 2 and 20 mum were frequent in TKR specimens; particles less than 1 mum in length were less common than in the THR specimens. Diffuse cytoplasmic birefringence was not a characteristic of the TKR cases. These histologic differences were so consistently distinct that the source of the specimen (i.e., from a THR or TKR) could be blindly determined by light microscopy.(ABSTRACT TRUNCATED AT 250 WORDS) PMID- 10147444 TI - A new technique for quantitation of metal particulates and metal reaction products in tissues near implants. AB - Tissue specimens retrieved from four regions adjacent to hip implants during revision surgery were subjected to a novel treatment to make possible the quantitative separation of residual metal particulates and metal reaction products (metal ions and metal-protein complexes). The tissues were exposed to sodium hypochlorite solution that degraded and solubilized them, liberating metal reaction product and leaving behind metal wear particles, which were separated by centrifugation. Atomic absorption spectrophotometry was used to analyze the concentrations of the separated metal ions and wear particles. Co ion concentrations were 0.05 to 0.9 mM, Cr ion concentrations were 0.04 to 2.1 mM, and of Ti ion concentrations were 0.30 to 0.60 mM. The weight of Co metal particles was 0.1 to 4.9 mg/100 mg tissue, of Cr metal particles 0.07 to 2.2 mg/100 mg of tissue, and Ti particles 0.09 to 5.2 mg/100 mg tissue; one black tissue sample contained 3333 mg Ti/100 mg tissue. No correlation was found between the concentrations of these two entities in the samples examined, probably due to the complex and varied processes creating them. The procedures discussed here will result in data that can help elucidate the separate contributions of metal reaction products and metal particulates to implant loosening. PMID- 10147445 TI - Fatigue behavior of titanium femoral hip prosthesis with proximal sleeve-stem modularity. AB - Modular hip prostheses are increasing in variety and utilization. Component stability, high endurance limit, and minimal particulate debris generation are critical for long-term clinical success. The purpose of this study was to characterize the fatigue response and evaluate the in vitro potential for component motion and wear of the S-ROM?, a Ti-6Al-4V hip prothesis with a modular design based on a Morse taper connection. A fatigue jib was designed to simulate fixation of the device at the sleeve-bone interface only with distal support mainly against the lateral endosteal cortex. Two series of tests were performed in air at room temperature: one with direct vertical loading (to produce high bending moments in the coronal plane) and one with a compounding loading angle directed at 15 degrees out-of-plane (to include torsional physiological loads). Applied loads using a servohydraulic test machine ranged from 5 x BW (body weight) to 9 x BW (1 x BW = 73 kg, approximately 160 lb) at 10 Hz on an Instron apparatus. No mechanical failures were observed on the 11-mm size stems below 6 x BW for in-plane vertical loading, and at or below 7 x BW for out-of-plane loading. Using displacement monitoring with a sensitivity of 35 mum, no measurable slippage or relative motion was detected between the stem and sleeve when they were properly assembled. Examination of the contact areas with scanning electron microscopy releaved random surface modification (an indication of fretting or burnishing) with occasional evidence of transfer of material between stem and sleeve.(ABSTRACT TRUNCATED AT 250 WORDS) PMID- 10147446 TI - Corrosion and cell culture evaluations of nickel-chromium dental casting alloys. AB - In this study, the corrosion and surface properties of four commercially available nickel-chromium dental casting alloys, were evaluated using electrochemical corrision testing and Auger electron microscopy. The corrosion tests were conducted under cell culture conditions of 5% CO 2 humidified atmosphere at 37 degrees C in minimum essential medium (MEM) balanced salt solution, 95% MEM-5% FBS (fetal bovine serum) cell culture media, and in 95% MEM 5% FBS media after cold solution sterilization of test samples. The results of the surface and corrision analyses were correlated to cytotoxicity and metal ion release from the alloys using agarose overlay and direct contact cell culture tests. The surface and electrochemical corrision analyses demonstrated that the non-beryllium containing alloys were more resistant to accelerated corrosion processes as compared to the beryllium-containing alloys. All alloys demonstrated decreased corrision rates in cell culture solutions after cold solution sterilization treatment. The corrision products released from the nickel-based alloys failed to alter the cellular morphology and viability of human gingival fibroblasts, however they did cause reductions in cellular proliferation. The potential for accelerated corrision and the exposure of local and systemic tissues to elevated levels of corrision products raises concerns over the biocompatibility of these alloys. PMID- 10147447 TI - Chemical stress relaxation of polyglycolic acid suture. AB - Chemical stress relaxation methods are employed to study chemical and mechanical factors influencing the degradation of uncoated polyglycolic (PG) sutures. Specially constructed instrumentation is used to study the kinetics of the load bearing capability of PG (Dexon?) 3-0 sutures in hydrolytic solution. The effects of pH, temperature, strain rate, and initial load on the rate of chemical stress relaxation are presented. Data show how mechanical factors such as the rate of loading (related to the speed of knot tying), as well as the final tension, are related to the rate of structural degradation. Maximum stability is observed at approximately 40 degrees C, with slower degradation both above and below this point. Results show that the slower and tighter the suture is pulled, the greater its ability to sustain tensile loads during hydrolysis. PMID- 10147448 TI - Evaluation of new absorbable Lactomer subcuticular staple. AB - The most recent advance in skin sampling is the Auto Suture SQS -20 disposable stapler. It approximates and everts wound edges, placing one synthetic absorbable pin in the dermis each time the instrument handle is activated. Staple wound closure was accomplished four times faster than sutural closure of the dermis. Wounds with staple pin closure exhibit superior resistance to infection than wounds approximated by dermal sutures. Although sutures provide more immediate wound security, as measured by wound breaking strength, than dermal pins, the breaking strength of wounds subjected to either dermal pins or dermal sutures were not significantly different 14 days after wounding. PMID- 10147449 TI - Physical properties of model viscoelastic materials. AB - Previous observations on polysaccharides used as viscoelastic agents in ophthalmic surgery suggest that the pseudoplasticity of solutions of hyaluronan (HA) and the low surface tension of hydroxypropylmethylcellulose (HPMC) solutions are physical properties that make these solutions useful clinically. Our laboratories are interested in correlating the physical properties of macromolecular solutions with the ability of these molecules to protect ocular structures during eye surgery. The purpose of this study is to compare the physical properties of model viscoelastics with the properties of HA and HPMC. The results of these studies suggest that polysaccharides that form extended structures in solution at low shear rates and that are characterized by large decreases in the axial ratio at high shear rates, exhibit pseudoplastic behavior. In this study pseudoplasticity is exhibited by polysaccharides with molecular weights in excess of 450 000, and is insensitive to the backbone chemistry for linear macromolecules. In addition, low surface tension is associated with charged macromolecules that have a high positive second virial coefficient. PMID- 10147450 TI - Creep behavior of hand-mixed Simplex P bone cement under cyclic tensile loading. AB - Acrylic cement, used for the fixation of total hip replacements and other orthopedic implants, is a subject of renewed scientific interest as a result of recent hypotheses about dynamic, long-term mechanical failure mechanisms suspected to play a role in prosthetic loosening. Little is known, however, about the long-term mechanical behavior of cement. In this study, the dynamic creep deformation of hand mixed acrylic cement was examined in laboratory tests. Strain patterns found represented the familiar creep process consisting of a primary, a secondary, and a tertiary creep phase. Specimens dynamically loaded with a maximum stress of 3 MPa from 0 were subject to creep of about 50% of the elastic strain after 250 000 loading cycles. A linear relationship between the logarithmic values of the creep-strain and the number of loading cycles was found. Specimens exposed to higher loads showed significantly higher creep strains. No relationship could be established between the strain levels and the porosity of the specimens. Specimens dynamically loaded with a maximal stress of 7 or 11 MPa from 0 failed during the tests. The number of loading cycles to failure was similar to fatigue strength data reported in earlier literature. PMID- 10147451 TI - Inhibition of in vitro calcium phosphate precipitation in presence of polyurethane via surface modification and drug delivery. AB - Biomaterial associated calcification is the principal cause of the clinical failure of bioprosthetic implants. The present investigation describes the mineralization of polymeric substrate in an extracirculatory environment and the possible methods of prevention. Calcification was examined on various polyurethane films (and bioprosthetic tissue) incubated in metastable solutions of calcium phosphate and the role of polymer casting and precipitation was evaluated. The formulation and the in vitro efficacy of prolonged controlled release chitosan matrices, containing the novel anticalcification agents, such as Fe +++ or protamine sulfate (PS), were also attempted. The in vitro release profiles of PS from chitosan beads was performed in a rotating shaker (100 rpm) in 0.1 M phosphate buffer (pH 7.4) and was monitored spectrophotometrically. The amount and percentage of drug release were much higher initially, which was controlled with the incorporation of egg phosphatidyl choline (EPC). The PS loaded chitosan beads (coincubated in calcium phosphate solution with the calcifiable polyurethane films) significantly inhibited biomaterial calcification (about 40-50% inhibition). Surface modification of polyurethanes with Fe +++ or PS also inhibited the calcification profile of the material. These findings suggest the possibility of a combination therapy for prevention of biomaterial associated calcification via surface modifications in conjunction with long-term controlled release of the anticalcifying drugs. PMID- 10147452 TI - New advances in electronic devices for hole detection. AB - Holes in surgical gloves are considered to be an important source of transmission of pathogens between surgeon and patient. Two new glove hole detectors have been devised to alert the surgeon to the presence of holes. These devices have been evaluated using six powder-free and seven powdered varieties of surgical gloves that were either dry or exposed to hydration. Eight of the 13 surgical gloves hydrated rapidly with water, altering their resistance to the conduction of electricity. Because the Barrier Integrity Monitor? only has a hydration monitor, 68 false positives occurred during the evaluation, indicating to the surgeon that he/she should change gloves unnecessarily because the glove had no hole. In contrast, the Surgic Alert Monitor? (SAM?) had a hydration alarm as well as a glove hole detection alarm. During the 104 tests, the SAM? device showed no false positives. In the testing of five of the rapidly hydrating types of surgical gloves, the SAM? device could not reliably detect holes. On the basis of this study, the SAM? device, in conjunction with gloves that resist hydration, appeared to be a reliable hole detection monitor. PMID- 10147453 TI - Meeting the challenges of neonatal cardiorespiratory event monitoring. PMID- 10147454 TI - Pulmonary function testing in the NICU: intermittent measurement versus continuous monitoring. PMID- 10147455 TI - Near-infrared interactance (NIR): a new non-invasive technique to estimate subcutaneous body fat in newborns. AB - Body fat (BF) is rarely determined routinely in infants due to the lack of a simple measuring device. A portable NIR instrument, successfully applied in adults, takes 5 seconds for a measurement and involves no skin manipulation. We designed this study 1) to compare BF estimates by NIR to skinfold thickness (ST) and 2) to assess the relationship of NIR and ST values with standard measures reflecting BF, such as Weight/Length Ratio, Body Mass Index and Ponderal Index. We studied BF in 40 healthy term infants within 12 hours of birth by NIR and ST at 3 standard sites: triceps (TRI), subscapular (SUB) and abdominal (ABD). RESULTS. Significant correlations were found between NIR and ST (R=0.70, 0.58 and 0.64 for SUB, TRI and ABD, respectively); between the sums of the 3 measurements (R= 0.69), and between birthweight and ST (R=0.57) or NIR (0.51), and between Weight/Length Ratio and ST (R=0.55) or NIR (R=0.51). We conclude that NIR measurements correlate well with skinfold measurements and NIR can be measured faster than skinfolds (5 vs 60 seconds). We speculate that NIR could be cost-effective for routine clinical measure of body fat and growth in infants. PMID- 10147456 TI - Intravitreal drug administration with depot devices. AB - The administration of medications by depot devices is a rapidly developing technology in ocular therapeutics. Sustained delivery of ophthalmic medications is a novel approach to treating chronic ocular conditions where systemic therapy may be accompanied by unwanted side effects and where repeated intravitreal drug administration carries significant risks. Eye diseases particularly suitable to this form of treatment include proliferative vitreoretinopathy and chronic intraocular infections such as cytomegalovirus retinitis. Liposomes, which have been extensively investigated over the last two decades, have not found any acceptable clinical application. Nonerodible polymers such as the ethylvinyl acetate/polyvinyl alcohol cup are in advanced phase III trials. The current status of microsphere development in the treatment of posterior segment disease is examined in the review and studies investigating the potential uses of the osmotic minipump are mentioned. PMID- 10147457 TI - The role of laser wavelength in the treatment of vitreoretinal diseases. AB - Advances in laser technology have provided ophthalmologists with lasers spanning the visible and near-infrared spectrum. Recently, prospective, randomized clinical trials have compared laser wavelengths in the treatment of specific disorders. The Krypton Argon Regression Neovascularization Study found no difference between argon blue-green and krypton red laser when performing panretinal photocoagulation to manage proliferative diabetic retinopathy. The Macular Photocoagulation Study Group and the Canadian Ophthalmology Study Group have independently found no substantial difference in treatment outcome when using argon green versus krypton red laser to treat choroidal neovascularization in eyes with age-related macular degeneration. These recent trials and others that evaluate laser management of proliferative diabetic retinopathy, choroidal neovascularization, retinopathy of prematurity, and retinal breaks are reviewed. Multiple studies have failed to identify a moderate difference in treatment outcome between treatments performed with different laser wavelengths; however, small differences in outcome cannot be excluded without further study involving great numbers of patients. At the present time, ophthalmologists should be reassured that individual preferences for one wavelength over another in specific situations should not have a major effect on the visual outcome of the procedure. PMID- 10147458 TI - Ionizing radiation and the retina. AB - This review considers the effects of ionizing radiation on the retina and examines the relationship between the natural course of radiation retinopathy and the radiobiology of the retinal vascular endothelial cell (RVEC). Radiation retinopathy presents clinically as a progressive pattern of degenerative and proliferative vascular changes, chiefly affecting the macula, and ranging from capillary occlusion, dilation, and microaneurysm formation, to telangiectasia, intraretinal microvascular abnormalities, and neovascularization. The total radiation dose and fractionation schedule are the major determinants for the time of onset, rate of progression, and severity of retinopathy, although other factors such as concomitant chemotherapy and preexisting diabetes may exaggerate the vasculopathy by intensifying the oxygen-derived free-radical assault on the vascular cells. The differential radiosensitivity of RVECs is attributed to their nuclear chromatin conformation, their antioxidant status, and their environment. We propose pathogenetic mechanisms for radiation retinopathy and suggest that the peculiar latency and unique clinical pattern is related to the life cycle of the RVEC. A rationale is also proposed for the use of radiotherapy in the treatment of subneovascularization and age-related macular degeneration. PMID- 10147459 TI - Screening and outcome of retinopathy of prematurity. AB - Retinopathy of prematurity continues to be a formidable problem for the premature infant, his or her family, and physicians and nurses caring for the child. In the past year, advances have been made in screening for serious retinopathy and in our understanding of the long-term visual function of eyes that had retinopathy during the infants' neonatal period. Further work has also been undertaken in defining the role of laser photocoagulation and cryotherapy in the treatment of threshold disease. PMID- 10147460 TI - Clinical management of retinoblastoma. AB - There have been many recent advances in the diagnosis and management of children with retinoblastoma. Regarding diagnosis, the judicial use of ancillary studies, particularly B-scan ultrasonography, has been instrumental in supplementing the diagnosis when opaque media preclude a clear view of the underlying neoplasm. Computed tomography and magnetic resonance imaging are important in the early detection of associated pinealoblastoma, which occurs as part of the recently described syndrome of "trilateral retinoblastoma." With regard to management, the technique of enucleation continues to improve and the scleralized hydroxyapatite implant is now available to provide a better cosmetic appearance and better motility of the artificial eye. Methods have been described for harvesting fresh tumor tissue immediately after enucleation for special DNA studies. Recent reports have documented a decreasing frequency of enucleation and an increasing tendency to use eye-preserving methods of management. Plaque radiotherapy, which provides more localized irradiation to the specific tumor, is gradually supplanting external beam irradiation for localized retinoblastoma that does not exhibit extensive vitreous seeding. The indications and contraindications for cryotherapy and photocoagulation have been more clearly delineated. The role of chemotherapy is being evaluated in the treatment of primary retinoblastoma and for metastatic disease. New breakthroughs in genetic research are being applied to clinical genetic counseling. The prognosis for life and for preservation of vision has improved greatly in recent years. PMID- 10147461 TI - Cardiac transplantation: a review for critical care nurses. AB - Advances in immunology, immunosuppressive therapy, and preservation techniques have contributed to making cardiac transplantation an accepted therapy for end stage heart disease. One-year survival rates now exceed 90% at some transplant centers. However, serious complications, such as infection, rejection, coronary artery disease, and malignancies, continue to plague long-term survival rates in this patient population. Balancing the immune system between infection and rejection requires the special expertise of experienced cardiologists and immunologists. An improved understanding of the immune system promises to increase long-term survival rates of cardiac transplant recipients. Critical care nurses require special assessment skills to meet the demanding challenges of cardiac transplant recipients in the immediate postoperative period. The impact of cardiac denervation, immunosuppression, and the risk for acute rejection add a different perspective for nursing interventions in the critical care environment. With mortality rates remaining at 8 to 10% for the first month following cardiac transplantation, the skill of critical care nurses is crucial to decreasing morbidity and increasing survival during the acute perioperative period. PMID- 10147462 TI - Trauma radiology: part III. Diagnostic and therapeutic angiography in trauma. AB - Angiography has a central role in both diagnosis and therapy of traumatic vascular injuries from blunt and penetrating mechanisms. Angiography is considered the "gold standard" for establishing the presence of vascular injury, but precise indications and appropriate timing of angiography in certain clinical situations, such as proximity injury to the extremities or penetrating neck injuries, remain controversial. We consider the role of angiography in the diagnosis of major arterial injury in the thorax, selective use of diagnostic and therapeutic angiography for intraabdominal trauma, identification and control of pelvic hemorrhage, and detection of vascular injury of the head, neck, and extremities. PMID- 10147463 TI - Futile care: prevention and process: educating patients about advance directives is crucial. AB - The current health care reform movement offers unique opportunities to address the issue of futile care. Possible solutions include the widespread use of advance directives, particularly durable power of attorney and cardiopulmonary resuscitation directives; the establishment of regional consortia for developing guidelines for the reasonable termination of care; and the use of patient registries and structured outcome studies to identify patients for whom treatment is likely to be futile. In addition to developing guidelines, regional consortia can serve as monitors for insurers or managed care plans that may attempt to limit care inappropriately. PMID- 10147464 TI - The technique of reversing ventricular fibrillation: improve the odds of success with this five-phase approach. AB - Early, repeated defibrillation is the key to managing ventricular fibrillation (VF). To maximize the likelihood of success, use this five-phase approach, modified from the advanced cardiac life support protocols. Phase I: When a patient is found in VF and with no pulse or signs of life, attempt electrical reversion with a 200-wsec shock, followed if necessary by a 300-wsec and a 360 wsec shock. Phase II: Manage reversible causes of VF with orotracheal intubation, hyperventilation, and epinephrine. Phase III: Use intravenous lidocaine aggressively, followed by a 360-wsec shock. Phase IV: Give bretylium and magnesium sulfate by intravenous push, again followed by a 360-wsec shock. Phase V: Treat refractory VF with repeated 360-wsec shocks, and give further doses of the anti-arrhythmic agents. PMID- 10147465 TI - Using cost-effectiveness analysis for formulary decision making: from theory into practice. AB - The growth of expenditures on healthcare and pharmaceutical products is a concern to third-party payers because of the absence of market discipline (price signals that consumers face). Cost-effectiveness analysis is a method that allows third party payers to systematically make judgements about the 'value for money' of these products. It moves beyond simple unit price comparisons of alternate interventions/products to consider the full stream of relevant cost and benefits. As formulary committees begin to adopt the systematic use of cost-effectiveness analyses to inform the debate, the exercise will move from an academic to a more practical application. This transition will require several important changes including defining the purpose of cost-effectiveness analysis, measurement of outcomes and data, format of reports, and contractual arrangements between the pharmaceutical industry and analysts. As more 'real world' experience is gained in the practical application of cost-effectiveness analysis, the quality of data will improve as will its value as an aid to decision making. PMID- 10147466 TI - The practical impact of pharmacoeconomics on institutional managers. AB - The value of pharmacoeconomics has been advocated by governments and academic establishments worldwide. However, the importance of pharmacoeconomic information to healthcare decision makers will depend upon the viewpoint from which the analysis is conducted. Institutional decision makers are likely to be concerned more with direct than with total costs, and to be influenced more by arguments that apply to the economic effects on the institution than by a societal perspective. Formularies have been employed for a considerable length of time, but their effectiveness has been assessed in terms of cost savings rather than overall value in healthcare outcomes. Many governments and institutions now advocate the importance of contracting for health gain by emphasising the importance of effectiveness of therapeutic interventions. By subjecting treatments to clinical audit, maximum effectiveness can be sought while minimising toxicity and improving compliance with medication through risk management strategies. Pharmacoeconomic evaluations will have maximum impact when there is wide flexibility in the management of resource allocation by virement between different budgets. The consideration of all costs and benefits as parts of a single healthcare budget would satisfy the majority of these needs and maximise the use of healthcare resources. PMID- 10147467 TI - Cost implications of lipid-lowering treatments. AB - Coronary heart disease (CHD) is the major cause of morbidity and mortality in the Western world, and contributes substantially to global healthcare costs. As pressure rises to certain health costs, it is essential to consider the cost effectiveness of different management strategies. In terms of CHD, treatment costs for different procedures for existing disease can be considered, and can also be compared with the costs of prevention programmes. PMID- 10147468 TI - Antiasthma drugs: quality-of-life rating scales and sensitivity to longitudinal change. AB - The causal hypothesis of quality of life predicts that questionnaire items measuring the construct of problems are more sensitive to change in a clinical trial compared with those measuring the construct of evaluations. This prediction was confirmed in 2 clinical trials of patients with asthma who were administered salmeterol in comparison with another treatment. These and other data show that whether a significant effect is obtained in a clinical trial, and the size of any effect, depend on the properties of the questionnaire used to assess quality of life. Quantitative assessments of improvement in quality of life should be treated with caution in economic evaluations. PMID- 10147469 TI - Economic evaluation in mental disorders: community versus institutional care. AB - Psychiatric illnesses have been shown to have a dramatic economic impact. The concept of economic efficiency is particularly relevant in the field of psychiatry because of different factors such as the high prevalence, the chronicity or cyclical nature of many mental disorders and the duration of most of their treatments. Despite the international diversity of healthcare systems, most developed nations spend approximately 10% of their total healthcare expenditures on the treatment of mental disorders. The current trends, including growth of the outpatient sector with no decline in institutional costs and increasing evidence of less expensive care in community based treatment facilities, have been confirmed by several studies. The costs of mental disorders consist largely of direct costs involving healthcare expenditures and indirect costs resulting from loss of productivity by individuals because of illness or death. Both direct costs with specific emphasis on hospital care, and indirect costs represent the major economic burden of psychiatric disorders. While increased detection and treatment might add to direct costs for the health delivery system, effective treatment might avert greater expenses that would be incurred as indirect costs. Therefore, to be efficient, any new therapeutic interventions in psychiatry would have to reduce both hospital costs (number or length of admissions) and indirect costs (loss of productivity). Increasingly, the chronic mentally ill are treated in community based facilities. Several studies support the cost effectiveness of community based social psychiatric treatment versus inpatient care.(ABSTRACT TRUNCATED AT 250 WORDS) PMID- 10147470 TI - Evaluation of the pharmacoeconomic literature. AB - Pharmacoeconomics identifies, measures, and compares the costs and consequences of pharmaceutical products and services. The cost effectiveness of a pharmacotherapy in a particular indication depends on the molecular configuration of the drug, its safety and efficacy, and local market factors such as the acquisition cost of the drug, the cost of a hospital bed, physician fees and nursing time. The types of study include cost minimisation, cost effectiveness, cost utility, cost benefit and cost of illness. Modelling studies are used to predict long term economic consequences of therapy. Retrospective studies apply local costs to clinical trials that may be international in scope. Full prospective pharmacoeconomic studies provide more complete information but are rare and expensive to perform. The principles of pharmacoeconomics are illustrated by 2 retrospective case studies from the literature. In the first study, ondansetron was compared with metoclopramide on the basis of efficacy and tolerability inferred from a previous well controlled clinical trial. A range of economic outputs provided answers from several perspectives. In the second study, a sound pharmacoeconomic analysis of corticosteroids in paediatric asthma used a comparator therapy that is now deemed clinically inappropriate. The case studies illustrate how conclusions from pharmacoeconomic studies must be interpreted with caution before they can be applied in a particular clinical setting. PMID- 10147471 TI - Presenting economic information for decision making. AB - This article identifies and discusses the interest and role of each of the stake holders in the pharmacoeconomics decision process: sponsors, researchers, medical and economics experts, and decision-makers. In addition, the different publication strategies available to facilitate successful presentation of pharmacoeconomic data are reviewed. It is apparent that the presentation of pharmacoeconomic data will be successful only when clear objectives and an intended target audience are identified at the outset of the study. PMID- 10147472 TI - 'This house believes that pharmacoeconomic analysis should be mandated by governments rather than left to market forces'. PMID- 10147473 TI - Economic outcomes of colfosceril palmitate rescue therapy in infants weighing 1250g or more with respiratory distress syndrome: results from a randomised trial. AB - An analysis of the economic data from a multicentre, randomised, placebo controlled clinical trial of colfosceril palmitate in infants with neonatal respiratory distress syndrome (NRDS) and birthweights of 1250g or more is presented. Two 5 ml/kg (67.5 mg/kg) doses of a synthetic surfactant (colfosceril palmitate) or air placebo were administered to 1237 infants who were receiving mechanical ventilation and had an arterial/alveolar oxygen tension ratio of less than 0.22. In addition to the clinical end-points for safety and efficacy, data were collected on length of hospital stay, days in the neonatal intensive care unit, days on mechanical ventilation, days on oxygen, and hospital charges until the child reached 1-year adjusted age. One-year adjusted age is attained when the time elapsed since birth is equal to 365 days plus the number of days of prematurity. Rescue treatment with synthetic surfactant therapy has been shown to reduce the incidence of complications of NRDS. Growth and development of infants who received colfosceril palmitate therapy in the study and survived to 1 year adjusted age were equivalent to those of the survivors in the air placebo group. For the cohort of treated infants, colfosceril palmitate reduced the average length of stay at 2 levels of care needed during both the initial hospitalisation (a reduction of 8 days overall and 5 days in intensive care) and all first year hospitalisations (a reduction of 9 days overall and 5 days in intensive care). Total hospital charges for the initial hospitalisation and through 1-year adjusted age for a hypothetical cohort of 100 infants treated with colfosceril palmitate were less than those for a comparable cohort in the air placebo group. The results would, therefore, suggest that rescue therapy with colfosceril palmitate in infants with NRDS and birthweights over 1250g can result in substantial reductions in hospital resource utilisation and charges in addition to the clinical benefits associated with its use. PMID- 10147475 TI - An optimal acute result after directional atherectomy or stent placement reduces the risk of subsequent restenosis. PMID- 10147476 TI - Gene therapy for the management of cardiovascular disease. PMID- 10147477 TI - Emergent coronary bypass for failed PTCA: a 10-year experience with 253 patients. PMID- 10147478 TI - Angioplasty versus coronary artery bypass surgery for multivessel disease--a BARI equivalent study. PMID- 10147474 TI - Metoprolol: a pharmacoeconomic and quality-of-life evaluation of its use in hypertension, post-myocardial infarction and dilated cardiomyopathy. AB - Metoprolol is a beta 1-selective adrenoceptor antagonist that is widely used in several indications. A recent investigation has also highlighted a potential role for metoprolol in selected patients with idiopathic dilated cardiomyopathy. Pharmacoeconomic and quality-of-life data for metoprolol are limited to the areas of hypertension, post-myocardial infarction and idiopathic dilated cardiomyopathy. In these settings, metoprolol has shown beneficial effects on morbidity and mortality, or closely-related end-points. Controlled release formulations offer the potential to maximise the confirmed antihypertensive benefits of metoprolol by maintaining clinically effective plasma drug concentrations within a narrow range over a 24-hour interval between doses. Recent data support the use of controlled release metoprolol at the low dose of 50 mg/day. Metoprolol is at least as effective as many other antihypertensive drugs, although compared with thiazide diuretics at relatively high doses in the MAPHY (Metoprolol Atherosclerosis Prevention in Hypertensives) trial, metoprolol was associated with a more favourable effect on mortality. Pharmacoeconomic analysis, also based on the MAPHY trial, indicates that metoprolol is more cost effective than high dose thiazide diuretics in middle-aged men with mild to moderate hypertension. However, the advantage for beta-blockade in this trial is not supported by results of other studies, and the applicability of these data to current medical practice using lower thiazide doses is therefore questionable. Quality of life in patients with mild to moderate hypertension did not deteriorate in most investigations with metoprolol. Furthermore, quality of life was similar for controlled release metoprolol and atenolol. With conventional/matrix-based sustained release metoprolol, quality of life was less satisfactory than with lisinopril but was only marginally different from that with diltiazem (at lower than usual therapeutic doses). Nevertheless, these newer agents have no proven beneficial effect on mortality, and further studies are also warranted with controlled release metoprolol 50 mg/day. When administered post-myocardial infarction, conventional metoprolol was associated with significant improvements in quality of life and was cost saving over a 3 year period. Significant improvements in quality of life were also evident for metoprolol-treated patients with idiopathic dilated cardiomyopathy. In summary, available data support the continued extensive usage of metoprolol as treatment for hypertension and as therapy post-myocardial infarction. Pharmacoeconomic data supporting an advantage for metoprolol over high dose thiazides in hypertension needs further assessment in settings reflecting usual general practice approaches to managing patients with hypertension, while differences in quality of life between metoprolol and other antihypertensive agents appear to be marginal.(ABSTRACT TRUNCATED AT 400 WORDS) PMID- 10147479 TI - Ultrapulse carbon dioxide laser removal of periocular wrinkles in association with laser blepharoplasty. AB - Removal of periocular wrinkles is a common yet difficult problem. There are many techniques currently available, all of which have some drawbacks. With the advent of new generation ultrapulse carbon dioxide lasers, skin can now be resurfaced successfully with minimal risk and side effects. In our study of 36 patients we assessed the benefit of using ultrapulse carbon dioxide (CO 2) laser to resurface the periorbital skin in association with transconjunctival lower lid CO 2 laser blepharoplasty. We found that 36/36 (100%) patients had good to excellent results. The incidence of side effects was very low. We also found that 2/36 (5.6%) of patients developed mild clinically insignificant hypopigmentation and 1/36 (2.8%) developed mild scarring, which resolved with one injection of triamanalone 10 mg/ml. No patients had hyperpigmentation. In addition, 1/36 (2.8%) patients developed transient ectropion, which resolved spontaneously in 6 weeks. We conclude that ultrapulse CO 2 laser is an excellent method for treating periocular wrinkle lines and can be readily performed in conjunction with a transconjunctival lower lid blepharoplasty. PMID- 10147480 TI - Photodynamic effect using a diode laser with mono-l-aspartyl chlorin e6 (NPe6) for implanted mouse tumor. AB - A new red diode laser has been developed that is suited for use in photodynamic therapy (PDT). The new laser can be used with NPe6, a photosensitizer that does not prolong normal skin sensitiveness. This study examined the effectiveness of PDT using the diode laser and compound for treatment of fibrosarcoma implanted in BALB/c mice. PMID- 10147481 TI - Effects of low-power laser irradiation on multiple unit discharges induced by noxious stimuli in the anesthetized rabbit. AB - This study discusses the effects of low-power laser irradiation upon multiple unit discharges within a peripheral nerve that were induced by a noxious stimulation in anesthetized rabbits. Responding to a pinch stimulation of plantar skin, transitory increase of neuronal discharges was induced in the sural nerve. This was reduced within a minute, and persistent increases, which continued during a period of the stimulation, occurred. These increases became significantly smaller than the control value during a low-power laser irradiation that was applied to the exposed sural nerve distal to the recording site. These results suggested an inhibitory effect of low-power laser irradiation on the impulse conduction within a peripheral nerve. Possible analgesic effects of low power irradiation are discussed. PMID- 10147482 TI - The Nd:YAG laser treatment of hemangioma. AB - An Nd:YAG laser was used in the treatment of 160 patients with hemangioma from January 1989 to January 1993. Irradiance was between 800 and 1600 W/cm 2 with energy between 400 and 1600 J/cm 2. The best results with almost total restoration were obtained in 21 of the 160 patients (13%). The size of the hemangioma was reduced by more than 50% in 88 cases (55%), by less than 50% in 56 cases (35%), and by a negligible amount in 3 cases (2%). Side effects as found in 160 patients or 10% included slow healing, superficial skin necrosis, and occurrence of scars. Most hemangiomas can shrink by themselves. However, the treatment is needed for cases with risk of various side effects including scar formation, sepsis, bleeding, or abnormal growth of an organ. We concluded that the Nd:YAG laser is a very useful instrument in the treatment of abnormality of blood vessels, such as hemangioma. PMID- 10147483 TI - Evaluation of laser Doppler flowmetry in renal transplantation. AB - Renal grafts are presently evaluated based on the surgeon's observation of the organ microcirculation. Effectiveness of organ microcirculation has traditionally been accomplished through evaluation of the appearance of the graft. Laser doppler flowmetry (LDF) has been suggested as a possible means to determine graft effectiveness. Renal grafts in 46 transplants were studied using LDF and the technique was evaluated. It was found to be a useful technique for monitoring effectiveness of grafts. PMID- 10147484 TI - Laser eye surgery: improvements in eye surgery on the way? PMID- 10147485 TI - PDT inhibits precursor to restenosis in animals. PMID- 10147486 TI - New device increases dermatology laser capabilities. PMID- 10147487 TI - Guidelines for treating different stages of hemangioma. PMID- 10147488 TI - Worksite health promotion and health care reform: an update. PMID- 10147489 TI - Role delineation for the position of director of worksite health promotion programs. PMID- 10147490 TI - Reflections on certification {comment}. PMID- 10147491 TI - Promotion of worksite smoking policy in two Minnesota communities. PMID- 10147492 TI - Perspectives beyond health promotion. PMID- 10147493 TI - European news and perspectives {news}. PMID- 10147494 TI - Social support in worksite smoking cessation: qualitative analysis of the EASE project. AB - PURPOSE: Mobilize and study social support in EASE, a worksite smoking cessation program. DESIGN: Qualitative study of social support in two pilot and two test worksites. SETTING: Collaboration with American Lung Association of eastern Missouri to implement program in 12 companies between 1982 and 1985. SUBJECTS: Ninety-eight participants in cessation clinics at pilot and test sites and 350 randomly sampled respondents from among all 877 employees at test sites. INTERVENTION: Steering committees included representatives of management and line employees and tailored the program from plans and materials for program promotion, self-help manuals, and a standard curriculum for a Group Comprehensive Clinic. MEASURES: Implementation and participation from project records. Outcomes and perceptions of social support from surveys of employees. RESULTS: Twelve to 24 months after program initiation, smoking cessation among active participants ranged from 21% to 41%. Consistent with emphasis on promoting support for quitting throughout the worksite, 10% to 25% of nonparticipants were abstinent at follow-ups, exceeding national base rates. Surveys indicated greater importance of social support than of program's procedures or materials and greater benefits of social ties to nonsmokers than to others attempting to quit. Differences among companies in both reported social support for nonsmoking and cessation rates paralleled differences in Steering Committees' activities and organizational support for the program. CONCLUSION: Though limited by lack of experimental controls, this qualitative study of active program participants as well as random samples of all employees indicates social support can be a strength of worksite smoking cessation programs. PMID- 10147495 TI - Application of theoretical models to exercise behavior among employed women. AB - PURPOSE: This study examines the utility of three theoretical models--the stages of change model, self-efficacy theory, and the decisional balance model--in understanding exercise behavior among employed women. DESIGN: Data for this cross sectional study were collected as part of a routine follow-up of a worksite-based smoking and health risk appraisal study. SETTING: The study was conducted in three Rhode Island worksites, including one manufacturing company, one medical center, and one retail outlet. SUBJECTS: Of a sample of 431 women who completed exercise questionnaires, 293 reported participation in a physical activity over the previous week. The average age of the sample was 41.1 years, and mean years of education was 12.8. MEASURES: Previously validated measures to determine stage of exercise behavior, exercise self-efficacy, exercise decisional balance, and physical activity participation were administered. Additional demographic information was also obtained. RESULTS: Frequency counts revealed that 39% of the population was sedentary, 34% were participating in irregular activity, and 27% were active. MANOVAs followed by one way ANOVAs revealed that women in Precontemplation scored the lowest and those in Maintenance scored the highest on the self-efficacy, pro, and decisional-balance indices, with the trend reversed on the con scale. A chi-square test revealed that women with one or more young children in the home were more likely to be in a lower stage of exercise adoption. CONCLUSIONS: Most of the women in this cross-sectional study did not engage in regular activity. Presence of young children in the home was significantly related to decreased activity.(ABSTRACT TRUNCATED AT 250 WORDS) PMID- 10147496 TI - A qualitative investigation of organizational issues in an alcohol awareness program for blue-collar workers. AB - PURPOSE: To explore sociopolitical and organizational issues in worksite alcohol health promotion. Few such programs are reported in the literature. DESIGN: Qualitative data were gathered during the development and implementation phases of a program through focus groups, key informant interviews, and observations made by the research team. SETTINGS AND SUBJECTS: One hundred and ninety-nine blue-collar workers from a private company (a group which was also involved in a randomized controlled trial) and 123 workers from four other organizations (nontrial groups) received the intervention. The nontrial groups were used to pilot-test the intervention and in a post-trial assessment. All companies were located in Montreal, Quebec, Canada. INTERVENTION: Two worksite health promotion sessions on responsible drinking were given to small groups of workers. MEASURES: The reactions of workers, unions, and employers to the program and to the evaluation trial were observed. The viewpoints of key informants were solicited through semi-structured interviews. Analysis was accomplished through several cycles of memo writing. RESULTS: Alcohol is a sensitive subject when discussed in worksite group settings. Our data suggest that there are alcohol problems in the workplace of which coworkers are clearly cognizant. In one setting the intervention led to the development of organizational rules regarding workers who reported to work inebriated, where this behavior had been previously tolerated. The sessions were better received when disease concepts were avoided. Evaluation research on alcohol requires particular care with confidentiality and ongoing communication with all stakeholders, especially unions. CONCLUSIONS: Worksite health promotion regarding alcohol is feasible.(ABSTRACT TRUNCATED AT 250 WORDS) PMID- 10147497 TI - Consider Ho:YAG for low-cost, effective laser lithotripsy. PMID- 10147498 TI - The Sprotte, Whitacre, and Quincke spinal needles. PMID- 10147499 TI - A review: secondary ion mass spectrometry (SIMS) of polymeric biomaterials. AB - This paper comprises a short review of the application of secondary ion mass spectrometry (SIMS) to the surface chemical analysis of biomaterials, with the main emphasis on biomedical polymers. By the use of appropriate examples, the technique is shown to provide detailed information on the surface chemical structure of the top 1-2 nm of a range of biodegradable polymers, copolymers, surface modified materials and drug delivery systems. Semi-quantitative information on the surface composition of copolymeric materials can also be obtained. The molecular specificity of the technique can be exploited to identify the presence of additives (eg. drugs, peptides) or contaminants in the surfaces of biomaterials. This approach can be extended to situations where biomolecules of interest are covalently immobilised on biomaterial surfaces. Finally, SIMS imaging analysis is shown to provide a means of determining the lateral distribution of additive molecules in surfaces. PMID- 10147500 TI - Characterization of bioacceptable carbon materials. AB - Bioacceptable carbon films deposited with a new low temperature technique have been investigated using Raman and X-ray photoelectron spectroscopy. Our results reveal a substantial similarity between the low temperature deposited film and the well-known bioacceptable low temperature isotropic (LTI) pyrocarbon. The Raman spectra, as well as the larger density and oxygen content in the bulk, lead to the speculation of the presence of the common tetrahedral bonds in these materials. PMID- 10147501 TI - Fluorine microanalysis in teeth. AB - Fluorine content in dental tissues has been measured by using nuclear reactions with high energy proton beams and detecting alpha particles and/or gamma rays emitted from fluorine nuclei. The sensitivity of the nuclear analysis reaches 0.1 mg/g and the depth distribution of fluorine atoms can be determined up to 5 mum. The depth resolution is about 0.3 mum with alpha particles and 0.1 mum with gamma rays. Distributions of fluorine both in surface enamel and in cross section of teeth were measured by using a proton probe 500 mum in diameter. A systematic increase in the fluorine concentration has been observed in the healthy incisors dental enamel (1-3 mg/g) with respect to the molar ones (0.5-1 mg/g). A comparison between the fluorine content in healthy teeth and in pathological ones was made. PMID- 10147502 TI - The characterization of plasma-modified polydimethylsiloxane interfaces with media of different surface energy. AB - The effect of interfacing fresh pig blood with polydimethylsiloxane (PDMS) samples of different surface energies and chemistries is presented. PDMS-treated surfaces were obtained using oxygen plasmas. Aging in air produced rather hydrophobic surfaces, although less hydrophobic than the untreated one, due to hydrophobic recovery. Aging in water hindered it, therefore the surface remained hydrophilic. The concentration of albumin and fibrinogen was measured as a function of contact time with fresh pig blood with untreated, treated and aged in air, and treated and aged in water surfaces. The albumin concentration changed in a constant fashion. Fibrinogen depletion was observed for both treated surfaces. In the case of most hydrophobic surface a 'passivating layer' was formed. The same effect was not possible for the hydrophilic surface, due to the low albumin/fibrinogen-treated surface fracture energy. PMID- 10147503 TI - Microstructure of interface regions and mechanical properties of Ti/Al 2O 3 and Ti-alloy/Al 2O 3 joints for dental implants. AB - Titanium and alumina are very well suited as constituents of dental metal/ceramic implants because of their excellent biocompatibility and their special chemical and mechanical properties which can be exploited to tailor composite implant structures. However, prior attempts to join pure titanium without any intermediate layer to alumina ceramic led to unsatisfactory results mainly due to thermal expansion mismatch between both materials. Therefore we used recently developed Ti alloys containing 30%wt Ta or 40%wt Nb for manufacturing dental implants. Moreover, we studied two alternative methods to join pure titanium with alumina using intermediate layers to reduce internal stresses within the joint caused by thermal expansion mismatch. We examined the interface region of these joints by metallographic, mechanical, analytical, and electron microscopy methods. Additionally, a comparison of the properties of the hitherto investigated types of joints with a view of their applicability in dental implants is given. Promising results were obtained for Ti/alumina joints with Nb interlayers. The studies are continuing. PMID- 10147504 TI - Calcium phosphate and polymer interfaces in orthopaedic cement. AB - In order to increase the mechanical properties and the bioactivity of surgical cement, the linkage of two monomers, namely hydroxyethylmethacrylate (HEMA) and methylmethacrylate (MMA), by copolymerization to a modified apatite has been studied. This linkage is obtained by grafting an organic molecule containing an ethylenic bond onto the apatite surface. These two studies have shown that after polymerization more than 70% of the modified apatite is irreversibly linked to the polymers. This linkage is due not to an adsorption but to the existence of a stable covalent bond between apatite and polymers. From these results, it should be possible to develop a new orthopaedic cement which will be more biocompatible and will have good mechanical properties. PMID- 10147505 TI - Mechanical and chemical bonding of artificial joints. AB - Biomaterials which create chemical and mechanical bonds with tissue, i.e. (1) non porous materials with or without a hydroxyapatite coating, (2) porous titanium alloy (beads) with or without a hydroxyapatite coating, (3) alpha-tricalcium phosphate bioactive bone cement and PMMA cement, and (4) interface bioactive bone cement made by interposing hydroxyapatite granules between polymethylmethacrylate cement and the bone, were used in animal experiments and clinical applications. The common problem with cementless fixation is that some patients complain of slight pain on weight-bearing, because a complete initial fixation is not obtained and micro-movement of the component may occur. Porous metal with hydroxyapatite coating is found to be better than that without coating for producing earlier and stronger fixation, and problems with fatigue and peeling of hydroxyapatite from the base metal are eliminated when the beads are coated with hydroxyapatite. As hydroxyapatite bonds chemically to the bone, pain on weight bearing due to micromovement should never occur. In order to obtain long-term and stable fixation for severe bony atrophy, bioactive bone cement or interface bioactive bone cement (interposing hydroxyapatite at the bone interface) is desirable. PMID- 10147506 TI - Artificial dental root made of natural calcium carbonate (Bioracine). AB - 'Bioracine' is an artificial dental root made of natural calcium carbonate (Pinctade maxima mother of pearl). This non-biodegradable material is very close to bone tissue in its physicochemical composition and presents remarkable hardness, resistance and elasticity. Bioracine is a buried dental implant with a special screw thread, presenting a large surface which shows pores of 2-3 mum. A histological study of the interface between the implant and human maxillary bone demonstrated an extraordinary cellular union between these two tissues. Furthermore, bioracine presents two new technical innovations: a periprosthetic epithelial attachment of connective tissue with an active shock absorbing system. Bioracine is an exceptional dental root substitute that matches the biological properties of natural bone. PMID- 10147507 TI - Experimental glueing of injured spleen by collagen glue. AB - This paper discusses the suitability of collagen adhesive for the treatment of a ruptured spleen, and presents a preliminary study on 20 Sprague Dawley rats. Results indicate that this system should be further investigated for clinical applications. PMID- 10147508 TI - Toxicological aspects of synthetic tissue adhesives. AB - Generally, in order to be able to conduct clinical trials or to obtain a product licence for adhesives, toxicological studies have to be conducted in such a way as to provide sufficient data to be able to assess the toxicity, i.e. the risk. This paper discusses the types of studies which may be needed to fulfill these requirements. PMID- 10147509 TI - Corrosion of surgical implants. AB - Corrosion on orthopaedic implants has been studied. Twelve intramedullary nails and twelve osteosynthesis plates were implanted up to eight and thirteen years, respectively. Analysis of biological fluids from all patients was carried out and revealed high concentrations of nickel and chromium that correlated to the implantation time. All implants were corroded by both crevice and intergranular corrosion. Intergranular corrosion is related to mechanical and heating treatments. Crevice-like corrosion is probably enhanced by sulphur present in amino-acids. Electronic probe analysis shows the reaction study between both sulphur and nickel and sulphur and chromium. These results are compared to the metal distribution in body fluids. After a certain incubation time the corrosion accelerates as is characteristic for crevice-like corrosion processes. Studies of the distribution rate of two Ni-Fe-Cr dental alloys in a cell culture system give similar results: metal-ion release increases with the exposure time. PMID- 10147510 TI - From a marketing perspective: where are the future market opportunities in biomaterials? AB - Europe is becoming a center for the development of biomaterials, as the industry becomes increasingly 'globalized'. From a materials perspective, it is clear that all the activity in the biomaterials/medical device industry is in polymers, and bioabsorbable polymers represent a significant market opportunity. To make profits in biomedical polymers, a chemical company must participate in the 'value added chain', whereby the supplier of the chemical (polymer) participates in the profits of the sale to the end-user. PMID- 10147511 TI - The effect of irradiation time on the physical properties of light-cured resins. AB - The physical properties of polymers whose initiation is by visible light are extremely dependent upon the intensity of that light, which may not be ideal in dental clinical conditions. This investigation determined the flexural strength, flexural modulus and indentation hardness of a range of dental composite resins. The curing was initiated by irradiation for 20, 40 and 60 s and the effects of conditioning were measured. Further simulation of clinical conditions was done by holding the light 5 mm away from the materials. The results showed that the materials were adversely affected by short irradiation times and that their conversion was poor immediately after irradiation. Highly significant increases in strength were caused by conditioning at 37 degrees C for 24 h. There was good correlation between the hardness and flexural properties. Flexural strength proved to be a good predictor of conversion. It is suggested that restorations may be very vulnerable to loading in their early stages. PMID- 10147512 TI - Marginal leakage of palladium-enriched amalgam restorations: an in-vitro study. AB - An in-vitro study of marginal leakage around class V restorations, prepared in freshly extracted upper central incisors, tested two types of high copper amalgam: spherical high copper amalgam (Tytin) and spherical high copper amalgam containing palladium (Valiant). No significant statistical difference was noted between the two types of amalgam at the three testing periods. It seemed that the addition of palladium did not improve the marginal leakage. PMID- 10147513 TI - Post-loosening mechanical behavior of femoral resurfacing prostheses. AB - The survival rate of femoral surface replacements has been low relative to conventional total hip replacements. The purpose of this investigation was to determine whether the early clinical loosening can be explained by mechanical causes. Using linear and nonlinear finite element methods, the pre- and post failure load-transfer characteristics of the femoral surface replacement were analysed, and stress patterns and relative motions at the implant/bone interface were evaluated for a particular hip-loading cycle. Using histology of revision material as a guideline, implant loosening, bone resorption and fibrous interface formation were introduced in the model and their mechanical consequences analysed. The results suggest that the high failure rates are not correlated directly with the chances for primary mechanical failure of the implant-bone interface, but rather indirectly with the sensitivity of the implant design to implant loosening and the propagation of bone resorption and fibrous tissue formation. This mechanism appears to be governed by the proliferation of relative motions between implant and bone. We conclude that the 'secondary stability' of implants in general and their capacity to obtain a stable post loosening configuration is an important design criterion for long-term survival. PMID- 10147514 TI - Effect of thermal stress on dentin adhesives used individually and in combination. AB - Polymerization shrinkage remains an inherent problem in composite restorations. Dentin adhesives generally improve bonding to dentin but do not consistently provide leak-free restorations. This study evaluated a dentin adhesive that bonds to dentinal calcium and another that bonds to dentinal collagen when used separately and in combination. The measurement of contraction gaps at the restoration-dentin interface was used as the means of testing the effectiveness of dentin adhesion. The effect of thermal stress on the dentin-polymer bond was also investigated. Results showed that the bisphenyl A glycidyl methacrylate (BISGMA)-based dentin adhesive was more effective when compared with the hydroxyethyl methacrylate (HEMA)-based adhesive. When used in combination, the mean contraction gaps of cavities were not found to be significantly better than those treated with only the BISGMA-based adhesive. Thermal stress reduced the effectiveness of dentin adhesives whether applied individually or in combination. PMID- 10147515 TI - Histological investigation of the tissue response to hydroxyapatite used as an implant material in periodontal treatment. AB - Patients with severe periodontitis and who had one or more teeth with infrabony pockets were treated by periodontal surgery with implantation of hydroxyapatite particles into the bone defects at the time of surgery. Subsequently, in three patients it was found necessary to extract a tooth for reasons not related to the previous periodontal treatment. Specimens that included the local soft tissues and crestal bone attached to the teeth were obtained at 22, 40 and 80 weeks after placement of the implant. They were decalcified and stained with haematoxylin and eosin and examined under light microscopy. The healing response was found to vary between specimens, and between sites within the same specimen. The early stage of healing showed the implant particles surrounded by collagen. Subsequently, varying degrees of resorption of the periphery of the particles was seen, and at some sites bone deposition was observed. These different healing responses were found to be progressing concurrently at sites in close proximity. Further work is needed to confirm the histological findings described in the paper. PMID- 10147516 TI - The use of antimicrobial acrylic strips in the nonsurgical management of chronic periodontitis. AB - Evidence to date has demonstrated the potential value of acrylic strips to deliver antimicrobial compounds into periodontal pockets. The present study was designed to evaluate further the therapeutic effect of antimicrobial acrylic strips in the management of chronic periodontitis. A total of 101 pockets in 69 patients were randomly treated with (1) chlorhexidine strips, (2) metronidazole strips, (3) tetracycline strips, (4) root planing, and (5) combined root planing and metronidazole strips. Immediately before and after treatment clinical measurements of disease were recorded over a three-month period. For all treatment groups significant improvements in clinical parameters were seen compared to control untreated sites but the most effective treatment was combined root planing and metronidazole and the least effective chlorhexidine. Although not significant, combined root planing and metronidazole also appeared to produce some adjunctive effects on clinical parameters compared to root planing alone. Antimicrobial acrylic strips appear useful treatments for chronic periodontitis, but should be used primarily as an adjunct to conventional root planing. PMID- 10147517 TI - The influence of bacterial contaminations on the biodegradation of PLA implants. AB - Metal implants employed in orthopaedic surgery have certain disadvantages. Intensive research work is therefore being done in the field of biodegradable implants, the behavior of which in the case of possible contamination or infection at the operation site has not yet been studied. In-vitro experiments on PLA-test bodies were performed to clarify the influence of bacteria on the polymer degradation. The investigated parameters were germ growth, course of the pH-value of the culture media, bending stiffness of the PLA-test bodies and the decrease in their molecular weight. The experiments performed did not demonstrate an accelerated degradation of PLA specimen in vitro incubated in different bacterial contaminated media. Therefore bacterial contamination may possibly not lead to a premature collapse of the PLA used in connection with fracture treatment by biodegradable osteosynthesis implants. PMID- 10147518 TI - An examination of the rigidity of major connectors for removable partial dentures: an in-vitro study investigating horizontal loading of mandibular connectors. AB - This study investigated the rigidity imparted by the dimensions and cross sectional shape of major connectors for a range of arch-forms. Sixteen cobalt chromium castings in all were fabricated, four in the form of standardised lingual bars, four as thickened lingual bars, four as lingual plates and two as modified sublingual bars. Arch-forms varied in length, radius of curvature and mid-sagittal angulation. All connectors were tested in compression on an Instron machine with and without a resilient base. The latter simulated the displacement of the periodontal membrane. A further apparatus was constructed to record the transmission of applied loads to the contralateral side of the arch; again resilient material was used as an analogue to the periodontal ligament. Results indicated that connector deflection varied directly with its length and inversely with its radius of curvature and the minimum cross-section of the anterior third. A 20 degrees change in mid-sagittal angulation was not significant. The theoretical relationships between a connector's dimensions and its rigidity were not confirmed. Regions of minimum connector dimension limited rigidity. The lingual bars and plates did not distribute lateral stresses effectively to the contralateral side of the arch and were found to be less rigid than the modified sublingual bars. PMID- 10147519 TI - The integration of dental resins with highly drawn polyethylene fibres. AB - This paper presents an initial study of an ongoing project on the reinforcement of acrylic denture base material with continuous, highly drawn linear polyethylene fibres. The mechanisms of integration of the fibres with various dental resins are investigated using pull-out techniques, complemented with observations made in deliberately broken reinforced denture bases. Attention is given to the effect of temperature and humidity to mimic the conditions of the oral environment. PMID- 10147520 TI - The effect of highly drawn polyethylene fibres on the mechanical properties of denture base resins. AB - This paper reports on the effect of reinforcing dental resins with continuous, longitudinally oriented highly drawn linear polyethylene fibres. The mechanical properties were measured in 3-point bending, and the composites showed a very substantial improvement when compared with the properties of an unreinforced resin. The performance improves as the fibre content increases, and the type of resin does not appear to be a significant factor. It is shown that the inclusion of the reinforcement changes the mode of failure of the resin from brittle to ductile; that is, the system may be damaged but it does not disintegrate. PMID- 10147521 TI - Structural and cellular characterization of solvent-casted polyurethane membranes. AB - Fibroblastic cell attachment and growth characteristics of different polyurethane (PU) films were tested. These films were prepared by a classical solvent-casting procedure. By changing the composition and the type of casting solution (i.e. tetrahydrofurane, dioxane, dimethyl formamide-tetrahydrofurane, tetrahydrofurane dioxane, etc.) PU films with different physical and chemical bulk and surface structures were obtained. Structural properties of these films were investigated by scanning electron microscopy, equilibrium swelling experiments and contact angle studies. In stationary cell culture tests, a model cell-line, i.e. baby hamster kidney (BHK) were used. Thus the effects of structural properties on the cell behaviour were investigated. The results demonstrate that it is possible to achieve different cell responses by changing the preparation conditions of the films. While the cell attachment is excellent on porous PU surfaces, the others showed similar adhesion. Better proliferation of BHK cells was obtained with PU films prepared from dioxane solution. PMID- 10147522 TI - The mechanical integrity of healed diaphyseal bone defects grafted with calcium hydroxyapatite/calcium triphosphate ceramic in a new animal model. AB - The need for an animal model to test bone graft materials simulating a weight bearing clinical situation is identified. The concept, design and operative detail of a new model is described. This model involved the creation of a mid diaphyseal wedge defect in the femur of the adult beagle which separated both cortices, plating with a six-hole dynamic compression plate, and allowed immediate full weight bearing. At six months plates were removed and immediate weight bearing was allowed for an additional six months to sacrifice. The initial animal project utilizing this model to evaluate a hydroxyapatite based synthetic graft material was performed using 12 dogs. In addition to the operative procedure, the retrieval testing in torsion of 12 healed grafted bones and their 12 contralateral unoperated controls is described and evaluated. Results showed no statistically significant difference between the torsional strength of test and control femurs (p less than or equal to 0.05). In addition, the future development of the model is discussed. PMID- 10147523 TI - Poly(2-hydroxyethyl methacrylate) beads for the preoperative endovascular occlusion of branches of the hepatic artery in focal alterations of the liver. AB - Spherical particles of porous poly(2-hydroxyethyl methacrylate) have been used in the treatment of patients suffering from focal alterations of the liver, namely haemangioma and hypervascular tumour. The treatment consisted of the preoperative endovascular occlusion of branches of the hepatic artery using these spherical particles, and was followed by an operation. The main merit of the preoperative occlusion of blood vessels is that it substantially reduces blood loss during surgery. In order to determine the optimal time for the operation on the liver, indicators of the coagulation system were examined in successive terms of the postemboilization period. Reaction of the organism to endovascular occlusion is reflected in hypercoagulation changes in the coagulation system. PMID- 10147524 TI - The influence of curing time and environment on the fracture properties of bone cement. AB - Fracture of bone cement at the bone-cement interface is considered to be of significance in the aseptic loosening of orthopaedic implants. The characterisation of the fracture properties of bone cement is influenced by the time and environment in which it is cured. Cement samples stored in air and water at 21 and 37 degrees C for 7 and 21 days were tested using the 'Chevron' test to determine the work of fracture. It was found that the storage temperature and environment had important influences on the fracture resistance of bone cement. In a physiological environment cement appears to take longer to attain a fracture resistance equivalent to that of cement stored at room temperature. PMID- 10147525 TI - Prehospital pharyngeotracheal lumen airway (PTLA) use. PMID- 10147526 TI - An improved multichannel high-speed spectrophotometer for fluorescence spectroscopy applications. PMID- 10147527 TI - Film quality assessment varies among specialties. PMID- 10147528 TI - Color Doppler extends study of female pelvis. PMID- 10147529 TI - Core biopsy advances as aspiration hangs on. PMID- 10147530 TI - Mammographers debate screening guidelines. PMID- 10147531 TI - New tracers revitalize brain scintigraphy field. PMID- 10147532 TI - MRI detects and stages musculoskeletal neoplasms. PMID- 10147533 TI - Better inner ear imaging can demystify symptoms. PMID- 10147534 TI - New sequences speed neuro MR throughput. PMID- 10147535 TI - Spiral CT creates 3-D neuro, body angiograms. PMID- 10147536 TI - MRI agents for abdomen offer high sensitivity. PMID- 10147537 TI - MRI probes atypical facial nerve disorders. PMID- 10147538 TI - The Utah total artificial heart. PMID- 10147539 TI - A critical appraisal of the cardiac arrhythmia suppression trial (CAST). AB - The presence of ventricular ectopic activity in the post-myocardial infarction patient, especially associated with left ventricular dysfunction, has been associated with a high incidence of sudden cardiac death. To test the PVC hypothesis, that PVC suppression in asymptomatic patients with ventricular arrhythmias post-myocardial infarction might reduce sudden death rate, the cardiac arrhythmia suppression trial (CAST) was performed. In patients treated with encainide or flecainide, total mortality at 10 months was 7.7% compared to only 3% overall mortality on placebo. The increase in mortality and sudden cardiac death with these two drugs raised the question of whether PVC suppression in this group of patients should be attempted. In addition, the extrapolation of the results of this study to other patient groups has resulted in a change of our antiarrhythmic prescription habits. Criticism of the CAST study has included a low placebo mortality, which may have been secondary to entry of low-risk groups of patients, deaths in the open label titration groups not being included, and recent advances in thrombolysis and revascularization. In addition, this low placebo mortality may have been explained by the concept that drug-responsive arrhythmias may have more benign prognosis. The above results suggest that, except for the use of beta blockers, benefits of other anti-arrhythmic drug treatment in the post-infarction patient with asymptomatic benign and potentially lethal ventricular arrhythmias is questionable. Flecainide and encainide should be avoided in this group of patients.(ABSTRACT TRUNCATED AT 250 WORDS) PMID- 10147540 TI - Surgical and catheter ablative techniques for treating supraventricular tachycardia. AB - Although antiarrhythmic drugs are commonly used in patients with supraventricular tachycardia, their use is limited due to inefficacy, side effects and patient compliance problems. Nonpharmacologic therapies used in the treatment of supraventricular tachycardia include: antitachycardia pacing, DC and radiofrequency catheter ablation and surgical therapy. Although certain pacing techniques can prevent the initiation of tachycardia, antitachycardia pacing is primarily used to terminate the supraventricular tachycardia once it has occurred. In patients with primary atrial tachycardias that are refractory to treatment, DC or radiofrequency catheter ablation can be used to modify or completely ablate the AV junction with resultant complete heart block. With DC AV junction ablation, 65% of patients will have resultant third degree AV block and 20% of patients will have modification of AV condition. Results with radiofrequency ablation have shown efficacy rates ranging from 56-9470 and can be used without the need for general anesthesia. Both forms of catheter ablation can be used to selectively alter the retrograde limb of an AV node reentrant circuit. Catheter ablation has been successful in ablating accessory pathways. DC catheter ablation has been predominantly used in posterior paraseptal pathways. More recently, radiofrequency catheter ablation of the ventricular insertion site of accessory pathways has demonstrated usefulness in selective laboratories. Surgical therapy for supraventricular tachycardia has been used for excision and/or ablation of an atrial ectopic focus, surgical ablation of the AV node in patients with refractory atrial tachyarrhythmias and microsurgery of the AV node in patients with AV node reentrant tachycardia.(ABSTRACT TRUNCATED AT 250 WORDS) PMID- 10147541 TI - Nuclear medicine in ARDS: clinical applications. AB - ARDS is still characterized by an exceedingly high mortality rate. Methods are then needed to detect ARDS at the earliest clinical stage. Over the last decade, radioisotopic techniques have developed, aimed at demonstrating an abnormal neutrophil sequestration in the lung or detecting functional alterations of the pulmonary alveolar-capillary barrier, which likely precede the onset of respiratory distress. Preliminary application of these techniques in patients with ARDS yielded conflicting results in terms of sensitivity and specificity. On the contrary, lung vascular abnormalities have been consistently observed in patients with ARDS studied by perfusion lung scanning. They consist of focal, non segmental perfusion defects, mostly peripheral and dorsal, with redistribution of blood flow to non-dependent lung regions. This scintigraphic pattern may be considered typical of ARDS since it is not observed in other acute lung disorders. Perfusion abnormalities on lung scans are detectable from the very early stage of ARDS and correlate with the severity of the syndrome as reflected by gas exchange, central hemodynamics, and chest radiography. Perfusion lung scanning may then be used in the early detection and evaluation of vascular injury in ARDS. PMID- 10147542 TI - Use of PEEP in management of life-threatening status asthmaticus: a method for the recovery of appropriate ventilation-perfusion ratio. AB - In 15 patients with asthma attack, evidence of the uneven distribution of air flow during controlled ventilation was obtained by detection of ventilatory asynchronism expressed by the incurvated profile of tracheal pressure waves associated with the repetitive interruptions of air flow. It was observed that low values of PEEP (mean: 5 +/- 2.5 cm H 2O) induced an increase in transbronchial pressure able to overcome ventilatory asynchronism. In these conditions, an appropriate ventilation-perfusion ratio was restored and improved gas exchanges as indicated by the mean increase of arterial PO 2 from 66.3 mmHg (+/- 2.57) to 96.89 mmHg (+/- 4.41) (p = 0.0005) associated with a mean decrease in arterial PCO 2 from 53.66 mmHg (+/- 2.71) to 42.07 mmHg (+/- 1.64) (p = 0.0005). Simultaneously hemoglobin oxygen saturation rose from 82.31% (+/- 1.97%) to 95.74% (+/- 0.5%). In our patients, such values of PEEP were not high enough to influence the pulmonary arterial circulation. The means of the pulmonary arterial pressures obtained before (syst.: 32.3; diast.: 15.1; mean: 22.00 mmHg) were quite the same (p greater than 0.2) as with PEEP (syst.: 32.00; diast.: 14.00; mean: 21.1 mmHg). The mean of the wedge pressure was found to be 8.3 (+/- 74 mmHg) prior to and 8.4 (+/- 0.68 mmHg) after PEEP (p greater than 0.3). Mean cardiac output rose slightly from 5.27 l/min (+/- 0.24) to 5.77 l/min (+/- 0.38) during PEEP (p = 0.01).(ABSTRACT TRUNCATED AT 250 WORDS) PMID- 10147543 TI - Recent advances in cardiopulmonary resuscitation. AB - Reversal of cardiac arrest is contingent on rapid and effective restoration of myocardial blood flow. Thirty years have elapsed since closed-chest cardiopulmonary resuscitation (CPR) was introduced in clinical practice. Because of its technical simplicity and noninvasiveness, CPR was rapidly implemented and almost universally utilized for cardiac resuscitation. However, there is increasing concern about its value for cardiac resuscitation since the limited hemodynamic efficacy of precordial compression accounts for a disappointingly low success rate. More invasive interventions by which blood flow is restored such as open-chest cardiac massage or extracorporeal circulation are consistently more effective than conventional CPR. Experimentally, both methods restore systemic and myocardial perfusion to viable levels and thereby increase the likelihood of restoring spontaneous circulation even after prolonged cardiac arrest or failure of conventional CPR. PMID- 10147544 TI - Shock: new developments in the management of shock. AB - Circulatory shock represents critical reductions of blood flow to tissues with curtailed delivery of energy substrate and especially oxygen. Generation of lactic acid highlights the onset of anaerobic metabolism and represents the clinical hallmark of perfusion failure. For the purpose of classification, prognostication and management, we now recognize four mechanisms by which circulatory shock may evolve. The first three represent states of decreased cardiac output in which shock may stem from acute decreases in circulating volume (hypovolemic shock), loss of patency to mainstream blood flow (obstructive shock) or impaired myocardial function (cardiogenic shock). The fourth one represents altered distribution of blood flow such that perfusion failure may emerge despite increases in total blood flow (distributive shock). PMID- 10147545 TI - The use of continuous arteriovenous hemodiafiltration in multiple organ failure patients. PMID- 10147546 TI - Circular fixation: interviews with Prof. Dott. Renato Spinelli. PMID- 10147547 TI - Healing of nonunion of a fractured lateral condyle of the humerus by pulsing electromagnetic induction. AB - Nonoperative salvage of a surgically resistant case of established nonunion of a fracture of the lateral condyle of the humerus in a child is described. Solid union was achieved by treatment with pulsed electromagnetic fields. A review of the literature indicates that this is the first published report of such a case. PMID- 10147548 TI - Lasers in orthopaedic surgery. PMID- 10147549 TI - Conservative care of low back pain with emphasis on isokinetic exercise. AB - Twenty patients with complaints of low back pain were treated using a sports medicine approach to rehabilitation with isokinetic back exercises for therapy and testing. Nineteen of the 20 patients were returned to regular work, and the remaining patient was able to resume light work. Physical therapy averaged 5.4 weeks in patients without a disc problem. As extensor strength increased in concurrent testing, pain symptoms decreased. A suggestion of an end point to physical therapy was noted, i.e., no further increase in extensor strength on concurrent testing. PMID- 10147550 TI - Management of distal femoral fractures. PMID- 10147551 TI - An improved technique for cement extraction in revision total hip arthroplasty. PMID- 10147552 TI - Endoscopic carpal tunnel release using the subligamentous two-portal technique. AB - The surgical treatment for entrapment neuropathy of the median nerve in the carpal tunnel is varied. Recent publications have demonstrated a closed, endoscopic method for release of the carpal tunnel using a two-portal technique. In this report, a surgical technique for performing a subligamentous modification of this two-portal procedure is discussed, and the special tools used in this approach are demonstrated. In the early portion of this series of 75 symptomatic hands in 65 patients, 8% (6/75 hands) developed transient postoperative ulnar nerve neuropraxia. One patient experienced an iatrogenic laceration of the median nerve. Following the institution of the subligamentous approach, no postoperative nerve complications occurred. The majority of the patients experienced a significant decrease in their median nerve symptoms. This procedure has been found to be safe and is equally as effective as open surgical treatment of patients with carpal tunnel syndrome. PMID- 10147553 TI - Duplex scanning in orthopaedic patients. AB - Duplex scanning with a combination of real-time and Doppler ultrasound is a noninvasive procedure used for the detection of deep vein thrombosis. The technique is described, its use in orthopaedic patients is discussed, and a plan of treatment based on duplex results is reported. PMID- 10147554 TI - Sciatic nerve block for residual limb pain following below-knee amputation. AB - Ten adult patients with diffuse nonphantom limb pain in the residual limb following below-knee amputation underwent from one to four sciatic nerve blocks for the treatment of that pain. Amputation had been performed for peripheral vascular insufficiency in eight patients and for problems resulting from open fractures in two. None of the patients had responded to prosthetic modification, oral medication, or transcutaneous nerve stimulation for treatment of their pain. At one-year following treatment with sciatic nerve blocks as described in this report, one patient had not responded well to treatment but six patients had a resolution of their symptoms, and three had less subjective pain adequate to resume their normal daily activities. PMID- 10147555 TI - Long-term follow-up of fracture nonunions treated with PEMFs. AB - One hundred thirty-nine established fracture nonunions were treated using a pulsed electromagnetic field (PEMF) device that also recorded patient usage. Patients who used the device less than an average of three hours a day had a success rate of 35.7% (5/14), while those who used the device in excess of three hours daily had an 80% success rate (108/135). The difference in the success rate was statistically significant at p less than .05. Treatment success was unaffected by long versus short bone, open versus closed fractures, nonunion of nine to 12 months duration compared to one to ten years, age of patient (whether less than or greater than age 60), gender, recalcitrant versus first time treatment, infected versus noninfected nonunions, fracture gaps up to 1cm, or weightbearing versus nonweightbearing. Ninety-seven fractures in 90 patients (90% follow-up) who averaged more than three hours of PEMF treatment daily and were originally classified as healed were reevaluated clinically and radiographically at four years following treatment (range: 3.6-5.4 years; mean: 4.1 years). Eighty-nine (92%) maintained a solid union. The success rate of PEMF treatment for nonunion repair demonstrated no statistically significant change over long term follow-up. PMID- 10147556 TI - Arthroscopically-assisted semitendinosus and gracilis tendon graft for anterior and posterior cruciate ligament deficiency. AB - A simple, reliable, arthroscopically-assisted procedure is presented in which a doubled and suture woven semitendinosus and gracilis free tendon graft is used in the anterior or posterior cruciate ligament deficient knee. A ligament guide system is used for isocentric placement of tibial and femoral drill holes. The procedure is performed using a button and staple technique that allows accurate placement of the ligament substitution and facilitates early ambulation. At an average follow-up of 2.5 years, good and excellent results have been demonstrated in 97% of 74 knees in which this technique was used, with only a 3% risk of graft failure. PMID- 10147557 TI - Current concepts in the management of herniated disc. PMID- 10147558 TI - Comparing three head-pointing systems using a single subject design. AB - The keyboard is the most commonly used input method for interfacing with computers. When using a keyboard is not possible, alternative computer input methods are needed. Three methods using head control are: Head Master by Prentke Romich, Free Wheel by Pointer Systems, and LROP by Words+. The purpose of this study was to compare these three methods for speed and accuracy using a single subject design for nine individuals with disabilities. Visual inspection of the data revealed that subjects obtained higher scores when using Head Master and LROP than Free Wheel. As a follow-up test, an analysis of variance test for repeated measures showed no difference between using Head Master and LROP but did show a significant difference between Head Master and Free Wheel, and LROP and Free Wheel. PMID- 10147559 TI - A pilot study comparing mouse and mouse-emulating interface devices for graphic input. AB - Adaptive interface devices make it possible for individuals with physical disabilities to use microcomputers and thus perform many tasks that they would otherwise be unable to accomplish. Special equipment is available that purports to allow functional access to the computer for users with disabilities. As technology moves from purely keyboard applications to include graphic input, it will be necessary for assistive interface devices to support graphics as well as text entry. Headpointing systems that emulate the mouse in combination with on screen keyboards are of particular interest to persons with severe physical impairment such as high level quadriplegia. Two such systems currently on the market are the HeadMaster and the Free Wheel. The authors have conducted a pilot study comparing graphic input speed using the mouse and two headpointing interface systems on the Macintosh computer. The study used a single subject design with six able-bodied subjects, to establish a baseline for comparison with persons with severe disabilities. Results of these preliminary data indicated that the HeadMaster was nearly as effective as the mouse and that it was superior to the Free Wheel for graphics input. This pilot study, however, demonstrated several experimental design problems that need to be addressed to make the study more robust. It also demonstrated the need to include the evaluation of text input so that the effectiveness of the interface devices with text and graphic input could be compared. PMID- 10147560 TI - Clinical trials and quality control: checkpoints in the provision of assistive technology. AB - Clinical trials and quality control measures are characterized by evaluation of assistive technology by users, and feedback to providers for the purpose of improving devices or service delivery. These processes recognize that consumer satisfaction is an important measure of device and service delivery effectiveness. In this article, types of clinical trials are reviewed, and both prospective and retrospective methods of quality control are presented. The authors take the position that rehabilitation engineering centers providing customized devices and adapted technology should implement quality control measures in order to improve services to their clients. PMID- 10147561 TI - Treatment of upper abdominal malignancies with organ cluster procedures. AB - Upper abdominal exenteration for upper abdominal malignancies was carried out in 15 patients with removal of the liver, spleen, pancreas, duodendum, all or part of the stomach, proximal jejunum and ascending and transverse colon. Organ replacement was with the liver, pancreas and duodenum plus, in some cases, a short segment of jejunum. Eleven of the 15 patients survived for more than 4 months; 2 died, after 61/2 and 10 months, of recurrent tumor. Of the 9 patients who are surviving after 61/2 to 14 months, recurrent tumor is suspected in only 1 and proven in none. Four patients with sarcomas and carcinoid tumors (2 each) have had no recurrences. The other 5 survivors had duct cell cancers (3 examples), a cholangiocarcinoma (1 example), and a hepatoma (1 example). The experience so far supports further cautious trials with this drastic cancer operation. PMID- 10147562 TI - UNOS: 1989. AB - This paper provides the current data which has been accrued by the UNOS National Scientific Registry as a result of the mandatory sharing of 6-antigen matched kidneys. The 6-month graft survival does not show, as yet, any benefit for first grafts (N = 72), but does show substantial benefit for repeat grafts (N = 25). No penalty from sharing could be demonstrated since graft survival for local and shared organs was the same. The rationale for two new UNOS policies are discussed: (1) mandatory sharing of phenotypically identical kidneys, (2) the "payback system" for shared kidneys. Finally, some personal comments of the author regarding the importance of the National Organ Procurement and Transplant Network are recorded. PMID- 10147563 TI - Organ preservation: experience with University of Wisconsin solution and plans for the future. AB - Transplantation of organs continues to be a primary therapeutic modality for treatment of end-stage organ disease, and 1-year graft survival rates show increasing improvements for most organs. A number of transplant centers show 1 yr graft survival rates approaching 90% or more for the kidney, liver and pancreas. Rejection continues to be the major cause for loss of organs and there is still a major shortage of organs for transplantation. Additionally, many organs showed delayed graft function (or primary nonfunction) which may be related to either donor factors or preservation factors. The University of Wisconsin solution for organ preservation has increased the safe time of preservation for the liver, kidney, and pancreas and helped to increase the quality and number of organs available for transplantation. However, the long range goal of organ preservation (unlimited preservation) is still far from being reached. In the past, preservation could accurately be categorized as an art and preservation solutions were developed based upon theoretical rationales about the mechanisms of organ injury at hypothermia and what agents would suppress injury. The utility and success of this approach is exemplified by the developments of Collins solution and the UW solution. However, further developments in methods to increase the quality and duration of preservation of all transplantable organs would appear to be dependent upon defining, systematically, how organs are injured and what can be done to suppress the injury.(ABSTRACT TRUNCATED AT 250 WORDS) PMID- 10147564 TI - Long-term follow-up of renal transplantation for Wegener's disease. AB - Eight patients with end-stage renal failure due to Wegener's granulomatosis underwent renal transplantation at the University of Minnesota. Seven patients were alive with a functioning graft 40 to 128 months posttransplant (mean follow up: 91 months). One patient died 126 months posttransplant with a well functioning graft. Posttransplant immunosuppression controlled primary disease in all but 1 patient, who presented with perisinusitis. Recurrent disease was not noted in any of the transplanted organs. We conclude that transplantation is an excellent treatment for renal failure secondary to Wegener's disease. PMID- 10147565 TI - Advances in MRI and their impact on neuro-ophthalmology. PMID- 10147566 TI - Electrophysiological evaluation of the neuro-ophthalmology patient: an algorithm for clinical use. PMID- 10147567 TI - Medical treatment as the initial therapy for open-angle glaucoma. PMID- 10147568 TI - Should laser trabeculoplasty be the initial mode of treatment in open-angle glaucoma? PMID- 10147569 TI - Double-stem silicone implant arthroplasty of all metatarsophalangeal joints in patients with rheumatoid arthritis. AB - Double-stem silicone implants have been used to reconstruct destroyed hallux metatarsophalangeal joints (MTPJ) for many years. When smaller implants became available, they were used to reconstruct the lateral four MTPJ. An arthroplasty of all MTPJ was performed using these implants in 44 patients (72 feet) with rheumatoid arthritis (RA). The mean age of patients was 46 years (range, 21 to 66) and 84% were female. Previous surgery had been performed on 28% of the feet. All patients were followed prospectively for an average of 67 months (range, 36 to 111). The patients were evaluated clinically and radiographically; results were recorded on a standardized foot form that allowed computer analysis of the data. The results showed improvement in the hallux valgus angle from 41.6 degrees to 16.1 degrees postoperatively, with no loss of correction over time. Similarly, other forefoot deformities, such as plantar callus and lateral toe abnormalities, all improved both clinically and radiographically. The pain, walking, and function scores all improved, with the greatest improvement being pain relief. Radiographic analysis showed some evidence of fracture in seven hallux (9.7%) and nine lateral toe (3%) implants. Only three toes with implant fracture had some pain at follow-up examination. Three other lateral toe implants were removed for pain. There was no evidence of deep infection or silicone synovitis. Other complications included superficial infection, delayed wound healing, and second surgery for heterotopic bone excision.(ABSTRACT TRUNCATED AT 250 WORDS) PMID- 10147570 TI - Arthroplasty of the second toe. AB - The pathology, pathophysiology, and clinical anatomy of claw, hammer, and crossover toe deformities are presented. Emphasis is placed on the deforming role of the collateral ligaments and intrinsic tendons. A sequential approach to soft-tissue releases about the metatarsophalangeal joint for correction of deformity is presented. In addition to these static deformities, instability of the second metatarsophalangeal joint, including subluxation and dislocation, is discussed. PMID- 10147571 TI - Survivorship and clinical evaluation of cementless, meniscal-bearing total ankle replacements. AB - A porous-coated, cementless, congruent-contact, meniscal-bearing total ankle replacement with a centrally placed trochlear groove and a cylindrical articulating axis representing the lateral talar curvature was developed and used clinically over a 10-year period. An initial clinical series of 40 ankle replacements involved the use of cobalt-chromium-molybdenum tibial and talar components with sintered-bead porous coating of 275-mum pore size and a shallow sulcus trochlear groove with a central fixation fin for the talar onlay component. The congruent meniscal bearing, made of ultrahigh molecular-weight polyethylene (UHMWPe), was flat superiorly and matched the shallow-sulcus and cylindrical geometry inferiorly. Two bearings in two patients subluxed laterally and required revision within 2 years. The overall cumulative survival at the 10 year interval for this group using revision as an end point was 94.75%. The clinical results, using a strict ankle evaluation scoring scale, demonstrated 85% overall good to excellent results. Three patients required further treatment for intermalleolar exostoses, one patient required a debridement for infection, two ankles had medially subluxed bearings, eight ankles developed talar component subsidence, and two patients suffered from chronic reflex-sympathetic dystrophy. A second clinical series of 14 ankle replacements involved the use of polished titanium-nitride-coated titanium-6 aluminum-4 vanadium tibial and talar components with sintered-bead porous coating of 350-mum pore size and a deep sulcus trochlear groove with two lateral fixation fins for the talar onlay component. The bearing element was similar to the initial series except that it had a deeper engagement in the trochlear groove to prevent subluxation.(ABSTRACT TRUNCATED AT 250 WORDS) PMID- 10147572 TI - Fusion techniques for failed total ankle arthroplasty. AB - Salvage of failed total ankle arthroplasty is challenging because of the large bony deficit and disturbed soft tissue envelope, and often is a concomitant subtalar joint disorder. Failures may be revised by implant removal and arthrodesis with or without bone graft. The four common fusion methods are reviewed. PMID- 10147573 TI - The appropriate use of contrast venography and pulmonary angiography in the orthopedic population. AB - Lower-extremity venous thrombosis and its major complication, pulmonary embolism, occur with an increased prevalence in the orthopedic population, even in patients receiving prophylactic therapy. Compression ultrasound has become the diagnostic test of choice to screen high-risk patients and to evaluate symptomatic patients. Contrast venography should be reserved to evaluate the few patients in whom adequate quality ultrasound examinations are unobtainable. Pulmonary angiography remains the "gold standard" in the diagnosis of pulmonary embolism and should be obtained in all patients in whom ventilation-perfusion scan results are discordant with clinical suspicion, and whenever treatment risks are extraordinary. PMID- 10147574 TI - Nuclear medicine in the diagnosis of deep venous thrombosis and pulmonary embolism. AB - Nuclear medicine techniques offer a variety of approaches to the diagnosis of deep venous thrombosis and pulmonary embolism. Several radionuclide methods are available to visualize venous structures, and many radiolabeled agents have been developed for direct visualization of blood clots, including platelets and monoclonal antibodies. Although still available on a limited basis, radiolabeled fibrinogen uptake studies have been replaced largely by newer methods. Ventilation-perfusion lung scanning remains the mainstay of nuclear medicine detection of pulmonary embolism as it has for the past two decades. PMID- 10147575 TI - Ultrasonography in the diagnosis of deep venous thrombosis. AB - The use of ultrasonography to detect thrombi in the lower extremities has recently become popular. In this article the principles of the ultrasound examination are reviewed, and the strengths and weaknesses of the technique are discussed. PMID- 10147576 TI - Mechanical prophylaxis and other modalities. AB - The efficacy of different mechanical prophylaxes against venous thromboembolism, such as aggressive early mobilization, elastic stockings, continuous passive motion, and external pneumatic compression, is discussed and placed in perspective. The published literature regarding dextran, hydroxychloroquine, and antithrombin III is reviewed and critically assessed in terms of efficacy and safety. PMID- 10147577 TI - Thromboembolism: prevention and treatment with vena cava filters. AB - Mechanical approaches to the prevention of pulmonary thromboembolism have evolved from direct operative procedures to the percutaneous insertion of a variety of filter devices. The longest follow-up experience is with the Greenfield vena caval filter (Medi-Tech, Inc, Watertown, MA), which has a long-term vena caval patency rate of 98% and a recurrent embolism rate of 4%. Alternative filters, such as the Bird's Nest (Cook, Inc, Bloomington, IN), VenaTech (VenaTech, Evanston, IL), and Simon Nitinol (Nitinol Medical Technologies, Woburn, MA), are effective in the prevention of embolism but have a vena caval thrombosis rate of 8% to 20%. The efficacy and safety of prophylactic insertion of the Greenfield filter has been demonstrated in several clinical trials, which appears to justify its use in appropriately selected high-risk patients scheduled for orthopedic procedures. PMID- 10147578 TI - Therapy for postoperative thromboembolic disease: indications and treatment. AB - Postarthroplasty patients develop venous thromboembolic disease because of venous stasis, hypercoaguability, and vessel wall injury. However, most venous thrombi are nonocclusive or small and elicit few symptoms; pulmonary emboli also tend to be asymptomatic. Noninvasive techniques to detect deep vein thrombosis do not appear to be reliable in this population, so venography may be required. Postoperative perfusion lung scans, with comparison to preoperative perfusion scans, are the best screen for asymptomatic pulmonary emboli. Heparin infusion, followed by oral warfarin, is indicated for symptomatic thromboembolic disease as well as for asymptomatic patients with substantial proximal deep venous thrombosis or large pulmonary emboli. PMID- 10147579 TI - Coronary angioscopy: a monorail angioscope with movable guide wire. AB - A new angioscope was devised for easier visualization of the coronary artery. In its tip, the angioscope (Olympus) with an outer diameter of 0.8 mm had a metal lumen, through which a 0.014-in steerable guide wire passed. Using a 8F guiding catheter and a guide wire, it was introduced into the distal coronary artery. With injection of warmed saline through the guiding catheter, the coronary segments were visualized. In the attempted 70 vessels (32 left anterior descending [LAD], 10 right coronary [RCA], 28 left circumflex [LCX]) from 48 patients, 60 vessels (86%) were successfully examined. Twenty-two patients who underwent attempted examination of both LAD and LCX; both coronary arteries were visualized in 19 patients (86%). In the proximal site of the lesion, 40 patients have the diagonal branch or the obtuse marginal branch. In 34 patients (85%) the angioscope was inserted beyond these branches. In 12 very tortuous vessels, eight vessels (67%) were examined. In conclusion, the new monorail coronary angioscope with movable guide wire is useful to examine the stenotic lesions of the coronary artery. PMID- 10147580 TI - Myocardial thallium 201 perfusion imaging. PMID- 10147581 TI - Ultrafast computed tomography in assessing coronary bypass grafts. AB - The evaluation of chest pain in the postoperative coronary artery bypass graft patient is an important part of the cardiologist's and cardiothoracic surgeon's practice. Ultrafast computed tomography, by virtue of its speed and 0.75- to 1.5 mm spatial resolution, can detect graft patency with sensitivities of 93% to 96% and specificities of 86% to 100% in 94.2% of patients studied. Although image resolution is insufficient to demonstrate graft stenosis or sequential anastomoses, ultrafast computed tomography is becoming an increasingly important, minimally invasive imaging modality for the evaluation of coronary artery bypass graft patency. PMID- 10147582 TI - Quantifying left ventricular regional and global systolic function using ultrafast computed tomography. PMID- 10147583 TI - MRI in ischemic heart disease: expansion of the current capabilities with MR contrast. AB - Magnetic resonance imaging (MRI) has been used to identify acute and chronic myocardial infarctions and the complications of myocardial infarctions. Studies in animals have shown high accuracy in the quantification of the volume (mass) of acute myocardial infarctions. However, the role of MRI in ischemic heart disease has been limited by the inability to detect noninfarctional myocardial ischemia or to reliably indicate relative myocardial perfusion. Studies in animal models of various myocardial ischemic events have shown that these aims can be addressed using MR contrast media. The effect of MR contrast media on regional myocardial signal intensity is complex and determined by several factors, including: (1) the type of contrast medium; (2) the dose of the contrast medium; (3) the T1- or T2-weighting of the imaging sequence; and (4) the type of imaging technique applied (spin echo, gradient echo, or echoplanar). This article describes some of the potential applications of MR contrast media in ischemic heart disease and the several factors that interact to cause the regional myocardial signal alterations induced by MR contrast media. PMID- 10147584 TI - Evolution of intravascular ultrasound imaging. PMID- 10147585 TI - Clinical applications of intravascular ultrasound imaging. PMID- 10147586 TI - Intravascular ultrasound imaging: in vivo peripheral and coronary artery studies. AB - Recent in vitro studies have demonstrated that intravascular ultrasound can obtain high-resolution cross-sectional images of arterial vessels. To further expand the use of this technique for in vivo visualization of peripheral and coronary vessels, we imaged 24 femoral and 13 carotid arteries from 19 sheep. Using a manual rotation technique, high-resolution images were obtained in 95% of the vessel sites with a rigid probe and in 82% of the vessel sites with a flexible catheter. In 14 of these arteries, good correlation was found between the lumen diameter measured by ultrasound and by angiography (P less than .001, r = .91). In addition, 6 left circumflex coronary arteries were imaged from 6 additional sheep by motor-driven rotation of the ultrasound probe at 1,800 rotations per minute, obtaining clear delineation of coronary lumen morphology and lumen-intima interface. Strong correlation was found also between intravascular ultrasound and cineangiography for coronary artery diameter measurement (P less than .001, r = .96). These studies demonstrate that this technique can provide high-resolution images of arterial vessels in vivo and may have unique advantages in diagnosis of atherosclerotic vascular disease and in the guidance of new catheter-based therapeutic modalities. PMID- 10147587 TI - Percutaneous intravascular ultrasound imaging: validation of a real-time synthetic aperture array catheter. AB - This study was designed to validate the dimensional accuracy and ability to characterize atherosclerotic vessel morphology of a new percutaneously passed ultrasound catheter. The 5.5F catheter used for this study has a synthetic aperture array transducer providing a radial field of view perpendicular to the catheter and can be passed over a standard 0.014-in guide wire. Initial in vitro studies were performed to assess accuracy of dimensional and morphologic information. In vitro images of fixed human vessels demonstrated good boundary definition, and dimensional measurements were closely correlated with histological samples (luminal area, r = .97; maximal lumen diameter, r = .95; maximal wall thickness, r = .83). Morphological subtypes were also closely correlated, with increasing severity of histological atherosclerosis characterized by predictable changes in the ultrasound images. Subsequently, the catheter was passed percutaneously in 28 patients to obtain images of coronary (n = 20) and pelvic (n = 12) vessels. Ultrasound images were compared with simultaneous digital angiograms. Correlation between ultrasonic and angiographic estimations of vessel diameters was good (r = .92). We conclude that intravascular ultrasound imaging will be useful for dimensional and morphological characterization of vascular disease, for the study of regression or progression of atherosclerosis, and, potentially, for guidance of therapeutic interventions such as atherectomy and angioplasty. PMID- 10147588 TI - Intravascular ultrasound assessment of arterial dissection, intimal flaps, and intraarterial thrombi. AB - Arterial dissection, intimal tears, and intraluminal thrombosis are common sequelae of catheter-based interventional procedures for coronary artery disease. These may not be recognized reliably by contrast angiography. Intravascular ultrasound imaging is an innovative method that allows visualization of the cross sectional anatomy with high-resolution real-time images. This article presents the recent experience in arterial imaging with this method. Studies documenting the ability of intravascular ultrasound to demonstrate arterial atherosclerosis and to unmask some problems related to atherosclerotic disease and its treatment by catheter-based maneuvers are presented. Problems of arterial dissection, intimal flaps, and intravascular thrombosis are described with in vitro and in vivo documentation of the capability of intravascular ultrasound to visualize these abnormalities. The clinical implications of real-time imaging of intimal flaps and intraluminal clots, and the possible value of this imaging modality in the performance of catheter-based therapeutic procedures for coronary and peripheral arterial disorders are discussed. PMID- 10147589 TI - Intravascular ultrasound imaging during balloon angioplasty. PMID- 10147590 TI - Functional description of the left ventricle in patients with volume overload, pressure overload, and myocardial disease using cine magnetic resonance imaging. AB - Cine magnetic resonance imaging (MRI) is a three-dimensional imaging technique with sufficient temporal resolution to provide quantitation of left ventricular (LV) dimensions and function. It can be used to describe the three-dimensional geometrical and functional characteristics of various cardiac disease states. Accordingly, the purpose of the study was to noninvasively characterize LV function with cine MRI using LV mass, systolic wall stress, ejection fraction, and fractional wall thickening, and to compare these functional determinants among three major cardiac disease states. Patients were selected from echocardiographic criteria and specific history of disease and divided into the following groups: compensated moderate to severe aortic regurgitation; compensated LV hypertrophy caused by systemic hypertension; and dilated congestive cardiomyopathy. Normal subjects without evidence of heart disease were studied for comparison. Cine MRI was performed at 1.5 Tesla in the short axis plane. Wall stress was calculated from MRI, along with blood pressure recordings and carotid pulse tracings, according to the Laplacian expression. The end-diastolic volume to LV mass ratio distinguished between concentric and eccentric LV hypertrophy. Peak-systolic wall stress was increased in volume overload lesions and myocardial disease and significantly different (P less than .01) compared with pressure overload lesions and normal subjects. Ejection fraction was significantly decreased (P less than .01) in myocardial disease compared with volume and pressure overload lesions and normal subjects. Among these disease states, LV mass was not different but was significantly higher in all (P less than .01) compared with normal subjects. Fractional wall thickening was increased in pressure overload lesions. Thus, the increase in LV mass in volume overload lesions and primary myocardial disease is not adequate to prevent an increase in wall stress, whereas LV mass increased sufficiently in pressure overload lesions to normalize systolic wall stress. Cine MRI can be used to noninvasively describe the three-dimensional geometry and functional state of the heart in various pathological conditions and might be used to monitor therapeutic effects. PMID- 10147591 TI - Are we prisoners of our own paradigms: which (if any) imaging modality for cardiac stress testing? PMID- 10147592 TI - Exercise echocardiography follow-up in percutaneous transluminal coronary angioplasty. AB - Exercise echocardiography has emerged as an excellent tool in the diagnosis of coronary artery disease and has proven to correlate very closely with the distribution and extent of coronary stenoses. In this report we describe our experience with the use of this noninvasive technique in evaluating patients at various stages before, shortly after, and later after percutaneous transluminal coronary angioplasty (PTCA). Coronary restenosis following PTCA occurs at rates between 25% and 40% and currently available screening tests including clinical history, routine exercise electrocardiography, and thallium scintigraphy have proven disappointing correlating with the presence or absence of restenosis. We have found that exercise echocardiography is useful not only in identifying patients who have coronary disease and in predicting the extent and distribution of this disease, but also in demonstrating even very early after angioplasty left ventricular functional improvement both at rest and with exercise. Once patients are discharged from the hospital and followed serially over 5 years, we have found that this tool is extremely valuable in predicting not only coronary restenosis at the site(s) of angioplasty but is also highly predictive of the development of new coronary stenoses. The capabilities of exercise echocardiography to predict restenosis and new disease far exceed the reliability of exercise electrocardiography or the presence or absence of symptoms as indicators of these problems. We have found exercise echocardiography to be an unexcelled screening test in the management of angioplasty patients. PMID- 10147593 TI - Dobutamine stress echocardiography. PMID- 10147594 TI - Atrial pacing stress in transesophageal echocardiography. PMID- 10147595 TI - Stress cardiac magnetic resonance imaging. PMID- 10147596 TI - Doppler echocardiography in stress testing. AB - Doppler ultrasound may have a role in the stress testing laboratory for the identification of patients with coronary disease through the assessment of dynamic ventricular systolic function. Quantitative systolic ejection phase indexes of maximal acceleration, peak velocity, and volume of blood ejected from the left ventricle can be obtained in the exercising patient. Trials comparing stress Doppler ultrasound with ST-segment changes, gated blood pool radionuclide or echocardiographic studies of ejection fraction or wall motion abnormality, and thallium scintigraphic perfusion defects have returned comparable or better sensitivity and specificity referencing coronary angiography. Graded treadmill exercise, stationary bicycle exercise, and pharmacological stress (dipyridamole) have been used. The normal Doppler stress response is a near linear increase in peak ejection velocity with increasing cardiac work, as reflected in heart rate. Patients with coronary artery disease show blunted augmentation of Doppler ejection dynamics between rest and peak stress, and the degree of blunting appears to be proportional to the anatomic extent of coronary disease and the magnitude of ventricular perfusion and performance impairment. Stress Doppler ultrasound achieves diagnostic power for coronary disease with ultrasonic technology, inexpensive equipment, without ionizing radiation, and few personnel. PMID- 10147597 TI - Stress testing using nuclear cardiology. PMID- 10147598 TI - The ongoing development of contrast echocardiography: its promise for myocardial perfusion assessment. PMID- 10147599 TI - In vitro development and clinical applications of sonicated echo contrast agents. PMID- 10147600 TI - Quantitation of myocardial perfusion with contrast echocardiography. PMID- 10147601 TI - Clinical experience with Albunex: a standard echocontrast agent for intravenous and intracoronary use. PMID- 10147602 TI - Emerging clinical roles of contrast echocardiography. PMID- 10147603 TI - Myocardial contrast echocardiography: applications of digital ultrasound data acquisition and processing. PMID- 10147604 TI - Doppler color flow mapping, transesophageal echocardiography, and intravascular ultrasound. PMID- 10147605 TI - Myocardial color perfusion images from ultrafast computed tomography. AB - This article presents a new method for visualization of myocardial perfusion information from ultrafast computed tomography (UFCT). Changes in myocardial density produced by intravenous contrast medium enhancement were color coded selectively and displayed in a cold to hot spectrum. Color coded images from anesthetized canines with temporarily occluded left anterior descending coronary arteries clearly showed ischemic myocardium. Other regional flow differences such as arrival times and regional heterogeneity of enhancement also were observed. An objective comparison of UFCT and microsphere data was made by the amount of ischemia and by the flow histograms of each method for control and occlusion states. The amount of ischemia detected by UFCT (5.6 +/- 2.3%) was less than that detected by microspheres (7.9 +/- 5.0%). Analysis of variance showed significant differences (P less than 0.05) caused by occluder status but not measurement method. The microsphere occlusion flow histogram was significantly different than the microsphere control and UFCT occlusion histograms at low flows. This preliminary evaluation shows promise for optimising visualization of flow patterns within the myocardium. PMID- 10147606 TI - Noninvasive imaging in the assessment of left ventricular function. PMID- 10147607 TI - Exercise two-dimensional echocardiography and Doppler assessment of left ventricular function. PMID- 10147608 TI - The technical and clinical applications of rest and exercise radionuclide ventriculography. PMID- 10147609 TI - Noninvasive assessment of left ventricular function. PMID- 10147610 TI - The assessment of left ventricular systolic and diastolic function by ultrafast computed tomography. PMID- 10147611 TI - Advances in myocardial scintigraphy in coronary heart disease. PMID- 10147612 TI - Pharmacological (stress) perfusion scintigraphy: methods, advantages, and applications. PMID- 10147613 TI - New Technetium 99m imaging agents: promising windows for myocardial perfusion and viability. PMID- 10147614 TI - Artifacts in planar and SPECT myocardial perfusion imaging. PMID- 10147615 TI - Current state of infarct avid imaging--advantages of SPECT evaluations: promise of antimyosin antibodies. PMID- 10147616 TI - Comparison of scintigraphic and echocardiographic methods in coronary heart disease. PMID- 10147618 TI - Role of echocardiography in myocardial infarction: from diagnosis to prognosis. PMID- 10147617 TI - Anatomic and functional assessment of stenosis severity with intravascular ultrasound imaging in vitro. AB - An in vitro study was performed to evaluate the accuracy of intravascular ultrasound imaging compared with roentgenography for determining the cross sectional area of a lumen; and to determine if the functional significance of an irregular stenosis is predicted more accurately by intravascular ultrasound than roentgenography. Varying degrees of stenosis were made in 17 rubber tubings by adjusting a plastic constrictor. The cross-sectional areas at the normal and the stenotic segments were determined by intravascular ultrasound, roentgenography, and then measured directly from an acrylamide gel cast of the lumen. To evaluate the functional significance of a stenosis, the pressure drop across the stenosis was measured using a fluid pumping circuit. The actual pressure drop was then compared with the predicted pressure drop derived from hydrodynamic equations using cross-sectional areas obtained by intravascular ultrasound or roentgenography. There was an excellent correlation between the cross-sectional areas at the tightest stenosis measured by intravascular ultrasound compared with the area from the acrylamide cast (7.2 +/- 2.6 v 6.6 +/- 2.4 mm 2, mean +/- SD, r = .93). Measurements of cross-sectional area from the roentgenograms (10.9 +/- 3.9 mm 2) also provided a relatively good correlation with those from the acrylamide casts (r = .84); however, the roentgenograms consistently overestimated the cross-sectional area of the stenosis. The mean values of the actual pressure drop and the predicted pressure drop by intravascular ultrasound and roentgenograms were 15.7 +/- 13.5, 11.3 +/- 11.9, and 4.3 +/- 4.5 mmHg, respectively.(ABSTRACT TRUNCATED AT 250 WORDS) PMID- 10147619 TI - Echo-Doppler in the management of acute non-Q wave myocardial infarction. PMID- 10147620 TI - Stress echocardiography following thrombolytic therapy and acute myocardial infarction. PMID- 10147621 TI - Myocardial contrast echocardiography in acute myocardial infarction. PMID- 10147622 TI - Conventional and ultrafast computed tomography in the detection of viable versus infarcted myocardium. PMID- 10147623 TI - Assessing myocardial viability with magnetic resonance imaging. PMID- 10147624 TI - Assessing myocardial ischemic insult using nuclear magnetic resonance spectroscopy. PMID- 10147625 TI - Liver transplantation in patients with situs inversus. AB - Two patients with situs inversus and biliary atresia were treated with hepatic transplantation, one with an auxiliary liver and the other with an orthotopic graft which was placed using a piggy-back technique. Both transplants functioned well initially. The auxiliary liver was rejected after 1 1/2 months, and the patient died after an attempt at retransplantation many months later. The recipient of the orthotopic liver has perfect liver function 10 months postoperatively. PMID- 10147626 TI - Diagnosis of pancreatic graft rejection by duplex-Doppler ultrasonography. AB - The utility of duplex-Doppler ultrasonography (US) in the diagnosis of pancreatic graft rejection was evaluated in 9 patients. The examinations assessed the resistive index (RI) of arteries within the graft parenchyma, the homogeneity and echogenicity of the parenchyma, and the presence of fluid collections around the grafts. For the first 3 days after transplantation, the RI was found to be high. Subsequently, it decreased, and when the graft was in a stable condition, the mean RI was 0.63. With acute rejection episodes, the RI increased to a mean of 0.68 (p=0.002). Thus the increase in mean RI was small but significant. If serial US examinations were performed then an increase in RI, above an individual stable base-line level, was more apparent. After successful anti-rejection treatment, the RI decreased again. In 1 case with chronic rejection, the RI was found to be high, and the parenchyma was non-homogenous with high echogenicity. With pancreatitis, the RI did not change significantly. In 2 patients, fluid collections--which later resolved spontaneously--were seen around the grafts. In 1 patient, an arterial pulsation, which had been detectable previously, was found to be absent, and arterial thrombosis was confirmed at operation. In conclusion, serial duplex-Doppler US may be useful for monitoring pancreatic grafts and the RI may assist in the diagnosis of pancreatic graft rejection. PMID- 10147627 TI - A critical analysis of morbidity and mortality as it relates to recipient age following cardiac transplantation. AB - Older patients (age greater than 55) are now being accepted as candidates for cardiac transplantation. The outcome following cardiac transplantation in this older age group has been largely limited to an analysis of mortality and rejection and infection incidence. In addition to these factors, this report investigates whether morbidity related to other organ system disease is greater in older patients. Seventy-eight cardiac transplant operations in patients aged 15 through 64 have been performed using the identical immunosuppression protocol from December 1985 to May 1989. Of these, 58 patients were under the age of 55 (younger), and 20 were 55 years of age or older (older). One- and 2-yr survival tended to be lower in the older group compared to the younger group, but was not statistically significant (1 yr--87% vs. 77%, respectively; 2 yr--84% vs. 77%, respectively, p=0.143). There were no statistical differences between groups in length of initial transplant hospitalization, number of readmissions or total duration of time in hospital (including readmissions) either absolutely or normalized to total months of follow-up for each patient. Neurologic and vascular problems represented a greater proportion of readmissions and rejection a lower proportion of readmissions in the older group compared to the younger group (p less than 0.05). Using hospitalization as a marker for important morbidity, there appears to be little impact of older age on post-cardiac transplant outcome. PMID- 10147628 TI - A critique of pancreas transplantation. AB - There are three possible indications for pancreas transplantation 1. to correct the diabetic state; 2. to cure or ameliorate the complications of diabetes or to delay or diminish their deterioration; 3. to prevent the complications. The diabetes we are considering here is type 1 or insulin-dependent diabetes, a disorder in which there is more or less complete insulin deficiency. No one has suggested pancreas transplantation for type 2, non-insulin dependent diabetes. This article questions the rationale of pancreas transplantation. It maintains that the value of the procedure has not been established. PMID- 10147629 TI - Quality of life in diabetic recipients of kidney transplants is better with the addition of the pancreas. AB - The present study is an evaluation of the quality of life of 32 patients following successful pancreatic transplantation. These patients were studied at from 6 months to 5 years post-transplantation. Over one-half of them were beyond the 21/2-yr mark. A questionnaire was developed that focused on symptoms of neuropathy, enteropathy, and retinopathy. All of the patients evaluated had completely normal carbohydrate metabolism, as evidenced by normal fasting blood sugars and hemoglobin A1C levels. Twenty-one of the 32 patients had symptomatic neuropathy pre-operatively, and 11 of these reported substantial subjective improvement. Eight remained unchanged and 2 became worse. Twenty-four patients had symptoms of enteropathy and 23 noted improvement post-transplantation. Retinopathy symptoms were not improved, but there was a suggestion that after 3 or 31/2 yr progression did not occur as rapidly as earlier. Virtually all of the patients had mood improvements and considerably less fatigue. We have determined that the risk of the procedure when receiving simultaneous renal and pancreas grafts is not significantly greater than that associated with a kidney transplant alone. Patients who are not uremic, either those with a successful kidney graft or those preuremic patients, are better candidates if symptoms are present. The risk of immunosuppression is insignificant in those patients who already have a successful renal transplant and are already on immunosuppressant drugs. Pancreatic transplantation can substantially improve the quality of life in diabetic patients, and should be considered as a therapeutic measure. PMID- 10147630 TI - Indications for pancreas transplantation: a commentary. PMID- 10147631 TI - The delayed duct occlusion technique of human pancreatic transplantation. AB - This is a report on a consecutive series of 50 primary human pancreatic transplants performed between 1980 and March 1989. All patients suffered from end-stage diabetic nephropathy, thus all received a kidney graft simultaneously. The basic technique consisted of intraperitoneal placement of a duct-occluded pancreas segment. The main technical and non-immunological complications included primary non-function (10%) because of ischemic damage or technical error, graft pancreatitis (4%), arterial thrombosis (6%) and venous thrombosis (16%). Five patients (10%) died in the later course with functioning transplant, and 10 transplants (20%) were lost due to acute or chronic rejection, 7 of them in the pre-cyclosporin era. The technical modifications introduced during these years to overcome complications consisted of temporary percutaneous drainage of the exocrine secretion for function control, delayed occlusion of the ductal system with polyurethane, and continuous heparin perfusion of the graft in the postoperative period by means of an arterial catheter. PMID- 10147632 TI - Efficacy of local graft irradiation in preventing cadaveric renal transplant rejection: a prospective randomized trial. AB - Successful renal transplantation depends on the modification of the normal immunologic response. The earliest attempts at such modification involved the use of ionizing irradiation. The significant morbidity and mortality of total body irradiation led to its abandonment in favor of the safer technique of local graft irradiation. While still commonly used, the efficacy of this technique has never been evaluated in a prospective, randomized fashion. The present study is a prospective, randomized, double blinded evaluation of the efficacy of the addition of local graft irradiation to our immunosuppressive protocol. One hundred consecutive cadaveric renal transplants were randomized to receive either conventional immunosuppression alone or conventional immunosuppression plus local graft irradiation delivered in doses of 150 rads on the 1st, 3rd and 5th post operative days. Patients were followed for a period of 2 years. No significant difference was demonstrated between the groups among any measured parameter. In conclusion, the addition of local graft irradiation in doses of 150 rads on d 1, 3, and 5 does not appear to offer any advantage over standard immunosuppressive therapy and its use cannot be recommended. PMID- 10147633 TI - Noninvasive assessment of cardiac risk in insulin-dependent diabetic patients being evaluated for pancreatic transplantation using thallium-201 myocardial perfusion scintigraphy. AB - We examined the value of thallium-201 myocardial perfusion scintigraphy in noninvasive assessment of cardiac risk in 36 insulin-dependent (type 1) diabetic patients being evaluated for pancreas or combined pancreas/kidney transplantation. An extensive cardiovascular evaluation including electrocardiogram was performed in all patients, and most patients were also evaluated by two-dimensional and Doppler echocardiography. Exercise thallium studies were performed in 31 patients. Five patients were unable to exercise and underwent dipyridamole-thallium study. The thallium images were abnormal in 12 patients, 10 of whom underwent coronary arteriography. Significant coronary artery disease was found in 7 of these patients. Nineteen patients underwent pancreatic (3 patients) or pancreato-renal (16) transplantation without any occurrence of cardiac death or nonfatal myocardial infarction peri-operatively or on follow-up ranging from 7 months to 21 months. In contrast, 3 cardiac events occurred in 12 patients not approved for transplantation, each of whom had an abnormal thallium study exhibiting significant ischemia. Resting left ventricular global and regional function was not helpful in determining perioperative risk. Thus, thallium-201 myocardial perfusion scintigraphy may be useful in identifying diabetic patients at low risk for pancreas transplantation and may obviate the need for routine coronary angiography in these patients. PMID- 10147634 TI - Pancreatico-duodenal transplantation with enteric exocrine drainage: technical aspects. AB - When a pancreatic transplant program was initiated in Stockholm in 1974 we elected to use enteric drainage of the pancreatic juice; 103 segmental pancreatic transplantations were performed with this technique. However, in 1988 we began to use pancreatico-duodenal grafts with enteric exocrine drainage and we have now performed 25 such procedures. Here we report the technical aspects of this procedure. The cumbersome pancreatico-enteric anastomosis previously needed for enteric drainage has now been replaced by a simple bowel-to-bowel anastomosis. In the present series, only one graft was lost due to the enteric drainage technique, i.e. because of exocrine leakage. No grafts were lost in thrombosis. In the uremic recipients of combined renal and pancreatic grafts the 1-year actuarial graft survival rate was 86%. Pancreatico-duodenal transplantation with enteric exocrine drainage would, therefore, seem to be a sound surgical procedure which is also physiological and not associated with any long-term sequelae. PMID- 10147635 TI - Technique of pancreas revascularization after combined liver and pancreas harvesting in the same cadaveric donor. AB - Combined liver and pancreas harvesting in the same donor is nowadays a routine procedure in our institution. In terms of sharing of the vascular pedicule the priority is given in the majority of cases to the liver graft. Thus vascular reconstruction of the pancreatic graft is often required before transplantation. From February 1987 to June 1990 we transplanted 62 pancreases coming from a donor where also a liver graft had been harvested; 46 were segmental grafts prepared by duct injection with neoprene, 14 were pancreatico-duodenal grafts with bladder diversion of the exocrine secretion, and 2 were whole pancreas scheduled for bladder diversion and secondarily reconverted to duct injection (1 whole and 1 segmental graft) for poor duodenal blood supply. Among the 47 segmental grafts (46 + 1 reconverted from whole to segmental), in only 10 cases was the celiac axis with an aortic patch possible; conversely in 37 cases the splenic artery had been divided at its origin during the harvesting; bench surgery for vascular reconstruction was realized in 33 cases. Among the 14 pancreatico-duodenal grafts with bladder diversion and the whole pancreas with duct obstruction, in 5 cases the celiac axis and the superior mesenteric artery were harvested on the same aortic patch; in 10 cases the splenic artery was divided at its origin during the harvesting, requiring bench surgery for reconstruction. PMID- 10147636 TI - Solid-organ transplantation in the pediatric population. AB - The results of solid-organ transplantation in children have improved dramatically in recent years with advances in surgical technique and immunosuppressive therapy regimens. Donor organ availability continues to be a limiting factor in the pediatric age-group, and it has been estimated that 20-30% of children waiting for a heart or liver transplant die before a suitable donor can be found. A number of problems remain for the long-term pediatric graft recipient, and these will need to be vigorously pursued so that optimal rehabilitation and longevity can be achieved for the transplanted child. PMID- 10147637 TI - Overview of pediatric renal transplantation. AB - Over 35 years, renal transplantation in infants and children has evolved dramatically. Once a desperate effort, transplantation is now the therapy of choice for virtually all children with end-stage renal disease (ESRD). The number of children less than 10 years old living with ESRD has more than doubled in the last 7 yr, but during that same interval the children with functioning transplants has quadrupled. Since 1963, 386 children and 21 infants have received 495 renal transplants at the University of Minnesota. When examined, several variables strongly influence the outcomes. Primary renal transplants, grafts from living-related donors, and transplants performed since 1979 have all been associated with markedly improved outcomes. But age of the recipient has no impact on either patient or graft survival. Beneficially, transplanted infants experience significantly accelerated head growth, returning them to the normal range. Their development test scores also significantly improve, again bringing them into the normal range. Finally, statural growth regularly improves following successful transplantation. These results support a strategy of early, aggressive support; prompt renal transplantation; and the use of dialysis primarily as a critical "bridge" to elective transplant surgery. PMID- 10147638 TI - Indications for liver transplantation in pediatric patients. AB - Orthotopic liver transplantation has become a widely accepted therapy for children with end-stage liver disease. Several factors need to be kept in mind when advocating this procedure in pediatric patients. These include the following: (1) Liver transplantation is a high-risk procedure with a 10-15% mortality in the best of circumstances. (2) Recipients require long-term drug administration and have a potential for chronic disability. (3) The procedure is extremely expensive. (4) The long-term survival remains unknown. (5) Newer techniques and procedures need to be carefully evaluated. These factors, and the indications and contraindications for this procedure are discussed in this overview. PMID- 10147639 TI - Liver transplantation in the pediatric population: indications and monitoring. AB - Advances in immunosuppressive therapy and surgical technique have brought liver transplantation to an effective therapeutic option for children with end-stage liver disease. The indications and contraindications for transplantation, recipient selection, ethical and financial considerations, and quality of life after transplantation are outlined in this review. PMID- 10147640 TI - Overview of reduced-size liver transplantation. AB - Organ donor availability is the major limiting factor in pediatric liver transplantation, and many children succumb from their liver disease before a suitable donor can be found. In an attempt to overcome this shortage, reduced size liver transplantation, split liver transplantation, and living-donor liver transplantation have been introduced. The eventual role of these techniques will be determined by accumulated experience over the next several years. PMID- 10147641 TI - Pancreas transplantation: long-term results. AB - The rationale behind pancreatic transplantation is to provide a self-regulated, endogenous source of insulin and other islet hormones, thus restoring normal metabolism with the ultimate goals of prevention, stabilization or reversal of secondary degenerative complications. We report clinical and metabolic data of 8 patients submitted to simultaneous kidney and pancreas transplantation in our institute, who had a pancreatic graft function for 4 (1 case) and 5 (7 cases) years. To assess the impact of transplanted pancreatic mass on long-term function, we also included 10 patients from a comparative study between segmental pancreas transplantation (group A, 5 pts) and whole pancreas with enteric diversion transplantation (group B, 5 pts), who had pancreatic function for 2 and 3 yr. All patients are alive. Seven of these patients are off insulin, while one patient lost pancreatic function during an operation performed to correct an arterial stenosis of the graft. HbAlc levels were normal during the entire follow-up period (5.2+/-0.14% at 4 yr; 5.1+/-0.6% at 5 yr). In 24-hour metabolic profiles we observed near normal blood glucose levels, with good insulin release at 4 yr and a mild hyperglycemia at 5 yr (BG at 9 p.m.: 8.8+/-1.3 mmol/l). OGTT performed in 5 patients, 4 yr after pancreas transplantation, showed an impaired glucose tolerance, while the same test performed at 5 yr, showed higher values (BG 120 minutes: 14.7+/-0.2 mmol/l). Group A and group B patients are all alive, with good renal and pancreatic function.(ABSTRACT TRUNCATED AT 250 WORDS) PMID- 10147642 TI - Multi-organ procurement utilizing cardiopulmonary bypass and profound hypothermic circulatory arrest. AB - Despite advances in preservation solutions, hypothermia remains a critical component of organ preservation for transplantation. Many surgeons involved in multi-organ procurement procedures have expressed concern about the possible detrimental effects of cardiopulmonary bypass and profound hypothermic circulatory arrest on non-thoracic transplant organ function. In order to assess the validity of these concerns, a review of 20 multi-organ harvest procedures performed utilizing cardiopulmonary bypass and profound hypothermic circulatory arrest was undertaken. In all instances this technique was combined with organ flushing utilizing cold preservation solution. Adequate data was available to assess post-transplant organ function of all organs recovered in 16 procedures. Indication for the use of this technique was procurement of a heart-lung bloc in 16 instances and donor instability (hypotension) refractory to volume loading and inotropic agents in 4 instances. Organs obtained, including all organs from unstable donors which would otherwise have been lost, functioned, acceptably. Additionally, blood drained into the pump was used for recipient transfusion in 8 instances. This report documents that cardiopulmonary bypass and profound hypothermic circulatory arrest may be easily combined with traditional procurement flushing techniques and it provides excellent organ preservation for subsequent transplantation. This approach can optimize organ recovery from hemodynamically unstable donors, increasing the number available for transplantation. PMID- 10147643 TI - Results of pancreas transplantation in the United States for 1987-90 from the United Network for Organ Sharing (UNOS) Registry with comparison to 1984-87 results. AB - An outcome analysis was performed on pancreas transplants in the United States reported to the United Network for Organ Sharing (UNOS) Registry from its inception on 1 October 1987 to 21 October 1990 (n=1021). These cases comprise nearly one-third of the 3082 pancreas transplants reported to the International Pancreas Transplant Registry (1819 U.S., 1263 non-U.S.) from 1 December 1966 to 31 December 1990, including 619 in 1990 (528 U.S., 91 non-U.S.). Nearly all pancreas transplants in the U.S. during the 1987-90 period were by the bladder drainage (BD) technique (92%). The overall patient and pancreas graft actuarial survival rates were 92% and 72% at 1 year. Patient survival rates were similar in all recipient categories, but pancreas graft survival rates were significantly higher (p less than 0.001) in recipients of a simultaneous pancreas and kidney (SPK) transplant (n=883) than in recipients of a pancreas after a kidney (PAK, n=112) or a pancreas transplant alone (PTA, n=71), being 77%, 52%, and 54%, respectively, at 1 yr. Kidney graft survival at 1 yr in U.S. SPK recipients was 86%. Most grafts (81%) were preserved in University of Wisconsin (UW) solution, and more than half were stored greater than 12 hours, with no difference in outcome with increasing duration of storage. At 1 yr, functional survival rates were 72% for U.S. pancreas grafts stored for either less than 12 (n=439), 12-24 (n=422), or 24-30 h (n=42). For grafts stored greater than 30 h (n=8), the 1-yr functional survival rate was 50% (p=ns versus the other storage times). On univariate analysis, no effect of HLA antigen mismatching on outcome for 1987-90 U.S. cases could be discerned. The results in the UNOS Registry were compared to the results for U.S. cases in the International Pancreas Transplant Registry performed between 1 January 1984 and 30 September 1987. In all recipient categories the pancreas graft functional survival rates were significantly higher in the 1987-90 (UNOS) than in the 1984-87 (pre-UNOS) era. A Cox multivariate analysis of 1984-90 cases showed the relative risk for pancreas graft loss to be significantly less (p less than 0.05) with bladder-drainage, with simultaneous transplantation of the kidney, with use of UW solution for preservation, and with 0-1 HLA-A, B, DR or 0 HLA-DR mismatches.(ABSTRACT TRUNCATED AT 400 WORDS) PMID- 10147644 TI - Combined liver-pancreas transplantation. PMID- 10147645 TI - Renal transplantation into ileal conduits: results and long-term follow-up. AB - From 1977 through 1990, 708 renal transplants were performed at our institution. Eight of these allografts (1.1%) were placed into recipients who required ileal conduits. This report describes the long-term follow-up of these patients. Five out of 8 patients currently have functioning allografts 29 to 102 months after transplantation (with a mean allograft survival of 50 months). Construction of an ileal conduit in patients without bladders or in those who have non-functioning bladders is a straightforward approach with minimal increased morbidity and good long-term results. PMID- 10147646 TI - Value of 111indium leukocyte scanning in febrile organ transplant patients. AB - Immunosuppressed febrile organ transplant patients present a diagnostic and therapeutic dilemma since symptomatology is often altered by immunosuppression, which also masks the location of infection. Fifty 111indium leukocyte ( 111In WBC) scans were performed to determine their usefulness in the organ transplant patient. The results were compared with computerized tomography (CT) and gallium 67-citrate (Ga) scanning. Eleven patients received both 111In WBC and Ga scans; 22 received both 111In WBC and CT scans. Ten 111In WBC scans had subtraction of 99m Tc sulfur or albumin colloid for liver evaluation and four 111In WBC scans had subtraction of 99m Tc DMSA for kidney evaluation. The overall sensitivity and specificity for 111In WBC scans was 90% and 90%, respectively. Lung uptake was sensitive (89%) and specific (97%) for pulmonary infections, including bacterial, fungal and cytomegalovirus pneumonias. Renal graft uptake occurred in 15 cases (41%), all except 2 being due to rejection, pyelonephritis, urinary tract infections, or cytomegalovirus infections. Pyelonephritis and renal abscesses were diagnosed in 3 cases with 99m Tc DMSA subtraction. Perihepatic abscesses (2), and infected liver cysts (4) were diagnosed with 99m Tc sulfur or albumin colloid subtraction. There were five false-negative CT scans and three false-negative Ga scans. Therefore, when compared with 111In: sensitivity = 88% vs 64% (CT), specificity = 80% vs 86% (CT); and sensitivity = 111In 90% vs 67% (Ga), specificity = 100% for both 111In WBC and Ga scans.(ABSTRACT TRUNCATED AT 250 WORDS) PMID- 10147647 TI - Role of duplex imaging and fine needle aspiration cytology of renal allografts in monitoring response to anti-rejection therapy. AB - The role of duplex imaging and fine-needle aspiration cytology (FNAC) in monitoring the response to anti-rejection therapy was investigated in 14 of the 22 rejection episodes which occurred in 30 renal allografts recipients. In 9 of these 14 episodes of rejection, with good resolution, both resistive (RI) and pulsatility (PI) indices decreased by significant proportions (p less than 0.05). The FNAC scores also fell significantly with anti-rejection therapy. In 5 other episodes of rejection where the graft continued to deteriorate there was no significant fall of RI and PI (p greater than or equal to 0.2). In a small group of patients, both FNAC and Doppler predicted rejection. In conclusion, both duplex imaging and FNAC have a role in selection and optimal modulation of drugs in the treatment of acute renal allograft rejection. PMID- 10147648 TI - Usefulness of non-invasive indices in the monitoring of heart-transplanted pediatric patients. AB - Seven patients underwent cardiac transplantation at Ste-Justine Hospital between June 1984 and October 1988 (age 3-16 years). Indices derived from M-mode echocardiography--left ventricular mass (LVM), isovolumetric relaxation time (IRT), shortening fraction (SF), velocity of circumferential fiber shortening (VCF), ejection fraction (EF), LV pre-ejection period/ejection time (PEP/ET), isometric contraction time (ICT)--and electrocardiography--summation of potentials (Sum Pot)--were used as non-invasive markers of rejection (367 studies), while rejection status was monitored by serial endomyocardial biopsy (55 biopsies). Spontaneous variation of such indices, as defined by the 90% distribution interval of their variation when biopsy was unchanged, was found to be important: -20% to +28% for IRT, -30% to +28% for LVM, -30% to 32% for Sum Pot, -32% to 42% for PEP/ET, etc. Using limits of spontaneous variation such as thresholds, none of the studied indices could consistently predict the 2 biopsy documented episodes of rejection or the 7 episodes of improvement. Among all the studied indices, IRT was the most promising, correctly predicting 1 of the episodes of rejection and almost predicting the 2nd. Remeasurement of all M-mode tracings by an unique observer, following strict rules to maximize reproducibility, did not decrease the spontaneous variation of these indices, nor did it improve their performance as predictors of changes in the rejection status. These results warrant the continuing search for other non-invasive methods for accurate monitoring of the rejection status. PMID- 10147649 TI - An evaluation of the cyclosporine parent-compound-specific whole blood TDx assay. AB - The new Abbott TDx cyclosporine parent-compound-specific fluorescence polarization immunoassay (TDxP) was evaluated and compared to the cyclosporine and-metabolites-specific TDx (TDxT) and a cyclosporine parent-compound-specific radioimmunoassay (RIA) (Sandimmun-Kit, INCSTAR). The TDxP assay was linear within the range of 31 to 1600 ng/ml (r = 0.985) with a lower limit of detection of less than 31 ng/ml. The TDxP had excellent intra- and interassay reproducibility (CV = 1.2 to 4.5) that was significantly better than that of the radioimmunoassay. 230 whole blood samples obtained from 65 kidney, 19 liver, and 8 pancreas transplant recipients were analyzed with each of the three assay methods. TDxP had a much stronger correlation with the RIA than did TDxT (r = 0.95 versus 0.83). The difference between the correlations was greatest for the liver and pancreas recipients. The mean ratio of the cyclosporine level determined by TDxP to RIA was 1.0 versus 2.4 for TDxT to RIA. The new TDxP assay provides results equal to a parent-compound-specific RIA but with the added advantages of decreased sample turn-around time and improved intra- and interassay coefficients of variation. PMID- 10147650 TI - Effect of storage temperature on early graft function following liver transplantation. AB - The effect of storage temperature on early graft function following liver transplantation was investigated by analyzing the results following transplantation during three periods in which different techniques for graft storage were used. The techniques involved ice-packing (period 1), storage in a standard operating room refrigerator without ice-packing (period 2) and storage in an accurately controlled refrigerator without ice-packing (period 3). In period 2 there was a significantly higher incidence of histological lesions, primary non-function and retransplantation compared to periods 1 and 3. It was concluded that this was due to inaccurate control of the standard refrigerator in period 2, thus allowing the temperature of the graft to increase, while in periods 1 and 3 the graft temperature was kept close to 4 degrees C by ice packing and accurate refrigerator control, respectively. These results demonstrate that accurate control of storage temperature is important in terms of subsequent graft function. This may become more important as storage times are progressively increased with the use of UW solution. PMID- 10147651 TI - Correlation of endomyocardial biopsy findings with electrocardiogram voltage in pediatric cardiac allografts. AB - Endomyocardial biopsy is said to be the gold standard for the diagnosis of cardiac rejection. In the pediatric age group endomyocardial biopsy is more difficult, and technically may be unsatisfactory. It is therefore desirable to correlate the biopsy finding with non-invasive studies so that patients may be monitored meaningfully, and endomyocardial biopsy may be used in a more selective manner. Ten pediatric patients (age range 2-16 years, mean 11.1 yr) underwent endomyocardial biopsy and electrocardiography simultaneously during their post transplant course (2-24 biopsies, mean 14 biopsies). All patients were treated with triple-drug therapy including cyclosporine, azathioprine and prednisone. Biopsies were classified according to the working formulation of the International Society for Heart Transplantation. The total electrocardiographic voltage (summation of leads 1, 2, 3, V1 and V6) and the limb lead voltage (summation of leads 1, 2, and 3) were calculated. The measurements were then converted into percentage of the highest voltage for each patient, and these values were then compared in the different biopsy groups by analysis of variance. Both the total voltage and the limb lead voltage were significantly lower in the group with grade 3 biopsies versus all other groups (p less than 0.0005). At a level of 10% decline in total voltage, changes in EKG voltage had low specificity (87%) and positive predictive value (51%) but high sensitivity (94%) and negative predictive value (99%). We conclude that, although strong correlation is present between rejection and low voltage, a decline in voltage is not specific for rejection.(ABSTRACT TRUNCATED AT 250 WORDS) PMID- 10147652 TI - Lung transplantation: state of the art. AB - Since the first long term successful single lung transplant in 1983, followed by a successful double lung transplant in 1986, lung transplantation has become established world-wide as an accepted option in the treatment of end-stage respiratory disease of various etiologies. Both procedures carry acceptable morbidity and mortality rates with the actuarial 5 year survivor rate of 80%. Single or double lung transplantation offers many advantages over heart-lung transplantation and is gradually supplanting the latter in most centers with certain exceptions. Differentiating injection from rejection continues to be a major problem but with added experience and new diagnostic tools this obstacle will be overcome. PMID- 10147653 TI - Intravascular oxygenation: adjunct in acute respiratory failure. AB - The IVOX device represents an early prototype of an intravascular membrane oxygenator that is capable of transferring significant amounts of O 2 and CO 2. It employs new hollow-fiber membrane technology and thromboresistant coatings that should allow the development of a membrane oxygenator that can be placed either intravascularly or ex vivo to provide significant gas exchange without the adverse effects seen in prior ECMO studies including bleeding from heparinization and plasma breakthrough resulting in the gradual deterioration of gas exchange. It may well be that this technology will eventually supplant conventional mechanical ventilation in the support of patients requiring intensive ventilator assistance or in those that are long term weaning problems, thus avoiding the not insignificant problems associated with high intensity and/or long term mechanical ventilation. PMID- 10147654 TI - Non-invasive monitoring during ventricular fibrillation. PMID- 10147655 TI - Microcomputer applications in health care delivery: focus on cost containment aspects. PMID- 10147656 TI - PPO network rental vs. ownership. PMID- 10147657 TI - The status of PPOs in 1992: results of the first annual AAPPO Journal survey. PMID- 10147658 TI - Contracting for physical therapy. PMID- 10147659 TI - Predictive value of Doppler ultrasonography in renal transplantation. AB - During a 17-month period, 268 Doppler sonography studies were performed on 46 consecutive renal transplant patients. There were 35 episodes of acute rejection in 10 patients, 8 episodes of delayed function and 47 episodes of high cyclosporine levels (greater than 800 ng/dl by TDX method) in 21 patients. Defining an abnormal resistive index (RI) as greater than 0.8 or a 20% increase above baseline, the test has a specificity of 99% and a sensitivity of 94% in the 1st month post-transplant and had an overall predictive value of 99%. Episodes of high cyclosporine levels ranging from 800 to 1650 ng/dl did not correlate with a high RI except in one circumstance with concurrent acute rejection. Within the 1st month post-transplant, only 1 false-negative study occurred. An additional 8 false-negative studies occurred beyond 1 month post-transplant. Patients with delayed function are separated into three groups based on the Doppler ultrasounds: Group I, patients with an accelerated acute rejection with high RI (N = 2); Group II, patients with true ischemic acute tubular necrosis with normal RI (N = 2); and Group III, patients with possible immunologically-mediated delayed function with intermediate RI between 0.6 and 0.8 (N = 4). Doppler ultrasound is a useful ancillary test to confirm the clinical suspicion of acute rejection. Since high cyclosporine levels do not cause an increase in RI, Doppler ultrasound may help to avoid confusion between acute rejection and cyclosporine toxicity. Additionally, this test may offer insight into the cause of early post-transplant renal dysfunction. PMID- 10147660 TI - PPO profitability: the first decade. PMID- 10147661 TI - Focus on large employer initiatives and attitudes. PMID- 10147662 TI - Appropriateness of drug use: UM or DUR. What's best for managed care? PMID- 10147663 TI - Creative finance? Procedure unbundling. PMID- 10147664 TI - Focus on delivery. PMID- 10147665 TI - Focus on financial stability. PMID- 10147666 TI - The role of cavitational activity in fragmentation processes by lithotripters. AB - The role of cavitation during shock wave exposure was poorly understood until now. Cavitational activity produces severe damage to nearby surfaces due to multiple high-speed liquid jets resulting from bubble collapse. These jet impacts can be made visible by microscopy. For investigating the presence of cavitational processes by shock waves outside and even inside of targets, we have performed the following experiments. Natural gallstones and artificial targets were examined microscopically with regard to the effects of shock pulses. Scanning electron and light microscopical investigations revealed regularly typical and uniform microjet impacts within the fissures and split lines. Since these experiments are the continuation of high-speed films of 10,000 frames/s of shock wave actions on targets, it is most likely that the shock wave produces at first split lines through the stone. Then liquid occupies these cracks. But the following shock waves create within these liquid-filled fissures cavitation and, therefore, cause the disintegration of the targets. It now becomes understandable why biliary lithotripsy is less effective than renal lithotripsy: bile fluid is a high-viscous liquid and, therefore, hinders the disintegration of stones more than low-viscous urine. Intervals between the application of shock waves in biliary lithotripsy, therefore, should improve the treatment results. PMID- 10147667 TI - Extracorporeal shock wave lithotripsy in symptomatic cholesterol gallbladder stone patients with a second generation electrohydraulic lithotripter (MPL-9000): experiences with 106 patients over 15 months. AB - One hundred and six patients were treated with a second generation underwater spark discharge lithotripter (Dornier MPL-9000). During the 15-month study period, Kaplan-Meier analysis predicted a stone clearance rate of 16.5% after 4 months, 37% (7 months), 71% (10 months), and 81% (15 months), respectively. Patients with multiple stones had a 5% probability to be free of stones after 13 months of treatment, when compared to 100% in patients with solitary stones smaller than 2 cm (p less than 0.001). Stones with densities below 100 Hounsfield units (HU) on computed tomography disappeared in 75% of the cases within 13 months. Rim calcified stones were cleared in 100% after 10 months of treatment. Fragmentation efficacy proved to be an essential predictive parameter for stone clearance: a fragment size below 5 mm after extracorporeal shock wave lithotripsy resulted in a 100% stone clearance within 13 months regardless of the initial stone number, size, and density. None of the stones fragmented to pieces of more than 10 mm in diameter could be dissolved within the observation period. Obviously, modern generation electrohydraulic lithotripters are effective in stone fragmentation, thus providing the basis for successful bile acid therapy provided the patients are properly selected. PMID- 10147668 TI - Radiation dose to patients and staff from Storz Modulith SL20 lithotripter. AB - Extracorporeal shock wave lithotripsy (ESWL) uses either X-ray fluoroscopy or ultrasound to localize and determine the end point of treatment. We report radiation doses to patients and personnel from the Storz Modulith lithotripter system recently installed in the Lithotripter Centre, St. Thomas' Hospital, London. The mean annual radiation dose to patients and staff was calculated at 0.73 mSv and 4.8 mSv, respectively. PMID- 10147669 TI - Parameters for predicting electromagnetic lithotripter failure: quality assurance implications. AB - Despite the extensive use of lithotripsy for treating renal and biliary calculi, there has been little data reported regarding the causes and manifestations of lithotripter failure. The clinical and service records for 145 consecutive treatments performed with the Siemens Lithostar Plus were reviewed. Service record analysis revealed eight failures of shock wave generation during a 10 month period. Six of these failures were subtle and still allowed shock wave generation. There were five in-line ultrasound probe failures during this period. The most useful clinical parameter for predicting lithotripter failure was reduced severity of sonographically evident cavitation bubbles during treatment. Lack of stone fragmentation and unexpectedly low analgesia requirements at high power levels were less useful in predicting lithotripter failure. All clinical parameters suffered from nonspecificity. Preliminary experience, with an ongoing quality assurance program using a test object hydrophone, suggests this is a useful method of predicting lithotripter function and avoiding compromised treatments. PMID- 10147670 TI - Management of lower and middle ureteral calculi "in situ" using the Dornier MFL 5000 lithotripter. AB - A new successful approach in treating lower and middle ureteral calculi in situ was undertaken utilizing the Dornier MFL-5000. From August 19, 1989 to February 7, 1990, 46 consecutive cases were treated representing 60 stones (54 lower, 6 middle). The average size of treated stones was 12 mm. Ten cases (21.1%) had two stones and two cases (4.2%) had three stones. Stones were not displaced and no ureteral catheter was used except in one case, a female, 28 years of age, with a lower ureteral stone, where the stone had to be displaced proximally using a double balloon ureteral catheter to follow FDA protocol in order to avoid the ovaries. Minimal IV sedation was required in 97.7% of the patients and only 2.1% required general anesthesia. Different positioning techniques were implemented. One (2.1%) out of 46 cases required retreatment. The average length of stay in the hospital was 1.2 days. No complications occurred to date. Follow-up, 48 hours post-treatment, revealed 94.6% stone-free. At 3 month's follow-up, 100% were stone-free. PMID- 10147671 TI - Use of a continuous alfentanil infusion for extracorporeal shock wave lithotripsy in the treatment of renal calculi. AB - Extracorporeal shock wave lithotripsy (ESWL) is the most widely used treatment for renal calculi. Newer second generation lithotripters are being produced, which are considered to be less painful than their prototypes. Thus, the trend in anesthesia for ESWL is away from general endotracheal and regional anesthesia and toward less involved and more easily monitored techniques such as intravenous analgesia (IVA). This report relates our experience with a continuous alfentanil infusion for ESWL treatment of renal calculi with a nonimmersion second generation Dornier HM-4 lithotripter model. Thirty-five patients treated pre operatively with droperidol and midazolam, followed by a continuous infusion of alfentanil, reported excellent pain relief via a numerical pain score and manifested little, if any, hypertension or tachycardia. Stone fragmentation, fluoroscopy, and recovery time did not differ between patients receiving IVA or general anesthesia. Potential disadvantages of IVA include elevation of transcutaneous CO 2, bradycardia in 14 patients requiring the use of atropine, slightly longer ESWL time, increased number of shocks needed for fragmentation, and a small failure rate, with 11% of patients requiring general anesthesia. With proper patient selection and respiratory monitoring, IVA is highly recommended for ESWL in the treatment of renal calculi. PMID- 10147672 TI - Sensitivity of normal and malignant cells to shock waves. AB - We examined the cytotoxic effect of shock waves for primary (embryonic chick kidney and thigh muscle) and permanently growing normal and malignant cells (human, rat, and mouse) in suspension. To avoid the influence of different media, the cells were suspended in phosphate buffered saline and shock wave treated. In all cases the acute cytotoxic effect (measured by flow cytometry) was a function of the applied shock waves. The investigated cells differed in their LD 50 values which, however, do not reveal a general difference in sensitivity to shock waves for normal and malignant cells. PMID- 10147673 TI - Extracorporeal shock wave lithotripsy of ureteral stones: clinical experience using a second generation lithotripter. AB - Extracorporeal shock wave lithotripsy (ESWL) has proven to be effective for the treatment of renal calculi. However, its use for ureteral stones as monotherapy is controversial. In this study, 142 patients underwent in situ ESWL for ureteral stones. Stone fragmentation was achieved in 87.4% of the patients. Stone clearance rate at 3 months was 95.8%, 94.7%, and 94.2% for stones located in upper, middle, and lower ureter, respectively. Efficiency quotient calculated for the overall stone clearance at 15 days, 1 month, and 3 months was 74.6, 71.8, and 71.7, respectively. Treatment was performed in 82.5% of patients as an outpatient procedure. Our data show that in situ monotherapy is an effective and noninvasive method for treating ureteral stones. PMID- 10147674 TI - Physical properties of antibiotic aerosols produced by jet and ultrasonic nebulizers. AB - The drug stability and the physical properties of aerosol of five different antibiotics were compared for ultrasonic and jet-type nebulization. These antibiotics were used alone, as well as combined with betamethasone sodium phosphate and/or tyloxapol glycerol sodium bicarbonate. The parameters investigated were changes in appearance, pH, temperature, viscosity, specific gravity and the residual potency of the antibiotics. No significant change was shown in appearance, viscosity and specific gravity. Temperatures of the solutions in the ultrasonic nebulizer cup increased with time, though almost no change after 10 minutes in the jet nebulizer. For pH, with antibiotics alone in the ultrasonic nebulizer, some drugs showed an increase, and other drugs showed a decrease, while generally a little change in the jet nebulizer. For residual potency, one drug showed decreased potency in the aerosol, though it was increased in the remnant solution, in contrast, another drug showed a tendency to increased potency in the aerosol and decreased potency in the remnant solution in the ultrasonic nebulizer. In the jet nebulizer, drugs showed generally slight increased potency and no difference among drugs. It was suggested that, with ultrasonic nebulization, in some drugs the solvents were nebulized and the principal ingredient tended to remain behind, while in other drugs the opposite occurred so that the effects were not uniform. PMID- 10147675 TI - Advantages of pressurized canister metered dose inhalers. AB - Metered dose inhalers (MDI) have provided a versatile, reliable, instantly available, self-contained, portable, low cost medical aerosol delivery system for more than 35 years. Currently, most of the drugs commonly used for treating reversible airflow obstruction due to asthma and chronic obstructive pulmonary disease (COPD) are available as MDI and consideration is being given to formulating other potentially useful drugs such as antibiotics, amiloride, and pentamidine in MDI. By means of particle size selective accessory devices, MDI can be used for pulmonary drug targeting which, by further improving the therapeutic ratio inherent to aerosol therapy, reduces local and systemic side effects and should allow application to the pulmonary airways of significantly larger doses of medication than could otherwise be administered safely. Appropriate masks and a variety of adapters have been developed to allow the MDI to be used in infants and children, as well as patients of all ages requiring assisted ventilation. While nebulizers and powder inhalers both have an important role to play in the management of airway and parenchymal disease, there is, as yet, no all-purpose aerosol generation and delivery system to replace the MDI. While the ideal is obviously to develop new environmentally friendly pressurizing liquid/gaseous systems that are chlorofluorocarbon free, this will take a minimum of a decade if, in the final analysis, it can be done at all. In the meantime, patients should be provided with the current formulations until appropriate substitutes become available. PMID- 10147676 TI - Dry powder inhalers: advantages and limitations. AB - New inhalers have been developed because of difficulty of using the conventional metered dose inhaler (MDI) and because of the impending ban on CFC's. Dry powder inhalers (DPI's) in general are easier to use than the MDI and cause fewer irritant effects. Unlike the MDI few patients develop a poor inhalation technique with continued use of DPI's. Comparisons of multidose DPI's have shown that they achieve a similar degree of bronchodilatation to the MDI. Comparisons of the Diskhaler and Turbuhaler have shown little difference in therapeutic efficacy, but most indicate patient preference for the Turbuhaler. The inspiratory flow necessary to achieve a therapeutic effect is critical with DPI's. The majority of patients with severe acute asthma can achieve a peak inspiratory flow sufficient to inhale a bronchodilator from a Turbuhaler. DPI's cannot be used with spacers; this may be a disadvantage in patients who inhale large doses of steroids. PMID- 10147677 TI - Issues surrounding MDI formulation development with non-CFC propellants. AB - Reformulation of metered-dose inhalers (MDIs) without the use of chlorofluorocarbon (CFC) propellants presents numerous obstacles because there are no alternative propellants that can serve as immediate replacements for pharmaceutical use. Hydrofluorocarbons (HFCs), hydrochlorofluorocarbons (HCFCs) and hydrocarbons (HCs) are all under consideration as possible alternatives for CFC propellants. However, no single propellant or combination of propellants has been identified with all of the physical-chemical properties of CFCs. Based on their zero ozone depletion potentials, relatively low global warming potentials, non-flammabilities, densities, and vapor pressures, HFA-134a and HFA-227 are the most attractive replacement propellants identified to date. Yet, their use in MDIs will still require: (1) identification of a metering valve with propellant and formulation-compatible gaskets, (2) use of current suspending agents at levels much lower than in present MDIs or identification (and characterization) of new suspending agents, and (3) modification of existing manufacturing technologies. Demonstration of acceptable final product stability, safety and efficacy will be necessary prior to submission to worldwide registration authorities. PMID- 10147678 TI - Inhalation therapy: alternative systems--an overview. AB - Three possibilities exist, in principle, to apply medication by inhalation: (1) Inhalation from Pressurized Metered Dose Inhalers (2) Direct Inhalation of Dry Powder (3) Inhalation of Nebulized Aqueous Solutions. Chlorofluorocarbons that are necessary for pressurized metered dose inhalers have unwanted environmental properties. Therefore, alternative gases are being developed (HFA-134a and HFA 227) on the premise that pressurized metered dose aerosols in airways therapy have distinct advantages which are reflected in the high acceptance and application of these MDIs worldwide. Dry powder inhalation requires sophisticated devices to provide for exact dosing. For nebulizers the major problem was their size and consequently their restricted use. Multi-dose pocket-size systems are on the market for (1) and (2). For nebulization such a system is currently being introduced. A critical comparison of benefits and disadvantages of the existing drug delivery systems to the airways leads to the conclusion that all three modes will remain essential to cover the therapeutic needs for a wide variety of drugs and patient populations. PMID- 10147679 TI - CFC replacements: safety testing, approval for use in metered dose inhalers. AB - HFA-134a and HFA-227 (chlorine free hydrofluoro-alkanes) are at present in extensive nonclinical safety testing sponsored by two joint research consortia (IPACT-I, IPACT-II) of companies interested in metered dose inhalers (MDI). The rationale for toxicity testing of these CFC replacements is to predict safety of their use as drug propellants in MDI. Frequency of use, intervals and systemic exposure levels are key parameters. Intact animals and in-vitro systems repeatedly exposed to multiples of patient doses, under conditions comparable to human administration should not show adverse reactions. With an emphasis different from non-U.S. Health Authorities, the U.S. FDA insists on proof of toxic effects which may require excessive doses. This principle is questioned for essentially inert gases such as CFCs and HFA-134a and HFA-227 which only through the effects of oxygen deprivation at unreasonably high concentrations of the inhaled propellant/air mixture indirectly cause mild toxic effects in animals. Provided that no intrinsic toxic effects will be detected, chances are good that these CFC replacements will eventually be approved. In view of the estimated 5-year testing time frame and the risks involved, CFCs should remain available for MDI for some time in the future. PMID- 10147680 TI - Aerosolized drug delivery: fractional deposition of inhaled particles. AB - Delivery of drugs by aerosol is increasingly used as a means of providing therapy to both the lungs and to the rest of the body through absorption into the pulmonary circulation. The techniques, definitions, and terminology for aerosol delivery are not standardized or necessarily understood by the increasing number of clinicians and clinical investigators involved in these studies. This paper attempts to establish some definitions and guidelines for defining and characterizing deposition of aerosols in the respiratory tract. Some of the parameters that affect deposition are discussed (e.g., particle size, breathing pattern, airway caliber). It is suggested that these parameters be controlled or measured when characterizing new aerosol delivery systems for clinical investigations. These recommendations were discussed and agreed upon during an expert meeting on definitions and standards related to aerosols in medicine at the 8th Congress of ISAM. PMID- 10147681 TI - Drug delivery via aerosol systems: concept of "aerosol inhaled". AB - The mass of aerosol inhaled is primarily a function of the patient's breathing pattern and the aerosol delivery system. Once inhaled, deposition is governed by factors related to the properties of the aerosol and the individual characteristics of the patient (e.g., particle size distribution, airway geometry, and residence time). This paper will center upon the actual generation and delivery of clinical aerosols by jet nebulizers and assess variability in aerosol delivery. Because of the practical difficulties in predicting nebulizer function from first principles, it will be advocated that nebulizer function be directly measured for each clinical situation. Terms like "nebulizer output", "efficiency", etc. are to be avoided. The following definition is proposed: "aerosol inhaled" represents that quantity of drug actually delivered by a given nebulizer for a defined breathing pattern and period of time. The concept of "aerosol inhaled" allows a direct comparison of the quantity of drug delivered by different nebulizer systems and adjustment of dose of a given therapeutic agent. Bench testing of aerosol systems and measurement of "aerosol inhaled" can be made in the laboratory if careful attention is paid to the relationship between laboratory conditions and actual use, including the particle distribution and the accuracy of a radiolabel in estimating the quantity of drug nebulized. PMID- 10147682 TI - Measurement of particle size characteristics of metered dose inhaler (MDI) aerosols. AB - Measurement of the aerodynamic size of an aerosol allows a prediction of its deposition efficiency and behaviour in the lung. The dynamics of volatile or pressurized (MDI) aerosols presents problems not encountered in the characterization of solid or liquid particles alone. For example, the data obtained in real-time sampling as opposed to measuring an aged aerosol provide a truer representation of circumstances during actual clinical use, yet this may be difficult to achieve due to propellent evaporation. A number of particle sizing systems have been developed based upon light scattering techniques and aerodynamic principles. Each method has its limitations; in general, they successfully measure the aerodynamic size distributions of MDI aerosols. Cascade impactors, the "gold standard" of the industry have the advantage that they allow analysis of drug mass as well as other tracers within the aerosol, but the process as a whole is labour intensive, with limited resolution. Highly automated laser-based systems developed over the past 10 years measure the surface characteristics of the aerosol rather than the direct measurement of mass. Because of different values obtained from various sizing systems, it is suggested that all MDI drugs be sized using cascade impactors but that parallel data be obtained using an alternative sizing system. PMID- 10147683 TI - The ideal drug delivery system: a look into the future. AB - In the very near future, the CFC manufacturers are going to be obliged to stop their production as a result of the "Montreal protocole on substances that deplete the ozone layer". The replacement of these propellants by other fluorinated ones will be possible as soon as their lack of toxicity has been demonstrated. Other substitution substances like haliphatic hydrocarbons (butane, propane) or compressed air generated by the device system itself or the user himself are also under development. The pulverisation can also be obtained by the pressure of a classical propellant onto an aluminum or plastic bag. The dispersion is achieved by means of a regulator which is positioned into the valve. The hand-operated spray pumps with or without compression will also allow the obtention of very small particles though the delivered doses are reduced. However, as few of the new devices have metered valves, they are not yet suitable for pulmonary administration. PMID- 10147684 TI - A comparison of 28kHz- and 160kHz- ultrasonic aerosolization of interferon-alpha. AB - The efficacy and utility of interferon (IFN) in prophylaxis and treatment of nasal infections have been evaluated in recent investigation. In our basic studies on aerosolization of IFN, we examined the effect of aerosolization on IFN alpha activity utilizing an ultrasonic inhaler (NE-U05). The effect of ultrasonic treatment (28kHz) on IFN activity was also studied. IFN activity was determined by a conventional cytopathic effect inhibition assay. Although IFN alpha activity was partially inactivated at a specific frequency of 28kHz, it was not affected by ultrasonic treatment (160kHz) from the ultrasonic inhaler. These results show that the aerosolization of IFN-alpha by the ultrasonic inhaler can be recommended for clinical use without inactivation of IFN-alpha activity. PMID- 10147685 TI - Measurement of particle and mass distribution of pentamidine aerosol by ultrasonic and air jet nebulizers. AB - The use of appropriate nebulizers is a major precondition for a successful treatment and prevention of Pneumocystis carinii pneumonia with pentamidine aerosol. The apparatus should supply a sufficient amount of pentamidine with adequate particle size. Using Fisons ultrasonic nebulizer FISO Neb, model FZV 40 BAMKI, De Vilbiss ultrasonic nebulizer, Porta-Sonic, model 8500 GB, and the Marquest Medical Products jet nebulizer Respirgard II, two pentamidine concentrations (300 mg/6 ml and 60 mg/6 ml) were compared by measuring nebulized pentamidine mass distribution and particle size distribution under in vitro conditions by means of a laser light-scattering particle sizer of the type Malvern Master sizer. It was found that there were significant differences among nebulizers. Mass distribution experiments with air flow 6 l/min showed that using FISO Neb the quantity of nebulized pentamidine was 201.4 mg and 36.7 mg, whereas using Porta-Sonic the values found decreased to 85.2 mg and 23.6 mg. Using Respirgard II the values were 80.0 mg and 10.64 mg. The measured total duration times of nebulization were 6 - 8.5 min, 12 min and 25 min for the nebulizers FISO Neb, Porta-Sonic and Respirgard II. A decomposition of pentamidine during nebulization in the case of ultrasonic nebulizers doesn't take place. The measured mass median diameters (MMD) were 5.6 - 6.9 mum, 1.96 - 3.04 mum and 1.9 - 2.5 mum for the nebulizers FISO Neb, Porta-Sonic and Respirgard II. Using 300 mg pentamidine the nebulized amounts of pentamidine containing particles sizes less than or equal to 2 mum predominately available for alveolar deposition were with values of about 43 mg markedly higher for Respirgard II and Porta-Sonic than the measured 10.5 mg for FISO Neb. PMID- 10147686 TI - 99mTc-DTPA-surfactant inhalation in adult respiratory distress syndrome (ARDS): a new diagnostic-therapeutic tool. AB - ARDS is a life-threatening pulmonary disease with a rapidly progressive decline due mainly to multi-organ failure. Death occurs in 50-75% of ARDS cases. The diagnosis and therapy should start in the first six days of this fatal disease when mortality is at its lowest level. The 99mTc-DTPA-measured pulmonary alveolar epithelial permeability (PAEP) is strikingly increased in ARDS even in comparison to heavy smokers. Furthermore, surfactant inhalation has been shown to be of therapeutic value. In five ARDS patients with increased PAEP (T0.5 = 12% pred.) 20 mg/kg of aerosolized surfactant determined a dramatic improvement in blood gases and PAEP (51.8% pred.) No patient remained dependent on ventilatory treatment. PMID- 10147687 TI - Aerosol filters. AB - This review discusses filter materials, filter mechanisms, filter testing and applications of filters in medicine. While many applications are satisfactorily solved, there seems to be a research need for generating particle free air to relieve pains from people suffering from allergens and standardization of filter testing procedures for filters used in exhalation lines with humid air. PMID- 10147688 TI - Efficacy of nine heat and moisture exchangers for intraoperative airway heat conservation. AB - The performance of heat and moisture exchangers (HMEs) were clinically evaluated for the effectiveness of intraoperative heat conservation. Ten groups of patients were studied, nine groups with commercially available HMEs (Gibeck Humidvent 1, Terumo Brethaid, Portex Thermovent 600, NMI Pneumoist 2, Pall HME15-22, Gambro Engstrom Edith 1000, Gambro Engstrom Edith 1500, Gambro Engstrom Edith Flex and Siemens Servo Humidifier 153) and a control group with no HMEs. Deep temperature of the forehead (107 patients) and heat and humidity at the airway (55 patients) were measured. The temperature decrease in one hour, the total body heat loss, the temperature and absolute humidity of inspired gas and the heat loss from the airway were much better for all groups with HMEs than for the group with no HMEs, and the nine HMEs had different efficiency. There were significant correlations between the index values of body temperature and the index values of heat and humidity at the airway. In conclusion, HMEs were useful devices for preventing heat loss from the airway and maintaining body temperature. PMID- 10147689 TI - Technetium 99m radiolabeling of aerosolized drug particles from metered dose inhalers. AB - To assess mechanisms of bronchodilation and effectiveness of metered dose inhalers, it may be useful to determine sites of drug deposition in the lung. To establish suitable test aerosols, two brands of metered dose inhalers containing bronchodilator (Brethaire, Proventil) were radiolabeled with technetium ( 99mTc) and tested to determine if the distribution of radioisotope in the aerosol was representative of the distribution of agonist activity. Cascade impaction was used to determine the particle size distribution of the radioisotope and drug aerosols by assaying each state of the cascade using scintillation and HPLC techniques. Possible influences of the radiolabeling method and delivery techniques on the particle distribution were assessed by analyzing distributions from nonradiolabeled inhalers using HPLC. For these drugs, there was an excellent correlation between the distribution of radioactivity and the drug within the captured aerosol (Brethaire r = 0.994, Proventil r = 0.998, 20 - 200 consecutive puffs). Distributions were close to log-normal and differences in mass median aerodynamic diameter (MMAD) between the radioisotope and agonist activities were not significant (Brethaire, MMAD +/- sigma g, radiolabel vs drug = 4.7 +/- 2.1 mum, vs 4.4 +/- 1.7 mum, and Proventil, 2.5 +/- 2.1 mum, vs 2.4 +/- 2.0 mum. Non-labeled inhalers produced similar drug distributions (Brethaire, 4.2 +/- 1.8 mum, and Proventil 2.0 +/- 1.9 mum). Pausing between actuations resulted in slightly smaller distributions (Brethaire, 3.6 +/- 1.8 mum, Proventil 1.8 +/- 1.8 mum, 20 puffs-60 sec pauses) but the differences were not significant. In addition, to search for multimodal distributions and assess the accuracy of the MMAD measurement via our cascade impactor (Delron), we also measured the distribution of the mass of material within the aerosols using a weight-sensitive cascade (California Measurements). Using the latter device (1 puff), the mass distributions of both aerosols were similar to the values obtained from the puffs with pauses (Brethaire 3.8 +/- 2.3 mum, Proventil 1.4 +/- 2.2 mum). Multi-modal distributions were not found. By all assessments, the distributions were nearly log-normal with drug activity well described by the radiolabel. PMID- 10147690 TI - Disinfection and sterilization in dentistry. Use of potentiated glutaraldehyde (DIBA-GLAXO) in the water systems of dentistry units: analysis of microbiological activity, physico-chemical compatibility and residues in washing water. AB - Glutaraldehyde is a potent sterilizing agent with a very broad-spectrum of biocidal activity including Gram-positive and -negative bacteria, spores and viruses such as HBV and HIV (the aetiological agents responsible for hepatitis B and AIDS, respectively). The aim of this study was to evaluate, in experimental conditions simulating the operative risk in dental practice, a 2% potentiated acid glutaraldehyde-based product (DIBA-GLAXO) not only in the disinfection and sterilization of the water circuits of dental units, but also with regard to physico-chemical compatibility, as well as from the toxicological viewpoint. DIBA, in the dental unit disinfection cycle, proved capable of destroying the bacterial cultures of all 16 pathogens used to contaminate artificially the water circuits of the unit handpieces. When the contamination was produced using bacterial spores, 5 hours of contact were sufficient to obtain sterility. The residual concentrations of glutaraldehyde in the circuit washing water, after optimization of the washing process, may be regarded as safe for the patient. Lastly, the product analysed was found to be compatible with the mechanical components of dental unit water circuits. No corrosion phenomena were observed even after total immersion in DIBA for a period equivalent to approximately 20,000 disinfection cycles. PMID- 10147691 TI - The effect of dead space on inhaled particle deposition. AB - Mathematical models which have been developed to predict the deposition of particles in the conducting airways of the lung require simplified anatomical models of the dimensions and geometry of the bronchial airways. In order to produce valid deposition predictions, the computed volumes of the conducting airways must be realistic in comparison to anatomical dead space. This requirement must be met even as the developing lung grows to maturity and then undergoes aging. The effect of these age-related changes on predicted particle deposition efficiencies has not been well studied. Numerous authors have suggested that differences in lung volumes (total lung capacity, functional residual capacity, dead space and tidal volume) may account for significant variations between predicted or observed particle deposition but no general age specific relationship has been proposed. New models are proposed to describe changes in dead space as functions of age and body size, and methods to adjust existing anatomical models to various dead space predictions are given. Also, the effect of these modifications to anatomical models on particle deposition efficiencies are simulated for a variety of breathing patterns for models scaled to represent young children, adults, and aged persons. PMID- 10147692 TI - Advances in laser sclerectomy. PMID- 10147693 TI - Laser iridectomy--1992. PMID- 10147694 TI - Laser trabeculoplasty. PMID- 10147695 TI - Photocoagulation with the laser indirect ophthalmoscope for retinopathy of prematurity. PMID- 10147696 TI - High-frequency ventilation: is there a clinical role? AB - Mechanical ventilation of the lungs is an integral component of modern medical practice, being utilized predominantly in the operating room and intensive care unit. The first mechanical ventilators were of the negative-pressure type. Currently, positive-pressure mechanical ventilation with frequency rates of up to 60 breaths per minute is referred to as conventional mechanical ventilation. In the 1960s, Sjostrand developed the concept of high-frequency positive-pressure ventilation. This development was a logical continuation of physiology studies that built on earlier observations, which were then directly applied to clinical use. This paper is a synopsis of the current rationale for the clinical use of high-frequency ventilation. PMID- 10147697 TI - Biplanar transesophageal echocardiography. PMID- 10147698 TI - Retrograde cardioplegia. PMID- 10147699 TI - Surface-heparinized neonatal ECMO circuit--an experimental animal study. AB - The present experiment examined the capacity of the Carmeda Bioactive Surface to prevent clot formation in an ECMO circuit designed for neonatal use. The Terumo Capiox oxygenator was used in the seven experiments. Mongrel dogs were perfused with veno-arterial bypass at a low flow rate of 200 ml/min. Without any blood heparinization, the circuit was totally occluded within a few hours. With a very low heparin infusion (10 IUxkg -1xh -1) extracorporeal blood flow could be maintained despite some clots forming in the oxygenator. With a small bolus injection of heparin (20 IU/kg) and a low continuous heparin infusion (20 IUxkg 1xh -1) the ECMO circuit showed negligible clotting. With better haemodynamic design of the device in combination with a thrombo-resistant surface, it may be possible to decrease the need for blood heparinization in the neonatal ECMO circuit. PMID- 10147700 TI - Clinical evaluation of the Bentley Univox membrane oxygenator. AB - This paper reports a clinical evaluation of Bentley's new Univox membrane oxygenator (Bentley Laboratories, Irvine, California). In this new device, the blood flow path is outside the fibre, the incorporated heat exchanger consists of a 22-channel stainless-steel bellows, and the polypropylene fibres are woven into fibre ribbons and wound into each of the bellows channels. In this way, heat and gas transfers take place simultaneously. The priming volume has been reduced to 220ml and the membrane has an effective surface area of 1.6m 2. A BMR 1900 collapsible reservoir (Bentley Laboratories, Irvine, California) was used as a venous reservoir. Ten consenting patients undergoing elective coronary artery bypass surgery were perfused with this new oxygenator. BSA was between 1.7 and 2.11m 2; mean BSA was 1.81. Minimum priming was 1200 ml. The blood-gas results were all within or close to the normal range used in our institution. Acid-base management was performed using alpha-stat regulation and no problems occurred in this series of patients. Average pO 2 was 155mmHG+/-53 with a mean O 2 transfer of 90.7ml and a maximum of 185ml. The heat exchange performance was very good, with a mean coefficient of heat exchange of 0.54+/-0.11 and a maximum of 0.87. PMID- 10147701 TI - A comparison of two oxygen transfer strategies: Bentley Univox and the Bard HF 5000. AB - The purpose of this study was to evaluate the oxygen transfer performance of two membrane oxygenators: Bentley Univox and the Bard HF 5000. This evaluation was based on the comparison between: (1) the oxygen transfer slope; (2) the gas phase arterial oxygen gradients; (3) the degree of blood shunting; (4) the maximum oxygen transfer; and (5) the diffusing capacity calculated for each membrane. The data were examined at both absolute values and relative to each device's membrane surface area. In absolute terms, the HF 5000 performed better than the Univox in each category. However, when surface area was taken into account, the Univox was clearly more efficient with regard to oxygen transfer. We conclude from this evaluation that the Univox does not offer a satisfactory oxygen transfer 'buffer' for larger, more metabolically active patients (297 ml/min for the Univox and 447 ml/min for the HF 5000). The trade-offs that were made between design and performance features, with the Univox, were unacceptable. PMID- 10147702 TI - The influence of pulsatile and nonpulsatile extracorporeal circulation on fluid retention following coronary artery bypass grafting. AB - Thirty male patients undergoing coronary artery bypass grafting were divided into two groups, group I receiving pulsatile perfusion, group II nonpulsatile perfusion. A double roller pump system for extracorporeal circulation was employed. Intra- and postoperative fluid balances and bodyweight gains were controlled under clinical conditions. There were no significant differences between the groups with regard to clinical data, operative procedure, perfusion parameters, drug treatment or intensive care treatment. The intra-operative mean fluid balance of group I was 794.0ml (66%) lower than that of group II, while the balance 24 hours postoperatively was 136.7ml (37%) lower in group I. Thus, the total mean fluid balance for the pulsatile group was 931.0ml (59%) lower than the nonpulsatile group, in accordance with the bodyweights, which showed a 954.0g (63%) lower outcome in the pulsatile group. Less supplementary volume and higher urine production were the main factors. It appears that volume saved during pulsatile ECC need not be replaced postoperatively. These findings indicate that pulsatile perfusion leads to diminished fluid overloading, which could be an important advantage, especially for high-risk patients. PMID- 10147703 TI - The effects of pulsatile flow on the leukocyte depleting qualities of the Pall LG6 leukocyte depleting arterial line filter: a laboratory investigation. AB - The Pall LG6 arterial line filter has, in a previous publication, demonstrated its inherent leukocyte depleting qualities. This initial study was however carried out under continuous flow conditions. The present study was designed to assess the effectiveness of the LG6 filter in performing this leukocyte removal function under the more dynamic conditions of pulsatile flow. In addition to leukocyte depletion, the general blood handling and degree of energy absorption associated with the LG6 and Stat-Prime filters was also assessed. The results demonstrated that the LG6 filter was unaffected by the flow regime employed in terms of leukocyte removal and platelet depletion. There was a higher level of measured haemolysis associated with the use of pulsatile rather than nonpulsatile flow, however, this was the case with both filter types and was not found to be the case when generated values were computed. The LG6 filter absorbed more energy than the Stat-Prime filter as reflected by energy equivalent pressure (EEP) measurement, but this difference did not reach a level which was considered to be clinically significant. PMID- 10147704 TI - The effect of a thin coating of polymethylmethacrylate on the torsional fatigue strength of the cement-metal interface. AB - Recent studies have established that a mechanism of initiation of failure of fixation of cemented femoral components is debonding of the cement-metal interface. Other studies have shown that the torsional forces induced by stair climbing and rising from a chair are very high. Thus, the interface between the femoral prosthesis and the bone cement in total hip arthroplasty (THA) is required to transmit high torsional loads from the metal to the cement in a cyclic shear mode many times per year. These torsional loads likely contribute to the debonding. This study evaluated the efficacy of a thin layer of polymethylmethacrylate (PMMA) precoating in increasing the torsional fatigue strength of the cement-metal interface. Fatigue studies were performed on 15 specimens. Each specimen was tested with and without PMMA precoating. The PMMA precoat significantly and substantially increased the torsional fatigue strength of the cement-metal interface. Thus, PMMA precoating is likely to be a clinical advantage in maintaining the long-term integrity of the cement-prosthesis interface. PMID- 10147705 TI - Performance of the polypropylene fiber tailstring. PMID- 10147706 TI - The effect of the addition of methylene blue on the fatigue strength of Simplex P bone-cement. AB - To aid in cement removal during revision arthroplasty, it has been proposed to add methylene blue to bone cement to provide contrast between the cement and bone. However, it is essential that the fatigue strength of the cement not be reduced by the addition of the methylene blue. The effect of adding 1 mL of an aqueous 1% solution of methylene blue to one pack of Simplex P prepared in the standard fashion (uncentrifuged) was studied. We also measured the fatigue properties of centrifuged Simplex P with three different methylene blue preparations. We studied adding 1 mL of an aqueous 1% solution of methylene blue, 0.5 g of methylene blue powder, and 0.1 mL of a 10% solution of methylene blue per pack of Simplex P bone cement. Adding 1 mL of a 1% methylene blue solution to 40 g of Simplex P without centrifuging the cement after mixing produced a cement with a mean fatigue life comparable to the uncentrifuged Simplex P without the methylene blue. However, the fatigue data scatter was higher for the uncentrifuged methylene blue preparation. The optimum methylene blue impregnated cement preparation was produced by adding 1 mL of a 1% methylene blue solution to 40 g of Simplex P powder, mixing with chilled monomer, and centrifuging for 60 s. Sterile 1 mL vials of 1% methylene blue solution are available in the operating room.(ABSTRACT TRUNCATED AT 250 WORDS) PMID- 10147707 TI - Polypropylene IUCD retrieval fibers: surface morphology, material properties, microbial attachment, and migration. AB - Highly drawn and oriented polypropylene fibers used for the retrieval thread of the Cu-7 intrauterine contraceptive device (IUCD) are compared as to surface morphology and crystallinity with polypropylene fibers prepared under different conditions. A series of experiments also demonstrates the colonization of the surface of polyolefin fibers by pathogenic bacteria that are often found in the human vagina. Moreover, it is demonstrated that the retrieval threads appear to encourage pathogenic bacteria to migrate across the surface of agar. The results also indicate that control of drawing and annealing can avoid the surface fibrillation and tendency to fail by separation into a bundle of multifilaments that are observed with the IUCD retrieval threads. PMID- 10147708 TI - Burst testing of condoms. I. Basic features of the force-deformation curve of latex-rubber condoms. AB - Inflation of a rubber condom involves biaxial deformation of the material which can be modeled by the use of an appropriate strain-energy function. Force versus deformation data for uniaxial extension of strips of condoms were used to determine the parameters for Ogden's form of a strain-energy function. These parameters were then used to fit experimentally obtained burst test data to a stress-strain equation formulated for inflation of condoms in a burst test. Experimental data on inflation of condoms agree well with theoretical curves verifying the applicability of the biaxial stress-strain equation to the particular strain-energy function on which it is based. PMID- 10147709 TI - Bioactive ceramics for periodontal treatment: comparative studies in the Patus monkey. AB - Four bioactive ceramic materials currently recommended for regeneration of osseous tissues in treatment of periodontal disease have been compared with Bioglass particulates, of equivalent size in two compositions, in a monkey model. Both Bioglass materials were found to be easily manipulated, were haemostatic and osteoproductive allowing restoration of both alveolar bone and periodontal ligament. Epithelial downgrowth was inhibited and epithelial attachment was close to the preimplantation level. The other materials were slower to act and epithelial downgrowth was to the same level as in unfilled control defects. PMID- 10147710 TI - Plasma surface modification of synthetic absorbable sutures. AB - The aim of the study was to examine the feasibility of using plasma surface modification technology to alter the hydrolytic degradation rate of commercial synthetic absorbable sutures. Size 2-0 Dexon, Vicryl, PDSII, and Maxon sutures were tested. They were treated by two different surface modification techniques: parylene deposition and plasma gases (Methane, trimethylsilane, and tetrafluoroethene). The thickness of surface treatment ranged from 200 to 1000 A. The treated sutures were subject to in vitro hydrolytic degradation in phosphate buffer of pH = 7.4 at 37 degrees C for up to 120 days. The tensile breaking strength, weight loss, surface wettability, bending stiffness, and surface morphology were evaluated. The results indicated that the concept of plasma surface treatment for altering the hydrolytic degradation of synthetic absorbable sutures was feasible, and the level of improvement depended on the type of sutures, the treatment conditions, and the duration of hydrolysis. Vicryl and PDSII sutures showed overall the best improvement in tensile strength retention among the four commercial sutures. Dexon and Maxon sutures, however, exhibited only marginal improvement. The observed improvement in tensile strength retention appeared to be related to the increasing hydrophobicity of the sutures. The surface treatments did not adversely affect the bending stiffness of the sutures and no visible surface morphological changes were observed. Refinements and optimization of the surface treatment conditions are needed for achieving the maximum advantage of the proposed concept, particularly shielding the harmful effect of uv during plasma treatment. PMID- 10147711 TI - A method to determine shear adhesive strength of fibrin sealants. AB - The adhesive strength of fibrin sealants has not been rigorously evaluated to date. The adhesive strength of six different concentrations of cryoprecipitated fibrinogen as well as the commercially available fibrin tissue adhesive Tissucol was tested under controlled conditions utilizing split-thickness skin grafts as the test adherand. This test configuration permitted the modeling of bonding strength for attachment of skin grafts as well as incorporate established engineering test standards for adhesives. An increase in fibrin concentration corresponded with an increase in shear adhesive strength. No significant increases in adhesive strength were attained after 5 min of bonding for all tested concentrations, except for the commercial adhesive, which attained the adhesive strength of an equivalent concentration of cryoprecipitated adhesive after 90 min. The adhesive strength, however, was an order of magnitude less than reported values of the tensile strength of fibrin material for similar concentrations. Therefore, it is important that the surgeon use a sufficiently high fibrinogen concentration for the specific clinical indication. The method of fibrin sealant preparation and/or the compounding adjuncts appear to have an effect on the development of adhesive strength. PMID- 10147712 TI - A silver-sulfadiazine-impregnated synthetic wound dressing composed of poly-L leucine spongy matrix: an evaluation of clinical cases. AB - The management of severe burns requires the suppression of bacterial growth, particularly when eschar and damaged tissue are present. For such cases, silver sulfadiazine (AgSD) cream has been traditionally applied. This antibacterial cream, however, cannot be used in conjunction with a temporary wound dressing that is needed to promote healing. The authors developed a synthetic wound dressing with drug delivery capability for clinical use by impregnating a poly-L leucine spongy matrix with AgSD, which is released in a controlled, sustained fashion. In general, the dressing adhered firmly to the wound in the case of superficial second-degree burns, and during the healing process it separated spontaneously from the re-epithelialized surface. In the management of deep second-degree burns where eschar and damaged tissue were present, the dressing had to be changed at intervals of 3 to 5 days until it adhered firmly to the wound. Once the dressing had firmly attached to the wound, it was left in place until it separated spontaneously from the re-epithelialized surface. Dressing changes were fewer than with other treatments and the pain was effectively reduced. Cleansed wounds were effectively protected from bacterial contamination. Of 52 cases treated with this wound dressing, 93% (14/15) of superficial second degree burns, 75% (3/4) of deep second-degree burns, 85% (6/7) of superficial and deep second-degree burns, and 75% (12/16) of split-thickness skin donor sites were evaluated as achieving good or excellent results. PMID- 10147713 TI - Thrombus deposition on polyurethanes designed for biomedical applications. AB - Thrombogenicity was assessed by measuring the amount of 111In-platelets and 125I fibrinogen deposited on the inner luminal surface of six polyurethanes for up to 60 min of blood contact in a canine ex-vivo shunt model. Commercial and laboratory synthesized polymers were examined. Two of the commercially synthesized polyurethanes (Biostable PURs) do not contain ether linkages in the polymer backbone and have previously shown resistance to oxidative and hydrolytic degradation. Static contact angle measurements, dynamic contact angle measurements, and ESCA were used to characterize the surfaces of these polyurethanes. The effectiveness of an acetone extraction used to remove extrusion waxes from Pellethane 2363-80A was similarly studied. Both Pellethane 2363-80A and the ether-free materials had relatively nonthrombogenic surfaces, as indicated by low platelet and fibrinogen deposition, making them potentially good candidates for biomedical applications. PMID- 10147714 TI - Effectiveness of silane treatment on absorbable microfibers. AB - Preliminary experiments suggest pretreatment of absorbable crystalline, calcium sodium-metaphosphate (CSM) microfibers with trimethoxy-based silane coupling agents yields a polysiloxane film barrier which protects the fiber surface from early dissolution due to water. Compared to thermoplastic poly(L-lactic acid) (PLLA) composites reinforced with untreated fibers, PLLA composites reinforced with a variety of silane pretreated microfibers showed increased mechanical properties, suggesting improved adhesion was achieved at the fiber/matrix interface. Unfortunately, the silane pretreated CSM/PLLA composite showed no increase in wet strength retention after short-term in vitro exposure. This may be due to plasticization from water entering the composite at areas of incomplete fiber wetting by the highly viscous molten PLLA. However, when a nonabsorbable, low viscosity unsaturated polyester thermoset resin was reinforced with methacryloxy-silane pretreated CSM microfibers, there was no decrease in flexural strength and less than a 10% decrease in flexural modulus after 7 days exposure to 7.4 pH Tris-buffered saline at 37 degrees C. PMID- 10147715 TI - Von Hippel-Lindau disease: clinical considerations and the use of fluorescein potentiated argon laser therapy for treatment of retinal angiomas. PMID- 10147716 TI - Biocompatibility and mechanical properties of a totally absorbable composite material for orthopaedic fixation devices. AB - Bioabsorbable polymer/inorganic phosphate fiber composites are prone to rapid degradation due to water sensitivity of the interface between the degradable polymer and the degradable fiber. This article describes successful fabrication and laboratory evaluation of a candidate bioabsorbable composite implant material with mechanical properties similar to bone. The composite studied was poly(ortho ester) reinforced with randomly-oriented, crystalline microfibers of calcium sodium-metaphosphate. The component materials showed no acute cytotoxicity as determined by tissue culture agar overlay. Treating the microfibers with a diamine-silane coupling agent improved mechanical properties and slowed degradation in saline, but strength still decreased 50% in 1 week. When the composite material was then coated with a layer of matrix polymer alone it retained 70% of its strength and 70% of its stiffness after 4 weeks exposure to 7.4 pH Tris-buffered saline at body temperature. The marked improvement with the coating can be attributed to the hydrophobicity of poly(ortho esters). PMID- 10147717 TI - Alkyl cyanoacrylates as space filling bone adhesives. AB - Higher chained alkyl cyanoacrylates have potential to function efficiently as space filling, hydrophobic, viscoelastic, biocompatible, and rapidly polymerizing bone adhesives. Hence they may be useful in applications where a void has to be filled, such as replacement of the intervertebral disc. To assess their applicability as space filling material in such an application, three alkyl cyanoacrylates; methoxyethyl cyanoacrylate, isobutyl cyanoacrylate, and isoamyl cyanoacrylate have been evaluated in this study. The bonding strength of these cyanoacrylates to bone in a space filling situation have been measured. The results indicate the bond strength of isoamyl cyanoacrylate (0.13 MPa) to be significantly (p less than 0.05) lower compared with methoxyethyl cyanoacrylate (0.33 MPa) and isobutyl cyanoacrylate (0.37 MPa). There was no significant difference in the bond strengths of isobutyl cyanoacrylate and methoxyethyl cyanoacrylate. PMID- 10147718 TI - Oncology applications of flow cytometry. AB - The application of flow cytometry in evaluation of neoplasms is reviewed, with emphasis on DNA content analysis and surface-membrane antigen analysis. By measuring total nuclear DNA content one can determine the ploidy status and S phase fraction of tumor cells. Aneuploidy, an abnormal DNA content, is a marker of malignancy and often a predictor of poor prognosis in a number of tumor categories. S-phase fraction reflects the proliferative activity of the tumor and is therefore related to the aggressiveness of the tumor. Surface-membrane antigen analysis of hematologic malignancies using monoclonal antibodies is useful in determining lineage and differentiation of tumor cells. This information is helpful in diagnosis and monitoring of patients and also has prognostic values. The flow cytometry is a new tool for the management of cancer patients because of its role in diagnosis, monitoring, and prognosis of tumors. PMID- 10147719 TI - Immunochemical assays in the clinical laboratory. AB - State-of-the-art immunochemical assays and future directions in this science are reviewed. Immunochemical assays may be categorized as follows: Type I, or single site noncompetitive immunoassays; type II, two-site noncompetitive immunoassays; type III, homogenous competitive immunoassays; and type IV, nonhomogenous competitive immunoassay. Assay systems use radionuclides, enzymes, fluorescence, chemiluminescence, and particles as reporters in the tests. Radionuclides will continue to decline in importance as other systems are refined. More sensitive reporters and clever multi-analyte systems will continue to be developed. PMID- 10147720 TI - Quality control guidelines for molecular diagnostics. PMID- 10147721 TI - Computers bring medicine's images to light: digital imaging makes inroads. PMID- 10147722 TI - Testing for heparin-induced thrombocytopenia by platelet aggregometry. PMID- 10147723 TI - Methods for a model blind proficiency testing system. AB - The method developed for establishing a blind proficiency testing (PT) system is presented. The Laboratory Assurance Program of the Graduate School of Public Health at San Diego State University is developing and pilot testing innovative strategies that will evaluate and improve the performance of clinical laboratories. To date, a total of 32 laboratories have been incorporated into this program along with 12 counseling and testing sites. From June 1988 to December 1989, five blind PT surveys for human immunodeficiency virus type 1 antibody testing were conducted, representing 306 proficiency specimens entered into the testing system as simulated patient specimens. Despite the difficulties and expense involved, we found the system to be acceptable and to have certain advantages over conventional methods of external testing. PMID- 10147724 TI - Analytic results of HIV-1 testing using blind proficiency testing. AB - The use of blind proficiency testing (PT) to examine analytic performance of human immunodeficiency virus type 1 (HIV-1) antibody testing. A total of 32 hospital, blood bank, public health, and commercial laboratories were included in this study. Test sera were introduced as clinical specimens for HIV-1 testing from private practitioners, group practices, clinics, and hospitals in Southern California. A total of 26 laboratories were located throughout California, with six laboratories located in six other states. Results from 306 enzyme immunoassay screening tests and 192 supplemental tests for HIV-1 were reported. Although one positive specimen was reported as indeterminate in almost 30% of results, screening and supplemental testing performances were excellent, with accuracy levels comparable to performance reported on open PT and performance evaluation surveys in the United States. The indeterminate results were attributed to the interpretive criteria used rather than to laboratory errors. Blind PT can be an important tool in improving the quality of total laboratory testing, the usefulness of laboratory results in patient care, and ultimately the health of the public. PMID- 10147725 TI - Identification of nonanalytic issues in HIV-1 antibody testing using blind proficiency testing. AB - Blind proficiency testing was used to examine nonanalytic performance indicators for human immunodeficiency virus type 1 (HIV-1) antibody testing. Physician offices, clinics, and hospitals located throughout Southern California submitted simulated patient specimens to laboratories as routine test requests. A total of 32 laboratories were involved during five blind proficiency testing surveys. Turnaround time for a reactive specimen ranged from three to 17 days. Laboratory charges for evaluating a reactive specimen varied depending on the volume of testing, prevalence of reactive specimens, and whether screening and confirmatory tests were billed separately or as a package price. Charges for an enzyme immunoassay screening test plus supplemental tests ranged from $11.75 to $114.50, with a median of $31.00 for 24 laboratories that participated in one of the five surveys. Evaluation of laboratory report content revealed that 37% of the 16 screening reports and 71% of the 14 supplemental reports contained information that was unrelated to the patient results. Evaluation of the testing system documents the need to monitor multiple outcomes of the total laboratory testing process, not just the analytic testing phase. PMID- 10147727 TI - Reuse of Ilizarov frame components: a potential cost savings? AB - Although there is a potential hospital cost savings in reusing Ilizarov frame components, such reuse must be carefully considered in view of the deterioration of the parts during clinical use. A study is presented that addresses this issue through examination of clinically removed frames, laboratory testing, and engineering calculations. PMID- 10147726 TI - Performance characteristics of state-of-the-art hematology analyzers. AB - Data were obtained from four state-of-the-art automated hematology analyzers and compared with those obtained from microscopic reference procedures. The instruments evaluated were the Technicon's H*1, Sysmex's NE-8000, Coulter's STKR, and Coulter's STKS. Accuracy was assessed by comparing machine-generated white blood cell and red blood cell profiles with those obtained manually by experienced laboratorians. Specimens used were actual clinical samples submitted for routine analysis. The precision of the instruments in counting and sizing blood cells was not significantly different at the clinical decision-making level and consistently exceeded that of the microscopic method. Significant shifts in the leukocyte population were detected with relatively similar sensitivity by all instruments. As expected, the oldest model's clinical efficiency was exceeded by that of the newer analyzers. None of the analyzers performed with an accuracy that permits the laboratory to completely eliminate a microscopic scan of a stained blood film obtained from a patient's initial specimen. PMID- 10147728 TI - The role of hemodynamics and duplex ultrasound in the diagnosis of peripheral arterial disease. AB - Recent reports have suggested that duplex ultrasound should replace hemodynamic measurements and the use of the ankle-to-arm systolic blood pressure ratio in evaluating patients with peripheral arterial disease. Measurement of peripheral hemodynamics in patients with peripheral arterial disease is well established and can be used for screening populations at risk for peripheral arterial disease; the finding of an abnormal ankle-to-arm ratio is associated with a high risk of cardiovascular morbidity and mortality. With the ankle-to-arm ratio, the diagnosis of vascular disease can be established in symptomatic patients and initial treatment plans can be formulated. In contrast, duplex ultrasound provides accurate information on vessel morphology and changes in blood-flow velocity in specific areas of stenosis. The test is noninvasive, and in some situations the duplex instrument may be superior to an angiogram in detecting patent distal vessels. Because it is more expensive and time-intensive than measuring peripheral pressures, duplex ultrasound should be used in selected patients in whom the knowledge of actual vessel morphology is critical to the patient's treatment. PMID- 10147729 TI - Echocardiography in coronary artery disease. AB - Echocardiography has come a long way since its beginnings in the early days of M mode. Today echocardiography is a useful tool in the management and diagnosis of coronary artery disease. It is used in the emergency room to aid in the exclusion or confirmation of acute coronary syndromes and in their management. The spreading use of stress echocardiography has greatly expanded the use of ultrasound in the diagnosis and management of coronary artery disease. Both pharmacologic and nonpharmacologic methods of stress testing have added to the sensitivity and specificity of this technique, making it a viable alternative to thallium imaging for the diagnostic screening of coronary artery disease. PMID- 10147730 TI - The use of electrocardiography as a diagnostic and prognostic tool in coronary artery disease. AB - The ECG is the most widely used noninvasive diagnostic and prognostic test administered to patients with suspected or proven coronary artery disease. When considering appropriate use of the electrocardiogram, physicians need to examine the clinical question being asked, the additional information that can be derived, whether or not a diagnosis can be established, and application of the information to make appropriate management decisions. PMID- 10147731 TI - Reperfusion intervention in acute myocardial infarction. AB - Over the past year, the results of large-scale trials have better defined the risk to benefit ratios of thrombolytic therapy in specific subgroups of patients. However, important issues such as prevention of early reocclusion, prehospital administration of thrombolytics, adjunctive treatment with beta-blockers or angiotensin-converting enzyme inhibitors and early noninvasive detection of reperfusion remained unsolved. Encouraging data have been reported in selected patients for the more aggressive approach of direct angioplasty without thrombolysis. However, the results from large, randomized trials, comparing direct angioplasty with conventional thrombolysis, are still lacking. A postthrombolysis strategy of watchful waiting has been corroborated by new findings. PMID- 10147732 TI - New technologies in interventional cardiology. AB - This review confines itself to the new technologies that are widely used and that are being tested in formal trials. To date there have been few well-performed trials to compare the technologies, a fact that may have opened the way for the inappropriate use of some of these new technologies. This has allowed enthusiasts to perform procedures with as yet unproven tools no better and possibly worse than balloon angioplasty. New technologies can be broadly divided into three categories depending on their intended role: 1) mechanical removal, such as directional atherectomy, extractional atherectomy, and rotational atherectomy, that is designed to debulk lesions and remove atheromatous material, 2) high-energy removal by laser technologies designed to disobliterate lesions without producing the theoretically damaging lateral stretching of normal balloon angioplasty, 3) intraluminal scaffolding through the use of stents designed to give intravascular support, eg, balloon expandable, self-expanding, and temporary removable devices. PMID- 10147733 TI - Contact lenses and corneal shields. AB - Contact lenses are widely used all over the world. If fitted and handled properly, contact lenses can be good cosmetic and therapeutic tools. In this review, the different indications for contact lens wear are discussed. Contact lenses can also lead to serious problems. Tear film and morphologic alterations of the cornea, as well as corneal infections of microbial origin, are reviewed. Collagen bandage lenses have been used for some time in the treatment of corneal epithelial defects. Currently, these lenses are being tested as drug delivery systems, especially for use with poorly penetrating drugs, in serious infections of the cornea. PMID- 10147734 TI - Corneal transplantation. AB - Corneal transplantation is the most widely practiced form of clinical transplantation. This was made possible by the development of donor handling and preservation techniques, such as cooled culture media and organ-culture systems, that guarantee a sufficient supply of donor tissue. Corneal grafting is performed to improve visual function, to preserve the integrity of the eye, or to reduce pain. Patients with visual disability who present with keratoconus or dystrophy have a good prognosis for retaining a thin, transparent graft on a long term basis. In this patient group the limiting factor for a gratifying visual outcome is high residual postkeratoplasty astigmatism, a still-too-frequent occurrence. Refinement in trephination techniques should help overcome this pitfall. Patients with vascularization or regrafting who are in the high-risk category may benefit from HLA matching or the use of cyclosporine and other immunosuppressive agents that are currently being tested in experimental models for reducing the impact of allograft rejection. PMID- 10147735 TI - Recent developments in refractive corneal surgery. AB - The 4- and 5-year results of the Prospective Evaluation of Radial Keratotomy Study reveal a hyperopic shift of more than 1.0 D within the follow-up time in 22% and 24%, respectively, of the eyes that underwent radial keratotomy. The number of eyes with this complication increased progressively from 6 months to 4 years. Attempts to correct this progressive hyperopia are discussed. Results of clinical studies of myopic photorefractive keratectomy performed with the excimer laser are reviewed. Regarding safety and short-term efficacy, photorefractive keratectomy is a promising technique. In the past, corneal topography has been interpreted qualitatively. Ray-tracing analysis now allows quantitative estimation of the influence of aspheric corneas on the degradation of the retinal image. Three approaches to correct hyperopia, radial thermokeratoplasty, laser thermokeratoplasty, and hexagonal keratotomy are reviewed and discussed. Additional concave intraocular lenses for correction of high myopia are still undergoing clinical evaluation. Endothelial damage is the most dangerous short term complication of implantation with these lenses. PMID- 10147736 TI - Management of uveitis. AB - The management of uveitis continues to rely on the relatively nonspecific use of topical, periocular, and systemic steroids. A notable exception is infectious causes of uveitis, which often require specific antimicrobial agents. This is particularly true in immunosuppressed patients in whom infectious diseases such as toxoplasmosis and herpes zoster may have atypical and fulminant clinical courses necessitating early therapeutic intervention. Analysis of local antibody production in the aqueous or vitreous humor may aid in the diagnosis. Severe forms of endogenous uveitis such as Behcet's disease have often required the use of nonspecific cytotoxic agents such as chlorambucil or cyclophosphamide. Agents such as cyclosporine and FK-506 are newer immunosuppressives that may have less severe long-term systemic side effects. Chorioretinal biopsy offers an additional tool for the specific etiologic diagnosis of uveitis. The role of posterior chamber lens implantation in patients with a history of uveitis continues to evolve. PMID- 10147737 TI - Peripheral blood stem cell transplantation: approaches to an optimal blood stem cell collection. PMID- 10147738 TI - Autologous blood stem cell grafting in hematological malignancies. Present status and future directions. PMID- 10147739 TI - Clinical applications of stem cell transfusion from cord blood. PMID- 10147740 TI - Perspectives in marrow graft T-cell depletion in allogeneic matched related bone marrow transplantation. PMID- 10147741 TI - Biocompatibility of leukocyte removal filters during bedside leukocyte filtration of red cell concentrates. PMID- 10147742 TI - AIDS impact on health insurance. PMID- 10147743 TI - Evaluating the medical record for the determination of insurability. PMID- 10147744 TI - A new generation of oral hypoglycemics. Their use, measurement, and effects on insurance risk assessment. AB - The increased use of oral hypoglycemics among the more than 14 million diabetics in the United States and the development of new pharmaceutical formulations requires the continued surveillance of their use in the insurance applicant population. Routine monitoring of urine glucose or even blood glucose or fructosamine measurements often fail to detect the diabetic using oral hypoglycemics. Urine analysis for the use of first generation sulfonylureas has shown a declining prevalence of their use due to the increased number of prescriptions written for newer and more effective drugs. In order to monitor the use of these second-generation oral hypoglycemics, an immunoassay was developed to detect the use of glyburide, 1-[4-[2-(5 chloro-2-methoxybenzamido) ethyl] phenyl] sulfonyl]-3-cyclohexylurea. After testing in a defined population of known users of this class of sulfonylureas, the assay was applied to a random population of 12,000 applicants applying for life insurance. Results demonstrate the predictive value of this assay in determining the prevalence of use of this drug in the insurance-buying population and its assistance in risk assessment. PMID- 10147745 TI - Noninvasive CO 2 laser fenestration improves treatment of onychomycosis. PMID- 10147746 TI - Laser coronary angioplasty using Ho:YAG surpasses excimer laser. PMID- 10147747 TI - CO 2, Nd:YAG lasers make strides in treatment of bullous emphysema. PMID- 10147748 TI - KTP successful with nasolacrimal duct surgery. PMID- 10147749 TI - Biologically modified polymeric biomaterial surfaces: introduction. AB - Synthetic polymers are the most diverse class of biomaterials. As with all other biomaterials, they must meet certain criteria depending on the intended medical application. Biocompatibility is one of the basic criteria for selection of a particular biomaterial. Biomaterial surfaces are believed to play an important role in determining their biocompatibilities. The study of the surface properties of biomaterials, and also interactions between the biomaterial and the living system interface are fundamental to define the behavior of the biomaterial in the biological environment, and therefore to evaluate accurately the biocompatibility of a new biomaterial. Surfaces of polymeric biomaterials may be modified by using a variety of biological entities (e.g. proteins and cells) not only to increase their biocompatibilities but also to add a functionality to the respective surfaces. I intended to highlight the topics which are discussed in depth in the other chapters of this volume. PMID- 10147750 TI - Present and emerging applications of polymeric biomaterials. AB - An important trend in biomaterials research and development is the synthesis of polymers, which combine capabilities of biologic recognition ('biomimetic') with special physicochemical properties of the synthetic polymer system. For example, an antibody may be conjugated to the backbone of a polymer which precipitates upon small changes in pH, temperature, or ionic strength. Crosslinked gels may also be synthesized from such polymers, and a biomolecule such as an enzyme may be chemically or physically entrapped in these gels. Such gels will shrink and swell in response to small changes in environmental stimuli. Another approach is to 'engineer', perhaps via computer-aided molecular design, new artificial biomimetic systems by exact placement of functional groups on rigid polymer backbones, crosslinked structures, or macromolecular assemblies. In this way, biocatalytic functioning or biorecognition similar to enzymes and antibodies can be achieved without the inherent instability often encountered with the native biomolecules or assemblies. In addition to these synthetic approaches, new and exciting analytical tools, such as the scanning tunnelling microscope and the atomic force microscope, are permitting visualization of individual and small clusters of proteins and other biomolecules on surfaces. Cell attachments and spreading may also be visualized at various depths within the cell using the confocal laser microscope. Such analytical techniques can lead to important new knowledge about biologic interactions with biomaterials, and, therefore, to development of even more biocompatible implants and devices. This paper overviews the field of polymeric biomaterials and highlights the important emerging trends in synthesis and analysis of these materials. PMID- 10147751 TI - Needs, problems, and opportunities in biomaterials and biocompatibility. AB - There are four topics related to biomaterials and biocompatibility which I feel are key problems, are often unrecognized, and are therefore rich opportunities for work in the near future: (i) the covalent instability of proteins, (ii) the concept of statistical specificity and statistical heterogeneity, (iii) the issue of solid surface dynamics and surface relaxation, and (iv) the growing concern with the costs of health care and of medical research. Each is briefly discussed in this paper. PMID- 10147752 TI - Characterization of biomaterial surfaces: ATR-FTIR, potentiometric and calorimetric analysis. AB - The usefulness of attenuated total reflection-Fourier transform infrared spectroscopy, potentiometry and calorimetry in surface characterization of biomaterials is discussed in this paper. Some examples of biomedical materials characterized by using these different techniques are also reported. PMID- 10147753 TI - Surface study of biomaterials by electron induced vibrational spectroscopy. AB - Besides the identification of elements and chemical groups on a material surface, the determination of its structure, or of the relative orientation of different chemical groups, is probably of utmost importance for biomaterials and their modified surfaces. 'Electron induced vibrational spectroscopy' is a new technique, as far as applications to biomaterials are concerned, and is capable of recording well-resolved vibrational bands from the extreme surface. Basics and the potentials of the technique are presented here for nonspecialists, with illustrations from model polymers, Langmuir-Blodgett films, carbon materials, and ceramics. PMID- 10147754 TI - Biologically modified PHEMA beads for hemoperfusion: preliminary studies. AB - Polyhydroxyethylmethacrylate (PHEMA) beads were prepared by phase separation polymerization. Hydroxyl groups on PHEMA beads were activated with CNBr at alkaline pH. Adsorption of heparin, blood proteins (i.e. albumin, fibrinogen and gamma-globulin), protein A, HIgG and DNA on these beads were studied. Preparation and activation procedures are given here. The preliminary results of these studies are also reported. PMID- 10147755 TI - Evaluation of capnography to predict arterial PCO 2 in neurosurgical patients. AB - This study was designed to see if capnography could be used to predict PaCO 2 so as to adjust ventilation to maintain PaCO 2 within the desired range in head injured patients undergoing prolonged mechanical ventilation. It was further designed to see if P ETCO 2 could accurately predict PaCO 2 based on only one arterial blood gas (ABG) measurement or if more frequent, i.e., daily, ABG measurements were required. PMID- 10147756 TI - A technique for brain temperature control during ischemia, suitable for measurements with ion-sensitive microelectrodes. AB - A technique is described for maintaining rat brain temperature constant during ischemia, a technique that also allows measurements with, and calibration of, ion sensitive microelectrodes under defined temperature conditions. The brain temperature is controlled by a stream of air of defined temperature and humidity, which is perfused through a box enclosing the animal's head. A device for calibration of ion-sensitive microelectrodes is temperature controlled by similar principles. The air stream is delivered by a heater/humidifier that is standard in many commercial respirators/ventilators. When the relative humidity of the air stream is greater than 98%, the neocortical temperature can be maintained within less than 0.5 degrees C during 15 min of ischemia. The biological applicability of the technique is discussed. PMID- 10147757 TI - Postischemic treatment with hypothermia improves outcome from incomplete cerebral ischemia in rats. AB - It is known that hypothermia can improve outcome when induced during ischemia. We evaluated whether hypothermia can decrease ischemic injury if it is induced after incomplete ischemia. Rats were anesthetized with 1.4% inspired isoflurane, and ischemia was produced by right carotid ligation combined with hemorrhagic hypotension to 30 mm Hg for 30 min. Hypothermia (31 degrees C) was induced or normothermia (37 degrees C) was maintained for 1 h after completion of the ischemic challenge. Isoflurane anesthesia was maintained during this period. Five of 15 normothermic rats and 3 of 15 hypothermic rats died of stroke after ischemia. For all rats tested, hypothermic-treated animals had a significantly better neurologic outcome than normothermic rats (p less than 0.05). Histopathology showed a correlation of r = 0.67 (p less than 0.05) with neurologic outcome, and neuronal damage was significantly worse in normothermic compared with hypothermic rats (p less than 0.05). These results show that postischemic hypothermia will decrease neuronal injury and improve neurologic outcome associated with incomplete ischemia. PMID- 10147758 TI - Detection of venous air embolism by continuous mixed venous oximetry in dogs. AB - Continuous mixed venous oxygen saturation (SvO 2) was evaluated as a monitor of venous air embolism in a canine model. Nineteen dogs were anesthetized, paralyzed, and mechanically ventilated. Invasive monitoring included SvO 2, systemic and pulmonary artery blood pressures, and thermodilution cardiac outputs. Air boluses of 0.25 and 0.5 ml/kg were injected in six dogs and 1 ml/kg in all. All 1 ml/kg emboli were detected by greater than or equal to 5% decreases in the SvO 2. The SvO 2 decreased from 82 +/- 8% to 72 +/- 11% (mean +/- SD), an average decrease of 9 +/- 5% (p = 0.004). Time to the SvO 2 nadir was 2.6 +/- 2.5 min. Of the 0.5 and 0.25 ml/kg emboli, 50% and 17% were detected, respectively. Cardiac output decreased from 2.9 +/- 0.8 to 2.1 +/- 0.8 L/min after the 1 ml/kg emboli (p = 0.02). The 1 ml/kg emboli increased pulmonary artery pressures and decreased systemic blood pressure in 100% and 75% of animals, respectively. Peak changes in pulmonary artery pressure occurred at 1.2 +/- 0.8 min. In the present study, time to maximum change was greater for SvO 2 than for pulmonary artery pressure changes. Use of fiberoptic pulmonary artery catheters for continuous measurement of SvO 2 can add a new diagnostic modality to venous air embolism detection in patients who require a pulmonary artery catheter for other medical indications. PMID- 10147759 TI - A pulmonary artery catheter does not affect the intravascular electrocardiogram from the air aspiration introducer sheath. AB - The air aspiration introducer sheath allows the use of a pulmonary artery (PA) catheter for monitoring during sitting neurosurgical procedures while providing a means of air aspiration that is more efficient than aspiration from the proximal and distal ports of the PA catheter alone. To place the 25-cm long introducer sheath safely into the right atrium, the PA catheter should be positioned first and used as a guide for the introducer sheath, which is then advanced into the atrium and positioned by observation of the intravascular electrocardiogram (IVECG). Placement of the introducer sheath with the IVECG has been described previously without a PA catheter in the lumen of the introducer sheath. In this study, performed in dogs, we have demonstrated that the presence of a PA catheter in the lumen of the introducer sheath does not affect the IVECG recorded from the introducer sheath. PMID- 10147760 TI - Clinical use of mild hypothermia for brain protection: a dream revisited. PMID- 10147761 TI - Should mild hypothermia be routinely used for human cerebral protection? The flip side. PMID- 10147762 TI - Detection of venous air embolism: comparison of oxygenation and ventilation monitoring methods in dogs. AB - Venous air embolism (VAE) results in both hypoxemia and hypercapnea with decreased end-tidal carbon dioxide (ETCO 2). Relative sensitivities for VAE detection were determined for (a) continuous oxygen saturation monitoring, as measured by pulse oximetry (SapO 2), an arterial fiberoptic catheter (SacO 2), and a pulmonary artery (PA) fiberoptic catheter (SvcO 2) compared with those determined by arterial and mixed venous blood gas measurements (SabgO 2 and SvbgO 2, respectively) and (b) continuous ETCO 2 and intermittent PaCO 2 measurements in eight anesthetized, mechanically ventilated mongrel dogs. Air was infused (in varied order) at 0.05, 0.10, and 0.20 ml/kg/min for 5 min into the jugular vein. Arterial and mixed venous blood gas tensions were determined prior to and at 2.5, 5, and 10 min after VAE was begun. VAE was diagnosed by a greater than or equal to 5% decrease in any O 2 saturation or a greater than or equal to 3 mm Hg increase in PaCO 2 or decrease in ETCO 2. Values obtained were statistically compared by multiple regression analyses, analysis of variance, and Student t tests, where applicable. VAE was detected more readily by decreases in ETCO 2 and increases in PaCO 2 than decreases in oxygen saturation, as measured by either method.(ABSTRACT TRUNCATED AT 250 WORDS) PMID- 10147763 TI - Brain tissue grafting and human applications. PMID- 10147764 TI - Single lung transplant for chronic respiratory failure. PMID- 10147765 TI - A broad view of brain injury rehabilitation. Community-integrated network of excellence. PMID- 10147766 TI - Integrating outcomes, value, and quality. An outcome validation system for post acute rehabilitation programs. PMID- 10147767 TI - Prognostic factors in localized breast cancer. PMID- 10147768 TI - A classification system for mortality and morbidity abstracts and related data. PMID- 10147769 TI - The impact of cancer biology, lead time bias, and length bias in the debate about cancer screening tests. PMID- 10147770 TI - Infrared accuracy for today's underwriting. PMID- 10147771 TI - An actuarial report on the cost effectiveness of a new medical technology. PMID- 10147772 TI - Workers Compensation cases with traumatic brain injury: an insurance carrier's analysis of care, costs, and outcomes. AB - The purpose of this survey was to review the medical care, medical costs, and outcomes of 86 Workers Compensation cases involving traumatic brain injury. An analysis of ICD-9 diagnoses, Rancho Los Amigos Cognitive Levels, age, sex, accident description, management techniques, costs, outcomes, and many other factors was conducted. The total indemnity (wage loss) and medical payments amounted to $27.1 million. For example, one case with temporal lobe hematoma, due to a fall in 1972, has had $1.1 million in medical payments since the injury occurred. The current average age is 40 years with 71% still residing at home. Only 10% are currently employed and 40% are known to be receiving other benefits. The increasing frequency and severity of these cases, as well as the extension of survival due to improved care and technology, highlight the need to address the question, "Who will be the caretakers, and what will be the associated costs?" Actuarial projections into the 21st century are given. It is concluded that, while further long-term studies are needed, Workers Compensation carrier representatives and health care providers must continue to work together on the interdisciplinary rehabilitation team. PMID- 10147773 TI - Use of cost data, provider experience, and clinical guidelines in the transition to managed care. PMID- 10147774 TI - Radiation prophylaxis of heterotopic bone formation following total hip arthroplasty: current status. AB - Differentiation of pluripotential stem cells into osteogenic precursors is exquisitely sensitive to ionizing radiation. Radiation prophylaxis effectively prevents ectopic ossification if delivered to the operative site within 5 days following total hip arthroplasty. Continued efforts at dose reduction over the last decade have demonstrated efficacy with as little as 6,000 to 8,000 rad; no soft tissue sarcomas have been reported in this low dose range following treatment of malignant disease. Precise limitation of the treatment field is necessary for application of this modality to cementless implants dependent on bony ingrowth for stable fixation. Trochanteric nonunion is reported in 25% of hips following radiation prophylaxis, but this is as likely related to the high proportion of revision surgery in these series as it is a direct consequence of the radiation. PMID- 10147775 TI - Technical considerations in the use of prophylactic radiation therapy to prevent heterotopic bone formation. AB - The UCLA Department of Radiation Oncology radiated 97 hips at high risk for heterotopic bone (HTB) formation from 1980 through 1988. Adequate follow-up (minimum of 2 months, median, 10 months) is available in 92 hips (82 patients). These hips were treated with a variety of doses, fractionation schedules, and shielding techniques as treatment evolved over time. There was a total of 49 hips with porous coated ingrowth prostheses. These were all shielded with custom blocks. There were no untoward complications in this subgroup. Only 6 of the 92 hips evaluable developed clinically significant HTB. Five of these 6 failures can be attributed to initiating treatment after postoperative day (POD) 5 or block malposition. Of the 78 hips that initiated radiation therapy before POD 6 (with proper shielding), only 1 (1.3%) developed clinically significant HTB. Radiation therapy is very effective at preventing HTB formation following hip surgery when treatment is initiated within 4 days of surgery. To assure an optimal outcome, close attention to the technical aspects treatment is critical. PMID- 10147776 TI - Nonsteroidal anti-inflammatory drugs for prevention of heterotopic ossification after total hip arthroplasty. AB - Nonsteroidal anti-inflammatory drugs (NSAID) have been proven highly effective as prophylaxis for periarticular heterotopic ossification (HO) following total hip arthroplasty (THA) both when given to patients considered to be at risk for this complication, and in consecutive double-blind studies. Treatment with a standard dosage for 10 days starting on the day of surgery seems to be adequate for the prophylactic effect. Furthermore, NSAID are effective in preventing recurrence of HO after resection. PMID- 10147777 TI - Preoperative interactive 2D-3D computed tomography assessment of heterotopic bone. AB - Total hip arthroplasty is a common orthopaedic procedure in this country. Postoperative heterotopic bone formation may be seen in anywhere from 5% to 76% of such procedures. Only a small subgroup of these patients are symptomatic. Approximately 6% of arthroplasty patients require evaluation of heterotopic bone. In such patients, computed tomography may be useful in staging the extent of bone formation and in helping to plan surgical or radiotherapy treatment. Reformatting transaxial data into coronal and sagittal planar images and into simulated three-dimensional images provides the most comprehensive overview and maximizes communication of relevant findings. PMID- 10147778 TI - Evolving techniques of cataract surgery: Continuous Curvilinear Capsulorhexis, down-slope sculpting, and nucleofractis. PMID- 10147779 TI - A strategic approach to phacoemulsification based on nuclear density. PMID- 10147780 TI - Transsclerally sutured posterior chamber lenses: improved lens designs and techniques to maximize lens stability and minimize suture erosion. PMID- 10147781 TI - Viscoelastic agents: formulation, clinical applications, and complications. PMID- 10147782 TI - Results of clinical investigation of the 3M diffractive multifocal intraocular lens. PMID- 10147783 TI - Practical consideration of intraocular lens implant power calculations. PMID- 10147784 TI - Combined glaucoma filtration surgery and phacoemulsification. PMID- 10147785 TI - Echocardiographic long-term evaluation of percutaneous balloon mitral valvotomy. AB - Percutaneous balloon mitral valvotomy (BMV) is an alternative therapeutic method for patients with mitral stenosis. We studied 62 patients (56 females, mean age 36.4 years) who underwent balloon mitral valvotomy. Five patients were pregnant and in New York Heart Association Functional Class IV. Doppler echocardiographic studies were performed prior to the procedure, and at 7 days, 6 months, 12 months, and 24 months after the procedure. We studied the following parameters: echo-score by the sum of valvular mobility, thickening, and calcification, and subvalvular disease, graded from 1 to 4; and mitral valve area (MVA) and mitral pressure gradient (MPG) by Doppler echocardiography. The patients were separated into two groups: group I with an echo-score less than or equal to 8 (40 patients), and group II with an echo-score greater than or equal to 9 (22 patients). Mitral valve area and MPG were compared with hemodynamics through the correlation coefficient and linear regression. Comparison between groups I and II was performed using the unpaired Student's t-test. Follow-up of MVA and MPG was analyzed by analysis of variance. The Student's t-test did not show any significant difference between MVA and MPG before balloon mitral valvotomy. There was significant decrease of MVA in group II (P less than 0.01) in the last three studies. There was significant increase in MPG in group II (P less than 0.01) in every postvalvotomy study. The analysis of variance of group I showed statistical increase of the MVA, and significant decrease of the MPG after BMV. The analysis of variance of group II showed significant increase in MVA and significant decrease in MPG between the pre- and the first postvalvotomy study. There was significant decrease (P less than 0.01) in MVA, and increase in MPG in the three postvalvotomy studies. Complications included mitral regurgitation, residual interatrial communication, pericardial effusion due to an atrial wall perforation, and peripheral embolization. Atrial fibrillation did not significantly alter the results of BMV. Results were considered positive when MVA was greater than 1.5 cm 2 and area increase was greater than 25%. Patients with an echo-score less than or equal to 8 (group I) benefit from BMV, with a positive predictive value greater than 78%. In pregnant patients the symptomatology was alleviated by BMV, without any signs of fetal compromise. PMID- 10147786 TI - The role of Doppler echocardiography in the assessment of left ventricular diastolic function. AB - The role of Doppler echocardiography of transmitral filling velocities in the assessment of diastolic function in man has not been adequately defined. It is now appreciated that multiple interacting factors such as loading conditions influence the transmitral velocity profile independent of intrinsic left ventricular diastolic function. Extrapolating the status of diastolic function from the transmitral velocity profile is complicated by these factors. The load dependence of ventricular filling has tempered the initial enthusiasm for the clinical application of the Doppler technique. In the present review, studies examining invasive parameters of diastolic function and Doppler indices of diastolic filling are discussed to gain greater insight and understanding of the role of Doppler echocardiography in the noninvasive assessment of diastolic function. These studies have demonstrated a relatively consistent influence of left ventricular relaxation, chamber stiffness, and left atrial pressure on the transmitral velocity filling profile. Impairment of relaxation impedes early filling and may result in a compensatory increase in atrial contribution to filling. An independent decrease in left atrial pressure from altered loading conditions may also reduce filling in early diastole. Increased left ventricular chamber stiffness (i.e., noncompliant left ventricle) impairs atrial contribution to filling and may enhance early filling. Theoretically, reduced left atrial contractility may decrease atrial contribution to filling. Pulmonic vein flow demonstrating increased retrograde flow during atrial systole helps to exclude impaired left atrial contractility. An increased left atrial pressure from altered loading conditions may also augment early filling. Therefore, an invasive or clinical assessment of left atrial pressure as being increased, decreased, or normal greatly aids in the interpretation of the transmitral filling velocity profile when inferences on the status of diastolic function are being made. Diastolic dysfunction is likely when a given pattern of filling cannot be explained on the basis of left atrial pressure. In situations where reasonable estimates on the status of left atrial pressure cannot be done, striking alterations in the transmitral velocity filling profile may be useful. PMID- 10147787 TI - Effect of loading conditions on Doppler-derived transmitral flow indices in normal subjects and patients with coronary artery disease. AB - The influence of alterations in preload and afterload on left ventricular diastolic filling using echocardiography was examined in nine normal volunteers (NLS) and nine patients (PTS) with coronary artery disease. The sequential interventions used were handgrip to increase afterload, nitroglycerin to decrease preload, and nifedipine to decrease afterload. Transmitral flow was measured using pulsed-Doppler echocardiography. Measurements were made pre- and post interventions. With increase in afterload using handgrip, the A and E wave velocities and the A/E ratio increased in both groups: 0.62 +/- 0.14 versus 0.86 +/- 0.17 in NLS; 0.75 +/- 0.45 versus 0.84 +/- 0.50 in PTS (P less than 0.05). Following administration of nitroglycerin to reduce preload, the A wave velocities increased, the E wave velocity decreased in both groups, and the A/E ratio increased 0.57 +/- 0.11 versus 0.67 +/- 0.13 in NLS; 0.78 +/- 0.40 versus 0.91 +/- 0.44 in PTS (P less than 0.05). Following use of nifedipine, the A and E wave velocities decreased in both groups with an increase in the A/E ratio in the patient group 0.83 +/- 0.13 versus 0.89 +/- 0.11 (P = NS). Thus, both normal subjects and patients with coronary artery disease had similar changes in Doppler derived indices of left ventricular filling following interventions that changed left ventricular preload and afterload. PMID- 10147788 TI - Intravascular ultrasound imaging of arterial wall architecture. AB - Intravascular ultrasound (IVUS) is a promising new technique for assessing vascular morphology and structure. Controversy exists whether the three-layer appearance of the arterial wall correctly reflects the histologic structures of the intima, media, and adventitia. We performed an experimental study to clarify the three-layer appearance. The vessel wall architecture was analyzed by IVUS on eight different kinds of plastic cylinders, 24 normal blood vessels from pigs, and 59 human arterial segments. A distinct three-layer appearance was observed on all the plastic cylinders when the ultrasound beam was perpendicular to the wall. A three-layer appearance was also seen in the arterial wall, in the muscular (iliac, femoral artery) and elastic types (aorta), when the echo beam was perpendicular to the vessel wall. The three-layer pattern was even observed on the arterial wall when the intima was removed. Furthermore, the removed intima itself provided a three-layer image. Histologic examination showed that there was no correspondence between the IVUS three-layer appearance and the intima, media, and adventitia. Moreover, we also performed IVUS on nine patients who suffered from aortic dissection. Intravascular ultrasonic visualization of the dissected intima showed a distinct three-layer pattern. The pattern disappeared when: (1) the echo beam was not perpendicular to the vessel wall; (2) there was connective tissue around the vessel wall; (3) there was arterial wall calcification; or (4) the vessel wall was too thick or the distance between the ultrasound transducer and the vessel wall was too large.(ABSTRACT TRUNCATED AT 250 WORDS) PMID- 10147789 TI - Use of a mouth gag instrument to facilitate bite block insertion and prevent finger and probe bites during transesophageal echocardiography. AB - Transesophageal echocardiography greatly enhances the examination of patients difficult to image transthoracically. While of low patient risk, a potential for harm from human bites to the echocardiography staff and to the transesophageal probe remains, particularly when dealing with uncooperative patients. This risk potential prompted implementation of additional anti-bite protection in our universal precautions policy beyond use of a standard mouth guard. A mouth gag instrument was modified by placing latex rubber tubing over the instrument blades. This instrument was inserted into the mouth and set in an open position giving the operator safe access for probe and mouth bite guard insertion. This technique improved access to the patient's mouth and visualization of probe insertion without the mouth bite guard. The mouth gag instrument provided an insertion of the transesophageal probe in impaired or otherwise uncooperative patients, which was safer for the patient, laboratory staff, and the probe itself. PMID- 10147790 TI - The improved yield of transesophageal echocardiography over transthoracic echocardiography in patients with neurological events is largely due to the detection of aortic protruding atheromas. AB - It is important to determine what, if any, the added contribution of transesophageal echocardiography is to the evaluation of patients with unexplained strokes and transient ischemic attacks. Transesophageal echocardiography was performed in 283 consecutive patients over an 8-month period. The reason for referral in 63 of these patients was unexplained stroke or transient ischemic attack. These 63 studies were evaluated for the presence of lesions that could be etiologic in these patients, including protruding aortic atheromas, spontaneous echo contrast, atrial septal aneurysms, and atrial clots. The transesophageal and transthoracic techniques were compared. The main finding was that there were 23 abnormal findings that might have been responsible for stroke or transient ischemic attacks seen on transesophageal echocardiography, which were not visualized on transthoracic echocardiography. Transthoracic echocardiography was false negative in 19 (30%) of 63 patients. None of the protruding aortic arch atheromas seen on transesophageal echocardiography were diagnosed with transthoracic echocardiography. Transesophageal echocardiography is indicated in the evaluation of patients with unexplained strokes and transient ischemic attacks, and the added yield of this technique is largely due to the finding of protruding aortic arch atheromas. PMID- 10147791 TI - Cardiovascular ultrasound: expanding frontiers in vascular disease. AB - Advances in cardiovascular ultrasound have included development of instrumentation providing outstanding images, as well as color spectral Doppler hemodynamic information. The increasing utilization of cardiovascular ultrasound has led to its increasing diagnostic application and accuracy in the evaluation of the patient with known or suspected cerebrovascular and peripheral vascular disease. The sensitivity of duplex ultrasound to detect carotid disease varies from 87% to 94% with a specificity of 88% to 93%. The accuracy of duplex examination for detection of peripheral venous disease, when compared to contrast venography, is high. A sensitivity of nearly 93% with a specificity of 98% has been noted. Cardiovascular ultrasound is a noninvasive technology with no known biological hazard that can be applied to the broad spectrum of patients including those who are critically ill. It is a relatively low-cost procedure when compared to other diagnostic procedures and can be performed on a serial basis. Since it provides anatomical and functional hemodynamic information, it is rapidly becoming the procedure of choice not only for diagnosis, but also for management. PMID- 10147792 TI - Noninvasive vascular laboratory in clinical practice. AB - Noninvasive vascular testing methods have validated application in the evaluation of patients with suspected peripheral arterial, cerebrovascular, or peripheral venous disease. Accurate and reproducible testing requires the use of appropriate instrumentation by experienced technologists, and interpretation of data with verified diagnostic criteria. Noninvasive testing can facilitate clinical decision-making by providing quantitative anatomical and hemodynamic data, thereby quantifying functional severity of disease. Duplex ultrasonography is essential instrumentation for cerebrovascular testing to localize and grade occlusive lesions. In peripheral arterial testing, the combination of segmental pressure measurements and waveform (velocity, pulse pressure) analysis should be the initial diagnostic method, with duplex scanning reserved for characterizing hemodynamically abnormal arterial segments. A number of techniques (duplex scanning, B-mode imaging supplemented by Doppler, venous outflow plethysmography) are appropriate for assessing the venous system for thrombosis, structural abnormalities, and venous valve function. Physicians should be aware of the pitfalls of noninvasive vascular testing and confirm equivocal studies using "gold standard" diagnostic methods such as arteriography and contrast venography. PMID- 10147793 TI - Vascular ultrasound: a radiologist perspective. AB - Color Doppler flow imaging (CDFI) is an evolutionary technical development that has considerably improved the diagnostic efficacy and clinical role of vascular ultrasound. The appropriate use of CDFI rests on an understanding of the instrumentation, factors affecting image quality and artifact, as well as the pathophysiology of the central and peripheral circulation. The modality has reached a relative plateau of performance. In this review, applications of CDFI for studies of the neck, abdomen, and extremities are evaluated. PMID- 10147794 TI - Evaluation of leg perfusion during exercise using technetium 99m sestamibi. A new test for peripheral vascular disease. AB - Thirty patients with occlusive peripheral vascular disease underwent clinical examination, segmental blood pressure determinations, intra-arterial digital subtraction angiography, and treadmill stress testing with injection of technetium 99m sestamibi at peak exercise. Radionuclide images of the thighs, calves, and feet showed clear delineation of major muscle groups. Diminished radiotracer distribution was closely correlated with the presence of occlusive vascular disease on angiography and with the presence of claudication and reduced segmental blood pressure. A quantitative scheme based on pixel intensity was developed to compare areas of regional perfusion. PMID- 10147795 TI - Magnetic resonance imaging of peripheral vascular disease. The state of the artery. AB - Peripheral vascular disease is a term often used to describe the manifestation of atherosclerosis below the bifurcation of the abdominal aorta. Peripheral atherosclerosis is a major cause of morbidity in the developed countries and 2% of adults in late middle age have intermittent claudication, which is severe enough in some patients to warrant hospital admission. The disease produces problems either by reducing blood flow or by the release of emboli from ulcerated plaques. The morphology and composition of arterial segments containing atheroma is of considerable importance. Plaques of different morphology have different effects on the arterial wall, such as the potential for thrombosis and the effect of arterial spasm. The lipid content may also affect the propensity for fissuring, ulceration, and thrombosis. In addition to discrete atherotic lesions, a localized and generalized sclerosis occurs. Sclerosis, or stiffness, can be demonstrated in experimental disease in animals and in man, and regression leads to reduced stiffness. Magnetic resonance imaging promises a comprehensive assessment of peripheral atherosclerosis noninvasively and without the use of ionizing radiation. Atheroma can be imaged directly, its size can be measured, its shape can be described, its lipid content can be assessed, and its effects upon vascular hemodynamics can be studied. In addition, arterial compliance, pulse wave velocity, and the pattern of flow within the vessel can be studied. It is thus a potential tool not only for the detection of disease but also for studying its natural history, risk factors, and the effects of pharmacological or surgical interventions. PMID- 10147796 TI - Transesophageal color Doppler flow imaging in the evaluation of prosthetic cardiac valves. AB - To determine the value of transesophageal echocardiography in the assessment of prosthetic cardiac valves, 11 patients with clinically suspected cardiac prosthetic valve dysfunction were studied by transesophageal two-dimensional imaging, as well as by color Doppler flow mapping. Among these 11 patients, there were 10 with biological tissue valves and 3 with metallic valves (1 Bjork Shiley, 2 St. Jude). Nine patients had replacement of mitral valves alone. The remaining two had received both mitral and aortic prostheses. The degree of mitral regurgitation was graded by transesophageal color Doppler according to the area of the regurgitant jet visualized. The degree of aortic regurgitation was graded by the jet height/left ventricular outflow height ratio method. All transesophageal studies were performed without complication and all were well tolerated. The pathological morphology of the cardiac prosthesis was clearly visualized by transesophageal two-dimensional imaging and subsequently proven at surgery. Of those tested, one patient was found to have a torn leaflet, one had a dislodged leaflet, one patient had paravalvular leakage, four had cusp vegetations, and five patients had prosthetic degeneration for other reasons. Mitral regurgitation was graded as absent in one patient, mild in two patients, moderate in two patients, and severe in six patients. Aortic regurgitation was graded as severe in both patients with aortic prostheses. We conclude that in patients with clinically suspected cardiac prosthetic dysfunction, transesophageal two-dimensional imaging combined with color Doppler can provide reliable information that corresponds to surgical findings. PMID- 10147797 TI - Transesophageal echocardiography with a single-plane probe. Long-axis views of the heart from the apical (transgastric) approach. AB - The literature suggests that during transesophageal echocardiography (TEE), a short-axis view can be obtained in the gastric position using a single-plane probe. Recently, we have found that a long-axis apical display of the heart can be achieved by placing the tip of the probe in the fundus of the stomach. In a 3 month period, we attempted to obtain this view in 54 consecutive patients. Twelve of the patients had TEE done under general anesthesia, while the other 42 patients had the procedure performed under sedation with midazolam at hospital bedside or as an outpatient. The long-axis transgastric view was obtained in 51 of the 54 patients (94%). The image quality was graded subjectively as good in 39 (72%) and fair in the other 12 patients (22%). This view helped to establish the diagnosis in eight patients (15%) and to increase the level of confidence about the accuracy of the diagnosis in 23 (43%) other patients. Four patients' findings are described. We conclude that the new long-axis transgastric view is easy to obtain, does not add much time to the usual TEE study, does not add to the low complication rate of TEE, and may help to interrogate the distal structures of the heart. PMID- 10147798 TI - Assessing prosthetic heart valve function. Value of Doppler echocardiography and patient/prosthetic valve identity and follow-up card. AB - Doppler echocardiography is being used increasingly in the follow-up of patients with valvular heart prostheses because it provides unique hemodynamic information about flow through prosthetic valves. A baseline checkup about 3 months after implantation is now recommended. We therefore now supply each patient with an identity and follow-up card for each particular prosthesis. PMID- 10147799 TI - Bioeffects in echocardiography. AB - Two mechanisms have been identified through which ultrasound as it is used clinically could produce biologically significant effects. One is heating that results from the absorption of ultrasonic energy by tissues. The other is cavitation, the ultrasonic activation of gas bodies including the potentially violent collapse of small gas bodies in or near tissue that is sometimes called transient or inertial cavitation. The heart, itself, is well perfused and the likelihood of significant heating of the heart tissues in the most extreme conditions known today is negligible. Lung also appears to be relatively immune to heating under diagnostic exposure conditions. In normal echocardiographic procedures, the only tissues that need serious consideration are the ribs. Under extreme conditions, ultrasonic heating of the bone might be as great as 6 degrees C. Nonthermal action of ultrasound has been demonstrated to cause lung hemorrhage at pressure levels on the order of 1 MPa. Although many diagnostic devices produce focal pressures greater than this amount, it appears unlikely that hemorrhage will occur in normal echocardiographic applications. Under certain conditions, pulsed ultrasound can either stimulate or modify the contraction of the heart but the exposures required are not used in normal echocardiographic applications. Since specific devices have been identified who's outputs approach levels required to produce thermal and nonthermal effects, the user should be aware of potential biological effects, particularly in pediatric or obstetric applications, as output levels increase. PMID- 10147800 TI - Color flow and conventional echocardiography of the Marfan syndrome. AB - Imaging and color flow Doppler echocardiography are an integral part of any evaluation of a patient with the Marfan syndrome. The major cardiovascular manifestations of this condition are aortic dilation, which may involve the proximal and distal aorta, aortic regurgitation, aortic dissection, mitral valve prolapse, and mitral regurgitation. Patients who have the Marfan syndrome should have serial echocardiograms to measure aortic root diameter carefully at the sinuses of Valsalva and subsequent levels (sinotubular junction, arch, descending and abdominal aorta). Additionally, color Doppler echocardiography assists in the diagnosis of aortic dissection and facilitates evaluation of the severity of aortic and mitral regurgitation that commonly complicate the Marfan syndrome. The risk of aortic dissection, which is the most serious manifestation of the Marfan syndrome, increases as the aorta enlarges. Therefore, elective composite graft surgery is recommended when the aortic root size reaches 60 mm, regardless of symptom status, or 55 mm in the presence of severe aortic regurgitation. Surgical replacement of the aortic root with a composite graft does not end the disease process. Color flow Doppler is useful in the diagnosis of dehiscence of the conduit sewing ring, coronary artery aneurysm, distal aortic dissections, and prosthetic valve dysfunction. PMID- 10147801 TI - Bedside cardiac catheterization using transesophageal echocardiographic guidance. AB - We describe for the first time the use of transesophageal echocardiography to guide cardiac catheterization performed at the bedside in the pediatric cardiac intensive care unit. The procedure was performed on a 2.6-kg infant with ventricular and atrial septal defects after repair of coarctation of the aorta. Poor hemodynamic status prevented obtaining the required hemodynamic information from cardiac catheterization in the cardiac catheterization laboratory. Transesophageal echocardiography provided cardiac and vascular imaging, which helped guide catheter placement where the small size of the infant and the extensive thoracic postoperative bandages prevented obtaining the echocardiographic information from other windows. PMID- 10147802 TI - The surgeon's use of epicardial echocardiography during repair of congenital heart defects. AB - Intraoperative echocardiography in the evaluation of congenital heart defects is a useful method to evaluate surgical anatomy, adequacy of repair, and ventricular performance. Since 1987, 733 patients have undergone epicardial echocardiography during repair. The routine use of this technique has led to the reduction in the need for both early and late reoperation. PMID- 10147803 TI - Multiplane transesophageal echocardiography. Imaging planes, echocardiographic anatomy, and clinical experience with a prototype phased array OmniPlane probe. AB - Multiplane transesophageal echocardiography is a new exciting development in echocardiography. We examined the methodology and echo-anatomic correlations of multiplane transesophageal echocardiography and its clinical applications in 100 patients. We used a 5-MHz phased array multiplane (OmniPlane) transesophageal probe. In this instrument, the transducer array can be steered through 180 degrees from any transducer location. This provides a vast assembly of imaging planes, allowing for detailed visualization of all dimensions of cardiac anatomy. This report presents our observations on the echocardiographic anatomy seen in various image planes and the unique clinical potential of multiplane transesophageal echocardiography in the diagnostic assessment of cardiovascular disorders. This technique appears to provide incremental diagnostic information that enhances the interpretative ability. Less esophageal probe manipulation is required with consequent decrease in patient discomfort. We conclude that multiplane transesophageal echocardiography enhances the versatility of transesophageal examination and offers many new avenues for developments such as three-dimensional echocardiography. PMID- 10147804 TI - Three-dimensional and four-dimensional transesophageal echocardiographic imaging of the heart and aorta in humans using a computed tomographic imaging probe. AB - We evaluated the clinical applicability of a prototype tomographic transesophageal echocardiographic (TEE) system, which not only provides conventional TEE images but also three-dimensional tissue reconstruction and four dimensional display capabilities. The probe was used in 16 patients in the echocardiographic laboratory, intensive care unit, and the operating room. The instrument is a 5-MHz, 64-element, phased array unit mounted on a sliding carriage within a casing. After appropriate probe placement within the esophagus, the probe is straightened, a balloon surrounding the probe is inflated, and data acquisition begun with ECG and respiration gating. With computer controlled transducer movement at 1-mm increments, a complete cardiac cycle is recorded at each tomographic level. These are processed using a dedicated four-dimensional software, and displayed as a dynamic three-dimensional tissue image of the heart. We were able to see the dynamic motion of the ventricles and all the valves in the four-dimensional format. In addition to four-dimensional display, we were able to cut and visualize the heart in dynamic mode in any desired plane and also in multiple planes. Patients tolerated the procedure well. We conclude that this tomographic four-dimensional approach, which does not require tedious off-line processing, can easily be performed in patients and has a strong clinical potential. PMID- 10147805 TI - The most expensive hysterectomy. PMID- 10147806 TI - Dual-image video endoscopy. AB - The use of a digital audio-video mixer is advocated when concurrent endoscopic procedures, such as laparoscopy and hysteroscopy, are performed. The device can also assist in postproduction work. PMID- 10147807 TI - Laparoscopy-assisted vaginal hysterectomy: report of seventy-five consecutive cases. AB - Patients who underwent laparoscopy-assisted vaginal hysterectomy with or without adnexectomy experienced less fever, required less postoperative analgesia, were able to tolerate a full diet within 24 hours of surgery, and had a faster recovery and shorter hospital stay than patients who had abdominal or traditional vaginal hysterectomy. PMID- 10147808 TI - Radiological patterns of mineralization as predictor of urinary stone etiology, associated pathology, and therapeutic outcome. PMID- 10147809 TI - Monoclonal antibody identification of a potentially lithogenic protein extracted from human renal calculi. AB - In an attempt to identify potentially lithogenic proteins, a detergent soluble extract of human renal calculi was used to produce a unique monoclonal antibody. The monoclonal antibody was found to detect the presence of a specific epitope in 77% of individually extracted kidney stones from our patients' stone bank at The Long Island Kidney Stone Unit, State University of New York, Stony Brook. Sodium dodecyl sulfate-polyacrylamide gel electrophoresis, immunoprecipitation, and Western Blot analysis revealed this monoclonal antibody to be specific to a protein of 83,000 dalton molecular weight. A secondary source of protein reactive to the monoclonal antibody was subjected to enzyme kinetic studies, those studies suggested that the 83,000 dalton protein is a member of the protein glutamine gammaglutamyltransferase (transglutaminase) family of enzymes. It was not determined in the present investigation whether a member of this family of enzymes initiates or is necessary for lithiasis. PMID- 10147810 TI - A performance analysis of an extracorporeal shock wave lithotripter: spatial pressure distribution and the effects of lithotripter voltage, electrode life, and tissue attenuation. AB - The Dornier MPL-9000 lithotripter was analyzed as a function of lithotripter voltage, electrode efficiency, and bovine muscle attenuation. The maximum pressure at 20 kV measured 65 +/- 4 MPa (mean +/- SD). The region containing 50% of the maximum pressure was a cylindrical volume with a diameter of 2.5 cm and a height of 7 cm. Pressure varied in a linear fashion with lithotripter voltage (r = 0.996). The average pressure produced by an electrode throughout the course of 2,200 shock waves was 78% of its maximum pressure. Shock wave pressure was reduced from 65 +/- 4 MPa to 49 +/- MPa, 44 +/- 3 MPa, and 44 +/- 1 MPa with 1-, 2-, and 3-cm thickness of intervening bovine muscle, respectively. There was a statistically significant decrease in pressure when muscle was interposed, but there was no significant difference in reduction of pressure between 1, 2, and 3 cm of muscle (ANOVA, Newman-Keuls, alpha = 0.01). Frequency spectral analysis revealed the major contribution to the shock wave comes from 0-200 kHz with a peak near 50 kHz. Major frequency intensities were reduced with a decrease in lithotripter voltage, attenuating tissue, and distance away from the center of the focal zone. PMID- 10147811 TI - Efficacy of supine versus prone biliary lithotripsy: an in vitro study. AB - Clinical extracorporeal shock wave lithotripsy (ESWL) results have shown that the smaller the gallstone fragments following ESWL, the faster the patient will become stone-free. At ESWL, an attempt is made to produce sand-like fragments that will easily pass through the cystic and common bile ducts. Sixteen pairs of gallstones of equal shape, size, and composition were harvested from cholecystectomy specimens and then fragmented on the Dornier MPL-9000 lithotripter (Dornier Medical Systems, Inc.), individually, in a phantom oriented to duplicate either supine or prone patient positions. The number and size of remaining fragments were compared following the supine versus prone treatments. The 32 stones, ranging from 5-15 mm in diameter, received 1,500 shock waves at 21 kV. Fragments with a maximal diameter of greater than or equal to 4 mm were measured and counted after 750 and 1,500 shock waves. Fragments greater than or equal to 4 mm were found in four out of 16 stones treated supine (25%) and 16 out of 16 stones treated prone (100%). The largest residual fragment regardless of size for each stone pair occurred in the prone group in 14 out of 16 cases (88%). Biliary lithotripsy performed with supine positioning results in more efficacious gallstone fragmentation in this in vitro model; these findings suggest that supine positioning for patients could improve fragmentation and treatment success. PMID- 10147813 TI - Directional atherectomy. PMID- 10147814 TI - Stents. PMID- 10147812 TI - Accelerated destruction of large, calcified gallstone burdens by performing lithotripsy in the presence of methyl t-butyl ether: an in vitro study. AB - Numerous, large, or calcified gallstones hinder successful extracorporeal fragmentation. The purpose of this study was to investigate an in vitro method that could accelerate the destruction of these types of gallstone burdens. Matched sets of partially calcified gallstones, each set having a combined stone diameter greater than 3 cm, underwent lithotripsy while immersed in either 15 cc of bile, methyl t-butyl ether (MTBE), or dimethyl sulfoxide (DMSO), with a fourth set serving as a control. Results showed a 20% reduction in the relative weight of all fragments, an eightfold reduction of the relative weight of fragments greater than 3 mm, and a 50% reduction of the number of large fragments when the stones were immersed and shocked in MTBE rather than when shocked in bile. Dimethyl sulfoxide hindered gallstone destruction. These results indicate that large, partially calcified gallstone burdens can be more successfully destroyed if lithotripsy is performed in the presence of a small quantity of MTBE rather than in bile alone or in the presence of DMSO. If proven safe in vivo, this technique could expand the applicability of lithotripsy to those with larger, partially calcified stone burdens. PMID- 10147815 TI - Rotational/mechanical ablation. PMID- 10147816 TI - Laser/thermal ablation. PMID- 10147817 TI - Current and future modalities of catheter ablation for the treatment of cardiac arrhythmias. AB - Catheter ablation has proven to be a safe and effective treatment for a wide variety of cardiac arrhythmias. By destroying the critical zone of conductive tissue responsible for impulse generation or propagation, the arrhythmias may be cured. A variety of modalities of catheter ablation have been tested in the past decade. Initially, high energy direct current shocks delivered through a conventional electrode catheter were used. Now, use of radiofrequency energy as a power supply has resulted in higher efficacy and much improved safety of this technique. New approaches including low energy direct current shock ablation, microwave hyperthermic ablation, and laser photocoagulation are being tested, and may result in further refinement of nonsurgical curative therapy of arrhythmias. PMID- 10147818 TI - Rotational ablation of balloon angioplasty failures. AB - In this series, we evaluated the use of rotational ablation in stenoses that were previously refractory to balloon angioplasty. Forty-one stenoses were treated; in 26, the balloon did not adequately expand within the lesion and in 15 the balloon could not be delivered to the stenosis. Rotational ablation was technically successful in 40 of 41 (97.6%) of the lesions attempted. Twenty-four patients have been followed (mean time = 9 +/- 5 months) and the restenosis rate was similar to that of balloon angioplasty. Rotational ablation appears well suited and may be the treatment of choice for heavily calcified, severely angulated, and diffusely diseased vessels. PMID- 10147819 TI - Percutaneous transluminal coronary angioplasty through six French catheters. AB - We present the results of 221 coronary angioplasty (PTCA) procedures in which a 6 French diagnostic catheter was chosen as a guiding catheter. A total of 218 were done through a femoral and 3 through an axillary approach. Total occlusion PTCA was done in 9 (4%) and multivessel PTCA in 19 procedures (9%). In 191 (86%) procedures a fixed-wire system was used (ACE Scimed, Probe USCI, Orion Cordis), and in 30 (14%) a monorail system (Speedy Schneider, Express Scimed). The mean nominal inflated balloon diameter was 2.9+/-0.3 mm (range 2.0-4.0), and the catheter internal lumen varied between 0.041 and 0.055 inch. In 186 procedures (84%) all targeted lesions could be successfully dilated through the 6 French catheter. In 30 (14%) patients, the guiding catheter was changed to a 7 or 8 French, for an overall success rate of 95%. Results with 6 French catheters were significantly better in our late experience (success rate of 92% for the last 110 procedures compared to 77% for the first 111 procedures) (p less than 0.01). There were no new Q-wave myocardial infarctions, but 6 patients (2.7%) had moderate CK elevation, 1 required emergent bypass surgery, 1 underwent emergent coronary stenting, and there was 1 in-hospital death. The overall major complication rate was 3.2%. In selected patients, PTCA can be safely and effectively done through a diagnostic 6 French guiding catheter.(ABSTRACT TRUNCATED AT 250 WORDS) PMID- 10147820 TI - PTCA at first sight: angioplasty based on video only. AB - The results of 326 coronary angioplasties (PTCAs) performed during a first diagnostic angiography and based on video images only (PTCA at first sight, Group I) are compared with those of 756 PTCAs done during the same time period in patients with a previous cine-film and therefore a known or predictable coronary anatomy (Group II). Group I patients had more single vessel disease (74% versus 58%, p less than 0.001), single vessel PTCA (93% versus 84%, p<0.001), unstable angina (54% versus 28%, p less than 0.001), recent myocardial infarction (66% versus 37%, p less than 0.001), and total occlusion PTCA (29% versus 19%, p<0.01). On the other hand, they had less severe stable angina (mean New York Heart Association class 1.3+/-1.2 versus 1.8+/-1.4, p less than 0.001), less advanced disease (average of 1.3+/-0.5 versus 1.5+/-0.7 diseased vessels, p less than 0.001) and worse left ventricular ejection fraction (61+/-12% versus 63+/ 12%, p less than 0.01). The angiographic and clinical success rates were 90% and 84% in Group I and 92% and 87% in Group II respectively, (p=NS). Complication rates were not statistically different between the groups (Q-wave myocardial infarction 2% versus 3%, non Q-wave myocardial infarction 4% in both groups, emergency surgery 0.3% versus 0.8% and inhospital mortality 0.9% for both groups). In selected patients, coronary angioplasty can be performed safely and effectively during a first coronary angiography based on video images exclusively. PMID- 10147821 TI - Transesophageal echocardiography in the evaluation of cardiac source of embolus and intracardiac masses. PMID- 10147822 TI - Procedural considerations in transesophageal echocardiography. PMID- 10147823 TI - Assessment of valvular regurgitation by transesophageal echocardiography. PMID- 10147824 TI - Quantifying estimated survival from exercise stress electrocardiography. PMID- 10147825 TI - Carotid endarterectomy in symptomatic carotid stenosis: NASCET comparative results at 30 months of follow-up. PMID- 10147826 TI - Mitral valve prolapse--recent advances in risk assessment. PMID- 10147827 TI - Managed care: technology assessment and technology control. PMID- 10147829 TI - Some thoughts about rehabilitation and case management: an insurer's viewpoint. PMID- 10147828 TI - Outcome validation in post-acute rehabilitation: trends and correlates in treatment and outcome. PMID- 10147831 TI - Cognitive disability and reimbursement for rehabilitation and psychiatry. PMID- 10147830 TI - Quantitative EEG analysis and rehabilitation issues in mild traumatic brain injury. PMID- 10147832 TI - Hemochromatosis 1991. What will increased clinical screening mean for medical directors? PMID- 10147833 TI - Long-term mortality and complications of Bjork-Shiley spherical-disc valves--a life table analysis. PMID- 10147834 TI - Saphenous vein graft failure: etiologic considerations and strategies for prevention. AB - Occlusion of saphenous vein coronary artery bypass grafts remains a significant clinical problem. Early occlusion can be minimized by optimizing surgical techniques and by antithrombotic treatments. Unfortunately, no modification of surgical technique or drug therapy has been shown to reduce late vein graft occlusion. This results from excessive proliferation of vascular smooth muscle cells and the superimposition of atheroma on the resulting thickened intima. Understanding the basic mechanisms underlying this response may be helpful in developing strategies to reduce vein graft occlusion. PMID- 10147835 TI - Coronary artery bypass grafting in the management of ventricular arrhythmias in patients with coronary artery disease. AB - This review analyzes the role of coronary artery bypass grafting in ventricular arrhythmia associated with exertion, problematic sustained ventricular tachycardia, and sudden cardiac death associated with documented ventricular arrhythmia, or first manifestation of coronary artery disease. Specifically discussed is the role of acute ischemia in initiating and perpetuating ventricular arrhythmia. Coronary artery bypass grafting is indicated as a curative intervention for ventricular arrhythmia, but in only one rare instance: exercise-induced ischemia associated with problematic sustained ventricular arrhythmia, when the tachycardia is documented as being induced by acute ischemia. In other instances, indications for coronary artery bypass grafting follow the current guidelines based on clinical trials. Patients with the most severely damaged coronary artery anatomy associated with impaired left ventricular dysfunction have their life expectancy significantly prolonged after coronary artery bypass grafting. These results have been presented as evidence that coronary artery bypass grafting prevents ventricular arrhythmia and sudden cardiac death by modifying the two most powerful predicting factors of sudden cardiac death: coronary artery anatomy and left ventricular function. PMID- 10147836 TI - New intraoperative cardioprotective strategies for myocardial protection. AB - Three clinical techniques providing significant changes in the approach to myocardial protection have been reported recently. These techniques deviate from conventional practice, and they infer that normothermia is superior to hypothermia, retrograde cardioplegia is more advantageous than antegrade administration, and continuous cardioplegic delivery is preferable to intermittent dosage. Encouraging preliminary clinical results with warm-blood cardioplegia are reported, but rigid clinical and experimental testing against conventional methods is not yet available for evaluation. The ideal cardioprotective strategy has yet to be determined, but these preliminary data suggest strongly that incorporation of these techniques with conventional methods will improve intraoperative myocardial protection and provide the cardiac surgeon with an augmented arsenal of strategies that can be employed to provide increased flexibility. PMID- 10147837 TI - Long-term results of coronary artery bypass grafting. AB - Coronary artery bypass grafting has been an established procedure for more than 20 years. This article summarizes recently published information regarding the long-term results of coronary artery bypass grafting, including several analyses of large data bases that extend over periods of 15 to 20 years. Other research pertinent to the etiology of conduit occlusion and information regarding the management of patients with recurrent ischemia following coronary artery bypass grafting is discussed. The studies reviewed for the present article confirmed the beneficial effect of internal mammary artery grafting on long-term survival and defined the factors influencing long-term survival in patients with saphenous vein grafts. Other studies determined the effect of initiating aspirin postoperatively on graft patency, evaluated novel conduits for grafting, and elucidated the remodeling of saphenous vein that occurs over time in the arterial circulation. PMID- 10147838 TI - Imaging and echocardiography. PMID- 10147839 TI - Magnetic resonance imaging and ultrafast computed tomography in cardiac tomography. AB - Cardiac magnetic resonance imaging and ultrafast computed tomography have been available for several years. While both modalities have become established research tools, neither has gained much acceptance in everyday clinical practice. Continued development has made both techniques easier to use and far more versatile. For patients to benefit from these improvements, it is important that clinicians become more familiar with the current state of the art. PMID- 10147840 TI - Comparative imaging techniques and models. AB - The explosion of high-resolution imaging technology in recent years has led to the increasing problem of choosing imaging modalities appropriate to specific clinical questions. In terms of structural information, for example, the relative benefits of ultrasound versus magnetic resonance imaging versus computed tomography scanning are often readily apparent, but in the related area of flow velocity imaging, difficulties may arise. These are perpetuated by the relative lack of information on the fundamental display characteristics of these imaging techniques. Much of this essential information can be acquired from in vitro modeling of the pressure and flow characteristics of a variety of pathologic lesions. The information obtained from such experimental investigation can provide a basis for a more rational approach to the interpretation of these imaging modalities in the clinical setting. We review the recent role of in vitro modeling for enhancing our understanding of the display characteristics of various imaging technologies, with particular emphasis on Doppler ultrasound and color Doppler flow mapping where in vitro modeling has been most extensively studied. PMID- 10147841 TI - Divided Palmaz-Schatz stent for discrete coronary stenosis. AB - This article shows the findings observed in a group of 7 patients with short coronary lesions who were treated by a divided (7 mm length) coronary Palmaz Schatz stent, in trying to match the length of the stent to that of the treated segment. All of the patients were male and had a mean age of 59 +/- 5 years; 6 had unstable and 1 stable angina. The angiographic length of the lesion was 4.3 +/- 1 mm. The divided stent was successfully deployed in all cases and remained in place without complications. The clinical condition stabilized and all 7 patients were symptom-free 6 months post-hospital discharge. At angiographic follow-up studies, performed before discharge and at 2 and 6 months later, there were no significant changes in the resultant minimal lumen diameter. The stented segment and surrounding areas remained smooth and without intraluminal defects. These observations suggest that a 7 mm length stent is effective in avoiding elastic recoil of discrete coronary lesions. This reduced length could be helpful in: 1) decreasing exposed metallic surface, 2) increasing deliverability and 3) preventing the origin of nearby side-branches to be covered by a standard 15 mm length stent. PMID- 10147842 TI - A new flexible and deflectable tip guidewire for coronary angioplasty and other invasive and interventional procedures. PMID- 10147843 TI - Controlled clinical trials: scientific, ethical and behavioral imperatives. PMID- 10147844 TI - Biplane transesophageal echocardiography: technique, anatomic orientation, complications, and future directions. PMID- 10147845 TI - Transesophageal echocardiography in infective endocarditis. PMID- 10147846 TI - Virtual reality redefines the meaning of real-time. PMID- 10147847 TI - Cine CT shows calcium prior to onset of CAD. PMID- 10147848 TI - Miniature probes assist in neonatal sonography. PMID- 10147849 TI - Restenosis: stalwart foe in peripheral vasculature. PMID- 10147850 TI - MRA abets visualization of intracranial aneurysms. PMID- 10147851 TI - Doppler scanning reveals physiology of transplants. PMID- 10147852 TI - Core biopsy typifies 21st century radiology. PMID- 10147853 TI - MRI premier imaging tool for sports injury evaluation. PMID- 10147854 TI - Pharmacologic agents aid perfusion imaging. PMID- 10147856 TI - Substandard radiology endemic in third world. PMID- 10147855 TI - Ultrasound shows masses in pediatric abdomen. PMID- 10147857 TI - Uterine specimen MR exhibits limited use. PMID- 10147858 TI - Low-field MRA images carotid arteries. PMID- 10147859 TI - Monoclonal antibody-coated magnetite particles as contrast agents for MR imaging and laser therapy of human tumors. AB - Attempts to improve human tumor detection by non-radioactive magnetic resonance techniques have led several investigators to develop antibody-linked paramagnetic contrast agents. Initial studies focused on gadolinium conjugated to monoclonal antibodies. However, very high levels of this contrast agent were needed to significantly reduce proton relaxation times and obtain improved MR images. The use of magnetite (Fe 3O 4) as an MR contrast agent provides a magnetic moment that is approximately one order of magnitude larger than gadolinium. In this study monoclonal antibodies 44 x 14 (specific for squamous cell carcinoma) and 436G10 (specific for melanoma) were obtained from ammonium sulfate precipitation of tumor ascitic fluid. Equal volumes of magnetite solution (1.87 mg Fe/ml) and antibody solution 44 x 14 (5.24 mg protein/ml) and 436G10 (0.64 mg protein/ml) were mixed and sonicated. The 44 x 14-magnetite and 436G10-magnetite solutions were then added to equal volumes of M20 and P3 squamous cell carcinoma cell lines. T1 and T2 values were obtained on a Praxis II NMR spectrometer equipped with a 10 mm probe and 0.25 Tesla permanent magnet. The T2 relaxation times of the magnetite-antibody-cell mixtures were 31 ms with an R = 0.985 for both experimental samples. Our results demonstrate a significant decrease in T2 by binding of the magnetite-coated antibodies to these melanoma and carcinoma cells in vitro. The possibility of detecting subclinical local and metastatic disease with magnetite linked to monoclonal antibodies followed by MRI guided laser tumor ablation therapy may render this technique clinically attractive for treatment of deep-seated tumors. PMID- 10147860 TI - Percutaneous excimer laser coronary angioplasty: results of one center in a multi center investigation. AB - A retrospective analysis of data accumulated over a 21-month period, from December 1989 to September 1991, regarding investigational use of a 308 nanometer Xenon Chloride Excimer Laser Coronary Angioplasty (ELCA) system (Advanced Interventional Systems, Inc., Irvine, CA) was performed. It included a cohort of 131 persons with coronary artery disease who underwent 158 laser angioplasty procedures for attempted treatment of a total of 206 atherosclerotic lesions. Approximately 17% of the lesions treated with ELCA were chronic occlusions, 20% were diffuse lesions greater than 20 mm in length and 30% of the initial ELCA lesions were restenoses of previous balloon-treated sites. Our initial results with ELCA demonstrate similar rates of success, complication, mortality, and restenosis when compared with the larger historical experience with standard coronary balloon technique. In selected subgroups, such as chronically occluded coronary lesions, the acute success rate when using ELCA appears superior to published success rates when similar lesions have been treated with conventional technology. PMID- 10147861 TI - Percutaneous laser disc decompression: an update--Spring 1992. AB - Percutaneous laser disc decompression (PLDD) is being performed in multiple centers in the United States, Germany, Austria, France, and Switzerland with the Nd:YAG having the longest follow up at more than 75 months. The experience with this procedure, in both humans and animals, carried out over the past decade is presented along with a detailed discussion of the surgical procedure. Conditions that favor such surgery and contraindications to the procedure are also presented. There are a number of important advantages to PLDD that make it a procedure that merits continued investigation. Because PLDD is relatively noninvasive, it can be repeated. Because there is no cutting, there is no perispinal scar formation, with possible future pain secondary to entrapment of nerves by scar. Because of its effectiveness for treatment, the laser, in this application, should prove to be an important addition to the spinal surgeon's armamentarium. PMID- 10147862 TI - Laser surgery of Neurofibromatosis 1 (NF 1). AB - Over six years of experience, the technique of treating NF 1 by laser surgery has been developed and has become a standardized treatment protocol. Whole-body therapy is undertaken over several sessions, during which a distinctive LPLL technique is applied to radically remove every NF fibroma, success being assured by nothing less than total extirpation of the tumors present. Either the argon or the carbon dioxide laser is employed, depending on the stage of the tumors. In 58 sessions of approximately 150 laser hours 21 patients have been treated. There have been no recurrences. A radically removed tumor diminishes the total number of programmed tumors by one. This is the basis underlying the therapy described. Psychosocial care of NF 1 patients remains a factor of great importance. In itself, however, it is not sufficient to achieve emotional recovery and physicocosmetic well-being. PMID- 10147863 TI - Laser instrumentation for intra-abdominal microlaser gynecologic surgery. AB - With proper laser instrumentation, the gynecologic microlaser surgeon enhances his ability to accomplish intra-abdominal fertility-promoting procedures in a safe and efficient manner. PMID- 10147864 TI - Ergonomics of medical lasers: operator's viewpoint. AB - Lasers are instruments that may enhance the surgeon's ability to perform surgery. Many medical lasers sit unused. Lack of use is associated with "user unfriendliness." Nurses and surgeons often cite factors such as complexity, location, and types of controls, and content of displays. Other factors such as culture-ethnology and its relationship to command words and symbols, affect understandability of controls, displays, and user friendliness. Laser designers and engineers must analyze the interaction between laser users and products. Laser design and operation must coincide with specific needs and expectations of the nurses and physicians. Poor design and engineering compromises result in nonuse of expensive instrumentation, products which are ineffective for clinical use, and could potentially increase the risk of possible injury to patients and staff. This discussion of the design and operation of medical laser systems, presents the advantages and disadvantages of several laser systems. User interfaces for controls: color, function, touch activation, labels and size, sound cues, laser activation, type and amount of feedback information during operation; design of storage for accessories, and need for features such as pulsing, and milliwatts will be discussed. We will present what we consider to be an ideal laser system. PMID- 10147865 TI - Alternative wavelengths for sutureless laser microvascular anastomosis: a preliminary study on acute samples. AB - Attempts to improve the speed and patency of microvascular anastomosis with laser assisted techniques have provided a modest reduction in operative time and comparable success rates. Using sutureless microvascular anastomoses, 30 end-to end anastomoses were created in the rat carotid artery using the gallium-aluminum arsenide diode laser (808 nm). Indocyanine green and fibrinogen were applied to enhance tissue absorption of the laser energy and strengthen the bond created. These were compared with previously reported welds using the THC:YAG laser (2150 nm). Mean welding times were 140 and 288 s, and mean bursting pressures immediately after welding were 515 and 400 mmHg for the diode and THC:YAG laser groups, respectively. Histologically, both lateral and vertical spread of thermal damage was limited. Since both lasers create welds of adequate initial strength without stay sutures and are faster and easier to use than existing systems, evaluation of long-term patency would be worthwhile. PMID- 10147866 TI - A pilot study of the holmium YAG laser in nasal turbinate and tonsil surgery. AB - A pilot study of the holmium YAG laser (a solid-state pulsed laser, wavelength 2.1 mum) was performed for tonsillectomy and nasal turbinate surgery. In the nose, intraoperative bleeding was negligible, facilitating an excellent view of the operative field and avoiding the need for postoperative nasal packs. There was no occurrence either of primary or secondary hemorrhage. Some intranasal crusts separated with no difficulty between 3 and 6 weeks. There was no significant delayed tissue destruction. Tonsillectomy was almost bloodless. There was some minor difficulty in mobilizing the upper tonsillar pole. Postoperative pain was no worse than routine tonsillectomy pain and may have been less than would be expected. The tonsil beds healed within two weeks. The comparable roles of the CO 2, the neodymium YAG, and the KTP/532 laser for nasal and oropharyngeal surgery are discussed. These preliminary results suggest a potential role for the holmium YAG laser in nasal turbinate and tonsillar surgery and the need for further evaluation. PMID- 10147867 TI - Clinical experience of laser angioplasty with angioscopic guidance. AB - Since 1986, intraoperative angioscopic observations have been followed by the study of laser angioplasty experimentally and clinically. The healing process of the lased arterial wall initially was evaluated angioscopically in the canine model. The lased area was observed as a crater covered with char soon after laser irradiation. One week after laser irradiation, subintimal bleeding around the crater and a small fresh thrombus on the crater were seen in some cases. Four weeks after laser irradiation, the crater was covered with new endothelium. In this experimental study angioscopy provides information which cannot be obtained by other means. PMID- 10147868 TI - A new instrument for pulmonary resection: the bipolar Nd-YAG laser dissector. AB - A bipolar Nd-YAG laser dissector was developed to quickly dissect or resect organs, and the possibility of laser pulmonary dissection without scissors and ligation threads was studied experimentally. Pulmonary tissue was completely and easily divided using a bipolar laser handpiece, and the dissected edge was perfectly sealed. Leakage of air and blood from the edge was not induced and no additional stitching was required. Histological examination of the dissected edge revealed tissue remodeling after laser irradiation. The formation of amorphous layers, including vacuoles, was peculiar to the fusion-coagulation area, and alveolar atelectasis and capillary obstructions were characteristic of the degenerative area. When tissue dissection was performed by laser vaporazation, tissue remodeling seemed to be the most important factor in the prevention of leakage. In conclusion, we can effectively and quickly resect pulmonary tissue using the bipolar Nd-YAG laser dissector without scissors and without ligation threads. PMID- 10147869 TI - Laser tissue fusion approaches clinical utility. PMID- 10147870 TI - New developments in laser disc surgery. PMID- 10147871 TI - Developments in endoscopic laser herniorrhaphy. PMID- 10147872 TI - The continued quest for an image of brain. PMID- 10147873 TI - Combined CO 2-Nd:YAG radiation in liver and anorectal diseases. AB - A 1986 report of the authors' experience in human liver surgery emphasized the promise of a combined delivery of CO 2 and Nd:YAG wavelengths, using an artificial procedure of linking two separate handpieces. A newer machine is available now which emits simultaneous CO 2 and Nd:YAG radiations in a single, coherent, coaxial beam (Combolaser, Lasermatic). This study compares the effects of the combined coaxial delivery in such fields as benign proctology, vaporizations of anorectal and liver tumors, and laser liver resections, where clinical experience with wavelengths used separately or successively have been reported. Between September 1989 and October 1991, 104 patients have had such operations. The results demonstrate a reduction of energy densities when combined delivery is compared with single laser irradiation for the same purpose. The necrotic zone is reduced with better hemostasis. Finally, a significant reduction of operative time for tumoral vaporizations has been noted. In conclusion, the combined beam modifies the laser-tissue interaction, and allows the surgeon to work with suitable power ratios, according to the tissues' stroma, and vascularity. PMID- 10147874 TI - The effect of Nd:YAG laser-induced hyperthermia on local tumor recurrence in experimental rat mammary tumors. AB - The influence of Nd:YAG laser hyperthermia (45 degrees C for 20 min) on local tumor recurrence followed by CO 2 laser or scalpel excision was studied on 150 F344 female rats that were implanted with R3230AC mammary tumor in the mammary ridge. The development of local tumor recurrence was observed for 39 days postoperatively. All groups undergoing CO 2 laser excision showed a significant reduction in local tumor recurrence (p less than 0.05) compared with the scalpel technique. Animals that underwent CO 2 laser excision and wound sterilization 48 h following laser hyperthermia demonstrated the lowest recurrence when compared with scalpel excision (p less than 0.01). These results indicate that the local thermal effect achieved by laser hyperthermia or laser sterilization plays an important role in the reduction of local tumor recurrence and augments complete local tumor resection. PMID- 10147875 TI - Power and time requirements for use of the argon laser to polymerize composite resins. AB - A carefully controlled laboratory study was conducted to determine the optimum power setting and polymerization cycle time to cure four commercially available composite resins with an argon laser. Most effective resin polymerization was achieved when Prisma APH was polymerized at 310 mW for 7 seconds, when Herculite was polymerized at 160 mW for 12 seconds, when P-50 was polymerized at 525 mW for 13 seconds and when Silux Plus was polymerized at 270 mW for 13 seconds. The exact parameters of laser power and exposure time seem to be material specific, with greater variation being noted in power setting than in exposure time. PMID- 10147876 TI - Laser education, laser usage, and surgical attitudes: a challenge for the future. AB - The results of a questionnaire distributed to enrollees at laser training programs at the Rochester General Hospital between 1986 and 1989 were compared with the results of a previous survey and current patterns of laser utilization and acceptance among surgical house staff. Laser utilization has improved slightly. However, both house staff and attending surgeons prefer, and are most comfortable with, nonlaser technology. Continued efforts to enhance the utilization of laser technology and the availability of laser education at teaching hospitals are key for the future. PMID- 10147877 TI - New tool combination: XeCl-excimer laser and tapered fiber enhances potential for atraumatic hard tissue operations. AB - XeCl excimer lasers have already been used to ablate bone, however, until now the results have been unsatisfactory until now. First, ablation of bone in air produced macroscopic noticeable carbonizations similar to those produced by thermal infrared lasers. Second, ablation rates were very low even on meniscus tissue. A new tool combination, XeCl excimer laser and tapered fibers, obtain higher ablation rates, because of its efficient light guiding capability. Using a liquid medium (water, normal saline solution) during laser application prevents macroscopic noticeable carbonizations. PMID- 10147878 TI - Effects of He-Ne laser irradiation on chick embryo mesonephros. AB - A study on the effects of He-Ne laser irradiation on glomeruli and renal tubules of the chick embryo mesonephros at 7 days of in ovo development was made. To this purpose, He-Ne laser irradiation (potency: 5 mW, wavelength: 632.8 nm) was beamed for 5 minutes through a window opened in the egg shell, and the eggs were maintained aseptically for 24 h in an incubator. Mesonephros were dissected out and processed for hematoxylin/eosin, periodic acid-Schiff, and Alcian blue at pH 2.5 and 1.0, toluidine Blue at pH 3.8. In controls, the glomeruli were formed by coiled capillaries with a homogeneous basement membrane, the proximal tubules presented a high cubic epithelium with acidophilic cytoplasm and a developed brush border. Distal and collecting segments were lined by cubic epithelium. An alcianophilic and PAS-positive reaction stood out at the membrane coats of the proximal tubules and tubular and glomerular basement membranes. No glomerular alterations were observed during the experiment. However, there was a marked enlargement of the tubular interstitium, with edema and lymphohistiocytic inflammatory infiltration. Some tubular cells desquamated to the lumen. Other cells presented a raveled apical surface. Some nuclei were dispersed out, and mixing with chromatin, formed diminutive granules. Pyknotic nuclei were seen occasionally. Epithelial necrosis and cytoplasmic debris in the lumen were also noted. For mucins, some zones showed brush border coats of the proximal tubules as discontinuous.(ABSTRACT TRUNCATED AT 250 WORDS) PMID- 10147879 TI - Application of intravenous low-intensity laser irradiation as part of anesthetic care during invasive surgery. AB - The aim of this study was to evaluate the possibility of applying low-intensity He-Ne laser irradiation as part of a complex system of anesthetic care of patients during invasive surgery. The following technique of intravenous low intensity laser irradiation (i.v. LILI) was used. A filament of He-Ne laser was introduced through the subclavian venous line into the ostium of the vena cava superior. The power output was 20 mV, the exposure period 30 minutes. The irradiation began 10-15 minutes before anesthesia was introduced. In some cases, a second session was required. The 61 patients enrolled in the study were divided into a study group of patients who were irradiated and into a control group of patients who did not receive i.v. LILI. It was shown that i.v. LILI decreases neuroautonomous strain on the patient. Under the influence of i.v. LILI the P 50 appears to increase, the index of tissue oxygen extraction does not change, and the data of the acid base balance tend to improve. Low plasma levels of 11 oxycorticosteroids and the plasma content of 5-HTA and histamine as well as moderate changes in plasma enzyme activity confirm the efficacy of protecting patients from surgical trauma by application of i.v. LILI. PMID- 10147880 TI - The treatment of epulis fissuratum of the oral cavity by CO 2 laser surgery. AB - A clinical study was conducted on a group of 20 patients who presented with epulis fissuratum caused by denture wearing. CO 2 laser surgery was used to treat these patients and the cases were followed up over a two-year period. The advantage of CO 2 laser surgery on oral tissues was evident by the good response to healing four weeks postoperatively and beyond. No sutures or packing of any kind were used and the wound was allowed to granulate. Re-epithelialization occurred in all patients within 14 days and was complete after about 4 weeks. The lack of wound contraction, scarring, and good re-epithelialization combined with precise tissue destruction make CO 2 laser surgery ideal for this procedure when compared with conventional surgical techniques. The advantage of using CO 2 laser surgery has been demonstrated clinically in the patients treated in this study. PMID- 10147881 TI - Photorefractive keratectomy drives development of ophthalmic lasers and techniques. PMID- 10147882 TI - Argon laser offers breakthrough in treating inner ear disorders. PMID- 10147883 TI - Laser facilitates cosmetic surgery. PMID- 10147884 TI - All good PACS come to those who wait. PMID- 10147885 TI - Balloon-facilitated antegrade endopyelotomy. PMID- 10147886 TI - Archive systems solve image storage dilemma. PMID- 10147887 TI - Changing face of PACS: past, present and future. PMID- 10147888 TI - A colorectal cancer update for the urologist. PMID- 10147889 TI - Hospital network plans high-resolution PACS. PMID- 10147890 TI - Pediatric ESWL: suitability hinges on long-term renal effects. PMID- 10147891 TI - Mobile mammography fosters compliance. PMID- 10147892 TI - Magic bullets pursue recurrent breast cancer. PMID- 10147893 TI - Rapid imaging methods add to MR complexity. PMID- 10147894 TI - Ultrasound shows changes in postmenopausal pelvis. PMID- 10147895 TI - Noninvasive tests detect, quantify and localize PVD. PMID- 10147896 TI - Choosing the proper trocar and cannula. PMID- 10147897 TI - Four new technologies for infertility: How practical are they? PMID- 10147898 TI - A look at ultrasonography equipment. PMID- 10147899 TI - Safer devices help avoid needlestick accidents. PMID- 10147900 TI - Ureteral stones yield to a balloon dilator and rigid scope. PMID- 10147901 TI - New staplers for endoscopic surgery. PMID- 10147902 TI - What your colleagues are buying. PMID- 10147903 TI - A bed made to order for kids in traction. PMID- 10147904 TI - Biocompatible circuits: an adjunct to non-cardiac extracorporeal cardiopulmonary support. AB - The utilization of cardiopulmonary bypass systems, for circulatory and/or pulmonary support of patients undergoing non-cardiac procedures, has been previously reported. There is, however, a sub-group of patients for whom total systemic anticoagulation for cardiopulmonary support is extremely undesirable or contraindicated altogether, due to the presenting pathology or procedure to be performed. Clinical and experimental reports have suggested that with the use of heparin-bonded bypass circuits, the amount of heparin required for anticoagulation of the patient may be substantially reduced, or eliminated, safely. This allows the resuscitation and/or support of patients in whom bypass would otherwise be contraindicated. We present our clinical experience with heparin-bonded, biocompatible circuits, for support of patients undergoing non cardiac procedures. In each case, low-dose or no heparin was administered. The group includes patients with trauma related pulmonary insufficiency, pulmonary embolism, hypothermia, neurosurgery, aortic aneurysm, aortic transection, respiratory distress syndrome, pericardiectomy, and cardiogenic shock. PMID- 10147905 TI - Overview of liver transplantation for the perfusionist. PMID- 10147906 TI - Standards of care in perfusion: should not continuous in-line blood gas monitoring be one? PMID- 10147907 TI - A multi-center trial with a modified design of the Sarns membrane oxygenator. AB - A redesigned hollow fiber bundle was incorporated into an existing oxygenator that underwent clinical trials at seven cardiovascular surgery centers. Clinical investigators were asked to assess gas transfer performance under clinical conditions that could be considered challenging to any microporous membrane oxygenator, i.e., with large body weight patients, long bypass times, or normothermic bypass and surgery. Sixty-six patients, ranging in weight from 54.5 kg to 143 kg, constituted the initial evaluation population. Enhanced oxygen transfer was noted by all of the investigators. Fi0 2 requirements for patients weighing 100 kg or more never exceeded .85, despite oxygen consumption levels reaching as high as 396 mL/min. Two centers documented a 15% to 18% reduction in Fi0 2 requirements compared to their standard oxygenator. PMID- 10147908 TI - Blood substitution: an experimental study. AB - Priming fluids for cardiopulmonary bypass have been extremely varied, with resultant hemodilution. Furthermore, major surgeries utilizing cardiopulmonary bypass require multiple postoperative transfusions of blood and blood products. The appeal of having a readily available blood substitute for major cardiovascular and neurosurgical operations could prove to be a life saver, while also eliminating the risk of diseases transmitted by transfusion. Blood substitutes could also lessen the reported complications resulting from blood damage due to prolonged circulation of the blood by the extracorporeal pump. A technique was examined in 15 dogs using hypothermia for maximum metabolic suppression, incorporating an aqueous blood substitute (Cryomedical Sciences, Inc., Rockville, MD). The anesthetized animals were cannulated for extracorporeal pump oxygenation. As temperature was lowered the dogs were exsanguinated and volume replaced with blood substitute to lower the hematocrit to less than 1%. After 3 hours of cardiac arrest and continuous perfusion at a core temperature less than 10 degrees C, rewarming began. When temperature reached greater than or equal to 10 degrees C, the blood substitute was drained and the animals were autotransfused. The heart was started at 15 degrees C and spontaneous respiration resumed at 29 degrees C. Using the first generation blood substitute the survival rate was maximal (100%) at 2.5 hrs under 10 degrees C and 3 hours of cardiac arrest. Research is underway on a new blood substitute, which is to serve as a universal hypothermic preservation solution (in situ organ preservation).(ABSTRACT TRUNCATED AT 250 WORDS) PMID- 10147909 TI - Psychosocial effects of cardiac transplantation. AB - As more cardiac transplant procedures are performed, the psychosocial implications of the procedure can be identified and investigated. The process of cardiac transplant can be viewed as a series of stages and adaptive tasks which begin with the proposal of transplant and progress to successful postoperative adaptation. The suggestion of transplant may evoke feelings of anxiety and ambivalence as patients realize that transplant may be their only option for long term survival. The evaluation process determines the need for transplant and whether there are circumstances that might limit post-transplant survival. Psychosocial evaluation is important as survival depends in part on the recipient's ability to cope with stressors and comply with a complex medical regimen. This evaluation is not standardized, and research continues to identify reliable predictors of postoperative behavioral and psychiatric complications. The wait for a donor may be the most stressful of all stages as candidates deal with increasing symptoms, increasingly intensive medical management and the fear of a donor will not be found in time. Following successful surgery, heart recipients and their families express feelings of joy and relief. During convalescence, adjustment difficulties may arise in the form of transient depression or body image concerns. After recipients are discharged from the hospital, they must comply with intensive medical follow-up to monitor their health. They continue to be vulnerable to physical, emotional and financial problems.(ABSTRACT TRUNCATED AT 250 WORDS) PMID- 10147910 TI - Critical care management of lung transplant recipients. AB - In the last 10 years, lung transplantation has become an increasingly common procedure for patients with end-stage respiratory disease. Although long-term survival can be achieved, there is still significant morbidity within the first year. Early postoperative problems that may be anticipated include respiratory insufficiency, airway anastomotic problems, hemorrhage, infection, and episodes of acute rejection. These problems and others make the immediate perioperative period particularly challenging. With aggressive management, however, the probability of a successful outcome can be enhanced. PMID- 10147911 TI - Elimination or propagation of pneumonia in the intensive care unit? A challenge for critical care technology. PMID- 10147912 TI - Pneumonia in the intensive care unit setting. AB - Nosocomial pneumonia is a common and serious occurrence in the ICU. It most often results from aspiration of oropharyngeal secretions that have become colonized with pathogenic enteric gram-negative bacilli. Colonization occurs in association with acute and chronic illness and particularly with therapy that includes nasogastric or endotracheal tubes, H 2 blocking antacid drugs, or antibiotics; aspiration is increased by anesthesia, sedative drugs, and upper airway instrumentation. The diagnosis of ICU-acquired pneumonia is complicated greatly by the nonspecificity of clinical and laboratory data, and the difficulty in distinguishing the organisms producing infection from those merely colonizing the airway when using routine culture techniques. Among specialized diagnostic techniques, quantitative culture of specimens obtained with the protected sampling brush offers the most promise in establishing a specific microbacteriologic diagnosis of nosocomial pneumonia. Empirical treatment with broad spectrum antibiotics is frequently necessary when a specific diagnosis cannot be made. The poor outcome associated with nosocomial pneumonia, regardless of treatment, suggests that methods to prevent dissemination and oropharyngeal colonization of the offending organisms should be emphasized. PMID- 10147913 TI - Rapid and definitive diagnosis of infectious diseases using peripheral blood smears. AB - A timely diagnosis is essential in the management of septicemia and septic shock. Three patients are described, all of whom presented with fever and one of whom was hypotensive at the time of admission. In each patient, rapid diagnosis of the cause of fever was possible because microorganisms were identified on a peripheral blood smear obtained at the time of admission. This identification permitted prompt initiation of appropriate antimicrobial therapy. In addition, a literature review of use of peripheral blood smears in the diagnosis of bacterial, fungal, and parasitic infections is provided. PMID- 10147914 TI - Continuous cerebral venous oximetry. PMID- 10147915 TI - The technique of slow continuous ultrafiltration. Steps to maintain fluid balance without hemodynamic instability. AB - Slow continuous ultrafiltration (SCUF) is ideally suited for fluid overloaded patients with renal insufficiency, and for patients who need intravenous fluids in amounts that exceed renal excretory capacity. Like other methods of continuous ultrafiltration, including CAVH and CAVHD, SCUF can be performed in the intensive care unit with a minimum of equipment. During SCUF, arterial blood (usually from the femoral artery) is passed through a hollow-fiber hemofilter; an ultrafiltrate of serum collects at a rate that is determined by the patient's blood pressure. Replacement of intravenous fluids is generally not required with SCUF. The amount of ultrafiltrate that is removed can be titrated to achieve the desired fluid balance. PMID- 10147916 TI - Techniques of continuous arteriovenous hemofiltration and hemodialysis. Renal replacement in the ICU for hypervolemic, uremic patients. AB - Continuous arteriovenous hemofiltration (CAVH) and continuous arteriovenous hemodialysis (CAVHD) are extracorporeal ultrafiltration techniques that permit ongoing removal of plasma water and uremic toxins. Both techniques are performed in the ICU with a minimum amount of equipment and achieve overall fluid balance more readily than intermittent hemodialysis. CAVH is used to manage hypervolemia, electrolyte imbalance, and/or mild uremia. CAVHD is used in hypercatabolic patients with acute renal failure who are hypervolemic and uremic; a dialysate fluid is used for more efficient solute removal. The most serious complications of CAVH and CAVHD relate to bleeding associated with cannulation or anticoagulation. Excess fluid and electrolyte losses may also occur. PMID- 10147917 TI - The technique of therapeutic apheresis. Removal of abnormal blood elements may succeed when all else fails. AB - Therapeutic apheresis is a generic term that refers to removal of abnormal blood cells and plasma constituents. The terms "plasmapheresis," "leukapheresis," and "erythrocytapheresis" describe the specific blood element that is removed. Apheresis therapies can be performed in the ICU to manage a number of neurologic, hematologic, and autoimmune disorders, including myasthenia gravis, Guillain Barre syndrome, sickle-cell disease, and Goodpasture's syndrome. Apheresis procedures generally require two points of contact with the circulation--one for blood withdrawal and one for return; the withdrawal site should sustain a flow rate of at least 50 mL/min. Although apheresis is generally quite safe, hemodynamic instability, hypocalcemia, and dilutional coagulopathy can occur. PMID- 10147918 TI - The technique of percutaneous endoscopic gastrostomy. A safe and cost-effective alternative to operative gastrostomy. AB - Percutaneous endoscopic gastrostomy (PEG) is an attractive method of providing enteral nutrition to patients who are candidates for operative gastrostomy or nasoenteric tube feeding; it is currently the procedure of choice for selected nutritionally compromised patients. PEG may be considered for patients who need short- or long-term enteral support; those unable to swallow or who cannot maintain adequate oral intake are ideal candidates. Several techniques are used to perform PEG; each involves the placement of a gastrostomy tube at a point where the stomach and abdominal walls are in closest contact. PEG can be done at the bedside without general anesthesia. Feeding can begin within 24 hours of PEG placement. Major complications (peritonitis and pulmonary aspiration) occur infrequently. PMID- 10147919 TI - What role for echocardiography in primary pulmonary hypertension? New ultrasound methods accurately estimate pulmonary pressures. AB - Several echocardiographic techniques provide accurate, noninvasive estimates of peak or mean pulmonary artery pressure and can aid in diagnosing primary pulmonary hypertension. One such method involves converting peak tricuspid velocity to an estimated peak right ventricular minus right atrial gradient; peak pulmonary artery pressure is roughly equal to the sum of the tricuspid gradient estimate and estimated mean right atrial pressure. A second technique evaluates the contour of the transpulmonary Doppler velocity profile; a third measures the interval between pulmonary valve closure and tricuspid valve opening. An M-mode method can be used to assess wedge pressure. Echocardiographic variables can also help evaluate prognosis in primary pulmonary hypertension. PMID- 10147920 TI - Percutaneous transvenous balloon mitral commissurotomy: When? For whom? An alternative to surgery in symptomatic mitral stenosis. AB - Percutaneous transvenous mitral commissurotomy (PTMC) is the therapy of choice for patients with mitral stenosis who are candidates for commissurotomy. PTMC also offers palliative therapy for patients who are not good surgical candidates. Patients with thin, pliable valve leaflets and little subvalvular disease are the best suited. Significant thrombus in the left atrium is a strong relative contraindication. PTMC with the Inoue balloon is technically easier to perform than is conventional balloon valvotomy and is better tolerated by most patients. During this procedure, the Inoue balloon is positioned against the mitral valve; it is repeatedly inflated at increasing balloon diameters until the transmitral valve gradient is sufficiently relieved. PTMC affords marked symptomatic improvement in most patients who undergo the procedure. PMID- 10147921 TI - The technique of minitracheotomy to clear secretions. Gain direct access to the trachea; preserve cough and speech. AB - Minitracheotomy, a new method of percutaneous tracheal cannulation, provides ready access to the trachea for removal of airway secretions in spontaneously breathing patients with sputum retention and atelectasis. The original technique calls for a vertical 1-cm stab incision over the cricothyroid membrane; a curved introducer is then passed through this incision into the trachea. A cannula is passed over the introducer, which is then removed. The external flange is secured to the patient's neck. A modified technique uses a Seldinger method for tube placement. Complications vary with the technique that is used; cough, subcutaneous emphysema, stridor, and rare instances of profuse hemorrhage have been reported. PMID- 10147922 TI - Pupil perimetry. AB - The pupillomotor and visual sensitivity were compared at the same 76 points across the 30 degrees field. The timing and amplitude of pupillary contractions to focal light stimuli were recorded using a computerized infrared pupillometer linked to a Humphrey automated perimeter. Pupil perimetry and standard threshold perimetry showed matching defects in the visual field of patients with ischemic and compressive optic neuropathy, but not in patients with primary open-angle glaucoma. Patients with isolated occipital strokes showed matching homonymous visual and pupillary fields, suggesting a suprageniculate influence upon the pupillary light reflex. Pupil perimetry is a useful objective form of perimetry and can be used to compare the effect of disease on the visual and pupillary pathways. PMID- 10147923 TI - Imaging advances in neuro-ophthalmology. AB - Magnetic resonance imaging has provided many advances in the field of neuro ophthalmology. Refinements in magnetic resonance imaging allow excellent evaluation of the brainstem, cranial nerves, and sellar and suprasellar regions. Gadopentetic acid enhancement allows identification of subtle lesions, which may not otherwise alter morphology, as this agent may cross an abnormal blood-brain barrier. This year I have focused on imaging advances in evaluation of optic gliomas, radionecrosis of the optic nerves and chiasm, internuclear ophthalmoplegia, and facial pain and hemifacial spasm. PMID- 10147924 TI - Orbital diagnosis and imaging. AB - A myriad of imaging modalities now exists to aid in the diagnosis of orbital disease. Most of the recent advances in orbital diagnosis are based on refinements of established techniques, although several represent the application of new technology. Invasive techniques, such as orbital arteriography and venography, have been supplanted with computed tomography, which has become the mainstay of orbital diagnosis. The use of magnetic resonance imaging in the assessment of orbital pathology has also increased. Color Doppler, a recent development in ultrasonography, has now been applied to the eye and orbit. PMID- 10147925 TI - Two-gradient-echo, two-dimensional, Fourier transform multisection imaging: comparison with spin-echo imaging. AB - A multisection, two-dimensional, Fourier transform, double-gradient-echo magnetic resonance imaging sequence with partial flip-angle excitation and section doubling by radiofrequency encoding approximately doubles the signal-to-noise ratio obtainable from a conventional spin-echo sequence at low field strength, while maintaining essentially equivalent contrast. PMID- 10147926 TI - Extracorporeal shock wave lithotripsy in the renal transplant patient: a case report and review of literature. AB - Renal allograft lithiasis is a rare complication of renal transplantation, which in the past has required various invasive procedures for adequate stone fragmentation and dissolution. Noninvasive techniques such as extracorporeal shock wave lithotripsy (ESWL) can now be extended to the renal transplant patient. Five cases have been previously reported in which ESWL was used effectively for dissolution of renal allograft calculi. We now report a 6th case in which a calculus, initially identified 2 weeks after renal transplantation, was effectively fragmented 3 years later using ESWL. Based on our experience and the reviewed composite experience in the literature, ESWL is a safe therapy for renal allograft calculi. PMID- 10147927 TI - Monitoring renal allograft rejection with duplex sonography. AB - Thirty-six renal allograft recipients were monitored by serial duplex Doppler ultrasound studies post-transplant and during early rejection. A separate reproducibility study demonstrated no significant inter- or intra-operator variability in measurements of resistive index of an interlobar artery (RI) (2.1% [1.5%] and 3.2% [2.3%] respectively, mean [standard error] of coefficients of variance). Twenty-one patients had rejection within 3 weeks of transplantation. These grafts showed greater overall rises in the RI, from day 2 to day 5 post transplant, than the grafts which had no rejection. Eleven of the 21 patients required more than one course of methyl-prednisolone for persistent or recurring rejection. These grafts had higher RI on the day rejection was diagnosed (81 [7.3], median [interquartile range]) compared with the remaining 10 patients (68.6 [8.7]). The 11 grafts with persistent rejection had higher RI (p less than 0.005, Mann-Whitney U-test) on day 2 post-transplant (76 [3.9]) compared with the 10 grafts successfully treated with a single course of methyl-prednisolone (63.2 [10.9]). This study demonstrates that grafts with an RI of greater than 70 on day 2 post-transplant are likely to have rejection requiring additional treatment (sensitivity--100%, specificity--80%). These patients may be candidates for earlier or alternative anti-rejection therapy. PMID- 10147928 TI - Flow cytometry PRA, a new test that is highly correlated with graft survival. AB - IgM antibodies present in the recipient sera are not necessarily harmful to the outcome of the graft. However, one primarily measures IgM with panel-reactive antibody (PRA) determined by microcytotoxicity. In order to develop a potentially more correlative PRA measurement, we have utilized the flow cytometer to measure IgG antibody to a panel of lymphocytes representing HLA antigens. This was accomplished by measuring the median channel shift associated with the patient's serum antibody binding to pooled target cells. The correlation between flow PRA and graft outcome was analyzed in 59 regraft recipients using current serum prior to transplantation. The PRA was determined by both cytotoxicity and flow cytometry. One-year follow up was available on all transplant recipients with 62% 1-yr actuarial graft survival. Cytotoxic PRAs were divided into greater than 10% and less than or equal to 10%, with a 72% vs 70% graft survival at 6 months and 62% vs 62% 1 yr graft survival, respectively. Flow cytometry PRA was divided into greater than 10 and less than or equal to 10 channel shift with 63% vs 86% graft survival at 6 months, and 53 vs 79% 1 yr graft survival respectively (p less than 0.05 for both time intervals). Serum creatinine levels were concomitantly lower at 1 and 3 months in the flow PRA-negative recipients. Flow PRA was a simple, rapid test which eliminates "false" positives due to IgM and detects non-complement fixing IgG, which occurred in 25% of the samples.(ABSTRACT TRUNCATED AT 250 WORDS) PMID- 10147929 TI - Health-related quality of life outcomes of pancreas transplant recipients. AB - The health status and quality of life outcomes of 131 patients who were 1 to 11 years post-pancreas transplant were studied. Patients were compared based on the current status of their pancreas graft, i.e. whether or not their grafts were successful in maintaining an insulin-independent state, and according to recipient category (pancreas alone vs kidney and pancreas). For this study, quality of life was defined as patients' perceptions of their well-being and ability to function in six areas: physical and mental health, social functioning, role (work and home) functioning, overall health perceptions, and physical pain. Patient self-report questions from the Medical Outcome Study were used to provide a score scaled from 0 to 100, for each area. Health status was assessed by sick days, hospitalizations, and emergency room visits. Patients with a successful pancreas graft (N = 65) reported significantly more positive health perceptions (51.9 vs 28.9), less pain (33.9 vs 45.3), and greater ability to function socially (84.9 vs 71.3) than did patients whose pancreas grafts were not successful. In addition, patients with successful pancreas grafts rated their ability to perform routine activities as nearer to normal on the Karnofsky Index (2.82 vs 3.63) and were more likely to view themselves as healthier since the pancreas transplant than were patients whose pancreas grafts were not successful. These effects persisted after statistical adjustment for recipient category and case-mix factors of age, sex, education, and length of time since pancreas transplant.(ABSTRACT TRUNCATED AT 250 WORDS) PMID- 10147930 TI - Depletion of natural antibodies in non-human primates--a step towards successful discordant xenografting in humans. AB - There is evidence to suggest that long-term survival of discordant xenografts may be possible if the organ is transplanted at a time when the host natural anti species (xenoreactive) antibodies are temporarily absent or otherwise inhibited from reacting with the donor antigens. There is also evidence that the target antigens on pig organs may be carbohydrate structures, as are the human A and B blood group antigens. The intravenous infusion of synthetic A or B trisaccharides in hyperimmunized baboons, coupled with pharmacologic immunosuppression, has prolonged ABO-incompatible cardiac allograft survival from a mean of 19 minutes to several days, and even to several weeks in one animal. The nature of the carbohydrate structures of the pig antigens against which human xenoreactive antibodies are directed has been investigated. Two of the most important of these would appear to be alpha galactosyl structures, referred to as linear B. If the central role of these carbohydrates can be confirmed, then it may be possible to adsorb out or inhibit human anti-pig antibodies in the same way as anti-A and anti-B antibodies. It may then be possible to offer organ transplantation to all suitable recipients under elective conditions without the restriction of donor availability. PMID- 10147931 TI - Timing of the revision total hip replacement. AB - The purpose of this article is to define guidelines in regard to timing of revision surgery for total hip replacement. One important variable, in addition to incapacitating pain, is the presence of progressive bone loss associated with loose implants. Indications for revision are presented based on the immediacy of the situation. Timing for revision is categorized as immediate, delayed up to 6 months, delayed beyond 6 months, and elective. Clinical examples of indications are included. Useful diagnostic studies for evaluating the need for revision surgery are discussed. These procedures include several types of arthrography to aid in differential diagnosis. PMID- 10147932 TI - Evaluation of the painful total hip arthroplasty. AB - The evaluation and treatment of the painful total hip arthroplasty requires diligent and disciplined medical management. A careful history and physical examination of the patient with roentgenograms and laboratory studies will provide information needed to treat the majority of these patients. Technetium 99 and indium-III-white blood cell scans may be helpful in more difficult cases. PMID- 10147933 TI - Medical assessment of the patient undergoing revision total hip arthroplasty. AB - As the geriatric population in the United States continues to increase relative to the general population, total joint arthroplasty has become an accepted medical tool in our medical armamentarium. Much of the perioperative milieu of the geriatric population tends to be poorly researched and minimally reported within the medical community. An enhanced appreciation of predictable preoperative and postoperative clinical considerations should optimize the availability of this technology and minimize morbidity and mortality. PMID- 10147934 TI - Blood conservation in revision total hip arthroplasty. AB - Blood loss from major orthopedic procedures such as spine and revision total joint arthroplasty often necessitates perioperative blood transfusion. The risk of infectious disease transmission associated with homologous blood transfusion, particularly hepatitis and acquired immune deficiency syndrome, mandates use of blood conservation techniques. Methods available to the orthopedic surgeon include preoperative autologous donation, intraoperative and postoperative blood salvage, hemodilution, and other selective anesthetic techniques such as hypotensive anesthesia and epidural or spinal anesthesia. The safest blood patients can receive is their own. With full use of these blood conservation methods, the need for homologous blood transfusion for elective orthopedic procedures should be minimal. PMID- 10147935 TI - Surgical exposure and cement removal in revision total hip arthroplasty. AB - The surgical approach in revision total hip arthroplasty (THA) must conform to the preoperative goals of revision surgery. Factors to be considered include adequate visualization, assessment of remaining bone stock, presence or absence of cement, status of the trochanter, leg length discrepancies, and previous surgical approaches. To maintain neurovascular structures, blood supply to the involved bone, postoperative abductor function, stability, and gait normalcy, an anterolateral approach is best used. Three anterolateral approaches are used to address various aspects of revision THA. Approach 1 allows for exposure of the acetabulum and proximal femur. The associated abductor muscle split allows for excellent proximal exposure. Approach 2 is performed when acetabular reconstruction is neither complex nor involved, and when extended access to the femur is necessary. The lateral-distal incision is determined by the need for adequate femur exposure for implant removal, cement removal, and any bone grafting procedures to reconstitute osseous structures. Approach 3 is further developed proximally to expose necessary anatomic regions of the acetabulum while preserving the underlying neurovascular structures. Using special instrumentation and controlled femoral perforations, cement mantles are quickly removed, minimizing damage to the bone and preserving the osseous structures. For all three approaches, abductor muscle separation repair and/or reattachment is performed with a heavy, no. 5, nonabsorbable suture. Postoperative patient management depends on the degree of dissection and extent of reconstruction. PMID- 10147936 TI - Cement removal in revision total hip arthroplasty. AB - The number of revision total hip arthroplasties performed on an annual basis continue to increase and are a direct and consequent result of the ever increasing number of primary total hip arthroplasties. The operative procedure is extremely demanding and complex, especially with respect to removal of the polymethylmethacrylate. This article reviews current available techniques and instrumentation for removal of polymethylmethacrylate. It is incumbent upon the orthopedic surgeon to determine which of these techniques and instruments can be used to facilitate removal of the polymethylmethacrylate while maximally preserving bone stock. PMID- 10147937 TI - The removal of well-fixed porous ingrown femoral components. AB - It is now evident that some biologically well-fixed hip prostheses may require removal and/or revision much earlier than originally anticipated. The relatively atraumatic removal of porous ingrown but clinically unacceptable femoral components, while difficult, has become increasingly feasible because of accumulated clinical experience and advances in biomedical technology. Preoperative planning, adequate instrument armamentarium, and intraoperative patience are important keys to the successful removal of these implants. PMID- 10147938 TI - The initial impact of computed tomography on mortality attributed to brain tumor. AB - The exponential growth in the number of computed tomography scanners in the United States between 1975 and 1977 was associated with a transient increase (11.9 and 14.4% for men and women, respectively) in annual crude mortality rates for primary malignant brain tumor from 1976 through 1978. This transient increase in mortality appears to have been an artifactual epiphenomenon associated with the introduction of a new technology. PMID- 10147939 TI - Angiographic magnetic resonance color composites of the normal brain and its vasculature. AB - Vascular magnetic resonance imaging (MRI) has become an important noninvasive adjunct to conventional cerebral MRI studies. To detect parenchymal changes associated with vascular anomalies, optimal diagnostic evaluation requires the comparison of both spin-echo and angiographic gradient-echo MRIs. To compress image data into a single 24-bit color image possessing the combined tissue contrast characteristics of both conventional spin-echo "black-blood" images and flow-sensitive gradient-echo "bright-blood" images, the red-green-blue color model and computer-based image-processing software were used to generate composites of MRI sets in which blood appears bright red while many stationary tissues possess near-natural colors. This technique may have potential applicability to human cerebrovascular MRI. PMID- 10147940 TI - Indications, technical considerations, and strategies for renal replacement therapy in the intensive care unit. AB - Renal replacement therapy in the intensive care unit can vary from simple procedures to very complex technologies. I discuss the factors that contribute to the decisions regarding the selection of a specific therapy. These factors include immediate and intermediate therapeutic goals (e.g., solute removal, dehydration), hemodynamic stability and other clinical conditions, and the technical requirements obligate to specific therapies. The differences between convective and diffusive solute removal are described, as well as the rationale for choosing one over the other. This choice is particularly relevant to and dependent on the therapeutic goal. Spontaneous blood flow versus pumped blood flow is debated. Lastly, the removal of middle molecular weight molecules is discussed in the context of toxic cytokines or bacterial products. PMID- 10147941 TI - Transport of critically ill patients. AB - Critically ill patients are transported within and between hospitals on a regular basis; thus, transport of the critically ill is a component of most intensivists practice. The motivation for these transports lies in obtaining diagnostic or therapeutic services not available at the bedside (intrahospital transport) or not available in the sending institution (interhospital transport). Deterioration in respiratory, cardiovascular, and other physiological systems is a potential complication of any patient transport. Using appropriate equipment and personnel and planning for each transport can minimize these complications and ensure optimal benefit to the patient. PMID- 10147942 TI - Bleeding esophageal varices: to balloon or not to balloon. PMID- 10147943 TI - Indications, technique, and complications of balloon tamponade for variceal gastrointestinal bleeding. AB - Timely treatment of bleeding esophageal varices with balloon tamponade effectively achieves initial hemostatis. However, therapeutic endoscopy and sclerotherapy in patients with acute upper gastrointestinal hemorrhage is associated with better short- and long-term follow-up. We describe the technique of esophagogastric balloon insertion, as well as principles of monitoring and maintenance. The different types of balloons for tamponade are described, as well as potential complications. PMID- 10147944 TI - Temporary wound closure with expanded polytetrafluoroethylene in pediatric liver transplantation. AB - A shortage of donor organs of appropriate size causes lengthy delays for many children awaiting liver transplantation, and results in the death of some children on the active waiting list. A major contribution to overcoming this problem has been the use of reduced livers from adult donors. However, reduced adult livers are frequently too large to be used for small pediatric recipients ( less than 8 kg) because of the serious problems which occur when too tight an abdominal closure is attempted. We report a technique which we have used successfully in 2 children, involving the insertion of a temporary patch graft of expanded polytetrafluoroethylene. This allowed comfortable abdominal wound closure, which would not otherwise have been possible. Delayed primary closure of the abdomen 4-5 days later was achieved without difficulty in each case, the liver grafts having decreased markedly in size by this time. The technique allows greater flexibility in the use of donor livers for pediatric recipients, and thus has the potential to reduce waiting times and deaths on the waiting list for small children requiring liver transplantation. PMID- 10147945 TI - A case control study of renal transplantation in patients with type I diabetes. AB - A case control study was undertaken comparing the outcome of 208 renal allografts transplanted into diabetic recipients with those transplanted into an appropriately matched group of non-diabetic recipients. In each group there were 151 cadaver, 21 two-haplotype identical, 35 one-haplotype identical, and one zero haplotype identical living-related grafts. For the entire group of diabetics, 1- and 5-year graft survivals were 71.3% and 46%. Graft survivals for the non diabetic recipients at 1 and 5 yr were 81.8% and 57.8% (p less than 0.05). In all patient subgroups divided according to the donor source, the graft and patient survival rates for the non-diabetic recipients exceeded those of the diabetic recipients. One- and 5-yr diabetic patient survivals were 90% and 70%, and for the non-diabetics they were 97% and 95%, respectively (p less than 0.001). There were 40 deaths among diabetics and 15 among the non-diabetics. Cardiovascular disease was the major cause of death in the diabetics, accounting for 40% of the deaths. In addition, allograft loss due to patient death was a significant cause of graft loss in the diabetic group, 24 grafts (28%). Seven grafts (10%) were lost due to patient death in the non-diabetic group (p less than 0.05). Post-transplant, diabetic recipients had a greater incidence of stroke, angina, myocardial infarction, peripheral vascular disease, urinary tract infections (p less than 0.01 for each), and wound infections (p less than 0.05).(ABSTRACT TRUNCATED AT 250 WORDS) PMID- 10147946 TI - PTCA update: is your patient now a candidate? Even complex multivessel lesions may succumb to balloon dilation. AB - Indications for PTCA continue to grow. In complex multivessel lesions, PTCA now has high primary success and low complication rates. Dilation of chronic total occlusions is less successful than in subtotal occlusions but may relieve angina in some patients. Occluded saphenous vein grafts can be dilated and long-term patency achieved--particularly in grafts implanted for less than 36 months. Restenosis remains a major drawback; antithrombotic therapy (with heparin during PTCA and aspirin thereafter) is recommended. PTCA is a useful adjunct in acute myocardial infarction when thrombolytic therapy fails or is contraindicated, or when significant luminal narrowing remains after thrombolysis. Investigational devices--atherectomy catheters, lasers or laser balloons, and intracoronary stents--may further expand the role of PTCA. PMID- 10147947 TI - The technique of percutaneous transluminal coronary angioplasty. Uses, abuses, training requirements, benefits, complications. AB - Like coronary artery bypass grafting, PTCA is used to manage multilesion and multivessel disease, new complete occlusions, and partial occlusions of saphenous vein or internal mammary artery grafts. PTCA is contraindicated for patients with a significant obstructive lesion in the left main coronary artery or with severe diffuse atherosclerosis. In determining whether this procedure provides the best treatment option, the risk of abrupt vessel closure, restenosis, MI, or incomplete revascularization must be considered. Guidelines for the performance of PTCA and physician and institutional responsibilities have been established; these guidelines must be regarded as necessary criteria for wide adoption. PMID- 10147948 TI - Diagnosing nosocomial pneumonia: to brush or not to brush. PMID- 10147949 TI - Evaluation of the protected brush catheter and bronchoalveolar lavage in the diagnosis of nosocomial pneumonia. AB - We assess the sensitivity and specificity of the protected brush catheter (PBC) and bronchoalveolar lavage (BAL) in diagnosing nosocomial pneumonia in nonimmunocompromised critically ill patients. Computerized bibliographic literature searches of MEDLINE were performed, and the reference list of each article selected was reviewed. Of 496 citations, there were 19 articles (describing 18 studies) that proved relevant. Study quality was assessed, and descriptive information concerning study populations, interventions, and clinically relevant outcome measurements was extracted. The sensitivity and specificity of PBC were high (pooled estimates, 89.9 and 94.5%, respectively). Criteria for a positive BAL have varied between studies, and sensitivity ranged from 53.3 to 100%, whereas specificity was 98.6%. Most studies did not report whether antibiotics were withheld on the basis of negative test results. In those that did, the incidence of adverse outcomes consequent on withholding antibiotics was low. BAL and PBC, combined with the use of quantitative cultures, appear to increase accuracy in diagnosing pneumonia. The strength of inference is hampered, however, by the absence of a "gold standard" for the diagnosis of pneumonia. Moreover, the generalizability of these findings is limited by the fact that there are so few methodologically sound studies from so few centers. A randomized trial of PBC is needed. PMID- 10147950 TI - Cardiac transplantation: a review for the intensivists. AB - Cardiac transplantation has now become accepted therapy for the treatment of end stage heart disease in both children and adults, and literally thousands of patients are bearers of cardiac grafts. Because of these patients' susceptibility to infections, rejection, coronary disease, and malignancy, as well as to serious illnesses unrelated to their transplantation, they will often be encountered at hospital centers both close to their homes and distant from the site of their surgery. The intensive care unit physician's role will be a demanding one when caring for these patients because of the broad differential diagnosis of infections, frequency of drug interactions and altered immunosuppression, and continuous uncertainty regarding the possibility of rejection, particularly during the first year after transplantation. PMID- 10147951 TI - Cardiac transplantation: problems and opportunities. PMID- 10147952 TI - A randomized control trial of right-heart catheterization in critically ill patients. Ontario Intensive Care Study Group. AB - We investigated the impact of right-heart catheterization (RHC) on physiological status and stay in the intensive care unit. Thirty-three of 148 potentially eligible patients were randomized. Fifty-two otherwise eligible patients were excluded because the attending physician felt that RHC was ethically mandated. Ten of 16 (63%) patients randomized to RHC, and 9 of 17 (53%) to no RHC, died (difference: -10%; 95% confidence interval [CI], -43% to 24%). Mean number of days in the intensive care unit were 10.3 for RHC and 8.1 for no RHC (difference, -2.2; CI, -10.2 to 5.8). The lowest modified APACHE score achieved after randomization was 10.8 for RHC and 8.1 for no RHC (difference, -3.8; CI, -7.0 to 0.6), and the mean modified APACHE score was 14.4 for RHC and 11.1 for no RHC (difference, -3.3; CI, -6.47 to -0.2). Physiological measures in this trial showed statistically significant differences in favor of patients not receiving RHC. Confidence intervals around other outcomes include clinically important differences in favor of both RHC and control groups. Although other controlled trials of RHC are crucial, investigators face major practical difficulties. PMID- 10147953 TI - Evaluation of right-heart catheterization: where do we go from here? PMID- 10147954 TI - Right-heart catheterization is a diagnostic procedure not a therapeutic intervention. PMID- 10147955 TI - The pharyngeal-tracheal lumen (PLT) airway. PMID- 10147956 TI - Critical appraisal of therapeutic interventions in the intensive care unit: human monoclonal antibody treatment in sepsis. Journal Club of the Hamilton Regional Critical Care Group. AB - Using the medical literature to solve patient problems is challenging and rewarding. For intensive care physicians, this evidence-based medicine approach is more compelling when basic critical appraisal skills are developed. We highlight the important methodological points for interpreting the literature on treatment, using a cogent example from the critical care literature--monoclonal antibody therapy in sepsis. It is likely that as we move into the 1990s, growth in the number of articles on immunotherapy in the sepsis syndrome will parallel the growth of the general biomedical literature. PMID- 10147957 TI - Investigation of elevated MCHC using a flowchart and the Technicon H-1. PMID- 10147958 TI - Coronary angiography: evaluation of atherosclerotic plaques and vascular injury. PMID- 10147959 TI - Monoclonal antibody imaging of atherosclerosis and vascular injury. PMID- 10147960 TI - Intravascular ultrasound: basic principles and role in assessing arterial morphology and function. PMID- 10147961 TI - Atherosclerotic plaque detection by nuclear magnetic resonance and radiolabeled autologous low-density lipoprotein. PMID- 10147962 TI - B-mode ultrasound imaging for detecting and monitoring peripheral atherosclerosis. PMID- 10147963 TI - Ultrafast computed tomography: imaging of coronary calcium in atherosclerosis. PMID- 10147964 TI - Percutaneous angioscopy in assessing coronary atherosclerosis and vascular injury. PMID- 10147966 TI - The effects of low-level energy density Nd:YAG irradiation on calculus removal. AB - This study assessed the effects of using an Nd:YAG laser to remove dental calculus from root surfaces. Human extracted molar teeth, with extensive calculus attachment to root surfaces, were irradiated with an Nd:YAG beam [power densities (PD) = 1.09 W/cm 2 and 2.19 W/cm 2; energy densities (ED) = 49.2 J/cm 2 and 98.4 J/cm 2]. An additional group of teeth was instrumented with a Gracey 11/12 curette. A separate group of untreated specimens served as controls. Specimens were examined under scanning electron microscopy and rated as to the degree of calculus detachment from root surfaces. Nd:YAG irradiation at low ED did not appreciably affect the integrity of the calculus root surface attachment. The higher-ED Nd:YAG irradiation appeared to mimic the type of calculus removal depicted with conventional hand instrumentation. Root surface damage from both laser ablations was negligible. PMID- 10147965 TI - Laser and daunomycin chemophototherapy of human carcinoma cells. AB - Adriamycin and daunomycin anticancer drugs are detectable in leukemias and solid tumors by cell fluorescence. We observed initial cytoplasmic fluorescence followed by slow nuclear localization of adriamycin and daunomycin after incubation with cultured human squamous cell (P3, FADU) and adenocarcinoma (HT29, SW620) lines by digital video imaging microscopy. Tumor cells incubated with 10 mug/ml of these drugs exhibited increased uptake for more than 3 h with intracellular levels in the range 0.5-2.5 mug/10 6 cells measured by dimethyl sulfoxide (DMSO) extraction and fluorescence spectrophotometry. Daunomycin had 10- to 100-fold higher toxicity for these carcinoma cells than for normal human epithelial keratinocytes measured by in vitro MTT tetrazolium assays. The viability of daunomycin-sensitized carcinoma cells was decreased 2- to 10-fold further by argon laser illumination at 488 nm (5W, T max = 8 degrees C) for 2-3 minutes. The results suggest that adriamycin derivatives may be useful targeting agents for adjuvant treatment and chemophototherapy of human solid tumors by MR guided laser fiberoptic endoscopy. PMID- 10147967 TI - Intravascular ultrasound imaging: the new standard for guidance and assessment of endovascular interventions? AB - Intravascular ultrasound has developed rapidly during the last few years, and provides a unique perspective from which to view vascular disease and the effects of intervention. This catheter-based imaging technique utilizes advances in echographic data processing and computerized image manipulation to produce accurate luminal and transmural images of blood vessels. Although these devices have only been available for a relatively short time, numerous diagnostic and therapeutic applications have been reported. By providing a detailed image of vessels before, during, and after intervention, intravascular ultrasound provides a method for both guidance of endoluminal devices and immediate assessment of the results of therapeutic techniques including balloon angioplasty, atherectomy, laser-assisted angioplasty, and intravascular stent deployment. Intravascular ultrasound also offers exciting possibilities in peripheral vascular research such as investigation of blood vessel compliance, dynamic changes in the vessel wall caused by disease or pharmacologic intervention, and elucidation of the morphologic changes associated with the natural history of atherosclerosis. PMID- 10147968 TI - Interstitial 1.06 Nd:YAG laser thermotherapy for brain tumors under real-time monitoring of MRI: experimental study and phase I clinical trial. AB - This paper presents the experimental and clinical results of interstitial 1.06 Nd:YAG laser thermotherapy (ILTT) for brain tumors under real-time monitoring by magnetic resonance imaging. The authors chose a laser heat source for interstitial thermotherapy of brain tumors for several important reasons: (1) Laser heat delivery is less complicated and more controlled; (2) laser effects on tissue can be tested, monitored, and controlled by MRI. A 1.064 nm Nd:YAG laser and a specially designed laser optic fiber (ILTT) were used in C.W. mode this study. The laser was used at 4 W at a C.W. mode pulse and total exposure duration was 10 minutes (total energy was 2400 joules). Temperature distribution was determined with a microprocessor-based thermometer and by the levels of the signal intensity under MRI. The relationship between the temperature and MRI signal intensity allowed exploration of the possibility of using MRI as a noninvasive temperature monitoring method. Two patients with glioblastoma and one patient with a brain metastasis were treated with this modality. The results and indications are presented and discussed. PMID- 10147969 TI - CO 2 laser used in surgical treatment of actinic cheilitis. AB - This study discusses the satisfactory CO 2 laser treatment of solar keratosis on Eastern European emigrants to Israel. It offers a comparison between cold blade vermilionectomy based on previous data and experience and reports postoperative results concerning cosmetic appearance and function of the lip. PMID- 10147970 TI - Surgical diode lasers. PMID- 10147971 TI - Diode laser promises improvements for treatment of detached retinas. PMID- 10147972 TI - Automated measurement of strabismic deviation. AB - A new computerized method of performing automated measurements of the angle of strabismus is presented, based on an infrared television camera, an image analyzer, and a commercial computer. This automated system provides a strategy of examination for patients in whom strabismus is suspected and makes possible a qualitative and quantitative diagnosis of the type of strabismus. In the case of a paralytic deviation, the involved muscle can also be identified with this instrument. The raw data from the image processor are saved and enhanced digitally. The image can be retrieved via monitor or printer, and data can be saved on mass memory. With this instrument, it is possible to follow various diagnostic procedures for strabismus step-by-step and to answer the following questions: is strabismus present? Is it convergent, divergent, or vertical strabismus? What is the angle of deviation? Which is the paralytic or paretic muscle in the case of incomitant deviation? PMID- 10147973 TI - Detection of amblyopia and development of binocular vision in infants and children. AB - Studies of visual development indicate that rapid changes occur in the first months of life and that it is during this period that the visual system is prone to aberrant development. The call for visual screening of children younger than 3 years of age is sensible in light of recent research findings. For children with visual problems, some recovery of visual function can occur if treatment is begun early. New tests of stereoacuity and vernier acuity may aid in the diagnosis of amblyopia, which is underestimated by grating acuity measures. Electrophysiologic testing, using visual evoked potentials and electroretinograms, is helpful in diagnosing visual problems at an early age. PMID- 10147974 TI - Rehabilitation and world blindness. PMID- 10147975 TI - Vision assessment and rehabilitation in low vision. AB - This subjective review of the year's literature on low vision, with particular emphasis on rehabilitation, attempts to search out and discuss what is new and innovative rather than to cover the year's publications with equal weight. The review covers areas of testing and assessment of children and the multiply impaired with low vision, vision stimulation, low vision aids and devices, approaches in congenital and acquired nystagmus, potential advances in high technology applied to low vision, and psychological and educational aspects including lighting requirements for the elderly. PMID- 10147976 TI - Functional MR techniques reveal the brain at work. PMID- 10147977 TI - Nuclear imaging maximizes care of emergency patients. PMID- 10147978 TI - Are the bells and whistles for infertility practical in an office setting? PMID- 10147979 TI - How the electromechanical stone impactor works. PMID- 10147980 TI - Engineered TPEs: new materials of choice for health care? AB - Engineered thermoplastic elastomers (ETPEs) are a relatively young, fast-growing generation of products and have an important strategic influence on both the rubber and plastics market. Much has been written about the increasing usage of plastics in the design and manufacture of medical devices, and today we may add ETPEs to this list, with significant benefits possible for the plastics industry manufacturing elastomeric parts using plastics processing technology. PMID- 10147981 TI - Choosing the correct materials for medical syringes. AB - The choice of the correct material for medical syringes is determined by the requirements demanded by users and manufacturers. New advances are making it easier to meet these requirements and leading to higher quality products with increased reliability. In this article, the author looks at the requirements of a good medical syringe and discusses the latest developments in polyolefins. Recent improvements are illustrated in a comparative study of glass, and polypropylene and polyethylene. PMID- 10147982 TI - PVC as a biomedical polymer--plasticizer and stabilizer toxicity. AB - During the last 40 years PVC has become the most widely studied and understood polymeric biomaterial. The success of PVC compounds is due to their ability to fulfill the complex needs of the medical device industry. The range of properties they possess, which includes flexibility and low toxicity, is achieved by their various formulations. Plasticizers are used to meet many of the requirements and because of their ability to be extracted into biofluids they present the greatest toxicological risk. In his discussion, the author looks at the ingredients of compound formulations and the influence of plasticizers on the toxicity. A detailed report is provided of studies carried out in connection with di(2-ethylhexyl)phthalate (DEHP), the most extensively used plasticizer, and the author questions the validity of using the results of animal tests for the assessment of risk to humans. A description of the commercial production of PVC polymers and a review of the various pharmocopoeia and national standards and requirements are also included. PMID- 10147983 TI - Clean room technologies of the 1990s. AB - The design and operation of clean rooms is a subject of interest to many professionals, and if all the sectors that use clean rooms are considered, it is a very complex technology. Great benefits can be gained if the different sectors of industry study the developments going on in other areas. In this article, the author presents a review of the developments that have taken place in the past forty years. Information on general standards, guidelines, and specific standards for the medical device and pharmaceutical industries is provided, together with an update on work that is currently being undertaken on new standards. PMID- 10147984 TI - The microbiology of irradiation sterilization. AB - In his discussion of the microbiological aspects of irradiation sterilization, the author examines the effects of irradiation on microbial populations and describes how sterility is assured and sterilization is achieved as well as the factors affecting lethality. Microbial response to radiation depends not on the dose rate but is influenced by the innate characteristics of the microorganisms and the physical or chemical conditions or agents existing within the cells or their immediate environment. Many external factors, including the effects of oxygen, water, other chemical agents, and temperature can protect or sensitize microorganisms from or to lethal radiation-induced damage. PMID- 10147985 TI - Quality testing of medical needles--laboratory and practice. AB - Tip deformities as small as 10 mum on cannulae can cause unnecessary pain to patients. The only way of preventing these deformed cannulae from reaching patients is to test every cannula at the manufacturing stage. Clinical and laboratory tests carried out by the company compare handling and trauma caused by medical cannulae with technical parameters for manufacturing and testing. This article discusses the results of these tests, which the author found verified that the properties of medical cannulae can be evaluated by measuring the penetration load piercing a skin substitute. The discovery of tip deformities with clinical significance led to the development of specially designed equipment that detects the presence of deformities by using the noise made by a deformed cannula penetrating a foil. PMID- 10147986 TI - Styrene block elastomers: an alternative material for medical applications. AB - The development of specific polymerization technology has led to a new generation of plastics called styrene block copolymers (SBCs). They have similar properties to vulcanized rubber, but these properties can be altered by heating the materials or adding other constituents to develop polymers that are specifically designed for particular applications. These materials are relatively recent additions to the medical device industry, and their full potential has yet to be realized. PMID- 10147987 TI - UV curing adhesives for medical device assembly. AB - UV cured medical-grade aerobic adhesives yield the same structural bond strength as thermal, sonic, or solvent welding. Solvents are recognized as having a potential for negative health and environmental effects. Substrate limitations have historically restricted medical device design when using sonic or thermal welding techniques. UV curing aerobic adhesives clearly represent a significant advance for an industry in which product reliability and user safety are a requisite. PMID- 10147988 TI - Designing medical equipment for electromagnetic compatibility. AB - In his second article on EMC, the author exhorts design engineers to integrate EMC from the very outset. Apart from the obvious benefits to manufacturers, the increasing use of digital electronics in medical equipment means that operating problems can be hazardous to life. In support of his proposal, the author provides practical information on ways to minimize and shield against electromagnetic emissions; these include recommendations for selecting or installing a clock oscillator, the use of continuous-power planes to reduce radiated emissions, filtering techniques, and tips on case design. PMID- 10147989 TI - Refining the qualification process for medical materials. AB - This article examines the history of the use of silicone elastomers in medical devices and explains the importance of understanding a material's physical and chemical properties. Related issues of biocompatibility testing, materials biodurability, process controls, regulation, cost, FDA master files, and expedited approval also are addressed. PMID- 10147990 TI - Computer design and fabrication of custom-contoured seating. AB - This article describes the development of a computer-controlled system for measuring anatomical contours and forces at the interface with seat surfaces. The system was designed to eliminate the cause of pressure sores, which are a major problem for wheelchair-bound individuals. A parallel and compatible system also has been developed for the rapid, precise, and cost-effective fabrication of custom-contoured seat cushions and other body supports from a range of open- and closed-cell foam materials. PMID- 10147991 TI - Coreless DC motors for sterilizable medical devices. AB - Coreless dc motors provide certain advantages when used in medical devices that require repeated sterilization. This article discusses the various sterilization methods used for medical devices, the effects that each method has on coreless dc motors, and ways to prevent damage to the motors during sterilization. PMID- 10147992 TI - The automatic implantable cardioverter-defibrillator: technology for preventing sudden cardiac death. AB - Sudden cardiac death is caused by a malignant heart rhythm known as ventricular fibrillation. The automatic implantable cardioverter-defibrillator (AICD) is a device that recognizes this rhythm and converts it to a normal sinus rhythm by delivering an electrical shock directly to the heart. This article reviews the technology and clinical status of AICD technology, and the ongoing research into techniques for detecting malignant arrhythmias. PMID- 10147993 TI - Preproduction quality assurance: quality intrinsic to design. AB - The Safe Medical Devices Act of 1990 made important changes to the Federal Food, Drug, and Cosmetic Act's provisions governing medical devices and in vitro diagnostics. Not the least of these changes is the addition of preproduction design validation "including a process to assess the performance of a device but not including an evaluation of the safety or effectiveness of a device," under the good manufacturing practice (GMP) regulation. Combining this new law with the existing GMP regulation on manufacturing operations yields the beginning of total quality management (TQM). PMID- 10147994 TI - Applying the interaction design approach to medical devices. AB - The medical industry is undergoing a radical transformation as increasingly powerful personal computers become the predominant user interface for both clinical and laboratory equipment. Accompanying this change is the introduction of a design discipline known as interaction design, which has given rise to a new breed of specialists whose role is to champion the end user--that is, the physician, scientist, or medical technician--at every stage of the product development cycle. PMID- 10147995 TI - Transesophageal echocardiography for congenital heart disease. PMID- 10147996 TI - The surface treatment of polypropylene molds and its effect on the quality of cast contact lenses. AB - An investigation of the surface by XPS photoelectron spectroscopy has shown that the process of production of cast contact lenses based on poly(2-hydroxyethyl methacrylate-co-diethyleneglycol methacrylate) is accompanied by mass transfer at the lens-mold boundary. This phenomenon, which impairs the compatibility of the lens during its application, can be considerably suppressed by employing a suitable surface modification of polypropylene molds. The surface treatment consisting in the oxidation of the mold surface by an AC corona discharge in the oxygen atmosphere increases hydrophilicity of the material, thus facilitating separation of the lens from the mold. The results of the XPS study were also confirmed microscopically by employing the SEM method. PMID- 10147997 TI - A versatile alginate droplet generator applicable for microencapsulation of pancreatic islets. AB - Alginate beads for immunoisolation of pancreatic islets by microencapsulation should be small, smooth, and spherical in order to ensure that around the islets a strong alginate-polylysine-alginate capsule will be formed with optimal biocompatibility and diffusion of nutrients and hormones. However, the preparation of small capsules around islets is difficult. Our newly designed air jet droplet generator allows for variations in the length and diameter of the alginate nozzle and the air jacket and is in this way adaptable to a required bead size. Alginate droplets are converted into rigid beads in a 100 mM CaCl 2 solution. Their size depends upon the diameter of the jacket, the air flow rate, and the outer diameter of the nozzle, whereas the production rate depends upon the pressure on the alginate, and on the diameter and the length of the nozzle. When the air flow or the alginate flow surpasses a certain rate, the droplets are fragmented. This study describes the mutual relationship of these variables and defines their optimal range for reproducible production of smooth and spherical beads for microencapsulation of islets at an acceptable production rate. PMID- 10147999 TI - Strain analysis of flexing blood pump diaphragms. AB - Blood pumps usually use elastomer diaphragms that undergo repeated small-strain flexing (deformation). The stresses and strains that develop in the mechanically actuated diaphragms dictate the useful life and fluid-solid interactions of the diaphragm. A knowledge of these stresses and strains is essential for proper design of the pump's elastomer diaphragm. A nonlinear axisymmetric finite element stress-strain analysis has been carried out on a Hexsyn rubber diaphragm used in a blood pump to illustrate a finite-element modeling technique. A situation involving the application of an axial deformation load on the diaphragm has been considered. In particular, the strains developed in a blood pump diaphragm during pumping have been quantified to illustrate the analysis technique. PMID- 10147998 TI - Fabrication and characterization of an asymmetric polyurethane membrane for use as a wound dressing. AB - To prevent wound dehydration and bacterial penetration, a wound dressing should be occlusive, but on the other hand it should also be permeable for wound exudate to prevent bullae formation. To meet these requirements a new type of polyurethane wound dressing which consists of a microporous top layer (pore size less than 0.7 mum) supported by a sublayer with a highly porous sponge-like structure containing micropores (pore size less than 10 mum) as well as macropores (pore size: 50-100 mum) was designed. The pores of both layers are interconnected and form a continuous structure in the membrane. Membranes according to this design were prepared either by means of a two-step or by means of a one-step casting process. Both fabrication methods are based on phase inversion techniques. Asymmetric polyurethane Biomer membranes prepared by the two-step casting process were tested in vivo as full thickness skin substitutes using guinea pigs. Neither wound dehydration nor infections were observed while the drainage capacity of the wound dressing was effective in preventing bullae formation. Furthermore the wound dressing remained firmly adhered to the wound surface during the whole process of wound healing. In contrast to all other commercial wound dressings currently available the polyurethane wound dressing applied on excised clean wounds did not need to be replaced during healing but could be left on the wound until full regeneration of the skin had taken place after which it was spontaneously repelled. PMID- 10148000 TI - The current status of cyanoacrylate and fibrin tissue adhesives. AB - Surgical tissue adhesives could simplify complex surgical procedures by stabilizing tissue surfaces through hemostasis, sealing wounds, and fixating tissue in areas inaccessible to suture placement. The most common surgical tissue adhesives available to the surgeon include the cyanoacrylate derivatives and the fibrin tissue adhesives. Butyl-2 cyanoacrylate (Histoacryl) is a cyanoacrylate derivative that is frequently used in Canada and Europe. This adhesive has excellent binding strength for skin closure; however, subcutaneous implantation can result in inflammation and foreign body giant cell reaction. Fibrin tissue adhesives use a fibrin clot as the binding moiety and vary in adhesive strength depending on the fibrinogen concentration of the preparation. Autologous fibrin tissue adhesives are prepared using one of several different methods, which vary in fibrinogen yield and concentration. The currently available autologous fibrin tissue adhesives demonstrate good hemostatic properties with relatively low binding strengths. This article reviews the status of cyanoacrylate adhesives and the preparation, efficacy, and clinical applications of the fibrin tissue adhesives. PMID- 10148001 TI - Examination of human bone surrounded by a dense hydroxyapatite dental implant after long-term use. AB - A high-density hydroxyapatite (D-HAP) ceramic dental implant that had functioned for more than 5 years was studied, using light and electron transmission microscopy, after it was retrieved from a human mandible. The D-HAP implant had come in contact with thick bone trabeculae; in the nontrabecular area, a thick bone addition was formed on the implant. The lamellar arrangement of the added bone was basically parallel to the implant's surface and continuously connected with the lamellar surface layer of the trabeculae at the added bone-trabeculae connection. Also, bone remodeling around the implant had occurred, especially in the area contacting the thickened trabeculae, wherein remodeling units were formed parallel to the implant surface. Moreover, positive results of chemical bonding existed and were recognized between the D-HAP and the bone. No structural changes were observed in the D-HAP ceramics. From this study, the characteristics of biological affinity, functional adaptability, and material stability suggested that D-HAP is a suitable material for dental implants. PMID- 10148002 TI - A review of the etiology and treatment of skin ulcers with wound dressings: comparison of the effects of occlusive and nonocclusive dressings. AB - This article reviews the etiology and treatment of skin ulceration caused by external pressure, vascular insufficiency, and diabetes. In the case of pressure sores, compression of skin against bone may cause ischemic injury to underlying fat and muscle that precedes necrosis of dermis and epidermis. Venous and arterial insufficiency lead to leg ulcers as a result of incompetency of the valves in the veins connecting the superficial to the deep venous systems and atherosclerosis, respectively. Diabetics are susceptible to foot ulcers because of atherosclerosis and the resulting occlusive arterial disease and peripheral neuropathy. Once the underlying medical condition is solved, occlusive and nonocclusive wound dressings can be used in an attempt to promote healing. A review of the literature of animal and clinical studies suggests that both occlusive and nonocclusive wound dressings promote healing compared with air exposed wounds. Dressings that absorb wound fluid offer some advantages over those that do not absorb large quantities of fluid in heavily exudative wounds and may require less frequent dressing changes. However, the chemistry of the material that comprises the wound dressing seems unimportant unless the material is biologically active. It is likely that the next generation of wound dressings will be composed of a moisture-retaining material coupled with material that has biological activity. PMID- 10148003 TI - Continuous arterio-venous haemodiafiltration in the treatment of myoglobinuric acute renal failure. PMID- 10148004 TI - Low volume ventilation with permissive hypercapnia in the Adult Respiratory Distress Syndrome. AB - Many animal studies have demonstrated that mechanical ventilation with high peak inspiratory pressures (PIP) can result in a form of acute lung injury closely resembling ARDS, ie characterised by hyaline membranes, granulocyte infiltration, increased pulmonary and systemic vascular permeability, and eventually proliferation of fibroblasts and type II pneumocytes. These studies have led to a concern that, in some patients, orthodox ventilatory management in severe ARDS may result in additional lung injury and, possibly, remote organ dysfunction. Mortality may be increased as a consequence. In an attempt to avoid such ventilator-induced lung injury in severe ARDS, several modifications of ventilatory management have been evaluated. We have previously reported the technique of low volume pressure limited ventilation with permissive hypercapnia, using tidal volumes of 5-7 ml/kg and allowing the PaCO 2 to rise substantially (maximum PaCO 2 17.2 kPa [129 mmHg]), mean maximum 8.3 kPa [62 mmHg]). In an uncontrolled study the mortality was significantly lower than that predicted by Apache II (16% vs 39.6%, p less than 0.01). Acute hypercapnia can cause many physiological disturbances but most of these appear to be due to the resulting intracellular acidosis and should not occur in hypercapnia of gradual onset, allowing the intracellular pH to be normalised. The time scales for compensation of intracellular and extracellular acidosis are markedly different. However, even severe acute hypercapnia appears to be remarkably well tolerated. Several clinical studies suggest that the avoidance of high PIP may reduce mortality in ARDS, but a randomised trial will be required to establish whether pressure limitation and permissive hypercapnia do improve outcome. PMID- 10148005 TI - Intermittent positive pressure ventilation. PMID- 10148006 TI - Rationing and regionalisation of health care services: a critical care physician's opinion. AB - It is becoming apparent that we have created a demand for medical goods and services that threatens to overwhelm our health care system. Present fiscal policies for financing health care such as excluding a large portion of the population are clearly unacceptable to the public. Current reimbursement policies for health care providers are so murky and, in some cases, so conflicting that they could have been designed only as a method of rationing by inconvenience. Some improvements in the cost effectiveness of health care delivery are needed without increasing the administrative and regulatory bureaucracy currently feeding on itself. Regionalisation of medical services has proven to be cost-effective in the specialties of trauma and neonatology. There is accumulating evidence that this same concept, using severity of illness scoring as an objective marker of potential benefit, may maximise cost/benefit for medical and surgical critical care patients. However, multifaceted deterrents to the concept of regionalisation must be addressed, including reimbursement problems, logistics of bed occupancy and physician incentives to participate. PMID- 10148007 TI - Physician and nursing (personnel) requirements for ICUs. Therapeutic Intervention Scoring System (TISS) versus time requirements for patient care--a comparative study in an interdisciplinary surgical intensive care unit. AB - OBJECTIVE: To measure total physician manoeuvres and total nursing manoeuvres in intensive care patients and to compare the results with calculated personnel requirements on the basis of TISS scores. DESIGN: Open prospective study. SETTING: Sixty-three ICU patients on two consecutive days. MEASUREMENT: 1. Total physician activities (TPM) in minutes/patient-day; total nursing manoeuvres (TNM) in min/patient-day. 2. TISS Calculation of personnel requirements on the basis of both parameters. RESULTS: TPM averaged at 3.9 hours. No fixed correlation was established between TISS and TPM. TNM averaged 1,073 minutes/patient-day and demonstrated a good correlation with TISS. CONCLUSIONS: Physician activities on a surgical ICU averaged 3.9 hours/patient-day. Nursing manoeuvres average 17.9 hours/patient-day. Individual measurements must be made before calculating personnel requirements on the basis of TISS scores. PMID- 10148008 TI - Emergency uses of fibre-optic bronchoscopy in the ICU. PMID- 10148009 TI - Support when gas exchange fails. PMID- 10148010 TI - Tonometry: theory and applications. PMID- 10148011 TI - Introduction to the special issue on practical functional electrical stimulation. PMID- 10148012 TI - Therapeutic FES: from rehabilitation to neural prosthetics. AB - The purpose of this paper is to review the therapeutic applications of electrical stimulation and to focus on functional neuromuscular electrical stimulation (FES), which is the production of useful muscle contractions for joint stability and limb movement. The use of FES to improve patient function during the recovery period after illness or injury and the transition to FES neural prosthetic systems for patients who do not fully recover will be discussed. Emphasis will be given to the maintenance of posture and the production of purposeful movement from the perspective of technologies and clinical strategies that are available today and from the perspective of those technologies that have the potential for transfer to community health care in the near future. PMID- 10148013 TI - Lower extremity applications of functional neuromuscular stimulation. AB - Functional electrical stimulation (FES) applications in the lower extremity are common in research laboratories, but clinical applications are minimal. This review summarizes current knowledge with respect to clinical application. When electrical stimulation is used in clinical applications for functional movement such as standing and walking, it is typically applied in an open-loop manner; a predetermined stimulus pattern is delivered regardless of the consequences of the actual movement. Few clinical applications of FES involve closed-loop control because of the numerous difficulties involved in its application. As with any volitional muscle contraction, electrically stimulated muscle contractions will exhibit fatigue. Although the dynamics of fatigue may differ, electrically stimulated muscle contractions cannot be continuously sustained, and if the duty cycle is too severe, even alternating periods of rest and contraction cannot be sustained at a constant force level. The exact nature of fatigue is highly specific to the past history of the individual muscle and to the individual subject. Despite their intricate detail, quantitative modeling studies have not yet been applied extensively to clinical applications. Present implantable systems are not yet a viable option for clinical application. It is not clear whether more success with surface or percutaneous systems must first be achieved to justify implantation or whether greater improvements in implantable technology and surgical protocols are needed before implantable systems will become practical. It is clear that almost any reasonably designed stimulation protocol will increase muscle bulk. The existence of other therapeutic benefits and their cost/benefit ratios remain to be fully established. It is possible to stand through bilateral stimulation of the quadriceps. Using surface electrodes, this technique is achievable in any physical therapy clinic having minimal expertise in neuromuscular stimulation. FES-aided standing must be conducted as a research project with a protocol approved by the local institutional review board, as there are currently no FDA-approved stimulation devices for standing. Multichannel FES systems are not currently available for clinical application in the United States. This may change if the "Parastep" system receives FDA approval. Percutaneous and implanted systems are years away from commercialization and clinical availability. Hybrid systems, based primarily on the reciprocating gait orthosis (RGO), are presently the only clinically available form of walking that includes some form of FES assistance. The costs and benefits of adding FES to the RGO and the long-term user acceptance rate for these systems remain to be determined. PMID- 10148014 TI - A review of the functional electrical stimulation equipment market. AB - The market for functional electrical stimulation (FES) equipment for use in rehabilitation is growing as increasingly sophisticated products enter the market each year. Factors that impact the availability of FES equipment include technological limitations, government regulation, reimbursement status, and clinician training. New products have become available in the last decade with many innovative applications available under investigational status. The current availability of FES equipment for selected applications such as therapeutic muscle stimulation, cardiovascular exercise, restoration of function in the lower and upper extremities, respiratory assist, restoration of bladder function, electroejaculation, and scoliosis correction is reviewed. A review of FES equipment for nonneuromuscular applications such as control of epilepsy, cochlear implants, electrotactile stimulation, and systems to enhance wound healing and bone growth is also included. Key manufacturers are identified. PMID- 10148015 TI - Clinical strength testing. PMID- 10148016 TI - Seating & positioning for the newly injured. PMID- 10148017 TI - Patellofemoral tracking syndrome. PMID- 10148018 TI - Enhancing human-machine interaction. PMID- 10148019 TI - Investigation of the defense system of the human lungs with ferrimagnetic particles. AB - Magnetic microparticles were used to investigate the defense system of the human lungs against foreign material. About 0.5 mg of spherical monodisperse magnetite particles were deposited in the alveolar region of the human lung by voluntary inhalation. After primary magnetization a remanent magnetic field (rmf) of the lung can be measured that allows estimation of the amount of dust retained in the lung. The decay of this rmf, called relaxation, results from a misalignment of the dipole particles due to the activity of pulmonary macrophages. This macrophage activity was characterized by a cell energy E z. With a secondary magnetization the lung can be remagnetized by rotation of the dipole particles. This allows estimation of the intracellular viscosity and motility of the alveolar macrophages in vivo. Secondary magnetization and relaxation curves of spherical monodisperse magnetite particles are presented. Intracelluar viscosity was estimated to be n approximately equal to 100 Paxs by a shear-rate near 0.01 s -1, macrophage activity was E z approximately equal to 5x10 -18 J. Aerosol exposure resulted in a faster relaxation, which was interpreted to be due to activation of the macrophages. The magnetite particles were cleared with a half time of approximately equal to 110 days. PMID- 10148020 TI - Successful transplantation of 50 single unit pediatric kidneys ages 11 to 48 months into adult recipients. AB - There is currently an imbalance between the need for cadaveric kidneys for transplantation and the supply. The medical criteria for accepting cadaveric donors are changing and organs that were originally thought to be unacceptable have functioned well. Previous reports have discussed the problems with transplanting pediatric allografts less than 4 years old into adult recipients, and the results have not been encouraging. From 1986 to 1991 a total of 50 kidneys ages 11 to 48 months were transplanted as single units into adult recipients (Group A). Ninety-one adult donor cadaveric transplants were used as controls (Group B). The cadaveric transplants were 2nd or 3rd transplants in 7 of the Group A and 12 of the Group B patients. Renal preservation, storage times, and demographics were the same. Prednisone, cyclosporine, and either Minnesota ALG or OKT3 were used for immunosuppression in both groups. Imuran was added in immunologically high-risk patients. The 1-year actuarial patient and allograft survivals for Group A versus Group B were 89.5% versus 94.2% (p=0.49) and 71.3% versus 87.8% (p=0.01), respectively. There was no difference in allograft or patient survival in kidneys from donors 11-24 months of age or 25-48 months (p=0.56). Renal growth, as measured by sonography, occurred while on cyclosporine A. Excretory and hormonal function as measured by creatinine and hematocrit both improved. Seventy percent of the Group A patients and 76% of the Group B patients were free from rejection in the first 2 months post transplantation (p=0.45).(ABSTRACT TRUNCATED AT 250 WORDS) PMID- 10148021 TI - Hepatic retransplantation: University of Nebraska Medical Center experience. AB - The lack of an artificial liver makes liver retransplantation a unique, life saving procedure when all the other alternatives to save a failed graft have been exhausted. On the other hand, the shortage of donors in line with the increasing number of end-stage liver disease patients who are waiting in long recipient lists represents a dilemma and raises the question of most appropriate recipient selection. In this report, we retrospectively analyzed the results of 350 primary, 48 secondary, and 5 tertiary hepatic transplants performed between July 1985 and January 1990 at University of Nebraska Medical Center. The same immunosuppression protocol was used in each case and the maintenance immunosuppressive therapy consisted of a cyclosporine (CyA) and steroids. The overall survival rate of 80.5% at 1 year which was achieved in the primary grafting group was significantly better than the secondary grafting group (63.0%, p less than 0.05). However, this difference was not significant in pediatric patients and their rates were 73.8% and 71.6% in primary and secondary grafting groups, respectively. When the retransplanted patients were considered as deaths unless secondary grafting was performed, the overall patient survival rate of 69.7% in primary grafting group at 1 yr increased to 77.8% in the retransplanted group and this difference was significant (p less than 0.05). Blood loss and operating time were found to be lower in the retransplanted group. Furthermore, the decrease of the operating time in the retransplanted pediatric patients reached statistical significance (p less than 0.05).(ABSTRACT TRUNCATED AT 250 WORDS) PMID- 10148022 TI - The effect of postoperative normovolaemic anaemia and autotransfusion on blood saving after internal mammary artery bypass surgery. AB - The efficacy of two blood conservation techniques in decreasing and in preventing the use of homologous blood products was retrospectively studied in 150 patients undergoing internal mammary artery bypass surgery. Patients were matched according to prebypass blood haemoglobin (Hb) content and body surface area and were allocated to one of three groups: in the patients of group 1 (n = 50), normovolaemic anaemia (NA) was accepted postoperatively (haematocrit [Hct] was accepted to a minimum level of 25%); the patients of group 2 (n = 50) were treated with postoperative autotransfusion (AT) of mediastinal shed blood and acceptance of NA. Group 3 (n = 50) contained control patients, not treated with NA or with AT (Hct was accepted to a minimum level of 30%). Patients of group 1 required 3.0 +/- 0.3 units of homologous blood products, but the patients of groups 2 and 3 received significantly more (p less than 0.01) units: 3.9 +/- 0.2 and 4.5 +/- 0.3 units. No donor blood products were needed in 36%, 9% and 5% of the patients in groups 1, 2 and 3 respectively. The net postoperative blood loss was similar in the groups: 1229 +/- 92 ml in group 1, 1098 +/- 74 ml in group 2 and 1243 +/- 72 ml in group 3. However, total blood loss (1982 +/- 135 ml), including the retransfused part (954 +/- 89 ml), was significantly larger (p less than 0.01) in group 2, than in groups 1 and 3.(ABSTRACT TRUNCATED AT 250 WORDS) PMID- 10148023 TI - Oxygen transfer performance of a new Sarns membrane oxygenator. AB - Oxygen transfer performance of the SMO 2, a new hollow-fibre membrane oxygenator from Sarns/3M, was evaluated. The maximum oxygen transfer of the SMO 2 (504 ml 0 2/min) was 57% higher than that for the SMO. This was true even though the membrane surface area increased by only 11% (1.8 m 2 to 2.0 m 2). The average gas phase-arterial oxygen gradient and the average shunt fraction was decreased by 35% and 30% respectively. The diffusing capacity of the SMO 2 was increased by 74% over the SMO. The oxygen transfer performance compared favourably, not only to the SMO, but to five other previously evaluated membrane oxygenators. It performed better in each category regardless of whether the result was expressed in absolute terms or relative to membrane surface area. PMID- 10148024 TI - The use of the Biomedicus centrifugal pump in combination with a separate reservoir with integrated heat exchanger in aneurysms of the thoracic aorta. AB - The surgical correction of aneurysms in the descending thoracic aorta necessitates clamping the aorta both proximal and distal to the aneurysm. The affected length can vary from a few centimetres to large portions of the upper and lower descending aorta. Clamping times can vary from a few minutes to more than one hour. No matter which technique is applied, these operations are often accompanied by excessive blood loss and the need for rapid transfusion, resulting in substantial haemodynamic fluctuations. Hypothermia may become a problem in these patients because most blood warmers are unable to warm blood adequately ( greater than 35 degrees C) at high flow rates (>100 cc/min). This may result in clotting problems. For this reason, our clinic decided from November 1990 to integrate a reservoir with its own heat exchanger (Cobe) into our left-left bypass system. This system largely regulates transfusion during partial extracorporeal circulation (PECC). The advantages of such a system are that (1) the transfusion rate can be adapted to blood loss and is not dependent on the quality and quantity of the infusion systems; (2) blood products and other infusion liquids are filtered; and (3) the transfusion blood is warmed. In this article, we describe our experience with this application of PECC on three patients who suffered excessive blood loss during operations for large thoracic aneurysms. PMID- 10148025 TI - Retrograde coronary sinus perfusion: pressure monitoring. PMID- 10148026 TI - High-flow femoro-femoral bypass utilizing small cannulae and a centrifugal pump on the venous side. AB - Femoro-femoral bypass is an established technique in the armamentarium of cardiac surgeons, but poor venous drainage usually restricts the flow rate that can be achieved. We describe a technique whereby full flow ( greater than 2.41 l/min/m 2 femoro-femoral bypass) can be achieved with a 17 F arterial and a single 21 F venous cannula placed percutaneously or via a cut-down. Transoesophageal echo is used to position the tip of the venous cannula accurately in the right atrium. The circuit includes a centrifugal pump on the venous side, pumping into a reservoir; a conventional roller pump delivers blood through the arterial cannula. A parallel arrangement allows the centrifugal pump to be excluded from the circuit at any stage. The system allows flow rates over 2.4 l/min/m 2 despite the size of the venous cannula; without the centrifugal pump working maximal flow rates are under 1.5 l/min/m 2. The right side of the heart is totally decompressed and there is no need to add volume or vasopressors to maintain the desired full flow rate. Once the chest is open, perfusion may continue as before or gravity drainage can be utilized after stopping the centrifugal pump; venous return may be augmented by placing additional cannulae. If desired, slowing drainage by the centrifugal pump temporarily permits the blind placement of a coronary sinus cannula without entraining air.(ABSTRACT TRUNCATED AT 250 WORDS) PMID- 10148027 TI - In vitro evaluation of the Mera Silox-S 0.5 and 0.8 m 2 silicone hollow-fibre membrane oxygenator for use in neonatal ECMO. AB - The Mera Silox-S is a silicone hollow-fibre membrane oxygenator made up of thousands of fibres in a clear polycarbonate housing. Being a silicone membrane it does not have the plasma leakage problem associated with conventional microporous hollow fibres when used in a long-term application. This device (Mera Senko Medical Instrument Co., Japan) is made in three sizes: 0.3, 0.5 and 0.8 m 2. The performance of the 0.5 m 2 and 0.8 m 2 Silox-S membrane oxygenators was tested in vitro using filtered ovine blood and a customized test circuit designed to provide a continuous source of de-oxygenated, CO 2-laden blood, according to the AAMI standard for oxygenator performance. The 0.8 m 2 membrane provided excellent oxygenation, with a transfer rate of 13.0-43.5 ml/min for blood flows of 200-800 ml/min. CO 2 transfer over the same range of flows measured 32.3-40.8 ml/min. Flow rates of 100-500 ml/min for the 0.5 m 2 membrane provided an oxygen transfer of 6.8-28.3 ml/min and would probably not be suited for the existing neonatal ECMO population. A matter of concern with both oxygenators was an increased pressure drop for blood flow through the devices. The delta P for the 0.5 m 2 for flows of 100-500 ml/min ranged from 155 +/- 7 mmHg to 516 +/- 6 mmHg. For the 0.8 m 2, delta P was 194 +/- 39 mmHg to 492 +/- 53 mmHg for flows of 200-800 ml/min. Overall, favourable results support further long-term evaluation for potential use in neonatal ECMO. PMID- 10148028 TI - Results and complications following a proximal curved osteotomy of the hallux metatarsal. PMID- 10148029 TI - Complications of resection arthroplasty (Keller) and replacement arthroplasty (silicone) procedures. PMID- 10148030 TI - A review of computerized tomography evaluation of acetabular fractures--part 1. AB - Computerized tomography is an established modality for use in the evaluation of acetabular fractures. As open reduction and internal fixation of acetabular fractures becomes more common, the need for an accurate understanding of the fracture anatomy is critical. An anatomic study of the innominate bone is reported and the relevant standard radiographic landmarks as seen with computerized tomography are illustrated. PMID- 10148031 TI - Electrical stimulation: current concepts and indications. AB - The use of electrical stimulation in fracture management is increasing. Electrical stimulation has been found to offer a reasonable means of treatment for nonunions that have failed to respond to previous bone grafting over an extended period of time. The effective use of electrical stimulation devices requires an understanding of the various principles and concepts employed by the four types of stimulators currently available. While the exact mechanism of electrically-induced osteogenesis is uncertain, current theories indicate that several factors probably are involved and more than one mechanism may be responsible. There are significant differences in the clinical applications of the various types of electrical stimulators. Whether these differences are significant from a practical standpoint remains to be seen. PMID- 10148032 TI - Lachman test revisited. AB - The Lachman test has become recognized as the most reliable noninvasive clinical method for determining the integrity of the anterior cruciate ligament. The original description provided for the test being reported as either positive or negative. The purpose of this study is to present a clinical grading system for positive examinations. The criteria are as follows: Grade I, proprioceptive appreciation of a positive test; Grade II, visible anterior translation of the tibia; Grade III, passive subluxation of the tibia with the patient supine; Grade IV, ability of the patient with a cruciate-deficient knee to actively sublux the proximal tibia. Seventy-five patients with arthroscopically-documented complete anterior cruciate ligament tears were examined clinically and graded using these criteria. In addition, all patients had arthrometric examinations to measure the amount of anterior subluxation of the tibia in millimeters. A one-way analysis of variance followed by Scheffe multiple comparisons demonstrated the mean measurements of anterior displacement of the tibia in each laxity group to be significantly different. PMID- 10148033 TI - Arthroscopically-assisted anterior cruciate ligament reconstruction: a follow-up study. AB - In order to determine the early results of arthroscopically-assisted reconstruction of the anterior cruciate ligament (ACL), a comprehensive follow-up evaluation of 20 athletes with an average postoperative time of 26 months was performed. Clinical knee examination and measurements of thigh circumference, range of motion, and maximum quadriceps/hamstring strength were obtained. A detailed personal interview regarding activity level, subjective ratings, and functional status was conducted. At follow-up, anterior knee laxity was dramatically reduced, with no patients demonstrating a pivot-shift. Thigh circumference, range of motion, and maximum muscle strength were not significantly different than in the normal, uninvolved leg. Sixteen patients (80%) had returned to their preinjury activity level. Only one of the remaining four cited knee problems as part of the reason for not returning to preinjury athletic activities. Patients' subjective ratings were highly favorable. The findings in this study led to the conclusion that modifying traditional open methods of ACL reconstruction to an arthroscopically-assisted technique is an attractive surgical option. PMID- 10148034 TI - The use of a swimming pool in the rehabilitation and reconditioning of athletic injuries. PMID- 10148035 TI - Nonoperative treatment of Neer type II distal clavicle fractures: a prospective study. AB - The first prospective series of nonoperatively treated Neer type II fractures of the lateral third of the clavicle with concomitant rupture of the coracoclavicular ligaments is reported. Among ten patients with an average follow-up of 14.3 months, there were seven healed fractures and three nonunions. None of the three patients with a nonunion desired surgery. Six of the seven patients with healed fractures were satisfied. Eight of the ten patients returned to full activities, although all three patients with nonunions experienced at least occasional discomfort in the affected shoulder. Based on the results in this series of patients, the authors conclude that nonoperative treatment is an effective alternative to surgical management of Neer type II distal clavicle fractures. PMID- 10148036 TI - Comprehensive approach to patellar pathology. AB - As investigators continue to report new realignment operations, controversy persists regarding the selection of procedures for patients with intractable patellar pain. This report summarizes an approach to the patella involving well documented operations used in individualized combinations tailored to each patient. The outline of the decision-making process is reviewed. PMID- 10148037 TI - Comparison of radiographic parameters for analysis of normal and dysplastic hips in the adult. AB - Radiographic quantitation of the dysplastic hip in adults is difficult. This study compares the values for commonly used indices, the acetabular angle (AA), the center edge angle (CEA), and femoral head coverage, and the X-Y coordinate system on the anteroposterior pelvic radiograph in 30 adult patients with 60 normal hips, and 20 adult patients with 27 dysplastic hips. Dysplastic hips demonstrated significantly higher values for the AA and the X-Y coordinates, and significantly lower values for the CEA and femoral head coverage compared to normal hips. Femoral head coverage in dysplastic hips correlated best (negatively) with the Y coordinate, i.e., poorer coverage was associated with greater superior migration of the femoral head. The AA describes the slope of the acetabular roof, but does not take into account the relative position of the femoral head. The CEA measures the position of the femoral head in relation to the lateral lip of the acetabulum, but does not necessarily use the true acetabulum. The X-Y coordinate system relates the center of the femoral head to an identifiable acetabular landmark, the teardrop shadow. These coordinates are easily determined and can serve as an adjunct to other radiographic indices that quantitate the amount of subluxation in dysplastic hips in adults. PMID- 10148038 TI - Tenotomy and postoperative brace treatment for muscular torticollis. AB - A postoperative corrective brace for congenital muscular torticollis is introduced and the results and indications for its use are presented. Thirty three of 55 patients who underwent open tenotomy of the sternocleidomastoid muscle with application of the brace following surgery were evaluated in follow up. Tenotomy was performed at the sternoclavicular origin of the muscle. The mean age at operation was six years; the mean follow-up period was seven years. The results were good in 21 patients (64%), fair in seven (21%), and poor in five (15%). Facial asymmetry remained in all patients over the age of ten who underwent operation. Alopecia, one of the complications of the brace, was found only in patients under age five. This combined treatment with tenotomy and postoperative brace is considered best indicated for patients between six and ten years of age. PMID- 10148039 TI - A sound way to diagnose congenital anomalies. PMID- 10148040 TI - Congenital heart defects--and other prenatal findings. PMID- 10148041 TI - A guide to office cholesterol testing. PMID- 10148042 TI - Pediatric vision screening: why? when? what? how? PMID- 10148043 TI - Urinalysis: oft obtained, oft ignored. PMID- 10148044 TI - Tympanic thermometry: temperatures without tears. PMID- 10148045 TI - Self-care for the young diabetic--home but not alone. PMID- 10148046 TI - Clavicle fractures. PMID- 10148047 TI - Application of cardiac monitoring to surgical patients. AB - Not all surgical patients need the utmost in sophisticated cardiac monitoring. For those who do, however, there is a considerable gain in morbidity and mortality reduction. In this paper, we outline the place of cardiac monitoring in the spectrum of cardiac disease and present cases illustrating its usefulness in both preoperative and postoperative settings. The significant capacity of cardiac monitoring to determine very poor risks for major surgery candidates is also determined. PMID- 10148048 TI - The utility medial portal: a new arthroscopic approach to the knee. AB - Placement of accurate arthroscopic portals is crucial in arthroscopic knee surgery. Unlike the inferolateral portal that is usually used initially in arthroscopic surgery, the utility medial portal allows excellent visualization of both the medial and lateral compartments as well as the patellofemoral articulation and suprapatellar pouch. Other diagnostic advantages include visualization of the anterior horn of the lateral meniscus, access into the posterior compartment of the knee, and visualization of the intercondylar notch. Surgically, this portal is invaluable in lateral meniscal procedures. Specifically, placement of the arthroscope in the utility medial portal allows access to the complete lateral meniscus, including the anterior and posterior horns, for both visualization and instrumentation. This portal is also outstanding for use in patellofemoral surgical procedures. This portal has been used with great success as a standard arthroscopic portal without difficulty, primarily in 550 arthroscopic procedures and secondarily in 240 procedures. This portal is recommended for examination of the knee in all cases except those in which there is a high suspicion of an isolated medial meniscus tear. Also, the portal may be used routinely for surgical visualization and instrumentation due to its flexibility. PMID- 10148049 TI - Supracondylar fractures of the femur: long-term follow-up of closed versus nonrigid internal fixation. AB - Twenty-nine patients were evaluated a minimum of ten years (average: 16 years) after femoral supracondylar fracture. Fracture type, mechanism of injury, and age of 14 patients initially treated nonoperatively were similar to those of 15 patients treated with nonrigid internal fixation. Complications were more common and more severe in the surgically-treated group. Knee range of motion remained permanently decreased in both groups, averaging 3 degrees lack of extension to 63 degrees of flexion. In both groups, 60% had symptoms of knee pain, instability, and gait abnormalities. Long-term poor results were caused by degenerative arthritis or loss of knee motion (or both). Degenerative arthritis developed in patients whose fracture healed with articular incongruity, greater that 15 degrees of valgus, any amount of varus, or a loss of normal mechanical axis. Results were satisfactory in seven of 15 patients in the surgical group and eight of 14 in the nonoperative group. PMID- 10148050 TI - The use of ultrasonic tools in revision arthroplasty procedures. AB - Cemented and uncemented prostheses removed from bone using ultrasonic tools were evaluated grossly, microscopically, and microradiographically. The findings in this study indicate that application of an ultrasonic tool to the intramedullary canal is a safe method for removal of a variety of components. In addition, when the energy is coupled directly to the metallic component, it can be separated from the cement-bone or prosthesis-bone interface instantly. PMID- 10148051 TI - Transpedicular fixation of thoracolumbar fractures. AB - Surgical treatment of thoracolumbar vertebral fractures is a controversial issue, especially in light of its doubtful advantages. Moreover, methods previously available have been associated with certain drawbacks, including insufficient stability. With the application of a new therapeutic principle in which the screws of the fixation instrument are placed in the pedicles of the vertebrae, the stability of vertebral fractures is improved considerably. This will increase the degree of mobilization, shorten the period of disability, and improve the comfort of the patient. Early effective stabilization, combined with decompression if necessary, also provides the best possibility for restoration of neurologic function. PMID- 10148052 TI - The use of magnetic resonance imaging in the diagnosis of triceps tendon ruptures. AB - Triceps tendon rupture is a rare injury. Three cases are presented with a brief review of the literature. Additionally, the use of magnetic resonance imaging to facilitate the diagnosis of triceps tendon rupture is described for the first time in the English literature. Each of the three patients has done well with a Mersilene tape repair of the triceps tendon. PMID- 10148053 TI - Femoral fracture reduction techniques. AB - Closed reduction techniques using a countersupport vector on an extension table, which minimize intraoperative reduction effort as well as surgeon radiation hazards, are described that are particularly suited for the polytrauma patient. PMID- 10148054 TI - Newer assessment approaches for the patient with low back pain. PMID- 10148055 TI - Herbert screw fixation of scaphoid fractures: indications and technique. PMID- 10148056 TI - A way to help your patients who use vacuum devices. PMID- 10148057 TI - Why we've abandoned polytef injection for VUR. PMID- 10148058 TI - Radical perineal prostatectomy redux. PMID- 10148059 TI - Using transrectal ultrasonography in the diagnosis of ejaculatory duct obstruction. PMID- 10148060 TI - Ultrasound of the normal prostate. PMID- 10148061 TI - Iodinated contrast media: new versus old. PMID- 10148062 TI - The surety of surgical repair of varicoceles. PMID- 10148063 TI - A guide to assisted reproductive techniques. PMID- 10148064 TI - The endosurgical alternative for upper-tract obstruction. PMID- 10148065 TI - New roads to fertility. PMID- 10148066 TI - Suddenly, urology takes up the laparoscope. PMID- 10148067 TI - Vaginal repair of high-grade cystocele. PMID- 10148068 TI - MRI looks at the kidney. PMID- 10148069 TI - Collagen injection for the dysfunctional urethra. PMID- 10148070 TI - Performance characteristics of hemofilters with heparin surface coating: an experimental study. AB - Heparin surface coated hemofilters and tubing sets were evaluated in comparison to identical but uncoated controls in 8 bovine experiments (74+/-6 kg). No heparin was given (neither systemically nor in the priming fluid). The hemofilters were primed with one liter of Ringer's lactate in both groups and the maximal filter performance (arterial line pressure 300 mmHg; transmembrane pressure (TMP) 500 mmHg) was measured over 6 hours or until filter occlusion. All coated and one control filter remained functional during the scheduled 6 hours. The mean filter patency was 360+/-0 minutes for coated versus 210+/-99 minutes for uncoated (p less than 0.01). Mean blood flow at 1 hour and 6 hours was 675+/-114 and 580+/-96 ml/min for coated versus 432+/-183 and 25+/-43 for uncoated (NS; p less than 0.01). Mean filter output during the 6th hour and total filter output over 6 hours was 4225+/-998 ml and 21779+/-4273 for coated versus 400+/-692 and 7717+/-9757 for uncoated (p less than 0.01; p<0.01). Mean lactatedehydrogenase (LDH) levels before and 30 minutes after hemofiltration were 1855+/-411 IU and 2007+/-635 for coated versus 2160+/-411 and 1945+/-500 for uncoated (NS; NS). The heparin coated hemofilters demonstrated improved thromboresistance resulting in superior filter performance. There was no evidence of increased blood trauma. PMID- 10148071 TI - Prediction of post-cardiopulmonary bypass cardiac output by venous oximetry. AB - The present study evaluates two equations for predicting the post-cardiopulmonary bypass cardiac output (CO) in 10 patients undergoing coronary artery bypass grafting. One equation is based on the relationship of CO with mixed venous oxygen saturation (SVO 2), while the second equation is based on the relationship with oxygen extraction (1 - SVO 2). Each patient served as his own control. During bypass, when the patients were normothermic and perfused with a pump flow of 2.4 L/min/m 2, the SVO 2 was monitored by an in-line Bentley oxystat Meter. Just before termination of bypass, the pump flow was decreased to 0.4 L/min/m 2 and the left atrial pressure was increased to 10-15 mmHg; the resulting SVO 2 was recorded. The post-bypass CO was predicted in every patient by the two equations. Immediately after weaning from bypass, the cardiac output was measured by thermodilution. The thermodilutional CO measurement was correlated with the CO predicted by the two equations. Correlation analysis suggests that CO prediction is more accurate and approaches the 1:1 ratio when the calculation of predicted CO is based on the relationship between cardiac output and oxygen extraction. PMID- 10148072 TI - Right ventricular support after implantation of a Novacor Left Ventricular Assist Device. AB - The objective was to determine which factors might help to predict the need for mechanical right ventricular support following insertion of a left ventricular assist device (LVAD). A retrospective analysis was performed on 24 patients with cardiomyopathies who had insertion of a LVAD as a bridge to heart transplantation at Presbyterian University Hospital during the period 1987 to 1991. Group 1 consisted of 18 patients who could be adequately supported with the LVAD alone, while Group 2 consisted of 6 patients who required additional support with a right ventricular assist device. Group 2 exhibited longer periods of hypotension on cardiopulmonary bypass, increased inotropic support and decreased right ventricular ejection fraction at time of chest closure post-LVAD. PMID- 10148073 TI - Heparin washout in the pediatric Cell Saver bowl. AB - The possibility of residual heparin in washed red cells transfused to neonatal or pediatric cardiac patients following bypass prompted a measurement of heparin concentrations. Samples were taken during 10 adult and 10 neonatal and pediatric bypass cases. Sample A was from the bypass circuit, Sample B from the Haemonetics Cell Saver bowl inlet before washing, Sample C from the Cell Saver bowl outlet after washing, and Sample D from the patient ten minutes after protamine. Heparin concentrations were measured by a chromogenic assay using activated Factor X. There was no significant difference between the adult and pediatric groups in the levels of heparin concentration on bypass, pre-washing and post-washing, and in the patients following protamine. In the pediatric group, only .002% of the pre-washed heparin remained after washing. This extremely low level of heparin (.0027 units/ml) is only 0.34 units in a 125 ml pediatric unit of Cell Saver blood. Based on post bypass patient samples, this has no clinical significance. Therefore, the Cell Saver can be used safely with neonates and pediatric patients without concern regarding residual heparin when properly processed. PMID- 10148074 TI - The effects of heparin bound surface modification (Carmeda Bioactive Surface) on human platelet alterations during simulated extracorporeal circulation. AB - To determine if treatment with covalently bound heparin (Carmeda Bioactive Surface (CBAS)) to the synthetic surface of the extracorporeal circuit (ECC) would alter the stereotypic pattern of adverse platelet alterations, 450 ml of heparinized blood (lU/ml) was recirculated at a flow rate of twice the circulating volume (L/min) for 2 hrs at 37 degrees C through either untreated (CONT,n=7) or treated (CBAS,n=7) circuits constructed of identical components including a pediatric (0.8m 2) reversed hollow fiber membrane oxygenator. In CONT circuits, platelet count maintained 88+1% (x+/-SEM) of its initial level in the circuit prime sample, dropped to 36+/-6% after 5 min, and returned to 56+/-2% following 2 hrs of ECC. In CBAS circuits, platelet count in the circuit prime sample demonstrated 90+/-4%, decreased to 68+/-10% after 5 min (p less than 0.05) and declined further to 45+/-5% after 2 hrs (NS). Although platelets from both groups retained reactivity to ADP after priming the circuit, only at 5 min of recirculation did CBAS circuits significantly preserve this responsiveness. In CONT circuits, baseline plasma levels of platelet factor 4 rose from 24+/-3 to 581+/-82 ng/ml in the primed circuit and continued to rise to 2933+/-276 ng/ml by 2 hrs of ECC. In contrast, CBAS circuits markedly reduced this release after 2 hrs (577+/-165 ng/ml). Furthermore by 2 hrs of ECC, plasma levels of thromboxane B 2 in the CBAS circuits were significantly reduced when compared to CONT circuits (3035+/-1529 vs 29916+/-16293 pg/ml, respectively).(ABSTRACT TRUNCATED AT 250 WORDS) PMID- 10148075 TI - Diagnosis by electroencephalographic topography. AB - In 5 patients, electroencephalographic (EEG) topography (Fourier analysis and topographic display of EEG data) demonstrated clinically significant acute brain lesions not seen by magnetic resonance imaging or computed tomography. EEG topography contributed to patient management more than standard EEG. Additional, carefully designed, prospective studies may indicate how frequently and in which settings EEG topography is a valuable diagnostic test. PMID- 10148076 TI - Differentiation between ischemic and hemorrhagic stroke by transcranial color coded real-time sonography. AB - Transcranial color-coded real-time sonography was applied to 20 patients with ischemic stroke and 28 patients with spontaneous intracerebral hemorrhage. In all patients the sonographic diagnosis corresponded closely to cranial computed tomography findings. Recent hemorrhages were visualized as a hyperechodense mass. The high contrast to minor echodense adjacent parenchyma led to a clear sonographic distinction. Older clots were characterized by a continuous decrease of echodensity and subsequently were interspersed by hypoechodense zones. In the acute stage of ischemic infarction, the vessel occlusion (17/20) and collateral vascular supply (10/20) could be depicted in the color-B-mode in two perpendicular planes and further verified by the Doppler mode. Brain edema was not visualized. Although in the acute stage no change of echo texture was observed within the infarction, hyperechodense regions (7/11) could be observed in some patients during the time course. Complications of intracerebral hemorrhage and ischemic stroke, such as disturbance of cerebrospinal fluid circulation, midline shift, and compression of adjacent territories, were depicted by transcranial color-coded sonography. These preliminary results illustrate that transcranial color-coded real-time sonography may be helpful in the early noninvasive differential diagnosis as well as long-term follow-up in patients with cerebrovascular disorders. PMID- 10148077 TI - Stroke neuroimaging. Evaluation of a recent stroke patient. PMID- 10148078 TI - Surgical repair of urethral strictures. PMID- 10148079 TI - How to approach the problematic ureteral stone. PMID- 10148080 TI - Modular insert for use on a standard operating room table for performing shoulder surgery in the sitting position. AB - The use of the sitting position for performing shoulder surgery is not a new concept. However, a standard surgical table cannot be readily converted for shoulder surgery without extensive and expensive modifications. A modular insert is described that is inexpensive and can easily be built for use in converting, in less than one minute, a standard surgical table into a table for performing shoulder surgery. PMID- 10148081 TI - Diagnostic guidelines for venous thromboembolism. PMID- 10148082 TI - The financial and clinical impact of redraws due to inadequate heelstick. PMID- 10148083 TI - Mechanical ventilation. PMID- 10148084 TI - Right sided endotracheal intubation: an alternative method for neonates. PMID- 10148085 TI - Cardiac pacing. AB - The symptom most frequently requiring investigation and consideration for cardiac pacing is syncope. This symptom is now receiving more attention than ever, mainly because of the advent of tilt table testing--a simple noninvasive procedure that has substantially reduced the number of syncopal patients remaining undiagnosed. The first part of this review addresses developments in the understanding of syncope, and the latter part covers developments in the understanding and therapy of atrioventricular block and sinus node disease, the management of carotid sinus syndrome, and two possible new indications for pacemaker therapy. PMID- 10148086 TI - Pacemakers, defibrillators, and direct current cardioversion. AB - Technology for pacemakers and automatic implantable defibrillators continues to evolve. Emphasis is placed not only on preventing cardiac death, but also on improving symptoms and quality of life. The basic antibradycardia function of pacemakers is complemented by highly sophisticated rate-responsive capabilities. The search for the perfect physiologic sensor has not ended; potential limitations of the systems currently available are considered in this review. Reports on outcome with pacing in different populations are also discussed. There have been two important advances in automatic implantable defibrillators. One is the introduction of the third generation defibrillator in clinical investigation. A tiered therapy (including antitachycardia pacing, cardioversion, and defibrillation) can now be programmed in the same device, with the protection of back-up antibradycardia pacing. The other remarkable innovation is the expanding use of nonthoracotomy techniques for implantable cardioverter-defibrillator placement. This approach permits the avoidance of a subcutaneous patch electrode in some cases, the system being entirely transvenous. Finally, recent insights on external cardioversion for atrial arrhythmias are briefly reviewed. PMID- 10148087 TI - Late potentials, heart rate variability, and electrocardiography. AB - Low-amplitude, high frequency components in the terminal QRS-complex (so-called late potentials) are thought to arise from diseased myocardial tissue that forms the "electrophysiologic substrate" for ventricular tachyarrhythmias. Recording of late potentials is now commercially available in several systems and may possibly become clinically routine in the near future. Increased attention has been given recently to heart rate variability as an indicator of conditions of the autonomic nervous system that might trigger ventricular tachyarrhythmias. The value of late potentials and heart rate variability for identification of patients at risk for developing life-threatening ventricular tachyarrhythmias is discussed, as are the other applications and limitations of both methods. PMID- 10148088 TI - Catheter ablation for cardiac arrhythmias. AB - With the introduction of radiofrequency energy, catheter ablation has become an established technique for managing many cardiac rhythm disturbances. High efficacy and safety have been reported for accessory pathway ablation, selective fast and slow atrioventricular nodal pathway ablation to eliminate atrioventricular nodal reentrant tachycardia (while preserving atrioventricular conduction), atrioventricular junctional ablation to control the ventricular response to atrial tachyarrhythmias, ablation of the right bundle branch to eliminate bundle branch reentrant ventricular tachycardia, and ablation of the site of tachycardia origin in patients with ventricular tachycardia unassociated with structural heart disease. In addition, there has been active investigation into ablation techniques for more complex arrhythmias such as atrial tachycardia, atrial flutter, and ventricular tachycardia associated with structural heart disease. PMID- 10148089 TI - Interventional catheterization in congenital heart disease. AB - Balloon dilation is now an established treatment for many congenital heart defects. Recent papers deal with the extension of this approach to more complex anomalies, such as tetralogy of Fallot and transposition of the great arteries; the results are variable. Another area of investigation is balloon valvoplasty in more contentious settings, such as neonatal aortic stenosis. The catheter method appears to be as effective as surgery in these cases. Attention has also been directed to the determinants of success or failure in, for example, aortic recoarctation. Here, as in aortic stenosis, basic anatomy plays an important role. Catheter closure procedures also figure in the literature. Closure of persistent ductus now appears to be established everywhere except in the United States. Also of interest are early reports of the "button device" for closure of atrial septal defects. The use of stents appears to offer effective treatment for peripheral pulmonary stenosis, a condition with disappointing results from surgery and balloon angioplasty. Stents may also offer an alternative method for long-term maintenance of duct patency. Catheter interventions now constitute a major part of the work of pediatric cardiologists, and the present status has been summarized in the past year. PMID- 10148090 TI - Pediatric electrophysiology. AB - Our understanding of pediatric arrhythmias continues to evolve through natural history studies of paroxysmal supraventricular tachycardia, the congenital long QT syndrome, and postoperative atrial and ventricular tachyarrhythmias. The influence of the autonomic nervous system on cardiovascular function may play a role in the sudden infant death syndrome, pallid breath-holding spells, and neurally mediated syncope; much work is necessary to understand these entities better. Therapeutic approaches to pediatric arrhythmias are extending beyond newer antiarrhythmic drugs and now include ablative therapy for many supraventricular tachyarrhythmias, both surgical and transcatheter. Advances in pacemaker therapy include novel implantation sites, down-sizing of devices, and the application of antitachycardia and rate-adaptive technologies. PMID- 10148091 TI - Dealing with the deficient acetabulum in revision hip arthroplasty: the importance of implant migration and use of the jumbo cup. AB - The complexity of acetabular anatomy makes operative planning for revision difficult. Plain radiographs do not provide as much detail about structural damage to the acetabulum as the surgeon would like in order to decide on the need for special components and bone grafts. The authors have found that analysis of acetabular implant migration has been a reliable surgical planning technique to indirectly assess residual acetabular bone stock. Superior shift on the anterioposterior radiograph implies posterior superior acetabular roof loss, seriously compromising the major weight-bearing area of the acetabulum. Although this may require a structural allograft, the authors have found that bone stock at the level of the true acetabulum is much better than in the false acetabulum created by the migration. Therefore, rather than a small cup placed high on the ilium, a large jumbo cup can frequently restore better hip biomechanics and take advantage of all of the remaining host bone for component stability and support, without the need for structural grafts. Medial shift implies medial superior migration leaving the physiologically strong rim of the acetabulum intact and therefore, less structurally damaging than posterior superior migration. Because the acetabular rim is anatomically designed for load bearing, a rim fit cup restores physiological weight transfer across the pelvis. Bone graft behind such a cup is protected from full weight-bearing forces and has proven to be very reliable. PMID- 10148092 TI - Cortical strut allografts for femoral reconstruction in revision hip arthroplasty. AB - One hundred thirty-six cortical strut allografts fixed to the femur in revision hip surgery were studied using quantitative and qualitative radiographic analysis. In addition, 58 patients were clinically evaluated. The grafts showed a consistent behavior characterized by some resorption, bony bridging between host and graft, and a high incidence of union. The grafts showed evidence of revascularization and in some cases complete incorporation. The average Harris scores in the clinical group increased from 48 to 79 and was not influenced by the quality of bone before revision. Strut allografting of the femur in revision surgery is a reliable method of augmenting bone stock. PMID- 10148093 TI - Managing chronic dislocated total hip arthroplasty. AB - Dislocation is the most common complication occurring after total hip arthroplasty. Thus, managing the patient with chronic dislocation will continue to be a challenging problem facing joint replacement surgeons. It is believed that several factors contribute to chronic dislocation, ie, surgical approach, inadequate restoration of soft-tissue tension, prosthetic design, and orientation of the prosthetic components. Methods of constraint, both internal and external, are valuable adjuncts available to the joint replacement surgeon that, with certain limitations, result in successful reduction of repeated dislocation and lead to initial stability of the hip joint. PMID- 10148094 TI - Managing infection in the revision total hip replacement patient. AB - Deep infection is one of the most devastating complications in total hip replacement. This dreaded complication is presented in considerable detail with special emphasis on prevention, diagnosis, and various methods of surgical and antibiotic treatment. Basic fundamentals of antibiotic therapy are reviewed. In addition, guidelines are given for the indications of surgical intervention, the type and staging of operative procedures, with detailed techniques of the various operative procedures used to treat the infected total hip implant patient. PMID- 10148095 TI - Revision total hip replacement with cement. AB - This article outlines the author's perspectives on the use of cement in revision total hip replacement. The results reported in the literature are briefly described and a follow-up of the author's personal results using cement the second time on the femoral side will be outlined. Specifically, 110 revisions were performed between 1974 and 1989 and only four of those have required revision for aseptic loosening. Three have been noted to be radiologically loose without sufficient symptoms to warrant revision. Specific cement techniques and prosthetic choices are described. Several clinical examples using cement will illustrate its versatility for treating significant femoral anatomical deficiencies. PMID- 10148096 TI - Results of noncemented revision. AB - The results of revision of total hip replacements with noncemented fixation are dependent on implant design, postoperative treatment, and the technique selected in relationship to the bone quality and quantity. When proximal femoral bone ingrowth fixation is desired an implant must have a double wedge design, which permits a high percentage contact between the host bone and the porous coating of the implant. Bone graft in either the femur or acetabulum should be used at a minimum. Every attempt to obtain host bone contact to porous coating should be done. When a bone graft is used to replace the proximal femur or when an acetabular bone graft covers more than 50% of the cup, the implant should be cemented into the bone graft. Bone structure affects the outcome of noncemented revisions more than the thickness of the bone. Even thin and weak femoral bone has dynamic remodeling capability. The structure influences result more according to the ability to contact the host bone to the porous coating. When this can be done, the bone will heal to the porous coating. Postoperatively, 40% of our patients are treated with a cast to protect bone grafts and weak bones that are important for stability of the implant. We believe that conservative postoperative rehabilitation for noncemented revision arthroplasty significantly improves the healing for the bone to the implant. PMID- 10148097 TI - A case for nonionic contrast media--despite the high cost. PMID- 10148098 TI - Serum FDP and plasma D-dimer testing: what are they measuring? PMID- 10148099 TI - Assessing quality assurance for sweat chloride testing. AB - Variations in sweat chloride tests were analyzed. A total of 1,806 sweat test results were analyzed for intra-assay and inter-assay variation in sweat chloride concentration and sweat weight. The mean and standard deviation of sweat chloride determinations for the negative population was 11.63 mmol/L (7.20 s.d.); for the borderline population was 50.01 mmol/L (6.27 s.d.); and for the positive population was 96.75 mmol/L (s.d. = 13.81). The percent of sweat tests that were negative was 86.77, borderline, 3.82, and positive, 9.41. The variation, represented as the standard deviation, between bilateral sweat chloride values on the same patient for negative results is 10.23 and for positive results is 14.60. The average variation within a patient with regard to sweat weight is 19%. Clinical laboratory scientists can use this information in assessing their own quality assurance procedures and patient results. PMID- 10148100 TI - Thinking of buying an ion-selective electrode analyser? PMID- 10148101 TI - The measurement of right ventricular ejection fraction. PMID- 10148102 TI - The fluidised bed I: basic principles, bacteriology and wound care. PMID- 10148103 TI - Plasmapheresis in intensive care. Part 2 of 2: indications for plasmapheresis and plasma exchange in the intensive care unit. PMID- 10148104 TI - Alternative modes of mechanical ventilation: on the adoration of inspiratory pressure and flow profiles. PMID- 10148105 TI - Ergonomics applied to an intensive care workplace. PMID- 10148106 TI - Techniques for weaning a patient from mechanical ventilation; when to begin, what method to use, and how to predict outcome. AB - A variety of methods have been employed to help wean patients from prolonged ventilatory support. Although synchronized intermittent mandatory ventilation is probably the most widely used, it has not been shown to be clearly superior to T piece or pressure support weaning. Regardless of the method you choose, begin weaning before the patient's lung function has returned to normal or baseline levels and end when the patient shows the minimum capacity necessary to sustain himself off the ventilator. The patient's response to the change in the level of ventilatory support governs the rapidity of weaning. The rapid shallow breathing index can be useful in predicting weaning outcome, as is the patient's ability to tolerate a weaning trial. PMID- 10148107 TI - Holes in the gate can leak savings. PMID- 10148109 TI - Viewpoint: the emergence and benefits of EPO-based POS products. PMID- 10148108 TI - Gatekeepers and the medical specialist: the impact of managed care on rheumatologists. PMID- 10148110 TI - Results of the First Annual AAPPO Journal Survey: part II. Size-dependent, AAPPO membership-dependent and accreditation-dependent operational characteristics. PMID- 10148111 TI - Managed care liability for utilization management. Corcoran v. United Healthcare, Inc. PMID- 10148112 TI - Use of polyglactin 910 mesh (Vicryl) in pelvic oncologic surgery. AB - Various synthetic materials have been shown to be useful surgical adjuncts in shielding the small intestine from pelvic radiation or in creating a new pelvic floor after major radical resections. Promising preliminary results with a polyglactin 910 (Vicryl) mesh in preventing radiation enteropathy prompted the authors to evaluate its clinical usefulness in reconstruction of the pelvic floor. Use of this mesh in pelvic exenterations (five total, one posterior) for advanced or recurrent gynecologic malignancies was associated with one enteroperineal fistula but no pelvic infection. In comparison with other pelvic reconstruction devices, this absorbable mesh significantly reduced intestinal morbidities in pelvic exenterations. This procedure appears to be feasible, reproducible, and safe, especially in patients who have undergone previous irradiation or those with an unsuitable omentum. PMID- 10148113 TI - Current advances in the therapy of sinus disease. AB - Recent technological advances in the diagnosis and treatment of sinus disease have had a significant impact on the way we handle this common condition. As a result of new technologies, we have gained an improved understanding of the pathophysiology of sinus disease. The functional endoscopic sinus surgery (FESS) procedure provides the latest approach to diagnose and aid in the treatment of patients with sinus disease. This endoscopic procedure improves diagnosis and assists in the evaluation of medical and surgical treatment modalities. Should surgery be indicated, a more functional technique can be performed. This includes the meticulous postoperative observation and care of the surgical site. This paper discusses these latest advances in endoscopic diagnosis, medical treatment, and functional surgery for the treatment of sinus diseases. It also outlines the team approach to physician care and management of these patients. PMID- 10148114 TI - Quantification of asymmetric valvular regurgitant jets by color Doppler ultrasound in vitro. AB - Accurate quantification of regurgitant jets in natural and prosthetic heart valves has been a goal of health care workers and researchers for many years. One promising new method applies the law of conservation of momentum transfer to velocities measured by color Doppler ultrasound to calculate the flow rate in the jet. One complicating factor is that regurgitant jets from real heart valves may be highly asymmetric. The purpose of this investigation was to determine whether the accurate calculation of the flow rate in asymmetric jets imaged by color Doppler requires an asymmetric formulation of the conservation of momentum transfer, combined with a method for imaging the jet in three dimensions. Asymmetric jets issuing from narrow slits were imaged in an in vitro, steady flow system. The ultrasound transducer was rotated around the jet axis to image the jet in three dimensions. The three-dimensional imaging confirmed that jets from slits are indeed asymmetric, but become relatively axisymmetric far from the orifice. Images were analyzed by computer and the calculated flows compared to measured flows. The accuracy of an asymmetric formulation of the conservation of momentum transfer method was compared to a simpler, axisymmetric formulation. If axisymmetry was assumed in asymmetric jets, significant errors in the calculated flow rates occurred. In these cases, the calculated flow also varied widely with distance from the orifice. When asymmetry was taken into account, the errors were considerably reduced. The results suggest that, in asymmetric jets, the momentum transfer is convected around the jet axis. PMID- 10148115 TI - Does cardiac function modify left heart opacification with transpulmonary echo contrast agents? AB - Dependence of left heart opacification on ventricular function was evaluated for the new transpulmonary echo enhancing agent (SH U 508-A). The contrast agent was injected intravenously in 5 patients with normal cardiac function (ejection fraction [EF] greater than 60% and echocardiographic left ventricular end diastolic diameter [LVED] less than 56 mm) and in five patients with pathological ventricular function (EF less than 40%, LVED greater than 65 mm). A concentration of 400 mg/mL with dosages of 5, 9, and 16 mL was used in all patients. The visually assessed signal enhancement as well as the videodensitometrically determined peak intensity and duration of signal enhancement did not differ significantly between the two patient groups, while the transit times were markedly prolonged in patients with impaired ventricular function. No significant alteration was found for systemic blood pressure and heart rate. Side effects were transitory and dose related. The noninvasive nature of the procedure and the absence of hemodynamic effects make repeated studies of left ventricular performance with SH U 508-A in patients with varied hemodynamic status possible. PMID- 10148116 TI - Comparison of color flow imaging and peripheral venous saline contrast during transesophageal echocardiography to evaluate right-to-left shunt at the atrial level. AB - Intravenous injections of agitated saline (contrast) are used to identify right to-left atrial shunt during transesophageal echocardiography (TEE). Color flow imaging (CFI) with TEE can be used to detect left-to-right atrial shunt but its application to detect right-to-left shunt is not known. We performed CFI and contrast during TEE in 72 patients for detection of right-to-left shunt. Frame-by frame review of CFI demonstrated discrete laminar jets of the left side of the atrial septum at the lower or upper margin of the fossa ovalis (FO) in 41 (57%) of 72; only 22 had positive contrast. Timing of shunts was late diastolic or early systolic and not related to pulmonary venous inflow. The length of the FO at end-systole was greater in those with positive CFI compared to negative CFI (13.5 +/- 5 vs 11 +/- 4 mm, P = 0.02). CFI was positive for right-to-left shunt in ten of 14 with atrial septal aneurysms. Contrast was positive for right-to left shunt in 29 (40%) of 72; all but six had positive CFI. The degree of left atrial opacification was minimal in 19 and moderate to severe in ten. FO size was greater in positive versus negative contrast (14 +/- 4 vs 11 +/- 5 mm, P = 0.02). Contrast was positive for shunt in ten of 14 with septal aneurysms. Thus, right-to-left atrial shunt more often occurs with increased FO size and septal aneurysms.(ABSTRACT TRUNCATED AT 250 WORDS) PMID- 10148117 TI - Variomatrix--a newly developed transesophageal echocardiography probe with a rotating matrix biplane transducer. Technological aspects and initial clinical experience. AB - The recently developed multiplane transesophageal echocardiography (TEE) probes cannot provide real-time synchronous biplane imaging. We have developed a new "Variomatrix" probe that combines the advantages of the rotating mechanism of the multiplane probe with the capability of providing simultaneous, side-by-side imaging. Its advantages are: (1) easy manipulation to obtain the optimal planes; (2) avoidance of excessive movement of the probe inside the esophagus; (3) assessment of oblique planes that are not viewed with the usual biplane probe; (4) better understanding of the continuity of structures by the simultaneous, side-by-side biplane, rotating images, providing clearer three-dimensional conception; and (5) shorter examination time by providing a 180 degrees imaging range by rotating the transducer just 90 degrees . PMID- 10148118 TI - Prognostic value of the dipyridamole echocardiography test performed early after aortocoronary bypass surgery. AB - It has been demonstrated that high dose (up to 0.84 mg/kg over 10 min) dipyridamole echocardiography stress testing is feasible even in the first few hours after coronary artery bypass graft surgery and can be used to assess the beneficial physiological effects of coronary revascularization as well as graft patency. The aim of this study was to assess the role of dipyridamole echocardiography testing performed shortly after myocardial revascularization in the stratification of prognosis during follow-up. We studied 49 consecutive patients (45 males and 4 females; mean age 56 +/- 8 years) referred to our institute for elective myocardial revascularization. Six patients had single, 14 double, and 29 triple vessel disease. Forty-two left internal mammary artery grafts, 16 sequential venous grafts, and 45 single venous grafts were performed. All patients were submitted to dipyridamole echocardiography testing before (range 1-3 days) and shortly after (range 5-7 days) myocardial revascularization, always with the patients off antianginal medication. An arbitrary wall-motion score grading from 0 to 3 (normal, hypokinesia, akinesia, and dyskinesia) was applied to the seven regions into which the left ventricle was divided. Before surgery 48 patients showed wall-motion abnormalities during the test (47 patients also presented ECG changes). Angina occurred in 48 patients. One patient had ischemic ECG changes and angina. The mean wall-motion score was 3.11 per patient before and 6.5 per patient after the test (P less than 0.001).(ABSTRACT TRUNCATED AT 250 WORDS) PMID- 10148119 TI - Current paediatric perfusion practice in the UK. PMID- 10148120 TI - Current paediatric perfusion practice in North America. PMID- 10148121 TI - The effects of bypass on the developing brain. PMID- 10148122 TI - Minimizing the bypass circuit: a rational step in the development of paediatric perfusion. PMID- 10148123 TI - ECMO parallels. PMID- 10148124 TI - Advances in electrical nerve stimulation techniques to manage chronic pain: an overview. AB - Pharmacologic treatments to manage chronic intractable pain have long been sought. Neuropathic pain is usually resistant to analgesics. At present, no analgesic drug totally relieves pain without producing significant unwanted side effects. Electrical stimulation can offer a degree of relief to some sufferers without risk. Transcutaneous electrical nerve stimulation (TENS) has a long clinical history. Stimulation parameters have been studied to improve the efficacy of this method. TENS is inadequate for extensive and bilateral pain, and epidural spinal cord stimulation is indicated. Dorsal column stimulation (DCS) initially was used to manage pain, but recent clinical reports show that it also can be effective in vascular disease and movement disorders. This review article reports on improvements in the electrical parameters used in neurostimulation and advances in research to overcome methodologic problems of DCS. PMID- 10148125 TI - Clinical significance of renal biopsy in subacute lupus erythematosus. AB - The renal biopsy plays an important role in the clinical evaluation of patients with lupus erythematosus. From numerous studies of renal biopsies in patients with lupus nephritis, it has become clear that although renal lesions are quite varied, the pattern of renal involvement correlates well with the clinical outcome. The broad spectrum of the lesions seen in lupus nephritis has been attributed to individual differences in the immune response in different patients or in the same patient during the course of illness. A classification of lupus nephritis authorized by the World Health Organization is presented. The classification combines all of the morphologic modalities of biopsy interpretation and semiquantitative assessment of activity and chronicity. The clinical correlation of this histologic classification is emphasized and demonstrates that the specific nature of the renal histopathology can predict both the acute and long term course of renal disease in lupus nephropathy and be useful in determining the management of individual patients. PMID- 10148126 TI - Can (should) apheresis supplant whole blood collection? PMID- 10148127 TI - Current trends: evolving concepts in transfusion medicine. Leukoreduced blood components: "you can filter now or you can filter later.". PMID- 10148128 TI - The organization and operation of blood transfusion services in Andalusia. AB - The starting point of recent blood transfusion history in Andalusia may be pinpointed around the mid-1980s with the inception of regional planning. Since then, important changes have come about which are having a positive effect on both blood collection and treatment structure and the clinical practice of transfusion. The underpinnings of these changes lie in the setting up of Transfusion Centers, which have paved the way for a new conception of transfusion services and have established the move towards regional self-sufficiency in blood and blood products as a real possibility. PMID- 10148129 TI - Leucocyte depletion of neocyte-rich red blood cell concentrates by use of immunomagnetic beads. AB - In a series of pilot experiments we depleted neocyte-rich red blood cell concentrates of contaminating leucocytes by use of immunomagnetic beads. The beads were coated with monoclonal antibodies directed against the leucocyte common antigen CD 45. The number of cells isolated depended on the dose of beads which also corresponded to the decrease in leucocytes in the neocyte concentrates. The required ratio of beads to target cells was approximately 25:1, the depletion rate of leucocytes was about 96.0-99.8%. PMID- 10148130 TI - Italy and apheresis: a fresh look at the end of 1991. PMID- 10148131 TI - Effective concentration of bone marrow mononuclear cells using density gradient separation within an automated cell separator. AB - An effective method for concentrating bone marrow is described. Concentration was achieved using an intermittent flow cell separator. Elimination of mature haemopoietic cells was enhanced by the addition of a density separation medium (Ficoll-metrizoate) which was then removed by washing. All procedures were undertaken using the cell separator, this allowed for standardization of procedure and less manipulation which is associated with enhanced mononuclear cell recovery and less risk of microbial contamination. Mature granulocytes were depleted by 86.8% and red cells by 97.7% whilst mononuclear cells showed a 49% recovery. Marrows processed in this way and subsequently purged and/or cyropreserved were shown to successfully engraft when reinfused. PMID- 10148132 TI - Artificial blood substitutes. PMID- 10148133 TI - Ultrafiltration and paediatric cardiopulmonary bypass. PMID- 10148134 TI - The technique of transesophageal echocardiography. How to procure detailed views of an array of cardiac structures. AB - Use of transesophageal echocardiography (TEE) is growing in ambulatory, intensive care, and intraoperative settings. Forward flexion or retroflexion of the TEE probe tip at different levels in the esophagus reveals a variety of intracardiac structures; in the basal short-axis view, for example, the aortic valve can be seen, as can the left atrial appendage lateral to the aorta and pulmonary artery. In the four-chamber view, the mitral and tricuspid valves and interatrial septum can be viewed, and the morphology of the mitral valve leaflets and mitral annulus can be assessed. Cross-sectional views of both ventricles can be obtained in the transgastric short-axis view. In addition, the entire thoracic aorta, as well as the proximal ascending and transverse arch, can be visualized with TEE. PMID- 10148135 TI - Can MDIs be used effectively by extubated ICU patients? AB - Metered-dose inhaler (MDI) therapy can be an effective, cost-efficient means of managing chronic airway obstruction in many patients in medical or surgical intensive care units who have recently been extubated. Because medication is delivered directly to the airways through an MDI, a relatively low dosage may be effective, and few adverse effects may be encountered. Candidates for MDI therapy should have a vital capacity of at least 900 mL, be able to hold their breath for at least 5 seconds, and have a respiratory rate of under 25 breaths per minute. The majority of patients who meet these criteria are able to convert to MDI therapy within 24 hours of extubation. PMID- 10148136 TI - Patient support surface selection. Guidelines for choosing pressure reduction devices. PMID- 10148137 TI - Pre-flight check. How to choose a quality air ambulance in an era of unregulation. PMID- 10148138 TI - The infusion projection. PMID- 10148139 TI - High risk obstetrics. PMID- 10148140 TI - Dextranomer (Debrisan) paste in post-operative wounds. A controlled study. AB - The clinical effect of dextranomer paste (Debrisan) in post-operative wounds (20 patients) was compared with the standard treatment in our department (polyvinylpyrrolidone, 20 patients) in a randomized study. All variables dealing with cleansing, inflammation-reducing effect and signs of ongoing healing were studied. Dextranomer paste appeared to be significantly better than polyvinylpyrrolidone in wounds with a high degree of pus and debris. No side effects were observed in the dextranomer paste group. One patient in the control group showed an allergic reaction (oedema and erythema) and was withdrawn from the study. PMID- 10148141 TI - Case management guidelines for ventilator patients. PMID- 10148142 TI - The application of decision analysis to critical care medicine. PMID- 10148143 TI - Tonometry: part 2 clinical use and cost implications. PMID- 10148144 TI - Dollars and sense. What to know when choosing your medical equipment provider. PMID- 10148145 TI - Pumped up. PMID- 10148146 TI - Oxygen decisions. PMID- 10148147 TI - The cost of caring. Balancing the human and economic factors when justifying costs of brain injury rehabilitation. PMID- 10148148 TI - The technique of fiberoptic bronchoscopy. Diagnostic and therapeutic uses in intubated, ventilated patients. AB - Fiberoptic bronchoscopy has a variety of applications in the intensive care unit. This procedure, which can be done at the patient's bedside, can be used to clear excess secretions; check the position of, or replace, an endotracheal tube; identify areas of active bleeding; diagnose opportunistic infections; and evaluate obstructive airway lesions. Before the bronchoscope is inserted, antisialagogues, anxiolytics, and topical anesthetics are administered along with supplemental oxygen. In intubated, ventilated patients, a fiberoptic bronchoscope may be passed through a swivel adapter to prevent loss of the delivered oxygen and tidal volume. Cardiac arrhythmias and hypoxemia are among the most common complications. PMID- 10148149 TI - The technique of bronchoalveolar lavage. A guide to sampling the terminal airways and alveolar space. AB - Bronchoalveolar lavage (BAL) provides a means of recovering cells and biochemical substances directly from the alveoli in patients with numerous pulmonary diseases. It is also useful in diagnosing opportunistic infections in immunocompromised patients. Upper airway contamination of BAL specimens is the chief liability. In diffuse lung disease, the bronchoscope is usually positioned in the middle lobe; when focal lung disease is present, the bronchoscope is placed in the area of greatest roentgenographic involvement. Sterile saline is instilled and recovered for analysis. Most side effects are related to endoscopic technique, location and extent of lavaged lung area, and the volume and temperature of instilled fluid. PMID- 10148150 TI - New treatment strategies for cardiogenic shock in acute MI. Management options depend on the availability of a cath lab. AB - Aggressive treatment strategies that include early revascularization may significantly improve survival from acute MI complicated by cardiogenic shock. Symptoms of impending cardiogenic shock include tachycardia, cool extremities, pallor, cyanosis, and a normal or low blood pressure. When possible, the right and left sides of the heart are catheterized immediately. For patients who need to be transferred to a hospital with a catheterization laboratory, use temporary support measures--intubation, administration of positive inotropic agents, and placement of an intra-aortic balloon pump. Coronary angiography can reveal whether direct PTCA or bypass surgery is appropriate. Thrombolysis is limited to patients for whom transfer is delayed and those in whom cardiogenic shock is ruled out. PMID- 10148151 TI - The technique of instituting mechanical ventilation. Patient preparation; endotracheal intubation; monitoring. AB - Potential indications for mechanical ventilation include hypoxemia unresponsive to oxygen administration, hypercapnia resulting in acidemia, and an unstable chest wall. For best results, carefully prepare the patient (both physically and emotionally) before instituting ventilation. Sedatives and local anesthesia can facilitate intubation; avoid paralytic agents unless you are experienced at intubation. The oral route is most commonly used. Once the patient circuit is attached to the endotracheal tube, reexamine the patient and double-check the inspiratory flow and I:E ratio; adjust the ventilator's settings as necessary. Monitor the patient frequently to ascertain the adequacy of alveolar ventilation and arterial oxygen. PMID- 10148152 TI - Ways to improve outcome after cardiopulmonary resuscitation. How to monitor patients, correct dysrhythmias. AB - Noninvasive monitoring techniques for assessing circulation during CPR include thoracic electrical bioimpedance and measurement of end-tidal carbon dioxide. Many dysrhythmias can be corrected with portable devices, such as automatic external defibrillation pacers, or with automatic implantable cardioverter defibrillators or external transcutaneous cardiac pacers. Bradycardia is treated, however, only if it is accompanied by hemodynamically significant hypotension or ventricular ectopy. Adenosine may be preferable to verapamil for the management of paroxysmal supraventricular tachycardia. Three consecutive energy discharges are now recommended for the management of ventricular fibrillation. PMID- 10148153 TI - The technique of occlusive-cuff impedance plethysmography. How to use this sensitive, noninvasive tool to detect proximal DVT. AB - Occlusive-cuff impedance plethysmography (IPG) is a rapid, reliable, and noninvasive method of diagnosing proximal deep venous thrombosis (DVT) in the lower extremities. The test is relatively easy to perform and carries an overall accuracy of greater than 90% when compared with venography. IPG is useful in detecting acute, symptomatic DVT and in determining the presence of recurrent DVT. In certain patients with nondiagnostic lung scans in whom pulmonary embolism is suspected, IPG may be helpful in determining appropriate therapy without use of pulmonary angiography. PMID- 10148154 TI - Guidelines for judicious use of electrocardiography. A summary of recommendations from the ACC/AHA Task Force Report. AB - Electrocardiography continues to be a cornerstone in the management of an array of cardiac and noncardiac disorders. However, the ease with which an electrocardiogram can be obtained, as well as its low cost, has led to widespread use--and possible overuse--of this technology. A joint committee of the American College of Cardiology and the American Heart Association recently published guidelines for appropriate use of electrocardiography in patients with known heart disease; in persons suspected of having, or who are at risk for, heart disease; and in persons with no apparent or suspected cardiac disease. These guidelines can help clinicians determine when, and for which patients in the intensive care unit, an electrocardiogram is warranted. PMID- 10148155 TI - The technique of inverse ratio ventilation. Steps to improve oxygenation and decrease dead space ventilation. AB - Inverse ratio ventilation (IRV) differs from other ventilatory techniques in that it employs a prolonged inspiratory time. In theory, pressure-control IRV allows you to maintain ventilation and oxygenation with lower peak airway and end expiratory pressures; this may reduce the potential for lung damage secondary to shearing forces. Consider pressure-control IRV for patients with acute lung disease characterized by low lung compliance, diffuse microatelectasis, and increased intrapulmonary shunting. Currently, the chief limitation of this technique is that the patient cannot breathe spontaneously during its use. The best inspiratory to expiratory ratio is the shortest inspiratory time that improves oxygenation with minimal hemodynamic compromise; depression of cardiac output will negate any potential improvement in arterial oxygenation. PMID- 10148156 TI - Getting best results from echocardiography in emergency situations. Indications include shock, infarction, heart failure, trauma, tamponade. AB - In the ICU, both transthoracic and transesophageal echocardiography can assist in the acute management of a number of different disorders. In hypotensive patients, echocardiography helps distinguish between cardiogenic shock (resulting from acute myocardial infarction), septic shock, and circulatory shock (associated with a reduction in circulating blood volume); it can also help determine whether pericardial effusion or obstruction to valvular flow is producing the hypotension and suggesting pulmonary embolus. Other roles for echocardiography include differentiating left- and right-sided heart failure, assessing the extent of pericardial disease, diagnosing disorders of the thoracic aorta, and evaluating traumatic heart disease. PMID- 10148157 TI - How best to use echocardiography for definitive assessment. Methods of estimating valvular integrity, LV function, pulmonary pressure. AB - In patients with myocardial infarction, echocardiography helps predict outcome, as well as guide the selection of interventional strategies. By assessing the extent of valvular dysfunction and abnormalities in LV and RV size and function, echocardiography can help determine whether surgery is needed in patients with valvular heart disease. Both pulmonary artery pressures and LV function can be evaluated and quantified with ultrasonically derived data. Although echocardiography cannot document active infection, vegetations may appear as areas of valvular thickening. The role of echocardiography will continue to evolve as new techniques are developed. PMID- 10148158 TI - Beyond the basics: operating the new generation of ventilator. A look at the features and functions of these units. AB - Most modern ventilators have several key features in common: microprocessor control of operational and monitoring functions; electromechanical valves to control and adjust gas flow patterns; and extensive monitoring systems. In addition, these machines can provide a number of different modes of ventilation (including pressure support). Though not microprocessor-controlled, the Siemens Servo 900 series ventilators use feedback electronics to adjust inspiratory flow based on expiratory flow to meet preset volumes. In contrast, the Bennett 7200 units use microprocessor-regulated solenoid valves to deliver preset tidal volume. High-frequency ventilators deliver smaller tidal volumes at rates greater than 60 bpm. PMID- 10148159 TI - Understanding and operating the Bennett MA-1 ventilator. Tips on adjusting the controls to avoid problems. AB - The Bennett MA-1 ventilator is a volume-cycled, constant flow generator that can act as an assistor, controller, or assist-controller. It is one of the most commonly used ventilators in clinical practice. With this unit, inspiration continues until a preset tidal volume is delivered to the patient--unless impedances to gas flow increase system pressures to a preselected limit. Thus, setting the maximum inspiratory pressure too low limits the ability of the ventilator to deliver the tidal volume, causing it to function as a pressure cycled device. Other basic controls allow you to establish the sensitivity of the ventilator to spontaneous breathing attempts, the maximum flow rate, the frequency of respirations, and the oxygen percentage. Special controls permit delivery of a sigh breath and slowing of exhalation. PMID- 10148160 TI - Techniques for IABP timing, use--and discontinuance. Counterpulsation can reduce ischemia and improve hemodynamics. AB - By restoring the balance between myocardial oxygen supply and demand, intra aortic balloon counterpulsation can aid the ischemic or failing left ventricle. Rapid inflation and deflation of the balloon reduces afterload and improves coronary perfusion. Timing of inflation and deflation is adjusted according to the arterial pressure waveform. The balloon should inflate just after the aortic valve closes and deflate just before the aortic valve opens; early or late balloon inflation or deflation blunts the therapeutic effects. Discontinue the IABP support gradually; monitor the patient frequently for any signs of hemodynamic compromise, redevelopment of ischemic chest pain, or electrocardiographic changes. PMID- 10148161 TI - A clinician's guide to ventilators: how they work and why they can fail. A classification system to make sense of available options. AB - To select a ventilator (or a ventilatory mode), consider the most basic characteristics: How is tidal volume generated (with a constant or nonconstant flow or pressure generator)? How does the ventilator trigger a changeover from exhalation to inhalation and cycle back to exhalation? How is tidal volume delivered to the patient (either directly from a power source or indirectly from an intermediate chamber)? What special functions are available? The answers to these questions will not only let you make the best selection but will also help you troubleshoot when a ventilator fails to function properly. PMID- 10148162 TI - Second- and third-generation ventilators: sorting through available options. When, and for which patients, are special functions needed? AB - Currently available ventilators offer a number of special options to meet the needs of critically ill patients. Intermittent mandatory ventilation allows a patient to breathe spontaneously without assistance. CPAP and PEEP ensure that the patient breathes at an elevated pressure either constantly or during expiration. Pressure support ventilation allows patients to participate in breathing but provides inspiratory assistance and is most useful during weaning. Airway pressure release ventilation facilitates venous return and decreases airway pressure. Sophisticated monitors provide detailed information on the patient's status, but alarm features are somewhat unreliable. Thorough knowledge of the controls on modern ventilators can help you provide the optimum form of respiratory support. PMID- 10148163 TI - The technique of inserting an intra-aortic balloon pump. Indications, contraindications, advice for avoiding complications. AB - The intra-aortic balloon pump (IABP) uses the timed inflation and deflation of a balloon placed in the descending aorta to augment coronary perfusion and reduce myocardial work. The IABP is useful in a number of settings, including acute myocardial ischemia, cardiogenic shock, and mechanical complications of acute myocardial infarction; it also provides support to perioperative patients. Because the device can be inserted percutaneously, mechanical circulatory support can be instituted rapidly Complications, most of which are reversible, occur in approximately 30% of patients. PMID- 10148164 TI - Antishock garments: more harm than good? PMID- 10148165 TI - The technique of percutaneous renal biopsy. How to minimize risk while ensuring adequate tissue sampling. AB - Percutaneous renal biopsy is useful in diagnosing a variety of kidney disorders, as well as certain systemic diseases with renal and/or nonrenal manifestations. The procedure is performed while the kidney is viewed by continuous ultrasonographic imaging. The kidney is first located with a spinal needle and the area is anesthetized. The biopsy needle is then inserted and advanced toward the capsule. When the capsule is pierced, the trochar is advanced into the renal cortex. The sheath is lowered, encompassing the cutting edge and the core biopsy sample. Complications, although rare, may include the creation of an arteriovenous malformation and laceration of the kidney or other intra-abdominal organ; close monitoring after the procedure is therefore required. PMID- 10148166 TI - Evolving challenges in prehospital trauma services. Current issues and suggested evaluation tools. AB - For the past two decades, prehospital trauma care has been addressed almost generically in terms of the related approaches to epidemiology, research, and management. However, evolving directions in research have helped emergency medical services (EMS) practitioners to delineate more focused treatment strategies according to the mechanisms of injury, anatomic involvement, and the patient's clinical condition. Recent studies in the areas of trauma-associated circulatory arrest, severe blunt head injury, and post-traumatic hemorrhage following penetrating truncal injury suggest that current standard approaches to patient care should be reconsidered. In turn, this need for re-examination of trauma management strategies calls for the development of appropriate evaluation tools within EMS systems. Proper research design is dependent upon several key issues including: 1) the type of study (system study versus examination of a specific intervention); 2) the population under study; 3) physiological and anatomical scoring method; 4) prospective definitions of interventions and meaningful outcome variables (both morbidity and mortality); 5) relative outcome compared to known standards; and 6) prospective determination of statistical requirements. PMID- 10148167 TI - Telemedicine and international disaster response. Medical consultation to Armenia and Russia via a Telemedicine Spacebridge. AB - The Telemedicine Spacebridge, a satellite-mediated, audio-video-fax link between four United States and two Armenian and Russian medical centers, permitted remote American consultants to assist Armenian and Russian physicians in the management of medical problems following the December 1988 earthquake in Armenia and the June 1989 gas explosion near Ufa. METHODS: During 12 weeks of operations, 247 Armenian and Russian and 175 American medical professionals participated in 34 half-day clinical conferences. A total of 209 patients were discussed, requiring expertise in 20 specialty areas. RESULTS: Telemedicine consultations resulted in altered diagnoses for 54, new diagnostic studies for 70, altered diagnostic processes for 47, and modified treatment plans for 47 of 185 Armenian patients presented. Simultaneous participation of several US medical centers was judged beneficial; quality of data transmission was judged excellent. CONCLUSION: These results suggest that interactive consultation by remote specialists can provide valuable assistance to on-site physicians and favorably influence clinical decisions in the aftermath of major disasters. PMID- 10148168 TI - Clinical guidelines for delayed or prolonged transport: II. Dislocations. Rural Affairs Committee, National Association of Emergency Medical Services Physicians. PMID- 10148169 TI - Pain measurement. An overview of two commonly used methods. AB - Two pain-measurement tools in particular have gained widespread acceptance by clinicians who work in the area of pain management: the visual analogue scale and the McGill Pain Questionnaire. The purpose of this paper is to describe briefly both of these methods and to consider some of their strengths, weaknesses, and applications. PMID- 10148170 TI - The Eschmann Tracheal Tube Introducer. (Gum elastic bougie). PMID- 10148171 TI - Using biodegradable polymers in advanced drug delivery systems. AB - Research currently is under way to design novel drug delivery systems that enhance the duration of activity and that provide site-specific release of the drug. Biodegradable polymers represent an important class of materials used in the manufacture of these systems. This article discusses some major types of biodegradable polymers and reviews their applications in advanced drug delivery. PMID- 10148172 TI - Altering the physical properties of silicone elastomers for medical device applications. AB - In designing prototypes of medical devices and molds, it is sometimes necessary to modify the working consistency of the unvulcanized elastomer or the softness of the vulcanized elastomer. This article presents data demonstrating the use of polydimethylsiloxane (PDMS) fluids to alter the handling or the final physical properties of the elastomer. PMID- 10148173 TI - Update on retinopathy of prematurity: the examination guidelines. PMID- 10148174 TI - Medical laser safety programs: management and training. By the medical and surgical users at Abbott Northwestern Hospital. PMID- 10148175 TI - Safe applications of lasers in dentistry call for proper training and approved uses. PMID- 10148176 TI - Recommendations for safe and appropriate use of lasers in dentistry in face of rising concerns. PMID- 10148177 TI - Laser safety primer outline for industrial/medical users. AB - Laser safety standards are detailed technical documents arising from the complexity of the different mechanisms, depending on the parameters of the laser beam, by which lasers interact with living tissue. As a result, their interpretation by non-expert laser users, who are concerned about safety issues, can cause many difficulties. Based on experience in advising industrial and medical laser users, we have developed a primer which (i) provides step-by-step guidance in the interpretation and use of the laser safety standards, and (ii) explains how to calculate the laser irradiance (on the retina or the skin) to which the user may be subjected in typical situations. A computer program has also been developed which, through a series of questions and answers, guides the user through the calculation of the maximum permissible exposure level and the nominal optical hazard distance for the application of interest. The overall package should be particularly useful to laser safety officers and users of lasers for research applications, as an independent check on safety calculations. It also provides a useful complement to the many worked examples in the laser safety standards. PMID- 10148178 TI - Probing plume protection problems in the health care environment. AB - This paper presents pragmatic particulars pertaining to plume protection problems with special emphasis on the health care environment. Practical approaches to optimizing protection are discussed with an eye toward facilitating the safety of personnel and the general health care environment from particulates, parasites, viruses and other undesirable entities, elements and compounds. PMID- 10148179 TI - Guidelines for routine measurement of blood hemoglobin oxygen affinity. IFCC Scientific Division, Committee on pH, Blood Gases, and Electrolytes. AB - Two methods for the routine determination of blood hemoglobin oxygen affinity are described. Both methods use whole blood and do not require special equipment, tonometry, or special gas mixtures. The first method consists of a one-point determination of p 50, and requires only 200 muL to 400 muL of whole blood, therefore making it suitable for the pediatric population. The second method uses multiple points, thereby establishing both the shape and position of the hemoglobin oxygen equilibrium curve between 10 and 99% oxygen saturation. Interpretation of p 50 is discussed in relation to evaluation of patients with hemoglobinopathies and as a parameter in estimating availability of oxygen to the tissues. PMID- 10148180 TI - Water's healing powers. Hydrotherapy for the old, the young--for all. PMID- 10148181 TI - Changing paradigms in pain management. chronic pain. PMID- 10148182 TI - Integrated vision: motion studies. PMID- 10148183 TI - Wound healing currents: a brief review of recent research points to electrical stimulation as a viable treatment technique. PMID- 10148184 TI - New developments in electrotherapy. AB - In the last decade, and especially in the last five years, there has been a proliferation of new electrotherapy devices on the physical therapy market. As therapists, we have looked for other modalities to enhance our ability to help our patients. We have also seen PTs develop innovative treatment approaches, using these devices for pain relief, edema control, wound healing, and enhancement of muscle contractility. The following is a brief overview of some innovative electrotherapy approaches being used by PTs. PMID- 10148186 TI - Stimulating conversations in needle EMG. AB - Needle electromyography (EMG) is a widely used modality that has been available for decades. Yet never has this invasive mode of EMG been enveloped in greater controversy than it is today. To explain the status--and future--of needle EMG while casting light upon the controversies surrounding it, Rehab Management spoke with three noted specialists in the field. PMID- 10148185 TI - Assessing surface EMG. PMID- 10148187 TI - Rehabilitation of the Ilizarov patient. PMID- 10148188 TI - A clinical evaluation of the effect of calf blood dialysate on the course of acute myocardial infarction. AB - The effect of daily intravenous treatment for 3 weeks with a calf blood dialysate presumed to improve disturbed oxidative metabolism was compared with placebo in a randomized double-blind study of 60 subjects with a first acute transmural myocardial infarction. Overall clinical evaluation of initial severity and clinical course suggested a better response of borderline significance in the dialysate-treated group. Blood enzyme elevations were statistically significantly less for that group on day 4 post-infarction for creatine kinase (CK) and aspartate aminotransferase (AspAT) but not for lactate dehydrogenase (LDH). ST segment elevations in the 36 lead ECG developing after admission were fewer in the verum treated than in the placebo group. Results by each of three criteria (clinical evaluation, enzyme elevations, and electrocardiographic changes) suggest a more favorable response to treatment with the calf blood dialysate as compared to placebo. PMID- 10148189 TI - Long-term implications of seating. PMID- 10148190 TI - Electrotherapy; applying several modes for maximum impact. AB - Astute clinicians have found that no single modality is useful for all purposes; rather, the utilization of several specific purposes best serves the patient. PMID- 10148191 TI - Microcurrent therapy; wave of the future? AB - In our six years of experience with muscular electrical nerve stimulation (MENS), we have not had any negative results. MENS has produced consistent, predictable results on a variety of patients. The results were initially excellent and have improved with our familiarization with the instrumentation. We would encourage clinicians who have not utilized MENS to do so. Optimal results with MENS will require a combination of direct, indirect, and regional techniques. PMID- 10148192 TI - Electrotherapy for wound healing. PMID- 10148193 TI - Measurement of intracranial pressure. PMID- 10148194 TI - Plasmapheresis in intensive care. Part 1 of 2: history, techniques and complications. PMID- 10148195 TI - Medical robots in intensive care. PMID- 10148196 TI - Buying a ventilator. PMID- 10148197 TI - EEG monitoring in the intensive therapy unit. PMID- 10148198 TI - Measurement of extravascular lung water. PMID- 10148199 TI - APACHE III study: a summary. AB - This paper summarizes the APACHE III Study now being performed by the ICU Research Unit at the George Washington University Medical Center. It presents a review of the material included in a recent detailed description of the APACHE III Study and introduces new work being developed with data from Brazilian hospitals. PMID- 10148200 TI - Measurement of blood gases. PMID- 10148201 TI - Pain control in critical care: a role for patient controlled analgesia? PMID- 10148202 TI - The organisation of experimental studies related to intensive care. PMID- 10148203 TI - Colloid osmotic pressure measurement in critically ill patients. PMID- 10148204 TI - Minitracheotomy. PMID- 10148205 TI - The current role of ECMO in paediatric practice. PMID- 10148206 TI - Intensive care in India: experience of a major teaching hospital. PMID- 10148207 TI - Lasers in neurosurgery: a historical overview. AB - This contribution to the history of laser applications to neurosurgical patients gives the background against which the subsequent developments took place. It covers the important facts regarding the theoretical formulations that led to the invention of the world's first laser in 1960. This was a pulsed ruby laser, which proved lacking in desirable surgical procedures, and at high powers was shown to be damaging to vital organs, such as the brain. It could be lethal to small animals. These very early tests of laser tissue and organ interaction included studies on protein in solution, cultured cells, brain, spinal cord and their surrounding tissues, and transplantable melanomas, as well as ependymoblastomas in mice. Fortunately, the continuous wave CO 2 laser came along in 1967 to replace both the pulsed ruby and neodymium-in-glass lasers. The CO 2 laser was quickly seen to possess surgical properties, namely, vaporization, cutting, hemostasis, and sterilization, without additional damage at a distance or remotely in time. Research studies on normal and pathologic tissues in and around the brain and spinal cord quickly and dramatically showed the potential for benefit to animal and human patients with experimental and naturally occurring neoplasms, burns, and decubitus ulcers. Lasers in neurosurgery are used largely for benign and malignant brain and spinal neoplasms. For benign tumors, debulking of tumor mass, and ablation of unwanted neoplasm without damaging adjacent, vital, functioning neural tissue, the laser adds another therapeutic adjunct and will, at times, aid in complete tumor removal. For malignant vascular growths, the laser will aid greatly in the safest possible excision with maximum hemostasis. Studies around the world, ongoing or planned, will surely extend the uses of lasers for neurosurgery into vascular, infectious, and reconstructive fields, particularly with the proliferation of laser instruments that exploit additional wavelengths into the larger infrared levels and even the shorter ultraviolet region. Experimental and, to some extent, clinical applications are testing the value of Nd:YAG, holmium:YAG, and erbium:YAG lasers in various surgical fields. PMID- 10148208 TI - Macroscopic and microscopic findings after excimer laser treatment of different tissue. AB - In reported tests, the interaction of excimer laser radiation with bone, meniscus, and tendon tissue was observed. Depending on various laser parameters, different tissue reactions were observed in all procedures. Ablation was performed in a liquid medium to ensure extended carbonizations even at low application energy and repetition rate. Our studies revealed that the longer the pulse, the lower the destruction rate of fibers. However, a longer pulse caused lower ablation rates than a shorter one. An increase of repetition rate instead of an increase of application energy resulted in higher heat accumulation in the adjacent tissue. Differentiation of the single parameters on various tissue allows flexibility of thermal effects from the laser procedure. PMID- 10148209 TI - Photons, physiatrics, and physicians: a practical guide to understanding laser light interaction with living tissue, part I. AB - In the past 32 years, lasers have progressed from interesting curiosities to important instruments in medicine and surgery, with a wide variety of wavelengths and medical-surgical applications. Today's physician is faced with a bewildering array of laser types, each touted by its manufacturer as the ultimate surgical tool. This article sets forth in simple, understandable prose, the basic principles of the interaction of laser light with living tissue, so that the physician can decide which type of laser is best suited to a given application, without relying on the manufacturer's sales literature. The topics discussed are the nature of light; reflection, absorption, scattering, and attenuation in living tissue; physical processes by which laser light destroys tissue; relative importance of the three unique properties of laser light in surgery and therapy; temporal modes of lasers; means of delivering laser beams to their targets; and considerations in the selection of laser systems. PMID- 10148210 TI - Holmium laser coronary thrombolysis--a new treatment modality for revascularization in acute myocardial infarction: review. AB - Thrombolytic therapy has changed the approach to management of acute myocardial infarction (AMI). Although its therapeutic benefit has been well established, only about one-third of AMI patients receive lytics. In AMI patients for whom thrombolytics fail to achieve revascularization or for whom lytics are contraindicated, percutaneous transluminal coronary balloon angioplasty (PTCA) can be utilized. However, in a clinical setting of AMI PTCA is less successful and is associated with a higher complication rate than with PTCA for angina alone. This review details a novel application of laser angioplasty; in patients with AMI complicated by continuous chest pain and ischemia, a mid-infrared (2.1 micron) solid-state, pulsed-wave Holmium:YAG coronary laser (Eclipse, Palo Alto, CA) can be utilized for coronary thrombolysis and plaque ablation. In each patient the laser was applied after failure of a thrombolytic agent or when thrombolytics were contraindicated. We have gained experience with 13 lesions, 12 in a coronary artery and 1 in a vein graft. In each case a multifiber with laser catheter (1.4, 1.5, 1.7 or 2.0 mm) was advanced over a guide wire, emitting 250-600 mj/pulse at 5 Hz, followed by adjunctive PTCA. Clinical success (defined as less than or equal to 50% residual stenosis, adequate thrombolysis, no complications [including death, CVA, CABGs, dissection, perforation]) was achieved in all patients. All patients improved clinically, survived the AMI, and were discharged. This initial clinical experience demonstrates the feasibility and safety of Holmium:YAG coronary laser angioplasty in revascularization during AMI.(ABSTRACT TRUNCATED AT 250 WORDS) PMID- 10148211 TI - In vitro and in vivo fall of intradiscal pressure with laser disc decompression. AB - In vitro and in vivo measurements of intradiscal pressure under load and without load, respectively, before and after laser ablation of small volumes of nucleus pulposus revealed significant falls of intradiscal pressure. This is the basic principle underlying percutaneous laser disc decompression (PLDD). PMID- 10148212 TI - Chronic nonhematogenous osteomyelitis treated with adjuvant CO 2 laser sterilization: a preliminary report. AB - A CO 2 laser was used to sterilize wounds resulting from trauma injuries to bone on 12 sites in 11 patients. This treatment relieved chronic osteomyelitis and enabled most of the patients to function normally within 3 months of surgery. PMID- 10148213 TI - A clinical investigation of the management of oral lichen planus with CO 2 laser surgery. AB - Ten patients with an established histologic diagnosis of lichen planus on various sites of the oral cavity were treated with CO 2 laser therapy under local anesthesia. Power output of 5 W at continuous mode was applied to vaporize the lesions. Eradication was achieved by aiming the laser in a moving criss-cross pattern with defocused spatial overlap. Depth of removal was subepithelial. No suturing of the wound was done. Follow-up occurred at intervals from 6 months to 4 years. The average length was about 3 years. Postlaser healing was uneventful, with little pain, swelling, or bleeding. There was immediate relief in all patients of associated burning sensations and a tolerance to hot and spicy foods. This symptomatic improvement lasted throughout the follow-up. Reepithelialization produced little visible scarring, and the mucosa color and texture were close to normal. Alterations in the immunologic status of the patients were implicated. Histologic rebiopsy in two cases suggested significant improvement, normalization of the epithelium, and a reduction of the subepithelial infiltrate. The CO 2 laser is effective in the immediate relief of symptoms and contributes to the clinical improvement of oral lichen planus. Immunologic studies and long-term follow-up are suggested. PMID- 10148214 TI - Outlook for coronary laser angioplasty. PMID- 10148215 TI - The CO 2 laser used for matrixectomy. PMID- 10148216 TI - For staging renal cell carcinoma, MRI shows merit. PMID- 10148217 TI - Autoaugmentation of the bladder. PMID- 10148218 TI - Monitoring respiration in the neonate. PMID- 10148219 TI - Respiratory care in the transport of critically ill and injured infants and children. PMID- 10148220 TI - Preventing needlesticks and their consequences. PMID- 10148221 TI - Introducing the midline catheter as a new intravenous access device in neonates. PMID- 10148222 TI - Clinical considerations for infant heel blood sampling. PMID- 10148223 TI - Clinical considerations for infant heel blood sampling. Part two. PMID- 10148224 TI - Continuous non-invasive respiratory monitoring with a neonatal workstation. PMID- 10148225 TI - Urologists and kidney transplantation: a proper alliance. PMID- 10148226 TI - Testis biopsy augments the infertility workup. PMID- 10148227 TI - PSA leads the way for detecting and following prostate cancer. PMID- 10148228 TI - A rapid EIA test for Clostridium difficile Toxin A. PMID- 10148229 TI - Automated and accurate analysis of data from receptor competition assays. PMID- 10148230 TI - Comparison of two cytotoxic food sensitivity tests. PMID- 10148231 TI - Identification of over 500 Gram-negative species by a single test panel. PMID- 10148232 TI - Improved technology for cytology specimen preparation. PMID- 10148233 TI - A simplified EIA test for chlamydia. PMID- 10148234 TI - Diagnosis of Lyme disease: evaluation of an enzyme-linked immunobinding assay. PMID- 10148235 TI - Considerations in the evaluation and purchase of a blood gas analyzer. PMID- 10148236 TI - A semi-automated urine chemistry analyzer. PMID- 10148237 TI - Evaluation of a noninvasive hematocrit monitor: a new technology. PMID- 10148238 TI - Rate nephelometry in a nutritional testing program. PMID- 10148239 TI - Mycoplasma pneumoniae latex agglutination and complement fixation: comparative serology. PMID- 10148240 TI - Volume-controlled ventilation for severe neonatal respiratory failure. AB - Volume-controlled ventilation was utilized as a rescue modality in six newborn infants with severe respiratory failure. Infants were switched from time-cycled, pressure-limited ventilation to volume-controlled ventilation at 10-12 mL/kg using the VIP-Bird infant ventilator. All six displayed dramatic improvements in oxygenation with virtually no change in mean airway pressure and with subsequent resolution of the respiratory failure. Preliminary analysis of pulmonary function during volume-controlled ventilation suggests differences in the patterns of delivery of tidal volume and minute ventilation, which are more consistent. This may improve stabilization of lung volume and decrease ventilation-perfusion mismatch. PMID- 10148241 TI - Treatment of combined renal failure and lactic acidosis by haemofiltration. AB - Twelve patients with renal failure and type A lactic acidosis were treated with haemofiltration during a 30-month period. The first three patients received only lactate-buffered replacement fluid and rapidly succumbed despite the infusion of large quantities of sodium bicarbonate. Bicarbonate-buffered replacement fluid was used for the remaining nine patients, of whom three survived. Haemofiltration with bicarbonate-buffered replacement fluid is an effective method of replacing renal function for this group of critically-ill patients. PMID- 10148242 TI - New approaches in the diagnosis and prevention of pulmonary infections in critically ill patients. PMID- 10148243 TI - New approaches in the diagnosis of pneumonia in ICU patients. AB - The following clinical criteria can be used for the diagnosis of pneumonia in ventilated patients: 1. New infiltrates on chest X-ray. 2. Purulent tracheal secretions (TS). 3. Positive bacteriological finding in TS. 4. Temperature over 38.5 degrees C. 5. Leucocyte count over 12,000/mm 3. 6. Characteristic auscultatory findings. 7. Impaired gas exchange. When the first three criteria are fulfilled and a further two criteria are positive, a respiratory tract infection is highly probable and therapy with antibiotics justified. When fewer criteria are fulfilled, or in cases in which specific criteria cannot be applied, for example, patients with the acute respiratory distress syndrome (ARDS), a lung contusion, or an infection located elsewhere, invasive bronchoscopic diagnosis by protected specimen brush (PSB) or bronchoalveolar lavage (BAL) is indicated. The PSB method is characterised by very good specificity, though a not so high sensitivity. Compared to the PSB method, the BAL method has a lower specificity but is more sensitive. Pre-conditions for the successful application of both methods include correct technical handling as well as close co-operation between the intensive care physician and the microbiology laboratory. PMID- 10148246 TI - Evaluation of an automated urinalysis instrument. PMID- 10148247 TI - Bioluminescent and chemiluminescent immunoassays. PMID- 10148248 TI - Particle-based tests and assays--pitfalls and problems in preparation. PMID- 10148249 TI - Laboratory procedures for diagnosis of infertility. PMID- 10148250 TI - Assisted reproductive technologies. PMID- 10148251 TI - An automated system for sickle cell screening. PMID- 10148252 TI - Heel blood sampling on older infants. PMID- 10148253 TI - Evaluation of the operational capabilities of a new extrathoracic negative pressure device for use in newborn infants. AB - We evaluated the operational capabilities of a new negative pressure incubator from Chelmsford, England prior to its use in our Neonatal Intensive Care Unit (NICU). Successful manufacturer's testing had already been completed. Teams of respiratory therapists and a biomedical engineer evaluated two identical units using 22 criteria, and results were scored on a pass/fail basis. The device passed our evaluation; we found it to be well built and reliable, with a wide range of rate, inspiratory time, peak negative inspiratory pressure and negative expiratory extrathoracic pressure settings. It did not pass criteria involving pressure monitor reliability, pressure relief, suction unit alarms, ease of service and service manual. This device may be used as a ventilator for intubated or non-intubated infants, in tandem with positive pressure mechanical ventilation replacing positive end-expiratory pressure with negative end-expiratory pressure, or alone in the continuous negative extrathoracic pressure mode. PMID- 10148254 TI - The neonatal information system. A clinical database management system for neonatology. PMID- 10148255 TI - Continuous neonatal pulmonary mechanics with the BICORE CP-100 monitor. PMID- 10148256 TI - Critical analysis of the validity of electronic fetal monitoring. PMID- 10148257 TI - Extracorporeal shock wave lithotripsy and percutaneous nephrostolithotomy for urinary calculi: comparison of immediate and long-term effects. AB - Extracorporeal shock wave lithotripsy and percutaneous nephrostolithotomy have become widely used technologies for removal of urinary calculi, despite a lack of adequate evaluative studies. The possibility of long-term adverse effects of these treatments has been raised, particularly an increase in stone recurrence and development of hypertension following extracorporeal shock wave lithotripsy. We conducted a retrospective study of 1,000 patients treated with extracorporeal shock wave lithotripsy or percutaneous nephrostolithotomy for upper tract stone disease to assess immediate effectiveness and complications, with prospective follow-up to assess stone recurrence and development of hypertension. The effectiveness of each treatment (defined in terms of patients rendered stone-free or having only fragments at discharge) was similar for most stone types. While stone recurrence rates in the first 2 years after treatment were similar in the two groups, cumulative recurrence at 3 years was higher following extracorporeal shock wave lithotripsy compared to percutaneous nephrostolithotomy (39% vs. 23%, p = 0.04). However, logistic regression and Kaplan-Meier analyses showed no significant difference in clinically evident recurrence for patients treated with extracorporeal shock wave lithotripsy. Cumulative incidence of clinically evident stone recurrence did not differ significantly between patients with fragments at discharge (20%) and patients rendered stone-free (15%) (p = 0.24). There was no difference in the development of new hypertension requiring medical treatment. Our findings indicate that extracorporeal shock wave lithotripsy is effective and associated with lower short-term morbidity than percutaneous nephrostolithotomy. Stone fragments left behind by lithotripsy do not appear to confer significant risk of early stone recurrence. Further study is necessary to define long-term risk of recurrence following extracorporeal shock wave lithotripsy. PMID- 10148258 TI - Parameters influencing piezoelectric shock wave lithotripsy of biliary calculi. AB - A total of 225 human gallbladder stones were divided into sets of two, three, or four identical calculi (with maximum diameters of 6-26 mm) and submitted to piezoelectric shock wave lithotripsy in vitro in order to investigate the influence of the following parameters on stone disintegration: shock wave intensity, pulse frequency, and various physicochemical parameters such as the volume and viscosity of the fluid surrounding the stone, the hardness of the calculus, and its chemical composition. The fragmentation efficacy increased with enhanced shock wave energy (P less than 0.01). If the volume of the fluid (30 mL) surrounding the calculus was small, the disintegration end-point (defined by maximum fragment diameters less than or equal to 4 mm) was achieved after a lower number of pulses (median: 250 pulses) than in the case of a large fluid volume (80 mL) (500 pulses; P less than 0.01). On the other hand, however, factors such as the shock wave pulse rate (0.9 Hz vs 1.6 Hz), variations in viscosity of a water-jelly mixture surrounding the stone, the chemical composition of the stones as determined by X-ray diffractometry, and stone hardness were found to have no significant influence on the fragmentation efficacy. PMID- 10148259 TI - Treatment of cystine urolithiasis by a combination of extracorporeal shock wave lithotripsy and chemolysis. AB - Minimally invasive surgical procedures are particularly desirable in patients with cystine stones because of their often multiple previous operations, complicated stone situations, and high risk of recurrences. Twenty-four treatment episodes for cystine stones were carried out, 12 with extracorporeal shock wave lithotripsy (ESWL) as monotherapy and 12 with a combination of ESWL and percutaneous irrigation with chemolytic solutions. In the ESWL monotherapy group, five of 12 renal units became stone-free and one more patient was discharged stone-free, except for an untreated stone in a calix diverticulum. Combined treatment, most often given in association with more complicated stone situations, rendered seven out of 12 kidneys stone-free. Even in this group, one patient was discharged with an untreated residual stone in a calix diverticulum. Our results show that even complicated cystine stone situations can be successfully treated in a minimally invasive way, with the best results obtained with a combination of ESWL and percutaneous chemolysis. Alkalization of urine seemed to be insufficient in preventing stone formation. No difference in recurrence rate was observed between our two treatment groups. PMID- 10148260 TI - In vitro gallstone fragmentation by three piezoelectric lithotripters. AB - Several different piezoelectric lithotripters have been under clinical investigation for gallstones in the USA. Design differences in the different shock wave generators result in different characteristics for the three devices and different peak pressures at the focus of the lithotripters. Using gallstone families, we sought to study fragmentation in the three lithotripters. A total of 56 gallstones from eight gallstone families were studied. Forty-eight stones were fragmented in three lithotripters (16 in each), Diasonics (Therasonic), EDAP (LT01), and Wolf lithotripter (Piezolith 2300), at maximum power and a rate of 2 2.5 Hz. A total of 500 shocks was applied to each stone in each of the three lithotripters. Gallstone composition was determined by infrared spectroscopy on one stone of each family (8 x 1). Initial stone weight and size were similar in all the three groups. All families consisted of cholesterol stones ( greater than 70% cholesterol). The fraction of the initial stone mass reduced to fragments less than or equal to 2 mm was not significantly different in the three lithotripters (Diasonics [n = 16] = 60 +/- 4%, EDAP [n = 16] = 53 +/- 6%, Wolf [n = 16] = 50 +/- 7%; p = 0.068).(ABSTRACT TRUNCATED AT 250 WORDS) PMID- 10148261 TI - Combined treatment of large and calcified gallstones by ESWL and laparoscopic cholecystectomy. AB - In order to facilitate laparoscopic cholecystectomy in the presence of large gallbladder stones seven patients underwent ESWL before operation. In six cases (83%) a fragmentation to less than or equal to 1 cm could be achieved by application of 1,605 to 2,900 (mean 2,266) shock waves with the spark-gap lithotripter Philips-Dornier MFL 5000. In these cases intraoperative stone destruction or an increase of the puncture incision size could be avoided, thus proving the efficacy of this combined treatment approach. Laparoscopic inspection was performed 2 to 48 hours after ESWL. Including two additional cases operated because of unsuccessful ESWL, hematomas of the liver and adjacent organs were observed in six of nine patients (67%). This high rate of subclinical tissue lesions warrants caution if repeated ESWL sessions are scheduled at short-term intervals. PMID- 10148262 TI - Current indications for bronchoscopy. PMID- 10148263 TI - Current options for uncomplicated gallstones. PMID- 10148264 TI - Why is mitral valve replacement more popular than repair? PMID- 10148265 TI - PTCA in the 1990s. PMID- 10148266 TI - The evolution in lung transplantation. PMID- 10148267 TI - The opportunities and challenges of cardiac pacing. PMID- 10148268 TI - Safer urinary catheterization. PMID- 10148269 TI - Does modern mechanical ventilation represent progress? PMID- 10148270 TI - Clinical applications for the signal-averaged ECG. PMID- 10148271 TI - Community-based MRA impacts patient care. PMID- 10148272 TI - MRI's role uncertain in carpal tunnel syndrome. PMID- 10148273 TI - Technetium agents refine hepatobiliary tract imaging. PMID- 10148274 TI - KTP laser offers advances in minimally invasive plastic surgery. PMID- 10148275 TI - Efficiency of infrared laser treatment examined in the healing of bedsores. PMID- 10148276 TI - Use of Nd:YAG laser therapy for treatment of hemorrhoidal disease. PMID- 10148277 TI - Avoiding hysterectomy: Nd:YAG laser and bipolar coagulating needle. PMID- 10148278 TI - Laser-assisted liposuction may benefit surgeons, patients. PMID- 10148279 TI - Contact tip YAG laser enhances safety of thyroidectomy. PMID- 10148280 TI - Q-switched lasers for dermatology: comparing new options. PMID- 10148281 TI - Health care reform: the AAPPO responds to the threat to managed care PPOs. PMID- 10148282 TI - Behavioral health care services: emerging concepts. PMID- 10148283 TI - Behavioral health, government reforms and contingency planning. PMID- 10148284 TI - Teacher interest in national health reform. PMID- 10148285 TI - Towards survival of rural hospital care. PMID- 10148286 TI - Pharmaceutical benefits: to carve or not to carve. PMID- 10148287 TI - Cataract surgery and lens implantation. PMID- 10148288 TI - Multifocal and bifocal implants. AB - Removal of cataract with intraocular lens implantation has been a well-accepted treatment for the past two decades. The development of monofocal intraocular lens technology has represented a significant advance over earlier treatments of cataract and, since the advent of widespread implantation of these lenses, most patients with cataract can achieve good postsurgical vision with the use of bifocal spectacles. PMID- 10148289 TI - The construction of sutureless cataract incision and the management of corneal astigmatism. AB - Extrapolating information from equations that govern fluid flow, a theoretical formula is developed for a sutureless cataract incision. This theoretical formula defines the resistance of aqueous outflow as a function of three variables: length of cataract incision, the length of the scleral tunnel, the tortuosity of the outflow channel, and one constant friction factor. The nonlinear relationship of corneal incisions to length, depth, and distance from the visual axis is also examined with respect to their effect on central corneal curvature and control of astigmatism. Finite element analysis of differential equations is discussed as the most plausible technique for predicting these incisional effects. PMID- 10148290 TI - Cataract surgical techniques. AB - Cataract surgery continues to evolve as modifications in techniques are introduced. Extracapsular surgery, whether by phacoemulsification or planned extracapsular cataract extraction, is a very safe and effective technique. Maintaining versatility in operative techniques, depending on the clinical situation, is a distinct challenge for the cataract surgeon. Adequate surgical planning, coupled with meticulous surgical technique, gives optimal results. Innovations in wound architecture provide intraoperative and postoperative advantages to the surgeon and to the patient. Capsulorhexis is the preferred method of capsulotomy in phacoemulsification and planned extracapsular cataract extraction. Hydrodissection and related techniques are useful in all types of extracapsular cataract extraction. This article reviews techniques in cataract surgery with an emphasis on the recent literature. PMID- 10148291 TI - Intraocular lenses. AB - Significant advances in intraocular lens designs have not been over the last year. The lack of successful lens implant designs to match the requirements of small-incision cataract surgery is frustrating. Although it is possible to comfortably remove the crystalline lens through a 2.7-mm incision, this incision inevitably has to be enlarged to accommodate even the most malleable lens implant available. Polymethyl methacrylate remains the preferred lens material for most surgeons, but silicone lens implants have gained consideration and have incited controversy. Acrylic polymers are in the early stages of clinical evaluation. Phakic lens implants for high myopia remain controversial while longer-term evidence for the safety of renewed designs is gathered. PMID- 10148292 TI - Cataract surgery and intraocular lens implantation in children. AB - As in the past, the current literature on childhood cataracts demonstrates the need for early diagnosis, surgical treatment that is quite different from adult cataract surgery, and prompt and adequate optical correction, as well as long term and conscientious amblyopia therapy in cases of uniocular cataract. The choice of optical correction continues to generate controversy. Contact lenses, intraocular lenses, and epikeratophakia all have their advocates. Although contact lenses are still the most common option, interest in using intraocular lenses in children has grown. Over the past year, however, two disturbing reports of complications due to intraocular lens implants were published. Treatment of childhood cataracts remains more challenging than treatment of cataracts in adults, and indications for particular approaches to optical rehabilitation in the pediatric population continue to evolve. PMID- 10148293 TI - Management of coincident cataract and glaucoma. AB - The management of patients with coincident cataract and glaucoma is a common and challenging clinical problem. Recent technologic advances in both cataract and glaucoma surgery have made the combined procedure a more viable option than in the past. The use of small-incision cataract surgery and trabeculectomy with antimetabolites performed beneath a 4-mm scleral flap with a limbus-based conjunctival flap and releasable or laserable sutures have resulted in a combined procedure that can closely mimic the standard trabeculectomy in terms of surgical methods. This discussion reviews many of the pertinent articles that have appeared in the literature during the scanning period and that address the management of combined cataract and glaucoma. The intention is not to provide a comprehensive review of this important topic but to discuss present opinions on issues such as antimetabolites, small-pupil phacoemulsification, sutured lenses, and the pseudoexfoliation syndrome as they relate to the combined glaucoma procedure. PMID- 10148294 TI - Management of concurrent corneal diseases and cataract. AB - Cataract surgery is the most common surgical procedure in the United States, and the likelihood of encountering complications from concurrent corneal disease and cataract surgery is great. The rise of pseudophakic bullous keratopathy as an indication for corneal transplantation reflects the current trend toward increasing corneal pathology arising from cataract surgery and intraocular lens complications. Attitudes regarding astigmatism have changed drastically. Cataract surgery, coupled with astigmatic procedures, is becoming the procedure of choice for visual rehabilitation. Congenital corneal conditions and systemic disease processes are also considered in this review. PMID- 10148295 TI - Management of the cataract patient with significant retinal disease. AB - Cataract surgery has influenced the course of certain retinal diseases just as vitreoretinal procedures have led to the de novo presentation or progression of cataracts. We review nearly 100 articles from the recent literature to determine the prevailing data and opinions concerning these vital issues. PMID- 10148296 TI - Clinical trials in interventional cardiology. PMID- 10148297 TI - The importance of subjective values to medical technology assessment and health policy. PMID- 10148298 TI - Outcomes in cardiology research: how much are we willing to compromise? PMID- 10148299 TI - Overview of percutaneous coronary catheter-based revascularization: past and present and the role of federal funding. PMID- 10148300 TI - Lasers in cataract surgery. AB - Several laser technologies including 1053-nm picosecond, excimer, erbium:yttrium aluminum-garnet, and neodymium:yttrium-aluminum-garnet (Nd:YAG) have been studied for use in the removal of cataractous lens tissue. Nd:YAG laser phacolysis involves laser pulses striking a titanium target that are incorporated into an irrigation-aspiration probe. With further refinement, Nd:YAG laser phacolysis may provide an alternative means of lens removal through a small incision, however, further study is required. PMID- 10148301 TI - A review of methodology for estrogen and progesterone receptor protein analysis. PMID- 10148302 TI - A calibrator for the determination of the erythrocyte concentration in electronic blood cell counting. AB - A stable calibrator, suitable for the quality control of electronic counting of erythrocytes, has been developed. The assigned concentration is determined by the cooperation of six laboratories using various types of blood cell counting instruments. The performance of the instruments was checked prior to operation. If required, corrections were applied, and deviations were taken into account. The suitability of the calibrator was tested in practice during a period of several years. The applicability of the preparation as a calibrator for use in routine practice was tested in 14 laboratories. PMID- 10148303 TI - The why and how of theophylline assay. PMID- 10148304 TI - Effect of time and storage conditions of Chemstrip bG on estimating blood glucose aboard ambulances. AB - This study tested the hypothesis that the age of Chemstrip bG aboard ambulances is not associated with decline of accuracy. This was accomplished by removing and testing Chemstrips bG from ambulances in Salt Lake City, Utah, U.S.A. Chemstrips were developed with three concentrations of glucose (2.0, 3.8, 12.4 mmol/L; 35, 68, 223 mg/dL, respectively) in a blinded manner by three different researchers and compared with fresh controls and with the Dimension Analyzer-derived glucose. Results showed that older Chemstrips read significantly higher than fresh strips at each value of glucose tested (p less than 0.05). Increased age was associated with higher readings. Therefore, it is possible that cases of hypoglycemia may be missed by reliance on older Chemstrips. While fresh strips tended to underestimate glucose at 12.4 mmol/L, age and storage aboard ambulances tended to reverse this underestimation; older Chemstrips were associated with a more accurate reading at 12.4 mmol/L. Older age was also associated with increased standard deviation of Chemstrips. Unless this bias is considered in clinical practice, it might result in a failure to detect and treat a patient with hypoglycemia. Chemstrips aboard ambulances should be interpreted with caution when evaluating a patient on the threshold of hypoglycemia. Meanwhile, institution of a quality control program is indicated. This would include periodic testing, but might also include storage of Chemstrips, when not in use, in a climate-controlled area either on or off the ambulance. PMID- 10148305 TI - Recommendation on sampling, transport, and storage for the determination of the concentration of ionized calcium in whole blood, plasma, and serum. IFC Scientific Division, Working Group on Ion-Selective Electrodes (WGSE). AB - The substance concentration of ionized calcium (cCa 2+) in blood, plasma, or serum preanalytically may be affected by pH changes of the sample, calcium binding by heparin, and dilution by the anticoagulant solution. pH changes in whole blood can be minimized by anaerobic sampling to avoid loss of CO 2, by measuring as soon as possible, or by storing the sample in iced water to avoid lactic acid formation. cCa 2+ and pH should be determined simultaneously. Plasma or serum: If centrifuged in a closed tube and measured immediately, the pH of the sample will be close to the original value. If there has been a delay between centrifugation and measurement, causing substantial loss of CO 2, equilibration of the sample with a gas mixture corresponding to pCO 2 = 5.3 kPa prior to the measurement is recommended. Conversion of the measured values to cCa 2+ (7.4) is only valid if the pH is in the range 7.2-7.6. Ca 2+ binding by heparin can be minimized by using either of the following: 1) a final concentration of sodium or lithium heparinate of 15 IU/mL blood or less; or 2) calcium-titrated heparin with a final concentration of less than 50 IU/mL blood. Dilution effect can be avoided by use of dry heparin in capillaries or syringes.(ABSTRACT TRUNCATED AT 250 WORDS) PMID- 10148306 TI - Accuracy and precision of a robotic sample processor. AB - The accuracy and precision of the Packard Probe 1000, a computer-driven robotic sample processor, were determined using NCCLS Guideline 18-P, employing a rigorous gravimetric procedure. For volumes of 25, 100, and 200 muL, inaccuracy ranged from -0.5 to +0.6% (saline) and -0.8 to +0.7% (human serum), and imprecision from 0.1 to 0.6% (saline) and 0.02 to 0.8% (human serum), in the dip and sip mode of pipetting. For the same volumes of saline in the dispense through pipetting mode, inaccuracy ranged from -0.1 to -0.9% and imprecision from 0.1 to 0.5%. To obtain this level of performance, the instrument's operating parameters were changed from the factory default settings. This automated liquid handling system is capable of impressive accuracy and precision, but it must be calibrated in the same manner as any other volumetric device. Performance varies with the volume, type of liquid, and mode of pipetting. Inaccuracy of less than or equal to 1.0% and imprecision of less than =1.0% can be attained along with rapid, walkaway pipetting of calibrators, controls, and large numbers of patient samples. PMID- 10148307 TI - The expanding role of robotics in the clinical laboratory. PMID- 10148308 TI - Plasma exchange in Guillain-Barre syndrome and related disorders. PMID- 10148309 TI - Adsorption therapy with tryptophan-conjugated polyvinyl alcohol gels in 10 patients with acute Guillain-Barre syndrome. AB - In 10 cases of acute Guillain-Barre syndrome selection adsorption (SEA) of immunoglobulins was performed with IM TR350 columns (Asahi Medical, Japan). During this therapy the symptoms of 8 patients were reduced. Side effects were moderate and not specific for SEA. The columns removed large amounts of immunoglobulins, but also eliminated other plasma components. PMID- 10148310 TI - Plasma exchange and selective adsorption in Guillain-Barre syndrome--a comparison of therapies by clinical course and side effects. AB - Selective adsorption is a new method of treating Guillain-Barre syndrome. Its therapeutic effects and its concomitant side effects were compared between plasma exchange and symptomatic treatment only. The clinical study of three groups of 10 Guillain-Barre patients, each matched for age and maximal disability, was analyzed. Selective adsorption compared favorably with plasma exchange in shortening the time to first improvement and duration of in-hospital treatment. Side effects were similar in both groups. Symptomatic arteriosclerosis should be considered a relative contraindication for selective adsorption. PMID- 10148311 TI - Leukocyte-depleted platelets prepared from pooled buffy coat post-transfusion increment and "in vitro bleeding time" using the Thrombostat 4000/2. AB - A technique for preparation of platelet concentrate (PC) from pooled buffy coat (BC) is described in this study. The yield of platelets from 4 BCs was 310+/ 48x10 9 per unit with a leukocyte content of 21+/-20x10 6 per unit. When a leukocyte removing filter was interconnected, Sepacell 5N and Pall PL-50 filters, no leukocytes could be found in 56 of 59 and in 36 of 37 PCs, with a maximum content of 2.3 and 0.54x10 6 leukocytes per PC, respectively. The platelet yield was 276+/-37 and 279+/-54x10 9 per unit, respectively. The in vitro bleeding time (IVBT), using the Thrombostat 4000/2, corresponded with the corrected count increment in most of 11 thrombocytopenic patients receiving platelet transfusions. However, in two transfusions no correction of IVBT was obtained. This technique offers a new possibility to investigate the functional capacity of transfused platelets. PMID- 10148312 TI - Platelet concentrates from buffy coats: improved conditions for preparation and evaluation in routine clinical use. AB - Since 1990, platelet concentrates prepared by soft centrifugation of buffy-coat pools diluted with a glucose-free, commercially available crystalloid solution (BC-PC) are the first choice product for all platelet recipients in our institution. Numerous in vitro and in vivo observations from our own and other laboratories indicate that BC-PC compare favorably to PC prepared from platelet rich plasma (PRP). In the present in vitro study we evaluated traditional and bottom-and-top bags and modified centrifugation conditions with the aim of increasing in vitro platelet yield in BC-PC. This was 14-18% higher compared with our previous protocol when prolonged centrifugation and bottom-and-top bags were used. In addition, we evaluated post-transfusion platelet count increments in 42 unselected adult hematological patients routinely transfused with 703 1-5 day-old BC-PC pools. Transfusion data were managed with PLATELET, an MS-DOS compatible program which includes automated calculation of transfusion efficacy and periodic patient reports. Mean pre-, 1 h and 24 h post-transfusion platelet counts were 16, 38 and 28x10 9/L, respectively. Mean 1 h and 24 h post-transfusion platelet count increments, expressed as percentage of expected, were 40 and 24%, respectively. These data were similar to those obtained previously in 189 unselected hematological patients given 2432 PRP-PC transfusions (mean 1 h post transfusion increment 46% of expected). The present in vitro study confirms that similar platelet yields can be obtained with the BC and PRP methods. In vivo findings show that also in routine conditions post-transfusion increments of PRP PC and BC-PC are similar.(ABSTRACT TRUNCATED AT 250 WORDS) PMID- 10148313 TI - First results obtained in France with the latest model of the Fresenius cell separator: AS 104. AB - In Besancon, we carried out 40 plateletphereses with the latest model of the Fresenius cell separator AS 104 to check this new system against the new generation of cell separators, according to the following criteria: less than 2x10 6 leukocytes (before filtration) and more than 5x10 11 platelets. The results show that platelet concentrates contained 5.04+/-0.88x10 11 platelets in a total volume of 435+/-113 mL. The mean platelet recovery was 40.95+/-4.86% (from 31.7 to 51.6). The leukocyte content was 2.28+/-5.48x10 6 and the red blood cell contamination was 3.48+/-2.38x10 8. The quality of the platelets was very satisfactory. There was no problem with donor biocompatibility or procedure safety, few adverse donor reactions (0.6%) and good therapeutic efficiency of platelet concentrates. PMID- 10148314 TI - Routine quality assurance requirements for apheresed platelets. PMID- 10148315 TI - Initial validation and quality control of platelet concentrates prepared by apheresis. PMID- 10148316 TI - Improvement of separation efficiency and concentrate purity of the Fresenius cell separator AS 104: results of a multicenter study. Haemapheresis Scientific Workshop Group of DGTI. AB - The aim of this multicenter study, initiated by the Haemapheresis Scientific Workshop Group of the DGTI was to evaluate separation protocols for the cell separator AS 104, marketed by Fresenius, using modified software and parameters which were believed to allow a more effective platelet collection with a significantly lower leukocyte contamination of the concentrates. Plateletpheresis data from 950 runs in ten hemapheresis centers, using virtually the same equipment, identical pheresis protocols, and cell counting methods were registered and statistically analyzed for each center and machine-related differences. Additionally, the counting methods of the centers were controlled by bi-weekly external cell count trials, and the plateletpheresis data were corrected using the results of these cell count trials, to obtain a comparison of the two versions of the protocol independent of the center effect. For protocol (or software version) 4.1, 610 runs were registered. The results of cell countings (chamber) are (given as means+/-standard deviations) 3.452x10 11+/ 1.009x10 11 for the platelet yield (or thrombocyte yield), 9x10 6+/-23x10 8 for leukocyte contamination, and 17x10 6+/-70x10 6 for the erythrocyte contamination, and 53%+/-13.5% for the extraction efficiency, respectively. For software version 4.4 with 340 runs, the results are 3.642x10 11+/-0.974x10 11 for the platelet yield, 15x10 6+/-74x10 8 for leukocyte contamination, 20x10 6+/-44x10 6 for erythrocyte contamination, and 59%+/-12.4% for the extraction efficiency, respectively. For the leukocyte and erythrocyte contaminations, the means and standard deviations must be interpreted carefully since the statistical distribution showed a considerable skewing of the data. From the automatic counts, marginally smaller means were found. The data were corrected by the values from the ring study; and for these mathematically corrected data, statistical tests showed a significant improvement in the extraction efficiency from software version 4.1 to 4.4. At the same time, the leukocyte contamination was significantly lower with version 4.4. PMID- 10148317 TI - Multicenter study of standardization of cell counting. Haemapheresis Scientific Workshop Group of DGTI. AB - Multicenter studies on cell separators give valid data (which can be compared between the different centers) only if the cell counting methods are uniform. This has to be demonstrated by ring studies or multicenter counting studies. Twelve apheresis centers involved in a multicenter study for the evaluation of the Fresenius AS 104 cell separator participated in such a ring study from July 1990 to July 1991. The twelve participating centers split into three significantly different groups according to the platelet counts in the platelet concentrates and a calculated pseudo extraction efficiency. No differences could be found in the white and red blood cell counts. No mailing effect--or time effect--and no personal effect could be found in the reference center. PMID- 10148318 TI - Apheresis activities in The Netherlands. PMID- 10148319 TI - Porcine aortic valve bioprostheses: morphologic and functional considerations. AB - Porcine aortic valve (PAV) xenografts are the most frequently used type of bioprosthetic (BP) valve for the replacement of damaged or diseased heart valves. Xenograft tissues are routinely crosslinked during manufacturing using low concentrations (i.e., less than 1%) of glutaraldehyde. Crosslinking of xenograft tissue reduces the antigenicity, the rate of in vivo enzymatic degradation, and results in the loss of cell viability. The purpose of this review is to provide an overview of the morphologic and functional properties of the native aortic valve and the effects of tissue harvesting, fixation, anticalcification treatments, and mounting on PAV structure and function. Although efforts have been undertaken to design bioprostheses having increased durability, primary tissue failure still limits the long-term performance of xenograft replacement heart valves. PMID- 10148320 TI - Comparison of knitted and woven aortoiliac and aortofemoral Dacron prostheses in the same patient: a 10-year prospective study. AB - This study represents the final and concise evaluation of all data obtained in a ten-year follow-up period and is a continuation of our previously published investigations. A specially manufactured bifurcated aortic graft with one limb woven and the other knitted was implanted in the aortoiliac or aortofemoral position in 158 patients. During an observation period ranging up to 10 years, no statistically significant difference was found either in platelet adherence or in clinical patency. According to the results of this and previous studies, the pore size of Dacron grafts in these positions does not seem to play any significant role either in platelet adherence or in patency rate. A high mortality rate from cardiovascular disease in the same patient population was also noted. PMID- 10148321 TI - Rewarming, ultraprofound hypothermia and cardiopulmonary bypass. AB - Rewarming, a key event in resuscitation from accidental, experimental and clinical hypothermia, is sometimes followed by neurologic, cardiac, and respiratory sequelae and may lead to death. The rate of rewarming has been implicated but not quantified as etiologic in these sequelae. Under anesthesia fifteen dogs were cannulated and connected to an extracorporeal circuit for oxygenation, core cooling and rewarming. They were subjected to ultra-profound hypothermia with a core (esophageal) temperature as low as 1.3 degrees C, cardiac arrest, blood substitution, and continuous low flow perfusion. After 2-3 hours of cardiac arrest, rewarming began. Mechanical activity of the heart was seen between 10 degrees and 28 degrees C and respiration resumed at 29 degrees C. The rewarming rates of the 15 dogs were retrospectively studied. They were placed into three categories (G) based on the outcome. G-I (N=2):no neurological complications, G-II (N=8):transient neurological problems, and G-III (N=5):death, mainly from cardiovascular and respiratory complications confirmed at death by autopsy. Heat gain by each animal was recorded as a function of time for all experiments. The time it took each dog to reach 35 degrees C was determined and a mean was calculated (rewarming rate). Normal body temperature for a dog is 37.8 degrees C. Statistical analysis (ANOVA) was performed ex post facto to determine the relationship between rewarming rate and outcome. Our data contradicts the notion that slow core rewarming from nadir to normal temperature offers better outcome.(ABSTRACT TRUNCATED AT 250 WORDS) PMID- 10148322 TI - Cephalic jugular venous blood gas measurement during neonatal venoarterial extracorporeal membrane oxygenation. AB - Cannulation of the cephalic portion of the right internal jugular vein during extracorporeal membrane oxygenation (ECMO) allows for increased venous return flow to the circuit. This procedure also allows access to venous drainage from the brain. We reviewed data from simultaneous blood gases obtained from the cephalic jugular vein and the mixed venous return in 5 neonates during venoarterial ECMO. Cephalic venous pO 2 values were significantly lower than mixed venous pO 2 values (P less than .001). The values for pH and pCO 2 did not vary between the sites. Our experience with 34 infants using cephalic jugular drainage is reviewed. Since the institution of right jugular venous drainage, the intracranial hemorrhage rate in neonates undergoing ECMO at our center has decreased from 34% to 6% (p less than .01). PMID- 10148323 TI - Laboratory evaluation of a low prime closed-circuit cardiopulmonary bypass system. AB - We have explored the potential advantages of a low prime closed-circuit cardiopulmonary bypass (CPB) system using a non-human primate model. Although manufacturers have reduced priming volumes in individual CPB components, the standard circuit volume remains high because of the tubing diameter and length necessary for gravity drainage. By replacing gravity drainage with the negative pressure generated by a centrifugal pump, we can realize significant tubing volume reduction. Closed-circuit bypass was conducted on 13 baboons ranging from 5-15 kg. The circuit consisted of a centrifugal pump, a hollow fiber oxygenator, and 1/4" arterial and venous tubing. The design of the circuit included the capacity to remove a limited amount of venous air. Circulatory arrest during deep hypothermia with volume displacement into a reservoir was also accomplished with this circuit. The potential benefits of this low prime closed-circuit bypass system include blood conservation and reduction in blood surface area contact. The future safe clinical use of this type of closed-circuit bypass for routine open heart surgery will depend upon the incorporation of a device in the venous line to remove air. This is the greatest threat to patient safety in a closed circuit system and its use for open chest surgery must wait until an efficient venous air elimination device is available. PMID- 10148324 TI - Trouble shooting the extracorporeal membrane oxygenator circuit and patient. AB - Patients requiring extracorporeal membrane oxygenation (ECMO) often become totally dependent on the mechanical life support. The Extracorporeal Life Support Organization (ELSO) reports 2486 incidents of mechanical complications in 5905 ECMO supports. To help decrease the number of mechanical complications, an active quality assurance program was initiated at our institution. This resulted in identification of only 14 incidents of mechanical complications in 100 patients (neonate, pediatric, adult, and cardiac). Techniques for dealing with problems such as loss of roller pump occlusion, changing out of the membrane lung or heat exchanger without interrupting ECMO support, venous air lock, tamponade, emergency transfusion, and other situations were generated into written policies and procedures. We routinely review and practice problem solving techniques with specific emphasis on monitoring patient hemodynamics and appearance. We conclude that written policies and procedures, "water drills," and continuing education can be beneficial in early recognition, intervention, and/or prevention of ECMO mechanical complications. PMID- 10148325 TI - How to do it: utilizing risk stratification to evaluate outcomes in adult open heart operations. AB - The purpose of this study is to demonstrate that by using a proven method of stratifying open-heart operations into levels of predicted mortality, hospitals can closely monitor trends of their open-heart programs and possibly improve the health planning decisions for their institution. A proven method of uniform risk stratification utilizing objective and readily available preoperative patient data was implemented at our institution for a 12 month period (September 1, 1991 through August 31, 1992). A total of 367 patients were included in this study. The patients were categorized into four risk ranges (0 to 4% good risk, 5 to 9% fair risk, 10 to 14% poor risk, and greater than or equal to 15% high risk) indicating a predictive percent probability of operative mortality. The number of patients categorized as either 0 to 4% good risk, 5 to 9% fair risk, 10 to 14% poor risk, and greater than or equal to 15% high risk were 46, 74, 84 and 163, respectively. The patient's average post-operative length of stay in each risk category was 7.6 days, 8.2 days, 10 days, and 12 days, respectively. The patient's average total hospital charges in each risk category were $48,241, $53,531, $60,416 and $75,555, respectively. This information has helped our hospital administration make relevant and objective decisions concerning our open heart program. Uniform risk stratification (outcomes research) should be incorporated into all adult open-heart surgery programs because it is simple, inexpensive, and can evaluate the outcomes and cost of open-heart surgery. PMID- 10148326 TI - Endoscopic carpal tunnel release: a single-portal technique. AB - A safe single-portal technique for performing endoscopic carpal tunnel release is described. The procedure can be done using equipment already available in any standard operating room. Evaluation of 100 cases done by the author using this method has shown encouraging results. PMID- 10148327 TI - A simplified method of total contact casting for diabetic foot ulcers. AB - A simplified method of total contact casting for diabetic plantar ulcerations is described in which a standard, well-molded short-leg walking cast is applied. Weekly cast changes are performed initially, followed by longer cast change intervals. Either fiberglass or plaster casting tape appears equally efficacious. Healing of all ulcers was demonstrated in 12 patients treated with this technique. PMID- 10148328 TI - Sauve-Kapandji operation for disorders of the distal radioulnar joint. AB - A series of 13 patients is reported in which a Sauve-Kapandji procedure consisting of arthrodesis of the articulation between the radius and ulna combined with resection of the collum ulnae was used to treat posttraumatic caput ulnae syndrome. Among the nine female and four male patients whose median age was 42 years (range: 23 to 77 years), nine sustained a distal fracture that had healed with shortening of the radius or with subluxation of the caput ulnae. Median postoperative observation time was 16 months (range: six to 27 months). Preoperatively, all patients had persistent medial wrist pain and restricted pronation-supination. At follow-up, ten patients were without symptoms and three others had improved significantly. No patient suffered from pain from the site of the resection. A significant improvement in pronation-supination of 45 degrees and flexion-extension of 25 degrees were found. Hand grip strength improved significantly during rehabilitation. At follow-up, the average hand grip strength on the operated wrists was 69% compared to the uninjured side. PMID- 10148329 TI - The Augustine Guide: a new device for blind orotracheal intubation. PMID- 10148330 TI - Basic features of biomedical assays. AB - All biomedical assays have certain aspects in common, the most striking of which is that they generally involve protein-binding. Ligand-ligator interactions and the resulting response form the basis of most assays. This paper reviews the advantages and limitations of different types of assays ranging from long-term bioassays to in vitro assays using cell-free components. Consideration of these aspects helps in the understanding of the different assays, selection of appropriate assays for different applications, and the better interpretation of assay results. Clinical chemists, hematologists, endocrinologists, immunologists, and scientists from other disciplines have each developed their own measurement methods and units. This paper seeks to identify those aspects and principles common to assays in all such disciplines, concentrating on protein binding systems. Understanding what and how different assays measure may clarify why different assay methods often give different results. PMID- 10148331 TI - Today's approach to PTCA: how it is performed, who might benefit. When can angioplasty replace medical therapy or bypass surgery? AB - The use of percutaneous transluminal coronary angioplasty has expanded tremendously over the past decade. Because equipment has improved and physicians' experience has increased, the procedure is often appropriate for patients with complex lesions or difficult coronary anatomies. Currently, stenoses are successfully opened in more than 90% of patients. Angioplasty is an alternative to medical therapy for patients with one- or two-vessel disease; in some patients with multivessel disease, it is an alternative to coronary artery bypass graft surgery. Among elderly patients, those who are poor candidates for bypass surgery, those who have had previous bypass surgery, and those with acute myocardial infarction or cardiogenic shock, coronary angioplasty may be particularly useful. PMID- 10148332 TI - The technique of percutaneous tracheostomy. Using serial dilation to secure an airway with minimal risk. AB - Percutaneous tracheostomy is the procedure of choice for most patients who require prolonged use of an artificial airway; it can be performed rapidly at the bedside and is associated with fewer complications than is the standard procedure. The serial dilational technique involves the insertion of prelubricated dilators that gradually enlarge the diameter of a tract made by a guidewire and guiding catheter, facilitating placement of a standard double cannula tracheostomy tube. The most dangerous complication, paratracheal insertion, occurs only rarely. The small skin incision and resulting tight fit of the tracheostomy tube in the stoma help prevent bleeding and infection. PMID- 10148333 TI - Cuspal movement and microleakage around reinforced glass ionomer cements. AB - The effect of restoration of mesio-occluso-distal cavities in molar teeth with reinforced glass ionomer cements on cuspal flexure in vitro is reported. Measurements of cuspal flexure using linear variable displacement transducers were carried out for 90 min after the placement of two types of reinforced glass ionomer cement. The measurements demonstrated that no movement occurred except in cases where the materials were allowed to dehydrate. Under these circumstances the opposing cusps moved toward one another. This movement was observed to be directly related to time. Microleakage was very much less than that observed for composite materials evaluated under the same test conditions. PMID- 10148334 TI - Effect of denture wax-pattern position on radial setting expansion. AB - Th dynamics of the setting expansion of gypsum-bonded investment is complicated by many variables and not well understood. The purposes of this study were to examine the fluid mechanics of the flow of investment during setting and to determine if the presence of wax patterns influences effective setting expansion. Mesial-occlusal-distal (MOD) inlay wax patterns were invested at six different radial positions and four different axial positions in plastics casting rings. Total expansion was determined by using xeroradiography. Combined results of radial expansion data at different axial and radial locations within casting rings suggest that expansion of gypsum-bonded investment may represent a variant of the laminar flow of a viscous fluid. PMID- 10148335 TI - Shear bond strength of orthodontic brackets using Panavia: an in-vitro study. AB - In this study, Panavia (a phosphonated Bis-GMA resin which is known to develop very high bond strengths with resin-bonded bridges) is compared to a conventional no-mix orthodontic Bis-GMA bracket adhesive. Results showed that there was no statistically significant difference in the shear bond strengths between the two resins when used as adhesives for bonding orthodontic brackets. Coupled with the fact that Panavia requires an anaerobic environment for complete polymerization, its routine use as a bracket adhesive in direct bonding of orthodontic brackets is not indicated. PMID- 10148336 TI - Fatigue failure in the cement mantle of an artificial hip joint. AB - The cement mantle of an artificial hip joint was retrieved, largely intact, during a revision operation, and subjected to detailed failure analysis. The results reveal a number of features which are important to our understanding of the failure of bone cement in situ and its consequences for prosthesis loosening. Microscopic examination showed clear evidence of fatigue cracking in the mantle prior to removal. This took the form of worn areas in certain regions of the fracture surfaces, which elsewhere showed evidence of rapid, brittle fracture. The mantle contained two large defects which had been introduced during insertion; fatigue was shown to have originated both from these defects and from the proximal surface. Results from a finite element analysis were used, together with the techniques of fracture mechanics, in an attempt to explain the magnitude and direction of fatigue cracking. Fracture mechanics calculations, though subject to some uncertainty in this case, indicate that the local stress intensity in the region of the principal defect would have been sufficient to exceed the threshold for fatigue crack propagation in this material. This approach demonstrates the advantages of this 'defect-tolerance' analysis. PMID- 10148337 TI - Corrosion behaviour of AISI 316L stainless-steel alloys in diabetic serum. AB - The present study investigates the pitting-corrosion behaviour of AISI 316L stainless steel in human physiological fluids. The emphasis is on the effect of diabetic serum with glucose and proteins, but reference solutions of isotonic saline solution with and without antibiotics were also used. Polarization experiments were carried out, and the results point to the innocuity of those fluids on the performance of the alloy as far as pitting corrosion is concerned. PMID- 10148338 TI - Bond strength of resin to dentin treated with calcium phosphate desensitizer. AB - In a previous study we proposed a new method utilizing immediate precipitation of calcium phosphate (CaP) in situ for treatment of dentin hypersensitivity. Sequential application of 5% disodium phosphate followed by 10% calcium chloride on patent dentin surface resulted in instant occlusion of dentin tubules and immediate relief from the hypersensitivity. To guarantee long-lasting effectiveness of the CaP treatment, resin coverage of the treated dentin surface will be the next practical approach. However, the CaP covering the surface may possibly affect bonding of resins. This study determined the effect of the CaP treatment on tensile bond strength of adhesive resins to dentin. Independent of the type of resin used, a bond strength of 4-5 MPa was obtained; cohesive failure occurred within the resin-CaP hybridized composite layer rather than at the dentin surface. The CaP treatment produced a significant increase in the bond strength of one resin. PMID- 10148339 TI - The effect of glass heat treatment on the properties of a novel polyalkenoate cement. AB - The effect of heat treating the glass component of a novel glass-ionomer (polyalkenoate) cement on cement properties has been determined, with specific reference to the reactivity of the glass, and the mechanical properties of the resultant cement. It has been shown that heat treatment is a suitable method of decreasing the glass reactivity and improving the handling characteristics of the mixed cement. Under some conditions, an increase in compressive strength was found, although the effect on tensile properties was not significant. PMID- 10148340 TI - The use of microwave energy to cure denture acrylic resins. AB - Experiments have been carried out on the curing of poly(methyl methacrylate) denture base material in a microwave oven, using conventional dental flasks and flask clamps. It has been shown that it is important (a) to maintain sufficient pressure on the materials, (b) to avoid gaseous porosity by not heating too rapidly initially, and (c) to ensure that all metal is protected from exposure to microwaves. When the appropriate conditions of polymerisation were used, microwave-cured samples had satisfactory physical and mechanical properties according to American Dental Association specification number 12. PMID- 10148341 TI - Strength of cement-metal interfaces in fatigue: comparison of smooth, porous and precoated specimens. AB - Radiographic follow-up studies of cemented total hip arthroplasty have shown that failure of the cement-metal interface of the femoral component is as high as 25% at 10 years. Recent analyses of clinically successful cemented femoral components obtained in toto with the surrounding cement and femurs after many years of in-vivo service have suggested that the mechanism of the initiation of failure of fixation of cemented femoral components is debonding at the cement metal interface. Since this critical interface is subjected primarily to cyclic loading, the evaluation of different surface preparations should be studied in fatigue, not static testing. In the current study, several contemporary methods for increasing the strength of the cement-metal interface were evaluated by testing the interfacial fatigue pushout strength under varying conditions of cyclic loading. The effect of a smooth 'implant finish' surface, a surface coated with polymethylmethacrylate (PMMA precoated surface), a combination of a textured surface with PMMA precoat, and a porous titanium mesh coated surface were examined. Precoating the metal with a thin film of PMMA significantly increased the number of compressive fatigue loading cycles required for failure of the cement-metal interface under cyclic loading compared to a smooth, uncoated surface. Adding indentations to the surface and then precoating with PMMA further significantly increased the fatigue life of the cement-metal interface. The strongest interface in fatigue was the titanium fibermesh-cement interface. PMID- 10148342 TI - The holmium:YAG laser: applications in urology. PMID- 10148343 TI - A study of the bioactive bone cement--bone interface: quantitative and histological evaluation. AB - The interface between bone and a bioactive glass cement--a mixture of bioactive glass powder and ammonium phosphate solution, previously reported on by the authors--was evaluated quantitatively and histologically. The materials tested were (1) the original bioactive glass cement (BCI cement); (2) an improved type of bioactive glass cement (BCII cement); (3) polymethylmethacrylate (PMMA) bone cement; and (4) a bioactive, apatite-wollastonite-containing, glass ceramic (A WGC). Hardened cylindrical specimens of each cement were inserted loosely into canine femora and the interfacial shear strengths were measured using a push-out test. The interfacial strength values of the bioactive glass cements increased with prolonged implantation time. At each postimplantation time studied (8, 12, and 24 weeks), the interfacial strength value of BCI cement did not differ significantly from that of A-WGC. BCII cement interfacial strength was greater than that of BCI cement, whereas the interfacial strength of PMMA bone cement remained at a very low level throughout the study. Histological examinations revealed that direct bonding of both bioactive glass cements to bone had occurred without pathologic degradation. After 24 weeks, the defects between the bone and the bioactive glass cements had been filled with mature lamellar bone. Because the bioactive glass cement system developed by the authors, especially BCII cement, shows excellent osteoconductivity and bonds to bone tightly, we consider it to be a promising material for fixing prostheses into bone. PMID- 10148344 TI - In vivo behavior of a high performance duplex stainless steel. AB - An in vivo investigation of a new high molybdenum and nitrogen duplex stainless steel (25Cr--7Ni--4Mo--0.3N) has been performed. Cylindrical pins and specially developed devices, to test in static conditions the in vivo localized corrosion resistance, made of this new duplex steel and of a common austenitic stainless steel were implanted in rabbit's femurs for 6 and 12 months. After sacrifice, SEM observations and EDS microanalyses to detect metallic ion release were carried out on the femur sections surrounding the pins. Morphologic observations with stereoscope and SEM were performed on the metallic surfaces of the special devices in order to detect the presence of localized corrosion. Both ion release and localized corrosion were observed for the specimens made of austenitic stainless steel, but not for those made of 25Cr--7Ni--4Mo--0.3N duplex stainless steel. PMID- 10148345 TI - Electrochemical behavior of Ti-6Al-4V alloy in static biosimulating solutions. AB - The static general corrosion behavior of Ti-6Al-4V alloy specimens in three lactated Ringer's-based solutions was investigated using d.c. potentiodynamic, d.c. linear polarization resistance, and a.c. impedance techniques. A critical appraisal of the use of these techniques for the estimation of the corrosion rate of the material is presented. Whence it was shown that the presence of bovine serum in or decreasing the pH level of (to about 1) lactated Ringer's solution leads to an increase in the corrosion rate of the alloy (relative to that in lactated Ringer's solution, pH 6.25). PMID- 10148346 TI - Effect of thermal treatment on heating characteristics of Ni-Cu alloy for hyperthermia: preliminary studies. AB - Ferromagnetic Ni-Cu alloy wires were characterized in order to obtain well defined thermoseeds for application in interstitial hyperthermia of prostate cancer. Thermoseeds have been produced which possess Curie points in the therapeutic hyperthermia range, approximately 40 to 50 degrees C. The effect of thermal treatment and composition on the heating characteristics of the thermoseeds were investigated. The preliminary study shows that the recrystallization is crucial for altering thermoseeds' heating characteristics. Obtaining thermoseeds which behave as desired depends on changes in annealing times and temperatures. One may increase the maximum heating temperature (similar to Curie temperature) by increasing the annealing time and cooling time. Decreasing the lower annealing plateau temperature also increases the maximum seed heating temperature. Higher nickel content compositions did not affect rise time but increased the maximum heating temperature. PMID- 10148347 TI - Handling characteristics of braided suture materials for tight tying. AB - To establish criteria for characterizing synthetic sutures, the handling characteristics of silk suture were analyzed. The characteristics that distinguish silk suture from other braided suture materials are its good "knot security" and relatively low "tiedown resistance." Analytic consideration of knot security suggests that not only superficial friction but also resistance force produced by cross-sectional deformity of braided threads plays an important role in silk's superior performance. Results of a "pullout friction test," developed to quantitatively evaluate resistance produced by surface friction and cross-sectional deformity suggest that the superiority of silk thread can be explained in terms of high static withdrawal resistance under low loads and relatively low dynamic withdrawal resistance under high loads. PMID- 10148348 TI - A study of the geometrical and mechanical properties of a self-expanding metallic stent--theory and experiment. AB - Stents are tubular devices that are used in cylindrical passages of the body following trauma or disease in order to keep the cross section of these passages open. A mathematical model of a self-expanding metallic stent has been developed with the aim of predicting various geometrical and mechanical properties of the stent. The model was developed with the main assumptions that the stent acts as a combination of a number of independent open-coiled helical springs with ends fixed against rotation, and that the springs undergo elastic deformations only. A series of experiments has been carried out in order to assess the validity of the model. The experimental results show good agreement with theory for the tests involving stent diameter and longitudinal force as a function of stent length and fair agreement, limited by frictional effects, for the tests involving radial pressure as a function of stent diameter. PMID- 10148349 TI - In vivo biocompatibility of an acrylic, fluoride-releasing, anion-exchange resin. AB - This study evaluated the biocompatibility of an unfilled, fluoride-releasing acrylic resin by subcutaneous implantation in guinea pigs. The experimental fluoride resin was compared to a nonfluoride, dental pit and fissure sealant (DELTON) of similar composition. Thirty-four male albino guinea pigs received four Teflon tubes each, implanted in the dorsal area. The tubes were open at both ends, three contained the experimental fluoride resin and one held the nonfluoride resin. The tubes and surrounding tissue were excised in 1-2 cm blocks, by necropsy, at 14 and 84 days. Histological evaluation showed that inflammatory response was none-to-slight at 14 days for 95% of the fluoride and 100% of the nonfluoride specimens. Five percent of the fluoride specimens produced a moderate tissue response. At 84 days, inflammatory response was none to-slight for 82.5% of the fluoride and 61.5% of the commercial nonfluoride specimens, while 17.5% of the fluoride and 38.5% of the nonfluoride specimens produced moderate tissue responses. Chi-squared analysis and Fisher's Exact test revealed no statistically significant difference (p less than or equal to 0.05) in tissue response between the two resins at either 14 or 84 days. Hence it is concluded that the experimental, fluoride-releasing resin produces a very mild subcutaneous tissue response and that its biocompatibility is comparable to that of a widely used nonfluoride dental resin. It can, therefore, be considered as having a high potential for biological safety as a dental restorative resin or adhesive, or for other biomedical applications. PMID- 10148350 TI - Clinical reviews: bioabsorbable implants for orthopaedic fracture fixation. PMID- 10148351 TI - Preliminary biocompatibility screening of several biodegradable phosphate fiber reinforced polymers. AB - This article describes preliminary biocompatibility screening of three degradable phosphate fibers containing K +, Ca +2/Na + and Na +/Ca +2/Al +3 ions in the polymer chain, and of several different degradable polymers reinforced with these fibers. Biodegradable phosphate fibers of calcium-sodium-metaphosphate (CSM) and sodium-calcium-aluminum-polyphosphate (NCAP) were acutely nontoxic in cellular, tissue, and whole animal evaluations, as determined by standard acute toxicity tests. Histological studies of bone implants sites fabricated from composites of copolymers of poly(E-caprolactone/L-lactide) and poly(ortho ester) reinforced with either CSM or NCAP fibers showed these composite materials to be nontoxic, with no abnormal inflammatory response. However, histological evaluation of muscle implants sites revealed the appearance of necrotic foci associated with implant sites in 12 of 22 NCAP containing composite specimens (p less than 0.05). Results of this preliminary biocompatibility screening suggest CSM fibers may be useful in reinforcing degradable polymers for production of completely biodegradable composites for implant use. PMID- 10148352 TI - Telemedicine permits long-distance diagnosis. PMID- 10148353 TI - Hospital takes plunge into full-fledged PACS. PMID- 10148354 TI - Therapy hinges on staging in upper GI tract cancer. PMID- 10148355 TI - Precise evaluation crucial in aortic dissection. PMID- 10148356 TI - Clinical use of QCT continues CT revolution. PMID- 10148357 TI - Fetal umbilical blood sampling. PMID- 10148358 TI - Intravascular oxygen monitoring: a perspective from the bedside. PMID- 10148359 TI - A homogeneous enzyme immunoassay method for ferritin. PMID- 10148360 TI - A system for improved detection of microbial growth. PMID- 10148361 TI - A study of medical device packaging. AB - In his article published in the January/February 1993 issue of Medical Device Technology, the author detailed a comprehensive packaging brief for designers of sterile medical device packaging. This article contains an evaluation of the packaging currently used in the industry, which include pouches, soft formings, and rigid blister packs. The study highlights their advantages and disadvantages and also offers some advice for developing a package that performs as designed. PMID- 10148362 TI - Moving forward. PMID- 10148363 TI - Chest tubes: indications, placement, management, and complications. AB - Use of tube thoracostomy in intensive care units for evacuation of air or fluid from the pleural space has become commonplace. In addition to recognition of pathological states necessitating chest tube insertion, intensivists are frequently involved in placement, maintenance, troubleshooting, and discontinuation of chest tubes. Numerous advances have permitted safe use of tube thoracostomy for treatment of spontaneous or iatrogenic pneumothoracies and hydrothoracies following cardiothoracic surgery or trauma, or for drainage of pus, bile, or chylous effusions. We review current indications for chest tube placement, insertion techniques, and available equipment, including drainage systems. Guidelines for maintenance and discontinuation are also discussed. As with any surgical procedure, complications may arise. Appropriate training and competence in usage may reduce the incidence of complications. PMID- 10148364 TI - Successful paratopic pancreas transplantation: a report of three cases with venous portal drainage and enteric exocrine drainage. AB - Pancreatic transplantation is able to produce euglycemia in patients with Type I diabetes mellitus. Current surgical techniques utilize revascularization of the graft through the recipient iliac vessels and drainage of the exocrine pancreatic secretions through a duodenal conduit into the bladder. We describe a technique utilized in 3 patients whereby venous pancreatic drainage is into the portal venous circulation via the proximal splenic vein. The exocrine pancreatic secretions are drained into the proximal jejunum via a side-to-side donor duodenum to proximal small bowel anastomosis. Results and complications of this technique are presented. Potential short-term and long-term advantages and disadvantages of this technique are discussed. Our early experience suggests that paratopic pancreatic transplantation with venous drainage into the portal vein and exocrine drainage into the proximal jejunum is both feasible and desirable. PMID- 10148365 TI - Successful revascularization of an orthotopic liver transplant (OLT) with the recipient right gastroepiploic artery. AB - A technique for revascularizing the arterial supply to an orthotopic liver transplant (OLT) in a 55-year-old male afflicted with end-stage alcoholic liver cirrhosis with portal hypertension is reported. The presence of well-developed portosystemic collaterals and an unsuitable recipient common hepatic artery necessitated the dissection and liberation of the right gastroepiploic artery (RGEA) for its subsequent use as the recipient arterial source. Posttransplantation, save for an early biliary leak which was corrected promptly, the patient's evolution was uneventful. Two separate celiac angiographic series at 6 weeks and 20 months posttransplantation revealed an excellent flow through the recipient and donor arterial systems. Additionally, the RGEA demonstrated an adaptation in caliber when pre- and posttransplantation angiograms were compared. It was concluded that the RGEA is a suitable rescue option for revascularization of OLT's provided it satisfies elementary hemodynamic requirements. PMID- 10148366 TI - Pancreatic graft survival after arterial thrombosis in simultaneous renal pancreatic transplantation. AB - Vascular thrombosis following pancreas transplantation is one of the main causes of early graft loss. Successful thrombectomy after pancreatic graft thrombosis has not been reported yet. A patient with arterial graft thrombosis in whom the graft survived after thrombectomy is described. Different varieties of pancreatic graft thrombosis are discussed. PMID- 10148368 TI - Xenotransplantation of discordant, immediately-vascularized organs. PMID- 10148369 TI - New concepts in organ preservation. PMID- 10148367 TI - Cellular transplantation and gene therapy. PMID- 10148370 TI - Commentary on new xenobiotic immunosuppressants for transplantation: Where are we, how did we get here, and where are we going? PMID- 10148371 TI - Should outpatient hysteroscopy replace conventional diagnostic dilatation and curettage in gynecologic practice? AB - Three hundred fifty patients attending gynecology outpatient clinics between 1984 and 1989 warranting a diagnostic D & C were offered instead a diagnostic hysteroscopy under local anesthesia (with or without intravenous Midazalom) or under general anesthesia. Subjective assessment of complications was performed by direct questioning of the patient during the procedure when the hysteroscopy was done under local anesthesia and by asking the patient to complete a questionnaire in the first 48 h after the operation. Objective assessment was performed by monitoring the pulse and blood pressure before and during the procedure and for an hour postoperatively. Subjective assessment of complications was significantly more in patients who had the hysteroscopic examination under general anesthesia (pain p less than 0.0001, nausea and/or vomiting p less than 0.0001, headache p < 0.0001, and general malaise p < 0.0001). There was no difference in objective measures of complications in the two groups. Patient acceptability was significantly higher for hysteroscopic examination under local anesthesia (p less than 0.0001). Diagnostic hysteroscopy under local anesthesia is a reliable and uncomplicated procedure. Patient acceptability is excellent. Hence, this examination can be performed in gynecologic outpatient clinics under local anesthesia. PMID- 10148372 TI - A prospective evaluation of an endometrial suction curette. AB - The object of this study was to assess the reliability of a technique using an endometrial suction curette to obtain tissue for diagnosis. A prospective study was performed. One hundred sequential outpatient biopsies using the Z-Sampler were studied. All samples were reviewed a second time by a single pathologist for adequacy. In 75% of samples, a histologic diagnosis could be determined. The remaining 25% were inadequate for diagnosis--4 identified at the time of sampling and completed with a Novak curette and 21 in which the sample would not support the histologic diagnosis. Analysis of the inadequate samples found that 12 of the 25 (48%) inadequate samples came from patients with the clinical diagnosis of postmenopausal or climacteric bleeding. This diagnosis was represented in only 18 of the 75 successful biopsies (24%, p less than 0.001). The findings suggest that endometrial sampling using disposable endometrial curettes provides adequate tissue for histologic interpretation in most patients. Although patients with postmenopausal or climacteric bleeding made up one half of all patients with an inadequate sample, 60% of these patients did have interpretable tissue obtained. In these patients, use of other or adjunctive sampling methods should be entertained based on clinical or other considerations. PMID- 10148373 TI - The effect of bipolar electrosurgical coagulation waveform on a rat uterine model of fallopian tube sterilization. AB - Laparoscopic bipolar electrosurgical sterilization has been employed for nearly two decades. This bipolar procedure was intended to reduce the incidence of unintended complications, such as bowel burns. However, compared to the monopolar procedure, it produced a higher failure rate. This study examines the role of the low power-high voltage coagulation waveform on the effectiveness of electrosurgical desiccation on the rat uterine model of the fallopian tube. Desiccations were performed with both Kleppinger and Storz forceps using generator settings from 2 to 6. Desiccations performed to the visual endpoint (blanch, swell, and collapse) required from 23.8 to 30.0 joules, although procedures performed at a generator setting of 2 required long application times, an average 15.4 sec (Storz) and 28.2 (Kleppinger). All bipolar procedures led to a loss of tissue at the desiccation site at 12 weeks postsurgery. Therefore, the electrosurgical coagulation waveform proved to be effective in producing adequate in vivo tissue destruction even at very low generator settings. PMID- 10148374 TI - Vaginal probe ultrasound guidance for internal jugular catheterization. AB - The use of ultrasound to assist needle cannulation of the internal jugular vein is well described. However, most ultrasound probes are too bulky to use easily on the neck. We describe a technique using a vaginal ultrasound probe to guide needle cannulation of the internal jugular vein. The small size of the vaginal probe permits visualization on the video screen of both the vein and the needle throughout the entire insertion of the needle, minimizing insertion attempts and preventing complications. PMID- 10148375 TI - Deciding timing and technique for tracheostomy. PMID- 10148376 TI - Clinical implications of ambulatory blood pressure monitoring. PMID- 10148377 TI - Surgical treatment of vertebral metastases. AB - Metastatic tumors often spread to the vertebral column. When the mechanical strength of a vertebra is decreased as a result of tumor-induced bone destruction, a pathologic fracture may occur. Such a fracture is often associated with severe pain. If it occurs in the thoracic or upper lumbar region, there is a major risk of paraplegia if the fractured vertebral body is displaced into the spinal canal. Metastases in the vertebral column also can cause neurologic symptoms due to direct infiltration of the tumor into the spinal canal. Due to recent advances in spinal surgery, effective help often can be provided to these patients. The extent and type of surgical intervention, however, must be carefully considered in each individual case. PMID- 10148378 TI - The intramedullary hip screw. AB - The intramedullary hip screw is a short intramedullary nail with interlocking screws that can be used to treat subtrochanteric and intertrochanteric femur fractures. This nail, which has the biomechanical advantage of being an intramedullary appliance but can be placed percutaneously, is inserted under fluoroscopic control with the patient on a fracture table. Reaming is not usually necessary. In an initial limited series, complication rates are comparable with existing techniques. Possible future concepts and developments are discussed. PMID- 10148379 TI - The treatment of tibial and fibular fractures with a rectangle-shaped intramedullary nail. AB - A study is reported in which excellent results were achieved with use of a flexible rectangle-shaped intramedullary (RIM) nail in the treatment of 171 tibial and fibular shaft fractures in a series of 165 patients. Mechanical analysis showed improved fracture stability compared to fractures treated with an Ender nail. To the best of the authors' knowledge, the method of treatment described in this report has not been discussed previously in the Western literature. PMID- 10148380 TI - Myocardial reperfusion imaging: basic principals and clinical applications. AB - In recent years, radionuclide imaging techniques have gained increasing popularity in clinical practice to evaluate regional myocardial perfusion and viability in patients with acute myocardial infarction who have undergone reperfusion therapy. Myocardial thallium-201 (Tl-201) or technetium-99m methoxyisobutyl isonitrile (Tc-99m Sestamibi) scintigraphy can be used for detecting and localizing areas of necrosis when injected at rest and can be used in conjunction with exercise or pharmacological stress testing for predischarge risk stratification and determining prognosis. In the presence of residual blood flow, uptake of Tl-201 by myocardial cells is not altered unless irreversible membrane injury is present. Postischemic myocardial "stunning" alone does not affect Tl-201 extraction. Tl-201 administered very soon after reperfusion is established may reflect more the hyperemic flow state rather than the degree of myocardial salvage. Initial myocardial uptake of Tc-99m Sestamibi after intravenous injection is also proportional to blood flow. When injected during coronary occlusion, the pattern of uptake of Tc-99m Sestamibi accurately delineates the "area of risk." When injected several hours after coronary reperfusion, the uptake pattern accurately reflects the degree of residual myocardial viability. Serial Tc-99m Sestamibi imaging in patients with myocardial infarction receiving thrombolytic therapy showed that patients with a patent infarct vessel had a significant reduction in defect size compared with prethrombolysis images. PMID- 10148381 TI - Assessing myocardial reperfusion with technetium-99m-labeled myocardial perfusion agents: basic concepts and clinical applications. AB - The accurate determination of reperfusion in the setting of acute myocardial infarction and the evaluation of vessel patency or reocclusion has become critical in the management of patients in the thrombolytic era. This article reviews the biological properties and potential clinical applications of the new technetium-99m-labeled perfusion agents following perfusion. Both 99mTc Sestamibi and 99mTc-Teboroxime have unique biological properties that may permit the assessment of reperfusion and vessel patency following thrombolysis. The noninvasive evaluation of patients following acute coronary reperfusion, must occur during acute, intermediate, and predischarge phases. Serial imaging with 99mTc-Sestamibi and 99mTc-Teboroxime in combination probably will serve in the future as an important means of assessing myocardial salvage, residual viability, and vessel patency following thrombolysis. PMID- 10148382 TI - Antimyosin monoclonal antibody imaging to assess myocardial viability in the setting of thrombolysis. PMID- 10148383 TI - Two-dimensional echocardiographic assessment of regional left ventricular function and geometry following myocardial reperfusion. AB - Two-dimensional echocardiography is ideally suited for the serial noninvasive assessment of regional function and geometry following reperfusion therapy. Patients with substantial myocardial salvage show slow but definite recovery in regional function within the first 2 weeks. The extent of recovery seems to be associated with the degree of necrosis. Patients with some salvage, which is not enough to cause recovery in regional function, may demonstrate lack of infarct expansion and left ventricular (LV) dilatation. In the future, newer approaches such as pharmacologic challenge may play a role in defining post-ischemic myocardium early after the ischemic event. PMID- 10148384 TI - Public health concerns stir mammography sales. PMID- 10148385 TI - Contrast media enhance ultrasound echogenicity. PMID- 10148386 TI - Ultrasound sheds new light on intracranial injury. PMID- 10148387 TI - When and when not to biopsy the breast. PMID- 10148388 TI - Mammography's upside outweighs possible risks. PMID- 10148389 TI - 3-D holography makes the nonobvious obvious. PMID- 10148390 TI - Diagnostic vitrectomy in the management of ocular disease. PMID- 10148391 TI - Cardiac catheterization and other imaging modalities in the evaluation of valvular heart disease. AB - This review describes recent publications using cardiac catheterization and diagnostic imaging modalities, excluding transesophageal and transthoracic echocardiography, to evaluate valvular heart disease. Radionuclide techniques and magnetic resonance imaging continue to be studied as to whether they can improve the quantification of valvular regurgitation. As yet, however, they are not justified in the routine evaluation of patients with valvular heart disease. Cardiac catheterization has been used by several authors to assess more completely the obstructive physiology of valve stenosis, including obtaining a better understanding of transvalvular pressure gradients; the phenomenon of downstream pressure recovery; and the utility of valve resistance in quantifying the severity of the valve stenosis, which complements the calculated valve area, especially in cases of low cardiac output. Traditional cardiac catheterization techniques have recently been used to show a sex difference in left ventricular systolic performance in aortic stenosis. Intracardiac ultrasound and electrocardiography are being studied as methods to guide percutaneous valvotomy. The analysis of myocardial tissue samples obtained by endocardial biopsy promises understanding gene-protein-function interactions. Specifically, myosin alterations in aortic valve disease and protooncogene expression in hypertrophy are exciting, emerging areas of investigation. PMID- 10148392 TI - Valvular heart disease: medical therapy and experimental and animal models. AB - Vasodilators have been advocated for the treatment of regurgitant valvular heart diseases for more than 12 years, and new information on their mechanisms of action is available. Anticoagulants continue as a mainstay of therapy for patients with prosthetic heart valves, and the most desirable levels of anticoagulation for different conditions have been examined. Clinical and animal research studies of cardiac adaptation to mitral and aortic valve diseases are discussed. PMID- 10148393 TI - Percutaneous mitral valvuloplasty. AB - The widespread use of percutaneous mitral valvuloplasty on the basis of gained experience, technical advances, and a thorough understanding of its pathophysiologic consequences, has generated great clinical enthusiasm and stimulated research efforts. Recent reports provide new insights into a number of topics, including technical issues, the current value of noninvasive techniques, and the results obtained with mitral valvuloplasty in particular clinical and anatomic settings. This review examines the information provided by recent studies. PMID- 10148394 TI - The results of cardiac valve procedures. AB - Valvular procedures have become increasingly safe and efficacious. The number of procedures and prostheses that are available increases each year. However, a precise comparison of alternative treatments for patients with valvular heart disease requires an accurate and unbiased recording of the results. The American Association for Thoracic Surgery and the Society of Thoracic Surgeons have developed guidelines that are intended to permit a comparison of alternative procedures and prostheses employed in the treatment of patients with valvular heart disease. These guidelines have been followed by most recent reports and have greatly facilitated the comparison of alternative treatment strategies. Reports evaluating the long-term effects of valvular heart surgery should carefully state the population from which the sample was taken, the adequacy of the follow-up, and the closing interval employed. Every attempt should be made to document the causes of death or other adverse events, because if they are not adequately documented they must be assumed to be valve related. Recent studies have demonstrated that age was the major predictor of structural valve failure at 10 years after bioprosthetic implantation. To avoid bioprosthetic failure some surgeons have employed a stentless porcine aortic valve or a homograft prosthesis. Both of these approaches will require the test of time. To compare alternative treatments, definitions and reporting techniques must be uniform. The guidelines have been adopted by most authors reporting the long-term results of valve procedures. PMID- 10148395 TI - Heart valve surgery. AB - Progress in valve repair and replacement continued over the past year. Aortic valve repair for aortic insufficiency appears promising, and aortic decalcification may still be a useful alternative in certain cases of aortic stenosis. Mitral valve repair, well accepted for myxomatous valves, presents a challenge in ischemic disease. Balloon mitral valvotomy offers significant short term hemodynamic improvement, but needs to be properly compared with surgical treatment of mitral stenosis. Although aortic valve replacement with homografts and pulmonary autografts yields excellent results, enthusiasm for the stentless porcine xenograft is increasing. Clinical results reported for the Carpentier Edwards pericardial valve (Baxter Healthcare Corp., Edwards Div., Santa Ana, CA) and the Bjork-Shiley monostrut valve (Shiley Inc., Irvine, CA) are excellent. Acute endocarditis continues to be a challenging problem but early aggressive debridement appears to offer patients the best chance of cure, regardless of what valve replacement is used. PMID- 10148396 TI - Aortic surgery, coarctation of the aorta, and aortic dissection. AB - During the past year, significant advances were made in the insertion of composite valve grafts for the ascending aorta, replacement of the aortic arch, treatment of thoracoabdominal aortic aneurysms, and in the screening of patients with abdominal aortic aneurysms for cardiac disease. Controversy remains as how to best manage patients with aortic coarctation, and a recent symposium reviewed the techniques extensively. Methods of detecting aortic dissection have evolved, with increasing use of advanced technology such as transesophageal echocardiography and magnetic resonance imaging. The management of the aortic arch in patients with acute aortic dissection has been debated. PMID- 10148397 TI - Surgery for ischemic heart disease. AB - Surgical treatment of ischemic heart disease continues to evolve, and specific criteria are available to guide management. The benefit of placing the left internal mammary artery to the left anterior descending artery is well known, and there are newer data, not including survival benefit, supporting the use of two internal mammary arteries. The role of more than two arterial conduits remains to be established. It is hoped that greater use of arterial conduits will reduce the need for reoperation due to saphenous vein graft closure. Operations on older patients and on those with severe impairment of left ventricular function continue to increase. These cases present an ongoing challenge, as do those when operation for acute failure of angioplasty is required. PMID- 10148398 TI - Cardiac arrhythmia surgery. AB - Cardiac arrhythmia surgery has changed dramatically in the past several years, as indicated by the articles published during the past year dealing with the surgical treatment of supraventricular and ventricular arrhythmias. With the increasing use of radiofrequnecy ablation for the treatment of arrhythmias, the Maze procedure for the cure of atrial fibrillation will undoubtedly be the most commonly performed supraventricular arrhythmia procedure; the results thus far have been excellent. The use of implantable cardioverter-defibrillators as therapy for ventricular tachycardia and sudden cardiac death has allowed for more optimal selection of patients for direct ventricular tachycardia surgery, with the result that surgical mortality for curative procedures is 4%, with excellent long-term survival and freedom from arrhythmia recurrence. Finally, use of the implantable cardioverter-defibrillator as a bridge to cardiac transplantion has been examined as well, with promising intermediate-term results. PMID- 10148399 TI - Bridging to cardiac transplantation with mechanical circulatory support. AB - During the last decade, it has been clearly demonstrated that mechanical assist devices are capable of supporting patients in the interim before cardiac transplantation. The use of these devices prior to transplantation has provided an important window of opportunity to evaluate critically the devices and their potential for adaptation to permanent systems. The overall survival rates in the bridge-to-transplant patient population have improved. This is in part due to lessons learned in the past several years with regard to better patient selection and applicability of the devices. This review focuses on selected papers published in the past year that have made significant contributions to the evolution of mechanical support. PMID- 10148400 TI - Immunologic and surgical developments in cardiac transplantation. AB - Clinical work in cardiac transplantation has focused on combating the major complications of this procedure, namely graft rejection and infection. Retrospective analyses suggest that prospective HLA typing, as is done in renal transplantation, may improve patient survival. Trials using FK 506 in cardiac transplantation have demonstrated some benefit using this agent over cyclosporine. Innovative immunologic interventions using novel monoclonal antibodies, methotrexate, total lymphoid irradiation, or photochemotherapy have shown promise in treating allograft rejection. Finally, prophylactic ganciclovir appears to prevent cytomegalovirus disease in seropositive transplant recipients; however, prevention of primary infection in seronegative patients may prove more difficult. PMID- 10148401 TI - Influence of jet impingement on color Doppler parameters of aortic regurgitation. AB - In vitro studies have demonstrated that the characteristics of a color Doppler jet are influenced by a number of factors including jet eccentricity and jet impingement. To explore the relationship of a jet impingement and aortic regurgitant color Doppler jet parameters, jet area, width, and length were measured from apical echocardiographic views of 84 patients 4 +/- 11 days prior to catheterization and compared to angiographic grade. An impinging color jet contacted the interventricular septum or mitral valve beneath the aortic valve in the imaging plane and a nonimpinging jet did not contact the septum or mitral valve in the imaging plane. As expected, the percentage of patients with impinging jets increased with aortic regurgitation angiographic grade. Neither left ventricular chamber dimensions nor the presence of an aortic prosthesis significantly influenced the color Doppler variables. For a given angiographic grade of aortic regurgitation, impinging jets were associated with larger color Doppler jet widths (P less than 0.05) and areas (P = 0.001) than nonimpinging jets. The color Doppler area and length increased significantly with angiographic grade for nonimpinging jets (P less than 0.05) but not for impinging jets. Impinging jets are associated with larger color Doppler widths and areas than nonimpinging jets for a given grade of aortic regurgitation, possibly because of the effect of jet deflection toward an adjacent wall. Jet impinging should be considered when using color Doppler techniques to evaluate aortic regurgitation. PMID- 10148402 TI - Problems and pitfalls in the echocardiographic assessment of pericardial effusion. AB - The echocardiographic diagnosis of pericardial effusions is usually based on visualization of a sonolucent circumcardiac space of varying width. However, potential fallacies in interpretation can arise if sonolucent spaces adjacent to the heart (pleural effusions, ascites, pericardial cysts) are mistaken for pericardial effusions. Loculated pericardial effusions, especially if unusual in location or configuration, can cause diagnostic difficulty on occasion. The differential diagnosis of various "solid" echoes within a pericardial effusion is of clinical relevance, yet not widely discussed. Inflammatory tissue, neoplastic involvement, pus, caseous material, and extravasated blood all have characteristic echocardiographic morphologies. All of the various reported echocardiographic signs of tamponade do not have the same significance, so that caution is necessary not to over- or under-read tamponade. Chamber collapse can be absent in real tamponade in specific situations. On the other hand, "regional" tamponade can occur if loculated pericardial effusions are sufficiently large and high tension; echocardiographic appearances are "atypical" but diagnostically valuable if correctly interpreted. These and certain other unusual variants of tamponade deserve to be better known among echocardiographers not only because of their intrinsic interest, but also to avoid potential pitfalls in the echocardiographic assessment of patients with suspected disease. PMID- 10148403 TI - Pitfalls in the echo-Doppler diagnosis of hypertrophic cardiomyopathy. AB - While Doppler echocardiography has become the gold standard for the diagnosis of hypertrophic cardiomyopathy, there are many pitfalls in its use. Some of these pitfalls are technical in nature resulting from inadequate image quality, incorrect transducer angulation, and improper equipment settings. Other pitfalls relate to the diversity and heterogeneity in defining hypertrophic cardiomyopathy and to the host of disorders that may mimic it by echocardiography. The pattern and extent of ventricular hypertrophy, systolic anterior motion of the mitral valve, and Doppler determination of left ventricular outflow tract obstruction, diastolic dysfunction, and mitral regurgitation are discussed, as are wall-motion abnormalities and myocardial echo reflectivity. While these echocardiographic features of hypertrophic cardiomyopathy are nonspecific when seen in isolation, their combined presence in the appropriate clinical setting makes the diagnosis likely. PMID- 10148404 TI - Pitfalls in the color Doppler diagnosis of valvular regurgitation. AB - Color Doppler flow mapping of the regurgitant jet is frequently used as a means of assessing the severity of valvular regurgitation. Although convenient, this method of assessing valvular regurgitation is subject to a number of hemodynamic and technical factors that may limit its accuracy. Variations in hemodynamic and structural factors such as orifice size, jet geometry, receiving chamber constraints, afterload, fluid viscosity, heart rate, and cardiac output may have profound effects on the measured regurgitant jet area. Variations in scanning and machine factors, such as scanning direction, Doppler angle, frame rate, color display algorithms, pulse repetition frequency (PRF), system gain, packet size, carrier frequency, wall filter, and transmit power have been shown to alter the measured regurgitant jet area significantly. Despite these limitations, color flow Doppler provides a relatively reliable noninvasive method for semiquantitative assessment of valvular regurgitation. Obviously, standardization of the design and application of the various available color mapping algorithms, as well as other machine and hemodynamic factors, would help provide more reliable and reproducible quantitative information about the degree of valvular insufficiency. PMID- 10148405 TI - Pitfalls in the echo-Doppler diagnosis of prosthetic valve disorders. AB - Assessment of artificial heart valves is a classic example of pitfalls in Doppler and color flow echocardiography. These limitations should be analyzed in the context of the most common clinical conditions associated with prosthetic valve dysfunction, that is, assessment of stenosis, regurgitation, endocarditis, and source of emboli. Estimation of the mean transvalvular gradient in addition to valve areas may avoid potential problems of over- or underestimation of stenotic lesions. The combination of acoustic attenuation, acoustic shadowing, and jet(s) eccentricity makes accurate grading of prosthetic regurgitation difficult and often frustrating. Reverberations and side lobe are frequent artifacts that decrease the ability of two-dimensional echocardiography to identify endocarditis induced lesions such as vegetations and abscesses, as well as potential sources of emboli such as thrombus and atrial septal abnormalities. Transesophageal echocardiography has provided a new window in the evaluation of prosthetic cardiac valve function. With this approach, high frequency, high resolution transducers greatly improve the quality of ultrasound and color flow Doppler images that result in a higher diagnostic yield. In patients with suspected mitral prosthesis malfunction, transesophageal echocardiography is the method of choice. Contrast study during the transesophageal examination increases the sensitivity to detect potential sources of emboli such as patent foramen ovale. The improvement in diagnostic accuracy may allow one to avoid further diagnostic tests and, in selected patients, it may facilitate optimal timing of a surgical intervention. PMID- 10148406 TI - Pitfalls in the echo-Doppler assessment of diastolic dysfunction. AB - The Doppler echocardiographic assessment of diastolic function is an essential part of the evaluation of heart failure, pericardial diseases, restrictive and infiltrative cardiomyopathies, and many other conditions. However, the echocardiographic evaluation of diastolic function has several limitations. The sonographer and physician must understand the technical factors, the effects of physiological and pathophysiological conditions, and the dynamics of pseudonormalization, all of which affect the evaluation. This article will review the most recent data essential for the proper performance and interpretation of a transthoracic or transesophageal Doppler echocardiographic examination of diastolic function. PMID- 10148407 TI - Kinetic therapy in critically ill trauma patients. AB - OBJECTIVES: To compare the incidence of pulmonary complications and hospital resource utilisation in patients treated with continuous rotation therapy versus manual turning in a traditional hospital bed. DESIGN: Prospective, randomised clinical trial. SETTING: Surgical intensive care unit of a large, tertiary care, urban hospital. PATIENTS: One-hundred-and-thirty-seven consecutive injured patients admitted to the Surgical Intensive Care Unit were prospectively randomised to receive either the Rotorest Kinetic Treatment Table or a traditional hospital bed. One hundred of these patients met the study criteria and are the basis of this report. METHODS: The patients' medical records were reviewed in a prospective manner to determine the frequency and severity of pulmonary complications and resource utilisation in the two patient groups. MAIN RESULTS: There were no significant differences in the minimum, average, or maximum pO 2, pCO 2, PEEP, IMV rate, or pre-extubation blood gases during the first seven days of the study. Fewer cardiac output measurements, arterial blood gas measurements, chest X-rays, respiratory therapies, hours intubated, days in the ICU, days in the step-down unit, days in the hospital, and lower ICU charges, respiratory care charges, and total hospital charges were utilised in the patients treated with the kinetic bed. The incidence of pulmonary event complications and process complications was lower in the group of patients treated on the Rotorest bed.(ABSTRACT TRUNCATED AT 250 WORDS) PMID- 10148408 TI - Devices for airway management and ventilation during cardiopulmonary resuscitation. PMID- 10148409 TI - Current management of laryngotracheobronchitis, bacterial tracheitis and epiglottitis. PMID- 10148410 TI - External high frequency oscillation--concept and practice. PMID- 10148411 TI - Intracranial monitoring as a management option for patients with liver failure. PMID- 10148412 TI - Third-party payment 101. PMID- 10148413 TI - Sensitivity limits of latex agglutination tests. PMID- 10148414 TI - Bronchoscopy in intensive care. AB - Fiberoptic bronchoscopy has revolutionized the practice of modern pulmonary medicine. It is estimated that as many as 98% of all bronchoscopies are currently performed using the flexible instrument, and most bronchoscopists have never been trained in the technique of rigid bronchoscopy. PMID- 10148415 TI - Oxygen delivery and utilization. AB - Under normal circumstances, O 2 transport (TO 2 = cardiac output x arterial O 2 content) is regulated to provide sufficient O 2 to meet the demands of oxidative phosphorylation, quantified as the O 2 consumption (VO 2). When metabolic demands increase, TO 2 is augmented and in addition, the fractional extraction of the delivered O 2 by the tissues, the O 2ER, also increases, to levels as high as 0.80 at maximum VO 2. If TO 2 is decreased, at least in the experimental animal, VO 2 can be maintained initially by an increase in O 2ER, but eventually this mechanism is exhausted, VO 2 begins to fall, and the body invokes anaerobic means of energy generation to maintain cell integrity. In normal man, this critical level of TO 2 (TO 2crit) has not been determined, but in experimental animals it has been found once the O 2ER exceeds 0.50. Patients with sepsis and the adult respiratory distress syndrome have a very high mortality and usually die as a result of multiple organ failure. They have in addition, an apparent abnormality in their ability to extract and utilize the delivered O 2. Despite a TO 2 which is often higher than normal, patients with sepsis commonly have a lactic acidosis and when TO 2 is reduced, both groups of patients are usually unable to increase their O 2ER above the normal resting value of 0.33.(ABSTRACT TRUNCATED AT 250 WORDS) PMID- 10148416 TI - Continuous hemodynamic monitoring: an integrated invasive-noninvasive approach using the Fick principle. AB - This paper reviews a continuous integrated computer based approach to monitoring oxygen supply (DO 2) and consumption (VO 2) relationships. A description of the technologic methodology and potential advantages over intermittent thermodilution monitoring are discussed. Lastly, the preliminary results of investigations in two populations (abdominal aortic surgery and adult respiratory distress syndrome) are presented. PMID- 10148417 TI - Respiratory monitoring in the ICU. PMID- 10148418 TI - Ventricular support by synchronized jet ventilation. PMID- 10148419 TI - Assessment of adequacy of oxygen transport in the critically ill. PMID- 10148420 TI - Pulmonary artery catheter problems. PMID- 10148421 TI - Electroencephalography, epilepsy and sleep. PMID- 10148422 TI - Pediatric neurosurgery. PMID- 10148423 TI - Imaging of the spinal canal and cord. PMID- 10148424 TI - General rehabilitation. PMID- 10148425 TI - Stroke: sequelae and rehabilitation. PMID- 10148426 TI - Rehabilitation of children with cerebral palsy or meningomyelocele. PMID- 10148427 TI - Rehabilitation of children with muscle disease. PMID- 10148428 TI - Pediatric electroencephalography. PMID- 10148429 TI - Magnetic resonance imaging of the lumbar spine in asymptomatic adults. Cooperative study--American Society of Neuroimaging. AB - We performed magnetic resonance imaging of the lumbar spine on 66 asymptomatic subjects and found that 12 (18%) had either a disc protrusion or herniation. An additional 26 (39%) had a bulge that was associated with degenerative disc disease. We also found examples of spinal stenosis, narrowed nerve root canals, osteophytes, and vertebral body involvement with multiple myeloma. Degenerative disc disease is a common finding in asymptomatic adults that increases in frequency with age. It occurs more frequently in men and usually involves more than one level. The most common location is L5-S1. PMID- 10148430 TI - Magnetic resonance imaging anatomy of the cranial nerves. AB - Correlation of findings on neurological examination of the cranial nerves with gross anatomy, neuroanatomy, and neuropathology provides the optimal diagnostic use of magnetic resonance imaging (MRI). Illustrations of the anatomy of each of the cranial nerves, with concise labeling of relevant anatomical relationships, are compared with brief neurological summaries and MRIs of patients. PMID- 10148431 TI - Neuroimaging. PMID- 10148432 TI - Cerebrovascular disease--including intravascular therapy. PMID- 10148433 TI - Head injury, otoneuroradiology and neuro-ophthalmology. PMID- 10148434 TI - Demyelinating, inflammatory and degenerative diseases. PMID- 10148435 TI - Technical advances in paediatric neuroimaging. PMID- 10148436 TI - Neurological rehabilitation. PMID- 10148437 TI - Sequelae and rehabilitation of spinal cord injuries. AB - Basic research in spinal cord regeneration, neurological recovery after medical or surgical primary treatment, and electrostimulation of muscles, nerves, diaphragm, bladder and bowel are covered in this review. The best results are obtained in bladder and bowel stimulation. Basic research seems to provide new hopes for paralyzed individuals. PMID- 10148438 TI - Sequelae and rehabilitation of head injury. AB - The increasing prevalence of traumatic brain injury is becoming an enormous problem for health care. Reports about social and vocational outcome are becoming more abundant. At the same time, a better evaluation of the neuropsychological outcome of brain-injured patients, essential for realistic functional treatment in rehabilitation, is developing. PMID- 10148439 TI - Sequelae and rehabilitation of stroke. AB - During rehabilitation after stroke, evaluation and treatment are carried out for sensorimotor impairments such as hemiplegia or dysphagia, perceptual-cognitive impairments such as unilateral spatial neglect, disabilities such as dependence in activities of daily living, as well as various types of handicaps. Research into these problems is reviewed. PMID- 10148440 TI - General rehabilitation, complications and evaluation. AB - Review of the literature regarding general aspects of neurological rehabilitation reveals three areas of professional and scientific advances. The first focuses on the importance of education in rehabilitation medicine and the assessment of factors contributing to the outcome of neurological rehabilitation programs. The second area represents the developing practice of interventional restorative neurology within neurorehabilitation programs. The third is centered on increased awareness of the practical value of new achievements in the neurosciences, especially with respect to recovery processes after injury to the nervous system. PMID- 10148441 TI - Electrical and magnetic spinal and cortical stimulation in man. AB - With the technique of transcranial and spinal electrical and magnetic stimulation it is possible to study the function of motor pathways in normal subjects. This technique is also a valuable tool in the investigation of motor pathways in patients with motor disturbances. PMID- 10148442 TI - Neuro-otology. AB - The physiology of the vestibulo-ocular reflex, and in particular vestibular compensation, optokinetic nystagmus and after-nystagmus, and visuo-vestibular interaction, is reviewed. Also covered are advances in neuro-otological examination and reports on peripheral labyrinthine disorders and cases of central vestibular disorders that are used as clinical models for improving our understanding of brainstem circuitry involved in ocular motor control. PMID- 10148443 TI - Neuro-ophthalmology. AB - Eye movement research during the last year is discussed. The review covers the fields of: memory-guided saccades in supplementary motor area lesions, and the vertical saccadic system; cerebral hemispheric localization of smooth pursuit asymmetry; oculomotor disturbances in Wallenberg's syndrome; locomotory gaze instability in vestibular dysfunction; smooth pursuit disorders in vermal infarct; physiologic end-point and rebound nystagmus and the results of surgical and optical treatment of manifest latent nystagmus; clinical/magnetic resonance imaging correlations in abnormalities of horizontal gaze; mesencephalic cholinergic nuclei in progressive supranuclear palsy; as well as mesencephalic damage in diabetic third nerve palsy, divisional oculomotor nerve paresis; and new hypotheses on eye muscle susceptibility in myasthenia gravis. PMID- 10148444 TI - Electroencephalographic mapping. AB - Topographic electroencephalographic (EEG) mapping is a non-invasive technique which assesses the functional state of the brain. Its recent application to diverse aspects of basic research reflects the increasing interest being shown in this technique. Clinical applications are as yet limited, but studies carried out so far seem to indicate that EEG mapping provides more subtle and detailed information than conventional inspection of background EEG activity. PMID- 10148445 TI - Neural transplantation. PMID- 10148446 TI - Repeated measurements over time: statistical analysis of the angiographic outcomes in the Probucol Quantitative Regression Swedish Trial (PQRST). AB - An increasing use of non-invasive techniques and arteriographies of the coronary, carotid or femoral arteries has taken place during recent years. This has prompted researchers to perform long-term randomized trials aiming at reducing atherosclerosis progression or achieving regression by cholesterol lowering in high risk populations. These trials are designed to use outcomes such as various indices of atherosclerosis which are assessed repeatedly over time. There are major decisions to be made contingent on the data structures in these trials, such as sphericity, interaction, development over time, missing data, non normality etc. So, the statistical analysis of such data needs to be planned and specified a priori in a unified manner. This is demonstrated for the Probucol Quantitative Regression Swedish Trial (PQRST) which is designed to answer the question whether the drug probucol, given in combination with diet and cholestyramine, can delay development of atherosclerosis in hypercholesterolemic patients up to 70 years old. Change in atheroma volume is assessed by a newly developed quantitative angiographic technique based on digitized angiograms. PMID- 10148447 TI - Using bronchodilators effectively. PMID- 10148448 TI - MRA of carotid origin minimizes expense, risk. PMID- 10148449 TI - MRI struggles for role in female pelvic disease. PMID- 10148450 TI - Transperineal ultrasound assists in GU diagnoses. PMID- 10148451 TI - Repair of congenital cardiovascular defects--25-year follow-up. PMID- 10148452 TI - Abdominal aortic aneurysm and risk of rupture. PMID- 10148453 TI - Durations, truncations, and Kaplan-Meier. PMID- 10148454 TI - T-wave abnormalities in bundle branch block. PMID- 10148455 TI - Laser scanning tomography to diagnose and monitor glaucoma. AB - Confocal scanning laser ophthalmoscopes offer practical tools for clinical use to obtain quantitative information of the optic nerve head and peripapillary retina. These instruments acquire objective and quantitative data and can be used in many eyes with undilated pupils and cataracts. Further, they acquire images rapidly and with low-level illumination. Because of wide variability in optic nerve head topography among normal eyes, their usefulness may be limited as a single test for change in the optic nerve head and peripapillary retina. These instruments require validation through widespread use and correlation with other structural and functional tests. PMID- 10148456 TI - Modern developments in clinical perimetry. AB - Recent developments in automated perimetry have emphasized the adaptation of specialized psychophysical procedures for visual field testing to measure visual properties other than the detection of light. In addition, many new methods to quantitatively analyze visual field data have been generated. These new developments are promising for enhancing the diagnostic capabilities of automated perimetry in patients with glaucoma and patients suspected of having glaucoma. A review of some of the most recent advances in automated perimetry are presented. PMID- 10148457 TI - Comparison of new psychophysics and perimetry with electrophysiological techniques in the diagnosis of glaucoma. AB - Many accounts show that the pattern electroretinogram is a sensitive index of glaucomatous visual damage, and can demonstrate losses before field defects are apparent. If the pattern electroretinogram is not specific, and although it is likely to have a role in patient management, it is not a screening technique. Many psychophysical tests, particularly of titan color vision, appear to be promising in this regard. PMID- 10148458 TI - Clinical electrophysiology relevant for early glaucoma diagnosis. AB - This review reports findings of the recent literature about electrophysiologic techniques that are used in glaucoma diagnosis and research. Included in this review are results obtained by recording electrical responses from the eye (electroretinograms) and from the brain (visual evoked potentials). Studies concerned the electroretinogram evoked by patterned stimuli that originates in the proximal retina and with flash-evoked responses that originate from the proximal retina, such as oscillatory potentials and scotopic threshold responses, from middle layers of the retina (B wave), and from the outer retina (A waves and C waves). Regarding the pattern electroretinogram, the authors agree on its usefulness in the diagnosis of glaucoma. However, the optimal stimulus conditions (temporal and spatial frequency, retinal location, contrast, and color), which component of the response to evaluate, and the value of the pattern electroretinogram in follow-up treatment are debatable. Flash-evoked components of the electroretinogram that have been considered in the past to be of low value in diagnosis of glaucoma now seem to be more important. New developments in visual evoked potentials techniques, such as photostress methods, contrast sensitivity measurements, ramp stimulation, and selective adaptation for isolating blue-cone activity seem to be promising in further increasing the diagnostic value of visual evoked potential measurements. PMID- 10148459 TI - Biomorphometry of the optic disc. AB - This review describes the goals and methods for biomorphometry of the papilla. Until a few years ago, analogue methods were used to process fundus photographs, but today digitized and computerized methods are applied. Thus, the examination has become considerably simplified and clinically practical. Two main points are discussed in connection with these modern methods. First, biomorphometry provides data useful for the understanding of glaucoma. Papillary size is meaningful with regard to the sensitivity of the papilla to pressure, and reversal of cupping depends on pressure as well. Second, for longitudinal studies to be dependable, the clinically applied methods must have a very small margin of error so that an observed papillary change can be ascribed to disease, and not to methodologic errors. PMID- 10148460 TI - Combined surgery for cataract and glaucoma. AB - The current literature and meeting abstracts regarding combined cataract and glaucoma surgery are reviewed. Potential acuity measurements are compared. Intraoperative manipulation of the pupil, wound size, antimetabolites, and types of filtration surgery are also discussed. Postoperative intraocular pressure rise, fibrinous anterior chamber reaction, induced postoperative astigmatism, and anterior and posterior capsular problems are presented. Although great strides in techniques in each of the areas of cataract and glaucoma surgery have occurred, the long-term benefits of combined surgery have yet to be demonstrated. Ethical issues surround the use of antimetabolites. PMID- 10148461 TI - The role of laser cyclocoagulation in cyclodestructive glaucoma surgery. AB - As a last-resort, antiglaucomatous procedure, laser cyclodestruction continues to attract attention. Whether this approach will be applied at an earlier stage in patients with glaucoma remains to be seen, although this procedure is already used in patients who refuse or do not tolerate surgery. The success rate of this procedure will improve as our understanding of the underlying mechanisms that contribute to intraocular pressure reduction are more thoroughly realized, and as safety improves with increased sophistication of instrumentation. PMID- 10148462 TI - Laser sclerostomy for the management of glaucoma. AB - Laser sclerostomy can be performed in a less invasive manner than standard filtering surgery. Recent studies have explored the use of laser energy of varying wavelengths, properties, and tissue interaction to create thermal sclerostomies. Several methods deliver laser energy by mirrored contact lenses to the internal face of the filtration angle or by fiberoptic cables for ab interno or ab externo sclerostomy formation. Certain laser techniques can be performed outside the standard operating room, in a clinic or minor surgery room. This article reviews the various laser sclerostomy techniques currently being investigated. PMID- 10148463 TI - Update on PTCA: what are its limitations? Can they be overcome by new devices? A look at atherectomy, intra-arterial stents, and laser catheters. AB - Complications limiting the use of percutaneous transluminal coronary angioplasty (PTCA) include abrupt vessel closure and restenosis. Certain coronary lesions, such as chronic total occlusions and diffuse or long stenoses, pose serious technical difficulties. New devices may overcome some of these limitations. For example, atherectomy may prove useful for thrombotic vessels or diffusely diseased vein grafts, and it may lower restenosis rates in larger vessels. Stents are currently used as a bailout measure when acute dissection occurs. Although lasers produce smoother margins than does conventional PTCA and effectively ablate atherosclerotic plaque material, the restenosis rate associated with use of these devices may be similar to that of conventional PTCA. PMID- 10148464 TI - Techniques for vascular access when venous entry is impossible. Route depends on urgency and the agent to be administered. AB - When a patient requires parenteral fluid or drug administration and venous cannulation cannot be performed, consider less typical routes. Intraosseus infusions are usually more effective in children than adults, but intraosseus cannulation failure may occur in as many as 20% of patients. Intra-arterial infusions are possible if pump pressures are kept high. Hypodermoclysis (infusion into the subcutaneous tissues) can correct moderate dehydration. Administering resuscitative drugs endobronchially is usually safe and effective, although pulmonary function may be somewhat compromised. A number of drugs may be given sublingually, either by injection or topical application. Finally, the corpora cavernosa of the penis may be used for short-term, large-volume fluid administration. PMID- 10148465 TI - Technical pitfalls in the use of the sliding hip screw for fixation of intertrochanteric hip fractures. AB - Two hundred fifty consecutive intertrochanteric fractures treated with a sliding hip screw (SHS) over a three year period were reviewed and specific types of technical pitfalls identified. Most pitfalls were technique dependent and potentially preventable with proper attention to the principles of fracture reduction and insertion of the device. Pitfalls encountered with the use of the SHS occurred as a result of either poor fracture reduction or implant insertion. Problems related to fracture reduction included poor radiographic visualization, posterior sag, varus angulation, and internal rotation of the femoral shaft in relation to the femoral neck. Potential pitfalls encountered during SHS insertion included superior guide wire placement, guide wire breakage or penetration into the hip joint or pelvis, loss of reduction during lag screw insertion, improper screw-barrel relationship, and improper plate application. Finally, the SHS may not be the implant of choice for all extracapsular hip fractures (i.e., the reverse obliquity fracture). This paper identifies the various pitfalls that may occur with the use of the SHS for the fixation of intertrochanteric hip fractures. Illustrative cases are provided and guidelines for avoiding these surgical pitfalls suggested. PMID- 10148466 TI - A general model for conducting protective value studies. PMID- 10148467 TI - Introduction to probability methods and concepts. PMID- 10148468 TI - Guidelines for evaluation of follow-up articles and preparation of mortality abstracts. PMID- 10148469 TI - Chronic obstructive pulmonary disease in European insureds. PMID- 10148470 TI - Essential hypertension, conservatively treated, circa 1950s. PMID- 10148471 TI - Centers of excellence: choosing the appropriate rehabilitation center. PMID- 10148472 TI - Clinical case management. PMID- 10148473 TI - Medical consultation and expert testimony in claims litigation. Professional and ethical guidelines. PMID- 10148474 TI - Stroke in the elderly treated for systolic hypertension (SHEP) part II- mortality. PMID- 10148475 TI - A method of relating life expectancy in the U.S. population life table to excess mortality. PMID- 10148476 TI - Use of genetic information by private insurers. Genetic advances: the perspective of an insurance medical director. PMID- 10148477 TI - Tumor biology and the surgical pathologist. PMID- 10148478 TI - Unexplained hypertrophy--assessing the risk. PMID- 10148479 TI - Center for medico-actuarial statistics (CMAS) of MIB, Inc. PMID- 10148480 TI - Mortality in patients with Parkinson's disease treated with dopa. PMID- 10148481 TI - Managed care: tools and applications. PMID- 10148482 TI - Managed care: electronic data interchange. PMID- 10148483 TI - Managed care: practice parameters. PMID- 10148484 TI - Managed care: the strategic future for education in quality. AB - This paper discusses the needs for future education in quality assurance, assessment and improvement, particularly in relation to managed care. The pressures for increased education about quality are derived from different components of the health care system; e.g., regulatory and governmental agencies, purchasers of care, and competitors of health institutions. The content of future education in health care quality is defined in six areas: (1) organization and management; (2) health systems; (3) quality theory and methods; (4) management information systems and research; (5) governmental policy; and (6) economics and finance. Education in health care quality in these content areas is delivered at both the primary and continuing education levels by universities, professional associations and private training and development corporations. Future oriented, strategic thinking education in health care quality is needed. The pressures for education about quality, including traditional concepts of quality assurance, methodologies for quality assessment and the newer approaches to continuing quality improvement, are clearly growing stronger. This article discusses the need for education in health care quality, the content areas and levels of education and the delivery system. PMID- 10148485 TI - Managed care: the role of outcomes management. PMID- 10148486 TI - Managed care: provider profiling. PMID- 10148487 TI - Epilepsy and other seizure disorders. PMID- 10148488 TI - Seizure recurrence after a first unprovoked seizure: 36 month follow-up of 238 patients. PMID- 10148489 TI - The use and financing of the health care system in the Netherlands: past, present and future. PMID- 10148490 TI - Stratification, competition and risk distribution: health insurance in Germany and the United States. AB - Issues of unequal risk distribution among sickness funds are given increasing attention in the current discussions on the reform of the statutory health insurance system in Germany. This paper examines the structural determinants of risk distribution and points toward the links between social stratification, competition, health risk and insurance status. A model showing the links between basic structural determinants is presented. Using health survey data from Germany and the U.S., statistical analyses are conducted. The results support the model and indicate its applicability for both health care systems. The paper concludes by indicating the relevance of such findings for health policy and future research. PMID- 10148491 TI - The future: insurance and the health care system. PMID- 10148492 TI - Deep-vein thrombosis and subsequent onset of cancer. PMID- 10148493 TI - Activities of daily living: tools to measure functional loss. PMID- 10148494 TI - Alternative psychological methods in patient care. Council on Scientific Affairs, American Medical Association. PMID- 10148495 TI - The real world--regulations and ethics. PMID- 10148496 TI - Panel discussion on tumor markers. PMID- 10148497 TI - The essence of managed care. PMID- 10148498 TI - The impact of managed care on the health insurance industry. PMID- 10148499 TI - Employee health benefit plans. A decade of change. PMID- 10148500 TI - Physicians in insurance management. An expanding opportunity for physician executives. PMID- 10148501 TI - Mortality among workers exposed to ethylene oxide. 16-year average follow-up of over 18,000 workers. PMID- 10148502 TI - The use of mortality studies in underwriting malignancies. PMID- 10148503 TI - Blended funding. A light at the end of the tunnel. PMID- 10148504 TI - Systematic care for persons with brain injury. A place for case management. PMID- 10148505 TI - The impact of spinal cord injury on long-term survival. PMID- 10148506 TI - Using psychological approaches to improve rehabilitation results. PMID- 10148507 TI - Outcome results of post-acute rehabilitation after head injury. Five consecutive studies of 198 individuals over a five-year period. PMID- 10148508 TI - Rehabilitation in a managed environment. The challenge of providing real value. PMID- 10148509 TI - Case management. A rehabilitation physician's perspective. PMID- 10148510 TI - Making sense of medical case management. Perspective from a case manager. PMID- 10148511 TI - Case management: cooperation among disciplines. A social work perspective. PMID- 10148512 TI - Case management. A reinsurance perspective. PMID- 10148513 TI - Stroke in the elderly treated for systolic hypertension (SHEP). PMID- 10148514 TI - Mortality in asymptomatic patients with carotid bruit. PMID- 10148515 TI - Life table analysis of AIDS mortality. PMID- 10148516 TI - Life table reconstruction from annual data for survival rate, P, and entrants, l. PMID- 10148517 TI - Methodologic notes. PMID- 10148518 TI - Mortality in patients treated with captopril for left ventricular dysfunction following myocardial infarction. PMID- 10148519 TI - Advances in the identification of bacteria and yeast. PMID- 10148520 TI - Ultrasound-guided positioning of temporary pacing catheters and pulmonary artery catheters after echogenic marking. AB - Pacing of the heart is one of the most effective emergency measures in the management of critical bradycardic arrhythmias. Positioning of the pacing catheter is safest under fluoroscopic control; however, this facility is not always readily available in emergency situations. A procedure was therefore developed by which pacing catheters could be easily positioned under echocardiographic control after echogenic marking. It involves the filling of commercially available balloon-tipped pacing catheters with an echogenic substance consisting of galactose microparticles suspended before use in a 0.9% saline solution (Echovist). The balloon on the pacing catheter is then easy to locate intravascularly by ultrasound and can be visually guided into the right ventricle. To date, this method has been used effectively and without complication to position both pacing catheters and pulmonary artery catheters. PMID- 10148521 TI - Veno-venous haemofiltration in the intensive care unit. PMID- 10148522 TI - Pre-hospital management of trauma patients: field stabilisation or scoop and run? PMID- 10148523 TI - No-scalpel vasectomy: a minimally invasive procedure. PMID- 10148524 TI - Clinical experiences with photodynamic therapy for recurrent malignancies of the lower female genital tract. AB - Photodynamic therapy (PDT) with Photofrin II was administered over a 7-year period to 17 patients with recurrent carcinoma in situ (CIS) of the vulva, vagina, and perianum. Ten patients were treated two or three times after average intervening periods of 23 and 19 months, respectively. A histologically complete response at 3 months after the PDT session was achieved for 27 of 38 (71%) anatomic sites. Ten patients of this group remain free of recurrences for periods of 2-7 years. Condylomata acuminata associated with CIS in 16 of 17 patients recurred rapidly in 7 patients after PDT. Only short-term palliative results were achieved for 4 patients treated with PDT for invasive carcinoma. Fifteen patients experienced a significant skin reaction to direct sunlight during a 7-week period post-PDT. PMID- 10148525 TI - Hypogastric artery ligation: a new perspective. AB - This study was conducted at the Lokmanya Tilak Municipal Medical College and General Hospital, Sion, Bombay. An analysis was made of the hypogastric artery ligations done at our institution from January 1985 to December 1990. A prospective pilot study beginning June 1989 was added to the existing data. The hemostasis achieved intraoperatively and the collateral circulation maintained after main trunk ligation vs selective anterior division ligation have been studied prospectively with pelvic angiography postoperatively. Pelvic angiography using the standard Seldinger technique was done 14 days posthypogastric artery ligation in emergency obstetric cases. In selected gynecologic cases posted for Wertheim's hysterectomy, pelvic angiography was done both before and after hypogastric artery ligation. All the collected data, including operative time, blood loss, and complications, have been tabulated and compared with other studies in the literature. PMID- 10148526 TI - Perils and pitfalls of magnetic resonance imaging in the diagnosis of multiple sclerosis. The Rochester-Toronto MRI Study Group. AB - Purpose. Magnetic resonance imaging (MRI) has come to assume a position of major importance in the diagnostic process for multiple sclerosis (MS). The authors believe that a tendency toward overreliance on MRI results in isolation from clinical findings continues to result in both false-positive and false-negative diagnostic errors. Methods. To evaluate this, MRI results in newly referred patients with clinical findings suggestive, but not diagnostic, for MS, were studied prospectively. Results. Of 99 consecutive referrals for suspected MS, there were 3 false-positive diagnoses of MS and 7 false-negatives, when the MRIs were read in isolation from specific clinical data. None of the scans in the false-negative groups were normal. Representative images of both groups are provided. Conclusion. In newly referred patients who fall short of criteria for definite MS, it remains dangerous for both clinicians and radiologists to rely too heavily only on MRI results. PMID- 10148527 TI - Ictal 99mTc HM-PAO brain single-photon emission computed tomography in electroencephalographic nonlocalizable partial seizures. AB - A 9-year-old child with intractable focal epilepsy was studied for possible surgical treatment. Multiple electroencephalographic studies did not localize the epileptic focus. An ictal single-photon emission computed tomography (SPECT) study with technetium 99m-hexamethylpropyleneamineoxime demonstrated a focal area of hyperperfusion. Through three-dimensional, functional to anatomical image matching techniques, the focus was overlaid on the magnetic resonance image localizing the cortical convolution responsible for the epileptogenic focus. Subdural electroencephalographic studies performed for seizure localization and functional mapping confirmed this location. This case emphasized the usefulness of ictal SPECT scans in patients with seizures nonlocalizable by electroencephalography being evaluated for epilepsy surgery. PMID- 10148528 TI - Motor activation by single-photon emission computed tomography. A comparison of xenon-133 and technetium-99m HM-PAO "split-dose" methods. AB - Single-photon emission computed tomography (SPECT) was used to investigate the feasibility of the technetium 99m-hexamethylpropyleneamineoxime ( 99mTc HM-PAO) split-dose method to evidence changes in regional cerebral blood flow during a motor activation task, in comparison with a quantitative method using the inhalatory xenon-133. Four subjects were studied twice with both methods, at rest and during finger opposition movements. On the activated cerebral hemisphere, a significant increase in regional cerebral blood flow was observed over the motor cortical areas. The average increases were +28.1 +/- 5.6% for the xenon-133 method and +12.3 +/- 5.2% for the 99mTc HM-PAO method. By using the linearization algorithm for the 99mTc HM-PAO method, a mean increase of +22.5 +/ 8.9% was calculated. This study demonstrated that the split-dose method allows the motor activation SPECT studies with 99mTc HM-PAO to be done in a single session. PMID- 10148529 TI - Transcranial Doppler ultrasound and magnetoencephalography in migraine. AB - Eighty subjects--30 migraineurs during the attack, 30 patients in the interictal period, and 20 healthy volunteers--were studied using two technologies for functional assessment: transcranial Doppler ultrasound and magnetoencephalography. Transcranial Doppler studies showed an increased mean flow velocity at rest (p less than 0.05) in the middle cerebral artery on the side of the headache and a decreased vasomotor response to CO 2 (p less than 0.001) on the same side compared to control subjects. Biomagnetic measurements of somatosensory evoked fields of 11 patients and 11 control subjects in this study did not demonstrate differences between migraineurs and the control group in current flow or latency measures. The data from this study tend to support the hypothesis of vascular disease as a primary underlying deficit in migraine. PMID- 10148530 TI - Magnetic resonance angiography in vertebrobasilar ischemia. Preliminary experience. AB - Forty-five patients were evaluated for vertebrobasilar ischemic disease by magnetic resonance imaging and magnetic resonance angiography (MRA). Ten also underwent intraarterial digital subtraction angiography. All were sorted into three groups based on results of the MRA and their clinical presentation. In the first group, vertebrobasilar ischemic disease could be reasonably excluded. In the second, such disease was nearly certain. In the third group, the vertebrobasilar system could not readily be assessed by the MRA alone and often required further studies. In 8 of 10 patients a strong correlation was found between MRA and intraarterial digital subtraction angiography. MRA provided valuable information for assessing vertebrobasilar disease and, in many instances, eliminated the need for invasive angiography. PMID- 10148531 TI - An economic analysis of pancreas transplantation: costs, insurance coverage, and reimbursement. AB - Since 1988 the demand for the pancreas transplantation has continued to increase. This has been accompanied by a growth in the number of centers offering the procedure, and an increase in the number of transplants performed. The National Cooperative Transplantation Study was undertaken to document the costs of all transplants, including pancreas transplantation. Data on transplantation procedure charges, from date of transplant to discharge, were obtained from 66.7% of all pancreas transplantation programs active in 1988. These programs accounted for 72% of all transplants performed that year. Valid sample survey data (no more than 25 transplants per center) were obtained for 133 randomly selected patients. This constituted 54% of all procedures done in the United States in 1988. Detailed data were also collected on sources of payment and amount reimbursed. Due to outlier data, we report statistical medians, rather than means, as our measure of central tendency. The median charge for a pancreas transplant with or without a kidney was $66917, with a hospital length of stay of 21 days, compared with a kidney transplant alone at $39625 and a hospital length of stay of 14 days. Total pancreas transplant charges fell between $45260 and $105375 for 50% of the cases studied. Half of the patients had a hospital length of stay between 16 and 33. Due to the small number of cases available for analysis, it was not meaningful to cross-classify the data according to various prognostic variables.(ABSTRACT TRUNCATED AT 250 WORDS) PMID- 10148532 TI - A comparison of duplex Doppler ultrasonography and intrarenal manometry in the diagnosis of acute renal transplant rejection. AB - Renal transplant rejection is frequently difficult to differentiate from other causes of renal dysfunction. This study examined the use of duplex Doppler ultrasound and intrarenal manometry in a consecutive series of 73 patients who underwent renal transplantation. Altogether 327 duplex scans were analyzed and, for each, a resistive index (RI) was calculated. A raised RI predicted rejection in patients with grafts that functioned immediately, but not in those that had delayed function. A rise in intrarenal pressure ( greater than or equal to 40 mmHg) indicated the presence of rejection in both groups. However, neither test had a sensitivity of more than 71% and this was not improved by combining the results of the two tests for each patient. Although both tests have a place in transplantation, renal biopsies may still be required to confirm rejection. PMID- 10148533 TI - Simultaneous PTFE reconstruction of the external iliac artery with kidney transplantation. AB - Four cases of simultaneous reconstruction of the external iliac artery with PTFE (polytetrafluoroethylene) during kidney transplantation are described. The procedure facilitated renal artery anastomosis in these cases where direct anastomosis to the external artery was deemed precarious because of marked atherosclerosis. All the kidneys functioned immediately, and there were no infectious or other complications encountered relative to PTFE placement. It is suggested that simultaneous iliac artery reconstruction with PTFE be considered when the renal artery anastomosis is complicated by severe iliac atherosclerosis. PMID- 10148534 TI - Use of single photon emission computed tomography in aerosol studies. AB - Single photon emission computed tomography (SPECT) has distinct advantages over the conventional planar imaging technique in generating more information about radionuclide distribution within the body. The general application of SPECT in lung studies has been extensive, but its specific use in aerosol research is still uncommon. This review focuses on the applications, the advantages and limitations, and the potential of quantification of SPECT in aerosol studies. PMID- 10148535 TI - Argon laser-welded bovine heterograft anastomoses. AB - This study evaluated the strength of laser-welded arteriovenous shunts established using St. Jude BioPolyMeric vascular grafts. The arterial anastomoses of the biological graft were laser welded with and without the addition of soluble collagen or fibrin sealant. In four dogs, 16 arteriovenous grafts were implanted between the femoral artery and vein or the carotid artery and jugular vein using a 6 cm long, 4 mm internal diameter prosthesis. The 16 arterial anastomoses were evenly divided into four groups: sutured control, laser welded (LW), LW with soluble collagen applied immediately before and during welding, and LW with fibrin sealant applied after welding. All arterial control and venous anastomoses were sutured using continuous 6-0 polypropylene suture. All LW anastomoses were initially divided into six 5 mm long segments using six evenly spaced 6-0 polypropylene stay sutures. Each segment was laser welded using 15 to 18 5-sec pulses of the 0.5 W (7.5 W/cm 2) argon laser energy delivered via a 300 mum fiber while cooling the tissue with slow-drip saline irrigation. Blood flow was established and maintained through each anastomosis for 1 h. The vessels were then controlled, and anastomotic bursting pressure was determined with infusion of heparinized blood. RESULTS: An additional hemostatic suture was required in 3 LW anastomoses (2 LW, 1 LW with collagen). Mean bursting pressures (mm Hg) of the arterial anastomoses were as follows: sutured controls 165 +/- 159, LW 144 +/- 58, LW and collagen 93 +/- 47, LW and fibrin sealant 181 +/- 45.(ABSTRACT TRUNCATED AT 250 WORDS) PMID- 10148536 TI - Transmyocardial laser revascularization: a review. AB - There is an increasing number of treatment alternatives available for those with ischemic heart disease. Surgical procedures are more sophisticated, a wide array of medications are available, and numerous catheter techniques have evolved to treat patients with coronary artery disease. Technical advances and lifestyle modifications have contributed to a decline in age-adjusted death rates. Despite these advances, there remain a significant number of patients with myocardial ischemia who are not candidates for conventional therapies. Transmyocardial laser revascularization may be a viable adjunct or alternative therapy. In performing this technique, channels are made, from the epicardial surface of the heart through the left ventricle and endocardium, with the CO 2 laser. Perfusion is from the blood supply in the left ventricle via the channels. Postoperative thallium stress tests and left ventriculography indicate that the channels remain patent and protect the ischemic muscle. Experimental and early clinical results of transmyocardial laser revascularization suggest that a group of patients may benefit from this treatment. PMID- 10148537 TI - Comparison between laser meniscectomy with excimer and Ho:YAG lasers. AB - The authors report their experiences using the excimer laser and holmium:YAG laser in arthroscopic meniscal surgery. Histologic and ultrastructural aspects caused by laser irradiation on meniscal tissues are evaluated. Two groups of 10 patients, each suffering from a bucket-handle lesion of the internal meniscus, were used for this study. The histologic results of the study confirm the clinical reliability of the laser even in the presence of different ultrastructural frames. PMID- 10148538 TI - The surgical management of facial syringomas using the superpulsed CO 2 laser. AB - Syringomas are benign tumors of eccrine origin that occur primarily in the lower eyelid region of females. Since they do not involute and are typically refractory to conventional forms of therapy, they may grow to become considerable, chronic cosmetic and functional deficits. The current study reports on a patient with familial syringomas, previously refractory to two different standard therapies, who was successfully treated with the superpulsed CO 2 laser. A simple, accurate, and reproducible method of dosimetry of laser energy was used to treat these lesions with the Sharplan 700 CO 2 laser connected to the operating microscope. Each lesion was irradiated separately with single pulses at a calculated energy density of 1 J/cm 2. Superficial scabbing was observed 1 week postoperatively, with no edema or pain. Mild erythema persisted for 1 month, with complete healing thereafter. No recurrences were noted after a 2 year follow-up. There was no evidence of scarring, ectropion, or changes in pigmentation. The disease and methods of treatment are reviewed. PMID- 10148539 TI - The use of centrally prepared reagents in an external quality experimental trial. AB - The authors provide the results of a short-term experimental trial in external quality assessment in 42 clinical laboratories conducted by the Mexican Ministry of Health. Assay kits for glucose, urea, and creatinine were prepared by the Ministry. The results may prove useful to organizers of external quality assessments in third-world countries who may opt for this strategy to improve performance. The laboratories performed the tests on reconstituted lyophilized control serum, also prepared by the Ministry. All three assays were performed manually using colorimetric methods. On the basis of their intralaboratory precision (coefficients of variation less than 8%, 8-12%, and greater than 12% for high, medium, and low precision, respectively), 12 laboratories demonstrated high precision for all three tests. Eight laboratories showed medium and low precision for different tests, while the other 22 fell in between. The results showed that the strategy of using centrally prepared reagents to improve interlaboratory agreement did not work well for urea and creatinine, but met expectations for glucose. The laboratories achieved an interlaboratory coefficient of variation of 10% for glucose in this first trial. PMID- 10148540 TI - Structure and genetic engineering of antigens and antibodies. Applications in immunoassays. PMID- 10148541 TI - Coagulation testing in the clinical chemistry laboratory. PMID- 10148542 TI - Designing small, low-cost, portable electromedical products. AB - In response to demands for smaller, cheaper, portable electromedical products, designers are developing circuitry that operates at reduced power levels, thereby allowing smaller batteries to be used. Application-specific integrated circuits (ASICs) enable products to have fewer components and are inherently more power efficient than circuits comprised of discrete components. In this article, the author examines the existing applications of ASICs and discusses how new design techniques can be used to reduce a product's overall power consumption and production costs. PMID- 10148543 TI - Prevalidation of computer systems regulating medical device manufacturing processes. AB - When developing a computer system for regulating a medical device manufacturing process, it is advisable to incorporate validation criteria in the design and development of the system from the very beginning. Quality begins at the design stage and cannot be added at a later stage of system development. In this article, the author details the step-by-step process of software development that is recommended by the United States Food and Drug Administration (FDA) and utilized by the company in its development of a prevalidated sterilizer control system. By following FDA recommendations and using an external consultant to confirm validation, a prevalidated system can be supplied to the end-user. This provides the end-user with a number of significant benefits. PMID- 10148544 TI - The biology of bone grafts. AB - The clinical outcome of bone grafting procedures depends on many factors, including type and fixation of the bone graft as well as the site and status of the host bed. Bone grafts serve one or both of two main functions, as a source of osteogenesis and as a mechanical support. Autografts, both cancellous and cortical, are implanted fresh, provide a source of osteoprogenitor cells, and are osteoinductive. The latter is a process whereby the transplanted tissue induces mesenchymal cells of the recipient to differentiate into osteoblastic cells. Cortical grafts, whether autogeneic or allogeneic, at least initially act as weight-bearing space fillers. All bone grafts are initially resorbed; cancellous grafts are completely replaced in time by creeping substitution, whereas cortical grafts remain an admixture of necrotic and viable bone for a prolonged period of time. The three-dimensional framework that supports invasion of the bone grafts by capillaries and osteoprogenitor cells, termed "osteoconduction", is another important function of both autografts and allografts. Because fresh allographs evoke both local and systemic immune responses that diminish or destroy the osteoinductive and conductive processes, freezing or freeze-drying of allografts is used clinically to improve incorporation. Graft incorporation is also influenced by the vascularity and composition of the host bed. Thus, the interaction of the host and the bone graft determines the success of these procedures, which ultimately is to provide a mechanically efficient support structure. PMID- 10148545 TI - Complications of allografts in arthroplasty. PMID- 10148546 TI - Bulk versus morselized bone graft in acetabular revision total hip replacement. AB - Use of bulk femoral head autografts and allografts as structural members in complete reconstruction of deficient acetabulae in total hip replacements is associated with a high failure rate after about 5 years. The failures are usually catastrophic requiring reoperations. The reoperation failure rate is eight times greater than those used in primary total hip replacement without structural bone grafting. Contemporary alternatives to bulk structural grafting involves the use of hemispherical, porous, cementless acetabular components fixed with screws and supplementary nonstructural bone grafting. These procedures have proven to be very successful over the short term, and it is hoped that they will provide results superior to those obtained with bulk femoral head allografts. There is also no need to use the bulk femoral head grafts to bring a high hip center down to the normal level. PMID- 10148547 TI - Techniques of acetabular reconstruction. AB - Acetabular reconstruction and revision can be a complex and demanding procedure. This article reviews the essential components of preoperative planning and surgical technique. In addition, there are several unsolved issues that will be addressed along the author's current prejudice on these issues. PMID- 10148548 TI - Allograft reconstruction of the acetabulum in revision hip surgery. AB - Acetabular deficiencies seen in revision hip arthroplasty require special attention. Custom components, space-filling cement, relocation of the hip center higher on ilium, and resection arthroplasties have all been used. Allograft reconstruction of acetabular defects has many attractive features, but methods of fixation, long-term success rates, and problems of graft resorption and implant loosening present significant questions. This article presents a classification system for acetabular defects and a surgical technique for correcting them. The results of 218 cementless acetabular reconstructions are reviewed and show the importance of the acetabular rim. When the rim is intact, 97% of reconstructions will remain stable, and 78% of allografts used will consolidate. When the acetabular rim is deficient, special techniques using bulk allograft and internal fixation must be used in order to avoid long-term graft resorption and implant loosening. PMID- 10148549 TI - Acetabular revision with the bipolar prosthesis and particulate bone grafting. AB - Acetabular revisions with bipolar prostheses and particulate bone grafting are seldom performed because of the clinical success of porous coated cementless acetabular components. When limited to cavitary defects and appropriate-sized implants, durable reconstructions with excellent clinical function can be achieved with bipolar revisions. Recalcitrant instability of total hip arthroplasty remains an indication for bipolar revisions. PMID- 10148550 TI - Proximal femoral allografts in revision total hip arthroplasty. AB - The senior authors have performed 141 proximal femoral whole-bone allografts in failed total hip reconstruction. The results of the first 50 have been previously reported. This study reviews 70 additional cases performed since 1987 and reflects improved technique and several different junctional constructs. Modest improvements in the rate of union (64% v 80%) and of dislocation (28% v 16%) have been achieved. The infection rate (6% v 4%) and demographics of the groups have remained constant. The frequency of complications (67% v 53%) has decreased, but unfortunately remains high. A step-out allograft junction with a long lateral sleeve has been the most reliable construct. PMID- 10148551 TI - The use of cortical allograft struts for fixation of fractures associated with well-fixed total joint prostheses. AB - Nineteen patients with 19 fractures around or below a well-fixed femoral stem, were treated by open reduction and internal fixation using massive cortical allograft struts and cerclage wires or cables. The first procedure was performed in 1982 and the last in 1990. Follow-up averaged 28 months. Seventeen patients united their fractures and returned to their preoperative functional status at an average time of 41/2 months. Sixteen healed anatomically. There was one mild malunion and there were two nonunions, both requiring further surgery. PMID- 10148552 TI - Allografting in total knee replacement arthroplasty. AB - Revision, and complicated primary total knee arthroplasty (TKA), may present with significant structural bony defects. Allograft offers blocks of material that can be shaped to the defect. The opportunity to gain a biological bond may theoretically enhance loading conditions and enhance any subsequent surgery. However, the biomechanical and biological issues of immune response, infection, graft incorporation, resorption, and load transfer render allografting a powerful but problematic technology. PMID- 10148553 TI - A comparison of infusion devices at 1 ml/hr. AB - Delivery of medications by some infusion devices is irregular. This study investigated instantaneous flow in several infusion devices set at a rate of 1 ml/hr. The following devices were tested: Infusion Pumps: IMED 956A, IVAC 570, IVION "Kids Pump." Syringe Pumps: Medfusion, Baxter, Baxter OR. Tests were performed using a Bio-Tek Infusion Device Analyzer (Model IDA-1). Instantaneous flow rate was defined as Q1/T1 where: Q=sample volume and T=time required to deliver sample volume. The infusion devices were received directly from their respective manufacturers and had not seen clinical service before testing. The units were fully charged and were tested while on AC power. The tests were conducted by the authors, using standard infusion sets and commercially prepared 5% dextrose and 0.45% sodium chloride solution. Each pump was tested for several hours and multiple trials were performed on each pump. The infusion pumps, IMED, IVION, and IVAC all demonstrated deviations from the desired flow rate. The IVAC pump had a greater fluctuation in flow from the set value of 1 ml/hr (p less than 0.02). Variances from mean +/- standard error for each device are shown in parenthesis. IMED 965A (0.005+/-0.014), IVION Kid's Pump (0.002+/-0.009), IVAC 570 (0.001+/-0.006). The Baxter syringe pump (0.002+/-0.009) also had a wide variance in flow. The Baxter OR (0.001+/-0.005) and the Medfusion (0.001+/ 0.008) syringe pumps maintained the most consistent flow and showed less variance than the other devices tested.(ABSTRACT TRUNCATED AT 250 WORDS) PMID- 10148554 TI - Central monitoring systems for the NICU. Review of a 2-year experience. PMID- 10148555 TI - Prolonged IV dwell in neonates. PMID- 10148556 TI - Selection and management of patients for cardiac transplantation. AB - Each month in the United States, approximately 170 patients undergo cardiac transplantation and 300 new candidates are listed. Provision of alternative therapies, identification of the patients who truly have no other option, and management of those candidates until transplantation is performed has created a challenging area of investigation. The results of heart failure trials conducted in populations with milder heart failure may not always extend to advanced heart failure, to which some prognostic and therapeutic principles are unique. Many patients with low ejection fractions and a history of severe heart-failure symptoms can nonetheless enjoy quality of life and survival equivalent to those of patients who have received transplants. Improvements in our ability to design optimal medical therapy and to identify risk factors for early mortality will allow many patients with advanced heart failure to defer or avoid transplantation, and enable the majority of candidates to remain stable until transplantation can be performed. PMID- 10148557 TI - Ethylene oxide sterilisation of allogenic bone implants. AB - We have evaluated the ability of ethylene oxide gas to penetrate bone matrices and subsequently kill a defined microbiological load. These experiments demonstrated that freeze-dried cancellous and cortical bone did not pose a barrier to the rapid diffusion of the gas. A normal cycle on a commercial ethylene oxide steriliser provided a sixfold overkill. Minor differences in the rate at which the microbiological load was killed (D-value) were seen between cortical and cancellous bone, processed and unprocessed bone, and bone of different thickness. These differences were negligible in comparison to the degree of overkill observed. Spore indicators placed freely in the steriliser chamber were shown to act as excellent monitors for the bone sterilisation process. Preliminary studies of ethylene oxide residuals indicated that processed, freeze-dried bone could be sterilised without leaving leachable toxic residuals in the matrix. PMID- 10148558 TI - The effect of variations in fibre length on the impact strength of poly(methyl methacrylate) resin reinforced with ultra-high-modulus polyethylene fibre. AB - A previous study demonstrated that the impact strength of poly(methyl methacrylate) resin can be improved by including randomly distributed 6-mm lengths of ultra-high-modulus polyethylene (UHMPE) fibre. In this study the effect of varying the fibre length on impact strength, fibre distribution and manipulative properties of the resin were investigated. A scanning electron microscopic examination of fibres at the fracture surface was also carried out. It was found that a 1% by weight loading of 3-mm, 6-mm and 12-mm fibre significantly improved impact strength when compared to control resin, the 3-mm and 6-mm groups performing significantly better than the 12-mm group. The 3-mm and 6-mm fibres afforded the optimum manipulative properties in the mixing and processing of the resin. Scanning electron microscopy revealed evidence of fibre pull-out. PMID- 10148559 TI - An in-vitro study of H 2O 2-treated titanium surfaces in contact with blood plasma and a simulated body fluid. AB - Ellipsometry and antibody techniques were used to investigate plasma protein adsorption onto titanium (Ti) surfaces pretreated in hydrogen peroxide (H 2O 2). Surfaces preincubated for short times in 10 mM or 100 mM H 2O 2 bound relatively large amounts of anti-high molecular weight kininogen (a-HMWK) after immersion in blood plasma. Increasing the preincubation time in H 2O 2 led to an increase in the total amount of bound plasma proteins and a large deposition of anti fibrinogen (a-Fib). Large amounts of a-HMWK and a-Fib were also deposited onto surfaces washed in trichloroethane, acetone and ethanol, whereas radiofrequency plasma-treated surfaces or surfaces incubated in deionized water bound preferentially a-HMWK after plasma immersion. Auger electron spectroscopy (AES) made on Ti-surfaces preincubated in 10 mM and 100 mM H 2O 2 solutions showed an increased oxide thickness and, after 16 h of immersion in a physiological buffer, an increased amount of calcium on and throughout the oxide. The rate of net oxide growth was larger in 10 mM than in 100 mM H 2O 2. PMID- 10148560 TI - Synolite as a base resin for dental composites and related biomaterials. AB - Synolite resin was analysed using FTIR, NMR and HPLC to determine its components and purity. The resin was found to be predominantly BIS-GMA containing traces of its two isomers. The analysis indicated that there was no unreacted methacrylic acid or other impurities. PMID- 10148561 TI - Torsional resistance and wear of a modular sleeve-stem hip system. AB - The torsional resistance and wear debris generation of the modular sleeve and stem S-ROM total hip system was evaluated. The results indicate that slippage of the sleeve-stem interface may occur under physiological loading conditions. Slippage is more likely to occur if the junction is contaminated by blood or tissue, or if the stem is disengaged and reimplanted into the sleeve. Significant wear debris was generated during cyclic fatigue loading. The wear debris was of the size (less than 10 mum) readily ingested by macrophages. Particles of these dimensions have been associated with osteolysis, implant loosening and pain. Based upon the findings of this study the implantation of this type system must be carefully considered. PMID- 10148562 TI - Studies on peri-root tissue formation around new type artificial root made of dense hydroxyapatite. AB - The aim of this study was to examine the wound healing process and tissue development around a new type of artificial root made of dense hydroxyapatite. The newly tailored artificial roots, which have characteristic corrugated configurations with smooth root surfaces, were implanted immediately after extraction of the premolars of adult dogs. After preliminary experiments, the following studies were carried out: for the observation of tissue formation around the artificial root, artificial root with surrounding tissue were extirpated after fixed periods (6-32 weeks) of implantation; to study tissue formation at the artificial root surface, undecalcified specimens with polished surfaces for microanalysis and decalcified specimens for light microscopic observation were prepared after 72 weeks of implantation. The following results were obtained: around the artificial roots in the jawbone, fibrous tissue formation with angled orientation, bone formation resembling alveolar bone proper, and calcified substance formation attaching to the root surface were observed. PMID- 10148563 TI - Effect of addition of antimicrobial drugs to human collagen membrane. AB - Antimicrobial agents included in graft material for use in guided tissue regeneration of periodontally diseased tissue may be of value in combating infection, but may also alter the properties of the membrane material and exert an effect upon the host immune response. Metronidazole, niridazole and tinidazole were added to a cross-linked freeze-dried human type I collagen membrane in various doses and the following measured: (i) daily drug release into an aqueous solution, (ii) minimum inhibitory concentration (MIC) of the drugs against periodontopathogens, (iii) the effect of the drugs on mechanical properties of the membrane, and (iv) degradation by bacterial collagenase. In addition, the effects of the drugs on in-vitro cellular response was assessed by measuring blastogenesis of mononuclear cells obtained from patients suffering from periodontal disease and age/sex matched controls following incubation with the periodontopathogen Actinobacillus actinomycetemcomitans (AaY4). It was found that the collagen membranes released high levels of the drugs, at concentrations well above the MIC values. The mechanical properties of the membranes were not affected by the addition of the drugs, although resistance to the collagenases were. The cellular immune response was likewise suppressed in both patient and controls at drug doses comparable with the in-vitro drug release patterns. It is concluded that incorporation of antimicrobial drugs in a collagen barrier membrane may be of value when used in guided tissue regeneration. PMID- 10148564 TI - Reinforced glass-ionomer cements--a review of properties and clinical use. AB - In recent years, two new metal-reinforced Glass-ionomers have been introduced. The aim has been to develop a cement which can be used successfully as a replacement for amalgam. This paper reviews the published literature on the mechanical properties and clinical use of both the cermet and so-called 'Miracle Mix' cements. The published results do not suggest an improvement in strength or adhesion to tooth material; wear resistance is improved, however. One problem encountered in reviewing this literature is the wide variation in test methodology and hence results. In clinical use, the metal-reinforced cement has been successful in Class I and II restorations, particularly using the tunnel technique, and has potential for use in a number of other applications. PMID- 10148565 TI - Intra- and extraoral prostheses using osseointegrated implants after maxillofacial surgery. AB - Maxillary and orbital defects due to the resection of maxillary tumors in six cases were treated utilizing maxillofacial prostheses employing pure titanium osseointegrated implants (Branemark system). A total of 17 fixtures were installed in the maxillary region, and 16 achieved osseointegration. For the orbital region, nine fixtures were installed, and all fixtures integrated well. Using these fixtures as anchors, four maxillary prostheses and three orbital prostheses were set. The stability of the prostheses were improved by anchors, and the prostheses were highly satisfactory to the patients. PMID- 10148566 TI - Clinical evaluation of two-piece apatite dental implants in 189 cases. AB - A two-piece apatite implant composed of a titanium abutment and a titanium tubular root portion cemented to an outer dense hydroxyapatite (D-HAP) tubular shell by resin cement has been authorized as High Advanced Medical Technology (H.M.A.T.) and applied since December 1987. We will show the success rate and the evaluation of the implants applied through May 1992. A successful implant was considered as one that provides functional comfort with no mobility and the absence of surrounding mucosal inflammation. The number of implants applied during the last 4.5 years was 810 pieces in 189 cases with an overall success rate of 92.5% for the 704 implants with abutment. The extirpation rate has no clear linear association with the duration of the implant or with the patient's age. Most of the extirpations resulted from cases where the patient used a provisional denture during the bone healing period, the time between implantation and abutment cementation. Extirpation rate of implant was high in cases using large maxillary provisional dentures with ten or more missing teeth. It is believed that all implant cases in which large dentures were used frequently contributed to the extirpation. These observations led us to suggest that provisional dentures may be harmful to the implant. When we shifted from the traditional method to the Delay Method 2.5 years ago, no incidence of extirpation was experienced in the mandible, even with the use of provisional dentures. In the maxilla, the Delay Method proved to be effective without the provisional denture. However, the results of the Delay Method with provisional dentures remains to be evaluated. The reason is that too few cases were encountered with large missing teeth to suffice for our observation. This Delay Method (named by us) consists of delaying the insertion of the implant for approximately 2 months after the first socket preparation, until the bone tissue activity has risen. After some adjustment in the prepared socket, the implant is then inserted during the second surgical procedure. We therefore consider this method of potential benefit over the traditional method. PMID- 10148567 TI - Tissue response of apatite-filled resin cement and titanium-reinforced apatite dental implants in dogs. AB - Abutment and root portion divided two-piece dental implants were designed to modify the one-piece dense hydroxyapatite (D-HAP) implant. The initial placement of the root portion endosseously ensured an aseptic environment and physical stability for the implant during the bone healing period. The outer D-HAP shell of the root portion was fortified by an inner titanium cylinder and cemented with an adhesive resin cement containing 4-methacryloyoxyethyl trimellitate anhydride (4-META) and reinforced by fine apatite filler. Upon attaining integration of the bone and implant, the abutment was screwed and fixed into the screw hole of the root portion. The tissue response of both the apatite-filled resin cement and root portion of the two-piece implant was studied by animal canine experiments. Light and electron microscopic examination of specimens taken from experimental animal tissue showed bone contacted directly not only the exposed apatite filler at the surface of the apatite-filled resin cement, but also the resin portion. These findings of direct bone contact suggested that the tissue response of apatite-filled resin cement was approximately similar to the usual D HAP. Because most of the surface of the outer D-HAP shell of the root portion came in contact with bone, it prevented the deposition of contamination on the D HAP surface during the manufacturing procedures of the root portion. PMID- 10148568 TI - Endoscopic pelvic lymph node dissection, by the extraperitoneal route. PMID- 10148569 TI - In pursuit of the best candidates and procedures for penile revascularization. AB - Coronary bypass surgery to provide better blood flow to deficient areas of the heart is commonplace; the arteries of the heart in which blockage occurs are relatively large, and rerouting of blood is readily accomplished. In the penis, the internal pudendal system that provides arterial inflow can be easily bypassed when injury to a large vessel is the cause of erectile dysfunction. In the great majority of cases of penile arterial disruption, however, large-vessel disease cannot be demonstrated; the problem of low arterial flow originates within the corpora cavernosa, in the so-called helicine arteries. These arteries are very small, and are inaccessible unless the spongy erectile tissue of the corpora cavernosa is violated. In recent years, modest success has been reported in revascularizing the smaller arteries of the penis. The expert panelists in this symposium discuss the indications for such revascularization procedures, compare their techniques, and review the success rate in their work. PMID- 10148570 TI - Safety of heparin-coated circuits in primates during deep hypothermic cardiopulmonary bypass. AB - The purpose of this study is to evaluate the biologic impact of heparin-coated circuits without systemic heparinization during deep hypothermia. Baboons (n=6) were placed on a heparin-coated pediatric closed-circuit cardiopulmonary bypass (CPB) system and cooled to 18 degrees C. A control group (n=7) underwent similar protocol with a non heparin-coated circuit and received systemic heparin. Either low flow at 0.5 L/min/m 2 (n=8; 4 in each group) or circulatory arrest (n=5; 2 in experimental group and 3 in control group) was used during deep hypothermia. Samples for complete blood count (CBC), hepatic and renal function tests, activated clotting time (ACT) and thrombelastogram (TEG) were obtained before, during, and after bypass. Cerebral blood flow was measured using Xenon-133 and autopsies were performed to assess end-organ damage. The ACT returned to baseline in both groups, and renal and hepatic function were within normal limits. There was no significant difference between the TEG values between the groups post bypass. Fibrin split products were absent and fibrinogen levels were normal in both groups following bypass. Cerebral blood flows were equivalent in both groups before and after bypass, although in the heparin-coated group cerebral blood flows were significantly higher during CPB. There were no brain histologic changes in the heparin-coated group and one focal cortical infarct in the control group. This study suggests that hypothermia induced a state of anticoagulation that did not result in thrombus formation or end organ dysfunction during CPB with a heparin-coated circuit.(ABSTRACT TRUNCATED AT 250 WORDS) PMID- 10148571 TI - Safe, compact and portable system for regional chemotherapeutic hyperthermic perfusion procedures. AB - Perfusion techniques utilizing hyperthermic chemotherapy have been established as a successful modality of therapy for isolated metastatic malignant melanoma. The combination of chemotherapeutic agents (Dactinomycin, thiotepa and Mechlorethamine HCl) given in high doses, not possible systemically, combined with hyperthermia (40-42 degrees C) in an isolated extremity has shown greater tumor regression compared with systemic medication only. Many of the isolated limb perfusion procedures are performed in non-cardiac centers, especially at specialized cancer institutions. This often presents new obstacles for the perfusionist including lack of adequate perfusion equipment and disposables. Other obstacles include unfamiliarity of the operating room staff with the heart lung machine and inappropriate and/or unsafe handling of the perfusion circuit. In order to overcome these obstacles and enhance safety, portability and effectiveness, the authors have developed an isolated limb perfusion system. The purpose of this study was to compare the parameters of treatment and long term outcomes demonstrated by our system and method, to previously published data. The qualitative comparative analysis was performed between eight treatments with this type of perfusion system and outcome data previously published. It is the authors' conclusion that the portable isolated limb perfusion system achieved all of the required parameters to provide safe and effective treatment for this type of melanoma. No demonstrated variation of the long term clinical results in our patient population was seen when compared to previously published data. PMID- 10148572 TI - An update on ethylene oxide sterilization issues. AB - The regulations governing ethylene oxide sterilization are becoming clearer with the appearance of European standards for validation and routine control of the process. In addition, the process has undergone technological changes in recent years. In this article, the author outlines the developments that have taken place in the areas of residue reduction, biological indicators, and emission control and suggests further improvements that would ensure its place as the principle method of sterilization for the twenty first century. PMID- 10148573 TI - Converting to gamma-radiation sterilization: an overview for medical device manufacturers. AB - Gamma radiation is becoming increasingly popular as a method of sterilizing disposable medical devices. The conversion from ethylene oxide sterilization to gamma radiation may involve redesigning products and packaging, and establishing a new method of sterilization. However, the conversion process can be regarded as an opportunity to enhance product design, improve processes, and reduce costs. In this article, the authors explain how conversion can be manageably achieved by providing a step-by-step conversion programme. PMID- 10148574 TI - Dosimetry for quality assurance in electron-beam sterilization of medical devices. AB - During recent years, electron-beamed sterilization has quickly moved towards being able to compete with gamma-radiation sterilization, particularly now that several companies are offering high-power accelerators that can deliver electron beams with energies of 10 MeV; these beams are powerful enough to penetrate most medical devices. This article describes the role of dosimetry and the procedures used in the quality assurance and documentation required for electron-beam sterilization. PMID- 10148575 TI - Low-temperature sterilization using gas plasmas. AB - A number of plasma-based techniques for sterilizing heat-sensitive medical equipment at low temperatures are being developed worldwide as alternatives to existing chemical and gaseous sterilization methods. The techniques involve the use of plasmas in controlled sterilization processes that increase operator safety and offer medical device manufacturers the option of using materials they cannot currently consider because of the incompatability of those materials with existing sterilization technologies. In this article, the author discusses three development programmes that are under way and assesses the potential applications of the technique as an alternative to ethylene oxide sterilization. The potential of the technique to meet in-house sterilization requirements of medical product manufacturers is also discussed. PMID- 10148576 TI - The 1993 Medical Device Technology sterilization survey. AB - The 1993 Medical Device Technology survey on sterilization is the second in a series of annual surveys that examines the use of sterilization techniques within the European medical device industry. By conducting this study each year, a database will be established and maintained on the various ways in which the sterilization of medical devices is achieved. In the longer term this will indicate changes in the market for sterilization equipment and services and will identify future trends in this very important segment of the medical device industry. Such information will be passed on to the readers of Medical Device Technology in forthcoming issues of the magazine. PMID- 10148577 TI - MRA gains momentum in peripheral disease. PMID- 10148578 TI - SCVIR steps up effort to prevent restenosis. PMID- 10148579 TI - Flow quantification extends MRA's neuro applications. PMID- 10148580 TI - Digital breast techniques excel at image display. PMID- 10148581 TI - Broadband transducers improve image quality. PMID- 10148582 TI - Regional anesthesia for shoulder arthroscopy: the interscalene block. PMID- 10148583 TI - Primary resection total knee arthroplasty for complicated fracture of the distal femur with an arthritic knee joint. AB - Treatment of fractures of the distal end of the femur in an elderly patient is difficult. If the knee joint is arthritic, the problem is even greater. The reports of two patients with rheumatoid arthritis who sustained fractures of the distal end of the femur and underwent unconventional treatment with a resection total knee arthroplasty are presented. PMID- 10148584 TI - Sweat testing for cystic fibrosis: profiles of patients with insufficient samples. PMID- 10148585 TI - Whole blood coagulation testing in neonates. PMID- 10148586 TI - Renal transplantation across the ABO barrier: the Midwest Organ Bank experience. PMID- 10148587 TI - Sexually transmitted diseases: risks, transmission, and laboratory diagnostic update. AB - Sexually transmitted diseases (STDs) are a major public health problem of the 1990s. In the pre-antibiotic era, these infections were often fatal. The 1960s saw an alteration in public attitudes toward sexual practices and a resultant increase in the incidence of STDs. Today, despite increased efforts in health education and the encouragement of "safe sex" practices, the incidence of STDs continues to rise. Infection control is complicated by the frequent lack of symptoms of many STDs. This article will discuss only the most common STDs in the United States. These include those caused by the organisms Neisseria gonorrhoeae, Herpes simplex virus, Chlamydia trachomatis, Treponema pallidum, Haemophilus ducreyi, and Hepatitis B virus. PMID- 10148588 TI - Physician experience with human immunodeficiency virus type 1 or hepatitis B virus testing in San Diego county: methods for a census survey. PMID- 10148589 TI - Syntax PAL: a system to improve the written syntax of language-impaired users. AB - In our work with children who have difficulty with spelling or with the physical action of writing, we have found a number of children who also have difficulty with written grammar. As an extension of PAL, an existing predictive spelling and typing aid, we have developed a writing aid to help these children with sentence construction. The enhanced system uses the syntax of the initial part of a sentence to enhance the position in the prediction list of syntactically correct words. It was postulated that this would discourage the use of incorrect syntax and encourage the use of correct syntax. In two case studies, the use of Syntax PAL significantly improved the quality and quantity of one child's written output, but had little effect on the other child's work. PMID- 10148590 TI - Use of environmental control devices by elderly nursing home patients. AB - This study explored the use of remote control devices by elderly nursing home patients. Two groups of patients were given radios, and each patient in one of the two groups was also given a remote device to simplify the task of turning the radio on and off. Over a period of 12 weeks, the experimental group showed a significantly higher rate of radio use than the control group. PMID- 10148591 TI - The driving advisement system: a computer-augmented quasi-simulation of the cognitive prerequisites for resumption of driving after brain injury. AB - No other activity so starkly pits the needs of the individual recovering from brain injury against the protection of society than does operating a motor vehicle. Cognitive abilities (e.g., response to complex processing demands, impulse control, ability to sustain performance, mental flexibility, and judgment), while evident only indirectly, are essential to performance, yet few are well sampled in currently used assessment procedures, which, instead, emphasize visuo-motor coordination and reaction time. In response to this need, a computerized quasi-simulation, the Driving Advisement System (DAS), was developed and is introduced here. The DAS incorporates a set of computer-based tasks for use by professionals charged with rendering advice concerning cognitive abilities necessary for driving safely. Normative data on DAS measures were obtained from a group of over 60 safe drivers free of significant neurological impairment. Preliminary validation findings are summarized. A sample DAS generated report for a brain-injury survivor, who sought to resume driving, is used to illustrate the graphic norm-referenced presentation of an individual's performance together with self-appraisal ratings. PMID- 10148592 TI - Cost-effective shock wave hydrophones. AB - This article presents the design of a newly developed wideband, quantitative shock wave sensor (hydrophone) made of piezoelectric material polyvinylidene difluoride (PVDF). The novel aspects of this device include a disposable sensor element to reduce the per shot costs, and a self-monitoring feature that informs the user that the sensor needs to be replaced. The development, design, and use of the sensors are presented. Results indicate that these sensors can fulfill the requirements for accurate, wideband measurement of lithotripter fields, suitable for quantitative biophysical research or Food and Drug Administration submissions. The disposable feature of the hydrophone system makes the system cost effective for research, quality assurance, and regulatory submissions. PMID- 10148593 TI - The ability of the acoustic energy/stone burden ratio to predict gallstone clearance in biliary lithotripsy. AB - The relationship between acoustic energy, stone burden, and stone clearance in biliary extracorporeal shock wave therapy (ESWL) is unclear. We hypothesized that there is a consistent relationship between these parameters that enables gallstone clearance to be predicted. Using a porcine model and various gallstone burdens, we performed biliary ESWL with varying energy levels and number of shock waves. The acoustic energy/stone burden ratio (AE/SB) was calculated that incorporated these variables. Stone clearance increased with higher energy settings and fewer stones present (p less than 0.005). The relationship between AE/SB ratio and stone clearance was logarithmic (r 2 = 0.82). The plateau of this curve showed optimal stone clearance at approximately 20 joules/g, beyond which point the benefit of further ESWL may not outweigh the risks. This relationship between AE/SB ratio and stone clearance may be able to predict the optimal energy required and probable outcome of biliary ESWL prior to the procedure. PMID- 10148594 TI - Results of combined electrohydraulic shock wave lithotripsy and oral litholytic therapy of gallbladder stones. PMID- 10148595 TI - Piezoelectric lithotripsy of radiopaque gallstones: results and six-month follow up. AB - Sixty-eight patients with radiopaque gallbladder stones (38 with a single stone, 30 with multiple stones) were treated with piezoelectric extracorporeal shock wave lithotripsy (ESWL) and results were compared with those of 69 patients with radiolucent stones (28 with a single stone, 41 with multiple stones). Stones were fragmented to 4 mm or less in 76.8% after 41,466 +/- 36,504 shock waves in the radiolucent stone group and 77.9% after 54,686 +/- 51,024 shock waves in the radiopaque stone group (p = 0.876 and 0.130, respectively). In 137 patients, ten patients were lost to follow-up. Average period of follow-up was 220 +/- 198 days. Six-month clearance rate of the radiolucent stone group was 43.5% and that of the radiopaque stone group was 16.4% (p less than 0.05) Figure 1. Six-month clearance rate of patients with single stones smaller than 2 cm was also significantly higher in the radiolucent stone group than in the radiopaque stone group (69.5% vs 18.6%; p less than 0.01). However, in patients with multiple stones, the presence of calcification did not affect rates of successful fragmentation or 6-month clearance. There was no statistically significant difference in incidence of complications between the radiolucent and radiopaque stone groups. Although the number of cases are small and the follow-up period is short, our results of ESWL on radiopaque gallstones are so far not satisfactory in terms of stone clearance. Strict patient selection is needed unless there is an improvement in the lithotripsy procedure or post-lithotripsy management. PMID- 10148596 TI - Sonographic classification of gallstones and outcome of extracorporeal shock wave lithotripsy. AB - The success of extracorporeal shock wave lithotripsy (ESWL) for gallstone elimination is dependent on the lithotripter's ability to reduce the stone to fragments less than 5 mm in diameter, but wide variation in successful fragmentation rates have been reported even with the same instrument. This variation is probably due in part to differences in stone composition. Tsuchiya et al. have recently related the pre-operative ultrasound properties of gallstones to their chemical compositions. In the present study, 138 patients with cholecystolithiasis were treated with ESWL and results were evaluated in light of the pre-treatment sonogram patterns as classified by the aforementioned authors. Complete fragmentation (CF), i.e., fragments less than 5 mm, was achieved in 90% of patients with type I a patterns (pure cholesterol stones); stone number, diameter, and volume had no effects on fragmentation. Significantly lower CF rates were obtained with I b and I c (mixed cholesterol), and type II (combination) stones (p less than 0.0003). No fragmentation at all was achieved in the six stones with type III (bilirubinate) patterns. Twelve months after treatment, 45%, 25%, and 9% of the patients with type 1 a, type I b, and types I c or II (the latter two combined), respectively, were stone-free. Pure and mixed cholesterol gallstones without calcification seem to respond best to ESWL; effective treatment can be expected even when stones are numerous (4-10) or large ( greater than 35 mm). We recommend the inclusion of ultrasound properties of gallstones in the selection criteria for candidates for ESWL. PMID- 10148597 TI - Electromagnetic shock wave lithotripsy of gallbladder stones in vitro: the role of different stone characteristics and treatment variables. AB - From 40 sets of five human gallstones obtained at cholecystectomy, four stones were subjected to either 125/250 (maximum generator output) or 250/500 (half maximum generator output) electromagnetic shock waves (treatments I/II and III/IV, respectively); the fifth stone was used for computed tomography (CT) and chemical analysis. Overall, 130 (81%) of 160 stones fragmented, including 72 (45%) adequately (fragments less than or equal to 5 mm). For the treatments I, II, III, and IV the overall fragmentation rates were 80%, 95%, 70%, and 80%, respectively. The corresponding percentages of adequate fragmentation ( less than or equal to 5 mm) were 38%, 70%, 30%, and 42%, respectively. The best results were thus obtained after application of 250 shock waves (maximum generator output; treatment II). Pure cholesterol stones (p less than 0.01), stones with a mean CT density less than or equal to 110 HU (p less than 0.001), and stones with a calcified rim (p < 0.05) fragmented significantly better, but adequate fragmentation ( less than or equal to 5 mm) was significantly determined by stone weight and diameter (p less than 0.001), bilirubin content (p less than 0.02), and calcium content (p less than 0.05). A weight greater than 500 mg and a diameter > 10 mm could be defined as stone characteristics with significant negative predictors of adequate fragmentation. However, because the experimental conditions in this in vitro study did not completely simulate clinical settings for various reasons, these observations must be interpreted accordingly.(ABSTRACT TRUNCATED AT 250 WORDS) PMID- 10148598 TI - Eligibility for extracorporeal shock wave lithotripsy of gallbladder stones using different entry criteria. AB - Extracorporeal shock wave lithotripsy (ESWL) was introduced as a nonsurgical treatment for uncomplicated, symptomatic gallstone disease. Due to its limited results and the possibility of stone recurrence, ESWL is mainly indicated for patients who reject or cannot tolerate cholecystectomy. For budgetary and planning purposes, it is essential to know what percentage of patients are eligible for this form of therapy. In the literature suitability is either reported variably (ranging from 10% to 53%) or not mentioned. We respectively assessed eligibility for ESWL for different entry criteria, based on the histories of 694 consecutive patients, who were referred for gallstone therapy from April 1, 1988 to October 1, 1991. Only 10.3%-46.9% of symptomatic patients were found eligible for ESWL, depending on the entry criteria used. When the overall results are compared with eligibility, there is no inverse relationship. This suggests that patient selection is not the only factor determining the results of therapy. It is concluded, therefore, that other factors, such as treatment schemes, the lithotripters used, and experience of the treating physicians, are important factors for the outcome of ESWL therapy. PMID- 10148599 TI - Noninvasive evaluation of newborns with congenital heart disease. AB - Over the last decade, diagnosis and management of neonates with congenital heart disease have been greatly influenced by the constant expansion of noninvasive methods. We classify the most common congenital defects presenting in the first 2 weeks of life, based on clinical presentation and hemodynamic characteristics, followed by a discussion of echocardiographic findings in the most common congenital heart lesions and how ultrasound techniques can help solve problems frequently encountered during the early postoperative period. PMID- 10148600 TI - A new bioactive bone cement consisting of BIS-GMA resin and bioactive glass powder. AB - We have developed a bioactive bone cement consisting of silane-treated CaO-SiO 2 P 2O 5-CaF 2 glass powder as the filling particles and bisphenol-a-glycidyl methacrylate (BIS-GMA) diluted with triethylene-glycol dimethacrylate (TEGDMA) as the organic matrix. Histological examination demonstrated direct bonding between the cement and bone along the circumference of the cement at 4 weeks after implantation in rat tibia. The compressive strength and toughness of the cement were two and four times greater than those of polymethylmethacrylate (PMMA) cement, respectively. The inflammatory reaction of the skin caused by the new cement was not as intense as that for PMMA 3 days after subcutaneous implantation. This new cement may be applicable as a bioactive bone cement with high mechanical strength. PMID- 10148601 TI - Trauma system development and future directions. AB - Traumatic injury, both unintentional and intentional, is a serious public health problem. Trauma care systems play a significant role in reducing mortality, morbidity, and disability due to injuries. However, barriers to the provision of prompt and appropriate emergency medical services still exist in many areas of the United States. Title XII of the Public Health Service Act provides for programs in support of trauma care planning and system development by states and localities. This legislation includes provisions for: 1) grants to state agencies to modify the trauma care component of the state Emergency Medical Services (EMS) plan; 2) grants to improve the quality and availability of trauma care in rural areas; 3) development of a Model Trauma Care System Plan for states to use as a guide in trauma system development; and 4) the establishment of a National Advisory Council on Trauma Care Systems. PMID- 10148602 TI - Complication rates for the esophageal obturator airway and endotracheal tube in the prehospital setting. AB - PURPOSE: The purpose of this study was to determine the complication rates associated with the use of the endotracheal tube (ET) and the use of the esophageal obturator airway/esophageal gastric tube airway (EOA/EGTA) during the treatment of patients with prehospital cardiac arrest. METHODS: A descriptive, quasi-experimental study of 509 consecutive adults, cardiac arrest patients was conducted. Patients were examined prospectively for airway intervention type and complications. Some patients were examined at their final destinations (field, morgue, funeral home), while other patients were examined by EMS providers in the field when airway adjuncts were switched. Also, airways were evaluated for complications by emergency physicians at destination emergency departments. RESULTS: The airway in use at the time of examination was the esophageal obturator airway (EOA) or esophageal gastric tube airway (EGTA) in 208 patients (40.1%); the ET (endotracheal tube) in 232 patients (45.6%); and an oral or nasopharyngeal airway in 47 patients (9.2%). Twenty-two patients (4.3%) had both an EOA/EGTA and an ET tube in place at the time of the examination. The survival rates were similar between the EOA/EGTA and the ET groups (28% and 32%, respectively). The complication rates overall also were similar, but the serious or potentially lethal complication rate was 3.3 times more common with the use of the EOA/EGTA than with the ET tube (8.7% versus 2.6%, respectively). CONCLUSIONS: The complication rate for the EOA/EGTA is unacceptably high, and careful thought must be given to its continued use.(ABSTRACT TRUNCATED AT 250 WORDS) PMID- 10148603 TI - Devices for expired air resuscitation. AB - OBJECTIVES: Expired air resuscitation is an essential part of first-aid and cannot be replaced by other measures. Because of the risk of transmitting infectious diseases, the use of devices is recommended. Three types are available--masks, tubes, and foils. PARTICIPANTS: Six masks (Air-Vita Bi-Protect, Laerdal Pocketmask, Drager Hivita Mask E, Rescue-Med Device, Resuscitator, SealEasy Resuscitation Kit), five tube instruments (Dr. Brook Airway, Dual-Aid, Goettinger Tubus, Lifeway, Sussex Valve Airway), and two foils (Ambu Life-Key, Laerdal ResusciFace Shield) were studied. MEASUREMENTS: Inspiratory and expiratory resistance, valve leakage, ability to protect against infection transmission, and practicability (e.g., possibility of training on standard mannequins, seal) were measured and tested in the laboratory. RESULTS: Only a few of the mask and tube devices had low inspiratory and expiratory resistances. Some of the one-way valves failed. There were definite risks of provoking complications (vomiting, lacerations) when using tube instruments. CONCLUSIONS: Devices consisting of a foil have definite advantages, and seem to be more appropriate for the use by first-aiders [first responders]. PMID- 10148604 TI - The utilization of quality assurance methods in emergency medical services. AB - OBJECTIVE: The concept of the necessity of a good quality assurance (QA) plan for emergency medical services (EMS) is well-accepted; guidelines as how best to achieve this and how current systems operate have have not been defined. The purpose of this study was to survey EMS systems to discover current methods used to perform medical control and QA and to examine whether the existence of an emergency medicine residency affected these components. METHODS: A survey was mailed in 1989 to the major teaching hospitals associated with all of the emergency medicine residency programs (n = 79) and all other hospitals with greater than 350 beds within the 50 largest United States metropolitan areas (n = 172). If no response was received, a second request was sent in 1990. The survey consisted of questions concerning four general EMS-QA categories: 1) general information; 2) prospective; 3) immediate; and 4) retrospective medical control. RESULTS: Completed surveys were received from 78.5% of residency and 50% of non-residency programs. The majority had an emergency medicine physician as medical director (80.1% vs 61.5%, p = .03). While both residency and non residency hospitals participated in initial public and prehospital personnel education, academic programs were more likely to be involved in continuing medical education (98.2% vs 82.3%, p = .009). On-line (direct) supervision was more likely to be provided by residency institutions (96.4% vs 81.0%, p = .017) which was provided by a physician in 88.3%.(ABSTRACT TRUNCATED AT 250 WORDS) PMID- 10148605 TI - Air medical transport utilization review in North Carolina. AB - OBJECTIVE: To perform a review of the collective experience of all hospital-based helicopter ambulances in the state of North Carolina for compliance with utilization review criteria. DESIGN: Flight records of the six members of the North Carolina Aeromedical Affiliation for the months of November and December 1989 were compared with utilization review criteria by an independent reviewer. A secondary review was performed by a staff member for each service. Scene responses and patients flown to a hospital other than the sponsor were evaluated. SETTING: All six hospital-based helicopter services in North Carolina. TYPE OF PARTICIPANTS: All available flight records for November and December 1989. INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: Of 756 transports, 747 flight records were available for review. Initial review demonstrated compliance with the criteria for 713 (95.4%) patients; secondary review showed compliance for 18 of 34 flights not meeting initial review, for an overall compliance rate of 97.9%. Compliance rates for scene responses and transports taken to a hospital other than the sponsoring facility were 96.6% and 94.1%, respectively. CONCLUSIONS: Review of all flights over a period of two-months by all six hospital-based helicopter services in North Carolina using utilization review criteria demonstrated a very high rate of compliance with the established criteria. PMID- 10148606 TI - Acute MI in the elderly: choosing the best revascularization method. Risks and benefits of thrombolysis, angioplasty, and bypass surgery. AB - MI is often recognized less promptly in elderly patients than in younger patients; thus, the best opportunity for reperfusion is often missed. If infarction is diagnosed in less than 12 hours and there are no strong contraindications, thrombolytic therapy is appropriate for the elderly. Coronary angioplasty is a suitable alternative if performed promptly, especially because elderly patients are more likely to have contraindications to, or higher mortality from, thrombolysis. Predictors of unfavorable outcome following angioplasty for acute MI in the elderly include multivessel disease, occlusion of the infarcted artery, and cardiogenic shock. CABG surgery (performed during infarction or in the peri-infarct setting) is also an option for those elderly patients who are hemodynamically stable. PMID- 10148607 TI - Techniques for chest tube insertion and pleurodesis. An updated look at two common procedures. AB - Chest tube insertion is warranted for drainage of large exudative pleural effusions, empyemas, hemothoraces, or chylothoraces, and for some pneumothoraces or parapneumonic effusions. Chest tubes may also be used to instill sclerosing agents to prevent recurrent malignant effusions or pneumothorax. There are no absolute contraindications to tube thoracostomy; however, if time allows, effort should be made to correct any coexisting hemorrhagic disorders before the procedure is performed. Pleurodesis may be contraindicated in patients who are expected to undergo lung surgery. The incisional method is safest for chest tube insertion and pleurodesis; bear in mind, however, that some patients with pneumothorax may be better treated with small-caliber drainage. PMID- 10148608 TI - The ABC's of managed care. PMID- 10148609 TI - Plasma exchange: a potential role in promyelocytic leukemia--disseminated intravascular coagulopathy. PMID- 10148610 TI - Neocyte transfusion: a current perspective. AB - The most important studies published to date concerning the methods of preparation and the clinical utility of young red blood cells are reviewed 20 years after the first discoveries were made in this field. The results of each of the seven methods utilized (cells separators, cell washers, manual methods, etc.) are analyzed and the author's opinion is given concerning the results of in vitro and in vivo application. With few exceptions, the reviewed studies were done using small numbers of individuals. The majority of the studies confirm that it is possible to obtain YRBC enriched units. They also agree that YRBC have a higher survival rate in vivo than do normal RBC. In contrast, many of the wider based studies did not show positive results when YRBC were used in patients or the results were too weak to justify the large amount of time and money these methods demand. Based on the review of all of the investigations published to date, there is little evidence to sustain the assumption of the clinical utility of YRBC used for multitransfused patients. PMID- 10148611 TI - Platelet storage lesions: analysis of platelet membrane glycoproteins and platelet-derived microparticles by fluorescence-activated flow cytometry. AB - We have used recently developed flow cytometric techniques in combination with specific monoclonal antibodies (MoAbs): (i) to study the membrane expression of two major platelet glyco-protein (GP) complexes, GP Ib-IX and GP IIb-IIIa, and the appearance of activation-dependent membrane epitopes, and (ii) to evaluate the relative proportion of platelet-derived microparticles and their GP pattern during storage of platelet-rich plasma. Binding of fluoresceinated (FITC) LJ-P3, an anti-GP Ibalpha MoAb, to platelets continuously decreased by 50% during storage for 6 days. Binding of FITC-LJ-P4, directed to the GP IIb-IIIa complex on the platelet surface, also decreased during day 1-3, but increased again to baseline levels from day 4-6 of storage. The re-increase of GP IIb-IIIa was associated with the exposure of secretion-dependent granule membrane proteins, GMP-140 and GP-53, and the presence of thrombospondin at the platelet surface. These neoantigens are indicative of platelet activation. Moreover, the proportion of platelet-derived microparticles increased from 6 to 22% (p less than 0.001), whereby a predominant subpopulation of GP Ib-negative microparticles was identified. Thus, significant changes in platelet membrane GP occur during standard platelet preservation. These changes, resulting from time-dependent platelet activation and/or proteolysis in vitro may affect platelet GP receptor function upon transfusion. PMID- 10148612 TI - Preparation of random donor leukocyte-poor platelets by cytapheresis. AB - Platelet refractoriness in treatment of multitransfused patients with haematologic malignancies can be delayed or prevented by transfusing leukocyte poor platelet concentrates. Absence of consensus about the number of residual leukocytes that leads to a delay or prevention of HLA-antibody formation, may be based on a lack of sampling for determination of leukocyte contamination levels in platelet concentrates. From data presented in this study we conclude that if every preparation of platelets is also tested for platelet count, it reduces costs when the pheresis platelets can be split. Transfusion of platelets in patients can also be better evaluated. PMID- 10148613 TI - Membranes and polymer structures--biocompatibility aspects with respect to production limits. AB - Plasmapheresis can be performed by centrifugation and by use of membrane technology. With the latter technique we receive a plasma which is absolutely free from platelets. This is why membranes are gaining market shares in this particular field of medical application. Today plasmapheresis membranes are mostly fabricated from synthetic polymers, such as polypropylene (e.g. PLASMAPHAN), polysulfone, polyacrylonitrile, polymethylmethacrylate, polyvinylalcohol and others, the only exception being cellulose acetate. Parameters determining the biocompatibility of plasmapheresis membranes are generation of complement C3a or C5a, hemolysis and possible thrombus formation. These parameters depend on various properties of the membrane polymer: e.g. the nature of the molecular end/side-groups, the distribution of electrical charges on the polymer surface and the different chemical structures and conformation of the polymer. In addition, membrane properties like pore distribution and geometry or the flow characteristics of a particular device-design may trigger cell activation or influence biocompatibility through the adsorption of various plasmacomponents. Most of the polymers which are used today for manufacturing plasmapheresis membranes have not been developed for this purpose. They were originally selected to be used as textile fibers. Further, no present membrane polymer has been specifically developed to achieve high biocompatibility. The membrane profile was designed in such a way that pheresis properties were met rather than optimizing biochemical blood/polymer interactions. One reason for this decision may be that the market volume of plasmapheresis technology is too small in order to justify specific and high-cost developments of polymers for this purpose. Polymer selection to achieve excellent biocompatibility profiles is determined by polymer-availability, costs, membrane-forming processes and environmental aspects related to possible pollution during the manufacturing process. The production of PLASMAPHAN by the unique Accurel-process combines several of these parameters. The main membrane production processes and especially the Accurel-process are described here. The influence of polymer surface properties, membrane structure and module-design on the biocompatibility of plasmapheresis treatments are discussed and explained by appropriate examples. PMID- 10148614 TI - Comparison of four filters for leukocyte depletion of single donor plateletapheresis products. AB - Removal of leukocytes from platelet suspensions is important in preventing the development of alloimmunization to HLA antigens in repeatedly transfused patients. Several types of filters have recently become available to remove leukocytes from platelet suspensions. We have compared the results obtained with Pall PL100S, Pall PL50S, Sepacell PL-10N and Sepacell PL-5N filters. Platelets were obtained by plateletapheresis using the Haemonetics V-50 TSPP surge procedure. A total of 160 platelet suspensions were studied, 40 for each type of filter used. The median number of leukocytes pre-filtration was 321x10 6 (range: 16-4068). The median number of leukocytes post-filtration was 2x10 6 ( less than 1-521) and was dependent on the number of leukocytes present pre-filtration but not on the type of filter used. All filters tested showed approximately a 2 log 10 reduction of leukocytes. When the number of leukocytes was below 500x10 6 pre filtration, the number of leukocytes post-filtration did not exceed 10x10 6. Overall platelet loss was 11+/-7% and was lowest with the Pall PL50S filters (7+/ 7%). Mean platelet volumes post-filtration were decreased with all types of filters used. PMID- 10148615 TI - A view of health care reform. PMID- 10148616 TI - Utilization management following health care reform: eight recommendations for managed care. PMID- 10148617 TI - The gatekeeper: an often overlooked part of reform. PMID- 10148618 TI - Restructuring health care at the local level. PMID- 10148619 TI - The cost of medication noncompliance. PMID- 10148620 TI - A model for integrating technology into a multi-agency community service delivery system. AB - This article presents the results of a 4-year project to develop and test a model for integrating technology into a multi-agency community human services delivery system. "Technology" in this sense refers to both information technology and assistive technology. The project focused on systems change rather than on the creation of comprehensive assistive technology services. Several strategies of the model were developed and tested by the project. The project developed an information/communication tier that lay on top of the existing service delivery system. The information/communication tier was provided to agencies through an electronic network and searchable database, assistive technology advice-giving software, a public awareness campaign, and professional training. The results of these strategies are used to illustrate the Community Assistive Technology Services Network (CATSN) model. The model consists of five modules: 1) client assessment and technology examination, 2) professional and client training and technical assistance, 3) information and referral and needs analysis, 4) special projects, and 5) central coordination and facilitation--the hub. This model is important given recent nationwide initiatives for using assistive technology to provide people with disabilities opportunities for maximum independence, productivity, and integration. PMID- 10148621 TI - Using seat contour measurements during seating evaluations of individuals with SCI. AB - Measuring the shape of the buttock-cushion interface has been used successfully in research to study tissue loading and as a means to fabricate custom contoured cushions. Seat contours are also able to provide useful clinical information on the weight-bearing surface of the cushion, which can be used to address posture. This article offers specific case studies that demonstrate how the analysis of seat contours can be used to identify pelvic tilt, pelvic obliquity, and areas of high loading. Seat contour measurements complement other clinical measures, such as seat interface pressures and general postural assessments, to form a more complete picture of the buttock-cushion interface. They have become useful in the clinical management of various pressure and posture problems experienced by individuals with spinal cord injury and other wheelchair users. PMID- 10148622 TI - Using single-subject design in clinical decision making: the effects of tilt-in space on head control for a child with cerebral palsy. AB - Single-subject design methodology is a research technique useful in demonstrating the effects of treatment. The technique is described here using the effects of tilt-in-space on the ability to maintain head control. The subject is a 9-year old child with cerebral palsy. The tilt-in-space angles used are 0 degrees , 15 degrees , and 30 degrees . Data are collected for the three different tilt angles in 10 sessions using an alternating rapid treatment design. Visual analysis of the results indicate that the subject displays greater head control when the wheelchair is placed at 15 degrees or 30 degrees tilt rather than at 0 degrees . This study shows how clinicians can complete single-subject studies to support recommendations for their clients and document the effects of their treatments. PMID- 10148623 TI - A synthetic membrane for testing needle penetration. AB - Needle performance is primarily judged by its penetration through tissue. For detailed studies of needle performance, tissue is too heterogeneous and unstable and difficult to obtain. A homogeneous, stable, and readily available polyurethane substrate has been evaluated as a suitable alternative to biological tissue for evaluation of needle penetration. The needle penetration profiles through the synthetic substrate correlated very well with those through natural tissue. In addition, the synthetic substrate was sensitive enough to easily detect a 20% increase in the force necessary to penetrate natural tissue. This polyurethane substrate offers a valid alternative to biological tissue for the testing of needle penetration performance. PMID- 10148624 TI - A comparison of a new polypropylene suture with Prolene. AB - The purpose of this paper is to examine the performance of the newly available monofilament polypropylene suture (Surgipro) manufactured by U.S. Surgical and compare it with commercial Prolene sutures for determining the merit of this new suture. Two different sizes of Surgipro sutures were used. They were 4/0 and 0 sizes and were tested in terms of their fundamental properties: level of crystallinity, melting temperature, fiber morphology, and mechanical properties including knot strength and knot security. The effect of three different sterilization methods on the mechanical and fundamental properties of the new polypropylene (PP) sutures was also examined. In general, the new Surgipro sutures performed as good as Prolene sutures in terms of mechanical properties; but there were some differences in fundamental properties between these two types of PP sutures, particularly in finer size PP sutures. The major differences were in interior fiber morphology, level of crystallinity, and melting temperature. Surgipro suture fibers showed homogeneous interior morphology, while Prolene fibers exhibited two distinctive fiber morphologies. These two types of PP suture fibers also responded differently to the three sterilization methods tested. Surgipro sutures are less affected by different sterilization methods than the same size Prolene control. Except for the Co 60 gamma sterilization, Surgipro suture fibers did not exhibit statistically significant differences in tensile breaking strength between sterilized and control. Ethylene oxide and autoclave sterilized Prolene suture fibers, however, showed statistically (p less than 0.05) consistently lower tensile breaking strength than their unsterilized controls.(ABSTRACT TRUNCATED AT 250 WORDS) PMID- 10148625 TI - A bibliography of monographic works on biomaterials and biocompatibility. AB - Organizing and accessing biomaterials-related information is problematic because of the interdisciplinary nature of the field. Relevant information appears in the literature of numerous science and technology subdisciplines and there is no one index or database that covers all of the related publications. An additional barrier to information retrieval is the lack of a thesaurus for the field. Multiple terms representing the same concepts are currently employed and it is not always readily apparent which terms to use in a literature search. As an aid for students and researchers in the discipline, the author provides an indexed bibliography of English language monographic works on biomaterials and biocompatibility published after 1973. PMID- 10148626 TI - What can comparative databases contribute to the evaluation of new technology? PMID- 10148627 TI - Trends in government regulation of device research. PMID- 10148628 TI - Coronary angioplasty: balloons and new devices. PMID- 10148629 TI - Issues in evaluating new devices: coronary atherectomy/rotational ablation. PMID- 10148630 TI - Issues in evaluating new devices: lasers. PMID- 10148631 TI - Issues in evaluating new devices: stents. PMID- 10148632 TI - Panel discussion: issues of new device development. PMID- 10148633 TI - From research to reality: the summary. PMID- 10148634 TI - Reproducibility of myocardial contrast echocardiography in human studies. AB - Experimental and clinical studies were performed to assess the ability of myocardial contrast echocardiography for quantitation of regional myocardial blood flow. To evaluate whether myocardial contrast echocardiography is a reproducible technique in humans, 18 nonselected patients undergoing coronary angiography were studied. A total of 107 intracoronary injections into either the left or the right coronary artery were analyzed by computer assisted videodensitometry for peak intensity, contrast decay half-time, and area under the curve. By means of these parameters intraobserver, interobserver, and interinjection variability were determined. Intraobserver measurements showed lowest variability with correlation coefficients of 0.83 for contrast decay half time, 0.93 for peak intensity, and 0.95 for area under the curve. Mean percent error varied between 6.8% (peak intensity) and 11.2% (area under the curve). The correlation coefficients for interobserver variability ranged from 0.73 for area under the curve to 0.97 for peak intensity. Mean percent error revealed a range between 7.5% for peak intensity and 19% for area under the curve. For interinjection variability, the correlation coefficient for contrast decay half time was lower (0.56) than for peak intensity (0.73) and area under the curve (0.84). Mean percent error were higher than for intraobserver and interobserver variability (range 24.1% to 34.2%). Thus, intraobserver and interobserver variability for parameters derived from time-intensity curves after intracoronary injection of echo contrast agent in humans are sufficient and comparable to data from animal studies. Interinjection variability, however, showed a higher mean percent error.(ABSTRACT TRUNCATED AT 250 WORDS) PMID- 10148635 TI - Assessment of aortic regurgitation by transesophageal echocardiography: correlation with angiographic determination. AB - Transthoracic echocardiographic studies have shown that color Doppler mapping of the aortic regurgitation (AR) jet correlated well with the severity of regurgitation as assessed by contrast aortography. The present study was performed to assess whether these parameters could be similarly applied to measurements determined by transesophageal echocardiography (TEE). In order to determine and validate criteria for the assessment of AR severity, 39 clinically stable patients with a TEE color Doppler study and contrast aortography within a 2-week period were identified. The ratio of the jet area (JA) to left ventricular diastolic area (LVDA) had the best correlation to AR severity as determined by contrast aortography (r = 0.89). Jet length, JA, the ratio of jet width to the width of the left ventricular outflow tract and jet width had r values of 0.88, 0.88, 0.83, and 0.84, respectively. The best sensitivity and specificity for the assessment of AR by TEE were obtained as follows: JA/LVDA ratio of 0%-7% predicts 0-1 + AR; 8%-20% 2-3 + AR, and greater than 20% 4 + AR. Of the three patients miscategorized, none was misgraded by more than one angiographic grade of AR. Jets that measure more than 6 cm in length or have an area of greater than 10 cm 2 have a 100% sensitivity and specificity for diagnosing 4 + AR. In the present study the ratio of JA to LVDA area correlates best with AR severity as determined by angiography. PMID- 10148636 TI - Transthoracic echocardiography for evaluation of hypertensive heart disease. AB - Systemic arterial hypertension is a common malady in the United States, with as many as 58 million persons having a diagnosis of hypertension. Left ventricular hypertrophy (LVH), which develops as a response to the elevated afterload, may be viewed as necessary and protective. However, many recent studies have demonstrated that significant abnormalities of the coronary circulation occur with LVH. These include impaired vasodilator reserve, altered autoregulation, increased tendency to ventricular arrhythmias, and increased infarct size. In addition, adverse effects directly on cardiac muscle which includes decreased contractility, and altered diastolic function may also be present. Therefore, the presence or absence of LVH may predict outcome in addition to hypertension alone. In this review I will discuss potential advantages and disadvantages of each transthoracic echocardiographic method of measuring LV mass. I will also discuss the controversy surrounding serial measurements of LV mass with antihypertensive therapies. PMID- 10148637 TI - Transesophageal echocardiography for prosthetic valve evaluation: is it always necessary? AB - Transesophageal echocardiography provides excellent images of mitral and aortic prostheses, due to its higher resolution and less interference from other cardiac structures. Since the introduction of transesophageal echocardiography, it has proved to be valuable for the evaluation of prosthetic heart valves. "Classic" indications include the evaluation of prosthetic valve endocarditis, the search for paravalvular abscesses, and the assessment of regurgitation in mechanical, especially mitral, prostheses. New technical developments such as biplane or multiplane transducers enhance the diagnostic capabilities of the technique. Transesophageal echocardiography can also have advantages in recognizing obstructive lesions such as thrombi or pannus, and help understand the complex morphology of prostheses in grafts. Transesophageal echocardiography should be considered a backup technique whenever transthoracic echocardiography, which always remains the primary approach, is inconclusive or negative in the presence of clinically suspected prosthetic valve malfunction. PMID- 10148638 TI - Use of echocardiography in detecting cardiac sources of embolus. AB - Up to 20% of all ischemic strokes are felt to be the result of emboli from the heart. High resolution transthoracic (TTE) and transesophageal (TEE) echocardiography have been the principal diagnostic tools for detecting associated cardiac abnormalities and for guiding medical and surgical approaches to these patients. In addition to identifying the precise location and morphological characteristics of intracardiac masses, echocardiography has improved our ability to predict embolic potential of these masses. Specific cardiac lesions that are predisposed to stroke and are readily identifiable by echocardiography include: cardiac thrombi, valvular vegetations, cardiac tumors, aortic atheroma, atrial septal aneurysm, and regional left ventricular wall abnormalities. Careful interrogation of patients with cerebrovascular accidents has identified a potential cardiac source of embolus in approximately 30%. This is largely due to the advent of TEE, which has provided much better assessment of posterior cardiac chambers including left atrium and left atrial appendage. Use of TEE in identifying a cardiac source of embolus is indicated in patients with stroke who are young, have no apparent cerebrovascular disease, or have recurrent embolic events. Echocardiography is an essential diagnostic tool in evaluating patients with a suspected cardiac source of embolus. TTE and TEE provide invaluable information regarding the majority of cardiac sources of embolus. PMID- 10148639 TI - Coronary artery disease in women: the role of diagnostic imaging. AB - In the United States, coronary artery disease (CAD) kills equal numbers of men and women, and is the leading cause of death in women. Except at the oldest ages, the prevalence of disease is lower in women than in men. This low prevalence decreases the accuracy of all noninvasive testing methods, making the noninvasive diagnosis of CAD in women more difficult. Perhaps because of this increased difficulty in diagnosis and the prognosis of women with angina has been perceived to be "benign," invasive testing has been used less often in women. Since the morbidity and mortality are greater in women compared with men with manifest CAD (i.e., myocardial infarction and coronary artery bypass grafting), an understanding of the strengths and limitations of noninvasive testing in women is critical. Due to the lower prevalence of CAD in women, symptoms of CAD (i.e., chest pain) and noninvasive tests (graded exercise treadmill) are less reliable with lower positive predictive values. Recent studies suggest using imaging techniques to improve the diagnostic sensitivity and specificity of noninvasive testing. This article will review the current literature regarding noninvasive diagnosis of CAD in women, including the use of stress echocardiography and thallium imaging in women. Detailed statistical descriptions of study populations are necessary so that study results can be accurately applied and interpreted in the general population. PMID- 10148640 TI - ELISA detection of antinuclear antibodies: correlation with immunodiffusion and immunofluorescent assay. PMID- 10148641 TI - The diagnosis of streptococcal pharyngitis by optical immunoassay. PMID- 10148642 TI - Single-photon emission computed tomography in distal field hypoperfusion. AB - To assess the ability of technetium-99m hexamethylpropyleneamineoxime single photon emission computed tomography (SPECT) imaging to differentiate distal field hypoperfusion from other stroke mechanisms, 24 patients with acute cerebral ischemia were studied. SPECT scans were read by two physicians according to a preestablished set of criteria for distal field hypoperfusion. SPECT patterns read as "probable" or "definite" for distal field hypoperfusion were found in 42% (10/24); of these, 80% (8/10) had ipsilateral carotid occlusion or high-grade stenosis. Severe carotid stenosis was found in 43% (6/14) with SPECT scans negative for distal field hypoperfusion (Fisher exact test [1-tailed] p = 0.0796). The results suggest that a distal field hypoperfusion pattern on SPECT may identify patients with hemodynamically significant large vessel disease. PMID- 10148643 TI - The use of surface coils for magnetic resonance-guided interventional procedures. PMID- 10148644 TI - The misperception of managed care PPOs by pharmaceutical companies. PMID- 10148645 TI - AAPPO's legislative efforts. PMID- 10148646 TI - Search for new solutions. PMID- 10148647 TI - National health care reform PPO threat or business opportunity? PMID- 10148648 TI - Managed care safe harbors: the AAPPO comments to the Office of the Inspector General. PMID- 10148649 TI - Viewpoint: vision for the managed care organization of the future. PMID- 10148650 TI - Cataract extraction in the diabetic patient. PMID- 10148651 TI - Globe perforation associated with retrobulbar and peribulbar anesthesia. PMID- 10148652 TI - Management of vitreous loss during cataract surgery. PMID- 10148653 TI - Management of expulsive choroidal hemorrhage. PMID- 10148654 TI - Infant mortality: a Turkish puzzle? AB - In this paper I examine the problem of high infant and child mortality in Turkey. In view of my research results, I argue for a re-evaluation of the theoretical paradigm that views childhood issues primarily in relation to mothers rather than within the dynamics of a broader cultural context. The present emphasis on mothers as a primary key to the problem reflects an extensive and implicit conceptualization of 'motherhood' that has penetrated scientific discourse and methodology. The research results presented here show that in our Istanbul sample most of the factors related to high child mortality are household and cultural conditions encircling the mother, and that only a few of the factors are direct attributes of the mother herself. These results have significant implications for research and policy on child health. PMID- 10148655 TI - Child survival and health care among low-income African-American families in the United States. AB - This paper provides an assessment and analysis of the increasing rates of mortality among the children of low-income African-American families in the United States and the intensifying problem of improper health care that seems to have given rise to it. The paper first documents the nature and determinants of the problem and then addresses the issue of policy prescriptions for eradicating the dilemma. The primary problem underlying the health-care access of low-income African-Americans is that there is neither a system of universal entitlement that ties their health care in with the rest of the population nor an explicit and comprehensive strategy for care outside the dominant private system. PMID- 10148656 TI - Child mortality in new industrial localities and opportunities for change: a survey in an Indian steel town. AB - As Asia becomes increasingly urbanized the effect of new industrial development on child mortality becomes of increasing interest. In India, considerable investment has been made in the social infrastructure of industrial new towns. This survey of Durgapur steel town in West Bengal shows that although the average level of child mortality in the working class population is favourable in comparison with other Indian cities, considerable differentials, that can be related to social, economic and environmental differences within the population, have arisen since the creation of the city in the late 1950s. The paper argues that the undertaking of selective sanitary interventions to improve access to drinking water (in particular) would be administratively feasible in these industrial new towns, of immediate impact, and indeed necessary if the differentials in mortality are to be eliminated. PMID- 10148657 TI - Sexually-transmitted disease risk in a Micronesian atoll population. AB - The potential health threat of AIDS to the native island-based populations in the Pacific is now widely appreciated by those working in the public-health sector throughout the region. Although several countries in the region are yet to identify any cases of AIDS or HIV seropositivity, there is reason to suspect that heterosexual contact may emerge as a predominant mode of spread of HIV infection into native Pacific island populations. Sexual networks and their relationship to potentially 'risky behaviours' are described for a single native Micronesian atoll community on the basis of ethnographic observation and interviewing. This description is combined with the investigation of historic-demographic dimensions of the epidemiology of sexually-transmitted diseases in the same population to draw some conclusions about the opportunities for HIV transmission and acquisition among the sexually-active portions of this community. Although sexually-transmitted diseases have not had an appreciable epidemiological or demographic impact on the population in the past, the sexual networks within the community and beyond provide ample opportunity for the introduction and spread of sexually transmitted diseases, including HIV and its sequel AIDS. PMID- 10148658 TI - Impurity and danger: the need for new barriers and bridges in the prevention of sexually-transmitted disease in the Tari Basin, Papua New Guinea. AB - The Huli of the Tari Basin have a serious problem with the spread of STDs following the opening of the Highlands Highway from Mendi in the early 1980s. Huli territory is now the site of huge mineral exploration and development and fears are held by health officers that the diseases may soon become an epidemic. The likelihood of AIDS entering the area in the near future provides a further need for all available barriers to be erected against the diseases and new bridges constructed to better health practices. Traditional teaching among the Huli emphasized the polluting effects of sexual contact. Missionary activity and the increasing commercialization of Huli culture have combined to weaken deterrents to premarital and extramarital sexual experiences. Traditionally, men believed that dangers of pollution came from two sources; women and outsiders. Only the Huli elders held these beliefs in the 1990s and little heed is paid to their warnings. Travel for work or pleasure has greatly increased among Huli men who no longer fear the outside world but rather wish to be part of it. Thus the traditional barriers which minimized infectious diseases have been demolished. The traditional Huli health-belief model is discussed and the possibility of harnessing traditional taboos in the fight against the spread of STDs is explored. PMID- 10148659 TI - The impact of a public-health intervention on sex differentials in childhood mortality in rural Punjab, India. AB - This paper examines the effects of a public-health intervention program on sex differentials in health and mortality during childhood. Among the different health-service packages offered as part of the experimental design, those including nutritional services seem to have been more successful in reducing excess female mortality. The reason for this success appears to have been careful follow-up of undernourished children by project workers. The results also indicate that, consistent with earlier research, girls with surviving older sisters had higher mortality rates after their first month of life. Contrary to earlier research, however, boys with surviving older brothers also have higher mortality rates, at least between the ages of one and three years. We conclude that these effects for boys and girls cannot be attributed to problems associated with larger family size, since the number of older siblings of the opposite sex (regardless of survival status) does not generally appear to be related to children's chances of survival. PMID- 10148660 TI - Malnutrition and gender relations in Western Kenya. AB - Child malnutrition, which is an increasing problem in Western Kenya, is addressed primarily through efforts to reach the individual mother with information about proper feeding of her children. A study carried out in Siaya, Kisumu and Busia Districts showed that mothers perceived nutrition problems differently, emphasizing their embeddedness in gender and family relations. In situations of marital conflict, male labour migration, and impoverishment, women must rely on support from others; thus health education should be addressed to husbands, grandmothers and mothers-in-law as well as mothers. PMID- 10148661 TI - The impact of family and budget structure on health treatment in Nigeria. AB - Health-treatment decisions, in much of the world, are affected by the family's ability to meet the cost. In West Africa the situation is more complex because husbands and wives typically have separate budgets. This article reports an exploration of the impact on treatment of divided family budgets in Nigeria where health services now charge for prescribed drugs. It was found that most child treatment is paid for by one person only, usually a parent, and that the treatment chosen is decided by the person meeting the cost. Mothers are most likely to pay for minor illnesses but the father's role becomes more important as the cost rises. Because the type, and even fact, of treatment depends on the ability to pay, and because the family is not a unity in these decisions, the health system may have to devise charging procedures that make both parents responsible, possibly with community involvement in securing payment. PMID- 10148662 TI - Development's 'downside': social and psychological pathology in countries undergoing social change. AB - Emphasis on the decline in mortality related to infectious disease, the improvement in child survival and the extension in longevity creates an optimistic view of the effects on health of social change. In contrast, attention to behavioural and social problems apparently stemming from current global social transformations leads to a more negative assessment. Specific historical processes shape local worlds of experience so as to yield complex patterns of social change with multiple outcomes. Study should be directed at the specific mediating social and moral processes that yield negative mental health outcomes in order to develop international mental-health policy to guide prevention, and to control the dangerously destructive effects of specific social transformations, planned as well as unplanned. PMID- 10148663 TI - Socioeconomic inequalities in childhood mortality: the 1970s to the 1980s. AB - The last three decades have witnessed substantial reductions in childhood mortality in most developing nations. Despite this encouraging picture, analysis of WFS and DHS survey data shows that socioeconomic disparities in survival chances have not narrowed between the 1970s and 1980s, and in some cases, have widened. Changes in mother's education and father's occupation contributed only modestly to secular declines in mortality. In most countries studied, no more than 20 per cent of the national trend could be accounted for by compositional improvements. The median contributions of improvements in mother's education and father's occupation were ten and eight per cent, respectively. PMID- 10148664 TI - Breastfeeding, lactational, infecundity, contraception and the spacing of births: implications of the Bellagio consensus statement. AB - While the nutritional, immunological and anti-bacterial benefits of breast milk are incontestable, the contraceptive effect of breastfeeding is more apparent in the aggregate than at the level of the individual. Nevertheless, it has recently been recommended that lactating women not consider adopting contraception until the earliest of their first post-partum menstruation, the introduction of supplementary feeding or their child's reaching six months of age. This article employs microsimulation to quantify the implications of this recommendation for the spacing of births and, in particular, for the proportion of birth intervals that are unacceptably short. The findings are not encouraging. The implementation of this protocol would not produce better birth spacing than a simpler strategy of initiating contraception early in the post-partum period and, unless implemented perfectly, the outcomes would be considerably worse. Breastfeeding should be viewed not as a method of birth control but as the best form of infant nourishment. Efficient contraception is the best way to ensure that children in modernizing societies can reap the benefits of breastfeeding, without being endangered by being weaned too early because of a new pregnancy. PMID- 10148665 TI - Utilization of maternal health-care services in Peru: the role of women's education. AB - This article explores the hypothesis that formal education of women influences the use of maternal health-care services in Peru, net of the mother's childhood place of residence, household socioeconomic status and access to health-care services. The findings are consistent with the hypothesis; both cross-sectional and fixed-effects logit models yield quantitatively important and statistically reliable estimates of the positive effect of maternal schooling on the use of prenatal care and delivery assistance. In addition, large differentials were found in the utilization of maternal health-care services by place of residence, suggesting that much greater efforts on the part of the government are required if modern maternal health-care services are to reach women in rural areas. PMID- 10148666 TI - From a high mortality regime to a high morbidity regime: is culture everything in sickness? PMID- 10148667 TI - Measuring the cultural inflation of morbidity during the decline in mortality. PMID- 10148668 TI - Implementing a year-long, worksite-based incentive program for smoking cessation. AB - BACKGROUND: There have been few reports of the process of implementing ongoing worksite health promotion programs. This article describes the implementation of a year-long smoking cessation program in nine worksites employing a total of approximately 700 smokers. METHODS: Issues discussed include: forming a partnership with organizations, design of the multicomponent incentive intervention, program promotion, maintaining participation, and the need to modify program components over time. RESULTS: The program produced high participation rates (29% of smokers joined the program) and moderate cessation rates among participants (during the last half of the program, monthly cessation rates averaged 20%). There was marked variability across worksites on both participation and cessation, and qualitative features of organizations associated with outcome are discussed. DISCUSSION: The importance of working with employee steering committees to tailor health promotion programs to fit the organization is discussed. The article concludes with recommendations for implementation of similar programs. PMID- 10148669 TI - Implementation and evaluation of a community-sponsored smoking cessation contest. AB - BACKGROUND: This article provides a description and evaluation of a community sponsored smoking cessation contest. Adapted from previous efforts, "Quit to Win" relied solely on community resources and was promoted to the two million residents of San Diego County, California. METHODS: A large recruitment campaign included print and electronic media. Eight hundred and two smokers participated in the contest. Contest entry forms served as the pretreatment measure, quit cards measured smoking status, and follow-up telephone interviews collected additional data on three groups: joiners, nonjoiners, and comparison subjects. RESULTS: Thirty-five percent of the participants reported being smoke-free two months after the program. Television was by far the most effective promotional medium, while individuals who received a promotional flyer were somewhat more likely to actually join the contest than those who heard of it through other sources. Self-confidence, outcome expectations, and lighter smoking habit were predictive of contest participation. Of joiners, those with a greater fear of suffering from withdrawal were less likely to quit. DISCUSSION: The approximate cost per quitter was $17.25 based on the direct budget expenses for the contest. However, this does not include the significant cost of the many donated services. Large smoking cessation contests can be cost-effective while providing direct and indirect benefits to anti-tobacco efforts. PMID- 10148670 TI - Weight reduction in the prevention and treatment of hypertension: a review of representative clinical trials. AB - Elevated blood pressure is a risk factor for cardiovascular disease, and weight reduction is currently advocated as a nonpharmacologic approach for the management of hypertension. Results of clinical trials indicate weight reduction is effective in preventing and treating hypertension. Knowledge of the results of clinical trials is extremely important for health educators since: 1) these findings provide a scientific basis for educating other health professionals about the beneficial effects of dietary approaches to the management of hypertension; 2) discussion of these results with patients may provide a means for altering patients' expectations and achieving improved treatment compliance; and 3) the processes by which clinical trials have achieved their dietary goals can provide health educators with extensive clinical experience upon which to draw in working with nonstudy patients. The content and general results of clinical trial programs are reviewed as well as features associated with health promotion in clinical trial and behavioral weight loss research. PMID- 10148671 TI - The relationship between sociodemographic characteristics and recruitment, retention, and health improvements in a worksite health promotion program. AB - BACKGROUND: Recruitment, retention, and success in a worksite health promotion program was examined among various demographic groups of employees (n = 11,830) of the Dallas, Texas Independent School District. METHODS: Enrolled employees (n = 3,873) were given a health screen consisting of health habit assessment, measurement of clinical variables, physical fitness testing, and a medical examination. RESULTS: Thirty-three percent of employees were successfully recruited into the program. Recruitment rates were virtually identical for men and women (32% and 33%, respectively), but varied across ethnic, age, and education groups. Blacks, younger employees, and noncollege graduates were less likely to be recruited. Sixty-nine percent of the employees were retained in the program, as defined by participation in the second screen, and women were more likely to be retained than men (71% versus 64%, respectively). Retention rates throughout the 10-week program were higher for whites and Hispanics, and were virtually identical for each age group and education level. Overall, participants in the program showed an improvement in physical fitness and general well-being, lost weight, and smoked less. These changes were relatively consistent across the various demographic groups. DISCUSSION: Data suggest demographic characteristics are related to recruitment and retention in a health promotion program. PMID- 10148672 TI - Worksite wellness programs: incremental comparison of screening and referral alone, health education, follow-up counseling, and plant organization. AB - BACKGROUND: Worksite wellness programs vary considerably in their design. This study tested four models to compare effectiveness at controlling high blood pressure, obesity, and cigarette smoking. METHODS: Baseline screening was conducted in four manufacturing plants. Site 1 offered screening only, with referral recommendations for those found to have CVD risks. Site 2 also provided health education information and classes. Site 3 added routine follow-up counseling and a menu of intervention types, and Site 4 added social organization within the plant. Random samples of 400 to 500 employees were rescreened at the end of three years. RESULTS: Major improvements in risk levels were found with the addition of routine follow-up counseling and a menu of interventions (Sites 3 and 4, compared with Sites 1 and 2). More hypertensives entered treatment and showed greater reductions in blood pressure. Participation in worksite weight loss and smoking cessation programs was significantly increased, and those who participated showed significantly better maintenance of improvements where follow up was provided. DISCUSSION: The program models that offered short-term interventions promoted through local media suffered in comparison with models that included personal outreach to people at risk, a variety of health improvement intervention modalities, and ongoing follow-up counseling to help people make decisions and sustain health improvements. PMID- 10148673 TI - Cardiovascular health among African-Americans: a review of the health status, risk reduction, and intervention strategies. AB - BACKGROUND: This article reviews the literature of African-American risk and identifies the disparity in cardiovascular health status, particularly hypertension, hypercholesterolemia, and cigarette smoking, and mortality rates between African-Americans and whites. METHODS: Data on African-Americans' knowledge and attitudes toward preventing hypertension and heart disease are summarized and compared to that of whites. RESULTS: Program implementation details such as communication channels, activities, and health outcomes in cardiovascular risk reduction programs in African-American communities are summarized. DISCUSSION: Promising approaches to program planning and implementation for cardiovascular risk reduction among African-Americans are recommended. PMID- 10148674 TI - A comparison of questionnaire and physiological data in predicting future chronic disease risk factor status in an employee population. AB - BACKGROUND: The ideal screening tool for worksite health screening programs has not yet been identified, and the effectiveness of screening programs in predicting future chronic disease risk factors status is not well understood. This study compared two commonly used screening tools, health-related questionnaires and measurement of physiological parameters, in terms of their ability to predict future chronic disease risk factor status in an employee population. METHODS: Data were collected over a 10-year period from Liberty Corporation employees (N = 723). Baseline evaluation included the administration of questionnaires and measurement of physiological data. Follow-up evaluation measured physiological data only. Regression analyses identified the statistically significant predictors of future risk factor status using 1) baseline questionnaire data; 2) baseline physiological data; and 3) both questionnaire and physiological data as predictor variables. RESULTS: Although both screening methods were able to predict future risk factor status, R 2 values were higher in models including baseline physiological measures than models including questionnaire data only. Adding questionnaire data to physiological data provided little or no additional predictive ability. DISCUSSION: These results suggest that physiological data, particularly baseline measures of a risk factor, are more predictive of future risk factor status than questionnaire data. PMID- 10148675 TI - A review and analysis of the health and cost-effective outcome studies of comprehensive health promotion and disease prevention programs. PMID- 10148676 TI - Personal power imagery and relaxation techniques used in smoking cessation programs. AB - BACKGROUND: Theoretically-based interventions are necessary for enhancing the power of self-control behaviors in smokers attempting to quit smoking cigarettes. The purpose of this study was to examine the use of guided imagery and relaxation techniques as interventions for smoking cessation. The relationship of imagery and self-control was also examined. METHODS: A convenience sample of 84 adult smokers participated in one of three treatment conditions: power imagery (n = 28), relaxation imagery (n = 29), and "placebo" control (n = 27). Treatment group members were taught imagery during a six-session smoking cessation program, and the control group was provided imagery training upon study completion. RESULTS: Smoking quit rates were 67% for the power imagery group, 69% for the relaxation group, and 27% for the control group. At a three-month follow up, the power imagery group had a continued abstinence rate of 52% (relapse rate = 48%), the relaxation group had an abstinence rate of 55% (relapse rate = 45%), and the control group cessation rate remained at 27% (relapse rate = 73%). One way and repeated measures MANOVAs demonstrated significant differences among the three groups at posttreatment, F (8, 158) = 13.92, p less than .05, and revealed that the practice of imagery treatments over time produced changes in power test scores and smoking rates, F (3, 127) = 24.67, p less than .05. DISCUSSION: This study demonstrated that power and relaxation imagery treatments were equally effective in reducing smoking rates. Further investigations into the therapeutic uses of imagery are recommended. PMID- 10148677 TI - Health messages on television commercials. AB - BACKGROUND AND PURPOSE: Television is an important source of health information in the United States, yet little research has focused on the presentation of general health issues on television. This preliminary study reports on the health-related content of television commercials found on a typical television day. METHODS: We conducted a content analysis of a composite day of television comprising 20 hours randomly selected over a three week period (April-May 1989). Findings are presented regarding health messages found in commercial time- advertisements, public service announcements (PSAs), editorials, and promotions for upcoming programs. RESULTS: Overall, 31% of the 654 commercial spots contained health messages. Most health messages were claims of good nutrition in food and beverage advertisements. PSAs comprise 1.4% of the 20-hour sample and 5.8% of the commercial time. Health messages appeared in 38% of PSAs, accounting for less than seven minutes. Not one PSA addressed tobacco, alcohol, or diet--the three leading behavioral risk factors for poor health. DISCUSSION: PSAs are usually seen as a mechanism by which the public health community can alert the public to important health issues. Given the declining pool of PSA time, public health educators will need to seek alternative strategies for influencing television content, such as media advocacy. In addition, further research on audience interpretation and response to commercial messages is suggested. PMID- 10148678 TI - Comparing medical costs by analyzing high-cost cases. AB - Most of the medical care expenses paid by an entire company are generated by a small percentage of employees. The most expensive employee may have costs 100 to 500 times as much as the typical employee. Instead of comparing average costs, it makes sense to investigate whether employees with unhealthy behaviors are more prone to extreme costs. This article describes methods of comparing the costs of health risk groups by examining the proportion of high-cost employees in each group. The article illustrates the methods using a health claims dataset that compares male smokers, ex-smokers, and nonsmokers. PMID- 10148679 TI - Measuring the diffusion of innovative health promotion programs. AB - Once a health promotion program has proven to be effective in one or two initial settings, attempts may be made to transfer the program to new settings. One way to conceptualize the transference of health promotion programs from one locale to another is by considering the programs to be innovations that are being diffused. In this way, diffusion of innovation theory can be applied to guide the process of program transference. This article reports on the development of six questionnaires to measure the extent to which health promotion programs are successfully disseminated: Organizational Climate, Awareness-Concern, Rogers's Adoption Variables, Level of Use, Level of Success, and Level of Institutionalization. The instruments are being successfully used in a study of the diffusion of health promotion/tobacco prevention curricula to junior high schools in North Carolina. The instruments, which measure the four steps of the diffusion process, have construct validity since they were developed within existing theories and are derived from the work of previous researchers. No previous research has attempted to use instruments like these to measure sequentially the stages of the diffusion process. PMID- 10148680 TI - The relation between aerobic fitness and serum cholesterol levels in a large employed population. AB - BACKGROUND: The purpose of this epidemiologic study was to determine the extent to which aerobic fitness was associated with total cholesterol/HDL-C ratios greater than 5.0 in 10,455 adults. The confounding effects of age, gender, income, body fat, smoking, and alcohol use were also examined. METHODS: A step test was used to estimate aerobic fitness, and serum cholesterol was measured in a certified lab. Lifestyle information was gathered using written questionnaires, and body fat was assessed using skinfold measurements. RESULTS: High fitness levels were associated with low prevalence of elevated total/HDL-C ratios. After controlling for the potential confounders, adults classified as having excellent, very good, good, or fair aerobic fitness levels were .46, .64, .61, and .85 times as likely to have elevated ratios compared to poorly fit adults, respectively. High-level fitness was also related to high HDL-C levels and low total cholesterol levels. DISCUSSION: Cause-and-effect conclusions are not warranted; however, poorly fit adults appear to be at increased risk of elevated levels of serum cholesterol. PMID- 10148681 TI - Changes in smoking associated with hospitalization: quit rates, predictive variables, and intervention implications. AB - BACKGROUND: Hospitalization can provide one of the most opportune times to prompt smoking cessation. This study determined the frequency of various smoking cessation related behaviors occurring during and following hospitalization and identified variables associated with these outcomes. METHODS: A sample of 526 HMO members who smoked prior to hospitalization and were hospitalized for nonpregnancy related, nonterminal conditions were surveyed to assess the natural history of smoking cessation associated with hospitalization. RESULTS: Three events were studied: not smoking while hospitalized (51% of subjects), attempting to quit following hospitalization (37%), and smoking status one year after hospitalization (16% abstinent). Similar factors were associated with not smoking in the hospital and quit attempts: older persons and patients with circulatory/respiratory diagnoses were only half as likely to smoke in the hospital as other patients and twice as likely to try to quit. Different variables predicted smoking status at follow-up: heavier smokers were significantly more likely to stop (26% cessation) than light or moderate smokers (10% and 11% cessation, respectively). DISCUSSION: The hospital may be an effective setting for smoking cessation programs, especially those aimed at heavy smokers. Research is needed to determine whether smokefree hospital policies alter smoking rates following hospitalization. PMID- 10148682 TI - Associations between health risk appraisal scores and employee medical claims costs in a manufacturing company. AB - BACKGROUND: The bivariate relationships between 18 health-related measures on a health appraisal and prospective medical claims costs were examined among 1,838 employees for three consecutive years. METHODS: Employees were classified into high- or low-risk categories for each of the 18 health-related measures, and divided into high- or low-cost categories according to their averaged three-year medical costs respective to the mean of their sex/age subgroup. RESULTS: Average annual medical costs for the 18 health-related measures were $67 to $778 higher for the employees classified at high risk. The high-cost category was statistically associated with high-risk status in 11 of 18 health-related measures with a high-cost/high-risk to high-cost/low-risk ratio of 1.26 to 2.50. The average annual medical claims costs were also significantly related to number of high-risk classifications. DISCUSSION: This study provides strong statistical evidence that, regardless of age and sex, employees in this sample with positive behaviors cost less in medical claims from 11 of 18 health-related measures. PMID- 10148683 TI - Support for restrictive tobacco policies among residents of selected Minnesota communities. AB - BACKGROUND: Tobacco related diseases remain the most important public health problem. Public policy approaches to tobacco control have been used historically, and remain a viable, though largely untested, tobacco control strategy. The purpose of this article is to report assessment of support for tobacco control policies among the general public. METHODS: A random sample of 821 residents from seven Minnesota communities was surveyed by telephone to assess their support for 12 measures designed to restrict smoking behavior and curb demand for tobacco. Some of these policies were similar to those already in place, while others had not yet been adopted. RESULTS: Over 50% of the respondents indicated that they strongly favored or somewhat favored each of the measures, suggesting that a constituency exists for further regulation of tobacco. Measures that restrict tobacco advertising, prohibit smoking in public places, increase the penalties for selling tobacco to minors, and reduce access of young people to tobacco are especially popular. Women, nonsmokers, and older people form the basis of support for these measures. CONCLUSIONS: These results suggest that Minnesota citizens are more supportive of restrictive tobacco control policies than policy makers might believe, and that more aggressive lobbying on behalf of such measures at the state and local level is warranted. PMID- 10148684 TI - A conceptual framework for the roles of legislation and education in reducing exposure to environmental tobacco smoke. AB - More and more legislation regulating smoking in public places is being enacted. A conceptual model is proposed incorporating a large number of factors that may affect smokers' compliance with resulting restrictions. The model stems from findings in our own research and from a consideration of the literature. It includes individual variables such as personality characteristics and attitudes, as well as population variables such as social norms and political and economic factors. Education about the health effects of environmental tobacco smoke and attitudes toward legislative measures regulating smoking, in the context of a supportive environment, are postulated to directly affect personal compliance with regulations. Some directions for future research and implications for public policy are presented. PMID- 10148685 TI - Threats to internal validity in worksite health promotion program research: common problems and possible solutions. AB - Reviews of the research on worksite health promotion programs reveal that most studies are limited in their ability to draw clear inferences about program effects because the studies employed flawed research designs and/or analyses. Conclusions are often drawn about program effectiveness with little consideration given to alternative explanations for the findings. In an effort to promote improved research, this article uses the Cook and Campbell delineation of threats to valid causal inference to illustrate how the threats can operate in worksite health promotion program research as well as how they can be examined and controlled. Researchers, even those attempting to conduct true experiments, must consider the existence of all plausible threats to validity and control or rule them out before valid causal inferences can be drawn. The theoretical and design issues involved in worksite health promotion program research are presented, followed by a discussion of threats to internal validity. PMID- 10148686 TI - The inadequacy of using means to compare medical costs of smokers and nonsmokers. AB - The costs associated with health risks have become a primary focus in the field of health promotion. Unfortunately, the nature and quality of medical cost data are not ideal for simple comparisons of health risk groups. Most health promotion professionals have had little or no training on how to interpret cost data and are thus unaware of the limitations and problems inherent in cost comparisons. This report illustrates the problems encountered when using cost data, using examples from a medical claims dataset. Specifically, the potential errors that result from comparing group means are shown. A set of alternatives for practitioners and researchers to consider when comparing costs for different groups are offered. PMID- 10148687 TI - Maximizing worksite survey response rates through community organization strategies and multiple contacts. AB - BACKGROUND: Worksites are natural settings for health promotion. In many cases, the effectiveness of such interventions is appraised by surveying employees to assess worksite-wide changes in the targeted behavior. Little attention has been paid to increasing worksite survey response rates. One way is to utilize community organization strategies, which involve enlisting the individuals within a group to work together with researchers to affect the social environment. METHODS: Community organization strategies and multiple contacts were used to obtain responses from employees in five worksites involved in a smoking cessation project. Employee Advisory Board members in each worksite reviewed, adapted, and revised the survey distribution method, the messages that accompanied the survey, and the survey content. Three major survey waves were undertaken: a worksite effort, a home mailing (in the pilot worksite only), and a telephone call to nonrespondents. RESULTS: Response rates to a worksite-wide survey in one worksite the first year and four additional worksites the next year yielded 99.3% and 98.4% response rates, respectively. In the pilot worksite, 273 employees were eligible for the survey with 366 eligible employees in the four other worksites. Chi-square or analysis of variance computations were used, as appropriate, to test for differences in characteristics of respondents in the various data collection waves. DISCUSSION: These results suggest that there may be merit in adapting such community organization intervention methods for research applications. PMID- 10148688 TI - African families and AIDS: context, reactions and potential interventions. AB - This paper reviews publications and research reports on how sub-Saharan African families have been affected by, and reacted to, the AIDS epidemic. The nature of the African family and its variation across the regions is shown to be basic to both an understanding of how the epidemic spread and of its impact. The volume of good social science research undertaken until now on the disease in Africa is shown to be extremely small relative to the need. PMID- 10148689 TI - Conceptual models for health education research and practice. AB - Although conceptual models are frequently used to illustrate research questions under investigation, there is a paucity of articles about how to develop conceptual models or their importance to health education research and practice. A number of uses of the term model exist. Therefore, we describe a conceptual model developed to guide health education research or practice as a diagram of proposed causal linkages among a set of concepts believed to be related to a specific public health problem. Although informed by the multicausal models of public health, the conceptual models we describe differ from those models in that they do not incorporate all factors correlated with an endpoint of interest. Rather they show only the small part of the causal web selected for study. Conceptual models differ from theory in that they are not usually concerned with global classes of behavior but with specific types of behavior in specific contexts. They often are informed by more than one theory, as well as by empirical findings. Because of the usefulness of conceptual models in narrowing both research questions and the targets of intervention, we advocate the inclusion of the model development process in public health education research methods courses. PMID- 10148690 TI - Health education theory: an application to the process of patient-provider communication. AB - Although the medical visit is widely acknowledged as an important event presenting unique opportunities for the modification of health beliefs and behaviors, health education theory has provided few explanatory mechanisms for understanding its communication process. The purpose of this paper is to explore a theoretical model loosely derived from social exchange and reciprocity theory for viewing the dynamics and consequences of patient-provider interaction during the medical encounter. We have elaborated this notion of reciprocity to suggest that provider behaviors within both the technical and socioemotional realm inspire parallel patient behaviors. For instance, a physician who is very informative may expect a patient to remember his instructions and comply with his recommendations. Further, a physician who is warm and friendly will inspire parallel patient attitudes in the socioemotional domain, such as friendliness and satisfaction. However, we believe that the reciprocity principle is only partially operative between domains. While an informative physician may be perceived as concerned and caring, merely being nice or caring, in the absence of indications of task performance (such as information giving), does not supply the evidence on competence that patients need to decide to attend to information or adhere to a therapeutic regimen. Our theory of reciprocal exchange in the medical visit is consistent with a consumerist perspective of patient-provider relations and with the activated patient philosophy of health education. PMID- 10148691 TI - Implementation of mass media community health education: the Forsyth County Cervical Cancer Prevention Project. AB - The Forsyth County Cervical Cancer Prevention Project (FCP) is a community-based health education project funded by the National Cancer Institute. The target population includes around 25 000 black women age 18 and older who reside in Forsyth County, North Carolina. The overall goal of the program is to prevent mortality from cervical cancer by promoting Pap smears and return for follow-up care when needed. Based on the principles of social marketing, a plan to reach the target population with mass media educational messages through electronic and print channels was developed. Guided by marketing objectives, the target population was divided into relatively discrete segments. The segments included church attenders, patients in waiting rooms of public and selected health providers, female students at local colleges, shoppers, viewers of radio and television, newspaper readers, and business owners and managers. Introduction of the program was based on strategies developed for reaching the target population in each segment with television, radio and print mass media messages. Qualitative assessment of the mass media developed by the program indicated that all forms of communication helped to increase awareness of the program. PMID- 10148692 TI - Evaluation of a mass-media-led campaign to increase Pap smear screening. AB - A health education campaign designed to encourage women between the ages of 18 and 70, especially 'older' women (defined as those 50 and over), to have a Pap smear took place in New South Wales (NSW), Australia in early 1988. The campaign involved the mass media, some related community activities and mailing of an educational package to all General Practitioners. According to a sample survey the media campaign was recalled by just over 40% of its target audience. Outcome evaluation was based on the analysis of Pap smear records for a representative 10% sample (N = 338 000) of women registered with the Australian universal health insurance scheme in NSW and three control States. From logistic regression models we estimate that, for women over 50 years and older in NSW, there was a 30% increase overall in Pap smears during the 4 months following the campaign and a 50% increase amongst those who had not had a smear in the previous 2 years. Smaller increases were observed in some other States. Increases of 13-20% were observed among the younger age groups in NSW. Although the campaign appears to have prompted short-term increases in screening rates, the effect is too small to make a substantial impact on the size of the under-screened population. PMID- 10148693 TI - Development of a strategy to encourage attendance for screening mammography. AB - The present study describes a method for the data-driven structuring of interventions to increase participation in screening mammography. We interviewed 668 randomly selected women from the target population of an Australian pilot screening mammography program before this Program commenced. The aims of the study were to use cross-sectional data to determine factors which predicted women's intentions regarding attendance at the Program, and on the basis of these results to develop optimal strategies to encourage attendances. Of the sample, 64% said they intended to go to the Program, while 11% were unsure. A number of variables were significantly associated with intention and regression analysis was used to determine the best model for predicting intention. Ten variables entered the final regression model: the intensity of thought about getting breast cancer; a belief that early detection is extremely desirable and that screening mammograms are accurate; having had a Pap test within the last 2 years; a belief that health is controlled by chance; perceived ease of getting to the hospital; subjective familiarity with the hospital location of the Program; age; having heard about screening mammography; and a feeling of personal susceptibility to breast cancer. This model explained 20% of the variance in intention to have a mammogram (R 2 = 0.20, F(10,492) = 12.08; P less than 0.0001). The practical applications of these findings are discussed in this report. It is recommended that if a campaign were to concentrate on changing women's perceptions on the dimensions found to be significantly associated with intention, then it would have maximum chance of encouraging attendance amongst women in the target population. The strategies we have developed based on these findings are discussed in this paper. PMID- 10148694 TI - Assessments of personal and general risks of HIV and AIDS in Harare, Zimbabwe. AB - This study examines the relationship between perceptions of personal risk and perceptions of general risk of HIV infection. It relates these perceptions to the likelihood of behavioural change, and to the health belief model. It is argued that as part of the education campaign concerning HIV and AIDS it is important to present images and messages which can be personalized by different sections of the community. PMID- 10148695 TI - Evaluation of a safe sex campaign regarding AIDS and other sexually transmitted diseases among young people in The Netherlands. AB - During the summer of 1989 a mass media campaign against the spread of AIDS and other sexually transmitted diseases (STDs) was launched in The Netherlands. The campaign was directed at young people and targeted inappropriate beliefs about the transmission of HIV and STDs. These inappropriate beliefs were considered to function as rationalizations and excuses for individuals and their sexual partners not to take preventive measures. To evaluate the campaign, young people who had noticed the campaign were compared with the ones interviewed at the pre test. The ones that had not noticed the campaign served as a quasi-experimental control group. The campaign not only reached a sizeable majority of young people, but also succeeded in bringing about some of the desired changes. The risk of HIV infection became personally more relevant to the exposed group and several misconceptions or excuses were less often endorsed. This suggests that a mass media campaign does not have to be restricted to mere attention-raising and increasing factual knowledge, but may be of relevance for other psychosocial processes as well. PMID- 10148696 TI - An evaluation of the effectiveness of a planned diffusion process: the Smoke-Free Class of 2000 project in Texas. AB - The first year of the Texas Triagency Coalition Smoke-Free Class of 2000 project (SFC2000) in Texas was evaluated using a descriptive model developed from diffusion theory. Tobacco-prevention education (TPE) materials were to be made available to all first grade teachers within the state. A random sample survey of 213 teachers indicated that 96 (44.7%) had received the materials. Adoption and implementation were high. By May of 1989, 64.2% of those teachers receiving materials had adopted and already implemented the program, and 25.3% had adopted and intended to use the materials. Almost all (96.8%) of those teachers who received the kit indicated that they would maintain the first grade program in the coming school year. Of respondents to a 1 year follow-up survey, 41.1% used it the first year only, 27.3% used it both years, 12.5% used it only in year 2 and 18.2% did not use it either year. Of those receiving the kits, 48% indicated that they had not previously taught TPE and thus were introduced to the concept of TPE through the SFC2000 kits. Receptivity was highest (over 90% agreement) for including TPE in elementary school curricula, with fewer teachers strongly agreeing with items tapping personal involvement with TPE. This evaluation of a statewide component of a national initiative reinforces the need to consider the dissemination and implementation of materials when planning large-scale interventions and evaluating their impact. PMID- 10148697 TI - Factors influencing acceptance of mammography: implications for enhancing worksite cancer control. AB - PURPOSE: The purposes of this article are to review what is known about participation in mammography programs and to propose several elements that warrant consideration in planning mammography screening programs in occupational settings. Breast cancer is the most common female cancer. Regular screening programs including mammography, clinical breast examination, and monthly breast self-examination can reduce breast cancer deaths by as much as 35%. However, mammography is underutilized. This review examines factors affecting acceptance of mammography and possible worksite-based strategies to increase its appropriate use. SEARCH METHODS: We identified the sources cited in this review through a combination of literature searches of computerized data bases, backward searches of reference lists, and contacts with active investigators. The article includes a selected subset of the most recent and relevant references. SUMMARY OF IMPORTANT FINDINGS: A variety of individual factors, environmental influences, health care system factors, and employer factors influence the acceptance of mammography. Workplace mammography programs can be especially important in reducing access barriers. MAJOR CONCLUSIONS: Six program elements which are central to planning successful worksite mammography programs are discussed: location and facilities; health professional involvement; the range of services; education and referral; employer policies, and plans for follow-up and repeat screening. PMID- 10148698 TI - Occupational mental health promotion: a prevention agenda based on education and treatment. The American Psychological Association/National Institute for Occupational Safety and Health, Health Promotion Panel, 1990 Work and Well-Being Conference. AB - PURPOSE OF THE REVIEW. Psychological disorders are one of the 10 leading work related diseases and injuries in the United States according to the National Institute for Occupational Safety and Health. This article addresses occupational metal health and preventive stress management in the workplace. The individual and organizational costs are briefly considered with concern for reducing the burden of suffering associated with these problems. SEARCH METHOD. As an American Psychological Association interdisciplinary panel, we searched the psychological, medical, public health, and organizational literature. We selected articles relevant to the problem of psychological disorders in the workplace and to enhancing occupational mental health and preventive stress management. IMPORTANT FINDINGS. The panel proposed a national agenda of education and treatment, combined with a program of evaluation research, for addressing these issues. Target populations are identified, and the need for collaboration among a variety of national constituencies is considered. Advancing occupational mental health and promoting skills in preventive stress management is considered in the context of comprehensive health promotion. MAJOR CONCLUSIONS. The panel concluded that there is a pressing need to: 1) set a 'gold' standard concerning the current state of knowledge in the domains of occupational mental health and stress management; 2) identify Diagnostically Related Groups (DRGs) which are stress-related; 3) establish assessment standards for stress and mental health; 4) set guidelines for reasonable interventions; and 5) establish acceptable post-outcome criteria. PMID- 10148699 TI - Enhancing adherence to referral advice given at blood cholesterol screenings: impact on participant follow-up and physician behavior. AB - Adherence to referral recommendations given to participants at blood cholesterol screening programs is a critical aspect of these efforts to help detect and control high blood cholesterol in the US adult population. In this study, 386 participants who had received two consecutive blood cholesterol measurements above 240 mg/dl (6.21 mmol/l) were interviewed by telephone 3 months after their second measurement (May 1987 - May 1988). Approximately 40% of respondents had seen a physician by the time of the interview; another 30% reported having scheduled an appointment. There was no significant difference in adherence behavior between participants who received a letter reiterating the referral and those who did not. However, participants who received the letter reported greater physician attention to the evaluation and treatment of their high blood cholesterol, primarily because these participants stated that they visited their physician for their high blood cholesterol. Significantly higher rates of further blood tests, cholesterol education material distribution, cholesterol lowering medication prescription and patient-physician discussions about cholesterol were the result. These findings suggest that consumers can be effective in stimulating and reinforcing physician practice behaviors related to cholesterol control. However, strategies must be crafted so that consumers are aware of, and appreciate, the necessity of seeking physician care when they become aware of a high blood cholesterol level. PMID- 10148700 TI - Smoking and pupil attitudes towards school: the implications for health education with young people. Results from the WHO Study of Health Behaviour among Schoolchildren. AB - It has been previously established that young people who have negative attitudes towards school and education are more likely to experiment with cigarette smoking and to become regular smokers. This paper explores this relationship across 10 countries (Austria, Belgium, Finland, Hungary, Israel, Norway, Scotland, Sweden, Switzerland and Wales) using data available from a unique cross-national study of children's health behaviour. The findings show that there is a strong association between regular smoking and alienation from school, which is consistent for both boys and girls in the different cultures and social organizations represented by participating countries. The implications of these findings for designing and managing health education programmes are considered. The importance of providing a supportive school environment and of identifying ways to improve the relevance of school to pupils is emphasized. PMID- 10148701 TI - The implementation of a cardiovascular school health promotion program: utilization and impact of a school health advisory committee: the Heart Smart program. AB - A multidisciplinary school health advisory committee was developed to enhance acceptance and support for a total elementary school cardiovascular health promotion program (Heart Smart). Composed of teachers, school lunch personnel, physical educators and parents, this coalition served as a liaison between the school and project investigators, providing feedback on program acceptability. As an environmental support mechanism to the Heart Smart intervention, the group was additionally charged with designing and implementing adjunct health promotion activities within the school. The interactive nature of this committee, coupled with self-directed goal setting, provides a school model for institutionalizing health promotion, providing school personnel and parents with program ownership, and reinforcing school commitment to heart health. The theoretical and organizational framework used in implementing a health advisory committee is described. PMID- 10148702 TI - Contraceptive behaviour of Norwegian adolescents. AB - This paper describes contraceptive practices among Norwegian adolescents. The data stem from a survey of a random sample of 3000 adolescents aged 17 - 19, yielding a response rate of 60.9%. On the most recent occasion when intercourse took place, every fifth adolescent did not use any contraception; one in three used a condom and approximately 40% reported having used the pill. Multiple logistic regression analysis showed that among both girls and boys non-use of contraception increased with alcohol consumption prior to intercourse. Among girls utilization of contraception was positively associated with educational aspirations whereas non-utilization was associated with number of sexual partners during the previous year. Among both boys and girls condom use declined with increased age, but was positively associated with both increased age at first intercourse and use of a condom at first experience of intercourse. Use of a condom most frequently occurred in relationships which had lasted for a period between 1 week and 6 months. Condom use was not associated with intake of alcohol prior to intercourse. A total of 33.4% of the girls and 43.3% of the boys reported that they had engaged in casual sex. Approximately one in four used a condom on the most recent occasion, whereas approximately four out of 10 did not use any contraception. It is concluded that a substantial proportion of adolescents indulge in high-risk practices both for unwanted pregnancies and sexually transmitted diseases. Moreover, despite the more prominent place given to matters of sexuality in schools and health centres during the last few decades, the proportion of non-users of contraception appear not to have substantially decreased. It is, therefore, clearly important to develop health promotion activities capable of reaching those groups of adolescents who fail to use contraception. PMID- 10148703 TI - Children's attitudes towards activity and perceptions of physical education. AB - The attitudes towards activity (CATPA) and perceptions of physical education of a sample of 291 secondary and 316 primary boys and girls were investigated with respect to health promotion. Using analysis of variance techniques significant differences between boys' and girls' attitudes were found in both the secondary and primary samples. Girls had significantly more positive attitudes towards physical activity than boys, but the data yielded no differences in attitudes between the socio-economic levels. The influence of CATPA scores of the literacy sets variable was significant, but the numeracy sets variable yielded non significant results. This result highlighted the implications of internal school organization for health promotion and children's affective development. MANOVA was used to analyse gender differences in CATPA subdomain scores. Girls from both samples were found to have significantly more positive attitudes than boys in the aesthetic domain. Differences were also found in social growth and vertigo scores. All groups ranked health and fitness objectives highly, with a similar pattern of pupil perceptions of physical education emerging from both samples. PMID- 10148704 TI - A comparison of the consistency of self-reported behavioural change within a study sample--postal versus home interviews. AB - Much health promotion research is directed towards increasing our understanding of the process of health-related behavioural change. However, little is known about the validity of self-reported changes in behaviour. This study aimed to assess the validity of self-reported changes in five behaviours--diet, cigarette smoking, alcohol consumption, weight control and physical activity--by comparing reports obtained from the same people through postal questionnaires and face-to face interviews. It was found that overall there was a consistency between self reports with interviewers confirming that in most cases change had taken place. However, in a large number of cases changes were reported that had occurred before the period specified in the questionnaire. The nature of the change, whether discrete or incremental, as well as the behaviour in question, were found to be related to the accuracy of self-reporting. The possible reasons for the observed discrepancies are discussed. PMID- 10148705 TI - Three-year follow-up of Pawtucket Heart Health's community-based weight loss programs. AB - PURPOSE: The purpose of the study was to evaluate the effectiveness of a community-based weight loss program. DESIGN: A questionnaire was administered by telephone to subjects one to three years following participation in a weight loss program. SETTING: The study took place in Pawtucket, Rhode Island. The Pawtucket Heart Health Program is part of this setting. SUBJECTS: A stratified sample of 400 subjects was randomly selected from 2,186 people who participated in weight loss programs between 1985 and 1987. A total of 285 subjects completed the questionnaire; 229 subjects provided sufficient information to be included in the study. INTERVENTION: The subjects participated in community-based and worksite based weight loss programs. MEASURES: Self-reported heights and weights before and after intervention and demographic data were collected. Desirable body weight and Garrow's health risk classifications were calculated. RESULTS: Overall, there was a 3.2% reduction in body weight between time of entrance into weight loss programs and time of interview. Eighty percent of the participants lost weight in the program; mean weight loss was 11 pounds. At time of follow-up interview one to three years later, 65% of subjects weighed less than at entrance into the community programs; on average, subjects weighed six pounds less. Sixty nine percent of the sample was above 20% desirable body weight at entrance and 26% of this group lost enough weight to lower their health risk category. CONCLUSIONS: Weight loss in this community-based program compares favorably with those reported by more intense and expensive clinic-bound programs.(ABSTRACT TRUNCATED AT 250 WORDS) PMID- 10148706 TI - Factors influencing the adoption and maintenance of Canadian, facility-based worksite health promotion programs. AB - PURPOSE: The purpose of this study was to determine senior management's rationale for adopting and maintaining worksite health promotion programs and the congruence of this rationale with the program objectives of health professionals who manage the programs. DESIGN: A multiple case study design was used. SETTING: Nine major Canadian organizations which had adopted facility-based health promotion programs were the settings for this study. DATA COLLECTION: Semi structured interviews (22 conducted) and two questionnaires (36 completed) were the methods used to collect data. RESPONDENTS: Senior managers involved in program adoption, senior managers responsible for program budgets, and senior health professionals responded to the interviews and questionnaires. RESULTS: Impetus for health promotion program adoption in the organizations we studied had more to do with tangential issues such as an organization moving to a new facility or having access to unused space than with employee health or organizational performance considerations. The most common program adoption rationale was related to employee recruitment/retention. Program continuance was based on process issues such as participation rates and the quality of activity offerings rather than on health or organizational outcomes. While health professionals and senior management both considered human relations and morale more important than cost savings outcomes, health professionals considered cost savings outcomes more important than did senior management. CONCLUSIONS: It is important for health promotion professionals to develop program objectives which are shared by organizational management. Future program adoptions and maintenance will be influenced by closer analyses of the effect of these programs on organizational performance. PMID- 10148707 TI - Cardiovascular health among Asian Americans/Pacific Islanders: an examination of health status and intervention approaches. AB - PURPOSE OF THE REVIEW. The purpose of this review is to examine the cardiovascular health status of Asian Americans/Pacific Islanders by primary risk factor and review current intervention approaches targeting this population. Asian Americans/Pacific Islanders in the United States have experienced triple digit percentage increases in population for every decade since 1970. Despite their rapidly increasing numbers, little is known about their cardiovascular health status. SEARCH METHODS USED. This article reviews the literature on the demographics, mortality, and prevalence of major cardiovascular risk factors among Asian Americans/Pacific Islanders. Selected intervention programs are also described. SUMMARY OF IMPORTANT FINDINGS. Data on cardiovascular disease mortality for Asian Americans/Pacific Islanders are relatively limited because few states collect ethnically specific mortality statistics. Data on cardiovascular risk factors, particularly smoking and hypertension, for certain Asian American/Pacific Islander groups portend excessive cardiovascular disease burdens. MAJOR CONCLUSIONS. Data specific to ethnic groups comprising Asian Americans and Pacific Islanders need to be called. Also, scientifically valid and linguistically appropriate interventions approved by ethnic community leaders are needed to address Asian Americans/Pacific Islanders. PMID- 10148708 TI - A critique of contemporary community health promotion approaches: based on a qualitative review of six programs in Maine. AB - PURPOSE: This article reports on a process evaluation of three Planned Approach to Community Health (PATCH) projects and three Community Chronic Disease Prevention Programs (CCDPP) that operated in the State of Maine. PATCH and CCDPP are similar approaches to community health promotion developed and disseminated by the Centers for Disease Control. The evaluators studied how the Planned Approach to Community Health and the Community Chronic Disease Prevention Program models worked as community health strategies across the six field sites. RESEARCH METHODS USED: Qualitative methods were used in a cross-case comparison of the six field sites. In studying each site, the evaluators focused on six stages common to both the Planned Approach to Community Health and the Community Chronic Disease Prevention program models: Stage 1: conducting a community needs assessment; Stage 2: analyzing needs assessment data; Stage 3: setting priorities for the project based on the data; Stage 4: implementing activities; Stage 5: producing process outcomes; and Stage 6: institutionalizing the project. The analysis focused on how each of the six communities traversed these stages. SUMMARY OF FINDINGS: Eight recommendations for refining Planned Approach to Community Health and Community Chronic Disease Prevention strategies resulted from the study: 1) do a community capacity assessment prior to initiating a community needs assessment; 2) do not overly rely on Behavioral Risk Factor Surveys; 3) analyze needs assessment data rapidly for community consumption; 4) allow flexibility and community input in determining priority health objectives; 5) provide technical assistance throughout a project, not just in the beginning; 6) fund at least one full-time local coordinator and extensive capacity building; 7) emphasize multiple interventions around one chronic condition at a time; and 8) emphasize program institutionalization. CONCLUSIONS: Community development approaches like Planned Approach to Community Health and Community Chronic Disease Prevention are promising health promotion strategies. To be optimally effective, however, these strategies need refinement based on systematic study in field settings. Because this study was limited to six sites in Maine, some of these findings may have limited generalizability. PMID- 10148709 TI - Evaluation of a community bicycle helmet promotion campaign: what works and why. AB - PURPOSE: This study identifies effective components of a bicycle helmet promotion campaign, and mechanisms by which these components affect child helmet ownership. DESIGN: A random telephone survey identified parents whose children did not own helmets prior to an educational campaign. A follow-up survey was conducted six months later. Regression analysis estimated the effects of four campaign components on child helmet ownership and tested for mediation by cognitive variables. SETTING: Study participants were residents of a suburban community which undertook a citywide educational campaign to increase child helmet ownership. SUBJECTS: Subjects were 210 parents with at least one school-aged child, none of whom owned helmets. INTERVENTION: A multicomponent campaign was implemented by a community coalition. In addition, random subsamples of the study participants received direct mail or direct telephone communications. RESULTS: Of the eligible respondents identified in the baseline sample, 39% completed the follow-up survey. Regression analysis showed that children whose parents received either helmet advice from a physician or direct telephone communications were 2.6 and 2.2 times more likely, respectively, to own helmets as children whose parents did not experience similar communication. Parental worry mediated the association, but parental beliefs about the effectiveness of helmets did not. CONCLUSION: Future helmet campaigns should use interpersonal strategies to increase parental worry about their children being involved in a bicycle accident. Generalization of these findings is limited by the high socioeconomic status of the study participants, and by the outcome measure, which is helmet ownership, not helmet use. PMID- 10148710 TI - The impact of a comprehensive medical benefit cost management program for the city of Birmingham: results at five years. AB - Double digit annual increases in the cost of medical benefits represent one of the major financial challenges for many private and public sector employers. Gaining greater control is a top priority. Since the procurement, administration, and delivery of employee/dependent medical care is a highly complex venture, it is unlikely that any one activity will contain costs effectively. This report examines a comprehensive cost management effort for the municipal government of the city of Birmingham, Alabama, which included health promotion, medical plan redesigning, managed care, and "how to use the medical system" education programs. The $3 million project was funded by the National Institutes of Health and the employer and conducted from 1985 to 1990. In 1985, medical benefits expenses for the 3,586 employees were $2,047 per employee which was about $400 above the state of Alabama per employee average. In 1990, for 4,000 employees, it was $2,075 which was $922 below the state average. While the project design does not permit a precise evaluation of the exact impact of each of the cost containment activities, attempts are made to estimate their impact. Several health promotion activities, which may be unique to this project, including the all-employee medical screen, are presented and evaluated. PMID- 10148711 TI - A review of the association between abdominal fat distribution, health outcome measures, and modifiable risk factors. AB - PURPOSE OF THE REVIEW. This review of the literature examines the relationship between abdominal fat distribution and specific health outcome measures, modifiable risk factors, the impact of intervention efforts, and the significance of measurement methods. SEARCH METHODS USED. The research material that was received was found through several on-line data bases, including MEDLINE and CINAHL, an examination of references from selected articles, a manual review of recent relevant journals, and interviews with several physicians and epidemiologists who are experts in this field of inquiry. Forty-three research articles were reviewed for the section on health risk outcomes and abdominal fat distribution. Twenty studies were reviewed in the section on modifiable variables associated with fat distribution. Finally, 10 studies which examined the effect of behavior change on fat distribution were included in this review. SUMMARY OF IMPORTANT FINDINGS. Recent research indicates that people whose body fat is deposited more in the central or abdominal area, especially the intra abdominal area, than it is in the gluteofemoral area are at increased risk for cardiovascular disease. This risk is independent of, but exacerbated by, the degree of obesity. Several nonmodifiable factors such as age, gender, and menopause as well as some modifiable factors such as obesity, smoking, physical inactivity, and alcohol intake are positively associated with abdominal fat deposition. MAJOR CONCLUSIONS. Intervention results indicate that it is possible to decrease abdominal fat with total weight loss or smoking cessation. PMID- 10148712 TI - Behavioral risk factor and illness day changes with workplace health promotion: two-year results. AB - PURPOSE: The impact of a workplace health promotion program was evaluated to determine changes in the number and level of seven behavioral risks and self reported illness days. DESIGN: The study employed a pretest/posttest intervention group (N=7,178) with a two-year follow-up and a time-lagged, nonequivalent comparison group (N=7,101). SETTING: The study population was drawn from a large manufacturing company with more than 100 United States locations. SUBJECTS: Approximately one half of the study population was 40 years of age or older, 75% were males, 90% were white, and about 40% were hourly manufacturing employees. INTERVENTION: The program consisted of 1) training and support of coordinators; 2) health risk appraisals; 3) on-site classes, safety meetings, and self-help options; 4) environmental changes, e.g., smoking policy, cafeteria offerings, and blood pressure machines; and 5) recognition. MEASURES: A 38-item health appraisal included self-report of illness days and behavioral risks, as well as information from company physical examinations. RESULTS: Both the number and the level of behavioral risk factors improved over two years. The proportion of employees with three or more risk factors decreased by 14% (p less than .001). The number of self-reported illness days in this group decreased by 12% during the same period (p less than .001). No change in illness days was observed in the group with fewer than three risk factors. Risk levels improved (range = 4.5% to 79%) for six of seven factors among high-risk individuals. CONCLUSIONS: (ABSTRACT TRUNCATED AT 250 WORDS) PMID- 10148713 TI - The impact of participation in health promotion on medical costs: a reconsideration of the Blue Cross and Blue Shield of Indiana study. AB - PURPOSE: The purpose of this study was to investigate whether participation in a comprehensive worksite health promotion program was associated with reduced employee health care costs. DESIGN: Four independent study groups, two treatment and two comparison, were identified based on type and date of first participation in the intervention. Two years of pre-program health cost data and five years of post-program data were collected for each subject. The Jonckheere-Terpstra statistical test was used to analyze the data. SETTING: The health promotion program was offered at Blue Cross and Blue Shield of Indiana corporate headquarters. The study period began on January 1, 1976, and continued through December 31, 1982. SUBJECTS: Seven hundred and forty-three men and women employed continuously by Blue Cross and Blue Shield of Indiana throughout a seven-year period were studied. INTERVENTION: The health promotion program consisted of four progressive phases which involved 1) health risk reduction mass education, 2) completion of a health risk appraisal and risk reduction counseling, 3) health promotion classes such as smoking cessation and nutrition education, and 4) follow-up and maintenance. MEASURES: The principal dependent variable was pre program to post-program changes in health costs as measured by employee health care expense claims paid for by the company's health insurance plan. RESULTS: This study found that program participation was not associated with reduced health care costs. CONCLUSIONS: It would be prudent to remain guarded about the health cost savings effects of worksite health promotion programs. PMID- 10148714 TI - Compliance with worksite nonsmoking policies: baseline results from the COMMIT study of worksites. AB - PURPOSE: Little is known about compliance with worksite nonsmoking policies. This study provides an examination of the relationship of policy compliance to characteristics of the organization and the manner in which the policy was implemented. DESIGN: Data came from two separate surveys of 1) representatives of worksites that reported having a nonsmoking policy and 2) employed residents from the same communities whose worksites had nonsmoking policies. SETTING: This study was conducted as part of the Community Intervention Trial for Smoking Cessation (COMMIT), being conducted in 11 diverse intervention communities. SUBJECTS: Data are presented from surveys of 710 worksites (response rate = 90%) and 3,143 employed residents (response rate = 80%) of the same communities. MEASURES: Compliance with nonsmoking policies was measured by self-report in both surveys and is compared with worksite and respondent characteristics, type of policy, and methods of policy implementation. RESULTS: Compliance with nonsmoking policies was high; 55% of worksites with a policy restricting smoking reported that employees always adhered to the policy. Compliance was highest in worksites with more restrictive policies and where labor-management relations were reported to be good. Compliance also was high where the policy was effectively communicated to workers, as through worksite distribution channels, the absence of cigarette vending machines, and the availability of cessation assistance. CONCLUSIONS: These findings indicate that compliance with worksite nonsmoking policies is generally high, especially in the presence of more stringent policies. PMID- 10148715 TI - Community activation and health promotion: identification of key organizations. AB - PURPOSE: The purpose of this study is to identify the kinds of community organizations community leaders consider important for community health promotion efforts. DESIGN: Key informants were identified by reputational sampling of organizations relevant to community health promotion. Key informants were asked to list organizations they considered important for community health promotion. Differences in identified organizations were compared across informants from seven urban, five suburban, seven rural, and three Native American communities, with significance evaluated by chi-square tests. SETTING: This survey was conducted in 22 Western U.S. communities comprising the intervention and control communities of the Community Health Promotion Grants Program of the Henry J. Kaiser Family Foundation. SUBJECTS: Key informants (N = 184) from community organizations, identified using a reputational sampling technique beginning with the health department, were interviewed by telephone. MEASURES: Key informants listed organizations considered important for community health promotion in five areas: adolescent pregnancy, substance abuse, tobacco use, cancer, and cardiovascular disease. RESULTS: Informants frequently identified the health department (mentioned by 78% of informants overall), schools (72%), governmental agencies (55%), hospitals (47%), health clinics (42%), churches (33%), and newspapers (32%) as important. Organizations more prominent in urban and suburban areas than in rural and Native American areas included television stations, health-related private nonprofit organizations, substance abuse treatment centers, and colleges. Private physicians were frequently identified in rural areas (44% of informants).(ABSTRACT TRUNCATED AT 250 WORDS) PMID- 10148716 TI - Risk-rated health insurance programs: a review of designs and important issues. AB - PURPOSE OF THE REVIEW. The purpose of this review is to assist those who work in the field of health promotion when considering the implementation of an individually risk-rated health insurance plan. It does so by introducing the reader to the concept of individually risk-rating health insurance; uncritically reviewing selected risk-rated health insurance plans; and exploring several issues related to plan implementation, administration, and appropriateness. SEARCH METHODS USED. The review is based on the authors' awareness of the literature in the fields of preventive medicine, health promotion, and employee benefits. The six individually risk-rated health insurance programs that are reviewed were chosen because they demonstrate how aspects of the National Association of Insurance Commissioners' Model have been implemented using various combinations of administrative procedures, verification strategies, and types of economic incentives or disincentives. This review is not intended to be a comprehensive review of the literature. SUMMARY OF IMPORTANT FINDINGS. Individually risk-rated health insurance programs have been established using a variety of administrative procedures, verification strategies, and types of economic incentives or disincentives. The frequency with which these programs are being established is increasing. As the number of risk-rated programs grows, it will be increasingly important to address the many issues that implementing such plans generate: How should lifestyle behaviors be verified? Will healthy lifestyles save money? Can employees fully control their risk factors? Is risk rating socially responsible? MAJOR CONCLUSIONS. As risk-rating becomes more widespread, there will be a continuing need to address the business, medical, ethical, and legal issues these programs create and to refine them accordingly. The health promotion community has both an opportunity and obligation to see to it that individually risk-rated health insurance programs are implemented in a socially acceptable manner and that the outcomes they generate are cost beneficial. PMID- 10148717 TI - LIFECHECK: a successful, low touch, low tech, in-plant, cardiovascular disease risk identification and modification program. AB - LIFECHECK, a voluntary, in-plant cardiovascular risk identification and modification program, was developed to complement Coors Wellness Center-based programs. LIFECHECK was offered to the 1,320 employees located at the Coors Engineering Center and Can Manufacturing Complex at the Coors Brewing Company. The initial 30-minute screening included height, weight, blood pressure, cholesterol, smoking history, weekly Kcal expenditure, self-rating of health, and health effects of stress. Participants concluded the screening session with a wellness counselor who reviewed results and referred them to the appropriate intervention activities. The eight-week intervention was provided at the worksite and was available to all shifts. The intervention included an activity competition and activity classes; nutrition, hypertension, smoking, and lipid classes; a smoke-out day; one-on-one counseling; exercise equipment at four worksites; posters; traymats; table tents; and electronic messages. A total of 692 employees, 52% of those eligible, participated in the initial screening. Of these, 91% had one or more risk factors, and 33% had three to five cardiovascular disease risk factors. A total of 499 employees, 72% of those eligible, completed the follow-up screening. Thirty-two percent of the employees who participated in LIFECHECK had not used the Wellness Center in the eight years it had been open. There were significant changes in employees who completed the eight-week program for systolic blood pressure, total cholesterol, weight, physical activity, and risk of ischemic heart disease within eight years as measured by the Framingham score (p less than 0.05).(ABSTRACT TRUNCATED AT 250 WORDS) PMID- 10148718 TI - A comparison of participants and nonparticipants in a worksite cholesterol screening. AB - PURPOSE: The purpose of this study is to determine if worksite cholesterol screening reaches only those who are already aware of their cholesterol and interested in lifestyle modification. DESIGN: A voluntary worksite cholesterol screening was conducted followed by a survey of a random sample of nonparticipants. SETTING: A large university worksite was the setting for this study. SUBJECTS: Out of 9,137 university employees, 1,583 attended the voluntary screening, and a random sample of nonparticipants was obtained (n = 154), of which 87% (n = 138) responded. MEASURES: Subjects completed a questionnaire on health behaviors, perceived risk, self-efficacy for diet change, and attention to media messages. A capillary blood cholesterol level was also taken. RESULTS: Nonparticipants were more likely to be male (64% versus 39%) and smokers (17% versus 9%), more likely to exercise, to have had a prior cholesterol measurement (64% versus 49%), and to "know" their cholesterol value (56% versus 26%). The two groups were otherwise similar. Over half (51%) of the participants were receiving their first cholesterol measurement. These subjects were younger, less educated, had less perceived risk, were less attentive to media messages, and more likely to be from a minority group than those individuals who had prior measurements. DISCUSSION: These findings suggest that worksite cholesterol screening does not only reach those already aware of their cholesterols, but also can reach some persons not previously screened or concerned. PMID- 10148719 TI - Exercise, lipids, and obesity in adolescents with parental history of coronary disease. AB - PURPOSE: The purpose of this study is to determine 1) if adolescents of parents with clinically manifest premature coronary artery disease (CAD) are less physically fit and habitually active, and have less favorable lipid profiles and more obesity than children of nonaffected parents, and 2) if aerobic fitness and activity are related to obesity and lipids in adolescents. SETTING: Patients were identified in the Coronary Care Unit or out-patient clinic. Adolescents were evaluated in the cardiovascular laboratories at the Francis Scott Key Medical Center. DESIGN: Comparisons between groups were tested with ANOVA: Univariate and multivariate regression were used to assess relationships among study variables. SUBJECTS: Thirty-six children of affected parents, ages 12 to 19 years, and 29 comparison subjects participated in the study. MEASURES: Fitness was determined by treadmill testing, fasting blood was analyzed for lipoprotein lipids, habitual physical activity was measured by self-report, and the sum of six skinfolds was used to calculate obesity. RESULTS: Total and LDL cholesterol were higher in girls with a parental history of CAD. The sample size was too small to draw any definitive conclusions about differences, based on parental history in lipids or fitness in the boys, or obesity in both genders. Overall, joggers were more fit and less fat than nonjoggers. Girls playing organized sports were more fit and less fat than nonparticipants. Aerobic fitness correlated negatively with obesity in both genders; fitness was independently associated with HDL cholesterol only in the boys. CONCLUSION: (ABSTRACT TRUNCATED AT 250 WORDS) PMID- 10148720 TI - Relationship between serum cholesterol levels and television viewing in 11,947 employed adults. AB - PURPOSE: The purpose of this study was to determine the prevalence of hypercholesterolemia among high-, moderate-, and low-duration television viewers. The confounding effects of age, gender, income, body fat percentage, weekly exercise duration, and smoking were also examined. DESIGN: A cross-sectional or correlational design was employed. Cochran-Mantel-Haenszel odds ratios were used to estimate risk of the television viewers regarding hypercholesterolemia. SETTING: Participants were employees of over 55 corporations that had their employees screened as part of the ongoing risk-management program of Health Advancement Services (HAS), Inc. SUBJECTS: Subjects were 11,947 employed adults. About 85% of the subjects eligible for participation completed the screenings and were used in the study. MEASURES: Serum cholesterol was assessed in a certified lab, and lifestyle information, including television viewing habits, was collected via a written questionnaire. Body fat was measured using skinfolds from three body sites. RESULTS: High-duration television viewers were almost two times more likely to suffer from hypercholesterolemia as infrequent viewers, with and without control of multiple confounding factors. Moderate-duration viewers were at 1.5 times the risk of hypercholesterolemia compared to infrequent viewers. Neither television group was at greater risk of moderately elevated cholesterol levels (200-239) compared to the infrequent viewers with all of the potential confounders controlled. CONCLUSIONS: Cause-and-effect conclusions are not warranted; however, this study coupled with other investigations shows that excessive television viewing may be an important lifestyle factor linked to decreased health and functioning. PMID- 10148721 TI - Employee advisory boards as a vehicle for organizing worksite health promotion programs. AB - PURPOSE: The purpose of this article is to describe the "employee advisory board model" applied in the Treatwell program, a worksite nutrition intervention program. DESIGN: The employee advisory boards of five of the seven intervention worksites participating in the Treatwell program were surveyed. Results were compared with results of employee surveys conducted in these five worksites. SETTING: The five worksites included in this study are among 16 participating worksites from Massachusetts and Rhode Island. SUBJECTS: Of the 95 board members represented in the five worksites, 88% responded to the survey. This article also presents results from the 698 respondents of the five intervention worksites where the board surveys were conducted. INTERVENTION: The boards in each worksite participated in planning, promoting, and implementing this program in each worksite. MEASURES: Respondents to the board survey were asked about their participation on and satisfaction with the board and factors they thought contributed to its effectiveness. A survey of all employees included information on demographics and program participation. RESULTS: Board members reported that they were highly satisfied with the board's functioning. Board member hours spent on Treatwell activities were directly related to the proportion of employees aware of the program. (r = .82). The boards' effectiveness was limited by conflicting priorities between the job and board responsibilities. CONCLUSION: The employee advisory board model provides promise for increasing worker awareness of worksite health promotion programs through enhanced worker ownership. PMID- 10148722 TI - From research to public policy: the prevention of motor vehicle injuries, childhood drownings, and firearm violence. AB - PURPOSE: The purpose of this article is to review the development of the modern sciences of injury epidemiology and injury prevention and to illustrate the use of applied research in formulating effective public policy. SEARCH METHODS: MEDLINE searches were conducted from 1966 to 1990, and bibliographies of articles thus obtained were reviewed. Fugitive sources were identified by multiple means. MAJOR FINDINGS: Motor vehicle fatality rates on a per mile driven basis have been reduced by 50% over the past 25 years, largely through attention to the road environment and design of motor vehicles. Passive restraint systems such as air bags promise further reductions. Drowning has emerged as a leading cause of death among young children. Complete pool fencing is expected to prevent many of these events. Firearm violence, particularly among young people, is rapidly increasing. Firearms are hazardous consumer products but are not addressed as such by our current regulatory structure and intervention agenda. CONCLUSIONS: Epidemiologic and other applied research can make important contributions to the development of public policies designed to prevent injury. Such policies often address the design and performance of hazardous products and environments and consider individual behavior change as only a secondary objective. PMID- 10148723 TI - The Swedish study circle--possibilities for application to health education in the United States. AB - There has been a growing recognition over the past decade of the need to broaden the focus of health promotion by placing greater emphasis on the social context in which individual behavior change interventions occur. As a result, health educators are being required to look for innovative pedagogical methods to address this broader focus. A model of education that is used extensively in Sweden and that takes a broader approach to health matters is the study circle. Because of its simple, flexible structure and its capacity to address lifestyle as well as social and environmental factors, the study circle could serve as a model for health education efforts undertaken in the United States. The first part of this article presents an overview of the literature from the field of public health that calls for a broader concept of health promotion. The second part of the article looks at the principles and concepts of the study circle. The role of the study circle in health promotion is discussed and use of the method is illustrated in three different case examples. In addition, possibilities for application of the model to health education in the United States are also addressed. PMID- 10148724 TI - Young people learning about AIDS: a study of beliefs and information sources. AB - A study of the views of Scottish teenagers and undergraduates on health education issues relevant to human immunodeficiency virus (HIV) spread is reported. A sample of 1008 young people (690 teenagers and 318 students) returned a postal questionnaire designed to measure a range of relevant cognitions. These included levels of concern, perceived knowledge, perceived vulnerability, perceived seriousness, recall of health education campaigns, preferred information sources and views on the discussion of HIV/AIDS with significant others. Low levels of perceived vulnerability, high levels of recall for national campaigns, and discrepancies between used and credible sources of information are reported. Cohort and gender differences and correspondences with American and Australian studies are discussed. The implications of these findings for future AIDS education campaigns are also considered. PMID- 10148725 TI - Ethnic and gender differences in Southwestern students' sources of information about health. AB - Students from several rural, Southwestern schools rated family, television, teachers and doctors as the most important of 11 sources of information about various health topics. However, doctors were only the fifth-ranked source of information about sex and reproduction and the seventh-ranked source of information about drugs, with friends being the fourth- and third-ranked sources of information about these two more personal and sensitive topics. American Indians reported even stronger reliance on doctors than did Hispanic and Anglo students, and rated clinic nurses as much more important sources of health information than did the other two ethnic groups. Females showed greater reliance on social sources and less on electronic media than did male students, and high school students relied more on print media and less on television, nurses and family than did younger children. Students felt more knowledgeable about smoking, alcohol and exercise than about diet, the heart-blood system and cancer; however, American Indians felt less informed about smoking and alcohol than did Anglos or Hispanics. These findings (especially when compared to previous results) suggest that effective health education programs must be tailored to particular populations and based on specific knowledge of their attitudes, behavior and environment. PMID- 10148726 TI - "Pssst . . . the really useful guide to alcohol": evaluation of an alcohol education television series. AB - The paper reports on the effectiveness of a six-part television series ("Pssst . . . the really useful guide to alcohol") in changing viewers' knowledge and alcohol-related behaviours and attitudes. Comparisons between viewers and matched controls indicated significant increases in knowledge relating to alcohol. No changes in attitudes were found, although some behavioural change was indicated. These results are discussed in the context of wider-ranging alcohol-related health promotion initiatives. PMID- 10148727 TI - Predictors of attempting and succeeding at smoking cessation. AB - This paper presents results of a prospective study which examined factors influencing self-initiated smoking behavior change in a cohort of smokers followed over 17 months. Employees of a cancer hospital and research center were surveyed about smoking habits, health status, attitudes about smoking and social environmental factors. Seventeen months later, employees identified as smokers were resurveyed about their current smoking status, recent attempts at cessation and use of cessation aids in these attempts. Overall, 47% of subjects had not tried to stop smoking (non-stoppers, NS), 38% had attempted to quit but returned to smoking (recidivists, R) and 15% had successfully quit (SQ). Predictors of attempting cessation (R and SQ versus NS) included smoking fewer cigarettes daily, starting smoking at a later age, previous attempts at quitting, lower nicotine dependence, greater pressure to stop smoking and an expectation to quit in the near future. Amount smoked daily was the strongest predictor of successful quitting (SQ versus R). Findings from this study suggest intention to stop smoking is the most important factor differentiating smokers who attempt cessation from those who do not. Strength of smoking habit appears to be the strongest factor associated with successful quitting. PMID- 10148728 TI - Providing an integrated program of low intensity tobacco cessation services in a health maintenance organization. AB - This paper reports on the development, promotion and use of a coordinated program of low intensity intervention services designed to appeal to smokers (and smokeless tobacco users) at various stages of change. An initial package of four components: a telephone advice line, self-help materials, single session group meetings and bi-monthly newsletter was offered to subjects in a variety of different settings (outpatient clinics, dental offices, worksites, hospitals) within a health maintenance (HMO) program project. Based upon consumer response and formative evaluations, these components were modified during the course of the year-long intervention. Results revealed differences in use of the various components of the program, with greatest use of self-help materials (manuals, 'tobacco substitutes' and a computerized smoking cessation aid) and least response to group meetings and the advice line. Most encouraging was the finding that it was possible to reach heavy smokers and to engage them in tobacco cessation activities through a centralized program of low intensity services. Data are presented on member characteristics associated with use/non-use of the various low intensity resources and suggestions are made for wider use of such interventions in other health care systems. PMID- 10148729 TI - The role of general medical practitioners in tobacco control programmes: a study in Bombay, India. PMID- 10148730 TI - From complacency to panic: AIDS and heterosexuals in the Australian press, July 1986 to June 1988. AB - AIDS is a disease which has received a great deal of attention from the popular media, which in turn has attracted the interests of those who analyse media. The health information conveyed to the general public by the popular press is a topic of special interest to health educators. This paper documents the Australian press' coverage of the AIDS threat to heterosexuals. The preliminary findings of a content analysis of all Australian articles mentioning AIDS published between June 1986 and July 1988 is reported. An overview of the issues gaining most attention in the press during that time is given and major narrative themes discussed. It is shown that the focus of the popular press' reporting of AIDS changed in that time from representing AIDS as a risk to only homosexuals and intravenous drug users, to generating panic-stricken articles suggesting that everyone was now threatened. The press generally lent their support to a major public health information campaign designed to warn heterosexuals of their risk of contracting AIDS (the 'Grim Reaper' campaign), although many articles exaggerated the threat and disseminated confusing information about the risk. Health educators need to have a good knowledge of press accounts of health issues, and be aware of the potential for support or conflicting information in the press both of health education campaigns and of the health issue itself. PMID- 10148731 TI - Inter-organizational responses to AIDS: a case study of the Worcester AIDS Consortium. AB - This case study focuses on development and community coordination of AIDS-related services and on coalition building. Its subject is the Worcester (Massachusetts) AIDS Consortium. The objectives are to: (1) describe the environmental conditions and pre-existing networks which facilitated the formation of the Worcester AIDS Consortium; (2) articulate processes which occurred during the formative, organizational and operational phases of the Worcester AIDS Consortium's development; (3) explore social and community goals and Consortium activities; and (4) document Consortium accomplishments. Data were collected through key informant interviews and review of archival materials. Information about the Worcester AIDS Consortium experience is compared with concepts and principles suggested by organizational theories and frameworks. PMID- 10148732 TI - Sexual knowledge, attitudes, fears and behaviors of adolescents in Finland (the KISS study). AB - In 1986 and 1988, a structured questionnaire on sexual knowledge, attitudes, fears and behaviors was administered to 13, 15 and 17 year olds in Finnish public schools; 5289 (88% response rate) responses were recorded. With the exception of a few small differences in attitudes, no significant regional differences were recorded--suggesting that the results are representative of all Finnish adolescents. Except for 13 year olds, knowledge level was satisfactory. With increasing age, most attitudes showed increasing tolerance towards sexual matters and liberalism. Although several fears increased, AIDS was not perceived as an exceptionally great personal danger. By comparison with data from surveys 20 years previously, the age of first experience of sexual intercourse was lower- especially among women. About a third of the adolescents surveyed used no birth control and about 60% used a condom. Implications for educational policy and planning are discussed. PMID- 10148733 TI - Nicotine gum assisted group therapy in smokers with an increased risk of coronary disease--evaluation in a primary care setting format. AB - Smoking cessation with the aid of nicotine chewing gum in a primary care setting format is reported to be more effective when additional behavioural training is introduced. We developed a standardized comprehensive treatment programme using nicotine chewing gum (Nicorette 2 mg) in conjunction with nutritional information for the prevention of weight gain, behavioural training for the promotion of self management techniques and the prescription of a date when to quit. The programme was conducted by 11 family physicians in a group setting format with 12 weekly 90 min sessions and three booster sessions. After an introduction to the programme, each physician selected smokers with additional risk factors for coronary heart disease from the files. Experimental and control subjects were matched for age, gender, cigarette consumption and duration since smoking onset. Complete data were obtained from 86 treated and 53 control subjects. The drop-out rate among the treated subjects was 5.8%. After the 3 month follow-up, data assessment shows an abstinence rate of 63.9% in the experimental subjects, a fact verified by CO measurements. Compared to the control group, blood pressure, heart rate, cholesterol and glucose levels did not change significantly during treatment. Weight increased by 1.7 kg. After a 12 month follow-up, abstention rates decreased to 52.3%. Abstainers reported less physical complaints and increased well-being when compared to control subjects or to treatment failures at both follow-up assessments. Changes in the risk profile, apart from smoking, were not verified. PMID- 10148734 TI - An application of the stage model of behavior change to dietary fat reduction. AB - To assess the applicability of Prochaska and DiClemente's stage model to dietary change, stage of dietary fat reduction was assessed in two samples of adults. Results were consistent across the two samples. Males and females differed in their distribution across five stages of change, with more males than females in a precontemplation stage and more females than males in a maintenance stage. Significant positive correlates with stage for men and women were age, education, body mass index, number of chronic conditions and being told one has a high serum cholesterol. For both genders, stage of dietary fat reduction was significantly associated with percent of calories from fat, even when controlling for demographic and health status covariates. PMID- 10148735 TI - A meta-analysis of studies of the Health Belief Model with adults. AB - The Health Belief Model (HBM) relates a socio-psychologic theory of decision making to individual health-related behaviors. We conducted a meta-analysis of the relationships between four HBM dimensions (Susceptibility, Severity, Benefits and Costs) and health behavior on 16 studies that measured all four of the dimensions, measured a behavioral dependent variable and included some measures of reliability, minimal criteria for establishing the validity of the dimensions. Mean effect sizes were computed for all the studies, subgroupings representing studies of screening, risk reduction and adherence to medical regimen, and prospective and retrospective study designs. Of 24 mean effect sizes, 22 were found to be positive and statistically significant. The actual variance accounted for ranged from 0.001 to 0.09. Homogeneity was rejected for 15 of the 22, however, suggesting that the same underlying construct was not measured. Retrospective studies were found to have significantly large effect sizes for benefits and costs and smaller effect sizes for severity when compared to prospective studies. The weak effect sizes and lack of homogeneity indicate that it is premature to draw conclusions about the predictive validity of the HBM as operationalized in these studies. Our finding of only 16 studies meeting minimal criteria for valid representation of the HBM dimensions indicates that future studies should focus more on such issues. PMID- 10148736 TI - Patterns of information transfer in health education: a bibliometric analysis of the research literature. AB - The purpose of this study is to examine the extent to which health education has become a distinctly separate field of inquiry as evidenced by the patterns of information transfer in the health education research literature. Bibliometric analysis is used to determine: (1) if health education has an identifiable core of journals, (2) the extent to which health education research is derivative of research from other disciplines and (3) the extent to which research from other disciplines draws upon research published in health education journals. The results suggest that there is an identifiable core of journals that serve to characterize health education as a distinct field of inquiry. However, health education research is found to be more derivative of research from other fields than are the other comparative fields in the sample. Moreover, researchers in other disciplines use health education research less than half as often as health education uses its own research. Differences in citing patterns in journals dedicated to health education and by researchers publishing on health education topics in research journals of other areas seem to indicate that health education research is not one unified undertaking. PMID- 10148737 TI - Evaluation of implementation of a cholesterol management program in physicians' offices. AB - This article describes an evaluation of the implementation of a cholesterol management program in family physicians' offices as part of the Physician-Based Nutrition Program to Lower Coronary Heart Disease Risk (PBNP). The evaluation, conducted through a partnership evaluation model, used multiple case study methodology and combined the use of quantitative and qualitative methods. Data sources included office staff reports and interviews, records of contacts with study personnel, patient care data, and patient telephone interviews. Data from these sources revealed gradual program implementation and considerable variation in practitioner and clinic involvement in cholesterol management. Clinic staff reported that the support provided by PBNP in the form of training, operations materials, patient education materials and ongoing assistance was very useful. This formative evaluation has implications for refinement of the PBNP and for other prevention programs in primary care settings. It demonstrates the feasibility and acceptability of a systems approach to physicians, cholesterol/nutrition educators and clinic support staff. It also suggests ways in which researchers and clinicians can implement and evaluate health care innovations. PMID- 10148738 TI - The effects of self-reinforcement and peer-reinforcement on the practice of breast self-examination. AB - Four months after learning breast self-examination (BSE), 169 sorority women assigned to one of three conditions (No Reinforcement, Self-Reinforcement or Peer Reinforcement) were compared on BSE frequency subsequent to the training. Participants in both of the reinforcement conditions had agreed to a specified reward after each month's BSE, which was either self-delivered (Self Reinforcement condition) or delivered by a partner (Peer-Reinforcement condition). Analysis of covariance revealed a significant difference among conditions and a Newman-Keuls test demonstrated that participants in both reinforcement conditions reported more months of BSE than those in the No Reinforcement condition. Furthermore, anxiety during BSE training was negatively correlated with BSE during the follow-up period. These results suggest that BSE, like other behaviors, is influenced by perceived support or rewards and by anxiety, and that BSE intervention programs should be designed with these findings in mind. PMID- 10148739 TI - Social surveys in HIV/AIDS: telling or writing? A comparison of interview and postal methods. AB - We compare a probability sample postal questionnaire survey and a quota controlled interview survey, and review the literature on these subjects. In contrast to other studies, where quota samples were not representative because of biased selection of respondents by interviewers, our quota sample was representative. Response rates were similar in our postal and interview surveys (74 and 77%, respectively), although many previous similar postal surveys had poor response rates. As in other comparison studies, costs were higher in our interview survey, substantive responses and the quality of responses to closed ended questions were similar, and responses to open-ended questions were better in the interview survey. 'Socially unacceptable' responses on sexual behaviour were less likely in interviews. Quota controlled surveys are appropriate in surveys on HIV/AIDS under certain circumstances, e.g. where the population parameters are well known, and where interviewers can gain access to the entire population. Postal questionnaires are better for obtaining information on sexual behaviour, if adequate steps are taken to improve response rates, and when in depth answers are not needed. For most surveys in the HIV/AIDS field we recommend the postal method. PMID- 10148740 TI - Perceived morbidity as a determinant of health behavior. AB - It is hypothesized that perceived morbidity, a concept closely related to perceived vulnerability, is an important determinant of health behaviors. In this cross-sectional study (N = 2740), perceived morbidity was conceptualized as a categorical variable defining six distinct morbidity groups: the hypertension, high cholesterol, angina pectoris, heart attack, stroke and 'morbidity-free' groups. We used analyses of covariance to identify differences in health behaviors between the six groups; the analyses were done separately for middle aged (40-60 years old) and older ( greater than 60 years old) respondents. Results show that perceived morbidity had a significant effect on fat consumption (P less than 0.001) and on physical activity (P < 0.01). In both age ranges, the morbidity-free group had the highest fat consumption; among the middle-aged respondents, the level of physical activity was significantly lower in the morbidity-free group than in the heart attack group. Furthermore, respondents in the high cholesterol group showed consistently a 'better' health behavior than people in the hypertension group. Overall, these results suggest that the concept of perceived morbidity may be useful in explaining inter-individual differences in health behaviors. PMID- 10148741 TI - Subjective norms about condoms are better predictors of use and intention to use than attitudes. AB - In a study of the applicability of the Theory of Reasoned Action to condom use, 173 homosexually active men were administered a questionnaire assessing attitudes toward and intentions to use condoms, behavioral beliefs about condoms, and subjective norms and normative behavior regarding condom use. Results indicated that attitudes toward condoms were poor predictors of intention to use condoms, but that subjective norms were good predictors of intention. Previous condom use was a good predictor of intention to use. These data suggest that interventions which emphasize peer-based education are likely to be more useful than those which attempt to alter behavioral beliefs about, and attitudes toward, condoms. PMID- 10148742 TI - Parents attitudinal and social influences on childhood vaccination. AB - The study examined beliefs and attitudes towards pertussis (and other) vaccinations in three groups of caregivers; those who had fully vaccinated a target child against pertussis (FV; n = 85), those whose child partially completed the course (PV; n = 70) and those who refused to have their child receive the pertussis vaccination (NV; n = 73). The NV group reported significantly more concern over long-term health problems as a result of pertussis vaccination, a lower risk of catching pertussis if not immunized and attached a lower importance to pertussis vaccination than either of the other two. They also rated their child as more likely to develop pertussis if immunized than those in the FV group. The NV group also reported a greater risk perception for some other vaccinations (e.g. mumps, rubella and measles) than the other groups. The implications for health education are discussed. PMID- 10148743 TI - Postpartum relapse to smoking: a prospective study. AB - A substantial proportion of women who quit smoking during pregnancy will relapse in postpartum. In order to better understand the psychosocial factors which precipitate relapse to smoking we conducted a prospective study of postpartum smoking relapse among a cohort (N = 106) of women who quit smoking during pregnancy. Participants were surveyed by telephone after the 28th week of pregnancy, and at 6 weeks and 6 months postpartum. Point prevalence estimates of smoking relapse indicated that at 6 weeks and 6 months follow-up, 24% (n = 26) and 40% (n = 42), respectively, of the women had returned to regular smoking. Spouse's smoking status, social support, decreases in self-efficacy, and the types of coping strategies used to resist smoking in pregnancy and postpartum predicted relapse to smoking in postpartum. Longitudinal data indicated that relapse occurred relatively gradually suggesting that early postpartum is not too late to encourage new mothers to remain abstinent. PMID- 10148744 TI - The relationship between cognitive maturity and information about health problems among school age children. AB - This study of urban, multi-ethnic children was undertaken to explore the relationships between age, cognitive developmental capability (termed 'cognitive maturity') and accuracy of information about health problems. A total of 299 children in the first, second and third grades from six public and one private school in New York City were individually interviewed using an open-ended set of questions. Findings indicated that having accurate health information is not the same as comprehending the abstract internal nature of the 'facts'. Results supported Piaget's levels of cognitive development applied to the area of health. Findings also showed that age is a better predictor of children's accuracy about health information than their cognitive maturity. The findings underscore the need for those providing health education to place emphasis on the cognitive abilities of children and not to mistake recitation of factual information for understanding of conceptual elements of a health problem. PMID- 10148745 TI - Evaluation of an intensive HIV/AIDS counselling course in Zimbabwe. AB - The anticipated increase in the number of people with HIV infection and AIDS in Zimbabwe, together with those who have associated worries, will place extra demands upon clinical and counselling services in the coming decade. To meet these demands, a wide range of health care staff will have to acquire specialist counselling skills. For this reason, an intensive 2 day HIV/AIDS counselling training course was run at the Family Counselling Unit, Harare, in February 1989. The structure, content and evaluation of the course are presented here. Overall, the course was positively evaluated by the 38 trainees. However, a number of trainees were critical about some of the teaching methods and the degree of emphasis given to some of the objectives. Our experiences may help others in establishing HIV/AIDS counselling courses elsewhere. PMID- 10148746 TI - Prediction of smoking behavior in Japanese young adults. AB - Eighty-eight second grade students of a senior high school in Saitama prefecture in Japan participated in a prospective study to predict cigarette smoking behavior 3.5 years later. Predictor variables include sex, knowledge, beliefs and attitudes toward smoking, previous smoking behavior, and smoking behavior of their families. Stepwise discriminant analyses revealed that 90% of the smokers and 65% of the non-smokers were correctly classified. In this model, previous smoking behavior proved to be the best predictor. Attitude toward adult male's smoking, sex and smoking behavior of subjects' families were also related. These four variables explained 35% of the variance in smoking behavior. As for stepwise discriminant analyses among those who had not smoked at baseline, 78% of the smokers and 76% of the non-smokers were correctly classified. Attitude toward adult male's smoking, sex, knowledge about long-term effects of cigarette smoking and smoking behavior of their families entered the model in this order. These four variables explained 37% of the variance. Implications of this study for smoking prevention programs in Japan are discussed. PMID- 10148747 TI - Learning from local knowledge to improve disease surveillance: perceptions of the guinea worm illness experience. AB - Surveillance is an essential tool in any campaign to eradicate disease; guinea worm (dracunculiasis), which is targeted for eradication before the year 2000, is no exception. One criterion of an eradicable disease is that it be easy to recognize as the program advances. Few experts doubt that the experience of a meter-long subcutaneous worm protruding through a painful ulcer can be missed or confused with another disease, thus ensuring that guinea worm meets this criterion. Field experiences of anthropologists and health educators have shown that one should never assume that community perceptions of illness experience coincide fully with medical case definitions of disease. This paper describes efforts to learn how the Yoruba people of southwestern Nigeria perceive sobia, the local name for guinea worm. Qualitative methods including informal interview, village discussion and participant observation were used to discern a pattern of illness presentation and progression. Interestingly, local perceptions were found to include a variety of illness manifestations beyond the common clinical case definition of an emergent worm, thus creating the potential for a high level of false positive reports. Local knowledge was then used to design a pilot project that trained volunteers to become part of the surveillance network for the national eradication program. The volunteers, who were largely illiterate, were able to distinguish between cultural and clinical definitions, and submit quite accurate reports on the guinea worm status of their villages. Among the 164 volunteers, only two submitted false reports due to incorrect disease definition. In contrast local government health workers who were conducting village searches during the same period were significantly more likely to register false positive reports. The culturally sensitive training based on local knowledge received by the village volunteers is thought to have contributed to their superior performance. PMID- 10148748 TI - Culturalizing the ethnic patient: educational films and images of interethnic relations in health care. AB - In the wake of an apparent increased utilization of health services by people from ethnic minorities and the perceptions of this as problematic, an educational 'offensive' has been launched in The Netherlands. It is directed at ethnic minority groups and health care professionals, and makes extensive use of educational films. In this article, we discuss results of a qualitative analysis of the ways in which educational films represent interethnic relations in health care, and compare them with the outcomes of an earlier analysis of educational films on discrimination and racism. Instead of a tendency to moralize ethnic attitudes of whites in the latter, we found that films on health care presuppose a professional will to learn and to adapt, but at the same time they emphasize the obstacles posed by ethnic backgrounds. In such films, the traditional culture, rather than institutional constraints, figures as the main reason for the setbacks the ethnic patient experiences and for the problems professionals face in order to accommodate the new situation. Educational films on ethnic minorities and health (care) could be improved by analysing problems rather than focusing on ready-made solutions, and by paying attention to institutional constraints rather than showing a seemingly boundless flexibility of medical professionals in their interaction with ethnic minorities. PMID- 10148749 TI - The construction of health knowledge in middle class families. AB - This paper examines some of the complexities involved in the relationship between knowledge, both 'lay' and 'scientific', and everyday health relevant behaviour. It is based on a multi-interview qualitative study of middle class family groups. The study explored the ways in which images of health, the socio-cultural context of behaviour and the constraints of daily life provided the background to health-relevant behaviour. The sample comprised a randomly selected group of home-owning, middle class couples, each with two children. Three rounds of semi structured interviews were carried out with spouses during an 18 month fieldwork period. Their children, age range 4-12, were also interviewed. The main focus of the study was on the development of health-relevant beliefs and behaviours in the context of everyday life, particularly domestic life. In this paper some characteristics of how respondents perceived, interpreted and evaluated health knowledge are described. Illustrations are given of the differences between respondents' initial accounts of their 'usual' behaviours and the detailed descriptions of their daily lives obtained in later interviews. It is concluded that knowledge about health was not necessarily translated into behavioural practices, even in a supposedly health promoting environment. Qualitative examination of the socio-cultural context of daily behaviour may add to our understanding of the gaps between knowledge, attitudes and practices. PMID- 10148750 TI - Assessing the qualitative data component in large-scale quantitative surveys: computer aided qualitative survey data management, retrieval and analysis. AB - In a large-scale survey the qualitative component of the interview is often used either to refine the quantitative coding categories or to get a 'general feel' for the respondents' comments with no attempt at analysis. This article reports on an approach which has been developed for solving some of the problems of linkage of qualitative and quantitative components at the survey analysis stage. This approach is dependent on efficient methods of data management and text retrieval, and presupposes a system of data collection that produces computer based text files to store the verbatim comments of study participants. The size of the data set necessitated using a mainframe computer for data management, text retrieval and analysis. The article provides illustrations of how the analysis of 11 000 files consisting of textual data was facilitated. PMID- 10148751 TI - Empowering school students in developing strategies to increase bicycle helmet wearing. AB - This paper outlines a 2 year community-based action research program to develop strategies for increasing bicycle helmet wearing by children from a rural town in Queensland, Australia. The results of six program components are provided: student observations, focus groups (n = 50), baseline survey (n = 565), student workshops (n = 80), meeting with student representatives (n = 4) and helmet trialing program (n = 17). The children were encouraged to become active participants in the research and to develop practical strategies to increase helmet wearing. The main barriers to helmet wearing reported were poor design and peer group derision. The majority of children never wore a helmet and only 7% wore one whenever bicycle riding. Strategies suggested to make helmets more acceptable were: develop more comfortable and fashionable designs, and lower helmet costs. Students taking part in the baseline survey and workshops disagreed that helmet wearing should be compulsory; however, in later workshops and focus groups students said this was the only sure way of getting students to wear helmets. The program was not evaluated because of the non-interventionist strategy recommended by the students and the introduction of compulsory helmets. However, the project demonstrated that action research can be successfully used with children. PMID- 10148752 TI - Smoking cessation in Texas-Mexico border communities: a quasi-experimental panel study. AB - BACKGROUDd. Smoking-related disease and injury is prominent among the numerous health problems on the U.S.-Mexico border, but little is known about the methods that might help promote smoking cessation among the low-income populations in this region. METHOD: Media campaigns were combined with different forms of intensive and community-wide interpersonal communication to encourage smoking cessation in a border U.S. city and in a Mexican city. Panels of moderate to heavy smokers were followed in four groups to allow quasi-experimental comparison of smoking cessation rates. RESULTS: Over a five-year study period smoking cessation rates of 17% (self-reported) and 8% (verified) were observed in panels in the program community (N = 160). In the comparison community (N = 135) corresponding rates of smoking cessation were 7% (self-reported) and 1.5% (verified). Within the program community, no differences were observed in smoking cessation among smokers exposed to a community-wide program and those assigned to receive personal counseling. DISCUSSION: Although the observed changes in smoking were unexpectedly small in the treatment and comparison groups, the approximately 8% effect size for the community-wide program was close to what was predicted. Results indicate that such programs may yield effects similar to those of more intensive approaches, but further research with greater statistical power will be necessary to confirm that point. PMID- 10148753 TI - Twelve years experience of a fitness program for the salaried employees of a Toronto life assurance company. PMID- 10148754 TI - Health locus of control and self-efficacy beliefs in a healthy elderly sample. AB - BACKGROUND: The elderly are the fastest growing segment of the population, and this will place additional burdens on the healthcare system. It is therefore valuable to study the elderly who have reached their later years relatively free of disease and in good health. METHODS: Health locus of control, self-efficacy beliefs, and lifestyle behaviors were studied in a sample of 57 healthy elderly subjects. Subjects completed the Multidimensional Health Locus of Control Scale, Self-Efficacy Scale, and Healthstyle Self-Test for Seniors. RESULTS: Most of the subjects were characterized by an internal health locus of control belief (91.2%), high generalized self-efficacy (57.9%), and good health behaviors. As hypothesized, positive relationships were found among these variables. DISCUSSION: Individuals with an internal health locus of control and high generalized self-efficacy are more likely to benefit from a health education program than those with an external locus of control and low self-efficacy. Health educators can better serve their clients by evaluating these parameters when developing programs. PMID- 10148755 TI - Mind-body health: research, clinical, and policy applications. AB - PURPOSE OF THE REVIEW. This critical review presents an overview of the development in the field of mind-body medicine over the last 10 years and has taken tentative steps toward suggesting the components of a new model of health based on psychoneuroimmunology. While documenting the major shortcomings of present research design, methodology, data analysis, and subsequent hypotheses, this article points out areas of sufficient promise for practical and responsible clinical applications of the research. SEARCH METHOD USED. A thorough review of the clinical and experimental medical literature related to the interaction between mind and body is presented, and the new and complex research in the field of psychoneuroimmunology is analyzed. SUMMARY OF IMPORTANT FINDINGS. Despite the mixed and sometimes conflicting findings in current research, there is an increasingly compelling body of scientific evidence indicating that mind-body interactions are at the root of both health and disease. Research demonstrates that psychological factors seem to play a causal role in the onset and course of many chronic disorders and that psychological, emotional, psychosocial, and behavioral interventions have at least as much proof of effectiveness as many purely medical treatments. MAJOR CONCLUSIONS. There is a substantial growing body of scientific and clinical knowledge which demonstrates an inextricable interaction between mind and body. Such an approach empowers individuals and organizations to assume greater responsibility for health as a basis for the development of a true health care system. PMID- 10148756 TI - Demographic characteristics of users of worksite health promotion written materials. AB - BACKGROUND: Despite a long history of work organizations supplying health oriented written materials to employees, little was known about the underlying factors contributing to their use. Earlier findings suggested that demographics might play a role in this process. Therefore, this research attempted to define user profiles of four basic written materials commonly found in worksite programs: medical self-care guide, newsletter, health risk appraisal (HRA), and HRA individual report. METHODS: The results of a post-program questionnaire were collected from 10 work organizations using a commercial health promotion program (N = 5,167; 29.8%). After defining a user for each piece, chi-square and logistic regression determined proportional differences between users and nonusers by selected demographics. RESULTS: After controlling for variable interactions, the most likely user of the medical self-care guide was a non white, lower educated female over age 40; the newsletter, a female over age 40; the HRA, a higher job rated female; and the HRA report, a female over age 40. DISCUSSION: Written materials may have a different use pattern than other program offerings, or different than what might have been suspected intuitively. Other than female gender, most demographic variables either offered insignificant or unexpected contributions to prediction models. These results suggest that written materials may have a wider appeal than previously recognized. PMID- 10148757 TI - Health risk changes with a low-cost individualized health promotion program: effects at up to 30 months. AB - BACKGROUND AND PURPOSE: Health promotion programs are increasingly important components of health care in an era of predominantly chronic illness preceded by identified health risk behaviors. We report a large and relatively long experience with a low-cost intervention delivered through the mail and using sequential time-oriented risk appraisal and personalized recommendations, each six months, together with self-management materials. METHODS: We performed a prospective, longitudinal, observational study of 103,937 consecutive program participants observed for at least six months and up to 30 months. The primary study endpoint is overall health risk score, with secondary analysis of individual risk behaviors. A concurrent comparison group utilizes the initial scores of new participants by calendar time over the study period. RESULTS: Strong overall positive effects were observed, with improvement in computed health risk scores over 18 months of 14.7% (p less than .0001) in those 65 and over and 18.4% (p<.0001) in those under 65. At 30 months, improvement was 18.8% (p less than .0001) and 25.7% (p less than .0001), respectively. There was improvement in self-report scores for all targeted health risk behaviors, except for pounds over ideal weight, including smoking; dietary fat, salt, and fiber; alcohol; exercise; cholesterol; and reported stress. There was progressive improvement approximating 5% each six-month period. Results were consistent across age groups 16-35, 36-50, 51-65, and over 65 and over different educational level. Results could not be accounted for by sequential changes in initial health habits of participants over time. DISCUSSION: (ABSTRACT TRUNCATED AT 250 WORDS) PMID- 10148758 TI - Integrating an educational program in health promotion and disease prevention into a medical school: the University of Tennessee, Memphis. PMID- 10148759 TI - The global metastasis of the Marlboro Man. PMID- 10148760 TI - Formative research on smoking cessation program attributes preferred by smokers. AB - BACKGROUND: This article reports formative research procedures used to identify smoking cessation program attributes preferred by smokers. A theoretical rationale and a program development framework are presented. METHODS: Findings from a series of qualitative and small sample quantitative studies were used to evaluate smoker response to specific program materials, and to identify a comprehensive set of preferred smoking cessation program attributes. These findings guided the development of a telephone survey administered to a random sample of 205 smokers interested in quitting. RESULTS: The 205 smokers completing telephone interviews frequently indicated preferences for program features having little to do with specific cessation methods used. Low demand on time, endorsements by medical authorities, relaxation instructions, weight control techniques, and a substantial research base were often cited as being most preferred. Overall, chi-square analyses provided minimal support for significant relationships between preferences and sociodemographic or smoking history variables. DISCUSSION: The benefits of combining qualitative and quantitative research methods in cessation program development efforts are noted. Implications for further research are discussed, particularly those concerning multiattribute analysis of consumer preferences. PMID- 10148761 TI - Efficiency of printed materials in worksite health promotion. AB - BACKGROUND: Printed health promotion materials are widely believed to be an efficient means of achieving basic health promotion objectives, such as increasing knowledge of risk factors. This study examined the efficiency of cardiovascular health promotion leaflets in reaching employees in a heterogeneous sample of worksites. METHODS: Two types of distribution were used: copies of the leaflets were either made available centrally or distributed to each individual employee. Interviews were conducted with 272 employees in six worksites. Respondents were asked whether they recognized, had read, and had learned something from the leaflets. RESULTS: Only one-quarter of respondents recognized the leaflets and only 14% stated that they had learned something. The efficiency of the leaflets was therefore much lower than expected. Z-tests for proportions showed that recognition, reading, and learning were significantly greater among those employees who had been given individual copies of the material. Among those who had been given individual copies, 45% reported recognizing the leaflet, 36% reading it, and 23% learning something from it. Among those who had only central access, the respective scores were 11%, 7% and 6%. DISCUSSION: These results suggest that the potential cost-effectiveness of printed materials such as leaflets and brochures should be weighed against alternative forms of intervention, given specific program objectives and characteristics of the target population. They also suggest that the cost and effort required in organizing the distribution of individual copies may be recouped in greater penetration. PMID- 10148762 TI - Past and future priorities in health promotion in the United States: a survey of experts. AB - BACKGROUND: The purpose of this study was to determine past and future priorities of the health promotion industry. Parameters included target markets, program staff, ethical issues, corporate programs, and program sites. METHODS: This study focused on the predictive perceptions of 76 prominent health and fitness professionals. Participants completed an inventory designed to compare past and future practices in health promotion. The Wilcoxon rank-sign test was used to determine changes in perceived importance from past to future periods. RESULTS: The most important markets in the future were women and the elderly. Predictions regarding staffing included an expected increase in staff size in many program settings, a high importance rating for marketers and health educators, and standardized training and certification for health promotion personnel. Many employers in the future were predicted to link medical care costs and reimbursements with lifestyle behaviors, support confidentiality of health status information, and offer voluntary participation in health promotion programs to all employees. Employers were also predicted to provide more healthful work environments. DISCUSSION: Future success of these projected programs will depend upon administrative flexibility, creativity, and strategic planning. PMID- 10148763 TI - HealthNet New Mexico: a community-based statewide health promotion program. PMID- 10148764 TI - Comparison of health risk prevalence reported in a health risk appraisal and predicted through demographic analysis. AB - BACKGROUND: The purpose of this study was to determine if the Healthier People Health Risk Appraisal and the RiskPlan Report, two different methods for measuring health risks of an employee population, produce the same estimates of health risk prevalence. METHODS: The prevalence of each of seven risk factors, directly measured by the Healthier People Health Risk Appraisal and predicted by the RiskPlan Report using demographic and normative data, were compared for a group of 239 employees participating in a voluntary health screening. Further, the 239 participants and 426 nonparticipants were compared with respect to demographic factors gleaned from personnel records, and risk factor prevalence derived from the RiskPlan Report. RESULTS: Significant differences were found in the prevalence of six of the seven risk factors measured by the Healthier People Health Risk Appraisal and predicted by the RiskPlan Report. Also, risk factor prevalence predicted by the RiskPlan Report was not significantly different in the participants and nonparticipants although three critical sociodemographic variables were significantly different. DISCUSSION: The results suggest that the prevalence of health risks based on normative data and the demographic profile of a population are not similar to those directly measured, and some doubt is raised about predicting health risks based on these data. PMID- 10148765 TI - Tracheostomy risks outweigh benefits in preventing pneumonia. PMID- 10148766 TI - Managing complications in heart transplant recipients. Improved techniques and medications increase survival rates. AB - Major problems facing cardiac transplant recipients include rejection, infection, and transplant coronary artery disease. Commonly used antirejection drugs are high-dose corticosteroids and cytolytic agents. Bacterial infections, such as those caused by staphylococci, occur early in the postoperative period, while opportunistic infections, including viral, fungal, and parasitic diseases, occur several weeks after transplant surgery. Coronary angiography is used to detect transplant coronary artery disease, the only definitive treatment for which is retransplantation. A number of promising new immunosuppressive agents and techniques may prevent some complications and further improve the care cardiac transplant recipients receive. PMID- 10148767 TI - Delivery of health care: the problem, the proposed solutions, and managed care- part 1. PMID- 10148768 TI - Rapid tibial polyethylene failure in porous-coated anatomic total knees as a cause of clinical failure. AB - Among 52 patients with porous-coated anatomic total knee arthroplasties, three (6%) underwent revision surgery because of failure of the tibial polyethylene at two years and three months, four years and three months, and four years and nine months after surgery. Thinning of the tibial polyethylene may have contributed to the failure in one patient. Heat pressing fabrication and the articular geometry possibly played a role in the development of failure in all three patients. Surgical latitude of the prosthetic design was considered to be too narrow to be applied to knee joints with severe deformity, for which knee prostheses with more intrinsic stability might be appropriate. PMID- 10148769 TI - Visual versus quantified digital radiographic determination of bone density. AB - Quantitative digital radiography (QDR) was used to assess the ability of physicians to determine bone mineral density (BMD) loss from a series of plain radiographs. Twenty-four spinal cord injured patients underwent QDR of the left knee. Seven of the 24 were selected, each of whom had bone mineral loss from 10 70% in 10% increments as assessed by comparison to average BMD of age-matched controls, and a standardized AP radiograph of the left knee was performed. Twenty five independent examiners (orthopaedic surgeons and residents) were then asked to view the randomly arranged radiographs and visually determine the amount of BMD loss for each radiograph as compared to a control radiograph at 100%. Chi square analysis of the data revealed that the distribution of responses was significantly different than expected at the p less than .01 level. Taking into account that responses may have erred by +/-10%, the distribution of responses was again found to be significant at the p less than .01 level. An accurate determination of BMD loss was achieved only at 10% bone loss and 70% bone loss. The results of this study suggest that the visual determination of bone loss based on plain radiographs is accurate only at very low or very high levels of bone loss. Using standardized techniques, only near normal radiographs or radiographs with at least 70% BMD loss can be assessed accurately. PMID- 10148770 TI - Recent advances in electrical stimulation. PMID- 10148771 TI - Nuances of transvaginal bladder-neck suspension. PMID- 10148772 TI - A guide to the office semen analysis. PMID- 10148773 TI - Peripheral vascular imaging: current and evolving technology. PMID- 10148774 TI - Peripheral angiography: optimal technique and current status in vascular imaging. AB - Angiography is the standard with which new methods of vascular imaging are compared. In this article, selected recent developments affecting the practice of angiography will be discussed. First, a brief review and update of contrast media for intravascular use will be presented. Second, principles and current methods of optimizing the diagnostic arteriogram will be covered with emphasis on the extremities and aorto-femoral angiography. Finally, some of the advantages, limitations, and the role of modern angiography will be discussed. PMID- 10148775 TI - Transcutaneous ultrasonic imaging in peripheral vascular diseases. AB - Imaging is an important method for studying vascular disease particularly if combined with pulsed Doppler. The only situations where imaging alone may provide enough information to proceed with therapy is with aneurysmal disease and acute deep vein thrombosis. With these disorders, therapy is dependent on identifying the problem, its location, and extent. When occlusive arterial disease is the problem, the need for therapy will depend on the degree of narrowing. At the present time, transcutaneous ultrasonic imaging alone is not adequate to determine the degree of stenosis. Although there is no doubt that plaques can be seen on B-mode imaging, the extent to which they narrow the artery depends on an assessment of the flow velocity through the site of greatest narrowing. This can be determined by using a pulsed Doppler that permits selective sampling of flow from any point within the visualized arterial segment. While the procedure to be used will vary from one site to another within the arterial system, the basic principles are the same. The amount of velocity increase within a stenosis is related to the extent to which the diameter of the artery is reduced. The use of the duplex scanning method will permit an evaluation of both the arterial and venous systems at all sites accessible to this form of energy. PMID- 10148776 TI - Intravascular ultrasound imaging. PMID- 10148777 TI - Ultrafast computed tomography in the diagnosis of diseases of great vessels. AB - Rapid and accurate detection of great vessel disease is of enormous importance in clinical practice. The search continues for the best technique to evaluate critically ill patients with acute aortic dissection and/or acute pulmonary embolism. Because of its speed and excellent spatial resolution, ultrafast computed tomography (CT) is a very useful tool and may alter the management of patients with aortic disease. Other techniques, such as magnetic resonance imaging (MRI) and transesophageal echocardiography (TEE) are also used in the diagnosis of aortic dissection. Each technique has advantages and pitfalls. At this time it is likely that one technique will complement the other. With further technical improvements, both MRI and ultrafast CT are likely to emerge as the diagnostic tests of choice. In the future, further validation and comparative studies in the acute setting may help to identify the most accurate and useful technique. PMID- 10148778 TI - Vascular imaging with magnetic resonance and computed tomography. AB - Cross-sectional imaging of the cardiovascular system is successfully achieved with computed tomography (CT) and, more recently, magnetic resonance imaging (MRI). Limits of spatial resolution confine the routine application of either device to assessment of larger vessels, such as the aorta, vena cava, and renal veins. The decision to use one modality versus the other is frequently influenced by the clinical status of the patient, as well as the indication for diagnostic imaging. Some of the more common vascular abnormalities are depicted in this article, as imaged by these relatively new and expensive technologies. An explanation of the complex appearance of blood flow on MR is dependent on an understanding of some basic physical principles, such as flow-related enhancement and even-echo rephasing. MRI is presently more suitable than CT for the evaluation of medium-size vessels since the development of effective techniques for magnetic resonance angiography (MRA). Some of the important concepts, along with the terminology of this still-evolving field are presented. The quantification of blood flow by MRI is similarly an area of active research, and may ultimately supplant the existing methods. PMID- 10148779 TI - Histologic investigations on 33 retrieved Nobelpharma implants. AB - Thirty Nobelpharma implants were retrieved from 17 patients despite a remaining clinical stability, after between 1 and 16 years of clinical function. The reasons for implant removal were bone resorption in combination with soft tissue disorders, psychological causes, implant fracture and post mortem cases. When measured at the cortical passage, there was an average of 84.9% direct bone-to implant contact and 81.8% average surface bone area in individual threads as evaluated in a computerized morphometric system at the light microscopic level. PMID- 10148780 TI - The surface finish of light-cured composite resin materials. AB - A necessity for any dental restorative material is its ability to take and maintain a smooth surface finish. Composite resin restorative materials with fillers and matrix of differing hardness are difficult to finish and polish. The use of aluminum trioxide discs is a popular and acceptable method of finishing composite restorative materials where the material is accessible. Burs and stones are used for finishing and polishing inaccessible areas. This study was undertaken to compare the surface finish of composite resin restorative material when finished with white stones, superfine diamond burs and aluminum trioxide discs. The finished surface was measured with a profilometer and the roughness average value used to compare the surfaces. The aluminum trioxide discs gave the best and most consistent results. It was possible to attain similar results with the superfine diamond bur. However, the results were highly variable. None of the methods used achieved the smoothness of composite resin cured against a transparent matrix. PMID- 10148781 TI - Comparative biological tests on segmented polyurethanes for cardio-vascular applications. AB - In order to select a candidate segmented polyurethane (SPU) elastomer for the preparation of cardio-vascular prostheses, a series of biological tests (namely haemolysis, aPTT and PT coagulation tests, cytotoxicity, human endothelial cells seeding) was carried out on five commercially available biomedical polyurethanes. The tests were performed on solvent cast samples, from THF (Cardiothane 51, Pellethane 2363 80A, Estane 5714 F1, and Estane 58810), or DMAC (Biomer). All the materials were sterilized by gamma-irradiation before being tested. From the results obtained all the polyurethanes used in this study were shown to be devoid of toxicity towards blood (as proved by haemolysis and coagulation time tests) or blood cells (as proved by cytotoxicity and cell adhesion assays). A clear difference among the tested copolymers didn't stand out under our test conditions, although Cardiothane, possibly due to its physico-chemical characteristics, was less effective in promoting endothelial cell adhesion. PMID- 10148782 TI - Biomechanical assessment of surface demineralized micro-perforated femoral diaphyseal segmental allograft. AB - The use of surface demineralized micro-perforated femoral allograft (SDMFA), in the form of short diaphyseal segments, is of interest for anterior thoracic and lumbar spine reconstruction. Its reported osteoinductive capacity is enhanced by demineralization, though the mechanical strength is reduced. The strength of SDMFA segments was significantly higher at 24 h of demineralization time as compared to 48 h of demineralization time. The SDMFA segments from the junction of the proximal and mid-third of the femoral diaphysis had the greatest load to failure and stiffness. PMID- 10148783 TI - The application of titanium alloy wires for the reattachment of the greater trochanter in total hip arthroplasty. AB - We developed a new fixing method using titanium alloy wires in order to facilitate the attachment of the greater trochanter in total hip arthroplasty. This wire is composed of Ti-3Al-2.5V by weight. According to the fatigue test in vitro, the titanium alloy wire had better fatigue properties than Ortron 90 wire of the same diameter. In experiments in vivo, both titanium alloy wires and SUS 316L wires were used for the reattachment of the greater trochanter of dogs, and the titanium alloy wires showed better biocompatibility than the latter. Thus, titanium alloy wires seem applicable for the reattachment of the greater trochanter in human total hip arthroplasty. PMID- 10148784 TI - Response of canine bone to a synthetic bone graft material. AB - A model simulating a spiral diaphyseal fracture with butterfly fragments and bone loss was utilized to evaluate an hydroxyapatite/tricalcium phosphate, and collagen composite bone graft substitute in twelve dogs. The resultant grafted and contralateral control femora were tested in torsion at one year. This study examines the histological response to the graft material as well as crack propagation and fracture surface morphology using light microscopy and SEM. SEM and gross evaluation of the grafted bones revealed that 8/12 had fractured through bone outside the osteotomy site and all fractures included bone outside the graft site. No graft material was demonstrated at the points of initiation or termination of fracture for any of the bones. It was apparent that recorticalization had begun to occur at the graft site but the canal had not yet fully formed. The HA/TCP was seen to be tightly bound in tissue which had the appearance of new bone. Bone was found to be in direct apposition to the surface of the ceramic and within pores with no intervening soft tissue. Much of the new bone had remodeled into well organized Haversian systems with some patchy areas of woven bone and osteoid seen with polarized light illumination. PMID- 10148785 TI - Liver: enhancing tumors and vascular obstructions. PMID- 10148786 TI - Female pelvis: overcoming hurdles to cancer staging. PMID- 10148787 TI - Heart: identifying ischemic and infarcted myocardium. PMID- 10148788 TI - Breast: visualizing Ca not seen by radiography. PMID- 10148789 TI - Pediatrics: assessing suspected mass lesions. PMID- 10148790 TI - Fetal ultrasound aims for no-risk guarantee. PMID- 10148791 TI - Cancer patients benefit from monoclonal imaging. PMID- 10148792 TI - Computers aid diagnosis of breast abnormalities. PMID- 10148793 TI - Polypropylene serving the medical sector. AB - Polypropylene has a range of properties that make it suitable for use in the manufacture of health care products. These properties can be varied to suit different applications and this has led to its increasing market share in the health care sector. This article discusses recent developments in polypropylene technology and some new applications, highlighting the benefits of polypropylene over the more traditional materials. PMID- 10148794 TI - Medical applications of copolyester elastomer films. AB - Medical dressings and devices are now required to fulfil a number of demands. These include preventing the entry of bacteria to the wound and improving the healing rate. Copolyester elastomers (COPEs) can play a significant role in providing these benefits because they can be blended to offer a range of characteristics. In this article, the author discusses the mechanical and physical properties of COPEs and discusses how these properties have been utilized, and their potential for future development. PMID- 10148795 TI - On the limited utility of KAP-style survey data in the practical epidemiology of AIDS, with reference to the AIDS epidemic in Chile. AB - Population surveys concerning 'risk behaviours' thought to be related to the AIDS epidemic are many. Nevertheless, unfocused inquiry into diffuse behaviours in undifferentiated populations is not productive in low-seroprevalence populations, especially when the point is to design some form of intervention that might actually avert further infection. This is because of a failure to distinguish conceptually between the relevance of AIDS-related behavioural data for individuals and for populations. An illustration is drawn from the AIDS epidemic in Santiago, Chile, and an alternative perspective, based on extensive interviews with persons with AIDS and a survey of current HIV-surveillance and blood screening programs, is described. PMID- 10148796 TI - Concepts and measures of reproductive morbidity. AB - This paper presents a conceptual and methodological framework developed by an interdisciplinary group of researchers to diagnose reproductive morbidity at the community level. The paper also presents a determinants structure that delineates the health and social factors hypothesized to influence reproductive morbidity. The high prevalence of reproductive-morbidity conditions revealed by implementation of the study framework in two villages of Giza in Egypt is reported. Based on this research experience and the process of presenting its results to the larger professional community, the paper discusses policy implications of the study in terms of reproductive-health services, education and training programs and research efforts for measurement of reproductive ill-health at a community setting. PMID- 10148797 TI - Condom use and the popular press in Nigeria. AB - The increased acceptability and use of condoms by men in southwestern Nigeria is reflected in joking references to condoms in the comic-style popular press. Yet these references display an ambivalence about condoms that is mirrored in survey data and in interviews regarding condom use by rural Ekiti Yoruba men. This ambivalence, which is often couched in terms of health, has implications for the acceptance of government-sponsored HIV/AIDS-related educational programs. Because of the irreverence of comic-style newspapers and the 'unofficial' nature of their authority which coincides with popular attitudes about health programs, they have a credibility that could be useful in educating adolescents about sexually-transmitted diseases and HIV/AIDS. PMID- 10148798 TI - Health expenditure and household budgets in rural Liberia. AB - Fieldwork conducted in Kpelle village in north-central Liberia revealed that health-care expenses constitute a major part of domestic spending. The actual transactions for major health-care expenditures are handled by men, typically using income that jointly belongs to the couple in addition to the husband's personal income. Women are likely to spend their personal incomes on minor health expenses for themselves and their children. Women's health expenditure, as well as their income handling arrangements, seem to differ according to the type of conjugal union they are in. Although Kpelle wives have input in most financial decisions, they tend to defer to men on issues which are associated with the Western world, namely Western health care, educational and tax expenditures. PMID- 10148799 TI - The determinants of use of maternal and child health services in Metro Cebu, the Philippines. AB - The determinants of the use of family planning, prenatal care, childhood immunizations and oral rehydration salts (ORS) were studied with survey data of 8000 women in Metro Cebu, the Philippines. Polytomous logistic regression methods were used. The level of maternal education was the most consistent and important determinant of use of these four health services in both urban and rural areas. For example, the estimated odds of using modern contraception increased by six and eleven per cent for each additional year of schooling in urban and rural strata respectively. Economic status and access to service variables had less consistent patterns: women's work status, for example, was associated only with contraceptive use. PMID- 10148800 TI - Persistence of inequalities in childhood mortality in the 1980s: a matter of economics or behaviour? PMID- 10148801 TI - What have we learnt about the cultural, social and behavioural determinants of health? From selected readings to the first Health Transition Workshop. AB - The article explores the issue of whether the holding of an international workshop in Canberra in 1989, and the preparation of papers for it, increased our knowledge of the cultural, social and behavioural determinants of health and whether the publication of the proceedings placed new knowledge in the public domain. The approach adopted is to compare those proceedings with a collection of selected readings on the subject made shortly before as part of the same program and also with certain other publications. The conclusions reached are that, in addition to having stimulated interest in the field, the workshop and its proceedings furthered knowledge in at least five important areas: (1) the existence of mortality-prone households; (2) the impact of differing cultural situations of women in terms of individualism on their children's survival; (3) the mechanisms whereby maternal education is translated into child survival; (4) the impact of culture and ethnicity on mortality; and (5) indirect indices of the impact of care. The workshop failed to contribute to substantial advances (or draw attention to the lack of advance) in the following areas: (1) the measurement of Third World morbidity or health; (2) adult health transition; (3) the impact of radicalism or egalitarianism in communities other than Kerala and Sri Lanka on mortality; (4) the impact of lifestyle diseases on Third World mortality; (5) the identification of economically optimum mixes of social change and the provision of health services in reducing mortality and improving health; and (6) the employment of health transition knowledge in the reduction of mortality and the improvement of health. PMID- 10148802 TI - Elements for a theory of the health transition. AB - This article presents the basic elements for developing a theory of the health transition. Such elements include the definition of concepts, the specification of a framework on the determinants of health status, the analysis of the mechanisms through which health change occurs in populations, the characterization of the attributes that allow us to identify different transition models, and the enumeration of the possible consequences of the transition. The propositions are presented with a sufficient level of generality as to make them applicable to different contexts; at the same time, an attempt is made to provide them with the necessary specificity to account for different national experiences, thus opening a space for future comparative research efforts. Through the systematization exercise presented in this article, we hope to contribute to the progress of a topic that has grown in importance during recent years. Such importance is due to the enormous potential that health transition theory has for understanding and transforming the growing complexity of our times. PMID- 10148803 TI - The health transition: the cultural inflation of morbidity during the decline of mortality. AB - It has become commonplace to observe that as mortality falls, morbidity levels rise. The question is why? The explanation offered here stresses the multidimensional nature of morbidity, and the important role that diverse cultural forces have on the patterns of behaviour which underlie reporting behaviour during modernization. These forces involve rising health expectations on the part of ordinary people, including their ability to perceive illness and their willingness to seek professional help, and institutional pressures on medical professionals which reward them for discovering and treating an ever growing set of non-fatal diseases. Since non-Western developing countries are training physicians to practice scientific medicine, are educating their citizens to think about disease along modern lines, and measure morbidity as developed countries do, there is every reason to suppose that as mortality falls in these countries, morbidity will rise, just as it has done in the developed world. PMID- 10148804 TI - Breastfeeding and popular aetiology in the Sahel. AB - Two views about breastfeeding and the resumption of intercourse after a birth are found to prevail in Bamako and Bobo-Dioulasso, two cities of the Sahel region of Africa: that sexual relations may spoil the milk; and that a child should be weaned when the woman is pregnant again. Both beliefs provide a rationale to abstain, but the postpartum taboo has been greatly reduced in the area, and the second belief is the most important. 'Bad milk' serves as an explanation for many of the diarrhoeas and diseases of nutritional origin that affect infants and children. Traditional medical treatments of diarrhoea and protein calorie malnutrition are consistent with the popular aetiology. The acceptance of modern techniques of infant care in this area may well be predicated on the diffusion of an alternative model of disease causation. PMID- 10148805 TI - Women's economic roles and child survival: the case of India. AB - This article provides evidence that women's employment, in spite of its other benefits, probably has one crucial adverse consequence: a higher level of child mortality than is found among women who do not work. We examine various intermediate mechanisms for this relationship and conclude that a shortage of time is one of the major reasons for this negative relation between maternal employment and child survival. However, even in the area of child survival, there is one aspect which is positively affected by female employment: the disadvantage to girls in survival which is characteristic of South Asia seems to be smaller among working mothers. This is in contrast to the effect of maternal education which may often have no clear relation to the sex ratio of childhood mortality even though absolute levels of child mortality are lower for educated mothers. PMID- 10148806 TI - Is the Bellagio consensus statement on the use of contraception second public health policy? PMID- 10148807 TI - Rehab for an aging population. PMID- 10148808 TI - The aquatic solution. PMID- 10148809 TI - Water on the knee. PMID- 10148810 TI - Ensuring quality in assistive technology provision. PMID- 10148811 TI - The quality priority. PMID- 10148812 TI - Experiments in health care reform. PMID- 10148813 TI - Invasive procedures available for diagnosing ventilator-associated pneumonia. PMID- 10148814 TI - Laryngeal mask. AB - The laryngeal mask, provides a totally patent airway when positioned in the hypopharynx with remarkable patient tolerance, even at very light planes of sedation. The major advantages of the laryngeal mask are its ease of insertion, the absence of contact with the vocal cards, and the fact that it frees the hands of the anesthesiologist. Contraindications to its use result from its failure to seal the airway against regurgitation of gastric content. Laryngeal masks can be used easily instead of facial masks during anesthesia with spontaneous ventilation and, with experience, can be used for longer procedures using controlled ventilation. Suspected difficult intubation and establishment of a patent airway in emergency conditions are good indications for the use of this device. The laryngeal mask does not replace endotracheal intubation. It can, however, permit better management of the airway while waiting for personnel trained in endotracheal intubation. The nature of the pulmonary pathology seen in intensive care patients limits use of the laryngeal mask during intensive care. In the operating room few complications have been described, and postoperative discomfort is minimal. The laryngeal mask is a device positioned in the hypopharynx which allows separation of the digestive tract from the airway, without violation of either the larynx or the upper oesophageal sphincter. An endotracheal tube, because of its positioning, hinders normal glottic movement and narrows the airway.(ABSTRACT TRUNCATED AT 250 WORDS) PMID- 10148815 TI - As the patient turns. PMID- 10148816 TI - The sound of music. Using songs to stimulate patients' minds and bodies, music therapists bring an imaginative approach to rehabilitation. PMID- 10148817 TI - Up in the air. Under a cloud of unregulated skies, fixed-wing transport operators recently introduced a plan that provides uniform regulation for air ambulance operators across the country. PMID- 10148818 TI - The provider's perspective. Appreciating the true costs of home infusion. PMID- 10148819 TI - Extracorporeal membrane oxygenation life support: a new approach. AB - The use of extracorporeal life support (ECLS) is considered in children who (1) have an acute life-threatening heart or lung disease, (2) are normal before the illness and are likely to be normal if they survive, and (3) have an 80% chance of death. Our use of a constrained vortex pump (CVP) offers a number of potential advantages compared to a roller pump. The circuit is designed to provide the capability of changing over to a new circuit while maintaining full support and is primed to match the biochemistry of the patient as closely as possible. Since May 1989 at the Royal Children's Hospital, Melbourne, Australia, we have provided ECLS to 30 neonates (20 of whom survived) and 22 children (eight of whom survived). ECLS is a useful technique for supporting patients who are unable to be adequately ventilated or oxygenated or who have an inadequate cardiac output. PMID- 10148820 TI - Can early therapy make a difference in treatment of strawberry hemangiomas? PMID- 10148821 TI - Criminal victimization among primary care medical patients: prevalence, incidence, and physician usage. AB - The study addressed the extent to which primary care physicians encounter crime victims in their practices. Crime prevalence and incidence rates were calculated from responses to a mailed survey of 2,291 women medical patients (45% response rate). The prevalence of crime victimization was 57%. The 12 month incidence of violent crime was 118 per 1,000 patients. Most notable was the finding that rape incidence was approximately 15 times higher than National Crime Survey estimates for women, even after adjustment for telescoping. Post-crime physician usage was documented by medical chart review. Although few crime victims required hospitalization for injuries, virtually all made out-patient physician visits in each of two post-crime years. The findings suggest that physicians are an important potential source of assistance for traumatized crime victims. PMID- 10148822 TI - Psychological effects of custody disputes on children. AB - This two-group, repeated measures examination of the psychological impact of child custody contests on children reports a subset of data from an ongoing longitudinal study of 95 children and their parents from 43 divorcing families. The authors report clinical observations concerning children's experience of custody litigation, as well as comparisons of baseline and post-test responses of contested and uncontested groups on measures of locus of control, separation anxiety and family concept. Contested children exhibited significantly greater internality of control orientation than the normative sample. Contested children's test scores also suggested significantly less separation anxiety and significantly more positive family concept than the uncontested group at post test. The implications of these unanticipated findings are discussed. PMID- 10148823 TI - Characteristics and outcomes of insanity acquittees in Oklahoma. AB - The insanity defense is perhaps the most vigorously debated topic at the interface of the legal and mental health systems. This article addresses the need for empirical evidence by providing data on insanity acquittees and their later outcomes in Oklahoma, a jurisdiction not previously studied. Information was obtained on the demographic, legal, psychiatric, hospitalization, and post hospitalization characteristics of all 61 defendants acquitted not guilty by reason of insanity (NGRI) and treated on the state forensic unit during a 5-year period. Insanity acquittees had few resources, significant psychopathology, and extensive involvement with the legal and mental health systems prior to the NGRI offense. Follow-up of three groups of discharged patients--those released at an initial court review, those who completed the NGRI treatment program, and those who absconded from the forensic unit--revealed that those who escaped from the unit had significantly more arrests and subsequent legal charges than regularly discharged patients. PMID- 10148824 TI - The needle-borne HIV epidemic: causes and public health responses. AB - Needle sharing among intravenous drug users is fueling the modern HIV epidemic. A public health approach to needle-borne infection has three components: prevention and education, availability of sterile injection equipment, and drug treatment. This essay examines the most controversial aspect of this strategy- sterile needle distribution and exchange. The sharing of drug injection equipment is the critical factor in the transmission of HIV in the drug using population. Sharing is not merely a learned response, but is also the result of a limited supply of needles and syringes. Limiting the supply of sterile equipment results from a policy choice which includes: (i) the adoption of drug paraphernalia statutes which criminalize the possession of equipment with the intention of using it for drug injection; (ii) the adoption of needle prescription statutes which criminalize the sale of needles and syringes without a medical prescription; and (iii) the failure to adopt a comprehensive program for the distribution, exchange, or sterilization of equipment. A public health approach to reduce the needle-borne HIV epidemic would repeal needle prescription laws, limit drug paraphernalia laws so they apply only to illicit sellers, and establish needle exchange programs with an array of education and drug treatment services attached. PMID- 10148825 TI - Investigating Hispanic adolescent involvement with alcohol: a focus group interview approach. AB - Focus group interviews were conducted with Hispanic teenagers to explore their patterns of alcohol consumption, influences on drinking and possible intervention strategies. The findings revealed that drinking and alcohol-impaired driving are common. Conviviality and social facilitation are the predominant contexts for alcohol consumption in this population. The strong influence of peers was detected where drinking to 'fit in' and be part of the crowd was observed. Parents were also noted to have influence. Some parents actively promoted drinking among their sons as it is often seen as a sign of masculinity or 'machismo'. Suggestions for effective prevention strategies included a preference for messages which vividly portray the harmful consequences of alcohol consumption and the use of testimonials from people who have suffered some form of impairment due to alcohol abuse. Teens, especially those who speak Spanish and understand the Hispanic culture, were seen as the most credible spokespersons for prevention campaigns. PMID- 10148826 TI - Perception of physical education classes among young adolescents: do physical education classes provide equal opportunities to all students? AB - From a public health perspective, physical activity in children and adolescents is seen as important for disease prevention and health promotion. Physical activity patterns are learned through socialization processes where one of the influential sources is the school through physical education classes. The purpose of the present study was (1) to examine young adolescents' general perception of physical education classes, and (2) to explore the relationship between these perceptions and students' social resources, gender and level of leisure time physical activity and self-evaluated competence in physical education. A total of 895 seventh graders (13 year olds) were surveyed in Norway concerning their perception of physical education classes. Indicators of social resources were chosen from the arenas of family, friends and school. The main finding was that a majority of students liked physical education classes. Physical education classes seemed, however, not to offer the less socially resourceful minority the same opportunities for positive experience with physical activity as the resourceful majority. Boys' general perception of physical education classes seemed to be more positive than girls' and physically active students perceived physical education classes more favorably than less physically active students. PMID- 10148827 TI - Scales for assessing perceptions of health hazard susceptibility. AB - Two studies examined the effectiveness of a variety of commonly used likelihood scales (dichotomous scale, five-point verbally-labeled scale, odds scale, percentage scale, etc.) for assessing perceptions of personal susceptibility to health and safety risks. Two direct evaluation criteria (subjects' ratings of how easy it was to use a scale and of how well the scale reflected their feelings) and three additional measures of validity and reliability (the agreement of scale-derived ranks with a direct ranking, the magnitude of correlations between risk perceptions and appropriate risk factors, and the stability of scores over time) were used to compare the scales. Increasing the number of scale categories did not necessarily improve performance. In fact, a scale with seven verbally-labeled categories performed as well as or better than other scales on all evaluation criteria. These data may help health education researchers in selecting scales to measure perceptions of susceptibility to harm. PMID- 10148828 TI - Process variables as predictors of risk factor changes in a family health behavior change program. AB - The purpose of the present study was to determine the extent to which intervention process measures are useful in predicting changes in cardiovascular disease (CVD) risk factors among subjects exposed to interventions. Subjects were 99 adult and 105 children who participated in an 18 session, family-based diet and exercise change program. During the intervention, each participant self monitored diet and exercise for 12 weeks. Additionally, attendance, session evaluation, confidence to achieve goals and goal achievement data were collected each week. The intervention was successful in changing diet, blood pressure and cholesterol levels, but did not produce significant changes in exercise or body mass index. Stepwise multiple regression analyses were conducted for each outcome variable at the 1 and 2 year follow-ups. Ethnicity and sex were first forced into each regression. None of the process measures consistently predicted multiple outcomes in adults and children. The pattern of results provides limited support for the hypothesis that intervention process variables such as attendance, adherence to self-monitoring, achievement of goals and attitude toward sessions partially mediate intervention effects. It is concluded that process measures should be collected in health behavior change programs so that process-outcome relationships can be further explored. PMID- 10148829 TI - Crutches, confetti or useful tools? Professionals' views on and use of health education leaflets. AB - This paper examines the views on and use of health education leaflets by a number of professional groups: health visitors, midwives, occupational health workers, pharmacists and school health education co-ordinators. Eighty nine percent currently obtain leaflets from health promotion units, with the exception of health visitors, professionals are largely satisfied with the units' service. Seventy six percent use commercial or sponsored leaflets primarily because of the large numbers and topics that are available. The numbers and type of leaflets used were found to vary across the professions. All professionals see an increasingly important role for leaflets in their work. A number of them, pharmacists and occupational health workers in particular, saw the numbers they use rising. These views were accompanied by lower levels of belief in a leaflets ability to increase knowledge and behaviour as well as lower levels of satisfaction with current leaflet use and a concern over the public's reception of leaflets. Methods of leaflet distribution to the public largely reflect the professionals' work contexts. Most popular were handing out leaflets with advice, leaving them in a public place and using them as a back-up to a meeting. A number of contradictions emerge between distribution practices and perceived effectiveness. Few professionals thought leaving leaflets in a public place was effective, and few health visitors and midwives believed giving leaflets to the family of a client was effective despite large numbers doing so. The implications of these findings for health promotion policy and practice are discussed. PMID- 10148830 TI - Prevention of home related injuries of pre-school children: safety measures taken by mothers. AB - Home related injuries are a major threat to the health of pre-school children in the Netherlands. Many risk situations can only be avoided through parental safety behaviour, especially with measures taken to structure the child's environment. This study was meant to contribute to the information needed to develop a safety education programme directed at parents. Therefore, we assessed mothers' safety measures related to poisoning, burns and falls, the consistency between these measures within one type of accident, and their relation to the mothers' education. A written questionnaire was completed by 1129 mothers of pre school children (response rate 84%). Results suggest that many of the safety measures taken by mothers have to be judged moderately safe or unsafe and therefore correction or development of these measures is needed. Furthermore, this study suggests that safety measures belonging to one type of accident are not consistent with one another. This implies that each measure has to be advocated separately. Moreover, there was no substantial evidence for a relation between the mothers' safety measures and their education. Safety educators, therefore, do not need to differentiate between mothers with different educational levels when designing programmes. PMID- 10148831 TI - Gender differentiated receptivity to sexuality education curricula by adolescents. AB - Teenagers comprise a substantial proportion of the 'at risk' population for sexually transmissible diseases (STDs) and AIDS. They are, also, potentially amenable to the curriculum influences of the high school, suggesting that a high profile needs to be accorded to sexuality education curricula. The variable of receptivity along gender lines to sexuality education programs is explored and reported in this study. An instrument was constructed to measure key constitutive variables in the dimensions of meaning and attitude, and administered to a sample of Western Australian high school students (N = 533). Data were subjected to a two-way ANOVA with sex and school as the dependent variables. It was found that there are differences in receptivity to sexuality education curricula between male and female high school students; that receptivity, irrespective of gender, rises with increasing curriculum provision and with males showing higher gains when compared with females. The findings have implications for policy makers and administrators in providing access to extensive school-based sexuality education curricula. PMID- 10148832 TI - In search of a psychology of safer-sex promotion; beyond beliefs and texts. AB - Belief and attitudinal change are important to the promotion of safer sexual behaviour. However, the individual decision-making psychology implicit in belief change models provides only a partial picture of the determinants of sexual behaviour. A broader psychological understanding emphasizing the complex social skills involved in regulating sexual interaction is advocated. A discourse analysis critique of the viability of characterizing individuals' psychology on the basis of verbal responses is discussed and it is noted that psychological models linking such responses to underlying beliefs and cognitions must be based on measures which accurately predict health behaviour. It is concluded that an interactive model incorporating personal, interpersonal and situational constraints on sexual behaviour could be used to design effective programmes addressing barriers to HIV protection. Such interventions would promote communication and sexual negotiating skills and could be included in school curricula. This would have radical implications for sex education, shifting its theoretical basis from biology to social psychology and its methods from information-giving to participation and practice. PMID- 10148833 TI - Black male college students and hypertension: a qualitative investigation. AB - Qualitative research was used to determine what young black male college students do and believe in the hypertension related areas of nutrition, stress and exercise. Black female college students also were asked about their perception of the men's beliefs and behaviors in regard to the above mentioned areas. The study identified stress, especially the stress of being a black male in the US, as the most important concern of both male and female students. There was also agreement in both gender groups that relatives and close friends, especially females, had more influence on men's health behavior than professionals or celebrities. The study discusses the implications of these findings for hypertension prevention programs targeted at young black male college students. PMID- 10148834 TI - HIV/AIDS education in further education: a survey. AB - This paper summarizes a report prepared for the Health Education Authority on the nature and extent of HIV/AIDS education in further education (FE) for the 16-19 age range. The results are based on a questionnaire survey of all the FE and tertiary colleges in England which was carried out by the authors in 1990. The main conclusion is that, although most colleges claim to be making some provision for HIV/AIDS education, such provision varies considerably, tends to be voluntary and, moreover, reaches very few students. Some factors do seem to enhance HIV/AIDS education, such as the appointment of a coordinator and the provision of in-service training, but many FE staff seem to question whether it is their role to provide education of such a non-specialist nature. PMID- 10148835 TI - Legal and policy issues in mental health services. PMID- 10148836 TI - Consent to mental health treatment: a theoretical analysis of coercion, freedom, and control. AB - Research has shown that substantial numbers of mental health patients may be coerced into 'voluntary' treatment. This article examines the concept of coercion to address the concerns of social scientists, treatment providers, and policy makers to know when coercion into treatment has occurred. This logically takes precedence over the second important question of whether or not coercion is desirable in some situations. A review of the scientific research on coercion and related topics of freedom, control, and choice leads to a theoretical framework in which coercion is defined in terms of opportunities to choose among courses of action. Implications of this analysis are drawn for mental health service delivery, mental health policy, and mental health research. PMID- 10148837 TI - Quality of mental health services and method of payment: an empirical study. AB - Data from a sample of clinicians are examined to study the relationship of the lower socio-economic client and therapist. Therapist practice variables are regressed on variables measuring client income and contrasting client's use of Medicaid with the use of private insurance or out-of-pocket funds. It is found that therapist practice variables can predict a significant proportion of the variance of these criterion variables. These relationships and their implications for the therapeutic needs of indigent clients with less severely impaired conditions are discussed. PMID- 10148838 TI - Obstacles and advocacy in children's mental health services: managing the Medicaid maze. AB - Of federal programs available, Medicaid offers the greatest potential for serving children's mental health needs. Obstacles to children receiving services through Medicaid are largely determined by a state's policy of regulating services. State policies affect the delivery of mental health services for children in two ways: first, by determining which services to make available, and second, by specifying the conditions of access to those services. Accordingly, this article focuses on obstacles within states' policies that prevent effective utilization of services by children. Specifically, states' choices of eligibility criteria, services, and the procedural obstacles present within payment options are examined. Suggestions for future research are made. PMID- 10148839 TI - Diversion of mentally disordered offenders: a legitimate role for clinicians? AB - Consultations to the courts often extend beyond criminal competencies and may include implicit statements regarding the diversion of mentally disordered offenders to treatment facilities. Arguments for diversion are based on humanitarian interests and treatment needs. Arguments opposing diversion recommendations emphasize (a) the variability of opinions regarding treatability, (b) the lack of sufficient outcome data, and (c) the potential for negative consequences in offering unsolicited opinions on diversion. Initial data from 271 pretrial evaluations underscore the range in psychiatric use of diversion recommendations, although inpatient referrals in particular appear to be based on clinical status. PMID- 10148840 TI - Itemmetric and scale analysis of a new computer-assisted competency assessment instrument (CADCOMP). AB - Male defendants (n = 99) who had been court ordered to a forensic treatment facility as incompetent to stand trial were tested using the Computer-Assisted Determination of Competency to Proceed (CADCOMP) instrument soon after admission (median days = 15). Shortly thereafter, competency was assessed by a forensic psychiatrist and by a majority decision of three mental health professionals who viewed a videotape of the forensic psychiatrist's interview. From the CADCOMP item pool, 18 scales were constructed on conceptual grounds. Internal consistency analyses revealed that most scales had reasonable item homogeneity and scale reliability. In addition, item and scale analyses, with few exceptions, followed predicted patterns of intercorrelation and association with competency as determined by both criteria. Scales and items measuring serious psychopathology, psycholegal ability, and criminal history demonstrated the strongest associations with competency. These findings suggest that additional research on CADCOMP is warranted. The instrument shows promise for use in forensic research and assessment. PMID- 10148841 TI - Psychological adjustment of liver transplant candidates. AB - The psychological functioning of 20 adult liver transplant candidates was evaluated. Using standardized assessment instruments, we found few personality disturbances and normal levels of anger. However, clinically significant levels of depression and anxiety were reported for 28% and 37% of the sample, respectively. Moreover, patients whose coping strategies were characterized by avoiding the exigencies of their illness reported more depression, more anxiety, and increased psychopathology. Disease severity was also positively correlated with anxiety and avoidant coping strategies. Implications of these findings for the pre-transplant psychological evaluation are discussed. PMID- 10148842 TI - Effect of race on renal transplant outcome. AB - Renal transplant outcome was compared in whites and blacks at a single center. All recipients transplanted between 1984 to 1991 were included in this study. White and black recipients were followed for a mean period of 37.6 (1-96) months. The age, sex, follow-up period, immunosuppressive protocol, number of retransplants, HLA mismatches and etiology of renal disease were comparable in the two races. Overall graft survival was lower in black recipients (p=0.0300). Graft survival in all cadaver (p=0.0520) and primary cadaver (p=0.1430) transplants was lower in blacks, though this was not statistically significant. Percentage of graft losses during the follow-up was higher in black 53/108 (49%), than white recipients 82/257 (32%)(p=0.002), as were cadaver graft losses due to rejection, 39/92 (42%) in blacks, 54/190 (28%) in whites (p=0.02). There was no significant difference in graft losses due to rejection between races in the 1 yr post transplant, but there were significantly more graft losses after 1 yr in blacks 16/83 (19%) compared to whites (16/156(10%)(p=0.05). In cadaver grafts functioning for 6 months, subsequent survival was lower in black recipients (p=0.0418). There was lower patient survival in blacks during the mean follow-up period of 37.6 months (1-96). In conclusion, lower graft survival in blacks can be partially explained by fewer LRD transplants in black recipients. Persistent lower graft survival in all black recipients and significantly more losses due to rejection beyond 1 yr may be related to immunological differences, poor compliance, or a combination of both. PMID- 10148843 TI - The effect of transfusions on renal allograft survival in the cyclosporine era: a single center report. AB - The potential efficacy of prior transplant transfusions on graft survival in the cyclosporine era has been reported from several centers which are reconsidering their transfusion policy. The purpose of this study has been to evaluate the results obtained in a large series of first kidney transplant patients (N=284) treated with cyclosporine. Our past experience showed a beneficial effect of blood transfusions in cadaveric renal transplants on conventional immunosuppression. Forty-eight patients never received blood transfusions, 85 patients received 1-2 transfusions, 72 patients received 3-5 transfusions and 79 patients received more than 5 transfusions in their pre-transplant periods. We did not show an obvious beneficial effect of prior blood transfusions in improving 1- and 2-year patient and graft survival. In fact, no statistically significant differences were found among any of the groups depending upon the transfusion status. In the transfused group, graft survival rates were 81.4% (1 year) and 77.8% (2 years) while in the non-transfused group they were 81.2% (1 year) and 78.4% (2 years)(p=n.s.). The patients who rejected had a significantly lower graft survival in the transfused group as compared to the non-transfused group. On the other hand, the transfused patients without rejection episodes experienced the best graft survival, suggesting a beneficial transfusion effect. We conclude that since it is impossible to determine which patients will not reject, pre-transplant transfusions under certain circumstances might be harmful, or at least not beneficial. We would recommend restricting transfusions in cyclosporine-tested patients only in cases of therapeutic necessity. PMID- 10148844 TI - Sequential Tc 99m mercaptoacetyl-triglycine (MAG3) renography as an evaluator of early renal transplant function. AB - A prospective study was carried out to evaluate the role of sequential Tc 99m MAG3 renography in assessing transplant function in the early post-operative period. Twenty patients were included in the study. Studies were performed on all patients at intervals of 48-72 hours until discharge. There were 11 clinically diagnosed episodes of rejection, 9 of which were correctly diagnosed using MAG3 renography. Six episodes of rejection were diagnosed prior to the onset of clinical symptoms. Two patients with graft infarction were correctly diagnosed. Six patients had evidence of transient renographic abnormalities in the immediate post-operative phase which were not associated with clinical symptoms, all of these resolved spontaneously on subsequent examinations and were presumed to be related to resolving acute tubular necrosis (ATN). The perfusion index was of no discriminatory value in this study. Sequential Tc 99m MAG3 renography is highly sensitive but entirely nonspecific in the evaluation of pathology in the transplant kidney. Rejection in an uncomplicated transplant can be readily detected in many cases well in advance of clinical manifestations. This study demonstrates that Tc 99m MAG3 renography is certainly equal to Tc 99m DTPA renography or Iodine 131 renography in assessing early transplant function. However, Tc 9m MAG3 exposes the patient to considerably less radiation and the images are of superior quality. PMID- 10148845 TI - Ten-year experience in the use of double balloon catheter for kidney procurement from non-heart beating donors in cadaveric kidney transplantation. AB - One-hundred-and-twenty patients underwent first cadaveric kidney transplantation from the non-heart beating donors. All of the organs were procured with the use of double balloon catheter for in situ cooling. The mean warm ischemic time and cold ischemic time were 10.7 +/- 17.0 minutes and 18.9 +/- 11.4 hours, respectively. One- and 5-year graft survival rates were 85.0 and 72.7%, respectively. Among 120 recipients, 30 (25%) grafts functioned immediately (immediate function), 82 (68.3%) grafts functioned after varying length of oliguric periods (delayed function) and 8 (6.7%) grafts never functioned (non function). The mean age of the donors in the group of immediate function (31.5 +/- 16.1 yr) was significantly lower than those of other two groups. The mean warm ischemic time in the group of immediate function (6.0 +/- 11.2 min) was significantly shorter than that of delayed function. However, there was no significant difference in donor hypotensive episode, types of preservation fluid and cold ischemic time between the groups. The conclusion is that the ultimate result of cadaveric kidney transplant from the non-heart beating donors with the use of double lumen catheter is acceptable despite a relatively high incidence of delayed graft function. PMID- 10148846 TI - Physicians attitudes toward living non-related renal transplantation (LNRRT). The Living non-Related Renal Transplant Study Group. AB - Renal transplantation is considered now the definitive treatment for patients with end-stage renal disease (ESRD). Unfortunately, the worldwide shortage of kidneys remains the most important obstacle to transplantation. In developing countries, including those of the Middle East, the shortage is even more dramatic. Despite great efforts to establish and maintain successful transplant centers, the number of kidneys that have been transplanted in the last few years has actually declined. The lack of a dependable kidney source played well into the hands of unscrupulous entrepreneurs who started brokerage of organs for profit. In this practice, patients with ESRD travel to India and other countries to purchase kidneys from living genetically non-related poor donors. Patient care was therefore relegated to the laws of the marketplace and both patients and donors were exploited to maximize profit. Additionally, reported results of this type of transplantation were inferior to those of other types of transplantation. Not unexpectedly, these issues have created intense controversy among transplant physicians and the general public in which moral, ethical and medical issues were debated. To investigate these issues, we conducted a large multicenter study in Saudi Arabia, Bahrain and Egypt. In the first phase of this study, we surveyed 50 institutions regarding their attitude toward LNRRT, of which 22 responded. The results of our survey clearly show that patients with ESRD take the initiative in seeking LNRRT despite physician discouragement and significant financial burden.(ABSTRACT TRUNCATED AT 250 WORDS) PMID- 10148847 TI - The influence of heparin-coated and uncoated extracorporeal circuits on blood rheology during cardiac surgery. AB - The effect of heparin-coated perfusion circuits on blood trauma during clinical cardiopulmonary bypass (CPB) was studied in order to find out if traumatic changes in the blood could be minimized. Twenty-four patients undergoing coronary artery bypass surgery were randomized prospectively to CPB with heparin coated circuits (HCC) or non-coated circuits (NCC). The trauma to blood was assessed by measuring damage to blood cells by estimating red and white cell rheology changes. These were measured as red cell filtration rate (RFR) and white cell filtration rate (WFR) using standard microfiltration methods. Furthermore, changes in plasma hemoglobin (P-Hb), whole blood and plasma viscosity were simultaneously assessed. The RFR was significantly reduced in both groups during CPB by 10% in the HCC and 32% in the NCC groups (p less than 0.01). When comparing the HCC and NCC groups, a significant difference was first seen after 30 minutes of bypass (p less than 0.05) and increased at the end of CPB (p less than 0.01). Similar results were seen regarding WFR (15% and 36%, p less than 0.01). After 30 minutes of bypass, a significant difference was seen between HCC and NCC groups (p less than 0.05). Furthermore, a significant increase in P-Hb levels were seen during CPB in both patient groups. At the end of CPB, there was a significant difference in P-Hb levels (HCC 305+/-90 mg/L; NCC 455+/-78 mg/L, p less than 0.01) when comparing the two groups.(ABSTRACT TRUNCATED AT 250 WORDS) PMID- 10148848 TI - Cardiotomy suction versus red cell spinning during repair of descending thoracic aortic aneurysms. AB - Two consecutive series of patients undergoing repair of descending thoracic and thoracoabdominal aortic aneurysms with partial cardiopulmonary bypass and low systemic heparinization (activated coagulation time: ACT greater than 180 sec) for proximal unloading and distal protection were analyzed. During the surgical procedures, thoracic shed blood was recovered either with a red cell spinning autotransfusion device (n=10) or two pump suckers and Duraflo II heparin surface coated cardiotomy reservoirs (n=10). There were 5/10 acute lesions and 1/10 ruptures for the autotransfusion group versus 5/10 acute lesions and 2/10 ruptures for the cardiotomy group (NS). Extension of aortic resection (range 1 8) was 3.6+/-1.2 for autotransfusion versus 3.5+/-1.4 for cardiotomy suction (NS). Mean number of reimplanted patches for intercostal and visceral reperfusion was 0.3+/-0.6 for autotransfusion versus 0.6+/-1.0 for cardiotomy (NS). Perfusion time was 41+/-17 min for autotransfusion versus 60+/-19 min for cardiotomy (p less than 0.05) and cross clamp time was 33+/-14 min for autotransfusion versus 43+/-17 min for cardiotomy (p less than 0.01). Total heparin dose was for 9500+/-2100 IU for autotransfusion versus 9800+/-1300 IU for cardiotomy (NS). The mean of the lowest ACTs measured during perfusion was 281+/ 121 sec for autotransfusion versus 258+/-58 sec for cardiotomy (NS). The total protamine dose given was 7800+/-2100 IU for autotransfusion versus 9700+/-1900 IU for cardiotomy (p less than 0.05). The volume of washed red cells prepared was 3186+/-1318 ml for autotransfusion versus 0 for cardiotomy (p less than 0.05).(ABSTRACT TRUNCATED AT 250 WORDS) PMID- 10148849 TI - Improved fluid management by a simple extracorporeal circuit design change. AB - Extracorporeal circulation (ECC) circuits vary in design in order to fulfill the needs and perfusion plans of the surgical team. There are as many variations in these configurations as there are perfusion techniques. This article describes a simple circuit modification that has diverse advantages in its application. The implementation of this modification may improve sterile technique, lower prime volume, sequester blood, and add versatility in fluid management. PMID- 10148850 TI - Solving fluid-flow control problems with porous plastics. AB - To tackle fluid-flow control problems, traditional porous materials, such as ceramics, glass, metal, fabric, paper, and fibres, are now being replaced by an increasing range of porous plastics. In this article, the author discusses some of those that are available, and outlines the advantages of using these materials to replace traditional ones. PMID- 10148851 TI - Developing a medical device package. AB - Effective packaging is vital to achieve an effective medical device, and it is essential that designers of sterile medical device packaging are fully aware of all of the factors involved. These considerations include not only the requirements of the package in terms of appropriate method of sterilization, product-packaging interactions, and shelf-life, but also the environment in which the product will be used, the needs of the production facility, and what storage and distribution hazards the packaged product may encounter. In this article, the author provides a comprehensive packaging brief for designers, which clearly defines the needs of the manufacturer and the customer. PMID- 10148852 TI - Is fetal heart rate monitoring during labor and delivery justified? PMID- 10148853 TI - New monitoring strategies in respiratory care of pre-term infants. PMID- 10148854 TI - The clinical utility of serum creatinine measurement vs calculated glomerular filtration rate in the assessment of renal function in the premature infant. AB - The ability to assess the glomerular filtration rate (GFR) without the necessity of collecting urine in premature infants would be of significant clinical benefit. In 1986, the modified Schwartz formula (MSF = 0.33 x length (cm)/plasma creatinine (mg/dL)) was developed. In the MSF, GFR was estimated in premature infants during the first post-natal year. The goal of the present study was to test the applicability of the MSF in premature infants during the neonatal period and to evaluate the clinical use of serum creatinine (Cr) as a predictor of GFR. In 42 premature infants of mean (+/-SD) birthweight 1506.6 (+/-388.8) g, gestational age 31.3 (+/-1.7) wks and post-natal age 14.7 (+/-8.3) d, the correlation between GFR, estimated by endogenous creatinine clearance (ECrC), was compared with the serum Cr and with GFR estimated by the MSF. The correlation coefficient between ECrC and serum Cr was 0.6789 and between estimated GFR derived from ECrC and MSF, 0.4657. In premature infants during the neonatal period, serum Cr has a better correlation with GFR than with MSF. When serum Cr is less than 0.9 mg/dL, the 95% confidence interval suggests that at least 89% of the infants can be expected to have an ECrC within the normal range. PMID- 10148855 TI - Outcome of hospitalization for defendants found incompetent to stand trial. AB - This study assessed the outcome of hospitalization for incompetent criminal defendants admitted to the forensic unit of a state hospital for treatment during a 4-year period. Findings suggested that the overwhelming majority of the defendants were restored to competency. The defendants also showed significant improvement in overall severity of psychopathology during hospitalization. Further, the duration of hospitalization for these defendants was relatively short. Although these results are promising with regard to treatment of incompetent defendants, predicting the outcome of hospitalization for these defendants was problematic. Prediction of competency restoration was precluded because persistent incompetence was so infrequent. Moreover, multiple regression analyses suggested limited predictive ability with regard to defendants' discharge level of functioning or length of hospitalization. These findings are consistent with the view that examiners should exercise caution in making recommendations to the courts concerning treatability of incompetent defendants. PMID- 10148856 TI - Evaluation of biocompatibility of various ceramic powders with human fibroblasts in vitro. AB - Cell reaction to powders of ceramics was studied in vitro. Cultured human fibroblasts were exposed to different types of ceramic powders: zirconia (ZP), alumina (A), tricalcium phosphate (TCP) and hydroxyapatite (HA), at various concentrations. The cell viability at the different exposure times was measured by the colony formation (expressed as colony forming efficiency, CFE), neutral red uptake (NR) and colorimetric tetrazolium (MTT) reduction. Alumina and hydroxyapatite showed no cytotoxic effects at studied doses (1-500 mug/ml) while zirconia and tricalcium phosphate inhibited cell viability, with 50% of CFE reduction at the concentration of about 50 mug/ml. In order to study the cytotoxic mechanism of zirconia powder, two further experiments were included, viz. the cellular response to the sintered zirconia ceramic powders (CZP) which were obtained by crushing the sintered ceramic material; and the measurement of the degradation of zirconia ceramic plate in the different solutions, i.e., either in saline or in 0.02 M lactic acid (pH 2.72). Similar cell reactions were obtained for the CZP and ZP by using MTT and NR assays. Slow releases of ions from zirconia ceramic plate, yttrium in both solutions and zirconium and yttrium in lactic acid, were detected. PMID- 10148857 TI - Research and development of alumina and zirconia artificial hip joint. AB - The object of the experiments was to discover the static and dynamic load carrying capacity of a prosthetic system consisting of a titanium allow stem, zirconia ceramic ball head and UHMWPE (ultra-high molecular weight polyethylene) socket molded in the ceramic shell, the latter two were both of 22 mm in diameter. The components of the artificial hip joint were placed in a vertical position and load was applied, alternating between 0 and 10 kN and then 12 kN with a frequency of 30 Hz under Ringer's solution up to 10 7 cycles respectively. After 2 x 10 7 cycles there was no sign of damage to be observed among the system tested using the joint simulator. This seems to be a very high safety factor compared with loads occurring in vivo. PMID- 10148858 TI - Ceramic formation on metallic surfaces (ceramization) for medical applications. AB - Surface transformations can be performed on metals in order to combine their load bearing properties to the inertness and wear resistance of ceramics. In a joint prosthesis, metals are useful for their high fatigue strength and ductility, but they are more sensitive to superficial corrosion and wear than ceramics. Coating a ceramic on metal surface will improve the qualities of the metallic component. The various ways of transforming a metallic surface into a ceramic one are described. First, the surface treatments to improve the friction and wear properties are analysed. Coatings and surface transformations give superficial inert compounds. Many techniques are used to create hard, corrosion resistant layers on the surface. The processes may involve heating of the treated parts. But some metals cannot be heated without an alteration of their mechanical properties. The adhesion strength--and thus, the lifetime--of the ceramic layers depend on the binding forces and on the structure of the interfaces between the bulk metal and the outermost ceramic. Coatings generally have a lower adhesion strength than in-situ formed phases and the risk of peeling is higher. Second, the plasma-sprayed coatings performed to improve the bone anchorage are described. This review does not deal with bioactive materials. So, only the alumina coatings and their mechanical compatibility advantage are present. PMID- 10148859 TI - Diamond-like carbon: a potential means of reducing wear in total joint replacements. AB - This paper begins with a review of recent studies of the progressive mechanisms of degradation in total hip and knee replacements. It is concluded that wear is a major problem due to resulting tissue reactions especially to fine polymeric debris. Methods of lessening or overcoming these problems by modern methods of surface modification are considered, among these being ion implantation and ion beam-assisted deposition. It is argued that the physical and chemical properties of diamond-like carbon (DLC) coatings make them especially promising for the reduction of friction and adhesive wear in all forms of joint replacement. An ion beam-assisted method of depositing DLC efficiently at low temperatures is described, together with the physical properties of the resulting material. PMID- 10148860 TI - Update on cardiac catheterization and coronary arteriography. AB - Indications for cardiac catheterization--including coronary angiography--have substantially broadened with the advent of nonsurgical therapeutic interventions performed in the catheterization laboratory. Consequently, the increasing number of facilities performing these procedures require clear and unmistakable guidelines regarding the indications for and the safety and ethical aspects of the procedure. Technical developments in image acquisition and evaluation, such as quantitative analysis, allow the exact, reproducible assessment of minute changes in cardiac morphology and function, the evaluation of which becomes increasingly important in prognosis-related clinical trials. PMID- 10148861 TI - Risk stratification after myocardial infarction. AB - The optimal approach to risk stratification after myocardial infarction remains controversial. Early risk stratification is designed to identify those patients who may benefit from mechanical myocardial revascularization procedures or more intensive medical therapy to prevent early adverse outcomes. Use of exercise testing and noninvasive cardiac imaging to identify residual myocardial ischemia and left ventricular dysfunction in order to divide patients into high- and low risk groups has gained increasing acceptance. Patients at high risk then undergo cardiac catheterization. There is also support for early cardiac catheterization to permit the rapid identification of patients who may benefit from mechanical revascularization. The challenge to physicians is to select the most accurate, safe, and cost-effective approach at their particular institution. PMID- 10148862 TI - New technologies in interventional cardiology. AB - New technologies for interventional cardiology include metallic intraluminal supports (stents), mechanical devices used for plaque removal (atherectomy), and photoablative devices (lasers). Several individual devices in each category are in active clinical investigation and appear to provide safe and effective treatment for many problems that have continued to plague conventional balloon angioplasty. These include failure to dilate eccentric, rigid, or diffuse stenoses; abrupt closure of the dilated segment; and restenosis after successful dilatation. Working with these devices, physicians have learned not only how to use them optimally but a great deal about the biology of restenosis and the manner in which new interventional devices should be evaluated. Although none of the new technologies is likely to replace balloon angioplasty, which has demonstrated broad applicability, success, and safety, the selective use of new devices seems certain to enhance the possibilities for percutaneous transluminal revascularization. PMID- 10148863 TI - Conventional coronary angioplasty. AB - Coronary angioplasty has come a long way since its inception 16 years ago. Although several new devices have shown promise, none, with the exception of the stent, has significantly changed results, and the "simple" balloon remains the backbone of coronary angioplasty. Increased operator experience and advanced guidewire and balloon technology have expanded indications for the procedure to include multivessel angioplasty, angioplasty of chronic occlusions and grafts, angioplasty in the setting of acute myocardial infarction, and supported, high risk angioplasty. However, single-vessel angioplasty remains by far the most common form of this procedure. Restenosis continues to be an unsolved problem. Results of several trials comparing angioplasty and surgery are expected soon, but they will not answer the question of which method of revascularization is best for the individual patient. PMID- 10148864 TI - Dealing with hematologic problems before surgery. PMID- 10148865 TI - Obstacles in reoperative orchiopexy--and a method to master them. PMID- 10148866 TI - Corneal and external disorders and refractive surgery. PMID- 10148867 TI - Contact lenses and corneal shields. AB - Contact lens wear has been associated with a wide spectrum of corneal complications. Disposable contact lenses have not eliminated the problem of corneal ulcers associated with extended-wear contact lenses. Rigid, gas-permeable extended-wear lenses may be considered as an acceptable alternative to extended wear of soft contact lenses. Collagen corneal shields are a clinical indicator of collagenase activity on the ocular surface and serve as a collagenase inhibitor. PMID- 10148868 TI - Corneal topography. AB - The heightened interest in refractive corneal surgery has resulted in the increased utility of videokeratography in clinical practice. During this past year, studies have provided new information about the accuracy, reproducibility, limitations, and comparative strengths and weaknesses of different topographic devices. Videokeratography studies have yielded new information about the effects of surgical procedures such as excimer laser photorefractive keratectomy, radial keratotomy, penetrating keratoplasty, trabeculectomy, and strabismus surgery on the shape of the cornea. The use of these devices in fitting patients with keratoconus and patients who have had radial keratotomy with contact lenses is illustrated and subtle topographic abnormalities induced by rigid and soft contact lenses are reported. The early detection of keratoconus with videokeratography has provided new insights into the genetics of this disorder. Computer-assisted topographic devices are rapidly gaining acceptance as screening tools for the detection of early keratoconus in candidates for myopic refractive surgery. PMID- 10148869 TI - Storage, surgery, outcome, and complications of corneal and conjunctival grafts. AB - Corneal transplantation is still limited by a shortage of donor material, but the type of storage medium used once a cornea has been acquired is probably irrelevant to graft outcome. Vancomycin HCl shows promise as a supplement to gentamicin sulfate in storage media. New methods of HLA typing using donor ocular tissue have largely helped to overcome the problems associated with typing of cadaveric blood, but the value of HLA typing in improving corneal graft survival is now in doubt. Alternative regimens of immunosuppression are being tested in animal models, but there is still no consensus on the best ways to use existing agents such as corticosteroids. Rejection remains the most common cause of unsuccessful corneal grafting in large cohorts, but glaucoma and astigmatism also limit postoperative graft function. Limbal stem cell grafts are promising for the management of many ocular surface diseases and conjunctival limbal autografts for pterygia may be the most successful surgical method for preventing recurrence. PMID- 10148870 TI - Mechanical methods in refractive corneal surgery. AB - Keratorefractive surgery has developed rapidly over the past decade. For patients with aphakia, however, posterior chamber lenses are safer and more predictable than refractive corneal surgery; myopia is the greatest challenge to this type of surgery. No technique as yet has an accuracy that is adequate for the general treatment of myopia. Keratotomy is the most common procedure currently performed for the correction of mild myopia and astigmatism. Results are less accurate and less stable with myopic than with aphakic epikeratoplasty. Although it is technically more difficult, keratomileusis seems to be more predictable than epikeratophakia. Nonfreeze lamellar corneal surgery accelerates wound healing. Synthetic lenses and ring-shaped implants are also being developed to modify corneal refraction. Current research is directed toward laser stromal keratomileusis on discs that are removed from the cornea using a microkeratome. PMID- 10148871 TI - Indications, results, and complications of refractive corneal surgery with lasers. AB - Large numbers of patients are being treated for myopia, hyperopia, and astigmatism using the excimer laser. For many patients who are treated for myopia and hyperopia, the procedure is elective and these treatments remain investigational. The use of other lasers for refractive surgery is at an earlier stage, with human trials commencing for infrared lasers. Animal studies are being performed for pulsed picosecond and solid-state ultraviolet lasers. The indications for refractive treatment should be clearly defined, although the results of laser application remain the subject of investigation. Complications of laser application to the cornea occur in the immediate, short-term, and long term posttreatment period. A continual improvement in refractive results along with a reduction in complications remains the goal of laser refractive research. PMID- 10148872 TI - A two-site immunoradiometric assay for intact parathyroid hormone. PMID- 10148873 TI - A rapid test for C. difficile. PMID- 10148874 TI - Advances in microtome technology. PMID- 10148875 TI - A cost-effective alternative for early diagnosis of AMI. PMID- 10148876 TI - Results of 1236 endoscopic carpal tunnel release procedures using the Brown technique. AB - In a series of 1236 patients who underwent endoscopic carpal tunnel releases using the two-portal Brown technique, the results were favorable in 98%, the failure rate was 2%, the instance of iatrogenic injury was 0.08% (one tendon injury), and the overall complication rate was 0.97%. The patients had resolution of carpal tunnel syndrome symptoms in an average of 14 days and returned to work in an average of 15 days. Recurrence rate to date has been 2%, with the longest follow-up of 30 months. These results indicate that this is a safe and efficacious method of treatment for patients with carpal tunnel syndrome who require surgery. PMID- 10148877 TI - Annular ligament reconstruction in chronic posttraumatic radial head dislocation in children. AB - Traumatic radial head dislocation without an associated fracture is an unusual injury in children. Occasionally, the diagnosis is missed or the injury is not treated acutely, leading to chronic radial head dislocation. The recommended treatment has been controversial, ranging from benign neglect to surgical reconstruction. This case report and review of the literature describes treatment indications and options, as well as potential risks and benefits for conservative and surgical approaches. PMID- 10148878 TI - Symposium: porous-coating methods: the pros and cons. PMID- 10148879 TI - Comparison of patient-controlled and nurse-administered analgesia using intravenous fentanyl during labor. AB - Preliminary observations have shown that fentanyl citrate, a potent narcotic, is helpful during labor without undue side effects. This randomized prospective investigation compared the patient-controlled administration of fentanyl with that of administration by nurses on request. Eighty healthy women beginning active labor (cervical dilation 4 cm) at term were assigned to receive fentanyl intravenously by either patient-controlled administration (n=37) or nurse administration on demand (n=43). Pain intensity measurements during early and late labor revealed the degree of analgesia to be the same in both groups. The delay in setting up the infusion system and the short time between requesting analgesia and vaginal delivery were limitations with self-administration. Maternal oversedation and vomiting did not occur. Neonatal naloxone therapy was used infrequently, umbilical serum levels of fentanyl were the same in both groups, and postnatal neuroadaptive testing revealed comparable results in both groups. Despite the usefulness of fentanyl during labor, administration by the patient had no advantages over administration by the nurses in significantly reducing drug use, improving pain relief, or avoiding drowsiness. PMID- 10148880 TI - The pulmonary artery catheter: twenty years of use. PMID- 10148881 TI - The total artificial heart--a bridge to transplantation. AB - Many heart centers are utilizing the total artificial heart for a bridging technique to transplantation, particularly in patients with bi-ventricular failure or irreversible left ventricular failure, where a donor heart is not readily available. This discussion includes the training procedure, operation and management of Canada's first total artificial heart performed on May 1, 1986. PMID- 10148882 TI - Support when gas exchange fails--ECMO, ECCO2R and IVOX. AB - The principles and problems of extracorporeal respiratory support (extracorporeal membrane oxygenation and extracorporeal carbon dioxide removal) are reviewed. The recent development of intravenous oxygenation (IVOX) is noted and compared with existing forms of extracorporeal support. PMID- 10148883 TI - Drawover anesthesia. A review of equipment, capabilities, and utility under austere conditions. AB - Anesthesia care may be required under austere conditions during military operations and natural disasters. Drawover anesthesia devices that provide inhalational anesthetic agents in air or an air/oxygen mixture are useful in these circumstances. This equipment must be portable, rugged, lightweight, and capable of functioning with an absolute requirement for compressed gas supplies. The historical experience, available equipment and literature on this subject are reviewed. PMID- 10148884 TI - An emergency auto-transfusion device designed for developing countries. PMID- 10148885 TI - Use of a pulmonary artery catheter in the management of the severe preeclamptic patient. AB - The perioperative management of the parturient with severe preeclampsia can be challenging with reference to fluid and antihypertensive therapy. A pulmonary artery catheter should be used when necessary to provide accurate information concerning the patient's hemodynamic status and to provide additional information regarding the effectiveness of the therapeutic modalities employed. PMID- 10148886 TI - Computerized hospital on-line resources allocation link (CHORAL): a mechanism to monitor and establish policy for hospital ambulance diversions. AB - Ongoing monitoring of the availability of hospital critical care resources is necessary to assure patients in the emergency medical services (EMS) system reach appropriate care. In this densely populated area Multnomah County, Oregon, ambulances have been diverted by radio from several hospitals before finding one that would accept the patient. Dispatch centers and base-stations had no reliable method to monitor the availability of hospital resources. Data were not available for use in establishing policy. In response, this community developed an on-line, computerized system known as Computerized Hospital On-Line Resources Allocation Link (CHORAL) that visually displays the resource status of all hospitals to the 911 center, base station, and participating hospitals. A change of status requires simple keystrokes for entry into the computer which in turn transmitted automatically to all other CHORAL computers. Six patient care resources are monitored: Adult Ward (AW); Computerized Axial Tomography Scan (CT); Critical Care (CC); Labor and Delivery (LD); Pediatric (PEDS); and Psychiatric Secure Beds (PSB). Paramedics use protocol to determine if a particular patient fits one of these categories. Availability is relayed to paramedics by the 911 center and the base-station. During the first three months of system operation, there were 337 diversions representing 4,527 hours among 10 of the 12 participating hospitals. The most common resource resulting in diversion was PSB, which was unavailable for 2,195 hours (48.5%). Unavailability of CT resulted in the lowest number of diversions (1.3%, 60.3 hours).(ABSTRACT TRUNCATED AT 250 WORDS) PMID- 10148887 TI - The integration of a helicopter emergency medical service in a mass casualty response system. AB - Since 1985, the state of Connecticut has been served by a hospital-based, advanced life support (ALS) helicopter air medical service. The service is stationed at a 1,000-bed, Level 1, trauma center that is responsible for its operation. Connecticut statute requires the hospital to file operations reports with the Office of Emergency Medical Services, which reports to the Connecticut Department of Public Health. Operations include response to requests for transportation of severely ill or injured patients from the scene of an incident, and patient transport from one hospital to a higher level, definitive-care hospital. This service also was charged to develop a disaster response plan to be integrated into the overall state plan for disaster responses. The helicopter disaster response involves all six New England states and three hospital-based emergency medical helicopter programs that operate in the New England states. This approach has allowed for joint planning and multi-agency, simulated drills. The helicopter emergency medical service has responded to 15 simulated emergencies (drills) and seven actual mass casualty incidents from May, 1985 to June, 1989. In Connecticut, the planning process conducted by the Department of Public Health and the Office of State EMS produced a coordinated, multi jurisdictional, mass-casualty response plan. PMID- 10148888 TI - High risk pediatric emergency air transport. AB - INTRODUCTION: Pediatric Emergency Air Transports (PEATs) at Massachusetts General Hospital, Boston, Massachusetts, were reviewed between November 1986 and December 1987. Severity of illness, complications, and outcome of PEATs were compared with ground transports. Factors associated with PEAT survival were identified. METHODS: Severity of illness was measured using a modified Denver Patient Status Category (DPSC) method and the Therapeutic Intervention Scoring System (TISS). There were 35 PEATs (30 helicopter, five fixed-wing) and 96 ground transports. RESULTS: Mean severity of illness for patients was greater in PEAT than for the ground transport (PEAT DPSC score=4.23+/-1.06 versus ground DPSC=3.57+/-0.89 [SD], p=.0005). The PEAT mortality was associated with a greater mean severity of illness (TISS survivors=19.1+/-11.4 versus non-survivors=44.3+/-9.5, p=.0001), but not with: the presence of an on-flight physician; transport delay; transport duration; age; sex; history of chronic illness; or intra-transport medical complications. CONCLUSIONS: Compared to ground transports, PEATs were used for higher risk patients. PMID- 10148889 TI - Allies or adversaries? The Bush administration and the managed health care industry. PMID- 10148890 TI - Designing quality development programs. PMID- 10148891 TI - New directions in cost containment strategies. PMID- 10148892 TI - Tips on customer service and conflict resolution. PMID- 10148893 TI - Viewpoint: considerations in contracting specialty PPO services. PMID- 10148894 TI - Practice parameters: a foundation for quality advancement. PMID- 10148895 TI - An overview of PPO physician credentialing. PMID- 10148896 TI - Recessionary times and beyond: the prospect for managed health care. An interview with Kenneth E. Raske. PMID- 10148897 TI - Utilization management--caveat emptor. PMID- 10148898 TI - Emerging trends in utilization review and management. PMID- 10148899 TI - New Jersey DRG situation. PMID- 10148900 TI - Liability relating to formularies and drug utilization management. PMID- 10148901 TI - Speech recognition cuts report turnaround time. PMID- 10148902 TI - Ultrasound may improve utility of defecography. PMID- 10148903 TI - Coaxial system improves thrombolysis of ischemia. PMID- 10148904 TI - Surgeon's perspective in MR imaging of the knee. PMID- 10148905 TI - New diagnostic insights in pediatric neurosonography. PMID- 10148906 TI - Directional coronary atherectomy. PMID- 10148907 TI - Cinefluoroscopy of the aortic valve: an accurate noninvasive method for assessing critical aortic stenosis in the elderly. AB - The purpose of this study was to assess whether the degree of fluoroscopic aortic valve calcification could help identify the presence of aortic stenosis in the elderly. To evaluate the diagnostic utility of cardiac fluoroscopy for the detection of aortic stenosis (aortic valve area less than or equal to 1.0 cm 2) in patients 60 years or older, aortic valve area determined by cardiac catheterization was related to the pattern of calcification seen on cinefluoroscopy in 97 patients (mean age of 72 +/- 6 years) with suspected aortic stenosis. Dense circumferential (3+) calcification of the aortic valve was seen on cinefluoroscopy in 56 of 59 patients with an aortic valve area less than or equal to 1.0 cm 2 (sensitivity 95%), compared to 5 of 38 patients with aortic valve area greater than 1.0 cm2 (specificity 87%) (p less than .001). These findings suggest that in patients 60 years of age or older with suspected aortic stenosis, a dense circumferential (3+) aortic valve calcification on cinefluoroscopy is highly predictive of an aortic valve area less than or equal to 1.0 cm2 with a positive predictive accuracy of 91% and a negative predictive accuracy of 91%. Thus cinefluoroscopy may provide an accurate adjunct or alternative to Doppler echocardiography in the assessment of aortic stenosis in the elderly. PMID- 10148908 TI - Clinical advances in nonepicardial implantable defibrillator lead systems. PMID- 10148910 TI - Current technologies for detection of myocardial ischemia during acute care. PMID- 10148909 TI - New trends in cardiac pacing: technological considerations, programmable functions, rate response, and antitachycardia pacing. PMID- 10148911 TI - Intravascular ultrasound: a review of an innovative and important diagnostic tool. PMID- 10148912 TI - Real-time computers in medicine and physiology. PMID- 10148913 TI - Bar code technology and application in health care. PMID- 10148914 TI - Piezoelectric extracorporeal shock wave lithotripsy by EDAP LT-01: the Singapore experience. AB - One hundred and eighty patients with stones in the calyces, renal pelvis, upper, middle, and lower ureter were treated by piezoelectric extracorporeal shock wave lithotripsy using the EDAP LT-01 lithotripter. The size of the stones treated ranged from 0.5 cm to 6.5 cm with the vast majority (94%) measuring less than 3.0 cm. Forty-eight patients (27%) had multiple stones in the renal collecting system. Successful fragmentation occurred in 79%, partial fragmentation in an additional 17%, and no fragmentation in 4%. Forty percent of patients required repeated treatment with an average of 2.3 sessions. Of those patients treated, none required general anesthesia, however, analgesia was needed in 121 patients (67%). Urosepsis occurred in 4% and 0.5% developed intrarenal hematoma. There was no mortality or loss of renal units in this series. The auxiliary procedure rate was 15% (percutaneous nephrolithotripsy 5%, ureteroscopic manipulation 9%, and open surgery 1%). The 3-month stone-free rate was 64%. PMID- 10148915 TI - Prehospital and emergency department verification of endotracheal tube position using a portable, non-directable, fiberoptic bronchoscope. AB - Verification of endotracheal tube (ETT) location in prehospital setting and the emergency department (ED) is a challenging task. Unrecognized esophageal intubations with potentially dangerous consequences may occur more frequently in these environments than in less hectic settings. To evaluate the capabilities of a portable, non-directable, fiberoptic bronchoscope (Visicath; Saratoga Medical, Saratoga, Calif., USA) to detect appropriate ETT placement, a prospective series of 22 intubated prehospital, air-medical, or ED patients underwent fiberoptic verification (FOV) of a newly placed ETT. Each patient was intubated under urgent circumstances. The time required for FOV, ETT location, the relative difficulty of intubation, and the changes in management as a result of FOV were recorded. A total of 24 FOVs were performed, twenty-one tracheal (88%), and two esophageal (8%) intubations were identified. Position could not be identified in one case (4%). FOV confirmed placement in 23 intubations (96%) in less than 25 seconds. Seven intubations (29%) were judged to be "difficult." FOV resulted in five minor changes in management (22%) and was the sole confirmation method for five intubations. We conclude that fiberoptic verification is a promising method of ETT position in air-medical and ED intubations. PMID- 10148916 TI - Rapid volume infusion in prehospital care. AB - The ability to deliver large volumes of intravenous (IV) fluids may be critical to the successful prehospital resuscitation of hypovolemic patients. We compared the time required to deliver one liter of crystalloid solution, using an administration set-up consisting of a 16-gauge (g), 1.25 inch, intravenous cannula, a pneumatic pressure bag, and either conventional intravenous tubing (3.2 mm internal diameter [ID]) or large bore (4.4 mm internal diameter [ID]) "shock" tubing. With the fluid bag positioned at 110cm (46 inches) above the level of the cannula, the mean elapsed time to deliver 1,000ml using the conventional tubing set-up was 6.0 minutes, while the same volume could be delivered in only 2.7 minutes with the shock tubing configuration. This time was reduced to 1.8 minutes when the intravenous cannula size was increased to 14g. By attaching a liter of fluid to each arm of the "Y" adapter of the shock tubing, virtually uninterrupted fluid flow may be maintained at this rate. We feel this intravenous configuration could enhance greatly the ability of paramedics to provide fluid resuscitation in the field setting. When such IVs are established en route to a receiving hospital, this technique may prove to be an important adjunct to improving patient outcome from hypovolemic shock. PMID- 10148917 TI - The role of aeromedical transportation in global disaster health care. AB - There are several unique aspects of aeromedical transportation that render it vital to the overall management of disaster emergencies. Valuable time can be saved in moving medical expertise, supplies, and equipment into the disaster area as well as in moving victims out of the hazardous area quickly and in large numbers. Chaotic ground traffic at and near the disaster scene as well as environmental obstacles en route often may be avoided. Large numbers of disaster victims can be cared for efficiently en route by proportionately fewer health care personnel than is possible using traditional land carriers due to the concentration of many patients in one aircraft. Patients with similar injuries (e.g., burns) can be routed to and concentrated in centralized institutions that specialize in the care of those specific injuries. The plans for execution of the foregoing should include the use of military troop-transport aircraft that may be converted easily for patient transport. Also, military personnel should be involved, as they are part of a highly organized structure that can be mobilized more easily and swiftly than can most civilian organizations. The United States Air Force aeromedical evacuation policies and management structure is reviewed with attention directed toward additions and adaptations of this system needed to allow it to serve global disaster response. Such a highly evolved system will require a governing body with global reach for purposes of coordination and management. The resources for such a system currently exist but such an organization has yet to be formed. PMID- 10148918 TI - Historical roots of lithotripsy. PMID- 10148919 TI - Gallstone lithotripsy: early American results and the new reality. AB - Early comparative data is now available from several different American Gallstone Lithotripsy, ("GSL") trials (Technomed, Dornier, and Medstone). While the 6-month gallbladder clearance results appear to be remarkably similar (36%-43% in less than 20-mm solitary stones), they do not appear to match the results obtained by the Munich group in their first 175 patients (63% clearance at 4-8 months). We review the currently available American data and describe our on-going national clinical trial with the Technomed Sonolith 3000 investigation. In this trial, patients are randomized to lithotripsy plus ursodiol (Actigall,? Ciba Geigy), or lithotripsy alone to determine the effect of oral bile salts on the gallbladder fragment clearance rate. To date, the early success rate is clearly better in the GSL plus ursodiol arm. Following one or two lithotripsy sessions, 62.1% of patients with solitary stones, 5-20 mm in size, have had fragmentation to 7 mm or less. In the same group, 39.1% of gallbladders are clear at 6 months. While the 6 month gallbladder clearance rate appears to be a reliable indicator of eventual gallbladder status it should not be regarded as the end point of therapy and it clearly does not represent the final efficacy rate for gallstone lithotripsy. A review of the results obtained from on-going American IDE trials is compared with the published German results using GSL and combination oral dissolution therapy. PMID- 10148920 TI - Extracorporeal shock wave lithotripsy: our experimental and clinical experience with the Direx machine. AB - The Direx Tripter X-1 is a modular extracorporeal shock wave system that uses underwater spark gaps as its source for lithotripsy. Experience with 712 treatments in 541 patients has given a fragmentation rate of 99%. Of these patients, 27% had stones larger than 2 cm or multiple stones. A stone free situation at 3 months follow-up was achieved in 75% of the cases. Seventeen percent had small fragments less than 4 mm and 8% had fragments greater than 4 mm. Auxiliary procedures following ESWL were required in 7%. No major complications were seen. The advantages of this system are: modularity, mobility, flexibility, and low cost. PMID- 10148921 TI - Regional hyperthermia combined with high energy shock wave treatment on Dunning prostate tumors. AB - Male Copenhagen rats implanted with Dunning R3327 prostate carcinoma were treated with regional hyperthermia and high energy shock waves (HESW). Twenty-four rats were divided into four equal groups. All rats in one group were matched with the corresponding rats in the other three groups according to tumor size. Hyperthermia was created by the resistive heating of a 22-gauge 1.5-cm needle; HESW were generated by the Dornier XL-1 experimental lithotripter. In two hyperthermia treatments administered 48 hours apart, the tumor was heated to 46.5 degrees C for 2 hours; HESW treatment involved 1,600 shocks at 18 kV. Twenty-nine days after initiation of this study, animals were sacrificed and tumor growth calculated. Tumor growth in group 1 (combined hyperthermia and HESW) was significantly delayed between the 7th and 29th day (p = 0.05). In group 2 (HESW alone), tumor growth was significantly delayed between the 7th and 22nd day (p = 0.01), while tumor growth in group 3 (hyperthermia alone) was delayed between the 3rd and 22nd day (p = 0.02). On day 22, mean percent change in tumor growth in the control group exceeded that of group 1 by 449% (p = 0.015) as well as that of groups 2 and 3, by 350% (p = 0.034) and by 268% (p = 0.049), respectively. As previous reports demonstrate the efficacy of hyperthermia in combination with irradiation or chemotherapy for the treatment of prostate carcinoma, our results indicate hyperthermia in combination with HESW may also be a useful treatment modality. PMID- 10148922 TI - Endoscopic treatment of large common bile duct stones with biliary endoprostheses. AB - Twelve elderly, ill patients with large common bile duct stones and cholelithiasis were treated with endoscopically placed biliary endoprostheses after endoscopic attempts at stone removal were unsuccessful. The patients were classified according to the American Society of Anesthesiologists' Physical Status Classification criteria and were Classes III and IV. The endoscopic procedures were tolerated well without complication. Resolution of biliary symptoms occurred in all patients. After extended follow-up of up to 60 months, no patient has required surgery for biliary symptoms or complications. One patient died following elective biliary surgery, six others have died from nonbiliary causes. The results suggest that management of large common bile duct stones by endoprosthesis placement can be done safely, and satisfactory long-term outcomes can be achieved. PMID- 10148923 TI - ESWL mapping of the extended focus (blast path) using uniform uric acid calculi. AB - Uniform uric acid calculi were used to map out the effectiveness of the Dornier HM-3 lithotripter in fragmenting stones at measured distances from the F2 focal point. Clinical application of findings for stones not able to be focused at F2 is suggested. PMID- 10148924 TI - Electrohydraulic lithotripsy of ureteral calculi: the Stony Brook experience. AB - We have used electrohydraulic lithotripsy for the treatment of ureteral calculi in a total of 29 patients. By combining the use of a 3.0 Fr electrode and a 9.5 Fr rigid ureteroscope, we have been able to successfully treat the majority of our patients with ureteral calculi. Bypass stenting of obstructing ureteral stones aided in access and effectiveness of ureteroscopy and endoscopic lithotripsy. The success rate in our series of 30 primary treatments was 80%; failures were primarily related to stone composition. In summary, we have found electrohydraulic lithotripsy of ureteral calculi to be a safe and effective treatment modality and routinely used it for stones throughout the length of the ureter that were either impacted or too large to extract primarily. PMID- 10148925 TI - Efficacy of electrohydraulic lithotripsy in the ureter. AB - Since January of 1983, 62 patients with ureteral calculi had their stones fragmented with electrohydraulic lithotripsy via an antegrade approach percutaneously or retrograde approach ureteroscopically. Success was achieved in 97% of these cases, with insignificant ureteral perforations noted in eight. Follow-up via intravenous pyelograms obtained in 60 patients revealed no significant persistent hydronephrosis. It appears, therefore, that the use of electrohydraulic lithotripsy in the ureter utilized with direct vision endoscopes is safe, efficacious and relatively inexpensive. PMID- 10148926 TI - Short-term effect of a new portable extracorporeal lithotripter on renal function. AB - Extracorporeal shock wave lithotripsy has become the treatment of choice for upper urinary tract stones. We evaluated the impact of a new lithotripter on the kidneys of 14 nonobstructed patients treated for renal stones, using several physiological parameters and renal ultrasonography. Glomerular filtration rates (GFR) were estimated from the renal scan. Complete disintegration of the stone was accomplished in all but one patient. Treatment did not alter the serum parameters or the renal ultrasonography. Also, no changes were found in the GFR on the follow-up renal scans in both kidneys. The implications of these findings are discussed. PMID- 10148927 TI - Immediate in situ ESWL as monotherapy in acute obstructive urolithiasis: useful or not? AB - Thirty-two patients with acute obstructive urolithiasis were treated without intervention (stent, nephrostomy tube) within 72 hours after onset of symptoms by extracorporeal shock wave lithotripsy (ESWL). Relief of obstruction, proven sonographically, was obtained within 48 hours in 78.6% of the patients and 90.6% were stone-free 6 weeks after treatment. Best results were obtained for proximal ureteral stones while the influence of stone volume did not appear to be significant. Whereas our stone-free results for treatment of calculi smaller than 5 mm (92.3%) can be criticized because without treatment these stones may pass spontaneously, a high success rate for larger stones (89.4%) was also noted. These results for in situ ESWL compare favorably to those of ESWL with stent bypass and suggest that ESWL monotherapy should be considered as a noninvasive first line therapy when treating acute obstructive urolithiasis. PMID- 10148928 TI - Mechanical and ultrasonic parameters of kidney stones. AB - The mechanical and ultrasonic parameters of kidney stones have been measured in vitro. The techniques used for these measurements are briefly described and the data are presented. It was found that the mechanical crushing strength correlates with the acoustic velocity in the calculi, which in turn is a function of the stones' chemical deposition. It was shown that the crushing strength increased exponentially with velocity in the range from approximately 22 kg/mm2 to approximately 100 kg/mm2. The corresponding ultrasonic velocity in the stones varied between approximately 2,200 m/sec to about 3,000 m/sec. It is suggested that these data could be used to determine the desirable characteristics of a piezoelectric lithotripter. PMID- 10148929 TI - Biliary lithotripsy with the Siemens Lithostar Plus overhead module. AB - A third shock head has been added to the Lithostar. This overhead module with integrated ultrasound complements the existing bilateral undertable shock heads with biplane x-ray amplifiers for stone targeting. Extracorporeal shock wave treatment of urinary tract stones, pancreatic stones, and stones in the gallbladder and bile ducts has thereby become possible in one true multipurpose lithotripter. Technical information and clinical experience in the biliary tract with the overhead module is presented. PMID- 10148930 TI - ESWL and endourology on the same table: a feasible concept? AB - Within 26 months a total of 4,126 procedures were performed on the ESWL multipurpose table. Forty percent of the procedures were comprised of endourology, 25% functional urinary tract radiology, and 37% ESWL therapy. Biplane fluoroscopy is an extraordinary help for percutaneous interventions. A further advantage is the possibility to perform endourology and ESWL in one session without having to transport the patient. This has facilitated pre- and post-operative ancillary measures in a total of 35.3%. Seventy-six percent of stones greater than 15 mm were managed via indwelling stents. In situ ESWL for ureteral stones has become the therapy of choice in more than 80% of patients due to the availability of radiological localization systems and a complication and failure rate of 20% for the push-and-smash procedure. The multipurpose table is equally successful as the piezoelectric system for ESWL therapy. Drawbacks include operational inconvenience with percutaneous interventions and the necessity to change patient position during ureterorenoscopy and retrograde pyelography. The multipurpose unit used is a valid compromise for ESWL and percutaneous endourology. For purely diagnostic interventions, a standard x-ray table is preferred. PMID- 10148931 TI - Continuous PaO2 monitoring through the umbilical artery. PMID- 10148932 TI - High frequency oscillatory ventilation: new technology for the neonatal intensive care unit. PMID- 10148933 TI - Assessment of fetal lung maturity in high risk pregnancies by fluorescence polarization. PMID- 10148934 TI - Prenatal diagnosis by ultrasound. AB - Prenatal diagnosis is defined as the determination of the nature of a disease in the fetus. Although only 3% to 5% of infants are born with a birth defect, prenatal diagnosis is an expanding field in health care practice. Prenatal diagnosis involves the disciplines of obstetric ultrasound, laboratory study for chromosome analysis/biochemical evaluation, and genetic counseling. To provide prenatal diagnosis, caregivers need state-of-the-art equipment, up-to-date procedures, and well-defined protocols. A critical tool used to provide prenatal diagnostic information is ultrasound, which is a widely accepted method for fetal diagnosis and assessment. This article describes the background of ultrasound, outlines fetal abnormalities that can be diagnosed with ultrasound, and discusses the relationship between diagnostic ultrasound and genetic counseling. PMID- 10148935 TI - HPEN therapy: assuring quality in home parenteral and enteral feeding. PMID- 10148936 TI - Reimbursing power wheelchairs: what are the options? PMID- 10148937 TI - Oxygen conserving devices: OCDs provide cost savings and improved quality of life. PMID- 10148938 TI - Solving reimbursement problems for home apnea. PMID- 10148939 TI - Air ambulances: how is the discharge planner to determine whose services to consider? PMID- 10148940 TI - Home phototherapy: reliable equipment, family education assure quality treatment. PMID- 10148941 TI - Understanding home infusion pumps for patient quality of life. PMID- 10148942 TI - Medical oxygen reimbursement: understanding HCFA criteria. PMID- 10148943 TI - Coverage and reimbursement for air flotation therapy. PMID- 10148944 TI - Diabetic retinopathy study results reveal combination therapy beneficial. PMID- 10148945 TI - The next decade for lasers: angiosurgery continues to be a hot area. PMID- 10148946 TI - Manifestation of the advantages and disadvantages of using the CO2 laser in oral surgery. AB - In their patient population, the authors summarize experience with 548 laser operations of oral lesions, the manifestation of the advantages and disadvantages of this technique. The hemostatic effect of the laser is of special significance, which became evident in the surgery of 90 hemangiomas, 17 patients with naveus flammeus, and 14 with clotting disturbance. For protection of the healthy tissues, various laser surgical methods were used--coagulation, vaporization, excision--and the postoperative edema, pain, inflammation, wound healing disturbances, and scarring were minimal. By the use of this method, the oral cavity functions can be well maintained. Following one laser treatment, the relapse rate was lower than 8 percent, after two treatments 1.1 percent. The laser treatment is economically favorable, since the absence of patients from work is minimal. Methods have been elaborated to overcome the disadvantages of laser treatment. It is established that the following can be favorably treated with the CO2 laser: leukoplakia, hemangioma, epulis, granuloma fissuratum, naveus flammeus, and clotting disturbance. The advantages of CO2 laser treatment in oral surgery manifest themselves very markedly. PMID- 10148947 TI - Laser-induced analgesia: major study attempts to secure concrete data. PMID- 10148948 TI - The Unilase CO2 microsurgical laser. PMID- 10148949 TI - Histological effects of He:Ne laser on the healing of experimental colon anastomoses in the rat. AB - Despite technical advances, the incidence of anastomotic leaks in elective colorectal surgery remains around 14%. Recent studies suggest that the use of low energy lasers may enhance wound healing in different tissues in a selective, nondestructive manner. Based on these findings we have attempted to provide experimental background on the histological effects of He:Ne laser during the early stages of healing in 70 colonic anastomoses performed on rats. The irradiation of the anastomoses by two doses of 3.6 J/cm2 produces an increase in the populations of round cells and fibroblasts of the scar tissue, an increase in new vessel formation, and a significant improvement in epithelialization. This suggests that the irradiation of colonic wounds with He:Ne lasers can result in an enhancement of healing. PMID- 10148950 TI - A compact, automated, dry-reagent chemistry analyzer. PMID- 10148951 TI - Two new nonradioisotopic immunoassays for TSH. PMID- 10148952 TI - Electrochemical immunoassay: an ultrasensitive method. AB - Hydrodynamic electrochemical techniques such as liquid chromatography and flow injection analysis with electrochemical detection are very effective for the rapid determination of the enzyme-generated product in enzyme immunoassays. The authors have used this detection method in various assay formats using both alkaline phosphatase and glucose-6-phosphate dehydrogenase as labels. Assays for digoxin will be used illustratively. Recently, the authors have used 70 mL microcapillary hematocrit tubes as the immunoassay reaction vessel and alkaline phosphatase as the labeling enzyme. The assay, complete in 30 min, had a detection limit of 5,6 x 10 -20 moles of IgG in serum. The linear range was four orders of magnitude. This low detection limit is due to a combination of the favorable geometry of the reaction vessel and the suppression of nonspecific adsorption by the addition of ion-pairing blocking agents. Even lower detectable amounts should be achievable with smaller reaction vessels. The capability for detecting such small amounts of analyte is potentially useful for the analysis of extremely small samples such as single cells and blood samples from premature infants. PMID- 10148953 TI - New developments in particle-based tests and immunoassays. AB - Latex agglutination tests were invented in 1957. Thirty years later, new tests are still being devised and applied to new analytes. Reproducibility and readability continue to improve. Qualitative tests have now evolved to quantitative particle immunoassays: agglutination is detected by spectrophotometers or nephelometers, in tubes or 96-well plates. These same particles are now also being used in particle capture ELIST and ELISA (enzyme linked immunosorbent tests and assays) where particles are caught upon a filter and act as supports for sandwich tests (those "+/-" or "blue-dot" tests). These also can be quantified, as in the Abbott IM x assay system. Dyed microspheres now function as the color tags in over-the-counter sandwich-type pregnancy tests. In the future, results from assays using this technology could be read on reflectometers (strip readers). Currently, magnetic particles are used in solid phase radioimmunoassays and DNA probes. PMID- 10148954 TI - Evaluation of the 550 Express for use with Emit reagents for drugs of abuse. PMID- 10148955 TI - The development of a membrane-based screening method to detect antibodies to intermediate filament proteins. AB - Autoantibodies directed against the intermediate filament proteins (IF) arise in a variety of disease states. The authors have investigated the binding of the IF to solid membrane supports in a dot blot format in an attempt to develop a simple procedure to detect antibodies (ab) to IF. Commercially obtained, purified IF were utilized. These were: vimentin (VIM), cytokeratin 8 (CYK), glial fibrillary acidic protein (GFA), desmin (DES), and the neurofilament triplet proteins (68, 160, and 200 KDa, respectively designated LMW, MMW, and HMW). Murine monoclonal antibody (mAb) probes were used to detect the presence and immunoreactivity of IF. The mAb were visualized with HRP-anti-mouse conjugates using alpha chloronaphthol/H 2O 2 as substrate. The membranes studied were nitrocellulose (NC), and two of modified nylon. Nitrocellulose provided the most reproducible binding; no advantage was found to ensue from the use of the other membranes with regard either to quantitative binding or improved capping. Among the IF studied, VIM, GFA, LMW, MMW, and HMW bound well to NC; optimal mass/dot was 1 mug. Filtered, non-fat dry milk is a better capping agent than either albumin or fetal calf serum, but interferes with ab binding to GFA. Binding of CYK and DES is weak at neutral pH. Standard densitometric techniques provide the possibility of quantitation. We conclude that dot and slot blot assays may be practical methods to detect ab to IF antigens. PMID- 10148956 TI - Mid-range infrared lasers: new applications yield to caution. PMID- 10148957 TI - Ophthalmic lasers in the 1990s: a glimpse of the future. PMID- 10148958 TI - Photodynamic therapy for early gastric cancer using a pulsed gold vapor laser. AB - Endoscopic photodynamic therapy (PDT) using a pulsed gold vapor laser (wavelength 628 nm, LaserSonics Inc.) was performed on eight cases of early gastric cancer. Three patients refused to have surgery, and the others were in a high-risk group due to old age or complications with other diseases. Hematoporphyrin derivative (HpD I, 2.5-3 mg/kg, Photofrin Inc.) was injected intravenously, and 48-72 hours later, the entire cancer lesion and 5 mm width mucosa encircling it were irradiated with a gold vapor laser through a single quartz fiber. The irradiation was delivered at 300-330 mW for 5-20 minutes, which gave about 90 J/cm 2 dosage. In seven of eight cases, local cure was achieved. Recurrence was noted only in one patient. In one of eight patients, operation was carried out 1 month after PDT. Pathological examination of the resected stomach revealed that the effect of PDT extended into the tunica muscularis propria. Side effects of HpD, such as skin rash, were noted in two patients, but no serious complications of PDT were encountered. This suggests that PDT with a pulsed gold vapor laser is clinically useful in the treatment of early gastric cancer. PMID- 10148959 TI - The use of the CO 2 laser in oral and maxillofacial surgery. AB - The CO 2 laser has a decided advantage in removing tumors of the oral cavity. This advantage is related to its ability to perform accurate hemostatic surgery, while at the same time sterilizing the operative area. During the past 4 years, 376 patients have been treated with the CO 2 laser (Sharplan 1040) at our hospital. A variety of benign oral lesions, malignant tumors, vascular tumors, preprosthetic surgery, and other oral lesions have been treated. PMID- 10148960 TI - Pregnancy after laser therapy for the treatment of uterine cervical neoplasia. AB - Three hundred and twenty-four patients with cervical intraepithelial neoplasia (33 mild dysplasia, 109 moderate dysplasia, 118 severe dysplasia, 64 carcinoma in situ) underwent laser vaporization with the CO 2 laser. Eighty-two patients with CIN (mild dysplasia 7, moderate dysplasia 10, severe dysplasia 16, carcinoma in situ 46) and microinvasive cancer (3) underwent laser excisional conization with the YAG laser. Their first cure rates showed 93.5% and 98.8%, respectively, for the follow-up period 6 months to 7 years. During the same period, 36 pregnancies in 34 patients occurred. Of these patients, 14 underwent dilatation and curettage, 6 terminated by spontaneous abortion in the first trimester and 1 in the second trimester (previous MacDonald's suture), and 1 had fetal death at 13 weeks of gestational age. There were 13 deliveries, 2 by cesarean section (either postenucleation of uterine myoma or premature rupture of the membranes and fetal distress), 3 by vacuum extraction, 1 by breech delivery, and 7 by normal vaginal delivery. One patient is currently in her 22nd week of pregnancy. Our laser therapies are good conservative methods for the treatment of CIN because of favorable cure rates and no effect on succeeding pregnancy and delivery. PMID- 10148961 TI - Evaluation of clinical results following laser recanalization of the peripheral arteries. AB - As experience is gained with laser-assisted angioplasty and as long-term follow up results become available, a realistic and objective view of its role in the treatment of patients with occlusive disease of arteries in the peripheral vascular tree is becoming available. Comparison with results of conventional treatment methods is warranted. Experience in treating patients with vascular lesions is helpful in patient selection, management during the procedure, and follow-up care. Evaluation of experience in 169 procedures, with a follow-up time of 1 month to 3 years indicates what direction evolving patency rates are taking. PMID- 10148962 TI - In vivo photosensitizer-enhanced laser angioplasty in atherosclerotic Yucatan miniswine. AB - Photosensitization of atherosclerotic (Ath) plaque with exogenous chromophores may confine laser irradiation (LI) injury to Ath plaque and allow safer and more efficacious laser angioplasty. Dihematoporphyrin ether (DHE) accumulates preferentially in plaque, and previous in vitro LI studies have shown confinement of LI injury to plaque. To further evaluate DHE enhanced laser angioplasty, 5 Ath Yucatan miniswine with 8 iliofemoral stenoses (Sten) were treated with 2.5 mg/kg of DHE IV. Twenty-four hours later, 632 nm continuous wave LI was delivered to Sten using 200mu core optical fiber with a 582mu x 1cm diffusing tip. Angiograms were performed before, immediately after, and two weeks following LI. 6 of 8 vessels showed improvement. Control mean Sten was 71%, immediate post LI was 55% and 2 weeks post LI was 19% Sten. In 4 of 6 responding vessels, there was 0% Sten at 2 weeks post LI and the previously stenotic segments appeared normal. 2 of 6 responders showed only modest improvement, from control mean Sten of 83% to 55% Sten at 2 weeks. 2 of 8 vessels showed no improvement. There were no perforations or dissections. The excellent results in some vessels demonstrate the potential of photosensitizer enhanced LI as very effective primary therapy of Ath. The time course of improvement indicates that both immediate thermal and delayed photochemical (photodynamic therapy) effects are operative. Further studies are required to identify reasons for failure in some vessels. PMID- 10148963 TI - Direct laser and laser-thermal irradiation of normal canine coronary arteries: implications for laser delivery methods. AB - Clinical use of laser recanalization has been mostly limited by arterial perforation. Two modifications of the optical fiber were used to decrease the perforation rate: (1) a guidewire to align the fiber in a coaxial position with the vascular lumen and (2) encapsulation of the optical fiber tip with a metal cap. Fourteen dogs were studied. Argon laser radiation was delivered through optical fibers, 9 with a 1.7-mm metal encapsulated fiber (Laserprobe-PLR,? Trimedyne, Santa Ana, CA) and 5 with a 2-mm metal encapsulated fiber with a window at the tip (Spectraprobe-PLR). Three dogs served as control, and no guidewire was used. In 11 dogs, laser irradiation was done either in advancing the probe or on pullback over a guidewire. Energy used ranged from 25 to 50 J. In vitro, this raised the probe temperature in blood to a maximum of 500 degrees C. Arterial perforation occurred in 2 of 4 lased arteries without guidewire (p less than 0.05). There was no difference in perforation rated comparing the Laserprobe (1 out of 17 arteries) and Spectraprobe (1 out of 8 arteries) (p greater than 0.05). At high laser energy (50 J), there was an increased incidence of thrombus formation, which appeared to be associated with adherence of the metal cap to the arterial wall (3 out of 6 vs. 1 out of 19, p less than 0.05).(ABSTRACT TRUNCATED AT 250 WORDS) PMID- 10148964 TI - Clinical and histological evaluation of laser myocardial revascularization. AB - Studies exploring methods to revascularize the ischemic myocardium through increasing the collateral circulation were conducted by many investigators before the advent of myocardial revascularization by aortocoronary bypass grafting. Present alternatives, including surgical intervention, balloon angioplasty, thrombolytic therapy, and medical management, are the treatment of choice for the majority of patients. There are, however, a number of patients who do not respond to conventional management strategies. A clinical protocol was designed to assess the efficacy of transmural revascularization by creating CO2 laser channels in the ischemic areas of the left ventricle. Channels were made from the epicardial surface of the heart, through the ventricle, to the endocardium. Patients entered in the study were candidates for bypass grafting, but because of the pathology of the coronary artery system, bypass grafting alone would have resulted in incomplete revascularization. Postoperative thallium stress tests and left ventriculography indicate that channels have remained patent and that they perfuse the myocardium. Myocardial revascularization by laser channels may offer a viable adjunct in the treatment of ischemic heart disease. PMID- 10148965 TI - Direct infarct angioplasty: therapy for the 1990's. PMID- 10148966 TI - Adjunctive therapy to thrombolysis in acute myocardial infarction. PMID- 10148967 TI - Physiologic effects of contrast media used in coronary angiography. PMID- 10148968 TI - Directional coronary atherectomy for the treatment of coronary lesions with abnormal contour. AB - Directional coronary atherectomy is a newly developed percutaneous transluminal procedure which excises and removes obstructive tissue from coronary arteries or saphenous vein grafts. This procedure was performed on 47 lesions with abnormal contour; 24 ulcerative lesions, 10 lesions with dissection, 7 flap-like lesions and 6 lesions with aneurysm dilatation. Overall success rate was 89%; 96% in ulcerative lesions, 70% in lesions with dissection, 86% in flap-like lesions and 100% in lesions with aneurysmal dilatation. Complications with this procedure were as follows: Vessel occlusion in 2 patients (4.5%), perforation in 1 patient (2.3%), and guiding catheter induced dissection in 1 patient (2.3%). Coronary artery bypass surgery was required in 4 patients (9.4%) for these complications. Of these, 3 patients had lesions with dissections prior to the atherectomy procedure. The success rate for lesions with abnormal contour was similar to those of 270 lesions with normal contour. In conclusion, directional coronary atherectomy is a safe and effective procedure for lesions with abnormal contour, however, outcome of a lesion with dissection is suboptimal and it needs to be approached cautiously. PMID- 10148969 TI - Balloon dilatation for discrete subaortic stenosis: immediate and intermediate term results. AB - Six children with subvalvar aortic stenosis underwent percutaneous balloon angioplasty over a 15-month-period ending October 1989. The mean systolic pressure gradient across the left ventricular outflow tract decreased from 56 +/- 19 (mean +/- SD) to 12 +/- 7 mmHg (p less than 0.001) immediately following valvuloplasty and the degree of aortic insufficiency did not significantly increase. Follow-up Doppler data (in all 6 patients) were available 3 to 16 months (mean, 11 months) after angioplasty and revealed a residual aortic subvalvar gradient of 21 +/- 5 mmHg, which continues to be significantly lower (p less than 0.001) than that prior to angioplasty. There was no increase in aortic insufficiency. The single infant with increase in gradient at followup was determined to have fibromuscular, tunnel type of subaortic obstruction. None of the five patients with discrete membranous obstruction had significantly increased their gradients. Use of balloons larger than aortic valve anulus did not produce any adverse effect, particularly aortic insufficiency. We surmise that the immediate and intermediate-term follow-up results of balloon angioplasty are encouraging and balloon angioplasty should be considered as a treatment option in the initial management of discrete subaortic membranous stenosis. PMID- 10148970 TI - Protected coronary angioplasty: minimizing the hazards of high risk coronary interventions. PMID- 10148971 TI - Balloon angioplasty/valvuloplasty in congenital heart disease. PMID- 10148972 TI - Percutaneous laser-assisted thermal coronary angioplasty in native coronary arteries and saphenous vein grafts: initial results and angiographic follow-up. AB - Percutaneous laser-assisted thermal coronary angioplasty was attempted in 29 vessels (27 patients): 10 left anterior descending, 2 left circumflex and 17 mid shaft (non-anastomotic) saphenous vein grafts. Argon or YAG laser thermal energy was applied via a 1.3, 1.6 or 1.9 mm metal capped probe followed by conventional balloon angioplasty in 27 vessels and sole thermal laser therapy in two vessels. The laser probe successfully crossed 83% (24/29) of vessels and subsequent balloon dilatation increased the success rate to 93% (25/27). Perforation occurred in a vein graft resulting in one in-hospital death post repeat emergency coronary artery bypass graft surgery. Angiographic follow-up was obtained in 85% (24/28) of vessels. Angiographic restenosis ( greater than 50% reduction in lumen diameter) occurred in 27% (3/11) of native coronary arteries and 62% (8/13) of saphenous vein grafts. Therefore, despite high initial success rates, the application of laser thermal energy with small laser probes relative to vessel size, followed by conventional balloon angioplasty, does not appear to alter restenosis. Further evaluation of coronary laser systems should be continued only with catheters that are capable of creating channels closer to the size of the vessel treated. PMID- 10148973 TI - Probe III catheter, an improved balloon-on-a-wire system: initial experience. Probe III Investigators Group. AB - Over the last several years, extremely low-profile balloon-on-a-wire catheters have extended the limits of coronary angioplasty. However, the first such fixed wire catheter, the Probe, experienced a number of mechanical failures, causing the manufacturer to reconfigure the catheter as the Probe III. The current study was therefore undertaken to assess the safety and efficacy of this new device in a variety of cases. The Probe III catheter was used as a primary dilatation device in 157 lesions in 113 patients over a three and one-half month period. One hundred-six (93%) of the procedures were successful. There were no mechanical failures. The low profile and enhanced trackability of the Probe III catheter led to a high rate of procedural success in a variety of lesions, including extremely tight lesions, distal stenoses, bifurcation lesions, and bend-point lesions. The low profile and enhanced trackability also enabled excellent visualization, as well as quick and successful angioplasty in most patients. PMID- 10148974 TI - Left ventricular support during high risk coronary angioplasty: an argument for the use of cardiopulmonary support. PMID- 10148975 TI - Intra-aortic balloon pump counterpulsation: the method of choice for supported "high risk" coronary angioplasty. PMID- 10148976 TI - Clinical application of percutaneous cardiopulmonary bypass for high risk coronary angioplasty. AB - Percutaneous cardiopulmonary bypass support was electively instituted prior to coronary angioplasty in 16 patients at high risk for hemodynamic collapse. In all cases the dilated artery supplied greater than 2/3 of the functioning myocardium. Eight patients had moderate LV dysfunction with ejection fraction 25 40%. Eight patients had an ejection fraction less than 20%. A 21 French cannula and a 17 French cannula were percutaneously inserted into the femoral vein and artery. Cardiopulmonary bypass support was instituted using a Bio-Medicus centrifugal pump just prior to coronary angioplasty at flow rates of 3.5-5 liters/minute. Thirteen patients had single vessel angioplasty and three patients had multivessel angioplasty. Complete loss of systolic function was observed in 9 (56%) patients. This finding when present confirms the absolute requirement for cardiopulmonary support. Technical success was achieved in all 16 patients (100%), clinical success was achieved in 14 patients (88%). Patient followup (mean 10 months) revealed 3 patients with class I-II angina and 10 patients were asymptomatic. There was one late death. In conclusion, percutaneous cardiopulmonary bypass support for carefully selected high risk patients may allow coronary angioplasty to be performed safely and effectively despite complete loss of systolic function during balloon inflation. PMID- 10148977 TI - The Nimbus Hemopump: a new left ventricular assist device that combines myocardial protection with circulatory support. AB - Recent advances in hemodynamic support can allow patients at high risk for cardiovascular collapse to become candidates for coronary interventions. A new axial blood flow pump has recently been developed and made available for clinical testing. This intravascular pump utilizes an Archimedes screw pump rotating at 25,000 rpms to provide a flow of 2 to 3.5 liters/minute. The 7 mm inlet cannula of the cable driven pump is delivered across the aortic valve. The pump discharges blood into the descending aorta. This design does not require a membrane oxygenator. This pump would be expected to: 1) provide circulatory support irrespective of heart arrhythmias; 2) provide left ventricular unloading and 3) lack the fluid and coagulation abnormalities of prolonged cardiopulmonary bypass. This unique device offers great promise to the interventional cardiologist. PMID- 10148978 TI - Intra-aortic balloon counterpulsation support for elective coronary angioplasty in the setting of poor left ventricular function: a two center experience. AB - A two-center elective coronary angioplasty experience with intra-aortic balloon pump support for patients with severe left ventricular dysfunction is reported. To prevent hemodynamic collapse, an intra-aortic balloon pump was inserted percutaneously before coronary angioplasty in 97 patients with a left ventricular ejection fraction less than 35% (26% of whom had ejection fractions less than 25%). The cohort was predominantly male (71%) with a mean age of 64 +/- 9 years. Angioplasty was successfully performed in 83 (85.6%) patients and 80 (82.5%) of these successful patients were discharged from the hospital. Seven patients had unsuccessful angioplasty without a major cardiac event. Seven patients (7.2%) suffered a major cardiac event; 4 had emergent coronary bypass surgery with q wave infarction, 2 had uneventful emergency coronary bypass surgery, and one patient died in the operating room after a failed angioplasty. Using logistic regression analysis, the presence of multivessel disease and a history of prior myocardial infarction were associated with more complications during angioplasty (p less than 0.05). Intra-aortic balloon pump placement did not interfere with the angioplasty procedure. Two patients had limb ischemia which resolved when the intra-aortic balloon pump was removed. Of the 80 successful patients discharged, 72 were followed for a mean of 22 months. At the latest follow-up, 52 had not suffered a myocardial infarction and were alive. Of the 20 late deaths, 16 were cardiac and 4 non-cardiac.(ABSTRACT TRUNCATED AT 250 WORDS) PMID- 10148979 TI - Coronary angioplasty in the 1990's--new tools for old troubles. PMID- 10148980 TI - Magnarail probing catheter: new tool for balloon recanalization of chronic total coronary occlusions. AB - The Magnarail probing catheter (Schneider Europe), a new tool for angioplasty of chronic total coronary occlusions, consists of a 135 cm/3.4 French single lumen shaft with the distal 17 cm (4.5 French) featuring a double lumen (Monorail section). The long lumen serves for contrast medium injection and pressure measurements. The short lumen accepts the guide wire and braces it to cross the occlusion. Once the lesion passed, the Magnarail probing catheter quickly can be exchanged for a balloon catheter. In case of failure to pass with the guide wire, no balloon is wasted. PMID- 10148981 TI - Coronary laser angioplasty: determining the ideal laser wavelength and catheter design. PMID- 10148982 TI - Early clinical experience with a hot tip laser wire in patients with chronic coronary artery occlusions. AB - Chronic coronary artery occlusions remain one of the problems limiting the use of percutaneous transluminal coronary angioplasty (PTCA). We have studied the use of an 0.018 inch laser hot tip wire. It was coupled either to a continuous wave argon or Nd-YAG laser generator and introduced through a balloon catheter to try and cross and dilate a series of chronic coronary artery occlusions in which initial conventional attempts had failed. Four LAD and 6 RCA occlusions were attempted; we successfully crossed and dilated 6 (60%) lesions, 4 (40%) using the laser wire alone to recanalize the occlusion and in 2 a combination of laser wire and conventional means. PMID- 10148983 TI - Laser balloon angioplasty: a review of the technique and clinical applications. LBA Study Group. PMID- 10148984 TI - Current status of excimer laser coronary angioplasty. PMID- 10148985 TI - A biomechanical study of tendon adhesion reduction using a biodegradable barrier in a rabbit model. AB - Adhesion formation associated with tendon surgery is a widespread problem in which a healing tendon becomes adherent via scar tissue to surrounding structures such as bone, muscle, skin, tendon sheath, or other tendons. A model is described in which adhesions were generated reproducibly between the plantaris and Achilles tendons of the rabbit using a partial tenotomy, a Bunnel suture, and immobilization. Using this model, the effect of an absorbable barrier, INTERCEED (TC7), on adhesion formation was investigated. This material, which is a fabric comprised of oxidized regenerated cellulose, was found to diminish significantly the extent and severity of intertendinous adhesions, assessed both mechanically and histologically. No evidence of a foreign body reaction was observed. PMID- 10148986 TI - Influence of needle holder jaw configuration on the biomechanics of curved surgical needle bending. PMID- 10148987 TI - Mechanical properties of biodegradable polymers and composites proposed for internal fixation of bone. AB - The mechanical properties of biodegradable polymers and composites proposed for use in internal fixation (in place of stainless steel) are crucial to the performance of devices made from them for support of healing bone. To assess the reported range of properties and degradation rates, we searched and reviewed papers and abstracts published in English from 1980 through 1988. Mechanical property data were found for poly(lactic acid), poly(glycolic acid), poly(epsilon caprolactone), polydioxanone, poly(ortho ester), poly(ethylene oxide), and/or their copolymers. Reports of composites based on several of these materials, reinforced with nondegradable and degradable fibers, were also found. The largest group of studies involved poly(lactic acid). Mechanical test methods varied widely, and studies of the degradation of mechanical properties were performed under a variety of conditions, mostly in vitro rather than in vivo. Compared to annealed stainless steel, unreinforced biodegradable polymers were initially up to 36% as strong in tension and 54% in bending, but only about 3% as stiff in either test mode. With fiber reinforcement, reported highest initial strengths exceeded that of stainless steel. Stiffness reached 62% of stainless steel with nondegradable carbon fibers, 15% with degradable inorganic fibers, but only 5% with degradable polymeric fibers. The slowest-degrading unreinforced biodegradable polymers were poly(L-lactic acid) and poly(ortho ester). Biodegradable composites with carbon or inorganic fibers generally lost strength rapidly, with a slower loss of stiffness, suggesting the difficulty of fiber matrix coupling in these systems. The strength of composites reinforced with (lower modulus) degradable polymeric fibers decreased more slowly. Low implant stiffness might be expected to allow too much bone motion for satisfactory healing. However, unreinforced or degradable polymeric fiber reinforced materials have been used successfully clinically. The key has been careful selection of applications, plus use of designs and fixation methods distinctly different from those appropriate for stainless steel devices. PMID- 10148988 TI - The status of photodynamic therapy research: an overview of current and future cancer clinical treatments. PMID- 10148989 TI - In vivo evaluation of 2-cyanoacrylates as surgical adhesives. AB - To evaluate 2-cyanoacrylates as surgical adhesives, the bond strength in vivo as well as the tissue reaction was investigated using methyl-, ethyl-, isobutyl-, and ethoxyethyl-2-cyanoacrylate. In addition, their set time and spreading on blood were studied. When the 2-cyanoacrylates were applied to an incised site of rabbit skin, they could maintain the skin closure without suturing during the first week and the bond strength increased during the second week. Significant inflammatory response was observed around the subcutaneous tissue glued with methyl- and ethoxyethyl-2-cyanoacrylate and persisted for approximately one week. All the 2-cyanoacrylate polymers were absorbed and the tissues treated were healed two weeks after the operation. There was a mild inflammatory reaction in the tissue treated with ethyl- and isobutyl-2-cyanoacrylate, and their polymers still remained at the wound site at the second week postoperatively. The disappearance rate of the 2-cyanoacrylate polymers was roughly in proportion to the inflammatory tissue response. Ethoxyethyl-2-cyanoacrylate spread more broadly on tissues than the other 2-cyanoacrylates, while its set time was shorter than that of methyl- and ethyl-2-cyanoacrylates. PMID- 10148990 TI - Semiconductor diode lasers: new technology for the 90s. PMID- 10148991 TI - Use of carbon dioxide laser in improving knot security in polyester sutures. AB - Knot slippage continues to be a serious concern in surgery. This study explored the possibility of improving knot performance by exposing it to radiation from a CO 2 laser. The specimens were mounted in a special device and exposed in a predetermined position for precisely controlled lengths of time. In the first set of experiments, the welding of ends was examined in nylon and polyester sutures. Although the welding was easily achieved, the joint was found brittle and its strength lower than that of a surgical knot. In the next set of experiments, the work was performed at a more fundamental level using oriented, high density, polyester films. The results showed that up to a certain level of exposure the tensile properties did not change, but beyond it a rapid decay took place. Shear tests on polyester sutures twisted together and then exposed to various levels of energy indicated that a bond of maximum strength developed at this exposure. Mersilene sutures of size 3/0 containing a two throw square knot when exposed to energy of this level produced optimal results. The knot strength increased by about 16% (from 13.4 N unexposed to 15.6 N exposed) and the slippage often known to occur in a two-throw knot was completely absent. This work performed under standard atmospheric conditions provided a direction for greatly enhancing the performance of a two-throw knot in terms of both the security and the strength.(ABSTRACT TRUNCATED AT 250 WORDS) PMID- 10148992 TI - Comparing mid-infrared lasers for clinical significance. PMID- 10148993 TI - Pulsed dye laser treatment in dermatology: one doctor shares his enthusiasm. PMID- 10148994 TI - CeramOptec angioplasty catheter. PMID- 10148995 TI - A bioactive glass powder-ammonium hydrogen phosphate composite for repairing bone defects. AB - Bioactive glass powder (AW-G) was made into a rigid compound by mixing with ammonium hydrogen phosphate and was evaluated as a bone-defect filler. The proximal metaphysis of the rat tibia was drilled and packed with (a) polymethyl methacrylate (PMMA) bone cement, (b) AW-G powder, (c) AW-G powder with ammonium hydrogen phosphate (AW-G)-(A-P), or (d) nothing, as a control. The animals, with different implantation periods up to 24 weeks, were sacrificed and the defective sites were histologically analyzed. The results revealed direct bonding between the bone tissue and the (AW-G)-(A-P). The general inflammatory reaction of (AW G)-(A-P) was less than that of PMMA bone cement. The compressive strength of (AW G)-(A-P) implanted subcutaneously into rats was measured chronologically and deterioration did not occur during a period of 24 weeks. The rigidity increased to 1.6 times 6 months after implantation as compared with the initial value. This compound can be used as paste and is transformed into a rigid compound in about 4 min without noticeable elevation of the temperature. Thus, this (AW-G) (A-P) composite can be used as a bone defect filler, and there is a possibility that it can even be used as a bone cement if higher rigidity can be attained. PMID- 10148996 TI - A device to cool the dental pulp. PMID- 10148997 TI - Communication. Comment on "A biomechanical study of tendon adhesion reduction using a biodegradable barrier in a rabbit model". PMID- 10148998 TI - A nondenaturing solid phase pharmaceutical carrier comprised of surface-modified nanocrystalline materials. AB - Numerous carrier systems have been developed for the controlled delivery of biologically active molecules such as drugs and diagnostic agents. The biophysical interactions between the biologically active molecules and their carriers, however, may denature the former and lead to reduced biological activity. In this study, a model nondenaturing carrier comprised of a nanocrystalline (10 -7 m) tin oxide core and a surface-charge-reducing organic bonding layer (GF292) was synthesized. A subsequently bound protein (human transferrin) showed significant retained conformation by immunoelectron microscopy. In the synthesis of targeted drug systems and vaccines, nanocrystalline cores treated with appropriate surface-modifying agents may be suitable carriers. PMID- 10148999 TI - Relationship of the diameter and tensile strength of nylon sutures to the USP specification and the effect of preconditioning. AB - Nylon monofilament sutures were tested in a straight pull as well as a conventional knot pull tensile test. In each test, sutures were evaluated following storage under prevailing atmospheric conditions or saturation in whole human blood. Blood saturation decreased the ultimate tensile strength by as much as 20%. The present investigation of sutures that were stored under prevailing atmospheric conditions substantiated the proposal previously made for polypropylene monofilaments--that 60% of the ultimate tensile strength could be established as a fundamental USP criterion for Class I monofilament sutures. PMID- 10149000 TI - Sutureless end-to-end bowel anastomosis using an argon laser and water-soluble intraluminal stent. AB - Sutureless end-to-end intestinal anastomoses were constructed in New Zealand white rabbits using an argon laser to weld the tissue edges, which were temporarily held together by a biodegradable, water-soluble, intraluminal stent. Various power settings ranging from 1.5 to 5 W were used with and without an exogenous chromophore (India ink). Delivering 4 W of power without using an exogenous chromophore but applying a continuous saline drip to the anastomotic seam during lasing proved most successful. We conclude that argon laser energy can be used to construct successful sutureless end-to-end intestinal anastomoses. PMID- 10149001 TI - Photodynamic inactivation of enveloped viruses: potential application for blood banking. PMID- 10149002 TI - The use of 1.32 Nd:YAG laser in neurosurgery: experimental data and clinical experience from 70 patients. AB - The authors present their experience with the 1.32 mum Nd:YAG laser in neurosurgical procedures. In a first step, they conducted experiments on rat cortex. The thermic data and histologic results confirmed that the 1.32 Nd:YAG laser has physical properties quite close to the CO2 laser. Furthermore, the fact that the 1.32 mum wavelength can be conducted through optic fibers makes it well adapted to neurosurgery. The authors present experimental data (50 rats) and comment on their surgical experience with such a wavelength (70 patients). In the future, this laser should see its indications broadened in conventional neurosurgical procedures as well as in endoscopic and stereotactic neurosurgery. PMID- 10149003 TI - Laser therapy in cerebral obstructive pathology and vascular malformations: a review. AB - Experimental results suggest the possibility of the use of lasers in the obstructive pathology and vascular malformations of the brain. PMID- 10149004 TI - Have lasers lost their glamour in neurosurgery? Neurosurgeons share their thoughts on the one-time miracle tool. PMID- 10149005 TI - Q-switched ruby laser brings scarless tattoo removal. PMID- 10149006 TI - Hematologic derangements of cardiopulmonary bypass: a comparison of two perfusion systems. AB - A major goal of new perfusion equipment is minimal trauma to blood elements. This study compares two perfusion systems, quantifies the change in blood components and generation of microemboli, as well as compares the hospital courses of each perfusion system. Forty-four coronary patients were assigned to either Group S, a silicone rubber membrane (SciMed) and centrifugal pump (Bio-Medicus) (N=19) or Group C (our routine equipment), a microporous polypropylene membrane (COBE CML) and roller pump (COBE) (N=25). The rise in plasma hemoglobin (26+/-14mg* in Group S and 26+/-17mg* in Group C), the drop in hematocrit (-15.0+/-3.9* in Group S and -14.7+/-3.8* in Group C at the second post-op day), and the decrease in platelet count (-152,000+/-78,000* in Group S and -129,000+/-52,000* in Group C) were similar in both groups. There was no difference in rise in post-op alveolar arterial oxygen gradients or debris generated by each system. 27.7% in Group S required red cell transfusions and only 8% required red cell transfusions in Group C. There was no significant difference in clinical endpoints such as ICU stay, hospital stay and complication rate. We found no advantage to more expensive perfusion devices and no improvement upon the extensive CPB damage to formed blood elements. * p less than .001 PMID- 10149007 TI - A flexible system for combined retrograde and antegrade delivery of blood or crystalloid cardioplegic solution. AB - A flexible but simple cardioplegic delivery system has been designed that offers the advantages of alternating antegrade and retrograde delivery or blood and crystalloid (Plegisol? solution) cardioplegia to optimize myocardial preservation. Initial antegrade delivery of crystalloid cardioplegic solution achieves rapid cardiac arrest while subsequent retrograde delivery with blood cardioplegia improves myocardial protection due to uniform distribution of the solution. Occasionally, temporary transferral from blood to crystalloid is indicated to clarify the surgical field. This system is designed to allow the repeated rapid switching from crystalloid to blood cardioplegia or vice versa using the antegrade or retrograde routes. PMID- 10149008 TI - Assessment of alveolar function in neonates on ECMO using the measurement of net CO2 transfer by the artificial lung. AB - The measurement of the net transfer of the CO2 by the artificial lung (Delta Cap) during ECMO indicates the rate at which the alveoli are becoming functional and allows the prediction of when weaning can best begin. Usually, an infant with lung disease placed on ECMO will need to excrete most of his CO2 production via the artificial lung. But as the alveoli heal, CO2 will be removed in increasing amounts by the infant's own lungs. When the Delta Cap reaches zero, all of the infant's CO2 production is being removed by his own lungs, an indication that he has adequate alveolar function to exchange O2. A capnagraph is used to measure the CO2 concentration of affluent and effluent sweep gas and the Delta Cap is determined by their difference. PMID- 10149009 TI - Evaluation of extracorporeal blood heat exchanger devices. AB - An accurate and easy to use test circuit has been developed for the performance evaluation of the heat exchangers used in cardiac surgery during extracorporeal circulation. The water part of the heat exchanger is fixed at a flow rate of 15 l/min and at a temperature of 40 degrees C. In the blood side, the flow rate is varied from 1 to 6 l/min and the temperature is 30 degrees C. The use of a precise thermometer (precision 0.01 degrees C) and of a microcomputer permits efficiency with a good reproducibility. The results obtained show a real improvement in the efficiency of the new extracorporeal blood heat exchangers devices. PMID- 10149010 TI - A comparative evaluation of pulmonary artery balloon counterpulsation and a centrifugal flow pump in an experimental model of right ventricular infarction. AB - To compare the efficiency of pulmonary artery balloon counterpulsation and a centrifugal flow pump in reversing the hemodynamic consequences of acute right sided heart failure, we employed both devices in 14 Yorkshire pigs in which right ventricular infarction was created via surgical ligation of branches of the right coronary artery. Pulmonary artery balloon counterpulsation improved some of the indicators of right heart failure, as manifested by significantly decreased right atrial pressure and increased mean systemic blood pressure. In contrast, the centrifugal flow pump consistently and significantly reversed all of the hemodynamic consequences of right ventricular infarction. In comparison to pulmonary artery balloon counterpulsation, the centrifugal flow pump resulted in lower right atrial pressures (p=0.020), lower mean pulmonary pressures (p less than 0.0001), increased left atrial pressures (p=0.026), increased cardiac output (p less than 0.0001), and increased mean systemic blood pressures (p less than 0.0001). Possible mechanisms to explain the superiority of the centrifugal flow pump include better hemodynamic unloading of the failing myocardium and independence from right ventricular output. PMID- 10149011 TI - A technique for automatic tubing occlusion in response to air bubble detection when using a centrifugal pump. AB - A double acting pneumatically powered cylinder, energized by an electrically activated solenoid valve, is used to occlude the outflow line from a Bio-Medicus (a) constrained vortex pump. The cylinder is mounted on a tubing guide that is fastened to a pole clamp. A Sarns (b) air bubble detector, placed on the pump inflow line is used to provide the signal to activate the solenoid valve. The outflow occluder is capable of 100% occlusion of 3/8 x 3/32 inch Tygon tubing up to pressures of 2586 mmHg. The occluder system is able to work with many types of bubble detectors and is applicable to any form of non-occlusive pump. PMID- 10149012 TI - Continuous warm blood cardioplegia: a new technique for myocardial protection. AB - Hypothermia is used to prolong the safe period of ischemic arrest by reducing the heart's oxygen demands. Due to this effect, hypothermia has been the fundamental component of most methods of myocardial protection during cardiac surgery. However, hypothermia has a number of unwanted side effects, such as detrimental effects on enzyme function, energy generation, and cell membranes. Since electromechanical arrest accounts for 90% of myocardial oxygen consumption, arresting the heart with chemical cardioplegia will reduce O2 consumption dramatically. Therefore, if the resting (arrested) heart is continuously perfused with oxygenated blood cardioplegia, one can easily provide the remaining 10% of O2 that it requires. Under these conditions, the need for hypothermia becomes questionable. In this paper, we describe the perfusionist's experience using the antegrade and retrograde technique of continuous warm blood cardioplegia. PMID- 10149013 TI - In vitro comparison tests of three LV vent valves. AB - Many surgical teams employ a sump pump to vent the left ventricle (LV). The problems associated with this technique are related to safety and convenience. If the flow is accidentally reversed in the LV vent line, air embolism accidents and subsequent litigation may be the result. If the cannula is occluded, it is inconvenient to juggle pump speed to prevent the line from collapsing while maintaining gentle but adequate suction. In this study we in vitro tested three commercially available LV vent valves (RLV-2100 "B," VRV-200 B, H-130) (GLV did not wish to send samples for comparison at the time of this study). Each valve was designed to: regulate suction in the LV vent line; prevent the flow of air towards the heart; and vent downstream pressure to the atmosphere. Each valve was tested for suction at various flow rates, pressure heads, and for the presence of air leakage during reversed flow conditions. The results of pressure and suction tests during normal flow and occluded line conditions have been tabulated. We found the RLV-2100 "B" offers the safest combination of suction control and pressure relief. The most astonishing fact learned was the RLV-2100 "B" was the only valve which prevented the flow of air towards the heart during reversed flow. As a result, we elected to use only this valve in our clinical practice. PMID- 10149014 TI - Article authored by A. William Paulsen made reference to tubing product. PMID- 10149015 TI - Ultrafiltration versus cell washing for blood concentration. PMID- 10149016 TI - Arterial-venous perfusion without anticoagulation: the impeller centrifugal pump. AB - A study was designed to test the effects of the absence of anticoagulation in the extracorporeal circuit. Five swine were subjected to this experiment utilizing the impeller centrifugal pump during which neither heparin nor any other anticoagulant was used. The extracorporeal circuit consisted of polyvinylchloride tubing, a Centri-Med pump and an external stainless steel heat exchanger that was primed with albuminized Ringer's solution. An arterial-venous circuit was employed with oxygenation supplied from the subject's lungs. A series of blood aliquots were analyzed for coagulation at various times throughout the procedure. Following total body cooling using topically applied ice water, the subjects were rewarmed utilizing bypass. Within 10 minutes after the initiation of bypass, the circuits became clotted, rendering perfusion and subsequent warming ineffective. The lab values indicated that intrinsically activated coagulation occurred upon exposure to the extracorporeal apparatus. Flow visualization studies revealed a source of stagnant blood flow in the area around the hub of the pump head. Blood clot was similarly located in this area, with clot extension throughout the return circuit being realized. It is imperative that areas of stagnation be eliminated from extracorporeal circuits, since they may be potential sites for clot formation. PMID- 10149017 TI - Percutaneous fiberoptic spinal laser endoscopy. AB - For percutaneous observation of lesions near the spinal cord and percutaneous spinal laser surgery under the visual field, we studied a method and approach to the spinal cord and intraspinal surgical procedures with laser using a newly developed, small-diameter laser endoscope. The subarachnoid and epidural spaces of a goat were punctured using a 17-gauge epidural needle, and the endoscope (diameter 0.7 mm) was inserted through the needle. The spinal cord and surrounding tissue were observed. Next, an endoscope (diameter 1.5 mm) was inserted into the subarachnoid space, and the quality of the picture and manageability of the endoscope were examined. The Xe:Cl excimer laser was irradiated to a nerve root through a 0.4 mm optical fiber for laser transmission through this endoscope. The spinal cord, nerve roots, and arachnoid were clearly observed through this endoscope. The pulsation of the artery accompanying a root was seen clearly, and the quality of the picture of the endoscope was thought to be sufficient for diagnosis. The nerve root was cut within 30 seconds by excimer laser, and the possibility of laser surgery was demonstrated. Although it was shown that this endoscope could be a useful diagnostic and therapeutic tool, improvement in the manageability of the tip of the endoscope was considered to be important for a clinically usable endoscope. PMID- 10149018 TI - Moderate hypothermic versus normothermic total cardiopulmonary bypass for coronary artery surgery: a retrospective study. AB - A retrospective analysis of 200 patients who underwent coronary artery bypass surgery between 1987 and 1990 was performed to ascertain whether there was any difference in morbidity or mortality with normothermic versus moderate hypothermic perfusion. Total cardiopulmonary bypass was used in all patients. 100 patients (Group H) were perfused using moderate (28-32 degrees C) hypothermia and the remaining 100 patients (Group N) were perfused at normothermia (37 degrees C). Both groups were comparable for age, weight, BSA, and perfusion time (Group H mean 64 years, 82 Kg., 1.92 m2, 94 minutes; Group N-mean 63 years, 82 Kg., 1.90 m2, 90 minutes). Mean perfusate temperature in Group H was 31 degrees C, while the normothermic group was maintained at 37 degrees C. Both groups were perfused to maintain a venous oxygen saturation between 65-70 percent and arterial pressure between 60-70 mmHg. The cardiac index during bypass for Group H was lower (2.32 +/- .19 L/m2/min) than Group N (2.55 +/- .11 L/m2/min) (p less than 0.001). Mean arterial pressure for Group H was 69 +/- 12.4 mmHg and for Group N was 63 +/- 7.8 mmHg (p less than 0.001). Oxygen transfer for Group N (159 +/- 43 cc/min) was higher than Group H (113 + 31cc/min) (p less than .001). Metabolic acidosis was not observed in either group. Group H required vasodilators while Group N required vasoconstriction to maintain pressures on total bypass between 60-70 mmHg.(ABSTRACT TRUNCATED AT 250 WORDS) PMID- 10149019 TI - Perioperative autotransfusion and its correlation to hemostasis and coagulopathies. AB - The use of autologous blood techniques affords the reduction or elimination of homologous blood transfusions for most patients. In addition, for certain religious faiths such as Jehovah's Witnesses or those patients with rare blood types, intraoperative salvage and return of the patient's own blood is the only source of available blood. Autologous blood salvage in the perioperative period includes: hemodilution; intraoperative salvage of lost blood; postoperative collection of shed blood. Perioperatively, autologous blood is salvaged and returned and the volumes involved do not create any hematological problems for the patient. In those cases involving large volumes of blood being processed and returned to the patient, the autotransfusionist must be aware of the possible alterations that may occur in the patient's coagulation system. The collection and reinfusion of wound drainage fluids from operative sites has the potential to cause severe bleeding problems. This paper will present an overview of autologous blood salvage techniques in the perioperative period along with a review of the clinical effects of autotransfusion on hemostasis. Also discussed will be possible coagulopathies that can be caused by returning collected autologous blood. PMID- 10149020 TI - An introduction to quality assurance with an application for perfusionists. AB - Cardiovascular perfusionists have always been interested in quality assurance (QA), most often in the form of equipment maintenance and record keeping. However, these activities have tended to be fragmented. In an attempt to define a more global approach to QA, basic concepts are identified and the steps used to start a formal QA program are illustrated. In the usual approach to QA, three areas are commonly assessed: Structure, Process, and Outcome. Structure evaluates the adequacy of facilities and personnel. Process involves review of the activities concerned with the management of patients. Outcome represents evaluation of the end points of care. In starting our formal QA program, five steps were delineated. These were planning the program, setting up an administration, assessing preexisting activities, initiating the program, and finally evaluating results. A QA specialist helped to define a number of concerns about perfusion from perfusionists, surgeons, anesthesiologists, and nurses. Using a standard approach to QA, these areas were defined according to Structure, Process, and Outcome. PMID- 10149021 TI - With reference to the article "In vitro comparison test of three LV vent valves". PMID- 10149023 TI - A safer sperm count revisited. PMID- 10149022 TI - Measurement of red blood cell adenosine nucleotides by high-performance liquid chromatography. AB - A new method for measuring ATP in stored red blood cells using high-performance liquid chromatography was compared with an established enzymatic method. The new method is based upon isocratic reverse phase chromatography using a polyvinyl alcohol gel stationary phase. The chromatograms produce quantitative results for ADP, AMP, and other nucleotides, and can be used to determine adenylate energy charge. The correlation coefficient between the two methods was 0.91, and mean ATP was 3.0 mumol/g Hb for both methods. Tests of hypothesis for mean and variance were not significant. The method is recommended as a means to study the relationships between poststorage red blood cell ATP, adenylate energy charge, total adenylates, and posttransfusion erythrocyte survival. PMID- 10149024 TI - Maintaining and testing serologic cellwashers. PMID- 10149025 TI - Evaluating software for the clinical laboratory. AB - A set of guidelines to assist in structuring the software-evaluation process is presented. In recent years, laboratory professionals have increasingly assumed responsibility for the evaluation of software to be used in the laboratory for patient testing or administrative functions. This is a positive trend that brings user expertise to the selection of computer software but one that mandates the development of appropriate software evaluation procedures on the part of laboratory personnel. Software should be chosen that best conforms to the needs of the laboratory. Proper evaluation of available software is critical. Documentation should be reviewed, the software should be tested, capabilities must be compared with accrediting or licensing bodies' standards, and vendor support should be assessed. Development of a well-defined procedure for software evaluation will ensure selection of software that solves, not creates, problems. PMID- 10149026 TI - Fluorescent probes for cancer detection. AB - Several new fluorescent dyes, derivatives of pyrene and of coumarin, were synthesized that have excitation and emission wavelength maxima considerably red shifted as compared to most pyrene and coumarin compounds. These new fluorescent compounds have high extinction coefficients and high quantum yields, and they also are very environmentally sensitive, which makes them good probes of biological systems. Several of these fluorescent compounds are preferentially taken up and retained by leukemic and other cancer tissue cell lines as compared to normals, particularly 1,3-dihydroxy 6,8-pyrenedisodiumsulfonate and 3 (carboxymethylester)-7-julolidinocoumarin. These compounds may have some usefulness in cancer detection. PMID- 10149027 TI - Hyperthermia and the CO 2 laser: an experimental study. PMID- 10149028 TI - Cost-effective enzymatic method for simultaneous determination of urinary creatine and creatinine using automatic analyzer. PMID- 10149029 TI - Impact of technology on clinical laboratory manpower. PMID- 10149030 TI - Lipoprotein(a) as a new biochemical marker for assessment of coronary heart disease risk. PMID- 10149031 TI - Transplantation: the role of microbiologic services. AB - The role of microbiologic services in transplantation is described. Transplantations have become widely accepted therapeutic practices in which the microbiology laboratory actively participates. Except for problems related to function and rejection of the transplanted organ, infections are the most important concern of the clinician. The infections can be caused by bacteria, fungi, protozoa, and viruses and may occur very early after surgery or as long as six months posttransplant. Specimens (sputum, throat, blood, stool, perirectal, and urine) are routinely sent to the microbiology laboratory before and after transplantation to aid in the diagnosis of potential infections. Rapid diagnostic tests are imperative, and results must be communicated to clinicians expeditiously; this information may be critical in guiding therapy of these infections. The microbiology laboratory plays an essential role in identifying etiologic agents of infections and in determining appropriate therapy. PMID- 10149032 TI - Standardization of the urine microscopic examination. AB - Two standardized systems for examining urine sediment, UriSystem and the Kova System, were compared using urines from renal patients, hospitalized patients, and a normal population. Red blood cells and white blood cells were counted with each system and counts were placed into one of three predetermined clinically relevant categories: normal, suspicious, or diagnostic. In addition, cell counts were evaluated to compare how the systems categorized cell counts when dipstick results for blood, nitrite, and leukocyte esterase were negative. Results indicated that the UriSystem placed patient values into a category of higher relevance than the Kova system. When the reagent strip test results were negative, cell counts by the UriSystem were more likely to be in the suspicious category, indicating a possible need for further patient work-up than the counts done by the Kova system. Normal ranges of the microscopic sediment of the urinalysis must be re-evaluated using standardized systems such as those studied. PMID- 10149033 TI - Solid-phase hemadsorption assay for IgM antibody to Treponema pallidum in serum and umbilical cord blood. AB - A solid-phase hemadsorption assay (SPHA) for Treponema pallidum was evaluated using serum and umbilical cord blood. A total of 133 sera reactive using immunofluorescent antibody assay were tested by SPHA for IgM antibody against T. pallidum. They were categorized into clinical stages of syphilis, including eight sera with primary, 32 sera with secondary, 68 sera with latent, 21 sera with unclassified, and four sera with congenital syphilis. Sera were reactive for 75%, 90.6%, and 33.8% using SPHA in the primary, secondary, and latent phases, respectively. The method gave 57.1% reactivity for the unclassified phase of syphilitic sera and 100% reactive for the congenital syphilitic sera. All 80 immunofluorescent nonreactive sera were nonreactive by SPHA. Of 19 reactive cord blood samples tested, seven samples were reactive by SPHA. However, all 20 nonreactive umbilical cord blood samples were nonreactive by SPHA. The SPHA assay for the determination of IgM antibody to T. pallidum in serum appears to be sensitive for primary, secondary, and congenital syphilis. The SPHA assay in the cord blood is sensitive and specific. PMID- 10149034 TI - Evaluation of the I L B G electrolytes. PMID- 10149035 TI - Guidelines for selection of reagents and instrumentation for hemostasis laboratories. PMID- 10149036 TI - Fetal lung maturity testing. PMID- 10149037 TI - Detection of anticytoplasmic antibodies by indirect immunofluorescence. PMID- 10149038 TI - Comparison of six activated partial thromboplastin time reagents: intrinsic system factors' sensitivity and responsiveness. AB - Six activated partial thromboplastin reagents from four manufacturers were evaluated for precision, sensitivity, and dose responsiveness to Factors VIII, IX, and XII. Normal and abnormal APTT samples were prepared. Precision was assessed using 10 replicates on three consecutive days. Factor sensitivity and responsiveness were measured using a log-log curve of percent activity versus the upper limit of normal of prepared samples. All reagents had acceptable precision (C.V. less than 5%) in the normal range, but three performed unacceptably in the abnormal range. Two of the reagents were determined to be too sensitive to certain factors, giving an abnormal APTT result when the factor activity was in the normal range. Sensitivity and dose responsiveness to factors should be considered as two separate characteristics of an APTT reagent. PMID- 10149039 TI - Flow cytometric DNA analysis. AB - Flow cytometric DNA analysis, including principles, techniques, and applications, is reviewed. Flow cytometry, a relatively recently developed technology, is being increasingly used in the diagnosis and treatment of a wide variety of benign and malignant diseases. Current major applications include phenotypic analysis of cells, cell sorting, and DNA analysis. DNA analysis by flow cytometry is rapid, reliable, and reproducible. Flow cytometric DNA analysis offers a quick, reliable method of analyzing cellular DNA content capable of identifying cell populations with abnormalities in total DNA content. PMID- 10149040 TI - Practical methods for controlling powered upper-extremity prostheses. AB - Myoelectric pickups (electrodes and processors for detecting the signal that is recorded as an electromyogram) are the most important human-machine interface for controlling powered upper-extremity prostheses. This article presents a simple explanation of myoelectric signal acquisition and then discusses how these signals are used to control the small motors in electric hands, elbows, wrist rotators, and other similar equipment. The less-familiar switch-based and proportional position-sensing controls are also explained. A complete listing of the major suppliers and products available will aid in understanding a discussion of the criteria for using external power instead of, or along with, body power to control and activate prosthetic function. PMID- 10149041 TI - An electromagnetic cervical range-of-motion system and its sensitivity to environmental metal. AB - A three-dimensional cervical spine range-of-motion system was developed using an electromagnetic tracking system for data collection and a personal computer for analysis and graphic representation of the data. A test was designed to investigate the sensitivity of the electromagnetic device to the proximity of metal. It was found that position errors could be kept below 0.5 cm, and rotation errors could be kept below 1.3 degrees , if all metal was at least 33 cm from the source and sensor. The sensitivity of the system to metal should not cause serious problems in the typical clinical environment if simple precautions are taken. PMID- 10149042 TI - Current evaluation of hydraulics to replace the cable force transmission system for body-powered upper-limb prostheses. AB - Present body-powered upper-limb prostheses use a cable control system employing World War II aircraft technology to transmit force from the body to the prosthesis for operation. The cable and associated hardware are located outside the prosthesis. Because individuals with arm amputations want prostheses that are natural looking with a smooth, soft outer surface, a design and development project was undertaken to replace the cable system with hydraulics located inside the prosthesis. Three different hydraulic transmission systems were built for evaluation, and other possibilities were explored. Results indicate that a hydraulic force transmission system remains an unmet challenge as a practical replacement for the cable system. The author was unable to develop a hydraulic system that meets the necessary dynamic requirements and is acceptable in size and appearance. PMID- 10149043 TI - International wheelchair standards: a study of costs and benefits. AB - We hypothesized that extra costs incurred in meeting the requirements of wheelchair standards are recouped within the life of the wheelchair. We selected standards-quality and non-standards-quality electric wheelchairs of the same make and subjected them to accelerated life tests in a laboratory to simulate 1 year's active use. Expenses and lost time incurred due to breakdowns were monitored, and the costs of upgrading were documented. Our results support the hypothesis, within the limits imposed by the availability of only a small number of makes of electric wheelchairs of recognized standards quality. The significance of this finding is that wheelchair standards can be used to upgrade wheelchair quality in a cost-effective manner. PMID- 10149044 TI - The Ohmeda 5250 respiratory gas monitor. PMID- 10149045 TI - The use of pressure support ventilation in the operating room. AB - Pressure support ventilation is used in intensive care units to improve patient ventilator synchrony and facilitate weaning. An anesthesia machine that employs this mode of ventilation can now be used to allow smooth inductions, emergence, and maintenance of anesthesia while the patient is mechanically ventilated. PMID- 10149046 TI - Liquid crystal temperature indicators. PMID- 10149047 TI - Continuous spinal anesthesia microcatheters. PMID- 10149048 TI - Pulmonary artery catheter sleeves. PMID- 10149049 TI - The difficult intubation kit. AB - A kit for difficult intubation can be assembled quickly from vascular catheters and sheaths commonly available in surgical facilities. The kit provides for continuous oxygen administration throughout all phases of its application in difficult upper airway management. Such applications include stylet-guided endotracheal intubation, cricothyroid puncture, transtracheal ventilation, and translaryngeal catheter-guided retrograde tracheal intubation. A technical description of the Difficult Intubation Kit and guidelines for its use in difficult airway management are presented. PMID- 10149050 TI - Combined continuous and demand narcotic dosing for patient-controlled analgesia after cesarean section. AB - New patient-controlled analgesia devices can deliver an analgesic by continuous infusion along with demand dosing. This prospective investigation involving postcesarean-section patients was undertaken to determine whether a combination of continuous infusion and demand dosing of meperidine would provide more effective analgesia than would demand dosing alone during the first 24 hours. During a 12-month period, 171 patients were prescribed meperidine postoperatively, using a 5- to 10-mg demand dose no more frequently than every 10 minutes. Patients were assigned to groups receiving no continuous infusion or infusion at rates of 10, 20, or 30 mg/h. The groups receiving continuous infusion showed more immediate and sustained pain relief, with no serious complications. All patients were able to understand the nurse, became ambulatory, and tolerated liquids on the first postoperative day. The infusion rate of 20 mg/h was most acceptable in requiring fewer demand doses while providing satisfactory pain relief without undesired sedation. In conclusion, a system combining continuous infusion and demand dosing was preferable to demand dosing alone, and added no apparent hazards. PMID- 10149051 TI - The Bullard intubating laryngoscopes. PMID- 10149052 TI - The Datex Relaxograph NMT-100. PMID- 10149053 TI - Structural stability of long-term implants of a collagen-based vascular prosthesis. AB - Samples of an ovine collagen-polyester composite device suitable for peripheral revascularization, the Omniflow Vascular Prosthesis, have been retrieved for morphological and immunohistological analyses during and up to 4 years of implantation in a dog aortoiliac by-pass model. At the various sample times, the prosthesis explants were shown to retain their structural integrity, with no aneurysm formation and with little thrombus accumulation. Immunohistological studies on samples of the prosthesis showed that the original ovine collagen was still present after 4 years, and that there had been augmentation by the deposition of new, host-derived connective tissue. PMID- 10149054 TI - Optimization of a trileaflet valve design. AB - This study investigates the fundamental principles that should govern the basic design of an optimal trileaflet valve. The geometry of the leaflets is described in terms of radius of the base (Rb), radius of the commissures (Rc), height of the valve (H), height of the commissures (Hs), and angle of the open leaflet to vertical (beta). Using computer-aided design software and these design parameters, a computer model of the valve was constructed. Choosing the parameters empirically did not produce an optimal valve. The four criteria for optimal performance were defined as: (1) a certain minimum coaptation height, (2) no folds in the leaflet, (3) minimum valve height, and (4) minimum leaflet flexion. Mathematical relationships were established between the design parameters and the performance parameters. These relationships indicated that the parameters Rc, Hs, and beta could be used to minimize valve height; however, a reduction in valve height must be balanced against the accompanying increase in leaflet flexion. For an optimal valve, the design parameters were Rb = 10 mm, then Rc = 8 to 10 mm, H = 11.5 mm, Hs = 2.4 to 2.6 mm, and beta = 4 degrees to 11 degrees . The optimal valve of any radius can be designed by scaling Rc, H, and Hs with respect to Rb. These design parameters were similar to those of the natural aortic valve. Trileaflet bioprosthetic valves designed on these principles are expected to have enhanced efficiency and longevity. PMID- 10149055 TI - Long-term compatibility of intraocular lens implant materials. AB - This paper provides a general review of the long-term compatibility of intraocular lenses (IOLs), with specific reference to the compatibility of synthetic polymers used to fabricate IOLs. The first IOL was implanted in 1949. It was composed of polymethylmethacrylate (PMMA) and placed in the posterior chamber of the eye. In 1990, approximately 1.4 million IOLs were implanted in the U.S., nearly all composed of PMMA and nearly all implanted in the posterior chamber of the eye. However, many changes have taken place in the past 40 years to improve the compatibility of IOLs and to make cataract surgery and IOL implantation among the safest and most effective major surgical procedures. PMID- 10149056 TI - Long-term tissue tolerance of titanium-encapsulated cobalt-samarium implants. AB - The tissue reactions of titanium-coated cobalt-samarium magnets were investigated following their full-thickness implantation into the skulls of dogs and pigs (six of each species). The implants, together with the surrounding bone, were removed en bloc 1, 2, 3, 6, 9, and 12 months postoperatively. Following physical and radiological examinations, the excised samples were subjected to histologic investigation. The osseointegration process was observed to follow a normal course around the titanium capsule. The magnetic field did not give rise to any tissue changes that could be demonstrated by means of classical histologic methods. PMID- 10149057 TI - An automated hematology instrument for comprehensive WBC, RBC, and platelet analysis. PMID- 10149058 TI - Laboratory tests for isoforms and isoenzymes of creatine kinase. PMID- 10149059 TI - Instrumentation for luminescent assays. PMID- 10149060 TI - A random access EIA system based on magnetic microbead technology. PMID- 10149061 TI - Biodegradable screw fixation of rabbit tibia proximal osteotomies. AB - The purpose of this study was to evaluate a biodegradable poly(L-lactide) (P-L LA) screw for osteosynthesis under a load-bearing condition. A proximal tibial osteotomy on 25 rabbits was fixed with a biodegradable screw made of P-L-LA. A follow-up study was done at 1, 2, 4, 8, and 16 weeks. In another 25 rabbits, the tibial osteotomy was fixed with stainless steel (SUS) screws of the same size as the P-L-LA screws with a similar follow-up period. Radiographic, histological, microradiographic, and oxytetracycline-labeling studies showed healing of the osteotomy within 4 to 8 weeks. The displacement of fragments and the mass of newly formed bone around the screws were measured by histomorphometric analysis. There was no significant difference in the displacement of the fragments in these two groups and new bone was more abundantly detected in the P-L-LA group than in the SUS group. Histologically, no inflammatory lesion was detected in either group. All osteotomies united without delay and the displacement was minimal, although no external support was applied and the rabbits were allowed to move freely after the operation. The results of this study suggest a possible use for a P-L-LA screw in the clinical treatment of human bone fractures. PMID- 10149062 TI - Histological and ultrastructural observations at the interface of expanded polytetrafluorethylene anterior cruciate ligament implants. AB - Anterior cruciate ligament (ACL) grafts made from expanded polytetrafluorethylene (ePTFE) were examined after failure (n = 7; 3 instabilities, 2 partial ruptures, and 2 complete ruptures) to provide information about secondary fixation mechanisms via ingrowth of the different tissues. The ultrastructural evaluation clearly evidenced the existence of two main interface areas of ePTFE ACL replacement: First, in areas without a dense cellular infiltrate there was interdigitating collagen producing a dense ePTFE-collagen network. Additionally, in a few areas of the graft/bone-tunnel interface a fibrous cartilage or bone regenerate could be demonstrated to be in contact with the prosthesis. Second, there was a dense infiltration of macrophages and multinuclear giant cells, partially containing birefringent material of implant origin, with and without a neosynovia-like reaction product, indicating a disturbance of tissue integration of the prosthesis. In areas of inflammation there was no bone development and only few collagen interdigitation with the graft material. This study provides further knowledge about mechanisms of secondary graft fixation due to tissue ingrowth. The interdigitation of collagen fibers and ePTFE filaments provides interfaces which should be at least partially resistant against load. PMID- 10149063 TI - Application of a device to lower pulpal temperatures in vivo. AB - Heat generated by tooth reduction and restoration procedures may be harmful to the pulp. Water spray during those procedures aids in maintaining lowered pulpal temperatures. A device that lowers intrapulpal temperatures has been developed and tested in an animal model. The animal's pulp chamber temperatures were lowered to 15.5 degrees C and 12.4 degrees C and maintained at those temperatures for 20 min. Histological examinations disclosed no inflammatory reaction to the testing. Therefore, this device may aid in reducing the trauma of dental preparation procedures as well as other effects of lowered temperature on the biology of the dental pulp. PMID- 10149064 TI - The laryngeal mask airway. PMID- 10149065 TI - The Thrombelastograph D coagulation analyzer. PMID- 10149066 TI - A survey of wheelchair seating problems of the institutionalized elderly. AB - This study attempted to define and quantify the need for appropriate seating for elderly nursing home residents. A questionnaire was administered to 200 randomly selected nonambulatory elderly residents living in six Memphis area nursing homes. The study results supported previous findings that many nursing home residents have seating and mobility problems. Of the 139 wheelchair users analyzed, 112 (80%) experienced at least one problem related to discomfort, hindered mobility, or poor posture. Thirty-four percent of the residents had at least one problem considered to be severe. In most cases our respondents' seating and mobility problems could have been solved by the tailored application of presently available technologies. PMID- 10149067 TI - Wheelchair seat comfort for the institutionalized elderly. AB - Studies have reported many wheelchair problems faced by the institutionalized elderly. Because knowledge is limited regarding seat comfort in general and for the nursing home population in particular, we elected to investigate seat comfort in order to gain insight needed to solve seat discomfort problems. This study's primary objective was to identify quantifiable indicators of seat comfort. Seat comfort was investigated in relation to peak sitting pressure, asymmetry of sitting pressure distribution, and seat cushion type. Fifty nursing home residents who were able to reliably rate the comfort of their wheelchairs were surveyed. The survey consisted of several questions regarding wheelchair seat comfort, wheelchair use, and functional and cognitive abilities. Measurements included peak sitting pressures and parameters of sitting posture. This study failed to identify robust indicators of seat comfort. It failed to confirm the hypothesis that higher peak sitting pressures correspond to greater discomfort. No relationship was found between the asymmetry of sitting pressure and reports of seat discomfort. Although we were unsuccessful in achieving statistically significant results, we did identify seat comfort indicators that are not only statistically significant but are also of practical clinical usefulness. Further research with additional subjects is required to identify cushions that are both comfortable and pressure relieving. PMID- 10149068 TI - Pediatric power wheelchairs: evaluation of function in the home and school environments. AB - The purpose of this study was to compare the performance of four power wheelchairs when used by children to perform a variety of indoor activities. Eight boys and eight girls performed a series of 11 functional tasks when positioned in each of four different power wheelchairs reflecting different design classes. There were no significant differences for many of the dependent variables. However, the Everaid Turbo was significantly better for functional positioning at a standard kitchen table and at school desks and for accessing objects at different heights. By contrast the Invacare Jaguar was better for straight-line driving speed. Other findings include children's subjective impressions of the four power wheelchairs. PMID- 10149069 TI - A multidimensional evaluation of a four-wheeled walker. AB - Walkers provide technologically simple help for people affected by diseases that disturb balance and/or support. However, very little research has been conducted on walkers in terms of their efficacy and efficiency. This is unfortunate given the fact that walkers offer a partial solution to problems involving falling among the elderly population. An experimental four-wheeled walker was evaluated using objective, observational, and self-report methods and contrasted with the individual's own walker. This part of the project represented an initial impressions phase. Results from this first phase indicate that the experimental walker increased users' speed, and that it enhanced performance when used on ramps. Conversely, observational data indicated that some problems controlling the walker may occur when attempting to perform tasks that compete with stabilizing the walker such as opening and closing household appliances. Although positive findings were achieved, a longitudinal experimental design that incorporates an evaluation in the individual's home environment must take place to ascertain whether the results can be generalized to functional use over time. PMID- 10149070 TI - Anesthesia for magnetic resonance imaging. AB - Magnetic resonance imaging (MRI) represents the latest advance in diagnostic tools available to the radiologist. Since the radiology suite is one of the most common areas requesting anesthesia, outside of the operating room, anesthesiologists will be required to understand the principles underlying MRI and how this technology affects anesthetic management in order to provide quality care in this environment. PMID- 10149071 TI - An update on mechanical ventilation for severe acute asthma. PMID- 10149072 TI - Use of the WALLACE Y-CAN 23g for arterial cannulation in paediatric patients. PMID- 10149073 TI - Pulmonary artery catheterisation in septic shock. Indications; therapeutic and prognostic implications. PMID- 10149074 TI - Critical care algorithms. Management of continuous haemo(dia)filtration. PMID- 10149075 TI - Attitudes to the delivery of enteral nutritional support to patients in British intensive care units. AB - OBJECTIVES: To assess the relative roles of medical, nursing and dietetic staff in the nutritional support of critically ill patients and the methods used to calculate energy requirements. DESIGN: Postal questionnaire. SETTING: United Kingdom. PARTICIPANTS: Medical, nursing and dietetic staff of 289 hospitals with three or more intensive care beds. RESULTS: Replies were received from 50.3% of participants. Doctors more commonly claimed responsibility for starting enteral nutrition (81.1%) although nurses and dietitians claimed a share of the decision in 28.6% and 11.4% of replies respectively. Doctors claimed that they alone prescribed enteral nutrition in 52.8% of replies and with dietitians in 17.3% of cases whereas the dietitians claimed that they alone prescribed in 46.6% of replies and with doctors in 22.7%. Estimation was the commonest method used to assess patient energy requirements (68% of doctors, 59.5% of nurses and 51.1% of dietitians). Most respondents believed that this was adequate although not accurate. CONCLUSIONS: There is evident confusion between medical, nursing and dietetic staff over responsibility for enteral nutrition. Without a co-ordinated team approach advances in the enteral nutritional support of critically ill patients are unlikely. Indirect calorimetry, an accurate predictor of an individual patient's energy requirements, has not gained widespread acceptance but will be necessary to tailor nutritional support to individual requirements. PMID- 10149076 TI - Minimal positive end expiratory pressure (PEEP): a safe, effective, defensible practice. PMID- 10149077 TI - Critical care algorithm. Positive end-expiratory pressure. PMID- 10149078 TI - Performance of the polypropylene fiber tailstring on the Copper 7 intrauterine device. AB - New and used polypropylene tailstrings from the Copper 7 (Cu-7) intrauterine device were examined by a combination of analytical techniques. Optical microscopy, scanning acoustic and electron microscopy, x-ray diffraction, energy dispersive x-ray analysis, and chemical etching were employed to elucidate both the surface and interior morphology of new Cu-7 tailstrings. Tailstrings removed from women following varying periods of use were investigated with optical microscopy, scanning and transmission electron microscopy. In addition, a subset of the used tailstrings were cultured to identify the types of microorganisms associated with them. Our findings show that unused Cu-7 tailstrings are in various stages of degradation owing to a combination of factors which include the high-draw ratio employed during manufacturing, the method of packaging, and the use of a particulate colourant. Furthermore, it is evident that used Cu-7 tailstrings undergo major deterioration while in situ because of the unfavorable interactions between the highly drawn polypropylene and the physiological environment. These results indicate that the polypropylene tailstrings as manufactured for use with the Cu-7 IUD fail to meet accepted design criteria for biomedical implants. PMID- 10149079 TI - Application of extracorporeal shock wave lithotripter (ECSWL) in orthopedics. I. Foundations and overview. AB - In this paper we have reviewed the feasibility of using a shock wave lithotripter to loosen the interface between the bone and acrylic bone cement for revision arthroplasty. We have reviewed the physics of shock wave and its applications in medicine, especially its interaction with tissues. The calculations show that the energy is greatly reduced at the interface both in the soft tissue-bone interface and cement-bone interface. On the other hand, a tensile and compressive pressure can be operated at the cement-bone interface that can cause the interface to break if the pressure exceeds the tensile strength of the cement bone interface. Subsequent papers will deal with in vitro and in vivo application of the shock wave in the treatment of the cement from the intramedullary canal. PMID- 10149080 TI - A heat-generating bioactive glass-ceramic for hyperthermia. AB - Glass plates of the chemical composition: CaO (29.0), SiO 2 (31.0), Fe 2O 3 (40.0), B 2O 3 (3.0), P 2O 5 (3.0) in weight ratio were heated to 1050 degrees C at a rate of 5 degrees C/min and then cooled to laboratory temperature. The resulting glass-ceramic containing magnetite and wollastonite crystals showed high-saturation magnetization. The bonding ability of this new glass-ceramic to bone tissue was evaluated using rabbit tibiae, and compared with glass of the same composition. This glass-ceramic formed a Ca, P-rich layer on its surface and bonded tightly with bone within 8 weeks of implantation. However, the glass did not form this Ca, P-rich layer, nor had it bonded with bone at 25 weeks. The bone-heating ability of this glass-ceramic was investigated by applying a max. 300-Oe, 100-kHz magnetic field. The granules of the glass-ceramic filled in the rabbit tibiae heated the whole surrounding bone to more than 42 degrees C and maintained this temperature for 30 min. Bioactive ceramics reinforce the mechanical strength of bone tissue. Furthermore, this heat-generating bioactive glass-ceramic can be used for hyperthermic treatment of bone tumors. PMID- 10149081 TI - Application of extracorporeal shock wave lithotripter (ECSWL) in orthopaedics. II. Dose-response and pressure distribution measurements. AB - In order to apply the extracorporeal shock wave lithotripter (ECSWL) technique to the loosening of the bone-cement interface for the extraction of the cement during revision arthroplasty it is essential to know the dose-response characteristics. The present study shows that the number of shocks needed to break the interface between a 2- and 6-mm-thick bovine femoral bone and bone cement is similar to the fatigue behavior of a material, that is, Log(N) = C(kV) + D, where N is the number of shock impulses, kV is the power setting of the lithotripter machine in kilovolts, and C and D are constants. Iso-pressure distribution of the traveling shock wave front through a simulated bone in a Plexiglass tube using Fuji pressure film showed quantitative pressure contours from which one can understand the effective area of shock wave and its distribution. The most effective area of the shock wave was about 1.5 cm in diameter at 23 and 25 kV with pressure at least 7.0 MPa which is more than sufficient to break the bone-cement interface in tension. PMID- 10149082 TI - Application of extracorporeal shock wave lithotripter (ECSWL) in orthopaedics. III. In vitro and in vivo studies. AB - The present study was conducted to compare the push-out strength of the treated and control samples obtained after implantation of intramedullary rod in canine femurs with bone cement to simulate the femoral stem implantation for 2 weeks, 3 and 6 months. Contralateral femur served as control. The result showed a significant decrease in push-out interfacial strength after shock wave treatment (average 48.4% decrease compared with control, p less than 0.0001) which is similar to the in vitro results. There was no significant difference if the shock treatment was applied and left for 2 weeks or 4 weeks compared to the ones tested immediately after sacrifice. There were some soft tissue damage immediately following shock treatment in the focal area but this returned to normal in 2 weeks. Human cadaveric femoral bone experiment results showed that results are similar for both human cadaveric femoral bones and the canine bone (the dosage level was higher for the human bone than canine). The number of impacts used to extract the bone cement plug out of a human femur segment (5-cm long) decreased about 68% at 23 and 25 kV treatment power level. These preliminary studies indicate that the shock wave can be utilized to reduce the interfacial strength of the bone and bone cement although more studies are needed to assess its efficacy in terms of cost, long-term effect on patients and the exact mechanism of the loosening before this technique can be used clinically. PMID- 10149083 TI - Bone graft and bone graft substitutes: a review of current technology and applications. AB - The morbidity associated with autogenous bone graft harvest and the recent concern regarding the transmission of live virus through use of allografts, have been the impetus for research into a variety of materials that could take the place of these standard materials for bone grafting. The positive results reported with various ceramics and/or bone derivatives suggest the possibility of a material with osteoconductive and/or osteoinductive properties for use with or in place of bone graft. This review discusses a variety of bone graft and bone graft substitute materials. Among the osteoconductive materials outlined are the hydroxyapatite and tricalcium phosphate ceramics as well as some reportedly osteoactive polymers. While osteoconduction is a favorable quality, much interest has focussed on the use of osteoinductive or osteogenic materials such as demineralized bone matrix or bone derivatives, that is, BMP, osteogenin, etc. It is increasingly apparent that these materials require a carrier vehicle for optimal expression of osteoactivity. Therefore, the review finishes with a comparison of the various materials suggested for use as carriers. PMID- 10149084 TI - The clinical status of low energy laser therapy in 1989. AB - Low energy laser therapy has gained varying acceptance as a treatment for a broad range of soft tissue, musculoskeletal and neurological conditions. A controversial, but surprisingly large body of research with cell cultures suggests that laser irradiation can nondestructively alter cellular processes. Unfortunately, animal and human studies are often contradictory and difficult to evaluate due to differing study designs. As a result, the clinical effectiveness of low energy laser therapy remains debatable. Nevertheless, the findings are intriguing and deserve further investigation. PMID- 10149085 TI - Exploring use of laser to determine caries location. PMID- 10149086 TI - Infrared optical fibers for surgical applications. AB - The basic characteristics of fibers that are appropriate for surgical use in the infrared are reviewed. New fiber materials, such as sapphire, fluorozirconate and chalcogenide glasses, and polycrystalline fibers are discussed as well as their applicability for surgical procedures. PMID- 10149087 TI - The use of laser systems in podiatric medicine. PMID- 10149088 TI - Erbium:YAG (2.94 mum) laser effects on dental tissues. AB - Past trials with soft and calcified tissues have demonstrated that long pulse train (2.5 mus) Er:YAG (2.94 mum) laser may be used to ablate tooth structure of human teeth. Determination of physical and thermal damage to surrounding tissue during removal of enamel and dentin is a primary objective of this study. Extracted human teeth with thermal probes imbedded in the pulp chambers were submitted to cavity preparation using an Erbium YAG laser with water mist. Wavelength selection as well as use of a water mist during the procedure resulted in efficient tissue removal without significant surrounding damage. Ground sections and SEM sections of teeth showed little or no melting or ash formation in adjacent dentin and enamel and no visible change in the pulp chamber. The surfaces produced by laser ablation were rough and irregular with craters and grooves. Average temperature change in the pulp chamber monitored during tooth preparation was 2.2 degrees Centigrade. These findings suggest that constantly available water aids vaporization and microexplosions, increasing the efficiency of tooth structure removal, and aids in cooling of the tooth structures. The long pulse Er:YAG (2.94 mum) laser may be an effective method for tooth reduction applications when used with a water mist. PMID- 10149089 TI - In support of prognostic scoring in intensive care. PMID- 10149090 TI - Evaluation of clinical scoring systems in critically ill infants and children. AB - Four scoring systems, the Acute Physiologic Score for Children (APSC), the Physiologic Stability Index (PSI), the Paediatric Risk of Mortality (PRISM) and the Therapeutic Intervention Scoring System (TISS), were evaluated for 103 critically ill infants and children according to the Clinical Classification System (CCS) class IV. The admission scores were higher for children who died than those who lived (APSC, PSI, PRISM p less than 0.001, TISS p <0.025). In addition, the mean APSC and PSI showed significant differences (p less than 0.01) between survivors (S) and nonsurvivors (NS) in all patients, mean PRISM showed significant differences (p less than 0.01) between S and NS in all but renal failure patients and the mean TISS showed only significant differences (p less than 0.01) between S and NS with primary cardiovascular and respiratory diseases. The mortality rate was 30%. Using the 0.5 predicted risk rate, total correct prediction of admission APSC, PSI, and PRISM was 80%, 80.5% and 80% respectively. Receiver Operating Characteristic (ROC) curves drawn for each severity index were in a discriminating position. There were no significant differences between the areas under the ROC curves of the physiological scores. However, there was a significant difference between the physiologic scores and TISS (p less than 0.001). Admission APSC, PSI and PRISM excellently describe severity of illness and give prognostic information in critically ill paediatric patients. In addition, TISS gives information about the therapeutic support needed. PMID- 10149091 TI - Severe acute pancreatitis. I: the conservative approach. PMID- 10149092 TI - Severe acute pancreatitis. II: the surgical approach. PMID- 10149093 TI - An evaluation of the costs and outcome of adult intensive care in two units in the UK. AB - To test the feasibility and value of an economic appraisal of intensive care, a retrospective follow-up study was performed in two intensive care units in England. Clinical activity data was extracted from the records of 100 consecutive admissions to each unit and used to cost the care received by each patient during their stay in the units. Outcome was measured in terms of survival and quality of life six months after admission. Mortality at discharge from the units was 25% and 15% rising to 31% and 38% respectively six months after admission. Between one-third and one-half of patients alive at six months reported that their health continued to restrict aspects of their daily activities and one-fifth reported serious disability or distress. Total costs averaged 2,000 pounds and 2,280 pounds, equivalent to 525 pounds and 465 pounds per in-patient day. Poor outcome was associated, though not always significantly, with increased age, severity of illness and increased costs. The small sample size and heterogeneous nature of intensive care prevent firm conclusions being drawn from this study but the results indicate that such investigations are both feasible and potentially rewarding. PMID- 10149094 TI - Renal replacement therapy for acute renal failure. AB - Mortality from acute renal failure (ARF) remains very high and is associated with the development of multisystem failure. Technical developments in haemodialysis machines and dialyser membranes have reduced complications associated with haemodialysis. However, some patients are too unstable to be haemodialysed successfully. Continuous haemofiltration and continuous arterio-venous (or veno venous) haemodialysis can be performed on Intensive Care Units in hospitals without the availability of a Renal Unit. These techniques provide more effective and controlled removal of fluid and uraemic toxins. There are now few indications for the use of peritoneal dialysis. These new developments have facilitated easier management of the unstable patient with acute renal failure. Whether the prognosis of acute renal failure patients will be improved remains to be determined. PMID- 10149095 TI - Secondary transport of the critically ill adult. PMID- 10149096 TI - Treatment of severe anaemia with perfluorocarbon blood substitutes: a clinical overview. PMID- 10149097 TI - Successful extracorporeal lung assist (ECLA) for a patient with severe asthma and cardiac arrest. AB - A 20-year-old male had a severe asthma attack complicated by a cardiac arrest despite maximal conventional therapy including mechanical ventilation. He was treated successfully with emergency veno-arterial Extra-corporeal Lung Assist started after 30 minutes of cardiopulmonary resuscitation. We believe that ECLA is a life-saving measure for intractable asthma and cardiac arrest. PMID- 10149098 TI - Physiological responses to endotracheal and oral suctioning in paediatric patients: the influence of endotracheal tube sizes and suction pressures. AB - OBJECTIVE: To study the influence of varying outer suction catheter (SC) diameter (OD) to inner endotracheal tube (ETT) diameter (ID) and suction pressures (SP) on heart rate (HR), respiratory rate (RR), mean arterial pressure (MAP), arterial oxygen saturation (SaO 2) and intracranial pressure (ICP) during ETT and oral suctioning. An additional aim was to define an optimal suction catheter size that would prove easy to introduce and be rapidly effective in clearing secretions with the least physiological alteration. DESIGN: Prospective study. SETTING: Paediatric intensive care unit. PATIENTS: Ventilated paediatric patients. INTERVENTION: Patients had ETT suctioning performed in a random fashion using suction catheters with SC outer diameter to inner ETT diameter of approximately 0.4, 0.7 and 0.9 using varying pressures (80, 100, 120 mmHg). Using the medium size suction catheter (OD/ID = 0.7) at 100 mmHg of suction pressure, oral suctioning was compared to ETT suctioning. MEASUREMENTS AND MAIN RESULTS: Seventeen patients were studied (age 6.5 + 5 months). All suction catheters at varying pressures resulted in similar transient alterations in HR, RR, MAP, SaO 2 and ICP following ETT suctioning. Significant changes were seen in SaO 2, HR and ICP, irrespective of the catheter diameter or suction pressure. Oral suctioning resulted in similar trends and magnitude of changes as for ETT suctioning in MAP, RR, HR, and ICP, but less change occurred in the SaO 2 (p less than 0.05). The catheters with OD/ID of 0.7 were easiest to introduce and most effective in clearing secretions. CONCLUSION: Our study suggests that: 1. Tracheal toilet using variations in OD/ID ratios and SP within limits tested resulted in similar significant adverse changes in HR, ICP and SaO 2 and similar trends in RR and MAP. 2. Based on the ease of introduction and the effectiveness of clearing secretions, a medium SC (OD/ID = 0.7) is most appropriate for infants and children. 3. Oral suctioning also results in adverse physiological changes, therefore similar precautions to those taken during tracheal suctioning should be followed for oral suctioning. PMID- 10149099 TI - Pressure-controlled inverse-ratio synchronised independent lung ventilation for a blast wound to the chest. AB - Massive unilateral pulmonary injury poses a severe ventilatory problem. We used pressure-controlled, inverse-ratio, independent lung ventilation for a shotgun injury. Two synchronised Siemens Servo 900C ventilators were connected to a double lumen endotracheal tube. Arterial pO2 tripled in 15 minutes, and the patient remained on SILV for 36 hours. PMID- 10149100 TI - Determination of the need for tricuspid valve replacement: value of preoperative right ventricular angiocardiography. AB - Of 530 patients undergoing tricuspid valve surgery from January 1, 1961 through December 31, 1987, those 362 patients having had preoperative right ventricular angiocardiography were studied. Mean age was 58.5 years. There were 71 males and 291 females. Tricuspid valve replacement (TVR) was performed in 126 (34.8%), and 236 underwent tricuspid valve repair (65.2%). The predominant pathology was combined tricuspid insufficiency and stenosis in 18 patients (4.9%), and isolated tricuspid insufficiency in 344 (95.1%). There were no complications related to the right ventriculogram. Preoperative angiographic severity of tricuspid valve incompetence was grade 1 in 23 patients (6.4%), grade 2 in 65 (17.9%), grade 3 in 109 (30.1%), and grade 4 in 165 (45.6%). Intraoperative assessment of the severity of tricuspid valve incompetence correlated 72% of the time with the preoperative angiographic assessment, in those patients with more severe degrees of incompetence (grade 3+ or 4+), p (X 2) less than 0.001. Increasing severity of preoperative angiographic triscuspid valve incompetence was associated with the requirement for TVR (vs. repair), p (X 2) = 0.0002. In conclusion, preoperative right ventricular angiography is a useful method for assessing tricuspid valve function and may predict the requirement for TVR in patients undergoing tricuspid valve surgery. PMID- 10149101 TI - Percutaneous transluminal coronary angioplasty of native coronary arteries via saphenous vein grafts. AB - We analyzed the immediate and long-term outcome of percutaneous transluminal angioplasty (PTCA) of native coronary arteries via saphenous vein grafts (SVG) in 30 patients. The mean age of the grafts was 69 months. Angioplasty was successful in 27 (90%) patients. One patient died following emergency bypass surgery. There were no distal embolizations and one non-Q myocardial infarction. Follow-up angiography was performed in 12 patients, which revealed restenosis in three patients. At a mean follow-up of 20 months, cumulative survival was 93%. Freedom from myocardial infarction, repeat bypass surgery, and death was 80%. We conclude that PTCA of native coronary arteries via SVG is a safe alternative to repeat CABG in selected patients. PMID- 10149102 TI - Randomized comparison of over-the-wire and fixed-wire balloon devices for coronary angioplasty. AB - One hundred and fifteen consecutive patients undergoing coronary angioplasty (PTCA) were randomized to low profile over-the-wire (OTW, e.g., Mini, Sulp II) or fixed-wire (FW, e.g., Ace, Orion, Probe) PTCA balloon wire devices. Overall success, ability to begin and finish with the same balloon device, fluoroscopy time, physician time, and amount of contrast media used were prospectively assessed. Overall final success rate was excellent regardless of which type of system was used first (OTW 92%; FW 96%). In 6 patients no wire would cross, in another, the stenosis would not dilate despite high pressure ( greater than 18 atm). When an OTW device was used first, it was initially successful in 69% of patients and was changed with success to a second OTW balloon in 4 (cumulative 76%). An OTW balloon was changed to FW in 11 patients (success 9 patients, 82%). This was because of inability to cross with balloon of the OTW system after a steerable wire had crossed in 9 of the patients. When a FW device was used first, it was initially successful in 89%. A change to another FW device led to success in 4 additional patients (cumulative 96%). In no patient was a FW changed to an OTW device. Thus, a FW device was more likely to be successful (either 54 of 56 patients initially randomized to FW, or 63 of 67 total patient number in whom a FW device was used) than an OTW device (45 of 59 patients) p less than .05.(ABSTRACT TRUNCATED AT 250 WORDS) PMID- 10149103 TI - Coronary angioplasty in stenotic lesions adjacent to coronary aneurysms. AB - The efficacy and safety of coronary angioplasty for stenoses adjacent to coronary aneurysms were studied in 25 patients (19 men and 6 women, mean age 62 +/- 11 years). The study represented 1.1% of patients undergoing coronary angioplasty during the study time period. The aneurysm diameter exceeded 1.8 +/- 0.2 times the normal artery diameter. Eleven (44%) of these aneurysms were localized in the left anterior descending, 3 (12%) in the circumflex and 11 (44%) in the right coronary artery. Percent diameter stenosis was reduced from 72 +/- 10% to 23 +/- 19%, and transstenotic gradient from 51 +/- 13 to 15 +/- 9 mmHg when measured. Clinical success (absence of pain on discharge without coronary bypass surgery, death, or infarction) was achieved in 24 (96%) patients. In one patient acute vessel closure occurred. No embolic events or coronary artery rupture occurred. Seventeen (71%) of the 24 successful patients remained asymptomatic at clinical follow-up (mean = 7.7 +/- 5.0 months). At late follow-up, one patient had sustained a myocardial infarction, two had elective bypass surgery, and two had successful repeat angioplasty. The data from this small patient population suggest that angioplasty for a stenosis adjacent to a coronary aneurysm can be performed safely with a high primary success rate. PMID- 10149104 TI - Coronary angioplasty in patients who were considered poor bypass surgery candidates. AB - In most patients who undergo coronary angioplasty (PTCA), coronary bypass surgery (CABG) is an alternative. Patients with severe symptoms secondary to coronary disease, amenable to PTCA, but who are poor CABG candidates are commonly seen. From April 1988 to December 1989 PTCA was performed in 751 patients. Patients with evolving infarction (47) were excluded. Of the remaining 704, 605 were considered candidates for CABG and they were compared to the 99 patients not felt to be candidates for CABG. The objective of this report was to compare these 2 patient groups. These salvage PTCA patients were older, had a higher incidence of heart failure, more prior CABG, higher left ventricular end-diastolic pressure and lower ejection fraction (all p less than 0.01). PTCA had a high success rate per lesion in both groups (96% CABG candidates vs. 95% salvage patients), but there were more patients whose culprit lesion could not be dilated in the salvage group (14% vs. 7%, p less than 0.02). Severe complications including Q wave infarction (2% vs. .3%) and in-hospital death (7% vs. 0.2%) were more common in salvage patients. As planned, emergency CABG was not performed on any salvage PTCA patient but on 2.6% of the other patients. Patients who may benefit from PTCA but were not felt to be operable made up 13% of our PTCA experience. PTCA can be performed in these patients but risks were increased. PMID- 10149105 TI - Atherectomy, stents and lasers. An annotated bibliography of recent references. AB - This is an annotated bibliography of selected references on atherectomy, stents and lasers that have appeared in the literature since the particular issue of the Journal of Invasive Cardiology covering that device was published. It has been structured to include pertinent details about each citation, including the site at which the device was used (coronary or peripheral), the type of article in which the research was reported (clinical paper, case report, abstract, review, editorial), the number of subjects or procedures and lesions treated, the design of the study (case study, single group, group comparison, or randomized trial), acute and late results, and comments about the study and its findings. PMID- 10149106 TI - Procedural variables associated with eventual long term angiographic success in patients with recurrent restenosis. AB - To determine the procedural variables associated with eventual long term angiographic success in patients with recurrent restenosis, we compared two successive PTCAs on the same segment, in the same 16 patients, where the first led to recurrent restenosis but the second to successful long term angiographic result. A long interval since previous PTCA and low inflation pressure are associated with long term success after repeated PTCA; other procedural variables are not linked with long term outcome. This study may help us to predict long term success after a repeated angioplasty procedure. PMID- 10149107 TI - The Ultra-Select guidewire: a new nitinol guidewire for coronary angioplasty. AB - The Ultra Select? guidewire is a solid nitinol core torque wire that recently became available for use in coronary angioplasty. This wire has near one-to-one torque with kink resistant axial strength. The wire is radioopaque and highly visible. It is effective in negotiating severe tortuosity. Nitinol (nickel titanium alloy) has unique properties that allow for specific performance advantages for use in coronary angioplasty. This report discusses this new guidewire and its use in coronary angioplasty. PMID- 10149108 TI - A new steerable cardiac catheter for crossing stenotic aortic valves. AB - A new cardiac catheter for crossing severely stenotic aortic valves is described. This catheter is an externally steerable one and it was used successfully and uneventfully in 12 patients after a conventional catheter had failed to cross the aortic valve. Six of the patients underwent aortic valvuloplasty. The most advantageous feature of the new catheter is its ability to scan the aortic valve orifice under entirely external manipulation. PMID- 10149109 TI - A double-blind study comparing the safety, tolerability, and efficacy of ioversol 350 and iohexol-350 in coronary arteriography with left ventriculography. AB - A multicenter, double-blind, randomized study was performed to compare the efficacy, patient tolerability and safety of ioversol-350 with that of iohexol 350 in patients undergoing selective coronary arteriography with left ventriculography. Demographic parameters with the exception of age were comparable between the contrast media groups. Ioversol-350 patients (mean 60.9 years) were significantly older than iohexol-350 patients (mean = 56.1 years) (p=0.0007). The treatment groups were comparable with respect to all measures of contrast media dose. All coronary arteriography procedures in both contrast media groups were rated as diagnostic by the investigators. Seventy-four of 80 (92.5%) ioversol-350 procedures were rated excellent or good in overall quality. The contrast media groups did not differ significantly with respect to heat associated with left ventricular (LV), left coronary artery (LCA), or right coronary artery (RCA) injections or with respect to pain associated with LCA or RCA injections. However, pain associated with LV injections was significantly greater in the iohexol-350 group compared with the ioversol-350 group (p=0.0087). The contrast media groups did not differ with respect to changes in ECG or hemodynamic parameters from baseline. Results of this study demonstrate that ioversol-350 is diagnostically effective, well tolerated and safe when used for selective coronary arteriography with left ventriculography. PMID- 10149110 TI - The Kensey catheter: what have we learned to date? PMID- 10149111 TI - Coronary rotational atherectomy: clinical application. PMID- 10149112 TI - Coronary transluminal extraction-endarterectomy. PMID- 10149113 TI - Over-the-wire coronary angioplasty through a diagnostic catheter. PMID- 10149114 TI - Measurement of arterial dimensions: review of visual and quantitative angiographic techniques. PMID- 10149115 TI - Overview of the Palmaz-Schatz stent. PMID- 10149116 TI - The Gianturco-Roubin balloon-expandable intracoronary flexible coil stent. PMID- 10149117 TI - Stents. An annotated bibliography of selected references. AB - This is an annotated bibliography of selected references on stents. It includes 90 annotated references and 6 others that were not annotated. It has been structured to include pertinent details about each citation, including the site at which the device was used (coronary or peripheral), the type of article in which the research was reported (clinical paper, case report, abstract, review, editorial), the number of subjects and lesions treated, the design of the study (case study, single group, group comparison, or randomized trial), acute and late results, and comments about the study and its findings. PMID- 10149118 TI - Evaluation of a total T3 assay on the Stratus fluorometric enzyme immunoassay system. AB - The Stratus total triiodothyronine (T3) immunoassay is an automated fluorometric enzyme immunoassay that utilizes a mouse monoclonal anti-T3 antibody preimmobilized onto glass fiber paper. The rate of formation of the enzyme product, as measured by front surface fluorometry, is inversely proportional to Total T3 concentration in the sample. The authors evaluated this method with respect to precision, sensitivity, interfering factors, and correlation with a radioimmunoassay. The overall, between-run, and within-run precision of the assay measured at three concentration levels for a total of 60 determinations each using immunoassay control materials, ranged from 2.5% to 14.3%. A total of 200 specimens, including 40 classified as hyperthyroid, and 38 classified as hypothyroid were analyzed in duplicate by the Stratus (STR) system and by a commercially available radioimmunoassay method. The coefficient of correlation obtained was 0.97. Icteric, hemolyzed, azotemic, and lipemic samples were included in the comparison and do not appear to have any interfering effect on the assay. The range of the assay is from 0.8 to 12 nmol/L. In summary, the Stratus Total T3 immunoassay offers the advantages of sensitivity, specificity, and automation with a throughput rate of 45 samples/h. PMID- 10149119 TI - Enzymatic spectrophotometric determination of sodium and potassium ions in serum or urine: a simple and satisfactory alternative to the use of flame photometry or ion-selective electrodes. PMID- 10149120 TI - Evaluation of the Lablyte 820 analyzer for simultaneous blood ionized calcium/pH and sodium/potassium measurements by ISE. PMID- 10149121 TI - Thrombogenesis and thrombolysis in acute ischemic syndromes. Pathophysiological and pharmacological rationales for and limitations of thrombolytic, antithrombin, antiplatelet therapy and angioplasty. PMID- 10149122 TI - The Wallstent: a self-expanding stent. PMID- 10149123 TI - Polymeric stents: modern alchemy or the future? PMID- 10149124 TI - Microwave balloon angioplasty. PMID- 10149125 TI - Direct PTCA vs. sequential thrombolytic PTCA therapy in acute myocardial infarction: a retrospective analysis. PMID- 10149126 TI - Coronary angioplasty and coronary bypass surgery. PMID- 10149127 TI - The role of new technology for coronary interventions. PMID- 10149128 TI - Intracoronary stenting as an adjunct to angioplasty in acute myocardial infarction. PMID- 10149129 TI - The effects of biological wound dressings on the healing process. AB - Three major biological dressings are available for the temporary closure of wounds: partial-thickness cadaveric human allograft skin, several forms of partial-thickness antibiotic-treated porcine xenograft skin, and human amnion. Generally, biological dressings reduce pain, close the wound to contamination and fluid loss, and prepare the wound bed for permanent closure, usually with autografts. The three types of biological dressings differ in their performance, with allograft skin being clearly superior in its wound maintenance and preparation characteristics, while porcine xenograft presents serious difficulties in incorporation into the wound bed and antigenic challenge to the recipient, and amnion is excessively fragile and tends to allow wound desiccation. The most serious potential liability of biological wound dressings is transmission of infection; however, the actual incidence of such transmission is extremely low. The advantages of physiological coverage provided by biological wound dressings greatly outweighs the chance for harm in the case of human allograft. PMID- 10149130 TI - Factors influencing the performance of temporary skin substitutes. AB - Advances in our knowledge of the wound healing process has led to the development of various synthetic skin substitutes, which when applied to the wound surface provide a microclimate conducive to healing. The requirements of an ideal temporary skin substitute are presented. This review also provides an updated account of the preclinical evaluation procedures utilized to assess these demands, particularly important parameters such as water vapour permeability, adherence to excised wound surface, oxygen permeability, mechanical properties, microbial permeability and exudate soaking capacity. PMID- 10149131 TI - Effects of glass composition and pretreatment on the reactivity of novel glass polyalkenoate (glass ionomers) dental cements. AB - This paper investigates some of the factors concerned in the reactivity of aluminoborate polyalkenoate cements. Possible methods to control the reactivity of the glass powders are described. PMID- 10149132 TI - Relationship of viscosity to porosities in automixed elastomeric impressions. AB - Porosities commonly presenting as voids have been recognized as an inherent problem in elastomeric impressions. Automixing of the impression has been found to be effective in reducing voids. The purpose of this study was to compare formation of voids in medium-viscosity and putty-wash materials in four automixed addition silicone elastomers. Impressions of a master model were made according to manufacturers' recommendations on manipulation of materials. Voids presenting on a predetermined surface were counted under a binocular microscope at a magnification factor of 7x. Results showed that Express exhibited a significantly higher number of voids than other materials in both categories. Putty-wash impressions generated significantly less voids than medium-viscosity impressions for all materials except Reprosil. The findings of this study suggested that putty-wash impressions produced significantly less porosities than medium viscosity impressions and, consequently, offer better tear strength for impressions. PMID- 10149133 TI - Cellular events in the mechanisms of prosthesis loosening. AB - The functional restoration of a joint damaged by trauma or disease is obtained by prosthetic surgery. In particular the implantation of hip prostheses is regarded as routine in orthopedic surgery and thorough research has been developed in this field. The prosthetic replacement of the knee and even more so the ankle and elbow occurs less frequently in clinical practice and has been studied less intensively. The results of artifical hip replacement are generally good, both in terms of pain relief and the restoration of satisfactory joint function. Nevertheless, as time passes, a high rate of failures have been recorded due to prosthesis infections, fracture and wearing of the prosthetic components and prosthesis loosening by various causes. The use of ultra-filtered air and laminar flow in operating theatres and antibiotic prophylaxis have dramatically reduced the incidence of infections in total hip arthroplasty. Thanks to the setting up of new stem configurations and the use of superalloys that are highly resistant to fatigue failure, the fracture of the femoral component has been virtually eliminated as a complication of total hip arthroplasty replacements. Loosening is thus the most frequent complication in total hip replacement. PMID- 10149134 TI - Contrast media for angiography: physicochemical properties, pharmacokinetics and biocompatibility. AB - Contrast agents are used as diagnostic molecules for the visualization of the vascular system. Despite their rapid pharmacokinetic distribution, and their excretion within a few minutes, their injection is associated with clinical symptoms of relative bioincompatibility. Allergoid reactions and disturbances of the hemostatic system represent the main fields of biological investigations. Due to the extent of clinical and experimental works the ubiquitous interactions between these molecules and cellular and/or protein systems have emerged. The development of a new family of low osmolality ionic or non-ionic contrast molecules had decreased the incidence of minor reactions, but did not modify the frequency of severe accidents and even led to the emergence of new iatrogenic syndromes. Despite extensive laboratory investigations there are still no predictive criteria nor any specific therapeutic prevention of these allergoid reactions. The suggested future line of investigation concerns the physicochemical interaction of CM and targeted biological systems which may allow the analysis and predictivity of these interactions at the molecular level. PMID- 10149135 TI - Fissure sealants as a means of prolonging longevity of amalgam restorations--an in-vitro feasibility study. AB - The presence of an interface gap around the periphery of old amalgam restorations in extracted teeth was confirmed by scanning electron microscopy (SEM) and light microscopy. Two fissure sealant resins (Concise White Sealant and Delton Fissure Sealant) were placed over amalgam margins in vitro and were found to occlude this gap. SEM studies permitted assessment of the integrity of the resin in the interface defect and degree of sealant penetration toward the enamel/dentine junction. Microleakage studies using dye immersion techniques confirmed the efficacy of sealants in limiting dye penetration. This study indicates that margins of amalgams may be sealed in vivo by this method, delaying the need for replacement of the old amalgam and potentially providing protection for the tooth from secondary marginal caries. PMID- 10149136 TI - Methods for improving drug release from poly(methyl)methacrylate bone cement. AB - Poly(methylmethacrylate) (PMMA) is a widely used material with both dental and orthopaedic applications. The acrylic cement is produced by the combination of polymethylacrylate beads with methylmethacrylate monomer. After polymerisation, a heterogeneous and porous matrix is formed which can be used to deliver therapeutic agents. In this work, the release of antibiotic, growth hormone and serum albumin is demonstrated. The mechanism is similar for all agents; a rapid release followed by a slow continuous release. The quantity of drug released depends upon the formulation of both the PMMA and the drug. The polymer-to monomer ratio can greatly affect the ratio of drug release; increased polymer-to monomer ratio leads to increased release of antibiotic. Optimum release is achieved if a crystalline formulation of the drug is used rather than a fine powder. Experimental methods to improve the drug release performance of bone cements are presented. PMID- 10149137 TI - Biocompatibility of poly (DL-lactic acid/glycine) copolymers. AB - In this review the authors discuss the polymer chemical, physical and cell biological aspects of poly (DL-lactic acid/glycine) copolymers, both in vitro and in vivo. The mechanism and rate of degradation and the degree of foreign body reaction were evaluated as a function of the molecular composition of the (co)polymer, its initial molecular weight and changes in crystallinity. Data from the literature concerning poly(lactic acid), poly(glycolic acid) and poly(amino acids) are included in this review. The choice to apply the polymers mentioned was determined by their nature: all are present in the human body as natural residues. Upon degradation, biocompatibility will thus not be impaired. The authors conclude that the degradation mechanism of poly(lactic acid), poly(glycolic acid) and poly(amino acids) are similar, i.e. bulk hydrolysis of ester bonds. The initial molecular weight and the chemical composition, determine the rate of degradation and the degree of foreign body reaction. PMID- 10149138 TI - Standardization of IgE antibody assays. PMID- 10149139 TI - Dry reagent measuring systems. PMID- 10149140 TI - Shock wave sensors: I. Requirements and design. AB - In the last 9 years, extracorporeal shock wave lithotripsy has become one of the preferred procedures for the treatment of urinary and gallbladder calculi. While there is still uncertainty as to the mechanisms of stone fragmentation, current hypotheses suggest that acoustical shock wave parameters such as rise time, peak compressional and rarefactional pressure, and frequency content may all influence the treatment's efficiency. Thus, optimization of lithotripsy treatment needs pressure sensors that can adequately characterize the shock wave field. This article presents and discusses the design of reliable, wideband, quantitative shock wave sensors made of piezoelectric material. The development, design, and performance characteristics of the sensors are presented. Sensor construction details are described, as are the methods used to characterize the sensor's acoustical performance. The key acoustical parameters of the sensor, its frequency response, and directivity pattern are presented; theory indicates that the probes feature uniform sensitivity over the frequency range up to 100 MHz. Preliminary experimental results indicate that piezoelectric polymer sensors made of polyvinylidene fluoride (PVDF) with a low acoustical impedance backing are suitable for lithotripter field measurements. The applicability of sensors based on fiber optics to shock wave measurements is also briefly discussed. In a companion article, shock wave measurement techniques are outlined and selected lithotripter test data are presented. PMID- 10149141 TI - Minimally invasive treatment of hemiacidrin soluble staghorn renal stones. AB - Among 78 patients with hemiacidrin soluble staghorn renal stones, 23 were treated with a combination of one session of percutaneous debulking and high-energy extracorporeal shock wave lithotripsy (ESWL) (Group A); 17 were treated with high energy ESWL only (Group B); and 38 were treated with low-energy only ESWL (Group C). In all patients percutaneous nephrostomies were inserted and the ESWL procedure was followed by hemiacidrin irrigation. ESWL was performed with anesthesia in Groups A and B, but without anesthesia in Group C. Groups A and B did not differ in number of ESWL sessions or length of hospital stay, and the therapeutic results at discharge and at 6-month follow-up were comparable, whereby 59% of the patients in both groups were either stone-free or had only small ( less than or equal to 3 mm) residual fragments. In Group C more ESWL sessions were performed, and the hospital stay as well as the hemiacidrin irrigation periods were longer. The fraction of stone-free renal units at discharge was significantly higher in Group C than in Group A (p less than 0.05) and after 4 weeks higher than in both Groups A (p less than 0.025) and B (p < 0.05). At 6 month follow-up, 92% of the patients in Group C were either stone free or had only small ( less than or equal to 3 mm) residual fragments. Combined low-energy ESWL and hemiacidrin irrigation can successfully be used for treatment of even very large infection staghorn stones. PMID- 10149142 TI - Glass-ionomer cement--origins, development and future. AB - The origin of the glass-ionomer cement lies in a change in attitude regarding the qualities demanded of a dental material. The foundation of dental materials science in the 1920s tended to stultify the development of dental materials because of an over emphasis on mechanical properties. In this period, traditional materials invented before the end of the 19th century remained in use. A change in approach in the 1950s and 1960s, brought about by the realization of the importance of biocompatibility and adhesion, led to a revolution in dental materials science. This era was characterized by closer collaboration between materials research scientist and clinician. New materials were developed, including the glass-ionomer cement, with novel properties which were exploited by the development of novel clinical techniques. The glass-ionomer cement has the crucial property of adhering to untreated dentine and enamel, a quality which has led to the development of clinical techniques to minimize cavity preparation and thus loss of tooth material. PMID- 10149143 TI - The clinical use of glass-ionomer cements--future and current developments. AB - Although the glass-ionomer cements were developed in the 1970s, it is only recently that their clinical use has expanded internationally. Improvements in formulation have resulted in better mechanical strengths, increased translucency and, more importantly, faster setting times. Their use as 'dentine substitutes' has expanded the versatility of laminate restorations in anterior and posterior teeth and the introduction of the silver-cermet ionomers provided materials with increased abrasion resistance. Glass-ionomer cements have a number of unique properties, including adhesion to moist tooth structure, biological compatibility, and anticariogenic properties due to their fluoride release. One of the major roles is the treatment of early carious lesions using microcavity preparation. However, like all materials, glass-ionomer cements have their weaknesses, the prime ones being lack of toughness, early water sensitivity, and porosity leading to poor surface polish. Future research should concentrate on correcting these deficiencies. PMID- 10149144 TI - Initial in-vivo evaluation of glass-ionomer cements for use as alveolar bone substitutes. AB - The response of rat femora to implantation of four glass-ionomer (polyalkenoic) cements (GIC) compared to that seen following implantation of densely sintered hydroxyapatite (Ha) ceramic was evaluated for periods up to 12 weeks. Light and transmission electron microscopic analysis of the GIC/bone interface revealed direct bonding of the GIC G338 and Ketac Cem (both based on fluoro-alumino silicate) glasses to bone, with a mineralized collagen-containing extra-cellular matrix deposited on the surface of the GIC. AquaCem and the fluoride-free GIC based on MP4 glass showed incomplete osseointegration. PMID- 10149145 TI - Physical properties of glass-ionomer cements influencing clinical performance. AB - This paper considers the modern commercial glass-ionomer cements and compares their variable physical properties with specific reference to working and setting times, powder liquid ratios used clinically, finishing techniques and the effects of etching for the laminate technique. The variation in long term mechanical properties of different restorative glass-ionomer cements is examined and the hybrid glass-ionomers are assessed. PMID- 10149146 TI - Biocompatibility evaluation of glass ionomer cement using cell culture techniques. AB - Cell culture techniques have been employed to carry out a preliminary investigation into the biocompatibility of a glass ionomer cement (GIC). A modification of the commonly used Agar Overlay test and a rapid, colorimetric assay based on the reduction of tetrazolium salt were used. The GIC is shown to leach a cytotoxic agent, possibly fluoride. This agent is effectively removed by an extraction procedure, and re-examination of the GIC demonstrates its cytocompatibility. PMID- 10149147 TI - The glass polyphosphonate cement: a novel glass-ionomer cement based on poly(vinyl phosphonic acid). AB - This paper outlines research which aimed to develop a new type of Glass-ionomer cement, the glass polyphosphonate cement. The glass polyalkenoate cement, a form of Glass-ionomer cement, is now widely used in dentistry and is based on the reaction between an ion-leachable aluminosilicate glass and an aqueous solution of poly(acrylic acid) or its copolymers. The new cements described in this paper employ a novel polymer, poly(vinyl phosphonic acid), PVPA, as the acidic component. This is a much stronger acid than those used in the glass polyalkenoate cement, and various means must be employed to moderate the reaction in order to obtain a viable cement. These cements show a number of important differences in performance in comparison with PAA-based systems and these differences are discussed in the paper. PMID- 10149148 TI - Extracorporeal shock wave lithotripsy in situ treatment for ureteral stones. AB - Three hundred and sixteen patients with ureteral stones were treated in situ (without retrograde stone manipulation) with and without stent bypass (DJ stent, ureteral catheter). Results were generally better with stent bypass, but only marginally so for stones larger than 10 mm in diameter. Regardless of whether or not the ureter was stented, lower ureteral stones were more difficult to fragment than upper ureteral stones and pre-sacral stones did not respond well to in situ treatment. We observed that evaluation of stone disintegration and fragment evacuation could only be properly assessed after approximately 3 weeks post-ESWL. PMID- 10149149 TI - Comparative physical tests on segmented polyurethanes for cardiovascular applications. AB - In order to select a candidate segmented polyurethane (SPU) elastomer for cardiovascular prostheses, a series of physical tests was carried out on five commercially available biomedical polyurethanes. The tests were performed on uniformly thick sheets (0.2-0.3 mm), obtained by solvent casting from THF (Cardiothane 51, Pellethane 2363 80A, Estane 5714 F1, and Estane 58810) or DMAC (Biomer). Tensile mechanical tests at 23 and 37 degrees C showed for all the copolymers typical stress/strain behaviour of elastomeric materials, with small individual differences. Hydrolytic stability was investigated at 85, 60, and 37 degrees C, at increasing times of exposure (96-168 h), in water or alkaline buffer (pH = 10). As indicated by gel permeation chromatography, in almost all cases a degradation of the molecular weight (particularly the M w) was noticed after the hydrolytic tests, but tensile, thermal (by DSC) and dynamic mechanical properties were substantially not affected. SEM was also performed on the materials, before and after the hydrolytic tests. Changes in the morphology of the materials (related to degradation effects) was observed only in the case of Biomer, as shown also by the thermomechanical analyses. After this first series of physical tests, a clear choice of a particular SPU among the five investigated was not found. PMID- 10149150 TI - What ever happened to biliary lithotripsy. PMID- 10149151 TI - Development of small-diameter vascular prostheses which release bioactive agents. AB - A porous, distensible, tubular membrane which incorporates albumin and basic Fibroblast Growth Factor (bFGF), and is potentially utilizable as a bioactive small-diameter vascular prosthesis, was fabricated by a combined spraying, phase inversion technique using a suspension of albumin and bFGF into a polyetherurethane-urea (Biomer) solution in dimethylacetamide (DMA). Scanning electron microscopy showed a material with an open-cell trabecular structure and small particles of albumin and/or bFGF entrapped in the bulk of the polyurethane trabeculae. The material released albumin and bFGF at an approximately constant rate for at least 2 weeks. The bFGF initially incorporated in the polymer remained biologically active as shown by in-vitro proliferation of human endothelial cells. PMID- 10149152 TI - Technology assessment: can biliary lithotripsy pay its own way? PMID- 10149153 TI - Biliary lithotripsy versus cholecystectomy: a cost-utility analysis. AB - Evaluating the economic impact of medical procedures is of increasing importance in the American health care system, and this is especially true in the case of new medical technologies. Both the cost and the outcome of a treatment, and its alternatives must be evaluated. A cost-utility analysis was performed to compare cholecystectomy with biliary lithotripsy accompanied by bile acid therapy. Using a Markov approach, a model was designed to project expected cost and quality adjusted survival over a 5-year period in patients with solitary stones of less than or equal to 20 mm in diameter. The viewpoint of the analysis was chosen to be that of the general society, since it can be considered as a consensus of all interest groups. Direct costs were obtained from hospitals in Atlanta, Georgia; indirect costs are based on average United States earnings. Utility was estimated using a model that combines different scales of well-being with an underlying etiology. The findings indicate that from society's point of view for all patients meeting lithotripsy inclusion criteria, based on this cost-utility analysis, biliary lithotripsy would be the procedure of choice. PMID- 10149154 TI - Initial experience using a new type extracorporeal lithotripter with an anti misshot control device. AB - Initial clinical trials using a new overhead piezoelectric extracorporeal lithotripter is presented. The advantages of this machine are the installation of an anti-misshot control device (AMCD) to prevent misshots to renal tissue, simplicity for ultrasound stone localization by the overhead type applicator, and elimination of necessity for anesthesia. Thirty patients with upper urinary tract calculi were treated by this machine with a success rate of 77% and stone destruction rate of 93%. No serious complication was observed. The AMCD functioned in such a manner that shock waves were generated only when the stone was in the focal region. Although there were AMCD nonfunctioning cases (small and deeply located stones), it is indicated that this machine is favorable for safe, extracorporeal lithotripsy. PMID- 10149155 TI - The acoustic fields of the Wolf electrohydraulic lithotripter. AB - Electric sparks are used as the sources for both intra- and extracorporeal shock wave lithotripters. Upon ignition, a pressure pulse, headed by a shock, is generated that propagates as a spherically diverging wave. Simultaneously, a bubble is created that, in the case of the Wolf Model 2137.50 Electrohydraulic Lithotripter, expands to a radius of approximately 5 mm and collapses spontaneously after approximately 1 msec. Upon rebound, the bubble generates a second pressure pulse that is almost equal in amplitude and acoustic energy to the first shock wave. Measured pressures are almost entirely positive and decrease in amplitude with the reciprocal of the distance from the source. For the Wolf lithotripter at its maximum output setting, the pressure amplitude at a distance of 3 cm from the spark is typically 3 MPa. PMID- 10149156 TI - Results of extracorporeal shock wave lithotripsy in young children. AB - Between 1985 and 1988, 2,200 patients were treated at our institution by extracorporeal shock wave lithotripsy. Forty-two children were included in this group and ranged in age from 3-8 years. Weight and height range was 13-28 kg and 82-126 cm, respectively. In order to treat children in this height and weight range some technical changes had to be made to the gantry chair of the Dornier HM 3 lithotripter. All children had upper urinary tract calculi with stone size ranging from 0.8-2.5 cm. The total number of treatments in these 42 children was 51, and the number of shock waves did not exceed 900 per session at 18 kV. A stone-free rate of 85% was achieved at 3-month follow-up. PMID- 10149157 TI - Magnetic resonance imaging of renal calculi: an in vitro study. AB - Extracorporeal shock wave lithotripsy (ESWL) has been established as a standard method of urinary stone treatment. Poor fragmentation with an increased rate of complications has been noticed with certain calculi types (calcium oxalate monohydrate and cystine). In devising appropriate pre-operative strategies, it would be useful to know the calculi composition. We have investigated the in vitro utility of using magnetic resonance imaging (MRI) in analyzing urinary calculi. Our in vitro analysis found no difference in signal characteristics between calculi of varying composition. The absence of signal can be understood from a molecular basis. We conclude that MRI will not offer any assistance in characterizing the composition of urinary calculi. PMID- 10149158 TI - Computed tomographic evaluation of gallstone calcification for biliary lithotripsy. AB - As the Food and Drug Administration trials for biliary lithotripsy in the United States near completion, future criteria for patient eligibility remain to be defined. Gallstone calcification greater than 3-mm partial rim on plain film (KUB) or oral cholecystogram (OCG) has excluded patients thus far, since early results of gallstone clearance (lithotripsy plus chemodissolution) were suboptimal with calcified stones. To evaluate the usefulness of these criteria for gallstone fragmentation, computed tomographic (CT) scans were performed on 20 patients immediately prior to lithotripsy to evaluate gallstone density and 24 hours after lithotripsy to observe the CT appearance of fragmentation. The adequacy of fragmentation was determined by pre- and post-lithotripsy sonography. This report constitutes the results of these investigations. PMID- 10149159 TI - Treatment in the prone position of calculi in the midureter overlying the bony sacrum with extracorporeal shock wave lithotripsy. AB - Thirty-six patients with radiopaque calculi in the segment of the ureter overlying the sacrum, were treated in the prone position with an unmodified Dornier HM-3 lithotripter. Thirty-one treatments were successful and five failed for a success rate of 86%. Success is defined as the absence of fragments on KUB. The five failures were all removed ureteroscopically. Epidural anesthesia was used for all cases. A post-extracorporeal shock wave lithotripter (post-ESWL) gastrointestinal (GI) bleeding episode, and an upper ureteral extravasation post ESWL, as well as two patients who could not tolerate the position are discussed. PMID- 10149160 TI - Body-absorbable osteosynthesis devices. AB - The need for the development of totally body-absorbable internal bone fixation devices has been documented in the literature during recent years. A new process called 'orientrusion' has been developed which has made it possible to increase the strength of the polyactide up to 490 MPa. This material was found to be totally absorbable, and biocompatible. Bone fixation devices made from the orientruded polylactide have been successfully used in the fixation of medial malleolar fractures in humans. PMID- 10149161 TI - Glass-ionomer cements in orthopaedic surgery: design of laboratory tests. AB - Recently, interest has been shown in the use of Glass-ionomer cement as a bone cement in orthopaedic surgery. This paper discusses the determination of working time, setting time and compressive strength for an experimental Glass-ionomer [GI] and the existing poly(methyl methacrylate) [PMMA] cement. Conventional test methods and some novel techniques are explored. Suggestions are made for new techniques which will allow the comparison of different types of cement. The effect of different storage media on cement stability has shown that both cements show a degree of instability dependent on the medium used. The properties reported for the GI cement suggest that it has the potential to be a new bone cement. PMID- 10149162 TI - Physical characterization of acrylic bone cement cured with new accelerator systems. AB - In the attempt to substitute dimethyl-p-toluidine (DMPT), a toxic tertiary aryl amine accelerator, into the formulation of acrylic cements, less toxic accelerator systems are developed. These systems consist of benzoyl peroxide (BPO) and unsaturated tertiary-aryl-amines, such as acryloyl- (ANP) and methacryloyl-(MNP) N-phenylpiperazine, which can be chemically incorporated in the polymerizing resin or, at least, result in less leaching from cured materials. In this work compressive mechanical properties and ageing tests for colour stability of acrylic cement cured with BPO and ANP or MNP have been considered. For compressive tests, cylindrical specimens were cured with BPO and equivalent molecular amounts of DMPT, ANP and MNP. Compressive yield stress (sigma y), strain at yield (epsilon y, %) and elastic modulus (E) gave very similar results for samples cured with DMPT and ANP, and slightly lower results for samples cured with MNP. In colour stability tests, the samples (disks of 1.5 cm diameter) were exposed to UV light at different irradiation times (up to 42 h). The evaluation of the colour change was performed with a digital analyser for images, and observed under scanning electron microscopy. From the obtained results, ANP appeared to be the best candidate as accelerator in the preparation of biomedical acrylic resins and composites. PMID- 10149163 TI - Structural properties and biocompatibility of polymers used in ophthalmology. AB - The chemico-physical and structural properties and biocompatibility of new polymers used for intraocular lens manufacture are studied. In particular, the vibrational infrared and Raman spectra of fluorinated polymethacrylates are presented and discussed in relation to those of polymethylmethacrylate (PMMA), in order to correlate their structure with their properties and biocompatibility. The thermal analysis points out that the polymers are more stable than polymethylmethacrylate and the biocompatibility tests show that they are as biocompatible as polymethylmethacrylate. PMID- 10149164 TI - Hyaluronate derivatives and their application to wound healing: preliminary observations. AB - Hyaluronic acid and its derivatives show promise as biomaterials in wound healing applications. Studies of cutaneous wound repair were carried out in two animal models to compare the biological effects of hyaluronic acid and hyaluronic acid ethyl ester, a new semisynthetic derivative. The two compounds were tested in partial-thickness excisional wounds in 40-kg pigs and full-thickness excisional wounds in the rabbit ear as 0.2% (w/w) formulations in a neutral Na alginate vehicle. All compounds were administered daily under an occlusive, polyurethane dressing. Neither hyaluronic acid nor the hyaluronic acid ethyl ester showed toxic or inflammatory influences over the observation period of about 2 weeks. Morphometric analysis of porcine wounds revealed small differences among treatment groups which may have been masked by the effect of the vehicle. The rabbit ear model data suggested a very slight inhibition of wound closure. Biochemical analysis of ear wounds showed this injury model to be a sensitive system for evaluation of vulnerary agents. The hyaluronate-treated wounds tended to accumulate collagen more slowly, which may reflect the capacity of these compounds to modify the scarring process. Given the ability to fabricate hyaluronate esters into films and fibers, these data suggest that such biomaterials will not, by themselves, exert a negative influence on the repair process and may improve healing, either alone or in combination with other soluble agents. PMID- 10149165 TI - Piezoelectric shock wave lithotripsy of salivary gland stones: an in vitro feasibility study. AB - The feasibility of fragmentation of salivary stones by a new extracorporeal piezoelectric lithotripter was investigated. A total of 40 salivary stones were submitted to piezoelectric shock wave treatment. The diameter, weight, and volume of all the stones were determined prior to shock wave administration. After shock wave administration the chemical composition of the stones was investigated by X-ray diffractometry. Fragmentation was achieved in 35 out of the 40 (87.5%) stones. Twenty-five of the 40 (62.5%) stones were disintegrated "therapeutically adequate" (residual fragments less than 1.5 mm). A statistically significant correlation was not observed between the number of discharges required for disintegration and the diameter, weight, volume, or the chemical composition of the stones. PMID- 10149166 TI - Piezoelectric lithotripsy monotherapy for partial or total staghorn lithiasis and calculi larger than thirty millimeters. AB - Thirty patients with partial or total staghorn lithiasis or calculi larger than 30 mm were treated by piezoelectric lithotripsy (PEL) monotherapy using an EDAP LT-01 lithotripter with ultrasound guidance. Nineteen of these patients had a pelvic stone; the other 11 had partial (nine) or total (two) staghorn lithiasis. All patients first underwent an initial lithotripsy session. No anesthesia or intravenous sedation was required in any case. If stone fracturization was achieved after this first session, a double J stent was inserted before the second lithotripsy session. Prior to the first session, 18 of 30 patients had a sterile urine culture; 12 of 30 presented major distention of the excretory tract. Results were analyzed to determine those factors influencing the outcome of this therapy. Three months after the first session, patients were considered cured if their stone had completely disappeared on abdominal plain films (14/30 = 46%). In seven patients (23.3%), fracturization had occurred but residual fragments remained (1-3 fragments less than or equal to 4 mm). No fracturization was obtained after the first session in nine patients (30.7%) (one total staghorn lithiasis, eight pelvic stones). The mean number of treatment sessions was five (range 1-15). Complications occurred in only 10% of patients (3/30): two steinstrasse and one acute pyelonephritis. Eighty-three percent of patients without major excretory tract distention and 55% of patients whose initial urine culture was sterile, achieved a stone-free state.(ABSTRACT TRUNCATED AT 250 WORDS) PMID- 10149167 TI - Gallstone imaging: getting the most out of the oral cholecystogram. AB - The introduction of "nonoperative" treatment alternatives to elective cholecystectomy (extracorporeal shock wave lithotripsy, contact dissolution of stones, and improved oral bile salts solvents) has reinstated the oral cholecystogram as an important diagnostic test providing structural and functional information on the status of the gallbladder. The basic principles involved in the proper performance and interpretation of the oral cholecystogram are reviewed from the perspective of the clinician who orders the test and makes management decisions based on its results. PMID- 10149168 TI - Urologic experience with the Dornier multipurpose lithotripter MPL 9000. AB - From March, 1988 until October, 1989, 502 patients with 603 stones were treated with the Dornier multipurpose lithotripter MPL 9000. Sixty-six percent of the stones were situated in the calix, 29.6% in the renal pelvis, 3% in the upper, and 1% in the distal ureter; 18.4% of the stones were radiolucent. Multiple MPL treatments were performed in 8.6%. In 6.1% fragments post-ESWL treatment were larger than 5 mm. In 58.6% of the treatments were performed without using analgesia or anesthesia. Intravenous anesthesia was used in 22.3%, analgesia and sedation in 16.9%, general anesthesia in 1.4%, and epidural anesthesia in 0.8%. After 3 months follow-up 73.1% were stone-free. Residual fragments were found in the upper calix in 1.1%, in the middle calix in 5.2%, in the lower calix in 13.4%, in the renal pelvis in 5.9%, and in the ureter in 1%. The MPL 9000 has been proven to be as effective for the treatment of renal stones, while difficulties in localizing ureteral stones were noted. The major number of treatments were performed without any analgesia or anesthesia. No major complications were encountered. PMID- 10149169 TI - Evolution of wound dressings and their effects on the healing process. AB - Over the last decade, there has been a rebirth of interest in wound healing research, partly due to advances in biotechnology leading to the feasibility of producing large quantities of pure, human growth factors thought to be important in the healing process and also due to the recognition that certain new dressing materials have a favorable impact in wound healing. This paper describes some of the newer dressing materials and discusses the basis for the biological effects of these products. As progress continues, it is likely that future approaches will combine the use of dressings with drugs or active agents selected to prevent or treat infection, start or stimulate the healing process, or control the production of scar tissue. PMID- 10149170 TI - Pressure ulcers: critical considerations in prevention and management. AB - Pressure ulcer development is a serious problem occurring predominately among elderly persons, who are confined to bed or chair. Factors associated with pressure ulcer development include: cerebrovascular accident, impaired nutritional intake, fecal incontinence, lymphocytopenia and a high comorbidity score. Implementation of preventative measures, such as: in-depth assessment for mobility, a pressure relieving device combined with adequate repositioning, thorough evaluation for nutritional status and urinary incontinence, significantly reduce pressure ulcer incidence. If the pressure ulcer is a partial thickness (Stage II) wound, the causative factors are probably friction and/or moisture. If the ulcer is full thickness (Stage III, IV) it is secondary to pressure and/or shearing forces. The development of wound infection is the most common complication. Osteomyelitis is not an uncommon occurrence and must be initially ruled out in all full thickness pressure ulcers. Surgical debridement of necrotic tissue is necessary prior to further treatment and /or assessments. Cultures and antibiotic therapy are indicated only upon evidence of infection (erythema, edema, cellulitis, osteomyelitis, leukocytosis, bandemia or fever). Topical pharmacologic agents may be used to prevent or treat infection but must be carefully controlled to avoid such adverse effects as toxicity to the wound, allergic reaction and development of resistant pathogens. Proper use of occlusive dressings increase patient comfort, enhance healing, decrease the possibility of infection, save time and reduce costs. A patient presenting an ulcer which fails to improve, or due to its size will take a great deal of time to heal, should be evaluated for surgical closure. PMID- 10149171 TI - The value of sonography in the assessment of cholecystolithotripsy. AB - To assess the reliability of ultrasound in measuring a minimum stone fragment burden we implanted radiolucent human gallstone fragments measuring from less than 1 mm up to 4 mm in size into the gallbladders of 12 domestic piglets. Forty eight hours later the fragments in each animal were assessed by a qualified radiologist using two different ultrasound machines in a randomized blinded fashion. With regard to size estimation using a 5 MHz sector scanner, in two out of 12 examinations there was an overestimation of fragment size such that in a clinical setting an unneccessary repeat lithotripsy session would have been requested. A 5 MHz linear array transducer was of sufficient reliability in all size estimations not to have resulted in such a request. No gallbladder was falsely declared fragment free. There were nonshadowing fragments present in five of 12 examinations using both transducers. Clumping of small fragments less than or equal to 3 mm was present in two examinations. We recommend that a second ultrasound examination is performed when the presence of clumping is suspected and also when a fragment-free gallbladder is initially diagnosed. PMID- 10149172 TI - Pressure distribution and energy flow in the focal region of two different electromagnetic shock wave sources. AB - In extracorporeal shock wave lithotripsy there is still a lack of knowledge about the basic physical terms that are essential for a scientific comparison of lithotripters with different technologies. The main goal of this article is to introduce the relation between pressure distribution, acoustic energy flow and intensity. The procedure of how these data can be achieved quantitatively is described. Technical data of two different commercially available electromagnetic shock wave sources are presented. The results show that acoustic energy flow and intensity depend on the variation of the shock wave parameters and the focal area. PMID- 10149173 TI - Extracorporeal piezoelectric shock wave lithotripsy of salivary gland stones: first clinical experiences. AB - Piezoelectric lithotripsy was undertaken on 14 patients with salivary stones, none of them requiring anesthesia, analgesics, or sedatives. All salivary stones were fragmented totally during the first lithotripsy session. Four months after treatment with extracorporeal shock waves all patients were free of symptoms, and in seven out of 14 patients no concrement could be found sonographically. The piezoelectric lithotripsy of salivary stones had caused no serious side effects proved by clinical, biochemical, sonographic, and magnetic resonance imaging examinations. Extracorporeal piezoelectric lithotripsy is a new and promising nonsurgical therapy for selected cases of sialolithiasis of the large salivary glands. PMID- 10149174 TI - The use of transcutaneous electrical nerve stimulation during the biliary lithotripsy procedure. AB - Transcutaneous electrical nerve stimulation (TENS) has been suggested as a means to reduce the amount of intravenous analgesia/sedation in patients undergoing extracorporeal shock wave lithotripsy (ESWL). A retrospective analysis of 79 ESWL procedures on 73 consecutive unselected patients was done in an attempt to determine the effectiveness of TENS in reducing the amount of intravenous fentanyl citrate and/or midazolam HCl needed to control pain and anxiety during the ESWL procedure. The study was divided into two parts: (1) all patients receiving TENS (n = 44) versus a non-TENS group (n = 35), and (2) comparison of the early (n = 22) and late non-TENS (n = 22) groups against each other; separately the late non-TENS group was compared to the entire TENS group. In the study, TENS reduce the amount of fentanyl citrate needed to control anxiety by 22.9% (P less than 0.025). No difference was noted when the early and late non TENS group of patients were compared to each other. A gender difference was noted with a significant reduction in the dose of fentanyl citrate only in female patients receiving TENS (45.4%). Likewise, there was a significant reduction in the dose of midazolam HCl only in males who had TENS (38.9%). The data suggests that TENS may be a useful addition to reduce the amount of sedation and analgesia during ESWL. PMID- 10149175 TI - Reflex transmission imaging improves ultrasonic visualization and characterization of calculi for lithotripsy applications. AB - A new ultrasound technique combining reflex transmission imaging (RTI) and integrated reflection C-scan (IRCS) imaging is being developed to enhance visualization of calculi for lithotripsy applications. Reflex transmission imaging/integrated reflection C-scan ultrasound produces orthographic images (similar to flat-field x-ray films) that improve the delineation of stone from soft tissue. Integrated reflection C-scan imaging is based on reflectivity while RTI is based on transmissivity of structures (stones) in the focal plane. Quantitative measurements of reflectance (IRCS) and attenuation (RTI) show potential for stone characterization and assessment of the degree of fragmentation. In vitro and in vivo images are presented. PMID- 10149176 TI - Gallstone lithotripsy (GSL): results of the Technomed Sonolith 3000 multicenter trials. AB - Gallstone lithotripsy (GSL) with the Technomed Sonolith 3000 extracorporeal lithotripter was studied in a multisite, international cooperative trial involving the United States, France, and Italy. All participating sites worked under a common protocol to investigate the safety and efficacy of GSL for symptomatic gallstone patients. These collective results are from a mix of 25 academic and community hospital sites using fixed and transportable/mobile versions of the lithotripter. As of November 1, 1990, 661 patients have been treated in this two-arm randomized study (GSL Only vs GSL + Ursodiol [Actigall]). Patients were treated with up to 2,500 shocks per session and only two treatments were allowed. All machines had standardized pressure settings (850 bar nominal) and operator adjustment of output voltage was not allowed. We saw no statistically significantly different results in initial fragmentation between patients pre-loaded with ursodiol for 2 weeks and those treated by GSL alone. Gallbladder clearance rates did vary with the stone number, size, and burden as well as the adequacy of initial fragmentation. In the GSL + Ursodiol Arm of the trial, 46.2% of patients with solitary, 5-to 20-mm calculi are stone-free at 6 months. PMID- 10149177 TI - What makes a shock wave efficient in lithotripsy? AB - The aim of this investigation was the connection of quantitative shock wave parameters to stone fragmentation in lithotripsy. We developed an in vitro procedure where eroded craters in artificial stones could be measured with respect to their geometric outlines. By altering the components of an electrodynamic ultrasonic source we obtained a multitude of shock wave foci with physical parameters covering a wide range. With these foci different craters were formed and measured. With a correlation method the quantitative stone erosion could be connected with single physical parameters of the shock waves. As a result we found strict linear dependence of the volume erosion on the effective energy. On the other hand, the peak pressure in the focus revealed to be a poor parameter to qualify the fragmentation efficiency of a lithotripter. Additionally the contribution of the rise time of the shock wave to stone erosion is of negligible influence. PMID- 10149178 TI - Experiences with lithotripters: measurements of standardized fragmentation. AB - A comparison of lithotripters in terms of the fragmentation efficacy was established by using artificial stones. Two hundred pulses were applied to identical calcium sulphate cubes at varied energy levels of different lithotripters. In the cubics the shock waves formed regular craters, which could be analyzed with regard to depth, diameter, and volume. Dimensions of the craters increased with increasing energy. Each shock wave source designed a typical crater form. Different efficacies of fragmentation within different lithotripters could be recognized. High focal peak pressures did not guarantee better fragmentation effects. By using different acoustic lenses in the same electromagnetic lithotripter, the influence of different focus zones of the shock wave on the fragmentation could be investigated without any changes of the energy input. Results clearly emphasize the possibility of an increase of fragmentation efficacy by changing only the focal zones and the distribution of energy within the focal area. PMID- 10149179 TI - Biliary lithotripsy can be enhanced with proper ultrasound probe position. AB - We have demonstrated in our in vitro system that an extracorporeal lithotripter utilizing a movable ultrasound probe can fragment gallstones more effectively when the ultrasound probe is not partially blocking shock waves. Using a pressure transducer we measured the pressures in the focal volume of a Wolf Piezolith 2300 lithotripter with the ultrasound probe fully extended and fully retracted. We also chose 12 pairs of twin gallstones, each taken from the same gallbladder. One stone from each pair was subjected to shock waves while the ultrasound probe was fully extended and the other treated while the probe was fully retracted. Shock wave pressures (which are converted to a measurable voltage output by our transducer) were clearly lower when the ultrasound probe was extended (5.45 volts; SEM = 0.10 volts) as compared to when the ultrasound scanner was retracted (6.7 volts: SEM = 0.08 volts). Significantly more shock waves were required to completely fragment stones when the ultrasound scanner was extended than when it was retracted (p = 0.01 using the nonparametric Wilcoxon's signed rank test). These results show that, in the lithotripter tested, an extended in-line ultrasound scanner can partially block shock waves. Retraction of an extendible ultrasound probe may enhance stone fragmentation when operating at the highest shock wave intensity. PMID- 10149180 TI - Stratification of gallstone fragments: the key to more effective fragmentation. AB - During previous experiments with in vitro fragmentation in a simulated gallbladder, we noticed that stone fragments tended to stratify with the dust and smaller fragments settled to the dependent portion, while the larger fragments settled on top. We reviewed the oral cholecystogram (OCG) of 10 patients examined 6 months following gallstone lithotripsy. In all cases with adequate visualization of stone fragments, the stratification phenomenon was observed. We hypothesized that adjusting the shock wave focus to target on these large fragments would improve the efficiency of fragmentation. To test this hypothesis, we fragmented three matched pairs of gallstones in vitro. For each pair, the stones were removed from the same gallbladder and the stone weights of the two stones were within 10%. The smaller member of each pair was fragmented using the "old method" with the focus on the fragment line. The larger stone was fragmented with the "new method" with the focus in the acoustic shadow deep to the echogenic line caused by the dust and small fragments in the dependent portion. The distribution of fragments was analyzed by passing the fragments through a series of filters. With the new method of targeting, the proportion of fragments less than 1.5 mm was doubled while the fragments greater than 5 mm were eliminated. The new method of targeting, taking into account the stratification of stone fragments, produces more effective fragmentation and should lead to more rapid clearance of fragments from the gallbladder. PMID- 10149181 TI - The effect of povidone-iodine solutions used as surgical preparations on the bacterial flora of the skin. AB - One hundred fifty hospitalized patients undergoing elective surgery were enrolled in an open study designed to assess the bactericidal and clinical efficacy of a preoperative skin preparation procedure--application of 7.5% povidone-iodine surgical scrub followed by 10% povidone-iodine antiseptic solution. Of 99 patients with bacterial colonization of the skin prior to surgery, 84 patients (85%) had no detectable levels of bacteria at completion of surgery; bacterial flora persisted after surgery in the remaining 15 patients (15%). The difference between pre- and post-surgical bacterial colonization was statistically significant (p = 0.004). Clinically, none of the 146 patients evaluable for analysis of efficacy developed infections at the incision or suture site and there were no incidents of skin irritation at the surgical site during the postoperative observation period. Thus, preoperative cleansing with povidone iodine surgical scrub followed by povidone-iodine antiseptic solution is an effective, non-irritating bactericidal regimen for use at surgical incision sites. PMID- 10149182 TI - VITRAX (sodium hyaluronate) in anterior segment surgery: a review and clinical study summary. AB - Anterior segment ophthalmic surgery has been greatly facilitated by the use of viscoelastic surgical aids containing sodium hyaluronate. VITRAX is a highly purified fraction of sodium hyaluronate dissolved in a physiological balanced salt solution. A multiclinic evaluation was conducted in 440 patients undergoing anterior segment surgery who received VITRAX or other viscoelastic surgical aids (HEALON, VISCOAT, or AMVISC). VITRAX was effective in facilitating complex intraocular surgical procedures and was comparable to HEALON in protecting corneal endothelium during surgery. Overall rates for complications and adverse reactions with VITRAX and the comparative agents were similar, although postoperative elevations in intraocular pressure were observed more frequently with HEALON. Vitrax is an effective and well-tolerated surgical aid for anterior chamber procedures. PMID- 10149183 TI - Electroconvulsive therapy and benzodiazepine use in patients who committed suicide. AB - While various aspects of suicide have been studied, there are few studies of particular modes of treatment. A unique opportunity to investigate electroconvulsive therapy (ECT) arose in two rural areas in Ireland. In one town, ECT is not used and there were no reports of suicide. In contrast, in an neighboring area where ECT is used, 30 cases of suicide were recorded from 1980 to 1989. These 30 cases of suicide and the influence of ECT and benzodiazepines are the subject of this study. We concluded that the rationale behind maintenance benzodiazepines in suicidal patients is questionable and that the efficacy of ECT in the prevention of suicide is doubtful. PMID- 10149184 TI - Electric sympathetic block: methods of measurement and a study assessing its effectiveness. AB - Electric sympathetic block is the procedure whereby sympathetic nerve fibers are blocked by application of controlled electrical impulses via electrodes placed on the skin. Methods of measuring the extent of sympathetic blockade and a clinical study using bipolar middle frequency currents to achieve electric sympathetic block are presented. Fifteen of 20 (75%) patients who underwent a 1-week series of electric sympathetic blocks reported at least 75% subjective relief from sympathetically mediated pain after completion of the series. PMID- 10149185 TI - Assessment of right atrial (RA) and right ventricular (RV) function by gated blood pool scan with krypton-81m: RA and RV pressure-volume loops with simultaneous pressure data. AB - We developed a new method of analyzing right atrial (RA) and right ventricular (RV) function by Krypton-81m gated blood pool scan (Kr-81m-GBPS). Pressure data were recorded simultaneously with a modified Swan-Ganz catheter. Krypton-81m (Kr 81m) is ideally suited to hemodynamic study of the right heart because of the following characteristics: physical half-life of 13 seconds; high photon yield and gamma ray energy of 190 KeV; low radiation exposure; and deployment during exhalation when the left heart is not active. A computerized method for list mode data acquisition was developed to collect data from the gamma camera, ECG wave, and RA and RV pressure simultaneously. RA and RV volume curves were obtained by calibrating the time-activity curves with end-diastolic volumes and cardiac output. Ejection fraction (EF) was used in the calculation of volume and cardiac output (CO) was measured by the thermodilution method. From RA and RV pressure and volume curves, RA and RV pressure-volume (P-V) loops were created simultaneously and displayed on the same plane. One spanning cardiac cycle of RV beats was separated into four phases: the ventricular emptying phase, the early ventricular filling phase, equilibrium, and the late ventricular filling phase. One spanning cardiac cycle of RA beats also was separated into four phases as follows: the atrial filling phase, the early atrial emptying phase, equilibrium, and the late atrial emptying phase. P-V loops of RA and RV were shifted after sublingual nitroglycerin administration. This new method is potentially useful in the study of right heart hemodynamics. PMID- 10149186 TI - The pathophysiology of pericardial disease--contributions derived from echocardiography/Doppler studies in animal models. AB - The use of acute and chronically prepared animal models of pericardial disease free of the confounding influences of other disease processes have greatly accelerated the development of echocardiographic and Doppler diagnostic methods and have allowed the correlation of these noninvasive findings with hemodynamic abnormalities. PMID- 10149187 TI - Ultrasonic tissue characterization of normal and ischemic myocardium. AB - Cardiac ultrasonic tissue characterization is designed to use the alterations in acoustic signals from the myocardium to differentiate normal from ischemic or infarcted tissue due to their characteristic backscatter attenuation. Various approaches such as use of a gray scale, color display, or quantitative image analysis have been used for tissue characterization, but all depend on subjective assessments and are not necessarily reproducible. The most promising method has been the use of "raw" radiofrequency signals and measure changes in the ultrasonic attenuation with an index of backscatter to distinguish normal from abnormal myocardium called "integrated backscatter" (IB). Various studies have demonstrated the changes in the ultrasonic backscatter with ischemia or infarction. In this review we summarize our experience with a research prototype instrument in tissue characterization and differentiation of normal, ischemic, infarcted, and post ischemic reperfused myocardium in anesthetized open chest dogs. Currently we are investigating the role of ultrasonic tissue characterization to estimate infarct size and plan to apply these observations to patients in order to detect viable myocardium and quantitate infarct size. PMID- 10149188 TI - Doppler echocardiographic evaluation of left ventricular function. AB - Invasive measurements of maximum acceleration of aortic blood flow are sensitive indicators of left ventricular function. Doppler echocardiography provides noninvasive measurements of aortic blood flow acceleration. Our studies establish the accuracy of Doppler-derived indices of aortic blood flow velocity for evaluation of left ventricular function. Doppler-derived peak velocity and mean acceleration showed excellent correlation with invasively measured peak left ventricular dP/dt and maximum aortic blood flow (dQ/dt) under varying heart rate, preload, afterload, and inotropic states. Similar correlations were observed between Doppler-derived peak velocity and mean acceleration and invasively measured left ventricular dP/dt and dQ/dt under conditions of varying degrees of myocardial ischemia. Thus, Doppler echocardiography provides an accurate noninvasive method to evaluate left ventricular performance. PMID- 10149189 TI - Experimental animal and in vitro contributions to the clinical practice of pediatric echocardiography. PMID- 10149190 TI - Echocardiographic contrast in two-dimensional echocardiography: new applications for an old technique? AB - Although Gramiak and Shah first introduced the technique of using contrast enhanced two-dimensional echocardiography in 1968, it has seen a resurgence of new and varied applications. Three of the areas of interest are in the use of microbubble enhanced contrast agents to evaluate: (1) regional myocardial blood flow; (2) regional myocardial function; and (3) myocardial ischemic areas and infarct size. Whether these new approaches will have applications and value in the clinical laboratory is still a matter of conjecture. The objective of this review is to briefly summarize the potential uses and the advantages and disadvantages of each application. PMID- 10149191 TI - Quantification of acute aortic regurgitation by color Doppler flow in an experimental animal model. AB - Color Doppler flow studies were performed on ten anesthetized open-chest dogs. Acute aortic regurgitation was created in the dogs by a special valve-spreading catheter. The magnitude of valvular regurgitation was determined by aortic electromagnetic flow recordings of regurgitant fraction. Arbitrarily-designated grades of aortic regurgitation: mild (4%-10%), moderate (11%-30%), and severe ( greater than 30%) were assigned on the basis of electromagnetic flow. We attempted to obtain studies of varying degrees of AR in each animal. Mean regurgitant fraction for the three grades were 6.8 +/- 0.6% (n = 11), 22.0 +/- 2.4% (n = 7), and 40.4 +/- 2.5 (n = 20), respectively (each P less than 0.05). By color Doppler flow assessment, the ratio of regurgitant jet height to the left ventricular dimension at the junction of the left ventricular outflow tract and the aortic annulus (JH/LVOH) was measured in each study. AR was classified by Doppler as grade I (mild), 1%-24%; II (moderate), 25%-64%; and III (severe), greater than or equal to 65% jet height/left ventricular outflow tract height. Color Doppler flow correlated well with flowmeter assessment of regurgitant fraction. Color Doppler flow tests had a calculated sensitivity of 88%, specificity of 83%, and predictive value of 85% for significant (moderate + severe) aortic regurgitation. Our data support the concept that this method of color Doppler flow assessment provides a quantitative noninvasive evaluation of aortic regurgitation. PMID- 10149192 TI - Evaluation of a technique for avoiding inadvertent myocardial laceration in an experimental canine model: expansion of the role of two-dimensional echocardiography. AB - An experimental animal model was utilized to evaluate the role of simultaneous two-dimensional echocardiography combined with a modified electrocardiographic monitoring technique for improving the safety of pericardiocentesis. This technique avoids the hazards of placing the sharp pericardiocentesis needle against the heart in order to determine its location against the epicardial surface. This technique was evaluated in eight dogs in over 100 aspiration attempts. Cardiac trauma occurred only in a single incidence with the use of a 20-gauge cannula. A detailed description of this procedure is provided in the text. PMID- 10149193 TI - Successful opacification of the left heart chambers on echocardiographic examination after intravenous injection of a new saccharide based contrast agent. AB - A new monosaccharide microparticle based echocardiographic contrast agent (SH U 508) was injected intravenously into five healthy male volunteers following which the heart was imaged in an apical four-chamber view. Volumes of 2, 4, 8, and 16 mL of SH U 508 were incrementally injected into each volunteer. Concentrations of 50, 100, 200, 300, and 400 mg microparticles per mL of suspension were used in five successive examinations. Left heart opacification of diagnostic value was obtained during the whole cardiac cycle with concentrations of 300 and 400 mg/mL. There was no interference in imaging of the left ventricular walls due to increased attenuation. SH U 508 showed a good tolerance. No side effect was observed and no clinical relevant changes were observed in the heart rate, blood pressure, ECG, blood chemistry, hematology or urinalysis findings. This new agent may greatly extend the role of cardiac ultrasound and may also permit the examination of the arterial circulation in other organs. PMID- 10149194 TI - Comparison of transthoracic and transesophageal assessment of prosthetic valve dysfunction. AB - Transesophageal echocardiography has added another dimension to the assessment of prosthetic valve dysfunction with high-resolution images that allow for more detailed structural evaluation of tissue and mechanical valves. This study is a retrospective analysis of 140 prosthetic valves (90 tissue, 50 mechanical) in the mitral (89), aortic (45), and tricuspid (6) position in 116 patients studied by transthoracic and transesophageal echocardiography techniques. Transesophageal echocardiography was consistently better than the transthoracic technique in the evaluation of structural abnormalities of tissue valves in the mitral and aortic positions with respect to leaflet thickening, prolapse, flail, and vegetations. With transesophageal echocardiography, five tissue mitral valves had flail leaflets that were not identified by the transthoracic technique. Transesophageal echocardiography was better than transthoracic in the detection, quantification, and localization of prosthetic mitral regurgitation. Physiological mitral regurgitation was detected in 31 valves by transesophageal echocardiography compared to seven by transthoracic technique. By transesophageal echocardiography, mitral regurgitation was paravalvular in 24% compared with 4% by transthoracic technique. Left atrial spontaneous contrast was seen in 42% of the patients with a mitral prosthesis detected only by transesophageal echocardiography. Six patients had left atrial or left atrial appendage thrombus and in five patients they were detected only by transesophageal echocardiography. We conclude that transesophageal echocardiography should be a complimentary test to transthoracic studies in patients with suspected prosthetic valve dysfunction or for the follow-up of older tissue valves. PMID- 10149195 TI - Doppler echocardiography assessment of prosthetic heart valves. AB - Transthoracic Doppler echocardiography is an accurate noninvasive method for the evaluation of prosthetic valve function. The flow characteristics and pressure gradients of normally functioning mechanical and bioprosthetic valves have been, in general established. Normal functioning mitral valve prostheses have a valve area greater than 1.8 cm 2 with the St. Jude valve having the largest effective valve area and normally functioning aortic prosthetic valves have a peak instantaneous gradient of less than 45 mmHg, with the Starr-Edwards valves (Starr Edwards, Irvine CA) showing the highest gradients. The incidence of minimal or mild regurgitation is approximately 15% to 30% in the mitral position and 25% to 50% in the aortic position, with the higher incidence of regurgitation seen with mechanical compared to bioprosthetic valves. Transthoracic Doppler echocardiography can accurately detect patients with prosthetic valvular stenosis. The presence of prosthetic aortic regurgitation can also generally be accurately assessed, except in the presence of both prosthetic aortic and mitral valves. Assessment of prosthetic mitral regurgitation remains limited due to significant attenuation of the ultrasound beam by the prosthesis and the frequent underestimation of severity of regurgitation. Other limitations of transthoracic studies include assessment of leaflet morphology, detection of vegetations and valve abscesses, and differentiation between valvular and paravalvular regurgitation. PMID- 10149196 TI - Role of transesophageal echocardiography in percutaneous balloon mitral valvuloplasty. AB - Echocardiography is useful in the selection of patients for percutaneous balloon mitral valvuloplasty, which is an effective treatment in suitable patients with rheumatic mitral stenosis. Transesophageal echocardiography appears superior to precordial echocardiography in this role because transesophageal echocardiography is not only reliable in the assessment of mitral valvular morphology but also more sensitive in the detection of left atrial thrombi and mitral regurgitation. Transesophageal echocardiography can be used in guiding the proper positioning of the catheters during the dilatation procedure. Complications of balloon mitral valvuloplasty such as torn mitral leaflets or atrial septal defects can also be diagnosed reliably by transesophageal echocardiography. Thus, transesophageal echocardiography should be an integral part of balloon mitral valvuloplasty. PMID- 10149197 TI - Impact of transesophageal color flow Doppler echocardiography in current cardiology practice. AB - Of 3,480 patients who were referred for cardiac ultrasound evaluation, 230 patients (6.6%) underwent transesophageal echocardiography because the transthoracic study was not feasible, technically inadequate, or provided insufficient diagnostic information for optimal patient management. There were 149 inpatients and 81 outpatients. The majority (182 patients, 79%) had aortic or mitral disorders. In 166 patients (72%), transesophageal echocardiography played a significant role in patient management. Transesophageal echocardiography was most useful in evaluating diseases of the aorta (dissection, root abscess, or aneurysm), mitral prosthesis, complications of endocarditis, left atrial appendage thrombi, and in determining the cause of mitral insufficiency. Transesophageal echocardiography was useful in the evaluation of critically ill patients and those with severe lung disease. PMID- 10149198 TI - Screening tests for intrauterine growth retardation: a comparison of umbilical artery Doppler to real-time ultrasound. AB - In a study designed to compare Doppler umbilical artery velocimetry to ultrasound morphometric measurements in the prediction of intrauterine growth retardation, 636 paired ultrasound and Doppler umbilical artery examinations were performed between 24 and 40 weeks gestational age. Intrauterine growth retardation was defined as birth weight less than the tenth percentile per gestational age and 25 (9.2%) of the infants born in our study met this criteria. In general, when the gestational age was limited to less than 30 weeks, none of the tests were highly predictive of intrauterine growth retardation. Doppler umbilical artery systolic to-diastolic ratios of greater than 3 had the highest sensitivity. However, due to inclusion of a large number of false-positives, it was considered a poor test. After 30 weeks, fetal abdominal circumference less than the tenth percentile had a greater sensitivity (45%) and positive predictive value (28%) than Doppler systolic-to-diastolic ratios greater than 3 (36% and 18%, respectively). Doppler ultrasound umbilical artery systolic-to-diastolic ratios are not more predictive of intrauterine growth retardation than ultrasound morphometric measurements. PMID- 10149199 TI - Combined femoral pseudoaneurysm and arteriovenous fistula: diagnosis by Doppler color flow mapping. AB - This case report is the first to describe a combined femoral pseudoaneurysm and arteriovenous fistula resulting from a cardiac catheterization, diagnosed by color Doppler. PMID- 10149200 TI - Intravascular imaging. PMID- 10149201 TI - Intravascular and intracardiac ultrasound imaging: current research and future directions. AB - Intravascular and intracardiac ultrasound imaging is a newly emerging catheter based imaging modality with considerable promise. This review article presents the rationale behind attempts at developing intravascular imaging methods, the design features of intravascular instrumentation, the knowledge obtained with in vitro studies, the in vivo experience in humans, and the potential applications of intravascular imaging in arterial atherosclerosis. The feasibility of pulmonary artery imaging and the potential applications of intracardiac echocardiography are discussed. Finally, future directions in intravascular imaging are outlined. PMID- 10149202 TI - Plaque characterization of atherosclerotic coronary arteries by intravascular ultrasound. AB - Intravascular ultrasound provides cross-sectional images of arteries and enables accurate delineation of lumen dimensions and wall structure. Moreover, ultrasound characterization of atherosclerotic plaque subtypes may have important implications in determining the natural history and the clinical outcome of patients with coronary artery disease. The reliability of intravascular ultrasound to differentiate plaque morphology subtypes was studied in 60 coronary segments excised from 33 coronary arteries obtained from 17 patients at necropsy. Ultrasound was performed with a 25-MHz transducer mounted on the distal end of a rigid probe that was rotated manually inside the lumen artery. Plane film radiography was also performed to establish the presence of calcific deposits. A total of 82 histologic transverse sections corresponding to 82 ultrasound imaging sites were studied from the 60 coronary segments. Of the first 54 images, 36 were fibrous plaques and yielded dense homogenous echo reflections, 6 had discrete areas of lipid that were less echogenic and 12 had calcific deposits that cast echo-free shadows beyond areas of intense echo reflections. The predictive accuracy of evaluating plaque composition in the remaining 28 ultrasound imaging sites was 96%. Thus, anatomical structure of coronary arteries and composition of atherosclerotic lesions can be assessed accurately with intravascular ultrasound and may have potential for better understanding of the atherosclerotic process and provide guidance to interventional procedures. PMID- 10149203 TI - Percutaneous balloon valvuloplasty and coronary angioplasty: what kind of guidance would be useful during the performance of these procedures? AB - Major advances have occurred during the last decade in the management of coronary arterial and valvular diseases using catheter-based treatment modalities. These methods, however, are still plagued by technical difficulties in the performance of the procedures because of the lack of appropriate guidance, and complications because of difficulties in patient selection. This review article deals with the various problems related to percutaneous balloon valvuloplasty and coronary angioplasty, outlines the specific needs in terms of guidance and discusses the possible guiding potential of intravascular ultrasound imaging methods. PMID- 10149204 TI - Percutaneous intracoronary ultrasound imaging: initial applications in patients. AB - This study was designed to evaluate the feasibility and potential clinical utility of intracoronary ultrasound imaging in patients using a 5.5 F synthetic aperture array, over-a-wire ultrasound catheter. Thirty patients underwent percutaneous intracoronary (n = 22) or peripheral (n = 8) ultrasound imaging at the time of cardiac catheterization. Ultrasound images were compared to simultaneous digital angiograms. Correlation between ultrasonic and angiographic estimation of coronary diameters was good (r = 0.80). Morphological analysis of ultrasound images obtained in patients revealed a pattern consistent with mild-to minimal atherosclerosis, as defined by prior in vitro studies. In 15 patients, imaging was performed during intracoronary infusion of vasoactive medications (papaverine 15 mg, nitroglycerine 100 mugm, and acetylcholine 2 x 10 -5 or 2 x 10 -6M). These medications were also infused during continuous intracoronary Doppler catheter monitoring of velocity and pressure, thus allowing calculation of volume flow and coronary resistance indices. Serial determination of ultrasound-derived epicardial vessel cross-sectional area demonstrated no change (-1 +/- 1%) after papaverine, an 8 +/- 2% increase after nitroglycerine, and a 9 +/- 3% decrease after acetylcholine. Calculated resistance fell 53 +/- 4% after acetylcholine and 60 +/- 3% after papaverine. Preliminary in vitro studies using a combination angioplasty balloon/ultrasound catheter demonstrated the ability to visualize vessel dilation in real time. We conclude that intravascular ultrasound imaging will be useful for dimensional and morphological characterization of vascular disease, for beat-to-beat monitoring of vasomotion, and potentially as a real time adjunct to therapeutic interventions. PMID- 10149205 TI - Intravascular ultrasound imaging: a new method for guiding interventional vascular procedures. PMID- 10149206 TI - Real-time intracardiac two-dimensional echocardiography: an experimental study of in vivo feasibility, imaging planes, and echocardiographic anatomy. AB - The traditional transthoracic and transesophageal echocardiographic examination have proven to be useful imaging tools for studying cardiac morphology, pathology, and function. Recently, catheter-based ultrasound transducers have been available for intravascular ultrasonic imaging. We supposed that echocardiographic examination performed from within the heart itself can provide useful information about cardiac structure and function, especially in settings where transthoracic or transesophageal echocardiography may be technically difficult to perform or poorly tolerated by the patient. To explore this concept, we performed intracardiac echocardiography in vivo in 22 dogs using both 5-MHz and 20-MHz transducers. High-quality images were obtained in all animals. Using the higher frequency transducer, detailed images with only a limited depth of field were obtained. With the 5-MHz transducer, a comprehensive cardiac examination was feasible from within the right atrium and inferior vena cava. We were able to visualize the great vessels, all cardiac valves, and cardiac chambers in a multitude of imaging planes. Alterations in ventricular function were instantly recognized. Color Doppler capabilities allowed visualization of flow abnormalities as well. We conclude that intracardiac echocardiography is feasible and could be potentially useful in certain clinical situations. With further research and development, this technique may have an important clinical impact in cardiac therapy and diagnosis. PMID- 10149207 TI - Intravascular ultrasonography: image interpretation and limitations. PMID- 10149208 TI - Intravascular ultrasound imaging and three-dimensional modeling of arteries. AB - In this article, we describe the reconstruction of arterial structures using solid modeling. The alternative approaches to three-dimensional modeling are discussed and the voxel space system we use for intra-arterial imaging, based on ultrasonic data, is described. The complete three-dimensional ultrasonic imaging system comprising a purpose-built, catheter-mounted ultrasound probe, ultrasonic transceiver, and computer system is presented. This system has been used to recreate three-dimensional computer models of arterial sections in vitro and in vivo. Examples to illustrate the power and flexibility of voxel space modeling in terms of postprocessing and software manipulation are given. Preliminary work on tissue differentiation, using arterial models and color coding of the image, and three-dimensional presentation of flow data is included. PMID- 10149209 TI - Percutaneous coronary angioscopy: methods, findings, and therapeutic implications. AB - The development and clinical implementation of percutaneous coronary angioscopy represents an engineering triumph, blending the newest technologies and materials in the field of fiberoptics with the most advanced techniques of balloon angioplasty catheter materials and construction. Current devices provide a safe method for acquiring excellent quality images of the coronary arteries. This is due to major advances in catheter alignment techniques allowing coaxial positioning of the angioscope in the relatively tortuous coronary arteries. Additional development is needed to further refine the degree of operator control over the field of view, which would also reduce procedure duration. The percutaneous coronary angioscope is currently a functional device for investigators attempting to correlate the morphology of atherosclerotic lesions and clinical coronary artery disease. Confirmation of the value of the angioscope as a clinically useful device for routine application in the diagnosis and management of cardiovascular disease will depend upon the results of further studies. PMID- 10149210 TI - Comparative studies of angioscopy and ultrasound for the evaluation of arterial disease. AB - In this in vitro investigation, we studied the histopathological basis for intravascular ultrasound image interpretation and how this technique compares with fiberoptic angioscopy in assessing atherosclerosis. This article presents the sensitivity and specificity of these techniques in the recognition of arterial abnormalities. The relevance of these data in interventional therapeutic procedures and the clinical implications of intravascular imaging methods are also discussed. PMID- 10149211 TI - Accuracy of Doppler ultrasound in evaluating changes of left ventricular diastolic properties. AB - In order to evaluate the effect of an increase in preload caused by contrast medium (Renografin-75) on Doppler echocardiographic indices of left ventricular diastolic properties, left ventricular pressure using a catheter tip micromanometer and pulsed-Doppler measurement of transmitral flow signals were measured simultaneously in 15 patients with coronary artery disease pre- and post left ventricular angiography. After left ventricular angiography, changes in indices determined from left ventricular pressure were significant: left ventricular end-diastolic pressure increased from 17 +/- 2 mmHg to 24 +/- 2 mmHg (mean +/- SE) (P less than 0.001), maximum -dP/dt increased from 1,129 +/- 63 to 1,307 +/- 90 mmHg/sec (P less than 0.005), and time constant decreased from 73 +/ 2 to 67 +/- 1 msec (P less than 0.01). Changes in Doppler-derived indices were also significant: A/E ratio decreased from 0.99 +/- 0.08 to 0.81 +/- 0.07 (P less than 0.01), peak velocity of early diastolic filling increased from 0.61 +/- 0.03 to 0.79 +/- 0.03 M/sec (P less than 0.01), and deceleration rate increased from 3.1 +/- 0.2 to 4.6 +/- 0.2 M/sec 2 (P less than 0.01). Changes in Doppler echocardiographic indices (DR, acceleration half time, deceleration half time, and A/E ratio) were accompanied by changes in time constant and maximum -dP/dt after left ventricular angiography. However, the correlations between changes in hemodynamic indices and changes in Doppler echocardiographic indices were poor (r = 0.06 to 0.67).(ABSTRACT TRUNCATED AT 250 WORDS) PMID- 10149212 TI - Noninvasive assessment of renal artery stenosis by combined conventional and color Doppler ultrasound. AB - We describe four angiographically-proven patients in whom Doppler color flow imaging in conjunction with conventional Doppler correctly diagnosed significant renal artery stenosis in three and ruled out stenosis in the fourth case. PMID- 10149213 TI - New direction of biplane transesophageal echocardiography with special emphasis on real-time biplane imaging and matrix phased-array biplane transducer. AB - This article reports on the technical aspects of an online real-time biplane transesophageal echocardiographic imaging system and of a single-matrix, phased array transducer capable of transverse and longitudinal scanning. PMID- 10149214 TI - Pediatric transesophageal color flow imaging 1990: the long and short of it. AB - Noninvasive cardiac imaging has dramatically altered the practice of cardiology, specifically, the pediatric patient with congenital heart disease over the past decade. Since the introduction of transesophageal echocardiography nearly 15 years ago, addition of high-resolution cross-sectional imaging combined with Doppler color flow mapping has provided a new window to examine the heart. Recently, miniaturization of the transesophageal probe to "pediatric-size" has enabled its use in the smallest of infants to add significantly to the assessment of congenital heart malformations. Most recently, addition of a longitudinal plane probe to the already-existent, transverse-plane probe has made biplane transesophageal echocardiography a reality with significant additional information being provided by orthogonal images of the cardiac structures. We used these probes in complementary fashion in 30 studies performed in 23 patients ages 1 day to 12 years with a mean of 35 months, weighing 2.6-40 kg (mean 12.4 kg). These studies were performed in the operating room, intensive care unit, cardiac catheterization laboratory, and outpatient department. Limitations of single-plane, transverse transesophageal echocardiography were overcome using the longitudinal-axis pediatric probe: left and right ventricular outflow tracts, distal pulmonary arteries, and all of the interventricular and atrial septa were easily visualized. Its use in the operating room and postoperative cardiac intensive care unit for continuous ventricular monitoring in otherwise inaccessible patients also provided critical information. Transesophageal echocardiography in infants and small children is a valuable "noninvasive" imaging technique which, with addition of complementary longitudinal-plane views, offers important additional information regarding congenital heart malformations and their repair. PMID- 10149215 TI - Use of the smaller pediatric transesophageal echocardiographic probe in adults. AB - Transesophageal echocardiography in the adult uses a relatively large diameter probe, which may be poorly tolerated by certain patients. The use of a smaller probe designed for pediatric patients was studied in 50 adults (21 males and 29 females), and concomitant transesophageal echocardiography studies were performed using the regular adult-sized probe in 28 of these patients. The smaller pediatric transesophageal echocardiography probe was easier to pass, better tolerated, caused a smaller heart rate increase (13 +/- 3 vs 20 +/- 4 beats/min, P = 0.0029), and required no sedation in more patients than the adult transducer. The resolution of the two-dimensional and color Doppler images in the mid and near fields of the smaller probe were comparable to the larger probe, as were the maximal area of mitral regurgitation and the ratio of the maximal proximal width of the aortic insufficiency jet to the left ventricular outflow tract diameter in patients with these lesions. However, the image resolution was noticeably inferior to the adult probe in the far field, such as when imaging the distal left ventricle or imaging structures transgastrically. Therefore, the smaller probe designed for pediatric use allows satisfactory near- and mid-field two dimensional and color Doppler flow imaging in comparison to the adult probe and would be expected to be beneficial in adult patients in whom superior quality imaging of the far-field is not required clinically, those who tolerate poorly the adult probe, relatively high-risk patients in whom no sedation is desirable, and in those patients in whom passage of the larger probe is unsuccessful. PMID- 10149216 TI - Pitfalls in the display of color Doppler jet areas: combined variability due to Doppler angle, frame rate, and scanning direction. AB - The Doppler color jet area depicting a regurgitant or shunt lesion may be useful in estimating its severity. However, color jet area may be affected by technical factors. We studied the combined effects of Doppler angle, frame rate, and scanning direction on the Doppler color jet area of a free jet with 10-mL injection. RESULTS: (1) Angle effects: color flow area was 11.7 +/- 2.0 cm2 at a Doppler angle of 20 degrees , and 2.3 +/- 1.2 cm2 at an angle of 60 degrees , when other parameters were kept constant (frame rate = 12 frames/sec, reverse scanning direction). (2) Frame rate effects: with other parameters kept constant (Doppler angle = 20 degrees , reverse scanning direction), color flow area was 11.7 +/- 2.0 cm2 at a rate of 12 frames/sec and 6.5 +/- 1.8 cm2 at 6 frames/sec. (3) Scanning direction effects: with other parameters kept constant (Doppler angle = 20 degrees , frame rate = 9 frames/sec), color flow area was 7.3 +/- 1.1 cm2 with scanning in the reverse direction, and 20.5 +/- 1.6 cm2 with scanning in the forward direction. (4) Combined effects: In our in vitro studies, the maximum color flow area was 20.5 +/- 1.6 cm2, and the minimum area was 1.5 +/- 0.2 cm2 (nearly twelve-fold). CONCLUSIONS: Doppler color jet area correlated inversely with Doppler angle (P less than 0.01) and directly with frame rate (P < 0.01).(ABSTRACT TRUNCATED AT 250 WORDS) PMID- 10149217 TI - Problems and pitfalls in the performance and interpretation of color Doppler flow imaging: observations based on the influences of technical and physiological factors on the color Doppler examination of mitral regurgitation. AB - Color Doppler flow imaging has become an integral part of the echocardiographic examination. By providing real-time, two-dimensional spatial maps of normal and abnormal cardiac blood flows, this technique provides important information that may be used to guide patient management. The acquisition and display of color Doppler flow information may be influenced by technical factors, by the physiological condition of the patient, by abnormalities of cardiac morphology, and, on occasion, by artifact. In this article, the results of a study performed to evaluate the influence of technical factors on the color Doppler assessment of mitral regurgitation are reported. Mitral regurgitation jet area size changed significantly with variation in the control settings for color gain, color process, color map, color image resolution, and sector width. A review of those factors that influence the performance and interpretation of the color Doppler flow examination is provided and their significance discussed. PMID- 10149218 TI - Color Doppler assessment of high flow velocities using a new technology: in vitro and clinical studies. AB - This study validates the accuracy of the newly-developed Quasar technique in the assessment of high flow velocities using color Doppler flow mapping. PMID- 10149219 TI - Transesophageal biplane echocardiographic imaging: technique, planes, and clinical usefulness. AB - The technique of examination, imaging planes, and the clinical utility of transesophageal biplane echocardiography are described. PMID- 10149221 TI - Intraoperative and interventional echocardiography: current use and future promise. PMID- 10149220 TI - Clinical perspectives of intravascular ultrasound. AB - The history of intravascular ultrasound imaging, recent developments in catheter technology, and the initial in vivo experience are reviewed. Additionally, the article also discusses the potential applications of intravascular ultrasound imaging in coronary and peripheral arterial atherosclerosis, hypertension, pulmonary arterial disorders, valvular heart disease, aortic abnormalities, and in congenital heart disorders. Possible future directions are outlined. PMID- 10149222 TI - Intraoperative echocardiography in cardiac emergencies. AB - Echocardiography has brought about a new modality of surgical decision making in open heart surgery. Especially in urgent and emergency surgery, echocardiography can provide decisive insight into the underlying pathophysiological processes, improved monitoring of cardiac function, as well as immediate quality control after the procedure. The importance of intraoperative echocardiography for the cardiac surgeon is illustrated in a number of selected case reports. PMID- 10149223 TI - Intraoperative evaluation of valvular regurgitation: comparison of echocardiographic techniques. AB - Intraoperative echocardiography provides information on cardiac structure and function that is unobtainable from routine monitoring modalities. Intraoperative imaging can be performed from the epicardial and/or transesophageal approach, and with the addition of contrast and/or color flow Doppler mapping, blood flow characteristics within the cardiac chambers can be visualized. The relative severity of regurgitation can be assessed before and after valvular surgery, and before the patient leaves the operating room, thereby facilitating successful valve repair or replacement. Surgeon preference, equipment availability, and valvular pathology will determine which technique will be utilized. PMID- 10149224 TI - Intraoperative assessment of myocardial perfusion using contrast echocardiography. AB - Myocardial contrast echocardiography is a new technique capable of assessing regional myocardial perfusion in vivo in real time. This article reviews the background, principles, experimental validation, and clinical uses of intraoperative myocardial contrast echocardiography. Data can be derived both for online visual and computer analyses. The technique can be useful in determining the sequence of bypass graft placement and the success of graft anastamoses. Anastamoses can be revised immediately if needed. It is hoped that this technique will improve intraoperative myocardial preservation and will diminish the rate of perioperative myocardial infarction. PMID- 10149225 TI - Intraoperative echocardiography and Doppler color flow mapping in freehand allograft aortic valve and root replacement. AB - Intraoperative epicardial echocardiography and color flow Doppler were performed before and after cardiopulmonary bypass in 17 consecutive patients undergoing 20 freehand allograft aortic valve replacements. Native aortic valves were replaced in 12, and prostheses in 8 patients. Precardiopulmonary bypass echocardiography estimates of annular diameter guided allograft selection and predicted length of allograft aortic root required, defined coronary situs, and revealed other cardiac abnormalities. These included unanticipated severe mitral regurgitation (which precluded allograft aortic valve replacements in one patient), left-to right shunts in the membranous septum, ascending aortic dissection, and aortic root pathology requiring coronary reimplantation or bypass. Postcardiopulmonary bypass echocardiography demonstrated acceptable competency of 18/19 allograft valves (mild or no aortic insufficiency), and successful repair of 3/4 shunts. Mild mitral regurgitation was detected more often at postcardiopulmonary bypass than precardiopulmonary bypass (15 vs 11 cases) and postcardiopulmonary bypass estimates of mitral regurgitation severity corollated well with subsequent postoperative follow-up. IOE allows selection and thawing of the allograft valves prior to aortic cross clamping, minimizing cross-clamp time. It detects important concomitant cardiac abnormalities, and predicts postoperative allograft valve and mitral competency. Intraoperative echocardiography Doppler, is therefore, a useful adjunct for allograft aortic valve replacements or aortic root replacement. PMID- 10149226 TI - Intraoperative epicardial echocardiography: technique and imaging planes. AB - With the recent innovations in cardiac surgical techniques, there is need for an immediate and reliable way to assess results in the operating room. Intraoperative epicardial echocardiography with Doppler color flow mapping provides an accurate and rapid imaging modality to assess the anatomical and functional results of cardiac surgery. This gives the surgeon a way to determine whether the hemodynamic abnormality has been successfully eliminated, prior to closure of the chest. After enclosure in a sterile sheath, a standard echocardiographic transducer is placed directly onto the epicardial surface. The heart is imaged in multiple tomographic planes developed specifically for intraoperative use: the parasternal equivalent; aortopulmonary sulcus; subcostal equivalent; and aorta-superior vena cava transducer positions. Two-dimensional echocardiography is useful to assess the morphology of valves and the size and function of cardiac chambers. Doppler color flow mapping provides a semi quantitative assessment of the severity and physiological mechanism of valvular regurgitation. Continuous-wave Doppler echocardiography is used to estimate gradients across stenotic valves. This comprehensive appraisal of cardiac anatomy and flow is useful in the pre- or postcardiopulmonary bypass phase of cardiac surgery. This review focuses on the technique of intraoperative echocardiography and its applications in valve reconstruction operations with specific emphasis on the epicardial imaging planes. PMID- 10149227 TI - Epicardial coronary artery imaging. AB - Intraoperative high-frequency echocardiography with a 12-MHz linear scanner is a diagnostic tool for imaging coronary morphology. This method was used in 630 vascular sections in 112 operations. The vessel diameter (80%), the absence of stenoses (77%), the condition of the vessel wall (39%), and the localization of occlusions (14%) were examined. Fifty vessels not visible to the eye (8%) could be echocardiographically imaged. Anastomoses were examined 45 times (7%). By using high-frequency echocardiography, intraoperative decisions could be acted upon immediately in 46 operations (41%). PMID- 10149228 TI - Intraoperative assessment of pulmonary vein flow. AB - This study was undertaken to assess the suitability for intraoperative pulmonary vein flow measurements in 15 patients undergoing coronary artery bypass grafting. Using two-dimensional color Doppler transesophageal echocardiography, all four pulmonary veins--right upper and lower and left upper and lower pulmonary veins were easily visualized. Pulmonary vein flow was pulsatile. J wave occurred in the ventricular systole with relaxation of the left atrium and K wave in the ventricular diastole with relaxation of the left ventricle. There were differences in suitability for flow measurements among four pulmonary veins: (1) consistent visualization; (2) stable visualization throughout measurement; (3) minimal angle between ultrasonic beam and pulmonary vein course; and (4) minimal shift of sampling volume during measurement. The left pulmonary veins were suitable for flow velocity measurement by transesophageal echocardiography. The left lower pulmonary vein was stable for visualization once it was visualized although the angle was occasionally large. The left upper pulmonary vein was consistently visualized although the angle was occasionally large. On the other hand, the right pulmonary veins were unsuitable for flow measurement. Since sampling volume shifted in the direction of the long axis by the average of 5 to 6 mm during cardiac cycle, it should be positioned inside of the pulmonary vein at about 5 mm from the orifice of the left atrium. PMID- 10149229 TI - Intraoperative echocardiography for surgical repair of the aortic valve and left ventricular outflow tract. AB - Valve conservation surgery represents an exciting advance in the evolution of valve surgery. Recent studies have shown the significant advantages of mitral valve repair over valve replacement. While there are significant advantages for valve repair, the surgeon requires a greater understanding of the mechanism of valvular dysfunction prior to repair and requires an accurate means to assess the adequacy of the repair in the operating room immediately following the repair. Intraoperative echocardiography with color flow Doppler mapping provides immediate and accurate assessment of cardiac anatomy, hemodynamics, and valve integrity. These data are vital for optimal intraoperative surgical decision making. Intraoperative echocardiography has an important role in the evaluation in patients undergoing surgery to the aortic valve and left ventricular outflow tract by the delineation of presence and mechanism of left ventricular outflow tract obstruction, the quantification of severity of the left ventricular outflow tract gradient, the severity and mechanism of aortic regurgitation, the distribution and severity of left ventricular hypertrophy, and identification of associated lesions such as mitral regurgitation. Aortic valve conservation surgery is more complex than mitral valve surgery. The surgical techniques for aortic valve repair have been slower to evolve than mitral repair with a much smaller percentage of patients currently suitable for valve repair. However, with the aid of intraoperative echocardiography, the future shows similar promise that has already been fulfilled with mitral valve repair. Even in its infancy, intraoperative echocardiography has become indispensable to the innovative cardiac surgeon. However, without consideration of adequate echocardiographic training, incorrect echocardiography diagnoses can lead to inappropriate surgical decisions. PMID- 10149230 TI - The use of intraoperative echocardiography with Doppler color flow imaging in the repair of congenital heart defects. AB - Surgical repair of congenital cardiac defects has undergone a remarkable evolution in the past decade. Major defects are now often completely corrected in early infancy with continually improving rates of survival. It has become clear that the next major focus will be improvements in the long-term quality-of life and this has prompted many innovations in surgical technique and approach. One advance is the use of intraoperative echocardiography with Doppler color flow imaging to evaluate the exactness of operative repair. Aside from anecdotal reports, very little information is available regarding the interpretation of images produced by this technology in the operating room. Furthermore, there have been no studies addressing the predictive value of intraoperative echocardiography with Doppler color flow imaging findings with respect to outcome for patients undergoing repair of congenital cardiac defects. The prospective data obtained by following the course of 273 patients receiving intraoperative echocardiography with Doppler color flow imaging has been reviewed after repair of a variety of congenital cardiac defects (age range 1-53 years; mean 5.3 years; smallest patient 1.8 kg). The average time required to perform a complete intraoperative echocardiography with Doppler color flow imaging evaluation was 3.64 +/- 1.73 minutes. Except for mild ectopy induced by pressure from the transducer, complications of the procedure were minimal. Echocardiography with Doppler color flow imaging revealed previously unsuspected details of the anatomy in 21% of patients and in 47% of patients, it was felt that the prebypass echocardiography with Doppler color flow imaging impacted in some way on planning of the operative procedure. Echocardiography with Doppler color flow imaging was 2.5 times more likely to provide help in planning the operation if a previously unrecognized anatomical finding was disclosed. Postbypass evaluation revealed that 47 patients (17%) had initially unacceptable results, by echocardiography, at the completion of their repair. Eighteen of these patients (7% of the entire series) had no clinical problems and the defects were discernible only by echocardiography. Twenty-six patients with initially unacceptable results had their repairs revised in the operating room and left with an acceptable result by echocardiography. Twenty-one patients were allowed to leave the operating room with echocardiographically discernible defects. Follow-up of these patients demonstrated a significantly higher (P less than 0.006) rate of reoperation (42% vs 3%) and an early death (29% vs 10%) for those patients whose defects were left unrepaired compared to those whose problems were corrected before leaving the operating room.(ABSTRACT TRUNCATED AT 400 WORDS) PMID- 10149231 TI - Intraoperative echocardiography in mitral and tricuspid valve repair. AB - Echocardiography with Doppler color flow mapping is a very useful intraoperative technique in patients undergoing mitral or tricuspid valve repair. In the patient who is a repair candidate, this technique can be used intraoperatively to answer important clinical questions: the severity of the regurgitation; the morphological basis of the regurgitant lesion; and the feasibility of repair. Other important issues such as the impact of physiological interventions on regurgitation severity, the presence of associated lesions, and the state of ventricular function can also be addressed. In the patient who has undergone a valve repair, this technique can be used intraoperatively prior to chest closure to assess the adequacy of the repair procedure and to detect associated complications such as outflow tract obstruction. PMID- 10149232 TI - Utility of Doppler echocardiography in the evaluation of aortic homograft valved conduit function in children: need for segmental conduit interrogation. AB - To assess the utility of Doppler echocardiography in evaluation of aortic homograft valved conduit function, 10 consecutive pediatric patients had Doppler examination of aortic homograft valved conduits associated with follow-up cardiac catheterization. General correlation was found between the Doppler-derived peak systolic pressure gradient across the aortic homograft valved conduit and cardiac catheterization (r = 0.65, P less than 0.05, SEE = 20.5). One patient with multilevel obstruction had significant underestimation of gradient by Doppler due to incomplete segmental interrogation of the aortic homograft valved conduit. For the other nine patients with complete segmental conduit interrogation, correlation between Doppler and cardiac catheterization was excellent (r = 0.93, P less than 0.01, SEE = 10). Conduit insufficiency in nine out of ten patients was graded qualitatively using Doppler color flow mapping with excellent correlation between color flow mapping and cardiac catheterization (r s = 98). Aortic homograft valved conduit function can be accurately noninvasively assessed by Doppler but proximal, valve, and distal conduit segmental interrogation is necessary to localize site of obstruction if present, rule out multilevel obstruction, and avoid underestimation of systolic gradient. PMID- 10149233 TI - Intravascular ultrasound evaluation of iliac stents one year following laser assisted angioplasty. AB - With the proliferation of sophisticated endovascular interventions, the need for more definitive assessment of preprocedural and postprocedural pathology and long term outcome is acute. A new technique, intravascular ultrasound imaging, was used to provide a 1-year evaluation of iliac artery stents in a patient whose renal insufficiency contraindicated protocol-mandated arteriography. The sonogram provided adequate visualization of the functional status of the stents through cross-sectional measurements and the intimal response to the devices. This represents the first use of intravascular ultrasound imaging for long-term evaluation of iliac stents. PMID- 10149234 TI - Visualization of mitral valve aneurysm by transesophageal echocardiography. AB - This article describes the transesophageal echocardiographic findings in a patient with pathologically proven mitral valve aneurysm. This aneurysm probably occurred as a complication of aortic valve endocarditis. Transesophageal echocardiography showed a saccular structure attached to the left atrial side of the anterior mitral leaflet with systolic expansion and diastolic collapse, and its orifice was visualized with excellent resolution. Transesophageal echocardiography is a useful diagnostic tool for evaluation of mitral valve aneurysm. PMID- 10149235 TI - Diagnosis of ruptured sinus of Valsalva aneurysms: potential value of transesophageal echocardiography. AB - Two patient cases are reported in which an aneurysm of the right coronary sinus of Valsalva ruptured into the right ventricular outflow tract, near the crux of the heart. Transthoracic two-dimensional echocardiography and transesophageal echocardiography using Doppler color flow mapping allowed accurate preoperative assessment of the left-to-right shunt, which was subsequently confirmed by contrast aortography and surgery. PMID- 10149236 TI - Transesophageal echocardiographic evaluation of mechanical biventricular assist device. AB - The usefulness of transesophageal echocardiography in the assessment of mechanical biventricular assist devices is described. PMID- 10149237 TI - Multiple secundum type atrial septal defects: identification by transthoracic color Doppler echocardiography. AB - This case illustrates the utility of two-dimensional color Doppler echocardiography in detecting and localizing multiple atrial septal defects not consistently demonstrated by standard two-dimensional echocardiography. PMID- 10149238 TI - Parameters and standardization in obstetric Doppler. AB - Obstetric Doppler is still largely empirically based, although possible clinical applications are already under examination. This article examines some of the basic instrumentation and hemodynamic issues--which physiological parameters would we ideally like to assess, and what can we do in practice with current Doppler instrumentation? It is shown that the rate of blood flow and the flow resistance are two of the most basic hemodynamic parameters. It is possible to estimate the flow rate with (specialized) Doppler equipment, but there is no method available at present to measure the flow resistance. Analysis of the blood velocity waveform provides some information concerning flow resistance, as long as it can be assumed that other factors that might affect the waveform have not deviated significantly from the norm. Practical considerations in choosing the instrumentation and designing the examination protocol are discussed, and issues of quality control are emphasized. PMID- 10149239 TI - Doppler velocimetry of the umbilical and uteroplacental circulation: a critical review. AB - During the past 8 years, there have been more than 300 articles published describing Doppler studies in the field of obstetrics. This review will analyze the data dealing with the umbilical and uteroplacental circulation. This is being done with the goal of formulating an opinion of the role of Doppler in the practice of clinical obstetrics. We have concluded from prospective studies that there is no clear definition of abnormal umbilical flow velocity before 30 weeks, except for absent end-diastolic velocity after the 20th week. Most of the prospective studies on the uteroplacental circulation have suffered from a lack of knowledge of the umbilical circulation, or only one uterine artery was studied. Most investigations until now have focused on demonstrating the pathophysiological correlations with Doppler studies. With the exception of a few dissenting voices, most have demonstrated strong correlations at probability levels of less than 0.01. A few studies have emerged that have attempted to evaluate Doppler as a screening or surveillance tool. The results have not been encouraging. In populations with a low perinatal mortality, it will be difficult to prove that Doppler will reduce perinatal mortality. Studies of Doppler efficacy will have to be designed to show improved usage and efficacy of fetal surveillance. Since Doppler uniquely identifies the fetus at risk for hypoxia before term, it could replace our current risking system for the detection of fetal disease.(ABSTRACT TRUNCATED AT 250 WORDS) PMID- 10149240 TI - Long-term Doppler ultrasound measurement through the anterior fontanel in neonates: choice of parameter for computer supported analysis. AB - There is no easy comparison of the Doppler spectra. Therefore, determining parameters is necessary for long-term measurements. A manual analysis is laborious, limits the number of possible examinations, and considerations are restricted to the envelope curve (maximal cerebral blood flow velocity). The applied ultrasonic apparatus (a modified HP 77020AC) determines three waveforms besides the Doppler spectrum: V max as maximal, V means as average, and V mode as the most frequently measured velocity. These data are directly transferred to a PC. Using low Doppler intensity V max resulted in values up to 39% lower than determined by manual analysis because of the apparatus' algorithm. By use of higher Doppler intensity this difference was reduced to 19%. Regarding clinical validity, the V s mean seemed to be the best parameter for further processing. Determining peak systolic velocity (V mean), end-diastolic velocity (V d mean), and mean velocity over time (V mean) were selected for standard analysis. The Pourcelot index was not taken into account, first for lack of definition for V mean and secondly for not missing simultaneous changes of the peak systolic and the end-diastolic velocity. PMID- 10149241 TI - Does pulsed-Doppler ultrasound have mutagenic effects? Application of the Ames mutagenicity assay to test pulsed-Doppler equipment. AB - Measurement of fetal blood flow has been accepted using pulsed-Doppler ultrasound. Until recently, there has been a lack of investigations concerning the potential risks of this method. The possible mutagenic effect of a pulsed Doppler system was examined in vitro by applying the Ames test. Tester strains of Salmonella typhimurium indicating point mutations were irradiated (TA 98, TA 100, TA 102, TA 1535, TA 1537, TA 1538). A commercially available duplex system was applied in the experiments emitting an ultrasound beam with a spatial-peak temporal-average of 5.2 mW/cm2 and a spatial-peak temporal-peak of 117 mW/cm2 at a frequency of 2 MHz. The tester strains were sonicated up to 60 minutes, the bacterial suspension being in direct contact with the transducer surface. The ultrasound-exposed bacterial suspensions were compared with nonexposed samples. Reference mutagens were used for checking the sensitivity of the system. The results do not indicate any mutagenic effects. PMID- 10149242 TI - Estimating left ventricular ejection fraction from two-dimensional echocardiograms: visual and computer-processed interpretations. AB - Digital echocardiography makes computer-processed estimates of ejection fraction feasible for clinical use but increases physician reading time. The practicabilities were examined by three novice fellows and four experienced attendings. Ejection fraction was visually estimated from playback of videotape or cine-loop displays. Ejection fraction was also estimated from single tracings of endocardium, digitized and applied to biplane Simpson's rule, and expressed in whole units. Differences between fellows' and attendings' visual estimates were close to 0 +/- 6.4 median standard deviation. The 95% confidence intervals for reproducing visual and computer-processed ejection fractions ranged from 15% to 46% of mean ejection fraction; for comparing the two methods, from 7% to 36%. Intraobserver reading errors varied widely and with one observer, systematically, and were independent of experience, but dependent on the quality of signals. Computer-processed readings of ejection fraction should be reserved for images of reasonable quality and for confirming visually estimated ejection fractions between the lower limits of normal (45%-50%) to moderately severely depressed (25%-30%), when accuracy is clinically relevant or when a serial change is at the confidence limits of the reader and needs verification. PMID- 10149243 TI - Correlations between cardiac imaging and electrophysiological studies: what is the state of the art? AB - Changes in ventricular activation produced by bundle branch block, pre excitation, and ventricular tachycardia and pacing have been studied by various cardiac imaging modalities. We reviewed results of previously published and newly generated imaging data correlated with known or measured electrophysiological studies. Echocardiography has been demonstrated to grossly correlate with abnormal ventricular wall motion when activation sequence was altered. However, phase analysis of radionuclide and cine-computed tomography have provided detailed noninvasive activation data that correlated reasonably well with measured electrical activation sequence in both animals and man. Analysis of wall motion may not predict activation sequence when muscle is damaged or excessive translational movement of the heart occurs. Body surface mapping of electrical potentials has the capability to accurately but noninvasively register an electrical activation image of the heart that circumvents the problems of imaging contraction sequence. In the future, body surface potential mapping should be more widely used clinically and experimentally. PMID- 10149244 TI - Applications of Doppler echocardiography in cardiac pacing. AB - The purpose of this article is to review the use of Doppler echocardiography for assessing responses during cardiac pacing. Doppler techniques allow the physician to select the optimal mode pacemaker and pacemaker settings with regard to heart rate and atrioventricular delay, at rest and during exercise. Doppler parameters can be used to predict the relative hemodynamic advantage of dual chamber or rate adaptive pacing over fixed rate pacing. This valuable noninvasive modality may enhance the benefit of pacemaker therapy. PMID- 10149245 TI - Myocardial perfusion and contrast echocardiography: review and new perspectives. AB - Myocardial perfusion can be assessed qualitatively and quantitatively with new ultrasound contrast techniques. This article reviews progress and problems in this area, discussing intracoronary and aortic root injections in animals and humans. The technique has great potential clinical application for the identification of coronary flow reserve, and the assessment of the need for and outcome of coronary revascularization procedures. It may allow direct measurements of regional myocardial perfusion. PMID- 10149246 TI - Tissue characterization by ultrasound: what is possible now? What will be possible? AB - The purpose of this review is to discuss the principles of ultrasound tissue characterization. We describe gray scale analysis, backscatter techniques, real time backscatter imaging, enhancement of abnormal tissue properties with contrast agents or liposomes, and use of acoustic microscopy. Ultrasound tissue characterization offers the promise of direct identification of abnormalities of the myocardium without relying on indirect manifestations such as abnormalities in cardiac function. PMID- 10149247 TI - Real-time, three-dimensional echocardiography: feasibility and initial use. AB - The purpose of this article is to review new approaches to three-dimensional acquisition and presentation of echocardiographic data. New three-dimensional phased-array devices hold great promise for the development and application of new descriptors for left ventricular performance, myocardial perfusion, and other important indices of cardiac function. PMID- 10149248 TI - Intracardiac echocardiography. Experimental observations on intracavitary imaging of cardiac structures with 20-MHz ultrasound catheters. AB - Recently catheter-based ultrasound devices have become available for obtaining high-resolution images of blood vessels. In this study we evaluated the feasibility of imaging cardiac structures using 20-MHz ultrasound catheters. In 25 dogs, the ultrasound catheter was advanced into the right and left heart chambers percutaneously. The intravascular devices yielded images of the right atrial wall, right and left ventricular myocardia, tricuspid, pulmonic, and aortic valves, and the great vessels. Although the small depth of field inherent to the frequency range of 20 MHz limited the visualization to only portions of the cardiac chambers, the images obtained were of high resolution and allowed easy identification of the various cardiac structures. Intracardiac echocardiography was easy to perform and did not result in damage to the cardiac structures. We conclude that intracardiac echocardiography using ultrasound catheters provides a new approach to cardiac imaging and that the development of lower frequency catheters could aid in extending the potential utility of intracardiac echocardiography. PMID- 10149249 TI - Dilated (congestive) and amyloid cardiomyopathy: recent echo-Doppler advances. PMID- 10149250 TI - Comparison of noninvasive measures of contractility in dilated cardiomyopathy. AB - Left ventricular performance is usually quantified by ejection phase indices such as ejection fraction, cardiac output, and fractional shortening. The load dependence of these measures may result in inaccurate estimation of intrinsic myocardial contractility in states of chronic pressure or volume overload. End systolic and stress-shortening relations have been proposed as measures of contractile state insofar as they are theoretically independent of preload and incorporate afterload. This article examines the behavior of these relations in response to changes in loading conditions and contractile state and reviews their application utilizing noninvasive methodology, particularly in the setting of dilated cardiomyopathy. PMID- 10149251 TI - Evaluation of left ventricular filling in dilated cardiomyopathy using digitized M-mode echocardiograms. AB - Digital M-mode echocardiography describes a characteristic alteration in the pattern of left ventricular filling when a dilated cardiomyopathy is present. The peak rates of early diastolic dimension change (dD/dt and dD/dt/D) are uniformly reduced but remain unchanged in time of occurrence (time to dD/dt). The rapid filling period is slightly shortened compared to normals, but the %deltaD taking place during rapid filling is not different than normals. This pattern is distinct from characteristic alterations seen in other cardiac diseases that have preserved systolic performance. While M-mode indices of left ventricular filling may be altered by several factors, the most significant factors in dilated cardiomyopathy are the severity of systolic dysfunction and preload. Left-sided conduction delays and associated right ventricular enlargement have no demonstrable effect on very early portions of diastole, but the conduction delay does prolong the rapid filling period and reduce the extent of filling during this period. Combined use of digitized M-mode echocardiograms and Doppler analysis of transmitral flow may allow a more complete description of left ventricular filling in future studies. PMID- 10149252 TI - A physiological approach to drug therapy in dilated cardiomyopathy. Echo-Doppler evaluation of cardiac mechanics, myocardial energetics, and ventriculo-vascular coupling. AB - Cardiac ultrasound imaging can be used in conjunction with calibrated external pulse recordings to provide detailed information regarding cardiovascular hemodynamics. This review establishes a physiological framework for the echo Doppler assessment of cardiac mechanics, left ventricular energetics, and ventriculo-systemic vascular coupling in patients with dilated cardiomyopathy. The section on cardiac mechanics concerns the evaluation of overall cardiac performance and its individual determinants. Particular emphasis is placed upon the use of noninvasive methodology to identify the relative contributions of altered loading conditions and intrinsic myocardial contractility to cardiac performance. The noninvasive evaluation of left ventricular energetics is based on the physiological premise that myocardial oxygen consumption is a function of three major determinants, i.e., heart rate, contractility, and the integral of left ventricular systolic load (or wall stress). Following a brief discussion of the vascular properties that determine the relationship between pressure and flow in the systemic circulation, noninvasive methods for determination of systemic vascular resistance and arterial compliance are described. At the end of each section, practical clinical applications of these techniques to the evaluation and management of patients with dilated cardiomyopathy are presented. PMID- 10149253 TI - Echocardiography of dilated cardiomyopathy in children. AB - Echocardiography is useful and reliable in the diagnosis and management of children with dilated cardiomyopathy. M-mode echocardiography provides quantitative information of left ventricular and left atrial dimensions and left ventricular wall thickness. Left ventricular function including shortening fraction, mean velocity of circumferential fiber shortening (V cf), systolic time intervals, left ventricular wall thickening and thinning rate, isovolumic contraction time, and wall stress can be derived from M-mode study. Left ventricular and left atrial dimensions are usually 1.5 times normal. Left ventricular systolic function is markedly reduced. Shortening fraction can be easily obtained and is the most informative index for assessing the severity of illness. Very low shortening fraction at presentation and follow-up (12-15%) is a poor prognostic sign. Two-dimensional echocardiography is valuable for excluding valvular lesion or coronary artery anomaly and detection of intracardiac thrombus. The left ventricular free wall is usually more severely affected than the ventricular septum as seen by two-dimensional echocardiography. PMID- 10149254 TI - Doppler assessment of diastolic function in cardiac amyloidosis. AB - The hallmark of cardiac amyloidosis is abnormal diastolic function secondary to amyloid infiltration of the ventricular walls, which accounts for the term "stiff heart syndrome." The abnormal diastolic function has not yet been well characterized, however. Thus, we assessed left and right ventricular diastolic function in 53 patients with cardiac amyloidosis. We measured the left and right ventricular inflow and venous flow velocities with Doppler echocardiography and found a range of Doppler filling abnormalities. These abnormalities were dependent on the degree of amyloid infiltration of the heart as measured by mean left ventricular wall thickness. Patients with advanced cardiac amyloidosis (a wall thickness greater than or equal to 15 mm) showed restriction, while patients with early cardiac amyloidosis (a wall thickness less than 15 mm) showed abnormal relaxation or normal filling. In another study, during a 13-month follow-up, patients with early cardiac amyloidosis showed Doppler patterns that evolved from abnormal relaxation through a normal stage, to an advanced stage of restrictive disease. We also have demonstrated the importance of left ventricular inflow variables in predicting the outcome of patients with cardiac amyloidosis. We concluded that Doppler echocardiography is useful in characterizing abnormal diastolic function in patients with cardiac amyloidosis. PMID- 10149255 TI - Two-dimensional echocardiography in myocardial amyloidosis. AB - Two-dimensional echocardiography is the best means of identifying early cardiac amyloid infiltration and gauging its subsequent progression. The early asymptomatic phase is characterized on echocardiography by a mild-to-moderate increase in left ventricular and/or right ventricular wall thicknesses. The distinctive combination of low electrocardiography voltage and increase in left ventricular mass on the echocardiogram, both compatible with substantial amyloid infiltration, is valuable in diagnosis and appears to indicate the severity of the disease. Other ancillary but common findings are left atrial dilatation, a small pericardial effusion, thickening of cardiac valves, papillary muscles, and interatrial septum. Finally, there is a peculiar texture of myocardial walls, with highly refractile areas that are typical, although not specific, of myocardial amyloidosis and can also be quantitatively described by digital image analysis techniques. The echocardiographic appearance of amyloidosis can closely mimic several other diseases. Asymmetric hypertrophy of the septum due to amyloid deposition may occur, simulating hypertrophic cardiomyopathy. The granular sparkling of myocardial walls is also found in myocarditis with severe fibrosis, and it is quite common in hypertrophic cardiomyopathy, as well as in other infiltrative diseases of the myocardium. It is not uncommon that the echocardiographic examination represents a turning point in the work-up of the patient, briskly orienting the clinician towards the correct diagnostic pathway. However, the likelihood of the cardiologist-echocardiographer to successfully and prospectively identify myocardial amyloidosis is substantially higher if all the clinical and electrocardiographic information is reviewed at the time of the echocardiographic examination. PMID- 10149256 TI - Intraoperative color Doppler assessment in valve repair surgery. AB - Intraoperative color Doppler recordings, obtained either from the epicardial or transesophageal approach, offer real-time information about the presence and severity of mitral regurgitation at the time of surgery. The technique allows instantaneous evaluation of mitral and tricuspid repair and may offer important information about the postoperative outcome. PMID- 10149257 TI - Fetal echocardiography. AB - Examination of the fetus offers a unique opportunity to understand the true scope of congenital and early acquired cardiac lesions. Diagnosis and management of arrhythmias remain the predominant use of these techniques. Structural heart disease can be completely characterized by two-dimensional and Doppler examination. Such studies enhance our understanding of heart disease and also provide the family and patient care team with valuable information for the planning of neonatal management. These advances in technology and emphasis on increased fetal salvage are expected to usher in the next age of surgical intervention in the fetus with structural heart disease. The ability to examine the fetus at increasingly earlier stages of gestation will provide invaluable means for unraveling the secrets of the origins of many cardiovascular alternations. PMID- 10149258 TI - Biplane transesophageal echocardiography utilizing transverse and sagittal imaging planes: technique, echo-anatomic correlations, and display approaches. AB - The recent development of biplane transesophageal probes equipped with both transverse plane and sagittal plane imaging transducers allows a more complete examination of cardiac and aortic anatomy than is possible with conventional single plane transesophageal instruments. While the imaging planes used in transverse plane transesophageal imaging have been standardized, several different approaches have been suggested for the orientation and display of the newer sagittal plane images. An accepted display convention for the transverse and sagittal plane images would ease interpretation of the multiple complex images obtained during the biplane transesophageal examination. In this article, the different transverse plane and sagittal plane echocardiographic images that may be acquired during the biplane transesophageal examination are described and correlated with cardiac anatomy. A method for image display orientation is suggested that is most consistent with that previously used for the single plane transesophageal examination. PMID- 10149259 TI - Doppler color flow image size: dependence on instrument settings. AB - Doppler color flow imaging provides important qualitative information about the location and spatial distribution of intracardiac blood flow. However, the effect of instrument-related variables on the size of color Doppler images requires further definition. Flow of a silicone particle solution was established in a tube or cylinder and scanned as color gain, pulse repetition frequency, depth, and transducer frequency were varied. The diameter of Doppler color flow images were measured during constant laminar or disturbed flow parallel to the ultrasound beam and during laminar flow perpendicular to the ultrasound beam. The diameter of color Doppler images of laminar flow perpendicular and parallel to the beam varied directly with color gain. Diameter varied inversely with transducer frequency for laminar flow parallel to the transducer and inversely with pulse repetition frequency for laminar flow perpendicular to the transducer. The diameter of laminar flow parallel to the transducer varied directly with the depth of the flow area below the transducer. The size of the color flow dropout of laminar flow exactly perpendicular to the ultrasound beam varied directly with transducer frequency and inversely with gain. During disturbed flow parallel to the transducer, the diameter of the image varied directly with gain and inversely with transducer frequency and pulse repetition frequency. Instrument settings have a significant impact on the size of color Doppler images. Understanding the effects of changes in these variables is important for reliable diagnostic use of Doppler color flow imaging. PMID- 10149260 TI - A new angled transducer for intraoperative epicardial echocardiography. AB - We tested a new angled transducer developed for intraoperative epicardial echocardiography in 42 patients. This small transducer, 70 x 20 x 15 mm in size, demonstrated superior operability and provided adequate two- or four-chamber imaging from the apical approach, which may lead to high-quality assessment with two-dimensional Doppler flow imaging. PMID- 10149261 TI - Hemodynamic changes in left ventricular function during acute coronary insufficiency: a Doppler echocardiographic study. AB - To define the availability of Doppler echocardiography in evaluating left ventricular hemodynamic changes induced by some clinical findings of acute coronary insufficiency, we selected 12 patients with angina and 32 affected by acute myocardial infarction. Doppler echocardiography was performed at hospital admittance and during recovery time. Left ventricular contractility was defined on the systolic aortic flow spectrum by measuring the aortic velocity maximum, the time to peak/left ventricular ejection time ratio, and the cardiac output. During the first examination, left ventricular contractility significantly decreased in patients with angina and in those with acute myocardial infarction. After the acute phase, these parameters slightly improved. Left ventricular diastolic filling was evaluated in the transmitral flow. A decreased E-wave velocity and an increased late component (A wave) with inversion of the E/A wave ratio were found in patients with acute myocardial infarction during the first examination. This morphology inverts when the patients stabilize. On the contrary, this ratio stayed above one during and after angina. In this study, we also defined the usefulness of the color Doppler method in setting up criteria to identify some early morphological complications of acute myocardial infarction in 12 patients with acute infarction and a new systolic murmur. This technique showed an ischemic rupture of the ventricular septum in five cases and mitral regurgitation in seven. The color Doppler method has allowed us to obtain a semi quantitative assessment of the mitral regurgitation and the location of the ventricular septal defect. PMID- 10149262 TI - Transesophageal echocardiography in aortopulmonary communications. AB - The assessment of congenital aortopulmonary communications by transthoracic echocardiography may be suboptimal, particularly postoperatively, due to limited acoustic windows. We performed intraoperative transesophageal echocardiograms in six patients with eight proven systemic-pulmonary communications. Diagnosis included truncus arteriosus (1), aortopulmonary window (1), Waterston anastomosis (3), central Gore-Tex shunt (1), and modified left Blalock-Taussig shunt (2). All communications were accurately demonstrated by transesophageal echocardiography (TEE). The transesophageal technique also provided an assessment of the size of the aortopulmonary communications and the proximal pulmonary arteries. In addition, the gradient across some of the communications could be accurately estimated utilizing the high pulse repetition frequency Doppler. On the other hand, only two of the seven aortopulmonary communications were detected by transthoracic echocardiography. Postoperatively, transesophageal imaging demonstrated unobstructed conduit in five of five patients who underwent conduit repair, as well as intact closure of aortopulmonary communications and concomitant closure of ventricular septal defects. PMID- 10149263 TI - Real-time, intracardiac, two-dimensional echocardiography: enhanced depth of field with a low-frequency (12.5 mhz) ultrasound catheter. AB - Advances in catheter-based ultrasound imaging technology allow for a unique opportunity to develop two-dimensional intracardiac echocardiography, an imaging method that could have significant clinical applications. In this study, we evaluated the potential of a new, percutaneous, 9-Fr prototype intracardiac echocardiographic catheter with a 12.5-MHz rotating crystal in 13 dogs. In all dogs, we were able to easily advance the intracardiac echocardiographic catheter into the right and left hearts percutaneously and obtain dynamic images of cardiac structures in various imaging planes. With the intracardiac echocardiographic catheter in the right atrium, the whole chamber could be visualized. Minor manipulation allowed visualization of the right atrium, right ventricle, and tricuspid valve in a two-chamber view; further maneuvering yielded four-chamber views. With advancement of the catheter into the right ventricle and pulmonary artery, the right ventricular cavity, right ventricular outflow tract, and pulmonary artery could be imaged. The intracardiac echocardiographic catheter in the aortic root allowed visualization of the pulmonary artery and its bifurcation, superior portions of the atria, interatrial septum, aortic valve, and the proximal left coronary artery. With the intracardiac echocardiographic catheter in the left ventricle, short-axis images of the whole left ventricle were obtained. Manipulating the catheter tip within the left ventricle, we could visualize the left ventricle, left atrium (LA), and the mitral valve in the long axis. We were also able to visualize and identify experimentally-induced ischemic regional left ventricular dyskinesis (four of of five dogs), aortic valvular tear (five out of five dogs), and pericardial effusion with right atrial collapse (two out of two dogs). Intracardiac echocardiography was not associated with any complications. We conclude that percutaneous, low-frequency intracardiac echocardiography with a 12.5-MHz, 9-Fr catheter yields cardiac images in many imaging planes with a good depth of field, allows identification of valvular, myocardial, and pericardial abnormalities, and has excellent clinical potential in the assessment of many cardiovascular disorders. PMID- 10149264 TI - The effects of the microbubble suspension SH U 454 (Echovist) on ultrasound induced cell lysis in a rotating tube exposure system. AB - Human erythrocytes resuspended at different hematocrits in autologous plasma at 37 degrees C were exposed to the therapeutic intensities of continuous-wave 0.75 MHz ultrasound in vitro in a rotating tube exposure apparatus designed to maximize the destructive effects of cavitational activity. Provided that large numbers of additional gas bubbles had not been introduced during the various preparative and manipulatory procedures, the addition of Echovist at final concentrations comparable with those currently being used for clinical investigations resulted in a statistically significant increase in the amount of cell lysis in vitro in those samples having hematocrits less than 2%. The amount of cell lysis produced at any given ultrasound intensity decreased with increasing hematocrit in both the controls and the cell suspensions containing Echovist until it was virtually zero in both cases at hematocrits of 5.5% or greater. The addition of Echovist to samples that already contained large numbers of stabilized gas bubbles and/or had hematocrits greater than 5.5% produced no detectable cell lysis even at ultrasonic intensities as high as 3 W/cm 2 spatial average, temporal average (SATA). It is therefore unlikely that Echovist would cause appreciable amounts of cell lysis when the gas bubbles were being exposed to ultrasound under the conditions used for clinical investigations in vivo. PMID- 10149265 TI - Cardiac ultrasound: its role in the recognition and management of fetal heart disease. AB - This article briefly reviews the role of ultrasound scanning in the diagnosis and management of fetal cardiac disease. Currently, the potential exists for the accurate identification of a wide range of cardiac defects and for the diagnosis and successful management of many cardiac rhythm disturbances. Considerable benefit is derived for families with previously affected children when a normal fetal cardiac ultrasound report can be provided. PMID- 10149266 TI - Echocardiographic segmental approach to complex congenital heart disease in the neonate. AB - A segmental echocardiographic approach to complex congenital heart disease in the neonate allows accurate and precise assessment of intracardiac, as well as extracardiac, anomalies. Determination of abnormalities of atrial and visceral situs, as well as the cardiac situs, provides a fundamental background for the echocardiographic examination. Subsequently, a segmental approach allows precise determination of abnormalities of atrioventricular and ventricular great artery connections. Recent echocardiographic advances including high-frequency (7.5 and 10 MHz) and color flow imaging capabilities have dramatically improved our ability to accurately define abnormalities of anatomy and connection in the neonate. These advances now have expanded our previous echocardiographic criteria and allow application of the echocardiographic segmental approach to characterize complex congenital heart disease in the neonate. PMID- 10149267 TI - Echocardiographic and color flow Doppler assessment of systemic and pulmonary venous connection and drainage in the neonate with congenital heart disease. AB - Systemic and pulmonary venous anomalies are frequently encountered either as isolated lesions or as a significant component of a more complex lesion in the newborn infant with congenital heart disease. Two-dimensional echocardiography and Doppler techniques (conventional and color flow) have become the primary diagnostic imaging modality in this setting. Precise pre-operative definition of these variable venous connection and drainage patterns is critical as the required surgical procedure may solely be based on exact understanding of the veins' anatomy and physiology. On the systemic venous site, anomalies of superior and inferior venae cavae, innominate vein, and coronary sinus can be equally well imaged with either echocardiography or angiography. However, on the pulmonary venous site, echocardiography and Doppler techniques including color flow mapping are superior to angiography for precise definition of the connection and drainage sites of the individual pulmonary veins. PMID- 10149268 TI - The role of Doppler echocardiography in the diagnosis, follow-up, and management of ventricular septal defects. AB - The defects of the ventricular septum have received special attention from investigators working in echocardiography. The method showed an incomparable capability to identify all the morphological features of the defects. The increasing improvement in definition of transducers associated with conventional and color Doppler contributed significantly to the reliability to detect most of the defects. The great majority of associated lesions can be easily identified and serial examinations allow prediction of which defect may become smaller or even close spontaneously as well as which have acquired deleterious changes in the heart. Several authors have shown very good statistical correlations between echocardiographic indices and hemodynamic parameters in patients with this type of defect. Doppler echocardiography has become an invaluable tool in the diagnosis and follow-up of ventricular septal defect reducing the need for cardiac catheterization and helping management of these patients. PMID- 10149269 TI - Echo contrast agents improve flow display of color Doppler: in vitro studies. AB - Flow detection by color Doppler is impaired by low velocity of flow and increasing attenuation and depth of ultrasound penetration. The effects of increased echogenicity on flow detection (Toshiba SSH 65A) were thus studied in a flow model, which yielded similar strengths of Doppler signals as seen in the clinical routine, by adding microbubble solutions to the blood analog fluid (45% aqueous glycerin) and comparing signal strength (score 0-5) prior to and after contrast. The flow within the plexiglass tube with less than 3 degrees angle of coincidence for Doppler interrogation was laminar with a parabolic velocity profile at physiological velocities and pressures. In comparison with various contrast agents at a flow velocity of 18 cm/sec and 19 dB attenuation, flow was not detectable in control color Doppler, after 4 mL of the blood analog fluid, and after 4 mL of an agitated saline solution 9 mg/mL, but visible after 4 mL of Echovist, a polysaccharide solution with reproducible bubble size and concentration and after 4 mL of an agitated polygelatin solution. Increasing concentration of Echovist (50-400 mg/mL) improved flow detection. Echovist 200 mg/mL enhanced the score by 1.1 + -0.6 for velocities 5-20 cm/sec (P less than 0.01), by 1.6 + -0.8 for 40-100 cm/sec (P less than 0.001), and by 1.1 + -0.6 for velocities greater than 150 cm/sec (P less than 0.001).(ABSTRACT TRUNCATED AT 250 WORDS) PMID- 10149270 TI - The relevance of transcranial Doppler to ischemic stroke outcome. AB - To assess the value of transcranial Doppler examination for the early prognosis of ischemic stroke, we examined 24 patients (15 males and 9 females, mean age 66.8 +/- 9.3 years) with hemispheric cerebral infarction, within 6 hours of stroke onset. Of these 24 patients, 22 were evaluated on the Canadian Neurological Scale, the Toronto Stroke Scale, and the Barthel Index on days 60 and 120. Mean flow velocity in the middle cerebral artery on the lesion side was measured and values outside the range 30 to 80 cm/sec were rated abnormal. Two of nine patients with normal flow velocity died compared to five of the 13 patients with abnormal values. Four of the seven remaining patients in the former group made a full recovery compared with none of the remaining eight patients in the latter group (P less than 0.05). Neurological and functional status measured on the scales used on days 60 and 120 were also significantly better in the group with normal flow velocity. Early transcranial Doppler may prove useful in predicting the outcome of hemispheric infarction in the acute phase of cerebral ischemia. PMID- 10149271 TI - The physiology of congenital heart disease: assessment by Doppler color flow mapping. AB - The use of Doppler echocardiography is a routine part of the noninvasive assessment of the patient with heart disease. In children with congenital heart disease, pulsed- and continuous-wave Doppler echocardiographic techniques provide accurate, reproducible hemodynamic data relative to structural defects. Doppler color flow imaging, however, allows for qualitative assessment of blood flow patterns, which may give important insights into the changing physiology of the newborn infant or that of a patient in the medical or surgical intensive care settings. Ten cases are presented in which this flow information is instructive in understanding the physiological sequelae of congenital heart disease. PMID- 10149272 TI - Transesophageal echocardiography for congenital heart disease. AB - Surface echocardiographic imaging of small children is routinely successful in defining anatomical details and Doppler flow patterns with even the most complex congenital cardiac malformations. However, in larger children or adults, imaging is frequently limited. A recent expansion of the role of echocardiography is intraoperative epicardial imaging. Epicardial and postoperative imaging, however, have significant limitations. To avoid some of these limitations, transesophageal echocardiography has increasingly been used in the arena of congenital heart disease. The more recent development of small sized gastroscopic probes has allowed transesophageal echocardiographic assessment of congenital heart disease in children down to newborn size. As detailed studies of individual lesions are reported, it has become clear that the mere presence of a congenital heart defect is not an indication for transesophageal echocardiography in most children if imaging can be accomplished by surface examination. However, transesophageal echocardiography may be indicated for the intraoperative or postoperative assessment of that defect, particularly when repair has been difficult or is known to be associated with significant residual abnormalities. Cardiac structures encountered with horizontal and vertical imaging plane transducers have been described and should be completely familiar to the examining echocardiographer. PMID- 10149273 TI - Quantification of mitral regurgitation: comparison between transthoracic and transesophageal color Doppler flow mapping. AB - We reviewed transthoracic (TTE) and transesophageal (TEE) echocardiograms of 100 consecutive patients: 63 male, 37 female, mean age 50 years (range 16-83 years), 32 with neoplastic disease, 18 aortic disease, 28 mitral valve disease, and 22 with other diseases. Absence or presence of mitral regurgitation (defined as mild, moderate, or severe) was assessed. TEE showed mild mitral regurgitation in 26 patients where TTE was negative. The overall estimate of regurgitant lesion severity was concordant at TEE and TTE in 64% of cases. The overall estimate of regurgitant lesion severity was also greater by one grade in 1% of cases at TTE, and in 35% of cases at TEE. Maximal digitized jet areas were 3.60 +/- 6.35 cm 2 at TTE and 3.04 +/- 3.79 cm 2 at TEE (P = NS). Correlation was r = 0.69 (TEE = 0.41 TTE + 1.55; P less than 0.001). TEE yielded a higher prevalence of mitral regurgitation than TTE with a trend toward greater overall estimate of mitral regurgitation at the semi-quantitative analysis. TTE and TEE showed similar mean results at the quantitative assessment of maximal jet areas. However, a highly significant random variability was observed in quantifying mitral regurgitation at TEE. PMID- 10149274 TI - Limitations of flow detection by color Doppler: in vitro comparison to conventional Doppler. AB - There is little awareness of the limitations of flow detection with the commercially available color Doppler flow mapping system. The influence of flow velocity, ultrasound attenuation, and penetration depth on flow detection in color Doppler (Toshiba SSH 65A) were therefore studied in vitro and compared with conventional Doppler. The flow model had physiological flow volumes and laminar flow with parabolic velocity profile in a horizontal tube of Lucite with less than 3 degrees of coincidence. Conventional Doppler flow velocity measurements correlated highly with laser Doppler anemometry results (r = 0.99, SEE = 3 cm/sec). Signal strength of color Doppler and pulsed Doppler was semi quantitatively graded using a scale from 0 to 5. Scale 1 (sparse signals) was useless for any assessment in color Doppler but just allowed velocity measurement in pulsed Doppler. Using 19-dB attenuation, flow velocities greater than 100 cm/sec had good scores with moderate gain, 60-100 cm/sec needed increasing gain, and velocities less than 40 cm/sec were not detectable with color Doppler but readily so with pulsed Doppler. With increasing attenuation (1-29 dB) and also with increasing penetration depth, flow detection was reduced significantly (P less than 0.001) more in color Doppler than in the pulsed technique (P less than 0.01). In conclusion, low flow velocities, high attenuation, and greater than 8 cm penetration depth may hamper flow detection in color Doppler and, thus, diagnostic accuracy. Conventional Doppler with its superior accuracy and sensitivity should therefore consolidate diagnostic ultrasound assessment. PMID- 10149275 TI - Comparison of transesophageal to transthoracic color Doppler echocardiography in the identification of intracardiac mycotic aneurysms in infective endocarditis. AB - We report on cases of mycotic aneurysms in a group of 14 patients with infective endocarditis, all of whom were evaluated with transthoracic (TTE) and transesophageal (TEE) color Doppler echocardiography. Four mycotic aneurysms were found, one each in the left ventricular outflow tract, the right coronary sinus of Valsalva, the anterior mitral leaflet, and the atrial septum. With TTE, only three of four cases of mycotic aneurysms could be detected. Utilizing TEE, however, all were detected and their connections with the heart chambers or great vessels could be readily and clearly depicted, especially those in the atrial septum and mitral leaflet. We are of the opinion that TEE is superior to TTE in the identification and detailed analysis of mycotic aneurysms complicating infective endocarditis. In addition, we feel that echocardiography may help evaluate the progress of the disease, the location and direction of infection, and the extent of involvement of the mycotic aneurysms, providing useful information for guiding surgical intervention. PMID- 10149276 TI - Transesophageal color Doppler flow mapping of iatrogenic left-to-right interatrial shunting after percutaneous transluminal mitral valvotomy. AB - Characteristics of transesophageal color Doppler flow mapping of iatrogenic left to-right interatrial shunts were assessed in 58 patients, 1 to 994 days after percutaneous transluminal mitral valvotomy. Transesophageal color Doppler flow mapping detected 22 cases of interatrial shunt whereas transthoracic two dimensional echocardiography visualized only five interatrial septal defects. Five types of color Doppler flow patterns of interatrial shunts were found: type 1, a bluish jet passing through the interatrial septum into the right atrium with a small bluish proximal flow in the left atrium (50%); type 2, a bluish jet passing through the interatrial septum into the right atrium without a proximal flow (13.6%); type 3, a predominant bluish proximal flow in the left atrium passing through the interatrial septum with minimal flow entering into the right atrium (18.2%); type 4, an "en face" bluish jet in the right atrium (4.5%); and type 5, a "wall jet" with proximal flow adhering to and entering into the interatrial septum (13.6%). Oximetry demonstrated increased pulmonary-to systemic flow ratio (range 1.07 to 3.32) in 11 patients (50%), which was significantly correlated with the maximal jet area derived from color Doppler flow mapping (r = 0.80, P = 0.001). Thus, transesophageal color Doppler flow mapping is useful in detection of left-to-right interatrial shunts after percutaneous transluminal mitral valvotomy, and recognition of the variable types of color flow mapping may further help identify these atypical interatrial shunts. PMID- 10149277 TI - Role of prenatal echocardiography in the study of hypertrophic cardiomyopathy in the fetus. AB - The increased incidence of hypertrophic cardiomyopathy in children of diabetic mothers has already been demonstrated, but its prenatal diagnosis has not yet been extensively studied. The purpose of this prospective study was to evaluate the frequency, severity, and echocardiographic features of fetal hypertrophic cardiomyopathy in a population with several indications for prenatal echocardiography. From March 1987 to April 1991, 283 fetuses were submitted to comprehensive prenatal echocardiography, including M-mode measurements, cross sectional imaging, Doppler studies, and color flow mapping. One hundred seventy six were pregnancies complicated by previous or gestational diabetes. The diagnosis of disproportionate septal hypertrophy was made in 39 fetuses (mean septal thickness 7.12 +/- 1.6 mm), at a mean gestational age of 32 weeks. Diabetes mellitus was present in 36 of these pregnancies (92.3%). In four cases, nonimmune hydrops was detected. A systolic anterior motion of the mitral valve was present in three fetuses, but only one showed a gradient across the left ventricular outflow tract. Postnatal echocardiographic examination in 27 babies did not show false positivity. In ten cases, spontaneous regression of the septal hypertrophy was shown. There were three neonatal deaths, unrelated to the myocardial disease. We concluded that transient hypertrophic cardiomyopathy is a frequent entity, especially when associated with diabetes during gestation, being a potential cause for nonimmune hydrops. Fetal echocardiography is the method of choice for its prenatal diagnosis and should always be indicated in diabetic mothers. PMID- 10149278 TI - "Nonanatomic" correlations of transesophageal echocardiography. PMID- 10149279 TI - Echo-anatomic correlations and image display approaches in transesophageal echocardiography. Purity with flip-flop or prudence without flip-flop? . PMID- 10149280 TI - Panoramic transesophageal echocardiography. Clinical application of real-time, wide-angle, transesophageal two-dimensional echocardiography and color flow imaging. AB - Panoramic transesophageal echocardiography is a new development in transesophageal echocardiography (TEE) technology, which yields a wide-angle imaging field for real-time two-dimensional and color flow imaging. We report our early experience in patients with the use of an annular-array TEE probe that provides a wide, 270 degrees angle imaging field for two-dimensional echocardiographic imaging. The field of view can, however, be narrowed to 15 degrees . The field of view for color flow imaging can be varied from 180 degrees to 10 degrees . Pulsed-Doppler recordings of flow velocity are also possible. This TEE system provides a panoramic vision of cardiac and paracardiac structures from the esophagus and stomach. Besides cardiovascular structures, other thoracic and upper abdominal organs can be visualized. The wide field of view allows a better comprehension of the cardiac anatomy and its relationship with adjacent structures. The initial experience suggests that this method, besides providing the usually required diagnostic information, may have a number of additional applications. Its clinical potential and directions for future developments are reviewed. PMID- 10149281 TI - Intraoperative transesophageal echocardiography of ventricular septal defect. AB - The accuracy and limitations of intraoperative two-dimensional (2-D) and color Doppler flow mapping transesophageal echocardiography (TEE) of ventricular septal defect (VSD), before and after cardiopulmonary bypass, were analyzed in 62 children. Twenty-one patients had an isolated VSD, and 41 had a VSD plus additional cardiac anomalies. Two-dimensional and color Doppler flow mapping TEE were performed with a miniaturized 5-MHz single (transverse) plane transducer in the 51 of 62 patients weighing less than 20 kg. The remaining 11 were monitored using a single plane adult probe (n = 4) and a biplane (transverse plus longitudinal) probe (N = 7). Prebypass TEE provided a correct diagnosis in 57 of 62 cases (92%) and corrected an erroneous preoperative transthoracic echocardiographic diagnosis in three of 62 cases (5%). Single plane TEE diagnosis was erroneous in five patients: four with doubly-committed subarterial VSD and one with multiple small apical muscular defects and pulmonary hypertension. Biplane TEE (transverse longitudinal) provided clear and complete imaging of the right ventricular outflow tract in all seven cases in whom it was used. Postbypass TEE showed absence of a hemodynamically significant residual VSD in 30 of 40 patients (95%) who underwent VSD patch closure, prospectively identified two of 40 with significant residual VSD, and accurately measured the color Doppler jet width of all residual VSDs. We conclude that hemodynamically significant VSDs can be identified immediately after cardiopulmonary bypass based on the width of the residual VSD color Doppler flow map jet. Therefore, 2-D and color Doppler flow mapping TEE provide an accurate diagnosis in most cases of VSD but may miss doubly-committed subarterial and apical muscular VSD unless biplane TEE is used. PMID- 10149282 TI - Evaluation of mitral regurgitation by Doppler echocardiography. AB - The diagnosis and assessment of mitral regurgitation has been one of the main challenges for cardiac ultrasound. Imaging techniques (M-mode and two dimensional echocardiography) provide direct morphologic and etiologic information of the evaluation of patients with suspected mitral regurgitation. The advent of cardiac Doppler increased tremendously the ability to evaluate mitral regurgitation noninvasively. Continuous-wave and pulsed Doppler have been found to be sensitive and specific in the detection of mitral regurgitation. The introduction of color flow Doppler simplified enormously the assessment of patients with suspected mitral regurgitation. The maximal regurgitant area and maximal regurgitant area corrected for left atrial size have become the most commonly used parameters to evaluate mitral regurgitation by color flow Doppler in the clinical setting. However, the color regurgitant jet area is highly dependent on anatomical, hemodynamic, and equipment factors. A new method, based on the proximal isovelocity surface area, is being evaluated and appears to be relatively independent of equipment factors. Transesophageal echocardiography has been shown to be exquisitely sensitive in the detection of mitral regurgitation. Quantitation of mitral regurgitation by transesophageal echocardiography is currently based on the maximal regurgitant area and this parameter appears to correlate closely with the angiographic degree of mitral regurgitation. Pulmonary venous flow analysis had been used in conjunction with color flow mapping for the evaluation of mitral regurgitation by transesophageal echocardiography. The presence of reversed systolic flow has been shown to be sensitive and specific for the diagnosis of severe mitral regurgitation. Patients with clinically difficult surface studies, flail mitral valve leaflets, and prosthetic mitral valve are best evaluated by the transesophageal approach with interrogation of pulmonary venous flow. PMID- 10149283 TI - Future technical prospects in biplane transesophageal echocardiography: use of adult and pediatric biplane matrix probes. AB - This study evaluates the feasibility of the combined use of an adult matrix probe with a real-time biplane imaging system, and also describes the performance of a newly developed pediatric matrix probe. PMID- 10149284 TI - Transesophageal echocardiography with color Doppler during interventional catheterization. AB - Echocardiography has been used during interventional cardiac catheterization for guidance of the procedure and assessment of results. However, limited echocardiographic windows and logistical difficulties make conventional echocardiography during interventional catheterization impractical and of limited value. Transesophageal echocardiography (TEE) with Doppler color flow mapping is more useful than conventional echocardiography for guidance of interventional catheterizations. Device closure of congenital atrial and ventricular septal defects (ASDs and VSDs) and of postoperative residual interatrial and interventricular communications, balloon valvuloplasty, and Brockenbrough atrial septal puncture with ASD creation have been performed under combined fluoroscopic and TEE guidance. Transesophageal echocardiography can be performed continuously throughout the procedure, allowing simultaneous fluoroscopic and echocardiographic assessment of catheter position. Localization of individual device arms during transcatheter device closure of ASDs and VSDs is easier and more accurate when TEE is used, resulting in a lower incidence of incorrect device positioning. Doppler color flow mapping is used to determine number, location, and size of defects, to detect residual shunts after device closure, and to assess valve insufficiency after balloon valvuloplasty and other procedures. Combined TEE and fluoroscopic guidance of interventional procedures, with echocardiographic assessment of results, reduces the amount of radiation and contrast used during the procedure, allowing performance of additional interventional procedures during the same catheterization. Transesophageal echocardiography is indicated during interventional procedures in which simultaneous Doppler color flow mapping and precise localization of catheter, balloon and/or device position will result in a higher success rate and decreased morbidity. PMID- 10149285 TI - Transesophageal echocardiographic examination of left-sided superior vena cava and azygos and hemiazygos veins. AB - In the present study, we describe our experience in the delineation of the left sided superior vena cava, azygos vein, and hemiazygos vein, using transesophageal echocardiography. PMID- 10149286 TI - Transesophageal echocardiographic imaging of the pulmonary veins. AB - This report focuses on the technical aspects of the assessment of pulmonary veins using biplane transesophageal echocardiography, taking into account their spatial anatomical orientation and relationship to neighboring structures. This is aimed at increasing the echocardiographer's ability to visualize the proximal segments of all four pulmonary veins. PMID- 10149287 TI - Cataract surgery and lens implantation. PMID- 10149288 TI - Cataract surgical techniques. AB - Cataract surgical techniques are constantly evolving and changing, offering the ophthalmologist new and sometimes improved options for optimal visual rehabilitation of their patients. This article reviews the surgical techniques used in cataract surgery with an emphasis on the recent literature. The following areas are covered: anesthesia, incisions and wound closure, capsulotomy, planned extracapsular cataract surgery, phacoemulsification, intraoperative management of the torn posterior capsule, trauma, and combined procedures. The use of phacoemulsification continues to increase in popularity in the developed countries. Small incisions for cataract surgery hasten visual rehabilitation, and continuous circular capsulorhexis has emerged as an advantageous capsulotomy technique. With proper intraoperative management, patients with torn posterior capsules have excellent visual results. Combined procedures allow for concurrent surgery in patients with cataract and coexistent ocular diseases. Cataract surgical techniques must be adapted to suit each patient. The modification of surgical techniques according to individual patient needs and associated ocular and systemic disorders offers a distinct challenge to the ophthalmic surgeon. PMID- 10149289 TI - Intraocular lenses. AB - In reviewing the 1990 literature on intraocular lenses, it is evident that the increased popularity of phacoemulsification in North America has stimulated interest in lens designs that can be inserted through small incisions, and various methods for folding soft lenses. Critical evaluation of various multifocal lenses has now resulted in greater understanding of their advantages and drawbacks, and it is becoming apparent that there are guidelines of suitable candidates for such lenses. Use of multifocals has stimulated interest in contrast sensitivity testing, and new more accurate lens power formulas. Heparin surface modification of polymethylmethacrylate lenses now seems to be accepted as having value in reducing pigment deposits after surgery. Clinical trials of lenses for patients suffering from age-related macular degeneration hold some promise for this large group of unhappy patients. However, the use of anterior chamber lenses to correct high myopia in phakic eyes is now on hold because of reports of progressive endothelial cell loss in some eyes. More reports are available on the technique and results of suturing posterior chamber lenses to the sclera where there is absent or insufficient capsule to support a conventional sulcus fixated posterior chamber lens. Intraocular lenses remain alive and well in 1990 with increased usage worldwide. PMID- 10149290 TI - Optics, refraction, and visual function. PMID- 10149291 TI - Refraction, including prisms. AB - The literature in the past year on refraction is replete with several isolated but very important topics that have been of interest to strabismologists and refractionists for many decades. The refractive changes in scleral buckling procedures include an increase in axial length as well as an increase in myopia, as would be expected. Tinted lenses in dyslexia show little positive effect in the nonasthmatic patients in one study. The use of spectacles or bifocals as a way to control increase in myopia is refuted in another report. It has been shown that in accommodative esotropia not all patients will be able to escape the use of bifocals in the teenage years, even though surgery might be performed. The hope that disposable contact lenses would cut down on the instance of giant papillary conjunctivitis and keratitis has been given some credence, and the conventional theory that sclerosis alone is the cause of presbyopia is attacked. Also, gas permeable bifocal contact lenses are reviewed and the difficulties of correcting presbyopia by this method outlined. The practice of giving an aphakic less bifocal addition instead of a nonaphakic, based on the presumption of increased effective power, is challenged. In the review of prisms, the majority of articles concern prism adaption. The most significant report is that of the Prism Adaptation Study Research Group (Arch Ophthalmol 1990, 108:1248-1256), showing that acquired esotropia in particular has an increased incidence of stable and full corrections surgically in the prism adaptation group versus the control group.(ABSTRACT TRUNCATED AT 250 WORDS) PMID- 10149292 TI - Dynamic retinoscopy. AB - Dynamic retinoscopy for the objective examination of accommodation was described in the ophthalmic literature in the 1890s but is rarely used in ophthalmology today. The technique has been extensively investigated by the optometric profession, however, sometimes with confusing, and sometimes with useful, results. It can be of value in screening infants for astigmatism and anisometropia, in detecting incomplete cycloplegia, in detecting abnormalities of accommodation, and probably in determining the treatment strategy for eyes with amblyopia and deficient accommodation. PMID- 10149293 TI - Update: diagnostic concepts in open-angle glaucoma. AB - New advances aided by computerized technology have been made in the detection and quantification of glaucomatous psychophysical and optic-nerve abnormalities. The aim of all these techniques is earlier detection of intraocular pressure-related damage to the optic nerve. In addition, improvements in the sensitivity and specificity of diagnostic modalities offer the possibility to better quantitate and therefore monitor the dynamics of the glaucomatous process. These devices offer great potential for pathophysiologic investigations. However, expanded research needs to be performed prior to the clinical application of the techniques discussed in this review. The future looks promising for improved methods in the diagnosis and management of glaucoma. PMID- 10149294 TI - New aspects in the laser treatment of glaucoma. AB - Over 50 papers, appearing between October 1989 and September 1990, were reviewed. Among these, 17 were found to be of interest and 2 of outstanding interest. Structural and molecular effects and prevention of postcoagulative pressure rises are discussed under the category of argon laser trabeculoplasty. Papers concerning the size of laser iridotomies and the assessment of their success are also reviewed. A size of at least 150 to 200 mum is recommended. The majority of recommended papers concern parameters for cyclophotocoagulation, clinically and experimentally. Papers on the topic of sclerostomy include one presenting clinical results of treatment with a neodymium:yttrium-aluminum-garnet laser ab interno and another presenting experimental investigation of a partial external trabeculectomy using the excimer laser. PMID- 10149295 TI - Perfluorocarbon liquids in the management of complicated retinal detachments. AB - Low viscosity perfluorocarbon liquids have unique physical properties making them ideal for the temporary tamponade, mechanical fixation, and manipulation of the retina. These substances are optically clear, have a specific gravity greater than that of water, and have interfacial tension properties similar to those of silicone oil. The temporary mechanical fixation of the retina by perfluorocarbon liquids facilitates the removal of epiretinal membranes and release of tractional forces. Intraoperative flattening of the retina under perfluorocarbon liquid eliminates the need for a posterior retinotomy. Perfluorocarbon liquids are being used intraoperatively for hydrokinetic manipulation of the retina during vitrectomy for complicated retinal detachments secondary to proliferative vitreoretinopathy, giant retinal tears, and trauma. Additional indications for the intraoperative utilization of perfluorocarbon liquids in vitreous surgery are discussed. PMID- 10149296 TI - New laser modalities for posterior segment treatment. AB - Laser light is currently used for photocoagulation and photoresection in the posterior segment of the eye. Randomized controlled clinical trials on huge caselists, employing rigorous methodology, have confirmed the efficacy of photocoagulation treatments in numerous retinal pathologies. On the basis of the findings of these trials, precise treatment protocols have been drawn up. Nevertheless, some doubts persist on the indications and exact modalities for laser treatment in certain clinical forms. While the various treatment protocols were being defined, research was focusing on the development of new equipment that would maintain at least the same level of therapeutic efficacy as conventional apparatus while offering advantages in reliability, costs, ease of handling, and working life. An important product of this line of research is the semiconductor diode laser photocoagulator. The new frequency-doubled neodymium:yttrium-aluminum-garnet laser and the continuous wave neodymium:yttrium aluminum-garnet laser hold promise for contact photocoagulation. Photoresection is acknowledged now as an important means of dealing with vitreoretinal lesions. It provides an adequate solution in selected cases of vitreoretinal pathology and serves as a useful adjunct in conventional surgery. PMID- 10149297 TI - Management of retinopathy of prematurity. AB - During the last year, ophthalmology has continued to benefit from an ordered approach to unraveling the pathophysiology and treatment of retinopathy of prematurity. Over the last year, new incidence and treatment information from the Cryotherapy for Retinopathy of Prematurity Study has been presented. The use of the indirect laser to treat retinopathy of prematurity has been introduced. Scleral buckling and vitrectomy continue to define themselves in the management of advanced retinopathy of prematurity. Oxygen continues to be deemphasized as a solitary causative agent in retinopathy of prematurity, and other biochemical agents are being explored as playing a role in the pathogenesis and treatment. PMID- 10149298 TI - Management of posterior segment ocular trauma. AB - Ocular trauma is a leading cause of visual impairment in the United States. Despite advances in treatment, almost half the patients with posterior, penetrating ocular injuries have permanent, severe visual loss. There is controversy with regard to the optimal role and timing of vitrectomy in the management of posterior segment injuries, as well as the proper management of magnetic intraocular foreign bodies. Improvements in surgical instrumentation and technique, combined with an increased understanding of posterior segment pathobiology, continue to modify the indications for treatment. Each of these issues is discussed in light of recent contributions to the literature. PMID- 10149299 TI - New developments in curative and refractive surgery for corneal and conjunctival disorders. AB - Ocular surface diseases especially after severe lye burns are an unresolved challenge. Autologous nasal mucosa transplantation, keratoepithelioplasty, and polytef alloplastic grafting are current tools in surgical management of the ocular surface diseases. "Merest sclera" surgery is an approach in surgical management of pterygium. Procedures for refractive corneal surgery, such as epikeratoplasty, radial keratotomy, and keratomileusis, are discussed. Anterior stromal puncture technique is a surgical treatment of recurrent corneal erosions. Curative corneal surgeries are keratoplasty alone or as combined procedure. Problems of graft-failure are discussed. The new technique of excimer-laser (193 nm) elliptical keratoplasty is described. PMID- 10149300 TI - Cosmetic blepharoplasty. AB - Performing flawless cosmetic blepharoplasty surgery requires attention to many details. A proper medical work-up with establishment of patient rapport and preoperative photographic documentation should begin the evaluation. The surgical correction of concomittant brow position abnormalities should be considered. Resection of the brow fat pad is useful in recontouring bulky brows and redefining the superior sulci. Upper lid tissue resection needs to be individualized with skin resection, skin muscle resection, and lipocontouring of the suborbicularis muscle as well as with Burows triangles and "W" plasties. Lower lids may be handled by skin flap resection alone, myocutaneous flaps resection, or a combination of both. Lateral tarsal suspension avoids lower skin retraction. PMID- 10149301 TI - Visual prostheses and visual rehabilitation in low vision research, assessment, and management. AB - This review is a highly selective and personal viewpoint regarding the past year's publications in low vision clinical practice and clinical research. This article reviews and provides references on selected aspects of low vision technology, reading, pediatric considerations, visual assessment for the multiply handicapped, and the psychosocial aspects of low vision and rehabilitation. We are impressed that the wealth of current publications underscores that this is an important, productive, and growing area of research and clinical activity. PMID- 10149302 TI - Cataract surgery and lens implantation. PMID- 10149303 TI - Cataract surgical techniques and adjuncts. AB - The ophthalmologist performing cataract surgery today has a wide variety of options in terms of both surgical technique and available surgical adjuncts, which can greatly enhance the results of cataract surgery. Surgical adjuncts used both preoperatively and intraoperatively include mydriatics, pupil maintainers, oculopressor devices, viscoelastics, and intraocular irrigating solutions. Cataract surgical techniques continue to evolve, and phacoemulsification continues to increase in popularity. Hydrodissection and related techniques have become an important part of all types of extracapsular cataract surgery. In this article, we review cataract surgical techniques and the use of surgical adjuncts with an emphasis on the recent literature. Modifying surgical techniques to incorporate new developments and thus enhance results remains a distinct challenge to the ophthalmic surgeon. PMID- 10149304 TI - Intraocular lenses. AB - I have again reviewed the current state of the art in intraocular lens design in what has been a year of consolidation rather than dramatic discoveries. In foldable lenses, silicone reigns supreme, but there is the promising development of high-refractive-index foldable acrylic lenses. Heparin surface modification is now accepted as valuable in high-risk eyes, but there remains a question mark over surface passivation value. Small-incision lenses continue to proliferate with the design of new haptics to facilitate insertion after circular tear capsulorhexis. Some doubt has been raised concerning the optical qualities of ovoid lenses. Anterior-chamber myopic lenses for phakic myopic patients remain controversial. However, an increasing volume of data concerning their advantages and disadvantages is now available. PMID- 10149305 TI - Optics, refraction, and visual function. PMID- 10149306 TI - Clinical uses of corneal topography analysis. AB - Corneal topography analysis has become an indispensable tool in the evaluation and treatment of corneal disease. It is helping us understand the normal corneal shape and how it is altered in ectatic diseases, by contact lens wear, and by surgery. Topography analysis is also now being used in planning procedures to correct astigmatism and in the fitting of contact lenses. PMID- 10149307 TI - Clinical accommodation testing. AB - Clinical accommodation tests can theoretically be categorized into five different types: 1) tests of accommodative amplitude, 2) tests of relative accommodation, 3) tests of accommodative facility, 4) tests measuring lag of accommodation, and 5) tests finding the dioptric accommodative stimulus at which dioptric stimulus and response levels are equal. Studies of the interrelation of accommodation tests indicate that a complete evaluation of accommodative disorders in nonpresbyopes should include at least one test from four of the five categories. Measurements of accommodative amplitude, lag, and facility, and relative accommodation should be included. Results from the fifth type of test listed above correlate well with lag of accommodation. Recent research is bringing greater acceptance and standardization to accommodative facility testing. PMID- 10149308 TI - Recent developments in ophthalmic lasers. AB - Recent developments in the field of ophthalmic lasers include new improvements and upgrades in existing units, new laser delivery systems and new wavelengths, and new applications for treating a wide variety of ophthalmic diseases. In the field of retinal disease, the efficacy of laser treatment in diabetic edema and of panretinal photocoagulation for proliferative diabetic retinopathy have been studied. Complications related to the use of these therapeutic techniques are discussed. The diode laser, which emits at a wavelength of 810 nm, has been found to be clinically useful in the treatment of retinal disease. In the area of glaucoma, a better understanding of argon laser trabeculoplasty and peripheral iridotomy is presented, and comparisons are made with other laser systems, including the neodymium:yttrium-aluminum-garnet and diode lasers. The benefits of contact and noncontact neodymium:yttrium-aluminum-garnet lasers are discussed. In the area of corneal disease, early results from clinical trials of photorefractive and phototherapeutic applications of the excimer laser appear encouraging and suggest that this laser system will play a vital role in the treatment of a number of diseases. Finally, the neodymium:yttrium-aluminum garnet laser and argon laser are finding a role in the field of oculoplastics. PMID- 10149309 TI - Soft toric lenses. AB - Astigmatism is a common refractive error found in a large percentage of patients who wear contact lenses. Since 1979, soft toric contact lenses have been available to correct for refractive astigmatism. Most of the original soft toric lenses had the correcting optical strength on the front surface, but more recently, soft toric lenses have been designed with the correcting optics on the back surface of the lens. Back-surface toric lenses provide much more stability, comfort, and increased visual acuity. There have been a number of research articles involving soft toric contact lenses that discuss various aspects of back surface toric lenses and their advantages over front-surface toric lenses. These advantages are presented and discussed in this paper. PMID- 10149310 TI - Diagnostic concepts in open-angle glaucoma. AB - Primary open-angle glaucoma is not yet fully understood in terms of its pathophysiologic mechanisms. However, they are being addressed more completely in the recent literature. To the list of known risk factors associated with this disease, systemic influences are now being added. Primary open-angle glaucoma is becoming a much more complex disease as research uncovers associations and relationships that were previously unknown. Without knowledge of these mechanisms, the clinician is unable to adequately diagnose and treat the problem. Advances in computer-based diagnostic tools have been made, and we are now beginning to understand their value and limitations. However, whatever technology has to offer, we must always remember that the ultimate decision on initial diagnosis and further deterioration remains a clinical one. PMID- 10149311 TI - Laser treatment of glaucoma. AB - The authors review the literature published between October 1990 and September 1991 on laser treatment of glaucoma. In particular, they assess their experience and that of other authors regarding both the various types of laser (argon, neodymium:yttrium-aluminum-garnet, diode, pulsed dye, and excimer) and the application techniques (iridotomy, goniotomy, gonioplasty, trabeculoplasty, trabeculopuncture, transpupillary cyclophotocoagulation, transscleral cyclophotocoagulation, sclerostomy, suture lysis, and trabecular ablation) for the parasurgical treatment of glaucoma. PMID- 10149312 TI - Fetal echocardiography. PMID- 10149313 TI - Extracorporeal membrane oxygenation. PMID- 10149314 TI - Cardiovascular imaging. PMID- 10149315 TI - Interventional cardiac catheterization. PMID- 10149316 TI - Congenital heart surgery. PMID- 10149317 TI - Preventive cardiology: smoking, lipids and atherosclerosis, and blood pressure. PMID- 10149318 TI - Cardiac pacing for bradyarrhythmias. PMID- 10149319 TI - Electrophysiology: update on the Wolff-Parkinson-White syndrome. PMID- 10149320 TI - Catheter ablation for the treatment of cardiac arrhythmias. PMID- 10149321 TI - Echocardiography in valvular heart disease. PMID- 10149322 TI - Percutaneous balloon valvuloplasty. PMID- 10149323 TI - Results of surgical therapy for valvular heart disease. PMID- 10149324 TI - Surgery for the mechanical complications of myocardial infarction in ischemic heart disease. PMID- 10149325 TI - Surgery for valvular heart disease. PMID- 10149326 TI - Surgery on the thoracic aorta. PMID- 10149327 TI - Myocardial protection after 15 years of cardioplegia. PMID- 10149328 TI - Assisted circulation. PMID- 10149329 TI - The evaluation and management of pericardial disease. PMID- 10149330 TI - Arterial grafts. PMID- 10149331 TI - Myocardial protection and surgical technique. PMID- 10149332 TI - Relative roles of angioplasty and surgery in the treatment of coronary artery disease. PMID- 10149333 TI - Surgery for left ventricular aneurysm. PMID- 10149334 TI - Imaging and echocardiography. PMID- 10149335 TI - Efficacy of myocardial imaging in thrombolysis, risk analysis, and silent ischemia. PMID- 10149336 TI - Nuclear magnetic resonance imaging and spectroscopy. PMID- 10149337 TI - Conventional and ultrafast cine-computed tomography in cardiac imaging. PMID- 10149338 TI - Cardiac imaging in the catheterization laboratory. PMID- 10149339 TI - Aortic dissection and coarctation. PMID- 10149340 TI - Invasive assessment of ischemic heart disease. PMID- 10149341 TI - Acute myocardial infarction, special care units, analgesia, and complications. PMID- 10149342 TI - Interventional cardiology: an intracoronary update. PMID- 10149343 TI - Surgery for coronary artery disease. PMID- 10149344 TI - Cardiac rehabilitation. PMID- 10149345 TI - Ultrasound boosts growth of interventional imaging. PMID- 10149346 TI - X-ray absorptiometry in bone mineral analysis. PMID- 10149347 TI - PCs invade processing of biomedical images. PMID- 10149348 TI - Clinical cardiac MRI: the state of the art. PMID- 10149349 TI - Imaging determines cause of hemodynamic impotence. PMID- 10149350 TI - MRI asserts potential in interventional care. PMID- 10149351 TI - Biomagnetic diagnosis: is radiology ready? . PMID- 10149352 TI - Imaging devices spread more thinly in Canada. PMID- 10149353 TI - Gallstone therapy options expand beyond lithotripsy. PMID- 10149354 TI - Fitting radiology into hospital of tomorrow. PMID- 10149355 TI - Selective MRA determines origin and direction of flow. PMID- 10149356 TI - PCs integrate imaging into hospital network. PMID- 10149357 TI - MRI's impact minimal on nuclear medicine. PMID- 10149358 TI - Biocompatible MoAbs detect, stage disease. PMID- 10149359 TI - 3-D CT improves accuracy of spinal trauma studies. PMID- 10149360 TI - MRI reveals pathology in neuro Lyme disease. PMID- 10149361 TI - Piezoelectric lithotripsy offers promising results. PMID- 10149362 TI - Ultrasound succumbs to allure of contrast media. PMID- 10149363 TI - CT and MRI compete in diagnosis of CNS disease. PMID- 10149364 TI - MR nerve stimulation: new safety concern? PMID- 10149365 TI - Mid-field magnets pose high-field advantages. PMID- 10149366 TI - Expediting the purchase of new imaging devices. PMID- 10149367 TI - What's in store for imaging workstations? PMID- 10149368 TI - MRA: how it's done and what it shows. PMID- 10149369 TI - IVIM method measures diffusion and perfusion. PMID- 10149370 TI - New tools extend value of intravascular therapy. PMID- 10149371 TI - Transvaginal Doppler defines pelvic pathology. PMID- 10149372 TI - Infertility treatment relies on angiography. PMID- 10149373 TI - 3-D imaging comes to diagnostic ultrasound. PMID- 10149374 TI - Large-core breast biopsy offers reliable diagnosis. PMID- 10149375 TI - Good mammography finds postop cancer recurrence. PMID- 10149376 TI - MR effective in detecting traumatic bone injuries. PMID- 10149377 TI - Mini-PACS fit needs of cautious hospitals. PMID- 10149378 TI - MR of pituitary shows surprising variability. PMID- 10149379 TI - Transfer of technology alters imaging practice. PMID- 10149380 TI - Low-field finds niche in routine MR imaging. PMID- 10149381 TI - Three-head scanning earns new credibility for SPECT. PMID- 10149382 TI - Color Doppler depicts flow patterns in legs. PMID- 10149383 TI - MRI assists in workup of cerebral aneurysms. PMID- 10149384 TI - Color Doppler evaluates peripheral vessel disease. PMID- 10149385 TI - High-risk pregnancies benefit from Doppler. PMID- 10149386 TI - MR distinguishes among cerebral infarctions. PMID- 10149387 TI - Placental ultrasound sees changes during pregnancy. PMID- 10149388 TI - MR seeks genetic source of leukodystrophy. PMID- 10149389 TI - New imaging strategy: MRI without a magnet. PMID- 10149390 TI - New algorithms extend utility of 3-D imaging. PMID- 10149391 TI - Lithotripsy users seek answers to QA issue. PMID- 10149392 TI - IVUS explores details of venous structures. PMID- 10149393 TI - Treatment of the transplantable FANFT induced bladder tumors with the purpurin SnET2 and red light emitted by a pulsed frequency doubled Nd:YAG laser. AB - Photodynamic therapy of transplantable N-[4-(5-nitro-2-furyl)-2-thiazolyl] formamide-induced tumors engrafted onto Fischer CDF (F-344)/CrlBR rats that had been sensitized with the photosensitizer tin (ll) etiopurpurin dichloride was performed in combination with visible light (approximately equal to 660 nm) emitted by either a continuous wave argon-dye laser or a pulsed, frequency doubled Nd:Yag laser. Tumor control was assessed either by tumor dry-weight 12 days after treatment or by the palpatory absence of tumor at 60 days after treatment. Both laser sources were effective in creating the desired photodynamic effect. This study demonstrates the potential for the use of a solid-state pulsed laser for photodynamic therapy when used in combination with the tumor sensitizer tin (ll) etiopurpurin dichloride. PMID- 10149394 TI - TENS units: electrotherapy is an alternative pain-control method. PMID- 10149395 TI - Wheelchair lifts: proper selection assures user of a long-term investment. PMID- 10149396 TI - Managed care's impact on home TPN. PMID- 10149397 TI - The payer and the pea. PMID- 10149398 TI - A new bioactive bone cement: its histological and mechanical characterization. AB - We have developed a bioactive bone cement using CaO-SiO 2-P 2O 5-CaF 2 glass powders and ammonium phosphate solution, and investigated its histological and mechanical characteristics in vivo. A bone defect was drilled in proximal metaphysis of the rat tibia and filled with the bioactive bone cement in paste form or polymethylmethacrylate (PMMA) bone cement in the dough state. The cements were allowed to harden in situ. Histological examination demonstrated direct bonding between the new cement and bone by 4 weeks. The bioactive bone cement did not degrade up to 24 weeks postimplantation. The inflammatory reaction to the bioactive bone cement was less intense than the reaction induced by PMMA. Changes in the mechanical properties of the cement in vivo were studied by implanting hardened cylindrical specimens of both types of cement into the hindlimb muscles of rats for 12 weeks. The compressive strength of the bioactive cement increased significantly after implantation, and reached 68 MPa in 1 week and 73 MPa in 4 weeks. These values were comparable to those of PMMA, and were maintained up to 12 weeks after implantation. This bioactive bone cement hardens in situ within a few minutes with negligible rise of temperature and can be easily handled as a paste for filling bone cavities of different shapes. In addition, this cement has good osteoconductive and bone bonding potential and fairly high mechanical strength. Therefore, this new cement could be used both as a bioactive bone cement and bone defect filler. PMID- 10149399 TI - Collagen-immobilized hydrogel as a material for lamellar keratoplasty. AB - A transparent poly(vinyl alcohol) hydrogel disc covalently immobilized with Type I collagen, fibronectin, and an adhesive oligopeptide and preseeded with corneal epithelial cells was implanted in the rabbit cornea using a technique of lamellar keratoplasty, and the tissue response was studied by light and electron microscopy. Covalent immobilization of type I collagen on the surface of hydrogel was found to support growth and adhesion of the corneal epithelium in vitro. The in vivo experiment showed that cell seeding could prevent infection of the hydrogel. However, the implanted disc was rejected from the host cornea by epithelial downgrowth and the exchange between the seeded cells and host corneal epithelia was not observed until 14 days after surgery. The rejection might have occurred because of unsatisfactory fixation of the hydrogel to the host cornea. PMID- 10149400 TI - Concerning "Performance of the polypropylene fibre tailstring on the Copper 7 intrauterine device". PMID- 10149401 TI - The application of extracorporal shock wave lithotripter in orthopedics. PMID- 10149402 TI - The effect of event recording home infant apnea/heart rate monitoring in the greater Los Angeles area. AB - This study presents the findings of 54 infants sent home on event recording apnea/heart rate monitors over a seven month period. The average gestational age was 35 weeks. The number of referring facilities was 13 hospitals and the number of referring physicians was 41. We separated the admitting diagnostic groups into the following categories: Apnea of prematurity, apnea of infancy, apparent life threatening event, subsequent SIDS sibling, gastroesophogeal reflux, maternal substance abuse, seizure disorders, respiratory distress syndrome, bradycardia of unknown origin, bronchopulmonary dysplasia, and Pierre Robin syndrome. From March 1990 to October 1990, a period of seven months, these children were placed in our services on event recording home apnea/heart rate monitors. The average time on service for these patients was 2.90 months, (p less than .07). This data indicates that event recording home apnea/heart rate monitoring greatly decreases the length of home monitoring. PMID- 10149403 TI - New approaches to infant hearing screening. PMID- 10149404 TI - The effect of 100% oxygen on the propagation of tracheobronchial injury during high-frequency and conventional mechanical ventilation. PMID- 10149405 TI - After the learning curve: improved catheter performance in the NICU with a new technology and technique. PMID- 10149406 TI - High frequency ventilation. PMID- 10149407 TI - Reduction of iatrogenic stress in neonates through the use of novel peripheral catheter technology. PMID- 10149408 TI - Biologic variation of plasma lipids and lipoproteins. PMID- 10149409 TI - Automated hematology: comparing and contrasting three systems. PMID- 10149410 TI - Bar codes in the clinical laboratory. AB - A basic overview of bar code technology is presented with a focus on applications in the clinical laboratory. Bar codes operate based on symbology, a pattern of bars and white spaces that define alphanumeric characters. The codes are read by scanners, which may be stationary or handheld. Bar codes may be printed using any of several available methods. Bar codes are currently being implemented in several areas of health care, including materials management, clinical laboratory, pharmacy, medical records, and asset management. Planning for implementation of a bar code system is very much like computer installation, in terms of systems analysis and design, procedures, and training. Clinical laboratories should consider use of bar code systems, as they often are faster, better, and more cost-effective than available alternatives. PMID- 10149411 TI - Analysis of reticulocyte counts using various methods. AB - The precision and accuracy of manual reticulocyte counts using the Miller disc reticle, other ruled reticle and no reticle are compared with the reticulocyte results from the automated Hematrak 590 instrument. Two slides of each of 50 patient blood specimens were sent to the hematology laboratories of each of six participating hospitals. In addition to between-method comparison (precision), the manual method results using the three different counting techniques were each compared with the Hematrak results to determine if there were significant differences in reported results (accuracy). Statistical analysis revealed that the Miller disc method was the most precise and accurate manual method as compared with the Hematrak. Methods without a Miller disc reported significantly higher reticulocyte counts. Imprecision was also higher among non-Miller manual methods. By using the Miller disc, the accuracy and precision of manual methods may be increased to that of the automated Hematrak method. PMID- 10149412 TI - White blood cell counts by automated and manual methods with backlighting. AB - White blood cell (WBC) counts were compared in the presence of "backlighting" using the Coulter S-Plus Jr and a manual system. Platelet aggregates and large platelets in specimens anticoagulated with ethylenediamine tetraacetic acid (EDTA) cause interference and prompt the WBC count on the Coulter S-Plus Jr to backlight. This means that the background behind the count on the data terminal display lights up, alerting the operator to a questionable result. A total of 29 automated backlighted WBC counts of blood samples collected in sodium and potassium salts of EDTA tubes were compared with the results by hemocytometer method. Values for WBC count by both methods showed good agreement. Smear examination detected platelet clumps and large platelets in 66% of the Na 2EDTA tubes. Only low WBC counts prompted backlighting in K 3EDTA. tubes. Liquid K 3EDTA is a preferred anticoagulant for whole blood analysis because of its rapid solubility, eliminating clumping of platelets and thus backlighting. PMID- 10149413 TI - Apoprotein assays: radial immunodiffusion versus an immunoturbidometric technique. AB - The measurement of apolipoprotein using radial immunodiffusion (RID) and Cobas Bio immunoturbidometric assays is compared. Samples were obtained from 100 patients in a fiber-diet study. RID assays were performed using plates, standards, and diluent from Tago Inc. The immunonephelometric assays were performed on a Cobas-Bio with DENS program centrifugal analyzer. The correlation coefficient for the apolipoprotein Al was 0.90 and for apolipoprotein B was 0.91. The bias of the RID was to report higher values. The Cobas-Bio system affords the clinical laboratory with a reliable and cost-effective means for assessing these apolipoproteins. PMID- 10149414 TI - Identification of Candida albicans with a commercially prepared germ-tube solution. AB - A commercially prepared lyophilized substrate [Germ Tube Solution (GTS); Remel] was evaluated for its ability to support germ-tube formation as a method for identifying Candida albicans. A total of 127 distinct yeast isolates, including 57 C. albicans, tested for germ-tube formation in GTS and two other commonly used substrates (horse serum and pooled human sera). At two and four hours, 96.5% and 100%, respectively, of the C. albicans isolates produced germ tubes in GTS. Two strains other than C. albicans also produced strains included on C. stellatoideae (a known germ-tube producer) and one C. tropicalis (an organism known to produce structures resembling germ tubes). GTS produces results similar to those attained in horse serum or pooled human sera and is a suitable alternative for identifying C. albicans. PMID- 10149415 TI - Technical aspects of enzyme immunosorbent assays. PMID- 10149416 TI - Monoclonal antibody blood grouping reagents. PMID- 10149417 TI - Isolation of large numbers of fully viable human reticulocytes using continuous Percoll density gradient. AB - A rapid one-step continuous density gradient centrifugation method for the separation of reticulocytes from peripheral blood is described. Each of 27 blood samples from patients whose initial reticulocytes ranged from 2.1% to 22.8% (X = 7.6%) was subjected to Percoll density gradient separation. Reticulocyte-rich areas were found in the 1.081 to 1.092 density range. The final reticulocyte yield ranged from 73.9% to 98.6% (X = 87.0%) and a recovery of 14.8%. Optimal reticulocyte yields were obtained using centrifugation tubes with an internal diameter of 16 mm and when the tubes were spun for 40 minutes. Two indices that may be reliable indicators of final reticulocyte yield were the mean corpuscular hemoglobin concentration (MCHC). This simple and reliable method can be used to separate platelets, granulocytes, erythrocytes, and mononuclear cells. PMID- 10149418 TI - Molecular genetics diagnostic applications in oncology. AB - The use of lineage and cytogenetic probes in diagnosis of oncologic disorders is reviewed. The presence of rearranged bands via Southern blot analysis may generate diagnostic support of hematopoietic malignancy in several instances. DNA probes can be used to demonstrate clonality, reveal lineage characteristics, or identify specific chromosomal aberrations. Lineage probes detect genetic events during normal lymphocyte differentiation, while cytogenetic probes detect a malignant characteristic. The number of translocations detectable using DNA probes will likely expand in the future. PMID- 10149419 TI - Applications of molecular genetics technology for prenatal diagnosis of genetic disease. AB - Information about the studies currently available and guidelines for identifying genetics resources, both clinical and laboratory, for provision of these services is provided. Rapid progress in the field of molecular genetics has provided increased opportunities for carrier and presymptomatic testing and prenatal diagnosis of numerous genetic diseases. The development of these diverse diagnostic services creates new challenges for clinical laboratory professionals who are likely to receive requests for these studies. Crucial decisions must be made in family identification for testing and in posttesting genetic counseling. Specific case examples are presented to illustrate the potential benefits and limitations of these studies. The molecular techniques currently available provide families with highly accurate information about their genetic risks. PMID- 10149420 TI - Staphylococcus aureus identification: thermonuclease agar for direct testing of blood isolates and a new slide agglutination test. AB - Simulated blood cultures were used to evaluate Thermonuclease agar (Remel) for distinguishing Staphylococcus aureus from coagulase-negative staphylococci (CNS) without subculture to agar media, and a new slide agglutination test (Staphylochrome; Innovative Diagnostic Systems) was evaluated for its ability to distinguish S. aureus from CNS after growth on blood agar. A total of 125 S. aureus and 124 CNS isolates were tested by each method. Reference identification methods included tube coagulase, thermonuclease detection from solid media, and biochemical characterization. Direct thermonuclease testing with simulated blood cultures correctly identified all 249 isolates. Staphylochrome correctly identified 121 of 125 S. aureus and all CNS isolates. S. aureus was reliably distinguished from CNS by both tests evaluated in this study. PMID- 10149421 TI - Evaluation of the Ciba Corning 634 ISE calcium/pH analyzer. PMID- 10149422 TI - Identification of renal calculi by computerized spectroscopy. PMID- 10149423 TI - Guidelines for selection of flow cytometry instrumentation for the clinical laboratory. PMID- 10149424 TI - Simultaneous measurement of VMA and HVA in 24-hour urine samples. AB - A simple method is described for the simultaneous measurement of vanillylmandelic acid (VMA) and homovanillic acid (HVA) in 24-hour urine samples based upon isocratic high-performance liquid chromatography with electrochemical detection (HPLC-ECD). VMA was measured using VMA-SKREEN kits (Biochemical Diagnostics), a microcolumn diazo method and HPLC-ECD test method. HVA was measured using Bio Rad HVA HPLC reagent kits (Bio-Rad Laboratories) and the test method. No significant statistical difference was found in mean or variance when this method was compared with the micro-column diazo method for VMA and HPLC-ECD for HVA using the commercial anion-exchange kit. The linear regression equation for VMA was y = 0.92 x + 0.21, and for HVA was y = 1.10 x + 0.06. The Pearson correlation coefficient for VMA was r = 0.896 and for HVA was r = 0.996. This method yields results for 24-hour urinary VMA and HVA that compare well with established commercial methods. PMID- 10149425 TI - Evaluation of the Cell-Dyn 1600 in an outpatient laboratory. AB - An evaluation of the Cell-Dyn 1600 hematology analyzer (Sequoia-Turner Corporation; Mountain View, CA) was performed in an outpatient laboratory in British Columbia, Canada, to assess the analytic performance and the ease of use of the instrument. The Cell-Dyn 1600 is a three-part differential, 18-analyte instrument that requires only 30 muL of whole blood for complete analysis. It is a compact instrument with an impressive data-management package that is remarkably easy to use. The correlation study was performed using a Coulter S880 (Coulter Electronics, Hialeah, Florida) and manual differentials. Precision, carry-over, and linearity values for the Cell-Dyn provided results well within manufacturer's specifications. The two instruments correlated well as did the granulocyte and lymphocyte population comparisons. The mid-cell correlation was consistent with other studies assessing three-part differentials. Overall the Cell-Dyn 1600 is a good choice for any small or medium-sized laboratory. PMID- 10149426 TI - Sterile connecting device: advance in blood component therapy. PMID- 10149427 TI - Testing medical disposables using the Limulus Amoebocyte Lysate (LAL) test. AB - Plastic, single-use devices intended for the administration of drugs or for the removal or transfer of body fluids must be free of pyrogenic contaminants. Unfortunately, very little information is available regarding tests to detect such contaminants. For this reason, many manufacturers of medical disposables must rely on their own discretion when they devise methods for extracting these substances from their products. This article discusses the use and value of the Limulus Amoebocyte Lysate (LAL) test for estimating the concentration and extraction of bacterial endotoxins in disposable medical devices. When bioburden control procedures are applied to products manufactured to GMP requirements, batch testing of products for pyrogenicity may not be essential. PMID- 10149428 TI - Clinical and research applications of magnetic resonance imaging. AB - In medicine, as in science and engineering, magnetic resonance imaging has become an invaluable tool; in certain applications it has already become the preferred diagnostic technique. The author briefly reviews the principles of magnetic resonance as they apply to diagnostic imaging, describes several of the more important clinical applications of the technology, and discusses some areas of investigation that may lead to future medical imaging uses. PMID- 10149429 TI - Safety of medical disposables. AB - Because of the heterogeneous nature of medical disposables, it is hard to define a uniform safety standard that is applicable to all products. Although good manufacturing practice (GMP) standards outline the framework for manufacturing conditions, a coherent safety philosophy for medical disposables does not exist. This article defines safety as it applies to these products and describes the various factors that can affect product safety, including economy, design, and inadequate instructions for use. PMID- 10149430 TI - Packaging of intravenous solutions. AB - Until recently, polypropylene was not used extensively in the packaging of intravenous (i.v.) solutions. Despite the excellent moisture-barrier properties and the high purity level of polypropylene, the prevailing i.v.-solution packaging concepts are based on plasticized polyvinyl chloride (PVC), glass, and polyethylene. In the light of an article that appeared in the March/April issue of Medical Device Technology, in which Wilhelm Striepe justifies the use of PVC in the manufacture of medical products, this article looks at alternatives to PVC for the packaging of i.v. solutions. PMID- 10149431 TI - Packaging matters--part I: design of the pack. AB - Following the author's discussion of seals and seal integrity in medical packaging in the May/June issue of Medical Device Technology, this article discusses the parameters involved in the design of a pack. These parameters are discussed in relation to each integral part of the overall medical device package, from the inner pack to the shelf pack, and the conclusion is reached that a number of pitfalls could be avoided if the device and the package were designed together. Part II will deal with material selection. PMID- 10149432 TI - Plastics: will their success story continue? AB - Plastics provide many advantages that set them apart as materials for use in medical applications. However, despite these advantages, an appreciation of the environmental concerns associated with their production and disposal is vital. This article provides an overview of the position of polymers in the medical industry and the various responses that have been taken to environmental issues. PMID- 10149433 TI - Packaging matters--part II: material selection. AB - The second part of this two-part article discusses material selection for medical device packaging. Part I analyzed the design of the pack and concluded that the package and the device should be designed together. In Part II, the constraints on material choice are discussed in relation to the overall device package, and the properties that device packaging must exhibit are defined. PMID- 10149434 TI - Mr. Philippe Lambert's article, Packaging of Intravenous Solutions, in the September/October issue. PMID- 10149435 TI - Design control--the ultimate protection? AB - Over the last decade or so, medical device manufacturers with customers in the United States and the United Kingdom should have discovered the benefits of using quality systems in their manufacturing process. Both the American GMP Regulations (21 CFR-820)--enforced by the U.S. Food and Drug Administration (FDA) -and the U.K. Department of Health Guides to Good Manufacturing Practice based upon BS 5750: Part I (1979)--enforced through the National Health Service supply chain-- have been applied with the objective of ensuring the availability of safe and effective medical devices. This article examines the design control aspects of a quality system and asks whether the medical device industry should be suspicious of third-party assessments of confidential documentation. PMID- 10149436 TI - Possible replacements for CFC-propelled metered-dose inhalers. PMID- 10149437 TI - Design quality--the key to product success. AB - Design control represents the essential difference between classical and modern quality assurance. Not only the product characteristics but also the basic product quality are determined during the design phase, and it is here that costly errors affecting the ultimate success of a product are avoided. These can be self-determined activities, requiring no intervention by third parties. In this article, the author urges medical device manufacturers to ensure product quality by implementing a design control from the very inception of a product. PMID- 10149438 TI - Injecting a little automation into needle packaging. AB - Manufacturers of sterile medical devices can benefit from an automated production system. In this article, the authors describe in detail the use of a fully automated packaging operation for injection needles. In relation to the German standard DIN 13097, they advocate high-speed automation, together with observance of the Good Manufacturing Practice (GMP) code in order to attain high output, consistently high quality, and greater economy. PMID- 10149439 TI - AIS Dymer 200+ approval recommended restenosis still unsolved. PMID- 10149440 TI - New infrared system promises advances in angioplasty. PMID- 10149441 TI - Laser-induced channels promote direct myocardial revascularization. PMID- 10149442 TI - The biological effects of low power laser irradiation on cultivated rat glial and glioma cells. AB - Two cell lines were used as models to investigate the biological effects resulting from irradiation by low power lasers. One was a well-established rat glial cell line (RBA-1) obtained from the dissociated culture of normal neonatal rat (JAR-2, F-51) brain tissue. The other was a rat C6 glioma cell line obtained from a propagated culture of rat glial tumor induced by N-nitrosomethylurea. Both of them showed relatively constant cellular morphological characteristics and had steady growth and proliferation in the monolayer system. In this study, the monolayer cell culture was exposed to irradiation by various lasers at low power density in various situations. These lasers with their low energy range are used conventionally in bioregulation and acupuncture, so that their output power primarily will not cause a significant elevation of temperature of the irradiated tissue. The effects on cellular morphology, proliferation, and other functional activities after various conditions of irradiation were studied. A biostimulatory effect was noted after He-Ne laser irradiation on C6 glioma cells and was dose related. A biostimulatory effect was noted also after IR (gallium arsenide infrared) laser irradiation but was not dose related. No significant biostimulatory effects on RBA-1 cells were noted after exposure to the four types of lasers used in this study. PMID- 10149443 TI - Evaluation of photodynamic therapy in advanced gastrointestinal cancer. AB - One hundred forty-two patients with advanced gastrointestinal cancers were treated by PDT from September 1982 to December 1988. Hematoporphyrin derivative (HpD) (5 mg/kg) was given intravenously 48-72 hours before PDT. The light source was an argon dye laser with an output beam of 630 nm. The entire tumor was irradiated with a light dose of 100-250 J/cm 2. Fifteen patients (10.6%) had a complete response, 53 (37.3%) had a partial response, and 32 (22.5%) had a mild response. In all, 100 patients (70.4%) had a response to PDT. The experiments and clinical results show that the estimated energy dose (EED) value 200-250 J/cm 2 is appropriate. All patients were treated by PDT and adjuvant chemotherapy and showed good results with a follow-up of 1-5 years. Thirteen of 15 patients in the CR group are alive (86.7%), and 12 patients survived more than 2 years (8.8%). PMID- 10149444 TI - Laser trends in minimally invasive treatment: atherosclerosis, disk herniations. AB - We embarked on a project to determine the feasibility of treating carotid artery stenosis with the laser and the clinical results of recanalizing peripheral arteries as a by-product of these studies. In addition, we present a 4-year follow-up of nearly 300 percutaneous disk denaturations in sciatic pain patients. Both methods minimize traditional surgical procedures. PMID- 10149445 TI - Potential acuity meter for predicting visual acuity after Nd:YAG posterior capsulotomy. AB - The potential acuity meter (PAM) was designed to evaluate visual acuity in 22 eyes that required secondary capsulotomies. The PAM prediction was within one line in 13 eyes (59%) and within two lines in 17 eyes (77%) and had an 18% rate of falsely bad prediction (more than two lines) and 5% rate of falsely good prediction for YAG capsulotomy. In aphakic patients, however, further study is necessary. PMID- 10149446 TI - The present status of bronchoscopic Nd:YAG laser. AB - In Japan, the first bronchoscopic Nd:YAG laser applied clinically was performed in our institute 10 years ago, and based on this decade of experience, the indications, effectiveness, and limitations were studied. Between 1980 and 1989, a total of 202 cases were treated by Nd:YAG laser in our institute. Among them, 94 (46.5%) cases were primary lung cancers, 10 (5.0%) cases were primary tracheal malignancies, 56 (27.7%) cases were metastatic tracheal tumors, 6 (3.0%) cases were benign tracheal tumors, and 36 (17.8%) cases were nontumorous tracheal lesions. The indications for Nd:YAG laser therapy were defined as emergency widening of airway, curative treatment, reduction of tumor size, nontumorous benign lesions, and hemostasis. The desired therapeutic effects were obtained in 55/58 (94.8%) for emergency airway widening, 22/27 (81.5%) for curative treatment, 69/88 (78.4%) for reduction of tumor size, and 48/68 (70.6%) for nontumorous benign lesions. While performing Nd:YAG laser treatment, some limitations, such as poor residual pulmonary function, tumor size, tumor depth, cartilage structure, granulation, and stricture length, were encountered. Since bronchoscopic Nd:YAG laser treatment has become a well-established therapeutic modality for tracheobroncheal lesions, areas to be addressed in the future are the training of bronchoscopic laser therapists and research on the extension of applications. To increase the range of clinical applications, it is hoped that makers of laser systems will provide tunable wavelength machines at reduced cost. PMID- 10149447 TI - A statistical study on the use of the infrared 904-nm low energy laser on calcaneal spurs. PMID- 10149448 TI - Glaucoma Laser Trial reports encouraging early results. PMID- 10149449 TI - New approval heats up next generation of lasers in ophthalmology. PMID- 10149450 TI - Laser infrared spectroscopy opens up new diagnostic procedure. PMID- 10149451 TI - CO 2 laser conization for cervical intraepithelial neoplasia: a comparison with cold knife conization during pregnancy. AB - Intraoperative and postoperative complications related to CO2 laser conization and cold knife conization were compared. From 1980 to 1984, 66 patients were hospitalized for cold knife conization. The mean operative time was 28.1 minutes, all patients had epidural anesthesia, and the mean time of admission was 6.8 days. Three percent of cases had infections, the mean intraoperative hemorrhage was 66 ml, and the rate of remaining foci of neoplasia was 18.2%. There were 116 patients hospitalized for CO2 laser conization from 1985 to 1987. The mean operative time was 15.6 minutes, 15.5% of patients had local anesthesia, and the mean time of admission was 0.6 days. No patients had infection or postoperative stenosis, the mean intraoperative hemorrhage was 75 ml, and 29.5% of patients had remaining foci of neoplasia. There was no significant difference in hemorrhage amounts at hysterectomy after conization using either method. In the 2 pregnant patients, CO2 laser conization could be performed safely and did not affect pregnancy or delivery. Thus in our experience, CO2 laser conization is more effective for clinical diagnosis and treating of cervical intraepithelial neoplasia. PMID- 10149452 TI - Evaluation of analgesic effect of low-power He:Ne laser on postherpetic neuralgia using VAS and modified McGill pain questionnaire. AB - In order to investigate the efficacy of low-power He:Ne laser in treatment of pain, we irradiated 18 outpatients with severe postherpetic neuralgia. The efficacy of the low-power laser treatment was evaluated using a four-grade estimation, visual analog scale (VAS), and modified McGill pain questionnaire (m MPQ) after every 10 of as many as 50 irradiations. The efficacy rate using a four-grade estimation at the end of 50 treatments was 94.4%. VAS decreased from 6.2 before irradiation therapy to 3.6 after 50 treatments, and the degree of pain relief was reduced to 44.6% and correlated with the number of treatments. The total numbers of words and the total scores of the m-MPQ decreased as the number of treatments increased. No complications attributable to the laser therapy were observed. These results suggest that repeated irradiation with low-power He:Ne laser is an effective and safe therapy for postherpetic neuralgia. PMID- 10149453 TI - Microsurgical techniques in the treatment of deep seated CNS neoplasms using CO2 laser: clinical case studies. PMID- 10149454 TI - Optimum laser parameters for port-wine stain treatment. AB - The choice of suitable laser parameters is important for effective treatment of port-wine stains. The considerations in the choice of laser parameters are discussed with the aim of coagulating and sealing the abnormal blood vessels and completely denaturing the associated perivascular tissues, while confining the thermal damage to the vicinity of the abnormal vessels. A mathematical model was used to simulate the volume absorbed photon intensity in skin for argon, dye, Nd:YAG, and CO 2 lasers. The model computes the number of photons absorbed within each region, and an optimum wavelength is chosen by selecting that which has the highest absorption ratio in the blood vessel compared with absorption in the epidermis and dermis. The model further computes the input energy and the corresponding pulse duration required to seal the blood vessels and hence remove the port-wine stain. PMID- 10149455 TI - New approaches to acoustic neuroma surgery. PMID- 10149456 TI - Low-energy density CO2 laser as deep tissue stimulator: a comparative study. AB - A series of experiments on 12 pigs to verify the tissue penetrating capacity of a LED CO2 laser have been conducted to confront its effects with those of a infrared (IR) diode laser. The tissue target was the external femoral condilus of the right hind limb knee. The right knee was taken as control. After a series of laser radiations with both lasers for up to 60 days it was verified that the LED CO2 laser, contrary to what has been reported by physicists, can produce very active tissue stimulation on deep tissues with significant results. The authors suggest that the definition of physical properties of lasers should be redesigned in order to better understand their biostimulating effects on tissues. PMID- 10149457 TI - Lasers in pediatric surgery: a review. PMID- 10149458 TI - Lasers in surgical hepatology. AB - In 48 patients with various hepatic diseases high-energy laser irradiation has been used in order to provide adequate parenchymal hemo- and cholestasis. This effect has been achieved by treating the wound surface of liver with CO2 (36 patients) and YAG laser beam (8 patients) as well as tissue incision with the contact laser scalpel (4 patients). Hermetization of large vessels and bile ductules during anatomical and nonanatomical liver resection (19 patients) has been achieved by application of mechanical suturing devices. Two patients (4.2%) died after the operation. No complications connected with laser application occurred. Our experience speaks for the effectiveness of laser application in hepatic surgery as well as its usefulness in clinical practice. PMID- 10149459 TI - Effect of CO2 laser beam angle of incidence in the oral cavity. AB - In the oral cavity of white rats a series of experiments were made by CO 2 laser beam, by handpiece, micromanipulator, and an operation microscope. The authors examined the extent of the damaged tissue on the surface and in the depth of the wound. They established that in the case of 90 degrees angle of incidence--same power, exposition time and focus--the laser beam caused the deepest crater and the least damage to the surface. The decrease in the angle of incidence caused a decrease in the depth of the laser crater and increase in the surface. The 90 degrees angle of incidence CO 2 laser beam gives the optimal possibility for the precise elimination of the pathologic tissues on the surface and in the depth, without damaging the surrounding healthy structures. This operation not only protects the normal structures but also defends the physiological functions. In cases where it is not possible to apply the CO 2 laser beam at a minimum of an incidence of 60 degrees --the indirect way--the reflection has to be chosen. These aspects are important not only in the oral cavity but in other CO 2 laser operations. PMID- 10149460 TI - Effect and application of CO 2 laser beam angle of incidence on different parts of the oral cavity using oral cavity endoscopes. AB - The CO 2 laser beam caused typical "V" form defects in living tissues directed at an incidence of 90 degrees . In other cases the defects are elliptic. By decreasing the angle of incidence of the laser beam, the depth of the laser crater decreases and the healthy tissues are also damaged. The authors constructed a measuring instrument and performed geometric measurement in the oral cavity. At an incidence of 90 degrees , considered by them to be optimal, the laser beam can reach the surface of the two third parts (medial and posterior) of the oral cavity only through reflection. The authors constructed a laser endoscope with a fixed and revolving mirror. Using this device they could not only direct the laser beam to the areas of the oral cavity that are accessible with difficulty but they could also achieve a laser beam incidence always close to 90 degrees . PMID- 10149461 TI - Endoscopic turbinate photocoagulation offers hope for chronic sinusitis. PMID- 10149462 TI - Tissue pathologies uncovered by spectral analysis. PMID- 10149463 TI - MRI guides Nd:YAG laser to remove deep metastases in breakthrough surgery. PMID- 10149464 TI - Low-intensive lasers in the treatment of peptic gastric and duodenal ulcers. AB - Pharmacochemical achievements have brought about considerable improvement in treating peptic ulcers. But possible side effects demand a very cautious approach to the administration of every new drug, and stimulate the search for nontraditional treatment. In 638 patients who were treated by semiconductor laser transcutaneously (external irradiation), an average term of ulcer healing was 11.5 days, that is, half the time required for controls. The healing process under laser therapy depends on the disease gravity as well as the diameter and depth of the ulcer. Morphologically, we noted a quick restoration of microvessels in the ulcer area. The most optimal parameters of laser irradiation are chosen with the help of biophotometry. PMID- 10149465 TI - Wound healing in mice using He-Ne scanning laser. PMID- 10149466 TI - Development of low reactive-level laser therapy and its present status. AB - A new subspecialty in the medical application of the laser has developed, especially over the last decade, depending on the therapeutic rather than the surgical applications of the laser. Laser therapy, or preferably, Low reactive Level Laser Therapy (LLLT) is now being recognized as a valid medical tool. Two types of LLLT are presented, simultaneous and pure. In surgical laser applications, ranges of heat are generated in the target tissue, destroying or altering its architecture. This is referred to as high reactive-level laser treatment, or HLLT. In addition, nonphotothermally destructive reactions may also occur, such as photo-osmosis. These are also part of HLLT. Simultaneously, nondestructive thermal and nonthermal bioactivation occur at the periphery of the target tissue: this is "simultaneous LLLT" and occurs along with HLLT, explaining some of the advantages of laser surgery. Laser systems have been developed which deliver power and energy densities below the destructive level, only to activate the irradiated tissue. This is "pure LLLT." The history and background of LLLT are presented, the terminology discussed, and practical applications of LLLT are presented. PMID- 10149467 TI - Denervation of the gastric acid-producing zone by a gastric wall laser seromyotomy. AB - The application of various surgical laser devices offers the possibility for significant simplification of the technique of the selective denervation of a gastric acid-producing zone proposed by Tylor as the gastric wall seromyotomy. The application of laser technique results in decreased operative time, a wide range of surgical practice, less operative bleeding, and more reliable denervation. Operations performed in 38 patients provide a basis for recommending optimal parameters of laser energy for the gastric wall incision and reveal the advantages and disadvantages of different irradiation sources. Early results of of the operation are not worse than after the proximal selective vagotomy. PMID- 10149468 TI - Removal of epulis by CO 2 laser. AB - From analysis of the epulis patient population for 40 years, it could be established that of 1019 lesions, 12.8% relapsed, in 40% of surgical interventions, with the extraction of the tooth involved. For the removal of epulis, we have developed our own method. As a first step, the tumor is excised by CO 2 laser. Thereafter, excochleation and bone decortication are performed, followed, as a third step, by evaporation. In each case, an attempt is made at preserving the teeth. When necessary, radicular treatment and fixation are performed. Postoperatively, minimal edema and pain occurred, and the majority of the patients were able to work on the first postoperative day. Following laser removal of 63 epulides, recurrence was seen in 5 cases (7.9%) without intraoperative tooth extraction. The combined method was applied successfully also in a hemophilic patient. Besides the conventional laser surgical handpiece, an endoscope of own construction was used on surfaces untreatable by direct sight. PMID- 10149469 TI - Experiences with the CO 2 laser in the surgical treatment of intraoral salivary gland pathology. PMID- 10149470 TI - Photodynamic therapy. PMID- 10149471 TI - Intravascular ultrasound provides unique guidance tool in interventional cardiology: reimbursement remains a problem. PMID- 10149472 TI - Excimer laser corneal refractive surgery proves viable alternative to eyeglasses for myopia. PMID- 10149473 TI - Autofluorescence for bronchial imaging. PMID- 10149474 TI - Infants with port wine stains respond to pulsed dye laser. PMID- 10149475 TI - The CO 2 laser in clinical surgery: past, present, and future. PMID- 10149476 TI - A light-diffusing device for intraoperative photodynamic therapy in the peritoneal or pleural cavity. AB - Light delivery to anatomic areas involved by tumor is critical for effective photodynamic therapy. The authors provide a detailed overview of a light diffusing device which they have used for intraoperative illumination of the peritoneal and pleural cavities in patients with tumors involving the surfaces of these cavities. Their device represents an inexpensive modification of widely available endotracheal tubes. It has been used to deliver intraoperative photodynamic therapy in over 50 patients without episodes of device failure. When combined with a lipid-based, light-diffusing medium and on-line power/energy density monitoring, it allows homogeneous illumination of these complex surfaces. PMID- 10149477 TI - New directions in the role of laser-tissue interaction modeling and feedback control. PMID- 10149478 TI - The immediate effects of different light doses for photodynamic therapy of endobronchial tumors. AB - The immediate effects of different power densities and light dosages were determined on 77 sites of endobronchial tumors in 28 patients. All received 2 mg/kg of dihematoporphyrin ether 2 days prior to photodynamic therapy (PDT). Light (630 nm) was delivered with a tunable dye laser system through quartz fibers modified at the delivery end to disperse the light perpendicular to the axis of the fiber. The degree of obstruction, tumor consistency, edema, exudate, bleeding, amount of relief of obstruction, and complications were estimated before and at the end of treatment and toilet bronchoscopy. The authors found no difference in the effect of power densities of 400 mW/CF or 500 mW/CF when compared to the same total light dosage. However, 700 mW/CF produced coagulation of fibrin collection on fibers. By the end of the treatment, bleeding tumors did not bleed enough to prevent removal, although they were bleeding prior to PDT. The only complication during or after the increased light dosages was the formation of exudate. Hard tumors became soft and edematous by the end of the treatment permitting immediate removal of some tumors. At the time of discharge, the authors achieved greater than 50% reduction of obstruction, that is, complete and partial responses, in 64% of the patients with 200 J/CF, 71% with 300 J/CF, 82% with 400 J/CF, 77% with 500 J/CF, and 100% with 700 J/CF. Overall, they observed a 74% response, again, complete and partial response, at discharge. PMID- 10149479 TI - Lasers in oral surgery. PMID- 10149480 TI - Separate and combined use of Nd:YAG and carbon dioxide lasers in oral surgery. AB - The experience obtained with 789 laser interventions used in oral surgery is summarized. In the first group, 756 patients were operated on by CO 2 laser, in the second, 17 were treated with Nd:YAG laser, and in the third, 16 were treated simultaneously with both types of lasers. Among the outpatient interventions performed under local anesthesia were 233 precancerous conditions, 491 benign tumours, and 65 other lesions. Following CO 2 laser interventions, the zone of the irreversible tissue damage did not exceed 300 mum in the instance of high energy cutting; it was almost 1 mm following Nd:YAG laser cutting, and it was 500 mum when cut by a combined laser beam. The precancerous conditions can successfully be treated by CO 2 laser, especially by evaporation. The Nd:YAG laser leaves a broad necrotic zone. The combined application, however, is highly advantageous to treat vascular lesions and markedly hemophilic structures/hemangioma, epulis, tongue resection, and so forth. In oral surgery the combined use of the CO 2 and Nd:YAG laser beams is extremely beneficial due to their excellent hemostatic effect. PMID- 10149481 TI - Red and green low-powered He-Ne lasers protect human erythrocytes from hypotonic hemolysis. AB - The effect of low-powered He-Ne lasers (red beam, 632.8 nm, 10.2 mW, and green beam, 543.5 nm, 0.44 mW) on hypotonic hemolysis in human red cells was investigated. Red cell solutions (0.9% NaCl, pH 7.00) were centrifuged and the sediments were irradiated with the red or the green beam for 0 (control), 1, 3, 5, 7, 10, 15 and 30 minutes. Each of the 40 irradiated samples were transferred into hypotonic solution (0.405% NaCl, pH 7.00). After leaving the samples at room temperature for 10 minutes, optical density of every suspension was measured spectrophotomechanically at a wavelength of 545 nm to determine hemoglobin content. Hemolysis percentages of the control samples in hypotonic solution were 52.2 +/- 10.7% (mean +/- SD, N = 20) in the red group and 55.0 +/- 12.0% (N = 20) in the green group. Relative values of hemolysis in the hypotonic solution after irradiation with the red or the green beam decreased significantly between the 7- and 30-minute irradiation. These results demonstrate that low-powered He-Ne lasers have a protective effect on red cell membranes from hypotonic hemolysis and stabilize the cell membranes. PMID- 10149482 TI - Photodynamic therapy for early stage lung cancer. PMID- 10149483 TI - Perfusion for paediatric open-heart surgery. PMID- 10149484 TI - Current priming solutions for cardiopulmonary bypass contain a potent coronary vasodilator. AB - We studied the effects of acetate (Ac), the buffer in crystalloids used during cardiopulmonary bypass (CPB) (e.g. Normosol-R and Plasma-Lyte, Ac = 27mEq/l), on coronary resistance (R) for the empty beating heart, and on vascular resistance (SVR) of 19 dogs on CPB. Control R with Ac = O (R c) was obtained by adjusting flow to give a pressure of 90 +/- 10mmHg (R = 532 +/- 32 dynes sec/cm 5g, other Rs are given as a percentage of their respective R c). Continuous addition of Ac = 1.6 or 7.1mEq/L of blood resulted in a rapid decrease in R to 34 +/- 3 and 17 +/- 2% of R c, followed by a recovery to higher steady values of 53 +/- 3 and 27 +/- 2% respectively (p less than 0.008). A bolus administration of 2mEq and 6mEq into the coronary circuit resulted in R dropping to 30 +/- 5 and 17 +/- 6% respectively. Rs obtained with Ac were compared to the Rs obtained for control 20sec reactive hyperaemia (35 +/- 1%), after 30 minutes global ischaemia (14 +/- 1%), and with the addition of bicarbonate (98 +/- 2%). Ac did not change heart rate, but caused an increase in O 2 consumption from 3.4 +/- 0.4 to 4.8 +/- 0.7 ml/min/100g, (p less than 0.038). Systemically, a bolus of 6mEq of Ac caused an immediate drop in SVR to 45 +/- 5% of control. The property of Ac as a potent coronary and vascular dilator may need to be considered when Ac is used during cardiac surgery. Statistical comparisons were made with the paired t-test. PMID- 10149485 TI - Comparison of hollow fibre membrane oxygenators during cardiopulmonary bypass in children: Dideco Masterflo versus Terumo Capiox II. AB - This prospective study was planned to compare two different (reversed blood and gaseous compartments) hollow fibre membrane oxygenators, Dideco Masterflo and Terumo Capiox II, in order to find out which of these oxygenators was less injurious during cardiopulmonary bypass (CPB) surgery in small children. Twenty children underwent CPB surgery for complex congenital cardiac malformations. Ten patients were selected for each study group by matching age and weight. Oxygenators were the only variables in the CPB circuit, and special attention was focused on the kinetics of white blood cell count (WBC), complement C3, anaphylatoxin C3a, total haemolytic complement (CH100), C-reactive protein (CRP) and haptoglobin. There were no significant differences between the parameters studied at any sample time. However, there was less intense C3a (peak C3a levels 2506 +/- 1187 SD versus 4302 +/- 3958 SD; p = 0.19) generation, and also less intense CH100 consumption (percentual drop of initial CH100 values was 30% versus 55.2%) in the Dideco Masterflo group of patients. Moreover, postoperative respiratory treatment was somewhat shorter when using Masterflo oxygenators (2.4 +/- 2.41 SD versus 4.0 +/- 2.49 SD days; p = 0.16), although statistical significance was not obtained. These findings may be important in high-risk paediatric patients undergoing open-heart surgery. PMID- 10149486 TI - In-vitro evaluation of neonatal ECMO cannulae with regard to flow characteristics. AB - One of the crucial points in a neonatal ECMO circuit is to obtain adequate venous drainage from the cannula in the right jugular vein, as the vessel diameter limits the size of cannula that can be used. For this reason the design of the cannula is of utmost importance. The aim of this paper was to compare different commercially available ECMO cannulae, and to try to find the cannula which had the best flow characteristics. Venous cannulae were evaluated with regard to maximum drainage capacity at different hydrostatic levels. For arterial use, pressure drop over the cannulae at different flow rates was measured. Of the cannulae studied, those from Biomedicus and Elecath had the best flow characteristics for both venous and arterial use. PMID- 10149487 TI - Evaluation of a range of extracorporeal membrane oxygenators. PMID- 10149488 TI - Biomedical engineering management of Novacor left ventricular assist system (LVAS) patients. AB - As the number of cardiac transplant centres increases, there is an associated decrease in the availability of donor organs per centre. Subsequently, hospitals are utilizing cardiac assist systems (total artificial heart and ventricular assist devices) as a bridge to cardiac transplantation. Because of the engineering complexities related to the clinical implantation and follow up of these devices, a successful centre should have a well co-ordinated biomedical engineering programme. These engineers are responsible for the calibration, monitoring, and continued operation of these units. This paper is intended to serve as a guide to any centre interested in utilizing total artificial heart and ventricular assist systems, in particular the Novacor left ventricular assist system, and focuses on the management and function of the biomedical engineering component of our cardiac assist programme. PMID- 10149489 TI - Devices and monitoring during neonatal ECMO: survey results. AB - A survey of active ECMO centres regarding neonatal ECMO equipment and personnel was obtained by telephone interview in late summer 1989. Forty-seven of the centres in the USA listed in the Ann Arbor ELSO (Extracorporeal Life Support Organization) Registry at the time ( greater than 90%) were contacted and all participated. Nearly all use a roller pump, while less than 5% use a centrifugal pump. All programmes use a SciMed membrane oxygenator and 90% a SciMed heat exchanger. Heat exchanger water sources include the Gaymar T-pump (42%), Seabrook (25%) and Cincinnati Sub-Zero (23%) units. Eighty-seven per cent use a bladder box servo-regulated to the roller pump; these are most often custom-made (69%) but 13% of programmes use a commercially available (Seabrook) bladder box. Ten per cent use a pressure-regulated roller pump rather than a conventional (displacement) bladder box to detect decreases in venous return. Nearly 80% monitor circuit line pressures between the pump and patient. Seventeen per cent use an air bubble detector on the arterial side of the circuit. Only 10% use an arterial bubble trap and 6% an arterial line filter. Seventy-five per cent do not monitor gas line pressures into the membrane lung, but one-third do use a gas line pop-off valve to prevent elevated gas phase pressures. Seventy per cent reported use of continuous in-line measurement of mixed venous oxygen saturation; no programme reported any blood chemistries being monitored in line.(ABSTRACT TRUNCATED AT 250 WORDS) PMID- 10149490 TI - The use of cardiopulmonary bypass with profound hypothermia and circulatory arrest during the surgical treatment of giant intracranial aneurysms. AB - The surgical treatment of giant intracranial aneurysms can be aided by using cardiopulmonary bypass to provide hypotension under hypothermic conditions. Cardiopulmonary techniques need to be modified to deal with the problems that arise during this type of neurosurgery. PMID- 10149491 TI - Evaluation of the Sorin Monolyth membrane oxygenator. PMID- 10149492 TI - Extracorporeal membrane oxygenation (ECMO): prolonged bedside cardiopulmonary bypass. PMID- 10149493 TI - Cardiopulmonary bypass with low systemic heparinization: an experimental study. PMID- 10149494 TI - Surface tension effects of heparin coating on arterial line filters. AB - An investigation was conducted to determine the effects that heparin-coated screen arterial line filters have on the surface tension of cardiopulmonary bypass (CPB) priming solution. Five brands of non-heparin coated arterial line filters (Bard H625, Bentley AF1040, Intersept 40mum, Pall EC3840 and Pall SP3840) and four brands of heparin-coated filters (Bard H640, Bentley AF1040C and AF1040D and Intersept 40mum) were tested in a closed-loop circuit containing two litres of Plasma-Lyte A and pumped at a rate of five litres per minute. Samples were collected at 0.5, 20, 60 and 120 minutes to determine the surface tension of the recirculated solution. The non-heparin coated arterial line filters showed no significant changes in surface tension, either between the individual groups or over time. The benzalkonium-heparin coated filters (Bard H640, Bentley AF1040C and Intersept 40mum) all showed significant decreases in surface tension when compared to zero circulation time or to the noncoated groups. The largest drop in surface tension occurred within the first five minutes of recirculation. The circuit with a Bentley AF 1040D (a new nonbenzalkonium process) coated filter showed no significant change in surface tension. PMID- 10149495 TI - Supportive angioplasty utilizing the Bard cardiopulmonary support device. PMID- 10149496 TI - Mediastinal autotransfusion. PMID- 10149497 TI - Postoperative autotransfusion of mediastinal blood: a review. PMID- 10149498 TI - Correlation of preoperative factors, severity of disease, type of oxygenator and perfusion times with mortality and morbidity of coronary bypass. AB - Previous studies have related preoperative status and severity of disease to the outcome of coronary artery bypass surgery. Although increased perfusion and clamp times increase the risk of cardiac surgical procedures, the importance of these factors in relation to the patient's preoperative condition and the severity of disease has not previously been determined. In this study of 1078 patients, we examined the correlation between the patient's preoperative condition, the severity of coronary disease, and duration of perfusion and clamp time, and the type of oxygenator used with the mortality and morbidity associated with coronary artery bypass grafting. One-way analysis of variance and multiple correlation analysis showed that perfusion time, clamp time and nonclamp perfusion time correlated with mortality, perioperative infarction, the use of intra-aortic balloon pump, stroke, renal failure, pulmonary failure, infection, and leg wound complications (p less than 0.05). Perfusion time, clamp time and nonclamp perfusion time did not correlate with postoperative bleeding or sternal wound complications. Nonclamp perfusion time correlated more strongly than any other factor with mortality, perioperative infarction, the use of intra-aortic balloon pump, renal failure, pulmonary failure and infection (p less than 0.05). Clamp time correlated more than any other factor with the development of leg wound complications (p less than 0.05). The use of a bubble rather than a membrane oxygenator was significantly related to mortality, stroke, infection and leg wound complications by one-way analysis of variance (p less than 0.05).(ABSTRACT TRUNCATED AT 250 WORDS) PMID- 10149499 TI - A successful modification of ultrafiltration for cardiopulmonary bypass in children. AB - Total body water (TBW) is increased after cardiopulmonary bypass (CPB) resulting in tissue oedema and organ dysfunction. Ultrafiltration has been used to reduce this accumulation of water, although conventional ultrafiltration seemed ineffective in reducing the rise in TBW after CPB in our clinical experience. We describe a modified technique in which ultrafiltration is performed in the first 10 minutes after the patient is weaned from bypass, returning nearly all the blood in the circuit to the patient and elevating the haematocrit (Hct) to any predetermined level. We carried out a pilot study on 21 children aged 4-144 months undergoing open-heart surgery and CPB for congenital heart defects. They were divided into three comparable groups: (1) controls (n = 6); (2) conventional ultrafiltration (n = 7); and (3) modified ultrafiltration (n = 8). TBW (bio-impedance), Hct, osmolality, mean corpuscular volume and mean corpuscular haemoglobin concentration were recorded at frequent intervals. Control patients showed elevation of TBW by 18.2% median (range 14.5-20.3), conventional ultrafiltration by 12.4% (7.9-15.0), modified ultrafiltration by 5.7% (4.5-7.1) (p less than 0.0001 compared to controls, p. less than 0.005 compared to conventional ultrafiltration, Mann-Whitney U test). Hct could be elevated to preoperative levels only by the modified method. Mean corpuscular volume, and mean corpuscular haemoglobin concentration osmolality were unaltered. Ultrafiltration by the modified method was more effective than conventional ultrafiltration in reducing the rise in TBW and elevating Hct after CPB. PMID- 10149500 TI - Blood salvage for cardiovascular surgery. AB - Intraoperative blood salvage produces safe and clinically effective red cells. Intraoperative salvage for cardiovascular surgery procedures can be expected to cause a substantial reduction in the use of homologous red cells in patients requiring redo operations, and repair of complex aortic aneurysms. The procedure per se will have very little impact on the use of other blood components such as platelets or plasma. For carefully selected patients, autologous perioperative or intraoperative collection of these components should also be considered. The primary risks of intraoperative blood transfusion include washout of clotting proteins and platelets, infusion of undesirable constituents (such as antibiotics and haemostatic agents added during the surgical procedure) and air embolism. Intraoperative autologous transfusion is only one part of an effective programme to minimize homologous transfusion. Equally important is the use of preoperatively donated blood, the use of effective and safe pharmacological agents to enhance haemostasis and haematopoiesis, a conservative approach that allows only the transfusion of blood components absolutely necessary, and, when possible, the elimination of anticoagulant and antiplatelet therapy several days prior to the cardiovascular surgical procedure. PMID- 10149501 TI - Haemofiltration during cardiopulmonary bypass. PMID- 10149502 TI - A new method for crystalloid cardioplegic oxygenation. AB - A new model of in vitro cardioplegic oxygenation was evaluated by placing Ringer's infusion bags in a pressure resistant barrel filled with pure oxygen maintaining 380mmHg. In this hyperbaric environment, oxygen gradually diffused directly through the wall of the infusion bag reaching a concentration exceeding four volumes percent after 96 hours. Decay in oxygen content was less than 1.5% after one week refrigerated at 4 degrees C. In conclusion, the method described above offers an alternative approach to cardioplegic oxygenation, with the advantage of being safe, simple and without any extra expenditure. PMID- 10149503 TI - Oxygen transfer efficiency of three microporous polypropylene membrane oxygenators. AB - The purpose of this investigation was to compare the oxygen transfer efficiency of three different membrane oxygenators, each utilizing microporous polypropylene as its gas transfer material. Gross oxygen transfer was compared for each membrane with their performance when differences in surface area were taken into account. It was found that when hollow fibres were used, with blood flow around the fibres, efficiency was maximized. Our study technique offers an additional objective approach in the evaluation of oxygen transfer for membrane oxygenators. PMID- 10149504 TI - In vitro and in vivo evaluations of the antithrombogenic properties of the spiral vortex pump for temporary left heart bypass. AB - From conception to realization, the design emphasis of the spiral vortex diaphragm pump has been on promoting efficient blood flow patterns in order to lower thrombogenicity. The tracer method was used to visualize flow patterns in this pump and the results were compared with those of a conventional diaphragm pump with paraxial inlet and outlet ports. During diastole, the flow through a 45 degrees angled inlet is tangential to the axis of the pump forming a continuous vortex central along the pump axis. During systole, the vortex converges to pass through the apically located outlet. No areas of turbulence or stasis could be found, whilst in the conventional pump only random flow with recirculation could be demonstrated. Dye washout tests confirmed good washout at the periphery of this pump with no signs of stasis. However, large areas of stagnation with incomplete washout at diaphragm-housing (D-H) junctions were observed in the conventional pump. The comparative in vitro haemolysis test revealed that the level of free plasma haemoglobin was doubled in a commercially available pump compared with that of the spiral vortex pump. No thrombus formed within the pump housing after up to 50 hours of pumping in five acute animal experiments without postoperative anticoagulants. However, thrombi were found at the D-H junction of this pump due to imperfect fabrication techniques in one of the four sheep that survived 14-21 days.(ABSTRACT TRUNCATED AT 250 WORDS) PMID- 10149505 TI - Evaluation of a range of extracorporeal membrane oxygenators. PMID- 10149506 TI - Extracorporeal membrane oxygenation in the 1990s--a personal view. PMID- 10149507 TI - Logistics of an ECMO programme. PMID- 10149508 TI - Thoracic organ preservation. AB - Clinical heart transplantation began in December 1967 when Cristiaan Barnard performed the first human to human heart transplant on a 57 year old man with ischaemic heart disease, in Cape Town. This ushered in a bout of enthusiastic heart transplantations world-wide over the subsequent few years which soon waned as the problems of acute rejection and infection became apparent to those who had embarked on this venture without fully understanding the complications. The importance of a well functioning donor heart cannot be overemphasized. Early donor heart failure accounts for approximately 26% of the deaths of heart transplant recipients today and there is also a steep rise in acute mortality associated with storage times in excess of two hours (9.8% less than 2 hours rising to 17.6 greater than 4 hours), although satisfactory function has been reported in a few hearts stored for up to 6 hours. Careful selection and meticulous management of the donor, followed by optimal storage, are therefore essential to a satisfactory outcome. There is evidence that some of the problems of organ preservation are related to metabolic changes in the donor consequent upon brain death and recent ongoing studies by our own group show some benefit from hormone replacement therapy in the donor. There are essentially two major approaches to the problem of organ storage; metabolic inhibition resulting in reduced substrate requirements, and the supply of metabolic requirements, or a combination of both. Although nonperfusion methods currently predominate, the simplicity of these methods are overshadowed by the short safe time interval which they allow and the variable functional quality which results. The author believes that perfusion preservation methods will predominate in the future and may also allow expansion of the donor pool by whole donor and/or ex vivo thoracic organ resuscitation. PMID- 10149509 TI - Support perfusion for liver transplantation. AB - Addenbrooke's Hospital, Cambridge, UK, has had an ongoing orthotopic liver transplant programme since 1968. Various support bypass techniques have been used intermittently since 1977. In 1990 bypass was needed for 38% of adult liver transplants, and bypass standby was provided for a further 25%. Adult liver recipients (high-risk) are selected for bypass in accordance with a number of surgical and anaesthetic criteria in order to maximize patient benefit and minimize risk. Before the start of the operation two cannulae (8 or 10 Fg) are placed into left and right internal jugular veins and/or the left brachial vein for rapid volume replacement. Femoral and portal vein cannulation (16 to 22 Fg) can quickly be achieved for splanchnic venous drainage to a heparin coated Biomedicus bypass system. This technique provides flows of 1.5 to 2.5 litres per minute with modest perfusion pressures (around 120mmHg) and provides adequate surgical venous decompression and circulatory support during the anhepatic phase. PMID- 10149510 TI - Clinical experience with heparin-coated cardiopulmonary bypass circuits. AB - The extensive area of contact between blood and synthetic surfaces during cardiopulmonary bypass results in the activation of the kallikrein, the complement and the clotting and fibrinolytic systems. This results in white cell activation and a whole body inflammatory response. Pulmonary neutrophil sequestration is also known to occur during cardiopulmonary bypass and has been associated with pulmonary damage. This has been previously demonstrated using the technique of differential neutrophil counts in simultaneous venous and left atrial samples. The efficacy of retinal fluorescein angiography as an indicator of cerebral microembolism has also been proved in previous studies. The objectives of this study were to determine whether heparin precoating with Duraflo II reduced pulmonary neutrophil sequestration, retinal microembolism and postoperative blood loss. Fourteen patients were randomized into two groups using either heparin-coated or nonheparin-coated cardiopulmonary bypass circuits. The preliminary results suggest a reduction in pulmonary neutrophil sequestration (p greater than 0.05) and the generation of thrombin antithrombin complexes (p less than 0.05). Retinal microembolism was not significantly different in the two groups nor was the postoperative blood loss. Thus, heparin-coated cardiopulmonary bypass circuits do not reduce pulmonary neutrophil sequestration, retinal microembolism or postoperative blood loss. PMID- 10149511 TI - Blood cardioplegia. PMID- 10149512 TI - Use of a heat exchanger in liver transplantation. AB - Of the first 16 patients who underwent orthoptic liver transplantation, 81% were observed to be hypothermic at termination of bypass (x = 34.5 degrees C, n = 16). In response, an in-line heat exchanger was added to the bypass circuit. Subsequently, 72% of the next 11 patients terminated bypass normothermic (x = 38.2 degrees C, n = 11). By removing from the sample those patients who incurred low blood flows, 100% of the patients terminated bypass normothermic (x = 38.2 degrees C, n = 8). At temperatures of 30-33 degrees C cardiac arrhythmias have been observed. Hypothermia has been documented to cause thrombocytopenia and neutropenia which can lead to blood loss. These low counts are only partially reversible with platelet infusion and white blood cells (WBC). The use of an in line heat exchanger during liver transplantation is essential in preventing hypothermia in our experience. PMID- 10149513 TI - Development and current status of a new intracorporeal membrane oxygenator (IVOX). AB - The IVOX (intravascular oxygenator) is an intracorporeal, hollow-fibre membrane oxygenator and carbon dioxide (CO 2) removal device. The IVOX is surgically placed into the vena cava via a femoral or jugular venotomy. Oxygen (O 2) is pulled through the hollow fibres by a vacuum pump controlled by a flow meter. There is no extracorporeal circulation of blood. Gas exchange occurs as the patient's blood flows over several hundred hollow fibres. Inlet and outlet gas conduits exit a small skin incision for inflow of 0 2 and outflow of CO 2. Studies in sheep show that the IVOX can support approximately 30% of gas exchange requirements. The position of the IVOX in the vena cava does not affect haemodynamics or cause thromboembolic complications. It can remain in place for up to 22 days without affecting haematologic or blood chemistry parameters. The IVOX is currently undergoing clinical trials at selected medical centres in patients with acute respiratory failure. PMID- 10149514 TI - Comparison study of the Hepcon System Four and the Hemostasis Management System. AB - Milwaukee Heart Surgery Associates, in affiliation with St. Mary's Medical Center, were asked to be clinical investigators for a comparison study of the current Hepcon System Four (HSF) and the next generation Hemostasis Management System (HMS) manufactured by HemoTec, Inc. The HSF has been in place at St. Mary's Medical Center for the past three years in a programme that performs approximately 900-1100 cardiac procedures a year. Heparin assays and high range activated clotting times (HR-ACTs) are performed routinely on all patients placed on cardiopulmonary bypass (CPB). This study will evaluate the results based upon the two systems run in tandem on a series of patients undergoing cardiac surgery with no exclusions, i.e. valve repair or replacement and myocardial revascularization. The study sets out to determine whether or not the new generation HMS has any distinct advantages over the HSF and whether it is or is not suitable for this clinical setting. PMID- 10149515 TI - Complications of retinal laser therapy and their prevention. PMID- 10149516 TI - Filtering surgery with lasers. PMID- 10149517 TI - Combined trabeculectomy and phacoemulsification. PMID- 10149518 TI - Ciliodestructive surgery. PMID- 10149519 TI - Clinical applications of corneal topographic analysis. PMID- 10149520 TI - Electrophysiological evaluation of children with visual impairment. PMID- 10149521 TI - MRI and CT in pediatric ophthalmology: a guide to their use. PMID- 10149522 TI - Pediatric penetrating keratoplasty. PMID- 10149523 TI - Biocompatibility of apheresis harness. PMID- 10149524 TI - Effectiveness of lymphocytapheresis in a patient with ankylosing spondylitis. AB - Immunomodulation by lymphocytapheresis (LCA) was carried out in a patient with ankylosing spondylitis (AS) who suffered severe pain in joints and back. LCA was performed once a week and 3 x 10 9 lymphocytes were extracted each time. Fifteen courses of LCA were completed. The joint score was gradually decreased and the improvement was maintained 11 months after treatment. The population of NK cells detected by Leu-7 and Leu-11 monoclonal antibodies decreased and HLA-DR positive CD3 cells increased during and after the treatment. The effectiveness of LCA in AS may confirm the participation of immunological mechanisms in the pathogenesis of AS. PMID- 10149525 TI - Screening blood products for HTLV-I: what is the best approach? AB - A recent concern for disease transmission by blood transfusion is T-lymphotropic virus type I (HTLV-I). This virus is endemic in Japan, the Caribbean basin, subsaharan Africa, and, to a lesser extent, the southeastern United States and parts of Central and South America. HTLV-I, which has been shown to be transmitted via transfusion, is associated with adult T-cell leukemia (ATL) and certain degenerative neurological disorders. Antibodies to HTLV-I, an indicator of exposure to the virus, have been demonstrated in 0.025% of healthy U.S. donors. This study, using the Decision Tree Model, presents an approach to a donor screening policy which should be cost-effective and yet ensure a safe blood supply. PMID- 10149526 TI - Bone marrow processing on the Haemonetics V50 cell separator. AB - We have processed 27 bone marrow (BM) harvests using the Haemonetics V50 cell separator with a paediatric plasmapheresis set and programmed for lymphocyte collection. The mean starting volume of 843 mL was processed in 6-8 cycles to a buffy coat (BC) with a mean volume of 230 mL. The mean starting mononuclear cell (MNC) count was 1.22 x 10 8/kg recipient weight, and recovery was 92%. Clonogenic potential of the BC was assessed using CFU-GM assays and recovery was measured after cryopreservation or purging. On 4 occasions where major ABO incompatibility existed between donor and recipient, both BM and BC were consecutively diluted in compatible blood and processed twice. This achieved a calculated reduction in donor erythrocytes of 98%. The procedure was efficient and yielded a BC fraction suitable for cryopreservation and purging. Adequate stem-cells were retained as verified by CFU-GM assays and documentation of stable engraftment. PMID- 10149527 TI - An attempt to prepare hepatitis B virus (HBV)-free plasma by ultrafiltration using microporous regenerated cellulose hollow fiber. AB - Hepatitis B virus (HBV) can be effectively removed from HBV-positive plasma by filtration with a Bemberg Microporous Membrane (BMM) with a pore size of 30 nm or less, however considerable amounts of macromolecular IgM and Factor VIII are trapped in the BMM. We report that HBV-free plasma with adequate amounts of all of the plasma proteins can be obtained by double filtration with a BMM with a port size of 50 nm. Thus it may be possible to remove HBV or other transfusion associated viruses from plasma by BMM filtration with good recovery of all of the plasma components. PMID- 10149528 TI - New strategies for plasma exchange in systemic vasculitis. AB - The use of plasma exchange in the treatment of systemic vasculitis has been controversial and poorly defined. Since the discovery of anti-neutrophil cytoplasm antibodies (ANCA) and the demonstration of their specificity for systemic vasculitis, there has been a reassessment of the use of plasma exchange along the same lines as its use in anti-glomerular basement membrane disease. ANCA has also contributed to the diagnosis and classification of rapidly progressive glomerulonephritis, in which there is now firmer evidence to support the use of plasma exchange. Current work into the immunoregulation of ANCA by idiotype/anti-idiotype interactions is leading to new approaches to therapy and plasma exchange alone appears capable of inducing prolonged remission in some patients with vasculitis, possibly through an effect on these interactions. PMID- 10149529 TI - Hemapheresis and hemorheology. PMID- 10149530 TI - Hazards of apheresis and the U.K. approach to guidelines. PMID- 10149531 TI - The German approach to apheresis guidelines. PMID- 10149532 TI - The French approach to therapeutic haemapheresis guidelines. PMID- 10149533 TI - The French approach to donor apheresis guidelines. PMID- 10149534 TI - One American approach to apheresis guidelines. PMID- 10149535 TI - Apheresis guidelines from the nurse/operator viewpoint. PMID- 10149536 TI - Autologous blood stem cell transplantation in myeloma. PMID- 10149537 TI - Biocompatibility of extracorporeal immunoadsorption systems. AB - Following the first publication of a technique aiming for clinical application in 1969, extracorporeal immunoadsorption is increasingly finding a place among haemapheresis techniques. The apparent advantages outweigh the technical difficulties and economical drawbacks still connected with this treatment modality. At present three different developments are under clinical investigation: Staphylococcus Protein-A based immunoadsorption (SpA), the antibody-mediated adsorption (therapeutic affinity chromotography) and hydrophobic interaction-based immunoglobulin adsorption. The exact binding capacity and mechanism has not been completely elucidated for SpA and amino acid based techniques. The lack of knowledge about pathogenic substrates exclusively responsible for the pathogenicity of many diseases, appears to be the major drawback for the prospective development of affinity chromatography-based extracorporeal systems. The practical application of molecular-biologic diagnostic procedures with a high grade of detection specificity (monoclonal antibodies) appears to be promising for the development of extracorporeal immunoadsorption. The immunomodulatory effect that results from the interaction of blood and plasma with artificial surfaces is an interesting subject of investigation, derived mainly from biocompatibility studies. The careful clinical and laboratory investigation of the biocompatibility of extracorporeal immunoadsorption systems contribute considerably to the prevention of undesired side effects. PMID- 10149538 TI - Evaluation of the Organon Teknika Plasmapur system with new software and two types of filter. AB - A convenient plasmapheresis apparatus is the Plasmapur system (Organon Teknika). Recently the software of the Plasmapur monitor has been changed. We evaluated the modified Plasmapur monitor and two types of Plasmapur separators containing polypropylene membranes with a mean maximum pore size of 0.5 mum and 0.6 mum respectively. 50 plasmaphereses with each separator were performed; during 10 procedures donor blood samples and samples from the plasma obtained were drawn. No hypersensitivity reactions were observed, the operator "hands on" time was less than 5 min, the mean procedure time was 45 min to collect 650 mL of plasma with both types of filters. Biochemical analysis of the samples indicated that with both separators the plasma obtained was of good quality with respect to Factor VIII and other proteins and that no significant activation of the complement or clotting cascades occurred. PMID- 10149539 TI - In vitro evaluation of a new dual screen microaggregate filter. AB - We compared a new second generation 40/150 mum dual screen microaggregate filter with a currently available 40 mum screen microaggregate filter. The evaluation included comparison of filter flow rate, capacity, degree of microaggregate removal, degree of leukocyte removal, and extent of filtration-induced hemolysis. We also studied the effect of both devices on filtration of stored platelet concentrates. The 40/150 mum dual screen microaggregate filter showed results comparable to that of the control screen filter following filtration of various types of units of red blood cells as well as units of stored platelet concentrates. Importantly, mean flow rates with the new 40/150 mum filter of 45 g/min after gravity filtration of 1600 mL of blood, make the filter suitable for use in trauma or other massive transfusion settings. We conclude that this new second generation microaggregate filter is suitable for use in clinical transfusion practice. PMID- 10149540 TI - Bone marrow transplantation using unrelated bone marrow donors--a technology in evolution. PMID- 10149541 TI - The use of unrelated bone marrow transplantation in the treatment of chronic myelogenous leukemia. AB - Although marrow transplantation is the treatment of choice for chronic myelogenous leukemia, its full application is limited by donor availability. It now appears that the use of volunteer unrelated donors will be feasible and efficacious, albeit with a higher likelihood of complications. Thus, marrow grafting from unrelated donors should be considered in most instances where transplantation from a matched sibling would be contemplated. PMID- 10149542 TI - Unrelated donor marrow transplantation for severe aplastic anaemia. AB - Severe aplastic anaemia (SAA) is frequently a lethal disease. Allogeneic marrow transplantation may offer the best chance of a cure but more than 50% of eligible patients will lack a suitable family donor. The development of large volunteer registries has established unrelated donor marrow transplantation (UD-BMT) as a possible alternative in these patients. Early clinical studies indicate that UD BMT for SAA is associated with a significantly greater risk of graft rejection and graft-versus-host disease (GVHD) than identical sibling BMT. Current strategies for improving results of UD-BMT for SAA include improved patient selection, more precise HLA matching between recipient and unrelated donor, and the use of more intensive pre-BMT immunosuppression and GVHD prophylaxis. PMID- 10149543 TI - Unrelated donor bone marrow transplantation for correction of lethal congenital immunodeficiencies. AB - The majority of children with lethal congenital immunodeficiencies lack histocompatible related bone marrow donors. T-cell depleted haploidentical parental bone marrow transplantation has been used successfully in selected patients with severe combined immunodeficiency (SCID), but it has not benefited most patients with other immunodeficiencies when it has been tried. For these reasons, we undertook a pilot study using closely matched unrelated donors for bone marrow transplantation of children with life-threatening primary immunodeficiencies. Unrelated donor searches were performed for 24 patients and one or more suitable donors were identified for 21 patients. Unrelated donor bone marrow transplantation (URD BMT) has been performed in 18 patients with various diagnoses: SCID (8), Wiskott-Aldrich syndrome (WAS) (2), Chediak-Higashi syndrome (CHS) (2), combined immunodeficiencies (3), Ataxia Telangiectasis (AT) (2), and one patient with combined immunodeficiency and large granular lymphocytosis (1). The overall actuarial survival rate is 59% with excellent results observed for infants with SCID and children with WAS and CHS. PMID- 10149544 TI - Bone marrow transplants for patients with acute leukemia and myelodysplastic syndrome using unrelated donors. PMID- 10149545 TI - Collection and transportation of human bone marrow cells from unrelated donors. PMID- 10149546 TI - The preparation of platelet concentrates by the light-spin/hard-spin technique. AB - For at least two decades the light-spin/hard-spin (LS/HS) method for preparation of platelet concentrates (PC) has been the standard of platelet support. With concern over the detrimental effects of platelet activation during component preparation and with increased recognition of the adverse consequences resulting from residual donor leukocytes in PC, new approaches to the production of PC have begun. This review addresses two aspects of the traditional LS/HS method of platelet preparation: platelet activation and residual leukocyte content. Studies of platelet activation are reviewed which focus on the second (hard-spin) centrifugation step during which pelleting of platelets occurs. Platelets studied immediately after the hard-spin exhibit evidence of alpha-granule release, expression of activation antigens, and decreased aggregation. There is a suggestion that some degree of reversal of platelet activation routinely occurs during the rest period following the hard-spin. The residual leukocyte content of PC prepared by the LS/HS method ranges from 10 7 to 10 9 leukocytes/unit. The residual donor leukocytes are predominantly lymphocytes and monocytes. Degeneration of residual donor leukocytes may release soluble cytokines resulting in febrile transfusion reactions. It remains controversial whether or not the cell-membrane fragments and microvesicles of degenerating donor leukocytes are capable of HLA allosensitization or viral transmission. Release of leukocyte elastase from degenerating leukocytes during platelet storage has been proposed as contributing to the platelet storage lesion. More research is needed to address the question of whether or not pre-storage leukocyte reduction during component preparation will result in improved PC. It appears likely that within the next few years radical changes will occur in the method of preparation of PC with the aim of providing the greatest degree of hemostatic effectiveness with the least toxicity to patients. PMID- 10149547 TI - Therapeutic leukapheresis. AB - For the majority of leukemic patients, leukapheresis represents emergency treatment aimed at reducing the number of white blood cells and producing an immediate improvement in the clinical picture. We have shown that leukapheresis procedures performed for the therapy of leukocytosis in 4 patients with acute leukemia (2 myelocytic; 1 lymphocytic; 1 monoblastic) resulted in marked reduction in the white blood cell count and a considerable reduction in symptomatology. Repeat removal of white blood cells applied in 20 instances for patients with chronic myelocytic leukemia also produced a significant decrease in the cell count and relief of symptoms such as sweating, malaise, and pain due to splenomegaly. In chronic lymphocytic leukemia (31 patients), intensive and frequent leukapheresis procedures were followed by a marked fall in white blood cell count, regression of splenomegaly/lymphadenopathy and resolution of many symptoms and signs induced by the large number of cells. PMID- 10149548 TI - Intensive plasmapheresis as an alternative therapy for intractable pruritus of primary biliary cirrhosis. AB - Primary biliary cirrhosis is a chronic disease of presumed autoimmune etiology, generally associated with other systemic abnormalities such as scleroderma, characteristic of Sjogren's syndrome and Raynaud's syndrome, for which pruritus is the most troublesome symptom. Treatment of this disease is a major unsolved problem. Although the use of cholestyramine has been effective, a considerable number of cases are refractory to the drug and to other agents such as corticosteroids, azathioprine and penicillamine. Plasma exchange has proven to be a useful option in four female patients with primary biliary cirrhosis--two with grade III histology and the other two with grade IV disease and intractable pruritus. The procedure was well tolerated and no side effects were observed. There was a temporary but significant attenuation of pruritus and improvement of melanoderma. Intensive plasma exchange is proposed as an alternative therapy in primary biliary cirrhosis with refractory pruritus. PMID- 10149549 TI - New "leap-frog" technique for autologous blood donation. AB - In order to obtain a sufficient volume of autologous blood for elective surgery, we used a Sterile Connection Device (SCD, DuPont, Mass. U.S.A.) and a liquid storage method that is called the leap-frog. From 300 to 2800 mL (mean 1158 mL) of blood were collected from 126 patients during an average of six donations over 14-125 days (mean 33 days). 101 patients (80%) required no homologous blood during their surgery. No bacterial contamination was observed in the connected tubes. We submit that it is possible to obtain an adequate volume of blood with a simple technique using this method. PMID- 10149550 TI - Long-term survival of the Charnley low-friction total hip arthroplasty. AB - A survivorship analysis of 1,151 Charnley low-friction total hip arthroplasties performed as a primary procedure showed the following 15-year failure probabilities: hip revision 13%, cup revision 8%, femoral revision 12%, radiographic femoral loosening 13%, and radiographic cup loosening 49%. Pain scores diminished gradually with time so that at 15 years, the probability of a Charnley pain score less than 5 was 70%. The data suggest that the Charnley low friction hip arthroplasty has a finite life span. PMID- 10149551 TI - Survival of cemented total hip replacements. AB - A Kaplan-Meier survival analysis of 240 Charnley, 149 Mueller (Depuy, Warsaw, IN), 576 Trapezoidal 28 (Zimmer, Warsaw, IN), and 100 Miami Orthopaedic Surgical Clinics (Biomet, Warsaw, IN) cemented total hip replacements with all polyethylene acetabular components, performed by the senior author (M.A.R.) should be the basis that all noncemented total hip replacements must exceed to be a reasonable alternative. Failure, ie, revision and a loose prosthesis, shows that 80%, 61%, and 63% of the Charnley, Mueller, and Trapezoidal 28, respectively, survive longer than 15 years. The Miami Orthopaedic Surgical Clinics prosthesis, which uses current cement technology, has been observed for only 8 years. Despite the fact that there are no differences noted between all four prostheses at 8 years, more time is needed to judge the usefulness of current cement technology. PMID- 10149552 TI - Long-term follow-up of the Indiana conservative resurfacing hip arthroplasty. AB - Sixty-four Indiana conservative (Depuy, Warsaw, IN) hip arthroplasties performed in 61 patients were reviewed for loosening, mechanisms of loosening, and revision rate. Mean follow-up time was 6.8 years. There were revisions in 26 hips (40.6%) with 4 hips awaiting revision, yielding a total of 30 hips (47%) defined as failures. Acetabular failure occurred in 20 hips, femoral failure in 18, and combined failure in 13. Failure of this prosthesis persists over time. There seems to be little or no place for this design in contemporary hip joint arthroplasty. PMID- 10149553 TI - Survival of a cemented porous-coated prosthesis. AB - Porous-surfaced femoral components were approved by the United States Food and Drug Administration for implantation with polymethyl methacrylate cement in total hip arthroplasty. The ability of porous coating to prevent loosening of prostheses in vivo has not been reported in the literature previously. This study compared the radiographic and clinical success of two structurally similar prosthetic designs, one of which incorporates a porous coat. Kaplan-Meier survival analysis showed no significant difference between the components (P greater than .05) when failure is defined as revision alone, radiolucency alone, or the combination of revision and radiolucency. PMID- 10149554 TI - Primary bipolar total hip arthroplasty. AB - A retrospective clinical and radiographic review of 140 primary total hip arthroplasties using a bipolar acetabular component and an uncemented AML femoral component (Depuy, Warsaw, IN) was done. The length of follow-up was from 2 to 5 years with a mean of 44.2 months. A mean postoperative Harris hip score of 84.3 points and a mean postoperative Harris pain score of 38.8 points were identified. Five hips required revision surgery, three for recurrent dislocations and two for infection. Nine percent of acetabular components were noted to have migrated within the bony pelvis by 2 mm or more. However, the presence of migration was not statistically associated with low pain or function scores. Ninety-eight percent of patients with surviving implants felt satisfied with the results of their surgery. Total hip arthroplasty using a bipolar acetabular component appears to be a successful method of hip replacement. PMID- 10149555 TI - Evaluation of the design and clinical performance of cementless acetabular components. AB - Three hundred four cementless acetabular components: 54 Ceramic (Richards Medical Co, Memphis, TN); 33 T-Tap (Richards Medical Co); 22 MHP, (Biomet Inc, Warsaw, IN); 109 PCA (Howmedica, Rutherford, NJ), and 86 S-ROM SuperCup (Joint Medical Products Co, Stamford, CT) were implanted in 271 patients between October 1982 and June 1986. Two hundred forty-one hips had good to excellent Harris hip scores, although a significant difference was found when the scores of patients with conical threaded cups were compared with those of patients who had hemispheric porous ingrowth cups and the SuperCup. Also, patients with conical threaded cups had a greater incidence of groin and buttock pain (P less than .01) and underwent more revision procedures (P less than .01). Our clinical and radiographic review indicates that all cementless acetabular cups are not equal and the hemispheric porous cups and hemispheric porous cups with peripheral threads are far superior to conical threaded cups. PMID- 10149556 TI - Roentgenographic evaluation of a conical threaded acetabular cup. AB - A radiographic analysis was done of 83 primary hip arthroplasties performed in 70 patients. The arthroplasty consisted of a truncated acetabular cup and a cemented titanium femoral stem. The patients were evaluated at an average of 3.3 years postoperatively (range 2 to 5 years). Using the method of DeLee and Charnley, the acetabulum was divided into three zones. Specific attention was focused on the percentage of fill in the threads of zones 1 and 3 and the measurement of radiolucency in zone 2. Over time, a large percentage of the acetabulae showed both a decrease in bone fill in zone 3 and an increase in radiolucency in zone 2. By the third postoperative year, 16% (11 of 70) of the acetabulae had migrated. Although all the hips had been rated good or excellent on the Charnley hip score, ie, receiving a 5 or better, 11 had migrated and 3 had been revised, indicating an unacceptable failure rate of the acetabular component. PMID- 10149557 TI - Universal total hip replacement with focus on the acetabular component and the hybrid hip. AB - One hundred sixty-one porous-coated Universal (Biomet Inc, Warsaw, IN) total hip arthroplasties were performed and studied preoperatively between July 1986 and June 1989. The study included 59 men (38 at 1-year follow-up; 21 at 2-year follow-up) and 91 women (60 at 1-year follow-up; 31 at 2-year follow-up). The average age was 62 years at 12-month follow-up and 64.7 years at 24-month follow up (range 28 to 90 years). Three groups of patients with components were evaluated both clinically and radiographically: uncemented femoral and acetabular components (group 1); cemented femoral stems and uncemented acetabular components, ie, hybrid total hip arthroplasties (group 2); and revision total hip replacement arthroplasties (group 3). Clinical results for all groups showed Harris hip scores of 87 at 1-year follow-up and 89 at 2-year follow-up. Moderate to no limp occurred in 93% of patients at 1-year follow-up and 95% at 2-year follow-up. No ambulatory aids were used by 43% of patients at 1-year follow-up or 47% at 2-year follow-up. Both walking distance and endurance improved over time. Anthropometric analysis showed no progressive lucencies around the femoral or acetabular component in either group. A Kaplan-Meier survivorship analysis could not be used, because there was only one failure. This eliminated a comparison group for those lost to follow-up. Early clinical and radiographic results have been encouraging; however, long-term analysis is needed to accurately assess the success of this total hip arthroplasty system. PMID- 10149558 TI - A radiographic analysis of a straight-stemmed uncemented femoral component and hemispheric porous-coated acetabular component in total hip arthroplasty. AB - A radiographic examination of 91 uncemented hemispheric titanium alloy acetabular components and 85 straight-stemmed titanium alloy femoral components was performed. Analysis included zonal radionuclides, migration, bone changes, and fit. Correlation of these parameters were made. Acetabular radiolucencies were common in zone 3 but none were progressive; also, they were unrelated to number and position of screws. Two acetabuli were considered to demonstrate loosening. Femoral changes of calcar atrophy, distal cortical hypertrophy, and distal femoral capping were independent of bone type and distal fit. One component subsided. Proximal radiolucency occurred in three patients, all on the lateral surface. Bony changes around the prostheses were statistically not related to bone type. PMID- 10149559 TI - Clinical and radiographic results with the Trilock femoral component--a wedge-fit porous ingrowth stem design. AB - Eighty-one cementless Trilock (Depuy, Warsaw, IN) femoral components were observed for 2 to 6 years. The following end points were examined: revision (none), pain score less than 5 (six patients), and radiographic settling greater than 5 mm (three patients). Four patients (5%) had thigh pain at follow-up. No complete radiopaque lines could be identified around the porous surface of the femoral components. By any standard, the wedge-fit tapered cementless femoral design is successful. As the follow-up period lengthens, a survivorship analysis can be done to assess the long-term potential of the Trilock design. PMID- 10149560 TI - Results of total hip replacement using porous coating as a fixation mode. AB - Successful cementless total hip arthroplasty is dependent on initial stabilization at the bone-prosthesis interface. Other factors, such as the adaptability of the prosthetic design to fit specific bony geometries, affect clinical outcome. These design considerations have been incorporated into the Mallory-Head (Biomet Inc., Warsaw, IN) prosthetic system so that it allows for immediate rigid stabilization of both the acetabular and femoral component in an effort to optimize the potential for bone ingrowth. Fifty primary cementless total hip arthroplasties, all performed by or under the direction of a codesigner of the prosthetic system, are reviewed. The average age of the patients was 53 years; the follow-up range was 24 to 52 months. The predominant preoperative diagnosis was osteoarthritis (88%). Using the Harris hip score, a noted improvement was seen in the preoperative score of 37 to a postoperative score of 94. Ninety-seven percent of the patients reported no pain or discomfort. In the Engh fixation scale, all femoral components were rated as optimum with signs of bone ingrowth. Radiographic evaluation showed no subsidence or shift of the femoral components. Five patients were noted to have acetabular migration of 4 mm to 6 mm. However, all were asymptomatic and fully functional in daily living activities. The early results of this cementless design compare favorably with those of similar series of cementless total hip arthroplasties. PMID- 10149561 TI - Anatomic Porous Replacement hip arthroplasty: first 100 consecutive cases. AB - One hundred consecutive Anatomic Porous Replacement (Intermedics Orthopaedics, Austin, TX) hip replacements were followed for 4 years. Eighty percent of patients had bone ingrowth fixation, 14% stable fibrous, and 6% unstable fibrous (loose) with 4% revised. Only two hips changed fixation grade after 2 years. Bone remodeling showed cancellous hypertrophy of the cortex, usually along the lateral cortex, and 7% had stress shielding (atrophy) of the proximal cortices. Adaptive bone remodeling almost always occurred in type B and C bone. Bone remodeling was statistically related to bone type, prosthetic fill, stem-bone ratio, and collar loading. We concluded that proximal bone ingrowth fixation with proximal load transfer provides good clinical results and excellent bone remodeling. Also, collar loading improves bone response. To expand this fixation in a predictable fashion to all type B and some type C bone requires geometry changes, which have been accomplished in the Anatomic Porous Replacement II. PMID- 10149562 TI - Initial stability of a collarless wedge-shaped prosthesis in the femoral canal. AB - A collarless wedge-shaped implant was inserted with cementless technique in seven fresh-frozen adult femora. Micromotion of the implant in the proximal femur was evaluated by applying an axial load of 3,000 N or a rotational force of 12 Nm. Six femurs were prepared using a cemented implant, and their stability was similarly determined for comparative purposes. In all tests, the amount of plastic deformation after load relief was quantitated. The cementless prosthesis had excellent initial stability with axial and rotational loading; also the micromotion was similar to that of the cemented implant. Deformation under these experimental conditions was predominantly elastic. The stability demonstrated with this cementless prosthesis satisfies the conditions necessary for bone ingrowth in vivo. PMID- 10149563 TI - Insertional femoral fracture: a biomechanical study of femoral component stability. AB - A Taperloc femoral component (Biomet Inc, Warsaw, IN) was implanted in seven fresh-frozen cadaver femora. In loads simulating single-leg stance and stair climbing, axial and rotational stability were tested before fracture, after fracture, and after fracture but with the addition of A-O cerclage wire fixation. All fractures were incomplete, began proximally at the anteromedial neck, and extended distally. More than 90% of the components showed decreased axial and rotational stability after fracture. The addition of cerclage wire fixation after femoral fracture provided acceptable axial stability in only three of seven femora and rotational stability in five of seven femora. In order to provide satisfactory initial implant stability after femoral fracture, improved methods of fixation and longer stemmed implants may be necessary. PMID- 10149564 TI - A radiographic and histological analysis of 17 retrieved ultrahigh-molecular weight polyethylene porous-coated femoral stems. AB - Radiographic and histological and evaluation for failure of 17 retrieved implants was performed. The implants consisted of a titanium stem with a 3-mm ultrahigh molecular-weight polyethylene coating and an outer 1.5-mm ultrahigh-molecular weight polyethylene fiber layer. Particular attention was paid to osteolysis, subsidence, debris, and foreign body reaction. Radiographic analysis showed subsidence (14 of 17), osteolytic lesions (9 of 14), and unique posterior medial exostoses (8 of 14). Histological analysis showed no significant evidence of acrylic bone cement either as debris or reactive tissue. There was an intense foreign body reaction directly related to the amount and size of polyethylene debris. PMID- 10149565 TI - Modular total shoulder: early experience and impressions. AB - All design considerations in shoulder arthroplasty are based on reconstructing normal anatomy and enhancing prosthetic fixation, particularly on the glenoid side. These goals are further enhanced by meticulous attention to detail in placement of the component parts relative to the bony anatomy. In addition, great attention must be paid to management of the soft tissue tensions and placement of the component parts relative to soft tissue origins and insertions so that asymmetric overloading of the components can be avoided and loosening and wear can be minimized. The problem of management of prosthetic replacement with associated massive rotator cuff tears continues to be a dilemma. Use of an oversized humeral head articulating with the acromion can offer a compromise solution to the problem. This technique can be combined with altered glenoid component placement or reshaping of the bony glenoid to accommodate its altered relationship with the humeral articular surface. Future design changes are needed to deal with this complex problem. PMID- 10149566 TI - Integral surgical maneuvers in prosthetic shoulder arthroplasty. AB - Total shoulder arthroplasty has advanced beyond addressing only the techniques of implant placement. To improve clinical results and assure maximum implant longevity, the surgeon needs to address soft tissue contractures, soft tissue deficiencies, glenohumeral instability, and bone deficiencies with a number and often a combination of surgical maneuvers. These techniques include excision of abnormal tissue, division of adhesions, selective tissue releases, variation in bone osteotomy or preparation to modify implant position, use of a variety of standard implants or custom devices, and supplementation of certain tissue deficiencies with autologous or allograft tissues. When the reconstruction is completed, the surgeon needs to assess movement, stability, and strength of the supporting tissues to plan an optimal rehabilitation program. PMID- 10149567 TI - Prosthetic replacement in acute fractures of the proximal humerus. AB - The surgical treatment of selected displaced fractures of the proximal humerus with a humeral head prosthesis is a challenging procedure. Adequate knowledge of the pertinent anatomy and biomechanics of the shoulder as well as a clear roentgenographic evaluation of the displaced fracture patterns are essential. Successful prosthetic replacement requires adherence to technical factors involving soft tissue mobilization, prosthetic insertion, and tuberosity repair. Also, it is important to have a closely supervised rehabilitation program to achieve early passive motion and strengthening after fracture healing. PMID- 10149568 TI - Constrained arthroplasty: its use and misuse. AB - Constrained arthroplasty is occasionally needed to salvage a destroyed glenohumeral joint when the rotator cuff is nonfunctioning and when an unconstrained prosthesis will not suffice. There is a high failure rate because of the severe forces between such a device and the contiguous bone. Accordingly, it is essential to know the limitations of constrained arthroplasty and when it should be avoided. For example, when the bone of the glenoid vault is highly demineralized or deficient or if there is a history of seizure disorder or alcoholism, use of such a device is contraindicated. Postoperatively, excessive force and extremes of motion should also be avoided during the rehabilitation program to avoid bone fracture or dislocation of the prosthesis. Various complications have been observed with constrained arthroplasty, including dislocation, bone fracture, pullout of the glenoid, infection, radial nerve injury after extrusion of bone cement through the humeral cortex when the cement has been pressurized, and screw breakage in a relative small number of cases after metal fatigue and loosening of the glenoid component. When the glenoid component has pulled away from the glenoid vault, it may be necessary to remove this component; the humeral head may be fitted with a bipolar 40- to 44-mm acetabular component, thereby allowing at least preservation, if not the active function of the shoulder contour. PMID- 10149569 TI - Cardiac pacing. AB - Sixty-seven recent publications in the field of cardiac pacing are reviewed under the headings of underlying mechanisms, temporary pacing, reports of therapy, pacing technology, and complications. The reference list is annotated, and papers considered of particular importance are highlighted. This review offers an appraisal of the recent advances in this highly technologic field, with particular emphasis on clinical problems, and is divided into five sections. The first covers the underlying mechanisms that lead to the need for pacing and the changes in hemodynamics and the neuroendocrine system that pacing imposes. The second examines two aspects of temporary pacing. The third gives a wide view of reports of therapy, and the fourth gives a clinical view of advances in pacing technology. The final section covers complications of pacing therapy. PMID- 10149570 TI - Electrophysiology: the Wolff-Parkinson-White syndrome. AB - Though tachyarrhythmias occur commonly in patients with the Wolff-Parkinson-White syndrome, many patients remain asymptomatic. Recent studies suggest that routine electrophysiologic testing in these individuals is of limited value. However, electrophysiologic testing remains very helpful in the symptomatic patient for predicting arrhythmia recurrence and for determining accessory pathway location and function. Unfortunately, noninvasive tests to predict high-risk WPW patients has not been proven helpful because of their low specificity. A number of recent studies have shown that autonomic function can markedly improve accessory pathway function and even counteract the effect of antiarrhythmic drugs. Given the frequent failure of antiarrhythmic therapy in the WPW syndrome, there has been increasing interest in nonpharmacologic therapies, including high-energy DC shock and radiofrequency catheter ablation of accessory pathways, which may prove to be more cost-effective than surgery. PMID- 10149571 TI - Diagnostic evaluation and management of syncope. AB - Syncope is a common and important clinical problem that occurs in up to 30% of adults and accounts for up to 6% of general hospital admissions. Syncope of cardiovascular origin is particularly important to identify as it is associated with a high risk of sudden cardiac death. A complete history and physical examination may suggest a diagnosis in the majority of patients, but additional evaluation is often required. Electrophysiologic testing is of highest diagnostic yield in patients with structural heart disease. Negative electrophysiology test results are also of importance as they predict a very low incidence of sudden cardiac death during follow-up. Tilt-table testing is a recently developed tool that allows a diagnosis of vasopressor syncope to be established despite an atypical clinical history. Tilt-table testing can also be used to guide therapy. PMID- 10149572 TI - Antiarrhythmic surgery. AB - Medically refractory tachyarrhythmias remain a significant clinical problem. The indications for surgical intervention in this challenging patient population continue to expand. Advances in noninvasive detection of patients at risk, as well as expanding electrophysiologic testing, continue to help define patients best served by surgical therapy. Refinements in surgical techniques, including rapid computerized intraoperative arrhythmia mapping, have made operative therapy safer and more effective. This review describes recent observations and advances in surgical therapy for supraventricular and ventricular tachyarrhythmias. PMID- 10149573 TI - Pediatric cardiovascular imaging. AB - Cardiovascular imaging in children has stressed acquisition of information with the least possible stress to the child. Improvements in noninvasive imaging have now largely supplanted the use of invasive techniques for diagnostic imaging. During the past year, major improvements in the diagnosis of complex cardiac malformations have occurred together with the extension of such techniques to the operating room. This review focuses on improvements in echocardiography, color flow imaging, and magnetic resonance in the imaging of complex cardiovascular defects, both intra- and extracardiac. Imaging of abnormalities of the atrioventricular region, intracardiac and coronary artery fistulae, homograft valved conduits, and pulmonary artery anatomy is discussed. The use of magnetic resonance imaging for the evaluation of pulmonary artery anatomy, ventricular septal defects, and aortic arch abnormalities is reviewed, as is the use of magnetic resonance imaging in small infants. Finally, the use of both epicardial and transesophageal echocardiography in the operating room for evaluation of the adequacy of surgical repair is reviewed. These studies demonstrate the ability of these techniques to provide information critical for the proper management of children undergoing cardiac surgery. PMID- 10149574 TI - Pediatric exercise testing. AB - The number of diagnostic modalities available to the pediatric cardiologist continues to escalate. However, with so many choices, it is often difficult to know what test is most efficacious in a given situation or how often to repeat it. This review summarizes the data from several exercise studies published within the past year. These studies address exercise as a diagnostic modality in children and adults with and without heart disease and compare exercise testing with other diagnostic modalities. They demonstrate some of the variables that should be routinely assessed during an exercise test, and they introduce many avenues for continued research. PMID- 10149575 TI - Interventional cardiac catheterization. AB - The use of the pediatric cardiac catheterization laboratory as a therapeutic modality has become standard practice in most pediatric cardiology centers. Accordingly, reviewing the results of this form of therapy has become very important. This review focuses on the initial and long-term results of balloon dilation procedures in infants and children. As the efficacy and safety has been proven for these early procedures, dilatation therapy has become available for the critically ill neonate with pulmonary and aortic stenosis. The usefulness of implantable devices for closing abnormal shunt pathways, such as the patent ductus arteriosus and atrial septal defect, has become clear. The importance of both transthoracic color-flow Doppler and transesophageal echocardiography in proper placement and follow-up of these implantable devices is now becoming apparent and also will be evaluated in this review. PMID- 10149576 TI - Role of Doppler echocardiography in coronary artery disease. AB - Doppler echocardiography can have a major role in the evaluation of patients with coronary artery disease. This review deals with the imaging planes in relation to coronary vascular territories and the role of Doppler echocardiography in evaluating patients with acute and chronic ischemic syndromes. PMID- 10149577 TI - Transcranial Doppler sonographic monitoring in the intensive care unit. AB - Transcranial Doppler sonography noninvasively measures flow velocities within the basal cerebral arteries. It has been used for the management of patients with ischemic cerebrovascular disease and subarachnoid hemorrhage, as well as in the determination of brain death. Its role and technical limitations in the intensive care unit are reviewed. PMID- 10149578 TI - Diagnosis and hemodynamic assessment of valvular heart disease. AB - This paper will discuss the contribution of nonultrasonic methods to the diagnosis and the hemodynamic assessment of valvular heart disease as it has been discussed in the literature since the end of 1989. From recently published papers, several topics can be developed: the continuing importance of evaluating symptoms, the possible end of the epidemic of mitral valve prolapse, the persisting value of invasive assessment in case of inadequate Doppler echocardiographic examination, the need for coronary angiogram before surgery, the assessment of the left ventricular function, and the relation between fluid mechanics and new diagnostic modalities. PMID- 10149579 TI - Echocardiography in valvular heart disease. AB - In 1990, echocardiography continued to develop rapidly, with new applications in the operating room and new solutions to common problems in the management of valvular heart disease. The newly published experiences with transesophageal and epicardial intraoperative echocardiography from Duke and the Cleveland Clinic illustrate the utility of these methods. Refinement of our concepts of mitral valve prolapse has occurred, along with echo Doppler support for awaiting symptoms prior to valve replacement in aortic stenosis. PMID- 10149580 TI - Medical treatment of valvular heart disease. AB - Despite recent advances in operative and percutaneous surgical techniques for valvular heart disease, medical management of complications of valvular disease, such as atrial fibrillation and infection, and prevention of thromboembolism remain important clinical problems. This review discusses recent data that address the role of vasodilator therapy in valvular regurgitation, the management of severe, asymptomatic aortic stenosis, and studies pertinent to the treatment of complications of valvular heart disease. Although vasodilators are promising agents, their efficacy in delaying the need for valve replacment remains unproven. PMID- 10149581 TI - Percutaneous balloon aortic valvuloplasty in adults with calcific aortic stenosis. AB - After 5 years' experience with percutaneous balloon aortic valvuloplasty and more than 550 patients dilated for calcific aortic stenosis in our series, the limits of the method are well recognized, and the indications have been reviewed. To date, the two main indications are very old patients with increased surgical risks and critically ill patients in whom the procedure is most often used as a bridge to surgery. From our series of 180 octogenarians and nonagenarians with several factors increasing the predicted perioperative mortality, we showed that the technique is able to efficiently palliate the symptoms and improve survival. Valve replacement remains, however, recommended in otherwise healthy and active elderly patients. Balloon aortic valvuloplasty is also clearly useful in critically ill patients with major left ventricular dysfunction and severe heart failure, especially in patients with cardiogenic shock in whom it may be life saving. A dramatic improvement of left ventricular function is most generally obtained, allowing valve replacement to be performed later with an acceptable lowered risk. Balloon aortic valvuloplasty, a low-cost and low-risk procedure in experienced hands, requiring only local anesthesia and a short hospitalization stay, partially reduces aortic stenosis but may in many cases be the only valuable therapeutic option for patient improvement. PMID- 10149582 TI - Valve surgery: indications and long-term results. AB - The decision to perform valve surgery requires knowledge of the natural history of valvular heart disease and of the results of surgical therapy. Recent reports have shed light on these important factors. Long-term results of valvular surgery are multifactorial, and data relating to age, type of prosthetic valve, and anticoagulation are presented. PMID- 10149583 TI - Valvular surgery. AB - The collection of clinical cardiac surgical articles published in the last year about valvular heart disease emphasizes the continuing accrual of data that compare prosthetic and bioprosthetic valves and suggest advantages and disadvantages of both: the indications for and long-term results of aortic valve replacement, particularly in patients with left ventricular dysfunction; newer elements of mitral valve reconstruction; and debate about the best operation for the tricuspid valve. A miscellaneous collection of interesting articles discusses endocarditis and anticoagulation in the pregnant patient who undergoes heart surgery. PMID- 10149584 TI - Aortic and vascular surgery. AB - Diagnosis and treatment of thoracic vascular disease remain difficult problems for the clinician. These pathologic conditions often result in significant morbidity and mortality. Currently, published series document long-term treatment results and allow investigators to analyze both pre- and postoperative predictors of outcome. This review outlines some of the many significant publications over the past 12 months dealing with these disorders. PMID- 10149585 TI - Surgery for arrhythmias, myocardial infarction, pericardial disease, cardiac tumors, and trauma, and intraoperative echocardiography. AB - This brief review highlights some of the advances made in selected areas of cardiac surgery over the past year, including surgery for arrhythmias, complications of myocardial infarction, pericardial disease, cardiac tumors, and trauma. In the treatment of arrhythmias, surgery for supraventricular arrhythmias and ventricular tachycardias is discussed, as is the role of the automatic implantable cardioverter-defibrillator in the surgical treatment of ventricular tachycardias. The usefulness of intraoperative echocardiography in evaluating valve disease, valve defects, and the results of surgical repair of atrioventricular septal defects is also discussed. The impact of these exciting developments can be expected to continue over the next several years. PMID- 10149586 TI - Skeletal muscle for cardiac assistance. AB - The last few years have witnessed considerable interest in the use of skeletal muscle to assist the heart. This review outlines developments of particular relevance and importance to this field during the past 12 months. The use of conditioned, fatigue resistant latissimus dorsi muscle has been proposed for cardiomyoplasty, for constructing separate pumping chambers, and for powering alternative assist systems. Although the cardiomyoplasty procedure has been applied clinically, the other techniques remain experimental, but promising, modes of support. PMID- 10149587 TI - Cardiac transplantation and ventricular assist devices. AB - During the last decade, heart transplantation has become an almost routine clinical entity limited only by the number of donors available. Temporary ventricular support has also gained acceptance for two particular groups of patients: 1) those in cardiogenic shock with reversible ventricular failure and 2) those with irreversible ventricular failure who require a bridge to transplantation. We review the experimental work, clinical research, results, specific cases and experiences in cardiac transplantation, and the use of ventricular assist devices during the past year. PMID- 10149588 TI - Coronary interventions in ischemic heart disease. AB - Coronary angioplasty has continued to undergo important developments, both in terms of the maturation of conventional balloon angioplasty, and the favorable preliminary results of a variety of novel adjunctive techniques. To the extent that these new techniques can address the residual limitations of conventional angioplasty--and thereby improve its success, safety, and durability--angioplasty is likely to become the dominant form of myocardial revascularization in the 1990s. To ensure that this tool is applied correctly, however, careful randomized trials must be performed to establish which medical, surgical, or catheter-based treatment represents the best approach to a given clinical situation. PMID- 10149589 TI - The diagnostic and prognostic value of exercise electrocardiography in asymptomatic subjects and stable symptomatic patients. AB - In asymptomatic patients, the use of exercise ECG testing for the detection of subclinical coronary artery disease has considerable theoretical appeal, but its practical application is severely hampered by the constraints of Bayes' theorem. Serial exercise ECGs do not appear to offer significant improvement in this regard. Thallium-201 perfusion scintigraphy performed in conjunction with an exercise ECG can greatly improve the predictive value of such testing, although at considerable cost. Screening strategies with promise are those that reserve exercise testing for individuals at greater-than-average risk for subclinical coronary artery disease (eg, patients with multiple coronary risk factors) or that prescribe sequential testing, where only those with an abnormal exercise ECG are subjected to thallium-201 scintigraphy. At present, the optimal method of identifying asymptomatic individuals at high risk of a major cardiac event remains undefined. The use of maximal-effort stress testing has stood the test of time in the evaluation of patients with stable symptoms suggestive of coronary artery disease. This is particularly true when variables other than the ECG response to exercise are considered. The independent contribution of exercise angina remains controversial; however, recent studies indicate that it correlates with a more severe symptom pattern and more extensive coronary artery disease. Prognostic stratification in these studies was improved by considering both subjective and objective manifestations of ischemia. Although exercise ECG testing has been shown to have important prognostic value after acute myocardial infarction, exercise thallium-201 scintigraphy offers several potential advantages for asymptomatic post-myocardial infarction patients, several of which this paper reviews. The more optimal prognostic efficiency of thallium-201 scintigraphy is due in part to the fact that the error rate in falsely classifying patients at low risk is substantially smaller with scintigraphy than with stress electrocardiography. Because of this, there appears to be adequate rationale for recommending exercise perfusion imaging, rather than exercise ECG testing alone, as the preferred method for evaluating mortality and morbidity risks after acute myocardial infarction. PMID- 10149590 TI - Exercise physiology in cardiovascular diseases. AB - Exercise testing protocols and training regimens are well established for patients recovering from myocardial infarction or coronary artery bypass surgery. However, exercise rehabilitation programs for patients with peripheral arterial disease or left ventricular dysfunction with congestive heart failure have not been well developed. Several recent reports have established reproducible exercise testing protocols with objective measures of performance for patients with peripheral arterial disease and congestive heart failure. Using these testing methods to define changes in exercise capacity, exercise training programs have been shown to result in a significant increase in exercise performance and community-based quality of life. The mechanism of improvement appears to involve peripheral adaptations in skeletal muscle metabolism rather than increases in cardiac output or peripheral blood flow. PMID- 10149591 TI - New directions in percutaneous intervention for peripheral vascular disease. AB - Balloon angioplasty is a safe and effective alternative to surgical reconstruction or bypass in selected patients with symptomatic iliofemoral and popliteal atherosclerosis. The current literature suggests an expanding role for balloon angioplasty in patients with symptomatic tibioperoneal disease as well as upper extremity claudication and subclavian steal syndrome. Newer percutaneous devices such as atherectomy, intravascular stents, and laser angioplasty may further broaden the indications for percutaneous intervention by improving their safety and long-term benefit. The latest advances in percutaneous intervention for peripheral vascular disease are reviewed. PMID- 10149592 TI - Coronary artery surgery. PMID- 10149593 TI - Vascular biology of coronary bypass grafts. AB - Clinical studies on the natural history of coronary bypass grafts strongly suggest that biologic properties of the vessels used importantly affect their function and patency. The endothelium is a source of substances regulating vascular tone, platelet function, and vascular growth; it produces nitric acid from L-arginine, which is a potent vasodilator and inhibitor of platelet function and has antiproliferative properties. Nitric oxide and prostacyclin, which have a similar profile of action, are released in greater amounts in arterial than venous coronary bypass vessels. Vascular smooth muscle cells are primary regulators of local blood flow and contribute to proliferative responses. The right gastroepiploic artery exhibits more pronounced contractions than the mammary artery but has a similar sensitivity to vasoconstrictors. Proliferative responses in coronary bypass vessels appear to be induced by changes in transmural pressure (particularly in veins), endothelial damage, and in turn, local release of platelet-derived growth factors, low-density lipoproteins, and intrinsic characteristics of the blood vessels. Thus, biologic properties of the endothelium and vascular smooth muscle significantly contribute to the function and patency of coronary bypass grafts. While the mammary artery has near-ideal characteristics, the right gastroepiploic artery exhibits marked contractile responses and the saphenous vein has unsatisfactory antithrombotic properties and more pronounced proliferative responses. PMID- 10149594 TI - Endothelialization of vascular grafts. AB - Although work on endothelial cell seeding of vascular prostheses was first published in 1978, no clinical breakthrough had yet been achieved. Clinical data on single-staged procedures using freshly harvested autologous venous or microvascular endothelial cells are scarce and controversial. The alternative approach--the application of culture techniques--has the disadvantage of being restricted to major centers. Moreover, this in vitro endothelialization is confined to elective cases because of the delay caused by cell cultivation. Nevertheless, initial clinical trials with this two-staged technique are encouraging and indicate that the creation of an endothelium on the inner surface of prosthetic grafts is feasible in humans. PMID- 10149595 TI - Technical progress in coronary surgery. AB - This report reviews the most recent technical advances that improve the results of coronary artery bypass grafting and discusses advantages and limitations in revascularization by extensive employment of arterial grafts. There is evidence that the use of the second internal mammary artery for coronary grafting, in selected cases, gives excellent long-term results. The use of alternative arterial conduits in conjunction with both internal mammary arteries in order to achieve complete revascularization with arterial grafts only has yielded good short-term results. However, for late results further and larger studies are necessary. In diffuse coronary artery disease, complex vessel endarterectomy and reconstruction procedures are currently performed by several surgeons with low operative risk and good midterm clinical results. Favorable results concerning the patency of the endarterectomized coronary arteries and related grafts have been reported. PMID- 10149596 TI - Free arterial grafts. AB - The use of free arterial grafts has increased since the late patency of free internal mammary artery grafts was found to approach that of pedicle internal mammary artery grafts. An intensified search for other suitable arterial grafts has resulted in reports on the use of free gastroepiploic artery grafts and free inferior epigastric artery grafts. Free arterial heterografts and free homograft saphenous veins have had very disappointing results in general. The lateral costal artery, when available, offers another possible arterial conduit in approximately 10% of patients. To effect a wider use of arterial conduits for coronary bypass grafts, a number of techniques have been devised to use the internal mammary artery and other arterial grafts as free grafts. PMID- 10149597 TI - Surgical revascularization in women. AB - Multiple studies have shown that coronary bypass surgery in women clearly has a higher risk of operative death. The reason for this higher risk remain less clear, however. Although earlier studies suggested that women were at higher risk due to their smaller body size, several recent studies have suggested that a significant component of the higher mortality of women may be late referral for bypass surgery. Complication rates and hospital stay also appear to be higher in women. Although operative mortality is higher, women have similar long-term results from bypass surgery. Thus, coronary bypass surgery is a valuable treatment option for women with advanced coronary disease with excellent long term outcomes. The short-term outcomes of women referred for bypass surgery may be improved with earlier referral of women for revascularization. PMID- 10149598 TI - The need for standards for audit of coronary surgery and angioplasty. AB - The purpose of auditing is to improve clinical practice, but there is little point in auditing the management of a single patient or a series of patients unless the correct management has been established. Auditing should involve comparing case management with a standard and should not be based on individual opinion. This review considers how standards for auditing of coronary artery surgery and angiography can be defined, and it describes recent publications of different types that potential auditors should consider before beginning their task. These publications include series of patients, registers, committee statements, and ratings of "appropriateness." PMID- 10149599 TI - Transluminal angioplasty after surgical revascularization. AB - Revascularization has become an established way of treating coronary heart disease. Progression of the disease, graft failure, and surgical complications may lead to recurrent symptoms in a significant number of patients after surgical revascularization. Transluminal techniques are the preferred way of dealing with the recurrences. Saphenous vein bypass grafts present high recurrence rates when submitted to percutaneous transluminal coronary angioplasty alone; the restenosis rate of stenoses in the proximal and mid segment of bypass grafts is more than 50%. Atherectomy has become an established way of treating diseased bypass grafts if the disease is limited to short segments. The best results may currently be obtained by implantation of intraluminal stents, which not only prevent embolization of graft material but also reduce the recurrence rate. Laser techniques may find their role in treatment of diffuse native coronary artery disease, particularly in small-diameter vessels and ostial lesions. PMID- 10149600 TI - Surgical treatment of coronary artery anomalies. AB - In this paper, we review literature from June 1990 through May 1991. We discuss normal anatomy and physiology of the proximal coronary arteries, anomalous origin of the coronary arteries from an inappropriate aortic sinus, and anomalous origin of the left coronary artery from the pulmonary artery. Other topics reviewed include coronary arteriovenous fistulas, coronary anomalies in left-sided heart syndrome and pulmonary atresia with intact interventricular septum, coronary arterial abnormalities in transposition of the great arteries, and iatrogenic coronary anomalies. PMID- 10149601 TI - Doppler echocardiography in the evaluation of left ventricular diastolic function. AB - The examination of diastolic filling velocities by Doppler echocardiography has provided increasing insights into the understanding of left ventricular diastolic performance in health and disease. However, several recent studies have emphasized the importance of a wide variety of physiologic variables, including heart rate, respiration, age, and loading conditions that need to be considered as potential confounding factors in the interpretation of these filling patterns. Despite this, Doppler echocardiographic assessment has been useful in the evaluation and prognostication of a variety of restrictive cardiomyopathies. Furthermore, the study of Doppler diastolic filling velocities has improved our understanding of common cardiac diseases, including hypertensive and ischemic myocardial disease. Further enhancement of our understanding of left ventricular diastolic filling in health and disease will depend on more precise elucidation of the mechanisms responsible for diastolic function. PMID- 10149602 TI - Magnetic resonance imaging and spectroscopy of the heart. AB - The value of magnetic resonance (MR) imaging and 31P spectroscopy is reported for evaluating the anatomy, function, and high-energy phosphate metabolism of the heart in patients with cardiovascular disease. Recent developments include the evaluation of myocardial contraction under pharmacologic stress and direct tracking of wall motion with myocardial tagging, assessment of first-pass myocardial perfusion with ultrafast MR in conjunction with MR contrast agents, and MR velocity mapping to determine flow velocity and volume in medium-sized vascular structures. The clinical significance of 31P spectroscopy is expanding, as shown in several studies in patients with ischemic heart disease and cardiomyopathy. The phosphocreatine to ATP ratio proved to be a sensitive marker for regional ischemia in patients with critical coronary artery stenoses. Changes in high-energy phosphate metabolism may be detected in patients with dilated cardiomyopathy, which may be useful to differentiate primary and secondary cardiomyopathies. MR imaging and 31P spectroscopy may be combined for a complete evaluation of patients with cardiovascular disease. PMID- 10149603 TI - Nuclear cardiac imaging. AB - Important developments in the field of nuclear cardiac imaging include increasing use of single-photon emission computed tomography; the availability of pharmacologic stress testing; the introduction of newer technetium-labeled perfusion imaging agents; and a number of other newer imaging agents and imaging techniques. Tomographic imaging improves image quality as well as sensitivity. This improvement is probably more noticeable with pharmacologic stress testing and with the newer technetium agents. A number of pharmacologic stress agents are now being used. These include dipyridamole, adenosine, and dobutamine. In our experience, thallium tomographic imaging during adenosine-induced coronary hyperemia has resulted in a high degree of accuracy in the diagnosis of coronary artery disease. Both 99mTc-sestaMIBI (hexakis-2-methoxyisobutyl-isonitrile) and 99mTc-teboroxime may be used for simultaneous assessment of perfusion and function. These agents, although similar to thallium in many aspects, differ in many other aspects as they differ from each other. For example, sestaMIBI has a long retention time, but teboroxime has a very rapid washout time. Therefore, the imaging protocols using these two agents are considerably different. Assessment of myocardial viability has been an area of interest; specifically, the use of the reinjection technique has improved the ability to differentiate between scar tissue and viable myocardium. PMID- 10149604 TI - Ultrafast computed tomography. AB - Ultrafast computed tomography is a developing cardiac imaging modality that can provide high temporal and spatial resolution images of the beating heart in the outpatient setting. The three-dimensional registration of these images has facilitated numerous studies showing this device to be capable of quantitating cardiac anatomy, cardiac function, and cardiac blood flow. During the past 1 to 2 years, these applications have extended into definition of right ventricular muscle mass, cardiac sources for embolization, and the possibility of diagnosing asymptomatic coronary artery disease through visualization of discrete coronary artery calcification. With respect to cardiac functional analysis, studies now suggest the application of exercise ergometry and ultrafast computed tomography imaging to define the physiologic significance of coronary stenoses. Studies involving the adaptation of indicator dilution methods to ultrafast computed tomography to quantitate regional myocardial perfusion continue to suggest this as a potential tool in the noninvasive quantitation of regional myocardial perfusion. The major limitation of this method is its availability, at present, in only a select number of major medical centers throughout the world. PMID- 10149605 TI - Imaging in the catheterization laboratory. AB - In the past decade, there has been dramatic growth in the number of catheterization procedures, with over 1.3 million performed in 1990. In the past year, several large studies have documented the clinical safety of nonionic contrast agents for performing angiography. These agents are much more expensive than conventional high-osmolarity ionic agents, and thus their widespread use continues to be controversial. Digital recording of angiographic images is now routinely available. Although useful for rapid review of images, digital processing for analysis of stenoses, ventriculography, and coronary flow has not been widely accepted. Several recent studies compared quantitative techniques with subjective analysis and found little advantage. Similarly, although flow can be determined, no practical clinical method has emerged. Over the past year, intracoronary ultrasound and angioscopy have made important advances. These adjunctive imaging techniques allow careful investigation of atheroma morphology and lumen geometry not available with routine angiography. Use of these imaging modalities will contribute greatly to the study of vascular disease in the catheterization laboratory. PMID- 10149606 TI - Flexible implant arthroplasty of the radiocarpal joint. AB - The radiocarpal, distal radioulnar, and intercarpal joints can be affected individually or in combination. Selection of the appropriate treatment method is based on accurate evaluation of the extent and severity of involvement. The durability of flexible implant resection arthroplasty of the radiocarpal joint has been further enhanced by the use of titanium grommets to protect the implant midsection, by secure dorsal and palmar capsuloligamentous reconstruction to restrict the mobility of 30 degrees flexion/30 degrees extension and 10 degrees ulnar/10 degrees radial deviation, by 6 weeks' postoperative immobilization, and by avoidance of abusive hand usage. PMID- 10149607 TI - Silicone rubber arthroplasty of the wrist. AB - The wrist is often referred to as the keystone of the hand. It is often affected in rheumatoid arthritis. Salvage procedures for patients with rheumatoid arthritis involving the wrist include silicone wrist arthroplasty, total joint arthroplasty, and wrist arthrodesis. In 1967, Swanson developed a double-stem, flexible-hinge implant for the radial carpal joint. In 1982, metal titanium bone liners (grommets) were added to help decrease the incidence of fractures. The authors feel that the gold standard is still wrist arthrodesis. However, they would use a flexible wrist arthroplasty in a patient who has bilateral wrist involvement with marked digital deformity and/or proximal interphalangeal stiffness. This is especially true in low-demand patients who have good alignment, good bone stock, and the associated proximal and distal disease. If these criteria are met and meticulous technique used, successful reconstruction of the wrist with a flexible wrist silicone implant can be performed in the patient with rheumatoid arthritis. PMID- 10149609 TI - Resection arthroplasty at the basilar joint of the thumb. AB - Resection arthroplasty at the base of the thumb has a long history in the surgical literature. It is a less complex procedure than other operative approaches; pain relief along with useful hand function is reliably achieved. Sixty-six trapezial resection arthroplasties using either a tendon or Gelfoam spacer (The Upjohn Co, Kalamazoo, MI) were reviewed with improvement noted in 62 patients. PMID- 10149608 TI - Basal joint arthroplasty using the Roosevelt Hospital techniques. AB - Many reconstructive procedures have been developed to treat osteoarthritis of the basal joint of the thumb. The current article describes techniques used at the Hand Surgery Center at Roosevelt Hospital in New York City. A tonometry applanation radiographic staging system is outlined; it serves as a rationale for selecting which form of arthroplasty is appropriate for a particular patient and is predicated on the extent of involvement of the trapezial articulations. Stage 1 disease implies symptomatic laxity of the trapeziometacarpal joint with normal articular surfaces and is most appropriately treated with volar ligament reconstruction. Stage 2 is an intermediate category and amenable to either volar ligament reconstruction or interpositional arthroplasty of the trapeziometacarpal joint, based on the condition of the articular cartilage at surgery. In stage 3 disease there are significant degenerative changes of the trapeziometacarpal joint with preservation of the articular surfaces of the scaphotrapezial joint. Two variations on ligament reconstruction with interpositional arthroplasty of the trapeziometacarpal joint are described; they have consistently good results. Finally, stage 4 is characterized by pantrapezial degenerative disease and necessitates trapezial resection. Reconstruction may be by silicone rubber implant arthroplasty using a stemmed trapezial implant stabilized by an abductor pollicis longus tenodesis. The alternative is a procedure in which the thumb metacarpal is tethered to the index metacarpal by a ligament reconstruction. PMID- 10149610 TI - Total joint replacement at the base of the thumb. AB - Total joint replacement at the base of the thumb has been used for almost two decades in cases of trapezium-metacarpal arthritis. The procedure involves the insertion of a titanium metacarpal component and a polyethylene trapezium implant. The system articulates in a semiconstrained ball and socket joint that allows a full range of motion with inherent stability. Methylmethacrylate cement is optional for the metacarpal component and is routinely used in the trapezium. Revision components are available if excision of the trapezium is required because of fracture, severe arthritic deterioration, or loss of bone stock. A trapezium revision procedure converts the system into a spacer arthroplasty, which requires standard soft tissue stabilization. There have been no implant fractures or evidence of excessive wear, infections, or unstable articulated components in 80 cases that have been carefully followed up for over 10 years. Trapezium components loosening in cement cases and metacarpal subsidence in uncemented cases have a complication rate of less than 10%. These cases respond to revision procedures that permit continued functional use of the thumb. Total joint replacement appears to be safe and reliable. It is especially helpful in older patients in whom host tissues are not optimal for joint stabilization and early mobilization is desired. Total joint replacement can also be combined with associated procedures such as metacarpal phalangeal joint capsulodesis, carpal tunnel release, and tendon transfers in performing complex reconstruction of the thumb. PMID- 10149611 TI - Silicone rubber arthroplasty of the proximal interphalangeal joint: dorsal and lateral approaches. AB - Although arthrodesis of an arthritic proximal interphalangeal joint provides excellent relief of pain, it does so at the expense of mobility. Silicone rubber implant arthroplasty also provides predictable relief of pain and approximately 60 degrees of motion. Insertion of the implant through a dorsal extensor splitting approach is preferred when a tendon reconstruction is necessary, as in cases of boutonniere deformity. If tendon reconstruction is not necessary, the lateral approach is an excellent alternative because it does not disturb the extensor mechanism and therefore permits earlier rehabilitation exercises. The following article outlines the dorsal and lateral techniques and postoperative rehabilitation of silicone rubber arthroplasty. PMID- 10149612 TI - Proximal interphalangeal joint arthroplasty: the volar approach. AB - Reconstruction of the proximal interphalangeal joint by arthroplasty using the Swanson implant is greatly simplified by the volar approach. The extensor tendon system is not violated, making an immediate motion program feasible. Combining this approach with local anesthesia allows for active and complete evaluation of the technique during the operative procedure. PMID- 10149613 TI - Distal interphalangeal joint silicone interpositional arthroplasty: surgical technique and functional outcome. AB - Distal interphalangeal joint arthroplasty is effective in alleviating the pain of degenerative arthritis while preserving motion and stability. This procedure was undertaken as an alternative to arthrodesis for 17 women with osteoarthritis and 1 woman with rheumatoid arthritis. Silicone interpositional arthroplasty was performed in 31 digits of patients whose mean age was 58.3 years. The patients were evaluated at an average of 72.2 months (range, 12.6 to 123.1 months) after surgery. All patients reported that their primary preoperative symptom of pain was effectively eliminated by the procedure. At reevaluation, the active range of motion of the distal interphalangeal joint averaged 32.2 degrees and extension lag averaged 12.7 degrees . Lateral stability of the distal joint was present in all but one middle finger implant. Two implants were removed at 3 months postoperatively for wound problems and one at 31 months because of prothesis fracture. PMID- 10149614 TI - Basic principles of hydroxyapatite in joint replacement surgery. AB - Hydroxyapatite (HA) is currently being investigated for use in total hip arthroplasty. This article reviews the principles underlying the rationale for its use. Important concepts to understand include basic characteristics of HA, the implant-HA and HA-bone interfaces, biodegradability and the ability of HA to bridge gaps in bone. PMID- 10149615 TI - Clinical and roentgenographic evaluation of hydroxyapatite-coated and uncoated porous total hip arthroplasty: a preliminary report. AB - Sixty osteoarthritic patients undergoing primary uncemented total hip arthroplasty were matched for age and weight and randomized into one of four groups with respect to implant coating and postoperative protected weight-bearing status: group 1, hydroxyapatite, 12 weeks; group 2, uncoated, 12 weeks; group 3, hydroxyapatite, 6 weeks; group 4, uncoated, 6 weeks. Tantalum spheres were implanted periprosthetically into the femur at the time of arthroplasty, thus providing constant references for stereoscopic radiographs. Patients were then evaluated over a 1-year period with clinical examination, plain radiography, and roentgen stereophotogrammetric analysis (RSA). Clinical evaluation using Charnley scoring showed no significant preoperative or postoperative intergroup differences, whereas visual analog testing noted less thigh pain with hydroxyapatite-coated stems at 12 weeks and 6 months follow-up. Plain radiographic analysis produced no significant differences, with no instability detected and bony ingrowth noted uniformly in all groups. The preliminary stereographic evaluation showed migration in all groups, but there were no significant differences between coated and uncoated stems or 6-week and 12-week partial weightbearing protocols. The Charnley, plain radiographic, and preliminary stereogrammetric evaluations all suggest that migration is unaltered by enhanced surfaces and that early unprotected weightbearing does not jeopardize implant fixation regardless of coating design. The lower incidence of visual analog thigh pain with the hydroxyapatite-coated stems, however, may be a reflection of bony ingrowth and as such add some validity to the theoretical advantages of enhanced surface prostheses. PMID- 10149616 TI - Clinical total hip replacement with hydroxyapatite from 1984 to 1991. AB - Hydroxyapatite (HA) has been used for revision and primary total hip replacement surgery. HA has been used on both textured and porous coated implants for both primary and revision surgery. The results with textured implants have been compared with those of textured press-fit implants; with both revision and primary surgery the HA-coated prostheses were superior both clinically and roentgenographically. The results with porous coated implants have shown better bone remodeling and less radiolucent lines around the implants. The author's conclusions are that HA is effective in providing earlier stability of the implant and demonstrates better remodeling of the bone around the implant than do implants without HA. The author recommends the use of HA on porous coated implants so that if resorption of the HA occurs, the fixation of the porous coating will be present to provide durability. PMID- 10149617 TI - Comparison of the early healing course of porous titanium with hydroxyapatite coated porous titanium hip implants: clinical considerations for the use of hydroxyapatite coating in total hip replacement. AB - The role of hydroxyapatite (HA) coating in the fixation of human total joint prostheses remains to be established. Results of animal studies have been favorable, showing very rapid bone formation with a corresponding increase in bone-implant bond strength. In addition, the quantity of bone may be increased. This study compared identical porous titanium primary total hip implants with and without HA in similar patient populations. All of these patients were healthy and reliable, and had optimal bone geometry and bone quality for cementless fixation. The purpose of the study was to contrast the sequence of events, in the first year after surgery, between the two implant groups to identify the contribution of HA to early patient function and early radiographic appearance of the prosthesis. No significant clinical difference could be demonstrated between the two groups at 1 year from surgery. However, the HA group progressed more rapidly when comparing clinical scores at 6 months (P = .0058), and appeared to demonstrate more rapid bone remodeling at 6 months on the femoral side, although this observation did not quite make statistical significance (P = .0618). There was no difference between the acetabular components during the course of this study. PMID- 10149618 TI - Early clinical results with the hydroxyapatite-coated porous long-term stable fixation total hip system. AB - The design and early clinical results with uncemented porous-coated long-term stable fixation anatomic and midstem total hip systems (Implant Technology, Inc, Secaucus, NJ) are described. In an ongoing Food and Drug Administration-approved Investigational Device Exemption-Premarket Approval Program, a random selection method is used to determine patients receiving implants with a hydroxyapatite (HA) coating applied to the porous surface and those receiving uncoated implants. The early clinical results with the HA-coated systems show them to appear superior to the uncoated systems. A greater percentage of patients with HA coated systems have clinical scores in the excellent to good range, which is primarily a reflection of less prostheses-related pain. Radiographically, all components appear well fixed, with evidence of bone ingrowth. The HA-coated systems have a decreased incidence of radiolucencies, particularly in proximal zones. PMID- 10149619 TI - Clinical and radiographic experience with a hydroxyapatite-coated titanium plasma sprayed porous implant. AB - The use of bioactive materials recently has given increased hope to achieving adequate fixation in cementless total hip arthroplasty. Hydroxyapatite, one of the most biocompatible materials known, interacts with surrounding bone and forms a chemical bond with the bone, rather than a mechanical microinterlock via bioingrowth. There is direct bonding of bone and the hydroxyapatite, as opposed to the development of an intervening fibrous tissue layer between the implant and the bone. Recent use of hydroxyapatite-coated implants has shown that very strong bonds with living bone occur within a relatively short period of time. In this article, 53 primary, cementless total hip arthroplasties, all performed by or under the direction of a codesigner of the prosthetic system, are reviewed. The average age of the patients at arthroplasty was 51 years; the follow-up period averaged 17 months. The preliminary results achieved in this group of patients were compared with those achieved in 50 patients who received the identical porous coated implant without hydroxyapatite. The preoperative diagnoses, Harris Hip Scores, and patient demographics were similar for both groups. A comparison of clinical results showed that patients with the hydroxyapatite-coated femoral implants experienced more rapid clinical improvement in the first 6 to 10 weeks after arthroplasty than the patients with the identical prosthesis without hydroxyapatite coating. Radiographically, in the hydroxyapatite group, there have been no femoral or acetabular component failures, and no instances of femoral component subsidence or acetabular component migration. PMID- 10149620 TI - Early clinical results of hydroxyapatite-coated total hip arthroplasty. AB - A retrospective clinical and radiographic review of 25 conventional cementless total hip replacements (THRs) and 25 cementless hydroxyapatite-coated THRs was performed to evaluate early postoperative results. The hydroxyapatite-coated group had a higher incidence of pain-free arthroplasties compared with the standard cementless group (72% v 44%, P = .045) at the 2-month postoperative evaluation. At the 6-month evaluation, 76% of hydroxyapatite-coated THRs were pain-free compared with 52% of conventional cementless THRs, although the statistical significance disappears (P greater than .05). No differences between groups existed in the 6-month Harris hip scores, average motion, use of external support, Trendelenberg gait, postoperative implant radiolucent lines. Adding a 50- to 75-mug hydroxyapatite coating to a proximal one-third porous femoral prosthesis and porous surface acetabular cup improved the early clinical results in cementless THR. Whether this improvement in pain scores reflects a more stable cementless prosthesis via increased rates and amount of osseus ingrowth or adjunctive bone hydroxyapatite chemical bonding remains unanswered. Long-term follow-up of femoral subsidence and THR revision is needed to indicate the durability and success of hydroxyapatite coating. PMID- 10149621 TI - Long-term care: coverage options. PMID- 10149622 TI - Health Access America: an AMA plan to strengthen the U.S. health care system. PMID- 10149623 TI - Data management. The hidden elements of success. PMID- 10149624 TI - Survey of triple-option point-of-service plan enrollees. PMID- 10149626 TI - What PPOs and insurers want from each other. PMID- 10149625 TI - Reaching a new health care market equilibrium. PMID- 10149628 TI - The trend toward accreditation. PMID- 10149627 TI - Quality-focused contracting for specialized managed care services. PMID- 10149629 TI - Managed care goes electronic. PMID- 10149630 TI - Point/counterpoint: perspectives on funding. Self-funded PPOs. PMID- 10149631 TI - Point/counterpoint: perspectives on funding. Insurer-sponsored PPOs. PMID- 10149632 TI - The managed care prescription benefit. Challenged by shifting care and shifting costs. PMID- 10149633 TI - Preserving hospitals with managed care. A panel discussion. PMID- 10149634 TI - Drug use review principles adopted by key organizations. A framework for better drug use review. PMID- 10149635 TI - Resolving the national practitioner data bank dilemma. PMID- 10149636 TI - Vision: an emerging benefit. A panel discussion. PMID- 10149637 TI - PPO fiduciary responsibility. AB - This article will be frustrating for you. It warns you of comprehensive legal liability--but does not give you step-by-step guidance or checklists. Why? Because there are practically no examples or specifics or checklists in the Employee Retirement Income Security Act of 1974 (ERISA), especially for fiduciary duty and the new "knowing participant" fiduciary duty which applies to PPOs. Other than a relative handful of official Prohibited Transaction Exemptions (PTEs), everything is judged on a case-by-case basis. Even Department of Labor Opinion articles are merely that--opinions written with lots of caveats and not considered legal precedents. In defense of the Department of Labor, the slightest difference in circumstance can trigger a totally opposite ruling, so their hesitancy to give simple checklists is understandable. This article also takes a conservative approach. Enforcement of ERISA fiduciary duty has been sporadic. However, this article is important to you and timely. In recent years, the Department of Labor has devoted at least 50 percent of its employee review with criminal penalties of benefits cases deemed to be fraud, waste, or abuse. It is important to remember that the Department of Labor will judge your actions with 20/20 hindsight. Thus, it is important not only to have good intentions, but also to be sure that it looks like you have taken the most prudent action when all is said and done--even if the action defies common sense or normal business practices.(ABSTRACT TRUNCATED AT 250 WORDS) PMID- 10149638 TI - Auto insurance managed care. PMID- 10149639 TI - Prescribing practices of physicians affiliated with multiple formularies. PMID- 10149640 TI - Dental benefit plans. PMID- 10149641 TI - Marketing strategies for the 1990s. PMID- 10149642 TI - Risky business. Managed health care heart programs. PMID- 10149643 TI - What benefit managers want from managed pharmacy programs. PMID- 10149644 TI - PPOs and homecare providers: a perfect partnership. PMID- 10149645 TI - Total ankle arthroplasty: new concepts and approaches. AB - A new type of total ankle arthroplasty developed with the use of a CAD-CAM computer was used in a series of 27 ankles between 1985 and 1989. Follow-up in 19 ankles ranging from 18 months to 5.5 years postoperatively indicates that the design of this implant appears to avoid the problems of subsidence and malleolar impingement. Based upon the results in this series, it appears that the best candidates for use of this type of total ankle implant are patients with rheumatoid arthritis. PMID- 10149646 TI - Negative MRI findings in knee injury: clinical implications. AB - Magnetic resonance imaging (MRI) is now commonly used to diagnose knee pathology. Based on results in a study conducted in a private practice setting, the diagnostic value of MRI for all articular cartilage surfaces, menisci, ligaments, and soft tissue structures of the knee was determined. Subjects included 102 consecutive patients undergoing arthroscopic knee surgery for whom MRI findings also were available. Sensitivity, specificity, accuracy, positive predictive value (PPV), and negative predictive value (NPV) of MRI were calculated. Sensitivity was highest for meniscus tears: 73.2% for medial tears and 63.3% for lateral tears. Sensitivity for other pathologies was poor, ranging from 26.2% for chondromalacia of the patella to 11.1% for loose bodies. Negative predictive values were variable, ranging from 84.3% for lateral meniscus tears to 39.2% for chondromalacia of the patella. MRI for most pathologies had an NPV between 50 and 75%. Results indicate a high rate of false negative MRI findings. PMID- 10149647 TI - Open versus closed nailing of femoral fractures in the polytrauma patient. AB - Thirty-four patients with severe multiple injuries underwent either open or closed nailing of 35 femoral fractures. Open nailing was performed in 17 femurs and closed nailing in 18 femurs. The average abbreviated injury score was 27 in both the open group (range: 17-45) and closed group (range: 22-36). Soft tissue injuries were present in eight (47%) cases in the open group compared to three (16%) in the closed group. The treatment protocol was similar in both groups. Intramedullary nailing was delayed an average of 11 days in the closed group. This was significantly different than the open group where the average time to nailing was less than 24 hours (p less than 0.001). Reamed nails were used in all cases except for two in the closed group. The median time to fracture healing was 5.0 months in the open group and 4.1 months in the closed group, with an average follow-up of 18 months in both groups. Two cases required reoperation (one nonunion and one shortening at the fracture site). Both these cases were in the open group. There were no superficial or deep infections in either group. Closed reamed intramedullary nailing is recommended for treatment of diaphyseal femur fractures in patients with severe coexistent injuries. Open nailing should be reserved for cases in which an adequate reduction cannot be achieved by closed methods. PMID- 10149648 TI - Wrist arthroscopy. PMID- 10149649 TI - Management of supracondylar fractures of the femur with the GSH intramedullary nail: preliminary report. AB - The GSH supracondylar nail is a closed section rigid intramedullary device that combines the biomechanical advantages of intramedullary fixation with the stability of rigid internal fixation for the management of supracondylar fractures of the femur. The use of this implant is indicated in the management of distal comminuted nonarticular fractures and fractures with intraarticular extension. Intramedullary fixation provides improved fracture stabilization in both elderly patients with osteoporotic metaphyseal bone and in younger patients with extensively comminuted fractures. The experience with the GSH supracondylar nail has shown that it provides better results than supracondylar plating for the stabilization of acute fractures or revision of failed internal fixation. PMID- 10149650 TI - In situ pin fixation of slipped capital femoral epiphysis. PMID- 10149651 TI - Technique and use of Akin osteotomy. PMID- 10149652 TI - Initial experience with a second generation locking femoral nail: the Russell Taylor reconstruction nail. AB - A series of 36 patients with 20 subtrochanteric fractures, 12 ipsilateral neck/shaft fractures, and five intertrochanteric fractures with shaft extension underwent closed intramedullary nailing with the Russell-Taylor reconstruction (RECON) nail. The average Injury Severity Score was 16, and seven of the fractures were open. All fractures were acute injuries, and all but one were treated within 24 hours of admission. Follow-up was obtained at three, six, nine, 12, and 24 months or until the fracture healed. The range of follow-up was one to three years. Complete follow-up was obtained in 33 of 36 patients. Union was achieved in all acute fractures. Shortening occurred in two cases and chondrolysis and avascular necrosis occurred in another patient. Excellent hip and knee range of motion were obtained except in a few cases of ipsilateral limb injuries. While many complex femoral shaft fractures can be treated successfully with first generation locking nails, this study demonstrates that second generation locking nails, such as the RECON nail, offer the added strength and design features necessary for more effective treatment of complex proximal and ipsilateral femoral neck/shaft fractures. PMID- 10149653 TI - Use of a distal trochanteric osteotomy in hip revision. AB - Revision of some Moore stems with a straight lateral shoulder where the stem has subsided distally and laterally may be difficult and can result in fracture of the greater trochanter. A trochanteric osteotomy that extends a long way down the lateral cortex of the femur facilitates this type of revision. A similar approach simplifies revision of proximally-fixed noncemented stems. PMID- 10149654 TI - Incomplete nondisplaced tibial osteotomy for treatment of osteoarthritic knee pain. AB - Intraosseous venous hypertension is considered a significant factor in the production of knee pain secondary to degenerative arthrosis, thus vascular decompression by means of tibial osteotomy is a rational option for treatment of selected patients. A preliminary report is presented of six patients with symptoms of primary or secondary degenerative arthrosis who were treated by incomplete nondisplaced proximal tibial osteotomy with good or excellent results. These patients were refractory to nonoperative treatment and were not deemed suitable candidates for angulated osteotomy, arthroscopic surgery alone, or total knee arthroplasty. Patients ranged in age from 36 to 61 years (mean age: 47 years). Follow-up ranged from .8 to 6.7 years (mean: 3.1 years). The subjects were studied postoperatively by interview, physical examination, radiographs, and bone scans. Results were assessed using the knee rating system of The Hospital for Special Surgery. PMID- 10149655 TI - The value of late remanipulation and nonrigid fixation of redislocated Colles' fracture: a retrospective study. AB - The value of late remanipulation followed by fixation with a Rush rod was studied in 14 patients with Older type 4 Colles' fractures. At follow-up, the dorsal angulation was improved in 13 of 14 patients, and the radial shortening was unchanged. Subjectively, six patients were fully satisfied, five were partially satisfied, and three were unsatisfied with the final result. It is concluded that operative management is successful and patients have good benefit from this form of treatment. PMID- 10149656 TI - Bone grafting with microvascular anastomosis in osteonecrosis of the femoral head. AB - Vascularized fibular grafting decompresses the femoral head, augments structural stability, and places healthy vascularized bone in the area of femoral head necrosis. Patients are selected for the procedure on the basis of symptomatology, age, mobility of the hip, and radiographic stage of the disease. Twenty-four patients were reviewed in the current report. Mean patient age was 33. Seven patients had stage II disease, 4 patients had stage III disease, 10 had early (less than 2 mm collapse) stage IV disease, and 1 had stage V disease. The mean follow-up was 32.8 months (range, 24-54 months). Five procedures failed. The remaining patients have had gratifying results in terms of pain relief, functional improvement, and cessation of disease progression. Longer follow-up will determine if vascularized fibular grafting alters the natural history of the condition and if vascularization of the fibular bone graft offers superior results to those obtained in the past with nonvascularized grafts. PMID- 10149657 TI - Intertrochanteric osteotomy for osteonecrosis. AB - Intertrochanteric osteotomy is an effective surgical option in certain well selected cases of osteonecrosis of the femoral head. The size of the lesion on plain radiographs in the anteroposterior and lateral projections is a critical determinant of success. The best candidates are patients with less than 50% of head involved in the necrotic sector. Collapse of the femoral head is not a contraindication to osteotomy. Location of the necrotic sector determines whether varus, valgus, flexion, or extension are most appropriate alone or in combination. PMID- 10149658 TI - Electrical stimulation of osteonecrosis of the femoral head. AB - Osteonecrosis of the femoral head in the adult is a progressive condition that, if untreated, usually results in femoral head collapse and secondary osteoarthritis. The experimental application of electrical and electromagnetic fields has been shown to favorably affect a number of biological processes pertinent to osteonecrosis of the femoral head and has led to several clinical trials. The condition has been treated by the application of electrical fields invasively by the surgical implantation of electrodes within the femoral head and noninvasively by capacitative or inductive coupling. This review describes results in osteonecrosis of the femoral head with these therapeutic techniques. Stimulation by means of inductive coupling with pulsed magnetic fields seems to be the most promising technique studied so far, but the optimal signal characteristics and device design are not yet known. PMID- 10149659 TI - Cup arthroplasty, surface replacement arthroplasty, and femoral head resurfacing for osteonecrosis. AB - Traditional cup arthroplasty and resurfacing arthroplasty of the femoral head and acetabulum have been proposed as bone-conserving procedures for avascular necrosis of the hip. Resurfacing of only the femoral head is not a definitive procedure but is an alternative to cup arthroplasty and resurfacing arthroplasty of the femoral head and acetabulum; hemiarthroplasty is recommended for the young patient with intact acetabular cartilage. Indications, technique, and clinical results are presented. PMID- 10149660 TI - The bipolar prosthesis in avascular necrosis of the femoral head. AB - Data are presented from five studies assessing the results of hip joint replacements with bipolar prostheses or total hip arthroplasties. Long-term results of 23 cemented bipolar prostheses were comparable with 14 uncemented bipolar prostheses. Excellent or good results were obtained about 60% of the time. Groin pain was objectionable in at least 12% of the patients. In a study of 43 arthroplasties performed between 1971 and 1982 in 51 patients with systemic lupus erythematosus and avascular necrosis of the femoral head, 29 cemented total hip arthroplasties were compared with 14 bipolar prostheses. Excellent or good results were obtained in 90% of the total hip arthroplasties and only 50% of the bipolar prostheses. A study of the complications and reoperations of both cemented and uncemented bipolar and total hip replacements performed between 1982 and 1986 showed a higher incidence of both complications and reoperations with the bipolar prosthesis. Clearly, the results of bipolar prostheses in avascular necrosis are inferior to those of total hip replacement. PMID- 10149661 TI - Total hip arthroplasty for osteonecrosis. AB - The success of Charnley cemented total hip arthroplasty for osteonecrosis of the femoral head was assessed using survival analysis. Eighty-seven total hip arthroplasties were followed up for an average of 5.7 years (range, 1.4-13.0 years). There were 59 women and 28 men. The average age was 60 years (range, 30 84 years). Using Charnley hip scores, all patients showed significant progress. The survival analysis showed that using femoral loosening, revision, and pain scores less than 5 as end points, survival was 0.61, 0.94, and 0.81, respectively. With revision as an end point, there were no differences between patients in groups less than 50 and greater than or equal to 50 years of age, weighing less than 185 and greater than =185 lb, and men versus women. There was an 11.5% overall revision rate. Charnley cemented total hip arthroplasty is a viable alternative for patients with painful osteonecrosis. PMID- 10149663 TI - Cataract surgery and lens implantation. PMID- 10149662 TI - Osteonecrosis of the hip: summary and conclusions. AB - This concluding chapter provides a summary and overview of a complex topic. It reviews the current concepts regarding the etiology and pathogenesis and describes methods for the early diagnosis, staging, and evaluation of avascular necrosis. Treatment options are discussed, including the role of conservative or nonoperative management, the procedures designed to retard progression and preserve the femoral head, and the arthroplasties and other reconstructive procedures required after femoral head collapse. PMID- 10149664 TI - Surgical methods. PMID- 10149665 TI - Management of the traumatic cataract. PMID- 10149666 TI - Intraocular lenses. PMID- 10149667 TI - Laser medicine. PMID- 10149668 TI - Optics of intraocular lenses and refractive keratoplasty. PMID- 10149669 TI - Contact lens update: problems and progress. PMID- 10149670 TI - Ophthalmic instruments. PMID- 10149671 TI - Diagnosis and follow-up of primary open-angle glaucoma. PMID- 10149672 TI - Treatment of the pediatric glaucomas. PMID- 10149673 TI - Laser surgery in glaucoma. PMID- 10149674 TI - Management of diabetic retinopathy. PMID- 10149675 TI - Advances in vitreoretinal surgery. PMID- 10149676 TI - New developments in contact lenses and corneal surgery. PMID- 10149677 TI - Cornea in organ culture. PMID- 10149678 TI - Surgical treatment of uveitis. PMID- 10149679 TI - An evaluation of nitrous oxide analgesia during transcutaneous pacing. AB - Transcutaneous cardiac pacing (TCP) is a promising prehospital intervention, but there are little data available regarding protocols to improve patient tolerance to TCP. A 50:50 nitrous oxide:oxygen analgesic mixture also is a commonly employed prehospital intervention. In this randomized, prospective study, we compared the discomfort experienced by 18 healthy subjects when paced in two trials at the capture threshold: one following breathing of a 50:50 nitrous oxide:oxygen mixture; and the second only breathing room air. Discomfort was rated on an analog scale from 1 (minimal discomfort) to 10 (severe pain). Of the 18 subjects, 15 (83%) reported that nitrous oxide improved the tolerance to pacing at capture threshold. The median pain scores at capture threshold in the nitrous oxide and room air group were 3.8 and 5.0 respectively (P less than .05). Nine of the subjects tolerated TCP for the maximum allotted time of 30 seconds in each trial; six tolerated TCP for a longer time period in the nitrous oxide trial; three tolerated TCP longer in the room air trial. These data suggest that inhalation of 50:50 nitrous oxide:oxygen mixture may improve tolerance to TCP in the conscious patient. PMID- 10149680 TI - Critical review: an evaluation of nitrous oxide analgesia during transcutaneous pacing by Kaplan, Heller, McPherson, and Paris. PMID- 10149681 TI - Use of nitrous oxide:oxygen mixtures in prehospital emergency care. National Association of Emergency Medical Services Physicians. PMID- 10149682 TI - The prehospital use of albuterol inhalation treatments. AB - The use of bronch odilators in the prehospital EMS setting is common. This study examined the safety of the administration of 2.5 mg albuterol using a hand-held nebulizer for the treatment of such patients. A total of 55 patients were included. Following treatment, peak expiratory flow rates (PEFR) increased a mean of 27 L/min, ventilatory rate decreased four breaths/min, heart rate decreased slightly, and systolic blood pressure increased 10 mmHg. Five of the 53 patients in whom cardiac rhythm was monitored, had premature ventricular complexes prior to treatment; only one did following therapy. Breath sounds improved in 61% and were unchanged in 39%. Breathing was reported by the patient as improved in 51 of the 53 (93%) and only one felt worse. Adverse reactions were reported in 15%, but none were severe. This study shows that albuterol (2.5 mg) administration by hand-held nebulizer is both safe and efficacious in the prehospital setting. PMID- 10149683 TI - Prehospital use of pulse oximetry in rotary-wing aircraft. AB - A prospective study of 200 patients was conducted to evaluate the use of pulse oximetry as an adjunct to clinical monitoring of clinically ill patients transported by rotary-wing aircraft with non-pressurized cabins. Thirty-four subjects (17%) were found to have significant hemoglobin desaturation of less than 90%, as defined by pulse oximetry (SpO 2). Data were recorded continuously for later review. Desaturation often was noted prior to alterations in vital signs or clinical appearance. In 32 of 34 hypoxemic subjects (94%), therapeutic interventions corrected the low SpO 2. The use of pulse oximetry permitted measures for cardiorespiratory support to be instituted and assessed more rapidly than otherwise would have been possible. The availability of a continuous record of SpO 2 facilitated detailed review of case management. It is concluded that the use of pulse oximetry is a practical and valuable adjunct for monitoring critically ill patients transported by rotary-wing aircraft. PMID- 10149684 TI - A comparison of field techniques used to pressure-infuse intravenous fluids. AB - Application of pressure infusion bags may increase intravenous (IV) flow rates three-fold. Commercially available pressure infusers, manual squeezing of the IV fluid bag, inflating a blood pressure (BP) cuff around the bag, and kneeling on the bag have been used by prehospital personnel attempting to augment fluid infusion rates. To test the efficacy of each these methods, seven experienced paramedics were asked to employ each method in two trials using a 1-liter bag of saline through a 14-gauge, 5.7cm catheter and a standard administration set. Gravity flow from 80 cm served as the control. Pressure infusers generated flow rates of 257+/-54 ml/min and 296+/-53 ml/min when inflated to 300 mmHg and maximum pressure respectively. This rate was 2-2.5 times that of gravity flow (123+/-2 ml/min) and significantly greater than those rates obtained by any other method (p less than .0005). Manually squeezing the bag also was significantly better than was gravity flow with flow rates of 184+/-46 ml/min and 173+/-40 ml/min achieved by each of two different squeezing methods (p less than .01). Neither blood pressure (BP) cuff application and inflation (135+/-28 ml/min) nor kneeling on the bag (125+/-36 ml/min) was better than gravity alone. These results indicate that pressure infusers should be used to the exclusion of other field methods of supplying infusion pressure. If pressure infusers are not available, manually squeezing the bag is the only alternative acceptable in the field. PMID- 10149685 TI - Analysis of hospital ability to provide trauma services: a comparison between teaching and community hospitals. AB - HYPOTHESIS: Teaching hospitals (TH) can maintain the American College of Surgeons Committee on Trauma (ACSCOT) criteria for Level II trauma care more consistently than can community hospitals (CH). METHODS: A retrospective analysis of 2,091 trauma system patients was done to determine if TH in an urban area are better able to meet the criteria for Level II trauma care than are CH. During the study period, a voluntary trauma plan existed among five hospitals; two TH and three CH. A hospital could accept patients that met trauma system entry criteria as long as, at that moment, it could provide the resources specified by ACSCOT. Hospitals were required to report their current resources accurately. A centralized communications center maintained a computerized, inter-hospital link which continuously monitored the availability of all participating hospitals. Trauma system protocols required paramedics to transport system patients to the closest available trauma hospital that had all the required resources available. Nine of the required ACSCOT Level II trauma center criteria were monitored for each institution emergency department (ED); trauma surgeon (TS); operating room (OR); angiography (ANG); anesthesiologist (ANE); intensive care unit (ICU); on call surgeon (OCS); neurosurgeon (NS); and CT scanner (CT) available at the time of each trauma system entry. RESULTS: With the exception of OR, TH generally maintained the required staff and services more successfully than did CH. Further, less day to night variation in the available resources occurred at the TH. Specifically, ANE, ICU, TS, NS, and CT were available more often both day and night, at TH than CH. However, OR was less available at TH than CH during both day and night (p less than .01). CONCLUSIONS: In this community, TH provided a greater availability of trauma services than did CH. This study supports the designation of TH as trauma centers. A similar availability can be performed in other communities to help guide trauma center designation. PMID- 10149686 TI - Assessment of a triage label system during a major incident exercise. AB - The Metag triage label system was assessed during a major incident exercise at an international airport. The exercise simulated a crash of a plane carrying 40 passengers within the airport boundaries. A secondary incident also was staged involving an explosion resulting in a fire with three victims injured. The exercise involved the airport, fire, police, ambulance, and medical services of three counties--Leicestershire, Derbyshire, and Nottinghamshire. Use of the labels enabled evaluation of the triage process, early medical intervention for victims, and completion of the cards. PMID- 10149687 TI - Development of medical technology in emergency medical services. PMID- 10149688 TI - An analysis of invasive airway management in a suburban emergency medical services system. AB - INTRODUCTION: Airway management is the most critical and potentially life-saving intervention performed by emergency medical service (EMS) providers. Invasive airway management often is required in non-cardiac-arrest patients who are combative or otherwise uncooperative. The success of prehospital invasive airway management in this patient population was evaluated. METHODS: A retrospective review was undertaken of the records of all such patients requiring endotracheal intubation over a three-year period (1987-1989). The study population included 278 patients enrolled by five advanced life support (ALS) units serving a suburban population of 425,000. Field trip sheets were reviewed for diagnosis, intubation method and success, number of intubation attempts, provider experience, reasons for unsuccessful intubations, and complications. RESULTS: A total of 394 invasive airway management attempts were performed on 278 patients. The overall successful intubation rate was 75% (41% orotracheal, 52% nasotracheal, 7% other or unknown). The most common diagnoses were COPD and pulmonary edema (30%) and trauma (24%). Experienced providers were successful on the first attempt in 57% of cases compared to 50% by inexperienced providers (p=.24). Multiple intubation attempts were required in 33% of the patients. There was no statistically significant difference in success rates between the orotracheal and nasotracheal methods (p=.51). The most common reason for unsuccessful intubation was altered level of consciousness. Complications occurred with 7% of successful attempts and in 18% of unsuccessful attempts (p less than .001). Forty-six percent of the patients who were not intubated successfully in the field and required intubation in the emergency department (ED) received a neuromuscular blocking agent prior to successful intubation. CONCLUSION: Prehospital providers can intubate a high but improvable proportion of non-cardiac-arrested patients by both the orotracheal and nasotracheal routes. The use of pharmacologic adjuncts to facilitate the prehospital intubation of selected, non-cardiac-arrested patients is a promising adjunct that needs further evaluation. PMID- 10149689 TI - Implementation of a regional medical control audit system. PMID- 10149690 TI - The pharyngeo-tracheal lumen (PTL) airway is being critically evaluated in the prehospital setting. PMID- 10149691 TI - Multi-agency, prehospital evaluation of the pharyngeo-tracheal lumen (PTL) airway. AB - INTRODUCTION: The purpose of this study was to assess subjectively the performance of the pharyngeo-tracheal lumen (PTL) airway in a multi-agency, prehospital emergency medical service (EMS) environment. METHODS: Data were recorded by the EMS provider on 167 [corrected] adult patients (age range 16-92 years) in whom a PTL or endotracheal (ET) airway insertion was attempted. Analysis of variance and Fisher's Exact tests were used for statistical analysis. RESULTS: There were no significant differences between the PTL and ET groups, either in patient demographics or in rates of successful ventilation with either airway overall or in trauma-related versus non-trauma-related cases, male versus female patients, or volunteer versus paid EMS providers. Basic life support (BLS) providers were able to ventilate successfully with the PTL as frequently as were ALS providers using the ET tube. CONCLUSIONS: The PTL appears to be a useful primary airway for BLS providers and for ALS providers who are called upon infrequently to manage an airway acutely. The PTL also may be used as an alternate airway for ALS providers when tracheal intubation cannot be accomplished. Further study is needed to define the effectiveness of the PTL in the management of patients with trauma-related injuries. PMID- 10149692 TI - Gas-powered and portable ventilators: an evaluation of six models. AB - INTRODUCTION: Gas-powered resuscitators (ventilators) designed to be used primarily for resuscitation should be basic and simple to use. They offer many advantages over manual methods of ventilation during in-hospital cardiopulmonary resuscitation. Portable ventilators intended for critical care transport require additional, more sophisticated features such as: adjustable pressure limiting valves, air-mixing, airway pressure gauge, independent tidal volume and rate controls, and a Positive End-Expiratory Pressure (PEEP) valve. The performance of six gas-powered resuscitators/portable ventilators (TransPAC, Oxylog, Ambu Matic, ERA 2000, Uni-Vent, and MARS) was evaluated. METHODS: The accuracy of volumes delivered to a test lung at three different compliance and resistance settings, was assessed for each ventilator prior to clinical evaluation during cardio-pulmonary resuscitation (CPR) and patient transport. RESULTS: In each circumstance, measured tidal volumes and level of minute ventilation decreased as resistance was increased and compliance reduced. Much of this loss of measured tidal volume occurred through inspiratory pressure relief valves that tended to start leaking at pressures below the preset level. Increasing levels of back pressure resulted in further reductions in tidal volume when the ventilators were tested using the air-mix mode (available on three of the devices). In general, each resuscitator functioned well when used during CPR within the hospital. CONCLUSIONS: Each resuscitator tested failed to deliver the preset volumes and this must be considered during their use. Inspiratory pressure relief valves for all but one of the ventilators tested would not permit the delivery of adequate levels of ventilation in patients with low pulmonary compliance and/or high airway resistance. PMID- 10149693 TI - Infant ventilation and oxygenation by basic life support providers: comparison of methods. AB - INTRODUCTION: Little information is available in the performance of infant ventilation by basic life support (BLS) personnel. HYPOTHESIS: There are no significant differences between mouth-to-mouth (M-M), mouth-to-mask (M-Ma), pediatric bag-mask (PBM), and adult bag-mask (ABM) devices in the percent of acceptable breaths delivered by BLS providers. METHODS: Fifty certified BLS providers performed five ventilation methods in random sequences for 60 seconds each on a 5kg infant mannequin following standardized instructions. Supplemental oxygen, 10 l/min, was supplied with one M-Ma trial and PBM methods. Airway patency, peak airway pressure (PAP), ventilatory rate (VR), tidal volume, and delivered oxygen concentration (FiO 2) were recorded. The percent of breaths with excessive PAP (i.e., greater than 30 mmHg), percent of acceptable breaths using loose (i.e., 25-125ml) and strict (i.e., 50-100ml) criteria, and FiO 2 at 15, 30, 45, and 60 seconds were compared between ventilation methods using ANOVA. RESULTS: For all subjects and those with a patent airway (n=36), there were no significant differences in the percentage of acceptable breaths produced by PBM (56+/-6) (mean+/-SEM; all subjects) and ABM (41+/-6.2) was significantly greater than M-Ma, with and without a patent airway. Although RR and the percentage of excessive breaths were not significantly different, the percentage of acceptable breaths and FiO 2 delivered with each ventilation method was significantly better in the patent airway group.(ABSTRACT TRUNCATED AT 250 WORDS) PMID- 10149694 TI - The extracorporeal joining of donor (pig) spleen (EJDS) for the treatment of patients with the complications of shockogenic trauma. AB - INTRODUCTION: A principal cause of death following presumed recovery from an episode of shock is the development of shockogenic trauma [post-resuscitation syndrome]. The causes of this complication remain unclear and its various treatments continue to be controversial. HYPOTHESIS: The use of perfusion of the blood of patients suffering shockogenic trauma through a donor pig spleen will decrease the mortality from the complications of this process. METHODS: Freshly harvested pig spleens were adjoined to the venous circulation of patients suffering severe shockogenic trauma and the patient's blood perfused through them for periods of 30-60 minutes. The mortality rates of similar patients treated in this manner were compared with those not treated. Blood analyses included measures of the functions of the renal, immune, and coagulation systems. RESULTS: The experience with 212 Extracorporeal Joinings of Donor (pig) Spleens (EJDS) by means of a veno-venous shunt for the treatment of 86 patients with severe shock trauma and its complications is reported. The clinical effects consisted of decreasing signs of intoxication, namely reduction in fever and in the severity of associated encephalopathy. Extracorporeal joinings on donor (pig) spleens (EJDS) was followed by a decline in the concentration of "middle molecules," fibrinogen levels, leucocyte intoxication index, and the number of circulating immune complexes at different times following completion of the procedure. The number of blood cells remained constant. On the following day, there occurred an increase in the number of thrombocytes. In addition, there was a decline in the quantity of circulating particles in the plasma.(ABSTRACT TRUNCATED AT 250 WORDS) PMID- 10149696 TI - Radiologic evaluation of neuro-ophthalmologic disease. PMID- 10149697 TI - Cosmetic eyelid and brow surgery. PMID- 10149698 TI - Lacrimal surgery. PMID- 10149699 TI - Ophthalmologic services provision: variations in the delivery of cataract services. PMID- 10149700 TI - Screening for ocular disease and visual impairment. PMID- 10149701 TI - Management of retinal vein occlusion. AB - Recent research into the relationship between retinal venous occlusion and general vascular disorders has shown that retinal venous occlusion seems to be related only to systemic hypertension. The role of systemic hemorrheologic parameters in the pathophysiology of venous occlusion is a controversial one. Of the various treatment modalities, isovolemic hemodilution has been found to improve retinal perfusion, but the treatment must be repeated about once a week for at least 2 months. The presence of tissue hypoxia in areas of ischemic venous occlusion has been confirmed by measurements of preretinal oxygen pressure in experimental venous occlusion. Reduced preretinal oxygen pressure in these experimental cases normalized after retinal scatter photocoagulation. The inhibiting role of posterior vitreous detachment on posterior segment neovascularization and the fact that panretinal photocoagulation has a better effect on anterior than on posterior segment neovascularization have been evaluated in clinical studies. PMID- 10149702 TI - Recent advances in the treatment of proliferative sickle cell retinopathy. AB - Sickle cell eye disease is characterized by microvascular occlusion that affects the peripheral retinal vasculature and results in retinal ischemia and the development of proliferative sickle cell retinopathy. Complications of proliferative sickle cell retinopathy such as vitreous hemorrhage and retinal detachment are the most common causes of visual loss in this disease. Prevention of this visual loss is therefore contingent on the prevention or early detection and treatment of proliferative sickle cell retinopathy. Most effort has been directed toward therapy for established proliferative sickle cell retinopathy, and several therapeutic trials have been reported. Much less is known about the risk factors for development of proliferative sickle cell retinopathy and its natural history, in particular the true incidence of permanent visual loss. Visual loss is believed to be predominantly a complication of perfused proliferative sickle cell retinopathy, and its autoinfarction renders such visual loss less likely. To better define the place of treatment, identification of the determinants of autoinfarction is required, but identification of patients whose proliferative sickle cell retinopathy is likely to proceed to visual loss is of greater importance. PMID- 10149703 TI - Cataract surgery and diabetic retinopathy. AB - The introduction of extracapsular cataract extraction (or phacoemulsification) with placement of a posterior chamber intraocular lens is a major benefit to diabetics because it probably does not lead to as rapid an acceleration of retinopathy as does intracapsular cataract extraction. Nevertheless, because many patients develop anterior chamber complications and neovascularization or severe macular edema, considerable caution is required. All patients must have close postoperative follow-up. Patients with preoperative macular edema have the worst prognosis, but the timing of treatment for postoperative macular edema remains to be worked out. All of the papers included in this review shed light on this challenging problem. PMID- 10149704 TI - Evolution of imaging far from complete. PMID- 10149705 TI - Diagnosis and therapy merge in 21st century. PMID- 10149706 TI - Diffusion-weighted MRI reveals white matter tracts. PMID- 10149707 TI - Advances roll back limitations of MRA. PMID- 10149708 TI - MR views sports-related bony, muscular injuries. PMID- 10149709 TI - Nonvascular endoluminal ultrasound makes debut. PMID- 10149711 TI - Breast biopsy. PMID- 10149710 TI - Use of contrast media beneficial to angioplasty. PMID- 10149712 TI - Ultrasound squares off against amniocentesis. PMID- 10149713 TI - Spiral scan capability increases utility of CT. PMID- 10149714 TI - CT helps complete puzzle of lumbar spine stenosis. PMID- 10149715 TI - Low-field design eases MRI-guided biopsies. PMID- 10149716 TI - Ultrasound secures place in breast Ca management. PMID- 10149717 TI - Refinements widen utility of interventional devices. PMID- 10149718 TI - Nonionic complexes will rival Gd-DTPA. PMID- 10149719 TI - Fast sequences add depth to 3-D images. PMID- 10149720 TI - Computerized diagnosis comes to mammography. PMID- 10149721 TI - Appraising the carotids with color-flow Doppler. PMID- 10149722 TI - Dual-isotope imaging speeds stroke assessment. PMID- 10149723 TI - Detecting lung disease with high-resolution CT. PMID- 10149724 TI - ESWL still integral to gallstone therapy. PMID- 10149725 TI - Conversion to nonionics packs economic punch. PMID- 10149726 TI - Developers can't agree what MRA actually is. PMID- 10149727 TI - Barriers begin to fall in bone densitometry. PMID- 10149728 TI - 3-D MRI systems swell diagnostic capability. PMID- 10149729 TI - 3-D ultrasound creates complex arterial images. PMID- 10149730 TI - US provides subtle clues aiding ectopic evaluation. PMID- 10149731 TI - MRI proves superiority in evaluating spinal cord. PMID- 10149732 TI - Local area networks oblige diverse needs. PMID- 10149733 TI - Screening strategies aim to increase compliance. PMID- 10149734 TI - Discriminating analysis uncovers breast lesions. PMID- 10149735 TI - New procedures upgrade genitourinary radiology. PMID- 10149736 TI - Art of positioning needs revival in mammography. PMID- 10149737 TI - IMACS support shift toward enhanced service. PMID- 10149738 TI - Mini-PACS help solve image problems today. PMID- 10149739 TI - MR essential in screening patients with knee pain. PMID- 10149740 TI - Laser angioplasty offers example of overreaction. PMID- 10149742 TI - MRI offers case study of technology's impact. PMID- 10149741 TI - Ultrasound links venous pathophysiology to pain. PMID- 10149743 TI - Phase-contrast imaging documents CSF in motion. PMID- 10149744 TI - Challenges remain in 3-D ob/gyn ultrasound. PMID- 10149745 TI - Spiral scanning puts new spin on fast MR. PMID- 10149746 TI - Workstations speed up soft-copy imaging. PMID- 10149747 TI - High-speed MR assists in abdominal diagnoses. PMID- 10149748 TI - Pulsed-spray thrombolysis accelerates clot dissolution. PMID- 10149749 TI - Void of important data in contrast controversy. PMID- 10149750 TI - 4-tesla sites initiate clinical MR studies. PMID- 10149751 TI - Evaluating image quality in high-res ultrasound. PMID- 10149752 TI - Developing EMS quality assessment indicators. AB - An emergency medical service (EMS) system is part of a broad health care system which no longer can be concerned exclusively with patient transportation. Integration of prehospital and in-hospital emergency care must be achieved to provide quality patient care. This article suggests modifications in the Joint Commission on Accreditation of Healthcare Organization's (JCAHO) 10-Step Model indicators that should help in an evaluation of the issues associated with the diversion of patients from Emergency Departments. The JCAHO model is one that can be used to help integrate prehospital and inhospital care. PMID- 10149753 TI - Air medical dispatch: guidelines for scene response. National Association of Emergency Medical Services Physicians. PMID- 10149754 TI - An appraisal of barrier agents in the reduction of adhesion formation following surgery. AB - Reduction of pelvic adhesion formation and reformation represents a major challenge for the reproductive pelvic surgeon. Recently developed barrier methods appear promising, offering the advantage of nonsystemic therapy. Presented is a review of the literature and appraisal of the evolution of barrier agents. The current state-of-the-art barrier agent Interceed (TC-7) is discussed. PMID- 10149755 TI - Clinical applications of a new Fujinon operating fiberoptic hysteroscope. AB - A soft and rigid operating fiberoptic hysteroscope (4.8 mm outer diameter) was developed by Lin et al., with the support of a Fuji Photo Optical Company. The functional part of the telescope consists of three sections: a soft, flexible front section, a rigid rotating middle section, and a semirigid, self-retaining rear section. With these features, the intrauterine target can be approached easily, directly, and closely, usually without cervical dilation or anesthesia and with the operator in a comfortable position. Clinical applications were divided into four groups: (1) directed biopsy, (2) transcervical tubocornual recanalization for the management of cornual occlusion, (3) hysteroscopic chorionic villus sampling, and (4) the removal of lost IUDs. Experience with 153 procedures is presented. No complications were encountered. The authors conclude that this new hysteroscope is a very useful tool for the treatment of intrauterine lesions, used easily in the office and the operating room alike. PMID- 10149756 TI - Hysteroscopic removal of submucous leiomyomas. AB - Uterine leiomyomas are benign neoplasms that, when symptomatic, may require surgical treatment. The most symptomatic leiomyomas are of the submucous variety, causing persistent or recurrent uterine bleeding. Fifty-nine women experiencing abnormal uterine bleeding, dysmenorrhea, and/or infertility were diagnosed to have submucous leiomyomas, and of these, 52 were treated by hysteroscopic removal. In all women treated, the symptoms disappeared or markedly decreased. Of 16 patients with associated infertility, 10 conceived and 8 of these delivered a viable infant vaginally. Two women had a spontaneous abortion at 6 weeks and 11 weeks gestation, respectively. Although hysteroscopic removal of submucous leiomyomas is feasible in some patients, specific criteria for patient selection are needed that will allow the hysteroscopist to avoid failures and prevent complications. Hysteroscopy offers the best diagnostic method to detect or confirm submucous leiomyomas and, in selected cases, provides a good surgical alternative for treatment. PMID- 10149757 TI - Invasive cervical cancer after laser vaporization for cervical intraepithelial neoplasia: a 10-year experience. AB - The treatment of cervical intraepithelial neoplasia by laser vaporization has been in progress at the Birmingham and Midland Hospital for Women since September 1977. In this interval, 3182 patients have been treated. Seven women have developed invasive cancer at intervals 4-34 months postlaser. The lesions diagnosed were stage Ia (3), Ib (1), IIb (1), IIIa (1), and IV (1). These case histories are presented. On retrospective assessment, there were contraindications to local destructive treatment in six of seven cases. This series emphasizes the need for thorough evaluation of patients before embarking on local destructive treatments and emphasizes the need for careful follow-up of treated patients. PMID- 10149758 TI - Laser treatment of cervical intraepithelial neoplasia and the endocervical button. AB - A prospective randomized clinical trial was undertaken to investigate the relationship between the shape of cervical tissue vaporized with CO 2 laser and the postoperative location of the squamocolumnar junction. It has been suggested that a button of columnar epithelium may be everted onto the exocervix by vaporizing a shallow 1 mm trench around the endocervical canal after the evaporization cone has been completed. Eighty-eight patients with cervical intraepithelial neoplasia (CIN) suitable for treatment by CO 2 laser were randomized into two groups. The transformation zone was ablated to 6 mm in all patients. In the flat group (n = 45), the base of the cervical defect was flat. In the contour group (n = 43), an additional 1 mm trench was vaporized at the periphery of the defect. Both groups were similar with respect to age, use of oral contraceptives, parity, operative complications, degree of CIN, and volume of tissue ablated. On follow-up at 6 months, significantly more patients in the contour group had an endocervical button of columnar epithelium compared to the flat group. No difference was seen at 3 and 12 months. There was a moderate relationship between the volume of tissue vaporized and the area of the button in the contour groups (p less than 0.001) but not in the flat group. The presence of squamous metaplasia tends to increase with time. There were 2 recurrences of CIN at 1 year follow-up. PMID- 10149759 TI - Relative strength of a new suture technique for fascial closure. AB - In an attempt to decrease the risk of fascial dehiscence, a new suture technique for fascial closure is proposed, referred to as the "secured" stitch. The secured interrupted stitch is performed by taking a double bite of fascia at each traditional site of fascial puncture. Relative strength of the secured interrupted stitch in comparison with the simple interrupted stitch is determined in samples of fresh bovine fascia. A significantly greater force is required to disrupt fascia repaired with the secured stitch compared with a simple interrupted repair. The secured stitch may afford a greater degree of protection from fascial dehiscence. PMID- 10149760 TI - Hysteroscopic sterilization with the Nd:YAG laser. AB - In 10 rabbits, ablation of the uterine horn endometrium and the fallopian tube was performed with the Nd:YAG laser at a power of 60 W using the touch technique. Eight weeks postsurgery, biopsies of the tissue site were obtained showing that the endometrium and tubal mucosa were completely destroyed. Thirty women were sterilized using a similar technique hysteroscopically. Tubal occlusion was demonstrated by hysterosalpingography in all cases at 3 months postoperatively. PMID- 10149761 TI - Pregnancy rates following tubal anastomosis: Pomeroy partial salpingectomy versus electrocautery. AB - Eighty-six tubal anastomosis patients were analyzed for successful outcome. Controlling for tubal length, we analyzed a number of possible confounding variables for their effects on pregnancy, including the type of sterilization performed. Results indicated term pregnancies in 63.9% of all patients, with no significant effect seen due to type of sterilization procedure. Monthly fecundity rates and life table analysis similarly demonstrated no significant differences between the two sterilization groups. With the use of multiple logistic regression, only age proved to be a significant predictor of pregnancy (p = 0.008). Type of sterilization as well as other tested variables had no demonstrable effect. We conclude that with careful initial selection of patients, exclusion of women without an anastomosed tube 4 cm or longer, and meticulous surgical technique, successful pregnancy rates higher than those generally quoted can be achieved. PMID- 10149762 TI - Incidental cholecystectomy in the treatment of gynecologic malignancy. AB - From October 1985 through September 1989, 46 patients with gynecologic malignancy had an incidental cholecystectomy at the time of surgery for their primary disease at the Albany Medical Center Hospital. The mean age was 59 (range 20-87 years). Indications for the gynecologic oncologic operation included endometrial carcinoma in 21 patients, suspected ovarian carcinoma in 17 patients and carcinoma of the cervix in 8 patients. Twenty-three patients (50%) had a preoperative diagnosis of cholelithiasis, and in the remaining 23 patients, the diagnosis of significant gallbladder disease was made intraoperatively. There was only 1 (2.2%) postoperative complication secondary to the cholecystectomy. Prophylactic cholecystectomy accompanying gynecologic cancer surgery can be performed safely and avoids the potential for postoperative cholecystitis and a second operative procedure. PMID- 10149763 TI - Conservative treatment of CIN: a review. AB - This review examines the indications for and the various therapeutic techniques used in the management of CIN. There is an extensive review of the literature. We believe that conization should be the long-term therapy of choice in over 90% of patients with CIN. PMID- 10149764 TI - Laser vaporization of genital condylomata in pregnancy. AB - Sixteen pregnant women with genital condylomata acuminata were treated with laser vaporization to assess effectiveness, complication rate, and impact on recurrence. Patients were treated at a gestational age of 13-35 weeks. No recurrences occurred before delivery. Five patients experienced uterine contractions before 37 weeks. Only one delivery before 37 weeks may have been attributed to the laser therapy. Four recurrences were detected during postpartum follow-up. Laser vaporization is a safe and effective treatment for condyloma during pregnancy. It is effective in maintaining a lesion-free state during pregnancy, but postpartum recurrences are not rare. PMID- 10149765 TI - Laminaria tent for diagnostic and operative hysterectomy. AB - Laminaria tents were inserted in 300 nonpregnant women to induce cervical dilation before diagnostic or operative hysteroscopy. All laminaria tents were inserted without anesthesia following uterine sounding. Diagnostic hysteroscopic procedures were performed with a 5.0 mm hysteroscope with video monitoring within 2-3 hours after insertion of the laminaria tent. Minimal analgesia was used. Operative procedures were performed approximately 24 hours after insertion of the laminaria tent with a 9 mm operative resectoscope. There were no complications with the use of the laminaria tent, such as infections or bleeding, but a few patients complained of mild menstrual-like lower abdominal discomfort. In all cases, the laminaria tent resulted in a softening and dilation of the cervix, which facilitated the passage of the diagnostic and operative hysteroscope. PMID- 10149766 TI - A new surgical technique for repairing cystocele in hysterectomized women. AB - No satisfactorily efficient surgical procedure for correction of cystocele subsequent to hysterectomy has so far been described. Anterior colporrhaphy generally is associated with risk of relapse, since no fibrous tissues or ligaments are available for sufficient fixation to the anterior pelvic wall. In the present study, a new surgical procedure was used, simultaneously performed transabdominally and vaginally by two surgeons. The elevated bladder was fixed without sutures to the posterior retropubic periosteum and to the lower abdominal wall by a two-component fibrin sealant (Tisseel, Immuno AB, Stockholm, Sweden) after invagination of the cystocele. Postoperatively, the vagina was tamponed for 12 hours, and a Foley catheter was used for 4-5 days. Antibiotics were administered for 7 days. This technique has been evaluated in nine patients. The procedure was found easy to perform and well tolerated by the patients. During the observation time 0.5-4 years, no relapse has been registered. This surgical procedure also proved to prevent postoperative stress incontinence, previously concealed by the cystocele. PMID- 10149767 TI - Should hysteroscopic Nd:YAG endometrial ablation be used only for women in whom hysterectomy would be contraindicated? Pro. PMID- 10149768 TI - Should hysteroscopic Nd:YAG endometrial ablation be used only for women in whom hysterectomy would be contraindicated? Con. PMID- 10149769 TI - Adhesion reformation: reduction by the use of Interceed (TC7) plus heparin. AB - Adhesions frequently develop after surgical procedures. Several groups have demonstrated that reduction of adhesion reformation is more difficult than reduction of adhesion formation. Previous studies have demonstrated the efficacy of Interceed (TC7) (oxidized regenerated cellulose) plus heparin in reducing adhesion formation. Adhesions were created using a previously standardized rabbit uterine horn model. After adhesiolysis, rabbits were assigned randomly to one of four groups: control, Interceed (TC7) alone, Interceed (TC7) plus 500 USP units heparin/horn, and Interceed (TC7) plus 1000 USP units heparin/horn. Adhesion reformation was evaluated 2 weeks later. Combination of the Interceed (TC7) barrier plus heparin resulted in a significant reduction of the adhesion reformation scores. It is concluded that Interceed (TC7) plus heparin is efficacious in reduction of both adhesion formation and adhesion reformation. PMID- 10149770 TI - A new approach to hysteroscopic cannulation of the fallopian tube. AB - Hysteroscopic cannulation of the fallopian tube has become an essential part of the treatment of interstitial fallopian tube obstruction. This report describes the use of a flexible instrument that can be introduced through a rigid hysteroscope for the purpose of hysteroscopic tubal cannulation. PMID- 10149771 TI - The use of carbon dioxide laser in female urology. AB - The carbon dioxide (CO 2) laser can be used to treat a variety of soft tissue disorders encountered by the urogynecologist. Urethral caruncles, red fleshy masses located at the urethral meatus, can be excised and vaporized using the CO 2 laser. Distal urethral diverticula, a common urologic disorder in women, can be marsupialized using the CO 2 laser. The epithelial lining of the diverticulum can be vaporized, thereby decreasing the risk of recurrence. Distal urethral stenosis may lead to symptoms associated with urethral syndrome and can be caused by a fibroelastic band of tissue. The CO 2 laser can be used to destroy this abnormal tissue band, increasing the caliber of the urethral meatus and improving symptoms. This review details the diagnostic workup of these disorders and describes the surgical management using the CO 2 laser. PMID- 10149772 TI - Use of the cytobrush in postmenopausal women. AB - Patients who were postmenopausal were identified, and the results of a standard Papanicolaou smear using a cotton-tipped applicator were compared with those using a cytobrush. One hundred one postmenopausal women were evaluated between August 1, 1987, and April 9, 1990. The standard Papanicolaou smear with a moistened cotton-tipped applicator yielded endocervical cells in 59 (58%) of the 101 patients, whereas the cytobrush yielded endocervical cells in 90% of the patients. The use of the cytobrush for cervical cytologic screening appears to be of value in postmenopausal women. PMID- 10149773 TI - Self-retaining retractor for vaginal operations. AB - A self-retaining retractor designed for the performance of vaginal operations reduces the physical effort by the assistant, improves the assistant's efficiency, and provides adequate, continuous exposure. In most instances, it eliminates the need for a second assistant. The retractor is composed of a vaginal ring, five retractor blades, four ratchets, and two accompanying bars to secure it in position. The mechanism of self-retraction is achieved by the pushing tension of the retracted tissues on the blades. It is most adequate for educational purposes, since the teaching surgeon, acting as assistant, is not obligated to hold retracting blades and can participate more freely in directing the procedure. The surgeon is provided with continuous adequate exposure regardless of the degree of expertise of the assistants. PMID- 10149774 TI - Is laser surgery superior to cryosurgery for the treatment of high grade CIN? Pro. PMID- 10149775 TI - Is laser surgery superior to cryosurgery for the treatment of high grade CIN? Con. PMID- 10149776 TI - Reproductive surgery vs assisted reproductive technologies: selecting the correct alternative. AB - Many innovations have been made in advanced reproductive technologies (ART) over the past several years. These procedures now yield pregnancy rates of over 20% per cycle, rates that compare favorably to many types of reproductive surgery. Therefore, ART now represents a viable alternative for many patients suffering from infertility. As these pregnancy rates continue to rise, gynecologists will have to choose between ART and reproductive surgery for a larger number of patients. This article reviews the commonly performed reproductive surgical procedures and compares expected postoperative pregnancy rates to those of ART in order to help the gynecologist make this decision. PMID- 10149777 TI - Electrosurgical thin loop conization by selective double excision. AB - Thin loop electrosurgical conization of the cervix was performed in 30 women, using a selective double excision (SDE) technique in order to conserve cervical tissue. The entire excisional cone was completed within 4 minutes, and blood loss was estimated at 5 ml or less. All cervices healed in patterns identical to CO 2 laser conizations. Critical tissue margins were easily identified by the pathologist. Compared to simple loop excisional cones, SDE saved greater than 2 cm3 of cervical stroma. PMID- 10149778 TI - A comparison study of pain associated with endocervical sampling techniques. AB - Endocervical curettage (ECC) is an important tool in the diagnosis and treatment of cervical neoplasia. Its use has been limited, however, because of the pain it can cause. We show that the use of a soft plastic curette cause statistically less pain without compromising the quantity or quality of the sample. PMID- 10149779 TI - Running mass closure of abdominal wounds using absorbable looped suture. AB - Three hundred patients undergoing celiotomies had fascial incisions closed using O-Maxon looped suture employing a knot-free running modification of the Smead Jones method. Two hundred ninety-three patients were evaluated prospectively to determine efficacy and safety of this technique. Seventy-two percent of patients underwent celiotomies for treatment of malignant diseases. A vertical incision was used in 79% and a transverse incision in 21% of patients. Mean fascial closure time was 8.4 minutes (range 3-32), without a significant difference between the vertical and transverse incisions. Overall suture handling was judged as excellent in 44% of the patients and good in 54%. Six weeks postoperatively, wounds were healed in 99% of patients, with less than 1% having residual infection or unclosed, granulating wounds. No herniation or fascial dehiscences occurred in this series. We conclude that Maxon looped suture employing a knot-free running Smead Jones technique appears to be a safe, efficient, and effective closure method in this group of patients. Further follow-up will be required to show whether this outcome is sustained. PMID- 10149780 TI - Reproductive outcome after ovarian surgery: microsurgery versus CO 2 laser. AB - The present study was undertaken to compare CO 2 laser vs microsurgery in ovarian surgery, evaluating both postoperative adhesion formation and reproductive outcome. Eighteen female white New Zealand rabbits were anesthetized, and the ovaries were exposed. At random, one ovary was longitudinally bivalved with a scalpel and then reconstructed by microsurgery. The contralateral ovary was similarly cut, but with a CO 2 laser set at a superpulsed mode. Four weeks after surgery, the rabbits were mated, and two weeks later, the animals were evaluated for extent of postoperative adhesion formation, number of corpora lutea in each ovary, and number of embryos in each uterine horn. The nidation index was calculated. The present study shows no difference in postoperative adhesion formation or reproductive function following ovarian surgery by microsurgery or CO 2 laser. PMID- 10149781 TI - Management of locally advanced squamous cell carcinoma of the vulva. AB - Carcinoma of the vulva is an uncommon malignancy, accounting for 5% of gynecologic cancers. Patients who have locally advanced disease often cannot be managed locally by a radical vulvar resection. Current approaches to the treatment of locally advanced vulvar cancer include ultraradical surgery, radiotherapy, or a combination of treatment modalities. Ultraradical surgery has been used for patients with clinically resectable vulvar lesions and generally has consisted of a radical vulvar operation combined with a partial or total pelvic exenterative type procedure. The use of primary radiotherapy for carcinoma of the vulva remains controversial but may be the only option available when the patient has unresectable disease. Data have accumulated to confirm that megavoltage radiotherapy can cause marked regression of even locally advanced vulvar carcinoma to the point where a more limited resection can then be undertaken, often with an improved resection margin, with sparing of organ function, and improved quality of life. As with preoperative radiotherapy, combined chemoradiotherapy with or without resection has been used increasingly, with some promising results in several squamous cell carcinomas. There are few data on this type of treatment for carcinoma of the vulva. PMID- 10149782 TI - Should conization by hot loop or laser replace cervical biopsy? Pro. PMID- 10149783 TI - Should conization by hot loop or laser replace cervical biopsy? Con. PMID- 10149784 TI - Pregnancy outcome in neosalpingostomy by the cuff vs Bruhat technique using the carbon dioxide laser. AB - Distal tubal occlusion is one of the most challenging conditions that the reproductive surgeon faces in the management of tubal disease. This study was designed to compare the pregnancy rates between two well-known techniques for tuboplasty using the carbon dioxide laser from March 1982 to October 1988. Alternate infertility patients with distal tubal occlusion were assigned to either a cuff or Bruhat technique. Only patients with bilateral hydrosalpinges and no other infertility factors qualified for this study. Nineteen patients had a cuff neosalpingostomy, and 15 patients had a Bruhat neosalpingostomy. Two patients who were assigned to the Bruhat technique had to be changed to the cuff technique because of technical problems. The mean age and length of infertility were similar in both groups. Six patients in the cuff group (31.6%) and 5 (33.3%) in the Bruhat group conceived. One ectopic pregnancy occurred in each group. This study shows that both techniques produce similar pregnancy rates. The Bruhat technique is considerably faster but cannot be applied adequately when the fallopian tubes have thick walls. PMID- 10149785 TI - Bacterial contamination at abdominal hysterectomy: a comparison of staple closure with regular suture closure of the vaginal wall. AB - Bacterial contamination of the pelvis from the vagina at abdominal hysterectomy is assumed to be a major cause of infectious complications. A pilot study was completed to compare the bacterial contamination that occurred when the vaginal vault was closed using an automatic stapling technique with a regular suture method. The findings suggested that there was considerably less contamination using the staple technique and that infectious complications were associated with heavy bacterial contamination from the vagina. More extensive studies of this association are needed to confirm the presented data. PMID- 10149786 TI - Reproductive outcome after fallopian tube canalization and microsurgery for bipolar tubal occlusion. AB - Surgical therapy for coexistent proximal and distal obstruction has consisted of combined proximal (reimplantation of reanastomosis) and distal (salpingostomy) repairs. Data suggest that successful relief of proximal obstruction by fluoroscopically guided tubal canalization (FTC) may be achieved in 60% to 95% of cases. We studied the use of FTC as a preoperative adjunct in 14 patients with coexistent proximal tubal obstruction (PTO) and distal tubal obstruction, progressing to surgical repair of distal disease if proximal patency was achieved. Unilateral (9/14) or bilateral (5/14) PTO was demonstrated on at least one hysterosalpingogram (HSG) and during chromotubation performed as part of the diagnostic laparoscopy. FTC was successful in four patients (28%). HSG revealed proximal reocclusion in two patients. Two patients had persistent proximal patency and underwent distal salpingostomies and adhesiolysis for mild hydrosalpinges and pelvic adhesive disease. No pregnancies have been achieved after 12 and 18 months follow-up. The lower patency rate and higher recurrence rates of PTO when compared to data of prior studies suggest that in vitro fertilization, though more costly, ultimately may represent the most expedient and effective method of management of coexistent proximal and distal tubal disease. PMID- 10149787 TI - Vaginoplasty using amniotic membranes in cases of vaginal agenesis or after vaginectomy. AB - Various treatments have been proposed for vaginal agenesis. The authors describe successful procedures using amniotic membranes as a graft on vaginoplasties. The amnion was not stripped from the chorion. The results showed the vagina to be well formed and of normal depth and caliber. PMID- 10149788 TI - Artificial sapphire contact probes in Nd:YAG endometrial ablation: a quantitative in vitro and in vivo study. AB - Artificial sapphire contact probes offer theoretical advantages in Nd:YAG endometrial ablation. To examine this, an in vitro and in vivo study of laser tissue interaction was performed. In vitro, a linear correlation was found between applied energy and total depth of effect, that is, photovaporization and photocoagulation. Using a Round (MTR 1.5) contact probe, an applied energy of 30 joules gave a depth of myometrial effect of 3.3 mm. In vivo, there was a significant reduction in tissue effect (p less than 0.001) compared to in vitro. Difficulty of manipulation of the contact laser probe within the uterus also caused a significant reduction (p less than 0.001) in depth of tissue ablation achieved on the posterior uterine wall compared with that achievable at the uterine fundus, but this may be counteracted by increasing applied energy. PMID- 10149789 TI - Angioplasty catheters improve procedural results. PMID- 10149790 TI - Argon laser treatment stabilizes tachycardia. PMID- 10149791 TI - Researchers optimistic about future of photosensitizer-enhanced laser angioplasty. PMID- 10149792 TI - Lasers investigated as diagnostic tools for breast cancer. PMID- 10149793 TI - Technical considerations and factors that influence the outcome of laser-assisted angioplasty. AB - In the last several years many studies have been conducted to evaluate the feasibility of laser-assisted angioplasty procedures as a therapeutic option for the treatment of patients with peripheral vascular disease. Assessing patient outcomes from studies done at various centers is complicated by the number of variables in patient selection, technical aspects of the procedures, laser parameters, and followup procedures. An ongoing process of defining and refining important parameters and aspects of these procedures is evolving. Important components in achieving good long-term results are technical dexterity with catheter systems, knowledge of angiography techniques, in-depth knowledge in the evaluation and treatment of patients with peripheral vascular disease, and a thorough understanding of laser biophysics and tissue interactions. The importance of technical details as a determinant of successful outcome in the treatment of these patients is discussed. Percutaneous vascular access is the method of choice for angioplasty procedures, but about 36% of patients will require surgical exposure of the femoral artery and possibly endarterectomy of patchplasty. In 11% of patients, the intraluminal channel is inadequate, revascularization is incomplete, or for other technical reasons surgical bypass is necessary. Peripheral laser-assisted angioplasty is a viable treatment alternative in selected patients. As the technique matures the value of its role in the therapeutic armamentarium will emerge. PMID- 10149794 TI - Laser-tissue interactions for angioplasty. PMID- 10149795 TI - Laser measurement of myocardial blood flow. AB - A He-Ne laser flowmeter (wavelength: 632.8 nm, power: 2 mW) has already been used to measure blood flow in skin, muscle, and mucosa. However, the application of this flowmeter for the beating heart has been left undeveloped due to its difficulty. For the purpose of establishment of the laser measurement of myocardial blood flow, we redesigned a flow probe to be small and light and used a connecting paste to support the subepicardial flow probe. After resolving many obstacles, the noninvasive and real-time blood flow measurement of the beating heart was made possible. The flow volume in subendocardial myocardium was greater than the volume in subepicardial myocardium, and the average ratio of subendocardial flow to subepicardial flow was 1.62 +/- 0.21. PMID- 10149796 TI - Experimental studies on laser coronary angioplasty. PMID- 10149797 TI - Experimental studies on argon laser angioplasty. PMID- 10149798 TI - Experimental studies using laser angioplasty combined with balloon angioplasty for stenotic cerebral lesions. AB - Basic studies were carried out on the treatment, with argon laser and balloon dilatation catheter, of stenotic arteries resulting from atherosclerotic plaque. Seventeen rabbits approximately 34 weeks old and weighing between 3 and 4 Kg were used. Each rabbit was fed a 1% cholesterol diet for 3 to 4 months to induce atherosclerotic lesions in the carotid arteries and the aorta. The argon laser unit used was a Model 20 Endocoagulator (HMG, Inc.; maximum power, 12W). Under an angioscope, two bare-ended laser probes (1.5 mm and 0.3 mm in diameter) were used to vaporize atheromatous plaque in the aortas of 10 rabbits, and a metal tip laser probe in the case of seven rabbits. The plaque remaining after this laser angioplasty was compressed to the luminal surface through inflation of a balloon catheter (balloon angioplasty) in order to sufficiently dilate the arteries. The animals were then sacrificed and examined both macroscopically and microscopically. When the bare-ended probes were used, there was a change in the depth of vaporization in line with the direction of the laser beam. Using a laser heating power of 25 J, perforation of the vessel wall was observed in 36% of the trials. A higher frequency of perforation was seen with the 0.3 mm probe than with the 1.5 mm probe. However, a constant vaporizing effect was achieved using the metal tip laser.(ABSTRACT TRUNCATED AT 250 WORDS) PMID- 10149799 TI - Holmium:YAG coronary laser angioplasty [HOLCA]. PMID- 10149800 TI - Effects of Nd:YAG laser irradiation on microcirculation. AB - Changes in microcirculation after irradiation by Nd:YAG laser were evaluated using the "rabbit ear chamber" method. Morphological changes of the vascular network related to time elapsed after irradiation was observed by a microscope video system. Findings such as vascular shrinkage, degeneration, coagulation, and stasis associated with irradiation were recognized shortly after the Nd:YAG laser was applied. Damage increased with irradiation energy increase. Expansion of the stasis region and appearance of hemorrhagic spots decreased, and vascularization began. On the seventh to tenth days, the damaged region was restored by a newly formed capillary network. When no change was noticed microscopically in the case of low-energy irradiation, transient increase of blood flow, determined by laser Doppler flowmeter, was observed. The results suggest that the effects of Nd:YAG laser irradiation are primarily thermal. It has good hemostatic and coagulation ability and some of the changes are nerve mediated by low-energy irradiation. PMID- 10149801 TI - Medilas Nd:YAG laser in oral cavity cancer. PMID- 10149802 TI - Initial results of laser angioplasty under angioscopic guidance for salvage of an ischemic lower limb: preliminary report. AB - From March to July 1989, nine patients at risk for peripheral artery disease underwent intraoperative Nd:YAG laser angioplasty using angioscopy at the Veterans General Hospital (Taipei, Taiwan, Republic of China). Following the laser angioplasty, balloon dilatation was performed in all cases. Eight men and one woman at an average age of 68 were included in the study (range: 58 to 78 years old). Ischemic symptoms included five patients with disabling claudication, four with pain at rest and one with gangrene on the toes. Eight of the nine patients had complete occlusions ranging from 2 to 19 cm in length. Two patients had high degree multiple segmental stenosis of the superficial femoral artery from 1 to 2 cm in length. Initial clinical success (indicated by relief of symptoms and increase in Doppler ankle pressure and index) and improvement in the angiographic luminal diameter was noted in 9 of 10 occluded vessels (90%) that underwent Nd:YAG laser treatment which was delivered at 10 to 12 watts through laser probes. Prelaser intraluminal diameter increased from 0.05 +/- 0.07 to 0.53 +/- 0.07 mm, Doppler ankle pressure index rose from 0.51 +/- 0.12 to 0.81 +/- 0.12, Doppler ankle pressure increased from 62.44 +/- 16.10 to 104 +/- 21.21 mmHg and the amplitude of pulse volume recorder at ankle level rose from 5.77 +/- 2.80 to 12.11 +/- 2.77 mm as compared with prelaser therapy (P less than 0.05).(ABSTRACT TRUNCATED AT 250 WORDS) PMID- 10149803 TI - High-resolution B-mode ultrasound scanning methods in the Atherosclerosis Risk in Communities Study (ARIC). The ARIC Study Group. AB - The Atherosclerosis Risk in Communities study examined popliteal and extracranial carotid arteries in approximately 16,000 randomly selected participants, aged 45 to 64 years. Vessels were studied noninvasively using high-resolution B-mode ultrasound imaging at baseline, to be repeated again after 3 years. The ultrasound examinations were performed according to a detailed standardized protocol by trained, certified sonographers subject to semiannual evaluation. Data on intrasonographer reliability from May 15, 1987, to June 30, 1989, showed that sonographers were able to visualize consistently a similar number of points along each of four arterial interfaces. Furthermore, the variability of measured combined intima-medial thicknesses was low, with 80% or more of duplicate scans differing by less than 0.267 mm. The validity of B-mode ultrasound imaging to detect asymptomatic carotid and popliteal artery atherosclerosis combined with high measurement reproducibility provides a powerful noninvasive scientific tool to test cross-sectional and prospective hypotheses related to disease epidemiology. PMID- 10149804 TI - Ultrasonic imaging of the internal jugular vein. AB - The ultrasonographic anatomy of the internal jugular vein is described. Current uses of ultrasonic imaging of this vessel are discussed, with special attention given to its use for calculating volume flow. PMID- 10149805 TI - Magnetic resonance imaging characteristics of multiple sclerosis plaques imaged with two-dimensional and three-dimensional Fourier transform techniques at low and mid field strengths. AB - A total of 58 multiple sclerosis lesions from 16 patients were used to characterize the performance of a low field system for the detection of edematous (e.g., water-elevating) brain lesions. Contrast, signal-to-noise, and their product (signal difference to noise) were measured for two-dimensional and three dimensional Fourier transform techniques at low field strength (640 G) and compared to two-dimensional sequences at mid field strength (3,500 G). The results showed numerically that low-field strength magnetic resonance imaging can reliably detect multiple sclerosis lesions, and, by extension, other water elevating lesions, although with lower confidence levels. PMID- 10149806 TI - Color velocity imaging: introduction to a new ultrasound technology. AB - Noninvasive ultrasound is the preferred methodology for the initial evaluation of carotid atherosclerosis. Since the early use of continuous-wave Doppler to assess carotid artery flow velocity blindly, neurosonology has progressed through crude B-mode imaging, spectral analysis of the Doppler signal, and gray-scale duplex Doppler/B-mode imaging, to color-flow Doppler duplex imaging. The latter allows color coding of Doppler data based on the velocity of blood flow. The combination of color-flow Doppler with gray-scale B-mode imaging allows simultaneous visual display of anatomical and hemodynamic information. Physical limitations of color-flow duplex Doppler imaging may affect the clinical utility of these techniques. Problems with pulse repetition frequency, aliasing, resolution capability of the color data, and interpolation of data make some applications difficult. Color velocity imaging uses the data contained in the gray-scale B-mode image scan lines to determine velocity of blood flow, and it offers potential advantages over conventional color-flow duplex Doppler for the assessment of carotid atherosclerosis and hemodynamics. Initial comparison of spectral Doppler and color velocity imaging data suggests that the latter is an accurate method to assess blood flow velocity. Understanding of the validity, utility, and prognostic advantages offered by color velocity imaging awaits careful prospective clinical trials. PMID- 10149807 TI - New method for optimal stabilization of the transcranial Doppler transducer during monitoring: normal controls and patient application. AB - Maintaining proper alignment of the transcranial Doppler probe during continuous monitoring has been a major limiting factor in its clinical and experimental application. We recently developed a simple yet reliable method of probe stabilization that allows continuous monitoring of blood flow velocities from any of the vessels accessible through the transtemporal window without regard to patient position or head movement. Under laboratory conditions, blood flow velocities were recorded in 5 subjects in the supine, sitting, standing, and head down positions. Also, measurements were carried out during flexion, extension, lateral rotation, and tilting of the neck. In addition, 10 patients were successfully monitored in the acute stroke unit for periods of 12 to 72 hours. There was excellent preservation of Doppler waveforms during all these maneuvers. This device offers a method of stabilizing transcranial Doppler transducers during continuous monitoring, which is more practical than those available so far. It results in an expansion of the potential clinical and experimental applications of this ultrasonic technique. PMID- 10149808 TI - Lipid-coated uniform microbubbles for earlier sonographic detection of brain tumors. AB - Rapid technological improvements have fostered the continued clinical development of intraoperative neurosonology, despite the fact that no suitable contrast media have been available for ultrasound studies. Because they can be made of uniform size (99% are less than 4.5 mum in diameter) and are thought to cross disruptions in the tumor vessels, artificial lipid-coated microbubbles can fill this gap. Furthermore, these microbubbles are stable in vitro for at least 6 months, with an in vivo halflife of 20 hours or more. This study demonstrated that lipid coated microbubbles injected intravascularly can intensify echoes from rat brain gliomas. Specifically, when this standardized microbubble contrast agent was injected intravenously daily in rats, the time to visual ultrasonic detection of developing brain tumors (C-6 gliomas) was 4.09 days (n = 11) after tumor inoculation, versus 6.67 days (n = 9) to detection without microbubble injection (Z = -3.71, p = 0.0004). PMID- 10149809 TI - Lateralization of epileptic foci by magnetic resonance imaging in temporal lobe epilepsy. AB - A retrospective single-blind study was carried out to assess the reliability of magnetic resonance imaging (MRI) for determining lateralization of the electrographic focus in 45 patients with intractable temporal lobe epilepsy. With strictly defined MRI diagnostic criteria, the electroencephalographic (EEG) focus was correctly lateralized in 86% of patients. Excluding patients with structural lesions, the criteria provided for correct lateralization of the epileptogenic focus in 78% and false lateralization in 5%. Hippocampal atrophy on T1-weighted images and increased signal intensity from mesial structures on T2 weighted scans were highly reliable for lateralization. Postoperative outcome did not differ between the patients with normal and those with abnormal findings on MRI, but the group sample was inadequate to assess the issue of surgical outcome. These findings suggest that with appropriate techniques and strictly defined diagnostic criteria, MRI can provide reliable seizure lateralization in patients with intractable temporal lobe epilepsy. PMID- 10149810 TI - High-resolution B-mode ultrasound reading methods in the Atherosclerosis Risk in Communities (ARIC) cohort. The ARIC Study Group. AB - To measure the association of cardiovascular disease risk factors with carotid artery diameter and thickness of the intima and media in the general population, standardized ultrasound scanning and reading protocols were performed on 15,800 individuals in the multicenter Atherosclerosis Risk in Communities (ARIC) Study. In a randomly selected subset of 855 participants, the mean artery diameter, minimum lumen diameter, and maximum near- and far-wall thicknesses were measured at a core laboratory from B-mode image recordings of the common carotid, bifurcation, and internal carotid arteries to determine both within-reader and between-reader variability. Measurements associated with the wall thickness are sensitive indicators of reader reproducibility, with between-reader reliability coefficients ranging from 0.78 to 0.93 and coefficients of variation ranging from 13.1 to 18.3%. The percent of paired readings in the three carotid segments for which the absolute difference of the far-wall thickness measured by different readers was not greater than one image pixel (0.067 mm) was 58% (common carotid), 53% (internal carotid), and 42% (bifurcation). Highly reproducible measurements of carotid artery dimensions can be achieved with standardized training and performance of ultrasound scanning and reading protocols. PMID- 10149811 TI - Air microbubbles as a contrast medium in transcranial Doppler sonography. A pilot study. AB - An insufficient signal-to-noise ratio is a significant limiting factor in assessing intracranial hemodynamic parameters by transcranial Doppler sonography. To establish the feasibility and validity of signal enhancement in transcranial Doppler sonography, stabilized air microbubbles bound to galactose microparticles as a carrier (SHU 454) were used in an animal model. The disadvantage of a short lasting effect is caused by instability of the contrast medium and a consequent reduced capacity to pass through the lung. Eight pigs received SHU 454 intraarterially in various concentrations and forms of application during transcranial monitoring of the middle cerebral artery with a 2 MHz pulsed ultrasound device. The effect was reproducible, dependent on the dose and application modalities. The best results were obtained with low concentrations (100 mg of microparticles/ml of suspension) and low injection speeds (0.5-1.0 ml/sec) into the common carotid artery by injection pump, reaching a homogeneous average enhancement of 6 to 12 dB over at least 5 minutes. Histological examination of the brain showed no evidence of air embolization. Further development requires a stable solution with similar properties and an ability to pass through the lung, therefore being suitable for intravenous application in humans. PMID- 10149812 TI - Predicting the failure of mechanical ventilation: new therapeutic options. PMID- 10149814 TI - Oximetry in the home care setting. PMID- 10149813 TI - Computer based pulmonary diagnostic systems for the neonate. PMID- 10149815 TI - Surgical options for congenital ptosis with poor levator muscle function. PMID- 10149816 TI - Suspension recession: hang-back and hemihang-back techniques in strabismus surgery. PMID- 10149817 TI - The quality of cholesterol tests from finger prick blood with physicians' office equipment. The need for rigid quality control and proper interaction. PMID- 10149818 TI - New whole blood methods and instruments: glucose measurement and test menus for critical care. AB - A glucose oxidase-H 2O 2 substrate-selective electrode (SSE) along with eight other electrodes allows the Stat Profile 5 (SP5) to measure glucose, electrolytes, blood gases, pH, and hematocrit simultaneously in whole blood. For heparinized blood gas syringe samples (n=178), orthogonal (Deming) regression showed y=0.43 + 1.00x (mmol/L), where y is whole blood glucose, and x is plasma glucose measured with the Ektachem 400 glucose oxidase slide method. For heparinized plasma (n=197), y=0.25 + 1.02x. Least squares linear regression showed y=0.25 + 1.00x (s yxx=0.49) for whole blood versus plasma, y = 0.30 + 1.01x (s yxx=0.49) for plasma versus plasma, and r=0.994 for both cases. Whole blood and plasma glucose in the same samples measured by SSE differed by less than 1%. The SP5 combines the largest number of whole blood tests currently available in a rapid response instrument well-suited for care of the critically ill patient. PMID- 10149819 TI - Arthroscopy using the pulsed Holmium:YAG laser. PMID- 10149820 TI - Percutaneous discectomy improved with KTP laser. PMID- 10149821 TI - Limited laser angioplasty ushers in endovascular surgery. PMID- 10149822 TI - Combined CO2 and Nd:YAG lasers in oncological surgery. PMID- 10149823 TI - Use of KTP-532 laser delays healing in tonsillectomy. PMID- 10149824 TI - ELCA an apt treatment for ostial, long lesions. PMID- 10149825 TI - PLDD offers advantages of safety, simplicity, speed. PMID- 10149826 TI - Transoral laser surgery for supraglottic cancer. PMID- 10149827 TI - Dental Nd:YAG laser beneficial for restoration, preparation. PMID- 10149828 TI - Bronchoscopy methods make pediatric cases practical. PMID- 10149829 TI - Argon laser emerging as superior for vascular malformation therapy. PMID- 10149830 TI - Laser culdotomy preferred for large tissue removal. PMID- 10149831 TI - Ophthalmic delivery system adapted for matrixectomy technique. PMID- 10149832 TI - Holmium laser provides new tool for fighting glaucoma. PMID- 10149833 TI - CO2 laser treatment for gingivectomies reduces hemorrhaging, post-op pain. PMID- 10149834 TI - Jet ventilator in microlaryngoscopy reduces anesthesia risks. PMID- 10149835 TI - Excimer laser coronary angioplasty for diseased saphenous vein bypass grafts. PMID- 10149836 TI - Thoracoscopic laser excision eases treatment of bronchogenic cysts. PMID- 10149837 TI - Candela laser eliminates scarring after treatment of benign pigmented lesions. PMID- 10149838 TI - Integrating a pharmacy benefit program into a managed health care plan. PMID- 10149839 TI - Third-party administrators in the new managed care market. PMID- 10149840 TI - Perspectives on the future of network-based managed behavioral health care systems. PMID- 10149842 TI - Inhibitions to a long-term solution to the health care [cost] crisis. PMID- 10149841 TI - Utilization review: a perspective on the future. PMID- 10149843 TI - Rural managed care. PMID- 10149844 TI - Thinking of affiliation? How insurance carriers evaluate potential PPO partners. PMID- 10149845 TI - The expanded role of TPAs in managed health care. PMID- 10149846 TI - Business coalitions: competing with managed care. PMID- 10149847 TI - New developments in the pulmonary circulation in children. AB - This article reviews new advances in the diagnosis, treatment, and pathophysiology of pulmonary hypertension. In diagnosis, Doppler echocardiography has been refined and its accuracy increased, and magnetic resonance imaging is being developed as a new tool. Prostacyclin and calcium channel blockers remain mainstays of short-term therapy, and single-lung transplantation has become a new therapeutic option. Newer pharmacotherapeutics are largely directed at reversing acute vasoconstriction and include approaches related to ATP and endothelial-derived relaxing factor. In pathophysiology, recent studies have shown the role of elastase in mediating the initiation and progression of pulmonary hypertension, the regulation of gene expression of collagen, elastin, endothelin, and growth factors including transforming growth factor-B and insulinlike growth factor-I, and mechanisms of signal transduction of smooth muscle cell proliferation. The migratory smooth muscle cell phenotype has been studied in terms of altered expression of endothelial and smooth muscle extracellular matrix components, including hyaluronan and fibronectin, respectively. PMID- 10149848 TI - Pediatric interventional cardiac catheterization. AB - Interventional cardiac catheterization has become a standard part of the practice of pediatric cardiology. In this review, articles on pediatric interventional catheterization that have been published over the past 2 years are summarized. The interventional procedures have been divided into the following: lesions, pulmonary valve, aortic valve, mitral valve, coarctation of the aorta, branch pulmonary artery stenosis, device closure of septal defects, and miscellaneous lesions. In addition, within these lesions the articles have been further categorized in the following manner: 1) large collaborative studies defining the short-term efficacy and complications associated with many of the interventional procedures; 2) follow-up studies that now define the intermediate (1 to 8 years) hemodynamic results and complications associated with the various interventional procedures; 3) the reports of new cardiac lesions that can be treated within the catheterization laboratory; and 4) the description of new technologies that have improved the results or expanded the scope of interventional pediatric cardiology. PMID- 10149849 TI - Catheter ablation and surgery for arrhythmias. AB - The technique of ablation was originally developed in the surgical theater and later extended to the catheterization laboratory. The technique of DC ablation, or fulguration, was the first ablative catheter technique to demonstrate its feasibility. New techniques using radiofrequency current look promising. The radiofrequency ablation seems more effective now than at its inception, especially since the introduction of the long-tip electrode and steerable catheters. These techniques are most effective in experienced hands. They have proved to reduce mortality as well as morbidity, to decrease the cost of medical therapy, and to reduce the hospital stay. However, the long-term outcome of radiofrequency is not completely known. Surgery is still used in patients who have a second indication for a surgical approach and remains the most effective method for the treatment of ventricular tachycardia. Surgery also remains on the forefront of research, as illustrated by the new approaches to the treatment of atrial fibrillation. However, in the future, modified techniques based on new catheters or different energies will be used for the complete treatment of a large population of patients with cardiac arrhythmias. PMID- 10149850 TI - Tilt-table testing and syncope. AB - Syncope is a common clinical problem with multiple potential causes. Recent studies have delineated the natural history and most frequent causes of recurrent syncopal episodes. The medical history and detailed physical examination are particularly important. Clinical electrophysiologic testing has also played a critical role in assessing causes of syncope, but recent reports suggest that its value lies primarily in treating patients with evident underlying structural heart disease. Among patients without structural heart disease, the neurally mediated forms of syncope, particularly the emotional or vasovagal faint, are by far the most common basis for symptoms. In these patients, head-up tilt-table testing has proved particularly valuable in defining the origin of the problem and in assessing therapeutic alternatives. Protocols for upright tilt-table testing remain in evolution. Nonetheless, current practice suggests that 25 minute tilt-test duration is reasonable if pharmacologic provocation is to be used for further evaluation of patients with negative initial findings. However, for those laboratories that do not favor pharmacologic intervention, a 45-minute tilt-test duration is probably essential. Overall, tilt-table testing has proved relatively sensitive and appropriately specific for the identification of patients susceptible to neurally mediated syncopal syndromes. PMID- 10149851 TI - Advances in evaluating and treating Wolff-Parkinson-White syndrome. AB - Interest has increased in the use of new noninvasive modalities, particularly body surface mapping, for localizing accessory pathways in Wolff-Parkinson-White syndrome. New data from invasive studies reviewed here include evidence of decremental conduction and the linking phenomenon in patients with accessory pathways. Risk factors for sudden death, including syncope and atrial fibrillation, are reviewed. The most notable advances involve our ability to offer patients catheter ablation, which has proven to be safe and effective. Both direct current and radiofrequency catheter ablation are discussed. PMID- 10149852 TI - Pacing and atrioventricular block. AB - Over the past year, many studies have reported progress in cardiac pacing. Better understanding of the cardiovascular and neuroendocrinologic physiology and sophisticated technologic advances have contributed to the development of new therapeutic approaches. In this review, we discuss the relevant literature on temporary pacing, physiologic mechanisms involved during pacing, the importance of atrioventricular synchrony and rate responsiveness, recent technologic advances, interactions between pacemakers and defibrillators, and reports on therapy. In the field of atrioventricular block, emphasis is on the characterization of new causes and clinical presentation in special populations. PMID- 10149853 TI - Echocardiography in valvular heart disease. AB - Last year alone, more than 140 reports on echocardiography and its different technical modalities (M-mode, two-dimensional, transesophageal, intraoperative, Doppler, and so forth.) in valvular heart disease were published in peer-reviewed journals. In this review we focus on selected papers that we believe made significant contributions to the diagnosis and management of valvular heart disease. Although intraoperative transesophageal echocardiography has been used for over 10 years and is widely accepted in certain clinical situations, this method continues to develop rapidly and to offer new insights into the identification and management of common valvular heart diseases such as mitral valve regurgitation, reconstruction, and infective endocarditis with its complications. In addition to adding to its undisputable advantages in the diagnosis of valvular lesions, new developments in Doppler echocardiography will add to the previously identified technical and methodologic limitations of this technique. PMID- 10149854 TI - Magnetic resonance and other imaging techniques in valvular and cardiac disease. AB - A number of new magnetic resonance imaging techniques are offering excellent views of the cardiovascular system. These techniques can provide accurate information about chamber sizes, ventricular mass, and wall motion. Blood flow patterns can be analyzed to provide semiquantitative estimates of valvular regurgitation. Accurate measurements of the area and velocity of great vessel flow may provide the first truly quantitative magnetic resonance imaging estimates of shunt flow and regurgitant volumes. Future developments and improvements may lead to coronary artery imaging in clinical patients. In addition to these promising developments in magnetic resonance imaging, several other interesting imaging papers are discussed in this review of magnetic resonance and other imaging techniques. PMID- 10149855 TI - Indications and outcome of valvuloplasty. AB - Balloon valvuloplasty is widely practiced, but its result depends on the pathology considered. Percutaneous mitral balloon valvuloplasty evolved from the earlier development of percutaneous balloon valvotomy of the pulmonic valve into an effective method for the treatment of patients with mitral stenosis. Percutaneous aortic balloon valvotomy has been used as an alternative to aortic valve replacement in elderly patients with degenerative calcific aortic stenosis, but immediate results are suboptimal and the short-term rate of restenosis is high. In congenital pulmonary valve stenosis, balloon valvotomy produces a dramatic relief of the pressure gradient with excellent long-term follow-up results. PMID- 10149856 TI - Characteristics, evaluation, and complications of prosthetic valves and valvular repair. AB - The availability of prosthetic heart valves and advances in techniques for their installation have drastically changed the outcome of valvular heart disease. Problems remain, however, in the assessment of prosthetic valve function, durability of prosthetic valves, preservation of left ventricular performance, and the treatment of complications of prosthetic dysfunction. Recent reports have addressed these issues. PMID- 10149857 TI - Indications, types, results, and complications of valvular surgery. AB - Results of long-term follow-up of new mechanical valves introduced in the 1980s and innovative new surgical techniques complementing repair of the mitral apparatus are discussed here. In addition, recent reports highlighting new information about the indications, types, results, and applications of valve surgery are described. PMID- 10149858 TI - Surgery. PMID- 10149859 TI - Valvular and coronary artery surgery. AB - This brief review supplements recent extensive discussion of valvular and coronary artery surgery in this journal. It includes 1) ultrasonic decalcifications of stenotic aortic valves, a technique once more found wanting because of induced aortic incompetence; 2) the concept of prosthesis-specific anticoagulation, adjusting the level of anticoagulant control for individual prosthetic valves to minimize thromboembolic and hemorrhagic complications; 3) the use of homograft aortic roots to treat aortic prosthetic valve endocarditis; and 4) a new approach to the repair of postinfarction ventricular septal defects, supported by excellent results. PMID- 10149860 TI - Congenital heart surgery. AB - In reviewing selected publications on congenital heart disease management for 1990 and 1991, some topics have been chosen for discussion, including isolated patent ductus arteriosus, coarctation of the aorta, critical aortic stenosis in early infancy, hypoplastic left-heart syndrome, pulmonary artery banding, Fontan procedures, pulmonary atresia and intact ventricular septum, Ebstein's anomaly, tetralogy of Fallot, transposition of the great vessels, and others. PMID- 10149861 TI - Heart transplantation, assist devices, and cardiomyoplasty. AB - Allograft replacement of the heart in pediatric patients has gained growing interest within the spectrum of cardiac transplantation. Here and in other age groups, new immunosuppressive agents are under investigation, hopefully providing more selective reduction of the immune response with lower side effects compared with conventional therapy. Many clinical investigators and basic scientists are working to understand, prevent, and possibly treat chronic cardiac allograft rejection, one of the major threats in long-term survivors. Within the scope of mechanical assist device application, bridge to transplantation does provide the best results. New developments include emergency treatment of cardiogenic shock by an intravascular left ventricular assist device and cardiopulmonary bypass, both designed as life support systems. Clinical studies on permanent implants of ventricular assist devices are on the way. As another alternative to heart transplantation, dynamic cardiomyoplasty using the latissimus dorsi muscle has gained increasing clinical attention. Results relating to clinical and hemodynamic improvement, however, remain conflicting, and long-term results are not yet available. PMID- 10149862 TI - Perioperative ultrasonic imaging in cardiac surgery. AB - The use of ultrasonic imaging in patients undergoing cardiac surgery continues to grow. Recent data have substantiated the utility of intraoperative transesophageal echocardiography in the patient with mitral valve disease. This technique has become the procedure of choice for the on-line assessment of the degree of mitral regurgitation before and after cardiopulmonary bypass. Transesophageal echocardiography is being more widely used for the detection of regional wall motion abnormalities intraoperatively because recent data suggest that hemodynamic parameters may be insensitive for the detection of ischemic events. In the evaluation of patients with congenital heart disease and suspected aortic dissection, transesophageal echocardiography is becoming increasingly important. Newer applications of ultrasonic techniques include contrast echocardiography for evaluating myocardial perfusion and intraoperative evaluation of the ascending aorta for detecting atherosclerosis, which may be a source of atheroembolism. Ultrasonic imaging has become invaluable in the treatment of patients undergoing cardiac surgery. PMID- 10149863 TI - Ancillary diagnostic and therapeutic issues in cardiac failure. AB - A truly important advance in medical science must have practical implications for the patient, eg, rendering diagnosis faster, safer, less distressing, or more accurate. Improvements in noninvasive techniques for hemodynamic monitoring constitute such progress. In other areas of cardiology, such as managing arrhythmias and preventing sudden death in heart failure, little progress is apparent. However, recent studies have at least identified some treatments that are either ineffective or harmful. Finally, alternative solutions, no matter how improbable, should be explored when a problem seems insoluble. Despite the fact that many would like scientific progress to be a series of logical steps, most medical advances are serendipitous or reinventive. PMID- 10149864 TI - Exercise physiology and the role of the periphery in cardiac failure. AB - Cardiopulmonary exercise testing remains the standard method of functional assessment in chronic heart failure, and both peak oxygen consumption achieved on progressive maximal exercise testing and anaerobic threshold are widely used endpoints in clinical trials. Peak oxygen consumption achieved on progressive maximal exercise testing may be used in clinical practice to estimate prognosis and aid the prioritization of patients for cardiac transplantation. Anaerobic threshold is a valuable index of submaximal exercise performance, but there are many different criteria used to define anaerobic threshold and careful attention to the methodology is essential. The mechanisms of limitation of exercise capacity and the importance of the peripheral abnormalities in chronic heart failure are still not elucidated. The skeletal muscles are reduced in size, weak, and easily fatigued; in addition, nuclear magnetic resonance spectroscopic studies have shown that high-energy phosphates are depleted and acidosis develops more rapidly during exercise in patients with chronic heart failure than in normal subjects. However, the relationship of these abnormalities to the mechanical performance of the muscles, the differences between treated and untreated heart failure, and the effects of physical training have yet to be clarified. PMID- 10149865 TI - Current trends in cardiac pacing technology. I. Bradycardia pacing. PMID- 10149866 TI - The value of transesophageal echocardiography in the diagnosis of cardiac metastasis. AB - To assess the diagnostic value of transesophageal two-dimensional echocardiography (TEE) as compared with transthoracic echocardiography (TTE), TTE and TEE were performed in eight consecutive patients (age range from 20 to 76 years, six male and two female) with clinical evidence of malignant tumors arising from the liver (n = 1), lung (n = 3), larynx (n = 1), osteogenic sarcoma (n = 1), lymphoma (n = 1), and yolk sac tumor in the anterior mediastinum (n = 1). In one case, the gastroscope could not be inserted because of tumor compression of the esophagus. Transesophageal echocardiography provided superior imaging in the detection of intracavitary metastatic lesions. In the case of right ventricular outflow tract tumor and greater vessel involvement, TTE may provide more imaging than TEE due to a blind area in this region by the transesophageal approach. In conclusion, TEE is complementary to TTE in the diagnosis of metastatic cardiac tumor. PMID- 10149867 TI - The neonatal transitional circulation: a combined noninvasive assessment. AB - Dramatic changes occur in the circulation of the newborn during the transition from fetal to neonatal life. Closure of the foramen ovale and ductus arteriosus, decrease in pulmonary vascular resistance, and improvement in right ventricular compliance are among these changes. These physiological-anatomical events were characterized by means of two-dimensional, Doppler and color flow echocardiography. Forty-five full-term infants (22 male, 23 female) were studied at a mean age of 4.2 hours (T1), 25.5 hours (T2), 49.8 hours (T3), and 73.8 hours (T4) by two-dimensional, Doppler and color flow echocardiography. At T1, T2, T3, and T4, the ductus arteriosus was patent by color flow echocardiography in 100%, 34%, 22%, and 11%, respectively. Conversely, patency of the ductus by Doppler alone was detected in 100% (T1), 13% (T2, T3), and 11% (T4). Reversal of flow in the descending aorta, reflective of diastolic ductal filling, was not sensitive in detecting ductal patency (T1 50%, T2 3%, T3 and T4 0%). The patency of the foramen ovale was noted to decrease over the course of the study. Right ventricular compliance was quantitatively assessed by pulsed-Doppler diastolic properties (E-to-A ratio). This changed significantly from T1 to T4 (0.90 to 0.97) reflecting improving compliance of the right ventricle. The ratio of acceleration to ejection time, a Doppler estimation measure of pulmonary vascular resistance, increased from 0.28 to 0.33 (T1 to T4) reflecting a decrease in pulmonary vascular resistance.(ABSTRACT TRUNCATED AT 250 WORDS) PMID- 10149868 TI - Doppler color flow "proximal isovelocity surface area (PISA)": an alternative method for estimating volume flow across narrowed orifices, regurgitant valves, and intracardiac shunt lesions. PMID- 10149869 TI - Experimental studies to define the geometry of the flow convergence region. Laser Doppler particle tracking and color Doppler imaging. AB - The color flow convergence method for calculating volume flow through regurgitant or forward flow restrictive orifices has gained significant interest and a number of in vitro studies have suggested that this method is accurate, even in pulsatile models. Clinical application of the method over a wide range of conditions will require improved understanding of the effect of orifice size, flow geometry, and flow rate on the flow convergence geometry. In this study, we performed laser particle tracking investigations to allow visualization of streamlines into stenotic orifices. These streamlines are theoretically perpendicular to the isovelocity surfaces used for flow convergence calculations. We compared those observations to color flow map, flow convergence images obtained with a Toshiba 160A for orifices 5 to 15 mm 2 with flow rates of 1.5 to 9.7 L/min. Our results show that for large orifices, low flow rates, and/or low pressure gradients, more oblique streamlines in the velocity of the orifice correspond to nonhemispherical, but more elliptical, flow convergence geometries. This can be corrected for by using lower Nyquist limits and calculating flow convergence at greater distances from the orifice. Under high flow and high gradient conditions, increased Nyquist limits and shorter aliasing radii are more suitable. Our studies yield insights into flow convergence geometry and yield corrective procedures to improve volume flow calculation. PMID- 10149870 TI - Color Doppler determination of regurgitant flow: from proximal isovelocity surface areas to proximal velocity profiles. An in vitro study. AB - There is not yet a completely satisfactory Doppler method for determining the severity of valvular regurgitation. Recently, interest has focused on the so called "flow convergence region." Color Doppler provides a longitudinal velocity profile of the flow convergence region proximal to restrictive orifices. With respect to determination of regurgitant flow rate, we studied the influence of orifice flow rate and orifice size on the proximal velocity profile. In a phantom model, flow across circular orifices was studied. The distance r (v) of discrete velocities detected proximal to the orifice was measured along the flow center line. Velocity profiles were established. (1) Proximal isovelocity surfaces: The radius r (v) also represented the central radius of the proximal isovelocity surfaces. Increases in flow resulted in larger central radii r (v). Application of the continuity equation and analysis of the resulting values yielded a radius and an orifice size dependence of the geometric isovelocity surface shape. Therefore, their surface area and flow rate could not be calculated from these axial measurements alone. (2) Proximal velocity profiles: The resulting hyperbolic velocity profile curves (x axis = velocity [v], y axis = distance [r (v)]) are shifted rightward by increases in flow. In contrast, increases in orifice size make the curve steeper, but large r (v) are not affected. This differential influence of flow rate and orifice size allows orifice size independent determination of flow rate. A nomogram is presented as one possible method for flow determination. PMID- 10149871 TI - Regurgitant volume estimation in patients with mitral regurgitation: initial studies using color Doppler "proximal isovelocity surface area" method. AB - Doppler color flow mapping of a proximal isovelocity surface area (PISA), calculated from a blue-red aliasing radius, has been shown in vitro to be accurate for estimating volume flow rate across a narrowed orifice. Volume flow rate (in cm 3/sec) can be calculated as PISA (in cm 2) x aliasing velocity (in cm/sec). This method has advantages over other color Doppler approaches in that PISA-derived volume flow rate calculations appear to be independent of machine parameter settings and orifice shape. We evaluated the clinical applicability of the PISA method in 49 patients with native valve mitral regurgitation (MR). Color Doppler flow mapping was performed at color aliasing velocities of 54-72 cm/sec. Twenty-four patients were excluded because a color aliasing radius was not clearly seen: 20 of these 24 patients had mild MR. In the remaining 25 patients, the ratio of maximum regurgitant jet area-to-left atrial area, as well as the regurgitant stroke volume estimated using the time-velocity integral method, were compared to regurgitant stroke volume calculated from the PISA method. Maximum PISA was calculated using a formula derived from previous in vitro studies: PISA = 8.05 x r 2, where r is the maximum color Doppler aliasing radius in the apical four-chamber view.(ABSTRACT TRUNCATED AT 250 WORDS) PMID- 10149872 TI - Stress echocardiography: diagnostic, prognostic, and management tool for the 1990s. PMID- 10149873 TI - Evolution of stress echocardiography. PMID- 10149874 TI - Quantitative stress echocardiography. AB - Dramatic improvements in our ability to treat coronary artery disease have created the need to develop sensitive and specific noninvasive tests for diagnosing and assessing the severity of ischemic disease. The purpose of this review is to examine stress echocardiography and, in particular, quantitative stress echocardiography in this context. Methodology and technical aspects of performing and interpreting stress echocardiography are discussed, including the type of exercise performed, imaging and recording techniques, and methods for on line and off-line analysis. Qualitative, semiquantitative, and quantitative approaches are compared and contrasted. In assessing quantitative stress echocardiography, the role of global measurements of left ventricular function including ejection fraction, peak systolic pressure to end-systolic volume index ratio, as well as regional measurements including wall-motion analysis and wall stress, are discussed. Pertinent literature using quantitative approaches is reviewed including those comparing quantitative stress echocardiography with other noninvasive modalities. Future directions for study are also addressed. We concluded that quantitative stress echocardiography has excellent sensitivity and specificity for diagnosing ischemic heart disease. It was useful in localizing lesions, defining multivessel disease, and predicting patients with poor prognosis postmyocardial infarction. Its reproducibility makes it a valuable technique in following patients noninvasively over time. PMID- 10149875 TI - Clinical applicability of echocardiographically detected regional wall-motion abnormalities provoked by upright treadmill exercise. AB - Exercise electrocardiography is the time-honored screening test for coronary artery disease but has serious limitations in many patient subgroups. A number of adjunctive modalities have been coupled to exercise ECG to increase the diagnostic accuracy of noninvasive testing, including thallium scintigraphy and gated blood pool radioventriculography. Exercise echocardiography has more recently emerged as a tool that can detect exercise-induced regional wall-motion abnormalities as an indicator of provoked myocardial ischemia. While there are conceptual advantages to performing echocardiography during maximal exercise, we have found that regional wall-motion analysis performed with echocardiograms obtained before and immediately after upright treadmill exercise allows highly accurate prediction of the extent and distribution of coronary artery disease as detected by angiography. This monograph summarizes our experience with this form of exercise echocardiography in three important patient groups: (1) patients being screened for the presence or absence of coronary artery disease; (2) patients who have undergone previous coronary artery bypass surgery and who are being evaluated for graft failure and/or progression of native-vessel disease; and (3) patients who have undergone coronary angioplasty and are at risk for restenosis and/or progression of disease. We believe, based on our experience and that of other investigators, that exercise echocardiography is a uniquely valuable tool in these and other patients for assessing the status of the coronary vascular anatomy. Not only can the presence or absence of obstructive disease be assessed, but the extent and distribution of disease can be accurately predicted, and other, noncoronary causes of chest pain such as aortic stenosis, mitral valve prolapse, hypertrophic cardiomyopathy, and pericardial disease can readily be identified. PMID- 10149876 TI - Bicycle stress echocardiography. AB - Bicycle stress echocardiography involves the recording and interpretation of two dimensional echocardiographic information before, during, and after bicycle exercise. The exercise test can be performed in the supine or upright posture. While there are important physiological differences between these two positions, they appear to provide similar diagnostic information on the presence or absence of coronary artery disease. A major advantage of bicycle stress echocardiography compared to treadmill exercise is the ability to image at peak exercise, rather than relying solely on pre- and postexercise imaging. This contributes to the greater sensitivity of the test for the detection of ischemia. The recent application of digital processing techniques may also improve sensitivity by permitting side-by-side comparison of rest and stress images. In summary, bicycle stress echocardiography is a useful tool in the management of patients with known or suspected coronary artery disease. It is a versatile and accurate technique, which competes favorably with other imaging modalities and provides information on regional and global left ventricular function. PMID- 10149877 TI - Dipyridamole echocardiography. AB - Intravenous dipyridamole is a potent coronary vasodilator that has been extensively investigated over the past several years in the noninvasive assessment of patients with suspected coronary artery disease when exercise cannot be performed or is suboptimal. As an alternative to exercise studies, dipyridamole has been used in combination with different cardiac imaging techniques such as echocardiography, thallium scintigraphy, and radionuclide ventriculography. Extensive experience has been obtained with dipyridamole thallium-201 imaging for coronary artery disease screening, risk stratification, and prognosis after an acute coronary event. However, experience with the use of dipyridamole in combination with two-dimensional echocardiography has been limited. Dipyridamole increases coronary blood flow in nondiseased coronary vessels relative to coronary vessels with significant luminal narrowings. These provide the basis for detecting regional differences in flow by using different cardiac imaging techniques. Two-dimensional echocardiography would show regional wall-motion abnormalities in response to those regional differences in coronary blood flow. In this article, the most commonly used protocols, safety, and practicability of dipyridamole echocardiography are reviewed. As an alternative to exercise, dipyridamole echocardiography shares all the indications of a standard exercise test. Clinical applications of dipyridamole echocardiography include coronary artery disease screening, suspected coronary artery spasm, postmyocardial infarction risk stratification, evaluation of percutaneous transluminal coronary angioplasty results, and prognosis following an acute coronary event. Compared to conventional (ECG) exercise testing, dipyridamole echocardiography appears to be equally sensitive but more specific. Compared to atrial pacing, dipyridamole provokes ischemia at a lower rate pressure product and results in a greater ST segment depression suggesting that dipyridamole induces more profound myocardial ischemia than atrial pacing. Dipyridamole thallium and exercise thallium have shown to be equally sensitive and specific in the assessment of coronary artery disease. High dose dipyridamole echocardiography appeared to be equally sensitive and more specific. Experimental studies have demonstrated that dobutamine appears to be a more powerful pharmacological agent in inducing wall-motion abnormalities. Dipyridamole echocardiography as compared to stress echocardiography offers the advantage of obtaining better quality postintervention images. With regard to sensitivity and for coronary artery disease diagnosis, both techniques appear to render similar results. Although further studies are needed, the available data indicates that cardiac ultrasound imaging prior to and following the intravenous administration of dipyridamole may be an attractive alternative to thallium perfusion imaging in the clinical setting, particularly when radionuclide capabilities are not present. PMID- 10149878 TI - Intravascular ultrasonic assessment of lumen geometry and distensibility of the angiographically normal artery: a correlation with quantitative angiography. AB - The feasibility of assessing lumen diameter and area using a 30-MHz mechanically driven ultrasound imaging device was evaluated in vitro in phantoms and in vivo in eight human arteries (six iliac, two brachial). Ultrasound data were compared to angiographic data derived from the cardiovascular angiographic analysis system. In addition, the change of lumen area in a given cardiac cycle was determined in each patient. A close relation between ultrasound and angiography was observed in the phantom studies. In the first three patients there was disagreement; ultrasound images showed larger values compared to the angiographically derived values. Disagreement was related to the use of nominal measurements of the sheath supplied by the manufacturer as calibration. Data on the five other patients showed a close relation between the values derived with ultrasound and angiography. The arterial lumen area revealed a 5% +/- 2% change during one cardiac cycle. The intra- and interobserver variability test showed good correlation for the ultrasound study. This study demonstrates that intravascular ultrasound is an accurate and reproducible technique to measure vascular diameter, lumen area, and arterial wall distensibility in vivo. PMID- 10149879 TI - Quantification of mitral regurgitation: a comparison of transesophageal echocardiography and contrast ventriculography. AB - Transesophageal echocardiography (TEE) allows an unobscured view of the left atrium for the assessment of mitral regurgitation (MR). However, criteria for assessing MR by TEE have not been carefully validated. In order to determine and validate criteria for the assessment of MR severity, 65 clinically stable patients with a TEE color Doppler study and contrast ventriculography within a 2 week period were identified. Maximal or peak mitral regurgitation jet area to left atrial area ratio (MR/LA) derived solely from TEE imaging had the best correlation to MR severity by contrast ventriculography (r = 0.89). Utilizing MR jet area without correction for LA size resulted in r = 0.72 to 0.75. Utilizing LA area data from transthoracic echocardiograms in a subset of 29 patients resulted in r = 0.77. Best sensitivity and specificity for the assessment of MR by TEE were obtained using the following criteria: Peak MR/LA of 0%-9% predicts 0 + MR; 10%-28% 1 + MR; 29%-54% 2 + to 3 + MR; and greater than 55% 4 + MR. Best sensitivity and specificity occurs for assessment of 0 + and 4 + MR. Considerable overlap in data occurs in the 1 + and 3 + MR range utilizing the above stated criteria. Peak MR/LA ratio derived from a single TEE view in which the MR jet is maximally imaged is the best determinant of MR severity. PMID- 10149880 TI - Usefulness of transesophageal echocardiography for the detection of left atrial thrombi in patients with rheumatic heart disease. AB - Transesophageal (TEE) and transthoracic (TTE) echocardiograms were performed in 110 patients with rheumatic heart disease to evaluate the usefulness of these methods for the detection of left atrial thrombi. TEE was better than TTE for detecting left atrial thrombi (21 vs 9). The thrombi not detected by TTE were in the left atrial appendage in ten and over the left atrial posterior wall in two. Patients with left atrial thrombi had significantly smaller mitral valve area (P less than 0.01) and greater left atrial dimension (P less than 0.05) than those without. All patients with left atrial thrombi had atrial fibrillation. Thirty one patients underwent surgical intervention and 13 were found to have left atrial thrombi. TEE detected left atrial thrombi in all 13 patients with a sensitivity of 100%, specificity of 100%, and accuracy of 100%, while TTE detected left atrial thrombi in only nine of these 13 patients with a sensitivity of 69.2%, specificity of 100%, and accuracy of 87.1%. Thus, TEE is superior to TTE for the detection of left atrial thrombi, especially for those thrombi located in the left atrial appendage and along the left atrial posterior wall. PMID- 10149881 TI - Application of echocardiographic color flow Doppler mitral regurgitation to the diagnosis of acute cardiac transplantation rejection. AB - Numerous noninvasive techniques have been examined for the detection of acute rejection following cardiac transplantation, but none has proven sufficiently sensitive to replace the endomyocardial biopsy. A prospective study was performed in 92 heart transplant patients in order to test the hypothesis that mitral regurgitant ratio by two-dimensional echocardiography with Doppler flow mapping could detect moderate or severe acute allograft rejection. There were 82 rejection episodes identified, of which 40% were associated with mitral regurgitation by echo-Doppler at the beginning of the episode. With augmentation of immunosuppression during a rejection episode, there was a progressive fall in the degree of mitral incompetence (P = 0.03). The sensitivity of color Doppler studies in identifying rejection was low (60% of all rejection episodes had no associated mitral incompetence at the beginning of the episode), but the likelihood of rejection progressively increased with higher degrees of mitral regurgitation (P less than 0.01), approaching 60% when the echo-Doppler regurgitant ratio exceeded 15%. Echo-Doppler studies do not provide sufficient sensitivity to be useful as a screening technique for acute cardiac rejection, but high or increasing echocardiographic mitral regurgitant ratio is predictive of acute rejection and should indicate prompt endomyocardial biopsy. PMID- 10149882 TI - Catecholamine stress echocardiography. AB - Two-dimensional echocardiographic monitoring during catecholamine infusion has shown promise as a safe and accurate method for detection of coronary artery disease. The clinical application of catecholamine stress echocardiography has been facilitated by the development of digital image processing techniques. The sensitivity of this method of stress testing has been improved by drug infusion protocols that are designed to maximize myocardial stress. Recent investigations have demonstrated the value of dobutamine stress echocardiography for detection of multivessel disease following myocardial infarction and for assessment of cardiac risk before noncardiac surgery. Evaluation of changes in wall motion and thickening that occur during low dose dobutamine infusion may enable detection of viable myocardium after thrombolytic treatment of acute myocardial infarction. Compared to alternative noninvasive diagnostic methods, catecholamine stress echocardiography permits continuous acquisition of high-quality information on regional and global systolic function. This and other advantages have prompted the search for broader applications of this technique. PMID- 10149883 TI - Stress Doppler echocardiography in the evaluation of ischemic heart disease. AB - Doppler echocardiography enables convenient, noninvasive evaluation of global, systolic performance at rest and during exercise. Early studies suggested that Doppler parameters of systolic function were sensitive to exercise-induced myocardial ischemia and could identify patients with severe coronary artery disease. Subsequent investigation, however, has identified several factors in addition to myocardial ischemia that can significantly influence exercise Doppler study results. Thus, in order to obtain reliable information, the many factors that can influence Doppler measurements of aortic flow velocity and acceleration must be accounted for. Further work in this area is likely to produce results that encourage greater application of this technique in experimental and clinical research. At present, the role of stress Doppler echocardiography in the evaluation of ischemic heart disease remains uncertain. PMID- 10149884 TI - Stress echocardiography versus radionuclide stress techniques. AB - The different modalities of stress echocardiography and stress thallium-201 imaging have comparable sensitivity, specificity, and overall predictive accuracy in the diagnosis and prognosis of coronary artery disease. They are also comparable in the assessment and follow-up of patients treated with thrombolytic therapy or who have undergone percutaneous transluminal coronary angioplasty and coronary artery bypass graft surgery. Stress radionuclide ventriculography has a lower sensitivity and specificity as compared to stress echocardiography and stress thallium. Dipyridamole thallium has a higher sensitivity as compared to dipyridamole echocardiography in the diagnosis and prognosis of coronary artery disease. New techniques such as dobutamine echocardiography, adenosine stress thallium-201, and adenosine echocardiography have individually shown high sensitivities, specificities, and accuracy. However, further studies are needed on their comparative value. The major advantages of stress echocardiography over radionuclide stress techniques are: lack of radiation exposure; less expense; less time consumption; less personnel required; and greater availability. Its major disadvantage, however, is the inability to obtain adequate studies in all patients. PMID- 10149885 TI - Utility of stress echocardiography for postinfarct prognosis. AB - Although high-risk patients following myocardial infarct are usually identified in the acute stage by clinical assessment and determination of left ventricular function at rest, a significant percentage of infarct patients with increased risks, i.e., presence of residual myocardial ischemia, remain undetected at discharge. Since the yield of adequate images for interpretation stress echocardiograms has been significantly improved with digital technology, stress echocardiography has become a truly practical technique to identify these patients. Presence of remote asynergy, i.e., asynergy not directly adjacent to the infarcted area and supposed to be related to another vascular region, directly following cessation of dynamic exercise appears to be highly related to multivessel disease and an unfavorable follow-up period. Treadmill electrocardiographic findings, however, appeared to be of limited value in this respect. Furthermore, the echocardiographic ejection fraction was also a poor predictor. The versatility of the technique, lack of injections, or radiation hazard, and the relatively low cost will undoubtedly increase the application of stress echocardiography for postinfarct stratification. PMID- 10149886 TI - Dipyridamole-echocardiography: clinical usefulness following interventions. AB - Dipyridamole-echocardiography test response can be expressed not only in a black or white (positive vs negative) code but also, in positive tests, by a gray scale integrating the severity and extent of the dyssynergy as well as the ischemia free stress time. The recognition of the dyssynergy is important to establish the diagnosis; however, the evaluation of the degree of the induced ischemia, stratified according to spatiotemporal coordinates, is even more important because it accurately predicts the coronary anatomical and functional situation, as well as the prognosis of the individual patient. Furthermore, the "shades of gray" in a positive response have proved useful in assessing the beneficial effects of several interventions: coronary angioplasty; coronary artery bypass surgery; thrombolysis; and medical antianginal therapy. Due to its excellent reproducibility, dipyridamole-echocardiography can play a pivotal role for simple, safe, fast, accurate, and objective assessment of therapeutic interventions, either mechanical or pharmacological, based upon the presence, timing, severity, and extent of dipyridamole-induced dyssynergy. PMID- 10149887 TI - Exercise Doppler: functional evaluation of right heart dynamics. AB - Exercise echocardiography is a versatile technique that includes not only two dimensional imaging, but also Doppler of aortic, mitral, and tricuspid valves. Doppler echocardiography can be useful in the evaluation of global left ventricular systolic and diastolic function, valvular function, transvalvular gradients, and pulmonary artery pressure. The technique lends itself to the study of the cardiac response to exercise in a variety of disease states, including pulmonary, coronary artery, valvular, and congenital heart disease. We review our experience using agitated saline-enhanced Doppler of tricuspid insufficiency to determine pulmonary artery pressure throughout exercise in chronic lung disease. PMID- 10149888 TI - Exercise evaluation of prosthetic heart valves by Doppler echocardiography: comparison with catheterization studies. AB - Although valve replacement remains the cornerstone of treatment for critical heart valve dysfunction, problems including thromboembolism, infection, and primary failure of the prosthesis remain. Resting studies of valve hemodynamics are sometimes insufficient to reveal valve dysfunction. Early studies using cardiac catheterization focused on changes in prosthetic function seen with various types of exercise or drug-induced stress. These studies suffered from an inability to adequately stress catheterized patients and were cumbersome to the patient and the investigator. With the introduction of Doppler echocardiography, however, studies could be performed after significant exercise with low risk and increased ease. Using echocardiography, reports of exercise-induced changes in aortic and mitral valve hemodynamics have appeared. Over 600 patients have been studied using Doppler echocardiography. In the aortic position, all prostheses studied have a mild peak instantaneous gradient (18-26 mmHg) at rest, which increases with exercise (35-63 mmHg). No significant differences between the four models of mechanical prostheses studied are found. The gradients achieved with exercise do not appear to be related to the heart rate achieved or duration of exercise. Smaller prostheses are associated with larger gradients; however, the correlation was not strong. All mitral valve prostheses studied are also mildly stenotic at rest (range of mean gradients 2.3-7.1 mmHg) and become moderately stenotic with exercise (range 5.1-16.5). Although the lowest gradients are seen with St. Jude Medical and Medtronic Hall prostheses, their gradients are not significantly less than with other valves.(ABSTRACT TRUNCATED AT 250 WORDS) PMID- 10149889 TI - Utility and limitations of linear models for echocardiographic estimation of left ventricular ejection fraction by segmental wall-motion scoring. A geometric analysis. AB - Although the geometric relation between left ventricular (LV) volume and its internal dimensions is nonlinear, recent clinical study has shown that LV ejection fraction (EF) predicted by a linear combination of segmental contraction scores correlates well with the EF by radionuclide angiography. To determine whether the linear coefficients found by empirical study are consistent with basic geometric principles, we compared the LV EF obtained by exact geometric calculation to the EF predicted using a simple linear combination of segmental contraction scores over a wide range of segmental function, from marked dyskinesis to marked hyperkinesis. We found that an optimal linear equation for global EF on geometric grounds is: Global EF = 4 + 0.28xC1 + 0.24xC2 + 0.12xC3, where C1, C2, and C3 are the mean segmental contraction scores at the base, mid left ventricle, and the apex, respectively. The EF predicted by this formula differs by less than 6 percentage points from the EF predicted by exact geometry when segmental contraction ranges from normal to akinetic, and the coefficients are in close accord with those found empirically by regression of linearly derived EFs against the radionuclide EFs in 50 patients. However, when segmental contraction is significantly hyperkinetic or dyskinetic, agreement with the exact geometric formula is poor. We conclude that: (1) a linear combination of segmental contraction scores can provide reasonable estimates of LV EF over a broad range of contraction; (2) previous, empirically determined linear coefficients are consistent with geometric principles; and (3) exact, nonlinear formulas may be required for ventricles with significant degrees of hyperkinesis or dyskinesis. PMID- 10149890 TI - The radionuclide assessment of left ventricular diastolic filling: methodology and clinical significance. AB - The radionuclide measurement of diastolic performance may provide a rapid noninvasive index available in the clinical setting. These measurements may be used to detect coronary artery disease, manifestations of hypertensive heart disease, isolated diastolic heart failure, and hypertrophic cardiomyopathy. The various radionuclide methods to measure diastolic filling are influenced by technological considerations, as well as applying the results in the appropriate clinical context. The importance of these derived measurements and how they correspond to various pathophysiological presentations will be discussed. PMID- 10149891 TI - Validation of computerized three-dimensional reconstruction of intravascular ultrasound: measurements of absolute luminal diameter and cross-sectional area in ex vivo human coronary arteries. AB - Computer based 3-dimensional reconstruction transforms 2-dimensional intravascular ultrasound images into a longitudinal format facilitating analysis of luminal narrowing. To validate the accuracy of current software in measuring coronary artery diameter and cross-sectional area, in arteries with atherosclerosis, we performed 3-dimensional reconstruction in 10 human pathologic coronary arterial segments of 10-25mm length. Images were obtained using a 4.8 French catheter with pullback speed of 1mm/sec acquired at 3 frames/sec onto VHS tape. The data were digitized and intraluminal 3-dimensional reconstruction performed using a voxel-based program. Pathologic sections were obtained every 3mm, and dimensions were measured with a resolution of 0.01 mm. Maximum, minimum, and 3 other representative diameters were recorded by an observer blinded to the ultrasound diameters. Average histo-pathologic diameters were reported, and specimen cross-sectional area was then calculated. RESULTS: In 53 sections, pathological diameters ranged from 1.4-4.5mm (mean 2.7 +/- 0.68mm) while 3-dimensional reconstructed diameters were 1.9 to 3.8mm (mean 2.6 +/- 0.54mm). Pathologic and ultrasound derived 3-dimensional reconstruction diameters had an excellent correlation (r=0.86, SEE=+/-0.36). Pathology and 3-dimensional reconstruction cross-sectional area also correlated closely (r=0.88, SEE=+/ 1.50). Diameters less than 2.0mm were systematically overestimated and diameters greater than 3.5mm underestimated by 3-dimensional reconstruction. Most 3 dimensional reconstruction values were within +/- 10% of pathology, but diverged at each diameter extreme, approaching +/- 20%. Thus, computerized 3-dimensional reconstruction of ultrasound images shows excellent quantification of luminal size in the 2.0-3.5mm range, suggesting important investigative and clinical applications. PMID- 10149892 TI - Transcatheter stenting of the ductus arteriosus: evaluation as an alternative to surgical shunts. AB - Implantation of 3.5 mm Gianturco-Roubin coronary artery stents into the ductus arteriosus was evaluated as an alternative to surgical systemic to pulmonary arterial shunts in 3 weanling piglets. Thrombosis of the ductus occurred in all 3 animals (95% confidence limits 29-100%) within 1 hour, despite pretreatment with heparin. In each case, thrombus filled the ductus arteriosus but did not extend to any extraductal portion of the stents. Rapid, heparin-resistant thrombus formation precludes use of this stent procedure as an alternative to surgical shunts. PMID- 10149893 TI - Quantitative analysis by 3-dimensional intravascular ultrasound. PMID- 10149894 TI - Randomized evaluation of 5 French catheters for coronary angiography with or without the CO2 powered Hercules syringe. AB - To evaluate the CO2 power-assisted hand-held Hercules syringe (Cordis) for diagnostic coronary angiography using 5 French catheters (Judkins number 4 exclusively), 200 consecutive patients (excluding patients with valve disease and prior bypass surgery) were randomized to conventional manual or Hercules injections. The angiography was done through a femoral artery with or without a sheath. Total duration and fluoroscopy time from the end of the ventriculogram to the end of the procedure, quantity of contrast medium required, length of cinefilm, quality of film (good, satisfactory, or bad), streaming, technical ease [scale 1 (easy) to 6 (difficult)], and need for larger catheters were analyzed. Adequate quality angiograms were obtained in 193 patients (97%). Crossover to a larger catheter was required in 7 patients due to difficulty in engaging coronary ostia (right 6, left 1). No significant differences between manual or Hercules injections were seen in total duration of the procedure (12.0 +/- 4.6 versus 12.9 +/- 8.5 min), fluoroscopy time (4.0 +/- 3.1 versus 4.2 +/- 4.8 min), quantity of contrast medium (81 +/- 28 versus 89 +/- 29 ml), and length of the film (1.1 +/- 0.6 versus 1.3 +/- 0.7 min). The conventional method was found to be easier (facility scale: conventional 1.7 +/- 0.5, Hercules 2.3 +/- 1.2, p less than 0.05) because there was significantly less dislodgement of the catheter from the coronary ostia during contrast injections. Five French number 4 Judkins catheters permit adequate diagnostic coronary angiograms in 97% of routine coronary patients.(ABSTRACT TRUNCATED AT 250 WORDS) PMID- 10149895 TI - Anticoagulant effect of iohexol vs. ioxaglate during cardiac catheterization. AB - Contrast agent safety during cardiac catheterization (CC) may relate in part to anti- or procoagulant effect. We studied these effects in 177 patients who underwent standard CC (N=112) or percutaneous transluminal coronary angioplasty (PTCA) (N=65) and received either iohexol (N=111) or ioxaglate (N=66). Patients received either 0 or 2000u heparin for CC or 10,000u for PTCA. The groups were similar in regards to age, sex, amount of contrast used, and procedure time. Partial thromboplastin time (PTT) and activated clotting time (ACT) were both significantly increased (P less than .01) in patients who received 10,000u heparin irrespective of type of contrast agent although larger increases were seen in the iohexol group. With 2000u of heparin, ACT and PTT increased significantly (P less than .01) only in the iohexol group. PTT and ACT actually decreased to similar and significant (P less than .01) degrees after both iohexol and ioxaglate when heparin was not used. We conclude: 1) commonly used measures of anticoagulant (ACT and PTT) show greater prolongation after either 2000 or 10,000u of heparin with iohexol than ioxaglate, 2) ACT and PCT appear to shorten with both iohexol and ioxaglate if no heparin is used. This data would suggest that ioxaglate does not have an anticoagulant advantage over iohexol. PMID- 10149896 TI - Coronary angioplasty: balloons and new devices. How big is a niche, how much is it worth . . . and to whom? PMID- 10149897 TI - Trials and tribulations in the development of the coronary artery stent: a personal perspective. PMID- 10149898 TI - Coronary excimer laser angioplasty. PMID- 10149899 TI - Development of a database for clinical use and multicenter collaborative data sharing. PMID- 10149900 TI - What criteria does the FDA use to evaluate new technology? PMID- 10149901 TI - The changing dynamics of cardiology in the 1990's. PMID- 10149902 TI - The status of research in invasive cardiology. PMID- 10149903 TI - Some alternative perspectives concerning medical technology assessment. PMID- 10149904 TI - Percutaneous laser discectomy. AB - Percutaneous discectomy, for treatment of lumbar disc herniation, was first described in 1975 by Hijikta. Since its inception, a variety of instruments including rongeurs, augers, automated mechanical devices, and more recently, lasers have been developed to remove tissue from the herniated disc. The advantages of lasers include miniaturized, safe, and efficient energy delivery for percutaneous tissue removal. This article reviews the development of lasers for percutaneous discectomy. PMID- 10149905 TI - Clinical investigation with KTP/YAG laser for lower genital tract disease. AB - The KTP/YAG laser (Laserscope) was clinically investigated in treatment of 54 patients, 28 of whom had cervical intraepithelial neoplasia (CIN), 11 who had cervical polyp, 4 with cervical myoma, 9 with condyloma acuminata, and 2 with vulvar tumors. All patients were treated on an outpatient basis with local anesthesia. The procedure was performed in contact and noncontact irradiation modes with the tissue by using a bare fiber held in a handpiece with a power setting of 10-15 watts. Laser excisional conization was carried out for the treatment of CIN, laser excision was used for the treatment of condyloma of the cervix, cervical polyp, cervical myoma, and benign tumor of the vulva, and laser vaporization was used for condyloma of the vulva. The first cure rates were all satisfactory for the follow-up periods of 4-10 months. Complications during and post operation were minimal. The KTP laser provided good vaporizing ability compared with CO 2 and YAG lasers. When massive bleeding occurred which could not be stopped with the KTP laser, the YAG laser was used. PMID- 10149906 TI - Prognosis of early gastric cancer after laser endoscopic therapy. PMID- 10149907 TI - Laser surgery in the oral cavity. AB - As a cutting instrument, the CO 2 laser is the most suitable type of laser currently available for medical applications. It has proved particularly advantageous in surgery of the upper aerodigestive tract, as its energy-absorbing properties, which do not depend on dyes, allow its effect in tissue to be controlled accurately. Additionally, the slight degree of postoperative edema is invaluable, especially in the region of the upper respiratory passages. PMID- 10149908 TI - The use of the CO 2 laser in oral surgery in the military. AB - From 1987 to 1990, there were 122 soldiers treated with the CO 2 laser (Sharplan 1010) in the Laser Center of the Israel Defense Forces. A variety of benign oral lesions, vascular tumors, and other oral lesions were excised or vaporized. Twenty-four soldiers with impacted wisdom teeth and wide pericoronitis underwent operculectomy using the CO 2 laser. The CO 2 laser has the ability to perform accurate hemostasis surgery, with minimal postoperative pain and edema, and rapid healing, resulting in fast recovery without significant discomfort. These advantages are particularly important in the military since soldiers can return to their duties immediately after surgery. PMID- 10149909 TI - Interstitial laserthermia in neurosurgery. AB - Deep-seated brain tumor is difficult to treat surgically. Hyperthermia using various energy sources has been tried, but has failed to gain wide use because of equipment problems and poor temperature control. It is possible now to use Nd:YAG laser with a stable low-energy supply as an energy source for laser hyperthermia (laserthermia). Animal study and clinical study were done using SLT CL50, Computer-control Laserthermia System to treat deep-seated brain tumors. Experimental study revealed that laserthermia produced minimal edema, temperature control was satisfactory, and blood-brain barrier opened up for 6 days following laserthermia. Five patients with brain tumors were treated with laserthermia. Follow-up CT scan revealed disappearance of tumor in 4 patients and decrease in volume in 1 patient. Long-term neurological follow up revealed no deterioration. Laserthermia using Nd:YAG laser is safe and easy to use and it is beneficial to treat deep-seated brain tumors. PMID- 10149910 TI - A study on the removal of the melanin pigmentation of dog gingiva by CO 2 laser irradiation. AB - Removal of melanin pigmentation of the gingiva with CO 2 laser irradiation was investigated. The melanin-pigmented gingiva of 5 dogs were classified according to the degree of gingival pigmentation (slight, moderate, severe) and its extent (local, extensive). CO 2 laser was irradiated on the surface of the pigmented gingiva under the following conditions; defocused beams of spot size 4 mm, irradiation time 0.2(S), output 6-8(W)). That is, the irradiation energy density was 9.6-12.8 J/cm 2. The irradiated gingiva was examined macroscopically and histopathologically. The histopathological changes were investigated by hematoxylin-eosin staining and Masson staining for the differential diagnosis of melanin pigmentation cells. These examinations were done one week and three weeks after the laser irradiation. Immediately after irradiation, the gingiva surface showed white color and bulla-like appearance. One week after irradiation, the pigmentation of the lased gingiva disappeared in all cases macroscopically. Histologically, the pigmented-laden cells could not be found and no inflammatory cell infiltration was observed. Three weeks after irradiation, no reappearance of pigmentation was observed in either macroscopical or microscopical investigations excluding severe/extensive cases. These findings suggested that it is possible to remove gingival melanin pigmentation by CO 2 laser irradiation. PMID- 10149911 TI - A new instrument for use with Nd:YAG in tonsillectomy. AB - In tonsillectomy, unexpected bleeding can be one of the most troublesome surgical procedures to perform. To resolve some inherent problems, we have developed a new elevator with contact Nd:YAG laser probe for blunt dissection around the tonsillar capsule. Of 63 cases of laser tonsillectomies performed over 5 years, 51 cases were performed using conventional contact Nd:YAG laser probe and a chisel type dissector. Tonsillectomy in the remaining 12 cases was undertaken by the newly developed elevator with contact Nd:YAG laser probe. We compared clinical evaluation between laser and conventional procedures. Additionally, the advantage of laser tonsillectomy is discussed. PMID- 10149912 TI - New laser for treatment of skin lesions. PMID- 10149913 TI - Laser thoracoscopy: revolutionizing thoracic surgery. PMID- 10149914 TI - Minimally invasive FNAB versus surgical biopsy. PMID- 10149915 TI - Options multiply for teleradiology systems. PMID- 10149916 TI - Use of viscoelastic solutions in ophthalmology: a review of physical properties and long-term effects. AB - Solutions of flexible macromolecules are used in ophthalmic surgery for insertion of intraocular lens, during corneal transplantation, in cataract, corneal, glaucoma, trauma, and vitreo-retinal surgery. Polymeric materials used in formulating these solutions include hyaluronic acid, chondroitin sulfate, polyacrylamide, collagen, and mixtures of some of these materials. Although the physical properties of these materials have been studied extensively, the long term effects resulting from transitory increases in intraocular pressure and loss of even a small number of corneal endothelial cells are still unknown. The purpose of this paper is to review the literature that is available on these topics. PMID- 10149917 TI - Perspectives on artificial joint design. AB - Due to poor interdisciplinary communication, many artifical joint designs fail to account for some features that normally allow bones to survive for life. In part, these features concern modeling drifts and remodeling basic multicellular units (BMUs), the microdamage thresholds of bone, its load-grain alignment and shear lock properties, load focusing and defocusing, mechanical usage/strain thresholds for controlling the biological mechanisms, and the regional acceleratory phenomenon. This article reviews briefly some major aspects of these features and suggests how implant design might account for them. PMID- 10149918 TI - Prevalence of artificial hips in the United States. AB - This report summarizes information about adults with artificial hips as derived from a national survey, the 1988 National Health Interview Survey Medical Device Implant Supplement. Based on extrapolation to the United States population from the survey sample, it is estimated that 674,000 adults are currently using 811,000 artificial hips. The prevalence rate is 3.8 persons per thousand (95% confidence interval, 3.2, 4.4). 91.5% of the implants are primary implants and 8.5% are revisions, with the predominant reason for revision being loosening. Arthritis and injury are the most common reasons for hip implantation. Almost 60% of the implants have been in use for 5 years or less. This prevalence information about adults with artificial hips is unique in that it represents the first such estimates based on a probability sample of the United States population. PMID- 10149919 TI - Low-field MRI provides reliable, versatile studies. PMID- 10149920 TI - Ultrasound best modality for imaging lower DVT. PMID- 10149921 TI - MR detects abnormalities, directs stroke management. PMID- 10149922 TI - What to look for when buying a mammo system. PMID- 10149923 TI - 3-D ultrasound images optimize fetal review. PMID- 10149924 TI - Anatomic realism comes to diagnostic imaging. PMID- 10149925 TI - Probability theory aids choice of optimal exam. PMID- 10149926 TI - MR imaging illuminates musculoskeletal trauma. PMID- 10149927 TI - Are niche scanners part of MR's future? PMID- 10149928 TI - Outcomes measures: their impact on imaging. PMID- 10149929 TI - Promising new therapy for variceal bleeding. PMID- 10149930 TI - MRA displays pathology in abdominal vessels. PMID- 10149931 TI - Imaging methods assess success of bone grafts. PMID- 10149932 TI - MR angiograms detect vascular flow effects. PMID- 10149933 TI - Computers: power tool for imaging diagnosis. PMID- 10149934 TI - MRI found superior for imaging of cord trauma. PMID- 10149935 TI - Wrist arthroscopy: an overview. AB - An introductory overview of wrist arthroscopy is presented. The relevant anatomy and pathology of the wrist are reviewed, with special emphasis on the triangular fibrocartilage complex. Operative technique and equipment are described, and operative indications are presented. The role of diagnostic arthroscopy is discussed and comparison is made to arthrography in terms of diagnostic efficacy. Some future directions for wrist arthroscopy are presented. PMID- 10149936 TI - Open reduction and internal fixation of proximal interphalangeal joint fracture subluxations. AB - Proximal interphalangeal (PIP) joint fracture-subluxations represent a small component of hyperextension injuries to the finger. Six unstable PIP fracture subluxations that were not amenable to nonoperative treatment underwent open reduction and internal fixation. Among the patients, the technique of open reduction and internal fixation with temporary transarticular K-wire fixation and early protected range of motion has been found to result in a good range of motion with minimal complaints on follow-up. PMID- 10149937 TI - Design rationale of a small ingrowth acetabular component: two to three years' results. AB - It is possible to use a noncemented porous metal-backed acetabular component with an outer diameter as small as 39mm with safety. A two to three year follow-up of the first 40 cases in which this type of acetabular component was used has revealed no particular problems. These small acetabular components have considerably reduced the necessity for acetabular bone grafting in patients with hip dysplasia. PMID- 10149938 TI - Intraoperative and postoperative red blood cell salvage. AB - The risks associated with homologous blood transfusions include hepatitis, transfusion reactions, and AIDS. Intraoperative and postoperative red blood cell salvage and reinfusion are techniques available to decrease the need for homologous transfusions. In this article the techniques of red blood cell salvage are described and the benefits and potential risks of these methods are discussed. PMID- 10149939 TI - Spinal instrumentation. Biomaterial, biomechanical, and clinical aspects. PMID- 10149940 TI - Noncemented tibial components: does a stem help? AB - A prospective, nonrandomized study was conducted in an attempt to determine if the addition of a stem to the tibial component in noncemented total knee replacement reduces the incidence of sinkage. A stemmed tibial component was used in 125 cases and an identical artificial knee without a stem was used in 307 cases. Follow-up was two to six years. Sinkage occurred in 0.8% of the cases with stemmed tibial components and in 3.5% of the nonstemmed tibial components, among which two (0.8%) required revision. The clinical results for both groups were similar. A small group of 34 patients who had a stemmed tibial component on one side and a nonstemmed component on the other also were examined. Fifty percent of these patients preferred the stemmed component knee. The results of these studies suggest that the addition of a stem to the tibial component in noncemented total knee replacement is of value in preventing tibial sinkage. PMID- 10149941 TI - Carpal replacement or arthrodesis? PMID- 10149942 TI - The effects of declining transfusion rates on elective total hip arthroplasty. AB - The incidence of red blood cell transfusion is reviewed in a series of 130 elective total hip arthroplasties performed over a four-year period. A significant downward trend was noted in the hemoglobin level at which patients were transfused (p less than 0.01). Conversely, no significant differences were noted in the rate of rehabilitation, the length of hospitalization, or the incidence of complications. In addition, patients who predonated autologous blood were transfused at a higher rate than those who did not (p less than 0.001), but they received less homologous blood than patients who had not predonated. PMID- 10149943 TI - Wrist arthrodesis by intramedullary rod fixation: a valuable technique. AB - Arthrodesis of the wrist with intramedullary rod fixation is a simple technique that provides the opportunity for performing concomitant procedures. Iliac bone graft usually is not required with this technique, as the intramedullary rod is a load-sharing construct that allows compression at the fusion site and facilitates union. Rod removal usually is optional, and the long intramedullary beam effect of the rod can function as an internal splint if fibrous or hypoplastic union occurs. Early mobilization is possible, sometimes with only minimal splinting. The results with use of this technique over a ten year period of time in ten wrists (nine patients) with endstage radiocarpal joint instability are reported. PMID- 10149944 TI - Selecting the appropriate imaging modality. PMID- 10149945 TI - Preoperative templating for the equalization of leg lengths in total hip arthroplasty. AB - The method and results of preoperative templating for the re-establishment of leg length equality during total hip replacement (THR) are reported. The method is a modification of the technique of Muller and requires an anteroposterior radiograph of the pelvis that includes the proximal third of both femora, appropriate acetabular and femoral templates, and tracing paper. To obtain equalization of leg lengths and tissue tension, a composite drawing is made of the operative plan, with all component sizes and important measurements clearly marked. During THR, the lesser trochanter is identified and the femoral neck is osteotomized after a direct measurement is made. These principles were followed in a prospective, consecutive series of 42 primary THR procedures performed by one surgeon. All the radiographic measurements were performed by a single observer. The leg length discrepancy on the postoperative radiograph averaged 3mm (standard deviation = 3mm, range: -9 to +9mm). The postoperative clinical leg length discrepancy averaged 0mm (range: -10 to +10mm). None of the patients complained of leg length inequality. Preoperative templating allows different alternatives to be traced on paper prior to the actual surgical procedure. This method also helps determine the requirements for special prosthetic implants. Acceptable results for postoperative leg length equality may be reliably achieved using this method. PMID- 10149946 TI - Clinical evaluation of BPAA patch in the treatment of extremity trauma. AB - In a multicenter clinical trial, the efficacy and usefulness of the BPAA Patch in the treatment of extremity trauma were evaluated in 64 patients and the safety was tested in 70 patients. In 89.1% of the patients studied, the final overall improvement was rated "moderate" or better, and no adverse reactions were reported. The results of this study indicate that the BPAA Patch is a highly useful topical antiinflammatory-analgesic agent for use in the treatment of pain and inflammatory symptoms following trauma. PMID- 10149947 TI - Self-guiding interlocking intramedullary nail. AB - A critical step in closed interlocking intramedullary nailing is the insertion of the proximal and distal screws under fluoroscopic control. An intramedullary nailing system is described that does not require the use of direct fluoroscopic control for distal screw insertion. With the SG interlocking intramedullary nail, the location and fixation of the distal screw is achieved by keying in on a transversely placed guide pin, with imaging required only to confirm the alignment and final placement of the instrumentation. PMID- 10149948 TI - Ventricular assist device (VAD) pathology analyses: guidelines for clinical studies. PMID- 10149949 TI - Healing of physeal fracture after fixation with biodegradable self-reinforced polyglycolic acid pins. An experimental study on growing rabbits. AB - Physeal fractures occur at a frequency of 15% of all long bone fractures in children. Undisturbed continued bone growth is the main goal of the treatment of these fractures. After the operative reduction and fixation, whenever needed, a second operation for the removal of the pins is inevitable. The purpose of this study was to develop a biodegradable fixation device for transphyseal fracture fixation, abolishing the need of removal operation. Epiphyseal separation of the distal femoral physis was made on the right side in 18 five-week-old rabbits. The fixation of the physeal fracture was made with two self-reinforced polyglycolic acid (SR-PGA) pins 1mm in nominal diameter and 25mm in length. The follow-up times were 3, 6, 12, 24, and 28 weeks. The distal femoral growth-plate of both femurs was analyzed by radiographic, microradiographic, oxytetracycline fluorescence, histological and histomorphometric studies. Histomorphometric studies showed normal features of growth. Two growth-plate-penetrating transcondylar SR-PGA implants, of 1mm in diameter, provided sufficient stability for the fixation of a distal femoral physeal fracture in a growing rabbit, and did not cause any growth disturbance. PMID- 10149950 TI - New arterial prostheses by filament winding. AB - A new manufacturing method for vascular grafts, based on a filament winding technique, is unveiled. The concept that pilots this method is presented and analysed in detail alongside the experimental results. A basic feature of filament winding is its ability to produce a two-phase structure built of a continuous fibre-reinforced polymeric matrix, shaped according to the shape of a mandrel. This structure offers a number of advantages over common vascular graft designs, e.g. better control of the mechanical properties and closer match with anisotropic properties of native arteries, and more degrees of design freedom with respect to pore size, biodegradability and biocompatibility. The experimental section offers a range of potential constituent materials, and presents an example of a Lycra fibre/Pellethane matrix prototypical prosthesis. PMID- 10149951 TI - A comparative study of porcelain repair materials. AB - Intra-oral fracture of metal-ceramic restorations sometimes occurs when clinical and laboratory techniques have been inadequate. Removal and refabrication of the prosthesis is the ideal solution, but may not always be practical. Recently, several products have been marketed for expediting the repair of fractured restorations in the mouth. This study compared the effectiveness of three of these repair systems (Super-C, Command Ultrafine and 3M Porcelain Repair Kits) with a control group of porcelain-fused-to-metal specimens. Measurement of failure load of each material being tested was carried out in compression using a universal testing apparatus and a specially designed jig. Each experimental and control group contained ten specimens. Each material was tested individually for repairs against metal and against porcelain. A comparison of the failure load values indicated that the control samples gave the highest mean value of 881.6 +/ 192.9 N, while that of Super-C against metal was the lowest at 385.4 +/- 102.4 N. The Command Ultrafine Repair Kit was the strongest of the repair systems studied. PMID- 10149952 TI - Performance of retrieved Kuntscher intramedullary rods: improved corrosion resistance with contemporary material design. AB - Eighteen Kuntscher-type intramedullary rods were obtained after human implantation periods ranging from 1 to 23 years. A clinical evaluation, metallurgical and chemical analyses of each implant were performed. Idiopathic, implant-related pain was the most common reason for removal, but was not related to extent of implant corrosion. When classified as early versus contemporary material compositions, a significant increase in surface corrosion, inclusion content and carbon content were demonstrated in rods made of the earlier composition of stainless steel. Intergranular corrosion was associated with structural design, rather than material microcleanliness or composition. While contemporary intramedullary fracture fixation provides excellent clinical results, the present investigation suggests that the performance of stainless steel implants may be improved through continued refinement of steel composition, careful consideration of structural design and fabrication techniques, and by routine removal of implants at the earliest opportunity. PMID- 10149953 TI - Development of novel dental cements. I. Formulation of aluminoborate glasses. AB - Aluminoborate glasses were formulated as potential novel glass-ionomer cement components, and their reactivity with a polyalkenoic acid was assessed by means of working and setting time measurements. Of the 20 prepared formulations, some containing fluoride, eight were found to have acceptable manipulative characteristics, and three of these formed hard set materials. PMID- 10149954 TI - Development of novel dental cements. II. Cement properties. AB - Following earlier work, three novel aluminoborate glasses have been studied as potential cement components. Factors studied include the effect of batch size on composition and manipulative characteristics, and the effect of tartaric acid and conditions of storage on mechanical properties. It was concluded that two materials have potential for application as dental luting agents. PMID- 10149955 TI - A study of some mechanical properties of an RTV polydimethylsiloxane for extraoral maxillofacial prostheses. AB - The construction of facial prostheses simulating the missing tissues as closely as possible is an imperative and demanding task. Such prostheses will be comprised of parts presenting different mechanical properties attempting to simulate facial tissues. In this study the mechanical properties of a room temperature vulcanized (RTV) silicone facial elastomer were modified, altering the molecular architecture by controlling the amount of cross-linking. A wide range of compliance was achieved which enables more lifelike facial prostheses to be made in clinical practice. PMID- 10149956 TI - Fixation of diaphyseal femoral osteotomy with self-reinforced biodegradable intramedullary implants: an experimental study on growing dogs. AB - Polyglycolic acid (PGA) was investigated for use as a biodegradable suture and fixation material for the repair of soft and osseous tissue. Self-reinforced (SR ) PGA has been used successfully since 1984 as an internal fixation material for fixation of cancellous bone fractures. The purpose of this study was to examine the possible usefulness of an intramedullary SR-PGA rod in the fixation of femoral shaft osteotomy in the growing dog. Osteotomy of the right femur was made in 14 Beagle dogs at 12 weeks of age. After accurate reduction, the osteotomy was fixed with an intramedullary 45 x 60 mm SR-PGA rod. The intramedullary SR-PGA rod provided sufficient stability for healing of a femoral shaft osteotomy in the growing dog and did not cause any significant growth disturbance. PMID- 10149957 TI - An evaluation of exposure time and temperature in the thermocycling of dental restorative materials. AB - This study indicates that some current procedures used in thermocycling dental restorative materials would not produce the desired thermal gradient in the specimens. The shortfall in gradient depends on the size of the specimen, the dwell time in the baths and whether the baths are stirred or not. The desired thermal gradient of 50 degrees C can be approximated with a dwell time of 60 s in well-circulated water baths at 5 degrees C and 55 degrees C. For critical studies a dwell time of 90 s is recommended. PMID- 10149958 TI - Use of poly(2-hydroxyethyl methacrylate) for endovascular occlusion in pediatric surgery. AB - Embolization using poly(2-hydroxyethyl methacrylate) (PHEMA) hydrogel particles, of cylindrical spherical form, was successfully achieved in 42 children treated for non-operable haemangiomas of the liver, and angiodysplasias. Spherical PHEMA hydrogels appeared to be the only possibility for the treatment of 26 children suffering from extensive cavernous haemangiomas of face and neck. Particles were able to cover the tumour, stop its growth and allow the use of local hyperthermia with the electromagnetic field. A partial two-stage embolization using beaded PHEMA was also used as part of the multistage treatment for curing the spleen in 28 children suffering from haemolytic spherocytic anaemia, thrombocytopenic purpura and portal hypertension. PMID- 10149959 TI - Raman spectroscopy in the study of biocompatibility. AB - This review deals with the application of Raman spectroscopy to the study of the biocompatibility of orthopaedic and ophthalmological materials and includes an introduction, a brief theory on the fundamental concepts of the technique, a description of the method and of the traditional and non-traditional instrumentation and a brief treatment of the surface properties of the different classes of materials. In the orthopaedic field, Raman studies on the structures of glasses, ceramic materials, carbon fibres and polymers before and after implantation are reviewed, particularly as far as structural modifications at the biomaterial-tissues interface are concerned. In the ophthalmological field, the chemical biocompatibility of hydrophobic and hydrophilic polymers for intraocular and intrastromal implants and for soft contact lenses is considered with respect to the presence of monomeric reactive centres in hydrophobic materials and the water amount in hydrophilic ones. The progress of the multichannel Raman technique for 'in-vivo' measurements is also described. PMID- 10149960 TI - New generation biodegradable plate for fracture fixation: comparison of bending strengths of mandibular osteotomies fixed with absorbable self-reinforced multi layer poly-l-lactide plates and metallic plates--an experimental study in sheep. AB - Eighteen osteotomies of sheep's mandibular corpus were fixed: nine with self reinforced multi-layer poly-l-lactide (SR-PLLA) plates and nine with metallic plates. Both plates were fixed with similar metallic screws. The right corpus of each sheep acted as a control. Radiographic analysis was carried out at 3 weeks and at sacrifice (6, 12 or 24 weeks) when the bending force needed to break the osteotomy site was measured. At 6 and 12 weeks of follow-up the osteotomy fixed with the PLA-plate seemed to tolerate the bending force better but no significant differences were detected at 3 or 24 weeks. The results have been satisfactory and have led the authors to continue with the development of a SR PLLA plate-and-screw device for fracture fixation. PMID- 10149961 TI - A glass ionomer for reconstructive surgery. Ionogran--an ionomeric micro implant. A biological evaluation. AB - A porous glass-ionomer (Ionogran) was evaluated and compared to hydroxyapatite Interpore 200. In an in-vivo screening test procedure, microfilter diffusion chambers embedded on the tibial surfaces of adult baboons were used to evaluate cell survival, cell regeneration and cell differentiation. In a bulk testing procedure a standardized bone core was removed from the tibia through the knee joint and the material exposed to the defense mechanisms of the system. Both materials were found to be biocompatible, non-toxic and did not inhibit cell proliferation in the enclosed environment of diffusion chambers. Histological response and cell arrangement within the chambers containing Ionogran were similar to that of the controls with cancellous bone only. Highly specialized haemopoietic tissues were in direct contact with the Ionogran. In the presence of hydroxyapatite new bone was actively formed. Haemopoietic elements were never found in contact with the hydroxyapatite. In the bulk testing procedure, the general histological appearance was that of a reactive tissue response to a low grade persistent stimulation coupled to surface degradation products. The Ionogran was found to be stable, osteo-conductive and promoted osteoid formation when in contact with bone. From a clinical point of view the material could serve as a permanent scaffold, maintaining form, and will be of value in bone reconstructive procedures. PMID- 10149962 TI - Comparison of bone screw holding strength in healthy bovine and osteoporotic human cancellous bone. AB - Pushout tests were carried out on two different diameter, self-tapping, cancellous bone screws (4 mm and 6.4 mm) inserted in bovine cancellous bone sections taken perpendicular and at 45 degrees to the long axis of the bone. Comparison was made with the same type of screws inserted into sections taken from osteoporotic and/or osteoarthritic human femoral heads. The results showed no significant difference in the holding strength of different diameter screws in bovine bone sections of given orientation but significant differences when the trabecular orientation of the section was changed. By comparison, the holding strengths of the same screws in diseased femoral heads were found to be both significantly different from each other and significantly lower than for the same screws inserted in healthy bovine bone. The screw diameter, trabecular orientation, mineral content and the health of the bone all need to be considered in order to optimise the holding strength of the screws in cancellous bone. PMID- 10149963 TI - Collagen engineering for biomaterial use. AB - Collagen is a typical biological macromolecule having been utilized for a long period of time as a material like cellulose. However, its application is becoming comprehensive, ranging from classical applications such as the leather, gelatine and food industries to the current one, namely, biomaterial and biotechnological uses. The diversification of collagen applications was enhanced by two factors, the accumulation of the scientific knowledge that permitted proper engineering of collagen for a biomaterial use, and the demand for new biomaterials with characteristic biological properties including interaction with cells. The collagen engineering described in this paper is designed for biomaterial use, based on the fundamental chemical and biological properties of collagen; however, it would be useful also for other applications apart from biomaterials. PMID- 10149964 TI - Collagen-based biomaterials. PMID- 10149965 TI - The effect of gamma irradiation on a xenograft tendon bioprosthesis. AB - Radiation sterilisation of xenograft prostheses has been shown to cause damage to the material. Such damage has been imputed to affect the mechanical and biological properties and may contribute to long-term failure. This study has examined the effect of 25 kGy (2.5 Mrad) of gamma radiation on the mechanical and physicochemical properties and the biological function of a xenograft tendon bioprosthesis derived from glutaraldehyde cross-linked kangaroo tail tendon. The ultimate tensile stress of nonirradiated glutaraldehyde cross-linked tendon was greater than that of fresh frozen tendon, but irradiated cross-linked tendon did not differ. Irradiation did not alter the response to prolonged collagenase exposure. There was a decrease in overall apparent cross-link density (as determined by thermal denaturation temperature). After 12 months implantation, there was a slightly more active cellular response around irradiated tendon and the very peripheral fibres were infiltrated, but the mechanical properties of the retrieved implants were the same for irradiated and nonirradiated material. Gamma irradiation would appear to be a satisfactory method of sterilisation for glutaraldehyde cross-linked tendon materials. However, as damage to the cross linked structure was detected in this study, it may not be appropriate in other applications. PMID- 10149967 TI - Haemostyptic preparations on the basis of collagen alone and as fixed combination with fibrin glue. AB - Preparations containing collagen play a prominent role among local haemostyptic agents in surgery. Sheets of collagen are used as degradable haemostyptic tampons. Various investigations have shown better haemostasis with collagen compared to other degradable materials, although the haemostyptic effect of these collagen preparations is limited. Concerning the mechanism of haemostasis, not all the reactions stimulated, e.g. by the collagen of an injured vessel wall, may be activated by a haemostyptic tampon from collagen. This depends very much on the kind of preparation. The combined application of a sheet of collagen with fibrin glue improved local haemostasis to a great extent. Large areas of capillary bleeding can be treated successfully with this method. Despite the very good results, this method has not been applied on a broad scale. This is due to the necessary skill and experience and the relatively cumbersome preparation required at the operation site. These drawbacks have been overcome with the latest development in this field--a sheet of collagen covered with a fixed layer of the solid components of a fibrin glue (fibrinogen, thrombin and aprotinin). The performance of this new local haemostyptic agent is described with special emphasis on the results of clinical trials. Haemostasis of large areas of capillary bleeding was very efficient and safe with the new material. Moreover, bile leakage and liquor, pancreatic and aerial fistulae could be sealed without problems. PMID- 10149966 TI - Immunoassay techniques for the detection of circulating antibodies to collagen following the use of collagen medical devices. AB - During the use of collagen medical devices, some adverse clinical reactions occur involving both the cellular and humoral types of the immune response. Thus, the development of immunoassay techniques for measuring the presence and the levels of circulating anticollagen antibodies is required. The authors present their protocol: it is a solid phase radioimmunoassay using collagen coated on polystyrene microplates and labelled protein A as the tracer. An example of the application of the technique is described. Anticollagen antibodies were monitored in 586 patients undergoing bovine collagen implant therapy. In a retrospective study on 166 patients we found a good correlation between the presence of antibodies to collagen and cellular immune reactions such as a positive skin test or adverse clinical reactions after implantation. A prospective study on 420 patients showed that the pretreatment anticollagen serologic test can be useful as an adjunct to skin testing in the conservative management of patients desiring bovine collagen implant therapy. The use of this double test allowed avoidance of any major clinical reaction and reduced minor signs of intolerance. PMID- 10149968 TI - Tissue regeneration by use of collagen-glycosaminoglycan copolymers. AB - Simple chemical analogs of extracellular matrices have been synthesized by graft copolymerization of a glycosaminoglycan on to type I collagen. A few of these collagen-graft-glycosaminoglycan copolymers (CG copolymers) have diverted decisively the kinetics and mechanism of skin wound healing in animals and humans away from contraction and scar synthesis, towards the direction of skin regeneration. Detailed animal studies show that CG copolymers show maximum biological activity when the average pore diameter and the degradation rate in collagenase are controlled within critical limits. When seeded with a minimum number of cells these active copolymers induce regeneration of skin, including synthesis of a new epidermis and a new dermis in the correct anatomical relationship. Certain unseeded copolymers have also induced regeneration of peripheral nerve. Another copolymer has induced regeneration of the knee meniscus. The unusual biological activity of these copolymers has led to extensive, successful clinical testing of novel medical devices for the treatment of skin loss with severely burned patients. PMID- 10149969 TI - Skin replacement using collagen extracted from bovine hide. AB - This paper reviews the use of biological sponge-shape matrices as dermal replacements in order to orient newly formed wound tissue. Sponge-shape matrices consist of a scaffold made of cross-linked collagen extracted from bovine hide. Other molecules with specific activities on wound tissue ingrowth are bound to collagen. The lamination of sponge with a synthetic material allows this device to be implanted as a temporary skin substitute. For the epidermal cell layer replacement, a biological film-shape matrix can be used in order to cultivate autologous cells during the period that biological sponge-shape matrices are invaded by wound tissue. PMID- 10149970 TI - Peripheral nerve repair with collagen conduits. AB - This paper describes the repair of peripheral nerves with a tubular conduit fabricated from collagen. The tubular collagen matrix was made semipermeable to permit nutrient exchange and accessibility of neurotrophic factors to the axonal growth zone during regeneration. In-vitro studies showed that the semipermeable collagen conduit allowed rapid diffusion of molecules the size of bovine serum albumin and was adequately cross-linked for controlled resorption in vivo. Studies on primates suggest that collagen conduits worked as effectively as nerve autografts in terms of physiological recovery of motor and sensory responses. The results of in-vitro and in-vivo studies of the collagen conduit represent a significant step towards our specific aim of developing suitable off-the-shelf prostheses for clinical repair of damaged peripheral nerves. PMID- 10149971 TI - Osteogenic capacity of collagen in repair of established periodontal defects. AB - Periodontal bone defects were established in four dogs, with one proximal lesion and one furcation lesion in each quadrant. These defects were treated with the implantation of collagen membranes, collagen sponge or a combination of membrane and sponge, inserted between the mucoperiosteal flaps and the bone defects. Control sites were treated in a similar surgical manner to the experimental sites, but no collagen was inserted. Substantial amounts of new bone formed in those cases treated with the collagen products, especially those treated with the membrane either with or without the sponge. The membranes limited the infiltration of small round cells, whereas in the control sites, inflammatory cells infiltrated to the bone surface. New connective tissue attachment was established in experimental situations, especially with the use of the membranes alone or in conjunction with sponge. PMID- 10149972 TI - Development of an ovine collagen-based composite biosynthetic vascular prosthesis. AB - The search for an ideal vascular prosthesis to bypass peripheral vascular obstructive lesions is necessary where autologous tissues are either unavailable or unsuitable. This paper will outline the development and use of vascular conduits, principally of biological origin. The clinical benefits and limitations of these materials are discussed. The development of a composite biosynthetic prosthesis (Omniflow?) is described, together with the testing methods used to determine and predict its suitability for use as an arterial substitute. The ovine biosynthetic prosthesis has significantly improved surface and mural properties over previous attempts at producing prostheses for vascular reconstruction. Immunohistological studies on samples recovered from dogs after 4 years show that the original ovine collagen is still present after 4 years, and it is further augmented by the deposition of new, host-derived connective tissue. PMID- 10149973 TI - The utility of collagen-based vehicles in delivery of growth factors for hard and soft tissue wound repair. AB - Bovine demineralized bone powder and reconstituted bovine dermal collagen have been effectively utilized during the past several years to deliver a variety of growth factors in animal models of hard and soft tissue wound repair. Bone morphogenetic proteins have been delivered in a demineralized bone powder matrix to promote ectopic bone formation in the rat subcutaneous model with the objective of studying the process of endochondral bone formation and evaluating the utility of such factors in promoting repair of hard tissue defects. Reconstituted bovine dermal collagen gels and sponges, including composites of collagen and heparin, have been utilized to deliver growth factors such as platelet-derived growth factor (PDGF), transforming growth factor-beta (TGF-beta) and fibroblast growth factor (FGF) to study their effects in subcutaneous and incisional models of dermal wound repair. The results of these experimental animal studies have provided convincing evidence that the rheological properties, biocompatibility and resorbable nature of type I collagen make it an excellent delivery vehicle for evaluation of a variety of growth factors in human clinical studies of hard and soft tissue would repair. PMID- 10149974 TI - The biologic responses to orthopedic implants and their wear debris. AB - The use of artificial materials in the treatment of orthopaedic conditions, most notably arthritis, over the past few decades has been increasing dramatically. Such use makes an understanding of the tissue responses to the various materials necessary to determine their effectiveness and acceptability. This review concentrates on the studies of the biological responses to the materials that are used mainly in joint replacements and fixation of fractures. In-vivo and in vitro experimental studies of various metals, polymers and ceramics and their constituents are first presented with discussions regarding their clinical importance. Studies of clinically successful implants are then presented to illustrate the expected morphological features of incorporation and acceptance by the host tissues. The local and systemic effects complicating the use of the implanted materials as well as the failure of the implant are then presented. PMID- 10149975 TI - Resorbable polymers for internal fixation. AB - Bone fractures are usually fixed with metallic internal and/or external fixation devices. Such devices have to be removed from the implantation site, once the bone fracture is healed. Metallic devices may also corrode in vivo releasing ions into the tissues. An ideal internal fixation device should allow adequate fracture fixation, immediate recovery of mobility of the limb, and be produced from a material which can be safely left at the implantation site when the fracture healing is completed. Resorbable polymers are candidates for construction of such devices. PMID- 10149976 TI - Biodegradable implants as intramedullary nails. A survey of recent studies and an introduction to their use. AB - The high stiffness of metallic implants often requires a removal of the implant through a second operation, after fracture healing has occurred, to prevent disuse osteoporosis from occurring. An absorbable implant, lending sufficient strength and stiffness for support of the fracture during the healing period, would then gradually decay, and shift acting forces over to the healing bone. This paper presents a background to the development of such an implant of self reinforced polylactic acid, and some recent results from different studies using these rod shaped implants for intramedullary nailing of both experimental and clinical fractures on animals. A short description of the operational technique for use of these implants is also given. PMID- 10149977 TI - Biodegradable self-reinforced composite materials; manufacturing structure and mechanical properties. AB - Biodegradable (or absorbable), self-reinforced polymeric composites fulfill the demands of secure orthopaedic fixation materials because of their high strength, appropriate stiffness and strength retention which can be tailored according to the healing rate of damaged tissues. Ultra-high strength, self-reinforced, macroscopical biodegradable polymeric composites can be manufactured by creating the polymeric microstructure, where oriented reinforcing elements and matrix material, which have the same chemical element composition, are bound together. Biodegradable, self-reinforced composites have attractive application possibilities in surgery. The materials can be processed into the form of rods, screws, tacks, cerclages, clamps, plates, spirals, etc., which have versatile applications in traumatology and in orthopaedic surgery. PMID- 10149978 TI - Synthesis of polylactides, polyglycolides and their copolymers. AB - An overview is given of several polymerization routes of lactides and glycolides. Well-known in the literature are melt- and bulk-polymerization. These two polymerization types are discussed, showing that they have certain advantages and disadvantages. Less known are the solution and suspension polymerization of lactides and glycolides. These two techniques are described in detail. In certain cases these polymerizations have advantages over the aforementioned ones. It is shown that lower system viscosity enables better heat transfer during the reaction, resulting in a better, controllable reaction. The first results of solution and suspension polymerization are presented, showing that these techniques have great potential in the future. PMID- 10149979 TI - Biodegradable implant materials in fracture fixation. AB - Based on our experiences in paediatric traumatology treated conservatively or with metallic implants, we looked for alternative fixation possibilities in the field of biodegradables. We designed a new driving system for screws consisting of an indwelling screw driver which transduces the torque force over the whole length of the thread. With this technical approach, the head and the neck of the screw as the most friable point for the fracture of the implant could be avoided. In 48 calves aged 6 weeks we performed a comparative study with either conservative treatment (repositioning and casting) or osteosynthesis with biodegradable screws made from polylactate acid or metallic screws (AO type) after an oblique osteotomy at a 45 degrees angle to the axis of the right metacarpal bone. Results from 1 to 6 weeks postoperatively were compared and good to excellent results obtained in equal amounts for PLA and steel screw osteosynthesis, whereas conservative treatment was only successful in one third of the cases. Clinical, radiological and histological follow-up proved the feasibility of biodegradable osteosynthesis in the growing skeleton. For clinical evaluation in children, the resorption time of biodegradable materials has to be lowered to 3 to 6 months. PMID- 10149980 TI - Biocompatibility issues in hemodialysis. AB - Hemodialysis, as a life-saving treatment modality for uremic patients, implies a repeated and compulsory contact of blood with foreign materials. As a consequence, biocompatibility problems are unavoidable. The same applies for the material used for the creation of vascular access, and for the alternative dialysis method, CAPD (continuous ambulatory peritoneal dialysis), although each system might cause its own and specific problems. Although in early dialysis the focus has been on maintenance of life and elimination of toxins, later on the important morbid implications of this lack of biocompatibility have been recognized. Eight major problems will be discussed, especially in the perspective of recent new findings in this field: (1) coagulation and clotting; (2) complement and leukocyte activation; (3) susceptibility to infection; (4) leaching or spallation; (5) surface alterations of solid materials; (6) allergic reactions; (7) shear; (8) transfer of compounds from contaminated dialysate. After description of the major biochemical and clinical implications of these problems, ways to prevent morbid events and future perspectives will be described. PMID- 10149981 TI - A piezoelectric film transducer for dental occlusal analysis. AB - Occlusal load, contact sequence and location are necessary parameters for the study of dental biomechanics, simulation and clinical treatment planning. A piezoelectric film transducer for dental occlusal analysis was developed and in vitro evaluations of the transducer were conducted in a servohydraulically driven artificial mouth. The transducer is designed to provide occlusal contact force information. The transducer thickness (9 mum) minimizes interference with normal mandibular closure. Voltage outputs from the sensor as a result of occlusal contacts generated in the artificial mouth were sampled through a computer controlled data acquisition system. The transducer output recorded by the data acquisition system was calibrated to the applied load in the artificial mouth. The output of the piezoelectric film was evaluated during varying loads, cycling frequencies, surface areas of contact, and transducer surface areas. The preliminary studies indicate that the piezoelectric film holds out considerable promise and with further development may be well suited as a diagnostic tool in dental occlusal analysis. PMID- 10149982 TI - Biomechanical factors affecting the bone-dental implant interface. AB - While it is known that dental implants can 'work'--the success of the Branemark 'osseointegrated' implant is a prime example--implants can also fail. The challenge is to develop a basic science understanding of all aspects which contribute to implant performance. In designing a successful dental implant, the main objective is to ensure that the implant can support biting forces and deliver them safely to interfacial tissues over the long term. Biomechanics are central in this design problem. Key topics include: (1) the nature of the biting forces on the implants; (2) how the biting forces are transferred to the interfacial tissues; (3) how the interfacial tissues react, biologically, to stress transfer conditions. For biting forces on dental implants, the basic problem is to determine the in-vivo loading components on implants in various prosthetic situations, e.g. for implants acting as single tooth replacements or as multiple supports for loaded bridgework. Significant progress has been made; several theoretical models have been presented for determining the partitioning of forces among dental implants supporting bridgework. However, more work will be needed to clarify how well these models match reality. Interfacial stress transfer and interfacial biology represent more difficult, interrelated problems. One problem is that the multitude of different shapes, sizes, materials, surgical sites and animal models for dental implants has precluded any generally accepted rules for biologically 'favorable' vs 'unfavorable' interfacial stress transfer conditions. While many engineering studies have shown that variables such as implant shape, elastic modulus, extent of bonding between implant and bone, etc., can affect the stress transfer conditions, the unresolved question is whether there is any biological significance to such differences. Recent research suggests that, at the very least, our search for a more detailed hypothesis regarding the relationship between interface mechanics and biology should take account of basic bone physiology, e.g. wound healing after implantation plus basic processes of bone modeling and remodeling. PMID- 10149983 TI - Surgical instrument design for the accurate cutting of bone for implant fixation. AB - Oscillating saws and rotary drills are the most common instruments used in orthopaedic surgery for the cutting of bone and the drilling of holes through the cortex in preparing surfaces for implants to be placed on the bone ends. To obtain precision of placement of the surfaces and holes, various techniques have been developed to guide the instruments, such as holes, slots and flat surfaces. For sawing surfaces in total knee replacement a survey was conducted to assess the accuracy of cutting the distal end of the femur and the proximal end of the tibia with both slotted and surface guides used in some of the currently available prostheses instrument sets. PMID- 10149984 TI - Do intramedullary rods of self-reinforced poly-L-lactide or poly-DL/L-lactide cause lactic acid acidosis in rabbits? AB - Intramedullary rods of self-reinforced poly-DL/L-lactic acid or poly-L-lactic acid were implanted in both femurs of ten rabbits for 60 weeks. Levels of arterial blood L- and D-lactate, pyruvate, pH, pCO2, base excess, standard bicarbonate, pO2 and O2-saturation were determined before implantation and 1, 3, 6, 12, 24, 36, 48 and 60 weeks after implantation. No significant increase in blood L- and D-lactate level was observed at any follow-up. Also, the blood acid base balance remained normal throughout the study. Further studies on larger implants and on larger animals with follow-ups up to 5 years are recommended. PMID- 10149985 TI - Experimental studies of the biological response to a new bone cement: II Soft tissue reactions in the rat. AB - The biological response to a new bone cement (London Hospital cement), which contains polyethylmethacrylate/n-butylmethacrylate, has been examined experimentally and compared with polymethylmethacrylate. The cellular reaction was identical when the polymer powders of the cements were inserted subcutaneously in rats, there being a macrophage response to the polymer beads of both materials. Experimental implantation of the two cements into the paraspinal musculature of rats showed that there was less tissue damage adjacent to the new material than to polyethylmethacrylate. There was a significantly smaller macrophage and giant cell reaction in relation to the polyethylmethacrylate/n butylmethacrylate cement. These differences may be related to the lower heat of polymerisation of the new cement and to its smoother surface contour, as demonstrated by scanning electron microscopy. PMID- 10149986 TI - Intramedullary fixation with screwed, conical stems--unsolicited results from animal experiments. AB - For the purpose of studying bone remodeling around prostheses, a segmental replacement for the goat tibia was designed, using a conical, screw-threaded, hydroxyapatite-coated stem for fixation. Eight goats were provided with the implant, seven of which loosened within 10 days post-operatively, displaying progressive radiolucency and gross rotational motion. The eighth one also loosened radiographically, but developed a stabilizing callus bridge to prevent motion. A second design of similar shape and coating, but lacking the screw threads, was designed and also applied in eight animals. In this case, no loosening occurred in the first 6 weeks post-operatively. It is concluded that the application of screwed intramedullary stems for prosthetic fixation is not a viable concept, because the threads prevent the stem from subsiding and restabilizing when minor initial interface stress-relaxation and remodeling has occurred. PMID- 10149987 TI - Chemical methods for improving the haemocompatibility of synthetic polymers. AB - Synthetic high polymers differ widely in their interactions with blood, and unfortunately polymers offering promising combinations of mechanical properties for prosthetic applications are rarely those with the highest haemocompatibility. This paper is concerned with methods available for reducing the thrombogenicity of polymer surfaces but does not include discussion of other important issues such as complement activation. A brief review of the processes occurring in blood coagulation is followed by a statement of the chief methods for improving haemocompatibility: (1) coupling anti-platelet agents (e.g. prostaglandins or analogues) or anti-coagulants such as heparin to the surface: (2) 'passivation', for example by increasing the hydrophilicity of the surface: (3) coupling an inert biomaterial (e.g. albumin) or biomimetic (e.g. phosphatidyl choline) to the surface. Chemical techniques for effecting these processes are described, together with some results obtained. An account is also included of solution studies, carried out for mechanistic purposes, of bioactivities of appropriate polymer-drug adducts. PMID- 10149988 TI - Gallstones: advantages and disadvantages of five treatment alternatives. AB - Cholecystectomy is the gold standard treatment for symptomatic gallstones. However, within the last decade peroral drug chemolysis, methyl-tert-butyl ether lavage, shock wave lithotripsy, and percutaneous cholecystolithotomy have been introduced. This article compares and contrasts the presently available therapeutic modalities for gallstones and highlights the limitations of each treatment option. PMID- 10149989 TI - How to equip the quadriplegic patient. PMID- 10149990 TI - Endoscopic laser cholecystectomy: initial report. AB - With the recent advent of endoscopic laser cholecystectomy, gallbladder removal has been transformed into a minimally invasive operative procedure. To date, we have performed this technique in 12 patients (nine women and three men, aged 24 to 66 years). Early in our experience, one procedure was converted from the endoscopic technique to a standard open cholecystectomy after the gallbladder was accidentally punctured by the grasping forceps. The remaining 11 cases were completed endoscopically. Eight days postoperatively, one patient underwent reexploration because of bile leakage secondary to a fallen cystic duct (which was thickened from chronic inflammation). Compared with traditional methods, the endoscopic technique resulted in decreased morbidity and discomfort, a shorter hospital stay, minimal scarring, and a faster return to work. PMID- 10149991 TI - Minimally invasive laser surgery: bright future, difficult issues. PMID- 10149992 TI - The state of laser angioplasty: radiologists call for prospective trials. PMID- 10149993 TI - Commercial software as the basis for an augmentative communication system on a personal computer. AB - Many severely speech-impaired individuals have a need or desire to maintain the capability for computerized speech generation while performing a variety of other computer-supported tasks such as word processing, financial analysis, or database management. Criteria are presented for augmentative communication systems that both incorporate a personal computer (PC) and provide capabilities for voice output to satisfy this requirement. Current approaches to such systems are categorized and reviewed in light of these criteria. A new method is then described in which word processing or other appropriate PC software is used for speech production, providing a natural integration of written and spoken communication. The approach separates the computer access and voice output functions to allow great flexibility in the choice of an alternative access system. This flexibility combined with appropriate exploitation of PC software features has the potential to yield a high communication rate as well as maximum compatibility with application software. PMID- 10149994 TI - Development of an integrated wheelchair tray system for augmentative communication. AB - This paper describes the development of a wheelchair tray system for persons with physical disabilities who require an augmentative communication system. The tray system offers advantages over existing systems by providing a convenient anterior/posterior tilt feature, a means for stowing the tray when not in use, and a method of accommodating communication systems and powered wheelchair controls. Caregivers of seven subjects fitted with the prototype system assessed its performance through the completion of questionnaires provided at the end of 6 week field trials. The technical performance of the systems was also monitored. The prototype system was favorably received by six participants. Several recommendations are made to further increase consumer acceptance of the final tray design. PMID- 10149995 TI - Restenosis rate after percutaneous transluminal coronary angioplasty: a literature overview. AB - In order to elucidate factors affecting the rate of angioplasty restenosis, we reviewed 212 published reports on restenosis after percutaneous transluminal coronary angioplasty. We used five specific methodologic standards to select the 31 reports most likely to produce unbiased results. Sixty one factors judged to be related to restenosis rate were investigated. Only shorter duration of data collection (p=0.0003) was related to higher restenosis rate. This factor may be related to inexperience in choosing subjects or performing procedures. Other factors whose association with restenosis rate did not reach our predetermined level of statistical significance (p less than .01) were angioplasties of the left circumflex artery (p=.02), angioplasty of total occlusions (p=.02) and advanced age (p=.05). The association of shorter data collection with higher restenosis rates suggests that improved outcome may result from consolidation to a few centers specializing in this technique. PMID- 10149996 TI - Ultrasound angioplasty. PMID- 10149997 TI - Overview of new angioplasty modalities. PMID- 10149998 TI - Laparoscopic cholecystectomy. PMID- 10149999 TI - Reduction of infectious morbidity with uterine stapling device. AB - Due to the recent development of absorbable surgical staples, application of gynecologic stapling methods has expanded to the field of obstetrics. Several studies have been published presenting the results of utilization of a novel hysterotomy and uterine stapling device for cesarean section (Poly CS-57, U.S. Surgical Corp, Norwalk CT). A review of all available data was analyzed to determine the rate of infectious morbidity secondary to the use of the device. Four studies fulfilled several criteria, including use of proper controls. A total of 383 patients were included in these studies with an infection rate of 6.4% (12/187) versus 16.3% (32/196) for the stapled and non-stapled (traditional sutured) group, respectively (p less than 0.001). The individual investigations attributed the decreased infection rate to reductions in blood loss and incisional hematoma formation and decreased reactivity of copolymer absorbable staples. PMID- 10150000 TI - Reduction of infectious morbidity with uterine stapling device. AB - Available data from comparative trials involving 483 patients were analyzed to determine the rate of infectious morbidity following the use of absorbable staples versus traditional incision and suturing of the vaginal cuff in abdominal hysterectomy. Infections occurred in 24 of 268 (9%) patients who received absorbable sutures versus 36 of 215 (16.7%) patients who received traditional suturing (p=0.007). The individual investigators attributed the lower infection rate to reduced operating time, decreased pelvic contamination from cervicovaginal flora, and decreased operative site blood loss. PMID- 10150001 TI - Interventional applications of intravascular ultrasound imaging: initial experience and future perspectives. AB - Intravascular ultrasound imaging offers the potential to provide more detailed information about vessel and lesion morphology and physiology than is currently available from angiography. The greatest impact of intravascular ultrasound upon clinical decisions may be in the area of cardiac and vascular interventions. To evaluate the utility of intravascular ultrasound, we prospectively studied 45 patients, 11 of whom underwent interventional procedures. Intravascular ultrasound imaging was performed before and after interventions using a 20 MHz, mechanically rotating transducer on either 6.5 Fr or 8.0 Fr catheter systems. Interventions included seven peripheral vessel balloon angioplasties (Femoral artery-two, Renal artery-two, Arteriovenous fistula-two, Aortic coarctation-one), two Femoral artery rotational atherectomies, and two balloon valvuloplasties (Pulmonic valve-1, Mitral valve-1). Intravascular ultrasound and digital angiography provided similar information about vessel size. However, morphological information about the vessel wall, plaque composition, plaque topography, luminal thrombus, and vessel dissections was better appreciated by intravascular ultrasound. Intravascular ultrasound was determined to have provided unique and clinically useful information in 10/11 (91%) interventions. These preliminary data illustrate the potential value of intravascular ultrasound for the evaluation of the vascular system and in particular its value in interventional procedures. PMID- 10150002 TI - Evaluation of blood flow velocity waveform in an animal model. AB - Blood flow velocity waveforms in the abdominal aorta of three anesthetized pigs were recorded by a combined 3.5-MHz real-time and 2-MHz pulsed-Doppler ultrasound. The flow velocity waveforms were analyzed for pulsatility index, systolic to diastolic ratio, rising slope, descending slope, and the minimum diastolic velocity, and then were compared with volume blood flow measured by electromagnetic flowmeter (Q), mean arterial pressure (MAP), and total peripheral resistance (TPR). Total peripheral resistance was calculated according to the formula TPR = MAP/Q. A total of 111 recordings were performed over a range of heart rate: 90-250 beats/min, of Q: 65-1318 mL/min, of MAP: 72-165 mmHg and of total peripheral resistance 0.10-2.17 mmHg x min/mL. A significant positive correlation was found between pulsatility index and total peripheral resistance (correlation coefficient r ranging 0.64-0.87) and between systolic to diastolic ratio and total peripheral resistance (r: 0.59-0.83). The minimum diastolic velocity showed a negative correlation to TPR(r: -0.68 - -0.76). The pulsatility index was dependent on the heart rate, mean arterial pressure and rising slope; however, the relations were not consistent in all experiments. The results indicate that the pulsatility index is a good indicator of the flow velocity waveform changes depending on changes in the peripheral vascular resistance, and that the relationship between the total peripheral resistance and pulsatility index is linear. The systolic to diastolic ratio proved to be comparable even though it is somewhat less effective in performance than the pulsatility index. PMID- 10150003 TI - Can anatomical left ventricular mass be estimated reliably by M-mode echocardiography? A clinicopathological study of ninety-three patients. AB - To evaluate the accuracy of M-mode echocardiography in the assessment of left ventricular mass, we compared various echocardiography-derived regression equations for left ventricular mass to postmortem left ventricular weights in 93 patients (mean age 68 +/- 11 years) who had autopsy within 30 days of technically adequate two-dimensional guided M-mode echocardiography and who had normal left ventricular shape. The left ventricle was enlarged in 36 patients (39%) and was involved by chronic ischemic disease in 48 patients (52%). Only a modest correlation was found between M-mode echocardiography and anatomical left ventricular mass (range of correlation coefficients, 0.58 to 0.67). Each echocardiographic formula demonstrated increasing deviations as left ventricular mass increased. A previously suggested correction formula lessened overestimation, but considerable data dispersion remained. Regional wall-motion abnormalities, present in 22%, did not affect the correlation. We conclude that M-mode echocardiography, performed with standard methods, does not reliably estimate anatomical left ventricular mass, especially in patients with large hearts. PMID- 10150004 TI - Atherosclerotic renovascular disease: diagnosis and management. PMID- 10150005 TI - Echocardiography in ischemic heart disease. PMID- 10150006 TI - Ultrasound-tipped catheter views arteries from inside. PMID- 10150007 TI - Balloon angioplasty still tops in peripheral vessels. PMID- 10150008 TI - Laser offers less invasive option for spinal disk surgery. PMID- 10150009 TI - Laser laparoscopic cholecystectomy: a state-of-the-art assessment. PMID- 10150010 TI - Endoscopic cholecystectomy with the holmium:YAG laser: preliminary report. AB - In the first clinical trial of its kind, the author used a pulsed holmium:YAG laser to perform endoscopic gallbladder removal in 10 patients. Compared to other endoscopic laser systems, the holmium:YAG produced relatively shallow tissue penetration. As a cutting instrument, it allowed faster dissection than other lasers. As a coagulating instrument, it provided such satisfactory hemostasis that no other hemostatic method was needed. This preliminary trial left no doubt that the holmium:YAG is a excellent laser for laparoscopic surgery, particularly removal of the gallbladder. PMID- 10150011 TI - Operating at the cutting edge: nine surgeons speak out on laparoscopic-guided colon resection. PMID- 10150013 TI - Stents aid PTA in battle to reduce restenosis rates. PMID- 10150012 TI - Workers' compensation in the 1990s. The role of risk managers in managed care. PMID- 10150014 TI - Chromic catgut suture should be abandoned for fascial closure of the anterior abdominal wall in favor of newer, stronger delayed absorbable suture materials. Pro. PMID- 10150015 TI - Chromic catgut suture should be abandoned for fascial closure of the anterior abdominal wall in favor of newer, stronger delayed absorbable suture materials. Con. PMID- 10150016 TI - Laparoscopic management of adnexal cystic masses. AB - Four hundred twenty of 481 patients with adnexal cystic masses (508 cysts) confirmed by laparoscopy were treated by translaparoscopic surgery only. The remaining 61 patients were treated by laparotomy for one of the following reasons: malignancy or suspicion of malignancy (19 cases) and dense adhesions or large cysts (42 cases). PMID- 10150017 TI - Laser laparoscopic adhesiolysis. AB - Carbon dioxide laser laparoscopy offers a safe, effective, and relatively easy means of performing intraabdominal adhesiolysis. Sixty-five patients suffering from chronic lower abdominal pain have undergone laser laparoscopic adhesiolysis during the past 6 years. Fifty-three patients (84%) experienced symptomatic relief. The controversial association between abdominal pain and intraabdominal adhesions can be resolved only by performing a controlled prospective laser laparoscopic adhesiolysis study. PMID- 10150018 TI - Laser laparoscopy versus laparotomy in the treatment of infertility patients with severe endometriosis. AB - The best pregnancy rates reported in the literature for infertility patients with severe pelvic endometriosis (stage IV) have been attributed to surgical management. In the last few years, improved endoscopic instruments have allowed gynecologists to treat difficult conditions with the CO 2 laser via laparoscopy, with good results. To assess the usefulness of the CO 2 laser via laparoscopy in treating severe pelvic endometriosis, two groups of patients were studied. Thirteen patients were treated by laparotomy (group I) and 11 patients by laparoscopy (group II). Seven achieved pregnancy in group I (53.8%), and pregnancy occurred in 6 patients in group II (54.5%). This study suggests that the management of severe pelvic endometriosis in infertility patients via laparoscopy seems to yield similar pregnancy rates to those treated with laparotomy, with the advantages of faster recovery and fewer hospitalization days for those undergoing laparoscopic surgery. PMID- 10150019 TI - Laparoscopy-assisted vaginal hysterectomy. AB - Intraoperative laparoscopy was used to evaluate pelvic pathology in 46 patients who had been anesthetized for abdominal hysterectomy. Because traditional indicators--clinical history, pelvic examination, and ultrasound studies- suggested the presence of more serious pelvic pathology, these patients were considered poor candidates for vaginal hysterectomy. Laparoscopic findings, however, revealed that 42 of the 46 (91%) could undergo uncomplicated vaginal surgery (which they did). Laparoscopy-assisted hysterectomy is recommended as an additional method of investigation in order to improve diagnostic accuracy and minimize surgical risk while allowing more frequent selection of the vaginal approach to hysterectomy. PMID- 10150020 TI - Are fiberoptic lasers better than CO 2 lasers for operative laparoscopy? Pro. PMID- 10150021 TI - Are fiberoptic lasers better than CO 2 lasers for operative laparoscopy? Con. PMID- 10150022 TI - Argon laser laparoscopy for treatment of pelvic endometriosis associated with infertility and pelvic pain. AB - Argon laser laparoscopy was used for treatment of 46 patients with pelvic endometriosis. Infertility was the primary diagnosis in 31 patients, and pelvic pain was the primary diagnosis in 21 patients. A 600 mum laser fiber was used through the operative channel of the laparoscope, and the tip of the fiber was kept at a distance of 2-3 mm from the lesions. The power density used varied between 1604 and 1069 W/cm 2 at the tissue level. The pregnancy rate following treatment of the infertile group was 42%. Eighty-four percent of these pregnancies occurred within the first 8 months of treatment. In the group with pelvic pain, 8 patients experienced complete pain relief, and 13 patients experienced partial pain relief. Difficulties with the use of the fiber included breakage in 3 patients and melting of the fiber tip in 1 patient. PMID- 10150023 TI - Primary mass closure of fascial incisions using a continuous absorbable suture. AB - Investigations with animal models and reported studies from the obstetric and gynecologic literature as well as the general surgical literature have suggested that a single mass closure is equal or superior to interrupted suture techniques. Over a 12-month period, 150 patients were operated on using a continuous mass technique for fascial closure with No.1 polydioxanone suture (PDS). One hundred thirty-five patients (90%) had risk factors that placed them at increased likelihood for wound complications. No fascial disruptions occurred. Wound complications were noted in 15 patients (10%). This technique merits wider use. PMID- 10150024 TI - Laparoscopic appendectomy. AB - Since early 1987, 62 laparoscopic appendectomies have been performed without any major operative or postoperative complications. Just over half of these patients required hospitalization overnight for observation. The rest went home with activity and dietary restriction for 48 to 72 hours. Indications for the appendectomies included abdominal or pelvic pain or both, with the appendix demonstrating endometriosis, adhesions causing entrapment, or histories compatible with chronic appendicitis. Opportunities for second-look laparoscopies after laparoscopic appendectomy have been accomplished with two patients showing an encouraging lack of adhesion formation in both. PMID- 10150025 TI - The use of CO 2 laser for reproductive surgery. AB - The use of the CO 2 dioxide laser in infertility surgery has expanded during the past several years. The results are equal to those of conventional microsurgery, and the CO 2 laser has been associated with bloodless surgery and easy accessibility to deep locations in the pelvic cavity. Tissue healing is good, with a marked reduction in fibrosis, especially with the use of pulsed mode. Recently, the introduction of the waveguide enhanced the use of the CO 2 laser during laparoscopy for treatment of pelvic pathology. The results suggest that laser laparoscopy shortens the recovery period and duration of hospitalization of patients. PMID- 10150026 TI - Reproductive outcome after ovarian surgery: suturing versus nonsuturing of the ovarian cortex. AB - The purpose of this study was to ascertain if microsurgical approximation of the ovarian edges after ovarian surgery alters postoperative results, as determined by both adhesion formation and reproductive outcome. Sixteen female white New Zealand rabbits were anesthetized, and the ovaries were exposed. Each ovary was longitudinally bivalved with a scalpel, but only one ovary was reconstructed microsurgically, whereas the contralateral ovary was left open. Four weeks after surgery, the rabbits were mated, and two weeks later, a laparotomy was performed to evaluate postoperative adhesions, the number of corpora lutea in each ovary, and the number of embryos in each uterine horn. The nidation index was calculated. No significant differences were found between the microsurgically sutured and the nonsutured ovaries for all the parameters evaluated. Our data suggest that not closing the ovarian incision does not alter either postoperative adhesion formation or reproductive outcome. PMID- 10150027 TI - Laparoscopic management of large ovarian endometrial cyst: use of fibrin sealant. AB - In order to prevent postoperative adhesions often present after CO 2 laser vaporization of large endometriomas, 62 patients with endometriomas greater than 3 cm diameter were treated with a new procedure. Partial cystectomy was performed using the CO 2 laser. Residual endometrial cyst was then vaporized. After laparoscopic vaporization of the interior cyst wall, a fibrin glue (Tissucol) was injected onto the vaporized area to close laparoscopically the ovarian cyst cavity. When performed, second-look laparoscopy demonstrated healing of the ovary without any periovarian adhesions. The incidence of periovarian adhesions was significantly lower (p less than 0.01) than in the group of women treated by laparoscopy and in whom the glue was not used to close the ovarian cyst cavity. PMID- 10150028 TI - Double laparoscopy: an alternative two-stage procedure to minimize bowel and blood vessel surgery. AB - We present double laparoscopy as an alternative technique especially useful with the scarred abdomen postlaparotomy or when open laparoscopy has failed. This is a two-stage abdominal endoscopic procedure. Stage 1. This is the establishment of a pneumoperitoneum with insertion of a Verres needle through the left upper quadrant of the abdominal wall lateral to the rectus muscle, two fingers beneath the inferior costal margin. A sharp 5 mm trocar and sleeve is inserted through a small skin incision at the needle puncture site, and a small endoscope is then inserted. The hysteroscope or a 5 mm OD diagnostic laparoscope is an excellent instrument for upper abdominal laparoscopy in the adult and for general laparoscopy in infants and children. The abdominal cavity is surveyed, especially viewing the periumbilical area. Stage 2. When an adhesion-free and bowel-free area is identified, a standard 10 mm sharp trocar and sleeve is inserted under direct vision, and a standard laparoscope is introduced. We present a small sampling (24 cases) of our combined experience of 5000 laparoscopies, where this technique proved useful. Although we have used this technique over the years without any complications, the procedure has never been published. PMID- 10150029 TI - Contact laser laparoscopy has distinct advantages over alternatives. PMID- 10150030 TI - Contact Nd:YAG adapts well to laparoscopic surgery. PMID- 10150031 TI - Contact Nd:YAG laparoscopy: a treatment for endometriosis. PMID- 10150032 TI - Early results with laparoscopic inguinal herniorrhaphy are promising. PMID- 10150033 TI - Laparoscopic approach offers benefits for appendectomy. PMID- 10150034 TI - Laparoscopic approach ideal for acute appendicitis. PMID- 10150035 TI - Nd:YAG offers advances to laparoscopic inguinal herniorrhaphy. PMID- 10150036 TI - Workers' compensation and managed care. PMID- 10150037 TI - The choice of therapy for the operative treatment of endometriosis is endoscopic laser surgery. Pro. PMID- 10150038 TI - The choice of therapy for the operative treatment of endometriosis is endoscopic laser surgery. Con. PMID- 10150039 TI - Development, evolution, and statement of biliary lithotripsy training guidelines of the American Lithotripsy Society. PMID- 10150040 TI - Transplantation: the role of immunohematologic services. AB - The role of the immunohematologic services in transplantation is described. Provision of blood products for transplantation is necessary for prevention of alloimmunization or graft rejection, graft versus host disease secondary to transfusion, and transfusion-transmissible diseases in an immunosuppressed patient while avoiding unnecessary donor exposure. Requirements differ with different types of transplants. The transfusion service needs to provide products according to the specific needs of the transplant recipient and establish protocols for each different transplantation program. PMID- 10150041 TI - Enzyme immunoassay for antibodies to Epstein-Barr virus nuclear antigen. AB - An enzyme immunoassay that detects IgM and IgG antibodies to the nuclear antigen of Epstein-Barr virus (EBV) is evaluated. The EIA was compared with a rapid monoscreen (Immunoscan-IM) and an indirect fluorescent antibody procedure to determine the correlation of the new test with the current methodology. Among 73 patients tested for heterophilic antibody, 36 were positive; 25 of these had IgM antibodies to nuclear antigen. The sensitivity of the EIA compared to the mono screen was 69.4% and specificity was 97.3%. In comparison with fluorescence assays for IgG to the nuclear antigen, 94 patients were tested with 84 showing positivity by the fluorescent method. Among these, 80 were positive by EIA yielding a sensitivity and specificity of 95.2% and 90.0%, respectively. The EIA does not appear sensitive enough for replacement of the monoscreen but was a sensitive, cost-effective alternative to the indirect fluorescent antibody test. PMID- 10150042 TI - The effects of different steam-sterilization programs on material properties of poly(L-lactide). AB - As-polymerized poly(L-lactide) test rods were sterilized by seven different specially designed computer-operated autoclaving programs. As a control, common hospital sterilization was performed. In all cases, the molecular weight decreased after sterilization. A short time high-temperature sterilization led to less molecular weight decrease than a low sterilization temperature cycle with a longer sterilization time. Regular hospital sterilization significantly reduced the elongation at break and also resulted in a decrease of 35% in tensile strength. The program causing minimal damage to the material properties was studied in detail. This program, with a sterilization period of 60 s and 129 degrees C, was effective for PLLA sterilization and also looks very promising for sterilization of other thermo- and moisture-labile polymers. PMID- 10150043 TI - The transcranial Doppler. PMID- 10150044 TI - Critical care algorithms. Pulmonary artery and central venous catheter monitoring. PMID- 10150045 TI - Percutaneous innominate vein catheterisation: a new technique for venous access in the critically ill. AB - Venous access in the critically ill can be a major problem despite the wide variety of methods now available. A new technique is described involving percutaneous catheterisation of the innominate vein via a right second intercostal space approach. It has been successful in five patients over a four year period. While there have been no major complications, it is advocated for use only when access is necessary for life-saving administration of fluids or drugs. Venous access can be obtained in the majority of patients by a variety of safe and accepted measures such as peripheral venepuncture, central vein catheterisation by the subclavian or internal jugular vein, or by a cutdown. There remains, however, a small subgroup of patients with venous thrombosis from a previous catheter insertion or intravenous drug abuse for whom a number of ingenious methods have been devised. These include cutdowns on the intercostal vein; the middle thyroid vein in infants; and on the inferior epigastric vein, the azygos vein, the iliac vein, and even the inferior vena cava in adults. Access for patients suffering from haemorrhagic shock can be facilitated by multiple catheters in one or more subclavian veins. Even more rarely, these methods may be unsuccessful or contraindicated because of vein thrombosis, infection overlying the insertion site, or patient instability. A new method has been developed allowing percutaneous catheterisation of the innominate vein. PMID- 10150046 TI - Assessment of electric differential treatment (EDiT) and Endosan treatment for ovarian cysts and concomitant symptoms. AB - The mechanisms of action and clinical applications of electric differential treatment (EDiT) and Endosan in the treatment of ovarian cysts and concomitant symptoms are reviewed. Possible mechanisms of action include an increased level of cyclic AMP, stimulation of endorphin release, anti-inflammatory action, and steroidogenesis resulting from normalization of intercellular communication. Favorable results in the clinical setting were achieved in the treatment of ovarian cysts. Treatment success was reflected in a significant reduction in overall cyst size as well as amelioration of various concomitant symptoms, including fever, chills, inflammation, and abdominal pain. EDiT and Endosan were shown to have potent analgesic and anti-inflammatory effects. No adverse effects have been reported. PMID- 10150047 TI - Recent advances in cardiac transplantation. PMID- 10150048 TI - Metabolic imaging with positron-emission tomography. PMID- 10150049 TI - Radionuclear assessment in ischemic heart disease. PMID- 10150050 TI - Is angiography dead in era of digital imaging? PMID- 10150051 TI - PET reveals disruption of blood-tumor barrier. PMID- 10150052 TI - Nanocrystalline Epstein-Barr virus decoys. AB - A novel biotechnology is introduced by way of the successful synthesis of nanocrystalline Epstein-Barr virus (EBV) decoys having specific in vivo immunogenic activity. Assembled from ultrafine surface modified tin oxide and purified DNA-free isolated EBV envelope proteins, the decoys consisted of less than 150 nm units whose electrophoretic mobilities were similar to whole EBV; whose outer coats were strongly immunoreactive with murine monoclonal anti-EBV antibodies; and which elicited immunospecific neutralizing anti-EBV antibodies in the rabbit. The development of this carrier technology for vaccine preparations is suggested. PMID- 10150053 TI - Evaluation of polymorphonuclear leukocyte myeloperoxidase using new age hematology analyzers. PMID- 10150054 TI - Laserthermia for the treatment of small hepatocellular carcinoma: a preliminary study. AB - A newly designed interstitial probe (hybrid probe) was used to treat small hepatocellular carcinoma (HCC) with laserthermia. Before the human study, testing in normal rabbit liver was done to measure the thermal map. Laserthermia was then studied in human small HCC. The set condition was 43-45 degrees C in thermocouple and the duration of laserthermia was 20 minutes. On follow-up computed tomography and liver biopsies, laserthermia had tumorcidal effect. It is concluded that laserthermia may be helpful to patients with small HCC. PMID- 10150055 TI - The problem of vascular access for hemapheresis. PMID- 10150056 TI - Optimal venous access. PMID- 10150057 TI - Principles of total knee arthroplasty. AB - Experience over the last two decades has demonstrated total knee arthroplasty to be a durable and reliable procedure for relief of pain and improved function. Proper patient and prosthesis selection are important for optimal results. Operative keys to a successful total knee arthroplasty include satisfactory exposure, soft tissue balance, proper alignment, and reconstruction of the patellofemoral joint. PMID- 10150058 TI - Survival analysis of total condylar-type prostheses. AB - Between 1975 and 1983, 280 patients received 422 posterior cruciate ligament retaining total condylar knee arthroplasties. Fifty-nine were excluded for one of the following reasons: previous total knee replacement, follow-up less than 1 year, or infection at any time during the life of the prosthesis. The 363 remaining knees were observed from 1 to 13 years (mean, 6.86). Kaplan-Meier and "crude" survival estimates at 12 years were 94.7% and 96.6%, respectively. Results of various survival analyses by other authors yield similar successful results. PMID- 10150059 TI - Failure mechanisms of unicompartmental knee replacement: the impact of changes in operative technique and component design. AB - Reliable unicompartmental knee replacement requires knowledge of the common failure mechanisms of this type of arthroplasty. The problem in the past has been loosening of components because of design flaws and technical failure. Whereas recent reports are very encouraging in terms of clinical results and enhanced durability of unicompartmental replacements, the current study confirms the observation that nonparallel orientation of femoral and tibial components is common and may produce excessive polyethylene wear and clinical failure. Newer unicompartmental designs with meniscal bearings may be the answer to this problem. PMID- 10150060 TI - The use of an antibiotic-impregnated spacer block for revision of the septic total knee arthroplasty. AB - Through the use of an antibiotic-impregnated polymethylmethacrylate spacer block in two-stage exchange arthroplasty, the chronically infected total knee arthroplasty can, in most cases, be effectively salvaged. In a review of 28 such consecutive cases by a single surgeon, all revised implants were retained except one which required arthrodesis. In the remaining cases, mean Hospital for Special Surgery knee scores were 86, with mean total range of motion of 90 degrees . All wounds healed eventually, and seven patients were thereafter able to undergo other total joint arthroplasties. Advantages of this technique included maintenance of ligamentous balance as well as bone stock with weight bearing, local antibiotic delivery, and facilitation of reimplantation. PMID- 10150061 TI - The effect of miscellaneous invasive procedures on subsequent total knee arthroplasty. AB - Invasive orthopedic procedures were performed on 112 joints that underwent total condylar knee arthroplasty between November 1975 and February 1987. These knees were divided into six categories based on the most traumatic surgical procedure the patients had experienced. The six classifications were total knee arthroplasty, proximal tibial osteotomy, fracture fixation, patellectomy, arthroscopy, and debridement. Each group of knees was compared with the 579 primary arthroplasties performed during the same time period. The only group in which results were significantly less favorable than those of the virgin joints was the previous total arthroplasty category. All other surgical classification groups had knee scores, radiolucency frequencies, and ranges of motion comparable with those of the primary replacement surgeries. When surgical techniques are modified to insure proper soft tissue alignment, patients who have undergone previous invasive procedures on their knees can expect highly favorable results from total joint arthroplasty. PMID- 10150062 TI - Principles of revisional total knee surgery. AB - The techniques and principles of revisional total knee surgery are reviewed, including soft tissue management, component excision, ligament and bone augmentation, and extensor mechanism supplementation. PMID- 10150063 TI - Diagnosis and quantitation of myocardial infarction. AB - In order to provide timely and proper therapy for patients with myocardial infarction, accurate diagnosis is essential. To assess the impact of therapy and to aid in long-term prognostication, it is also desirable to quantitate accurately the extent of infarct size. For diagnostic purposes, the conventional methods of clinical evaluation, 12-lead electrocardiography, and analysis of serum enzymes are accurate. However, more sophisticated approaches, such as radionuclide, echocardiographic, and magnetic resonance imaging, can be useful adjuncts for diagnosis. In contrast, the sizing of infarcts is often best performed using imaging methods. This paper reviews the application of various techniques to accomplish the goals of accurate diagnosis and quantitation of myocardial infarction. PMID- 10150064 TI - Myocardial perfusion imaging in ischemic heart disease anno 1990. AB - The field of radionuclide myocardial perfusion imaging is in a rapid state of change. Stress-rest myocardial imaging is important not only for the detection of coronary artery disease but also for prognostic stratification of patients. In particular, assessment of myocardial viability in patients with left ventricular dysfunction is a recent focus of investigation. Single-photon emission computed tomography has become widely accepted as the preferred (albeit challenging) imaging modality for myocardial perfusion imaging. Silent myocardial ischemia and its clinical significance continues to be an intriguing aspect of the clinical manifestation of coronary artery disease. Myocardial perfusion imaging is an invaluable independent method to unravel this problem. Dipyridamole was approved for pharmacologic vasodilation in conjunction with myocardial perfusion imaging. At the same time, direct infusion of adenosine was proposed as an alternative method of effecting vasodilatory stress. In 1990, several new technetium-99m-labeled myocardial perfusion imaging agents have been introduced (teboroxime and hexakis-2-methoxyisobutyl-isonitrile [sestaMIBI]) that may have a profound impact on imaging techniques and applications of myocardial perfusion imaging. PMID- 10150066 TI - Imaging and echocardiography. PMID- 10150065 TI - Venous thromboembolic disease. AB - During the past year, the findings of several clinical trials have been published that have important implications for the care of patients with venous thromboembolism. These clinical trials have produced advances in the diagnosis and treatment of venous thrombosis and pulmonary embolism and in the prevention of venous thromboembolism in high-risk patients. In patients with clinically suspected pulmonary embolism, the value and limitations of ventilation-perfusion lung scanning have been established, and it is now accepted that objective tests for deep vein thrombosis have an important role. There have been important advances also in the diagnosis of deep vein thrombosis; these advances include the finding that impedance plethysmography is effective in pregnant symptomatic patients and the development of an objective technique for Doppler ultrasound. The optimal duration of initial intravenous heparin treatment of established thrombosis has been determined. In the prevention of venous thromboembolism, the effectiveness of sequential intermittent compression in patients having hip replacement has been established, and further data on the effectiveness of low molecular-weight heparin in high-risk patients have become available. PMID- 10150067 TI - Assessment of cardiac metabolic disorders with positron emission tomography. AB - This review covers literature on the assessment of cardiac metabolic disorders with positron emission tomography from the period June 1990 through May 1991. We highlight myocardial perfusion, myocardial metabolism, and myocardial receptor studies. PMID- 10150068 TI - Advances push imaging past recognizable limits. PMID- 10150069 TI - 3-D images bridge gap between Dx and therapy. PMID- 10150070 TI - Computer options open new radiology windows. PMID- 10150071 TI - PET complements CT in imaging of lung tumors. PMID- 10150072 TI - Integrated approach best for neuroimaging workup. PMID- 10150073 TI - Diagnosing human papillomavirus of the female lower genital tract: failure of the Pap smear as a sole screening test. AB - Of 197 patients referred for colposcopy who underwent repeat Pap smears and colposcopic biopsies (when indicated), histologic evidence of human papillomavirus (HPV) infection involving the endocervix, cervix, or vagina or all three sites was documented in 109 biopsies. Sixty-six (61%) had normal Pap smears at the time of colposcopy. Despite a specificity of 92% for detecting HPV, the Pap smear demonstrated a low sensitivity (39%), with a positive and negative predictive test value of 88% and 50%, respectively. In patients with biopsies revealing HPV infection without associated dysplasia, false negative Pap smears were found most often in women with strictly vaginal HPV (74%) (P less than 0.05), followed by those with coexistent cervical and vaginal HPV (65%), and then by those with solely cervical HPV (51%). We question the use of the Pap smear for the detection of lower genital tract HPV, particularly in patients with only vaginal involvement, especially when the smear is repeated at the time of colposcopy. Benefits and disadvantages of other screening tests for HPV are discussed. PMID- 10150074 TI - Laser ablation of recurrent Paget's disease of vulva and perineum. AB - We describe the management by CO 2 laser of a case of recurrent extramammary Paget's disease of vulva and perineum, previously managed on three occasions with conventional surgical excision. Ablation of the whole lesion took less than 30 minutes, and the patient was able to go home on the third postoperative day. There were no significant complications. At follow-up after 12 months, multiple biopsies from the lasered area have shown no recurrence, and the symptomatic improvement has been satisfactory. PMID- 10150075 TI - Current and future technological trends in positron emission tomography. AB - Current trends in positron emission tomography (PET) instrumentation are examined, with an emphasis on providing information suitable to the prospective PET user. Basic principles underlying PET are explained and information on performance measurements, techniques, and quantitation are given in order to allow the user to compare and contrast different types of PET scanners. These scanner designs are described. Specific examples are given and the combination of PET with other modalities is discussed. PMID- 10150076 TI - Medical and financial justification of new intravenous technologies in the NICU. PMID- 10150077 TI - Stereotactic system guides laser resection of tumors. PMID- 10150078 TI - Argon laser treatment tackles recurrent plantar verrucae. PMID- 10150079 TI - PET impacts patient care of coronary artery disease. PMID- 10150080 TI - Morphological changes of poly(ethylene terephthalate) on multiple steam sterilization. AB - Poly(ethylene terephthalate) (PET) was steam sterilized by autoclaving for 15, 30 and 60 min. The thermal properties, T m, delta-H and percent crystallinity were determined using differential scanning calorimetry. Molecular weight distribution was determined using gel permeation liquid chromatography. Crystallinity of PET was also monitored by infrared spectrophotometry. The analyses indicate that that chain scission and cyclization reactions take place in PET, forming cyclic oligomers, that can migrate to the polymer surface and which may affect long term performance of PET. PMID- 10150081 TI - The effects of chemical sterilisation on the dimensional stability of some elastomeric impression materials. AB - The dimensional stability of a range of dental elastomeric impression materials has been assessed, to study the effect of storage in sterilising solutions. Experiments were carried out on polysulphides, a poly(ether urethane) and several condensation and addition silicones. The last materials had the greatest dimensional stability over a range of storage conditions, which included aqueous glutaraldehyde and hypochlorite solutions. PMID- 10150082 TI - Ionos bone cement (glass-ionomer): an experimental and clinical evaluation in joint replacement. AB - Ionos bone cement (glass-ionomer) was evaluated in total joint replacement procedures, initially in a baboon model, and finally in a highly selected group of patients in whom polymethyl methacrylate cement was contra-indicated. It was found that the cement has no inhibitory effect on bone tissue development. It is effectively incorporated into the bone, both structurally and functionally without the interposition of fibrous tissue. Under the functional stress situation in baboon hip and knee arthroplasties, the bone and marrow in direct contact with the cement responded favourably. A direct bone bond was demonstrated. The clinical results achieved were satisfactory, notwithstanding the complexity of the clinical problems included in the series. The continued clinical evaluation on a controlled basis has been shown to be well-justified. PMID- 10150083 TI - Automated region identification and its application to measuring cardiac function. PMID- 10150084 TI - Current and emerging scintigraphic methods to assess myocardial viability and their clinical importance. PMID- 10150085 TI - Current and future developments in scintigraphy to assess myocardial perfusion and function. PMID- 10150086 TI - Assessing myocardial viability using thallium scintigraphy. PMID- 10150087 TI - Assessing myocardial viability with dobutamine stress echocardiography. PMID- 10150088 TI - Treatment of metastatic Vipoma by liver transplantation. AB - We report the first case of metastatic Vipoma treated by orthotopic liver transplantation. A woman with explosive secretory diarrhea causing hypokalemic acidosis was diagnosed as having a vasoactive intestinal peptide secreting tumor with widespread hepatic metastases. The symptoms were initially controlled for 9 months with increasing doses of long-acting somatostatin analogue (Sandostatin, Sandoz Ltd, UK). Alpha interferon was not tolerated, causing an acute paranoid psychosis. Eventually orthotopic liver transplantation was performed with the removal of the primary tumor from the distal pancreas. Postoperatively, complications were associated with the distal pancreatectomy. The patient has no evidence of tumor recurrence on imaging or serum VIP level 12 months posttransplantation. PMID- 10150089 TI - Colonic screening prior to renal transplantation and its impact on post transplant colonic complications. AB - Colonic complications after renal transplantation are uncommon but have a high mortality rate. Some have recommended colonic screening in patients over 50 years of age prior to transplantation to lessen the impact of colonic diverticular disease. We report our 9-year experience of colonic screening for diverticular disease in potential recipients over the age of 50 and compare these results to the overall colonic complication rate in the same time period. From 1981-1990, 1186 renal transplants in 1019 patients were performed, during which time all potential recipients over the age of 50 yr were required to undergo colon evaluation prior to transplantation. Twenty cases of diverticular disease were found with more than a quarter of the cases in patients with adult polycystic disease. All underwent renal transplantation without a pre-transplant colectomy, and none had post transplant symptomatic colon disease. During that same time period a total of 14 colonic complications requiring surgical intervention were encountered with a mortality rate of 40%. Acute diverticulitis occurred in 5 patients, all of whom were over 50 yr of age, on low-dose immunosuppression, and in most cases it occurred remotely after transplantation. Colonic dysplasia/neoplasia also occurred remotely after transplantation in 2 patients over the age of 50. Cytomegalovirus (CMV) colitis was the next most common complication, accounting for 3 cases. This complication, which occurred in younger patients, was associated with high-dose steroid immunosuppression and had a high mortality rate, in spite of surgical intervention.(ABSTRACT TRUNCATED AT 250 WORDS) PMID- 10150090 TI - Importance of bone marrow cell dose in bone marrow transplantation. AB - The importance of the size of the infused marrow cell dose (MCD) was investigated in 274 patients undergoing allogeneic BMT between 1975 and 1990. Among those, 65 had acute myelogenous leukemia (AML), 79 acute lymphoblastic leukemia (ALL), 58 chronic myelogenous leukemia (CML) and 25 severe aplastic anemia (SAA). MCD was analyzed in bivariate and multivariate analysis together with 6 other clinical factors. In multivariate analysis a low MCD was significantly associated with increased incidence of acute graft-versus-host disease (GvHD) in all patients (p = 0.005) and in ALL patients (p = 0.02) whereas in CML a high dose was instead correlated to acute GvHD. A low MCD was also correlated to an increased incidence of symptomatic cytomegalovirus (CMV) infection (p = 0.001). A low MCD was also correlated to death in acute GvHD in all patients (p = 0.01) and to a poor survival in all patients (p = 0.04) (AML, p = 0.07). PMID- 10150091 TI - An improved affinity support and immunoadsorbent with a synthetic blood group oligosaccharide and polymer coating for hemoperfusion. AB - An improved affinity support and an immunoadsorbent suitable for extracorporeal perfusion of whole blood (or plasma) are reported. The affinity support consists of calcined diatomite-type silica particles to which a synthetic oligosaccharide hapten, viz. A-trisaccharide representing human blood group A, with a linking spacer-arm is chemically attached. The immunoadsorbent thus obtained is surface modified with a polymer coating. The modified immunoadsorbent is not hemolytic and shows no loss of biological activity in reducing antibody titers in vitro. An important feature of the improved immunoadsorbent is that the polymer coating provides a better surface resistance and therefore stability to the affinity support to prevent the release of potentially harmful fines. The usefulness of a physically stable support as an affinity adsorbent for the selective removal of specific antibodies or unwanted substances directly from the blood circulation by extracorporeal immunoadsorption has profound medical significance because this would provide an efficient but safe and practical alternative to therapeutic intervention using plasma exchange or plasma perfusion, both of which require plasmapheresis. PMID- 10150092 TI - Advances in imaging for assessment of ischemic heart disease. AB - Cardiac imaging techniques continue to develop for the noninvasive detection and evaluation of patients with coronary artery disease. These techniques include single photon and positron emission tomography along with computed tomography and magnetic resonance imaging. The new myocardial perfusion tracers 99mTc-hexakis-2 methoxyisobutyl-isonitrile and 99mTc-teboroxime have recently come into general use for these purposes, and their role alongside that of more traditional agents is currently being defined using new imaging protocols and instrumentation. 99mTc hexakis-2-methoxyisobutyl-isonitrile has also been documented as an important research tool for evaluating both at-risk myocardium and the degree of subsequent myocardial salvage following reperfusion therapies for acute myocardial infarction. Antimyosin antibody imaging is another emerging approach in the evaluation of patients with acute myocardial infarction. Metabolic imaging with 18F-fluoro-2-deoxyglucose using positron emission tomography to detect myocardial segments with compromised blood flow but preserved glucose metabolism is currently the best noninvasive method of identifying viable myocardium in patients with left ventricular dysfunction who may benefit from revascularization. Insights from these studies have led to development of the current 201Tl stress-rest reinjection protocols for viability evaluation using single photon emission computed tomography. Positron emission tomography, in combination with blood flow tracers using kinetic modeling, provides accurate estimates of coronary blood flow and flow reserve. The use of these new imaging techniques will allow increasingly accurate evaluation of patients with suspected and proven coronary artery disease in the future. PMID- 10150093 TI - Transcranial Doppler in pediatrics. PMID- 10150094 TI - Uses of transcranial Doppler. PMID- 10150095 TI - Transcranial Doppler ultrasound: a "flash in the pan" or new wave of monitoring? PMID- 10150096 TI - Early detection of DCIS broadens therapy options. PMID- 10150097 TI - Qualitative membrane enzyme immunoassay for detection of cytomegalovirus antibody. AB - A new qualitative membrane immunoassay for use in detecting IgG antibodies to cytomegalovirus (CMV) was compared with a standard microplate enzyme immunoassay (EIA). A total of 179 patients were tested by the EIA for IgG- and IgM-specific antibodies to CMV and then compared with the new membrane immunoassay. Among the 179 sera, five specimens were repeatably invalid. Among the 174 evaluable sera, 128 (73.6%) were positive for IgG antibody to CMV by the EIA method. Of these 128 sera, the Transtat-CMV was positive in 124 (96.9%). The remaining 46 sera were negative for IgG antibodies by both methods. The Transtat-CMV membrane immunoassay appears to be a reliable and easily used method not requiring additional equipment or extended incubation times. As a qualitative-only assay, it cannot be used for diagnosis. PMID- 10150098 TI - Effect of He-Ne laser irradiation on synaptic transmission of the superior cervical sympathetic ganglion in the rat. AB - The effect of low-power He-Ne laser on synaptic transmission was studied in the superior cervical sympathetic ganglion of Wistar rats. Extracellular and intracellular recordings were made from isolated ganglia before and after laser irradiation. In addition, effects of ganglion irradiation on skin blood flow were observed in in vivo preparations. Irradiation on the isolated ganglion decreased the amplitude of evoked compound action potentials in the extracellular recordings. Intracellular recordings from ganglion cells revealed that the neuronal membrane was hyperpolarized, while threshold potential and latency of response were unchanged. The reduction of skin blood flow during preganglionic nerve stimulation lessened by irradiation on the ganglion. Our results indicate that low-power He-Ne laser depresses sympathetic ganglionic transmission, and hyperpolarization of ganglionic cells takes part in the mechanism of action. PMID- 10150099 TI - Adaptation of NASA technology for the optimum design of orthopedic knee implants. AB - NASA technology originally developed for designing aircraft turbine-engine blades has been adapted and applied to orthopedic knee implants. This article describes a method for tailoring an implant for optimal interaction with the environment of the tibia. The implant components are designed to control stresses in the bone for minimizing bone degradation and preventing failures. Engineers expect the tailoring system to improve knee prosthesis design and allow customized implants for individual patients. PMID- 10150100 TI - Bone marrow transplants. Managing BMT patients in alternate site health care settings with infusion therapy. PMID- 10150101 TI - Standards for reporting clinical trials. PMID- 10150102 TI - A gridded Pap slide to assure quality with high throughput. PMID- 10150103 TI - Fast spin-echo technique extends versatility of MR. PMID- 10150104 TI - Whole-body PET finds promising clinical niche. PMID- 10150105 TI - Tumor endoprostheses vs. bone grafts in bone tumor surgery: experiences in Hungary. AB - From 1981 through 1991, 76 bone tumor patients were treated by limb salvage operations at the Orthopaedic Department of the Semmelweis Medical University in Budapest. The bone defect was reconstructed with endoprostheses in 25 cases and with bone grafts in 51 cases. The mean follow-up period of 72 patients was 51 months (minimum 12 months). There were local recurrences in 11% of the patients. The functional rating of the tumor endoprostheses was "excellent" or "good" in 74%. Complications occurred in two cases. The most common complications with bone grafting were infection (9.8%), fracture (11.8%), which did not influence the end result, and nonunion (9.8%), which often occurred in homografts of resection-arthrodesis during chemotherapy. These complications were successfully managed without loss of the limb in all but two cases. The bone grafts were rated as functionally acceptable ("excellent" or "good") in 66% of the patients. The reconstruction of bone defect with bone grafting is suggested in cases of semimalignant and low malignant tumors; however, tumor endoprostheses implantation is preferred in high malignant tumors that need chemotherapy. PMID- 10150106 TI - Introduction: Are conventional imaging strategies used following myocardial infarction equally appropriate in the thrombolytic era? PMID- 10150107 TI - Metabolic imaging with positron emission tomography during myocardial reperfusion. PMID- 10150108 TI - The need for vascular access: a bell-shaped curve of progress. PMID- 10150109 TI - Alternative techniques for gaining venous access. What to do when peripheral intravenous catheterization is not possible. AB - There are a number of therapeutic options for fluid administration in patients who lack usual venous access. Ways to establish this access include limb elevation and wrapping, the application of nitroglycerin ointment to dilate veins, and blood pressure cuff inflation. Ultrasonography can also be used to delineate vascular structures. Cutdown procedures are the oldest, most direct method to reach uncommon venous sites, such as the inferior epigastric, intercostal, iliac, and lateral thoracic veins. Today, cutdown procedures are regarded as the method of last resort, and they should be performed in operating suites or similar settings. Possible complications include inadvertent arterial puncture and hemorrhage. PMID- 10150110 TI - Truck infusion therapy. PMID- 10150111 TI - Nerve conduction and electromyography. PMID- 10150112 TI - Tumors in and adjacent to the brain. PMID- 10150113 TI - Neuropsychiatric disease. PMID- 10150114 TI - Human papillomavirus testing in the clinical laboratory. Part I: squamous lesions of the cervix. AB - The aim of this study was twofold: (1) to evaluate the contribution of viral (HPV) testing for improving the sensitivity of cervical cytology and (2) to correlate HPV types with the histology of the detected cervical cancer precursors, particularly the low-grade, CIN I variant. We used the dot blot hybridization technique (ViraPap) and polymerase chain reaction (PCR) in 63 women referred to our colposcopy clinic for evaluation of an abnormal Pap test. Histopathologic samples obtained by multiple colposcope-directed punch biopsies were used for a diagnostic gold standard. Among the 53 women with histologically proven CIN, precolposcopy cytology was positive in 38 (72%) compared to 53% and 60% HPV positivity by ViraPap and PCR, respectively (p less than 0.01). When the yields of ViraPap/PCR and cytology were combined, however, the detection rate of CIN was 91%, a significant improvement over cytology alone (p less than 0.02). HPV DNA was found either by ViraPap or PCR in 45 of 63 (71%) biopsy specimens, and 37 of 38 (97%) HPV-positive CIN, including the low-grade CIN I variant, contained oncogenic HPV types. HPV type 16 was present in 22 of 38 (58%) CIN lesions and mixed with HPV 6/11, 18, or the 30s group in 6 of 38 (16%) of the cases. HPV 6/11 alone was found only in 1 case of CIN I (2.7%). HPV testing by molecular technology increases the sensitivity of cytology.(ABSTRACT TRUNCATED AT 250 WORDS) PMID- 10150115 TI - Human papillomavirus testing in the clinical laboratory. Part II: vaginal, vulvar, perineal, and penile squamous lesions. AB - The accurate diagnosis of HPV-related diseases of the lower genital tract requires expertise, and sometimes even the expert may face a dilemma as to the precise nature of the biopsies submitted from colposcopically suspicious HPV related lesions. We have evaluated the role of viral testing using dot blot hybridization (ViraType) and PCR in the diagnosis of histologically typical (42 cases) and equivocal (30 cases) squamous intraepithelial lesions of the vagina (7), vulva (30), perianal epithelium (3), penis (31), and scrotum (1). The viral kits were used according to the manufacturer's instructions in a routine laboratory setting, and the probes available were HPV 6/11, 16, 18, and 31, 33, 35 (the 30s group). HPV DNA was found in 45 of 72 (62%) of all lesions. PCR was more sensitive (58%) than ViraType (39%) for detecting HPV DNA sequences (p less than 0.02), particularly in equivocal lesions (EQHPV), 14 of 30 (47%) by PCR vs 4 of 30 (13%) by ViraType (p less than 0.004). The majority of lesions contained oncogenic type viruses irrespective of their histologic presentation, namely, type 16. Only condylomata acuminata were predominantly HPV 6 or 11 positive. Viral testing may play a role in the quality control of the diagnostic expertise of routine laboratories as well as ascertaining the HPV-relatedness of histologically equivocal lesions of the anogenital tract. In view of the relatively high false-negative rates for detecting HPV DNA by ViraType and PCR, only a positive test may be meaningful unless other HPV types are added. PMID- 10150116 TI - In vitro validation of color velocity imaging and spectral Doppler for velocity determination. AB - Color velocity imaging (CVI) is a new non-Doppler ultrasound technique for vascular color flow imaging. Using information contained in the two-dimensional B-mode, gray-scale image to determine velocity, CVI offers potential advantages over Doppler color flow imaging methods. In order to be used clinically, velocity determination with CVI must be validated by other current methods. A Doppler string phantom was studied with a Philips CVI ultrasound system. Velocity measurements were obtained by both CVI and duplex Doppler spectral analysis for constant string speeds from 10 to 200 cm/sec, at intervals of 10 cm/sec. Twenty separate estimates were obtained with each method, at each string speed. Linear regression assessed the relationship between estimated and actual string velocities, with CVI and spectral Doppler analysis yielding highly valid results (CVI = -0.713 + 1.000997 x phantom; r 2 = 0.9979). At all string speeds tested, the averaged estimated and the actual velocities for both methods were within the 95% confidence estimates. The range for the CVI 95% confidence limits from the regression line varied from +/-1.07 cm/sec at the lowest speed of 10 cm/sec (11.6%) to +/-7.72 cm/sec at 200 cm/sec (3.87%). Based on in vitro testing, CVI is as accurate as Doppler spectral analysis for the estimation of flow velocity. PMID- 10150117 TI - The clinical utility of transcranial Doppler ultrasound in suspected vertebrobasilar ischemia. AB - The impact of transcranial Doppler ultrasound (TCD) on the management of 107 consecutively referred patients with suspected vertebrobasilar ischemia was studied. Physicians who referred patients for TCD of the posterior circulation were interviewed before and after being given the results of the TCD examination. Management plans devised prior to knowledge of the TCD results were compared to those devised after TCD results were given. Management changed in 42% of the patients after TCD results were given, and there was a 58% reduction in the use of angiography (p = 0.04) and a 128% increase in the use of aspirin (p = 0.005). Changes in the use of anticoagulants and other diagnostic or therapeutic approaches were not significant. TCD appears to have a significant impact on the management of patients with suspected vertebrobasilar ischemia. PMID- 10150118 TI - Techniques of bone grafting in total knee arthroplasty. AB - Bone grafting of osseous defects in primary or secondary total knee arthroplasty remains a popular and often indispensable solution to reconstructive problems. Solutions to contained, uncontained, and massive defects of both the tibia and femur are presented, as well as several options for reconstruction of deficient or ruptured extensor mechanisms. PMID- 10150119 TI - Filling the gap: subacute care. PMID- 10150120 TI - Issues in the non-invasive measurement of outcome by echocardiographic and radionuclide techniques. PMID- 10150121 TI - PET poised to take off pending Medicare nod. PMID- 10150122 TI - The role of nuclear imaging in ischemic heart disease. AB - Assessment of myocardial perfusion during exercise and pharmacologic stress testing is an important factor in the detection of coronary artery disease and in risk assessment. Imaging techniques that examine myocardial perfusion and cellular integrity or myocardial metabolism flow mismatches aid in the detection of reversible causes of left ventricular dysfunction. These techniques are also helpful in managing patients after percutaneous transluminal coronary angioplasty or thrombolytic therapy. PMID- 10150124 TI - Pulsolith laser lithotripter. PMID- 10150123 TI - Laser lithotripsy of ureteral calculi: initial experience with a new pulsed dye laser. AB - Thirty-two patients with ureteral calculi ranging in size from 5 x 5 to 12 x 18 mm underwent lithotripsy with a new pulsed dye laser (Pulsolith, TMI). In 24 cases, the patients were entirely free of stones following laser lithotripsy alone, or with adjunctive stone basket removal. There were three instances of equipment failure and five calcium oxalate monohydrate stones that did not respond to laser energy. PMID- 10150125 TI - Blind antegrade lasertripsy for ureteral stones. PMID- 10150126 TI - Application systems for intracorporeal laser-induced shockwave lithotripsy using the Nd:YAG Q-switched laser. AB - For laser-induced shockwave lithotripsy, the electromagnetic energy of a laser light pulse is converted intracorporeally into the acoustic energy of a shockwave. The lithotriptor is based on a specially developed, Q-switched Nd:YAG laser whose high power light pulses (70 mJ, 25 nsec) are coupled into a flexible quartz fiber with a core diameter of 600 mum. Using focusing elements, energy densities higher than 6 x 10 5 J m -2 can be achieved, resulting in an optical breakdown in water followed by a shockwave. As a result of different absorption mechanisms, the breakdown threshold can be decreased by placing a metallic target into the laser beam. The different shockwave formations of such optomechanical transducers have been measured. First clinical applications have been performed. PMID- 10150127 TI - Clinical experience with a new pulsed dye laser for ureteral stone lithotripsy. AB - Forty-five patients with 46 ureteral stones were treated using a new pulsed dye laser (Pulsolith, TMI). A fiber of 250 micrometers was used through rigid (40 cases) or flexible (6 cases) ureteroscopes. Stones were located in the upper third (5 cases), middle third (5 cases), or lower third (36 cases) of the ureter. Stone composition was calcium oxalate dihydrate or monohydrate, struvite, or uric acid in 34, 7, 2, and 2 patients, respectively. Thirty-six stones (78%) were fragmented, including 14 cases that required basket removal of fragments at the same time. Ten stones were not fragmented, 6 because of the pure monohydrate composition and 4 due to a laser breakdown. No damage to the ureteral wall was noted. Retrograde rigid ureteroscopy with laser lithotripsy was effective for lower and middle third ureteral stones. Flexible ureteroscopy with laser lithotripsy was effective (impacted stones) but difficult for upper third ureteral stones. Laser lithotripsy was not effective for pure calcium oxalate monohydrate stones. PMID- 10150128 TI - Vascular reactivity and endothelial function of bypass grafts. PMID- 10150129 TI - MRI helps characterize foot, ankle abnormalities. PMID- 10150130 TI - Use of DNA probes in paternity testing. PMID- 10150131 TI - Biliary calculi fragmentation by a 308 nm excimer laser: a preliminary study. AB - The use of a 308-nm XeCl excimer laser for biliary stone fragmentation is reported. The 130-nsec laser pulses are delivered via UV grade fused silica fibers to the target stones immersed in normal saline solution and placed in direct contact with the fiber. Sixty biliary calculi, 20 cholesterol and 40 pigment, were fragmented in vitro. The energy delivered per unit mass of the stone is kept constant at 50 mJ/mg. The effect of laser repetition rate, energy fluence, and fiber core size on stone fragmentation was studied. Fragmentation thresholds for a variety of biliary calculi of known composition were measured. It was found that higher fragmentation efficiency was obtained with larger fluence, lower repetition rate, and fiber of larger core. Our study indicates that the 308-nm excimer laser may be effective as a laser lithotriptor with low threshold and good efficiency for biliary stone fragmentation. PMID- 10150132 TI - Percutaneous endoscopic laser lithotripsy of a cystic duct stone: a case report. AB - A case report of an elderly patient with severe heart disease and chronic obstructive pulmonary disease who required laser lithotripsy for a retained cystic duct stone is presented. This high-risk patient underwent a laparoscopic cholecystostomy and gallstone removal as treatment for symptomatic gallstone disease. On cholecystography the patient was found to have a small stone fragment in the cystic duct. Under intravenous sedation this stone fragment was fragmented and removed using an 8.5F flexible ureteroscope and a coumarin pulsed dye laser lithotriptor. The stone was fragmented and washed into the common bile duct. Follow-up cholecystogram prior to removal of the cholecystostomy tube demonstrated no stones in the gallbladder, cystic duct, or common bile duct. The management of percutaneous removal of retained stones is reviewed. PMID- 10150133 TI - Pulsed dye laser lithotripsy--currently applied to urologic and biliary calculi. AB - The flash lamp excitation of coumarin dye to produce light energy of the specific wavelength of 504 nm is the basis for the new wave of pulsed dye lasers. Numerous urological applications have been developed. Treatment of ureteral and renal calculi has proven to be an atraumatic and effective treatment modality. Most recently, this technology has been applied to the endoscopic treatment of biliary calculi. The authors review the most recent treatment techniques in both biliary and urinary stone disease. PMID- 10150134 TI - Orthotics versus casting in the management of lower extremity sprains, fractures, and other common orthopaedic problems. PMID- 10150135 TI - New (EHL) 5F laser overcomes lithotripsy disadvantages. PMID- 10150136 TI - Stress echocardiographic techniques. An overview. AB - The choice of upright or supine exercise, pharmacological agents, or atrial pacing for the induction of ischemia depends on the goals and the imaging modality. Dynamic stress echocardiography has improved diagnostic accuracy over and above the stress electrocardiogram. Indications include patients with atypical symptoms, prior nondiagnostic stress electrocardiograms, or baseline electrocardiographic abnormalities. Pharmacological agents coupled with echocardiography do well in the high-risk preoperative patient (e.g., abdominal aneurysmectomy) or in those unable to walk due to orthopedic, neurological, or peripheral vascular disease. When there is uncertainty as to the physiological significance of anatomical (angiographic) stenosis, dynamic stress echocardiography in the ambulatory patient or atrial pacing (or beta-agonist pharmacological stressors) in the catheterization laboratory are useful. The accuracy of stress echocardiography for detection of ischemia in the follow-up of interventional procedures or for postmyocardial infarction risk stratification is superior to standard stress electrocardiography alone. PMID- 10150137 TI - Stem cell transfusion. PMID- 10150138 TI - Stem cells for grafting. PMID- 10150139 TI - Stem cell transfusion from long-term marrow culture. PMID- 10150140 TI - New approaches for bone marrow purging. PMID- 10150141 TI - Fetal brain tissue grafting as therapy for brain dysfunctions: Unanswered questions, unknown factors, and practical concerns. AB - Grafting of embryonic neural tissue into the brains of adult patients is being given serious consideration as therapy for a variety of degenerative and traumatic disorders. It has been argued that neural transplantation can promote functional recovery by replacement of damaged nerve cells, the reestablishment of specific nerve pathways lost as a result of injury, the release of specific neurotransmitters, or the production of factors that promote neuronal growth. This review evaluates the use of transplants to promote recovery from brain injury and highlights the kinds of questions and problems that clinicians need to consider before recommending this form of therapy to patients. PMID- 10150142 TI - Application of an ELISA method for screening antibody levels to Entamoeba histolytica. PMID- 10150143 TI - Some principles of blood stem cell transplantation. PMID- 10150144 TI - Peripheral blood stem cell transplantation for breast cancer patients with bone marrow metastases using GM-CSF priming. AB - Twenty-seven patients with metastastic breast cancer to the bone marrow underwent successful collection of peripheral blood progenitor cells (PBPC) following GM CSF cytokine priming and were engrafted following courses of high-dose chemotherapy. Myeloid engraftment was observed in a median of 12 days, with a range of 8-29 days. The cell dose infused correlated, although weakly, with days to engraftment, although assays of CFU-GM and CD34+ cells did not, suggesting refinement in such assays is needed. The failure to observe complete remission of the tumor suggests alternative chemotherapy regimens should be investigated. PMID- 10150145 TI - Quality control in stem cell processing for autotransplantation. PMID- 10150146 TI - Flashlamp exited pulsed dye laser and electrohydraulic lithotripsy: in vitro study on tissue effects. AB - Intracorporal lithotripsy has gathered momentum in the management of gallstone disease due to the increasing sophistication of technical equipment for the percutaneous, as well as the retrograde-endoscopic route. Laser-induced shock wave lithotripsy (LISL) and electrohydraulic lithotripsy (EHL) have proved feasible by allowing reliable fragmentation of biliary calculi. Evaluation of therapeutic risks, e.g., effects of accidental irradiation of the gallbladder wall, has been performed in small sample sizes only. We investigated the effects of LISL and EHL on multiple sets of human and porcine gallbladders under in vitro conditions. Gallbladders were freshly harvested, mounted, and immersed in different mediums (normal saline, blood, bile). They were swiftly exposed to LISL (Pulsolith?) and EHL (Lithotron EL 23?) under differing experimental conditions (energy setting, pulse mode, exposition time, medium, probe pressure) and subjected to standard procedures for morphometric evaluation (Bioquant?). Tissue effects were described by the depth (d) and width (w) of the cratered lesions, as well as the extension of the damage in the surrounding tissue(s). Serial cuts of the exposed areas yielded 894 section for morphometric analysis. Multivariate analysis of variance (MANOVA) revealed a significant effect of laser energy (p[d] less than 0.002, p[w] < 0.05, p[s] < 0.05), medium (p[d] less than 0.03, p[w] < 0.001, p[s] < 0.04, and exposition time (p[d] less than 0.001, p[s] < 0.001) on the degree of tissue lesion.(ABSTRACT TRUNCATED AT 250 WORDS) PMID- 10150147 TI - Donor hemapheresis in France at the start of 1992. PMID- 10150148 TI - Diagnosing and treating acute upper GI bleeding. PMID- 10150149 TI - Cerebral perfusion index: a new marker for clinical outcome in acute stroke. AB - Single-photon emission computed tomography (SPECT) and transcranial Doppler (TCD) ultrasound are of good prognostic value in acute stroke, and combined they may be an accurate way to determine a target group of patients with maximum therapeutic response. Seventy consecutive patients were studied (42 with middle cerebral artery strokes, 18 with transient ischemic attacks {TIAs}; 10 were excluded due to failure of insonation). Two SPECT studies were performed at 2.1 +/- 1.2 and 13.8 +/- 3.1 days after onset. Serial TCD studies were done at 10 hours and at the time of the SPECT studies. Neurological deficit was scored on admission and 2 weeks later (using the Canadian Neurological Scale). Cerebral perfusion index (CPI) was derived by multiplying the values for TCD and SPECT patterns. Positive correlation was obtained in all 16 patients in whom cerebral angiography was performed within the first 3 days after onset. The occlusive TCD pattern and absence of perfusion on SPECT were common in the stroke group (19/42 patients) and were never seen in those with TIAs. A normal TCD pattern and normal perfusion on SPECT were more common in the patients with TIAs (9/18 vs 8/42, p = 0.02; 5/10 vs 1/40, p = 0.0003). The occlusive TCD and SPECT patterns were associated with the highest mean infarction volume (147 +/- 87 vs 19 +/- 21, p less than 0.0001) and all nonocclusive TCD and SPECT patterns were associated with the better short-term outcome (43.2 +/- 33.9 vs 92.4 +/- 20.2, p less than 0.0001).(ABSTRACT TRUNCATED AT 250 WORDS) PMID- 10150150 TI - Periodic variations in transcranial Doppler mean velocities. AB - Although serial transcranial Doppler measurements of blood flow velocity are of considerable clinical utility, their use assumes that the velocity signals are stable and unchanging during short time periods. Contrary to this assumption, the authors found significant variations in mean velocity signals in both normal subjects and patients, which may confound the interpretation of serial studies. Signals were continuously obtained for 5 to 10 minutes from the middle cerebral artery of 11 normal subjects and 18 patients (22 studies) with a variety of neurosurgical disorders. The average difference between the peak and the trough in the waves observed in the normal population was 11 +/- 4% (standard error of mean), and 5 of the 11 had at least one wave with a difference of more than 20%. The average difference between the peak and trough signals in the neurosurgical population was 14 +/- 13% (SEM) and 13 of the 22 studies showed at least one wave with a difference of more than 20%. These variations were consistently seen and may be related to similar variations in blood pressure or intracranial pressure waves. Whatever the origin, these variations should be recognized during the interpretation of transcranial Doppler signal in clinical practice. PMID- 10150151 TI - The transcranial Doppler standardization project. Phase 1 results. The TCD Study Group, American Society of Neuroimaging. AB - A project to pursue standardization of the performance and interpretation of transcranial Doppler studies was designed. Phase I consisted of a national survey of the current practice of transcranial Doppler in the United States. From 200 ultrasound laboratories surveyed about the use of transcranial Doppler, 60 completed questionnaires were returned. The results show that further standardization of transcranial Doppler performance and interpretation is necessary, and provide the foundation for phases II and III of the project. PMID- 10150152 TI - Transcranial Doppler validation pilot study. AB - The use of transcranial Doppler sonography (TCD) for the evaluation of patients with ischemic cerebrovascular disease remains controversial. This study was organized to gather preliminary data regarding the sensitivity and specificity of TCD when compared to cerebral angiography in detecting stenosing lesions and collateral flow patterns of the anterior cerebral circulation. Forty-two patients from six medical centers were prospectively enrolled. Each received cerebral angiography and TCD testing within 24 hours of each other. Based on TCD criteria established a priori, the results were first analyzed by a blinded investigator and then by computer. Computerized analyses were then repeated with modified criteria. Collateral flow through the anterior communicating and ophthalmic arteries was detected with sensitivities of 62% and 100%, and specificities of 98% and 92%, respectively. Internal carotid artery proximal and distal severe ( greater than 70%) stenoses were detected with sensitivities of 79% and 100% and specificities of 88% and 97%. Middle and anterior cerebral artery stenoses and middle cerebral artery occlusion were detected with specificities exceeding 98%; however, the data were insufficient to determine sensitivity. Computerized analyses did not permit improvement of sensitivity and specificity of the baseline criteria. The selected TCD criteria are highly specific in detecting intracranial stenoses and collateral flow patterns of the anterior circulation. The criteria have limited but acceptable sensitivity and specificity in detecting internal carotid artery origin severe stenoses, and are highly sensitive in detecting ophthalmic artery retrograde flow. A study with a larger sample is necessary to provide definitive guidelines for diagnosis. PMID- 10150153 TI - Crisis in Newport. PMID- 10150155 TI - Cost, benefits and unintended gastrointestinal side effects of pharmaceutical therapy. AB - All healthcare services, however beneficial, carry inherent risks in addition to the costs of care, which may involve expenditures on unanticipated side effects. Substantial research over the past few decades has elucidated the full range of clinical and resource use effects of peptic ulcer medications, particularly for histamine H 2-receptor antagonists and nonsteroidal anti-inflammatory drug (NSAID)-related gastropathy. Less well known are some of the positive and negative side effects of many different types of pharmaceuticals on the gastrointestinal tract. This paper summarises information on unintended and unexpected positive and negative gastrointestinal side effects of medications administered to treat gastrointestinal and other diseases. It further analyses 2 drug classes and their effects on the gastrointestinal tract, histamine H 2 receptor antagonists, which have a positive impact on clinical effects and resource use, and NSAIDs, which have negative effects. PMID- 10150154 TI - Formulary considerations in selection of beta-blockers. AB - Selection of beta-adrenergic blockers for formulary addition can be a difficult task, especially with the increasing availability of new beta-blockers, as well as the numerous differences in pharmacodynamic and pharmacokinetic properties of currently available agents. Nevertheless, appropriate evaluation of the important characteristics of beta-blockers should allow selection of the most cost effective agents for formulary addition. Most importantly, differences in efficacy, product formulation and cost should be carefully considered when making formulary decisions. Notably, evidence from clinical trials indicates differences in efficacy among beta-blockers for post-myocardial infarction prophylaxis, situational anxiety, essential tremor, thyrotoxicosis, migraine prophylaxis and prevention of bleeding associated with oesophageal varices. For many clinical situations, it is also important to select an effective agent that is available in both an oral and intravenous formulation, especially for cardioprotection after acute myocardial infarction and for use in supraventricular arrhythmias. In addition, availability of sustained release products and generic formulations should be considered for their potential to increase compliance and decrease cost, respectively. Comparative drug costs, as well as costs associated with decreased compliance, should also be carefully evaluated. Differences in beta-receptor selectivity, duration of action and presence of intrinsic sympathomimetic activity (ISA) are also important considerations in the selection of beta-blockers for formulary consideration. Although degree of selectivity is relative, beta 1-selective agents may be less likely to induce bronchospasm in patients with chronic obstructive pulmonary disease (COPD) and may be less likely to affect glucose homeostasis in patients with diabetes mellitus. Duration of action of a beta-blocker is an important consideration for evaluation of efficacy throughout the recommended dosage interval. In addition, beta-blockers with a long duration of action can often be administered once or twice daily, potentially leading to increased compliance and thereby improved effectiveness and economic efficiency. The presence of ISA is an important consideration because certain beta-blockers with ISA may be less effective than those without ISA for certain indications. Factors considered to be less important when making formulary decisions of choice of beta-blockers include the route of elimination, lipophilicity and presence of membrane stabilising activity. PMID- 10150157 TI - Therapeutic interchange as a cost-containment measure {editorial}. PMID- 10150156 TI - Pharmacoeconomics of the therapy of diarrhoeal disease. AB - We review the pathophysiology of intestinal water and electrolyte transport leading to diarrhoea, the currently available pharmacological strategies for its treatment, and the economic implications of such treatments. Diarrhoea occurs most frequently and is associated with highest mortality in children under 5. Oral rehydration therapy (ORT) is the cornerstone of its management. The safety and efficacy of ORT in the prevention of death from dehydration, both in field and also in hospital settings, are now well established. Because it is also inexpensive, ORT is widely applicable worldwide. More recently, rice-based ORT has emerged, based on well known traditional remedies for diarrhoea in southeast Asia and the Far East. Rice-based ORT has the advantage of being more culturally acceptable, readily available even in rural homes in developing countries, and is more effective in reducing stool output and the duration of diarrhoea, compared with conventional glucose-electrolyte solutions such as World Health Organization ORT. For infants, the well known antidiarrhoeal properties of human milk needs emphasis for a variety of reasons including economic ones. Data concerning the economic benefits to a nations' health budget as a result of nationwide implementation of oral rehydration solution (ORS) use are limited. Available data from individual centres in developing countries, if projected to national level, would incur considerable economic advantage. Except for a few notable infections such as shigellosis, cholera, amoebiasis and giardiasis, the widespread use of antibiotics in acute diarrhoea, still a common practice in many developing countries, has no proven value and may be detrimental. The economic implications of antibiotic abuse in the treatment of diarrhoea in developing countries is enormous. Despite the availability of a wide spectrum of pharmacological agents for diarrhoea reviewed in this article, only a few such agents are of proven clinical efficacy: corticosteroids, aminosalicylates and immunosuppressants in the treatment of inflammatory bowel disease and opioid derivatives such as loperamide which may be useful in protracted diarrhoea in children and in disorders where rapid gastrointestinal transit is the main cause of diarrhoea. Opioids are not recommended for acute infective diarrhoea in childhood. Octreotide, a somatostatin analogue, is reported to be useful in the treatment of secretory diarrhoea due to noninfective causes and in the treatment of intractable diarrhoea associated with AIDS. Its high cost and need for parenteral administration prevent its wider application.(ABSTRACT TRUNCATED AT 400 WORDS) PMID- 10150158 TI - beta-blockers vs calcium channel blockers vs ACE inhibitors. PMID- 10150159 TI - Cost savings with antacid treatment? PMID- 10150161 TI - Biomechanical studies on shape effect of hydroxyapatite artificial root upon surrounding jawbone. AB - To study the shape effect upon surrounding tissue of artificial dental root made of synthetic hydroxyapatite, this paper deals with the numerical analysis of the artificial root on functioning jawbone with the aid of the finite element method (FEM). The stress distribution around artificial roots in the shape of a cylinder, a cone, and three types of corrugated cone, including the newly tailored type implanted in the mandibular molar region, was analyzed in the plane strain state. The numerical results showed that the stress distribution was sensitive to the artificial root shape, and that the stress state was distributed in mitigatory way around the roots of the newly tailored form. The pattern of osteogenesis in the animal experiment and the finite element analysis (FEA) pattern showed a close correlation. Osteogenesis was assumed to occur in the weak or moderate stress distribution zone. The principal stress trajectory pattern in the lamina dura around the tailored artificial root was indicated as being either parallel or normal to the root surface. From this study, the biomechanical property of the tooth can be identified as a vehicle of mastication forces which disperse stresses moderately and equally upon surrounding tissues. Also, the periodontal ligament can be identified as a converting system of principal stress trajectories. PMID- 10150160 TI - Translating safety, efficacy and compliance into economic value for controlled release dosage forms. AB - Advanced controlled release (CR) dosage forms are relative newcomers to pharmaceutical markets, and few studies relate their efficacy, safety or compliance benefits to economic value. This literature review was undertaken to assess the cost effectiveness of CR dosage forms using such measures as purchase costs, total treatment costs, and economic value of improved therapeutic outcomes compared with those with non-CR dosage forms. Three therapeutic areas were examined: cardiovascular therapy, pain management and estrogen replacement therapy. In cardiovascular therapy, prescription costs of sustained release (SR) verapamil were significantly higher than for conventional release verapamil. However, these were more than offset by lower physician, hospital and laboratory expenditures for the SR group, in whom compliance was superior. Similarly, patients receiving SR diltiazem had better prescription refill compliance than those using a conventional formulation of the drug, as well as significantly lower aggregate healthcare costs during a 1-year study period. These lower costs with both SR verapamil and diltiazem may relate to better compliance. CR nifedipine has lower daily acquisition costs than the conventional form, simplifies the dosage regimen to once daily, extends the indications of the drug to hypertension as well as angina, and reduces vasodilatory adverse effects by reducing peak plasma drug concentrations and the postdose rate of increase in concentration. Compared with oral clonidine given twice daily, transdermal clonidine, given once weekly, had higher purchase costs, but was associated with improved compliance, reduced adverse effects (due to control of plasma concentrations), and lower nondrug health costs, such as physician, hospital and laboratory costs. Lower costs were also found for once daily oral formulations of various antihypertensives, suggesting that the economics of both types of CR dosage forms related to compliance. CR metoprolol 50 or 100mg and conventional release atenolol 50mg, each given once daily, provided effective beta1 adrenoceptor blockade. The conventional formulation caused deterioration in the sense of well-being that was temporally associated with sharp peaking of its plasma concentrations. Such peaking did not occur with either dose of CR metoprolol, nor did any deterioration in the sense of well-being. Transdermal nitroglycerin (glyceryl trinitrate), compared with long-acting oral nitrates, improved quality of life (QOL) {despite a higher incidence of some adverse effects, such as headache, dizziness and skin irritation}. Furthermore, in some studies, this formulation reduced angina attacks, sublingual nitroglycerin use, and hospitalisation or emergency room use. Cost comparisons between transdermal products favoured those that have superior adhesion.(ABSTRACT TRUNCATED AT 400 WORDS) PMID- 10150162 TI - The use of acellular autologous skeletal muscle grafts in peripheral nerve repair: a morphometrical-morphological study. AB - Alternative materials for autologous nerve grafts in peripheral nerve surgery have long been investigated. This report describes the use of acellular (freeze thawed) autologous skeletal muscle grafts (ASMG) to bridge a 2 cm gap in the sciatic nerve of rats. Neurophysiologic and morphometric studies performed 6 weeks after surgical procedure showed for the nine treated Sprague-Dawley rats (Group A) a good axon regeneration rate, although this was lower than that for the control group (Group B), a lower Nerve Conduction Velocity (NCV) and a thinner myelin sheath than in group B (n = 9 Sprague-Dawley rats). In the latter case, complete resection of 2 cm of the sciatic nerve was followed by an immediate coaptation of the proximal and distal ends. PMID- 10150163 TI - Prestresses around the acetabulum generated by screwed cups. AB - Screwed acetabular cups, applied in total hip replacements, generate stresses in the surrounding bone during implantation (prestresses). The effect of these prestresses on the endurance of the hip replacement are unknown. The prestresses in the acetabulum were examined both experimentally, using strain gauge techniques, and numerically, using the finite element method. It was found that the prestresses were of the same order of magnitude, if not larger, than the stresses due to the hip reaction force during one-legged stance. In some cases, the prestresses even approximated the ultimate tensile strength of cortical bone. The prestresses seemed to have a strong dependence on the outer shape of the cup, rather than on the flexibility of the cup or whether the cup had a self-cutting thread or not. Furthermore, it was found that the prestresses are not very susceptible to stress relaxation due to the visco-elastic behaviour of bone. This means that prestresses will remain present over long periods of time. So even when a patient has resumed normal daily activities, the prestresses will still play an important role in the overall stress distributions around the acetabulum. Due to the interaction of prestresses and stresses due to normal loading, the primary stability of a metal-backed screwed cup is better guaranteed than the primary stability of an all-polyethylene screwed cup. PMID- 10150164 TI - Accuracy of titanium cast crowns obtained from calcia base mold. AB - A calcia base investment has high stability even with melted titanium and, therefore, can produce an excellent titanium casting. In this study, titanium powder was distributed to a calcia base investment as an expanding agent, and the firing temperature of the mold was controlled at 800 degrees C. The calcia base investment with 6.1% wt titanium powder expanded 1.7% during 2 h heating at 800 degrees C. The marginal discrepancies between the die and the titanium crown were improved by the addition of the titanium powder to the investment. The mean thickness of the cement layer between the epoxy teeth and the crown using 6.1% wt titanium powder content was from 40-80 microns. PMID- 10150165 TI - Evaluating materials used for constructing soft earmoulds. AB - The use of penetrometry for the assessment of materials employed for soft earmoulds is investigated. Selected test conditions are used for the characterisation of 10 materials of five types (cold-cured methacrylate, heat cured methacrylate, heat-cured silicone, polyvinyl chloride co-polymer and polyethylene copolymer) used in clinical practice. The results are compared with the outcome of subjective assessments surveyed for four representative materials. The effect of ageing is assessed for a heat-cured silicone (Molloplast B) and a heat-cured methacrylate (Coe Super-Soft). PMID- 10150166 TI - Lactate dehydrogenase activity as a rapid and sensitive test for the quantification of cell numbers in vitro. AB - Lactate dehydrogenase (LDH) has been used extensively as a marker for cell death both in vitro and in vivo. The release of LDH into tissue culture medium accurately reflects cell viability in vitro. We have investigated the relationship between cell concentration and total LDH activity in samples of cell lysate. Although there are differences in the amount of LDH present in different cell types, the total enzyme activity in a sample of cell lysate is directly proportional to the concentration of cells in the sample. The measurement of LDH activity in vitro provides a sensitive, accurate and cost-effective alternative to the use of either radioisotopic or dye-based assays for the determination of cell numbers. PMID- 10150167 TI - Modelling the anisotropic behaviour of filament wound vascular grafts. AB - The model according to the Law of Laplace, describing the mechanical behaviour of blood vessels and vascular grafts, was applied to filament wound arterial prostheses, which have been manufactured with different winding angles. By varying the winding angle, the anisotropic behaviour of the grafts could be changed and fitted to the anisotropic properties of natural blood vessels. Thus, the Laplace model had to be modified, and answers now to the requirement of responding to the anisotropic behaviour in hoop versus axial direction of the grafts. The experimental data of hoop and axial compliances obtained by biaxial inflation tests could be then correlated to the material properties of the vascular grafts measured by uniaxial tensile loading. It is shown that with the modified Laplace model the changes in the anisotropic behaviour due to different winding angles can be described and predicted. The calculated compliance values derived from the uniaxial tensile tests fitted the experimental data obtained by the biaxial inflation tests, although the calculated hoop compliance values tended to be higher than the experimental data. PMID- 10150168 TI - Human osteoblast response to PTFE surfaces. AB - Recently, expanded polytetrafluoroethylene (ePTFE, Gortex) vascular grafts have been rolled and used for interpositional arthroplasties of the carpus in the wrist. Little data, however, are available on the response of human osteoblasts to ePTFE. In-vitro cell culture is a useful method to determine initial cell biomaterial interactions. The present study explores the morphological and mitogenic response of human bone cells cultured on vascular grade ePTFE grafts. The present findings suggest that neither the inner nor the outer surface of ePTFE, in its present form, support osteoblast growth. PTFE may be a suitable material to act as a space filler for carpal bone interpositional arthroplasties. PMID- 10150169 TI - An in vitro study of the effect of environment and storage time on the fracture properties of bone cement. AB - Changes either within the bone cement or at the cement-bone interface are known to contribute to loosening and hence failure of many cemented joint replacements. This study examines the in vitro changes in the fracture properties of bone cement as a result of storage, at both 21 and 37 degrees C, in air, water, Ringer's solution and lipid over a period of 2 years. Specimens stored in the fluid media were found to behave in a more ductile manner than those stored in air. Samples stored at 37 degrees C behaved in a more brittle manner than those stored at 21 degrees C. Although the work of fracture values measured for the samples stored in the water-based media increased during the first 18 months, this was followed by a decrease in the subsequent 6 months. PMID- 10150170 TI - BOP: biocompatible osteoconductive polymer: an experimental approach. AB - BOP (biocompatible osteoconductive polymer) is a material proposed for osteosyntheses and for filling of bone defects in orthopaedics, neurosurgery and stomatology. It is a composite made of a copolymer of N-vinylpyrrolidone and methylmethacrylate, of polyamide-6 fibers and of calcium gluconate. The histological investigation includes the study of 30 intact rabbit femurs instrumented with a BOP rod, as well as the study of organs of the reticuloendothelial system. The currently available results show the absence of toxicity on hematopoietic tissue. Zones of osteoblastic activity surround the rods, coupled with an osteoclastic reaction which may result in the partial fragmentation of the polyamide fibers and its incorporation in the newly formed bone. We also observed the encapsulation of the material. The biomechanical approach investigated the mechanical properties of the material in bending and in shear. The radiological aspects of the investigation consisted of computerized axial tomography of the implanted femurs to measure density at the bone-implant interface. PMID- 10150171 TI - The effects of diamond-like carbon coatings on macrophages, fibroblasts and osteoblast-like cells in vitro. AB - The elaboration of metallic and polymeric particles from the wear of joint replacement components is widely implicated in the pathogensis of aseptic loosening of these implants. Diamond-like carbon (DLC) coatings show great potential as wear-retardant coatings and may offer a possible solution to this problem. We have studied the effects of DLC coatings on cells derived from the tissues that surround a total joint replacement (macrophages, fibroblasts and osteoblast-like cells). There was no evidence that DLC coatings, deposited on a variety of different substrates, caused cytotoxicity in vitro. Cells grown on the coated substrates exhibited normal cellular growth and morphology. DLC coatings are biocompatible in vitro and should now be tested in animal models to determine their behaviour in vivo. PMID- 10150172 TI - The elastic modulus of dentine determined by static and dynamic methods. AB - The purpose of this investigation was to determine a static elastic modulus of dentine using a three point beam test and a dynamic modulus in the frequency range of 0.1 Hz and 10 Hz across a temperature range of 27-37 degrees C. At body temperature, the mean static modulus was 8.6 GPa, (standard deviation 0.86 GPa). The dynamic test produced a range of modulus values. At 0.1 Hz the modulus ranged from 14.3 to 15.2 GPa; for 1.0 Hz the range was 14.6-15.5 GPa and for 10 Hz the range was 14.9-15.8 GPa. The results are of value in the design and analysis of restorative materials. PMID- 10150173 TI - Osteosynthesis of the proximal femur anchorage of a cervical nail. AB - One of the factors determining the stability of osteosynthesis is the mechanical strength of the bone fragments required for the anchorage of the implant. The aim is to study the driving of a Thornton nail in the proximal epiphysis of a human femur as a way to measure the strength of the trabecular bone and to predict the stability of the implanted system. PMID- 10150174 TI - Glutaraldehyde crosslinking of collagen: effects of time, temperature, concentration and presoaking as measured by shrinkage temperature. AB - Experiments were carried out to study the effect on the degree of crosslinking of: (a) short term (1 or 5 min) high (50 degrees C) temperature glutaraldehyde (GA) fixation of native collagen membrane, (b) a combination of GA presoaking at low temperature [0 degree C or room temperature (rt)] followed by short time (< 3 min) heating of synthetic collagen fleece in a multilayer diffusion model. As a measure for the degree of crosslinking the shrinkage temperature (Ts) was determined. Short time (1 or 5 min) high temperature (50 degrees C) fixation using 0.1% GA solution caused the shrinkage temperature to increase to 80% and 93% respectively, of the maximum attainable Ts employing GA crosslinking (ca 91 degrees C). Fixation with 0.01% GA for 5 min at 50 degrees C appeared equally as effective as 1 min with 0.1% GA. Although an elevated fixation temperature (from rt to 45 degrees C) was found to produce a substantial increase in Ts of the collagen sheets, a homogeneous distribution of cross links was not obtained by this method. Presoaking the samples at rt (1 h) or at 0 degree C (3 h) with subsequent short time heating to 45 degrees C caused an almost equal rise in shrinkage temperature in Ts throughout the collagen samples. PMID- 10150175 TI - Synthesis of bioactive coatings on Ti substrates using glass enamel. AB - Bioactive coatings on titanium can be prepared by dispersing hydroxyapatite particles into a borosilicate glass enamel doped with TiO2. Adhesion of the coating is obtained when the titanium substrate has been preoxidized before enameling in such a way as to form a continuous TiO2-layer. Adhesion results from the diffusion of this TiO2-layer into the liquid glass during enameling. The evolution of the diffusion zone was followed by scanning electron microscopy and electron probe microanalysis. Adhesion disappears after a critical time of firing which corresponds to the completion of the dissolution of the TiO2-layer by the glass. The borosilicate glass wets the hydroxyapatite particles and adheres strongly to them after cooling. PMID- 10150176 TI - Resorbable synthetic polymers as replacements for bone graft. AB - The potential of resorbable synthetic polymers derived from the poly(alpha hydroxy acids), poly(lactide) and poly(glycolide), to fulfill a role as bone graft substitutes is reviewed. The various elements of the relationship between the degradation behaviour of resorbable implants and polymer synthesis and chain structure, implant morphology, processing and dimensions have been defined. The production of resorbable polymeric implants has been extensively documented so as to provide a wide basis for selection of an appropriate manufacturing technique. The key requirement of implant dimensional stability over the early stages of bone healing is emphasised so as to provide a stable surface on which osteoblasts and/or their precursor cells may migrate and secrete bone matrix. Minimisation of the content of slow resorbing polymers such as poly(L-lactide) is recommended, consistent with retention of an adequate implant degradation characteristic. The review concludes with a summary of alternative resorbable polymers such as the polyphosphazines which are interesting candidate materials for bone repair and reconstruction. PMID- 10150177 TI - Prostate biopsy in the community: who are the most likely candidates? PMID- 10150178 TI - Empiric antibiotics: selection and use in urology. PMID- 10150179 TI - The iceberg phenomenon and publication bias: the editors' fault? PMID- 10150180 TI - A double-blind randomised dose-effect trial of anisoylated plasminogen streptokinase activator complex (APSAC) in acute myocardial infarction. The APSAC Research Group. AB - A double-blind controlled trial was performed to evaluate the dose-effect relationship of APSAC on coronary reperfusion in patients with acute myocardial infarction. A total of 103 patients were recruited in 14 centres and randomly allocated to receive 3.75, 7.5, 15.0 or 30.0 U of anisoylated plasminogen streptokinase activator complex (APSAC), a thrombolytic. Angiograms were taken at baseline to assess eligibility and at six times after administration at 15-min intervals (up to 90 min). A control angiogram was performed at 24 h for patients with a patent artery at 90 min. Angiograms were read centrally by independent readers. There was a non-significant difference between the four groups for the main outcome, reperfusion of an initially occluded artery: 5/20 (25%; 3.75 U); 13/22 (59%; 7.5 U); 11/22 (50%; 15.0 U); 14/25 (56%; 30.0 U); p = 0.11. There was no apparent difference between group 7.5 U, 15.0 U and 30.0 U (mean recanalisation rate: 55%), but the reperfusion rate in the 3.75 U group was significantly lower (p = 0.02). No apparent differences were observed for the delay of recanalisation between the four groups. The mean values of minimum fibrinogen concentration were different in the four groups, with a clear dose effect relationship (p = 0.0004). The side effects were not found to be dose dependent. PMID- 10150181 TI - Evaluation of treatment effects on patients' quality of life: what approach? From the concepts to the instruments. AB - A critical review of currently used methods to evaluate quality of life in therapeutic trials (economic approach and medical approach) is presented. A new approach focused on subjective quality of life was developed. As efficient as the others it has the advantage to refer to a greater extent to the initial concepts which contributed to the emergence of this new field of research and to bring forward the patient point of view. PMID- 10150182 TI - Effects of defibrotide on physical performance and hemorheologic picture in patients with peripheral arteriopathy. AB - In a random double-blind study versus placebo, 60 ambulatory patients with peripheral occlusive disease of the lower limbs and claudicatio intermittens (Leriche's stage 2), were treated for 60 days with defibrotide (400 mg b.i.d., oral, n = 30) or placebo (n = 30). Patients in the defibrotide group received additional treatment with the same drug at the reduced rate of 400 mg once daily for another 120 days for maintenance (total treatment duration 180 days). All patients were assessed at intake and 60 days for relative and absolute walking distance (RWD and AWD) in a standard treadmill test and for the Winsor Index (WI) at rest and after exercise; patients of the defibrotide treatment group were retested in the same way at 90-180 days. In a subgroup of patients (defibrotide = 11, placebo = 12), blood samples were obtained for the assessment of whole blood and plasma viscosity at intake and after 60 days of treatment. These samples could not be collected properly in the remaining cases, for technical reasons. At day 60, we compared the effects of the two treatments on physical performance: mean (SE) values of RWD were for defibrotide 148 (9.7) and 179 (12.4) m in basal and post-treatment conditions, respectively, and 209 (16.2) and 212 (17.1) m for placebo. Similar changes were observed for AWD: for defibrotide 206 (13.4) and 241 (15.2) m and for placebo 270 (22.9) and 272 (23.1) m. The mean changes were significantly larger with defibrotide: for RWD + 33 (7.1) vs. + 0.3 (3.8) m (p < 0.01) and for AWD + 34 (9.2) and -2 (6.6) m (p < 0.01). The overall gain of walking distance after maintenance therapy with the reduced defibrotide dosage amounted to approximately + 50% over basal (after 180 days). Blood and plasma viscosity improved in patients on defibrotide but the change fell short of statistical significance versus placebo. All findings confirm the potential usefulness of defibrotide in the treatment of peripheral arterial disease, at the same time encouraging further studies of the involved mechanisms of action. PMID- 10150183 TI - The trapidil restenosis trial (STARC study): background, methods and clinical characteristics of the patient population. AB - Restenosis remains the principal drawback of percutaneous transluminal coronary angioplasty (PTCA) since 30-35% of patients still experience it 6 months after the intervention. Several studies have clearly demonstrated that restenosis is a complex multifactorial process that involves smooth muscle cell (SMC) migration and proliferation in the intimal layer of the coronary artery. Among others, the platelet-derived growth factor (PDGF) seems to play an important role in this process. That is why researches have been made in finding and developing new agents able to inhibit PDGF. Trapidil (triazolopyrimidine) (T), is a potent PDGF inhibitor that has been efficacious in preventing restenosis after balloon angioplasty in the experimental animal and after PTCA in a limited clinical trial. The Trapidil Restenosis Trial (STARC study) is a double blind randomized trial of T 100 mg t.i.d. vs. Aspirin (ASA) 100 mg t.i.d. 360 patients have been enrolled from April 1990 until May 1992, excluding recent myocardial infarctions, thrombolysis, restenotic and venous graft lesions and 302 have terminated follow up. This paper describes the clinical background, the protocol and baseline data of the patient population including data regarding initial stenosis and type of vessel treated. PMID- 10150184 TI - A randomised clinical trial of the effect of informed consent on the analgesic activity of placebo and naproxen in cancer pain. AB - To determine whether informed consent in a therapeutic trial modifies the analgesic effect of naproxen and placebo, we conducted a prospective, randomised, single dose, placebo-controlled trial. Patients were randomly selected to receive or not information concerning the study. All patients included were then given a single dose of naproxen and placebo according to a crossover, double-blind design. Forty-nine patients with mild or moderate cancer pain which did not need narcotic analgesics entered the study. Twenty-five received both treatments without any information and constituted the uninformed group. Twenty-four had a complete information about the trial; six refused to participate. The 18 others constituted the informed-consent group. Visual analogue scales of pain before and 30, 60, 120 and 180 min after the intake of naproxen and placebo were recorded. As an analgesic, naproxen was more effective than placebo in both groups of patients (p = 0.001). For naproxen as well as for placebo, the analgesic effect was better in the informed-consent group compared to the uninformed group (p = 0.012). The difference in therapeutic activity between naproxen and placebo was moderately higher in the uninformed patients (p = 0.08). We concluded that, in contrast with parallel studies, giving information in a crossover, placebo controlled trial may increase the apparent efficacy of both the tested agent and the placebo, and decrease the perceived difference the two. PMID- 10150185 TI - Lack of effects of trimetazidine on systemic hemodynamics in patients with coronary artery disease: a placebo-controlled study. AB - Trimetazidine has been shown to improve anginal symptoms and exercise tolerance in patients with coronary artery disease (CAD). To determine the hemodynamic effects of trimetazidine, systemic hemodynamics were studied in 15 patients suffering from CAD (12 male, 3 female, mean age +/- SEM = 58.6 +/- 1.8 years). Cardiac index was determined by thermodilution method. Left ventricular and aortic pressures were measured using micromanometers (Miller Instruments). After basal measurements, patients were randomly given either placebo (n = 5) or one of two therapeutic doses of trimetazidine 1 mg.kg-1 (n = 5) or trimetazidine 1.5 mg.kg-1 (n = 5) in a double-blind procedure. Data were recorded 5, 10 and 20 min after intravenous drug bolus. Throughout the procedure, the evolution of systemic hemodynamic parameters was not statistically different between the three groups, in particular heart rate, cardiac index, systolic, diastolic and mean aortic pressures, end-diastolic ventricular pressure, mean capillary wedge pressure, pulmonary artery pressures or systemic vascular resistances. We conclude that, unlike other antianginal drugs (particularly beta-blockers, nitrates and calcium channel inhibitors), trimetazidine does not modify systemic hemodynamics in patients with CAD. These results are consistent with a direct effect of trimetazidine on the ischemic myocardial cell previously reported. PMID- 10150186 TI - From pharmacological promises to controlled clinical trials to meta-analysis and back: the case of nimodipine in cerebrovascular disorders. AB - On the basis of their promising experimental evidence, calcium channel blockers are today largely used in clinical practice for treatment of patients with cerebrovascular disorders. We propose a meta-analytical evaluation of published clinical trials on nimodipine, a dihydropiridin calcium antagonist, in subarachnoid hemorrhage and in ischemic stroke. In seven trials of subarachnoid hemorrhage, 112 deaths occurred among 682 patients randomized to active treatment compared with 154 deaths among 689 control patients (odds ratio of 0.68, 95% confidence interval of 0.52 to 0.90). Poor outcome due to delayed cerebral ischemia following subarachnoid hemorrhage was also lower in the group allocated to receive nimodipine (odds ratio of 0.47, 95% confidence interval of 0.36 to 0.62). In 12 trials of ischemic stroke, 382 deaths occurred among 2056 patients allocated to receive nimodipine compared to 288 deaths among 1462 control patients (odds ratio of 0.98, 95% confidence interval of 0.82 to 1.18). Pooled results strongly suggest a protective effect of nimodipine in delayed cerebral ischemia following subarachnoid hemorrhage and no effect in ischemic stroke, but the direction and the significance of these results are due to the contribution of a single large trial on subarachnoid hemorrhage and of two trials on ischemic stroke, which account respectively for 40% and 65% of randomized patients. The dissociated effect of nimodipine on these similar conditions could be related to its preventive role in ischemic damage, resembling animal models of ischemic stroke where a beneficial effect of calcium antagonists was clearly shown only when treatment was started before experimental cerebral artery occlusion. In this view, the negative results obtained from the clinical setting of ischemic stroke seem to indicate nimodipine as an aspecific neuroprotective agent without a curative effect. PMID- 10150187 TI - Rationale for the use of antiplatelet drugs in patients with peripheral vascular disease. AB - Peripheral vascular disease (PVD) is complicated by progression of atherosclerotic disease of lower limbs and by cardiovascular events occurring in cardiac and cerebral area. Antiplatelet treatment seems to be able to retard the atherosclerotic progression of peripheral vessel. This was demonstrated by angiographic studies and by a clinical trial showing that aspirin reduced the need of surgical intervention in PVD patients. Three large clinical trials have been planned to assess the effect of antiplatelet treatment on cardiovascular complications. By intention-to-treat analysis, no study showed a beneficial effect for this treatment. Conversely, by on-treatment analysis, antiplatelet treatment showed a significant reduction of global cardiovascular events. Until now, no study has had the power to assess the effect of antiplatelet treatment on major cardiovascular events. The evaluation of patients at high risk of major events by antiplatelet treatment should be an important issue of future clinical trials. PMID- 10150188 TI - Living through yet another health care upheaval. PMID- 10150189 TI - Stealth viruses as neuropathogens. AB - Neuropsychiatric diseases viewed as multifaceted expression of a dysfunctional brain in which atypical responses are evoked by various sensory inputs. Disease entities have traditionally been classified according to the predominant manifestation ( ) without regard to the overlapping features of many of the diseases (+/-). Thus, mild to moderate pain, mood, cognitive, and neurosomatic symptoms are frequently present in chronic fatigue syndrome (CFS) patients. Fibromyalgia syndrome (FMS) is listed as an example of a predominantly chronic pain syndrome. Affect (mood) disorders include depression (Depress.), anxiety, panic reactions, blunted affect, mania, etc. Schizophrenia (Schizo.) is listed as an example of a major cognitive psychosis. Autism as well as various forms of dementia would be included in this category. Irritable bowel syndrome (IBS) is an example of a neurosomatic disease. PMID- 10150191 TI - Client/server computing breaks into the lab. PMID- 10150190 TI - Preventing tuberculosis transmission. The chaos over respirators. PMID- 10150192 TI - Tuberculosis: what role for rapid tests? PMID- 10150193 TI - A menu of markers for breast cancer. PMID- 10150194 TI - Monitoring heparin therapy: problems and promise. PMID- 10150195 TI - Hanging together. PMID- 10150196 TI - Fungi: the next worst pathogens. PMID- 10150197 TI - Coping with cuts: when staff has to go. PMID- 10150198 TI - Fungal pathogens and PCR.